hospital_name,last_updated_on,version,hospital_location,hospital_address,license_number|TX,"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.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Cuero Regional Hospital,12/18/2024,2.0.0,Cuero Regional Hospital,"2550 N Esplanade Street Cuero, TX 77954",74,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|ACCOUNTABLE HP OF AMERICA|COMMERCIAL|negotiated_dollar,standard_charge|ACCOUNTABLE HP OF AMERICA|COMMERCIAL|negotiated_percentage,standard_charge|ACCOUNTABLE HP OF AMERICA|COMMERCIAL|negotiated_algorithm,estimated_amount|ACCOUNTABLE HP OF AMERICA|COMMERCIAL,standard_charge|ACCOUNTABLE HP OF AMERICA|COMMERCIAL|methodology,additional_payer_notes|ACCOUNTABLE HP OF AMERICA|COMMERCIAL,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 BLUE ADVANTAGE HMO|COMMERCIAL|negotiated_dollar,standard_charge|BCBS BLUE ADVANTAGE HMO|COMMERCIAL|negotiated_percentage,standard_charge|BCBS BLUE ADVANTAGE HMO|COMMERCIAL|negotiated_algorithm,estimated_amount|BCBS BLUE ADVANTAGE HMO|COMMERCIAL,standard_charge|BCBS BLUE ADVANTAGE HMO|COMMERCIAL|methodology,additional_payer_notes|BCBS BLUE ADVANTAGE HMO|COMMERCIAL,standard_charge|BCBS BLUE ESSENTIALS|COMMERCIAL|negotiated_dollar,standard_charge|BCBS BLUE ESSENTIALS|COMMERCIAL|negotiated_percentage,standard_charge|BCBS BLUE ESSENTIALS|COMMERCIAL|negotiated_algorithm,estimated_amount|BCBS BLUE ESSENTIALS|COMMERCIAL,standard_charge|BCBS BLUE ESSENTIALS|COMMERCIAL|methodology,additional_payer_notes|BCBS BLUE ESSENTIALS|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|BCBS TRADITIONAL|COMMERCIAL|negotiated_dollar,standard_charge|BCBS TRADITIONAL|COMMERCIAL|negotiated_percentage,standard_charge|BCBS TRADITIONAL|COMMERCIAL|negotiated_algorithm,estimated_amount|BCBS TRADITIONAL|COMMERCIAL,standard_charge|BCBS TRADITIONAL|COMMERCIAL|methodology,additional_payer_notes|BCBS TRADITIONAL|COMMERCIAL,standard_charge|BEECH STREET|COMMERCIAL|negotiated_dollar,standard_charge|BEECH STREET|COMMERCIAL|negotiated_percentage,standard_charge|BEECH STREET|COMMERCIAL|negotiated_algorithm,estimated_amount|BEECH STREET|COMMERCIAL,standard_charge|BEECH STREET|COMMERCIAL|methodology,additional_payer_notes|BEECH STREET|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|COVENTRY|COMMERCIAL|negotiated_dollar,standard_charge|COVENTRY|COMMERCIAL|negotiated_percentage,standard_charge|COVENTRY|COMMERCIAL|negotiated_algorithm,estimated_amount|COVENTRY|COMMERCIAL,standard_charge|COVENTRY|COMMERCIAL|methodology,additional_payer_notes|COVENTRY|COMMERCIAL,standard_charge|GALAXY|COMMERCIAL|negotiated_dollar,standard_charge|GALAXY|COMMERCIAL|negotiated_percentage,standard_charge|GALAXY|COMMERCIAL|negotiated_algorithm,estimated_amount|GALAXY|COMMERCIAL,standard_charge|GALAXY|COMMERCIAL|methodology,additional_payer_notes|GALAXY|COMMERCIAL,standard_charge|HUMANA|COMMERCIAL|negotiated_dollar,standard_charge|HUMANA|COMMERCIAL|negotiated_percentage,standard_charge|HUMANA|COMMERCIAL|negotiated_algorithm,estimated_amount|HUMANA|COMMERCIAL,standard_charge|HUMANA|COMMERCIAL|methodology,additional_payer_notes|HUMANA|COMMERCIAL,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|SUPERIOR|COMMERCIAL|negotiated_dollar,standard_charge|SUPERIOR|COMMERCIAL|negotiated_percentage,standard_charge|SUPERIOR|COMMERCIAL|negotiated_algorithm,estimated_amount|SUPERIOR|COMMERCIAL,standard_charge|SUPERIOR|COMMERCIAL|methodology,additional_payer_notes|SUPERIOR|COMMERCIAL,standard_charge|TRICARE|COMMERCIAL|negotiated_dollar,standard_charge|TRICARE|COMMERCIAL|negotiated_percentage,standard_charge|TRICARE|COMMERCIAL|negotiated_algorithm,estimated_amount|TRICARE|COMMERCIAL,standard_charge|TRICARE|COMMERCIAL|methodology,additional_payer_notes|TRICARE|COMMERCIAL,standard_charge|UNICARE|COMMERCIAL|negotiated_dollar,standard_charge|UNICARE|COMMERCIAL|negotiated_percentage,standard_charge|UNICARE|COMMERCIAL|negotiated_algorithm,estimated_amount|UNICARE|COMMERCIAL,standard_charge|UNICARE|COMMERCIAL|methodology,additional_payer_notes|UNICARE|COMMERCIAL,standard_charge|UNITED HEALTHCARE|COMMERCIAL|negotiated_dollar,standard_charge|UNITED HEALTHCARE|COMMERCIAL|negotiated_percentage,standard_charge|UNITED HEALTHCARE|COMMERCIAL|negotiated_algorithm,estimated_amount|UNITED HEALTHCARE|COMMERCIAL,standard_charge|UNITED HEALTHCARE|COMMERCIAL|methodology,additional_payer_notes|UNITED HEALTHCARE|COMMERCIAL,standard_charge|UNITED HEALTHCARE MEDICAID|MEDICAID|negotiated_dollar,standard_charge|UNITED HEALTHCARE MEDICAID|MEDICAID|negotiated_percentage,standard_charge|UNITED HEALTHCARE MEDICAID|MEDICAID|negotiated_algorithm,estimated_amount|UNITED HEALTHCARE MEDICAID|MEDICAID,standard_charge|UNITED HEALTHCARE MEDICAID|MEDICAID|methodology,additional_payer_notes|UNITED HEALTHCARE MEDICAID|MEDICAID,standard_charge|min,standard_charge|max,additional_generic_notes
PRIVATE ROOM MED/SURG,1100001,CDM,110,RC,,,inpatient,,,1703,681.20,,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,, ,,,other ,not seperately reimbursable,1396.46,82,,1117.168,percent of total billed charges,82% of total billed charges,1447.55,85,,1158.04,percent of total billed charges,85% of total billed charges,1447.55,85,,1158.04,percent of total billed charges,85% of total billed charges,1447.55,85,,1158.04,percent of total billed charges,85% of total billed charges,1532.7,90,,1226.16,percent of total billed charges,90% of total billed charges,1362.4,80,,1089.92,percent of total billed charges,80% of total billed charges,1532.7,90,,1226.16,percent of total billed charges,90% of total billed charges,850,100,,,per diem,pays based on per day rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1141.01,67,,912.808,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,1106.95,65,,885.56,percent of total billed charges,65% of total billed charges,,,,,other ,not seperately reimbursable,850,1532.7,
PRIVATE ROOM OB,1100005,CDM,110,RC,,,inpatient,,,1703,681.20,,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,1396.46,82,,1117.168,percent of total billed charges,82% of total billed charges,1447.55,85,,1158.04,percent of total billed charges,85% of total billed charges,1447.55,85,,1158.04,percent of total billed charges,85% of total billed charges,1447.55,85,,1158.04,percent of total billed charges,85% of total billed charges,1532.7,90,,1226.16,percent of total billed charges,90% of total billed charges,1362.4,80,,1089.92,percent of total billed charges,80% of total billed charges,1532.7,90,,1226.16,percent of total billed charges,90% of total billed charges,850,100,,,per diem,pays based on per day rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1141.01,67,,912.808,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,1106.95,65,,885.56,percent of total billed charges,65% of total billed charges,,,,,other ,not seperately reimbursable,850,1532.7,
PRIVATE ROOM MED SURG OVERFLOW,1100020,CDM,110,RC,,,inpatient,,,1670,668.00,,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,1369.4,82,,1095.52,percent of total billed charges,82% of total billed charges,1419.5,85,,1135.6,percent of total billed charges,85% of total billed charges,1419.5,85,,1135.6,percent of total billed charges,85% of total billed charges,1419.5,85,,1135.6,percent of total billed charges,85% of total billed charges,1503,90,,1202.4,percent of total billed charges,90% of total billed charges,1336,80,,1068.8,percent of total billed charges,80% of total billed charges,1503,90,,1202.4,percent of total billed charges,90% of total billed charges,850,100,,,per diem,pays based on per day rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1118.9,67,,895.12,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,1085.5,65,,868.4,percent of total billed charges,65% of total billed charges,,,,,other ,not seperately reimbursable,850,1503,
ROOM AND BOARD SEMI PVT,1200001,CDM,120,RC,,,inpatient,,,863,345.20,,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,707.66,82,,566.128,percent of total billed charges,82% of total billed charges,733.55,85,,586.84,percent of total billed charges,85% of total billed charges,733.55,85,,586.84,percent of total billed charges,85% of total billed charges,733.55,85,,586.84,percent of total billed charges,85% of total billed charges,776.7,90,,621.36,percent of total billed charges,90% of total billed charges,690.4,80,,552.32,percent of total billed charges,80% of total billed charges,776.7,90,,621.36,percent of total billed charges,90% of total billed charges,850,100,,,per diem,pays based on per day rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,578.21,67,,462.568,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,560.95,65,,448.76,percent of total billed charges,65% of total billed charges,,,,,other ,not seperately reimbursable,560.95,850,
NURSERY ROOM AND BOARD,1700001,CDM,170,RC,,,inpatient,,,1806,722.40,,205,100,,,per diem,pays based on per day rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,1480.92,82,,1184.736,percent of total billed charges,82% of total billed charges,1035,100,,,per diem,pays based on per day rate,1035,100,,,per diem,pays based on per day rate,1035,100,,,per diem,pays based on per day rate,1625.4,90,,1300.32,percent of total billed charges,90% of total billed charges,1444.8,80,,1155.84,percent of total billed charges,80% of total billed charges,1625.4,90,,1300.32,percent of total billed charges,90% of total billed charges,200,100,,,per diem,pays based on per day rate,418,122,,,fee schedule,122% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1210.02,67,,968.016,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,350,100,,,per diem,pays based on per day rate,1173.9,65,,939.12,percent of total billed charges,65% of total billed charges,,,,,other ,not seperately reimbursable,200,1625.4,
ISOLATION NURSERY,1700002,CDM,170,RC,,,inpatient,,,1063,425.20,,205,100,,,per diem,pays based on per day rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,871.66,82,,697.328,percent of total billed charges,82% of total billed charges,1035,100,,,per diem,pays based on per day rate,1035,100,,,per diem,pays based on per day rate,1035,100,,,per diem,pays based on per day rate,956.7,90,,765.36,percent of total billed charges,90% of total billed charges,850.4,80,,680.32,percent of total billed charges,80% of total billed charges,956.7,90,,765.36,percent of total billed charges,90% of total billed charges,200,100,,,per diem,pays based on per day rate,418,122,,,fee schedule,122% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,712.21,67,,569.768,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,350,100,,,per diem,pays based on per day rate,690.95,65,,552.76,percent of total billed charges,65% of total billed charges,,,,,other ,not seperately reimbursable,200,1035,
ICU ROOM CHARGE-REV CODE 200,1100010,CDM,200,RC,,,inpatient,,,3131,1252.40,,1300,100,,,per diem,pays based on per day rate,1337,100,,,per diem,pays based on per day rate,,,,,other ,not seperately reimbursable,2567.42,82,,2053.936,percent of total billed charges,82% of total billed charges,2661.35,85,,2129.08,percent of total billed charges,85% of total billed charges,2661.35,85,,2129.08,percent of total billed charges,85% of total billed charges,2661.35,85,,2129.08,percent of total billed charges,85% of total billed charges,2817.9,90,,2254.32,percent of total billed charges,90% of total billed charges,2504.8,80,,2003.84,percent of total billed charges,80% of total billed charges,2817.9,90,,2254.32,percent of total billed charges,90% of total billed charges,1300,100,,,per diem,pays based on per day rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2097.77,67,,1678.216,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1750,100,,,per diem,pays based on per day rate,2035.15,65,,1628.12,percent of total billed charges,65% of total billed charges,,,,,other ,not seperately reimbursable,1300,2817.9,
PRIVATE ROOM MED/SURG TELE,1100206,CDM,206,RC,,,inpatient,,,2266,906.40,,850,100,,,per diem,pays based on per day rate,946.85,100,,,per diem,pays based on per day rate,,,,,other ,not seperately reimbursable,1858.12,82,,1486.496,percent of total billed charges,82% of total billed charges,1926.1,85,,1540.88,percent of total billed charges,85% of total billed charges,1926.1,85,,1540.88,percent of total billed charges,85% of total billed charges,1926.1,85,,1540.88,percent of total billed charges,85% of total billed charges,2039.4,90,,1631.52,percent of total billed charges,90% of total billed charges,1812.8,80,,1450.24,percent of total billed charges,80% of total billed charges,2039.4,90,,1631.52,percent of total billed charges,90% of total billed charges,850,100,,,per diem,pays based on per day rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1518.22,67,,1214.576,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,1472.9,65,,1178.32,percent of total billed charges,65% of total billed charges,,,,,other ,not seperately reimbursable,850,2039.4,
MORPHINE SULFATE ORAL 10MG/5ML,2010018,CDM,250,RC,,,outpatient,,,81,32.40,,68.85,85,,55.08,percent of total billed charges,85% of total billed charges,62.37,77,,49.9,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,66.42,82,,53.136,percent of total billed charges,82% of total billed charges,68.85,85,,55.08,percent of total billed charges,85% of total billed charges,68.85,85,,55.08,percent of total billed charges,85% of total billed charges,68.85,85,,55.08,percent of total billed charges,85% of total billed charges,72.9,90,,58.32,percent of total billed charges,90% of total billed charges,64.8,80,,51.84,percent of total billed charges,80% of total billed charges,72.9,90,,58.32,percent of total billed charges,90% of total billed charges,60.75,75,,48.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,23.49,29,,18.792,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,54.27,67,,43.416,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,64.8,80,,51.84,percent of total billed charges,80% of total billed charges,52.65,65,,42.12,percent of total billed charges,65% of total billed charges,28.89,35.67,,23.112,percent of total billed charges,35.67% of total billed charges,23.49,72.9,
ACCUPRIL 10 MG/TAB,2500020,CDM,250,RC,,,outpatient,,,12,4.80,,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,9.24,77,,7.39,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,9.84,82,,7.872,percent of total billed charges,82% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,10.8,90,,8.64,percent of total billed charges,90% of total billed charges,9.6,80,,7.68,percent of total billed charges,80% of total billed charges,10.8,90,,8.64,percent of total billed charges,90% of total billed charges,9,75,,7.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,3.48,29,,2.784,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,8.04,67,,6.432,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,9.6,80,,7.68,percent of total billed charges,80% of total billed charges,7.8,65,,6.24,percent of total billed charges,65% of total billed charges,4.28,35.67,,3.424,percent of total billed charges,35.67% of total billed charges,3.48,10.8,
ABILIFY 5 MG TAB,2500023,CDM,250,RC,,,outpatient,,,90,36.00,,76.5,85,,61.2,percent of total billed charges,85% of total billed charges,69.3,77,,55.44,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,73.8,82,,59.04,percent of total billed charges,82% of total billed charges,76.5,85,,61.2,percent of total billed charges,85% of total billed charges,76.5,85,,61.2,percent of total billed charges,85% of total billed charges,76.5,85,,61.2,percent of total billed charges,85% of total billed charges,81,90,,64.8,percent of total billed charges,90% of total billed charges,72,80,,57.6,percent of total billed charges,80% of total billed charges,81,90,,64.8,percent of total billed charges,90% of total billed charges,67.5,75,,54,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,26.1,29,,20.88,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,60.3,67,,48.24,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,72,80,,57.6,percent of total billed charges,80% of total billed charges,58.5,65,,46.8,percent of total billed charges,65% of total billed charges,32.1,35.67,,25.68,percent of total billed charges,35.67% of total billed charges,26.1,81,
ACETAMINOPHEN 120 MG SUPP,2500030,CDM,250,RC,,,outpatient,,,6,2.40,,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,4.62,77,,3.7,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,4.92,82,,3.936,percent of total billed charges,82% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,5.4,90,,4.32,percent of total billed charges,90% of total billed charges,4.8,80,,3.84,percent of total billed charges,80% of total billed charges,5.4,90,,4.32,percent of total billed charges,90% of total billed charges,4.5,75,,3.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,1.74,29,,1.392,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4.02,67,,3.216,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,4.8,80,,3.84,percent of total billed charges,80% of total billed charges,3.9,65,,3.12,percent of total billed charges,65% of total billed charges,2.14,35.67,,1.712,percent of total billed charges,35.67% of total billed charges,1.74,5.4,
ACETAMINOPHEN 325 MG SUPP,2500035,CDM,250,RC,,,outpatient,,,6,2.40,,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,4.62,77,,3.7,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,4.92,82,,3.936,percent of total billed charges,82% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,5.4,90,,4.32,percent of total billed charges,90% of total billed charges,4.8,80,,3.84,percent of total billed charges,80% of total billed charges,5.4,90,,4.32,percent of total billed charges,90% of total billed charges,4.5,75,,3.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,1.74,29,,1.392,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4.02,67,,3.216,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,4.8,80,,3.84,percent of total billed charges,80% of total billed charges,3.9,65,,3.12,percent of total billed charges,65% of total billed charges,2.14,35.67,,1.712,percent of total billed charges,35.67% of total billed charges,1.74,5.4,
ACETAMINOPHEN  650 MG SUPP,2500040,CDM,250,RC,,,outpatient,,,6,2.40,,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,4.62,77,,3.7,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,4.92,82,,3.936,percent of total billed charges,82% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,5.4,90,,4.32,percent of total billed charges,90% of total billed charges,4.8,80,,3.84,percent of total billed charges,80% of total billed charges,5.4,90,,4.32,percent of total billed charges,90% of total billed charges,4.5,75,,3.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,1.74,29,,1.392,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4.02,67,,3.216,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,4.8,80,,3.84,percent of total billed charges,80% of total billed charges,3.9,65,,3.12,percent of total billed charges,65% of total billed charges,2.14,35.67,,1.712,percent of total billed charges,35.67% of total billed charges,1.74,5.4,
ACETAMINOPHEN SUPP 80 MG,2500041,CDM,250,RC,,,outpatient,,,6,2.40,,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,4.62,77,,3.7,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,4.92,82,,3.936,percent of total billed charges,82% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,5.4,90,,4.32,percent of total billed charges,90% of total billed charges,4.8,80,,3.84,percent of total billed charges,80% of total billed charges,5.4,90,,4.32,percent of total billed charges,90% of total billed charges,4.5,75,,3.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,1.74,29,,1.392,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4.02,67,,3.216,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,4.8,80,,3.84,percent of total billed charges,80% of total billed charges,3.9,65,,3.12,percent of total billed charges,65% of total billed charges,2.14,35.67,,1.712,percent of total billed charges,35.67% of total billed charges,1.74,5.4,
ACTONEL 35 MG TAB WEEKLY,2500056,CDM,250,RC,,,outpatient,,,146,58.40,,124.1,85,,99.28,percent of total billed charges,85% of total billed charges,112.42,77,,89.94,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,119.72,82,,95.776,percent of total billed charges,82% of total billed charges,124.1,85,,99.28,percent of total billed charges,85% of total billed charges,124.1,85,,99.28,percent of total billed charges,85% of total billed charges,124.1,85,,99.28,percent of total billed charges,85% of total billed charges,131.4,90,,105.12,percent of total billed charges,90% of total billed charges,116.8,80,,93.44,percent of total billed charges,80% of total billed charges,131.4,90,,105.12,percent of total billed charges,90% of total billed charges,109.5,75,,87.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,42.34,29,,33.872,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,97.82,67,,78.256,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,116.8,80,,93.44,percent of total billed charges,80% of total billed charges,94.9,65,,75.92,percent of total billed charges,65% of total billed charges,52.08,35.67,,41.664,percent of total billed charges,35.67% of total billed charges,42.34,131.4,
ACTIDOSE P.O.,2500065,CDM,250,RC,,,outpatient,,,57,22.80,,48.45,85,,38.76,percent of total billed charges,85% of total billed charges,43.89,77,,35.11,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,46.74,82,,37.392,percent of total billed charges,82% of total billed charges,48.45,85,,38.76,percent of total billed charges,85% of total billed charges,48.45,85,,38.76,percent of total billed charges,85% of total billed charges,48.45,85,,38.76,percent of total billed charges,85% of total billed charges,51.3,90,,41.04,percent of total billed charges,90% of total billed charges,45.6,80,,36.48,percent of total billed charges,80% of total billed charges,51.3,90,,41.04,percent of total billed charges,90% of total billed charges,42.75,75,,34.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,16.53,29,,13.224,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,38.19,67,,30.552,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,45.6,80,,36.48,percent of total billed charges,80% of total billed charges,37.05,65,,29.64,percent of total billed charges,65% of total billed charges,20.33,35.67,,16.264,percent of total billed charges,35.67% of total billed charges,16.53,51.3,
ACTIDOSE SORBITOL 120 ML LIQ,2500066,CDM,250,RC,,,outpatient,,,63,25.20,,53.55,85,,42.84,percent of total billed charges,85% of total billed charges,48.51,77,,38.81,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,51.66,82,,41.328,percent of total billed charges,82% of total billed charges,53.55,85,,42.84,percent of total billed charges,85% of total billed charges,53.55,85,,42.84,percent of total billed charges,85% of total billed charges,53.55,85,,42.84,percent of total billed charges,85% of total billed charges,56.7,90,,45.36,percent of total billed charges,90% of total billed charges,50.4,80,,40.32,percent of total billed charges,80% of total billed charges,56.7,90,,45.36,percent of total billed charges,90% of total billed charges,47.25,75,,37.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,18.27,29,,14.616,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,42.21,67,,33.768,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,50.4,80,,40.32,percent of total billed charges,80% of total billed charges,40.95,65,,32.76,percent of total billed charges,65% of total billed charges,22.47,35.67,,17.976,percent of total billed charges,35.67% of total billed charges,18.27,56.7,
ACTOS 15 MG PO,2500114,CDM,250,RC,,,outpatient,,,41,16.40,,34.85,85,,27.88,percent of total billed charges,85% of total billed charges,31.57,77,,25.26,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,33.62,82,,26.896,percent of total billed charges,82% of total billed charges,34.85,85,,27.88,percent of total billed charges,85% of total billed charges,34.85,85,,27.88,percent of total billed charges,85% of total billed charges,34.85,85,,27.88,percent of total billed charges,85% of total billed charges,36.9,90,,29.52,percent of total billed charges,90% of total billed charges,32.8,80,,26.24,percent of total billed charges,80% of total billed charges,36.9,90,,29.52,percent of total billed charges,90% of total billed charges,30.75,75,,24.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,11.89,29,,9.512,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,27.47,67,,21.976,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,32.8,80,,26.24,percent of total billed charges,80% of total billed charges,26.65,65,,21.32,percent of total billed charges,65% of total billed charges,14.62,35.67,,11.696,percent of total billed charges,35.67% of total billed charges,11.89,36.9,
ACTOS 30 MG PO,2500116,CDM,250,RC,,,outpatient,,,52,20.80,,44.2,85,,35.36,percent of total billed charges,85% of total billed charges,40.04,77,,32.03,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,42.64,82,,34.112,percent of total billed charges,82% of total billed charges,44.2,85,,35.36,percent of total billed charges,85% of total billed charges,44.2,85,,35.36,percent of total billed charges,85% of total billed charges,44.2,85,,35.36,percent of total billed charges,85% of total billed charges,46.8,90,,37.44,percent of total billed charges,90% of total billed charges,41.6,80,,33.28,percent of total billed charges,80% of total billed charges,46.8,90,,37.44,percent of total billed charges,90% of total billed charges,39,75,,31.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,15.08,29,,12.064,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,34.84,67,,27.872,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,41.6,80,,33.28,percent of total billed charges,80% of total billed charges,33.8,65,,27.04,percent of total billed charges,65% of total billed charges,18.55,35.67,,14.84,percent of total billed charges,35.67% of total billed charges,15.08,46.8,
ACTOS 45 MG PO,2500117,CDM,250,RC,,,outpatient,,,53,21.20,,45.05,85,,36.04,percent of total billed charges,85% of total billed charges,40.81,77,,32.65,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,43.46,82,,34.768,percent of total billed charges,82% of total billed charges,45.05,85,,36.04,percent of total billed charges,85% of total billed charges,45.05,85,,36.04,percent of total billed charges,85% of total billed charges,45.05,85,,36.04,percent of total billed charges,85% of total billed charges,47.7,90,,38.16,percent of total billed charges,90% of total billed charges,42.4,80,,33.92,percent of total billed charges,80% of total billed charges,47.7,90,,38.16,percent of total billed charges,90% of total billed charges,39.75,75,,31.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,15.37,29,,12.296,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,35.51,67,,28.408,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,42.4,80,,33.92,percent of total billed charges,80% of total billed charges,34.45,65,,27.56,percent of total billed charges,65% of total billed charges,18.91,35.67,,15.128,percent of total billed charges,35.67% of total billed charges,15.37,47.7,
ACULAR .5% 5 ML OPTH DROPS,2500121,CDM,250,RC,,,outpatient,,,325,130.00,,276.25,85,,221,percent of total billed charges,85% of total billed charges,250.25,77,,200.2,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,266.5,82,,213.2,percent of total billed charges,82% of total billed charges,276.25,85,,221,percent of total billed charges,85% of total billed charges,276.25,85,,221,percent of total billed charges,85% of total billed charges,276.25,85,,221,percent of total billed charges,85% of total billed charges,292.5,90,,234,percent of total billed charges,90% of total billed charges,260,80,,208,percent of total billed charges,80% of total billed charges,292.5,90,,234,percent of total billed charges,90% of total billed charges,243.75,75,,195,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,94.25,29,,75.4,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,217.75,67,,174.2,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,260,80,,208,percent of total billed charges,80% of total billed charges,211.25,65,,169,percent of total billed charges,65% of total billed charges,115.93,35.67,,92.744,percent of total billed charges,35.67% of total billed charges,94.25,292.5,
ADVAIR INHALER 100/50 28 DISK,2500129,CDM,250,RC,,,outpatient,,,304,121.60,,258.4,85,,206.72,percent of total billed charges,85% of total billed charges,234.08,77,,187.26,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,249.28,82,,199.424,percent of total billed charges,82% of total billed charges,258.4,85,,206.72,percent of total billed charges,85% of total billed charges,258.4,85,,206.72,percent of total billed charges,85% of total billed charges,258.4,85,,206.72,percent of total billed charges,85% of total billed charges,273.6,90,,218.88,percent of total billed charges,90% of total billed charges,243.2,80,,194.56,percent of total billed charges,80% of total billed charges,273.6,90,,218.88,percent of total billed charges,90% of total billed charges,228,75,,182.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,88.16,29,,70.528,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,203.68,67,,162.944,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,243.2,80,,194.56,percent of total billed charges,80% of total billed charges,197.6,65,,158.08,percent of total billed charges,65% of total billed charges,108.44,35.67,,86.752,percent of total billed charges,35.67% of total billed charges,88.16,273.6,
ADVAIR INHALER 250/50 28 DISK,2500131,CDM,250,RC,,,outpatient,,,272,108.80,,231.2,85,,184.96,percent of total billed charges,85% of total billed charges,209.44,77,,167.55,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,223.04,82,,178.432,percent of total billed charges,82% of total billed charges,231.2,85,,184.96,percent of total billed charges,85% of total billed charges,231.2,85,,184.96,percent of total billed charges,85% of total billed charges,231.2,85,,184.96,percent of total billed charges,85% of total billed charges,244.8,90,,195.84,percent of total billed charges,90% of total billed charges,217.6,80,,174.08,percent of total billed charges,80% of total billed charges,244.8,90,,195.84,percent of total billed charges,90% of total billed charges,204,75,,163.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,78.88,29,,63.104,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,182.24,67,,145.792,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,217.6,80,,174.08,percent of total billed charges,80% of total billed charges,176.8,65,,141.44,percent of total billed charges,65% of total billed charges,97.02,35.67,,77.616,percent of total billed charges,35.67% of total billed charges,78.88,244.8,
ADVAIR DISKUS 250/50 SIZE 14,2500138,CDM,250,RC,,,outpatient,,,285,114.00,,242.25,85,,193.8,percent of total billed charges,85% of total billed charges,219.45,77,,175.56,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,233.7,82,,186.96,percent of total billed charges,82% of total billed charges,242.25,85,,193.8,percent of total billed charges,85% of total billed charges,242.25,85,,193.8,percent of total billed charges,85% of total billed charges,242.25,85,,193.8,percent of total billed charges,85% of total billed charges,256.5,90,,205.2,percent of total billed charges,90% of total billed charges,228,80,,182.4,percent of total billed charges,80% of total billed charges,256.5,90,,205.2,percent of total billed charges,90% of total billed charges,213.75,75,,171,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,82.65,29,,66.12,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,190.95,67,,152.76,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,228,80,,182.4,percent of total billed charges,80% of total billed charges,185.25,65,,148.2,percent of total billed charges,65% of total billed charges,101.66,35.67,,81.328,percent of total billed charges,35.67% of total billed charges,82.65,256.5,
ADVAIR DISKUS 500/50 SIZE 14,2500139,CDM,250,RC,,,outpatient,,,458,183.20,,389.3,85,,311.44,percent of total billed charges,85% of total billed charges,352.66,77,,282.13,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,375.56,82,,300.448,percent of total billed charges,82% of total billed charges,389.3,85,,311.44,percent of total billed charges,85% of total billed charges,389.3,85,,311.44,percent of total billed charges,85% of total billed charges,389.3,85,,311.44,percent of total billed charges,85% of total billed charges,412.2,90,,329.76,percent of total billed charges,90% of total billed charges,366.4,80,,293.12,percent of total billed charges,80% of total billed charges,412.2,90,,329.76,percent of total billed charges,90% of total billed charges,343.5,75,,274.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,132.82,29,,106.256,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,306.86,67,,245.488,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,366.4,80,,293.12,percent of total billed charges,80% of total billed charges,297.7,65,,238.16,percent of total billed charges,65% of total billed charges,163.37,35.67,,130.696,percent of total billed charges,35.67% of total billed charges,132.82,412.2,
ADVIL 200 MG TAB,2500155,CDM,250,RC,,,outpatient,,,7,2.80,,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.39,77,,4.31,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,5.74,82,,4.592,percent of total billed charges,82% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.25,75,,4.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.03,29,,1.624,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4.69,67,,3.752,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,4.55,65,,3.64,percent of total billed charges,65% of total billed charges,2.5,35.67,,2,percent of total billed charges,35.67% of total billed charges,2.03,6.3,
ADVICOR 500/20MG TAB,2500156,CDM,250,RC,,,outpatient,,,16,6.40,,13.6,85,,10.88,percent of total billed charges,85% of total billed charges,12.32,77,,9.86,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,13.12,82,,10.496,percent of total billed charges,82% of total billed charges,13.6,85,,10.88,percent of total billed charges,85% of total billed charges,13.6,85,,10.88,percent of total billed charges,85% of total billed charges,13.6,85,,10.88,percent of total billed charges,85% of total billed charges,14.4,90,,11.52,percent of total billed charges,90% of total billed charges,12.8,80,,10.24,percent of total billed charges,80% of total billed charges,14.4,90,,11.52,percent of total billed charges,90% of total billed charges,12,75,,9.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,4.64,29,,3.712,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,10.72,67,,8.576,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,12.8,80,,10.24,percent of total billed charges,80% of total billed charges,10.4,65,,8.32,percent of total billed charges,65% of total billed charges,5.71,35.67,,4.568,percent of total billed charges,35.67% of total billed charges,4.64,14.4,
ADVIL 100 MG CHEW TAB,2500157,CDM,250,RC,,,outpatient,,,5,2.00,,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,3.85,77,,3.08,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,4.1,82,,3.28,percent of total billed charges,82% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,4.5,90,,3.6,percent of total billed charges,90% of total billed charges,4,80,,3.2,percent of total billed charges,80% of total billed charges,4.5,90,,3.6,percent of total billed charges,90% of total billed charges,3.75,75,,3,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,1.45,29,,1.16,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,3.35,67,,2.68,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,4,80,,3.2,percent of total billed charges,80% of total billed charges,3.25,65,,2.6,percent of total billed charges,65% of total billed charges,1.78,35.67,,1.424,percent of total billed charges,35.67% of total billed charges,1.45,4.5,
AFRIN NOSE DROPS,2500165,CDM,250,RC,,,outpatient,,,18,7.20,,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,13.86,77,,11.09,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,14.76,82,,11.808,percent of total billed charges,82% of total billed charges,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,16.2,90,,12.96,percent of total billed charges,90% of total billed charges,14.4,80,,11.52,percent of total billed charges,80% of total billed charges,16.2,90,,12.96,percent of total billed charges,90% of total billed charges,13.5,75,,10.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,5.22,29,,4.176,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,12.06,67,,9.648,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,14.4,80,,11.52,percent of total billed charges,80% of total billed charges,11.7,65,,9.36,percent of total billed charges,65% of total billed charges,6.42,35.67,,5.136,percent of total billed charges,35.67% of total billed charges,5.22,16.2,
AGRYLIN 0.5 MG PO,2500169,CDM,250,RC,,,outpatient,,,32,12.80,,27.2,85,,21.76,percent of total billed charges,85% of total billed charges,24.64,77,,19.71,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,26.24,82,,20.992,percent of total billed charges,82% of total billed charges,27.2,85,,21.76,percent of total billed charges,85% of total billed charges,27.2,85,,21.76,percent of total billed charges,85% of total billed charges,27.2,85,,21.76,percent of total billed charges,85% of total billed charges,28.8,90,,23.04,percent of total billed charges,90% of total billed charges,25.6,80,,20.48,percent of total billed charges,80% of total billed charges,28.8,90,,23.04,percent of total billed charges,90% of total billed charges,24,75,,19.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,9.28,29,,7.424,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,21.44,67,,17.152,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,25.6,80,,20.48,percent of total billed charges,80% of total billed charges,20.8,65,,16.64,percent of total billed charges,65% of total billed charges,11.41,35.67,,9.128,percent of total billed charges,35.67% of total billed charges,9.28,28.8,
AFRIN SPRAY,2500170,CDM,250,RC,,,outpatient,,,19,7.60,,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,14.63,77,,11.7,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,15.58,82,,12.464,percent of total billed charges,82% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,15.2,80,,12.16,percent of total billed charges,80% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,14.25,75,,11.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,5.51,29,,4.408,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,12.73,67,,10.184,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,15.2,80,,12.16,percent of total billed charges,80% of total billed charges,12.35,65,,9.88,percent of total billed charges,65% of total billed charges,6.78,35.67,,5.424,percent of total billed charges,35.67% of total billed charges,5.51,17.1,
AGGRENOX 25/200 MG PO,2500176,CDM,250,RC,,,outpatient,,,27,10.80,,22.95,85,,18.36,percent of total billed charges,85% of total billed charges,20.79,77,,16.63,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,22.14,82,,17.712,percent of total billed charges,82% of total billed charges,22.95,85,,18.36,percent of total billed charges,85% of total billed charges,22.95,85,,18.36,percent of total billed charges,85% of total billed charges,22.95,85,,18.36,percent of total billed charges,85% of total billed charges,24.3,90,,19.44,percent of total billed charges,90% of total billed charges,21.6,80,,17.28,percent of total billed charges,80% of total billed charges,24.3,90,,19.44,percent of total billed charges,90% of total billed charges,20.25,75,,16.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,7.83,29,,6.264,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,18.09,67,,14.472,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,21.6,80,,17.28,percent of total billed charges,80% of total billed charges,17.55,65,,14.04,percent of total billed charges,65% of total billed charges,9.63,35.67,,7.704,percent of total billed charges,35.67% of total billed charges,7.83,24.3,
ALCAINE OPTH. GTTS.,2500180,CDM,250,RC,,,outpatient,,,161,64.40,,136.85,85,,109.48,percent of total billed charges,85% of total billed charges,123.97,77,,99.18,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,132.02,82,,105.616,percent of total billed charges,82% of total billed charges,136.85,85,,109.48,percent of total billed charges,85% of total billed charges,136.85,85,,109.48,percent of total billed charges,85% of total billed charges,136.85,85,,109.48,percent of total billed charges,85% of total billed charges,144.9,90,,115.92,percent of total billed charges,90% of total billed charges,128.8,80,,103.04,percent of total billed charges,80% of total billed charges,144.9,90,,115.92,percent of total billed charges,90% of total billed charges,120.75,75,,96.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,46.69,29,,37.352,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,107.87,67,,86.296,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,128.8,80,,103.04,percent of total billed charges,80% of total billed charges,104.65,65,,83.72,percent of total billed charges,65% of total billed charges,57.43,35.67,,45.944,percent of total billed charges,35.67% of total billed charges,46.69,144.9,
ALBUTEROL INHALATION 1.25 MG,2500182,CDM,250,RC,J7613,HCPCS,outpatient,,,10,4.00,,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,7.7,77,,6.16,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,0.31,385,,,fee schedule,385% of BCBS fee schedule,0.32,401,,,fee schedule,401% of BCBS fee schedule,0.32,401,,,fee schedule,401% of BCBS fee schedule,0.32,401,,,fee schedule,401% of BCBS fee schedule,9,90,,7.2,percent of total billed charges,90% of total billed charges,8,80,,6.4,percent of total billed charges,80% of total billed charges,9,90,,7.2,percent of total billed charges,90% of total billed charges,7.5,75,,6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.9,29,,2.32,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,6.7,67,,5.36,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,8,80,,6.4,percent of total billed charges,80% of total billed charges,6.5,65,,5.2,percent of total billed charges,65% of total billed charges,3.57,35.67,,2.856,percent of total billed charges,35.67% of total billed charges,0.31,9,
ALBUTEROL INHALATION 0.021%,2500183,CDM,250,RC,,,outpatient,,,11,4.40,,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,8.47,77,,6.78,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,9.02,82,,7.216,percent of total billed charges,82% of total billed charges,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,9.9,90,,7.92,percent of total billed charges,90% of total billed charges,8.8,80,,7.04,percent of total billed charges,80% of total billed charges,9.9,90,,7.92,percent of total billed charges,90% of total billed charges,8.25,75,,6.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,3.19,29,,2.552,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,7.37,67,,5.896,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,8.8,80,,7.04,percent of total billed charges,80% of total billed charges,7.15,65,,5.72,percent of total billed charges,65% of total billed charges,3.92,35.67,,3.136,percent of total billed charges,35.67% of total billed charges,3.19,9.9,
ALDACTONE 25 MG TAB,2500195,CDM,250,RC,,,outpatient,,,9,3.60,,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,6.93,77,,5.54,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,7.38,82,,5.904,percent of total billed charges,82% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,8.1,90,,6.48,percent of total billed charges,90% of total billed charges,7.2,80,,5.76,percent of total billed charges,80% of total billed charges,8.1,90,,6.48,percent of total billed charges,90% of total billed charges,6.75,75,,5.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.61,29,,2.088,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,6.03,67,,4.824,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,7.2,80,,5.76,percent of total billed charges,80% of total billed charges,5.85,65,,4.68,percent of total billed charges,65% of total billed charges,3.21,35.67,,2.568,percent of total billed charges,35.67% of total billed charges,2.61,8.1,
ALPHAGAN 0.2% OPTH DROPS 5 ML,2500272,CDM,250,RC,,,outpatient,,,121,48.40,,102.85,85,,82.28,percent of total billed charges,85% of total billed charges,93.17,77,,74.54,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,99.22,82,,79.376,percent of total billed charges,82% of total billed charges,102.85,85,,82.28,percent of total billed charges,85% of total billed charges,102.85,85,,82.28,percent of total billed charges,85% of total billed charges,102.85,85,,82.28,percent of total billed charges,85% of total billed charges,108.9,90,,87.12,percent of total billed charges,90% of total billed charges,96.8,80,,77.44,percent of total billed charges,80% of total billed charges,108.9,90,,87.12,percent of total billed charges,90% of total billed charges,90.75,75,,72.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,35.09,29,,28.072,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,81.07,67,,64.856,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,96.8,80,,77.44,percent of total billed charges,80% of total billed charges,78.65,65,,62.92,percent of total billed charges,65% of total billed charges,43.16,35.67,,34.528,percent of total billed charges,35.67% of total billed charges,35.09,108.9,
AMARYL 2 MG PO,2500313,CDM,250,RC,,,outpatient,,,9,3.60,,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,6.93,77,,5.54,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,7.38,82,,5.904,percent of total billed charges,82% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,8.1,90,,6.48,percent of total billed charges,90% of total billed charges,7.2,80,,5.76,percent of total billed charges,80% of total billed charges,8.1,90,,6.48,percent of total billed charges,90% of total billed charges,6.75,75,,5.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.61,29,,2.088,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,6.03,67,,4.824,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,7.2,80,,5.76,percent of total billed charges,80% of total billed charges,5.85,65,,4.68,percent of total billed charges,65% of total billed charges,3.21,35.67,,2.568,percent of total billed charges,35.67% of total billed charges,2.61,8.1,
AMBIEN 5 MG TAB,2500315,CDM,250,RC,,,outpatient,,,46,18.40,,39.1,85,,31.28,percent of total billed charges,85% of total billed charges,35.42,77,,28.34,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,37.72,82,,30.176,percent of total billed charges,82% of total billed charges,39.1,85,,31.28,percent of total billed charges,85% of total billed charges,39.1,85,,31.28,percent of total billed charges,85% of total billed charges,39.1,85,,31.28,percent of total billed charges,85% of total billed charges,41.4,90,,33.12,percent of total billed charges,90% of total billed charges,36.8,80,,29.44,percent of total billed charges,80% of total billed charges,41.4,90,,33.12,percent of total billed charges,90% of total billed charges,34.5,75,,27.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,13.34,29,,10.672,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,30.82,67,,24.656,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,36.8,80,,29.44,percent of total billed charges,80% of total billed charges,29.9,65,,23.92,percent of total billed charges,65% of total billed charges,16.41,35.67,,13.128,percent of total billed charges,35.67% of total billed charges,13.34,41.4,
AMICAR 500 MG TAB,2500349,CDM,250,RC,,,outpatient,,,88,35.20,,74.8,85,,59.84,percent of total billed charges,85% of total billed charges,67.76,77,,54.21,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,72.16,82,,57.728,percent of total billed charges,82% of total billed charges,74.8,85,,59.84,percent of total billed charges,85% of total billed charges,74.8,85,,59.84,percent of total billed charges,85% of total billed charges,74.8,85,,59.84,percent of total billed charges,85% of total billed charges,79.2,90,,63.36,percent of total billed charges,90% of total billed charges,70.4,80,,56.32,percent of total billed charges,80% of total billed charges,79.2,90,,63.36,percent of total billed charges,90% of total billed charges,66,75,,52.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,25.52,29,,20.416,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,58.96,67,,47.168,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,70.4,80,,56.32,percent of total billed charges,80% of total billed charges,57.2,65,,45.76,percent of total billed charges,65% of total billed charges,31.39,35.67,,25.112,percent of total billed charges,35.67% of total billed charges,25.52,79.2,
AMIDATE 20 MG/10 ML INJ,2500351,CDM,250,RC,,,outpatient,,,64,25.60,,54.4,85,,43.52,percent of total billed charges,85% of total billed charges,49.28,77,,39.42,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,52.48,82,,41.984,percent of total billed charges,82% of total billed charges,54.4,85,,43.52,percent of total billed charges,85% of total billed charges,54.4,85,,43.52,percent of total billed charges,85% of total billed charges,54.4,85,,43.52,percent of total billed charges,85% of total billed charges,57.6,90,,46.08,percent of total billed charges,90% of total billed charges,51.2,80,,40.96,percent of total billed charges,80% of total billed charges,57.6,90,,46.08,percent of total billed charges,90% of total billed charges,48,75,,38.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,18.56,29,,14.848,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,42.88,67,,34.304,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,51.2,80,,40.96,percent of total billed charges,80% of total billed charges,41.6,65,,33.28,percent of total billed charges,65% of total billed charges,22.83,35.67,,18.264,percent of total billed charges,35.67% of total billed charges,18.56,57.6,
AMIDATE 40 MG/20ML,2500353,CDM,250,RC,,,outpatient,,,71,28.40,,60.35,85,,48.28,percent of total billed charges,85% of total billed charges,54.67,77,,43.74,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,58.22,82,,46.576,percent of total billed charges,82% of total billed charges,60.35,85,,48.28,percent of total billed charges,85% of total billed charges,60.35,85,,48.28,percent of total billed charges,85% of total billed charges,60.35,85,,48.28,percent of total billed charges,85% of total billed charges,63.9,90,,51.12,percent of total billed charges,90% of total billed charges,56.8,80,,45.44,percent of total billed charges,80% of total billed charges,63.9,90,,51.12,percent of total billed charges,90% of total billed charges,53.25,75,,42.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,20.59,29,,16.472,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,47.57,67,,38.056,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,56.8,80,,45.44,percent of total billed charges,80% of total billed charges,46.15,65,,36.92,percent of total billed charges,65% of total billed charges,25.33,35.67,,20.264,percent of total billed charges,35.67% of total billed charges,20.59,63.9,
AMICAR 5 GM INJ,2500355,CDM,250,RC,,,outpatient,,,14,5.60,,11.9,85,,9.52,percent of total billed charges,85% of total billed charges,10.78,77,,8.62,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,11.48,82,,9.184,percent of total billed charges,82% of total billed charges,11.9,85,,9.52,percent of total billed charges,85% of total billed charges,11.9,85,,9.52,percent of total billed charges,85% of total billed charges,11.9,85,,9.52,percent of total billed charges,85% of total billed charges,12.6,90,,10.08,percent of total billed charges,90% of total billed charges,11.2,80,,8.96,percent of total billed charges,80% of total billed charges,12.6,90,,10.08,percent of total billed charges,90% of total billed charges,10.5,75,,8.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,4.06,29,,3.248,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,9.38,67,,7.504,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,11.2,80,,8.96,percent of total billed charges,80% of total billed charges,9.1,65,,7.28,percent of total billed charges,65% of total billed charges,4.99,35.67,,3.992,percent of total billed charges,35.67% of total billed charges,4.06,12.6,
AMMONIA INHALANT,2500395,CDM,250,RC,,,outpatient,,,10,4.00,,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,7.7,77,,6.16,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,8.2,82,,6.56,percent of total billed charges,82% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,9,90,,7.2,percent of total billed charges,90% of total billed charges,8,80,,6.4,percent of total billed charges,80% of total billed charges,9,90,,7.2,percent of total billed charges,90% of total billed charges,7.5,75,,6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.9,29,,2.32,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,6.7,67,,5.36,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,8,80,,6.4,percent of total billed charges,80% of total billed charges,6.5,65,,5.2,percent of total billed charges,65% of total billed charges,3.57,35.67,,2.856,percent of total billed charges,35.67% of total billed charges,2.9,9,
AMITIZA 8 MCG CAP,2500397,CDM,250,RC,,,outpatient,,,26,10.40,,22.1,85,,17.68,percent of total billed charges,85% of total billed charges,20.02,77,,16.02,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,21.32,82,,17.056,percent of total billed charges,82% of total billed charges,22.1,85,,17.68,percent of total billed charges,85% of total billed charges,22.1,85,,17.68,percent of total billed charges,85% of total billed charges,22.1,85,,17.68,percent of total billed charges,85% of total billed charges,23.4,90,,18.72,percent of total billed charges,90% of total billed charges,20.8,80,,16.64,percent of total billed charges,80% of total billed charges,23.4,90,,18.72,percent of total billed charges,90% of total billed charges,19.5,75,,15.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,7.54,29,,6.032,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,17.42,67,,13.936,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,20.8,80,,16.64,percent of total billed charges,80% of total billed charges,16.9,65,,13.52,percent of total billed charges,65% of total billed charges,9.27,35.67,,7.416,percent of total billed charges,35.67% of total billed charges,7.54,23.4,
AMOXIL 250 MG CAP,2500410,CDM,250,RC,,,outpatient,,,7,2.80,,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.39,77,,4.31,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,5.74,82,,4.592,percent of total billed charges,82% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.25,75,,4.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.03,29,,1.624,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4.69,67,,3.752,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,4.55,65,,3.64,percent of total billed charges,65% of total billed charges,2.5,35.67,,2,percent of total billed charges,35.67% of total billed charges,2.03,6.3,
AMOXIL 400MG/5ML 100ML,2500411,CDM,250,RC,,,outpatient,,,19,7.60,,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,14.63,77,,11.7,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,15.58,82,,12.464,percent of total billed charges,82% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,15.2,80,,12.16,percent of total billed charges,80% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,14.25,75,,11.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,5.51,29,,4.408,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,12.73,67,,10.184,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,15.2,80,,12.16,percent of total billed charges,80% of total billed charges,12.35,65,,9.88,percent of total billed charges,65% of total billed charges,6.78,35.67,,5.424,percent of total billed charges,35.67% of total billed charges,5.51,17.1,
ANTILIRIUM 2MG/2ML AMP,2500635,CDM,250,RC,,,outpatient,,,149,59.60,,126.65,85,,101.32,percent of total billed charges,85% of total billed charges,114.73,77,,91.78,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,122.18,82,,97.744,percent of total billed charges,82% of total billed charges,126.65,85,,101.32,percent of total billed charges,85% of total billed charges,126.65,85,,101.32,percent of total billed charges,85% of total billed charges,126.65,85,,101.32,percent of total billed charges,85% of total billed charges,134.1,90,,107.28,percent of total billed charges,90% of total billed charges,119.2,80,,95.36,percent of total billed charges,80% of total billed charges,134.1,90,,107.28,percent of total billed charges,90% of total billed charges,111.75,75,,89.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,43.21,29,,34.568,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,99.83,67,,79.864,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,119.2,80,,95.36,percent of total billed charges,80% of total billed charges,96.85,65,,77.48,percent of total billed charges,65% of total billed charges,53.15,35.67,,42.52,percent of total billed charges,35.67% of total billed charges,43.21,134.1,
ANTIVERT 12.5 MG TAB,2500650,CDM,250,RC,,,outpatient,,,7,2.80,,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.39,77,,4.31,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,5.74,82,,4.592,percent of total billed charges,82% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.25,75,,4.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.03,29,,1.624,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4.69,67,,3.752,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,4.55,65,,3.64,percent of total billed charges,65% of total billed charges,2.5,35.67,,2,percent of total billed charges,35.67% of total billed charges,2.03,6.3,
ANUSOL HC CREAM 1 OZ,2500660,CDM,250,RC,,,outpatient,,,292,116.80,,248.2,85,,198.56,percent of total billed charges,85% of total billed charges,224.84,77,,179.87,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,239.44,82,,191.552,percent of total billed charges,82% of total billed charges,248.2,85,,198.56,percent of total billed charges,85% of total billed charges,248.2,85,,198.56,percent of total billed charges,85% of total billed charges,248.2,85,,198.56,percent of total billed charges,85% of total billed charges,262.8,90,,210.24,percent of total billed charges,90% of total billed charges,233.6,80,,186.88,percent of total billed charges,80% of total billed charges,262.8,90,,210.24,percent of total billed charges,90% of total billed charges,219,75,,175.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,84.68,29,,67.744,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,195.64,67,,156.512,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,233.6,80,,186.88,percent of total billed charges,80% of total billed charges,189.8,65,,151.84,percent of total billed charges,65% of total billed charges,104.16,35.67,,83.328,percent of total billed charges,35.67% of total billed charges,84.68,262.8,
ANUSOL HC SUPPOS,2500665,CDM,250,RC,,,outpatient,,,51,20.40,,43.35,85,,34.68,percent of total billed charges,85% of total billed charges,39.27,77,,31.42,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,41.82,82,,33.456,percent of total billed charges,82% of total billed charges,43.35,85,,34.68,percent of total billed charges,85% of total billed charges,43.35,85,,34.68,percent of total billed charges,85% of total billed charges,43.35,85,,34.68,percent of total billed charges,85% of total billed charges,45.9,90,,36.72,percent of total billed charges,90% of total billed charges,40.8,80,,32.64,percent of total billed charges,80% of total billed charges,45.9,90,,36.72,percent of total billed charges,90% of total billed charges,38.25,75,,30.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,14.79,29,,11.832,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,34.17,67,,27.336,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,40.8,80,,32.64,percent of total billed charges,80% of total billed charges,33.15,65,,26.52,percent of total billed charges,65% of total billed charges,18.19,35.67,,14.552,percent of total billed charges,35.67% of total billed charges,14.79,45.9,
APRESOLINE 10 MG TAB,2500705,CDM,250,RC,,,outpatient,,,7,2.80,,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.39,77,,4.31,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,5.74,82,,4.592,percent of total billed charges,82% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.25,75,,4.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.03,29,,1.624,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4.69,67,,3.752,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,4.55,65,,3.64,percent of total billed charges,65% of total billed charges,2.5,35.67,,2,percent of total billed charges,35.67% of total billed charges,2.03,6.3,
APRESOLINE 25 MG TAB,2500725,CDM,250,RC,,,outpatient,,,7,2.80,,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.39,77,,4.31,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,5.74,82,,4.592,percent of total billed charges,82% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.25,75,,4.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.03,29,,1.624,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4.69,67,,3.752,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,4.55,65,,3.64,percent of total billed charges,65% of total billed charges,2.5,35.67,,2,percent of total billed charges,35.67% of total billed charges,2.03,6.3,
APIDRA 100 UNITS/ML INJ,2500726,CDM,250,RC,,,outpatient,,,17,6.80,,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,13.09,77,,10.47,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,13.94,82,,11.152,percent of total billed charges,82% of total billed charges,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,15.3,90,,12.24,percent of total billed charges,90% of total billed charges,13.6,80,,10.88,percent of total billed charges,80% of total billed charges,15.3,90,,12.24,percent of total billed charges,90% of total billed charges,12.75,75,,10.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,4.93,29,,3.944,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,11.39,67,,9.112,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,13.6,80,,10.88,percent of total billed charges,80% of total billed charges,11.05,65,,8.84,percent of total billed charges,65% of total billed charges,6.06,35.67,,4.848,percent of total billed charges,35.67% of total billed charges,4.93,15.3,
APIXABAN BASE 2.5 MG TAB,2500727,CDM,250,RC,,,outpatient,,,28,11.20,,23.8,85,,19.04,percent of total billed charges,85% of total billed charges,21.56,77,,17.25,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,22.96,82,,18.368,percent of total billed charges,82% of total billed charges,23.8,85,,19.04,percent of total billed charges,85% of total billed charges,23.8,85,,19.04,percent of total billed charges,85% of total billed charges,23.8,85,,19.04,percent of total billed charges,85% of total billed charges,25.2,90,,20.16,percent of total billed charges,90% of total billed charges,22.4,80,,17.92,percent of total billed charges,80% of total billed charges,25.2,90,,20.16,percent of total billed charges,90% of total billed charges,21,75,,16.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,8.12,29,,6.496,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,18.76,67,,15.008,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,22.4,80,,17.92,percent of total billed charges,80% of total billed charges,18.2,65,,14.56,percent of total billed charges,65% of total billed charges,9.99,35.67,,7.992,percent of total billed charges,35.67% of total billed charges,8.12,25.2,
ARICEPT 5 MG PO,2500771,CDM,250,RC,,,outpatient,,,54,21.60,,45.9,85,,36.72,percent of total billed charges,85% of total billed charges,41.58,77,,33.26,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,44.28,82,,35.424,percent of total billed charges,82% of total billed charges,45.9,85,,36.72,percent of total billed charges,85% of total billed charges,45.9,85,,36.72,percent of total billed charges,85% of total billed charges,45.9,85,,36.72,percent of total billed charges,85% of total billed charges,48.6,90,,38.88,percent of total billed charges,90% of total billed charges,43.2,80,,34.56,percent of total billed charges,80% of total billed charges,48.6,90,,38.88,percent of total billed charges,90% of total billed charges,40.5,75,,32.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,15.66,29,,12.528,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,36.18,67,,28.944,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,43.2,80,,34.56,percent of total billed charges,80% of total billed charges,35.1,65,,28.08,percent of total billed charges,65% of total billed charges,19.26,35.67,,15.408,percent of total billed charges,35.67% of total billed charges,15.66,48.6,
ARISTOCORT A 0.1%(TRIAM.) CR,2500785,CDM,250,RC,,,outpatient,,,23,9.20,,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,17.71,77,,14.17,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,18.86,82,,15.088,percent of total billed charges,82% of total billed charges,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,20.7,90,,16.56,percent of total billed charges,90% of total billed charges,18.4,80,,14.72,percent of total billed charges,80% of total billed charges,20.7,90,,16.56,percent of total billed charges,90% of total billed charges,17.25,75,,13.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,6.67,29,,5.336,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,15.41,67,,12.328,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,18.4,80,,14.72,percent of total billed charges,80% of total billed charges,14.95,65,,11.96,percent of total billed charges,65% of total billed charges,8.2,35.67,,6.56,percent of total billed charges,35.67% of total billed charges,6.67,20.7,
ASPIRIN 81 MG TAB ADULT(COATED,2500821,CDM,250,RC,,,outpatient,,,7,2.80,,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.39,77,,4.31,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,5.74,82,,4.592,percent of total billed charges,82% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.25,75,,4.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.03,29,,1.624,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4.69,67,,3.752,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,4.55,65,,3.64,percent of total billed charges,65% of total billed charges,2.5,35.67,,2,percent of total billed charges,35.67% of total billed charges,2.03,6.3,
ASPIRIN CHEWABLE TAB,2500824,CDM,250,RC,,,outpatient,,,5,2.00,,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,3.85,77,,3.08,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,4.1,82,,3.28,percent of total billed charges,82% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,4.5,90,,3.6,percent of total billed charges,90% of total billed charges,4,80,,3.2,percent of total billed charges,80% of total billed charges,4.5,90,,3.6,percent of total billed charges,90% of total billed charges,3.75,75,,3,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,1.45,29,,1.16,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,3.35,67,,2.68,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,4,80,,3.2,percent of total billed charges,80% of total billed charges,3.25,65,,2.6,percent of total billed charges,65% of total billed charges,1.78,35.67,,1.424,percent of total billed charges,35.67% of total billed charges,1.45,4.5,
ASA GR 325MG TAB,2500835,CDM,250,RC,,,outpatient,,,6,2.40,,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,4.62,77,,3.7,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,4.92,82,,3.936,percent of total billed charges,82% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,5.4,90,,4.32,percent of total billed charges,90% of total billed charges,4.8,80,,3.84,percent of total billed charges,80% of total billed charges,5.4,90,,4.32,percent of total billed charges,90% of total billed charges,4.5,75,,3.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,1.74,29,,1.392,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4.02,67,,3.216,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,4.8,80,,3.84,percent of total billed charges,80% of total billed charges,3.9,65,,3.12,percent of total billed charges,65% of total billed charges,2.14,35.67,,1.712,percent of total billed charges,35.67% of total billed charges,1.74,5.4,
ASA GR X SUPPOS (600 MG),2500840,CDM,250,RC,,,outpatient,,,9,3.60,,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,6.93,77,,5.54,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,7.38,82,,5.904,percent of total billed charges,82% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,8.1,90,,6.48,percent of total billed charges,90% of total billed charges,7.2,80,,5.76,percent of total billed charges,80% of total billed charges,8.1,90,,6.48,percent of total billed charges,90% of total billed charges,6.75,75,,5.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.61,29,,2.088,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,6.03,67,,4.824,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,7.2,80,,5.76,percent of total billed charges,80% of total billed charges,5.85,65,,4.68,percent of total billed charges,65% of total billed charges,3.21,35.67,,2.568,percent of total billed charges,35.67% of total billed charges,2.61,8.1,
SORBITOL 3% IRRIGATION 3000ML,25008527,CDM,250,RC,,,outpatient,,,106,42.40,,90.1,85,,72.08,percent of total billed charges,85% of total billed charges,81.62,77,,65.3,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,86.92,82,,69.536,percent of total billed charges,82% of total billed charges,90.1,85,,72.08,percent of total billed charges,85% of total billed charges,90.1,85,,72.08,percent of total billed charges,85% of total billed charges,90.1,85,,72.08,percent of total billed charges,85% of total billed charges,95.4,90,,76.32,percent of total billed charges,90% of total billed charges,84.8,80,,67.84,percent of total billed charges,80% of total billed charges,95.4,90,,76.32,percent of total billed charges,90% of total billed charges,79.5,75,,63.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,30.74,29,,24.592,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,71.02,67,,56.816,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,84.8,80,,67.84,percent of total billed charges,80% of total billed charges,68.9,65,,55.12,percent of total billed charges,65% of total billed charges,37.81,35.67,,30.248,percent of total billed charges,35.67% of total billed charges,30.74,95.4,
ASCORBIC ACID 500 MG TAB,2500855,CDM,250,RC,,,outpatient,,,7,2.80,,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.39,77,,4.31,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,5.74,82,,4.592,percent of total billed charges,82% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.25,75,,4.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.03,29,,1.624,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4.69,67,,3.752,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,4.55,65,,3.64,percent of total billed charges,65% of total billed charges,2.5,35.67,,2,percent of total billed charges,35.67% of total billed charges,2.03,6.3,
ASCORBIC ACID 500MG/ML VIAL,2500856,CDM,250,RC,,,outpatient,,,65,26.00,,55.25,85,,44.2,percent of total billed charges,85% of total billed charges,50.05,77,,40.04,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,53.3,82,,42.64,percent of total billed charges,82% of total billed charges,55.25,85,,44.2,percent of total billed charges,85% of total billed charges,55.25,85,,44.2,percent of total billed charges,85% of total billed charges,55.25,85,,44.2,percent of total billed charges,85% of total billed charges,58.5,90,,46.8,percent of total billed charges,90% of total billed charges,52,80,,41.6,percent of total billed charges,80% of total billed charges,58.5,90,,46.8,percent of total billed charges,90% of total billed charges,48.75,75,,39,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,18.85,29,,15.08,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,43.55,67,,34.84,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,52,80,,41.6,percent of total billed charges,80% of total billed charges,42.25,65,,33.8,percent of total billed charges,65% of total billed charges,23.19,35.67,,18.552,percent of total billed charges,35.67% of total billed charges,18.85,58.5,
ATARAX 25 MG TAB,2500895,CDM,250,RC,,,outpatient,,,7,2.80,,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.39,77,,4.31,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,5.74,82,,4.592,percent of total billed charges,82% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.25,75,,4.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.03,29,,1.624,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4.69,67,,3.752,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,4.55,65,,3.64,percent of total billed charges,65% of total billed charges,2.5,35.67,,2,percent of total billed charges,35.67% of total billed charges,2.03,6.3,
ATIVAN .5 MG TAB,2500910,CDM,250,RC,,,outpatient,,,30,12.00,,25.5,85,,20.4,percent of total billed charges,85% of total billed charges,23.1,77,,18.48,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,24.6,82,,19.68,percent of total billed charges,82% of total billed charges,25.5,85,,20.4,percent of total billed charges,85% of total billed charges,25.5,85,,20.4,percent of total billed charges,85% of total billed charges,25.5,85,,20.4,percent of total billed charges,85% of total billed charges,27,90,,21.6,percent of total billed charges,90% of total billed charges,24,80,,19.2,percent of total billed charges,80% of total billed charges,27,90,,21.6,percent of total billed charges,90% of total billed charges,22.5,75,,18,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,8.7,29,,6.96,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,20.1,67,,16.08,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,24,80,,19.2,percent of total billed charges,80% of total billed charges,19.5,65,,15.6,percent of total billed charges,65% of total billed charges,10.7,35.67,,8.56,percent of total billed charges,35.67% of total billed charges,8.7,27,
ATROPINE 1% 5 ML OPTH DROPS,2500956,CDM,250,RC,,,outpatient,,,198,79.20,,168.3,85,,134.64,percent of total billed charges,85% of total billed charges,152.46,77,,121.97,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,162.36,82,,129.888,percent of total billed charges,82% of total billed charges,168.3,85,,134.64,percent of total billed charges,85% of total billed charges,168.3,85,,134.64,percent of total billed charges,85% of total billed charges,168.3,85,,134.64,percent of total billed charges,85% of total billed charges,178.2,90,,142.56,percent of total billed charges,90% of total billed charges,158.4,80,,126.72,percent of total billed charges,80% of total billed charges,178.2,90,,142.56,percent of total billed charges,90% of total billed charges,148.5,75,,118.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,57.42,29,,45.936,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,132.66,67,,106.128,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,158.4,80,,126.72,percent of total billed charges,80% of total billed charges,128.7,65,,102.96,percent of total billed charges,65% of total billed charges,70.63,35.67,,56.504,percent of total billed charges,35.67% of total billed charges,57.42,178.2,
ATROVENT UD NEB 0.5MG,2500976,CDM,250,RC,,,outpatient,,,10,4.00,,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,7.7,77,,6.16,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,8.2,82,,6.56,percent of total billed charges,82% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,9,90,,7.2,percent of total billed charges,90% of total billed charges,8,80,,6.4,percent of total billed charges,80% of total billed charges,9,90,,7.2,percent of total billed charges,90% of total billed charges,7.5,75,,6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.9,29,,2.32,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,6.7,67,,5.36,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,8,80,,6.4,percent of total billed charges,80% of total billed charges,6.5,65,,5.2,percent of total billed charges,65% of total billed charges,3.57,35.67,,2.856,percent of total billed charges,35.67% of total billed charges,2.9,9,
ATROVENT 15 ML NASAL SPRAY,2500978,CDM,250,RC,,,outpatient,,,259,103.60,,220.15,85,,176.12,percent of total billed charges,85% of total billed charges,199.43,77,,159.54,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,212.38,82,,169.904,percent of total billed charges,82% of total billed charges,220.15,85,,176.12,percent of total billed charges,85% of total billed charges,220.15,85,,176.12,percent of total billed charges,85% of total billed charges,220.15,85,,176.12,percent of total billed charges,85% of total billed charges,233.1,90,,186.48,percent of total billed charges,90% of total billed charges,207.2,80,,165.76,percent of total billed charges,80% of total billed charges,233.1,90,,186.48,percent of total billed charges,90% of total billed charges,194.25,75,,155.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,75.11,29,,60.088,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,173.53,67,,138.824,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,207.2,80,,165.76,percent of total billed charges,80% of total billed charges,168.35,65,,134.68,percent of total billed charges,65% of total billed charges,92.39,35.67,,73.912,percent of total billed charges,35.67% of total billed charges,75.11,233.1,
AUGMENTIN 250 MG/5 ML BOTTLE,2500980,CDM,250,RC,,,outpatient,,,404,161.60,,343.4,85,,274.72,percent of total billed charges,85% of total billed charges,311.08,77,,248.86,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,331.28,82,,265.024,percent of total billed charges,82% of total billed charges,343.4,85,,274.72,percent of total billed charges,85% of total billed charges,343.4,85,,274.72,percent of total billed charges,85% of total billed charges,343.4,85,,274.72,percent of total billed charges,85% of total billed charges,363.6,90,,290.88,percent of total billed charges,90% of total billed charges,323.2,80,,258.56,percent of total billed charges,80% of total billed charges,363.6,90,,290.88,percent of total billed charges,90% of total billed charges,303,75,,242.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,117.16,29,,93.728,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,270.68,67,,216.544,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,323.2,80,,258.56,percent of total billed charges,80% of total billed charges,262.6,65,,210.08,percent of total billed charges,65% of total billed charges,144.11,35.67,,115.288,percent of total billed charges,35.67% of total billed charges,117.16,363.6,
AUGMENTIN 500 MG TAB,2500990,CDM,250,RC,,,outpatient,,,27,10.80,,22.95,85,,18.36,percent of total billed charges,85% of total billed charges,20.79,77,,16.63,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,22.14,82,,17.712,percent of total billed charges,82% of total billed charges,22.95,85,,18.36,percent of total billed charges,85% of total billed charges,22.95,85,,18.36,percent of total billed charges,85% of total billed charges,22.95,85,,18.36,percent of total billed charges,85% of total billed charges,24.3,90,,19.44,percent of total billed charges,90% of total billed charges,21.6,80,,17.28,percent of total billed charges,80% of total billed charges,24.3,90,,19.44,percent of total billed charges,90% of total billed charges,20.25,75,,16.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,7.83,29,,6.264,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,18.09,67,,14.472,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,21.6,80,,17.28,percent of total billed charges,80% of total billed charges,17.55,65,,14.04,percent of total billed charges,65% of total billed charges,9.63,35.67,,7.704,percent of total billed charges,35.67% of total billed charges,7.83,24.3,
AUGMENTIN 875 MGS PO,2500991,CDM,250,RC,,,outpatient,,,58,23.20,,49.3,85,,39.44,percent of total billed charges,85% of total billed charges,44.66,77,,35.73,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,47.56,82,,38.048,percent of total billed charges,82% of total billed charges,49.3,85,,39.44,percent of total billed charges,85% of total billed charges,49.3,85,,39.44,percent of total billed charges,85% of total billed charges,49.3,85,,39.44,percent of total billed charges,85% of total billed charges,52.2,90,,41.76,percent of total billed charges,90% of total billed charges,46.4,80,,37.12,percent of total billed charges,80% of total billed charges,52.2,90,,41.76,percent of total billed charges,90% of total billed charges,43.5,75,,34.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,16.82,29,,13.456,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,38.86,67,,31.088,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,46.4,80,,37.12,percent of total billed charges,80% of total billed charges,37.7,65,,30.16,percent of total billed charges,65% of total billed charges,20.69,35.67,,16.552,percent of total billed charges,35.67% of total billed charges,16.82,52.2,
AVODART 0.5 MG CAP,2501018,CDM,250,RC,,,outpatient,,,27,10.80,,22.95,85,,18.36,percent of total billed charges,85% of total billed charges,20.79,77,,16.63,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,22.14,82,,17.712,percent of total billed charges,82% of total billed charges,22.95,85,,18.36,percent of total billed charges,85% of total billed charges,22.95,85,,18.36,percent of total billed charges,85% of total billed charges,22.95,85,,18.36,percent of total billed charges,85% of total billed charges,24.3,90,,19.44,percent of total billed charges,90% of total billed charges,21.6,80,,17.28,percent of total billed charges,80% of total billed charges,24.3,90,,19.44,percent of total billed charges,90% of total billed charges,20.25,75,,16.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,7.83,29,,6.264,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,18.09,67,,14.472,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,21.6,80,,17.28,percent of total billed charges,80% of total billed charges,17.55,65,,14.04,percent of total billed charges,65% of total billed charges,9.63,35.67,,7.704,percent of total billed charges,35.67% of total billed charges,7.83,24.3,
AZACTAM 1 GM INJ.,2501030,CDM,250,RC,,,outpatient,,,157,62.80,,133.45,85,,106.76,percent of total billed charges,85% of total billed charges,120.89,77,,96.71,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,128.74,82,,102.992,percent of total billed charges,82% of total billed charges,133.45,85,,106.76,percent of total billed charges,85% of total billed charges,133.45,85,,106.76,percent of total billed charges,85% of total billed charges,133.45,85,,106.76,percent of total billed charges,85% of total billed charges,141.3,90,,113.04,percent of total billed charges,90% of total billed charges,125.6,80,,100.48,percent of total billed charges,80% of total billed charges,141.3,90,,113.04,percent of total billed charges,90% of total billed charges,117.75,75,,94.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,45.53,29,,36.424,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,105.19,67,,84.152,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,125.6,80,,100.48,percent of total billed charges,80% of total billed charges,102.05,65,,81.64,percent of total billed charges,65% of total billed charges,56,35.67,,44.8,percent of total billed charges,35.67% of total billed charges,45.53,141.3,
AZOPT 1% OPTH DROPS (10ML BOT),2501047,CDM,250,RC,,,outpatient,,,544,217.60,,462.4,85,,369.92,percent of total billed charges,85% of total billed charges,418.88,77,,335.1,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,446.08,82,,356.864,percent of total billed charges,82% of total billed charges,462.4,85,,369.92,percent of total billed charges,85% of total billed charges,462.4,85,,369.92,percent of total billed charges,85% of total billed charges,462.4,85,,369.92,percent of total billed charges,85% of total billed charges,489.6,90,,391.68,percent of total billed charges,90% of total billed charges,435.2,80,,348.16,percent of total billed charges,80% of total billed charges,489.6,90,,391.68,percent of total billed charges,90% of total billed charges,408,75,,326.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,157.76,29,,126.208,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,364.48,67,,291.584,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,435.2,80,,348.16,percent of total billed charges,80% of total billed charges,353.6,65,,282.88,percent of total billed charges,65% of total billed charges,194.04,35.67,,155.232,percent of total billed charges,35.67% of total billed charges,157.76,489.6,
B & O SUPPRETTES SUPP,2501055,CDM,250,RC,,,outpatient,,,94,37.60,,79.9,85,,63.92,percent of total billed charges,85% of total billed charges,72.38,77,,57.9,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,77.08,82,,61.664,percent of total billed charges,82% of total billed charges,79.9,85,,63.92,percent of total billed charges,85% of total billed charges,79.9,85,,63.92,percent of total billed charges,85% of total billed charges,79.9,85,,63.92,percent of total billed charges,85% of total billed charges,84.6,90,,67.68,percent of total billed charges,90% of total billed charges,75.2,80,,60.16,percent of total billed charges,80% of total billed charges,84.6,90,,67.68,percent of total billed charges,90% of total billed charges,70.5,75,,56.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,27.26,29,,21.808,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,62.98,67,,50.384,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,75.2,80,,60.16,percent of total billed charges,80% of total billed charges,61.1,65,,48.88,percent of total billed charges,65% of total billed charges,33.53,35.67,,26.824,percent of total billed charges,35.67% of total billed charges,27.26,84.6,
BACTRIM DS TAB 1 EACH,2501085,CDM,250,RC,,,outpatient,,,14,5.60,,11.9,85,,9.52,percent of total billed charges,85% of total billed charges,10.78,77,,8.62,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,11.48,82,,9.184,percent of total billed charges,82% of total billed charges,11.9,85,,9.52,percent of total billed charges,85% of total billed charges,11.9,85,,9.52,percent of total billed charges,85% of total billed charges,11.9,85,,9.52,percent of total billed charges,85% of total billed charges,12.6,90,,10.08,percent of total billed charges,90% of total billed charges,11.2,80,,8.96,percent of total billed charges,80% of total billed charges,12.6,90,,10.08,percent of total billed charges,90% of total billed charges,10.5,75,,8.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,4.06,29,,3.248,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,9.38,67,,7.504,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,11.2,80,,8.96,percent of total billed charges,80% of total billed charges,9.1,65,,7.28,percent of total billed charges,65% of total billed charges,4.99,35.67,,3.992,percent of total billed charges,35.67% of total billed charges,4.06,12.6,
BACTRIM  5 ML INJ,2501090,CDM,250,RC,,,outpatient,,,33,13.20,,28.05,85,,22.44,percent of total billed charges,85% of total billed charges,25.41,77,,20.33,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,27.06,82,,21.648,percent of total billed charges,82% of total billed charges,28.05,85,,22.44,percent of total billed charges,85% of total billed charges,28.05,85,,22.44,percent of total billed charges,85% of total billed charges,28.05,85,,22.44,percent of total billed charges,85% of total billed charges,29.7,90,,23.76,percent of total billed charges,90% of total billed charges,26.4,80,,21.12,percent of total billed charges,80% of total billed charges,29.7,90,,23.76,percent of total billed charges,90% of total billed charges,24.75,75,,19.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,9.57,29,,7.656,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,22.11,67,,17.688,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,26.4,80,,21.12,percent of total billed charges,80% of total billed charges,21.45,65,,17.16,percent of total billed charges,65% of total billed charges,11.77,35.67,,9.416,percent of total billed charges,35.67% of total billed charges,9.57,29.7,
BACTROBAN 22 GM OINTMENT,2501113,CDM,250,RC,,,outpatient,,,341,136.40,,289.85,85,,231.88,percent of total billed charges,85% of total billed charges,262.57,77,,210.06,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,279.62,82,,223.696,percent of total billed charges,82% of total billed charges,289.85,85,,231.88,percent of total billed charges,85% of total billed charges,289.85,85,,231.88,percent of total billed charges,85% of total billed charges,289.85,85,,231.88,percent of total billed charges,85% of total billed charges,306.9,90,,245.52,percent of total billed charges,90% of total billed charges,272.8,80,,218.24,percent of total billed charges,80% of total billed charges,306.9,90,,245.52,percent of total billed charges,90% of total billed charges,255.75,75,,204.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,98.89,29,,79.112,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,228.47,67,,182.776,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,272.8,80,,218.24,percent of total billed charges,80% of total billed charges,221.65,65,,177.32,percent of total billed charges,65% of total billed charges,121.63,35.67,,97.304,percent of total billed charges,35.67% of total billed charges,98.89,306.9,
BALANCE SALT SOLUTION 15 ML,2501124,CDM,250,RC,,,outpatient,,,53,21.20,,45.05,85,,36.04,percent of total billed charges,85% of total billed charges,40.81,77,,32.65,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,43.46,82,,34.768,percent of total billed charges,82% of total billed charges,45.05,85,,36.04,percent of total billed charges,85% of total billed charges,45.05,85,,36.04,percent of total billed charges,85% of total billed charges,45.05,85,,36.04,percent of total billed charges,85% of total billed charges,47.7,90,,38.16,percent of total billed charges,90% of total billed charges,42.4,80,,33.92,percent of total billed charges,80% of total billed charges,47.7,90,,38.16,percent of total billed charges,90% of total billed charges,39.75,75,,31.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,15.37,29,,12.296,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,35.51,67,,28.408,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,42.4,80,,33.92,percent of total billed charges,80% of total billed charges,34.45,65,,27.56,percent of total billed charges,65% of total billed charges,18.91,35.67,,15.128,percent of total billed charges,35.67% of total billed charges,15.37,47.7,
BENADRYL 30 GRAM TUBE,2501151,CDM,250,RC,,,outpatient,,,18,7.20,,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,13.86,77,,11.09,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,14.76,82,,11.808,percent of total billed charges,82% of total billed charges,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,16.2,90,,12.96,percent of total billed charges,90% of total billed charges,14.4,80,,11.52,percent of total billed charges,80% of total billed charges,16.2,90,,12.96,percent of total billed charges,90% of total billed charges,13.5,75,,10.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,5.22,29,,4.176,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,12.06,67,,9.648,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,14.4,80,,11.52,percent of total billed charges,80% of total billed charges,11.7,65,,9.36,percent of total billed charges,65% of total billed charges,6.42,35.67,,5.136,percent of total billed charges,35.67% of total billed charges,5.22,16.2,
BENADRYL 25 MG CAPS,2501160,CDM,250,RC,,,outpatient,,,7,2.80,,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.39,77,,4.31,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,5.74,82,,4.592,percent of total billed charges,82% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.25,75,,4.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.03,29,,1.624,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4.69,67,,3.752,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,4.55,65,,3.64,percent of total billed charges,65% of total billed charges,2.5,35.67,,2,percent of total billed charges,35.67% of total billed charges,2.03,6.3,
BENADRYL 12.5 MG/5ML UNIT DOSE,2501166,CDM,250,RC,,,outpatient,,,7,2.80,,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.39,77,,4.31,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,5.74,82,,4.592,percent of total billed charges,82% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.25,75,,4.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.03,29,,1.624,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4.69,67,,3.752,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,4.55,65,,3.64,percent of total billed charges,65% of total billed charges,2.5,35.67,,2,percent of total billed charges,35.67% of total billed charges,2.03,6.3,
BENTYL 10 MG CAPS,2501205,CDM,250,RC,,,outpatient,,,7,2.80,,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.39,77,,4.31,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,5.74,82,,4.592,percent of total billed charges,82% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.25,75,,4.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.03,29,,1.624,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4.69,67,,3.752,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,4.55,65,,3.64,percent of total billed charges,65% of total billed charges,2.5,35.67,,2,percent of total billed charges,35.67% of total billed charges,2.03,6.3,
BETADINE OINTMENT 30 G,25012600,CDM,250,RC,,,outpatient,,,33,13.20,,28.05,85,,22.44,percent of total billed charges,85% of total billed charges,25.41,77,,20.33,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,27.06,82,,21.648,percent of total billed charges,82% of total billed charges,28.05,85,,22.44,percent of total billed charges,85% of total billed charges,28.05,85,,22.44,percent of total billed charges,85% of total billed charges,28.05,85,,22.44,percent of total billed charges,85% of total billed charges,29.7,90,,23.76,percent of total billed charges,90% of total billed charges,26.4,80,,21.12,percent of total billed charges,80% of total billed charges,29.7,90,,23.76,percent of total billed charges,90% of total billed charges,24.75,75,,19.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,9.57,29,,7.656,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,22.11,67,,17.688,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,26.4,80,,21.12,percent of total billed charges,80% of total billed charges,21.45,65,,17.16,percent of total billed charges,65% of total billed charges,11.77,35.67,,9.416,percent of total billed charges,35.67% of total billed charges,9.57,29.7,
BETADINE OINT UNIT DOSE PACK,2501268,CDM,250,RC,,,outpatient,,,7,2.80,,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.39,77,,4.31,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,5.74,82,,4.592,percent of total billed charges,82% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.25,75,,4.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.03,29,,1.624,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4.69,67,,3.752,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,4.55,65,,3.64,percent of total billed charges,65% of total billed charges,2.5,35.67,,2,percent of total billed charges,35.67% of total billed charges,2.03,6.3,
BETAPACE 80 MG TAB,2501271,CDM,250,RC,,,outpatient,,,12,4.80,,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,9.24,77,,7.39,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,9.84,82,,7.872,percent of total billed charges,82% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,10.8,90,,8.64,percent of total billed charges,90% of total billed charges,9.6,80,,7.68,percent of total billed charges,80% of total billed charges,10.8,90,,8.64,percent of total billed charges,90% of total billed charges,9,75,,7.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,3.48,29,,2.784,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,8.04,67,,6.432,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,9.6,80,,7.68,percent of total billed charges,80% of total billed charges,7.8,65,,6.24,percent of total billed charges,65% of total billed charges,4.28,35.67,,3.424,percent of total billed charges,35.67% of total billed charges,3.48,10.8,
BIAXIN 500 MG TAB,2501285,CDM,250,RC,,,outpatient,,,34,13.60,,28.9,85,,23.12,percent of total billed charges,85% of total billed charges,26.18,77,,20.94,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,27.88,82,,22.304,percent of total billed charges,82% of total billed charges,28.9,85,,23.12,percent of total billed charges,85% of total billed charges,28.9,85,,23.12,percent of total billed charges,85% of total billed charges,28.9,85,,23.12,percent of total billed charges,85% of total billed charges,30.6,90,,24.48,percent of total billed charges,90% of total billed charges,27.2,80,,21.76,percent of total billed charges,80% of total billed charges,30.6,90,,24.48,percent of total billed charges,90% of total billed charges,25.5,75,,20.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,9.86,29,,7.888,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,22.78,67,,18.224,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,27.2,80,,21.76,percent of total billed charges,80% of total billed charges,22.1,65,,17.68,percent of total billed charges,65% of total billed charges,12.13,35.67,,9.704,percent of total billed charges,35.67% of total billed charges,9.86,30.6,
BIAXIN 250MG/5 ML BOTTLE,2501286,CDM,250,RC,,,outpatient,,,240,96.00,,204,85,,163.2,percent of total billed charges,85% of total billed charges,184.8,77,,147.84,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,196.8,82,,157.44,percent of total billed charges,82% of total billed charges,204,85,,163.2,percent of total billed charges,85% of total billed charges,204,85,,163.2,percent of total billed charges,85% of total billed charges,204,85,,163.2,percent of total billed charges,85% of total billed charges,216,90,,172.8,percent of total billed charges,90% of total billed charges,192,80,,153.6,percent of total billed charges,80% of total billed charges,216,90,,172.8,percent of total billed charges,90% of total billed charges,180,75,,144,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,69.6,29,,55.68,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,160.8,67,,128.64,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,192,80,,153.6,percent of total billed charges,80% of total billed charges,156,65,,124.8,percent of total billed charges,65% of total billed charges,85.61,35.67,,68.488,percent of total billed charges,35.67% of total billed charges,69.6,216,
BETHANECHOL 10 MG PO,2501289,CDM,250,RC,,,outpatient,,,13,5.20,,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,10.01,77,,8.01,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,10.66,82,,8.528,percent of total billed charges,82% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,11.7,90,,9.36,percent of total billed charges,90% of total billed charges,10.4,80,,8.32,percent of total billed charges,80% of total billed charges,11.7,90,,9.36,percent of total billed charges,90% of total billed charges,9.75,75,,7.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,3.77,29,,3.016,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,8.71,67,,6.968,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,10.4,80,,8.32,percent of total billed charges,80% of total billed charges,8.45,65,,6.76,percent of total billed charges,65% of total billed charges,4.64,35.67,,3.712,percent of total billed charges,35.67% of total billed charges,3.77,11.7,
BICITRA LIQUID 3 GM/30 ML UDC,2501325,CDM,250,RC,,,outpatient,,,11,4.40,,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,8.47,77,,6.78,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,9.02,82,,7.216,percent of total billed charges,82% of total billed charges,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,9.9,90,,7.92,percent of total billed charges,90% of total billed charges,8.8,80,,7.04,percent of total billed charges,80% of total billed charges,9.9,90,,7.92,percent of total billed charges,90% of total billed charges,8.25,75,,6.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,3.19,29,,2.552,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,7.37,67,,5.896,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,8.8,80,,7.04,percent of total billed charges,80% of total billed charges,7.15,65,,5.72,percent of total billed charges,65% of total billed charges,3.92,35.67,,3.136,percent of total billed charges,35.67% of total billed charges,3.19,9.9,
BLEPH 10% OPTH DROPS,2501340,CDM,250,RC,,,outpatient,,,204,81.60,,173.4,85,,138.72,percent of total billed charges,85% of total billed charges,157.08,77,,125.66,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,167.28,82,,133.824,percent of total billed charges,82% of total billed charges,173.4,85,,138.72,percent of total billed charges,85% of total billed charges,173.4,85,,138.72,percent of total billed charges,85% of total billed charges,173.4,85,,138.72,percent of total billed charges,85% of total billed charges,183.6,90,,146.88,percent of total billed charges,90% of total billed charges,163.2,80,,130.56,percent of total billed charges,80% of total billed charges,183.6,90,,146.88,percent of total billed charges,90% of total billed charges,153,75,,122.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,59.16,29,,47.328,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,136.68,67,,109.344,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,163.2,80,,130.56,percent of total billed charges,80% of total billed charges,132.6,65,,106.08,percent of total billed charges,65% of total billed charges,72.77,35.67,,58.216,percent of total billed charges,35.67% of total billed charges,59.16,183.6,
BRETHINE 2.5 MG TAB,2501360,CDM,250,RC,,,outpatient,,,22,8.80,,18.7,85,,14.96,percent of total billed charges,85% of total billed charges,16.94,77,,13.55,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,18.04,82,,14.432,percent of total billed charges,82% of total billed charges,18.7,85,,14.96,percent of total billed charges,85% of total billed charges,18.7,85,,14.96,percent of total billed charges,85% of total billed charges,18.7,85,,14.96,percent of total billed charges,85% of total billed charges,19.8,90,,15.84,percent of total billed charges,90% of total billed charges,17.6,80,,14.08,percent of total billed charges,80% of total billed charges,19.8,90,,15.84,percent of total billed charges,90% of total billed charges,16.5,75,,13.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,6.38,29,,5.104,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,14.74,67,,11.792,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,17.6,80,,14.08,percent of total billed charges,80% of total billed charges,14.3,65,,11.44,percent of total billed charges,65% of total billed charges,7.85,35.67,,6.28,percent of total billed charges,35.67% of total billed charges,6.38,19.8,
BREVIBLOC 100 MG/10 ML INJ,2501376,CDM,250,RC,,,outpatient,,,87,34.80,,73.95,85,,59.16,percent of total billed charges,85% of total billed charges,66.99,77,,53.59,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,71.34,82,,57.072,percent of total billed charges,82% of total billed charges,73.95,85,,59.16,percent of total billed charges,85% of total billed charges,73.95,85,,59.16,percent of total billed charges,85% of total billed charges,73.95,85,,59.16,percent of total billed charges,85% of total billed charges,78.3,90,,62.64,percent of total billed charges,90% of total billed charges,69.6,80,,55.68,percent of total billed charges,80% of total billed charges,78.3,90,,62.64,percent of total billed charges,90% of total billed charges,65.25,75,,52.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,25.23,29,,20.184,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,58.29,67,,46.632,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,69.6,80,,55.68,percent of total billed charges,80% of total billed charges,56.55,65,,45.24,percent of total billed charges,65% of total billed charges,31.03,35.67,,24.824,percent of total billed charges,35.67% of total billed charges,25.23,78.3,
BUMEX 2.5MG/10 ML VIAL,2501416,CDM,250,RC,,,outpatient,,,24,9.60,,20.4,85,,16.32,percent of total billed charges,85% of total billed charges,18.48,77,,14.78,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,19.68,82,,15.744,percent of total billed charges,82% of total billed charges,20.4,85,,16.32,percent of total billed charges,85% of total billed charges,20.4,85,,16.32,percent of total billed charges,85% of total billed charges,20.4,85,,16.32,percent of total billed charges,85% of total billed charges,21.6,90,,17.28,percent of total billed charges,90% of total billed charges,19.2,80,,15.36,percent of total billed charges,80% of total billed charges,21.6,90,,17.28,percent of total billed charges,90% of total billed charges,18,75,,14.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,6.96,29,,5.568,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,16.08,67,,12.864,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,19.2,80,,15.36,percent of total billed charges,80% of total billed charges,15.6,65,,12.48,percent of total billed charges,65% of total billed charges,8.56,35.67,,6.848,percent of total billed charges,35.67% of total billed charges,6.96,21.6,
BUMEX 1MG INJ,2501425,CDM,250,RC,,,outpatient,,,12,4.80,,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,9.24,77,,7.39,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,9.84,82,,7.872,percent of total billed charges,82% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,10.8,90,,8.64,percent of total billed charges,90% of total billed charges,9.6,80,,7.68,percent of total billed charges,80% of total billed charges,10.8,90,,8.64,percent of total billed charges,90% of total billed charges,9,75,,7.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,3.48,29,,2.784,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,8.04,67,,6.432,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,9.6,80,,7.68,percent of total billed charges,80% of total billed charges,7.8,65,,6.24,percent of total billed charges,65% of total billed charges,4.28,35.67,,3.424,percent of total billed charges,35.67% of total billed charges,3.48,10.8,
BUMEX 1MG TAB,2501430,CDM,250,RC,,,outpatient,,,7,2.80,,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.39,77,,4.31,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,5.74,82,,4.592,percent of total billed charges,82% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.25,75,,4.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.03,29,,1.624,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4.69,67,,3.752,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,4.55,65,,3.64,percent of total billed charges,65% of total billed charges,2.5,35.67,,2,percent of total billed charges,35.67% of total billed charges,2.03,6.3,
BUSPAR 5MG TAB,2501450,CDM,250,RC,,,outpatient,,,8,3.20,,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,6.16,77,,4.93,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,6.56,82,,5.248,percent of total billed charges,82% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,7.2,90,,5.76,percent of total billed charges,90% of total billed charges,6.4,80,,5.12,percent of total billed charges,80% of total billed charges,7.2,90,,5.76,percent of total billed charges,90% of total billed charges,6,75,,4.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.32,29,,1.856,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,5.36,67,,4.288,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,6.4,80,,5.12,percent of total billed charges,80% of total billed charges,5.2,65,,4.16,percent of total billed charges,65% of total billed charges,2.85,35.67,,2.28,percent of total billed charges,35.67% of total billed charges,2.32,7.2,
BYSTOLIC 2.5 MG TABLET,2501462,CDM,250,RC,,,outpatient,,,17,6.80,,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,13.09,77,,10.47,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,13.94,82,,11.152,percent of total billed charges,82% of total billed charges,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,15.3,90,,12.24,percent of total billed charges,90% of total billed charges,13.6,80,,10.88,percent of total billed charges,80% of total billed charges,15.3,90,,12.24,percent of total billed charges,90% of total billed charges,12.75,75,,10.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,4.93,29,,3.944,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,11.39,67,,9.112,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,13.6,80,,10.88,percent of total billed charges,80% of total billed charges,11.05,65,,8.84,percent of total billed charges,65% of total billed charges,6.06,35.67,,4.848,percent of total billed charges,35.67% of total billed charges,4.93,15.3,
CALAN 180 SR TAB,2501500,CDM,250,RC,,,outpatient,,,16,6.40,,13.6,85,,10.88,percent of total billed charges,85% of total billed charges,12.32,77,,9.86,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,13.12,82,,10.496,percent of total billed charges,82% of total billed charges,13.6,85,,10.88,percent of total billed charges,85% of total billed charges,13.6,85,,10.88,percent of total billed charges,85% of total billed charges,13.6,85,,10.88,percent of total billed charges,85% of total billed charges,14.4,90,,11.52,percent of total billed charges,90% of total billed charges,12.8,80,,10.24,percent of total billed charges,80% of total billed charges,14.4,90,,11.52,percent of total billed charges,90% of total billed charges,12,75,,9.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,4.64,29,,3.712,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,10.72,67,,8.576,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,12.8,80,,10.24,percent of total billed charges,80% of total billed charges,10.4,65,,8.32,percent of total billed charges,65% of total billed charges,5.71,35.67,,4.568,percent of total billed charges,35.67% of total billed charges,4.64,14.4,
CALAN 5 MG/2CC INJ/VERAPAMIL,2501515,CDM,250,RC,,,outpatient,,,51,20.40,,43.35,85,,34.68,percent of total billed charges,85% of total billed charges,39.27,77,,31.42,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,41.82,82,,33.456,percent of total billed charges,82% of total billed charges,43.35,85,,34.68,percent of total billed charges,85% of total billed charges,43.35,85,,34.68,percent of total billed charges,85% of total billed charges,43.35,85,,34.68,percent of total billed charges,85% of total billed charges,45.9,90,,36.72,percent of total billed charges,90% of total billed charges,40.8,80,,32.64,percent of total billed charges,80% of total billed charges,45.9,90,,36.72,percent of total billed charges,90% of total billed charges,38.25,75,,30.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,14.79,29,,11.832,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,34.17,67,,27.336,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,40.8,80,,32.64,percent of total billed charges,80% of total billed charges,33.15,65,,26.52,percent of total billed charges,65% of total billed charges,18.19,35.67,,14.552,percent of total billed charges,35.67% of total billed charges,14.79,45.9,
CALCIUM CHLORIDE 10% INJ PFS,2501550,CDM,250,RC,,,outpatient,,,12,4.80,,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,9.24,77,,7.39,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,9.84,82,,7.872,percent of total billed charges,82% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,10.8,90,,8.64,percent of total billed charges,90% of total billed charges,9.6,80,,7.68,percent of total billed charges,80% of total billed charges,10.8,90,,8.64,percent of total billed charges,90% of total billed charges,9,75,,7.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,3.48,29,,2.784,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,8.04,67,,6.432,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,9.6,80,,7.68,percent of total billed charges,80% of total billed charges,7.8,65,,6.24,percent of total billed charges,65% of total billed charges,4.28,35.67,,3.424,percent of total billed charges,35.67% of total billed charges,3.48,10.8,
CALCIUM CHLORIDE 10% 10ML INJ,2501551,CDM,250,RC,,,outpatient,,,45,18.00,,38.25,85,,30.6,percent of total billed charges,85% of total billed charges,34.65,77,,27.72,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,36.9,82,,29.52,percent of total billed charges,82% of total billed charges,38.25,85,,30.6,percent of total billed charges,85% of total billed charges,38.25,85,,30.6,percent of total billed charges,85% of total billed charges,38.25,85,,30.6,percent of total billed charges,85% of total billed charges,40.5,90,,32.4,percent of total billed charges,90% of total billed charges,36,80,,28.8,percent of total billed charges,80% of total billed charges,40.5,90,,32.4,percent of total billed charges,90% of total billed charges,33.75,75,,27,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,13.05,29,,10.44,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,30.15,67,,24.12,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,36,80,,28.8,percent of total billed charges,80% of total billed charges,29.25,65,,23.4,percent of total billed charges,65% of total billed charges,16.05,35.67,,12.84,percent of total billed charges,35.67% of total billed charges,13.05,40.5,
CAPOTEN 25 MG TAB,2501585,CDM,250,RC,,,outpatient,,,9,3.60,,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,6.93,77,,5.54,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,7.38,82,,5.904,percent of total billed charges,82% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,8.1,90,,6.48,percent of total billed charges,90% of total billed charges,7.2,80,,5.76,percent of total billed charges,80% of total billed charges,8.1,90,,6.48,percent of total billed charges,90% of total billed charges,6.75,75,,5.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.61,29,,2.088,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,6.03,67,,4.824,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,7.2,80,,5.76,percent of total billed charges,80% of total billed charges,5.85,65,,4.68,percent of total billed charges,65% of total billed charges,3.21,35.67,,2.568,percent of total billed charges,35.67% of total billed charges,2.61,8.1,
CARAFATE 1 GM TAB,2501615,CDM,250,RC,,,outpatient,,,11,4.40,,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,8.47,77,,6.78,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,9.02,82,,7.216,percent of total billed charges,82% of total billed charges,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,9.9,90,,7.92,percent of total billed charges,90% of total billed charges,8.8,80,,7.04,percent of total billed charges,80% of total billed charges,9.9,90,,7.92,percent of total billed charges,90% of total billed charges,8.25,75,,6.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,3.19,29,,2.552,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,7.37,67,,5.896,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,8.8,80,,7.04,percent of total billed charges,80% of total billed charges,7.15,65,,5.72,percent of total billed charges,65% of total billed charges,3.92,35.67,,3.136,percent of total billed charges,35.67% of total billed charges,3.19,9.9,
CARAFATE 1 GRAM PER 10 ML UNIT,2501618,CDM,250,RC,,,outpatient,,,33,13.20,,28.05,85,,22.44,percent of total billed charges,85% of total billed charges,25.41,77,,20.33,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,27.06,82,,21.648,percent of total billed charges,82% of total billed charges,28.05,85,,22.44,percent of total billed charges,85% of total billed charges,28.05,85,,22.44,percent of total billed charges,85% of total billed charges,28.05,85,,22.44,percent of total billed charges,85% of total billed charges,29.7,90,,23.76,percent of total billed charges,90% of total billed charges,26.4,80,,21.12,percent of total billed charges,80% of total billed charges,29.7,90,,23.76,percent of total billed charges,90% of total billed charges,24.75,75,,19.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,9.57,29,,7.656,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,22.11,67,,17.688,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,26.4,80,,21.12,percent of total billed charges,80% of total billed charges,21.45,65,,17.16,percent of total billed charges,65% of total billed charges,11.77,35.67,,9.416,percent of total billed charges,35.67% of total billed charges,9.57,29.7,
CARDIZEM 50 MG/10 ML INJ.,2501646,CDM,250,RC,,,outpatient,,,22,8.80,,18.7,85,,14.96,percent of total billed charges,85% of total billed charges,16.94,77,,13.55,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,18.04,82,,14.432,percent of total billed charges,82% of total billed charges,18.7,85,,14.96,percent of total billed charges,85% of total billed charges,18.7,85,,14.96,percent of total billed charges,85% of total billed charges,18.7,85,,14.96,percent of total billed charges,85% of total billed charges,19.8,90,,15.84,percent of total billed charges,90% of total billed charges,17.6,80,,14.08,percent of total billed charges,80% of total billed charges,19.8,90,,15.84,percent of total billed charges,90% of total billed charges,16.5,75,,13.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,6.38,29,,5.104,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,14.74,67,,11.792,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,17.6,80,,14.08,percent of total billed charges,80% of total billed charges,14.3,65,,11.44,percent of total billed charges,65% of total billed charges,7.85,35.67,,6.28,percent of total billed charges,35.67% of total billed charges,6.38,19.8,
CARDIAZEM INJ 25 MG/5 ML,2501647,CDM,250,RC,,,outpatient,,,12,4.80,,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,9.24,77,,7.39,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,9.84,82,,7.872,percent of total billed charges,82% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,10.8,90,,8.64,percent of total billed charges,90% of total billed charges,9.6,80,,7.68,percent of total billed charges,80% of total billed charges,10.8,90,,8.64,percent of total billed charges,90% of total billed charges,9,75,,7.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,3.48,29,,2.784,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,8.04,67,,6.432,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,9.6,80,,7.68,percent of total billed charges,80% of total billed charges,7.8,65,,6.24,percent of total billed charges,65% of total billed charges,4.28,35.67,,3.424,percent of total billed charges,35.67% of total billed charges,3.48,10.8,
CARDIZEM 30 MG TAB,2501650,CDM,250,RC,,,outpatient,,,15,6.00,,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,11.55,77,,9.24,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,12.3,82,,9.84,percent of total billed charges,82% of total billed charges,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,13.5,90,,10.8,percent of total billed charges,90% of total billed charges,12,80,,9.6,percent of total billed charges,80% of total billed charges,13.5,90,,10.8,percent of total billed charges,90% of total billed charges,11.25,75,,9,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,4.35,29,,3.48,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,10.05,67,,8.04,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,12,80,,9.6,percent of total billed charges,80% of total billed charges,9.75,65,,7.8,percent of total billed charges,65% of total billed charges,5.35,35.67,,4.28,percent of total billed charges,35.67% of total billed charges,4.35,13.5,
CARDIZEM CD 120 MG CAP,2501665,CDM,250,RC,,,outpatient,,,19,7.60,,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,14.63,77,,11.7,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,15.58,82,,12.464,percent of total billed charges,82% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,15.2,80,,12.16,percent of total billed charges,80% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,14.25,75,,11.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,5.51,29,,4.408,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,12.73,67,,10.184,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,15.2,80,,12.16,percent of total billed charges,80% of total billed charges,12.35,65,,9.88,percent of total billed charges,65% of total billed charges,6.78,35.67,,5.424,percent of total billed charges,35.67% of total billed charges,5.51,17.1,
CARDURA 2 MG TAB,2501705,CDM,250,RC,,,outpatient,,,12,4.80,,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,9.24,77,,7.39,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,9.84,82,,7.872,percent of total billed charges,82% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,10.8,90,,8.64,percent of total billed charges,90% of total billed charges,9.6,80,,7.68,percent of total billed charges,80% of total billed charges,10.8,90,,8.64,percent of total billed charges,90% of total billed charges,9,75,,7.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,3.48,29,,2.784,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,8.04,67,,6.432,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,9.6,80,,7.68,percent of total billed charges,80% of total billed charges,7.8,65,,6.24,percent of total billed charges,65% of total billed charges,4.28,35.67,,3.424,percent of total billed charges,35.67% of total billed charges,3.48,10.8,
CARBOXYMETHYLCELLULOSE SODIUM,2501706,CDM,250,RC,,,outpatient,,,8,3.20,,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,6.16,77,,4.93,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,6.56,82,,5.248,percent of total billed charges,82% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,7.2,90,,5.76,percent of total billed charges,90% of total billed charges,6.4,80,,5.12,percent of total billed charges,80% of total billed charges,7.2,90,,5.76,percent of total billed charges,90% of total billed charges,6,75,,4.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.32,29,,1.856,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,5.36,67,,4.288,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,6.4,80,,5.12,percent of total billed charges,80% of total billed charges,5.2,65,,4.16,percent of total billed charges,65% of total billed charges,2.85,35.67,,2.28,percent of total billed charges,35.67% of total billed charges,2.32,7.2,
CARMEX OINTMENT,2501714,CDM,250,RC,,,outpatient,,,7,2.80,,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.39,77,,4.31,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,5.74,82,,4.592,percent of total billed charges,82% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.25,75,,4.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.03,29,,1.624,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4.69,67,,3.752,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,4.55,65,,3.64,percent of total billed charges,65% of total billed charges,2.5,35.67,,2,percent of total billed charges,35.67% of total billed charges,2.03,6.3,
CATAPRES/CLONIDINE  0.1 MG TAB,2501735,CDM,250,RC,,,outpatient,,,11,4.40,,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,8.47,77,,6.78,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,9.02,82,,7.216,percent of total billed charges,82% of total billed charges,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,9.9,90,,7.92,percent of total billed charges,90% of total billed charges,8.8,80,,7.04,percent of total billed charges,80% of total billed charges,9.9,90,,7.92,percent of total billed charges,90% of total billed charges,8.25,75,,6.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,3.19,29,,2.552,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,7.37,67,,5.896,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,8.8,80,,7.04,percent of total billed charges,80% of total billed charges,7.15,65,,5.72,percent of total billed charges,65% of total billed charges,3.92,35.67,,3.136,percent of total billed charges,35.67% of total billed charges,3.19,9.9,
CCH STOMACH MIX 30 ML BTL,2501738,CDM,250,RC,,,outpatient,,,25,10.00,,21.25,85,,17,percent of total billed charges,85% of total billed charges,19.25,77,,15.4,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,20.5,82,,16.4,percent of total billed charges,82% of total billed charges,21.25,85,,17,percent of total billed charges,85% of total billed charges,21.25,85,,17,percent of total billed charges,85% of total billed charges,21.25,85,,17,percent of total billed charges,85% of total billed charges,22.5,90,,18,percent of total billed charges,90% of total billed charges,20,80,,16,percent of total billed charges,80% of total billed charges,22.5,90,,18,percent of total billed charges,90% of total billed charges,18.75,75,,15,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,7.25,29,,5.8,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,16.75,67,,13.4,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,20,80,,16,percent of total billed charges,80% of total billed charges,16.25,65,,13,percent of total billed charges,65% of total billed charges,8.92,35.67,,7.136,percent of total billed charges,35.67% of total billed charges,7.25,22.5,
CATAPRES-TTS 1 PATCH,2501750,CDM,250,RC,,,outpatient,,,184,73.60,,156.4,85,,125.12,percent of total billed charges,85% of total billed charges,141.68,77,,113.34,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,150.88,82,,120.704,percent of total billed charges,82% of total billed charges,156.4,85,,125.12,percent of total billed charges,85% of total billed charges,156.4,85,,125.12,percent of total billed charges,85% of total billed charges,156.4,85,,125.12,percent of total billed charges,85% of total billed charges,165.6,90,,132.48,percent of total billed charges,90% of total billed charges,147.2,80,,117.76,percent of total billed charges,80% of total billed charges,165.6,90,,132.48,percent of total billed charges,90% of total billed charges,138,75,,110.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,53.36,29,,42.688,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,123.28,67,,98.624,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,147.2,80,,117.76,percent of total billed charges,80% of total billed charges,119.6,65,,95.68,percent of total billed charges,65% of total billed charges,65.63,35.67,,52.504,percent of total billed charges,35.67% of total billed charges,53.36,165.6,
CATAPRES-TTS 2 PATCH,2501755,CDM,250,RC,,,outpatient,,,306,122.40,,260.1,85,,208.08,percent of total billed charges,85% of total billed charges,235.62,77,,188.5,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,250.92,82,,200.736,percent of total billed charges,82% of total billed charges,260.1,85,,208.08,percent of total billed charges,85% of total billed charges,260.1,85,,208.08,percent of total billed charges,85% of total billed charges,260.1,85,,208.08,percent of total billed charges,85% of total billed charges,275.4,90,,220.32,percent of total billed charges,90% of total billed charges,244.8,80,,195.84,percent of total billed charges,80% of total billed charges,275.4,90,,220.32,percent of total billed charges,90% of total billed charges,229.5,75,,183.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,88.74,29,,70.992,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,205.02,67,,164.016,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,244.8,80,,195.84,percent of total billed charges,80% of total billed charges,198.9,65,,159.12,percent of total billed charges,65% of total billed charges,109.15,35.67,,87.32,percent of total billed charges,35.67% of total billed charges,88.74,275.4,
CATAPRES-TTS 3 PATCH,2501760,CDM,250,RC,,,outpatient,,,351,140.40,,298.35,85,,238.68,percent of total billed charges,85% of total billed charges,270.27,77,,216.22,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,287.82,82,,230.256,percent of total billed charges,82% of total billed charges,298.35,85,,238.68,percent of total billed charges,85% of total billed charges,298.35,85,,238.68,percent of total billed charges,85% of total billed charges,298.35,85,,238.68,percent of total billed charges,85% of total billed charges,315.9,90,,252.72,percent of total billed charges,90% of total billed charges,280.8,80,,224.64,percent of total billed charges,80% of total billed charges,315.9,90,,252.72,percent of total billed charges,90% of total billed charges,263.25,75,,210.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,101.79,29,,81.432,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,235.17,67,,188.136,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,280.8,80,,224.64,percent of total billed charges,80% of total billed charges,228.15,65,,182.52,percent of total billed charges,65% of total billed charges,125.2,35.67,,100.16,percent of total billed charges,35.67% of total billed charges,101.79,315.9,
CEFOTETAN IV ANTIBIOTIC,2501799,CDM,250,RC,,,outpatient,,,52,20.80,,44.2,85,,35.36,percent of total billed charges,85% of total billed charges,40.04,77,,32.03,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,42.64,82,,34.112,percent of total billed charges,82% of total billed charges,44.2,85,,35.36,percent of total billed charges,85% of total billed charges,44.2,85,,35.36,percent of total billed charges,85% of total billed charges,44.2,85,,35.36,percent of total billed charges,85% of total billed charges,46.8,90,,37.44,percent of total billed charges,90% of total billed charges,41.6,80,,33.28,percent of total billed charges,80% of total billed charges,46.8,90,,37.44,percent of total billed charges,90% of total billed charges,39,75,,31.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,15.08,29,,12.064,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,34.84,67,,27.872,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,41.6,80,,33.28,percent of total billed charges,80% of total billed charges,33.8,65,,27.04,percent of total billed charges,65% of total billed charges,18.55,35.67,,14.84,percent of total billed charges,35.67% of total billed charges,15.08,46.8,
CEFZIL 125MG/5CC 50 CC PO,2501810,CDM,250,RC,,,outpatient,,,79,31.60,,67.15,85,,53.72,percent of total billed charges,85% of total billed charges,60.83,77,,48.66,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,64.78,82,,51.824,percent of total billed charges,82% of total billed charges,67.15,85,,53.72,percent of total billed charges,85% of total billed charges,67.15,85,,53.72,percent of total billed charges,85% of total billed charges,67.15,85,,53.72,percent of total billed charges,85% of total billed charges,71.1,90,,56.88,percent of total billed charges,90% of total billed charges,63.2,80,,50.56,percent of total billed charges,80% of total billed charges,71.1,90,,56.88,percent of total billed charges,90% of total billed charges,59.25,75,,47.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,22.91,29,,18.328,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,52.93,67,,42.344,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,63.2,80,,50.56,percent of total billed charges,80% of total billed charges,51.35,65,,41.08,percent of total billed charges,65% of total billed charges,28.18,35.67,,22.544,percent of total billed charges,35.67% of total billed charges,22.91,71.1,
CELEXA 20 MG PO,2501846,CDM,250,RC,,,outpatient,,,24,9.60,,20.4,85,,16.32,percent of total billed charges,85% of total billed charges,18.48,77,,14.78,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,19.68,82,,15.744,percent of total billed charges,82% of total billed charges,20.4,85,,16.32,percent of total billed charges,85% of total billed charges,20.4,85,,16.32,percent of total billed charges,85% of total billed charges,20.4,85,,16.32,percent of total billed charges,85% of total billed charges,21.6,90,,17.28,percent of total billed charges,90% of total billed charges,19.2,80,,15.36,percent of total billed charges,80% of total billed charges,21.6,90,,17.28,percent of total billed charges,90% of total billed charges,18,75,,14.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,6.96,29,,5.568,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,16.08,67,,12.864,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,19.2,80,,15.36,percent of total billed charges,80% of total billed charges,15.6,65,,12.48,percent of total billed charges,65% of total billed charges,8.56,35.67,,6.848,percent of total billed charges,35.67% of total billed charges,6.96,21.6,
CERAVE MOISURIZING LOTION,2501848,CDM,250,RC,,,outpatient,,,22,8.80,,18.7,85,,14.96,percent of total billed charges,85% of total billed charges,16.94,77,,13.55,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,18.04,82,,14.432,percent of total billed charges,82% of total billed charges,18.7,85,,14.96,percent of total billed charges,85% of total billed charges,18.7,85,,14.96,percent of total billed charges,85% of total billed charges,18.7,85,,14.96,percent of total billed charges,85% of total billed charges,19.8,90,,15.84,percent of total billed charges,90% of total billed charges,17.6,80,,14.08,percent of total billed charges,80% of total billed charges,19.8,90,,15.84,percent of total billed charges,90% of total billed charges,16.5,75,,13.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,6.38,29,,5.104,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,14.74,67,,11.792,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,17.6,80,,14.08,percent of total billed charges,80% of total billed charges,14.3,65,,11.44,percent of total billed charges,65% of total billed charges,7.85,35.67,,6.28,percent of total billed charges,35.67% of total billed charges,6.38,19.8,
CEREFOLIN NAC CAPLET,2501868,CDM,250,RC,,,outpatient,,,17,6.80,,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,13.09,77,,10.47,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,13.94,82,,11.152,percent of total billed charges,82% of total billed charges,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,15.3,90,,12.24,percent of total billed charges,90% of total billed charges,13.6,80,,10.88,percent of total billed charges,80% of total billed charges,15.3,90,,12.24,percent of total billed charges,90% of total billed charges,12.75,75,,10.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,4.93,29,,3.944,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,11.39,67,,9.112,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,13.6,80,,10.88,percent of total billed charges,80% of total billed charges,11.05,65,,8.84,percent of total billed charges,65% of total billed charges,6.06,35.67,,4.848,percent of total billed charges,35.67% of total billed charges,4.93,15.3,
CEPASTAT LOZENGE,2501880,CDM,250,RC,,,outpatient,,,12,4.80,,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,9.24,77,,7.39,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,9.84,82,,7.872,percent of total billed charges,82% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,10.8,90,,8.64,percent of total billed charges,90% of total billed charges,9.6,80,,7.68,percent of total billed charges,80% of total billed charges,10.8,90,,8.64,percent of total billed charges,90% of total billed charges,9,75,,7.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,3.48,29,,2.784,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,8.04,67,,6.432,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,9.6,80,,7.68,percent of total billed charges,80% of total billed charges,7.8,65,,6.24,percent of total billed charges,65% of total billed charges,4.28,35.67,,3.424,percent of total billed charges,35.67% of total billed charges,3.48,10.8,
CERVIDIL 10 MG SUPP.,2501881,CDM,250,RC,,,outpatient,,,1232,492.80,,1047.2,85,,837.76,percent of total billed charges,85% of total billed charges,948.64,77,,758.91,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,1010.24,82,,808.192,percent of total billed charges,82% of total billed charges,1047.2,85,,837.76,percent of total billed charges,85% of total billed charges,1047.2,85,,837.76,percent of total billed charges,85% of total billed charges,1047.2,85,,837.76,percent of total billed charges,85% of total billed charges,1108.8,90,,887.04,percent of total billed charges,90% of total billed charges,985.6,80,,788.48,percent of total billed charges,80% of total billed charges,1108.8,90,,887.04,percent of total billed charges,90% of total billed charges,924,75,,739.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,357.28,29,,285.824,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,825.44,67,,660.352,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,985.6,80,,788.48,percent of total billed charges,80% of total billed charges,800.8,65,,640.64,percent of total billed charges,65% of total billed charges,439.45,35.67,,351.56,percent of total billed charges,35.67% of total billed charges,357.28,1108.8,
CETAPHIL LOTION 8 OZ,2501900,CDM,250,RC,,,outpatient,,,28,11.20,,23.8,85,,19.04,percent of total billed charges,85% of total billed charges,21.56,77,,17.25,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,22.96,82,,18.368,percent of total billed charges,82% of total billed charges,23.8,85,,19.04,percent of total billed charges,85% of total billed charges,23.8,85,,19.04,percent of total billed charges,85% of total billed charges,23.8,85,,19.04,percent of total billed charges,85% of total billed charges,25.2,90,,20.16,percent of total billed charges,90% of total billed charges,22.4,80,,17.92,percent of total billed charges,80% of total billed charges,25.2,90,,20.16,percent of total billed charges,90% of total billed charges,21,75,,16.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,8.12,29,,6.496,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,18.76,67,,15.008,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,22.4,80,,17.92,percent of total billed charges,80% of total billed charges,18.2,65,,14.56,percent of total billed charges,65% of total billed charges,9.99,35.67,,7.992,percent of total billed charges,35.67% of total billed charges,8.12,25.2,
MOTRIN INFANT DROPS 15 ML,2501912,CDM,250,RC,,,outpatient,,,22,8.80,,18.7,85,,14.96,percent of total billed charges,85% of total billed charges,16.94,77,,13.55,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,18.04,82,,14.432,percent of total billed charges,82% of total billed charges,18.7,85,,14.96,percent of total billed charges,85% of total billed charges,18.7,85,,14.96,percent of total billed charges,85% of total billed charges,18.7,85,,14.96,percent of total billed charges,85% of total billed charges,19.8,90,,15.84,percent of total billed charges,90% of total billed charges,17.6,80,,14.08,percent of total billed charges,80% of total billed charges,19.8,90,,15.84,percent of total billed charges,90% of total billed charges,16.5,75,,13.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,6.38,29,,5.104,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,14.74,67,,11.792,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,17.6,80,,14.08,percent of total billed charges,80% of total billed charges,14.3,65,,11.44,percent of total billed charges,65% of total billed charges,7.85,35.67,,6.28,percent of total billed charges,35.67% of total billed charges,6.38,19.8,
CIPRODEX OTIC SUSPENSION 7.5ML,2501914,CDM,250,RC,,,outpatient,,,707,282.80,,600.95,85,,480.76,percent of total billed charges,85% of total billed charges,544.39,77,,435.51,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,579.74,82,,463.792,percent of total billed charges,82% of total billed charges,600.95,85,,480.76,percent of total billed charges,85% of total billed charges,600.95,85,,480.76,percent of total billed charges,85% of total billed charges,600.95,85,,480.76,percent of total billed charges,85% of total billed charges,636.3,90,,509.04,percent of total billed charges,90% of total billed charges,565.6,80,,452.48,percent of total billed charges,80% of total billed charges,636.3,90,,509.04,percent of total billed charges,90% of total billed charges,530.25,75,,424.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,205.03,29,,164.024,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,473.69,67,,378.952,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,565.6,80,,452.48,percent of total billed charges,80% of total billed charges,459.55,65,,367.64,percent of total billed charges,65% of total billed charges,252.19,35.67,,201.752,percent of total billed charges,35.67% of total billed charges,205.03,636.3,
"MOTRIN, CHILDRENS 100MG/5ML DO",2501917,CDM,250,RC,,,outpatient,,,10,4.00,,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,7.7,77,,6.16,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,8.2,82,,6.56,percent of total billed charges,82% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,9,90,,7.2,percent of total billed charges,90% of total billed charges,8,80,,6.4,percent of total billed charges,80% of total billed charges,9,90,,7.2,percent of total billed charges,90% of total billed charges,7.5,75,,6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.9,29,,2.32,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,6.7,67,,5.36,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,8,80,,6.4,percent of total billed charges,80% of total billed charges,6.5,65,,5.2,percent of total billed charges,65% of total billed charges,3.57,35.67,,2.856,percent of total billed charges,35.67% of total billed charges,2.9,9,
MOUTH MIX 4 OZ BTL,2501922,CDM,250,RC,,,outpatient,,,133,53.20,,113.05,85,,90.44,percent of total billed charges,85% of total billed charges,102.41,77,,81.93,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,109.06,82,,87.248,percent of total billed charges,82% of total billed charges,113.05,85,,90.44,percent of total billed charges,85% of total billed charges,113.05,85,,90.44,percent of total billed charges,85% of total billed charges,113.05,85,,90.44,percent of total billed charges,85% of total billed charges,119.7,90,,95.76,percent of total billed charges,90% of total billed charges,106.4,80,,85.12,percent of total billed charges,80% of total billed charges,119.7,90,,95.76,percent of total billed charges,90% of total billed charges,99.75,75,,79.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,38.57,29,,30.856,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,89.11,67,,71.288,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,106.4,80,,85.12,percent of total billed charges,80% of total billed charges,86.45,65,,69.16,percent of total billed charges,65% of total billed charges,47.44,35.67,,37.952,percent of total billed charges,35.67% of total billed charges,38.57,119.7,
CHLOROSEPTIC THROAT SPRAY 20ML,2501936,CDM,250,RC,,,outpatient,,,10,4.00,,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,7.7,77,,6.16,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,8.2,82,,6.56,percent of total billed charges,82% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,9,90,,7.2,percent of total billed charges,90% of total billed charges,8,80,,6.4,percent of total billed charges,80% of total billed charges,9,90,,7.2,percent of total billed charges,90% of total billed charges,7.5,75,,6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.9,29,,2.32,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,6.7,67,,5.36,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,8,80,,6.4,percent of total billed charges,80% of total billed charges,6.5,65,,5.2,percent of total billed charges,65% of total billed charges,3.57,35.67,,2.856,percent of total billed charges,35.67% of total billed charges,2.9,9,
ZYRTEC 5 MG/5ML UDC,2501968,CDM,250,RC,,,outpatient,,,7,2.80,,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.39,77,,4.31,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,5.74,82,,4.592,percent of total billed charges,82% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.25,75,,4.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.03,29,,1.624,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4.69,67,,3.752,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,4.55,65,,3.64,percent of total billed charges,65% of total billed charges,2.5,35.67,,2,percent of total billed charges,35.67% of total billed charges,2.03,6.3,
CIPRO HC OTIS GTTS 10 ML,2502017,CDM,250,RC,,,outpatient,,,868,347.20,,737.8,85,,590.24,percent of total billed charges,85% of total billed charges,668.36,77,,534.69,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,711.76,82,,569.408,percent of total billed charges,82% of total billed charges,737.8,85,,590.24,percent of total billed charges,85% of total billed charges,737.8,85,,590.24,percent of total billed charges,85% of total billed charges,737.8,85,,590.24,percent of total billed charges,85% of total billed charges,781.2,90,,624.96,percent of total billed charges,90% of total billed charges,694.4,80,,555.52,percent of total billed charges,80% of total billed charges,781.2,90,,624.96,percent of total billed charges,90% of total billed charges,651,75,,520.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,251.72,29,,201.376,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,581.56,67,,465.248,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,694.4,80,,555.52,percent of total billed charges,80% of total billed charges,564.2,65,,451.36,percent of total billed charges,65% of total billed charges,309.62,35.67,,247.696,percent of total billed charges,35.67% of total billed charges,251.72,781.2,
CLEOCIN 150 MG CAP,2502095,CDM,250,RC,,,outpatient,,,20,8.00,,17,85,,13.6,percent of total billed charges,85% of total billed charges,15.4,77,,12.32,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,16.4,82,,13.12,percent of total billed charges,82% of total billed charges,17,85,,13.6,percent of total billed charges,85% of total billed charges,17,85,,13.6,percent of total billed charges,85% of total billed charges,17,85,,13.6,percent of total billed charges,85% of total billed charges,18,90,,14.4,percent of total billed charges,90% of total billed charges,16,80,,12.8,percent of total billed charges,80% of total billed charges,18,90,,14.4,percent of total billed charges,90% of total billed charges,15,75,,12,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,5.8,29,,4.64,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,13.4,67,,10.72,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,16,80,,12.8,percent of total billed charges,80% of total billed charges,13,65,,10.4,percent of total billed charges,65% of total billed charges,7.13,35.67,,5.704,percent of total billed charges,35.67% of total billed charges,5.8,18,
CLEOCIN 600 MG INJ,2502105,CDM,250,RC,S0077,HCPCS,outpatient,,,41,16.40,,34.85,85,,27.88,percent of total billed charges,85% of total billed charges,31.57,77,,25.26,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,3.31,385,,,fee schedule,385% of BCBS fee schedule,3.45,401,,,fee schedule,401% of BCBS fee schedule,3.45,401,,,fee schedule,401% of BCBS fee schedule,3.45,401,,,fee schedule,401% of BCBS fee schedule,36.9,90,,29.52,percent of total billed charges,90% of total billed charges,32.8,80,,26.24,percent of total billed charges,80% of total billed charges,36.9,90,,29.52,percent of total billed charges,90% of total billed charges,30.75,75,,24.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,11.89,29,,9.512,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,27.47,67,,21.976,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,32.8,80,,26.24,percent of total billed charges,80% of total billed charges,26.65,65,,21.32,percent of total billed charges,65% of total billed charges,14.62,35.67,,11.696,percent of total billed charges,35.67% of total billed charges,3.31,36.9,
CLEOCIN 900 MG INJ PREMIX,2502107,CDM,250,RC,S0077,HCPCS,outpatient,,,95,38.00,,80.75,85,,64.6,percent of total billed charges,85% of total billed charges,73.15,77,,58.52,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,3.31,385,,,fee schedule,385% of BCBS fee schedule,3.45,401,,,fee schedule,401% of BCBS fee schedule,3.45,401,,,fee schedule,401% of BCBS fee schedule,3.45,401,,,fee schedule,401% of BCBS fee schedule,85.5,90,,68.4,percent of total billed charges,90% of total billed charges,76,80,,60.8,percent of total billed charges,80% of total billed charges,85.5,90,,68.4,percent of total billed charges,90% of total billed charges,71.25,75,,57,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,27.55,29,,22.04,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,63.65,67,,50.92,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,76,80,,60.8,percent of total billed charges,80% of total billed charges,61.75,65,,49.4,percent of total billed charges,65% of total billed charges,33.89,35.67,,27.112,percent of total billed charges,35.67% of total billed charges,3.31,85.5,
CLEOCIN 300 MG PREMIX BAG,2502108,CDM,250,RC,,,outpatient,,,52,20.80,,44.2,85,,35.36,percent of total billed charges,85% of total billed charges,40.04,77,,32.03,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,42.64,82,,34.112,percent of total billed charges,82% of total billed charges,44.2,85,,35.36,percent of total billed charges,85% of total billed charges,44.2,85,,35.36,percent of total billed charges,85% of total billed charges,44.2,85,,35.36,percent of total billed charges,85% of total billed charges,46.8,90,,37.44,percent of total billed charges,90% of total billed charges,41.6,80,,33.28,percent of total billed charges,80% of total billed charges,46.8,90,,37.44,percent of total billed charges,90% of total billed charges,39,75,,31.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,15.08,29,,12.064,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,34.84,67,,27.872,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,41.6,80,,33.28,percent of total billed charges,80% of total billed charges,33.8,65,,27.04,percent of total billed charges,65% of total billed charges,18.55,35.67,,14.84,percent of total billed charges,35.67% of total billed charges,15.08,46.8,
CLEOCIN 600 MG PREMIX BAG,2502109,CDM,250,RC,,,outpatient,,,80,32.00,,68,85,,54.4,percent of total billed charges,85% of total billed charges,61.6,77,,49.28,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,65.6,82,,52.48,percent of total billed charges,82% of total billed charges,68,85,,54.4,percent of total billed charges,85% of total billed charges,68,85,,54.4,percent of total billed charges,85% of total billed charges,68,85,,54.4,percent of total billed charges,85% of total billed charges,72,90,,57.6,percent of total billed charges,90% of total billed charges,64,80,,51.2,percent of total billed charges,80% of total billed charges,72,90,,57.6,percent of total billed charges,90% of total billed charges,60,75,,48,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,23.2,29,,18.56,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,53.6,67,,42.88,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,64,80,,51.2,percent of total billed charges,80% of total billed charges,52,65,,41.6,percent of total billed charges,65% of total billed charges,28.54,35.67,,22.832,percent of total billed charges,35.67% of total billed charges,23.2,72,
CLEOCIN 300 MG VIAL,2502111,CDM,250,RC,,,outpatient,,,17,6.80,,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,13.09,77,,10.47,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,13.94,82,,11.152,percent of total billed charges,82% of total billed charges,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,15.3,90,,12.24,percent of total billed charges,90% of total billed charges,13.6,80,,10.88,percent of total billed charges,80% of total billed charges,15.3,90,,12.24,percent of total billed charges,90% of total billed charges,12.75,75,,10.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,4.93,29,,3.944,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,11.39,67,,9.112,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,13.6,80,,10.88,percent of total billed charges,80% of total billed charges,11.05,65,,8.84,percent of total billed charges,65% of total billed charges,6.06,35.67,,4.848,percent of total billed charges,35.67% of total billed charges,4.93,15.3,
CLEOCIN 900 MG INJ,2502120,CDM,250,RC,,,outpatient,,,82,32.80,,69.7,85,,55.76,percent of total billed charges,85% of total billed charges,63.14,77,,50.51,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,67.24,82,,53.792,percent of total billed charges,82% of total billed charges,69.7,85,,55.76,percent of total billed charges,85% of total billed charges,69.7,85,,55.76,percent of total billed charges,85% of total billed charges,69.7,85,,55.76,percent of total billed charges,85% of total billed charges,73.8,90,,59.04,percent of total billed charges,90% of total billed charges,65.6,80,,52.48,percent of total billed charges,80% of total billed charges,73.8,90,,59.04,percent of total billed charges,90% of total billed charges,61.5,75,,49.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,23.78,29,,19.024,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,54.94,67,,43.952,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,65.6,80,,52.48,percent of total billed charges,80% of total billed charges,53.3,65,,42.64,percent of total billed charges,65% of total billed charges,29.25,35.67,,23.4,percent of total billed charges,35.67% of total billed charges,23.78,73.8,
CLEOCIN VAG CREAM,2502125,CDM,250,RC,,,outpatient,,,329,131.60,,279.65,85,,223.72,percent of total billed charges,85% of total billed charges,253.33,77,,202.66,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,269.78,82,,215.824,percent of total billed charges,82% of total billed charges,279.65,85,,223.72,percent of total billed charges,85% of total billed charges,279.65,85,,223.72,percent of total billed charges,85% of total billed charges,279.65,85,,223.72,percent of total billed charges,85% of total billed charges,296.1,90,,236.88,percent of total billed charges,90% of total billed charges,263.2,80,,210.56,percent of total billed charges,80% of total billed charges,296.1,90,,236.88,percent of total billed charges,90% of total billed charges,246.75,75,,197.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,95.41,29,,76.328,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,220.43,67,,176.344,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,263.2,80,,210.56,percent of total billed charges,80% of total billed charges,213.85,65,,171.08,percent of total billed charges,65% of total billed charges,117.35,35.67,,93.88,percent of total billed charges,35.67% of total billed charges,95.41,296.1,
CLINIMIX E 4.25/5 1000ML BAG,2502128,CDM,250,RC,,,outpatient,,,400,160.00,,340,85,,272,percent of total billed charges,85% of total billed charges,308,77,,246.4,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,328,82,,262.4,percent of total billed charges,82% of total billed charges,340,85,,272,percent of total billed charges,85% of total billed charges,340,85,,272,percent of total billed charges,85% of total billed charges,340,85,,272,percent of total billed charges,85% of total billed charges,360,90,,288,percent of total billed charges,90% of total billed charges,320,80,,256,percent of total billed charges,80% of total billed charges,360,90,,288,percent of total billed charges,90% of total billed charges,300,75,,240,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,116,29,,92.8,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,268,67,,214.4,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,320,80,,256,percent of total billed charges,80% of total billed charges,260,65,,208,percent of total billed charges,65% of total billed charges,142.68,35.67,,114.144,percent of total billed charges,35.67% of total billed charges,116,360,
CLINIMIX E 4.25%-5% 2000 ML,2502129,CDM,250,RC,,,outpatient,,,561,224.40,,476.85,85,,381.48,percent of total billed charges,85% of total billed charges,431.97,77,,345.58,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,460.02,82,,368.016,percent of total billed charges,82% of total billed charges,476.85,85,,381.48,percent of total billed charges,85% of total billed charges,476.85,85,,381.48,percent of total billed charges,85% of total billed charges,476.85,85,,381.48,percent of total billed charges,85% of total billed charges,504.9,90,,403.92,percent of total billed charges,90% of total billed charges,448.8,80,,359.04,percent of total billed charges,80% of total billed charges,504.9,90,,403.92,percent of total billed charges,90% of total billed charges,420.75,75,,336.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,162.69,29,,130.152,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,375.87,67,,300.696,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,448.8,80,,359.04,percent of total billed charges,80% of total billed charges,364.65,65,,291.72,percent of total billed charges,65% of total billed charges,200.11,35.67,,160.088,percent of total billed charges,35.67% of total billed charges,162.69,504.9,
CLINIMIX E 4.25/25 CENT LINE,2502130,CDM,250,RC,,,outpatient,,,555,222.00,,471.75,85,,377.4,percent of total billed charges,85% of total billed charges,427.35,77,,341.88,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,455.1,82,,364.08,percent of total billed charges,82% of total billed charges,471.75,85,,377.4,percent of total billed charges,85% of total billed charges,471.75,85,,377.4,percent of total billed charges,85% of total billed charges,471.75,85,,377.4,percent of total billed charges,85% of total billed charges,499.5,90,,399.6,percent of total billed charges,90% of total billed charges,444,80,,355.2,percent of total billed charges,80% of total billed charges,499.5,90,,399.6,percent of total billed charges,90% of total billed charges,416.25,75,,333,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,160.95,29,,128.76,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,371.85,67,,297.48,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,444,80,,355.2,percent of total billed charges,80% of total billed charges,360.75,65,,288.6,percent of total billed charges,65% of total billed charges,197.97,35.67,,158.376,percent of total billed charges,35.67% of total billed charges,160.95,499.5,
COENZYME Q10 PO,2502168,CDM,250,RC,,,outpatient,,,7,2.80,,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.39,77,,4.31,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,5.74,82,,4.592,percent of total billed charges,82% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.25,75,,4.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.03,29,,1.624,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4.69,67,,3.752,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,4.55,65,,3.64,percent of total billed charges,65% of total billed charges,2.5,35.67,,2,percent of total billed charges,35.67% of total billed charges,2.03,6.3,
COGENTIN 1 MG TAB,2502175,CDM,250,RC,,,outpatient,,,19,7.60,,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,14.63,77,,11.7,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,15.58,82,,12.464,percent of total billed charges,82% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,15.2,80,,12.16,percent of total billed charges,80% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,14.25,75,,11.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,5.51,29,,4.408,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,12.73,67,,10.184,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,15.2,80,,12.16,percent of total billed charges,80% of total billed charges,12.35,65,,9.88,percent of total billed charges,65% of total billed charges,6.78,35.67,,5.424,percent of total billed charges,35.67% of total billed charges,5.51,17.1,
COLACE 100 MG CAP,2502200,CDM,250,RC,,,outpatient,,,7,2.80,,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.39,77,,4.31,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,5.74,82,,4.592,percent of total billed charges,82% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.25,75,,4.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.03,29,,1.624,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4.69,67,,3.752,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,4.55,65,,3.64,percent of total billed charges,65% of total billed charges,2.5,35.67,,2,percent of total billed charges,35.67% of total billed charges,2.03,6.3,
COLCHICINE 0.6 MG TAB,2502221,CDM,250,RC,,,outpatient,,,27,10.80,,22.95,85,,18.36,percent of total billed charges,85% of total billed charges,20.79,77,,16.63,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,22.14,82,,17.712,percent of total billed charges,82% of total billed charges,22.95,85,,18.36,percent of total billed charges,85% of total billed charges,22.95,85,,18.36,percent of total billed charges,85% of total billed charges,22.95,85,,18.36,percent of total billed charges,85% of total billed charges,24.3,90,,19.44,percent of total billed charges,90% of total billed charges,21.6,80,,17.28,percent of total billed charges,80% of total billed charges,24.3,90,,19.44,percent of total billed charges,90% of total billed charges,20.25,75,,16.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,7.83,29,,6.264,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,18.09,67,,14.472,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,21.6,80,,17.28,percent of total billed charges,80% of total billed charges,17.55,65,,14.04,percent of total billed charges,65% of total billed charges,9.63,35.67,,7.704,percent of total billed charges,35.67% of total billed charges,7.83,24.3,
DEXMEDTOMIDINE IN NS 20 ML,2502224,CDM,250,RC,,,outpatient,,,56,22.40,,47.6,85,,38.08,percent of total billed charges,85% of total billed charges,43.12,77,,34.5,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,45.92,82,,36.736,percent of total billed charges,82% of total billed charges,47.6,85,,38.08,percent of total billed charges,85% of total billed charges,47.6,85,,38.08,percent of total billed charges,85% of total billed charges,47.6,85,,38.08,percent of total billed charges,85% of total billed charges,50.4,90,,40.32,percent of total billed charges,90% of total billed charges,44.8,80,,35.84,percent of total billed charges,80% of total billed charges,50.4,90,,40.32,percent of total billed charges,90% of total billed charges,42,75,,33.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,16.24,29,,12.992,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,37.52,67,,30.016,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,44.8,80,,35.84,percent of total billed charges,80% of total billed charges,36.4,65,,29.12,percent of total billed charges,65% of total billed charges,19.98,35.67,,15.984,percent of total billed charges,35.67% of total billed charges,16.24,50.4,
COMBIVENT RESPIMAT,2502241,CDM,250,RC,,,outpatient,,,614,245.60,,521.9,85,,417.52,percent of total billed charges,85% of total billed charges,472.78,77,,378.22,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,503.48,82,,402.784,percent of total billed charges,82% of total billed charges,521.9,85,,417.52,percent of total billed charges,85% of total billed charges,521.9,85,,417.52,percent of total billed charges,85% of total billed charges,521.9,85,,417.52,percent of total billed charges,85% of total billed charges,552.6,90,,442.08,percent of total billed charges,90% of total billed charges,491.2,80,,392.96,percent of total billed charges,80% of total billed charges,552.6,90,,442.08,percent of total billed charges,90% of total billed charges,460.5,75,,368.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,178.06,29,,142.448,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,411.38,67,,329.104,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,491.2,80,,392.96,percent of total billed charges,80% of total billed charges,399.1,65,,319.28,percent of total billed charges,65% of total billed charges,219.01,35.67,,175.208,percent of total billed charges,35.67% of total billed charges,178.06,552.6,
COMTAN 200 MG PO,2502272,CDM,250,RC,,,outpatient,,,22,8.80,,18.7,85,,14.96,percent of total billed charges,85% of total billed charges,16.94,77,,13.55,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,18.04,82,,14.432,percent of total billed charges,82% of total billed charges,18.7,85,,14.96,percent of total billed charges,85% of total billed charges,18.7,85,,14.96,percent of total billed charges,85% of total billed charges,18.7,85,,14.96,percent of total billed charges,85% of total billed charges,19.8,90,,15.84,percent of total billed charges,90% of total billed charges,17.6,80,,14.08,percent of total billed charges,80% of total billed charges,19.8,90,,15.84,percent of total billed charges,90% of total billed charges,16.5,75,,13.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,6.38,29,,5.104,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,14.74,67,,11.792,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,17.6,80,,14.08,percent of total billed charges,80% of total billed charges,14.3,65,,11.44,percent of total billed charges,65% of total billed charges,7.85,35.67,,6.28,percent of total billed charges,35.67% of total billed charges,6.38,19.8,
CONSTULOSE 10 GM/30ML,2502284,CDM,250,RC,,,outpatient,,,8,3.20,,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,6.16,77,,4.93,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,6.56,82,,5.248,percent of total billed charges,82% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,7.2,90,,5.76,percent of total billed charges,90% of total billed charges,6.4,80,,5.12,percent of total billed charges,80% of total billed charges,7.2,90,,5.76,percent of total billed charges,90% of total billed charges,6,75,,4.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.32,29,,1.856,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,5.36,67,,4.288,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,6.4,80,,5.12,percent of total billed charges,80% of total billed charges,5.2,65,,4.16,percent of total billed charges,65% of total billed charges,2.85,35.67,,2.28,percent of total billed charges,35.67% of total billed charges,2.32,7.2,
CORDARONE 200 MG TABS,2502290,CDM,250,RC,,,outpatient,,,15,6.00,,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,11.55,77,,9.24,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,12.3,82,,9.84,percent of total billed charges,82% of total billed charges,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,13.5,90,,10.8,percent of total billed charges,90% of total billed charges,12,80,,9.6,percent of total billed charges,80% of total billed charges,13.5,90,,10.8,percent of total billed charges,90% of total billed charges,11.25,75,,9,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,4.35,29,,3.48,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,10.05,67,,8.04,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,12,80,,9.6,percent of total billed charges,80% of total billed charges,9.75,65,,7.8,percent of total billed charges,65% of total billed charges,5.35,35.67,,4.28,percent of total billed charges,35.67% of total billed charges,4.35,13.5,
COREG 3.125 MG PO,2502311,CDM,250,RC,,,outpatient,,,14,5.60,,11.9,85,,9.52,percent of total billed charges,85% of total billed charges,10.78,77,,8.62,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,11.48,82,,9.184,percent of total billed charges,82% of total billed charges,11.9,85,,9.52,percent of total billed charges,85% of total billed charges,11.9,85,,9.52,percent of total billed charges,85% of total billed charges,11.9,85,,9.52,percent of total billed charges,85% of total billed charges,12.6,90,,10.08,percent of total billed charges,90% of total billed charges,11.2,80,,8.96,percent of total billed charges,80% of total billed charges,12.6,90,,10.08,percent of total billed charges,90% of total billed charges,10.5,75,,8.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,4.06,29,,3.248,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,9.38,67,,7.504,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,11.2,80,,8.96,percent of total billed charges,80% of total billed charges,9.1,65,,7.28,percent of total billed charges,65% of total billed charges,4.99,35.67,,3.992,percent of total billed charges,35.67% of total billed charges,4.06,12.6,
COREG 25 MG TAB,2502314,CDM,250,RC,,,outpatient,,,13,5.20,,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,10.01,77,,8.01,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,10.66,82,,8.528,percent of total billed charges,82% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,11.7,90,,9.36,percent of total billed charges,90% of total billed charges,10.4,80,,8.32,percent of total billed charges,80% of total billed charges,11.7,90,,9.36,percent of total billed charges,90% of total billed charges,9.75,75,,7.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,3.77,29,,3.016,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,8.71,67,,6.968,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,10.4,80,,8.32,percent of total billed charges,80% of total billed charges,8.45,65,,6.76,percent of total billed charges,65% of total billed charges,4.64,35.67,,3.712,percent of total billed charges,35.67% of total billed charges,3.77,11.7,
CORGARD 40 MG TAB,2502335,CDM,250,RC,,,outpatient,,,28,11.20,,23.8,85,,19.04,percent of total billed charges,85% of total billed charges,21.56,77,,17.25,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,22.96,82,,18.368,percent of total billed charges,82% of total billed charges,23.8,85,,19.04,percent of total billed charges,85% of total billed charges,23.8,85,,19.04,percent of total billed charges,85% of total billed charges,23.8,85,,19.04,percent of total billed charges,85% of total billed charges,25.2,90,,20.16,percent of total billed charges,90% of total billed charges,22.4,80,,17.92,percent of total billed charges,80% of total billed charges,25.2,90,,20.16,percent of total billed charges,90% of total billed charges,21,75,,16.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,8.12,29,,6.496,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,18.76,67,,15.008,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,22.4,80,,17.92,percent of total billed charges,80% of total billed charges,18.2,65,,14.56,percent of total billed charges,65% of total billed charges,9.99,35.67,,7.992,percent of total billed charges,35.67% of total billed charges,8.12,25.2,
CORTEF 10 MG TAB PO,2502359,CDM,250,RC,,,outpatient,,,7,2.80,,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.39,77,,4.31,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,5.74,82,,4.592,percent of total billed charges,82% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.25,75,,4.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.03,29,,1.624,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4.69,67,,3.752,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,4.55,65,,3.64,percent of total billed charges,65% of total billed charges,2.5,35.67,,2,percent of total billed charges,35.67% of total billed charges,2.03,6.3,
CORTISPORIN OPTH OINTMENT,2502375,CDM,250,RC,,,outpatient,,,218,87.20,,185.3,85,,148.24,percent of total billed charges,85% of total billed charges,167.86,77,,134.29,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,178.76,82,,143.008,percent of total billed charges,82% of total billed charges,185.3,85,,148.24,percent of total billed charges,85% of total billed charges,185.3,85,,148.24,percent of total billed charges,85% of total billed charges,185.3,85,,148.24,percent of total billed charges,85% of total billed charges,196.2,90,,156.96,percent of total billed charges,90% of total billed charges,174.4,80,,139.52,percent of total billed charges,80% of total billed charges,196.2,90,,156.96,percent of total billed charges,90% of total billed charges,163.5,75,,130.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,63.22,29,,50.576,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,146.06,67,,116.848,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,174.4,80,,139.52,percent of total billed charges,80% of total billed charges,141.7,65,,113.36,percent of total billed charges,65% of total billed charges,77.76,35.67,,62.208,percent of total billed charges,35.67% of total billed charges,63.22,196.2,
CORTISPORIN OPTH SUSPENSION,2502380,CDM,250,RC,,,outpatient,,,386,154.40,,328.1,85,,262.48,percent of total billed charges,85% of total billed charges,297.22,77,,237.78,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,316.52,82,,253.216,percent of total billed charges,82% of total billed charges,328.1,85,,262.48,percent of total billed charges,85% of total billed charges,328.1,85,,262.48,percent of total billed charges,85% of total billed charges,328.1,85,,262.48,percent of total billed charges,85% of total billed charges,347.4,90,,277.92,percent of total billed charges,90% of total billed charges,308.8,80,,247.04,percent of total billed charges,80% of total billed charges,347.4,90,,277.92,percent of total billed charges,90% of total billed charges,289.5,75,,231.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,111.94,29,,89.552,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,258.62,67,,206.896,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,308.8,80,,247.04,percent of total billed charges,80% of total billed charges,250.9,65,,200.72,percent of total billed charges,65% of total billed charges,137.69,35.67,,110.152,percent of total billed charges,35.67% of total billed charges,111.94,347.4,
CORTISPORIN OTIC SOLUTION,2502385,CDM,250,RC,,,outpatient,,,334,133.60,,283.9,85,,227.12,percent of total billed charges,85% of total billed charges,257.18,77,,205.74,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,273.88,82,,219.104,percent of total billed charges,82% of total billed charges,283.9,85,,227.12,percent of total billed charges,85% of total billed charges,283.9,85,,227.12,percent of total billed charges,85% of total billed charges,283.9,85,,227.12,percent of total billed charges,85% of total billed charges,300.6,90,,240.48,percent of total billed charges,90% of total billed charges,267.2,80,,213.76,percent of total billed charges,80% of total billed charges,300.6,90,,240.48,percent of total billed charges,90% of total billed charges,250.5,75,,200.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,96.86,29,,77.488,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,223.78,67,,179.024,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,267.2,80,,213.76,percent of total billed charges,80% of total billed charges,217.1,65,,173.68,percent of total billed charges,65% of total billed charges,119.14,35.67,,95.312,percent of total billed charges,35.67% of total billed charges,96.86,300.6,
CORTISPORIN OTIC SUSPENSION,2502390,CDM,250,RC,,,outpatient,,,308,123.20,,261.8,85,,209.44,percent of total billed charges,85% of total billed charges,237.16,77,,189.73,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,252.56,82,,202.048,percent of total billed charges,82% of total billed charges,261.8,85,,209.44,percent of total billed charges,85% of total billed charges,261.8,85,,209.44,percent of total billed charges,85% of total billed charges,261.8,85,,209.44,percent of total billed charges,85% of total billed charges,277.2,90,,221.76,percent of total billed charges,90% of total billed charges,246.4,80,,197.12,percent of total billed charges,80% of total billed charges,277.2,90,,221.76,percent of total billed charges,90% of total billed charges,231,75,,184.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,89.32,29,,71.456,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,206.36,67,,165.088,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,246.4,80,,197.12,percent of total billed charges,80% of total billed charges,200.2,65,,160.16,percent of total billed charges,65% of total billed charges,109.86,35.67,,87.888,percent of total billed charges,35.67% of total billed charges,89.32,277.2,
COSOPT 10ML BOTTLE EYE DROPS,2502407,CDM,250,RC,,,outpatient,,,414,165.60,,351.9,85,,281.52,percent of total billed charges,85% of total billed charges,318.78,77,,255.02,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,339.48,82,,271.584,percent of total billed charges,82% of total billed charges,351.9,85,,281.52,percent of total billed charges,85% of total billed charges,351.9,85,,281.52,percent of total billed charges,85% of total billed charges,351.9,85,,281.52,percent of total billed charges,85% of total billed charges,372.6,90,,298.08,percent of total billed charges,90% of total billed charges,331.2,80,,264.96,percent of total billed charges,80% of total billed charges,372.6,90,,298.08,percent of total billed charges,90% of total billed charges,310.5,75,,248.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,120.06,29,,96.048,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,277.38,67,,221.904,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,331.2,80,,264.96,percent of total billed charges,80% of total billed charges,269.1,65,,215.28,percent of total billed charges,65% of total billed charges,147.67,35.67,,118.136,percent of total billed charges,35.67% of total billed charges,120.06,372.6,
COUMADIN 1 MG TAB PO,2502409,CDM,250,RC,,,outpatient,,,9,3.60,,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,6.93,77,,5.54,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,7.38,82,,5.904,percent of total billed charges,82% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,8.1,90,,6.48,percent of total billed charges,90% of total billed charges,7.2,80,,5.76,percent of total billed charges,80% of total billed charges,8.1,90,,6.48,percent of total billed charges,90% of total billed charges,6.75,75,,5.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.61,29,,2.088,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,6.03,67,,4.824,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,7.2,80,,5.76,percent of total billed charges,80% of total billed charges,5.85,65,,4.68,percent of total billed charges,65% of total billed charges,3.21,35.67,,2.568,percent of total billed charges,35.67% of total billed charges,2.61,8.1,
COUMADIN 2.5 MG TAB,2502425,CDM,250,RC,,,outpatient,,,10,4.00,,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,7.7,77,,6.16,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,8.2,82,,6.56,percent of total billed charges,82% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,9,90,,7.2,percent of total billed charges,90% of total billed charges,8,80,,6.4,percent of total billed charges,80% of total billed charges,9,90,,7.2,percent of total billed charges,90% of total billed charges,7.5,75,,6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.9,29,,2.32,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,6.7,67,,5.36,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,8,80,,6.4,percent of total billed charges,80% of total billed charges,6.5,65,,5.2,percent of total billed charges,65% of total billed charges,3.57,35.67,,2.856,percent of total billed charges,35.67% of total billed charges,2.9,9,
COUMADIN 5 MG TAB,2502435,CDM,250,RC,,,outpatient,,,12,4.80,,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,9.24,77,,7.39,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,9.84,82,,7.872,percent of total billed charges,82% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,10.8,90,,8.64,percent of total billed charges,90% of total billed charges,9.6,80,,7.68,percent of total billed charges,80% of total billed charges,10.8,90,,8.64,percent of total billed charges,90% of total billed charges,9,75,,7.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,3.48,29,,2.784,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,8.04,67,,6.432,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,9.6,80,,7.68,percent of total billed charges,80% of total billed charges,7.8,65,,6.24,percent of total billed charges,65% of total billed charges,4.28,35.67,,3.424,percent of total billed charges,35.67% of total billed charges,3.48,10.8,
COZAAR 25 MG TAB,2502446,CDM,250,RC,,,outpatient,,,15,6.00,,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,11.55,77,,9.24,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,12.3,82,,9.84,percent of total billed charges,82% of total billed charges,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,13.5,90,,10.8,percent of total billed charges,90% of total billed charges,12,80,,9.6,percent of total billed charges,80% of total billed charges,13.5,90,,10.8,percent of total billed charges,90% of total billed charges,11.25,75,,9,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,4.35,29,,3.48,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,10.05,67,,8.04,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,12,80,,9.6,percent of total billed charges,80% of total billed charges,9.75,65,,7.8,percent of total billed charges,65% of total billed charges,5.35,35.67,,4.28,percent of total billed charges,35.67% of total billed charges,4.35,13.5,
CYANIDE ANTIDOTE KIT PO,2502454,CDM,250,RC,,,outpatient,,,1554,621.60,,1320.9,85,,1056.72,percent of total billed charges,85% of total billed charges,1196.58,77,,957.26,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,1274.28,82,,1019.424,percent of total billed charges,82% of total billed charges,1320.9,85,,1056.72,percent of total billed charges,85% of total billed charges,1320.9,85,,1056.72,percent of total billed charges,85% of total billed charges,1320.9,85,,1056.72,percent of total billed charges,85% of total billed charges,1398.6,90,,1118.88,percent of total billed charges,90% of total billed charges,1243.2,80,,994.56,percent of total billed charges,80% of total billed charges,1398.6,90,,1118.88,percent of total billed charges,90% of total billed charges,1165.5,75,,932.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,450.66,29,,360.528,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1041.18,67,,832.944,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1243.2,80,,994.56,percent of total billed charges,80% of total billed charges,1010.1,65,,808.08,percent of total billed charges,65% of total billed charges,554.31,35.67,,443.448,percent of total billed charges,35.67% of total billed charges,450.66,1398.6,
CYCLOGYL 1% 2 ML OPTH GTTS,2502459,CDM,250,RC,,,outpatient,,,61,24.40,,51.85,85,,41.48,percent of total billed charges,85% of total billed charges,46.97,77,,37.58,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,50.02,82,,40.016,percent of total billed charges,82% of total billed charges,51.85,85,,41.48,percent of total billed charges,85% of total billed charges,51.85,85,,41.48,percent of total billed charges,85% of total billed charges,51.85,85,,41.48,percent of total billed charges,85% of total billed charges,54.9,90,,43.92,percent of total billed charges,90% of total billed charges,48.8,80,,39.04,percent of total billed charges,80% of total billed charges,54.9,90,,43.92,percent of total billed charges,90% of total billed charges,45.75,75,,36.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,17.69,29,,14.152,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,40.87,67,,32.696,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,48.8,80,,39.04,percent of total billed charges,80% of total billed charges,39.65,65,,31.72,percent of total billed charges,65% of total billed charges,21.76,35.67,,17.408,percent of total billed charges,35.67% of total billed charges,17.69,54.9,
CYCLOGYL OPTH DROPS 1% 5 ML,2502460,CDM,250,RC,,,outpatient,,,186,74.40,,158.1,85,,126.48,percent of total billed charges,85% of total billed charges,143.22,77,,114.58,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,152.52,82,,122.016,percent of total billed charges,82% of total billed charges,158.1,85,,126.48,percent of total billed charges,85% of total billed charges,158.1,85,,126.48,percent of total billed charges,85% of total billed charges,158.1,85,,126.48,percent of total billed charges,85% of total billed charges,167.4,90,,133.92,percent of total billed charges,90% of total billed charges,148.8,80,,119.04,percent of total billed charges,80% of total billed charges,167.4,90,,133.92,percent of total billed charges,90% of total billed charges,139.5,75,,111.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,53.94,29,,43.152,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,124.62,67,,99.696,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,148.8,80,,119.04,percent of total billed charges,80% of total billed charges,120.9,65,,96.72,percent of total billed charges,65% of total billed charges,66.35,35.67,,53.08,percent of total billed charges,35.67% of total billed charges,53.94,167.4,
CUROSURF PER 3 ML VIAL,2502467,CDM,250,RC,,,outpatient,,,1791,716.40,,1522.35,85,,1217.88,percent of total billed charges,85% of total billed charges,1379.07,77,,1103.26,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,1468.62,82,,1174.896,percent of total billed charges,82% of total billed charges,1522.35,85,,1217.88,percent of total billed charges,85% of total billed charges,1522.35,85,,1217.88,percent of total billed charges,85% of total billed charges,1522.35,85,,1217.88,percent of total billed charges,85% of total billed charges,1611.9,90,,1289.52,percent of total billed charges,90% of total billed charges,1432.8,80,,1146.24,percent of total billed charges,80% of total billed charges,1611.9,90,,1289.52,percent of total billed charges,90% of total billed charges,1343.25,75,,1074.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,519.39,29,,415.512,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1199.97,67,,959.976,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1432.8,80,,1146.24,percent of total billed charges,80% of total billed charges,1164.15,65,,931.32,percent of total billed charges,65% of total billed charges,638.85,35.67,,511.08,percent of total billed charges,35.67% of total billed charges,519.39,1611.9,
"CREON 6,000 UNITS CAPSULE",2502471,CDM,250,RC,,,outpatient,,,9,3.60,,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,6.93,77,,5.54,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,7.38,82,,5.904,percent of total billed charges,82% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,8.1,90,,6.48,percent of total billed charges,90% of total billed charges,7.2,80,,5.76,percent of total billed charges,80% of total billed charges,8.1,90,,6.48,percent of total billed charges,90% of total billed charges,6.75,75,,5.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.61,29,,2.088,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,6.03,67,,4.824,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,7.2,80,,5.76,percent of total billed charges,80% of total billed charges,5.85,65,,4.68,percent of total billed charges,65% of total billed charges,3.21,35.67,,2.568,percent of total billed charges,35.67% of total billed charges,2.61,8.1,
CYMBALTA HCL 30 MG,2502477,CDM,250,RC,,,outpatient,,,33,13.20,,28.05,85,,22.44,percent of total billed charges,85% of total billed charges,25.41,77,,20.33,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,27.06,82,,21.648,percent of total billed charges,82% of total billed charges,28.05,85,,22.44,percent of total billed charges,85% of total billed charges,28.05,85,,22.44,percent of total billed charges,85% of total billed charges,28.05,85,,22.44,percent of total billed charges,85% of total billed charges,29.7,90,,23.76,percent of total billed charges,90% of total billed charges,26.4,80,,21.12,percent of total billed charges,80% of total billed charges,29.7,90,,23.76,percent of total billed charges,90% of total billed charges,24.75,75,,19.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,9.57,29,,7.656,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,22.11,67,,17.688,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,26.4,80,,21.12,percent of total billed charges,80% of total billed charges,21.45,65,,17.16,percent of total billed charges,65% of total billed charges,11.77,35.67,,9.416,percent of total billed charges,35.67% of total billed charges,9.57,29.7,
CYTOTEC 100 MCG TAB,2502500,CDM,250,RC,,,outpatient,,,13,5.20,,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,10.01,77,,8.01,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,10.66,82,,8.528,percent of total billed charges,82% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,11.7,90,,9.36,percent of total billed charges,90% of total billed charges,10.4,80,,8.32,percent of total billed charges,80% of total billed charges,11.7,90,,9.36,percent of total billed charges,90% of total billed charges,9.75,75,,7.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,3.77,29,,3.016,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,8.71,67,,6.968,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,10.4,80,,8.32,percent of total billed charges,80% of total billed charges,8.45,65,,6.76,percent of total billed charges,65% of total billed charges,4.64,35.67,,3.712,percent of total billed charges,35.67% of total billed charges,3.77,11.7,
DACRIOSE SOL. 120 ML,2502521,CDM,250,RC,,,outpatient,,,18,7.20,,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,13.86,77,,11.09,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,14.76,82,,11.808,percent of total billed charges,82% of total billed charges,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,16.2,90,,12.96,percent of total billed charges,90% of total billed charges,14.4,80,,11.52,percent of total billed charges,80% of total billed charges,16.2,90,,12.96,percent of total billed charges,90% of total billed charges,13.5,75,,10.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,5.22,29,,4.176,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,12.06,67,,9.648,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,14.4,80,,11.52,percent of total billed charges,80% of total billed charges,11.7,65,,9.36,percent of total billed charges,65% of total billed charges,6.42,35.67,,5.136,percent of total billed charges,35.67% of total billed charges,5.22,16.2,
DAKINS 1/2 STRENGTH SOL 473 ML,2502523,CDM,250,RC,,,outpatient,,,44,17.60,,37.4,85,,29.92,percent of total billed charges,85% of total billed charges,33.88,77,,27.1,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,36.08,82,,28.864,percent of total billed charges,82% of total billed charges,37.4,85,,29.92,percent of total billed charges,85% of total billed charges,37.4,85,,29.92,percent of total billed charges,85% of total billed charges,37.4,85,,29.92,percent of total billed charges,85% of total billed charges,39.6,90,,31.68,percent of total billed charges,90% of total billed charges,35.2,80,,28.16,percent of total billed charges,80% of total billed charges,39.6,90,,31.68,percent of total billed charges,90% of total billed charges,33,75,,26.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,12.76,29,,10.208,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,29.48,67,,23.584,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,35.2,80,,28.16,percent of total billed charges,80% of total billed charges,28.6,65,,22.88,percent of total billed charges,65% of total billed charges,15.69,35.67,,12.552,percent of total billed charges,35.67% of total billed charges,12.76,39.6,
DAKIN SOLUTION FULL STRENGTH,2502525,CDM,250,RC,,,outpatient,,,44,17.60,,37.4,85,,29.92,percent of total billed charges,85% of total billed charges,33.88,77,,27.1,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,36.08,82,,28.864,percent of total billed charges,82% of total billed charges,37.4,85,,29.92,percent of total billed charges,85% of total billed charges,37.4,85,,29.92,percent of total billed charges,85% of total billed charges,37.4,85,,29.92,percent of total billed charges,85% of total billed charges,39.6,90,,31.68,percent of total billed charges,90% of total billed charges,35.2,80,,28.16,percent of total billed charges,80% of total billed charges,39.6,90,,31.68,percent of total billed charges,90% of total billed charges,33,75,,26.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,12.76,29,,10.208,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,29.48,67,,23.584,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,35.2,80,,28.16,percent of total billed charges,80% of total billed charges,28.6,65,,22.88,percent of total billed charges,65% of total billed charges,15.69,35.67,,12.552,percent of total billed charges,35.67% of total billed charges,12.76,39.6,
DANTRIUM 20 MG INJ.,2502547,CDM,250,RC,,,outpatient,,,316,126.40,,268.6,85,,214.88,percent of total billed charges,85% of total billed charges,243.32,77,,194.66,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,259.12,82,,207.296,percent of total billed charges,82% of total billed charges,268.6,85,,214.88,percent of total billed charges,85% of total billed charges,268.6,85,,214.88,percent of total billed charges,85% of total billed charges,268.6,85,,214.88,percent of total billed charges,85% of total billed charges,284.4,90,,227.52,percent of total billed charges,90% of total billed charges,252.8,80,,202.24,percent of total billed charges,80% of total billed charges,284.4,90,,227.52,percent of total billed charges,90% of total billed charges,237,75,,189.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,91.64,29,,73.312,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,211.72,67,,169.376,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,252.8,80,,202.24,percent of total billed charges,80% of total billed charges,205.4,65,,164.32,percent of total billed charges,65% of total billed charges,112.72,35.67,,90.176,percent of total billed charges,35.67% of total billed charges,91.64,284.4,
DEBROX EAR DROPS 15 ML BOTTLE,2502586,CDM,250,RC,,,outpatient,,,25,10.00,,21.25,85,,17,percent of total billed charges,85% of total billed charges,19.25,77,,15.4,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,20.5,82,,16.4,percent of total billed charges,82% of total billed charges,21.25,85,,17,percent of total billed charges,85% of total billed charges,21.25,85,,17,percent of total billed charges,85% of total billed charges,21.25,85,,17,percent of total billed charges,85% of total billed charges,22.5,90,,18,percent of total billed charges,90% of total billed charges,20,80,,16,percent of total billed charges,80% of total billed charges,22.5,90,,18,percent of total billed charges,90% of total billed charges,18.75,75,,15,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,7.25,29,,5.8,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,16.75,67,,13.4,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,20,80,,16,percent of total billed charges,80% of total billed charges,16.25,65,,13,percent of total billed charges,65% of total billed charges,8.92,35.67,,7.136,percent of total billed charges,35.67% of total billed charges,7.25,22.5,
DECADRON 10 MG INJ,2502615,CDM,250,RC,,,outpatient,,,31,12.40,,26.35,85,,21.08,percent of total billed charges,85% of total billed charges,23.87,77,,19.1,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,25.42,82,,20.336,percent of total billed charges,82% of total billed charges,26.35,85,,21.08,percent of total billed charges,85% of total billed charges,26.35,85,,21.08,percent of total billed charges,85% of total billed charges,26.35,85,,21.08,percent of total billed charges,85% of total billed charges,27.9,90,,22.32,percent of total billed charges,90% of total billed charges,24.8,80,,19.84,percent of total billed charges,80% of total billed charges,27.9,90,,22.32,percent of total billed charges,90% of total billed charges,23.25,75,,18.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,8.99,29,,7.192,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,20.77,67,,16.616,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,24.8,80,,19.84,percent of total billed charges,80% of total billed charges,20.15,65,,16.12,percent of total billed charges,65% of total billed charges,11.06,35.67,,8.848,percent of total billed charges,35.67% of total billed charges,8.99,27.9,
DECADRON 2 MG INJ,2502620,CDM,250,RC,,,outpatient,,,19,7.60,,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,14.63,77,,11.7,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,15.58,82,,12.464,percent of total billed charges,82% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,15.2,80,,12.16,percent of total billed charges,80% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,14.25,75,,11.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,5.51,29,,4.408,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,12.73,67,,10.184,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,15.2,80,,12.16,percent of total billed charges,80% of total billed charges,12.35,65,,9.88,percent of total billed charges,65% of total billed charges,6.78,35.67,,5.424,percent of total billed charges,35.67% of total billed charges,5.51,17.1,
DECADRON 6MG INJ,2502640,CDM,250,RC,,,outpatient,,,20,8.00,,17,85,,13.6,percent of total billed charges,85% of total billed charges,15.4,77,,12.32,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,16.4,82,,13.12,percent of total billed charges,82% of total billed charges,17,85,,13.6,percent of total billed charges,85% of total billed charges,17,85,,13.6,percent of total billed charges,85% of total billed charges,17,85,,13.6,percent of total billed charges,85% of total billed charges,18,90,,14.4,percent of total billed charges,90% of total billed charges,16,80,,12.8,percent of total billed charges,80% of total billed charges,18,90,,14.4,percent of total billed charges,90% of total billed charges,15,75,,12,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,5.8,29,,4.64,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,13.4,67,,10.72,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,16,80,,12.8,percent of total billed charges,80% of total billed charges,13,65,,10.4,percent of total billed charges,65% of total billed charges,7.13,35.67,,5.704,percent of total billed charges,35.67% of total billed charges,5.8,18,
DEMEDEX 20 MG TAB,2502727,CDM,250,RC,,,outpatient,,,12,4.80,,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,9.24,77,,7.39,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,9.84,82,,7.872,percent of total billed charges,82% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,10.8,90,,8.64,percent of total billed charges,90% of total billed charges,9.6,80,,7.68,percent of total billed charges,80% of total billed charges,10.8,90,,8.64,percent of total billed charges,90% of total billed charges,9,75,,7.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,3.48,29,,2.784,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,8.04,67,,6.432,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,9.6,80,,7.68,percent of total billed charges,80% of total billed charges,7.8,65,,6.24,percent of total billed charges,65% of total billed charges,4.28,35.67,,3.424,percent of total billed charges,35.67% of total billed charges,3.48,10.8,
DEPACON 500 MG/5ML INJ,2502813,CDM,250,RC,,,outpatient,,,106,42.40,,90.1,85,,72.08,percent of total billed charges,85% of total billed charges,81.62,77,,65.3,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,86.92,82,,69.536,percent of total billed charges,82% of total billed charges,90.1,85,,72.08,percent of total billed charges,85% of total billed charges,90.1,85,,72.08,percent of total billed charges,85% of total billed charges,90.1,85,,72.08,percent of total billed charges,85% of total billed charges,95.4,90,,76.32,percent of total billed charges,90% of total billed charges,84.8,80,,67.84,percent of total billed charges,80% of total billed charges,95.4,90,,76.32,percent of total billed charges,90% of total billed charges,79.5,75,,63.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,30.74,29,,24.592,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,71.02,67,,56.816,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,84.8,80,,67.84,percent of total billed charges,80% of total billed charges,68.9,65,,55.12,percent of total billed charges,65% of total billed charges,37.81,35.67,,30.248,percent of total billed charges,35.67% of total billed charges,30.74,95.4,
DEPAKENE 250 MG CAP PO,2502814,CDM,250,RC,,,outpatient,,,17,6.80,,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,13.09,77,,10.47,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,13.94,82,,11.152,percent of total billed charges,82% of total billed charges,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,15.3,90,,12.24,percent of total billed charges,90% of total billed charges,13.6,80,,10.88,percent of total billed charges,80% of total billed charges,15.3,90,,12.24,percent of total billed charges,90% of total billed charges,12.75,75,,10.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,4.93,29,,3.944,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,11.39,67,,9.112,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,13.6,80,,10.88,percent of total billed charges,80% of total billed charges,11.05,65,,8.84,percent of total billed charges,65% of total billed charges,6.06,35.67,,4.848,percent of total billed charges,35.67% of total billed charges,4.93,15.3,
DEPAKENE SYRUP 250MG/5ML UDC,2502816,CDM,250,RC,,,outpatient,,,11,4.40,,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,8.47,77,,6.78,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,9.02,82,,7.216,percent of total billed charges,82% of total billed charges,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,9.9,90,,7.92,percent of total billed charges,90% of total billed charges,8.8,80,,7.04,percent of total billed charges,80% of total billed charges,9.9,90,,7.92,percent of total billed charges,90% of total billed charges,8.25,75,,6.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,3.19,29,,2.552,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,7.37,67,,5.896,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,8.8,80,,7.04,percent of total billed charges,80% of total billed charges,7.15,65,,5.72,percent of total billed charges,65% of total billed charges,3.92,35.67,,3.136,percent of total billed charges,35.67% of total billed charges,3.19,9.9,
DEPAKOTE 125 MG TAB,2502819,CDM,250,RC,,,outpatient,,,8,3.20,,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,6.16,77,,4.93,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,6.56,82,,5.248,percent of total billed charges,82% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,7.2,90,,5.76,percent of total billed charges,90% of total billed charges,6.4,80,,5.12,percent of total billed charges,80% of total billed charges,7.2,90,,5.76,percent of total billed charges,90% of total billed charges,6,75,,4.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.32,29,,1.856,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,5.36,67,,4.288,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,6.4,80,,5.12,percent of total billed charges,80% of total billed charges,5.2,65,,4.16,percent of total billed charges,65% of total billed charges,2.85,35.67,,2.28,percent of total billed charges,35.67% of total billed charges,2.32,7.2,
DEPAKOTE 250 MG TAB PO,2502821,CDM,250,RC,,,outpatient,,,12,4.80,,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,9.24,77,,7.39,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,9.84,82,,7.872,percent of total billed charges,82% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,10.8,90,,8.64,percent of total billed charges,90% of total billed charges,9.6,80,,7.68,percent of total billed charges,80% of total billed charges,10.8,90,,8.64,percent of total billed charges,90% of total billed charges,9,75,,7.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,3.48,29,,2.784,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,8.04,67,,6.432,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,9.6,80,,7.68,percent of total billed charges,80% of total billed charges,7.8,65,,6.24,percent of total billed charges,65% of total billed charges,4.28,35.67,,3.424,percent of total billed charges,35.67% of total billed charges,3.48,10.8,
DEPAKOTE ER 250 MG TAB,2502824,CDM,250,RC,,,outpatient,,,12,4.80,,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,9.24,77,,7.39,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,9.84,82,,7.872,percent of total billed charges,82% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,10.8,90,,8.64,percent of total billed charges,90% of total billed charges,9.6,80,,7.68,percent of total billed charges,80% of total billed charges,10.8,90,,8.64,percent of total billed charges,90% of total billed charges,9,75,,7.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,3.48,29,,2.784,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,8.04,67,,6.432,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,9.6,80,,7.68,percent of total billed charges,80% of total billed charges,7.8,65,,6.24,percent of total billed charges,65% of total billed charges,4.28,35.67,,3.424,percent of total billed charges,35.67% of total billed charges,3.48,10.8,
DERMOPLAST SPRAY (TOPICAL),2502875,CDM,250,RC,,,outpatient,,,23,9.20,,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,17.71,77,,14.17,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,18.86,82,,15.088,percent of total billed charges,82% of total billed charges,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,20.7,90,,16.56,percent of total billed charges,90% of total billed charges,18.4,80,,14.72,percent of total billed charges,80% of total billed charges,20.7,90,,16.56,percent of total billed charges,90% of total billed charges,17.25,75,,13.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,6.67,29,,5.336,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,15.41,67,,12.328,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,18.4,80,,14.72,percent of total billed charges,80% of total billed charges,14.95,65,,11.96,percent of total billed charges,65% of total billed charges,8.2,35.67,,6.56,percent of total billed charges,35.67% of total billed charges,6.67,20.7,
DESYREL 50 MG TAB,2502905,CDM,250,RC,,,outpatient,,,7,2.80,,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.39,77,,4.31,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,5.74,82,,4.592,percent of total billed charges,82% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.25,75,,4.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.03,29,,1.624,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4.69,67,,3.752,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,4.55,65,,3.64,percent of total billed charges,65% of total billed charges,2.5,35.67,,2,percent of total billed charges,35.67% of total billed charges,2.03,6.3,
DEXTROSE 50CC PREFILLED 50%INJ,2502920,CDM,250,RC,,,outpatient,,,47,18.80,,39.95,85,,31.96,percent of total billed charges,85% of total billed charges,36.19,77,,28.95,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,38.54,82,,30.832,percent of total billed charges,82% of total billed charges,39.95,85,,31.96,percent of total billed charges,85% of total billed charges,39.95,85,,31.96,percent of total billed charges,85% of total billed charges,39.95,85,,31.96,percent of total billed charges,85% of total billed charges,42.3,90,,33.84,percent of total billed charges,90% of total billed charges,37.6,80,,30.08,percent of total billed charges,80% of total billed charges,42.3,90,,33.84,percent of total billed charges,90% of total billed charges,35.25,75,,28.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,13.63,29,,10.904,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,31.49,67,,25.192,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,37.6,80,,30.08,percent of total billed charges,80% of total billed charges,30.55,65,,24.44,percent of total billed charges,65% of total billed charges,16.76,35.67,,13.408,percent of total billed charges,35.67% of total billed charges,13.63,42.3,
"DEXTROSE+HEPARIN SOD25,000/250",2502941,CDM,250,RC,,,outpatient,,,40,16.00,,34,85,,27.2,percent of total billed charges,85% of total billed charges,30.8,77,,24.64,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,32.8,82,,26.24,percent of total billed charges,82% of total billed charges,34,85,,27.2,percent of total billed charges,85% of total billed charges,34,85,,27.2,percent of total billed charges,85% of total billed charges,34,85,,27.2,percent of total billed charges,85% of total billed charges,36,90,,28.8,percent of total billed charges,90% of total billed charges,32,80,,25.6,percent of total billed charges,80% of total billed charges,36,90,,28.8,percent of total billed charges,90% of total billed charges,30,75,,24,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,11.6,29,,9.28,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,26.8,67,,21.44,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,32,80,,25.6,percent of total billed charges,80% of total billed charges,26,65,,20.8,percent of total billed charges,65% of total billed charges,14.27,35.67,,11.416,percent of total billed charges,35.67% of total billed charges,11.6,36,
DIAMOX 250 MG TAB,2502955,CDM,250,RC,,,outpatient,,,13,5.20,,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,10.01,77,,8.01,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,10.66,82,,8.528,percent of total billed charges,82% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,11.7,90,,9.36,percent of total billed charges,90% of total billed charges,10.4,80,,8.32,percent of total billed charges,80% of total billed charges,11.7,90,,9.36,percent of total billed charges,90% of total billed charges,9.75,75,,7.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,3.77,29,,3.016,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,8.71,67,,6.968,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,10.4,80,,8.32,percent of total billed charges,80% of total billed charges,8.45,65,,6.76,percent of total billed charges,65% of total billed charges,4.64,35.67,,3.712,percent of total billed charges,35.67% of total billed charges,3.77,11.7,
DIAMOX SEQUELS 500 MG CAP,2502965,CDM,250,RC,,,outpatient,,,25,10.00,,21.25,85,,17,percent of total billed charges,85% of total billed charges,19.25,77,,15.4,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,20.5,82,,16.4,percent of total billed charges,82% of total billed charges,21.25,85,,17,percent of total billed charges,85% of total billed charges,21.25,85,,17,percent of total billed charges,85% of total billed charges,21.25,85,,17,percent of total billed charges,85% of total billed charges,22.5,90,,18,percent of total billed charges,90% of total billed charges,20,80,,16,percent of total billed charges,80% of total billed charges,22.5,90,,18,percent of total billed charges,90% of total billed charges,18.75,75,,15,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,7.25,29,,5.8,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,16.75,67,,13.4,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,20,80,,16,percent of total billed charges,80% of total billed charges,16.25,65,,13,percent of total billed charges,65% of total billed charges,8.92,35.67,,7.136,percent of total billed charges,35.67% of total billed charges,7.25,22.5,
DIASTAT 10 MG RECTAL GEL,2502973,CDM,250,RC,,,outpatient,,,561,224.40,,476.85,85,,381.48,percent of total billed charges,85% of total billed charges,431.97,77,,345.58,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,460.02,82,,368.016,percent of total billed charges,82% of total billed charges,476.85,85,,381.48,percent of total billed charges,85% of total billed charges,476.85,85,,381.48,percent of total billed charges,85% of total billed charges,476.85,85,,381.48,percent of total billed charges,85% of total billed charges,504.9,90,,403.92,percent of total billed charges,90% of total billed charges,448.8,80,,359.04,percent of total billed charges,80% of total billed charges,504.9,90,,403.92,percent of total billed charges,90% of total billed charges,420.75,75,,336.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,162.69,29,,130.152,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,375.87,67,,300.696,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,448.8,80,,359.04,percent of total billed charges,80% of total billed charges,364.65,65,,291.72,percent of total billed charges,65% of total billed charges,200.11,35.67,,160.088,percent of total billed charges,35.67% of total billed charges,162.69,504.9,
DIFLUCAN 100MG TAB,2502990,CDM,250,RC,,,outpatient,,,80,32.00,,68,85,,54.4,percent of total billed charges,85% of total billed charges,61.6,77,,49.28,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,65.6,82,,52.48,percent of total billed charges,82% of total billed charges,68,85,,54.4,percent of total billed charges,85% of total billed charges,68,85,,54.4,percent of total billed charges,85% of total billed charges,68,85,,54.4,percent of total billed charges,85% of total billed charges,72,90,,57.6,percent of total billed charges,90% of total billed charges,64,80,,51.2,percent of total billed charges,80% of total billed charges,72,90,,57.6,percent of total billed charges,90% of total billed charges,60,75,,48,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,23.2,29,,18.56,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,53.6,67,,42.88,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,64,80,,51.2,percent of total billed charges,80% of total billed charges,52,65,,41.6,percent of total billed charges,65% of total billed charges,28.54,35.67,,22.832,percent of total billed charges,35.67% of total billed charges,23.2,72,
DILANTIN 100 MG CAP,2503025,CDM,250,RC,,,outpatient,,,7,2.80,,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.39,77,,4.31,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,5.74,82,,4.592,percent of total billed charges,82% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.25,75,,4.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.03,29,,1.624,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4.69,67,,3.752,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,4.55,65,,3.64,percent of total billed charges,65% of total billed charges,2.5,35.67,,2,percent of total billed charges,35.67% of total billed charges,2.03,6.3,
DILANTIN 125MG/5ML UDC,2503062,CDM,250,RC,,,outpatient,,,9,3.60,,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,6.93,77,,5.54,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,7.38,82,,5.904,percent of total billed charges,82% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,8.1,90,,6.48,percent of total billed charges,90% of total billed charges,7.2,80,,5.76,percent of total billed charges,80% of total billed charges,8.1,90,,6.48,percent of total billed charges,90% of total billed charges,6.75,75,,5.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.61,29,,2.088,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,6.03,67,,4.824,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,7.2,80,,5.76,percent of total billed charges,80% of total billed charges,5.85,65,,4.68,percent of total billed charges,65% of total billed charges,3.21,35.67,,2.568,percent of total billed charges,35.67% of total billed charges,2.61,8.1,
DILAUDID 2 MG TAB,2503080,CDM,250,RC,,,outpatient,,,9,3.60,,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,6.93,77,,5.54,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,7.38,82,,5.904,percent of total billed charges,82% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,8.1,90,,6.48,percent of total billed charges,90% of total billed charges,7.2,80,,5.76,percent of total billed charges,80% of total billed charges,8.1,90,,6.48,percent of total billed charges,90% of total billed charges,6.75,75,,5.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.61,29,,2.088,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,6.03,67,,4.824,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,7.2,80,,5.76,percent of total billed charges,80% of total billed charges,5.85,65,,4.68,percent of total billed charges,65% of total billed charges,3.21,35.67,,2.568,percent of total billed charges,35.67% of total billed charges,2.61,8.1,
DIPRIVAN 50 ML VIAL,2503139,CDM,250,RC,,,outpatient,,,70,28.00,,59.5,85,,47.6,percent of total billed charges,85% of total billed charges,53.9,77,,43.12,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,57.4,82,,45.92,percent of total billed charges,82% of total billed charges,59.5,85,,47.6,percent of total billed charges,85% of total billed charges,59.5,85,,47.6,percent of total billed charges,85% of total billed charges,59.5,85,,47.6,percent of total billed charges,85% of total billed charges,63,90,,50.4,percent of total billed charges,90% of total billed charges,56,80,,44.8,percent of total billed charges,80% of total billed charges,63,90,,50.4,percent of total billed charges,90% of total billed charges,52.5,75,,42,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,20.3,29,,16.24,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,46.9,67,,37.52,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,56,80,,44.8,percent of total billed charges,80% of total billed charges,45.5,65,,36.4,percent of total billed charges,65% of total billed charges,24.97,35.67,,19.976,percent of total billed charges,35.67% of total billed charges,20.3,63,
DITROPAN 5 MG TAB,2503180,CDM,250,RC,,,outpatient,,,7,2.80,,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.39,77,,4.31,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,5.74,82,,4.592,percent of total billed charges,82% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.25,75,,4.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.03,29,,1.624,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4.69,67,,3.752,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,4.55,65,,3.64,percent of total billed charges,65% of total billed charges,2.5,35.67,,2,percent of total billed charges,35.67% of total billed charges,2.03,6.3,
LYRICA 100 MG PO,2503207,CDM,250,RC,J8499,HCPCS,outpatient,,,188,75.20,,159.8,85,,127.84,percent of total billed charges,85% of total billed charges,144.76,77,,115.81,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,154.16,82,,123.328,percent of total billed charges,82% of total billed charges,159.8,85,,127.84,percent of total billed charges,85% of total billed charges,159.8,85,,127.84,percent of total billed charges,85% of total billed charges,159.8,85,,127.84,percent of total billed charges,85% of total billed charges,169.2,90,,135.36,percent of total billed charges,90% of total billed charges,150.4,80,,120.32,percent of total billed charges,80% of total billed charges,169.2,90,,135.36,percent of total billed charges,90% of total billed charges,141,75,,112.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,54.52,29,,43.616,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,125.96,67,,100.768,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,150.4,80,,120.32,percent of total billed charges,80% of total billed charges,122.2,65,,97.76,percent of total billed charges,65% of total billed charges,67.06,35.67,,53.648,percent of total billed charges,35.67% of total billed charges,54.52,169.2,
DOMEBORO POWDER SOAKS,2503225,CDM,250,RC,,,outpatient,,,10,4.00,,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,7.7,77,,6.16,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,8.2,82,,6.56,percent of total billed charges,82% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,9,90,,7.2,percent of total billed charges,90% of total billed charges,8,80,,6.4,percent of total billed charges,80% of total billed charges,9,90,,7.2,percent of total billed charges,90% of total billed charges,7.5,75,,6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.9,29,,2.32,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,6.7,67,,5.36,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,8,80,,6.4,percent of total billed charges,80% of total billed charges,6.5,65,,5.2,percent of total billed charges,65% of total billed charges,3.57,35.67,,2.856,percent of total billed charges,35.67% of total billed charges,2.9,9,
DRAMAMINE TAB,2503370,CDM,250,RC,,,outpatient,,,7,2.80,,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.39,77,,4.31,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,5.74,82,,4.592,percent of total billed charges,82% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.25,75,,4.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.03,29,,1.624,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4.69,67,,3.752,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,4.55,65,,3.64,percent of total billed charges,65% of total billed charges,2.5,35.67,,2,percent of total billed charges,35.67% of total billed charges,2.03,6.3,
DRYSOL 37.5 ML SOL.,2503381,CDM,250,RC,,,outpatient,,,32,12.80,,27.2,85,,21.76,percent of total billed charges,85% of total billed charges,24.64,77,,19.71,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,26.24,82,,20.992,percent of total billed charges,82% of total billed charges,27.2,85,,21.76,percent of total billed charges,85% of total billed charges,27.2,85,,21.76,percent of total billed charges,85% of total billed charges,27.2,85,,21.76,percent of total billed charges,85% of total billed charges,28.8,90,,23.04,percent of total billed charges,90% of total billed charges,25.6,80,,20.48,percent of total billed charges,80% of total billed charges,28.8,90,,23.04,percent of total billed charges,90% of total billed charges,24,75,,19.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,9.28,29,,7.424,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,21.44,67,,17.152,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,25.6,80,,20.48,percent of total billed charges,80% of total billed charges,20.8,65,,16.64,percent of total billed charges,65% of total billed charges,11.41,35.67,,9.128,percent of total billed charges,35.67% of total billed charges,9.28,28.8,
DULCOLAX 10 MG SUPPOS,2503400,CDM,250,RC,,,outpatient,,,8,3.20,,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,6.16,77,,4.93,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,6.56,82,,5.248,percent of total billed charges,82% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,7.2,90,,5.76,percent of total billed charges,90% of total billed charges,6.4,80,,5.12,percent of total billed charges,80% of total billed charges,7.2,90,,5.76,percent of total billed charges,90% of total billed charges,6,75,,4.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.32,29,,1.856,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,5.36,67,,4.288,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,6.4,80,,5.12,percent of total billed charges,80% of total billed charges,5.2,65,,4.16,percent of total billed charges,65% of total billed charges,2.85,35.67,,2.28,percent of total billed charges,35.67% of total billed charges,2.32,7.2,
DULCOLAX 5 MG TAB,2503405,CDM,250,RC,,,outpatient,,,7,2.80,,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.39,77,,4.31,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,5.74,82,,4.592,percent of total billed charges,82% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.25,75,,4.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.03,29,,1.624,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4.69,67,,3.752,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,4.55,65,,3.64,percent of total billed charges,65% of total billed charges,2.5,35.67,,2,percent of total billed charges,35.67% of total billed charges,2.03,6.3,
DUOVISC .75 ML OPTH DROPS,2503407,CDM,250,RC,,,outpatient,,,436,174.40,,370.6,85,,296.48,percent of total billed charges,85% of total billed charges,335.72,77,,268.58,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,357.52,82,,286.016,percent of total billed charges,82% of total billed charges,370.6,85,,296.48,percent of total billed charges,85% of total billed charges,370.6,85,,296.48,percent of total billed charges,85% of total billed charges,370.6,85,,296.48,percent of total billed charges,85% of total billed charges,392.4,90,,313.92,percent of total billed charges,90% of total billed charges,348.8,80,,279.04,percent of total billed charges,80% of total billed charges,392.4,90,,313.92,percent of total billed charges,90% of total billed charges,327,75,,261.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,126.44,29,,101.152,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,292.12,67,,233.696,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,348.8,80,,279.04,percent of total billed charges,80% of total billed charges,283.4,65,,226.72,percent of total billed charges,65% of total billed charges,155.52,35.67,,124.416,percent of total billed charges,35.67% of total billed charges,126.44,392.4,
DURAGESIC 100 MCG/HR PATCH,2503425,CDM,250,RC,,,outpatient,,,401,160.40,,340.85,85,,272.68,percent of total billed charges,85% of total billed charges,308.77,77,,247.02,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,328.82,82,,263.056,percent of total billed charges,82% of total billed charges,340.85,85,,272.68,percent of total billed charges,85% of total billed charges,340.85,85,,272.68,percent of total billed charges,85% of total billed charges,340.85,85,,272.68,percent of total billed charges,85% of total billed charges,360.9,90,,288.72,percent of total billed charges,90% of total billed charges,320.8,80,,256.64,percent of total billed charges,80% of total billed charges,360.9,90,,288.72,percent of total billed charges,90% of total billed charges,300.75,75,,240.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,116.29,29,,93.032,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,268.67,67,,214.936,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,320.8,80,,256.64,percent of total billed charges,80% of total billed charges,260.65,65,,208.52,percent of total billed charges,65% of total billed charges,143.04,35.67,,114.432,percent of total billed charges,35.67% of total billed charges,116.29,360.9,
DURAGESIC 75 MG PATCH,2503426,CDM,250,RC,,,outpatient,,,336,134.40,,285.6,85,,228.48,percent of total billed charges,85% of total billed charges,258.72,77,,206.98,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,275.52,82,,220.416,percent of total billed charges,82% of total billed charges,285.6,85,,228.48,percent of total billed charges,85% of total billed charges,285.6,85,,228.48,percent of total billed charges,85% of total billed charges,285.6,85,,228.48,percent of total billed charges,85% of total billed charges,302.4,90,,241.92,percent of total billed charges,90% of total billed charges,268.8,80,,215.04,percent of total billed charges,80% of total billed charges,302.4,90,,241.92,percent of total billed charges,90% of total billed charges,252,75,,201.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,97.44,29,,77.952,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,225.12,67,,180.096,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,268.8,80,,215.04,percent of total billed charges,80% of total billed charges,218.4,65,,174.72,percent of total billed charges,65% of total billed charges,119.85,35.67,,95.88,percent of total billed charges,35.67% of total billed charges,97.44,302.4,
DURAGESIC 25 MCG/H PATCH,2503429,CDM,250,RC,,,outpatient,,,148,59.20,,125.8,85,,100.64,percent of total billed charges,85% of total billed charges,113.96,77,,91.17,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,121.36,82,,97.088,percent of total billed charges,82% of total billed charges,125.8,85,,100.64,percent of total billed charges,85% of total billed charges,125.8,85,,100.64,percent of total billed charges,85% of total billed charges,125.8,85,,100.64,percent of total billed charges,85% of total billed charges,133.2,90,,106.56,percent of total billed charges,90% of total billed charges,118.4,80,,94.72,percent of total billed charges,80% of total billed charges,133.2,90,,106.56,percent of total billed charges,90% of total billed charges,111,75,,88.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,42.92,29,,34.336,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,99.16,67,,79.328,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,118.4,80,,94.72,percent of total billed charges,80% of total billed charges,96.2,65,,76.96,percent of total billed charges,65% of total billed charges,52.79,35.67,,42.232,percent of total billed charges,35.67% of total billed charges,42.92,133.2,
DURAGESIC 50 MCG/HR PATCH,2503430,CDM,250,RC,,,outpatient,,,224,89.60,,190.4,85,,152.32,percent of total billed charges,85% of total billed charges,172.48,77,,137.98,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,183.68,82,,146.944,percent of total billed charges,82% of total billed charges,190.4,85,,152.32,percent of total billed charges,85% of total billed charges,190.4,85,,152.32,percent of total billed charges,85% of total billed charges,190.4,85,,152.32,percent of total billed charges,85% of total billed charges,201.6,90,,161.28,percent of total billed charges,90% of total billed charges,179.2,80,,143.36,percent of total billed charges,80% of total billed charges,201.6,90,,161.28,percent of total billed charges,90% of total billed charges,168,75,,134.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,64.96,29,,51.968,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,150.08,67,,120.064,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,179.2,80,,143.36,percent of total billed charges,80% of total billed charges,145.6,65,,116.48,percent of total billed charges,65% of total billed charges,79.9,35.67,,63.92,percent of total billed charges,35.67% of total billed charges,64.96,201.6,
DURAGESIC 12 MCG PATCH,2503439,CDM,250,RC,,,outpatient,,,100,40.00,,85,85,,68,percent of total billed charges,85% of total billed charges,77,77,,61.6,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,82,82,,65.6,percent of total billed charges,82% of total billed charges,85,85,,68,percent of total billed charges,85% of total billed charges,85,85,,68,percent of total billed charges,85% of total billed charges,85,85,,68,percent of total billed charges,85% of total billed charges,90,90,,72,percent of total billed charges,90% of total billed charges,80,80,,64,percent of total billed charges,80% of total billed charges,90,90,,72,percent of total billed charges,90% of total billed charges,75,75,,60,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,29,29,,23.2,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,67,67,,53.6,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,80,80,,64,percent of total billed charges,80% of total billed charges,65,65,,52,percent of total billed charges,65% of total billed charges,35.67,35.67,,28.536,percent of total billed charges,35.67% of total billed charges,29,90,
DUO NEB 3 ML VIAL,2503441,CDM,250,RC,,,outpatient,,,10,4.00,,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,7.7,77,,6.16,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,8.2,82,,6.56,percent of total billed charges,82% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,9,90,,7.2,percent of total billed charges,90% of total billed charges,8,80,,6.4,percent of total billed charges,80% of total billed charges,9,90,,7.2,percent of total billed charges,90% of total billed charges,7.5,75,,6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.9,29,,2.32,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,6.7,67,,5.36,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,8,80,,6.4,percent of total billed charges,80% of total billed charges,6.5,65,,5.2,percent of total billed charges,65% of total billed charges,3.57,35.67,,2.856,percent of total billed charges,35.67% of total billed charges,2.9,9,
ECOTRIN TAB,2503505,CDM,250,RC,,,outpatient,,,7,2.80,,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.39,77,,4.31,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,5.74,82,,4.592,percent of total billed charges,82% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.25,75,,4.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.03,29,,1.624,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4.69,67,,3.752,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,4.55,65,,3.64,percent of total billed charges,65% of total billed charges,2.5,35.67,,2,percent of total billed charges,35.67% of total billed charges,2.03,6.3,
EFFEXOR 75 MG TAB PO,2503528,CDM,250,RC,,,outpatient,,,11,4.40,,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,8.47,77,,6.78,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,9.02,82,,7.216,percent of total billed charges,82% of total billed charges,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,9.9,90,,7.92,percent of total billed charges,90% of total billed charges,8.8,80,,7.04,percent of total billed charges,80% of total billed charges,9.9,90,,7.92,percent of total billed charges,90% of total billed charges,8.25,75,,6.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,3.19,29,,2.552,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,7.37,67,,5.896,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,8.8,80,,7.04,percent of total billed charges,80% of total billed charges,7.15,65,,5.72,percent of total billed charges,65% of total billed charges,3.92,35.67,,3.136,percent of total billed charges,35.67% of total billed charges,3.19,9.9,
EFFIENT 10 MG TAB,2503532,CDM,250,RC,,,outpatient,,,54,21.60,,45.9,85,,36.72,percent of total billed charges,85% of total billed charges,41.58,77,,33.26,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,44.28,82,,35.424,percent of total billed charges,82% of total billed charges,45.9,85,,36.72,percent of total billed charges,85% of total billed charges,45.9,85,,36.72,percent of total billed charges,85% of total billed charges,45.9,85,,36.72,percent of total billed charges,85% of total billed charges,48.6,90,,38.88,percent of total billed charges,90% of total billed charges,43.2,80,,34.56,percent of total billed charges,80% of total billed charges,48.6,90,,38.88,percent of total billed charges,90% of total billed charges,40.5,75,,32.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,15.66,29,,12.528,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,36.18,67,,28.944,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,43.2,80,,34.56,percent of total billed charges,80% of total billed charges,35.1,65,,28.08,percent of total billed charges,65% of total billed charges,19.26,35.67,,15.408,percent of total billed charges,35.67% of total billed charges,15.66,48.6,
ELAVIL 10 MG TAB,2503545,CDM,250,RC,,,outpatient,,,7,2.80,,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.39,77,,4.31,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,5.74,82,,4.592,percent of total billed charges,82% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.25,75,,4.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.03,29,,1.624,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4.69,67,,3.752,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,4.55,65,,3.64,percent of total billed charges,65% of total billed charges,2.5,35.67,,2,percent of total billed charges,35.67% of total billed charges,2.03,6.3,
ELAVIL 25 MG TAB,2503565,CDM,250,RC,,,outpatient,,,7,2.80,,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.39,77,,4.31,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,5.74,82,,4.592,percent of total billed charges,82% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.25,75,,4.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.03,29,,1.624,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4.69,67,,3.752,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,4.55,65,,3.64,percent of total billed charges,65% of total billed charges,2.5,35.67,,2,percent of total billed charges,35.67% of total billed charges,2.03,6.3,
ELIMITE LOTION,2503585,CDM,250,RC,,,outpatient,,,375,150.00,,318.75,85,,255,percent of total billed charges,85% of total billed charges,288.75,77,,231,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,307.5,82,,246,percent of total billed charges,82% of total billed charges,318.75,85,,255,percent of total billed charges,85% of total billed charges,318.75,85,,255,percent of total billed charges,85% of total billed charges,318.75,85,,255,percent of total billed charges,85% of total billed charges,337.5,90,,270,percent of total billed charges,90% of total billed charges,300,80,,240,percent of total billed charges,80% of total billed charges,337.5,90,,270,percent of total billed charges,90% of total billed charges,281.25,75,,225,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,108.75,29,,87,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,251.25,67,,201,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,300,80,,240,percent of total billed charges,80% of total billed charges,243.75,65,,195,percent of total billed charges,65% of total billed charges,133.76,35.67,,107.008,percent of total billed charges,35.67% of total billed charges,108.75,337.5,
EMLA 5 GRAM TUBE,2503601,CDM,250,RC,,,outpatient,,,38,15.20,,32.3,85,,25.84,percent of total billed charges,85% of total billed charges,29.26,77,,23.41,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,31.16,82,,24.928,percent of total billed charges,82% of total billed charges,32.3,85,,25.84,percent of total billed charges,85% of total billed charges,32.3,85,,25.84,percent of total billed charges,85% of total billed charges,32.3,85,,25.84,percent of total billed charges,85% of total billed charges,34.2,90,,27.36,percent of total billed charges,90% of total billed charges,30.4,80,,24.32,percent of total billed charges,80% of total billed charges,34.2,90,,27.36,percent of total billed charges,90% of total billed charges,28.5,75,,22.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,11.02,29,,8.816,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,25.46,67,,20.368,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,30.4,80,,24.32,percent of total billed charges,80% of total billed charges,24.7,65,,19.76,percent of total billed charges,65% of total billed charges,13.55,35.67,,10.84,percent of total billed charges,35.67% of total billed charges,11.02,34.2,
ENLON PLUS INJ,2503641,CDM,250,RC,,,outpatient,,,34,13.60,,28.9,85,,23.12,percent of total billed charges,85% of total billed charges,26.18,77,,20.94,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,27.88,82,,22.304,percent of total billed charges,82% of total billed charges,28.9,85,,23.12,percent of total billed charges,85% of total billed charges,28.9,85,,23.12,percent of total billed charges,85% of total billed charges,28.9,85,,23.12,percent of total billed charges,85% of total billed charges,30.6,90,,24.48,percent of total billed charges,90% of total billed charges,27.2,80,,21.76,percent of total billed charges,80% of total billed charges,30.6,90,,24.48,percent of total billed charges,90% of total billed charges,25.5,75,,20.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,9.86,29,,7.888,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,22.78,67,,18.224,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,27.2,80,,21.76,percent of total billed charges,80% of total billed charges,22.1,65,,17.68,percent of total billed charges,65% of total billed charges,12.13,35.67,,9.704,percent of total billed charges,35.67% of total billed charges,9.86,30.6,
EPSOM SALT 120 GM,2503701,CDM,250,RC,,,outpatient,,,15,6.00,,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,11.55,77,,9.24,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,12.3,82,,9.84,percent of total billed charges,82% of total billed charges,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,13.5,90,,10.8,percent of total billed charges,90% of total billed charges,12,80,,9.6,percent of total billed charges,80% of total billed charges,13.5,90,,10.8,percent of total billed charges,90% of total billed charges,11.25,75,,9,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,4.35,29,,3.48,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,10.05,67,,8.04,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,12,80,,9.6,percent of total billed charges,80% of total billed charges,9.75,65,,7.8,percent of total billed charges,65% of total billed charges,5.35,35.67,,4.28,percent of total billed charges,35.67% of total billed charges,4.35,13.5,
ERY-TAB 250 MG PO,2503726,CDM,250,RC,,,outpatient,,,42,16.80,,35.7,85,,28.56,percent of total billed charges,85% of total billed charges,32.34,77,,25.87,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,34.44,82,,27.552,percent of total billed charges,82% of total billed charges,35.7,85,,28.56,percent of total billed charges,85% of total billed charges,35.7,85,,28.56,percent of total billed charges,85% of total billed charges,35.7,85,,28.56,percent of total billed charges,85% of total billed charges,37.8,90,,30.24,percent of total billed charges,90% of total billed charges,33.6,80,,26.88,percent of total billed charges,80% of total billed charges,37.8,90,,30.24,percent of total billed charges,90% of total billed charges,31.5,75,,25.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,12.18,29,,9.744,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,28.14,67,,22.512,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,33.6,80,,26.88,percent of total billed charges,80% of total billed charges,27.3,65,,21.84,percent of total billed charges,65% of total billed charges,14.98,35.67,,11.984,percent of total billed charges,35.67% of total billed charges,12.18,37.8,
ACULAR .5% OPTH,2503737,CDM,250,RC,,,outpatient,,,498,199.20,,423.3,85,,338.64,percent of total billed charges,85% of total billed charges,383.46,77,,306.77,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,408.36,82,,326.688,percent of total billed charges,82% of total billed charges,423.3,85,,338.64,percent of total billed charges,85% of total billed charges,423.3,85,,338.64,percent of total billed charges,85% of total billed charges,423.3,85,,338.64,percent of total billed charges,85% of total billed charges,448.2,90,,358.56,percent of total billed charges,90% of total billed charges,398.4,80,,318.72,percent of total billed charges,80% of total billed charges,448.2,90,,358.56,percent of total billed charges,90% of total billed charges,373.5,75,,298.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,144.42,29,,115.536,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,333.66,67,,266.928,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,398.4,80,,318.72,percent of total billed charges,80% of total billed charges,323.7,65,,258.96,percent of total billed charges,65% of total billed charges,177.64,35.67,,142.112,percent of total billed charges,35.67% of total billed charges,144.42,448.2,
EYE GEL,2503837,CDM,250,RC,,,outpatient,,,306,122.40,,260.1,85,,208.08,percent of total billed charges,85% of total billed charges,235.62,77,,188.5,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,250.92,82,,200.736,percent of total billed charges,82% of total billed charges,260.1,85,,208.08,percent of total billed charges,85% of total billed charges,260.1,85,,208.08,percent of total billed charges,85% of total billed charges,260.1,85,,208.08,percent of total billed charges,85% of total billed charges,275.4,90,,220.32,percent of total billed charges,90% of total billed charges,244.8,80,,195.84,percent of total billed charges,80% of total billed charges,275.4,90,,220.32,percent of total billed charges,90% of total billed charges,229.5,75,,183.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,88.74,29,,70.992,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,205.02,67,,164.016,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,244.8,80,,195.84,percent of total billed charges,80% of total billed charges,198.9,65,,159.12,percent of total billed charges,65% of total billed charges,109.15,35.67,,87.32,percent of total billed charges,35.67% of total billed charges,88.74,275.4,
EUCERIN CREME 2 OZ,2503871,CDM,250,RC,,,outpatient,,,18,7.20,,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,13.86,77,,11.09,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,14.76,82,,11.808,percent of total billed charges,82% of total billed charges,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,16.2,90,,12.96,percent of total billed charges,90% of total billed charges,14.4,80,,11.52,percent of total billed charges,80% of total billed charges,16.2,90,,12.96,percent of total billed charges,90% of total billed charges,13.5,75,,10.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,5.22,29,,4.176,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,12.06,67,,9.648,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,14.4,80,,11.52,percent of total billed charges,80% of total billed charges,11.7,65,,9.36,percent of total billed charges,65% of total billed charges,6.42,35.67,,5.136,percent of total billed charges,35.67% of total billed charges,5.22,16.2,
EURAX CREAM 60 GRAM TOP,2503872,CDM,250,RC,,,outpatient,,,459,183.60,,390.15,85,,312.12,percent of total billed charges,85% of total billed charges,353.43,77,,282.74,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,376.38,82,,301.104,percent of total billed charges,82% of total billed charges,390.15,85,,312.12,percent of total billed charges,85% of total billed charges,390.15,85,,312.12,percent of total billed charges,85% of total billed charges,390.15,85,,312.12,percent of total billed charges,85% of total billed charges,413.1,90,,330.48,percent of total billed charges,90% of total billed charges,367.2,80,,293.76,percent of total billed charges,80% of total billed charges,413.1,90,,330.48,percent of total billed charges,90% of total billed charges,344.25,75,,275.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,133.11,29,,106.488,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,307.53,67,,246.024,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,367.2,80,,293.76,percent of total billed charges,80% of total billed charges,298.35,65,,238.68,percent of total billed charges,65% of total billed charges,163.73,35.67,,130.984,percent of total billed charges,35.67% of total billed charges,133.11,413.1,
EVISTA 60 MG PO,2503876,CDM,250,RC,,,outpatient,,,30,12.00,,25.5,85,,20.4,percent of total billed charges,85% of total billed charges,23.1,77,,18.48,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,24.6,82,,19.68,percent of total billed charges,82% of total billed charges,25.5,85,,20.4,percent of total billed charges,85% of total billed charges,25.5,85,,20.4,percent of total billed charges,85% of total billed charges,25.5,85,,20.4,percent of total billed charges,85% of total billed charges,27,90,,21.6,percent of total billed charges,90% of total billed charges,24,80,,19.2,percent of total billed charges,80% of total billed charges,27,90,,21.6,percent of total billed charges,90% of total billed charges,22.5,75,,18,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,8.7,29,,6.96,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,20.1,67,,16.08,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,24,80,,19.2,percent of total billed charges,80% of total billed charges,19.5,65,,15.6,percent of total billed charges,65% of total billed charges,10.7,35.67,,8.56,percent of total billed charges,35.67% of total billed charges,8.7,27,
ETHYL CHLORIDE SPRAY 3.5 OZ,2503878,CDM,250,RC,,,outpatient,,,20,8.00,,17,85,,13.6,percent of total billed charges,85% of total billed charges,15.4,77,,12.32,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,16.4,82,,13.12,percent of total billed charges,82% of total billed charges,17,85,,13.6,percent of total billed charges,85% of total billed charges,17,85,,13.6,percent of total billed charges,85% of total billed charges,17,85,,13.6,percent of total billed charges,85% of total billed charges,18,90,,14.4,percent of total billed charges,90% of total billed charges,16,80,,12.8,percent of total billed charges,80% of total billed charges,18,90,,14.4,percent of total billed charges,90% of total billed charges,15,75,,12,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,5.8,29,,4.64,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,13.4,67,,10.72,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,16,80,,12.8,percent of total billed charges,80% of total billed charges,13,65,,10.4,percent of total billed charges,65% of total billed charges,7.13,35.67,,5.704,percent of total billed charges,35.67% of total billed charges,5.8,18,
EXELON 1.5 MG PO,2503887,CDM,250,RC,,,outpatient,,,25,10.00,,21.25,85,,17,percent of total billed charges,85% of total billed charges,19.25,77,,15.4,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,20.5,82,,16.4,percent of total billed charges,82% of total billed charges,21.25,85,,17,percent of total billed charges,85% of total billed charges,21.25,85,,17,percent of total billed charges,85% of total billed charges,21.25,85,,17,percent of total billed charges,85% of total billed charges,22.5,90,,18,percent of total billed charges,90% of total billed charges,20,80,,16,percent of total billed charges,80% of total billed charges,22.5,90,,18,percent of total billed charges,90% of total billed charges,18.75,75,,15,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,7.25,29,,5.8,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,16.75,67,,13.4,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,20,80,,16,percent of total billed charges,80% of total billed charges,16.25,65,,13,percent of total billed charges,65% of total billed charges,8.92,35.67,,7.136,percent of total billed charges,35.67% of total billed charges,7.25,22.5,
FAMVIR 500 MG TAB,2503892,CDM,250,RC,,,outpatient,,,78,31.20,,66.3,85,,53.04,percent of total billed charges,85% of total billed charges,60.06,77,,48.05,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,63.96,82,,51.168,percent of total billed charges,82% of total billed charges,66.3,85,,53.04,percent of total billed charges,85% of total billed charges,66.3,85,,53.04,percent of total billed charges,85% of total billed charges,66.3,85,,53.04,percent of total billed charges,85% of total billed charges,70.2,90,,56.16,percent of total billed charges,90% of total billed charges,62.4,80,,49.92,percent of total billed charges,80% of total billed charges,70.2,90,,56.16,percent of total billed charges,90% of total billed charges,58.5,75,,46.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,22.62,29,,18.096,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,52.26,67,,41.808,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,62.4,80,,49.92,percent of total billed charges,80% of total billed charges,50.7,65,,40.56,percent of total billed charges,65% of total billed charges,27.82,35.67,,22.256,percent of total billed charges,35.67% of total billed charges,22.62,70.2,
FAT EMULSIONS 500 BAG,2503899,CDM,250,RC,,,outpatient,,,425,170.00,,361.25,85,,289,percent of total billed charges,85% of total billed charges,327.25,77,,261.8,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,348.5,82,,278.8,percent of total billed charges,82% of total billed charges,361.25,85,,289,percent of total billed charges,85% of total billed charges,361.25,85,,289,percent of total billed charges,85% of total billed charges,361.25,85,,289,percent of total billed charges,85% of total billed charges,382.5,90,,306,percent of total billed charges,90% of total billed charges,340,80,,272,percent of total billed charges,80% of total billed charges,382.5,90,,306,percent of total billed charges,90% of total billed charges,318.75,75,,255,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,123.25,29,,98.6,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,284.75,67,,227.8,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,340,80,,272,percent of total billed charges,80% of total billed charges,276.25,65,,221,percent of total billed charges,65% of total billed charges,151.6,35.67,,121.28,percent of total billed charges,35.67% of total billed charges,123.25,382.5,
FEOSOL 300MG/5ML,2503927,CDM,250,RC,,,outpatient,,,7,2.80,,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.39,77,,4.31,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,5.74,82,,4.592,percent of total billed charges,82% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.25,75,,4.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.03,29,,1.624,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4.69,67,,3.752,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,4.55,65,,3.64,percent of total billed charges,65% of total billed charges,2.5,35.67,,2,percent of total billed charges,35.67% of total billed charges,2.03,6.3,
FER-IN-SOL VIT BOTTLE,2503955,CDM,250,RC,,,outpatient,,,42,16.80,,35.7,85,,28.56,percent of total billed charges,85% of total billed charges,32.34,77,,25.87,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,34.44,82,,27.552,percent of total billed charges,82% of total billed charges,35.7,85,,28.56,percent of total billed charges,85% of total billed charges,35.7,85,,28.56,percent of total billed charges,85% of total billed charges,35.7,85,,28.56,percent of total billed charges,85% of total billed charges,37.8,90,,30.24,percent of total billed charges,90% of total billed charges,33.6,80,,26.88,percent of total billed charges,80% of total billed charges,37.8,90,,30.24,percent of total billed charges,90% of total billed charges,31.5,75,,25.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,12.18,29,,9.744,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,28.14,67,,22.512,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,33.6,80,,26.88,percent of total billed charges,80% of total billed charges,27.3,65,,21.84,percent of total billed charges,65% of total billed charges,14.98,35.67,,11.984,percent of total billed charges,35.67% of total billed charges,12.18,37.8,
FIBERCON TAB,2503965,CDM,250,RC,,,outpatient,,,7,2.80,,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.39,77,,4.31,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,5.74,82,,4.592,percent of total billed charges,82% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.25,75,,4.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.03,29,,1.624,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4.69,67,,3.752,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,4.55,65,,3.64,percent of total billed charges,65% of total billed charges,2.5,35.67,,2,percent of total billed charges,35.67% of total billed charges,2.03,6.3,
FIORICET TABS,2503975,CDM,250,RC,,,outpatient,,,11,4.40,,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,8.47,77,,6.78,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,9.02,82,,7.216,percent of total billed charges,82% of total billed charges,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,9.9,90,,7.92,percent of total billed charges,90% of total billed charges,8.8,80,,7.04,percent of total billed charges,80% of total billed charges,9.9,90,,7.92,percent of total billed charges,90% of total billed charges,8.25,75,,6.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,3.19,29,,2.552,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,7.37,67,,5.896,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,8.8,80,,7.04,percent of total billed charges,80% of total billed charges,7.15,65,,5.72,percent of total billed charges,65% of total billed charges,3.92,35.67,,3.136,percent of total billed charges,35.67% of total billed charges,3.19,9.9,
FLAGYL 500MG TAB,2504000,CDM,250,RC,,,outpatient,,,32,12.80,,27.2,85,,21.76,percent of total billed charges,85% of total billed charges,24.64,77,,19.71,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,26.24,82,,20.992,percent of total billed charges,82% of total billed charges,27.2,85,,21.76,percent of total billed charges,85% of total billed charges,27.2,85,,21.76,percent of total billed charges,85% of total billed charges,27.2,85,,21.76,percent of total billed charges,85% of total billed charges,28.8,90,,23.04,percent of total billed charges,90% of total billed charges,25.6,80,,20.48,percent of total billed charges,80% of total billed charges,28.8,90,,23.04,percent of total billed charges,90% of total billed charges,24,75,,19.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,9.28,29,,7.424,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,21.44,67,,17.152,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,25.6,80,,20.48,percent of total billed charges,80% of total billed charges,20.8,65,,16.64,percent of total billed charges,65% of total billed charges,11.41,35.67,,9.128,percent of total billed charges,35.67% of total billed charges,9.28,28.8,
FISH OIL FATTY ACID 1000MG PO,2504003,CDM,250,RC,,,outpatient,,,7,2.80,,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.39,77,,4.31,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,5.74,82,,4.592,percent of total billed charges,82% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.25,75,,4.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.03,29,,1.624,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4.69,67,,3.752,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,4.55,65,,3.64,percent of total billed charges,65% of total billed charges,2.5,35.67,,2,percent of total billed charges,35.67% of total billed charges,2.03,6.3,
FLECTOR 1.3% TOPICAL PATCH,2504026,CDM,250,RC,,,outpatient,,,32,12.80,,27.2,85,,21.76,percent of total billed charges,85% of total billed charges,24.64,77,,19.71,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,26.24,82,,20.992,percent of total billed charges,82% of total billed charges,27.2,85,,21.76,percent of total billed charges,85% of total billed charges,27.2,85,,21.76,percent of total billed charges,85% of total billed charges,27.2,85,,21.76,percent of total billed charges,85% of total billed charges,28.8,90,,23.04,percent of total billed charges,90% of total billed charges,25.6,80,,20.48,percent of total billed charges,80% of total billed charges,28.8,90,,23.04,percent of total billed charges,90% of total billed charges,24,75,,19.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,9.28,29,,7.424,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,21.44,67,,17.152,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,25.6,80,,20.48,percent of total billed charges,80% of total billed charges,20.8,65,,16.64,percent of total billed charges,65% of total billed charges,11.41,35.67,,9.128,percent of total billed charges,35.67% of total billed charges,9.28,28.8,
FLEXERIL 5 MG TAB,2504029,CDM,250,RC,,,outpatient,,,9,3.60,,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,6.93,77,,5.54,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,7.38,82,,5.904,percent of total billed charges,82% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,8.1,90,,6.48,percent of total billed charges,90% of total billed charges,7.2,80,,5.76,percent of total billed charges,80% of total billed charges,8.1,90,,6.48,percent of total billed charges,90% of total billed charges,6.75,75,,5.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.61,29,,2.088,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,6.03,67,,4.824,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,7.2,80,,5.76,percent of total billed charges,80% of total billed charges,5.85,65,,4.68,percent of total billed charges,65% of total billed charges,3.21,35.67,,2.568,percent of total billed charges,35.67% of total billed charges,2.61,8.1,
FLOMAX 0.4 MG  PO,2504036,CDM,250,RC,,,outpatient,,,27,10.80,,22.95,85,,18.36,percent of total billed charges,85% of total billed charges,20.79,77,,16.63,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,22.14,82,,17.712,percent of total billed charges,82% of total billed charges,22.95,85,,18.36,percent of total billed charges,85% of total billed charges,22.95,85,,18.36,percent of total billed charges,85% of total billed charges,22.95,85,,18.36,percent of total billed charges,85% of total billed charges,24.3,90,,19.44,percent of total billed charges,90% of total billed charges,21.6,80,,17.28,percent of total billed charges,80% of total billed charges,24.3,90,,19.44,percent of total billed charges,90% of total billed charges,20.25,75,,16.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,7.83,29,,6.264,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,18.09,67,,14.472,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,21.6,80,,17.28,percent of total billed charges,80% of total billed charges,17.55,65,,14.04,percent of total billed charges,65% of total billed charges,9.63,35.67,,7.704,percent of total billed charges,35.67% of total billed charges,7.83,24.3,
FLONASE NASAL SPRAY,2504037,CDM,250,RC,,,outpatient,,,263,105.20,,223.55,85,,178.84,percent of total billed charges,85% of total billed charges,202.51,77,,162.01,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,215.66,82,,172.528,percent of total billed charges,82% of total billed charges,223.55,85,,178.84,percent of total billed charges,85% of total billed charges,223.55,85,,178.84,percent of total billed charges,85% of total billed charges,223.55,85,,178.84,percent of total billed charges,85% of total billed charges,236.7,90,,189.36,percent of total billed charges,90% of total billed charges,210.4,80,,168.32,percent of total billed charges,80% of total billed charges,236.7,90,,189.36,percent of total billed charges,90% of total billed charges,197.25,75,,157.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,76.27,29,,61.016,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,176.21,67,,140.968,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,210.4,80,,168.32,percent of total billed charges,80% of total billed charges,170.95,65,,136.76,percent of total billed charges,65% of total billed charges,93.81,35.67,,75.048,percent of total billed charges,35.67% of total billed charges,76.27,236.7,
FLORINEF 0.1MG TAB,2504050,CDM,250,RC,,,outpatient,,,7,2.80,,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.39,77,,4.31,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,5.74,82,,4.592,percent of total billed charges,82% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.25,75,,4.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.03,29,,1.624,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4.69,67,,3.752,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,4.55,65,,3.64,percent of total billed charges,65% of total billed charges,2.5,35.67,,2,percent of total billed charges,35.67% of total billed charges,2.03,6.3,
FLOVENT 110 MG INHALER,2504052,CDM,250,RC,,,outpatient,,,397,158.80,,337.45,85,,269.96,percent of total billed charges,85% of total billed charges,305.69,77,,244.55,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,325.54,82,,260.432,percent of total billed charges,82% of total billed charges,337.45,85,,269.96,percent of total billed charges,85% of total billed charges,337.45,85,,269.96,percent of total billed charges,85% of total billed charges,337.45,85,,269.96,percent of total billed charges,85% of total billed charges,357.3,90,,285.84,percent of total billed charges,90% of total billed charges,317.6,80,,254.08,percent of total billed charges,80% of total billed charges,357.3,90,,285.84,percent of total billed charges,90% of total billed charges,297.75,75,,238.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,115.13,29,,92.104,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,265.99,67,,212.792,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,317.6,80,,254.08,percent of total billed charges,80% of total billed charges,258.05,65,,206.44,percent of total billed charges,65% of total billed charges,141.61,35.67,,113.288,percent of total billed charges,35.67% of total billed charges,115.13,357.3,
FLORANEX TAB,2504055,CDM,250,RC,,,outpatient,,,6,2.40,,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,4.62,77,,3.7,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,4.92,82,,3.936,percent of total billed charges,82% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,5.4,90,,4.32,percent of total billed charges,90% of total billed charges,4.8,80,,3.84,percent of total billed charges,80% of total billed charges,5.4,90,,4.32,percent of total billed charges,90% of total billed charges,4.5,75,,3.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,1.74,29,,1.392,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4.02,67,,3.216,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,4.8,80,,3.84,percent of total billed charges,80% of total billed charges,3.9,65,,3.12,percent of total billed charges,65% of total billed charges,2.14,35.67,,1.712,percent of total billed charges,35.67% of total billed charges,1.74,5.4,
FLOXIN OTIC 0.3% 5ML DROP,2504078,CDM,250,RC,,,outpatient,,,399,159.60,,339.15,85,,271.32,percent of total billed charges,85% of total billed charges,307.23,77,,245.78,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,327.18,82,,261.744,percent of total billed charges,82% of total billed charges,339.15,85,,271.32,percent of total billed charges,85% of total billed charges,339.15,85,,271.32,percent of total billed charges,85% of total billed charges,339.15,85,,271.32,percent of total billed charges,85% of total billed charges,359.1,90,,287.28,percent of total billed charges,90% of total billed charges,319.2,80,,255.36,percent of total billed charges,80% of total billed charges,359.1,90,,287.28,percent of total billed charges,90% of total billed charges,299.25,75,,239.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,115.71,29,,92.568,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,267.33,67,,213.864,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,319.2,80,,255.36,percent of total billed charges,80% of total billed charges,259.35,65,,207.48,percent of total billed charges,65% of total billed charges,142.32,35.67,,113.856,percent of total billed charges,35.67% of total billed charges,115.71,359.1,
FLUOR-I-STRIP 9 MG TOPICAL,2504101,CDM,250,RC,,,outpatient,,,8,3.20,,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,6.16,77,,4.93,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,6.56,82,,5.248,percent of total billed charges,82% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,7.2,90,,5.76,percent of total billed charges,90% of total billed charges,6.4,80,,5.12,percent of total billed charges,80% of total billed charges,7.2,90,,5.76,percent of total billed charges,90% of total billed charges,6,75,,4.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.32,29,,1.856,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,5.36,67,,4.288,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,6.4,80,,5.12,percent of total billed charges,80% of total billed charges,5.2,65,,4.16,percent of total billed charges,65% of total billed charges,2.85,35.67,,2.28,percent of total billed charges,35.67% of total billed charges,2.32,7.2,
GASTROVIEW 30 ML BOTTLE,2504108,CDM,250,RC,,,outpatient,,,75,30.00,,63.75,85,,51,percent of total billed charges,85% of total billed charges,57.75,77,,46.2,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,61.5,82,,49.2,percent of total billed charges,82% of total billed charges,63.75,85,,51,percent of total billed charges,85% of total billed charges,63.75,85,,51,percent of total billed charges,85% of total billed charges,63.75,85,,51,percent of total billed charges,85% of total billed charges,67.5,90,,54,percent of total billed charges,90% of total billed charges,60,80,,48,percent of total billed charges,80% of total billed charges,67.5,90,,54,percent of total billed charges,90% of total billed charges,56.25,75,,45,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,21.75,29,,17.4,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,50.25,67,,40.2,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,60,80,,48,percent of total billed charges,80% of total billed charges,48.75,65,,39,percent of total billed charges,65% of total billed charges,26.75,35.67,,21.4,percent of total billed charges,35.67% of total billed charges,21.75,67.5,
FOLVITE 5 MG/ML PER 10ML VIAL,2504111,CDM,250,RC,,,outpatient,,,7,2.80,,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.39,77,,4.31,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,5.74,82,,4.592,percent of total billed charges,82% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.25,75,,4.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.03,29,,1.624,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4.69,67,,3.752,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,4.55,65,,3.64,percent of total billed charges,65% of total billed charges,2.5,35.67,,2,percent of total billed charges,35.67% of total billed charges,2.03,6.3,
GARAMYCIN CREAM 15 GRAM,2504195,CDM,250,RC,,,outpatient,,,182,72.80,,154.7,85,,123.76,percent of total billed charges,85% of total billed charges,140.14,77,,112.11,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,149.24,82,,119.392,percent of total billed charges,82% of total billed charges,154.7,85,,123.76,percent of total billed charges,85% of total billed charges,154.7,85,,123.76,percent of total billed charges,85% of total billed charges,154.7,85,,123.76,percent of total billed charges,85% of total billed charges,163.8,90,,131.04,percent of total billed charges,90% of total billed charges,145.6,80,,116.48,percent of total billed charges,80% of total billed charges,163.8,90,,131.04,percent of total billed charges,90% of total billed charges,136.5,75,,109.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,52.78,29,,42.224,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,121.94,67,,97.552,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,145.6,80,,116.48,percent of total billed charges,80% of total billed charges,118.3,65,,94.64,percent of total billed charges,65% of total billed charges,64.92,35.67,,51.936,percent of total billed charges,35.67% of total billed charges,52.78,163.8,
GENTAMICIN 30 GM TUBE,2504196,CDM,250,RC,,,outpatient,,,324,129.60,,275.4,85,,220.32,percent of total billed charges,85% of total billed charges,249.48,77,,199.58,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,265.68,82,,212.544,percent of total billed charges,82% of total billed charges,275.4,85,,220.32,percent of total billed charges,85% of total billed charges,275.4,85,,220.32,percent of total billed charges,85% of total billed charges,275.4,85,,220.32,percent of total billed charges,85% of total billed charges,291.6,90,,233.28,percent of total billed charges,90% of total billed charges,259.2,80,,207.36,percent of total billed charges,80% of total billed charges,291.6,90,,233.28,percent of total billed charges,90% of total billed charges,243,75,,194.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,93.96,29,,75.168,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,217.08,67,,173.664,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,259.2,80,,207.36,percent of total billed charges,80% of total billed charges,210.6,65,,168.48,percent of total billed charges,65% of total billed charges,115.57,35.67,,92.456,percent of total billed charges,35.67% of total billed charges,93.96,291.6,
GARAMYCIN OINTMENT 15 MG,2504200,CDM,250,RC,,,outpatient,,,122,48.80,,103.7,85,,82.96,percent of total billed charges,85% of total billed charges,93.94,77,,75.15,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,100.04,82,,80.032,percent of total billed charges,82% of total billed charges,103.7,85,,82.96,percent of total billed charges,85% of total billed charges,103.7,85,,82.96,percent of total billed charges,85% of total billed charges,103.7,85,,82.96,percent of total billed charges,85% of total billed charges,109.8,90,,87.84,percent of total billed charges,90% of total billed charges,97.6,80,,78.08,percent of total billed charges,80% of total billed charges,109.8,90,,87.84,percent of total billed charges,90% of total billed charges,91.5,75,,73.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,35.38,29,,28.304,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,81.74,67,,65.392,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,97.6,80,,78.08,percent of total billed charges,80% of total billed charges,79.3,65,,63.44,percent of total billed charges,65% of total billed charges,43.52,35.67,,34.816,percent of total billed charges,35.67% of total billed charges,35.38,109.8,
GARAMYCIN OPTH SOLUTION,2504205,CDM,250,RC,,,outpatient,,,81,32.40,,68.85,85,,55.08,percent of total billed charges,85% of total billed charges,62.37,77,,49.9,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,66.42,82,,53.136,percent of total billed charges,82% of total billed charges,68.85,85,,55.08,percent of total billed charges,85% of total billed charges,68.85,85,,55.08,percent of total billed charges,85% of total billed charges,68.85,85,,55.08,percent of total billed charges,85% of total billed charges,72.9,90,,58.32,percent of total billed charges,90% of total billed charges,64.8,80,,51.84,percent of total billed charges,80% of total billed charges,72.9,90,,58.32,percent of total billed charges,90% of total billed charges,60.75,75,,48.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,23.49,29,,18.792,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,54.27,67,,43.416,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,64.8,80,,51.84,percent of total billed charges,80% of total billed charges,52.65,65,,42.12,percent of total billed charges,65% of total billed charges,28.89,35.67,,23.112,percent of total billed charges,35.67% of total billed charges,23.49,72.9,
GARAMYCIN OPTH OINT,2504210,CDM,250,RC,,,outpatient,,,75,30.00,,63.75,85,,51,percent of total billed charges,85% of total billed charges,57.75,77,,46.2,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,61.5,82,,49.2,percent of total billed charges,82% of total billed charges,63.75,85,,51,percent of total billed charges,85% of total billed charges,63.75,85,,51,percent of total billed charges,85% of total billed charges,63.75,85,,51,percent of total billed charges,85% of total billed charges,67.5,90,,54,percent of total billed charges,90% of total billed charges,60,80,,48,percent of total billed charges,80% of total billed charges,67.5,90,,54,percent of total billed charges,90% of total billed charges,56.25,75,,45,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,21.75,29,,17.4,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,50.25,67,,40.2,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,60,80,,48,percent of total billed charges,80% of total billed charges,48.75,65,,39,percent of total billed charges,65% of total billed charges,26.75,35.67,,21.4,percent of total billed charges,35.67% of total billed charges,21.75,67.5,
GENERIC PIGGY BACK,2504213,CDM,250,RC,,,outpatient,,,40,16.00,,34,85,,27.2,percent of total billed charges,85% of total billed charges,30.8,77,,24.64,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,32.8,82,,26.24,percent of total billed charges,82% of total billed charges,34,85,,27.2,percent of total billed charges,85% of total billed charges,34,85,,27.2,percent of total billed charges,85% of total billed charges,34,85,,27.2,percent of total billed charges,85% of total billed charges,36,90,,28.8,percent of total billed charges,90% of total billed charges,32,80,,25.6,percent of total billed charges,80% of total billed charges,36,90,,28.8,percent of total billed charges,90% of total billed charges,30,75,,24,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,11.6,29,,9.28,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,26.8,67,,21.44,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,32,80,,25.6,percent of total billed charges,80% of total billed charges,26,65,,20.8,percent of total billed charges,65% of total billed charges,14.27,35.67,,11.416,percent of total billed charges,35.67% of total billed charges,11.6,36,
GEODON 20 MG CAPSULE,2504259,CDM,250,RC,,,outpatient,,,34,13.60,,28.9,85,,23.12,percent of total billed charges,85% of total billed charges,26.18,77,,20.94,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,27.88,82,,22.304,percent of total billed charges,82% of total billed charges,28.9,85,,23.12,percent of total billed charges,85% of total billed charges,28.9,85,,23.12,percent of total billed charges,85% of total billed charges,28.9,85,,23.12,percent of total billed charges,85% of total billed charges,30.6,90,,24.48,percent of total billed charges,90% of total billed charges,27.2,80,,21.76,percent of total billed charges,80% of total billed charges,30.6,90,,24.48,percent of total billed charges,90% of total billed charges,25.5,75,,20.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,9.86,29,,7.888,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,22.78,67,,18.224,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,27.2,80,,21.76,percent of total billed charges,80% of total billed charges,22.1,65,,17.68,percent of total billed charges,65% of total billed charges,12.13,35.67,,9.704,percent of total billed charges,35.67% of total billed charges,9.86,30.6,
GLUCOPHAGE 500 MG TAB,2504277,CDM,250,RC,,,outpatient,,,7,2.80,,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.39,77,,4.31,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,5.74,82,,4.592,percent of total billed charges,82% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.25,75,,4.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.03,29,,1.624,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4.69,67,,3.752,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,4.55,65,,3.64,percent of total billed charges,65% of total billed charges,2.5,35.67,,2,percent of total billed charges,35.67% of total billed charges,2.03,6.3,
GLUCOPHAGE 850 MG PO,2504279,CDM,250,RC,,,outpatient,,,10,4.00,,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,7.7,77,,6.16,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,8.2,82,,6.56,percent of total billed charges,82% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,9,90,,7.2,percent of total billed charges,90% of total billed charges,8,80,,6.4,percent of total billed charges,80% of total billed charges,9,90,,7.2,percent of total billed charges,90% of total billed charges,7.5,75,,6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.9,29,,2.32,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,6.7,67,,5.36,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,8,80,,6.4,percent of total billed charges,80% of total billed charges,6.5,65,,5.2,percent of total billed charges,65% of total billed charges,3.57,35.67,,2.856,percent of total billed charges,35.67% of total billed charges,2.9,9,
GLUCOTROL 5 MG TAB,2504295,CDM,250,RC,,,outpatient,,,7,2.80,,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.39,77,,4.31,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,5.74,82,,4.592,percent of total billed charges,82% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.25,75,,4.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.03,29,,1.624,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4.69,67,,3.752,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,4.55,65,,3.64,percent of total billed charges,65% of total billed charges,2.5,35.67,,2,percent of total billed charges,35.67% of total billed charges,2.03,6.3,
GLUTOSE 15 ORAL GEL,2504303,CDM,250,RC,,,outpatient,,,17,6.80,,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,13.09,77,,10.47,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,13.94,82,,11.152,percent of total billed charges,82% of total billed charges,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,15.3,90,,12.24,percent of total billed charges,90% of total billed charges,13.6,80,,10.88,percent of total billed charges,80% of total billed charges,15.3,90,,12.24,percent of total billed charges,90% of total billed charges,12.75,75,,10.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,4.93,29,,3.944,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,11.39,67,,9.112,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,13.6,80,,10.88,percent of total billed charges,80% of total billed charges,11.05,65,,8.84,percent of total billed charges,65% of total billed charges,6.06,35.67,,4.848,percent of total billed charges,35.67% of total billed charges,4.93,15.3,
GLYCERIN ADULT SUPPOS,2504305,CDM,250,RC,,,outpatient,,,8,3.20,,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,6.16,77,,4.93,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,6.56,82,,5.248,percent of total billed charges,82% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,7.2,90,,5.76,percent of total billed charges,90% of total billed charges,6.4,80,,5.12,percent of total billed charges,80% of total billed charges,7.2,90,,5.76,percent of total billed charges,90% of total billed charges,6,75,,4.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.32,29,,1.856,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,5.36,67,,4.288,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,6.4,80,,5.12,percent of total billed charges,80% of total billed charges,5.2,65,,4.16,percent of total billed charges,65% of total billed charges,2.85,35.67,,2.28,percent of total billed charges,35.67% of total billed charges,2.32,7.2,
GLUCLOSE 40% SYRINGE,2504306,CDM,250,RC,,,outpatient,,,10,4.00,,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,7.7,77,,6.16,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,8.2,82,,6.56,percent of total billed charges,82% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,9,90,,7.2,percent of total billed charges,90% of total billed charges,8,80,,6.4,percent of total billed charges,80% of total billed charges,9,90,,7.2,percent of total billed charges,90% of total billed charges,7.5,75,,6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.9,29,,2.32,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,6.7,67,,5.36,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,8,80,,6.4,percent of total billed charges,80% of total billed charges,6.5,65,,5.2,percent of total billed charges,65% of total billed charges,3.57,35.67,,2.856,percent of total billed charges,35.67% of total billed charges,2.9,9,
GLYCERIN SUPPOSITORY PEDI,2504310,CDM,250,RC,J3490,HCPCS,outpatient,,,8,3.20,,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,6.16,77,,4.93,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,6.56,82,,5.248,percent of total billed charges,82% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,7.2,90,,5.76,percent of total billed charges,90% of total billed charges,6.4,80,,5.12,percent of total billed charges,80% of total billed charges,7.2,90,,5.76,percent of total billed charges,90% of total billed charges,6,75,,4.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.32,29,,1.856,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,5.36,67,,4.288,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,6.4,80,,5.12,percent of total billed charges,80% of total billed charges,5.2,65,,4.16,percent of total billed charges,65% of total billed charges,2.85,35.67,,2.28,percent of total billed charges,35.67% of total billed charges,2.32,7.2,
GLYNASE 3 MG TAB,2504320,CDM,250,RC,,,outpatient,,,10,4.00,,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,7.7,77,,6.16,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,8.2,82,,6.56,percent of total billed charges,82% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,9,90,,7.2,percent of total billed charges,90% of total billed charges,8,80,,6.4,percent of total billed charges,80% of total billed charges,9,90,,7.2,percent of total billed charges,90% of total billed charges,7.5,75,,6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.9,29,,2.32,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,6.7,67,,5.36,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,8,80,,6.4,percent of total billed charges,80% of total billed charges,6.5,65,,5.2,percent of total billed charges,65% of total billed charges,3.57,35.67,,2.856,percent of total billed charges,35.67% of total billed charges,2.9,9,
GOLYTELY/COLYTE COLON PREP,2504330,CDM,250,RC,,,outpatient,,,87,34.80,,73.95,85,,59.16,percent of total billed charges,85% of total billed charges,66.99,77,,53.59,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,71.34,82,,57.072,percent of total billed charges,82% of total billed charges,73.95,85,,59.16,percent of total billed charges,85% of total billed charges,73.95,85,,59.16,percent of total billed charges,85% of total billed charges,73.95,85,,59.16,percent of total billed charges,85% of total billed charges,78.3,90,,62.64,percent of total billed charges,90% of total billed charges,69.6,80,,55.68,percent of total billed charges,80% of total billed charges,78.3,90,,62.64,percent of total billed charges,90% of total billed charges,65.25,75,,52.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,25.23,29,,20.184,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,58.29,67,,46.632,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,69.6,80,,55.68,percent of total billed charges,80% of total billed charges,56.55,65,,45.24,percent of total billed charges,65% of total billed charges,31.03,35.67,,24.824,percent of total billed charges,35.67% of total billed charges,25.23,78.3,
KLONOPIN .5 MG PO,2504341,CDM,250,RC,,,outpatient,,,12,4.80,,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,9.24,77,,7.39,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,9.84,82,,7.872,percent of total billed charges,82% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,10.8,90,,8.64,percent of total billed charges,90% of total billed charges,9.6,80,,7.68,percent of total billed charges,80% of total billed charges,10.8,90,,8.64,percent of total billed charges,90% of total billed charges,9,75,,7.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,3.48,29,,2.784,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,8.04,67,,6.432,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,9.6,80,,7.68,percent of total billed charges,80% of total billed charges,7.8,65,,6.24,percent of total billed charges,65% of total billed charges,4.28,35.67,,3.424,percent of total billed charges,35.67% of total billed charges,3.48,10.8,
HALDOL 2 MG TAB,2504405,CDM,250,RC,,,outpatient,,,7,2.80,,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.39,77,,4.31,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,5.74,82,,4.592,percent of total billed charges,82% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.25,75,,4.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.03,29,,1.624,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4.69,67,,3.752,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,4.55,65,,3.64,percent of total billed charges,65% of total billed charges,2.5,35.67,,2,percent of total billed charges,35.67% of total billed charges,2.03,6.3,
HEMABATE 250 MCG/ML AMP,2504481,CDM,250,RC,,,outpatient,,,663,265.20,,563.55,85,,450.84,percent of total billed charges,85% of total billed charges,510.51,77,,408.41,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,543.66,82,,434.928,percent of total billed charges,82% of total billed charges,563.55,85,,450.84,percent of total billed charges,85% of total billed charges,563.55,85,,450.84,percent of total billed charges,85% of total billed charges,563.55,85,,450.84,percent of total billed charges,85% of total billed charges,596.7,90,,477.36,percent of total billed charges,90% of total billed charges,530.4,80,,424.32,percent of total billed charges,80% of total billed charges,596.7,90,,477.36,percent of total billed charges,90% of total billed charges,497.25,75,,397.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,192.27,29,,153.816,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,444.21,67,,355.368,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,530.4,80,,424.32,percent of total billed charges,80% of total billed charges,430.95,65,,344.76,percent of total billed charges,65% of total billed charges,236.49,35.67,,189.192,percent of total billed charges,35.67% of total billed charges,192.27,596.7,
HEPARIN LOCK FLUSH 300 U 3ML,2504516,CDM,250,RC,,,outpatient,,,15,6.00,,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,11.55,77,,9.24,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,12.3,82,,9.84,percent of total billed charges,82% of total billed charges,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,13.5,90,,10.8,percent of total billed charges,90% of total billed charges,12,80,,9.6,percent of total billed charges,80% of total billed charges,13.5,90,,10.8,percent of total billed charges,90% of total billed charges,11.25,75,,9,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,4.35,29,,3.48,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,10.05,67,,8.04,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,12,80,,9.6,percent of total billed charges,80% of total billed charges,9.75,65,,7.8,percent of total billed charges,65% of total billed charges,5.35,35.67,,4.28,percent of total billed charges,35.67% of total billed charges,4.35,13.5,
HEPARIN LOCK FLUSH 100 UNIT ML,2504517,CDM,250,RC,,,outpatient,,,29,11.60,,24.65,85,,19.72,percent of total billed charges,85% of total billed charges,22.33,77,,17.86,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,23.78,82,,19.024,percent of total billed charges,82% of total billed charges,24.65,85,,19.72,percent of total billed charges,85% of total billed charges,24.65,85,,19.72,percent of total billed charges,85% of total billed charges,24.65,85,,19.72,percent of total billed charges,85% of total billed charges,26.1,90,,20.88,percent of total billed charges,90% of total billed charges,23.2,80,,18.56,percent of total billed charges,80% of total billed charges,26.1,90,,20.88,percent of total billed charges,90% of total billed charges,21.75,75,,17.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,8.41,29,,6.728,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,19.43,67,,15.544,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,23.2,80,,18.56,percent of total billed charges,80% of total billed charges,18.85,65,,15.08,percent of total billed charges,65% of total billed charges,10.34,35.67,,8.272,percent of total billed charges,35.67% of total billed charges,8.41,26.1,
HEPARIN PF 100 UNITS/10ML MDV,2504546,CDM,250,RC,,,outpatient,,,33,13.20,,28.05,85,,22.44,percent of total billed charges,85% of total billed charges,25.41,77,,20.33,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,27.06,82,,21.648,percent of total billed charges,82% of total billed charges,28.05,85,,22.44,percent of total billed charges,85% of total billed charges,28.05,85,,22.44,percent of total billed charges,85% of total billed charges,28.05,85,,22.44,percent of total billed charges,85% of total billed charges,29.7,90,,23.76,percent of total billed charges,90% of total billed charges,26.4,80,,21.12,percent of total billed charges,80% of total billed charges,29.7,90,,23.76,percent of total billed charges,90% of total billed charges,24.75,75,,19.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,9.57,29,,7.656,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,22.11,67,,17.688,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,26.4,80,,21.12,percent of total billed charges,80% of total billed charges,21.45,65,,17.16,percent of total billed charges,65% of total billed charges,11.77,35.67,,9.416,percent of total billed charges,35.67% of total billed charges,9.57,29.7,
HEPAT.B VAC.PEDI 2.5MG.5ML INJ,2504565,CDM,250,RC,,,outpatient,,,107,42.80,,90.95,85,,72.76,percent of total billed charges,85% of total billed charges,82.39,77,,65.91,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,87.74,82,,70.192,percent of total billed charges,82% of total billed charges,90.95,85,,72.76,percent of total billed charges,85% of total billed charges,90.95,85,,72.76,percent of total billed charges,85% of total billed charges,90.95,85,,72.76,percent of total billed charges,85% of total billed charges,96.3,90,,77.04,percent of total billed charges,90% of total billed charges,85.6,80,,68.48,percent of total billed charges,80% of total billed charges,96.3,90,,77.04,percent of total billed charges,90% of total billed charges,80.25,75,,64.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,31.03,29,,24.824,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,71.69,67,,57.352,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,85.6,80,,68.48,percent of total billed charges,80% of total billed charges,69.55,65,,55.64,percent of total billed charges,65% of total billed charges,38.17,35.67,,30.536,percent of total billed charges,35.67% of total billed charges,31.03,96.3,
HESPAN 6% 500 ML BAG,2504569,CDM,250,RC,,,outpatient,,,179,71.60,,152.15,85,,121.72,percent of total billed charges,85% of total billed charges,137.83,77,,110.26,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,146.78,82,,117.424,percent of total billed charges,82% of total billed charges,152.15,85,,121.72,percent of total billed charges,85% of total billed charges,152.15,85,,121.72,percent of total billed charges,85% of total billed charges,152.15,85,,121.72,percent of total billed charges,85% of total billed charges,161.1,90,,128.88,percent of total billed charges,90% of total billed charges,143.2,80,,114.56,percent of total billed charges,80% of total billed charges,161.1,90,,128.88,percent of total billed charges,90% of total billed charges,134.25,75,,107.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,51.91,29,,41.528,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,119.93,67,,95.944,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,143.2,80,,114.56,percent of total billed charges,80% of total billed charges,116.35,65,,93.08,percent of total billed charges,65% of total billed charges,63.85,35.67,,51.08,percent of total billed charges,35.67% of total billed charges,51.91,161.1,
HURRICANE SPRAY (TOPICAL),2504610,CDM,250,RC,,,outpatient,,,163,65.20,,138.55,85,,110.84,percent of total billed charges,85% of total billed charges,125.51,77,,100.41,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,133.66,82,,106.928,percent of total billed charges,82% of total billed charges,138.55,85,,110.84,percent of total billed charges,85% of total billed charges,138.55,85,,110.84,percent of total billed charges,85% of total billed charges,138.55,85,,110.84,percent of total billed charges,85% of total billed charges,146.7,90,,117.36,percent of total billed charges,90% of total billed charges,130.4,80,,104.32,percent of total billed charges,80% of total billed charges,146.7,90,,117.36,percent of total billed charges,90% of total billed charges,122.25,75,,97.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,47.27,29,,37.816,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,109.21,67,,87.368,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,130.4,80,,104.32,percent of total billed charges,80% of total billed charges,105.95,65,,84.76,percent of total billed charges,65% of total billed charges,58.14,35.67,,46.512,percent of total billed charges,35.67% of total billed charges,47.27,146.7,
HUMULIN 70/30  3 ML VIAL,2504612,CDM,250,RC,,,outpatient,,,110,44.00,,93.5,85,,74.8,percent of total billed charges,85% of total billed charges,84.7,77,,67.76,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,90.2,82,,72.16,percent of total billed charges,82% of total billed charges,93.5,85,,74.8,percent of total billed charges,85% of total billed charges,93.5,85,,74.8,percent of total billed charges,85% of total billed charges,93.5,85,,74.8,percent of total billed charges,85% of total billed charges,99,90,,79.2,percent of total billed charges,90% of total billed charges,88,80,,70.4,percent of total billed charges,80% of total billed charges,99,90,,79.2,percent of total billed charges,90% of total billed charges,82.5,75,,66,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,31.9,29,,25.52,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,73.7,67,,58.96,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,88,80,,70.4,percent of total billed charges,80% of total billed charges,71.5,65,,57.2,percent of total billed charges,65% of total billed charges,39.24,35.67,,31.392,percent of total billed charges,35.67% of total billed charges,31.9,99,
HUMULIN N 3 ML VIAL,2504613,CDM,250,RC,J1815,HCPCS,outpatient,,,122,48.80,,103.7,85,,82.96,percent of total billed charges,85% of total billed charges,93.94,77,,75.15,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,0.54,385,,,fee schedule,385% of BCBS fee schedule,0.56,401,,,fee schedule,401% of BCBS fee schedule,0.56,401,,,fee schedule,401% of BCBS fee schedule,0.56,401,,,fee schedule,401% of BCBS fee schedule,109.8,90,,87.84,percent of total billed charges,90% of total billed charges,97.6,80,,78.08,percent of total billed charges,80% of total billed charges,109.8,90,,87.84,percent of total billed charges,90% of total billed charges,91.5,75,,73.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,35.38,29,,28.304,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,81.74,67,,65.392,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,97.6,80,,78.08,percent of total billed charges,80% of total billed charges,79.3,65,,63.44,percent of total billed charges,65% of total billed charges,43.52,35.67,,34.816,percent of total billed charges,35.67% of total billed charges,0.54,109.8,
HUMULIN R 3ML VIAL,2504617,CDM,250,RC,,,outpatient,,,182,72.80,,154.7,85,,123.76,percent of total billed charges,85% of total billed charges,140.14,77,,112.11,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,149.24,82,,119.392,percent of total billed charges,82% of total billed charges,154.7,85,,123.76,percent of total billed charges,85% of total billed charges,154.7,85,,123.76,percent of total billed charges,85% of total billed charges,154.7,85,,123.76,percent of total billed charges,85% of total billed charges,163.8,90,,131.04,percent of total billed charges,90% of total billed charges,145.6,80,,116.48,percent of total billed charges,80% of total billed charges,163.8,90,,131.04,percent of total billed charges,90% of total billed charges,136.5,75,,109.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,52.78,29,,42.224,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,121.94,67,,97.552,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,145.6,80,,116.48,percent of total billed charges,80% of total billed charges,118.3,65,,94.64,percent of total billed charges,65% of total billed charges,64.92,35.67,,51.936,percent of total billed charges,35.67% of total billed charges,52.78,163.8,
HYOSYNE 0.125 MG,2504622,CDM,250,RC,,,outpatient,,,9,3.60,,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,6.93,77,,5.54,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,7.38,82,,5.904,percent of total billed charges,82% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,8.1,90,,6.48,percent of total billed charges,90% of total billed charges,7.2,80,,5.76,percent of total billed charges,80% of total billed charges,8.1,90,,6.48,percent of total billed charges,90% of total billed charges,6.75,75,,5.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.61,29,,2.088,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,6.03,67,,4.824,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,7.2,80,,5.76,percent of total billed charges,80% of total billed charges,5.85,65,,4.68,percent of total billed charges,65% of total billed charges,3.21,35.67,,2.568,percent of total billed charges,35.67% of total billed charges,2.61,8.1,
HYDROCHLORTHIAZIDE 25 MG/TAB,2504655,CDM,250,RC,,,outpatient,,,7,2.80,,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.39,77,,4.31,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,5.74,82,,4.592,percent of total billed charges,82% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.25,75,,4.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.03,29,,1.624,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4.69,67,,3.752,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,4.55,65,,3.64,percent of total billed charges,65% of total billed charges,2.5,35.67,,2,percent of total billed charges,35.67% of total billed charges,2.03,6.3,
HYDROXOCOBALAMIN 30MG/30ML,2504659,CDM,250,RC,,,outpatient,,,194,77.60,,164.9,85,,131.92,percent of total billed charges,85% of total billed charges,149.38,77,,119.5,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,159.08,82,,127.264,percent of total billed charges,82% of total billed charges,164.9,85,,131.92,percent of total billed charges,85% of total billed charges,164.9,85,,131.92,percent of total billed charges,85% of total billed charges,164.9,85,,131.92,percent of total billed charges,85% of total billed charges,174.6,90,,139.68,percent of total billed charges,90% of total billed charges,155.2,80,,124.16,percent of total billed charges,80% of total billed charges,174.6,90,,139.68,percent of total billed charges,90% of total billed charges,145.5,75,,116.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,56.26,29,,45.008,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,129.98,67,,103.984,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,155.2,80,,124.16,percent of total billed charges,80% of total billed charges,126.1,65,,100.88,percent of total billed charges,65% of total billed charges,69.2,35.67,,55.36,percent of total billed charges,35.67% of total billed charges,56.26,174.6,
HYGROTON 100 MG INJ.,2504695,CDM,250,RC,,,outpatient,,,7,2.80,,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.39,77,,4.31,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,5.74,82,,4.592,percent of total billed charges,82% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.25,75,,4.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.03,29,,1.624,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4.69,67,,3.752,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,4.55,65,,3.64,percent of total billed charges,65% of total billed charges,2.5,35.67,,2,percent of total billed charges,35.67% of total billed charges,2.03,6.3,
HYTONE 2.5% CREAM 1 OZ. TOP.,2504735,CDM,250,RC,,,outpatient,,,157,62.80,,133.45,85,,106.76,percent of total billed charges,85% of total billed charges,120.89,77,,96.71,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,128.74,82,,102.992,percent of total billed charges,82% of total billed charges,133.45,85,,106.76,percent of total billed charges,85% of total billed charges,133.45,85,,106.76,percent of total billed charges,85% of total billed charges,133.45,85,,106.76,percent of total billed charges,85% of total billed charges,141.3,90,,113.04,percent of total billed charges,90% of total billed charges,125.6,80,,100.48,percent of total billed charges,80% of total billed charges,141.3,90,,113.04,percent of total billed charges,90% of total billed charges,117.75,75,,94.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,45.53,29,,36.424,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,105.19,67,,84.152,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,125.6,80,,100.48,percent of total billed charges,80% of total billed charges,102.05,65,,81.64,percent of total billed charges,65% of total billed charges,56,35.67,,44.8,percent of total billed charges,35.67% of total billed charges,45.53,141.3,
HYTONE 1% 15 GM TUBE,2504736,CDM,250,RC,,,outpatient,,,18,7.20,,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,13.86,77,,11.09,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,14.76,82,,11.808,percent of total billed charges,82% of total billed charges,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,16.2,90,,12.96,percent of total billed charges,90% of total billed charges,14.4,80,,11.52,percent of total billed charges,80% of total billed charges,16.2,90,,12.96,percent of total billed charges,90% of total billed charges,13.5,75,,10.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,5.22,29,,4.176,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,12.06,67,,9.648,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,14.4,80,,11.52,percent of total billed charges,80% of total billed charges,11.7,65,,9.36,percent of total billed charges,65% of total billed charges,6.42,35.67,,5.136,percent of total billed charges,35.67% of total billed charges,5.22,16.2,
HYTRIN 1 MG TAB,2504745,CDM,250,RC,,,outpatient,,,9,3.60,,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,6.93,77,,5.54,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,7.38,82,,5.904,percent of total billed charges,82% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,8.1,90,,6.48,percent of total billed charges,90% of total billed charges,7.2,80,,5.76,percent of total billed charges,80% of total billed charges,8.1,90,,6.48,percent of total billed charges,90% of total billed charges,6.75,75,,5.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.61,29,,2.088,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,6.03,67,,4.824,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,7.2,80,,5.76,percent of total billed charges,80% of total billed charges,5.85,65,,4.68,percent of total billed charges,65% of total billed charges,3.21,35.67,,2.568,percent of total billed charges,35.67% of total billed charges,2.61,8.1,
HYTRIN 5 MG TAB,2504755,CDM,250,RC,,,outpatient,,,9,3.60,,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,6.93,77,,5.54,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,7.38,82,,5.904,percent of total billed charges,82% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,8.1,90,,6.48,percent of total billed charges,90% of total billed charges,7.2,80,,5.76,percent of total billed charges,80% of total billed charges,8.1,90,,6.48,percent of total billed charges,90% of total billed charges,6.75,75,,5.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.61,29,,2.088,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,6.03,67,,4.824,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,7.2,80,,5.76,percent of total billed charges,80% of total billed charges,5.85,65,,4.68,percent of total billed charges,65% of total billed charges,3.21,35.67,,2.568,percent of total billed charges,35.67% of total billed charges,2.61,8.1,
ILOTYCIN OPTH OINT,2504815,CDM,250,RC,,,outpatient,,,48,19.20,,40.8,85,,32.64,percent of total billed charges,85% of total billed charges,36.96,77,,29.57,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,39.36,82,,31.488,percent of total billed charges,82% of total billed charges,40.8,85,,32.64,percent of total billed charges,85% of total billed charges,40.8,85,,32.64,percent of total billed charges,85% of total billed charges,40.8,85,,32.64,percent of total billed charges,85% of total billed charges,43.2,90,,34.56,percent of total billed charges,90% of total billed charges,38.4,80,,30.72,percent of total billed charges,80% of total billed charges,43.2,90,,34.56,percent of total billed charges,90% of total billed charges,36,75,,28.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,13.92,29,,11.136,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,32.16,67,,25.728,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,38.4,80,,30.72,percent of total billed charges,80% of total billed charges,31.2,65,,24.96,percent of total billed charges,65% of total billed charges,17.12,35.67,,13.696,percent of total billed charges,35.67% of total billed charges,13.92,43.2,
IMDUR ER 30 MG,2504824,CDM,250,RC,,,outpatient,,,15,6.00,,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,11.55,77,,9.24,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,12.3,82,,9.84,percent of total billed charges,82% of total billed charges,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,13.5,90,,10.8,percent of total billed charges,90% of total billed charges,12,80,,9.6,percent of total billed charges,80% of total billed charges,13.5,90,,10.8,percent of total billed charges,90% of total billed charges,11.25,75,,9,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,4.35,29,,3.48,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,10.05,67,,8.04,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,12,80,,9.6,percent of total billed charges,80% of total billed charges,9.75,65,,7.8,percent of total billed charges,65% of total billed charges,5.35,35.67,,4.28,percent of total billed charges,35.67% of total billed charges,4.35,13.5,
IMITREX 25 MG TAB,2504836,CDM,250,RC,,,outpatient,,,124,49.60,,105.4,85,,84.32,percent of total billed charges,85% of total billed charges,95.48,77,,76.38,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,101.68,82,,81.344,percent of total billed charges,82% of total billed charges,105.4,85,,84.32,percent of total billed charges,85% of total billed charges,105.4,85,,84.32,percent of total billed charges,85% of total billed charges,105.4,85,,84.32,percent of total billed charges,85% of total billed charges,111.6,90,,89.28,percent of total billed charges,90% of total billed charges,99.2,80,,79.36,percent of total billed charges,80% of total billed charges,111.6,90,,89.28,percent of total billed charges,90% of total billed charges,93,75,,74.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,35.96,29,,28.768,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,83.08,67,,66.464,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,99.2,80,,79.36,percent of total billed charges,80% of total billed charges,80.6,65,,64.48,percent of total billed charges,65% of total billed charges,44.23,35.67,,35.384,percent of total billed charges,35.67% of total billed charges,35.96,111.6,
LOPERAMIDE HCL 15MG,2504846,CDM,250,RC,,,outpatient,,,10,4.00,,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,7.7,77,,6.16,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,8.2,82,,6.56,percent of total billed charges,82% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,9,90,,7.2,percent of total billed charges,90% of total billed charges,8,80,,6.4,percent of total billed charges,80% of total billed charges,9,90,,7.2,percent of total billed charges,90% of total billed charges,7.5,75,,6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.9,29,,2.32,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,6.7,67,,5.36,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,8,80,,6.4,percent of total billed charges,80% of total billed charges,6.5,65,,5.2,percent of total billed charges,65% of total billed charges,3.57,35.67,,2.856,percent of total billed charges,35.67% of total billed charges,2.9,9,
IMODIUM TAB,2504850,CDM,250,RC,,,outpatient,,,7,2.80,,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.39,77,,4.31,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,5.74,82,,4.592,percent of total billed charges,82% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.25,75,,4.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.03,29,,1.624,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4.69,67,,3.752,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,4.55,65,,3.64,percent of total billed charges,65% of total billed charges,2.5,35.67,,2,percent of total billed charges,35.67% of total billed charges,2.03,6.3,
INDERAL 10 MG TAB,2504870,CDM,250,RC,,,outpatient,,,7,2.80,,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.39,77,,4.31,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,5.74,82,,4.592,percent of total billed charges,82% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.25,75,,4.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.03,29,,1.624,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4.69,67,,3.752,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,4.55,65,,3.64,percent of total billed charges,65% of total billed charges,2.5,35.67,,2,percent of total billed charges,35.67% of total billed charges,2.03,6.3,
INDERAL 40 MG TAB,2504880,CDM,250,RC,,,outpatient,,,7,2.80,,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.39,77,,4.31,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,5.74,82,,4.592,percent of total billed charges,82% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.25,75,,4.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.03,29,,1.624,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4.69,67,,3.752,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,4.55,65,,3.64,percent of total billed charges,65% of total billed charges,2.5,35.67,,2,percent of total billed charges,35.67% of total billed charges,2.03,6.3,
HECTORAL 2 MCG/ML,2504882,CDM,250,RC,,,outpatient,,,13,5.20,,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,10.01,77,,8.01,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,10.66,82,,8.528,percent of total billed charges,82% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,11.7,90,,9.36,percent of total billed charges,90% of total billed charges,10.4,80,,8.32,percent of total billed charges,80% of total billed charges,11.7,90,,9.36,percent of total billed charges,90% of total billed charges,9.75,75,,7.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,3.77,29,,3.016,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,8.71,67,,6.968,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,10.4,80,,8.32,percent of total billed charges,80% of total billed charges,8.45,65,,6.76,percent of total billed charges,65% of total billed charges,4.64,35.67,,3.712,percent of total billed charges,35.67% of total billed charges,3.77,11.7,
INDOMETHACIN 25 MG PO,2504911,CDM,250,RC,,,outpatient,,,8,3.20,,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,6.16,77,,4.93,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,6.56,82,,5.248,percent of total billed charges,82% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,7.2,90,,5.76,percent of total billed charges,90% of total billed charges,6.4,80,,5.12,percent of total billed charges,80% of total billed charges,7.2,90,,5.76,percent of total billed charges,90% of total billed charges,6,75,,4.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.32,29,,1.856,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,5.36,67,,4.288,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,6.4,80,,5.12,percent of total billed charges,80% of total billed charges,5.2,65,,4.16,percent of total billed charges,65% of total billed charges,2.85,35.67,,2.28,percent of total billed charges,35.67% of total billed charges,2.32,7.2,
INTEGRA CAP,2504997,CDM,250,RC,,,outpatient,,,7,2.80,,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.39,77,,4.31,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,5.74,82,,4.592,percent of total billed charges,82% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.25,75,,4.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.03,29,,1.624,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4.69,67,,3.752,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,4.55,65,,3.64,percent of total billed charges,65% of total billed charges,2.5,35.67,,2,percent of total billed charges,35.67% of total billed charges,2.03,6.3,
INTEGRA PLUS CAP,2505002,CDM,250,RC,,,outpatient,,,7,2.80,,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.39,77,,4.31,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,5.74,82,,4.592,percent of total billed charges,82% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.25,75,,4.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.03,29,,1.624,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4.69,67,,3.752,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,4.55,65,,3.64,percent of total billed charges,65% of total billed charges,2.5,35.67,,2,percent of total billed charges,35.67% of total billed charges,2.03,6.3,
ISMO TABS 20 MGS,2505025,CDM,250,RC,,,outpatient,,,7,2.80,,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.39,77,,4.31,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,5.74,82,,4.592,percent of total billed charges,82% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.25,75,,4.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.03,29,,1.624,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4.69,67,,3.752,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,4.55,65,,3.64,percent of total billed charges,65% of total billed charges,2.5,35.67,,2,percent of total billed charges,35.67% of total billed charges,2.03,6.3,
ISOPTIN INJ 5MG/2CC,2505060,CDM,250,RC,,,outpatient,,,118,47.20,,100.3,85,,80.24,percent of total billed charges,85% of total billed charges,90.86,77,,72.69,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,96.76,82,,77.408,percent of total billed charges,82% of total billed charges,100.3,85,,80.24,percent of total billed charges,85% of total billed charges,100.3,85,,80.24,percent of total billed charges,85% of total billed charges,100.3,85,,80.24,percent of total billed charges,85% of total billed charges,106.2,90,,84.96,percent of total billed charges,90% of total billed charges,94.4,80,,75.52,percent of total billed charges,80% of total billed charges,106.2,90,,84.96,percent of total billed charges,90% of total billed charges,88.5,75,,70.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,34.22,29,,27.376,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,79.06,67,,63.248,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,94.4,80,,75.52,percent of total billed charges,80% of total billed charges,76.7,65,,61.36,percent of total billed charges,65% of total billed charges,42.09,35.67,,33.672,percent of total billed charges,35.67% of total billed charges,34.22,106.2,
ISOPTO CARPINE 1% OPTH SOL.,2505070,CDM,250,RC,,,outpatient,,,329,131.60,,279.65,85,,223.72,percent of total billed charges,85% of total billed charges,253.33,77,,202.66,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,269.78,82,,215.824,percent of total billed charges,82% of total billed charges,279.65,85,,223.72,percent of total billed charges,85% of total billed charges,279.65,85,,223.72,percent of total billed charges,85% of total billed charges,279.65,85,,223.72,percent of total billed charges,85% of total billed charges,296.1,90,,236.88,percent of total billed charges,90% of total billed charges,263.2,80,,210.56,percent of total billed charges,80% of total billed charges,296.1,90,,236.88,percent of total billed charges,90% of total billed charges,246.75,75,,197.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,95.41,29,,76.328,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,220.43,67,,176.344,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,263.2,80,,210.56,percent of total billed charges,80% of total billed charges,213.85,65,,171.08,percent of total billed charges,65% of total billed charges,117.35,35.67,,93.88,percent of total billed charges,35.67% of total billed charges,95.41,296.1,
ISONIAZID TABLET,2505076,CDM,250,RC,,,outpatient,,,18,7.20,,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,13.86,77,,11.09,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,14.76,82,,11.808,percent of total billed charges,82% of total billed charges,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,16.2,90,,12.96,percent of total billed charges,90% of total billed charges,14.4,80,,11.52,percent of total billed charges,80% of total billed charges,16.2,90,,12.96,percent of total billed charges,90% of total billed charges,13.5,75,,10.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,5.22,29,,4.176,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,12.06,67,,9.648,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,14.4,80,,11.52,percent of total billed charges,80% of total billed charges,11.7,65,,9.36,percent of total billed charges,65% of total billed charges,6.42,35.67,,5.136,percent of total billed charges,35.67% of total billed charges,5.22,16.2,
JANUVIA 25 MG TAB,2505117,CDM,250,RC,,,outpatient,,,54,21.60,,45.9,85,,36.72,percent of total billed charges,85% of total billed charges,41.58,77,,33.26,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,44.28,82,,35.424,percent of total billed charges,82% of total billed charges,45.9,85,,36.72,percent of total billed charges,85% of total billed charges,45.9,85,,36.72,percent of total billed charges,85% of total billed charges,45.9,85,,36.72,percent of total billed charges,85% of total billed charges,48.6,90,,38.88,percent of total billed charges,90% of total billed charges,43.2,80,,34.56,percent of total billed charges,80% of total billed charges,48.6,90,,38.88,percent of total billed charges,90% of total billed charges,40.5,75,,32.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,15.66,29,,12.528,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,36.18,67,,28.944,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,43.2,80,,34.56,percent of total billed charges,80% of total billed charges,35.1,65,,28.08,percent of total billed charges,65% of total billed charges,19.26,35.67,,15.408,percent of total billed charges,35.67% of total billed charges,15.66,48.6,
ISORDIL 20 MG TAB,2505130,CDM,250,RC,,,outpatient,,,12,4.80,,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,9.24,77,,7.39,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,9.84,82,,7.872,percent of total billed charges,82% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,10.8,90,,8.64,percent of total billed charges,90% of total billed charges,9.6,80,,7.68,percent of total billed charges,80% of total billed charges,10.8,90,,8.64,percent of total billed charges,90% of total billed charges,9,75,,7.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,3.48,29,,2.784,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,8.04,67,,6.432,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,9.6,80,,7.68,percent of total billed charges,80% of total billed charges,7.8,65,,6.24,percent of total billed charges,65% of total billed charges,4.28,35.67,,3.424,percent of total billed charges,35.67% of total billed charges,3.48,10.8,
K-DUR 20 MEQ TAB,2505170,CDM,250,RC,,,outpatient,,,13,5.20,,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,10.01,77,,8.01,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,10.66,82,,8.528,percent of total billed charges,82% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,11.7,90,,9.36,percent of total billed charges,90% of total billed charges,10.4,80,,8.32,percent of total billed charges,80% of total billed charges,11.7,90,,9.36,percent of total billed charges,90% of total billed charges,9.75,75,,7.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,3.77,29,,3.016,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,8.71,67,,6.968,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,10.4,80,,8.32,percent of total billed charges,80% of total billed charges,8.45,65,,6.76,percent of total billed charges,65% of total billed charges,4.64,35.67,,3.712,percent of total billed charges,35.67% of total billed charges,3.77,11.7,
K-LYTE TABS,2505180,CDM,250,RC,,,outpatient,,,7,2.80,,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.39,77,,4.31,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,5.74,82,,4.592,percent of total billed charges,82% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.25,75,,4.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.03,29,,1.624,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4.69,67,,3.752,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,4.55,65,,3.64,percent of total billed charges,65% of total billed charges,2.5,35.67,,2,percent of total billed charges,35.67% of total billed charges,2.03,6.3,
KAYEXALATE PER DOSE 15 GR/60ML,2505225,CDM,250,RC,,,outpatient,,,44,17.60,,37.4,85,,29.92,percent of total billed charges,85% of total billed charges,33.88,77,,27.1,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,36.08,82,,28.864,percent of total billed charges,82% of total billed charges,37.4,85,,29.92,percent of total billed charges,85% of total billed charges,37.4,85,,29.92,percent of total billed charges,85% of total billed charges,37.4,85,,29.92,percent of total billed charges,85% of total billed charges,39.6,90,,31.68,percent of total billed charges,90% of total billed charges,35.2,80,,28.16,percent of total billed charges,80% of total billed charges,39.6,90,,31.68,percent of total billed charges,90% of total billed charges,33,75,,26.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,12.76,29,,10.208,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,29.48,67,,23.584,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,35.2,80,,28.16,percent of total billed charges,80% of total billed charges,28.6,65,,22.88,percent of total billed charges,65% of total billed charges,15.69,35.67,,12.552,percent of total billed charges,35.67% of total billed charges,12.76,39.6,
KEFLEX 250 MG CAP,2505230,CDM,250,RC,,,outpatient,,,38,15.20,,32.3,85,,25.84,percent of total billed charges,85% of total billed charges,29.26,77,,23.41,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,31.16,82,,24.928,percent of total billed charges,82% of total billed charges,32.3,85,,25.84,percent of total billed charges,85% of total billed charges,32.3,85,,25.84,percent of total billed charges,85% of total billed charges,32.3,85,,25.84,percent of total billed charges,85% of total billed charges,34.2,90,,27.36,percent of total billed charges,90% of total billed charges,30.4,80,,24.32,percent of total billed charges,80% of total billed charges,34.2,90,,27.36,percent of total billed charges,90% of total billed charges,28.5,75,,22.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,11.02,29,,8.816,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,25.46,67,,20.368,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,30.4,80,,24.32,percent of total billed charges,80% of total billed charges,24.7,65,,19.76,percent of total billed charges,65% of total billed charges,13.55,35.67,,10.84,percent of total billed charges,35.67% of total billed charges,11.02,34.2,
KEFLEX 250 MG/5 & 100 CC (BTL),2505235,CDM,250,RC,,,outpatient,,,107,42.80,,90.95,85,,72.76,percent of total billed charges,85% of total billed charges,82.39,77,,65.91,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,87.74,82,,70.192,percent of total billed charges,82% of total billed charges,90.95,85,,72.76,percent of total billed charges,85% of total billed charges,90.95,85,,72.76,percent of total billed charges,85% of total billed charges,90.95,85,,72.76,percent of total billed charges,85% of total billed charges,96.3,90,,77.04,percent of total billed charges,90% of total billed charges,85.6,80,,68.48,percent of total billed charges,80% of total billed charges,96.3,90,,77.04,percent of total billed charges,90% of total billed charges,80.25,75,,64.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,31.03,29,,24.824,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,71.69,67,,57.352,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,85.6,80,,68.48,percent of total billed charges,80% of total billed charges,69.55,65,,55.64,percent of total billed charges,65% of total billed charges,38.17,35.67,,30.536,percent of total billed charges,35.67% of total billed charges,31.03,96.3,
KENALOG IN ORABASE GEL,2505300,CDM,250,RC,,,outpatient,,,269,107.60,,228.65,85,,182.92,percent of total billed charges,85% of total billed charges,207.13,77,,165.7,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,220.58,82,,176.464,percent of total billed charges,82% of total billed charges,228.65,85,,182.92,percent of total billed charges,85% of total billed charges,228.65,85,,182.92,percent of total billed charges,85% of total billed charges,228.65,85,,182.92,percent of total billed charges,85% of total billed charges,242.1,90,,193.68,percent of total billed charges,90% of total billed charges,215.2,80,,172.16,percent of total billed charges,80% of total billed charges,242.1,90,,193.68,percent of total billed charges,90% of total billed charges,201.75,75,,161.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,78.01,29,,62.408,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,180.23,67,,144.184,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,215.2,80,,172.16,percent of total billed charges,80% of total billed charges,174.85,65,,139.88,percent of total billed charges,65% of total billed charges,95.95,35.67,,76.76,percent of total billed charges,35.67% of total billed charges,78.01,242.1,
KEPPRA 500 MG TAB,2505314,CDM,250,RC,,,outpatient,,,15,6.00,,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,11.55,77,,9.24,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,12.3,82,,9.84,percent of total billed charges,82% of total billed charges,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,13.5,90,,10.8,percent of total billed charges,90% of total billed charges,12,80,,9.6,percent of total billed charges,80% of total billed charges,13.5,90,,10.8,percent of total billed charges,90% of total billed charges,11.25,75,,9,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,4.35,29,,3.48,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,10.05,67,,8.04,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,12,80,,9.6,percent of total billed charges,80% of total billed charges,9.75,65,,7.8,percent of total billed charges,65% of total billed charges,5.35,35.67,,4.28,percent of total billed charges,35.67% of total billed charges,4.35,13.5,
KETALAR (KETAMINE)INJ 50MG/1CC,2505320,CDM,250,RC,,,outpatient,,,22,8.80,,18.7,85,,14.96,percent of total billed charges,85% of total billed charges,16.94,77,,13.55,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,18.04,82,,14.432,percent of total billed charges,82% of total billed charges,18.7,85,,14.96,percent of total billed charges,85% of total billed charges,18.7,85,,14.96,percent of total billed charges,85% of total billed charges,18.7,85,,14.96,percent of total billed charges,85% of total billed charges,19.8,90,,15.84,percent of total billed charges,90% of total billed charges,17.6,80,,14.08,percent of total billed charges,80% of total billed charges,19.8,90,,15.84,percent of total billed charges,90% of total billed charges,16.5,75,,13.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,6.38,29,,5.104,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,14.74,67,,11.792,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,17.6,80,,14.08,percent of total billed charges,80% of total billed charges,14.3,65,,11.44,percent of total billed charges,65% of total billed charges,7.85,35.67,,6.28,percent of total billed charges,35.67% of total billed charges,6.38,19.8,
KETALAR 100 MG/ML,2505322,CDM,250,RC,,,outpatient,,,46,18.40,,39.1,85,,31.28,percent of total billed charges,85% of total billed charges,35.42,77,,28.34,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,37.72,82,,30.176,percent of total billed charges,82% of total billed charges,39.1,85,,31.28,percent of total billed charges,85% of total billed charges,39.1,85,,31.28,percent of total billed charges,85% of total billed charges,39.1,85,,31.28,percent of total billed charges,85% of total billed charges,41.4,90,,33.12,percent of total billed charges,90% of total billed charges,36.8,80,,29.44,percent of total billed charges,80% of total billed charges,41.4,90,,33.12,percent of total billed charges,90% of total billed charges,34.5,75,,27.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,13.34,29,,10.672,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,30.82,67,,24.656,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,36.8,80,,29.44,percent of total billed charges,80% of total billed charges,29.9,65,,23.92,percent of total billed charges,65% of total billed charges,16.41,35.67,,13.128,percent of total billed charges,35.67% of total billed charges,13.34,41.4,
KETAMINE 200 MG INJ,2505325,CDM,250,RC,,,outpatient,,,39,15.60,,33.15,85,,26.52,percent of total billed charges,85% of total billed charges,30.03,77,,24.02,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,31.98,82,,25.584,percent of total billed charges,82% of total billed charges,33.15,85,,26.52,percent of total billed charges,85% of total billed charges,33.15,85,,26.52,percent of total billed charges,85% of total billed charges,33.15,85,,26.52,percent of total billed charges,85% of total billed charges,35.1,90,,28.08,percent of total billed charges,90% of total billed charges,31.2,80,,24.96,percent of total billed charges,80% of total billed charges,35.1,90,,28.08,percent of total billed charges,90% of total billed charges,29.25,75,,23.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,11.31,29,,9.048,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,26.13,67,,20.904,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,31.2,80,,24.96,percent of total billed charges,80% of total billed charges,25.35,65,,20.28,percent of total billed charges,65% of total billed charges,13.91,35.67,,11.128,percent of total billed charges,35.67% of total billed charges,11.31,35.1,
KEPPRA 500 MG/5 ML UDC,2505326,CDM,250,RC,,,outpatient,,,36,14.40,,30.6,85,,24.48,percent of total billed charges,85% of total billed charges,27.72,77,,22.18,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,29.52,82,,23.616,percent of total billed charges,82% of total billed charges,30.6,85,,24.48,percent of total billed charges,85% of total billed charges,30.6,85,,24.48,percent of total billed charges,85% of total billed charges,30.6,85,,24.48,percent of total billed charges,85% of total billed charges,32.4,90,,25.92,percent of total billed charges,90% of total billed charges,28.8,80,,23.04,percent of total billed charges,80% of total billed charges,32.4,90,,25.92,percent of total billed charges,90% of total billed charges,27,75,,21.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,10.44,29,,8.352,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,24.12,67,,19.296,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,28.8,80,,23.04,percent of total billed charges,80% of total billed charges,23.4,65,,18.72,percent of total billed charges,65% of total billed charges,12.84,35.67,,10.272,percent of total billed charges,35.67% of total billed charges,10.44,32.4,
GUAIFENESIN/DEXTROMETH 200 MG,2505331,CDM,250,RC,,,outpatient,,,13,5.20,,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,10.01,77,,8.01,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,10.66,82,,8.528,percent of total billed charges,82% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,11.7,90,,9.36,percent of total billed charges,90% of total billed charges,10.4,80,,8.32,percent of total billed charges,80% of total billed charges,11.7,90,,9.36,percent of total billed charges,90% of total billed charges,9.75,75,,7.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,3.77,29,,3.016,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,8.71,67,,6.968,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,10.4,80,,8.32,percent of total billed charges,80% of total billed charges,8.45,65,,6.76,percent of total billed charges,65% of total billed charges,4.64,35.67,,3.712,percent of total billed charges,35.67% of total billed charges,3.77,11.7,
GUAIFENESIN WITH CODEINE 10ML,2505332,CDM,250,RC,,,outpatient,,,8,3.20,,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,6.16,77,,4.93,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,6.56,82,,5.248,percent of total billed charges,82% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,7.2,90,,5.76,percent of total billed charges,90% of total billed charges,6.4,80,,5.12,percent of total billed charges,80% of total billed charges,7.2,90,,5.76,percent of total billed charges,90% of total billed charges,6,75,,4.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.32,29,,1.856,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,5.36,67,,4.288,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,6.4,80,,5.12,percent of total billed charges,80% of total billed charges,5.2,65,,4.16,percent of total billed charges,65% of total billed charges,2.85,35.67,,2.28,percent of total billed charges,35.67% of total billed charges,2.32,7.2,
KETAMINE PED DOSE INJ. 10MG,2505335,CDM,250,RC,,,outpatient,,,44,17.60,,37.4,85,,29.92,percent of total billed charges,85% of total billed charges,33.88,77,,27.1,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,36.08,82,,28.864,percent of total billed charges,82% of total billed charges,37.4,85,,29.92,percent of total billed charges,85% of total billed charges,37.4,85,,29.92,percent of total billed charges,85% of total billed charges,37.4,85,,29.92,percent of total billed charges,85% of total billed charges,39.6,90,,31.68,percent of total billed charges,90% of total billed charges,35.2,80,,28.16,percent of total billed charges,80% of total billed charges,39.6,90,,31.68,percent of total billed charges,90% of total billed charges,33,75,,26.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,12.76,29,,10.208,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,29.48,67,,23.584,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,35.2,80,,28.16,percent of total billed charges,80% of total billed charges,28.6,65,,22.88,percent of total billed charges,65% of total billed charges,15.69,35.67,,12.552,percent of total billed charges,35.67% of total billed charges,12.76,39.6,
KWELL (LINDANE) SHAMPOO,2505370,CDM,250,RC,,,outpatient,,,373,149.20,,317.05,85,,253.64,percent of total billed charges,85% of total billed charges,287.21,77,,229.77,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,305.86,82,,244.688,percent of total billed charges,82% of total billed charges,317.05,85,,253.64,percent of total billed charges,85% of total billed charges,317.05,85,,253.64,percent of total billed charges,85% of total billed charges,317.05,85,,253.64,percent of total billed charges,85% of total billed charges,335.7,90,,268.56,percent of total billed charges,90% of total billed charges,298.4,80,,238.72,percent of total billed charges,80% of total billed charges,335.7,90,,268.56,percent of total billed charges,90% of total billed charges,279.75,75,,223.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,108.17,29,,86.536,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,249.91,67,,199.928,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,298.4,80,,238.72,percent of total billed charges,80% of total billed charges,242.45,65,,193.96,percent of total billed charges,65% of total billed charges,133.05,35.67,,106.44,percent of total billed charges,35.67% of total billed charges,108.17,335.7,
LACRILUBE 3.5GM OPTH OINT,2505385,CDM,250,RC,,,outpatient,,,44,17.60,,37.4,85,,29.92,percent of total billed charges,85% of total billed charges,33.88,77,,27.1,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,36.08,82,,28.864,percent of total billed charges,82% of total billed charges,37.4,85,,29.92,percent of total billed charges,85% of total billed charges,37.4,85,,29.92,percent of total billed charges,85% of total billed charges,37.4,85,,29.92,percent of total billed charges,85% of total billed charges,39.6,90,,31.68,percent of total billed charges,90% of total billed charges,35.2,80,,28.16,percent of total billed charges,80% of total billed charges,39.6,90,,31.68,percent of total billed charges,90% of total billed charges,33,75,,26.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,12.76,29,,10.208,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,29.48,67,,23.584,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,35.2,80,,28.16,percent of total billed charges,80% of total billed charges,28.6,65,,22.88,percent of total billed charges,65% of total billed charges,15.69,35.67,,12.552,percent of total billed charges,35.67% of total billed charges,12.76,39.6,
LAMICTAL 25 MG PO,2505406,CDM,250,RC,,,outpatient,,,32,12.80,,27.2,85,,21.76,percent of total billed charges,85% of total billed charges,24.64,77,,19.71,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,26.24,82,,20.992,percent of total billed charges,82% of total billed charges,27.2,85,,21.76,percent of total billed charges,85% of total billed charges,27.2,85,,21.76,percent of total billed charges,85% of total billed charges,27.2,85,,21.76,percent of total billed charges,85% of total billed charges,28.8,90,,23.04,percent of total billed charges,90% of total billed charges,25.6,80,,20.48,percent of total billed charges,80% of total billed charges,28.8,90,,23.04,percent of total billed charges,90% of total billed charges,24,75,,19.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,9.28,29,,7.424,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,21.44,67,,17.152,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,25.6,80,,20.48,percent of total billed charges,80% of total billed charges,20.8,65,,16.64,percent of total billed charges,65% of total billed charges,11.41,35.67,,9.128,percent of total billed charges,35.67% of total billed charges,9.28,28.8,
LAMISIL CREAM 1% 15 GRAMS,2505410,CDM,250,RC,,,outpatient,,,30,12.00,,25.5,85,,20.4,percent of total billed charges,85% of total billed charges,23.1,77,,18.48,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,24.6,82,,19.68,percent of total billed charges,82% of total billed charges,25.5,85,,20.4,percent of total billed charges,85% of total billed charges,25.5,85,,20.4,percent of total billed charges,85% of total billed charges,25.5,85,,20.4,percent of total billed charges,85% of total billed charges,27,90,,21.6,percent of total billed charges,90% of total billed charges,24,80,,19.2,percent of total billed charges,80% of total billed charges,27,90,,21.6,percent of total billed charges,90% of total billed charges,22.5,75,,18,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,8.7,29,,6.96,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,20.1,67,,16.08,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,24,80,,19.2,percent of total billed charges,80% of total billed charges,19.5,65,,15.6,percent of total billed charges,65% of total billed charges,10.7,35.67,,8.56,percent of total billed charges,35.67% of total billed charges,8.7,27,
LANOXIN (DIGOXIN) 0.125MG TAB,2505430,CDM,250,RC,,,outpatient,,,13,5.20,,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,10.01,77,,8.01,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,10.66,82,,8.528,percent of total billed charges,82% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,11.7,90,,9.36,percent of total billed charges,90% of total billed charges,10.4,80,,8.32,percent of total billed charges,80% of total billed charges,11.7,90,,9.36,percent of total billed charges,90% of total billed charges,9.75,75,,7.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,3.77,29,,3.016,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,8.71,67,,6.968,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,10.4,80,,8.32,percent of total billed charges,80% of total billed charges,8.45,65,,6.76,percent of total billed charges,65% of total billed charges,4.64,35.67,,3.712,percent of total billed charges,35.67% of total billed charges,3.77,11.7,
LASIX TAB 40MG,2505560,CDM,250,RC,,,outpatient,,,7,2.80,,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.39,77,,4.31,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,5.74,82,,4.592,percent of total billed charges,82% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.25,75,,4.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.03,29,,1.624,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4.69,67,,3.752,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,4.55,65,,3.64,percent of total billed charges,65% of total billed charges,2.5,35.67,,2,percent of total billed charges,35.67% of total billed charges,2.03,6.3,
LAT SOLUTION 3 ML,2505574,CDM,250,RC,,,outpatient,,,26,10.40,,22.1,85,,17.68,percent of total billed charges,85% of total billed charges,20.02,77,,16.02,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,21.32,82,,17.056,percent of total billed charges,82% of total billed charges,22.1,85,,17.68,percent of total billed charges,85% of total billed charges,22.1,85,,17.68,percent of total billed charges,85% of total billed charges,22.1,85,,17.68,percent of total billed charges,85% of total billed charges,23.4,90,,18.72,percent of total billed charges,90% of total billed charges,20.8,80,,16.64,percent of total billed charges,80% of total billed charges,23.4,90,,18.72,percent of total billed charges,90% of total billed charges,19.5,75,,15.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,7.54,29,,6.032,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,17.42,67,,13.936,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,20.8,80,,16.64,percent of total billed charges,80% of total billed charges,16.9,65,,13.52,percent of total billed charges,65% of total billed charges,9.27,35.67,,7.416,percent of total billed charges,35.67% of total billed charges,7.54,23.4,
LEVSIN 0.125 MG PO,2505582,CDM,250,RC,,,outpatient,,,8,3.20,,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,6.16,77,,4.93,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,6.56,82,,5.248,percent of total billed charges,82% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,7.2,90,,5.76,percent of total billed charges,90% of total billed charges,6.4,80,,5.12,percent of total billed charges,80% of total billed charges,7.2,90,,5.76,percent of total billed charges,90% of total billed charges,6,75,,4.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.32,29,,1.856,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,5.36,67,,4.288,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,6.4,80,,5.12,percent of total billed charges,80% of total billed charges,5.2,65,,4.16,percent of total billed charges,65% of total billed charges,2.85,35.67,,2.28,percent of total billed charges,35.67% of total billed charges,2.32,7.2,
LEVAQUIN 250 MG PO,2505584,CDM,250,RC,,,outpatient,,,96,38.40,,81.6,85,,65.28,percent of total billed charges,85% of total billed charges,73.92,77,,59.14,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,78.72,82,,62.976,percent of total billed charges,82% of total billed charges,81.6,85,,65.28,percent of total billed charges,85% of total billed charges,81.6,85,,65.28,percent of total billed charges,85% of total billed charges,81.6,85,,65.28,percent of total billed charges,85% of total billed charges,86.4,90,,69.12,percent of total billed charges,90% of total billed charges,76.8,80,,61.44,percent of total billed charges,80% of total billed charges,86.4,90,,69.12,percent of total billed charges,90% of total billed charges,72,75,,57.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,27.84,29,,22.272,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,64.32,67,,51.456,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,76.8,80,,61.44,percent of total billed charges,80% of total billed charges,62.4,65,,49.92,percent of total billed charges,65% of total billed charges,34.24,35.67,,27.392,percent of total billed charges,35.67% of total billed charges,27.84,86.4,
LEVOPHED AMPS 4CC INJ,2505585,CDM,250,RC,,,outpatient,,,86,34.40,,73.1,85,,58.48,percent of total billed charges,85% of total billed charges,66.22,77,,52.98,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,70.52,82,,56.416,percent of total billed charges,82% of total billed charges,73.1,85,,58.48,percent of total billed charges,85% of total billed charges,73.1,85,,58.48,percent of total billed charges,85% of total billed charges,73.1,85,,58.48,percent of total billed charges,85% of total billed charges,77.4,90,,61.92,percent of total billed charges,90% of total billed charges,68.8,80,,55.04,percent of total billed charges,80% of total billed charges,77.4,90,,61.92,percent of total billed charges,90% of total billed charges,64.5,75,,51.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,24.94,29,,19.952,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,57.62,67,,46.096,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,68.8,80,,55.04,percent of total billed charges,80% of total billed charges,55.9,65,,44.72,percent of total billed charges,65% of total billed charges,30.68,35.67,,24.544,percent of total billed charges,35.67% of total billed charges,24.94,77.4,
LEVOTHROID 0.137 MG TAB,2505593,CDM,250,RC,,,outpatient,,,7,2.80,,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.39,77,,4.31,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,5.74,82,,4.592,percent of total billed charges,82% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.25,75,,4.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.03,29,,1.624,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4.69,67,,3.752,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,4.55,65,,3.64,percent of total billed charges,65% of total billed charges,2.5,35.67,,2,percent of total billed charges,35.67% of total billed charges,2.03,6.3,
LEVOP NOREPRINEPHRINE 4MG/250,2505599,CDM,250,RC,,,outpatient,,,133,53.20,,113.05,85,,90.44,percent of total billed charges,85% of total billed charges,102.41,77,,81.93,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,109.06,82,,87.248,percent of total billed charges,82% of total billed charges,113.05,85,,90.44,percent of total billed charges,85% of total billed charges,113.05,85,,90.44,percent of total billed charges,85% of total billed charges,113.05,85,,90.44,percent of total billed charges,85% of total billed charges,119.7,90,,95.76,percent of total billed charges,90% of total billed charges,106.4,80,,85.12,percent of total billed charges,80% of total billed charges,119.7,90,,95.76,percent of total billed charges,90% of total billed charges,99.75,75,,79.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,38.57,29,,30.856,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,89.11,67,,71.288,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,106.4,80,,85.12,percent of total billed charges,80% of total billed charges,86.45,65,,69.16,percent of total billed charges,65% of total billed charges,47.44,35.67,,37.952,percent of total billed charges,35.67% of total billed charges,38.57,119.7,
LIBRIUM 10 MG TAB,2505625,CDM,250,RC,,,outpatient,,,8,3.20,,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,6.16,77,,4.93,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,6.56,82,,5.248,percent of total billed charges,82% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,7.2,90,,5.76,percent of total billed charges,90% of total billed charges,6.4,80,,5.12,percent of total billed charges,80% of total billed charges,7.2,90,,5.76,percent of total billed charges,90% of total billed charges,6,75,,4.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.32,29,,1.856,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,5.36,67,,4.288,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,6.4,80,,5.12,percent of total billed charges,80% of total billed charges,5.2,65,,4.16,percent of total billed charges,65% of total billed charges,2.85,35.67,,2.28,percent of total billed charges,35.67% of total billed charges,2.32,7.2,
LIBRIUM 25MG TAB,2505630,CDM,250,RC,,,outpatient,,,7,2.80,,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.39,77,,4.31,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,5.74,82,,4.592,percent of total billed charges,82% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.25,75,,4.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.03,29,,1.624,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4.69,67,,3.752,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,4.55,65,,3.64,percent of total billed charges,65% of total billed charges,2.5,35.67,,2,percent of total billed charges,35.67% of total billed charges,2.03,6.3,
LIDEX CREAM .05% 15 GRAMS,2505655,CDM,250,RC,,,outpatient,,,179,71.60,,152.15,85,,121.72,percent of total billed charges,85% of total billed charges,137.83,77,,110.26,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,146.78,82,,117.424,percent of total billed charges,82% of total billed charges,152.15,85,,121.72,percent of total billed charges,85% of total billed charges,152.15,85,,121.72,percent of total billed charges,85% of total billed charges,152.15,85,,121.72,percent of total billed charges,85% of total billed charges,161.1,90,,128.88,percent of total billed charges,90% of total billed charges,143.2,80,,114.56,percent of total billed charges,80% of total billed charges,161.1,90,,128.88,percent of total billed charges,90% of total billed charges,134.25,75,,107.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,51.91,29,,41.528,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,119.93,67,,95.944,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,143.2,80,,114.56,percent of total billed charges,80% of total billed charges,116.35,65,,93.08,percent of total billed charges,65% of total billed charges,63.85,35.67,,51.08,percent of total billed charges,35.67% of total billed charges,51.91,161.1,
LIDODERM 5% PATCH,2505659,CDM,250,RC,,,outpatient,,,45,18.00,,38.25,85,,30.6,percent of total billed charges,85% of total billed charges,34.65,77,,27.72,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,36.9,82,,29.52,percent of total billed charges,82% of total billed charges,38.25,85,,30.6,percent of total billed charges,85% of total billed charges,38.25,85,,30.6,percent of total billed charges,85% of total billed charges,38.25,85,,30.6,percent of total billed charges,85% of total billed charges,40.5,90,,32.4,percent of total billed charges,90% of total billed charges,36,80,,28.8,percent of total billed charges,80% of total billed charges,40.5,90,,32.4,percent of total billed charges,90% of total billed charges,33.75,75,,27,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,13.05,29,,10.44,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,30.15,67,,24.12,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,36,80,,28.8,percent of total billed charges,80% of total billed charges,29.25,65,,23.4,percent of total billed charges,65% of total billed charges,16.05,35.67,,12.84,percent of total billed charges,35.67% of total billed charges,13.05,40.5,
LIDOCAINE JELLY 2% 200MG/10ML,2505668,CDM,250,RC,,,outpatient,,,30,12.00,,25.5,85,,20.4,percent of total billed charges,85% of total billed charges,23.1,77,,18.48,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,24.6,82,,19.68,percent of total billed charges,82% of total billed charges,25.5,85,,20.4,percent of total billed charges,85% of total billed charges,25.5,85,,20.4,percent of total billed charges,85% of total billed charges,25.5,85,,20.4,percent of total billed charges,85% of total billed charges,27,90,,21.6,percent of total billed charges,90% of total billed charges,24,80,,19.2,percent of total billed charges,80% of total billed charges,27,90,,21.6,percent of total billed charges,90% of total billed charges,22.5,75,,18,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,8.7,29,,6.96,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,20.1,67,,16.08,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,24,80,,19.2,percent of total billed charges,80% of total billed charges,19.5,65,,15.6,percent of total billed charges,65% of total billed charges,10.7,35.67,,8.56,percent of total billed charges,35.67% of total billed charges,8.7,27,
LIDOCAINE HCL 10MG/ML,2505669,CDM,250,RC,,,outpatient,,,13,5.20,,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,10.01,77,,8.01,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,10.66,82,,8.528,percent of total billed charges,82% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,11.7,90,,9.36,percent of total billed charges,90% of total billed charges,10.4,80,,8.32,percent of total billed charges,80% of total billed charges,11.7,90,,9.36,percent of total billed charges,90% of total billed charges,9.75,75,,7.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,3.77,29,,3.016,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,8.71,67,,6.968,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,10.4,80,,8.32,percent of total billed charges,80% of total billed charges,8.45,65,,6.76,percent of total billed charges,65% of total billed charges,4.64,35.67,,3.712,percent of total billed charges,35.67% of total billed charges,3.77,11.7,
LIPITOR 40 MG TAB,2505707,CDM,250,RC,,,outpatient,,,36,14.40,,30.6,85,,24.48,percent of total billed charges,85% of total billed charges,27.72,77,,22.18,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,29.52,82,,23.616,percent of total billed charges,82% of total billed charges,30.6,85,,24.48,percent of total billed charges,85% of total billed charges,30.6,85,,24.48,percent of total billed charges,85% of total billed charges,30.6,85,,24.48,percent of total billed charges,85% of total billed charges,32.4,90,,25.92,percent of total billed charges,90% of total billed charges,28.8,80,,23.04,percent of total billed charges,80% of total billed charges,32.4,90,,25.92,percent of total billed charges,90% of total billed charges,27,75,,21.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,10.44,29,,8.352,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,24.12,67,,19.296,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,28.8,80,,23.04,percent of total billed charges,80% of total billed charges,23.4,65,,18.72,percent of total billed charges,65% of total billed charges,12.84,35.67,,10.272,percent of total billed charges,35.67% of total billed charges,10.44,32.4,
LIORESAL 10MG TAB,2505710,CDM,250,RC,,,outpatient,,,7,2.80,,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.39,77,,4.31,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,5.74,82,,4.592,percent of total billed charges,82% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.25,75,,4.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.03,29,,1.624,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4.69,67,,3.752,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,4.55,65,,3.64,percent of total billed charges,65% of total billed charges,2.5,35.67,,2,percent of total billed charges,35.67% of total billed charges,2.03,6.3,
LITHOBID 300 MG TAB,2505713,CDM,250,RC,,,outpatient,,,16,6.40,,13.6,85,,10.88,percent of total billed charges,85% of total billed charges,12.32,77,,9.86,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,13.12,82,,10.496,percent of total billed charges,82% of total billed charges,13.6,85,,10.88,percent of total billed charges,85% of total billed charges,13.6,85,,10.88,percent of total billed charges,85% of total billed charges,13.6,85,,10.88,percent of total billed charges,85% of total billed charges,14.4,90,,11.52,percent of total billed charges,90% of total billed charges,12.8,80,,10.24,percent of total billed charges,80% of total billed charges,14.4,90,,11.52,percent of total billed charges,90% of total billed charges,12,75,,9.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,4.64,29,,3.712,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,10.72,67,,8.576,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,12.8,80,,10.24,percent of total billed charges,80% of total billed charges,10.4,65,,8.32,percent of total billed charges,65% of total billed charges,5.71,35.67,,4.568,percent of total billed charges,35.67% of total billed charges,4.64,14.4,
LITHIUM CARBONATE 150 MG CAP,2505717,CDM,250,RC,,,outpatient,,,7,2.80,,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.39,77,,4.31,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,5.74,82,,4.592,percent of total billed charges,82% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.25,75,,4.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.03,29,,1.624,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4.69,67,,3.752,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,4.55,65,,3.64,percent of total billed charges,65% of total billed charges,2.5,35.67,,2,percent of total billed charges,35.67% of total billed charges,2.03,6.3,
LOMOTIL TAB,2505735,CDM,250,RC,,,outpatient,,,10,4.00,,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,7.7,77,,6.16,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,8.2,82,,6.56,percent of total billed charges,82% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,9,90,,7.2,percent of total billed charges,90% of total billed charges,8,80,,6.4,percent of total billed charges,80% of total billed charges,9,90,,7.2,percent of total billed charges,90% of total billed charges,7.5,75,,6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.9,29,,2.32,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,6.7,67,,5.36,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,8,80,,6.4,percent of total billed charges,80% of total billed charges,6.5,65,,5.2,percent of total billed charges,65% of total billed charges,3.57,35.67,,2.856,percent of total billed charges,35.67% of total billed charges,2.9,9,
LONITIN/MINOXIDIL 2.5MG TAB,2505745,CDM,250,RC,S0139,HCPCS,outpatient,,,9,3.60,,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,6.93,77,,5.54,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,1.42,385,,,fee schedule,385% of BCBS fee schedule,1.48,401,,,fee schedule,401% of BCBS fee schedule,1.48,401,,,fee schedule,401% of BCBS fee schedule,1.48,401,,,fee schedule,401% of BCBS fee schedule,8.1,90,,6.48,percent of total billed charges,90% of total billed charges,7.2,80,,5.76,percent of total billed charges,80% of total billed charges,8.1,90,,6.48,percent of total billed charges,90% of total billed charges,6.75,75,,5.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.61,29,,2.088,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,6.03,67,,4.824,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,7.2,80,,5.76,percent of total billed charges,80% of total billed charges,5.85,65,,4.68,percent of total billed charges,65% of total billed charges,3.21,35.67,,2.568,percent of total billed charges,35.67% of total billed charges,1.42,8.1,
LOPRESSOR 25 MG TAB,2505780,CDM,250,RC,,,outpatient,,,7,2.80,,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.39,77,,4.31,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,5.74,82,,4.592,percent of total billed charges,82% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.25,75,,4.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.03,29,,1.624,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4.69,67,,3.752,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,4.55,65,,3.64,percent of total billed charges,65% of total billed charges,2.5,35.67,,2,percent of total billed charges,35.67% of total billed charges,2.03,6.3,
LOPRESSOR INJ. 5MG,2505790,CDM,250,RC,,,outpatient,,,106,42.40,,90.1,85,,72.08,percent of total billed charges,85% of total billed charges,81.62,77,,65.3,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,86.92,82,,69.536,percent of total billed charges,82% of total billed charges,90.1,85,,72.08,percent of total billed charges,85% of total billed charges,90.1,85,,72.08,percent of total billed charges,85% of total billed charges,90.1,85,,72.08,percent of total billed charges,85% of total billed charges,95.4,90,,76.32,percent of total billed charges,90% of total billed charges,84.8,80,,67.84,percent of total billed charges,80% of total billed charges,95.4,90,,76.32,percent of total billed charges,90% of total billed charges,79.5,75,,63.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,30.74,29,,24.592,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,71.02,67,,56.816,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,84.8,80,,67.84,percent of total billed charges,80% of total billed charges,68.9,65,,55.12,percent of total billed charges,65% of total billed charges,37.81,35.67,,30.248,percent of total billed charges,35.67% of total billed charges,30.74,95.4,
LOPROX CREAM,2505795,CDM,250,RC,,,outpatient,,,198,79.20,,168.3,85,,134.64,percent of total billed charges,85% of total billed charges,152.46,77,,121.97,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,162.36,82,,129.888,percent of total billed charges,82% of total billed charges,168.3,85,,134.64,percent of total billed charges,85% of total billed charges,168.3,85,,134.64,percent of total billed charges,85% of total billed charges,168.3,85,,134.64,percent of total billed charges,85% of total billed charges,178.2,90,,142.56,percent of total billed charges,90% of total billed charges,158.4,80,,126.72,percent of total billed charges,80% of total billed charges,178.2,90,,142.56,percent of total billed charges,90% of total billed charges,148.5,75,,118.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,57.42,29,,45.936,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,132.66,67,,106.128,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,158.4,80,,126.72,percent of total billed charges,80% of total billed charges,128.7,65,,102.96,percent of total billed charges,65% of total billed charges,70.63,35.67,,56.504,percent of total billed charges,35.67% of total billed charges,57.42,178.2,
LORTAB 7.5 MG/15ML UDC,2505818,CDM,250,RC,,,outpatient,,,19,7.60,,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,14.63,77,,11.7,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,15.58,82,,12.464,percent of total billed charges,82% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,15.2,80,,12.16,percent of total billed charges,80% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,14.25,75,,11.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,5.51,29,,4.408,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,12.73,67,,10.184,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,15.2,80,,12.16,percent of total billed charges,80% of total billed charges,12.35,65,,9.88,percent of total billed charges,65% of total billed charges,6.78,35.67,,5.424,percent of total billed charges,35.67% of total billed charges,5.51,17.1,
LOTEMAX 0.5% OPTH SUS 5ML,2505827,CDM,250,RC,,,outpatient,,,374,149.60,,317.9,85,,254.32,percent of total billed charges,85% of total billed charges,287.98,77,,230.38,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,306.68,82,,245.344,percent of total billed charges,82% of total billed charges,317.9,85,,254.32,percent of total billed charges,85% of total billed charges,317.9,85,,254.32,percent of total billed charges,85% of total billed charges,317.9,85,,254.32,percent of total billed charges,85% of total billed charges,336.6,90,,269.28,percent of total billed charges,90% of total billed charges,299.2,80,,239.36,percent of total billed charges,80% of total billed charges,336.6,90,,269.28,percent of total billed charges,90% of total billed charges,280.5,75,,224.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,108.46,29,,86.768,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,250.58,67,,200.464,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,299.2,80,,239.36,percent of total billed charges,80% of total billed charges,243.1,65,,194.48,percent of total billed charges,65% of total billed charges,133.41,35.67,,106.728,percent of total billed charges,35.67% of total billed charges,108.46,336.6,
LOTRIMIN CREAM 1% 15 GM,2505850,CDM,250,RC,,,outpatient,,,55,22.00,,46.75,85,,37.4,percent of total billed charges,85% of total billed charges,42.35,77,,33.88,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,45.1,82,,36.08,percent of total billed charges,82% of total billed charges,46.75,85,,37.4,percent of total billed charges,85% of total billed charges,46.75,85,,37.4,percent of total billed charges,85% of total billed charges,46.75,85,,37.4,percent of total billed charges,85% of total billed charges,49.5,90,,39.6,percent of total billed charges,90% of total billed charges,44,80,,35.2,percent of total billed charges,80% of total billed charges,49.5,90,,39.6,percent of total billed charges,90% of total billed charges,41.25,75,,33,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,15.95,29,,12.76,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,36.85,67,,29.48,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,44,80,,35.2,percent of total billed charges,80% of total billed charges,35.75,65,,28.6,percent of total billed charges,65% of total billed charges,19.62,35.67,,15.696,percent of total billed charges,35.67% of total billed charges,15.95,49.5,
LOTRISONE CREAM 15 GM TUBE,2505865,CDM,250,RC,,,outpatient,,,185,74.00,,157.25,85,,125.8,percent of total billed charges,85% of total billed charges,142.45,77,,113.96,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,151.7,82,,121.36,percent of total billed charges,82% of total billed charges,157.25,85,,125.8,percent of total billed charges,85% of total billed charges,157.25,85,,125.8,percent of total billed charges,85% of total billed charges,157.25,85,,125.8,percent of total billed charges,85% of total billed charges,166.5,90,,133.2,percent of total billed charges,90% of total billed charges,148,80,,118.4,percent of total billed charges,80% of total billed charges,166.5,90,,133.2,percent of total billed charges,90% of total billed charges,138.75,75,,111,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,53.65,29,,42.92,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,123.95,67,,99.16,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,148,80,,118.4,percent of total billed charges,80% of total billed charges,120.25,65,,96.2,percent of total billed charges,65% of total billed charges,65.99,35.67,,52.792,percent of total billed charges,35.67% of total billed charges,53.65,166.5,
LYRICA 50 MG CAP,2505922,CDM,250,RC,,,outpatient,,,30,12.00,,25.5,85,,20.4,percent of total billed charges,85% of total billed charges,23.1,77,,18.48,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,24.6,82,,19.68,percent of total billed charges,82% of total billed charges,25.5,85,,20.4,percent of total billed charges,85% of total billed charges,25.5,85,,20.4,percent of total billed charges,85% of total billed charges,25.5,85,,20.4,percent of total billed charges,85% of total billed charges,27,90,,21.6,percent of total billed charges,90% of total billed charges,24,80,,19.2,percent of total billed charges,80% of total billed charges,27,90,,21.6,percent of total billed charges,90% of total billed charges,22.5,75,,18,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,8.7,29,,6.96,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,20.1,67,,16.08,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,24,80,,19.2,percent of total billed charges,80% of total billed charges,19.5,65,,15.6,percent of total billed charges,65% of total billed charges,10.7,35.67,,8.56,percent of total billed charges,35.67% of total billed charges,8.7,27,
LYRICA 25 MG CAP,2505924,CDM,250,RC,,,outpatient,,,25,10.00,,21.25,85,,17,percent of total billed charges,85% of total billed charges,19.25,77,,15.4,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,20.5,82,,16.4,percent of total billed charges,82% of total billed charges,21.25,85,,17,percent of total billed charges,85% of total billed charges,21.25,85,,17,percent of total billed charges,85% of total billed charges,21.25,85,,17,percent of total billed charges,85% of total billed charges,22.5,90,,18,percent of total billed charges,90% of total billed charges,20,80,,16,percent of total billed charges,80% of total billed charges,22.5,90,,18,percent of total billed charges,90% of total billed charges,18.75,75,,15,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,7.25,29,,5.8,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,16.75,67,,13.4,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,20,80,,16,percent of total billed charges,80% of total billed charges,16.25,65,,13,percent of total billed charges,65% of total billed charges,8.92,35.67,,7.136,percent of total billed charges,35.67% of total billed charges,7.25,22.5,
MAALOX PLUS 30 ML UDC,2505931,CDM,250,RC,,,outpatient,,,7,2.80,,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.39,77,,4.31,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,5.74,82,,4.592,percent of total billed charges,82% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.25,75,,4.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.03,29,,1.624,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4.69,67,,3.752,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,4.55,65,,3.64,percent of total billed charges,65% of total billed charges,2.5,35.67,,2,percent of total billed charges,35.67% of total billed charges,2.03,6.3,
MACROBID CAPS,2505950,CDM,250,RC,,,outpatient,,,32,12.80,,27.2,85,,21.76,percent of total billed charges,85% of total billed charges,24.64,77,,19.71,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,26.24,82,,20.992,percent of total billed charges,82% of total billed charges,27.2,85,,21.76,percent of total billed charges,85% of total billed charges,27.2,85,,21.76,percent of total billed charges,85% of total billed charges,27.2,85,,21.76,percent of total billed charges,85% of total billed charges,28.8,90,,23.04,percent of total billed charges,90% of total billed charges,25.6,80,,20.48,percent of total billed charges,80% of total billed charges,28.8,90,,23.04,percent of total billed charges,90% of total billed charges,24,75,,19.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,9.28,29,,7.424,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,21.44,67,,17.152,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,25.6,80,,20.48,percent of total billed charges,80% of total billed charges,20.8,65,,16.64,percent of total billed charges,65% of total billed charges,11.41,35.67,,9.128,percent of total billed charges,35.67% of total billed charges,9.28,28.8,
MAGNESIUM CITRATE 300 ML LIQ,2505965,CDM,250,RC,,,outpatient,,,9,3.60,,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,6.93,77,,5.54,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,7.38,82,,5.904,percent of total billed charges,82% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,8.1,90,,6.48,percent of total billed charges,90% of total billed charges,7.2,80,,5.76,percent of total billed charges,80% of total billed charges,8.1,90,,6.48,percent of total billed charges,90% of total billed charges,6.75,75,,5.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.61,29,,2.088,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,6.03,67,,4.824,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,7.2,80,,5.76,percent of total billed charges,80% of total billed charges,5.85,65,,4.68,percent of total billed charges,65% of total billed charges,3.21,35.67,,2.568,percent of total billed charges,35.67% of total billed charges,2.61,8.1,
MAGNESIUM OXIDE 400 MG PO,2505981,CDM,250,RC,,,outpatient,,,7,2.80,,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.39,77,,4.31,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,5.74,82,,4.592,percent of total billed charges,82% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.25,75,,4.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.03,29,,1.624,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4.69,67,,3.752,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,4.55,65,,3.64,percent of total billed charges,65% of total billed charges,2.5,35.67,,2,percent of total billed charges,35.67% of total billed charges,2.03,6.3,
MARCAINE 0.25% INJ PER CC,2506040,CDM,250,RC,,,outpatient,,,32,12.80,,27.2,85,,21.76,percent of total billed charges,85% of total billed charges,24.64,77,,19.71,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,26.24,82,,20.992,percent of total billed charges,82% of total billed charges,27.2,85,,21.76,percent of total billed charges,85% of total billed charges,27.2,85,,21.76,percent of total billed charges,85% of total billed charges,27.2,85,,21.76,percent of total billed charges,85% of total billed charges,28.8,90,,23.04,percent of total billed charges,90% of total billed charges,25.6,80,,20.48,percent of total billed charges,80% of total billed charges,28.8,90,,23.04,percent of total billed charges,90% of total billed charges,24,75,,19.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,9.28,29,,7.424,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,21.44,67,,17.152,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,25.6,80,,20.48,percent of total billed charges,80% of total billed charges,20.8,65,,16.64,percent of total billed charges,65% of total billed charges,11.41,35.67,,9.128,percent of total billed charges,35.67% of total billed charges,9.28,28.8,
MARCAINE 0.25% 10 ML SINGLE,2506041,CDM,250,RC,,,outpatient,,,15,6.00,,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,11.55,77,,9.24,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,12.3,82,,9.84,percent of total billed charges,82% of total billed charges,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,13.5,90,,10.8,percent of total billed charges,90% of total billed charges,12,80,,9.6,percent of total billed charges,80% of total billed charges,13.5,90,,10.8,percent of total billed charges,90% of total billed charges,11.25,75,,9,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,4.35,29,,3.48,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,10.05,67,,8.04,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,12,80,,9.6,percent of total billed charges,80% of total billed charges,9.75,65,,7.8,percent of total billed charges,65% of total billed charges,5.35,35.67,,4.28,percent of total billed charges,35.67% of total billed charges,4.35,13.5,
MARCAINE 0.25% EPI 30 ML VIAL,2506042,CDM,250,RC,,,outpatient,,,34,13.60,,28.9,85,,23.12,percent of total billed charges,85% of total billed charges,26.18,77,,20.94,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,27.88,82,,22.304,percent of total billed charges,82% of total billed charges,28.9,85,,23.12,percent of total billed charges,85% of total billed charges,28.9,85,,23.12,percent of total billed charges,85% of total billed charges,28.9,85,,23.12,percent of total billed charges,85% of total billed charges,30.6,90,,24.48,percent of total billed charges,90% of total billed charges,27.2,80,,21.76,percent of total billed charges,80% of total billed charges,30.6,90,,24.48,percent of total billed charges,90% of total billed charges,25.5,75,,20.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,9.86,29,,7.888,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,22.78,67,,18.224,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,27.2,80,,21.76,percent of total billed charges,80% of total billed charges,22.1,65,,17.68,percent of total billed charges,65% of total billed charges,12.13,35.67,,9.704,percent of total billed charges,35.67% of total billed charges,9.86,30.6,
MARCAINE 0.5% WITH EPI 50 ML,2506044,CDM,250,RC,,,outpatient,,,50,20.00,,42.5,85,,34,percent of total billed charges,85% of total billed charges,38.5,77,,30.8,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,41,82,,32.8,percent of total billed charges,82% of total billed charges,42.5,85,,34,percent of total billed charges,85% of total billed charges,42.5,85,,34,percent of total billed charges,85% of total billed charges,42.5,85,,34,percent of total billed charges,85% of total billed charges,45,90,,36,percent of total billed charges,90% of total billed charges,40,80,,32,percent of total billed charges,80% of total billed charges,45,90,,36,percent of total billed charges,90% of total billed charges,37.5,75,,30,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,14.5,29,,11.6,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,33.5,67,,26.8,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,40,80,,32,percent of total billed charges,80% of total billed charges,32.5,65,,26,percent of total billed charges,65% of total billed charges,17.84,35.67,,14.272,percent of total billed charges,35.67% of total billed charges,14.5,45,
MARCAINE 0.5% INJ PER CC,2506045,CDM,250,RC,,,outpatient,,,30,12.00,,25.5,85,,20.4,percent of total billed charges,85% of total billed charges,23.1,77,,18.48,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,24.6,82,,19.68,percent of total billed charges,82% of total billed charges,25.5,85,,20.4,percent of total billed charges,85% of total billed charges,25.5,85,,20.4,percent of total billed charges,85% of total billed charges,25.5,85,,20.4,percent of total billed charges,85% of total billed charges,27,90,,21.6,percent of total billed charges,90% of total billed charges,24,80,,19.2,percent of total billed charges,80% of total billed charges,27,90,,21.6,percent of total billed charges,90% of total billed charges,22.5,75,,18,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,8.7,29,,6.96,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,20.1,67,,16.08,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,24,80,,19.2,percent of total billed charges,80% of total billed charges,19.5,65,,15.6,percent of total billed charges,65% of total billed charges,10.7,35.67,,8.56,percent of total billed charges,35.67% of total billed charges,8.7,27,
MARCAINE.25% W/ EPI PER CC INJ,2506051,CDM,250,RC,,,outpatient,,,17,6.80,,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,13.09,77,,10.47,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,13.94,82,,11.152,percent of total billed charges,82% of total billed charges,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,15.3,90,,12.24,percent of total billed charges,90% of total billed charges,13.6,80,,10.88,percent of total billed charges,80% of total billed charges,15.3,90,,12.24,percent of total billed charges,90% of total billed charges,12.75,75,,10.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,4.93,29,,3.944,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,11.39,67,,9.112,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,13.6,80,,10.88,percent of total billed charges,80% of total billed charges,11.05,65,,8.84,percent of total billed charges,65% of total billed charges,6.06,35.67,,4.848,percent of total billed charges,35.67% of total billed charges,4.93,15.3,
MARCAINE .5% W/ EPI PER CC INJ,2506052,CDM,250,RC,,,outpatient,,,24,9.60,,20.4,85,,16.32,percent of total billed charges,85% of total billed charges,18.48,77,,14.78,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,19.68,82,,15.744,percent of total billed charges,82% of total billed charges,20.4,85,,16.32,percent of total billed charges,85% of total billed charges,20.4,85,,16.32,percent of total billed charges,85% of total billed charges,20.4,85,,16.32,percent of total billed charges,85% of total billed charges,21.6,90,,17.28,percent of total billed charges,90% of total billed charges,19.2,80,,15.36,percent of total billed charges,80% of total billed charges,21.6,90,,17.28,percent of total billed charges,90% of total billed charges,18,75,,14.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,6.96,29,,5.568,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,16.08,67,,12.864,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,19.2,80,,15.36,percent of total billed charges,80% of total billed charges,15.6,65,,12.48,percent of total billed charges,65% of total billed charges,8.56,35.67,,6.848,percent of total billed charges,35.67% of total billed charges,6.96,21.6,
MARCAINE 0.75% 30 ML SDV INJ,2506053,CDM,250,RC,,,outpatient,,,27,10.80,,22.95,85,,18.36,percent of total billed charges,85% of total billed charges,20.79,77,,16.63,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,22.14,82,,17.712,percent of total billed charges,82% of total billed charges,22.95,85,,18.36,percent of total billed charges,85% of total billed charges,22.95,85,,18.36,percent of total billed charges,85% of total billed charges,22.95,85,,18.36,percent of total billed charges,85% of total billed charges,24.3,90,,19.44,percent of total billed charges,90% of total billed charges,21.6,80,,17.28,percent of total billed charges,80% of total billed charges,24.3,90,,19.44,percent of total billed charges,90% of total billed charges,20.25,75,,16.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,7.83,29,,6.264,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,18.09,67,,14.472,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,21.6,80,,17.28,percent of total billed charges,80% of total billed charges,17.55,65,,14.04,percent of total billed charges,65% of total billed charges,9.63,35.67,,7.704,percent of total billed charges,35.67% of total billed charges,7.83,24.3,
MARCAINE 0.5% WITH EPI 30 ML,2506058,CDM,250,RC,,,outpatient,,,24,9.60,,20.4,85,,16.32,percent of total billed charges,85% of total billed charges,18.48,77,,14.78,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,19.68,82,,15.744,percent of total billed charges,82% of total billed charges,20.4,85,,16.32,percent of total billed charges,85% of total billed charges,20.4,85,,16.32,percent of total billed charges,85% of total billed charges,20.4,85,,16.32,percent of total billed charges,85% of total billed charges,21.6,90,,17.28,percent of total billed charges,90% of total billed charges,19.2,80,,15.36,percent of total billed charges,80% of total billed charges,21.6,90,,17.28,percent of total billed charges,90% of total billed charges,18,75,,14.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,6.96,29,,5.568,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,16.08,67,,12.864,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,19.2,80,,15.36,percent of total billed charges,80% of total billed charges,15.6,65,,12.48,percent of total billed charges,65% of total billed charges,8.56,35.67,,6.848,percent of total billed charges,35.67% of total billed charges,6.96,21.6,
MEDROL DOSEPAK 4MG TAB,2506125,CDM,250,RC,,,outpatient,,,9,3.60,,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,6.93,77,,5.54,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,7.38,82,,5.904,percent of total billed charges,82% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,8.1,90,,6.48,percent of total billed charges,90% of total billed charges,7.2,80,,5.76,percent of total billed charges,80% of total billed charges,8.1,90,,6.48,percent of total billed charges,90% of total billed charges,6.75,75,,5.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.61,29,,2.088,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,6.03,67,,4.824,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,7.2,80,,5.76,percent of total billed charges,80% of total billed charges,5.85,65,,4.68,percent of total billed charges,65% of total billed charges,3.21,35.67,,2.568,percent of total billed charges,35.67% of total billed charges,2.61,8.1,
MEGACE 20 MG TAB,2506150,CDM,250,RC,,,outpatient,,,7,2.80,,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.39,77,,4.31,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,5.74,82,,4.592,percent of total billed charges,82% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.25,75,,4.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.03,29,,1.624,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4.69,67,,3.752,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,4.55,65,,3.64,percent of total billed charges,65% of total billed charges,2.5,35.67,,2,percent of total billed charges,35.67% of total billed charges,2.03,6.3,
MEGACE ES 625 MG/5ML 60 ML,2506161,CDM,250,RC,,,outpatient,,,509,203.60,,432.65,85,,346.12,percent of total billed charges,85% of total billed charges,391.93,77,,313.54,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,417.38,82,,333.904,percent of total billed charges,82% of total billed charges,432.65,85,,346.12,percent of total billed charges,85% of total billed charges,432.65,85,,346.12,percent of total billed charges,85% of total billed charges,432.65,85,,346.12,percent of total billed charges,85% of total billed charges,458.1,90,,366.48,percent of total billed charges,90% of total billed charges,407.2,80,,325.76,percent of total billed charges,80% of total billed charges,458.1,90,,366.48,percent of total billed charges,90% of total billed charges,381.75,75,,305.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,147.61,29,,118.088,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,341.03,67,,272.824,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,407.2,80,,325.76,percent of total billed charges,80% of total billed charges,330.85,65,,264.68,percent of total billed charges,65% of total billed charges,181.56,35.67,,145.248,percent of total billed charges,35.67% of total billed charges,147.61,458.1,
MEGACE 400MG/10ML UNIT DOSE,2506162,CDM,250,RC,,,outpatient,,,19,7.60,,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,14.63,77,,11.7,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,15.58,82,,12.464,percent of total billed charges,82% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,15.2,80,,12.16,percent of total billed charges,80% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,14.25,75,,11.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,5.51,29,,4.408,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,12.73,67,,10.184,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,15.2,80,,12.16,percent of total billed charges,80% of total billed charges,12.35,65,,9.88,percent of total billed charges,65% of total billed charges,6.78,35.67,,5.424,percent of total billed charges,35.67% of total billed charges,5.51,17.1,
MESTINON 60MG TAB,2506215,CDM,250,RC,,,outpatient,,,13,5.20,,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,10.01,77,,8.01,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,10.66,82,,8.528,percent of total billed charges,82% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,11.7,90,,9.36,percent of total billed charges,90% of total billed charges,10.4,80,,8.32,percent of total billed charges,80% of total billed charges,11.7,90,,9.36,percent of total billed charges,90% of total billed charges,9.75,75,,7.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,3.77,29,,3.016,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,8.71,67,,6.968,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,10.4,80,,8.32,percent of total billed charges,80% of total billed charges,8.45,65,,6.76,percent of total billed charges,65% of total billed charges,4.64,35.67,,3.712,percent of total billed charges,35.67% of total billed charges,3.77,11.7,
METHERGINE 0.25MG TAB,2506225,CDM,250,RC,,,outpatient,,,67,26.80,,56.95,85,,45.56,percent of total billed charges,85% of total billed charges,51.59,77,,41.27,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,54.94,82,,43.952,percent of total billed charges,82% of total billed charges,56.95,85,,45.56,percent of total billed charges,85% of total billed charges,56.95,85,,45.56,percent of total billed charges,85% of total billed charges,56.95,85,,45.56,percent of total billed charges,85% of total billed charges,60.3,90,,48.24,percent of total billed charges,90% of total billed charges,53.6,80,,42.88,percent of total billed charges,80% of total billed charges,60.3,90,,48.24,percent of total billed charges,90% of total billed charges,50.25,75,,40.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,19.43,29,,15.544,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,44.89,67,,35.912,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,53.6,80,,42.88,percent of total billed charges,80% of total billed charges,43.55,65,,34.84,percent of total billed charges,65% of total billed charges,23.9,35.67,,19.12,percent of total billed charges,35.67% of total billed charges,19.43,60.3,
METHYLENE BLUE INJ. 10 MG.,2506245,CDM,250,RC,Q9968,HCPCS,outpatient,,,380,152.00,,323,85,,258.4,percent of total billed charges,85% of total billed charges,292.6,77,,234.08,percent of total billed charges,77% of total billed charges,8.52,100,,,fee schedule,100% of CMS OPPS rate,4.47,385,,,fee schedule,385% of BCBS fee schedule,4.65,401,,,fee schedule,401% of BCBS fee schedule,4.65,401,,,fee schedule,401% of BCBS fee schedule,4.65,401,,,fee schedule,401% of BCBS fee schedule,342,90,,273.6,percent of total billed charges,90% of total billed charges,304,80,,243.2,percent of total billed charges,80% of total billed charges,342,90,,273.6,percent of total billed charges,90% of total billed charges,285,75,,228,percent of total billed charges,75% of total billed charges,10.4,122,,,fee schedule,122% of APC rate,110.2,29,,88.16,percent of total billed charges,29% of total billed charges,8.52,100,,,fee schedule,100% of CMS OPPS rate,254.6,67,,203.68,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,304,80,,243.2,percent of total billed charges,80% of total billed charges,247,65,,197.6,percent of total billed charges,65% of total billed charges,135.55,35.67,,108.44,percent of total billed charges,35.67% of total billed charges,4.47,342,
METROGEL VAG GEL/APPLICATOR,2506250,CDM,250,RC,,,outpatient,,,345,138.00,,293.25,85,,234.6,percent of total billed charges,85% of total billed charges,265.65,77,,212.52,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,282.9,82,,226.32,percent of total billed charges,82% of total billed charges,293.25,85,,234.6,percent of total billed charges,85% of total billed charges,293.25,85,,234.6,percent of total billed charges,85% of total billed charges,293.25,85,,234.6,percent of total billed charges,85% of total billed charges,310.5,90,,248.4,percent of total billed charges,90% of total billed charges,276,80,,220.8,percent of total billed charges,80% of total billed charges,310.5,90,,248.4,percent of total billed charges,90% of total billed charges,258.75,75,,207,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,100.05,29,,80.04,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,231.15,67,,184.92,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,276,80,,220.8,percent of total billed charges,80% of total billed charges,224.25,65,,179.4,percent of total billed charges,65% of total billed charges,123.06,35.67,,98.448,percent of total billed charges,35.67% of total billed charges,100.05,310.5,
METROCREAM 45 GRAM TUBE,2506254,CDM,250,RC,,,outpatient,,,554,221.60,,470.9,85,,376.72,percent of total billed charges,85% of total billed charges,426.58,77,,341.26,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,454.28,82,,363.424,percent of total billed charges,82% of total billed charges,470.9,85,,376.72,percent of total billed charges,85% of total billed charges,470.9,85,,376.72,percent of total billed charges,85% of total billed charges,470.9,85,,376.72,percent of total billed charges,85% of total billed charges,498.6,90,,398.88,percent of total billed charges,90% of total billed charges,443.2,80,,354.56,percent of total billed charges,80% of total billed charges,498.6,90,,398.88,percent of total billed charges,90% of total billed charges,415.5,75,,332.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,160.66,29,,128.528,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,371.18,67,,296.944,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,443.2,80,,354.56,percent of total billed charges,80% of total billed charges,360.1,65,,288.08,percent of total billed charges,65% of total billed charges,197.61,35.67,,158.088,percent of total billed charges,35.67% of total billed charges,160.66,498.6,
MIACALCIN NASAL SPRAY,2506268,CDM,250,RC,,,outpatient,,,298,119.20,,253.3,85,,202.64,percent of total billed charges,85% of total billed charges,229.46,77,,183.57,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,244.36,82,,195.488,percent of total billed charges,82% of total billed charges,253.3,85,,202.64,percent of total billed charges,85% of total billed charges,253.3,85,,202.64,percent of total billed charges,85% of total billed charges,253.3,85,,202.64,percent of total billed charges,85% of total billed charges,268.2,90,,214.56,percent of total billed charges,90% of total billed charges,238.4,80,,190.72,percent of total billed charges,80% of total billed charges,268.2,90,,214.56,percent of total billed charges,90% of total billed charges,223.5,75,,178.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,86.42,29,,69.136,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,199.66,67,,159.728,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,238.4,80,,190.72,percent of total billed charges,80% of total billed charges,193.7,65,,154.96,percent of total billed charges,65% of total billed charges,106.3,35.67,,85.04,percent of total billed charges,35.67% of total billed charges,86.42,268.2,
MICRONASE 5 MG TAB,2506295,CDM,250,RC,,,outpatient,,,10,4.00,,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,7.7,77,,6.16,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,8.2,82,,6.56,percent of total billed charges,82% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,9,90,,7.2,percent of total billed charges,90% of total billed charges,8,80,,6.4,percent of total billed charges,80% of total billed charges,9,90,,7.2,percent of total billed charges,90% of total billed charges,7.5,75,,6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.9,29,,2.32,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,6.7,67,,5.36,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,8,80,,6.4,percent of total billed charges,80% of total billed charges,6.5,65,,5.2,percent of total billed charges,65% of total billed charges,3.57,35.67,,2.856,percent of total billed charges,35.67% of total billed charges,2.9,9,
MILK OF MAGNESIA 30 ML UN DOSE,2506325,CDM,250,RC,,,outpatient,,,7,2.80,,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.39,77,,4.31,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,5.74,82,,4.592,percent of total billed charges,82% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.25,75,,4.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.03,29,,1.624,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4.69,67,,3.752,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,4.55,65,,3.64,percent of total billed charges,65% of total billed charges,2.5,35.67,,2,percent of total billed charges,35.67% of total billed charges,2.03,6.3,
MINERAL OIL 30 ML UDC,2506356,CDM,250,RC,,,outpatient,,,10,4.00,,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,7.7,77,,6.16,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,8.2,82,,6.56,percent of total billed charges,82% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,9,90,,7.2,percent of total billed charges,90% of total billed charges,8,80,,6.4,percent of total billed charges,80% of total billed charges,9,90,,7.2,percent of total billed charges,90% of total billed charges,7.5,75,,6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.9,29,,2.32,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,6.7,67,,5.36,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,8,80,,6.4,percent of total billed charges,80% of total billed charges,6.5,65,,5.2,percent of total billed charges,65% of total billed charges,3.57,35.67,,2.856,percent of total billed charges,35.67% of total billed charges,2.9,9,
MINOCIN CAPS 50MG,2506405,CDM,250,RC,,,outpatient,,,9,3.60,,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,6.93,77,,5.54,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,7.38,82,,5.904,percent of total billed charges,82% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,8.1,90,,6.48,percent of total billed charges,90% of total billed charges,7.2,80,,5.76,percent of total billed charges,80% of total billed charges,8.1,90,,6.48,percent of total billed charges,90% of total billed charges,6.75,75,,5.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.61,29,,2.088,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,6.03,67,,4.824,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,7.2,80,,5.76,percent of total billed charges,80% of total billed charges,5.85,65,,4.68,percent of total billed charges,65% of total billed charges,3.21,35.67,,2.568,percent of total billed charges,35.67% of total billed charges,2.61,8.1,
MIRALAX 8.3 OZ BOTTLE,2506406,CDM,250,RC,,,outpatient,,,44,17.60,,37.4,85,,29.92,percent of total billed charges,85% of total billed charges,33.88,77,,27.1,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,36.08,82,,28.864,percent of total billed charges,82% of total billed charges,37.4,85,,29.92,percent of total billed charges,85% of total billed charges,37.4,85,,29.92,percent of total billed charges,85% of total billed charges,37.4,85,,29.92,percent of total billed charges,85% of total billed charges,39.6,90,,31.68,percent of total billed charges,90% of total billed charges,35.2,80,,28.16,percent of total billed charges,80% of total billed charges,39.6,90,,31.68,percent of total billed charges,90% of total billed charges,33,75,,26.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,12.76,29,,10.208,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,29.48,67,,23.584,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,35.2,80,,28.16,percent of total billed charges,80% of total billed charges,28.6,65,,22.88,percent of total billed charges,65% of total billed charges,15.69,35.67,,12.552,percent of total billed charges,35.67% of total billed charges,12.76,39.6,
MIVACRON 20MG INJ,2506415,CDM,250,RC,,,outpatient,,,68,27.20,,57.8,85,,46.24,percent of total billed charges,85% of total billed charges,52.36,77,,41.89,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,55.76,82,,44.608,percent of total billed charges,82% of total billed charges,57.8,85,,46.24,percent of total billed charges,85% of total billed charges,57.8,85,,46.24,percent of total billed charges,85% of total billed charges,57.8,85,,46.24,percent of total billed charges,85% of total billed charges,61.2,90,,48.96,percent of total billed charges,90% of total billed charges,54.4,80,,43.52,percent of total billed charges,80% of total billed charges,61.2,90,,48.96,percent of total billed charges,90% of total billed charges,51,75,,40.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,19.72,29,,15.776,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,45.56,67,,36.448,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,54.4,80,,43.52,percent of total billed charges,80% of total billed charges,44.2,65,,35.36,percent of total billed charges,65% of total billed charges,24.26,35.67,,19.408,percent of total billed charges,35.67% of total billed charges,19.72,61.2,
MIRAPEX 0.25 MG PO,2506416,CDM,250,RC,,,outpatient,,,28,11.20,,23.8,85,,19.04,percent of total billed charges,85% of total billed charges,21.56,77,,17.25,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,22.96,82,,18.368,percent of total billed charges,82% of total billed charges,23.8,85,,19.04,percent of total billed charges,85% of total billed charges,23.8,85,,19.04,percent of total billed charges,85% of total billed charges,23.8,85,,19.04,percent of total billed charges,85% of total billed charges,25.2,90,,20.16,percent of total billed charges,90% of total billed charges,22.4,80,,17.92,percent of total billed charges,80% of total billed charges,25.2,90,,20.16,percent of total billed charges,90% of total billed charges,21,75,,16.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,8.12,29,,6.496,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,18.76,67,,15.008,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,22.4,80,,17.92,percent of total billed charges,80% of total billed charges,18.2,65,,14.56,percent of total billed charges,65% of total billed charges,9.99,35.67,,7.992,percent of total billed charges,35.67% of total billed charges,8.12,25.2,
MOBIC 7.5 MG PO,2506421,CDM,250,RC,,,outpatient,,,13,5.20,,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,10.01,77,,8.01,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,10.66,82,,8.528,percent of total billed charges,82% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,11.7,90,,9.36,percent of total billed charges,90% of total billed charges,10.4,80,,8.32,percent of total billed charges,80% of total billed charges,11.7,90,,9.36,percent of total billed charges,90% of total billed charges,9.75,75,,7.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,3.77,29,,3.016,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,8.71,67,,6.968,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,10.4,80,,8.32,percent of total billed charges,80% of total billed charges,8.45,65,,6.76,percent of total billed charges,65% of total billed charges,4.64,35.67,,3.712,percent of total billed charges,35.67% of total billed charges,3.77,11.7,
MIRALAX PKT 17 GR UNIT DOSE,2506422,CDM,250,RC,,,outpatient,,,13,5.20,,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,10.01,77,,8.01,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,10.66,82,,8.528,percent of total billed charges,82% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,11.7,90,,9.36,percent of total billed charges,90% of total billed charges,10.4,80,,8.32,percent of total billed charges,80% of total billed charges,11.7,90,,9.36,percent of total billed charges,90% of total billed charges,9.75,75,,7.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,3.77,29,,3.016,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,8.71,67,,6.968,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,10.4,80,,8.32,percent of total billed charges,80% of total billed charges,8.45,65,,6.76,percent of total billed charges,65% of total billed charges,4.64,35.67,,3.712,percent of total billed charges,35.67% of total billed charges,3.77,11.7,
MIOSTAT INTRAOCULAR SOL 1.5 ML,2506424,CDM,250,RC,,,outpatient,,,150,60.00,,127.5,85,,102,percent of total billed charges,85% of total billed charges,115.5,77,,92.4,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,123,82,,98.4,percent of total billed charges,82% of total billed charges,127.5,85,,102,percent of total billed charges,85% of total billed charges,127.5,85,,102,percent of total billed charges,85% of total billed charges,127.5,85,,102,percent of total billed charges,85% of total billed charges,135,90,,108,percent of total billed charges,90% of total billed charges,120,80,,96,percent of total billed charges,80% of total billed charges,135,90,,108,percent of total billed charges,90% of total billed charges,112.5,75,,90,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,43.5,29,,34.8,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,100.5,67,,80.4,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,120,80,,96,percent of total billed charges,80% of total billed charges,97.5,65,,78,percent of total billed charges,65% of total billed charges,53.51,35.67,,42.808,percent of total billed charges,35.67% of total billed charges,43.5,135,
MIRAPEX 1 MG TAB,2506427,CDM,250,RC,,,outpatient,,,28,11.20,,23.8,85,,19.04,percent of total billed charges,85% of total billed charges,21.56,77,,17.25,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,22.96,82,,18.368,percent of total billed charges,82% of total billed charges,23.8,85,,19.04,percent of total billed charges,85% of total billed charges,23.8,85,,19.04,percent of total billed charges,85% of total billed charges,23.8,85,,19.04,percent of total billed charges,85% of total billed charges,25.2,90,,20.16,percent of total billed charges,90% of total billed charges,22.4,80,,17.92,percent of total billed charges,80% of total billed charges,25.2,90,,20.16,percent of total billed charges,90% of total billed charges,21,75,,16.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,8.12,29,,6.496,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,18.76,67,,15.008,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,22.4,80,,17.92,percent of total billed charges,80% of total billed charges,18.2,65,,14.56,percent of total billed charges,65% of total billed charges,9.99,35.67,,7.992,percent of total billed charges,35.67% of total billed charges,8.12,25.2,
MONISTAT 3 VAGINAL CREAM,2506436,CDM,250,RC,,,outpatient,,,52,20.80,,44.2,85,,35.36,percent of total billed charges,85% of total billed charges,40.04,77,,32.03,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,42.64,82,,34.112,percent of total billed charges,82% of total billed charges,44.2,85,,35.36,percent of total billed charges,85% of total billed charges,44.2,85,,35.36,percent of total billed charges,85% of total billed charges,44.2,85,,35.36,percent of total billed charges,85% of total billed charges,46.8,90,,37.44,percent of total billed charges,90% of total billed charges,41.6,80,,33.28,percent of total billed charges,80% of total billed charges,46.8,90,,37.44,percent of total billed charges,90% of total billed charges,39,75,,31.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,15.08,29,,12.064,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,34.84,67,,27.872,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,41.6,80,,33.28,percent of total billed charges,80% of total billed charges,33.8,65,,27.04,percent of total billed charges,65% of total billed charges,18.55,35.67,,14.84,percent of total billed charges,35.67% of total billed charges,15.08,46.8,
MONISTAT 1 DOSE VAGINAL OINT,2506437,CDM,250,RC,,,outpatient,,,65,26.00,,55.25,85,,44.2,percent of total billed charges,85% of total billed charges,50.05,77,,40.04,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,53.3,82,,42.64,percent of total billed charges,82% of total billed charges,55.25,85,,44.2,percent of total billed charges,85% of total billed charges,55.25,85,,44.2,percent of total billed charges,85% of total billed charges,55.25,85,,44.2,percent of total billed charges,85% of total billed charges,58.5,90,,46.8,percent of total billed charges,90% of total billed charges,52,80,,41.6,percent of total billed charges,80% of total billed charges,58.5,90,,46.8,percent of total billed charges,90% of total billed charges,48.75,75,,39,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,18.85,29,,15.08,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,43.55,67,,34.84,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,52,80,,41.6,percent of total billed charges,80% of total billed charges,42.25,65,,33.8,percent of total billed charges,65% of total billed charges,23.19,35.67,,18.552,percent of total billed charges,35.67% of total billed charges,18.85,58.5,
MONISTAT CREAM-PLAIN 30 GR TUB,2506438,CDM,250,RC,,,outpatient,,,96,38.40,,81.6,85,,65.28,percent of total billed charges,85% of total billed charges,73.92,77,,59.14,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,78.72,82,,62.976,percent of total billed charges,82% of total billed charges,81.6,85,,65.28,percent of total billed charges,85% of total billed charges,81.6,85,,65.28,percent of total billed charges,85% of total billed charges,81.6,85,,65.28,percent of total billed charges,85% of total billed charges,86.4,90,,69.12,percent of total billed charges,90% of total billed charges,76.8,80,,61.44,percent of total billed charges,80% of total billed charges,86.4,90,,69.12,percent of total billed charges,90% of total billed charges,72,75,,57.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,27.84,29,,22.272,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,64.32,67,,51.456,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,76.8,80,,61.44,percent of total billed charges,80% of total billed charges,62.4,65,,49.92,percent of total billed charges,65% of total billed charges,34.24,35.67,,27.392,percent of total billed charges,35.67% of total billed charges,27.84,86.4,
MONSEL'S SOLUTION TOPICAL,2506470,CDM,250,RC,,,outpatient,,,9,3.60,,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,6.93,77,,5.54,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,7.38,82,,5.904,percent of total billed charges,82% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,8.1,90,,6.48,percent of total billed charges,90% of total billed charges,7.2,80,,5.76,percent of total billed charges,80% of total billed charges,8.1,90,,6.48,percent of total billed charges,90% of total billed charges,6.75,75,,5.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.61,29,,2.088,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,6.03,67,,4.824,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,7.2,80,,5.76,percent of total billed charges,80% of total billed charges,5.85,65,,4.68,percent of total billed charges,65% of total billed charges,3.21,35.67,,2.568,percent of total billed charges,35.67% of total billed charges,2.61,8.1,
MORPHINE PRES FREE 5MG/10ML,2506521,CDM,250,RC,,,outpatient,,,14,5.60,,11.9,85,,9.52,percent of total billed charges,85% of total billed charges,10.78,77,,8.62,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,11.48,82,,9.184,percent of total billed charges,82% of total billed charges,11.9,85,,9.52,percent of total billed charges,85% of total billed charges,11.9,85,,9.52,percent of total billed charges,85% of total billed charges,11.9,85,,9.52,percent of total billed charges,85% of total billed charges,12.6,90,,10.08,percent of total billed charges,90% of total billed charges,11.2,80,,8.96,percent of total billed charges,80% of total billed charges,12.6,90,,10.08,percent of total billed charges,90% of total billed charges,10.5,75,,8.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,4.06,29,,3.248,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,9.38,67,,7.504,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,11.2,80,,8.96,percent of total billed charges,80% of total billed charges,9.1,65,,7.28,percent of total billed charges,65% of total billed charges,4.99,35.67,,3.992,percent of total billed charges,35.67% of total billed charges,4.06,12.6,
MORPHINE CONTIN 30 MG TAB,2506530,CDM,250,RC,,,outpatient,,,18,7.20,,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,13.86,77,,11.09,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,14.76,82,,11.808,percent of total billed charges,82% of total billed charges,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,16.2,90,,12.96,percent of total billed charges,90% of total billed charges,14.4,80,,11.52,percent of total billed charges,80% of total billed charges,16.2,90,,12.96,percent of total billed charges,90% of total billed charges,13.5,75,,10.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,5.22,29,,4.176,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,12.06,67,,9.648,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,14.4,80,,11.52,percent of total billed charges,80% of total billed charges,11.7,65,,9.36,percent of total billed charges,65% of total billed charges,6.42,35.67,,5.136,percent of total billed charges,35.67% of total billed charges,5.22,16.2,
MORPHINE CONTIN TAB PO 100 MG,2506531,CDM,250,RC,,,outpatient,,,48,19.20,,40.8,85,,32.64,percent of total billed charges,85% of total billed charges,36.96,77,,29.57,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,39.36,82,,31.488,percent of total billed charges,82% of total billed charges,40.8,85,,32.64,percent of total billed charges,85% of total billed charges,40.8,85,,32.64,percent of total billed charges,85% of total billed charges,40.8,85,,32.64,percent of total billed charges,85% of total billed charges,43.2,90,,34.56,percent of total billed charges,90% of total billed charges,38.4,80,,30.72,percent of total billed charges,80% of total billed charges,43.2,90,,34.56,percent of total billed charges,90% of total billed charges,36,75,,28.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,13.92,29,,11.136,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,32.16,67,,25.728,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,38.4,80,,30.72,percent of total billed charges,80% of total billed charges,31.2,65,,24.96,percent of total billed charges,65% of total billed charges,17.12,35.67,,13.696,percent of total billed charges,35.67% of total billed charges,13.92,43.2,
MUCOMYST 4CC 20%,2506560,CDM,250,RC,,,outpatient,,,28,11.20,,23.8,85,,19.04,percent of total billed charges,85% of total billed charges,21.56,77,,17.25,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,22.96,82,,18.368,percent of total billed charges,82% of total billed charges,23.8,85,,19.04,percent of total billed charges,85% of total billed charges,23.8,85,,19.04,percent of total billed charges,85% of total billed charges,23.8,85,,19.04,percent of total billed charges,85% of total billed charges,25.2,90,,20.16,percent of total billed charges,90% of total billed charges,22.4,80,,17.92,percent of total billed charges,80% of total billed charges,25.2,90,,20.16,percent of total billed charges,90% of total billed charges,21,75,,16.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,8.12,29,,6.496,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,18.76,67,,15.008,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,22.4,80,,17.92,percent of total billed charges,80% of total billed charges,18.2,65,,14.56,percent of total billed charges,65% of total billed charges,9.99,35.67,,7.992,percent of total billed charges,35.67% of total billed charges,8.12,25.2,
MUCOMYST 30CC 20%,2506565,CDM,250,RC,,,outpatient,,,84,33.60,,71.4,85,,57.12,percent of total billed charges,85% of total billed charges,64.68,77,,51.74,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,68.88,82,,55.104,percent of total billed charges,82% of total billed charges,71.4,85,,57.12,percent of total billed charges,85% of total billed charges,71.4,85,,57.12,percent of total billed charges,85% of total billed charges,71.4,85,,57.12,percent of total billed charges,85% of total billed charges,75.6,90,,60.48,percent of total billed charges,90% of total billed charges,67.2,80,,53.76,percent of total billed charges,80% of total billed charges,75.6,90,,60.48,percent of total billed charges,90% of total billed charges,63,75,,50.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,24.36,29,,19.488,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,56.28,67,,45.024,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,67.2,80,,53.76,percent of total billed charges,80% of total billed charges,54.6,65,,43.68,percent of total billed charges,65% of total billed charges,29.96,35.67,,23.968,percent of total billed charges,35.67% of total billed charges,24.36,75.6,
MUCINEX 600 MG,2506566,CDM,250,RC,,,outpatient,,,7,2.80,,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.39,77,,4.31,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,5.74,82,,4.592,percent of total billed charges,82% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.25,75,,4.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.03,29,,1.624,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4.69,67,,3.752,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,4.55,65,,3.64,percent of total billed charges,65% of total billed charges,2.5,35.67,,2,percent of total billed charges,35.67% of total billed charges,2.03,6.3,
MUCINEX DM TABLET,2506567,CDM,250,RC,,,outpatient,,,7,2.80,,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.39,77,,4.31,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,5.74,82,,4.592,percent of total billed charges,82% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.25,75,,4.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.03,29,,1.624,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4.69,67,,3.752,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,4.55,65,,3.64,percent of total billed charges,65% of total billed charges,2.5,35.67,,2,percent of total billed charges,35.67% of total billed charges,2.03,6.3,
MURO 128 EYE DROPS,2506575,CDM,250,RC,,,outpatient,,,67,26.80,,56.95,85,,45.56,percent of total billed charges,85% of total billed charges,51.59,77,,41.27,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,54.94,82,,43.952,percent of total billed charges,82% of total billed charges,56.95,85,,45.56,percent of total billed charges,85% of total billed charges,56.95,85,,45.56,percent of total billed charges,85% of total billed charges,56.95,85,,45.56,percent of total billed charges,85% of total billed charges,60.3,90,,48.24,percent of total billed charges,90% of total billed charges,53.6,80,,42.88,percent of total billed charges,80% of total billed charges,60.3,90,,48.24,percent of total billed charges,90% of total billed charges,50.25,75,,40.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,19.43,29,,15.544,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,44.89,67,,35.912,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,53.6,80,,42.88,percent of total billed charges,80% of total billed charges,43.55,65,,34.84,percent of total billed charges,65% of total billed charges,23.9,35.67,,19.12,percent of total billed charges,35.67% of total billed charges,19.43,60.3,
MURO 128 EYE OINT,2506580,CDM,250,RC,,,outpatient,,,68,27.20,,57.8,85,,46.24,percent of total billed charges,85% of total billed charges,52.36,77,,41.89,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,55.76,82,,44.608,percent of total billed charges,82% of total billed charges,57.8,85,,46.24,percent of total billed charges,85% of total billed charges,57.8,85,,46.24,percent of total billed charges,85% of total billed charges,57.8,85,,46.24,percent of total billed charges,85% of total billed charges,61.2,90,,48.96,percent of total billed charges,90% of total billed charges,54.4,80,,43.52,percent of total billed charges,80% of total billed charges,61.2,90,,48.96,percent of total billed charges,90% of total billed charges,51,75,,40.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,19.72,29,,15.776,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,45.56,67,,36.448,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,54.4,80,,43.52,percent of total billed charges,80% of total billed charges,44.2,65,,35.36,percent of total billed charges,65% of total billed charges,24.26,35.67,,19.408,percent of total billed charges,35.67% of total billed charges,19.72,61.2,
MVI ADULT VIAL,2506592,CDM,250,RC,,,outpatient,,,251,100.40,,213.35,85,,170.68,percent of total billed charges,85% of total billed charges,193.27,77,,154.62,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,205.82,82,,164.656,percent of total billed charges,82% of total billed charges,213.35,85,,170.68,percent of total billed charges,85% of total billed charges,213.35,85,,170.68,percent of total billed charges,85% of total billed charges,213.35,85,,170.68,percent of total billed charges,85% of total billed charges,225.9,90,,180.72,percent of total billed charges,90% of total billed charges,200.8,80,,160.64,percent of total billed charges,80% of total billed charges,225.9,90,,180.72,percent of total billed charges,90% of total billed charges,188.25,75,,150.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,72.79,29,,58.232,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,168.17,67,,134.536,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,200.8,80,,160.64,percent of total billed charges,80% of total billed charges,163.15,65,,130.52,percent of total billed charges,65% of total billed charges,89.53,35.67,,71.624,percent of total billed charges,35.67% of total billed charges,72.79,225.9,
MYAMBUTAL 400 MG TAB,2506594,CDM,250,RC,,,outpatient,,,10,4.00,,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,7.7,77,,6.16,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,8.2,82,,6.56,percent of total billed charges,82% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,9,90,,7.2,percent of total billed charges,90% of total billed charges,8,80,,6.4,percent of total billed charges,80% of total billed charges,9,90,,7.2,percent of total billed charges,90% of total billed charges,7.5,75,,6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.9,29,,2.32,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,6.7,67,,5.36,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,8,80,,6.4,percent of total billed charges,80% of total billed charges,6.5,65,,5.2,percent of total billed charges,65% of total billed charges,3.57,35.67,,2.856,percent of total billed charges,35.67% of total billed charges,2.9,9,
MYDRIACYL 3 ML OPTH GTTS,2506619,CDM,250,RC,,,outpatient,,,98,39.20,,83.3,85,,66.64,percent of total billed charges,85% of total billed charges,75.46,77,,60.37,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,80.36,82,,64.288,percent of total billed charges,82% of total billed charges,83.3,85,,66.64,percent of total billed charges,85% of total billed charges,83.3,85,,66.64,percent of total billed charges,85% of total billed charges,83.3,85,,66.64,percent of total billed charges,85% of total billed charges,88.2,90,,70.56,percent of total billed charges,90% of total billed charges,78.4,80,,62.72,percent of total billed charges,80% of total billed charges,88.2,90,,70.56,percent of total billed charges,90% of total billed charges,73.5,75,,58.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,28.42,29,,22.736,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,65.66,67,,52.528,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,78.4,80,,62.72,percent of total billed charges,80% of total billed charges,63.7,65,,50.96,percent of total billed charges,65% of total billed charges,34.96,35.67,,27.968,percent of total billed charges,35.67% of total billed charges,28.42,88.2,
MYDRIACYL EYE GTT 1% 15ML,2506620,CDM,250,RC,,,outpatient,,,269,107.60,,228.65,85,,182.92,percent of total billed charges,85% of total billed charges,207.13,77,,165.7,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,220.58,82,,176.464,percent of total billed charges,82% of total billed charges,228.65,85,,182.92,percent of total billed charges,85% of total billed charges,228.65,85,,182.92,percent of total billed charges,85% of total billed charges,228.65,85,,182.92,percent of total billed charges,85% of total billed charges,242.1,90,,193.68,percent of total billed charges,90% of total billed charges,215.2,80,,172.16,percent of total billed charges,80% of total billed charges,242.1,90,,193.68,percent of total billed charges,90% of total billed charges,201.75,75,,161.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,78.01,29,,62.408,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,180.23,67,,144.184,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,215.2,80,,172.16,percent of total billed charges,80% of total billed charges,174.85,65,,139.88,percent of total billed charges,65% of total billed charges,95.95,35.67,,76.76,percent of total billed charges,35.67% of total billed charges,78.01,242.1,
MYLICON 80 MG TAB,2506640,CDM,250,RC,,,outpatient,,,7,2.80,,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.39,77,,4.31,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,5.74,82,,4.592,percent of total billed charges,82% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.25,75,,4.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.03,29,,1.624,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4.69,67,,3.752,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,4.55,65,,3.64,percent of total billed charges,65% of total billed charges,2.5,35.67,,2,percent of total billed charges,35.67% of total billed charges,2.03,6.3,
MYLICON LIQ. 30CC GTTS.,2506650,CDM,250,RC,,,outpatient,,,28,11.20,,23.8,85,,19.04,percent of total billed charges,85% of total billed charges,21.56,77,,17.25,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,22.96,82,,18.368,percent of total billed charges,82% of total billed charges,23.8,85,,19.04,percent of total billed charges,85% of total billed charges,23.8,85,,19.04,percent of total billed charges,85% of total billed charges,23.8,85,,19.04,percent of total billed charges,85% of total billed charges,25.2,90,,20.16,percent of total billed charges,90% of total billed charges,22.4,80,,17.92,percent of total billed charges,80% of total billed charges,25.2,90,,20.16,percent of total billed charges,90% of total billed charges,21,75,,16.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,8.12,29,,6.496,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,18.76,67,,15.008,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,22.4,80,,17.92,percent of total billed charges,80% of total billed charges,18.2,65,,14.56,percent of total billed charges,65% of total billed charges,9.99,35.67,,7.992,percent of total billed charges,35.67% of total billed charges,8.12,25.2,
MYSOLINE 250 MG TAB,2506675,CDM,250,RC,,,outpatient,,,20,8.00,,17,85,,13.6,percent of total billed charges,85% of total billed charges,15.4,77,,12.32,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,16.4,82,,13.12,percent of total billed charges,82% of total billed charges,17,85,,13.6,percent of total billed charges,85% of total billed charges,17,85,,13.6,percent of total billed charges,85% of total billed charges,17,85,,13.6,percent of total billed charges,85% of total billed charges,18,90,,14.4,percent of total billed charges,90% of total billed charges,16,80,,12.8,percent of total billed charges,80% of total billed charges,18,90,,14.4,percent of total billed charges,90% of total billed charges,15,75,,12,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,5.8,29,,4.64,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,13.4,67,,10.72,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,16,80,,12.8,percent of total billed charges,80% of total billed charges,13,65,,10.4,percent of total billed charges,65% of total billed charges,7.13,35.67,,5.704,percent of total billed charges,35.67% of total billed charges,5.8,18,
MYSOLINE TAB 50 MG,2506680,CDM,250,RC,,,outpatient,,,13,5.20,,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,10.01,77,,8.01,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,10.66,82,,8.528,percent of total billed charges,82% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,11.7,90,,9.36,percent of total billed charges,90% of total billed charges,10.4,80,,8.32,percent of total billed charges,80% of total billed charges,11.7,90,,9.36,percent of total billed charges,90% of total billed charges,9.75,75,,7.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,3.77,29,,3.016,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,8.71,67,,6.968,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,10.4,80,,8.32,percent of total billed charges,80% of total billed charges,8.45,65,,6.76,percent of total billed charges,65% of total billed charges,4.64,35.67,,3.712,percent of total billed charges,35.67% of total billed charges,3.77,11.7,
MYTREX (MYCOLOG) 15GM CREAM,2506685,CDM,250,RC,,,outpatient,,,342,136.80,,290.7,85,,232.56,percent of total billed charges,85% of total billed charges,263.34,77,,210.67,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,280.44,82,,224.352,percent of total billed charges,82% of total billed charges,290.7,85,,232.56,percent of total billed charges,85% of total billed charges,290.7,85,,232.56,percent of total billed charges,85% of total billed charges,290.7,85,,232.56,percent of total billed charges,85% of total billed charges,307.8,90,,246.24,percent of total billed charges,90% of total billed charges,273.6,80,,218.88,percent of total billed charges,80% of total billed charges,307.8,90,,246.24,percent of total billed charges,90% of total billed charges,256.5,75,,205.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,99.18,29,,79.344,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,229.14,67,,183.312,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,273.6,80,,218.88,percent of total billed charges,80% of total billed charges,222.3,65,,177.84,percent of total billed charges,65% of total billed charges,121.99,35.67,,97.592,percent of total billed charges,35.67% of total billed charges,99.18,307.8,
NAFCIL 2000 MG INJ,2506696,CDM,250,RC,,,outpatient,,,105,42.00,,89.25,85,,71.4,percent of total billed charges,85% of total billed charges,80.85,77,,64.68,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,86.1,82,,68.88,percent of total billed charges,82% of total billed charges,89.25,85,,71.4,percent of total billed charges,85% of total billed charges,89.25,85,,71.4,percent of total billed charges,85% of total billed charges,89.25,85,,71.4,percent of total billed charges,85% of total billed charges,94.5,90,,75.6,percent of total billed charges,90% of total billed charges,84,80,,67.2,percent of total billed charges,80% of total billed charges,94.5,90,,75.6,percent of total billed charges,90% of total billed charges,78.75,75,,63,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,30.45,29,,24.36,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,70.35,67,,56.28,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,84,80,,67.2,percent of total billed charges,80% of total billed charges,68.25,65,,54.6,percent of total billed charges,65% of total billed charges,37.45,35.67,,29.96,percent of total billed charges,35.67% of total billed charges,30.45,94.5,
NAMENDA 5 MG TAB,2506737,CDM,250,RC,,,outpatient,,,25,10.00,,21.25,85,,17,percent of total billed charges,85% of total billed charges,19.25,77,,15.4,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,20.5,82,,16.4,percent of total billed charges,82% of total billed charges,21.25,85,,17,percent of total billed charges,85% of total billed charges,21.25,85,,17,percent of total billed charges,85% of total billed charges,21.25,85,,17,percent of total billed charges,85% of total billed charges,22.5,90,,18,percent of total billed charges,90% of total billed charges,20,80,,16,percent of total billed charges,80% of total billed charges,22.5,90,,18,percent of total billed charges,90% of total billed charges,18.75,75,,15,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,7.25,29,,5.8,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,16.75,67,,13.4,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,20,80,,16,percent of total billed charges,80% of total billed charges,16.25,65,,13,percent of total billed charges,65% of total billed charges,8.92,35.67,,7.136,percent of total billed charges,35.67% of total billed charges,7.25,22.5,
NAPROSYN 250MG TAB,2506745,CDM,250,RC,,,outpatient,,,10,4.00,,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,7.7,77,,6.16,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,8.2,82,,6.56,percent of total billed charges,82% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,9,90,,7.2,percent of total billed charges,90% of total billed charges,8,80,,6.4,percent of total billed charges,80% of total billed charges,9,90,,7.2,percent of total billed charges,90% of total billed charges,7.5,75,,6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.9,29,,2.32,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,6.7,67,,5.36,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,8,80,,6.4,percent of total billed charges,80% of total billed charges,6.5,65,,5.2,percent of total billed charges,65% of total billed charges,3.57,35.67,,2.856,percent of total billed charges,35.67% of total billed charges,2.9,9,
NASALCROM W/PUMP INHALER,2506785,CDM,250,RC,,,outpatient,,,28,11.20,,23.8,85,,19.04,percent of total billed charges,85% of total billed charges,21.56,77,,17.25,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,22.96,82,,18.368,percent of total billed charges,82% of total billed charges,23.8,85,,19.04,percent of total billed charges,85% of total billed charges,23.8,85,,19.04,percent of total billed charges,85% of total billed charges,23.8,85,,19.04,percent of total billed charges,85% of total billed charges,25.2,90,,20.16,percent of total billed charges,90% of total billed charges,22.4,80,,17.92,percent of total billed charges,80% of total billed charges,25.2,90,,20.16,percent of total billed charges,90% of total billed charges,21,75,,16.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,8.12,29,,6.496,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,18.76,67,,15.008,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,22.4,80,,17.92,percent of total billed charges,80% of total billed charges,18.2,65,,14.56,percent of total billed charges,65% of total billed charges,9.99,35.67,,7.992,percent of total billed charges,35.67% of total billed charges,8.12,25.2,
NAROPIN 10 MG VIAL,2506881,CDM,250,RC,,,outpatient,,,76,30.40,,64.6,85,,51.68,percent of total billed charges,85% of total billed charges,58.52,77,,46.82,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,62.32,82,,49.856,percent of total billed charges,82% of total billed charges,64.6,85,,51.68,percent of total billed charges,85% of total billed charges,64.6,85,,51.68,percent of total billed charges,85% of total billed charges,64.6,85,,51.68,percent of total billed charges,85% of total billed charges,68.4,90,,54.72,percent of total billed charges,90% of total billed charges,60.8,80,,48.64,percent of total billed charges,80% of total billed charges,68.4,90,,54.72,percent of total billed charges,90% of total billed charges,57,75,,45.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,22.04,29,,17.632,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,50.92,67,,40.736,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,60.8,80,,48.64,percent of total billed charges,80% of total billed charges,49.4,65,,39.52,percent of total billed charges,65% of total billed charges,27.11,35.67,,21.688,percent of total billed charges,35.67% of total billed charges,22.04,68.4,
LITTLE NOSES 0.125% 15 ML BTL,2506904,CDM,250,RC,,,outpatient,,,15,6.00,,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,11.55,77,,9.24,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,12.3,82,,9.84,percent of total billed charges,82% of total billed charges,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,13.5,90,,10.8,percent of total billed charges,90% of total billed charges,12,80,,9.6,percent of total billed charges,80% of total billed charges,13.5,90,,10.8,percent of total billed charges,90% of total billed charges,11.25,75,,9,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,4.35,29,,3.48,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,10.05,67,,8.04,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,12,80,,9.6,percent of total billed charges,80% of total billed charges,9.75,65,,7.8,percent of total billed charges,65% of total billed charges,5.35,35.67,,4.28,percent of total billed charges,35.67% of total billed charges,4.35,13.5,
NEO-SYNEPHRINE REG STRENGTH 15,2506906,CDM,250,RC,,,outpatient,,,15,6.00,,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,11.55,77,,9.24,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,12.3,82,,9.84,percent of total billed charges,82% of total billed charges,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,13.5,90,,10.8,percent of total billed charges,90% of total billed charges,12,80,,9.6,percent of total billed charges,80% of total billed charges,13.5,90,,10.8,percent of total billed charges,90% of total billed charges,11.25,75,,9,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,4.35,29,,3.48,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,10.05,67,,8.04,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,12,80,,9.6,percent of total billed charges,80% of total billed charges,9.75,65,,7.8,percent of total billed charges,65% of total billed charges,5.35,35.67,,4.28,percent of total billed charges,35.67% of total billed charges,4.35,13.5,
NEOSYNEPHRINE 10% VISC GTTS,2506911,CDM,250,RC,,,outpatient,,,177,70.80,,150.45,85,,120.36,percent of total billed charges,85% of total billed charges,136.29,77,,109.03,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,145.14,82,,116.112,percent of total billed charges,82% of total billed charges,150.45,85,,120.36,percent of total billed charges,85% of total billed charges,150.45,85,,120.36,percent of total billed charges,85% of total billed charges,150.45,85,,120.36,percent of total billed charges,85% of total billed charges,159.3,90,,127.44,percent of total billed charges,90% of total billed charges,141.6,80,,113.28,percent of total billed charges,80% of total billed charges,159.3,90,,127.44,percent of total billed charges,90% of total billed charges,132.75,75,,106.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,51.33,29,,41.064,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,118.59,67,,94.872,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,141.6,80,,113.28,percent of total billed charges,80% of total billed charges,115.05,65,,92.04,percent of total billed charges,65% of total billed charges,63.14,35.67,,50.512,percent of total billed charges,35.67% of total billed charges,51.33,159.3,
NEOMYCIN SULF 500 MG TAB,2506930,CDM,250,RC,,,outpatient,,,10,4.00,,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,7.7,77,,6.16,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,8.2,82,,6.56,percent of total billed charges,82% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,9,90,,7.2,percent of total billed charges,90% of total billed charges,8,80,,6.4,percent of total billed charges,80% of total billed charges,9,90,,7.2,percent of total billed charges,90% of total billed charges,7.5,75,,6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.9,29,,2.32,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,6.7,67,,5.36,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,8,80,,6.4,percent of total billed charges,80% of total billed charges,6.5,65,,5.2,percent of total billed charges,65% of total billed charges,3.57,35.67,,2.856,percent of total billed charges,35.67% of total billed charges,2.9,9,
NEOMYCIN COLIST HC THONZONIUM,2506932,CDM,250,RC,,,outpatient,,,761,304.40,,646.85,85,,517.48,percent of total billed charges,85% of total billed charges,585.97,77,,468.78,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,624.02,82,,499.216,percent of total billed charges,82% of total billed charges,646.85,85,,517.48,percent of total billed charges,85% of total billed charges,646.85,85,,517.48,percent of total billed charges,85% of total billed charges,646.85,85,,517.48,percent of total billed charges,85% of total billed charges,684.9,90,,547.92,percent of total billed charges,90% of total billed charges,608.8,80,,487.04,percent of total billed charges,80% of total billed charges,684.9,90,,547.92,percent of total billed charges,90% of total billed charges,570.75,75,,456.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,220.69,29,,176.552,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,509.87,67,,407.896,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,608.8,80,,487.04,percent of total billed charges,80% of total billed charges,494.65,65,,395.72,percent of total billed charges,65% of total billed charges,271.45,35.67,,217.16,percent of total billed charges,35.67% of total billed charges,220.69,684.9,
NEOSPORIN FOIL PKG. OINT,2506940,CDM,250,RC,,,outpatient,,,8,3.20,,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,6.16,77,,4.93,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,6.56,82,,5.248,percent of total billed charges,82% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,7.2,90,,5.76,percent of total billed charges,90% of total billed charges,6.4,80,,5.12,percent of total billed charges,80% of total billed charges,7.2,90,,5.76,percent of total billed charges,90% of total billed charges,6,75,,4.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.32,29,,1.856,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,5.36,67,,4.288,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,6.4,80,,5.12,percent of total billed charges,80% of total billed charges,5.2,65,,4.16,percent of total billed charges,65% of total billed charges,2.85,35.67,,2.28,percent of total billed charges,35.67% of total billed charges,2.32,7.2,
NEOSPORIN OPTH OINT,2506955,CDM,250,RC,,,outpatient,,,191,76.40,,162.35,85,,129.88,percent of total billed charges,85% of total billed charges,147.07,77,,117.66,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,156.62,82,,125.296,percent of total billed charges,82% of total billed charges,162.35,85,,129.88,percent of total billed charges,85% of total billed charges,162.35,85,,129.88,percent of total billed charges,85% of total billed charges,162.35,85,,129.88,percent of total billed charges,85% of total billed charges,171.9,90,,137.52,percent of total billed charges,90% of total billed charges,152.8,80,,122.24,percent of total billed charges,80% of total billed charges,171.9,90,,137.52,percent of total billed charges,90% of total billed charges,143.25,75,,114.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,55.39,29,,44.312,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,127.97,67,,102.376,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,152.8,80,,122.24,percent of total billed charges,80% of total billed charges,124.15,65,,99.32,percent of total billed charges,65% of total billed charges,68.13,35.67,,54.504,percent of total billed charges,35.67% of total billed charges,55.39,171.9,
NEOSPORIN OPTH. SOL. 10CC,2506960,CDM,250,RC,,,outpatient,,,208,83.20,,176.8,85,,141.44,percent of total billed charges,85% of total billed charges,160.16,77,,128.13,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,170.56,82,,136.448,percent of total billed charges,82% of total billed charges,176.8,85,,141.44,percent of total billed charges,85% of total billed charges,176.8,85,,141.44,percent of total billed charges,85% of total billed charges,176.8,85,,141.44,percent of total billed charges,85% of total billed charges,187.2,90,,149.76,percent of total billed charges,90% of total billed charges,166.4,80,,133.12,percent of total billed charges,80% of total billed charges,187.2,90,,149.76,percent of total billed charges,90% of total billed charges,156,75,,124.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,60.32,29,,48.256,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,139.36,67,,111.488,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,166.4,80,,133.12,percent of total billed charges,80% of total billed charges,135.2,65,,108.16,percent of total billed charges,65% of total billed charges,74.19,35.67,,59.352,percent of total billed charges,35.67% of total billed charges,60.32,187.2,
NEURONTIN 100 MG CAP,2506991,CDM,250,RC,,,outpatient,,,8,3.20,,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,6.16,77,,4.93,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,6.56,82,,5.248,percent of total billed charges,82% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,7.2,90,,5.76,percent of total billed charges,90% of total billed charges,6.4,80,,5.12,percent of total billed charges,80% of total billed charges,7.2,90,,5.76,percent of total billed charges,90% of total billed charges,6,75,,4.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.32,29,,1.856,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,5.36,67,,4.288,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,6.4,80,,5.12,percent of total billed charges,80% of total billed charges,5.2,65,,4.16,percent of total billed charges,65% of total billed charges,2.85,35.67,,2.28,percent of total billed charges,35.67% of total billed charges,2.32,7.2,
NEURONTIN 300 MG CAP,2506992,CDM,250,RC,,,outpatient,,,15,6.00,,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,11.55,77,,9.24,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,12.3,82,,9.84,percent of total billed charges,82% of total billed charges,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,13.5,90,,10.8,percent of total billed charges,90% of total billed charges,12,80,,9.6,percent of total billed charges,80% of total billed charges,13.5,90,,10.8,percent of total billed charges,90% of total billed charges,11.25,75,,9,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,4.35,29,,3.48,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,10.05,67,,8.04,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,12,80,,9.6,percent of total billed charges,80% of total billed charges,9.75,65,,7.8,percent of total billed charges,65% of total billed charges,5.35,35.67,,4.28,percent of total billed charges,35.67% of total billed charges,4.35,13.5,
NEUT 25MG/5CC *,2506993,CDM,250,RC,,,outpatient,,,34,13.60,,28.9,85,,23.12,percent of total billed charges,85% of total billed charges,26.18,77,,20.94,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,27.88,82,,22.304,percent of total billed charges,82% of total billed charges,28.9,85,,23.12,percent of total billed charges,85% of total billed charges,28.9,85,,23.12,percent of total billed charges,85% of total billed charges,28.9,85,,23.12,percent of total billed charges,85% of total billed charges,30.6,90,,24.48,percent of total billed charges,90% of total billed charges,27.2,80,,21.76,percent of total billed charges,80% of total billed charges,30.6,90,,24.48,percent of total billed charges,90% of total billed charges,25.5,75,,20.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,9.86,29,,7.888,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,22.78,67,,18.224,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,27.2,80,,21.76,percent of total billed charges,80% of total billed charges,22.1,65,,17.68,percent of total billed charges,65% of total billed charges,12.13,35.67,,9.704,percent of total billed charges,35.67% of total billed charges,9.86,30.6,
NIACIN 500 MG TAB,2507001,CDM,250,RC,,,outpatient,,,7,2.80,,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.39,77,,4.31,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,5.74,82,,4.592,percent of total billed charges,82% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.25,75,,4.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.03,29,,1.624,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4.69,67,,3.752,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,4.55,65,,3.64,percent of total billed charges,65% of total billed charges,2.5,35.67,,2,percent of total billed charges,35.67% of total billed charges,2.03,6.3,
NEXIUM 40 MG VIAL,2507014,CDM,250,RC,,,outpatient,,,153,61.20,,130.05,85,,104.04,percent of total billed charges,85% of total billed charges,117.81,77,,94.25,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,125.46,82,,100.368,percent of total billed charges,82% of total billed charges,130.05,85,,104.04,percent of total billed charges,85% of total billed charges,130.05,85,,104.04,percent of total billed charges,85% of total billed charges,130.05,85,,104.04,percent of total billed charges,85% of total billed charges,137.7,90,,110.16,percent of total billed charges,90% of total billed charges,122.4,80,,97.92,percent of total billed charges,80% of total billed charges,137.7,90,,110.16,percent of total billed charges,90% of total billed charges,114.75,75,,91.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,44.37,29,,35.496,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,102.51,67,,82.008,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,122.4,80,,97.92,percent of total billed charges,80% of total billed charges,99.45,65,,79.56,percent of total billed charges,65% of total billed charges,54.58,35.67,,43.664,percent of total billed charges,35.67% of total billed charges,44.37,137.7,
NICORETTE 4 GUM EACH PIECE,2507016,CDM,250,RC,,,outpatient,,,91,36.40,,77.35,85,,61.88,percent of total billed charges,85% of total billed charges,70.07,77,,56.06,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,74.62,82,,59.696,percent of total billed charges,82% of total billed charges,77.35,85,,61.88,percent of total billed charges,85% of total billed charges,77.35,85,,61.88,percent of total billed charges,85% of total billed charges,77.35,85,,61.88,percent of total billed charges,85% of total billed charges,81.9,90,,65.52,percent of total billed charges,90% of total billed charges,72.8,80,,58.24,percent of total billed charges,80% of total billed charges,81.9,90,,65.52,percent of total billed charges,90% of total billed charges,68.25,75,,54.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,26.39,29,,21.112,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,60.97,67,,48.776,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,72.8,80,,58.24,percent of total billed charges,80% of total billed charges,59.15,65,,47.32,percent of total billed charges,65% of total billed charges,32.46,35.67,,25.968,percent of total billed charges,35.67% of total billed charges,26.39,81.9,
NIPRIDE 50 MG INJ,2507030,CDM,250,RC,,,outpatient,,,2040,816.00,,1734,85,,1387.2,percent of total billed charges,85% of total billed charges,1570.8,77,,1256.64,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,1672.8,82,,1338.24,percent of total billed charges,82% of total billed charges,1734,85,,1387.2,percent of total billed charges,85% of total billed charges,1734,85,,1387.2,percent of total billed charges,85% of total billed charges,1734,85,,1387.2,percent of total billed charges,85% of total billed charges,1836,90,,1468.8,percent of total billed charges,90% of total billed charges,1632,80,,1305.6,percent of total billed charges,80% of total billed charges,1836,90,,1468.8,percent of total billed charges,90% of total billed charges,1530,75,,1224,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,591.6,29,,473.28,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1366.8,67,,1093.44,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1632,80,,1305.6,percent of total billed charges,80% of total billed charges,1326,65,,1060.8,percent of total billed charges,65% of total billed charges,727.67,35.67,,582.136,percent of total billed charges,35.67% of total billed charges,591.6,1836,
NITRO DUR PATCH 0.3 MG TOPICAL,2507046,CDM,250,RC,,,outpatient,,,25,10.00,,21.25,85,,17,percent of total billed charges,85% of total billed charges,19.25,77,,15.4,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,20.5,82,,16.4,percent of total billed charges,82% of total billed charges,21.25,85,,17,percent of total billed charges,85% of total billed charges,21.25,85,,17,percent of total billed charges,85% of total billed charges,21.25,85,,17,percent of total billed charges,85% of total billed charges,22.5,90,,18,percent of total billed charges,90% of total billed charges,20,80,,16,percent of total billed charges,80% of total billed charges,22.5,90,,18,percent of total billed charges,90% of total billed charges,18.75,75,,15,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,7.25,29,,5.8,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,16.75,67,,13.4,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,20,80,,16,percent of total billed charges,80% of total billed charges,16.25,65,,13,percent of total billed charges,65% of total billed charges,8.92,35.67,,7.136,percent of total billed charges,35.67% of total billed charges,7.25,22.5,
NITROGLYCERIN 50 MG PREMIX 250,2507061,CDM,250,RC,,,outpatient,,,80,32.00,,68,85,,54.4,percent of total billed charges,85% of total billed charges,61.6,77,,49.28,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,65.6,82,,52.48,percent of total billed charges,82% of total billed charges,68,85,,54.4,percent of total billed charges,85% of total billed charges,68,85,,54.4,percent of total billed charges,85% of total billed charges,68,85,,54.4,percent of total billed charges,85% of total billed charges,72,90,,57.6,percent of total billed charges,90% of total billed charges,64,80,,51.2,percent of total billed charges,80% of total billed charges,72,90,,57.6,percent of total billed charges,90% of total billed charges,60,75,,48,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,23.2,29,,18.56,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,53.6,67,,42.88,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,64,80,,51.2,percent of total billed charges,80% of total billed charges,52,65,,41.6,percent of total billed charges,65% of total billed charges,28.54,35.67,,22.832,percent of total billed charges,35.67% of total billed charges,23.2,72,
NITROGLYCERIN 0.4 MG TAB,2507065,CDM,250,RC,,,outpatient,,,8,3.20,,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,6.16,77,,4.93,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,6.56,82,,5.248,percent of total billed charges,82% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,7.2,90,,5.76,percent of total billed charges,90% of total billed charges,6.4,80,,5.12,percent of total billed charges,80% of total billed charges,7.2,90,,5.76,percent of total billed charges,90% of total billed charges,6,75,,4.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.32,29,,1.856,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,5.36,67,,4.288,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,6.4,80,,5.12,percent of total billed charges,80% of total billed charges,5.2,65,,4.16,percent of total billed charges,65% of total billed charges,2.85,35.67,,2.28,percent of total billed charges,35.67% of total billed charges,2.32,7.2,
NITROL OINTMENT 2% FOIL PACK,2507072,CDM,250,RC,,,outpatient,,,11,4.40,,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,8.47,77,,6.78,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,9.02,82,,7.216,percent of total billed charges,82% of total billed charges,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,9.9,90,,7.92,percent of total billed charges,90% of total billed charges,8.8,80,,7.04,percent of total billed charges,80% of total billed charges,9.9,90,,7.92,percent of total billed charges,90% of total billed charges,8.25,75,,6.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,3.19,29,,2.552,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,7.37,67,,5.896,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,8.8,80,,7.04,percent of total billed charges,80% of total billed charges,7.15,65,,5.72,percent of total billed charges,65% of total billed charges,3.92,35.67,,3.136,percent of total billed charges,35.67% of total billed charges,3.19,9.9,
NITROLINGUAL SPRAY,2507075,CDM,250,RC,,,outpatient,,,521,208.40,,442.85,85,,354.28,percent of total billed charges,85% of total billed charges,401.17,77,,320.94,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,427.22,82,,341.776,percent of total billed charges,82% of total billed charges,442.85,85,,354.28,percent of total billed charges,85% of total billed charges,442.85,85,,354.28,percent of total billed charges,85% of total billed charges,442.85,85,,354.28,percent of total billed charges,85% of total billed charges,468.9,90,,375.12,percent of total billed charges,90% of total billed charges,416.8,80,,333.44,percent of total billed charges,80% of total billed charges,468.9,90,,375.12,percent of total billed charges,90% of total billed charges,390.75,75,,312.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,151.09,29,,120.872,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,349.07,67,,279.256,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,416.8,80,,333.44,percent of total billed charges,80% of total billed charges,338.65,65,,270.92,percent of total billed charges,65% of total billed charges,185.84,35.67,,148.672,percent of total billed charges,35.67% of total billed charges,151.09,468.9,
NIX CREAM RINSE 1 % SH,2507085,CDM,250,RC,,,outpatient,,,40,16.00,,34,85,,27.2,percent of total billed charges,85% of total billed charges,30.8,77,,24.64,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,32.8,82,,26.24,percent of total billed charges,82% of total billed charges,34,85,,27.2,percent of total billed charges,85% of total billed charges,34,85,,27.2,percent of total billed charges,85% of total billed charges,34,85,,27.2,percent of total billed charges,85% of total billed charges,36,90,,28.8,percent of total billed charges,90% of total billed charges,32,80,,25.6,percent of total billed charges,80% of total billed charges,36,90,,28.8,percent of total billed charges,90% of total billed charges,30,75,,24,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,11.6,29,,9.28,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,26.8,67,,21.44,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,32,80,,25.6,percent of total billed charges,80% of total billed charges,26,65,,20.8,percent of total billed charges,65% of total billed charges,14.27,35.67,,11.416,percent of total billed charges,35.67% of total billed charges,11.6,36,
NOLVADEX 10 MG PO*,2507115,CDM,250,RC,,,outpatient,,,11,4.40,,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,8.47,77,,6.78,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,9.02,82,,7.216,percent of total billed charges,82% of total billed charges,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,9.9,90,,7.92,percent of total billed charges,90% of total billed charges,8.8,80,,7.04,percent of total billed charges,80% of total billed charges,9.9,90,,7.92,percent of total billed charges,90% of total billed charges,8.25,75,,6.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,3.19,29,,2.552,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,7.37,67,,5.896,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,8.8,80,,7.04,percent of total billed charges,80% of total billed charges,7.15,65,,5.72,percent of total billed charges,65% of total billed charges,3.92,35.67,,3.136,percent of total billed charges,35.67% of total billed charges,3.19,9.9,
NORCURON INJ. 1 MG.,2507120,CDM,250,RC,,,outpatient,,,42,16.80,,35.7,85,,28.56,percent of total billed charges,85% of total billed charges,32.34,77,,25.87,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,34.44,82,,27.552,percent of total billed charges,82% of total billed charges,35.7,85,,28.56,percent of total billed charges,85% of total billed charges,35.7,85,,28.56,percent of total billed charges,85% of total billed charges,35.7,85,,28.56,percent of total billed charges,85% of total billed charges,37.8,90,,30.24,percent of total billed charges,90% of total billed charges,33.6,80,,26.88,percent of total billed charges,80% of total billed charges,37.8,90,,30.24,percent of total billed charges,90% of total billed charges,31.5,75,,25.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,12.18,29,,9.744,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,28.14,67,,22.512,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,33.6,80,,26.88,percent of total billed charges,80% of total billed charges,27.3,65,,21.84,percent of total billed charges,65% of total billed charges,14.98,35.67,,11.984,percent of total billed charges,35.67% of total billed charges,12.18,37.8,
NOREL DM 5 ML ORAL UDC,2507121,CDM,250,RC,,,outpatient,,,7,2.80,,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.39,77,,4.31,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,5.74,82,,4.592,percent of total billed charges,82% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.25,75,,4.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.03,29,,1.624,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4.69,67,,3.752,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,4.55,65,,3.64,percent of total billed charges,65% of total billed charges,2.5,35.67,,2,percent of total billed charges,35.67% of total billed charges,2.03,6.3,
NORCO 10/325,2507122,CDM,250,RC,,,outpatient,,,13,5.20,,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,10.01,77,,8.01,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,10.66,82,,8.528,percent of total billed charges,82% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,11.7,90,,9.36,percent of total billed charges,90% of total billed charges,10.4,80,,8.32,percent of total billed charges,80% of total billed charges,11.7,90,,9.36,percent of total billed charges,90% of total billed charges,9.75,75,,7.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,3.77,29,,3.016,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,8.71,67,,6.968,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,10.4,80,,8.32,percent of total billed charges,80% of total billed charges,8.45,65,,6.76,percent of total billed charges,65% of total billed charges,4.64,35.67,,3.712,percent of total billed charges,35.67% of total billed charges,3.77,11.7,
NORCO 5/325 MG TAB,2507128,CDM,250,RC,,,outpatient,,,9,3.60,,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,6.93,77,,5.54,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,7.38,82,,5.904,percent of total billed charges,82% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,8.1,90,,6.48,percent of total billed charges,90% of total billed charges,7.2,80,,5.76,percent of total billed charges,80% of total billed charges,8.1,90,,6.48,percent of total billed charges,90% of total billed charges,6.75,75,,5.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.61,29,,2.088,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,6.03,67,,4.824,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,7.2,80,,5.76,percent of total billed charges,80% of total billed charges,5.85,65,,4.68,percent of total billed charges,65% of total billed charges,3.21,35.67,,2.568,percent of total billed charges,35.67% of total billed charges,2.61,8.1,
NORCO 7.5/325 MG TAB,2507129,CDM,250,RC,,,outpatient,,,10,4.00,,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,7.7,77,,6.16,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,8.2,82,,6.56,percent of total billed charges,82% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,9,90,,7.2,percent of total billed charges,90% of total billed charges,8,80,,6.4,percent of total billed charges,80% of total billed charges,9,90,,7.2,percent of total billed charges,90% of total billed charges,7.5,75,,6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.9,29,,2.32,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,6.7,67,,5.36,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,8,80,,6.4,percent of total billed charges,80% of total billed charges,6.5,65,,5.2,percent of total billed charges,65% of total billed charges,3.57,35.67,,2.856,percent of total billed charges,35.67% of total billed charges,2.9,9,
NORFLEX TAB 100 MG,2507140,CDM,250,RC,,,outpatient,,,11,4.40,,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,8.47,77,,6.78,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,9.02,82,,7.216,percent of total billed charges,82% of total billed charges,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,9.9,90,,7.92,percent of total billed charges,90% of total billed charges,8.8,80,,7.04,percent of total billed charges,80% of total billed charges,9.9,90,,7.92,percent of total billed charges,90% of total billed charges,8.25,75,,6.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,3.19,29,,2.552,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,7.37,67,,5.896,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,8.8,80,,7.04,percent of total billed charges,80% of total billed charges,7.15,65,,5.72,percent of total billed charges,65% of total billed charges,3.92,35.67,,3.136,percent of total billed charges,35.67% of total billed charges,3.19,9.9,
LABETALOL 20 MG/4 ML,2507162,CDM,250,RC,,,outpatient,,,46,18.40,,39.1,85,,31.28,percent of total billed charges,85% of total billed charges,35.42,77,,28.34,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,37.72,82,,30.176,percent of total billed charges,82% of total billed charges,39.1,85,,31.28,percent of total billed charges,85% of total billed charges,39.1,85,,31.28,percent of total billed charges,85% of total billed charges,39.1,85,,31.28,percent of total billed charges,85% of total billed charges,41.4,90,,33.12,percent of total billed charges,90% of total billed charges,36.8,80,,29.44,percent of total billed charges,80% of total billed charges,41.4,90,,33.12,percent of total billed charges,90% of total billed charges,34.5,75,,27.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,13.34,29,,10.672,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,30.82,67,,24.656,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,36.8,80,,29.44,percent of total billed charges,80% of total billed charges,29.9,65,,23.92,percent of total billed charges,65% of total billed charges,16.41,35.67,,13.128,percent of total billed charges,35.67% of total billed charges,13.34,41.4,
TRADJENTA 5 MG TAB,2507164,CDM,250,RC,,,outpatient,,,51,20.40,,43.35,85,,34.68,percent of total billed charges,85% of total billed charges,39.27,77,,31.42,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,41.82,82,,33.456,percent of total billed charges,82% of total billed charges,43.35,85,,34.68,percent of total billed charges,85% of total billed charges,43.35,85,,34.68,percent of total billed charges,85% of total billed charges,43.35,85,,34.68,percent of total billed charges,85% of total billed charges,45.9,90,,36.72,percent of total billed charges,90% of total billed charges,40.8,80,,32.64,percent of total billed charges,80% of total billed charges,45.9,90,,36.72,percent of total billed charges,90% of total billed charges,38.25,75,,30.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,14.79,29,,11.832,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,34.17,67,,27.336,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,40.8,80,,32.64,percent of total billed charges,80% of total billed charges,33.15,65,,26.52,percent of total billed charges,65% of total billed charges,18.19,35.67,,14.552,percent of total billed charges,35.67% of total billed charges,14.79,45.9,
NORGESTIMATE & ESTRADIOL TAB,2507199,CDM,250,RC,,,outpatient,,,8,3.20,,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,6.16,77,,4.93,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,6.56,82,,5.248,percent of total billed charges,82% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,7.2,90,,5.76,percent of total billed charges,90% of total billed charges,6.4,80,,5.12,percent of total billed charges,80% of total billed charges,7.2,90,,5.76,percent of total billed charges,90% of total billed charges,6,75,,4.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.32,29,,1.856,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,5.36,67,,4.288,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,6.4,80,,5.12,percent of total billed charges,80% of total billed charges,5.2,65,,4.16,percent of total billed charges,65% of total billed charges,2.85,35.67,,2.28,percent of total billed charges,35.67% of total billed charges,2.32,7.2,
NORVASC 5 MG TAB,2507225,CDM,250,RC,,,outpatient,,,14,5.60,,11.9,85,,9.52,percent of total billed charges,85% of total billed charges,10.78,77,,8.62,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,11.48,82,,9.184,percent of total billed charges,82% of total billed charges,11.9,85,,9.52,percent of total billed charges,85% of total billed charges,11.9,85,,9.52,percent of total billed charges,85% of total billed charges,11.9,85,,9.52,percent of total billed charges,85% of total billed charges,12.6,90,,10.08,percent of total billed charges,90% of total billed charges,11.2,80,,8.96,percent of total billed charges,80% of total billed charges,12.6,90,,10.08,percent of total billed charges,90% of total billed charges,10.5,75,,8.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,4.06,29,,3.248,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,9.38,67,,7.504,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,11.2,80,,8.96,percent of total billed charges,80% of total billed charges,9.1,65,,7.28,percent of total billed charges,65% of total billed charges,4.99,35.67,,3.992,percent of total billed charges,35.67% of total billed charges,4.06,12.6,
NUPERCAINAL ANE OINT,2507295,CDM,250,RC,,,outpatient,,,24,9.60,,20.4,85,,16.32,percent of total billed charges,85% of total billed charges,18.48,77,,14.78,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,19.68,82,,15.744,percent of total billed charges,82% of total billed charges,20.4,85,,16.32,percent of total billed charges,85% of total billed charges,20.4,85,,16.32,percent of total billed charges,85% of total billed charges,20.4,85,,16.32,percent of total billed charges,85% of total billed charges,21.6,90,,17.28,percent of total billed charges,90% of total billed charges,19.2,80,,15.36,percent of total billed charges,80% of total billed charges,21.6,90,,17.28,percent of total billed charges,90% of total billed charges,18,75,,14.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,6.96,29,,5.568,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,16.08,67,,12.864,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,19.2,80,,15.36,percent of total billed charges,80% of total billed charges,15.6,65,,12.48,percent of total billed charges,65% of total billed charges,8.56,35.67,,6.848,percent of total billed charges,35.67% of total billed charges,6.96,21.6,
NYSTATIN OINTMENT 15 GM TOP,2507304,CDM,250,RC,,,outpatient,,,65,26.00,,55.25,85,,44.2,percent of total billed charges,85% of total billed charges,50.05,77,,40.04,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,53.3,82,,42.64,percent of total billed charges,82% of total billed charges,55.25,85,,44.2,percent of total billed charges,85% of total billed charges,55.25,85,,44.2,percent of total billed charges,85% of total billed charges,55.25,85,,44.2,percent of total billed charges,85% of total billed charges,58.5,90,,46.8,percent of total billed charges,90% of total billed charges,52,80,,41.6,percent of total billed charges,80% of total billed charges,58.5,90,,46.8,percent of total billed charges,90% of total billed charges,48.75,75,,39,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,18.85,29,,15.08,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,43.55,67,,34.84,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,52,80,,41.6,percent of total billed charges,80% of total billed charges,42.25,65,,33.8,percent of total billed charges,65% of total billed charges,23.19,35.67,,18.552,percent of total billed charges,35.67% of total billed charges,18.85,58.5,
NYSTATIN/MYCOSTATIN CREAM,2507305,CDM,250,RC,,,outpatient,,,66,26.40,,56.1,85,,44.88,percent of total billed charges,85% of total billed charges,50.82,77,,40.66,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,54.12,82,,43.296,percent of total billed charges,82% of total billed charges,56.1,85,,44.88,percent of total billed charges,85% of total billed charges,56.1,85,,44.88,percent of total billed charges,85% of total billed charges,56.1,85,,44.88,percent of total billed charges,85% of total billed charges,59.4,90,,47.52,percent of total billed charges,90% of total billed charges,52.8,80,,42.24,percent of total billed charges,80% of total billed charges,59.4,90,,47.52,percent of total billed charges,90% of total billed charges,49.5,75,,39.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,19.14,29,,15.312,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,44.22,67,,35.376,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,52.8,80,,42.24,percent of total billed charges,80% of total billed charges,42.9,65,,34.32,percent of total billed charges,65% of total billed charges,23.54,35.67,,18.832,percent of total billed charges,35.67% of total billed charges,19.14,59.4,
NYSTATIN 5ML UDC,2507310,CDM,250,RC,,,outpatient,,,12,4.80,,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,9.24,77,,7.39,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,9.84,82,,7.872,percent of total billed charges,82% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,10.8,90,,8.64,percent of total billed charges,90% of total billed charges,9.6,80,,7.68,percent of total billed charges,80% of total billed charges,10.8,90,,8.64,percent of total billed charges,90% of total billed charges,9,75,,7.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,3.48,29,,2.784,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,8.04,67,,6.432,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,9.6,80,,7.68,percent of total billed charges,80% of total billed charges,7.8,65,,6.24,percent of total billed charges,65% of total billed charges,4.28,35.67,,3.424,percent of total billed charges,35.67% of total billed charges,3.48,10.8,
NYSTATIN (MYCOSTATIN) POWDER,2507315,CDM,250,RC,,,outpatient,,,139,55.60,,118.15,85,,94.52,percent of total billed charges,85% of total billed charges,107.03,77,,85.62,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,113.98,82,,91.184,percent of total billed charges,82% of total billed charges,118.15,85,,94.52,percent of total billed charges,85% of total billed charges,118.15,85,,94.52,percent of total billed charges,85% of total billed charges,118.15,85,,94.52,percent of total billed charges,85% of total billed charges,125.1,90,,100.08,percent of total billed charges,90% of total billed charges,111.2,80,,88.96,percent of total billed charges,80% of total billed charges,125.1,90,,100.08,percent of total billed charges,90% of total billed charges,104.25,75,,83.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,40.31,29,,32.248,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,93.13,67,,74.504,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,111.2,80,,88.96,percent of total billed charges,80% of total billed charges,90.35,65,,72.28,percent of total billed charges,65% of total billed charges,49.58,35.67,,39.664,percent of total billed charges,35.67% of total billed charges,40.31,125.1,
OCEAN SPRAY,2507330,CDM,250,RC,,,outpatient,,,11,4.40,,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,8.47,77,,6.78,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,9.02,82,,7.216,percent of total billed charges,82% of total billed charges,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,9.9,90,,7.92,percent of total billed charges,90% of total billed charges,8.8,80,,7.04,percent of total billed charges,80% of total billed charges,9.9,90,,7.92,percent of total billed charges,90% of total billed charges,8.25,75,,6.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,3.19,29,,2.552,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,7.37,67,,5.896,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,8.8,80,,7.04,percent of total billed charges,80% of total billed charges,7.15,65,,5.72,percent of total billed charges,65% of total billed charges,3.92,35.67,,3.136,percent of total billed charges,35.67% of total billed charges,3.19,9.9,
OCUFEN 0.03% OPTH GTTS,2507335,CDM,250,RC,,,outpatient,,,131,52.40,,111.35,85,,89.08,percent of total billed charges,85% of total billed charges,100.87,77,,80.7,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,107.42,82,,85.936,percent of total billed charges,82% of total billed charges,111.35,85,,89.08,percent of total billed charges,85% of total billed charges,111.35,85,,89.08,percent of total billed charges,85% of total billed charges,111.35,85,,89.08,percent of total billed charges,85% of total billed charges,117.9,90,,94.32,percent of total billed charges,90% of total billed charges,104.8,80,,83.84,percent of total billed charges,80% of total billed charges,117.9,90,,94.32,percent of total billed charges,90% of total billed charges,98.25,75,,78.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,37.99,29,,30.392,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,87.77,67,,70.216,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,104.8,80,,83.84,percent of total billed charges,80% of total billed charges,85.15,65,,68.12,percent of total billed charges,65% of total billed charges,46.73,35.67,,37.384,percent of total billed charges,35.67% of total billed charges,37.99,117.9,
OCUFLOX 5 ML OPTH BOTTLE,2507336,CDM,250,RC,,,outpatient,,,377,150.80,,320.45,85,,256.36,percent of total billed charges,85% of total billed charges,290.29,77,,232.23,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,309.14,82,,247.312,percent of total billed charges,82% of total billed charges,320.45,85,,256.36,percent of total billed charges,85% of total billed charges,320.45,85,,256.36,percent of total billed charges,85% of total billed charges,320.45,85,,256.36,percent of total billed charges,85% of total billed charges,339.3,90,,271.44,percent of total billed charges,90% of total billed charges,301.6,80,,241.28,percent of total billed charges,80% of total billed charges,339.3,90,,271.44,percent of total billed charges,90% of total billed charges,282.75,75,,226.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,109.33,29,,87.464,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,252.59,67,,202.072,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,301.6,80,,241.28,percent of total billed charges,80% of total billed charges,245.05,65,,196.04,percent of total billed charges,65% of total billed charges,134.48,35.67,,107.584,percent of total billed charges,35.67% of total billed charges,109.33,339.3,
OMNICEF 300 MG PO,2507362,CDM,250,RC,,,outpatient,,,21,8.40,,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,16.17,77,,12.94,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,17.22,82,,13.776,percent of total billed charges,82% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,18.9,90,,15.12,percent of total billed charges,90% of total billed charges,16.8,80,,13.44,percent of total billed charges,80% of total billed charges,18.9,90,,15.12,percent of total billed charges,90% of total billed charges,15.75,75,,12.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,6.09,29,,4.872,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,14.07,67,,11.256,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,16.8,80,,13.44,percent of total billed charges,80% of total billed charges,13.65,65,,10.92,percent of total billed charges,65% of total billed charges,7.49,35.67,,5.992,percent of total billed charges,35.67% of total billed charges,6.09,18.9,
OMNICEF 250MG/5ML SUSP 60ML BO,2507368,CDM,250,RC,,,outpatient,,,742,296.80,,630.7,85,,504.56,percent of total billed charges,85% of total billed charges,571.34,77,,457.07,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,608.44,82,,486.752,percent of total billed charges,82% of total billed charges,630.7,85,,504.56,percent of total billed charges,85% of total billed charges,630.7,85,,504.56,percent of total billed charges,85% of total billed charges,630.7,85,,504.56,percent of total billed charges,85% of total billed charges,667.8,90,,534.24,percent of total billed charges,90% of total billed charges,593.6,80,,474.88,percent of total billed charges,80% of total billed charges,667.8,90,,534.24,percent of total billed charges,90% of total billed charges,556.5,75,,445.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,215.18,29,,172.144,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,497.14,67,,397.712,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,593.6,80,,474.88,percent of total billed charges,80% of total billed charges,482.3,65,,385.84,percent of total billed charges,65% of total billed charges,264.67,35.67,,211.736,percent of total billed charges,35.67% of total billed charges,215.18,667.8,
ORAJEL CREAM,2507415,CDM,250,RC,,,outpatient,,,20,8.00,,17,85,,13.6,percent of total billed charges,85% of total billed charges,15.4,77,,12.32,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,16.4,82,,13.12,percent of total billed charges,82% of total billed charges,17,85,,13.6,percent of total billed charges,85% of total billed charges,17,85,,13.6,percent of total billed charges,85% of total billed charges,17,85,,13.6,percent of total billed charges,85% of total billed charges,18,90,,14.4,percent of total billed charges,90% of total billed charges,16,80,,12.8,percent of total billed charges,80% of total billed charges,18,90,,14.4,percent of total billed charges,90% of total billed charges,15,75,,12,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,5.8,29,,4.64,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,13.4,67,,10.72,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,16,80,,12.8,percent of total billed charges,80% of total billed charges,13,65,,10.4,percent of total billed charges,65% of total billed charges,7.13,35.67,,5.704,percent of total billed charges,35.67% of total billed charges,5.8,18,
OXYCONTIN 40 MG PO,2507494,CDM,250,RC,,,outpatient,,,42,16.80,,35.7,85,,28.56,percent of total billed charges,85% of total billed charges,32.34,77,,25.87,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,34.44,82,,27.552,percent of total billed charges,82% of total billed charges,35.7,85,,28.56,percent of total billed charges,85% of total billed charges,35.7,85,,28.56,percent of total billed charges,85% of total billed charges,35.7,85,,28.56,percent of total billed charges,85% of total billed charges,37.8,90,,30.24,percent of total billed charges,90% of total billed charges,33.6,80,,26.88,percent of total billed charges,80% of total billed charges,37.8,90,,30.24,percent of total billed charges,90% of total billed charges,31.5,75,,25.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,12.18,29,,9.744,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,28.14,67,,22.512,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,33.6,80,,26.88,percent of total billed charges,80% of total billed charges,27.3,65,,21.84,percent of total billed charges,65% of total billed charges,14.98,35.67,,11.984,percent of total billed charges,35.67% of total billed charges,12.18,37.8,
OXYCONTIN 10 MG PO,2507499,CDM,250,RC,,,outpatient,,,15,6.00,,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,11.55,77,,9.24,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,12.3,82,,9.84,percent of total billed charges,82% of total billed charges,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,13.5,90,,10.8,percent of total billed charges,90% of total billed charges,12,80,,9.6,percent of total billed charges,80% of total billed charges,13.5,90,,10.8,percent of total billed charges,90% of total billed charges,11.25,75,,9,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,4.35,29,,3.48,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,10.05,67,,8.04,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,12,80,,9.6,percent of total billed charges,80% of total billed charges,9.75,65,,7.8,percent of total billed charges,65% of total billed charges,5.35,35.67,,4.28,percent of total billed charges,35.67% of total billed charges,4.35,13.5,
PAIN EASE SPRAY,2507504,CDM,250,RC,,,outpatient,,,128,51.20,,108.8,85,,87.04,percent of total billed charges,85% of total billed charges,98.56,77,,78.85,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,104.96,82,,83.968,percent of total billed charges,82% of total billed charges,108.8,85,,87.04,percent of total billed charges,85% of total billed charges,108.8,85,,87.04,percent of total billed charges,85% of total billed charges,108.8,85,,87.04,percent of total billed charges,85% of total billed charges,115.2,90,,92.16,percent of total billed charges,90% of total billed charges,102.4,80,,81.92,percent of total billed charges,80% of total billed charges,115.2,90,,92.16,percent of total billed charges,90% of total billed charges,96,75,,76.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,37.12,29,,29.696,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,85.76,67,,68.608,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,102.4,80,,81.92,percent of total billed charges,80% of total billed charges,83.2,65,,66.56,percent of total billed charges,65% of total billed charges,45.66,35.67,,36.528,percent of total billed charges,35.67% of total billed charges,37.12,115.2,
PATANOL 5 ML,2507581,CDM,250,RC,,,outpatient,,,490,196.00,,416.5,85,,333.2,percent of total billed charges,85% of total billed charges,377.3,77,,301.84,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,401.8,82,,321.44,percent of total billed charges,82% of total billed charges,416.5,85,,333.2,percent of total billed charges,85% of total billed charges,416.5,85,,333.2,percent of total billed charges,85% of total billed charges,416.5,85,,333.2,percent of total billed charges,85% of total billed charges,441,90,,352.8,percent of total billed charges,90% of total billed charges,392,80,,313.6,percent of total billed charges,80% of total billed charges,441,90,,352.8,percent of total billed charges,90% of total billed charges,367.5,75,,294,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,142.1,29,,113.68,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,328.3,67,,262.64,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,392,80,,313.6,percent of total billed charges,80% of total billed charges,318.5,65,,254.8,percent of total billed charges,65% of total billed charges,174.78,35.67,,139.824,percent of total billed charges,35.67% of total billed charges,142.1,441,
PAXIL 20MG TAB,2507605,CDM,250,RC,,,outpatient,,,22,8.80,,18.7,85,,14.96,percent of total billed charges,85% of total billed charges,16.94,77,,13.55,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,18.04,82,,14.432,percent of total billed charges,82% of total billed charges,18.7,85,,14.96,percent of total billed charges,85% of total billed charges,18.7,85,,14.96,percent of total billed charges,85% of total billed charges,18.7,85,,14.96,percent of total billed charges,85% of total billed charges,19.8,90,,15.84,percent of total billed charges,90% of total billed charges,17.6,80,,14.08,percent of total billed charges,80% of total billed charges,19.8,90,,15.84,percent of total billed charges,90% of total billed charges,16.5,75,,13.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,6.38,29,,5.104,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,14.74,67,,11.792,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,17.6,80,,14.08,percent of total billed charges,80% of total billed charges,14.3,65,,11.44,percent of total billed charges,65% of total billed charges,7.85,35.67,,6.28,percent of total billed charges,35.67% of total billed charges,6.38,19.8,
PAXIL CR 12.5 MG TAB,2507608,CDM,250,RC,,,outpatient,,,22,8.80,,18.7,85,,14.96,percent of total billed charges,85% of total billed charges,16.94,77,,13.55,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,18.04,82,,14.432,percent of total billed charges,82% of total billed charges,18.7,85,,14.96,percent of total billed charges,85% of total billed charges,18.7,85,,14.96,percent of total billed charges,85% of total billed charges,18.7,85,,14.96,percent of total billed charges,85% of total billed charges,19.8,90,,15.84,percent of total billed charges,90% of total billed charges,17.6,80,,14.08,percent of total billed charges,80% of total billed charges,19.8,90,,15.84,percent of total billed charges,90% of total billed charges,16.5,75,,13.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,6.38,29,,5.104,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,14.74,67,,11.792,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,17.6,80,,14.08,percent of total billed charges,80% of total billed charges,14.3,65,,11.44,percent of total billed charges,65% of total billed charges,7.85,35.67,,6.28,percent of total billed charges,35.67% of total billed charges,6.38,19.8,
PEN VK 250MG TAB,2507640,CDM,250,RC,,,outpatient,,,7,2.80,,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.39,77,,4.31,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,5.74,82,,4.592,percent of total billed charges,82% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.25,75,,4.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.03,29,,1.624,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4.69,67,,3.752,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,4.55,65,,3.64,percent of total billed charges,65% of total billed charges,2.5,35.67,,2,percent of total billed charges,35.67% of total billed charges,2.03,6.3,
PEPCID 20MG/2CC INJ. SH,2507690,CDM,250,RC,,,outpatient,,,11,4.40,,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,8.47,77,,6.78,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,9.02,82,,7.216,percent of total billed charges,82% of total billed charges,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,9.9,90,,7.92,percent of total billed charges,90% of total billed charges,8.8,80,,7.04,percent of total billed charges,80% of total billed charges,9.9,90,,7.92,percent of total billed charges,90% of total billed charges,8.25,75,,6.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,3.19,29,,2.552,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,7.37,67,,5.896,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,8.8,80,,7.04,percent of total billed charges,80% of total billed charges,7.15,65,,5.72,percent of total billed charges,65% of total billed charges,3.92,35.67,,3.136,percent of total billed charges,35.67% of total billed charges,3.19,9.9,
PEPCID 40MG/4ML VIAL,2507691,CDM,250,RC,,,outpatient,,,8,3.20,,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,6.16,77,,4.93,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,6.56,82,,5.248,percent of total billed charges,82% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,7.2,90,,5.76,percent of total billed charges,90% of total billed charges,6.4,80,,5.12,percent of total billed charges,80% of total billed charges,7.2,90,,5.76,percent of total billed charges,90% of total billed charges,6,75,,4.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.32,29,,1.856,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,5.36,67,,4.288,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,6.4,80,,5.12,percent of total billed charges,80% of total billed charges,5.2,65,,4.16,percent of total billed charges,65% of total billed charges,2.85,35.67,,2.28,percent of total billed charges,35.67% of total billed charges,2.32,7.2,
PEPCID 20MG/TAB,2507695,CDM,250,RC,,,outpatient,,,11,4.40,,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,8.47,77,,6.78,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,9.02,82,,7.216,percent of total billed charges,82% of total billed charges,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,9.9,90,,7.92,percent of total billed charges,90% of total billed charges,8.8,80,,7.04,percent of total billed charges,80% of total billed charges,9.9,90,,7.92,percent of total billed charges,90% of total billed charges,8.25,75,,6.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,3.19,29,,2.552,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,7.37,67,,5.896,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,8.8,80,,7.04,percent of total billed charges,80% of total billed charges,7.15,65,,5.72,percent of total billed charges,65% of total billed charges,3.92,35.67,,3.136,percent of total billed charges,35.67% of total billed charges,3.19,9.9,
PEPTO BISMOL 30 ML UNIT DOSE,2507717,CDM,250,RC,,,outpatient,,,7,2.80,,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.39,77,,4.31,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,5.74,82,,4.592,percent of total billed charges,82% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.25,75,,4.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.03,29,,1.624,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4.69,67,,3.752,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,4.55,65,,3.64,percent of total billed charges,65% of total billed charges,2.5,35.67,,2,percent of total billed charges,35.67% of total billed charges,2.03,6.3,
PERFOROMIST 20 MCG FOR NEBULI,2507759,CDM,250,RC,,,outpatient,,,48,19.20,,40.8,85,,32.64,percent of total billed charges,85% of total billed charges,36.96,77,,29.57,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,39.36,82,,31.488,percent of total billed charges,82% of total billed charges,40.8,85,,32.64,percent of total billed charges,85% of total billed charges,40.8,85,,32.64,percent of total billed charges,85% of total billed charges,40.8,85,,32.64,percent of total billed charges,85% of total billed charges,43.2,90,,34.56,percent of total billed charges,90% of total billed charges,38.4,80,,30.72,percent of total billed charges,80% of total billed charges,43.2,90,,34.56,percent of total billed charges,90% of total billed charges,36,75,,28.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,13.92,29,,11.136,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,32.16,67,,25.728,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,38.4,80,,30.72,percent of total billed charges,80% of total billed charges,31.2,65,,24.96,percent of total billed charges,65% of total billed charges,17.12,35.67,,13.696,percent of total billed charges,35.67% of total billed charges,13.92,43.2,
PHENOL LIQUIFIED 60 ML BOTTLE,2507788,CDM,250,RC,,,outpatient,,,117,46.80,,99.45,85,,79.56,percent of total billed charges,85% of total billed charges,90.09,77,,72.07,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,95.94,82,,76.752,percent of total billed charges,82% of total billed charges,99.45,85,,79.56,percent of total billed charges,85% of total billed charges,99.45,85,,79.56,percent of total billed charges,85% of total billed charges,99.45,85,,79.56,percent of total billed charges,85% of total billed charges,105.3,90,,84.24,percent of total billed charges,90% of total billed charges,93.6,80,,74.88,percent of total billed charges,80% of total billed charges,105.3,90,,84.24,percent of total billed charges,90% of total billed charges,87.75,75,,70.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,33.93,29,,27.144,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,78.39,67,,62.712,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,93.6,80,,74.88,percent of total billed charges,80% of total billed charges,76.05,65,,60.84,percent of total billed charges,65% of total billed charges,41.73,35.67,,33.384,percent of total billed charges,35.67% of total billed charges,33.93,105.3,
PHENERGAN DM SYRUP 5ML UDC,2507853,CDM,250,RC,,,outpatient,,,7,2.80,,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.39,77,,4.31,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,5.74,82,,4.592,percent of total billed charges,82% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.25,75,,4.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.03,29,,1.624,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4.69,67,,3.752,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,4.55,65,,3.64,percent of total billed charges,65% of total billed charges,2.5,35.67,,2,percent of total billed charges,35.67% of total billed charges,2.03,6.3,
PHENERGAN 12.5 MG SUPPOS,2507855,CDM,250,RC,,,outpatient,,,24,9.60,,20.4,85,,16.32,percent of total billed charges,85% of total billed charges,18.48,77,,14.78,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,19.68,82,,15.744,percent of total billed charges,82% of total billed charges,20.4,85,,16.32,percent of total billed charges,85% of total billed charges,20.4,85,,16.32,percent of total billed charges,85% of total billed charges,20.4,85,,16.32,percent of total billed charges,85% of total billed charges,21.6,90,,17.28,percent of total billed charges,90% of total billed charges,19.2,80,,15.36,percent of total billed charges,80% of total billed charges,21.6,90,,17.28,percent of total billed charges,90% of total billed charges,18,75,,14.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,6.96,29,,5.568,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,16.08,67,,12.864,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,19.2,80,,15.36,percent of total billed charges,80% of total billed charges,15.6,65,,12.48,percent of total billed charges,65% of total billed charges,8.56,35.67,,6.848,percent of total billed charges,35.67% of total billed charges,6.96,21.6,
PHENERGAN 25 MG TAB,2507865,CDM,250,RC,,,outpatient,,,7,2.80,,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.39,77,,4.31,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,5.74,82,,4.592,percent of total billed charges,82% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.25,75,,4.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.03,29,,1.624,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4.69,67,,3.752,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,4.55,65,,3.64,percent of total billed charges,65% of total billed charges,2.5,35.67,,2,percent of total billed charges,35.67% of total billed charges,2.03,6.3,
PHENERGAN 6.25MG/5ML UDC,2507891,CDM,250,RC,,,outpatient,,,7,2.80,,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.39,77,,4.31,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,5.74,82,,4.592,percent of total billed charges,82% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.25,75,,4.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.03,29,,1.624,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4.69,67,,3.752,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,4.55,65,,3.64,percent of total billed charges,65% of total billed charges,2.5,35.67,,2,percent of total billed charges,35.67% of total billed charges,2.03,6.3,
PHENERGAN WITH CODEINE UDC,2507946,CDM,250,RC,,,outpatient,,,7,2.80,,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.39,77,,4.31,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,5.74,82,,4.592,percent of total billed charges,82% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.25,75,,4.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.03,29,,1.624,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4.69,67,,3.752,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,4.55,65,,3.64,percent of total billed charges,65% of total billed charges,2.5,35.67,,2,percent of total billed charges,35.67% of total billed charges,2.03,6.3,
PHENOBARBITAL 20MG/5ML UDC,2507970,CDM,250,RC,,,outpatient,,,7,2.80,,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.39,77,,4.31,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,5.74,82,,4.592,percent of total billed charges,82% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.25,75,,4.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.03,29,,1.624,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4.69,67,,3.752,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,4.55,65,,3.64,percent of total billed charges,65% of total billed charges,2.5,35.67,,2,percent of total billed charges,35.67% of total billed charges,2.03,6.3,
PHENOBARBITAL TAB 15 MG,2507975,CDM,250,RC,,,outpatient,,,7,2.80,,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.39,77,,4.31,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,5.74,82,,4.592,percent of total billed charges,82% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.25,75,,4.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.03,29,,1.624,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4.69,67,,3.752,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,4.55,65,,3.64,percent of total billed charges,65% of total billed charges,2.5,35.67,,2,percent of total billed charges,35.67% of total billed charges,2.03,6.3,
PHOS LO 667 MG TAB,2507990,CDM,250,RC,,,outpatient,,,8,3.20,,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,6.16,77,,4.93,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,6.56,82,,5.248,percent of total billed charges,82% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,7.2,90,,5.76,percent of total billed charges,90% of total billed charges,6.4,80,,5.12,percent of total billed charges,80% of total billed charges,7.2,90,,5.76,percent of total billed charges,90% of total billed charges,6,75,,4.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.32,29,,1.856,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,5.36,67,,4.288,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,6.4,80,,5.12,percent of total billed charges,80% of total billed charges,5.2,65,,4.16,percent of total billed charges,65% of total billed charges,2.85,35.67,,2.28,percent of total billed charges,35.67% of total billed charges,2.32,7.2,
PIPRACIL 3 GRAM INJ,2508020,CDM,250,RC,,,outpatient,,,59,23.60,,50.15,85,,40.12,percent of total billed charges,85% of total billed charges,45.43,77,,36.34,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,48.38,82,,38.704,percent of total billed charges,82% of total billed charges,50.15,85,,40.12,percent of total billed charges,85% of total billed charges,50.15,85,,40.12,percent of total billed charges,85% of total billed charges,50.15,85,,40.12,percent of total billed charges,85% of total billed charges,53.1,90,,42.48,percent of total billed charges,90% of total billed charges,47.2,80,,37.76,percent of total billed charges,80% of total billed charges,53.1,90,,42.48,percent of total billed charges,90% of total billed charges,44.25,75,,35.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,17.11,29,,13.688,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,39.53,67,,31.624,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,47.2,80,,37.76,percent of total billed charges,80% of total billed charges,38.35,65,,30.68,percent of total billed charges,65% of total billed charges,21.05,35.67,,16.84,percent of total billed charges,35.67% of total billed charges,17.11,53.1,
PLAN B ONE-STEP,2508042,CDM,250,RC,,,outpatient,,,144,57.60,,122.4,85,,97.92,percent of total billed charges,85% of total billed charges,110.88,77,,88.7,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,118.08,82,,94.464,percent of total billed charges,82% of total billed charges,122.4,85,,97.92,percent of total billed charges,85% of total billed charges,122.4,85,,97.92,percent of total billed charges,85% of total billed charges,122.4,85,,97.92,percent of total billed charges,85% of total billed charges,129.6,90,,103.68,percent of total billed charges,90% of total billed charges,115.2,80,,92.16,percent of total billed charges,80% of total billed charges,129.6,90,,103.68,percent of total billed charges,90% of total billed charges,108,75,,86.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,41.76,29,,33.408,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,96.48,67,,77.184,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,115.2,80,,92.16,percent of total billed charges,80% of total billed charges,93.6,65,,74.88,percent of total billed charges,65% of total billed charges,51.36,35.67,,41.088,percent of total billed charges,35.67% of total billed charges,41.76,129.6,
PLAVIX 75 MG PO,2508056,CDM,250,RC,,,outpatient,,,30,12.00,,25.5,85,,20.4,percent of total billed charges,85% of total billed charges,23.1,77,,18.48,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,24.6,82,,19.68,percent of total billed charges,82% of total billed charges,25.5,85,,20.4,percent of total billed charges,85% of total billed charges,25.5,85,,20.4,percent of total billed charges,85% of total billed charges,25.5,85,,20.4,percent of total billed charges,85% of total billed charges,27,90,,21.6,percent of total billed charges,90% of total billed charges,24,80,,19.2,percent of total billed charges,80% of total billed charges,27,90,,21.6,percent of total billed charges,90% of total billed charges,22.5,75,,18,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,8.7,29,,6.96,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,20.1,67,,16.08,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,24,80,,19.2,percent of total billed charges,80% of total billed charges,19.5,65,,15.6,percent of total billed charges,65% of total billed charges,10.7,35.67,,8.56,percent of total billed charges,35.67% of total billed charges,8.7,27,
PLENDIL 2.5 MG TAB,2508059,CDM,250,RC,,,outpatient,,,9,3.60,,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,6.93,77,,5.54,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,7.38,82,,5.904,percent of total billed charges,82% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,8.1,90,,6.48,percent of total billed charges,90% of total billed charges,7.2,80,,5.76,percent of total billed charges,80% of total billed charges,8.1,90,,6.48,percent of total billed charges,90% of total billed charges,6.75,75,,5.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.61,29,,2.088,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,6.03,67,,4.824,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,7.2,80,,5.76,percent of total billed charges,80% of total billed charges,5.85,65,,4.68,percent of total billed charges,65% of total billed charges,3.21,35.67,,2.568,percent of total billed charges,35.67% of total billed charges,2.61,8.1,
PLETAL 50 MG PO,2508062,CDM,250,RC,,,outpatient,,,15,6.00,,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,11.55,77,,9.24,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,12.3,82,,9.84,percent of total billed charges,82% of total billed charges,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,13.5,90,,10.8,percent of total billed charges,90% of total billed charges,12,80,,9.6,percent of total billed charges,80% of total billed charges,13.5,90,,10.8,percent of total billed charges,90% of total billed charges,11.25,75,,9,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,4.35,29,,3.48,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,10.05,67,,8.04,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,12,80,,9.6,percent of total billed charges,80% of total billed charges,9.75,65,,7.8,percent of total billed charges,65% of total billed charges,5.35,35.67,,4.28,percent of total billed charges,35.67% of total billed charges,4.35,13.5,
POLYSPORIN OPTH OINT,2508105,CDM,250,RC,,,outpatient,,,122,48.80,,103.7,85,,82.96,percent of total billed charges,85% of total billed charges,93.94,77,,75.15,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,100.04,82,,80.032,percent of total billed charges,82% of total billed charges,103.7,85,,82.96,percent of total billed charges,85% of total billed charges,103.7,85,,82.96,percent of total billed charges,85% of total billed charges,103.7,85,,82.96,percent of total billed charges,85% of total billed charges,109.8,90,,87.84,percent of total billed charges,90% of total billed charges,97.6,80,,78.08,percent of total billed charges,80% of total billed charges,109.8,90,,87.84,percent of total billed charges,90% of total billed charges,91.5,75,,73.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,35.38,29,,28.304,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,81.74,67,,65.392,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,97.6,80,,78.08,percent of total billed charges,80% of total billed charges,79.3,65,,63.44,percent of total billed charges,65% of total billed charges,43.52,35.67,,34.816,percent of total billed charges,35.67% of total billed charges,35.38,109.8,
POLYTRIM OPTH SOL.,2508120,CDM,250,RC,,,outpatient,,,180,72.00,,153,85,,122.4,percent of total billed charges,85% of total billed charges,138.6,77,,110.88,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,147.6,82,,118.08,percent of total billed charges,82% of total billed charges,153,85,,122.4,percent of total billed charges,85% of total billed charges,153,85,,122.4,percent of total billed charges,85% of total billed charges,153,85,,122.4,percent of total billed charges,85% of total billed charges,162,90,,129.6,percent of total billed charges,90% of total billed charges,144,80,,115.2,percent of total billed charges,80% of total billed charges,162,90,,129.6,percent of total billed charges,90% of total billed charges,135,75,,108,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,52.2,29,,41.76,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,120.6,67,,96.48,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,144,80,,115.2,percent of total billed charges,80% of total billed charges,117,65,,93.6,percent of total billed charges,65% of total billed charges,64.21,35.67,,51.368,percent of total billed charges,35.67% of total billed charges,52.2,162,
PONTOCAIN .5% OPTH DROPS 2CC,2508127,CDM,250,RC,,,outpatient,,,43,17.20,,36.55,85,,29.24,percent of total billed charges,85% of total billed charges,33.11,77,,26.49,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,35.26,82,,28.208,percent of total billed charges,82% of total billed charges,36.55,85,,29.24,percent of total billed charges,85% of total billed charges,36.55,85,,29.24,percent of total billed charges,85% of total billed charges,36.55,85,,29.24,percent of total billed charges,85% of total billed charges,38.7,90,,30.96,percent of total billed charges,90% of total billed charges,34.4,80,,27.52,percent of total billed charges,80% of total billed charges,38.7,90,,30.96,percent of total billed charges,90% of total billed charges,32.25,75,,25.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,12.47,29,,9.976,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,28.81,67,,23.048,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,34.4,80,,27.52,percent of total billed charges,80% of total billed charges,27.95,65,,22.36,percent of total billed charges,65% of total billed charges,15.34,35.67,,12.272,percent of total billed charges,35.67% of total billed charges,12.47,38.7,
POTASSIUM CL 20 MEQ PO,2508139,CDM,250,RC,,,outpatient,,,22,8.80,,18.7,85,,14.96,percent of total billed charges,85% of total billed charges,16.94,77,,13.55,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,18.04,82,,14.432,percent of total billed charges,82% of total billed charges,18.7,85,,14.96,percent of total billed charges,85% of total billed charges,18.7,85,,14.96,percent of total billed charges,85% of total billed charges,18.7,85,,14.96,percent of total billed charges,85% of total billed charges,19.8,90,,15.84,percent of total billed charges,90% of total billed charges,17.6,80,,14.08,percent of total billed charges,80% of total billed charges,19.8,90,,15.84,percent of total billed charges,90% of total billed charges,16.5,75,,13.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,6.38,29,,5.104,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,14.74,67,,11.792,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,17.6,80,,14.08,percent of total billed charges,80% of total billed charges,14.3,65,,11.44,percent of total billed charges,65% of total billed charges,7.85,35.67,,6.28,percent of total billed charges,35.67% of total billed charges,6.38,19.8,
POTASSIUM PHOSPHATE 45mM/15 ML,2508177,CDM,250,RC,,,outpatient,,,64,25.60,,54.4,85,,43.52,percent of total billed charges,85% of total billed charges,49.28,77,,39.42,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,52.48,82,,41.984,percent of total billed charges,82% of total billed charges,54.4,85,,43.52,percent of total billed charges,85% of total billed charges,54.4,85,,43.52,percent of total billed charges,85% of total billed charges,54.4,85,,43.52,percent of total billed charges,85% of total billed charges,57.6,90,,46.08,percent of total billed charges,90% of total billed charges,51.2,80,,40.96,percent of total billed charges,80% of total billed charges,57.6,90,,46.08,percent of total billed charges,90% of total billed charges,48,75,,38.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,18.56,29,,14.848,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,42.88,67,,34.304,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,51.2,80,,40.96,percent of total billed charges,80% of total billed charges,41.6,65,,33.28,percent of total billed charges,65% of total billed charges,22.83,35.67,,18.264,percent of total billed charges,35.67% of total billed charges,18.56,57.6,
POTASSIUM PHOSPHATE 3 MM/ML,2508178,CDM,250,RC,,,outpatient,,,184,73.60,,156.4,85,,125.12,percent of total billed charges,85% of total billed charges,141.68,77,,113.34,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,150.88,82,,120.704,percent of total billed charges,82% of total billed charges,156.4,85,,125.12,percent of total billed charges,85% of total billed charges,156.4,85,,125.12,percent of total billed charges,85% of total billed charges,156.4,85,,125.12,percent of total billed charges,85% of total billed charges,165.6,90,,132.48,percent of total billed charges,90% of total billed charges,147.2,80,,117.76,percent of total billed charges,80% of total billed charges,165.6,90,,132.48,percent of total billed charges,90% of total billed charges,138,75,,110.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,53.36,29,,42.688,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,123.28,67,,98.624,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,147.2,80,,117.76,percent of total billed charges,80% of total billed charges,119.6,65,,95.68,percent of total billed charges,65% of total billed charges,65.63,35.67,,52.504,percent of total billed charges,35.67% of total billed charges,53.36,165.6,
PRAVACHOL 40 MG PO,2508183,CDM,250,RC,,,outpatient,,,22,8.80,,18.7,85,,14.96,percent of total billed charges,85% of total billed charges,16.94,77,,13.55,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,18.04,82,,14.432,percent of total billed charges,82% of total billed charges,18.7,85,,14.96,percent of total billed charges,85% of total billed charges,18.7,85,,14.96,percent of total billed charges,85% of total billed charges,18.7,85,,14.96,percent of total billed charges,85% of total billed charges,19.8,90,,15.84,percent of total billed charges,90% of total billed charges,17.6,80,,14.08,percent of total billed charges,80% of total billed charges,19.8,90,,15.84,percent of total billed charges,90% of total billed charges,16.5,75,,13.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,6.38,29,,5.104,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,14.74,67,,11.792,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,17.6,80,,14.08,percent of total billed charges,80% of total billed charges,14.3,65,,11.44,percent of total billed charges,65% of total billed charges,7.85,35.67,,6.28,percent of total billed charges,35.67% of total billed charges,6.38,19.8,
PRAVACHOL TABS,2508185,CDM,250,RC,,,outpatient,,,14,5.60,,11.9,85,,9.52,percent of total billed charges,85% of total billed charges,10.78,77,,8.62,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,11.48,82,,9.184,percent of total billed charges,82% of total billed charges,11.9,85,,9.52,percent of total billed charges,85% of total billed charges,11.9,85,,9.52,percent of total billed charges,85% of total billed charges,11.9,85,,9.52,percent of total billed charges,85% of total billed charges,12.6,90,,10.08,percent of total billed charges,90% of total billed charges,11.2,80,,8.96,percent of total billed charges,80% of total billed charges,12.6,90,,10.08,percent of total billed charges,90% of total billed charges,10.5,75,,8.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,4.06,29,,3.248,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,9.38,67,,7.504,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,11.2,80,,8.96,percent of total billed charges,80% of total billed charges,9.1,65,,7.28,percent of total billed charges,65% of total billed charges,4.99,35.67,,3.992,percent of total billed charges,35.67% of total billed charges,4.06,12.6,
PRADAXA 75 MG CAPSULE,2508202,CDM,250,RC,,,outpatient,,,26,10.40,,22.1,85,,17.68,percent of total billed charges,85% of total billed charges,20.02,77,,16.02,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,21.32,82,,17.056,percent of total billed charges,82% of total billed charges,22.1,85,,17.68,percent of total billed charges,85% of total billed charges,22.1,85,,17.68,percent of total billed charges,85% of total billed charges,22.1,85,,17.68,percent of total billed charges,85% of total billed charges,23.4,90,,18.72,percent of total billed charges,90% of total billed charges,20.8,80,,16.64,percent of total billed charges,80% of total billed charges,23.4,90,,18.72,percent of total billed charges,90% of total billed charges,19.5,75,,15.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,7.54,29,,6.032,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,17.42,67,,13.936,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,20.8,80,,16.64,percent of total billed charges,80% of total billed charges,16.9,65,,13.52,percent of total billed charges,65% of total billed charges,9.27,35.67,,7.416,percent of total billed charges,35.67% of total billed charges,7.54,23.4,
PRECEDEX .9% SODIUM CHLORIDE,2508222,CDM,250,RC,,,outpatient,,,90,36.00,,76.5,85,,61.2,percent of total billed charges,85% of total billed charges,69.3,77,,55.44,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,73.8,82,,59.04,percent of total billed charges,82% of total billed charges,76.5,85,,61.2,percent of total billed charges,85% of total billed charges,76.5,85,,61.2,percent of total billed charges,85% of total billed charges,76.5,85,,61.2,percent of total billed charges,85% of total billed charges,81,90,,64.8,percent of total billed charges,90% of total billed charges,72,80,,57.6,percent of total billed charges,80% of total billed charges,81,90,,64.8,percent of total billed charges,90% of total billed charges,67.5,75,,54,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,26.1,29,,20.88,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,60.3,67,,48.24,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,72,80,,57.6,percent of total billed charges,80% of total billed charges,58.5,65,,46.8,percent of total billed charges,65% of total billed charges,32.1,35.67,,25.68,percent of total billed charges,35.67% of total billed charges,26.1,81,
PRECEDEX 200MCG/2ML VIAL,2508223,CDM,250,RC,,,outpatient,,,89,35.60,,75.65,85,,60.52,percent of total billed charges,85% of total billed charges,68.53,77,,54.82,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,72.98,82,,58.384,percent of total billed charges,82% of total billed charges,75.65,85,,60.52,percent of total billed charges,85% of total billed charges,75.65,85,,60.52,percent of total billed charges,85% of total billed charges,75.65,85,,60.52,percent of total billed charges,85% of total billed charges,80.1,90,,64.08,percent of total billed charges,90% of total billed charges,71.2,80,,56.96,percent of total billed charges,80% of total billed charges,80.1,90,,64.08,percent of total billed charges,90% of total billed charges,66.75,75,,53.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,25.81,29,,20.648,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,59.63,67,,47.704,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,71.2,80,,56.96,percent of total billed charges,80% of total billed charges,57.85,65,,46.28,percent of total billed charges,65% of total billed charges,31.75,35.67,,25.4,percent of total billed charges,35.67% of total billed charges,25.81,80.1,
DEXMEDETOMIDINE NS 20 ML,2508224,CDM,250,RC,,,outpatient,,,89,35.60,,75.65,85,,60.52,percent of total billed charges,85% of total billed charges,68.53,77,,54.82,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,72.98,82,,58.384,percent of total billed charges,82% of total billed charges,75.65,85,,60.52,percent of total billed charges,85% of total billed charges,75.65,85,,60.52,percent of total billed charges,85% of total billed charges,75.65,85,,60.52,percent of total billed charges,85% of total billed charges,80.1,90,,64.08,percent of total billed charges,90% of total billed charges,71.2,80,,56.96,percent of total billed charges,80% of total billed charges,80.1,90,,64.08,percent of total billed charges,90% of total billed charges,66.75,75,,53.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,25.81,29,,20.648,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,59.63,67,,47.704,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,71.2,80,,56.96,percent of total billed charges,80% of total billed charges,57.85,65,,46.28,percent of total billed charges,65% of total billed charges,31.75,35.67,,25.4,percent of total billed charges,35.67% of total billed charges,25.81,80.1,
PHOSPHA 250 NEUTRAL TABLET,2508226,CDM,250,RC,,,outpatient,,,8,3.20,,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,6.16,77,,4.93,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,6.56,82,,5.248,percent of total billed charges,82% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,7.2,90,,5.76,percent of total billed charges,90% of total billed charges,6.4,80,,5.12,percent of total billed charges,80% of total billed charges,7.2,90,,5.76,percent of total billed charges,90% of total billed charges,6,75,,4.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.32,29,,1.856,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,5.36,67,,4.288,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,6.4,80,,5.12,percent of total billed charges,80% of total billed charges,5.2,65,,4.16,percent of total billed charges,65% of total billed charges,2.85,35.67,,2.28,percent of total billed charges,35.67% of total billed charges,2.32,7.2,
PREGABLIN 150 MG CAPSULE,2508227,CDM,250,RC,,,outpatient,,,8,3.20,,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,6.16,77,,4.93,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,6.56,82,,5.248,percent of total billed charges,82% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,7.2,90,,5.76,percent of total billed charges,90% of total billed charges,6.4,80,,5.12,percent of total billed charges,80% of total billed charges,7.2,90,,5.76,percent of total billed charges,90% of total billed charges,6,75,,4.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.32,29,,1.856,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,5.36,67,,4.288,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,6.4,80,,5.12,percent of total billed charges,80% of total billed charges,5.2,65,,4.16,percent of total billed charges,65% of total billed charges,2.85,35.67,,2.28,percent of total billed charges,35.67% of total billed charges,2.32,7.2,
PREMARIN 0.9 MG TAB,2508285,CDM,250,RC,,,outpatient,,,12,4.80,,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,9.24,77,,7.39,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,9.84,82,,7.872,percent of total billed charges,82% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,10.8,90,,8.64,percent of total billed charges,90% of total billed charges,9.6,80,,7.68,percent of total billed charges,80% of total billed charges,10.8,90,,8.64,percent of total billed charges,90% of total billed charges,9,75,,7.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,3.48,29,,2.784,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,8.04,67,,6.432,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,9.6,80,,7.68,percent of total billed charges,80% of total billed charges,7.8,65,,6.24,percent of total billed charges,65% of total billed charges,4.28,35.67,,3.424,percent of total billed charges,35.67% of total billed charges,3.48,10.8,
PREMARIN VAG. CREAM APPLICAT25,2508310,CDM,250,RC,,,outpatient,,,950,380.00,,807.5,85,,646,percent of total billed charges,85% of total billed charges,731.5,77,,585.2,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,779,82,,623.2,percent of total billed charges,82% of total billed charges,807.5,85,,646,percent of total billed charges,85% of total billed charges,807.5,85,,646,percent of total billed charges,85% of total billed charges,807.5,85,,646,percent of total billed charges,85% of total billed charges,855,90,,684,percent of total billed charges,90% of total billed charges,760,80,,608,percent of total billed charges,80% of total billed charges,855,90,,684,percent of total billed charges,90% of total billed charges,712.5,75,,570,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,275.5,29,,220.4,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,636.5,67,,509.2,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,760,80,,608,percent of total billed charges,80% of total billed charges,617.5,65,,494,percent of total billed charges,65% of total billed charges,338.87,35.67,,271.096,percent of total billed charges,35.67% of total billed charges,275.5,855,
PRINIVIL 5 MG PO,2508371,CDM,250,RC,,,outpatient,,,9,3.60,,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,6.93,77,,5.54,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,7.38,82,,5.904,percent of total billed charges,82% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,8.1,90,,6.48,percent of total billed charges,90% of total billed charges,7.2,80,,5.76,percent of total billed charges,80% of total billed charges,8.1,90,,6.48,percent of total billed charges,90% of total billed charges,6.75,75,,5.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.61,29,,2.088,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,6.03,67,,4.824,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,7.2,80,,5.76,percent of total billed charges,80% of total billed charges,5.85,65,,4.68,percent of total billed charges,65% of total billed charges,3.21,35.67,,2.568,percent of total billed charges,35.67% of total billed charges,2.61,8.1,
PRINIVIL (ZESTRIL) 20MG TAB,2508375,CDM,250,RC,,,outpatient,,,9,3.60,,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,6.93,77,,5.54,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,7.38,82,,5.904,percent of total billed charges,82% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,8.1,90,,6.48,percent of total billed charges,90% of total billed charges,7.2,80,,5.76,percent of total billed charges,80% of total billed charges,8.1,90,,6.48,percent of total billed charges,90% of total billed charges,6.75,75,,5.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.61,29,,2.088,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,6.03,67,,4.824,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,7.2,80,,5.76,percent of total billed charges,80% of total billed charges,5.85,65,,4.68,percent of total billed charges,65% of total billed charges,3.21,35.67,,2.568,percent of total billed charges,35.67% of total billed charges,2.61,8.1,
PROCARDIA 10 MG CAP,2508420,CDM,250,RC,,,outpatient,,,8,3.20,,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,6.16,77,,4.93,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,6.56,82,,5.248,percent of total billed charges,82% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,7.2,90,,5.76,percent of total billed charges,90% of total billed charges,6.4,80,,5.12,percent of total billed charges,80% of total billed charges,7.2,90,,5.76,percent of total billed charges,90% of total billed charges,6,75,,4.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.32,29,,1.856,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,5.36,67,,4.288,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,6.4,80,,5.12,percent of total billed charges,80% of total billed charges,5.2,65,,4.16,percent of total billed charges,65% of total billed charges,2.85,35.67,,2.28,percent of total billed charges,35.67% of total billed charges,2.32,7.2,
PROCARDIA 30 MG XL,2508430,CDM,250,RC,,,outpatient,,,9,3.60,,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,6.93,77,,5.54,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,7.38,82,,5.904,percent of total billed charges,82% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,8.1,90,,6.48,percent of total billed charges,90% of total billed charges,7.2,80,,5.76,percent of total billed charges,80% of total billed charges,8.1,90,,6.48,percent of total billed charges,90% of total billed charges,6.75,75,,5.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.61,29,,2.088,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,6.03,67,,4.824,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,7.2,80,,5.76,percent of total billed charges,80% of total billed charges,5.85,65,,4.68,percent of total billed charges,65% of total billed charges,3.21,35.67,,2.568,percent of total billed charges,35.67% of total billed charges,2.61,8.1,
PROCTOFOAM HC 10 GRAM,2508451,CDM,250,RC,,,outpatient,,,397,158.80,,337.45,85,,269.96,percent of total billed charges,85% of total billed charges,305.69,77,,244.55,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,325.54,82,,260.432,percent of total billed charges,82% of total billed charges,337.45,85,,269.96,percent of total billed charges,85% of total billed charges,337.45,85,,269.96,percent of total billed charges,85% of total billed charges,337.45,85,,269.96,percent of total billed charges,85% of total billed charges,357.3,90,,285.84,percent of total billed charges,90% of total billed charges,317.6,80,,254.08,percent of total billed charges,80% of total billed charges,357.3,90,,285.84,percent of total billed charges,90% of total billed charges,297.75,75,,238.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,115.13,29,,92.104,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,265.99,67,,212.792,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,317.6,80,,254.08,percent of total billed charges,80% of total billed charges,258.05,65,,206.44,percent of total billed charges,65% of total billed charges,141.61,35.67,,113.288,percent of total billed charges,35.67% of total billed charges,115.13,357.3,
PROPYLTHIOURACIL 50 MG TAB,2508545,CDM,250,RC,,,outpatient,,,9,3.60,,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,6.93,77,,5.54,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,7.38,82,,5.904,percent of total billed charges,82% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,8.1,90,,6.48,percent of total billed charges,90% of total billed charges,7.2,80,,5.76,percent of total billed charges,80% of total billed charges,8.1,90,,6.48,percent of total billed charges,90% of total billed charges,6.75,75,,5.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.61,29,,2.088,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,6.03,67,,4.824,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,7.2,80,,5.76,percent of total billed charges,80% of total billed charges,5.85,65,,4.68,percent of total billed charges,65% of total billed charges,3.21,35.67,,2.568,percent of total billed charges,35.67% of total billed charges,2.61,8.1,
PROTONIX 40 MG PO,2508602,CDM,250,RC,,,outpatient,,,32,12.80,,27.2,85,,21.76,percent of total billed charges,85% of total billed charges,24.64,77,,19.71,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,26.24,82,,20.992,percent of total billed charges,82% of total billed charges,27.2,85,,21.76,percent of total billed charges,85% of total billed charges,27.2,85,,21.76,percent of total billed charges,85% of total billed charges,27.2,85,,21.76,percent of total billed charges,85% of total billed charges,28.8,90,,23.04,percent of total billed charges,90% of total billed charges,25.6,80,,20.48,percent of total billed charges,80% of total billed charges,28.8,90,,23.04,percent of total billed charges,90% of total billed charges,24,75,,19.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,9.28,29,,7.424,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,21.44,67,,17.152,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,25.6,80,,20.48,percent of total billed charges,80% of total billed charges,20.8,65,,16.64,percent of total billed charges,65% of total billed charges,11.41,35.67,,9.128,percent of total billed charges,35.67% of total billed charges,9.28,28.8,
ALBUTEROL 2.5 MG/3 ML NEB,2508620,CDM,250,RC,J7609,HCPCS,outpatient,,,10,4.00,,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,7.7,77,,6.16,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,0.39,385,,,fee schedule,385% of BCBS fee schedule,0.4,401,,,fee schedule,401% of BCBS fee schedule,0.4,401,,,fee schedule,401% of BCBS fee schedule,0.4,401,,,fee schedule,401% of BCBS fee schedule,9,90,,7.2,percent of total billed charges,90% of total billed charges,8,80,,6.4,percent of total billed charges,80% of total billed charges,9,90,,7.2,percent of total billed charges,90% of total billed charges,7.5,75,,6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.9,29,,2.32,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,6.7,67,,5.36,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,8,80,,6.4,percent of total billed charges,80% of total billed charges,6.5,65,,5.2,percent of total billed charges,65% of total billed charges,3.57,35.67,,2.856,percent of total billed charges,35.67% of total billed charges,0.39,9,
PROVENTIL 2MG/5 ML SYRU,2508625,CDM,250,RC,,,outpatient,,,16,6.40,,13.6,85,,10.88,percent of total billed charges,85% of total billed charges,12.32,77,,9.86,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,13.12,82,,10.496,percent of total billed charges,82% of total billed charges,13.6,85,,10.88,percent of total billed charges,85% of total billed charges,13.6,85,,10.88,percent of total billed charges,85% of total billed charges,13.6,85,,10.88,percent of total billed charges,85% of total billed charges,14.4,90,,11.52,percent of total billed charges,90% of total billed charges,12.8,80,,10.24,percent of total billed charges,80% of total billed charges,14.4,90,,11.52,percent of total billed charges,90% of total billed charges,12,75,,9.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,4.64,29,,3.712,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,10.72,67,,8.576,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,12.8,80,,10.24,percent of total billed charges,80% of total billed charges,10.4,65,,8.32,percent of total billed charges,65% of total billed charges,5.71,35.67,,4.568,percent of total billed charges,35.67% of total billed charges,4.64,14.4,
PROVENTIL .5 % SOLUTION,2508630,CDM,250,RC,,,outpatient,,,53,21.20,,45.05,85,,36.04,percent of total billed charges,85% of total billed charges,40.81,77,,32.65,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,43.46,82,,34.768,percent of total billed charges,82% of total billed charges,45.05,85,,36.04,percent of total billed charges,85% of total billed charges,45.05,85,,36.04,percent of total billed charges,85% of total billed charges,45.05,85,,36.04,percent of total billed charges,85% of total billed charges,47.7,90,,38.16,percent of total billed charges,90% of total billed charges,42.4,80,,33.92,percent of total billed charges,80% of total billed charges,47.7,90,,38.16,percent of total billed charges,90% of total billed charges,39.75,75,,31.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,15.37,29,,12.296,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,35.51,67,,28.408,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,42.4,80,,33.92,percent of total billed charges,80% of total billed charges,34.45,65,,27.56,percent of total billed charges,65% of total billed charges,18.91,35.67,,15.128,percent of total billed charges,35.67% of total billed charges,15.37,47.7,
MEDROXYPROGESTERONE 2.5 MG,2508640,CDM,250,RC,,,outpatient,,,8,3.20,,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,6.16,77,,4.93,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,6.56,82,,5.248,percent of total billed charges,82% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,7.2,90,,5.76,percent of total billed charges,90% of total billed charges,6.4,80,,5.12,percent of total billed charges,80% of total billed charges,7.2,90,,5.76,percent of total billed charges,90% of total billed charges,6,75,,4.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.32,29,,1.856,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,5.36,67,,4.288,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,6.4,80,,5.12,percent of total billed charges,80% of total billed charges,5.2,65,,4.16,percent of total billed charges,65% of total billed charges,2.85,35.67,,2.28,percent of total billed charges,35.67% of total billed charges,2.32,7.2,
MEDROXYPROGESTERONE 150 MG SYG,2508641,CDM,250,RC,,,outpatient,,,13,5.20,,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,10.01,77,,8.01,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,10.66,82,,8.528,percent of total billed charges,82% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,11.7,90,,9.36,percent of total billed charges,90% of total billed charges,10.4,80,,8.32,percent of total billed charges,80% of total billed charges,11.7,90,,9.36,percent of total billed charges,90% of total billed charges,9.75,75,,7.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,3.77,29,,3.016,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,8.71,67,,6.968,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,10.4,80,,8.32,percent of total billed charges,80% of total billed charges,8.45,65,,6.76,percent of total billed charges,65% of total billed charges,4.64,35.67,,3.712,percent of total billed charges,35.67% of total billed charges,3.77,11.7,
PROZAC 10 MG CAP,2508654,CDM,250,RC,,,outpatient,,,31,12.40,,26.35,85,,21.08,percent of total billed charges,85% of total billed charges,23.87,77,,19.1,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,25.42,82,,20.336,percent of total billed charges,82% of total billed charges,26.35,85,,21.08,percent of total billed charges,85% of total billed charges,26.35,85,,21.08,percent of total billed charges,85% of total billed charges,26.35,85,,21.08,percent of total billed charges,85% of total billed charges,27.9,90,,22.32,percent of total billed charges,90% of total billed charges,24.8,80,,19.84,percent of total billed charges,80% of total billed charges,27.9,90,,22.32,percent of total billed charges,90% of total billed charges,23.25,75,,18.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,8.99,29,,7.192,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,20.77,67,,16.616,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,24.8,80,,19.84,percent of total billed charges,80% of total billed charges,20.15,65,,16.12,percent of total billed charges,65% of total billed charges,11.06,35.67,,8.848,percent of total billed charges,35.67% of total billed charges,8.99,27.9,
BUMETANIDE .25 MG-ML,2508681,CDM,250,RC,,,outpatient,,,33,13.20,,28.05,85,,22.44,percent of total billed charges,85% of total billed charges,25.41,77,,20.33,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,27.06,82,,21.648,percent of total billed charges,82% of total billed charges,28.05,85,,22.44,percent of total billed charges,85% of total billed charges,28.05,85,,22.44,percent of total billed charges,85% of total billed charges,28.05,85,,22.44,percent of total billed charges,85% of total billed charges,29.7,90,,23.76,percent of total billed charges,90% of total billed charges,26.4,80,,21.12,percent of total billed charges,80% of total billed charges,29.7,90,,23.76,percent of total billed charges,90% of total billed charges,24.75,75,,19.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,9.57,29,,7.656,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,22.11,67,,17.688,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,26.4,80,,21.12,percent of total billed charges,80% of total billed charges,21.45,65,,17.16,percent of total billed charges,65% of total billed charges,11.77,35.67,,9.416,percent of total billed charges,35.67% of total billed charges,9.57,29.7,
PULMICORT 0.5MG/2ML RESPULES,2508682,CDM,250,RC,,,outpatient,,,41,16.40,,34.85,85,,27.88,percent of total billed charges,85% of total billed charges,31.57,77,,25.26,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,33.62,82,,26.896,percent of total billed charges,82% of total billed charges,34.85,85,,27.88,percent of total billed charges,85% of total billed charges,34.85,85,,27.88,percent of total billed charges,85% of total billed charges,34.85,85,,27.88,percent of total billed charges,85% of total billed charges,36.9,90,,29.52,percent of total billed charges,90% of total billed charges,32.8,80,,26.24,percent of total billed charges,80% of total billed charges,36.9,90,,29.52,percent of total billed charges,90% of total billed charges,30.75,75,,24.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,11.89,29,,9.512,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,27.47,67,,21.976,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,32.8,80,,26.24,percent of total billed charges,80% of total billed charges,26.65,65,,21.32,percent of total billed charges,65% of total billed charges,14.62,35.67,,11.696,percent of total billed charges,35.67% of total billed charges,11.89,36.9,
PYRIDIUM 100MG TAB,2508700,CDM,250,RC,,,outpatient,,,10,4.00,,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,7.7,77,,6.16,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,8.2,82,,6.56,percent of total billed charges,82% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,9,90,,7.2,percent of total billed charges,90% of total billed charges,8,80,,6.4,percent of total billed charges,80% of total billed charges,9,90,,7.2,percent of total billed charges,90% of total billed charges,7.5,75,,6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.9,29,,2.32,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,6.7,67,,5.36,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,8,80,,6.4,percent of total billed charges,80% of total billed charges,6.5,65,,5.2,percent of total billed charges,65% of total billed charges,3.57,35.67,,2.856,percent of total billed charges,35.67% of total billed charges,2.9,9,
QUESTRAN PACKET-POWDER,2508710,CDM,250,RC,,,outpatient,,,21,8.40,,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,16.17,77,,12.94,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,17.22,82,,13.776,percent of total billed charges,82% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,18.9,90,,15.12,percent of total billed charges,90% of total billed charges,16.8,80,,13.44,percent of total billed charges,80% of total billed charges,18.9,90,,15.12,percent of total billed charges,90% of total billed charges,15.75,75,,12.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,6.09,29,,4.872,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,14.07,67,,11.256,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,16.8,80,,13.44,percent of total billed charges,80% of total billed charges,13.65,65,,10.92,percent of total billed charges,65% of total billed charges,7.49,35.67,,5.992,percent of total billed charges,35.67% of total billed charges,6.09,18.9,
QUESTRAN LIGHT 1 EACH PO,2508711,CDM,250,RC,,,outpatient,,,21,8.40,,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,16.17,77,,12.94,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,17.22,82,,13.776,percent of total billed charges,82% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,18.9,90,,15.12,percent of total billed charges,90% of total billed charges,16.8,80,,13.44,percent of total billed charges,80% of total billed charges,18.9,90,,15.12,percent of total billed charges,90% of total billed charges,15.75,75,,12.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,6.09,29,,4.872,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,14.07,67,,11.256,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,16.8,80,,13.44,percent of total billed charges,80% of total billed charges,13.65,65,,10.92,percent of total billed charges,65% of total billed charges,7.49,35.67,,5.992,percent of total billed charges,35.67% of total billed charges,6.09,18.9,
RID SPRAY PER CAN,2508764,CDM,250,RC,,,outpatient,,,22,8.80,,18.7,85,,14.96,percent of total billed charges,85% of total billed charges,16.94,77,,13.55,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,18.04,82,,14.432,percent of total billed charges,82% of total billed charges,18.7,85,,14.96,percent of total billed charges,85% of total billed charges,18.7,85,,14.96,percent of total billed charges,85% of total billed charges,18.7,85,,14.96,percent of total billed charges,85% of total billed charges,19.8,90,,15.84,percent of total billed charges,90% of total billed charges,17.6,80,,14.08,percent of total billed charges,80% of total billed charges,19.8,90,,15.84,percent of total billed charges,90% of total billed charges,16.5,75,,13.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,6.38,29,,5.104,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,14.74,67,,11.792,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,17.6,80,,14.08,percent of total billed charges,80% of total billed charges,14.3,65,,11.44,percent of total billed charges,65% of total billed charges,7.85,35.67,,6.28,percent of total billed charges,35.67% of total billed charges,6.38,19.8,
RACEPINEPHRINE INHALATION SOL,2508771,CDM,250,RC,,,outpatient,,,10,4.00,,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,7.7,77,,6.16,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,8.2,82,,6.56,percent of total billed charges,82% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,9,90,,7.2,percent of total billed charges,90% of total billed charges,8,80,,6.4,percent of total billed charges,80% of total billed charges,9,90,,7.2,percent of total billed charges,90% of total billed charges,7.5,75,,6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.9,29,,2.32,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,6.7,67,,5.36,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,8,80,,6.4,percent of total billed charges,80% of total billed charges,6.5,65,,5.2,percent of total billed charges,65% of total billed charges,3.57,35.67,,2.856,percent of total billed charges,35.67% of total billed charges,2.9,9,
RAZADYNE ER 8 MG TAB,2508778,CDM,250,RC,,,outpatient,,,34,13.60,,28.9,85,,23.12,percent of total billed charges,85% of total billed charges,26.18,77,,20.94,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,27.88,82,,22.304,percent of total billed charges,82% of total billed charges,28.9,85,,23.12,percent of total billed charges,85% of total billed charges,28.9,85,,23.12,percent of total billed charges,85% of total billed charges,28.9,85,,23.12,percent of total billed charges,85% of total billed charges,30.6,90,,24.48,percent of total billed charges,90% of total billed charges,27.2,80,,21.76,percent of total billed charges,80% of total billed charges,30.6,90,,24.48,percent of total billed charges,90% of total billed charges,25.5,75,,20.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,9.86,29,,7.888,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,22.78,67,,18.224,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,27.2,80,,21.76,percent of total billed charges,80% of total billed charges,22.1,65,,17.68,percent of total billed charges,65% of total billed charges,12.13,35.67,,9.704,percent of total billed charges,35.67% of total billed charges,9.86,30.6,
RANEXA 500 MG TAB,2508783,CDM,250,RC,,,outpatient,,,21,8.40,,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,16.17,77,,12.94,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,17.22,82,,13.776,percent of total billed charges,82% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,18.9,90,,15.12,percent of total billed charges,90% of total billed charges,16.8,80,,13.44,percent of total billed charges,80% of total billed charges,18.9,90,,15.12,percent of total billed charges,90% of total billed charges,15.75,75,,12.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,6.09,29,,4.872,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,14.07,67,,11.256,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,16.8,80,,13.44,percent of total billed charges,80% of total billed charges,13.65,65,,10.92,percent of total billed charges,65% of total billed charges,7.49,35.67,,5.992,percent of total billed charges,35.67% of total billed charges,6.09,18.9,
REGLAN 10MG/ML UDC,2508791,CDM,250,RC,,,outpatient,,,7,2.80,,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.39,77,,4.31,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,5.74,82,,4.592,percent of total billed charges,82% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.25,75,,4.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.03,29,,1.624,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4.69,67,,3.752,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,4.55,65,,3.64,percent of total billed charges,65% of total billed charges,2.5,35.67,,2,percent of total billed charges,35.67% of total billed charges,2.03,6.3,
REGLAN TAB 10 MG,2508810,CDM,250,RC,,,outpatient,,,12,4.80,,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,9.24,77,,7.39,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,9.84,82,,7.872,percent of total billed charges,82% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,10.8,90,,8.64,percent of total billed charges,90% of total billed charges,9.6,80,,7.68,percent of total billed charges,80% of total billed charges,10.8,90,,8.64,percent of total billed charges,90% of total billed charges,9,75,,7.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,3.48,29,,2.784,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,8.04,67,,6.432,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,9.6,80,,7.68,percent of total billed charges,80% of total billed charges,7.8,65,,6.24,percent of total billed charges,65% of total billed charges,4.28,35.67,,3.424,percent of total billed charges,35.67% of total billed charges,3.48,10.8,
REMERON SOL 15 MG ODT,2508819,CDM,250,RC,,,outpatient,,,12,4.80,,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,9.24,77,,7.39,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,9.84,82,,7.872,percent of total billed charges,82% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,10.8,90,,8.64,percent of total billed charges,90% of total billed charges,9.6,80,,7.68,percent of total billed charges,80% of total billed charges,10.8,90,,8.64,percent of total billed charges,90% of total billed charges,9,75,,7.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,3.48,29,,2.784,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,8.04,67,,6.432,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,9.6,80,,7.68,percent of total billed charges,80% of total billed charges,7.8,65,,6.24,percent of total billed charges,65% of total billed charges,4.28,35.67,,3.424,percent of total billed charges,35.67% of total billed charges,3.48,10.8,
REMINYL 4 MG PO,2508821,CDM,250,RC,,,outpatient,,,19,7.60,,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,14.63,77,,11.7,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,15.58,82,,12.464,percent of total billed charges,82% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,15.2,80,,12.16,percent of total billed charges,80% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,14.25,75,,11.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,5.51,29,,4.408,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,12.73,67,,10.184,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,15.2,80,,12.16,percent of total billed charges,80% of total billed charges,12.35,65,,9.88,percent of total billed charges,65% of total billed charges,6.78,35.67,,5.424,percent of total billed charges,35.67% of total billed charges,5.51,17.1,
REQUIP 0.25 MG TABLET,2508843,CDM,250,RC,,,outpatient,,,16,6.40,,13.6,85,,10.88,percent of total billed charges,85% of total billed charges,12.32,77,,9.86,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,13.12,82,,10.496,percent of total billed charges,82% of total billed charges,13.6,85,,10.88,percent of total billed charges,85% of total billed charges,13.6,85,,10.88,percent of total billed charges,85% of total billed charges,13.6,85,,10.88,percent of total billed charges,85% of total billed charges,14.4,90,,11.52,percent of total billed charges,90% of total billed charges,12.8,80,,10.24,percent of total billed charges,80% of total billed charges,14.4,90,,11.52,percent of total billed charges,90% of total billed charges,12,75,,9.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,4.64,29,,3.712,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,10.72,67,,8.576,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,12.8,80,,10.24,percent of total billed charges,80% of total billed charges,10.4,65,,8.32,percent of total billed charges,65% of total billed charges,5.71,35.67,,4.568,percent of total billed charges,35.67% of total billed charges,4.64,14.4,
RESTASIS 0.05% OPTHALMIC DROP,2508857,CDM,250,RC,,,outpatient,,,466,186.40,,396.1,85,,316.88,percent of total billed charges,85% of total billed charges,358.82,77,,287.06,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,382.12,82,,305.696,percent of total billed charges,82% of total billed charges,396.1,85,,316.88,percent of total billed charges,85% of total billed charges,396.1,85,,316.88,percent of total billed charges,85% of total billed charges,396.1,85,,316.88,percent of total billed charges,85% of total billed charges,419.4,90,,335.52,percent of total billed charges,90% of total billed charges,372.8,80,,298.24,percent of total billed charges,80% of total billed charges,419.4,90,,335.52,percent of total billed charges,90% of total billed charges,349.5,75,,279.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,135.14,29,,108.112,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,312.22,67,,249.776,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,372.8,80,,298.24,percent of total billed charges,80% of total billed charges,302.9,65,,242.32,percent of total billed charges,65% of total billed charges,166.22,35.67,,132.976,percent of total billed charges,35.67% of total billed charges,135.14,419.4,
RESTORIL CAPS 15 MG,2508860,CDM,250,RC,,,outpatient,,,52,20.80,,44.2,85,,35.36,percent of total billed charges,85% of total billed charges,40.04,77,,32.03,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,42.64,82,,34.112,percent of total billed charges,82% of total billed charges,44.2,85,,35.36,percent of total billed charges,85% of total billed charges,44.2,85,,35.36,percent of total billed charges,85% of total billed charges,44.2,85,,35.36,percent of total billed charges,85% of total billed charges,46.8,90,,37.44,percent of total billed charges,90% of total billed charges,41.6,80,,33.28,percent of total billed charges,80% of total billed charges,46.8,90,,37.44,percent of total billed charges,90% of total billed charges,39,75,,31.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,15.08,29,,12.064,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,34.84,67,,27.872,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,41.6,80,,33.28,percent of total billed charges,80% of total billed charges,33.8,65,,27.04,percent of total billed charges,65% of total billed charges,18.55,35.67,,14.84,percent of total billed charges,35.67% of total billed charges,15.08,46.8,
RISPERDAL 1 MG TAB PO,2508911,CDM,250,RC,,,outpatient,,,39,15.60,,33.15,85,,26.52,percent of total billed charges,85% of total billed charges,30.03,77,,24.02,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,31.98,82,,25.584,percent of total billed charges,82% of total billed charges,33.15,85,,26.52,percent of total billed charges,85% of total billed charges,33.15,85,,26.52,percent of total billed charges,85% of total billed charges,33.15,85,,26.52,percent of total billed charges,85% of total billed charges,35.1,90,,28.08,percent of total billed charges,90% of total billed charges,31.2,80,,24.96,percent of total billed charges,80% of total billed charges,35.1,90,,28.08,percent of total billed charges,90% of total billed charges,29.25,75,,23.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,11.31,29,,9.048,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,26.13,67,,20.904,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,31.2,80,,24.96,percent of total billed charges,80% of total billed charges,25.35,65,,20.28,percent of total billed charges,65% of total billed charges,13.91,35.67,,11.128,percent of total billed charges,35.67% of total billed charges,11.31,35.1,
RISPERDAL 0.25 MG TAB,2508916,CDM,250,RC,,,outpatient,,,24,9.60,,20.4,85,,16.32,percent of total billed charges,85% of total billed charges,18.48,77,,14.78,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,19.68,82,,15.744,percent of total billed charges,82% of total billed charges,20.4,85,,16.32,percent of total billed charges,85% of total billed charges,20.4,85,,16.32,percent of total billed charges,85% of total billed charges,20.4,85,,16.32,percent of total billed charges,85% of total billed charges,21.6,90,,17.28,percent of total billed charges,90% of total billed charges,19.2,80,,15.36,percent of total billed charges,80% of total billed charges,21.6,90,,17.28,percent of total billed charges,90% of total billed charges,18,75,,14.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,6.96,29,,5.568,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,16.08,67,,12.864,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,19.2,80,,15.36,percent of total billed charges,80% of total billed charges,15.6,65,,12.48,percent of total billed charges,65% of total billed charges,8.56,35.67,,6.848,percent of total billed charges,35.67% of total billed charges,6.96,21.6,
ROBIMUL 0.2 MG/ML VIAL (1)20ML,2508961,CDM,250,RC,,,outpatient,,,120,48.00,,102,85,,81.6,percent of total billed charges,85% of total billed charges,92.4,77,,73.92,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,98.4,82,,78.72,percent of total billed charges,82% of total billed charges,102,85,,81.6,percent of total billed charges,85% of total billed charges,102,85,,81.6,percent of total billed charges,85% of total billed charges,102,85,,81.6,percent of total billed charges,85% of total billed charges,108,90,,86.4,percent of total billed charges,90% of total billed charges,96,80,,76.8,percent of total billed charges,80% of total billed charges,108,90,,86.4,percent of total billed charges,90% of total billed charges,90,75,,72,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,34.8,29,,27.84,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,80.4,67,,64.32,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,96,80,,76.8,percent of total billed charges,80% of total billed charges,78,65,,62.4,percent of total billed charges,65% of total billed charges,42.8,35.67,,34.24,percent of total billed charges,35.67% of total billed charges,34.8,108,
ROBINUL 1MG/5ML (0.2),2508965,CDM,250,RC,,,outpatient,,,151,60.40,,128.35,85,,102.68,percent of total billed charges,85% of total billed charges,116.27,77,,93.02,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,123.82,82,,99.056,percent of total billed charges,82% of total billed charges,128.35,85,,102.68,percent of total billed charges,85% of total billed charges,128.35,85,,102.68,percent of total billed charges,85% of total billed charges,128.35,85,,102.68,percent of total billed charges,85% of total billed charges,135.9,90,,108.72,percent of total billed charges,90% of total billed charges,120.8,80,,96.64,percent of total billed charges,80% of total billed charges,135.9,90,,108.72,percent of total billed charges,90% of total billed charges,113.25,75,,90.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,43.79,29,,35.032,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,101.17,67,,80.936,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,120.8,80,,96.64,percent of total billed charges,80% of total billed charges,98.15,65,,78.52,percent of total billed charges,65% of total billed charges,53.86,35.67,,43.088,percent of total billed charges,35.67% of total billed charges,43.79,135.9,
"INJ, HYALURONIDASE",2509002,CDM,250,RC,,,outpatient,,,21,8.40,,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,16.17,77,,12.94,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,17.22,82,,13.776,percent of total billed charges,82% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,18.9,90,,15.12,percent of total billed charges,90% of total billed charges,16.8,80,,13.44,percent of total billed charges,80% of total billed charges,18.9,90,,15.12,percent of total billed charges,90% of total billed charges,15.75,75,,12.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,6.09,29,,4.872,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,14.07,67,,11.256,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,16.8,80,,13.44,percent of total billed charges,80% of total billed charges,13.65,65,,10.92,percent of total billed charges,65% of total billed charges,7.49,35.67,,5.992,percent of total billed charges,35.67% of total billed charges,6.09,18.9,
"INJ, OCTREOTIDE 100MG",2509003,CDM,250,RC,,,outpatient,,,24,9.60,,20.4,85,,16.32,percent of total billed charges,85% of total billed charges,18.48,77,,14.78,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,19.68,82,,15.744,percent of total billed charges,82% of total billed charges,20.4,85,,16.32,percent of total billed charges,85% of total billed charges,20.4,85,,16.32,percent of total billed charges,85% of total billed charges,20.4,85,,16.32,percent of total billed charges,85% of total billed charges,21.6,90,,17.28,percent of total billed charges,90% of total billed charges,19.2,80,,15.36,percent of total billed charges,80% of total billed charges,21.6,90,,17.28,percent of total billed charges,90% of total billed charges,18,75,,14.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,6.96,29,,5.568,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,16.08,67,,12.864,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,19.2,80,,15.36,percent of total billed charges,80% of total billed charges,15.6,65,,12.48,percent of total billed charges,65% of total billed charges,8.56,35.67,,6.848,percent of total billed charges,35.67% of total billed charges,6.96,21.6,
ROBITUSSIN DM LIQ 5 ML UDC,2509006,CDM,250,RC,,,outpatient,,,7,2.80,,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.39,77,,4.31,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,5.74,82,,4.592,percent of total billed charges,82% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.25,75,,4.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.03,29,,1.624,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4.69,67,,3.752,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,4.55,65,,3.64,percent of total billed charges,65% of total billed charges,2.5,35.67,,2,percent of total billed charges,35.67% of total billed charges,2.03,6.3,
ROCALTROL 0.25 MG PO,2509026,CDM,250,RC,,,outpatient,,,9,3.60,,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,6.93,77,,5.54,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,7.38,82,,5.904,percent of total billed charges,82% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,8.1,90,,6.48,percent of total billed charges,90% of total billed charges,7.2,80,,5.76,percent of total billed charges,80% of total billed charges,8.1,90,,6.48,percent of total billed charges,90% of total billed charges,6.75,75,,5.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.61,29,,2.088,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,6.03,67,,4.824,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,7.2,80,,5.76,percent of total billed charges,80% of total billed charges,5.85,65,,4.68,percent of total billed charges,65% of total billed charges,3.21,35.67,,2.568,percent of total billed charges,35.67% of total billed charges,2.61,8.1,
ROBITUSSIN 200 MG/10ML UDC,2509029,CDM,250,RC,,,outpatient,,,7,2.80,,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.39,77,,4.31,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,5.74,82,,4.592,percent of total billed charges,82% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.25,75,,4.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.03,29,,1.624,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4.69,67,,3.752,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,4.55,65,,3.64,percent of total billed charges,65% of total billed charges,2.5,35.67,,2,percent of total billed charges,35.67% of total billed charges,2.03,6.3,
ROXICODONE 5 MG PO,2509174,CDM,250,RC,,,outpatient,,,7,2.80,,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.39,77,,4.31,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,5.74,82,,4.592,percent of total billed charges,82% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.25,75,,4.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.03,29,,1.624,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4.69,67,,3.752,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,4.55,65,,3.64,percent of total billed charges,65% of total billed charges,2.5,35.67,,2,percent of total billed charges,35.67% of total billed charges,2.03,6.3,
RYTHMOL 150 MG TAB,2509215,CDM,250,RC,,,outpatient,,,24,9.60,,20.4,85,,16.32,percent of total billed charges,85% of total billed charges,18.48,77,,14.78,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,19.68,82,,15.744,percent of total billed charges,82% of total billed charges,20.4,85,,16.32,percent of total billed charges,85% of total billed charges,20.4,85,,16.32,percent of total billed charges,85% of total billed charges,20.4,85,,16.32,percent of total billed charges,85% of total billed charges,21.6,90,,17.28,percent of total billed charges,90% of total billed charges,19.2,80,,15.36,percent of total billed charges,80% of total billed charges,21.6,90,,17.28,percent of total billed charges,90% of total billed charges,18,75,,14.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,6.96,29,,5.568,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,16.08,67,,12.864,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,19.2,80,,15.36,percent of total billed charges,80% of total billed charges,15.6,65,,12.48,percent of total billed charges,65% of total billed charges,8.56,35.67,,6.848,percent of total billed charges,35.67% of total billed charges,6.96,21.6,
RYTHMOL SR 225 MG CAP,2509218,CDM,250,RC,,,outpatient,,,28,11.20,,23.8,85,,19.04,percent of total billed charges,85% of total billed charges,21.56,77,,17.25,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,22.96,82,,18.368,percent of total billed charges,82% of total billed charges,23.8,85,,19.04,percent of total billed charges,85% of total billed charges,23.8,85,,19.04,percent of total billed charges,85% of total billed charges,23.8,85,,19.04,percent of total billed charges,85% of total billed charges,25.2,90,,20.16,percent of total billed charges,90% of total billed charges,22.4,80,,17.92,percent of total billed charges,80% of total billed charges,25.2,90,,20.16,percent of total billed charges,90% of total billed charges,21,75,,16.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,8.12,29,,6.496,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,18.76,67,,15.008,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,22.4,80,,17.92,percent of total billed charges,80% of total billed charges,18.2,65,,14.56,percent of total billed charges,65% of total billed charges,9.99,35.67,,7.992,percent of total billed charges,35.67% of total billed charges,8.12,25.2,
SANTYL 30 GM TUBE,2509247,CDM,250,RC,,,outpatient,,,649,259.60,,551.65,85,,441.32,percent of total billed charges,85% of total billed charges,499.73,77,,399.78,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,532.18,82,,425.744,percent of total billed charges,82% of total billed charges,551.65,85,,441.32,percent of total billed charges,85% of total billed charges,551.65,85,,441.32,percent of total billed charges,85% of total billed charges,551.65,85,,441.32,percent of total billed charges,85% of total billed charges,584.1,90,,467.28,percent of total billed charges,90% of total billed charges,519.2,80,,415.36,percent of total billed charges,80% of total billed charges,584.1,90,,467.28,percent of total billed charges,90% of total billed charges,486.75,75,,389.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,188.21,29,,150.568,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,434.83,67,,347.864,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,519.2,80,,415.36,percent of total billed charges,80% of total billed charges,421.85,65,,337.48,percent of total billed charges,65% of total billed charges,231.5,35.67,,185.2,percent of total billed charges,35.67% of total billed charges,188.21,584.1,
SENOKOT-S 1 EACH PO,2509291,CDM,250,RC,,,outpatient,,,7,2.80,,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.39,77,,4.31,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,5.74,82,,4.592,percent of total billed charges,82% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.25,75,,4.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.03,29,,1.624,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4.69,67,,3.752,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,4.55,65,,3.64,percent of total billed charges,65% of total billed charges,2.5,35.67,,2,percent of total billed charges,35.67% of total billed charges,2.03,6.3,
SEPTRA 10 ML VIAL,2509301,CDM,250,RC,,,outpatient,,,33,13.20,,28.05,85,,22.44,percent of total billed charges,85% of total billed charges,25.41,77,,20.33,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,27.06,82,,21.648,percent of total billed charges,82% of total billed charges,28.05,85,,22.44,percent of total billed charges,85% of total billed charges,28.05,85,,22.44,percent of total billed charges,85% of total billed charges,28.05,85,,22.44,percent of total billed charges,85% of total billed charges,29.7,90,,23.76,percent of total billed charges,90% of total billed charges,26.4,80,,21.12,percent of total billed charges,80% of total billed charges,29.7,90,,23.76,percent of total billed charges,90% of total billed charges,24.75,75,,19.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,9.57,29,,7.656,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,22.11,67,,17.688,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,26.4,80,,21.12,percent of total billed charges,80% of total billed charges,21.45,65,,17.16,percent of total billed charges,65% of total billed charges,11.77,35.67,,9.416,percent of total billed charges,35.67% of total billed charges,9.57,29.7,
SEPTRA SUSPENSION 20 ML UDC,2509302,CDM,250,RC,,,outpatient,,,19,7.60,,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,14.63,77,,11.7,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,15.58,82,,12.464,percent of total billed charges,82% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,15.2,80,,12.16,percent of total billed charges,80% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,14.25,75,,11.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,5.51,29,,4.408,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,12.73,67,,10.184,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,15.2,80,,12.16,percent of total billed charges,80% of total billed charges,12.35,65,,9.88,percent of total billed charges,65% of total billed charges,6.78,35.67,,5.424,percent of total billed charges,35.67% of total billed charges,5.51,17.1,
SEROQUEL 300 MG TAB,2509331,CDM,250,RC,,,outpatient,,,75,30.00,,63.75,85,,51,percent of total billed charges,85% of total billed charges,57.75,77,,46.2,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,61.5,82,,49.2,percent of total billed charges,82% of total billed charges,63.75,85,,51,percent of total billed charges,85% of total billed charges,63.75,85,,51,percent of total billed charges,85% of total billed charges,63.75,85,,51,percent of total billed charges,85% of total billed charges,67.5,90,,54,percent of total billed charges,90% of total billed charges,60,80,,48,percent of total billed charges,80% of total billed charges,67.5,90,,54,percent of total billed charges,90% of total billed charges,56.25,75,,45,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,21.75,29,,17.4,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,50.25,67,,40.2,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,60,80,,48,percent of total billed charges,80% of total billed charges,48.75,65,,39,percent of total billed charges,65% of total billed charges,26.75,35.67,,21.4,percent of total billed charges,35.67% of total billed charges,21.75,67.5,
SEROQUEL 100 MG PO,2509332,CDM,250,RC,,,outpatient,,,31,12.40,,26.35,85,,21.08,percent of total billed charges,85% of total billed charges,23.87,77,,19.1,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,25.42,82,,20.336,percent of total billed charges,82% of total billed charges,26.35,85,,21.08,percent of total billed charges,85% of total billed charges,26.35,85,,21.08,percent of total billed charges,85% of total billed charges,26.35,85,,21.08,percent of total billed charges,85% of total billed charges,27.9,90,,22.32,percent of total billed charges,90% of total billed charges,24.8,80,,19.84,percent of total billed charges,80% of total billed charges,27.9,90,,22.32,percent of total billed charges,90% of total billed charges,23.25,75,,18.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,8.99,29,,7.192,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,20.77,67,,16.616,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,24.8,80,,19.84,percent of total billed charges,80% of total billed charges,20.15,65,,16.12,percent of total billed charges,65% of total billed charges,11.06,35.67,,8.848,percent of total billed charges,35.67% of total billed charges,8.99,27.9,
SEROQUEL 25 MG PO,2509336,CDM,250,RC,,,outpatient,,,19,7.60,,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,14.63,77,,11.7,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,15.58,82,,12.464,percent of total billed charges,82% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,15.2,80,,12.16,percent of total billed charges,80% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,14.25,75,,11.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,5.51,29,,4.408,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,12.73,67,,10.184,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,15.2,80,,12.16,percent of total billed charges,80% of total billed charges,12.35,65,,9.88,percent of total billed charges,65% of total billed charges,6.78,35.67,,5.424,percent of total billed charges,35.67% of total billed charges,5.51,17.1,
SILVADENE CR. 20 GM TUBE,2509345,CDM,250,RC,,,outpatient,,,34,13.60,,28.9,85,,23.12,percent of total billed charges,85% of total billed charges,26.18,77,,20.94,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,27.88,82,,22.304,percent of total billed charges,82% of total billed charges,28.9,85,,23.12,percent of total billed charges,85% of total billed charges,28.9,85,,23.12,percent of total billed charges,85% of total billed charges,28.9,85,,23.12,percent of total billed charges,85% of total billed charges,30.6,90,,24.48,percent of total billed charges,90% of total billed charges,27.2,80,,21.76,percent of total billed charges,80% of total billed charges,30.6,90,,24.48,percent of total billed charges,90% of total billed charges,25.5,75,,20.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,9.86,29,,7.888,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,22.78,67,,18.224,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,27.2,80,,21.76,percent of total billed charges,80% of total billed charges,22.1,65,,17.68,percent of total billed charges,65% of total billed charges,12.13,35.67,,9.704,percent of total billed charges,35.67% of total billed charges,9.86,30.6,
SILVADENE CR. 400 GR.,2509350,CDM,250,RC,,,outpatient,,,236,94.40,,200.6,85,,160.48,percent of total billed charges,85% of total billed charges,181.72,77,,145.38,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,193.52,82,,154.816,percent of total billed charges,82% of total billed charges,200.6,85,,160.48,percent of total billed charges,85% of total billed charges,200.6,85,,160.48,percent of total billed charges,85% of total billed charges,200.6,85,,160.48,percent of total billed charges,85% of total billed charges,212.4,90,,169.92,percent of total billed charges,90% of total billed charges,188.8,80,,151.04,percent of total billed charges,80% of total billed charges,212.4,90,,169.92,percent of total billed charges,90% of total billed charges,177,75,,141.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,68.44,29,,54.752,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,158.12,67,,126.496,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,188.8,80,,151.04,percent of total billed charges,80% of total billed charges,153.4,65,,122.72,percent of total billed charges,65% of total billed charges,84.18,35.67,,67.344,percent of total billed charges,35.67% of total billed charges,68.44,212.4,
SILVER NITRATE APPLICATOR,2509360,CDM,250,RC,,,outpatient,,,8,3.20,,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,6.16,77,,4.93,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,6.56,82,,5.248,percent of total billed charges,82% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,7.2,90,,5.76,percent of total billed charges,90% of total billed charges,6.4,80,,5.12,percent of total billed charges,80% of total billed charges,7.2,90,,5.76,percent of total billed charges,90% of total billed charges,6,75,,4.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.32,29,,1.856,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,5.36,67,,4.288,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,6.4,80,,5.12,percent of total billed charges,80% of total billed charges,5.2,65,,4.16,percent of total billed charges,65% of total billed charges,2.85,35.67,,2.28,percent of total billed charges,35.67% of total billed charges,2.32,7.2,
SINEMET 10-100 TAB,2509365,CDM,250,RC,,,outpatient,,,8,3.20,,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,6.16,77,,4.93,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,6.56,82,,5.248,percent of total billed charges,82% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,7.2,90,,5.76,percent of total billed charges,90% of total billed charges,6.4,80,,5.12,percent of total billed charges,80% of total billed charges,7.2,90,,5.76,percent of total billed charges,90% of total billed charges,6,75,,4.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.32,29,,1.856,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,5.36,67,,4.288,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,6.4,80,,5.12,percent of total billed charges,80% of total billed charges,5.2,65,,4.16,percent of total billed charges,65% of total billed charges,2.85,35.67,,2.28,percent of total billed charges,35.67% of total billed charges,2.32,7.2,
SINEMET 25-100 TAB,2509370,CDM,250,RC,,,outpatient,,,8,3.20,,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,6.16,77,,4.93,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,6.56,82,,5.248,percent of total billed charges,82% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,7.2,90,,5.76,percent of total billed charges,90% of total billed charges,6.4,80,,5.12,percent of total billed charges,80% of total billed charges,7.2,90,,5.76,percent of total billed charges,90% of total billed charges,6,75,,4.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.32,29,,1.856,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,5.36,67,,4.288,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,6.4,80,,5.12,percent of total billed charges,80% of total billed charges,5.2,65,,4.16,percent of total billed charges,65% of total billed charges,2.85,35.67,,2.28,percent of total billed charges,35.67% of total billed charges,2.32,7.2,
SINEMET 25-250 TAB,2509375,CDM,250,RC,,,outpatient,,,9,3.60,,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,6.93,77,,5.54,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,7.38,82,,5.904,percent of total billed charges,82% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,8.1,90,,6.48,percent of total billed charges,90% of total billed charges,7.2,80,,5.76,percent of total billed charges,80% of total billed charges,8.1,90,,6.48,percent of total billed charges,90% of total billed charges,6.75,75,,5.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.61,29,,2.088,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,6.03,67,,4.824,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,7.2,80,,5.76,percent of total billed charges,80% of total billed charges,5.85,65,,4.68,percent of total billed charges,65% of total billed charges,3.21,35.67,,2.568,percent of total billed charges,35.67% of total billed charges,2.61,8.1,
SINEQUAN 10 MG CAP,2509385,CDM,250,RC,,,outpatient,,,7,2.80,,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.39,77,,4.31,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,5.74,82,,4.592,percent of total billed charges,82% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.25,75,,4.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.03,29,,1.624,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4.69,67,,3.752,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,4.55,65,,3.64,percent of total billed charges,65% of total billed charges,2.5,35.67,,2,percent of total billed charges,35.67% of total billed charges,2.03,6.3,
SINEQUAN 25 MG CAP,2509395,CDM,250,RC,,,outpatient,,,7,2.80,,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.39,77,,4.31,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,5.74,82,,4.592,percent of total billed charges,82% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.25,75,,4.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.03,29,,1.624,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4.69,67,,3.752,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,4.55,65,,3.64,percent of total billed charges,65% of total billed charges,2.5,35.67,,2,percent of total billed charges,35.67% of total billed charges,2.03,6.3,
SINGULAIR 4 MG CHEWABLE,2509417,CDM,250,RC,,,outpatient,,,25,10.00,,21.25,85,,17,percent of total billed charges,85% of total billed charges,19.25,77,,15.4,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,20.5,82,,16.4,percent of total billed charges,82% of total billed charges,21.25,85,,17,percent of total billed charges,85% of total billed charges,21.25,85,,17,percent of total billed charges,85% of total billed charges,21.25,85,,17,percent of total billed charges,85% of total billed charges,22.5,90,,18,percent of total billed charges,90% of total billed charges,20,80,,16,percent of total billed charges,80% of total billed charges,22.5,90,,18,percent of total billed charges,90% of total billed charges,18.75,75,,15,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,7.25,29,,5.8,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,16.75,67,,13.4,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,20,80,,16,percent of total billed charges,80% of total billed charges,16.25,65,,13,percent of total billed charges,65% of total billed charges,8.92,35.67,,7.136,percent of total billed charges,35.67% of total billed charges,7.25,22.5,
SINGULAIR 10 MG PO,2509419,CDM,250,RC,,,outpatient,,,27,10.80,,22.95,85,,18.36,percent of total billed charges,85% of total billed charges,20.79,77,,16.63,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,22.14,82,,17.712,percent of total billed charges,82% of total billed charges,22.95,85,,18.36,percent of total billed charges,85% of total billed charges,22.95,85,,18.36,percent of total billed charges,85% of total billed charges,22.95,85,,18.36,percent of total billed charges,85% of total billed charges,24.3,90,,19.44,percent of total billed charges,90% of total billed charges,21.6,80,,17.28,percent of total billed charges,80% of total billed charges,24.3,90,,19.44,percent of total billed charges,90% of total billed charges,20.25,75,,16.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,7.83,29,,6.264,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,18.09,67,,14.472,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,21.6,80,,17.28,percent of total billed charges,80% of total billed charges,17.55,65,,14.04,percent of total billed charges,65% of total billed charges,9.63,35.67,,7.704,percent of total billed charges,35.67% of total billed charges,7.83,24.3,
SM AMT OF WOUND CLEANSER,2509496,CDM,250,RC,,,outpatient,,,6,2.40,,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,4.62,77,,3.7,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,4.92,82,,3.936,percent of total billed charges,82% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,5.4,90,,4.32,percent of total billed charges,90% of total billed charges,4.8,80,,3.84,percent of total billed charges,80% of total billed charges,5.4,90,,4.32,percent of total billed charges,90% of total billed charges,4.5,75,,3.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,1.74,29,,1.392,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4.02,67,,3.216,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,4.8,80,,3.84,percent of total billed charges,80% of total billed charges,3.9,65,,3.12,percent of total billed charges,65% of total billed charges,2.14,35.67,,1.712,percent of total billed charges,35.67% of total billed charges,1.74,5.4,
SOD. CHLORIDE .9% 3ML INJ,2509500,CDM,250,RC,,,outpatient,,,10,4.00,,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,7.7,77,,6.16,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,8.2,82,,6.56,percent of total billed charges,82% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,9,90,,7.2,percent of total billed charges,90% of total billed charges,8,80,,6.4,percent of total billed charges,80% of total billed charges,9,90,,7.2,percent of total billed charges,90% of total billed charges,7.5,75,,6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.9,29,,2.32,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,6.7,67,,5.36,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,8,80,,6.4,percent of total billed charges,80% of total billed charges,6.5,65,,5.2,percent of total billed charges,65% of total billed charges,3.57,35.67,,2.856,percent of total billed charges,35.67% of total billed charges,2.9,9,
SODIUM CHLORIDE .9% 100 ML IV,2509503,CDM,250,RC,,,outpatient,,,11,4.40,,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,8.47,77,,6.78,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,9.02,82,,7.216,percent of total billed charges,82% of total billed charges,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,9.9,90,,7.92,percent of total billed charges,90% of total billed charges,8.8,80,,7.04,percent of total billed charges,80% of total billed charges,9.9,90,,7.92,percent of total billed charges,90% of total billed charges,8.25,75,,6.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,3.19,29,,2.552,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,7.37,67,,5.896,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,8.8,80,,7.04,percent of total billed charges,80% of total billed charges,7.15,65,,5.72,percent of total billed charges,65% of total billed charges,3.92,35.67,,3.136,percent of total billed charges,35.67% of total billed charges,3.19,9.9,
SODIUM CHLORIDE .9% 50 ML IV,2509504,CDM,250,RC,,,outpatient,,,52,20.80,,44.2,85,,35.36,percent of total billed charges,85% of total billed charges,40.04,77,,32.03,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,42.64,82,,34.112,percent of total billed charges,82% of total billed charges,44.2,85,,35.36,percent of total billed charges,85% of total billed charges,44.2,85,,35.36,percent of total billed charges,85% of total billed charges,44.2,85,,35.36,percent of total billed charges,85% of total billed charges,46.8,90,,37.44,percent of total billed charges,90% of total billed charges,41.6,80,,33.28,percent of total billed charges,80% of total billed charges,46.8,90,,37.44,percent of total billed charges,90% of total billed charges,39,75,,31.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,15.08,29,,12.064,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,34.84,67,,27.872,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,41.6,80,,33.28,percent of total billed charges,80% of total billed charges,33.8,65,,27.04,percent of total billed charges,65% of total billed charges,18.55,35.67,,14.84,percent of total billed charges,35.67% of total billed charges,15.08,46.8,
SODIUM CHLORIDE .9% 100 ML IV,2509505,CDM,250,RC,,,outpatient,,,11,4.40,,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,8.47,77,,6.78,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,9.02,82,,7.216,percent of total billed charges,82% of total billed charges,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,9.9,90,,7.92,percent of total billed charges,90% of total billed charges,8.8,80,,7.04,percent of total billed charges,80% of total billed charges,9.9,90,,7.92,percent of total billed charges,90% of total billed charges,8.25,75,,6.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,3.19,29,,2.552,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,7.37,67,,5.896,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,8.8,80,,7.04,percent of total billed charges,80% of total billed charges,7.15,65,,5.72,percent of total billed charges,65% of total billed charges,3.92,35.67,,3.136,percent of total billed charges,35.67% of total billed charges,3.19,9.9,
SODIUM CHLORIDE .9% 250 ML IV,2509506,CDM,250,RC,,,outpatient,,,15,6.00,,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,11.55,77,,9.24,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,12.3,82,,9.84,percent of total billed charges,82% of total billed charges,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,13.5,90,,10.8,percent of total billed charges,90% of total billed charges,12,80,,9.6,percent of total billed charges,80% of total billed charges,13.5,90,,10.8,percent of total billed charges,90% of total billed charges,11.25,75,,9,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,4.35,29,,3.48,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,10.05,67,,8.04,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,12,80,,9.6,percent of total billed charges,80% of total billed charges,9.75,65,,7.8,percent of total billed charges,65% of total billed charges,5.35,35.67,,4.28,percent of total billed charges,35.67% of total billed charges,4.35,13.5,
SODIUM CHLORIDE .9% 5ML PFS,2509508,CDM,250,RC,,,outpatient,,,15,6.00,,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,11.55,77,,9.24,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,12.3,82,,9.84,percent of total billed charges,82% of total billed charges,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,13.5,90,,10.8,percent of total billed charges,90% of total billed charges,12,80,,9.6,percent of total billed charges,80% of total billed charges,13.5,90,,10.8,percent of total billed charges,90% of total billed charges,11.25,75,,9,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,4.35,29,,3.48,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,10.05,67,,8.04,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,12,80,,9.6,percent of total billed charges,80% of total billed charges,9.75,65,,7.8,percent of total billed charges,65% of total billed charges,5.35,35.67,,4.28,percent of total billed charges,35.67% of total billed charges,4.35,13.5,
SODIUM CHLORIDE .9 10ML SYRING,2509509,CDM,250,RC,,,outpatient,,,11,4.40,,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,8.47,77,,6.78,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,9.02,82,,7.216,percent of total billed charges,82% of total billed charges,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,9.9,90,,7.92,percent of total billed charges,90% of total billed charges,8.8,80,,7.04,percent of total billed charges,80% of total billed charges,9.9,90,,7.92,percent of total billed charges,90% of total billed charges,8.25,75,,6.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,3.19,29,,2.552,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,7.37,67,,5.896,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,8.8,80,,7.04,percent of total billed charges,80% of total billed charges,7.15,65,,5.72,percent of total billed charges,65% of total billed charges,3.92,35.67,,3.136,percent of total billed charges,35.67% of total billed charges,3.19,9.9,
SODIUM BICARB 8.4% 50 ML INJ,2509510,CDM,250,RC,,,outpatient,,,47,18.80,,39.95,85,,31.96,percent of total billed charges,85% of total billed charges,36.19,77,,28.95,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,38.54,82,,30.832,percent of total billed charges,82% of total billed charges,39.95,85,,31.96,percent of total billed charges,85% of total billed charges,39.95,85,,31.96,percent of total billed charges,85% of total billed charges,39.95,85,,31.96,percent of total billed charges,85% of total billed charges,42.3,90,,33.84,percent of total billed charges,90% of total billed charges,37.6,80,,30.08,percent of total billed charges,80% of total billed charges,42.3,90,,33.84,percent of total billed charges,90% of total billed charges,35.25,75,,28.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,13.63,29,,10.904,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,31.49,67,,25.192,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,37.6,80,,30.08,percent of total billed charges,80% of total billed charges,30.55,65,,24.44,percent of total billed charges,65% of total billed charges,16.76,35.67,,13.408,percent of total billed charges,35.67% of total billed charges,13.63,42.3,
SODIUM CHLORIDE 3% 500 ML BAG,2509511,CDM,250,RC,,,outpatient,,,176,70.40,,149.6,85,,119.68,percent of total billed charges,85% of total billed charges,135.52,77,,108.42,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,144.32,82,,115.456,percent of total billed charges,82% of total billed charges,149.6,85,,119.68,percent of total billed charges,85% of total billed charges,149.6,85,,119.68,percent of total billed charges,85% of total billed charges,149.6,85,,119.68,percent of total billed charges,85% of total billed charges,158.4,90,,126.72,percent of total billed charges,90% of total billed charges,140.8,80,,112.64,percent of total billed charges,80% of total billed charges,158.4,90,,126.72,percent of total billed charges,90% of total billed charges,132,75,,105.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,51.04,29,,40.832,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,117.92,67,,94.336,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,140.8,80,,112.64,percent of total billed charges,80% of total billed charges,114.4,65,,91.52,percent of total billed charges,65% of total billed charges,62.78,35.67,,50.224,percent of total billed charges,35.67% of total billed charges,51.04,158.4,
SODIUM CHLORIDE 5% 500 MG BAG,2509512,CDM,250,RC,,,outpatient,,,70,28.00,,59.5,85,,47.6,percent of total billed charges,85% of total billed charges,53.9,77,,43.12,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,57.4,82,,45.92,percent of total billed charges,82% of total billed charges,59.5,85,,47.6,percent of total billed charges,85% of total billed charges,59.5,85,,47.6,percent of total billed charges,85% of total billed charges,59.5,85,,47.6,percent of total billed charges,85% of total billed charges,63,90,,50.4,percent of total billed charges,90% of total billed charges,56,80,,44.8,percent of total billed charges,80% of total billed charges,63,90,,50.4,percent of total billed charges,90% of total billed charges,52.5,75,,42,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,20.3,29,,16.24,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,46.9,67,,37.52,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,56,80,,44.8,percent of total billed charges,80% of total billed charges,45.5,65,,36.4,percent of total billed charges,65% of total billed charges,24.97,35.67,,19.976,percent of total billed charges,35.67% of total billed charges,20.3,63,
SODIUM BICARB 50 ML VIAL,2509513,CDM,250,RC,,,outpatient,,,332,132.80,,282.2,85,,225.76,percent of total billed charges,85% of total billed charges,255.64,77,,204.51,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,272.24,82,,217.792,percent of total billed charges,82% of total billed charges,282.2,85,,225.76,percent of total billed charges,85% of total billed charges,282.2,85,,225.76,percent of total billed charges,85% of total billed charges,282.2,85,,225.76,percent of total billed charges,85% of total billed charges,298.8,90,,239.04,percent of total billed charges,90% of total billed charges,265.6,80,,212.48,percent of total billed charges,80% of total billed charges,298.8,90,,239.04,percent of total billed charges,90% of total billed charges,249,75,,199.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,96.28,29,,77.024,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,222.44,67,,177.952,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,265.6,80,,212.48,percent of total billed charges,80% of total billed charges,215.8,65,,172.64,percent of total billed charges,65% of total billed charges,118.42,35.67,,94.736,percent of total billed charges,35.67% of total billed charges,96.28,298.8,
SODIUM BICARBONATE 650 MG TAB,2509517,CDM,250,RC,,,outpatient,,,7,2.80,,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.39,77,,4.31,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,5.74,82,,4.592,percent of total billed charges,82% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.25,75,,4.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.03,29,,1.624,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4.69,67,,3.752,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,4.55,65,,3.64,percent of total billed charges,65% of total billed charges,2.5,35.67,,2,percent of total billed charges,35.67% of total billed charges,2.03,6.3,
SODIUM CHLORIDE 10 ML PF,2509521,CDM,250,RC,,,outpatient,,,11,4.40,,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,8.47,77,,6.78,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,9.02,82,,7.216,percent of total billed charges,82% of total billed charges,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,9.9,90,,7.92,percent of total billed charges,90% of total billed charges,8.8,80,,7.04,percent of total billed charges,80% of total billed charges,9.9,90,,7.92,percent of total billed charges,90% of total billed charges,8.25,75,,6.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,3.19,29,,2.552,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,7.37,67,,5.896,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,8.8,80,,7.04,percent of total billed charges,80% of total billed charges,7.15,65,,5.72,percent of total billed charges,65% of total billed charges,3.92,35.67,,3.136,percent of total billed charges,35.67% of total billed charges,3.19,9.9,
SODIUM CHLORIDE 10% INJ EPIDUR,2509524,CDM,250,RC,,,outpatient,,,303,121.20,,257.55,85,,206.04,percent of total billed charges,85% of total billed charges,233.31,77,,186.65,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,248.46,82,,198.768,percent of total billed charges,82% of total billed charges,257.55,85,,206.04,percent of total billed charges,85% of total billed charges,257.55,85,,206.04,percent of total billed charges,85% of total billed charges,257.55,85,,206.04,percent of total billed charges,85% of total billed charges,272.7,90,,218.16,percent of total billed charges,90% of total billed charges,242.4,80,,193.92,percent of total billed charges,80% of total billed charges,272.7,90,,218.16,percent of total billed charges,90% of total billed charges,227.25,75,,181.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,87.87,29,,70.296,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,203.01,67,,162.408,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,242.4,80,,193.92,percent of total billed charges,80% of total billed charges,196.95,65,,157.56,percent of total billed charges,65% of total billed charges,108.08,35.67,,86.464,percent of total billed charges,35.67% of total billed charges,87.87,272.7,
SODIUM CHLOR 1000ML+20mEq POT,2509527,CDM,250,RC,,,outpatient,,,46,18.40,,39.1,85,,31.28,percent of total billed charges,85% of total billed charges,35.42,77,,28.34,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,37.72,82,,30.176,percent of total billed charges,82% of total billed charges,39.1,85,,31.28,percent of total billed charges,85% of total billed charges,39.1,85,,31.28,percent of total billed charges,85% of total billed charges,39.1,85,,31.28,percent of total billed charges,85% of total billed charges,41.4,90,,33.12,percent of total billed charges,90% of total billed charges,36.8,80,,29.44,percent of total billed charges,80% of total billed charges,41.4,90,,33.12,percent of total billed charges,90% of total billed charges,34.5,75,,27.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,13.34,29,,10.672,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,30.82,67,,24.656,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,36.8,80,,29.44,percent of total billed charges,80% of total billed charges,29.9,65,,23.92,percent of total billed charges,65% of total billed charges,16.41,35.67,,13.128,percent of total billed charges,35.67% of total billed charges,13.34,41.4,
SODIUM CHLORIDE 0.45%+20mEgKCL,2509533,CDM,250,RC,,,outpatient,,,46,18.40,,39.1,85,,31.28,percent of total billed charges,85% of total billed charges,35.42,77,,28.34,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,37.72,82,,30.176,percent of total billed charges,82% of total billed charges,39.1,85,,31.28,percent of total billed charges,85% of total billed charges,39.1,85,,31.28,percent of total billed charges,85% of total billed charges,39.1,85,,31.28,percent of total billed charges,85% of total billed charges,41.4,90,,33.12,percent of total billed charges,90% of total billed charges,36.8,80,,29.44,percent of total billed charges,80% of total billed charges,41.4,90,,33.12,percent of total billed charges,90% of total billed charges,34.5,75,,27.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,13.34,29,,10.672,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,30.82,67,,24.656,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,36.8,80,,29.44,percent of total billed charges,80% of total billed charges,29.9,65,,23.92,percent of total billed charges,65% of total billed charges,16.41,35.67,,13.128,percent of total billed charges,35.67% of total billed charges,13.34,41.4,
SODIUM THIOSULFATE 10% VIAL,2509542,CDM,250,RC,,,outpatient,,,70,28.00,,59.5,85,,47.6,percent of total billed charges,85% of total billed charges,53.9,77,,43.12,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,57.4,82,,45.92,percent of total billed charges,82% of total billed charges,59.5,85,,47.6,percent of total billed charges,85% of total billed charges,59.5,85,,47.6,percent of total billed charges,85% of total billed charges,59.5,85,,47.6,percent of total billed charges,85% of total billed charges,63,90,,50.4,percent of total billed charges,90% of total billed charges,56,80,,44.8,percent of total billed charges,80% of total billed charges,63,90,,50.4,percent of total billed charges,90% of total billed charges,52.5,75,,42,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,20.3,29,,16.24,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,46.9,67,,37.52,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,56,80,,44.8,percent of total billed charges,80% of total billed charges,45.5,65,,36.4,percent of total billed charges,65% of total billed charges,24.97,35.67,,19.976,percent of total billed charges,35.67% of total billed charges,20.3,63,
SORBITOL LIQUID,2509610,CDM,250,RC,,,outpatient,,,14,5.60,,11.9,85,,9.52,percent of total billed charges,85% of total billed charges,10.78,77,,8.62,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,11.48,82,,9.184,percent of total billed charges,82% of total billed charges,11.9,85,,9.52,percent of total billed charges,85% of total billed charges,11.9,85,,9.52,percent of total billed charges,85% of total billed charges,11.9,85,,9.52,percent of total billed charges,85% of total billed charges,12.6,90,,10.08,percent of total billed charges,90% of total billed charges,11.2,80,,8.96,percent of total billed charges,80% of total billed charges,12.6,90,,10.08,percent of total billed charges,90% of total billed charges,10.5,75,,8.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,4.06,29,,3.248,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,9.38,67,,7.504,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,11.2,80,,8.96,percent of total billed charges,80% of total billed charges,9.1,65,,7.28,percent of total billed charges,65% of total billed charges,4.99,35.67,,3.992,percent of total billed charges,35.67% of total billed charges,4.06,12.6,
STARLIX 60 MG TAB,2509677,CDM,250,RC,,,outpatient,,,10,4.00,,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,7.7,77,,6.16,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,8.2,82,,6.56,percent of total billed charges,82% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,9,90,,7.2,percent of total billed charges,90% of total billed charges,8,80,,6.4,percent of total billed charges,80% of total billed charges,9,90,,7.2,percent of total billed charges,90% of total billed charges,7.5,75,,6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.9,29,,2.32,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,6.7,67,,5.36,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,8,80,,6.4,percent of total billed charges,80% of total billed charges,6.5,65,,5.2,percent of total billed charges,65% of total billed charges,3.57,35.67,,2.856,percent of total billed charges,35.67% of total billed charges,2.9,9,
STERILE WATER 10CC,2509700,CDM,250,RC,,,outpatient,,,8,3.20,,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,6.16,77,,4.93,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,6.56,82,,5.248,percent of total billed charges,82% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,7.2,90,,5.76,percent of total billed charges,90% of total billed charges,6.4,80,,5.12,percent of total billed charges,80% of total billed charges,7.2,90,,5.76,percent of total billed charges,90% of total billed charges,6,75,,4.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.32,29,,1.856,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,5.36,67,,4.288,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,6.4,80,,5.12,percent of total billed charges,80% of total billed charges,5.2,65,,4.16,percent of total billed charges,65% of total billed charges,2.85,35.67,,2.28,percent of total billed charges,35.67% of total billed charges,2.32,7.2,
STERILE WATER 10 ML PF VIAL,2509701,CDM,250,RC,,,outpatient,,,17,6.80,,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,13.09,77,,10.47,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,13.94,82,,11.152,percent of total billed charges,82% of total billed charges,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,15.3,90,,12.24,percent of total billed charges,90% of total billed charges,13.6,80,,10.88,percent of total billed charges,80% of total billed charges,15.3,90,,12.24,percent of total billed charges,90% of total billed charges,12.75,75,,10.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,4.93,29,,3.944,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,11.39,67,,9.112,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,13.6,80,,10.88,percent of total billed charges,80% of total billed charges,11.05,65,,8.84,percent of total billed charges,65% of total billed charges,6.06,35.67,,4.848,percent of total billed charges,35.67% of total billed charges,4.93,15.3,
STERILE WATER 50ML VIAL,2509702,CDM,250,RC,,,outpatient,,,17,6.80,,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,13.09,77,,10.47,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,13.94,82,,11.152,percent of total billed charges,82% of total billed charges,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,15.3,90,,12.24,percent of total billed charges,90% of total billed charges,13.6,80,,10.88,percent of total billed charges,80% of total billed charges,15.3,90,,12.24,percent of total billed charges,90% of total billed charges,12.75,75,,10.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,4.93,29,,3.944,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,11.39,67,,9.112,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,13.6,80,,10.88,percent of total billed charges,80% of total billed charges,11.05,65,,8.84,percent of total billed charges,65% of total billed charges,6.06,35.67,,4.848,percent of total billed charges,35.67% of total billed charges,4.93,15.3,
STROMECTOL 3 MG PO,2509741,CDM,250,RC,,,outpatient,,,23,9.20,,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,17.71,77,,14.17,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,18.86,82,,15.088,percent of total billed charges,82% of total billed charges,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,20.7,90,,16.56,percent of total billed charges,90% of total billed charges,18.4,80,,14.72,percent of total billed charges,80% of total billed charges,20.7,90,,16.56,percent of total billed charges,90% of total billed charges,17.25,75,,13.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,6.67,29,,5.336,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,15.41,67,,12.328,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,18.4,80,,14.72,percent of total billed charges,80% of total billed charges,14.95,65,,11.96,percent of total billed charges,65% of total billed charges,8.2,35.67,,6.56,percent of total billed charges,35.67% of total billed charges,6.67,20.7,
SUPREP BOWEL PREP,2509776,CDM,250,RC,,,outpatient,,,330,132.00,,280.5,85,,224.4,percent of total billed charges,85% of total billed charges,254.1,77,,203.28,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,270.6,82,,216.48,percent of total billed charges,82% of total billed charges,280.5,85,,224.4,percent of total billed charges,85% of total billed charges,280.5,85,,224.4,percent of total billed charges,85% of total billed charges,280.5,85,,224.4,percent of total billed charges,85% of total billed charges,297,90,,237.6,percent of total billed charges,90% of total billed charges,264,80,,211.2,percent of total billed charges,80% of total billed charges,297,90,,237.6,percent of total billed charges,90% of total billed charges,247.5,75,,198,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,95.7,29,,76.56,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,221.1,67,,176.88,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,264,80,,211.2,percent of total billed charges,80% of total billed charges,214.5,65,,171.6,percent of total billed charges,65% of total billed charges,117.71,35.67,,94.168,percent of total billed charges,35.67% of total billed charges,95.7,297,
SUPRANE PER EACH 15 MINUETS,2509797,CDM,250,RC,,,outpatient,,,32,12.80,,27.2,85,,21.76,percent of total billed charges,85% of total billed charges,24.64,77,,19.71,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,26.24,82,,20.992,percent of total billed charges,82% of total billed charges,27.2,85,,21.76,percent of total billed charges,85% of total billed charges,27.2,85,,21.76,percent of total billed charges,85% of total billed charges,27.2,85,,21.76,percent of total billed charges,85% of total billed charges,28.8,90,,23.04,percent of total billed charges,90% of total billed charges,25.6,80,,20.48,percent of total billed charges,80% of total billed charges,28.8,90,,23.04,percent of total billed charges,90% of total billed charges,24,75,,19.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,9.28,29,,7.424,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,21.44,67,,17.152,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,25.6,80,,20.48,percent of total billed charges,80% of total billed charges,20.8,65,,16.64,percent of total billed charges,65% of total billed charges,11.41,35.67,,9.128,percent of total billed charges,35.67% of total billed charges,9.28,28.8,
SUFENTANIL 50MCG/ML,2509814,CDM,250,RC,,,outpatient,,,56,22.40,,47.6,85,,38.08,percent of total billed charges,85% of total billed charges,43.12,77,,34.5,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,45.92,82,,36.736,percent of total billed charges,82% of total billed charges,47.6,85,,38.08,percent of total billed charges,85% of total billed charges,47.6,85,,38.08,percent of total billed charges,85% of total billed charges,47.6,85,,38.08,percent of total billed charges,85% of total billed charges,50.4,90,,40.32,percent of total billed charges,90% of total billed charges,44.8,80,,35.84,percent of total billed charges,80% of total billed charges,50.4,90,,40.32,percent of total billed charges,90% of total billed charges,42,75,,33.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,16.24,29,,12.992,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,37.52,67,,30.016,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,44.8,80,,35.84,percent of total billed charges,80% of total billed charges,36.4,65,,29.12,percent of total billed charges,65% of total billed charges,19.98,35.67,,15.984,percent of total billed charges,35.67% of total billed charges,16.24,50.4,
SUTAB SULF/POT/MAG/SULF 1.479,2509816,CDM,250,RC,,,outpatient,,,41,16.40,,34.85,85,,27.88,percent of total billed charges,85% of total billed charges,31.57,77,,25.26,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,33.62,82,,26.896,percent of total billed charges,82% of total billed charges,34.85,85,,27.88,percent of total billed charges,85% of total billed charges,34.85,85,,27.88,percent of total billed charges,85% of total billed charges,34.85,85,,27.88,percent of total billed charges,85% of total billed charges,36.9,90,,29.52,percent of total billed charges,90% of total billed charges,32.8,80,,26.24,percent of total billed charges,80% of total billed charges,36.9,90,,29.52,percent of total billed charges,90% of total billed charges,30.75,75,,24.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,11.89,29,,9.512,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,27.47,67,,21.976,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,32.8,80,,26.24,percent of total billed charges,80% of total billed charges,26.65,65,,21.32,percent of total billed charges,65% of total billed charges,14.62,35.67,,11.696,percent of total billed charges,35.67% of total billed charges,11.89,36.9,
SYMMETREL 100MG CAP,2509835,CDM,250,RC,,,outpatient,,,12,4.80,,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,9.24,77,,7.39,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,9.84,82,,7.872,percent of total billed charges,82% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,10.8,90,,8.64,percent of total billed charges,90% of total billed charges,9.6,80,,7.68,percent of total billed charges,80% of total billed charges,10.8,90,,8.64,percent of total billed charges,90% of total billed charges,9,75,,7.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,3.48,29,,2.784,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,8.04,67,,6.432,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,9.6,80,,7.68,percent of total billed charges,80% of total billed charges,7.8,65,,6.24,percent of total billed charges,65% of total billed charges,4.28,35.67,,3.424,percent of total billed charges,35.67% of total billed charges,3.48,10.8,
SYSTANE EYE DROP 5 ML,2509849,CDM,250,RC,,,outpatient,,,34,13.60,,28.9,85,,23.12,percent of total billed charges,85% of total billed charges,26.18,77,,20.94,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,27.88,82,,22.304,percent of total billed charges,82% of total billed charges,28.9,85,,23.12,percent of total billed charges,85% of total billed charges,28.9,85,,23.12,percent of total billed charges,85% of total billed charges,28.9,85,,23.12,percent of total billed charges,85% of total billed charges,30.6,90,,24.48,percent of total billed charges,90% of total billed charges,27.2,80,,21.76,percent of total billed charges,80% of total billed charges,30.6,90,,24.48,percent of total billed charges,90% of total billed charges,25.5,75,,20.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,9.86,29,,7.888,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,22.78,67,,18.224,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,27.2,80,,21.76,percent of total billed charges,80% of total billed charges,22.1,65,,17.68,percent of total billed charges,65% of total billed charges,12.13,35.67,,9.704,percent of total billed charges,35.67% of total billed charges,9.86,30.6,
SYNTHROID 0.05 MG TAB,2509855,CDM,250,RC,,,outpatient,,,7,2.80,,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.39,77,,4.31,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,5.74,82,,4.592,percent of total billed charges,82% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.25,75,,4.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.03,29,,1.624,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4.69,67,,3.752,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,4.55,65,,3.64,percent of total billed charges,65% of total billed charges,2.5,35.67,,2,percent of total billed charges,35.67% of total billed charges,2.03,6.3,
SYNTHROID 0.075 MG TAB,2509860,CDM,250,RC,,,outpatient,,,7,2.80,,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.39,77,,4.31,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,5.74,82,,4.592,percent of total billed charges,82% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.25,75,,4.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.03,29,,1.624,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4.69,67,,3.752,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,4.55,65,,3.64,percent of total billed charges,65% of total billed charges,2.5,35.67,,2,percent of total billed charges,35.67% of total billed charges,2.03,6.3,
SYNTHROID 0.112 MG TAB,2509861,CDM,250,RC,,,outpatient,,,7,2.80,,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.39,77,,4.31,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,5.74,82,,4.592,percent of total billed charges,82% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.25,75,,4.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.03,29,,1.624,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4.69,67,,3.752,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,4.55,65,,3.64,percent of total billed charges,65% of total billed charges,2.5,35.67,,2,percent of total billed charges,35.67% of total billed charges,2.03,6.3,
SYNTHROID 0.125 MG TAB,2509865,CDM,250,RC,,,outpatient,,,7,2.80,,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.39,77,,4.31,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,5.74,82,,4.592,percent of total billed charges,82% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.25,75,,4.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.03,29,,1.624,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4.69,67,,3.752,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,4.55,65,,3.64,percent of total billed charges,65% of total billed charges,2.5,35.67,,2,percent of total billed charges,35.67% of total billed charges,2.03,6.3,
SYNTHROID 0.175 MG TAB,2509866,CDM,250,RC,,,outpatient,,,7,2.80,,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.39,77,,4.31,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,5.74,82,,4.592,percent of total billed charges,82% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.25,75,,4.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.03,29,,1.624,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4.69,67,,3.752,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,4.55,65,,3.64,percent of total billed charges,65% of total billed charges,2.5,35.67,,2,percent of total billed charges,35.67% of total billed charges,2.03,6.3,
SYNTHROID 0.15 MG TAB,2509870,CDM,250,RC,,,outpatient,,,8,3.20,,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,6.16,77,,4.93,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,6.56,82,,5.248,percent of total billed charges,82% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,7.2,90,,5.76,percent of total billed charges,90% of total billed charges,6.4,80,,5.12,percent of total billed charges,80% of total billed charges,7.2,90,,5.76,percent of total billed charges,90% of total billed charges,6,75,,4.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.32,29,,1.856,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,5.36,67,,4.288,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,6.4,80,,5.12,percent of total billed charges,80% of total billed charges,5.2,65,,4.16,percent of total billed charges,65% of total billed charges,2.85,35.67,,2.28,percent of total billed charges,35.67% of total billed charges,2.32,7.2,
SYNTHROID 0.088 MG PO,2509881,CDM,250,RC,,,outpatient,,,7,2.80,,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.39,77,,4.31,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,5.74,82,,4.592,percent of total billed charges,82% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.25,75,,4.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.03,29,,1.624,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4.69,67,,3.752,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,4.55,65,,3.64,percent of total billed charges,65% of total billed charges,2.5,35.67,,2,percent of total billed charges,35.67% of total billed charges,2.03,6.3,
BOUDREAUX'S BUTT PASTE,2509888,CDM,250,RC,,,outpatient,,,13,5.20,,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,10.01,77,,8.01,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,10.66,82,,8.528,percent of total billed charges,82% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,11.7,90,,9.36,percent of total billed charges,90% of total billed charges,10.4,80,,8.32,percent of total billed charges,80% of total billed charges,11.7,90,,9.36,percent of total billed charges,90% of total billed charges,9.75,75,,7.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,3.77,29,,3.016,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,8.71,67,,6.968,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,10.4,80,,8.32,percent of total billed charges,80% of total billed charges,8.45,65,,6.76,percent of total billed charges,65% of total billed charges,4.64,35.67,,3.712,percent of total billed charges,35.67% of total billed charges,3.77,11.7,
TAMBOCAR 50 MG TAB,2509950,CDM,250,RC,,,outpatient,,,17,6.80,,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,13.09,77,,10.47,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,13.94,82,,11.152,percent of total billed charges,82% of total billed charges,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,15.3,90,,12.24,percent of total billed charges,90% of total billed charges,13.6,80,,10.88,percent of total billed charges,80% of total billed charges,15.3,90,,12.24,percent of total billed charges,90% of total billed charges,12.75,75,,10.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,4.93,29,,3.944,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,11.39,67,,9.112,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,13.6,80,,10.88,percent of total billed charges,80% of total billed charges,11.05,65,,8.84,percent of total billed charges,65% of total billed charges,6.06,35.67,,4.848,percent of total billed charges,35.67% of total billed charges,4.93,15.3,
TAMIFLU 75 MG PO,2509958,CDM,250,RC,,,outpatient,,,60,24.00,,51,85,,40.8,percent of total billed charges,85% of total billed charges,46.2,77,,36.96,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,49.2,82,,39.36,percent of total billed charges,82% of total billed charges,51,85,,40.8,percent of total billed charges,85% of total billed charges,51,85,,40.8,percent of total billed charges,85% of total billed charges,51,85,,40.8,percent of total billed charges,85% of total billed charges,54,90,,43.2,percent of total billed charges,90% of total billed charges,48,80,,38.4,percent of total billed charges,80% of total billed charges,54,90,,43.2,percent of total billed charges,90% of total billed charges,45,75,,36,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,17.4,29,,13.92,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,40.2,67,,32.16,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,48,80,,38.4,percent of total billed charges,80% of total billed charges,39,65,,31.2,percent of total billed charges,65% of total billed charges,21.4,35.67,,17.12,percent of total billed charges,35.67% of total billed charges,17.4,54,
TAPAZOLE 5 MG TAB,2509971,CDM,250,RC,,,outpatient,,,8,3.20,,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,6.16,77,,4.93,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,6.56,82,,5.248,percent of total billed charges,82% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,7.2,90,,5.76,percent of total billed charges,90% of total billed charges,6.4,80,,5.12,percent of total billed charges,80% of total billed charges,7.2,90,,5.76,percent of total billed charges,90% of total billed charges,6,75,,4.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.32,29,,1.856,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,5.36,67,,4.288,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,6.4,80,,5.12,percent of total billed charges,80% of total billed charges,5.2,65,,4.16,percent of total billed charges,65% of total billed charges,2.85,35.67,,2.28,percent of total billed charges,35.67% of total billed charges,2.32,7.2,
XYlOCAINE 1% EPI,2509996,CDM,250,RC,,,outpatient,,,39,15.60,,33.15,85,,26.52,percent of total billed charges,85% of total billed charges,30.03,77,,24.02,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,31.98,82,,25.584,percent of total billed charges,82% of total billed charges,33.15,85,,26.52,percent of total billed charges,85% of total billed charges,33.15,85,,26.52,percent of total billed charges,85% of total billed charges,33.15,85,,26.52,percent of total billed charges,85% of total billed charges,35.1,90,,28.08,percent of total billed charges,90% of total billed charges,31.2,80,,24.96,percent of total billed charges,80% of total billed charges,35.1,90,,28.08,percent of total billed charges,90% of total billed charges,29.25,75,,23.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,11.31,29,,9.048,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,26.13,67,,20.904,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,31.2,80,,24.96,percent of total billed charges,80% of total billed charges,25.35,65,,20.28,percent of total billed charges,65% of total billed charges,13.91,35.67,,11.128,percent of total billed charges,35.67% of total billed charges,11.31,35.1,
TRANEXAMIC ACID 1000MG/10 ML,2509997,CDM,250,RC,,,outpatient,,,64,25.60,,54.4,85,,43.52,percent of total billed charges,85% of total billed charges,49.28,77,,39.42,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,52.48,82,,41.984,percent of total billed charges,82% of total billed charges,54.4,85,,43.52,percent of total billed charges,85% of total billed charges,54.4,85,,43.52,percent of total billed charges,85% of total billed charges,54.4,85,,43.52,percent of total billed charges,85% of total billed charges,57.6,90,,46.08,percent of total billed charges,90% of total billed charges,51.2,80,,40.96,percent of total billed charges,80% of total billed charges,57.6,90,,46.08,percent of total billed charges,90% of total billed charges,48,75,,38.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,18.56,29,,14.848,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,42.88,67,,34.304,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,51.2,80,,40.96,percent of total billed charges,80% of total billed charges,41.6,65,,33.28,percent of total billed charges,65% of total billed charges,22.83,35.67,,18.264,percent of total billed charges,35.67% of total billed charges,18.56,57.6,
CHLORHEXIDINE GLUCONATE 0.12%,2510004,CDM,250,RC,,,outpatient,,,8,3.20,,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,6.16,77,,4.93,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,6.56,82,,5.248,percent of total billed charges,82% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,7.2,90,,5.76,percent of total billed charges,90% of total billed charges,6.4,80,,5.12,percent of total billed charges,80% of total billed charges,7.2,90,,5.76,percent of total billed charges,90% of total billed charges,6,75,,4.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.32,29,,1.856,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,5.36,67,,4.288,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,6.4,80,,5.12,percent of total billed charges,80% of total billed charges,5.2,65,,4.16,percent of total billed charges,65% of total billed charges,2.85,35.67,,2.28,percent of total billed charges,35.67% of total billed charges,2.32,7.2,
FERROUS GLUC TAB 5 GR,2510007,CDM,250,RC,,,outpatient,,,7,2.80,,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.39,77,,4.31,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,5.74,82,,4.592,percent of total billed charges,82% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.25,75,,4.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.03,29,,1.624,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4.69,67,,3.752,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,4.55,65,,3.64,percent of total billed charges,65% of total billed charges,2.5,35.67,,2,percent of total billed charges,35.67% of total billed charges,2.03,6.3,
TETRACAINE HCL 15 ML OPTH,2510008,CDM,250,RC,,,outpatient,,,42,16.80,,35.7,85,,28.56,percent of total billed charges,85% of total billed charges,32.34,77,,25.87,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,34.44,82,,27.552,percent of total billed charges,82% of total billed charges,35.7,85,,28.56,percent of total billed charges,85% of total billed charges,35.7,85,,28.56,percent of total billed charges,85% of total billed charges,35.7,85,,28.56,percent of total billed charges,85% of total billed charges,37.8,90,,30.24,percent of total billed charges,90% of total billed charges,33.6,80,,26.88,percent of total billed charges,80% of total billed charges,37.8,90,,30.24,percent of total billed charges,90% of total billed charges,31.5,75,,25.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,12.18,29,,9.744,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,28.14,67,,22.512,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,33.6,80,,26.88,percent of total billed charges,80% of total billed charges,27.3,65,,21.84,percent of total billed charges,65% of total billed charges,14.98,35.67,,11.984,percent of total billed charges,35.67% of total billed charges,12.18,37.8,
TEKTURNA 150 MG TABLET,2510013,CDM,250,RC,,,outpatient,,,22,8.80,,18.7,85,,14.96,percent of total billed charges,85% of total billed charges,16.94,77,,13.55,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,18.04,82,,14.432,percent of total billed charges,82% of total billed charges,18.7,85,,14.96,percent of total billed charges,85% of total billed charges,18.7,85,,14.96,percent of total billed charges,85% of total billed charges,18.7,85,,14.96,percent of total billed charges,85% of total billed charges,19.8,90,,15.84,percent of total billed charges,90% of total billed charges,17.6,80,,14.08,percent of total billed charges,80% of total billed charges,19.8,90,,15.84,percent of total billed charges,90% of total billed charges,16.5,75,,13.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,6.38,29,,5.104,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,14.74,67,,11.792,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,17.6,80,,14.08,percent of total billed charges,80% of total billed charges,14.3,65,,11.44,percent of total billed charges,65% of total billed charges,7.85,35.67,,6.28,percent of total billed charges,35.67% of total billed charges,6.38,19.8,
MORPHINE SULFATE/ROXANOL 20 MG,2510021,CDM,250,RC,,,outpatient,,,13,5.20,,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,10.01,77,,8.01,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,10.66,82,,8.528,percent of total billed charges,82% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,11.7,90,,9.36,percent of total billed charges,90% of total billed charges,10.4,80,,8.32,percent of total billed charges,80% of total billed charges,11.7,90,,9.36,percent of total billed charges,90% of total billed charges,9.75,75,,7.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,3.77,29,,3.016,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,8.71,67,,6.968,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,10.4,80,,8.32,percent of total billed charges,80% of total billed charges,8.45,65,,6.76,percent of total billed charges,65% of total billed charges,4.64,35.67,,3.712,percent of total billed charges,35.67% of total billed charges,3.77,11.7,
ENTRESTO 24 MG PO,2510022,CDM,250,RC,,,outpatient,,,31,12.40,,26.35,85,,21.08,percent of total billed charges,85% of total billed charges,23.87,77,,19.1,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,25.42,82,,20.336,percent of total billed charges,82% of total billed charges,26.35,85,,21.08,percent of total billed charges,85% of total billed charges,26.35,85,,21.08,percent of total billed charges,85% of total billed charges,26.35,85,,21.08,percent of total billed charges,85% of total billed charges,27.9,90,,22.32,percent of total billed charges,90% of total billed charges,24.8,80,,19.84,percent of total billed charges,80% of total billed charges,27.9,90,,22.32,percent of total billed charges,90% of total billed charges,23.25,75,,18.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,8.99,29,,7.192,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,20.77,67,,16.616,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,24.8,80,,19.84,percent of total billed charges,80% of total billed charges,20.15,65,,16.12,percent of total billed charges,65% of total billed charges,11.06,35.67,,8.848,percent of total billed charges,35.67% of total billed charges,8.99,27.9,
DESMOPRESSIN ACETATE 0.1 MG PO,2510024,CDM,250,RC,,,outpatient,,,13,5.20,,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,10.01,77,,8.01,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,10.66,82,,8.528,percent of total billed charges,82% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,11.7,90,,9.36,percent of total billed charges,90% of total billed charges,10.4,80,,8.32,percent of total billed charges,80% of total billed charges,11.7,90,,9.36,percent of total billed charges,90% of total billed charges,9.75,75,,7.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,3.77,29,,3.016,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,8.71,67,,6.968,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,10.4,80,,8.32,percent of total billed charges,80% of total billed charges,8.45,65,,6.76,percent of total billed charges,65% of total billed charges,4.64,35.67,,3.712,percent of total billed charges,35.67% of total billed charges,3.77,11.7,
INSULIN REGULAR .9%,2510041,CDM,250,RC,J3590,HCPCS,outpatient,,,99,39.60,,84.15,85,,67.32,percent of total billed charges,85% of total billed charges,76.23,77,,60.98,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,81.18,82,,64.944,percent of total billed charges,82% of total billed charges,84.15,85,,67.32,percent of total billed charges,85% of total billed charges,84.15,85,,67.32,percent of total billed charges,85% of total billed charges,84.15,85,,67.32,percent of total billed charges,85% of total billed charges,89.1,90,,71.28,percent of total billed charges,90% of total billed charges,79.2,80,,63.36,percent of total billed charges,80% of total billed charges,89.1,90,,71.28,percent of total billed charges,90% of total billed charges,74.25,75,,59.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,28.71,29,,22.968,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,66.33,67,,53.064,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,79.2,80,,63.36,percent of total billed charges,80% of total billed charges,64.35,65,,51.48,percent of total billed charges,65% of total billed charges,35.31,35.67,,28.248,percent of total billed charges,35.67% of total billed charges,28.71,89.1,
INSULIN REGULAR .9% NACL 100UN,2510042,CDM,250,RC,J3590,HCPCS,outpatient,,,289,115.60,,245.65,85,,196.52,percent of total billed charges,85% of total billed charges,222.53,77,,178.02,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,236.98,82,,189.584,percent of total billed charges,82% of total billed charges,245.65,85,,196.52,percent of total billed charges,85% of total billed charges,245.65,85,,196.52,percent of total billed charges,85% of total billed charges,245.65,85,,196.52,percent of total billed charges,85% of total billed charges,260.1,90,,208.08,percent of total billed charges,90% of total billed charges,231.2,80,,184.96,percent of total billed charges,80% of total billed charges,260.1,90,,208.08,percent of total billed charges,90% of total billed charges,216.75,75,,173.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,83.81,29,,67.048,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,193.63,67,,154.904,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,231.2,80,,184.96,percent of total billed charges,80% of total billed charges,187.85,65,,150.28,percent of total billed charges,65% of total billed charges,103.09,35.67,,82.472,percent of total billed charges,35.67% of total billed charges,83.81,260.1,
TENORETIC 50MG TAB,2510055,CDM,250,RC,,,outpatient,,,11,4.40,,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,8.47,77,,6.78,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,9.02,82,,7.216,percent of total billed charges,82% of total billed charges,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,9.9,90,,7.92,percent of total billed charges,90% of total billed charges,8.8,80,,7.04,percent of total billed charges,80% of total billed charges,9.9,90,,7.92,percent of total billed charges,90% of total billed charges,8.25,75,,6.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,3.19,29,,2.552,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,7.37,67,,5.896,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,8.8,80,,7.04,percent of total billed charges,80% of total billed charges,7.15,65,,5.72,percent of total billed charges,65% of total billed charges,3.92,35.67,,3.136,percent of total billed charges,35.67% of total billed charges,3.19,9.9,
TENORMIN 25 MG PO,2510065,CDM,250,RC,,,outpatient,,,10,4.00,,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,7.7,77,,6.16,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,8.2,82,,6.56,percent of total billed charges,82% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,9,90,,7.2,percent of total billed charges,90% of total billed charges,8,80,,6.4,percent of total billed charges,80% of total billed charges,9,90,,7.2,percent of total billed charges,90% of total billed charges,7.5,75,,6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.9,29,,2.32,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,6.7,67,,5.36,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,8,80,,6.4,percent of total billed charges,80% of total billed charges,6.5,65,,5.2,percent of total billed charges,65% of total billed charges,3.57,35.67,,2.856,percent of total billed charges,35.67% of total billed charges,2.9,9,
MIDODRINE HYDROCHLORIDE TAB 10,2510071,CDM,250,RC,,,outpatient,,,8,3.20,,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,6.16,77,,4.93,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,6.56,82,,5.248,percent of total billed charges,82% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,7.2,90,,5.76,percent of total billed charges,90% of total billed charges,6.4,80,,5.12,percent of total billed charges,80% of total billed charges,7.2,90,,5.76,percent of total billed charges,90% of total billed charges,6,75,,4.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.32,29,,1.856,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,5.36,67,,4.288,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,6.4,80,,5.12,percent of total billed charges,80% of total billed charges,5.2,65,,4.16,percent of total billed charges,65% of total billed charges,2.85,35.67,,2.28,percent of total billed charges,35.67% of total billed charges,2.32,7.2,
DIFICID 200 MG PO,2510092,CDM,250,RC,,,outpatient,,,373,149.20,,317.05,85,,253.64,percent of total billed charges,85% of total billed charges,287.21,77,,229.77,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,305.86,82,,244.688,percent of total billed charges,82% of total billed charges,317.05,85,,253.64,percent of total billed charges,85% of total billed charges,317.05,85,,253.64,percent of total billed charges,85% of total billed charges,317.05,85,,253.64,percent of total billed charges,85% of total billed charges,335.7,90,,268.56,percent of total billed charges,90% of total billed charges,298.4,80,,238.72,percent of total billed charges,80% of total billed charges,335.7,90,,268.56,percent of total billed charges,90% of total billed charges,279.75,75,,223.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,108.17,29,,86.536,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,249.91,67,,199.928,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,298.4,80,,238.72,percent of total billed charges,80% of total billed charges,242.45,65,,193.96,percent of total billed charges,65% of total billed charges,133.05,35.67,,106.44,percent of total billed charges,35.67% of total billed charges,108.17,335.7,
DILANTIN/PHENYTOIN 100 MG/2ML,2510093,CDM,250,RC,,,outpatient,,,61,24.40,,51.85,85,,41.48,percent of total billed charges,85% of total billed charges,46.97,77,,37.58,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,50.02,82,,40.016,percent of total billed charges,82% of total billed charges,51.85,85,,41.48,percent of total billed charges,85% of total billed charges,51.85,85,,41.48,percent of total billed charges,85% of total billed charges,51.85,85,,41.48,percent of total billed charges,85% of total billed charges,54.9,90,,43.92,percent of total billed charges,90% of total billed charges,48.8,80,,39.04,percent of total billed charges,80% of total billed charges,54.9,90,,43.92,percent of total billed charges,90% of total billed charges,45.75,75,,36.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,17.69,29,,14.152,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,40.87,67,,32.696,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,48.8,80,,39.04,percent of total billed charges,80% of total billed charges,39.65,65,,31.72,percent of total billed charges,65% of total billed charges,21.76,35.67,,17.408,percent of total billed charges,35.67% of total billed charges,17.69,54.9,
PRED-FORTE 1% 1 ML,2510098,CDM,250,RC,,,outpatient,,,68,27.20,,57.8,85,,46.24,percent of total billed charges,85% of total billed charges,52.36,77,,41.89,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,55.76,82,,44.608,percent of total billed charges,82% of total billed charges,57.8,85,,46.24,percent of total billed charges,85% of total billed charges,57.8,85,,46.24,percent of total billed charges,85% of total billed charges,57.8,85,,46.24,percent of total billed charges,85% of total billed charges,61.2,90,,48.96,percent of total billed charges,90% of total billed charges,54.4,80,,43.52,percent of total billed charges,80% of total billed charges,61.2,90,,48.96,percent of total billed charges,90% of total billed charges,51,75,,40.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,19.72,29,,15.776,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,45.56,67,,36.448,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,54.4,80,,43.52,percent of total billed charges,80% of total billed charges,44.2,65,,35.36,percent of total billed charges,65% of total billed charges,24.26,35.67,,19.408,percent of total billed charges,35.67% of total billed charges,19.72,61.2,
ENTEREG 12 MG PO,2510099,CDM,250,RC,,,outpatient,,,444,177.60,,377.4,85,,301.92,percent of total billed charges,85% of total billed charges,341.88,77,,273.5,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,364.08,82,,291.264,percent of total billed charges,82% of total billed charges,377.4,85,,301.92,percent of total billed charges,85% of total billed charges,377.4,85,,301.92,percent of total billed charges,85% of total billed charges,377.4,85,,301.92,percent of total billed charges,85% of total billed charges,399.6,90,,319.68,percent of total billed charges,90% of total billed charges,355.2,80,,284.16,percent of total billed charges,80% of total billed charges,399.6,90,,319.68,percent of total billed charges,90% of total billed charges,333,75,,266.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,128.76,29,,103.008,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,297.48,67,,237.984,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,355.2,80,,284.16,percent of total billed charges,80% of total billed charges,288.6,65,,230.88,percent of total billed charges,65% of total billed charges,158.37,35.67,,126.696,percent of total billed charges,35.67% of total billed charges,128.76,399.6,
TETRACAINE - PONTACAINE GTTS,2510101,CDM,250,RC,,,outpatient,,,42,16.80,,35.7,85,,28.56,percent of total billed charges,85% of total billed charges,32.34,77,,25.87,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,34.44,82,,27.552,percent of total billed charges,82% of total billed charges,35.7,85,,28.56,percent of total billed charges,85% of total billed charges,35.7,85,,28.56,percent of total billed charges,85% of total billed charges,35.7,85,,28.56,percent of total billed charges,85% of total billed charges,37.8,90,,30.24,percent of total billed charges,90% of total billed charges,33.6,80,,26.88,percent of total billed charges,80% of total billed charges,37.8,90,,30.24,percent of total billed charges,90% of total billed charges,31.5,75,,25.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,12.18,29,,9.744,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,28.14,67,,22.512,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,33.6,80,,26.88,percent of total billed charges,80% of total billed charges,27.3,65,,21.84,percent of total billed charges,65% of total billed charges,14.98,35.67,,11.984,percent of total billed charges,35.67% of total billed charges,12.18,37.8,
TESSALON PERLES 100MG CAP,2510105,CDM,250,RC,,,outpatient,,,7,2.80,,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.39,77,,4.31,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,5.74,82,,4.592,percent of total billed charges,82% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.25,75,,4.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.03,29,,1.624,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4.69,67,,3.752,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,4.55,65,,3.64,percent of total billed charges,65% of total billed charges,2.5,35.67,,2,percent of total billed charges,35.67% of total billed charges,2.03,6.3,
NICARDIPINE HCL,2510106,CDM,250,RC,,,outpatient,,,89,35.60,,75.65,85,,60.52,percent of total billed charges,85% of total billed charges,68.53,77,,54.82,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,72.98,82,,58.384,percent of total billed charges,82% of total billed charges,75.65,85,,60.52,percent of total billed charges,85% of total billed charges,75.65,85,,60.52,percent of total billed charges,85% of total billed charges,75.65,85,,60.52,percent of total billed charges,85% of total billed charges,80.1,90,,64.08,percent of total billed charges,90% of total billed charges,71.2,80,,56.96,percent of total billed charges,80% of total billed charges,80.1,90,,64.08,percent of total billed charges,90% of total billed charges,66.75,75,,53.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,25.81,29,,20.648,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,59.63,67,,47.704,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,71.2,80,,56.96,percent of total billed charges,80% of total billed charges,57.85,65,,46.28,percent of total billed charges,65% of total billed charges,31.75,35.67,,25.4,percent of total billed charges,35.67% of total billed charges,25.81,80.1,
BRIDION 200 MG/2 ML,2510107,CDM,250,RC,,,outpatient,,,338,135.20,,287.3,85,,229.84,percent of total billed charges,85% of total billed charges,260.26,77,,208.21,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,277.16,82,,221.728,percent of total billed charges,82% of total billed charges,287.3,85,,229.84,percent of total billed charges,85% of total billed charges,287.3,85,,229.84,percent of total billed charges,85% of total billed charges,287.3,85,,229.84,percent of total billed charges,85% of total billed charges,304.2,90,,243.36,percent of total billed charges,90% of total billed charges,270.4,80,,216.32,percent of total billed charges,80% of total billed charges,304.2,90,,243.36,percent of total billed charges,90% of total billed charges,253.5,75,,202.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,98.02,29,,78.416,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,226.46,67,,181.168,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,270.4,80,,216.32,percent of total billed charges,80% of total billed charges,219.7,65,,175.76,percent of total billed charges,65% of total billed charges,120.56,35.67,,96.448,percent of total billed charges,35.67% of total billed charges,98.02,304.2,
METOPROLOL CUCCINATE 100 MG PO,2510111,CDM,250,RC,,,outpatient,,,8,3.20,,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,6.16,77,,4.93,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,6.56,82,,5.248,percent of total billed charges,82% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,7.2,90,,5.76,percent of total billed charges,90% of total billed charges,6.4,80,,5.12,percent of total billed charges,80% of total billed charges,7.2,90,,5.76,percent of total billed charges,90% of total billed charges,6,75,,4.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.32,29,,1.856,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,5.36,67,,4.288,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,6.4,80,,5.12,percent of total billed charges,80% of total billed charges,5.2,65,,4.16,percent of total billed charges,65% of total billed charges,2.85,35.67,,2.28,percent of total billed charges,35.67% of total billed charges,2.32,7.2,
POTASSIUM 20 MEQ IN 50 ML,2510142,CDM,250,RC,,,outpatient,,,23,9.20,,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,17.71,77,,14.17,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,18.86,82,,15.088,percent of total billed charges,82% of total billed charges,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,20.7,90,,16.56,percent of total billed charges,90% of total billed charges,18.4,80,,14.72,percent of total billed charges,80% of total billed charges,20.7,90,,16.56,percent of total billed charges,90% of total billed charges,17.25,75,,13.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,6.67,29,,5.336,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,15.41,67,,12.328,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,18.4,80,,14.72,percent of total billed charges,80% of total billed charges,14.95,65,,11.96,percent of total billed charges,65% of total billed charges,8.2,35.67,,6.56,percent of total billed charges,35.67% of total billed charges,6.67,20.7,
ABREVA 2 GM TUBE,2510158,CDM,250,RC,,,outpatient,,,85,34.00,,72.25,85,,57.8,percent of total billed charges,85% of total billed charges,65.45,77,,52.36,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,69.7,82,,55.76,percent of total billed charges,82% of total billed charges,72.25,85,,57.8,percent of total billed charges,85% of total billed charges,72.25,85,,57.8,percent of total billed charges,85% of total billed charges,72.25,85,,57.8,percent of total billed charges,85% of total billed charges,76.5,90,,61.2,percent of total billed charges,90% of total billed charges,68,80,,54.4,percent of total billed charges,80% of total billed charges,76.5,90,,61.2,percent of total billed charges,90% of total billed charges,63.75,75,,51,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,24.65,29,,19.72,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,56.95,67,,45.56,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,68,80,,54.4,percent of total billed charges,80% of total billed charges,55.25,65,,44.2,percent of total billed charges,65% of total billed charges,30.32,35.67,,24.256,percent of total billed charges,35.67% of total billed charges,24.65,76.5,
CEFTRIAXONE DEXTROSE INJ 50 ML,2510159,CDM,250,RC,,,outpatient,,,79,31.60,,67.15,85,,53.72,percent of total billed charges,85% of total billed charges,60.83,77,,48.66,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,64.78,82,,51.824,percent of total billed charges,82% of total billed charges,67.15,85,,53.72,percent of total billed charges,85% of total billed charges,67.15,85,,53.72,percent of total billed charges,85% of total billed charges,67.15,85,,53.72,percent of total billed charges,85% of total billed charges,71.1,90,,56.88,percent of total billed charges,90% of total billed charges,63.2,80,,50.56,percent of total billed charges,80% of total billed charges,71.1,90,,56.88,percent of total billed charges,90% of total billed charges,59.25,75,,47.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,22.91,29,,18.328,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,52.93,67,,42.344,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,63.2,80,,50.56,percent of total billed charges,80% of total billed charges,51.35,65,,41.08,percent of total billed charges,65% of total billed charges,28.18,35.67,,22.544,percent of total billed charges,35.67% of total billed charges,22.91,71.1,
CHLORASEPTIC LOZENGES,2510161,CDM,250,RC,,,outpatient,,,5,2.00,,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,3.85,77,,3.08,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,4.1,82,,3.28,percent of total billed charges,82% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,4.5,90,,3.6,percent of total billed charges,90% of total billed charges,4,80,,3.2,percent of total billed charges,80% of total billed charges,4.5,90,,3.6,percent of total billed charges,90% of total billed charges,3.75,75,,3,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,1.45,29,,1.16,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,3.35,67,,2.68,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,4,80,,3.2,percent of total billed charges,80% of total billed charges,3.25,65,,2.6,percent of total billed charges,65% of total billed charges,1.78,35.67,,1.424,percent of total billed charges,35.67% of total billed charges,1.45,4.5,
CEFTRIAXONE SOD 1000 MG BAG,2510162,CDM,250,RC,,,outpatient,,,46,18.40,,39.1,85,,31.28,percent of total billed charges,85% of total billed charges,35.42,77,,28.34,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,37.72,82,,30.176,percent of total billed charges,82% of total billed charges,39.1,85,,31.28,percent of total billed charges,85% of total billed charges,39.1,85,,31.28,percent of total billed charges,85% of total billed charges,39.1,85,,31.28,percent of total billed charges,85% of total billed charges,41.4,90,,33.12,percent of total billed charges,90% of total billed charges,36.8,80,,29.44,percent of total billed charges,80% of total billed charges,41.4,90,,33.12,percent of total billed charges,90% of total billed charges,34.5,75,,27.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,13.34,29,,10.672,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,30.82,67,,24.656,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,36.8,80,,29.44,percent of total billed charges,80% of total billed charges,29.9,65,,23.92,percent of total billed charges,65% of total billed charges,16.41,35.67,,13.128,percent of total billed charges,35.67% of total billed charges,13.34,41.4,
INVOKANA 100 MG PO,2510166,CDM,250,RC,,,outpatient,,,59,23.60,,50.15,85,,40.12,percent of total billed charges,85% of total billed charges,45.43,77,,36.34,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,48.38,82,,38.704,percent of total billed charges,82% of total billed charges,50.15,85,,40.12,percent of total billed charges,85% of total billed charges,50.15,85,,40.12,percent of total billed charges,85% of total billed charges,50.15,85,,40.12,percent of total billed charges,85% of total billed charges,53.1,90,,42.48,percent of total billed charges,90% of total billed charges,47.2,80,,37.76,percent of total billed charges,80% of total billed charges,53.1,90,,42.48,percent of total billed charges,90% of total billed charges,44.25,75,,35.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,17.11,29,,13.688,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,39.53,67,,31.624,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,47.2,80,,37.76,percent of total billed charges,80% of total billed charges,38.35,65,,30.68,percent of total billed charges,65% of total billed charges,21.05,35.67,,16.84,percent of total billed charges,35.67% of total billed charges,17.11,53.1,
NEPHROCAPS,2510174,CDM,250,RC,,,outpatient,,,7,2.80,,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.39,77,,4.31,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,5.74,82,,4.592,percent of total billed charges,82% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.25,75,,4.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.03,29,,1.624,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4.69,67,,3.752,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,4.55,65,,3.64,percent of total billed charges,65% of total billed charges,2.5,35.67,,2,percent of total billed charges,35.67% of total billed charges,2.03,6.3,
THERAGESIC CREAM,2510220,CDM,250,RC,,,outpatient,,,17,6.80,,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,13.09,77,,10.47,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,13.94,82,,11.152,percent of total billed charges,82% of total billed charges,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,15.3,90,,12.24,percent of total billed charges,90% of total billed charges,13.6,80,,10.88,percent of total billed charges,80% of total billed charges,15.3,90,,12.24,percent of total billed charges,90% of total billed charges,12.75,75,,10.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,4.93,29,,3.944,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,11.39,67,,9.112,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,13.6,80,,10.88,percent of total billed charges,80% of total billed charges,11.05,65,,8.84,percent of total billed charges,65% of total billed charges,6.06,35.67,,4.848,percent of total billed charges,35.67% of total billed charges,4.93,15.3,
SODIUM CHLORIDE 20 ML VIAL,2510221,CDM,250,RC,,,outpatient,,,61,24.40,,51.85,85,,41.48,percent of total billed charges,85% of total billed charges,46.97,77,,37.58,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,50.02,82,,40.016,percent of total billed charges,82% of total billed charges,51.85,85,,41.48,percent of total billed charges,85% of total billed charges,51.85,85,,41.48,percent of total billed charges,85% of total billed charges,51.85,85,,41.48,percent of total billed charges,85% of total billed charges,54.9,90,,43.92,percent of total billed charges,90% of total billed charges,48.8,80,,39.04,percent of total billed charges,80% of total billed charges,54.9,90,,43.92,percent of total billed charges,90% of total billed charges,45.75,75,,36.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,17.69,29,,14.152,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,40.87,67,,32.696,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,48.8,80,,39.04,percent of total billed charges,80% of total billed charges,39.65,65,,31.72,percent of total billed charges,65% of total billed charges,21.76,35.67,,17.408,percent of total billed charges,35.67% of total billed charges,17.69,54.9,
THERAGRAN-M 1 TAB PO,2510226,CDM,250,RC,,,outpatient,,,7,2.80,,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.39,77,,4.31,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,5.74,82,,4.592,percent of total billed charges,82% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.25,75,,4.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.03,29,,1.624,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4.69,67,,3.752,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,4.55,65,,3.64,percent of total billed charges,65% of total billed charges,2.5,35.67,,2,percent of total billed charges,35.67% of total billed charges,2.03,6.3,
HYDROXYCHLORAQUINE 200 MG PO,2510233,CDM,250,RC,,,outpatient,,,13,5.20,,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,10.01,77,,8.01,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,10.66,82,,8.528,percent of total billed charges,82% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,11.7,90,,9.36,percent of total billed charges,90% of total billed charges,10.4,80,,8.32,percent of total billed charges,80% of total billed charges,11.7,90,,9.36,percent of total billed charges,90% of total billed charges,9.75,75,,7.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,3.77,29,,3.016,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,8.71,67,,6.968,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,10.4,80,,8.32,percent of total billed charges,80% of total billed charges,8.45,65,,6.76,percent of total billed charges,65% of total billed charges,4.64,35.67,,3.712,percent of total billed charges,35.67% of total billed charges,3.77,11.7,
THERMO SALT TAB,2510235,CDM,250,RC,,,outpatient,,,7,2.80,,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.39,77,,4.31,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,5.74,82,,4.592,percent of total billed charges,82% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.25,75,,4.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.03,29,,1.624,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4.69,67,,3.752,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,4.55,65,,3.64,percent of total billed charges,65% of total billed charges,2.5,35.67,,2,percent of total billed charges,35.67% of total billed charges,2.03,6.3,
THIAMINE 100MG TAB,2510240,CDM,250,RC,,,outpatient,,,7,2.80,,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.39,77,,4.31,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,5.74,82,,4.592,percent of total billed charges,82% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.25,75,,4.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.03,29,,1.624,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4.69,67,,3.752,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,4.55,65,,3.64,percent of total billed charges,65% of total billed charges,2.5,35.67,,2,percent of total billed charges,35.67% of total billed charges,2.03,6.3,
ZINC 50 MG PO,2510251,CDM,250,RC,,,outpatient,,,8,3.20,,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,6.16,77,,4.93,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,6.56,82,,5.248,percent of total billed charges,82% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,7.2,90,,5.76,percent of total billed charges,90% of total billed charges,6.4,80,,5.12,percent of total billed charges,80% of total billed charges,7.2,90,,5.76,percent of total billed charges,90% of total billed charges,6,75,,4.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.32,29,,1.856,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,5.36,67,,4.288,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,6.4,80,,5.12,percent of total billed charges,80% of total billed charges,5.2,65,,4.16,percent of total billed charges,65% of total billed charges,2.85,35.67,,2.28,percent of total billed charges,35.67% of total billed charges,2.32,7.2,
MELATONIN 3 MG PO,2510252,CDM,250,RC,,,outpatient,,,8,3.20,,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,6.16,77,,4.93,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,6.56,82,,5.248,percent of total billed charges,82% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,7.2,90,,5.76,percent of total billed charges,90% of total billed charges,6.4,80,,5.12,percent of total billed charges,80% of total billed charges,7.2,90,,5.76,percent of total billed charges,90% of total billed charges,6,75,,4.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.32,29,,1.856,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,5.36,67,,4.288,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,6.4,80,,5.12,percent of total billed charges,80% of total billed charges,5.2,65,,4.16,percent of total billed charges,65% of total billed charges,2.85,35.67,,2.28,percent of total billed charges,35.67% of total billed charges,2.32,7.2,
THORAZINE 25 MG TAB,2510290,CDM,250,RC,,,outpatient,,,36,14.40,,30.6,85,,24.48,percent of total billed charges,85% of total billed charges,27.72,77,,22.18,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,29.52,82,,23.616,percent of total billed charges,82% of total billed charges,30.6,85,,24.48,percent of total billed charges,85% of total billed charges,30.6,85,,24.48,percent of total billed charges,85% of total billed charges,30.6,85,,24.48,percent of total billed charges,85% of total billed charges,32.4,90,,25.92,percent of total billed charges,90% of total billed charges,28.8,80,,23.04,percent of total billed charges,80% of total billed charges,32.4,90,,25.92,percent of total billed charges,90% of total billed charges,27,75,,21.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,10.44,29,,8.352,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,24.12,67,,19.296,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,28.8,80,,23.04,percent of total billed charges,80% of total billed charges,23.4,65,,18.72,percent of total billed charges,65% of total billed charges,12.84,35.67,,10.272,percent of total billed charges,35.67% of total billed charges,10.44,32.4,
SODIUM CHLORIDE VIAL .9%,2510306,CDM,250,RC,,,outpatient,,,13,5.20,,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,10.01,77,,8.01,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,10.66,82,,8.528,percent of total billed charges,82% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,11.7,90,,9.36,percent of total billed charges,90% of total billed charges,10.4,80,,8.32,percent of total billed charges,80% of total billed charges,11.7,90,,9.36,percent of total billed charges,90% of total billed charges,9.75,75,,7.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,3.77,29,,3.016,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,8.71,67,,6.968,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,10.4,80,,8.32,percent of total billed charges,80% of total billed charges,8.45,65,,6.76,percent of total billed charges,65% of total billed charges,4.64,35.67,,3.712,percent of total billed charges,35.67% of total billed charges,3.77,11.7,
POTASSIUM CHLORIDE 40 MEQ,2510307,CDM,250,RC,,,outpatient,,,18,7.20,,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,13.86,77,,11.09,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,14.76,82,,11.808,percent of total billed charges,82% of total billed charges,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,16.2,90,,12.96,percent of total billed charges,90% of total billed charges,14.4,80,,11.52,percent of total billed charges,80% of total billed charges,16.2,90,,12.96,percent of total billed charges,90% of total billed charges,13.5,75,,10.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,5.22,29,,4.176,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,12.06,67,,9.648,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,14.4,80,,11.52,percent of total billed charges,80% of total billed charges,11.7,65,,9.36,percent of total billed charges,65% of total billed charges,6.42,35.67,,5.136,percent of total billed charges,35.67% of total billed charges,5.22,16.2,
DOSIUM CHLORIDE .9% 25 ML,2510308,CDM,250,RC,,,outpatient,,,13,5.20,,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,10.01,77,,8.01,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,10.66,82,,8.528,percent of total billed charges,82% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,11.7,90,,9.36,percent of total billed charges,90% of total billed charges,10.4,80,,8.32,percent of total billed charges,80% of total billed charges,11.7,90,,9.36,percent of total billed charges,90% of total billed charges,9.75,75,,7.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,3.77,29,,3.016,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,8.71,67,,6.968,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,10.4,80,,8.32,percent of total billed charges,80% of total billed charges,8.45,65,,6.76,percent of total billed charges,65% of total billed charges,4.64,35.67,,3.712,percent of total billed charges,35.67% of total billed charges,3.77,11.7,
THROMBIN 1000 UNITS TOPICAL,2510335,CDM,250,RC,,,outpatient,,,30,12.00,,25.5,85,,20.4,percent of total billed charges,85% of total billed charges,23.1,77,,18.48,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,24.6,82,,19.68,percent of total billed charges,82% of total billed charges,25.5,85,,20.4,percent of total billed charges,85% of total billed charges,25.5,85,,20.4,percent of total billed charges,85% of total billed charges,25.5,85,,20.4,percent of total billed charges,85% of total billed charges,27,90,,21.6,percent of total billed charges,90% of total billed charges,24,80,,19.2,percent of total billed charges,80% of total billed charges,27,90,,21.6,percent of total billed charges,90% of total billed charges,22.5,75,,18,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,8.7,29,,6.96,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,20.1,67,,16.08,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,24,80,,19.2,percent of total billed charges,80% of total billed charges,19.5,65,,15.6,percent of total billed charges,65% of total billed charges,10.7,35.67,,8.56,percent of total billed charges,35.67% of total billed charges,8.7,27,
DILTIAZEM 180 MG PO,2510339,CDM,250,RC,,,outpatient,,,8,3.20,,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,6.16,77,,4.93,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,6.56,82,,5.248,percent of total billed charges,82% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,7.2,90,,5.76,percent of total billed charges,90% of total billed charges,6.4,80,,5.12,percent of total billed charges,80% of total billed charges,7.2,90,,5.76,percent of total billed charges,90% of total billed charges,6,75,,4.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.32,29,,1.856,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,5.36,67,,4.288,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,6.4,80,,5.12,percent of total billed charges,80% of total billed charges,5.2,65,,4.16,percent of total billed charges,65% of total billed charges,2.85,35.67,,2.28,percent of total billed charges,35.67% of total billed charges,2.32,7.2,
"THROMBIN 20,000 UNITS TOPICAL",2510341,CDM,250,RC,,,outpatient,,,923,369.20,,784.55,85,,627.64,percent of total billed charges,85% of total billed charges,710.71,77,,568.57,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,756.86,82,,605.488,percent of total billed charges,82% of total billed charges,784.55,85,,627.64,percent of total billed charges,85% of total billed charges,784.55,85,,627.64,percent of total billed charges,85% of total billed charges,784.55,85,,627.64,percent of total billed charges,85% of total billed charges,830.7,90,,664.56,percent of total billed charges,90% of total billed charges,738.4,80,,590.72,percent of total billed charges,80% of total billed charges,830.7,90,,664.56,percent of total billed charges,90% of total billed charges,692.25,75,,553.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,267.67,29,,214.136,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,618.41,67,,494.728,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,738.4,80,,590.72,percent of total billed charges,80% of total billed charges,599.95,65,,479.96,percent of total billed charges,65% of total billed charges,329.23,35.67,,263.384,percent of total billed charges,35.67% of total billed charges,267.67,830.7,
THROMBIN 5000 UNITS TOPICAL,2510345,CDM,250,RC,,,outpatient,,,291,116.40,,247.35,85,,197.88,percent of total billed charges,85% of total billed charges,224.07,77,,179.26,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,238.62,82,,190.896,percent of total billed charges,82% of total billed charges,247.35,85,,197.88,percent of total billed charges,85% of total billed charges,247.35,85,,197.88,percent of total billed charges,85% of total billed charges,247.35,85,,197.88,percent of total billed charges,85% of total billed charges,261.9,90,,209.52,percent of total billed charges,90% of total billed charges,232.8,80,,186.24,percent of total billed charges,80% of total billed charges,261.9,90,,209.52,percent of total billed charges,90% of total billed charges,218.25,75,,174.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,84.39,29,,67.512,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,194.97,67,,155.976,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,232.8,80,,186.24,percent of total billed charges,80% of total billed charges,189.15,65,,151.32,percent of total billed charges,65% of total billed charges,103.8,35.67,,83.04,percent of total billed charges,35.67% of total billed charges,84.39,261.9,
THYROID 60 MG TAB (1 GRAIN),2510370,CDM,250,RC,,,outpatient,,,7,2.80,,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.39,77,,4.31,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,5.74,82,,4.592,percent of total billed charges,82% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.25,75,,4.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.03,29,,1.624,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4.69,67,,3.752,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,4.55,65,,3.64,percent of total billed charges,65% of total billed charges,2.5,35.67,,2,percent of total billed charges,35.67% of total billed charges,2.03,6.3,
POTASSIUM CHLORIDE 40 MEQ VIAL,2510399,CDM,250,RC,,,outpatient,,,24,9.60,,20.4,85,,16.32,percent of total billed charges,85% of total billed charges,18.48,77,,14.78,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,19.68,82,,15.744,percent of total billed charges,82% of total billed charges,20.4,85,,16.32,percent of total billed charges,85% of total billed charges,20.4,85,,16.32,percent of total billed charges,85% of total billed charges,20.4,85,,16.32,percent of total billed charges,85% of total billed charges,21.6,90,,17.28,percent of total billed charges,90% of total billed charges,19.2,80,,15.36,percent of total billed charges,80% of total billed charges,21.6,90,,17.28,percent of total billed charges,90% of total billed charges,18,75,,14.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,6.96,29,,5.568,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,16.08,67,,12.864,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,19.2,80,,15.36,percent of total billed charges,80% of total billed charges,15.6,65,,12.48,percent of total billed charges,65% of total billed charges,8.56,35.67,,6.848,percent of total billed charges,35.67% of total billed charges,6.96,21.6,
TIMOPTIC OPTH GTTS 0.5%,2510445,CDM,250,RC,,,outpatient,,,64,25.60,,54.4,85,,43.52,percent of total billed charges,85% of total billed charges,49.28,77,,39.42,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,52.48,82,,41.984,percent of total billed charges,82% of total billed charges,54.4,85,,43.52,percent of total billed charges,85% of total billed charges,54.4,85,,43.52,percent of total billed charges,85% of total billed charges,54.4,85,,43.52,percent of total billed charges,85% of total billed charges,57.6,90,,46.08,percent of total billed charges,90% of total billed charges,51.2,80,,40.96,percent of total billed charges,80% of total billed charges,57.6,90,,46.08,percent of total billed charges,90% of total billed charges,48,75,,38.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,18.56,29,,14.848,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,42.88,67,,34.304,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,51.2,80,,40.96,percent of total billed charges,80% of total billed charges,41.6,65,,33.28,percent of total billed charges,65% of total billed charges,22.83,35.67,,18.264,percent of total billed charges,35.67% of total billed charges,18.56,57.6,
TIMOPTIC XE 0.5% 2.5 ML,2510447,CDM,250,RC,,,outpatient,,,685,274.00,,582.25,85,,465.8,percent of total billed charges,85% of total billed charges,527.45,77,,421.96,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,561.7,82,,449.36,percent of total billed charges,82% of total billed charges,582.25,85,,465.8,percent of total billed charges,85% of total billed charges,582.25,85,,465.8,percent of total billed charges,85% of total billed charges,582.25,85,,465.8,percent of total billed charges,85% of total billed charges,616.5,90,,493.2,percent of total billed charges,90% of total billed charges,548,80,,438.4,percent of total billed charges,80% of total billed charges,616.5,90,,493.2,percent of total billed charges,90% of total billed charges,513.75,75,,411,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,198.65,29,,158.92,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,458.95,67,,367.16,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,548,80,,438.4,percent of total billed charges,80% of total billed charges,445.25,65,,356.2,percent of total billed charges,65% of total billed charges,244.34,35.67,,195.472,percent of total billed charges,35.67% of total billed charges,198.65,616.5,
TIMOPTIC-XE 0.25% GEL FORMING,2510448,CDM,250,RC,,,outpatient,,,182,72.80,,154.7,85,,123.76,percent of total billed charges,85% of total billed charges,140.14,77,,112.11,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,149.24,82,,119.392,percent of total billed charges,82% of total billed charges,154.7,85,,123.76,percent of total billed charges,85% of total billed charges,154.7,85,,123.76,percent of total billed charges,85% of total billed charges,154.7,85,,123.76,percent of total billed charges,85% of total billed charges,163.8,90,,131.04,percent of total billed charges,90% of total billed charges,145.6,80,,116.48,percent of total billed charges,80% of total billed charges,163.8,90,,131.04,percent of total billed charges,90% of total billed charges,136.5,75,,109.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,52.78,29,,42.224,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,121.94,67,,97.552,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,145.6,80,,116.48,percent of total billed charges,80% of total billed charges,118.3,65,,94.64,percent of total billed charges,65% of total billed charges,64.92,35.67,,51.936,percent of total billed charges,35.67% of total billed charges,52.78,163.8,
TOBRADEX OPTH.  DROPS,2510470,CDM,250,RC,,,outpatient,,,255,102.00,,216.75,85,,173.4,percent of total billed charges,85% of total billed charges,196.35,77,,157.08,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,209.1,82,,167.28,percent of total billed charges,82% of total billed charges,216.75,85,,173.4,percent of total billed charges,85% of total billed charges,216.75,85,,173.4,percent of total billed charges,85% of total billed charges,216.75,85,,173.4,percent of total billed charges,85% of total billed charges,229.5,90,,183.6,percent of total billed charges,90% of total billed charges,204,80,,163.2,percent of total billed charges,80% of total billed charges,229.5,90,,183.6,percent of total billed charges,90% of total billed charges,191.25,75,,153,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,73.95,29,,59.16,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,170.85,67,,136.68,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,204,80,,163.2,percent of total billed charges,80% of total billed charges,165.75,65,,132.6,percent of total billed charges,65% of total billed charges,90.96,35.67,,72.768,percent of total billed charges,35.67% of total billed charges,73.95,229.5,
TOBRADEX OPTH OINTMENT 3 GM,2510472,CDM,250,RC,,,outpatient,,,406,162.40,,345.1,85,,276.08,percent of total billed charges,85% of total billed charges,312.62,77,,250.1,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,332.92,82,,266.336,percent of total billed charges,82% of total billed charges,345.1,85,,276.08,percent of total billed charges,85% of total billed charges,345.1,85,,276.08,percent of total billed charges,85% of total billed charges,345.1,85,,276.08,percent of total billed charges,85% of total billed charges,365.4,90,,292.32,percent of total billed charges,90% of total billed charges,324.8,80,,259.84,percent of total billed charges,80% of total billed charges,365.4,90,,292.32,percent of total billed charges,90% of total billed charges,304.5,75,,243.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,117.74,29,,94.192,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,272.02,67,,217.616,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,324.8,80,,259.84,percent of total billed charges,80% of total billed charges,263.9,65,,211.12,percent of total billed charges,65% of total billed charges,144.82,35.67,,115.856,percent of total billed charges,35.67% of total billed charges,117.74,365.4,
TOBREX OPTH SOLUTION 5CC .3%,2510475,CDM,250,RC,,,outpatient,,,68,27.20,,57.8,85,,46.24,percent of total billed charges,85% of total billed charges,52.36,77,,41.89,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,55.76,82,,44.608,percent of total billed charges,82% of total billed charges,57.8,85,,46.24,percent of total billed charges,85% of total billed charges,57.8,85,,46.24,percent of total billed charges,85% of total billed charges,57.8,85,,46.24,percent of total billed charges,85% of total billed charges,61.2,90,,48.96,percent of total billed charges,90% of total billed charges,54.4,80,,43.52,percent of total billed charges,80% of total billed charges,61.2,90,,48.96,percent of total billed charges,90% of total billed charges,51,75,,40.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,19.72,29,,15.776,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,45.56,67,,36.448,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,54.4,80,,43.52,percent of total billed charges,80% of total billed charges,44.2,65,,35.36,percent of total billed charges,65% of total billed charges,24.26,35.67,,19.408,percent of total billed charges,35.67% of total billed charges,19.72,61.2,
TOFRANIL TAB 10MG,2510515,CDM,250,RC,,,outpatient,,,33,13.20,,28.05,85,,22.44,percent of total billed charges,85% of total billed charges,25.41,77,,20.33,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,27.06,82,,21.648,percent of total billed charges,82% of total billed charges,28.05,85,,22.44,percent of total billed charges,85% of total billed charges,28.05,85,,22.44,percent of total billed charges,85% of total billed charges,28.05,85,,22.44,percent of total billed charges,85% of total billed charges,29.7,90,,23.76,percent of total billed charges,90% of total billed charges,26.4,80,,21.12,percent of total billed charges,80% of total billed charges,29.7,90,,23.76,percent of total billed charges,90% of total billed charges,24.75,75,,19.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,9.57,29,,7.656,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,22.11,67,,17.688,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,26.4,80,,21.12,percent of total billed charges,80% of total billed charges,21.45,65,,17.16,percent of total billed charges,65% of total billed charges,11.77,35.67,,9.416,percent of total billed charges,35.67% of total billed charges,9.57,29.7,
LIDOCAINE 4 ML VIAL,2510556,CDM,250,RC,,,outpatient,,,95,38.00,,80.75,85,,64.6,percent of total billed charges,85% of total billed charges,73.15,77,,58.52,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,77.9,82,,62.32,percent of total billed charges,82% of total billed charges,80.75,85,,64.6,percent of total billed charges,85% of total billed charges,80.75,85,,64.6,percent of total billed charges,85% of total billed charges,80.75,85,,64.6,percent of total billed charges,85% of total billed charges,85.5,90,,68.4,percent of total billed charges,90% of total billed charges,76,80,,60.8,percent of total billed charges,80% of total billed charges,85.5,90,,68.4,percent of total billed charges,90% of total billed charges,71.25,75,,57,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,27.55,29,,22.04,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,63.65,67,,50.92,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,76,80,,60.8,percent of total billed charges,80% of total billed charges,61.75,65,,49.4,percent of total billed charges,65% of total billed charges,33.89,35.67,,27.112,percent of total billed charges,35.67% of total billed charges,27.55,85.5,
TOPAMAX 25 MG PO,2510561,CDM,250,RC,,,outpatient,,,17,6.80,,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,13.09,77,,10.47,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,13.94,82,,11.152,percent of total billed charges,82% of total billed charges,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,15.3,90,,12.24,percent of total billed charges,90% of total billed charges,13.6,80,,10.88,percent of total billed charges,80% of total billed charges,15.3,90,,12.24,percent of total billed charges,90% of total billed charges,12.75,75,,10.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,4.93,29,,3.944,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,11.39,67,,9.112,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,13.6,80,,10.88,percent of total billed charges,80% of total billed charges,11.05,65,,8.84,percent of total billed charges,65% of total billed charges,6.06,35.67,,4.848,percent of total billed charges,35.67% of total billed charges,4.93,15.3,
TOPAMAX 100 MG TAB,2510562,CDM,250,RC,,,outpatient,,,46,18.40,,39.1,85,,31.28,percent of total billed charges,85% of total billed charges,35.42,77,,28.34,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,37.72,82,,30.176,percent of total billed charges,82% of total billed charges,39.1,85,,31.28,percent of total billed charges,85% of total billed charges,39.1,85,,31.28,percent of total billed charges,85% of total billed charges,39.1,85,,31.28,percent of total billed charges,85% of total billed charges,41.4,90,,33.12,percent of total billed charges,90% of total billed charges,36.8,80,,29.44,percent of total billed charges,80% of total billed charges,41.4,90,,33.12,percent of total billed charges,90% of total billed charges,34.5,75,,27.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,13.34,29,,10.672,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,30.82,67,,24.656,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,36.8,80,,29.44,percent of total billed charges,80% of total billed charges,29.9,65,,23.92,percent of total billed charges,65% of total billed charges,16.41,35.67,,13.128,percent of total billed charges,35.67% of total billed charges,13.34,41.4,
TOPICORT 0.25% CREAM 15 GR TUB,2510564,CDM,250,RC,,,outpatient,,,195,78.00,,165.75,85,,132.6,percent of total billed charges,85% of total billed charges,150.15,77,,120.12,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,159.9,82,,127.92,percent of total billed charges,82% of total billed charges,165.75,85,,132.6,percent of total billed charges,85% of total billed charges,165.75,85,,132.6,percent of total billed charges,85% of total billed charges,165.75,85,,132.6,percent of total billed charges,85% of total billed charges,175.5,90,,140.4,percent of total billed charges,90% of total billed charges,156,80,,124.8,percent of total billed charges,80% of total billed charges,175.5,90,,140.4,percent of total billed charges,90% of total billed charges,146.25,75,,117,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,56.55,29,,45.24,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,130.65,67,,104.52,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,156,80,,124.8,percent of total billed charges,80% of total billed charges,126.75,65,,101.4,percent of total billed charges,65% of total billed charges,69.56,35.67,,55.648,percent of total billed charges,35.67% of total billed charges,56.55,175.5,
TOPROL XL 25 MG TAB,2510586,CDM,250,RC,,,outpatient,,,8,3.20,,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,6.16,77,,4.93,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,6.56,82,,5.248,percent of total billed charges,82% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,7.2,90,,5.76,percent of total billed charges,90% of total billed charges,6.4,80,,5.12,percent of total billed charges,80% of total billed charges,7.2,90,,5.76,percent of total billed charges,90% of total billed charges,6,75,,4.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.32,29,,1.856,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,5.36,67,,4.288,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,6.4,80,,5.12,percent of total billed charges,80% of total billed charges,5.2,65,,4.16,percent of total billed charges,65% of total billed charges,2.85,35.67,,2.28,percent of total billed charges,35.67% of total billed charges,2.32,7.2,
TORADOL 10MG TAB,2510590,CDM,250,RC,,,outpatient,,,7,2.80,,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.39,77,,4.31,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,5.74,82,,4.592,percent of total billed charges,82% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.25,75,,4.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.03,29,,1.624,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4.69,67,,3.752,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,4.55,65,,3.64,percent of total billed charges,65% of total billed charges,2.5,35.67,,2,percent of total billed charges,35.67% of total billed charges,2.03,6.3,
TRANDATE 100MG TAB,2510625,CDM,250,RC,,,outpatient,,,7,2.80,,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.39,77,,4.31,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,5.74,82,,4.592,percent of total billed charges,82% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.25,75,,4.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.03,29,,1.624,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4.69,67,,3.752,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,4.55,65,,3.64,percent of total billed charges,65% of total billed charges,2.5,35.67,,2,percent of total billed charges,35.67% of total billed charges,2.03,6.3,
TRANSDERM NITRO 10CM (0.4MG),2510645,CDM,250,RC,,,outpatient,,,21,8.40,,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,16.17,77,,12.94,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,17.22,82,,13.776,percent of total billed charges,82% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,18.9,90,,15.12,percent of total billed charges,90% of total billed charges,16.8,80,,13.44,percent of total billed charges,80% of total billed charges,18.9,90,,15.12,percent of total billed charges,90% of total billed charges,15.75,75,,12.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,6.09,29,,4.872,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,14.07,67,,11.256,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,16.8,80,,13.44,percent of total billed charges,80% of total billed charges,13.65,65,,10.92,percent of total billed charges,65% of total billed charges,7.49,35.67,,5.992,percent of total billed charges,35.67% of total billed charges,6.09,18.9,
TRANSDERM NITRO 5CM 0.2MG,2510660,CDM,250,RC,,,outpatient,,,25,10.00,,21.25,85,,17,percent of total billed charges,85% of total billed charges,19.25,77,,15.4,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,20.5,82,,16.4,percent of total billed charges,82% of total billed charges,21.25,85,,17,percent of total billed charges,85% of total billed charges,21.25,85,,17,percent of total billed charges,85% of total billed charges,21.25,85,,17,percent of total billed charges,85% of total billed charges,22.5,90,,18,percent of total billed charges,90% of total billed charges,20,80,,16,percent of total billed charges,80% of total billed charges,22.5,90,,18,percent of total billed charges,90% of total billed charges,18.75,75,,15,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,7.25,29,,5.8,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,16.75,67,,13.4,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,20,80,,16,percent of total billed charges,80% of total billed charges,16.25,65,,13,percent of total billed charges,65% of total billed charges,8.92,35.67,,7.136,percent of total billed charges,35.67% of total billed charges,7.25,22.5,
TRANSDERM SCOP PATCH,2510665,CDM,250,RC,,,outpatient,,,84,33.60,,71.4,85,,57.12,percent of total billed charges,85% of total billed charges,64.68,77,,51.74,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,68.88,82,,55.104,percent of total billed charges,82% of total billed charges,71.4,85,,57.12,percent of total billed charges,85% of total billed charges,71.4,85,,57.12,percent of total billed charges,85% of total billed charges,71.4,85,,57.12,percent of total billed charges,85% of total billed charges,75.6,90,,60.48,percent of total billed charges,90% of total billed charges,67.2,80,,53.76,percent of total billed charges,80% of total billed charges,75.6,90,,60.48,percent of total billed charges,90% of total billed charges,63,75,,50.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,24.36,29,,19.488,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,56.28,67,,45.024,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,67.2,80,,53.76,percent of total billed charges,80% of total billed charges,54.6,65,,43.68,percent of total billed charges,65% of total billed charges,29.96,35.67,,23.968,percent of total billed charges,35.67% of total billed charges,24.36,75.6,
TRIDIL 50 MG INJ.,2510735,CDM,250,RC,,,outpatient,,,27,10.80,,22.95,85,,18.36,percent of total billed charges,85% of total billed charges,20.79,77,,16.63,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,22.14,82,,17.712,percent of total billed charges,82% of total billed charges,22.95,85,,18.36,percent of total billed charges,85% of total billed charges,22.95,85,,18.36,percent of total billed charges,85% of total billed charges,22.95,85,,18.36,percent of total billed charges,85% of total billed charges,24.3,90,,19.44,percent of total billed charges,90% of total billed charges,21.6,80,,17.28,percent of total billed charges,80% of total billed charges,24.3,90,,19.44,percent of total billed charges,90% of total billed charges,20.25,75,,16.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,7.83,29,,6.264,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,18.09,67,,14.472,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,21.6,80,,17.28,percent of total billed charges,80% of total billed charges,17.55,65,,14.04,percent of total billed charges,65% of total billed charges,9.63,35.67,,7.704,percent of total billed charges,35.67% of total billed charges,7.83,24.3,
TRICOR 145 MG TAB,2510737,CDM,250,RC,,,outpatient,,,27,10.80,,22.95,85,,18.36,percent of total billed charges,85% of total billed charges,20.79,77,,16.63,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,22.14,82,,17.712,percent of total billed charges,82% of total billed charges,22.95,85,,18.36,percent of total billed charges,85% of total billed charges,22.95,85,,18.36,percent of total billed charges,85% of total billed charges,22.95,85,,18.36,percent of total billed charges,85% of total billed charges,24.3,90,,19.44,percent of total billed charges,90% of total billed charges,21.6,80,,17.28,percent of total billed charges,80% of total billed charges,24.3,90,,19.44,percent of total billed charges,90% of total billed charges,20.25,75,,16.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,7.83,29,,6.264,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,18.09,67,,14.472,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,21.6,80,,17.28,percent of total billed charges,80% of total billed charges,17.55,65,,14.04,percent of total billed charges,65% of total billed charges,9.63,35.67,,7.704,percent of total billed charges,35.67% of total billed charges,7.83,24.3,
TRIMPEX PROLOPRIM 100MG TAB,2510760,CDM,250,RC,,,outpatient,,,7,2.80,,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.39,77,,4.31,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,5.74,82,,4.592,percent of total billed charges,82% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.25,75,,4.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.03,29,,1.624,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4.69,67,,3.752,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,4.55,65,,3.64,percent of total billed charges,65% of total billed charges,2.5,35.67,,2,percent of total billed charges,35.67% of total billed charges,2.03,6.3,
TRIPLE DYE TOPICAL,2510775,CDM,250,RC,,,outpatient,,,14,5.60,,11.9,85,,9.52,percent of total billed charges,85% of total billed charges,10.78,77,,8.62,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,11.48,82,,9.184,percent of total billed charges,82% of total billed charges,11.9,85,,9.52,percent of total billed charges,85% of total billed charges,11.9,85,,9.52,percent of total billed charges,85% of total billed charges,11.9,85,,9.52,percent of total billed charges,85% of total billed charges,12.6,90,,10.08,percent of total billed charges,90% of total billed charges,11.2,80,,8.96,percent of total billed charges,80% of total billed charges,12.6,90,,10.08,percent of total billed charges,90% of total billed charges,10.5,75,,8.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,4.06,29,,3.248,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,9.38,67,,7.504,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,11.2,80,,8.96,percent of total billed charges,80% of total billed charges,9.1,65,,7.28,percent of total billed charges,65% of total billed charges,4.99,35.67,,3.992,percent of total billed charges,35.67% of total billed charges,4.06,12.6,
TRUSOPT 2% 5 ML BOTTLE,2510778,CDM,250,RC,,,outpatient,,,266,106.40,,226.1,85,,180.88,percent of total billed charges,85% of total billed charges,204.82,77,,163.86,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,218.12,82,,174.496,percent of total billed charges,82% of total billed charges,226.1,85,,180.88,percent of total billed charges,85% of total billed charges,226.1,85,,180.88,percent of total billed charges,85% of total billed charges,226.1,85,,180.88,percent of total billed charges,85% of total billed charges,239.4,90,,191.52,percent of total billed charges,90% of total billed charges,212.8,80,,170.24,percent of total billed charges,80% of total billed charges,239.4,90,,191.52,percent of total billed charges,90% of total billed charges,199.5,75,,159.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,77.14,29,,61.712,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,178.22,67,,142.576,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,212.8,80,,170.24,percent of total billed charges,80% of total billed charges,172.9,65,,138.32,percent of total billed charges,65% of total billed charges,94.88,35.67,,75.904,percent of total billed charges,35.67% of total billed charges,77.14,239.4,
TUCKS DRESSING 40,2510790,CDM,250,RC,,,outpatient,,,22,8.80,,18.7,85,,14.96,percent of total billed charges,85% of total billed charges,16.94,77,,13.55,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,18.04,82,,14.432,percent of total billed charges,82% of total billed charges,18.7,85,,14.96,percent of total billed charges,85% of total billed charges,18.7,85,,14.96,percent of total billed charges,85% of total billed charges,18.7,85,,14.96,percent of total billed charges,85% of total billed charges,19.8,90,,15.84,percent of total billed charges,90% of total billed charges,17.6,80,,14.08,percent of total billed charges,80% of total billed charges,19.8,90,,15.84,percent of total billed charges,90% of total billed charges,16.5,75,,13.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,6.38,29,,5.104,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,14.74,67,,11.792,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,17.6,80,,14.08,percent of total billed charges,80% of total billed charges,14.3,65,,11.44,percent of total billed charges,65% of total billed charges,7.85,35.67,,6.28,percent of total billed charges,35.67% of total billed charges,6.38,19.8,
TUMS TAB,2510810,CDM,250,RC,,,outpatient,,,7,2.80,,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.39,77,,4.31,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,5.74,82,,4.592,percent of total billed charges,82% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.25,75,,4.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.03,29,,1.624,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4.69,67,,3.752,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,4.55,65,,3.64,percent of total billed charges,65% of total billed charges,2.5,35.67,,2,percent of total billed charges,35.67% of total billed charges,2.03,6.3,
TUSSIONEX 5 ML UDC,2510862,CDM,250,RC,,,outpatient,,,28,11.20,,23.8,85,,19.04,percent of total billed charges,85% of total billed charges,21.56,77,,17.25,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,22.96,82,,18.368,percent of total billed charges,82% of total billed charges,23.8,85,,19.04,percent of total billed charges,85% of total billed charges,23.8,85,,19.04,percent of total billed charges,85% of total billed charges,23.8,85,,19.04,percent of total billed charges,85% of total billed charges,25.2,90,,20.16,percent of total billed charges,90% of total billed charges,22.4,80,,17.92,percent of total billed charges,80% of total billed charges,25.2,90,,20.16,percent of total billed charges,90% of total billed charges,21,75,,16.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,8.12,29,,6.496,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,18.76,67,,15.008,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,22.4,80,,17.92,percent of total billed charges,80% of total billed charges,18.2,65,,14.56,percent of total billed charges,65% of total billed charges,9.99,35.67,,7.992,percent of total billed charges,35.67% of total billed charges,8.12,25.2,
TYLENOL & COD NO 3 TAB,2510870,CDM,250,RC,,,outpatient,,,6,2.40,,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,4.62,77,,3.7,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,4.92,82,,3.936,percent of total billed charges,82% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,5.4,90,,4.32,percent of total billed charges,90% of total billed charges,4.8,80,,3.84,percent of total billed charges,80% of total billed charges,5.4,90,,4.32,percent of total billed charges,90% of total billed charges,4.5,75,,3.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,1.74,29,,1.392,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4.02,67,,3.216,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,4.8,80,,3.84,percent of total billed charges,80% of total billed charges,3.9,65,,3.12,percent of total billed charges,65% of total billed charges,2.14,35.67,,1.712,percent of total billed charges,35.67% of total billed charges,1.74,5.4,
TYLENOL CAP 500MG,2510885,CDM,250,RC,,,outpatient,,,9,3.60,,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,6.93,77,,5.54,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,7.38,82,,5.904,percent of total billed charges,82% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,8.1,90,,6.48,percent of total billed charges,90% of total billed charges,7.2,80,,5.76,percent of total billed charges,80% of total billed charges,8.1,90,,6.48,percent of total billed charges,90% of total billed charges,6.75,75,,5.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.61,29,,2.088,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,6.03,67,,4.824,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,7.2,80,,5.76,percent of total billed charges,80% of total billed charges,5.85,65,,4.68,percent of total billed charges,65% of total billed charges,3.21,35.67,,2.568,percent of total billed charges,35.67% of total billed charges,2.61,8.1,
TYLENOL CHEWABLE 160 MG TAB,2510891,CDM,250,RC,,,outpatient,,,6,2.40,,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,4.62,77,,3.7,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,4.92,82,,3.936,percent of total billed charges,82% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,5.4,90,,4.32,percent of total billed charges,90% of total billed charges,4.8,80,,3.84,percent of total billed charges,80% of total billed charges,5.4,90,,4.32,percent of total billed charges,90% of total billed charges,4.5,75,,3.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,1.74,29,,1.392,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4.02,67,,3.216,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,4.8,80,,3.84,percent of total billed charges,80% of total billed charges,3.9,65,,3.12,percent of total billed charges,65% of total billed charges,2.14,35.67,,1.712,percent of total billed charges,35.67% of total billed charges,1.74,5.4,
TYLENOL TAB 325 MG,2510915,CDM,250,RC,,,outpatient,,,6,2.40,,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,4.62,77,,3.7,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,4.92,82,,3.936,percent of total billed charges,82% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,5.4,90,,4.32,percent of total billed charges,90% of total billed charges,4.8,80,,3.84,percent of total billed charges,80% of total billed charges,5.4,90,,4.32,percent of total billed charges,90% of total billed charges,4.5,75,,3.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,1.74,29,,1.392,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4.02,67,,3.216,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,4.8,80,,3.84,percent of total billed charges,80% of total billed charges,3.9,65,,3.12,percent of total billed charges,65% of total billed charges,2.14,35.67,,1.712,percent of total billed charges,35.67% of total billed charges,1.74,5.4,
TYLENOL 160 MG 5 ML UNIT DOSE,2510931,CDM,250,RC,,,outpatient,,,7,2.80,,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.39,77,,4.31,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,5.74,82,,4.592,percent of total billed charges,82% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.25,75,,4.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.03,29,,1.624,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4.69,67,,3.752,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,4.55,65,,3.64,percent of total billed charges,65% of total billed charges,2.5,35.67,,2,percent of total billed charges,35.67% of total billed charges,2.03,6.3,
TYLENOL WITH CODEINE 5 ML UDC,2510936,CDM,250,RC,,,outpatient,,,7,2.80,,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.39,77,,4.31,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,5.74,82,,4.592,percent of total billed charges,82% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.25,75,,4.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.03,29,,1.624,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4.69,67,,3.752,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,4.55,65,,3.64,percent of total billed charges,65% of total billed charges,2.5,35.67,,2,percent of total billed charges,35.67% of total billed charges,2.03,6.3,
ULORIC TABLET 40 MG,2510951,CDM,250,RC,,,outpatient,,,32,12.80,,27.2,85,,21.76,percent of total billed charges,85% of total billed charges,24.64,77,,19.71,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,26.24,82,,20.992,percent of total billed charges,82% of total billed charges,27.2,85,,21.76,percent of total billed charges,85% of total billed charges,27.2,85,,21.76,percent of total billed charges,85% of total billed charges,27.2,85,,21.76,percent of total billed charges,85% of total billed charges,28.8,90,,23.04,percent of total billed charges,90% of total billed charges,25.6,80,,20.48,percent of total billed charges,80% of total billed charges,28.8,90,,23.04,percent of total billed charges,90% of total billed charges,24,75,,19.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,9.28,29,,7.424,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,21.44,67,,17.152,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,25.6,80,,20.48,percent of total billed charges,80% of total billed charges,20.8,65,,16.64,percent of total billed charges,65% of total billed charges,11.41,35.67,,9.128,percent of total billed charges,35.67% of total billed charges,9.28,28.8,
ULTANE ANESTHESIA 20 ML NJ,2510952,CDM,250,RC,,,outpatient,,,179,71.60,,152.15,85,,121.72,percent of total billed charges,85% of total billed charges,137.83,77,,110.26,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,146.78,82,,117.424,percent of total billed charges,82% of total billed charges,152.15,85,,121.72,percent of total billed charges,85% of total billed charges,152.15,85,,121.72,percent of total billed charges,85% of total billed charges,152.15,85,,121.72,percent of total billed charges,85% of total billed charges,161.1,90,,128.88,percent of total billed charges,90% of total billed charges,143.2,80,,114.56,percent of total billed charges,80% of total billed charges,161.1,90,,128.88,percent of total billed charges,90% of total billed charges,134.25,75,,107.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,51.91,29,,41.528,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,119.93,67,,95.944,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,143.2,80,,114.56,percent of total billed charges,80% of total billed charges,116.35,65,,93.08,percent of total billed charges,65% of total billed charges,63.85,35.67,,51.08,percent of total billed charges,35.67% of total billed charges,51.91,161.1,
ULTIVA 2MG/5ML INJ,2510953,CDM,250,RC,,,outpatient,,,374,149.60,,317.9,85,,254.32,percent of total billed charges,85% of total billed charges,287.98,77,,230.38,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,306.68,82,,245.344,percent of total billed charges,82% of total billed charges,317.9,85,,254.32,percent of total billed charges,85% of total billed charges,317.9,85,,254.32,percent of total billed charges,85% of total billed charges,317.9,85,,254.32,percent of total billed charges,85% of total billed charges,336.6,90,,269.28,percent of total billed charges,90% of total billed charges,299.2,80,,239.36,percent of total billed charges,80% of total billed charges,336.6,90,,269.28,percent of total billed charges,90% of total billed charges,280.5,75,,224.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,108.46,29,,86.768,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,250.58,67,,200.464,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,299.2,80,,239.36,percent of total billed charges,80% of total billed charges,243.1,65,,194.48,percent of total billed charges,65% of total billed charges,133.41,35.67,,106.728,percent of total billed charges,35.67% of total billed charges,108.46,336.6,
ULTRAM 50 MG TABLET,2510954,CDM,250,RC,,,outpatient,,,12,4.80,,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,9.24,77,,7.39,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,9.84,82,,7.872,percent of total billed charges,82% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,10.8,90,,8.64,percent of total billed charges,90% of total billed charges,9.6,80,,7.68,percent of total billed charges,80% of total billed charges,10.8,90,,8.64,percent of total billed charges,90% of total billed charges,9,75,,7.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,3.48,29,,2.784,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,8.04,67,,6.432,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,9.6,80,,7.68,percent of total billed charges,80% of total billed charges,7.8,65,,6.24,percent of total billed charges,65% of total billed charges,4.28,35.67,,3.424,percent of total billed charges,35.67% of total billed charges,3.48,10.8,
ULTIVA 1 MG = 3 ML VIAL,2510958,CDM,250,RC,,,outpatient,,,228,91.20,,193.8,85,,155.04,percent of total billed charges,85% of total billed charges,175.56,77,,140.45,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,186.96,82,,149.568,percent of total billed charges,82% of total billed charges,193.8,85,,155.04,percent of total billed charges,85% of total billed charges,193.8,85,,155.04,percent of total billed charges,85% of total billed charges,193.8,85,,155.04,percent of total billed charges,85% of total billed charges,205.2,90,,164.16,percent of total billed charges,90% of total billed charges,182.4,80,,145.92,percent of total billed charges,80% of total billed charges,205.2,90,,164.16,percent of total billed charges,90% of total billed charges,171,75,,136.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,66.12,29,,52.896,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,152.76,67,,122.208,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,182.4,80,,145.92,percent of total billed charges,80% of total billed charges,148.2,65,,118.56,percent of total billed charges,65% of total billed charges,81.33,35.67,,65.064,percent of total billed charges,35.67% of total billed charges,66.12,205.2,
ULTANE PER 15 MINUTES,2510959,CDM,250,RC,,,outpatient,,,32,12.80,,27.2,85,,21.76,percent of total billed charges,85% of total billed charges,24.64,77,,19.71,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,26.24,82,,20.992,percent of total billed charges,82% of total billed charges,27.2,85,,21.76,percent of total billed charges,85% of total billed charges,27.2,85,,21.76,percent of total billed charges,85% of total billed charges,27.2,85,,21.76,percent of total billed charges,85% of total billed charges,28.8,90,,23.04,percent of total billed charges,90% of total billed charges,25.6,80,,20.48,percent of total billed charges,80% of total billed charges,28.8,90,,23.04,percent of total billed charges,90% of total billed charges,24,75,,19.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,9.28,29,,7.424,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,21.44,67,,17.152,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,25.6,80,,20.48,percent of total billed charges,80% of total billed charges,20.8,65,,16.64,percent of total billed charges,65% of total billed charges,11.41,35.67,,9.128,percent of total billed charges,35.67% of total billed charges,9.28,28.8,
VALIUM 2 MG TAB,2511050,CDM,250,RC,,,outpatient,,,15,6.00,,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,11.55,77,,9.24,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,12.3,82,,9.84,percent of total billed charges,82% of total billed charges,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,13.5,90,,10.8,percent of total billed charges,90% of total billed charges,12,80,,9.6,percent of total billed charges,80% of total billed charges,13.5,90,,10.8,percent of total billed charges,90% of total billed charges,11.25,75,,9,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,4.35,29,,3.48,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,10.05,67,,8.04,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,12,80,,9.6,percent of total billed charges,80% of total billed charges,9.75,65,,7.8,percent of total billed charges,65% of total billed charges,5.35,35.67,,4.28,percent of total billed charges,35.67% of total billed charges,4.35,13.5,
VALIUM 5 MG TAB,2511070,CDM,250,RC,,,outpatient,,,21,8.40,,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,16.17,77,,12.94,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,17.22,82,,13.776,percent of total billed charges,82% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,18.9,90,,15.12,percent of total billed charges,90% of total billed charges,16.8,80,,13.44,percent of total billed charges,80% of total billed charges,18.9,90,,15.12,percent of total billed charges,90% of total billed charges,15.75,75,,12.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,6.09,29,,4.872,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,14.07,67,,11.256,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,16.8,80,,13.44,percent of total billed charges,80% of total billed charges,13.65,65,,10.92,percent of total billed charges,65% of total billed charges,7.49,35.67,,5.992,percent of total billed charges,35.67% of total billed charges,6.09,18.9,
VALTREX 500 MG TAB,2511086,CDM,250,RC,,,outpatient,,,32,12.80,,27.2,85,,21.76,percent of total billed charges,85% of total billed charges,24.64,77,,19.71,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,26.24,82,,20.992,percent of total billed charges,82% of total billed charges,27.2,85,,21.76,percent of total billed charges,85% of total billed charges,27.2,85,,21.76,percent of total billed charges,85% of total billed charges,27.2,85,,21.76,percent of total billed charges,85% of total billed charges,28.8,90,,23.04,percent of total billed charges,90% of total billed charges,25.6,80,,20.48,percent of total billed charges,80% of total billed charges,28.8,90,,23.04,percent of total billed charges,90% of total billed charges,24,75,,19.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,9.28,29,,7.424,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,21.44,67,,17.152,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,25.6,80,,20.48,percent of total billed charges,80% of total billed charges,20.8,65,,16.64,percent of total billed charges,65% of total billed charges,11.41,35.67,,9.128,percent of total billed charges,35.67% of total billed charges,9.28,28.8,
VANCOMYCIN 125 MG CAP,2511106,CDM,250,RC,,,outpatient,,,179,71.60,,152.15,85,,121.72,percent of total billed charges,85% of total billed charges,137.83,77,,110.26,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,146.78,82,,117.424,percent of total billed charges,82% of total billed charges,152.15,85,,121.72,percent of total billed charges,85% of total billed charges,152.15,85,,121.72,percent of total billed charges,85% of total billed charges,152.15,85,,121.72,percent of total billed charges,85% of total billed charges,161.1,90,,128.88,percent of total billed charges,90% of total billed charges,143.2,80,,114.56,percent of total billed charges,80% of total billed charges,161.1,90,,128.88,percent of total billed charges,90% of total billed charges,134.25,75,,107.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,51.91,29,,41.528,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,119.93,67,,95.944,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,143.2,80,,114.56,percent of total billed charges,80% of total billed charges,116.35,65,,93.08,percent of total billed charges,65% of total billed charges,63.85,35.67,,51.08,percent of total billed charges,35.67% of total billed charges,51.91,161.1,
POTASSIUM CHLORIDE 20 MEQ/10ML,2511112,CDM,250,RC,,,outpatient,,,102,40.80,,86.7,85,,69.36,percent of total billed charges,85% of total billed charges,78.54,77,,62.83,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,83.64,82,,66.912,percent of total billed charges,82% of total billed charges,86.7,85,,69.36,percent of total billed charges,85% of total billed charges,86.7,85,,69.36,percent of total billed charges,85% of total billed charges,86.7,85,,69.36,percent of total billed charges,85% of total billed charges,91.8,90,,73.44,percent of total billed charges,90% of total billed charges,81.6,80,,65.28,percent of total billed charges,80% of total billed charges,91.8,90,,73.44,percent of total billed charges,90% of total billed charges,76.5,75,,61.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,29.58,29,,23.664,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,68.34,67,,54.672,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,81.6,80,,65.28,percent of total billed charges,80% of total billed charges,66.3,65,,53.04,percent of total billed charges,65% of total billed charges,36.38,35.67,,29.104,percent of total billed charges,35.67% of total billed charges,29.58,91.8,
VANCOMYCIN COMPOUND SOLUTION,2511121,CDM,250,RC,,,outpatient,,,906,362.40,,770.1,85,,616.08,percent of total billed charges,85% of total billed charges,697.62,77,,558.1,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,742.92,82,,594.336,percent of total billed charges,82% of total billed charges,770.1,85,,616.08,percent of total billed charges,85% of total billed charges,770.1,85,,616.08,percent of total billed charges,85% of total billed charges,770.1,85,,616.08,percent of total billed charges,85% of total billed charges,815.4,90,,652.32,percent of total billed charges,90% of total billed charges,724.8,80,,579.84,percent of total billed charges,80% of total billed charges,815.4,90,,652.32,percent of total billed charges,90% of total billed charges,679.5,75,,543.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,262.74,29,,210.192,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,607.02,67,,485.616,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,724.8,80,,579.84,percent of total billed charges,80% of total billed charges,588.9,65,,471.12,percent of total billed charges,65% of total billed charges,323.17,35.67,,258.536,percent of total billed charges,35.67% of total billed charges,262.74,815.4,
VASOTEC 1.25 INJ,2511160,CDM,250,RC,,,outpatient,,,17,6.80,,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,13.09,77,,10.47,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,13.94,82,,11.152,percent of total billed charges,82% of total billed charges,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,15.3,90,,12.24,percent of total billed charges,90% of total billed charges,13.6,80,,10.88,percent of total billed charges,80% of total billed charges,15.3,90,,12.24,percent of total billed charges,90% of total billed charges,12.75,75,,10.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,4.93,29,,3.944,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,11.39,67,,9.112,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,13.6,80,,10.88,percent of total billed charges,80% of total billed charges,11.05,65,,8.84,percent of total billed charges,65% of total billed charges,6.06,35.67,,4.848,percent of total billed charges,35.67% of total billed charges,4.93,15.3,
VIBRAMYCIN 100 MG TABLET,2511320,CDM,250,RC,,,outpatient,,,26,10.40,,22.1,85,,17.68,percent of total billed charges,85% of total billed charges,20.02,77,,16.02,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,21.32,82,,17.056,percent of total billed charges,82% of total billed charges,22.1,85,,17.68,percent of total billed charges,85% of total billed charges,22.1,85,,17.68,percent of total billed charges,85% of total billed charges,22.1,85,,17.68,percent of total billed charges,85% of total billed charges,23.4,90,,18.72,percent of total billed charges,90% of total billed charges,20.8,80,,16.64,percent of total billed charges,80% of total billed charges,23.4,90,,18.72,percent of total billed charges,90% of total billed charges,19.5,75,,15.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,7.54,29,,6.032,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,17.42,67,,13.936,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,20.8,80,,16.64,percent of total billed charges,80% of total billed charges,16.9,65,,13.52,percent of total billed charges,65% of total billed charges,9.27,35.67,,7.416,percent of total billed charges,35.67% of total billed charges,7.54,23.4,
VIBRAMYCIN 100 MG INJ,2511325,CDM,250,RC,,,outpatient,,,88,35.20,,74.8,85,,59.84,percent of total billed charges,85% of total billed charges,67.76,77,,54.21,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,72.16,82,,57.728,percent of total billed charges,82% of total billed charges,74.8,85,,59.84,percent of total billed charges,85% of total billed charges,74.8,85,,59.84,percent of total billed charges,85% of total billed charges,74.8,85,,59.84,percent of total billed charges,85% of total billed charges,79.2,90,,63.36,percent of total billed charges,90% of total billed charges,70.4,80,,56.32,percent of total billed charges,80% of total billed charges,79.2,90,,63.36,percent of total billed charges,90% of total billed charges,66,75,,52.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,25.52,29,,20.416,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,58.96,67,,47.168,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,70.4,80,,56.32,percent of total billed charges,80% of total billed charges,57.2,65,,45.76,percent of total billed charges,65% of total billed charges,31.39,35.67,,25.112,percent of total billed charges,35.67% of total billed charges,25.52,79.2,
VICOPROFEN 7.5/200 MG PO,2511356,CDM,250,RC,,,outpatient,,,16,6.40,,13.6,85,,10.88,percent of total billed charges,85% of total billed charges,12.32,77,,9.86,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,13.12,82,,10.496,percent of total billed charges,82% of total billed charges,13.6,85,,10.88,percent of total billed charges,85% of total billed charges,13.6,85,,10.88,percent of total billed charges,85% of total billed charges,13.6,85,,10.88,percent of total billed charges,85% of total billed charges,14.4,90,,11.52,percent of total billed charges,90% of total billed charges,12.8,80,,10.24,percent of total billed charges,80% of total billed charges,14.4,90,,11.52,percent of total billed charges,90% of total billed charges,12,75,,9.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,4.64,29,,3.712,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,10.72,67,,8.576,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,12.8,80,,10.24,percent of total billed charges,80% of total billed charges,10.4,65,,8.32,percent of total billed charges,65% of total billed charges,5.71,35.67,,4.568,percent of total billed charges,35.67% of total billed charges,4.64,14.4,
VISINE OPTH GT,2511420,CDM,250,RC,,,outpatient,,,22,8.80,,18.7,85,,14.96,percent of total billed charges,85% of total billed charges,16.94,77,,13.55,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,18.04,82,,14.432,percent of total billed charges,82% of total billed charges,18.7,85,,14.96,percent of total billed charges,85% of total billed charges,18.7,85,,14.96,percent of total billed charges,85% of total billed charges,18.7,85,,14.96,percent of total billed charges,85% of total billed charges,19.8,90,,15.84,percent of total billed charges,90% of total billed charges,17.6,80,,14.08,percent of total billed charges,80% of total billed charges,19.8,90,,15.84,percent of total billed charges,90% of total billed charges,16.5,75,,13.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,6.38,29,,5.104,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,14.74,67,,11.792,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,17.6,80,,14.08,percent of total billed charges,80% of total billed charges,14.3,65,,11.44,percent of total billed charges,65% of total billed charges,7.85,35.67,,6.28,percent of total billed charges,35.67% of total billed charges,6.38,19.8,
VISTARIL 25 MG CAP,2511435,CDM,250,RC,,,outpatient,,,11,4.40,,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,8.47,77,,6.78,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,9.02,82,,7.216,percent of total billed charges,82% of total billed charges,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,9.9,90,,7.92,percent of total billed charges,90% of total billed charges,8.8,80,,7.04,percent of total billed charges,80% of total billed charges,9.9,90,,7.92,percent of total billed charges,90% of total billed charges,8.25,75,,6.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,3.19,29,,2.552,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,7.37,67,,5.896,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,8.8,80,,7.04,percent of total billed charges,80% of total billed charges,7.15,65,,5.72,percent of total billed charges,65% of total billed charges,3.92,35.67,,3.136,percent of total billed charges,35.67% of total billed charges,3.19,9.9,
VITAMIN B COMPLEX 100 MG PO,2511486,CDM,250,RC,,,outpatient,,,7,2.80,,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.39,77,,4.31,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,5.74,82,,4.592,percent of total billed charges,82% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.25,75,,4.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.03,29,,1.624,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4.69,67,,3.752,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,4.55,65,,3.64,percent of total billed charges,65% of total billed charges,2.5,35.67,,2,percent of total billed charges,35.67% of total billed charges,2.03,6.3,
VITAMIN B6 50 MG TAB PO,2511496,CDM,250,RC,,,outpatient,,,7,2.80,,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.39,77,,4.31,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,5.74,82,,4.592,percent of total billed charges,82% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.25,75,,4.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.03,29,,1.624,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4.69,67,,3.752,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,4.55,65,,3.64,percent of total billed charges,65% of total billed charges,2.5,35.67,,2,percent of total billed charges,35.67% of total billed charges,2.03,6.3,
VITAMIN B 12 500 MCG TAB PO,2511521,CDM,250,RC,,,outpatient,,,7,2.80,,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.39,77,,4.31,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,5.74,82,,4.592,percent of total billed charges,82% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.25,75,,4.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.03,29,,1.624,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4.69,67,,3.752,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,4.55,65,,3.64,percent of total billed charges,65% of total billed charges,2.5,35.67,,2,percent of total billed charges,35.67% of total billed charges,2.03,6.3,
VITAMIN E 1000 INTERNATIONAL U,2511548,CDM,250,RC,,,outpatient,,,7,2.80,,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.39,77,,4.31,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,5.74,82,,4.592,percent of total billed charges,82% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.25,75,,4.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.03,29,,1.624,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4.69,67,,3.752,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,4.55,65,,3.64,percent of total billed charges,65% of total billed charges,2.5,35.67,,2,percent of total billed charges,35.67% of total billed charges,2.03,6.3,
"VITAMIN D 1,000 INTERNAT UNITS",2511554,CDM,250,RC,,,outpatient,,,7,2.80,,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.39,77,,4.31,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,5.74,82,,4.592,percent of total billed charges,82% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.25,75,,4.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.03,29,,1.624,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4.69,67,,3.752,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,4.55,65,,3.64,percent of total billed charges,65% of total billed charges,2.5,35.67,,2,percent of total billed charges,35.67% of total billed charges,2.03,6.3,
VOLTAREN 1% GEL,2511556,CDM,250,RC,,,outpatient,,,185,74.00,,157.25,85,,125.8,percent of total billed charges,85% of total billed charges,142.45,77,,113.96,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,151.7,82,,121.36,percent of total billed charges,82% of total billed charges,157.25,85,,125.8,percent of total billed charges,85% of total billed charges,157.25,85,,125.8,percent of total billed charges,85% of total billed charges,157.25,85,,125.8,percent of total billed charges,85% of total billed charges,166.5,90,,133.2,percent of total billed charges,90% of total billed charges,148,80,,118.4,percent of total billed charges,80% of total billed charges,166.5,90,,133.2,percent of total billed charges,90% of total billed charges,138.75,75,,111,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,53.65,29,,42.92,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,123.95,67,,99.16,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,148,80,,118.4,percent of total billed charges,80% of total billed charges,120.25,65,,96.2,percent of total billed charges,65% of total billed charges,65.99,35.67,,52.792,percent of total billed charges,35.67% of total billed charges,53.65,166.5,
WATER FOR INJ. 30 ML,2511566,CDM,250,RC,,,outpatient,,,11,4.40,,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,8.47,77,,6.78,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,9.02,82,,7.216,percent of total billed charges,82% of total billed charges,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,9.9,90,,7.92,percent of total billed charges,90% of total billed charges,8.8,80,,7.04,percent of total billed charges,80% of total billed charges,9.9,90,,7.92,percent of total billed charges,90% of total billed charges,8.25,75,,6.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,3.19,29,,2.552,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,7.37,67,,5.896,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,8.8,80,,7.04,percent of total billed charges,80% of total billed charges,7.15,65,,5.72,percent of total billed charges,65% of total billed charges,3.92,35.67,,3.136,percent of total billed charges,35.67% of total billed charges,3.19,9.9,
WATER FOR INJ PF 50 ML,2511567,CDM,250,RC,,,outpatient,,,12,4.80,,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,9.24,77,,7.39,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,9.84,82,,7.872,percent of total billed charges,82% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,10.8,90,,8.64,percent of total billed charges,90% of total billed charges,9.6,80,,7.68,percent of total billed charges,80% of total billed charges,10.8,90,,8.64,percent of total billed charges,90% of total billed charges,9,75,,7.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,3.48,29,,2.784,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,8.04,67,,6.432,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,9.6,80,,7.68,percent of total billed charges,80% of total billed charges,7.8,65,,6.24,percent of total billed charges,65% of total billed charges,4.28,35.67,,3.424,percent of total billed charges,35.67% of total billed charges,3.48,10.8,
WATER FOR INJ 1000 ML,2511568,CDM,250,RC,,,outpatient,,,25,10.00,,21.25,85,,17,percent of total billed charges,85% of total billed charges,19.25,77,,15.4,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,20.5,82,,16.4,percent of total billed charges,82% of total billed charges,21.25,85,,17,percent of total billed charges,85% of total billed charges,21.25,85,,17,percent of total billed charges,85% of total billed charges,21.25,85,,17,percent of total billed charges,85% of total billed charges,22.5,90,,18,percent of total billed charges,90% of total billed charges,20,80,,16,percent of total billed charges,80% of total billed charges,22.5,90,,18,percent of total billed charges,90% of total billed charges,18.75,75,,15,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,7.25,29,,5.8,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,16.75,67,,13.4,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,20,80,,16,percent of total billed charges,80% of total billed charges,16.25,65,,13,percent of total billed charges,65% of total billed charges,8.92,35.67,,7.136,percent of total billed charges,35.67% of total billed charges,7.25,22.5,
WELLBUTRIN HCL 100 MG TAB,2511579,CDM,250,RC,,,outpatient,,,15,6.00,,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,11.55,77,,9.24,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,12.3,82,,9.84,percent of total billed charges,82% of total billed charges,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,13.5,90,,10.8,percent of total billed charges,90% of total billed charges,12,80,,9.6,percent of total billed charges,80% of total billed charges,13.5,90,,10.8,percent of total billed charges,90% of total billed charges,11.25,75,,9,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,4.35,29,,3.48,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,10.05,67,,8.04,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,12,80,,9.6,percent of total billed charges,80% of total billed charges,9.75,65,,7.8,percent of total billed charges,65% of total billed charges,5.35,35.67,,4.28,percent of total billed charges,35.67% of total billed charges,4.35,13.5,
XALANTAN 2.5 ML OPTH DROPS,2511636,CDM,250,RC,,,outpatient,,,394,157.60,,334.9,85,,267.92,percent of total billed charges,85% of total billed charges,303.38,77,,242.7,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,323.08,82,,258.464,percent of total billed charges,82% of total billed charges,334.9,85,,267.92,percent of total billed charges,85% of total billed charges,334.9,85,,267.92,percent of total billed charges,85% of total billed charges,334.9,85,,267.92,percent of total billed charges,85% of total billed charges,354.6,90,,283.68,percent of total billed charges,90% of total billed charges,315.2,80,,252.16,percent of total billed charges,80% of total billed charges,354.6,90,,283.68,percent of total billed charges,90% of total billed charges,295.5,75,,236.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,114.26,29,,91.408,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,263.98,67,,211.184,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,315.2,80,,252.16,percent of total billed charges,80% of total billed charges,256.1,65,,204.88,percent of total billed charges,65% of total billed charges,140.54,35.67,,112.432,percent of total billed charges,35.67% of total billed charges,114.26,354.6,
XANAX (ALPRAZOLAM) 0.5MG TAB,2511650,CDM,250,RC,,,outpatient,,,13,5.20,,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,10.01,77,,8.01,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,10.66,82,,8.528,percent of total billed charges,82% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,11.7,90,,9.36,percent of total billed charges,90% of total billed charges,10.4,80,,8.32,percent of total billed charges,80% of total billed charges,11.7,90,,9.36,percent of total billed charges,90% of total billed charges,9.75,75,,7.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,3.77,29,,3.016,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,8.71,67,,6.968,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,10.4,80,,8.32,percent of total billed charges,80% of total billed charges,8.45,65,,6.76,percent of total billed charges,65% of total billed charges,4.64,35.67,,3.712,percent of total billed charges,35.67% of total billed charges,3.77,11.7,
XYLOCAINE 1% WITH EPI PER CC,2511692,CDM,250,RC,,,outpatient,,,5,2.00,,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,3.85,77,,3.08,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,4.1,82,,3.28,percent of total billed charges,82% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,4.5,90,,3.6,percent of total billed charges,90% of total billed charges,4,80,,3.2,percent of total billed charges,80% of total billed charges,4.5,90,,3.6,percent of total billed charges,90% of total billed charges,3.75,75,,3,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,1.45,29,,1.16,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,3.35,67,,2.68,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,4,80,,3.2,percent of total billed charges,80% of total billed charges,3.25,65,,2.6,percent of total billed charges,65% of total billed charges,1.78,35.67,,1.424,percent of total billed charges,35.67% of total billed charges,1.45,4.5,
XOPENEX .63 MG/3ML INH,2511696,CDM,250,RC,,,outpatient,,,24,9.60,,20.4,85,,16.32,percent of total billed charges,85% of total billed charges,18.48,77,,14.78,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,19.68,82,,15.744,percent of total billed charges,82% of total billed charges,20.4,85,,16.32,percent of total billed charges,85% of total billed charges,20.4,85,,16.32,percent of total billed charges,85% of total billed charges,20.4,85,,16.32,percent of total billed charges,85% of total billed charges,21.6,90,,17.28,percent of total billed charges,90% of total billed charges,19.2,80,,15.36,percent of total billed charges,80% of total billed charges,21.6,90,,17.28,percent of total billed charges,90% of total billed charges,18,75,,14.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,6.96,29,,5.568,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,16.08,67,,12.864,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,19.2,80,,15.36,percent of total billed charges,80% of total billed charges,15.6,65,,12.48,percent of total billed charges,65% of total billed charges,8.56,35.67,,6.848,percent of total billed charges,35.67% of total billed charges,6.96,21.6,
XOPENEX 1.25 MG/3ML,2511698,CDM,250,RC,,,outpatient,,,24,9.60,,20.4,85,,16.32,percent of total billed charges,85% of total billed charges,18.48,77,,14.78,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,19.68,82,,15.744,percent of total billed charges,82% of total billed charges,20.4,85,,16.32,percent of total billed charges,85% of total billed charges,20.4,85,,16.32,percent of total billed charges,85% of total billed charges,20.4,85,,16.32,percent of total billed charges,85% of total billed charges,21.6,90,,17.28,percent of total billed charges,90% of total billed charges,19.2,80,,15.36,percent of total billed charges,80% of total billed charges,21.6,90,,17.28,percent of total billed charges,90% of total billed charges,18,75,,14.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,6.96,29,,5.568,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,16.08,67,,12.864,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,19.2,80,,15.36,percent of total billed charges,80% of total billed charges,15.6,65,,12.48,percent of total billed charges,65% of total billed charges,8.56,35.67,,6.848,percent of total billed charges,35.67% of total billed charges,6.96,21.6,
XOPENEX 0.31 MG/3ML,2511699,CDM,250,RC,,,outpatient,,,24,9.60,,20.4,85,,16.32,percent of total billed charges,85% of total billed charges,18.48,77,,14.78,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,19.68,82,,15.744,percent of total billed charges,82% of total billed charges,20.4,85,,16.32,percent of total billed charges,85% of total billed charges,20.4,85,,16.32,percent of total billed charges,85% of total billed charges,20.4,85,,16.32,percent of total billed charges,85% of total billed charges,21.6,90,,17.28,percent of total billed charges,90% of total billed charges,19.2,80,,15.36,percent of total billed charges,80% of total billed charges,21.6,90,,17.28,percent of total billed charges,90% of total billed charges,18,75,,14.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,6.96,29,,5.568,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,16.08,67,,12.864,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,19.2,80,,15.36,percent of total billed charges,80% of total billed charges,15.6,65,,12.48,percent of total billed charges,65% of total billed charges,8.56,35.67,,6.848,percent of total billed charges,35.67% of total billed charges,6.96,21.6,
XARELTO 15MG TAB,2511706,CDM,250,RC,,,outpatient,,,51,20.40,,43.35,85,,34.68,percent of total billed charges,85% of total billed charges,39.27,77,,31.42,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,41.82,82,,33.456,percent of total billed charges,82% of total billed charges,43.35,85,,34.68,percent of total billed charges,85% of total billed charges,43.35,85,,34.68,percent of total billed charges,85% of total billed charges,43.35,85,,34.68,percent of total billed charges,85% of total billed charges,45.9,90,,36.72,percent of total billed charges,90% of total billed charges,40.8,80,,32.64,percent of total billed charges,80% of total billed charges,45.9,90,,36.72,percent of total billed charges,90% of total billed charges,38.25,75,,30.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,14.79,29,,11.832,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,34.17,67,,27.336,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,40.8,80,,32.64,percent of total billed charges,80% of total billed charges,33.15,65,,26.52,percent of total billed charges,65% of total billed charges,18.19,35.67,,14.552,percent of total billed charges,35.67% of total billed charges,14.79,45.9,
XARELTO 10 MG TAB,2511707,CDM,250,RC,,,outpatient,,,49,19.60,,41.65,85,,33.32,percent of total billed charges,85% of total billed charges,37.73,77,,30.18,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,40.18,82,,32.144,percent of total billed charges,82% of total billed charges,41.65,85,,33.32,percent of total billed charges,85% of total billed charges,41.65,85,,33.32,percent of total billed charges,85% of total billed charges,41.65,85,,33.32,percent of total billed charges,85% of total billed charges,44.1,90,,35.28,percent of total billed charges,90% of total billed charges,39.2,80,,31.36,percent of total billed charges,80% of total billed charges,44.1,90,,35.28,percent of total billed charges,90% of total billed charges,36.75,75,,29.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,14.21,29,,11.368,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,32.83,67,,26.264,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,39.2,80,,31.36,percent of total billed charges,80% of total billed charges,31.85,65,,25.48,percent of total billed charges,65% of total billed charges,17.48,35.67,,13.984,percent of total billed charges,35.67% of total billed charges,14.21,44.1,
STERILE WATER FOR INJ 20 ML,2511708,CDM,250,RC,,,outpatient,,,28,11.20,,23.8,85,,19.04,percent of total billed charges,85% of total billed charges,21.56,77,,17.25,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,22.96,82,,18.368,percent of total billed charges,82% of total billed charges,23.8,85,,19.04,percent of total billed charges,85% of total billed charges,23.8,85,,19.04,percent of total billed charges,85% of total billed charges,23.8,85,,19.04,percent of total billed charges,85% of total billed charges,25.2,90,,20.16,percent of total billed charges,90% of total billed charges,22.4,80,,17.92,percent of total billed charges,80% of total billed charges,25.2,90,,20.16,percent of total billed charges,90% of total billed charges,21,75,,16.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,8.12,29,,6.496,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,18.76,67,,15.008,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,22.4,80,,17.92,percent of total billed charges,80% of total billed charges,18.2,65,,14.56,percent of total billed charges,65% of total billed charges,9.99,35.67,,7.992,percent of total billed charges,35.67% of total billed charges,8.12,25.2,
XYLOCAINE 2% 50CC INJ,2511710,CDM,250,RC,,,outpatient,,,27,10.80,,22.95,85,,18.36,percent of total billed charges,85% of total billed charges,20.79,77,,16.63,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,22.14,82,,17.712,percent of total billed charges,82% of total billed charges,22.95,85,,18.36,percent of total billed charges,85% of total billed charges,22.95,85,,18.36,percent of total billed charges,85% of total billed charges,22.95,85,,18.36,percent of total billed charges,85% of total billed charges,24.3,90,,19.44,percent of total billed charges,90% of total billed charges,21.6,80,,17.28,percent of total billed charges,80% of total billed charges,24.3,90,,19.44,percent of total billed charges,90% of total billed charges,20.25,75,,16.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,7.83,29,,6.264,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,18.09,67,,14.472,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,21.6,80,,17.28,percent of total billed charges,80% of total billed charges,17.55,65,,14.04,percent of total billed charges,65% of total billed charges,9.63,35.67,,7.704,percent of total billed charges,35.67% of total billed charges,7.83,24.3,
XYLOCAINE 2% 5CC INJ,2511715,CDM,250,RC,,,outpatient,,,16,6.40,,13.6,85,,10.88,percent of total billed charges,85% of total billed charges,12.32,77,,9.86,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,13.12,82,,10.496,percent of total billed charges,82% of total billed charges,13.6,85,,10.88,percent of total billed charges,85% of total billed charges,13.6,85,,10.88,percent of total billed charges,85% of total billed charges,13.6,85,,10.88,percent of total billed charges,85% of total billed charges,14.4,90,,11.52,percent of total billed charges,90% of total billed charges,12.8,80,,10.24,percent of total billed charges,80% of total billed charges,14.4,90,,11.52,percent of total billed charges,90% of total billed charges,12,75,,9.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,4.64,29,,3.712,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,10.72,67,,8.576,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,12.8,80,,10.24,percent of total billed charges,80% of total billed charges,10.4,65,,8.32,percent of total billed charges,65% of total billed charges,5.71,35.67,,4.568,percent of total billed charges,35.67% of total billed charges,4.64,14.4,
XYLOCAINE 4% 50CC INJ,2511720,CDM,250,RC,,,outpatient,,,16,6.40,,13.6,85,,10.88,percent of total billed charges,85% of total billed charges,12.32,77,,9.86,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,13.12,82,,10.496,percent of total billed charges,82% of total billed charges,13.6,85,,10.88,percent of total billed charges,85% of total billed charges,13.6,85,,10.88,percent of total billed charges,85% of total billed charges,13.6,85,,10.88,percent of total billed charges,85% of total billed charges,14.4,90,,11.52,percent of total billed charges,90% of total billed charges,12.8,80,,10.24,percent of total billed charges,80% of total billed charges,14.4,90,,11.52,percent of total billed charges,90% of total billed charges,12,75,,9.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,4.64,29,,3.712,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,10.72,67,,8.576,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,12.8,80,,10.24,percent of total billed charges,80% of total billed charges,10.4,65,,8.32,percent of total billed charges,65% of total billed charges,5.71,35.67,,4.568,percent of total billed charges,35.67% of total billed charges,4.64,14.4,
XYLOCAINE 2.0% MPF 5 ML INJ,2511724,CDM,250,RC,,,outpatient,,,84,33.60,,71.4,85,,57.12,percent of total billed charges,85% of total billed charges,64.68,77,,51.74,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,68.88,82,,55.104,percent of total billed charges,82% of total billed charges,71.4,85,,57.12,percent of total billed charges,85% of total billed charges,71.4,85,,57.12,percent of total billed charges,85% of total billed charges,71.4,85,,57.12,percent of total billed charges,85% of total billed charges,75.6,90,,60.48,percent of total billed charges,90% of total billed charges,67.2,80,,53.76,percent of total billed charges,80% of total billed charges,75.6,90,,60.48,percent of total billed charges,90% of total billed charges,63,75,,50.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,24.36,29,,19.488,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,56.28,67,,45.024,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,67.2,80,,53.76,percent of total billed charges,80% of total billed charges,54.6,65,,43.68,percent of total billed charges,65% of total billed charges,29.96,35.67,,23.968,percent of total billed charges,35.67% of total billed charges,24.36,75.6,
XYLOCAINE 5% 35 GM TOPICAL,2511726,CDM,250,RC,,,outpatient,,,243,97.20,,206.55,85,,165.24,percent of total billed charges,85% of total billed charges,187.11,77,,149.69,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,199.26,82,,159.408,percent of total billed charges,82% of total billed charges,206.55,85,,165.24,percent of total billed charges,85% of total billed charges,206.55,85,,165.24,percent of total billed charges,85% of total billed charges,206.55,85,,165.24,percent of total billed charges,85% of total billed charges,218.7,90,,174.96,percent of total billed charges,90% of total billed charges,194.4,80,,155.52,percent of total billed charges,80% of total billed charges,218.7,90,,174.96,percent of total billed charges,90% of total billed charges,182.25,75,,145.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,70.47,29,,56.376,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,162.81,67,,130.248,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,194.4,80,,155.52,percent of total billed charges,80% of total billed charges,157.95,65,,126.36,percent of total billed charges,65% of total billed charges,86.68,35.67,,69.344,percent of total billed charges,35.67% of total billed charges,70.47,218.7,
XYLOCAINE 4% 5 ML,2511728,CDM,250,RC,,,outpatient,,,29,11.60,,24.65,85,,19.72,percent of total billed charges,85% of total billed charges,22.33,77,,17.86,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,23.78,82,,19.024,percent of total billed charges,82% of total billed charges,24.65,85,,19.72,percent of total billed charges,85% of total billed charges,24.65,85,,19.72,percent of total billed charges,85% of total billed charges,24.65,85,,19.72,percent of total billed charges,85% of total billed charges,26.1,90,,20.88,percent of total billed charges,90% of total billed charges,23.2,80,,18.56,percent of total billed charges,80% of total billed charges,26.1,90,,20.88,percent of total billed charges,90% of total billed charges,21.75,75,,17.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,8.41,29,,6.728,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,19.43,67,,15.544,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,23.2,80,,18.56,percent of total billed charges,80% of total billed charges,18.85,65,,15.08,percent of total billed charges,65% of total billed charges,10.34,35.67,,8.272,percent of total billed charges,35.67% of total billed charges,8.41,26.1,
XYLOCAINE JELLY 2% 30ML TOPI.,2511730,CDM,250,RC,,,outpatient,,,77,30.80,,65.45,85,,52.36,percent of total billed charges,85% of total billed charges,59.29,77,,47.43,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,63.14,82,,50.512,percent of total billed charges,82% of total billed charges,65.45,85,,52.36,percent of total billed charges,85% of total billed charges,65.45,85,,52.36,percent of total billed charges,85% of total billed charges,65.45,85,,52.36,percent of total billed charges,85% of total billed charges,69.3,90,,55.44,percent of total billed charges,90% of total billed charges,61.6,80,,49.28,percent of total billed charges,80% of total billed charges,69.3,90,,55.44,percent of total billed charges,90% of total billed charges,57.75,75,,46.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,22.33,29,,17.864,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,51.59,67,,41.272,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,61.6,80,,49.28,percent of total billed charges,80% of total billed charges,50.05,65,,40.04,percent of total billed charges,65% of total billed charges,27.47,35.67,,21.976,percent of total billed charges,35.67% of total billed charges,22.33,69.3,
XYLOCAINE 2% JELLY 5 ML TOPICA,2511731,CDM,250,RC,,,outpatient,,,32,12.80,,27.2,85,,21.76,percent of total billed charges,85% of total billed charges,24.64,77,,19.71,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,26.24,82,,20.992,percent of total billed charges,82% of total billed charges,27.2,85,,21.76,percent of total billed charges,85% of total billed charges,27.2,85,,21.76,percent of total billed charges,85% of total billed charges,27.2,85,,21.76,percent of total billed charges,85% of total billed charges,28.8,90,,23.04,percent of total billed charges,90% of total billed charges,25.6,80,,20.48,percent of total billed charges,80% of total billed charges,28.8,90,,23.04,percent of total billed charges,90% of total billed charges,24,75,,19.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,9.28,29,,7.424,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,21.44,67,,17.152,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,25.6,80,,20.48,percent of total billed charges,80% of total billed charges,20.8,65,,16.64,percent of total billed charges,65% of total billed charges,11.41,35.67,,9.128,percent of total billed charges,35.67% of total billed charges,9.28,28.8,
LIDOCAINE 1% MPF 2 ML VIAL,2511732,CDM,250,RC,,,outpatient,,,15,6.00,,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,11.55,77,,9.24,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,12.3,82,,9.84,percent of total billed charges,82% of total billed charges,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,13.5,90,,10.8,percent of total billed charges,90% of total billed charges,12,80,,9.6,percent of total billed charges,80% of total billed charges,13.5,90,,10.8,percent of total billed charges,90% of total billed charges,11.25,75,,9,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,4.35,29,,3.48,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,10.05,67,,8.04,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,12,80,,9.6,percent of total billed charges,80% of total billed charges,9.75,65,,7.8,percent of total billed charges,65% of total billed charges,5.35,35.67,,4.28,percent of total billed charges,35.67% of total billed charges,4.35,13.5,
LIDOCAINE MPF 1% 5 ML VIAL,2511733,CDM,250,RC,,,outpatient,,,17,6.80,,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,13.09,77,,10.47,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,13.94,82,,11.152,percent of total billed charges,82% of total billed charges,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,15.3,90,,12.24,percent of total billed charges,90% of total billed charges,13.6,80,,10.88,percent of total billed charges,80% of total billed charges,15.3,90,,12.24,percent of total billed charges,90% of total billed charges,12.75,75,,10.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,4.93,29,,3.944,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,11.39,67,,9.112,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,13.6,80,,10.88,percent of total billed charges,80% of total billed charges,11.05,65,,8.84,percent of total billed charges,65% of total billed charges,6.06,35.67,,4.848,percent of total billed charges,35.67% of total billed charges,4.93,15.3,
XYLOCAINE VISCOUS 2% SOLUTION,2511738,CDM,250,RC,,,outpatient,,,13,5.20,,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,10.01,77,,8.01,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,10.66,82,,8.528,percent of total billed charges,82% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,11.7,90,,9.36,percent of total billed charges,90% of total billed charges,10.4,80,,8.32,percent of total billed charges,80% of total billed charges,11.7,90,,9.36,percent of total billed charges,90% of total billed charges,9.75,75,,7.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,3.77,29,,3.016,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,8.71,67,,6.968,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,10.4,80,,8.32,percent of total billed charges,80% of total billed charges,8.45,65,,6.76,percent of total billed charges,65% of total billed charges,4.64,35.67,,3.712,percent of total billed charges,35.67% of total billed charges,3.77,11.7,
XYLOCAINE W/EPI. 2% INJ,2511745,CDM,250,RC,,,outpatient,,,71,28.40,,60.35,85,,48.28,percent of total billed charges,85% of total billed charges,54.67,77,,43.74,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,58.22,82,,46.576,percent of total billed charges,82% of total billed charges,60.35,85,,48.28,percent of total billed charges,85% of total billed charges,60.35,85,,48.28,percent of total billed charges,85% of total billed charges,60.35,85,,48.28,percent of total billed charges,85% of total billed charges,63.9,90,,51.12,percent of total billed charges,90% of total billed charges,56.8,80,,45.44,percent of total billed charges,80% of total billed charges,63.9,90,,51.12,percent of total billed charges,90% of total billed charges,53.25,75,,42.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,20.59,29,,16.472,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,47.57,67,,38.056,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,56.8,80,,45.44,percent of total billed charges,80% of total billed charges,46.15,65,,36.92,percent of total billed charges,65% of total billed charges,25.33,35.67,,20.264,percent of total billed charges,35.67% of total billed charges,20.59,63.9,
XYLOCAINE 2% EPI 50 ML INJ,2511746,CDM,250,RC,,,outpatient,,,29,11.60,,24.65,85,,19.72,percent of total billed charges,85% of total billed charges,22.33,77,,17.86,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,23.78,82,,19.024,percent of total billed charges,82% of total billed charges,24.65,85,,19.72,percent of total billed charges,85% of total billed charges,24.65,85,,19.72,percent of total billed charges,85% of total billed charges,24.65,85,,19.72,percent of total billed charges,85% of total billed charges,26.1,90,,20.88,percent of total billed charges,90% of total billed charges,23.2,80,,18.56,percent of total billed charges,80% of total billed charges,26.1,90,,20.88,percent of total billed charges,90% of total billed charges,21.75,75,,17.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,8.41,29,,6.728,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,19.43,67,,15.544,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,23.2,80,,18.56,percent of total billed charges,80% of total billed charges,18.85,65,,15.08,percent of total billed charges,65% of total billed charges,10.34,35.67,,8.272,percent of total billed charges,35.67% of total billed charges,8.41,26.1,
XYLOCAIN 2% EPI 10 INJ,2511747,CDM,250,RC,,,outpatient,,,44,17.60,,37.4,85,,29.92,percent of total billed charges,85% of total billed charges,33.88,77,,27.1,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,36.08,82,,28.864,percent of total billed charges,82% of total billed charges,37.4,85,,29.92,percent of total billed charges,85% of total billed charges,37.4,85,,29.92,percent of total billed charges,85% of total billed charges,37.4,85,,29.92,percent of total billed charges,85% of total billed charges,39.6,90,,31.68,percent of total billed charges,90% of total billed charges,35.2,80,,28.16,percent of total billed charges,80% of total billed charges,39.6,90,,31.68,percent of total billed charges,90% of total billed charges,33,75,,26.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,12.76,29,,10.208,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,29.48,67,,23.584,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,35.2,80,,28.16,percent of total billed charges,80% of total billed charges,28.6,65,,22.88,percent of total billed charges,65% of total billed charges,15.69,35.67,,12.552,percent of total billed charges,35.67% of total billed charges,12.76,39.6,
XYLOCAINE 2% PER CC,2511772,CDM,250,RC,,,outpatient,,,10,4.00,,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,7.7,77,,6.16,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,8.2,82,,6.56,percent of total billed charges,82% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,9,90,,7.2,percent of total billed charges,90% of total billed charges,8,80,,6.4,percent of total billed charges,80% of total billed charges,9,90,,7.2,percent of total billed charges,90% of total billed charges,7.5,75,,6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.9,29,,2.32,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,6.7,67,,5.36,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,8,80,,6.4,percent of total billed charges,80% of total billed charges,6.5,65,,5.2,percent of total billed charges,65% of total billed charges,3.57,35.67,,2.856,percent of total billed charges,35.67% of total billed charges,2.9,9,
ZAROXOLYN TAB 2.5 MG,2511800,CDM,250,RC,,,outpatient,,,12,4.80,,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,9.24,77,,7.39,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,9.84,82,,7.872,percent of total billed charges,82% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,10.8,90,,8.64,percent of total billed charges,90% of total billed charges,9.6,80,,7.68,percent of total billed charges,80% of total billed charges,10.8,90,,8.64,percent of total billed charges,90% of total billed charges,9,75,,7.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,3.48,29,,2.784,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,8.04,67,,6.432,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,9.6,80,,7.68,percent of total billed charges,80% of total billed charges,7.8,65,,6.24,percent of total billed charges,65% of total billed charges,4.28,35.67,,3.424,percent of total billed charges,35.67% of total billed charges,3.48,10.8,
ZEBETA 5 MG PO,2511807,CDM,250,RC,,,outpatient,,,22,8.80,,18.7,85,,14.96,percent of total billed charges,85% of total billed charges,16.94,77,,13.55,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,18.04,82,,14.432,percent of total billed charges,82% of total billed charges,18.7,85,,14.96,percent of total billed charges,85% of total billed charges,18.7,85,,14.96,percent of total billed charges,85% of total billed charges,18.7,85,,14.96,percent of total billed charges,85% of total billed charges,19.8,90,,15.84,percent of total billed charges,90% of total billed charges,17.6,80,,14.08,percent of total billed charges,80% of total billed charges,19.8,90,,15.84,percent of total billed charges,90% of total billed charges,16.5,75,,13.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,6.38,29,,5.104,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,14.74,67,,11.792,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,17.6,80,,14.08,percent of total billed charges,80% of total billed charges,14.3,65,,11.44,percent of total billed charges,65% of total billed charges,7.85,35.67,,6.28,percent of total billed charges,35.67% of total billed charges,6.38,19.8,
ZEMURON 10 MG/ML INJ,2511809,CDM,250,RC,,,outpatient,,,94,37.60,,79.9,85,,63.92,percent of total billed charges,85% of total billed charges,72.38,77,,57.9,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,77.08,82,,61.664,percent of total billed charges,82% of total billed charges,79.9,85,,63.92,percent of total billed charges,85% of total billed charges,79.9,85,,63.92,percent of total billed charges,85% of total billed charges,79.9,85,,63.92,percent of total billed charges,85% of total billed charges,84.6,90,,67.68,percent of total billed charges,90% of total billed charges,75.2,80,,60.16,percent of total billed charges,80% of total billed charges,84.6,90,,67.68,percent of total billed charges,90% of total billed charges,70.5,75,,56.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,27.26,29,,21.808,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,62.98,67,,50.384,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,75.2,80,,60.16,percent of total billed charges,80% of total billed charges,61.1,65,,48.88,percent of total billed charges,65% of total billed charges,33.53,35.67,,26.824,percent of total billed charges,35.67% of total billed charges,27.26,84.6,
ZEMURON 100MG VIAL,2511814,CDM,250,RC,,,outpatient,,,73,29.20,,62.05,85,,49.64,percent of total billed charges,85% of total billed charges,56.21,77,,44.97,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,59.86,82,,47.888,percent of total billed charges,82% of total billed charges,62.05,85,,49.64,percent of total billed charges,85% of total billed charges,62.05,85,,49.64,percent of total billed charges,85% of total billed charges,62.05,85,,49.64,percent of total billed charges,85% of total billed charges,65.7,90,,52.56,percent of total billed charges,90% of total billed charges,58.4,80,,46.72,percent of total billed charges,80% of total billed charges,65.7,90,,52.56,percent of total billed charges,90% of total billed charges,54.75,75,,43.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,21.17,29,,16.936,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,48.91,67,,39.128,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,58.4,80,,46.72,percent of total billed charges,80% of total billed charges,47.45,65,,37.96,percent of total billed charges,65% of total billed charges,26.04,35.67,,20.832,percent of total billed charges,35.67% of total billed charges,21.17,65.7,
ZETIA 10 MG TAB,2511836,CDM,250,RC,,,outpatient,,,25,10.00,,21.25,85,,17,percent of total billed charges,85% of total billed charges,19.25,77,,15.4,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,20.5,82,,16.4,percent of total billed charges,82% of total billed charges,21.25,85,,17,percent of total billed charges,85% of total billed charges,21.25,85,,17,percent of total billed charges,85% of total billed charges,21.25,85,,17,percent of total billed charges,85% of total billed charges,22.5,90,,18,percent of total billed charges,90% of total billed charges,20,80,,16,percent of total billed charges,80% of total billed charges,22.5,90,,18,percent of total billed charges,90% of total billed charges,18.75,75,,15,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,7.25,29,,5.8,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,16.75,67,,13.4,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,20,80,,16,percent of total billed charges,80% of total billed charges,16.25,65,,13,percent of total billed charges,65% of total billed charges,8.92,35.67,,7.136,percent of total billed charges,35.67% of total billed charges,7.25,22.5,
ZINC OXIDE OINT 1 OZ,2511860,CDM,250,RC,,,outpatient,,,13,5.20,,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,10.01,77,,8.01,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,10.66,82,,8.528,percent of total billed charges,82% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,11.7,90,,9.36,percent of total billed charges,90% of total billed charges,10.4,80,,8.32,percent of total billed charges,80% of total billed charges,11.7,90,,9.36,percent of total billed charges,90% of total billed charges,9.75,75,,7.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,3.77,29,,3.016,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,8.71,67,,6.968,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,10.4,80,,8.32,percent of total billed charges,80% of total billed charges,8.45,65,,6.76,percent of total billed charges,65% of total billed charges,4.64,35.67,,3.712,percent of total billed charges,35.67% of total billed charges,3.77,11.7,
ZINC SULFATE 325 MG TAB,2511875,CDM,250,RC,,,outpatient,,,7,2.80,,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.39,77,,4.31,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,5.74,82,,4.592,percent of total billed charges,82% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.25,75,,4.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.03,29,,1.624,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4.69,67,,3.752,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,4.55,65,,3.64,percent of total billed charges,65% of total billed charges,2.5,35.67,,2,percent of total billed charges,35.67% of total billed charges,2.03,6.3,
AZITHROMYCIN 200 MG-5,2511888,CDM,250,RC,J8499,HCPCS,outpatient,,,74,29.60,,62.9,85,,50.32,percent of total billed charges,85% of total billed charges,56.98,77,,45.58,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,60.68,82,,48.544,percent of total billed charges,82% of total billed charges,62.9,85,,50.32,percent of total billed charges,85% of total billed charges,62.9,85,,50.32,percent of total billed charges,85% of total billed charges,62.9,85,,50.32,percent of total billed charges,85% of total billed charges,66.6,90,,53.28,percent of total billed charges,90% of total billed charges,59.2,80,,47.36,percent of total billed charges,80% of total billed charges,66.6,90,,53.28,percent of total billed charges,90% of total billed charges,55.5,75,,44.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,21.46,29,,17.168,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,49.58,67,,39.664,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,59.2,80,,47.36,percent of total billed charges,80% of total billed charges,48.1,65,,38.48,percent of total billed charges,65% of total billed charges,26.4,35.67,,21.12,percent of total billed charges,35.67% of total billed charges,21.46,66.6,
ZOFRAN 4 MG ODT TAB,2511892,CDM,250,RC,J8597,HCPCS,outpatient,,,93,37.20,,79.05,85,,63.24,percent of total billed charges,85% of total billed charges,71.61,77,,57.29,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,76.26,82,,61.008,percent of total billed charges,82% of total billed charges,79.05,85,,63.24,percent of total billed charges,85% of total billed charges,79.05,85,,63.24,percent of total billed charges,85% of total billed charges,79.05,85,,63.24,percent of total billed charges,85% of total billed charges,83.7,90,,66.96,percent of total billed charges,90% of total billed charges,74.4,80,,59.52,percent of total billed charges,80% of total billed charges,83.7,90,,66.96,percent of total billed charges,90% of total billed charges,69.75,75,,55.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,26.97,29,,21.576,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,62.31,67,,49.848,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,74.4,80,,59.52,percent of total billed charges,80% of total billed charges,60.45,65,,48.36,percent of total billed charges,65% of total billed charges,33.17,35.67,,26.536,percent of total billed charges,35.67% of total billed charges,26.97,83.7,
ZOLOFT 50 MG TAB,2511905,CDM,250,RC,,,outpatient,,,23,9.20,,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,17.71,77,,14.17,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,18.86,82,,15.088,percent of total billed charges,82% of total billed charges,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,20.7,90,,16.56,percent of total billed charges,90% of total billed charges,18.4,80,,14.72,percent of total billed charges,80% of total billed charges,20.7,90,,16.56,percent of total billed charges,90% of total billed charges,17.25,75,,13.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,6.67,29,,5.336,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,15.41,67,,12.328,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,18.4,80,,14.72,percent of total billed charges,80% of total billed charges,14.95,65,,11.96,percent of total billed charges,65% of total billed charges,8.2,35.67,,6.56,percent of total billed charges,35.67% of total billed charges,6.67,20.7,
ZOLYSE 750 UNITS INJ,2511910,CDM,250,RC,,,outpatient,,,10,4.00,,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,7.7,77,,6.16,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,8.2,82,,6.56,percent of total billed charges,82% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,9,90,,7.2,percent of total billed charges,90% of total billed charges,8,80,,6.4,percent of total billed charges,80% of total billed charges,9,90,,7.2,percent of total billed charges,90% of total billed charges,7.5,75,,6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.9,29,,2.32,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,6.7,67,,5.36,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,8,80,,6.4,percent of total billed charges,80% of total billed charges,6.5,65,,5.2,percent of total billed charges,65% of total billed charges,3.57,35.67,,2.856,percent of total billed charges,35.67% of total billed charges,2.9,9,
ZOVIRAX 5% CREAM (5 GRAM TUBE),2511938,CDM,250,RC,,,outpatient,,,2184,873.60,,1856.4,85,,1485.12,percent of total billed charges,85% of total billed charges,1681.68,77,,1345.34,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,1790.88,82,,1432.704,percent of total billed charges,82% of total billed charges,1856.4,85,,1485.12,percent of total billed charges,85% of total billed charges,1856.4,85,,1485.12,percent of total billed charges,85% of total billed charges,1856.4,85,,1485.12,percent of total billed charges,85% of total billed charges,1965.6,90,,1572.48,percent of total billed charges,90% of total billed charges,1747.2,80,,1397.76,percent of total billed charges,80% of total billed charges,1965.6,90,,1572.48,percent of total billed charges,90% of total billed charges,1638,75,,1310.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,633.36,29,,506.688,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1463.28,67,,1170.624,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1747.2,80,,1397.76,percent of total billed charges,80% of total billed charges,1419.6,65,,1135.68,percent of total billed charges,65% of total billed charges,779.03,35.67,,623.224,percent of total billed charges,35.67% of total billed charges,633.36,1965.6,
ZOVIRAX TAB 200 MG,2511945,CDM,250,RC,,,outpatient,,,15,6.00,,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,11.55,77,,9.24,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,12.3,82,,9.84,percent of total billed charges,82% of total billed charges,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,13.5,90,,10.8,percent of total billed charges,90% of total billed charges,12,80,,9.6,percent of total billed charges,80% of total billed charges,13.5,90,,10.8,percent of total billed charges,90% of total billed charges,11.25,75,,9,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,4.35,29,,3.48,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,10.05,67,,8.04,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,12,80,,9.6,percent of total billed charges,80% of total billed charges,9.75,65,,7.8,percent of total billed charges,65% of total billed charges,5.35,35.67,,4.28,percent of total billed charges,35.67% of total billed charges,4.35,13.5,
ZOVIRAX 200 MG/5ML UDC,2511954,CDM,250,RC,,,outpatient,,,19,7.60,,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,14.63,77,,11.7,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,15.58,82,,12.464,percent of total billed charges,82% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,15.2,80,,12.16,percent of total billed charges,80% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,14.25,75,,11.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,5.51,29,,4.408,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,12.73,67,,10.184,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,15.2,80,,12.16,percent of total billed charges,80% of total billed charges,12.35,65,,9.88,percent of total billed charges,65% of total billed charges,6.78,35.67,,5.424,percent of total billed charges,35.67% of total billed charges,5.51,17.1,
ZYLOPRIM 100 MG TAB,2511955,CDM,250,RC,,,outpatient,,,7,2.80,,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.39,77,,4.31,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,5.74,82,,4.592,percent of total billed charges,82% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.25,75,,4.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.03,29,,1.624,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4.69,67,,3.752,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,4.55,65,,3.64,percent of total billed charges,65% of total billed charges,2.5,35.67,,2,percent of total billed charges,35.67% of total billed charges,2.03,6.3,
ZYLOPRIM 300 MG TAB,2511960,CDM,250,RC,,,outpatient,,,15,6.00,,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,11.55,77,,9.24,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,12.3,82,,9.84,percent of total billed charges,82% of total billed charges,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,13.5,90,,10.8,percent of total billed charges,90% of total billed charges,12,80,,9.6,percent of total billed charges,80% of total billed charges,13.5,90,,10.8,percent of total billed charges,90% of total billed charges,11.25,75,,9,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,4.35,29,,3.48,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,10.05,67,,8.04,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,12,80,,9.6,percent of total billed charges,80% of total billed charges,9.75,65,,7.8,percent of total billed charges,65% of total billed charges,5.35,35.67,,4.28,percent of total billed charges,35.67% of total billed charges,4.35,13.5,
ZYPREXA 2.5 MG PO,2511962,CDM,250,RC,,,outpatient,,,52,20.80,,44.2,85,,35.36,percent of total billed charges,85% of total billed charges,40.04,77,,32.03,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,42.64,82,,34.112,percent of total billed charges,82% of total billed charges,44.2,85,,35.36,percent of total billed charges,85% of total billed charges,44.2,85,,35.36,percent of total billed charges,85% of total billed charges,44.2,85,,35.36,percent of total billed charges,85% of total billed charges,46.8,90,,37.44,percent of total billed charges,90% of total billed charges,41.6,80,,33.28,percent of total billed charges,80% of total billed charges,46.8,90,,37.44,percent of total billed charges,90% of total billed charges,39,75,,31.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,15.08,29,,12.064,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,34.84,67,,27.872,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,41.6,80,,33.28,percent of total billed charges,80% of total billed charges,33.8,65,,27.04,percent of total billed charges,65% of total billed charges,18.55,35.67,,14.84,percent of total billed charges,35.67% of total billed charges,15.08,46.8,
ZYPREXA 10 MG PO,2511963,CDM,250,RC,,,outpatient,,,83,33.20,,70.55,85,,56.44,percent of total billed charges,85% of total billed charges,63.91,77,,51.13,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,68.06,82,,54.448,percent of total billed charges,82% of total billed charges,70.55,85,,56.44,percent of total billed charges,85% of total billed charges,70.55,85,,56.44,percent of total billed charges,85% of total billed charges,70.55,85,,56.44,percent of total billed charges,85% of total billed charges,74.7,90,,59.76,percent of total billed charges,90% of total billed charges,66.4,80,,53.12,percent of total billed charges,80% of total billed charges,74.7,90,,59.76,percent of total billed charges,90% of total billed charges,62.25,75,,49.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,24.07,29,,19.256,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,55.61,67,,44.488,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,66.4,80,,53.12,percent of total billed charges,80% of total billed charges,53.95,65,,43.16,percent of total billed charges,65% of total billed charges,29.61,35.67,,23.688,percent of total billed charges,35.67% of total billed charges,24.07,74.7,
ZYRTEC 10 MG TAB,2511965,CDM,250,RC,,,outpatient,,,13,5.20,,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,10.01,77,,8.01,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,10.66,82,,8.528,percent of total billed charges,82% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,11.7,90,,9.36,percent of total billed charges,90% of total billed charges,10.4,80,,8.32,percent of total billed charges,80% of total billed charges,11.7,90,,9.36,percent of total billed charges,90% of total billed charges,9.75,75,,7.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,3.77,29,,3.016,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,8.71,67,,6.968,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,10.4,80,,8.32,percent of total billed charges,80% of total billed charges,8.45,65,,6.76,percent of total billed charges,65% of total billed charges,4.64,35.67,,3.712,percent of total billed charges,35.67% of total billed charges,3.77,11.7,
ZYVOX 600 MG TAB,2511971,CDM,250,RC,,,outpatient,,,391,156.40,,332.35,85,,265.88,percent of total billed charges,85% of total billed charges,301.07,77,,240.86,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,320.62,82,,256.496,percent of total billed charges,82% of total billed charges,332.35,85,,265.88,percent of total billed charges,85% of total billed charges,332.35,85,,265.88,percent of total billed charges,85% of total billed charges,332.35,85,,265.88,percent of total billed charges,85% of total billed charges,351.9,90,,281.52,percent of total billed charges,90% of total billed charges,312.8,80,,250.24,percent of total billed charges,80% of total billed charges,351.9,90,,281.52,percent of total billed charges,90% of total billed charges,293.25,75,,234.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,113.39,29,,90.712,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,261.97,67,,209.576,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,312.8,80,,250.24,percent of total billed charges,80% of total billed charges,254.15,65,,203.32,percent of total billed charges,65% of total billed charges,139.47,35.67,,111.576,percent of total billed charges,35.67% of total billed charges,113.39,351.9,
DEXTROSE 10% 500 ML IN WATER,2512922,CDM,250,RC,,,outpatient,,,88,35.20,,74.8,85,,59.84,percent of total billed charges,85% of total billed charges,67.76,77,,54.21,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,72.16,82,,57.728,percent of total billed charges,82% of total billed charges,74.8,85,,59.84,percent of total billed charges,85% of total billed charges,74.8,85,,59.84,percent of total billed charges,85% of total billed charges,74.8,85,,59.84,percent of total billed charges,85% of total billed charges,79.2,90,,63.36,percent of total billed charges,90% of total billed charges,70.4,80,,56.32,percent of total billed charges,80% of total billed charges,79.2,90,,63.36,percent of total billed charges,90% of total billed charges,66,75,,52.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,25.52,29,,20.416,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,58.96,67,,47.168,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,70.4,80,,56.32,percent of total billed charges,80% of total billed charges,57.2,65,,45.76,percent of total billed charges,65% of total billed charges,31.39,35.67,,25.112,percent of total billed charges,35.67% of total billed charges,25.52,79.2,
NYSTATIN-TRIAMCIN CREAM,2512923,CDM,250,RC,,,outpatient,,,490,196.00,,416.5,85,,333.2,percent of total billed charges,85% of total billed charges,377.3,77,,301.84,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,401.8,82,,321.44,percent of total billed charges,82% of total billed charges,416.5,85,,333.2,percent of total billed charges,85% of total billed charges,416.5,85,,333.2,percent of total billed charges,85% of total billed charges,416.5,85,,333.2,percent of total billed charges,85% of total billed charges,441,90,,352.8,percent of total billed charges,90% of total billed charges,392,80,,313.6,percent of total billed charges,80% of total billed charges,441,90,,352.8,percent of total billed charges,90% of total billed charges,367.5,75,,294,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,142.1,29,,113.68,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,328.3,67,,262.64,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,392,80,,313.6,percent of total billed charges,80% of total billed charges,318.5,65,,254.8,percent of total billed charges,65% of total billed charges,174.78,35.67,,139.824,percent of total billed charges,35.67% of total billed charges,142.1,441,
LIDOCAINE HCL 1% 30 ML,2513149,CDM,250,RC,,,outpatient,,,15,6.00,,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,11.55,77,,9.24,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,12.3,82,,9.84,percent of total billed charges,82% of total billed charges,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,13.5,90,,10.8,percent of total billed charges,90% of total billed charges,12,80,,9.6,percent of total billed charges,80% of total billed charges,13.5,90,,10.8,percent of total billed charges,90% of total billed charges,11.25,75,,9,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,4.35,29,,3.48,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,10.05,67,,8.04,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,12,80,,9.6,percent of total billed charges,80% of total billed charges,9.75,65,,7.8,percent of total billed charges,65% of total billed charges,5.35,35.67,,4.28,percent of total billed charges,35.67% of total billed charges,4.35,13.5,
LIDOCAINE WITH EPI 1%  10 ML,2513151,CDM,250,RC,,,outpatient,,,23,9.20,,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,17.71,77,,14.17,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,18.86,82,,15.088,percent of total billed charges,82% of total billed charges,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,20.7,90,,16.56,percent of total billed charges,90% of total billed charges,18.4,80,,14.72,percent of total billed charges,80% of total billed charges,20.7,90,,16.56,percent of total billed charges,90% of total billed charges,17.25,75,,13.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,6.67,29,,5.336,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,15.41,67,,12.328,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,18.4,80,,14.72,percent of total billed charges,80% of total billed charges,14.95,65,,11.96,percent of total billed charges,65% of total billed charges,8.2,35.67,,6.56,percent of total billed charges,35.67% of total billed charges,6.67,20.7,
LISINOPRIL 10 MG PO,2513159,CDM,250,RC,,,outpatient,,,9,3.60,,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,6.93,77,,5.54,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,7.38,82,,5.904,percent of total billed charges,82% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,8.1,90,,6.48,percent of total billed charges,90% of total billed charges,7.2,80,,5.76,percent of total billed charges,80% of total billed charges,8.1,90,,6.48,percent of total billed charges,90% of total billed charges,6.75,75,,5.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.61,29,,2.088,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,6.03,67,,4.824,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,7.2,80,,5.76,percent of total billed charges,80% of total billed charges,5.85,65,,4.68,percent of total billed charges,65% of total billed charges,3.21,35.67,,2.568,percent of total billed charges,35.67% of total billed charges,2.61,8.1,
SILDENAFIL 20 MG PO,2513515,CDM,250,RC,,,outpatient,,,62,24.80,,52.7,85,,42.16,percent of total billed charges,85% of total billed charges,47.74,77,,38.19,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,50.84,82,,40.672,percent of total billed charges,82% of total billed charges,52.7,85,,42.16,percent of total billed charges,85% of total billed charges,52.7,85,,42.16,percent of total billed charges,85% of total billed charges,52.7,85,,42.16,percent of total billed charges,85% of total billed charges,55.8,90,,44.64,percent of total billed charges,90% of total billed charges,49.6,80,,39.68,percent of total billed charges,80% of total billed charges,55.8,90,,44.64,percent of total billed charges,90% of total billed charges,46.5,75,,37.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,17.98,29,,14.384,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,41.54,67,,33.232,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,49.6,80,,39.68,percent of total billed charges,80% of total billed charges,40.3,65,,32.24,percent of total billed charges,65% of total billed charges,22.12,35.67,,17.696,percent of total billed charges,35.67% of total billed charges,17.98,55.8,
KETAMINE 10 ML,2515321,CDM,250,RC,,,outpatient,,,18,7.20,,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,13.86,77,,11.09,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,14.76,82,,11.808,percent of total billed charges,82% of total billed charges,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,16.2,90,,12.96,percent of total billed charges,90% of total billed charges,14.4,80,,11.52,percent of total billed charges,80% of total billed charges,16.2,90,,12.96,percent of total billed charges,90% of total billed charges,13.5,75,,10.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,5.22,29,,4.176,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,12.06,67,,9.648,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,14.4,80,,11.52,percent of total billed charges,80% of total billed charges,11.7,65,,9.36,percent of total billed charges,65% of total billed charges,6.42,35.67,,5.136,percent of total billed charges,35.67% of total billed charges,5.22,16.2,
STERILE WATER INJ 10 ML VIAL,2518555,CDM,250,RC,,,outpatient,,,13,5.20,,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,10.01,77,,8.01,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,10.66,82,,8.528,percent of total billed charges,82% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,11.7,90,,9.36,percent of total billed charges,90% of total billed charges,10.4,80,,8.32,percent of total billed charges,80% of total billed charges,11.7,90,,9.36,percent of total billed charges,90% of total billed charges,9.75,75,,7.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,3.77,29,,3.016,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,8.71,67,,6.968,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,10.4,80,,8.32,percent of total billed charges,80% of total billed charges,8.45,65,,6.76,percent of total billed charges,65% of total billed charges,4.64,35.67,,3.712,percent of total billed charges,35.67% of total billed charges,3.77,11.7,
LOSARTAN POTASSIUM 50 MG PO,2519909,CDM,250,RC,,,outpatient,,,13,5.20,,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,10.01,77,,8.01,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,10.66,82,,8.528,percent of total billed charges,82% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,11.7,90,,9.36,percent of total billed charges,90% of total billed charges,10.4,80,,8.32,percent of total billed charges,80% of total billed charges,11.7,90,,9.36,percent of total billed charges,90% of total billed charges,9.75,75,,7.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,3.77,29,,3.016,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,8.71,67,,6.968,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,10.4,80,,8.32,percent of total billed charges,80% of total billed charges,8.45,65,,6.76,percent of total billed charges,65% of total billed charges,4.64,35.67,,3.712,percent of total billed charges,35.67% of total billed charges,3.77,11.7,
TRYPAN BLUE 0.5 MG INJ,2519911,CDM,250,RC,,,outpatient,,,63,25.20,,53.55,85,,42.84,percent of total billed charges,85% of total billed charges,48.51,77,,38.81,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,51.66,82,,41.328,percent of total billed charges,82% of total billed charges,53.55,85,,42.84,percent of total billed charges,85% of total billed charges,53.55,85,,42.84,percent of total billed charges,85% of total billed charges,53.55,85,,42.84,percent of total billed charges,85% of total billed charges,56.7,90,,45.36,percent of total billed charges,90% of total billed charges,50.4,80,,40.32,percent of total billed charges,80% of total billed charges,56.7,90,,45.36,percent of total billed charges,90% of total billed charges,47.25,75,,37.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,18.27,29,,14.616,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,42.21,67,,33.768,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,50.4,80,,40.32,percent of total billed charges,80% of total billed charges,40.95,65,,32.76,percent of total billed charges,65% of total billed charges,22.47,35.67,,17.976,percent of total billed charges,35.67% of total billed charges,18.27,56.7,
MAG DELAY 64 MG PO,2519915,CDM,250,RC,,,outpatient,,,6,2.40,,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,4.62,77,,3.7,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,4.92,82,,3.936,percent of total billed charges,82% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,5.4,90,,4.32,percent of total billed charges,90% of total billed charges,4.8,80,,3.84,percent of total billed charges,80% of total billed charges,5.4,90,,4.32,percent of total billed charges,90% of total billed charges,4.5,75,,3.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,1.74,29,,1.392,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4.02,67,,3.216,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,4.8,80,,3.84,percent of total billed charges,80% of total billed charges,3.9,65,,3.12,percent of total billed charges,65% of total billed charges,2.14,35.67,,1.712,percent of total billed charges,35.67% of total billed charges,1.74,5.4,
BYSTOLIC 5 MG PO,2519988,CDM,250,RC,,,outpatient,,,13,5.20,,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,10.01,77,,8.01,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,10.66,82,,8.528,percent of total billed charges,82% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,11.7,90,,9.36,percent of total billed charges,90% of total billed charges,10.4,80,,8.32,percent of total billed charges,80% of total billed charges,11.7,90,,9.36,percent of total billed charges,90% of total billed charges,9.75,75,,7.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,3.77,29,,3.016,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,8.71,67,,6.968,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,10.4,80,,8.32,percent of total billed charges,80% of total billed charges,8.45,65,,6.76,percent of total billed charges,65% of total billed charges,4.64,35.67,,3.712,percent of total billed charges,35.67% of total billed charges,3.77,11.7,
BYSTOLIC 10 MG PO,2519989,CDM,250,RC,,,outpatient,,,13,5.20,,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,10.01,77,,8.01,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,10.66,82,,8.528,percent of total billed charges,82% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,11.7,90,,9.36,percent of total billed charges,90% of total billed charges,10.4,80,,8.32,percent of total billed charges,80% of total billed charges,11.7,90,,9.36,percent of total billed charges,90% of total billed charges,9.75,75,,7.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,3.77,29,,3.016,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,8.71,67,,6.968,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,10.4,80,,8.32,percent of total billed charges,80% of total billed charges,8.45,65,,6.76,percent of total billed charges,65% of total billed charges,4.64,35.67,,3.712,percent of total billed charges,35.67% of total billed charges,3.77,11.7,
STERILE WATER 250 ML BAG,2519996,CDM,250,RC,,,outpatient,,,13,5.20,,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,10.01,77,,8.01,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,10.66,82,,8.528,percent of total billed charges,82% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,11.7,90,,9.36,percent of total billed charges,90% of total billed charges,10.4,80,,8.32,percent of total billed charges,80% of total billed charges,11.7,90,,9.36,percent of total billed charges,90% of total billed charges,9.75,75,,7.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,3.77,29,,3.016,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,8.71,67,,6.968,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,10.4,80,,8.32,percent of total billed charges,80% of total billed charges,8.45,65,,6.76,percent of total billed charges,65% of total billed charges,4.64,35.67,,3.712,percent of total billed charges,35.67% of total billed charges,3.77,11.7,
SODIUM BICARBONATE 10 ML 4.25%,2520920,CDM,250,RC,,,outpatient,,,49,19.60,,41.65,85,,33.32,percent of total billed charges,85% of total billed charges,37.73,77,,30.18,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,40.18,82,,32.144,percent of total billed charges,82% of total billed charges,41.65,85,,33.32,percent of total billed charges,85% of total billed charges,41.65,85,,33.32,percent of total billed charges,85% of total billed charges,41.65,85,,33.32,percent of total billed charges,85% of total billed charges,44.1,90,,35.28,percent of total billed charges,90% of total billed charges,39.2,80,,31.36,percent of total billed charges,80% of total billed charges,44.1,90,,35.28,percent of total billed charges,90% of total billed charges,36.75,75,,29.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,14.21,29,,11.368,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,32.83,67,,26.264,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,39.2,80,,31.36,percent of total billed charges,80% of total billed charges,31.85,65,,25.48,percent of total billed charges,65% of total billed charges,17.48,35.67,,13.984,percent of total billed charges,35.67% of total billed charges,14.21,44.1,
SULFASALAZINE 500 MG TAB,2521581,CDM,250,RC,,,outpatient,,,10,4.00,,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,7.7,77,,6.16,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,8.2,82,,6.56,percent of total billed charges,82% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,9,90,,7.2,percent of total billed charges,90% of total billed charges,8,80,,6.4,percent of total billed charges,80% of total billed charges,9,90,,7.2,percent of total billed charges,90% of total billed charges,7.5,75,,6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.9,29,,2.32,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,6.7,67,,5.36,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,8,80,,6.4,percent of total billed charges,80% of total billed charges,6.5,65,,5.2,percent of total billed charges,65% of total billed charges,3.57,35.67,,2.856,percent of total billed charges,35.67% of total billed charges,2.9,9,
SUMATRIPTAN SUCCINATE 100 MG,2521582,CDM,250,RC,,,outpatient,,,33,13.20,,28.05,85,,22.44,percent of total billed charges,85% of total billed charges,25.41,77,,20.33,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,27.06,82,,21.648,percent of total billed charges,82% of total billed charges,28.05,85,,22.44,percent of total billed charges,85% of total billed charges,28.05,85,,22.44,percent of total billed charges,85% of total billed charges,28.05,85,,22.44,percent of total billed charges,85% of total billed charges,29.7,90,,23.76,percent of total billed charges,90% of total billed charges,26.4,80,,21.12,percent of total billed charges,80% of total billed charges,29.7,90,,23.76,percent of total billed charges,90% of total billed charges,24.75,75,,19.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,9.57,29,,7.656,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,22.11,67,,17.688,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,26.4,80,,21.12,percent of total billed charges,80% of total billed charges,21.45,65,,17.16,percent of total billed charges,65% of total billed charges,11.77,35.67,,9.416,percent of total billed charges,35.67% of total billed charges,9.57,29.7,
IV DEXTROSE 5% 1/2 NS + 40 KCL,2524540,CDM,250,RC,,,outpatient,,,46,18.40,,39.1,85,,31.28,percent of total billed charges,85% of total billed charges,35.42,77,,28.34,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,37.72,82,,30.176,percent of total billed charges,82% of total billed charges,39.1,85,,31.28,percent of total billed charges,85% of total billed charges,39.1,85,,31.28,percent of total billed charges,85% of total billed charges,39.1,85,,31.28,percent of total billed charges,85% of total billed charges,41.4,90,,33.12,percent of total billed charges,90% of total billed charges,36.8,80,,29.44,percent of total billed charges,80% of total billed charges,41.4,90,,33.12,percent of total billed charges,90% of total billed charges,34.5,75,,27.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,13.34,29,,10.672,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,30.82,67,,24.656,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,36.8,80,,29.44,percent of total billed charges,80% of total billed charges,29.9,65,,23.92,percent of total billed charges,65% of total billed charges,16.41,35.67,,13.128,percent of total billed charges,35.67% of total billed charges,13.34,41.4,
IV DEXTROSE 5%/NS + 40 KCL,2524550,CDM,250,RC,,,outpatient,,,46,18.40,,39.1,85,,31.28,percent of total billed charges,85% of total billed charges,35.42,77,,28.34,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,37.72,82,,30.176,percent of total billed charges,82% of total billed charges,39.1,85,,31.28,percent of total billed charges,85% of total billed charges,39.1,85,,31.28,percent of total billed charges,85% of total billed charges,39.1,85,,31.28,percent of total billed charges,85% of total billed charges,41.4,90,,33.12,percent of total billed charges,90% of total billed charges,36.8,80,,29.44,percent of total billed charges,80% of total billed charges,41.4,90,,33.12,percent of total billed charges,90% of total billed charges,34.5,75,,27.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,13.34,29,,10.672,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,30.82,67,,24.656,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,36.8,80,,29.44,percent of total billed charges,80% of total billed charges,29.9,65,,23.92,percent of total billed charges,65% of total billed charges,16.41,35.67,,13.128,percent of total billed charges,35.67% of total billed charges,13.34,41.4,
IV DEXTROSE 5% LR +20 KCL,2524561,CDM,250,RC,,,outpatient,,,52,20.80,,44.2,85,,35.36,percent of total billed charges,85% of total billed charges,40.04,77,,32.03,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,42.64,82,,34.112,percent of total billed charges,82% of total billed charges,44.2,85,,35.36,percent of total billed charges,85% of total billed charges,44.2,85,,35.36,percent of total billed charges,85% of total billed charges,44.2,85,,35.36,percent of total billed charges,85% of total billed charges,46.8,90,,37.44,percent of total billed charges,90% of total billed charges,41.6,80,,33.28,percent of total billed charges,80% of total billed charges,46.8,90,,37.44,percent of total billed charges,90% of total billed charges,39,75,,31.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,15.08,29,,12.064,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,34.84,67,,27.872,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,41.6,80,,33.28,percent of total billed charges,80% of total billed charges,33.8,65,,27.04,percent of total billed charges,65% of total billed charges,18.55,35.67,,14.84,percent of total billed charges,35.67% of total billed charges,15.08,46.8,
TRILEPTAL 300 MB TAB,2590001,CDM,250,RC,,,outpatient,,,21,8.40,,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,16.17,77,,12.94,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,17.22,82,,13.776,percent of total billed charges,82% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,18.9,90,,15.12,percent of total billed charges,90% of total billed charges,16.8,80,,13.44,percent of total billed charges,80% of total billed charges,18.9,90,,15.12,percent of total billed charges,90% of total billed charges,15.75,75,,12.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,6.09,29,,4.872,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,14.07,67,,11.256,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,16.8,80,,13.44,percent of total billed charges,80% of total billed charges,13.65,65,,10.92,percent of total billed charges,65% of total billed charges,7.49,35.67,,5.992,percent of total billed charges,35.67% of total billed charges,6.09,18.9,
METAMUCIL SUGAR FREE PKT,2590002,CDM,250,RC,,,outpatient,,,7,2.80,,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.39,77,,4.31,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,5.74,82,,4.592,percent of total billed charges,82% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.25,75,,4.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.03,29,,1.624,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4.69,67,,3.752,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,4.55,65,,3.64,percent of total billed charges,65% of total billed charges,2.5,35.67,,2,percent of total billed charges,35.67% of total billed charges,2.03,6.3,
OS-CAL 500+D TAB,2590003,CDM,250,RC,,,outpatient,,,6,2.40,,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,4.62,77,,3.7,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,4.92,82,,3.936,percent of total billed charges,82% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,5.4,90,,4.32,percent of total billed charges,90% of total billed charges,4.8,80,,3.84,percent of total billed charges,80% of total billed charges,5.4,90,,4.32,percent of total billed charges,90% of total billed charges,4.5,75,,3.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,1.74,29,,1.392,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4.02,67,,3.216,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,4.8,80,,3.84,percent of total billed charges,80% of total billed charges,3.9,65,,3.12,percent of total billed charges,65% of total billed charges,2.14,35.67,,1.712,percent of total billed charges,35.67% of total billed charges,1.74,5.4,
IV PLASMALYTE D5IH 1000 CC,26000380,CDM,250,RC,,,outpatient,,,301,120.40,,255.85,85,,204.68,percent of total billed charges,85% of total billed charges,231.77,77,,185.42,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,246.82,82,,197.456,percent of total billed charges,82% of total billed charges,255.85,85,,204.68,percent of total billed charges,85% of total billed charges,255.85,85,,204.68,percent of total billed charges,85% of total billed charges,255.85,85,,204.68,percent of total billed charges,85% of total billed charges,270.9,90,,216.72,percent of total billed charges,90% of total billed charges,240.8,80,,192.64,percent of total billed charges,80% of total billed charges,270.9,90,,216.72,percent of total billed charges,90% of total billed charges,225.75,75,,180.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,87.29,29,,69.832,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,201.67,67,,161.336,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,240.8,80,,192.64,percent of total billed charges,80% of total billed charges,195.65,65,,156.52,percent of total billed charges,65% of total billed charges,107.37,35.67,,85.896,percent of total billed charges,35.67% of total billed charges,87.29,270.9,
IV PLASMALYTE D5IS 1000 CC **,26000381,CDM,250,RC,,,outpatient,,,281,112.40,,238.85,85,,191.08,percent of total billed charges,85% of total billed charges,216.37,77,,173.1,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,230.42,82,,184.336,percent of total billed charges,82% of total billed charges,238.85,85,,191.08,percent of total billed charges,85% of total billed charges,238.85,85,,191.08,percent of total billed charges,85% of total billed charges,238.85,85,,191.08,percent of total billed charges,85% of total billed charges,252.9,90,,202.32,percent of total billed charges,90% of total billed charges,224.8,80,,179.84,percent of total billed charges,80% of total billed charges,252.9,90,,202.32,percent of total billed charges,90% of total billed charges,210.75,75,,168.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,81.49,29,,65.192,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,188.27,67,,150.616,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,224.8,80,,179.84,percent of total billed charges,80% of total billed charges,182.65,65,,146.12,percent of total billed charges,65% of total billed charges,100.23,35.67,,80.184,percent of total billed charges,35.67% of total billed charges,81.49,252.9,
INJECTION OTHER DRUG OP,2650253,CDM,250,RC,96372,HCPCS,outpatient,,,283,113.20,,240.55,85,,192.44,percent of total billed charges,85% of total billed charges,217.91,77,,174.33,percent of total billed charges,77% of total billed charges,61.6,100,,,fee schedule,100% of CMS OPPS rate,249.68,429,,,fee schedule,429% of BCBS fee schedule,260.15,447,,,fee schedule,447% of BCBS fee schedule,260.15,447,,,fee schedule,447% of BCBS fee schedule,260.15,447,,,fee schedule,447% of BCBS fee schedule,254.7,90,,203.76,percent of total billed charges,90% of total billed charges,226.4,80,,181.12,percent of total billed charges,80% of total billed charges,254.7,90,,203.76,percent of total billed charges,90% of total billed charges,212.25,75,,169.8,percent of total billed charges,75% of total billed charges,75.16,122,,,fee schedule,122% of APC rate,82.07,29,,65.656,percent of total billed charges,29% of total billed charges,61.6,100,,,fee schedule,100% of CMS OPPS rate,189.61,67,,151.688,percent of total billed charges,67% of total billed charges,32.45,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,226.4,80,,181.12,percent of total billed charges,80% of total billed charges,183.95,65,,147.16,percent of total billed charges,65% of total billed charges,100.95,35.67,,80.76,percent of total billed charges,35.67% of total billed charges,32.45,260.15,
OSTOMY POWDER,27000497,CDM,250,RC,,,outpatient,,,58,23.20,,49.3,85,,39.44,percent of total billed charges,85% of total billed charges,44.66,77,,35.73,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,47.56,82,,38.048,percent of total billed charges,82% of total billed charges,49.3,85,,39.44,percent of total billed charges,85% of total billed charges,49.3,85,,39.44,percent of total billed charges,85% of total billed charges,49.3,85,,39.44,percent of total billed charges,85% of total billed charges,52.2,90,,41.76,percent of total billed charges,90% of total billed charges,46.4,80,,37.12,percent of total billed charges,80% of total billed charges,52.2,90,,41.76,percent of total billed charges,90% of total billed charges,43.5,75,,34.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,16.82,29,,13.456,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,38.86,67,,31.088,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,46.4,80,,37.12,percent of total billed charges,80% of total billed charges,37.7,65,,30.16,percent of total billed charges,65% of total billed charges,20.69,35.67,,16.552,percent of total billed charges,35.67% of total billed charges,16.82,52.2,
IV SOLUTION SET FOR CT,27000818,CDM,250,RC,,,outpatient,,,12,4.80,,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,9.24,77,,7.39,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,9.84,82,,7.872,percent of total billed charges,82% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,10.8,90,,8.64,percent of total billed charges,90% of total billed charges,9.6,80,,7.68,percent of total billed charges,80% of total billed charges,10.8,90,,8.64,percent of total billed charges,90% of total billed charges,9,75,,7.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,3.48,29,,2.784,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,8.04,67,,6.432,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,9.6,80,,7.68,percent of total billed charges,80% of total billed charges,7.8,65,,6.24,percent of total billed charges,65% of total billed charges,4.28,35.67,,3.424,percent of total billed charges,35.67% of total billed charges,3.48,10.8,
ROBINUL 0.2 MG/ML (0.05) 2ML,2508955,CDM,251,RC,,,outpatient,,,32,12.80,,27.2,85,,21.76,percent of total billed charges,85% of total billed charges,24.64,77,,19.71,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,26.24,82,,20.992,percent of total billed charges,82% of total billed charges,27.2,85,,21.76,percent of total billed charges,85% of total billed charges,27.2,85,,21.76,percent of total billed charges,85% of total billed charges,27.2,85,,21.76,percent of total billed charges,85% of total billed charges,28.8,90,,23.04,percent of total billed charges,90% of total billed charges,25.6,80,,20.48,percent of total billed charges,80% of total billed charges,28.8,90,,23.04,percent of total billed charges,90% of total billed charges,24,75,,19.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,9.28,29,,7.424,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,21.44,67,,17.152,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,25.6,80,,20.48,percent of total billed charges,80% of total billed charges,20.8,65,,16.64,percent of total billed charges,65% of total billed charges,11.41,35.67,,9.128,percent of total billed charges,35.67% of total billed charges,9.28,28.8,
ROMAZICON 0.5 MG/5 ML INJ.,2509156,CDM,251,RC,,,outpatient,,,47,18.80,,39.95,85,,31.96,percent of total billed charges,85% of total billed charges,36.19,77,,28.95,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,38.54,82,,30.832,percent of total billed charges,82% of total billed charges,39.95,85,,31.96,percent of total billed charges,85% of total billed charges,39.95,85,,31.96,percent of total billed charges,85% of total billed charges,39.95,85,,31.96,percent of total billed charges,85% of total billed charges,42.3,90,,33.84,percent of total billed charges,90% of total billed charges,37.6,80,,30.08,percent of total billed charges,80% of total billed charges,42.3,90,,33.84,percent of total billed charges,90% of total billed charges,35.25,75,,28.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,13.63,29,,10.904,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,31.49,67,,25.192,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,37.6,80,,30.08,percent of total billed charges,80% of total billed charges,30.55,65,,24.44,percent of total billed charges,65% of total billed charges,16.76,35.67,,13.408,percent of total billed charges,35.67% of total billed charges,13.63,42.3,
OMNISCAN PER ML,6100005,CDM,254,RC,A9579,HCPCS,outpatient,,,18,7.20,,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,13.86,77,,11.09,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,8.51,385,,,fee schedule,385% of BCBS fee schedule,8.86,401,,,fee schedule,401% of BCBS fee schedule,8.86,401,,,fee schedule,401% of BCBS fee schedule,8.86,401,,,fee schedule,401% of BCBS fee schedule,16.2,90,,12.96,percent of total billed charges,90% of total billed charges,14.4,80,,11.52,percent of total billed charges,80% of total billed charges,16.2,90,,12.96,percent of total billed charges,90% of total billed charges,13.5,75,,10.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,5.22,29,,4.176,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,12.06,67,,9.648,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,14.4,80,,11.52,percent of total billed charges,80% of total billed charges,11.7,65,,9.36,percent of total billed charges,65% of total billed charges,6.42,35.67,,5.136,percent of total billed charges,35.67% of total billed charges,5.22,16.2,
TC 99 MAG -3 ISOTOPE,3400598,CDM,255,RC,A4641,HCPCS,outpatient,,,336,134.40,,285.6,85,,228.48,percent of total billed charges,85% of total billed charges,258.72,77,,206.98,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,275.52,82,,220.416,percent of total billed charges,82% of total billed charges,285.6,85,,228.48,percent of total billed charges,85% of total billed charges,285.6,85,,228.48,percent of total billed charges,85% of total billed charges,285.6,85,,228.48,percent of total billed charges,85% of total billed charges,302.4,90,,241.92,percent of total billed charges,90% of total billed charges,268.8,80,,215.04,percent of total billed charges,80% of total billed charges,302.4,90,,241.92,percent of total billed charges,90% of total billed charges,252,75,,201.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,97.44,29,,77.952,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,225.12,67,,180.096,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,268.8,80,,215.04,percent of total billed charges,80% of total billed charges,218.4,65,,174.72,percent of total billed charges,65% of total billed charges,119.85,35.67,,95.88,percent of total billed charges,35.67% of total billed charges,97.44,302.4,
IV AMINOSYN 5.5% 1000 CC **,26000343,CDM,258,RC,,,outpatient,,,392,156.80,,333.2,85,,266.56,percent of total billed charges,85% of total billed charges,301.84,77,,241.47,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,321.44,82,,257.152,percent of total billed charges,82% of total billed charges,333.2,85,,266.56,percent of total billed charges,85% of total billed charges,333.2,85,,266.56,percent of total billed charges,85% of total billed charges,333.2,85,,266.56,percent of total billed charges,85% of total billed charges,352.8,90,,282.24,percent of total billed charges,90% of total billed charges,313.6,80,,250.88,percent of total billed charges,80% of total billed charges,352.8,90,,282.24,percent of total billed charges,90% of total billed charges,294,75,,235.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,113.68,29,,90.944,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,262.64,67,,210.112,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,313.6,80,,250.88,percent of total billed charges,80% of total billed charges,254.8,65,,203.84,percent of total billed charges,65% of total billed charges,139.83,35.67,,111.864,percent of total billed charges,35.67% of total billed charges,113.68,352.8,
IV NS 250 CC (GLASS),26000344,CDM,258,RC,J7050,HCPCS,outpatient,,,146,58.40,,124.1,85,,99.28,percent of total billed charges,85% of total billed charges,112.42,77,,89.94,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,15.9,385,,,fee schedule,385% of BCBS fee schedule,16.56,401,,,fee schedule,401% of BCBS fee schedule,16.56,401,,,fee schedule,401% of BCBS fee schedule,16.56,401,,,fee schedule,401% of BCBS fee schedule,131.4,90,,105.12,percent of total billed charges,90% of total billed charges,116.8,80,,93.44,percent of total billed charges,80% of total billed charges,131.4,90,,105.12,percent of total billed charges,90% of total billed charges,109.5,75,,87.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,42.34,29,,33.872,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,97.82,67,,78.256,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,116.8,80,,93.44,percent of total billed charges,80% of total billed charges,94.9,65,,75.92,percent of total billed charges,65% of total billed charges,52.08,35.67,,41.664,percent of total billed charges,35.67% of total billed charges,15.9,131.4,
IV-D5W 250CCS,26000347,CDM,258,RC,J7060,HCPCS,outpatient,,,144,57.60,,122.4,85,,97.92,percent of total billed charges,85% of total billed charges,110.88,77,,88.7,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,27.95,385,,,fee schedule,385% of BCBS fee schedule,29.11,401,,,fee schedule,401% of BCBS fee schedule,29.11,401,,,fee schedule,401% of BCBS fee schedule,29.11,401,,,fee schedule,401% of BCBS fee schedule,129.6,90,,103.68,percent of total billed charges,90% of total billed charges,115.2,80,,92.16,percent of total billed charges,80% of total billed charges,129.6,90,,103.68,percent of total billed charges,90% of total billed charges,108,75,,86.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,41.76,29,,33.408,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,96.48,67,,77.184,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,115.2,80,,92.16,percent of total billed charges,80% of total billed charges,93.6,65,,74.88,percent of total billed charges,65% of total billed charges,51.36,35.67,,41.088,percent of total billed charges,35.67% of total billed charges,27.95,129.6,
IV-D5W 500 CC,26000348,CDM,258,RC,J7060,HCPCS,outpatient,,,146,58.40,,124.1,85,,99.28,percent of total billed charges,85% of total billed charges,112.42,77,,89.94,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,27.95,385,,,fee schedule,385% of BCBS fee schedule,29.11,401,,,fee schedule,401% of BCBS fee schedule,29.11,401,,,fee schedule,401% of BCBS fee schedule,29.11,401,,,fee schedule,401% of BCBS fee schedule,131.4,90,,105.12,percent of total billed charges,90% of total billed charges,116.8,80,,93.44,percent of total billed charges,80% of total billed charges,131.4,90,,105.12,percent of total billed charges,90% of total billed charges,109.5,75,,87.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,42.34,29,,33.872,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,97.82,67,,78.256,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,116.8,80,,93.44,percent of total billed charges,80% of total billed charges,94.9,65,,75.92,percent of total billed charges,65% of total billed charges,52.08,35.67,,41.664,percent of total billed charges,35.67% of total billed charges,27.95,131.4,
IV D5W 250 CC,26000349,CDM,258,RC,J7060,HCPCS,outpatient,,,68,27.20,,57.8,85,,46.24,percent of total billed charges,85% of total billed charges,52.36,77,,41.89,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,27.95,385,,,fee schedule,385% of BCBS fee schedule,29.11,401,,,fee schedule,401% of BCBS fee schedule,29.11,401,,,fee schedule,401% of BCBS fee schedule,29.11,401,,,fee schedule,401% of BCBS fee schedule,61.2,90,,48.96,percent of total billed charges,90% of total billed charges,54.4,80,,43.52,percent of total billed charges,80% of total billed charges,61.2,90,,48.96,percent of total billed charges,90% of total billed charges,51,75,,40.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,19.72,29,,15.776,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,45.56,67,,36.448,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,54.4,80,,43.52,percent of total billed charges,80% of total billed charges,44.2,65,,35.36,percent of total billed charges,65% of total billed charges,24.26,35.67,,19.408,percent of total billed charges,35.67% of total billed charges,19.72,61.2,
IV D5W 500 CC,26000350,CDM,258,RC,J7060,HCPCS,outpatient,,,120,48.00,,102,85,,81.6,percent of total billed charges,85% of total billed charges,92.4,77,,73.92,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,27.95,385,,,fee schedule,385% of BCBS fee schedule,29.11,401,,,fee schedule,401% of BCBS fee schedule,29.11,401,,,fee schedule,401% of BCBS fee schedule,29.11,401,,,fee schedule,401% of BCBS fee schedule,108,90,,86.4,percent of total billed charges,90% of total billed charges,96,80,,76.8,percent of total billed charges,80% of total billed charges,108,90,,86.4,percent of total billed charges,90% of total billed charges,90,75,,72,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,34.8,29,,27.84,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,80.4,67,,64.32,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,96,80,,76.8,percent of total billed charges,80% of total billed charges,78,65,,62.4,percent of total billed charges,65% of total billed charges,42.8,35.67,,34.24,percent of total billed charges,35.67% of total billed charges,27.95,108,
IV D5W 1000 CC,26000351,CDM,258,RC,J7060,HCPCS,outpatient,,,128,51.20,,108.8,85,,87.04,percent of total billed charges,85% of total billed charges,98.56,77,,78.85,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,27.95,385,,,fee schedule,385% of BCBS fee schedule,29.11,401,,,fee schedule,401% of BCBS fee schedule,29.11,401,,,fee schedule,401% of BCBS fee schedule,29.11,401,,,fee schedule,401% of BCBS fee schedule,115.2,90,,92.16,percent of total billed charges,90% of total billed charges,102.4,80,,81.92,percent of total billed charges,80% of total billed charges,115.2,90,,92.16,percent of total billed charges,90% of total billed charges,96,75,,76.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,37.12,29,,29.696,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,85.76,67,,68.608,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,102.4,80,,81.92,percent of total billed charges,80% of total billed charges,83.2,65,,66.56,percent of total billed charges,65% of total billed charges,45.66,35.67,,36.528,percent of total billed charges,35.67% of total billed charges,27.95,115.2,
IV D5W 100 CC,26000352,CDM,258,RC,J7060,HCPCS,outpatient,,,68,27.20,,57.8,85,,46.24,percent of total billed charges,85% of total billed charges,52.36,77,,41.89,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,27.95,385,,,fee schedule,385% of BCBS fee schedule,29.11,401,,,fee schedule,401% of BCBS fee schedule,29.11,401,,,fee schedule,401% of BCBS fee schedule,29.11,401,,,fee schedule,401% of BCBS fee schedule,61.2,90,,48.96,percent of total billed charges,90% of total billed charges,54.4,80,,43.52,percent of total billed charges,80% of total billed charges,61.2,90,,48.96,percent of total billed charges,90% of total billed charges,51,75,,40.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,19.72,29,,15.776,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,45.56,67,,36.448,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,54.4,80,,43.52,percent of total billed charges,80% of total billed charges,44.2,65,,35.36,percent of total billed charges,65% of total billed charges,24.26,35.67,,19.408,percent of total billed charges,35.67% of total billed charges,19.72,61.2,
IV D10W 250 CC,26000354,CDM,258,RC,J7060,HCPCS,outpatient,,,65,26.00,,55.25,85,,44.2,percent of total billed charges,85% of total billed charges,50.05,77,,40.04,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,27.95,385,,,fee schedule,385% of BCBS fee schedule,29.11,401,,,fee schedule,401% of BCBS fee schedule,29.11,401,,,fee schedule,401% of BCBS fee schedule,29.11,401,,,fee schedule,401% of BCBS fee schedule,58.5,90,,46.8,percent of total billed charges,90% of total billed charges,52,80,,41.6,percent of total billed charges,80% of total billed charges,58.5,90,,46.8,percent of total billed charges,90% of total billed charges,48.75,75,,39,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,18.85,29,,15.08,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,43.55,67,,34.84,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,52,80,,41.6,percent of total billed charges,80% of total billed charges,42.25,65,,33.8,percent of total billed charges,65% of total billed charges,23.19,35.67,,18.552,percent of total billed charges,35.67% of total billed charges,18.85,58.5,
IV D10W 500 CC **,26000355,CDM,258,RC,,,outpatient,,,110,44.00,,93.5,85,,74.8,percent of total billed charges,85% of total billed charges,84.7,77,,67.76,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,90.2,82,,72.16,percent of total billed charges,82% of total billed charges,93.5,85,,74.8,percent of total billed charges,85% of total billed charges,93.5,85,,74.8,percent of total billed charges,85% of total billed charges,93.5,85,,74.8,percent of total billed charges,85% of total billed charges,99,90,,79.2,percent of total billed charges,90% of total billed charges,88,80,,70.4,percent of total billed charges,80% of total billed charges,99,90,,79.2,percent of total billed charges,90% of total billed charges,82.5,75,,66,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,31.9,29,,25.52,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,73.7,67,,58.96,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,88,80,,70.4,percent of total billed charges,80% of total billed charges,71.5,65,,57.2,percent of total billed charges,65% of total billed charges,39.24,35.67,,31.392,percent of total billed charges,35.67% of total billed charges,31.9,99,
IV D10W 1000 CC,26000356,CDM,258,RC,J7070,HCPCS,outpatient,,,142,56.80,,120.7,85,,96.56,percent of total billed charges,85% of total billed charges,109.34,77,,87.47,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,55.9,385,,,fee schedule,385% of BCBS fee schedule,58.23,401,,,fee schedule,401% of BCBS fee schedule,58.23,401,,,fee schedule,401% of BCBS fee schedule,58.23,401,,,fee schedule,401% of BCBS fee schedule,127.8,90,,102.24,percent of total billed charges,90% of total billed charges,113.6,80,,90.88,percent of total billed charges,80% of total billed charges,127.8,90,,102.24,percent of total billed charges,90% of total billed charges,106.5,75,,85.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,41.18,29,,32.944,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,95.14,67,,76.112,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,113.6,80,,90.88,percent of total billed charges,80% of total billed charges,92.3,65,,73.84,percent of total billed charges,65% of total billed charges,50.65,35.67,,40.52,percent of total billed charges,35.67% of total billed charges,41.18,127.8,
IV LIDOCAINE 500 CCS,26000357,CDM,258,RC,,,outpatient,,,264,105.60,,224.4,85,,179.52,percent of total billed charges,85% of total billed charges,203.28,77,,162.62,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,216.48,82,,173.184,percent of total billed charges,82% of total billed charges,224.4,85,,179.52,percent of total billed charges,85% of total billed charges,224.4,85,,179.52,percent of total billed charges,85% of total billed charges,224.4,85,,179.52,percent of total billed charges,85% of total billed charges,237.6,90,,190.08,percent of total billed charges,90% of total billed charges,211.2,80,,168.96,percent of total billed charges,80% of total billed charges,237.6,90,,190.08,percent of total billed charges,90% of total billed charges,198,75,,158.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,76.56,29,,61.248,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,176.88,67,,141.504,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,211.2,80,,168.96,percent of total billed charges,80% of total billed charges,171.6,65,,137.28,percent of total billed charges,65% of total billed charges,94.17,35.67,,75.336,percent of total billed charges,35.67% of total billed charges,76.56,237.6,
IV D5NS 500 CC,26000358,CDM,258,RC,J7060,HCPCS,outpatient,,,127,50.80,,107.95,85,,86.36,percent of total billed charges,85% of total billed charges,97.79,77,,78.23,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,27.95,385,,,fee schedule,385% of BCBS fee schedule,29.11,401,,,fee schedule,401% of BCBS fee schedule,29.11,401,,,fee schedule,401% of BCBS fee schedule,29.11,401,,,fee schedule,401% of BCBS fee schedule,114.3,90,,91.44,percent of total billed charges,90% of total billed charges,101.6,80,,81.28,percent of total billed charges,80% of total billed charges,114.3,90,,91.44,percent of total billed charges,90% of total billed charges,95.25,75,,76.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,36.83,29,,29.464,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,85.09,67,,68.072,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,101.6,80,,81.28,percent of total billed charges,80% of total billed charges,82.55,65,,66.04,percent of total billed charges,65% of total billed charges,45.3,35.67,,36.24,percent of total billed charges,35.67% of total billed charges,27.95,114.3,
IV D5NS 1000 CC,26000359,CDM,258,RC,J7070,HCPCS,outpatient,,,128,51.20,,108.8,85,,87.04,percent of total billed charges,85% of total billed charges,98.56,77,,78.85,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,55.9,385,,,fee schedule,385% of BCBS fee schedule,58.23,401,,,fee schedule,401% of BCBS fee schedule,58.23,401,,,fee schedule,401% of BCBS fee schedule,58.23,401,,,fee schedule,401% of BCBS fee schedule,115.2,90,,92.16,percent of total billed charges,90% of total billed charges,102.4,80,,81.92,percent of total billed charges,80% of total billed charges,115.2,90,,92.16,percent of total billed charges,90% of total billed charges,96,75,,76.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,37.12,29,,29.696,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,85.76,67,,68.608,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,102.4,80,,81.92,percent of total billed charges,80% of total billed charges,83.2,65,,66.56,percent of total billed charges,65% of total billed charges,45.66,35.67,,36.528,percent of total billed charges,35.67% of total billed charges,37.12,115.2,
IV D5 HALF NS 500 CC,26000360,CDM,258,RC,J7060,HCPCS,outpatient,,,129,51.60,,109.65,85,,87.72,percent of total billed charges,85% of total billed charges,99.33,77,,79.46,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,27.95,385,,,fee schedule,385% of BCBS fee schedule,29.11,401,,,fee schedule,401% of BCBS fee schedule,29.11,401,,,fee schedule,401% of BCBS fee schedule,29.11,401,,,fee schedule,401% of BCBS fee schedule,116.1,90,,92.88,percent of total billed charges,90% of total billed charges,103.2,80,,82.56,percent of total billed charges,80% of total billed charges,116.1,90,,92.88,percent of total billed charges,90% of total billed charges,96.75,75,,77.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,37.41,29,,29.928,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,86.43,67,,69.144,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,103.2,80,,82.56,percent of total billed charges,80% of total billed charges,83.85,65,,67.08,percent of total billed charges,65% of total billed charges,46.01,35.67,,36.808,percent of total billed charges,35.67% of total billed charges,27.95,116.1,
IV D5 HALF NS 1000 CC,26000361,CDM,258,RC,J7070,HCPCS,outpatient,,,128,51.20,,108.8,85,,87.04,percent of total billed charges,85% of total billed charges,98.56,77,,78.85,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,55.9,385,,,fee schedule,385% of BCBS fee schedule,58.23,401,,,fee schedule,401% of BCBS fee schedule,58.23,401,,,fee schedule,401% of BCBS fee schedule,58.23,401,,,fee schedule,401% of BCBS fee schedule,115.2,90,,92.16,percent of total billed charges,90% of total billed charges,102.4,80,,81.92,percent of total billed charges,80% of total billed charges,115.2,90,,92.16,percent of total billed charges,90% of total billed charges,96,75,,76.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,37.12,29,,29.696,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,85.76,67,,68.608,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,102.4,80,,81.92,percent of total billed charges,80% of total billed charges,83.2,65,,66.56,percent of total billed charges,65% of total billed charges,45.66,35.67,,36.528,percent of total billed charges,35.67% of total billed charges,37.12,115.2,
IV D5 1/4 NS 500 CC,26000362,CDM,258,RC,J7060,HCPCS,outpatient,,,129,51.60,,109.65,85,,87.72,percent of total billed charges,85% of total billed charges,99.33,77,,79.46,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,27.95,385,,,fee schedule,385% of BCBS fee schedule,29.11,401,,,fee schedule,401% of BCBS fee schedule,29.11,401,,,fee schedule,401% of BCBS fee schedule,29.11,401,,,fee schedule,401% of BCBS fee schedule,116.1,90,,92.88,percent of total billed charges,90% of total billed charges,103.2,80,,82.56,percent of total billed charges,80% of total billed charges,116.1,90,,92.88,percent of total billed charges,90% of total billed charges,96.75,75,,77.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,37.41,29,,29.928,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,86.43,67,,69.144,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,103.2,80,,82.56,percent of total billed charges,80% of total billed charges,83.85,65,,67.08,percent of total billed charges,65% of total billed charges,46.01,35.67,,36.808,percent of total billed charges,35.67% of total billed charges,27.95,116.1,
IV D5 1/4 NS 1000 CC,26000363,CDM,258,RC,J7070,HCPCS,outpatient,,,128,51.20,,108.8,85,,87.04,percent of total billed charges,85% of total billed charges,98.56,77,,78.85,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,55.9,385,,,fee schedule,385% of BCBS fee schedule,58.23,401,,,fee schedule,401% of BCBS fee schedule,58.23,401,,,fee schedule,401% of BCBS fee schedule,58.23,401,,,fee schedule,401% of BCBS fee schedule,115.2,90,,92.16,percent of total billed charges,90% of total billed charges,102.4,80,,81.92,percent of total billed charges,80% of total billed charges,115.2,90,,92.16,percent of total billed charges,90% of total billed charges,96,75,,76.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,37.12,29,,29.696,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,85.76,67,,68.608,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,102.4,80,,81.92,percent of total billed charges,80% of total billed charges,83.2,65,,66.56,percent of total billed charges,65% of total billed charges,45.66,35.67,,36.528,percent of total billed charges,35.67% of total billed charges,37.12,115.2,
IV NS 50 CC,26000364,CDM,258,RC,J7050,HCPCS,outpatient,,,105,42.00,,89.25,85,,71.4,percent of total billed charges,85% of total billed charges,80.85,77,,64.68,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,15.9,385,,,fee schedule,385% of BCBS fee schedule,16.56,401,,,fee schedule,401% of BCBS fee schedule,16.56,401,,,fee schedule,401% of BCBS fee schedule,16.56,401,,,fee schedule,401% of BCBS fee schedule,94.5,90,,75.6,percent of total billed charges,90% of total billed charges,84,80,,67.2,percent of total billed charges,80% of total billed charges,94.5,90,,75.6,percent of total billed charges,90% of total billed charges,78.75,75,,63,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,30.45,29,,24.36,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,70.35,67,,56.28,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,84,80,,67.2,percent of total billed charges,80% of total billed charges,68.25,65,,54.6,percent of total billed charges,65% of total billed charges,37.45,35.67,,29.96,percent of total billed charges,35.67% of total billed charges,15.9,94.5,
IV NS 100 CC,26000365,CDM,258,RC,J7050,HCPCS,outpatient,,,68,27.20,,57.8,85,,46.24,percent of total billed charges,85% of total billed charges,52.36,77,,41.89,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,15.9,385,,,fee schedule,385% of BCBS fee schedule,16.56,401,,,fee schedule,401% of BCBS fee schedule,16.56,401,,,fee schedule,401% of BCBS fee schedule,16.56,401,,,fee schedule,401% of BCBS fee schedule,61.2,90,,48.96,percent of total billed charges,90% of total billed charges,54.4,80,,43.52,percent of total billed charges,80% of total billed charges,61.2,90,,48.96,percent of total billed charges,90% of total billed charges,51,75,,40.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,19.72,29,,15.776,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,45.56,67,,36.448,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,54.4,80,,43.52,percent of total billed charges,80% of total billed charges,44.2,65,,35.36,percent of total billed charges,65% of total billed charges,24.26,35.67,,19.408,percent of total billed charges,35.67% of total billed charges,15.9,61.2,
IV HALF NS 500 CC,26000366,CDM,258,RC,J7040,HCPCS,outpatient,,,129,51.60,,109.65,85,,87.72,percent of total billed charges,85% of total billed charges,99.33,77,,79.46,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,31.84,385,,,fee schedule,385% of BCBS fee schedule,33.16,401,,,fee schedule,401% of BCBS fee schedule,33.16,401,,,fee schedule,401% of BCBS fee schedule,33.16,401,,,fee schedule,401% of BCBS fee schedule,116.1,90,,92.88,percent of total billed charges,90% of total billed charges,103.2,80,,82.56,percent of total billed charges,80% of total billed charges,116.1,90,,92.88,percent of total billed charges,90% of total billed charges,96.75,75,,77.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,37.41,29,,29.928,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,86.43,67,,69.144,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,103.2,80,,82.56,percent of total billed charges,80% of total billed charges,83.85,65,,67.08,percent of total billed charges,65% of total billed charges,46.01,35.67,,36.808,percent of total billed charges,35.67% of total billed charges,31.84,116.1,
IV HALF NS 1000 CC,26000367,CDM,258,RC,,,outpatient,,,128,51.20,,108.8,85,,87.04,percent of total billed charges,85% of total billed charges,98.56,77,,78.85,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,104.96,82,,83.968,percent of total billed charges,82% of total billed charges,108.8,85,,87.04,percent of total billed charges,85% of total billed charges,108.8,85,,87.04,percent of total billed charges,85% of total billed charges,108.8,85,,87.04,percent of total billed charges,85% of total billed charges,115.2,90,,92.16,percent of total billed charges,90% of total billed charges,102.4,80,,81.92,percent of total billed charges,80% of total billed charges,115.2,90,,92.16,percent of total billed charges,90% of total billed charges,96,75,,76.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,37.12,29,,29.696,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,85.76,67,,68.608,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,102.4,80,,81.92,percent of total billed charges,80% of total billed charges,83.2,65,,66.56,percent of total billed charges,65% of total billed charges,45.66,35.67,,36.528,percent of total billed charges,35.67% of total billed charges,37.12,115.2,
IV NS 250 CC,26000368,CDM,258,RC,J7050,HCPCS,outpatient,,,60,24.00,,51,85,,40.8,percent of total billed charges,85% of total billed charges,46.2,77,,36.96,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,15.9,385,,,fee schedule,385% of BCBS fee schedule,16.56,401,,,fee schedule,401% of BCBS fee schedule,16.56,401,,,fee schedule,401% of BCBS fee schedule,16.56,401,,,fee schedule,401% of BCBS fee schedule,54,90,,43.2,percent of total billed charges,90% of total billed charges,48,80,,38.4,percent of total billed charges,80% of total billed charges,54,90,,43.2,percent of total billed charges,90% of total billed charges,45,75,,36,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,17.4,29,,13.92,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,40.2,67,,32.16,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,48,80,,38.4,percent of total billed charges,80% of total billed charges,39,65,,31.2,percent of total billed charges,65% of total billed charges,21.4,35.67,,17.12,percent of total billed charges,35.67% of total billed charges,15.9,54,
IV NS 150 CC,26000369,CDM,258,RC,J7050,HCPCS,outpatient,,,73,29.20,,62.05,85,,49.64,percent of total billed charges,85% of total billed charges,56.21,77,,44.97,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,15.9,385,,,fee schedule,385% of BCBS fee schedule,16.56,401,,,fee schedule,401% of BCBS fee schedule,16.56,401,,,fee schedule,401% of BCBS fee schedule,16.56,401,,,fee schedule,401% of BCBS fee schedule,65.7,90,,52.56,percent of total billed charges,90% of total billed charges,58.4,80,,46.72,percent of total billed charges,80% of total billed charges,65.7,90,,52.56,percent of total billed charges,90% of total billed charges,54.75,75,,43.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,21.17,29,,16.936,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,48.91,67,,39.128,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,58.4,80,,46.72,percent of total billed charges,80% of total billed charges,47.45,65,,37.96,percent of total billed charges,65% of total billed charges,26.04,35.67,,20.832,percent of total billed charges,35.67% of total billed charges,15.9,65.7,
IV NS 500 CC,26000370,CDM,258,RC,J7050,HCPCS,outpatient,,,119,47.60,,101.15,85,,80.92,percent of total billed charges,85% of total billed charges,91.63,77,,73.3,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,15.9,385,,,fee schedule,385% of BCBS fee schedule,16.56,401,,,fee schedule,401% of BCBS fee schedule,16.56,401,,,fee schedule,401% of BCBS fee schedule,16.56,401,,,fee schedule,401% of BCBS fee schedule,107.1,90,,85.68,percent of total billed charges,90% of total billed charges,95.2,80,,76.16,percent of total billed charges,80% of total billed charges,107.1,90,,85.68,percent of total billed charges,90% of total billed charges,89.25,75,,71.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,34.51,29,,27.608,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,79.73,67,,63.784,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,95.2,80,,76.16,percent of total billed charges,80% of total billed charges,77.35,65,,61.88,percent of total billed charges,65% of total billed charges,42.45,35.67,,33.96,percent of total billed charges,35.67% of total billed charges,15.9,107.1,
IV D5LR 500 CC,26000372,CDM,258,RC,J7060,HCPCS,outpatient,,,130,52.00,,110.5,85,,88.4,percent of total billed charges,85% of total billed charges,100.1,77,,80.08,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,27.95,385,,,fee schedule,385% of BCBS fee schedule,29.11,401,,,fee schedule,401% of BCBS fee schedule,29.11,401,,,fee schedule,401% of BCBS fee schedule,29.11,401,,,fee schedule,401% of BCBS fee schedule,117,90,,93.6,percent of total billed charges,90% of total billed charges,104,80,,83.2,percent of total billed charges,80% of total billed charges,117,90,,93.6,percent of total billed charges,90% of total billed charges,97.5,75,,78,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,37.7,29,,30.16,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,87.1,67,,69.68,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,104,80,,83.2,percent of total billed charges,80% of total billed charges,84.5,65,,67.6,percent of total billed charges,65% of total billed charges,46.37,35.67,,37.096,percent of total billed charges,35.67% of total billed charges,27.95,117,
IV D5LR 1000 CC,26000373,CDM,258,RC,J7042,HCPCS,outpatient,,,125,50.00,,106.25,85,,85,percent of total billed charges,85% of total billed charges,96.25,77,,77,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,6.16,385,,,fee schedule,385% of BCBS fee schedule,6.42,401,,,fee schedule,401% of BCBS fee schedule,6.42,401,,,fee schedule,401% of BCBS fee schedule,6.42,401,,,fee schedule,401% of BCBS fee schedule,112.5,90,,90,percent of total billed charges,90% of total billed charges,100,80,,80,percent of total billed charges,80% of total billed charges,112.5,90,,90,percent of total billed charges,90% of total billed charges,93.75,75,,75,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,36.25,29,,29,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,83.75,67,,67,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,100,80,,80,percent of total billed charges,80% of total billed charges,81.25,65,,65,percent of total billed charges,65% of total billed charges,44.59,35.67,,35.672,percent of total billed charges,35.67% of total billed charges,6.16,112.5,
IV RINGERS 1000 CC,26000374,CDM,258,RC,,,outpatient,,,114,45.60,,96.9,85,,77.52,percent of total billed charges,85% of total billed charges,87.78,77,,70.22,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,93.48,82,,74.784,percent of total billed charges,82% of total billed charges,96.9,85,,77.52,percent of total billed charges,85% of total billed charges,96.9,85,,77.52,percent of total billed charges,85% of total billed charges,96.9,85,,77.52,percent of total billed charges,85% of total billed charges,102.6,90,,82.08,percent of total billed charges,90% of total billed charges,91.2,80,,72.96,percent of total billed charges,80% of total billed charges,102.6,90,,82.08,percent of total billed charges,90% of total billed charges,85.5,75,,68.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,33.06,29,,26.448,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,76.38,67,,61.104,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,91.2,80,,72.96,percent of total billed charges,80% of total billed charges,74.1,65,,59.28,percent of total billed charges,65% of total billed charges,40.66,35.67,,32.528,percent of total billed charges,35.67% of total billed charges,33.06,102.6,
IV LR 500 CC,26000375,CDM,258,RC,,,outpatient,,,122,48.80,,103.7,85,,82.96,percent of total billed charges,85% of total billed charges,93.94,77,,75.15,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,100.04,82,,80.032,percent of total billed charges,82% of total billed charges,103.7,85,,82.96,percent of total billed charges,85% of total billed charges,103.7,85,,82.96,percent of total billed charges,85% of total billed charges,103.7,85,,82.96,percent of total billed charges,85% of total billed charges,109.8,90,,87.84,percent of total billed charges,90% of total billed charges,97.6,80,,78.08,percent of total billed charges,80% of total billed charges,109.8,90,,87.84,percent of total billed charges,90% of total billed charges,91.5,75,,73.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,35.38,29,,28.304,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,81.74,67,,65.392,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,97.6,80,,78.08,percent of total billed charges,80% of total billed charges,79.3,65,,63.44,percent of total billed charges,65% of total billed charges,43.52,35.67,,34.816,percent of total billed charges,35.67% of total billed charges,35.38,109.8,
IV LR 1000 CC,26000376,CDM,258,RC,,,outpatient,,,128,51.20,,108.8,85,,87.04,percent of total billed charges,85% of total billed charges,98.56,77,,78.85,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,104.96,82,,83.968,percent of total billed charges,82% of total billed charges,108.8,85,,87.04,percent of total billed charges,85% of total billed charges,108.8,85,,87.04,percent of total billed charges,85% of total billed charges,108.8,85,,87.04,percent of total billed charges,85% of total billed charges,115.2,90,,92.16,percent of total billed charges,90% of total billed charges,102.4,80,,81.92,percent of total billed charges,80% of total billed charges,115.2,90,,92.16,percent of total billed charges,90% of total billed charges,96,75,,76.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,37.12,29,,29.696,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,85.76,67,,68.608,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,102.4,80,,81.92,percent of total billed charges,80% of total billed charges,83.2,65,,66.56,percent of total billed charges,65% of total billed charges,45.66,35.67,,36.528,percent of total billed charges,35.67% of total billed charges,37.12,115.2,
IV D5R 1000 CC **,26000379,CDM,258,RC,J7070,HCPCS,outpatient,,,111,44.40,,94.35,85,,75.48,percent of total billed charges,85% of total billed charges,85.47,77,,68.38,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,55.9,385,,,fee schedule,385% of BCBS fee schedule,58.23,401,,,fee schedule,401% of BCBS fee schedule,58.23,401,,,fee schedule,401% of BCBS fee schedule,58.23,401,,,fee schedule,401% of BCBS fee schedule,99.9,90,,79.92,percent of total billed charges,90% of total billed charges,88.8,80,,71.04,percent of total billed charges,80% of total billed charges,99.9,90,,79.92,percent of total billed charges,90% of total billed charges,83.25,75,,66.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,32.19,29,,25.752,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,74.37,67,,59.496,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,88.8,80,,71.04,percent of total billed charges,80% of total billed charges,72.15,65,,57.72,percent of total billed charges,65% of total billed charges,39.59,35.67,,31.672,percent of total billed charges,35.67% of total billed charges,32.19,99.9,
IV HESPAN 500 CCS,26000390,CDM,258,RC,J7110,HCPCS,outpatient,,,151,60.40,,128.35,85,,102.68,percent of total billed charges,85% of total billed charges,116.27,77,,93.02,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,123.82,82,,99.056,percent of total billed charges,82% of total billed charges,128.35,85,,102.68,percent of total billed charges,85% of total billed charges,128.35,85,,102.68,percent of total billed charges,85% of total billed charges,128.35,85,,102.68,percent of total billed charges,85% of total billed charges,135.9,90,,108.72,percent of total billed charges,90% of total billed charges,120.8,80,,96.64,percent of total billed charges,80% of total billed charges,135.9,90,,108.72,percent of total billed charges,90% of total billed charges,113.25,75,,90.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,43.79,29,,35.032,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,101.17,67,,80.936,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,120.8,80,,96.64,percent of total billed charges,80% of total billed charges,98.15,65,,78.52,percent of total billed charges,65% of total billed charges,53.86,35.67,,43.088,percent of total billed charges,35.67% of total billed charges,43.79,135.9,
IV 0.9% NACL 100 ML,26004099,CDM,258,RC,J7050,HCPCS,outpatient,,,79,31.60,,67.15,85,,53.72,percent of total billed charges,85% of total billed charges,60.83,77,,48.66,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,15.9,385,,,fee schedule,385% of BCBS fee schedule,16.56,401,,,fee schedule,401% of BCBS fee schedule,16.56,401,,,fee schedule,401% of BCBS fee schedule,16.56,401,,,fee schedule,401% of BCBS fee schedule,71.1,90,,56.88,percent of total billed charges,90% of total billed charges,63.2,80,,50.56,percent of total billed charges,80% of total billed charges,71.1,90,,56.88,percent of total billed charges,90% of total billed charges,59.25,75,,47.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,22.91,29,,18.328,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,52.93,67,,42.344,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,63.2,80,,50.56,percent of total billed charges,80% of total billed charges,51.35,65,,41.08,percent of total billed charges,65% of total billed charges,28.18,35.67,,22.544,percent of total billed charges,35.67% of total billed charges,15.9,71.1,
IV INTRALIPID 1000 CC **,27000341,CDM,258,RC,,,outpatient,,,363,145.20,,308.55,85,,246.84,percent of total billed charges,85% of total billed charges,279.51,77,,223.61,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,297.66,82,,238.128,percent of total billed charges,82% of total billed charges,308.55,85,,246.84,percent of total billed charges,85% of total billed charges,308.55,85,,246.84,percent of total billed charges,85% of total billed charges,308.55,85,,246.84,percent of total billed charges,85% of total billed charges,326.7,90,,261.36,percent of total billed charges,90% of total billed charges,290.4,80,,232.32,percent of total billed charges,80% of total billed charges,326.7,90,,261.36,percent of total billed charges,90% of total billed charges,272.25,75,,217.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,105.27,29,,84.216,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,243.21,67,,194.568,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,290.4,80,,232.32,percent of total billed charges,80% of total billed charges,235.95,65,,188.76,percent of total billed charges,65% of total billed charges,129.48,35.67,,103.584,percent of total billed charges,35.67% of total billed charges,105.27,326.7,
3% SODIUM CHLORIDE 500 CC **,27002883,CDM,258,RC,,,outpatient,,,94,37.60,,79.9,85,,63.92,percent of total billed charges,85% of total billed charges,72.38,77,,57.9,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,77.08,82,,61.664,percent of total billed charges,82% of total billed charges,79.9,85,,63.92,percent of total billed charges,85% of total billed charges,79.9,85,,63.92,percent of total billed charges,85% of total billed charges,79.9,85,,63.92,percent of total billed charges,85% of total billed charges,84.6,90,,67.68,percent of total billed charges,90% of total billed charges,75.2,80,,60.16,percent of total billed charges,80% of total billed charges,84.6,90,,67.68,percent of total billed charges,90% of total billed charges,70.5,75,,56.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,27.26,29,,21.808,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,62.98,67,,50.384,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,75.2,80,,60.16,percent of total billed charges,80% of total billed charges,61.1,65,,48.88,percent of total billed charges,65% of total billed charges,33.53,35.67,,26.824,percent of total billed charges,35.67% of total billed charges,27.26,84.6,
IV TRAVASOL 8.5% 1000CC **,27002893,CDM,258,RC,,,outpatient,,,323,129.20,,274.55,85,,219.64,percent of total billed charges,85% of total billed charges,248.71,77,,198.97,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,264.86,82,,211.888,percent of total billed charges,82% of total billed charges,274.55,85,,219.64,percent of total billed charges,85% of total billed charges,274.55,85,,219.64,percent of total billed charges,85% of total billed charges,274.55,85,,219.64,percent of total billed charges,85% of total billed charges,290.7,90,,232.56,percent of total billed charges,90% of total billed charges,258.4,80,,206.72,percent of total billed charges,80% of total billed charges,290.7,90,,232.56,percent of total billed charges,90% of total billed charges,242.25,75,,193.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,93.67,29,,74.936,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,216.41,67,,173.128,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,258.4,80,,206.72,percent of total billed charges,80% of total billed charges,209.95,65,,167.96,percent of total billed charges,65% of total billed charges,115.21,35.67,,92.168,percent of total billed charges,35.67% of total billed charges,93.67,290.7,
IV KCL 20 MEQ PREMIXED,27003134,CDM,258,RC,,,outpatient,,,51,20.40,,43.35,85,,34.68,percent of total billed charges,85% of total billed charges,39.27,77,,31.42,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,41.82,82,,33.456,percent of total billed charges,82% of total billed charges,43.35,85,,34.68,percent of total billed charges,85% of total billed charges,43.35,85,,34.68,percent of total billed charges,85% of total billed charges,43.35,85,,34.68,percent of total billed charges,85% of total billed charges,45.9,90,,36.72,percent of total billed charges,90% of total billed charges,40.8,80,,32.64,percent of total billed charges,80% of total billed charges,45.9,90,,36.72,percent of total billed charges,90% of total billed charges,38.25,75,,30.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,14.79,29,,11.832,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,34.17,67,,27.336,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,40.8,80,,32.64,percent of total billed charges,80% of total billed charges,33.15,65,,26.52,percent of total billed charges,65% of total billed charges,18.19,35.67,,14.552,percent of total billed charges,35.67% of total billed charges,14.79,45.9,
IV KCL 10 MEQ PREMIXED,27003135,CDM,258,RC,,,outpatient,,,51,20.40,,43.35,85,,34.68,percent of total billed charges,85% of total billed charges,39.27,77,,31.42,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,41.82,82,,33.456,percent of total billed charges,82% of total billed charges,43.35,85,,34.68,percent of total billed charges,85% of total billed charges,43.35,85,,34.68,percent of total billed charges,85% of total billed charges,43.35,85,,34.68,percent of total billed charges,85% of total billed charges,45.9,90,,36.72,percent of total billed charges,90% of total billed charges,40.8,80,,32.64,percent of total billed charges,80% of total billed charges,45.9,90,,36.72,percent of total billed charges,90% of total billed charges,38.25,75,,30.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,14.79,29,,11.832,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,34.17,67,,27.336,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,40.8,80,,32.64,percent of total billed charges,80% of total billed charges,33.15,65,,26.52,percent of total billed charges,65% of total billed charges,18.19,35.67,,14.552,percent of total billed charges,35.67% of total billed charges,14.79,45.9,
IV KCL 30 MEQ PREMIXED,27003136,CDM,258,RC,,,outpatient,,,83,33.20,,70.55,85,,56.44,percent of total billed charges,85% of total billed charges,63.91,77,,51.13,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,68.06,82,,54.448,percent of total billed charges,82% of total billed charges,70.55,85,,56.44,percent of total billed charges,85% of total billed charges,70.55,85,,56.44,percent of total billed charges,85% of total billed charges,70.55,85,,56.44,percent of total billed charges,85% of total billed charges,74.7,90,,59.76,percent of total billed charges,90% of total billed charges,66.4,80,,53.12,percent of total billed charges,80% of total billed charges,74.7,90,,59.76,percent of total billed charges,90% of total billed charges,62.25,75,,49.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,24.07,29,,19.256,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,55.61,67,,44.488,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,66.4,80,,53.12,percent of total billed charges,80% of total billed charges,53.95,65,,43.16,percent of total billed charges,65% of total billed charges,29.61,35.67,,23.688,percent of total billed charges,35.67% of total billed charges,24.07,74.7,
IV DEXTROSE 500 ML/12 1000ML,27007008,CDM,258,RC,,,outpatient,,,124,49.60,,105.4,85,,84.32,percent of total billed charges,85% of total billed charges,95.48,77,,76.38,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,101.68,82,,81.344,percent of total billed charges,82% of total billed charges,105.4,85,,84.32,percent of total billed charges,85% of total billed charges,105.4,85,,84.32,percent of total billed charges,85% of total billed charges,105.4,85,,84.32,percent of total billed charges,85% of total billed charges,111.6,90,,89.28,percent of total billed charges,90% of total billed charges,99.2,80,,79.36,percent of total billed charges,80% of total billed charges,111.6,90,,89.28,percent of total billed charges,90% of total billed charges,93,75,,74.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,35.96,29,,28.768,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,83.08,67,,66.464,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,99.2,80,,79.36,percent of total billed charges,80% of total billed charges,80.6,65,,64.48,percent of total billed charges,65% of total billed charges,44.23,35.67,,35.384,percent of total billed charges,35.67% of total billed charges,35.96,111.6,
INJECTION - IV DRUG M/S,2600256,CDM,259,RC,96374,HCPCS,outpatient,,,362,144.80,59,307.7,85,,246.16,percent of total billed charges,85% of total billed charges,278.74,77,,222.99,percent of total billed charges,77% of total billed charges,187.44,100,,,fee schedule,100% of CMS OPPS rate,201.67,429,,,fee schedule,429% of BCBS fee schedule,210.13,447,,,fee schedule,447% of BCBS fee schedule,210.13,447,,,fee schedule,447% of BCBS fee schedule,210.13,447,,,fee schedule,447% of BCBS fee schedule,325.8,90,,260.64,percent of total billed charges,90% of total billed charges,289.6,80,,231.68,percent of total billed charges,80% of total billed charges,325.8,90,,260.64,percent of total billed charges,90% of total billed charges,271.5,75,,217.2,percent of total billed charges,75% of total billed charges,228.67,122,,,fee schedule,122% of APC rate,104.98,29,,83.984,percent of total billed charges,29% of total billed charges,187.44,100,,,fee schedule,100% of CMS OPPS rate,242.54,67,,194.032,percent of total billed charges,67% of total billed charges,32.45,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,289.6,80,,231.68,percent of total billed charges,80% of total billed charges,235.3,65,,188.24,percent of total billed charges,65% of total billed charges,129.13,35.67,,103.304,percent of total billed charges,35.67% of total billed charges,32.45,325.8,
INFUSION THERAPY IV FIRST HR,2600200,CDM,260,RC,96365,HCPCS,outpatient,,,464,185.60,,394.4,85,,315.52,percent of total billed charges,85% of total billed charges,357.28,77,,285.82,percent of total billed charges,77% of total billed charges,187.44,100,,,fee schedule,100% of CMS OPPS rate,317.16,429,,,fee schedule,429% of BCBS fee schedule,330.47,447,,,fee schedule,447% of BCBS fee schedule,330.47,447,,,fee schedule,447% of BCBS fee schedule,330.47,447,,,fee schedule,447% of BCBS fee schedule,417.6,90,,334.08,percent of total billed charges,90% of total billed charges,371.2,80,,296.96,percent of total billed charges,80% of total billed charges,417.6,90,,334.08,percent of total billed charges,90% of total billed charges,348,75,,278.4,percent of total billed charges,75% of total billed charges,228.67,122,,,fee schedule,122% of APC rate,134.56,29,,107.648,percent of total billed charges,29% of total billed charges,187.44,100,,,fee schedule,100% of CMS OPPS rate,310.88,67,,248.704,percent of total billed charges,67% of total billed charges,118.05,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,371.2,80,,296.96,percent of total billed charges,80% of total billed charges,301.6,65,,241.28,percent of total billed charges,65% of total billed charges,165.51,35.67,,132.408,percent of total billed charges,35.67% of total billed charges,118.05,417.6,
"IV INFUSION, ADDITIONAL HOUR",2600209,CDM,260,RC,96366,HCPCS,outpatient,,,169,67.60,,143.65,85,,114.92,percent of total billed charges,85% of total billed charges,130.13,77,,104.1,percent of total billed charges,77% of total billed charges,41.54,100,,,fee schedule,100% of CMS OPPS rate,95.45,429,,,fee schedule,429% of BCBS fee schedule,99.46,447,,,fee schedule,447% of BCBS fee schedule,99.46,447,,,fee schedule,447% of BCBS fee schedule,99.46,447,,,fee schedule,447% of BCBS fee schedule,152.1,90,,121.68,percent of total billed charges,90% of total billed charges,135.2,80,,108.16,percent of total billed charges,80% of total billed charges,152.1,90,,121.68,percent of total billed charges,90% of total billed charges,126.75,75,,101.4,percent of total billed charges,75% of total billed charges,50.67,122,,,fee schedule,122% of APC rate,49.01,29,,39.208,percent of total billed charges,29% of total billed charges,41.54,100,,,fee schedule,100% of CMS OPPS rate,113.23,67,,90.584,percent of total billed charges,67% of total billed charges,32.45,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,135.2,80,,108.16,percent of total billed charges,80% of total billed charges,109.85,65,,87.88,percent of total billed charges,65% of total billed charges,60.28,35.67,,48.224,percent of total billed charges,35.67% of total billed charges,32.45,152.1,
IV HYDRATION 31 MIN-1 HR INTIA,2600212,CDM,260,RC,96360,HCPCS,outpatient,,,303,121.20,,257.55,85,,206.04,percent of total billed charges,85% of total billed charges,233.31,77,,186.65,percent of total billed charges,77% of total billed charges,187.44,100,,,fee schedule,100% of CMS OPPS rate,203.22,429,,,fee schedule,429% of BCBS fee schedule,211.74,447,,,fee schedule,447% of BCBS fee schedule,211.74,447,,,fee schedule,447% of BCBS fee schedule,211.74,447,,,fee schedule,447% of BCBS fee schedule,272.7,90,,218.16,percent of total billed charges,90% of total billed charges,242.4,80,,193.92,percent of total billed charges,80% of total billed charges,272.7,90,,218.16,percent of total billed charges,90% of total billed charges,227.25,75,,181.8,percent of total billed charges,75% of total billed charges,228.67,122,,,fee schedule,122% of APC rate,87.87,29,,70.296,percent of total billed charges,29% of total billed charges,187.44,100,,,fee schedule,100% of CMS OPPS rate,203.01,67,,162.408,percent of total billed charges,67% of total billed charges,67.76,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,242.4,80,,193.92,percent of total billed charges,80% of total billed charges,196.95,65,,157.56,percent of total billed charges,65% of total billed charges,108.08,35.67,,86.464,percent of total billed charges,35.67% of total billed charges,67.76,272.7,
IV HYDRATION-EA ADD HR,2600213,CDM,260,RC,96361,HCPCS,outpatient,,,169,67.60,,143.65,85,,114.92,percent of total billed charges,85% of total billed charges,130.13,77,,104.1,percent of total billed charges,77% of total billed charges,41.54,100,,,fee schedule,100% of CMS OPPS rate,60.06,429,,,fee schedule,429% of BCBS fee schedule,62.58,447,,,fee schedule,447% of BCBS fee schedule,62.58,447,,,fee schedule,447% of BCBS fee schedule,62.58,447,,,fee schedule,447% of BCBS fee schedule,152.1,90,,121.68,percent of total billed charges,90% of total billed charges,135.2,80,,108.16,percent of total billed charges,80% of total billed charges,152.1,90,,121.68,percent of total billed charges,90% of total billed charges,126.75,75,,101.4,percent of total billed charges,75% of total billed charges,50.67,122,,,fee schedule,122% of APC rate,49.01,29,,39.208,percent of total billed charges,29% of total billed charges,41.54,100,,,fee schedule,100% of CMS OPPS rate,113.23,67,,90.584,percent of total billed charges,67% of total billed charges,23.12,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,135.2,80,,108.16,percent of total billed charges,80% of total billed charges,109.85,65,,87.88,percent of total billed charges,65% of total billed charges,60.28,35.67,,48.224,percent of total billed charges,35.67% of total billed charges,23.12,152.1,
IV INFUSION-SEQUENTIAL NEW DRU,2600218,CDM,260,RC,96367,HCPCS,outpatient,,,279,111.60,,237.15,85,,189.72,percent of total billed charges,85% of total billed charges,214.83,77,,171.86,percent of total billed charges,77% of total billed charges,61.6,100,,,fee schedule,100% of CMS OPPS rate,137.02,429,,,fee schedule,429% of BCBS fee schedule,142.77,447,,,fee schedule,447% of BCBS fee schedule,142.77,447,,,fee schedule,447% of BCBS fee schedule,142.77,447,,,fee schedule,447% of BCBS fee schedule,251.1,90,,200.88,percent of total billed charges,90% of total billed charges,223.2,80,,178.56,percent of total billed charges,80% of total billed charges,251.1,90,,200.88,percent of total billed charges,90% of total billed charges,209.25,75,,167.4,percent of total billed charges,75% of total billed charges,75.15,122,,,fee schedule,122% of APC rate,80.91,29,,64.728,percent of total billed charges,29% of total billed charges,61.6,100,,,fee schedule,100% of CMS OPPS rate,186.93,67,,149.544,percent of total billed charges,67% of total billed charges,32.45,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,223.2,80,,178.56,percent of total billed charges,80% of total billed charges,181.35,65,,145.08,percent of total billed charges,65% of total billed charges,99.52,35.67,,79.616,percent of total billed charges,35.67% of total billed charges,32.45,251.1,
IV INFUSION CONCURRENT,2600223,CDM,260,RC,96368,HCPCS,outpatient,,,107,42.80,,90.95,85,,72.76,percent of total billed charges,85% of total billed charges,82.39,77,,65.91,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,90.82,429,,,fee schedule,429% of BCBS fee schedule,94.63,447,,,fee schedule,447% of BCBS fee schedule,94.63,447,,,fee schedule,447% of BCBS fee schedule,94.63,447,,,fee schedule,447% of BCBS fee schedule,96.3,90,,77.04,percent of total billed charges,90% of total billed charges,85.6,80,,68.48,percent of total billed charges,80% of total billed charges,96.3,90,,77.04,percent of total billed charges,90% of total billed charges,80.25,75,,64.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,31.03,29,,24.824,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,71.69,67,,57.352,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,85.6,80,,68.48,percent of total billed charges,80% of total billed charges,69.55,65,,55.64,percent of total billed charges,65% of total billed charges,38.17,35.67,,30.536,percent of total billed charges,35.67% of total billed charges,31.03,96.3,
INFUSION THERAPY 1ST HR  OP,2650200,CDM,260,RC,96365,HCPCS,outpatient,,,464,185.60,,394.4,85,,315.52,percent of total billed charges,85% of total billed charges,357.28,77,,285.82,percent of total billed charges,77% of total billed charges,187.44,100,,,fee schedule,100% of CMS OPPS rate,317.16,429,,,fee schedule,429% of BCBS fee schedule,330.47,447,,,fee schedule,447% of BCBS fee schedule,330.47,447,,,fee schedule,447% of BCBS fee schedule,330.47,447,,,fee schedule,447% of BCBS fee schedule,417.6,90,,334.08,percent of total billed charges,90% of total billed charges,371.2,80,,296.96,percent of total billed charges,80% of total billed charges,417.6,90,,334.08,percent of total billed charges,90% of total billed charges,348,75,,278.4,percent of total billed charges,75% of total billed charges,228.67,122,,,fee schedule,122% of APC rate,134.56,29,,107.648,percent of total billed charges,29% of total billed charges,187.44,100,,,fee schedule,100% of CMS OPPS rate,310.88,67,,248.704,percent of total billed charges,67% of total billed charges,118.05,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,371.2,80,,296.96,percent of total billed charges,80% of total billed charges,301.6,65,,241.28,percent of total billed charges,65% of total billed charges,165.51,35.67,,132.408,percent of total billed charges,35.67% of total billed charges,118.05,417.6,
IV INFUSION ADDITIONAL HR  OP,2650209,CDM,260,RC,96366,HCPCS,outpatient,,,169,67.60,,143.65,85,,114.92,percent of total billed charges,85% of total billed charges,130.13,77,,104.1,percent of total billed charges,77% of total billed charges,41.54,100,,,fee schedule,100% of CMS OPPS rate,95.45,429,,,fee schedule,429% of BCBS fee schedule,99.46,447,,,fee schedule,447% of BCBS fee schedule,99.46,447,,,fee schedule,447% of BCBS fee schedule,99.46,447,,,fee schedule,447% of BCBS fee schedule,152.1,90,,121.68,percent of total billed charges,90% of total billed charges,135.2,80,,108.16,percent of total billed charges,80% of total billed charges,152.1,90,,121.68,percent of total billed charges,90% of total billed charges,126.75,75,,101.4,percent of total billed charges,75% of total billed charges,50.67,122,,,fee schedule,122% of APC rate,49.01,29,,39.208,percent of total billed charges,29% of total billed charges,41.54,100,,,fee schedule,100% of CMS OPPS rate,113.23,67,,90.584,percent of total billed charges,67% of total billed charges,32.45,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,135.2,80,,108.16,percent of total billed charges,80% of total billed charges,109.85,65,,87.88,percent of total billed charges,65% of total billed charges,60.28,35.67,,48.224,percent of total billed charges,35.67% of total billed charges,32.45,152.1,
IV HYDRATION 31-1 HR INT  OP,2650212,CDM,260,RC,96360,HCPCS,outpatient,,,303,121.20,,257.55,85,,206.04,percent of total billed charges,85% of total billed charges,233.31,77,,186.65,percent of total billed charges,77% of total billed charges,187.44,100,,,fee schedule,100% of CMS OPPS rate,203.22,429,,,fee schedule,429% of BCBS fee schedule,211.74,447,,,fee schedule,447% of BCBS fee schedule,211.74,447,,,fee schedule,447% of BCBS fee schedule,211.74,447,,,fee schedule,447% of BCBS fee schedule,272.7,90,,218.16,percent of total billed charges,90% of total billed charges,242.4,80,,193.92,percent of total billed charges,80% of total billed charges,272.7,90,,218.16,percent of total billed charges,90% of total billed charges,227.25,75,,181.8,percent of total billed charges,75% of total billed charges,228.67,122,,,fee schedule,122% of APC rate,87.87,29,,70.296,percent of total billed charges,29% of total billed charges,187.44,100,,,fee schedule,100% of CMS OPPS rate,203.01,67,,162.408,percent of total billed charges,67% of total billed charges,67.76,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,242.4,80,,193.92,percent of total billed charges,80% of total billed charges,196.95,65,,157.56,percent of total billed charges,65% of total billed charges,108.08,35.67,,86.464,percent of total billed charges,35.67% of total billed charges,67.76,272.7,
IV INFUSION SEQUENTIAL NEW OP,2650218,CDM,260,RC,96367,HCPCS,outpatient,,,273,109.20,,232.05,85,,185.64,percent of total billed charges,85% of total billed charges,210.21,77,,168.17,percent of total billed charges,77% of total billed charges,61.6,100,,,fee schedule,100% of CMS OPPS rate,137.02,429,,,fee schedule,429% of BCBS fee schedule,142.77,447,,,fee schedule,447% of BCBS fee schedule,142.77,447,,,fee schedule,447% of BCBS fee schedule,142.77,447,,,fee schedule,447% of BCBS fee schedule,245.7,90,,196.56,percent of total billed charges,90% of total billed charges,218.4,80,,174.72,percent of total billed charges,80% of total billed charges,245.7,90,,196.56,percent of total billed charges,90% of total billed charges,204.75,75,,163.8,percent of total billed charges,75% of total billed charges,75.15,122,,,fee schedule,122% of APC rate,79.17,29,,63.336,percent of total billed charges,29% of total billed charges,61.6,100,,,fee schedule,100% of CMS OPPS rate,182.91,67,,146.328,percent of total billed charges,67% of total billed charges,32.45,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,218.4,80,,174.72,percent of total billed charges,80% of total billed charges,177.45,65,,141.96,percent of total billed charges,65% of total billed charges,97.38,35.67,,77.904,percent of total billed charges,35.67% of total billed charges,32.45,245.7,
IV INFUSION CONCURRENT OP,2650223,CDM,260,RC,96368,HCPCS,outpatient,,,106,42.40,,90.1,85,,72.08,percent of total billed charges,85% of total billed charges,81.62,77,,65.3,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,90.82,429,,,fee schedule,429% of BCBS fee schedule,94.63,447,,,fee schedule,447% of BCBS fee schedule,94.63,447,,,fee schedule,447% of BCBS fee schedule,94.63,447,,,fee schedule,447% of BCBS fee schedule,95.4,90,,76.32,percent of total billed charges,90% of total billed charges,84.8,80,,67.84,percent of total billed charges,80% of total billed charges,95.4,90,,76.32,percent of total billed charges,90% of total billed charges,79.5,75,,63.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,30.74,29,,24.592,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,71.02,67,,56.816,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,84.8,80,,67.84,percent of total billed charges,80% of total billed charges,68.9,65,,55.12,percent of total billed charges,65% of total billed charges,37.81,35.67,,30.248,percent of total billed charges,35.67% of total billed charges,30.74,95.4,
THERAP INJ IM/SUBQ,2650252,CDM,260,RC,96372,HCPCS,outpatient,,,283,113.20,,240.55,85,,192.44,percent of total billed charges,85% of total billed charges,217.91,77,,174.33,percent of total billed charges,77% of total billed charges,61.6,100,,,fee schedule,100% of CMS OPPS rate,249.68,429,,,fee schedule,429% of BCBS fee schedule,260.15,447,,,fee schedule,447% of BCBS fee schedule,260.15,447,,,fee schedule,447% of BCBS fee schedule,260.15,447,,,fee schedule,447% of BCBS fee schedule,254.7,90,,203.76,percent of total billed charges,90% of total billed charges,226.4,80,,181.12,percent of total billed charges,80% of total billed charges,254.7,90,,203.76,percent of total billed charges,90% of total billed charges,212.25,75,,169.8,percent of total billed charges,75% of total billed charges,75.16,122,,,fee schedule,122% of APC rate,82.07,29,,65.656,percent of total billed charges,29% of total billed charges,61.6,100,,,fee schedule,100% of CMS OPPS rate,189.61,67,,151.688,percent of total billed charges,67% of total billed charges,32.45,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,226.4,80,,181.12,percent of total billed charges,80% of total billed charges,183.95,65,,147.16,percent of total billed charges,65% of total billed charges,100.95,35.67,,80.76,percent of total billed charges,35.67% of total billed charges,32.45,260.15,
IV HYDRATION OB 31 MIN - 1 HR,7300037,CDM,260,RC,96360,HCPCS,outpatient,,,303,121.20,,257.55,85,,206.04,percent of total billed charges,85% of total billed charges,233.31,77,,186.65,percent of total billed charges,77% of total billed charges,187.44,100,,,fee schedule,100% of CMS OPPS rate,203.22,429,,,fee schedule,429% of BCBS fee schedule,211.74,447,,,fee schedule,447% of BCBS fee schedule,211.74,447,,,fee schedule,447% of BCBS fee schedule,211.74,447,,,fee schedule,447% of BCBS fee schedule,272.7,90,,218.16,percent of total billed charges,90% of total billed charges,242.4,80,,193.92,percent of total billed charges,80% of total billed charges,272.7,90,,218.16,percent of total billed charges,90% of total billed charges,227.25,75,,181.8,percent of total billed charges,75% of total billed charges,228.67,122,,,fee schedule,122% of APC rate,87.87,29,,70.296,percent of total billed charges,29% of total billed charges,187.44,100,,,fee schedule,100% of CMS OPPS rate,203.01,67,,162.408,percent of total billed charges,67% of total billed charges,67.76,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,242.4,80,,193.92,percent of total billed charges,80% of total billed charges,196.95,65,,157.56,percent of total billed charges,65% of total billed charges,108.08,35.67,,86.464,percent of total billed charges,35.67% of total billed charges,67.76,272.7,
IV HYDRATION OB,7600037,CDM,260,RC,96360,HCPCS,outpatient,,,303,121.20,,257.55,85,,206.04,percent of total billed charges,85% of total billed charges,233.31,77,,186.65,percent of total billed charges,77% of total billed charges,187.44,100,,,fee schedule,100% of CMS OPPS rate,203.22,429,,,fee schedule,429% of BCBS fee schedule,211.74,447,,,fee schedule,447% of BCBS fee schedule,211.74,447,,,fee schedule,447% of BCBS fee schedule,211.74,447,,,fee schedule,447% of BCBS fee schedule,272.7,90,,218.16,percent of total billed charges,90% of total billed charges,242.4,80,,193.92,percent of total billed charges,80% of total billed charges,272.7,90,,218.16,percent of total billed charges,90% of total billed charges,227.25,75,,181.8,percent of total billed charges,75% of total billed charges,228.67,122,,,fee schedule,122% of APC rate,87.87,29,,70.296,percent of total billed charges,29% of total billed charges,187.44,100,,,fee schedule,100% of CMS OPPS rate,203.01,67,,162.408,percent of total billed charges,67% of total billed charges,67.76,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,242.4,80,,193.92,percent of total billed charges,80% of total billed charges,196.95,65,,157.56,percent of total billed charges,65% of total billed charges,108.08,35.67,,86.464,percent of total billed charges,35.67% of total billed charges,67.76,272.7,
IV HYDRATION OB EACH ADD HR,7600038,CDM,260,RC,96361,HCPCS,outpatient,,,169,67.60,,143.65,85,,114.92,percent of total billed charges,85% of total billed charges,130.13,77,,104.1,percent of total billed charges,77% of total billed charges,41.54,100,,,fee schedule,100% of CMS OPPS rate,60.06,429,,,fee schedule,429% of BCBS fee schedule,62.58,447,,,fee schedule,447% of BCBS fee schedule,62.58,447,,,fee schedule,447% of BCBS fee schedule,62.58,447,,,fee schedule,447% of BCBS fee schedule,152.1,90,,121.68,percent of total billed charges,90% of total billed charges,135.2,80,,108.16,percent of total billed charges,80% of total billed charges,152.1,90,,121.68,percent of total billed charges,90% of total billed charges,126.75,75,,101.4,percent of total billed charges,75% of total billed charges,50.67,122,,,fee schedule,122% of APC rate,49.01,29,,39.208,percent of total billed charges,29% of total billed charges,41.54,100,,,fee schedule,100% of CMS OPPS rate,113.23,67,,90.584,percent of total billed charges,67% of total billed charges,23.12,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,135.2,80,,108.16,percent of total billed charges,80% of total billed charges,109.85,65,,87.88,percent of total billed charges,65% of total billed charges,60.28,35.67,,48.224,percent of total billed charges,35.67% of total billed charges,23.12,152.1,
IV INFUSION THERAPY OB 1 HR,7600039,CDM,260,RC,96365,HCPCS,outpatient,,,464,185.60,,394.4,85,,315.52,percent of total billed charges,85% of total billed charges,357.28,77,,285.82,percent of total billed charges,77% of total billed charges,187.44,100,,,fee schedule,100% of CMS OPPS rate,317.16,429,,,fee schedule,429% of BCBS fee schedule,330.47,447,,,fee schedule,447% of BCBS fee schedule,330.47,447,,,fee schedule,447% of BCBS fee schedule,330.47,447,,,fee schedule,447% of BCBS fee schedule,417.6,90,,334.08,percent of total billed charges,90% of total billed charges,371.2,80,,296.96,percent of total billed charges,80% of total billed charges,417.6,90,,334.08,percent of total billed charges,90% of total billed charges,348,75,,278.4,percent of total billed charges,75% of total billed charges,228.67,122,,,fee schedule,122% of APC rate,134.56,29,,107.648,percent of total billed charges,29% of total billed charges,187.44,100,,,fee schedule,100% of CMS OPPS rate,310.88,67,,248.704,percent of total billed charges,67% of total billed charges,118.05,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,371.2,80,,296.96,percent of total billed charges,80% of total billed charges,301.6,65,,241.28,percent of total billed charges,65% of total billed charges,165.51,35.67,,132.408,percent of total billed charges,35.67% of total billed charges,118.05,417.6,
IV INFUSION TX OB EACH ADD HR,7600040,CDM,260,RC,96366,HCPCS,outpatient,,,169,67.60,,143.65,85,,114.92,percent of total billed charges,85% of total billed charges,130.13,77,,104.1,percent of total billed charges,77% of total billed charges,41.54,100,,,fee schedule,100% of CMS OPPS rate,95.45,429,,,fee schedule,429% of BCBS fee schedule,99.46,447,,,fee schedule,447% of BCBS fee schedule,99.46,447,,,fee schedule,447% of BCBS fee schedule,99.46,447,,,fee schedule,447% of BCBS fee schedule,152.1,90,,121.68,percent of total billed charges,90% of total billed charges,135.2,80,,108.16,percent of total billed charges,80% of total billed charges,152.1,90,,121.68,percent of total billed charges,90% of total billed charges,126.75,75,,101.4,percent of total billed charges,75% of total billed charges,50.67,122,,,fee schedule,122% of APC rate,49.01,29,,39.208,percent of total billed charges,29% of total billed charges,41.54,100,,,fee schedule,100% of CMS OPPS rate,113.23,67,,90.584,percent of total billed charges,67% of total billed charges,32.45,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,135.2,80,,108.16,percent of total billed charges,80% of total billed charges,109.85,65,,87.88,percent of total billed charges,65% of total billed charges,60.28,35.67,,48.224,percent of total billed charges,35.67% of total billed charges,32.45,152.1,
IV INFUSION OB SEQUENTIAL,7600041,CDM,260,RC,96367,HCPCS,outpatient,,,279,111.60,,237.15,85,,189.72,percent of total billed charges,85% of total billed charges,214.83,77,,171.86,percent of total billed charges,77% of total billed charges,61.6,100,,,fee schedule,100% of CMS OPPS rate,137.02,429,,,fee schedule,429% of BCBS fee schedule,142.77,447,,,fee schedule,447% of BCBS fee schedule,142.77,447,,,fee schedule,447% of BCBS fee schedule,142.77,447,,,fee schedule,447% of BCBS fee schedule,251.1,90,,200.88,percent of total billed charges,90% of total billed charges,223.2,80,,178.56,percent of total billed charges,80% of total billed charges,251.1,90,,200.88,percent of total billed charges,90% of total billed charges,209.25,75,,167.4,percent of total billed charges,75% of total billed charges,75.15,122,,,fee schedule,122% of APC rate,80.91,29,,64.728,percent of total billed charges,29% of total billed charges,61.6,100,,,fee schedule,100% of CMS OPPS rate,186.93,67,,149.544,percent of total billed charges,67% of total billed charges,32.45,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,223.2,80,,178.56,percent of total billed charges,80% of total billed charges,181.35,65,,145.08,percent of total billed charges,65% of total billed charges,99.52,35.67,,79.616,percent of total billed charges,35.67% of total billed charges,32.45,251.1,
IV INFUSION OB CONCURRENT,7600042,CDM,260,RC,96368,HCPCS,outpatient,,,106,42.40,,90.1,85,,72.08,percent of total billed charges,85% of total billed charges,81.62,77,,65.3,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,90.82,429,,,fee schedule,429% of BCBS fee schedule,94.63,447,,,fee schedule,447% of BCBS fee schedule,94.63,447,,,fee schedule,447% of BCBS fee schedule,94.63,447,,,fee schedule,447% of BCBS fee schedule,95.4,90,,76.32,percent of total billed charges,90% of total billed charges,84.8,80,,67.84,percent of total billed charges,80% of total billed charges,95.4,90,,76.32,percent of total billed charges,90% of total billed charges,79.5,75,,63.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,30.74,29,,24.592,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,71.02,67,,56.816,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,84.8,80,,67.84,percent of total billed charges,80% of total billed charges,68.9,65,,55.12,percent of total billed charges,65% of total billed charges,37.81,35.67,,30.248,percent of total billed charges,35.67% of total billed charges,30.74,95.4,
THERAP INJ IM/SUBQ,7600045,CDM,260,RC,96372,HCPCS,outpatient,,,289,115.60,,245.65,85,,196.52,percent of total billed charges,85% of total billed charges,222.53,77,,178.02,percent of total billed charges,77% of total billed charges,61.6,100,,,fee schedule,100% of CMS OPPS rate,249.68,429,,,fee schedule,429% of BCBS fee schedule,260.15,447,,,fee schedule,447% of BCBS fee schedule,260.15,447,,,fee schedule,447% of BCBS fee schedule,260.15,447,,,fee schedule,447% of BCBS fee schedule,260.1,90,,208.08,percent of total billed charges,90% of total billed charges,231.2,80,,184.96,percent of total billed charges,80% of total billed charges,260.1,90,,208.08,percent of total billed charges,90% of total billed charges,216.75,75,,173.4,percent of total billed charges,75% of total billed charges,75.16,122,,,fee schedule,122% of APC rate,83.81,29,,67.048,percent of total billed charges,29% of total billed charges,61.6,100,,,fee schedule,100% of CMS OPPS rate,193.63,67,,154.904,percent of total billed charges,67% of total billed charges,32.45,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,231.2,80,,184.96,percent of total billed charges,80% of total billed charges,187.85,65,,150.28,percent of total billed charges,65% of total billed charges,103.09,35.67,,82.472,percent of total billed charges,35.67% of total billed charges,32.45,260.15,
IV PUSH OB,7600046,CDM,260,RC,96374,HCPCS,outpatient,,,233,93.20,,198.05,85,,158.44,percent of total billed charges,85% of total billed charges,179.41,77,,143.53,percent of total billed charges,77% of total billed charges,187.44,100,,,fee schedule,100% of CMS OPPS rate,201.67,429,,,fee schedule,429% of BCBS fee schedule,210.13,447,,,fee schedule,447% of BCBS fee schedule,210.13,447,,,fee schedule,447% of BCBS fee schedule,210.13,447,,,fee schedule,447% of BCBS fee schedule,209.7,90,,167.76,percent of total billed charges,90% of total billed charges,186.4,80,,149.12,percent of total billed charges,80% of total billed charges,209.7,90,,167.76,percent of total billed charges,90% of total billed charges,174.75,75,,139.8,percent of total billed charges,75% of total billed charges,228.67,122,,,fee schedule,122% of APC rate,67.57,29,,54.056,percent of total billed charges,29% of total billed charges,187.44,100,,,fee schedule,100% of CMS OPPS rate,156.11,67,,124.888,percent of total billed charges,67% of total billed charges,32.45,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,186.4,80,,149.12,percent of total billed charges,80% of total billed charges,151.45,65,,121.16,percent of total billed charges,65% of total billed charges,83.11,35.67,,66.488,percent of total billed charges,35.67% of total billed charges,32.45,228.67,
EACH ADD IVP NEW DRUG OB,7600047,CDM,260,RC,96375,HCPCS,outpatient,,,279,111.60,,237.15,85,,189.72,percent of total billed charges,85% of total billed charges,214.83,77,,171.86,percent of total billed charges,77% of total billed charges,41.54,100,,,fee schedule,100% of CMS OPPS rate,78.51,429,,,fee schedule,429% of BCBS fee schedule,81.8,447,,,fee schedule,447% of BCBS fee schedule,81.8,447,,,fee schedule,447% of BCBS fee schedule,81.8,447,,,fee schedule,447% of BCBS fee schedule,251.1,90,,200.88,percent of total billed charges,90% of total billed charges,223.2,80,,178.56,percent of total billed charges,80% of total billed charges,251.1,90,,200.88,percent of total billed charges,90% of total billed charges,209.25,75,,167.4,percent of total billed charges,75% of total billed charges,50.67,122,,,fee schedule,122% of APC rate,80.91,29,,64.728,percent of total billed charges,29% of total billed charges,41.54,100,,,fee schedule,100% of CMS OPPS rate,186.93,67,,149.544,percent of total billed charges,67% of total billed charges,32.45,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,223.2,80,,178.56,percent of total billed charges,80% of total billed charges,181.35,65,,145.08,percent of total billed charges,65% of total billed charges,99.52,35.67,,79.616,percent of total billed charges,35.67% of total billed charges,32.45,251.1,
EAD ADD IVP SAME DRUG OB,7600048,CDM,260,RC,96376,HCPCS,outpatient,,,279,111.60,,237.15,85,,189.72,percent of total billed charges,85% of total billed charges,214.83,77,,171.86,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,98.54,429,,,fee schedule,429% of BCBS fee schedule,102.68,447,,,fee schedule,447% of BCBS fee schedule,102.68,447,,,fee schedule,447% of BCBS fee schedule,102.68,447,,,fee schedule,447% of BCBS fee schedule,251.1,90,,200.88,percent of total billed charges,90% of total billed charges,223.2,80,,178.56,percent of total billed charges,80% of total billed charges,251.1,90,,200.88,percent of total billed charges,90% of total billed charges,209.25,75,,167.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,80.91,29,,64.728,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,186.93,67,,149.544,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,223.2,80,,178.56,percent of total billed charges,80% of total billed charges,181.35,65,,145.08,percent of total billed charges,65% of total billed charges,99.52,35.67,,79.616,percent of total billed charges,35.67% of total billed charges,80.91,251.1,
SODIUM CHLORIDE 1000 ML IRR.,2509531,CDM,270,RC,,,outpatient,,,53,21.20,,45.05,85,,36.04,percent of total billed charges,85% of total billed charges,40.81,77,,32.65,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,43.46,82,,34.768,percent of total billed charges,82% of total billed charges,45.05,85,,36.04,percent of total billed charges,85% of total billed charges,45.05,85,,36.04,percent of total billed charges,85% of total billed charges,45.05,85,,36.04,percent of total billed charges,85% of total billed charges,47.7,90,,38.16,percent of total billed charges,90% of total billed charges,42.4,80,,33.92,percent of total billed charges,80% of total billed charges,47.7,90,,38.16,percent of total billed charges,90% of total billed charges,39.75,75,,31.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,15.37,29,,12.296,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,35.51,67,,28.408,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,42.4,80,,33.92,percent of total billed charges,80% of total billed charges,34.45,65,,27.56,percent of total billed charges,65% of total billed charges,18.91,35.67,,15.128,percent of total billed charges,35.67% of total billed charges,15.37,47.7,
STERILE H2O IRR. 1000 ML,2524320,CDM,270,RC,,,outpatient,,,23,9.20,,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,17.71,77,,14.17,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,18.86,82,,15.088,percent of total billed charges,82% of total billed charges,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,20.7,90,,16.56,percent of total billed charges,90% of total billed charges,18.4,80,,14.72,percent of total billed charges,80% of total billed charges,20.7,90,,16.56,percent of total billed charges,90% of total billed charges,17.25,75,,13.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,6.67,29,,5.336,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,15.41,67,,12.328,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,18.4,80,,14.72,percent of total billed charges,80% of total billed charges,14.95,65,,11.96,percent of total billed charges,65% of total billed charges,8.2,35.67,,6.56,percent of total billed charges,35.67% of total billed charges,6.67,20.7,
CPM MACHINE DAILY CHARGE,2600003,CDM,270,RC,,,outpatient,,,93,37.20,,79.05,85,,63.24,percent of total billed charges,85% of total billed charges,71.61,77,,57.29,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,76.26,82,,61.008,percent of total billed charges,82% of total billed charges,79.05,85,,63.24,percent of total billed charges,85% of total billed charges,79.05,85,,63.24,percent of total billed charges,85% of total billed charges,79.05,85,,63.24,percent of total billed charges,85% of total billed charges,83.7,90,,66.96,percent of total billed charges,90% of total billed charges,74.4,80,,59.52,percent of total billed charges,80% of total billed charges,83.7,90,,66.96,percent of total billed charges,90% of total billed charges,69.75,75,,55.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,26.97,29,,21.576,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,62.31,67,,49.848,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,74.4,80,,59.52,percent of total billed charges,80% of total billed charges,60.45,65,,48.36,percent of total billed charges,65% of total billed charges,33.17,35.67,,26.536,percent of total billed charges,35.67% of total billed charges,26.97,83.7,
SCD UNIT DAILY CHARGE,2600006,CDM,270,RC,,,outpatient,,,117,46.80,,99.45,85,,79.56,percent of total billed charges,85% of total billed charges,90.09,77,,72.07,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,95.94,82,,76.752,percent of total billed charges,82% of total billed charges,99.45,85,,79.56,percent of total billed charges,85% of total billed charges,99.45,85,,79.56,percent of total billed charges,85% of total billed charges,99.45,85,,79.56,percent of total billed charges,85% of total billed charges,105.3,90,,84.24,percent of total billed charges,90% of total billed charges,93.6,80,,74.88,percent of total billed charges,80% of total billed charges,105.3,90,,84.24,percent of total billed charges,90% of total billed charges,87.75,75,,70.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,33.93,29,,27.144,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,78.39,67,,62.712,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,93.6,80,,74.88,percent of total billed charges,80% of total billed charges,76.05,65,,60.84,percent of total billed charges,65% of total billed charges,41.73,35.67,,33.384,percent of total billed charges,35.67% of total billed charges,33.93,105.3,
WOUND VACUUM PROCEDURE DAILY,2600007,CDM,270,RC,,,outpatient,,,170,68.00,,144.5,85,,115.6,percent of total billed charges,85% of total billed charges,130.9,77,,104.72,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,139.4,82,,111.52,percent of total billed charges,82% of total billed charges,144.5,85,,115.6,percent of total billed charges,85% of total billed charges,144.5,85,,115.6,percent of total billed charges,85% of total billed charges,144.5,85,,115.6,percent of total billed charges,85% of total billed charges,153,90,,122.4,percent of total billed charges,90% of total billed charges,136,80,,108.8,percent of total billed charges,80% of total billed charges,153,90,,122.4,percent of total billed charges,90% of total billed charges,127.5,75,,102,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,49.3,29,,39.44,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,113.9,67,,91.12,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,136,80,,108.8,percent of total billed charges,80% of total billed charges,110.5,65,,88.4,percent of total billed charges,65% of total billed charges,60.64,35.67,,48.512,percent of total billed charges,35.67% of total billed charges,49.3,153,
FEEDING PUMP,2600030,CDM,270,RC,,,outpatient,,,102,40.80,,86.7,85,,69.36,percent of total billed charges,85% of total billed charges,78.54,77,,62.83,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,83.64,82,,66.912,percent of total billed charges,82% of total billed charges,86.7,85,,69.36,percent of total billed charges,85% of total billed charges,86.7,85,,69.36,percent of total billed charges,85% of total billed charges,86.7,85,,69.36,percent of total billed charges,85% of total billed charges,91.8,90,,73.44,percent of total billed charges,90% of total billed charges,81.6,80,,65.28,percent of total billed charges,80% of total billed charges,91.8,90,,73.44,percent of total billed charges,90% of total billed charges,76.5,75,,61.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,29.58,29,,23.664,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,68.34,67,,54.672,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,81.6,80,,65.28,percent of total billed charges,80% of total billed charges,66.3,65,,53.04,percent of total billed charges,65% of total billed charges,36.38,35.67,,29.104,percent of total billed charges,35.67% of total billed charges,29.58,91.8,
EVACUATED CONTAINER 1000 CC,26000345,CDM,270,RC,,,outpatient,,,156,62.40,,132.6,85,,106.08,percent of total billed charges,85% of total billed charges,120.12,77,,96.1,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,127.92,82,,102.336,percent of total billed charges,82% of total billed charges,132.6,85,,106.08,percent of total billed charges,85% of total billed charges,132.6,85,,106.08,percent of total billed charges,85% of total billed charges,132.6,85,,106.08,percent of total billed charges,85% of total billed charges,140.4,90,,112.32,percent of total billed charges,90% of total billed charges,124.8,80,,99.84,percent of total billed charges,80% of total billed charges,140.4,90,,112.32,percent of total billed charges,90% of total billed charges,117,75,,93.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,45.24,29,,36.192,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,104.52,67,,83.616,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,124.8,80,,99.84,percent of total billed charges,80% of total billed charges,101.4,65,,81.12,percent of total billed charges,65% of total billed charges,55.65,35.67,,44.52,percent of total billed charges,35.67% of total billed charges,45.24,140.4,
NACL .9% IRRIGATION 3000 CC,26000384,CDM,270,RC,,,outpatient,,,107,42.80,,90.95,85,,72.76,percent of total billed charges,85% of total billed charges,82.39,77,,65.91,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,87.74,82,,70.192,percent of total billed charges,82% of total billed charges,90.95,85,,72.76,percent of total billed charges,85% of total billed charges,90.95,85,,72.76,percent of total billed charges,85% of total billed charges,90.95,85,,72.76,percent of total billed charges,85% of total billed charges,96.3,90,,77.04,percent of total billed charges,90% of total billed charges,85.6,80,,68.48,percent of total billed charges,80% of total billed charges,96.3,90,,77.04,percent of total billed charges,90% of total billed charges,80.25,75,,64.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,31.03,29,,24.824,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,71.69,67,,57.352,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,85.6,80,,68.48,percent of total billed charges,80% of total billed charges,69.55,65,,55.64,percent of total billed charges,65% of total billed charges,38.17,35.67,,30.536,percent of total billed charges,35.67% of total billed charges,31.03,96.3,
1.5% GLYCINE IRR 3000 CC,26000385,CDM,270,RC,,,outpatient,,,129,51.60,,109.65,85,,87.72,percent of total billed charges,85% of total billed charges,99.33,77,,79.46,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,105.78,82,,84.624,percent of total billed charges,82% of total billed charges,109.65,85,,87.72,percent of total billed charges,85% of total billed charges,109.65,85,,87.72,percent of total billed charges,85% of total billed charges,109.65,85,,87.72,percent of total billed charges,85% of total billed charges,116.1,90,,92.88,percent of total billed charges,90% of total billed charges,103.2,80,,82.56,percent of total billed charges,80% of total billed charges,116.1,90,,92.88,percent of total billed charges,90% of total billed charges,96.75,75,,77.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,37.41,29,,29.928,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,86.43,67,,69.144,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,103.2,80,,82.56,percent of total billed charges,80% of total billed charges,83.85,65,,67.08,percent of total billed charges,65% of total billed charges,46.01,35.67,,36.808,percent of total billed charges,35.67% of total billed charges,37.41,116.1,
DEXTROSTIX,2600052,CDM,270,RC,,,outpatient,,,12,4.80,,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,9.24,77,,7.39,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,9.84,82,,7.872,percent of total billed charges,82% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,10.8,90,,8.64,percent of total billed charges,90% of total billed charges,9.6,80,,7.68,percent of total billed charges,80% of total billed charges,10.8,90,,8.64,percent of total billed charges,90% of total billed charges,9,75,,7.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,3.48,29,,2.784,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,8.04,67,,6.432,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,9.6,80,,7.68,percent of total billed charges,80% of total billed charges,7.8,65,,6.24,percent of total billed charges,65% of total billed charges,4.28,35.67,,3.424,percent of total billed charges,35.67% of total billed charges,3.48,10.8,
ADULT PLASTER CAST-SHORT,2600069,CDM,270,RC,,,outpatient,,,102,40.80,,86.7,85,,69.36,percent of total billed charges,85% of total billed charges,78.54,77,,62.83,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,83.64,82,,66.912,percent of total billed charges,82% of total billed charges,86.7,85,,69.36,percent of total billed charges,85% of total billed charges,86.7,85,,69.36,percent of total billed charges,85% of total billed charges,86.7,85,,69.36,percent of total billed charges,85% of total billed charges,91.8,90,,73.44,percent of total billed charges,90% of total billed charges,81.6,80,,65.28,percent of total billed charges,80% of total billed charges,91.8,90,,73.44,percent of total billed charges,90% of total billed charges,76.5,75,,61.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,29.58,29,,23.664,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,68.34,67,,54.672,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,81.6,80,,65.28,percent of total billed charges,80% of total billed charges,66.3,65,,53.04,percent of total billed charges,65% of total billed charges,36.38,35.67,,29.104,percent of total billed charges,35.67% of total billed charges,29.58,91.8,
CHILD PLASTER CAST ARM/LEG,2600070,CDM,270,RC,,,outpatient,,,93,37.20,,79.05,85,,63.24,percent of total billed charges,85% of total billed charges,71.61,77,,57.29,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,76.26,82,,61.008,percent of total billed charges,82% of total billed charges,79.05,85,,63.24,percent of total billed charges,85% of total billed charges,79.05,85,,63.24,percent of total billed charges,85% of total billed charges,79.05,85,,63.24,percent of total billed charges,85% of total billed charges,83.7,90,,66.96,percent of total billed charges,90% of total billed charges,74.4,80,,59.52,percent of total billed charges,80% of total billed charges,83.7,90,,66.96,percent of total billed charges,90% of total billed charges,69.75,75,,55.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,26.97,29,,21.576,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,62.31,67,,49.848,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,74.4,80,,59.52,percent of total billed charges,80% of total billed charges,60.45,65,,48.36,percent of total billed charges,65% of total billed charges,33.17,35.67,,26.536,percent of total billed charges,35.67% of total billed charges,26.97,83.7,
CHILD LRG PLASTER CAST ARM/LEG,2600072,CDM,270,RC,,,outpatient,,,102,40.80,,86.7,85,,69.36,percent of total billed charges,85% of total billed charges,78.54,77,,62.83,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,83.64,82,,66.912,percent of total billed charges,82% of total billed charges,86.7,85,,69.36,percent of total billed charges,85% of total billed charges,86.7,85,,69.36,percent of total billed charges,85% of total billed charges,86.7,85,,69.36,percent of total billed charges,85% of total billed charges,91.8,90,,73.44,percent of total billed charges,90% of total billed charges,81.6,80,,65.28,percent of total billed charges,80% of total billed charges,91.8,90,,73.44,percent of total billed charges,90% of total billed charges,76.5,75,,61.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,29.58,29,,23.664,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,68.34,67,,54.672,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,81.6,80,,65.28,percent of total billed charges,80% of total billed charges,66.3,65,,53.04,percent of total billed charges,65% of total billed charges,36.38,35.67,,29.104,percent of total billed charges,35.67% of total billed charges,29.58,91.8,
EYE TRAY,2600114,CDM,270,RC,,,outpatient,,,59,23.60,,50.15,85,,40.12,percent of total billed charges,85% of total billed charges,45.43,77,,36.34,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,48.38,82,,38.704,percent of total billed charges,82% of total billed charges,50.15,85,,40.12,percent of total billed charges,85% of total billed charges,50.15,85,,40.12,percent of total billed charges,85% of total billed charges,50.15,85,,40.12,percent of total billed charges,85% of total billed charges,53.1,90,,42.48,percent of total billed charges,90% of total billed charges,47.2,80,,37.76,percent of total billed charges,80% of total billed charges,53.1,90,,42.48,percent of total billed charges,90% of total billed charges,44.25,75,,35.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,17.11,29,,13.688,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,39.53,67,,31.624,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,47.2,80,,37.76,percent of total billed charges,80% of total billed charges,38.35,65,,30.68,percent of total billed charges,65% of total billed charges,21.05,35.67,,16.84,percent of total billed charges,35.67% of total billed charges,17.11,53.1,
PERI LIGHT,2600120,CDM,270,RC,,,outpatient,,,59,23.60,,50.15,85,,40.12,percent of total billed charges,85% of total billed charges,45.43,77,,36.34,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,48.38,82,,38.704,percent of total billed charges,82% of total billed charges,50.15,85,,40.12,percent of total billed charges,85% of total billed charges,50.15,85,,40.12,percent of total billed charges,85% of total billed charges,50.15,85,,40.12,percent of total billed charges,85% of total billed charges,53.1,90,,42.48,percent of total billed charges,90% of total billed charges,47.2,80,,37.76,percent of total billed charges,80% of total billed charges,53.1,90,,42.48,percent of total billed charges,90% of total billed charges,44.25,75,,35.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,17.11,29,,13.688,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,39.53,67,,31.624,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,47.2,80,,37.76,percent of total billed charges,80% of total billed charges,38.35,65,,30.68,percent of total billed charges,65% of total billed charges,21.05,35.67,,16.84,percent of total billed charges,35.67% of total billed charges,17.11,53.1,
SUCTION TONSIL TIP YANKAUER,27000076,CDM,270,RC,,,outpatient,,,12,4.80,,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,9.24,77,,7.39,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,9.84,82,,7.872,percent of total billed charges,82% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,10.8,90,,8.64,percent of total billed charges,90% of total billed charges,9.6,80,,7.68,percent of total billed charges,80% of total billed charges,10.8,90,,8.64,percent of total billed charges,90% of total billed charges,9,75,,7.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,3.48,29,,2.784,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,8.04,67,,6.432,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,9.6,80,,7.68,percent of total billed charges,80% of total billed charges,7.8,65,,6.24,percent of total billed charges,65% of total billed charges,4.28,35.67,,3.424,percent of total billed charges,35.67% of total billed charges,3.48,10.8,
STRAIGHT ADAPTER 4086,27000097,CDM,270,RC,,,outpatient,,,13,5.20,,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,10.01,77,,8.01,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,10.66,82,,8.528,percent of total billed charges,82% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,11.7,90,,9.36,percent of total billed charges,90% of total billed charges,10.4,80,,8.32,percent of total billed charges,80% of total billed charges,11.7,90,,9.36,percent of total billed charges,90% of total billed charges,9.75,75,,7.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,3.77,29,,3.016,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,8.71,67,,6.968,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,10.4,80,,8.32,percent of total billed charges,80% of total billed charges,8.45,65,,6.76,percent of total billed charges,65% of total billed charges,4.64,35.67,,3.712,percent of total billed charges,35.67% of total billed charges,3.77,11.7,
COLD PACK INSTANT,27000122,CDM,270,RC,,,outpatient,,,34,13.60,,28.9,85,,23.12,percent of total billed charges,85% of total billed charges,26.18,77,,20.94,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,27.88,82,,22.304,percent of total billed charges,82% of total billed charges,28.9,85,,23.12,percent of total billed charges,85% of total billed charges,28.9,85,,23.12,percent of total billed charges,85% of total billed charges,28.9,85,,23.12,percent of total billed charges,85% of total billed charges,30.6,90,,24.48,percent of total billed charges,90% of total billed charges,27.2,80,,21.76,percent of total billed charges,80% of total billed charges,30.6,90,,24.48,percent of total billed charges,90% of total billed charges,25.5,75,,20.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,9.86,29,,7.888,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,22.78,67,,18.224,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,27.2,80,,21.76,percent of total billed charges,80% of total billed charges,22.1,65,,17.68,percent of total billed charges,65% of total billed charges,12.13,35.67,,9.704,percent of total billed charges,35.67% of total billed charges,9.86,30.6,
COLD PACK PERINEAL,27000123,CDM,270,RC,,,outpatient,,,13,5.20,,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,10.01,77,,8.01,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,10.66,82,,8.528,percent of total billed charges,82% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,11.7,90,,9.36,percent of total billed charges,90% of total billed charges,10.4,80,,8.32,percent of total billed charges,80% of total billed charges,11.7,90,,9.36,percent of total billed charges,90% of total billed charges,9.75,75,,7.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,3.77,29,,3.016,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,8.71,67,,6.968,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,10.4,80,,8.32,percent of total billed charges,80% of total billed charges,8.45,65,,6.76,percent of total billed charges,65% of total billed charges,4.64,35.67,,3.712,percent of total billed charges,35.67% of total billed charges,3.77,11.7,
DUO-THERMAL PAD 3X24,27000125,CDM,270,RC,,,outpatient,,,73,29.20,,62.05,85,,49.64,percent of total billed charges,85% of total billed charges,56.21,77,,44.97,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,59.86,82,,47.888,percent of total billed charges,82% of total billed charges,62.05,85,,49.64,percent of total billed charges,85% of total billed charges,62.05,85,,49.64,percent of total billed charges,85% of total billed charges,62.05,85,,49.64,percent of total billed charges,85% of total billed charges,65.7,90,,52.56,percent of total billed charges,90% of total billed charges,58.4,80,,46.72,percent of total billed charges,80% of total billed charges,65.7,90,,52.56,percent of total billed charges,90% of total billed charges,54.75,75,,43.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,21.17,29,,16.936,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,48.91,67,,39.128,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,58.4,80,,46.72,percent of total billed charges,80% of total billed charges,47.45,65,,37.96,percent of total billed charges,65% of total billed charges,26.04,35.67,,20.832,percent of total billed charges,35.67% of total billed charges,21.17,65.7,
DUO-THERM PAD 13X18,27000126,CDM,270,RC,,,outpatient,,,185,74.00,,157.25,85,,125.8,percent of total billed charges,85% of total billed charges,142.45,77,,113.96,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,151.7,82,,121.36,percent of total billed charges,82% of total billed charges,157.25,85,,125.8,percent of total billed charges,85% of total billed charges,157.25,85,,125.8,percent of total billed charges,85% of total billed charges,157.25,85,,125.8,percent of total billed charges,85% of total billed charges,166.5,90,,133.2,percent of total billed charges,90% of total billed charges,148,80,,118.4,percent of total billed charges,80% of total billed charges,166.5,90,,133.2,percent of total billed charges,90% of total billed charges,138.75,75,,111,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,53.65,29,,42.92,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,123.95,67,,99.16,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,148,80,,118.4,percent of total billed charges,80% of total billed charges,120.25,65,,96.2,percent of total billed charges,65% of total billed charges,65.99,35.67,,52.792,percent of total billed charges,35.67% of total billed charges,53.65,166.5,
DUO-THERM PAD 14X20,27000127,CDM,270,RC,,,outpatient,,,87,34.80,,73.95,85,,59.16,percent of total billed charges,85% of total billed charges,66.99,77,,53.59,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,71.34,82,,57.072,percent of total billed charges,82% of total billed charges,73.95,85,,59.16,percent of total billed charges,85% of total billed charges,73.95,85,,59.16,percent of total billed charges,85% of total billed charges,73.95,85,,59.16,percent of total billed charges,85% of total billed charges,78.3,90,,62.64,percent of total billed charges,90% of total billed charges,69.6,80,,55.68,percent of total billed charges,80% of total billed charges,78.3,90,,62.64,percent of total billed charges,90% of total billed charges,65.25,75,,52.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,25.23,29,,20.184,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,58.29,67,,46.632,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,69.6,80,,55.68,percent of total billed charges,80% of total billed charges,56.55,65,,45.24,percent of total billed charges,65% of total billed charges,31.03,35.67,,24.824,percent of total billed charges,35.67% of total billed charges,25.23,78.3,
CATHETER CLAMP,27000136,CDM,270,RC,,,outpatient,,,34,13.60,,28.9,85,,23.12,percent of total billed charges,85% of total billed charges,26.18,77,,20.94,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,27.88,82,,22.304,percent of total billed charges,82% of total billed charges,28.9,85,,23.12,percent of total billed charges,85% of total billed charges,28.9,85,,23.12,percent of total billed charges,85% of total billed charges,28.9,85,,23.12,percent of total billed charges,85% of total billed charges,30.6,90,,24.48,percent of total billed charges,90% of total billed charges,27.2,80,,21.76,percent of total billed charges,80% of total billed charges,30.6,90,,24.48,percent of total billed charges,90% of total billed charges,25.5,75,,20.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,9.86,29,,7.888,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,22.78,67,,18.224,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,27.2,80,,21.76,percent of total billed charges,80% of total billed charges,22.1,65,,17.68,percent of total billed charges,65% of total billed charges,12.13,35.67,,9.704,percent of total billed charges,35.67% of total billed charges,9.86,30.6,
PEDI URINE COLLECTOR,27000145,CDM,270,RC,,,outpatient,,,10,4.00,,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,7.7,77,,6.16,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,8.2,82,,6.56,percent of total billed charges,82% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,9,90,,7.2,percent of total billed charges,90% of total billed charges,8,80,,6.4,percent of total billed charges,80% of total billed charges,9,90,,7.2,percent of total billed charges,90% of total billed charges,7.5,75,,6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.9,29,,2.32,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,6.7,67,,5.36,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,8,80,,6.4,percent of total billed charges,80% of total billed charges,6.5,65,,5.2,percent of total billed charges,65% of total billed charges,3.57,35.67,,2.856,percent of total billed charges,35.67% of total billed charges,2.9,9,
HONEYCOMB BANDAGE 2,27000167,CDM,270,RC,,,outpatient,,,13,5.20,,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,10.01,77,,8.01,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,10.66,82,,8.528,percent of total billed charges,82% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,11.7,90,,9.36,percent of total billed charges,90% of total billed charges,10.4,80,,8.32,percent of total billed charges,80% of total billed charges,11.7,90,,9.36,percent of total billed charges,90% of total billed charges,9.75,75,,7.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,3.77,29,,3.016,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,8.71,67,,6.968,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,10.4,80,,8.32,percent of total billed charges,80% of total billed charges,8.45,65,,6.76,percent of total billed charges,65% of total billed charges,4.64,35.67,,3.712,percent of total billed charges,35.67% of total billed charges,3.77,11.7,
HONEYCOMB BANDAGE 3,27000168,CDM,270,RC,,,outpatient,,,14,5.60,,11.9,85,,9.52,percent of total billed charges,85% of total billed charges,10.78,77,,8.62,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,11.48,82,,9.184,percent of total billed charges,82% of total billed charges,11.9,85,,9.52,percent of total billed charges,85% of total billed charges,11.9,85,,9.52,percent of total billed charges,85% of total billed charges,11.9,85,,9.52,percent of total billed charges,85% of total billed charges,12.6,90,,10.08,percent of total billed charges,90% of total billed charges,11.2,80,,8.96,percent of total billed charges,80% of total billed charges,12.6,90,,10.08,percent of total billed charges,90% of total billed charges,10.5,75,,8.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,4.06,29,,3.248,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,9.38,67,,7.504,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,11.2,80,,8.96,percent of total billed charges,80% of total billed charges,9.1,65,,7.28,percent of total billed charges,65% of total billed charges,4.99,35.67,,3.992,percent of total billed charges,35.67% of total billed charges,4.06,12.6,
HONEYCOMB BANDAGE 4,27000169,CDM,270,RC,,,outpatient,,,17,6.80,,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,13.09,77,,10.47,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,13.94,82,,11.152,percent of total billed charges,82% of total billed charges,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,15.3,90,,12.24,percent of total billed charges,90% of total billed charges,13.6,80,,10.88,percent of total billed charges,80% of total billed charges,15.3,90,,12.24,percent of total billed charges,90% of total billed charges,12.75,75,,10.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,4.93,29,,3.944,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,11.39,67,,9.112,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,13.6,80,,10.88,percent of total billed charges,80% of total billed charges,11.05,65,,8.84,percent of total billed charges,65% of total billed charges,6.06,35.67,,4.848,percent of total billed charges,35.67% of total billed charges,4.93,15.3,
HONEYCOMB BANDAGE 6,27000170,CDM,270,RC,,,outpatient,,,18,7.20,,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,13.86,77,,11.09,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,14.76,82,,11.808,percent of total billed charges,82% of total billed charges,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,16.2,90,,12.96,percent of total billed charges,90% of total billed charges,14.4,80,,11.52,percent of total billed charges,80% of total billed charges,16.2,90,,12.96,percent of total billed charges,90% of total billed charges,13.5,75,,10.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,5.22,29,,4.176,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,12.06,67,,9.648,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,14.4,80,,11.52,percent of total billed charges,80% of total billed charges,11.7,65,,9.36,percent of total billed charges,65% of total billed charges,6.42,35.67,,5.136,percent of total billed charges,35.67% of total billed charges,5.22,16.2,
VAGINAL SPECULUM MEDIUM,27000180,CDM,270,RC,,,outpatient,,,19,7.60,,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,14.63,77,,11.7,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,15.58,82,,12.464,percent of total billed charges,82% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,15.2,80,,12.16,percent of total billed charges,80% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,14.25,75,,11.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,5.51,29,,4.408,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,12.73,67,,10.184,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,15.2,80,,12.16,percent of total billed charges,80% of total billed charges,12.35,65,,9.88,percent of total billed charges,65% of total billed charges,6.78,35.67,,5.424,percent of total billed charges,35.67% of total billed charges,5.51,17.1,
ABDUCTION PILLOW MEDIUM,27000249,CDM,270,RC,,,outpatient,,,197,78.80,,167.45,85,,133.96,percent of total billed charges,85% of total billed charges,151.69,77,,121.35,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,161.54,82,,129.232,percent of total billed charges,82% of total billed charges,167.45,85,,133.96,percent of total billed charges,85% of total billed charges,167.45,85,,133.96,percent of total billed charges,85% of total billed charges,167.45,85,,133.96,percent of total billed charges,85% of total billed charges,177.3,90,,141.84,percent of total billed charges,90% of total billed charges,157.6,80,,126.08,percent of total billed charges,80% of total billed charges,177.3,90,,141.84,percent of total billed charges,90% of total billed charges,147.75,75,,118.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,57.13,29,,45.704,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,131.99,67,,105.592,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,157.6,80,,126.08,percent of total billed charges,80% of total billed charges,128.05,65,,102.44,percent of total billed charges,65% of total billed charges,70.27,35.67,,56.216,percent of total billed charges,35.67% of total billed charges,57.13,177.3,
ABDUCTION PILLOW LG,27000250,CDM,270,RC,,,outpatient,,,197,78.80,,167.45,85,,133.96,percent of total billed charges,85% of total billed charges,151.69,77,,121.35,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,161.54,82,,129.232,percent of total billed charges,82% of total billed charges,167.45,85,,133.96,percent of total billed charges,85% of total billed charges,167.45,85,,133.96,percent of total billed charges,85% of total billed charges,167.45,85,,133.96,percent of total billed charges,85% of total billed charges,177.3,90,,141.84,percent of total billed charges,90% of total billed charges,157.6,80,,126.08,percent of total billed charges,80% of total billed charges,177.3,90,,141.84,percent of total billed charges,90% of total billed charges,147.75,75,,118.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,57.13,29,,45.704,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,131.99,67,,105.592,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,157.6,80,,126.08,percent of total billed charges,80% of total billed charges,128.05,65,,102.44,percent of total billed charges,65% of total billed charges,70.27,35.67,,56.216,percent of total billed charges,35.67% of total billed charges,57.13,177.3,
SURGIGUT 2-0 SUTURE,27000268,CDM,270,RC,,,outpatient,,,65,26.00,,55.25,85,,44.2,percent of total billed charges,85% of total billed charges,50.05,77,,40.04,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,53.3,82,,42.64,percent of total billed charges,82% of total billed charges,55.25,85,,44.2,percent of total billed charges,85% of total billed charges,55.25,85,,44.2,percent of total billed charges,85% of total billed charges,55.25,85,,44.2,percent of total billed charges,85% of total billed charges,58.5,90,,46.8,percent of total billed charges,90% of total billed charges,52,80,,41.6,percent of total billed charges,80% of total billed charges,58.5,90,,46.8,percent of total billed charges,90% of total billed charges,48.75,75,,39,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,18.85,29,,15.08,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,43.55,67,,34.84,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,52,80,,41.6,percent of total billed charges,80% of total billed charges,42.25,65,,33.8,percent of total billed charges,65% of total billed charges,23.19,35.67,,18.552,percent of total billed charges,35.67% of total billed charges,18.85,58.5,
BIPAP CIRCUIT,270003335,CDM,270,RC,,,outpatient,,,88,35.20,,74.8,85,,59.84,percent of total billed charges,85% of total billed charges,67.76,77,,54.21,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,72.16,82,,57.728,percent of total billed charges,82% of total billed charges,74.8,85,,59.84,percent of total billed charges,85% of total billed charges,74.8,85,,59.84,percent of total billed charges,85% of total billed charges,74.8,85,,59.84,percent of total billed charges,85% of total billed charges,79.2,90,,63.36,percent of total billed charges,90% of total billed charges,70.4,80,,56.32,percent of total billed charges,80% of total billed charges,79.2,90,,63.36,percent of total billed charges,90% of total billed charges,66,75,,52.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,25.52,29,,20.416,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,58.96,67,,47.168,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,70.4,80,,56.32,percent of total billed charges,80% of total billed charges,57.2,65,,45.76,percent of total billed charges,65% of total billed charges,31.39,35.67,,25.112,percent of total billed charges,35.67% of total billed charges,25.52,79.2,
EVAC CONTAINER,27000345,CDM,270,RC,,,outpatient,,,145,58.00,,123.25,85,,98.6,percent of total billed charges,85% of total billed charges,111.65,77,,89.32,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,118.9,82,,95.12,percent of total billed charges,82% of total billed charges,123.25,85,,98.6,percent of total billed charges,85% of total billed charges,123.25,85,,98.6,percent of total billed charges,85% of total billed charges,123.25,85,,98.6,percent of total billed charges,85% of total billed charges,130.5,90,,104.4,percent of total billed charges,90% of total billed charges,116,80,,92.8,percent of total billed charges,80% of total billed charges,130.5,90,,104.4,percent of total billed charges,90% of total billed charges,108.75,75,,87,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,42.05,29,,33.64,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,97.15,67,,77.72,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,116,80,,92.8,percent of total billed charges,80% of total billed charges,94.25,65,,75.4,percent of total billed charges,65% of total billed charges,51.72,35.67,,41.376,percent of total billed charges,35.67% of total billed charges,42.05,130.5,
SAF-CLENS WOUND CLEANSER **,27000396,CDM,270,RC,,,outpatient,,,50,20.00,,42.5,85,,34,percent of total billed charges,85% of total billed charges,38.5,77,,30.8,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,41,82,,32.8,percent of total billed charges,82% of total billed charges,42.5,85,,34,percent of total billed charges,85% of total billed charges,42.5,85,,34,percent of total billed charges,85% of total billed charges,42.5,85,,34,percent of total billed charges,85% of total billed charges,45,90,,36,percent of total billed charges,90% of total billed charges,40,80,,32,percent of total billed charges,80% of total billed charges,45,90,,36,percent of total billed charges,90% of total billed charges,37.5,75,,30,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,14.5,29,,11.6,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,33.5,67,,26.8,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,40,80,,32,percent of total billed charges,80% of total billed charges,32.5,65,,26,percent of total billed charges,65% of total billed charges,17.84,35.67,,14.272,percent of total billed charges,35.67% of total billed charges,14.5,45,
CUSHION ROCKER CAST SHOE SM,27000405,CDM,270,RC,,,outpatient,,,101,40.40,,85.85,85,,68.68,percent of total billed charges,85% of total billed charges,77.77,77,,62.22,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,82.82,82,,66.256,percent of total billed charges,82% of total billed charges,85.85,85,,68.68,percent of total billed charges,85% of total billed charges,85.85,85,,68.68,percent of total billed charges,85% of total billed charges,85.85,85,,68.68,percent of total billed charges,85% of total billed charges,90.9,90,,72.72,percent of total billed charges,90% of total billed charges,80.8,80,,64.64,percent of total billed charges,80% of total billed charges,90.9,90,,72.72,percent of total billed charges,90% of total billed charges,75.75,75,,60.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,29.29,29,,23.432,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,67.67,67,,54.136,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,80.8,80,,64.64,percent of total billed charges,80% of total billed charges,65.65,65,,52.52,percent of total billed charges,65% of total billed charges,36.03,35.67,,28.824,percent of total billed charges,35.67% of total billed charges,29.29,90.9,
CUSHION ROCKER CAST SHOE MED,27000406,CDM,270,RC,,,outpatient,,,102,40.80,,86.7,85,,69.36,percent of total billed charges,85% of total billed charges,78.54,77,,62.83,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,83.64,82,,66.912,percent of total billed charges,82% of total billed charges,86.7,85,,69.36,percent of total billed charges,85% of total billed charges,86.7,85,,69.36,percent of total billed charges,85% of total billed charges,86.7,85,,69.36,percent of total billed charges,85% of total billed charges,91.8,90,,73.44,percent of total billed charges,90% of total billed charges,81.6,80,,65.28,percent of total billed charges,80% of total billed charges,91.8,90,,73.44,percent of total billed charges,90% of total billed charges,76.5,75,,61.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,29.58,29,,23.664,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,68.34,67,,54.672,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,81.6,80,,65.28,percent of total billed charges,80% of total billed charges,66.3,65,,53.04,percent of total billed charges,65% of total billed charges,36.38,35.67,,29.104,percent of total billed charges,35.67% of total billed charges,29.58,91.8,
CUSHION ROCKER CAST SHOE LG,27000407,CDM,270,RC,,,outpatient,,,102,40.80,,86.7,85,,69.36,percent of total billed charges,85% of total billed charges,78.54,77,,62.83,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,83.64,82,,66.912,percent of total billed charges,82% of total billed charges,86.7,85,,69.36,percent of total billed charges,85% of total billed charges,86.7,85,,69.36,percent of total billed charges,85% of total billed charges,86.7,85,,69.36,percent of total billed charges,85% of total billed charges,91.8,90,,73.44,percent of total billed charges,90% of total billed charges,81.6,80,,65.28,percent of total billed charges,80% of total billed charges,91.8,90,,73.44,percent of total billed charges,90% of total billed charges,76.5,75,,61.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,29.58,29,,23.664,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,68.34,67,,54.672,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,81.6,80,,65.28,percent of total billed charges,80% of total billed charges,66.3,65,,53.04,percent of total billed charges,65% of total billed charges,36.38,35.67,,29.104,percent of total billed charges,35.67% of total billed charges,29.58,91.8,
LUMBAR SUPPORT UNIVERSAL **,27000411,CDM,270,RC,,,outpatient,,,198,79.20,,168.3,85,,134.64,percent of total billed charges,85% of total billed charges,152.46,77,,121.97,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,162.36,82,,129.888,percent of total billed charges,82% of total billed charges,168.3,85,,134.64,percent of total billed charges,85% of total billed charges,168.3,85,,134.64,percent of total billed charges,85% of total billed charges,168.3,85,,134.64,percent of total billed charges,85% of total billed charges,178.2,90,,142.56,percent of total billed charges,90% of total billed charges,158.4,80,,126.72,percent of total billed charges,80% of total billed charges,178.2,90,,142.56,percent of total billed charges,90% of total billed charges,148.5,75,,118.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,57.42,29,,45.936,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,132.66,67,,106.128,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,158.4,80,,126.72,percent of total billed charges,80% of total billed charges,128.7,65,,102.96,percent of total billed charges,65% of total billed charges,70.63,35.67,,56.504,percent of total billed charges,35.67% of total billed charges,57.42,178.2,
TUBE ESOPH/NASO BLAKEMORE,270004213,CDM,270,RC,,,outpatient,,,1598,639.20,,1358.3,85,,1086.64,percent of total billed charges,85% of total billed charges,1230.46,77,,984.37,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,1310.36,82,,1048.288,percent of total billed charges,82% of total billed charges,1358.3,85,,1086.64,percent of total billed charges,85% of total billed charges,1358.3,85,,1086.64,percent of total billed charges,85% of total billed charges,1358.3,85,,1086.64,percent of total billed charges,85% of total billed charges,1438.2,90,,1150.56,percent of total billed charges,90% of total billed charges,1278.4,80,,1022.72,percent of total billed charges,80% of total billed charges,1438.2,90,,1150.56,percent of total billed charges,90% of total billed charges,1198.5,75,,958.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,463.42,29,,370.736,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1070.66,67,,856.528,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1278.4,80,,1022.72,percent of total billed charges,80% of total billed charges,1038.7,65,,830.96,percent of total billed charges,65% of total billed charges,570.01,35.67,,456.008,percent of total billed charges,35.67% of total billed charges,463.42,1438.2,
CERVICAL COLLAR FOAM XL,27000430,CDM,270,RC,,,outpatient,,,67,26.80,,56.95,85,,45.56,percent of total billed charges,85% of total billed charges,51.59,77,,41.27,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,54.94,82,,43.952,percent of total billed charges,82% of total billed charges,56.95,85,,45.56,percent of total billed charges,85% of total billed charges,56.95,85,,45.56,percent of total billed charges,85% of total billed charges,56.95,85,,45.56,percent of total billed charges,85% of total billed charges,60.3,90,,48.24,percent of total billed charges,90% of total billed charges,53.6,80,,42.88,percent of total billed charges,80% of total billed charges,60.3,90,,48.24,percent of total billed charges,90% of total billed charges,50.25,75,,40.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,19.43,29,,15.544,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,44.89,67,,35.912,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,53.6,80,,42.88,percent of total billed charges,80% of total billed charges,43.55,65,,34.84,percent of total billed charges,65% of total billed charges,23.9,35.67,,19.12,percent of total billed charges,35.67% of total billed charges,19.43,60.3,
ARM SLING SMALL,27000431,CDM,270,RC,,,outpatient,,,50,20.00,,42.5,85,,34,percent of total billed charges,85% of total billed charges,38.5,77,,30.8,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,41,82,,32.8,percent of total billed charges,82% of total billed charges,42.5,85,,34,percent of total billed charges,85% of total billed charges,42.5,85,,34,percent of total billed charges,85% of total billed charges,42.5,85,,34,percent of total billed charges,85% of total billed charges,45,90,,36,percent of total billed charges,90% of total billed charges,40,80,,32,percent of total billed charges,80% of total billed charges,45,90,,36,percent of total billed charges,90% of total billed charges,37.5,75,,30,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,14.5,29,,11.6,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,33.5,67,,26.8,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,40,80,,32,percent of total billed charges,80% of total billed charges,32.5,65,,26,percent of total billed charges,65% of total billed charges,17.84,35.67,,14.272,percent of total billed charges,35.67% of total billed charges,14.5,45,
ARM SLING MED,27000432,CDM,270,RC,,,outpatient,,,50,20.00,,42.5,85,,34,percent of total billed charges,85% of total billed charges,38.5,77,,30.8,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,41,82,,32.8,percent of total billed charges,82% of total billed charges,42.5,85,,34,percent of total billed charges,85% of total billed charges,42.5,85,,34,percent of total billed charges,85% of total billed charges,42.5,85,,34,percent of total billed charges,85% of total billed charges,45,90,,36,percent of total billed charges,90% of total billed charges,40,80,,32,percent of total billed charges,80% of total billed charges,45,90,,36,percent of total billed charges,90% of total billed charges,37.5,75,,30,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,14.5,29,,11.6,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,33.5,67,,26.8,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,40,80,,32,percent of total billed charges,80% of total billed charges,32.5,65,,26,percent of total billed charges,65% of total billed charges,17.84,35.67,,14.272,percent of total billed charges,35.67% of total billed charges,14.5,45,
ARM SLING LG,27000433,CDM,270,RC,,,outpatient,,,31,12.40,,26.35,85,,21.08,percent of total billed charges,85% of total billed charges,23.87,77,,19.1,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,25.42,82,,20.336,percent of total billed charges,82% of total billed charges,26.35,85,,21.08,percent of total billed charges,85% of total billed charges,26.35,85,,21.08,percent of total billed charges,85% of total billed charges,26.35,85,,21.08,percent of total billed charges,85% of total billed charges,27.9,90,,22.32,percent of total billed charges,90% of total billed charges,24.8,80,,19.84,percent of total billed charges,80% of total billed charges,27.9,90,,22.32,percent of total billed charges,90% of total billed charges,23.25,75,,18.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,8.99,29,,7.192,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,20.77,67,,16.616,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,24.8,80,,19.84,percent of total billed charges,80% of total billed charges,20.15,65,,16.12,percent of total billed charges,65% of total billed charges,11.06,35.67,,8.848,percent of total billed charges,35.67% of total billed charges,8.99,27.9,
ARM SLING XL,27000434,CDM,270,RC,,,outpatient,,,31,12.40,,26.35,85,,21.08,percent of total billed charges,85% of total billed charges,23.87,77,,19.1,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,25.42,82,,20.336,percent of total billed charges,82% of total billed charges,26.35,85,,21.08,percent of total billed charges,85% of total billed charges,26.35,85,,21.08,percent of total billed charges,85% of total billed charges,26.35,85,,21.08,percent of total billed charges,85% of total billed charges,27.9,90,,22.32,percent of total billed charges,90% of total billed charges,24.8,80,,19.84,percent of total billed charges,80% of total billed charges,27.9,90,,22.32,percent of total billed charges,90% of total billed charges,23.25,75,,18.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,8.99,29,,7.192,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,20.77,67,,16.616,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,24.8,80,,19.84,percent of total billed charges,80% of total billed charges,20.15,65,,16.12,percent of total billed charges,65% of total billed charges,11.06,35.67,,8.848,percent of total billed charges,35.67% of total billed charges,8.99,27.9,
SHOULDER IMMOB MEN SM,27000435,CDM,270,RC,L3650,HCPCS,outpatient,,,102,40.80,,86.7,85,,69.36,percent of total billed charges,85% of total billed charges,78.54,77,,62.83,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,83.64,82,,66.912,percent of total billed charges,82% of total billed charges,86.7,85,,69.36,percent of total billed charges,85% of total billed charges,86.7,85,,69.36,percent of total billed charges,85% of total billed charges,86.7,85,,69.36,percent of total billed charges,85% of total billed charges,91.8,90,,73.44,percent of total billed charges,90% of total billed charges,81.6,80,,65.28,percent of total billed charges,80% of total billed charges,91.8,90,,73.44,percent of total billed charges,90% of total billed charges,76.5,75,,61.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,29.58,29,,23.664,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,68.34,67,,54.672,percent of total billed charges,67% of total billed charges,60.62,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,81.6,80,,65.28,percent of total billed charges,80% of total billed charges,66.3,65,,53.04,percent of total billed charges,65% of total billed charges,36.38,35.67,,29.104,percent of total billed charges,35.67% of total billed charges,29.58,91.8,
RIB BELT MEN 8,27000448,CDM,270,RC,,,outpatient,,,319,127.60,,271.15,85,,216.92,percent of total billed charges,85% of total billed charges,245.63,77,,196.5,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,261.58,82,,209.264,percent of total billed charges,82% of total billed charges,271.15,85,,216.92,percent of total billed charges,85% of total billed charges,271.15,85,,216.92,percent of total billed charges,85% of total billed charges,271.15,85,,216.92,percent of total billed charges,85% of total billed charges,287.1,90,,229.68,percent of total billed charges,90% of total billed charges,255.2,80,,204.16,percent of total billed charges,80% of total billed charges,287.1,90,,229.68,percent of total billed charges,90% of total billed charges,239.25,75,,191.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,92.51,29,,74.008,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,213.73,67,,170.984,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,255.2,80,,204.16,percent of total billed charges,80% of total billed charges,207.35,65,,165.88,percent of total billed charges,65% of total billed charges,113.79,35.67,,91.032,percent of total billed charges,35.67% of total billed charges,92.51,287.1,
RIB BELT WOMEN 6,27000449,CDM,270,RC,,,outpatient,,,319,127.60,,271.15,85,,216.92,percent of total billed charges,85% of total billed charges,245.63,77,,196.5,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,261.58,82,,209.264,percent of total billed charges,82% of total billed charges,271.15,85,,216.92,percent of total billed charges,85% of total billed charges,271.15,85,,216.92,percent of total billed charges,85% of total billed charges,271.15,85,,216.92,percent of total billed charges,85% of total billed charges,287.1,90,,229.68,percent of total billed charges,90% of total billed charges,255.2,80,,204.16,percent of total billed charges,80% of total billed charges,287.1,90,,229.68,percent of total billed charges,90% of total billed charges,239.25,75,,191.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,92.51,29,,74.008,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,213.73,67,,170.984,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,255.2,80,,204.16,percent of total billed charges,80% of total billed charges,207.35,65,,165.88,percent of total billed charges,65% of total billed charges,113.79,35.67,,91.032,percent of total billed charges,35.67% of total billed charges,92.51,287.1,
MINI-EVACUATOR WOUND DRAIN,27000455,CDM,270,RC,,,outpatient,,,118,47.20,,100.3,85,,80.24,percent of total billed charges,85% of total billed charges,90.86,77,,72.69,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,96.76,82,,77.408,percent of total billed charges,82% of total billed charges,100.3,85,,80.24,percent of total billed charges,85% of total billed charges,100.3,85,,80.24,percent of total billed charges,85% of total billed charges,100.3,85,,80.24,percent of total billed charges,85% of total billed charges,106.2,90,,84.96,percent of total billed charges,90% of total billed charges,94.4,80,,75.52,percent of total billed charges,80% of total billed charges,106.2,90,,84.96,percent of total billed charges,90% of total billed charges,88.5,75,,70.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,34.22,29,,27.376,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,79.06,67,,63.248,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,94.4,80,,75.52,percent of total billed charges,80% of total billed charges,76.7,65,,61.36,percent of total billed charges,65% of total billed charges,42.09,35.67,,33.672,percent of total billed charges,35.67% of total billed charges,34.22,106.2,
FINGER SPLINT FOAM STRIP,27000457,CDM,270,RC,,,outpatient,,,13,5.20,,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,10.01,77,,8.01,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,10.66,82,,8.528,percent of total billed charges,82% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,11.7,90,,9.36,percent of total billed charges,90% of total billed charges,10.4,80,,8.32,percent of total billed charges,80% of total billed charges,11.7,90,,9.36,percent of total billed charges,90% of total billed charges,9.75,75,,7.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,3.77,29,,3.016,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,8.71,67,,6.968,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,10.4,80,,8.32,percent of total billed charges,80% of total billed charges,8.45,65,,6.76,percent of total billed charges,65% of total billed charges,4.64,35.67,,3.712,percent of total billed charges,35.67% of total billed charges,3.77,11.7,
FINGER PROTECTOR 2,27000458,CDM,270,RC,,,outpatient,,,13,5.20,,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,10.01,77,,8.01,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,10.66,82,,8.528,percent of total billed charges,82% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,11.7,90,,9.36,percent of total billed charges,90% of total billed charges,10.4,80,,8.32,percent of total billed charges,80% of total billed charges,11.7,90,,9.36,percent of total billed charges,90% of total billed charges,9.75,75,,7.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,3.77,29,,3.016,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,8.71,67,,6.968,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,10.4,80,,8.32,percent of total billed charges,80% of total billed charges,8.45,65,,6.76,percent of total billed charges,65% of total billed charges,4.64,35.67,,3.712,percent of total billed charges,35.67% of total billed charges,3.77,11.7,
FINGER PROTECTOR 1 1/2,27000459,CDM,270,RC,,,outpatient,,,13,5.20,,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,10.01,77,,8.01,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,10.66,82,,8.528,percent of total billed charges,82% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,11.7,90,,9.36,percent of total billed charges,90% of total billed charges,10.4,80,,8.32,percent of total billed charges,80% of total billed charges,11.7,90,,9.36,percent of total billed charges,90% of total billed charges,9.75,75,,7.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,3.77,29,,3.016,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,8.71,67,,6.968,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,10.4,80,,8.32,percent of total billed charges,80% of total billed charges,8.45,65,,6.76,percent of total billed charges,65% of total billed charges,4.64,35.67,,3.712,percent of total billed charges,35.67% of total billed charges,3.77,11.7,
FINGER PROTECTOR 3 1/2,27000460,CDM,270,RC,,,outpatient,,,13,5.20,,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,10.01,77,,8.01,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,10.66,82,,8.528,percent of total billed charges,82% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,11.7,90,,9.36,percent of total billed charges,90% of total billed charges,10.4,80,,8.32,percent of total billed charges,80% of total billed charges,11.7,90,,9.36,percent of total billed charges,90% of total billed charges,9.75,75,,7.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,3.77,29,,3.016,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,8.71,67,,6.968,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,10.4,80,,8.32,percent of total billed charges,80% of total billed charges,8.45,65,,6.76,percent of total billed charges,65% of total billed charges,4.64,35.67,,3.712,percent of total billed charges,35.67% of total billed charges,3.77,11.7,
SURGICAL LUBRICANT 4.25 OZ,27000462,CDM,270,RC,,,outpatient,,,9,3.60,,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,6.93,77,,5.54,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,7.38,82,,5.904,percent of total billed charges,82% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,8.1,90,,6.48,percent of total billed charges,90% of total billed charges,7.2,80,,5.76,percent of total billed charges,80% of total billed charges,8.1,90,,6.48,percent of total billed charges,90% of total billed charges,6.75,75,,5.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.61,29,,2.088,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,6.03,67,,4.824,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,7.2,80,,5.76,percent of total billed charges,80% of total billed charges,5.85,65,,4.68,percent of total billed charges,65% of total billed charges,3.21,35.67,,2.568,percent of total billed charges,35.67% of total billed charges,2.61,8.1,
ELASTOPLAST BANDAGE 1,27000467,CDM,270,RC,,,outpatient,,,18,7.20,,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,13.86,77,,11.09,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,14.76,82,,11.808,percent of total billed charges,82% of total billed charges,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,16.2,90,,12.96,percent of total billed charges,90% of total billed charges,14.4,80,,11.52,percent of total billed charges,80% of total billed charges,16.2,90,,12.96,percent of total billed charges,90% of total billed charges,13.5,75,,10.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,5.22,29,,4.176,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,12.06,67,,9.648,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,14.4,80,,11.52,percent of total billed charges,80% of total billed charges,11.7,65,,9.36,percent of total billed charges,65% of total billed charges,6.42,35.67,,5.136,percent of total billed charges,35.67% of total billed charges,5.22,16.2,
ELASTOPLAST BANDAGE 2,27000468,CDM,270,RC,,,outpatient,,,29,11.60,,24.65,85,,19.72,percent of total billed charges,85% of total billed charges,22.33,77,,17.86,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,23.78,82,,19.024,percent of total billed charges,82% of total billed charges,24.65,85,,19.72,percent of total billed charges,85% of total billed charges,24.65,85,,19.72,percent of total billed charges,85% of total billed charges,24.65,85,,19.72,percent of total billed charges,85% of total billed charges,26.1,90,,20.88,percent of total billed charges,90% of total billed charges,23.2,80,,18.56,percent of total billed charges,80% of total billed charges,26.1,90,,20.88,percent of total billed charges,90% of total billed charges,21.75,75,,17.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,8.41,29,,6.728,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,19.43,67,,15.544,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,23.2,80,,18.56,percent of total billed charges,80% of total billed charges,18.85,65,,15.08,percent of total billed charges,65% of total billed charges,10.34,35.67,,8.272,percent of total billed charges,35.67% of total billed charges,8.41,26.1,
ELASTOPLAST BANDAGE 3,27000469,CDM,270,RC,,,outpatient,,,44,17.60,,37.4,85,,29.92,percent of total billed charges,85% of total billed charges,33.88,77,,27.1,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,36.08,82,,28.864,percent of total billed charges,82% of total billed charges,37.4,85,,29.92,percent of total billed charges,85% of total billed charges,37.4,85,,29.92,percent of total billed charges,85% of total billed charges,37.4,85,,29.92,percent of total billed charges,85% of total billed charges,39.6,90,,31.68,percent of total billed charges,90% of total billed charges,35.2,80,,28.16,percent of total billed charges,80% of total billed charges,39.6,90,,31.68,percent of total billed charges,90% of total billed charges,33,75,,26.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,12.76,29,,10.208,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,29.48,67,,23.584,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,35.2,80,,28.16,percent of total billed charges,80% of total billed charges,28.6,65,,22.88,percent of total billed charges,65% of total billed charges,15.69,35.67,,12.552,percent of total billed charges,35.67% of total billed charges,12.76,39.6,
ELASTOPLAST BANDAGE 4,27000470,CDM,270,RC,,,outpatient,,,56,22.40,,47.6,85,,38.08,percent of total billed charges,85% of total billed charges,43.12,77,,34.5,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,45.92,82,,36.736,percent of total billed charges,82% of total billed charges,47.6,85,,38.08,percent of total billed charges,85% of total billed charges,47.6,85,,38.08,percent of total billed charges,85% of total billed charges,47.6,85,,38.08,percent of total billed charges,85% of total billed charges,50.4,90,,40.32,percent of total billed charges,90% of total billed charges,44.8,80,,35.84,percent of total billed charges,80% of total billed charges,50.4,90,,40.32,percent of total billed charges,90% of total billed charges,42,75,,33.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,16.24,29,,12.992,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,37.52,67,,30.016,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,44.8,80,,35.84,percent of total billed charges,80% of total billed charges,36.4,65,,29.12,percent of total billed charges,65% of total billed charges,19.98,35.67,,15.984,percent of total billed charges,35.67% of total billed charges,16.24,50.4,
BETADINE SOLUTION 4 OZ,27000472,CDM,270,RC,,,outpatient,,,17,6.80,,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,13.09,77,,10.47,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,13.94,82,,11.152,percent of total billed charges,82% of total billed charges,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,15.3,90,,12.24,percent of total billed charges,90% of total billed charges,13.6,80,,10.88,percent of total billed charges,80% of total billed charges,15.3,90,,12.24,percent of total billed charges,90% of total billed charges,12.75,75,,10.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,4.93,29,,3.944,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,11.39,67,,9.112,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,13.6,80,,10.88,percent of total billed charges,80% of total billed charges,11.05,65,,8.84,percent of total billed charges,65% of total billed charges,6.06,35.67,,4.848,percent of total billed charges,35.67% of total billed charges,4.93,15.3,
HIBICLENS SKIN CLEANSER 4 OZ,27000474,CDM,270,RC,,,outpatient,,,48,19.20,,40.8,85,,32.64,percent of total billed charges,85% of total billed charges,36.96,77,,29.57,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,39.36,82,,31.488,percent of total billed charges,82% of total billed charges,40.8,85,,32.64,percent of total billed charges,85% of total billed charges,40.8,85,,32.64,percent of total billed charges,85% of total billed charges,40.8,85,,32.64,percent of total billed charges,85% of total billed charges,43.2,90,,34.56,percent of total billed charges,90% of total billed charges,38.4,80,,30.72,percent of total billed charges,80% of total billed charges,43.2,90,,34.56,percent of total billed charges,90% of total billed charges,36,75,,28.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,13.92,29,,11.136,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,32.16,67,,25.728,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,38.4,80,,30.72,percent of total billed charges,80% of total billed charges,31.2,65,,24.96,percent of total billed charges,65% of total billed charges,17.12,35.67,,13.696,percent of total billed charges,35.67% of total billed charges,13.92,43.2,
HIBICLENS SKIN CLEANSER 16OZ**,27000475,CDM,270,RC,,,outpatient,,,95,38.00,,80.75,85,,64.6,percent of total billed charges,85% of total billed charges,73.15,77,,58.52,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,77.9,82,,62.32,percent of total billed charges,82% of total billed charges,80.75,85,,64.6,percent of total billed charges,85% of total billed charges,80.75,85,,64.6,percent of total billed charges,85% of total billed charges,80.75,85,,64.6,percent of total billed charges,85% of total billed charges,85.5,90,,68.4,percent of total billed charges,90% of total billed charges,76,80,,60.8,percent of total billed charges,80% of total billed charges,85.5,90,,68.4,percent of total billed charges,90% of total billed charges,71.25,75,,57,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,27.55,29,,22.04,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,63.65,67,,50.92,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,76,80,,60.8,percent of total billed charges,80% of total billed charges,61.75,65,,49.4,percent of total billed charges,65% of total billed charges,33.89,35.67,,27.112,percent of total billed charges,35.67% of total billed charges,27.55,85.5,
HYDROGEN PEROXIDE 4OZ,27000478,CDM,270,RC,,,outpatient,,,15,6.00,,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,11.55,77,,9.24,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,12.3,82,,9.84,percent of total billed charges,82% of total billed charges,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,13.5,90,,10.8,percent of total billed charges,90% of total billed charges,12,80,,9.6,percent of total billed charges,80% of total billed charges,13.5,90,,10.8,percent of total billed charges,90% of total billed charges,11.25,75,,9,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,4.35,29,,3.48,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,10.05,67,,8.04,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,12,80,,9.6,percent of total billed charges,80% of total billed charges,9.75,65,,7.8,percent of total billed charges,65% of total billed charges,5.35,35.67,,4.28,percent of total billed charges,35.67% of total billed charges,4.35,13.5,
VASELINE 1OZ,27000479,CDM,270,RC,,,outpatient,,,11,4.40,,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,8.47,77,,6.78,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,9.02,82,,7.216,percent of total billed charges,82% of total billed charges,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,9.9,90,,7.92,percent of total billed charges,90% of total billed charges,8.8,80,,7.04,percent of total billed charges,80% of total billed charges,9.9,90,,7.92,percent of total billed charges,90% of total billed charges,8.25,75,,6.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,3.19,29,,2.552,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,7.37,67,,5.896,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,8.8,80,,7.04,percent of total billed charges,80% of total billed charges,7.15,65,,5.72,percent of total billed charges,65% of total billed charges,3.92,35.67,,3.136,percent of total billed charges,35.67% of total billed charges,3.19,9.9,
FLEET ENEMA CHILDREN,27000488,CDM,270,RC,,,outpatient,,,28,11.20,,23.8,85,,19.04,percent of total billed charges,85% of total billed charges,21.56,77,,17.25,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,22.96,82,,18.368,percent of total billed charges,82% of total billed charges,23.8,85,,19.04,percent of total billed charges,85% of total billed charges,23.8,85,,19.04,percent of total billed charges,85% of total billed charges,23.8,85,,19.04,percent of total billed charges,85% of total billed charges,25.2,90,,20.16,percent of total billed charges,90% of total billed charges,22.4,80,,17.92,percent of total billed charges,80% of total billed charges,25.2,90,,20.16,percent of total billed charges,90% of total billed charges,21,75,,16.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,8.12,29,,6.496,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,18.76,67,,15.008,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,22.4,80,,17.92,percent of total billed charges,80% of total billed charges,18.2,65,,14.56,percent of total billed charges,65% of total billed charges,9.99,35.67,,7.992,percent of total billed charges,35.67% of total billed charges,8.12,25.2,
FLEET ENEMA MINERAL OIL,27000490,CDM,270,RC,,,outpatient,,,28,11.20,,23.8,85,,19.04,percent of total billed charges,85% of total billed charges,21.56,77,,17.25,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,22.96,82,,18.368,percent of total billed charges,82% of total billed charges,23.8,85,,19.04,percent of total billed charges,85% of total billed charges,23.8,85,,19.04,percent of total billed charges,85% of total billed charges,23.8,85,,19.04,percent of total billed charges,85% of total billed charges,25.2,90,,20.16,percent of total billed charges,90% of total billed charges,22.4,80,,17.92,percent of total billed charges,80% of total billed charges,25.2,90,,20.16,percent of total billed charges,90% of total billed charges,21,75,,16.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,8.12,29,,6.496,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,18.76,67,,15.008,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,22.4,80,,17.92,percent of total billed charges,80% of total billed charges,18.2,65,,14.56,percent of total billed charges,65% of total billed charges,9.99,35.67,,7.992,percent of total billed charges,35.67% of total billed charges,8.12,25.2,
FLEET ENEMA PHOSPHATE,27000491,CDM,270,RC,,,outpatient,,,18,7.20,,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,13.86,77,,11.09,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,14.76,82,,11.808,percent of total billed charges,82% of total billed charges,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,16.2,90,,12.96,percent of total billed charges,90% of total billed charges,14.4,80,,11.52,percent of total billed charges,80% of total billed charges,16.2,90,,12.96,percent of total billed charges,90% of total billed charges,13.5,75,,10.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,5.22,29,,4.176,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,12.06,67,,9.648,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,14.4,80,,11.52,percent of total billed charges,80% of total billed charges,11.7,65,,9.36,percent of total billed charges,65% of total billed charges,6.42,35.67,,5.136,percent of total billed charges,35.67% of total billed charges,5.22,16.2,
FLEET BABY LAX GLYCERINE,27000492,CDM,270,RC,,,outpatient,,,12,4.80,,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,9.24,77,,7.39,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,9.84,82,,7.872,percent of total billed charges,82% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,10.8,90,,8.64,percent of total billed charges,90% of total billed charges,9.6,80,,7.68,percent of total billed charges,80% of total billed charges,10.8,90,,8.64,percent of total billed charges,90% of total billed charges,9,75,,7.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,3.48,29,,2.784,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,8.04,67,,6.432,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,9.6,80,,7.68,percent of total billed charges,80% of total billed charges,7.8,65,,6.24,percent of total billed charges,65% of total billed charges,4.28,35.67,,3.424,percent of total billed charges,35.67% of total billed charges,3.48,10.8,
FOLEY CATHETER HOLDER,27000493,CDM,270,RC,,,outpatient,,,46,18.40,,39.1,85,,31.28,percent of total billed charges,85% of total billed charges,35.42,77,,28.34,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,37.72,82,,30.176,percent of total billed charges,82% of total billed charges,39.1,85,,31.28,percent of total billed charges,85% of total billed charges,39.1,85,,31.28,percent of total billed charges,85% of total billed charges,39.1,85,,31.28,percent of total billed charges,85% of total billed charges,41.4,90,,33.12,percent of total billed charges,90% of total billed charges,36.8,80,,29.44,percent of total billed charges,80% of total billed charges,41.4,90,,33.12,percent of total billed charges,90% of total billed charges,34.5,75,,27.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,13.34,29,,10.672,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,30.82,67,,24.656,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,36.8,80,,29.44,percent of total billed charges,80% of total billed charges,29.9,65,,23.92,percent of total billed charges,65% of total billed charges,16.41,35.67,,13.128,percent of total billed charges,35.67% of total billed charges,13.34,41.4,
OSTOMY PASTE,27000496,CDM,270,RC,,,outpatient,,,81,32.40,,68.85,85,,55.08,percent of total billed charges,85% of total billed charges,62.37,77,,49.9,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,66.42,82,,53.136,percent of total billed charges,82% of total billed charges,68.85,85,,55.08,percent of total billed charges,85% of total billed charges,68.85,85,,55.08,percent of total billed charges,85% of total billed charges,68.85,85,,55.08,percent of total billed charges,85% of total billed charges,72.9,90,,58.32,percent of total billed charges,90% of total billed charges,64.8,80,,51.84,percent of total billed charges,80% of total billed charges,72.9,90,,58.32,percent of total billed charges,90% of total billed charges,60.75,75,,48.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,23.49,29,,18.792,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,54.27,67,,43.416,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,64.8,80,,51.84,percent of total billed charges,80% of total billed charges,52.65,65,,42.12,percent of total billed charges,65% of total billed charges,28.89,35.67,,23.112,percent of total billed charges,35.67% of total billed charges,23.49,72.9,
LEMON-GLYCERIN SWABS,27000500,CDM,270,RC,,,outpatient,,,10,4.00,,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,7.7,77,,6.16,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,8.2,82,,6.56,percent of total billed charges,82% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,9,90,,7.2,percent of total billed charges,90% of total billed charges,8,80,,6.4,percent of total billed charges,80% of total billed charges,9,90,,7.2,percent of total billed charges,90% of total billed charges,7.5,75,,6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.9,29,,2.32,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,6.7,67,,5.36,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,8,80,,6.4,percent of total billed charges,80% of total billed charges,6.5,65,,5.2,percent of total billed charges,65% of total billed charges,3.57,35.67,,2.856,percent of total billed charges,35.67% of total billed charges,2.9,9,
HIBICLENS E-Z SCRUB BRUSH,27000524,CDM,270,RC,,,outpatient,,,13,5.20,,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,10.01,77,,8.01,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,10.66,82,,8.528,percent of total billed charges,82% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,11.7,90,,9.36,percent of total billed charges,90% of total billed charges,10.4,80,,8.32,percent of total billed charges,80% of total billed charges,11.7,90,,9.36,percent of total billed charges,90% of total billed charges,9.75,75,,7.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,3.77,29,,3.016,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,8.71,67,,6.968,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,10.4,80,,8.32,percent of total billed charges,80% of total billed charges,8.45,65,,6.76,percent of total billed charges,65% of total billed charges,4.64,35.67,,3.712,percent of total billed charges,35.67% of total billed charges,3.77,11.7,
NEEDLE COUNTER,27000526,CDM,270,RC,,,outpatient,,,18,7.20,,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,13.86,77,,11.09,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,14.76,82,,11.808,percent of total billed charges,82% of total billed charges,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,16.2,90,,12.96,percent of total billed charges,90% of total billed charges,14.4,80,,11.52,percent of total billed charges,80% of total billed charges,16.2,90,,12.96,percent of total billed charges,90% of total billed charges,13.5,75,,10.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,5.22,29,,4.176,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,12.06,67,,9.648,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,14.4,80,,11.52,percent of total billed charges,80% of total billed charges,11.7,65,,9.36,percent of total billed charges,65% of total billed charges,6.42,35.67,,5.136,percent of total billed charges,35.67% of total billed charges,5.22,16.2,
GAUZE DRESSING 4X4 NONSTERILE,27000528,CDM,270,RC,,,outpatient,,,53,21.20,,45.05,85,,36.04,percent of total billed charges,85% of total billed charges,40.81,77,,32.65,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,43.46,82,,34.768,percent of total billed charges,82% of total billed charges,45.05,85,,36.04,percent of total billed charges,85% of total billed charges,45.05,85,,36.04,percent of total billed charges,85% of total billed charges,45.05,85,,36.04,percent of total billed charges,85% of total billed charges,47.7,90,,38.16,percent of total billed charges,90% of total billed charges,42.4,80,,33.92,percent of total billed charges,80% of total billed charges,47.7,90,,38.16,percent of total billed charges,90% of total billed charges,39.75,75,,31.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,15.37,29,,12.296,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,35.51,67,,28.408,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,42.4,80,,33.92,percent of total billed charges,80% of total billed charges,34.45,65,,27.56,percent of total billed charges,65% of total billed charges,18.91,35.67,,15.128,percent of total billed charges,35.67% of total billed charges,15.37,47.7,
DIAPERS PREMATURE,27000545,CDM,270,RC,,,outpatient,,,24,9.60,,20.4,85,,16.32,percent of total billed charges,85% of total billed charges,18.48,77,,14.78,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,19.68,82,,15.744,percent of total billed charges,82% of total billed charges,20.4,85,,16.32,percent of total billed charges,85% of total billed charges,20.4,85,,16.32,percent of total billed charges,85% of total billed charges,20.4,85,,16.32,percent of total billed charges,85% of total billed charges,21.6,90,,17.28,percent of total billed charges,90% of total billed charges,19.2,80,,15.36,percent of total billed charges,80% of total billed charges,21.6,90,,17.28,percent of total billed charges,90% of total billed charges,18,75,,14.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,6.96,29,,5.568,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,16.08,67,,12.864,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,19.2,80,,15.36,percent of total billed charges,80% of total billed charges,15.6,65,,12.48,percent of total billed charges,65% of total billed charges,8.56,35.67,,6.848,percent of total billed charges,35.67% of total billed charges,6.96,21.6,
DIAPERS NEWBORN,27000546,CDM,270,RC,,,outpatient,,,19,7.60,,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,14.63,77,,11.7,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,15.58,82,,12.464,percent of total billed charges,82% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,15.2,80,,12.16,percent of total billed charges,80% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,14.25,75,,11.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,5.51,29,,4.408,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,12.73,67,,10.184,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,15.2,80,,12.16,percent of total billed charges,80% of total billed charges,12.35,65,,9.88,percent of total billed charges,65% of total billed charges,6.78,35.67,,5.424,percent of total billed charges,35.67% of total billed charges,5.51,17.1,
DIAPERS INFANT MED,27000547,CDM,270,RC,,,outpatient,,,24,9.60,,20.4,85,,16.32,percent of total billed charges,85% of total billed charges,18.48,77,,14.78,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,19.68,82,,15.744,percent of total billed charges,82% of total billed charges,20.4,85,,16.32,percent of total billed charges,85% of total billed charges,20.4,85,,16.32,percent of total billed charges,85% of total billed charges,20.4,85,,16.32,percent of total billed charges,85% of total billed charges,21.6,90,,17.28,percent of total billed charges,90% of total billed charges,19.2,80,,15.36,percent of total billed charges,80% of total billed charges,21.6,90,,17.28,percent of total billed charges,90% of total billed charges,18,75,,14.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,6.96,29,,5.568,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,16.08,67,,12.864,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,19.2,80,,15.36,percent of total billed charges,80% of total billed charges,15.6,65,,12.48,percent of total billed charges,65% of total billed charges,8.56,35.67,,6.848,percent of total billed charges,35.67% of total billed charges,6.96,21.6,
DIAPERS INFANT LG,27000548,CDM,270,RC,,,outpatient,,,31,12.40,,26.35,85,,21.08,percent of total billed charges,85% of total billed charges,23.87,77,,19.1,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,25.42,82,,20.336,percent of total billed charges,82% of total billed charges,26.35,85,,21.08,percent of total billed charges,85% of total billed charges,26.35,85,,21.08,percent of total billed charges,85% of total billed charges,26.35,85,,21.08,percent of total billed charges,85% of total billed charges,27.9,90,,22.32,percent of total billed charges,90% of total billed charges,24.8,80,,19.84,percent of total billed charges,80% of total billed charges,27.9,90,,22.32,percent of total billed charges,90% of total billed charges,23.25,75,,18.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,8.99,29,,7.192,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,20.77,67,,16.616,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,24.8,80,,19.84,percent of total billed charges,80% of total billed charges,20.15,65,,16.12,percent of total billed charges,65% of total billed charges,11.06,35.67,,8.848,percent of total billed charges,35.67% of total billed charges,8.99,27.9,
DIAPERS TODDLER,27000549,CDM,270,RC,,,outpatient,,,34,13.60,,28.9,85,,23.12,percent of total billed charges,85% of total billed charges,26.18,77,,20.94,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,27.88,82,,22.304,percent of total billed charges,82% of total billed charges,28.9,85,,23.12,percent of total billed charges,85% of total billed charges,28.9,85,,23.12,percent of total billed charges,85% of total billed charges,28.9,85,,23.12,percent of total billed charges,85% of total billed charges,30.6,90,,24.48,percent of total billed charges,90% of total billed charges,27.2,80,,21.76,percent of total billed charges,80% of total billed charges,30.6,90,,24.48,percent of total billed charges,90% of total billed charges,25.5,75,,20.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,9.86,29,,7.888,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,22.78,67,,18.224,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,27.2,80,,21.76,percent of total billed charges,80% of total billed charges,22.1,65,,17.68,percent of total billed charges,65% of total billed charges,12.13,35.67,,9.704,percent of total billed charges,35.67% of total billed charges,9.86,30.6,
ELECTRODE 3 PK,27000581,CDM,270,RC,,,outpatient,,,10,4.00,,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,7.7,77,,6.16,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,8.2,82,,6.56,percent of total billed charges,82% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,9,90,,7.2,percent of total billed charges,90% of total billed charges,8,80,,6.4,percent of total billed charges,80% of total billed charges,9,90,,7.2,percent of total billed charges,90% of total billed charges,7.5,75,,6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.9,29,,2.32,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,6.7,67,,5.36,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,8,80,,6.4,percent of total billed charges,80% of total billed charges,6.5,65,,5.2,percent of total billed charges,65% of total billed charges,3.57,35.67,,2.856,percent of total billed charges,35.67% of total billed charges,2.9,9,
EGGCRATE,27000604,CDM,270,RC,,,outpatient,,,113,45.20,,96.05,85,,76.84,percent of total billed charges,85% of total billed charges,87.01,77,,69.61,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,92.66,82,,74.128,percent of total billed charges,82% of total billed charges,96.05,85,,76.84,percent of total billed charges,85% of total billed charges,96.05,85,,76.84,percent of total billed charges,85% of total billed charges,96.05,85,,76.84,percent of total billed charges,85% of total billed charges,101.7,90,,81.36,percent of total billed charges,90% of total billed charges,90.4,80,,72.32,percent of total billed charges,80% of total billed charges,101.7,90,,81.36,percent of total billed charges,90% of total billed charges,84.75,75,,67.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,32.77,29,,26.216,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,75.71,67,,60.568,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,90.4,80,,72.32,percent of total billed charges,80% of total billed charges,73.45,65,,58.76,percent of total billed charges,65% of total billed charges,40.31,35.67,,32.248,percent of total billed charges,35.67% of total billed charges,32.77,101.7,
BILE BAG,27000634,CDM,270,RC,,,outpatient,,,109,43.60,,92.65,85,,74.12,percent of total billed charges,85% of total billed charges,83.93,77,,67.14,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,89.38,82,,71.504,percent of total billed charges,82% of total billed charges,92.65,85,,74.12,percent of total billed charges,85% of total billed charges,92.65,85,,74.12,percent of total billed charges,85% of total billed charges,92.65,85,,74.12,percent of total billed charges,85% of total billed charges,98.1,90,,78.48,percent of total billed charges,90% of total billed charges,87.2,80,,69.76,percent of total billed charges,80% of total billed charges,98.1,90,,78.48,percent of total billed charges,90% of total billed charges,81.75,75,,65.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,31.61,29,,25.288,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,73.03,67,,58.424,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,87.2,80,,69.76,percent of total billed charges,80% of total billed charges,70.85,65,,56.68,percent of total billed charges,65% of total billed charges,38.88,35.67,,31.104,percent of total billed charges,35.67% of total billed charges,31.61,98.1,
CALCULI STRAINER,27000645,CDM,270,RC,,,outpatient,,,31,12.40,,26.35,85,,21.08,percent of total billed charges,85% of total billed charges,23.87,77,,19.1,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,25.42,82,,20.336,percent of total billed charges,82% of total billed charges,26.35,85,,21.08,percent of total billed charges,85% of total billed charges,26.35,85,,21.08,percent of total billed charges,85% of total billed charges,26.35,85,,21.08,percent of total billed charges,85% of total billed charges,27.9,90,,22.32,percent of total billed charges,90% of total billed charges,24.8,80,,19.84,percent of total billed charges,80% of total billed charges,27.9,90,,22.32,percent of total billed charges,90% of total billed charges,23.25,75,,18.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,8.99,29,,7.192,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,20.77,67,,16.616,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,24.8,80,,19.84,percent of total billed charges,80% of total billed charges,20.15,65,,16.12,percent of total billed charges,65% of total billed charges,11.06,35.67,,8.848,percent of total billed charges,35.67% of total billed charges,8.99,27.9,
SITZ BATH,27000647,CDM,270,RC,,,outpatient,,,27,10.80,,22.95,85,,18.36,percent of total billed charges,85% of total billed charges,20.79,77,,16.63,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,22.14,82,,17.712,percent of total billed charges,82% of total billed charges,22.95,85,,18.36,percent of total billed charges,85% of total billed charges,22.95,85,,18.36,percent of total billed charges,85% of total billed charges,22.95,85,,18.36,percent of total billed charges,85% of total billed charges,24.3,90,,19.44,percent of total billed charges,90% of total billed charges,21.6,80,,17.28,percent of total billed charges,80% of total billed charges,24.3,90,,19.44,percent of total billed charges,90% of total billed charges,20.25,75,,16.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,7.83,29,,6.264,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,18.09,67,,14.472,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,21.6,80,,17.28,percent of total billed charges,80% of total billed charges,17.55,65,,14.04,percent of total billed charges,65% of total billed charges,9.63,35.67,,7.704,percent of total billed charges,35.67% of total billed charges,7.83,24.3,
UROSTOMY POUCH,27000658,CDM,270,RC,,,outpatient,,,27,10.80,,22.95,85,,18.36,percent of total billed charges,85% of total billed charges,20.79,77,,16.63,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,22.14,82,,17.712,percent of total billed charges,82% of total billed charges,22.95,85,,18.36,percent of total billed charges,85% of total billed charges,22.95,85,,18.36,percent of total billed charges,85% of total billed charges,22.95,85,,18.36,percent of total billed charges,85% of total billed charges,24.3,90,,19.44,percent of total billed charges,90% of total billed charges,21.6,80,,17.28,percent of total billed charges,80% of total billed charges,24.3,90,,19.44,percent of total billed charges,90% of total billed charges,20.25,75,,16.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,7.83,29,,6.264,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,18.09,67,,14.472,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,21.6,80,,17.28,percent of total billed charges,80% of total billed charges,17.55,65,,14.04,percent of total billed charges,65% of total billed charges,9.63,35.67,,7.704,percent of total billed charges,35.67% of total billed charges,7.83,24.3,
UROSTOMY POUCH,27000659,CDM,270,RC,,,outpatient,,,27,10.80,,22.95,85,,18.36,percent of total billed charges,85% of total billed charges,20.79,77,,16.63,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,22.14,82,,17.712,percent of total billed charges,82% of total billed charges,22.95,85,,18.36,percent of total billed charges,85% of total billed charges,22.95,85,,18.36,percent of total billed charges,85% of total billed charges,22.95,85,,18.36,percent of total billed charges,85% of total billed charges,24.3,90,,19.44,percent of total billed charges,90% of total billed charges,21.6,80,,17.28,percent of total billed charges,80% of total billed charges,24.3,90,,19.44,percent of total billed charges,90% of total billed charges,20.25,75,,16.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,7.83,29,,6.264,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,18.09,67,,14.472,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,21.6,80,,17.28,percent of total billed charges,80% of total billed charges,17.55,65,,14.04,percent of total billed charges,65% of total billed charges,9.63,35.67,,7.704,percent of total billed charges,35.67% of total billed charges,7.83,24.3,
OSTOMY POUCH DRAINABLE,27000662,CDM,270,RC,,,outpatient,,,27,10.80,,22.95,85,,18.36,percent of total billed charges,85% of total billed charges,20.79,77,,16.63,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,22.14,82,,17.712,percent of total billed charges,82% of total billed charges,22.95,85,,18.36,percent of total billed charges,85% of total billed charges,22.95,85,,18.36,percent of total billed charges,85% of total billed charges,22.95,85,,18.36,percent of total billed charges,85% of total billed charges,24.3,90,,19.44,percent of total billed charges,90% of total billed charges,21.6,80,,17.28,percent of total billed charges,80% of total billed charges,24.3,90,,19.44,percent of total billed charges,90% of total billed charges,20.25,75,,16.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,7.83,29,,6.264,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,18.09,67,,14.472,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,21.6,80,,17.28,percent of total billed charges,80% of total billed charges,17.55,65,,14.04,percent of total billed charges,65% of total billed charges,9.63,35.67,,7.704,percent of total billed charges,35.67% of total billed charges,7.83,24.3,
OSTOMY CLAMP,27000664,CDM,270,RC,,,outpatient,,,19,7.60,,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,14.63,77,,11.7,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,15.58,82,,12.464,percent of total billed charges,82% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,15.2,80,,12.16,percent of total billed charges,80% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,14.25,75,,11.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,5.51,29,,4.408,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,12.73,67,,10.184,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,15.2,80,,12.16,percent of total billed charges,80% of total billed charges,12.35,65,,9.88,percent of total billed charges,65% of total billed charges,6.78,35.67,,5.424,percent of total billed charges,35.67% of total billed charges,5.51,17.1,
OSTOMY IRRIG SLEEVE 1 3/4,27000666,CDM,270,RC,,,outpatient,,,43,17.20,,36.55,85,,29.24,percent of total billed charges,85% of total billed charges,33.11,77,,26.49,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,35.26,82,,28.208,percent of total billed charges,82% of total billed charges,36.55,85,,29.24,percent of total billed charges,85% of total billed charges,36.55,85,,29.24,percent of total billed charges,85% of total billed charges,36.55,85,,29.24,percent of total billed charges,85% of total billed charges,38.7,90,,30.96,percent of total billed charges,90% of total billed charges,34.4,80,,27.52,percent of total billed charges,80% of total billed charges,38.7,90,,30.96,percent of total billed charges,90% of total billed charges,32.25,75,,25.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,12.47,29,,9.976,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,28.81,67,,23.048,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,34.4,80,,27.52,percent of total billed charges,80% of total billed charges,27.95,65,,22.36,percent of total billed charges,65% of total billed charges,15.34,35.67,,12.272,percent of total billed charges,35.67% of total billed charges,12.47,38.7,
SUCTION CATHETER 8 FR,27000690,CDM,270,RC,,,outpatient,,,10,4.00,,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,7.7,77,,6.16,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,8.2,82,,6.56,percent of total billed charges,82% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,9,90,,7.2,percent of total billed charges,90% of total billed charges,8,80,,6.4,percent of total billed charges,80% of total billed charges,9,90,,7.2,percent of total billed charges,90% of total billed charges,7.5,75,,6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.9,29,,2.32,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,6.7,67,,5.36,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,8,80,,6.4,percent of total billed charges,80% of total billed charges,6.5,65,,5.2,percent of total billed charges,65% of total billed charges,3.57,35.67,,2.856,percent of total billed charges,35.67% of total billed charges,2.9,9,
CIRCUMCISION BELT,27000704,CDM,270,RC,,,outpatient,,,10,4.00,,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,7.7,77,,6.16,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,8.2,82,,6.56,percent of total billed charges,82% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,9,90,,7.2,percent of total billed charges,90% of total billed charges,8,80,,6.4,percent of total billed charges,80% of total billed charges,9,90,,7.2,percent of total billed charges,90% of total billed charges,7.5,75,,6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.9,29,,2.32,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,6.7,67,,5.36,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,8,80,,6.4,percent of total billed charges,80% of total billed charges,6.5,65,,5.2,percent of total billed charges,65% of total billed charges,3.57,35.67,,2.856,percent of total billed charges,35.67% of total billed charges,2.9,9,
PLASTIBELL 1.5 CM **,27000711,CDM,270,RC,,,outpatient,,,33,13.20,,28.05,85,,22.44,percent of total billed charges,85% of total billed charges,25.41,77,,20.33,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,27.06,82,,21.648,percent of total billed charges,82% of total billed charges,28.05,85,,22.44,percent of total billed charges,85% of total billed charges,28.05,85,,22.44,percent of total billed charges,85% of total billed charges,28.05,85,,22.44,percent of total billed charges,85% of total billed charges,29.7,90,,23.76,percent of total billed charges,90% of total billed charges,26.4,80,,21.12,percent of total billed charges,80% of total billed charges,29.7,90,,23.76,percent of total billed charges,90% of total billed charges,24.75,75,,19.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,9.57,29,,7.656,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,22.11,67,,17.688,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,26.4,80,,21.12,percent of total billed charges,80% of total billed charges,21.45,65,,17.16,percent of total billed charges,65% of total billed charges,11.77,35.67,,9.416,percent of total billed charges,35.67% of total billed charges,9.57,29.7,
BILIRUBIN MASK,27000715,CDM,270,RC,,,outpatient,,,27,10.80,,22.95,85,,18.36,percent of total billed charges,85% of total billed charges,20.79,77,,16.63,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,22.14,82,,17.712,percent of total billed charges,82% of total billed charges,22.95,85,,18.36,percent of total billed charges,85% of total billed charges,22.95,85,,18.36,percent of total billed charges,85% of total billed charges,22.95,85,,18.36,percent of total billed charges,85% of total billed charges,24.3,90,,19.44,percent of total billed charges,90% of total billed charges,21.6,80,,17.28,percent of total billed charges,80% of total billed charges,24.3,90,,19.44,percent of total billed charges,90% of total billed charges,20.25,75,,16.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,7.83,29,,6.264,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,18.09,67,,14.472,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,21.6,80,,17.28,percent of total billed charges,80% of total billed charges,17.55,65,,14.04,percent of total billed charges,65% of total billed charges,9.63,35.67,,7.704,percent of total billed charges,35.67% of total billed charges,7.83,24.3,
INJECTION SITE 7/8 LL **,27000723,CDM,270,RC,,,outpatient,,,10,4.00,,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,7.7,77,,6.16,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,8.2,82,,6.56,percent of total billed charges,82% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,9,90,,7.2,percent of total billed charges,90% of total billed charges,8,80,,6.4,percent of total billed charges,80% of total billed charges,9,90,,7.2,percent of total billed charges,90% of total billed charges,7.5,75,,6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.9,29,,2.32,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,6.7,67,,5.36,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,8,80,,6.4,percent of total billed charges,80% of total billed charges,6.5,65,,5.2,percent of total billed charges,65% of total billed charges,3.57,35.67,,2.856,percent of total billed charges,35.67% of total billed charges,2.9,9,
SPECIMEN PAN,27000727,CDM,270,RC,,,outpatient,,,11,4.40,,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,8.47,77,,6.78,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,9.02,82,,7.216,percent of total billed charges,82% of total billed charges,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,9.9,90,,7.92,percent of total billed charges,90% of total billed charges,8.8,80,,7.04,percent of total billed charges,80% of total billed charges,9.9,90,,7.92,percent of total billed charges,90% of total billed charges,8.25,75,,6.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,3.19,29,,2.552,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,7.37,67,,5.896,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,8.8,80,,7.04,percent of total billed charges,80% of total billed charges,7.15,65,,5.72,percent of total billed charges,65% of total billed charges,3.92,35.67,,3.136,percent of total billed charges,35.67% of total billed charges,3.19,9.9,
ENEMA SET 1500 CC,27000731,CDM,270,RC,,,outpatient,,,18,7.20,,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,13.86,77,,11.09,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,14.76,82,,11.808,percent of total billed charges,82% of total billed charges,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,16.2,90,,12.96,percent of total billed charges,90% of total billed charges,14.4,80,,11.52,percent of total billed charges,80% of total billed charges,16.2,90,,12.96,percent of total billed charges,90% of total billed charges,13.5,75,,10.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,5.22,29,,4.176,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,12.06,67,,9.648,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,14.4,80,,11.52,percent of total billed charges,80% of total billed charges,11.7,65,,9.36,percent of total billed charges,65% of total billed charges,6.42,35.67,,5.136,percent of total billed charges,35.67% of total billed charges,5.22,16.2,
TED HOSE THIGH SMALL SHORT,27000736,CDM,270,RC,,,outpatient,,,84,33.60,,71.4,85,,57.12,percent of total billed charges,85% of total billed charges,64.68,77,,51.74,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,68.88,82,,55.104,percent of total billed charges,82% of total billed charges,71.4,85,,57.12,percent of total billed charges,85% of total billed charges,71.4,85,,57.12,percent of total billed charges,85% of total billed charges,71.4,85,,57.12,percent of total billed charges,85% of total billed charges,75.6,90,,60.48,percent of total billed charges,90% of total billed charges,67.2,80,,53.76,percent of total billed charges,80% of total billed charges,75.6,90,,60.48,percent of total billed charges,90% of total billed charges,63,75,,50.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,24.36,29,,19.488,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,56.28,67,,45.024,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,67.2,80,,53.76,percent of total billed charges,80% of total billed charges,54.6,65,,43.68,percent of total billed charges,65% of total billed charges,29.96,35.67,,23.968,percent of total billed charges,35.67% of total billed charges,24.36,75.6,
TED HOSE THIGH SMALL REG,27000737,CDM,270,RC,,,outpatient,,,84,33.60,,71.4,85,,57.12,percent of total billed charges,85% of total billed charges,64.68,77,,51.74,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,68.88,82,,55.104,percent of total billed charges,82% of total billed charges,71.4,85,,57.12,percent of total billed charges,85% of total billed charges,71.4,85,,57.12,percent of total billed charges,85% of total billed charges,71.4,85,,57.12,percent of total billed charges,85% of total billed charges,75.6,90,,60.48,percent of total billed charges,90% of total billed charges,67.2,80,,53.76,percent of total billed charges,80% of total billed charges,75.6,90,,60.48,percent of total billed charges,90% of total billed charges,63,75,,50.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,24.36,29,,19.488,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,56.28,67,,45.024,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,67.2,80,,53.76,percent of total billed charges,80% of total billed charges,54.6,65,,43.68,percent of total billed charges,65% of total billed charges,29.96,35.67,,23.968,percent of total billed charges,35.67% of total billed charges,24.36,75.6,
TED HOSE THIGH SMALL LONG,27000738,CDM,270,RC,,,outpatient,,,84,33.60,,71.4,85,,57.12,percent of total billed charges,85% of total billed charges,64.68,77,,51.74,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,68.88,82,,55.104,percent of total billed charges,82% of total billed charges,71.4,85,,57.12,percent of total billed charges,85% of total billed charges,71.4,85,,57.12,percent of total billed charges,85% of total billed charges,71.4,85,,57.12,percent of total billed charges,85% of total billed charges,75.6,90,,60.48,percent of total billed charges,90% of total billed charges,67.2,80,,53.76,percent of total billed charges,80% of total billed charges,75.6,90,,60.48,percent of total billed charges,90% of total billed charges,63,75,,50.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,24.36,29,,19.488,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,56.28,67,,45.024,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,67.2,80,,53.76,percent of total billed charges,80% of total billed charges,54.6,65,,43.68,percent of total billed charges,65% of total billed charges,29.96,35.67,,23.968,percent of total billed charges,35.67% of total billed charges,24.36,75.6,
TED HOSE THIGH MED LONG,27000741,CDM,270,RC,,,outpatient,,,93,37.20,,79.05,85,,63.24,percent of total billed charges,85% of total billed charges,71.61,77,,57.29,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,76.26,82,,61.008,percent of total billed charges,82% of total billed charges,79.05,85,,63.24,percent of total billed charges,85% of total billed charges,79.05,85,,63.24,percent of total billed charges,85% of total billed charges,79.05,85,,63.24,percent of total billed charges,85% of total billed charges,83.7,90,,66.96,percent of total billed charges,90% of total billed charges,74.4,80,,59.52,percent of total billed charges,80% of total billed charges,83.7,90,,66.96,percent of total billed charges,90% of total billed charges,69.75,75,,55.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,26.97,29,,21.576,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,62.31,67,,49.848,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,74.4,80,,59.52,percent of total billed charges,80% of total billed charges,60.45,65,,48.36,percent of total billed charges,65% of total billed charges,33.17,35.67,,26.536,percent of total billed charges,35.67% of total billed charges,26.97,83.7,
TED HOSE THIGH LG REG,27000743,CDM,270,RC,,,outpatient,,,92,36.80,,78.2,85,,62.56,percent of total billed charges,85% of total billed charges,70.84,77,,56.67,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,75.44,82,,60.352,percent of total billed charges,82% of total billed charges,78.2,85,,62.56,percent of total billed charges,85% of total billed charges,78.2,85,,62.56,percent of total billed charges,85% of total billed charges,78.2,85,,62.56,percent of total billed charges,85% of total billed charges,82.8,90,,66.24,percent of total billed charges,90% of total billed charges,73.6,80,,58.88,percent of total billed charges,80% of total billed charges,82.8,90,,66.24,percent of total billed charges,90% of total billed charges,69,75,,55.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,26.68,29,,21.344,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,61.64,67,,49.312,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,73.6,80,,58.88,percent of total billed charges,80% of total billed charges,59.8,65,,47.84,percent of total billed charges,65% of total billed charges,32.82,35.67,,26.256,percent of total billed charges,35.67% of total billed charges,26.68,82.8,
TED HOSE THIGH LARGE LONG,27000744,CDM,270,RC,,,outpatient,,,92,36.80,,78.2,85,,62.56,percent of total billed charges,85% of total billed charges,70.84,77,,56.67,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,75.44,82,,60.352,percent of total billed charges,82% of total billed charges,78.2,85,,62.56,percent of total billed charges,85% of total billed charges,78.2,85,,62.56,percent of total billed charges,85% of total billed charges,78.2,85,,62.56,percent of total billed charges,85% of total billed charges,82.8,90,,66.24,percent of total billed charges,90% of total billed charges,73.6,80,,58.88,percent of total billed charges,80% of total billed charges,82.8,90,,66.24,percent of total billed charges,90% of total billed charges,69,75,,55.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,26.68,29,,21.344,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,61.64,67,,49.312,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,73.6,80,,58.88,percent of total billed charges,80% of total billed charges,59.8,65,,47.84,percent of total billed charges,65% of total billed charges,32.82,35.67,,26.256,percent of total billed charges,35.67% of total billed charges,26.68,82.8,
PERINEAL CLEANSING BOTTLE,27000749,CDM,270,RC,,,outpatient,,,16,6.40,,13.6,85,,10.88,percent of total billed charges,85% of total billed charges,12.32,77,,9.86,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,13.12,82,,10.496,percent of total billed charges,82% of total billed charges,13.6,85,,10.88,percent of total billed charges,85% of total billed charges,13.6,85,,10.88,percent of total billed charges,85% of total billed charges,13.6,85,,10.88,percent of total billed charges,85% of total billed charges,14.4,90,,11.52,percent of total billed charges,90% of total billed charges,12.8,80,,10.24,percent of total billed charges,80% of total billed charges,14.4,90,,11.52,percent of total billed charges,90% of total billed charges,12,75,,9.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,4.64,29,,3.712,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,10.72,67,,8.576,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,12.8,80,,10.24,percent of total billed charges,80% of total billed charges,10.4,65,,8.32,percent of total billed charges,65% of total billed charges,5.71,35.67,,4.568,percent of total billed charges,35.67% of total billed charges,4.64,14.4,
EAR WICK 15MM **,27000759,CDM,270,RC,,,outpatient,,,18,7.20,,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,13.86,77,,11.09,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,14.76,82,,11.808,percent of total billed charges,82% of total billed charges,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,16.2,90,,12.96,percent of total billed charges,90% of total billed charges,14.4,80,,11.52,percent of total billed charges,80% of total billed charges,16.2,90,,12.96,percent of total billed charges,90% of total billed charges,13.5,75,,10.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,5.22,29,,4.176,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,12.06,67,,9.648,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,14.4,80,,11.52,percent of total billed charges,80% of total billed charges,11.7,65,,9.36,percent of total billed charges,65% of total billed charges,6.42,35.67,,5.136,percent of total billed charges,35.67% of total billed charges,5.22,16.2,
THERMAL PAD 26 X 33 **,27000762,CDM,270,RC,,,outpatient,,,109,43.60,,92.65,85,,74.12,percent of total billed charges,85% of total billed charges,83.93,77,,67.14,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,89.38,82,,71.504,percent of total billed charges,82% of total billed charges,92.65,85,,74.12,percent of total billed charges,85% of total billed charges,92.65,85,,74.12,percent of total billed charges,85% of total billed charges,92.65,85,,74.12,percent of total billed charges,85% of total billed charges,98.1,90,,78.48,percent of total billed charges,90% of total billed charges,87.2,80,,69.76,percent of total billed charges,80% of total billed charges,98.1,90,,78.48,percent of total billed charges,90% of total billed charges,81.75,75,,65.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,31.61,29,,25.288,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,73.03,67,,58.424,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,87.2,80,,69.76,percent of total billed charges,80% of total billed charges,70.85,65,,56.68,percent of total billed charges,65% of total billed charges,38.88,35.67,,31.104,percent of total billed charges,35.67% of total billed charges,31.61,98.1,
CASTING TAPE 3,27000770,CDM,270,RC,,,outpatient,,,53,21.20,,45.05,85,,36.04,percent of total billed charges,85% of total billed charges,40.81,77,,32.65,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,43.46,82,,34.768,percent of total billed charges,82% of total billed charges,45.05,85,,36.04,percent of total billed charges,85% of total billed charges,45.05,85,,36.04,percent of total billed charges,85% of total billed charges,45.05,85,,36.04,percent of total billed charges,85% of total billed charges,47.7,90,,38.16,percent of total billed charges,90% of total billed charges,42.4,80,,33.92,percent of total billed charges,80% of total billed charges,47.7,90,,38.16,percent of total billed charges,90% of total billed charges,39.75,75,,31.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,15.37,29,,12.296,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,35.51,67,,28.408,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,42.4,80,,33.92,percent of total billed charges,80% of total billed charges,34.45,65,,27.56,percent of total billed charges,65% of total billed charges,18.91,35.67,,15.128,percent of total billed charges,35.67% of total billed charges,15.37,47.7,
CASTING TAPE 4,27000771,CDM,270,RC,,,outpatient,,,79,31.60,,67.15,85,,53.72,percent of total billed charges,85% of total billed charges,60.83,77,,48.66,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,64.78,82,,51.824,percent of total billed charges,82% of total billed charges,67.15,85,,53.72,percent of total billed charges,85% of total billed charges,67.15,85,,53.72,percent of total billed charges,85% of total billed charges,67.15,85,,53.72,percent of total billed charges,85% of total billed charges,71.1,90,,56.88,percent of total billed charges,90% of total billed charges,63.2,80,,50.56,percent of total billed charges,80% of total billed charges,71.1,90,,56.88,percent of total billed charges,90% of total billed charges,59.25,75,,47.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,22.91,29,,18.328,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,52.93,67,,42.344,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,63.2,80,,50.56,percent of total billed charges,80% of total billed charges,51.35,65,,41.08,percent of total billed charges,65% of total billed charges,28.18,35.67,,22.544,percent of total billed charges,35.67% of total billed charges,22.91,71.1,
FIBERGLASS CAST PADDING,27000773,CDM,270,RC,,,outpatient,,,16,6.40,,13.6,85,,10.88,percent of total billed charges,85% of total billed charges,12.32,77,,9.86,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,13.12,82,,10.496,percent of total billed charges,82% of total billed charges,13.6,85,,10.88,percent of total billed charges,85% of total billed charges,13.6,85,,10.88,percent of total billed charges,85% of total billed charges,13.6,85,,10.88,percent of total billed charges,85% of total billed charges,14.4,90,,11.52,percent of total billed charges,90% of total billed charges,12.8,80,,10.24,percent of total billed charges,80% of total billed charges,14.4,90,,11.52,percent of total billed charges,90% of total billed charges,12,75,,9.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,4.64,29,,3.712,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,10.72,67,,8.576,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,12.8,80,,10.24,percent of total billed charges,80% of total billed charges,10.4,65,,8.32,percent of total billed charges,65% of total billed charges,5.71,35.67,,4.568,percent of total billed charges,35.67% of total billed charges,4.64,14.4,
FIBERGLASS CAST PAD,27000774,CDM,270,RC,,,outpatient,,,11,4.40,,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,8.47,77,,6.78,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,9.02,82,,7.216,percent of total billed charges,82% of total billed charges,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,9.9,90,,7.92,percent of total billed charges,90% of total billed charges,8.8,80,,7.04,percent of total billed charges,80% of total billed charges,9.9,90,,7.92,percent of total billed charges,90% of total billed charges,8.25,75,,6.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,3.19,29,,2.552,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,7.37,67,,5.896,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,8.8,80,,7.04,percent of total billed charges,80% of total billed charges,7.15,65,,5.72,percent of total billed charges,65% of total billed charges,3.92,35.67,,3.136,percent of total billed charges,35.67% of total billed charges,3.19,9.9,
BETADINE SWABSTICK,27000923,CDM,270,RC,,,outpatient,,,10,4.00,,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,7.7,77,,6.16,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,8.2,82,,6.56,percent of total billed charges,82% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,9,90,,7.2,percent of total billed charges,90% of total billed charges,8,80,,6.4,percent of total billed charges,80% of total billed charges,9,90,,7.2,percent of total billed charges,90% of total billed charges,7.5,75,,6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.9,29,,2.32,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,6.7,67,,5.36,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,8,80,,6.4,percent of total billed charges,80% of total billed charges,6.5,65,,5.2,percent of total billed charges,65% of total billed charges,3.57,35.67,,2.856,percent of total billed charges,35.67% of total billed charges,2.9,9,
FETAL MONITOR BELT,27000930,CDM,270,RC,,,outpatient,,,22,8.80,,18.7,85,,14.96,percent of total billed charges,85% of total billed charges,16.94,77,,13.55,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,18.04,82,,14.432,percent of total billed charges,82% of total billed charges,18.7,85,,14.96,percent of total billed charges,85% of total billed charges,18.7,85,,14.96,percent of total billed charges,85% of total billed charges,18.7,85,,14.96,percent of total billed charges,85% of total billed charges,19.8,90,,15.84,percent of total billed charges,90% of total billed charges,17.6,80,,14.08,percent of total billed charges,80% of total billed charges,19.8,90,,15.84,percent of total billed charges,90% of total billed charges,16.5,75,,13.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,6.38,29,,5.104,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,14.74,67,,11.792,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,17.6,80,,14.08,percent of total billed charges,80% of total billed charges,14.3,65,,11.44,percent of total billed charges,65% of total billed charges,7.85,35.67,,6.28,percent of total billed charges,35.67% of total billed charges,6.38,19.8,
PULSE OXIMETER PROBE OXYTIP,27000951,CDM,270,RC,,,outpatient,,,93,37.20,,79.05,85,,63.24,percent of total billed charges,85% of total billed charges,71.61,77,,57.29,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,76.26,82,,61.008,percent of total billed charges,82% of total billed charges,79.05,85,,63.24,percent of total billed charges,85% of total billed charges,79.05,85,,63.24,percent of total billed charges,85% of total billed charges,79.05,85,,63.24,percent of total billed charges,85% of total billed charges,83.7,90,,66.96,percent of total billed charges,90% of total billed charges,74.4,80,,59.52,percent of total billed charges,80% of total billed charges,83.7,90,,66.96,percent of total billed charges,90% of total billed charges,69.75,75,,55.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,26.97,29,,21.576,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,62.31,67,,49.848,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,74.4,80,,59.52,percent of total billed charges,80% of total billed charges,60.45,65,,48.36,percent of total billed charges,65% of total billed charges,33.17,35.67,,26.536,percent of total billed charges,35.67% of total billed charges,26.97,83.7,
ALCON MICROSURGICAL NEEDLE,27000972,CDM,270,RC,,,outpatient,,,89,35.60,,75.65,85,,60.52,percent of total billed charges,85% of total billed charges,68.53,77,,54.82,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,72.98,82,,58.384,percent of total billed charges,82% of total billed charges,75.65,85,,60.52,percent of total billed charges,85% of total billed charges,75.65,85,,60.52,percent of total billed charges,85% of total billed charges,75.65,85,,60.52,percent of total billed charges,85% of total billed charges,80.1,90,,64.08,percent of total billed charges,90% of total billed charges,71.2,80,,56.96,percent of total billed charges,80% of total billed charges,80.1,90,,64.08,percent of total billed charges,90% of total billed charges,66.75,75,,53.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,25.81,29,,20.648,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,59.63,67,,47.704,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,71.2,80,,56.96,percent of total billed charges,80% of total billed charges,57.85,65,,46.28,percent of total billed charges,65% of total billed charges,31.75,35.67,,25.4,percent of total billed charges,35.67% of total billed charges,25.81,80.1,
ISOLATION CART (DAILY) **,27000999,CDM,270,RC,,,outpatient,,,230,92.00,,195.5,85,,156.4,percent of total billed charges,85% of total billed charges,177.1,77,,141.68,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,188.6,82,,150.88,percent of total billed charges,82% of total billed charges,195.5,85,,156.4,percent of total billed charges,85% of total billed charges,195.5,85,,156.4,percent of total billed charges,85% of total billed charges,195.5,85,,156.4,percent of total billed charges,85% of total billed charges,207,90,,165.6,percent of total billed charges,90% of total billed charges,184,80,,147.2,percent of total billed charges,80% of total billed charges,207,90,,165.6,percent of total billed charges,90% of total billed charges,172.5,75,,138,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,66.7,29,,53.36,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,154.1,67,,123.28,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,184,80,,147.2,percent of total billed charges,80% of total billed charges,149.5,65,,119.6,percent of total billed charges,65% of total billed charges,82.04,35.67,,65.632,percent of total billed charges,35.67% of total billed charges,66.7,207,
BSS PLUS 500CC **,27001115,CDM,270,RC,,,outpatient,,,480,192.00,,408,85,,326.4,percent of total billed charges,85% of total billed charges,369.6,77,,295.68,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,393.6,82,,314.88,percent of total billed charges,82% of total billed charges,408,85,,326.4,percent of total billed charges,85% of total billed charges,408,85,,326.4,percent of total billed charges,85% of total billed charges,408,85,,326.4,percent of total billed charges,85% of total billed charges,432,90,,345.6,percent of total billed charges,90% of total billed charges,384,80,,307.2,percent of total billed charges,80% of total billed charges,432,90,,345.6,percent of total billed charges,90% of total billed charges,360,75,,288,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,139.2,29,,111.36,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,321.6,67,,257.28,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,384,80,,307.2,percent of total billed charges,80% of total billed charges,312,65,,249.6,percent of total billed charges,65% of total billed charges,171.22,35.67,,136.976,percent of total billed charges,35.67% of total billed charges,139.2,432,
ENDO FOG,27001131,CDM,270,RC,,,outpatient,,,49,19.60,,41.65,85,,33.32,percent of total billed charges,85% of total billed charges,37.73,77,,30.18,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,40.18,82,,32.144,percent of total billed charges,82% of total billed charges,41.65,85,,33.32,percent of total billed charges,85% of total billed charges,41.65,85,,33.32,percent of total billed charges,85% of total billed charges,41.65,85,,33.32,percent of total billed charges,85% of total billed charges,44.1,90,,35.28,percent of total billed charges,90% of total billed charges,39.2,80,,31.36,percent of total billed charges,80% of total billed charges,44.1,90,,35.28,percent of total billed charges,90% of total billed charges,36.75,75,,29.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,14.21,29,,11.368,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,32.83,67,,26.264,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,39.2,80,,31.36,percent of total billed charges,80% of total billed charges,31.85,65,,25.48,percent of total billed charges,65% of total billed charges,17.48,35.67,,13.984,percent of total billed charges,35.67% of total billed charges,14.21,44.1,
THERMOFLOW FILTER,27001422,CDM,270,RC,,,outpatient,,,10,4.00,,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,7.7,77,,6.16,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,8.2,82,,6.56,percent of total billed charges,82% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,9,90,,7.2,percent of total billed charges,90% of total billed charges,8,80,,6.4,percent of total billed charges,80% of total billed charges,9,90,,7.2,percent of total billed charges,90% of total billed charges,7.5,75,,6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.9,29,,2.32,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,6.7,67,,5.36,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,8,80,,6.4,percent of total billed charges,80% of total billed charges,6.5,65,,5.2,percent of total billed charges,65% of total billed charges,3.57,35.67,,2.856,percent of total billed charges,35.67% of total billed charges,2.9,9,
SUMP SUCTION CONVERT SLEEVE,27001472,CDM,270,RC,,,outpatient,,,136,54.40,,115.6,85,,92.48,percent of total billed charges,85% of total billed charges,104.72,77,,83.78,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,111.52,82,,89.216,percent of total billed charges,82% of total billed charges,115.6,85,,92.48,percent of total billed charges,85% of total billed charges,115.6,85,,92.48,percent of total billed charges,85% of total billed charges,115.6,85,,92.48,percent of total billed charges,85% of total billed charges,122.4,90,,97.92,percent of total billed charges,90% of total billed charges,108.8,80,,87.04,percent of total billed charges,80% of total billed charges,122.4,90,,97.92,percent of total billed charges,90% of total billed charges,102,75,,81.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,39.44,29,,31.552,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,91.12,67,,72.896,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,108.8,80,,87.04,percent of total billed charges,80% of total billed charges,88.4,65,,70.72,percent of total billed charges,65% of total billed charges,48.51,35.67,,38.808,percent of total billed charges,35.67% of total billed charges,39.44,122.4,
MONTGOMERY STRAP,27001590,CDM,270,RC,,,outpatient,,,29,11.60,,24.65,85,,19.72,percent of total billed charges,85% of total billed charges,22.33,77,,17.86,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,23.78,82,,19.024,percent of total billed charges,82% of total billed charges,24.65,85,,19.72,percent of total billed charges,85% of total billed charges,24.65,85,,19.72,percent of total billed charges,85% of total billed charges,24.65,85,,19.72,percent of total billed charges,85% of total billed charges,26.1,90,,20.88,percent of total billed charges,90% of total billed charges,23.2,80,,18.56,percent of total billed charges,80% of total billed charges,26.1,90,,20.88,percent of total billed charges,90% of total billed charges,21.75,75,,17.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,8.41,29,,6.728,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,19.43,67,,15.544,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,23.2,80,,18.56,percent of total billed charges,80% of total billed charges,18.85,65,,15.08,percent of total billed charges,65% of total billed charges,10.34,35.67,,8.272,percent of total billed charges,35.67% of total billed charges,8.41,26.1,
UNNA BOOT 4,27001599,CDM,270,RC,,,outpatient,,,84,33.60,,71.4,85,,57.12,percent of total billed charges,85% of total billed charges,64.68,77,,51.74,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,68.88,82,,55.104,percent of total billed charges,82% of total billed charges,71.4,85,,57.12,percent of total billed charges,85% of total billed charges,71.4,85,,57.12,percent of total billed charges,85% of total billed charges,71.4,85,,57.12,percent of total billed charges,85% of total billed charges,75.6,90,,60.48,percent of total billed charges,90% of total billed charges,67.2,80,,53.76,percent of total billed charges,80% of total billed charges,75.6,90,,60.48,percent of total billed charges,90% of total billed charges,63,75,,50.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,24.36,29,,19.488,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,56.28,67,,45.024,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,67.2,80,,53.76,percent of total billed charges,80% of total billed charges,54.6,65,,43.68,percent of total billed charges,65% of total billed charges,29.96,35.67,,23.968,percent of total billed charges,35.67% of total billed charges,24.36,75.6,
INTERNAL STAPLER ILA-100,27001655,CDM,270,RC,,,outpatient,,,2241,896.40,,1904.85,85,,1523.88,percent of total billed charges,85% of total billed charges,1725.57,77,,1380.46,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,1837.62,82,,1470.096,percent of total billed charges,82% of total billed charges,1904.85,85,,1523.88,percent of total billed charges,85% of total billed charges,1904.85,85,,1523.88,percent of total billed charges,85% of total billed charges,1904.85,85,,1523.88,percent of total billed charges,85% of total billed charges,2016.9,90,,1613.52,percent of total billed charges,90% of total billed charges,1792.8,80,,1434.24,percent of total billed charges,80% of total billed charges,2016.9,90,,1613.52,percent of total billed charges,90% of total billed charges,1680.75,75,,1344.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,649.89,29,,519.912,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1501.47,67,,1201.176,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1792.8,80,,1434.24,percent of total billed charges,80% of total billed charges,1456.65,65,,1165.32,percent of total billed charges,65% of total billed charges,799.36,35.67,,639.488,percent of total billed charges,35.67% of total billed charges,649.89,2016.9,
PERITONEAL LAVAGE TRAY,27001709,CDM,270,RC,C1752,HCPCS,outpatient,,,238,95.20,,202.3,85,,161.84,percent of total billed charges,85% of total billed charges,183.26,77,,146.61,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,195.16,82,,156.128,percent of total billed charges,82% of total billed charges,202.3,85,,161.84,percent of total billed charges,85% of total billed charges,202.3,85,,161.84,percent of total billed charges,85% of total billed charges,202.3,85,,161.84,percent of total billed charges,85% of total billed charges,214.2,90,,171.36,percent of total billed charges,90% of total billed charges,190.4,80,,152.32,percent of total billed charges,80% of total billed charges,214.2,90,,171.36,percent of total billed charges,90% of total billed charges,178.5,75,,142.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,69.02,29,,55.216,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,159.46,67,,127.568,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,190.4,80,,152.32,percent of total billed charges,80% of total billed charges,154.7,65,,123.76,percent of total billed charges,65% of total billed charges,84.89,35.67,,67.912,percent of total billed charges,35.67% of total billed charges,69.02,214.2,
EXTRA LARGE BAND-AIDS,27001779,CDM,270,RC,,,outpatient,,,11,4.40,,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,8.47,77,,6.78,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,9.02,82,,7.216,percent of total billed charges,82% of total billed charges,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,9.9,90,,7.92,percent of total billed charges,90% of total billed charges,8.8,80,,7.04,percent of total billed charges,80% of total billed charges,9.9,90,,7.92,percent of total billed charges,90% of total billed charges,8.25,75,,6.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,3.19,29,,2.552,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,7.37,67,,5.896,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,8.8,80,,7.04,percent of total billed charges,80% of total billed charges,7.15,65,,5.72,percent of total billed charges,65% of total billed charges,3.92,35.67,,3.136,percent of total billed charges,35.67% of total billed charges,3.19,9.9,
NASOGASTRIC TUBE HOLDER,27001868,CDM,270,RC,,,outpatient,,,10,4.00,,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,7.7,77,,6.16,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,8.2,82,,6.56,percent of total billed charges,82% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,9,90,,7.2,percent of total billed charges,90% of total billed charges,8,80,,6.4,percent of total billed charges,80% of total billed charges,9,90,,7.2,percent of total billed charges,90% of total billed charges,7.5,75,,6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.9,29,,2.32,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,6.7,67,,5.36,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,8,80,,6.4,percent of total billed charges,80% of total billed charges,6.5,65,,5.2,percent of total billed charges,65% of total billed charges,3.57,35.67,,2.856,percent of total billed charges,35.67% of total billed charges,2.9,9,
GASTROSTOMY TUBE 26FR,27001953,CDM,270,RC,,,outpatient,,,225,90.00,,191.25,85,,153,percent of total billed charges,85% of total billed charges,173.25,77,,138.6,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,184.5,82,,147.6,percent of total billed charges,82% of total billed charges,191.25,85,,153,percent of total billed charges,85% of total billed charges,191.25,85,,153,percent of total billed charges,85% of total billed charges,191.25,85,,153,percent of total billed charges,85% of total billed charges,202.5,90,,162,percent of total billed charges,90% of total billed charges,180,80,,144,percent of total billed charges,80% of total billed charges,202.5,90,,162,percent of total billed charges,90% of total billed charges,168.75,75,,135,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,65.25,29,,52.2,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,150.75,67,,120.6,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,180,80,,144,percent of total billed charges,80% of total billed charges,146.25,65,,117,percent of total billed charges,65% of total billed charges,80.26,35.67,,64.208,percent of total billed charges,35.67% of total billed charges,65.25,202.5,
BREAST BIOPSY NEEDLE 22G 3,27001965,CDM,270,RC,,,outpatient,,,110,44.00,,93.5,85,,74.8,percent of total billed charges,85% of total billed charges,84.7,77,,67.76,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,90.2,82,,72.16,percent of total billed charges,82% of total billed charges,93.5,85,,74.8,percent of total billed charges,85% of total billed charges,93.5,85,,74.8,percent of total billed charges,85% of total billed charges,93.5,85,,74.8,percent of total billed charges,85% of total billed charges,99,90,,79.2,percent of total billed charges,90% of total billed charges,88,80,,70.4,percent of total billed charges,80% of total billed charges,99,90,,79.2,percent of total billed charges,90% of total billed charges,82.5,75,,66,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,31.9,29,,25.52,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,73.7,67,,58.96,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,88,80,,70.4,percent of total billed charges,80% of total billed charges,71.5,65,,57.2,percent of total billed charges,65% of total billed charges,39.24,35.67,,31.392,percent of total billed charges,35.67% of total billed charges,31.9,99,
JEJUNAL FEEDING TUBE 12 FR,27001999,CDM,270,RC,,,outpatient,,,797,318.80,,677.45,85,,541.96,percent of total billed charges,85% of total billed charges,613.69,77,,490.95,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,653.54,82,,522.832,percent of total billed charges,82% of total billed charges,677.45,85,,541.96,percent of total billed charges,85% of total billed charges,677.45,85,,541.96,percent of total billed charges,85% of total billed charges,677.45,85,,541.96,percent of total billed charges,85% of total billed charges,717.3,90,,573.84,percent of total billed charges,90% of total billed charges,637.6,80,,510.08,percent of total billed charges,80% of total billed charges,717.3,90,,573.84,percent of total billed charges,90% of total billed charges,597.75,75,,478.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,231.13,29,,184.904,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,533.99,67,,427.192,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,637.6,80,,510.08,percent of total billed charges,80% of total billed charges,518.05,65,,414.44,percent of total billed charges,65% of total billed charges,284.29,35.67,,227.432,percent of total billed charges,35.67% of total billed charges,231.13,717.3,
SCALPEL SZ 11,27002070,CDM,270,RC,,,outpatient,,,19,7.60,,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,14.63,77,,11.7,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,15.58,82,,12.464,percent of total billed charges,82% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,15.2,80,,12.16,percent of total billed charges,80% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,14.25,75,,11.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,5.51,29,,4.408,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,12.73,67,,10.184,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,15.2,80,,12.16,percent of total billed charges,80% of total billed charges,12.35,65,,9.88,percent of total billed charges,65% of total billed charges,6.78,35.67,,5.424,percent of total billed charges,35.67% of total billed charges,5.51,17.1,
SCALPEL SZ 15,27002071,CDM,270,RC,,,outpatient,,,17,6.80,,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,13.09,77,,10.47,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,13.94,82,,11.152,percent of total billed charges,82% of total billed charges,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,15.3,90,,12.24,percent of total billed charges,90% of total billed charges,13.6,80,,10.88,percent of total billed charges,80% of total billed charges,15.3,90,,12.24,percent of total billed charges,90% of total billed charges,12.75,75,,10.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,4.93,29,,3.944,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,11.39,67,,9.112,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,13.6,80,,10.88,percent of total billed charges,80% of total billed charges,11.05,65,,8.84,percent of total billed charges,65% of total billed charges,6.06,35.67,,4.848,percent of total billed charges,35.67% of total billed charges,4.93,15.3,
SURGICLIP SMALL 9.0,27002100,CDM,270,RC,,,outpatient,,,1554,621.60,,1320.9,85,,1056.72,percent of total billed charges,85% of total billed charges,1196.58,77,,957.26,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,1274.28,82,,1019.424,percent of total billed charges,82% of total billed charges,1320.9,85,,1056.72,percent of total billed charges,85% of total billed charges,1320.9,85,,1056.72,percent of total billed charges,85% of total billed charges,1320.9,85,,1056.72,percent of total billed charges,85% of total billed charges,1398.6,90,,1118.88,percent of total billed charges,90% of total billed charges,1243.2,80,,994.56,percent of total billed charges,80% of total billed charges,1398.6,90,,1118.88,percent of total billed charges,90% of total billed charges,1165.5,75,,932.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,450.66,29,,360.528,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1041.18,67,,832.944,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1243.2,80,,994.56,percent of total billed charges,80% of total billed charges,1010.1,65,,808.08,percent of total billed charges,65% of total billed charges,554.31,35.67,,443.448,percent of total billed charges,35.67% of total billed charges,450.66,1398.6,
WARMING BLANKET BAIR HUGGER,27002108,CDM,270,RC,,,outpatient,,,79,31.60,,67.15,85,,53.72,percent of total billed charges,85% of total billed charges,60.83,77,,48.66,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,64.78,82,,51.824,percent of total billed charges,82% of total billed charges,67.15,85,,53.72,percent of total billed charges,85% of total billed charges,67.15,85,,53.72,percent of total billed charges,85% of total billed charges,67.15,85,,53.72,percent of total billed charges,85% of total billed charges,71.1,90,,56.88,percent of total billed charges,90% of total billed charges,63.2,80,,50.56,percent of total billed charges,80% of total billed charges,71.1,90,,56.88,percent of total billed charges,90% of total billed charges,59.25,75,,47.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,22.91,29,,18.328,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,52.93,67,,42.344,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,63.2,80,,50.56,percent of total billed charges,80% of total billed charges,51.35,65,,41.08,percent of total billed charges,65% of total billed charges,28.18,35.67,,22.544,percent of total billed charges,35.67% of total billed charges,22.91,71.1,
WARMING BLANKET LOWER BODY,27002110,CDM,270,RC,,,outpatient,,,106,42.40,,90.1,85,,72.08,percent of total billed charges,85% of total billed charges,81.62,77,,65.3,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,86.92,82,,69.536,percent of total billed charges,82% of total billed charges,90.1,85,,72.08,percent of total billed charges,85% of total billed charges,90.1,85,,72.08,percent of total billed charges,85% of total billed charges,90.1,85,,72.08,percent of total billed charges,85% of total billed charges,95.4,90,,76.32,percent of total billed charges,90% of total billed charges,84.8,80,,67.84,percent of total billed charges,80% of total billed charges,95.4,90,,76.32,percent of total billed charges,90% of total billed charges,79.5,75,,63.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,30.74,29,,24.592,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,71.02,67,,56.816,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,84.8,80,,67.84,percent of total billed charges,80% of total billed charges,68.9,65,,55.12,percent of total billed charges,65% of total billed charges,37.81,35.67,,30.248,percent of total billed charges,35.67% of total billed charges,30.74,95.4,
SCALPELS SZ 10,27002146,CDM,270,RC,,,outpatient,,,17,6.80,,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,13.09,77,,10.47,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,13.94,82,,11.152,percent of total billed charges,82% of total billed charges,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,15.3,90,,12.24,percent of total billed charges,90% of total billed charges,13.6,80,,10.88,percent of total billed charges,80% of total billed charges,15.3,90,,12.24,percent of total billed charges,90% of total billed charges,12.75,75,,10.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,4.93,29,,3.944,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,11.39,67,,9.112,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,13.6,80,,10.88,percent of total billed charges,80% of total billed charges,11.05,65,,8.84,percent of total billed charges,65% of total billed charges,6.06,35.67,,4.848,percent of total billed charges,35.67% of total billed charges,4.93,15.3,
MAXI PADS INDIVIDUAL,27002242,CDM,270,RC,,,outpatient,,,10,4.00,,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,7.7,77,,6.16,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,8.2,82,,6.56,percent of total billed charges,82% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,9,90,,7.2,percent of total billed charges,90% of total billed charges,8,80,,6.4,percent of total billed charges,80% of total billed charges,9,90,,7.2,percent of total billed charges,90% of total billed charges,7.5,75,,6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.9,29,,2.32,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,6.7,67,,5.36,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,8,80,,6.4,percent of total billed charges,80% of total billed charges,6.5,65,,5.2,percent of total billed charges,65% of total billed charges,3.57,35.67,,2.856,percent of total billed charges,35.67% of total billed charges,2.9,9,
DURASHELL PLASTER BANDAGE 6**,27002255,CDM,270,RC,,,outpatient,,,19,7.60,,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,14.63,77,,11.7,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,15.58,82,,12.464,percent of total billed charges,82% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,15.2,80,,12.16,percent of total billed charges,80% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,14.25,75,,11.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,5.51,29,,4.408,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,12.73,67,,10.184,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,15.2,80,,12.16,percent of total billed charges,80% of total billed charges,12.35,65,,9.88,percent of total billed charges,65% of total billed charges,6.78,35.67,,5.424,percent of total billed charges,35.67% of total billed charges,5.51,17.1,
POSTOP SHOE WOMENS SMALL,27002321,CDM,270,RC,,,outpatient,,,97,38.80,,82.45,85,,65.96,percent of total billed charges,85% of total billed charges,74.69,77,,59.75,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,79.54,82,,63.632,percent of total billed charges,82% of total billed charges,82.45,85,,65.96,percent of total billed charges,85% of total billed charges,82.45,85,,65.96,percent of total billed charges,85% of total billed charges,82.45,85,,65.96,percent of total billed charges,85% of total billed charges,87.3,90,,69.84,percent of total billed charges,90% of total billed charges,77.6,80,,62.08,percent of total billed charges,80% of total billed charges,87.3,90,,69.84,percent of total billed charges,90% of total billed charges,72.75,75,,58.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,28.13,29,,22.504,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,64.99,67,,51.992,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,77.6,80,,62.08,percent of total billed charges,80% of total billed charges,63.05,65,,50.44,percent of total billed charges,65% of total billed charges,34.6,35.67,,27.68,percent of total billed charges,35.67% of total billed charges,28.13,87.3,
POSTOP SHOE WOMENS MEDIUM,27002322,CDM,270,RC,,,outpatient,,,97,38.80,,82.45,85,,65.96,percent of total billed charges,85% of total billed charges,74.69,77,,59.75,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,79.54,82,,63.632,percent of total billed charges,82% of total billed charges,82.45,85,,65.96,percent of total billed charges,85% of total billed charges,82.45,85,,65.96,percent of total billed charges,85% of total billed charges,82.45,85,,65.96,percent of total billed charges,85% of total billed charges,87.3,90,,69.84,percent of total billed charges,90% of total billed charges,77.6,80,,62.08,percent of total billed charges,80% of total billed charges,87.3,90,,69.84,percent of total billed charges,90% of total billed charges,72.75,75,,58.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,28.13,29,,22.504,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,64.99,67,,51.992,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,77.6,80,,62.08,percent of total billed charges,80% of total billed charges,63.05,65,,50.44,percent of total billed charges,65% of total billed charges,34.6,35.67,,27.68,percent of total billed charges,35.67% of total billed charges,28.13,87.3,
POSTOP SHOE WOMENS LARGE,27002323,CDM,270,RC,,,outpatient,,,97,38.80,,82.45,85,,65.96,percent of total billed charges,85% of total billed charges,74.69,77,,59.75,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,79.54,82,,63.632,percent of total billed charges,82% of total billed charges,82.45,85,,65.96,percent of total billed charges,85% of total billed charges,82.45,85,,65.96,percent of total billed charges,85% of total billed charges,82.45,85,,65.96,percent of total billed charges,85% of total billed charges,87.3,90,,69.84,percent of total billed charges,90% of total billed charges,77.6,80,,62.08,percent of total billed charges,80% of total billed charges,87.3,90,,69.84,percent of total billed charges,90% of total billed charges,72.75,75,,58.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,28.13,29,,22.504,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,64.99,67,,51.992,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,77.6,80,,62.08,percent of total billed charges,80% of total billed charges,63.05,65,,50.44,percent of total billed charges,65% of total billed charges,34.6,35.67,,27.68,percent of total billed charges,35.67% of total billed charges,28.13,87.3,
POSTOP SHOE MENS MED,27002324,CDM,270,RC,,,outpatient,,,97,38.80,,82.45,85,,65.96,percent of total billed charges,85% of total billed charges,74.69,77,,59.75,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,79.54,82,,63.632,percent of total billed charges,82% of total billed charges,82.45,85,,65.96,percent of total billed charges,85% of total billed charges,82.45,85,,65.96,percent of total billed charges,85% of total billed charges,82.45,85,,65.96,percent of total billed charges,85% of total billed charges,87.3,90,,69.84,percent of total billed charges,90% of total billed charges,77.6,80,,62.08,percent of total billed charges,80% of total billed charges,87.3,90,,69.84,percent of total billed charges,90% of total billed charges,72.75,75,,58.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,28.13,29,,22.504,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,64.99,67,,51.992,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,77.6,80,,62.08,percent of total billed charges,80% of total billed charges,63.05,65,,50.44,percent of total billed charges,65% of total billed charges,34.6,35.67,,27.68,percent of total billed charges,35.67% of total billed charges,28.13,87.3,
POSTOP SHOE MENS LARGE,27002325,CDM,270,RC,,,outpatient,,,97,38.80,,82.45,85,,65.96,percent of total billed charges,85% of total billed charges,74.69,77,,59.75,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,79.54,82,,63.632,percent of total billed charges,82% of total billed charges,82.45,85,,65.96,percent of total billed charges,85% of total billed charges,82.45,85,,65.96,percent of total billed charges,85% of total billed charges,82.45,85,,65.96,percent of total billed charges,85% of total billed charges,87.3,90,,69.84,percent of total billed charges,90% of total billed charges,77.6,80,,62.08,percent of total billed charges,80% of total billed charges,87.3,90,,69.84,percent of total billed charges,90% of total billed charges,72.75,75,,58.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,28.13,29,,22.504,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,64.99,67,,51.992,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,77.6,80,,62.08,percent of total billed charges,80% of total billed charges,63.05,65,,50.44,percent of total billed charges,65% of total billed charges,34.6,35.67,,27.68,percent of total billed charges,35.67% of total billed charges,28.13,87.3,
SUTURE SILK 3-0 18,27002370,CDM,270,RC,,,outpatient,,,113,45.20,,96.05,85,,76.84,percent of total billed charges,85% of total billed charges,87.01,77,,69.61,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,92.66,82,,74.128,percent of total billed charges,82% of total billed charges,96.05,85,,76.84,percent of total billed charges,85% of total billed charges,96.05,85,,76.84,percent of total billed charges,85% of total billed charges,96.05,85,,76.84,percent of total billed charges,85% of total billed charges,101.7,90,,81.36,percent of total billed charges,90% of total billed charges,90.4,80,,72.32,percent of total billed charges,80% of total billed charges,101.7,90,,81.36,percent of total billed charges,90% of total billed charges,84.75,75,,67.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,32.77,29,,26.216,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,75.71,67,,60.568,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,90.4,80,,72.32,percent of total billed charges,80% of total billed charges,73.45,65,,58.76,percent of total billed charges,65% of total billed charges,40.31,35.67,,32.248,percent of total billed charges,35.67% of total billed charges,32.77,101.7,
VAGINAL SPECULUMS SMALL,27002387,CDM,270,RC,,,outpatient,,,22,8.80,,18.7,85,,14.96,percent of total billed charges,85% of total billed charges,16.94,77,,13.55,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,18.04,82,,14.432,percent of total billed charges,82% of total billed charges,18.7,85,,14.96,percent of total billed charges,85% of total billed charges,18.7,85,,14.96,percent of total billed charges,85% of total billed charges,18.7,85,,14.96,percent of total billed charges,85% of total billed charges,19.8,90,,15.84,percent of total billed charges,90% of total billed charges,17.6,80,,14.08,percent of total billed charges,80% of total billed charges,19.8,90,,15.84,percent of total billed charges,90% of total billed charges,16.5,75,,13.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,6.38,29,,5.104,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,14.74,67,,11.792,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,17.6,80,,14.08,percent of total billed charges,80% of total billed charges,14.3,65,,11.44,percent of total billed charges,65% of total billed charges,7.85,35.67,,6.28,percent of total billed charges,35.67% of total billed charges,6.38,19.8,
DURA STEP ORTHO BOOT LARGE,27002446,CDM,270,RC,,,outpatient,,,328,131.20,,278.8,85,,223.04,percent of total billed charges,85% of total billed charges,252.56,77,,202.05,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,268.96,82,,215.168,percent of total billed charges,82% of total billed charges,278.8,85,,223.04,percent of total billed charges,85% of total billed charges,278.8,85,,223.04,percent of total billed charges,85% of total billed charges,278.8,85,,223.04,percent of total billed charges,85% of total billed charges,295.2,90,,236.16,percent of total billed charges,90% of total billed charges,262.4,80,,209.92,percent of total billed charges,80% of total billed charges,295.2,90,,236.16,percent of total billed charges,90% of total billed charges,246,75,,196.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,95.12,29,,76.096,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,219.76,67,,175.808,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,262.4,80,,209.92,percent of total billed charges,80% of total billed charges,213.2,65,,170.56,percent of total billed charges,65% of total billed charges,117,35.67,,93.6,percent of total billed charges,35.67% of total billed charges,95.12,295.2,
SUTURE BIOSYN SZ 3-0 27,27002489,CDM,270,RC,,,outpatient,,,131,52.40,,111.35,85,,89.08,percent of total billed charges,85% of total billed charges,100.87,77,,80.7,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,107.42,82,,85.936,percent of total billed charges,82% of total billed charges,111.35,85,,89.08,percent of total billed charges,85% of total billed charges,111.35,85,,89.08,percent of total billed charges,85% of total billed charges,111.35,85,,89.08,percent of total billed charges,85% of total billed charges,117.9,90,,94.32,percent of total billed charges,90% of total billed charges,104.8,80,,83.84,percent of total billed charges,80% of total billed charges,117.9,90,,94.32,percent of total billed charges,90% of total billed charges,98.25,75,,78.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,37.99,29,,30.392,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,87.77,67,,70.216,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,104.8,80,,83.84,percent of total billed charges,80% of total billed charges,85.15,65,,68.12,percent of total billed charges,65% of total billed charges,46.73,35.67,,37.384,percent of total billed charges,35.67% of total billed charges,37.99,117.9,
ZIMMER PLASTIC BASIN **,27002583,CDM,270,RC,,,outpatient,,,24,9.60,,20.4,85,,16.32,percent of total billed charges,85% of total billed charges,18.48,77,,14.78,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,19.68,82,,15.744,percent of total billed charges,82% of total billed charges,20.4,85,,16.32,percent of total billed charges,85% of total billed charges,20.4,85,,16.32,percent of total billed charges,85% of total billed charges,20.4,85,,16.32,percent of total billed charges,85% of total billed charges,21.6,90,,17.28,percent of total billed charges,90% of total billed charges,19.2,80,,15.36,percent of total billed charges,80% of total billed charges,21.6,90,,17.28,percent of total billed charges,90% of total billed charges,18,75,,14.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,6.96,29,,5.568,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,16.08,67,,12.864,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,19.2,80,,15.36,percent of total billed charges,80% of total billed charges,15.6,65,,12.48,percent of total billed charges,65% of total billed charges,8.56,35.67,,6.848,percent of total billed charges,35.67% of total billed charges,6.96,21.6,
LANSINOH BREAST CREAM,27002640,CDM,270,RC,,,outpatient,,,24,9.60,,20.4,85,,16.32,percent of total billed charges,85% of total billed charges,18.48,77,,14.78,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,19.68,82,,15.744,percent of total billed charges,82% of total billed charges,20.4,85,,16.32,percent of total billed charges,85% of total billed charges,20.4,85,,16.32,percent of total billed charges,85% of total billed charges,20.4,85,,16.32,percent of total billed charges,85% of total billed charges,21.6,90,,17.28,percent of total billed charges,90% of total billed charges,19.2,80,,15.36,percent of total billed charges,80% of total billed charges,21.6,90,,17.28,percent of total billed charges,90% of total billed charges,18,75,,14.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,6.96,29,,5.568,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,16.08,67,,12.864,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,19.2,80,,15.36,percent of total billed charges,80% of total billed charges,15.6,65,,12.48,percent of total billed charges,65% of total billed charges,8.56,35.67,,6.848,percent of total billed charges,35.67% of total billed charges,6.96,21.6,
CATHETER FOLEY 14 COUDE **,27002708,CDM,270,RC,,,outpatient,,,66,26.40,,56.1,85,,44.88,percent of total billed charges,85% of total billed charges,50.82,77,,40.66,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,54.12,82,,43.296,percent of total billed charges,82% of total billed charges,56.1,85,,44.88,percent of total billed charges,85% of total billed charges,56.1,85,,44.88,percent of total billed charges,85% of total billed charges,56.1,85,,44.88,percent of total billed charges,85% of total billed charges,59.4,90,,47.52,percent of total billed charges,90% of total billed charges,52.8,80,,42.24,percent of total billed charges,80% of total billed charges,59.4,90,,47.52,percent of total billed charges,90% of total billed charges,49.5,75,,39.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,19.14,29,,15.312,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,44.22,67,,35.376,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,52.8,80,,42.24,percent of total billed charges,80% of total billed charges,42.9,65,,34.32,percent of total billed charges,65% of total billed charges,23.54,35.67,,18.832,percent of total billed charges,35.67% of total billed charges,19.14,59.4,
SURGICAL START KIT,27002716,CDM,270,RC,,,outpatient,,,250,100.00,,212.5,85,,170,percent of total billed charges,85% of total billed charges,192.5,77,,154,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,205,82,,164,percent of total billed charges,82% of total billed charges,212.5,85,,170,percent of total billed charges,85% of total billed charges,212.5,85,,170,percent of total billed charges,85% of total billed charges,212.5,85,,170,percent of total billed charges,85% of total billed charges,225,90,,180,percent of total billed charges,90% of total billed charges,200,80,,160,percent of total billed charges,80% of total billed charges,225,90,,180,percent of total billed charges,90% of total billed charges,187.5,75,,150,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,72.5,29,,58,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,167.5,67,,134,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,200,80,,160,percent of total billed charges,80% of total billed charges,162.5,65,,130,percent of total billed charges,65% of total billed charges,89.18,35.67,,71.344,percent of total billed charges,35.67% of total billed charges,72.5,225,
PHOTO DOCUMENTATION,27002744,CDM,270,RC,,,outpatient,,,25,10.00,,21.25,85,,17,percent of total billed charges,85% of total billed charges,19.25,77,,15.4,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,20.5,82,,16.4,percent of total billed charges,82% of total billed charges,21.25,85,,17,percent of total billed charges,85% of total billed charges,21.25,85,,17,percent of total billed charges,85% of total billed charges,21.25,85,,17,percent of total billed charges,85% of total billed charges,22.5,90,,18,percent of total billed charges,90% of total billed charges,20,80,,16,percent of total billed charges,80% of total billed charges,22.5,90,,18,percent of total billed charges,90% of total billed charges,18.75,75,,15,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,7.25,29,,5.8,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,16.75,67,,13.4,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,20,80,,16,percent of total billed charges,80% of total billed charges,16.25,65,,13,percent of total billed charges,65% of total billed charges,8.92,35.67,,7.136,percent of total billed charges,35.67% of total billed charges,7.25,22.5,
SAF GEL WOUND DRESSING **,27002753,CDM,270,RC,,,outpatient,,,130,52.00,,110.5,85,,88.4,percent of total billed charges,85% of total billed charges,100.1,77,,80.08,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,106.6,82,,85.28,percent of total billed charges,82% of total billed charges,110.5,85,,88.4,percent of total billed charges,85% of total billed charges,110.5,85,,88.4,percent of total billed charges,85% of total billed charges,110.5,85,,88.4,percent of total billed charges,85% of total billed charges,117,90,,93.6,percent of total billed charges,90% of total billed charges,104,80,,83.2,percent of total billed charges,80% of total billed charges,117,90,,93.6,percent of total billed charges,90% of total billed charges,97.5,75,,78,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,37.7,29,,30.16,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,87.1,67,,69.68,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,104,80,,83.2,percent of total billed charges,80% of total billed charges,84.5,65,,67.6,percent of total billed charges,65% of total billed charges,46.37,35.67,,37.096,percent of total billed charges,35.67% of total billed charges,37.7,117,
TERRY TREAD SOCKS CHILDREN,27002801,CDM,270,RC,,,outpatient,,,10,4.00,,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,7.7,77,,6.16,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,8.2,82,,6.56,percent of total billed charges,82% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,9,90,,7.2,percent of total billed charges,90% of total billed charges,8,80,,6.4,percent of total billed charges,80% of total billed charges,9,90,,7.2,percent of total billed charges,90% of total billed charges,7.5,75,,6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.9,29,,2.32,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,6.7,67,,5.36,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,8,80,,6.4,percent of total billed charges,80% of total billed charges,6.5,65,,5.2,percent of total billed charges,65% of total billed charges,3.57,35.67,,2.856,percent of total billed charges,35.67% of total billed charges,2.9,9,
FLUID COLLECTION DRAPE,27002807,CDM,270,RC,,,outpatient,,,67,26.80,,56.95,85,,45.56,percent of total billed charges,85% of total billed charges,51.59,77,,41.27,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,54.94,82,,43.952,percent of total billed charges,82% of total billed charges,56.95,85,,45.56,percent of total billed charges,85% of total billed charges,56.95,85,,45.56,percent of total billed charges,85% of total billed charges,56.95,85,,45.56,percent of total billed charges,85% of total billed charges,60.3,90,,48.24,percent of total billed charges,90% of total billed charges,53.6,80,,42.88,percent of total billed charges,80% of total billed charges,60.3,90,,48.24,percent of total billed charges,90% of total billed charges,50.25,75,,40.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,19.43,29,,15.544,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,44.89,67,,35.912,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,53.6,80,,42.88,percent of total billed charges,80% of total billed charges,43.55,65,,34.84,percent of total billed charges,65% of total billed charges,23.9,35.67,,19.12,percent of total billed charges,35.67% of total billed charges,19.43,60.3,
COMB,27002809,CDM,270,RC,,,outpatient,,,10,4.00,,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,7.7,77,,6.16,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,8.2,82,,6.56,percent of total billed charges,82% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,9,90,,7.2,percent of total billed charges,90% of total billed charges,8,80,,6.4,percent of total billed charges,80% of total billed charges,9,90,,7.2,percent of total billed charges,90% of total billed charges,7.5,75,,6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.9,29,,2.32,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,6.7,67,,5.36,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,8,80,,6.4,percent of total billed charges,80% of total billed charges,6.5,65,,5.2,percent of total billed charges,65% of total billed charges,3.57,35.67,,2.856,percent of total billed charges,35.67% of total billed charges,2.9,9,
DADDY SCRUB PACK SET,27002810,CDM,270,RC,,,outpatient,,,90,36.00,,76.5,85,,61.2,percent of total billed charges,85% of total billed charges,69.3,77,,55.44,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,73.8,82,,59.04,percent of total billed charges,82% of total billed charges,76.5,85,,61.2,percent of total billed charges,85% of total billed charges,76.5,85,,61.2,percent of total billed charges,85% of total billed charges,76.5,85,,61.2,percent of total billed charges,85% of total billed charges,81,90,,64.8,percent of total billed charges,90% of total billed charges,72,80,,57.6,percent of total billed charges,80% of total billed charges,81,90,,64.8,percent of total billed charges,90% of total billed charges,67.5,75,,54,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,26.1,29,,20.88,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,60.3,67,,48.24,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,72,80,,57.6,percent of total billed charges,80% of total billed charges,58.5,65,,46.8,percent of total billed charges,65% of total billed charges,32.1,35.67,,25.68,percent of total billed charges,35.67% of total billed charges,26.1,81,
NEEDLE HUBER 19G 3/4,27002863,CDM,270,RC,,,outpatient,,,55,22.00,,46.75,85,,37.4,percent of total billed charges,85% of total billed charges,42.35,77,,33.88,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,45.1,82,,36.08,percent of total billed charges,82% of total billed charges,46.75,85,,37.4,percent of total billed charges,85% of total billed charges,46.75,85,,37.4,percent of total billed charges,85% of total billed charges,46.75,85,,37.4,percent of total billed charges,85% of total billed charges,49.5,90,,39.6,percent of total billed charges,90% of total billed charges,44,80,,35.2,percent of total billed charges,80% of total billed charges,49.5,90,,39.6,percent of total billed charges,90% of total billed charges,41.25,75,,33,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,15.95,29,,12.76,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,36.85,67,,29.48,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,44,80,,35.2,percent of total billed charges,80% of total billed charges,35.75,65,,28.6,percent of total billed charges,65% of total billed charges,19.62,35.67,,15.696,percent of total billed charges,35.67% of total billed charges,15.95,49.5,
SAFELINE CLIP CANNULA,27002868,CDM,270,RC,,,outpatient,,,12,4.80,,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,9.24,77,,7.39,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,9.84,82,,7.872,percent of total billed charges,82% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,10.8,90,,8.64,percent of total billed charges,90% of total billed charges,9.6,80,,7.68,percent of total billed charges,80% of total billed charges,10.8,90,,8.64,percent of total billed charges,90% of total billed charges,9,75,,7.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,3.48,29,,2.784,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,8.04,67,,6.432,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,9.6,80,,7.68,percent of total billed charges,80% of total billed charges,7.8,65,,6.24,percent of total billed charges,65% of total billed charges,4.28,35.67,,3.424,percent of total billed charges,35.67% of total billed charges,3.48,10.8,
ULTRASITE VALVE **,27002872,CDM,270,RC,,,outpatient,,,13,5.20,,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,10.01,77,,8.01,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,10.66,82,,8.528,percent of total billed charges,82% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,11.7,90,,9.36,percent of total billed charges,90% of total billed charges,10.4,80,,8.32,percent of total billed charges,80% of total billed charges,11.7,90,,9.36,percent of total billed charges,90% of total billed charges,9.75,75,,7.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,3.77,29,,3.016,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,8.71,67,,6.968,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,10.4,80,,8.32,percent of total billed charges,80% of total billed charges,8.45,65,,6.76,percent of total billed charges,65% of total billed charges,4.64,35.67,,3.712,percent of total billed charges,35.67% of total billed charges,3.77,11.7,
SOOTHIE NEWBORN PACIFIER **,27002904,CDM,270,RC,,,outpatient,,,13,5.20,,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,10.01,77,,8.01,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,10.66,82,,8.528,percent of total billed charges,82% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,11.7,90,,9.36,percent of total billed charges,90% of total billed charges,10.4,80,,8.32,percent of total billed charges,80% of total billed charges,11.7,90,,9.36,percent of total billed charges,90% of total billed charges,9.75,75,,7.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,3.77,29,,3.016,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,8.71,67,,6.968,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,10.4,80,,8.32,percent of total billed charges,80% of total billed charges,8.45,65,,6.76,percent of total billed charges,65% of total billed charges,4.64,35.67,,3.712,percent of total billed charges,35.67% of total billed charges,3.77,11.7,
PACING ELECTRODE PEDI,27002918,CDM,270,RC,,,outpatient,,,269,107.60,,228.65,85,,182.92,percent of total billed charges,85% of total billed charges,207.13,77,,165.7,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,220.58,82,,176.464,percent of total billed charges,82% of total billed charges,228.65,85,,182.92,percent of total billed charges,85% of total billed charges,228.65,85,,182.92,percent of total billed charges,85% of total billed charges,228.65,85,,182.92,percent of total billed charges,85% of total billed charges,242.1,90,,193.68,percent of total billed charges,90% of total billed charges,215.2,80,,172.16,percent of total billed charges,80% of total billed charges,242.1,90,,193.68,percent of total billed charges,90% of total billed charges,201.75,75,,161.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,78.01,29,,62.408,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,180.23,67,,144.184,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,215.2,80,,172.16,percent of total billed charges,80% of total billed charges,174.85,65,,139.88,percent of total billed charges,65% of total billed charges,95.95,35.67,,76.76,percent of total billed charges,35.67% of total billed charges,78.01,242.1,
DURA STEPPER WALKER SM,27002953,CDM,270,RC,,,outpatient,,,328,131.20,,278.8,85,,223.04,percent of total billed charges,85% of total billed charges,252.56,77,,202.05,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,268.96,82,,215.168,percent of total billed charges,82% of total billed charges,278.8,85,,223.04,percent of total billed charges,85% of total billed charges,278.8,85,,223.04,percent of total billed charges,85% of total billed charges,278.8,85,,223.04,percent of total billed charges,85% of total billed charges,295.2,90,,236.16,percent of total billed charges,90% of total billed charges,262.4,80,,209.92,percent of total billed charges,80% of total billed charges,295.2,90,,236.16,percent of total billed charges,90% of total billed charges,246,75,,196.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,95.12,29,,76.096,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,219.76,67,,175.808,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,262.4,80,,209.92,percent of total billed charges,80% of total billed charges,213.2,65,,170.56,percent of total billed charges,65% of total billed charges,117,35.67,,93.6,percent of total billed charges,35.67% of total billed charges,95.12,295.2,
SPINAL NEEDLE 25G 5 1/2 **,27002968,CDM,270,RC,,,outpatient,,,16,6.40,,13.6,85,,10.88,percent of total billed charges,85% of total billed charges,12.32,77,,9.86,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,13.12,82,,10.496,percent of total billed charges,82% of total billed charges,13.6,85,,10.88,percent of total billed charges,85% of total billed charges,13.6,85,,10.88,percent of total billed charges,85% of total billed charges,13.6,85,,10.88,percent of total billed charges,85% of total billed charges,14.4,90,,11.52,percent of total billed charges,90% of total billed charges,12.8,80,,10.24,percent of total billed charges,80% of total billed charges,14.4,90,,11.52,percent of total billed charges,90% of total billed charges,12,75,,9.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,4.64,29,,3.712,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,10.72,67,,8.576,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,12.8,80,,10.24,percent of total billed charges,80% of total billed charges,10.4,65,,8.32,percent of total billed charges,65% of total billed charges,5.71,35.67,,4.568,percent of total billed charges,35.67% of total billed charges,4.64,14.4,
SUTURE MONOSOF 5-0 SM 1955,27002969,CDM,270,RC,,,outpatient,,,176,70.40,,149.6,85,,119.68,percent of total billed charges,85% of total billed charges,135.52,77,,108.42,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,144.32,82,,115.456,percent of total billed charges,82% of total billed charges,149.6,85,,119.68,percent of total billed charges,85% of total billed charges,149.6,85,,119.68,percent of total billed charges,85% of total billed charges,149.6,85,,119.68,percent of total billed charges,85% of total billed charges,158.4,90,,126.72,percent of total billed charges,90% of total billed charges,140.8,80,,112.64,percent of total billed charges,80% of total billed charges,158.4,90,,126.72,percent of total billed charges,90% of total billed charges,132,75,,105.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,51.04,29,,40.832,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,117.92,67,,94.336,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,140.8,80,,112.64,percent of total billed charges,80% of total billed charges,114.4,65,,91.52,percent of total billed charges,65% of total billed charges,62.78,35.67,,50.224,percent of total billed charges,35.67% of total billed charges,51.04,158.4,
QUIK-COMBO PEDI ELECTRODE,27002984,CDM,270,RC,,,outpatient,,,307,122.80,,260.95,85,,208.76,percent of total billed charges,85% of total billed charges,236.39,77,,189.11,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,251.74,82,,201.392,percent of total billed charges,82% of total billed charges,260.95,85,,208.76,percent of total billed charges,85% of total billed charges,260.95,85,,208.76,percent of total billed charges,85% of total billed charges,260.95,85,,208.76,percent of total billed charges,85% of total billed charges,276.3,90,,221.04,percent of total billed charges,90% of total billed charges,245.6,80,,196.48,percent of total billed charges,80% of total billed charges,276.3,90,,221.04,percent of total billed charges,90% of total billed charges,230.25,75,,184.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,89.03,29,,71.224,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,205.69,67,,164.552,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,245.6,80,,196.48,percent of total billed charges,80% of total billed charges,199.55,65,,159.64,percent of total billed charges,65% of total billed charges,109.51,35.67,,87.608,percent of total billed charges,35.67% of total billed charges,89.03,276.3,
FAST PATCH ELECTRODE ADULT,27002985,CDM,270,RC,,,outpatient,,,171,68.40,,145.35,85,,116.28,percent of total billed charges,85% of total billed charges,131.67,77,,105.34,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,140.22,82,,112.176,percent of total billed charges,82% of total billed charges,145.35,85,,116.28,percent of total billed charges,85% of total billed charges,145.35,85,,116.28,percent of total billed charges,85% of total billed charges,145.35,85,,116.28,percent of total billed charges,85% of total billed charges,153.9,90,,123.12,percent of total billed charges,90% of total billed charges,136.8,80,,109.44,percent of total billed charges,80% of total billed charges,153.9,90,,123.12,percent of total billed charges,90% of total billed charges,128.25,75,,102.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,49.59,29,,39.672,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,114.57,67,,91.656,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,136.8,80,,109.44,percent of total billed charges,80% of total billed charges,111.15,65,,88.92,percent of total billed charges,65% of total billed charges,61,35.67,,48.8,percent of total billed charges,35.67% of total billed charges,49.59,153.9,
POSEY FOOT ELEVATOR,27002998,CDM,270,RC,,,outpatient,,,154,61.60,,130.9,85,,104.72,percent of total billed charges,85% of total billed charges,118.58,77,,94.86,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,126.28,82,,101.024,percent of total billed charges,82% of total billed charges,130.9,85,,104.72,percent of total billed charges,85% of total billed charges,130.9,85,,104.72,percent of total billed charges,85% of total billed charges,130.9,85,,104.72,percent of total billed charges,85% of total billed charges,138.6,90,,110.88,percent of total billed charges,90% of total billed charges,123.2,80,,98.56,percent of total billed charges,80% of total billed charges,138.6,90,,110.88,percent of total billed charges,90% of total billed charges,115.5,75,,92.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,44.66,29,,35.728,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,103.18,67,,82.544,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,123.2,80,,98.56,percent of total billed charges,80% of total billed charges,100.1,65,,80.08,percent of total billed charges,65% of total billed charges,54.93,35.67,,43.944,percent of total billed charges,35.67% of total billed charges,44.66,138.6,
VENTILATOR ELBOW **,27003088,CDM,270,RC,,,outpatient,,,10,4.00,,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,7.7,77,,6.16,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,8.2,82,,6.56,percent of total billed charges,82% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,9,90,,7.2,percent of total billed charges,90% of total billed charges,8,80,,6.4,percent of total billed charges,80% of total billed charges,9,90,,7.2,percent of total billed charges,90% of total billed charges,7.5,75,,6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.9,29,,2.32,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,6.7,67,,5.36,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,8,80,,6.4,percent of total billed charges,80% of total billed charges,6.5,65,,5.2,percent of total billed charges,65% of total billed charges,3.57,35.67,,2.856,percent of total billed charges,35.67% of total billed charges,2.9,9,
VENTILATOR THERMOMETER **,27003089,CDM,270,RC,,,outpatient,,,13,5.20,,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,10.01,77,,8.01,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,10.66,82,,8.528,percent of total billed charges,82% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,11.7,90,,9.36,percent of total billed charges,90% of total billed charges,10.4,80,,8.32,percent of total billed charges,80% of total billed charges,11.7,90,,9.36,percent of total billed charges,90% of total billed charges,9.75,75,,7.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,3.77,29,,3.016,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,8.71,67,,6.968,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,10.4,80,,8.32,percent of total billed charges,80% of total billed charges,8.45,65,,6.76,percent of total billed charges,65% of total billed charges,4.64,35.67,,3.712,percent of total billed charges,35.67% of total billed charges,3.77,11.7,
VENTILATOR ELBOW **,27003092,CDM,270,RC,,,outpatient,,,10,4.00,,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,7.7,77,,6.16,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,8.2,82,,6.56,percent of total billed charges,82% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,9,90,,7.2,percent of total billed charges,90% of total billed charges,8,80,,6.4,percent of total billed charges,80% of total billed charges,9,90,,7.2,percent of total billed charges,90% of total billed charges,7.5,75,,6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.9,29,,2.32,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,6.7,67,,5.36,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,8,80,,6.4,percent of total billed charges,80% of total billed charges,6.5,65,,5.2,percent of total billed charges,65% of total billed charges,3.57,35.67,,2.856,percent of total billed charges,35.67% of total billed charges,2.9,9,
SUTURE SOFSILK 4.0,27003105,CDM,270,RC,,,outpatient,,,180,72.00,,153,85,,122.4,percent of total billed charges,85% of total billed charges,138.6,77,,110.88,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,147.6,82,,118.08,percent of total billed charges,82% of total billed charges,153,85,,122.4,percent of total billed charges,85% of total billed charges,153,85,,122.4,percent of total billed charges,85% of total billed charges,153,85,,122.4,percent of total billed charges,85% of total billed charges,162,90,,129.6,percent of total billed charges,90% of total billed charges,144,80,,115.2,percent of total billed charges,80% of total billed charges,162,90,,129.6,percent of total billed charges,90% of total billed charges,135,75,,108,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,52.2,29,,41.76,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,120.6,67,,96.48,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,144,80,,115.2,percent of total billed charges,80% of total billed charges,117,65,,93.6,percent of total billed charges,65% of total billed charges,64.21,35.67,,51.368,percent of total billed charges,35.67% of total billed charges,52.2,162,
AMBU BAG NEONATAL,27003109,CDM,270,RC,,,outpatient,,,98,39.20,,83.3,85,,66.64,percent of total billed charges,85% of total billed charges,75.46,77,,60.37,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,80.36,82,,64.288,percent of total billed charges,82% of total billed charges,83.3,85,,66.64,percent of total billed charges,85% of total billed charges,83.3,85,,66.64,percent of total billed charges,85% of total billed charges,83.3,85,,66.64,percent of total billed charges,85% of total billed charges,88.2,90,,70.56,percent of total billed charges,90% of total billed charges,78.4,80,,62.72,percent of total billed charges,80% of total billed charges,88.2,90,,70.56,percent of total billed charges,90% of total billed charges,73.5,75,,58.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,28.42,29,,22.736,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,65.66,67,,52.528,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,78.4,80,,62.72,percent of total billed charges,80% of total billed charges,63.7,65,,50.96,percent of total billed charges,65% of total billed charges,34.96,35.67,,27.968,percent of total billed charges,35.67% of total billed charges,28.42,88.2,
HEAD IMMOBILIZER,27003141,CDM,270,RC,,,outpatient,,,95,38.00,,80.75,85,,64.6,percent of total billed charges,85% of total billed charges,73.15,77,,58.52,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,77.9,82,,62.32,percent of total billed charges,82% of total billed charges,80.75,85,,64.6,percent of total billed charges,85% of total billed charges,80.75,85,,64.6,percent of total billed charges,85% of total billed charges,80.75,85,,64.6,percent of total billed charges,85% of total billed charges,85.5,90,,68.4,percent of total billed charges,90% of total billed charges,76,80,,60.8,percent of total billed charges,80% of total billed charges,85.5,90,,68.4,percent of total billed charges,90% of total billed charges,71.25,75,,57,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,27.55,29,,22.04,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,63.65,67,,50.92,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,76,80,,60.8,percent of total billed charges,80% of total billed charges,61.75,65,,49.4,percent of total billed charges,65% of total billed charges,33.89,35.67,,27.112,percent of total billed charges,35.67% of total billed charges,27.55,85.5,
QUIK CONNECT SPIRAL OB,27003168,CDM,270,RC,,,outpatient,,,43,17.20,,36.55,85,,29.24,percent of total billed charges,85% of total billed charges,33.11,77,,26.49,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,35.26,82,,28.208,percent of total billed charges,82% of total billed charges,36.55,85,,29.24,percent of total billed charges,85% of total billed charges,36.55,85,,29.24,percent of total billed charges,85% of total billed charges,36.55,85,,29.24,percent of total billed charges,85% of total billed charges,38.7,90,,30.96,percent of total billed charges,90% of total billed charges,34.4,80,,27.52,percent of total billed charges,80% of total billed charges,38.7,90,,30.96,percent of total billed charges,90% of total billed charges,32.25,75,,25.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,12.47,29,,9.976,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,28.81,67,,23.048,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,34.4,80,,27.52,percent of total billed charges,80% of total billed charges,27.95,65,,22.36,percent of total billed charges,65% of total billed charges,15.34,35.67,,12.272,percent of total billed charges,35.67% of total billed charges,12.47,38.7,
ELECTRODE PAD OB,27003169,CDM,270,RC,,,outpatient,,,18,7.20,,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,13.86,77,,11.09,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,14.76,82,,11.808,percent of total billed charges,82% of total billed charges,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,16.2,90,,12.96,percent of total billed charges,90% of total billed charges,14.4,80,,11.52,percent of total billed charges,80% of total billed charges,16.2,90,,12.96,percent of total billed charges,90% of total billed charges,13.5,75,,10.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,5.22,29,,4.176,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,12.06,67,,9.648,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,14.4,80,,11.52,percent of total billed charges,80% of total billed charges,11.7,65,,9.36,percent of total billed charges,65% of total billed charges,6.42,35.67,,5.136,percent of total billed charges,35.67% of total billed charges,5.22,16.2,
STAINLESS STEEL ELECTRODE **,27003171,CDM,270,RC,,,outpatient,,,132,52.80,,112.2,85,,89.76,percent of total billed charges,85% of total billed charges,101.64,77,,81.31,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,108.24,82,,86.592,percent of total billed charges,82% of total billed charges,112.2,85,,89.76,percent of total billed charges,85% of total billed charges,112.2,85,,89.76,percent of total billed charges,85% of total billed charges,112.2,85,,89.76,percent of total billed charges,85% of total billed charges,118.8,90,,95.04,percent of total billed charges,90% of total billed charges,105.6,80,,84.48,percent of total billed charges,80% of total billed charges,118.8,90,,95.04,percent of total billed charges,90% of total billed charges,99,75,,79.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,38.28,29,,30.624,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,88.44,67,,70.752,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,105.6,80,,84.48,percent of total billed charges,80% of total billed charges,85.8,65,,68.64,percent of total billed charges,65% of total billed charges,47.08,35.67,,37.664,percent of total billed charges,35.67% of total billed charges,38.28,118.8,
BIOSYN 1-0 SUTURE,27003181,CDM,270,RC,,,outpatient,,,121,48.40,,102.85,85,,82.28,percent of total billed charges,85% of total billed charges,93.17,77,,74.54,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,99.22,82,,79.376,percent of total billed charges,82% of total billed charges,102.85,85,,82.28,percent of total billed charges,85% of total billed charges,102.85,85,,82.28,percent of total billed charges,85% of total billed charges,102.85,85,,82.28,percent of total billed charges,85% of total billed charges,108.9,90,,87.12,percent of total billed charges,90% of total billed charges,96.8,80,,77.44,percent of total billed charges,80% of total billed charges,108.9,90,,87.12,percent of total billed charges,90% of total billed charges,90.75,75,,72.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,35.09,29,,28.072,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,81.07,67,,64.856,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,96.8,80,,77.44,percent of total billed charges,80% of total billed charges,78.65,65,,62.92,percent of total billed charges,65% of total billed charges,43.16,35.67,,34.528,percent of total billed charges,35.67% of total billed charges,35.09,108.9,
COLLECTION SET TUBING,27003204,CDM,270,RC,,,outpatient,,,93,37.20,,79.05,85,,63.24,percent of total billed charges,85% of total billed charges,71.61,77,,57.29,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,76.26,82,,61.008,percent of total billed charges,82% of total billed charges,79.05,85,,63.24,percent of total billed charges,85% of total billed charges,79.05,85,,63.24,percent of total billed charges,85% of total billed charges,79.05,85,,63.24,percent of total billed charges,85% of total billed charges,83.7,90,,66.96,percent of total billed charges,90% of total billed charges,74.4,80,,59.52,percent of total billed charges,80% of total billed charges,83.7,90,,66.96,percent of total billed charges,90% of total billed charges,69.75,75,,55.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,26.97,29,,21.576,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,62.31,67,,49.848,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,74.4,80,,59.52,percent of total billed charges,80% of total billed charges,60.45,65,,48.36,percent of total billed charges,65% of total billed charges,33.17,35.67,,26.536,percent of total billed charges,35.67% of total billed charges,26.97,83.7,
VACURETTE CURVED 8MM,27003206,CDM,270,RC,,,outpatient,,,58,23.20,,49.3,85,,39.44,percent of total billed charges,85% of total billed charges,44.66,77,,35.73,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,47.56,82,,38.048,percent of total billed charges,82% of total billed charges,49.3,85,,39.44,percent of total billed charges,85% of total billed charges,49.3,85,,39.44,percent of total billed charges,85% of total billed charges,49.3,85,,39.44,percent of total billed charges,85% of total billed charges,52.2,90,,41.76,percent of total billed charges,90% of total billed charges,46.4,80,,37.12,percent of total billed charges,80% of total billed charges,52.2,90,,41.76,percent of total billed charges,90% of total billed charges,43.5,75,,34.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,16.82,29,,13.456,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,38.86,67,,31.088,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,46.4,80,,37.12,percent of total billed charges,80% of total billed charges,37.7,65,,30.16,percent of total billed charges,65% of total billed charges,20.69,35.67,,16.552,percent of total billed charges,35.67% of total billed charges,16.82,52.2,
VACURETTE CURVED 9MM,27003207,CDM,270,RC,,,outpatient,,,59,23.60,,50.15,85,,40.12,percent of total billed charges,85% of total billed charges,45.43,77,,36.34,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,48.38,82,,38.704,percent of total billed charges,82% of total billed charges,50.15,85,,40.12,percent of total billed charges,85% of total billed charges,50.15,85,,40.12,percent of total billed charges,85% of total billed charges,50.15,85,,40.12,percent of total billed charges,85% of total billed charges,53.1,90,,42.48,percent of total billed charges,90% of total billed charges,47.2,80,,37.76,percent of total billed charges,80% of total billed charges,53.1,90,,42.48,percent of total billed charges,90% of total billed charges,44.25,75,,35.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,17.11,29,,13.688,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,39.53,67,,31.624,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,47.2,80,,37.76,percent of total billed charges,80% of total billed charges,38.35,65,,30.68,percent of total billed charges,65% of total billed charges,21.05,35.67,,16.84,percent of total billed charges,35.67% of total billed charges,17.11,53.1,
VACURETTE CURVED 10 MM,27003208,CDM,270,RC,,,outpatient,,,58,23.20,,49.3,85,,39.44,percent of total billed charges,85% of total billed charges,44.66,77,,35.73,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,47.56,82,,38.048,percent of total billed charges,82% of total billed charges,49.3,85,,39.44,percent of total billed charges,85% of total billed charges,49.3,85,,39.44,percent of total billed charges,85% of total billed charges,49.3,85,,39.44,percent of total billed charges,85% of total billed charges,52.2,90,,41.76,percent of total billed charges,90% of total billed charges,46.4,80,,37.12,percent of total billed charges,80% of total billed charges,52.2,90,,41.76,percent of total billed charges,90% of total billed charges,43.5,75,,34.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,16.82,29,,13.456,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,38.86,67,,31.088,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,46.4,80,,37.12,percent of total billed charges,80% of total billed charges,37.7,65,,30.16,percent of total billed charges,65% of total billed charges,20.69,35.67,,16.552,percent of total billed charges,35.67% of total billed charges,16.82,52.2,
SPLIT DRAPE SHEET **,27003237,CDM,270,RC,,,outpatient,,,23,9.20,,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,17.71,77,,14.17,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,18.86,82,,15.088,percent of total billed charges,82% of total billed charges,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,20.7,90,,16.56,percent of total billed charges,90% of total billed charges,18.4,80,,14.72,percent of total billed charges,80% of total billed charges,20.7,90,,16.56,percent of total billed charges,90% of total billed charges,17.25,75,,13.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,6.67,29,,5.336,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,15.41,67,,12.328,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,18.4,80,,14.72,percent of total billed charges,80% of total billed charges,14.95,65,,11.96,percent of total billed charges,65% of total billed charges,8.2,35.67,,6.56,percent of total billed charges,35.67% of total billed charges,6.67,20.7,
INTRAUTERINE CATH SYSTEM,27003251,CDM,270,RC,,,outpatient,,,271,108.40,,230.35,85,,184.28,percent of total billed charges,85% of total billed charges,208.67,77,,166.94,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,222.22,82,,177.776,percent of total billed charges,82% of total billed charges,230.35,85,,184.28,percent of total billed charges,85% of total billed charges,230.35,85,,184.28,percent of total billed charges,85% of total billed charges,230.35,85,,184.28,percent of total billed charges,85% of total billed charges,243.9,90,,195.12,percent of total billed charges,90% of total billed charges,216.8,80,,173.44,percent of total billed charges,80% of total billed charges,243.9,90,,195.12,percent of total billed charges,90% of total billed charges,203.25,75,,162.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,78.59,29,,62.872,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,181.57,67,,145.256,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,216.8,80,,173.44,percent of total billed charges,80% of total billed charges,176.15,65,,140.92,percent of total billed charges,65% of total billed charges,96.67,35.67,,77.336,percent of total billed charges,35.67% of total billed charges,78.59,243.9,
LAPAROTOMY PACK W/POUCH,27003293,CDM,270,RC,,,outpatient,,,147,58.80,,124.95,85,,99.96,percent of total billed charges,85% of total billed charges,113.19,77,,90.55,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,120.54,82,,96.432,percent of total billed charges,82% of total billed charges,124.95,85,,99.96,percent of total billed charges,85% of total billed charges,124.95,85,,99.96,percent of total billed charges,85% of total billed charges,124.95,85,,99.96,percent of total billed charges,85% of total billed charges,132.3,90,,105.84,percent of total billed charges,90% of total billed charges,117.6,80,,94.08,percent of total billed charges,80% of total billed charges,132.3,90,,105.84,percent of total billed charges,90% of total billed charges,110.25,75,,88.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,42.63,29,,34.104,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,98.49,67,,78.792,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,117.6,80,,94.08,percent of total billed charges,80% of total billed charges,95.55,65,,76.44,percent of total billed charges,65% of total billed charges,52.43,35.67,,41.944,percent of total billed charges,35.67% of total billed charges,42.63,132.3,
SUPPORTER SCROTAL SMALL,27003296,CDM,270,RC,,,outpatient,,,66,26.40,,56.1,85,,44.88,percent of total billed charges,85% of total billed charges,50.82,77,,40.66,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,54.12,82,,43.296,percent of total billed charges,82% of total billed charges,56.1,85,,44.88,percent of total billed charges,85% of total billed charges,56.1,85,,44.88,percent of total billed charges,85% of total billed charges,56.1,85,,44.88,percent of total billed charges,85% of total billed charges,59.4,90,,47.52,percent of total billed charges,90% of total billed charges,52.8,80,,42.24,percent of total billed charges,80% of total billed charges,59.4,90,,47.52,percent of total billed charges,90% of total billed charges,49.5,75,,39.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,19.14,29,,15.312,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,44.22,67,,35.376,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,52.8,80,,42.24,percent of total billed charges,80% of total billed charges,42.9,65,,34.32,percent of total billed charges,65% of total billed charges,23.54,35.67,,18.832,percent of total billed charges,35.67% of total billed charges,19.14,59.4,
SUPPORTER SCROTAL MED,27003297,CDM,270,RC,,,outpatient,,,70,28.00,,59.5,85,,47.6,percent of total billed charges,85% of total billed charges,53.9,77,,43.12,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,57.4,82,,45.92,percent of total billed charges,82% of total billed charges,59.5,85,,47.6,percent of total billed charges,85% of total billed charges,59.5,85,,47.6,percent of total billed charges,85% of total billed charges,59.5,85,,47.6,percent of total billed charges,85% of total billed charges,63,90,,50.4,percent of total billed charges,90% of total billed charges,56,80,,44.8,percent of total billed charges,80% of total billed charges,63,90,,50.4,percent of total billed charges,90% of total billed charges,52.5,75,,42,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,20.3,29,,16.24,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,46.9,67,,37.52,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,56,80,,44.8,percent of total billed charges,80% of total billed charges,45.5,65,,36.4,percent of total billed charges,65% of total billed charges,24.97,35.67,,19.976,percent of total billed charges,35.67% of total billed charges,20.3,63,
SUPPORTER SCROTAL LARGE,27003298,CDM,270,RC,,,outpatient,,,73,29.20,,62.05,85,,49.64,percent of total billed charges,85% of total billed charges,56.21,77,,44.97,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,59.86,82,,47.888,percent of total billed charges,82% of total billed charges,62.05,85,,49.64,percent of total billed charges,85% of total billed charges,62.05,85,,49.64,percent of total billed charges,85% of total billed charges,62.05,85,,49.64,percent of total billed charges,85% of total billed charges,65.7,90,,52.56,percent of total billed charges,90% of total billed charges,58.4,80,,46.72,percent of total billed charges,80% of total billed charges,65.7,90,,52.56,percent of total billed charges,90% of total billed charges,54.75,75,,43.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,21.17,29,,16.936,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,48.91,67,,39.128,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,58.4,80,,46.72,percent of total billed charges,80% of total billed charges,47.45,65,,37.96,percent of total billed charges,65% of total billed charges,26.04,35.67,,20.832,percent of total billed charges,35.67% of total billed charges,21.17,65.7,
TUBING INSUFLOW **,27003303,CDM,270,RC,,,outpatient,,,842,336.80,,715.7,85,,572.56,percent of total billed charges,85% of total billed charges,648.34,77,,518.67,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,690.44,82,,552.352,percent of total billed charges,82% of total billed charges,715.7,85,,572.56,percent of total billed charges,85% of total billed charges,715.7,85,,572.56,percent of total billed charges,85% of total billed charges,715.7,85,,572.56,percent of total billed charges,85% of total billed charges,757.8,90,,606.24,percent of total billed charges,90% of total billed charges,673.6,80,,538.88,percent of total billed charges,80% of total billed charges,757.8,90,,606.24,percent of total billed charges,90% of total billed charges,631.5,75,,505.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,244.18,29,,195.344,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,564.14,67,,451.312,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,673.6,80,,538.88,percent of total billed charges,80% of total billed charges,547.3,65,,437.84,percent of total billed charges,65% of total billed charges,300.34,35.67,,240.272,percent of total billed charges,35.67% of total billed charges,244.18,757.8,
DERMABOND PROPEN,27003309,CDM,270,RC,,,outpatient,,,194,77.60,,164.9,85,,131.92,percent of total billed charges,85% of total billed charges,149.38,77,,119.5,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,159.08,82,,127.264,percent of total billed charges,82% of total billed charges,164.9,85,,131.92,percent of total billed charges,85% of total billed charges,164.9,85,,131.92,percent of total billed charges,85% of total billed charges,164.9,85,,131.92,percent of total billed charges,85% of total billed charges,174.6,90,,139.68,percent of total billed charges,90% of total billed charges,155.2,80,,124.16,percent of total billed charges,80% of total billed charges,174.6,90,,139.68,percent of total billed charges,90% of total billed charges,145.5,75,,116.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,56.26,29,,45.008,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,129.98,67,,103.984,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,155.2,80,,124.16,percent of total billed charges,80% of total billed charges,126.1,65,,100.88,percent of total billed charges,65% of total billed charges,69.2,35.67,,55.36,percent of total billed charges,35.67% of total billed charges,56.26,174.6,
CURASORB DRESSING 4X4 **,27003315,CDM,270,RC,,,outpatient,,,40,16.00,,34,85,,27.2,percent of total billed charges,85% of total billed charges,30.8,77,,24.64,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,32.8,82,,26.24,percent of total billed charges,82% of total billed charges,34,85,,27.2,percent of total billed charges,85% of total billed charges,34,85,,27.2,percent of total billed charges,85% of total billed charges,34,85,,27.2,percent of total billed charges,85% of total billed charges,36,90,,28.8,percent of total billed charges,90% of total billed charges,32,80,,25.6,percent of total billed charges,80% of total billed charges,36,90,,28.8,percent of total billed charges,90% of total billed charges,30,75,,24,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,11.6,29,,9.28,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,26.8,67,,21.44,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,32,80,,25.6,percent of total billed charges,80% of total billed charges,26,65,,20.8,percent of total billed charges,65% of total billed charges,14.27,35.67,,11.416,percent of total billed charges,35.67% of total billed charges,11.6,36,
TECHNI-CARE SCRUB 4 OZ,27003322,CDM,270,RC,,,outpatient,,,44,17.60,,37.4,85,,29.92,percent of total billed charges,85% of total billed charges,33.88,77,,27.1,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,36.08,82,,28.864,percent of total billed charges,82% of total billed charges,37.4,85,,29.92,percent of total billed charges,85% of total billed charges,37.4,85,,29.92,percent of total billed charges,85% of total billed charges,37.4,85,,29.92,percent of total billed charges,85% of total billed charges,39.6,90,,31.68,percent of total billed charges,90% of total billed charges,35.2,80,,28.16,percent of total billed charges,80% of total billed charges,39.6,90,,31.68,percent of total billed charges,90% of total billed charges,33,75,,26.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,12.76,29,,10.208,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,29.48,67,,23.584,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,35.2,80,,28.16,percent of total billed charges,80% of total billed charges,28.6,65,,22.88,percent of total billed charges,65% of total billed charges,15.69,35.67,,12.552,percent of total billed charges,35.67% of total billed charges,12.76,39.6,
SCRUB BRUSH TECHNI-CARE **,27003323,CDM,270,RC,,,outpatient,,,14,5.60,,11.9,85,,9.52,percent of total billed charges,85% of total billed charges,10.78,77,,8.62,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,11.48,82,,9.184,percent of total billed charges,82% of total billed charges,11.9,85,,9.52,percent of total billed charges,85% of total billed charges,11.9,85,,9.52,percent of total billed charges,85% of total billed charges,11.9,85,,9.52,percent of total billed charges,85% of total billed charges,12.6,90,,10.08,percent of total billed charges,90% of total billed charges,11.2,80,,8.96,percent of total billed charges,80% of total billed charges,12.6,90,,10.08,percent of total billed charges,90% of total billed charges,10.5,75,,8.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,4.06,29,,3.248,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,9.38,67,,7.504,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,11.2,80,,8.96,percent of total billed charges,80% of total billed charges,9.1,65,,7.28,percent of total billed charges,65% of total billed charges,4.99,35.67,,3.992,percent of total billed charges,35.67% of total billed charges,4.06,12.6,
KNEE COVERS  - PURPLE,27003325,CDM,270,RC,,,outpatient,,,70,28.00,,59.5,85,,47.6,percent of total billed charges,85% of total billed charges,53.9,77,,43.12,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,57.4,82,,45.92,percent of total billed charges,82% of total billed charges,59.5,85,,47.6,percent of total billed charges,85% of total billed charges,59.5,85,,47.6,percent of total billed charges,85% of total billed charges,59.5,85,,47.6,percent of total billed charges,85% of total billed charges,63,90,,50.4,percent of total billed charges,90% of total billed charges,56,80,,44.8,percent of total billed charges,80% of total billed charges,63,90,,50.4,percent of total billed charges,90% of total billed charges,52.5,75,,42,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,20.3,29,,16.24,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,46.9,67,,37.52,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,56,80,,44.8,percent of total billed charges,80% of total billed charges,45.5,65,,36.4,percent of total billed charges,65% of total billed charges,24.97,35.67,,19.976,percent of total billed charges,35.67% of total billed charges,20.3,63,
PREMIUM PLUS STAPLER CEEA 25,27003328,CDM,270,RC,,,outpatient,,,6148,2459.20,,5225.8,85,,4180.64,percent of total billed charges,85% of total billed charges,4733.96,77,,3787.17,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,5041.36,82,,4033.088,percent of total billed charges,82% of total billed charges,5225.8,85,,4180.64,percent of total billed charges,85% of total billed charges,5225.8,85,,4180.64,percent of total billed charges,85% of total billed charges,5225.8,85,,4180.64,percent of total billed charges,85% of total billed charges,5533.2,90,,4426.56,percent of total billed charges,90% of total billed charges,4918.4,80,,3934.72,percent of total billed charges,80% of total billed charges,5533.2,90,,4426.56,percent of total billed charges,90% of total billed charges,4611,75,,3688.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,1782.92,29,,1426.336,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4119.16,67,,3295.328,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,4918.4,80,,3934.72,percent of total billed charges,80% of total billed charges,3996.2,65,,3196.96,percent of total billed charges,65% of total billed charges,2192.99,35.67,,1754.392,percent of total billed charges,35.67% of total billed charges,1782.92,5533.2,
ADULT CANNULA FOR OR,27003331,CDM,270,RC,,,outpatient,,,62,24.80,,52.7,85,,42.16,percent of total billed charges,85% of total billed charges,47.74,77,,38.19,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,50.84,82,,40.672,percent of total billed charges,82% of total billed charges,52.7,85,,42.16,percent of total billed charges,85% of total billed charges,52.7,85,,42.16,percent of total billed charges,85% of total billed charges,52.7,85,,42.16,percent of total billed charges,85% of total billed charges,55.8,90,,44.64,percent of total billed charges,90% of total billed charges,49.6,80,,39.68,percent of total billed charges,80% of total billed charges,55.8,90,,44.64,percent of total billed charges,90% of total billed charges,46.5,75,,37.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,17.98,29,,14.384,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,41.54,67,,33.232,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,49.6,80,,39.68,percent of total billed charges,80% of total billed charges,40.3,65,,32.24,percent of total billed charges,65% of total billed charges,22.12,35.67,,17.696,percent of total billed charges,35.67% of total billed charges,17.98,55.8,
BIS SENSOR PEDI,27003334,CDM,270,RC,,,outpatient,,,226,90.40,,192.1,85,,153.68,percent of total billed charges,85% of total billed charges,174.02,77,,139.22,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,185.32,82,,148.256,percent of total billed charges,82% of total billed charges,192.1,85,,153.68,percent of total billed charges,85% of total billed charges,192.1,85,,153.68,percent of total billed charges,85% of total billed charges,192.1,85,,153.68,percent of total billed charges,85% of total billed charges,203.4,90,,162.72,percent of total billed charges,90% of total billed charges,180.8,80,,144.64,percent of total billed charges,80% of total billed charges,203.4,90,,162.72,percent of total billed charges,90% of total billed charges,169.5,75,,135.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,65.54,29,,52.432,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,151.42,67,,121.136,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,180.8,80,,144.64,percent of total billed charges,80% of total billed charges,146.9,65,,117.52,percent of total billed charges,65% of total billed charges,80.61,35.67,,64.488,percent of total billed charges,35.67% of total billed charges,65.54,203.4,
PULSE OXIMETER FLEXIFORM PEDI,27003337,CDM,270,RC,,,outpatient,,,142,56.80,,120.7,85,,96.56,percent of total billed charges,85% of total billed charges,109.34,77,,87.47,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,116.44,82,,93.152,percent of total billed charges,82% of total billed charges,120.7,85,,96.56,percent of total billed charges,85% of total billed charges,120.7,85,,96.56,percent of total billed charges,85% of total billed charges,120.7,85,,96.56,percent of total billed charges,85% of total billed charges,127.8,90,,102.24,percent of total billed charges,90% of total billed charges,113.6,80,,90.88,percent of total billed charges,80% of total billed charges,127.8,90,,102.24,percent of total billed charges,90% of total billed charges,106.5,75,,85.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,41.18,29,,32.944,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,95.14,67,,76.112,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,113.6,80,,90.88,percent of total billed charges,80% of total billed charges,92.3,65,,73.84,percent of total billed charges,65% of total billed charges,50.65,35.67,,40.52,percent of total billed charges,35.67% of total billed charges,41.18,127.8,
JURGAN PIN BALLS 3MM,27003338,CDM,270,RC,,,outpatient,,,274,109.60,,232.9,85,,186.32,percent of total billed charges,85% of total billed charges,210.98,77,,168.78,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,224.68,82,,179.744,percent of total billed charges,82% of total billed charges,232.9,85,,186.32,percent of total billed charges,85% of total billed charges,232.9,85,,186.32,percent of total billed charges,85% of total billed charges,232.9,85,,186.32,percent of total billed charges,85% of total billed charges,246.6,90,,197.28,percent of total billed charges,90% of total billed charges,219.2,80,,175.36,percent of total billed charges,80% of total billed charges,246.6,90,,197.28,percent of total billed charges,90% of total billed charges,205.5,75,,164.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,79.46,29,,63.568,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,183.58,67,,146.864,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,219.2,80,,175.36,percent of total billed charges,80% of total billed charges,178.1,65,,142.48,percent of total billed charges,65% of total billed charges,97.74,35.67,,78.192,percent of total billed charges,35.67% of total billed charges,79.46,246.6,
JURGAN PIN BALL 4MM,27003339,CDM,270,RC,,,outpatient,,,274,109.60,,232.9,85,,186.32,percent of total billed charges,85% of total billed charges,210.98,77,,168.78,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,224.68,82,,179.744,percent of total billed charges,82% of total billed charges,232.9,85,,186.32,percent of total billed charges,85% of total billed charges,232.9,85,,186.32,percent of total billed charges,85% of total billed charges,232.9,85,,186.32,percent of total billed charges,85% of total billed charges,246.6,90,,197.28,percent of total billed charges,90% of total billed charges,219.2,80,,175.36,percent of total billed charges,80% of total billed charges,246.6,90,,197.28,percent of total billed charges,90% of total billed charges,205.5,75,,164.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,79.46,29,,63.568,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,183.58,67,,146.864,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,219.2,80,,175.36,percent of total billed charges,80% of total billed charges,178.1,65,,142.48,percent of total billed charges,65% of total billed charges,97.74,35.67,,78.192,percent of total billed charges,35.67% of total billed charges,79.46,246.6,
JURGAN PIN BALL 5 MM,27003340,CDM,270,RC,,,outpatient,,,274,109.60,,232.9,85,,186.32,percent of total billed charges,85% of total billed charges,210.98,77,,168.78,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,224.68,82,,179.744,percent of total billed charges,82% of total billed charges,232.9,85,,186.32,percent of total billed charges,85% of total billed charges,232.9,85,,186.32,percent of total billed charges,85% of total billed charges,232.9,85,,186.32,percent of total billed charges,85% of total billed charges,246.6,90,,197.28,percent of total billed charges,90% of total billed charges,219.2,80,,175.36,percent of total billed charges,80% of total billed charges,246.6,90,,197.28,percent of total billed charges,90% of total billed charges,205.5,75,,164.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,79.46,29,,63.568,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,183.58,67,,146.864,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,219.2,80,,175.36,percent of total billed charges,80% of total billed charges,178.1,65,,142.48,percent of total billed charges,65% of total billed charges,97.74,35.67,,78.192,percent of total billed charges,35.67% of total billed charges,79.46,246.6,
JURGAN PIN BALL 6MM,27003341,CDM,270,RC,,,outpatient,,,274,109.60,,232.9,85,,186.32,percent of total billed charges,85% of total billed charges,210.98,77,,168.78,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,224.68,82,,179.744,percent of total billed charges,82% of total billed charges,232.9,85,,186.32,percent of total billed charges,85% of total billed charges,232.9,85,,186.32,percent of total billed charges,85% of total billed charges,232.9,85,,186.32,percent of total billed charges,85% of total billed charges,246.6,90,,197.28,percent of total billed charges,90% of total billed charges,219.2,80,,175.36,percent of total billed charges,80% of total billed charges,246.6,90,,197.28,percent of total billed charges,90% of total billed charges,205.5,75,,164.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,79.46,29,,63.568,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,183.58,67,,146.864,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,219.2,80,,175.36,percent of total billed charges,80% of total billed charges,178.1,65,,142.48,percent of total billed charges,65% of total billed charges,97.74,35.67,,78.192,percent of total billed charges,35.67% of total billed charges,79.46,246.6,
JURGAN PIN BALL 1.1MM,27003342,CDM,270,RC,,,outpatient,,,274,109.60,,232.9,85,,186.32,percent of total billed charges,85% of total billed charges,210.98,77,,168.78,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,224.68,82,,179.744,percent of total billed charges,82% of total billed charges,232.9,85,,186.32,percent of total billed charges,85% of total billed charges,232.9,85,,186.32,percent of total billed charges,85% of total billed charges,232.9,85,,186.32,percent of total billed charges,85% of total billed charges,246.6,90,,197.28,percent of total billed charges,90% of total billed charges,219.2,80,,175.36,percent of total billed charges,80% of total billed charges,246.6,90,,197.28,percent of total billed charges,90% of total billed charges,205.5,75,,164.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,79.46,29,,63.568,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,183.58,67,,146.864,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,219.2,80,,175.36,percent of total billed charges,80% of total billed charges,178.1,65,,142.48,percent of total billed charges,65% of total billed charges,97.74,35.67,,78.192,percent of total billed charges,35.67% of total billed charges,79.46,246.6,
JURGAN PIN BALL 1.6MM,27003343,CDM,270,RC,,,outpatient,,,274,109.60,,232.9,85,,186.32,percent of total billed charges,85% of total billed charges,210.98,77,,168.78,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,224.68,82,,179.744,percent of total billed charges,82% of total billed charges,232.9,85,,186.32,percent of total billed charges,85% of total billed charges,232.9,85,,186.32,percent of total billed charges,85% of total billed charges,232.9,85,,186.32,percent of total billed charges,85% of total billed charges,246.6,90,,197.28,percent of total billed charges,90% of total billed charges,219.2,80,,175.36,percent of total billed charges,80% of total billed charges,246.6,90,,197.28,percent of total billed charges,90% of total billed charges,205.5,75,,164.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,79.46,29,,63.568,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,183.58,67,,146.864,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,219.2,80,,175.36,percent of total billed charges,80% of total billed charges,178.1,65,,142.48,percent of total billed charges,65% of total billed charges,97.74,35.67,,78.192,percent of total billed charges,35.67% of total billed charges,79.46,246.6,
JURGAN PIN BALL 2MM,27003344,CDM,270,RC,,,outpatient,,,274,109.60,,232.9,85,,186.32,percent of total billed charges,85% of total billed charges,210.98,77,,168.78,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,224.68,82,,179.744,percent of total billed charges,82% of total billed charges,232.9,85,,186.32,percent of total billed charges,85% of total billed charges,232.9,85,,186.32,percent of total billed charges,85% of total billed charges,232.9,85,,186.32,percent of total billed charges,85% of total billed charges,246.6,90,,197.28,percent of total billed charges,90% of total billed charges,219.2,80,,175.36,percent of total billed charges,80% of total billed charges,246.6,90,,197.28,percent of total billed charges,90% of total billed charges,205.5,75,,164.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,79.46,29,,63.568,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,183.58,67,,146.864,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,219.2,80,,175.36,percent of total billed charges,80% of total billed charges,178.1,65,,142.48,percent of total billed charges,65% of total billed charges,97.74,35.67,,78.192,percent of total billed charges,35.67% of total billed charges,79.46,246.6,
JURGAN PIN BALL 2.5MM,27003345,CDM,270,RC,,,outpatient,,,277,110.80,,235.45,85,,188.36,percent of total billed charges,85% of total billed charges,213.29,77,,170.63,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,227.14,82,,181.712,percent of total billed charges,82% of total billed charges,235.45,85,,188.36,percent of total billed charges,85% of total billed charges,235.45,85,,188.36,percent of total billed charges,85% of total billed charges,235.45,85,,188.36,percent of total billed charges,85% of total billed charges,249.3,90,,199.44,percent of total billed charges,90% of total billed charges,221.6,80,,177.28,percent of total billed charges,80% of total billed charges,249.3,90,,199.44,percent of total billed charges,90% of total billed charges,207.75,75,,166.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,80.33,29,,64.264,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,185.59,67,,148.472,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,221.6,80,,177.28,percent of total billed charges,80% of total billed charges,180.05,65,,144.04,percent of total billed charges,65% of total billed charges,98.81,35.67,,79.048,percent of total billed charges,35.67% of total billed charges,80.33,249.3,
OXISENSOR FOR ICU,27003347,CDM,270,RC,,,outpatient,,,74,29.60,,62.9,85,,50.32,percent of total billed charges,85% of total billed charges,56.98,77,,45.58,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,60.68,82,,48.544,percent of total billed charges,82% of total billed charges,62.9,85,,50.32,percent of total billed charges,85% of total billed charges,62.9,85,,50.32,percent of total billed charges,85% of total billed charges,62.9,85,,50.32,percent of total billed charges,85% of total billed charges,66.6,90,,53.28,percent of total billed charges,90% of total billed charges,59.2,80,,47.36,percent of total billed charges,80% of total billed charges,66.6,90,,53.28,percent of total billed charges,90% of total billed charges,55.5,75,,44.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,21.46,29,,17.168,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,49.58,67,,39.664,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,59.2,80,,47.36,percent of total billed charges,80% of total billed charges,48.1,65,,38.48,percent of total billed charges,65% of total billed charges,26.4,35.67,,21.12,percent of total billed charges,35.67% of total billed charges,21.46,66.6,
CARE CUBE OXYGEN TENT **,27003349,CDM,270,RC,,,outpatient,,,204,81.60,,173.4,85,,138.72,percent of total billed charges,85% of total billed charges,157.08,77,,125.66,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,167.28,82,,133.824,percent of total billed charges,82% of total billed charges,173.4,85,,138.72,percent of total billed charges,85% of total billed charges,173.4,85,,138.72,percent of total billed charges,85% of total billed charges,173.4,85,,138.72,percent of total billed charges,85% of total billed charges,183.6,90,,146.88,percent of total billed charges,90% of total billed charges,163.2,80,,130.56,percent of total billed charges,80% of total billed charges,183.6,90,,146.88,percent of total billed charges,90% of total billed charges,153,75,,122.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,59.16,29,,47.328,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,136.68,67,,109.344,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,163.2,80,,130.56,percent of total billed charges,80% of total billed charges,132.6,65,,106.08,percent of total billed charges,65% of total billed charges,72.77,35.67,,58.216,percent of total billed charges,35.67% of total billed charges,59.16,183.6,
MONOSOF 5-0 SUTURE,27003355,CDM,270,RC,,,outpatient,,,154,61.60,,130.9,85,,104.72,percent of total billed charges,85% of total billed charges,118.58,77,,94.86,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,126.28,82,,101.024,percent of total billed charges,82% of total billed charges,130.9,85,,104.72,percent of total billed charges,85% of total billed charges,130.9,85,,104.72,percent of total billed charges,85% of total billed charges,130.9,85,,104.72,percent of total billed charges,85% of total billed charges,138.6,90,,110.88,percent of total billed charges,90% of total billed charges,123.2,80,,98.56,percent of total billed charges,80% of total billed charges,138.6,90,,110.88,percent of total billed charges,90% of total billed charges,115.5,75,,92.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,44.66,29,,35.728,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,103.18,67,,82.544,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,123.2,80,,98.56,percent of total billed charges,80% of total billed charges,100.1,65,,80.08,percent of total billed charges,65% of total billed charges,54.93,35.67,,43.944,percent of total billed charges,35.67% of total billed charges,44.66,138.6,
ROTICULATOR STAPLER,27003363,CDM,270,RC,,,outpatient,,,2886,1154.40,,2453.1,85,,1962.48,percent of total billed charges,85% of total billed charges,2222.22,77,,1777.78,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,2366.52,82,,1893.216,percent of total billed charges,82% of total billed charges,2453.1,85,,1962.48,percent of total billed charges,85% of total billed charges,2453.1,85,,1962.48,percent of total billed charges,85% of total billed charges,2453.1,85,,1962.48,percent of total billed charges,85% of total billed charges,2597.4,90,,2077.92,percent of total billed charges,90% of total billed charges,2308.8,80,,1847.04,percent of total billed charges,80% of total billed charges,2597.4,90,,2077.92,percent of total billed charges,90% of total billed charges,2164.5,75,,1731.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,836.94,29,,669.552,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1933.62,67,,1546.896,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,2308.8,80,,1847.04,percent of total billed charges,80% of total billed charges,1875.9,65,,1500.72,percent of total billed charges,65% of total billed charges,1029.44,35.67,,823.552,percent of total billed charges,35.67% of total billed charges,836.94,2597.4,
ROUND CUTTING BUR,27003375,CDM,270,RC,,,outpatient,,,238,95.20,,202.3,85,,161.84,percent of total billed charges,85% of total billed charges,183.26,77,,146.61,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,195.16,82,,156.128,percent of total billed charges,82% of total billed charges,202.3,85,,161.84,percent of total billed charges,85% of total billed charges,202.3,85,,161.84,percent of total billed charges,85% of total billed charges,202.3,85,,161.84,percent of total billed charges,85% of total billed charges,214.2,90,,171.36,percent of total billed charges,90% of total billed charges,190.4,80,,152.32,percent of total billed charges,80% of total billed charges,214.2,90,,171.36,percent of total billed charges,90% of total billed charges,178.5,75,,142.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,69.02,29,,55.216,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,159.46,67,,127.568,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,190.4,80,,152.32,percent of total billed charges,80% of total billed charges,154.7,65,,123.76,percent of total billed charges,65% of total billed charges,84.89,35.67,,67.912,percent of total billed charges,35.67% of total billed charges,69.02,214.2,
SAGITTAL SAW BLADE 6.9X19.8,27003376,CDM,270,RC,,,outpatient,,,93,37.20,,79.05,85,,63.24,percent of total billed charges,85% of total billed charges,71.61,77,,57.29,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,76.26,82,,61.008,percent of total billed charges,82% of total billed charges,79.05,85,,63.24,percent of total billed charges,85% of total billed charges,79.05,85,,63.24,percent of total billed charges,85% of total billed charges,79.05,85,,63.24,percent of total billed charges,85% of total billed charges,83.7,90,,66.96,percent of total billed charges,90% of total billed charges,74.4,80,,59.52,percent of total billed charges,80% of total billed charges,83.7,90,,66.96,percent of total billed charges,90% of total billed charges,69.75,75,,55.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,26.97,29,,21.576,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,62.31,67,,49.848,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,74.4,80,,59.52,percent of total billed charges,80% of total billed charges,60.45,65,,48.36,percent of total billed charges,65% of total billed charges,33.17,35.67,,26.536,percent of total billed charges,35.67% of total billed charges,26.97,83.7,
BABY BATH HEAD TO TOE,27003383,CDM,270,RC,,,outpatient,,,10,4.00,,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,7.7,77,,6.16,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,8.2,82,,6.56,percent of total billed charges,82% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,9,90,,7.2,percent of total billed charges,90% of total billed charges,8,80,,6.4,percent of total billed charges,80% of total billed charges,9,90,,7.2,percent of total billed charges,90% of total billed charges,7.5,75,,6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.9,29,,2.32,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,6.7,67,,5.36,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,8,80,,6.4,percent of total billed charges,80% of total billed charges,6.5,65,,5.2,percent of total billed charges,65% of total billed charges,3.57,35.67,,2.856,percent of total billed charges,35.67% of total billed charges,2.9,9,
SHANNON BUR BLADE 2.1MM,27003390,CDM,270,RC,,,outpatient,,,147,58.80,,124.95,85,,99.96,percent of total billed charges,85% of total billed charges,113.19,77,,90.55,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,120.54,82,,96.432,percent of total billed charges,82% of total billed charges,124.95,85,,99.96,percent of total billed charges,85% of total billed charges,124.95,85,,99.96,percent of total billed charges,85% of total billed charges,124.95,85,,99.96,percent of total billed charges,85% of total billed charges,132.3,90,,105.84,percent of total billed charges,90% of total billed charges,117.6,80,,94.08,percent of total billed charges,80% of total billed charges,132.3,90,,105.84,percent of total billed charges,90% of total billed charges,110.25,75,,88.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,42.63,29,,34.104,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,98.49,67,,78.792,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,117.6,80,,94.08,percent of total billed charges,80% of total billed charges,95.55,65,,76.44,percent of total billed charges,65% of total billed charges,52.43,35.67,,41.944,percent of total billed charges,35.67% of total billed charges,42.63,132.3,
WIRE PASS DRILL BUR,27003391,CDM,270,RC,,,outpatient,,,107,42.80,,90.95,85,,72.76,percent of total billed charges,85% of total billed charges,82.39,77,,65.91,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,87.74,82,,70.192,percent of total billed charges,82% of total billed charges,90.95,85,,72.76,percent of total billed charges,85% of total billed charges,90.95,85,,72.76,percent of total billed charges,85% of total billed charges,90.95,85,,72.76,percent of total billed charges,85% of total billed charges,96.3,90,,77.04,percent of total billed charges,90% of total billed charges,85.6,80,,68.48,percent of total billed charges,80% of total billed charges,96.3,90,,77.04,percent of total billed charges,90% of total billed charges,80.25,75,,64.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,31.03,29,,24.824,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,71.69,67,,57.352,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,85.6,80,,68.48,percent of total billed charges,80% of total billed charges,69.55,65,,55.64,percent of total billed charges,65% of total billed charges,38.17,35.67,,30.536,percent of total billed charges,35.67% of total billed charges,31.03,96.3,
SURGIPRO 6-0 SUTURE,27003441,CDM,270,RC,,,outpatient,,,185,74.00,,157.25,85,,125.8,percent of total billed charges,85% of total billed charges,142.45,77,,113.96,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,151.7,82,,121.36,percent of total billed charges,82% of total billed charges,157.25,85,,125.8,percent of total billed charges,85% of total billed charges,157.25,85,,125.8,percent of total billed charges,85% of total billed charges,157.25,85,,125.8,percent of total billed charges,85% of total billed charges,166.5,90,,133.2,percent of total billed charges,90% of total billed charges,148,80,,118.4,percent of total billed charges,80% of total billed charges,166.5,90,,133.2,percent of total billed charges,90% of total billed charges,138.75,75,,111,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,53.65,29,,42.92,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,123.95,67,,99.16,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,148,80,,118.4,percent of total billed charges,80% of total billed charges,120.25,65,,96.2,percent of total billed charges,65% of total billed charges,65.99,35.67,,52.792,percent of total billed charges,35.67% of total billed charges,53.65,166.5,
INTERNAL STAPLES TA30 LOADS**,27003450,CDM,270,RC,,,outpatient,,,342,136.80,,290.7,85,,232.56,percent of total billed charges,85% of total billed charges,263.34,77,,210.67,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,280.44,82,,224.352,percent of total billed charges,82% of total billed charges,290.7,85,,232.56,percent of total billed charges,85% of total billed charges,290.7,85,,232.56,percent of total billed charges,85% of total billed charges,290.7,85,,232.56,percent of total billed charges,85% of total billed charges,307.8,90,,246.24,percent of total billed charges,90% of total billed charges,273.6,80,,218.88,percent of total billed charges,80% of total billed charges,307.8,90,,246.24,percent of total billed charges,90% of total billed charges,256.5,75,,205.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,99.18,29,,79.344,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,229.14,67,,183.312,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,273.6,80,,218.88,percent of total billed charges,80% of total billed charges,222.3,65,,177.84,percent of total billed charges,65% of total billed charges,121.99,35.67,,97.592,percent of total billed charges,35.67% of total billed charges,99.18,307.8,
MICROBORE IV EXTENSION SET,27003462,CDM,270,RC,,,outpatient,,,13,5.20,,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,10.01,77,,8.01,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,10.66,82,,8.528,percent of total billed charges,82% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,11.7,90,,9.36,percent of total billed charges,90% of total billed charges,10.4,80,,8.32,percent of total billed charges,80% of total billed charges,11.7,90,,9.36,percent of total billed charges,90% of total billed charges,9.75,75,,7.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,3.77,29,,3.016,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,8.71,67,,6.968,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,10.4,80,,8.32,percent of total billed charges,80% of total billed charges,8.45,65,,6.76,percent of total billed charges,65% of total billed charges,4.64,35.67,,3.712,percent of total billed charges,35.67% of total billed charges,3.77,11.7,
SMALLBORE T-PORT EXT SET,27003463,CDM,270,RC,,,outpatient,,,19,7.60,,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,14.63,77,,11.7,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,15.58,82,,12.464,percent of total billed charges,82% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,15.2,80,,12.16,percent of total billed charges,80% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,14.25,75,,11.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,5.51,29,,4.408,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,12.73,67,,10.184,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,15.2,80,,12.16,percent of total billed charges,80% of total billed charges,12.35,65,,9.88,percent of total billed charges,65% of total billed charges,6.78,35.67,,5.424,percent of total billed charges,35.67% of total billed charges,5.51,17.1,
ICE PACK,27003466,CDM,270,RC,,,outpatient,,,16,6.40,,13.6,85,,10.88,percent of total billed charges,85% of total billed charges,12.32,77,,9.86,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,13.12,82,,10.496,percent of total billed charges,82% of total billed charges,13.6,85,,10.88,percent of total billed charges,85% of total billed charges,13.6,85,,10.88,percent of total billed charges,85% of total billed charges,13.6,85,,10.88,percent of total billed charges,85% of total billed charges,14.4,90,,11.52,percent of total billed charges,90% of total billed charges,12.8,80,,10.24,percent of total billed charges,80% of total billed charges,14.4,90,,11.52,percent of total billed charges,90% of total billed charges,12,75,,9.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,4.64,29,,3.712,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,10.72,67,,8.576,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,12.8,80,,10.24,percent of total billed charges,80% of total billed charges,10.4,65,,8.32,percent of total billed charges,65% of total billed charges,5.71,35.67,,4.568,percent of total billed charges,35.67% of total billed charges,4.64,14.4,
CONVATEC UROSTOMY BAG 1-3/4,27003469,CDM,270,RC,,,outpatient,,,25,10.00,,21.25,85,,17,percent of total billed charges,85% of total billed charges,19.25,77,,15.4,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,20.5,82,,16.4,percent of total billed charges,82% of total billed charges,21.25,85,,17,percent of total billed charges,85% of total billed charges,21.25,85,,17,percent of total billed charges,85% of total billed charges,21.25,85,,17,percent of total billed charges,85% of total billed charges,22.5,90,,18,percent of total billed charges,90% of total billed charges,20,80,,16,percent of total billed charges,80% of total billed charges,22.5,90,,18,percent of total billed charges,90% of total billed charges,18.75,75,,15,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,7.25,29,,5.8,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,16.75,67,,13.4,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,20,80,,16,percent of total billed charges,80% of total billed charges,16.25,65,,13,percent of total billed charges,65% of total billed charges,8.92,35.67,,7.136,percent of total billed charges,35.67% of total billed charges,7.25,22.5,
SPINAL NEEDLE 18GX3 1/2,27003472,CDM,270,RC,,,outpatient,,,40,16.00,,34,85,,27.2,percent of total billed charges,85% of total billed charges,30.8,77,,24.64,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,32.8,82,,26.24,percent of total billed charges,82% of total billed charges,34,85,,27.2,percent of total billed charges,85% of total billed charges,34,85,,27.2,percent of total billed charges,85% of total billed charges,34,85,,27.2,percent of total billed charges,85% of total billed charges,36,90,,28.8,percent of total billed charges,90% of total billed charges,32,80,,25.6,percent of total billed charges,80% of total billed charges,36,90,,28.8,percent of total billed charges,90% of total billed charges,30,75,,24,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,11.6,29,,9.28,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,26.8,67,,21.44,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,32,80,,25.6,percent of total billed charges,80% of total billed charges,26,65,,20.8,percent of total billed charges,65% of total billed charges,14.27,35.67,,11.416,percent of total billed charges,35.67% of total billed charges,11.6,36,
HERBST CRADLE SHOE SM **,27003479,CDM,270,RC,,,outpatient,,,359,143.60,,305.15,85,,244.12,percent of total billed charges,85% of total billed charges,276.43,77,,221.14,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,294.38,82,,235.504,percent of total billed charges,82% of total billed charges,305.15,85,,244.12,percent of total billed charges,85% of total billed charges,305.15,85,,244.12,percent of total billed charges,85% of total billed charges,305.15,85,,244.12,percent of total billed charges,85% of total billed charges,323.1,90,,258.48,percent of total billed charges,90% of total billed charges,287.2,80,,229.76,percent of total billed charges,80% of total billed charges,323.1,90,,258.48,percent of total billed charges,90% of total billed charges,269.25,75,,215.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,104.11,29,,83.288,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,240.53,67,,192.424,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,287.2,80,,229.76,percent of total billed charges,80% of total billed charges,233.35,65,,186.68,percent of total billed charges,65% of total billed charges,128.06,35.67,,102.448,percent of total billed charges,35.67% of total billed charges,104.11,323.1,
HERBST CRADLE SHOE MED,27003480,CDM,270,RC,,,outpatient,,,311,124.40,,264.35,85,,211.48,percent of total billed charges,85% of total billed charges,239.47,77,,191.58,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,255.02,82,,204.016,percent of total billed charges,82% of total billed charges,264.35,85,,211.48,percent of total billed charges,85% of total billed charges,264.35,85,,211.48,percent of total billed charges,85% of total billed charges,264.35,85,,211.48,percent of total billed charges,85% of total billed charges,279.9,90,,223.92,percent of total billed charges,90% of total billed charges,248.8,80,,199.04,percent of total billed charges,80% of total billed charges,279.9,90,,223.92,percent of total billed charges,90% of total billed charges,233.25,75,,186.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,90.19,29,,72.152,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,208.37,67,,166.696,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,248.8,80,,199.04,percent of total billed charges,80% of total billed charges,202.15,65,,161.72,percent of total billed charges,65% of total billed charges,110.93,35.67,,88.744,percent of total billed charges,35.67% of total billed charges,90.19,279.9,
HERBST CRADLE SHOE LG,27003481,CDM,270,RC,,,outpatient,,,311,124.40,,264.35,85,,211.48,percent of total billed charges,85% of total billed charges,239.47,77,,191.58,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,255.02,82,,204.016,percent of total billed charges,82% of total billed charges,264.35,85,,211.48,percent of total billed charges,85% of total billed charges,264.35,85,,211.48,percent of total billed charges,85% of total billed charges,264.35,85,,211.48,percent of total billed charges,85% of total billed charges,279.9,90,,223.92,percent of total billed charges,90% of total billed charges,248.8,80,,199.04,percent of total billed charges,80% of total billed charges,279.9,90,,223.92,percent of total billed charges,90% of total billed charges,233.25,75,,186.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,90.19,29,,72.152,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,208.37,67,,166.696,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,248.8,80,,199.04,percent of total billed charges,80% of total billed charges,202.15,65,,161.72,percent of total billed charges,65% of total billed charges,110.93,35.67,,88.744,percent of total billed charges,35.67% of total billed charges,90.19,279.9,
CATHETER KIT PEDI 5FR,27003483,CDM,270,RC,,,outpatient,,,26,10.40,,22.1,85,,17.68,percent of total billed charges,85% of total billed charges,20.02,77,,16.02,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,21.32,82,,17.056,percent of total billed charges,82% of total billed charges,22.1,85,,17.68,percent of total billed charges,85% of total billed charges,22.1,85,,17.68,percent of total billed charges,85% of total billed charges,22.1,85,,17.68,percent of total billed charges,85% of total billed charges,23.4,90,,18.72,percent of total billed charges,90% of total billed charges,20.8,80,,16.64,percent of total billed charges,80% of total billed charges,23.4,90,,18.72,percent of total billed charges,90% of total billed charges,19.5,75,,15.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,7.54,29,,6.032,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,17.42,67,,13.936,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,20.8,80,,16.64,percent of total billed charges,80% of total billed charges,16.9,65,,13.52,percent of total billed charges,65% of total billed charges,9.27,35.67,,7.416,percent of total billed charges,35.67% of total billed charges,7.54,23.4,
DRAINAGE BULB HOLDER,27003486,CDM,270,RC,,,outpatient,,,96,38.40,,81.6,85,,65.28,percent of total billed charges,85% of total billed charges,73.92,77,,59.14,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,78.72,82,,62.976,percent of total billed charges,82% of total billed charges,81.6,85,,65.28,percent of total billed charges,85% of total billed charges,81.6,85,,65.28,percent of total billed charges,85% of total billed charges,81.6,85,,65.28,percent of total billed charges,85% of total billed charges,86.4,90,,69.12,percent of total billed charges,90% of total billed charges,76.8,80,,61.44,percent of total billed charges,80% of total billed charges,86.4,90,,69.12,percent of total billed charges,90% of total billed charges,72,75,,57.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,27.84,29,,22.272,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,64.32,67,,51.456,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,76.8,80,,61.44,percent of total billed charges,80% of total billed charges,62.4,65,,49.92,percent of total billed charges,65% of total billed charges,34.24,35.67,,27.392,percent of total billed charges,35.67% of total billed charges,27.84,86.4,
APPLICATOR DURAPREP 26ML,27003492,CDM,270,RC,,,outpatient,,,62,24.80,,52.7,85,,42.16,percent of total billed charges,85% of total billed charges,47.74,77,,38.19,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,50.84,82,,40.672,percent of total billed charges,82% of total billed charges,52.7,85,,42.16,percent of total billed charges,85% of total billed charges,52.7,85,,42.16,percent of total billed charges,85% of total billed charges,52.7,85,,42.16,percent of total billed charges,85% of total billed charges,55.8,90,,44.64,percent of total billed charges,90% of total billed charges,49.6,80,,39.68,percent of total billed charges,80% of total billed charges,55.8,90,,44.64,percent of total billed charges,90% of total billed charges,46.5,75,,37.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,17.98,29,,14.384,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,41.54,67,,33.232,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,49.6,80,,39.68,percent of total billed charges,80% of total billed charges,40.3,65,,32.24,percent of total billed charges,65% of total billed charges,22.12,35.67,,17.696,percent of total billed charges,35.67% of total billed charges,17.98,55.8,
ENDO GIA 30-3.5 LOADS **,27003499,CDM,270,RC,,,outpatient,,,701,280.40,,595.85,85,,476.68,percent of total billed charges,85% of total billed charges,539.77,77,,431.82,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,574.82,82,,459.856,percent of total billed charges,82% of total billed charges,595.85,85,,476.68,percent of total billed charges,85% of total billed charges,595.85,85,,476.68,percent of total billed charges,85% of total billed charges,595.85,85,,476.68,percent of total billed charges,85% of total billed charges,630.9,90,,504.72,percent of total billed charges,90% of total billed charges,560.8,80,,448.64,percent of total billed charges,80% of total billed charges,630.9,90,,504.72,percent of total billed charges,90% of total billed charges,525.75,75,,420.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,203.29,29,,162.632,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,469.67,67,,375.736,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,560.8,80,,448.64,percent of total billed charges,80% of total billed charges,455.65,65,,364.52,percent of total billed charges,65% of total billed charges,250.05,35.67,,200.04,percent of total billed charges,35.67% of total billed charges,203.29,630.9,
ORTHOPEDIC PACK I- MAJOR **,27003502,CDM,270,RC,,,outpatient,,,191,76.40,,162.35,85,,129.88,percent of total billed charges,85% of total billed charges,147.07,77,,117.66,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,156.62,82,,125.296,percent of total billed charges,82% of total billed charges,162.35,85,,129.88,percent of total billed charges,85% of total billed charges,162.35,85,,129.88,percent of total billed charges,85% of total billed charges,162.35,85,,129.88,percent of total billed charges,85% of total billed charges,171.9,90,,137.52,percent of total billed charges,90% of total billed charges,152.8,80,,122.24,percent of total billed charges,80% of total billed charges,171.9,90,,137.52,percent of total billed charges,90% of total billed charges,143.25,75,,114.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,55.39,29,,44.312,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,127.97,67,,102.376,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,152.8,80,,122.24,percent of total billed charges,80% of total billed charges,124.15,65,,99.32,percent of total billed charges,65% of total billed charges,68.13,35.67,,54.504,percent of total billed charges,35.67% of total billed charges,55.39,171.9,
SOTCKINETTE IMPERVIOUS 8 X 38,27003506,CDM,270,RC,,,outpatient,,,58,23.20,,49.3,85,,39.44,percent of total billed charges,85% of total billed charges,44.66,77,,35.73,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,47.56,82,,38.048,percent of total billed charges,82% of total billed charges,49.3,85,,39.44,percent of total billed charges,85% of total billed charges,49.3,85,,39.44,percent of total billed charges,85% of total billed charges,49.3,85,,39.44,percent of total billed charges,85% of total billed charges,52.2,90,,41.76,percent of total billed charges,90% of total billed charges,46.4,80,,37.12,percent of total billed charges,80% of total billed charges,52.2,90,,41.76,percent of total billed charges,90% of total billed charges,43.5,75,,34.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,16.82,29,,13.456,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,38.86,67,,31.088,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,46.4,80,,37.12,percent of total billed charges,80% of total billed charges,37.7,65,,30.16,percent of total billed charges,65% of total billed charges,20.69,35.67,,16.552,percent of total billed charges,35.67% of total billed charges,16.82,52.2,
WEBRIL PADDING 6 **,27003541,CDM,270,RC,,,outpatient,,,17,6.80,,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,13.09,77,,10.47,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,13.94,82,,11.152,percent of total billed charges,82% of total billed charges,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,15.3,90,,12.24,percent of total billed charges,90% of total billed charges,13.6,80,,10.88,percent of total billed charges,80% of total billed charges,15.3,90,,12.24,percent of total billed charges,90% of total billed charges,12.75,75,,10.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,4.93,29,,3.944,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,11.39,67,,9.112,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,13.6,80,,10.88,percent of total billed charges,80% of total billed charges,11.05,65,,8.84,percent of total billed charges,65% of total billed charges,6.06,35.67,,4.848,percent of total billed charges,35.67% of total billed charges,4.93,15.3,
COBAN BANDAGE COHESIVE 2  TAN,27003555,CDM,270,RC,,,outpatient,,,23,9.20,,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,17.71,77,,14.17,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,18.86,82,,15.088,percent of total billed charges,82% of total billed charges,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,20.7,90,,16.56,percent of total billed charges,90% of total billed charges,18.4,80,,14.72,percent of total billed charges,80% of total billed charges,20.7,90,,16.56,percent of total billed charges,90% of total billed charges,17.25,75,,13.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,6.67,29,,5.336,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,15.41,67,,12.328,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,18.4,80,,14.72,percent of total billed charges,80% of total billed charges,14.95,65,,11.96,percent of total billed charges,65% of total billed charges,8.2,35.67,,6.56,percent of total billed charges,35.67% of total billed charges,6.67,20.7,
COBAN STERILE WRAP 4,27003562,CDM,270,RC,,,outpatient,,,42,16.80,,35.7,85,,28.56,percent of total billed charges,85% of total billed charges,32.34,77,,25.87,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,34.44,82,,27.552,percent of total billed charges,82% of total billed charges,35.7,85,,28.56,percent of total billed charges,85% of total billed charges,35.7,85,,28.56,percent of total billed charges,85% of total billed charges,35.7,85,,28.56,percent of total billed charges,85% of total billed charges,37.8,90,,30.24,percent of total billed charges,90% of total billed charges,33.6,80,,26.88,percent of total billed charges,80% of total billed charges,37.8,90,,30.24,percent of total billed charges,90% of total billed charges,31.5,75,,25.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,12.18,29,,9.744,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,28.14,67,,22.512,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,33.6,80,,26.88,percent of total billed charges,80% of total billed charges,27.3,65,,21.84,percent of total billed charges,65% of total billed charges,14.98,35.67,,11.984,percent of total billed charges,35.67% of total billed charges,12.18,37.8,
DRESSING XEROFLO **,27003568,CDM,270,RC,,,outpatient,,,18,7.20,,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,13.86,77,,11.09,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,14.76,82,,11.808,percent of total billed charges,82% of total billed charges,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,16.2,90,,12.96,percent of total billed charges,90% of total billed charges,14.4,80,,11.52,percent of total billed charges,80% of total billed charges,16.2,90,,12.96,percent of total billed charges,90% of total billed charges,13.5,75,,10.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,5.22,29,,4.176,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,12.06,67,,9.648,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,14.4,80,,11.52,percent of total billed charges,80% of total billed charges,11.7,65,,9.36,percent of total billed charges,65% of total billed charges,6.42,35.67,,5.136,percent of total billed charges,35.67% of total billed charges,5.22,16.2,
SAGITTAL BLADE 12.7X25X0.3,27003587,CDM,270,RC,,,outpatient,,,93,37.20,,79.05,85,,63.24,percent of total billed charges,85% of total billed charges,71.61,77,,57.29,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,76.26,82,,61.008,percent of total billed charges,82% of total billed charges,79.05,85,,63.24,percent of total billed charges,85% of total billed charges,79.05,85,,63.24,percent of total billed charges,85% of total billed charges,79.05,85,,63.24,percent of total billed charges,85% of total billed charges,83.7,90,,66.96,percent of total billed charges,90% of total billed charges,74.4,80,,59.52,percent of total billed charges,80% of total billed charges,83.7,90,,66.96,percent of total billed charges,90% of total billed charges,69.75,75,,55.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,26.97,29,,21.576,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,62.31,67,,49.848,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,74.4,80,,59.52,percent of total billed charges,80% of total billed charges,60.45,65,,48.36,percent of total billed charges,65% of total billed charges,33.17,35.67,,26.536,percent of total billed charges,35.67% of total billed charges,26.97,83.7,
COVER KAPS,27003588,CDM,270,RC,,,outpatient,,,29,11.60,,24.65,85,,19.72,percent of total billed charges,85% of total billed charges,22.33,77,,17.86,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,23.78,82,,19.024,percent of total billed charges,82% of total billed charges,24.65,85,,19.72,percent of total billed charges,85% of total billed charges,24.65,85,,19.72,percent of total billed charges,85% of total billed charges,24.65,85,,19.72,percent of total billed charges,85% of total billed charges,26.1,90,,20.88,percent of total billed charges,90% of total billed charges,23.2,80,,18.56,percent of total billed charges,80% of total billed charges,26.1,90,,20.88,percent of total billed charges,90% of total billed charges,21.75,75,,17.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,8.41,29,,6.728,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,19.43,67,,15.544,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,23.2,80,,18.56,percent of total billed charges,80% of total billed charges,18.85,65,,15.08,percent of total billed charges,65% of total billed charges,10.34,35.67,,8.272,percent of total billed charges,35.67% of total billed charges,8.41,26.1,
PERITONEAL CATH ADAP CAP,27003603,CDM,270,RC,,,outpatient,,,25,10.00,,21.25,85,,17,percent of total billed charges,85% of total billed charges,19.25,77,,15.4,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,20.5,82,,16.4,percent of total billed charges,82% of total billed charges,21.25,85,,17,percent of total billed charges,85% of total billed charges,21.25,85,,17,percent of total billed charges,85% of total billed charges,21.25,85,,17,percent of total billed charges,85% of total billed charges,22.5,90,,18,percent of total billed charges,90% of total billed charges,20,80,,16,percent of total billed charges,80% of total billed charges,22.5,90,,18,percent of total billed charges,90% of total billed charges,18.75,75,,15,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,7.25,29,,5.8,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,16.75,67,,13.4,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,20,80,,16,percent of total billed charges,80% of total billed charges,16.25,65,,13,percent of total billed charges,65% of total billed charges,8.92,35.67,,7.136,percent of total billed charges,35.67% of total billed charges,7.25,22.5,
TICRON 2 SUTURES **,27003604,CDM,270,RC,,,outpatient,,,10,4.00,,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,7.7,77,,6.16,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,8.2,82,,6.56,percent of total billed charges,82% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,9,90,,7.2,percent of total billed charges,90% of total billed charges,8,80,,6.4,percent of total billed charges,80% of total billed charges,9,90,,7.2,percent of total billed charges,90% of total billed charges,7.5,75,,6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.9,29,,2.32,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,6.7,67,,5.36,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,8,80,,6.4,percent of total billed charges,80% of total billed charges,6.5,65,,5.2,percent of total billed charges,65% of total billed charges,3.57,35.67,,2.856,percent of total billed charges,35.67% of total billed charges,2.9,9,
PLAIN PACKING 1/4 X 5,27003605,CDM,270,RC,,,outpatient,,,32,12.80,,27.2,85,,21.76,percent of total billed charges,85% of total billed charges,24.64,77,,19.71,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,26.24,82,,20.992,percent of total billed charges,82% of total billed charges,27.2,85,,21.76,percent of total billed charges,85% of total billed charges,27.2,85,,21.76,percent of total billed charges,85% of total billed charges,27.2,85,,21.76,percent of total billed charges,85% of total billed charges,28.8,90,,23.04,percent of total billed charges,90% of total billed charges,25.6,80,,20.48,percent of total billed charges,80% of total billed charges,28.8,90,,23.04,percent of total billed charges,90% of total billed charges,24,75,,19.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,9.28,29,,7.424,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,21.44,67,,17.152,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,25.6,80,,20.48,percent of total billed charges,80% of total billed charges,20.8,65,,16.64,percent of total billed charges,65% of total billed charges,11.41,35.67,,9.128,percent of total billed charges,35.67% of total billed charges,9.28,28.8,
RECIPROCATOR BLADE 12.5X76,27003620,CDM,270,RC,,,outpatient,,,218,87.20,,185.3,85,,148.24,percent of total billed charges,85% of total billed charges,167.86,77,,134.29,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,178.76,82,,143.008,percent of total billed charges,82% of total billed charges,185.3,85,,148.24,percent of total billed charges,85% of total billed charges,185.3,85,,148.24,percent of total billed charges,85% of total billed charges,185.3,85,,148.24,percent of total billed charges,85% of total billed charges,196.2,90,,156.96,percent of total billed charges,90% of total billed charges,174.4,80,,139.52,percent of total billed charges,80% of total billed charges,196.2,90,,156.96,percent of total billed charges,90% of total billed charges,163.5,75,,130.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,63.22,29,,50.576,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,146.06,67,,116.848,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,174.4,80,,139.52,percent of total billed charges,80% of total billed charges,141.7,65,,113.36,percent of total billed charges,65% of total billed charges,77.76,35.67,,62.208,percent of total billed charges,35.67% of total billed charges,63.22,196.2,
OSCILLATOR BLADE 19.5X90X1.2,27003621,CDM,270,RC,,,outpatient,,,316,126.40,,268.6,85,,214.88,percent of total billed charges,85% of total billed charges,243.32,77,,194.66,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,259.12,82,,207.296,percent of total billed charges,82% of total billed charges,268.6,85,,214.88,percent of total billed charges,85% of total billed charges,268.6,85,,214.88,percent of total billed charges,85% of total billed charges,268.6,85,,214.88,percent of total billed charges,85% of total billed charges,284.4,90,,227.52,percent of total billed charges,90% of total billed charges,252.8,80,,202.24,percent of total billed charges,80% of total billed charges,284.4,90,,227.52,percent of total billed charges,90% of total billed charges,237,75,,189.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,91.64,29,,73.312,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,211.72,67,,169.376,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,252.8,80,,202.24,percent of total billed charges,80% of total billed charges,205.4,65,,164.32,percent of total billed charges,65% of total billed charges,112.72,35.67,,90.176,percent of total billed charges,35.67% of total billed charges,91.64,284.4,
MICRO SAGITTAL BLADE 9.5X25,27003622,CDM,270,RC,,,outpatient,,,127,50.80,,107.95,85,,86.36,percent of total billed charges,85% of total billed charges,97.79,77,,78.23,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,104.14,82,,83.312,percent of total billed charges,82% of total billed charges,107.95,85,,86.36,percent of total billed charges,85% of total billed charges,107.95,85,,86.36,percent of total billed charges,85% of total billed charges,107.95,85,,86.36,percent of total billed charges,85% of total billed charges,114.3,90,,91.44,percent of total billed charges,90% of total billed charges,101.6,80,,81.28,percent of total billed charges,80% of total billed charges,114.3,90,,91.44,percent of total billed charges,90% of total billed charges,95.25,75,,76.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,36.83,29,,29.464,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,85.09,67,,68.072,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,101.6,80,,81.28,percent of total billed charges,80% of total billed charges,82.55,65,,66.04,percent of total billed charges,65% of total billed charges,45.3,35.67,,36.24,percent of total billed charges,35.67% of total billed charges,36.83,114.3,
OSCILLATOR BLADE 19.5X71X0.8,27003623,CDM,270,RC,,,outpatient,,,127,50.80,,107.95,85,,86.36,percent of total billed charges,85% of total billed charges,97.79,77,,78.23,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,104.14,82,,83.312,percent of total billed charges,82% of total billed charges,107.95,85,,86.36,percent of total billed charges,85% of total billed charges,107.95,85,,86.36,percent of total billed charges,85% of total billed charges,107.95,85,,86.36,percent of total billed charges,85% of total billed charges,114.3,90,,91.44,percent of total billed charges,90% of total billed charges,101.6,80,,81.28,percent of total billed charges,80% of total billed charges,114.3,90,,91.44,percent of total billed charges,90% of total billed charges,95.25,75,,76.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,36.83,29,,29.464,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,85.09,67,,68.072,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,101.6,80,,81.28,percent of total billed charges,80% of total billed charges,82.55,65,,66.04,percent of total billed charges,65% of total billed charges,45.3,35.67,,36.24,percent of total billed charges,35.67% of total billed charges,36.83,114.3,
FOGARTY BILARY BALLOON 5 FR,27003631,CDM,270,RC,,,outpatient,,,368,147.20,,312.8,85,,250.24,percent of total billed charges,85% of total billed charges,283.36,77,,226.69,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,301.76,82,,241.408,percent of total billed charges,82% of total billed charges,312.8,85,,250.24,percent of total billed charges,85% of total billed charges,312.8,85,,250.24,percent of total billed charges,85% of total billed charges,312.8,85,,250.24,percent of total billed charges,85% of total billed charges,331.2,90,,264.96,percent of total billed charges,90% of total billed charges,294.4,80,,235.52,percent of total billed charges,80% of total billed charges,331.2,90,,264.96,percent of total billed charges,90% of total billed charges,276,75,,220.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,106.72,29,,85.376,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,246.56,67,,197.248,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,294.4,80,,235.52,percent of total billed charges,80% of total billed charges,239.2,65,,191.36,percent of total billed charges,65% of total billed charges,131.27,35.67,,105.016,percent of total billed charges,35.67% of total billed charges,106.72,331.2,
BIPOLAR COAG PROBE 300CM **,27003633,CDM,270,RC,,,outpatient,,,1344,537.60,,1142.4,85,,913.92,percent of total billed charges,85% of total billed charges,1034.88,77,,827.9,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,1102.08,82,,881.664,percent of total billed charges,82% of total billed charges,1142.4,85,,913.92,percent of total billed charges,85% of total billed charges,1142.4,85,,913.92,percent of total billed charges,85% of total billed charges,1142.4,85,,913.92,percent of total billed charges,85% of total billed charges,1209.6,90,,967.68,percent of total billed charges,90% of total billed charges,1075.2,80,,860.16,percent of total billed charges,80% of total billed charges,1209.6,90,,967.68,percent of total billed charges,90% of total billed charges,1008,75,,806.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,389.76,29,,311.808,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,900.48,67,,720.384,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1075.2,80,,860.16,percent of total billed charges,80% of total billed charges,873.6,65,,698.88,percent of total billed charges,65% of total billed charges,479.4,35.67,,383.52,percent of total billed charges,35.67% of total billed charges,389.76,1209.6,
SPINAL NEEDLE WHITACRE 25G,27003649,CDM,270,RC,,,outpatient,,,86,34.40,,73.1,85,,58.48,percent of total billed charges,85% of total billed charges,66.22,77,,52.98,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,70.52,82,,56.416,percent of total billed charges,82% of total billed charges,73.1,85,,58.48,percent of total billed charges,85% of total billed charges,73.1,85,,58.48,percent of total billed charges,85% of total billed charges,73.1,85,,58.48,percent of total billed charges,85% of total billed charges,77.4,90,,61.92,percent of total billed charges,90% of total billed charges,68.8,80,,55.04,percent of total billed charges,80% of total billed charges,77.4,90,,61.92,percent of total billed charges,90% of total billed charges,64.5,75,,51.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,24.94,29,,19.952,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,57.62,67,,46.096,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,68.8,80,,55.04,percent of total billed charges,80% of total billed charges,55.9,65,,44.72,percent of total billed charges,65% of total billed charges,30.68,35.67,,24.544,percent of total billed charges,35.67% of total billed charges,24.94,77.4,
DELTAFLO SUCTION HANDLE,27003650,CDM,270,RC,,,outpatient,,,150,60.00,,127.5,85,,102,percent of total billed charges,85% of total billed charges,115.5,77,,92.4,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,123,82,,98.4,percent of total billed charges,82% of total billed charges,127.5,85,,102,percent of total billed charges,85% of total billed charges,127.5,85,,102,percent of total billed charges,85% of total billed charges,127.5,85,,102,percent of total billed charges,85% of total billed charges,135,90,,108,percent of total billed charges,90% of total billed charges,120,80,,96,percent of total billed charges,80% of total billed charges,135,90,,108,percent of total billed charges,90% of total billed charges,112.5,75,,90,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,43.5,29,,34.8,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,100.5,67,,80.4,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,120,80,,96,percent of total billed charges,80% of total billed charges,97.5,65,,78,percent of total billed charges,65% of total billed charges,53.51,35.67,,42.808,percent of total billed charges,35.67% of total billed charges,43.5,135,
MASK FACE TODDLER SZ 3,27003672,CDM,270,RC,,,outpatient,,,29,11.60,,24.65,85,,19.72,percent of total billed charges,85% of total billed charges,22.33,77,,17.86,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,23.78,82,,19.024,percent of total billed charges,82% of total billed charges,24.65,85,,19.72,percent of total billed charges,85% of total billed charges,24.65,85,,19.72,percent of total billed charges,85% of total billed charges,24.65,85,,19.72,percent of total billed charges,85% of total billed charges,26.1,90,,20.88,percent of total billed charges,90% of total billed charges,23.2,80,,18.56,percent of total billed charges,80% of total billed charges,26.1,90,,20.88,percent of total billed charges,90% of total billed charges,21.75,75,,17.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,8.41,29,,6.728,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,19.43,67,,15.544,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,23.2,80,,18.56,percent of total billed charges,80% of total billed charges,18.85,65,,15.08,percent of total billed charges,65% of total billed charges,10.34,35.67,,8.272,percent of total billed charges,35.67% of total billed charges,8.41,26.1,
FACE MASK CHILD,27003673,CDM,270,RC,,,outpatient,,,29,11.60,,24.65,85,,19.72,percent of total billed charges,85% of total billed charges,22.33,77,,17.86,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,23.78,82,,19.024,percent of total billed charges,82% of total billed charges,24.65,85,,19.72,percent of total billed charges,85% of total billed charges,24.65,85,,19.72,percent of total billed charges,85% of total billed charges,24.65,85,,19.72,percent of total billed charges,85% of total billed charges,26.1,90,,20.88,percent of total billed charges,90% of total billed charges,23.2,80,,18.56,percent of total billed charges,80% of total billed charges,26.1,90,,20.88,percent of total billed charges,90% of total billed charges,21.75,75,,17.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,8.41,29,,6.728,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,19.43,67,,15.544,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,23.2,80,,18.56,percent of total billed charges,80% of total billed charges,18.85,65,,15.08,percent of total billed charges,65% of total billed charges,10.34,35.67,,8.272,percent of total billed charges,35.67% of total billed charges,8.41,26.1,
COMPRESSION SLEEVE KNEE LG,27003677,CDM,270,RC,,,outpatient,,,400,160.00,,340,85,,272,percent of total billed charges,85% of total billed charges,308,77,,246.4,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,328,82,,262.4,percent of total billed charges,82% of total billed charges,340,85,,272,percent of total billed charges,85% of total billed charges,340,85,,272,percent of total billed charges,85% of total billed charges,340,85,,272,percent of total billed charges,85% of total billed charges,360,90,,288,percent of total billed charges,90% of total billed charges,320,80,,256,percent of total billed charges,80% of total billed charges,360,90,,288,percent of total billed charges,90% of total billed charges,300,75,,240,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,116,29,,92.8,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,268,67,,214.4,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,320,80,,256,percent of total billed charges,80% of total billed charges,260,65,,208,percent of total billed charges,65% of total billed charges,142.68,35.67,,114.144,percent of total billed charges,35.67% of total billed charges,116,360,
WOUND VAC CANISTER W/ GEL,27003678,CDM,270,RC,,,outpatient,,,273,109.20,,232.05,85,,185.64,percent of total billed charges,85% of total billed charges,210.21,77,,168.17,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,223.86,82,,179.088,percent of total billed charges,82% of total billed charges,232.05,85,,185.64,percent of total billed charges,85% of total billed charges,232.05,85,,185.64,percent of total billed charges,85% of total billed charges,232.05,85,,185.64,percent of total billed charges,85% of total billed charges,245.7,90,,196.56,percent of total billed charges,90% of total billed charges,218.4,80,,174.72,percent of total billed charges,80% of total billed charges,245.7,90,,196.56,percent of total billed charges,90% of total billed charges,204.75,75,,163.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,79.17,29,,63.336,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,182.91,67,,146.328,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,218.4,80,,174.72,percent of total billed charges,80% of total billed charges,177.45,65,,141.96,percent of total billed charges,65% of total billed charges,97.38,35.67,,77.904,percent of total billed charges,35.67% of total billed charges,79.17,245.7,
WOUND VAC BLACK FOAM DRESS,27003679,CDM,270,RC,,,outpatient,,,399,159.60,,339.15,85,,271.32,percent of total billed charges,85% of total billed charges,307.23,77,,245.78,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,327.18,82,,261.744,percent of total billed charges,82% of total billed charges,339.15,85,,271.32,percent of total billed charges,85% of total billed charges,339.15,85,,271.32,percent of total billed charges,85% of total billed charges,339.15,85,,271.32,percent of total billed charges,85% of total billed charges,359.1,90,,287.28,percent of total billed charges,90% of total billed charges,319.2,80,,255.36,percent of total billed charges,80% of total billed charges,359.1,90,,287.28,percent of total billed charges,90% of total billed charges,299.25,75,,239.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,115.71,29,,92.568,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,267.33,67,,213.864,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,319.2,80,,255.36,percent of total billed charges,80% of total billed charges,259.35,65,,207.48,percent of total billed charges,65% of total billed charges,142.32,35.67,,113.856,percent of total billed charges,35.67% of total billed charges,115.71,359.1,
IOBAN DRAPE MEDIUM 13X13,27003699,CDM,270,RC,,,outpatient,,,79,31.60,,67.15,85,,53.72,percent of total billed charges,85% of total billed charges,60.83,77,,48.66,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,64.78,82,,51.824,percent of total billed charges,82% of total billed charges,67.15,85,,53.72,percent of total billed charges,85% of total billed charges,67.15,85,,53.72,percent of total billed charges,85% of total billed charges,67.15,85,,53.72,percent of total billed charges,85% of total billed charges,71.1,90,,56.88,percent of total billed charges,90% of total billed charges,63.2,80,,50.56,percent of total billed charges,80% of total billed charges,71.1,90,,56.88,percent of total billed charges,90% of total billed charges,59.25,75,,47.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,22.91,29,,18.328,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,52.93,67,,42.344,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,63.2,80,,50.56,percent of total billed charges,80% of total billed charges,51.35,65,,41.08,percent of total billed charges,65% of total billed charges,28.18,35.67,,22.544,percent of total billed charges,35.67% of total billed charges,22.91,71.1,
IOBAN DRAPE LARGE 35X23,27003700,CDM,270,RC,,,outpatient,,,92,36.80,,78.2,85,,62.56,percent of total billed charges,85% of total billed charges,70.84,77,,56.67,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,75.44,82,,60.352,percent of total billed charges,82% of total billed charges,78.2,85,,62.56,percent of total billed charges,85% of total billed charges,78.2,85,,62.56,percent of total billed charges,85% of total billed charges,78.2,85,,62.56,percent of total billed charges,85% of total billed charges,82.8,90,,66.24,percent of total billed charges,90% of total billed charges,73.6,80,,58.88,percent of total billed charges,80% of total billed charges,82.8,90,,66.24,percent of total billed charges,90% of total billed charges,69,75,,55.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,26.68,29,,21.344,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,61.64,67,,49.312,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,73.6,80,,58.88,percent of total billed charges,80% of total billed charges,59.8,65,,47.84,percent of total billed charges,65% of total billed charges,32.82,35.67,,26.256,percent of total billed charges,35.67% of total billed charges,26.68,82.8,
VIA-GUARD PED SUCTION SET,27003704,CDM,270,RC,,,outpatient,,,271,108.40,,230.35,85,,184.28,percent of total billed charges,85% of total billed charges,208.67,77,,166.94,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,222.22,82,,177.776,percent of total billed charges,82% of total billed charges,230.35,85,,184.28,percent of total billed charges,85% of total billed charges,230.35,85,,184.28,percent of total billed charges,85% of total billed charges,230.35,85,,184.28,percent of total billed charges,85% of total billed charges,243.9,90,,195.12,percent of total billed charges,90% of total billed charges,216.8,80,,173.44,percent of total billed charges,80% of total billed charges,243.9,90,,195.12,percent of total billed charges,90% of total billed charges,203.25,75,,162.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,78.59,29,,62.872,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,181.57,67,,145.256,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,216.8,80,,173.44,percent of total billed charges,80% of total billed charges,176.15,65,,140.92,percent of total billed charges,65% of total billed charges,96.67,35.67,,77.336,percent of total billed charges,35.67% of total billed charges,78.59,243.9,
PEDI BREATHING CIRCUIT,27003706,CDM,270,RC,,,outpatient,,,100,40.00,,85,85,,68,percent of total billed charges,85% of total billed charges,77,77,,61.6,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,82,82,,65.6,percent of total billed charges,82% of total billed charges,85,85,,68,percent of total billed charges,85% of total billed charges,85,85,,68,percent of total billed charges,85% of total billed charges,85,85,,68,percent of total billed charges,85% of total billed charges,90,90,,72,percent of total billed charges,90% of total billed charges,80,80,,64,percent of total billed charges,80% of total billed charges,90,90,,72,percent of total billed charges,90% of total billed charges,75,75,,60,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,29,29,,23.2,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,67,67,,53.6,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,80,80,,64,percent of total billed charges,80% of total billed charges,65,65,,52,percent of total billed charges,65% of total billed charges,35.67,35.67,,28.536,percent of total billed charges,35.67% of total billed charges,29,90,
SCHLEIN POSITIONER,27003711,CDM,270,RC,,,outpatient,,,334,133.60,,283.9,85,,227.12,percent of total billed charges,85% of total billed charges,257.18,77,,205.74,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,273.88,82,,219.104,percent of total billed charges,82% of total billed charges,283.9,85,,227.12,percent of total billed charges,85% of total billed charges,283.9,85,,227.12,percent of total billed charges,85% of total billed charges,283.9,85,,227.12,percent of total billed charges,85% of total billed charges,300.6,90,,240.48,percent of total billed charges,90% of total billed charges,267.2,80,,213.76,percent of total billed charges,80% of total billed charges,300.6,90,,240.48,percent of total billed charges,90% of total billed charges,250.5,75,,200.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,96.86,29,,77.488,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,223.78,67,,179.024,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,267.2,80,,213.76,percent of total billed charges,80% of total billed charges,217.1,65,,173.68,percent of total billed charges,65% of total billed charges,119.14,35.67,,95.312,percent of total billed charges,35.67% of total billed charges,96.86,300.6,
PROTECTIVE HELMET SYSTEM,27003718,CDM,270,RC,,,outpatient,,,86,34.40,,73.1,85,,58.48,percent of total billed charges,85% of total billed charges,66.22,77,,52.98,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,70.52,82,,56.416,percent of total billed charges,82% of total billed charges,73.1,85,,58.48,percent of total billed charges,85% of total billed charges,73.1,85,,58.48,percent of total billed charges,85% of total billed charges,73.1,85,,58.48,percent of total billed charges,85% of total billed charges,77.4,90,,61.92,percent of total billed charges,90% of total billed charges,68.8,80,,55.04,percent of total billed charges,80% of total billed charges,77.4,90,,61.92,percent of total billed charges,90% of total billed charges,64.5,75,,51.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,24.94,29,,19.952,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,57.62,67,,46.096,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,68.8,80,,55.04,percent of total billed charges,80% of total billed charges,55.9,65,,44.72,percent of total billed charges,65% of total billed charges,30.68,35.67,,24.544,percent of total billed charges,35.67% of total billed charges,24.94,77.4,
SURGIPRO SUTURE 7-0 **,27003721,CDM,270,RC,,,outpatient,,,62,24.80,,52.7,85,,42.16,percent of total billed charges,85% of total billed charges,47.74,77,,38.19,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,50.84,82,,40.672,percent of total billed charges,82% of total billed charges,52.7,85,,42.16,percent of total billed charges,85% of total billed charges,52.7,85,,42.16,percent of total billed charges,85% of total billed charges,52.7,85,,42.16,percent of total billed charges,85% of total billed charges,55.8,90,,44.64,percent of total billed charges,90% of total billed charges,49.6,80,,39.68,percent of total billed charges,80% of total billed charges,55.8,90,,44.64,percent of total billed charges,90% of total billed charges,46.5,75,,37.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,17.98,29,,14.384,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,41.54,67,,33.232,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,49.6,80,,39.68,percent of total billed charges,80% of total billed charges,40.3,65,,32.24,percent of total billed charges,65% of total billed charges,22.12,35.67,,17.696,percent of total billed charges,35.67% of total billed charges,17.98,55.8,
SURGIPRO SUTURE 5-0,27003722,CDM,270,RC,,,outpatient,,,185,74.00,,157.25,85,,125.8,percent of total billed charges,85% of total billed charges,142.45,77,,113.96,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,151.7,82,,121.36,percent of total billed charges,82% of total billed charges,157.25,85,,125.8,percent of total billed charges,85% of total billed charges,157.25,85,,125.8,percent of total billed charges,85% of total billed charges,157.25,85,,125.8,percent of total billed charges,85% of total billed charges,166.5,90,,133.2,percent of total billed charges,90% of total billed charges,148,80,,118.4,percent of total billed charges,80% of total billed charges,166.5,90,,133.2,percent of total billed charges,90% of total billed charges,138.75,75,,111,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,53.65,29,,42.92,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,123.95,67,,99.16,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,148,80,,118.4,percent of total billed charges,80% of total billed charges,120.25,65,,96.2,percent of total billed charges,65% of total billed charges,65.99,35.67,,52.792,percent of total billed charges,35.67% of total billed charges,53.65,166.5,
CURAFIL GEL WOUND DRESSING **,27003735,CDM,270,RC,,,outpatient,,,59,23.60,,50.15,85,,40.12,percent of total billed charges,85% of total billed charges,45.43,77,,36.34,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,48.38,82,,38.704,percent of total billed charges,82% of total billed charges,50.15,85,,40.12,percent of total billed charges,85% of total billed charges,50.15,85,,40.12,percent of total billed charges,85% of total billed charges,50.15,85,,40.12,percent of total billed charges,85% of total billed charges,53.1,90,,42.48,percent of total billed charges,90% of total billed charges,47.2,80,,37.76,percent of total billed charges,80% of total billed charges,53.1,90,,42.48,percent of total billed charges,90% of total billed charges,44.25,75,,35.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,17.11,29,,13.688,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,39.53,67,,31.624,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,47.2,80,,37.76,percent of total billed charges,80% of total billed charges,38.35,65,,30.68,percent of total billed charges,65% of total billed charges,21.05,35.67,,16.84,percent of total billed charges,35.67% of total billed charges,17.11,53.1,
POLYPECTOMY SNARE W/ HANDLE **,27003736,CDM,270,RC,,,outpatient,,,245,98.00,,208.25,85,,166.6,percent of total billed charges,85% of total billed charges,188.65,77,,150.92,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,200.9,82,,160.72,percent of total billed charges,82% of total billed charges,208.25,85,,166.6,percent of total billed charges,85% of total billed charges,208.25,85,,166.6,percent of total billed charges,85% of total billed charges,208.25,85,,166.6,percent of total billed charges,85% of total billed charges,220.5,90,,176.4,percent of total billed charges,90% of total billed charges,196,80,,156.8,percent of total billed charges,80% of total billed charges,220.5,90,,176.4,percent of total billed charges,90% of total billed charges,183.75,75,,147,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,71.05,29,,56.84,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,164.15,67,,131.32,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,196,80,,156.8,percent of total billed charges,80% of total billed charges,159.25,65,,127.4,percent of total billed charges,65% of total billed charges,87.39,35.67,,69.912,percent of total billed charges,35.67% of total billed charges,71.05,220.5,
ANESTHESIA CIRCUIT,27003737,CDM,270,RC,,,outpatient,,,141,56.40,,119.85,85,,95.88,percent of total billed charges,85% of total billed charges,108.57,77,,86.86,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,115.62,82,,92.496,percent of total billed charges,82% of total billed charges,119.85,85,,95.88,percent of total billed charges,85% of total billed charges,119.85,85,,95.88,percent of total billed charges,85% of total billed charges,119.85,85,,95.88,percent of total billed charges,85% of total billed charges,126.9,90,,101.52,percent of total billed charges,90% of total billed charges,112.8,80,,90.24,percent of total billed charges,80% of total billed charges,126.9,90,,101.52,percent of total billed charges,90% of total billed charges,105.75,75,,84.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,40.89,29,,32.712,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,94.47,67,,75.576,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,112.8,80,,90.24,percent of total billed charges,80% of total billed charges,91.65,65,,73.32,percent of total billed charges,65% of total billed charges,50.29,35.67,,40.232,percent of total billed charges,35.67% of total billed charges,40.89,126.9,
LIMB PROTECTION SLEEVES,27003750,CDM,270,RC,,,outpatient,,,68,27.20,,57.8,85,,46.24,percent of total billed charges,85% of total billed charges,52.36,77,,41.89,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,55.76,82,,44.608,percent of total billed charges,82% of total billed charges,57.8,85,,46.24,percent of total billed charges,85% of total billed charges,57.8,85,,46.24,percent of total billed charges,85% of total billed charges,57.8,85,,46.24,percent of total billed charges,85% of total billed charges,61.2,90,,48.96,percent of total billed charges,90% of total billed charges,54.4,80,,43.52,percent of total billed charges,80% of total billed charges,61.2,90,,48.96,percent of total billed charges,90% of total billed charges,51,75,,40.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,19.72,29,,15.776,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,45.56,67,,36.448,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,54.4,80,,43.52,percent of total billed charges,80% of total billed charges,44.2,65,,35.36,percent of total billed charges,65% of total billed charges,24.26,35.67,,19.408,percent of total billed charges,35.67% of total billed charges,19.72,61.2,
CPM PAD KIT **,27003769,CDM,270,RC,,,outpatient,,,146,58.40,,124.1,85,,99.28,percent of total billed charges,85% of total billed charges,112.42,77,,89.94,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,119.72,82,,95.776,percent of total billed charges,82% of total billed charges,124.1,85,,99.28,percent of total billed charges,85% of total billed charges,124.1,85,,99.28,percent of total billed charges,85% of total billed charges,124.1,85,,99.28,percent of total billed charges,85% of total billed charges,131.4,90,,105.12,percent of total billed charges,90% of total billed charges,116.8,80,,93.44,percent of total billed charges,80% of total billed charges,131.4,90,,105.12,percent of total billed charges,90% of total billed charges,109.5,75,,87.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,42.34,29,,33.872,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,97.82,67,,78.256,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,116.8,80,,93.44,percent of total billed charges,80% of total billed charges,94.9,65,,75.92,percent of total billed charges,65% of total billed charges,52.08,35.67,,41.664,percent of total billed charges,35.67% of total billed charges,42.34,131.4,
GRAFTON 1 CC GEL,27003791,CDM,270,RC,,,outpatient,,,969,387.60,,823.65,85,,658.92,percent of total billed charges,85% of total billed charges,746.13,77,,596.9,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,794.58,82,,635.664,percent of total billed charges,82% of total billed charges,823.65,85,,658.92,percent of total billed charges,85% of total billed charges,823.65,85,,658.92,percent of total billed charges,85% of total billed charges,823.65,85,,658.92,percent of total billed charges,85% of total billed charges,872.1,90,,697.68,percent of total billed charges,90% of total billed charges,775.2,80,,620.16,percent of total billed charges,80% of total billed charges,872.1,90,,697.68,percent of total billed charges,90% of total billed charges,726.75,75,,581.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,281.01,29,,224.808,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,649.23,67,,519.384,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,775.2,80,,620.16,percent of total billed charges,80% of total billed charges,629.85,65,,503.88,percent of total billed charges,65% of total billed charges,345.64,35.67,,276.512,percent of total billed charges,35.67% of total billed charges,281.01,872.1,
HEEL AND ELBOW PAD **,27003811,CDM,270,RC,,,outpatient,,,22,8.80,,18.7,85,,14.96,percent of total billed charges,85% of total billed charges,16.94,77,,13.55,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,18.04,82,,14.432,percent of total billed charges,82% of total billed charges,18.7,85,,14.96,percent of total billed charges,85% of total billed charges,18.7,85,,14.96,percent of total billed charges,85% of total billed charges,18.7,85,,14.96,percent of total billed charges,85% of total billed charges,19.8,90,,15.84,percent of total billed charges,90% of total billed charges,17.6,80,,14.08,percent of total billed charges,80% of total billed charges,19.8,90,,15.84,percent of total billed charges,90% of total billed charges,16.5,75,,13.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,6.38,29,,5.104,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,14.74,67,,11.792,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,17.6,80,,14.08,percent of total billed charges,80% of total billed charges,14.3,65,,11.44,percent of total billed charges,65% of total billed charges,7.85,35.67,,6.28,percent of total billed charges,35.67% of total billed charges,6.38,19.8,
BARRIER ISLAND DRESSING **,27003813,CDM,270,RC,,,outpatient,,,24,9.60,,20.4,85,,16.32,percent of total billed charges,85% of total billed charges,18.48,77,,14.78,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,19.68,82,,15.744,percent of total billed charges,82% of total billed charges,20.4,85,,16.32,percent of total billed charges,85% of total billed charges,20.4,85,,16.32,percent of total billed charges,85% of total billed charges,20.4,85,,16.32,percent of total billed charges,85% of total billed charges,21.6,90,,17.28,percent of total billed charges,90% of total billed charges,19.2,80,,15.36,percent of total billed charges,80% of total billed charges,21.6,90,,17.28,percent of total billed charges,90% of total billed charges,18,75,,14.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,6.96,29,,5.568,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,16.08,67,,12.864,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,19.2,80,,15.36,percent of total billed charges,80% of total billed charges,15.6,65,,12.48,percent of total billed charges,65% of total billed charges,8.56,35.67,,6.848,percent of total billed charges,35.67% of total billed charges,6.96,21.6,
NASAL PACKING 450 4.5CM ANT,27003816,CDM,270,RC,,,outpatient,,,322,128.80,,273.7,85,,218.96,percent of total billed charges,85% of total billed charges,247.94,77,,198.35,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,264.04,82,,211.232,percent of total billed charges,82% of total billed charges,273.7,85,,218.96,percent of total billed charges,85% of total billed charges,273.7,85,,218.96,percent of total billed charges,85% of total billed charges,273.7,85,,218.96,percent of total billed charges,85% of total billed charges,289.8,90,,231.84,percent of total billed charges,90% of total billed charges,257.6,80,,206.08,percent of total billed charges,80% of total billed charges,289.8,90,,231.84,percent of total billed charges,90% of total billed charges,241.5,75,,193.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,93.38,29,,74.704,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,215.74,67,,172.592,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,257.6,80,,206.08,percent of total billed charges,80% of total billed charges,209.3,65,,167.44,percent of total billed charges,65% of total billed charges,114.86,35.67,,91.888,percent of total billed charges,35.67% of total billed charges,93.38,289.8,
NASAL PACKING 550 5.5CM ANT,27003817,CDM,270,RC,,,outpatient,,,219,87.60,,186.15,85,,148.92,percent of total billed charges,85% of total billed charges,168.63,77,,134.9,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,179.58,82,,143.664,percent of total billed charges,82% of total billed charges,186.15,85,,148.92,percent of total billed charges,85% of total billed charges,186.15,85,,148.92,percent of total billed charges,85% of total billed charges,186.15,85,,148.92,percent of total billed charges,85% of total billed charges,197.1,90,,157.68,percent of total billed charges,90% of total billed charges,175.2,80,,140.16,percent of total billed charges,80% of total billed charges,197.1,90,,157.68,percent of total billed charges,90% of total billed charges,164.25,75,,131.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,63.51,29,,50.808,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,146.73,67,,117.384,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,175.2,80,,140.16,percent of total billed charges,80% of total billed charges,142.35,65,,113.88,percent of total billed charges,65% of total billed charges,78.12,35.67,,62.496,percent of total billed charges,35.67% of total billed charges,63.51,197.1,
NASAL PACKING 551 5.5CM ANT,27003818,CDM,270,RC,,,outpatient,,,218,87.20,,185.3,85,,148.24,percent of total billed charges,85% of total billed charges,167.86,77,,134.29,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,178.76,82,,143.008,percent of total billed charges,82% of total billed charges,185.3,85,,148.24,percent of total billed charges,85% of total billed charges,185.3,85,,148.24,percent of total billed charges,85% of total billed charges,185.3,85,,148.24,percent of total billed charges,85% of total billed charges,196.2,90,,156.96,percent of total billed charges,90% of total billed charges,174.4,80,,139.52,percent of total billed charges,80% of total billed charges,196.2,90,,156.96,percent of total billed charges,90% of total billed charges,163.5,75,,130.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,63.22,29,,50.576,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,146.06,67,,116.848,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,174.4,80,,139.52,percent of total billed charges,80% of total billed charges,141.7,65,,113.36,percent of total billed charges,65% of total billed charges,77.76,35.67,,62.208,percent of total billed charges,35.67% of total billed charges,63.22,196.2,
NASAL PACKING 750 7.5CM ANT,27003819,CDM,270,RC,,,outpatient,,,215,86.00,,182.75,85,,146.2,percent of total billed charges,85% of total billed charges,165.55,77,,132.44,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,176.3,82,,141.04,percent of total billed charges,82% of total billed charges,182.75,85,,146.2,percent of total billed charges,85% of total billed charges,182.75,85,,146.2,percent of total billed charges,85% of total billed charges,182.75,85,,146.2,percent of total billed charges,85% of total billed charges,193.5,90,,154.8,percent of total billed charges,90% of total billed charges,172,80,,137.6,percent of total billed charges,80% of total billed charges,193.5,90,,154.8,percent of total billed charges,90% of total billed charges,161.25,75,,129,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,62.35,29,,49.88,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,144.05,67,,115.24,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,172,80,,137.6,percent of total billed charges,80% of total billed charges,139.75,65,,111.8,percent of total billed charges,65% of total billed charges,76.69,35.67,,61.352,percent of total billed charges,35.67% of total billed charges,62.35,193.5,
HOOK SCISSORS **,27003820,CDM,270,RC,,,outpatient,,,563,225.20,,478.55,85,,382.84,percent of total billed charges,85% of total billed charges,433.51,77,,346.81,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,461.66,82,,369.328,percent of total billed charges,82% of total billed charges,478.55,85,,382.84,percent of total billed charges,85% of total billed charges,478.55,85,,382.84,percent of total billed charges,85% of total billed charges,478.55,85,,382.84,percent of total billed charges,85% of total billed charges,506.7,90,,405.36,percent of total billed charges,90% of total billed charges,450.4,80,,360.32,percent of total billed charges,80% of total billed charges,506.7,90,,405.36,percent of total billed charges,90% of total billed charges,422.25,75,,337.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,163.27,29,,130.616,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,377.21,67,,301.768,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,450.4,80,,360.32,percent of total billed charges,80% of total billed charges,365.95,65,,292.76,percent of total billed charges,65% of total billed charges,200.82,35.67,,160.656,percent of total billed charges,35.67% of total billed charges,163.27,506.7,
AEM CORD,27003821,CDM,270,RC,,,outpatient,,,120,48.00,,102,85,,81.6,percent of total billed charges,85% of total billed charges,92.4,77,,73.92,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,98.4,82,,78.72,percent of total billed charges,82% of total billed charges,102,85,,81.6,percent of total billed charges,85% of total billed charges,102,85,,81.6,percent of total billed charges,85% of total billed charges,102,85,,81.6,percent of total billed charges,85% of total billed charges,108,90,,86.4,percent of total billed charges,90% of total billed charges,96,80,,76.8,percent of total billed charges,80% of total billed charges,108,90,,86.4,percent of total billed charges,90% of total billed charges,90,75,,72,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,34.8,29,,27.84,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,80.4,67,,64.32,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,96,80,,76.8,percent of total billed charges,80% of total billed charges,78,65,,62.4,percent of total billed charges,65% of total billed charges,42.8,35.67,,34.24,percent of total billed charges,35.67% of total billed charges,34.8,108,
CURVED SCISSORS,27003822,CDM,270,RC,,,outpatient,,,469,187.60,,398.65,85,,318.92,percent of total billed charges,85% of total billed charges,361.13,77,,288.9,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,384.58,82,,307.664,percent of total billed charges,82% of total billed charges,398.65,85,,318.92,percent of total billed charges,85% of total billed charges,398.65,85,,318.92,percent of total billed charges,85% of total billed charges,398.65,85,,318.92,percent of total billed charges,85% of total billed charges,422.1,90,,337.68,percent of total billed charges,90% of total billed charges,375.2,80,,300.16,percent of total billed charges,80% of total billed charges,422.1,90,,337.68,percent of total billed charges,90% of total billed charges,351.75,75,,281.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,136.01,29,,108.808,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,314.23,67,,251.384,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,375.2,80,,300.16,percent of total billed charges,80% of total billed charges,304.85,65,,243.88,percent of total billed charges,65% of total billed charges,167.29,35.67,,133.832,percent of total billed charges,35.67% of total billed charges,136.01,422.1,
INDERMALTISSUE ADHESIVE **,27003830,CDM,270,RC,,,outpatient,,,204,81.60,,173.4,85,,138.72,percent of total billed charges,85% of total billed charges,157.08,77,,125.66,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,167.28,82,,133.824,percent of total billed charges,82% of total billed charges,173.4,85,,138.72,percent of total billed charges,85% of total billed charges,173.4,85,,138.72,percent of total billed charges,85% of total billed charges,173.4,85,,138.72,percent of total billed charges,85% of total billed charges,183.6,90,,146.88,percent of total billed charges,90% of total billed charges,163.2,80,,130.56,percent of total billed charges,80% of total billed charges,183.6,90,,146.88,percent of total billed charges,90% of total billed charges,153,75,,122.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,59.16,29,,47.328,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,136.68,67,,109.344,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,163.2,80,,130.56,percent of total billed charges,80% of total billed charges,132.6,65,,106.08,percent of total billed charges,65% of total billed charges,72.77,35.67,,58.216,percent of total billed charges,35.67% of total billed charges,59.16,183.6,
"Dressing, Owen's Non-adhere",27003851,CDM,270,RC,,,outpatient,,,22,8.80,,18.7,85,,14.96,percent of total billed charges,85% of total billed charges,16.94,77,,13.55,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,18.04,82,,14.432,percent of total billed charges,82% of total billed charges,18.7,85,,14.96,percent of total billed charges,85% of total billed charges,18.7,85,,14.96,percent of total billed charges,85% of total billed charges,18.7,85,,14.96,percent of total billed charges,85% of total billed charges,19.8,90,,15.84,percent of total billed charges,90% of total billed charges,17.6,80,,14.08,percent of total billed charges,80% of total billed charges,19.8,90,,15.84,percent of total billed charges,90% of total billed charges,16.5,75,,13.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,6.38,29,,5.104,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,14.74,67,,11.792,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,17.6,80,,14.08,percent of total billed charges,80% of total billed charges,14.3,65,,11.44,percent of total billed charges,65% of total billed charges,7.85,35.67,,6.28,percent of total billed charges,35.67% of total billed charges,6.38,19.8,
BALL SURGICAL E1550,27003871,CDM,270,RC,,,outpatient,,,18,7.20,,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,13.86,77,,11.09,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,14.76,82,,11.808,percent of total billed charges,82% of total billed charges,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,16.2,90,,12.96,percent of total billed charges,90% of total billed charges,14.4,80,,11.52,percent of total billed charges,80% of total billed charges,16.2,90,,12.96,percent of total billed charges,90% of total billed charges,13.5,75,,10.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,5.22,29,,4.176,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,12.06,67,,9.648,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,14.4,80,,11.52,percent of total billed charges,80% of total billed charges,11.7,65,,9.36,percent of total billed charges,65% of total billed charges,6.42,35.67,,5.136,percent of total billed charges,35.67% of total billed charges,5.22,16.2,
ACE WRAP STERILE 2,27003916,CDM,270,RC,,,outpatient,,,32,12.80,,27.2,85,,21.76,percent of total billed charges,85% of total billed charges,24.64,77,,19.71,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,26.24,82,,20.992,percent of total billed charges,82% of total billed charges,27.2,85,,21.76,percent of total billed charges,85% of total billed charges,27.2,85,,21.76,percent of total billed charges,85% of total billed charges,27.2,85,,21.76,percent of total billed charges,85% of total billed charges,28.8,90,,23.04,percent of total billed charges,90% of total billed charges,25.6,80,,20.48,percent of total billed charges,80% of total billed charges,28.8,90,,23.04,percent of total billed charges,90% of total billed charges,24,75,,19.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,9.28,29,,7.424,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,21.44,67,,17.152,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,25.6,80,,20.48,percent of total billed charges,80% of total billed charges,20.8,65,,16.64,percent of total billed charges,65% of total billed charges,11.41,35.67,,9.128,percent of total billed charges,35.67% of total billed charges,9.28,28.8,
ACE WRAP STERILE 3,27003917,CDM,270,RC,,,outpatient,,,43,17.20,,36.55,85,,29.24,percent of total billed charges,85% of total billed charges,33.11,77,,26.49,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,35.26,82,,28.208,percent of total billed charges,82% of total billed charges,36.55,85,,29.24,percent of total billed charges,85% of total billed charges,36.55,85,,29.24,percent of total billed charges,85% of total billed charges,36.55,85,,29.24,percent of total billed charges,85% of total billed charges,38.7,90,,30.96,percent of total billed charges,90% of total billed charges,34.4,80,,27.52,percent of total billed charges,80% of total billed charges,38.7,90,,30.96,percent of total billed charges,90% of total billed charges,32.25,75,,25.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,12.47,29,,9.976,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,28.81,67,,23.048,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,34.4,80,,27.52,percent of total billed charges,80% of total billed charges,27.95,65,,22.36,percent of total billed charges,65% of total billed charges,15.34,35.67,,12.272,percent of total billed charges,35.67% of total billed charges,12.47,38.7,
ACE WRAP STERILE 4,27003918,CDM,270,RC,,,outpatient,,,56,22.40,,47.6,85,,38.08,percent of total billed charges,85% of total billed charges,43.12,77,,34.5,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,45.92,82,,36.736,percent of total billed charges,82% of total billed charges,47.6,85,,38.08,percent of total billed charges,85% of total billed charges,47.6,85,,38.08,percent of total billed charges,85% of total billed charges,47.6,85,,38.08,percent of total billed charges,85% of total billed charges,50.4,90,,40.32,percent of total billed charges,90% of total billed charges,44.8,80,,35.84,percent of total billed charges,80% of total billed charges,50.4,90,,40.32,percent of total billed charges,90% of total billed charges,42,75,,33.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,16.24,29,,12.992,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,37.52,67,,30.016,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,44.8,80,,35.84,percent of total billed charges,80% of total billed charges,36.4,65,,29.12,percent of total billed charges,65% of total billed charges,19.98,35.67,,15.984,percent of total billed charges,35.67% of total billed charges,16.24,50.4,
ACE WRAP STERILE 6,27003919,CDM,270,RC,,,outpatient,,,56,22.40,,47.6,85,,38.08,percent of total billed charges,85% of total billed charges,43.12,77,,34.5,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,45.92,82,,36.736,percent of total billed charges,82% of total billed charges,47.6,85,,38.08,percent of total billed charges,85% of total billed charges,47.6,85,,38.08,percent of total billed charges,85% of total billed charges,47.6,85,,38.08,percent of total billed charges,85% of total billed charges,50.4,90,,40.32,percent of total billed charges,90% of total billed charges,44.8,80,,35.84,percent of total billed charges,80% of total billed charges,50.4,90,,40.32,percent of total billed charges,90% of total billed charges,42,75,,33.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,16.24,29,,12.992,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,37.52,67,,30.016,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,44.8,80,,35.84,percent of total billed charges,80% of total billed charges,36.4,65,,29.12,percent of total billed charges,65% of total billed charges,19.98,35.67,,15.984,percent of total billed charges,35.67% of total billed charges,16.24,50.4,
JACKSON REESE BAG,27003923,CDM,270,RC,,,outpatient,,,130,52.00,,110.5,85,,88.4,percent of total billed charges,85% of total billed charges,100.1,77,,80.08,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,106.6,82,,85.28,percent of total billed charges,82% of total billed charges,110.5,85,,88.4,percent of total billed charges,85% of total billed charges,110.5,85,,88.4,percent of total billed charges,85% of total billed charges,110.5,85,,88.4,percent of total billed charges,85% of total billed charges,117,90,,93.6,percent of total billed charges,90% of total billed charges,104,80,,83.2,percent of total billed charges,80% of total billed charges,117,90,,93.6,percent of total billed charges,90% of total billed charges,97.5,75,,78,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,37.7,29,,30.16,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,87.1,67,,69.68,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,104,80,,83.2,percent of total billed charges,80% of total billed charges,84.5,65,,67.6,percent of total billed charges,65% of total billed charges,46.37,35.67,,37.096,percent of total billed charges,35.67% of total billed charges,37.7,117,
OVASSAPIAN AIRWAY,27003924,CDM,270,RC,,,outpatient,,,102,40.80,,86.7,85,,69.36,percent of total billed charges,85% of total billed charges,78.54,77,,62.83,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,83.64,82,,66.912,percent of total billed charges,82% of total billed charges,86.7,85,,69.36,percent of total billed charges,85% of total billed charges,86.7,85,,69.36,percent of total billed charges,85% of total billed charges,86.7,85,,69.36,percent of total billed charges,85% of total billed charges,91.8,90,,73.44,percent of total billed charges,90% of total billed charges,81.6,80,,65.28,percent of total billed charges,80% of total billed charges,91.8,90,,73.44,percent of total billed charges,90% of total billed charges,76.5,75,,61.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,29.58,29,,23.664,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,68.34,67,,54.672,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,81.6,80,,65.28,percent of total billed charges,80% of total billed charges,66.3,65,,53.04,percent of total billed charges,65% of total billed charges,36.38,35.67,,29.104,percent of total billed charges,35.67% of total billed charges,29.58,91.8,
FIBEROPTIC CONNECTOR **,27003925,CDM,270,RC,,,outpatient,,,79,31.60,,67.15,85,,53.72,percent of total billed charges,85% of total billed charges,60.83,77,,48.66,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,64.78,82,,51.824,percent of total billed charges,82% of total billed charges,67.15,85,,53.72,percent of total billed charges,85% of total billed charges,67.15,85,,53.72,percent of total billed charges,85% of total billed charges,67.15,85,,53.72,percent of total billed charges,85% of total billed charges,71.1,90,,56.88,percent of total billed charges,90% of total billed charges,63.2,80,,50.56,percent of total billed charges,80% of total billed charges,71.1,90,,56.88,percent of total billed charges,90% of total billed charges,59.25,75,,47.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,22.91,29,,18.328,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,52.93,67,,42.344,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,63.2,80,,50.56,percent of total billed charges,80% of total billed charges,51.35,65,,41.08,percent of total billed charges,65% of total billed charges,28.18,35.67,,22.544,percent of total billed charges,35.67% of total billed charges,22.91,71.1,
TOUHY NEEDLE 17 G X 5,27003932,CDM,270,RC,,,outpatient,,,107,42.80,,90.95,85,,72.76,percent of total billed charges,85% of total billed charges,82.39,77,,65.91,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,87.74,82,,70.192,percent of total billed charges,82% of total billed charges,90.95,85,,72.76,percent of total billed charges,85% of total billed charges,90.95,85,,72.76,percent of total billed charges,85% of total billed charges,90.95,85,,72.76,percent of total billed charges,85% of total billed charges,96.3,90,,77.04,percent of total billed charges,90% of total billed charges,85.6,80,,68.48,percent of total billed charges,80% of total billed charges,96.3,90,,77.04,percent of total billed charges,90% of total billed charges,80.25,75,,64.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,31.03,29,,24.824,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,71.69,67,,57.352,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,85.6,80,,68.48,percent of total billed charges,80% of total billed charges,69.55,65,,55.64,percent of total billed charges,65% of total billed charges,38.17,35.67,,30.536,percent of total billed charges,35.67% of total billed charges,31.03,96.3,
FASTRACH LMA 6.0,27003941,CDM,270,RC,,,outpatient,,,440,176.00,,374,85,,299.2,percent of total billed charges,85% of total billed charges,338.8,77,,271.04,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,360.8,82,,288.64,percent of total billed charges,82% of total billed charges,374,85,,299.2,percent of total billed charges,85% of total billed charges,374,85,,299.2,percent of total billed charges,85% of total billed charges,374,85,,299.2,percent of total billed charges,85% of total billed charges,396,90,,316.8,percent of total billed charges,90% of total billed charges,352,80,,281.6,percent of total billed charges,80% of total billed charges,396,90,,316.8,percent of total billed charges,90% of total billed charges,330,75,,264,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,127.6,29,,102.08,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,294.8,67,,235.84,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,352,80,,281.6,percent of total billed charges,80% of total billed charges,286,65,,228.8,percent of total billed charges,65% of total billed charges,156.95,35.67,,125.56,percent of total billed charges,35.67% of total billed charges,127.6,396,
FASTRACH LMA 6.5,27003942,CDM,270,RC,,,outpatient,,,440,176.00,,374,85,,299.2,percent of total billed charges,85% of total billed charges,338.8,77,,271.04,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,360.8,82,,288.64,percent of total billed charges,82% of total billed charges,374,85,,299.2,percent of total billed charges,85% of total billed charges,374,85,,299.2,percent of total billed charges,85% of total billed charges,374,85,,299.2,percent of total billed charges,85% of total billed charges,396,90,,316.8,percent of total billed charges,90% of total billed charges,352,80,,281.6,percent of total billed charges,80% of total billed charges,396,90,,316.8,percent of total billed charges,90% of total billed charges,330,75,,264,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,127.6,29,,102.08,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,294.8,67,,235.84,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,352,80,,281.6,percent of total billed charges,80% of total billed charges,286,65,,228.8,percent of total billed charges,65% of total billed charges,156.95,35.67,,125.56,percent of total billed charges,35.67% of total billed charges,127.6,396,
FASTRACH LMA 7.0,27003943,CDM,270,RC,,,outpatient,,,440,176.00,,374,85,,299.2,percent of total billed charges,85% of total billed charges,338.8,77,,271.04,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,360.8,82,,288.64,percent of total billed charges,82% of total billed charges,374,85,,299.2,percent of total billed charges,85% of total billed charges,374,85,,299.2,percent of total billed charges,85% of total billed charges,374,85,,299.2,percent of total billed charges,85% of total billed charges,396,90,,316.8,percent of total billed charges,90% of total billed charges,352,80,,281.6,percent of total billed charges,80% of total billed charges,396,90,,316.8,percent of total billed charges,90% of total billed charges,330,75,,264,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,127.6,29,,102.08,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,294.8,67,,235.84,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,352,80,,281.6,percent of total billed charges,80% of total billed charges,286,65,,228.8,percent of total billed charges,65% of total billed charges,156.95,35.67,,125.56,percent of total billed charges,35.67% of total billed charges,127.6,396,
FASTRACH LMA 7.5,27003944,CDM,270,RC,,,outpatient,,,440,176.00,,374,85,,299.2,percent of total billed charges,85% of total billed charges,338.8,77,,271.04,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,360.8,82,,288.64,percent of total billed charges,82% of total billed charges,374,85,,299.2,percent of total billed charges,85% of total billed charges,374,85,,299.2,percent of total billed charges,85% of total billed charges,374,85,,299.2,percent of total billed charges,85% of total billed charges,396,90,,316.8,percent of total billed charges,90% of total billed charges,352,80,,281.6,percent of total billed charges,80% of total billed charges,396,90,,316.8,percent of total billed charges,90% of total billed charges,330,75,,264,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,127.6,29,,102.08,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,294.8,67,,235.84,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,352,80,,281.6,percent of total billed charges,80% of total billed charges,286,65,,228.8,percent of total billed charges,65% of total billed charges,156.95,35.67,,125.56,percent of total billed charges,35.67% of total billed charges,127.6,396,
FASTRACH LMA 8.0,27003945,CDM,270,RC,,,outpatient,,,440,176.00,,374,85,,299.2,percent of total billed charges,85% of total billed charges,338.8,77,,271.04,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,360.8,82,,288.64,percent of total billed charges,82% of total billed charges,374,85,,299.2,percent of total billed charges,85% of total billed charges,374,85,,299.2,percent of total billed charges,85% of total billed charges,374,85,,299.2,percent of total billed charges,85% of total billed charges,396,90,,316.8,percent of total billed charges,90% of total billed charges,352,80,,281.6,percent of total billed charges,80% of total billed charges,396,90,,316.8,percent of total billed charges,90% of total billed charges,330,75,,264,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,127.6,29,,102.08,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,294.8,67,,235.84,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,352,80,,281.6,percent of total billed charges,80% of total billed charges,286,65,,228.8,percent of total billed charges,65% of total billed charges,156.95,35.67,,125.56,percent of total billed charges,35.67% of total billed charges,127.6,396,
FASTRACH STABILIZING ROD,27003946,CDM,270,RC,,,outpatient,,,237,94.80,,201.45,85,,161.16,percent of total billed charges,85% of total billed charges,182.49,77,,145.99,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,194.34,82,,155.472,percent of total billed charges,82% of total billed charges,201.45,85,,161.16,percent of total billed charges,85% of total billed charges,201.45,85,,161.16,percent of total billed charges,85% of total billed charges,201.45,85,,161.16,percent of total billed charges,85% of total billed charges,213.3,90,,170.64,percent of total billed charges,90% of total billed charges,189.6,80,,151.68,percent of total billed charges,80% of total billed charges,213.3,90,,170.64,percent of total billed charges,90% of total billed charges,177.75,75,,142.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,68.73,29,,54.984,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,158.79,67,,127.032,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,189.6,80,,151.68,percent of total billed charges,80% of total billed charges,154.05,65,,123.24,percent of total billed charges,65% of total billed charges,84.54,35.67,,67.632,percent of total billed charges,35.67% of total billed charges,68.73,213.3,
SUTURE CV-6 30 **,27003948,CDM,270,RC,,,outpatient,,,169,67.60,,143.65,85,,114.92,percent of total billed charges,85% of total billed charges,130.13,77,,104.1,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,138.58,82,,110.864,percent of total billed charges,82% of total billed charges,143.65,85,,114.92,percent of total billed charges,85% of total billed charges,143.65,85,,114.92,percent of total billed charges,85% of total billed charges,143.65,85,,114.92,percent of total billed charges,85% of total billed charges,152.1,90,,121.68,percent of total billed charges,90% of total billed charges,135.2,80,,108.16,percent of total billed charges,80% of total billed charges,152.1,90,,121.68,percent of total billed charges,90% of total billed charges,126.75,75,,101.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,49.01,29,,39.208,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,113.23,67,,90.584,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,135.2,80,,108.16,percent of total billed charges,80% of total billed charges,109.85,65,,87.88,percent of total billed charges,65% of total billed charges,60.28,35.67,,48.224,percent of total billed charges,35.67% of total billed charges,49.01,152.1,
SUTURE CV-7 30 **,27003949,CDM,270,RC,,,outpatient,,,175,70.00,,148.75,85,,119,percent of total billed charges,85% of total billed charges,134.75,77,,107.8,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,143.5,82,,114.8,percent of total billed charges,82% of total billed charges,148.75,85,,119,percent of total billed charges,85% of total billed charges,148.75,85,,119,percent of total billed charges,85% of total billed charges,148.75,85,,119,percent of total billed charges,85% of total billed charges,157.5,90,,126,percent of total billed charges,90% of total billed charges,140,80,,112,percent of total billed charges,80% of total billed charges,157.5,90,,126,percent of total billed charges,90% of total billed charges,131.25,75,,105,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,50.75,29,,40.6,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,117.25,67,,93.8,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,140,80,,112,percent of total billed charges,80% of total billed charges,113.75,65,,91,percent of total billed charges,65% of total billed charges,62.42,35.67,,49.936,percent of total billed charges,35.67% of total billed charges,50.75,157.5,
SPINAL NEEDLE 25 X 5,27003958,CDM,270,RC,,,outpatient,,,51,20.40,,43.35,85,,34.68,percent of total billed charges,85% of total billed charges,39.27,77,,31.42,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,41.82,82,,33.456,percent of total billed charges,82% of total billed charges,43.35,85,,34.68,percent of total billed charges,85% of total billed charges,43.35,85,,34.68,percent of total billed charges,85% of total billed charges,43.35,85,,34.68,percent of total billed charges,85% of total billed charges,45.9,90,,36.72,percent of total billed charges,90% of total billed charges,40.8,80,,32.64,percent of total billed charges,80% of total billed charges,45.9,90,,36.72,percent of total billed charges,90% of total billed charges,38.25,75,,30.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,14.79,29,,11.832,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,34.17,67,,27.336,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,40.8,80,,32.64,percent of total billed charges,80% of total billed charges,33.15,65,,26.52,percent of total billed charges,65% of total billed charges,18.19,35.67,,14.552,percent of total billed charges,35.67% of total billed charges,14.79,45.9,
SPINAL NEEDLE 22 X 5,27003959,CDM,270,RC,,,outpatient,,,59,23.60,,50.15,85,,40.12,percent of total billed charges,85% of total billed charges,45.43,77,,36.34,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,48.38,82,,38.704,percent of total billed charges,82% of total billed charges,50.15,85,,40.12,percent of total billed charges,85% of total billed charges,50.15,85,,40.12,percent of total billed charges,85% of total billed charges,50.15,85,,40.12,percent of total billed charges,85% of total billed charges,53.1,90,,42.48,percent of total billed charges,90% of total billed charges,47.2,80,,37.76,percent of total billed charges,80% of total billed charges,53.1,90,,42.48,percent of total billed charges,90% of total billed charges,44.25,75,,35.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,17.11,29,,13.688,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,39.53,67,,31.624,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,47.2,80,,37.76,percent of total billed charges,80% of total billed charges,38.35,65,,30.68,percent of total billed charges,65% of total billed charges,21.05,35.67,,16.84,percent of total billed charges,35.67% of total billed charges,17.11,53.1,
GLASSSMAN VISCERA RETAINER,27003973,CDM,270,RC,,,outpatient,,,216,86.40,,183.6,85,,146.88,percent of total billed charges,85% of total billed charges,166.32,77,,133.06,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,177.12,82,,141.696,percent of total billed charges,82% of total billed charges,183.6,85,,146.88,percent of total billed charges,85% of total billed charges,183.6,85,,146.88,percent of total billed charges,85% of total billed charges,183.6,85,,146.88,percent of total billed charges,85% of total billed charges,194.4,90,,155.52,percent of total billed charges,90% of total billed charges,172.8,80,,138.24,percent of total billed charges,80% of total billed charges,194.4,90,,155.52,percent of total billed charges,90% of total billed charges,162,75,,129.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,62.64,29,,50.112,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,144.72,67,,115.776,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,172.8,80,,138.24,percent of total billed charges,80% of total billed charges,140.4,65,,112.32,percent of total billed charges,65% of total billed charges,77.05,35.67,,61.64,percent of total billed charges,35.67% of total billed charges,62.64,194.4,
CASSETTE COVER 24X20,27004001,CDM,270,RC,,,outpatient,,,47,18.80,,39.95,85,,31.96,percent of total billed charges,85% of total billed charges,36.19,77,,28.95,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,38.54,82,,30.832,percent of total billed charges,82% of total billed charges,39.95,85,,31.96,percent of total billed charges,85% of total billed charges,39.95,85,,31.96,percent of total billed charges,85% of total billed charges,39.95,85,,31.96,percent of total billed charges,85% of total billed charges,42.3,90,,33.84,percent of total billed charges,90% of total billed charges,37.6,80,,30.08,percent of total billed charges,80% of total billed charges,42.3,90,,33.84,percent of total billed charges,90% of total billed charges,35.25,75,,28.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,13.63,29,,10.904,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,31.49,67,,25.192,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,37.6,80,,30.08,percent of total billed charges,80% of total billed charges,30.55,65,,24.44,percent of total billed charges,65% of total billed charges,16.76,35.67,,13.408,percent of total billed charges,35.67% of total billed charges,13.63,42.3,
SAFETOUCH BOTTLE & TOP,27004003,CDM,270,RC,,,outpatient,,,95,38.00,,80.75,85,,64.6,percent of total billed charges,85% of total billed charges,73.15,77,,58.52,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,77.9,82,,62.32,percent of total billed charges,82% of total billed charges,80.75,85,,64.6,percent of total billed charges,85% of total billed charges,80.75,85,,64.6,percent of total billed charges,85% of total billed charges,80.75,85,,64.6,percent of total billed charges,85% of total billed charges,85.5,90,,68.4,percent of total billed charges,90% of total billed charges,76,80,,60.8,percent of total billed charges,80% of total billed charges,85.5,90,,68.4,percent of total billed charges,90% of total billed charges,71.25,75,,57,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,27.55,29,,22.04,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,63.65,67,,50.92,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,76,80,,60.8,percent of total billed charges,80% of total billed charges,61.75,65,,49.4,percent of total billed charges,65% of total billed charges,33.89,35.67,,27.112,percent of total billed charges,35.67% of total billed charges,27.55,85.5,
MASK WITH STRAP PEDI,27004006,CDM,270,RC,,,outpatient,,,142,56.80,,120.7,85,,96.56,percent of total billed charges,85% of total billed charges,109.34,77,,87.47,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,116.44,82,,93.152,percent of total billed charges,82% of total billed charges,120.7,85,,96.56,percent of total billed charges,85% of total billed charges,120.7,85,,96.56,percent of total billed charges,85% of total billed charges,120.7,85,,96.56,percent of total billed charges,85% of total billed charges,127.8,90,,102.24,percent of total billed charges,90% of total billed charges,113.6,80,,90.88,percent of total billed charges,80% of total billed charges,127.8,90,,102.24,percent of total billed charges,90% of total billed charges,106.5,75,,85.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,41.18,29,,32.944,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,95.14,67,,76.112,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,113.6,80,,90.88,percent of total billed charges,80% of total billed charges,92.3,65,,73.84,percent of total billed charges,65% of total billed charges,50.65,35.67,,40.52,percent of total billed charges,35.67% of total billed charges,41.18,127.8,
SWEE-EASE SUCROSE SOLUTION,27004019,CDM,270,RC,,,outpatient,,,10,4.00,,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,7.7,77,,6.16,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,8.2,82,,6.56,percent of total billed charges,82% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,9,90,,7.2,percent of total billed charges,90% of total billed charges,8,80,,6.4,percent of total billed charges,80% of total billed charges,9,90,,7.2,percent of total billed charges,90% of total billed charges,7.5,75,,6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.9,29,,2.32,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,6.7,67,,5.36,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,8,80,,6.4,percent of total billed charges,80% of total billed charges,6.5,65,,5.2,percent of total billed charges,65% of total billed charges,3.57,35.67,,2.856,percent of total billed charges,35.67% of total billed charges,2.9,9,
ARMBOARD NEONATAL,27004020,CDM,270,RC,,,outpatient,,,17,6.80,,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,13.09,77,,10.47,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,13.94,82,,11.152,percent of total billed charges,82% of total billed charges,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,15.3,90,,12.24,percent of total billed charges,90% of total billed charges,13.6,80,,10.88,percent of total billed charges,80% of total billed charges,15.3,90,,12.24,percent of total billed charges,90% of total billed charges,12.75,75,,10.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,4.93,29,,3.944,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,11.39,67,,9.112,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,13.6,80,,10.88,percent of total billed charges,80% of total billed charges,11.05,65,,8.84,percent of total billed charges,65% of total billed charges,6.06,35.67,,4.848,percent of total billed charges,35.67% of total billed charges,4.93,15.3,
JEJUNAL FEEDING TUBE 18FR,27004021,CDM,270,RC,,,outpatient,,,835,334.00,,709.75,85,,567.8,percent of total billed charges,85% of total billed charges,642.95,77,,514.36,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,684.7,82,,547.76,percent of total billed charges,82% of total billed charges,709.75,85,,567.8,percent of total billed charges,85% of total billed charges,709.75,85,,567.8,percent of total billed charges,85% of total billed charges,709.75,85,,567.8,percent of total billed charges,85% of total billed charges,751.5,90,,601.2,percent of total billed charges,90% of total billed charges,668,80,,534.4,percent of total billed charges,80% of total billed charges,751.5,90,,601.2,percent of total billed charges,90% of total billed charges,626.25,75,,501,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,242.15,29,,193.72,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,559.45,67,,447.56,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,668,80,,534.4,percent of total billed charges,80% of total billed charges,542.75,65,,434.2,percent of total billed charges,65% of total billed charges,297.84,35.67,,238.272,percent of total billed charges,35.67% of total billed charges,242.15,751.5,
IV PCA PUMP FOR BAG,27004023,CDM,270,RC,,,outpatient,,,225,90.00,,191.25,85,,153,percent of total billed charges,85% of total billed charges,173.25,77,,138.6,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,184.5,82,,147.6,percent of total billed charges,82% of total billed charges,191.25,85,,153,percent of total billed charges,85% of total billed charges,191.25,85,,153,percent of total billed charges,85% of total billed charges,191.25,85,,153,percent of total billed charges,85% of total billed charges,202.5,90,,162,percent of total billed charges,90% of total billed charges,180,80,,144,percent of total billed charges,80% of total billed charges,202.5,90,,162,percent of total billed charges,90% of total billed charges,168.75,75,,135,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,65.25,29,,52.2,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,150.75,67,,120.6,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,180,80,,144,percent of total billed charges,80% of total billed charges,146.25,65,,117,percent of total billed charges,65% of total billed charges,80.26,35.67,,64.208,percent of total billed charges,35.67% of total billed charges,65.25,202.5,
SILVASORB SILVER HYDROGEL **,27004036,CDM,270,RC,,,outpatient,,,167,66.80,,141.95,85,,113.56,percent of total billed charges,85% of total billed charges,128.59,77,,102.87,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,136.94,82,,109.552,percent of total billed charges,82% of total billed charges,141.95,85,,113.56,percent of total billed charges,85% of total billed charges,141.95,85,,113.56,percent of total billed charges,85% of total billed charges,141.95,85,,113.56,percent of total billed charges,85% of total billed charges,150.3,90,,120.24,percent of total billed charges,90% of total billed charges,133.6,80,,106.88,percent of total billed charges,80% of total billed charges,150.3,90,,120.24,percent of total billed charges,90% of total billed charges,125.25,75,,100.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,48.43,29,,38.744,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,111.89,67,,89.512,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,133.6,80,,106.88,percent of total billed charges,80% of total billed charges,108.55,65,,86.84,percent of total billed charges,65% of total billed charges,59.57,35.67,,47.656,percent of total billed charges,35.67% of total billed charges,48.43,150.3,
MEDFIL PARTICLES 10ML **,27004037,CDM,270,RC,,,outpatient,,,79,31.60,,67.15,85,,53.72,percent of total billed charges,85% of total billed charges,60.83,77,,48.66,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,64.78,82,,51.824,percent of total billed charges,82% of total billed charges,67.15,85,,53.72,percent of total billed charges,85% of total billed charges,67.15,85,,53.72,percent of total billed charges,85% of total billed charges,67.15,85,,53.72,percent of total billed charges,85% of total billed charges,71.1,90,,56.88,percent of total billed charges,90% of total billed charges,63.2,80,,50.56,percent of total billed charges,80% of total billed charges,71.1,90,,56.88,percent of total billed charges,90% of total billed charges,59.25,75,,47.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,22.91,29,,18.328,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,52.93,67,,42.344,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,63.2,80,,50.56,percent of total billed charges,80% of total billed charges,51.35,65,,41.08,percent of total billed charges,65% of total billed charges,28.18,35.67,,22.544,percent of total billed charges,35.67% of total billed charges,22.91,71.1,
GAUZE BORDERED 4 X 4 (HHC) **,27004038,CDM,270,RC,A6219,HCPCS,outpatient,,,19,7.60,,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,14.63,77,,11.7,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,4.16,385,,,fee schedule,385% of BCBS fee schedule,4.33,401,,,fee schedule,401% of BCBS fee schedule,4.33,401,,,fee schedule,401% of BCBS fee schedule,4.33,401,,,fee schedule,401% of BCBS fee schedule,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,15.2,80,,12.16,percent of total billed charges,80% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,14.25,75,,11.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,5.51,29,,4.408,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,12.73,67,,10.184,percent of total billed charges,67% of total billed charges,1.07,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,15.2,80,,12.16,percent of total billed charges,80% of total billed charges,12.35,65,,9.88,percent of total billed charges,65% of total billed charges,6.78,35.67,,5.424,percent of total billed charges,35.67% of total billed charges,1.07,17.1,
DRESSING SURESITE 4X4.5 **,27004039,CDM,270,RC,,,outpatient,,,11,4.40,,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,8.47,77,,6.78,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,9.02,82,,7.216,percent of total billed charges,82% of total billed charges,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,9.9,90,,7.92,percent of total billed charges,90% of total billed charges,8.8,80,,7.04,percent of total billed charges,80% of total billed charges,9.9,90,,7.92,percent of total billed charges,90% of total billed charges,8.25,75,,6.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,3.19,29,,2.552,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,7.37,67,,5.896,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,8.8,80,,7.04,percent of total billed charges,80% of total billed charges,7.15,65,,5.72,percent of total billed charges,65% of total billed charges,3.92,35.67,,3.136,percent of total billed charges,35.67% of total billed charges,3.19,9.9,
ROTH NET 3X6 **,27004055,CDM,270,RC,,,outpatient,,,623,249.20,,529.55,85,,423.64,percent of total billed charges,85% of total billed charges,479.71,77,,383.77,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,510.86,82,,408.688,percent of total billed charges,82% of total billed charges,529.55,85,,423.64,percent of total billed charges,85% of total billed charges,529.55,85,,423.64,percent of total billed charges,85% of total billed charges,529.55,85,,423.64,percent of total billed charges,85% of total billed charges,560.7,90,,448.56,percent of total billed charges,90% of total billed charges,498.4,80,,398.72,percent of total billed charges,80% of total billed charges,560.7,90,,448.56,percent of total billed charges,90% of total billed charges,467.25,75,,373.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,180.67,29,,144.536,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,417.41,67,,333.928,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,498.4,80,,398.72,percent of total billed charges,80% of total billed charges,404.95,65,,323.96,percent of total billed charges,65% of total billed charges,222.22,35.67,,177.776,percent of total billed charges,35.67% of total billed charges,180.67,560.7,
PACKING IODOFORM STRIP 1/4,27004074,CDM,270,RC,,,outpatient,,,32,12.80,,27.2,85,,21.76,percent of total billed charges,85% of total billed charges,24.64,77,,19.71,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,26.24,82,,20.992,percent of total billed charges,82% of total billed charges,27.2,85,,21.76,percent of total billed charges,85% of total billed charges,27.2,85,,21.76,percent of total billed charges,85% of total billed charges,27.2,85,,21.76,percent of total billed charges,85% of total billed charges,28.8,90,,23.04,percent of total billed charges,90% of total billed charges,25.6,80,,20.48,percent of total billed charges,80% of total billed charges,28.8,90,,23.04,percent of total billed charges,90% of total billed charges,24,75,,19.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,9.28,29,,7.424,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,21.44,67,,17.152,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,25.6,80,,20.48,percent of total billed charges,80% of total billed charges,20.8,65,,16.64,percent of total billed charges,65% of total billed charges,11.41,35.67,,9.128,percent of total billed charges,35.67% of total billed charges,9.28,28.8,
EYE PAK DRAPE,27004096,CDM,270,RC,,,outpatient,,,123,49.20,,104.55,85,,83.64,percent of total billed charges,85% of total billed charges,94.71,77,,75.77,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,100.86,82,,80.688,percent of total billed charges,82% of total billed charges,104.55,85,,83.64,percent of total billed charges,85% of total billed charges,104.55,85,,83.64,percent of total billed charges,85% of total billed charges,104.55,85,,83.64,percent of total billed charges,85% of total billed charges,110.7,90,,88.56,percent of total billed charges,90% of total billed charges,98.4,80,,78.72,percent of total billed charges,80% of total billed charges,110.7,90,,88.56,percent of total billed charges,90% of total billed charges,92.25,75,,73.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,35.67,29,,28.536,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,82.41,67,,65.928,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,98.4,80,,78.72,percent of total billed charges,80% of total billed charges,79.95,65,,63.96,percent of total billed charges,65% of total billed charges,43.87,35.67,,35.096,percent of total billed charges,35.67% of total billed charges,35.67,110.7,
SURGICAL BLADE NO 22,27004098,CDM,270,RC,,,outpatient,,,8,3.20,,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,6.16,77,,4.93,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,6.56,82,,5.248,percent of total billed charges,82% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,7.2,90,,5.76,percent of total billed charges,90% of total billed charges,6.4,80,,5.12,percent of total billed charges,80% of total billed charges,7.2,90,,5.76,percent of total billed charges,90% of total billed charges,6,75,,4.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.32,29,,1.856,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,5.36,67,,4.288,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,6.4,80,,5.12,percent of total billed charges,80% of total billed charges,5.2,65,,4.16,percent of total billed charges,65% of total billed charges,2.85,35.67,,2.28,percent of total billed charges,35.67% of total billed charges,2.32,7.2,
FROG SPLINT W/FOAM SM,27004103,CDM,270,RC,,,outpatient,,,16,6.40,,13.6,85,,10.88,percent of total billed charges,85% of total billed charges,12.32,77,,9.86,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,13.12,82,,10.496,percent of total billed charges,82% of total billed charges,13.6,85,,10.88,percent of total billed charges,85% of total billed charges,13.6,85,,10.88,percent of total billed charges,85% of total billed charges,13.6,85,,10.88,percent of total billed charges,85% of total billed charges,14.4,90,,11.52,percent of total billed charges,90% of total billed charges,12.8,80,,10.24,percent of total billed charges,80% of total billed charges,14.4,90,,11.52,percent of total billed charges,90% of total billed charges,12,75,,9.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,4.64,29,,3.712,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,10.72,67,,8.576,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,12.8,80,,10.24,percent of total billed charges,80% of total billed charges,10.4,65,,8.32,percent of total billed charges,65% of total billed charges,5.71,35.67,,4.568,percent of total billed charges,35.67% of total billed charges,4.64,14.4,
FROG FINGER SPLINT MED,27004104,CDM,270,RC,,,outpatient,,,16,6.40,,13.6,85,,10.88,percent of total billed charges,85% of total billed charges,12.32,77,,9.86,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,13.12,82,,10.496,percent of total billed charges,82% of total billed charges,13.6,85,,10.88,percent of total billed charges,85% of total billed charges,13.6,85,,10.88,percent of total billed charges,85% of total billed charges,13.6,85,,10.88,percent of total billed charges,85% of total billed charges,14.4,90,,11.52,percent of total billed charges,90% of total billed charges,12.8,80,,10.24,percent of total billed charges,80% of total billed charges,14.4,90,,11.52,percent of total billed charges,90% of total billed charges,12,75,,9.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,4.64,29,,3.712,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,10.72,67,,8.576,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,12.8,80,,10.24,percent of total billed charges,80% of total billed charges,10.4,65,,8.32,percent of total billed charges,65% of total billed charges,5.71,35.67,,4.568,percent of total billed charges,35.67% of total billed charges,4.64,14.4,
FROG FINGER SPLING LG,27004105,CDM,270,RC,,,outpatient,,,16,6.40,,13.6,85,,10.88,percent of total billed charges,85% of total billed charges,12.32,77,,9.86,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,13.12,82,,10.496,percent of total billed charges,82% of total billed charges,13.6,85,,10.88,percent of total billed charges,85% of total billed charges,13.6,85,,10.88,percent of total billed charges,85% of total billed charges,13.6,85,,10.88,percent of total billed charges,85% of total billed charges,14.4,90,,11.52,percent of total billed charges,90% of total billed charges,12.8,80,,10.24,percent of total billed charges,80% of total billed charges,14.4,90,,11.52,percent of total billed charges,90% of total billed charges,12,75,,9.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,4.64,29,,3.712,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,10.72,67,,8.576,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,12.8,80,,10.24,percent of total billed charges,80% of total billed charges,10.4,65,,8.32,percent of total billed charges,65% of total billed charges,5.71,35.67,,4.568,percent of total billed charges,35.67% of total billed charges,4.64,14.4,
BASEBALL FINGER SPLINT SM,27004106,CDM,270,RC,,,outpatient,,,16,6.40,,13.6,85,,10.88,percent of total billed charges,85% of total billed charges,12.32,77,,9.86,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,13.12,82,,10.496,percent of total billed charges,82% of total billed charges,13.6,85,,10.88,percent of total billed charges,85% of total billed charges,13.6,85,,10.88,percent of total billed charges,85% of total billed charges,13.6,85,,10.88,percent of total billed charges,85% of total billed charges,14.4,90,,11.52,percent of total billed charges,90% of total billed charges,12.8,80,,10.24,percent of total billed charges,80% of total billed charges,14.4,90,,11.52,percent of total billed charges,90% of total billed charges,12,75,,9.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,4.64,29,,3.712,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,10.72,67,,8.576,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,12.8,80,,10.24,percent of total billed charges,80% of total billed charges,10.4,65,,8.32,percent of total billed charges,65% of total billed charges,5.71,35.67,,4.568,percent of total billed charges,35.67% of total billed charges,4.64,14.4,
BASEBALL FINGER SPLINT MED,27004107,CDM,270,RC,,,outpatient,,,16,6.40,,13.6,85,,10.88,percent of total billed charges,85% of total billed charges,12.32,77,,9.86,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,13.12,82,,10.496,percent of total billed charges,82% of total billed charges,13.6,85,,10.88,percent of total billed charges,85% of total billed charges,13.6,85,,10.88,percent of total billed charges,85% of total billed charges,13.6,85,,10.88,percent of total billed charges,85% of total billed charges,14.4,90,,11.52,percent of total billed charges,90% of total billed charges,12.8,80,,10.24,percent of total billed charges,80% of total billed charges,14.4,90,,11.52,percent of total billed charges,90% of total billed charges,12,75,,9.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,4.64,29,,3.712,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,10.72,67,,8.576,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,12.8,80,,10.24,percent of total billed charges,80% of total billed charges,10.4,65,,8.32,percent of total billed charges,65% of total billed charges,5.71,35.67,,4.568,percent of total billed charges,35.67% of total billed charges,4.64,14.4,
BASEBALL SPLINT W/LINING LG,27004108,CDM,270,RC,,,outpatient,,,16,6.40,,13.6,85,,10.88,percent of total billed charges,85% of total billed charges,12.32,77,,9.86,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,13.12,82,,10.496,percent of total billed charges,82% of total billed charges,13.6,85,,10.88,percent of total billed charges,85% of total billed charges,13.6,85,,10.88,percent of total billed charges,85% of total billed charges,13.6,85,,10.88,percent of total billed charges,85% of total billed charges,14.4,90,,11.52,percent of total billed charges,90% of total billed charges,12.8,80,,10.24,percent of total billed charges,80% of total billed charges,14.4,90,,11.52,percent of total billed charges,90% of total billed charges,12,75,,9.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,4.64,29,,3.712,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,10.72,67,,8.576,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,12.8,80,,10.24,percent of total billed charges,80% of total billed charges,10.4,65,,8.32,percent of total billed charges,65% of total billed charges,5.71,35.67,,4.568,percent of total billed charges,35.67% of total billed charges,4.64,14.4,
FOLD OVER SPLINT W/FOAM XS,27004109,CDM,270,RC,,,outpatient,,,18,7.20,,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,13.86,77,,11.09,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,14.76,82,,11.808,percent of total billed charges,82% of total billed charges,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,16.2,90,,12.96,percent of total billed charges,90% of total billed charges,14.4,80,,11.52,percent of total billed charges,80% of total billed charges,16.2,90,,12.96,percent of total billed charges,90% of total billed charges,13.5,75,,10.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,5.22,29,,4.176,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,12.06,67,,9.648,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,14.4,80,,11.52,percent of total billed charges,80% of total billed charges,11.7,65,,9.36,percent of total billed charges,65% of total billed charges,6.42,35.67,,5.136,percent of total billed charges,35.67% of total billed charges,5.22,16.2,
FOLD OVER SPLINT W/FOAM MED,27004110,CDM,270,RC,,,outpatient,,,14,5.60,,11.9,85,,9.52,percent of total billed charges,85% of total billed charges,10.78,77,,8.62,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,11.48,82,,9.184,percent of total billed charges,82% of total billed charges,11.9,85,,9.52,percent of total billed charges,85% of total billed charges,11.9,85,,9.52,percent of total billed charges,85% of total billed charges,11.9,85,,9.52,percent of total billed charges,85% of total billed charges,12.6,90,,10.08,percent of total billed charges,90% of total billed charges,11.2,80,,8.96,percent of total billed charges,80% of total billed charges,12.6,90,,10.08,percent of total billed charges,90% of total billed charges,10.5,75,,8.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,4.06,29,,3.248,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,9.38,67,,7.504,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,11.2,80,,8.96,percent of total billed charges,80% of total billed charges,9.1,65,,7.28,percent of total billed charges,65% of total billed charges,4.99,35.67,,3.992,percent of total billed charges,35.67% of total billed charges,4.06,12.6,
FOLD OVER SPLINT W/FOAM LG,27004111,CDM,270,RC,,,outpatient,,,14,5.60,,11.9,85,,9.52,percent of total billed charges,85% of total billed charges,10.78,77,,8.62,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,11.48,82,,9.184,percent of total billed charges,82% of total billed charges,11.9,85,,9.52,percent of total billed charges,85% of total billed charges,11.9,85,,9.52,percent of total billed charges,85% of total billed charges,11.9,85,,9.52,percent of total billed charges,85% of total billed charges,12.6,90,,10.08,percent of total billed charges,90% of total billed charges,11.2,80,,8.96,percent of total billed charges,80% of total billed charges,12.6,90,,10.08,percent of total billed charges,90% of total billed charges,10.5,75,,8.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,4.06,29,,3.248,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,9.38,67,,7.504,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,11.2,80,,8.96,percent of total billed charges,80% of total billed charges,9.1,65,,7.28,percent of total billed charges,65% of total billed charges,4.99,35.67,,3.992,percent of total billed charges,35.67% of total billed charges,4.06,12.6,
GUTTER FINGER SPLINT 1.5,27004112,CDM,270,RC,,,outpatient,,,13,5.20,,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,10.01,77,,8.01,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,10.66,82,,8.528,percent of total billed charges,82% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,11.7,90,,9.36,percent of total billed charges,90% of total billed charges,10.4,80,,8.32,percent of total billed charges,80% of total billed charges,11.7,90,,9.36,percent of total billed charges,90% of total billed charges,9.75,75,,7.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,3.77,29,,3.016,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,8.71,67,,6.968,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,10.4,80,,8.32,percent of total billed charges,80% of total billed charges,8.45,65,,6.76,percent of total billed charges,65% of total billed charges,4.64,35.67,,3.712,percent of total billed charges,35.67% of total billed charges,3.77,11.7,
BRUSH CYTOLOGY 2.3MMX240CM **,27004132,CDM,270,RC,,,outpatient,,,100,40.00,,85,85,,68,percent of total billed charges,85% of total billed charges,77,77,,61.6,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,82,82,,65.6,percent of total billed charges,82% of total billed charges,85,85,,68,percent of total billed charges,85% of total billed charges,85,85,,68,percent of total billed charges,85% of total billed charges,85,85,,68,percent of total billed charges,85% of total billed charges,90,90,,72,percent of total billed charges,90% of total billed charges,80,80,,64,percent of total billed charges,80% of total billed charges,90,90,,72,percent of total billed charges,90% of total billed charges,75,75,,60,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,29,29,,23.2,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,67,67,,53.6,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,80,80,,64,percent of total billed charges,80% of total billed charges,65,65,,52,percent of total billed charges,65% of total billed charges,35.67,35.67,,28.536,percent of total billed charges,35.67% of total billed charges,29,90,
TI-CRON 0 SUTURE **,27004142,CDM,270,RC,,,outpatient,,,180,72.00,,153,85,,122.4,percent of total billed charges,85% of total billed charges,138.6,77,,110.88,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,147.6,82,,118.08,percent of total billed charges,82% of total billed charges,153,85,,122.4,percent of total billed charges,85% of total billed charges,153,85,,122.4,percent of total billed charges,85% of total billed charges,153,85,,122.4,percent of total billed charges,85% of total billed charges,162,90,,129.6,percent of total billed charges,90% of total billed charges,144,80,,115.2,percent of total billed charges,80% of total billed charges,162,90,,129.6,percent of total billed charges,90% of total billed charges,135,75,,108,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,52.2,29,,41.76,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,120.6,67,,96.48,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,144,80,,115.2,percent of total billed charges,80% of total billed charges,117,65,,93.6,percent of total billed charges,65% of total billed charges,64.21,35.67,,51.368,percent of total billed charges,35.67% of total billed charges,52.2,162,
POLYSORB 0 SUTURE,27004146,CDM,270,RC,,,outpatient,,,203,81.20,,172.55,85,,138.04,percent of total billed charges,85% of total billed charges,156.31,77,,125.05,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,166.46,82,,133.168,percent of total billed charges,82% of total billed charges,172.55,85,,138.04,percent of total billed charges,85% of total billed charges,172.55,85,,138.04,percent of total billed charges,85% of total billed charges,172.55,85,,138.04,percent of total billed charges,85% of total billed charges,182.7,90,,146.16,percent of total billed charges,90% of total billed charges,162.4,80,,129.92,percent of total billed charges,80% of total billed charges,182.7,90,,146.16,percent of total billed charges,90% of total billed charges,152.25,75,,121.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,58.87,29,,47.096,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,136.01,67,,108.808,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,162.4,80,,129.92,percent of total billed charges,80% of total billed charges,131.95,65,,105.56,percent of total billed charges,65% of total billed charges,72.41,35.67,,57.928,percent of total billed charges,35.67% of total billed charges,58.87,182.7,
POLYSORB 1-0 SUTURE,27004147,CDM,270,RC,,,outpatient,,,231,92.40,,196.35,85,,157.08,percent of total billed charges,85% of total billed charges,177.87,77,,142.3,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,189.42,82,,151.536,percent of total billed charges,82% of total billed charges,196.35,85,,157.08,percent of total billed charges,85% of total billed charges,196.35,85,,157.08,percent of total billed charges,85% of total billed charges,196.35,85,,157.08,percent of total billed charges,85% of total billed charges,207.9,90,,166.32,percent of total billed charges,90% of total billed charges,184.8,80,,147.84,percent of total billed charges,80% of total billed charges,207.9,90,,166.32,percent of total billed charges,90% of total billed charges,173.25,75,,138.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,66.99,29,,53.592,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,154.77,67,,123.816,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,184.8,80,,147.84,percent of total billed charges,80% of total billed charges,150.15,65,,120.12,percent of total billed charges,65% of total billed charges,82.4,35.67,,65.92,percent of total billed charges,35.67% of total billed charges,66.99,207.9,
POLYSORB 1 SUTURE,27004148,CDM,270,RC,,,outpatient,,,111,44.40,,94.35,85,,75.48,percent of total billed charges,85% of total billed charges,85.47,77,,68.38,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,91.02,82,,72.816,percent of total billed charges,82% of total billed charges,94.35,85,,75.48,percent of total billed charges,85% of total billed charges,94.35,85,,75.48,percent of total billed charges,85% of total billed charges,94.35,85,,75.48,percent of total billed charges,85% of total billed charges,99.9,90,,79.92,percent of total billed charges,90% of total billed charges,88.8,80,,71.04,percent of total billed charges,80% of total billed charges,99.9,90,,79.92,percent of total billed charges,90% of total billed charges,83.25,75,,66.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,32.19,29,,25.752,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,74.37,67,,59.496,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,88.8,80,,71.04,percent of total billed charges,80% of total billed charges,72.15,65,,57.72,percent of total billed charges,65% of total billed charges,39.59,35.67,,31.672,percent of total billed charges,35.67% of total billed charges,32.19,99.9,
CHROMIC 1-0 SUTURE,27004150,CDM,270,RC,,,outpatient,,,102,40.80,,86.7,85,,69.36,percent of total billed charges,85% of total billed charges,78.54,77,,62.83,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,83.64,82,,66.912,percent of total billed charges,82% of total billed charges,86.7,85,,69.36,percent of total billed charges,85% of total billed charges,86.7,85,,69.36,percent of total billed charges,85% of total billed charges,86.7,85,,69.36,percent of total billed charges,85% of total billed charges,91.8,90,,73.44,percent of total billed charges,90% of total billed charges,81.6,80,,65.28,percent of total billed charges,80% of total billed charges,91.8,90,,73.44,percent of total billed charges,90% of total billed charges,76.5,75,,61.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,29.58,29,,23.664,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,68.34,67,,54.672,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,81.6,80,,65.28,percent of total billed charges,80% of total billed charges,66.3,65,,53.04,percent of total billed charges,65% of total billed charges,36.38,35.67,,29.104,percent of total billed charges,35.67% of total billed charges,29.58,91.8,
CHROMIC 3-0 SUTURE **,27004151,CDM,270,RC,,,outpatient,,,25,10.00,,21.25,85,,17,percent of total billed charges,85% of total billed charges,19.25,77,,15.4,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,20.5,82,,16.4,percent of total billed charges,82% of total billed charges,21.25,85,,17,percent of total billed charges,85% of total billed charges,21.25,85,,17,percent of total billed charges,85% of total billed charges,21.25,85,,17,percent of total billed charges,85% of total billed charges,22.5,90,,18,percent of total billed charges,90% of total billed charges,20,80,,16,percent of total billed charges,80% of total billed charges,22.5,90,,18,percent of total billed charges,90% of total billed charges,18.75,75,,15,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,7.25,29,,5.8,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,16.75,67,,13.4,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,20,80,,16,percent of total billed charges,80% of total billed charges,16.25,65,,13,percent of total billed charges,65% of total billed charges,8.92,35.67,,7.136,percent of total billed charges,35.67% of total billed charges,7.25,22.5,
BIOSYN 0 SUTURE **,27004152,CDM,270,RC,,,outpatient,,,97,38.80,,82.45,85,,65.96,percent of total billed charges,85% of total billed charges,74.69,77,,59.75,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,79.54,82,,63.632,percent of total billed charges,82% of total billed charges,82.45,85,,65.96,percent of total billed charges,85% of total billed charges,82.45,85,,65.96,percent of total billed charges,85% of total billed charges,82.45,85,,65.96,percent of total billed charges,85% of total billed charges,87.3,90,,69.84,percent of total billed charges,90% of total billed charges,77.6,80,,62.08,percent of total billed charges,80% of total billed charges,87.3,90,,69.84,percent of total billed charges,90% of total billed charges,72.75,75,,58.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,28.13,29,,22.504,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,64.99,67,,51.992,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,77.6,80,,62.08,percent of total billed charges,80% of total billed charges,63.05,65,,50.44,percent of total billed charges,65% of total billed charges,34.6,35.67,,27.68,percent of total billed charges,35.67% of total billed charges,28.13,87.3,
BIOSYN 2-0 SUTURE **,27004153,CDM,270,RC,,,outpatient,,,23,9.20,,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,17.71,77,,14.17,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,18.86,82,,15.088,percent of total billed charges,82% of total billed charges,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,20.7,90,,16.56,percent of total billed charges,90% of total billed charges,18.4,80,,14.72,percent of total billed charges,80% of total billed charges,20.7,90,,16.56,percent of total billed charges,90% of total billed charges,17.25,75,,13.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,6.67,29,,5.336,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,15.41,67,,12.328,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,18.4,80,,14.72,percent of total billed charges,80% of total billed charges,14.95,65,,11.96,percent of total billed charges,65% of total billed charges,8.2,35.67,,6.56,percent of total billed charges,35.67% of total billed charges,6.67,20.7,
BIOSYN 4-0 SUTURE,27004154,CDM,270,RC,,,outpatient,,,111,44.40,,94.35,85,,75.48,percent of total billed charges,85% of total billed charges,85.47,77,,68.38,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,91.02,82,,72.816,percent of total billed charges,82% of total billed charges,94.35,85,,75.48,percent of total billed charges,85% of total billed charges,94.35,85,,75.48,percent of total billed charges,85% of total billed charges,94.35,85,,75.48,percent of total billed charges,85% of total billed charges,99.9,90,,79.92,percent of total billed charges,90% of total billed charges,88.8,80,,71.04,percent of total billed charges,80% of total billed charges,99.9,90,,79.92,percent of total billed charges,90% of total billed charges,83.25,75,,66.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,32.19,29,,25.752,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,74.37,67,,59.496,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,88.8,80,,71.04,percent of total billed charges,80% of total billed charges,72.15,65,,57.72,percent of total billed charges,65% of total billed charges,39.59,35.67,,31.672,percent of total billed charges,35.67% of total billed charges,32.19,99.9,
BIOSYN 3-0 SUTURE **,27004155,CDM,270,RC,,,outpatient,,,102,40.80,,86.7,85,,69.36,percent of total billed charges,85% of total billed charges,78.54,77,,62.83,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,83.64,82,,66.912,percent of total billed charges,82% of total billed charges,86.7,85,,69.36,percent of total billed charges,85% of total billed charges,86.7,85,,69.36,percent of total billed charges,85% of total billed charges,86.7,85,,69.36,percent of total billed charges,85% of total billed charges,91.8,90,,73.44,percent of total billed charges,90% of total billed charges,81.6,80,,65.28,percent of total billed charges,80% of total billed charges,91.8,90,,73.44,percent of total billed charges,90% of total billed charges,76.5,75,,61.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,29.58,29,,23.664,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,68.34,67,,54.672,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,81.6,80,,65.28,percent of total billed charges,80% of total billed charges,66.3,65,,53.04,percent of total billed charges,65% of total billed charges,36.38,35.67,,29.104,percent of total billed charges,35.67% of total billed charges,29.58,91.8,
SOFSILK 2-0 SUTURE **,27004158,CDM,270,RC,,,outpatient,,,64,25.60,,54.4,85,,43.52,percent of total billed charges,85% of total billed charges,49.28,77,,39.42,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,52.48,82,,41.984,percent of total billed charges,82% of total billed charges,54.4,85,,43.52,percent of total billed charges,85% of total billed charges,54.4,85,,43.52,percent of total billed charges,85% of total billed charges,54.4,85,,43.52,percent of total billed charges,85% of total billed charges,57.6,90,,46.08,percent of total billed charges,90% of total billed charges,51.2,80,,40.96,percent of total billed charges,80% of total billed charges,57.6,90,,46.08,percent of total billed charges,90% of total billed charges,48,75,,38.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,18.56,29,,14.848,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,42.88,67,,34.304,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,51.2,80,,40.96,percent of total billed charges,80% of total billed charges,41.6,65,,33.28,percent of total billed charges,65% of total billed charges,22.83,35.67,,18.264,percent of total billed charges,35.67% of total billed charges,18.56,57.6,
SOFSILK 0 SUTURE,27004159,CDM,270,RC,,,outpatient,,,60,24.00,,51,85,,40.8,percent of total billed charges,85% of total billed charges,46.2,77,,36.96,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,49.2,82,,39.36,percent of total billed charges,82% of total billed charges,51,85,,40.8,percent of total billed charges,85% of total billed charges,51,85,,40.8,percent of total billed charges,85% of total billed charges,51,85,,40.8,percent of total billed charges,85% of total billed charges,54,90,,43.2,percent of total billed charges,90% of total billed charges,48,80,,38.4,percent of total billed charges,80% of total billed charges,54,90,,43.2,percent of total billed charges,90% of total billed charges,45,75,,36,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,17.4,29,,13.92,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,40.2,67,,32.16,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,48,80,,38.4,percent of total billed charges,80% of total billed charges,39,65,,31.2,percent of total billed charges,65% of total billed charges,21.4,35.67,,17.12,percent of total billed charges,35.67% of total billed charges,17.4,54,
SOFSILK 3-0 SUTURE **,27004160,CDM,270,RC,,,outpatient,,,30,12.00,,25.5,85,,20.4,percent of total billed charges,85% of total billed charges,23.1,77,,18.48,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,24.6,82,,19.68,percent of total billed charges,82% of total billed charges,25.5,85,,20.4,percent of total billed charges,85% of total billed charges,25.5,85,,20.4,percent of total billed charges,85% of total billed charges,25.5,85,,20.4,percent of total billed charges,85% of total billed charges,27,90,,21.6,percent of total billed charges,90% of total billed charges,24,80,,19.2,percent of total billed charges,80% of total billed charges,27,90,,21.6,percent of total billed charges,90% of total billed charges,22.5,75,,18,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,8.7,29,,6.96,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,20.1,67,,16.08,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,24,80,,19.2,percent of total billed charges,80% of total billed charges,19.5,65,,15.6,percent of total billed charges,65% of total billed charges,10.7,35.67,,8.56,percent of total billed charges,35.67% of total billed charges,8.7,27,
SILK 6-0 SUTURE **,27004162,CDM,270,RC,,,outpatient,,,217,86.80,,184.45,85,,147.56,percent of total billed charges,85% of total billed charges,167.09,77,,133.67,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,177.94,82,,142.352,percent of total billed charges,82% of total billed charges,184.45,85,,147.56,percent of total billed charges,85% of total billed charges,184.45,85,,147.56,percent of total billed charges,85% of total billed charges,184.45,85,,147.56,percent of total billed charges,85% of total billed charges,195.3,90,,156.24,percent of total billed charges,90% of total billed charges,173.6,80,,138.88,percent of total billed charges,80% of total billed charges,195.3,90,,156.24,percent of total billed charges,90% of total billed charges,162.75,75,,130.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,62.93,29,,50.344,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,145.39,67,,116.312,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,173.6,80,,138.88,percent of total billed charges,80% of total billed charges,141.05,65,,112.84,percent of total billed charges,65% of total billed charges,77.4,35.67,,61.92,percent of total billed charges,35.67% of total billed charges,62.93,195.3,
SURGIGUT 3-0 SUTURE **,27004163,CDM,270,RC,,,outpatient,,,22,8.80,,18.7,85,,14.96,percent of total billed charges,85% of total billed charges,16.94,77,,13.55,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,18.04,82,,14.432,percent of total billed charges,82% of total billed charges,18.7,85,,14.96,percent of total billed charges,85% of total billed charges,18.7,85,,14.96,percent of total billed charges,85% of total billed charges,18.7,85,,14.96,percent of total billed charges,85% of total billed charges,19.8,90,,15.84,percent of total billed charges,90% of total billed charges,17.6,80,,14.08,percent of total billed charges,80% of total billed charges,19.8,90,,15.84,percent of total billed charges,90% of total billed charges,16.5,75,,13.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,6.38,29,,5.104,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,14.74,67,,11.792,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,17.6,80,,14.08,percent of total billed charges,80% of total billed charges,14.3,65,,11.44,percent of total billed charges,65% of total billed charges,7.85,35.67,,6.28,percent of total billed charges,35.67% of total billed charges,6.38,19.8,
SUTURE FAST SORB 5-0 18,27004164,CDM,270,RC,,,outpatient,,,213,85.20,,181.05,85,,144.84,percent of total billed charges,85% of total billed charges,164.01,77,,131.21,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,174.66,82,,139.728,percent of total billed charges,82% of total billed charges,181.05,85,,144.84,percent of total billed charges,85% of total billed charges,181.05,85,,144.84,percent of total billed charges,85% of total billed charges,181.05,85,,144.84,percent of total billed charges,85% of total billed charges,191.7,90,,153.36,percent of total billed charges,90% of total billed charges,170.4,80,,136.32,percent of total billed charges,80% of total billed charges,191.7,90,,153.36,percent of total billed charges,90% of total billed charges,159.75,75,,127.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,61.77,29,,49.416,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,142.71,67,,114.168,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,170.4,80,,136.32,percent of total billed charges,80% of total billed charges,138.45,65,,110.76,percent of total billed charges,65% of total billed charges,75.98,35.67,,60.784,percent of total billed charges,35.67% of total billed charges,61.77,191.7,
SUTURE BONE WAX,27004165,CDM,270,RC,,,outpatient,,,111,44.40,,94.35,85,,75.48,percent of total billed charges,85% of total billed charges,85.47,77,,68.38,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,91.02,82,,72.816,percent of total billed charges,82% of total billed charges,94.35,85,,75.48,percent of total billed charges,85% of total billed charges,94.35,85,,75.48,percent of total billed charges,85% of total billed charges,94.35,85,,75.48,percent of total billed charges,85% of total billed charges,99.9,90,,79.92,percent of total billed charges,90% of total billed charges,88.8,80,,71.04,percent of total billed charges,80% of total billed charges,99.9,90,,79.92,percent of total billed charges,90% of total billed charges,83.25,75,,66.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,32.19,29,,25.752,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,74.37,67,,59.496,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,88.8,80,,71.04,percent of total billed charges,80% of total billed charges,72.15,65,,57.72,percent of total billed charges,65% of total billed charges,39.59,35.67,,31.672,percent of total billed charges,35.67% of total billed charges,32.19,99.9,
ETHIBOND 2-0 SUTURE **,27004166,CDM,270,RC,,,outpatient,,,131,52.40,,111.35,85,,89.08,percent of total billed charges,85% of total billed charges,100.87,77,,80.7,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,107.42,82,,85.936,percent of total billed charges,82% of total billed charges,111.35,85,,89.08,percent of total billed charges,85% of total billed charges,111.35,85,,89.08,percent of total billed charges,85% of total billed charges,111.35,85,,89.08,percent of total billed charges,85% of total billed charges,117.9,90,,94.32,percent of total billed charges,90% of total billed charges,104.8,80,,83.84,percent of total billed charges,80% of total billed charges,117.9,90,,94.32,percent of total billed charges,90% of total billed charges,98.25,75,,78.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,37.99,29,,30.392,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,87.77,67,,70.216,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,104.8,80,,83.84,percent of total billed charges,80% of total billed charges,85.15,65,,68.12,percent of total billed charges,65% of total billed charges,46.73,35.67,,37.384,percent of total billed charges,35.67% of total billed charges,37.99,117.9,
POLYSORB 3-0 SUTURE **,27004167,CDM,270,RC,,,outpatient,,,42,16.80,,35.7,85,,28.56,percent of total billed charges,85% of total billed charges,32.34,77,,25.87,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,34.44,82,,27.552,percent of total billed charges,82% of total billed charges,35.7,85,,28.56,percent of total billed charges,85% of total billed charges,35.7,85,,28.56,percent of total billed charges,85% of total billed charges,35.7,85,,28.56,percent of total billed charges,85% of total billed charges,37.8,90,,30.24,percent of total billed charges,90% of total billed charges,33.6,80,,26.88,percent of total billed charges,80% of total billed charges,37.8,90,,30.24,percent of total billed charges,90% of total billed charges,31.5,75,,25.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,12.18,29,,9.744,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,28.14,67,,22.512,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,33.6,80,,26.88,percent of total billed charges,80% of total billed charges,27.3,65,,21.84,percent of total billed charges,65% of total billed charges,14.98,35.67,,11.984,percent of total billed charges,35.67% of total billed charges,12.18,37.8,
POLYSORB 4-0 SUTURE,27004168,CDM,270,RC,,,outpatient,,,113,45.20,,96.05,85,,76.84,percent of total billed charges,85% of total billed charges,87.01,77,,69.61,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,92.66,82,,74.128,percent of total billed charges,82% of total billed charges,96.05,85,,76.84,percent of total billed charges,85% of total billed charges,96.05,85,,76.84,percent of total billed charges,85% of total billed charges,96.05,85,,76.84,percent of total billed charges,85% of total billed charges,101.7,90,,81.36,percent of total billed charges,90% of total billed charges,90.4,80,,72.32,percent of total billed charges,80% of total billed charges,101.7,90,,81.36,percent of total billed charges,90% of total billed charges,84.75,75,,67.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,32.77,29,,26.216,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,75.71,67,,60.568,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,90.4,80,,72.32,percent of total billed charges,80% of total billed charges,73.45,65,,58.76,percent of total billed charges,65% of total billed charges,40.31,35.67,,32.248,percent of total billed charges,35.67% of total billed charges,32.77,101.7,
MONSOFT 2-0 SUTURE,27004169,CDM,270,RC,,,outpatient,,,87,34.80,,73.95,85,,59.16,percent of total billed charges,85% of total billed charges,66.99,77,,53.59,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,71.34,82,,57.072,percent of total billed charges,82% of total billed charges,73.95,85,,59.16,percent of total billed charges,85% of total billed charges,73.95,85,,59.16,percent of total billed charges,85% of total billed charges,73.95,85,,59.16,percent of total billed charges,85% of total billed charges,78.3,90,,62.64,percent of total billed charges,90% of total billed charges,69.6,80,,55.68,percent of total billed charges,80% of total billed charges,78.3,90,,62.64,percent of total billed charges,90% of total billed charges,65.25,75,,52.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,25.23,29,,20.184,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,58.29,67,,46.632,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,69.6,80,,55.68,percent of total billed charges,80% of total billed charges,56.55,65,,45.24,percent of total billed charges,65% of total billed charges,31.03,35.67,,24.824,percent of total billed charges,35.67% of total billed charges,25.23,78.3,
SURGIPRO 2-0 SUTURE,27004170,CDM,270,RC,,,outpatient,,,162,64.80,,137.7,85,,110.16,percent of total billed charges,85% of total billed charges,124.74,77,,99.79,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,132.84,82,,106.272,percent of total billed charges,82% of total billed charges,137.7,85,,110.16,percent of total billed charges,85% of total billed charges,137.7,85,,110.16,percent of total billed charges,85% of total billed charges,137.7,85,,110.16,percent of total billed charges,85% of total billed charges,145.8,90,,116.64,percent of total billed charges,90% of total billed charges,129.6,80,,103.68,percent of total billed charges,80% of total billed charges,145.8,90,,116.64,percent of total billed charges,90% of total billed charges,121.5,75,,97.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,46.98,29,,37.584,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,108.54,67,,86.832,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,129.6,80,,103.68,percent of total billed charges,80% of total billed charges,105.3,65,,84.24,percent of total billed charges,65% of total billed charges,57.79,35.67,,46.232,percent of total billed charges,35.67% of total billed charges,46.98,145.8,
SURGIPRO 2-0 SUTURE **,27004171,CDM,270,RC,,,outpatient,,,24,9.60,,20.4,85,,16.32,percent of total billed charges,85% of total billed charges,18.48,77,,14.78,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,19.68,82,,15.744,percent of total billed charges,82% of total billed charges,20.4,85,,16.32,percent of total billed charges,85% of total billed charges,20.4,85,,16.32,percent of total billed charges,85% of total billed charges,20.4,85,,16.32,percent of total billed charges,85% of total billed charges,21.6,90,,17.28,percent of total billed charges,90% of total billed charges,19.2,80,,15.36,percent of total billed charges,80% of total billed charges,21.6,90,,17.28,percent of total billed charges,90% of total billed charges,18,75,,14.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,6.96,29,,5.568,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,16.08,67,,12.864,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,19.2,80,,15.36,percent of total billed charges,80% of total billed charges,15.6,65,,12.48,percent of total billed charges,65% of total billed charges,8.56,35.67,,6.848,percent of total billed charges,35.67% of total billed charges,6.96,21.6,
SURGIPRO 5-0 SUTURE **,27004172,CDM,270,RC,,,outpatient,,,27,10.80,,22.95,85,,18.36,percent of total billed charges,85% of total billed charges,20.79,77,,16.63,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,22.14,82,,17.712,percent of total billed charges,82% of total billed charges,22.95,85,,18.36,percent of total billed charges,85% of total billed charges,22.95,85,,18.36,percent of total billed charges,85% of total billed charges,22.95,85,,18.36,percent of total billed charges,85% of total billed charges,24.3,90,,19.44,percent of total billed charges,90% of total billed charges,21.6,80,,17.28,percent of total billed charges,80% of total billed charges,24.3,90,,19.44,percent of total billed charges,90% of total billed charges,20.25,75,,16.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,7.83,29,,6.264,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,18.09,67,,14.472,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,21.6,80,,17.28,percent of total billed charges,80% of total billed charges,17.55,65,,14.04,percent of total billed charges,65% of total billed charges,9.63,35.67,,7.704,percent of total billed charges,35.67% of total billed charges,7.83,24.3,
SURGIPRO 6-0 SUTURE **,27004173,CDM,270,RC,,,outpatient,,,51,20.40,,43.35,85,,34.68,percent of total billed charges,85% of total billed charges,39.27,77,,31.42,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,41.82,82,,33.456,percent of total billed charges,82% of total billed charges,43.35,85,,34.68,percent of total billed charges,85% of total billed charges,43.35,85,,34.68,percent of total billed charges,85% of total billed charges,43.35,85,,34.68,percent of total billed charges,85% of total billed charges,45.9,90,,36.72,percent of total billed charges,90% of total billed charges,40.8,80,,32.64,percent of total billed charges,80% of total billed charges,45.9,90,,36.72,percent of total billed charges,90% of total billed charges,38.25,75,,30.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,14.79,29,,11.832,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,34.17,67,,27.336,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,40.8,80,,32.64,percent of total billed charges,80% of total billed charges,33.15,65,,26.52,percent of total billed charges,65% of total billed charges,18.19,35.67,,14.552,percent of total billed charges,35.67% of total billed charges,14.79,45.9,
CAPROSYN 5-0 SUTURE **,27004176,CDM,270,RC,,,outpatient,,,93,37.20,,79.05,85,,63.24,percent of total billed charges,85% of total billed charges,71.61,77,,57.29,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,76.26,82,,61.008,percent of total billed charges,82% of total billed charges,79.05,85,,63.24,percent of total billed charges,85% of total billed charges,79.05,85,,63.24,percent of total billed charges,85% of total billed charges,79.05,85,,63.24,percent of total billed charges,85% of total billed charges,83.7,90,,66.96,percent of total billed charges,90% of total billed charges,74.4,80,,59.52,percent of total billed charges,80% of total billed charges,83.7,90,,66.96,percent of total billed charges,90% of total billed charges,69.75,75,,55.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,26.97,29,,21.576,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,62.31,67,,49.848,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,74.4,80,,59.52,percent of total billed charges,80% of total billed charges,60.45,65,,48.36,percent of total billed charges,65% of total billed charges,33.17,35.67,,26.536,percent of total billed charges,35.67% of total billed charges,26.97,83.7,
SURGIPRO 1-0 SUTURE,27004177,CDM,270,RC,,,outpatient,,,97,38.80,,82.45,85,,65.96,percent of total billed charges,85% of total billed charges,74.69,77,,59.75,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,79.54,82,,63.632,percent of total billed charges,82% of total billed charges,82.45,85,,65.96,percent of total billed charges,85% of total billed charges,82.45,85,,65.96,percent of total billed charges,85% of total billed charges,82.45,85,,65.96,percent of total billed charges,85% of total billed charges,87.3,90,,69.84,percent of total billed charges,90% of total billed charges,77.6,80,,62.08,percent of total billed charges,80% of total billed charges,87.3,90,,69.84,percent of total billed charges,90% of total billed charges,72.75,75,,58.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,28.13,29,,22.504,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,64.99,67,,51.992,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,77.6,80,,62.08,percent of total billed charges,80% of total billed charges,63.05,65,,50.44,percent of total billed charges,65% of total billed charges,34.6,35.67,,27.68,percent of total billed charges,35.67% of total billed charges,28.13,87.3,
SURGIPRO 7-0 SUTURE **,27004178,CDM,270,RC,,,outpatient,,,71,28.40,,60.35,85,,48.28,percent of total billed charges,85% of total billed charges,54.67,77,,43.74,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,58.22,82,,46.576,percent of total billed charges,82% of total billed charges,60.35,85,,48.28,percent of total billed charges,85% of total billed charges,60.35,85,,48.28,percent of total billed charges,85% of total billed charges,60.35,85,,48.28,percent of total billed charges,85% of total billed charges,63.9,90,,51.12,percent of total billed charges,90% of total billed charges,56.8,80,,45.44,percent of total billed charges,80% of total billed charges,63.9,90,,51.12,percent of total billed charges,90% of total billed charges,53.25,75,,42.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,20.59,29,,16.472,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,47.57,67,,38.056,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,56.8,80,,45.44,percent of total billed charges,80% of total billed charges,46.15,65,,36.92,percent of total billed charges,65% of total billed charges,25.33,35.67,,20.264,percent of total billed charges,35.67% of total billed charges,20.59,63.9,
SURGIPRO 5-0 SUTURE **,27004179,CDM,270,RC,,,outpatient,,,63,25.20,,53.55,85,,42.84,percent of total billed charges,85% of total billed charges,48.51,77,,38.81,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,51.66,82,,41.328,percent of total billed charges,82% of total billed charges,53.55,85,,42.84,percent of total billed charges,85% of total billed charges,53.55,85,,42.84,percent of total billed charges,85% of total billed charges,53.55,85,,42.84,percent of total billed charges,85% of total billed charges,56.7,90,,45.36,percent of total billed charges,90% of total billed charges,50.4,80,,40.32,percent of total billed charges,80% of total billed charges,56.7,90,,45.36,percent of total billed charges,90% of total billed charges,47.25,75,,37.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,18.27,29,,14.616,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,42.21,67,,33.768,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,50.4,80,,40.32,percent of total billed charges,80% of total billed charges,40.95,65,,32.76,percent of total billed charges,65% of total billed charges,22.47,35.67,,17.976,percent of total billed charges,35.67% of total billed charges,18.27,56.7,
BIOSYN 1-0 SUTURE **,27004180,CDM,270,RC,,,outpatient,,,54,21.60,,45.9,85,,36.72,percent of total billed charges,85% of total billed charges,41.58,77,,33.26,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,44.28,82,,35.424,percent of total billed charges,82% of total billed charges,45.9,85,,36.72,percent of total billed charges,85% of total billed charges,45.9,85,,36.72,percent of total billed charges,85% of total billed charges,45.9,85,,36.72,percent of total billed charges,85% of total billed charges,48.6,90,,38.88,percent of total billed charges,90% of total billed charges,43.2,80,,34.56,percent of total billed charges,80% of total billed charges,48.6,90,,38.88,percent of total billed charges,90% of total billed charges,40.5,75,,32.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,15.66,29,,12.528,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,36.18,67,,28.944,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,43.2,80,,34.56,percent of total billed charges,80% of total billed charges,35.1,65,,28.08,percent of total billed charges,65% of total billed charges,19.26,35.67,,15.408,percent of total billed charges,35.67% of total billed charges,15.66,48.6,
POLYSORB 0 SUTURE,27004181,CDM,270,RC,,,outpatient,,,100,40.00,,85,85,,68,percent of total billed charges,85% of total billed charges,77,77,,61.6,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,82,82,,65.6,percent of total billed charges,82% of total billed charges,85,85,,68,percent of total billed charges,85% of total billed charges,85,85,,68,percent of total billed charges,85% of total billed charges,85,85,,68,percent of total billed charges,85% of total billed charges,90,90,,72,percent of total billed charges,90% of total billed charges,80,80,,64,percent of total billed charges,80% of total billed charges,90,90,,72,percent of total billed charges,90% of total billed charges,75,75,,60,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,29,29,,23.2,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,67,67,,53.6,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,80,80,,64,percent of total billed charges,80% of total billed charges,65,65,,52,percent of total billed charges,65% of total billed charges,35.67,35.67,,28.536,percent of total billed charges,35.67% of total billed charges,29,90,
BIOSYN 2-0 SUTURE,27004182,CDM,270,RC,,,outpatient,,,99,39.60,,84.15,85,,67.32,percent of total billed charges,85% of total billed charges,76.23,77,,60.98,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,81.18,82,,64.944,percent of total billed charges,82% of total billed charges,84.15,85,,67.32,percent of total billed charges,85% of total billed charges,84.15,85,,67.32,percent of total billed charges,85% of total billed charges,84.15,85,,67.32,percent of total billed charges,85% of total billed charges,89.1,90,,71.28,percent of total billed charges,90% of total billed charges,79.2,80,,63.36,percent of total billed charges,80% of total billed charges,89.1,90,,71.28,percent of total billed charges,90% of total billed charges,74.25,75,,59.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,28.71,29,,22.968,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,66.33,67,,53.064,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,79.2,80,,63.36,percent of total billed charges,80% of total billed charges,64.35,65,,51.48,percent of total billed charges,65% of total billed charges,35.31,35.67,,28.248,percent of total billed charges,35.67% of total billed charges,28.71,89.1,
SURGIPRO 2-0 SUTURE,27004183,CDM,270,RC,,,outpatient,,,96,38.40,,81.6,85,,65.28,percent of total billed charges,85% of total billed charges,73.92,77,,59.14,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,78.72,82,,62.976,percent of total billed charges,82% of total billed charges,81.6,85,,65.28,percent of total billed charges,85% of total billed charges,81.6,85,,65.28,percent of total billed charges,85% of total billed charges,81.6,85,,65.28,percent of total billed charges,85% of total billed charges,86.4,90,,69.12,percent of total billed charges,90% of total billed charges,76.8,80,,61.44,percent of total billed charges,80% of total billed charges,86.4,90,,69.12,percent of total billed charges,90% of total billed charges,72,75,,57.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,27.84,29,,22.272,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,64.32,67,,51.456,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,76.8,80,,61.44,percent of total billed charges,80% of total billed charges,62.4,65,,49.92,percent of total billed charges,65% of total billed charges,34.24,35.67,,27.392,percent of total billed charges,35.67% of total billed charges,27.84,86.4,
CHROMIC 5-0 SUTURE **,27004184,CDM,270,RC,,,outpatient,,,46,18.40,,39.1,85,,31.28,percent of total billed charges,85% of total billed charges,35.42,77,,28.34,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,37.72,82,,30.176,percent of total billed charges,82% of total billed charges,39.1,85,,31.28,percent of total billed charges,85% of total billed charges,39.1,85,,31.28,percent of total billed charges,85% of total billed charges,39.1,85,,31.28,percent of total billed charges,85% of total billed charges,41.4,90,,33.12,percent of total billed charges,90% of total billed charges,36.8,80,,29.44,percent of total billed charges,80% of total billed charges,41.4,90,,33.12,percent of total billed charges,90% of total billed charges,34.5,75,,27.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,13.34,29,,10.672,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,30.82,67,,24.656,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,36.8,80,,29.44,percent of total billed charges,80% of total billed charges,29.9,65,,23.92,percent of total billed charges,65% of total billed charges,16.41,35.67,,13.128,percent of total billed charges,35.67% of total billed charges,13.34,41.4,
CATHETER FOLEY 30FR 30CC **,27004185,CDM,270,RC,,,outpatient,,,81,32.40,,68.85,85,,55.08,percent of total billed charges,85% of total billed charges,62.37,77,,49.9,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,66.42,82,,53.136,percent of total billed charges,82% of total billed charges,68.85,85,,55.08,percent of total billed charges,85% of total billed charges,68.85,85,,55.08,percent of total billed charges,85% of total billed charges,68.85,85,,55.08,percent of total billed charges,85% of total billed charges,72.9,90,,58.32,percent of total billed charges,90% of total billed charges,64.8,80,,51.84,percent of total billed charges,80% of total billed charges,72.9,90,,58.32,percent of total billed charges,90% of total billed charges,60.75,75,,48.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,23.49,29,,18.792,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,54.27,67,,43.416,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,64.8,80,,51.84,percent of total billed charges,80% of total billed charges,52.65,65,,42.12,percent of total billed charges,65% of total billed charges,28.89,35.67,,23.112,percent of total billed charges,35.67% of total billed charges,23.49,72.9,
DRESSING TRANSPARENT 4 X 4 **,27004194,CDM,270,RC,,,outpatient,,,13,5.20,,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,10.01,77,,8.01,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,10.66,82,,8.528,percent of total billed charges,82% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,11.7,90,,9.36,percent of total billed charges,90% of total billed charges,10.4,80,,8.32,percent of total billed charges,80% of total billed charges,11.7,90,,9.36,percent of total billed charges,90% of total billed charges,9.75,75,,7.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,3.77,29,,3.016,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,8.71,67,,6.968,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,10.4,80,,8.32,percent of total billed charges,80% of total billed charges,8.45,65,,6.76,percent of total billed charges,65% of total billed charges,4.64,35.67,,3.712,percent of total billed charges,35.67% of total billed charges,3.77,11.7,
HANDSWITCHING PENCIL (OR),27004203,CDM,270,RC,,,outpatient,,,95,38.00,,80.75,85,,64.6,percent of total billed charges,85% of total billed charges,73.15,77,,58.52,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,77.9,82,,62.32,percent of total billed charges,82% of total billed charges,80.75,85,,64.6,percent of total billed charges,85% of total billed charges,80.75,85,,64.6,percent of total billed charges,85% of total billed charges,80.75,85,,64.6,percent of total billed charges,85% of total billed charges,85.5,90,,68.4,percent of total billed charges,90% of total billed charges,76,80,,60.8,percent of total billed charges,80% of total billed charges,85.5,90,,68.4,percent of total billed charges,90% of total billed charges,71.25,75,,57,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,27.55,29,,22.04,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,63.65,67,,50.92,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,76,80,,60.8,percent of total billed charges,80% of total billed charges,61.75,65,,49.4,percent of total billed charges,65% of total billed charges,33.89,35.67,,27.112,percent of total billed charges,35.67% of total billed charges,27.55,85.5,
DUAL FOIL DISPERS PAD (OR),27004204,CDM,270,RC,,,outpatient,,,36,14.40,,30.6,85,,24.48,percent of total billed charges,85% of total billed charges,27.72,77,,22.18,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,29.52,82,,23.616,percent of total billed charges,82% of total billed charges,30.6,85,,24.48,percent of total billed charges,85% of total billed charges,30.6,85,,24.48,percent of total billed charges,85% of total billed charges,30.6,85,,24.48,percent of total billed charges,85% of total billed charges,32.4,90,,25.92,percent of total billed charges,90% of total billed charges,28.8,80,,23.04,percent of total billed charges,80% of total billed charges,32.4,90,,25.92,percent of total billed charges,90% of total billed charges,27,75,,21.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,10.44,29,,8.352,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,24.12,67,,19.296,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,28.8,80,,23.04,percent of total billed charges,80% of total billed charges,23.4,65,,18.72,percent of total billed charges,65% of total billed charges,12.84,35.67,,10.272,percent of total billed charges,35.67% of total billed charges,10.44,32.4,
BLADE ULTRACLEAN TIP 6 OR,27004205,CDM,270,RC,,,outpatient,,,65,26.00,,55.25,85,,44.2,percent of total billed charges,85% of total billed charges,50.05,77,,40.04,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,53.3,82,,42.64,percent of total billed charges,82% of total billed charges,55.25,85,,44.2,percent of total billed charges,85% of total billed charges,55.25,85,,44.2,percent of total billed charges,85% of total billed charges,55.25,85,,44.2,percent of total billed charges,85% of total billed charges,58.5,90,,46.8,percent of total billed charges,90% of total billed charges,52,80,,41.6,percent of total billed charges,80% of total billed charges,58.5,90,,46.8,percent of total billed charges,90% of total billed charges,48.75,75,,39,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,18.85,29,,15.08,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,43.55,67,,34.84,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,52,80,,41.6,percent of total billed charges,80% of total billed charges,42.25,65,,33.8,percent of total billed charges,65% of total billed charges,23.19,35.67,,18.552,percent of total billed charges,35.67% of total billed charges,18.85,58.5,
NEEDLE ULTRACLEAN 1 OR,27004206,CDM,270,RC,,,outpatient,,,60,24.00,,51,85,,40.8,percent of total billed charges,85% of total billed charges,46.2,77,,36.96,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,49.2,82,,39.36,percent of total billed charges,82% of total billed charges,51,85,,40.8,percent of total billed charges,85% of total billed charges,51,85,,40.8,percent of total billed charges,85% of total billed charges,51,85,,40.8,percent of total billed charges,85% of total billed charges,54,90,,43.2,percent of total billed charges,90% of total billed charges,48,80,,38.4,percent of total billed charges,80% of total billed charges,54,90,,43.2,percent of total billed charges,90% of total billed charges,45,75,,36,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,17.4,29,,13.92,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,40.2,67,,32.16,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,48,80,,38.4,percent of total billed charges,80% of total billed charges,39,65,,31.2,percent of total billed charges,65% of total billed charges,21.4,35.67,,17.12,percent of total billed charges,35.67% of total billed charges,17.4,54,
TENDERWET 2.2 ROUND,27004210,CDM,270,RC,,,outpatient,,,62,24.80,,52.7,85,,42.16,percent of total billed charges,85% of total billed charges,47.74,77,,38.19,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,50.84,82,,40.672,percent of total billed charges,82% of total billed charges,52.7,85,,42.16,percent of total billed charges,85% of total billed charges,52.7,85,,42.16,percent of total billed charges,85% of total billed charges,52.7,85,,42.16,percent of total billed charges,85% of total billed charges,55.8,90,,44.64,percent of total billed charges,90% of total billed charges,49.6,80,,39.68,percent of total billed charges,80% of total billed charges,55.8,90,,44.64,percent of total billed charges,90% of total billed charges,46.5,75,,37.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,17.98,29,,14.384,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,41.54,67,,33.232,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,49.6,80,,39.68,percent of total billed charges,80% of total billed charges,40.3,65,,32.24,percent of total billed charges,65% of total billed charges,22.12,35.67,,17.696,percent of total billed charges,35.67% of total billed charges,17.98,55.8,
TUBE ESOPHAGEAL-NASAGASTRIC,27004213,CDM,270,RC,,,outpatient,,,1631,652.40,,1386.35,85,,1109.08,percent of total billed charges,85% of total billed charges,1255.87,77,,1004.7,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,1337.42,82,,1069.936,percent of total billed charges,82% of total billed charges,1386.35,85,,1109.08,percent of total billed charges,85% of total billed charges,1386.35,85,,1109.08,percent of total billed charges,85% of total billed charges,1386.35,85,,1109.08,percent of total billed charges,85% of total billed charges,1467.9,90,,1174.32,percent of total billed charges,90% of total billed charges,1304.8,80,,1043.84,percent of total billed charges,80% of total billed charges,1467.9,90,,1174.32,percent of total billed charges,90% of total billed charges,1223.25,75,,978.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,472.99,29,,378.392,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1092.77,67,,874.216,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1304.8,80,,1043.84,percent of total billed charges,80% of total billed charges,1060.15,65,,848.12,percent of total billed charges,65% of total billed charges,581.78,35.67,,465.424,percent of total billed charges,35.67% of total billed charges,472.99,1467.9,
CRICOTHYROTOMY KIT 6.0 MM,27004214,CDM,270,RC,,,outpatient,,,247,98.80,,209.95,85,,167.96,percent of total billed charges,85% of total billed charges,190.19,77,,152.15,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,202.54,82,,162.032,percent of total billed charges,82% of total billed charges,209.95,85,,167.96,percent of total billed charges,85% of total billed charges,209.95,85,,167.96,percent of total billed charges,85% of total billed charges,209.95,85,,167.96,percent of total billed charges,85% of total billed charges,222.3,90,,177.84,percent of total billed charges,90% of total billed charges,197.6,80,,158.08,percent of total billed charges,80% of total billed charges,222.3,90,,177.84,percent of total billed charges,90% of total billed charges,185.25,75,,148.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,71.63,29,,57.304,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,165.49,67,,132.392,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,197.6,80,,158.08,percent of total billed charges,80% of total billed charges,160.55,65,,128.44,percent of total billed charges,65% of total billed charges,88.1,35.67,,70.48,percent of total billed charges,35.67% of total billed charges,71.63,222.3,
CRICOTHROTOMY FIELD 5.5,27004215,CDM,270,RC,,,outpatient,,,247,98.80,,209.95,85,,167.96,percent of total billed charges,85% of total billed charges,190.19,77,,152.15,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,202.54,82,,162.032,percent of total billed charges,82% of total billed charges,209.95,85,,167.96,percent of total billed charges,85% of total billed charges,209.95,85,,167.96,percent of total billed charges,85% of total billed charges,209.95,85,,167.96,percent of total billed charges,85% of total billed charges,222.3,90,,177.84,percent of total billed charges,90% of total billed charges,197.6,80,,158.08,percent of total billed charges,80% of total billed charges,222.3,90,,177.84,percent of total billed charges,90% of total billed charges,185.25,75,,148.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,71.63,29,,57.304,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,165.49,67,,132.392,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,197.6,80,,158.08,percent of total billed charges,80% of total billed charges,160.55,65,,128.44,percent of total billed charges,65% of total billed charges,88.1,35.67,,70.48,percent of total billed charges,35.67% of total billed charges,71.63,222.3,
BOOT COVER FLUID RESISTANT,27004219,CDM,270,RC,,,outpatient,,,73,29.20,,62.05,85,,49.64,percent of total billed charges,85% of total billed charges,56.21,77,,44.97,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,59.86,82,,47.888,percent of total billed charges,82% of total billed charges,62.05,85,,49.64,percent of total billed charges,85% of total billed charges,62.05,85,,49.64,percent of total billed charges,85% of total billed charges,62.05,85,,49.64,percent of total billed charges,85% of total billed charges,65.7,90,,52.56,percent of total billed charges,90% of total billed charges,58.4,80,,46.72,percent of total billed charges,80% of total billed charges,65.7,90,,52.56,percent of total billed charges,90% of total billed charges,54.75,75,,43.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,21.17,29,,16.936,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,48.91,67,,39.128,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,58.4,80,,46.72,percent of total billed charges,80% of total billed charges,47.45,65,,37.96,percent of total billed charges,65% of total billed charges,26.04,35.67,,20.832,percent of total billed charges,35.67% of total billed charges,21.17,65.7,
MICROBORE EXTENSION SET,27004270,CDM,270,RC,,,outpatient,,,17,6.80,,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,13.09,77,,10.47,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,13.94,82,,11.152,percent of total billed charges,82% of total billed charges,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,15.3,90,,12.24,percent of total billed charges,90% of total billed charges,13.6,80,,10.88,percent of total billed charges,80% of total billed charges,15.3,90,,12.24,percent of total billed charges,90% of total billed charges,12.75,75,,10.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,4.93,29,,3.944,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,11.39,67,,9.112,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,13.6,80,,10.88,percent of total billed charges,80% of total billed charges,11.05,65,,8.84,percent of total billed charges,65% of total billed charges,6.06,35.67,,4.848,percent of total billed charges,35.67% of total billed charges,4.93,15.3,
NEEDLE STIMUPLEX 6 **,27004273,CDM,270,RC,,,outpatient,,,127,50.80,,107.95,85,,86.36,percent of total billed charges,85% of total billed charges,97.79,77,,78.23,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,104.14,82,,83.312,percent of total billed charges,82% of total billed charges,107.95,85,,86.36,percent of total billed charges,85% of total billed charges,107.95,85,,86.36,percent of total billed charges,85% of total billed charges,107.95,85,,86.36,percent of total billed charges,85% of total billed charges,114.3,90,,91.44,percent of total billed charges,90% of total billed charges,101.6,80,,81.28,percent of total billed charges,80% of total billed charges,114.3,90,,91.44,percent of total billed charges,90% of total billed charges,95.25,75,,76.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,36.83,29,,29.464,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,85.09,67,,68.072,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,101.6,80,,81.28,percent of total billed charges,80% of total billed charges,82.55,65,,66.04,percent of total billed charges,65% of total billed charges,45.3,35.67,,36.24,percent of total billed charges,35.67% of total billed charges,36.83,114.3,
NEEDLE STIMUPLEX 2 **,27004274,CDM,270,RC,,,outpatient,,,85,34.00,,72.25,85,,57.8,percent of total billed charges,85% of total billed charges,65.45,77,,52.36,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,69.7,82,,55.76,percent of total billed charges,82% of total billed charges,72.25,85,,57.8,percent of total billed charges,85% of total billed charges,72.25,85,,57.8,percent of total billed charges,85% of total billed charges,72.25,85,,57.8,percent of total billed charges,85% of total billed charges,76.5,90,,61.2,percent of total billed charges,90% of total billed charges,68,80,,54.4,percent of total billed charges,80% of total billed charges,76.5,90,,61.2,percent of total billed charges,90% of total billed charges,63.75,75,,51,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,24.65,29,,19.72,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,56.95,67,,45.56,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,68,80,,54.4,percent of total billed charges,80% of total billed charges,55.25,65,,44.2,percent of total billed charges,65% of total billed charges,30.32,35.67,,24.256,percent of total billed charges,35.67% of total billed charges,24.65,76.5,
NEEDLE LOCALIZATION 21GX5CM,27004278,CDM,270,RC,,,outpatient,,,237,94.80,,201.45,85,,161.16,percent of total billed charges,85% of total billed charges,182.49,77,,145.99,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,194.34,82,,155.472,percent of total billed charges,82% of total billed charges,201.45,85,,161.16,percent of total billed charges,85% of total billed charges,201.45,85,,161.16,percent of total billed charges,85% of total billed charges,201.45,85,,161.16,percent of total billed charges,85% of total billed charges,213.3,90,,170.64,percent of total billed charges,90% of total billed charges,189.6,80,,151.68,percent of total billed charges,80% of total billed charges,213.3,90,,170.64,percent of total billed charges,90% of total billed charges,177.75,75,,142.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,68.73,29,,54.984,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,158.79,67,,127.032,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,189.6,80,,151.68,percent of total billed charges,80% of total billed charges,154.05,65,,123.24,percent of total billed charges,65% of total billed charges,84.54,35.67,,67.632,percent of total billed charges,35.67% of total billed charges,68.73,213.3,
DISTILLED WATER (GALLON),27004302,CDM,270,RC,,,outpatient,,,19,7.60,,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,14.63,77,,11.7,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,15.58,82,,12.464,percent of total billed charges,82% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,15.2,80,,12.16,percent of total billed charges,80% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,14.25,75,,11.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,5.51,29,,4.408,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,12.73,67,,10.184,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,15.2,80,,12.16,percent of total billed charges,80% of total billed charges,12.35,65,,9.88,percent of total billed charges,65% of total billed charges,6.78,35.67,,5.424,percent of total billed charges,35.67% of total billed charges,5.51,17.1,
SENSOR MAX FAST **,27004311,CDM,270,RC,,,outpatient,,,204,81.60,,173.4,85,,138.72,percent of total billed charges,85% of total billed charges,157.08,77,,125.66,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,167.28,82,,133.824,percent of total billed charges,82% of total billed charges,173.4,85,,138.72,percent of total billed charges,85% of total billed charges,173.4,85,,138.72,percent of total billed charges,85% of total billed charges,173.4,85,,138.72,percent of total billed charges,85% of total billed charges,183.6,90,,146.88,percent of total billed charges,90% of total billed charges,163.2,80,,130.56,percent of total billed charges,80% of total billed charges,183.6,90,,146.88,percent of total billed charges,90% of total billed charges,153,75,,122.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,59.16,29,,47.328,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,136.68,67,,109.344,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,163.2,80,,130.56,percent of total billed charges,80% of total billed charges,132.6,65,,106.08,percent of total billed charges,65% of total billed charges,72.77,35.67,,58.216,percent of total billed charges,35.67% of total billed charges,59.16,183.6,
ARGLAES POWDER 5 GM,27004319,CDM,270,RC,,,outpatient,,,139,55.60,,118.15,85,,94.52,percent of total billed charges,85% of total billed charges,107.03,77,,85.62,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,113.98,82,,91.184,percent of total billed charges,82% of total billed charges,118.15,85,,94.52,percent of total billed charges,85% of total billed charges,118.15,85,,94.52,percent of total billed charges,85% of total billed charges,118.15,85,,94.52,percent of total billed charges,85% of total billed charges,125.1,90,,100.08,percent of total billed charges,90% of total billed charges,111.2,80,,88.96,percent of total billed charges,80% of total billed charges,125.1,90,,100.08,percent of total billed charges,90% of total billed charges,104.25,75,,83.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,40.31,29,,32.248,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,93.13,67,,74.504,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,111.2,80,,88.96,percent of total billed charges,80% of total billed charges,90.35,65,,72.28,percent of total billed charges,65% of total billed charges,49.58,35.67,,39.664,percent of total billed charges,35.67% of total billed charges,40.31,125.1,
DRESSING SILVASORB 6GM STR,27004321,CDM,270,RC,,,outpatient,,,145,58.00,,123.25,85,,98.6,percent of total billed charges,85% of total billed charges,111.65,77,,89.32,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,118.9,82,,95.12,percent of total billed charges,82% of total billed charges,123.25,85,,98.6,percent of total billed charges,85% of total billed charges,123.25,85,,98.6,percent of total billed charges,85% of total billed charges,123.25,85,,98.6,percent of total billed charges,85% of total billed charges,130.5,90,,104.4,percent of total billed charges,90% of total billed charges,116,80,,92.8,percent of total billed charges,80% of total billed charges,130.5,90,,104.4,percent of total billed charges,90% of total billed charges,108.75,75,,87,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,42.05,29,,33.64,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,97.15,67,,77.72,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,116,80,,92.8,percent of total billed charges,80% of total billed charges,94.25,65,,75.4,percent of total billed charges,65% of total billed charges,51.72,35.67,,41.376,percent of total billed charges,35.67% of total billed charges,42.05,130.5,
DRESSING SILVASORB 1.5 TUBE,27004322,CDM,270,RC,,,outpatient,,,208,83.20,,176.8,85,,141.44,percent of total billed charges,85% of total billed charges,160.16,77,,128.13,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,170.56,82,,136.448,percent of total billed charges,82% of total billed charges,176.8,85,,141.44,percent of total billed charges,85% of total billed charges,176.8,85,,141.44,percent of total billed charges,85% of total billed charges,176.8,85,,141.44,percent of total billed charges,85% of total billed charges,187.2,90,,149.76,percent of total billed charges,90% of total billed charges,166.4,80,,133.12,percent of total billed charges,80% of total billed charges,187.2,90,,149.76,percent of total billed charges,90% of total billed charges,156,75,,124.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,60.32,29,,48.256,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,139.36,67,,111.488,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,166.4,80,,133.12,percent of total billed charges,80% of total billed charges,135.2,65,,108.16,percent of total billed charges,65% of total billed charges,74.19,35.67,,59.352,percent of total billed charges,35.67% of total billed charges,60.32,187.2,
DRESSING MEDFIL PARTICLES,27004323,CDM,270,RC,,,outpatient,,,179,71.60,,152.15,85,,121.72,percent of total billed charges,85% of total billed charges,137.83,77,,110.26,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,146.78,82,,117.424,percent of total billed charges,82% of total billed charges,152.15,85,,121.72,percent of total billed charges,85% of total billed charges,152.15,85,,121.72,percent of total billed charges,85% of total billed charges,152.15,85,,121.72,percent of total billed charges,85% of total billed charges,161.1,90,,128.88,percent of total billed charges,90% of total billed charges,143.2,80,,114.56,percent of total billed charges,80% of total billed charges,161.1,90,,128.88,percent of total billed charges,90% of total billed charges,134.25,75,,107.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,51.91,29,,41.528,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,119.93,67,,95.944,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,143.2,80,,114.56,percent of total billed charges,80% of total billed charges,116.35,65,,93.08,percent of total billed charges,65% of total billed charges,63.85,35.67,,51.08,percent of total billed charges,35.67% of total billed charges,51.91,161.1,
BIOSYN 0 SUTURE **,27004351,CDM,270,RC,,,outpatient,,,27,10.80,,22.95,85,,18.36,percent of total billed charges,85% of total billed charges,20.79,77,,16.63,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,22.14,82,,17.712,percent of total billed charges,82% of total billed charges,22.95,85,,18.36,percent of total billed charges,85% of total billed charges,22.95,85,,18.36,percent of total billed charges,85% of total billed charges,22.95,85,,18.36,percent of total billed charges,85% of total billed charges,24.3,90,,19.44,percent of total billed charges,90% of total billed charges,21.6,80,,17.28,percent of total billed charges,80% of total billed charges,24.3,90,,19.44,percent of total billed charges,90% of total billed charges,20.25,75,,16.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,7.83,29,,6.264,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,18.09,67,,14.472,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,21.6,80,,17.28,percent of total billed charges,80% of total billed charges,17.55,65,,14.04,percent of total billed charges,65% of total billed charges,9.63,35.67,,7.704,percent of total billed charges,35.67% of total billed charges,7.83,24.3,
PLAIN GUT 6-0 SUTURE,27004352,CDM,270,RC,,,outpatient,,,456,182.40,,387.6,85,,310.08,percent of total billed charges,85% of total billed charges,351.12,77,,280.9,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,373.92,82,,299.136,percent of total billed charges,82% of total billed charges,387.6,85,,310.08,percent of total billed charges,85% of total billed charges,387.6,85,,310.08,percent of total billed charges,85% of total billed charges,387.6,85,,310.08,percent of total billed charges,85% of total billed charges,410.4,90,,328.32,percent of total billed charges,90% of total billed charges,364.8,80,,291.84,percent of total billed charges,80% of total billed charges,410.4,90,,328.32,percent of total billed charges,90% of total billed charges,342,75,,273.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,132.24,29,,105.792,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,305.52,67,,244.416,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,364.8,80,,291.84,percent of total billed charges,80% of total billed charges,296.4,65,,237.12,percent of total billed charges,65% of total billed charges,162.66,35.67,,130.128,percent of total billed charges,35.67% of total billed charges,132.24,410.4,
SURGIGUT 3-0 SUTURE **,27004353,CDM,270,RC,,,outpatient,,,23,9.20,,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,17.71,77,,14.17,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,18.86,82,,15.088,percent of total billed charges,82% of total billed charges,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,20.7,90,,16.56,percent of total billed charges,90% of total billed charges,18.4,80,,14.72,percent of total billed charges,80% of total billed charges,20.7,90,,16.56,percent of total billed charges,90% of total billed charges,17.25,75,,13.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,6.67,29,,5.336,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,15.41,67,,12.328,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,18.4,80,,14.72,percent of total billed charges,80% of total billed charges,14.95,65,,11.96,percent of total billed charges,65% of total billed charges,8.2,35.67,,6.56,percent of total billed charges,35.67% of total billed charges,6.67,20.7,
CHROMIC 4-0 SUTURE,27004354,CDM,270,RC,,,outpatient,,,98,39.20,,83.3,85,,66.64,percent of total billed charges,85% of total billed charges,75.46,77,,60.37,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,80.36,82,,64.288,percent of total billed charges,82% of total billed charges,83.3,85,,66.64,percent of total billed charges,85% of total billed charges,83.3,85,,66.64,percent of total billed charges,85% of total billed charges,83.3,85,,66.64,percent of total billed charges,85% of total billed charges,88.2,90,,70.56,percent of total billed charges,90% of total billed charges,78.4,80,,62.72,percent of total billed charges,80% of total billed charges,88.2,90,,70.56,percent of total billed charges,90% of total billed charges,73.5,75,,58.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,28.42,29,,22.736,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,65.66,67,,52.528,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,78.4,80,,62.72,percent of total billed charges,80% of total billed charges,63.7,65,,50.96,percent of total billed charges,65% of total billed charges,34.96,35.67,,27.968,percent of total billed charges,35.67% of total billed charges,28.42,88.2,
SOFSILK 5-0 SUTURE,27004355,CDM,270,RC,,,outpatient,,,61,24.40,,51.85,85,,41.48,percent of total billed charges,85% of total billed charges,46.97,77,,37.58,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,50.02,82,,40.016,percent of total billed charges,82% of total billed charges,51.85,85,,41.48,percent of total billed charges,85% of total billed charges,51.85,85,,41.48,percent of total billed charges,85% of total billed charges,51.85,85,,41.48,percent of total billed charges,85% of total billed charges,54.9,90,,43.92,percent of total billed charges,90% of total billed charges,48.8,80,,39.04,percent of total billed charges,80% of total billed charges,54.9,90,,43.92,percent of total billed charges,90% of total billed charges,45.75,75,,36.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,17.69,29,,14.152,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,40.87,67,,32.696,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,48.8,80,,39.04,percent of total billed charges,80% of total billed charges,39.65,65,,31.72,percent of total billed charges,65% of total billed charges,21.76,35.67,,17.408,percent of total billed charges,35.67% of total billed charges,17.69,54.9,
MONSOF 6-0 SUTURE,27004356,CDM,270,RC,,,outpatient,,,70,28.00,,59.5,85,,47.6,percent of total billed charges,85% of total billed charges,53.9,77,,43.12,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,57.4,82,,45.92,percent of total billed charges,82% of total billed charges,59.5,85,,47.6,percent of total billed charges,85% of total billed charges,59.5,85,,47.6,percent of total billed charges,85% of total billed charges,59.5,85,,47.6,percent of total billed charges,85% of total billed charges,63,90,,50.4,percent of total billed charges,90% of total billed charges,56,80,,44.8,percent of total billed charges,80% of total billed charges,63,90,,50.4,percent of total billed charges,90% of total billed charges,52.5,75,,42,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,20.3,29,,16.24,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,46.9,67,,37.52,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,56,80,,44.8,percent of total billed charges,80% of total billed charges,45.5,65,,36.4,percent of total billed charges,65% of total billed charges,24.97,35.67,,19.976,percent of total billed charges,35.67% of total billed charges,20.3,63,
SURGIPRO 6-0 SUTURE,27004357,CDM,270,RC,,,outpatient,,,93,37.20,,79.05,85,,63.24,percent of total billed charges,85% of total billed charges,71.61,77,,57.29,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,76.26,82,,61.008,percent of total billed charges,82% of total billed charges,79.05,85,,63.24,percent of total billed charges,85% of total billed charges,79.05,85,,63.24,percent of total billed charges,85% of total billed charges,79.05,85,,63.24,percent of total billed charges,85% of total billed charges,83.7,90,,66.96,percent of total billed charges,90% of total billed charges,74.4,80,,59.52,percent of total billed charges,80% of total billed charges,83.7,90,,66.96,percent of total billed charges,90% of total billed charges,69.75,75,,55.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,26.97,29,,21.576,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,62.31,67,,49.848,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,74.4,80,,59.52,percent of total billed charges,80% of total billed charges,60.45,65,,48.36,percent of total billed charges,65% of total billed charges,33.17,35.67,,26.536,percent of total billed charges,35.67% of total billed charges,26.97,83.7,
NUTRISHIELD CREAM,27004364,CDM,270,RC,,,outpatient,,,84,33.60,,71.4,85,,57.12,percent of total billed charges,85% of total billed charges,64.68,77,,51.74,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,68.88,82,,55.104,percent of total billed charges,82% of total billed charges,71.4,85,,57.12,percent of total billed charges,85% of total billed charges,71.4,85,,57.12,percent of total billed charges,85% of total billed charges,71.4,85,,57.12,percent of total billed charges,85% of total billed charges,75.6,90,,60.48,percent of total billed charges,90% of total billed charges,67.2,80,,53.76,percent of total billed charges,80% of total billed charges,75.6,90,,60.48,percent of total billed charges,90% of total billed charges,63,75,,50.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,24.36,29,,19.488,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,56.28,67,,45.024,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,67.2,80,,53.76,percent of total billed charges,80% of total billed charges,54.6,65,,43.68,percent of total billed charges,65% of total billed charges,29.96,35.67,,23.968,percent of total billed charges,35.67% of total billed charges,24.36,75.6,
SUTURE BIOSYN 4-0 GM 321 **,27004389,CDM,270,RC,,,outpatient,,,28,11.20,,23.8,85,,19.04,percent of total billed charges,85% of total billed charges,21.56,77,,17.25,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,22.96,82,,18.368,percent of total billed charges,82% of total billed charges,23.8,85,,19.04,percent of total billed charges,85% of total billed charges,23.8,85,,19.04,percent of total billed charges,85% of total billed charges,23.8,85,,19.04,percent of total billed charges,85% of total billed charges,25.2,90,,20.16,percent of total billed charges,90% of total billed charges,22.4,80,,17.92,percent of total billed charges,80% of total billed charges,25.2,90,,20.16,percent of total billed charges,90% of total billed charges,21,75,,16.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,8.12,29,,6.496,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,18.76,67,,15.008,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,22.4,80,,17.92,percent of total billed charges,80% of total billed charges,18.2,65,,14.56,percent of total billed charges,65% of total billed charges,9.99,35.67,,7.992,percent of total billed charges,35.67% of total billed charges,8.12,25.2,
SMART CAPNOLINE PLUS ADULT,27004428,CDM,270,RC,,,outpatient,,,210,84.00,,178.5,85,,142.8,percent of total billed charges,85% of total billed charges,161.7,77,,129.36,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,172.2,82,,137.76,percent of total billed charges,82% of total billed charges,178.5,85,,142.8,percent of total billed charges,85% of total billed charges,178.5,85,,142.8,percent of total billed charges,85% of total billed charges,178.5,85,,142.8,percent of total billed charges,85% of total billed charges,189,90,,151.2,percent of total billed charges,90% of total billed charges,168,80,,134.4,percent of total billed charges,80% of total billed charges,189,90,,151.2,percent of total billed charges,90% of total billed charges,157.5,75,,126,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,60.9,29,,48.72,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,140.7,67,,112.56,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,168,80,,134.4,percent of total billed charges,80% of total billed charges,136.5,65,,109.2,percent of total billed charges,65% of total billed charges,74.91,35.67,,59.928,percent of total billed charges,35.67% of total billed charges,60.9,189,
SMART CAPNOLINE PLUS PEDI,27004429,CDM,270,RC,,,outpatient,,,115,46.00,,97.75,85,,78.2,percent of total billed charges,85% of total billed charges,88.55,77,,70.84,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,94.3,82,,75.44,percent of total billed charges,82% of total billed charges,97.75,85,,78.2,percent of total billed charges,85% of total billed charges,97.75,85,,78.2,percent of total billed charges,85% of total billed charges,97.75,85,,78.2,percent of total billed charges,85% of total billed charges,103.5,90,,82.8,percent of total billed charges,90% of total billed charges,92,80,,73.6,percent of total billed charges,80% of total billed charges,103.5,90,,82.8,percent of total billed charges,90% of total billed charges,86.25,75,,69,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,33.35,29,,26.68,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,77.05,67,,61.64,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,92,80,,73.6,percent of total billed charges,80% of total billed charges,74.75,65,,59.8,percent of total billed charges,65% of total billed charges,41.02,35.67,,32.816,percent of total billed charges,35.67% of total billed charges,33.35,103.5,
FILTERLINE H SET ADLT/PEDI,27004430,CDM,270,RC,,,outpatient,,,111,44.40,,94.35,85,,75.48,percent of total billed charges,85% of total billed charges,85.47,77,,68.38,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,91.02,82,,72.816,percent of total billed charges,82% of total billed charges,94.35,85,,75.48,percent of total billed charges,85% of total billed charges,94.35,85,,75.48,percent of total billed charges,85% of total billed charges,94.35,85,,75.48,percent of total billed charges,85% of total billed charges,99.9,90,,79.92,percent of total billed charges,90% of total billed charges,88.8,80,,71.04,percent of total billed charges,80% of total billed charges,99.9,90,,79.92,percent of total billed charges,90% of total billed charges,83.25,75,,66.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,32.19,29,,25.752,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,74.37,67,,59.496,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,88.8,80,,71.04,percent of total billed charges,80% of total billed charges,72.15,65,,57.72,percent of total billed charges,65% of total billed charges,39.59,35.67,,31.672,percent of total billed charges,35.67% of total billed charges,32.19,99.9,
CLEANER ANTIMICROBIAL WOUND,27004445,CDM,270,RC,,,outpatient,,,30,12.00,,25.5,85,,20.4,percent of total billed charges,85% of total billed charges,23.1,77,,18.48,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,24.6,82,,19.68,percent of total billed charges,82% of total billed charges,25.5,85,,20.4,percent of total billed charges,85% of total billed charges,25.5,85,,20.4,percent of total billed charges,85% of total billed charges,25.5,85,,20.4,percent of total billed charges,85% of total billed charges,27,90,,21.6,percent of total billed charges,90% of total billed charges,24,80,,19.2,percent of total billed charges,80% of total billed charges,27,90,,21.6,percent of total billed charges,90% of total billed charges,22.5,75,,18,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,8.7,29,,6.96,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,20.1,67,,16.08,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,24,80,,19.2,percent of total billed charges,80% of total billed charges,19.5,65,,15.6,percent of total billed charges,65% of total billed charges,10.7,35.67,,8.56,percent of total billed charges,35.67% of total billed charges,8.7,27,
ELECTRODES 3 DISP. SOLID GEL,27004463,CDM,270,RC,,,outpatient,,,95,38.00,,80.75,85,,64.6,percent of total billed charges,85% of total billed charges,73.15,77,,58.52,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,77.9,82,,62.32,percent of total billed charges,82% of total billed charges,80.75,85,,64.6,percent of total billed charges,85% of total billed charges,80.75,85,,64.6,percent of total billed charges,85% of total billed charges,80.75,85,,64.6,percent of total billed charges,85% of total billed charges,85.5,90,,68.4,percent of total billed charges,90% of total billed charges,76,80,,60.8,percent of total billed charges,80% of total billed charges,85.5,90,,68.4,percent of total billed charges,90% of total billed charges,71.25,75,,57,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,27.55,29,,22.04,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,63.65,67,,50.92,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,76,80,,60.8,percent of total billed charges,80% of total billed charges,61.75,65,,49.4,percent of total billed charges,65% of total billed charges,33.89,35.67,,27.112,percent of total billed charges,35.67% of total billed charges,27.55,85.5,
NEEDLE EZ-IO **,27004476,CDM,270,RC,,,outpatient,,,667,266.80,,566.95,85,,453.56,percent of total billed charges,85% of total billed charges,513.59,77,,410.87,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,546.94,82,,437.552,percent of total billed charges,82% of total billed charges,566.95,85,,453.56,percent of total billed charges,85% of total billed charges,566.95,85,,453.56,percent of total billed charges,85% of total billed charges,566.95,85,,453.56,percent of total billed charges,85% of total billed charges,600.3,90,,480.24,percent of total billed charges,90% of total billed charges,533.6,80,,426.88,percent of total billed charges,80% of total billed charges,600.3,90,,480.24,percent of total billed charges,90% of total billed charges,500.25,75,,400.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,193.43,29,,154.744,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,446.89,67,,357.512,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,533.6,80,,426.88,percent of total billed charges,80% of total billed charges,433.55,65,,346.84,percent of total billed charges,65% of total billed charges,237.92,35.67,,190.336,percent of total billed charges,35.67% of total billed charges,193.43,600.3,
BICAP BIPOLAR HEMASTSIS PRBE**,27004487,CDM,270,RC,,,outpatient,,,1255,502.00,,1066.75,85,,853.4,percent of total billed charges,85% of total billed charges,966.35,77,,773.08,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,1029.1,82,,823.28,percent of total billed charges,82% of total billed charges,1066.75,85,,853.4,percent of total billed charges,85% of total billed charges,1066.75,85,,853.4,percent of total billed charges,85% of total billed charges,1066.75,85,,853.4,percent of total billed charges,85% of total billed charges,1129.5,90,,903.6,percent of total billed charges,90% of total billed charges,1004,80,,803.2,percent of total billed charges,80% of total billed charges,1129.5,90,,903.6,percent of total billed charges,90% of total billed charges,941.25,75,,753,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,363.95,29,,291.16,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,840.85,67,,672.68,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1004,80,,803.2,percent of total billed charges,80% of total billed charges,815.75,65,,652.6,percent of total billed charges,65% of total billed charges,447.66,35.67,,358.128,percent of total billed charges,35.67% of total billed charges,363.95,1129.5,
EYE PACK BOOZALIS,27004543,CDM,270,RC,,,outpatient,,,1388,555.20,,1179.8,85,,943.84,percent of total billed charges,85% of total billed charges,1068.76,77,,855.01,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,1138.16,82,,910.528,percent of total billed charges,82% of total billed charges,1179.8,85,,943.84,percent of total billed charges,85% of total billed charges,1179.8,85,,943.84,percent of total billed charges,85% of total billed charges,1179.8,85,,943.84,percent of total billed charges,85% of total billed charges,1249.2,90,,999.36,percent of total billed charges,90% of total billed charges,1110.4,80,,888.32,percent of total billed charges,80% of total billed charges,1249.2,90,,999.36,percent of total billed charges,90% of total billed charges,1041,75,,832.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,402.52,29,,322.016,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,929.96,67,,743.968,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1110.4,80,,888.32,percent of total billed charges,80% of total billed charges,902.2,65,,721.76,percent of total billed charges,65% of total billed charges,495.1,35.67,,396.08,percent of total billed charges,35.67% of total billed charges,402.52,1249.2,
BABY BEANIE CAP **,27004567,CDM,270,RC,,,outpatient,,,16,6.40,,13.6,85,,10.88,percent of total billed charges,85% of total billed charges,12.32,77,,9.86,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,13.12,82,,10.496,percent of total billed charges,82% of total billed charges,13.6,85,,10.88,percent of total billed charges,85% of total billed charges,13.6,85,,10.88,percent of total billed charges,85% of total billed charges,13.6,85,,10.88,percent of total billed charges,85% of total billed charges,14.4,90,,11.52,percent of total billed charges,90% of total billed charges,12.8,80,,10.24,percent of total billed charges,80% of total billed charges,14.4,90,,11.52,percent of total billed charges,90% of total billed charges,12,75,,9.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,4.64,29,,3.712,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,10.72,67,,8.576,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,12.8,80,,10.24,percent of total billed charges,80% of total billed charges,10.4,65,,8.32,percent of total billed charges,65% of total billed charges,5.71,35.67,,4.568,percent of total billed charges,35.67% of total billed charges,4.64,14.4,
PUNCH BIOPSY 2 MM  **,27004693,CDM,270,RC,,,outpatient,,,15,6.00,,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,11.55,77,,9.24,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,12.3,82,,9.84,percent of total billed charges,82% of total billed charges,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,13.5,90,,10.8,percent of total billed charges,90% of total billed charges,12,80,,9.6,percent of total billed charges,80% of total billed charges,13.5,90,,10.8,percent of total billed charges,90% of total billed charges,11.25,75,,9,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,4.35,29,,3.48,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,10.05,67,,8.04,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,12,80,,9.6,percent of total billed charges,80% of total billed charges,9.75,65,,7.8,percent of total billed charges,65% of total billed charges,5.35,35.67,,4.28,percent of total billed charges,35.67% of total billed charges,4.35,13.5,
UNDERCAST 3 PADDING STRL,27004868,CDM,270,RC,,,outpatient,,,18,7.20,,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,13.86,77,,11.09,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,14.76,82,,11.808,percent of total billed charges,82% of total billed charges,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,16.2,90,,12.96,percent of total billed charges,90% of total billed charges,14.4,80,,11.52,percent of total billed charges,80% of total billed charges,16.2,90,,12.96,percent of total billed charges,90% of total billed charges,13.5,75,,10.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,5.22,29,,4.176,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,12.06,67,,9.648,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,14.4,80,,11.52,percent of total billed charges,80% of total billed charges,11.7,65,,9.36,percent of total billed charges,65% of total billed charges,6.42,35.67,,5.136,percent of total billed charges,35.67% of total billed charges,5.22,16.2,
UNDERCAST 4 PADDING STRL,27004869,CDM,270,RC,,,outpatient,,,22,8.80,,18.7,85,,14.96,percent of total billed charges,85% of total billed charges,16.94,77,,13.55,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,18.04,82,,14.432,percent of total billed charges,82% of total billed charges,18.7,85,,14.96,percent of total billed charges,85% of total billed charges,18.7,85,,14.96,percent of total billed charges,85% of total billed charges,18.7,85,,14.96,percent of total billed charges,85% of total billed charges,19.8,90,,15.84,percent of total billed charges,90% of total billed charges,17.6,80,,14.08,percent of total billed charges,80% of total billed charges,19.8,90,,15.84,percent of total billed charges,90% of total billed charges,16.5,75,,13.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,6.38,29,,5.104,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,14.74,67,,11.792,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,17.6,80,,14.08,percent of total billed charges,80% of total billed charges,14.3,65,,11.44,percent of total billed charges,65% of total billed charges,7.85,35.67,,6.28,percent of total billed charges,35.67% of total billed charges,6.38,19.8,
UNDERCAST 6 PADDING STRL,27004870,CDM,270,RC,,,outpatient,,,29,11.60,,24.65,85,,19.72,percent of total billed charges,85% of total billed charges,22.33,77,,17.86,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,23.78,82,,19.024,percent of total billed charges,82% of total billed charges,24.65,85,,19.72,percent of total billed charges,85% of total billed charges,24.65,85,,19.72,percent of total billed charges,85% of total billed charges,24.65,85,,19.72,percent of total billed charges,85% of total billed charges,26.1,90,,20.88,percent of total billed charges,90% of total billed charges,23.2,80,,18.56,percent of total billed charges,80% of total billed charges,26.1,90,,20.88,percent of total billed charges,90% of total billed charges,21.75,75,,17.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,8.41,29,,6.728,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,19.43,67,,15.544,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,23.2,80,,18.56,percent of total billed charges,80% of total billed charges,18.85,65,,15.08,percent of total billed charges,65% of total billed charges,10.34,35.67,,8.272,percent of total billed charges,35.67% of total billed charges,8.41,26.1,
GAUZE 2X2 SPONGE STRL,27004871,CDM,270,RC,,,outpatient,,,10,4.00,,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,7.7,77,,6.16,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,8.2,82,,6.56,percent of total billed charges,82% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,9,90,,7.2,percent of total billed charges,90% of total billed charges,8,80,,6.4,percent of total billed charges,80% of total billed charges,9,90,,7.2,percent of total billed charges,90% of total billed charges,7.5,75,,6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.9,29,,2.32,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,6.7,67,,5.36,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,8,80,,6.4,percent of total billed charges,80% of total billed charges,6.5,65,,5.2,percent of total billed charges,65% of total billed charges,3.57,35.67,,2.856,percent of total billed charges,35.67% of total billed charges,2.9,9,
NET POLUP RETRIEVAL ROTH **,27004883,CDM,270,RC,,,outpatient,,,529,211.60,,449.65,85,,359.72,percent of total billed charges,85% of total billed charges,407.33,77,,325.86,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,433.78,82,,347.024,percent of total billed charges,82% of total billed charges,449.65,85,,359.72,percent of total billed charges,85% of total billed charges,449.65,85,,359.72,percent of total billed charges,85% of total billed charges,449.65,85,,359.72,percent of total billed charges,85% of total billed charges,476.1,90,,380.88,percent of total billed charges,90% of total billed charges,423.2,80,,338.56,percent of total billed charges,80% of total billed charges,476.1,90,,380.88,percent of total billed charges,90% of total billed charges,396.75,75,,317.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,153.41,29,,122.728,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,354.43,67,,283.544,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,423.2,80,,338.56,percent of total billed charges,80% of total billed charges,343.85,65,,275.08,percent of total billed charges,65% of total billed charges,188.69,35.67,,150.952,percent of total billed charges,35.67% of total billed charges,153.41,476.1,
POLYP PACK,27004898,CDM,270,RC,,,outpatient,,,561,224.40,,476.85,85,,381.48,percent of total billed charges,85% of total billed charges,431.97,77,,345.58,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,460.02,82,,368.016,percent of total billed charges,82% of total billed charges,476.85,85,,381.48,percent of total billed charges,85% of total billed charges,476.85,85,,381.48,percent of total billed charges,85% of total billed charges,476.85,85,,381.48,percent of total billed charges,85% of total billed charges,504.9,90,,403.92,percent of total billed charges,90% of total billed charges,448.8,80,,359.04,percent of total billed charges,80% of total billed charges,504.9,90,,403.92,percent of total billed charges,90% of total billed charges,420.75,75,,336.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,162.69,29,,130.152,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,375.87,67,,300.696,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,448.8,80,,359.04,percent of total billed charges,80% of total billed charges,364.65,65,,291.72,percent of total billed charges,65% of total billed charges,200.11,35.67,,160.088,percent of total billed charges,35.67% of total billed charges,162.69,504.9,
UROSTOMY WAFER 1-3/4,27005132,CDM,270,RC,,,outpatient,,,43,17.20,,36.55,85,,29.24,percent of total billed charges,85% of total billed charges,33.11,77,,26.49,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,35.26,82,,28.208,percent of total billed charges,82% of total billed charges,36.55,85,,29.24,percent of total billed charges,85% of total billed charges,36.55,85,,29.24,percent of total billed charges,85% of total billed charges,36.55,85,,29.24,percent of total billed charges,85% of total billed charges,38.7,90,,30.96,percent of total billed charges,90% of total billed charges,34.4,80,,27.52,percent of total billed charges,80% of total billed charges,38.7,90,,30.96,percent of total billed charges,90% of total billed charges,32.25,75,,25.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,12.47,29,,9.976,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,28.81,67,,23.048,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,34.4,80,,27.52,percent of total billed charges,80% of total billed charges,27.95,65,,22.36,percent of total billed charges,65% of total billed charges,15.34,35.67,,12.272,percent of total billed charges,35.67% of total billed charges,12.47,38.7,
PROBE COVER 3-D WITH GEL,27005158,CDM,270,RC,,,outpatient,,,90,36.00,,76.5,85,,61.2,percent of total billed charges,85% of total billed charges,69.3,77,,55.44,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,73.8,82,,59.04,percent of total billed charges,82% of total billed charges,76.5,85,,61.2,percent of total billed charges,85% of total billed charges,76.5,85,,61.2,percent of total billed charges,85% of total billed charges,76.5,85,,61.2,percent of total billed charges,85% of total billed charges,81,90,,64.8,percent of total billed charges,90% of total billed charges,72,80,,57.6,percent of total billed charges,80% of total billed charges,81,90,,64.8,percent of total billed charges,90% of total billed charges,67.5,75,,54,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,26.1,29,,20.88,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,60.3,67,,48.24,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,72,80,,57.6,percent of total billed charges,80% of total billed charges,58.5,65,,46.8,percent of total billed charges,65% of total billed charges,32.1,35.67,,25.68,percent of total billed charges,35.67% of total billed charges,26.1,81,
WAFER STOMA W/FLANGE 1 3/4 **,27005208,CDM,270,RC,,,outpatient,,,28,11.20,,23.8,85,,19.04,percent of total billed charges,85% of total billed charges,21.56,77,,17.25,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,22.96,82,,18.368,percent of total billed charges,82% of total billed charges,23.8,85,,19.04,percent of total billed charges,85% of total billed charges,23.8,85,,19.04,percent of total billed charges,85% of total billed charges,23.8,85,,19.04,percent of total billed charges,85% of total billed charges,25.2,90,,20.16,percent of total billed charges,90% of total billed charges,22.4,80,,17.92,percent of total billed charges,80% of total billed charges,25.2,90,,20.16,percent of total billed charges,90% of total billed charges,21,75,,16.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,8.12,29,,6.496,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,18.76,67,,15.008,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,22.4,80,,17.92,percent of total billed charges,80% of total billed charges,18.2,65,,14.56,percent of total billed charges,65% of total billed charges,9.99,35.67,,7.992,percent of total billed charges,35.67% of total billed charges,8.12,25.2,
BIO CORKSCREW PUNCH DISP,27005228,CDM,270,RC,,,outpatient,,,607,242.80,,515.95,85,,412.76,percent of total billed charges,85% of total billed charges,467.39,77,,373.91,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,497.74,82,,398.192,percent of total billed charges,82% of total billed charges,515.95,85,,412.76,percent of total billed charges,85% of total billed charges,515.95,85,,412.76,percent of total billed charges,85% of total billed charges,515.95,85,,412.76,percent of total billed charges,85% of total billed charges,546.3,90,,437.04,percent of total billed charges,90% of total billed charges,485.6,80,,388.48,percent of total billed charges,80% of total billed charges,546.3,90,,437.04,percent of total billed charges,90% of total billed charges,455.25,75,,364.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,176.03,29,,140.824,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,406.69,67,,325.352,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,485.6,80,,388.48,percent of total billed charges,80% of total billed charges,394.55,65,,315.64,percent of total billed charges,65% of total billed charges,216.52,35.67,,173.216,percent of total billed charges,35.67% of total billed charges,176.03,546.3,
DRAIN POUCH 1 3/4 1 SD FLK **,27005499,CDM,270,RC,,,outpatient,,,28,11.20,,23.8,85,,19.04,percent of total billed charges,85% of total billed charges,21.56,77,,17.25,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,22.96,82,,18.368,percent of total billed charges,82% of total billed charges,23.8,85,,19.04,percent of total billed charges,85% of total billed charges,23.8,85,,19.04,percent of total billed charges,85% of total billed charges,23.8,85,,19.04,percent of total billed charges,85% of total billed charges,25.2,90,,20.16,percent of total billed charges,90% of total billed charges,22.4,80,,17.92,percent of total billed charges,80% of total billed charges,25.2,90,,20.16,percent of total billed charges,90% of total billed charges,21,75,,16.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,8.12,29,,6.496,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,18.76,67,,15.008,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,22.4,80,,17.92,percent of total billed charges,80% of total billed charges,18.2,65,,14.56,percent of total billed charges,65% of total billed charges,9.99,35.67,,7.992,percent of total billed charges,35.67% of total billed charges,8.12,25.2,
TRACHEAL TUBE ORAL RAE 8.0,27005606,CDM,270,RC,,,outpatient,,,60,24.00,,51,85,,40.8,percent of total billed charges,85% of total billed charges,46.2,77,,36.96,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,49.2,82,,39.36,percent of total billed charges,82% of total billed charges,51,85,,40.8,percent of total billed charges,85% of total billed charges,51,85,,40.8,percent of total billed charges,85% of total billed charges,51,85,,40.8,percent of total billed charges,85% of total billed charges,54,90,,43.2,percent of total billed charges,90% of total billed charges,48,80,,38.4,percent of total billed charges,80% of total billed charges,54,90,,43.2,percent of total billed charges,90% of total billed charges,45,75,,36,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,17.4,29,,13.92,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,40.2,67,,32.16,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,48,80,,38.4,percent of total billed charges,80% of total billed charges,39,65,,31.2,percent of total billed charges,65% of total billed charges,21.4,35.67,,17.12,percent of total billed charges,35.67% of total billed charges,17.4,54,
TRACHEAL TUBE NASAL RAE 7.0,27005607,CDM,270,RC,,,outpatient,,,60,24.00,,51,85,,40.8,percent of total billed charges,85% of total billed charges,46.2,77,,36.96,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,49.2,82,,39.36,percent of total billed charges,82% of total billed charges,51,85,,40.8,percent of total billed charges,85% of total billed charges,51,85,,40.8,percent of total billed charges,85% of total billed charges,51,85,,40.8,percent of total billed charges,85% of total billed charges,54,90,,43.2,percent of total billed charges,90% of total billed charges,48,80,,38.4,percent of total billed charges,80% of total billed charges,54,90,,43.2,percent of total billed charges,90% of total billed charges,45,75,,36,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,17.4,29,,13.92,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,40.2,67,,32.16,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,48,80,,38.4,percent of total billed charges,80% of total billed charges,39,65,,31.2,percent of total billed charges,65% of total billed charges,21.4,35.67,,17.12,percent of total billed charges,35.67% of total billed charges,17.4,54,
SUTURE SURGIPRO 6.0,27005621,CDM,270,RC,,,outpatient,,,205,82.00,,174.25,85,,139.4,percent of total billed charges,85% of total billed charges,157.85,77,,126.28,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,168.1,82,,134.48,percent of total billed charges,82% of total billed charges,174.25,85,,139.4,percent of total billed charges,85% of total billed charges,174.25,85,,139.4,percent of total billed charges,85% of total billed charges,174.25,85,,139.4,percent of total billed charges,85% of total billed charges,184.5,90,,147.6,percent of total billed charges,90% of total billed charges,164,80,,131.2,percent of total billed charges,80% of total billed charges,184.5,90,,147.6,percent of total billed charges,90% of total billed charges,153.75,75,,123,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,59.45,29,,47.56,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,137.35,67,,109.88,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,164,80,,131.2,percent of total billed charges,80% of total billed charges,133.25,65,,106.6,percent of total billed charges,65% of total billed charges,73.12,35.67,,58.496,percent of total billed charges,35.67% of total billed charges,59.45,184.5,
CLAMP BIOPSY MUSCLE 10MM **,27005713,CDM,270,RC,,,outpatient,,,194,77.60,,164.9,85,,131.92,percent of total billed charges,85% of total billed charges,149.38,77,,119.5,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,159.08,82,,127.264,percent of total billed charges,82% of total billed charges,164.9,85,,131.92,percent of total billed charges,85% of total billed charges,164.9,85,,131.92,percent of total billed charges,85% of total billed charges,164.9,85,,131.92,percent of total billed charges,85% of total billed charges,174.6,90,,139.68,percent of total billed charges,90% of total billed charges,155.2,80,,124.16,percent of total billed charges,80% of total billed charges,174.6,90,,139.68,percent of total billed charges,90% of total billed charges,145.5,75,,116.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,56.26,29,,45.008,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,129.98,67,,103.984,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,155.2,80,,124.16,percent of total billed charges,80% of total billed charges,126.1,65,,100.88,percent of total billed charges,65% of total billed charges,69.2,35.67,,55.36,percent of total billed charges,35.67% of total billed charges,56.26,174.6,
RASP MICROAIRE CROSS CUT TEAR,27005716,CDM,270,RC,,,outpatient,,,294,117.60,,249.9,85,,199.92,percent of total billed charges,85% of total billed charges,226.38,77,,181.1,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,241.08,82,,192.864,percent of total billed charges,82% of total billed charges,249.9,85,,199.92,percent of total billed charges,85% of total billed charges,249.9,85,,199.92,percent of total billed charges,85% of total billed charges,249.9,85,,199.92,percent of total billed charges,85% of total billed charges,264.6,90,,211.68,percent of total billed charges,90% of total billed charges,235.2,80,,188.16,percent of total billed charges,80% of total billed charges,264.6,90,,211.68,percent of total billed charges,90% of total billed charges,220.5,75,,176.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,85.26,29,,68.208,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,196.98,67,,157.584,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,235.2,80,,188.16,percent of total billed charges,80% of total billed charges,191.1,65,,152.88,percent of total billed charges,65% of total billed charges,104.87,35.67,,83.896,percent of total billed charges,35.67% of total billed charges,85.26,264.6,
POLYSORB 2-0 27,27005922,CDM,270,RC,,,outpatient,,,87,34.80,,73.95,85,,59.16,percent of total billed charges,85% of total billed charges,66.99,77,,53.59,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,71.34,82,,57.072,percent of total billed charges,82% of total billed charges,73.95,85,,59.16,percent of total billed charges,85% of total billed charges,73.95,85,,59.16,percent of total billed charges,85% of total billed charges,73.95,85,,59.16,percent of total billed charges,85% of total billed charges,78.3,90,,62.64,percent of total billed charges,90% of total billed charges,69.6,80,,55.68,percent of total billed charges,80% of total billed charges,78.3,90,,62.64,percent of total billed charges,90% of total billed charges,65.25,75,,52.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,25.23,29,,20.184,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,58.29,67,,46.632,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,69.6,80,,55.68,percent of total billed charges,80% of total billed charges,56.55,65,,45.24,percent of total billed charges,65% of total billed charges,31.03,35.67,,24.824,percent of total billed charges,35.67% of total billed charges,25.23,78.3,
COLON DECOMPRESSION SET **,27005929,CDM,270,RC,,,outpatient,,,942,376.80,,800.7,85,,640.56,percent of total billed charges,85% of total billed charges,725.34,77,,580.27,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,772.44,82,,617.952,percent of total billed charges,82% of total billed charges,800.7,85,,640.56,percent of total billed charges,85% of total billed charges,800.7,85,,640.56,percent of total billed charges,85% of total billed charges,800.7,85,,640.56,percent of total billed charges,85% of total billed charges,847.8,90,,678.24,percent of total billed charges,90% of total billed charges,753.6,80,,602.88,percent of total billed charges,80% of total billed charges,847.8,90,,678.24,percent of total billed charges,90% of total billed charges,706.5,75,,565.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,273.18,29,,218.544,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,631.14,67,,504.912,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,753.6,80,,602.88,percent of total billed charges,80% of total billed charges,612.3,65,,489.84,percent of total billed charges,65% of total billed charges,336.01,35.67,,268.808,percent of total billed charges,35.67% of total billed charges,273.18,847.8,
l-HOOK ELECTRODE SUCTION/IRRIG,27006075,CDM,270,RC,,,outpatient,,,1679,671.60,,1427.15,85,,1141.72,percent of total billed charges,85% of total billed charges,1292.83,77,,1034.26,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,1376.78,82,,1101.424,percent of total billed charges,82% of total billed charges,1427.15,85,,1141.72,percent of total billed charges,85% of total billed charges,1427.15,85,,1141.72,percent of total billed charges,85% of total billed charges,1427.15,85,,1141.72,percent of total billed charges,85% of total billed charges,1511.1,90,,1208.88,percent of total billed charges,90% of total billed charges,1343.2,80,,1074.56,percent of total billed charges,80% of total billed charges,1511.1,90,,1208.88,percent of total billed charges,90% of total billed charges,1259.25,75,,1007.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,486.91,29,,389.528,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1124.93,67,,899.944,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1343.2,80,,1074.56,percent of total billed charges,80% of total billed charges,1091.35,65,,873.08,percent of total billed charges,65% of total billed charges,598.9,35.67,,479.12,percent of total billed charges,35.67% of total billed charges,486.91,1511.1,
CABLE MICRODEBRIDER TOPAZ,27006078,CDM,270,RC,,,outpatient,,,1700,680.00,,1445,85,,1156,percent of total billed charges,85% of total billed charges,1309,77,,1047.2,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,1394,82,,1115.2,percent of total billed charges,82% of total billed charges,1445,85,,1156,percent of total billed charges,85% of total billed charges,1445,85,,1156,percent of total billed charges,85% of total billed charges,1445,85,,1156,percent of total billed charges,85% of total billed charges,1530,90,,1224,percent of total billed charges,90% of total billed charges,1360,80,,1088,percent of total billed charges,80% of total billed charges,1530,90,,1224,percent of total billed charges,90% of total billed charges,1275,75,,1020,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,493,29,,394.4,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1139,67,,911.2,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1360,80,,1088,percent of total billed charges,80% of total billed charges,1105,65,,884,percent of total billed charges,65% of total billed charges,606.39,35.67,,485.112,percent of total billed charges,35.67% of total billed charges,493,1530,
PERITONIAL CATHETER TENCKOFF,27006122,CDM,270,RC,,,outpatient,,,289,115.60,,245.65,85,,196.52,percent of total billed charges,85% of total billed charges,222.53,77,,178.02,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,236.98,82,,189.584,percent of total billed charges,82% of total billed charges,245.65,85,,196.52,percent of total billed charges,85% of total billed charges,245.65,85,,196.52,percent of total billed charges,85% of total billed charges,245.65,85,,196.52,percent of total billed charges,85% of total billed charges,260.1,90,,208.08,percent of total billed charges,90% of total billed charges,231.2,80,,184.96,percent of total billed charges,80% of total billed charges,260.1,90,,208.08,percent of total billed charges,90% of total billed charges,216.75,75,,173.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,83.81,29,,67.048,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,193.63,67,,154.904,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,231.2,80,,184.96,percent of total billed charges,80% of total billed charges,187.85,65,,150.28,percent of total billed charges,65% of total billed charges,103.09,35.67,,82.472,percent of total billed charges,35.67% of total billed charges,83.81,260.1,
VAGINAL GAUZE STERILE,27006198,CDM,270,RC,,,outpatient,,,38,15.20,,32.3,85,,25.84,percent of total billed charges,85% of total billed charges,29.26,77,,23.41,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,31.16,82,,24.928,percent of total billed charges,82% of total billed charges,32.3,85,,25.84,percent of total billed charges,85% of total billed charges,32.3,85,,25.84,percent of total billed charges,85% of total billed charges,32.3,85,,25.84,percent of total billed charges,85% of total billed charges,34.2,90,,27.36,percent of total billed charges,90% of total billed charges,30.4,80,,24.32,percent of total billed charges,80% of total billed charges,34.2,90,,27.36,percent of total billed charges,90% of total billed charges,28.5,75,,22.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,11.02,29,,8.816,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,25.46,67,,20.368,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,30.4,80,,24.32,percent of total billed charges,80% of total billed charges,24.7,65,,19.76,percent of total billed charges,65% of total billed charges,13.55,35.67,,10.84,percent of total billed charges,35.67% of total billed charges,11.02,34.2,
APPLICATOR CHLORAPREP TL 10.5,27006263,CDM,270,RC,,,outpatient,,,48,19.20,,40.8,85,,32.64,percent of total billed charges,85% of total billed charges,36.96,77,,29.57,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,39.36,82,,31.488,percent of total billed charges,82% of total billed charges,40.8,85,,32.64,percent of total billed charges,85% of total billed charges,40.8,85,,32.64,percent of total billed charges,85% of total billed charges,40.8,85,,32.64,percent of total billed charges,85% of total billed charges,43.2,90,,34.56,percent of total billed charges,90% of total billed charges,38.4,80,,30.72,percent of total billed charges,80% of total billed charges,43.2,90,,34.56,percent of total billed charges,90% of total billed charges,36,75,,28.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,13.92,29,,11.136,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,32.16,67,,25.728,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,38.4,80,,30.72,percent of total billed charges,80% of total billed charges,31.2,65,,24.96,percent of total billed charges,65% of total billed charges,17.12,35.67,,13.696,percent of total billed charges,35.67% of total billed charges,13.92,43.2,
HARMONIC 36 CM,27006274,CDM,270,RC,,,outpatient,,,2059,823.60,,1750.15,85,,1400.12,percent of total billed charges,85% of total billed charges,1585.43,77,,1268.34,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,1688.38,82,,1350.704,percent of total billed charges,82% of total billed charges,1750.15,85,,1400.12,percent of total billed charges,85% of total billed charges,1750.15,85,,1400.12,percent of total billed charges,85% of total billed charges,1750.15,85,,1400.12,percent of total billed charges,85% of total billed charges,1853.1,90,,1482.48,percent of total billed charges,90% of total billed charges,1647.2,80,,1317.76,percent of total billed charges,80% of total billed charges,1853.1,90,,1482.48,percent of total billed charges,90% of total billed charges,1544.25,75,,1235.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,597.11,29,,477.688,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1379.53,67,,1103.624,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1647.2,80,,1317.76,percent of total billed charges,80% of total billed charges,1338.35,65,,1070.68,percent of total billed charges,65% of total billed charges,734.45,35.67,,587.56,percent of total billed charges,35.67% of total billed charges,597.11,1853.1,
HARMONIC 14 CM,27006275,CDM,270,RC,,,outpatient,,,2008,803.20,,1706.8,85,,1365.44,percent of total billed charges,85% of total billed charges,1546.16,77,,1236.93,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,1646.56,82,,1317.248,percent of total billed charges,82% of total billed charges,1706.8,85,,1365.44,percent of total billed charges,85% of total billed charges,1706.8,85,,1365.44,percent of total billed charges,85% of total billed charges,1706.8,85,,1365.44,percent of total billed charges,85% of total billed charges,1807.2,90,,1445.76,percent of total billed charges,90% of total billed charges,1606.4,80,,1285.12,percent of total billed charges,80% of total billed charges,1807.2,90,,1445.76,percent of total billed charges,90% of total billed charges,1506,75,,1204.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,582.32,29,,465.856,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1345.36,67,,1076.288,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1606.4,80,,1285.12,percent of total billed charges,80% of total billed charges,1305.2,65,,1044.16,percent of total billed charges,65% of total billed charges,716.25,35.67,,573,percent of total billed charges,35.67% of total billed charges,582.32,1807.2,
BRUSH MAX CHANNEL DISPOSABLE,27006330,CDM,270,RC,,,outpatient,,,31,12.40,,26.35,85,,21.08,percent of total billed charges,85% of total billed charges,23.87,77,,19.1,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,25.42,82,,20.336,percent of total billed charges,82% of total billed charges,26.35,85,,21.08,percent of total billed charges,85% of total billed charges,26.35,85,,21.08,percent of total billed charges,85% of total billed charges,26.35,85,,21.08,percent of total billed charges,85% of total billed charges,27.9,90,,22.32,percent of total billed charges,90% of total billed charges,24.8,80,,19.84,percent of total billed charges,80% of total billed charges,27.9,90,,22.32,percent of total billed charges,90% of total billed charges,23.25,75,,18.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,8.99,29,,7.192,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,20.77,67,,16.616,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,24.8,80,,19.84,percent of total billed charges,80% of total billed charges,20.15,65,,16.12,percent of total billed charges,65% of total billed charges,11.06,35.67,,8.848,percent of total billed charges,35.67% of total billed charges,8.99,27.9,
ELBOW SWIVEL ADAPTER,27006339,CDM,270,RC,,,outpatient,,,58,23.20,,49.3,85,,39.44,percent of total billed charges,85% of total billed charges,44.66,77,,35.73,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,47.56,82,,38.048,percent of total billed charges,82% of total billed charges,49.3,85,,39.44,percent of total billed charges,85% of total billed charges,49.3,85,,39.44,percent of total billed charges,85% of total billed charges,49.3,85,,39.44,percent of total billed charges,85% of total billed charges,52.2,90,,41.76,percent of total billed charges,90% of total billed charges,46.4,80,,37.12,percent of total billed charges,80% of total billed charges,52.2,90,,41.76,percent of total billed charges,90% of total billed charges,43.5,75,,34.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,16.82,29,,13.456,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,38.86,67,,31.088,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,46.4,80,,37.12,percent of total billed charges,80% of total billed charges,37.7,65,,30.16,percent of total billed charges,65% of total billed charges,20.69,35.67,,16.552,percent of total billed charges,35.67% of total billed charges,16.82,52.2,
INTROCAN NEEDLE 20G X 1,27006604,CDM,270,RC,,,outpatient,,,53,21.20,,45.05,85,,36.04,percent of total billed charges,85% of total billed charges,40.81,77,,32.65,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,43.46,82,,34.768,percent of total billed charges,82% of total billed charges,45.05,85,,36.04,percent of total billed charges,85% of total billed charges,45.05,85,,36.04,percent of total billed charges,85% of total billed charges,45.05,85,,36.04,percent of total billed charges,85% of total billed charges,47.7,90,,38.16,percent of total billed charges,90% of total billed charges,42.4,80,,33.92,percent of total billed charges,80% of total billed charges,47.7,90,,38.16,percent of total billed charges,90% of total billed charges,39.75,75,,31.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,15.37,29,,12.296,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,35.51,67,,28.408,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,42.4,80,,33.92,percent of total billed charges,80% of total billed charges,34.45,65,,27.56,percent of total billed charges,65% of total billed charges,18.91,35.67,,15.128,percent of total billed charges,35.67% of total billed charges,15.37,47.7,
EZ IO NDL INTRAOSSEOUS PEDI,27006659,CDM,270,RC,,,outpatient,,,758,303.20,,644.3,85,,515.44,percent of total billed charges,85% of total billed charges,583.66,77,,466.93,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,621.56,82,,497.248,percent of total billed charges,82% of total billed charges,644.3,85,,515.44,percent of total billed charges,85% of total billed charges,644.3,85,,515.44,percent of total billed charges,85% of total billed charges,644.3,85,,515.44,percent of total billed charges,85% of total billed charges,682.2,90,,545.76,percent of total billed charges,90% of total billed charges,606.4,80,,485.12,percent of total billed charges,80% of total billed charges,682.2,90,,545.76,percent of total billed charges,90% of total billed charges,568.5,75,,454.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,219.82,29,,175.856,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,507.86,67,,406.288,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,606.4,80,,485.12,percent of total billed charges,80% of total billed charges,492.7,65,,394.16,percent of total billed charges,65% of total billed charges,270.38,35.67,,216.304,percent of total billed charges,35.67% of total billed charges,219.82,682.2,
EZ IO NEEDLE 15GX1 ADULT,27006660,CDM,270,RC,,,outpatient,,,848,339.20,,720.8,85,,576.64,percent of total billed charges,85% of total billed charges,652.96,77,,522.37,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,695.36,82,,556.288,percent of total billed charges,82% of total billed charges,720.8,85,,576.64,percent of total billed charges,85% of total billed charges,720.8,85,,576.64,percent of total billed charges,85% of total billed charges,720.8,85,,576.64,percent of total billed charges,85% of total billed charges,763.2,90,,610.56,percent of total billed charges,90% of total billed charges,678.4,80,,542.72,percent of total billed charges,80% of total billed charges,763.2,90,,610.56,percent of total billed charges,90% of total billed charges,636,75,,508.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,245.92,29,,196.736,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,568.16,67,,454.528,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,678.4,80,,542.72,percent of total billed charges,80% of total billed charges,551.2,65,,440.96,percent of total billed charges,65% of total billed charges,302.48,35.67,,241.984,percent of total billed charges,35.67% of total billed charges,245.92,763.2,
COTTON ROLL 1# STERILE,27006669,CDM,270,RC,,,outpatient,,,49,19.60,,41.65,85,,33.32,percent of total billed charges,85% of total billed charges,37.73,77,,30.18,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,40.18,82,,32.144,percent of total billed charges,82% of total billed charges,41.65,85,,33.32,percent of total billed charges,85% of total billed charges,41.65,85,,33.32,percent of total billed charges,85% of total billed charges,41.65,85,,33.32,percent of total billed charges,85% of total billed charges,44.1,90,,35.28,percent of total billed charges,90% of total billed charges,39.2,80,,31.36,percent of total billed charges,80% of total billed charges,44.1,90,,35.28,percent of total billed charges,90% of total billed charges,36.75,75,,29.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,14.21,29,,11.368,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,32.83,67,,26.264,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,39.2,80,,31.36,percent of total billed charges,80% of total billed charges,31.85,65,,25.48,percent of total billed charges,65% of total billed charges,17.48,35.67,,13.984,percent of total billed charges,35.67% of total billed charges,14.21,44.1,
VIGILON DRESSING STERILE 4X4,27006677,CDM,270,RC,,,outpatient,,,56,22.40,,47.6,85,,38.08,percent of total billed charges,85% of total billed charges,43.12,77,,34.5,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,45.92,82,,36.736,percent of total billed charges,82% of total billed charges,47.6,85,,38.08,percent of total billed charges,85% of total billed charges,47.6,85,,38.08,percent of total billed charges,85% of total billed charges,47.6,85,,38.08,percent of total billed charges,85% of total billed charges,50.4,90,,40.32,percent of total billed charges,90% of total billed charges,44.8,80,,35.84,percent of total billed charges,80% of total billed charges,50.4,90,,40.32,percent of total billed charges,90% of total billed charges,42,75,,33.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,16.24,29,,12.992,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,37.52,67,,30.016,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,44.8,80,,35.84,percent of total billed charges,80% of total billed charges,36.4,65,,29.12,percent of total billed charges,65% of total billed charges,19.98,35.67,,15.984,percent of total billed charges,35.67% of total billed charges,16.24,50.4,
TRAP POLYP,27006734,CDM,270,RC,,,outpatient,,,102,40.80,,86.7,85,,69.36,percent of total billed charges,85% of total billed charges,78.54,77,,62.83,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,83.64,82,,66.912,percent of total billed charges,82% of total billed charges,86.7,85,,69.36,percent of total billed charges,85% of total billed charges,86.7,85,,69.36,percent of total billed charges,85% of total billed charges,86.7,85,,69.36,percent of total billed charges,85% of total billed charges,91.8,90,,73.44,percent of total billed charges,90% of total billed charges,81.6,80,,65.28,percent of total billed charges,80% of total billed charges,91.8,90,,73.44,percent of total billed charges,90% of total billed charges,76.5,75,,61.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,29.58,29,,23.664,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,68.34,67,,54.672,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,81.6,80,,65.28,percent of total billed charges,80% of total billed charges,66.3,65,,53.04,percent of total billed charges,65% of total billed charges,36.38,35.67,,29.104,percent of total billed charges,35.67% of total billed charges,29.58,91.8,
BITE BLOCK,27006735,CDM,270,RC,,,outpatient,,,46,18.40,,39.1,85,,31.28,percent of total billed charges,85% of total billed charges,35.42,77,,28.34,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,37.72,82,,30.176,percent of total billed charges,82% of total billed charges,39.1,85,,31.28,percent of total billed charges,85% of total billed charges,39.1,85,,31.28,percent of total billed charges,85% of total billed charges,39.1,85,,31.28,percent of total billed charges,85% of total billed charges,41.4,90,,33.12,percent of total billed charges,90% of total billed charges,36.8,80,,29.44,percent of total billed charges,80% of total billed charges,41.4,90,,33.12,percent of total billed charges,90% of total billed charges,34.5,75,,27.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,13.34,29,,10.672,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,30.82,67,,24.656,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,36.8,80,,29.44,percent of total billed charges,80% of total billed charges,29.9,65,,23.92,percent of total billed charges,65% of total billed charges,16.41,35.67,,13.128,percent of total billed charges,35.67% of total billed charges,13.34,41.4,
LAMB'S WOOL PADDING,27006768,CDM,270,RC,,,outpatient,,,36,14.40,,30.6,85,,24.48,percent of total billed charges,85% of total billed charges,27.72,77,,22.18,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,29.52,82,,23.616,percent of total billed charges,82% of total billed charges,30.6,85,,24.48,percent of total billed charges,85% of total billed charges,30.6,85,,24.48,percent of total billed charges,85% of total billed charges,30.6,85,,24.48,percent of total billed charges,85% of total billed charges,32.4,90,,25.92,percent of total billed charges,90% of total billed charges,28.8,80,,23.04,percent of total billed charges,80% of total billed charges,32.4,90,,25.92,percent of total billed charges,90% of total billed charges,27,75,,21.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,10.44,29,,8.352,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,24.12,67,,19.296,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,28.8,80,,23.04,percent of total billed charges,80% of total billed charges,23.4,65,,18.72,percent of total billed charges,65% of total billed charges,12.84,35.67,,10.272,percent of total billed charges,35.67% of total billed charges,10.44,32.4,
VAGINAL SPECULUM LG DISPOSABLE,27006949,CDM,270,RC,,,outpatient,,,24,9.60,,20.4,85,,16.32,percent of total billed charges,85% of total billed charges,18.48,77,,14.78,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,19.68,82,,15.744,percent of total billed charges,82% of total billed charges,20.4,85,,16.32,percent of total billed charges,85% of total billed charges,20.4,85,,16.32,percent of total billed charges,85% of total billed charges,20.4,85,,16.32,percent of total billed charges,85% of total billed charges,21.6,90,,17.28,percent of total billed charges,90% of total billed charges,19.2,80,,15.36,percent of total billed charges,80% of total billed charges,21.6,90,,17.28,percent of total billed charges,90% of total billed charges,18,75,,14.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,6.96,29,,5.568,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,16.08,67,,12.864,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,19.2,80,,15.36,percent of total billed charges,80% of total billed charges,15.6,65,,12.48,percent of total billed charges,65% of total billed charges,8.56,35.67,,6.848,percent of total billed charges,35.67% of total billed charges,6.96,21.6,
CUTTER STAPLER CURVED CONTOUR,27006987,CDM,270,RC,,,outpatient,,,888,355.20,,754.8,85,,603.84,percent of total billed charges,85% of total billed charges,683.76,77,,547.01,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,728.16,82,,582.528,percent of total billed charges,82% of total billed charges,754.8,85,,603.84,percent of total billed charges,85% of total billed charges,754.8,85,,603.84,percent of total billed charges,85% of total billed charges,754.8,85,,603.84,percent of total billed charges,85% of total billed charges,799.2,90,,639.36,percent of total billed charges,90% of total billed charges,710.4,80,,568.32,percent of total billed charges,80% of total billed charges,799.2,90,,639.36,percent of total billed charges,90% of total billed charges,666,75,,532.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,257.52,29,,206.016,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,594.96,67,,475.968,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,710.4,80,,568.32,percent of total billed charges,80% of total billed charges,577.2,65,,461.76,percent of total billed charges,65% of total billed charges,316.75,35.67,,253.4,percent of total billed charges,35.67% of total billed charges,257.52,799.2,
SLEEVE LIMB PROTECTION ADLT XS,27007033,CDM,270,RC,,,outpatient,,,64,25.60,,54.4,85,,43.52,percent of total billed charges,85% of total billed charges,49.28,77,,39.42,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,52.48,82,,41.984,percent of total billed charges,82% of total billed charges,54.4,85,,43.52,percent of total billed charges,85% of total billed charges,54.4,85,,43.52,percent of total billed charges,85% of total billed charges,54.4,85,,43.52,percent of total billed charges,85% of total billed charges,57.6,90,,46.08,percent of total billed charges,90% of total billed charges,51.2,80,,40.96,percent of total billed charges,80% of total billed charges,57.6,90,,46.08,percent of total billed charges,90% of total billed charges,48,75,,38.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,18.56,29,,14.848,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,42.88,67,,34.304,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,51.2,80,,40.96,percent of total billed charges,80% of total billed charges,41.6,65,,33.28,percent of total billed charges,65% of total billed charges,22.83,35.67,,18.264,percent of total billed charges,35.67% of total billed charges,18.56,57.6,
LIMB PROTECTION SLEEVE REG ADL,27007049,CDM,270,RC,,,outpatient,,,58,23.20,,49.3,85,,39.44,percent of total billed charges,85% of total billed charges,44.66,77,,35.73,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,47.56,82,,38.048,percent of total billed charges,82% of total billed charges,49.3,85,,39.44,percent of total billed charges,85% of total billed charges,49.3,85,,39.44,percent of total billed charges,85% of total billed charges,49.3,85,,39.44,percent of total billed charges,85% of total billed charges,52.2,90,,41.76,percent of total billed charges,90% of total billed charges,46.4,80,,37.12,percent of total billed charges,80% of total billed charges,52.2,90,,41.76,percent of total billed charges,90% of total billed charges,43.5,75,,34.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,16.82,29,,13.456,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,38.86,67,,31.088,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,46.4,80,,37.12,percent of total billed charges,80% of total billed charges,37.7,65,,30.16,percent of total billed charges,65% of total billed charges,20.69,35.67,,16.552,percent of total billed charges,35.67% of total billed charges,16.82,52.2,
PUNCH BIOPSY DERMAL 3.5MM,27007094,CDM,270,RC,,,outpatient,,,17,6.80,,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,13.09,77,,10.47,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,13.94,82,,11.152,percent of total billed charges,82% of total billed charges,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,15.3,90,,12.24,percent of total billed charges,90% of total billed charges,13.6,80,,10.88,percent of total billed charges,80% of total billed charges,15.3,90,,12.24,percent of total billed charges,90% of total billed charges,12.75,75,,10.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,4.93,29,,3.944,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,11.39,67,,9.112,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,13.6,80,,10.88,percent of total billed charges,80% of total billed charges,11.05,65,,8.84,percent of total billed charges,65% of total billed charges,6.06,35.67,,4.848,percent of total billed charges,35.67% of total billed charges,4.93,15.3,
PUNCH BIOPSY DERMAL 3.0MM,27007095,CDM,270,RC,,,outpatient,,,17,6.80,,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,13.09,77,,10.47,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,13.94,82,,11.152,percent of total billed charges,82% of total billed charges,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,15.3,90,,12.24,percent of total billed charges,90% of total billed charges,13.6,80,,10.88,percent of total billed charges,80% of total billed charges,15.3,90,,12.24,percent of total billed charges,90% of total billed charges,12.75,75,,10.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,4.93,29,,3.944,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,11.39,67,,9.112,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,13.6,80,,10.88,percent of total billed charges,80% of total billed charges,11.05,65,,8.84,percent of total billed charges,65% of total billed charges,6.06,35.67,,4.848,percent of total billed charges,35.67% of total billed charges,4.93,15.3,
ENDOSCOPIC PLANTAR FISCIA TRAY,27007239,CDM,270,RC,,,outpatient,,,4455,1782.00,,3786.75,85,,3029.4,percent of total billed charges,85% of total billed charges,3430.35,77,,2744.28,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,3653.1,82,,2922.48,percent of total billed charges,82% of total billed charges,3786.75,85,,3029.4,percent of total billed charges,85% of total billed charges,3786.75,85,,3029.4,percent of total billed charges,85% of total billed charges,3786.75,85,,3029.4,percent of total billed charges,85% of total billed charges,4009.5,90,,3207.6,percent of total billed charges,90% of total billed charges,3564,80,,2851.2,percent of total billed charges,80% of total billed charges,4009.5,90,,3207.6,percent of total billed charges,90% of total billed charges,3341.25,75,,2673,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,1291.95,29,,1033.56,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,2984.85,67,,2387.88,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,3564,80,,2851.2,percent of total billed charges,80% of total billed charges,2895.75,65,,2316.6,percent of total billed charges,65% of total billed charges,1589.1,35.67,,1271.28,percent of total billed charges,35.67% of total billed charges,1291.95,4009.5,
DONUT CUSHION CONVOLUTE,27007360,CDM,270,RC,,,outpatient,,,115,46.00,,97.75,85,,78.2,percent of total billed charges,85% of total billed charges,88.55,77,,70.84,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,94.3,82,,75.44,percent of total billed charges,82% of total billed charges,97.75,85,,78.2,percent of total billed charges,85% of total billed charges,97.75,85,,78.2,percent of total billed charges,85% of total billed charges,97.75,85,,78.2,percent of total billed charges,85% of total billed charges,103.5,90,,82.8,percent of total billed charges,90% of total billed charges,92,80,,73.6,percent of total billed charges,80% of total billed charges,103.5,90,,82.8,percent of total billed charges,90% of total billed charges,86.25,75,,69,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,33.35,29,,26.68,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,77.05,67,,61.64,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,92,80,,73.6,percent of total billed charges,80% of total billed charges,74.75,65,,59.8,percent of total billed charges,65% of total billed charges,41.02,35.67,,32.816,percent of total billed charges,35.67% of total billed charges,33.35,103.5,
SURGIGUT SUTURE 5-0 18 6876,27007379,CDM,270,RC,,,outpatient,,,177,70.80,,150.45,85,,120.36,percent of total billed charges,85% of total billed charges,136.29,77,,109.03,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,145.14,82,,116.112,percent of total billed charges,82% of total billed charges,150.45,85,,120.36,percent of total billed charges,85% of total billed charges,150.45,85,,120.36,percent of total billed charges,85% of total billed charges,150.45,85,,120.36,percent of total billed charges,85% of total billed charges,159.3,90,,127.44,percent of total billed charges,90% of total billed charges,141.6,80,,113.28,percent of total billed charges,80% of total billed charges,159.3,90,,127.44,percent of total billed charges,90% of total billed charges,132.75,75,,106.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,51.33,29,,41.064,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,118.59,67,,94.872,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,141.6,80,,113.28,percent of total billed charges,80% of total billed charges,115.05,65,,92.04,percent of total billed charges,65% of total billed charges,63.14,35.67,,50.512,percent of total billed charges,35.67% of total billed charges,51.33,159.3,
QUICKCLOT 1ST RESPONSE SPONGE,27007382,CDM,270,RC,,,outpatient,,,102,40.80,,86.7,85,,69.36,percent of total billed charges,85% of total billed charges,78.54,77,,62.83,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,83.64,82,,66.912,percent of total billed charges,82% of total billed charges,86.7,85,,69.36,percent of total billed charges,85% of total billed charges,86.7,85,,69.36,percent of total billed charges,85% of total billed charges,86.7,85,,69.36,percent of total billed charges,85% of total billed charges,91.8,90,,73.44,percent of total billed charges,90% of total billed charges,81.6,80,,65.28,percent of total billed charges,80% of total billed charges,91.8,90,,73.44,percent of total billed charges,90% of total billed charges,76.5,75,,61.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,29.58,29,,23.664,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,68.34,67,,54.672,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,81.6,80,,65.28,percent of total billed charges,80% of total billed charges,66.3,65,,53.04,percent of total billed charges,65% of total billed charges,36.38,35.67,,29.104,percent of total billed charges,35.67% of total billed charges,29.58,91.8,
SPINAL QUINCKE NEEDLE 25X1,27007383,CDM,270,RC,,,outpatient,,,43,17.20,,36.55,85,,29.24,percent of total billed charges,85% of total billed charges,33.11,77,,26.49,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,35.26,82,,28.208,percent of total billed charges,82% of total billed charges,36.55,85,,29.24,percent of total billed charges,85% of total billed charges,36.55,85,,29.24,percent of total billed charges,85% of total billed charges,36.55,85,,29.24,percent of total billed charges,85% of total billed charges,38.7,90,,30.96,percent of total billed charges,90% of total billed charges,34.4,80,,27.52,percent of total billed charges,80% of total billed charges,38.7,90,,30.96,percent of total billed charges,90% of total billed charges,32.25,75,,25.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,12.47,29,,9.976,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,28.81,67,,23.048,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,34.4,80,,27.52,percent of total billed charges,80% of total billed charges,27.95,65,,22.36,percent of total billed charges,65% of total billed charges,15.34,35.67,,12.272,percent of total billed charges,35.67% of total billed charges,12.47,38.7,
BACTERIA FILTER DISP D/FLEX,27007400,CDM,270,RC,,,outpatient,,,93,37.20,,79.05,85,,63.24,percent of total billed charges,85% of total billed charges,71.61,77,,57.29,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,76.26,82,,61.008,percent of total billed charges,82% of total billed charges,79.05,85,,63.24,percent of total billed charges,85% of total billed charges,79.05,85,,63.24,percent of total billed charges,85% of total billed charges,79.05,85,,63.24,percent of total billed charges,85% of total billed charges,83.7,90,,66.96,percent of total billed charges,90% of total billed charges,74.4,80,,59.52,percent of total billed charges,80% of total billed charges,83.7,90,,66.96,percent of total billed charges,90% of total billed charges,69.75,75,,55.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,26.97,29,,21.576,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,62.31,67,,49.848,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,74.4,80,,59.52,percent of total billed charges,80% of total billed charges,60.45,65,,48.36,percent of total billed charges,65% of total billed charges,33.17,35.67,,26.536,percent of total billed charges,35.67% of total billed charges,26.97,83.7,
MYELO-NATE KIT W/22GX1.5NDLE,27007408,CDM,270,RC,,,outpatient,,,97,38.80,,82.45,85,,65.96,percent of total billed charges,85% of total billed charges,74.69,77,,59.75,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,79.54,82,,63.632,percent of total billed charges,82% of total billed charges,82.45,85,,65.96,percent of total billed charges,85% of total billed charges,82.45,85,,65.96,percent of total billed charges,85% of total billed charges,82.45,85,,65.96,percent of total billed charges,85% of total billed charges,87.3,90,,69.84,percent of total billed charges,90% of total billed charges,77.6,80,,62.08,percent of total billed charges,80% of total billed charges,87.3,90,,69.84,percent of total billed charges,90% of total billed charges,72.75,75,,58.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,28.13,29,,22.504,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,64.99,67,,51.992,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,77.6,80,,62.08,percent of total billed charges,80% of total billed charges,63.05,65,,50.44,percent of total billed charges,65% of total billed charges,34.6,35.67,,27.68,percent of total billed charges,35.67% of total billed charges,28.13,87.3,
MYELO-NATE NEEDLE 22G X 1.5,27007409,CDM,270,RC,,,outpatient,,,43,17.20,,36.55,85,,29.24,percent of total billed charges,85% of total billed charges,33.11,77,,26.49,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,35.26,82,,28.208,percent of total billed charges,82% of total billed charges,36.55,85,,29.24,percent of total billed charges,85% of total billed charges,36.55,85,,29.24,percent of total billed charges,85% of total billed charges,36.55,85,,29.24,percent of total billed charges,85% of total billed charges,38.7,90,,30.96,percent of total billed charges,90% of total billed charges,34.4,80,,27.52,percent of total billed charges,80% of total billed charges,38.7,90,,30.96,percent of total billed charges,90% of total billed charges,32.25,75,,25.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,12.47,29,,9.976,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,28.81,67,,23.048,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,34.4,80,,27.52,percent of total billed charges,80% of total billed charges,27.95,65,,22.36,percent of total billed charges,65% of total billed charges,15.34,35.67,,12.272,percent of total billed charges,35.67% of total billed charges,12.47,38.7,
ELECTRODE FOR EEG AND SLPSTUDY,27007410,CDM,270,RC,,,outpatient,,,16,6.40,,13.6,85,,10.88,percent of total billed charges,85% of total billed charges,12.32,77,,9.86,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,13.12,82,,10.496,percent of total billed charges,82% of total billed charges,13.6,85,,10.88,percent of total billed charges,85% of total billed charges,13.6,85,,10.88,percent of total billed charges,85% of total billed charges,13.6,85,,10.88,percent of total billed charges,85% of total billed charges,14.4,90,,11.52,percent of total billed charges,90% of total billed charges,12.8,80,,10.24,percent of total billed charges,80% of total billed charges,14.4,90,,11.52,percent of total billed charges,90% of total billed charges,12,75,,9.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,4.64,29,,3.712,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,10.72,67,,8.576,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,12.8,80,,10.24,percent of total billed charges,80% of total billed charges,10.4,65,,8.32,percent of total billed charges,65% of total billed charges,5.71,35.67,,4.568,percent of total billed charges,35.67% of total billed charges,4.64,14.4,
"HUMIDIFIER, HIGH FLOW",27007434,CDM,270,RC,,,outpatient,,,20,8.00,,17,85,,13.6,percent of total billed charges,85% of total billed charges,15.4,77,,12.32,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,16.4,82,,13.12,percent of total billed charges,82% of total billed charges,17,85,,13.6,percent of total billed charges,85% of total billed charges,17,85,,13.6,percent of total billed charges,85% of total billed charges,17,85,,13.6,percent of total billed charges,85% of total billed charges,18,90,,14.4,percent of total billed charges,90% of total billed charges,16,80,,12.8,percent of total billed charges,80% of total billed charges,18,90,,14.4,percent of total billed charges,90% of total billed charges,15,75,,12,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,5.8,29,,4.64,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,13.4,67,,10.72,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,16,80,,12.8,percent of total billed charges,80% of total billed charges,13,65,,10.4,percent of total billed charges,65% of total billed charges,7.13,35.67,,5.704,percent of total billed charges,35.67% of total billed charges,5.8,18,
BIOPSY VALVE DISPOSABLE BIO,27007436,CDM,270,RC,,,outpatient,,,48,19.20,,40.8,85,,32.64,percent of total billed charges,85% of total billed charges,36.96,77,,29.57,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,39.36,82,,31.488,percent of total billed charges,82% of total billed charges,40.8,85,,32.64,percent of total billed charges,85% of total billed charges,40.8,85,,32.64,percent of total billed charges,85% of total billed charges,40.8,85,,32.64,percent of total billed charges,85% of total billed charges,43.2,90,,34.56,percent of total billed charges,90% of total billed charges,38.4,80,,30.72,percent of total billed charges,80% of total billed charges,43.2,90,,34.56,percent of total billed charges,90% of total billed charges,36,75,,28.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,13.92,29,,11.136,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,32.16,67,,25.728,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,38.4,80,,30.72,percent of total billed charges,80% of total billed charges,31.2,65,,24.96,percent of total billed charges,65% of total billed charges,17.12,35.67,,13.696,percent of total billed charges,35.67% of total billed charges,13.92,43.2,
SAFFLOWER OIL,27007439,CDM,270,RC,,,outpatient,,,31,12.40,,26.35,85,,21.08,percent of total billed charges,85% of total billed charges,23.87,77,,19.1,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,25.42,82,,20.336,percent of total billed charges,82% of total billed charges,26.35,85,,21.08,percent of total billed charges,85% of total billed charges,26.35,85,,21.08,percent of total billed charges,85% of total billed charges,26.35,85,,21.08,percent of total billed charges,85% of total billed charges,27.9,90,,22.32,percent of total billed charges,90% of total billed charges,24.8,80,,19.84,percent of total billed charges,80% of total billed charges,27.9,90,,22.32,percent of total billed charges,90% of total billed charges,23.25,75,,18.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,8.99,29,,7.192,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,20.77,67,,16.616,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,24.8,80,,19.84,percent of total billed charges,80% of total billed charges,20.15,65,,16.12,percent of total billed charges,65% of total billed charges,11.06,35.67,,8.848,percent of total billed charges,35.67% of total billed charges,8.99,27.9,
FIBERWIRE LOOP 2-0 NDL DMND 26,27007503,CDM,270,RC,,,outpatient,,,316,126.40,,268.6,85,,214.88,percent of total billed charges,85% of total billed charges,243.32,77,,194.66,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,259.12,82,,207.296,percent of total billed charges,82% of total billed charges,268.6,85,,214.88,percent of total billed charges,85% of total billed charges,268.6,85,,214.88,percent of total billed charges,85% of total billed charges,268.6,85,,214.88,percent of total billed charges,85% of total billed charges,284.4,90,,227.52,percent of total billed charges,90% of total billed charges,252.8,80,,202.24,percent of total billed charges,80% of total billed charges,284.4,90,,227.52,percent of total billed charges,90% of total billed charges,237,75,,189.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,91.64,29,,73.312,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,211.72,67,,169.376,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,252.8,80,,202.24,percent of total billed charges,80% of total billed charges,205.4,65,,164.32,percent of total billed charges,65% of total billed charges,112.72,35.67,,90.176,percent of total billed charges,35.67% of total billed charges,91.64,284.4,
FOLEY CATHETER PEDI 6 FR 2 WAY,27007517,CDM,270,RC,,,outpatient,,,44,17.60,,37.4,85,,29.92,percent of total billed charges,85% of total billed charges,33.88,77,,27.1,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,36.08,82,,28.864,percent of total billed charges,82% of total billed charges,37.4,85,,29.92,percent of total billed charges,85% of total billed charges,37.4,85,,29.92,percent of total billed charges,85% of total billed charges,37.4,85,,29.92,percent of total billed charges,85% of total billed charges,39.6,90,,31.68,percent of total billed charges,90% of total billed charges,35.2,80,,28.16,percent of total billed charges,80% of total billed charges,39.6,90,,31.68,percent of total billed charges,90% of total billed charges,33,75,,26.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,12.76,29,,10.208,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,29.48,67,,23.584,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,35.2,80,,28.16,percent of total billed charges,80% of total billed charges,28.6,65,,22.88,percent of total billed charges,65% of total billed charges,15.69,35.67,,12.552,percent of total billed charges,35.67% of total billed charges,12.76,39.6,
PLATELET CONC SEP KIT,27007580,CDM,270,RC,,,outpatient,,,897,358.80,,762.45,85,,609.96,percent of total billed charges,85% of total billed charges,690.69,77,,552.55,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,735.54,82,,588.432,percent of total billed charges,82% of total billed charges,762.45,85,,609.96,percent of total billed charges,85% of total billed charges,762.45,85,,609.96,percent of total billed charges,85% of total billed charges,762.45,85,,609.96,percent of total billed charges,85% of total billed charges,807.3,90,,645.84,percent of total billed charges,90% of total billed charges,717.6,80,,574.08,percent of total billed charges,80% of total billed charges,807.3,90,,645.84,percent of total billed charges,90% of total billed charges,672.75,75,,538.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,260.13,29,,208.104,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,600.99,67,,480.792,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,717.6,80,,574.08,percent of total billed charges,80% of total billed charges,583.05,65,,466.44,percent of total billed charges,65% of total billed charges,319.96,35.67,,255.968,percent of total billed charges,35.67% of total billed charges,260.13,807.3,
"ALLEN WRENCH, SURGICAL",27007599,CDM,270,RC,,,outpatient,,,136,54.40,,115.6,85,,92.48,percent of total billed charges,85% of total billed charges,104.72,77,,83.78,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,111.52,82,,89.216,percent of total billed charges,82% of total billed charges,115.6,85,,92.48,percent of total billed charges,85% of total billed charges,115.6,85,,92.48,percent of total billed charges,85% of total billed charges,115.6,85,,92.48,percent of total billed charges,85% of total billed charges,122.4,90,,97.92,percent of total billed charges,90% of total billed charges,108.8,80,,87.04,percent of total billed charges,80% of total billed charges,122.4,90,,97.92,percent of total billed charges,90% of total billed charges,102,75,,81.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,39.44,29,,31.552,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,91.12,67,,72.896,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,108.8,80,,87.04,percent of total billed charges,80% of total billed charges,88.4,65,,70.72,percent of total billed charges,65% of total billed charges,48.51,35.67,,38.808,percent of total billed charges,35.67% of total billed charges,39.44,122.4,
"T-WRENCH, SURGICAL",27007601,CDM,270,RC,,,outpatient,,,607,242.80,,515.95,85,,412.76,percent of total billed charges,85% of total billed charges,467.39,77,,373.91,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,497.74,82,,398.192,percent of total billed charges,82% of total billed charges,515.95,85,,412.76,percent of total billed charges,85% of total billed charges,515.95,85,,412.76,percent of total billed charges,85% of total billed charges,515.95,85,,412.76,percent of total billed charges,85% of total billed charges,546.3,90,,437.04,percent of total billed charges,90% of total billed charges,485.6,80,,388.48,percent of total billed charges,80% of total billed charges,546.3,90,,437.04,percent of total billed charges,90% of total billed charges,455.25,75,,364.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,176.03,29,,140.824,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,406.69,67,,325.352,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,485.6,80,,388.48,percent of total billed charges,80% of total billed charges,394.55,65,,315.64,percent of total billed charges,65% of total billed charges,216.52,35.67,,173.216,percent of total billed charges,35.67% of total billed charges,176.03,546.3,
PEG DRIVER,27007624,CDM,270,RC,,,outpatient,,,204,81.60,,173.4,85,,138.72,percent of total billed charges,85% of total billed charges,157.08,77,,125.66,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,167.28,82,,133.824,percent of total billed charges,82% of total billed charges,173.4,85,,138.72,percent of total billed charges,85% of total billed charges,173.4,85,,138.72,percent of total billed charges,85% of total billed charges,173.4,85,,138.72,percent of total billed charges,85% of total billed charges,183.6,90,,146.88,percent of total billed charges,90% of total billed charges,163.2,80,,130.56,percent of total billed charges,80% of total billed charges,183.6,90,,146.88,percent of total billed charges,90% of total billed charges,153,75,,122.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,59.16,29,,47.328,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,136.68,67,,109.344,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,163.2,80,,130.56,percent of total billed charges,80% of total billed charges,132.6,65,,106.08,percent of total billed charges,65% of total billed charges,72.77,35.67,,58.216,percent of total billed charges,35.67% of total billed charges,59.16,183.6,
LEEP GROUNDING PAD,27007646,CDM,270,RC,,,outpatient,,,145,58.00,,123.25,85,,98.6,percent of total billed charges,85% of total billed charges,111.65,77,,89.32,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,118.9,82,,95.12,percent of total billed charges,82% of total billed charges,123.25,85,,98.6,percent of total billed charges,85% of total billed charges,123.25,85,,98.6,percent of total billed charges,85% of total billed charges,123.25,85,,98.6,percent of total billed charges,85% of total billed charges,130.5,90,,104.4,percent of total billed charges,90% of total billed charges,116,80,,92.8,percent of total billed charges,80% of total billed charges,130.5,90,,104.4,percent of total billed charges,90% of total billed charges,108.75,75,,87,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,42.05,29,,33.64,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,97.15,67,,77.72,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,116,80,,92.8,percent of total billed charges,80% of total billed charges,94.25,65,,75.4,percent of total billed charges,65% of total billed charges,51.72,35.67,,41.376,percent of total billed charges,35.67% of total billed charges,42.05,130.5,
LEEP PREFILTER SMOKE EVAC,27007647,CDM,270,RC,,,outpatient,,,200,80.00,,170,85,,136,percent of total billed charges,85% of total billed charges,154,77,,123.2,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,164,82,,131.2,percent of total billed charges,82% of total billed charges,170,85,,136,percent of total billed charges,85% of total billed charges,170,85,,136,percent of total billed charges,85% of total billed charges,170,85,,136,percent of total billed charges,85% of total billed charges,180,90,,144,percent of total billed charges,90% of total billed charges,160,80,,128,percent of total billed charges,80% of total billed charges,180,90,,144,percent of total billed charges,90% of total billed charges,150,75,,120,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,58,29,,46.4,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,134,67,,107.2,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,160,80,,128,percent of total billed charges,80% of total billed charges,130,65,,104,percent of total billed charges,65% of total billed charges,71.34,35.67,,57.072,percent of total billed charges,35.67% of total billed charges,58,180,
LEEP HANDPENCILS,27007648,CDM,270,RC,,,outpatient,,,52,20.80,,44.2,85,,35.36,percent of total billed charges,85% of total billed charges,40.04,77,,32.03,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,42.64,82,,34.112,percent of total billed charges,82% of total billed charges,44.2,85,,35.36,percent of total billed charges,85% of total billed charges,44.2,85,,35.36,percent of total billed charges,85% of total billed charges,44.2,85,,35.36,percent of total billed charges,85% of total billed charges,46.8,90,,37.44,percent of total billed charges,90% of total billed charges,41.6,80,,33.28,percent of total billed charges,80% of total billed charges,46.8,90,,37.44,percent of total billed charges,90% of total billed charges,39,75,,31.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,15.08,29,,12.064,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,34.84,67,,27.872,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,41.6,80,,33.28,percent of total billed charges,80% of total billed charges,33.8,65,,27.04,percent of total billed charges,65% of total billed charges,18.55,35.67,,14.84,percent of total billed charges,35.67% of total billed charges,15.08,46.8,
LEEP ULPA FILTER,27007649,CDM,270,RC,,,outpatient,,,852,340.80,,724.2,85,,579.36,percent of total billed charges,85% of total billed charges,656.04,77,,524.83,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,698.64,82,,558.912,percent of total billed charges,82% of total billed charges,724.2,85,,579.36,percent of total billed charges,85% of total billed charges,724.2,85,,579.36,percent of total billed charges,85% of total billed charges,724.2,85,,579.36,percent of total billed charges,85% of total billed charges,766.8,90,,613.44,percent of total billed charges,90% of total billed charges,681.6,80,,545.28,percent of total billed charges,80% of total billed charges,766.8,90,,613.44,percent of total billed charges,90% of total billed charges,639,75,,511.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,247.08,29,,197.664,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,570.84,67,,456.672,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,681.6,80,,545.28,percent of total billed charges,80% of total billed charges,553.8,65,,443.04,percent of total billed charges,65% of total billed charges,303.91,35.67,,243.128,percent of total billed charges,35.67% of total billed charges,247.08,766.8,
LEEP REDUCER FOR SMOKE EVAC,27007650,CDM,270,RC,,,outpatient,,,53,21.20,,45.05,85,,36.04,percent of total billed charges,85% of total billed charges,40.81,77,,32.65,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,43.46,82,,34.768,percent of total billed charges,82% of total billed charges,45.05,85,,36.04,percent of total billed charges,85% of total billed charges,45.05,85,,36.04,percent of total billed charges,85% of total billed charges,45.05,85,,36.04,percent of total billed charges,85% of total billed charges,47.7,90,,38.16,percent of total billed charges,90% of total billed charges,42.4,80,,33.92,percent of total billed charges,80% of total billed charges,47.7,90,,38.16,percent of total billed charges,90% of total billed charges,39.75,75,,31.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,15.37,29,,12.296,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,35.51,67,,28.408,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,42.4,80,,33.92,percent of total billed charges,80% of total billed charges,34.45,65,,27.56,percent of total billed charges,65% of total billed charges,18.91,35.67,,15.128,percent of total billed charges,35.67% of total billed charges,15.37,47.7,
LEEP TUBING ST SMOKE EVACUATOR,27007651,CDM,270,RC,,,outpatient,,,141,56.40,,119.85,85,,95.88,percent of total billed charges,85% of total billed charges,108.57,77,,86.86,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,115.62,82,,92.496,percent of total billed charges,82% of total billed charges,119.85,85,,95.88,percent of total billed charges,85% of total billed charges,119.85,85,,95.88,percent of total billed charges,85% of total billed charges,119.85,85,,95.88,percent of total billed charges,85% of total billed charges,126.9,90,,101.52,percent of total billed charges,90% of total billed charges,112.8,80,,90.24,percent of total billed charges,80% of total billed charges,126.9,90,,101.52,percent of total billed charges,90% of total billed charges,105.75,75,,84.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,40.89,29,,32.712,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,94.47,67,,75.576,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,112.8,80,,90.24,percent of total billed charges,80% of total billed charges,91.65,65,,73.32,percent of total billed charges,65% of total billed charges,50.29,35.67,,40.232,percent of total billed charges,35.67% of total billed charges,40.89,126.9,
LEEP TUBING DSE,27007652,CDM,270,RC,,,outpatient,,,53,21.20,,45.05,85,,36.04,percent of total billed charges,85% of total billed charges,40.81,77,,32.65,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,43.46,82,,34.768,percent of total billed charges,82% of total billed charges,45.05,85,,36.04,percent of total billed charges,85% of total billed charges,45.05,85,,36.04,percent of total billed charges,85% of total billed charges,45.05,85,,36.04,percent of total billed charges,85% of total billed charges,47.7,90,,38.16,percent of total billed charges,90% of total billed charges,42.4,80,,33.92,percent of total billed charges,80% of total billed charges,47.7,90,,38.16,percent of total billed charges,90% of total billed charges,39.75,75,,31.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,15.37,29,,12.296,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,35.51,67,,28.408,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,42.4,80,,33.92,percent of total billed charges,80% of total billed charges,34.45,65,,27.56,percent of total billed charges,65% of total billed charges,18.91,35.67,,15.128,percent of total billed charges,35.67% of total billed charges,15.37,47.7,
LEEP ELECTRODE CONDYLOMA,27007653,CDM,270,RC,,,outpatient,,,155,62.00,,131.75,85,,105.4,percent of total billed charges,85% of total billed charges,119.35,77,,95.48,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,127.1,82,,101.68,percent of total billed charges,82% of total billed charges,131.75,85,,105.4,percent of total billed charges,85% of total billed charges,131.75,85,,105.4,percent of total billed charges,85% of total billed charges,131.75,85,,105.4,percent of total billed charges,85% of total billed charges,139.5,90,,111.6,percent of total billed charges,90% of total billed charges,124,80,,99.2,percent of total billed charges,80% of total billed charges,139.5,90,,111.6,percent of total billed charges,90% of total billed charges,116.25,75,,93,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,44.95,29,,35.96,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,103.85,67,,83.08,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,124,80,,99.2,percent of total billed charges,80% of total billed charges,100.75,65,,80.6,percent of total billed charges,65% of total billed charges,55.29,35.67,,44.232,percent of total billed charges,35.67% of total billed charges,44.95,139.5,
LEEP ELECTRODE BALL,27007654,CDM,270,RC,,,outpatient,,,155,62.00,,131.75,85,,105.4,percent of total billed charges,85% of total billed charges,119.35,77,,95.48,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,127.1,82,,101.68,percent of total billed charges,82% of total billed charges,131.75,85,,105.4,percent of total billed charges,85% of total billed charges,131.75,85,,105.4,percent of total billed charges,85% of total billed charges,131.75,85,,105.4,percent of total billed charges,85% of total billed charges,139.5,90,,111.6,percent of total billed charges,90% of total billed charges,124,80,,99.2,percent of total billed charges,80% of total billed charges,139.5,90,,111.6,percent of total billed charges,90% of total billed charges,116.25,75,,93,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,44.95,29,,35.96,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,103.85,67,,83.08,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,124,80,,99.2,percent of total billed charges,80% of total billed charges,100.75,65,,80.6,percent of total billed charges,65% of total billed charges,55.29,35.67,,44.232,percent of total billed charges,35.67% of total billed charges,44.95,139.5,
CASTING TAPE GREEN 4X4 YRD,27007656,CDM,270,RC,,,outpatient,,,56,22.40,,47.6,85,,38.08,percent of total billed charges,85% of total billed charges,43.12,77,,34.5,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,45.92,82,,36.736,percent of total billed charges,82% of total billed charges,47.6,85,,38.08,percent of total billed charges,85% of total billed charges,47.6,85,,38.08,percent of total billed charges,85% of total billed charges,47.6,85,,38.08,percent of total billed charges,85% of total billed charges,50.4,90,,40.32,percent of total billed charges,90% of total billed charges,44.8,80,,35.84,percent of total billed charges,80% of total billed charges,50.4,90,,40.32,percent of total billed charges,90% of total billed charges,42,75,,33.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,16.24,29,,12.992,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,37.52,67,,30.016,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,44.8,80,,35.84,percent of total billed charges,80% of total billed charges,36.4,65,,29.12,percent of total billed charges,65% of total billed charges,19.98,35.67,,15.984,percent of total billed charges,35.67% of total billed charges,16.24,50.4,
CASTING TAPE GREEN 3X4YRD,27007657,CDM,270,RC,,,outpatient,,,38,15.20,,32.3,85,,25.84,percent of total billed charges,85% of total billed charges,29.26,77,,23.41,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,31.16,82,,24.928,percent of total billed charges,82% of total billed charges,32.3,85,,25.84,percent of total billed charges,85% of total billed charges,32.3,85,,25.84,percent of total billed charges,85% of total billed charges,32.3,85,,25.84,percent of total billed charges,85% of total billed charges,34.2,90,,27.36,percent of total billed charges,90% of total billed charges,30.4,80,,24.32,percent of total billed charges,80% of total billed charges,34.2,90,,27.36,percent of total billed charges,90% of total billed charges,28.5,75,,22.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,11.02,29,,8.816,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,25.46,67,,20.368,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,30.4,80,,24.32,percent of total billed charges,80% of total billed charges,24.7,65,,19.76,percent of total billed charges,65% of total billed charges,13.55,35.67,,10.84,percent of total billed charges,35.67% of total billed charges,11.02,34.2,
CASTING TAPE GREEN 2X4YRD,27007658,CDM,270,RC,,,outpatient,,,46,18.40,,39.1,85,,31.28,percent of total billed charges,85% of total billed charges,35.42,77,,28.34,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,37.72,82,,30.176,percent of total billed charges,82% of total billed charges,39.1,85,,31.28,percent of total billed charges,85% of total billed charges,39.1,85,,31.28,percent of total billed charges,85% of total billed charges,39.1,85,,31.28,percent of total billed charges,85% of total billed charges,41.4,90,,33.12,percent of total billed charges,90% of total billed charges,36.8,80,,29.44,percent of total billed charges,80% of total billed charges,41.4,90,,33.12,percent of total billed charges,90% of total billed charges,34.5,75,,27.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,13.34,29,,10.672,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,30.82,67,,24.656,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,36.8,80,,29.44,percent of total billed charges,80% of total billed charges,29.9,65,,23.92,percent of total billed charges,65% of total billed charges,16.41,35.67,,13.128,percent of total billed charges,35.67% of total billed charges,13.34,41.4,
CASTING TAPE PINK 4X4 YRD,27007659,CDM,270,RC,,,outpatient,,,68,27.20,,57.8,85,,46.24,percent of total billed charges,85% of total billed charges,52.36,77,,41.89,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,55.76,82,,44.608,percent of total billed charges,82% of total billed charges,57.8,85,,46.24,percent of total billed charges,85% of total billed charges,57.8,85,,46.24,percent of total billed charges,85% of total billed charges,57.8,85,,46.24,percent of total billed charges,85% of total billed charges,61.2,90,,48.96,percent of total billed charges,90% of total billed charges,54.4,80,,43.52,percent of total billed charges,80% of total billed charges,61.2,90,,48.96,percent of total billed charges,90% of total billed charges,51,75,,40.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,19.72,29,,15.776,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,45.56,67,,36.448,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,54.4,80,,43.52,percent of total billed charges,80% of total billed charges,44.2,65,,35.36,percent of total billed charges,65% of total billed charges,24.26,35.67,,19.408,percent of total billed charges,35.67% of total billed charges,19.72,61.2,
CASTING TAPE PINK 3X4YRD,27007660,CDM,270,RC,,,outpatient,,,66,26.40,,56.1,85,,44.88,percent of total billed charges,85% of total billed charges,50.82,77,,40.66,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,54.12,82,,43.296,percent of total billed charges,82% of total billed charges,56.1,85,,44.88,percent of total billed charges,85% of total billed charges,56.1,85,,44.88,percent of total billed charges,85% of total billed charges,56.1,85,,44.88,percent of total billed charges,85% of total billed charges,59.4,90,,47.52,percent of total billed charges,90% of total billed charges,52.8,80,,42.24,percent of total billed charges,80% of total billed charges,59.4,90,,47.52,percent of total billed charges,90% of total billed charges,49.5,75,,39.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,19.14,29,,15.312,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,44.22,67,,35.376,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,52.8,80,,42.24,percent of total billed charges,80% of total billed charges,42.9,65,,34.32,percent of total billed charges,65% of total billed charges,23.54,35.67,,18.832,percent of total billed charges,35.67% of total billed charges,19.14,59.4,
CASTING TAPE PINK 2X4YRD,27007661,CDM,270,RC,,,outpatient,,,46,18.40,,39.1,85,,31.28,percent of total billed charges,85% of total billed charges,35.42,77,,28.34,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,37.72,82,,30.176,percent of total billed charges,82% of total billed charges,39.1,85,,31.28,percent of total billed charges,85% of total billed charges,39.1,85,,31.28,percent of total billed charges,85% of total billed charges,39.1,85,,31.28,percent of total billed charges,85% of total billed charges,41.4,90,,33.12,percent of total billed charges,90% of total billed charges,36.8,80,,29.44,percent of total billed charges,80% of total billed charges,41.4,90,,33.12,percent of total billed charges,90% of total billed charges,34.5,75,,27.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,13.34,29,,10.672,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,30.82,67,,24.656,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,36.8,80,,29.44,percent of total billed charges,80% of total billed charges,29.9,65,,23.92,percent of total billed charges,65% of total billed charges,16.41,35.67,,13.128,percent of total billed charges,35.67% of total billed charges,13.34,41.4,
CASTING TAPE BLUE 4X4 YRD,27007662,CDM,270,RC,,,outpatient,,,68,27.20,,57.8,85,,46.24,percent of total billed charges,85% of total billed charges,52.36,77,,41.89,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,55.76,82,,44.608,percent of total billed charges,82% of total billed charges,57.8,85,,46.24,percent of total billed charges,85% of total billed charges,57.8,85,,46.24,percent of total billed charges,85% of total billed charges,57.8,85,,46.24,percent of total billed charges,85% of total billed charges,61.2,90,,48.96,percent of total billed charges,90% of total billed charges,54.4,80,,43.52,percent of total billed charges,80% of total billed charges,61.2,90,,48.96,percent of total billed charges,90% of total billed charges,51,75,,40.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,19.72,29,,15.776,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,45.56,67,,36.448,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,54.4,80,,43.52,percent of total billed charges,80% of total billed charges,44.2,65,,35.36,percent of total billed charges,65% of total billed charges,24.26,35.67,,19.408,percent of total billed charges,35.67% of total billed charges,19.72,61.2,
CASTING TAPE BLUE 3X4YRD,27007663,CDM,270,RC,,,outpatient,,,38,15.20,,32.3,85,,25.84,percent of total billed charges,85% of total billed charges,29.26,77,,23.41,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,31.16,82,,24.928,percent of total billed charges,82% of total billed charges,32.3,85,,25.84,percent of total billed charges,85% of total billed charges,32.3,85,,25.84,percent of total billed charges,85% of total billed charges,32.3,85,,25.84,percent of total billed charges,85% of total billed charges,34.2,90,,27.36,percent of total billed charges,90% of total billed charges,30.4,80,,24.32,percent of total billed charges,80% of total billed charges,34.2,90,,27.36,percent of total billed charges,90% of total billed charges,28.5,75,,22.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,11.02,29,,8.816,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,25.46,67,,20.368,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,30.4,80,,24.32,percent of total billed charges,80% of total billed charges,24.7,65,,19.76,percent of total billed charges,65% of total billed charges,13.55,35.67,,10.84,percent of total billed charges,35.67% of total billed charges,11.02,34.2,
CASTING TAPE BLUE 2X4YRD,27007664,CDM,270,RC,,,outpatient,,,47,18.80,,39.95,85,,31.96,percent of total billed charges,85% of total billed charges,36.19,77,,28.95,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,38.54,82,,30.832,percent of total billed charges,82% of total billed charges,39.95,85,,31.96,percent of total billed charges,85% of total billed charges,39.95,85,,31.96,percent of total billed charges,85% of total billed charges,39.95,85,,31.96,percent of total billed charges,85% of total billed charges,42.3,90,,33.84,percent of total billed charges,90% of total billed charges,37.6,80,,30.08,percent of total billed charges,80% of total billed charges,42.3,90,,33.84,percent of total billed charges,90% of total billed charges,35.25,75,,28.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,13.63,29,,10.904,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,31.49,67,,25.192,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,37.6,80,,30.08,percent of total billed charges,80% of total billed charges,30.55,65,,24.44,percent of total billed charges,65% of total billed charges,16.76,35.67,,13.408,percent of total billed charges,35.67% of total billed charges,13.63,42.3,
YANKUER WITH COVER SET,27007678,CDM,270,RC,,,outpatient,,,27,10.80,,22.95,85,,18.36,percent of total billed charges,85% of total billed charges,20.79,77,,16.63,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,22.14,82,,17.712,percent of total billed charges,82% of total billed charges,22.95,85,,18.36,percent of total billed charges,85% of total billed charges,22.95,85,,18.36,percent of total billed charges,85% of total billed charges,22.95,85,,18.36,percent of total billed charges,85% of total billed charges,24.3,90,,19.44,percent of total billed charges,90% of total billed charges,21.6,80,,17.28,percent of total billed charges,80% of total billed charges,24.3,90,,19.44,percent of total billed charges,90% of total billed charges,20.25,75,,16.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,7.83,29,,6.264,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,18.09,67,,14.472,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,21.6,80,,17.28,percent of total billed charges,80% of total billed charges,17.55,65,,14.04,percent of total billed charges,65% of total billed charges,9.63,35.67,,7.704,percent of total billed charges,35.67% of total billed charges,7.83,24.3,
WRAP STYLE SPU VESTS SMALL,27007679,CDM,270,RC,,,outpatient,,,394,157.60,,334.9,85,,267.92,percent of total billed charges,85% of total billed charges,303.38,77,,242.7,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,323.08,82,,258.464,percent of total billed charges,82% of total billed charges,334.9,85,,267.92,percent of total billed charges,85% of total billed charges,334.9,85,,267.92,percent of total billed charges,85% of total billed charges,334.9,85,,267.92,percent of total billed charges,85% of total billed charges,354.6,90,,283.68,percent of total billed charges,90% of total billed charges,315.2,80,,252.16,percent of total billed charges,80% of total billed charges,354.6,90,,283.68,percent of total billed charges,90% of total billed charges,295.5,75,,236.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,114.26,29,,91.408,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,263.98,67,,211.184,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,315.2,80,,252.16,percent of total billed charges,80% of total billed charges,256.1,65,,204.88,percent of total billed charges,65% of total billed charges,140.54,35.67,,112.432,percent of total billed charges,35.67% of total billed charges,114.26,354.6,
TED HOSE STOCKING XLARGE KNEE,27007697,CDM,270,RC,,,outpatient,,,163,65.20,,138.55,85,,110.84,percent of total billed charges,85% of total billed charges,125.51,77,,100.41,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,133.66,82,,106.928,percent of total billed charges,82% of total billed charges,138.55,85,,110.84,percent of total billed charges,85% of total billed charges,138.55,85,,110.84,percent of total billed charges,85% of total billed charges,138.55,85,,110.84,percent of total billed charges,85% of total billed charges,146.7,90,,117.36,percent of total billed charges,90% of total billed charges,130.4,80,,104.32,percent of total billed charges,80% of total billed charges,146.7,90,,117.36,percent of total billed charges,90% of total billed charges,122.25,75,,97.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,47.27,29,,37.816,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,109.21,67,,87.368,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,130.4,80,,104.32,percent of total billed charges,80% of total billed charges,105.95,65,,84.76,percent of total billed charges,65% of total billed charges,58.14,35.67,,46.512,percent of total billed charges,35.67% of total billed charges,47.27,146.7,
FOLEY CATH SILCH 20FR 5ML 3WAY,27007741,CDM,270,RC,,,outpatient,,,165,66.00,,140.25,85,,112.2,percent of total billed charges,85% of total billed charges,127.05,77,,101.64,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,135.3,82,,108.24,percent of total billed charges,82% of total billed charges,140.25,85,,112.2,percent of total billed charges,85% of total billed charges,140.25,85,,112.2,percent of total billed charges,85% of total billed charges,140.25,85,,112.2,percent of total billed charges,85% of total billed charges,148.5,90,,118.8,percent of total billed charges,90% of total billed charges,132,80,,105.6,percent of total billed charges,80% of total billed charges,148.5,90,,118.8,percent of total billed charges,90% of total billed charges,123.75,75,,99,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,47.85,29,,38.28,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,110.55,67,,88.44,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,132,80,,105.6,percent of total billed charges,80% of total billed charges,107.25,65,,85.8,percent of total billed charges,65% of total billed charges,58.86,35.67,,47.088,percent of total billed charges,35.67% of total billed charges,47.85,148.5,
FOLEY CATHETER SILCH 22 FR 3WA,27007742,CDM,270,RC,,,outpatient,,,165,66.00,,140.25,85,,112.2,percent of total billed charges,85% of total billed charges,127.05,77,,101.64,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,135.3,82,,108.24,percent of total billed charges,82% of total billed charges,140.25,85,,112.2,percent of total billed charges,85% of total billed charges,140.25,85,,112.2,percent of total billed charges,85% of total billed charges,140.25,85,,112.2,percent of total billed charges,85% of total billed charges,148.5,90,,118.8,percent of total billed charges,90% of total billed charges,132,80,,105.6,percent of total billed charges,80% of total billed charges,148.5,90,,118.8,percent of total billed charges,90% of total billed charges,123.75,75,,99,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,47.85,29,,38.28,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,110.55,67,,88.44,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,132,80,,105.6,percent of total billed charges,80% of total billed charges,107.25,65,,85.8,percent of total billed charges,65% of total billed charges,58.86,35.67,,47.088,percent of total billed charges,35.67% of total billed charges,47.85,148.5,
FOLEY CATHETER SILCN 20FR 30ML,27007743,CDM,270,RC,,,outpatient,,,105,42.00,,89.25,85,,71.4,percent of total billed charges,85% of total billed charges,80.85,77,,64.68,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,86.1,82,,68.88,percent of total billed charges,82% of total billed charges,89.25,85,,71.4,percent of total billed charges,85% of total billed charges,89.25,85,,71.4,percent of total billed charges,85% of total billed charges,89.25,85,,71.4,percent of total billed charges,85% of total billed charges,94.5,90,,75.6,percent of total billed charges,90% of total billed charges,84,80,,67.2,percent of total billed charges,80% of total billed charges,94.5,90,,75.6,percent of total billed charges,90% of total billed charges,78.75,75,,63,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,30.45,29,,24.36,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,70.35,67,,56.28,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,84,80,,67.2,percent of total billed charges,80% of total billed charges,68.25,65,,54.6,percent of total billed charges,65% of total billed charges,37.45,35.67,,29.96,percent of total billed charges,35.67% of total billed charges,30.45,94.5,
MALE EXTERNAL CATHETER SMALL,27007758,CDM,270,RC,,,outpatient,,,22,8.80,,18.7,85,,14.96,percent of total billed charges,85% of total billed charges,16.94,77,,13.55,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,18.04,82,,14.432,percent of total billed charges,82% of total billed charges,18.7,85,,14.96,percent of total billed charges,85% of total billed charges,18.7,85,,14.96,percent of total billed charges,85% of total billed charges,18.7,85,,14.96,percent of total billed charges,85% of total billed charges,19.8,90,,15.84,percent of total billed charges,90% of total billed charges,17.6,80,,14.08,percent of total billed charges,80% of total billed charges,19.8,90,,15.84,percent of total billed charges,90% of total billed charges,16.5,75,,13.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,6.38,29,,5.104,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,14.74,67,,11.792,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,17.6,80,,14.08,percent of total billed charges,80% of total billed charges,14.3,65,,11.44,percent of total billed charges,65% of total billed charges,7.85,35.67,,6.28,percent of total billed charges,35.67% of total billed charges,6.38,19.8,
EXTERNAL MALE CATHETER LG,27007759,CDM,270,RC,,,outpatient,,,27,10.80,,22.95,85,,18.36,percent of total billed charges,85% of total billed charges,20.79,77,,16.63,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,22.14,82,,17.712,percent of total billed charges,82% of total billed charges,22.95,85,,18.36,percent of total billed charges,85% of total billed charges,22.95,85,,18.36,percent of total billed charges,85% of total billed charges,22.95,85,,18.36,percent of total billed charges,85% of total billed charges,24.3,90,,19.44,percent of total billed charges,90% of total billed charges,21.6,80,,17.28,percent of total billed charges,80% of total billed charges,24.3,90,,19.44,percent of total billed charges,90% of total billed charges,20.25,75,,16.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,7.83,29,,6.264,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,18.09,67,,14.472,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,21.6,80,,17.28,percent of total billed charges,80% of total billed charges,17.55,65,,14.04,percent of total billed charges,65% of total billed charges,9.63,35.67,,7.704,percent of total billed charges,35.67% of total billed charges,7.83,24.3,
CLEANSER DOUCHE DISPOSABLE 6OZ,27007760,CDM,270,RC,,,outpatient,,,11,4.40,,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,8.47,77,,6.78,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,9.02,82,,7.216,percent of total billed charges,82% of total billed charges,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,9.9,90,,7.92,percent of total billed charges,90% of total billed charges,8.8,80,,7.04,percent of total billed charges,80% of total billed charges,9.9,90,,7.92,percent of total billed charges,90% of total billed charges,8.25,75,,6.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,3.19,29,,2.552,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,7.37,67,,5.896,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,8.8,80,,7.04,percent of total billed charges,80% of total billed charges,7.15,65,,5.72,percent of total billed charges,65% of total billed charges,3.92,35.67,,3.136,percent of total billed charges,35.67% of total billed charges,3.19,9.9,
OPTICAL LARYNOGOSCOPE REGULAR,27007787,CDM,270,RC,,,outpatient,,,581,232.40,,493.85,85,,395.08,percent of total billed charges,85% of total billed charges,447.37,77,,357.9,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,476.42,82,,381.136,percent of total billed charges,82% of total billed charges,493.85,85,,395.08,percent of total billed charges,85% of total billed charges,493.85,85,,395.08,percent of total billed charges,85% of total billed charges,493.85,85,,395.08,percent of total billed charges,85% of total billed charges,522.9,90,,418.32,percent of total billed charges,90% of total billed charges,464.8,80,,371.84,percent of total billed charges,80% of total billed charges,522.9,90,,418.32,percent of total billed charges,90% of total billed charges,435.75,75,,348.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,168.49,29,,134.792,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,389.27,67,,311.416,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,464.8,80,,371.84,percent of total billed charges,80% of total billed charges,377.65,65,,302.12,percent of total billed charges,65% of total billed charges,207.24,35.67,,165.792,percent of total billed charges,35.67% of total billed charges,168.49,522.9,
CANNULATED SELF DRILL 80 MM,27007804,CDM,270,RC,,,outpatient,,,1720,688.00,,1462,85,,1169.6,percent of total billed charges,85% of total billed charges,1324.4,77,,1059.52,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,1410.4,82,,1128.32,percent of total billed charges,82% of total billed charges,1462,85,,1169.6,percent of total billed charges,85% of total billed charges,1462,85,,1169.6,percent of total billed charges,85% of total billed charges,1462,85,,1169.6,percent of total billed charges,85% of total billed charges,1548,90,,1238.4,percent of total billed charges,90% of total billed charges,1376,80,,1100.8,percent of total billed charges,80% of total billed charges,1548,90,,1238.4,percent of total billed charges,90% of total billed charges,1290,75,,1032,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,498.8,29,,399.04,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1152.4,67,,921.92,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1376,80,,1100.8,percent of total billed charges,80% of total billed charges,1118,65,,894.4,percent of total billed charges,65% of total billed charges,613.52,35.67,,490.816,percent of total billed charges,35.67% of total billed charges,498.8,1548,
TI CANNULATED SEL DRILL 55 MM,27007805,CDM,270,RC,,,outpatient,,,1720,688.00,,1462,85,,1169.6,percent of total billed charges,85% of total billed charges,1324.4,77,,1059.52,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,1410.4,82,,1128.32,percent of total billed charges,82% of total billed charges,1462,85,,1169.6,percent of total billed charges,85% of total billed charges,1462,85,,1169.6,percent of total billed charges,85% of total billed charges,1462,85,,1169.6,percent of total billed charges,85% of total billed charges,1548,90,,1238.4,percent of total billed charges,90% of total billed charges,1376,80,,1100.8,percent of total billed charges,80% of total billed charges,1548,90,,1238.4,percent of total billed charges,90% of total billed charges,1290,75,,1032,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,498.8,29,,399.04,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1152.4,67,,921.92,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1376,80,,1100.8,percent of total billed charges,80% of total billed charges,1118,65,,894.4,percent of total billed charges,65% of total billed charges,613.52,35.67,,490.816,percent of total billed charges,35.67% of total billed charges,498.8,1548,
CATHETER AIRWAY EXCHANGE ADPTR,27007826,CDM,270,RC,,,outpatient,,,291,116.40,,247.35,85,,197.88,percent of total billed charges,85% of total billed charges,224.07,77,,179.26,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,238.62,82,,190.896,percent of total billed charges,82% of total billed charges,247.35,85,,197.88,percent of total billed charges,85% of total billed charges,247.35,85,,197.88,percent of total billed charges,85% of total billed charges,247.35,85,,197.88,percent of total billed charges,85% of total billed charges,261.9,90,,209.52,percent of total billed charges,90% of total billed charges,232.8,80,,186.24,percent of total billed charges,80% of total billed charges,261.9,90,,209.52,percent of total billed charges,90% of total billed charges,218.25,75,,174.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,84.39,29,,67.512,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,194.97,67,,155.976,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,232.8,80,,186.24,percent of total billed charges,80% of total billed charges,189.15,65,,151.32,percent of total billed charges,65% of total billed charges,103.8,35.67,,83.04,percent of total billed charges,35.67% of total billed charges,84.39,261.9,
OPTICAL LARYNGOSCOPE AIRTRAQ,27007827,CDM,270,RC,,,outpatient,,,465,186.00,,395.25,85,,316.2,percent of total billed charges,85% of total billed charges,358.05,77,,286.44,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,381.3,82,,305.04,percent of total billed charges,82% of total billed charges,395.25,85,,316.2,percent of total billed charges,85% of total billed charges,395.25,85,,316.2,percent of total billed charges,85% of total billed charges,395.25,85,,316.2,percent of total billed charges,85% of total billed charges,418.5,90,,334.8,percent of total billed charges,90% of total billed charges,372,80,,297.6,percent of total billed charges,80% of total billed charges,418.5,90,,334.8,percent of total billed charges,90% of total billed charges,348.75,75,,279,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,134.85,29,,107.88,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,311.55,67,,249.24,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,372,80,,297.6,percent of total billed charges,80% of total billed charges,302.25,65,,241.8,percent of total billed charges,65% of total billed charges,165.87,35.67,,132.696,percent of total billed charges,35.67% of total billed charges,134.85,418.5,
MONARCH II IOL D CARTRIDGE,27007869,CDM,270,RC,,,outpatient,,,204,81.60,,173.4,85,,138.72,percent of total billed charges,85% of total billed charges,157.08,77,,125.66,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,167.28,82,,133.824,percent of total billed charges,82% of total billed charges,173.4,85,,138.72,percent of total billed charges,85% of total billed charges,173.4,85,,138.72,percent of total billed charges,85% of total billed charges,173.4,85,,138.72,percent of total billed charges,85% of total billed charges,183.6,90,,146.88,percent of total billed charges,90% of total billed charges,163.2,80,,130.56,percent of total billed charges,80% of total billed charges,183.6,90,,146.88,percent of total billed charges,90% of total billed charges,153,75,,122.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,59.16,29,,47.328,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,136.68,67,,109.344,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,163.2,80,,130.56,percent of total billed charges,80% of total billed charges,132.6,65,,106.08,percent of total billed charges,65% of total billed charges,72.77,35.67,,58.216,percent of total billed charges,35.67% of total billed charges,59.16,183.6,
MASTISOL SURGICAL ADHESIVE LIQ,27007884,CDM,270,RC,,,outpatient,,,74,29.60,,62.9,85,,50.32,percent of total billed charges,85% of total billed charges,56.98,77,,45.58,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,60.68,82,,48.544,percent of total billed charges,82% of total billed charges,62.9,85,,50.32,percent of total billed charges,85% of total billed charges,62.9,85,,50.32,percent of total billed charges,85% of total billed charges,62.9,85,,50.32,percent of total billed charges,85% of total billed charges,66.6,90,,53.28,percent of total billed charges,90% of total billed charges,59.2,80,,47.36,percent of total billed charges,80% of total billed charges,66.6,90,,53.28,percent of total billed charges,90% of total billed charges,55.5,75,,44.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,21.46,29,,17.168,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,49.58,67,,39.664,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,59.2,80,,47.36,percent of total billed charges,80% of total billed charges,48.1,65,,38.48,percent of total billed charges,65% of total billed charges,26.4,35.67,,21.12,percent of total billed charges,35.67% of total billed charges,21.46,66.6,
TRIM IT 1.5,27007888,CDM,270,RC,,,outpatient,,,1645,658.00,,1398.25,85,,1118.6,percent of total billed charges,85% of total billed charges,1266.65,77,,1013.32,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,1348.9,82,,1079.12,percent of total billed charges,82% of total billed charges,1398.25,85,,1118.6,percent of total billed charges,85% of total billed charges,1398.25,85,,1118.6,percent of total billed charges,85% of total billed charges,1398.25,85,,1118.6,percent of total billed charges,85% of total billed charges,1480.5,90,,1184.4,percent of total billed charges,90% of total billed charges,1316,80,,1052.8,percent of total billed charges,80% of total billed charges,1480.5,90,,1184.4,percent of total billed charges,90% of total billed charges,1233.75,75,,987,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,477.05,29,,381.64,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1102.15,67,,881.72,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1316,80,,1052.8,percent of total billed charges,80% of total billed charges,1069.25,65,,855.4,percent of total billed charges,65% of total billed charges,586.77,35.67,,469.416,percent of total billed charges,35.67% of total billed charges,477.05,1480.5,
CALIBRATED DRILL BIT 2.0MM,27007916,CDM,270,RC,,,outpatient,,,785,314.00,,667.25,85,,533.8,percent of total billed charges,85% of total billed charges,604.45,77,,483.56,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,643.7,82,,514.96,percent of total billed charges,82% of total billed charges,667.25,85,,533.8,percent of total billed charges,85% of total billed charges,667.25,85,,533.8,percent of total billed charges,85% of total billed charges,667.25,85,,533.8,percent of total billed charges,85% of total billed charges,706.5,90,,565.2,percent of total billed charges,90% of total billed charges,628,80,,502.4,percent of total billed charges,80% of total billed charges,706.5,90,,565.2,percent of total billed charges,90% of total billed charges,588.75,75,,471,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,227.65,29,,182.12,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,525.95,67,,420.76,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,628,80,,502.4,percent of total billed charges,80% of total billed charges,510.25,65,,408.2,percent of total billed charges,65% of total billed charges,280.01,35.67,,224.008,percent of total billed charges,35.67% of total billed charges,227.65,706.5,
MONOFILAMENT SURG STEEL S22,27007982,CDM,270,RC,,,outpatient,,,26,10.40,,22.1,85,,17.68,percent of total billed charges,85% of total billed charges,20.02,77,,16.02,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,21.32,82,,17.056,percent of total billed charges,82% of total billed charges,22.1,85,,17.68,percent of total billed charges,85% of total billed charges,22.1,85,,17.68,percent of total billed charges,85% of total billed charges,22.1,85,,17.68,percent of total billed charges,85% of total billed charges,23.4,90,,18.72,percent of total billed charges,90% of total billed charges,20.8,80,,16.64,percent of total billed charges,80% of total billed charges,23.4,90,,18.72,percent of total billed charges,90% of total billed charges,19.5,75,,15.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,7.54,29,,6.032,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,17.42,67,,13.936,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,20.8,80,,16.64,percent of total billed charges,80% of total billed charges,16.9,65,,13.52,percent of total billed charges,65% of total billed charges,9.27,35.67,,7.416,percent of total billed charges,35.67% of total billed charges,7.54,23.4,
VAC SILVER FOAM DRESSING MED,27007983,CDM,270,RC,,,outpatient,,,323,129.20,,274.55,85,,219.64,percent of total billed charges,85% of total billed charges,248.71,77,,198.97,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,264.86,82,,211.888,percent of total billed charges,82% of total billed charges,274.55,85,,219.64,percent of total billed charges,85% of total billed charges,274.55,85,,219.64,percent of total billed charges,85% of total billed charges,274.55,85,,219.64,percent of total billed charges,85% of total billed charges,290.7,90,,232.56,percent of total billed charges,90% of total billed charges,258.4,80,,206.72,percent of total billed charges,80% of total billed charges,290.7,90,,232.56,percent of total billed charges,90% of total billed charges,242.25,75,,193.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,93.67,29,,74.936,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,216.41,67,,173.128,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,258.4,80,,206.72,percent of total billed charges,80% of total billed charges,209.95,65,,167.96,percent of total billed charges,65% of total billed charges,115.21,35.67,,92.168,percent of total billed charges,35.67% of total billed charges,93.67,290.7,
CUP MYSTIC II MITY SOFT BELL,27008097,CDM,270,RC,,,outpatient,,,213,85.20,,181.05,85,,144.84,percent of total billed charges,85% of total billed charges,164.01,77,,131.21,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,174.66,82,,139.728,percent of total billed charges,82% of total billed charges,181.05,85,,144.84,percent of total billed charges,85% of total billed charges,181.05,85,,144.84,percent of total billed charges,85% of total billed charges,181.05,85,,144.84,percent of total billed charges,85% of total billed charges,191.7,90,,153.36,percent of total billed charges,90% of total billed charges,170.4,80,,136.32,percent of total billed charges,80% of total billed charges,191.7,90,,153.36,percent of total billed charges,90% of total billed charges,159.75,75,,127.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,61.77,29,,49.416,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,142.71,67,,114.168,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,170.4,80,,136.32,percent of total billed charges,80% of total billed charges,138.45,65,,110.76,percent of total billed charges,65% of total billed charges,75.98,35.67,,60.784,percent of total billed charges,35.67% of total billed charges,61.77,191.7,
COBALT PMMA W/GENT,27008141,CDM,270,RC,,,outpatient,,,2651,1060.40,,2253.35,85,,1802.68,percent of total billed charges,85% of total billed charges,2041.27,77,,1633.02,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,2173.82,82,,1739.056,percent of total billed charges,82% of total billed charges,2253.35,85,,1802.68,percent of total billed charges,85% of total billed charges,2253.35,85,,1802.68,percent of total billed charges,85% of total billed charges,2253.35,85,,1802.68,percent of total billed charges,85% of total billed charges,2385.9,90,,1908.72,percent of total billed charges,90% of total billed charges,2120.8,80,,1696.64,percent of total billed charges,80% of total billed charges,2385.9,90,,1908.72,percent of total billed charges,90% of total billed charges,1988.25,75,,1590.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,768.79,29,,615.032,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1776.17,67,,1420.936,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,2120.8,80,,1696.64,percent of total billed charges,80% of total billed charges,1723.15,65,,1378.52,percent of total billed charges,65% of total billed charges,945.61,35.67,,756.488,percent of total billed charges,35.67% of total billed charges,768.79,2385.9,
MIXING SYSTEM,27008142,CDM,270,RC,,,outpatient,,,674,269.60,,572.9,85,,458.32,percent of total billed charges,85% of total billed charges,518.98,77,,415.18,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,552.68,82,,442.144,percent of total billed charges,82% of total billed charges,572.9,85,,458.32,percent of total billed charges,85% of total billed charges,572.9,85,,458.32,percent of total billed charges,85% of total billed charges,572.9,85,,458.32,percent of total billed charges,85% of total billed charges,606.6,90,,485.28,percent of total billed charges,90% of total billed charges,539.2,80,,431.36,percent of total billed charges,80% of total billed charges,606.6,90,,485.28,percent of total billed charges,90% of total billed charges,505.5,75,,404.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,195.46,29,,156.368,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,451.58,67,,361.264,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,539.2,80,,431.36,percent of total billed charges,80% of total billed charges,438.1,65,,350.48,percent of total billed charges,65% of total billed charges,240.42,35.67,,192.336,percent of total billed charges,35.67% of total billed charges,195.46,606.6,
KNEE HIGH HOSE,27008212,CDM,270,RC,,,outpatient,,,111,44.40,,94.35,85,,75.48,percent of total billed charges,85% of total billed charges,85.47,77,,68.38,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,91.02,82,,72.816,percent of total billed charges,82% of total billed charges,94.35,85,,75.48,percent of total billed charges,85% of total billed charges,94.35,85,,75.48,percent of total billed charges,85% of total billed charges,94.35,85,,75.48,percent of total billed charges,85% of total billed charges,99.9,90,,79.92,percent of total billed charges,90% of total billed charges,88.8,80,,71.04,percent of total billed charges,80% of total billed charges,99.9,90,,79.92,percent of total billed charges,90% of total billed charges,83.25,75,,66.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,32.19,29,,25.752,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,74.37,67,,59.496,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,88.8,80,,71.04,percent of total billed charges,80% of total billed charges,72.15,65,,57.72,percent of total billed charges,65% of total billed charges,39.59,35.67,,31.672,percent of total billed charges,35.67% of total billed charges,32.19,99.9,
BIO TENODESIS DISPOSABLE KIT,27008222,CDM,270,RC,,,outpatient,,,1579,631.60,,1342.15,85,,1073.72,percent of total billed charges,85% of total billed charges,1215.83,77,,972.66,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,1294.78,82,,1035.824,percent of total billed charges,82% of total billed charges,1342.15,85,,1073.72,percent of total billed charges,85% of total billed charges,1342.15,85,,1073.72,percent of total billed charges,85% of total billed charges,1342.15,85,,1073.72,percent of total billed charges,85% of total billed charges,1421.1,90,,1136.88,percent of total billed charges,90% of total billed charges,1263.2,80,,1010.56,percent of total billed charges,80% of total billed charges,1421.1,90,,1136.88,percent of total billed charges,90% of total billed charges,1184.25,75,,947.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,457.91,29,,366.328,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1057.93,67,,846.344,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1263.2,80,,1010.56,percent of total billed charges,80% of total billed charges,1026.35,65,,821.08,percent of total billed charges,65% of total billed charges,563.23,35.67,,450.584,percent of total billed charges,35.67% of total billed charges,457.91,1421.1,
SPINAL EPIDURAL TRAY,27008292,CDM,270,RC,,,outpatient,,,255,102.00,,216.75,85,,173.4,percent of total billed charges,85% of total billed charges,196.35,77,,157.08,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,209.1,82,,167.28,percent of total billed charges,82% of total billed charges,216.75,85,,173.4,percent of total billed charges,85% of total billed charges,216.75,85,,173.4,percent of total billed charges,85% of total billed charges,216.75,85,,173.4,percent of total billed charges,85% of total billed charges,229.5,90,,183.6,percent of total billed charges,90% of total billed charges,204,80,,163.2,percent of total billed charges,80% of total billed charges,229.5,90,,183.6,percent of total billed charges,90% of total billed charges,191.25,75,,153,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,73.95,29,,59.16,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,170.85,67,,136.68,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,204,80,,163.2,percent of total billed charges,80% of total billed charges,165.75,65,,132.6,percent of total billed charges,65% of total billed charges,90.96,35.67,,72.768,percent of total billed charges,35.67% of total billed charges,73.95,229.5,
RESSECTOR CUTTER 375-552-000,27008319,CDM,270,RC,,,outpatient,,,522,208.80,,443.7,85,,354.96,percent of total billed charges,85% of total billed charges,401.94,77,,321.55,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,428.04,82,,342.432,percent of total billed charges,82% of total billed charges,443.7,85,,354.96,percent of total billed charges,85% of total billed charges,443.7,85,,354.96,percent of total billed charges,85% of total billed charges,443.7,85,,354.96,percent of total billed charges,85% of total billed charges,469.8,90,,375.84,percent of total billed charges,90% of total billed charges,417.6,80,,334.08,percent of total billed charges,80% of total billed charges,469.8,90,,375.84,percent of total billed charges,90% of total billed charges,391.5,75,,313.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,151.38,29,,121.104,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,349.74,67,,279.792,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,417.6,80,,334.08,percent of total billed charges,80% of total billed charges,339.3,65,,271.44,percent of total billed charges,65% of total billed charges,186.2,35.67,,148.96,percent of total billed charges,35.67% of total billed charges,151.38,469.8,
SERFAS SUCTION PROBE 3.5,27008320,CDM,270,RC,,,outpatient,,,1000,400.00,,850,85,,680,percent of total billed charges,85% of total billed charges,770,77,,616,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,820,82,,656,percent of total billed charges,82% of total billed charges,850,85,,680,percent of total billed charges,85% of total billed charges,850,85,,680,percent of total billed charges,85% of total billed charges,850,85,,680,percent of total billed charges,85% of total billed charges,900,90,,720,percent of total billed charges,90% of total billed charges,800,80,,640,percent of total billed charges,80% of total billed charges,900,90,,720,percent of total billed charges,90% of total billed charges,750,75,,600,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,290,29,,232,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,670,67,,536,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,800,80,,640,percent of total billed charges,80% of total billed charges,650,65,,520,percent of total billed charges,65% of total billed charges,356.7,35.67,,285.36,percent of total billed charges,35.67% of total billed charges,290,900,
MEN'S XLARGE POST OP SHOE,27008359,CDM,270,RC,,,outpatient,,,97,38.80,,82.45,85,,65.96,percent of total billed charges,85% of total billed charges,74.69,77,,59.75,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,79.54,82,,63.632,percent of total billed charges,82% of total billed charges,82.45,85,,65.96,percent of total billed charges,85% of total billed charges,82.45,85,,65.96,percent of total billed charges,85% of total billed charges,82.45,85,,65.96,percent of total billed charges,85% of total billed charges,87.3,90,,69.84,percent of total billed charges,90% of total billed charges,77.6,80,,62.08,percent of total billed charges,80% of total billed charges,87.3,90,,69.84,percent of total billed charges,90% of total billed charges,72.75,75,,58.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,28.13,29,,22.504,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,64.99,67,,51.992,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,77.6,80,,62.08,percent of total billed charges,80% of total billed charges,63.05,65,,50.44,percent of total billed charges,65% of total billed charges,34.6,35.67,,27.68,percent of total billed charges,35.67% of total billed charges,28.13,87.3,
U DRAPE IMPERVIOUS 60X84,27008396,CDM,270,RC,,,outpatient,,,46,18.40,,39.1,85,,31.28,percent of total billed charges,85% of total billed charges,35.42,77,,28.34,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,37.72,82,,30.176,percent of total billed charges,82% of total billed charges,39.1,85,,31.28,percent of total billed charges,85% of total billed charges,39.1,85,,31.28,percent of total billed charges,85% of total billed charges,39.1,85,,31.28,percent of total billed charges,85% of total billed charges,41.4,90,,33.12,percent of total billed charges,90% of total billed charges,36.8,80,,29.44,percent of total billed charges,80% of total billed charges,41.4,90,,33.12,percent of total billed charges,90% of total billed charges,34.5,75,,27.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,13.34,29,,10.672,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,30.82,67,,24.656,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,36.8,80,,29.44,percent of total billed charges,80% of total billed charges,29.9,65,,23.92,percent of total billed charges,65% of total billed charges,16.41,35.67,,13.128,percent of total billed charges,35.67% of total billed charges,13.34,41.4,
TRUFIT OXYTIP INFANT SENSOR,27008397,CDM,270,RC,,,outpatient,,,119,47.60,,101.15,85,,80.92,percent of total billed charges,85% of total billed charges,91.63,77,,73.3,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,97.58,82,,78.064,percent of total billed charges,82% of total billed charges,101.15,85,,80.92,percent of total billed charges,85% of total billed charges,101.15,85,,80.92,percent of total billed charges,85% of total billed charges,101.15,85,,80.92,percent of total billed charges,85% of total billed charges,107.1,90,,85.68,percent of total billed charges,90% of total billed charges,95.2,80,,76.16,percent of total billed charges,80% of total billed charges,107.1,90,,85.68,percent of total billed charges,90% of total billed charges,89.25,75,,71.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,34.51,29,,27.608,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,79.73,67,,63.784,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,95.2,80,,76.16,percent of total billed charges,80% of total billed charges,77.35,65,,61.88,percent of total billed charges,65% of total billed charges,42.45,35.67,,33.96,percent of total billed charges,35.67% of total billed charges,34.51,107.1,
NASAL PACKING EACH,27008442,CDM,270,RC,,,outpatient,,,44,17.60,,37.4,85,,29.92,percent of total billed charges,85% of total billed charges,33.88,77,,27.1,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,36.08,82,,28.864,percent of total billed charges,82% of total billed charges,37.4,85,,29.92,percent of total billed charges,85% of total billed charges,37.4,85,,29.92,percent of total billed charges,85% of total billed charges,37.4,85,,29.92,percent of total billed charges,85% of total billed charges,39.6,90,,31.68,percent of total billed charges,90% of total billed charges,35.2,80,,28.16,percent of total billed charges,80% of total billed charges,39.6,90,,31.68,percent of total billed charges,90% of total billed charges,33,75,,26.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,12.76,29,,10.208,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,29.48,67,,23.584,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,35.2,80,,28.16,percent of total billed charges,80% of total billed charges,28.6,65,,22.88,percent of total billed charges,65% of total billed charges,15.69,35.67,,12.552,percent of total billed charges,35.67% of total billed charges,12.76,39.6,
ELECTRODE CUTTING LOOP 0.12,27008535,CDM,270,RC,,,outpatient,,,342,136.80,,290.7,85,,232.56,percent of total billed charges,85% of total billed charges,263.34,77,,210.67,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,280.44,82,,224.352,percent of total billed charges,82% of total billed charges,290.7,85,,232.56,percent of total billed charges,85% of total billed charges,290.7,85,,232.56,percent of total billed charges,85% of total billed charges,290.7,85,,232.56,percent of total billed charges,85% of total billed charges,307.8,90,,246.24,percent of total billed charges,90% of total billed charges,273.6,80,,218.88,percent of total billed charges,80% of total billed charges,307.8,90,,246.24,percent of total billed charges,90% of total billed charges,256.5,75,,205.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,99.18,29,,79.344,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,229.14,67,,183.312,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,273.6,80,,218.88,percent of total billed charges,80% of total billed charges,222.3,65,,177.84,percent of total billed charges,65% of total billed charges,121.99,35.67,,97.592,percent of total billed charges,35.67% of total billed charges,99.18,307.8,
CORD ACTIVE DISPOSABLE,27008536,CDM,270,RC,,,outpatient,,,136,54.40,,115.6,85,,92.48,percent of total billed charges,85% of total billed charges,104.72,77,,83.78,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,111.52,82,,89.216,percent of total billed charges,82% of total billed charges,115.6,85,,92.48,percent of total billed charges,85% of total billed charges,115.6,85,,92.48,percent of total billed charges,85% of total billed charges,115.6,85,,92.48,percent of total billed charges,85% of total billed charges,122.4,90,,97.92,percent of total billed charges,90% of total billed charges,108.8,80,,87.04,percent of total billed charges,80% of total billed charges,122.4,90,,97.92,percent of total billed charges,90% of total billed charges,102,75,,81.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,39.44,29,,31.552,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,91.12,67,,72.896,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,108.8,80,,87.04,percent of total billed charges,80% of total billed charges,88.4,65,,70.72,percent of total billed charges,65% of total billed charges,48.51,35.67,,38.808,percent of total billed charges,35.67% of total billed charges,39.44,122.4,
BIPOLAR PROBE 400 CM,27008573,CDM,270,RC,,,outpatient,,,1161,464.40,,986.85,85,,789.48,percent of total billed charges,85% of total billed charges,893.97,77,,715.18,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,952.02,82,,761.616,percent of total billed charges,82% of total billed charges,986.85,85,,789.48,percent of total billed charges,85% of total billed charges,986.85,85,,789.48,percent of total billed charges,85% of total billed charges,986.85,85,,789.48,percent of total billed charges,85% of total billed charges,1044.9,90,,835.92,percent of total billed charges,90% of total billed charges,928.8,80,,743.04,percent of total billed charges,80% of total billed charges,1044.9,90,,835.92,percent of total billed charges,90% of total billed charges,870.75,75,,696.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,336.69,29,,269.352,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,777.87,67,,622.296,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,928.8,80,,743.04,percent of total billed charges,80% of total billed charges,754.65,65,,603.72,percent of total billed charges,65% of total billed charges,414.13,35.67,,331.304,percent of total billed charges,35.67% of total billed charges,336.69,1044.9,
MISC OR CHARGE,27008705,CDM,270,RC,,,outpatient,,,4076,1630.40,,3464.6,85,,2771.68,percent of total billed charges,85% of total billed charges,3138.52,77,,2510.82,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,3342.32,82,,2673.856,percent of total billed charges,82% of total billed charges,3464.6,85,,2771.68,percent of total billed charges,85% of total billed charges,3464.6,85,,2771.68,percent of total billed charges,85% of total billed charges,3464.6,85,,2771.68,percent of total billed charges,85% of total billed charges,3668.4,90,,2934.72,percent of total billed charges,90% of total billed charges,3260.8,80,,2608.64,percent of total billed charges,80% of total billed charges,3668.4,90,,2934.72,percent of total billed charges,90% of total billed charges,3057,75,,2445.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,1182.04,29,,945.632,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,2730.92,67,,2184.736,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,3260.8,80,,2608.64,percent of total billed charges,80% of total billed charges,2649.4,65,,2119.52,percent of total billed charges,65% of total billed charges,1453.91,35.67,,1163.128,percent of total billed charges,35.67% of total billed charges,1182.04,3668.4,
BIT DRILL W/DEPTH MARKING 20MM,27008812,CDM,270,RC,,,outpatient,,,895,358.00,,760.75,85,,608.6,percent of total billed charges,85% of total billed charges,689.15,77,,551.32,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,733.9,82,,587.12,percent of total billed charges,82% of total billed charges,760.75,85,,608.6,percent of total billed charges,85% of total billed charges,760.75,85,,608.6,percent of total billed charges,85% of total billed charges,760.75,85,,608.6,percent of total billed charges,85% of total billed charges,805.5,90,,644.4,percent of total billed charges,90% of total billed charges,716,80,,572.8,percent of total billed charges,80% of total billed charges,805.5,90,,644.4,percent of total billed charges,90% of total billed charges,671.25,75,,537,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,259.55,29,,207.64,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,599.65,67,,479.72,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,716,80,,572.8,percent of total billed charges,80% of total billed charges,581.75,65,,465.4,percent of total billed charges,65% of total billed charges,319.25,35.67,,255.4,percent of total billed charges,35.67% of total billed charges,259.55,805.5,
BIT DRILL 27MM,27008813,CDM,270,RC,,,outpatient,,,425,170.00,,361.25,85,,289,percent of total billed charges,85% of total billed charges,327.25,77,,261.8,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,348.5,82,,278.8,percent of total billed charges,82% of total billed charges,361.25,85,,289,percent of total billed charges,85% of total billed charges,361.25,85,,289,percent of total billed charges,85% of total billed charges,361.25,85,,289,percent of total billed charges,85% of total billed charges,382.5,90,,306,percent of total billed charges,90% of total billed charges,340,80,,272,percent of total billed charges,80% of total billed charges,382.5,90,,306,percent of total billed charges,90% of total billed charges,318.75,75,,255,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,123.25,29,,98.6,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,284.75,67,,227.8,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,340,80,,272,percent of total billed charges,80% of total billed charges,276.25,65,,221,percent of total billed charges,65% of total billed charges,151.6,35.67,,121.28,percent of total billed charges,35.67% of total billed charges,123.25,382.5,
"HUMIDIFIER, COOL WATER",27008848,CDM,270,RC,,,outpatient,,,226,90.40,,192.1,85,,153.68,percent of total billed charges,85% of total billed charges,174.02,77,,139.22,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,185.32,82,,148.256,percent of total billed charges,82% of total billed charges,192.1,85,,153.68,percent of total billed charges,85% of total billed charges,192.1,85,,153.68,percent of total billed charges,85% of total billed charges,192.1,85,,153.68,percent of total billed charges,85% of total billed charges,203.4,90,,162.72,percent of total billed charges,90% of total billed charges,180.8,80,,144.64,percent of total billed charges,80% of total billed charges,203.4,90,,162.72,percent of total billed charges,90% of total billed charges,169.5,75,,135.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,65.54,29,,52.432,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,151.42,67,,121.136,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,180.8,80,,144.64,percent of total billed charges,80% of total billed charges,146.9,65,,117.52,percent of total billed charges,65% of total billed charges,80.61,35.67,,64.488,percent of total billed charges,35.67% of total billed charges,65.54,203.4,
BUTTERFLY NEEDLE,27008945,CDM,270,RC,,,outpatient,,,14,5.60,,11.9,85,,9.52,percent of total billed charges,85% of total billed charges,10.78,77,,8.62,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,11.48,82,,9.184,percent of total billed charges,82% of total billed charges,11.9,85,,9.52,percent of total billed charges,85% of total billed charges,11.9,85,,9.52,percent of total billed charges,85% of total billed charges,11.9,85,,9.52,percent of total billed charges,85% of total billed charges,12.6,90,,10.08,percent of total billed charges,90% of total billed charges,11.2,80,,8.96,percent of total billed charges,80% of total billed charges,12.6,90,,10.08,percent of total billed charges,90% of total billed charges,10.5,75,,8.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,4.06,29,,3.248,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,9.38,67,,7.504,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,11.2,80,,8.96,percent of total billed charges,80% of total billed charges,9.1,65,,7.28,percent of total billed charges,65% of total billed charges,4.99,35.67,,3.992,percent of total billed charges,35.67% of total billed charges,4.06,12.6,
KATZ EXTRCTOR OTO-RHINO,27008955,CDM,270,RC,,,outpatient,,,322,128.80,,273.7,85,,218.96,percent of total billed charges,85% of total billed charges,247.94,77,,198.35,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,264.04,82,,211.232,percent of total billed charges,82% of total billed charges,273.7,85,,218.96,percent of total billed charges,85% of total billed charges,273.7,85,,218.96,percent of total billed charges,85% of total billed charges,273.7,85,,218.96,percent of total billed charges,85% of total billed charges,289.8,90,,231.84,percent of total billed charges,90% of total billed charges,257.6,80,,206.08,percent of total billed charges,80% of total billed charges,289.8,90,,231.84,percent of total billed charges,90% of total billed charges,241.5,75,,193.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,93.38,29,,74.704,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,215.74,67,,172.592,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,257.6,80,,206.08,percent of total billed charges,80% of total billed charges,209.3,65,,167.44,percent of total billed charges,65% of total billed charges,114.86,35.67,,91.888,percent of total billed charges,35.67% of total billed charges,93.38,289.8,
INFUSION SLEEVE ANT VIRECTOMY,27008982,CDM,270,RC,,,outpatient,,,318,127.20,,270.3,85,,216.24,percent of total billed charges,85% of total billed charges,244.86,77,,195.89,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,260.76,82,,208.608,percent of total billed charges,82% of total billed charges,270.3,85,,216.24,percent of total billed charges,85% of total billed charges,270.3,85,,216.24,percent of total billed charges,85% of total billed charges,270.3,85,,216.24,percent of total billed charges,85% of total billed charges,286.2,90,,228.96,percent of total billed charges,90% of total billed charges,254.4,80,,203.52,percent of total billed charges,80% of total billed charges,286.2,90,,228.96,percent of total billed charges,90% of total billed charges,238.5,75,,190.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,92.22,29,,73.776,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,213.06,67,,170.448,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,254.4,80,,203.52,percent of total billed charges,80% of total billed charges,206.7,65,,165.36,percent of total billed charges,65% of total billed charges,113.43,35.67,,90.744,percent of total billed charges,35.67% of total billed charges,92.22,286.2,
HUBER NEEDLE,27009000,CDM,270,RC,,,outpatient,,,61,24.40,,51.85,85,,41.48,percent of total billed charges,85% of total billed charges,46.97,77,,37.58,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,50.02,82,,40.016,percent of total billed charges,82% of total billed charges,51.85,85,,41.48,percent of total billed charges,85% of total billed charges,51.85,85,,41.48,percent of total billed charges,85% of total billed charges,51.85,85,,41.48,percent of total billed charges,85% of total billed charges,54.9,90,,43.92,percent of total billed charges,90% of total billed charges,48.8,80,,39.04,percent of total billed charges,80% of total billed charges,54.9,90,,43.92,percent of total billed charges,90% of total billed charges,45.75,75,,36.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,17.69,29,,14.152,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,40.87,67,,32.696,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,48.8,80,,39.04,percent of total billed charges,80% of total billed charges,39.65,65,,31.72,percent of total billed charges,65% of total billed charges,21.76,35.67,,17.408,percent of total billed charges,35.67% of total billed charges,17.69,54.9,
INFANT PATCH HEAT REFLECTING,27009145,CDM,270,RC,,,outpatient,,,10,4.00,,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,7.7,77,,6.16,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,8.2,82,,6.56,percent of total billed charges,82% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,9,90,,7.2,percent of total billed charges,90% of total billed charges,8,80,,6.4,percent of total billed charges,80% of total billed charges,9,90,,7.2,percent of total billed charges,90% of total billed charges,7.5,75,,6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.9,29,,2.32,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,6.7,67,,5.36,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,8,80,,6.4,percent of total billed charges,80% of total billed charges,6.5,65,,5.2,percent of total billed charges,65% of total billed charges,3.57,35.67,,2.856,percent of total billed charges,35.67% of total billed charges,2.9,9,
EYEGUARD STRIP SENSITIVE,27009215,CDM,270,RC,,,outpatient,,,10,4.00,,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,7.7,77,,6.16,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,8.2,82,,6.56,percent of total billed charges,82% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,9,90,,7.2,percent of total billed charges,90% of total billed charges,8,80,,6.4,percent of total billed charges,80% of total billed charges,9,90,,7.2,percent of total billed charges,90% of total billed charges,7.5,75,,6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.9,29,,2.32,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,6.7,67,,5.36,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,8,80,,6.4,percent of total billed charges,80% of total billed charges,6.5,65,,5.2,percent of total billed charges,65% of total billed charges,3.57,35.67,,2.856,percent of total billed charges,35.67% of total billed charges,2.9,9,
ADULT DIAPER DEPENDS,27009314,CDM,270,RC,,,outpatient,,,106,42.40,,90.1,85,,72.08,percent of total billed charges,85% of total billed charges,81.62,77,,65.3,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,86.92,82,,69.536,percent of total billed charges,82% of total billed charges,90.1,85,,72.08,percent of total billed charges,85% of total billed charges,90.1,85,,72.08,percent of total billed charges,85% of total billed charges,90.1,85,,72.08,percent of total billed charges,85% of total billed charges,95.4,90,,76.32,percent of total billed charges,90% of total billed charges,84.8,80,,67.84,percent of total billed charges,80% of total billed charges,95.4,90,,76.32,percent of total billed charges,90% of total billed charges,79.5,75,,63.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,30.74,29,,24.592,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,71.02,67,,56.816,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,84.8,80,,67.84,percent of total billed charges,80% of total billed charges,68.9,65,,55.12,percent of total billed charges,65% of total billed charges,37.81,35.67,,30.248,percent of total billed charges,35.67% of total billed charges,30.74,95.4,
MONOFILAMENT WIRE TIES 28G,27009348,CDM,270,RC,,,outpatient,,,24,9.60,,20.4,85,,16.32,percent of total billed charges,85% of total billed charges,18.48,77,,14.78,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,19.68,82,,15.744,percent of total billed charges,82% of total billed charges,20.4,85,,16.32,percent of total billed charges,85% of total billed charges,20.4,85,,16.32,percent of total billed charges,85% of total billed charges,20.4,85,,16.32,percent of total billed charges,85% of total billed charges,21.6,90,,17.28,percent of total billed charges,90% of total billed charges,19.2,80,,15.36,percent of total billed charges,80% of total billed charges,21.6,90,,17.28,percent of total billed charges,90% of total billed charges,18,75,,14.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,6.96,29,,5.568,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,16.08,67,,12.864,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,19.2,80,,15.36,percent of total billed charges,80% of total billed charges,15.6,65,,12.48,percent of total billed charges,65% of total billed charges,8.56,35.67,,6.848,percent of total billed charges,35.67% of total billed charges,6.96,21.6,
ETHIBOND 5 SUTURE 30 IN,27009352,CDM,270,RC,,,outpatient,,,98,39.20,,83.3,85,,66.64,percent of total billed charges,85% of total billed charges,75.46,77,,60.37,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,80.36,82,,64.288,percent of total billed charges,82% of total billed charges,83.3,85,,66.64,percent of total billed charges,85% of total billed charges,83.3,85,,66.64,percent of total billed charges,85% of total billed charges,83.3,85,,66.64,percent of total billed charges,85% of total billed charges,88.2,90,,70.56,percent of total billed charges,90% of total billed charges,78.4,80,,62.72,percent of total billed charges,80% of total billed charges,88.2,90,,70.56,percent of total billed charges,90% of total billed charges,73.5,75,,58.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,28.42,29,,22.736,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,65.66,67,,52.528,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,78.4,80,,62.72,percent of total billed charges,80% of total billed charges,63.7,65,,50.96,percent of total billed charges,65% of total billed charges,34.96,35.67,,27.968,percent of total billed charges,35.67% of total billed charges,28.42,88.2,
CUTTER AGGRESSIVE PLUS 3.5MM,27009353,CDM,270,RC,,,outpatient,,,494,197.60,,419.9,85,,335.92,percent of total billed charges,85% of total billed charges,380.38,77,,304.3,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,405.08,82,,324.064,percent of total billed charges,82% of total billed charges,419.9,85,,335.92,percent of total billed charges,85% of total billed charges,419.9,85,,335.92,percent of total billed charges,85% of total billed charges,419.9,85,,335.92,percent of total billed charges,85% of total billed charges,444.6,90,,355.68,percent of total billed charges,90% of total billed charges,395.2,80,,316.16,percent of total billed charges,80% of total billed charges,444.6,90,,355.68,percent of total billed charges,90% of total billed charges,370.5,75,,296.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,143.26,29,,114.608,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,330.98,67,,264.784,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,395.2,80,,316.16,percent of total billed charges,80% of total billed charges,321.1,65,,256.88,percent of total billed charges,65% of total billed charges,176.21,35.67,,140.968,percent of total billed charges,35.67% of total billed charges,143.26,444.6,
ACL DISP KIT W/SAW BLADE,27009362,CDM,270,RC,,,outpatient,,,1456,582.40,,1237.6,85,,990.08,percent of total billed charges,85% of total billed charges,1121.12,77,,896.9,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,1193.92,82,,955.136,percent of total billed charges,82% of total billed charges,1237.6,85,,990.08,percent of total billed charges,85% of total billed charges,1237.6,85,,990.08,percent of total billed charges,85% of total billed charges,1237.6,85,,990.08,percent of total billed charges,85% of total billed charges,1310.4,90,,1048.32,percent of total billed charges,90% of total billed charges,1164.8,80,,931.84,percent of total billed charges,80% of total billed charges,1310.4,90,,1048.32,percent of total billed charges,90% of total billed charges,1092,75,,873.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,422.24,29,,337.792,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,975.52,67,,780.416,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1164.8,80,,931.84,percent of total billed charges,80% of total billed charges,946.4,65,,757.12,percent of total billed charges,65% of total billed charges,519.36,35.67,,415.488,percent of total billed charges,35.67% of total billed charges,422.24,1310.4,
FIBERWARE BRAIDED SUTURE,27009364,CDM,270,RC,,,outpatient,,,168,67.20,,142.8,85,,114.24,percent of total billed charges,85% of total billed charges,129.36,77,,103.49,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,137.76,82,,110.208,percent of total billed charges,82% of total billed charges,142.8,85,,114.24,percent of total billed charges,85% of total billed charges,142.8,85,,114.24,percent of total billed charges,85% of total billed charges,142.8,85,,114.24,percent of total billed charges,85% of total billed charges,151.2,90,,120.96,percent of total billed charges,90% of total billed charges,134.4,80,,107.52,percent of total billed charges,80% of total billed charges,151.2,90,,120.96,percent of total billed charges,90% of total billed charges,126,75,,100.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,48.72,29,,38.976,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,112.56,67,,90.048,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,134.4,80,,107.52,percent of total billed charges,80% of total billed charges,109.2,65,,87.36,percent of total billed charges,65% of total billed charges,59.93,35.67,,47.944,percent of total billed charges,35.67% of total billed charges,48.72,151.2,
GUARDOAM LARGE VOLUME CANISTER,27009390,CDM,270,RC,,,outpatient,,,229,91.60,,194.65,85,,155.72,percent of total billed charges,85% of total billed charges,176.33,77,,141.06,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,187.78,82,,150.224,percent of total billed charges,82% of total billed charges,194.65,85,,155.72,percent of total billed charges,85% of total billed charges,194.65,85,,155.72,percent of total billed charges,85% of total billed charges,194.65,85,,155.72,percent of total billed charges,85% of total billed charges,206.1,90,,164.88,percent of total billed charges,90% of total billed charges,183.2,80,,146.56,percent of total billed charges,80% of total billed charges,206.1,90,,164.88,percent of total billed charges,90% of total billed charges,171.75,75,,137.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,66.41,29,,53.128,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,153.43,67,,122.744,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,183.2,80,,146.56,percent of total billed charges,80% of total billed charges,148.85,65,,119.08,percent of total billed charges,65% of total billed charges,81.68,35.67,,65.344,percent of total billed charges,35.67% of total billed charges,66.41,206.1,
CEMENT MIXING BOWL W/ SPATULA,27009425,CDM,270,RC,,,outpatient,,,202,80.80,,171.7,85,,137.36,percent of total billed charges,85% of total billed charges,155.54,77,,124.43,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,165.64,82,,132.512,percent of total billed charges,82% of total billed charges,171.7,85,,137.36,percent of total billed charges,85% of total billed charges,171.7,85,,137.36,percent of total billed charges,85% of total billed charges,171.7,85,,137.36,percent of total billed charges,85% of total billed charges,181.8,90,,145.44,percent of total billed charges,90% of total billed charges,161.6,80,,129.28,percent of total billed charges,80% of total billed charges,181.8,90,,145.44,percent of total billed charges,90% of total billed charges,151.5,75,,121.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,58.58,29,,46.864,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,135.34,67,,108.272,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,161.6,80,,129.28,percent of total billed charges,80% of total billed charges,131.3,65,,105.04,percent of total billed charges,65% of total billed charges,72.05,35.67,,57.64,percent of total billed charges,35.67% of total billed charges,58.58,181.8,
LARYNGOSCOPE GLIDESCOPE SZ 3,27009539,CDM,270,RC,,,outpatient,,,161,64.40,,136.85,85,,109.48,percent of total billed charges,85% of total billed charges,123.97,77,,99.18,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,132.02,82,,105.616,percent of total billed charges,82% of total billed charges,136.85,85,,109.48,percent of total billed charges,85% of total billed charges,136.85,85,,109.48,percent of total billed charges,85% of total billed charges,136.85,85,,109.48,percent of total billed charges,85% of total billed charges,144.9,90,,115.92,percent of total billed charges,90% of total billed charges,128.8,80,,103.04,percent of total billed charges,80% of total billed charges,144.9,90,,115.92,percent of total billed charges,90% of total billed charges,120.75,75,,96.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,46.69,29,,37.352,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,107.87,67,,86.296,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,128.8,80,,103.04,percent of total billed charges,80% of total billed charges,104.65,65,,83.72,percent of total billed charges,65% of total billed charges,57.43,35.67,,45.944,percent of total billed charges,35.67% of total billed charges,46.69,144.9,
EARPHONES AND SENSORS ALGO,27009551,CDM,270,RC,,,outpatient,,,135,54.00,,114.75,85,,91.8,percent of total billed charges,85% of total billed charges,103.95,77,,83.16,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,110.7,82,,88.56,percent of total billed charges,82% of total billed charges,114.75,85,,91.8,percent of total billed charges,85% of total billed charges,114.75,85,,91.8,percent of total billed charges,85% of total billed charges,114.75,85,,91.8,percent of total billed charges,85% of total billed charges,121.5,90,,97.2,percent of total billed charges,90% of total billed charges,108,80,,86.4,percent of total billed charges,80% of total billed charges,121.5,90,,97.2,percent of total billed charges,90% of total billed charges,101.25,75,,81,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,39.15,29,,31.32,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,90.45,67,,72.36,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,108,80,,86.4,percent of total billed charges,80% of total billed charges,87.75,65,,70.2,percent of total billed charges,65% of total billed charges,48.15,35.67,,38.52,percent of total billed charges,35.67% of total billed charges,39.15,121.5,
LARYNGOSCOPE COVER SIZE 1,27009606,CDM,270,RC,,,outpatient,,,203,81.20,,172.55,85,,138.04,percent of total billed charges,85% of total billed charges,156.31,77,,125.05,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,166.46,82,,133.168,percent of total billed charges,82% of total billed charges,172.55,85,,138.04,percent of total billed charges,85% of total billed charges,172.55,85,,138.04,percent of total billed charges,85% of total billed charges,172.55,85,,138.04,percent of total billed charges,85% of total billed charges,182.7,90,,146.16,percent of total billed charges,90% of total billed charges,162.4,80,,129.92,percent of total billed charges,80% of total billed charges,182.7,90,,146.16,percent of total billed charges,90% of total billed charges,152.25,75,,121.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,58.87,29,,47.096,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,136.01,67,,108.808,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,162.4,80,,129.92,percent of total billed charges,80% of total billed charges,131.95,65,,105.56,percent of total billed charges,65% of total billed charges,72.41,35.67,,57.928,percent of total billed charges,35.67% of total billed charges,58.87,182.7,
LARYNGOSCOPES COVER SIZE 2,27009607,CDM,270,RC,,,outpatient,,,131,52.40,,111.35,85,,89.08,percent of total billed charges,85% of total billed charges,100.87,77,,80.7,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,107.42,82,,85.936,percent of total billed charges,82% of total billed charges,111.35,85,,89.08,percent of total billed charges,85% of total billed charges,111.35,85,,89.08,percent of total billed charges,85% of total billed charges,111.35,85,,89.08,percent of total billed charges,85% of total billed charges,117.9,90,,94.32,percent of total billed charges,90% of total billed charges,104.8,80,,83.84,percent of total billed charges,80% of total billed charges,117.9,90,,94.32,percent of total billed charges,90% of total billed charges,98.25,75,,78.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,37.99,29,,30.392,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,87.77,67,,70.216,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,104.8,80,,83.84,percent of total billed charges,80% of total billed charges,85.15,65,,68.12,percent of total billed charges,65% of total billed charges,46.73,35.67,,37.384,percent of total billed charges,35.67% of total billed charges,37.99,117.9,
MAT FLOOR SUCTION 54 X 29 OR,27009654,CDM,270,RC,,,outpatient,,,115,46.00,,97.75,85,,78.2,percent of total billed charges,85% of total billed charges,88.55,77,,70.84,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,94.3,82,,75.44,percent of total billed charges,82% of total billed charges,97.75,85,,78.2,percent of total billed charges,85% of total billed charges,97.75,85,,78.2,percent of total billed charges,85% of total billed charges,97.75,85,,78.2,percent of total billed charges,85% of total billed charges,103.5,90,,82.8,percent of total billed charges,90% of total billed charges,92,80,,73.6,percent of total billed charges,80% of total billed charges,103.5,90,,82.8,percent of total billed charges,90% of total billed charges,86.25,75,,69,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,33.35,29,,26.68,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,77.05,67,,61.64,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,92,80,,73.6,percent of total billed charges,80% of total billed charges,74.75,65,,59.8,percent of total billed charges,65% of total billed charges,41.02,35.67,,32.816,percent of total billed charges,35.67% of total billed charges,33.35,103.5,
NEBULIZER BREATH ACTDUATED,27009704,CDM,270,RC,,,outpatient,,,64,25.60,,54.4,85,,43.52,percent of total billed charges,85% of total billed charges,49.28,77,,39.42,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,52.48,82,,41.984,percent of total billed charges,82% of total billed charges,54.4,85,,43.52,percent of total billed charges,85% of total billed charges,54.4,85,,43.52,percent of total billed charges,85% of total billed charges,54.4,85,,43.52,percent of total billed charges,85% of total billed charges,57.6,90,,46.08,percent of total billed charges,90% of total billed charges,51.2,80,,40.96,percent of total billed charges,80% of total billed charges,57.6,90,,46.08,percent of total billed charges,90% of total billed charges,48,75,,38.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,18.56,29,,14.848,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,42.88,67,,34.304,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,51.2,80,,40.96,percent of total billed charges,80% of total billed charges,41.6,65,,33.28,percent of total billed charges,65% of total billed charges,22.83,35.67,,18.264,percent of total billed charges,35.67% of total billed charges,18.56,57.6,
MASK FOR AERO ELIPSE LARGE,27009705,CDM,270,RC,,,outpatient,,,15,6.00,,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,11.55,77,,9.24,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,12.3,82,,9.84,percent of total billed charges,82% of total billed charges,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,13.5,90,,10.8,percent of total billed charges,90% of total billed charges,12,80,,9.6,percent of total billed charges,80% of total billed charges,13.5,90,,10.8,percent of total billed charges,90% of total billed charges,11.25,75,,9,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,4.35,29,,3.48,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,10.05,67,,8.04,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,12,80,,9.6,percent of total billed charges,80% of total billed charges,9.75,65,,7.8,percent of total billed charges,65% of total billed charges,5.35,35.67,,4.28,percent of total billed charges,35.67% of total billed charges,4.35,13.5,
LOANER SHOULDER SET,27009723,CDM,270,RC,,,outpatient,,,1679,671.60,,1427.15,85,,1141.72,percent of total billed charges,85% of total billed charges,1292.83,77,,1034.26,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,1376.78,82,,1101.424,percent of total billed charges,82% of total billed charges,1427.15,85,,1141.72,percent of total billed charges,85% of total billed charges,1427.15,85,,1141.72,percent of total billed charges,85% of total billed charges,1427.15,85,,1141.72,percent of total billed charges,85% of total billed charges,1511.1,90,,1208.88,percent of total billed charges,90% of total billed charges,1343.2,80,,1074.56,percent of total billed charges,80% of total billed charges,1511.1,90,,1208.88,percent of total billed charges,90% of total billed charges,1259.25,75,,1007.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,486.91,29,,389.528,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1124.93,67,,899.944,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1343.2,80,,1074.56,percent of total billed charges,80% of total billed charges,1091.35,65,,873.08,percent of total billed charges,65% of total billed charges,598.9,35.67,,479.12,percent of total billed charges,35.67% of total billed charges,486.91,1511.1,
ELECTRODE HE LOOP 26FR 35WI 12,27009760,CDM,270,RC,,,outpatient,,,528,211.20,,448.8,85,,359.04,percent of total billed charges,85% of total billed charges,406.56,77,,325.25,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,432.96,82,,346.368,percent of total billed charges,82% of total billed charges,448.8,85,,359.04,percent of total billed charges,85% of total billed charges,448.8,85,,359.04,percent of total billed charges,85% of total billed charges,448.8,85,,359.04,percent of total billed charges,85% of total billed charges,475.2,90,,380.16,percent of total billed charges,90% of total billed charges,422.4,80,,337.92,percent of total billed charges,80% of total billed charges,475.2,90,,380.16,percent of total billed charges,90% of total billed charges,396,75,,316.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,153.12,29,,122.496,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,353.76,67,,283.008,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,422.4,80,,337.92,percent of total billed charges,80% of total billed charges,343.2,65,,274.56,percent of total billed charges,65% of total billed charges,188.34,35.67,,150.672,percent of total billed charges,35.67% of total billed charges,153.12,475.2,
ELECTRODE HE LOOP 26FR 35W 30D,27009761,CDM,270,RC,,,outpatient,,,528,211.20,,448.8,85,,359.04,percent of total billed charges,85% of total billed charges,406.56,77,,325.25,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,432.96,82,,346.368,percent of total billed charges,82% of total billed charges,448.8,85,,359.04,percent of total billed charges,85% of total billed charges,448.8,85,,359.04,percent of total billed charges,85% of total billed charges,448.8,85,,359.04,percent of total billed charges,85% of total billed charges,475.2,90,,380.16,percent of total billed charges,90% of total billed charges,422.4,80,,337.92,percent of total billed charges,80% of total billed charges,475.2,90,,380.16,percent of total billed charges,90% of total billed charges,396,75,,316.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,153.12,29,,122.496,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,353.76,67,,283.008,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,422.4,80,,337.92,percent of total billed charges,80% of total billed charges,343.2,65,,274.56,percent of total billed charges,65% of total billed charges,188.34,35.67,,150.672,percent of total billed charges,35.67% of total billed charges,153.12,475.2,
ELECTRODE HE ROLLER 24-28FR 12,27009762,CDM,270,RC,,,outpatient,,,528,211.20,,448.8,85,,359.04,percent of total billed charges,85% of total billed charges,406.56,77,,325.25,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,432.96,82,,346.368,percent of total billed charges,82% of total billed charges,448.8,85,,359.04,percent of total billed charges,85% of total billed charges,448.8,85,,359.04,percent of total billed charges,85% of total billed charges,448.8,85,,359.04,percent of total billed charges,85% of total billed charges,475.2,90,,380.16,percent of total billed charges,90% of total billed charges,422.4,80,,337.92,percent of total billed charges,80% of total billed charges,475.2,90,,380.16,percent of total billed charges,90% of total billed charges,396,75,,316.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,153.12,29,,122.496,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,353.76,67,,283.008,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,422.4,80,,337.92,percent of total billed charges,80% of total billed charges,343.2,65,,274.56,percent of total billed charges,65% of total billed charges,188.34,35.67,,150.672,percent of total billed charges,35.67% of total billed charges,153.12,475.2,
ELECTRODE BUGBEE FULGURATING,27009763,CDM,270,RC,,,outpatient,,,130,52.00,,110.5,85,,88.4,percent of total billed charges,85% of total billed charges,100.1,77,,80.08,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,106.6,82,,85.28,percent of total billed charges,82% of total billed charges,110.5,85,,88.4,percent of total billed charges,85% of total billed charges,110.5,85,,88.4,percent of total billed charges,85% of total billed charges,110.5,85,,88.4,percent of total billed charges,85% of total billed charges,117,90,,93.6,percent of total billed charges,90% of total billed charges,104,80,,83.2,percent of total billed charges,80% of total billed charges,117,90,,93.6,percent of total billed charges,90% of total billed charges,97.5,75,,78,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,37.7,29,,30.16,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,87.1,67,,69.68,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,104,80,,83.2,percent of total billed charges,80% of total billed charges,84.5,65,,67.6,percent of total billed charges,65% of total billed charges,46.37,35.67,,37.096,percent of total billed charges,35.67% of total billed charges,37.7,117,
KNIFE 24-28FR 12DEG 30DEB STER,27009793,CDM,270,RC,,,outpatient,,,736,294.40,,625.6,85,,500.48,percent of total billed charges,85% of total billed charges,566.72,77,,453.38,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,603.52,82,,482.816,percent of total billed charges,82% of total billed charges,625.6,85,,500.48,percent of total billed charges,85% of total billed charges,625.6,85,,500.48,percent of total billed charges,85% of total billed charges,625.6,85,,500.48,percent of total billed charges,85% of total billed charges,662.4,90,,529.92,percent of total billed charges,90% of total billed charges,588.8,80,,471.04,percent of total billed charges,80% of total billed charges,662.4,90,,529.92,percent of total billed charges,90% of total billed charges,552,75,,441.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,213.44,29,,170.752,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,493.12,67,,394.496,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,588.8,80,,471.04,percent of total billed charges,80% of total billed charges,478.4,65,,382.72,percent of total billed charges,65% of total billed charges,262.53,35.67,,210.024,percent of total billed charges,35.67% of total billed charges,213.44,662.4,
BARD MAXCORE 18G 20CM,27009794,CDM,270,RC,,,outpatient,,,352,140.80,,299.2,85,,239.36,percent of total billed charges,85% of total billed charges,271.04,77,,216.83,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,288.64,82,,230.912,percent of total billed charges,82% of total billed charges,299.2,85,,239.36,percent of total billed charges,85% of total billed charges,299.2,85,,239.36,percent of total billed charges,85% of total billed charges,299.2,85,,239.36,percent of total billed charges,85% of total billed charges,316.8,90,,253.44,percent of total billed charges,90% of total billed charges,281.6,80,,225.28,percent of total billed charges,80% of total billed charges,316.8,90,,253.44,percent of total billed charges,90% of total billed charges,264,75,,211.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,102.08,29,,81.664,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,235.84,67,,188.672,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,281.6,80,,225.28,percent of total billed charges,80% of total billed charges,228.8,65,,183.04,percent of total billed charges,65% of total billed charges,125.56,35.67,,100.448,percent of total billed charges,35.67% of total billed charges,102.08,316.8,
IV PCA EPIDRAL SET (GEMSTAR),27009804,CDM,270,RC,,,outpatient,,,111,44.40,,94.35,85,,75.48,percent of total billed charges,85% of total billed charges,85.47,77,,68.38,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,91.02,82,,72.816,percent of total billed charges,82% of total billed charges,94.35,85,,75.48,percent of total billed charges,85% of total billed charges,94.35,85,,75.48,percent of total billed charges,85% of total billed charges,94.35,85,,75.48,percent of total billed charges,85% of total billed charges,99.9,90,,79.92,percent of total billed charges,90% of total billed charges,88.8,80,,71.04,percent of total billed charges,80% of total billed charges,99.9,90,,79.92,percent of total billed charges,90% of total billed charges,83.25,75,,66.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,32.19,29,,25.752,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,74.37,67,,59.496,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,88.8,80,,71.04,percent of total billed charges,80% of total billed charges,72.15,65,,57.72,percent of total billed charges,65% of total billed charges,39.59,35.67,,31.672,percent of total billed charges,35.67% of total billed charges,32.19,99.9,
IV PCA PUMP SET SYRINGE,27009805,CDM,270,RC,,,outpatient,,,97,38.80,,82.45,85,,65.96,percent of total billed charges,85% of total billed charges,74.69,77,,59.75,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,79.54,82,,63.632,percent of total billed charges,82% of total billed charges,82.45,85,,65.96,percent of total billed charges,85% of total billed charges,82.45,85,,65.96,percent of total billed charges,85% of total billed charges,82.45,85,,65.96,percent of total billed charges,85% of total billed charges,87.3,90,,69.84,percent of total billed charges,90% of total billed charges,77.6,80,,62.08,percent of total billed charges,80% of total billed charges,87.3,90,,69.84,percent of total billed charges,90% of total billed charges,72.75,75,,58.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,28.13,29,,22.504,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,64.99,67,,51.992,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,77.6,80,,62.08,percent of total billed charges,80% of total billed charges,63.05,65,,50.44,percent of total billed charges,65% of total billed charges,34.6,35.67,,27.68,percent of total billed charges,35.67% of total billed charges,28.13,87.3,
CHOLARAPREP APPLICATOR 26ML,27009809,CDM,270,RC,,,outpatient,,,84,33.60,,71.4,85,,57.12,percent of total billed charges,85% of total billed charges,64.68,77,,51.74,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,68.88,82,,55.104,percent of total billed charges,82% of total billed charges,71.4,85,,57.12,percent of total billed charges,85% of total billed charges,71.4,85,,57.12,percent of total billed charges,85% of total billed charges,71.4,85,,57.12,percent of total billed charges,85% of total billed charges,75.6,90,,60.48,percent of total billed charges,90% of total billed charges,67.2,80,,53.76,percent of total billed charges,80% of total billed charges,75.6,90,,60.48,percent of total billed charges,90% of total billed charges,63,75,,50.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,24.36,29,,19.488,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,56.28,67,,45.024,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,67.2,80,,53.76,percent of total billed charges,80% of total billed charges,54.6,65,,43.68,percent of total billed charges,65% of total billed charges,29.96,35.67,,23.968,percent of total billed charges,35.67% of total billed charges,24.36,75.6,
UROLOGY GYN SURIGICAL DRAPE,27009810,CDM,270,RC,,,outpatient,,,130,52.00,,110.5,85,,88.4,percent of total billed charges,85% of total billed charges,100.1,77,,80.08,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,106.6,82,,85.28,percent of total billed charges,82% of total billed charges,110.5,85,,88.4,percent of total billed charges,85% of total billed charges,110.5,85,,88.4,percent of total billed charges,85% of total billed charges,110.5,85,,88.4,percent of total billed charges,85% of total billed charges,117,90,,93.6,percent of total billed charges,90% of total billed charges,104,80,,83.2,percent of total billed charges,80% of total billed charges,117,90,,93.6,percent of total billed charges,90% of total billed charges,97.5,75,,78,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,37.7,29,,30.16,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,87.1,67,,69.68,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,104,80,,83.2,percent of total billed charges,80% of total billed charges,84.5,65,,67.6,percent of total billed charges,65% of total billed charges,46.37,35.67,,37.096,percent of total billed charges,35.67% of total billed charges,37.7,117,
PELVISCOPY SURGICAL DRAPE,27009811,CDM,270,RC,,,outpatient,,,173,69.20,,147.05,85,,117.64,percent of total billed charges,85% of total billed charges,133.21,77,,106.57,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,141.86,82,,113.488,percent of total billed charges,82% of total billed charges,147.05,85,,117.64,percent of total billed charges,85% of total billed charges,147.05,85,,117.64,percent of total billed charges,85% of total billed charges,147.05,85,,117.64,percent of total billed charges,85% of total billed charges,155.7,90,,124.56,percent of total billed charges,90% of total billed charges,138.4,80,,110.72,percent of total billed charges,80% of total billed charges,155.7,90,,124.56,percent of total billed charges,90% of total billed charges,129.75,75,,103.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,50.17,29,,40.136,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,115.91,67,,92.728,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,138.4,80,,110.72,percent of total billed charges,80% of total billed charges,112.45,65,,89.96,percent of total billed charges,65% of total billed charges,61.71,35.67,,49.368,percent of total billed charges,35.67% of total billed charges,50.17,155.7,
RUMLKOH EFFICIENT 2.5 CM,27009816,CDM,270,RC,,,outpatient,,,505,202.00,,429.25,85,,343.4,percent of total billed charges,85% of total billed charges,388.85,77,,311.08,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,414.1,82,,331.28,percent of total billed charges,82% of total billed charges,429.25,85,,343.4,percent of total billed charges,85% of total billed charges,429.25,85,,343.4,percent of total billed charges,85% of total billed charges,429.25,85,,343.4,percent of total billed charges,85% of total billed charges,454.5,90,,363.6,percent of total billed charges,90% of total billed charges,404,80,,323.2,percent of total billed charges,80% of total billed charges,454.5,90,,363.6,percent of total billed charges,90% of total billed charges,378.75,75,,303,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,146.45,29,,117.16,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,338.35,67,,270.68,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,404,80,,323.2,percent of total billed charges,80% of total billed charges,328.25,65,,262.6,percent of total billed charges,65% of total billed charges,180.13,35.67,,144.104,percent of total billed charges,35.67% of total billed charges,146.45,454.5,
RUMLKOH EFFICIENT 3.0 CM,27009817,CDM,270,RC,,,outpatient,,,505,202.00,,429.25,85,,343.4,percent of total billed charges,85% of total billed charges,388.85,77,,311.08,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,414.1,82,,331.28,percent of total billed charges,82% of total billed charges,429.25,85,,343.4,percent of total billed charges,85% of total billed charges,429.25,85,,343.4,percent of total billed charges,85% of total billed charges,429.25,85,,343.4,percent of total billed charges,85% of total billed charges,454.5,90,,363.6,percent of total billed charges,90% of total billed charges,404,80,,323.2,percent of total billed charges,80% of total billed charges,454.5,90,,363.6,percent of total billed charges,90% of total billed charges,378.75,75,,303,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,146.45,29,,117.16,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,338.35,67,,270.68,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,404,80,,323.2,percent of total billed charges,80% of total billed charges,328.25,65,,262.6,percent of total billed charges,65% of total billed charges,180.13,35.67,,144.104,percent of total billed charges,35.67% of total billed charges,146.45,454.5,
RUMLKOH EFFICIENT 3.5 CM,27009818,CDM,270,RC,,,outpatient,,,505,202.00,,429.25,85,,343.4,percent of total billed charges,85% of total billed charges,388.85,77,,311.08,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,414.1,82,,331.28,percent of total billed charges,82% of total billed charges,429.25,85,,343.4,percent of total billed charges,85% of total billed charges,429.25,85,,343.4,percent of total billed charges,85% of total billed charges,429.25,85,,343.4,percent of total billed charges,85% of total billed charges,454.5,90,,363.6,percent of total billed charges,90% of total billed charges,404,80,,323.2,percent of total billed charges,80% of total billed charges,454.5,90,,363.6,percent of total billed charges,90% of total billed charges,378.75,75,,303,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,146.45,29,,117.16,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,338.35,67,,270.68,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,404,80,,323.2,percent of total billed charges,80% of total billed charges,328.25,65,,262.6,percent of total billed charges,65% of total billed charges,180.13,35.67,,144.104,percent of total billed charges,35.67% of total billed charges,146.45,454.5,
RUMLKOH EFFICIENT 4.0 CM,27009819,CDM,270,RC,,,outpatient,,,505,202.00,,429.25,85,,343.4,percent of total billed charges,85% of total billed charges,388.85,77,,311.08,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,414.1,82,,331.28,percent of total billed charges,82% of total billed charges,429.25,85,,343.4,percent of total billed charges,85% of total billed charges,429.25,85,,343.4,percent of total billed charges,85% of total billed charges,429.25,85,,343.4,percent of total billed charges,85% of total billed charges,454.5,90,,363.6,percent of total billed charges,90% of total billed charges,404,80,,323.2,percent of total billed charges,80% of total billed charges,454.5,90,,363.6,percent of total billed charges,90% of total billed charges,378.75,75,,303,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,146.45,29,,117.16,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,338.35,67,,270.68,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,404,80,,323.2,percent of total billed charges,80% of total billed charges,328.25,65,,262.6,percent of total billed charges,65% of total billed charges,180.13,35.67,,144.104,percent of total billed charges,35.67% of total billed charges,146.45,454.5,
RUMLTIP YELLOW 5.1 MM X 3.75CM,27009820,CDM,270,RC,,,outpatient,,,347,138.80,,294.95,85,,235.96,percent of total billed charges,85% of total billed charges,267.19,77,,213.75,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,284.54,82,,227.632,percent of total billed charges,82% of total billed charges,294.95,85,,235.96,percent of total billed charges,85% of total billed charges,294.95,85,,235.96,percent of total billed charges,85% of total billed charges,294.95,85,,235.96,percent of total billed charges,85% of total billed charges,312.3,90,,249.84,percent of total billed charges,90% of total billed charges,277.6,80,,222.08,percent of total billed charges,80% of total billed charges,312.3,90,,249.84,percent of total billed charges,90% of total billed charges,260.25,75,,208.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,100.63,29,,80.504,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,232.49,67,,185.992,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,277.6,80,,222.08,percent of total billed charges,80% of total billed charges,225.55,65,,180.44,percent of total billed charges,65% of total billed charges,123.77,35.67,,99.016,percent of total billed charges,35.67% of total billed charges,100.63,312.3,
RUMLTIP LAVENDER 5.1MM X 6CM,27009821,CDM,270,RC,,,outpatient,,,347,138.80,,294.95,85,,235.96,percent of total billed charges,85% of total billed charges,267.19,77,,213.75,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,284.54,82,,227.632,percent of total billed charges,82% of total billed charges,294.95,85,,235.96,percent of total billed charges,85% of total billed charges,294.95,85,,235.96,percent of total billed charges,85% of total billed charges,294.95,85,,235.96,percent of total billed charges,85% of total billed charges,312.3,90,,249.84,percent of total billed charges,90% of total billed charges,277.6,80,,222.08,percent of total billed charges,80% of total billed charges,312.3,90,,249.84,percent of total billed charges,90% of total billed charges,260.25,75,,208.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,100.63,29,,80.504,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,232.49,67,,185.992,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,277.6,80,,222.08,percent of total billed charges,80% of total billed charges,225.55,65,,180.44,percent of total billed charges,65% of total billed charges,123.77,35.67,,99.016,percent of total billed charges,35.67% of total billed charges,100.63,312.3,
RUMLTIP WHITE 6.7 MM X 6CM,27009822,CDM,270,RC,,,outpatient,,,347,138.80,,294.95,85,,235.96,percent of total billed charges,85% of total billed charges,267.19,77,,213.75,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,284.54,82,,227.632,percent of total billed charges,82% of total billed charges,294.95,85,,235.96,percent of total billed charges,85% of total billed charges,294.95,85,,235.96,percent of total billed charges,85% of total billed charges,294.95,85,,235.96,percent of total billed charges,85% of total billed charges,312.3,90,,249.84,percent of total billed charges,90% of total billed charges,277.6,80,,222.08,percent of total billed charges,80% of total billed charges,312.3,90,,249.84,percent of total billed charges,90% of total billed charges,260.25,75,,208.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,100.63,29,,80.504,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,232.49,67,,185.992,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,277.6,80,,222.08,percent of total billed charges,80% of total billed charges,225.55,65,,180.44,percent of total billed charges,65% of total billed charges,123.77,35.67,,99.016,percent of total billed charges,35.67% of total billed charges,100.63,312.3,
RUMLTIP BLUE 6.7 X 8 CM,27009823,CDM,270,RC,,,outpatient,,,347,138.80,,294.95,85,,235.96,percent of total billed charges,85% of total billed charges,267.19,77,,213.75,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,284.54,82,,227.632,percent of total billed charges,82% of total billed charges,294.95,85,,235.96,percent of total billed charges,85% of total billed charges,294.95,85,,235.96,percent of total billed charges,85% of total billed charges,294.95,85,,235.96,percent of total billed charges,85% of total billed charges,312.3,90,,249.84,percent of total billed charges,90% of total billed charges,277.6,80,,222.08,percent of total billed charges,80% of total billed charges,312.3,90,,249.84,percent of total billed charges,90% of total billed charges,260.25,75,,208.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,100.63,29,,80.504,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,232.49,67,,185.992,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,277.6,80,,222.08,percent of total billed charges,80% of total billed charges,225.55,65,,180.44,percent of total billed charges,65% of total billed charges,123.77,35.67,,99.016,percent of total billed charges,35.67% of total billed charges,100.63,312.3,
RUMLTIP GREEN 6.7 X 10CM,27009824,CDM,270,RC,,,outpatient,,,297,118.80,,252.45,85,,201.96,percent of total billed charges,85% of total billed charges,228.69,77,,182.95,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,243.54,82,,194.832,percent of total billed charges,82% of total billed charges,252.45,85,,201.96,percent of total billed charges,85% of total billed charges,252.45,85,,201.96,percent of total billed charges,85% of total billed charges,252.45,85,,201.96,percent of total billed charges,85% of total billed charges,267.3,90,,213.84,percent of total billed charges,90% of total billed charges,237.6,80,,190.08,percent of total billed charges,80% of total billed charges,267.3,90,,213.84,percent of total billed charges,90% of total billed charges,222.75,75,,178.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,86.13,29,,68.904,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,198.99,67,,159.192,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,237.6,80,,190.08,percent of total billed charges,80% of total billed charges,193.05,65,,154.44,percent of total billed charges,65% of total billed charges,105.94,35.67,,84.752,percent of total billed charges,35.67% of total billed charges,86.13,267.3,
RUMLTIP ORANGE 6.7MM X 12CM,27009825,CDM,270,RC,,,outpatient,,,297,118.80,,252.45,85,,201.96,percent of total billed charges,85% of total billed charges,228.69,77,,182.95,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,243.54,82,,194.832,percent of total billed charges,82% of total billed charges,252.45,85,,201.96,percent of total billed charges,85% of total billed charges,252.45,85,,201.96,percent of total billed charges,85% of total billed charges,252.45,85,,201.96,percent of total billed charges,85% of total billed charges,267.3,90,,213.84,percent of total billed charges,90% of total billed charges,237.6,80,,190.08,percent of total billed charges,80% of total billed charges,267.3,90,,213.84,percent of total billed charges,90% of total billed charges,222.75,75,,178.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,86.13,29,,68.904,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,198.99,67,,159.192,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,237.6,80,,190.08,percent of total billed charges,80% of total billed charges,193.05,65,,154.44,percent of total billed charges,65% of total billed charges,105.94,35.67,,84.752,percent of total billed charges,35.67% of total billed charges,86.13,267.3,
LONE STAR APS RETRACTOR,27009826,CDM,270,RC,,,outpatient,,,493,197.20,,419.05,85,,335.24,percent of total billed charges,85% of total billed charges,379.61,77,,303.69,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,404.26,82,,323.408,percent of total billed charges,82% of total billed charges,419.05,85,,335.24,percent of total billed charges,85% of total billed charges,419.05,85,,335.24,percent of total billed charges,85% of total billed charges,419.05,85,,335.24,percent of total billed charges,85% of total billed charges,443.7,90,,354.96,percent of total billed charges,90% of total billed charges,394.4,80,,315.52,percent of total billed charges,80% of total billed charges,443.7,90,,354.96,percent of total billed charges,90% of total billed charges,369.75,75,,295.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,142.97,29,,114.376,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,330.31,67,,264.248,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,394.4,80,,315.52,percent of total billed charges,80% of total billed charges,320.45,65,,256.36,percent of total billed charges,65% of total billed charges,175.85,35.67,,140.68,percent of total billed charges,35.67% of total billed charges,142.97,443.7,
LONE STAR 5 MM SHARP HOOK,27009827,CDM,270,RC,,,outpatient,,,303,121.20,,257.55,85,,206.04,percent of total billed charges,85% of total billed charges,233.31,77,,186.65,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,248.46,82,,198.768,percent of total billed charges,82% of total billed charges,257.55,85,,206.04,percent of total billed charges,85% of total billed charges,257.55,85,,206.04,percent of total billed charges,85% of total billed charges,257.55,85,,206.04,percent of total billed charges,85% of total billed charges,272.7,90,,218.16,percent of total billed charges,90% of total billed charges,242.4,80,,193.92,percent of total billed charges,80% of total billed charges,272.7,90,,218.16,percent of total billed charges,90% of total billed charges,227.25,75,,181.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,87.87,29,,70.296,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,203.01,67,,162.408,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,242.4,80,,193.92,percent of total billed charges,80% of total billed charges,196.95,65,,157.56,percent of total billed charges,65% of total billed charges,108.08,35.67,,86.464,percent of total billed charges,35.67% of total billed charges,87.87,272.7,
SPIRAL CATHETER 5 FR,27009837,CDM,270,RC,,,outpatient,,,120,48.00,,102,85,,81.6,percent of total billed charges,85% of total billed charges,92.4,77,,73.92,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,98.4,82,,78.72,percent of total billed charges,82% of total billed charges,102,85,,81.6,percent of total billed charges,85% of total billed charges,102,85,,81.6,percent of total billed charges,85% of total billed charges,102,85,,81.6,percent of total billed charges,85% of total billed charges,108,90,,86.4,percent of total billed charges,90% of total billed charges,96,80,,76.8,percent of total billed charges,80% of total billed charges,108,90,,86.4,percent of total billed charges,90% of total billed charges,90,75,,72,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,34.8,29,,27.84,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,80.4,67,,64.32,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,96,80,,76.8,percent of total billed charges,80% of total billed charges,78,65,,62.4,percent of total billed charges,65% of total billed charges,42.8,35.67,,34.24,percent of total billed charges,35.67% of total billed charges,34.8,108,
INSTRATEK ENDOSCOPIC SET,27009856,CDM,270,RC,,,outpatient,,,1679,671.60,,1427.15,85,,1141.72,percent of total billed charges,85% of total billed charges,1292.83,77,,1034.26,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,1376.78,82,,1101.424,percent of total billed charges,82% of total billed charges,1427.15,85,,1141.72,percent of total billed charges,85% of total billed charges,1427.15,85,,1141.72,percent of total billed charges,85% of total billed charges,1427.15,85,,1141.72,percent of total billed charges,85% of total billed charges,1511.1,90,,1208.88,percent of total billed charges,90% of total billed charges,1343.2,80,,1074.56,percent of total billed charges,80% of total billed charges,1511.1,90,,1208.88,percent of total billed charges,90% of total billed charges,1259.25,75,,1007.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,486.91,29,,389.528,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1124.93,67,,899.944,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1343.2,80,,1074.56,percent of total billed charges,80% of total billed charges,1091.35,65,,873.08,percent of total billed charges,65% of total billed charges,598.9,35.67,,479.12,percent of total billed charges,35.67% of total billed charges,486.91,1511.1,
GEMSTAR TUBING,27009858,CDM,270,RC,,,outpatient,,,102,40.80,,86.7,85,,69.36,percent of total billed charges,85% of total billed charges,78.54,77,,62.83,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,83.64,82,,66.912,percent of total billed charges,82% of total billed charges,86.7,85,,69.36,percent of total billed charges,85% of total billed charges,86.7,85,,69.36,percent of total billed charges,85% of total billed charges,86.7,85,,69.36,percent of total billed charges,85% of total billed charges,91.8,90,,73.44,percent of total billed charges,90% of total billed charges,81.6,80,,65.28,percent of total billed charges,80% of total billed charges,91.8,90,,73.44,percent of total billed charges,90% of total billed charges,76.5,75,,61.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,29.58,29,,23.664,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,68.34,67,,54.672,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,81.6,80,,65.28,percent of total billed charges,80% of total billed charges,66.3,65,,53.04,percent of total billed charges,65% of total billed charges,36.38,35.67,,29.104,percent of total billed charges,35.67% of total billed charges,29.58,91.8,
ENDOSCOPIC FASCIOTOMY KT BLADE,27009867,CDM,270,RC,,,outpatient,,,68,27.20,,57.8,85,,46.24,percent of total billed charges,85% of total billed charges,52.36,77,,41.89,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,55.76,82,,44.608,percent of total billed charges,82% of total billed charges,57.8,85,,46.24,percent of total billed charges,85% of total billed charges,57.8,85,,46.24,percent of total billed charges,85% of total billed charges,57.8,85,,46.24,percent of total billed charges,85% of total billed charges,61.2,90,,48.96,percent of total billed charges,90% of total billed charges,54.4,80,,43.52,percent of total billed charges,80% of total billed charges,61.2,90,,48.96,percent of total billed charges,90% of total billed charges,51,75,,40.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,19.72,29,,15.776,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,45.56,67,,36.448,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,54.4,80,,43.52,percent of total billed charges,80% of total billed charges,44.2,65,,35.36,percent of total billed charges,65% of total billed charges,24.26,35.67,,19.408,percent of total billed charges,35.67% of total billed charges,19.72,61.2,
POLYSORB 0 SUTURE CL71M,27009920,CDM,270,RC,,,outpatient,,,309,123.60,,262.65,85,,210.12,percent of total billed charges,85% of total billed charges,237.93,77,,190.34,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,253.38,82,,202.704,percent of total billed charges,82% of total billed charges,262.65,85,,210.12,percent of total billed charges,85% of total billed charges,262.65,85,,210.12,percent of total billed charges,85% of total billed charges,262.65,85,,210.12,percent of total billed charges,85% of total billed charges,278.1,90,,222.48,percent of total billed charges,90% of total billed charges,247.2,80,,197.76,percent of total billed charges,80% of total billed charges,278.1,90,,222.48,percent of total billed charges,90% of total billed charges,231.75,75,,185.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,89.61,29,,71.688,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,207.03,67,,165.624,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,247.2,80,,197.76,percent of total billed charges,80% of total billed charges,200.85,65,,160.68,percent of total billed charges,65% of total billed charges,110.22,35.67,,88.176,percent of total billed charges,35.67% of total billed charges,89.61,278.1,
SCROTAL SUPPORT X-LARGE,27009966,CDM,270,RC,,,outpatient,,,47,18.80,,39.95,85,,31.96,percent of total billed charges,85% of total billed charges,36.19,77,,28.95,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,38.54,82,,30.832,percent of total billed charges,82% of total billed charges,39.95,85,,31.96,percent of total billed charges,85% of total billed charges,39.95,85,,31.96,percent of total billed charges,85% of total billed charges,39.95,85,,31.96,percent of total billed charges,85% of total billed charges,42.3,90,,33.84,percent of total billed charges,90% of total billed charges,37.6,80,,30.08,percent of total billed charges,80% of total billed charges,42.3,90,,33.84,percent of total billed charges,90% of total billed charges,35.25,75,,28.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,13.63,29,,10.904,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,31.49,67,,25.192,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,37.6,80,,30.08,percent of total billed charges,80% of total billed charges,30.55,65,,24.44,percent of total billed charges,65% of total billed charges,16.76,35.67,,13.408,percent of total billed charges,35.67% of total billed charges,13.63,42.3,
MILTEX BABCOCK SUTURE WIRE 22G,27009977,CDM,270,RC,,,outpatient,,,280,112.00,,238,85,,190.4,percent of total billed charges,85% of total billed charges,215.6,77,,172.48,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,229.6,82,,183.68,percent of total billed charges,82% of total billed charges,238,85,,190.4,percent of total billed charges,85% of total billed charges,238,85,,190.4,percent of total billed charges,85% of total billed charges,238,85,,190.4,percent of total billed charges,85% of total billed charges,252,90,,201.6,percent of total billed charges,90% of total billed charges,224,80,,179.2,percent of total billed charges,80% of total billed charges,252,90,,201.6,percent of total billed charges,90% of total billed charges,210,75,,168,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,81.2,29,,64.96,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,187.6,67,,150.08,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,224,80,,179.2,percent of total billed charges,80% of total billed charges,182,65,,145.6,percent of total billed charges,65% of total billed charges,99.88,35.67,,79.904,percent of total billed charges,35.67% of total billed charges,81.2,252,
CANNULA TWIST IN NO SQUIRT CAP,27009978,CDM,270,RC,,,outpatient,,,226,90.40,,192.1,85,,153.68,percent of total billed charges,85% of total billed charges,174.02,77,,139.22,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,185.32,82,,148.256,percent of total billed charges,82% of total billed charges,192.1,85,,153.68,percent of total billed charges,85% of total billed charges,192.1,85,,153.68,percent of total billed charges,85% of total billed charges,192.1,85,,153.68,percent of total billed charges,85% of total billed charges,203.4,90,,162.72,percent of total billed charges,90% of total billed charges,180.8,80,,144.64,percent of total billed charges,80% of total billed charges,203.4,90,,162.72,percent of total billed charges,90% of total billed charges,169.5,75,,135.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,65.54,29,,52.432,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,151.42,67,,121.136,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,180.8,80,,144.64,percent of total billed charges,80% of total billed charges,146.9,65,,117.52,percent of total billed charges,65% of total billed charges,80.61,35.67,,64.488,percent of total billed charges,35.67% of total billed charges,65.54,203.4,
SLAP BUR 4.0MM 6 FLUTE,27009979,CDM,270,RC,,,outpatient,,,579,231.60,,492.15,85,,393.72,percent of total billed charges,85% of total billed charges,445.83,77,,356.66,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,474.78,82,,379.824,percent of total billed charges,82% of total billed charges,492.15,85,,393.72,percent of total billed charges,85% of total billed charges,492.15,85,,393.72,percent of total billed charges,85% of total billed charges,492.15,85,,393.72,percent of total billed charges,85% of total billed charges,521.1,90,,416.88,percent of total billed charges,90% of total billed charges,463.2,80,,370.56,percent of total billed charges,80% of total billed charges,521.1,90,,416.88,percent of total billed charges,90% of total billed charges,434.25,75,,347.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,167.91,29,,134.328,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,387.93,67,,310.344,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,463.2,80,,370.56,percent of total billed charges,80% of total billed charges,376.35,65,,301.08,percent of total billed charges,65% of total billed charges,206.53,35.67,,165.224,percent of total billed charges,35.67% of total billed charges,167.91,521.1,
SUTURE SPOOL WIRE S/S 18G,27009997,CDM,270,RC,,,outpatient,,,28,11.20,,23.8,85,,19.04,percent of total billed charges,85% of total billed charges,21.56,77,,17.25,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,22.96,82,,18.368,percent of total billed charges,82% of total billed charges,23.8,85,,19.04,percent of total billed charges,85% of total billed charges,23.8,85,,19.04,percent of total billed charges,85% of total billed charges,23.8,85,,19.04,percent of total billed charges,85% of total billed charges,25.2,90,,20.16,percent of total billed charges,90% of total billed charges,22.4,80,,17.92,percent of total billed charges,80% of total billed charges,25.2,90,,20.16,percent of total billed charges,90% of total billed charges,21,75,,16.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,8.12,29,,6.496,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,18.76,67,,15.008,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,22.4,80,,17.92,percent of total billed charges,80% of total billed charges,18.2,65,,14.56,percent of total billed charges,65% of total billed charges,9.99,35.67,,7.992,percent of total billed charges,35.67% of total billed charges,8.12,25.2,
MILTEX BABCOCK SUTURE 24GX10',27010002,CDM,270,RC,,,outpatient,,,29,11.60,,24.65,85,,19.72,percent of total billed charges,85% of total billed charges,22.33,77,,17.86,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,23.78,82,,19.024,percent of total billed charges,82% of total billed charges,24.65,85,,19.72,percent of total billed charges,85% of total billed charges,24.65,85,,19.72,percent of total billed charges,85% of total billed charges,24.65,85,,19.72,percent of total billed charges,85% of total billed charges,26.1,90,,20.88,percent of total billed charges,90% of total billed charges,23.2,80,,18.56,percent of total billed charges,80% of total billed charges,26.1,90,,20.88,percent of total billed charges,90% of total billed charges,21.75,75,,17.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,8.41,29,,6.728,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,19.43,67,,15.544,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,23.2,80,,18.56,percent of total billed charges,80% of total billed charges,18.85,65,,15.08,percent of total billed charges,65% of total billed charges,10.34,35.67,,8.272,percent of total billed charges,35.67% of total billed charges,8.41,26.1,
LIGASURE IMPACT SEALER/DIVIDER,27010053,CDM,270,RC,,,outpatient,,,2366,946.40,,2011.1,85,,1608.88,percent of total billed charges,85% of total billed charges,1821.82,77,,1457.46,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,1940.12,82,,1552.096,percent of total billed charges,82% of total billed charges,2011.1,85,,1608.88,percent of total billed charges,85% of total billed charges,2011.1,85,,1608.88,percent of total billed charges,85% of total billed charges,2011.1,85,,1608.88,percent of total billed charges,85% of total billed charges,2129.4,90,,1703.52,percent of total billed charges,90% of total billed charges,1892.8,80,,1514.24,percent of total billed charges,80% of total billed charges,2129.4,90,,1703.52,percent of total billed charges,90% of total billed charges,1774.5,75,,1419.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,686.14,29,,548.912,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1585.22,67,,1268.176,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1892.8,80,,1514.24,percent of total billed charges,80% of total billed charges,1537.9,65,,1230.32,percent of total billed charges,65% of total billed charges,843.95,35.67,,675.16,percent of total billed charges,35.67% of total billed charges,686.14,2129.4,
POLYSORB SUTURE 2-0,27010055,CDM,270,RC,,,outpatient,,,607,242.80,,515.95,85,,412.76,percent of total billed charges,85% of total billed charges,467.39,77,,373.91,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,497.74,82,,398.192,percent of total billed charges,82% of total billed charges,515.95,85,,412.76,percent of total billed charges,85% of total billed charges,515.95,85,,412.76,percent of total billed charges,85% of total billed charges,515.95,85,,412.76,percent of total billed charges,85% of total billed charges,546.3,90,,437.04,percent of total billed charges,90% of total billed charges,485.6,80,,388.48,percent of total billed charges,80% of total billed charges,546.3,90,,437.04,percent of total billed charges,90% of total billed charges,455.25,75,,364.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,176.03,29,,140.824,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,406.69,67,,325.352,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,485.6,80,,388.48,percent of total billed charges,80% of total billed charges,394.55,65,,315.64,percent of total billed charges,65% of total billed charges,216.52,35.67,,173.216,percent of total billed charges,35.67% of total billed charges,176.03,546.3,
DEVICE SUTURING ENDO 10MM,27010056,CDM,270,RC,,,outpatient,,,1570,628.00,,1334.5,85,,1067.6,percent of total billed charges,85% of total billed charges,1208.9,77,,967.12,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,1287.4,82,,1029.92,percent of total billed charges,82% of total billed charges,1334.5,85,,1067.6,percent of total billed charges,85% of total billed charges,1334.5,85,,1067.6,percent of total billed charges,85% of total billed charges,1334.5,85,,1067.6,percent of total billed charges,85% of total billed charges,1413,90,,1130.4,percent of total billed charges,90% of total billed charges,1256,80,,1004.8,percent of total billed charges,80% of total billed charges,1413,90,,1130.4,percent of total billed charges,90% of total billed charges,1177.5,75,,942,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,455.3,29,,364.24,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1051.9,67,,841.52,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1256,80,,1004.8,percent of total billed charges,80% of total billed charges,1020.5,65,,816.4,percent of total billed charges,65% of total billed charges,560.02,35.67,,448.016,percent of total billed charges,35.67% of total billed charges,455.3,1413,
LAPRA-TY ABSORBABLE SUTURE CLP,27010057,CDM,270,RC,,,outpatient,,,923,369.20,,784.55,85,,627.64,percent of total billed charges,85% of total billed charges,710.71,77,,568.57,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,756.86,82,,605.488,percent of total billed charges,82% of total billed charges,784.55,85,,627.64,percent of total billed charges,85% of total billed charges,784.55,85,,627.64,percent of total billed charges,85% of total billed charges,784.55,85,,627.64,percent of total billed charges,85% of total billed charges,830.7,90,,664.56,percent of total billed charges,90% of total billed charges,738.4,80,,590.72,percent of total billed charges,80% of total billed charges,830.7,90,,664.56,percent of total billed charges,90% of total billed charges,692.25,75,,553.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,267.67,29,,214.136,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,618.41,67,,494.728,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,738.4,80,,590.72,percent of total billed charges,80% of total billed charges,599.95,65,,479.96,percent of total billed charges,65% of total billed charges,329.23,35.67,,263.384,percent of total billed charges,35.67% of total billed charges,267.67,830.7,
SALEM SUMP ANTI-REFLUX VALVE,27010072,CDM,270,RC,,,outpatient,,,71,28.40,,60.35,85,,48.28,percent of total billed charges,85% of total billed charges,54.67,77,,43.74,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,58.22,82,,46.576,percent of total billed charges,82% of total billed charges,60.35,85,,48.28,percent of total billed charges,85% of total billed charges,60.35,85,,48.28,percent of total billed charges,85% of total billed charges,60.35,85,,48.28,percent of total billed charges,85% of total billed charges,63.9,90,,51.12,percent of total billed charges,90% of total billed charges,56.8,80,,45.44,percent of total billed charges,80% of total billed charges,63.9,90,,51.12,percent of total billed charges,90% of total billed charges,53.25,75,,42.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,20.59,29,,16.472,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,47.57,67,,38.056,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,56.8,80,,45.44,percent of total billed charges,80% of total billed charges,46.15,65,,36.92,percent of total billed charges,65% of total billed charges,25.33,35.67,,20.264,percent of total billed charges,35.67% of total billed charges,20.59,63.9,
CASTING TAPE RED 2X4,27010073,CDM,270,RC,,,outpatient,,,29,11.60,,24.65,85,,19.72,percent of total billed charges,85% of total billed charges,22.33,77,,17.86,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,23.78,82,,19.024,percent of total billed charges,82% of total billed charges,24.65,85,,19.72,percent of total billed charges,85% of total billed charges,24.65,85,,19.72,percent of total billed charges,85% of total billed charges,24.65,85,,19.72,percent of total billed charges,85% of total billed charges,26.1,90,,20.88,percent of total billed charges,90% of total billed charges,23.2,80,,18.56,percent of total billed charges,80% of total billed charges,26.1,90,,20.88,percent of total billed charges,90% of total billed charges,21.75,75,,17.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,8.41,29,,6.728,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,19.43,67,,15.544,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,23.2,80,,18.56,percent of total billed charges,80% of total billed charges,18.85,65,,15.08,percent of total billed charges,65% of total billed charges,10.34,35.67,,8.272,percent of total billed charges,35.67% of total billed charges,8.41,26.1,
CASTING TAPE GREEN 2X4,27010074,CDM,270,RC,,,outpatient,,,40,16.00,,34,85,,27.2,percent of total billed charges,85% of total billed charges,30.8,77,,24.64,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,32.8,82,,26.24,percent of total billed charges,82% of total billed charges,34,85,,27.2,percent of total billed charges,85% of total billed charges,34,85,,27.2,percent of total billed charges,85% of total billed charges,34,85,,27.2,percent of total billed charges,85% of total billed charges,36,90,,28.8,percent of total billed charges,90% of total billed charges,32,80,,25.6,percent of total billed charges,80% of total billed charges,36,90,,28.8,percent of total billed charges,90% of total billed charges,30,75,,24,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,11.6,29,,9.28,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,26.8,67,,21.44,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,32,80,,25.6,percent of total billed charges,80% of total billed charges,26,65,,20.8,percent of total billed charges,65% of total billed charges,14.27,35.67,,11.416,percent of total billed charges,35.67% of total billed charges,11.6,36,
CASTING TAPE PINK 2X4,27010075,CDM,270,RC,,,outpatient,,,47,18.80,,39.95,85,,31.96,percent of total billed charges,85% of total billed charges,36.19,77,,28.95,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,38.54,82,,30.832,percent of total billed charges,82% of total billed charges,39.95,85,,31.96,percent of total billed charges,85% of total billed charges,39.95,85,,31.96,percent of total billed charges,85% of total billed charges,39.95,85,,31.96,percent of total billed charges,85% of total billed charges,42.3,90,,33.84,percent of total billed charges,90% of total billed charges,37.6,80,,30.08,percent of total billed charges,80% of total billed charges,42.3,90,,33.84,percent of total billed charges,90% of total billed charges,35.25,75,,28.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,13.63,29,,10.904,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,31.49,67,,25.192,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,37.6,80,,30.08,percent of total billed charges,80% of total billed charges,30.55,65,,24.44,percent of total billed charges,65% of total billed charges,16.76,35.67,,13.408,percent of total billed charges,35.67% of total billed charges,13.63,42.3,
CASTING TAPE RED 3 IN,27010076,CDM,270,RC,,,outpatient,,,33,13.20,,28.05,85,,22.44,percent of total billed charges,85% of total billed charges,25.41,77,,20.33,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,27.06,82,,21.648,percent of total billed charges,82% of total billed charges,28.05,85,,22.44,percent of total billed charges,85% of total billed charges,28.05,85,,22.44,percent of total billed charges,85% of total billed charges,28.05,85,,22.44,percent of total billed charges,85% of total billed charges,29.7,90,,23.76,percent of total billed charges,90% of total billed charges,26.4,80,,21.12,percent of total billed charges,80% of total billed charges,29.7,90,,23.76,percent of total billed charges,90% of total billed charges,24.75,75,,19.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,9.57,29,,7.656,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,22.11,67,,17.688,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,26.4,80,,21.12,percent of total billed charges,80% of total billed charges,21.45,65,,17.16,percent of total billed charges,65% of total billed charges,11.77,35.67,,9.416,percent of total billed charges,35.67% of total billed charges,9.57,29.7,
LIGASURE IMPACT SEALER/DIVIDER,27010082,CDM,270,RC,,,outpatient,,,2485,994.00,,2112.25,85,,1689.8,percent of total billed charges,85% of total billed charges,1913.45,77,,1530.76,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,2037.7,82,,1630.16,percent of total billed charges,82% of total billed charges,2112.25,85,,1689.8,percent of total billed charges,85% of total billed charges,2112.25,85,,1689.8,percent of total billed charges,85% of total billed charges,2112.25,85,,1689.8,percent of total billed charges,85% of total billed charges,2236.5,90,,1789.2,percent of total billed charges,90% of total billed charges,1988,80,,1590.4,percent of total billed charges,80% of total billed charges,2236.5,90,,1789.2,percent of total billed charges,90% of total billed charges,1863.75,75,,1491,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,720.65,29,,576.52,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1664.95,67,,1331.96,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1988,80,,1590.4,percent of total billed charges,80% of total billed charges,1615.25,65,,1292.2,percent of total billed charges,65% of total billed charges,886.4,35.67,,709.12,percent of total billed charges,35.67% of total billed charges,720.65,2236.5,
LIGASURE IMPACT SEALER/DIVIDER,27010083,CDM,270,RC,,,outpatient,,,2366,946.40,,2011.1,85,,1608.88,percent of total billed charges,85% of total billed charges,1821.82,77,,1457.46,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,1940.12,82,,1552.096,percent of total billed charges,82% of total billed charges,2011.1,85,,1608.88,percent of total billed charges,85% of total billed charges,2011.1,85,,1608.88,percent of total billed charges,85% of total billed charges,2011.1,85,,1608.88,percent of total billed charges,85% of total billed charges,2129.4,90,,1703.52,percent of total billed charges,90% of total billed charges,1892.8,80,,1514.24,percent of total billed charges,80% of total billed charges,2129.4,90,,1703.52,percent of total billed charges,90% of total billed charges,1774.5,75,,1419.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,686.14,29,,548.912,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1585.22,67,,1268.176,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1892.8,80,,1514.24,percent of total billed charges,80% of total billed charges,1537.9,65,,1230.32,percent of total billed charges,65% of total billed charges,843.95,35.67,,675.16,percent of total billed charges,35.67% of total billed charges,686.14,2129.4,
PASSING WIRE SUTURE,27010090,CDM,270,RC,,,outpatient,,,607,242.80,,515.95,85,,412.76,percent of total billed charges,85% of total billed charges,467.39,77,,373.91,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,497.74,82,,398.192,percent of total billed charges,82% of total billed charges,515.95,85,,412.76,percent of total billed charges,85% of total billed charges,515.95,85,,412.76,percent of total billed charges,85% of total billed charges,515.95,85,,412.76,percent of total billed charges,85% of total billed charges,546.3,90,,437.04,percent of total billed charges,90% of total billed charges,485.6,80,,388.48,percent of total billed charges,80% of total billed charges,546.3,90,,437.04,percent of total billed charges,90% of total billed charges,455.25,75,,364.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,176.03,29,,140.824,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,406.69,67,,325.352,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,485.6,80,,388.48,percent of total billed charges,80% of total billed charges,394.55,65,,315.64,percent of total billed charges,65% of total billed charges,216.52,35.67,,173.216,percent of total billed charges,35.67% of total billed charges,176.03,546.3,
TRANSFIX KIT,27010091,CDM,270,RC,,,outpatient,,,933,373.20,,793.05,85,,634.44,percent of total billed charges,85% of total billed charges,718.41,77,,574.73,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,765.06,82,,612.048,percent of total billed charges,82% of total billed charges,793.05,85,,634.44,percent of total billed charges,85% of total billed charges,793.05,85,,634.44,percent of total billed charges,85% of total billed charges,793.05,85,,634.44,percent of total billed charges,85% of total billed charges,839.7,90,,671.76,percent of total billed charges,90% of total billed charges,746.4,80,,597.12,percent of total billed charges,80% of total billed charges,839.7,90,,671.76,percent of total billed charges,90% of total billed charges,699.75,75,,559.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,270.57,29,,216.456,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,625.11,67,,500.088,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,746.4,80,,597.12,percent of total billed charges,80% of total billed charges,606.45,65,,485.16,percent of total billed charges,65% of total billed charges,332.8,35.67,,266.24,percent of total billed charges,35.67% of total billed charges,270.57,839.7,
TRANSFIX KIT,27010093,CDM,270,RC,,,outpatient,,,1567,626.80,,1331.95,85,,1065.56,percent of total billed charges,85% of total billed charges,1206.59,77,,965.27,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,1284.94,82,,1027.952,percent of total billed charges,82% of total billed charges,1331.95,85,,1065.56,percent of total billed charges,85% of total billed charges,1331.95,85,,1065.56,percent of total billed charges,85% of total billed charges,1331.95,85,,1065.56,percent of total billed charges,85% of total billed charges,1410.3,90,,1128.24,percent of total billed charges,90% of total billed charges,1253.6,80,,1002.88,percent of total billed charges,80% of total billed charges,1410.3,90,,1128.24,percent of total billed charges,90% of total billed charges,1175.25,75,,940.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,454.43,29,,363.544,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1049.89,67,,839.912,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1253.6,80,,1002.88,percent of total billed charges,80% of total billed charges,1018.55,65,,814.84,percent of total billed charges,65% of total billed charges,558.95,35.67,,447.16,percent of total billed charges,35.67% of total billed charges,454.43,1410.3,
PAIN CPT KIT DR WHITE,27010103,CDM,270,RC,,,outpatient,,,142,56.80,,120.7,85,,96.56,percent of total billed charges,85% of total billed charges,109.34,77,,87.47,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,116.44,82,,93.152,percent of total billed charges,82% of total billed charges,120.7,85,,96.56,percent of total billed charges,85% of total billed charges,120.7,85,,96.56,percent of total billed charges,85% of total billed charges,120.7,85,,96.56,percent of total billed charges,85% of total billed charges,127.8,90,,102.24,percent of total billed charges,90% of total billed charges,113.6,80,,90.88,percent of total billed charges,80% of total billed charges,127.8,90,,102.24,percent of total billed charges,90% of total billed charges,106.5,75,,85.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,41.18,29,,32.944,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,95.14,67,,76.112,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,113.6,80,,90.88,percent of total billed charges,80% of total billed charges,92.3,65,,73.84,percent of total billed charges,65% of total billed charges,50.65,35.67,,40.52,percent of total billed charges,35.67% of total billed charges,41.18,127.8,
WILLIAMS NEEDLE,27010109,CDM,270,RC,,,outpatient,,,209,83.60,,177.65,85,,142.12,percent of total billed charges,85% of total billed charges,160.93,77,,128.74,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,171.38,82,,137.104,percent of total billed charges,82% of total billed charges,177.65,85,,142.12,percent of total billed charges,85% of total billed charges,177.65,85,,142.12,percent of total billed charges,85% of total billed charges,177.65,85,,142.12,percent of total billed charges,85% of total billed charges,188.1,90,,150.48,percent of total billed charges,90% of total billed charges,167.2,80,,133.76,percent of total billed charges,80% of total billed charges,188.1,90,,150.48,percent of total billed charges,90% of total billed charges,156.75,75,,125.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,60.61,29,,48.488,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,140.03,67,,112.024,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,167.2,80,,133.76,percent of total billed charges,80% of total billed charges,135.85,65,,108.68,percent of total billed charges,65% of total billed charges,74.55,35.67,,59.64,percent of total billed charges,35.67% of total billed charges,60.61,188.1,
LIGASURE IMPACT SEALER DIVIDER,27010136,CDM,270,RC,,,outpatient,,,1814,725.60,,1541.9,85,,1233.52,percent of total billed charges,85% of total billed charges,1396.78,77,,1117.42,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,1487.48,82,,1189.984,percent of total billed charges,82% of total billed charges,1541.9,85,,1233.52,percent of total billed charges,85% of total billed charges,1541.9,85,,1233.52,percent of total billed charges,85% of total billed charges,1541.9,85,,1233.52,percent of total billed charges,85% of total billed charges,1632.6,90,,1306.08,percent of total billed charges,90% of total billed charges,1451.2,80,,1160.96,percent of total billed charges,80% of total billed charges,1632.6,90,,1306.08,percent of total billed charges,90% of total billed charges,1360.5,75,,1088.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,526.06,29,,420.848,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1215.38,67,,972.304,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1451.2,80,,1160.96,percent of total billed charges,80% of total billed charges,1179.1,65,,943.28,percent of total billed charges,65% of total billed charges,647.05,35.67,,517.64,percent of total billed charges,35.67% of total billed charges,526.06,1632.6,
PLASMA WAND EVAC 70 XTRA,27010140,CDM,270,RC,,,outpatient,,,1008,403.20,,856.8,85,,685.44,percent of total billed charges,85% of total billed charges,776.16,77,,620.93,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,826.56,82,,661.248,percent of total billed charges,82% of total billed charges,856.8,85,,685.44,percent of total billed charges,85% of total billed charges,856.8,85,,685.44,percent of total billed charges,85% of total billed charges,856.8,85,,685.44,percent of total billed charges,85% of total billed charges,907.2,90,,725.76,percent of total billed charges,90% of total billed charges,806.4,80,,645.12,percent of total billed charges,80% of total billed charges,907.2,90,,725.76,percent of total billed charges,90% of total billed charges,756,75,,604.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,292.32,29,,233.856,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,675.36,67,,540.288,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,806.4,80,,645.12,percent of total billed charges,80% of total billed charges,655.2,65,,524.16,percent of total billed charges,65% of total billed charges,359.55,35.67,,287.64,percent of total billed charges,35.67% of total billed charges,292.32,907.2,
PLASMA WAND REFLEX ULTRA 45,27010141,CDM,270,RC,,,outpatient,,,965,386.00,,820.25,85,,656.2,percent of total billed charges,85% of total billed charges,743.05,77,,594.44,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,791.3,82,,633.04,percent of total billed charges,82% of total billed charges,820.25,85,,656.2,percent of total billed charges,85% of total billed charges,820.25,85,,656.2,percent of total billed charges,85% of total billed charges,820.25,85,,656.2,percent of total billed charges,85% of total billed charges,868.5,90,,694.8,percent of total billed charges,90% of total billed charges,772,80,,617.6,percent of total billed charges,80% of total billed charges,868.5,90,,694.8,percent of total billed charges,90% of total billed charges,723.75,75,,579,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,279.85,29,,223.88,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,646.55,67,,517.24,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,772,80,,617.6,percent of total billed charges,80% of total billed charges,627.25,65,,501.8,percent of total billed charges,65% of total billed charges,344.22,35.67,,275.376,percent of total billed charges,35.67% of total billed charges,279.85,868.5,
STAMMBERGER SINUFOAM,27010142,CDM,270,RC,,,outpatient,,,751,300.40,,638.35,85,,510.68,percent of total billed charges,85% of total billed charges,578.27,77,,462.62,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,615.82,82,,492.656,percent of total billed charges,82% of total billed charges,638.35,85,,510.68,percent of total billed charges,85% of total billed charges,638.35,85,,510.68,percent of total billed charges,85% of total billed charges,638.35,85,,510.68,percent of total billed charges,85% of total billed charges,675.9,90,,540.72,percent of total billed charges,90% of total billed charges,600.8,80,,480.64,percent of total billed charges,80% of total billed charges,675.9,90,,540.72,percent of total billed charges,90% of total billed charges,563.25,75,,450.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,217.79,29,,174.232,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,503.17,67,,402.536,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,600.8,80,,480.64,percent of total billed charges,80% of total billed charges,488.15,65,,390.52,percent of total billed charges,65% of total billed charges,267.88,35.67,,214.304,percent of total billed charges,35.67% of total billed charges,217.79,675.9,
WRIST TRACTON TOWER LOANER FEE,27010147,CDM,270,RC,,,outpatient,,,450,180.00,,382.5,85,,306,percent of total billed charges,85% of total billed charges,346.5,77,,277.2,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,369,82,,295.2,percent of total billed charges,82% of total billed charges,382.5,85,,306,percent of total billed charges,85% of total billed charges,382.5,85,,306,percent of total billed charges,85% of total billed charges,382.5,85,,306,percent of total billed charges,85% of total billed charges,405,90,,324,percent of total billed charges,90% of total billed charges,360,80,,288,percent of total billed charges,80% of total billed charges,405,90,,324,percent of total billed charges,90% of total billed charges,337.5,75,,270,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,130.5,29,,104.4,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,301.5,67,,241.2,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,360,80,,288,percent of total billed charges,80% of total billed charges,292.5,65,,234,percent of total billed charges,65% of total billed charges,160.52,35.67,,128.416,percent of total billed charges,35.67% of total billed charges,130.5,405,
STRYKER SHAVER 3.5MM,27010149,CDM,270,RC,,,outpatient,,,301,120.40,,255.85,85,,204.68,percent of total billed charges,85% of total billed charges,231.77,77,,185.42,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,246.82,82,,197.456,percent of total billed charges,82% of total billed charges,255.85,85,,204.68,percent of total billed charges,85% of total billed charges,255.85,85,,204.68,percent of total billed charges,85% of total billed charges,255.85,85,,204.68,percent of total billed charges,85% of total billed charges,270.9,90,,216.72,percent of total billed charges,90% of total billed charges,240.8,80,,192.64,percent of total billed charges,80% of total billed charges,270.9,90,,216.72,percent of total billed charges,90% of total billed charges,225.75,75,,180.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,87.29,29,,69.832,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,201.67,67,,161.336,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,240.8,80,,192.64,percent of total billed charges,80% of total billed charges,195.65,65,,156.52,percent of total billed charges,65% of total billed charges,107.37,35.67,,85.896,percent of total billed charges,35.67% of total billed charges,87.29,270.9,
BUR 3.0 MM SMALL JOINT,27010150,CDM,270,RC,,,outpatient,,,318,127.20,,270.3,85,,216.24,percent of total billed charges,85% of total billed charges,244.86,77,,195.89,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,260.76,82,,208.608,percent of total billed charges,82% of total billed charges,270.3,85,,216.24,percent of total billed charges,85% of total billed charges,270.3,85,,216.24,percent of total billed charges,85% of total billed charges,270.3,85,,216.24,percent of total billed charges,85% of total billed charges,286.2,90,,228.96,percent of total billed charges,90% of total billed charges,254.4,80,,203.52,percent of total billed charges,80% of total billed charges,286.2,90,,228.96,percent of total billed charges,90% of total billed charges,238.5,75,,190.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,92.22,29,,73.776,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,213.06,67,,170.448,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,254.4,80,,203.52,percent of total billed charges,80% of total billed charges,206.7,65,,165.36,percent of total billed charges,65% of total billed charges,113.43,35.67,,90.744,percent of total billed charges,35.67% of total billed charges,92.22,286.2,
WRIST TRACTION TOWER INSERT,27010157,CDM,270,RC,,,outpatient,,,245,98.00,,208.25,85,,166.6,percent of total billed charges,85% of total billed charges,188.65,77,,150.92,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,200.9,82,,160.72,percent of total billed charges,82% of total billed charges,208.25,85,,166.6,percent of total billed charges,85% of total billed charges,208.25,85,,166.6,percent of total billed charges,85% of total billed charges,208.25,85,,166.6,percent of total billed charges,85% of total billed charges,220.5,90,,176.4,percent of total billed charges,90% of total billed charges,196,80,,156.8,percent of total billed charges,80% of total billed charges,220.5,90,,176.4,percent of total billed charges,90% of total billed charges,183.75,75,,147,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,71.05,29,,56.84,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,164.15,67,,131.32,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,196,80,,156.8,percent of total billed charges,80% of total billed charges,159.25,65,,127.4,percent of total billed charges,65% of total billed charges,87.39,35.67,,69.912,percent of total billed charges,35.67% of total billed charges,71.05,220.5,
FINGER TRAP MED,27010158,CDM,270,RC,,,outpatient,,,254,101.60,,215.9,85,,172.72,percent of total billed charges,85% of total billed charges,195.58,77,,156.46,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,208.28,82,,166.624,percent of total billed charges,82% of total billed charges,215.9,85,,172.72,percent of total billed charges,85% of total billed charges,215.9,85,,172.72,percent of total billed charges,85% of total billed charges,215.9,85,,172.72,percent of total billed charges,85% of total billed charges,228.6,90,,182.88,percent of total billed charges,90% of total billed charges,203.2,80,,162.56,percent of total billed charges,80% of total billed charges,228.6,90,,182.88,percent of total billed charges,90% of total billed charges,190.5,75,,152.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,73.66,29,,58.928,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,170.18,67,,136.144,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,203.2,80,,162.56,percent of total billed charges,80% of total billed charges,165.1,65,,132.08,percent of total billed charges,65% of total billed charges,90.6,35.67,,72.48,percent of total billed charges,35.67% of total billed charges,73.66,228.6,
DEPTH GAUGE FOR 2.7 MM BIT,27010181,CDM,270,RC,,,outpatient,,,1737,694.80,,1476.45,85,,1181.16,percent of total billed charges,85% of total billed charges,1337.49,77,,1069.99,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,1424.34,82,,1139.472,percent of total billed charges,82% of total billed charges,1476.45,85,,1181.16,percent of total billed charges,85% of total billed charges,1476.45,85,,1181.16,percent of total billed charges,85% of total billed charges,1476.45,85,,1181.16,percent of total billed charges,85% of total billed charges,1563.3,90,,1250.64,percent of total billed charges,90% of total billed charges,1389.6,80,,1111.68,percent of total billed charges,80% of total billed charges,1563.3,90,,1250.64,percent of total billed charges,90% of total billed charges,1302.75,75,,1042.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,503.73,29,,402.984,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1163.79,67,,931.032,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1389.6,80,,1111.68,percent of total billed charges,80% of total billed charges,1129.05,65,,903.24,percent of total billed charges,65% of total billed charges,619.59,35.67,,495.672,percent of total billed charges,35.67% of total billed charges,503.73,1563.3,
CANULATED DRILL BIT 2.7MM,27010185,CDM,270,RC,,,outpatient,,,2258,903.20,,1919.3,85,,1535.44,percent of total billed charges,85% of total billed charges,1738.66,77,,1390.93,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,1851.56,82,,1481.248,percent of total billed charges,82% of total billed charges,1919.3,85,,1535.44,percent of total billed charges,85% of total billed charges,1919.3,85,,1535.44,percent of total billed charges,85% of total billed charges,1919.3,85,,1535.44,percent of total billed charges,85% of total billed charges,2032.2,90,,1625.76,percent of total billed charges,90% of total billed charges,1806.4,80,,1445.12,percent of total billed charges,80% of total billed charges,2032.2,90,,1625.76,percent of total billed charges,90% of total billed charges,1693.5,75,,1354.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,654.82,29,,523.856,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1512.86,67,,1210.288,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1806.4,80,,1445.12,percent of total billed charges,80% of total billed charges,1467.7,65,,1174.16,percent of total billed charges,65% of total billed charges,805.43,35.67,,644.344,percent of total billed charges,35.67% of total billed charges,654.82,2032.2,
NEEDLE EPIDURAL RK 166 89MM,27010221,CDM,270,RC,,,outpatient,,,177,70.80,,150.45,85,,120.36,percent of total billed charges,85% of total billed charges,136.29,77,,109.03,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,145.14,82,,116.112,percent of total billed charges,82% of total billed charges,150.45,85,,120.36,percent of total billed charges,85% of total billed charges,150.45,85,,120.36,percent of total billed charges,85% of total billed charges,150.45,85,,120.36,percent of total billed charges,85% of total billed charges,159.3,90,,127.44,percent of total billed charges,90% of total billed charges,141.6,80,,113.28,percent of total billed charges,80% of total billed charges,159.3,90,,127.44,percent of total billed charges,90% of total billed charges,132.75,75,,106.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,51.33,29,,41.064,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,118.59,67,,94.872,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,141.6,80,,113.28,percent of total billed charges,80% of total billed charges,115.05,65,,92.04,percent of total billed charges,65% of total billed charges,63.14,35.67,,50.512,percent of total billed charges,35.67% of total billed charges,51.33,159.3,
CATHETER 24 RADIO OPQ EPIDURAL,27010222,CDM,270,RC,,,outpatient,,,518,207.20,,440.3,85,,352.24,percent of total billed charges,85% of total billed charges,398.86,77,,319.09,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,424.76,82,,339.808,percent of total billed charges,82% of total billed charges,440.3,85,,352.24,percent of total billed charges,85% of total billed charges,440.3,85,,352.24,percent of total billed charges,85% of total billed charges,440.3,85,,352.24,percent of total billed charges,85% of total billed charges,466.2,90,,372.96,percent of total billed charges,90% of total billed charges,414.4,80,,331.52,percent of total billed charges,80% of total billed charges,466.2,90,,372.96,percent of total billed charges,90% of total billed charges,388.5,75,,310.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,150.22,29,,120.176,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,347.06,67,,277.648,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,414.4,80,,331.52,percent of total billed charges,80% of total billed charges,336.7,65,,269.36,percent of total billed charges,65% of total billed charges,184.77,35.67,,147.816,percent of total billed charges,35.67% of total billed charges,150.22,466.2,
ENDOMETRIAL CELL SAMPLER,27010223,CDM,270,RC,,,outpatient,,,64,25.60,,54.4,85,,43.52,percent of total billed charges,85% of total billed charges,49.28,77,,39.42,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,52.48,82,,41.984,percent of total billed charges,82% of total billed charges,54.4,85,,43.52,percent of total billed charges,85% of total billed charges,54.4,85,,43.52,percent of total billed charges,85% of total billed charges,54.4,85,,43.52,percent of total billed charges,85% of total billed charges,57.6,90,,46.08,percent of total billed charges,90% of total billed charges,51.2,80,,40.96,percent of total billed charges,80% of total billed charges,57.6,90,,46.08,percent of total billed charges,90% of total billed charges,48,75,,38.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,18.56,29,,14.848,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,42.88,67,,34.304,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,51.2,80,,40.96,percent of total billed charges,80% of total billed charges,41.6,65,,33.28,percent of total billed charges,65% of total billed charges,22.83,35.67,,18.264,percent of total billed charges,35.67% of total billed charges,18.56,57.6,
CANNULAE FOR 100 PROBE,27010242,CDM,270,RC,,,outpatient,,,218,87.20,,185.3,85,,148.24,percent of total billed charges,85% of total billed charges,167.86,77,,134.29,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,178.76,82,,143.008,percent of total billed charges,82% of total billed charges,185.3,85,,148.24,percent of total billed charges,85% of total billed charges,185.3,85,,148.24,percent of total billed charges,85% of total billed charges,185.3,85,,148.24,percent of total billed charges,85% of total billed charges,196.2,90,,156.96,percent of total billed charges,90% of total billed charges,174.4,80,,139.52,percent of total billed charges,80% of total billed charges,196.2,90,,156.96,percent of total billed charges,90% of total billed charges,163.5,75,,130.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,63.22,29,,50.576,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,146.06,67,,116.848,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,174.4,80,,139.52,percent of total billed charges,80% of total billed charges,141.7,65,,113.36,percent of total billed charges,65% of total billed charges,77.76,35.67,,62.208,percent of total billed charges,35.67% of total billed charges,63.22,196.2,
CANNULAE,27010243,CDM,270,RC,,,outpatient,,,218,87.20,,185.3,85,,148.24,percent of total billed charges,85% of total billed charges,167.86,77,,134.29,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,178.76,82,,143.008,percent of total billed charges,82% of total billed charges,185.3,85,,148.24,percent of total billed charges,85% of total billed charges,185.3,85,,148.24,percent of total billed charges,85% of total billed charges,185.3,85,,148.24,percent of total billed charges,85% of total billed charges,196.2,90,,156.96,percent of total billed charges,90% of total billed charges,174.4,80,,139.52,percent of total billed charges,80% of total billed charges,196.2,90,,156.96,percent of total billed charges,90% of total billed charges,163.5,75,,130.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,63.22,29,,50.576,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,146.06,67,,116.848,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,174.4,80,,139.52,percent of total billed charges,80% of total billed charges,141.7,65,,113.36,percent of total billed charges,65% of total billed charges,77.76,35.67,,62.208,percent of total billed charges,35.67% of total billed charges,63.22,196.2,
GROUNDING PADS,27010244,CDM,270,RC,,,outpatient,,,99,39.60,,84.15,85,,67.32,percent of total billed charges,85% of total billed charges,76.23,77,,60.98,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,81.18,82,,64.944,percent of total billed charges,82% of total billed charges,84.15,85,,67.32,percent of total billed charges,85% of total billed charges,84.15,85,,67.32,percent of total billed charges,85% of total billed charges,84.15,85,,67.32,percent of total billed charges,85% of total billed charges,89.1,90,,71.28,percent of total billed charges,90% of total billed charges,79.2,80,,63.36,percent of total billed charges,80% of total billed charges,89.1,90,,71.28,percent of total billed charges,90% of total billed charges,74.25,75,,59.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,28.71,29,,22.968,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,66.33,67,,53.064,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,79.2,80,,63.36,percent of total billed charges,80% of total billed charges,64.35,65,,51.48,percent of total billed charges,65% of total billed charges,35.31,35.67,,28.248,percent of total billed charges,35.67% of total billed charges,28.71,89.1,
FLUID TRANSFER EZ CONNECT,27010257,CDM,270,RC,,,outpatient,,,56,22.40,,47.6,85,,38.08,percent of total billed charges,85% of total billed charges,43.12,77,,34.5,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,45.92,82,,36.736,percent of total billed charges,82% of total billed charges,47.6,85,,38.08,percent of total billed charges,85% of total billed charges,47.6,85,,38.08,percent of total billed charges,85% of total billed charges,47.6,85,,38.08,percent of total billed charges,85% of total billed charges,50.4,90,,40.32,percent of total billed charges,90% of total billed charges,44.8,80,,35.84,percent of total billed charges,80% of total billed charges,50.4,90,,40.32,percent of total billed charges,90% of total billed charges,42,75,,33.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,16.24,29,,12.992,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,37.52,67,,30.016,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,44.8,80,,35.84,percent of total billed charges,80% of total billed charges,36.4,65,,29.12,percent of total billed charges,65% of total billed charges,19.98,35.67,,15.984,percent of total billed charges,35.67% of total billed charges,16.24,50.4,
CANNULA BUTTON PASSPORT,27010274,CDM,270,RC,,,outpatient,,,312,124.80,,265.2,85,,212.16,percent of total billed charges,85% of total billed charges,240.24,77,,192.19,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,255.84,82,,204.672,percent of total billed charges,82% of total billed charges,265.2,85,,212.16,percent of total billed charges,85% of total billed charges,265.2,85,,212.16,percent of total billed charges,85% of total billed charges,265.2,85,,212.16,percent of total billed charges,85% of total billed charges,280.8,90,,224.64,percent of total billed charges,90% of total billed charges,249.6,80,,199.68,percent of total billed charges,80% of total billed charges,280.8,90,,224.64,percent of total billed charges,90% of total billed charges,234,75,,187.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,90.48,29,,72.384,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,209.04,67,,167.232,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,249.6,80,,199.68,percent of total billed charges,80% of total billed charges,202.8,65,,162.24,percent of total billed charges,65% of total billed charges,111.29,35.67,,89.032,percent of total billed charges,35.67% of total billed charges,90.48,280.8,
NEEDLE SCORPION MULTIFIRE,27010275,CDM,270,RC,,,outpatient,,,1088,435.20,,924.8,85,,739.84,percent of total billed charges,85% of total billed charges,837.76,77,,670.21,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,892.16,82,,713.728,percent of total billed charges,82% of total billed charges,924.8,85,,739.84,percent of total billed charges,85% of total billed charges,924.8,85,,739.84,percent of total billed charges,85% of total billed charges,924.8,85,,739.84,percent of total billed charges,85% of total billed charges,979.2,90,,783.36,percent of total billed charges,90% of total billed charges,870.4,80,,696.32,percent of total billed charges,80% of total billed charges,979.2,90,,783.36,percent of total billed charges,90% of total billed charges,816,75,,652.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,315.52,29,,252.416,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,728.96,67,,583.168,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,870.4,80,,696.32,percent of total billed charges,80% of total billed charges,707.2,65,,565.76,percent of total billed charges,65% of total billed charges,388.09,35.67,,310.472,percent of total billed charges,35.67% of total billed charges,315.52,979.2,
EZ IO NEEDLE INTASSEOUS BRTC,27010302,CDM,270,RC,,,outpatient,,,646,258.40,,549.1,85,,439.28,percent of total billed charges,85% of total billed charges,497.42,77,,397.94,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,529.72,82,,423.776,percent of total billed charges,82% of total billed charges,549.1,85,,439.28,percent of total billed charges,85% of total billed charges,549.1,85,,439.28,percent of total billed charges,85% of total billed charges,549.1,85,,439.28,percent of total billed charges,85% of total billed charges,581.4,90,,465.12,percent of total billed charges,90% of total billed charges,516.8,80,,413.44,percent of total billed charges,80% of total billed charges,581.4,90,,465.12,percent of total billed charges,90% of total billed charges,484.5,75,,387.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,187.34,29,,149.872,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,432.82,67,,346.256,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,516.8,80,,413.44,percent of total billed charges,80% of total billed charges,419.9,65,,335.92,percent of total billed charges,65% of total billed charges,230.43,35.67,,184.344,percent of total billed charges,35.67% of total billed charges,187.34,581.4,
WAND PLASMA EVAC 70,27010413,CDM,270,RC,,,outpatient,,,1053,421.20,,895.05,85,,716.04,percent of total billed charges,85% of total billed charges,810.81,77,,648.65,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,863.46,82,,690.768,percent of total billed charges,82% of total billed charges,895.05,85,,716.04,percent of total billed charges,85% of total billed charges,895.05,85,,716.04,percent of total billed charges,85% of total billed charges,895.05,85,,716.04,percent of total billed charges,85% of total billed charges,947.7,90,,758.16,percent of total billed charges,90% of total billed charges,842.4,80,,673.92,percent of total billed charges,80% of total billed charges,947.7,90,,758.16,percent of total billed charges,90% of total billed charges,789.75,75,,631.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,305.37,29,,244.296,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,705.51,67,,564.408,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,842.4,80,,673.92,percent of total billed charges,80% of total billed charges,684.45,65,,547.56,percent of total billed charges,65% of total billed charges,375.61,35.67,,300.488,percent of total billed charges,35.67% of total billed charges,305.37,947.7,
CATHETER RED RUBBER 10FR RED,27010460,CDM,270,RC,,,outpatient,,,21,8.40,,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,16.17,77,,12.94,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,17.22,82,,13.776,percent of total billed charges,82% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,18.9,90,,15.12,percent of total billed charges,90% of total billed charges,16.8,80,,13.44,percent of total billed charges,80% of total billed charges,18.9,90,,15.12,percent of total billed charges,90% of total billed charges,15.75,75,,12.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,6.09,29,,4.872,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,14.07,67,,11.256,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,16.8,80,,13.44,percent of total billed charges,80% of total billed charges,13.65,65,,10.92,percent of total billed charges,65% of total billed charges,7.49,35.67,,5.992,percent of total billed charges,35.67% of total billed charges,6.09,18.9,
ABLATION HAND PIENCE NOVASURE,27010473,CDM,270,RC,,,outpatient,,,4094,1637.60,,3479.9,85,,2783.92,percent of total billed charges,85% of total billed charges,3152.38,77,,2521.9,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,3357.08,82,,2685.664,percent of total billed charges,82% of total billed charges,3479.9,85,,2783.92,percent of total billed charges,85% of total billed charges,3479.9,85,,2783.92,percent of total billed charges,85% of total billed charges,3479.9,85,,2783.92,percent of total billed charges,85% of total billed charges,3684.6,90,,2947.68,percent of total billed charges,90% of total billed charges,3275.2,80,,2620.16,percent of total billed charges,80% of total billed charges,3684.6,90,,2947.68,percent of total billed charges,90% of total billed charges,3070.5,75,,2456.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,1187.26,29,,949.808,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,2742.98,67,,2194.384,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,3275.2,80,,2620.16,percent of total billed charges,80% of total billed charges,2661.1,65,,2128.88,percent of total billed charges,65% of total billed charges,1460.33,35.67,,1168.264,percent of total billed charges,35.67% of total billed charges,1187.26,3684.6,
FIBERTAPE,27010496,CDM,270,RC,,,outpatient,,,363,145.20,,308.55,85,,246.84,percent of total billed charges,85% of total billed charges,279.51,77,,223.61,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,297.66,82,,238.128,percent of total billed charges,82% of total billed charges,308.55,85,,246.84,percent of total billed charges,85% of total billed charges,308.55,85,,246.84,percent of total billed charges,85% of total billed charges,308.55,85,,246.84,percent of total billed charges,85% of total billed charges,326.7,90,,261.36,percent of total billed charges,90% of total billed charges,290.4,80,,232.32,percent of total billed charges,80% of total billed charges,326.7,90,,261.36,percent of total billed charges,90% of total billed charges,272.25,75,,217.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,105.27,29,,84.216,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,243.21,67,,194.568,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,290.4,80,,232.32,percent of total billed charges,80% of total billed charges,235.95,65,,188.76,percent of total billed charges,65% of total billed charges,129.48,35.67,,103.584,percent of total billed charges,35.67% of total billed charges,105.27,326.7,
TIGERTAPE,27010497,CDM,270,RC,,,outpatient,,,363,145.20,,308.55,85,,246.84,percent of total billed charges,85% of total billed charges,279.51,77,,223.61,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,297.66,82,,238.128,percent of total billed charges,82% of total billed charges,308.55,85,,246.84,percent of total billed charges,85% of total billed charges,308.55,85,,246.84,percent of total billed charges,85% of total billed charges,308.55,85,,246.84,percent of total billed charges,85% of total billed charges,326.7,90,,261.36,percent of total billed charges,90% of total billed charges,290.4,80,,232.32,percent of total billed charges,80% of total billed charges,326.7,90,,261.36,percent of total billed charges,90% of total billed charges,272.25,75,,217.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,105.27,29,,84.216,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,243.21,67,,194.568,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,290.4,80,,232.32,percent of total billed charges,80% of total billed charges,235.95,65,,188.76,percent of total billed charges,65% of total billed charges,129.48,35.67,,103.584,percent of total billed charges,35.67% of total billed charges,105.27,326.7,
URETHERAL CATHETER,27010549,CDM,270,RC,,,outpatient,,,21,8.40,,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,16.17,77,,12.94,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,17.22,82,,13.776,percent of total billed charges,82% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,18.9,90,,15.12,percent of total billed charges,90% of total billed charges,16.8,80,,13.44,percent of total billed charges,80% of total billed charges,18.9,90,,15.12,percent of total billed charges,90% of total billed charges,15.75,75,,12.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,6.09,29,,4.872,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,14.07,67,,11.256,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,16.8,80,,13.44,percent of total billed charges,80% of total billed charges,13.65,65,,10.92,percent of total billed charges,65% of total billed charges,7.49,35.67,,5.992,percent of total billed charges,35.67% of total billed charges,6.09,18.9,
SPINAL NEEDLE 20G X 6,27010559,CDM,270,RC,,,outpatient,,,77,30.80,,65.45,85,,52.36,percent of total billed charges,85% of total billed charges,59.29,77,,47.43,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,63.14,82,,50.512,percent of total billed charges,82% of total billed charges,65.45,85,,52.36,percent of total billed charges,85% of total billed charges,65.45,85,,52.36,percent of total billed charges,85% of total billed charges,65.45,85,,52.36,percent of total billed charges,85% of total billed charges,69.3,90,,55.44,percent of total billed charges,90% of total billed charges,61.6,80,,49.28,percent of total billed charges,80% of total billed charges,69.3,90,,55.44,percent of total billed charges,90% of total billed charges,57.75,75,,46.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,22.33,29,,17.864,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,51.59,67,,41.272,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,61.6,80,,49.28,percent of total billed charges,80% of total billed charges,50.05,65,,40.04,percent of total billed charges,65% of total billed charges,27.47,35.67,,21.976,percent of total billed charges,35.67% of total billed charges,22.33,69.3,
SPINAL NEEDLE 25G X 8,27010584,CDM,270,RC,,,outpatient,,,102,40.80,,86.7,85,,69.36,percent of total billed charges,85% of total billed charges,78.54,77,,62.83,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,83.64,82,,66.912,percent of total billed charges,82% of total billed charges,86.7,85,,69.36,percent of total billed charges,85% of total billed charges,86.7,85,,69.36,percent of total billed charges,85% of total billed charges,86.7,85,,69.36,percent of total billed charges,85% of total billed charges,91.8,90,,73.44,percent of total billed charges,90% of total billed charges,81.6,80,,65.28,percent of total billed charges,80% of total billed charges,91.8,90,,73.44,percent of total billed charges,90% of total billed charges,76.5,75,,61.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,29.58,29,,23.664,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,68.34,67,,54.672,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,81.6,80,,65.28,percent of total billed charges,80% of total billed charges,66.3,65,,53.04,percent of total billed charges,65% of total billed charges,36.38,35.67,,29.104,percent of total billed charges,35.67% of total billed charges,29.58,91.8,
BLADE,27010609,CDM,270,RC,,,outpatient,,,737,294.80,,626.45,85,,501.16,percent of total billed charges,85% of total billed charges,567.49,77,,453.99,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,604.34,82,,483.472,percent of total billed charges,82% of total billed charges,626.45,85,,501.16,percent of total billed charges,85% of total billed charges,626.45,85,,501.16,percent of total billed charges,85% of total billed charges,626.45,85,,501.16,percent of total billed charges,85% of total billed charges,663.3,90,,530.64,percent of total billed charges,90% of total billed charges,589.6,80,,471.68,percent of total billed charges,80% of total billed charges,663.3,90,,530.64,percent of total billed charges,90% of total billed charges,552.75,75,,442.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,213.73,29,,170.984,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,493.79,67,,395.032,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,589.6,80,,471.68,percent of total billed charges,80% of total billed charges,479.05,65,,383.24,percent of total billed charges,65% of total billed charges,262.89,35.67,,210.312,percent of total billed charges,35.67% of total billed charges,213.73,663.3,
RENTAL PASS THRU,27010610,CDM,270,RC,,,outpatient,,,561,224.40,,476.85,85,,381.48,percent of total billed charges,85% of total billed charges,431.97,77,,345.58,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,460.02,82,,368.016,percent of total billed charges,82% of total billed charges,476.85,85,,381.48,percent of total billed charges,85% of total billed charges,476.85,85,,381.48,percent of total billed charges,85% of total billed charges,476.85,85,,381.48,percent of total billed charges,85% of total billed charges,504.9,90,,403.92,percent of total billed charges,90% of total billed charges,448.8,80,,359.04,percent of total billed charges,80% of total billed charges,504.9,90,,403.92,percent of total billed charges,90% of total billed charges,420.75,75,,336.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,162.69,29,,130.152,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,375.87,67,,300.696,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,448.8,80,,359.04,percent of total billed charges,80% of total billed charges,364.65,65,,291.72,percent of total billed charges,65% of total billed charges,200.11,35.67,,160.088,percent of total billed charges,35.67% of total billed charges,162.69,504.9,
URETHRAL S CURVE DILATOR SET,27010628,CDM,270,RC,,,outpatient,,,1016,406.40,,863.6,85,,690.88,percent of total billed charges,85% of total billed charges,782.32,77,,625.86,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,833.12,82,,666.496,percent of total billed charges,82% of total billed charges,863.6,85,,690.88,percent of total billed charges,85% of total billed charges,863.6,85,,690.88,percent of total billed charges,85% of total billed charges,863.6,85,,690.88,percent of total billed charges,85% of total billed charges,914.4,90,,731.52,percent of total billed charges,90% of total billed charges,812.8,80,,650.24,percent of total billed charges,80% of total billed charges,914.4,90,,731.52,percent of total billed charges,90% of total billed charges,762,75,,609.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,294.64,29,,235.712,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,680.72,67,,544.576,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,812.8,80,,650.24,percent of total billed charges,80% of total billed charges,660.4,65,,528.32,percent of total billed charges,65% of total billed charges,362.41,35.67,,289.928,percent of total billed charges,35.67% of total billed charges,294.64,914.4,
MEDTRONIC DUAL ACCESSORY KIT,27010629,CDM,270,RC,,,outpatient,,,617,246.80,,524.45,85,,419.56,percent of total billed charges,85% of total billed charges,475.09,77,,380.07,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,505.94,82,,404.752,percent of total billed charges,82% of total billed charges,524.45,85,,419.56,percent of total billed charges,85% of total billed charges,524.45,85,,419.56,percent of total billed charges,85% of total billed charges,524.45,85,,419.56,percent of total billed charges,85% of total billed charges,555.3,90,,444.24,percent of total billed charges,90% of total billed charges,493.6,80,,394.88,percent of total billed charges,80% of total billed charges,555.3,90,,444.24,percent of total billed charges,90% of total billed charges,462.75,75,,370.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,178.93,29,,143.144,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,413.39,67,,330.712,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,493.6,80,,394.88,percent of total billed charges,80% of total billed charges,401.05,65,,320.84,percent of total billed charges,65% of total billed charges,220.08,35.67,,176.064,percent of total billed charges,35.67% of total billed charges,178.93,555.3,
PROLENE SUTURE 5-0 36 8580H,27010633,CDM,270,RC,,,outpatient,,,77,30.80,,65.45,85,,52.36,percent of total billed charges,85% of total billed charges,59.29,77,,47.43,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,63.14,82,,50.512,percent of total billed charges,82% of total billed charges,65.45,85,,52.36,percent of total billed charges,85% of total billed charges,65.45,85,,52.36,percent of total billed charges,85% of total billed charges,65.45,85,,52.36,percent of total billed charges,85% of total billed charges,69.3,90,,55.44,percent of total billed charges,90% of total billed charges,61.6,80,,49.28,percent of total billed charges,80% of total billed charges,69.3,90,,55.44,percent of total billed charges,90% of total billed charges,57.75,75,,46.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,22.33,29,,17.864,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,51.59,67,,41.272,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,61.6,80,,49.28,percent of total billed charges,80% of total billed charges,50.05,65,,40.04,percent of total billed charges,65% of total billed charges,27.47,35.67,,21.976,percent of total billed charges,35.67% of total billed charges,22.33,69.3,
ORTHOCARD DBL,27010635,CDM,270,RC,,,outpatient,,,296,118.40,,251.6,85,,201.28,percent of total billed charges,85% of total billed charges,227.92,77,,182.34,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,242.72,82,,194.176,percent of total billed charges,82% of total billed charges,251.6,85,,201.28,percent of total billed charges,85% of total billed charges,251.6,85,,201.28,percent of total billed charges,85% of total billed charges,251.6,85,,201.28,percent of total billed charges,85% of total billed charges,266.4,90,,213.12,percent of total billed charges,90% of total billed charges,236.8,80,,189.44,percent of total billed charges,80% of total billed charges,266.4,90,,213.12,percent of total billed charges,90% of total billed charges,222,75,,177.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,85.84,29,,68.672,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,198.32,67,,158.656,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,236.8,80,,189.44,percent of total billed charges,80% of total billed charges,192.4,65,,153.92,percent of total billed charges,65% of total billed charges,105.58,35.67,,84.464,percent of total billed charges,35.67% of total billed charges,85.84,266.4,
BOWL WITH SPATULA,27010644,CDM,270,RC,,,outpatient,,,226,90.40,,192.1,85,,153.68,percent of total billed charges,85% of total billed charges,174.02,77,,139.22,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,185.32,82,,148.256,percent of total billed charges,82% of total billed charges,192.1,85,,153.68,percent of total billed charges,85% of total billed charges,192.1,85,,153.68,percent of total billed charges,85% of total billed charges,192.1,85,,153.68,percent of total billed charges,85% of total billed charges,203.4,90,,162.72,percent of total billed charges,90% of total billed charges,180.8,80,,144.64,percent of total billed charges,80% of total billed charges,203.4,90,,162.72,percent of total billed charges,90% of total billed charges,169.5,75,,135.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,65.54,29,,52.432,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,151.42,67,,121.136,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,180.8,80,,144.64,percent of total billed charges,80% of total billed charges,146.9,65,,117.52,percent of total billed charges,65% of total billed charges,80.61,35.67,,64.488,percent of total billed charges,35.67% of total billed charges,65.54,203.4,
HI TEMP CAUTERY CORDLESS STERL,27010658,CDM,270,RC,,,outpatient,,,103,41.20,,87.55,85,,70.04,percent of total billed charges,85% of total billed charges,79.31,77,,63.45,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,84.46,82,,67.568,percent of total billed charges,82% of total billed charges,87.55,85,,70.04,percent of total billed charges,85% of total billed charges,87.55,85,,70.04,percent of total billed charges,85% of total billed charges,87.55,85,,70.04,percent of total billed charges,85% of total billed charges,92.7,90,,74.16,percent of total billed charges,90% of total billed charges,82.4,80,,65.92,percent of total billed charges,80% of total billed charges,92.7,90,,74.16,percent of total billed charges,90% of total billed charges,77.25,75,,61.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,29.87,29,,23.896,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,69.01,67,,55.208,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,82.4,80,,65.92,percent of total billed charges,80% of total billed charges,66.95,65,,53.56,percent of total billed charges,65% of total billed charges,36.74,35.67,,29.392,percent of total billed charges,35.67% of total billed charges,29.87,92.7,
STENT RETRIEVER 4.5FR X 65CM,27010675,CDM,270,RC,,,outpatient,,,285,114.00,,242.25,85,,193.8,percent of total billed charges,85% of total billed charges,219.45,77,,175.56,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,233.7,82,,186.96,percent of total billed charges,82% of total billed charges,242.25,85,,193.8,percent of total billed charges,85% of total billed charges,242.25,85,,193.8,percent of total billed charges,85% of total billed charges,242.25,85,,193.8,percent of total billed charges,85% of total billed charges,256.5,90,,205.2,percent of total billed charges,90% of total billed charges,228,80,,182.4,percent of total billed charges,80% of total billed charges,256.5,90,,205.2,percent of total billed charges,90% of total billed charges,213.75,75,,171,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,82.65,29,,66.12,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,190.95,67,,152.76,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,228,80,,182.4,percent of total billed charges,80% of total billed charges,185.25,65,,148.2,percent of total billed charges,65% of total billed charges,101.66,35.67,,81.328,percent of total billed charges,35.67% of total billed charges,82.65,256.5,
CANNJULATED DRILL 3.5,27010683,CDM,270,RC,,,outpatient,,,2001,800.40,,1700.85,85,,1360.68,percent of total billed charges,85% of total billed charges,1540.77,77,,1232.62,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,1640.82,82,,1312.656,percent of total billed charges,82% of total billed charges,1700.85,85,,1360.68,percent of total billed charges,85% of total billed charges,1700.85,85,,1360.68,percent of total billed charges,85% of total billed charges,1700.85,85,,1360.68,percent of total billed charges,85% of total billed charges,1800.9,90,,1440.72,percent of total billed charges,90% of total billed charges,1600.8,80,,1280.64,percent of total billed charges,80% of total billed charges,1800.9,90,,1440.72,percent of total billed charges,90% of total billed charges,1500.75,75,,1200.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,580.29,29,,464.232,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1340.67,67,,1072.536,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1600.8,80,,1280.64,percent of total billed charges,80% of total billed charges,1300.65,65,,1040.52,percent of total billed charges,65% of total billed charges,713.76,35.67,,571.008,percent of total billed charges,35.67% of total billed charges,580.29,1800.9,
HUBER NEEDLE,27010706,CDM,270,RC,,,outpatient,,,61,24.40,,51.85,85,,41.48,percent of total billed charges,85% of total billed charges,46.97,77,,37.58,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,50.02,82,,40.016,percent of total billed charges,82% of total billed charges,51.85,85,,41.48,percent of total billed charges,85% of total billed charges,51.85,85,,41.48,percent of total billed charges,85% of total billed charges,51.85,85,,41.48,percent of total billed charges,85% of total billed charges,54.9,90,,43.92,percent of total billed charges,90% of total billed charges,48.8,80,,39.04,percent of total billed charges,80% of total billed charges,54.9,90,,43.92,percent of total billed charges,90% of total billed charges,45.75,75,,36.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,17.69,29,,14.152,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,40.87,67,,32.696,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,48.8,80,,39.04,percent of total billed charges,80% of total billed charges,39.65,65,,31.72,percent of total billed charges,65% of total billed charges,21.76,35.67,,17.408,percent of total billed charges,35.67% of total billed charges,17.69,54.9,
OMNISPAN DEP GUN,27010818,CDM,270,RC,,,outpatient,,,931,372.40,,791.35,85,,633.08,percent of total billed charges,85% of total billed charges,716.87,77,,573.5,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,763.42,82,,610.736,percent of total billed charges,82% of total billed charges,791.35,85,,633.08,percent of total billed charges,85% of total billed charges,791.35,85,,633.08,percent of total billed charges,85% of total billed charges,791.35,85,,633.08,percent of total billed charges,85% of total billed charges,837.9,90,,670.32,percent of total billed charges,90% of total billed charges,744.8,80,,595.84,percent of total billed charges,80% of total billed charges,837.9,90,,670.32,percent of total billed charges,90% of total billed charges,698.25,75,,558.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,269.99,29,,215.992,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,623.77,67,,499.016,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,744.8,80,,595.84,percent of total billed charges,80% of total billed charges,605.15,65,,484.12,percent of total billed charges,65% of total billed charges,332.09,35.67,,265.672,percent of total billed charges,35.67% of total billed charges,269.99,837.9,
OMINS NEEDLE 12 DEGREE,27010819,CDM,270,RC,,,outpatient,,,1478,591.20,,1256.3,85,,1005.04,percent of total billed charges,85% of total billed charges,1138.06,77,,910.45,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,1211.96,82,,969.568,percent of total billed charges,82% of total billed charges,1256.3,85,,1005.04,percent of total billed charges,85% of total billed charges,1256.3,85,,1005.04,percent of total billed charges,85% of total billed charges,1256.3,85,,1005.04,percent of total billed charges,85% of total billed charges,1330.2,90,,1064.16,percent of total billed charges,90% of total billed charges,1182.4,80,,945.92,percent of total billed charges,80% of total billed charges,1330.2,90,,1064.16,percent of total billed charges,90% of total billed charges,1108.5,75,,886.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,428.62,29,,342.896,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,990.26,67,,792.208,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1182.4,80,,945.92,percent of total billed charges,80% of total billed charges,960.7,65,,768.56,percent of total billed charges,65% of total billed charges,527.2,35.67,,421.76,percent of total billed charges,35.67% of total billed charges,428.62,1330.2,
ACCESSORY KIT 355531,27010835,CDM,270,RC,,,outpatient,,,897,358.80,,762.45,85,,609.96,percent of total billed charges,85% of total billed charges,690.69,77,,552.55,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,735.54,82,,588.432,percent of total billed charges,82% of total billed charges,762.45,85,,609.96,percent of total billed charges,85% of total billed charges,762.45,85,,609.96,percent of total billed charges,85% of total billed charges,762.45,85,,609.96,percent of total billed charges,85% of total billed charges,807.3,90,,645.84,percent of total billed charges,90% of total billed charges,717.6,80,,574.08,percent of total billed charges,80% of total billed charges,807.3,90,,645.84,percent of total billed charges,90% of total billed charges,672.75,75,,538.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,260.13,29,,208.104,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,600.99,67,,480.792,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,717.6,80,,574.08,percent of total billed charges,80% of total billed charges,583.05,65,,466.44,percent of total billed charges,65% of total billed charges,319.96,35.67,,255.968,percent of total billed charges,35.67% of total billed charges,260.13,807.3,
PATIENT PROGRAMMER 37746,27010836,CDM,270,RC,,,outpatient,,,3673,1469.20,,3122.05,85,,2497.64,percent of total billed charges,85% of total billed charges,2828.21,77,,2262.57,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,3011.86,82,,2409.488,percent of total billed charges,82% of total billed charges,3122.05,85,,2497.64,percent of total billed charges,85% of total billed charges,3122.05,85,,2497.64,percent of total billed charges,85% of total billed charges,3122.05,85,,2497.64,percent of total billed charges,85% of total billed charges,3305.7,90,,2644.56,percent of total billed charges,90% of total billed charges,2938.4,80,,2350.72,percent of total billed charges,80% of total billed charges,3305.7,90,,2644.56,percent of total billed charges,90% of total billed charges,2754.75,75,,2203.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,1065.17,29,,852.136,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,2460.91,67,,1968.728,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,2938.4,80,,2350.72,percent of total billed charges,80% of total billed charges,2387.45,65,,1909.96,percent of total billed charges,65% of total billed charges,1310.16,35.67,,1048.128,percent of total billed charges,35.67% of total billed charges,1065.17,3305.7,
CONNECTOR DRAINAGE BAG,27010840,CDM,270,RC,,,outpatient,,,87,34.80,,73.95,85,,59.16,percent of total billed charges,85% of total billed charges,66.99,77,,53.59,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,71.34,82,,57.072,percent of total billed charges,82% of total billed charges,73.95,85,,59.16,percent of total billed charges,85% of total billed charges,73.95,85,,59.16,percent of total billed charges,85% of total billed charges,73.95,85,,59.16,percent of total billed charges,85% of total billed charges,78.3,90,,62.64,percent of total billed charges,90% of total billed charges,69.6,80,,55.68,percent of total billed charges,80% of total billed charges,78.3,90,,62.64,percent of total billed charges,90% of total billed charges,65.25,75,,52.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,25.23,29,,20.184,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,58.29,67,,46.632,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,69.6,80,,55.68,percent of total billed charges,80% of total billed charges,56.55,65,,45.24,percent of total billed charges,65% of total billed charges,31.03,35.67,,24.824,percent of total billed charges,35.67% of total billed charges,25.23,78.3,
GRAFT BOARD-USAGE FEE,27010847,CDM,270,RC,,,outpatient,,,1120,448.00,,952,85,,761.6,percent of total billed charges,85% of total billed charges,862.4,77,,689.92,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,918.4,82,,734.72,percent of total billed charges,82% of total billed charges,952,85,,761.6,percent of total billed charges,85% of total billed charges,952,85,,761.6,percent of total billed charges,85% of total billed charges,952,85,,761.6,percent of total billed charges,85% of total billed charges,1008,90,,806.4,percent of total billed charges,90% of total billed charges,896,80,,716.8,percent of total billed charges,80% of total billed charges,1008,90,,806.4,percent of total billed charges,90% of total billed charges,840,75,,672,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,324.8,29,,259.84,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,750.4,67,,600.32,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,896,80,,716.8,percent of total billed charges,80% of total billed charges,728,65,,582.4,percent of total billed charges,65% of total billed charges,399.5,35.67,,319.6,percent of total billed charges,35.67% of total billed charges,324.8,1008,
MULTIFIRE SCORPION NEEDLE,27010864,CDM,270,RC,,,outpatient,,,1088,435.20,,924.8,85,,739.84,percent of total billed charges,85% of total billed charges,837.76,77,,670.21,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,892.16,82,,713.728,percent of total billed charges,82% of total billed charges,924.8,85,,739.84,percent of total billed charges,85% of total billed charges,924.8,85,,739.84,percent of total billed charges,85% of total billed charges,924.8,85,,739.84,percent of total billed charges,85% of total billed charges,979.2,90,,783.36,percent of total billed charges,90% of total billed charges,870.4,80,,696.32,percent of total billed charges,80% of total billed charges,979.2,90,,783.36,percent of total billed charges,90% of total billed charges,816,75,,652.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,315.52,29,,252.416,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,728.96,67,,583.168,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,870.4,80,,696.32,percent of total billed charges,80% of total billed charges,707.2,65,,565.76,percent of total billed charges,65% of total billed charges,388.09,35.67,,310.472,percent of total billed charges,35.67% of total billed charges,315.52,979.2,
HCS SHORT THREAD 3.0MM,27010954,CDM,270,RC,,,outpatient,,,2010,804.00,,1708.5,85,,1366.8,percent of total billed charges,85% of total billed charges,1547.7,77,,1238.16,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,1648.2,82,,1318.56,percent of total billed charges,82% of total billed charges,1708.5,85,,1366.8,percent of total billed charges,85% of total billed charges,1708.5,85,,1366.8,percent of total billed charges,85% of total billed charges,1708.5,85,,1366.8,percent of total billed charges,85% of total billed charges,1809,90,,1447.2,percent of total billed charges,90% of total billed charges,1608,80,,1286.4,percent of total billed charges,80% of total billed charges,1809,90,,1447.2,percent of total billed charges,90% of total billed charges,1507.5,75,,1206,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,582.9,29,,466.32,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1346.7,67,,1077.36,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1608,80,,1286.4,percent of total billed charges,80% of total billed charges,1306.5,65,,1045.2,percent of total billed charges,65% of total billed charges,716.97,35.67,,573.576,percent of total billed charges,35.67% of total billed charges,582.9,1809,
NEEDLE INJECTION PERI 20GX20,27010957,CDM,270,RC,,,outpatient,,,94,37.60,,79.9,85,,63.92,percent of total billed charges,85% of total billed charges,72.38,77,,57.9,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,77.08,82,,61.664,percent of total billed charges,82% of total billed charges,79.9,85,,63.92,percent of total billed charges,85% of total billed charges,79.9,85,,63.92,percent of total billed charges,85% of total billed charges,79.9,85,,63.92,percent of total billed charges,85% of total billed charges,84.6,90,,67.68,percent of total billed charges,90% of total billed charges,75.2,80,,60.16,percent of total billed charges,80% of total billed charges,84.6,90,,67.68,percent of total billed charges,90% of total billed charges,70.5,75,,56.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,27.26,29,,21.808,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,62.98,67,,50.384,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,75.2,80,,60.16,percent of total billed charges,80% of total billed charges,61.1,65,,48.88,percent of total billed charges,65% of total billed charges,33.53,35.67,,26.824,percent of total billed charges,35.67% of total billed charges,27.26,84.6,
FEMERAL STD INT FIX 8 X 8.5,27010969,CDM,270,RC,,,outpatient,,,1907,762.80,,1620.95,85,,1296.76,percent of total billed charges,85% of total billed charges,1468.39,77,,1174.71,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,1563.74,82,,1250.992,percent of total billed charges,82% of total billed charges,1620.95,85,,1296.76,percent of total billed charges,85% of total billed charges,1620.95,85,,1296.76,percent of total billed charges,85% of total billed charges,1620.95,85,,1296.76,percent of total billed charges,85% of total billed charges,1716.3,90,,1373.04,percent of total billed charges,90% of total billed charges,1525.6,80,,1220.48,percent of total billed charges,80% of total billed charges,1716.3,90,,1373.04,percent of total billed charges,90% of total billed charges,1430.25,75,,1144.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,553.03,29,,442.424,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1277.69,67,,1022.152,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1525.6,80,,1220.48,percent of total billed charges,80% of total billed charges,1239.55,65,,991.64,percent of total billed charges,65% of total billed charges,680.23,35.67,,544.184,percent of total billed charges,35.67% of total billed charges,553.03,1716.3,
VIO INTRAFIX 7-9 X 30,27010970,CDM,270,RC,,,outpatient,,,1244,497.60,,1057.4,85,,845.92,percent of total billed charges,85% of total billed charges,957.88,77,,766.3,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,1020.08,82,,816.064,percent of total billed charges,82% of total billed charges,1057.4,85,,845.92,percent of total billed charges,85% of total billed charges,1057.4,85,,845.92,percent of total billed charges,85% of total billed charges,1057.4,85,,845.92,percent of total billed charges,85% of total billed charges,1119.6,90,,895.68,percent of total billed charges,90% of total billed charges,995.2,80,,796.16,percent of total billed charges,80% of total billed charges,1119.6,90,,895.68,percent of total billed charges,90% of total billed charges,933,75,,746.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,360.76,29,,288.608,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,833.48,67,,666.784,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,995.2,80,,796.16,percent of total billed charges,80% of total billed charges,808.6,65,,646.88,percent of total billed charges,65% of total billed charges,443.73,35.67,,354.984,percent of total billed charges,35.67% of total billed charges,360.76,1119.6,
SKIN PROTECTANT CALAZIME,27010979,CDM,270,RC,,,outpatient,,,48,19.20,,40.8,85,,32.64,percent of total billed charges,85% of total billed charges,36.96,77,,29.57,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,39.36,82,,31.488,percent of total billed charges,82% of total billed charges,40.8,85,,32.64,percent of total billed charges,85% of total billed charges,40.8,85,,32.64,percent of total billed charges,85% of total billed charges,40.8,85,,32.64,percent of total billed charges,85% of total billed charges,43.2,90,,34.56,percent of total billed charges,90% of total billed charges,38.4,80,,30.72,percent of total billed charges,80% of total billed charges,43.2,90,,34.56,percent of total billed charges,90% of total billed charges,36,75,,28.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,13.92,29,,11.136,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,32.16,67,,25.728,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,38.4,80,,30.72,percent of total billed charges,80% of total billed charges,31.2,65,,24.96,percent of total billed charges,65% of total billed charges,17.12,35.67,,13.696,percent of total billed charges,35.67% of total billed charges,13.92,43.2,
ENDOCAVITY NEEDLE GUIDE STERIL,27011007,CDM,270,RC,,,outpatient,,,127,50.80,,107.95,85,,86.36,percent of total billed charges,85% of total billed charges,97.79,77,,78.23,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,104.14,82,,83.312,percent of total billed charges,82% of total billed charges,107.95,85,,86.36,percent of total billed charges,85% of total billed charges,107.95,85,,86.36,percent of total billed charges,85% of total billed charges,107.95,85,,86.36,percent of total billed charges,85% of total billed charges,114.3,90,,91.44,percent of total billed charges,90% of total billed charges,101.6,80,,81.28,percent of total billed charges,80% of total billed charges,114.3,90,,91.44,percent of total billed charges,90% of total billed charges,95.25,75,,76.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,36.83,29,,29.464,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,85.09,67,,68.072,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,101.6,80,,81.28,percent of total billed charges,80% of total billed charges,82.55,65,,66.04,percent of total billed charges,65% of total billed charges,45.3,35.67,,36.24,percent of total billed charges,35.67% of total billed charges,36.83,114.3,
COVER LATEX 3.5 X 20CM NON STL,27011008,CDM,270,RC,,,outpatient,,,10,4.00,,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,7.7,77,,6.16,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,8.2,82,,6.56,percent of total billed charges,82% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,9,90,,7.2,percent of total billed charges,90% of total billed charges,8,80,,6.4,percent of total billed charges,80% of total billed charges,9,90,,7.2,percent of total billed charges,90% of total billed charges,7.5,75,,6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.9,29,,2.32,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,6.7,67,,5.36,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,8,80,,6.4,percent of total billed charges,80% of total billed charges,6.5,65,,5.2,percent of total billed charges,65% of total billed charges,3.57,35.67,,2.856,percent of total billed charges,35.67% of total billed charges,2.9,9,
BUNDLE SEMI T GRACILLIS,27011016,CDM,270,RC,29888,HCPCS,outpatient,,,6577,2630.80,,1150,,,,case rate,pays based on per visit,5064.29,77,,4051.43,percent of total billed charges,77% of total billed charges,6256.43,100,,,fee schedule,100% of CMS OPPS rate,5393.14,82,,4314.512,percent of total billed charges,82% of total billed charges,5590.45,85,,4472.36,percent of total billed charges,85% of total billed charges,5590.45,85,,4472.36,percent of total billed charges,85% of total billed charges,5590.45,85,,4472.36,percent of total billed charges,85% of total billed charges,5919.3,90,,4735.44,percent of total billed charges,90% of total billed charges,5261.6,80,,4209.28,percent of total billed charges,80% of total billed charges,5919.3,90,,4735.44,percent of total billed charges,90% of total billed charges,4932.75,75,,3946.2,percent of total billed charges,75% of total billed charges,7632.85,122,,,fee schedule,122% of APC rate,3300.05,100,,,fee schedule,100% of ASC tier grouping rate,6256.43,100,,,fee schedule,100% of CMS OPPS rate,4406.59,67,,3525.272,percent of total billed charges,67% of total billed charges,5786.25,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,5261.6,80,,4209.28,percent of total billed charges,80% of total billed charges,4275.05,65,,3420.04,percent of total billed charges,65% of total billed charges,4059.06,123,,,fee schedule,123% of ASC tier grouping rate,1150,7632.85,
LEAVER GRAFT BOARD,27011017,CDM,270,RC,,,outpatient,,,897,358.80,,762.45,85,,609.96,percent of total billed charges,85% of total billed charges,690.69,77,,552.55,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,735.54,82,,588.432,percent of total billed charges,82% of total billed charges,762.45,85,,609.96,percent of total billed charges,85% of total billed charges,762.45,85,,609.96,percent of total billed charges,85% of total billed charges,762.45,85,,609.96,percent of total billed charges,85% of total billed charges,807.3,90,,645.84,percent of total billed charges,90% of total billed charges,717.6,80,,574.08,percent of total billed charges,80% of total billed charges,807.3,90,,645.84,percent of total billed charges,90% of total billed charges,672.75,75,,538.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,260.13,29,,208.104,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,600.99,67,,480.792,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,717.6,80,,574.08,percent of total billed charges,80% of total billed charges,583.05,65,,466.44,percent of total billed charges,65% of total billed charges,319.96,35.67,,255.968,percent of total billed charges,35.67% of total billed charges,260.13,807.3,
BIO TENODESIS LOANER SET,27011036,CDM,270,RC,,,outpatient,,,1120,448.00,,952,85,,761.6,percent of total billed charges,85% of total billed charges,862.4,77,,689.92,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,918.4,82,,734.72,percent of total billed charges,82% of total billed charges,952,85,,761.6,percent of total billed charges,85% of total billed charges,952,85,,761.6,percent of total billed charges,85% of total billed charges,952,85,,761.6,percent of total billed charges,85% of total billed charges,1008,90,,806.4,percent of total billed charges,90% of total billed charges,896,80,,716.8,percent of total billed charges,80% of total billed charges,1008,90,,806.4,percent of total billed charges,90% of total billed charges,840,75,,672,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,324.8,29,,259.84,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,750.4,67,,600.32,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,896,80,,716.8,percent of total billed charges,80% of total billed charges,728,65,,582.4,percent of total billed charges,65% of total billed charges,399.5,35.67,,319.6,percent of total billed charges,35.67% of total billed charges,324.8,1008,
TIGERSTICK,27011059,CDM,270,RC,,,outpatient,,,372,148.80,,316.2,85,,252.96,percent of total billed charges,85% of total billed charges,286.44,77,,229.15,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,305.04,82,,244.032,percent of total billed charges,82% of total billed charges,316.2,85,,252.96,percent of total billed charges,85% of total billed charges,316.2,85,,252.96,percent of total billed charges,85% of total billed charges,316.2,85,,252.96,percent of total billed charges,85% of total billed charges,334.8,90,,267.84,percent of total billed charges,90% of total billed charges,297.6,80,,238.08,percent of total billed charges,80% of total billed charges,334.8,90,,267.84,percent of total billed charges,90% of total billed charges,279,75,,223.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,107.88,29,,86.304,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,249.24,67,,199.392,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,297.6,80,,238.08,percent of total billed charges,80% of total billed charges,241.8,65,,193.44,percent of total billed charges,65% of total billed charges,132.69,35.67,,106.152,percent of total billed charges,35.67% of total billed charges,107.88,334.8,
MULITFIRE SCORPION NEEDLE,27011117,CDM,270,RC,,,outpatient,,,1156,462.40,,982.6,85,,786.08,percent of total billed charges,85% of total billed charges,890.12,77,,712.1,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,947.92,82,,758.336,percent of total billed charges,82% of total billed charges,982.6,85,,786.08,percent of total billed charges,85% of total billed charges,982.6,85,,786.08,percent of total billed charges,85% of total billed charges,982.6,85,,786.08,percent of total billed charges,85% of total billed charges,1040.4,90,,832.32,percent of total billed charges,90% of total billed charges,924.8,80,,739.84,percent of total billed charges,80% of total billed charges,1040.4,90,,832.32,percent of total billed charges,90% of total billed charges,867,75,,693.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,335.24,29,,268.192,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,774.52,67,,619.616,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,924.8,80,,739.84,percent of total billed charges,80% of total billed charges,751.4,65,,601.12,percent of total billed charges,65% of total billed charges,412.35,35.67,,329.88,percent of total billed charges,35.67% of total billed charges,335.24,1040.4,
COLLAGEN COATED FIBERTAPE,27011118,CDM,270,RC,,,outpatient,,,607,242.80,,515.95,85,,412.76,percent of total billed charges,85% of total billed charges,467.39,77,,373.91,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,497.74,82,,398.192,percent of total billed charges,82% of total billed charges,515.95,85,,412.76,percent of total billed charges,85% of total billed charges,515.95,85,,412.76,percent of total billed charges,85% of total billed charges,515.95,85,,412.76,percent of total billed charges,85% of total billed charges,546.3,90,,437.04,percent of total billed charges,90% of total billed charges,485.6,80,,388.48,percent of total billed charges,80% of total billed charges,546.3,90,,437.04,percent of total billed charges,90% of total billed charges,455.25,75,,364.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,176.03,29,,140.824,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,406.69,67,,325.352,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,485.6,80,,388.48,percent of total billed charges,80% of total billed charges,394.55,65,,315.64,percent of total billed charges,65% of total billed charges,216.52,35.67,,173.216,percent of total billed charges,35.67% of total billed charges,176.03,546.3,
"CATHETER,GOESHON FOR CATH KIT",2701112,CDM,270,RC,C1751,HCPCS,outpatient,,,322,128.80,,273.7,85,,218.96,percent of total billed charges,85% of total billed charges,247.94,77,,198.35,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,264.04,82,,211.232,percent of total billed charges,82% of total billed charges,273.7,85,,218.96,percent of total billed charges,85% of total billed charges,273.7,85,,218.96,percent of total billed charges,85% of total billed charges,273.7,85,,218.96,percent of total billed charges,85% of total billed charges,289.8,90,,231.84,percent of total billed charges,90% of total billed charges,257.6,80,,206.08,percent of total billed charges,80% of total billed charges,289.8,90,,231.84,percent of total billed charges,90% of total billed charges,241.5,75,,193.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,93.38,29,,74.704,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,215.74,67,,172.592,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,257.6,80,,206.08,percent of total billed charges,80% of total billed charges,209.3,65,,167.44,percent of total billed charges,65% of total billed charges,114.86,35.67,,91.888,percent of total billed charges,35.67% of total billed charges,93.38,289.8,
TUBE FLUROPLASTIC VENT 1.14MM,27011155,CDM,270,RC,,,outpatient,,,204,81.60,,173.4,85,,138.72,percent of total billed charges,85% of total billed charges,157.08,77,,125.66,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,167.28,82,,133.824,percent of total billed charges,82% of total billed charges,173.4,85,,138.72,percent of total billed charges,85% of total billed charges,173.4,85,,138.72,percent of total billed charges,85% of total billed charges,173.4,85,,138.72,percent of total billed charges,85% of total billed charges,183.6,90,,146.88,percent of total billed charges,90% of total billed charges,163.2,80,,130.56,percent of total billed charges,80% of total billed charges,183.6,90,,146.88,percent of total billed charges,90% of total billed charges,153,75,,122.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,59.16,29,,47.328,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,136.68,67,,109.344,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,163.2,80,,130.56,percent of total billed charges,80% of total billed charges,132.6,65,,106.08,percent of total billed charges,65% of total billed charges,72.77,35.67,,58.216,percent of total billed charges,35.67% of total billed charges,59.16,183.6,
OMINS NEEDLE 27 DEGREE,27011160,CDM,270,RC,,,outpatient,,,1478,591.20,,1256.3,85,,1005.04,percent of total billed charges,85% of total billed charges,1138.06,77,,910.45,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,1211.96,82,,969.568,percent of total billed charges,82% of total billed charges,1256.3,85,,1005.04,percent of total billed charges,85% of total billed charges,1256.3,85,,1005.04,percent of total billed charges,85% of total billed charges,1256.3,85,,1005.04,percent of total billed charges,85% of total billed charges,1330.2,90,,1064.16,percent of total billed charges,90% of total billed charges,1182.4,80,,945.92,percent of total billed charges,80% of total billed charges,1330.2,90,,1064.16,percent of total billed charges,90% of total billed charges,1108.5,75,,886.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,428.62,29,,342.896,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,990.26,67,,792.208,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1182.4,80,,945.92,percent of total billed charges,80% of total billed charges,960.7,65,,768.56,percent of total billed charges,65% of total billed charges,527.2,35.67,,421.76,percent of total billed charges,35.67% of total billed charges,428.62,1330.2,
EYE SHIELD ALUM WITH CLOTH,27011217,CDM,270,RC,,,outpatient,,,12,4.80,,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,9.24,77,,7.39,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,9.84,82,,7.872,percent of total billed charges,82% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,10.8,90,,8.64,percent of total billed charges,90% of total billed charges,9.6,80,,7.68,percent of total billed charges,80% of total billed charges,10.8,90,,8.64,percent of total billed charges,90% of total billed charges,9,75,,7.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,3.48,29,,2.784,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,8.04,67,,6.432,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,9.6,80,,7.68,percent of total billed charges,80% of total billed charges,7.8,65,,6.24,percent of total billed charges,65% of total billed charges,4.28,35.67,,3.424,percent of total billed charges,35.67% of total billed charges,3.48,10.8,
CANNULATED DRILL 4.9MM,27011275,CDM,270,RC,,,outpatient,,,2028,811.20,,1723.8,85,,1379.04,percent of total billed charges,85% of total billed charges,1561.56,77,,1249.25,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,1662.96,82,,1330.368,percent of total billed charges,82% of total billed charges,1723.8,85,,1379.04,percent of total billed charges,85% of total billed charges,1723.8,85,,1379.04,percent of total billed charges,85% of total billed charges,1723.8,85,,1379.04,percent of total billed charges,85% of total billed charges,1825.2,90,,1460.16,percent of total billed charges,90% of total billed charges,1622.4,80,,1297.92,percent of total billed charges,80% of total billed charges,1825.2,90,,1460.16,percent of total billed charges,90% of total billed charges,1521,75,,1216.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,588.12,29,,470.496,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1358.76,67,,1087.008,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1622.4,80,,1297.92,percent of total billed charges,80% of total billed charges,1318.2,65,,1054.56,percent of total billed charges,65% of total billed charges,723.39,35.67,,578.712,percent of total billed charges,35.67% of total billed charges,588.12,1825.2,
EXPRESSEW,27011284,CDM,270,RC,,,outpatient,,,810,324.00,,688.5,85,,550.8,percent of total billed charges,85% of total billed charges,623.7,77,,498.96,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,664.2,82,,531.36,percent of total billed charges,82% of total billed charges,688.5,85,,550.8,percent of total billed charges,85% of total billed charges,688.5,85,,550.8,percent of total billed charges,85% of total billed charges,688.5,85,,550.8,percent of total billed charges,85% of total billed charges,729,90,,583.2,percent of total billed charges,90% of total billed charges,648,80,,518.4,percent of total billed charges,80% of total billed charges,729,90,,583.2,percent of total billed charges,90% of total billed charges,607.5,75,,486,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,234.9,29,,187.92,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,542.7,67,,434.16,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,648,80,,518.4,percent of total billed charges,80% of total billed charges,526.5,65,,421.2,percent of total billed charges,65% of total billed charges,288.93,35.67,,231.144,percent of total billed charges,35.67% of total billed charges,234.9,729,
CANNULA 7 X 75,27011285,CDM,270,RC,,,outpatient,,,217,86.80,,184.45,85,,147.56,percent of total billed charges,85% of total billed charges,167.09,77,,133.67,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,177.94,82,,142.352,percent of total billed charges,82% of total billed charges,184.45,85,,147.56,percent of total billed charges,85% of total billed charges,184.45,85,,147.56,percent of total billed charges,85% of total billed charges,184.45,85,,147.56,percent of total billed charges,85% of total billed charges,195.3,90,,156.24,percent of total billed charges,90% of total billed charges,173.6,80,,138.88,percent of total billed charges,80% of total billed charges,195.3,90,,156.24,percent of total billed charges,90% of total billed charges,162.75,75,,130.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,62.93,29,,50.344,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,145.39,67,,116.312,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,173.6,80,,138.88,percent of total billed charges,80% of total billed charges,141.05,65,,112.84,percent of total billed charges,65% of total billed charges,77.4,35.67,,61.92,percent of total billed charges,35.67% of total billed charges,62.93,195.3,
PIOLT DRILL 1.5 MM,27011341,CDM,270,RC,,,outpatient,,,842,336.80,,715.7,85,,572.56,percent of total billed charges,85% of total billed charges,648.34,77,,518.67,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,690.44,82,,552.352,percent of total billed charges,82% of total billed charges,715.7,85,,572.56,percent of total billed charges,85% of total billed charges,715.7,85,,572.56,percent of total billed charges,85% of total billed charges,715.7,85,,572.56,percent of total billed charges,85% of total billed charges,757.8,90,,606.24,percent of total billed charges,90% of total billed charges,673.6,80,,538.88,percent of total billed charges,80% of total billed charges,757.8,90,,606.24,percent of total billed charges,90% of total billed charges,631.5,75,,505.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,244.18,29,,195.344,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,564.14,67,,451.312,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,673.6,80,,538.88,percent of total billed charges,80% of total billed charges,547.3,65,,437.84,percent of total billed charges,65% of total billed charges,300.34,35.67,,240.272,percent of total billed charges,35.67% of total billed charges,244.18,757.8,
CANNULATED DRILL2.3MM QUICK RE,27011350,CDM,270,RC,,,outpatient,,,1434,573.60,,1218.9,85,,975.12,percent of total billed charges,85% of total billed charges,1104.18,77,,883.34,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,1175.88,82,,940.704,percent of total billed charges,82% of total billed charges,1218.9,85,,975.12,percent of total billed charges,85% of total billed charges,1218.9,85,,975.12,percent of total billed charges,85% of total billed charges,1218.9,85,,975.12,percent of total billed charges,85% of total billed charges,1290.6,90,,1032.48,percent of total billed charges,90% of total billed charges,1147.2,80,,917.76,percent of total billed charges,80% of total billed charges,1290.6,90,,1032.48,percent of total billed charges,90% of total billed charges,1075.5,75,,860.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,415.86,29,,332.688,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,960.78,67,,768.624,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1147.2,80,,917.76,percent of total billed charges,80% of total billed charges,932.1,65,,745.68,percent of total billed charges,65% of total billed charges,511.51,35.67,,409.208,percent of total billed charges,35.67% of total billed charges,415.86,1290.6,
HA 5.5 BR 3 LOT#3714891,27011472,CDM,270,RC,,,outpatient,,,1630,652.00,,1385.5,85,,1108.4,percent of total billed charges,85% of total billed charges,1255.1,77,,1004.08,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,1336.6,82,,1069.28,percent of total billed charges,82% of total billed charges,1385.5,85,,1108.4,percent of total billed charges,85% of total billed charges,1385.5,85,,1108.4,percent of total billed charges,85% of total billed charges,1385.5,85,,1108.4,percent of total billed charges,85% of total billed charges,1467,90,,1173.6,percent of total billed charges,90% of total billed charges,1304,80,,1043.2,percent of total billed charges,80% of total billed charges,1467,90,,1173.6,percent of total billed charges,90% of total billed charges,1222.5,75,,978,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,472.7,29,,378.16,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1092.1,67,,873.68,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1304,80,,1043.2,percent of total billed charges,80% of total billed charges,1059.5,65,,847.6,percent of total billed charges,65% of total billed charges,581.42,35.67,,465.136,percent of total billed charges,35.67% of total billed charges,472.7,1467,
PULL UP BRIEF ADULT LRG 44-54,27011520,CDM,270,RC,,,outpatient,,,11,4.40,,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,8.47,77,,6.78,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,9.02,82,,7.216,percent of total billed charges,82% of total billed charges,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,9.9,90,,7.92,percent of total billed charges,90% of total billed charges,8.8,80,,7.04,percent of total billed charges,80% of total billed charges,9.9,90,,7.92,percent of total billed charges,90% of total billed charges,8.25,75,,6.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,3.19,29,,2.552,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,7.37,67,,5.896,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,8.8,80,,7.04,percent of total billed charges,80% of total billed charges,7.15,65,,5.72,percent of total billed charges,65% of total billed charges,3.92,35.67,,3.136,percent of total billed charges,35.67% of total billed charges,3.19,9.9,
PULL UP BRIEF ADLT S/M 34-46,27011521,CDM,270,RC,,,outpatient,,,11,4.40,,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,8.47,77,,6.78,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,9.02,82,,7.216,percent of total billed charges,82% of total billed charges,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,9.9,90,,7.92,percent of total billed charges,90% of total billed charges,8.8,80,,7.04,percent of total billed charges,80% of total billed charges,9.9,90,,7.92,percent of total billed charges,90% of total billed charges,8.25,75,,6.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,3.19,29,,2.552,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,7.37,67,,5.896,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,8.8,80,,7.04,percent of total billed charges,80% of total billed charges,7.15,65,,5.72,percent of total billed charges,65% of total billed charges,3.92,35.67,,3.136,percent of total billed charges,35.67% of total billed charges,3.19,9.9,
NEEDLE SPINAL QUINCKE 22GX7,27011522,CDM,270,RC,,,outpatient,,,45,18.00,,38.25,85,,30.6,percent of total billed charges,85% of total billed charges,34.65,77,,27.72,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,36.9,82,,29.52,percent of total billed charges,82% of total billed charges,38.25,85,,30.6,percent of total billed charges,85% of total billed charges,38.25,85,,30.6,percent of total billed charges,85% of total billed charges,38.25,85,,30.6,percent of total billed charges,85% of total billed charges,40.5,90,,32.4,percent of total billed charges,90% of total billed charges,36,80,,28.8,percent of total billed charges,80% of total billed charges,40.5,90,,32.4,percent of total billed charges,90% of total billed charges,33.75,75,,27,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,13.05,29,,10.44,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,30.15,67,,24.12,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,36,80,,28.8,percent of total billed charges,80% of total billed charges,29.25,65,,23.4,percent of total billed charges,65% of total billed charges,16.05,35.67,,12.84,percent of total billed charges,35.67% of total billed charges,13.05,40.5,
DISPOSABLE KIT FOR 2.9MM LOCK,27011534,CDM,270,RC,,,outpatient,,,1120,448.00,,952,85,,761.6,percent of total billed charges,85% of total billed charges,862.4,77,,689.92,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,918.4,82,,734.72,percent of total billed charges,82% of total billed charges,952,85,,761.6,percent of total billed charges,85% of total billed charges,952,85,,761.6,percent of total billed charges,85% of total billed charges,952,85,,761.6,percent of total billed charges,85% of total billed charges,1008,90,,806.4,percent of total billed charges,90% of total billed charges,896,80,,716.8,percent of total billed charges,80% of total billed charges,1008,90,,806.4,percent of total billed charges,90% of total billed charges,840,75,,672,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,324.8,29,,259.84,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,750.4,67,,600.32,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,896,80,,716.8,percent of total billed charges,80% of total billed charges,728,65,,582.4,percent of total billed charges,65% of total billed charges,399.5,35.67,,319.6,percent of total billed charges,35.67% of total billed charges,324.8,1008,
FIBERSTICK # 2 FIBERWARE,27011537,CDM,270,RC,,,outpatient,,,372,148.80,,316.2,85,,252.96,percent of total billed charges,85% of total billed charges,286.44,77,,229.15,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,305.04,82,,244.032,percent of total billed charges,82% of total billed charges,316.2,85,,252.96,percent of total billed charges,85% of total billed charges,316.2,85,,252.96,percent of total billed charges,85% of total billed charges,316.2,85,,252.96,percent of total billed charges,85% of total billed charges,334.8,90,,267.84,percent of total billed charges,90% of total billed charges,297.6,80,,238.08,percent of total billed charges,80% of total billed charges,334.8,90,,267.84,percent of total billed charges,90% of total billed charges,279,75,,223.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,107.88,29,,86.304,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,249.24,67,,199.392,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,297.6,80,,238.08,percent of total billed charges,80% of total billed charges,241.8,65,,193.44,percent of total billed charges,65% of total billed charges,132.69,35.67,,106.152,percent of total billed charges,35.67% of total billed charges,107.88,334.8,
ANKLE ARTHROSCOPY DISTRACTOR S,27011549,CDM,270,RC,,,outpatient,,,363,145.20,,308.55,85,,246.84,percent of total billed charges,85% of total billed charges,279.51,77,,223.61,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,297.66,82,,238.128,percent of total billed charges,82% of total billed charges,308.55,85,,246.84,percent of total billed charges,85% of total billed charges,308.55,85,,246.84,percent of total billed charges,85% of total billed charges,308.55,85,,246.84,percent of total billed charges,85% of total billed charges,326.7,90,,261.36,percent of total billed charges,90% of total billed charges,290.4,80,,232.32,percent of total billed charges,80% of total billed charges,326.7,90,,261.36,percent of total billed charges,90% of total billed charges,272.25,75,,217.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,105.27,29,,84.216,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,243.21,67,,194.568,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,290.4,80,,232.32,percent of total billed charges,80% of total billed charges,235.95,65,,188.76,percent of total billed charges,65% of total billed charges,129.48,35.67,,103.584,percent of total billed charges,35.67% of total billed charges,105.27,326.7,
ARTHREX PASSPORT BUTTON CHANNU,27011556,CDM,270,RC,,,outpatient,,,312,124.80,,265.2,85,,212.16,percent of total billed charges,85% of total billed charges,240.24,77,,192.19,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,255.84,82,,204.672,percent of total billed charges,82% of total billed charges,265.2,85,,212.16,percent of total billed charges,85% of total billed charges,265.2,85,,212.16,percent of total billed charges,85% of total billed charges,265.2,85,,212.16,percent of total billed charges,85% of total billed charges,280.8,90,,224.64,percent of total billed charges,90% of total billed charges,249.6,80,,199.68,percent of total billed charges,80% of total billed charges,280.8,90,,224.64,percent of total billed charges,90% of total billed charges,234,75,,187.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,90.48,29,,72.384,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,209.04,67,,167.232,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,249.6,80,,199.68,percent of total billed charges,80% of total billed charges,202.8,65,,162.24,percent of total billed charges,65% of total billed charges,111.29,35.67,,89.032,percent of total billed charges,35.67% of total billed charges,90.48,280.8,
ACCESSORY KIT 3550-27,27011619,CDM,270,RC,,,outpatient,,,1567,626.80,,1331.95,85,,1065.56,percent of total billed charges,85% of total billed charges,1206.59,77,,965.27,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,1284.94,82,,1027.952,percent of total billed charges,82% of total billed charges,1331.95,85,,1065.56,percent of total billed charges,85% of total billed charges,1331.95,85,,1065.56,percent of total billed charges,85% of total billed charges,1331.95,85,,1065.56,percent of total billed charges,85% of total billed charges,1410.3,90,,1128.24,percent of total billed charges,90% of total billed charges,1253.6,80,,1002.88,percent of total billed charges,80% of total billed charges,1410.3,90,,1128.24,percent of total billed charges,90% of total billed charges,1175.25,75,,940.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,454.43,29,,363.544,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1049.89,67,,839.912,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1253.6,80,,1002.88,percent of total billed charges,80% of total billed charges,1018.55,65,,814.84,percent of total billed charges,65% of total billed charges,558.95,35.67,,447.16,percent of total billed charges,35.67% of total billed charges,454.43,1410.3,
PUMP SET ARTHROSCOPY (RED),27011628,CDM,270,RC,,,outpatient,,,2089,835.60,,1775.65,85,,1420.52,percent of total billed charges,85% of total billed charges,1608.53,77,,1286.82,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,1712.98,82,,1370.384,percent of total billed charges,82% of total billed charges,1775.65,85,,1420.52,percent of total billed charges,85% of total billed charges,1775.65,85,,1420.52,percent of total billed charges,85% of total billed charges,1775.65,85,,1420.52,percent of total billed charges,85% of total billed charges,1880.1,90,,1504.08,percent of total billed charges,90% of total billed charges,1671.2,80,,1336.96,percent of total billed charges,80% of total billed charges,1880.1,90,,1504.08,percent of total billed charges,90% of total billed charges,1566.75,75,,1253.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,605.81,29,,484.648,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1399.63,67,,1119.704,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1671.2,80,,1336.96,percent of total billed charges,80% of total billed charges,1357.85,65,,1086.28,percent of total billed charges,65% of total billed charges,745.15,35.67,,596.12,percent of total billed charges,35.67% of total billed charges,605.81,1880.1,
PEDI ARM SLING,27011638,CDM,270,RC,,,outpatient,,,30,12.00,,25.5,85,,20.4,percent of total billed charges,85% of total billed charges,23.1,77,,18.48,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,24.6,82,,19.68,percent of total billed charges,82% of total billed charges,25.5,85,,20.4,percent of total billed charges,85% of total billed charges,25.5,85,,20.4,percent of total billed charges,85% of total billed charges,25.5,85,,20.4,percent of total billed charges,85% of total billed charges,27,90,,21.6,percent of total billed charges,90% of total billed charges,24,80,,19.2,percent of total billed charges,80% of total billed charges,27,90,,21.6,percent of total billed charges,90% of total billed charges,22.5,75,,18,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,8.7,29,,6.96,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,20.1,67,,16.08,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,24,80,,19.2,percent of total billed charges,80% of total billed charges,19.5,65,,15.6,percent of total billed charges,65% of total billed charges,10.7,35.67,,8.56,percent of total billed charges,35.67% of total billed charges,8.7,27,
LARGE TIBIAL SHEATH,27011651,CDM,270,RC,,,outpatient,,,1398,559.20,,1188.3,85,,950.64,percent of total billed charges,85% of total billed charges,1076.46,77,,861.17,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,1146.36,82,,917.088,percent of total billed charges,82% of total billed charges,1188.3,85,,950.64,percent of total billed charges,85% of total billed charges,1188.3,85,,950.64,percent of total billed charges,85% of total billed charges,1188.3,85,,950.64,percent of total billed charges,85% of total billed charges,1258.2,90,,1006.56,percent of total billed charges,90% of total billed charges,1118.4,80,,894.72,percent of total billed charges,80% of total billed charges,1258.2,90,,1006.56,percent of total billed charges,90% of total billed charges,1048.5,75,,838.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,405.42,29,,324.336,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,936.66,67,,749.328,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1118.4,80,,894.72,percent of total billed charges,80% of total billed charges,908.7,65,,726.96,percent of total billed charges,65% of total billed charges,498.67,35.67,,398.936,percent of total billed charges,35.67% of total billed charges,405.42,1258.2,
PLASMA 60 CC INJECTION KIT,27011867,CDM,270,RC,,,outpatient,,,2645,1058.00,,2248.25,85,,1798.6,percent of total billed charges,85% of total billed charges,2036.65,77,,1629.32,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,2168.9,82,,1735.12,percent of total billed charges,82% of total billed charges,2248.25,85,,1798.6,percent of total billed charges,85% of total billed charges,2248.25,85,,1798.6,percent of total billed charges,85% of total billed charges,2248.25,85,,1798.6,percent of total billed charges,85% of total billed charges,2380.5,90,,1904.4,percent of total billed charges,90% of total billed charges,2116,80,,1692.8,percent of total billed charges,80% of total billed charges,2380.5,90,,1904.4,percent of total billed charges,90% of total billed charges,1983.75,75,,1587,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,767.05,29,,613.64,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1772.15,67,,1417.72,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,2116,80,,1692.8,percent of total billed charges,80% of total billed charges,1719.25,65,,1375.4,percent of total billed charges,65% of total billed charges,943.47,35.67,,754.776,percent of total billed charges,35.67% of total billed charges,767.05,2380.5,
FULL MASK HEADGEAR,27011903,CDM,270,RC,,,outpatient,,,195,78.00,,165.75,85,,132.6,percent of total billed charges,85% of total billed charges,150.15,77,,120.12,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,159.9,82,,127.92,percent of total billed charges,82% of total billed charges,165.75,85,,132.6,percent of total billed charges,85% of total billed charges,165.75,85,,132.6,percent of total billed charges,85% of total billed charges,165.75,85,,132.6,percent of total billed charges,85% of total billed charges,175.5,90,,140.4,percent of total billed charges,90% of total billed charges,156,80,,124.8,percent of total billed charges,80% of total billed charges,175.5,90,,140.4,percent of total billed charges,90% of total billed charges,146.25,75,,117,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,56.55,29,,45.24,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,130.65,67,,104.52,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,156,80,,124.8,percent of total billed charges,80% of total billed charges,126.75,65,,101.4,percent of total billed charges,65% of total billed charges,69.56,35.67,,55.648,percent of total billed charges,35.67% of total billed charges,56.55,175.5,
NASAL CRADLES HEADGEAR,27011904,CDM,270,RC,,,outpatient,,,286,114.40,,243.1,85,,194.48,percent of total billed charges,85% of total billed charges,220.22,77,,176.18,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,234.52,82,,187.616,percent of total billed charges,82% of total billed charges,243.1,85,,194.48,percent of total billed charges,85% of total billed charges,243.1,85,,194.48,percent of total billed charges,85% of total billed charges,243.1,85,,194.48,percent of total billed charges,85% of total billed charges,257.4,90,,205.92,percent of total billed charges,90% of total billed charges,228.8,80,,183.04,percent of total billed charges,80% of total billed charges,257.4,90,,205.92,percent of total billed charges,90% of total billed charges,214.5,75,,171.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,82.94,29,,66.352,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,191.62,67,,153.296,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,228.8,80,,183.04,percent of total billed charges,80% of total billed charges,185.9,65,,148.72,percent of total billed charges,65% of total billed charges,102.02,35.67,,81.616,percent of total billed charges,35.67% of total billed charges,82.94,257.4,
COVER BILI PAD DISP LARGE,27011928,CDM,270,RC,,,outpatient,,,32,12.80,,27.2,85,,21.76,percent of total billed charges,85% of total billed charges,24.64,77,,19.71,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,26.24,82,,20.992,percent of total billed charges,82% of total billed charges,27.2,85,,21.76,percent of total billed charges,85% of total billed charges,27.2,85,,21.76,percent of total billed charges,85% of total billed charges,27.2,85,,21.76,percent of total billed charges,85% of total billed charges,28.8,90,,23.04,percent of total billed charges,90% of total billed charges,25.6,80,,20.48,percent of total billed charges,80% of total billed charges,28.8,90,,23.04,percent of total billed charges,90% of total billed charges,24,75,,19.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,9.28,29,,7.424,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,21.44,67,,17.152,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,25.6,80,,20.48,percent of total billed charges,80% of total billed charges,20.8,65,,16.64,percent of total billed charges,65% of total billed charges,11.41,35.67,,9.128,percent of total billed charges,35.67% of total billed charges,9.28,28.8,
VICRYL SUTURE,27011942,CDM,270,RC,,,outpatient,,,44,17.60,,37.4,85,,29.92,percent of total billed charges,85% of total billed charges,33.88,77,,27.1,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,36.08,82,,28.864,percent of total billed charges,82% of total billed charges,37.4,85,,29.92,percent of total billed charges,85% of total billed charges,37.4,85,,29.92,percent of total billed charges,85% of total billed charges,37.4,85,,29.92,percent of total billed charges,85% of total billed charges,39.6,90,,31.68,percent of total billed charges,90% of total billed charges,35.2,80,,28.16,percent of total billed charges,80% of total billed charges,39.6,90,,31.68,percent of total billed charges,90% of total billed charges,33,75,,26.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,12.76,29,,10.208,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,29.48,67,,23.584,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,35.2,80,,28.16,percent of total billed charges,80% of total billed charges,28.6,65,,22.88,percent of total billed charges,65% of total billed charges,15.69,35.67,,12.552,percent of total billed charges,35.67% of total billed charges,12.76,39.6,
ENDO 2 TAPER ADPT NECK,27011955,CDM,270,RC,,,outpatient,,,812,324.80,,690.2,85,,552.16,percent of total billed charges,85% of total billed charges,625.24,77,,500.19,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,665.84,82,,532.672,percent of total billed charges,82% of total billed charges,690.2,85,,552.16,percent of total billed charges,85% of total billed charges,690.2,85,,552.16,percent of total billed charges,85% of total billed charges,690.2,85,,552.16,percent of total billed charges,85% of total billed charges,730.8,90,,584.64,percent of total billed charges,90% of total billed charges,649.6,80,,519.68,percent of total billed charges,80% of total billed charges,730.8,90,,584.64,percent of total billed charges,90% of total billed charges,609,75,,487.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,235.48,29,,188.384,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,544.04,67,,435.232,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,649.6,80,,519.68,percent of total billed charges,80% of total billed charges,527.8,65,,422.24,percent of total billed charges,65% of total billed charges,289.64,35.67,,231.712,percent of total billed charges,35.67% of total billed charges,235.48,730.8,
KIT FEE,27011981,CDM,270,RC,,,outpatient,,,842,336.80,,715.7,85,,572.56,percent of total billed charges,85% of total billed charges,648.34,77,,518.67,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,690.44,82,,552.352,percent of total billed charges,82% of total billed charges,715.7,85,,572.56,percent of total billed charges,85% of total billed charges,715.7,85,,572.56,percent of total billed charges,85% of total billed charges,715.7,85,,572.56,percent of total billed charges,85% of total billed charges,757.8,90,,606.24,percent of total billed charges,90% of total billed charges,673.6,80,,538.88,percent of total billed charges,80% of total billed charges,757.8,90,,606.24,percent of total billed charges,90% of total billed charges,631.5,75,,505.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,244.18,29,,195.344,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,564.14,67,,451.312,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,673.6,80,,538.88,percent of total billed charges,80% of total billed charges,547.3,65,,437.84,percent of total billed charges,65% of total billed charges,300.34,35.67,,240.272,percent of total billed charges,35.67% of total billed charges,244.18,757.8,
NOVASURE ABLATION DEVICE,27012021,CDM,270,RC,,,outpatient,,,3710,1484.00,,3153.5,85,,2522.8,percent of total billed charges,85% of total billed charges,2856.7,77,,2285.36,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,3042.2,82,,2433.76,percent of total billed charges,82% of total billed charges,3153.5,85,,2522.8,percent of total billed charges,85% of total billed charges,3153.5,85,,2522.8,percent of total billed charges,85% of total billed charges,3153.5,85,,2522.8,percent of total billed charges,85% of total billed charges,3339,90,,2671.2,percent of total billed charges,90% of total billed charges,2968,80,,2374.4,percent of total billed charges,80% of total billed charges,3339,90,,2671.2,percent of total billed charges,90% of total billed charges,2782.5,75,,2226,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,1075.9,29,,860.72,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,2485.7,67,,1988.56,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,2968,80,,2374.4,percent of total billed charges,80% of total billed charges,2411.5,65,,1929.2,percent of total billed charges,65% of total billed charges,1323.36,35.67,,1058.688,percent of total billed charges,35.67% of total billed charges,1075.9,3339,
CUTTER STAPLER,27012032,CDM,270,RC,,,outpatient,,,1791,716.40,,1522.35,85,,1217.88,percent of total billed charges,85% of total billed charges,1379.07,77,,1103.26,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,1468.62,82,,1174.896,percent of total billed charges,82% of total billed charges,1522.35,85,,1217.88,percent of total billed charges,85% of total billed charges,1522.35,85,,1217.88,percent of total billed charges,85% of total billed charges,1522.35,85,,1217.88,percent of total billed charges,85% of total billed charges,1611.9,90,,1289.52,percent of total billed charges,90% of total billed charges,1432.8,80,,1146.24,percent of total billed charges,80% of total billed charges,1611.9,90,,1289.52,percent of total billed charges,90% of total billed charges,1343.25,75,,1074.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,519.39,29,,415.512,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1199.97,67,,959.976,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1432.8,80,,1146.24,percent of total billed charges,80% of total billed charges,1164.15,65,,931.32,percent of total billed charges,65% of total billed charges,638.85,35.67,,511.08,percent of total billed charges,35.67% of total billed charges,519.39,1611.9,
CAST BOOT WALKER X LARGE,27012051,CDM,270,RC,,,outpatient,,,266,106.40,,226.1,85,,180.88,percent of total billed charges,85% of total billed charges,204.82,77,,163.86,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,218.12,82,,174.496,percent of total billed charges,82% of total billed charges,226.1,85,,180.88,percent of total billed charges,85% of total billed charges,226.1,85,,180.88,percent of total billed charges,85% of total billed charges,226.1,85,,180.88,percent of total billed charges,85% of total billed charges,239.4,90,,191.52,percent of total billed charges,90% of total billed charges,212.8,80,,170.24,percent of total billed charges,80% of total billed charges,239.4,90,,191.52,percent of total billed charges,90% of total billed charges,199.5,75,,159.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,77.14,29,,61.712,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,178.22,67,,142.576,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,212.8,80,,170.24,percent of total billed charges,80% of total billed charges,172.9,65,,138.32,percent of total billed charges,65% of total billed charges,94.88,35.67,,75.904,percent of total billed charges,35.67% of total billed charges,77.14,239.4,
CAST BOOT WALKER X SMALL,27012052,CDM,270,RC,,,outpatient,,,266,106.40,,226.1,85,,180.88,percent of total billed charges,85% of total billed charges,204.82,77,,163.86,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,218.12,82,,174.496,percent of total billed charges,82% of total billed charges,226.1,85,,180.88,percent of total billed charges,85% of total billed charges,226.1,85,,180.88,percent of total billed charges,85% of total billed charges,226.1,85,,180.88,percent of total billed charges,85% of total billed charges,239.4,90,,191.52,percent of total billed charges,90% of total billed charges,212.8,80,,170.24,percent of total billed charges,80% of total billed charges,239.4,90,,191.52,percent of total billed charges,90% of total billed charges,199.5,75,,159.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,77.14,29,,61.712,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,178.22,67,,142.576,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,212.8,80,,170.24,percent of total billed charges,80% of total billed charges,172.9,65,,138.32,percent of total billed charges,65% of total billed charges,94.88,35.67,,75.904,percent of total billed charges,35.67% of total billed charges,77.14,239.4,
ANESTHESIA SET,27012085,CDM,270,RC,,,outpatient,,,45,18.00,,38.25,85,,30.6,percent of total billed charges,85% of total billed charges,34.65,77,,27.72,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,36.9,82,,29.52,percent of total billed charges,82% of total billed charges,38.25,85,,30.6,percent of total billed charges,85% of total billed charges,38.25,85,,30.6,percent of total billed charges,85% of total billed charges,38.25,85,,30.6,percent of total billed charges,85% of total billed charges,40.5,90,,32.4,percent of total billed charges,90% of total billed charges,36,80,,28.8,percent of total billed charges,80% of total billed charges,40.5,90,,32.4,percent of total billed charges,90% of total billed charges,33.75,75,,27,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,13.05,29,,10.44,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,30.15,67,,24.12,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,36,80,,28.8,percent of total billed charges,80% of total billed charges,29.25,65,,23.4,percent of total billed charges,65% of total billed charges,16.05,35.67,,12.84,percent of total billed charges,35.67% of total billed charges,13.05,40.5,
PRASS PAIRED ELECTRODES,27012101,CDM,270,RC,,,outpatient,,,551,220.40,,468.35,85,,374.68,percent of total billed charges,85% of total billed charges,424.27,77,,339.42,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,451.82,82,,361.456,percent of total billed charges,82% of total billed charges,468.35,85,,374.68,percent of total billed charges,85% of total billed charges,468.35,85,,374.68,percent of total billed charges,85% of total billed charges,468.35,85,,374.68,percent of total billed charges,85% of total billed charges,495.9,90,,396.72,percent of total billed charges,90% of total billed charges,440.8,80,,352.64,percent of total billed charges,80% of total billed charges,495.9,90,,396.72,percent of total billed charges,90% of total billed charges,413.25,75,,330.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,159.79,29,,127.832,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,369.17,67,,295.336,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,440.8,80,,352.64,percent of total billed charges,80% of total billed charges,358.15,65,,286.52,percent of total billed charges,65% of total billed charges,196.54,35.67,,157.232,percent of total billed charges,35.67% of total billed charges,159.79,495.9,
ARTHROSCOPY PUMP,27012110,CDM,270,RC,,,outpatient,,,245,98.00,,208.25,85,,166.6,percent of total billed charges,85% of total billed charges,188.65,77,,150.92,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,200.9,82,,160.72,percent of total billed charges,82% of total billed charges,208.25,85,,166.6,percent of total billed charges,85% of total billed charges,208.25,85,,166.6,percent of total billed charges,85% of total billed charges,208.25,85,,166.6,percent of total billed charges,85% of total billed charges,220.5,90,,176.4,percent of total billed charges,90% of total billed charges,196,80,,156.8,percent of total billed charges,80% of total billed charges,220.5,90,,176.4,percent of total billed charges,90% of total billed charges,183.75,75,,147,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,71.05,29,,56.84,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,164.15,67,,131.32,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,196,80,,156.8,percent of total billed charges,80% of total billed charges,159.25,65,,127.4,percent of total billed charges,65% of total billed charges,87.39,35.67,,69.912,percent of total billed charges,35.67% of total billed charges,71.05,220.5,
"TRAY LACERATION, STERILE",27012125,CDM,270,RC,,,outpatient,,,80,32.00,,68,85,,54.4,percent of total billed charges,85% of total billed charges,61.6,77,,49.28,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,65.6,82,,52.48,percent of total billed charges,82% of total billed charges,68,85,,54.4,percent of total billed charges,85% of total billed charges,68,85,,54.4,percent of total billed charges,85% of total billed charges,68,85,,54.4,percent of total billed charges,85% of total billed charges,72,90,,57.6,percent of total billed charges,90% of total billed charges,64,80,,51.2,percent of total billed charges,80% of total billed charges,72,90,,57.6,percent of total billed charges,90% of total billed charges,60,75,,48,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,23.2,29,,18.56,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,53.6,67,,42.88,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,64,80,,51.2,percent of total billed charges,80% of total billed charges,52,65,,41.6,percent of total billed charges,65% of total billed charges,28.54,35.67,,22.832,percent of total billed charges,35.67% of total billed charges,23.2,72,
SMALL VAC FOAM DRESSING,27012186,CDM,270,RC,,,outpatient,,,109,43.60,,92.65,85,,74.12,percent of total billed charges,85% of total billed charges,83.93,77,,67.14,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,89.38,82,,71.504,percent of total billed charges,82% of total billed charges,92.65,85,,74.12,percent of total billed charges,85% of total billed charges,92.65,85,,74.12,percent of total billed charges,85% of total billed charges,92.65,85,,74.12,percent of total billed charges,85% of total billed charges,98.1,90,,78.48,percent of total billed charges,90% of total billed charges,87.2,80,,69.76,percent of total billed charges,80% of total billed charges,98.1,90,,78.48,percent of total billed charges,90% of total billed charges,81.75,75,,65.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,31.61,29,,25.288,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,73.03,67,,58.424,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,87.2,80,,69.76,percent of total billed charges,80% of total billed charges,70.85,65,,56.68,percent of total billed charges,65% of total billed charges,38.88,35.67,,31.104,percent of total billed charges,35.67% of total billed charges,31.61,98.1,
TELFA DRESSING 4X10,27012248,CDM,270,RC,,,outpatient,,,20,8.00,,17,85,,13.6,percent of total billed charges,85% of total billed charges,15.4,77,,12.32,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,16.4,82,,13.12,percent of total billed charges,82% of total billed charges,17,85,,13.6,percent of total billed charges,85% of total billed charges,17,85,,13.6,percent of total billed charges,85% of total billed charges,17,85,,13.6,percent of total billed charges,85% of total billed charges,18,90,,14.4,percent of total billed charges,90% of total billed charges,16,80,,12.8,percent of total billed charges,80% of total billed charges,18,90,,14.4,percent of total billed charges,90% of total billed charges,15,75,,12,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,5.8,29,,4.64,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,13.4,67,,10.72,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,16,80,,12.8,percent of total billed charges,80% of total billed charges,13,65,,10.4,percent of total billed charges,65% of total billed charges,7.13,35.67,,5.704,percent of total billed charges,35.67% of total billed charges,5.8,18,
TELFA DRESSING 2X3,27012249,CDM,270,RC,,,outpatient,,,17,6.80,,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,13.09,77,,10.47,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,13.94,82,,11.152,percent of total billed charges,82% of total billed charges,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,15.3,90,,12.24,percent of total billed charges,90% of total billed charges,13.6,80,,10.88,percent of total billed charges,80% of total billed charges,15.3,90,,12.24,percent of total billed charges,90% of total billed charges,12.75,75,,10.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,4.93,29,,3.944,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,11.39,67,,9.112,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,13.6,80,,10.88,percent of total billed charges,80% of total billed charges,11.05,65,,8.84,percent of total billed charges,65% of total billed charges,6.06,35.67,,4.848,percent of total billed charges,35.67% of total billed charges,4.93,15.3,
BIT DRILL 1.1 MM,27012286,CDM,270,RC,,,outpatient,,,697,278.80,,592.45,85,,473.96,percent of total billed charges,85% of total billed charges,536.69,77,,429.35,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,571.54,82,,457.232,percent of total billed charges,82% of total billed charges,592.45,85,,473.96,percent of total billed charges,85% of total billed charges,592.45,85,,473.96,percent of total billed charges,85% of total billed charges,592.45,85,,473.96,percent of total billed charges,85% of total billed charges,627.3,90,,501.84,percent of total billed charges,90% of total billed charges,557.6,80,,446.08,percent of total billed charges,80% of total billed charges,627.3,90,,501.84,percent of total billed charges,90% of total billed charges,522.75,75,,418.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,202.13,29,,161.704,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,466.99,67,,373.592,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,557.6,80,,446.08,percent of total billed charges,80% of total billed charges,453.05,65,,362.44,percent of total billed charges,65% of total billed charges,248.62,35.67,,198.896,percent of total billed charges,35.67% of total billed charges,202.13,627.3,
BIT DRILL,27012287,CDM,270,RC,,,outpatient,,,808,323.20,,686.8,85,,549.44,percent of total billed charges,85% of total billed charges,622.16,77,,497.73,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,662.56,82,,530.048,percent of total billed charges,82% of total billed charges,686.8,85,,549.44,percent of total billed charges,85% of total billed charges,686.8,85,,549.44,percent of total billed charges,85% of total billed charges,686.8,85,,549.44,percent of total billed charges,85% of total billed charges,727.2,90,,581.76,percent of total billed charges,90% of total billed charges,646.4,80,,517.12,percent of total billed charges,80% of total billed charges,727.2,90,,581.76,percent of total billed charges,90% of total billed charges,606,75,,484.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,234.32,29,,187.456,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,541.36,67,,433.088,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,646.4,80,,517.12,percent of total billed charges,80% of total billed charges,525.2,65,,420.16,percent of total billed charges,65% of total billed charges,288.21,35.67,,230.568,percent of total billed charges,35.67% of total billed charges,234.32,727.2,
BIT DRILL 1.5 MM,27012288,CDM,270,RC,,,outpatient,,,574,229.60,,487.9,85,,390.32,percent of total billed charges,85% of total billed charges,441.98,77,,353.58,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,470.68,82,,376.544,percent of total billed charges,82% of total billed charges,487.9,85,,390.32,percent of total billed charges,85% of total billed charges,487.9,85,,390.32,percent of total billed charges,85% of total billed charges,487.9,85,,390.32,percent of total billed charges,85% of total billed charges,516.6,90,,413.28,percent of total billed charges,90% of total billed charges,459.2,80,,367.36,percent of total billed charges,80% of total billed charges,516.6,90,,413.28,percent of total billed charges,90% of total billed charges,430.5,75,,344.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,166.46,29,,133.168,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,384.58,67,,307.664,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,459.2,80,,367.36,percent of total billed charges,80% of total billed charges,373.1,65,,298.48,percent of total billed charges,65% of total billed charges,204.75,35.67,,163.8,percent of total billed charges,35.67% of total billed charges,166.46,516.6,
REAMER PILOTED HEAD 7.5 MM,27012315,CDM,270,RC,,,outpatient,,,1313,525.20,,1116.05,85,,892.84,percent of total billed charges,85% of total billed charges,1011.01,77,,808.81,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,1076.66,82,,861.328,percent of total billed charges,82% of total billed charges,1116.05,85,,892.84,percent of total billed charges,85% of total billed charges,1116.05,85,,892.84,percent of total billed charges,85% of total billed charges,1116.05,85,,892.84,percent of total billed charges,85% of total billed charges,1181.7,90,,945.36,percent of total billed charges,90% of total billed charges,1050.4,80,,840.32,percent of total billed charges,80% of total billed charges,1181.7,90,,945.36,percent of total billed charges,90% of total billed charges,984.75,75,,787.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,380.77,29,,304.616,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,879.71,67,,703.768,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1050.4,80,,840.32,percent of total billed charges,80% of total billed charges,853.45,65,,682.76,percent of total billed charges,65% of total billed charges,468.35,35.67,,374.68,percent of total billed charges,35.67% of total billed charges,380.77,1181.7,
TUOHY NEEDLE,27012330,CDM,270,RC,,,outpatient,,,83,33.20,,70.55,85,,56.44,percent of total billed charges,85% of total billed charges,63.91,77,,51.13,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,68.06,82,,54.448,percent of total billed charges,82% of total billed charges,70.55,85,,56.44,percent of total billed charges,85% of total billed charges,70.55,85,,56.44,percent of total billed charges,85% of total billed charges,70.55,85,,56.44,percent of total billed charges,85% of total billed charges,74.7,90,,59.76,percent of total billed charges,90% of total billed charges,66.4,80,,53.12,percent of total billed charges,80% of total billed charges,74.7,90,,59.76,percent of total billed charges,90% of total billed charges,62.25,75,,49.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,24.07,29,,19.256,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,55.61,67,,44.488,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,66.4,80,,53.12,percent of total billed charges,80% of total billed charges,53.95,65,,43.16,percent of total billed charges,65% of total billed charges,29.61,35.67,,23.688,percent of total billed charges,35.67% of total billed charges,24.07,74.7,
NEEDLE OMNISPAN 0 DEGREE,27012448,CDM,270,RC,,,outpatient,,,1710,684.00,,1453.5,85,,1162.8,percent of total billed charges,85% of total billed charges,1316.7,77,,1053.36,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,1402.2,82,,1121.76,percent of total billed charges,82% of total billed charges,1453.5,85,,1162.8,percent of total billed charges,85% of total billed charges,1453.5,85,,1162.8,percent of total billed charges,85% of total billed charges,1453.5,85,,1162.8,percent of total billed charges,85% of total billed charges,1539,90,,1231.2,percent of total billed charges,90% of total billed charges,1368,80,,1094.4,percent of total billed charges,80% of total billed charges,1539,90,,1231.2,percent of total billed charges,90% of total billed charges,1282.5,75,,1026,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,495.9,29,,396.72,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1145.7,67,,916.56,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1368,80,,1094.4,percent of total billed charges,80% of total billed charges,1111.5,65,,889.2,percent of total billed charges,65% of total billed charges,609.96,35.67,,487.968,percent of total billed charges,35.67% of total billed charges,495.9,1539,
NEEDLE SUREFIRE,27012465,CDM,270,RC,,,outpatient,,,785,314.00,,667.25,85,,533.8,percent of total billed charges,85% of total billed charges,604.45,77,,483.56,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,643.7,82,,514.96,percent of total billed charges,82% of total billed charges,667.25,85,,533.8,percent of total billed charges,85% of total billed charges,667.25,85,,533.8,percent of total billed charges,85% of total billed charges,667.25,85,,533.8,percent of total billed charges,85% of total billed charges,706.5,90,,565.2,percent of total billed charges,90% of total billed charges,628,80,,502.4,percent of total billed charges,80% of total billed charges,706.5,90,,565.2,percent of total billed charges,90% of total billed charges,588.75,75,,471,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,227.65,29,,182.12,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,525.95,67,,420.76,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,628,80,,502.4,percent of total billed charges,80% of total billed charges,510.25,65,,408.2,percent of total billed charges,65% of total billed charges,280.01,35.67,,224.008,percent of total billed charges,35.67% of total billed charges,227.65,706.5,
TAPER FIBERLINK,27012468,CDM,270,RC,,,outpatient,,,403,161.20,,342.55,85,,274.04,percent of total billed charges,85% of total billed charges,310.31,77,,248.25,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,330.46,82,,264.368,percent of total billed charges,82% of total billed charges,342.55,85,,274.04,percent of total billed charges,85% of total billed charges,342.55,85,,274.04,percent of total billed charges,85% of total billed charges,342.55,85,,274.04,percent of total billed charges,85% of total billed charges,362.7,90,,290.16,percent of total billed charges,90% of total billed charges,322.4,80,,257.92,percent of total billed charges,80% of total billed charges,362.7,90,,290.16,percent of total billed charges,90% of total billed charges,302.25,75,,241.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,116.87,29,,93.496,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,270.01,67,,216.008,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,322.4,80,,257.92,percent of total billed charges,80% of total billed charges,261.95,65,,209.56,percent of total billed charges,65% of total billed charges,143.75,35.67,,115,percent of total billed charges,35.67% of total billed charges,116.87,362.7,
TAPE TIGER,27012469,CDM,270,RC,,,outpatient,,,363,145.20,,308.55,85,,246.84,percent of total billed charges,85% of total billed charges,279.51,77,,223.61,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,297.66,82,,238.128,percent of total billed charges,82% of total billed charges,308.55,85,,246.84,percent of total billed charges,85% of total billed charges,308.55,85,,246.84,percent of total billed charges,85% of total billed charges,308.55,85,,246.84,percent of total billed charges,85% of total billed charges,326.7,90,,261.36,percent of total billed charges,90% of total billed charges,290.4,80,,232.32,percent of total billed charges,80% of total billed charges,326.7,90,,261.36,percent of total billed charges,90% of total billed charges,272.25,75,,217.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,105.27,29,,84.216,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,243.21,67,,194.568,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,290.4,80,,232.32,percent of total billed charges,80% of total billed charges,235.95,65,,188.76,percent of total billed charges,65% of total billed charges,129.48,35.67,,103.584,percent of total billed charges,35.67% of total billed charges,105.27,326.7,
REAMER HEADED 8 MM,27012489,CDM,270,RC,,,outpatient,,,1313,525.20,,1116.05,85,,892.84,percent of total billed charges,85% of total billed charges,1011.01,77,,808.81,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,1076.66,82,,861.328,percent of total billed charges,82% of total billed charges,1116.05,85,,892.84,percent of total billed charges,85% of total billed charges,1116.05,85,,892.84,percent of total billed charges,85% of total billed charges,1116.05,85,,892.84,percent of total billed charges,85% of total billed charges,1181.7,90,,945.36,percent of total billed charges,90% of total billed charges,1050.4,80,,840.32,percent of total billed charges,80% of total billed charges,1181.7,90,,945.36,percent of total billed charges,90% of total billed charges,984.75,75,,787.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,380.77,29,,304.616,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,879.71,67,,703.768,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1050.4,80,,840.32,percent of total billed charges,80% of total billed charges,853.45,65,,682.76,percent of total billed charges,65% of total billed charges,468.35,35.67,,374.68,percent of total billed charges,35.67% of total billed charges,380.77,1181.7,
BIT DRILL 2.0,27012528,CDM,270,RC,,,outpatient,,,701,280.40,,595.85,85,,476.68,percent of total billed charges,85% of total billed charges,539.77,77,,431.82,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,574.82,82,,459.856,percent of total billed charges,82% of total billed charges,595.85,85,,476.68,percent of total billed charges,85% of total billed charges,595.85,85,,476.68,percent of total billed charges,85% of total billed charges,595.85,85,,476.68,percent of total billed charges,85% of total billed charges,630.9,90,,504.72,percent of total billed charges,90% of total billed charges,560.8,80,,448.64,percent of total billed charges,80% of total billed charges,630.9,90,,504.72,percent of total billed charges,90% of total billed charges,525.75,75,,420.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,203.29,29,,162.632,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,469.67,67,,375.736,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,560.8,80,,448.64,percent of total billed charges,80% of total billed charges,455.65,65,,364.52,percent of total billed charges,65% of total billed charges,250.05,35.67,,200.04,percent of total billed charges,35.67% of total billed charges,203.29,630.9,
BEACON TIME OUT STERILE CLOTH,27012577,CDM,270,RC,,,outpatient,,,102,40.80,,86.7,85,,69.36,percent of total billed charges,85% of total billed charges,78.54,77,,62.83,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,83.64,82,,66.912,percent of total billed charges,82% of total billed charges,86.7,85,,69.36,percent of total billed charges,85% of total billed charges,86.7,85,,69.36,percent of total billed charges,85% of total billed charges,86.7,85,,69.36,percent of total billed charges,85% of total billed charges,91.8,90,,73.44,percent of total billed charges,90% of total billed charges,81.6,80,,65.28,percent of total billed charges,80% of total billed charges,91.8,90,,73.44,percent of total billed charges,90% of total billed charges,76.5,75,,61.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,29.58,29,,23.664,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,68.34,67,,54.672,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,81.6,80,,65.28,percent of total billed charges,80% of total billed charges,66.3,65,,53.04,percent of total billed charges,65% of total billed charges,36.38,35.67,,29.104,percent of total billed charges,35.67% of total billed charges,29.58,91.8,
DISSECTOR - KITTNER,27012633,CDM,270,RC,,,outpatient,,,102,40.80,,86.7,85,,69.36,percent of total billed charges,85% of total billed charges,78.54,77,,62.83,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,83.64,82,,66.912,percent of total billed charges,82% of total billed charges,86.7,85,,69.36,percent of total billed charges,85% of total billed charges,86.7,85,,69.36,percent of total billed charges,85% of total billed charges,86.7,85,,69.36,percent of total billed charges,85% of total billed charges,91.8,90,,73.44,percent of total billed charges,90% of total billed charges,81.6,80,,65.28,percent of total billed charges,80% of total billed charges,91.8,90,,73.44,percent of total billed charges,90% of total billed charges,76.5,75,,61.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,29.58,29,,23.664,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,68.34,67,,54.672,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,81.6,80,,65.28,percent of total billed charges,80% of total billed charges,66.3,65,,53.04,percent of total billed charges,65% of total billed charges,36.38,35.67,,29.104,percent of total billed charges,35.67% of total billed charges,29.58,91.8,
ENDO CLOSE TROCAR,27012638,CDM,270,RC,,,outpatient,,,379,151.60,,322.15,85,,257.72,percent of total billed charges,85% of total billed charges,291.83,77,,233.46,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,310.78,82,,248.624,percent of total billed charges,82% of total billed charges,322.15,85,,257.72,percent of total billed charges,85% of total billed charges,322.15,85,,257.72,percent of total billed charges,85% of total billed charges,322.15,85,,257.72,percent of total billed charges,85% of total billed charges,341.1,90,,272.88,percent of total billed charges,90% of total billed charges,303.2,80,,242.56,percent of total billed charges,80% of total billed charges,341.1,90,,272.88,percent of total billed charges,90% of total billed charges,284.25,75,,227.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,109.91,29,,87.928,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,253.93,67,,203.144,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,303.2,80,,242.56,percent of total billed charges,80% of total billed charges,246.35,65,,197.08,percent of total billed charges,65% of total billed charges,135.19,35.67,,108.152,percent of total billed charges,35.67% of total billed charges,109.91,341.1,
TK-TI KNOT DEVICE,27012648,CDM,270,RC,,,outpatient,,,785,314.00,,667.25,85,,533.8,percent of total billed charges,85% of total billed charges,604.45,77,,483.56,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,643.7,82,,514.96,percent of total billed charges,82% of total billed charges,667.25,85,,533.8,percent of total billed charges,85% of total billed charges,667.25,85,,533.8,percent of total billed charges,85% of total billed charges,667.25,85,,533.8,percent of total billed charges,85% of total billed charges,706.5,90,,565.2,percent of total billed charges,90% of total billed charges,628,80,,502.4,percent of total billed charges,80% of total billed charges,706.5,90,,565.2,percent of total billed charges,90% of total billed charges,588.75,75,,471,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,227.65,29,,182.12,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,525.95,67,,420.76,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,628,80,,502.4,percent of total billed charges,80% of total billed charges,510.25,65,,408.2,percent of total billed charges,65% of total billed charges,280.01,35.67,,224.008,percent of total billed charges,35.67% of total billed charges,227.65,706.5,
TK QUICK LOAD,27012649,CDM,270,RC,,,outpatient,,,271,108.40,,230.35,85,,184.28,percent of total billed charges,85% of total billed charges,208.67,77,,166.94,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,222.22,82,,177.776,percent of total billed charges,82% of total billed charges,230.35,85,,184.28,percent of total billed charges,85% of total billed charges,230.35,85,,184.28,percent of total billed charges,85% of total billed charges,230.35,85,,184.28,percent of total billed charges,85% of total billed charges,243.9,90,,195.12,percent of total billed charges,90% of total billed charges,216.8,80,,173.44,percent of total billed charges,80% of total billed charges,243.9,90,,195.12,percent of total billed charges,90% of total billed charges,203.25,75,,162.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,78.59,29,,62.872,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,181.57,67,,145.256,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,216.8,80,,173.44,percent of total billed charges,80% of total billed charges,176.15,65,,140.92,percent of total billed charges,65% of total billed charges,96.67,35.67,,77.336,percent of total billed charges,35.67% of total billed charges,78.59,243.9,
VERSASTEP DILATOR CANNULA,27012652,CDM,270,RC,,,outpatient,,,1265,506.00,,1075.25,85,,860.2,percent of total billed charges,85% of total billed charges,974.05,77,,779.24,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,1037.3,82,,829.84,percent of total billed charges,82% of total billed charges,1075.25,85,,860.2,percent of total billed charges,85% of total billed charges,1075.25,85,,860.2,percent of total billed charges,85% of total billed charges,1075.25,85,,860.2,percent of total billed charges,85% of total billed charges,1138.5,90,,910.8,percent of total billed charges,90% of total billed charges,1012,80,,809.6,percent of total billed charges,80% of total billed charges,1138.5,90,,910.8,percent of total billed charges,90% of total billed charges,948.75,75,,759,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,366.85,29,,293.48,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,847.55,67,,678.04,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1012,80,,809.6,percent of total billed charges,80% of total billed charges,822.25,65,,657.8,percent of total billed charges,65% of total billed charges,451.23,35.67,,360.984,percent of total billed charges,35.67% of total billed charges,366.85,1138.5,
STAPLER ESCHELON ENDOPATH 60,27012664,CDM,270,RC,,,outpatient,,,4358,1743.20,,3704.3,85,,2963.44,percent of total billed charges,85% of total billed charges,3355.66,77,,2684.53,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,3573.56,82,,2858.848,percent of total billed charges,82% of total billed charges,3704.3,85,,2963.44,percent of total billed charges,85% of total billed charges,3704.3,85,,2963.44,percent of total billed charges,85% of total billed charges,3704.3,85,,2963.44,percent of total billed charges,85% of total billed charges,3922.2,90,,3137.76,percent of total billed charges,90% of total billed charges,3486.4,80,,2789.12,percent of total billed charges,80% of total billed charges,3922.2,90,,3137.76,percent of total billed charges,90% of total billed charges,3268.5,75,,2614.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,1263.82,29,,1011.056,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,2919.86,67,,2335.888,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,3486.4,80,,2789.12,percent of total billed charges,80% of total billed charges,2832.7,65,,2266.16,percent of total billed charges,65% of total billed charges,1554.5,35.67,,1243.6,percent of total billed charges,35.67% of total billed charges,1263.82,3922.2,
SUTURE PDS,27012671,CDM,270,RC,,,outpatient,,,105,42.00,,89.25,85,,71.4,percent of total billed charges,85% of total billed charges,80.85,77,,64.68,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,86.1,82,,68.88,percent of total billed charges,82% of total billed charges,89.25,85,,71.4,percent of total billed charges,85% of total billed charges,89.25,85,,71.4,percent of total billed charges,85% of total billed charges,89.25,85,,71.4,percent of total billed charges,85% of total billed charges,94.5,90,,75.6,percent of total billed charges,90% of total billed charges,84,80,,67.2,percent of total billed charges,80% of total billed charges,94.5,90,,75.6,percent of total billed charges,90% of total billed charges,78.75,75,,63,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,30.45,29,,24.36,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,70.35,67,,56.28,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,84,80,,67.2,percent of total billed charges,80% of total billed charges,68.25,65,,54.6,percent of total billed charges,65% of total billed charges,37.45,35.67,,29.96,percent of total billed charges,35.67% of total billed charges,30.45,94.5,
SUTURE ENDOLOOP PDS,27012672,CDM,270,RC,,,outpatient,,,657,262.80,,558.45,85,,446.76,percent of total billed charges,85% of total billed charges,505.89,77,,404.71,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,538.74,82,,430.992,percent of total billed charges,82% of total billed charges,558.45,85,,446.76,percent of total billed charges,85% of total billed charges,558.45,85,,446.76,percent of total billed charges,85% of total billed charges,558.45,85,,446.76,percent of total billed charges,85% of total billed charges,591.3,90,,473.04,percent of total billed charges,90% of total billed charges,525.6,80,,420.48,percent of total billed charges,80% of total billed charges,591.3,90,,473.04,percent of total billed charges,90% of total billed charges,492.75,75,,394.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,190.53,29,,152.424,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,440.19,67,,352.152,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,525.6,80,,420.48,percent of total billed charges,80% of total billed charges,427.05,65,,341.64,percent of total billed charges,65% of total billed charges,234.35,35.67,,187.48,percent of total billed charges,35.67% of total billed charges,190.53,591.3,
SUTURE CHROMIC GUT,27012673,CDM,270,RC,,,outpatient,,,446,178.40,,379.1,85,,303.28,percent of total billed charges,85% of total billed charges,343.42,77,,274.74,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,365.72,82,,292.576,percent of total billed charges,82% of total billed charges,379.1,85,,303.28,percent of total billed charges,85% of total billed charges,379.1,85,,303.28,percent of total billed charges,85% of total billed charges,379.1,85,,303.28,percent of total billed charges,85% of total billed charges,401.4,90,,321.12,percent of total billed charges,90% of total billed charges,356.8,80,,285.44,percent of total billed charges,80% of total billed charges,401.4,90,,321.12,percent of total billed charges,90% of total billed charges,334.5,75,,267.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,129.34,29,,103.472,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,298.82,67,,239.056,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,356.8,80,,285.44,percent of total billed charges,80% of total billed charges,289.9,65,,231.92,percent of total billed charges,65% of total billed charges,159.09,35.67,,127.272,percent of total billed charges,35.67% of total billed charges,129.34,401.4,
STAPLER ESCHELON ENDOPATH 45 M,27012676,CDM,270,RC,,,outpatient,,,372,148.80,,316.2,85,,252.96,percent of total billed charges,85% of total billed charges,286.44,77,,229.15,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,305.04,82,,244.032,percent of total billed charges,82% of total billed charges,316.2,85,,252.96,percent of total billed charges,85% of total billed charges,316.2,85,,252.96,percent of total billed charges,85% of total billed charges,316.2,85,,252.96,percent of total billed charges,85% of total billed charges,334.8,90,,267.84,percent of total billed charges,90% of total billed charges,297.6,80,,238.08,percent of total billed charges,80% of total billed charges,334.8,90,,267.84,percent of total billed charges,90% of total billed charges,279,75,,223.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,107.88,29,,86.304,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,249.24,67,,199.392,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,297.6,80,,238.08,percent of total billed charges,80% of total billed charges,241.8,65,,193.44,percent of total billed charges,65% of total billed charges,132.69,35.67,,106.152,percent of total billed charges,35.67% of total billed charges,107.88,334.8,
LOAD ESCHELON ENDOPATH 45 MM,27012677,CDM,270,RC,,,outpatient,,,2139,855.60,,1818.15,85,,1454.52,percent of total billed charges,85% of total billed charges,1647.03,77,,1317.62,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,1753.98,82,,1403.184,percent of total billed charges,82% of total billed charges,1818.15,85,,1454.52,percent of total billed charges,85% of total billed charges,1818.15,85,,1454.52,percent of total billed charges,85% of total billed charges,1818.15,85,,1454.52,percent of total billed charges,85% of total billed charges,1925.1,90,,1540.08,percent of total billed charges,90% of total billed charges,1711.2,80,,1368.96,percent of total billed charges,80% of total billed charges,1925.1,90,,1540.08,percent of total billed charges,90% of total billed charges,1604.25,75,,1283.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,620.31,29,,496.248,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1433.13,67,,1146.504,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1711.2,80,,1368.96,percent of total billed charges,80% of total billed charges,1390.35,65,,1112.28,percent of total billed charges,65% of total billed charges,762.98,35.67,,610.384,percent of total billed charges,35.67% of total billed charges,620.31,1925.1,
LOAD ESCHELON ENDOPATH BLE 45,27012678,CDM,270,RC,,,outpatient,,,2139,855.60,,1818.15,85,,1454.52,percent of total billed charges,85% of total billed charges,1647.03,77,,1317.62,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,1753.98,82,,1403.184,percent of total billed charges,82% of total billed charges,1818.15,85,,1454.52,percent of total billed charges,85% of total billed charges,1818.15,85,,1454.52,percent of total billed charges,85% of total billed charges,1818.15,85,,1454.52,percent of total billed charges,85% of total billed charges,1925.1,90,,1540.08,percent of total billed charges,90% of total billed charges,1711.2,80,,1368.96,percent of total billed charges,80% of total billed charges,1925.1,90,,1540.08,percent of total billed charges,90% of total billed charges,1604.25,75,,1283.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,620.31,29,,496.248,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1433.13,67,,1146.504,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1711.2,80,,1368.96,percent of total billed charges,80% of total billed charges,1390.35,65,,1112.28,percent of total billed charges,65% of total billed charges,762.98,35.67,,610.384,percent of total billed charges,35.67% of total billed charges,620.31,1925.1,
LOAD ESCHELON ENDOPATH GRN 45,27012679,CDM,270,RC,,,outpatient,,,2139,855.60,,1818.15,85,,1454.52,percent of total billed charges,85% of total billed charges,1647.03,77,,1317.62,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,1753.98,82,,1403.184,percent of total billed charges,82% of total billed charges,1818.15,85,,1454.52,percent of total billed charges,85% of total billed charges,1818.15,85,,1454.52,percent of total billed charges,85% of total billed charges,1818.15,85,,1454.52,percent of total billed charges,85% of total billed charges,1925.1,90,,1540.08,percent of total billed charges,90% of total billed charges,1711.2,80,,1368.96,percent of total billed charges,80% of total billed charges,1925.1,90,,1540.08,percent of total billed charges,90% of total billed charges,1604.25,75,,1283.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,620.31,29,,496.248,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1433.13,67,,1146.504,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1711.2,80,,1368.96,percent of total billed charges,80% of total billed charges,1390.35,65,,1112.28,percent of total billed charges,65% of total billed charges,762.98,35.67,,610.384,percent of total billed charges,35.67% of total billed charges,620.31,1925.1,
LOAD ESCHELON ENDOPATH BLU 60,27012680,CDM,270,RC,,,outpatient,,,1921,768.40,,1632.85,85,,1306.28,percent of total billed charges,85% of total billed charges,1479.17,77,,1183.34,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,1575.22,82,,1260.176,percent of total billed charges,82% of total billed charges,1632.85,85,,1306.28,percent of total billed charges,85% of total billed charges,1632.85,85,,1306.28,percent of total billed charges,85% of total billed charges,1632.85,85,,1306.28,percent of total billed charges,85% of total billed charges,1728.9,90,,1383.12,percent of total billed charges,90% of total billed charges,1536.8,80,,1229.44,percent of total billed charges,80% of total billed charges,1728.9,90,,1383.12,percent of total billed charges,90% of total billed charges,1440.75,75,,1152.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,557.09,29,,445.672,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1287.07,67,,1029.656,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1536.8,80,,1229.44,percent of total billed charges,80% of total billed charges,1248.65,65,,998.92,percent of total billed charges,65% of total billed charges,685.22,35.67,,548.176,percent of total billed charges,35.67% of total billed charges,557.09,1728.9,
LOAD ESCHELON ENDOPATH GRN 60,27012681,CDM,270,RC,,,outpatient,,,1921,768.40,,1632.85,85,,1306.28,percent of total billed charges,85% of total billed charges,1479.17,77,,1183.34,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,1575.22,82,,1260.176,percent of total billed charges,82% of total billed charges,1632.85,85,,1306.28,percent of total billed charges,85% of total billed charges,1632.85,85,,1306.28,percent of total billed charges,85% of total billed charges,1632.85,85,,1306.28,percent of total billed charges,85% of total billed charges,1728.9,90,,1383.12,percent of total billed charges,90% of total billed charges,1536.8,80,,1229.44,percent of total billed charges,80% of total billed charges,1728.9,90,,1383.12,percent of total billed charges,90% of total billed charges,1440.75,75,,1152.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,557.09,29,,445.672,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1287.07,67,,1029.656,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1536.8,80,,1229.44,percent of total billed charges,80% of total billed charges,1248.65,65,,998.92,percent of total billed charges,65% of total billed charges,685.22,35.67,,548.176,percent of total billed charges,35.67% of total billed charges,557.09,1728.9,
LOAD ESCHELON ENDOPATH BLAC 60,27012682,CDM,270,RC,,,outpatient,,,1921,768.40,,1632.85,85,,1306.28,percent of total billed charges,85% of total billed charges,1479.17,77,,1183.34,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,1575.22,82,,1260.176,percent of total billed charges,82% of total billed charges,1632.85,85,,1306.28,percent of total billed charges,85% of total billed charges,1632.85,85,,1306.28,percent of total billed charges,85% of total billed charges,1632.85,85,,1306.28,percent of total billed charges,85% of total billed charges,1728.9,90,,1383.12,percent of total billed charges,90% of total billed charges,1536.8,80,,1229.44,percent of total billed charges,80% of total billed charges,1728.9,90,,1383.12,percent of total billed charges,90% of total billed charges,1440.75,75,,1152.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,557.09,29,,445.672,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1287.07,67,,1029.656,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1536.8,80,,1229.44,percent of total billed charges,80% of total billed charges,1248.65,65,,998.92,percent of total billed charges,65% of total billed charges,685.22,35.67,,548.176,percent of total billed charges,35.67% of total billed charges,557.09,1728.9,
HARMONIC 9 CM,27012687,CDM,270,RC,,,outpatient,,,2333,933.20,,1983.05,85,,1586.44,percent of total billed charges,85% of total billed charges,1796.41,77,,1437.13,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,1913.06,82,,1530.448,percent of total billed charges,82% of total billed charges,1983.05,85,,1586.44,percent of total billed charges,85% of total billed charges,1983.05,85,,1586.44,percent of total billed charges,85% of total billed charges,1983.05,85,,1586.44,percent of total billed charges,85% of total billed charges,2099.7,90,,1679.76,percent of total billed charges,90% of total billed charges,1866.4,80,,1493.12,percent of total billed charges,80% of total billed charges,2099.7,90,,1679.76,percent of total billed charges,90% of total billed charges,1749.75,75,,1399.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,676.57,29,,541.256,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1563.11,67,,1250.488,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1866.4,80,,1493.12,percent of total billed charges,80% of total billed charges,1516.45,65,,1213.16,percent of total billed charges,65% of total billed charges,832.18,35.67,,665.744,percent of total billed charges,35.67% of total billed charges,676.57,2099.7,
CHROMIC CATGUT SUTURE,27012692,CDM,270,RC,,,outpatient,,,70,28.00,,59.5,85,,47.6,percent of total billed charges,85% of total billed charges,53.9,77,,43.12,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,57.4,82,,45.92,percent of total billed charges,82% of total billed charges,59.5,85,,47.6,percent of total billed charges,85% of total billed charges,59.5,85,,47.6,percent of total billed charges,85% of total billed charges,59.5,85,,47.6,percent of total billed charges,85% of total billed charges,63,90,,50.4,percent of total billed charges,90% of total billed charges,56,80,,44.8,percent of total billed charges,80% of total billed charges,63,90,,50.4,percent of total billed charges,90% of total billed charges,52.5,75,,42,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,20.3,29,,16.24,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,46.9,67,,37.52,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,56,80,,44.8,percent of total billed charges,80% of total billed charges,45.5,65,,36.4,percent of total billed charges,65% of total billed charges,24.97,35.67,,19.976,percent of total billed charges,35.67% of total billed charges,20.3,63,
AVITENE COLLAGEN HEMOSTAT,27012693,CDM,270,RC,,,outpatient,,,574,229.60,,487.9,85,,390.32,percent of total billed charges,85% of total billed charges,441.98,77,,353.58,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,470.68,82,,376.544,percent of total billed charges,82% of total billed charges,487.9,85,,390.32,percent of total billed charges,85% of total billed charges,487.9,85,,390.32,percent of total billed charges,85% of total billed charges,487.9,85,,390.32,percent of total billed charges,85% of total billed charges,516.6,90,,413.28,percent of total billed charges,90% of total billed charges,459.2,80,,367.36,percent of total billed charges,80% of total billed charges,516.6,90,,413.28,percent of total billed charges,90% of total billed charges,430.5,75,,344.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,166.46,29,,133.168,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,384.58,67,,307.664,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,459.2,80,,367.36,percent of total billed charges,80% of total billed charges,373.1,65,,298.48,percent of total billed charges,65% of total billed charges,204.75,35.67,,163.8,percent of total billed charges,35.67% of total billed charges,166.46,516.6,
CHEST TUBE KIT,27012725,CDM,270,RC,,,outpatient,,,680,272.00,,578,85,,462.4,percent of total billed charges,85% of total billed charges,523.6,77,,418.88,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,557.6,82,,446.08,percent of total billed charges,82% of total billed charges,578,85,,462.4,percent of total billed charges,85% of total billed charges,578,85,,462.4,percent of total billed charges,85% of total billed charges,578,85,,462.4,percent of total billed charges,85% of total billed charges,612,90,,489.6,percent of total billed charges,90% of total billed charges,544,80,,435.2,percent of total billed charges,80% of total billed charges,612,90,,489.6,percent of total billed charges,90% of total billed charges,510,75,,408,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,197.2,29,,157.76,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,455.6,67,,364.48,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,544,80,,435.2,percent of total billed charges,80% of total billed charges,442,65,,353.6,percent of total billed charges,65% of total billed charges,242.56,35.67,,194.048,percent of total billed charges,35.67% of total billed charges,197.2,612,
PRESSURE SENSOR TUBING,27012727,CDM,270,RC,,,outpatient,,,243,97.20,,206.55,85,,165.24,percent of total billed charges,85% of total billed charges,187.11,77,,149.69,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,199.26,82,,159.408,percent of total billed charges,82% of total billed charges,206.55,85,,165.24,percent of total billed charges,85% of total billed charges,206.55,85,,165.24,percent of total billed charges,85% of total billed charges,206.55,85,,165.24,percent of total billed charges,85% of total billed charges,218.7,90,,174.96,percent of total billed charges,90% of total billed charges,194.4,80,,155.52,percent of total billed charges,80% of total billed charges,218.7,90,,174.96,percent of total billed charges,90% of total billed charges,182.25,75,,145.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,70.47,29,,56.376,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,162.81,67,,130.248,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,194.4,80,,155.52,percent of total billed charges,80% of total billed charges,157.95,65,,126.36,percent of total billed charges,65% of total billed charges,86.68,35.67,,69.344,percent of total billed charges,35.67% of total billed charges,70.47,218.7,
TUBING WITH LAPROFLATOR,27012729,CDM,270,RC,,,outpatient,,,33,13.20,,28.05,85,,22.44,percent of total billed charges,85% of total billed charges,25.41,77,,20.33,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,27.06,82,,21.648,percent of total billed charges,82% of total billed charges,28.05,85,,22.44,percent of total billed charges,85% of total billed charges,28.05,85,,22.44,percent of total billed charges,85% of total billed charges,28.05,85,,22.44,percent of total billed charges,85% of total billed charges,29.7,90,,23.76,percent of total billed charges,90% of total billed charges,26.4,80,,21.12,percent of total billed charges,80% of total billed charges,29.7,90,,23.76,percent of total billed charges,90% of total billed charges,24.75,75,,19.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,9.57,29,,7.656,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,22.11,67,,17.688,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,26.4,80,,21.12,percent of total billed charges,80% of total billed charges,21.45,65,,17.16,percent of total billed charges,65% of total billed charges,11.77,35.67,,9.416,percent of total billed charges,35.67% of total billed charges,9.57,29.7,
INSUFFLATION TUBING,27012731,CDM,270,RC,,,outpatient,,,177,70.80,,150.45,85,,120.36,percent of total billed charges,85% of total billed charges,136.29,77,,109.03,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,145.14,82,,116.112,percent of total billed charges,82% of total billed charges,150.45,85,,120.36,percent of total billed charges,85% of total billed charges,150.45,85,,120.36,percent of total billed charges,85% of total billed charges,150.45,85,,120.36,percent of total billed charges,85% of total billed charges,159.3,90,,127.44,percent of total billed charges,90% of total billed charges,141.6,80,,113.28,percent of total billed charges,80% of total billed charges,159.3,90,,127.44,percent of total billed charges,90% of total billed charges,132.75,75,,106.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,51.33,29,,41.064,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,118.59,67,,94.872,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,141.6,80,,113.28,percent of total billed charges,80% of total billed charges,115.05,65,,92.04,percent of total billed charges,65% of total billed charges,63.14,35.67,,50.512,percent of total billed charges,35.67% of total billed charges,51.33,159.3,
PROLENE 0,27012741,CDM,270,RC,,,outpatient,,,238,95.20,,202.3,85,,161.84,percent of total billed charges,85% of total billed charges,183.26,77,,146.61,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,195.16,82,,156.128,percent of total billed charges,82% of total billed charges,202.3,85,,161.84,percent of total billed charges,85% of total billed charges,202.3,85,,161.84,percent of total billed charges,85% of total billed charges,202.3,85,,161.84,percent of total billed charges,85% of total billed charges,214.2,90,,171.36,percent of total billed charges,90% of total billed charges,190.4,80,,152.32,percent of total billed charges,80% of total billed charges,214.2,90,,171.36,percent of total billed charges,90% of total billed charges,178.5,75,,142.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,69.02,29,,55.216,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,159.46,67,,127.568,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,190.4,80,,152.32,percent of total billed charges,80% of total billed charges,154.7,65,,123.76,percent of total billed charges,65% of total billed charges,84.89,35.67,,67.912,percent of total billed charges,35.67% of total billed charges,69.02,214.2,
PALASCO R&G,27012749,CDM,270,RC,,,outpatient,,,1063,425.20,,903.55,85,,722.84,percent of total billed charges,85% of total billed charges,818.51,77,,654.81,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,871.66,82,,697.328,percent of total billed charges,82% of total billed charges,903.55,85,,722.84,percent of total billed charges,85% of total billed charges,903.55,85,,722.84,percent of total billed charges,85% of total billed charges,903.55,85,,722.84,percent of total billed charges,85% of total billed charges,956.7,90,,765.36,percent of total billed charges,90% of total billed charges,850.4,80,,680.32,percent of total billed charges,80% of total billed charges,956.7,90,,765.36,percent of total billed charges,90% of total billed charges,797.25,75,,637.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,308.27,29,,246.616,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,712.21,67,,569.768,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,850.4,80,,680.32,percent of total billed charges,80% of total billed charges,690.95,65,,552.76,percent of total billed charges,65% of total billed charges,379.17,35.67,,303.336,percent of total billed charges,35.67% of total billed charges,308.27,956.7,
ETHICON SUTURE,27012750,CDM,270,RC,,,outpatient,,,182,72.80,,154.7,85,,123.76,percent of total billed charges,85% of total billed charges,140.14,77,,112.11,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,149.24,82,,119.392,percent of total billed charges,82% of total billed charges,154.7,85,,123.76,percent of total billed charges,85% of total billed charges,154.7,85,,123.76,percent of total billed charges,85% of total billed charges,154.7,85,,123.76,percent of total billed charges,85% of total billed charges,163.8,90,,131.04,percent of total billed charges,90% of total billed charges,145.6,80,,116.48,percent of total billed charges,80% of total billed charges,163.8,90,,131.04,percent of total billed charges,90% of total billed charges,136.5,75,,109.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,52.78,29,,42.224,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,121.94,67,,97.552,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,145.6,80,,116.48,percent of total billed charges,80% of total billed charges,118.3,65,,94.64,percent of total billed charges,65% of total billed charges,64.92,35.67,,51.936,percent of total billed charges,35.67% of total billed charges,52.78,163.8,
INFANT CONNECTOR STRAIGHT,27012761,CDM,270,RC,,,outpatient,,,71,28.40,,60.35,85,,48.28,percent of total billed charges,85% of total billed charges,54.67,77,,43.74,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,58.22,82,,46.576,percent of total billed charges,82% of total billed charges,60.35,85,,48.28,percent of total billed charges,85% of total billed charges,60.35,85,,48.28,percent of total billed charges,85% of total billed charges,60.35,85,,48.28,percent of total billed charges,85% of total billed charges,63.9,90,,51.12,percent of total billed charges,90% of total billed charges,56.8,80,,45.44,percent of total billed charges,80% of total billed charges,63.9,90,,51.12,percent of total billed charges,90% of total billed charges,53.25,75,,42.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,20.59,29,,16.472,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,47.57,67,,38.056,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,56.8,80,,45.44,percent of total billed charges,80% of total billed charges,46.15,65,,36.92,percent of total billed charges,65% of total billed charges,25.33,35.67,,20.264,percent of total billed charges,35.67% of total billed charges,20.59,63.9,
SUTURE BRAIDED ENDOEVOLUTION,27012766,CDM,270,RC,,,outpatient,,,1427,570.80,,1212.95,85,,970.36,percent of total billed charges,85% of total billed charges,1098.79,77,,879.03,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,1170.14,82,,936.112,percent of total billed charges,82% of total billed charges,1212.95,85,,970.36,percent of total billed charges,85% of total billed charges,1212.95,85,,970.36,percent of total billed charges,85% of total billed charges,1212.95,85,,970.36,percent of total billed charges,85% of total billed charges,1284.3,90,,1027.44,percent of total billed charges,90% of total billed charges,1141.6,80,,913.28,percent of total billed charges,80% of total billed charges,1284.3,90,,1027.44,percent of total billed charges,90% of total billed charges,1070.25,75,,856.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,413.83,29,,331.064,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,956.09,67,,764.872,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1141.6,80,,913.28,percent of total billed charges,80% of total billed charges,927.55,65,,742.04,percent of total billed charges,65% of total billed charges,509.01,35.67,,407.208,percent of total billed charges,35.67% of total billed charges,413.83,1284.3,
SUTURE NON ABSORBABLE ENDOEVOL,27012767,CDM,270,RC,,,outpatient,,,2179,871.60,,1852.15,85,,1481.72,percent of total billed charges,85% of total billed charges,1677.83,77,,1342.26,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,1786.78,82,,1429.424,percent of total billed charges,82% of total billed charges,1852.15,85,,1481.72,percent of total billed charges,85% of total billed charges,1852.15,85,,1481.72,percent of total billed charges,85% of total billed charges,1852.15,85,,1481.72,percent of total billed charges,85% of total billed charges,1961.1,90,,1568.88,percent of total billed charges,90% of total billed charges,1743.2,80,,1394.56,percent of total billed charges,80% of total billed charges,1961.1,90,,1568.88,percent of total billed charges,90% of total billed charges,1634.25,75,,1307.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,631.91,29,,505.528,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1459.93,67,,1167.944,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1743.2,80,,1394.56,percent of total billed charges,80% of total billed charges,1416.35,65,,1133.08,percent of total billed charges,65% of total billed charges,777.25,35.67,,621.8,percent of total billed charges,35.67% of total billed charges,631.91,1961.1,
SUTURE MONOCRYL 27,27012784,CDM,270,RC,,,outpatient,,,84,33.60,,71.4,85,,57.12,percent of total billed charges,85% of total billed charges,64.68,77,,51.74,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,68.88,82,,55.104,percent of total billed charges,82% of total billed charges,71.4,85,,57.12,percent of total billed charges,85% of total billed charges,71.4,85,,57.12,percent of total billed charges,85% of total billed charges,71.4,85,,57.12,percent of total billed charges,85% of total billed charges,75.6,90,,60.48,percent of total billed charges,90% of total billed charges,67.2,80,,53.76,percent of total billed charges,80% of total billed charges,75.6,90,,60.48,percent of total billed charges,90% of total billed charges,63,75,,50.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,24.36,29,,19.488,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,56.28,67,,45.024,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,67.2,80,,53.76,percent of total billed charges,80% of total billed charges,54.6,65,,43.68,percent of total billed charges,65% of total billed charges,29.96,35.67,,23.968,percent of total billed charges,35.67% of total billed charges,24.36,75.6,
SUTURE MONOCRYL 2-0,27012785,CDM,270,RC,,,outpatient,,,81,32.40,,68.85,85,,55.08,percent of total billed charges,85% of total billed charges,62.37,77,,49.9,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,66.42,82,,53.136,percent of total billed charges,82% of total billed charges,68.85,85,,55.08,percent of total billed charges,85% of total billed charges,68.85,85,,55.08,percent of total billed charges,85% of total billed charges,68.85,85,,55.08,percent of total billed charges,85% of total billed charges,72.9,90,,58.32,percent of total billed charges,90% of total billed charges,64.8,80,,51.84,percent of total billed charges,80% of total billed charges,72.9,90,,58.32,percent of total billed charges,90% of total billed charges,60.75,75,,48.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,23.49,29,,18.792,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,54.27,67,,43.416,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,64.8,80,,51.84,percent of total billed charges,80% of total billed charges,52.65,65,,42.12,percent of total billed charges,65% of total billed charges,28.89,35.67,,23.112,percent of total billed charges,35.67% of total billed charges,23.49,72.9,
SUTURE MONOCRYL 3-0,27012786,CDM,270,RC,,,outpatient,,,81,32.40,,68.85,85,,55.08,percent of total billed charges,85% of total billed charges,62.37,77,,49.9,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,66.42,82,,53.136,percent of total billed charges,82% of total billed charges,68.85,85,,55.08,percent of total billed charges,85% of total billed charges,68.85,85,,55.08,percent of total billed charges,85% of total billed charges,68.85,85,,55.08,percent of total billed charges,85% of total billed charges,72.9,90,,58.32,percent of total billed charges,90% of total billed charges,64.8,80,,51.84,percent of total billed charges,80% of total billed charges,72.9,90,,58.32,percent of total billed charges,90% of total billed charges,60.75,75,,48.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,23.49,29,,18.792,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,54.27,67,,43.416,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,64.8,80,,51.84,percent of total billed charges,80% of total billed charges,52.65,65,,42.12,percent of total billed charges,65% of total billed charges,28.89,35.67,,23.112,percent of total billed charges,35.67% of total billed charges,23.49,72.9,
SUTURE PDS,27012787,CDM,270,RC,,,outpatient,,,100,40.00,,85,85,,68,percent of total billed charges,85% of total billed charges,77,77,,61.6,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,82,82,,65.6,percent of total billed charges,82% of total billed charges,85,85,,68,percent of total billed charges,85% of total billed charges,85,85,,68,percent of total billed charges,85% of total billed charges,85,85,,68,percent of total billed charges,85% of total billed charges,90,90,,72,percent of total billed charges,90% of total billed charges,80,80,,64,percent of total billed charges,80% of total billed charges,90,90,,72,percent of total billed charges,90% of total billed charges,75,75,,60,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,29,29,,23.2,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,67,67,,53.6,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,80,80,,64,percent of total billed charges,80% of total billed charges,65,65,,52,percent of total billed charges,65% of total billed charges,35.67,35.67,,28.536,percent of total billed charges,35.67% of total billed charges,29,90,
SUTURE CTD VICRYL,27012788,CDM,270,RC,,,outpatient,,,80,32.00,,68,85,,54.4,percent of total billed charges,85% of total billed charges,61.6,77,,49.28,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,65.6,82,,52.48,percent of total billed charges,82% of total billed charges,68,85,,54.4,percent of total billed charges,85% of total billed charges,68,85,,54.4,percent of total billed charges,85% of total billed charges,68,85,,54.4,percent of total billed charges,85% of total billed charges,72,90,,57.6,percent of total billed charges,90% of total billed charges,64,80,,51.2,percent of total billed charges,80% of total billed charges,72,90,,57.6,percent of total billed charges,90% of total billed charges,60,75,,48,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,23.2,29,,18.56,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,53.6,67,,42.88,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,64,80,,51.2,percent of total billed charges,80% of total billed charges,52,65,,41.6,percent of total billed charges,65% of total billed charges,28.54,35.67,,22.832,percent of total billed charges,35.67% of total billed charges,23.2,72,
SUTURE PLAIN GUT,27012789,CDM,270,RC,,,outpatient,,,118,47.20,,100.3,85,,80.24,percent of total billed charges,85% of total billed charges,90.86,77,,72.69,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,96.76,82,,77.408,percent of total billed charges,82% of total billed charges,100.3,85,,80.24,percent of total billed charges,85% of total billed charges,100.3,85,,80.24,percent of total billed charges,85% of total billed charges,100.3,85,,80.24,percent of total billed charges,85% of total billed charges,106.2,90,,84.96,percent of total billed charges,90% of total billed charges,94.4,80,,75.52,percent of total billed charges,80% of total billed charges,106.2,90,,84.96,percent of total billed charges,90% of total billed charges,88.5,75,,70.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,34.22,29,,27.376,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,79.06,67,,63.248,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,94.4,80,,75.52,percent of total billed charges,80% of total billed charges,76.7,65,,61.36,percent of total billed charges,65% of total billed charges,42.09,35.67,,33.672,percent of total billed charges,35.67% of total billed charges,34.22,106.2,
TROCAR 5 MM,27012799,CDM,270,RC,,,outpatient,,,218,87.20,,185.3,85,,148.24,percent of total billed charges,85% of total billed charges,167.86,77,,134.29,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,178.76,82,,143.008,percent of total billed charges,82% of total billed charges,185.3,85,,148.24,percent of total billed charges,85% of total billed charges,185.3,85,,148.24,percent of total billed charges,85% of total billed charges,185.3,85,,148.24,percent of total billed charges,85% of total billed charges,196.2,90,,156.96,percent of total billed charges,90% of total billed charges,174.4,80,,139.52,percent of total billed charges,80% of total billed charges,196.2,90,,156.96,percent of total billed charges,90% of total billed charges,163.5,75,,130.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,63.22,29,,50.576,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,146.06,67,,116.848,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,174.4,80,,139.52,percent of total billed charges,80% of total billed charges,141.7,65,,113.36,percent of total billed charges,65% of total billed charges,77.76,35.67,,62.208,percent of total billed charges,35.67% of total billed charges,63.22,196.2,
TROCAR 11 MM,27012800,CDM,270,RC,,,outpatient,,,286,114.40,,243.1,85,,194.48,percent of total billed charges,85% of total billed charges,220.22,77,,176.18,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,234.52,82,,187.616,percent of total billed charges,82% of total billed charges,243.1,85,,194.48,percent of total billed charges,85% of total billed charges,243.1,85,,194.48,percent of total billed charges,85% of total billed charges,243.1,85,,194.48,percent of total billed charges,85% of total billed charges,257.4,90,,205.92,percent of total billed charges,90% of total billed charges,228.8,80,,183.04,percent of total billed charges,80% of total billed charges,257.4,90,,205.92,percent of total billed charges,90% of total billed charges,214.5,75,,171.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,82.94,29,,66.352,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,191.62,67,,153.296,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,228.8,80,,183.04,percent of total billed charges,80% of total billed charges,185.9,65,,148.72,percent of total billed charges,65% of total billed charges,102.02,35.67,,81.616,percent of total billed charges,35.67% of total billed charges,82.94,257.4,
TROCAR 12 MM,27012801,CDM,270,RC,,,outpatient,,,218,87.20,,185.3,85,,148.24,percent of total billed charges,85% of total billed charges,167.86,77,,134.29,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,178.76,82,,143.008,percent of total billed charges,82% of total billed charges,185.3,85,,148.24,percent of total billed charges,85% of total billed charges,185.3,85,,148.24,percent of total billed charges,85% of total billed charges,185.3,85,,148.24,percent of total billed charges,85% of total billed charges,196.2,90,,156.96,percent of total billed charges,90% of total billed charges,174.4,80,,139.52,percent of total billed charges,80% of total billed charges,196.2,90,,156.96,percent of total billed charges,90% of total billed charges,163.5,75,,130.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,63.22,29,,50.576,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,146.06,67,,116.848,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,174.4,80,,139.52,percent of total billed charges,80% of total billed charges,141.7,65,,113.36,percent of total billed charges,65% of total billed charges,77.76,35.67,,62.208,percent of total billed charges,35.67% of total billed charges,63.22,196.2,
RETRACTOR,27012803,CDM,270,RC,,,outpatient,,,406,162.40,,345.1,85,,276.08,percent of total billed charges,85% of total billed charges,312.62,77,,250.1,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,332.92,82,,266.336,percent of total billed charges,82% of total billed charges,345.1,85,,276.08,percent of total billed charges,85% of total billed charges,345.1,85,,276.08,percent of total billed charges,85% of total billed charges,345.1,85,,276.08,percent of total billed charges,85% of total billed charges,365.4,90,,292.32,percent of total billed charges,90% of total billed charges,324.8,80,,259.84,percent of total billed charges,80% of total billed charges,365.4,90,,292.32,percent of total billed charges,90% of total billed charges,304.5,75,,243.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,117.74,29,,94.192,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,272.02,67,,217.616,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,324.8,80,,259.84,percent of total billed charges,80% of total billed charges,263.9,65,,211.12,percent of total billed charges,65% of total billed charges,144.82,35.67,,115.856,percent of total billed charges,35.67% of total billed charges,117.74,365.4,
CATHETER MALECOT,27012809,CDM,270,RC,,,outpatient,,,129,51.60,,109.65,85,,87.72,percent of total billed charges,85% of total billed charges,99.33,77,,79.46,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,105.78,82,,84.624,percent of total billed charges,82% of total billed charges,109.65,85,,87.72,percent of total billed charges,85% of total billed charges,109.65,85,,87.72,percent of total billed charges,85% of total billed charges,109.65,85,,87.72,percent of total billed charges,85% of total billed charges,116.1,90,,92.88,percent of total billed charges,90% of total billed charges,103.2,80,,82.56,percent of total billed charges,80% of total billed charges,116.1,90,,92.88,percent of total billed charges,90% of total billed charges,96.75,75,,77.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,37.41,29,,29.928,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,86.43,67,,69.144,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,103.2,80,,82.56,percent of total billed charges,80% of total billed charges,83.85,65,,67.08,percent of total billed charges,65% of total billed charges,46.01,35.67,,36.808,percent of total billed charges,35.67% of total billed charges,37.41,116.1,
CORE BIOPSY NEEDLE,27012820,CDM,270,RC,,,outpatient,,,368,147.20,,312.8,85,,250.24,percent of total billed charges,85% of total billed charges,283.36,77,,226.69,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,301.76,82,,241.408,percent of total billed charges,82% of total billed charges,312.8,85,,250.24,percent of total billed charges,85% of total billed charges,312.8,85,,250.24,percent of total billed charges,85% of total billed charges,312.8,85,,250.24,percent of total billed charges,85% of total billed charges,331.2,90,,264.96,percent of total billed charges,90% of total billed charges,294.4,80,,235.52,percent of total billed charges,80% of total billed charges,331.2,90,,264.96,percent of total billed charges,90% of total billed charges,276,75,,220.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,106.72,29,,85.376,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,246.56,67,,197.248,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,294.4,80,,235.52,percent of total billed charges,80% of total billed charges,239.2,65,,191.36,percent of total billed charges,65% of total billed charges,131.27,35.67,,105.016,percent of total billed charges,35.67% of total billed charges,106.72,331.2,
SURGICAL GOWN,27012834,CDM,270,RC,,,outpatient,,,12,4.80,,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,9.24,77,,7.39,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,9.84,82,,7.872,percent of total billed charges,82% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,10.8,90,,8.64,percent of total billed charges,90% of total billed charges,9.6,80,,7.68,percent of total billed charges,80% of total billed charges,10.8,90,,8.64,percent of total billed charges,90% of total billed charges,9,75,,7.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,3.48,29,,2.784,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,8.04,67,,6.432,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,9.6,80,,7.68,percent of total billed charges,80% of total billed charges,7.8,65,,6.24,percent of total billed charges,65% of total billed charges,4.28,35.67,,3.424,percent of total billed charges,35.67% of total billed charges,3.48,10.8,
LAPAROSCOPIC CORD,27012843,CDM,270,RC,,,outpatient,,,147,58.80,,124.95,85,,99.96,percent of total billed charges,85% of total billed charges,113.19,77,,90.55,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,120.54,82,,96.432,percent of total billed charges,82% of total billed charges,124.95,85,,99.96,percent of total billed charges,85% of total billed charges,124.95,85,,99.96,percent of total billed charges,85% of total billed charges,124.95,85,,99.96,percent of total billed charges,85% of total billed charges,132.3,90,,105.84,percent of total billed charges,90% of total billed charges,117.6,80,,94.08,percent of total billed charges,80% of total billed charges,132.3,90,,105.84,percent of total billed charges,90% of total billed charges,110.25,75,,88.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,42.63,29,,34.104,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,98.49,67,,78.792,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,117.6,80,,94.08,percent of total billed charges,80% of total billed charges,95.55,65,,76.44,percent of total billed charges,65% of total billed charges,52.43,35.67,,41.944,percent of total billed charges,35.67% of total billed charges,42.63,132.3,
PROXIMAL LINEAR CUTTER BLUE,27012873,CDM,270,RC,,,outpatient,,,1211,484.40,,1029.35,85,,823.48,percent of total billed charges,85% of total billed charges,932.47,77,,745.98,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,993.02,82,,794.416,percent of total billed charges,82% of total billed charges,1029.35,85,,823.48,percent of total billed charges,85% of total billed charges,1029.35,85,,823.48,percent of total billed charges,85% of total billed charges,1029.35,85,,823.48,percent of total billed charges,85% of total billed charges,1089.9,90,,871.92,percent of total billed charges,90% of total billed charges,968.8,80,,775.04,percent of total billed charges,80% of total billed charges,1089.9,90,,871.92,percent of total billed charges,90% of total billed charges,908.25,75,,726.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,351.19,29,,280.952,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,811.37,67,,649.096,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,968.8,80,,775.04,percent of total billed charges,80% of total billed charges,787.15,65,,629.72,percent of total billed charges,65% of total billed charges,431.96,35.67,,345.568,percent of total billed charges,35.67% of total billed charges,351.19,1089.9,
LINEAR CUTTER CARTRIDGE,27012874,CDM,270,RC,,,outpatient,,,438,175.20,,372.3,85,,297.84,percent of total billed charges,85% of total billed charges,337.26,77,,269.81,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,359.16,82,,287.328,percent of total billed charges,82% of total billed charges,372.3,85,,297.84,percent of total billed charges,85% of total billed charges,372.3,85,,297.84,percent of total billed charges,85% of total billed charges,372.3,85,,297.84,percent of total billed charges,85% of total billed charges,394.2,90,,315.36,percent of total billed charges,90% of total billed charges,350.4,80,,280.32,percent of total billed charges,80% of total billed charges,394.2,90,,315.36,percent of total billed charges,90% of total billed charges,328.5,75,,262.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,127.02,29,,101.616,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,293.46,67,,234.768,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,350.4,80,,280.32,percent of total billed charges,80% of total billed charges,284.7,65,,227.76,percent of total billed charges,65% of total billed charges,156.23,35.67,,124.984,percent of total billed charges,35.67% of total billed charges,127.02,394.2,
PROXIMAL LINEAR CUTTER 75 M,27012875,CDM,270,RC,,,outpatient,,,1317,526.80,,1119.45,85,,895.56,percent of total billed charges,85% of total billed charges,1014.09,77,,811.27,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,1079.94,82,,863.952,percent of total billed charges,82% of total billed charges,1119.45,85,,895.56,percent of total billed charges,85% of total billed charges,1119.45,85,,895.56,percent of total billed charges,85% of total billed charges,1119.45,85,,895.56,percent of total billed charges,85% of total billed charges,1185.3,90,,948.24,percent of total billed charges,90% of total billed charges,1053.6,80,,842.88,percent of total billed charges,80% of total billed charges,1185.3,90,,948.24,percent of total billed charges,90% of total billed charges,987.75,75,,790.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,381.93,29,,305.544,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,882.39,67,,705.912,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1053.6,80,,842.88,percent of total billed charges,80% of total billed charges,856.05,65,,684.84,percent of total billed charges,65% of total billed charges,469.77,35.67,,375.816,percent of total billed charges,35.67% of total billed charges,381.93,1185.3,
PROXIMAL LINEAR CUTTER GREEN,27012876,CDM,270,RC,,,outpatient,,,501,200.40,,425.85,85,,340.68,percent of total billed charges,85% of total billed charges,385.77,77,,308.62,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,410.82,82,,328.656,percent of total billed charges,82% of total billed charges,425.85,85,,340.68,percent of total billed charges,85% of total billed charges,425.85,85,,340.68,percent of total billed charges,85% of total billed charges,425.85,85,,340.68,percent of total billed charges,85% of total billed charges,450.9,90,,360.72,percent of total billed charges,90% of total billed charges,400.8,80,,320.64,percent of total billed charges,80% of total billed charges,450.9,90,,360.72,percent of total billed charges,90% of total billed charges,375.75,75,,300.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,145.29,29,,116.232,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,335.67,67,,268.536,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,400.8,80,,320.64,percent of total billed charges,80% of total billed charges,325.65,65,,260.52,percent of total billed charges,65% of total billed charges,178.71,35.67,,142.968,percent of total billed charges,35.67% of total billed charges,145.29,450.9,
PROLENE SUTURE,27012877,CDM,270,RC,,,outpatient,,,36,14.40,,30.6,85,,24.48,percent of total billed charges,85% of total billed charges,27.72,77,,22.18,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,29.52,82,,23.616,percent of total billed charges,82% of total billed charges,30.6,85,,24.48,percent of total billed charges,85% of total billed charges,30.6,85,,24.48,percent of total billed charges,85% of total billed charges,30.6,85,,24.48,percent of total billed charges,85% of total billed charges,32.4,90,,25.92,percent of total billed charges,90% of total billed charges,28.8,80,,23.04,percent of total billed charges,80% of total billed charges,32.4,90,,25.92,percent of total billed charges,90% of total billed charges,27,75,,21.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,10.44,29,,8.352,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,24.12,67,,19.296,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,28.8,80,,23.04,percent of total billed charges,80% of total billed charges,23.4,65,,18.72,percent of total billed charges,65% of total billed charges,12.84,35.67,,10.272,percent of total billed charges,35.67% of total billed charges,10.44,32.4,
SILK SUTURE,27012878,CDM,270,RC,,,outpatient,,,101,40.40,,85.85,85,,68.68,percent of total billed charges,85% of total billed charges,77.77,77,,62.22,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,82.82,82,,66.256,percent of total billed charges,82% of total billed charges,85.85,85,,68.68,percent of total billed charges,85% of total billed charges,85.85,85,,68.68,percent of total billed charges,85% of total billed charges,85.85,85,,68.68,percent of total billed charges,85% of total billed charges,90.9,90,,72.72,percent of total billed charges,90% of total billed charges,80.8,80,,64.64,percent of total billed charges,80% of total billed charges,90.9,90,,72.72,percent of total billed charges,90% of total billed charges,75.75,75,,60.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,29.29,29,,23.432,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,67.67,67,,54.136,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,80.8,80,,64.64,percent of total billed charges,80% of total billed charges,65.65,65,,52.52,percent of total billed charges,65% of total billed charges,36.03,35.67,,28.824,percent of total billed charges,35.67% of total billed charges,29.29,90.9,
LINEAR CUTTER - WHITE,27012886,CDM,270,RC,,,outpatient,,,586,234.40,,498.1,85,,398.48,percent of total billed charges,85% of total billed charges,451.22,77,,360.98,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,480.52,82,,384.416,percent of total billed charges,82% of total billed charges,498.1,85,,398.48,percent of total billed charges,85% of total billed charges,498.1,85,,398.48,percent of total billed charges,85% of total billed charges,498.1,85,,398.48,percent of total billed charges,85% of total billed charges,527.4,90,,421.92,percent of total billed charges,90% of total billed charges,468.8,80,,375.04,percent of total billed charges,80% of total billed charges,527.4,90,,421.92,percent of total billed charges,90% of total billed charges,439.5,75,,351.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,169.94,29,,135.952,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,392.62,67,,314.096,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,468.8,80,,375.04,percent of total billed charges,80% of total billed charges,380.9,65,,304.72,percent of total billed charges,65% of total billed charges,209.03,35.67,,167.224,percent of total billed charges,35.67% of total billed charges,169.94,527.4,
LINEAR CARTRIDGE WHITE,27012887,CDM,270,RC,,,outpatient,,,327,130.80,,277.95,85,,222.36,percent of total billed charges,85% of total billed charges,251.79,77,,201.43,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,268.14,82,,214.512,percent of total billed charges,82% of total billed charges,277.95,85,,222.36,percent of total billed charges,85% of total billed charges,277.95,85,,222.36,percent of total billed charges,85% of total billed charges,277.95,85,,222.36,percent of total billed charges,85% of total billed charges,294.3,90,,235.44,percent of total billed charges,90% of total billed charges,261.6,80,,209.28,percent of total billed charges,80% of total billed charges,294.3,90,,235.44,percent of total billed charges,90% of total billed charges,245.25,75,,196.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,94.83,29,,75.864,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,219.09,67,,175.272,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,261.6,80,,209.28,percent of total billed charges,80% of total billed charges,212.55,65,,170.04,percent of total billed charges,65% of total billed charges,116.64,35.67,,93.312,percent of total billed charges,35.67% of total billed charges,94.83,294.3,
BONE CEMENT MIXER,27012915,CDM,270,RC,,,outpatient,,,1036,414.40,,880.6,85,,704.48,percent of total billed charges,85% of total billed charges,797.72,77,,638.18,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,849.52,82,,679.616,percent of total billed charges,82% of total billed charges,880.6,85,,704.48,percent of total billed charges,85% of total billed charges,880.6,85,,704.48,percent of total billed charges,85% of total billed charges,880.6,85,,704.48,percent of total billed charges,85% of total billed charges,932.4,90,,745.92,percent of total billed charges,90% of total billed charges,828.8,80,,663.04,percent of total billed charges,80% of total billed charges,932.4,90,,745.92,percent of total billed charges,90% of total billed charges,777,75,,621.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,300.44,29,,240.352,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,694.12,67,,555.296,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,828.8,80,,663.04,percent of total billed charges,80% of total billed charges,673.4,65,,538.72,percent of total billed charges,65% of total billed charges,369.54,35.67,,295.632,percent of total billed charges,35.67% of total billed charges,300.44,932.4,
APPLIER CLIP,27012926,CDM,270,RC,,,outpatient,,,1512,604.80,,1285.2,85,,1028.16,percent of total billed charges,85% of total billed charges,1164.24,77,,931.39,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,1239.84,82,,991.872,percent of total billed charges,82% of total billed charges,1285.2,85,,1028.16,percent of total billed charges,85% of total billed charges,1285.2,85,,1028.16,percent of total billed charges,85% of total billed charges,1285.2,85,,1028.16,percent of total billed charges,85% of total billed charges,1360.8,90,,1088.64,percent of total billed charges,90% of total billed charges,1209.6,80,,967.68,percent of total billed charges,80% of total billed charges,1360.8,90,,1088.64,percent of total billed charges,90% of total billed charges,1134,75,,907.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,438.48,29,,350.784,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1013.04,67,,810.432,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1209.6,80,,967.68,percent of total billed charges,80% of total billed charges,982.8,65,,786.24,percent of total billed charges,65% of total billed charges,539.33,35.67,,431.464,percent of total billed charges,35.67% of total billed charges,438.48,1360.8,
SUTURE MONOCRYL 0 CT,27012927,CDM,270,RC,,,outpatient,,,68,27.20,,57.8,85,,46.24,percent of total billed charges,85% of total billed charges,52.36,77,,41.89,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,55.76,82,,44.608,percent of total billed charges,82% of total billed charges,57.8,85,,46.24,percent of total billed charges,85% of total billed charges,57.8,85,,46.24,percent of total billed charges,85% of total billed charges,57.8,85,,46.24,percent of total billed charges,85% of total billed charges,61.2,90,,48.96,percent of total billed charges,90% of total billed charges,54.4,80,,43.52,percent of total billed charges,80% of total billed charges,61.2,90,,48.96,percent of total billed charges,90% of total billed charges,51,75,,40.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,19.72,29,,15.776,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,45.56,67,,36.448,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,54.4,80,,43.52,percent of total billed charges,80% of total billed charges,44.2,65,,35.36,percent of total billed charges,65% of total billed charges,24.26,35.67,,19.408,percent of total billed charges,35.67% of total billed charges,19.72,61.2,
SUTURE PDS II CTX MONOCRYLE,27012928,CDM,270,RC,,,outpatient,,,40,16.00,,34,85,,27.2,percent of total billed charges,85% of total billed charges,30.8,77,,24.64,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,32.8,82,,26.24,percent of total billed charges,82% of total billed charges,34,85,,27.2,percent of total billed charges,85% of total billed charges,34,85,,27.2,percent of total billed charges,85% of total billed charges,34,85,,27.2,percent of total billed charges,85% of total billed charges,36,90,,28.8,percent of total billed charges,90% of total billed charges,32,80,,25.6,percent of total billed charges,80% of total billed charges,36,90,,28.8,percent of total billed charges,90% of total billed charges,30,75,,24,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,11.6,29,,9.28,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,26.8,67,,21.44,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,32,80,,25.6,percent of total billed charges,80% of total billed charges,26,65,,20.8,percent of total billed charges,65% of total billed charges,14.27,35.67,,11.416,percent of total billed charges,35.67% of total billed charges,11.6,36,
SUTURE MONOCRYL 2-0 CTX,27012929,CDM,270,RC,,,outpatient,,,32,12.80,,27.2,85,,21.76,percent of total billed charges,85% of total billed charges,24.64,77,,19.71,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,26.24,82,,20.992,percent of total billed charges,82% of total billed charges,27.2,85,,21.76,percent of total billed charges,85% of total billed charges,27.2,85,,21.76,percent of total billed charges,85% of total billed charges,27.2,85,,21.76,percent of total billed charges,85% of total billed charges,28.8,90,,23.04,percent of total billed charges,90% of total billed charges,25.6,80,,20.48,percent of total billed charges,80% of total billed charges,28.8,90,,23.04,percent of total billed charges,90% of total billed charges,24,75,,19.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,9.28,29,,7.424,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,21.44,67,,17.152,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,25.6,80,,20.48,percent of total billed charges,80% of total billed charges,20.8,65,,16.64,percent of total billed charges,65% of total billed charges,11.41,35.67,,9.128,percent of total billed charges,35.67% of total billed charges,9.28,28.8,
GIGLI WIRE SAW,27012940,CDM,270,RC,,,outpatient,,,83,33.20,,70.55,85,,56.44,percent of total billed charges,85% of total billed charges,63.91,77,,51.13,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,68.06,82,,54.448,percent of total billed charges,82% of total billed charges,70.55,85,,56.44,percent of total billed charges,85% of total billed charges,70.55,85,,56.44,percent of total billed charges,85% of total billed charges,70.55,85,,56.44,percent of total billed charges,85% of total billed charges,74.7,90,,59.76,percent of total billed charges,90% of total billed charges,66.4,80,,53.12,percent of total billed charges,80% of total billed charges,74.7,90,,59.76,percent of total billed charges,90% of total billed charges,62.25,75,,49.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,24.07,29,,19.256,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,55.61,67,,44.488,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,66.4,80,,53.12,percent of total billed charges,80% of total billed charges,53.95,65,,43.16,percent of total billed charges,65% of total billed charges,29.61,35.67,,23.688,percent of total billed charges,35.67% of total billed charges,24.07,74.7,
LINEAR CUTTER,27012941,CDM,270,RC,,,outpatient,,,1228,491.20,,1043.8,85,,835.04,percent of total billed charges,85% of total billed charges,945.56,77,,756.45,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,1006.96,82,,805.568,percent of total billed charges,82% of total billed charges,1043.8,85,,835.04,percent of total billed charges,85% of total billed charges,1043.8,85,,835.04,percent of total billed charges,85% of total billed charges,1043.8,85,,835.04,percent of total billed charges,85% of total billed charges,1105.2,90,,884.16,percent of total billed charges,90% of total billed charges,982.4,80,,785.92,percent of total billed charges,80% of total billed charges,1105.2,90,,884.16,percent of total billed charges,90% of total billed charges,921,75,,736.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,356.12,29,,284.896,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,822.76,67,,658.208,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,982.4,80,,785.92,percent of total billed charges,80% of total billed charges,798.2,65,,638.56,percent of total billed charges,65% of total billed charges,438.03,35.67,,350.424,percent of total billed charges,35.67% of total billed charges,356.12,1105.2,
STAPLE RELOAD BLUE,27012942,CDM,270,RC,,,outpatient,,,796,318.40,,676.6,85,,541.28,percent of total billed charges,85% of total billed charges,612.92,77,,490.34,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,652.72,82,,522.176,percent of total billed charges,82% of total billed charges,676.6,85,,541.28,percent of total billed charges,85% of total billed charges,676.6,85,,541.28,percent of total billed charges,85% of total billed charges,676.6,85,,541.28,percent of total billed charges,85% of total billed charges,716.4,90,,573.12,percent of total billed charges,90% of total billed charges,636.8,80,,509.44,percent of total billed charges,80% of total billed charges,716.4,90,,573.12,percent of total billed charges,90% of total billed charges,597,75,,477.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,230.84,29,,184.672,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,533.32,67,,426.656,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,636.8,80,,509.44,percent of total billed charges,80% of total billed charges,517.4,65,,413.92,percent of total billed charges,65% of total billed charges,283.93,35.67,,227.144,percent of total billed charges,35.67% of total billed charges,230.84,716.4,
STAPLE RELOAD GREEN,27012943,CDM,270,RC,,,outpatient,,,781,312.40,,663.85,85,,531.08,percent of total billed charges,85% of total billed charges,601.37,77,,481.1,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,640.42,82,,512.336,percent of total billed charges,82% of total billed charges,663.85,85,,531.08,percent of total billed charges,85% of total billed charges,663.85,85,,531.08,percent of total billed charges,85% of total billed charges,663.85,85,,531.08,percent of total billed charges,85% of total billed charges,702.9,90,,562.32,percent of total billed charges,90% of total billed charges,624.8,80,,499.84,percent of total billed charges,80% of total billed charges,702.9,90,,562.32,percent of total billed charges,90% of total billed charges,585.75,75,,468.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,226.49,29,,181.192,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,523.27,67,,418.616,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,624.8,80,,499.84,percent of total billed charges,80% of total billed charges,507.65,65,,406.12,percent of total billed charges,65% of total billed charges,278.58,35.67,,222.864,percent of total billed charges,35.67% of total billed charges,226.49,702.9,
INTRALUMINAL STAPLER,27012950,CDM,270,RC,,,outpatient,,,1272,508.80,,1081.2,85,,864.96,percent of total billed charges,85% of total billed charges,979.44,77,,783.55,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,1043.04,82,,834.432,percent of total billed charges,82% of total billed charges,1081.2,85,,864.96,percent of total billed charges,85% of total billed charges,1081.2,85,,864.96,percent of total billed charges,85% of total billed charges,1081.2,85,,864.96,percent of total billed charges,85% of total billed charges,1144.8,90,,915.84,percent of total billed charges,90% of total billed charges,1017.6,80,,814.08,percent of total billed charges,80% of total billed charges,1144.8,90,,915.84,percent of total billed charges,90% of total billed charges,954,75,,763.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,368.88,29,,295.104,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,852.24,67,,681.792,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1017.6,80,,814.08,percent of total billed charges,80% of total billed charges,826.8,65,,661.44,percent of total billed charges,65% of total billed charges,453.72,35.67,,362.976,percent of total billed charges,35.67% of total billed charges,368.88,1144.8,
INTRALUMINAL STAPLER,27012951,CDM,270,RC,,,outpatient,,,1720,688.00,,1462,85,,1169.6,percent of total billed charges,85% of total billed charges,1324.4,77,,1059.52,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,1410.4,82,,1128.32,percent of total billed charges,82% of total billed charges,1462,85,,1169.6,percent of total billed charges,85% of total billed charges,1462,85,,1169.6,percent of total billed charges,85% of total billed charges,1462,85,,1169.6,percent of total billed charges,85% of total billed charges,1548,90,,1238.4,percent of total billed charges,90% of total billed charges,1376,80,,1100.8,percent of total billed charges,80% of total billed charges,1548,90,,1238.4,percent of total billed charges,90% of total billed charges,1290,75,,1032,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,498.8,29,,399.04,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1152.4,67,,921.92,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1376,80,,1100.8,percent of total billed charges,80% of total billed charges,1118,65,,894.4,percent of total billed charges,65% of total billed charges,613.52,35.67,,490.816,percent of total billed charges,35.67% of total billed charges,498.8,1548,
circular sizer set 25,27012952,CDM,270,RC,,,outpatient,,,590,236.00,,501.5,85,,401.2,percent of total billed charges,85% of total billed charges,454.3,77,,363.44,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,483.8,82,,387.04,percent of total billed charges,82% of total billed charges,501.5,85,,401.2,percent of total billed charges,85% of total billed charges,501.5,85,,401.2,percent of total billed charges,85% of total billed charges,501.5,85,,401.2,percent of total billed charges,85% of total billed charges,531,90,,424.8,percent of total billed charges,90% of total billed charges,472,80,,377.6,percent of total billed charges,80% of total billed charges,531,90,,424.8,percent of total billed charges,90% of total billed charges,442.5,75,,354,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,171.1,29,,136.88,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,395.3,67,,316.24,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,472,80,,377.6,percent of total billed charges,80% of total billed charges,383.5,65,,306.8,percent of total billed charges,65% of total billed charges,210.45,35.67,,168.36,percent of total billed charges,35.67% of total billed charges,171.1,531,
SUTURE ETHIBOND XTRA 2-0 30,27012978,CDM,270,RC,,,outpatient,,,31,12.40,,26.35,85,,21.08,percent of total billed charges,85% of total billed charges,23.87,77,,19.1,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,25.42,82,,20.336,percent of total billed charges,82% of total billed charges,26.35,85,,21.08,percent of total billed charges,85% of total billed charges,26.35,85,,21.08,percent of total billed charges,85% of total billed charges,26.35,85,,21.08,percent of total billed charges,85% of total billed charges,27.9,90,,22.32,percent of total billed charges,90% of total billed charges,24.8,80,,19.84,percent of total billed charges,80% of total billed charges,27.9,90,,22.32,percent of total billed charges,90% of total billed charges,23.25,75,,18.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,8.99,29,,7.192,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,20.77,67,,16.616,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,24.8,80,,19.84,percent of total billed charges,80% of total billed charges,20.15,65,,16.12,percent of total billed charges,65% of total billed charges,11.06,35.67,,8.848,percent of total billed charges,35.67% of total billed charges,8.99,27.9,
BIOPSY FORCEP ENDOJAW,27012989,CDM,270,RC,,,outpatient,,,93,37.20,,79.05,85,,63.24,percent of total billed charges,85% of total billed charges,71.61,77,,57.29,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,76.26,82,,61.008,percent of total billed charges,82% of total billed charges,79.05,85,,63.24,percent of total billed charges,85% of total billed charges,79.05,85,,63.24,percent of total billed charges,85% of total billed charges,79.05,85,,63.24,percent of total billed charges,85% of total billed charges,83.7,90,,66.96,percent of total billed charges,90% of total billed charges,74.4,80,,59.52,percent of total billed charges,80% of total billed charges,83.7,90,,66.96,percent of total billed charges,90% of total billed charges,69.75,75,,55.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,26.97,29,,21.576,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,62.31,67,,49.848,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,74.4,80,,59.52,percent of total billed charges,80% of total billed charges,60.45,65,,48.36,percent of total billed charges,65% of total billed charges,33.17,35.67,,26.536,percent of total billed charges,35.67% of total billed charges,26.97,83.7,
AUXILIARY CHANNEL WATER TUBE,27012990,CDM,270,RC,,,outpatient,,,197,78.80,,167.45,85,,133.96,percent of total billed charges,85% of total billed charges,151.69,77,,121.35,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,161.54,82,,129.232,percent of total billed charges,82% of total billed charges,167.45,85,,133.96,percent of total billed charges,85% of total billed charges,167.45,85,,133.96,percent of total billed charges,85% of total billed charges,167.45,85,,133.96,percent of total billed charges,85% of total billed charges,177.3,90,,141.84,percent of total billed charges,90% of total billed charges,157.6,80,,126.08,percent of total billed charges,80% of total billed charges,177.3,90,,141.84,percent of total billed charges,90% of total billed charges,147.75,75,,118.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,57.13,29,,45.704,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,131.99,67,,105.592,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,157.6,80,,126.08,percent of total billed charges,80% of total billed charges,128.05,65,,102.44,percent of total billed charges,65% of total billed charges,70.27,35.67,,56.216,percent of total billed charges,35.67% of total billed charges,57.13,177.3,
INJECTOR FORCE MAX,27012991,CDM,270,RC,,,outpatient,,,338,135.20,,287.3,85,,229.84,percent of total billed charges,85% of total billed charges,260.26,77,,208.21,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,277.16,82,,221.728,percent of total billed charges,82% of total billed charges,287.3,85,,229.84,percent of total billed charges,85% of total billed charges,287.3,85,,229.84,percent of total billed charges,85% of total billed charges,287.3,85,,229.84,percent of total billed charges,85% of total billed charges,304.2,90,,243.36,percent of total billed charges,90% of total billed charges,270.4,80,,216.32,percent of total billed charges,80% of total billed charges,304.2,90,,243.36,percent of total billed charges,90% of total billed charges,253.5,75,,202.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,98.02,29,,78.416,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,226.46,67,,181.168,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,270.4,80,,216.32,percent of total billed charges,80% of total billed charges,219.7,65,,175.76,percent of total billed charges,65% of total billed charges,120.56,35.67,,96.448,percent of total billed charges,35.67% of total billed charges,98.02,304.2,
SHARE ELECTROSURGICAL,27012992,CDM,270,RC,,,outpatient,,,136,54.40,,115.6,85,,92.48,percent of total billed charges,85% of total billed charges,104.72,77,,83.78,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,111.52,82,,89.216,percent of total billed charges,82% of total billed charges,115.6,85,,92.48,percent of total billed charges,85% of total billed charges,115.6,85,,92.48,percent of total billed charges,85% of total billed charges,115.6,85,,92.48,percent of total billed charges,85% of total billed charges,122.4,90,,97.92,percent of total billed charges,90% of total billed charges,108.8,80,,87.04,percent of total billed charges,80% of total billed charges,122.4,90,,97.92,percent of total billed charges,90% of total billed charges,102,75,,81.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,39.44,29,,31.552,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,91.12,67,,72.896,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,108.8,80,,87.04,percent of total billed charges,80% of total billed charges,88.4,65,,70.72,percent of total billed charges,65% of total billed charges,48.51,35.67,,38.808,percent of total billed charges,35.67% of total billed charges,39.44,122.4,
MOUTHPIECE ENDOSCOPE LIP PRESS,27012995,CDM,270,RC,,,outpatient,,,21,8.40,,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,16.17,77,,12.94,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,17.22,82,,13.776,percent of total billed charges,82% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,18.9,90,,15.12,percent of total billed charges,90% of total billed charges,16.8,80,,13.44,percent of total billed charges,80% of total billed charges,18.9,90,,15.12,percent of total billed charges,90% of total billed charges,15.75,75,,12.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,6.09,29,,4.872,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,14.07,67,,11.256,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,16.8,80,,13.44,percent of total billed charges,80% of total billed charges,13.65,65,,10.92,percent of total billed charges,65% of total billed charges,7.49,35.67,,5.992,percent of total billed charges,35.67% of total billed charges,6.09,18.9,
NEURO SPONGE,27013061,CDM,270,RC,,,outpatient,,,48,19.20,,40.8,85,,32.64,percent of total billed charges,85% of total billed charges,36.96,77,,29.57,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,39.36,82,,31.488,percent of total billed charges,82% of total billed charges,40.8,85,,32.64,percent of total billed charges,85% of total billed charges,40.8,85,,32.64,percent of total billed charges,85% of total billed charges,40.8,85,,32.64,percent of total billed charges,85% of total billed charges,43.2,90,,34.56,percent of total billed charges,90% of total billed charges,38.4,80,,30.72,percent of total billed charges,80% of total billed charges,43.2,90,,34.56,percent of total billed charges,90% of total billed charges,36,75,,28.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,13.92,29,,11.136,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,32.16,67,,25.728,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,38.4,80,,30.72,percent of total billed charges,80% of total billed charges,31.2,65,,24.96,percent of total billed charges,65% of total billed charges,17.12,35.67,,13.696,percent of total billed charges,35.67% of total billed charges,13.92,43.2,
ENDOSCOPIC PUNCH RETRIEVAL,27013134,CDM,270,RC,,,outpatient,,,590,236.00,,501.5,85,,401.2,percent of total billed charges,85% of total billed charges,454.3,77,,363.44,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,483.8,82,,387.04,percent of total billed charges,82% of total billed charges,501.5,85,,401.2,percent of total billed charges,85% of total billed charges,501.5,85,,401.2,percent of total billed charges,85% of total billed charges,501.5,85,,401.2,percent of total billed charges,85% of total billed charges,531,90,,424.8,percent of total billed charges,90% of total billed charges,472,80,,377.6,percent of total billed charges,80% of total billed charges,531,90,,424.8,percent of total billed charges,90% of total billed charges,442.5,75,,354,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,171.1,29,,136.88,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,395.3,67,,316.24,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,472,80,,377.6,percent of total billed charges,80% of total billed charges,383.5,65,,306.8,percent of total billed charges,65% of total billed charges,210.45,35.67,,168.36,percent of total billed charges,35.67% of total billed charges,171.1,531,
CURVED 90  DEGREE LASSO,27013344,CDM,270,RC,,,outpatient,,,1006,402.40,,855.1,85,,684.08,percent of total billed charges,85% of total billed charges,774.62,77,,619.7,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,824.92,82,,659.936,percent of total billed charges,82% of total billed charges,855.1,85,,684.08,percent of total billed charges,85% of total billed charges,855.1,85,,684.08,percent of total billed charges,85% of total billed charges,855.1,85,,684.08,percent of total billed charges,85% of total billed charges,905.4,90,,724.32,percent of total billed charges,90% of total billed charges,804.8,80,,643.84,percent of total billed charges,80% of total billed charges,905.4,90,,724.32,percent of total billed charges,90% of total billed charges,754.5,75,,603.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,291.74,29,,233.392,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,674.02,67,,539.216,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,804.8,80,,643.84,percent of total billed charges,80% of total billed charges,653.9,65,,523.12,percent of total billed charges,65% of total billed charges,358.84,35.67,,287.072,percent of total billed charges,35.67% of total billed charges,291.74,905.4,
ELEVATION ARM PILLOW,27013346,CDM,270,RC,,,outpatient,,,220,88.00,,187,85,,149.6,percent of total billed charges,85% of total billed charges,169.4,77,,135.52,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,180.4,82,,144.32,percent of total billed charges,82% of total billed charges,187,85,,149.6,percent of total billed charges,85% of total billed charges,187,85,,149.6,percent of total billed charges,85% of total billed charges,187,85,,149.6,percent of total billed charges,85% of total billed charges,198,90,,158.4,percent of total billed charges,90% of total billed charges,176,80,,140.8,percent of total billed charges,80% of total billed charges,198,90,,158.4,percent of total billed charges,90% of total billed charges,165,75,,132,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,63.8,29,,51.04,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,147.4,67,,117.92,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,176,80,,140.8,percent of total billed charges,80% of total billed charges,143,65,,114.4,percent of total billed charges,65% of total billed charges,78.47,35.67,,62.776,percent of total billed charges,35.67% of total billed charges,63.8,198,
FRAZIER INSTRUMENT 18 FR,27013373,CDM,270,RC,,,outpatient,,,19,7.60,,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,14.63,77,,11.7,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,15.58,82,,12.464,percent of total billed charges,82% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,15.2,80,,12.16,percent of total billed charges,80% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,14.25,75,,11.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,5.51,29,,4.408,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,12.73,67,,10.184,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,15.2,80,,12.16,percent of total billed charges,80% of total billed charges,12.35,65,,9.88,percent of total billed charges,65% of total billed charges,6.78,35.67,,5.424,percent of total billed charges,35.67% of total billed charges,5.51,17.1,
FRAZIER INSTRUMENT 10 FT,27013374,CDM,270,RC,,,outpatient,,,19,7.60,,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,14.63,77,,11.7,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,15.58,82,,12.464,percent of total billed charges,82% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,15.2,80,,12.16,percent of total billed charges,80% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,14.25,75,,11.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,5.51,29,,4.408,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,12.73,67,,10.184,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,15.2,80,,12.16,percent of total billed charges,80% of total billed charges,12.35,65,,9.88,percent of total billed charges,65% of total billed charges,6.78,35.67,,5.424,percent of total billed charges,35.67% of total billed charges,5.51,17.1,
BIPOLAR CORD 12 FT GREEN,27013375,CDM,270,RC,,,outpatient,,,46,18.40,,39.1,85,,31.28,percent of total billed charges,85% of total billed charges,35.42,77,,28.34,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,37.72,82,,30.176,percent of total billed charges,82% of total billed charges,39.1,85,,31.28,percent of total billed charges,85% of total billed charges,39.1,85,,31.28,percent of total billed charges,85% of total billed charges,39.1,85,,31.28,percent of total billed charges,85% of total billed charges,41.4,90,,33.12,percent of total billed charges,90% of total billed charges,36.8,80,,29.44,percent of total billed charges,80% of total billed charges,41.4,90,,33.12,percent of total billed charges,90% of total billed charges,34.5,75,,27.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,13.34,29,,10.672,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,30.82,67,,24.656,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,36.8,80,,29.44,percent of total billed charges,80% of total billed charges,29.9,65,,23.92,percent of total billed charges,65% of total billed charges,16.41,35.67,,13.128,percent of total billed charges,35.67% of total billed charges,13.34,41.4,
KAIRISON TUBING,27013376,CDM,270,RC,,,outpatient,,,768,307.20,,652.8,85,,522.24,percent of total billed charges,85% of total billed charges,591.36,77,,473.09,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,629.76,82,,503.808,percent of total billed charges,82% of total billed charges,652.8,85,,522.24,percent of total billed charges,85% of total billed charges,652.8,85,,522.24,percent of total billed charges,85% of total billed charges,652.8,85,,522.24,percent of total billed charges,85% of total billed charges,691.2,90,,552.96,percent of total billed charges,90% of total billed charges,614.4,80,,491.52,percent of total billed charges,80% of total billed charges,691.2,90,,552.96,percent of total billed charges,90% of total billed charges,576,75,,460.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,222.72,29,,178.176,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,514.56,67,,411.648,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,614.4,80,,491.52,percent of total billed charges,80% of total billed charges,499.2,65,,399.36,percent of total billed charges,65% of total billed charges,273.95,35.67,,219.16,percent of total billed charges,35.67% of total billed charges,222.72,691.2,
CODMAN SURGICAL PATTIES 1 X 1,27013377,CDM,270,RC,,,outpatient,,,142,56.80,,120.7,85,,96.56,percent of total billed charges,85% of total billed charges,109.34,77,,87.47,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,116.44,82,,93.152,percent of total billed charges,82% of total billed charges,120.7,85,,96.56,percent of total billed charges,85% of total billed charges,120.7,85,,96.56,percent of total billed charges,85% of total billed charges,120.7,85,,96.56,percent of total billed charges,85% of total billed charges,127.8,90,,102.24,percent of total billed charges,90% of total billed charges,113.6,80,,90.88,percent of total billed charges,80% of total billed charges,127.8,90,,102.24,percent of total billed charges,90% of total billed charges,106.5,75,,85.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,41.18,29,,32.944,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,95.14,67,,76.112,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,113.6,80,,90.88,percent of total billed charges,80% of total billed charges,92.3,65,,73.84,percent of total billed charges,65% of total billed charges,50.65,35.67,,40.52,percent of total billed charges,35.67% of total billed charges,41.18,127.8,
SURGICEL FIBRILLAR HEMOSTAT,27013379,CDM,270,RC,,,outpatient,,,1243,497.20,,1056.55,85,,845.24,percent of total billed charges,85% of total billed charges,957.11,77,,765.69,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,1019.26,82,,815.408,percent of total billed charges,82% of total billed charges,1056.55,85,,845.24,percent of total billed charges,85% of total billed charges,1056.55,85,,845.24,percent of total billed charges,85% of total billed charges,1056.55,85,,845.24,percent of total billed charges,85% of total billed charges,1118.7,90,,894.96,percent of total billed charges,90% of total billed charges,994.4,80,,795.52,percent of total billed charges,80% of total billed charges,1118.7,90,,894.96,percent of total billed charges,90% of total billed charges,932.25,75,,745.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,360.47,29,,288.376,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,832.81,67,,666.248,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,994.4,80,,795.52,percent of total billed charges,80% of total billed charges,807.95,65,,646.36,percent of total billed charges,65% of total billed charges,443.38,35.67,,354.704,percent of total billed charges,35.67% of total billed charges,360.47,1118.7,
SUTURE VICRYL,27013381,CDM,270,RC,,,outpatient,,,32,12.80,,27.2,85,,21.76,percent of total billed charges,85% of total billed charges,24.64,77,,19.71,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,26.24,82,,20.992,percent of total billed charges,82% of total billed charges,27.2,85,,21.76,percent of total billed charges,85% of total billed charges,27.2,85,,21.76,percent of total billed charges,85% of total billed charges,27.2,85,,21.76,percent of total billed charges,85% of total billed charges,28.8,90,,23.04,percent of total billed charges,90% of total billed charges,25.6,80,,20.48,percent of total billed charges,80% of total billed charges,28.8,90,,23.04,percent of total billed charges,90% of total billed charges,24,75,,19.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,9.28,29,,7.424,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,21.44,67,,17.152,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,25.6,80,,20.48,percent of total billed charges,80% of total billed charges,20.8,65,,16.64,percent of total billed charges,65% of total billed charges,11.41,35.67,,9.128,percent of total billed charges,35.67% of total billed charges,9.28,28.8,
EYE PROTECTOR FOAM STERILE,27013384,CDM,270,RC,,,outpatient,,,91,36.40,,77.35,85,,61.88,percent of total billed charges,85% of total billed charges,70.07,77,,56.06,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,74.62,82,,59.696,percent of total billed charges,82% of total billed charges,77.35,85,,61.88,percent of total billed charges,85% of total billed charges,77.35,85,,61.88,percent of total billed charges,85% of total billed charges,77.35,85,,61.88,percent of total billed charges,85% of total billed charges,81.9,90,,65.52,percent of total billed charges,90% of total billed charges,72.8,80,,58.24,percent of total billed charges,80% of total billed charges,81.9,90,,65.52,percent of total billed charges,90% of total billed charges,68.25,75,,54.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,26.39,29,,21.112,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,60.97,67,,48.776,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,72.8,80,,58.24,percent of total billed charges,80% of total billed charges,59.15,65,,47.32,percent of total billed charges,65% of total billed charges,32.46,35.67,,25.968,percent of total billed charges,35.67% of total billed charges,26.39,81.9,
SHEET LAP INCISE DRAPE,27013392,CDM,270,RC,,,outpatient,,,17,6.80,,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,13.09,77,,10.47,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,13.94,82,,11.152,percent of total billed charges,82% of total billed charges,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,15.3,90,,12.24,percent of total billed charges,90% of total billed charges,13.6,80,,10.88,percent of total billed charges,80% of total billed charges,15.3,90,,12.24,percent of total billed charges,90% of total billed charges,12.75,75,,10.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,4.93,29,,3.944,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,11.39,67,,9.112,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,13.6,80,,10.88,percent of total billed charges,80% of total billed charges,11.05,65,,8.84,percent of total billed charges,65% of total billed charges,6.06,35.67,,4.848,percent of total billed charges,35.67% of total billed charges,4.93,15.3,
C ARM DRAPE IMAGE,27013393,CDM,270,RC,,,outpatient,,,44,17.60,,37.4,85,,29.92,percent of total billed charges,85% of total billed charges,33.88,77,,27.1,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,36.08,82,,28.864,percent of total billed charges,82% of total billed charges,37.4,85,,29.92,percent of total billed charges,85% of total billed charges,37.4,85,,29.92,percent of total billed charges,85% of total billed charges,37.4,85,,29.92,percent of total billed charges,85% of total billed charges,39.6,90,,31.68,percent of total billed charges,90% of total billed charges,35.2,80,,28.16,percent of total billed charges,80% of total billed charges,39.6,90,,31.68,percent of total billed charges,90% of total billed charges,33,75,,26.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,12.76,29,,10.208,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,29.48,67,,23.584,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,35.2,80,,28.16,percent of total billed charges,80% of total billed charges,28.6,65,,22.88,percent of total billed charges,65% of total billed charges,15.69,35.67,,12.552,percent of total billed charges,35.67% of total billed charges,12.76,39.6,
INSULATED EDGE BLADE,27013394,CDM,270,RC,,,outpatient,,,94,37.60,,79.9,85,,63.92,percent of total billed charges,85% of total billed charges,72.38,77,,57.9,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,77.08,82,,61.664,percent of total billed charges,82% of total billed charges,79.9,85,,63.92,percent of total billed charges,85% of total billed charges,79.9,85,,63.92,percent of total billed charges,85% of total billed charges,79.9,85,,63.92,percent of total billed charges,85% of total billed charges,84.6,90,,67.68,percent of total billed charges,90% of total billed charges,75.2,80,,60.16,percent of total billed charges,80% of total billed charges,84.6,90,,67.68,percent of total billed charges,90% of total billed charges,70.5,75,,56.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,27.26,29,,21.808,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,62.98,67,,50.384,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,75.2,80,,60.16,percent of total billed charges,80% of total billed charges,61.1,65,,48.88,percent of total billed charges,65% of total billed charges,33.53,35.67,,26.824,percent of total billed charges,35.67% of total billed charges,27.26,84.6,
INSULATED COASTED EDGE BLADE,27013395,CDM,270,RC,,,outpatient,,,73,29.20,,62.05,85,,49.64,percent of total billed charges,85% of total billed charges,56.21,77,,44.97,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,59.86,82,,47.888,percent of total billed charges,82% of total billed charges,62.05,85,,49.64,percent of total billed charges,85% of total billed charges,62.05,85,,49.64,percent of total billed charges,85% of total billed charges,62.05,85,,49.64,percent of total billed charges,85% of total billed charges,65.7,90,,52.56,percent of total billed charges,90% of total billed charges,58.4,80,,46.72,percent of total billed charges,80% of total billed charges,65.7,90,,52.56,percent of total billed charges,90% of total billed charges,54.75,75,,43.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,21.17,29,,16.936,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,48.91,67,,39.128,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,58.4,80,,46.72,percent of total billed charges,80% of total billed charges,47.45,65,,37.96,percent of total billed charges,65% of total billed charges,26.04,35.67,,20.832,percent of total billed charges,35.67% of total billed charges,21.17,65.7,
SUTURE NUROLON 6-0,27013396,CDM,270,RC,,,outpatient,,,51,20.40,,43.35,85,,34.68,percent of total billed charges,85% of total billed charges,39.27,77,,31.42,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,41.82,82,,33.456,percent of total billed charges,82% of total billed charges,43.35,85,,34.68,percent of total billed charges,85% of total billed charges,43.35,85,,34.68,percent of total billed charges,85% of total billed charges,43.35,85,,34.68,percent of total billed charges,85% of total billed charges,45.9,90,,36.72,percent of total billed charges,90% of total billed charges,40.8,80,,32.64,percent of total billed charges,80% of total billed charges,45.9,90,,36.72,percent of total billed charges,90% of total billed charges,38.25,75,,30.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,14.79,29,,11.832,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,34.17,67,,27.336,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,40.8,80,,32.64,percent of total billed charges,80% of total billed charges,33.15,65,,26.52,percent of total billed charges,65% of total billed charges,18.19,35.67,,14.552,percent of total billed charges,35.67% of total billed charges,14.79,45.9,
NEURO TRAY,27013398,CDM,270,RC,,,outpatient,,,1411,564.40,,1199.35,85,,959.48,percent of total billed charges,85% of total billed charges,1086.47,77,,869.18,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,1157.02,82,,925.616,percent of total billed charges,82% of total billed charges,1199.35,85,,959.48,percent of total billed charges,85% of total billed charges,1199.35,85,,959.48,percent of total billed charges,85% of total billed charges,1199.35,85,,959.48,percent of total billed charges,85% of total billed charges,1269.9,90,,1015.92,percent of total billed charges,90% of total billed charges,1128.8,80,,903.04,percent of total billed charges,80% of total billed charges,1269.9,90,,1015.92,percent of total billed charges,90% of total billed charges,1058.25,75,,846.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,409.19,29,,327.352,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,945.37,67,,756.296,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1128.8,80,,903.04,percent of total billed charges,80% of total billed charges,917.15,65,,733.72,percent of total billed charges,65% of total billed charges,503.3,35.67,,402.64,percent of total billed charges,35.67% of total billed charges,409.19,1269.9,
JACKSON PRATT DRAIN,27013399,CDM,270,RC,,,outpatient,,,146,58.40,,124.1,85,,99.28,percent of total billed charges,85% of total billed charges,112.42,77,,89.94,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,119.72,82,,95.776,percent of total billed charges,82% of total billed charges,124.1,85,,99.28,percent of total billed charges,85% of total billed charges,124.1,85,,99.28,percent of total billed charges,85% of total billed charges,124.1,85,,99.28,percent of total billed charges,85% of total billed charges,131.4,90,,105.12,percent of total billed charges,90% of total billed charges,116.8,80,,93.44,percent of total billed charges,80% of total billed charges,131.4,90,,105.12,percent of total billed charges,90% of total billed charges,109.5,75,,87.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,42.34,29,,33.872,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,97.82,67,,78.256,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,116.8,80,,93.44,percent of total billed charges,80% of total billed charges,94.9,65,,75.92,percent of total billed charges,65% of total billed charges,52.08,35.67,,41.664,percent of total billed charges,35.67% of total billed charges,42.34,131.4,
ENDOLOOP SUTURE VICRYL 18,27013416,CDM,270,RC,,,outpatient,,,216,86.40,,183.6,85,,146.88,percent of total billed charges,85% of total billed charges,166.32,77,,133.06,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,177.12,82,,141.696,percent of total billed charges,82% of total billed charges,183.6,85,,146.88,percent of total billed charges,85% of total billed charges,183.6,85,,146.88,percent of total billed charges,85% of total billed charges,183.6,85,,146.88,percent of total billed charges,85% of total billed charges,194.4,90,,155.52,percent of total billed charges,90% of total billed charges,172.8,80,,138.24,percent of total billed charges,80% of total billed charges,194.4,90,,155.52,percent of total billed charges,90% of total billed charges,162,75,,129.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,62.64,29,,50.112,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,144.72,67,,115.776,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,172.8,80,,138.24,percent of total billed charges,80% of total billed charges,140.4,65,,112.32,percent of total billed charges,65% of total billed charges,77.05,35.67,,61.64,percent of total billed charges,35.67% of total billed charges,62.64,194.4,
SILK SUTURE,27013432,CDM,270,RC,,,outpatient,,,64,25.60,,54.4,85,,43.52,percent of total billed charges,85% of total billed charges,49.28,77,,39.42,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,52.48,82,,41.984,percent of total billed charges,82% of total billed charges,54.4,85,,43.52,percent of total billed charges,85% of total billed charges,54.4,85,,43.52,percent of total billed charges,85% of total billed charges,54.4,85,,43.52,percent of total billed charges,85% of total billed charges,57.6,90,,46.08,percent of total billed charges,90% of total billed charges,51.2,80,,40.96,percent of total billed charges,80% of total billed charges,57.6,90,,46.08,percent of total billed charges,90% of total billed charges,48,75,,38.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,18.56,29,,14.848,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,42.88,67,,34.304,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,51.2,80,,40.96,percent of total billed charges,80% of total billed charges,41.6,65,,33.28,percent of total billed charges,65% of total billed charges,22.83,35.67,,18.264,percent of total billed charges,35.67% of total billed charges,18.56,57.6,
ULTRAPOWER 43 MM CYLINDRICAL,27013446,CDM,270,RC,,,outpatient,,,370,148.00,,314.5,85,,251.6,percent of total billed charges,85% of total billed charges,284.9,77,,227.92,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,303.4,82,,242.72,percent of total billed charges,82% of total billed charges,314.5,85,,251.6,percent of total billed charges,85% of total billed charges,314.5,85,,251.6,percent of total billed charges,85% of total billed charges,314.5,85,,251.6,percent of total billed charges,85% of total billed charges,333,90,,266.4,percent of total billed charges,90% of total billed charges,296,80,,236.8,percent of total billed charges,80% of total billed charges,333,90,,266.4,percent of total billed charges,90% of total billed charges,277.5,75,,222,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,107.3,29,,85.84,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,247.9,67,,198.32,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,296,80,,236.8,percent of total billed charges,80% of total billed charges,240.5,65,,192.4,percent of total billed charges,65% of total billed charges,131.98,35.67,,105.584,percent of total billed charges,35.67% of total billed charges,107.3,333,
ULTRAPOWER RND BUR,27013448,CDM,270,RC,,,outpatient,,,455,182.00,,386.75,85,,309.4,percent of total billed charges,85% of total billed charges,350.35,77,,280.28,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,373.1,82,,298.48,percent of total billed charges,82% of total billed charges,386.75,85,,309.4,percent of total billed charges,85% of total billed charges,386.75,85,,309.4,percent of total billed charges,85% of total billed charges,386.75,85,,309.4,percent of total billed charges,85% of total billed charges,409.5,90,,327.6,percent of total billed charges,90% of total billed charges,364,80,,291.2,percent of total billed charges,80% of total billed charges,409.5,90,,327.6,percent of total billed charges,90% of total billed charges,341.25,75,,273,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,131.95,29,,105.56,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,304.85,67,,243.88,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,364,80,,291.2,percent of total billed charges,80% of total billed charges,295.75,65,,236.6,percent of total billed charges,65% of total billed charges,162.3,35.67,,129.84,percent of total billed charges,35.67% of total billed charges,131.95,409.5,
NEW IMAGE URO KIT,27013462,CDM,270,RC,,,outpatient,,,164,65.60,,139.4,85,,111.52,percent of total billed charges,85% of total billed charges,126.28,77,,101.02,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,134.48,82,,107.584,percent of total billed charges,82% of total billed charges,139.4,85,,111.52,percent of total billed charges,85% of total billed charges,139.4,85,,111.52,percent of total billed charges,85% of total billed charges,139.4,85,,111.52,percent of total billed charges,85% of total billed charges,147.6,90,,118.08,percent of total billed charges,90% of total billed charges,131.2,80,,104.96,percent of total billed charges,80% of total billed charges,147.6,90,,118.08,percent of total billed charges,90% of total billed charges,123,75,,98.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,47.56,29,,38.048,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,109.88,67,,87.904,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,131.2,80,,104.96,percent of total billed charges,80% of total billed charges,106.6,65,,85.28,percent of total billed charges,65% of total billed charges,58.5,35.67,,46.8,percent of total billed charges,35.67% of total billed charges,47.56,147.6,
NEW IMAGE URO KIT,27013464,CDM,270,RC,,,outpatient,,,152,60.80,,129.2,85,,103.36,percent of total billed charges,85% of total billed charges,117.04,77,,93.63,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,124.64,82,,99.712,percent of total billed charges,82% of total billed charges,129.2,85,,103.36,percent of total billed charges,85% of total billed charges,129.2,85,,103.36,percent of total billed charges,85% of total billed charges,129.2,85,,103.36,percent of total billed charges,85% of total billed charges,136.8,90,,109.44,percent of total billed charges,90% of total billed charges,121.6,80,,97.28,percent of total billed charges,80% of total billed charges,136.8,90,,109.44,percent of total billed charges,90% of total billed charges,114,75,,91.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,44.08,29,,35.264,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,101.84,67,,81.472,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,121.6,80,,97.28,percent of total billed charges,80% of total billed charges,98.8,65,,79.04,percent of total billed charges,65% of total billed charges,54.22,35.67,,43.376,percent of total billed charges,35.67% of total billed charges,44.08,136.8,
REEMER 8 MM,27013521,CDM,270,RC,,,outpatient,,,945,378.00,,803.25,85,,642.6,percent of total billed charges,85% of total billed charges,727.65,77,,582.12,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,774.9,82,,619.92,percent of total billed charges,82% of total billed charges,803.25,85,,642.6,percent of total billed charges,85% of total billed charges,803.25,85,,642.6,percent of total billed charges,85% of total billed charges,803.25,85,,642.6,percent of total billed charges,85% of total billed charges,850.5,90,,680.4,percent of total billed charges,90% of total billed charges,756,80,,604.8,percent of total billed charges,80% of total billed charges,850.5,90,,680.4,percent of total billed charges,90% of total billed charges,708.75,75,,567,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,274.05,29,,219.24,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,633.15,67,,506.52,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,756,80,,604.8,percent of total billed charges,80% of total billed charges,614.25,65,,491.4,percent of total billed charges,65% of total billed charges,337.08,35.67,,269.664,percent of total billed charges,35.67% of total billed charges,274.05,850.5,
REEMER 9 MM,27013522,CDM,270,RC,,,outpatient,,,945,378.00,,803.25,85,,642.6,percent of total billed charges,85% of total billed charges,727.65,77,,582.12,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,774.9,82,,619.92,percent of total billed charges,82% of total billed charges,803.25,85,,642.6,percent of total billed charges,85% of total billed charges,803.25,85,,642.6,percent of total billed charges,85% of total billed charges,803.25,85,,642.6,percent of total billed charges,85% of total billed charges,850.5,90,,680.4,percent of total billed charges,90% of total billed charges,756,80,,604.8,percent of total billed charges,80% of total billed charges,850.5,90,,680.4,percent of total billed charges,90% of total billed charges,708.75,75,,567,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,274.05,29,,219.24,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,633.15,67,,506.52,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,756,80,,604.8,percent of total billed charges,80% of total billed charges,614.25,65,,491.4,percent of total billed charges,65% of total billed charges,337.08,35.67,,269.664,percent of total billed charges,35.67% of total billed charges,274.05,850.5,
NUROLON SUTURE,27013551,CDM,270,RC,,,outpatient,,,84,33.60,,71.4,85,,57.12,percent of total billed charges,85% of total billed charges,64.68,77,,51.74,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,68.88,82,,55.104,percent of total billed charges,82% of total billed charges,71.4,85,,57.12,percent of total billed charges,85% of total billed charges,71.4,85,,57.12,percent of total billed charges,85% of total billed charges,71.4,85,,57.12,percent of total billed charges,85% of total billed charges,75.6,90,,60.48,percent of total billed charges,90% of total billed charges,67.2,80,,53.76,percent of total billed charges,80% of total billed charges,75.6,90,,60.48,percent of total billed charges,90% of total billed charges,63,75,,50.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,24.36,29,,19.488,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,56.28,67,,45.024,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,67.2,80,,53.76,percent of total billed charges,80% of total billed charges,54.6,65,,43.68,percent of total billed charges,65% of total billed charges,29.96,35.67,,23.968,percent of total billed charges,35.67% of total billed charges,24.36,75.6,
ALGIS FOAM DISC,27013553,CDM,270,RC,,,outpatient,,,54,21.60,,45.9,85,,36.72,percent of total billed charges,85% of total billed charges,41.58,77,,33.26,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,44.28,82,,35.424,percent of total billed charges,82% of total billed charges,45.9,85,,36.72,percent of total billed charges,85% of total billed charges,45.9,85,,36.72,percent of total billed charges,85% of total billed charges,45.9,85,,36.72,percent of total billed charges,85% of total billed charges,48.6,90,,38.88,percent of total billed charges,90% of total billed charges,43.2,80,,34.56,percent of total billed charges,80% of total billed charges,48.6,90,,38.88,percent of total billed charges,90% of total billed charges,40.5,75,,32.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,15.66,29,,12.528,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,36.18,67,,28.944,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,43.2,80,,34.56,percent of total billed charges,80% of total billed charges,35.1,65,,28.08,percent of total billed charges,65% of total billed charges,19.26,35.67,,15.408,percent of total billed charges,35.67% of total billed charges,15.66,48.6,
ACL TOOLBOX INSTRUMENTS,27013590,CDM,270,RC,,,outpatient,,,1646,658.40,,1399.1,85,,1119.28,percent of total billed charges,85% of total billed charges,1267.42,77,,1013.94,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,1349.72,82,,1079.776,percent of total billed charges,82% of total billed charges,1399.1,85,,1119.28,percent of total billed charges,85% of total billed charges,1399.1,85,,1119.28,percent of total billed charges,85% of total billed charges,1399.1,85,,1119.28,percent of total billed charges,85% of total billed charges,1481.4,90,,1185.12,percent of total billed charges,90% of total billed charges,1316.8,80,,1053.44,percent of total billed charges,80% of total billed charges,1481.4,90,,1185.12,percent of total billed charges,90% of total billed charges,1234.5,75,,987.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,477.34,29,,381.872,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1102.82,67,,882.256,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1316.8,80,,1053.44,percent of total billed charges,80% of total billed charges,1069.9,65,,855.92,percent of total billed charges,65% of total billed charges,587.13,35.67,,469.704,percent of total billed charges,35.67% of total billed charges,477.34,1481.4,
TRANSFIX INSTRUMENTS,27013591,CDM,270,RC,,,outpatient,,,770,308.00,,654.5,85,,523.6,percent of total billed charges,85% of total billed charges,592.9,77,,474.32,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,631.4,82,,505.12,percent of total billed charges,82% of total billed charges,654.5,85,,523.6,percent of total billed charges,85% of total billed charges,654.5,85,,523.6,percent of total billed charges,85% of total billed charges,654.5,85,,523.6,percent of total billed charges,85% of total billed charges,693,90,,554.4,percent of total billed charges,90% of total billed charges,616,80,,492.8,percent of total billed charges,80% of total billed charges,693,90,,554.4,percent of total billed charges,90% of total billed charges,577.5,75,,462,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,223.3,29,,178.64,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,515.9,67,,412.72,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,616,80,,492.8,percent of total billed charges,80% of total billed charges,500.5,65,,400.4,percent of total billed charges,65% of total billed charges,274.66,35.67,,219.728,percent of total billed charges,35.67% of total billed charges,223.3,693,
TISSEEL FIBRIN 10 GRAM SEALANT,27013601,CDM,270,RC,,,outpatient,,,1861,744.40,,1581.85,85,,1265.48,percent of total billed charges,85% of total billed charges,1432.97,77,,1146.38,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,1526.02,82,,1220.816,percent of total billed charges,82% of total billed charges,1581.85,85,,1265.48,percent of total billed charges,85% of total billed charges,1581.85,85,,1265.48,percent of total billed charges,85% of total billed charges,1581.85,85,,1265.48,percent of total billed charges,85% of total billed charges,1674.9,90,,1339.92,percent of total billed charges,90% of total billed charges,1488.8,80,,1191.04,percent of total billed charges,80% of total billed charges,1674.9,90,,1339.92,percent of total billed charges,90% of total billed charges,1395.75,75,,1116.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,539.69,29,,431.752,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1246.87,67,,997.496,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1488.8,80,,1191.04,percent of total billed charges,80% of total billed charges,1209.65,65,,967.72,percent of total billed charges,65% of total billed charges,663.82,35.67,,531.056,percent of total billed charges,35.67% of total billed charges,539.69,1674.9,
ELECTRODE BLADE,27013608,CDM,270,RC,,,outpatient,,,49,19.60,,41.65,85,,33.32,percent of total billed charges,85% of total billed charges,37.73,77,,30.18,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,40.18,82,,32.144,percent of total billed charges,82% of total billed charges,41.65,85,,33.32,percent of total billed charges,85% of total billed charges,41.65,85,,33.32,percent of total billed charges,85% of total billed charges,41.65,85,,33.32,percent of total billed charges,85% of total billed charges,44.1,90,,35.28,percent of total billed charges,90% of total billed charges,39.2,80,,31.36,percent of total billed charges,80% of total billed charges,44.1,90,,35.28,percent of total billed charges,90% of total billed charges,36.75,75,,29.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,14.21,29,,11.368,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,32.83,67,,26.264,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,39.2,80,,31.36,percent of total billed charges,80% of total billed charges,31.85,65,,25.48,percent of total billed charges,65% of total billed charges,17.48,35.67,,13.984,percent of total billed charges,35.67% of total billed charges,14.21,44.1,
SUTURE NUROLON,27013610,CDM,270,RC,,,outpatient,,,85,34.00,,72.25,85,,57.8,percent of total billed charges,85% of total billed charges,65.45,77,,52.36,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,69.7,82,,55.76,percent of total billed charges,82% of total billed charges,72.25,85,,57.8,percent of total billed charges,85% of total billed charges,72.25,85,,57.8,percent of total billed charges,85% of total billed charges,72.25,85,,57.8,percent of total billed charges,85% of total billed charges,76.5,90,,61.2,percent of total billed charges,90% of total billed charges,68,80,,54.4,percent of total billed charges,80% of total billed charges,76.5,90,,61.2,percent of total billed charges,90% of total billed charges,63.75,75,,51,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,24.65,29,,19.72,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,56.95,67,,45.56,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,68,80,,54.4,percent of total billed charges,80% of total billed charges,55.25,65,,44.2,percent of total billed charges,65% of total billed charges,30.32,35.67,,24.256,percent of total billed charges,35.67% of total billed charges,24.65,76.5,
SYSTEM JACKSON PRATT TROCAR,27013623,CDM,270,RC,,,outpatient,,,93,37.20,,79.05,85,,63.24,percent of total billed charges,85% of total billed charges,71.61,77,,57.29,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,76.26,82,,61.008,percent of total billed charges,82% of total billed charges,79.05,85,,63.24,percent of total billed charges,85% of total billed charges,79.05,85,,63.24,percent of total billed charges,85% of total billed charges,79.05,85,,63.24,percent of total billed charges,85% of total billed charges,83.7,90,,66.96,percent of total billed charges,90% of total billed charges,74.4,80,,59.52,percent of total billed charges,80% of total billed charges,83.7,90,,66.96,percent of total billed charges,90% of total billed charges,69.75,75,,55.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,26.97,29,,21.576,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,62.31,67,,49.848,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,74.4,80,,59.52,percent of total billed charges,80% of total billed charges,60.45,65,,48.36,percent of total billed charges,65% of total billed charges,33.17,35.67,,26.536,percent of total billed charges,35.67% of total billed charges,26.97,83.7,
GRAFT PASS WIRE SET,27013625,CDM,270,RC,,,outpatient,,,959,383.60,,815.15,85,,652.12,percent of total billed charges,85% of total billed charges,738.43,77,,590.74,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,786.38,82,,629.104,percent of total billed charges,82% of total billed charges,815.15,85,,652.12,percent of total billed charges,85% of total billed charges,815.15,85,,652.12,percent of total billed charges,85% of total billed charges,815.15,85,,652.12,percent of total billed charges,85% of total billed charges,863.1,90,,690.48,percent of total billed charges,90% of total billed charges,767.2,80,,613.76,percent of total billed charges,80% of total billed charges,863.1,90,,690.48,percent of total billed charges,90% of total billed charges,719.25,75,,575.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,278.11,29,,222.488,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,642.53,67,,514.024,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,767.2,80,,613.76,percent of total billed charges,80% of total billed charges,623.35,65,,498.68,percent of total billed charges,65% of total billed charges,342.08,35.67,,273.664,percent of total billed charges,35.67% of total billed charges,278.11,863.1,
SPINAL SURGERY KIT,27013639,CDM,270,RC,,,outpatient,,,989,395.60,,840.65,85,,672.52,percent of total billed charges,85% of total billed charges,761.53,77,,609.22,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,810.98,82,,648.784,percent of total billed charges,82% of total billed charges,840.65,85,,672.52,percent of total billed charges,85% of total billed charges,840.65,85,,672.52,percent of total billed charges,85% of total billed charges,840.65,85,,672.52,percent of total billed charges,85% of total billed charges,890.1,90,,712.08,percent of total billed charges,90% of total billed charges,791.2,80,,632.96,percent of total billed charges,80% of total billed charges,890.1,90,,712.08,percent of total billed charges,90% of total billed charges,741.75,75,,593.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,286.81,29,,229.448,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,662.63,67,,530.104,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,791.2,80,,632.96,percent of total billed charges,80% of total billed charges,642.85,65,,514.28,percent of total billed charges,65% of total billed charges,352.78,35.67,,282.224,percent of total billed charges,35.67% of total billed charges,286.81,890.1,
JAMSHIRI NEEDLE,27013662,CDM,270,RC,,,outpatient,,,1143,457.20,,971.55,85,,777.24,percent of total billed charges,85% of total billed charges,880.11,77,,704.09,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,937.26,82,,749.808,percent of total billed charges,82% of total billed charges,971.55,85,,777.24,percent of total billed charges,85% of total billed charges,971.55,85,,777.24,percent of total billed charges,85% of total billed charges,971.55,85,,777.24,percent of total billed charges,85% of total billed charges,1028.7,90,,822.96,percent of total billed charges,90% of total billed charges,914.4,80,,731.52,percent of total billed charges,80% of total billed charges,1028.7,90,,822.96,percent of total billed charges,90% of total billed charges,857.25,75,,685.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,331.47,29,,265.176,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,765.81,67,,612.648,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,914.4,80,,731.52,percent of total billed charges,80% of total billed charges,742.95,65,,594.36,percent of total billed charges,65% of total billed charges,407.71,35.67,,326.168,percent of total billed charges,35.67% of total billed charges,331.47,1028.7,
CHIPS CANCELLOUS,27013665,CDM,270,RC,,,outpatient,,,1809,723.60,,1537.65,85,,1230.12,percent of total billed charges,85% of total billed charges,1392.93,77,,1114.34,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,1483.38,82,,1186.704,percent of total billed charges,82% of total billed charges,1537.65,85,,1230.12,percent of total billed charges,85% of total billed charges,1537.65,85,,1230.12,percent of total billed charges,85% of total billed charges,1537.65,85,,1230.12,percent of total billed charges,85% of total billed charges,1628.1,90,,1302.48,percent of total billed charges,90% of total billed charges,1447.2,80,,1157.76,percent of total billed charges,80% of total billed charges,1628.1,90,,1302.48,percent of total billed charges,90% of total billed charges,1356.75,75,,1085.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,524.61,29,,419.688,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1212.03,67,,969.624,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1447.2,80,,1157.76,percent of total billed charges,80% of total billed charges,1175.85,65,,940.68,percent of total billed charges,65% of total billed charges,645.27,35.67,,516.216,percent of total billed charges,35.67% of total billed charges,524.61,1628.1,
CHIPS CANCELLOUS,27013666,CDM,270,RC,,,outpatient,,,1809,723.60,,1537.65,85,,1230.12,percent of total billed charges,85% of total billed charges,1392.93,77,,1114.34,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,1483.38,82,,1186.704,percent of total billed charges,82% of total billed charges,1537.65,85,,1230.12,percent of total billed charges,85% of total billed charges,1537.65,85,,1230.12,percent of total billed charges,85% of total billed charges,1537.65,85,,1230.12,percent of total billed charges,85% of total billed charges,1628.1,90,,1302.48,percent of total billed charges,90% of total billed charges,1447.2,80,,1157.76,percent of total billed charges,80% of total billed charges,1628.1,90,,1302.48,percent of total billed charges,90% of total billed charges,1356.75,75,,1085.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,524.61,29,,419.688,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1212.03,67,,969.624,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1447.2,80,,1157.76,percent of total billed charges,80% of total billed charges,1175.85,65,,940.68,percent of total billed charges,65% of total billed charges,645.27,35.67,,516.216,percent of total billed charges,35.67% of total billed charges,524.61,1628.1,
CHIPS CANCELLOUS,27013667,CDM,270,RC,,,outpatient,,,1809,723.60,,1537.65,85,,1230.12,percent of total billed charges,85% of total billed charges,1392.93,77,,1114.34,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,1483.38,82,,1186.704,percent of total billed charges,82% of total billed charges,1537.65,85,,1230.12,percent of total billed charges,85% of total billed charges,1537.65,85,,1230.12,percent of total billed charges,85% of total billed charges,1537.65,85,,1230.12,percent of total billed charges,85% of total billed charges,1628.1,90,,1302.48,percent of total billed charges,90% of total billed charges,1447.2,80,,1157.76,percent of total billed charges,80% of total billed charges,1628.1,90,,1302.48,percent of total billed charges,90% of total billed charges,1356.75,75,,1085.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,524.61,29,,419.688,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1212.03,67,,969.624,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1447.2,80,,1157.76,percent of total billed charges,80% of total billed charges,1175.85,65,,940.68,percent of total billed charges,65% of total billed charges,645.27,35.67,,516.216,percent of total billed charges,35.67% of total billed charges,524.61,1628.1,
CHIPS CANCELLOUS,27013668,CDM,270,RC,,,outpatient,,,1225,490.00,,1041.25,85,,833,percent of total billed charges,85% of total billed charges,943.25,77,,754.6,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,1004.5,82,,803.6,percent of total billed charges,82% of total billed charges,1041.25,85,,833,percent of total billed charges,85% of total billed charges,1041.25,85,,833,percent of total billed charges,85% of total billed charges,1041.25,85,,833,percent of total billed charges,85% of total billed charges,1102.5,90,,882,percent of total billed charges,90% of total billed charges,980,80,,784,percent of total billed charges,80% of total billed charges,1102.5,90,,882,percent of total billed charges,90% of total billed charges,918.75,75,,735,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,355.25,29,,284.2,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,820.75,67,,656.6,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,980,80,,784,percent of total billed charges,80% of total billed charges,796.25,65,,637,percent of total billed charges,65% of total billed charges,436.96,35.67,,349.568,percent of total billed charges,35.67% of total billed charges,355.25,1102.5,
TUBE DRILLING LINVATEC,27013672,CDM,270,RC,,,outpatient,,,139,55.60,,118.15,85,,94.52,percent of total billed charges,85% of total billed charges,107.03,77,,85.62,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,113.98,82,,91.184,percent of total billed charges,82% of total billed charges,118.15,85,,94.52,percent of total billed charges,85% of total billed charges,118.15,85,,94.52,percent of total billed charges,85% of total billed charges,118.15,85,,94.52,percent of total billed charges,85% of total billed charges,125.1,90,,100.08,percent of total billed charges,90% of total billed charges,111.2,80,,88.96,percent of total billed charges,80% of total billed charges,125.1,90,,100.08,percent of total billed charges,90% of total billed charges,104.25,75,,83.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,40.31,29,,32.248,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,93.13,67,,74.504,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,111.2,80,,88.96,percent of total billed charges,80% of total billed charges,90.35,65,,72.28,percent of total billed charges,65% of total billed charges,49.58,35.67,,39.664,percent of total billed charges,35.67% of total billed charges,40.31,125.1,
BLADE 2.75,27013679,CDM,270,RC,,,outpatient,,,49,19.60,,41.65,85,,33.32,percent of total billed charges,85% of total billed charges,37.73,77,,30.18,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,40.18,82,,32.144,percent of total billed charges,82% of total billed charges,41.65,85,,33.32,percent of total billed charges,85% of total billed charges,41.65,85,,33.32,percent of total billed charges,85% of total billed charges,41.65,85,,33.32,percent of total billed charges,85% of total billed charges,44.1,90,,35.28,percent of total billed charges,90% of total billed charges,39.2,80,,31.36,percent of total billed charges,80% of total billed charges,44.1,90,,35.28,percent of total billed charges,90% of total billed charges,36.75,75,,29.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,14.21,29,,11.368,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,32.83,67,,26.264,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,39.2,80,,31.36,percent of total billed charges,80% of total billed charges,31.85,65,,25.48,percent of total billed charges,65% of total billed charges,17.48,35.67,,13.984,percent of total billed charges,35.67% of total billed charges,14.21,44.1,
CAST TAPE,27013714,CDM,270,RC,,,outpatient,,,56,22.40,,47.6,85,,38.08,percent of total billed charges,85% of total billed charges,43.12,77,,34.5,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,45.92,82,,36.736,percent of total billed charges,82% of total billed charges,47.6,85,,38.08,percent of total billed charges,85% of total billed charges,47.6,85,,38.08,percent of total billed charges,85% of total billed charges,47.6,85,,38.08,percent of total billed charges,85% of total billed charges,50.4,90,,40.32,percent of total billed charges,90% of total billed charges,44.8,80,,35.84,percent of total billed charges,80% of total billed charges,50.4,90,,40.32,percent of total billed charges,90% of total billed charges,42,75,,33.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,16.24,29,,12.992,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,37.52,67,,30.016,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,44.8,80,,35.84,percent of total billed charges,80% of total billed charges,36.4,65,,29.12,percent of total billed charges,65% of total billed charges,19.98,35.67,,15.984,percent of total billed charges,35.67% of total billed charges,16.24,50.4,
HEADLESS DRILL BIT,27013815,CDM,270,RC,,,outpatient,,,1427,570.80,,1212.95,85,,970.36,percent of total billed charges,85% of total billed charges,1098.79,77,,879.03,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,1170.14,82,,936.112,percent of total billed charges,82% of total billed charges,1212.95,85,,970.36,percent of total billed charges,85% of total billed charges,1212.95,85,,970.36,percent of total billed charges,85% of total billed charges,1212.95,85,,970.36,percent of total billed charges,85% of total billed charges,1284.3,90,,1027.44,percent of total billed charges,90% of total billed charges,1141.6,80,,913.28,percent of total billed charges,80% of total billed charges,1284.3,90,,1027.44,percent of total billed charges,90% of total billed charges,1070.25,75,,856.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,413.83,29,,331.064,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,956.09,67,,764.872,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1141.6,80,,913.28,percent of total billed charges,80% of total billed charges,927.55,65,,742.04,percent of total billed charges,65% of total billed charges,509.01,35.67,,407.208,percent of total billed charges,35.67% of total billed charges,413.83,1284.3,
HEADLESS DRILL BIT,27013816,CDM,270,RC,,,outpatient,,,1427,570.80,,1212.95,85,,970.36,percent of total billed charges,85% of total billed charges,1098.79,77,,879.03,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,1170.14,82,,936.112,percent of total billed charges,82% of total billed charges,1212.95,85,,970.36,percent of total billed charges,85% of total billed charges,1212.95,85,,970.36,percent of total billed charges,85% of total billed charges,1212.95,85,,970.36,percent of total billed charges,85% of total billed charges,1284.3,90,,1027.44,percent of total billed charges,90% of total billed charges,1141.6,80,,913.28,percent of total billed charges,80% of total billed charges,1284.3,90,,1027.44,percent of total billed charges,90% of total billed charges,1070.25,75,,856.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,413.83,29,,331.064,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,956.09,67,,764.872,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1141.6,80,,913.28,percent of total billed charges,80% of total billed charges,927.55,65,,742.04,percent of total billed charges,65% of total billed charges,509.01,35.67,,407.208,percent of total billed charges,35.67% of total billed charges,413.83,1284.3,
CHAIR SENSOR PAD,27013829,CDM,270,RC,,,outpatient,,,179,71.60,,152.15,85,,121.72,percent of total billed charges,85% of total billed charges,137.83,77,,110.26,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,146.78,82,,117.424,percent of total billed charges,82% of total billed charges,152.15,85,,121.72,percent of total billed charges,85% of total billed charges,152.15,85,,121.72,percent of total billed charges,85% of total billed charges,152.15,85,,121.72,percent of total billed charges,85% of total billed charges,161.1,90,,128.88,percent of total billed charges,90% of total billed charges,143.2,80,,114.56,percent of total billed charges,80% of total billed charges,161.1,90,,128.88,percent of total billed charges,90% of total billed charges,134.25,75,,107.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,51.91,29,,41.528,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,119.93,67,,95.944,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,143.2,80,,114.56,percent of total billed charges,80% of total billed charges,116.35,65,,93.08,percent of total billed charges,65% of total billed charges,63.85,35.67,,51.08,percent of total billed charges,35.67% of total billed charges,51.91,161.1,
BONE MARROW NEEDLE,27013831,CDM,270,RC,,,outpatient,,,202,80.80,,171.7,85,,137.36,percent of total billed charges,85% of total billed charges,155.54,77,,124.43,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,165.64,82,,132.512,percent of total billed charges,82% of total billed charges,171.7,85,,137.36,percent of total billed charges,85% of total billed charges,171.7,85,,137.36,percent of total billed charges,85% of total billed charges,171.7,85,,137.36,percent of total billed charges,85% of total billed charges,181.8,90,,145.44,percent of total billed charges,90% of total billed charges,161.6,80,,129.28,percent of total billed charges,80% of total billed charges,181.8,90,,145.44,percent of total billed charges,90% of total billed charges,151.5,75,,121.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,58.58,29,,46.864,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,135.34,67,,108.272,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,161.6,80,,129.28,percent of total billed charges,80% of total billed charges,131.3,65,,105.04,percent of total billed charges,65% of total billed charges,72.05,35.67,,57.64,percent of total billed charges,35.67% of total billed charges,58.58,181.8,
EGGCRATE FOAM,27013837,CDM,270,RC,,,outpatient,,,46,18.40,,39.1,85,,31.28,percent of total billed charges,85% of total billed charges,35.42,77,,28.34,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,37.72,82,,30.176,percent of total billed charges,82% of total billed charges,39.1,85,,31.28,percent of total billed charges,85% of total billed charges,39.1,85,,31.28,percent of total billed charges,85% of total billed charges,39.1,85,,31.28,percent of total billed charges,85% of total billed charges,41.4,90,,33.12,percent of total billed charges,90% of total billed charges,36.8,80,,29.44,percent of total billed charges,80% of total billed charges,41.4,90,,33.12,percent of total billed charges,90% of total billed charges,34.5,75,,27.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,13.34,29,,10.672,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,30.82,67,,24.656,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,36.8,80,,29.44,percent of total billed charges,80% of total billed charges,29.9,65,,23.92,percent of total billed charges,65% of total billed charges,16.41,35.67,,13.128,percent of total billed charges,35.67% of total billed charges,13.34,41.4,
SUTURE NURLON,27013845,CDM,270,RC,,,outpatient,,,45,18.00,,38.25,85,,30.6,percent of total billed charges,85% of total billed charges,34.65,77,,27.72,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,36.9,82,,29.52,percent of total billed charges,82% of total billed charges,38.25,85,,30.6,percent of total billed charges,85% of total billed charges,38.25,85,,30.6,percent of total billed charges,85% of total billed charges,38.25,85,,30.6,percent of total billed charges,85% of total billed charges,40.5,90,,32.4,percent of total billed charges,90% of total billed charges,36,80,,28.8,percent of total billed charges,80% of total billed charges,40.5,90,,32.4,percent of total billed charges,90% of total billed charges,33.75,75,,27,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,13.05,29,,10.44,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,30.15,67,,24.12,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,36,80,,28.8,percent of total billed charges,80% of total billed charges,29.25,65,,23.4,percent of total billed charges,65% of total billed charges,16.05,35.67,,12.84,percent of total billed charges,35.67% of total billed charges,13.05,40.5,
HEMOSTAT,27013846,CDM,270,RC,,,outpatient,,,513,205.20,,436.05,85,,348.84,percent of total billed charges,85% of total billed charges,395.01,77,,316.01,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,420.66,82,,336.528,percent of total billed charges,82% of total billed charges,436.05,85,,348.84,percent of total billed charges,85% of total billed charges,436.05,85,,348.84,percent of total billed charges,85% of total billed charges,436.05,85,,348.84,percent of total billed charges,85% of total billed charges,461.7,90,,369.36,percent of total billed charges,90% of total billed charges,410.4,80,,328.32,percent of total billed charges,80% of total billed charges,461.7,90,,369.36,percent of total billed charges,90% of total billed charges,384.75,75,,307.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,148.77,29,,119.016,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,343.71,67,,274.968,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,410.4,80,,328.32,percent of total billed charges,80% of total billed charges,333.45,65,,266.76,percent of total billed charges,65% of total billed charges,182.99,35.67,,146.392,percent of total billed charges,35.67% of total billed charges,148.77,461.7,
ENDOCUFF GREEN,27013852,CDM,270,RC,,,outpatient,,,213,85.20,,181.05,85,,144.84,percent of total billed charges,85% of total billed charges,164.01,77,,131.21,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,174.66,82,,139.728,percent of total billed charges,82% of total billed charges,181.05,85,,144.84,percent of total billed charges,85% of total billed charges,181.05,85,,144.84,percent of total billed charges,85% of total billed charges,181.05,85,,144.84,percent of total billed charges,85% of total billed charges,191.7,90,,153.36,percent of total billed charges,90% of total billed charges,170.4,80,,136.32,percent of total billed charges,80% of total billed charges,191.7,90,,153.36,percent of total billed charges,90% of total billed charges,159.75,75,,127.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,61.77,29,,49.416,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,142.71,67,,114.168,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,170.4,80,,136.32,percent of total billed charges,80% of total billed charges,138.45,65,,110.76,percent of total billed charges,65% of total billed charges,75.98,35.67,,60.784,percent of total billed charges,35.67% of total billed charges,61.77,191.7,
ENDOCUFF SMALL,27013853,CDM,270,RC,,,outpatient,,,213,85.20,,181.05,85,,144.84,percent of total billed charges,85% of total billed charges,164.01,77,,131.21,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,174.66,82,,139.728,percent of total billed charges,82% of total billed charges,181.05,85,,144.84,percent of total billed charges,85% of total billed charges,181.05,85,,144.84,percent of total billed charges,85% of total billed charges,181.05,85,,144.84,percent of total billed charges,85% of total billed charges,191.7,90,,153.36,percent of total billed charges,90% of total billed charges,170.4,80,,136.32,percent of total billed charges,80% of total billed charges,191.7,90,,153.36,percent of total billed charges,90% of total billed charges,159.75,75,,127.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,61.77,29,,49.416,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,142.71,67,,114.168,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,170.4,80,,136.32,percent of total billed charges,80% of total billed charges,138.45,65,,110.76,percent of total billed charges,65% of total billed charges,75.98,35.67,,60.784,percent of total billed charges,35.67% of total billed charges,61.77,191.7,
QUICK CLIP PRO,27013854,CDM,270,RC,,,outpatient,,,798,319.20,,678.3,85,,542.64,percent of total billed charges,85% of total billed charges,614.46,77,,491.57,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,654.36,82,,523.488,percent of total billed charges,82% of total billed charges,678.3,85,,542.64,percent of total billed charges,85% of total billed charges,678.3,85,,542.64,percent of total billed charges,85% of total billed charges,678.3,85,,542.64,percent of total billed charges,85% of total billed charges,718.2,90,,574.56,percent of total billed charges,90% of total billed charges,638.4,80,,510.72,percent of total billed charges,80% of total billed charges,718.2,90,,574.56,percent of total billed charges,90% of total billed charges,598.5,75,,478.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,231.42,29,,185.136,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,534.66,67,,427.728,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,638.4,80,,510.72,percent of total billed charges,80% of total billed charges,518.7,65,,414.96,percent of total billed charges,65% of total billed charges,284.65,35.67,,227.72,percent of total billed charges,35.67% of total billed charges,231.42,718.2,
POLY LOOP,27013859,CDM,270,RC,,,outpatient,,,353,141.20,,300.05,85,,240.04,percent of total billed charges,85% of total billed charges,271.81,77,,217.45,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,289.46,82,,231.568,percent of total billed charges,82% of total billed charges,300.05,85,,240.04,percent of total billed charges,85% of total billed charges,300.05,85,,240.04,percent of total billed charges,85% of total billed charges,300.05,85,,240.04,percent of total billed charges,85% of total billed charges,317.7,90,,254.16,percent of total billed charges,90% of total billed charges,282.4,80,,225.92,percent of total billed charges,80% of total billed charges,317.7,90,,254.16,percent of total billed charges,90% of total billed charges,264.75,75,,211.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,102.37,29,,81.896,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,236.51,67,,189.208,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,282.4,80,,225.92,percent of total billed charges,80% of total billed charges,229.45,65,,183.56,percent of total billed charges,65% of total billed charges,125.92,35.67,,100.736,percent of total billed charges,35.67% of total billed charges,102.37,317.7,
FRAG SET,27013885,CDM,270,RC,,,outpatient,,,824,329.60,,700.4,85,,560.32,percent of total billed charges,85% of total billed charges,634.48,77,,507.58,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,675.68,82,,540.544,percent of total billed charges,82% of total billed charges,700.4,85,,560.32,percent of total billed charges,85% of total billed charges,700.4,85,,560.32,percent of total billed charges,85% of total billed charges,700.4,85,,560.32,percent of total billed charges,85% of total billed charges,741.6,90,,593.28,percent of total billed charges,90% of total billed charges,659.2,80,,527.36,percent of total billed charges,80% of total billed charges,741.6,90,,593.28,percent of total billed charges,90% of total billed charges,618,75,,494.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,238.96,29,,191.168,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,552.08,67,,441.664,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,659.2,80,,527.36,percent of total billed charges,80% of total billed charges,535.6,65,,428.48,percent of total billed charges,65% of total billed charges,293.92,35.67,,235.136,percent of total billed charges,35.67% of total billed charges,238.96,741.6,
RASP,27014000,CDM,270,RC,,,outpatient,,,326,130.40,,277.1,85,,221.68,percent of total billed charges,85% of total billed charges,251.02,77,,200.82,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,267.32,82,,213.856,percent of total billed charges,82% of total billed charges,277.1,85,,221.68,percent of total billed charges,85% of total billed charges,277.1,85,,221.68,percent of total billed charges,85% of total billed charges,277.1,85,,221.68,percent of total billed charges,85% of total billed charges,293.4,90,,234.72,percent of total billed charges,90% of total billed charges,260.8,80,,208.64,percent of total billed charges,80% of total billed charges,293.4,90,,234.72,percent of total billed charges,90% of total billed charges,244.5,75,,195.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,94.54,29,,75.632,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,218.42,67,,174.736,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,260.8,80,,208.64,percent of total billed charges,80% of total billed charges,211.9,65,,169.52,percent of total billed charges,65% of total billed charges,116.28,35.67,,93.024,percent of total billed charges,35.67% of total billed charges,94.54,293.4,
OVAL BUR,27014002,CDM,270,RC,,,outpatient,,,119,47.60,,101.15,85,,80.92,percent of total billed charges,85% of total billed charges,91.63,77,,73.3,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,97.58,82,,78.064,percent of total billed charges,82% of total billed charges,101.15,85,,80.92,percent of total billed charges,85% of total billed charges,101.15,85,,80.92,percent of total billed charges,85% of total billed charges,101.15,85,,80.92,percent of total billed charges,85% of total billed charges,107.1,90,,85.68,percent of total billed charges,90% of total billed charges,95.2,80,,76.16,percent of total billed charges,80% of total billed charges,107.1,90,,85.68,percent of total billed charges,90% of total billed charges,89.25,75,,71.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,34.51,29,,27.608,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,79.73,67,,63.784,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,95.2,80,,76.16,percent of total billed charges,80% of total billed charges,77.35,65,,61.88,percent of total billed charges,65% of total billed charges,42.45,35.67,,33.96,percent of total billed charges,35.67% of total billed charges,34.51,107.1,
BLADE,27014003,CDM,270,RC,,,outpatient,,,102,40.80,,86.7,85,,69.36,percent of total billed charges,85% of total billed charges,78.54,77,,62.83,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,83.64,82,,66.912,percent of total billed charges,82% of total billed charges,86.7,85,,69.36,percent of total billed charges,85% of total billed charges,86.7,85,,69.36,percent of total billed charges,85% of total billed charges,86.7,85,,69.36,percent of total billed charges,85% of total billed charges,91.8,90,,73.44,percent of total billed charges,90% of total billed charges,81.6,80,,65.28,percent of total billed charges,80% of total billed charges,91.8,90,,73.44,percent of total billed charges,90% of total billed charges,76.5,75,,61.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,29.58,29,,23.664,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,68.34,67,,54.672,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,81.6,80,,65.28,percent of total billed charges,80% of total billed charges,66.3,65,,53.04,percent of total billed charges,65% of total billed charges,36.38,35.67,,29.104,percent of total billed charges,35.67% of total billed charges,29.58,91.8,
BLADE,27014004,CDM,270,RC,,,outpatient,,,103,41.20,,87.55,85,,70.04,percent of total billed charges,85% of total billed charges,79.31,77,,63.45,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,84.46,82,,67.568,percent of total billed charges,82% of total billed charges,87.55,85,,70.04,percent of total billed charges,85% of total billed charges,87.55,85,,70.04,percent of total billed charges,85% of total billed charges,87.55,85,,70.04,percent of total billed charges,85% of total billed charges,92.7,90,,74.16,percent of total billed charges,90% of total billed charges,82.4,80,,65.92,percent of total billed charges,80% of total billed charges,92.7,90,,74.16,percent of total billed charges,90% of total billed charges,77.25,75,,61.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,29.87,29,,23.896,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,69.01,67,,55.208,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,82.4,80,,65.92,percent of total billed charges,80% of total billed charges,66.95,65,,53.56,percent of total billed charges,65% of total billed charges,36.74,35.67,,29.392,percent of total billed charges,35.67% of total billed charges,29.87,92.7,
BLADE,27014005,CDM,270,RC,,,outpatient,,,151,60.40,,128.35,85,,102.68,percent of total billed charges,85% of total billed charges,116.27,77,,93.02,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,123.82,82,,99.056,percent of total billed charges,82% of total billed charges,128.35,85,,102.68,percent of total billed charges,85% of total billed charges,128.35,85,,102.68,percent of total billed charges,85% of total billed charges,128.35,85,,102.68,percent of total billed charges,85% of total billed charges,135.9,90,,108.72,percent of total billed charges,90% of total billed charges,120.8,80,,96.64,percent of total billed charges,80% of total billed charges,135.9,90,,108.72,percent of total billed charges,90% of total billed charges,113.25,75,,90.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,43.79,29,,35.032,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,101.17,67,,80.936,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,120.8,80,,96.64,percent of total billed charges,80% of total billed charges,98.15,65,,78.52,percent of total billed charges,65% of total billed charges,53.86,35.67,,43.088,percent of total billed charges,35.67% of total billed charges,43.79,135.9,
BLADE,27014006,CDM,270,RC,,,outpatient,,,83,33.20,,70.55,85,,56.44,percent of total billed charges,85% of total billed charges,63.91,77,,51.13,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,68.06,82,,54.448,percent of total billed charges,82% of total billed charges,70.55,85,,56.44,percent of total billed charges,85% of total billed charges,70.55,85,,56.44,percent of total billed charges,85% of total billed charges,70.55,85,,56.44,percent of total billed charges,85% of total billed charges,74.7,90,,59.76,percent of total billed charges,90% of total billed charges,66.4,80,,53.12,percent of total billed charges,80% of total billed charges,74.7,90,,59.76,percent of total billed charges,90% of total billed charges,62.25,75,,49.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,24.07,29,,19.256,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,55.61,67,,44.488,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,66.4,80,,53.12,percent of total billed charges,80% of total billed charges,53.95,65,,43.16,percent of total billed charges,65% of total billed charges,29.61,35.67,,23.688,percent of total billed charges,35.67% of total billed charges,24.07,74.7,
KCI Y CONNECTOR,27014047,CDM,270,RC,,,outpatient,,,18,7.20,,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,13.86,77,,11.09,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,14.76,82,,11.808,percent of total billed charges,82% of total billed charges,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,16.2,90,,12.96,percent of total billed charges,90% of total billed charges,14.4,80,,11.52,percent of total billed charges,80% of total billed charges,16.2,90,,12.96,percent of total billed charges,90% of total billed charges,13.5,75,,10.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,5.22,29,,4.176,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,12.06,67,,9.648,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,14.4,80,,11.52,percent of total billed charges,80% of total billed charges,11.7,65,,9.36,percent of total billed charges,65% of total billed charges,6.42,35.67,,5.136,percent of total billed charges,35.67% of total billed charges,5.22,16.2,
MINI SQUAIR SMOKE SYSTEM,27014102,CDM,270,RC,,,outpatient,,,165,66.00,,140.25,85,,112.2,percent of total billed charges,85% of total billed charges,127.05,77,,101.64,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,135.3,82,,108.24,percent of total billed charges,82% of total billed charges,140.25,85,,112.2,percent of total billed charges,85% of total billed charges,140.25,85,,112.2,percent of total billed charges,85% of total billed charges,140.25,85,,112.2,percent of total billed charges,85% of total billed charges,148.5,90,,118.8,percent of total billed charges,90% of total billed charges,132,80,,105.6,percent of total billed charges,80% of total billed charges,148.5,90,,118.8,percent of total billed charges,90% of total billed charges,123.75,75,,99,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,47.85,29,,38.28,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,110.55,67,,88.44,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,132,80,,105.6,percent of total billed charges,80% of total billed charges,107.25,65,,85.8,percent of total billed charges,65% of total billed charges,58.86,35.67,,47.088,percent of total billed charges,35.67% of total billed charges,47.85,148.5,
SUTURE 3-0 VICRYL,27014175,CDM,270,RC,,,outpatient,,,145,58.00,,123.25,85,,98.6,percent of total billed charges,85% of total billed charges,111.65,77,,89.32,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,118.9,82,,95.12,percent of total billed charges,82% of total billed charges,123.25,85,,98.6,percent of total billed charges,85% of total billed charges,123.25,85,,98.6,percent of total billed charges,85% of total billed charges,123.25,85,,98.6,percent of total billed charges,85% of total billed charges,130.5,90,,104.4,percent of total billed charges,90% of total billed charges,116,80,,92.8,percent of total billed charges,80% of total billed charges,130.5,90,,104.4,percent of total billed charges,90% of total billed charges,108.75,75,,87,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,42.05,29,,33.64,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,97.15,67,,77.72,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,116,80,,92.8,percent of total billed charges,80% of total billed charges,94.25,65,,75.4,percent of total billed charges,65% of total billed charges,51.72,35.67,,41.376,percent of total billed charges,35.67% of total billed charges,42.05,130.5,
SUTURE COATED VICRYL,27014176,CDM,270,RC,,,outpatient,,,21,8.40,,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,16.17,77,,12.94,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,17.22,82,,13.776,percent of total billed charges,82% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,18.9,90,,15.12,percent of total billed charges,90% of total billed charges,16.8,80,,13.44,percent of total billed charges,80% of total billed charges,18.9,90,,15.12,percent of total billed charges,90% of total billed charges,15.75,75,,12.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,6.09,29,,4.872,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,14.07,67,,11.256,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,16.8,80,,13.44,percent of total billed charges,80% of total billed charges,13.65,65,,10.92,percent of total billed charges,65% of total billed charges,7.49,35.67,,5.992,percent of total billed charges,35.67% of total billed charges,6.09,18.9,
SURGICAL SKIN CLOSURE,27014184,CDM,270,RC,,,outpatient,,,425,170.00,,361.25,85,,289,percent of total billed charges,85% of total billed charges,327.25,77,,261.8,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,348.5,82,,278.8,percent of total billed charges,82% of total billed charges,361.25,85,,289,percent of total billed charges,85% of total billed charges,361.25,85,,289,percent of total billed charges,85% of total billed charges,361.25,85,,289,percent of total billed charges,85% of total billed charges,382.5,90,,306,percent of total billed charges,90% of total billed charges,340,80,,272,percent of total billed charges,80% of total billed charges,382.5,90,,306,percent of total billed charges,90% of total billed charges,318.75,75,,255,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,123.25,29,,98.6,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,284.75,67,,227.8,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,340,80,,272,percent of total billed charges,80% of total billed charges,276.25,65,,221,percent of total billed charges,65% of total billed charges,151.6,35.67,,121.28,percent of total billed charges,35.67% of total billed charges,123.25,382.5,
SURGICAL SKIN CLOSURE,27014185,CDM,270,RC,,,outpatient,,,483,193.20,,410.55,85,,328.44,percent of total billed charges,85% of total billed charges,371.91,77,,297.53,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,396.06,82,,316.848,percent of total billed charges,82% of total billed charges,410.55,85,,328.44,percent of total billed charges,85% of total billed charges,410.55,85,,328.44,percent of total billed charges,85% of total billed charges,410.55,85,,328.44,percent of total billed charges,85% of total billed charges,434.7,90,,347.76,percent of total billed charges,90% of total billed charges,386.4,80,,309.12,percent of total billed charges,80% of total billed charges,434.7,90,,347.76,percent of total billed charges,90% of total billed charges,362.25,75,,289.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,140.07,29,,112.056,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,323.61,67,,258.888,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,386.4,80,,309.12,percent of total billed charges,80% of total billed charges,313.95,65,,251.16,percent of total billed charges,65% of total billed charges,172.29,35.67,,137.832,percent of total billed charges,35.67% of total billed charges,140.07,434.7,
KING TUBES AIRWAY KIT,27014200,CDM,270,RC,,,outpatient,,,209,83.60,,177.65,85,,142.12,percent of total billed charges,85% of total billed charges,160.93,77,,128.74,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,171.38,82,,137.104,percent of total billed charges,82% of total billed charges,177.65,85,,142.12,percent of total billed charges,85% of total billed charges,177.65,85,,142.12,percent of total billed charges,85% of total billed charges,177.65,85,,142.12,percent of total billed charges,85% of total billed charges,188.1,90,,150.48,percent of total billed charges,90% of total billed charges,167.2,80,,133.76,percent of total billed charges,80% of total billed charges,188.1,90,,150.48,percent of total billed charges,90% of total billed charges,156.75,75,,125.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,60.61,29,,48.488,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,140.03,67,,112.024,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,167.2,80,,133.76,percent of total billed charges,80% of total billed charges,135.85,65,,108.68,percent of total billed charges,65% of total billed charges,74.55,35.67,,59.64,percent of total billed charges,35.67% of total billed charges,60.61,188.1,
KING TUBES AIRWAY KIT,27014201,CDM,270,RC,,,outpatient,,,209,83.60,,177.65,85,,142.12,percent of total billed charges,85% of total billed charges,160.93,77,,128.74,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,171.38,82,,137.104,percent of total billed charges,82% of total billed charges,177.65,85,,142.12,percent of total billed charges,85% of total billed charges,177.65,85,,142.12,percent of total billed charges,85% of total billed charges,177.65,85,,142.12,percent of total billed charges,85% of total billed charges,188.1,90,,150.48,percent of total billed charges,90% of total billed charges,167.2,80,,133.76,percent of total billed charges,80% of total billed charges,188.1,90,,150.48,percent of total billed charges,90% of total billed charges,156.75,75,,125.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,60.61,29,,48.488,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,140.03,67,,112.024,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,167.2,80,,133.76,percent of total billed charges,80% of total billed charges,135.85,65,,108.68,percent of total billed charges,65% of total billed charges,74.55,35.67,,59.64,percent of total billed charges,35.67% of total billed charges,60.61,188.1,
KING TUBES AIRWAY KIT,27014202,CDM,270,RC,,,outpatient,,,209,83.60,,177.65,85,,142.12,percent of total billed charges,85% of total billed charges,160.93,77,,128.74,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,171.38,82,,137.104,percent of total billed charges,82% of total billed charges,177.65,85,,142.12,percent of total billed charges,85% of total billed charges,177.65,85,,142.12,percent of total billed charges,85% of total billed charges,177.65,85,,142.12,percent of total billed charges,85% of total billed charges,188.1,90,,150.48,percent of total billed charges,90% of total billed charges,167.2,80,,133.76,percent of total billed charges,80% of total billed charges,188.1,90,,150.48,percent of total billed charges,90% of total billed charges,156.75,75,,125.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,60.61,29,,48.488,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,140.03,67,,112.024,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,167.2,80,,133.76,percent of total billed charges,80% of total billed charges,135.85,65,,108.68,percent of total billed charges,65% of total billed charges,74.55,35.67,,59.64,percent of total billed charges,35.67% of total billed charges,60.61,188.1,
MONOCRYL SUTURE,27014266,CDM,270,RC,,,outpatient,,,34,13.60,,28.9,85,,23.12,percent of total billed charges,85% of total billed charges,26.18,77,,20.94,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,27.88,82,,22.304,percent of total billed charges,82% of total billed charges,28.9,85,,23.12,percent of total billed charges,85% of total billed charges,28.9,85,,23.12,percent of total billed charges,85% of total billed charges,28.9,85,,23.12,percent of total billed charges,85% of total billed charges,30.6,90,,24.48,percent of total billed charges,90% of total billed charges,27.2,80,,21.76,percent of total billed charges,80% of total billed charges,30.6,90,,24.48,percent of total billed charges,90% of total billed charges,25.5,75,,20.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,9.86,29,,7.888,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,22.78,67,,18.224,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,27.2,80,,21.76,percent of total billed charges,80% of total billed charges,22.1,65,,17.68,percent of total billed charges,65% of total billed charges,12.13,35.67,,9.704,percent of total billed charges,35.67% of total billed charges,9.86,30.6,
MOTOBAND INST KIT,27014286,CDM,270,RC,,,outpatient,,,2291,916.40,,1947.35,85,,1557.88,percent of total billed charges,85% of total billed charges,1764.07,77,,1411.26,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,1878.62,82,,1502.896,percent of total billed charges,82% of total billed charges,1947.35,85,,1557.88,percent of total billed charges,85% of total billed charges,1947.35,85,,1557.88,percent of total billed charges,85% of total billed charges,1947.35,85,,1557.88,percent of total billed charges,85% of total billed charges,2061.9,90,,1649.52,percent of total billed charges,90% of total billed charges,1832.8,80,,1466.24,percent of total billed charges,80% of total billed charges,2061.9,90,,1649.52,percent of total billed charges,90% of total billed charges,1718.25,75,,1374.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,664.39,29,,531.512,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1534.97,67,,1227.976,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1832.8,80,,1466.24,percent of total billed charges,80% of total billed charges,1489.15,65,,1191.32,percent of total billed charges,65% of total billed charges,817.2,35.67,,653.76,percent of total billed charges,35.67% of total billed charges,664.39,2061.9,
RECTAL DECOMPRESSION SET,27014292,CDM,270,RC,,,outpatient,,,604,241.60,,513.4,85,,410.72,percent of total billed charges,85% of total billed charges,465.08,77,,372.06,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,495.28,82,,396.224,percent of total billed charges,82% of total billed charges,513.4,85,,410.72,percent of total billed charges,85% of total billed charges,513.4,85,,410.72,percent of total billed charges,85% of total billed charges,513.4,85,,410.72,percent of total billed charges,85% of total billed charges,543.6,90,,434.88,percent of total billed charges,90% of total billed charges,483.2,80,,386.56,percent of total billed charges,80% of total billed charges,543.6,90,,434.88,percent of total billed charges,90% of total billed charges,453,75,,362.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,175.16,29,,140.128,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,404.68,67,,323.744,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,483.2,80,,386.56,percent of total billed charges,80% of total billed charges,392.6,65,,314.08,percent of total billed charges,65% of total billed charges,215.45,35.67,,172.36,percent of total billed charges,35.67% of total billed charges,175.16,543.6,
KIWI LOW PROFILE CESEARAN DEV,27014293,CDM,270,RC,,,outpatient,,,301,120.40,,255.85,85,,204.68,percent of total billed charges,85% of total billed charges,231.77,77,,185.42,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,246.82,82,,197.456,percent of total billed charges,82% of total billed charges,255.85,85,,204.68,percent of total billed charges,85% of total billed charges,255.85,85,,204.68,percent of total billed charges,85% of total billed charges,255.85,85,,204.68,percent of total billed charges,85% of total billed charges,270.9,90,,216.72,percent of total billed charges,90% of total billed charges,240.8,80,,192.64,percent of total billed charges,80% of total billed charges,270.9,90,,216.72,percent of total billed charges,90% of total billed charges,225.75,75,,180.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,87.29,29,,69.832,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,201.67,67,,161.336,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,240.8,80,,192.64,percent of total billed charges,80% of total billed charges,195.65,65,,156.52,percent of total billed charges,65% of total billed charges,107.37,35.67,,85.896,percent of total billed charges,35.67% of total billed charges,87.29,270.9,
PICC LINE 4 FR,27014355,CDM,270,RC,C1751,HCPCS,outpatient,,,930,372.00,,790.5,85,,632.4,percent of total billed charges,85% of total billed charges,716.1,77,,572.88,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,762.6,82,,610.08,percent of total billed charges,82% of total billed charges,790.5,85,,632.4,percent of total billed charges,85% of total billed charges,790.5,85,,632.4,percent of total billed charges,85% of total billed charges,790.5,85,,632.4,percent of total billed charges,85% of total billed charges,837,90,,669.6,percent of total billed charges,90% of total billed charges,744,80,,595.2,percent of total billed charges,80% of total billed charges,837,90,,669.6,percent of total billed charges,90% of total billed charges,697.5,75,,558,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,269.7,29,,215.76,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,623.1,67,,498.48,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,744,80,,595.2,percent of total billed charges,80% of total billed charges,604.5,65,,483.6,percent of total billed charges,65% of total billed charges,331.73,35.67,,265.384,percent of total billed charges,35.67% of total billed charges,269.7,837,
REMEDY ANTIFUNGAL POWDER,27014380,CDM,270,RC,,,outpatient,,,33,13.20,,28.05,85,,22.44,percent of total billed charges,85% of total billed charges,25.41,77,,20.33,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,27.06,82,,21.648,percent of total billed charges,82% of total billed charges,28.05,85,,22.44,percent of total billed charges,85% of total billed charges,28.05,85,,22.44,percent of total billed charges,85% of total billed charges,28.05,85,,22.44,percent of total billed charges,85% of total billed charges,29.7,90,,23.76,percent of total billed charges,90% of total billed charges,26.4,80,,21.12,percent of total billed charges,80% of total billed charges,29.7,90,,23.76,percent of total billed charges,90% of total billed charges,24.75,75,,19.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,9.57,29,,7.656,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,22.11,67,,17.688,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,26.4,80,,21.12,percent of total billed charges,80% of total billed charges,21.45,65,,17.16,percent of total billed charges,65% of total billed charges,11.77,35.67,,9.416,percent of total billed charges,35.67% of total billed charges,9.57,29.7,
LEAD ANCHOR KIT,27014390,CDM,270,RC,,,outpatient,,,655,262.00,,556.75,85,,445.4,percent of total billed charges,85% of total billed charges,504.35,77,,403.48,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,537.1,82,,429.68,percent of total billed charges,82% of total billed charges,556.75,85,,445.4,percent of total billed charges,85% of total billed charges,556.75,85,,445.4,percent of total billed charges,85% of total billed charges,556.75,85,,445.4,percent of total billed charges,85% of total billed charges,589.5,90,,471.6,percent of total billed charges,90% of total billed charges,524,80,,419.2,percent of total billed charges,80% of total billed charges,589.5,90,,471.6,percent of total billed charges,90% of total billed charges,491.25,75,,393,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,189.95,29,,151.96,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,438.85,67,,351.08,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,524,80,,419.2,percent of total billed charges,80% of total billed charges,425.75,65,,340.6,percent of total billed charges,65% of total billed charges,233.64,35.67,,186.912,percent of total billed charges,35.67% of total billed charges,189.95,589.5,
CHARGER KIT,27014391,CDM,270,RC,,,outpatient,,,3132,1252.80,,2662.2,85,,2129.76,percent of total billed charges,85% of total billed charges,2411.64,77,,1929.31,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,2568.24,82,,2054.592,percent of total billed charges,82% of total billed charges,2662.2,85,,2129.76,percent of total billed charges,85% of total billed charges,2662.2,85,,2129.76,percent of total billed charges,85% of total billed charges,2662.2,85,,2129.76,percent of total billed charges,85% of total billed charges,2818.8,90,,2255.04,percent of total billed charges,90% of total billed charges,2505.6,80,,2004.48,percent of total billed charges,80% of total billed charges,2818.8,90,,2255.04,percent of total billed charges,90% of total billed charges,2349,75,,1879.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,908.28,29,,726.624,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,2098.44,67,,1678.752,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,2505.6,80,,2004.48,percent of total billed charges,80% of total billed charges,2035.8,65,,1628.64,percent of total billed charges,65% of total billed charges,1117.18,35.67,,893.744,percent of total billed charges,35.67% of total billed charges,908.28,2818.8,
PATIENT REMOTE KIT,27014392,CDM,270,RC,,,outpatient,,,3132,1252.80,,2662.2,85,,2129.76,percent of total billed charges,85% of total billed charges,2411.64,77,,1929.31,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,2568.24,82,,2054.592,percent of total billed charges,82% of total billed charges,2662.2,85,,2129.76,percent of total billed charges,85% of total billed charges,2662.2,85,,2129.76,percent of total billed charges,85% of total billed charges,2662.2,85,,2129.76,percent of total billed charges,85% of total billed charges,2818.8,90,,2255.04,percent of total billed charges,90% of total billed charges,2505.6,80,,2004.48,percent of total billed charges,80% of total billed charges,2818.8,90,,2255.04,percent of total billed charges,90% of total billed charges,2349,75,,1879.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,908.28,29,,726.624,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,2098.44,67,,1678.752,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,2505.6,80,,2004.48,percent of total billed charges,80% of total billed charges,2035.8,65,,1628.64,percent of total billed charges,65% of total billed charges,1117.18,35.67,,893.744,percent of total billed charges,35.67% of total billed charges,908.28,2818.8,
GASTROSTOMY TUBE,27014418,CDM,270,RC,,,outpatient,,,32,12.80,,27.2,85,,21.76,percent of total billed charges,85% of total billed charges,24.64,77,,19.71,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,26.24,82,,20.992,percent of total billed charges,82% of total billed charges,27.2,85,,21.76,percent of total billed charges,85% of total billed charges,27.2,85,,21.76,percent of total billed charges,85% of total billed charges,27.2,85,,21.76,percent of total billed charges,85% of total billed charges,28.8,90,,23.04,percent of total billed charges,90% of total billed charges,25.6,80,,20.48,percent of total billed charges,80% of total billed charges,28.8,90,,23.04,percent of total billed charges,90% of total billed charges,24,75,,19.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,9.28,29,,7.424,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,21.44,67,,17.152,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,25.6,80,,20.48,percent of total billed charges,80% of total billed charges,20.8,65,,16.64,percent of total billed charges,65% of total billed charges,11.41,35.67,,9.128,percent of total billed charges,35.67% of total billed charges,9.28,28.8,
CATHETER POWERGLIDE,27014419,CDM,270,RC,,,outpatient,,,374,149.60,,317.9,85,,254.32,percent of total billed charges,85% of total billed charges,287.98,77,,230.38,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,306.68,82,,245.344,percent of total billed charges,82% of total billed charges,317.9,85,,254.32,percent of total billed charges,85% of total billed charges,317.9,85,,254.32,percent of total billed charges,85% of total billed charges,317.9,85,,254.32,percent of total billed charges,85% of total billed charges,336.6,90,,269.28,percent of total billed charges,90% of total billed charges,299.2,80,,239.36,percent of total billed charges,80% of total billed charges,336.6,90,,269.28,percent of total billed charges,90% of total billed charges,280.5,75,,224.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,108.46,29,,86.768,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,250.58,67,,200.464,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,299.2,80,,239.36,percent of total billed charges,80% of total billed charges,243.1,65,,194.48,percent of total billed charges,65% of total billed charges,133.41,35.67,,106.728,percent of total billed charges,35.67% of total billed charges,108.46,336.6,
MICROINDUCER,27014420,CDM,270,RC,,,outpatient,,,191,76.40,,162.35,85,,129.88,percent of total billed charges,85% of total billed charges,147.07,77,,117.66,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,156.62,82,,125.296,percent of total billed charges,82% of total billed charges,162.35,85,,129.88,percent of total billed charges,85% of total billed charges,162.35,85,,129.88,percent of total billed charges,85% of total billed charges,162.35,85,,129.88,percent of total billed charges,85% of total billed charges,171.9,90,,137.52,percent of total billed charges,90% of total billed charges,152.8,80,,122.24,percent of total billed charges,80% of total billed charges,171.9,90,,137.52,percent of total billed charges,90% of total billed charges,143.25,75,,114.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,55.39,29,,44.312,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,127.97,67,,102.376,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,152.8,80,,122.24,percent of total billed charges,80% of total billed charges,124.15,65,,99.32,percent of total billed charges,65% of total billed charges,68.13,35.67,,54.504,percent of total billed charges,35.67% of total billed charges,55.39,171.9,
PICC LINE KIT,27014423,CDM,270,RC,,,outpatient,,,120,48.00,,102,85,,81.6,percent of total billed charges,85% of total billed charges,92.4,77,,73.92,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,98.4,82,,78.72,percent of total billed charges,82% of total billed charges,102,85,,81.6,percent of total billed charges,85% of total billed charges,102,85,,81.6,percent of total billed charges,85% of total billed charges,102,85,,81.6,percent of total billed charges,85% of total billed charges,108,90,,86.4,percent of total billed charges,90% of total billed charges,96,80,,76.8,percent of total billed charges,80% of total billed charges,108,90,,86.4,percent of total billed charges,90% of total billed charges,90,75,,72,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,34.8,29,,27.84,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,80.4,67,,64.32,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,96,80,,76.8,percent of total billed charges,80% of total billed charges,78,65,,62.4,percent of total billed charges,65% of total billed charges,42.8,35.67,,34.24,percent of total billed charges,35.67% of total billed charges,34.8,108,
INVISION NEEDLELESS CATH,27014424,CDM,270,RC,,,outpatient,,,30,12.00,,25.5,85,,20.4,percent of total billed charges,85% of total billed charges,23.1,77,,18.48,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,24.6,82,,19.68,percent of total billed charges,82% of total billed charges,25.5,85,,20.4,percent of total billed charges,85% of total billed charges,25.5,85,,20.4,percent of total billed charges,85% of total billed charges,25.5,85,,20.4,percent of total billed charges,85% of total billed charges,27,90,,21.6,percent of total billed charges,90% of total billed charges,24,80,,19.2,percent of total billed charges,80% of total billed charges,27,90,,21.6,percent of total billed charges,90% of total billed charges,22.5,75,,18,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,8.7,29,,6.96,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,20.1,67,,16.08,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,24,80,,19.2,percent of total billed charges,80% of total billed charges,19.5,65,,15.6,percent of total billed charges,65% of total billed charges,10.7,35.67,,8.56,percent of total billed charges,35.67% of total billed charges,8.7,27,
MTP FUSION REAMER,27014438,CDM,270,RC,,,outpatient,,,1463,585.20,,1243.55,85,,994.84,percent of total billed charges,85% of total billed charges,1126.51,77,,901.21,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,1199.66,82,,959.728,percent of total billed charges,82% of total billed charges,1243.55,85,,994.84,percent of total billed charges,85% of total billed charges,1243.55,85,,994.84,percent of total billed charges,85% of total billed charges,1243.55,85,,994.84,percent of total billed charges,85% of total billed charges,1316.7,90,,1053.36,percent of total billed charges,90% of total billed charges,1170.4,80,,936.32,percent of total billed charges,80% of total billed charges,1316.7,90,,1053.36,percent of total billed charges,90% of total billed charges,1097.25,75,,877.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,424.27,29,,339.416,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,980.21,67,,784.168,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1170.4,80,,936.32,percent of total billed charges,80% of total billed charges,950.95,65,,760.76,percent of total billed charges,65% of total billed charges,521.85,35.67,,417.48,percent of total billed charges,35.67% of total billed charges,424.27,1316.7,
SUTURE CHROMIC GUT 6-0,27014531,CDM,270,RC,,,outpatient,,,113,45.20,,96.05,85,,76.84,percent of total billed charges,85% of total billed charges,87.01,77,,69.61,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,92.66,82,,74.128,percent of total billed charges,82% of total billed charges,96.05,85,,76.84,percent of total billed charges,85% of total billed charges,96.05,85,,76.84,percent of total billed charges,85% of total billed charges,96.05,85,,76.84,percent of total billed charges,85% of total billed charges,101.7,90,,81.36,percent of total billed charges,90% of total billed charges,90.4,80,,72.32,percent of total billed charges,80% of total billed charges,101.7,90,,81.36,percent of total billed charges,90% of total billed charges,84.75,75,,67.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,32.77,29,,26.216,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,75.71,67,,60.568,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,90.4,80,,72.32,percent of total billed charges,80% of total billed charges,73.45,65,,58.76,percent of total billed charges,65% of total billed charges,40.31,35.67,,32.248,percent of total billed charges,35.67% of total billed charges,32.77,101.7,
ETHIBOND SUTURE,27014532,CDM,270,RC,,,outpatient,,,64,25.60,,54.4,85,,43.52,percent of total billed charges,85% of total billed charges,49.28,77,,39.42,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,52.48,82,,41.984,percent of total billed charges,82% of total billed charges,54.4,85,,43.52,percent of total billed charges,85% of total billed charges,54.4,85,,43.52,percent of total billed charges,85% of total billed charges,54.4,85,,43.52,percent of total billed charges,85% of total billed charges,57.6,90,,46.08,percent of total billed charges,90% of total billed charges,51.2,80,,40.96,percent of total billed charges,80% of total billed charges,57.6,90,,46.08,percent of total billed charges,90% of total billed charges,48,75,,38.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,18.56,29,,14.848,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,42.88,67,,34.304,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,51.2,80,,40.96,percent of total billed charges,80% of total billed charges,41.6,65,,33.28,percent of total billed charges,65% of total billed charges,22.83,35.67,,18.264,percent of total billed charges,35.67% of total billed charges,18.56,57.6,
CANNULATED DRILL BIT,27014634,CDM,270,RC,,,outpatient,,,1255,502.00,,1066.75,85,,853.4,percent of total billed charges,85% of total billed charges,966.35,77,,773.08,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,1029.1,82,,823.28,percent of total billed charges,82% of total billed charges,1066.75,85,,853.4,percent of total billed charges,85% of total billed charges,1066.75,85,,853.4,percent of total billed charges,85% of total billed charges,1066.75,85,,853.4,percent of total billed charges,85% of total billed charges,1129.5,90,,903.6,percent of total billed charges,90% of total billed charges,1004,80,,803.2,percent of total billed charges,80% of total billed charges,1129.5,90,,903.6,percent of total billed charges,90% of total billed charges,941.25,75,,753,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,363.95,29,,291.16,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,840.85,67,,672.68,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1004,80,,803.2,percent of total billed charges,80% of total billed charges,815.75,65,,652.6,percent of total billed charges,65% of total billed charges,447.66,35.67,,358.128,percent of total billed charges,35.67% of total billed charges,363.95,1129.5,
FORCEP VEO SINGLE BIPOLAR,27014668,CDM,270,RC,,,outpatient,,,1360,544.00,,1156,85,,924.8,percent of total billed charges,85% of total billed charges,1047.2,77,,837.76,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,1115.2,82,,892.16,percent of total billed charges,82% of total billed charges,1156,85,,924.8,percent of total billed charges,85% of total billed charges,1156,85,,924.8,percent of total billed charges,85% of total billed charges,1156,85,,924.8,percent of total billed charges,85% of total billed charges,1224,90,,979.2,percent of total billed charges,90% of total billed charges,1088,80,,870.4,percent of total billed charges,80% of total billed charges,1224,90,,979.2,percent of total billed charges,90% of total billed charges,1020,75,,816,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,394.4,29,,315.52,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,911.2,67,,728.96,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1088,80,,870.4,percent of total billed charges,80% of total billed charges,884,65,,707.2,percent of total billed charges,65% of total billed charges,485.11,35.67,,388.088,percent of total billed charges,35.67% of total billed charges,394.4,1224,
NEURO PROBE,27014669,CDM,270,RC,,,outpatient,,,5807,2322.80,,4935.95,85,,3948.76,percent of total billed charges,85% of total billed charges,4471.39,77,,3577.11,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,4761.74,82,,3809.392,percent of total billed charges,82% of total billed charges,4935.95,85,,3948.76,percent of total billed charges,85% of total billed charges,4935.95,85,,3948.76,percent of total billed charges,85% of total billed charges,4935.95,85,,3948.76,percent of total billed charges,85% of total billed charges,5226.3,90,,4181.04,percent of total billed charges,90% of total billed charges,4645.6,80,,3716.48,percent of total billed charges,80% of total billed charges,5226.3,90,,4181.04,percent of total billed charges,90% of total billed charges,4355.25,75,,3484.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,1684.03,29,,1347.224,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,3890.69,67,,3112.552,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,4645.6,80,,3716.48,percent of total billed charges,80% of total billed charges,3774.55,65,,3019.64,percent of total billed charges,65% of total billed charges,2071.36,35.67,,1657.088,percent of total billed charges,35.67% of total billed charges,1684.03,5226.3,
CALIBRATED DRILL BIT,27014699,CDM,270,RC,,,outpatient,,,773,309.20,,657.05,85,,525.64,percent of total billed charges,85% of total billed charges,595.21,77,,476.17,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,633.86,82,,507.088,percent of total billed charges,82% of total billed charges,657.05,85,,525.64,percent of total billed charges,85% of total billed charges,657.05,85,,525.64,percent of total billed charges,85% of total billed charges,657.05,85,,525.64,percent of total billed charges,85% of total billed charges,695.7,90,,556.56,percent of total billed charges,90% of total billed charges,618.4,80,,494.72,percent of total billed charges,80% of total billed charges,695.7,90,,556.56,percent of total billed charges,90% of total billed charges,579.75,75,,463.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,224.17,29,,179.336,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,517.91,67,,414.328,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,618.4,80,,494.72,percent of total billed charges,80% of total billed charges,502.45,65,,401.96,percent of total billed charges,65% of total billed charges,275.73,35.67,,220.584,percent of total billed charges,35.67% of total billed charges,224.17,695.7,
CALIBRATED DRILL BIT,27014700,CDM,270,RC,,,outpatient,,,773,309.20,,657.05,85,,525.64,percent of total billed charges,85% of total billed charges,595.21,77,,476.17,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,633.86,82,,507.088,percent of total billed charges,82% of total billed charges,657.05,85,,525.64,percent of total billed charges,85% of total billed charges,657.05,85,,525.64,percent of total billed charges,85% of total billed charges,657.05,85,,525.64,percent of total billed charges,85% of total billed charges,695.7,90,,556.56,percent of total billed charges,90% of total billed charges,618.4,80,,494.72,percent of total billed charges,80% of total billed charges,695.7,90,,556.56,percent of total billed charges,90% of total billed charges,579.75,75,,463.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,224.17,29,,179.336,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,517.91,67,,414.328,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,618.4,80,,494.72,percent of total billed charges,80% of total billed charges,502.45,65,,401.96,percent of total billed charges,65% of total billed charges,275.73,35.67,,220.584,percent of total billed charges,35.67% of total billed charges,224.17,695.7,
MILOOP LENS FRAGMENTATION DEV.,27014746,CDM,270,RC,,,outpatient,,,681,272.40,,578.85,85,,463.08,percent of total billed charges,85% of total billed charges,524.37,77,,419.5,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,558.42,82,,446.736,percent of total billed charges,82% of total billed charges,578.85,85,,463.08,percent of total billed charges,85% of total billed charges,578.85,85,,463.08,percent of total billed charges,85% of total billed charges,578.85,85,,463.08,percent of total billed charges,85% of total billed charges,612.9,90,,490.32,percent of total billed charges,90% of total billed charges,544.8,80,,435.84,percent of total billed charges,80% of total billed charges,612.9,90,,490.32,percent of total billed charges,90% of total billed charges,510.75,75,,408.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,197.49,29,,157.992,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,456.27,67,,365.016,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,544.8,80,,435.84,percent of total billed charges,80% of total billed charges,442.65,65,,354.12,percent of total billed charges,65% of total billed charges,242.91,35.67,,194.328,percent of total billed charges,35.67% of total billed charges,197.49,612.9,
STERILE LATERAL TIGER SHARK,27014751,CDM,270,RC,C1713,HCPCS,outpatient,,,9392,3756.80,,7983.2,85,,6386.56,percent of total billed charges,85% of total billed charges,7231.84,77,,5785.47,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,7701.44,82,,6161.152,percent of total billed charges,82% of total billed charges,7983.2,85,,6386.56,percent of total billed charges,85% of total billed charges,7983.2,85,,6386.56,percent of total billed charges,85% of total billed charges,7983.2,85,,6386.56,percent of total billed charges,85% of total billed charges,8452.8,90,,6762.24,percent of total billed charges,90% of total billed charges,7513.6,80,,6010.88,percent of total billed charges,80% of total billed charges,8452.8,90,,6762.24,percent of total billed charges,90% of total billed charges,7044,75,,5635.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2723.68,29,,2178.944,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,6292.64,67,,5034.112,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,7513.6,80,,6010.88,percent of total billed charges,80% of total billed charges,6104.8,65,,4883.84,percent of total billed charges,65% of total billed charges,3350.13,35.67,,2680.104,percent of total billed charges,35.67% of total billed charges,2723.68,8452.8,
KIT IVAS BALOON,27014810,CDM,270,RC,,,outpatient,,,3046,1218.40,,2589.1,85,,2071.28,percent of total billed charges,85% of total billed charges,2345.42,77,,1876.34,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,2497.72,82,,1998.176,percent of total billed charges,82% of total billed charges,2589.1,85,,2071.28,percent of total billed charges,85% of total billed charges,2589.1,85,,2071.28,percent of total billed charges,85% of total billed charges,2589.1,85,,2071.28,percent of total billed charges,85% of total billed charges,2741.4,90,,2193.12,percent of total billed charges,90% of total billed charges,2436.8,80,,1949.44,percent of total billed charges,80% of total billed charges,2741.4,90,,2193.12,percent of total billed charges,90% of total billed charges,2284.5,75,,1827.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,883.34,29,,706.672,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,2040.82,67,,1632.656,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,2436.8,80,,1949.44,percent of total billed charges,80% of total billed charges,1979.9,65,,1583.92,percent of total billed charges,65% of total billed charges,1086.51,35.67,,869.208,percent of total billed charges,35.67% of total billed charges,883.34,2741.4,
CEMENT VEREPORT,27014812,CDM,270,RC,,,outpatient,,,306,122.40,,260.1,85,,208.08,percent of total billed charges,85% of total billed charges,235.62,77,,188.5,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,250.92,82,,200.736,percent of total billed charges,82% of total billed charges,260.1,85,,208.08,percent of total billed charges,85% of total billed charges,260.1,85,,208.08,percent of total billed charges,85% of total billed charges,260.1,85,,208.08,percent of total billed charges,85% of total billed charges,275.4,90,,220.32,percent of total billed charges,90% of total billed charges,244.8,80,,195.84,percent of total billed charges,80% of total billed charges,275.4,90,,220.32,percent of total billed charges,90% of total billed charges,229.5,75,,183.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,88.74,29,,70.992,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,205.02,67,,164.016,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,244.8,80,,195.84,percent of total billed charges,80% of total billed charges,198.9,65,,159.12,percent of total billed charges,65% of total billed charges,109.15,35.67,,87.32,percent of total billed charges,35.67% of total billed charges,88.74,275.4,
CURVED NEEDLE,27014813,CDM,270,RC,,,outpatient,,,1668,667.20,,1417.8,85,,1134.24,percent of total billed charges,85% of total billed charges,1284.36,77,,1027.49,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,1367.76,82,,1094.208,percent of total billed charges,82% of total billed charges,1417.8,85,,1134.24,percent of total billed charges,85% of total billed charges,1417.8,85,,1134.24,percent of total billed charges,85% of total billed charges,1417.8,85,,1134.24,percent of total billed charges,85% of total billed charges,1501.2,90,,1200.96,percent of total billed charges,90% of total billed charges,1334.4,80,,1067.52,percent of total billed charges,80% of total billed charges,1501.2,90,,1200.96,percent of total billed charges,90% of total billed charges,1251,75,,1000.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,483.72,29,,386.976,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1117.56,67,,894.048,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1334.4,80,,1067.52,percent of total billed charges,80% of total billed charges,1084.2,65,,867.36,percent of total billed charges,65% of total billed charges,594.98,35.67,,475.984,percent of total billed charges,35.67% of total billed charges,483.72,1501.2,
DISPOSABLE LEAD WIRE,27014838,CDM,270,RC,,,outpatient,,,1583,633.20,,1345.55,85,,1076.44,percent of total billed charges,85% of total billed charges,1218.91,77,,975.13,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,1298.06,82,,1038.448,percent of total billed charges,82% of total billed charges,1345.55,85,,1076.44,percent of total billed charges,85% of total billed charges,1345.55,85,,1076.44,percent of total billed charges,85% of total billed charges,1345.55,85,,1076.44,percent of total billed charges,85% of total billed charges,1424.7,90,,1139.76,percent of total billed charges,90% of total billed charges,1266.4,80,,1013.12,percent of total billed charges,80% of total billed charges,1424.7,90,,1139.76,percent of total billed charges,90% of total billed charges,1187.25,75,,949.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,459.07,29,,367.256,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1060.61,67,,848.488,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1266.4,80,,1013.12,percent of total billed charges,80% of total billed charges,1028.95,65,,823.16,percent of total billed charges,65% of total billed charges,564.66,35.67,,451.728,percent of total billed charges,35.67% of total billed charges,459.07,1424.7,
ZEUS CUTTER BLADE,27014840,CDM,270,RC,,,outpatient,,,1562,624.80,,1327.7,85,,1062.16,percent of total billed charges,85% of total billed charges,1202.74,77,,962.19,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,1280.84,82,,1024.672,percent of total billed charges,82% of total billed charges,1327.7,85,,1062.16,percent of total billed charges,85% of total billed charges,1327.7,85,,1062.16,percent of total billed charges,85% of total billed charges,1327.7,85,,1062.16,percent of total billed charges,85% of total billed charges,1405.8,90,,1124.64,percent of total billed charges,90% of total billed charges,1249.6,80,,999.68,percent of total billed charges,80% of total billed charges,1405.8,90,,1124.64,percent of total billed charges,90% of total billed charges,1171.5,75,,937.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,452.98,29,,362.384,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1046.54,67,,837.232,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1249.6,80,,999.68,percent of total billed charges,80% of total billed charges,1015.3,65,,812.24,percent of total billed charges,65% of total billed charges,557.17,35.67,,445.736,percent of total billed charges,35.67% of total billed charges,452.98,1405.8,
BONE RONGEUR,27014880,CDM,270,RC,,,outpatient,,,610,244.00,,518.5,85,,414.8,percent of total billed charges,85% of total billed charges,469.7,77,,375.76,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,500.2,82,,400.16,percent of total billed charges,82% of total billed charges,518.5,85,,414.8,percent of total billed charges,85% of total billed charges,518.5,85,,414.8,percent of total billed charges,85% of total billed charges,518.5,85,,414.8,percent of total billed charges,85% of total billed charges,549,90,,439.2,percent of total billed charges,90% of total billed charges,488,80,,390.4,percent of total billed charges,80% of total billed charges,549,90,,439.2,percent of total billed charges,90% of total billed charges,457.5,75,,366,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,176.9,29,,141.52,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,408.7,67,,326.96,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,488,80,,390.4,percent of total billed charges,80% of total billed charges,396.5,65,,317.2,percent of total billed charges,65% of total billed charges,217.59,35.67,,174.072,percent of total billed charges,35.67% of total billed charges,176.9,549,
REAMER USAGE,27014883,CDM,270,RC,,,outpatient,,,383,153.20,,325.55,85,,260.44,percent of total billed charges,85% of total billed charges,294.91,77,,235.93,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,314.06,82,,251.248,percent of total billed charges,82% of total billed charges,325.55,85,,260.44,percent of total billed charges,85% of total billed charges,325.55,85,,260.44,percent of total billed charges,85% of total billed charges,325.55,85,,260.44,percent of total billed charges,85% of total billed charges,344.7,90,,275.76,percent of total billed charges,90% of total billed charges,306.4,80,,245.12,percent of total billed charges,80% of total billed charges,344.7,90,,275.76,percent of total billed charges,90% of total billed charges,287.25,75,,229.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,111.07,29,,88.856,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,256.61,67,,205.288,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,306.4,80,,245.12,percent of total billed charges,80% of total billed charges,248.95,65,,199.16,percent of total billed charges,65% of total billed charges,136.62,35.67,,109.296,percent of total billed charges,35.67% of total billed charges,111.07,344.7,
INSULATED DILATORS,27014937,CDM,270,RC,,,outpatient,,,4090,1636.00,,3476.5,85,,2781.2,percent of total billed charges,85% of total billed charges,3149.3,77,,2519.44,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,3353.8,82,,2683.04,percent of total billed charges,82% of total billed charges,3476.5,85,,2781.2,percent of total billed charges,85% of total billed charges,3476.5,85,,2781.2,percent of total billed charges,85% of total billed charges,3476.5,85,,2781.2,percent of total billed charges,85% of total billed charges,3681,90,,2944.8,percent of total billed charges,90% of total billed charges,3272,80,,2617.6,percent of total billed charges,80% of total billed charges,3681,90,,2944.8,percent of total billed charges,90% of total billed charges,3067.5,75,,2454,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,1186.1,29,,948.88,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,2740.3,67,,2192.24,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,3272,80,,2617.6,percent of total billed charges,80% of total billed charges,2658.5,65,,2126.8,percent of total billed charges,65% of total billed charges,1458.9,35.67,,1167.12,percent of total billed charges,35.67% of total billed charges,1186.1,3681,
DILATOR CLIPS,27014938,CDM,270,RC,,,outpatient,,,1583,633.20,,1345.55,85,,1076.44,percent of total billed charges,85% of total billed charges,1218.91,77,,975.13,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,1298.06,82,,1038.448,percent of total billed charges,82% of total billed charges,1345.55,85,,1076.44,percent of total billed charges,85% of total billed charges,1345.55,85,,1076.44,percent of total billed charges,85% of total billed charges,1345.55,85,,1076.44,percent of total billed charges,85% of total billed charges,1424.7,90,,1139.76,percent of total billed charges,90% of total billed charges,1266.4,80,,1013.12,percent of total billed charges,80% of total billed charges,1424.7,90,,1139.76,percent of total billed charges,90% of total billed charges,1187.25,75,,949.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,459.07,29,,367.256,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1060.61,67,,848.488,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1266.4,80,,1013.12,percent of total billed charges,80% of total billed charges,1028.95,65,,823.16,percent of total billed charges,65% of total billed charges,564.66,35.67,,451.728,percent of total billed charges,35.67% of total billed charges,459.07,1424.7,
NEUROMONITORING PROBE,27015016,CDM,270,RC,,,outpatient,,,1562,624.80,,1327.7,85,,1062.16,percent of total billed charges,85% of total billed charges,1202.74,77,,962.19,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,1280.84,82,,1024.672,percent of total billed charges,82% of total billed charges,1327.7,85,,1062.16,percent of total billed charges,85% of total billed charges,1327.7,85,,1062.16,percent of total billed charges,85% of total billed charges,1327.7,85,,1062.16,percent of total billed charges,85% of total billed charges,1405.8,90,,1124.64,percent of total billed charges,90% of total billed charges,1249.6,80,,999.68,percent of total billed charges,80% of total billed charges,1405.8,90,,1124.64,percent of total billed charges,90% of total billed charges,1171.5,75,,937.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,452.98,29,,362.384,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1046.54,67,,837.232,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1249.6,80,,999.68,percent of total billed charges,80% of total billed charges,1015.3,65,,812.24,percent of total billed charges,65% of total billed charges,557.17,35.67,,445.736,percent of total billed charges,35.67% of total billed charges,452.98,1405.8,
FLIP CUTTER 9.5 MM,27015123,CDM,270,RC,,,outpatient,,,1886,754.40,,1603.1,85,,1282.48,percent of total billed charges,85% of total billed charges,1452.22,77,,1161.78,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,1546.52,82,,1237.216,percent of total billed charges,82% of total billed charges,1603.1,85,,1282.48,percent of total billed charges,85% of total billed charges,1603.1,85,,1282.48,percent of total billed charges,85% of total billed charges,1603.1,85,,1282.48,percent of total billed charges,85% of total billed charges,1697.4,90,,1357.92,percent of total billed charges,90% of total billed charges,1508.8,80,,1207.04,percent of total billed charges,80% of total billed charges,1697.4,90,,1357.92,percent of total billed charges,90% of total billed charges,1414.5,75,,1131.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,546.94,29,,437.552,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1263.62,67,,1010.896,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1508.8,80,,1207.04,percent of total billed charges,80% of total billed charges,1225.9,65,,980.72,percent of total billed charges,65% of total billed charges,672.74,35.67,,538.192,percent of total billed charges,35.67% of total billed charges,546.94,1697.4,
OPTICELL SILVER DRESSING 2 X 2,27015147,CDM,270,RC,,,outpatient,,,42,16.80,,35.7,85,,28.56,percent of total billed charges,85% of total billed charges,32.34,77,,25.87,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,34.44,82,,27.552,percent of total billed charges,82% of total billed charges,35.7,85,,28.56,percent of total billed charges,85% of total billed charges,35.7,85,,28.56,percent of total billed charges,85% of total billed charges,35.7,85,,28.56,percent of total billed charges,85% of total billed charges,37.8,90,,30.24,percent of total billed charges,90% of total billed charges,33.6,80,,26.88,percent of total billed charges,80% of total billed charges,37.8,90,,30.24,percent of total billed charges,90% of total billed charges,31.5,75,,25.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,12.18,29,,9.744,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,28.14,67,,22.512,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,33.6,80,,26.88,percent of total billed charges,80% of total billed charges,27.3,65,,21.84,percent of total billed charges,65% of total billed charges,14.98,35.67,,11.984,percent of total billed charges,35.67% of total billed charges,12.18,37.8,
JEJUNAL TRANSGASTRIC TUBE,27015211,CDM,270,RC,,,outpatient,,,910,364.00,,773.5,85,,618.8,percent of total billed charges,85% of total billed charges,700.7,77,,560.56,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,746.2,82,,596.96,percent of total billed charges,82% of total billed charges,773.5,85,,618.8,percent of total billed charges,85% of total billed charges,773.5,85,,618.8,percent of total billed charges,85% of total billed charges,773.5,85,,618.8,percent of total billed charges,85% of total billed charges,819,90,,655.2,percent of total billed charges,90% of total billed charges,728,80,,582.4,percent of total billed charges,80% of total billed charges,819,90,,655.2,percent of total billed charges,90% of total billed charges,682.5,75,,546,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,263.9,29,,211.12,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,609.7,67,,487.76,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,728,80,,582.4,percent of total billed charges,80% of total billed charges,591.5,65,,473.2,percent of total billed charges,65% of total billed charges,324.6,35.67,,259.68,percent of total billed charges,35.67% of total billed charges,263.9,819,
INTRODUCER KIT,27015212,CDM,270,RC,,,outpatient,,,845,338.00,,718.25,85,,574.6,percent of total billed charges,85% of total billed charges,650.65,77,,520.52,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,692.9,82,,554.32,percent of total billed charges,82% of total billed charges,718.25,85,,574.6,percent of total billed charges,85% of total billed charges,718.25,85,,574.6,percent of total billed charges,85% of total billed charges,718.25,85,,574.6,percent of total billed charges,85% of total billed charges,760.5,90,,608.4,percent of total billed charges,90% of total billed charges,676,80,,540.8,percent of total billed charges,80% of total billed charges,760.5,90,,608.4,percent of total billed charges,90% of total billed charges,633.75,75,,507,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,245.05,29,,196.04,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,566.15,67,,452.92,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,676,80,,540.8,percent of total billed charges,80% of total billed charges,549.25,65,,439.4,percent of total billed charges,65% of total billed charges,301.41,35.67,,241.128,percent of total billed charges,35.67% of total billed charges,245.05,760.5,
MIXING BOWLS,27015261,CDM,270,RC,,,outpatient,,,342,136.80,,290.7,85,,232.56,percent of total billed charges,85% of total billed charges,263.34,77,,210.67,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,280.44,82,,224.352,percent of total billed charges,82% of total billed charges,290.7,85,,232.56,percent of total billed charges,85% of total billed charges,290.7,85,,232.56,percent of total billed charges,85% of total billed charges,290.7,85,,232.56,percent of total billed charges,85% of total billed charges,307.8,90,,246.24,percent of total billed charges,90% of total billed charges,273.6,80,,218.88,percent of total billed charges,80% of total billed charges,307.8,90,,246.24,percent of total billed charges,90% of total billed charges,256.5,75,,205.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,99.18,29,,79.344,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,229.14,67,,183.312,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,273.6,80,,218.88,percent of total billed charges,80% of total billed charges,222.3,65,,177.84,percent of total billed charges,65% of total billed charges,121.99,35.67,,97.592,percent of total billed charges,35.67% of total billed charges,99.18,307.8,
MTP FUSION REAMER,27015476,CDM,270,RC,,,outpatient,,,1084,433.60,,921.4,85,,737.12,percent of total billed charges,85% of total billed charges,834.68,77,,667.74,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,888.88,82,,711.104,percent of total billed charges,82% of total billed charges,921.4,85,,737.12,percent of total billed charges,85% of total billed charges,921.4,85,,737.12,percent of total billed charges,85% of total billed charges,921.4,85,,737.12,percent of total billed charges,85% of total billed charges,975.6,90,,780.48,percent of total billed charges,90% of total billed charges,867.2,80,,693.76,percent of total billed charges,80% of total billed charges,975.6,90,,780.48,percent of total billed charges,90% of total billed charges,813,75,,650.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,314.36,29,,251.488,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,726.28,67,,581.024,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,867.2,80,,693.76,percent of total billed charges,80% of total billed charges,704.6,65,,563.68,percent of total billed charges,65% of total billed charges,386.66,35.67,,309.328,percent of total billed charges,35.67% of total billed charges,314.36,975.6,
MTP FUSION REAMER MET,27015477,CDM,270,RC,,,outpatient,,,1233,493.20,,1048.05,85,,838.44,percent of total billed charges,85% of total billed charges,949.41,77,,759.53,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,1011.06,82,,808.848,percent of total billed charges,82% of total billed charges,1048.05,85,,838.44,percent of total billed charges,85% of total billed charges,1048.05,85,,838.44,percent of total billed charges,85% of total billed charges,1048.05,85,,838.44,percent of total billed charges,85% of total billed charges,1109.7,90,,887.76,percent of total billed charges,90% of total billed charges,986.4,80,,789.12,percent of total billed charges,80% of total billed charges,1109.7,90,,887.76,percent of total billed charges,90% of total billed charges,924.75,75,,739.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,357.57,29,,286.056,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,826.11,67,,660.888,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,986.4,80,,789.12,percent of total billed charges,80% of total billed charges,801.45,65,,641.16,percent of total billed charges,65% of total billed charges,439.81,35.67,,351.848,percent of total billed charges,35.67% of total billed charges,357.57,1109.7,
SCREW DRIVER TAPPING,27015501,CDM,270,RC,,,outpatient,,,1156,462.40,,982.6,85,,786.08,percent of total billed charges,85% of total billed charges,890.12,77,,712.1,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,947.92,82,,758.336,percent of total billed charges,82% of total billed charges,982.6,85,,786.08,percent of total billed charges,85% of total billed charges,982.6,85,,786.08,percent of total billed charges,85% of total billed charges,982.6,85,,786.08,percent of total billed charges,85% of total billed charges,1040.4,90,,832.32,percent of total billed charges,90% of total billed charges,924.8,80,,739.84,percent of total billed charges,80% of total billed charges,1040.4,90,,832.32,percent of total billed charges,90% of total billed charges,867,75,,693.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,335.24,29,,268.192,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,774.52,67,,619.616,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,924.8,80,,739.84,percent of total billed charges,80% of total billed charges,751.4,65,,601.12,percent of total billed charges,65% of total billed charges,412.35,35.67,,329.88,percent of total billed charges,35.67% of total billed charges,335.24,1040.4,
OPTIFOAM DRESSING,27015679,CDM,270,RC,,,outpatient,,,22,8.80,,18.7,85,,14.96,percent of total billed charges,85% of total billed charges,16.94,77,,13.55,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,18.04,82,,14.432,percent of total billed charges,82% of total billed charges,18.7,85,,14.96,percent of total billed charges,85% of total billed charges,18.7,85,,14.96,percent of total billed charges,85% of total billed charges,18.7,85,,14.96,percent of total billed charges,85% of total billed charges,19.8,90,,15.84,percent of total billed charges,90% of total billed charges,17.6,80,,14.08,percent of total billed charges,80% of total billed charges,19.8,90,,15.84,percent of total billed charges,90% of total billed charges,16.5,75,,13.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,6.38,29,,5.104,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,14.74,67,,11.792,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,17.6,80,,14.08,percent of total billed charges,80% of total billed charges,14.3,65,,11.44,percent of total billed charges,65% of total billed charges,7.85,35.67,,6.28,percent of total billed charges,35.67% of total billed charges,6.38,19.8,
SUTURE SPRIAL MONOCRYL PLS 2-0,27015803,CDM,270,RC,,,outpatient,,,81,32.40,,68.85,85,,55.08,percent of total billed charges,85% of total billed charges,62.37,77,,49.9,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,66.42,82,,53.136,percent of total billed charges,82% of total billed charges,68.85,85,,55.08,percent of total billed charges,85% of total billed charges,68.85,85,,55.08,percent of total billed charges,85% of total billed charges,68.85,85,,55.08,percent of total billed charges,85% of total billed charges,72.9,90,,58.32,percent of total billed charges,90% of total billed charges,64.8,80,,51.84,percent of total billed charges,80% of total billed charges,72.9,90,,58.32,percent of total billed charges,90% of total billed charges,60.75,75,,48.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,23.49,29,,18.792,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,54.27,67,,43.416,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,64.8,80,,51.84,percent of total billed charges,80% of total billed charges,52.65,65,,42.12,percent of total billed charges,65% of total billed charges,28.89,35.67,,23.112,percent of total billed charges,35.67% of total billed charges,23.49,72.9,
RETRACTOR SURGICAL BLADDER,27016100,CDM,270,RC,,,outpatient,,,397,158.80,,337.45,85,,269.96,percent of total billed charges,85% of total billed charges,305.69,77,,244.55,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,325.54,82,,260.432,percent of total billed charges,82% of total billed charges,337.45,85,,269.96,percent of total billed charges,85% of total billed charges,337.45,85,,269.96,percent of total billed charges,85% of total billed charges,337.45,85,,269.96,percent of total billed charges,85% of total billed charges,357.3,90,,285.84,percent of total billed charges,90% of total billed charges,317.6,80,,254.08,percent of total billed charges,80% of total billed charges,357.3,90,,285.84,percent of total billed charges,90% of total billed charges,297.75,75,,238.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,115.13,29,,92.104,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,265.99,67,,212.792,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,317.6,80,,254.08,percent of total billed charges,80% of total billed charges,258.05,65,,206.44,percent of total billed charges,65% of total billed charges,141.61,35.67,,113.288,percent of total billed charges,35.67% of total billed charges,115.13,357.3,
HOOK ELASTIC STAY 5 MM,27016101,CDM,270,RC,,,outpatient,,,397,158.80,,337.45,85,,269.96,percent of total billed charges,85% of total billed charges,305.69,77,,244.55,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,325.54,82,,260.432,percent of total billed charges,82% of total billed charges,337.45,85,,269.96,percent of total billed charges,85% of total billed charges,337.45,85,,269.96,percent of total billed charges,85% of total billed charges,337.45,85,,269.96,percent of total billed charges,85% of total billed charges,357.3,90,,285.84,percent of total billed charges,90% of total billed charges,317.6,80,,254.08,percent of total billed charges,80% of total billed charges,357.3,90,,285.84,percent of total billed charges,90% of total billed charges,297.75,75,,238.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,115.13,29,,92.104,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,265.99,67,,212.792,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,317.6,80,,254.08,percent of total billed charges,80% of total billed charges,258.05,65,,206.44,percent of total billed charges,65% of total billed charges,141.61,35.67,,113.288,percent of total billed charges,35.67% of total billed charges,115.13,357.3,
UTERINE MANIPULATOR,27016214,CDM,270,RC,,,outpatient,,,166,66.40,,141.1,85,,112.88,percent of total billed charges,85% of total billed charges,127.82,77,,102.26,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,136.12,82,,108.896,percent of total billed charges,82% of total billed charges,141.1,85,,112.88,percent of total billed charges,85% of total billed charges,141.1,85,,112.88,percent of total billed charges,85% of total billed charges,141.1,85,,112.88,percent of total billed charges,85% of total billed charges,149.4,90,,119.52,percent of total billed charges,90% of total billed charges,132.8,80,,106.24,percent of total billed charges,80% of total billed charges,149.4,90,,119.52,percent of total billed charges,90% of total billed charges,124.5,75,,99.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,48.14,29,,38.512,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,111.22,67,,88.976,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,132.8,80,,106.24,percent of total billed charges,80% of total billed charges,107.9,65,,86.32,percent of total billed charges,65% of total billed charges,59.21,35.67,,47.368,percent of total billed charges,35.67% of total billed charges,48.14,149.4,
SUTURE STRATAFIX SYMETRIC,27016215,CDM,270,RC,,,outpatient,,,204,81.60,,173.4,85,,138.72,percent of total billed charges,85% of total billed charges,157.08,77,,125.66,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,167.28,82,,133.824,percent of total billed charges,82% of total billed charges,173.4,85,,138.72,percent of total billed charges,85% of total billed charges,173.4,85,,138.72,percent of total billed charges,85% of total billed charges,173.4,85,,138.72,percent of total billed charges,85% of total billed charges,183.6,90,,146.88,percent of total billed charges,90% of total billed charges,163.2,80,,130.56,percent of total billed charges,80% of total billed charges,183.6,90,,146.88,percent of total billed charges,90% of total billed charges,153,75,,122.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,59.16,29,,47.328,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,136.68,67,,109.344,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,163.2,80,,130.56,percent of total billed charges,80% of total billed charges,132.6,65,,106.08,percent of total billed charges,65% of total billed charges,72.77,35.67,,58.216,percent of total billed charges,35.67% of total billed charges,59.16,183.6,
UTERINE MANIPULATOR,27016278,CDM,270,RC,,,outpatient,,,367,146.80,,311.95,85,,249.56,percent of total billed charges,85% of total billed charges,282.59,77,,226.07,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,300.94,82,,240.752,percent of total billed charges,82% of total billed charges,311.95,85,,249.56,percent of total billed charges,85% of total billed charges,311.95,85,,249.56,percent of total billed charges,85% of total billed charges,311.95,85,,249.56,percent of total billed charges,85% of total billed charges,330.3,90,,264.24,percent of total billed charges,90% of total billed charges,293.6,80,,234.88,percent of total billed charges,80% of total billed charges,330.3,90,,264.24,percent of total billed charges,90% of total billed charges,275.25,75,,220.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,106.43,29,,85.144,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,245.89,67,,196.712,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,293.6,80,,234.88,percent of total billed charges,80% of total billed charges,238.55,65,,190.84,percent of total billed charges,65% of total billed charges,130.91,35.67,,104.728,percent of total billed charges,35.67% of total billed charges,106.43,330.3,
PROBE TEMP FOR PANDA WARMER,27016351,CDM,270,RC,,,outpatient,,,76,30.40,,64.6,85,,51.68,percent of total billed charges,85% of total billed charges,58.52,77,,46.82,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,62.32,82,,49.856,percent of total billed charges,82% of total billed charges,64.6,85,,51.68,percent of total billed charges,85% of total billed charges,64.6,85,,51.68,percent of total billed charges,85% of total billed charges,64.6,85,,51.68,percent of total billed charges,85% of total billed charges,68.4,90,,54.72,percent of total billed charges,90% of total billed charges,60.8,80,,48.64,percent of total billed charges,80% of total billed charges,68.4,90,,54.72,percent of total billed charges,90% of total billed charges,57,75,,45.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,22.04,29,,17.632,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,50.92,67,,40.736,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,60.8,80,,48.64,percent of total billed charges,80% of total billed charges,49.4,65,,39.52,percent of total billed charges,65% of total billed charges,27.11,35.67,,21.688,percent of total billed charges,35.67% of total billed charges,22.04,68.4,
KIT CIRCUIT NEONATE,27016352,CDM,270,RC,,,outpatient,,,94,37.60,,79.9,85,,63.92,percent of total billed charges,85% of total billed charges,72.38,77,,57.9,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,77.08,82,,61.664,percent of total billed charges,82% of total billed charges,79.9,85,,63.92,percent of total billed charges,85% of total billed charges,79.9,85,,63.92,percent of total billed charges,85% of total billed charges,79.9,85,,63.92,percent of total billed charges,85% of total billed charges,84.6,90,,67.68,percent of total billed charges,90% of total billed charges,75.2,80,,60.16,percent of total billed charges,80% of total billed charges,84.6,90,,67.68,percent of total billed charges,90% of total billed charges,70.5,75,,56.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,27.26,29,,21.808,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,62.98,67,,50.384,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,75.2,80,,60.16,percent of total billed charges,80% of total billed charges,61.1,65,,48.88,percent of total billed charges,65% of total billed charges,33.53,35.67,,26.824,percent of total billed charges,35.67% of total billed charges,27.26,84.6,
KIT NEONATE CIRCUIT,27016353,CDM,270,RC,,,outpatient,,,131,52.40,,111.35,85,,89.08,percent of total billed charges,85% of total billed charges,100.87,77,,80.7,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,107.42,82,,85.936,percent of total billed charges,82% of total billed charges,111.35,85,,89.08,percent of total billed charges,85% of total billed charges,111.35,85,,89.08,percent of total billed charges,85% of total billed charges,111.35,85,,89.08,percent of total billed charges,85% of total billed charges,117.9,90,,94.32,percent of total billed charges,90% of total billed charges,104.8,80,,83.84,percent of total billed charges,80% of total billed charges,117.9,90,,94.32,percent of total billed charges,90% of total billed charges,98.25,75,,78.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,37.99,29,,30.392,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,87.77,67,,70.216,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,104.8,80,,83.84,percent of total billed charges,80% of total billed charges,85.15,65,,68.12,percent of total billed charges,65% of total billed charges,46.73,35.67,,37.384,percent of total billed charges,35.67% of total billed charges,37.99,117.9,
CANISTER FOR PANDA WARMER,27016354,CDM,270,RC,,,outpatient,,,56,22.40,,47.6,85,,38.08,percent of total billed charges,85% of total billed charges,43.12,77,,34.5,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,45.92,82,,36.736,percent of total billed charges,82% of total billed charges,47.6,85,,38.08,percent of total billed charges,85% of total billed charges,47.6,85,,38.08,percent of total billed charges,85% of total billed charges,47.6,85,,38.08,percent of total billed charges,85% of total billed charges,50.4,90,,40.32,percent of total billed charges,90% of total billed charges,44.8,80,,35.84,percent of total billed charges,80% of total billed charges,50.4,90,,40.32,percent of total billed charges,90% of total billed charges,42,75,,33.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,16.24,29,,12.992,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,37.52,67,,30.016,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,44.8,80,,35.84,percent of total billed charges,80% of total billed charges,36.4,65,,29.12,percent of total billed charges,65% of total billed charges,19.98,35.67,,15.984,percent of total billed charges,35.67% of total billed charges,16.24,50.4,
FACE MASK INFANT,27016358,CDM,270,RC,,,outpatient,,,14,5.60,,11.9,85,,9.52,percent of total billed charges,85% of total billed charges,10.78,77,,8.62,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,11.48,82,,9.184,percent of total billed charges,82% of total billed charges,11.9,85,,9.52,percent of total billed charges,85% of total billed charges,11.9,85,,9.52,percent of total billed charges,85% of total billed charges,11.9,85,,9.52,percent of total billed charges,85% of total billed charges,12.6,90,,10.08,percent of total billed charges,90% of total billed charges,11.2,80,,8.96,percent of total billed charges,80% of total billed charges,12.6,90,,10.08,percent of total billed charges,90% of total billed charges,10.5,75,,8.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,4.06,29,,3.248,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,9.38,67,,7.504,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,11.2,80,,8.96,percent of total billed charges,80% of total billed charges,9.1,65,,7.28,percent of total billed charges,65% of total billed charges,4.99,35.67,,3.992,percent of total billed charges,35.67% of total billed charges,4.06,12.6,
PROBE COVER WITH GEL,27016475,CDM,270,RC,,,outpatient,,,40,16.00,,34,85,,27.2,percent of total billed charges,85% of total billed charges,30.8,77,,24.64,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,32.8,82,,26.24,percent of total billed charges,82% of total billed charges,34,85,,27.2,percent of total billed charges,85% of total billed charges,34,85,,27.2,percent of total billed charges,85% of total billed charges,34,85,,27.2,percent of total billed charges,85% of total billed charges,36,90,,28.8,percent of total billed charges,90% of total billed charges,32,80,,25.6,percent of total billed charges,80% of total billed charges,36,90,,28.8,percent of total billed charges,90% of total billed charges,30,75,,24,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,11.6,29,,9.28,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,26.8,67,,21.44,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,32,80,,25.6,percent of total billed charges,80% of total billed charges,26,65,,20.8,percent of total billed charges,65% of total billed charges,14.27,35.67,,11.416,percent of total billed charges,35.67% of total billed charges,11.6,36,
WOUND KIT PICO,27016548,CDM,270,RC,,,outpatient,,,1162,464.80,,987.7,85,,790.16,percent of total billed charges,85% of total billed charges,894.74,77,,715.79,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,952.84,82,,762.272,percent of total billed charges,82% of total billed charges,987.7,85,,790.16,percent of total billed charges,85% of total billed charges,987.7,85,,790.16,percent of total billed charges,85% of total billed charges,987.7,85,,790.16,percent of total billed charges,85% of total billed charges,1045.8,90,,836.64,percent of total billed charges,90% of total billed charges,929.6,80,,743.68,percent of total billed charges,80% of total billed charges,1045.8,90,,836.64,percent of total billed charges,90% of total billed charges,871.5,75,,697.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,336.98,29,,269.584,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,778.54,67,,622.832,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,929.6,80,,743.68,percent of total billed charges,80% of total billed charges,755.3,65,,604.24,percent of total billed charges,65% of total billed charges,414.49,35.67,,331.592,percent of total billed charges,35.67% of total billed charges,336.98,1045.8,
UTERINE DILATOR,27016798,CDM,270,RC,,,outpatient,,,202,80.80,,171.7,85,,137.36,percent of total billed charges,85% of total billed charges,155.54,77,,124.43,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,165.64,82,,132.512,percent of total billed charges,82% of total billed charges,171.7,85,,137.36,percent of total billed charges,85% of total billed charges,171.7,85,,137.36,percent of total billed charges,85% of total billed charges,171.7,85,,137.36,percent of total billed charges,85% of total billed charges,181.8,90,,145.44,percent of total billed charges,90% of total billed charges,161.6,80,,129.28,percent of total billed charges,80% of total billed charges,181.8,90,,145.44,percent of total billed charges,90% of total billed charges,151.5,75,,121.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,58.58,29,,46.864,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,135.34,67,,108.272,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,161.6,80,,129.28,percent of total billed charges,80% of total billed charges,131.3,65,,105.04,percent of total billed charges,65% of total billed charges,72.05,35.67,,57.64,percent of total billed charges,35.67% of total billed charges,58.58,181.8,
UTERINE DILATOR,27016800,CDM,270,RC,,,outpatient,,,202,80.80,,171.7,85,,137.36,percent of total billed charges,85% of total billed charges,155.54,77,,124.43,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,165.64,82,,132.512,percent of total billed charges,82% of total billed charges,171.7,85,,137.36,percent of total billed charges,85% of total billed charges,171.7,85,,137.36,percent of total billed charges,85% of total billed charges,171.7,85,,137.36,percent of total billed charges,85% of total billed charges,181.8,90,,145.44,percent of total billed charges,90% of total billed charges,161.6,80,,129.28,percent of total billed charges,80% of total billed charges,181.8,90,,145.44,percent of total billed charges,90% of total billed charges,151.5,75,,121.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,58.58,29,,46.864,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,135.34,67,,108.272,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,161.6,80,,129.28,percent of total billed charges,80% of total billed charges,131.3,65,,105.04,percent of total billed charges,65% of total billed charges,72.05,35.67,,57.64,percent of total billed charges,35.67% of total billed charges,58.58,181.8,
UTERINE DILATOR,27016801,CDM,270,RC,,,outpatient,,,202,80.80,,171.7,85,,137.36,percent of total billed charges,85% of total billed charges,155.54,77,,124.43,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,165.64,82,,132.512,percent of total billed charges,82% of total billed charges,171.7,85,,137.36,percent of total billed charges,85% of total billed charges,171.7,85,,137.36,percent of total billed charges,85% of total billed charges,171.7,85,,137.36,percent of total billed charges,85% of total billed charges,181.8,90,,145.44,percent of total billed charges,90% of total billed charges,161.6,80,,129.28,percent of total billed charges,80% of total billed charges,181.8,90,,145.44,percent of total billed charges,90% of total billed charges,151.5,75,,121.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,58.58,29,,46.864,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,135.34,67,,108.272,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,161.6,80,,129.28,percent of total billed charges,80% of total billed charges,131.3,65,,105.04,percent of total billed charges,65% of total billed charges,72.05,35.67,,57.64,percent of total billed charges,35.67% of total billed charges,58.58,181.8,
UTERINE DILATOR,27016802,CDM,270,RC,,,outpatient,,,202,80.80,,171.7,85,,137.36,percent of total billed charges,85% of total billed charges,155.54,77,,124.43,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,165.64,82,,132.512,percent of total billed charges,82% of total billed charges,171.7,85,,137.36,percent of total billed charges,85% of total billed charges,171.7,85,,137.36,percent of total billed charges,85% of total billed charges,171.7,85,,137.36,percent of total billed charges,85% of total billed charges,181.8,90,,145.44,percent of total billed charges,90% of total billed charges,161.6,80,,129.28,percent of total billed charges,80% of total billed charges,181.8,90,,145.44,percent of total billed charges,90% of total billed charges,151.5,75,,121.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,58.58,29,,46.864,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,135.34,67,,108.272,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,161.6,80,,129.28,percent of total billed charges,80% of total billed charges,131.3,65,,105.04,percent of total billed charges,65% of total billed charges,72.05,35.67,,57.64,percent of total billed charges,35.67% of total billed charges,58.58,181.8,
UTERINE DILATOR,27016803,CDM,270,RC,,,outpatient,,,202,80.80,,171.7,85,,137.36,percent of total billed charges,85% of total billed charges,155.54,77,,124.43,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,165.64,82,,132.512,percent of total billed charges,82% of total billed charges,171.7,85,,137.36,percent of total billed charges,85% of total billed charges,171.7,85,,137.36,percent of total billed charges,85% of total billed charges,171.7,85,,137.36,percent of total billed charges,85% of total billed charges,181.8,90,,145.44,percent of total billed charges,90% of total billed charges,161.6,80,,129.28,percent of total billed charges,80% of total billed charges,181.8,90,,145.44,percent of total billed charges,90% of total billed charges,151.5,75,,121.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,58.58,29,,46.864,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,135.34,67,,108.272,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,161.6,80,,129.28,percent of total billed charges,80% of total billed charges,131.3,65,,105.04,percent of total billed charges,65% of total billed charges,72.05,35.67,,57.64,percent of total billed charges,35.67% of total billed charges,58.58,181.8,
UTERINE DILATOR,27016804,CDM,270,RC,,,outpatient,,,202,80.80,,171.7,85,,137.36,percent of total billed charges,85% of total billed charges,155.54,77,,124.43,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,165.64,82,,132.512,percent of total billed charges,82% of total billed charges,171.7,85,,137.36,percent of total billed charges,85% of total billed charges,171.7,85,,137.36,percent of total billed charges,85% of total billed charges,171.7,85,,137.36,percent of total billed charges,85% of total billed charges,181.8,90,,145.44,percent of total billed charges,90% of total billed charges,161.6,80,,129.28,percent of total billed charges,80% of total billed charges,181.8,90,,145.44,percent of total billed charges,90% of total billed charges,151.5,75,,121.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,58.58,29,,46.864,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,135.34,67,,108.272,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,161.6,80,,129.28,percent of total billed charges,80% of total billed charges,131.3,65,,105.04,percent of total billed charges,65% of total billed charges,72.05,35.67,,57.64,percent of total billed charges,35.67% of total billed charges,58.58,181.8,
SELSUM BLUE DANDRUFF SHAMPOO,27016851,CDM,270,RC,,,outpatient,,,19,7.60,,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,14.63,77,,11.7,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,15.58,82,,12.464,percent of total billed charges,82% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,15.2,80,,12.16,percent of total billed charges,80% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,14.25,75,,11.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,5.51,29,,4.408,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,12.73,67,,10.184,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,15.2,80,,12.16,percent of total billed charges,80% of total billed charges,12.35,65,,9.88,percent of total billed charges,65% of total billed charges,6.78,35.67,,5.424,percent of total billed charges,35.67% of total billed charges,5.51,17.1,
FUSION REAMER,27016921,CDM,270,RC,,,outpatient,,,2352,940.80,,1999.2,85,,1599.36,percent of total billed charges,85% of total billed charges,1811.04,77,,1448.83,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,1928.64,82,,1542.912,percent of total billed charges,82% of total billed charges,1999.2,85,,1599.36,percent of total billed charges,85% of total billed charges,1999.2,85,,1599.36,percent of total billed charges,85% of total billed charges,1999.2,85,,1599.36,percent of total billed charges,85% of total billed charges,2116.8,90,,1693.44,percent of total billed charges,90% of total billed charges,1881.6,80,,1505.28,percent of total billed charges,80% of total billed charges,2116.8,90,,1693.44,percent of total billed charges,90% of total billed charges,1764,75,,1411.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,682.08,29,,545.664,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1575.84,67,,1260.672,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1881.6,80,,1505.28,percent of total billed charges,80% of total billed charges,1528.8,65,,1223.04,percent of total billed charges,65% of total billed charges,838.96,35.67,,671.168,percent of total billed charges,35.67% of total billed charges,682.08,2116.8,
CUP CONE REAMERS,27017225,CDM,270,RC,,,outpatient,,,902,360.80,,766.7,85,,613.36,percent of total billed charges,85% of total billed charges,694.54,77,,555.63,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,739.64,82,,591.712,percent of total billed charges,82% of total billed charges,766.7,85,,613.36,percent of total billed charges,85% of total billed charges,766.7,85,,613.36,percent of total billed charges,85% of total billed charges,766.7,85,,613.36,percent of total billed charges,85% of total billed charges,811.8,90,,649.44,percent of total billed charges,90% of total billed charges,721.6,80,,577.28,percent of total billed charges,80% of total billed charges,811.8,90,,649.44,percent of total billed charges,90% of total billed charges,676.5,75,,541.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,261.58,29,,209.264,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,604.34,67,,483.472,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,721.6,80,,577.28,percent of total billed charges,80% of total billed charges,586.3,65,,469.04,percent of total billed charges,65% of total billed charges,321.74,35.67,,257.392,percent of total billed charges,35.67% of total billed charges,261.58,811.8,
SUPPLIES FOR EYE CASE,27017271,CDM,270,RC,,,outpatient,,,1690,676.00,,1436.5,85,,1149.2,percent of total billed charges,85% of total billed charges,1301.3,77,,1041.04,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,1385.8,82,,1108.64,percent of total billed charges,82% of total billed charges,1436.5,85,,1149.2,percent of total billed charges,85% of total billed charges,1436.5,85,,1149.2,percent of total billed charges,85% of total billed charges,1436.5,85,,1149.2,percent of total billed charges,85% of total billed charges,1521,90,,1216.8,percent of total billed charges,90% of total billed charges,1352,80,,1081.6,percent of total billed charges,80% of total billed charges,1521,90,,1216.8,percent of total billed charges,90% of total billed charges,1267.5,75,,1014,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,490.1,29,,392.08,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1132.3,67,,905.84,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1352,80,,1081.6,percent of total billed charges,80% of total billed charges,1098.5,65,,878.8,percent of total billed charges,65% of total billed charges,602.82,35.67,,482.256,percent of total billed charges,35.67% of total billed charges,490.1,1521,
DISTRACTOR ANKLE ARTHROSCOPY,27017327,CDM,270,RC,,,outpatient,,,3378,1351.20,,2871.3,85,,2297.04,percent of total billed charges,85% of total billed charges,2601.06,77,,2080.85,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,2769.96,82,,2215.968,percent of total billed charges,82% of total billed charges,2871.3,85,,2297.04,percent of total billed charges,85% of total billed charges,2871.3,85,,2297.04,percent of total billed charges,85% of total billed charges,2871.3,85,,2297.04,percent of total billed charges,85% of total billed charges,3040.2,90,,2432.16,percent of total billed charges,90% of total billed charges,2702.4,80,,2161.92,percent of total billed charges,80% of total billed charges,3040.2,90,,2432.16,percent of total billed charges,90% of total billed charges,2533.5,75,,2026.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,979.62,29,,783.696,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,2263.26,67,,1810.608,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,2702.4,80,,2161.92,percent of total billed charges,80% of total billed charges,2195.7,65,,1756.56,percent of total billed charges,65% of total billed charges,1204.93,35.67,,963.944,percent of total billed charges,35.67% of total billed charges,979.62,3040.2,
INJECTABLE BONE CANNULA,27017427,CDM,270,RC,,,outpatient,,,1353,541.20,,1150.05,85,,920.04,percent of total billed charges,85% of total billed charges,1041.81,77,,833.45,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,1109.46,82,,887.568,percent of total billed charges,82% of total billed charges,1150.05,85,,920.04,percent of total billed charges,85% of total billed charges,1150.05,85,,920.04,percent of total billed charges,85% of total billed charges,1150.05,85,,920.04,percent of total billed charges,85% of total billed charges,1217.7,90,,974.16,percent of total billed charges,90% of total billed charges,1082.4,80,,865.92,percent of total billed charges,80% of total billed charges,1217.7,90,,974.16,percent of total billed charges,90% of total billed charges,1014.75,75,,811.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,392.37,29,,313.896,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,906.51,67,,725.208,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1082.4,80,,865.92,percent of total billed charges,80% of total billed charges,879.45,65,,703.56,percent of total billed charges,65% of total billed charges,482.62,35.67,,386.096,percent of total billed charges,35.67% of total billed charges,392.37,1217.7,
DILATOR SET URETHERAL,27017657,CDM,270,RC,,,outpatient,,,690,276.00,,586.5,85,,469.2,percent of total billed charges,85% of total billed charges,531.3,77,,425.04,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,565.8,82,,452.64,percent of total billed charges,82% of total billed charges,586.5,85,,469.2,percent of total billed charges,85% of total billed charges,586.5,85,,469.2,percent of total billed charges,85% of total billed charges,586.5,85,,469.2,percent of total billed charges,85% of total billed charges,621,90,,496.8,percent of total billed charges,90% of total billed charges,552,80,,441.6,percent of total billed charges,80% of total billed charges,621,90,,496.8,percent of total billed charges,90% of total billed charges,517.5,75,,414,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,200.1,29,,160.08,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,462.3,67,,369.84,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,552,80,,441.6,percent of total billed charges,80% of total billed charges,448.5,65,,358.8,percent of total billed charges,65% of total billed charges,246.12,35.67,,196.896,percent of total billed charges,35.67% of total billed charges,200.1,621,
FUSION REAMER,27019620,CDM,270,RC,,,outpatient,,,2352,940.80,,1999.2,85,,1599.36,percent of total billed charges,85% of total billed charges,1811.04,77,,1448.83,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,1928.64,82,,1542.912,percent of total billed charges,82% of total billed charges,1999.2,85,,1599.36,percent of total billed charges,85% of total billed charges,1999.2,85,,1599.36,percent of total billed charges,85% of total billed charges,1999.2,85,,1599.36,percent of total billed charges,85% of total billed charges,2116.8,90,,1693.44,percent of total billed charges,90% of total billed charges,1881.6,80,,1505.28,percent of total billed charges,80% of total billed charges,2116.8,90,,1693.44,percent of total billed charges,90% of total billed charges,1764,75,,1411.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,682.08,29,,545.664,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1575.84,67,,1260.672,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1881.6,80,,1505.28,percent of total billed charges,80% of total billed charges,1528.8,65,,1223.04,percent of total billed charges,65% of total billed charges,838.96,35.67,,671.168,percent of total billed charges,35.67% of total billed charges,682.08,2116.8,
FOLEY CATHETER W/TEMP SENSOR,27019690,CDM,270,RC,,,outpatient,,,29,11.60,,24.65,85,,19.72,percent of total billed charges,85% of total billed charges,22.33,77,,17.86,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,23.78,82,,19.024,percent of total billed charges,82% of total billed charges,24.65,85,,19.72,percent of total billed charges,85% of total billed charges,24.65,85,,19.72,percent of total billed charges,85% of total billed charges,24.65,85,,19.72,percent of total billed charges,85% of total billed charges,26.1,90,,20.88,percent of total billed charges,90% of total billed charges,23.2,80,,18.56,percent of total billed charges,80% of total billed charges,26.1,90,,20.88,percent of total billed charges,90% of total billed charges,21.75,75,,17.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,8.41,29,,6.728,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,19.43,67,,15.544,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,23.2,80,,18.56,percent of total billed charges,80% of total billed charges,18.85,65,,15.08,percent of total billed charges,65% of total billed charges,10.34,35.67,,8.272,percent of total billed charges,35.67% of total billed charges,8.41,26.1,
ACP ACD A KIT,27019919,CDM,270,RC,,,outpatient,,,720,288.00,,612,85,,489.6,percent of total billed charges,85% of total billed charges,554.4,77,,443.52,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,590.4,82,,472.32,percent of total billed charges,82% of total billed charges,612,85,,489.6,percent of total billed charges,85% of total billed charges,612,85,,489.6,percent of total billed charges,85% of total billed charges,612,85,,489.6,percent of total billed charges,85% of total billed charges,648,90,,518.4,percent of total billed charges,90% of total billed charges,576,80,,460.8,percent of total billed charges,80% of total billed charges,648,90,,518.4,percent of total billed charges,90% of total billed charges,540,75,,432,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,208.8,29,,167.04,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,482.4,67,,385.92,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,576,80,,460.8,percent of total billed charges,80% of total billed charges,468,65,,374.4,percent of total billed charges,65% of total billed charges,256.82,35.67,,205.456,percent of total billed charges,35.67% of total billed charges,208.8,648,
SUTURE PASSER 14G,27020476,CDM,270,RC,,,outpatient,,,55,22.00,,46.75,85,,37.4,percent of total billed charges,85% of total billed charges,42.35,77,,33.88,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,45.1,82,,36.08,percent of total billed charges,82% of total billed charges,46.75,85,,37.4,percent of total billed charges,85% of total billed charges,46.75,85,,37.4,percent of total billed charges,85% of total billed charges,46.75,85,,37.4,percent of total billed charges,85% of total billed charges,49.5,90,,39.6,percent of total billed charges,90% of total billed charges,44,80,,35.2,percent of total billed charges,80% of total billed charges,49.5,90,,39.6,percent of total billed charges,90% of total billed charges,41.25,75,,33,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,15.95,29,,12.76,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,36.85,67,,29.48,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,44,80,,35.2,percent of total billed charges,80% of total billed charges,35.75,65,,28.6,percent of total billed charges,65% of total billed charges,19.62,35.67,,15.696,percent of total billed charges,35.67% of total billed charges,15.95,49.5,
STAPLER RELOAD GREEN 60,27020540,CDM,270,RC,,,outpatient,,,747,298.80,,634.95,85,,507.96,percent of total billed charges,85% of total billed charges,575.19,77,,460.15,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,612.54,82,,490.032,percent of total billed charges,82% of total billed charges,634.95,85,,507.96,percent of total billed charges,85% of total billed charges,634.95,85,,507.96,percent of total billed charges,85% of total billed charges,634.95,85,,507.96,percent of total billed charges,85% of total billed charges,672.3,90,,537.84,percent of total billed charges,90% of total billed charges,597.6,80,,478.08,percent of total billed charges,80% of total billed charges,672.3,90,,537.84,percent of total billed charges,90% of total billed charges,560.25,75,,448.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,216.63,29,,173.304,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,500.49,67,,400.392,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,597.6,80,,478.08,percent of total billed charges,80% of total billed charges,485.55,65,,388.44,percent of total billed charges,65% of total billed charges,266.45,35.67,,213.16,percent of total billed charges,35.67% of total billed charges,216.63,672.3,
STAPLER RELOAD BLUE 60,27020541,CDM,270,RC,,,outpatient,,,747,298.80,,634.95,85,,507.96,percent of total billed charges,85% of total billed charges,575.19,77,,460.15,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,612.54,82,,490.032,percent of total billed charges,82% of total billed charges,634.95,85,,507.96,percent of total billed charges,85% of total billed charges,634.95,85,,507.96,percent of total billed charges,85% of total billed charges,634.95,85,,507.96,percent of total billed charges,85% of total billed charges,672.3,90,,537.84,percent of total billed charges,90% of total billed charges,597.6,80,,478.08,percent of total billed charges,80% of total billed charges,672.3,90,,537.84,percent of total billed charges,90% of total billed charges,560.25,75,,448.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,216.63,29,,173.304,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,500.49,67,,400.392,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,597.6,80,,478.08,percent of total billed charges,80% of total billed charges,485.55,65,,388.44,percent of total billed charges,65% of total billed charges,266.45,35.67,,213.16,percent of total billed charges,35.67% of total billed charges,216.63,672.3,
STAPLER RELOAD WHITE 60,27020542,CDM,270,RC,,,outpatient,,,747,298.80,,634.95,85,,507.96,percent of total billed charges,85% of total billed charges,575.19,77,,460.15,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,612.54,82,,490.032,percent of total billed charges,82% of total billed charges,634.95,85,,507.96,percent of total billed charges,85% of total billed charges,634.95,85,,507.96,percent of total billed charges,85% of total billed charges,634.95,85,,507.96,percent of total billed charges,85% of total billed charges,672.3,90,,537.84,percent of total billed charges,90% of total billed charges,597.6,80,,478.08,percent of total billed charges,80% of total billed charges,672.3,90,,537.84,percent of total billed charges,90% of total billed charges,560.25,75,,448.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,216.63,29,,173.304,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,500.49,67,,400.392,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,597.6,80,,478.08,percent of total billed charges,80% of total billed charges,485.55,65,,388.44,percent of total billed charges,65% of total billed charges,266.45,35.67,,213.16,percent of total billed charges,35.67% of total billed charges,216.63,672.3,
STAPLER RELOAD 45 WHITE 6 ROW,27020553,CDM,270,RC,,,outpatient,,,618,247.20,,525.3,85,,420.24,percent of total billed charges,85% of total billed charges,475.86,77,,380.69,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,506.76,82,,405.408,percent of total billed charges,82% of total billed charges,525.3,85,,420.24,percent of total billed charges,85% of total billed charges,525.3,85,,420.24,percent of total billed charges,85% of total billed charges,525.3,85,,420.24,percent of total billed charges,85% of total billed charges,556.2,90,,444.96,percent of total billed charges,90% of total billed charges,494.4,80,,395.52,percent of total billed charges,80% of total billed charges,556.2,90,,444.96,percent of total billed charges,90% of total billed charges,463.5,75,,370.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,179.22,29,,143.376,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,414.06,67,,331.248,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,494.4,80,,395.52,percent of total billed charges,80% of total billed charges,401.7,65,,321.36,percent of total billed charges,65% of total billed charges,220.44,35.67,,176.352,percent of total billed charges,35.67% of total billed charges,179.22,556.2,
STAPLER RELOAD BLUE 45,27020554,CDM,270,RC,,,outpatient,,,649,259.60,,551.65,85,,441.32,percent of total billed charges,85% of total billed charges,499.73,77,,399.78,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,532.18,82,,425.744,percent of total billed charges,82% of total billed charges,551.65,85,,441.32,percent of total billed charges,85% of total billed charges,551.65,85,,441.32,percent of total billed charges,85% of total billed charges,551.65,85,,441.32,percent of total billed charges,85% of total billed charges,584.1,90,,467.28,percent of total billed charges,90% of total billed charges,519.2,80,,415.36,percent of total billed charges,80% of total billed charges,584.1,90,,467.28,percent of total billed charges,90% of total billed charges,486.75,75,,389.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,188.21,29,,150.568,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,434.83,67,,347.864,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,519.2,80,,415.36,percent of total billed charges,80% of total billed charges,421.85,65,,337.48,percent of total billed charges,65% of total billed charges,231.5,35.67,,185.2,percent of total billed charges,35.67% of total billed charges,188.21,584.1,
STAPLER RELOAD 45 GREEN 6 ROW,27020555,CDM,270,RC,,,outpatient,,,618,247.20,,525.3,85,,420.24,percent of total billed charges,85% of total billed charges,475.86,77,,380.69,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,506.76,82,,405.408,percent of total billed charges,82% of total billed charges,525.3,85,,420.24,percent of total billed charges,85% of total billed charges,525.3,85,,420.24,percent of total billed charges,85% of total billed charges,525.3,85,,420.24,percent of total billed charges,85% of total billed charges,556.2,90,,444.96,percent of total billed charges,90% of total billed charges,494.4,80,,395.52,percent of total billed charges,80% of total billed charges,556.2,90,,444.96,percent of total billed charges,90% of total billed charges,463.5,75,,370.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,179.22,29,,143.376,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,414.06,67,,331.248,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,494.4,80,,395.52,percent of total billed charges,80% of total billed charges,401.7,65,,321.36,percent of total billed charges,65% of total billed charges,220.44,35.67,,176.352,percent of total billed charges,35.67% of total billed charges,179.22,556.2,
MIDLINE KIT 4FR,27021081,CDM,270,RC,,,outpatient,,,547,218.80,,464.95,85,,371.96,percent of total billed charges,85% of total billed charges,421.19,77,,336.95,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,448.54,82,,358.832,percent of total billed charges,82% of total billed charges,464.95,85,,371.96,percent of total billed charges,85% of total billed charges,464.95,85,,371.96,percent of total billed charges,85% of total billed charges,464.95,85,,371.96,percent of total billed charges,85% of total billed charges,492.3,90,,393.84,percent of total billed charges,90% of total billed charges,437.6,80,,350.08,percent of total billed charges,80% of total billed charges,492.3,90,,393.84,percent of total billed charges,90% of total billed charges,410.25,75,,328.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,158.63,29,,126.904,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,366.49,67,,293.192,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,437.6,80,,350.08,percent of total billed charges,80% of total billed charges,355.55,65,,284.44,percent of total billed charges,65% of total billed charges,195.11,35.67,,156.088,percent of total billed charges,35.67% of total billed charges,158.63,492.3,
ACUTE DUAL LUMEN CATHETER TRAY,27021136,CDM,270,RC,,,outpatient,,,223,89.20,,189.55,85,,151.64,percent of total billed charges,85% of total billed charges,171.71,77,,137.37,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,182.86,82,,146.288,percent of total billed charges,82% of total billed charges,189.55,85,,151.64,percent of total billed charges,85% of total billed charges,189.55,85,,151.64,percent of total billed charges,85% of total billed charges,189.55,85,,151.64,percent of total billed charges,85% of total billed charges,200.7,90,,160.56,percent of total billed charges,90% of total billed charges,178.4,80,,142.72,percent of total billed charges,80% of total billed charges,200.7,90,,160.56,percent of total billed charges,90% of total billed charges,167.25,75,,133.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,64.67,29,,51.736,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,149.41,67,,119.528,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,178.4,80,,142.72,percent of total billed charges,80% of total billed charges,144.95,65,,115.96,percent of total billed charges,65% of total billed charges,79.54,35.67,,63.632,percent of total billed charges,35.67% of total billed charges,64.67,200.7,
DIGNISHIELD DRAINAGE BAG,27021322,CDM,270,RC,,,outpatient,,,283,113.20,,240.55,85,,192.44,percent of total billed charges,85% of total billed charges,217.91,77,,174.33,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,232.06,82,,185.648,percent of total billed charges,82% of total billed charges,240.55,85,,192.44,percent of total billed charges,85% of total billed charges,240.55,85,,192.44,percent of total billed charges,85% of total billed charges,240.55,85,,192.44,percent of total billed charges,85% of total billed charges,254.7,90,,203.76,percent of total billed charges,90% of total billed charges,226.4,80,,181.12,percent of total billed charges,80% of total billed charges,254.7,90,,203.76,percent of total billed charges,90% of total billed charges,212.25,75,,169.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,82.07,29,,65.656,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,189.61,67,,151.688,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,226.4,80,,181.12,percent of total billed charges,80% of total billed charges,183.95,65,,147.16,percent of total billed charges,65% of total billed charges,100.95,35.67,,80.76,percent of total billed charges,35.67% of total billed charges,82.07,254.7,
DIGNISHIELD COLLECTION BAG,27021323,CDM,270,RC,,,outpatient,,,106,42.40,,90.1,85,,72.08,percent of total billed charges,85% of total billed charges,81.62,77,,65.3,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,86.92,82,,69.536,percent of total billed charges,82% of total billed charges,90.1,85,,72.08,percent of total billed charges,85% of total billed charges,90.1,85,,72.08,percent of total billed charges,85% of total billed charges,90.1,85,,72.08,percent of total billed charges,85% of total billed charges,95.4,90,,76.32,percent of total billed charges,90% of total billed charges,84.8,80,,67.84,percent of total billed charges,80% of total billed charges,95.4,90,,76.32,percent of total billed charges,90% of total billed charges,79.5,75,,63.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,30.74,29,,24.592,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,71.02,67,,56.816,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,84.8,80,,67.84,percent of total billed charges,80% of total billed charges,68.9,65,,55.12,percent of total billed charges,65% of total billed charges,37.81,35.67,,30.248,percent of total billed charges,35.67% of total billed charges,30.74,95.4,
PHALANGEAL REAMER 10MM,27021423,CDM,270,RC,,,outpatient,,,1505,602.00,,1279.25,85,,1023.4,percent of total billed charges,85% of total billed charges,1158.85,77,,927.08,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,1234.1,82,,987.28,percent of total billed charges,82% of total billed charges,1279.25,85,,1023.4,percent of total billed charges,85% of total billed charges,1279.25,85,,1023.4,percent of total billed charges,85% of total billed charges,1279.25,85,,1023.4,percent of total billed charges,85% of total billed charges,1354.5,90,,1083.6,percent of total billed charges,90% of total billed charges,1204,80,,963.2,percent of total billed charges,80% of total billed charges,1354.5,90,,1083.6,percent of total billed charges,90% of total billed charges,1128.75,75,,903,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,436.45,29,,349.16,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1008.35,67,,806.68,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1204,80,,963.2,percent of total billed charges,80% of total billed charges,978.25,65,,782.6,percent of total billed charges,65% of total billed charges,536.83,35.67,,429.464,percent of total billed charges,35.67% of total billed charges,436.45,1354.5,
MTP FUSION REAMER 16MM,27021623,CDM,270,RC,,,outpatient,,,1530,612.00,,1300.5,85,,1040.4,percent of total billed charges,85% of total billed charges,1178.1,77,,942.48,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,1254.6,82,,1003.68,percent of total billed charges,82% of total billed charges,1300.5,85,,1040.4,percent of total billed charges,85% of total billed charges,1300.5,85,,1040.4,percent of total billed charges,85% of total billed charges,1300.5,85,,1040.4,percent of total billed charges,85% of total billed charges,1377,90,,1101.6,percent of total billed charges,90% of total billed charges,1224,80,,979.2,percent of total billed charges,80% of total billed charges,1377,90,,1101.6,percent of total billed charges,90% of total billed charges,1147.5,75,,918,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,443.7,29,,354.96,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1025.1,67,,820.08,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1224,80,,979.2,percent of total billed charges,80% of total billed charges,994.5,65,,795.6,percent of total billed charges,65% of total billed charges,545.75,35.67,,436.6,percent of total billed charges,35.67% of total billed charges,443.7,1377,
CANNULA 15G DELIVERY,27021809,CDM,270,RC,,,outpatient,,,1236,494.40,,1050.6,85,,840.48,percent of total billed charges,85% of total billed charges,951.72,77,,761.38,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,1013.52,82,,810.816,percent of total billed charges,82% of total billed charges,1050.6,85,,840.48,percent of total billed charges,85% of total billed charges,1050.6,85,,840.48,percent of total billed charges,85% of total billed charges,1050.6,85,,840.48,percent of total billed charges,85% of total billed charges,1112.4,90,,889.92,percent of total billed charges,90% of total billed charges,988.8,80,,791.04,percent of total billed charges,80% of total billed charges,1112.4,90,,889.92,percent of total billed charges,90% of total billed charges,927,75,,741.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,358.44,29,,286.752,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,828.12,67,,662.496,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,988.8,80,,791.04,percent of total billed charges,80% of total billed charges,803.4,65,,642.72,percent of total billed charges,65% of total billed charges,440.88,35.67,,352.704,percent of total billed charges,35.67% of total billed charges,358.44,1112.4,
PROXIMATE STAPLE RELOAD GREEN,27021983,CDM,270,RC,,,outpatient,,,107,42.80,,90.95,85,,72.76,percent of total billed charges,85% of total billed charges,82.39,77,,65.91,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,87.74,82,,70.192,percent of total billed charges,82% of total billed charges,90.95,85,,72.76,percent of total billed charges,85% of total billed charges,90.95,85,,72.76,percent of total billed charges,85% of total billed charges,90.95,85,,72.76,percent of total billed charges,85% of total billed charges,96.3,90,,77.04,percent of total billed charges,90% of total billed charges,85.6,80,,68.48,percent of total billed charges,80% of total billed charges,96.3,90,,77.04,percent of total billed charges,90% of total billed charges,80.25,75,,64.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,31.03,29,,24.824,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,71.69,67,,57.352,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,85.6,80,,68.48,percent of total billed charges,80% of total billed charges,69.55,65,,55.64,percent of total billed charges,65% of total billed charges,38.17,35.67,,30.536,percent of total billed charges,35.67% of total billed charges,31.03,96.3,
PROXIMATE STAPLE RELOAD BLUE,27021984,CDM,270,RC,,,outpatient,,,107,42.80,,90.95,85,,72.76,percent of total billed charges,85% of total billed charges,82.39,77,,65.91,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,87.74,82,,70.192,percent of total billed charges,82% of total billed charges,90.95,85,,72.76,percent of total billed charges,85% of total billed charges,90.95,85,,72.76,percent of total billed charges,85% of total billed charges,90.95,85,,72.76,percent of total billed charges,85% of total billed charges,96.3,90,,77.04,percent of total billed charges,90% of total billed charges,85.6,80,,68.48,percent of total billed charges,80% of total billed charges,96.3,90,,77.04,percent of total billed charges,90% of total billed charges,80.25,75,,64.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,31.03,29,,24.824,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,71.69,67,,57.352,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,85.6,80,,68.48,percent of total billed charges,80% of total billed charges,69.55,65,,55.64,percent of total billed charges,65% of total billed charges,38.17,35.67,,30.536,percent of total billed charges,35.67% of total billed charges,31.03,96.3,
PROXIMATE LINEAR STAPLER GREEN,27021987,CDM,270,RC,,,outpatient,,,223,89.20,,189.55,85,,151.64,percent of total billed charges,85% of total billed charges,171.71,77,,137.37,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,182.86,82,,146.288,percent of total billed charges,82% of total billed charges,189.55,85,,151.64,percent of total billed charges,85% of total billed charges,189.55,85,,151.64,percent of total billed charges,85% of total billed charges,189.55,85,,151.64,percent of total billed charges,85% of total billed charges,200.7,90,,160.56,percent of total billed charges,90% of total billed charges,178.4,80,,142.72,percent of total billed charges,80% of total billed charges,200.7,90,,160.56,percent of total billed charges,90% of total billed charges,167.25,75,,133.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,64.67,29,,51.736,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,149.41,67,,119.528,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,178.4,80,,142.72,percent of total billed charges,80% of total billed charges,144.95,65,,115.96,percent of total billed charges,65% of total billed charges,79.54,35.67,,63.632,percent of total billed charges,35.67% of total billed charges,64.67,200.7,
PROXIMATE LINEAR STAPLER BLUE,27021988,CDM,270,RC,,,outpatient,,,223,89.20,,189.55,85,,151.64,percent of total billed charges,85% of total billed charges,171.71,77,,137.37,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,182.86,82,,146.288,percent of total billed charges,82% of total billed charges,189.55,85,,151.64,percent of total billed charges,85% of total billed charges,189.55,85,,151.64,percent of total billed charges,85% of total billed charges,189.55,85,,151.64,percent of total billed charges,85% of total billed charges,200.7,90,,160.56,percent of total billed charges,90% of total billed charges,178.4,80,,142.72,percent of total billed charges,80% of total billed charges,200.7,90,,160.56,percent of total billed charges,90% of total billed charges,167.25,75,,133.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,64.67,29,,51.736,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,149.41,67,,119.528,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,178.4,80,,142.72,percent of total billed charges,80% of total billed charges,144.95,65,,115.96,percent of total billed charges,65% of total billed charges,79.54,35.67,,63.632,percent of total billed charges,35.67% of total billed charges,64.67,200.7,
PHACO UNIT,2702737,CDM,270,RC,,,outpatient,,,121,48.40,,102.85,85,,82.28,percent of total billed charges,85% of total billed charges,93.17,77,,74.54,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,99.22,82,,79.376,percent of total billed charges,82% of total billed charges,102.85,85,,82.28,percent of total billed charges,85% of total billed charges,102.85,85,,82.28,percent of total billed charges,85% of total billed charges,102.85,85,,82.28,percent of total billed charges,85% of total billed charges,108.9,90,,87.12,percent of total billed charges,90% of total billed charges,96.8,80,,77.44,percent of total billed charges,80% of total billed charges,108.9,90,,87.12,percent of total billed charges,90% of total billed charges,90.75,75,,72.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,35.09,29,,28.072,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,81.07,67,,64.856,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,96.8,80,,77.44,percent of total billed charges,80% of total billed charges,78.65,65,,62.92,percent of total billed charges,65% of total billed charges,43.16,35.67,,34.528,percent of total billed charges,35.67% of total billed charges,35.09,108.9,
QWIK CONNECT PLUS SPIRAL **,2703168,CDM,270,RC,,,outpatient,,,40,16.00,,34,85,,27.2,percent of total billed charges,85% of total billed charges,30.8,77,,24.64,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,32.8,82,,26.24,percent of total billed charges,82% of total billed charges,34,85,,27.2,percent of total billed charges,85% of total billed charges,34,85,,27.2,percent of total billed charges,85% of total billed charges,34,85,,27.2,percent of total billed charges,85% of total billed charges,36,90,,28.8,percent of total billed charges,90% of total billed charges,32,80,,25.6,percent of total billed charges,80% of total billed charges,36,90,,28.8,percent of total billed charges,90% of total billed charges,30,75,,24,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,11.6,29,,9.28,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,26.8,67,,21.44,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,32,80,,25.6,percent of total billed charges,80% of total billed charges,26,65,,20.8,percent of total billed charges,65% of total billed charges,14.27,35.67,,11.416,percent of total billed charges,35.67% of total billed charges,11.6,36,
PREM PLUS CEEA STAPLER 31MM,2703200,CDM,270,RC,,,outpatient,,,3052,1220.80,,2594.2,85,,2075.36,percent of total billed charges,85% of total billed charges,2350.04,77,,1880.03,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,2502.64,82,,2002.112,percent of total billed charges,82% of total billed charges,2594.2,85,,2075.36,percent of total billed charges,85% of total billed charges,2594.2,85,,2075.36,percent of total billed charges,85% of total billed charges,2594.2,85,,2075.36,percent of total billed charges,85% of total billed charges,2746.8,90,,2197.44,percent of total billed charges,90% of total billed charges,2441.6,80,,1953.28,percent of total billed charges,80% of total billed charges,2746.8,90,,2197.44,percent of total billed charges,90% of total billed charges,2289,75,,1831.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,885.08,29,,708.064,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,2044.84,67,,1635.872,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,2441.6,80,,1953.28,percent of total billed charges,80% of total billed charges,1983.8,65,,1587.04,percent of total billed charges,65% of total billed charges,1088.65,35.67,,870.92,percent of total billed charges,35.67% of total billed charges,885.08,2746.8,
STOCKINET 4 SINGLE USE,2703268,CDM,270,RC,,,outpatient,,,22,8.80,,18.7,85,,14.96,percent of total billed charges,85% of total billed charges,16.94,77,,13.55,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,18.04,82,,14.432,percent of total billed charges,82% of total billed charges,18.7,85,,14.96,percent of total billed charges,85% of total billed charges,18.7,85,,14.96,percent of total billed charges,85% of total billed charges,18.7,85,,14.96,percent of total billed charges,85% of total billed charges,19.8,90,,15.84,percent of total billed charges,90% of total billed charges,17.6,80,,14.08,percent of total billed charges,80% of total billed charges,19.8,90,,15.84,percent of total billed charges,90% of total billed charges,16.5,75,,13.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,6.38,29,,5.104,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,14.74,67,,11.792,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,17.6,80,,14.08,percent of total billed charges,80% of total billed charges,14.3,65,,11.44,percent of total billed charges,65% of total billed charges,7.85,35.67,,6.28,percent of total billed charges,35.67% of total billed charges,6.38,19.8,
PREM PLUS STAPLER CEEA 28MM,2703305,CDM,270,RC,,,outpatient,,,4124,1649.60,,3505.4,85,,2804.32,percent of total billed charges,85% of total billed charges,3175.48,77,,2540.38,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,3381.68,82,,2705.344,percent of total billed charges,82% of total billed charges,3505.4,85,,2804.32,percent of total billed charges,85% of total billed charges,3505.4,85,,2804.32,percent of total billed charges,85% of total billed charges,3505.4,85,,2804.32,percent of total billed charges,85% of total billed charges,3711.6,90,,2969.28,percent of total billed charges,90% of total billed charges,3299.2,80,,2639.36,percent of total billed charges,80% of total billed charges,3711.6,90,,2969.28,percent of total billed charges,90% of total billed charges,3093,75,,2474.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,1195.96,29,,956.768,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,2763.08,67,,2210.464,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,3299.2,80,,2639.36,percent of total billed charges,80% of total billed charges,2680.6,65,,2144.48,percent of total billed charges,65% of total billed charges,1471.03,35.67,,1176.824,percent of total billed charges,35.67% of total billed charges,1195.96,3711.6,
HYDROGEL WOUND DRESSING 2X3 **,2703308,CDM,270,RC,,,outpatient,,,25,10.00,,21.25,85,,17,percent of total billed charges,85% of total billed charges,19.25,77,,15.4,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,20.5,82,,16.4,percent of total billed charges,82% of total billed charges,21.25,85,,17,percent of total billed charges,85% of total billed charges,21.25,85,,17,percent of total billed charges,85% of total billed charges,21.25,85,,17,percent of total billed charges,85% of total billed charges,22.5,90,,18,percent of total billed charges,90% of total billed charges,20,80,,16,percent of total billed charges,80% of total billed charges,22.5,90,,18,percent of total billed charges,90% of total billed charges,18.75,75,,15,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,7.25,29,,5.8,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,16.75,67,,13.4,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,20,80,,16,percent of total billed charges,80% of total billed charges,16.25,65,,13,percent of total billed charges,65% of total billed charges,8.92,35.67,,7.136,percent of total billed charges,35.67% of total billed charges,7.25,22.5,
NASAL PACKING AIRWAY TUBE **,2703392,CDM,270,RC,,,outpatient,,,73,29.20,,62.05,85,,49.64,percent of total billed charges,85% of total billed charges,56.21,77,,44.97,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,59.86,82,,47.888,percent of total billed charges,82% of total billed charges,62.05,85,,49.64,percent of total billed charges,85% of total billed charges,62.05,85,,49.64,percent of total billed charges,85% of total billed charges,62.05,85,,49.64,percent of total billed charges,85% of total billed charges,65.7,90,,52.56,percent of total billed charges,90% of total billed charges,58.4,80,,46.72,percent of total billed charges,80% of total billed charges,65.7,90,,52.56,percent of total billed charges,90% of total billed charges,54.75,75,,43.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,21.17,29,,16.936,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,48.91,67,,39.128,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,58.4,80,,46.72,percent of total billed charges,80% of total billed charges,47.45,65,,37.96,percent of total billed charges,65% of total billed charges,26.04,35.67,,20.832,percent of total billed charges,35.67% of total billed charges,21.17,65.7,
NASAL PACKING AIRWAY 4.5X1.5**,2703393,CDM,270,RC,,,outpatient,,,60,24.00,,51,85,,40.8,percent of total billed charges,85% of total billed charges,46.2,77,,36.96,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,49.2,82,,39.36,percent of total billed charges,82% of total billed charges,51,85,,40.8,percent of total billed charges,85% of total billed charges,51,85,,40.8,percent of total billed charges,85% of total billed charges,51,85,,40.8,percent of total billed charges,85% of total billed charges,54,90,,43.2,percent of total billed charges,90% of total billed charges,48,80,,38.4,percent of total billed charges,80% of total billed charges,54,90,,43.2,percent of total billed charges,90% of total billed charges,45,75,,36,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,17.4,29,,13.92,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,40.2,67,,32.16,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,48,80,,38.4,percent of total billed charges,80% of total billed charges,39,65,,31.2,percent of total billed charges,65% of total billed charges,21.4,35.67,,17.12,percent of total billed charges,35.67% of total billed charges,17.4,54,
TROCAR W/CANNULA 5MM,2703397,CDM,270,RC,,,outpatient,,,703,281.20,,597.55,85,,478.04,percent of total billed charges,85% of total billed charges,541.31,77,,433.05,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,576.46,82,,461.168,percent of total billed charges,82% of total billed charges,597.55,85,,478.04,percent of total billed charges,85% of total billed charges,597.55,85,,478.04,percent of total billed charges,85% of total billed charges,597.55,85,,478.04,percent of total billed charges,85% of total billed charges,632.7,90,,506.16,percent of total billed charges,90% of total billed charges,562.4,80,,449.92,percent of total billed charges,80% of total billed charges,632.7,90,,506.16,percent of total billed charges,90% of total billed charges,527.25,75,,421.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,203.87,29,,163.096,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,471.01,67,,376.808,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,562.4,80,,449.92,percent of total billed charges,80% of total billed charges,456.95,65,,365.56,percent of total billed charges,65% of total billed charges,250.76,35.67,,200.608,percent of total billed charges,35.67% of total billed charges,203.87,632.7,
VERASTEP PLUS TROCAR,2703398,CDM,270,RC,,,outpatient,,,783,313.20,,665.55,85,,532.44,percent of total billed charges,85% of total billed charges,602.91,77,,482.33,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,642.06,82,,513.648,percent of total billed charges,82% of total billed charges,665.55,85,,532.44,percent of total billed charges,85% of total billed charges,665.55,85,,532.44,percent of total billed charges,85% of total billed charges,665.55,85,,532.44,percent of total billed charges,85% of total billed charges,704.7,90,,563.76,percent of total billed charges,90% of total billed charges,626.4,80,,501.12,percent of total billed charges,80% of total billed charges,704.7,90,,563.76,percent of total billed charges,90% of total billed charges,587.25,75,,469.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,227.07,29,,181.656,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,524.61,67,,419.688,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,626.4,80,,501.12,percent of total billed charges,80% of total billed charges,508.95,65,,407.16,percent of total billed charges,65% of total billed charges,279.3,35.67,,223.44,percent of total billed charges,35.67% of total billed charges,227.07,704.7,
VERASTEP SLEEVE 12MM,2703399,CDM,270,RC,,,outpatient,,,487,194.80,,413.95,85,,331.16,percent of total billed charges,85% of total billed charges,374.99,77,,299.99,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,399.34,82,,319.472,percent of total billed charges,82% of total billed charges,413.95,85,,331.16,percent of total billed charges,85% of total billed charges,413.95,85,,331.16,percent of total billed charges,85% of total billed charges,413.95,85,,331.16,percent of total billed charges,85% of total billed charges,438.3,90,,350.64,percent of total billed charges,90% of total billed charges,389.6,80,,311.68,percent of total billed charges,80% of total billed charges,438.3,90,,350.64,percent of total billed charges,90% of total billed charges,365.25,75,,292.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,141.23,29,,112.984,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,326.29,67,,261.032,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,389.6,80,,311.68,percent of total billed charges,80% of total billed charges,316.55,65,,253.24,percent of total billed charges,65% of total billed charges,173.71,35.67,,138.968,percent of total billed charges,35.67% of total billed charges,141.23,438.3,
SUTURE MONOSOF 10-0 12,2703433,CDM,270,RC,,,outpatient,,,158,63.20,,134.3,85,,107.44,percent of total billed charges,85% of total billed charges,121.66,77,,97.33,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,129.56,82,,103.648,percent of total billed charges,82% of total billed charges,134.3,85,,107.44,percent of total billed charges,85% of total billed charges,134.3,85,,107.44,percent of total billed charges,85% of total billed charges,134.3,85,,107.44,percent of total billed charges,85% of total billed charges,142.2,90,,113.76,percent of total billed charges,90% of total billed charges,126.4,80,,101.12,percent of total billed charges,80% of total billed charges,142.2,90,,113.76,percent of total billed charges,90% of total billed charges,118.5,75,,94.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,45.82,29,,36.656,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,105.86,67,,84.688,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,126.4,80,,101.12,percent of total billed charges,80% of total billed charges,102.7,65,,82.16,percent of total billed charges,65% of total billed charges,56.36,35.67,,45.088,percent of total billed charges,35.67% of total billed charges,45.82,142.2,
INTERNAL STAPLER TA30,2703449,CDM,270,RC,,,outpatient,,,2051,820.40,,1743.35,85,,1394.68,percent of total billed charges,85% of total billed charges,1579.27,77,,1263.42,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,1681.82,82,,1345.456,percent of total billed charges,82% of total billed charges,1743.35,85,,1394.68,percent of total billed charges,85% of total billed charges,1743.35,85,,1394.68,percent of total billed charges,85% of total billed charges,1743.35,85,,1394.68,percent of total billed charges,85% of total billed charges,1845.9,90,,1476.72,percent of total billed charges,90% of total billed charges,1640.8,80,,1312.64,percent of total billed charges,80% of total billed charges,1845.9,90,,1476.72,percent of total billed charges,90% of total billed charges,1538.25,75,,1230.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,594.79,29,,475.832,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1374.17,67,,1099.336,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1640.8,80,,1312.64,percent of total billed charges,80% of total billed charges,1333.15,65,,1066.52,percent of total billed charges,65% of total billed charges,731.59,35.67,,585.272,percent of total billed charges,35.67% of total billed charges,594.79,1845.9,
HERBST CRADLE SHOE SMALL **,2703479,CDM,270,RC,,,outpatient,,,342,136.80,,290.7,85,,232.56,percent of total billed charges,85% of total billed charges,263.34,77,,210.67,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,280.44,82,,224.352,percent of total billed charges,82% of total billed charges,290.7,85,,232.56,percent of total billed charges,85% of total billed charges,290.7,85,,232.56,percent of total billed charges,85% of total billed charges,290.7,85,,232.56,percent of total billed charges,85% of total billed charges,307.8,90,,246.24,percent of total billed charges,90% of total billed charges,273.6,80,,218.88,percent of total billed charges,80% of total billed charges,307.8,90,,246.24,percent of total billed charges,90% of total billed charges,256.5,75,,205.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,99.18,29,,79.344,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,229.14,67,,183.312,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,273.6,80,,218.88,percent of total billed charges,80% of total billed charges,222.3,65,,177.84,percent of total billed charges,65% of total billed charges,121.99,35.67,,97.592,percent of total billed charges,35.67% of total billed charges,99.18,307.8,
TRACTION BOOT SMALL **,2703493,CDM,270,RC,,,outpatient,,,137,54.80,,116.45,85,,93.16,percent of total billed charges,85% of total billed charges,105.49,77,,84.39,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,112.34,82,,89.872,percent of total billed charges,82% of total billed charges,116.45,85,,93.16,percent of total billed charges,85% of total billed charges,116.45,85,,93.16,percent of total billed charges,85% of total billed charges,116.45,85,,93.16,percent of total billed charges,85% of total billed charges,123.3,90,,98.64,percent of total billed charges,90% of total billed charges,109.6,80,,87.68,percent of total billed charges,80% of total billed charges,123.3,90,,98.64,percent of total billed charges,90% of total billed charges,102.75,75,,82.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,39.73,29,,31.784,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,91.79,67,,73.432,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,109.6,80,,87.68,percent of total billed charges,80% of total billed charges,89.05,65,,71.24,percent of total billed charges,65% of total billed charges,48.87,35.67,,39.096,percent of total billed charges,35.67% of total billed charges,39.73,123.3,
"TRACTION BOOT, MEDIUM **",2703494,CDM,270,RC,,,outpatient,,,124,49.60,,105.4,85,,84.32,percent of total billed charges,85% of total billed charges,95.48,77,,76.38,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,101.68,82,,81.344,percent of total billed charges,82% of total billed charges,105.4,85,,84.32,percent of total billed charges,85% of total billed charges,105.4,85,,84.32,percent of total billed charges,85% of total billed charges,105.4,85,,84.32,percent of total billed charges,85% of total billed charges,111.6,90,,89.28,percent of total billed charges,90% of total billed charges,99.2,80,,79.36,percent of total billed charges,80% of total billed charges,111.6,90,,89.28,percent of total billed charges,90% of total billed charges,93,75,,74.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,35.96,29,,28.768,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,83.08,67,,66.464,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,99.2,80,,79.36,percent of total billed charges,80% of total billed charges,80.6,65,,64.48,percent of total billed charges,65% of total billed charges,44.23,35.67,,35.384,percent of total billed charges,35.67% of total billed charges,35.96,111.6,
"TRACTION BOOT, LARGE **",2703495,CDM,270,RC,,,outpatient,,,137,54.80,,116.45,85,,93.16,percent of total billed charges,85% of total billed charges,105.49,77,,84.39,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,112.34,82,,89.872,percent of total billed charges,82% of total billed charges,116.45,85,,93.16,percent of total billed charges,85% of total billed charges,116.45,85,,93.16,percent of total billed charges,85% of total billed charges,116.45,85,,93.16,percent of total billed charges,85% of total billed charges,123.3,90,,98.64,percent of total billed charges,90% of total billed charges,109.6,80,,87.68,percent of total billed charges,80% of total billed charges,123.3,90,,98.64,percent of total billed charges,90% of total billed charges,102.75,75,,82.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,39.73,29,,31.784,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,91.79,67,,73.432,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,109.6,80,,87.68,percent of total billed charges,80% of total billed charges,89.05,65,,71.24,percent of total billed charges,65% of total billed charges,48.87,35.67,,39.096,percent of total billed charges,35.67% of total billed charges,39.73,123.3,
"TRACTION BOOT, X-LARGE **",2703496,CDM,270,RC,,,outpatient,,,137,54.80,,116.45,85,,93.16,percent of total billed charges,85% of total billed charges,105.49,77,,84.39,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,112.34,82,,89.872,percent of total billed charges,82% of total billed charges,116.45,85,,93.16,percent of total billed charges,85% of total billed charges,116.45,85,,93.16,percent of total billed charges,85% of total billed charges,116.45,85,,93.16,percent of total billed charges,85% of total billed charges,123.3,90,,98.64,percent of total billed charges,90% of total billed charges,109.6,80,,87.68,percent of total billed charges,80% of total billed charges,123.3,90,,98.64,percent of total billed charges,90% of total billed charges,102.75,75,,82.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,39.73,29,,31.784,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,91.79,67,,73.432,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,109.6,80,,87.68,percent of total billed charges,80% of total billed charges,89.05,65,,71.24,percent of total billed charges,65% of total billed charges,48.87,35.67,,39.096,percent of total billed charges,35.67% of total billed charges,39.73,123.3,
ENDO GIA 30 3.5 LOADS,2703499,CDM,270,RC,,,outpatient,,,1679,671.60,,1427.15,85,,1141.72,percent of total billed charges,85% of total billed charges,1292.83,77,,1034.26,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,1376.78,82,,1101.424,percent of total billed charges,82% of total billed charges,1427.15,85,,1141.72,percent of total billed charges,85% of total billed charges,1427.15,85,,1141.72,percent of total billed charges,85% of total billed charges,1427.15,85,,1141.72,percent of total billed charges,85% of total billed charges,1511.1,90,,1208.88,percent of total billed charges,90% of total billed charges,1343.2,80,,1074.56,percent of total billed charges,80% of total billed charges,1511.1,90,,1208.88,percent of total billed charges,90% of total billed charges,1259.25,75,,1007.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,486.91,29,,389.528,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1124.93,67,,899.944,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1343.2,80,,1074.56,percent of total billed charges,80% of total billed charges,1091.35,65,,873.08,percent of total billed charges,65% of total billed charges,598.9,35.67,,479.12,percent of total billed charges,35.67% of total billed charges,486.91,1511.1,
EXTREMITY DRAPE 90X124,2703503,CDM,270,RC,,,outpatient,,,81,32.40,,68.85,85,,55.08,percent of total billed charges,85% of total billed charges,62.37,77,,49.9,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,66.42,82,,53.136,percent of total billed charges,82% of total billed charges,68.85,85,,55.08,percent of total billed charges,85% of total billed charges,68.85,85,,55.08,percent of total billed charges,85% of total billed charges,68.85,85,,55.08,percent of total billed charges,85% of total billed charges,72.9,90,,58.32,percent of total billed charges,90% of total billed charges,64.8,80,,51.84,percent of total billed charges,80% of total billed charges,72.9,90,,58.32,percent of total billed charges,90% of total billed charges,60.75,75,,48.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,23.49,29,,18.792,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,54.27,67,,43.416,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,64.8,80,,51.84,percent of total billed charges,80% of total billed charges,52.65,65,,42.12,percent of total billed charges,65% of total billed charges,28.89,35.67,,23.112,percent of total billed charges,35.67% of total billed charges,23.49,72.9,
THREE QUARTER DRAPE  **,2703504,CDM,270,RC,,,outpatient,,,26,10.40,,22.1,85,,17.68,percent of total billed charges,85% of total billed charges,20.02,77,,16.02,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,21.32,82,,17.056,percent of total billed charges,82% of total billed charges,22.1,85,,17.68,percent of total billed charges,85% of total billed charges,22.1,85,,17.68,percent of total billed charges,85% of total billed charges,22.1,85,,17.68,percent of total billed charges,85% of total billed charges,23.4,90,,18.72,percent of total billed charges,90% of total billed charges,20.8,80,,16.64,percent of total billed charges,80% of total billed charges,23.4,90,,18.72,percent of total billed charges,90% of total billed charges,19.5,75,,15.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,7.54,29,,6.032,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,17.42,67,,13.936,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,20.8,80,,16.64,percent of total billed charges,80% of total billed charges,16.9,65,,13.52,percent of total billed charges,65% of total billed charges,9.27,35.67,,7.416,percent of total billed charges,35.67% of total billed charges,7.54,23.4,
ENDO EKG MONITOR,27035112,CDM,270,RC,,,outpatient,,,70,28.00,,59.5,85,,47.6,percent of total billed charges,85% of total billed charges,53.9,77,,43.12,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,57.4,82,,45.92,percent of total billed charges,82% of total billed charges,59.5,85,,47.6,percent of total billed charges,85% of total billed charges,59.5,85,,47.6,percent of total billed charges,85% of total billed charges,59.5,85,,47.6,percent of total billed charges,85% of total billed charges,63,90,,50.4,percent of total billed charges,90% of total billed charges,56,80,,44.8,percent of total billed charges,80% of total billed charges,63,90,,50.4,percent of total billed charges,90% of total billed charges,52.5,75,,42,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,20.3,29,,16.24,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,46.9,67,,37.52,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,56,80,,44.8,percent of total billed charges,80% of total billed charges,45.5,65,,36.4,percent of total billed charges,65% of total billed charges,24.97,35.67,,19.976,percent of total billed charges,35.67% of total billed charges,20.3,63,
ENDO B/P MONITOR,27035113,CDM,270,RC,,,outpatient,,,33,13.20,,28.05,85,,22.44,percent of total billed charges,85% of total billed charges,25.41,77,,20.33,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,27.06,82,,21.648,percent of total billed charges,82% of total billed charges,28.05,85,,22.44,percent of total billed charges,85% of total billed charges,28.05,85,,22.44,percent of total billed charges,85% of total billed charges,28.05,85,,22.44,percent of total billed charges,85% of total billed charges,29.7,90,,23.76,percent of total billed charges,90% of total billed charges,26.4,80,,21.12,percent of total billed charges,80% of total billed charges,29.7,90,,23.76,percent of total billed charges,90% of total billed charges,24.75,75,,19.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,9.57,29,,7.656,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,22.11,67,,17.688,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,26.4,80,,21.12,percent of total billed charges,80% of total billed charges,21.45,65,,17.16,percent of total billed charges,65% of total billed charges,11.77,35.67,,9.416,percent of total billed charges,35.67% of total billed charges,9.57,29.7,
ENDO PULSE OXIMETRY,27035114,CDM,270,RC,,,outpatient,,,54,21.60,,45.9,85,,36.72,percent of total billed charges,85% of total billed charges,41.58,77,,33.26,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,44.28,82,,35.424,percent of total billed charges,82% of total billed charges,45.9,85,,36.72,percent of total billed charges,85% of total billed charges,45.9,85,,36.72,percent of total billed charges,85% of total billed charges,45.9,85,,36.72,percent of total billed charges,85% of total billed charges,48.6,90,,38.88,percent of total billed charges,90% of total billed charges,43.2,80,,34.56,percent of total billed charges,80% of total billed charges,48.6,90,,38.88,percent of total billed charges,90% of total billed charges,40.5,75,,32.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,15.66,29,,12.528,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,36.18,67,,28.944,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,43.2,80,,34.56,percent of total billed charges,80% of total billed charges,35.1,65,,28.08,percent of total billed charges,65% of total billed charges,19.26,35.67,,15.408,percent of total billed charges,35.67% of total billed charges,15.66,48.6,
COHESIVE BANDAGE 2 **,2703555,CDM,270,RC,,,outpatient,,,13,5.20,,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,10.01,77,,8.01,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,10.66,82,,8.528,percent of total billed charges,82% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,11.7,90,,9.36,percent of total billed charges,90% of total billed charges,10.4,80,,8.32,percent of total billed charges,80% of total billed charges,11.7,90,,9.36,percent of total billed charges,90% of total billed charges,9.75,75,,7.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,3.77,29,,3.016,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,8.71,67,,6.968,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,10.4,80,,8.32,percent of total billed charges,80% of total billed charges,8.45,65,,6.76,percent of total billed charges,65% of total billed charges,4.64,35.67,,3.712,percent of total billed charges,35.67% of total billed charges,3.77,11.7,
COHESIVE BANDAGE 3 **,2703556,CDM,270,RC,,,outpatient,,,16,6.40,,13.6,85,,10.88,percent of total billed charges,85% of total billed charges,12.32,77,,9.86,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,13.12,82,,10.496,percent of total billed charges,82% of total billed charges,13.6,85,,10.88,percent of total billed charges,85% of total billed charges,13.6,85,,10.88,percent of total billed charges,85% of total billed charges,13.6,85,,10.88,percent of total billed charges,85% of total billed charges,14.4,90,,11.52,percent of total billed charges,90% of total billed charges,12.8,80,,10.24,percent of total billed charges,80% of total billed charges,14.4,90,,11.52,percent of total billed charges,90% of total billed charges,12,75,,9.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,4.64,29,,3.712,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,10.72,67,,8.576,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,12.8,80,,10.24,percent of total billed charges,80% of total billed charges,10.4,65,,8.32,percent of total billed charges,65% of total billed charges,5.71,35.67,,4.568,percent of total billed charges,35.67% of total billed charges,4.64,14.4,
COHESIVE BANDAGE 4,2703557,CDM,270,RC,,,outpatient,,,32,12.80,,27.2,85,,21.76,percent of total billed charges,85% of total billed charges,24.64,77,,19.71,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,26.24,82,,20.992,percent of total billed charges,82% of total billed charges,27.2,85,,21.76,percent of total billed charges,85% of total billed charges,27.2,85,,21.76,percent of total billed charges,85% of total billed charges,27.2,85,,21.76,percent of total billed charges,85% of total billed charges,28.8,90,,23.04,percent of total billed charges,90% of total billed charges,25.6,80,,20.48,percent of total billed charges,80% of total billed charges,28.8,90,,23.04,percent of total billed charges,90% of total billed charges,24,75,,19.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,9.28,29,,7.424,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,21.44,67,,17.152,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,25.6,80,,20.48,percent of total billed charges,80% of total billed charges,20.8,65,,16.64,percent of total billed charges,65% of total billed charges,11.41,35.67,,9.128,percent of total billed charges,35.67% of total billed charges,9.28,28.8,
COHESIVE BANDAGE 6 **,2703558,CDM,270,RC,,,outpatient,,,30,12.00,,25.5,85,,20.4,percent of total billed charges,85% of total billed charges,23.1,77,,18.48,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,24.6,82,,19.68,percent of total billed charges,82% of total billed charges,25.5,85,,20.4,percent of total billed charges,85% of total billed charges,25.5,85,,20.4,percent of total billed charges,85% of total billed charges,25.5,85,,20.4,percent of total billed charges,85% of total billed charges,27,90,,21.6,percent of total billed charges,90% of total billed charges,24,80,,19.2,percent of total billed charges,80% of total billed charges,27,90,,21.6,percent of total billed charges,90% of total billed charges,22.5,75,,18,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,8.7,29,,6.96,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,20.1,67,,16.08,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,24,80,,19.2,percent of total billed charges,80% of total billed charges,19.5,65,,15.6,percent of total billed charges,65% of total billed charges,10.7,35.67,,8.56,percent of total billed charges,35.67% of total billed charges,8.7,27,
STERILE SLEEVE ARM **,2703564,CDM,270,RC,,,outpatient,,,13,5.20,,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,10.01,77,,8.01,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,10.66,82,,8.528,percent of total billed charges,82% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,11.7,90,,9.36,percent of total billed charges,90% of total billed charges,10.4,80,,8.32,percent of total billed charges,80% of total billed charges,11.7,90,,9.36,percent of total billed charges,90% of total billed charges,9.75,75,,7.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,3.77,29,,3.016,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,8.71,67,,6.968,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,10.4,80,,8.32,percent of total billed charges,80% of total billed charges,8.45,65,,6.76,percent of total billed charges,65% of total billed charges,4.64,35.67,,3.712,percent of total billed charges,35.67% of total billed charges,3.77,11.7,
TIROD **,2703578,CDM,270,RC,,,outpatient,,,2174,869.60,,1847.9,85,,1478.32,percent of total billed charges,85% of total billed charges,1673.98,77,,1339.18,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,1782.68,82,,1426.144,percent of total billed charges,82% of total billed charges,1847.9,85,,1478.32,percent of total billed charges,85% of total billed charges,1847.9,85,,1478.32,percent of total billed charges,85% of total billed charges,1847.9,85,,1478.32,percent of total billed charges,85% of total billed charges,1956.6,90,,1565.28,percent of total billed charges,90% of total billed charges,1739.2,80,,1391.36,percent of total billed charges,80% of total billed charges,1956.6,90,,1565.28,percent of total billed charges,90% of total billed charges,1630.5,75,,1304.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,630.46,29,,504.368,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1456.58,67,,1165.264,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1739.2,80,,1391.36,percent of total billed charges,80% of total billed charges,1413.1,65,,1130.48,percent of total billed charges,65% of total billed charges,775.47,35.67,,620.376,percent of total billed charges,35.67% of total billed charges,630.46,1956.6,
DR CAMPBELL PLASMA INJECTION,2709999,CDM,270,RC,,,outpatient,,,357,142.80,,303.45,85,,242.76,percent of total billed charges,85% of total billed charges,274.89,77,,219.91,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,292.74,82,,234.192,percent of total billed charges,82% of total billed charges,303.45,85,,242.76,percent of total billed charges,85% of total billed charges,303.45,85,,242.76,percent of total billed charges,85% of total billed charges,303.45,85,,242.76,percent of total billed charges,85% of total billed charges,321.3,90,,257.04,percent of total billed charges,90% of total billed charges,285.6,80,,228.48,percent of total billed charges,80% of total billed charges,321.3,90,,257.04,percent of total billed charges,90% of total billed charges,267.75,75,,214.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,103.53,29,,82.824,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,239.19,67,,191.352,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,285.6,80,,228.48,percent of total billed charges,80% of total billed charges,232.05,65,,185.64,percent of total billed charges,65% of total billed charges,127.34,35.67,,101.872,percent of total billed charges,35.67% of total billed charges,103.53,321.3,
GOLIAD OT EXER KIT THERABAND,4450815,CDM,270,RC,,,outpatient,,,19,7.60,,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,14.63,77,,11.7,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,15.58,82,,12.464,percent of total billed charges,82% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,15.2,80,,12.16,percent of total billed charges,80% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,14.25,75,,11.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,5.51,29,,4.408,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,12.73,67,,10.184,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,15.2,80,,12.16,percent of total billed charges,80% of total billed charges,12.35,65,,9.88,percent of total billed charges,65% of total billed charges,6.78,35.67,,5.424,percent of total billed charges,35.67% of total billed charges,5.51,17.1,
MISC SUPPLIES OR,9999996,CDM,270,RC,,,outpatient,,,30,12.00,,25.5,85,,20.4,percent of total billed charges,85% of total billed charges,23.1,77,,18.48,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,24.6,82,,19.68,percent of total billed charges,82% of total billed charges,25.5,85,,20.4,percent of total billed charges,85% of total billed charges,25.5,85,,20.4,percent of total billed charges,85% of total billed charges,25.5,85,,20.4,percent of total billed charges,85% of total billed charges,27,90,,21.6,percent of total billed charges,90% of total billed charges,24,80,,19.2,percent of total billed charges,80% of total billed charges,27,90,,21.6,percent of total billed charges,90% of total billed charges,22.5,75,,18,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,8.7,29,,6.96,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,20.1,67,,16.08,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,24,80,,19.2,percent of total billed charges,80% of total billed charges,19.5,65,,15.6,percent of total billed charges,65% of total billed charges,10.7,35.67,,8.56,percent of total billed charges,35.67% of total billed charges,8.7,27,
CLINITRON/THERAPULSE BED,2600165,CDM,271,RC,,,outpatient,,,170,68.00,,144.5,85,,115.6,percent of total billed charges,85% of total billed charges,130.9,77,,104.72,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,139.4,82,,111.52,percent of total billed charges,82% of total billed charges,144.5,85,,115.6,percent of total billed charges,85% of total billed charges,144.5,85,,115.6,percent of total billed charges,85% of total billed charges,144.5,85,,115.6,percent of total billed charges,85% of total billed charges,153,90,,122.4,percent of total billed charges,90% of total billed charges,136,80,,108.8,percent of total billed charges,80% of total billed charges,153,90,,122.4,percent of total billed charges,90% of total billed charges,127.5,75,,102,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,49.3,29,,39.44,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,113.9,67,,91.12,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,136,80,,108.8,percent of total billed charges,80% of total billed charges,110.5,65,,88.4,percent of total billed charges,65% of total billed charges,60.64,35.67,,48.512,percent of total billed charges,35.67% of total billed charges,49.3,153,
OSTOMY POUCH 12,27000654,CDM,271,RC,,,outpatient,,,32,12.80,,27.2,85,,21.76,percent of total billed charges,85% of total billed charges,24.64,77,,19.71,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,26.24,82,,20.992,percent of total billed charges,82% of total billed charges,27.2,85,,21.76,percent of total billed charges,85% of total billed charges,27.2,85,,21.76,percent of total billed charges,85% of total billed charges,27.2,85,,21.76,percent of total billed charges,85% of total billed charges,28.8,90,,23.04,percent of total billed charges,90% of total billed charges,25.6,80,,20.48,percent of total billed charges,80% of total billed charges,28.8,90,,23.04,percent of total billed charges,90% of total billed charges,24,75,,19.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,9.28,29,,7.424,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,21.44,67,,17.152,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,25.6,80,,20.48,percent of total billed charges,80% of total billed charges,20.8,65,,16.64,percent of total billed charges,65% of total billed charges,11.41,35.67,,9.128,percent of total billed charges,35.67% of total billed charges,9.28,28.8,
OSTOMY POUCH,27000655,CDM,271,RC,,,outpatient,,,43,17.20,,36.55,85,,29.24,percent of total billed charges,85% of total billed charges,33.11,77,,26.49,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,35.26,82,,28.208,percent of total billed charges,82% of total billed charges,36.55,85,,29.24,percent of total billed charges,85% of total billed charges,36.55,85,,29.24,percent of total billed charges,85% of total billed charges,36.55,85,,29.24,percent of total billed charges,85% of total billed charges,38.7,90,,30.96,percent of total billed charges,90% of total billed charges,34.4,80,,27.52,percent of total billed charges,80% of total billed charges,38.7,90,,30.96,percent of total billed charges,90% of total billed charges,32.25,75,,25.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,12.47,29,,9.976,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,28.81,67,,23.048,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,34.4,80,,27.52,percent of total billed charges,80% of total billed charges,27.95,65,,22.36,percent of total billed charges,65% of total billed charges,15.34,35.67,,12.272,percent of total billed charges,35.67% of total billed charges,12.47,38.7,
OSTOMY POUCH,27000656,CDM,271,RC,,,outpatient,,,19,7.60,,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,14.63,77,,11.7,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,15.58,82,,12.464,percent of total billed charges,82% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,15.2,80,,12.16,percent of total billed charges,80% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,14.25,75,,11.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,5.51,29,,4.408,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,12.73,67,,10.184,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,15.2,80,,12.16,percent of total billed charges,80% of total billed charges,12.35,65,,9.88,percent of total billed charges,65% of total billed charges,6.78,35.67,,5.424,percent of total billed charges,35.67% of total billed charges,5.51,17.1,
UROSTOMY POUCH,27000657,CDM,271,RC,,,outpatient,,,27,10.80,,22.95,85,,18.36,percent of total billed charges,85% of total billed charges,20.79,77,,16.63,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,22.14,82,,17.712,percent of total billed charges,82% of total billed charges,22.95,85,,18.36,percent of total billed charges,85% of total billed charges,22.95,85,,18.36,percent of total billed charges,85% of total billed charges,22.95,85,,18.36,percent of total billed charges,85% of total billed charges,24.3,90,,19.44,percent of total billed charges,90% of total billed charges,21.6,80,,17.28,percent of total billed charges,80% of total billed charges,24.3,90,,19.44,percent of total billed charges,90% of total billed charges,20.25,75,,16.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,7.83,29,,6.264,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,18.09,67,,14.472,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,21.6,80,,17.28,percent of total billed charges,80% of total billed charges,17.55,65,,14.04,percent of total billed charges,65% of total billed charges,9.63,35.67,,7.704,percent of total billed charges,35.67% of total billed charges,7.83,24.3,
WARMING BLANKET UPPER BODY,27002109,CDM,271,RC,,,outpatient,,,109,43.60,,92.65,85,,74.12,percent of total billed charges,85% of total billed charges,83.93,77,,67.14,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,89.38,82,,71.504,percent of total billed charges,82% of total billed charges,92.65,85,,74.12,percent of total billed charges,85% of total billed charges,92.65,85,,74.12,percent of total billed charges,85% of total billed charges,92.65,85,,74.12,percent of total billed charges,85% of total billed charges,98.1,90,,78.48,percent of total billed charges,90% of total billed charges,87.2,80,,69.76,percent of total billed charges,80% of total billed charges,98.1,90,,78.48,percent of total billed charges,90% of total billed charges,81.75,75,,65.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,31.61,29,,25.288,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,73.03,67,,58.424,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,87.2,80,,69.76,percent of total billed charges,80% of total billed charges,70.85,65,,56.68,percent of total billed charges,65% of total billed charges,38.88,35.67,,31.104,percent of total billed charges,35.67% of total billed charges,31.61,98.1,
KERLIX SUPER SPONGE,2703381,CDM,271,RC,,,outpatient,,,12,4.80,,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,9.24,77,,7.39,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,9.84,82,,7.872,percent of total billed charges,82% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,10.8,90,,8.64,percent of total billed charges,90% of total billed charges,9.6,80,,7.68,percent of total billed charges,80% of total billed charges,10.8,90,,8.64,percent of total billed charges,90% of total billed charges,9,75,,7.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,3.48,29,,2.784,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,8.04,67,,6.432,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,9.6,80,,7.68,percent of total billed charges,80% of total billed charges,7.8,65,,6.24,percent of total billed charges,65% of total billed charges,4.28,35.67,,3.424,percent of total billed charges,35.67% of total billed charges,3.48,10.8,
OXYGEN PER HOUR,4100205,CDM,271,RC,,,outpatient,,,15,6.00,,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,11.55,77,,9.24,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,12.3,82,,9.84,percent of total billed charges,82% of total billed charges,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,13.5,90,,10.8,percent of total billed charges,90% of total billed charges,12,80,,9.6,percent of total billed charges,80% of total billed charges,13.5,90,,10.8,percent of total billed charges,90% of total billed charges,11.25,75,,9,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,4.35,29,,3.48,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,10.05,67,,8.04,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,12,80,,9.6,percent of total billed charges,80% of total billed charges,9.75,65,,7.8,percent of total billed charges,65% of total billed charges,5.35,35.67,,4.28,percent of total billed charges,35.67% of total billed charges,4.35,13.5,
"OT EXERCISE KIT, THERABAND",4300085,CDM,271,RC,,,outpatient,,,20,8.00,,17,85,,13.6,percent of total billed charges,85% of total billed charges,15.4,77,,12.32,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,16.4,82,,13.12,percent of total billed charges,82% of total billed charges,17,85,,13.6,percent of total billed charges,85% of total billed charges,17,85,,13.6,percent of total billed charges,85% of total billed charges,17,85,,13.6,percent of total billed charges,85% of total billed charges,18,90,,14.4,percent of total billed charges,90% of total billed charges,16,80,,12.8,percent of total billed charges,80% of total billed charges,18,90,,14.4,percent of total billed charges,90% of total billed charges,15,75,,12,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,5.8,29,,4.64,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,13.4,67,,10.72,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,16,80,,12.8,percent of total billed charges,80% of total billed charges,13,65,,10.4,percent of total billed charges,65% of total billed charges,7.13,35.67,,5.704,percent of total billed charges,35.67% of total billed charges,5.8,18,
ACETIC ACID IRR. 1000 CC .25%,26000386,CDM,272,RC,,,outpatient,,,23,9.20,,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,17.71,77,,14.17,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,18.86,82,,15.088,percent of total billed charges,82% of total billed charges,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,20.7,90,,16.56,percent of total billed charges,90% of total billed charges,18.4,80,,14.72,percent of total billed charges,80% of total billed charges,20.7,90,,16.56,percent of total billed charges,90% of total billed charges,17.25,75,,13.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,6.67,29,,5.336,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,15.41,67,,12.328,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,18.4,80,,14.72,percent of total billed charges,80% of total billed charges,14.95,65,,11.96,percent of total billed charges,65% of total billed charges,8.2,35.67,,6.56,percent of total billed charges,35.67% of total billed charges,6.67,20.7,
0.9% NACL IRR. 500 CC,26000388,CDM,272,RC,,,outpatient,,,30,12.00,,25.5,85,,20.4,percent of total billed charges,85% of total billed charges,23.1,77,,18.48,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,24.6,82,,19.68,percent of total billed charges,82% of total billed charges,25.5,85,,20.4,percent of total billed charges,85% of total billed charges,25.5,85,,20.4,percent of total billed charges,85% of total billed charges,25.5,85,,20.4,percent of total billed charges,85% of total billed charges,27,90,,21.6,percent of total billed charges,90% of total billed charges,24,80,,19.2,percent of total billed charges,80% of total billed charges,27,90,,21.6,percent of total billed charges,90% of total billed charges,22.5,75,,18,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,8.7,29,,6.96,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,20.1,67,,16.08,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,24,80,,19.2,percent of total billed charges,80% of total billed charges,19.5,65,,15.6,percent of total billed charges,65% of total billed charges,10.7,35.67,,8.56,percent of total billed charges,35.67% of total billed charges,8.7,27,
0.9% NACL IRR. 1000 CC,26000389,CDM,272,RC,,,outpatient,,,30,12.00,,25.5,85,,20.4,percent of total billed charges,85% of total billed charges,23.1,77,,18.48,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,24.6,82,,19.68,percent of total billed charges,82% of total billed charges,25.5,85,,20.4,percent of total billed charges,85% of total billed charges,25.5,85,,20.4,percent of total billed charges,85% of total billed charges,25.5,85,,20.4,percent of total billed charges,85% of total billed charges,27,90,,21.6,percent of total billed charges,90% of total billed charges,24,80,,19.2,percent of total billed charges,80% of total billed charges,27,90,,21.6,percent of total billed charges,90% of total billed charges,22.5,75,,18,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,8.7,29,,6.96,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,20.1,67,,16.08,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,24,80,,19.2,percent of total billed charges,80% of total billed charges,19.5,65,,15.6,percent of total billed charges,65% of total billed charges,10.7,35.67,,8.56,percent of total billed charges,35.67% of total billed charges,8.7,27,
ACETIC ACID 3% 500 ML,26000397,CDM,272,RC,,,outpatient,,,210,84.00,,178.5,85,,142.8,percent of total billed charges,85% of total billed charges,161.7,77,,129.36,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,172.2,82,,137.76,percent of total billed charges,82% of total billed charges,178.5,85,,142.8,percent of total billed charges,85% of total billed charges,178.5,85,,142.8,percent of total billed charges,85% of total billed charges,178.5,85,,142.8,percent of total billed charges,85% of total billed charges,189,90,,151.2,percent of total billed charges,90% of total billed charges,168,80,,134.4,percent of total billed charges,80% of total billed charges,189,90,,151.2,percent of total billed charges,90% of total billed charges,157.5,75,,126,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,60.9,29,,48.72,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,140.7,67,,112.56,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,168,80,,134.4,percent of total billed charges,80% of total billed charges,136.5,65,,109.2,percent of total billed charges,65% of total billed charges,74.91,35.67,,59.928,percent of total billed charges,35.67% of total billed charges,60.9,189,
EYE VALVE AND ALLOGRAFT,2603300,CDM,272,RC,,,outpatient,,,1746,698.40,,1484.1,85,,1187.28,percent of total billed charges,85% of total billed charges,1344.42,77,,1075.54,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,1431.72,82,,1145.376,percent of total billed charges,82% of total billed charges,1484.1,85,,1187.28,percent of total billed charges,85% of total billed charges,1484.1,85,,1187.28,percent of total billed charges,85% of total billed charges,1484.1,85,,1187.28,percent of total billed charges,85% of total billed charges,1571.4,90,,1257.12,percent of total billed charges,90% of total billed charges,1396.8,80,,1117.44,percent of total billed charges,80% of total billed charges,1571.4,90,,1257.12,percent of total billed charges,90% of total billed charges,1309.5,75,,1047.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,506.34,29,,405.072,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1169.82,67,,935.856,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1396.8,80,,1117.44,percent of total billed charges,80% of total billed charges,1134.9,65,,907.92,percent of total billed charges,65% of total billed charges,622.8,35.67,,498.24,percent of total billed charges,35.67% of total billed charges,506.34,1571.4,
CATHETER FOLEY 12FR 5CC,27000060,CDM,272,RC,,,outpatient,,,107,42.80,,90.95,85,,72.76,percent of total billed charges,85% of total billed charges,82.39,77,,65.91,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,87.74,82,,70.192,percent of total billed charges,82% of total billed charges,90.95,85,,72.76,percent of total billed charges,85% of total billed charges,90.95,85,,72.76,percent of total billed charges,85% of total billed charges,90.95,85,,72.76,percent of total billed charges,85% of total billed charges,96.3,90,,77.04,percent of total billed charges,90% of total billed charges,85.6,80,,68.48,percent of total billed charges,80% of total billed charges,96.3,90,,77.04,percent of total billed charges,90% of total billed charges,80.25,75,,64.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,31.03,29,,24.824,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,71.69,67,,57.352,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,85.6,80,,68.48,percent of total billed charges,80% of total billed charges,69.55,65,,55.64,percent of total billed charges,65% of total billed charges,38.17,35.67,,30.536,percent of total billed charges,35.67% of total billed charges,31.03,96.3,
CATHETER FOLEY 14 FR 5 CC,27000061,CDM,272,RC,,,outpatient,,,147,58.80,,124.95,85,,99.96,percent of total billed charges,85% of total billed charges,113.19,77,,90.55,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,120.54,82,,96.432,percent of total billed charges,82% of total billed charges,124.95,85,,99.96,percent of total billed charges,85% of total billed charges,124.95,85,,99.96,percent of total billed charges,85% of total billed charges,124.95,85,,99.96,percent of total billed charges,85% of total billed charges,132.3,90,,105.84,percent of total billed charges,90% of total billed charges,117.6,80,,94.08,percent of total billed charges,80% of total billed charges,132.3,90,,105.84,percent of total billed charges,90% of total billed charges,110.25,75,,88.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,42.63,29,,34.104,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,98.49,67,,78.792,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,117.6,80,,94.08,percent of total billed charges,80% of total billed charges,95.55,65,,76.44,percent of total billed charges,65% of total billed charges,52.43,35.67,,41.944,percent of total billed charges,35.67% of total billed charges,42.63,132.3,
CATHETER FOLEY 16 FR 5 CC,27000062,CDM,272,RC,,,outpatient,,,46,18.40,,39.1,85,,31.28,percent of total billed charges,85% of total billed charges,35.42,77,,28.34,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,37.72,82,,30.176,percent of total billed charges,82% of total billed charges,39.1,85,,31.28,percent of total billed charges,85% of total billed charges,39.1,85,,31.28,percent of total billed charges,85% of total billed charges,39.1,85,,31.28,percent of total billed charges,85% of total billed charges,41.4,90,,33.12,percent of total billed charges,90% of total billed charges,36.8,80,,29.44,percent of total billed charges,80% of total billed charges,41.4,90,,33.12,percent of total billed charges,90% of total billed charges,34.5,75,,27.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,13.34,29,,10.672,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,30.82,67,,24.656,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,36.8,80,,29.44,percent of total billed charges,80% of total billed charges,29.9,65,,23.92,percent of total billed charges,65% of total billed charges,16.41,35.67,,13.128,percent of total billed charges,35.67% of total billed charges,13.34,41.4,
FOLEY CATHETER 18 FR 5CC,27000063,CDM,272,RC,,,outpatient,,,22,8.80,,18.7,85,,14.96,percent of total billed charges,85% of total billed charges,16.94,77,,13.55,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,18.04,82,,14.432,percent of total billed charges,82% of total billed charges,18.7,85,,14.96,percent of total billed charges,85% of total billed charges,18.7,85,,14.96,percent of total billed charges,85% of total billed charges,18.7,85,,14.96,percent of total billed charges,85% of total billed charges,19.8,90,,15.84,percent of total billed charges,90% of total billed charges,17.6,80,,14.08,percent of total billed charges,80% of total billed charges,19.8,90,,15.84,percent of total billed charges,90% of total billed charges,16.5,75,,13.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,6.38,29,,5.104,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,14.74,67,,11.792,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,17.6,80,,14.08,percent of total billed charges,80% of total billed charges,14.3,65,,11.44,percent of total billed charges,65% of total billed charges,7.85,35.67,,6.28,percent of total billed charges,35.67% of total billed charges,6.38,19.8,
CATHETER FOLEY 20 FR 5 CC,27000064,CDM,272,RC,,,outpatient,,,147,58.80,,124.95,85,,99.96,percent of total billed charges,85% of total billed charges,113.19,77,,90.55,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,120.54,82,,96.432,percent of total billed charges,82% of total billed charges,124.95,85,,99.96,percent of total billed charges,85% of total billed charges,124.95,85,,99.96,percent of total billed charges,85% of total billed charges,124.95,85,,99.96,percent of total billed charges,85% of total billed charges,132.3,90,,105.84,percent of total billed charges,90% of total billed charges,117.6,80,,94.08,percent of total billed charges,80% of total billed charges,132.3,90,,105.84,percent of total billed charges,90% of total billed charges,110.25,75,,88.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,42.63,29,,34.104,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,98.49,67,,78.792,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,117.6,80,,94.08,percent of total billed charges,80% of total billed charges,95.55,65,,76.44,percent of total billed charges,65% of total billed charges,52.43,35.67,,41.944,percent of total billed charges,35.67% of total billed charges,42.63,132.3,
CATHETER FOLEY 22 FR 5 CC,27000065,CDM,272,RC,,,outpatient,,,147,58.80,,124.95,85,,99.96,percent of total billed charges,85% of total billed charges,113.19,77,,90.55,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,120.54,82,,96.432,percent of total billed charges,82% of total billed charges,124.95,85,,99.96,percent of total billed charges,85% of total billed charges,124.95,85,,99.96,percent of total billed charges,85% of total billed charges,124.95,85,,99.96,percent of total billed charges,85% of total billed charges,132.3,90,,105.84,percent of total billed charges,90% of total billed charges,117.6,80,,94.08,percent of total billed charges,80% of total billed charges,132.3,90,,105.84,percent of total billed charges,90% of total billed charges,110.25,75,,88.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,42.63,29,,34.104,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,98.49,67,,78.792,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,117.6,80,,94.08,percent of total billed charges,80% of total billed charges,95.55,65,,76.44,percent of total billed charges,65% of total billed charges,52.43,35.67,,41.944,percent of total billed charges,35.67% of total billed charges,42.63,132.3,
CATHETER FOLEY 16 FR 30CC,27000066,CDM,272,RC,,,outpatient,,,62,24.80,,52.7,85,,42.16,percent of total billed charges,85% of total billed charges,47.74,77,,38.19,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,50.84,82,,40.672,percent of total billed charges,82% of total billed charges,52.7,85,,42.16,percent of total billed charges,85% of total billed charges,52.7,85,,42.16,percent of total billed charges,85% of total billed charges,52.7,85,,42.16,percent of total billed charges,85% of total billed charges,55.8,90,,44.64,percent of total billed charges,90% of total billed charges,49.6,80,,39.68,percent of total billed charges,80% of total billed charges,55.8,90,,44.64,percent of total billed charges,90% of total billed charges,46.5,75,,37.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,17.98,29,,14.384,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,41.54,67,,33.232,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,49.6,80,,39.68,percent of total billed charges,80% of total billed charges,40.3,65,,32.24,percent of total billed charges,65% of total billed charges,22.12,35.67,,17.696,percent of total billed charges,35.67% of total billed charges,17.98,55.8,
CATHETER FOLEY 18 FR 30 CC,27000067,CDM,272,RC,,,outpatient,,,58,23.20,,49.3,85,,39.44,percent of total billed charges,85% of total billed charges,44.66,77,,35.73,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,47.56,82,,38.048,percent of total billed charges,82% of total billed charges,49.3,85,,39.44,percent of total billed charges,85% of total billed charges,49.3,85,,39.44,percent of total billed charges,85% of total billed charges,49.3,85,,39.44,percent of total billed charges,85% of total billed charges,52.2,90,,41.76,percent of total billed charges,90% of total billed charges,46.4,80,,37.12,percent of total billed charges,80% of total billed charges,52.2,90,,41.76,percent of total billed charges,90% of total billed charges,43.5,75,,34.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,16.82,29,,13.456,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,38.86,67,,31.088,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,46.4,80,,37.12,percent of total billed charges,80% of total billed charges,37.7,65,,30.16,percent of total billed charges,65% of total billed charges,20.69,35.67,,16.552,percent of total billed charges,35.67% of total billed charges,16.82,52.2,
CATHETER FOLEY 20 FR 30 CC,27000068,CDM,272,RC,,,outpatient,,,58,23.20,,49.3,85,,39.44,percent of total billed charges,85% of total billed charges,44.66,77,,35.73,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,47.56,82,,38.048,percent of total billed charges,82% of total billed charges,49.3,85,,39.44,percent of total billed charges,85% of total billed charges,49.3,85,,39.44,percent of total billed charges,85% of total billed charges,49.3,85,,39.44,percent of total billed charges,85% of total billed charges,52.2,90,,41.76,percent of total billed charges,90% of total billed charges,46.4,80,,37.12,percent of total billed charges,80% of total billed charges,52.2,90,,41.76,percent of total billed charges,90% of total billed charges,43.5,75,,34.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,16.82,29,,13.456,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,38.86,67,,31.088,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,46.4,80,,37.12,percent of total billed charges,80% of total billed charges,37.7,65,,30.16,percent of total billed charges,65% of total billed charges,20.69,35.67,,16.552,percent of total billed charges,35.67% of total billed charges,16.82,52.2,
CATHETER FOLEY 22 FR 30 CC,27000069,CDM,272,RC,,,outpatient,,,58,23.20,,49.3,85,,39.44,percent of total billed charges,85% of total billed charges,44.66,77,,35.73,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,47.56,82,,38.048,percent of total billed charges,82% of total billed charges,49.3,85,,39.44,percent of total billed charges,85% of total billed charges,49.3,85,,39.44,percent of total billed charges,85% of total billed charges,49.3,85,,39.44,percent of total billed charges,85% of total billed charges,52.2,90,,41.76,percent of total billed charges,90% of total billed charges,46.4,80,,37.12,percent of total billed charges,80% of total billed charges,52.2,90,,41.76,percent of total billed charges,90% of total billed charges,43.5,75,,34.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,16.82,29,,13.456,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,38.86,67,,31.088,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,46.4,80,,37.12,percent of total billed charges,80% of total billed charges,37.7,65,,30.16,percent of total billed charges,65% of total billed charges,20.69,35.67,,16.552,percent of total billed charges,35.67% of total billed charges,16.82,52.2,
CATHETER FOLEY 26 FR 30 CC,27000070,CDM,272,RC,,,outpatient,,,58,23.20,,49.3,85,,39.44,percent of total billed charges,85% of total billed charges,44.66,77,,35.73,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,47.56,82,,38.048,percent of total billed charges,82% of total billed charges,49.3,85,,39.44,percent of total billed charges,85% of total billed charges,49.3,85,,39.44,percent of total billed charges,85% of total billed charges,49.3,85,,39.44,percent of total billed charges,85% of total billed charges,52.2,90,,41.76,percent of total billed charges,90% of total billed charges,46.4,80,,37.12,percent of total billed charges,80% of total billed charges,52.2,90,,41.76,percent of total billed charges,90% of total billed charges,43.5,75,,34.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,16.82,29,,13.456,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,38.86,67,,31.088,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,46.4,80,,37.12,percent of total billed charges,80% of total billed charges,37.7,65,,30.16,percent of total billed charges,65% of total billed charges,20.69,35.67,,16.552,percent of total billed charges,35.67% of total billed charges,16.82,52.2,
CATHETER FOLEY 28 FR 30 CC,27000071,CDM,272,RC,,,outpatient,,,58,23.20,,49.3,85,,39.44,percent of total billed charges,85% of total billed charges,44.66,77,,35.73,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,47.56,82,,38.048,percent of total billed charges,82% of total billed charges,49.3,85,,39.44,percent of total billed charges,85% of total billed charges,49.3,85,,39.44,percent of total billed charges,85% of total billed charges,49.3,85,,39.44,percent of total billed charges,85% of total billed charges,52.2,90,,41.76,percent of total billed charges,90% of total billed charges,46.4,80,,37.12,percent of total billed charges,80% of total billed charges,52.2,90,,41.76,percent of total billed charges,90% of total billed charges,43.5,75,,34.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,16.82,29,,13.456,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,38.86,67,,31.088,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,46.4,80,,37.12,percent of total billed charges,80% of total billed charges,37.7,65,,30.16,percent of total billed charges,65% of total billed charges,20.69,35.67,,16.552,percent of total billed charges,35.67% of total billed charges,16.82,52.2,
CATHETER FOLEY 18 FR 5CC,27000072,CDM,272,RC,,,outpatient,,,136,54.40,,115.6,85,,92.48,percent of total billed charges,85% of total billed charges,104.72,77,,83.78,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,111.52,82,,89.216,percent of total billed charges,82% of total billed charges,115.6,85,,92.48,percent of total billed charges,85% of total billed charges,115.6,85,,92.48,percent of total billed charges,85% of total billed charges,115.6,85,,92.48,percent of total billed charges,85% of total billed charges,122.4,90,,97.92,percent of total billed charges,90% of total billed charges,108.8,80,,87.04,percent of total billed charges,80% of total billed charges,122.4,90,,97.92,percent of total billed charges,90% of total billed charges,102,75,,81.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,39.44,29,,31.552,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,91.12,67,,72.896,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,108.8,80,,87.04,percent of total billed charges,80% of total billed charges,88.4,65,,70.72,percent of total billed charges,65% of total billed charges,48.51,35.67,,38.808,percent of total billed charges,35.67% of total billed charges,39.44,122.4,
TUBE NASOGASTRIC 18 FR,27000074,CDM,272,RC,,,outpatient,,,21,8.40,,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,16.17,77,,12.94,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,17.22,82,,13.776,percent of total billed charges,82% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,18.9,90,,15.12,percent of total billed charges,90% of total billed charges,16.8,80,,13.44,percent of total billed charges,80% of total billed charges,18.9,90,,15.12,percent of total billed charges,90% of total billed charges,15.75,75,,12.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,6.09,29,,4.872,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,14.07,67,,11.256,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,16.8,80,,13.44,percent of total billed charges,80% of total billed charges,13.65,65,,10.92,percent of total billed charges,65% of total billed charges,7.49,35.67,,5.992,percent of total billed charges,35.67% of total billed charges,6.09,18.9,
CATHETER IN/OUT 14-16FR,27000077,CDM,272,RC,,,outpatient,,,13,5.20,,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,10.01,77,,8.01,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,10.66,82,,8.528,percent of total billed charges,82% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,11.7,90,,9.36,percent of total billed charges,90% of total billed charges,10.4,80,,8.32,percent of total billed charges,80% of total billed charges,11.7,90,,9.36,percent of total billed charges,90% of total billed charges,9.75,75,,7.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,3.77,29,,3.016,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,8.71,67,,6.968,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,10.4,80,,8.32,percent of total billed charges,80% of total billed charges,8.45,65,,6.76,percent of total billed charges,65% of total billed charges,4.64,35.67,,3.712,percent of total billed charges,35.67% of total billed charges,3.77,11.7,
CATHETER FOLEY 22 FR 30 CC **,27000078,CDM,272,RC,,,outpatient,,,30,12.00,,25.5,85,,20.4,percent of total billed charges,85% of total billed charges,23.1,77,,18.48,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,24.6,82,,19.68,percent of total billed charges,82% of total billed charges,25.5,85,,20.4,percent of total billed charges,85% of total billed charges,25.5,85,,20.4,percent of total billed charges,85% of total billed charges,25.5,85,,20.4,percent of total billed charges,85% of total billed charges,27,90,,21.6,percent of total billed charges,90% of total billed charges,24,80,,19.2,percent of total billed charges,80% of total billed charges,27,90,,21.6,percent of total billed charges,90% of total billed charges,22.5,75,,18,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,8.7,29,,6.96,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,20.1,67,,16.08,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,24,80,,19.2,percent of total billed charges,80% of total billed charges,19.5,65,,15.6,percent of total billed charges,65% of total billed charges,10.7,35.67,,8.56,percent of total billed charges,35.67% of total billed charges,8.7,27,
URINARY LEG BAG 1000CC,27000101,CDM,272,RC,,,outpatient,,,31,12.40,,26.35,85,,21.08,percent of total billed charges,85% of total billed charges,23.87,77,,19.1,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,25.42,82,,20.336,percent of total billed charges,82% of total billed charges,26.35,85,,21.08,percent of total billed charges,85% of total billed charges,26.35,85,,21.08,percent of total billed charges,85% of total billed charges,26.35,85,,21.08,percent of total billed charges,85% of total billed charges,27.9,90,,22.32,percent of total billed charges,90% of total billed charges,24.8,80,,19.84,percent of total billed charges,80% of total billed charges,27.9,90,,22.32,percent of total billed charges,90% of total billed charges,23.25,75,,18.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,8.99,29,,7.192,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,20.77,67,,16.616,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,24.8,80,,19.84,percent of total billed charges,80% of total billed charges,20.15,65,,16.12,percent of total billed charges,65% of total billed charges,11.06,35.67,,8.848,percent of total billed charges,35.67% of total billed charges,8.99,27.9,
IRRIGATION TRAY 60 CC,27000102,CDM,272,RC,,,outpatient,,,30,12.00,,25.5,85,,20.4,percent of total billed charges,85% of total billed charges,23.1,77,,18.48,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,24.6,82,,19.68,percent of total billed charges,82% of total billed charges,25.5,85,,20.4,percent of total billed charges,85% of total billed charges,25.5,85,,20.4,percent of total billed charges,85% of total billed charges,25.5,85,,20.4,percent of total billed charges,85% of total billed charges,27,90,,21.6,percent of total billed charges,90% of total billed charges,24,80,,19.2,percent of total billed charges,80% of total billed charges,27,90,,21.6,percent of total billed charges,90% of total billed charges,22.5,75,,18,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,8.7,29,,6.96,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,20.1,67,,16.08,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,24,80,,19.2,percent of total billed charges,80% of total billed charges,19.5,65,,15.6,percent of total billed charges,65% of total billed charges,10.7,35.67,,8.56,percent of total billed charges,35.67% of total billed charges,8.7,27,
SKIN PREP TRAY,27000107,CDM,272,RC,,,outpatient,,,77,30.80,,65.45,85,,52.36,percent of total billed charges,85% of total billed charges,59.29,77,,47.43,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,63.14,82,,50.512,percent of total billed charges,82% of total billed charges,65.45,85,,52.36,percent of total billed charges,85% of total billed charges,65.45,85,,52.36,percent of total billed charges,85% of total billed charges,65.45,85,,52.36,percent of total billed charges,85% of total billed charges,69.3,90,,55.44,percent of total billed charges,90% of total billed charges,61.6,80,,49.28,percent of total billed charges,80% of total billed charges,69.3,90,,55.44,percent of total billed charges,90% of total billed charges,57.75,75,,46.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,22.33,29,,17.864,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,51.59,67,,41.272,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,61.6,80,,49.28,percent of total billed charges,80% of total billed charges,50.05,65,,40.04,percent of total billed charges,65% of total billed charges,27.47,35.67,,21.976,percent of total billed charges,35.67% of total billed charges,22.33,69.3,
URINARY DRAINAGE BAG,27000112,CDM,272,RC,,,outpatient,,,29,11.60,,24.65,85,,19.72,percent of total billed charges,85% of total billed charges,22.33,77,,17.86,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,23.78,82,,19.024,percent of total billed charges,82% of total billed charges,24.65,85,,19.72,percent of total billed charges,85% of total billed charges,24.65,85,,19.72,percent of total billed charges,85% of total billed charges,24.65,85,,19.72,percent of total billed charges,85% of total billed charges,26.1,90,,20.88,percent of total billed charges,90% of total billed charges,23.2,80,,18.56,percent of total billed charges,80% of total billed charges,26.1,90,,20.88,percent of total billed charges,90% of total billed charges,21.75,75,,17.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,8.41,29,,6.728,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,19.43,67,,15.544,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,23.2,80,,18.56,percent of total billed charges,80% of total billed charges,18.85,65,,15.08,percent of total billed charges,65% of total billed charges,10.34,35.67,,8.272,percent of total billed charges,35.67% of total billed charges,8.41,26.1,
CATHETER TRAY - NO CATH,27000113,CDM,272,RC,,,outpatient,,,85,34.00,,72.25,85,,57.8,percent of total billed charges,85% of total billed charges,65.45,77,,52.36,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,69.7,82,,55.76,percent of total billed charges,82% of total billed charges,72.25,85,,57.8,percent of total billed charges,85% of total billed charges,72.25,85,,57.8,percent of total billed charges,85% of total billed charges,72.25,85,,57.8,percent of total billed charges,85% of total billed charges,76.5,90,,61.2,percent of total billed charges,90% of total billed charges,68,80,,54.4,percent of total billed charges,80% of total billed charges,76.5,90,,61.2,percent of total billed charges,90% of total billed charges,63.75,75,,51,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,24.65,29,,19.72,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,56.95,67,,45.56,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,68,80,,54.4,percent of total billed charges,80% of total billed charges,55.25,65,,44.2,percent of total billed charges,65% of total billed charges,30.32,35.67,,24.256,percent of total billed charges,35.67% of total billed charges,24.65,76.5,
CATHETER TRAY-16 FR 5CC,27000114,CDM,272,RC,,,outpatient,,,70,28.00,,59.5,85,,47.6,percent of total billed charges,85% of total billed charges,53.9,77,,43.12,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,57.4,82,,45.92,percent of total billed charges,82% of total billed charges,59.5,85,,47.6,percent of total billed charges,85% of total billed charges,59.5,85,,47.6,percent of total billed charges,85% of total billed charges,59.5,85,,47.6,percent of total billed charges,85% of total billed charges,63,90,,50.4,percent of total billed charges,90% of total billed charges,56,80,,44.8,percent of total billed charges,80% of total billed charges,63,90,,50.4,percent of total billed charges,90% of total billed charges,52.5,75,,42,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,20.3,29,,16.24,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,46.9,67,,37.52,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,56,80,,44.8,percent of total billed charges,80% of total billed charges,45.5,65,,36.4,percent of total billed charges,65% of total billed charges,24.97,35.67,,19.976,percent of total billed charges,35.67% of total billed charges,20.3,63,
CATHETER TRAY 18FR 5 CC,27000115,CDM,272,RC,,,outpatient,,,74,29.60,,62.9,85,,50.32,percent of total billed charges,85% of total billed charges,56.98,77,,45.58,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,60.68,82,,48.544,percent of total billed charges,82% of total billed charges,62.9,85,,50.32,percent of total billed charges,85% of total billed charges,62.9,85,,50.32,percent of total billed charges,85% of total billed charges,62.9,85,,50.32,percent of total billed charges,85% of total billed charges,66.6,90,,53.28,percent of total billed charges,90% of total billed charges,59.2,80,,47.36,percent of total billed charges,80% of total billed charges,66.6,90,,53.28,percent of total billed charges,90% of total billed charges,55.5,75,,44.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,21.46,29,,17.168,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,49.58,67,,39.664,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,59.2,80,,47.36,percent of total billed charges,80% of total billed charges,48.1,65,,38.48,percent of total billed charges,65% of total billed charges,26.4,35.67,,21.12,percent of total billed charges,35.67% of total billed charges,21.46,66.6,
BIOSYN 0 SUTURE,27000135,CDM,272,RC,,,outpatient,,,93,37.20,,79.05,85,,63.24,percent of total billed charges,85% of total billed charges,71.61,77,,57.29,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,76.26,82,,61.008,percent of total billed charges,82% of total billed charges,79.05,85,,63.24,percent of total billed charges,85% of total billed charges,79.05,85,,63.24,percent of total billed charges,85% of total billed charges,79.05,85,,63.24,percent of total billed charges,85% of total billed charges,83.7,90,,66.96,percent of total billed charges,90% of total billed charges,74.4,80,,59.52,percent of total billed charges,80% of total billed charges,83.7,90,,66.96,percent of total billed charges,90% of total billed charges,69.75,75,,55.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,26.97,29,,21.576,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,62.31,67,,49.848,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,74.4,80,,59.52,percent of total billed charges,80% of total billed charges,60.45,65,,48.36,percent of total billed charges,65% of total billed charges,33.17,35.67,,26.536,percent of total billed charges,35.67% of total billed charges,26.97,83.7,
MONOSOF 3-0 SUTURE,27000150,CDM,272,RC,,,outpatient,,,79,31.60,,67.15,85,,53.72,percent of total billed charges,85% of total billed charges,60.83,77,,48.66,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,64.78,82,,51.824,percent of total billed charges,82% of total billed charges,67.15,85,,53.72,percent of total billed charges,85% of total billed charges,67.15,85,,53.72,percent of total billed charges,85% of total billed charges,67.15,85,,53.72,percent of total billed charges,85% of total billed charges,71.1,90,,56.88,percent of total billed charges,90% of total billed charges,63.2,80,,50.56,percent of total billed charges,80% of total billed charges,71.1,90,,56.88,percent of total billed charges,90% of total billed charges,59.25,75,,47.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,22.91,29,,18.328,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,52.93,67,,42.344,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,63.2,80,,50.56,percent of total billed charges,80% of total billed charges,51.35,65,,41.08,percent of total billed charges,65% of total billed charges,28.18,35.67,,22.544,percent of total billed charges,35.67% of total billed charges,22.91,71.1,
PENROSE DRAIN 12 X 1/4,27000159,CDM,272,RC,,,outpatient,,,24,9.60,,20.4,85,,16.32,percent of total billed charges,85% of total billed charges,18.48,77,,14.78,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,19.68,82,,15.744,percent of total billed charges,82% of total billed charges,20.4,85,,16.32,percent of total billed charges,85% of total billed charges,20.4,85,,16.32,percent of total billed charges,85% of total billed charges,20.4,85,,16.32,percent of total billed charges,85% of total billed charges,21.6,90,,17.28,percent of total billed charges,90% of total billed charges,19.2,80,,15.36,percent of total billed charges,80% of total billed charges,21.6,90,,17.28,percent of total billed charges,90% of total billed charges,18,75,,14.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,6.96,29,,5.568,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,16.08,67,,12.864,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,19.2,80,,15.36,percent of total billed charges,80% of total billed charges,15.6,65,,12.48,percent of total billed charges,65% of total billed charges,8.56,35.67,,6.848,percent of total billed charges,35.67% of total billed charges,6.96,21.6,
PETROLATUM GAUZE DRESSING,27000163,CDM,272,RC,,,outpatient,,,17,6.80,,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,13.09,77,,10.47,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,13.94,82,,11.152,percent of total billed charges,82% of total billed charges,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,15.3,90,,12.24,percent of total billed charges,90% of total billed charges,13.6,80,,10.88,percent of total billed charges,80% of total billed charges,15.3,90,,12.24,percent of total billed charges,90% of total billed charges,12.75,75,,10.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,4.93,29,,3.944,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,11.39,67,,9.112,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,13.6,80,,10.88,percent of total billed charges,80% of total billed charges,11.05,65,,8.84,percent of total billed charges,65% of total billed charges,6.06,35.67,,4.848,percent of total billed charges,35.67% of total billed charges,4.93,15.3,
CHROMIC 4-0 SUTURE,27000251,CDM,272,RC,,,outpatient,,,68,27.20,,57.8,85,,46.24,percent of total billed charges,85% of total billed charges,52.36,77,,41.89,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,55.76,82,,44.608,percent of total billed charges,82% of total billed charges,57.8,85,,46.24,percent of total billed charges,85% of total billed charges,57.8,85,,46.24,percent of total billed charges,85% of total billed charges,57.8,85,,46.24,percent of total billed charges,85% of total billed charges,61.2,90,,48.96,percent of total billed charges,90% of total billed charges,54.4,80,,43.52,percent of total billed charges,80% of total billed charges,61.2,90,,48.96,percent of total billed charges,90% of total billed charges,51,75,,40.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,19.72,29,,15.776,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,45.56,67,,36.448,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,54.4,80,,43.52,percent of total billed charges,80% of total billed charges,44.2,65,,35.36,percent of total billed charges,65% of total billed charges,24.26,35.67,,19.408,percent of total billed charges,35.67% of total billed charges,19.72,61.2,
MONOSOF 5-0 SUTURE,27000255,CDM,272,RC,,,outpatient,,,74,29.60,,62.9,85,,50.32,percent of total billed charges,85% of total billed charges,56.98,77,,45.58,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,60.68,82,,48.544,percent of total billed charges,82% of total billed charges,62.9,85,,50.32,percent of total billed charges,85% of total billed charges,62.9,85,,50.32,percent of total billed charges,85% of total billed charges,62.9,85,,50.32,percent of total billed charges,85% of total billed charges,66.6,90,,53.28,percent of total billed charges,90% of total billed charges,59.2,80,,47.36,percent of total billed charges,80% of total billed charges,66.6,90,,53.28,percent of total billed charges,90% of total billed charges,55.5,75,,44.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,21.46,29,,17.168,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,49.58,67,,39.664,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,59.2,80,,47.36,percent of total billed charges,80% of total billed charges,48.1,65,,38.48,percent of total billed charges,65% of total billed charges,26.4,35.67,,21.12,percent of total billed charges,35.67% of total billed charges,21.46,66.6,
MONOSOF 4-0 SUTURE,27000256,CDM,272,RC,,,outpatient,,,74,29.60,,62.9,85,,50.32,percent of total billed charges,85% of total billed charges,56.98,77,,45.58,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,60.68,82,,48.544,percent of total billed charges,82% of total billed charges,62.9,85,,50.32,percent of total billed charges,85% of total billed charges,62.9,85,,50.32,percent of total billed charges,85% of total billed charges,62.9,85,,50.32,percent of total billed charges,85% of total billed charges,66.6,90,,53.28,percent of total billed charges,90% of total billed charges,59.2,80,,47.36,percent of total billed charges,80% of total billed charges,66.6,90,,53.28,percent of total billed charges,90% of total billed charges,55.5,75,,44.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,21.46,29,,17.168,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,49.58,67,,39.664,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,59.2,80,,47.36,percent of total billed charges,80% of total billed charges,48.1,65,,38.48,percent of total billed charges,65% of total billed charges,26.4,35.67,,21.12,percent of total billed charges,35.67% of total billed charges,21.46,66.6,
MONOSOF 3-0 SUTURE,27000257,CDM,272,RC,,,outpatient,,,84,33.60,,71.4,85,,57.12,percent of total billed charges,85% of total billed charges,64.68,77,,51.74,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,68.88,82,,55.104,percent of total billed charges,82% of total billed charges,71.4,85,,57.12,percent of total billed charges,85% of total billed charges,71.4,85,,57.12,percent of total billed charges,85% of total billed charges,71.4,85,,57.12,percent of total billed charges,85% of total billed charges,75.6,90,,60.48,percent of total billed charges,90% of total billed charges,67.2,80,,53.76,percent of total billed charges,80% of total billed charges,75.6,90,,60.48,percent of total billed charges,90% of total billed charges,63,75,,50.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,24.36,29,,19.488,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,56.28,67,,45.024,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,67.2,80,,53.76,percent of total billed charges,80% of total billed charges,54.6,65,,43.68,percent of total billed charges,65% of total billed charges,29.96,35.67,,23.968,percent of total billed charges,35.67% of total billed charges,24.36,75.6,
VASELINE GAUZE DRESSING 1X8,27000261,CDM,272,RC,,,outpatient,,,10,4.00,,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,7.7,77,,6.16,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,8.2,82,,6.56,percent of total billed charges,82% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,9,90,,7.2,percent of total billed charges,90% of total billed charges,8,80,,6.4,percent of total billed charges,80% of total billed charges,9,90,,7.2,percent of total billed charges,90% of total billed charges,7.5,75,,6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.9,29,,2.32,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,6.7,67,,5.36,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,8,80,,6.4,percent of total billed charges,80% of total billed charges,6.5,65,,5.2,percent of total billed charges,65% of total billed charges,3.57,35.67,,2.856,percent of total billed charges,35.67% of total billed charges,2.9,9,
SURGIGUT 2-0 SUTURE,27000263,CDM,272,RC,,,outpatient,,,99,39.60,,84.15,85,,67.32,percent of total billed charges,85% of total billed charges,76.23,77,,60.98,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,81.18,82,,64.944,percent of total billed charges,82% of total billed charges,84.15,85,,67.32,percent of total billed charges,85% of total billed charges,84.15,85,,67.32,percent of total billed charges,85% of total billed charges,84.15,85,,67.32,percent of total billed charges,85% of total billed charges,89.1,90,,71.28,percent of total billed charges,90% of total billed charges,79.2,80,,63.36,percent of total billed charges,80% of total billed charges,89.1,90,,71.28,percent of total billed charges,90% of total billed charges,74.25,75,,59.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,28.71,29,,22.968,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,66.33,67,,53.064,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,79.2,80,,63.36,percent of total billed charges,80% of total billed charges,64.35,65,,51.48,percent of total billed charges,65% of total billed charges,35.31,35.67,,28.248,percent of total billed charges,35.67% of total billed charges,28.71,89.1,
SURGIPRO 3-0 SUTURE **,27000264,CDM,272,RC,,,outpatient,,,93,37.20,,79.05,85,,63.24,percent of total billed charges,85% of total billed charges,71.61,77,,57.29,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,76.26,82,,61.008,percent of total billed charges,82% of total billed charges,79.05,85,,63.24,percent of total billed charges,85% of total billed charges,79.05,85,,63.24,percent of total billed charges,85% of total billed charges,79.05,85,,63.24,percent of total billed charges,85% of total billed charges,83.7,90,,66.96,percent of total billed charges,90% of total billed charges,74.4,80,,59.52,percent of total billed charges,80% of total billed charges,83.7,90,,66.96,percent of total billed charges,90% of total billed charges,69.75,75,,55.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,26.97,29,,21.576,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,62.31,67,,49.848,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,74.4,80,,59.52,percent of total billed charges,80% of total billed charges,60.45,65,,48.36,percent of total billed charges,65% of total billed charges,33.17,35.67,,26.536,percent of total billed charges,35.67% of total billed charges,26.97,83.7,
SURGIPRO 4-0 SUTURE,27000266,CDM,272,RC,,,outpatient,,,73,29.20,,62.05,85,,49.64,percent of total billed charges,85% of total billed charges,56.21,77,,44.97,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,59.86,82,,47.888,percent of total billed charges,82% of total billed charges,62.05,85,,49.64,percent of total billed charges,85% of total billed charges,62.05,85,,49.64,percent of total billed charges,85% of total billed charges,62.05,85,,49.64,percent of total billed charges,85% of total billed charges,65.7,90,,52.56,percent of total billed charges,90% of total billed charges,58.4,80,,46.72,percent of total billed charges,80% of total billed charges,65.7,90,,52.56,percent of total billed charges,90% of total billed charges,54.75,75,,43.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,21.17,29,,16.936,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,48.91,67,,39.128,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,58.4,80,,46.72,percent of total billed charges,80% of total billed charges,47.45,65,,37.96,percent of total billed charges,65% of total billed charges,26.04,35.67,,20.832,percent of total billed charges,35.67% of total billed charges,21.17,65.7,
SURGIPRO 3-0 SUTURE,27000269,CDM,272,RC,,,outpatient,,,113,45.20,,96.05,85,,76.84,percent of total billed charges,85% of total billed charges,87.01,77,,69.61,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,92.66,82,,74.128,percent of total billed charges,82% of total billed charges,96.05,85,,76.84,percent of total billed charges,85% of total billed charges,96.05,85,,76.84,percent of total billed charges,85% of total billed charges,96.05,85,,76.84,percent of total billed charges,85% of total billed charges,101.7,90,,81.36,percent of total billed charges,90% of total billed charges,90.4,80,,72.32,percent of total billed charges,80% of total billed charges,101.7,90,,81.36,percent of total billed charges,90% of total billed charges,84.75,75,,67.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,32.77,29,,26.216,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,75.71,67,,60.568,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,90.4,80,,72.32,percent of total billed charges,80% of total billed charges,73.45,65,,58.76,percent of total billed charges,65% of total billed charges,40.31,35.67,,32.248,percent of total billed charges,35.67% of total billed charges,32.77,101.7,
MONOSOF 10-0 SUTURE **,27000287,CDM,272,RC,,,outpatient,,,165,66.00,,140.25,85,,112.2,percent of total billed charges,85% of total billed charges,127.05,77,,101.64,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,135.3,82,,108.24,percent of total billed charges,82% of total billed charges,140.25,85,,112.2,percent of total billed charges,85% of total billed charges,140.25,85,,112.2,percent of total billed charges,85% of total billed charges,140.25,85,,112.2,percent of total billed charges,85% of total billed charges,148.5,90,,118.8,percent of total billed charges,90% of total billed charges,132,80,,105.6,percent of total billed charges,80% of total billed charges,148.5,90,,118.8,percent of total billed charges,90% of total billed charges,123.75,75,,99,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,47.85,29,,38.28,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,110.55,67,,88.44,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,132,80,,105.6,percent of total billed charges,80% of total billed charges,107.25,65,,85.8,percent of total billed charges,65% of total billed charges,58.86,35.67,,47.088,percent of total billed charges,35.67% of total billed charges,47.85,148.5,
SURGIPRO 3-0 SUTURE,27000290,CDM,272,RC,,,outpatient,,,106,42.40,,90.1,85,,72.08,percent of total billed charges,85% of total billed charges,81.62,77,,65.3,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,86.92,82,,69.536,percent of total billed charges,82% of total billed charges,90.1,85,,72.08,percent of total billed charges,85% of total billed charges,90.1,85,,72.08,percent of total billed charges,85% of total billed charges,90.1,85,,72.08,percent of total billed charges,85% of total billed charges,95.4,90,,76.32,percent of total billed charges,90% of total billed charges,84.8,80,,67.84,percent of total billed charges,80% of total billed charges,95.4,90,,76.32,percent of total billed charges,90% of total billed charges,79.5,75,,63.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,30.74,29,,24.592,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,71.02,67,,56.816,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,84.8,80,,67.84,percent of total billed charges,80% of total billed charges,68.9,65,,55.12,percent of total billed charges,65% of total billed charges,37.81,35.67,,30.248,percent of total billed charges,35.67% of total billed charges,30.74,95.4,
SUTURE TI-CRON 0 30,27000293,CDM,272,RC,,,outpatient,,,103,41.20,,87.55,85,,70.04,percent of total billed charges,85% of total billed charges,79.31,77,,63.45,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,84.46,82,,67.568,percent of total billed charges,82% of total billed charges,87.55,85,,70.04,percent of total billed charges,85% of total billed charges,87.55,85,,70.04,percent of total billed charges,85% of total billed charges,87.55,85,,70.04,percent of total billed charges,85% of total billed charges,92.7,90,,74.16,percent of total billed charges,90% of total billed charges,82.4,80,,65.92,percent of total billed charges,80% of total billed charges,92.7,90,,74.16,percent of total billed charges,90% of total billed charges,77.25,75,,61.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,29.87,29,,23.896,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,69.01,67,,55.208,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,82.4,80,,65.92,percent of total billed charges,80% of total billed charges,66.95,65,,53.56,percent of total billed charges,65% of total billed charges,36.74,35.67,,29.392,percent of total billed charges,35.67% of total billed charges,29.87,92.7,
SUTURE SOFSILK 0 18 **,27000295,CDM,272,RC,,,outpatient,,,103,41.20,,87.55,85,,70.04,percent of total billed charges,85% of total billed charges,79.31,77,,63.45,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,84.46,82,,67.568,percent of total billed charges,82% of total billed charges,87.55,85,,70.04,percent of total billed charges,85% of total billed charges,87.55,85,,70.04,percent of total billed charges,85% of total billed charges,87.55,85,,70.04,percent of total billed charges,85% of total billed charges,92.7,90,,74.16,percent of total billed charges,90% of total billed charges,82.4,80,,65.92,percent of total billed charges,80% of total billed charges,92.7,90,,74.16,percent of total billed charges,90% of total billed charges,77.25,75,,61.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,29.87,29,,23.896,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,69.01,67,,55.208,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,82.4,80,,65.92,percent of total billed charges,80% of total billed charges,66.95,65,,53.56,percent of total billed charges,65% of total billed charges,36.74,35.67,,29.392,percent of total billed charges,35.67% of total billed charges,29.87,92.7,
SOFSILK 4-0 SUTURE **,27000296,CDM,272,RC,,,outpatient,,,63,25.20,,53.55,85,,42.84,percent of total billed charges,85% of total billed charges,48.51,77,,38.81,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,51.66,82,,41.328,percent of total billed charges,82% of total billed charges,53.55,85,,42.84,percent of total billed charges,85% of total billed charges,53.55,85,,42.84,percent of total billed charges,85% of total billed charges,53.55,85,,42.84,percent of total billed charges,85% of total billed charges,56.7,90,,45.36,percent of total billed charges,90% of total billed charges,50.4,80,,40.32,percent of total billed charges,80% of total billed charges,56.7,90,,45.36,percent of total billed charges,90% of total billed charges,47.25,75,,37.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,18.27,29,,14.616,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,42.21,67,,33.768,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,50.4,80,,40.32,percent of total billed charges,80% of total billed charges,40.95,65,,32.76,percent of total billed charges,65% of total billed charges,22.47,35.67,,17.976,percent of total billed charges,35.67% of total billed charges,18.27,56.7,
SUTURE CHROMIC 3-0 30,27000299,CDM,272,RC,,,outpatient,,,100,40.00,,85,85,,68,percent of total billed charges,85% of total billed charges,77,77,,61.6,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,82,82,,65.6,percent of total billed charges,82% of total billed charges,85,85,,68,percent of total billed charges,85% of total billed charges,85,85,,68,percent of total billed charges,85% of total billed charges,85,85,,68,percent of total billed charges,85% of total billed charges,90,90,,72,percent of total billed charges,90% of total billed charges,80,80,,64,percent of total billed charges,80% of total billed charges,90,90,,72,percent of total billed charges,90% of total billed charges,75,75,,60,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,29,29,,23.2,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,67,67,,53.6,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,80,80,,64,percent of total billed charges,80% of total billed charges,65,65,,52,percent of total billed charges,65% of total billed charges,35.67,35.67,,28.536,percent of total billed charges,35.67% of total billed charges,29,90,
CHROMIC 2-0 SUTURE,27000300,CDM,272,RC,,,outpatient,,,97,38.80,,82.45,85,,65.96,percent of total billed charges,85% of total billed charges,74.69,77,,59.75,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,79.54,82,,63.632,percent of total billed charges,82% of total billed charges,82.45,85,,65.96,percent of total billed charges,85% of total billed charges,82.45,85,,65.96,percent of total billed charges,85% of total billed charges,82.45,85,,65.96,percent of total billed charges,85% of total billed charges,87.3,90,,69.84,percent of total billed charges,90% of total billed charges,77.6,80,,62.08,percent of total billed charges,80% of total billed charges,87.3,90,,69.84,percent of total billed charges,90% of total billed charges,72.75,75,,58.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,28.13,29,,22.504,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,64.99,67,,51.992,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,77.6,80,,62.08,percent of total billed charges,80% of total billed charges,63.05,65,,50.44,percent of total billed charges,65% of total billed charges,34.6,35.67,,27.68,percent of total billed charges,35.67% of total billed charges,28.13,87.3,
SURGIGUT 3-0 SUTURE,27000302,CDM,272,RC,,,outpatient,,,113,45.20,,96.05,85,,76.84,percent of total billed charges,85% of total billed charges,87.01,77,,69.61,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,92.66,82,,74.128,percent of total billed charges,82% of total billed charges,96.05,85,,76.84,percent of total billed charges,85% of total billed charges,96.05,85,,76.84,percent of total billed charges,85% of total billed charges,96.05,85,,76.84,percent of total billed charges,85% of total billed charges,101.7,90,,81.36,percent of total billed charges,90% of total billed charges,90.4,80,,72.32,percent of total billed charges,80% of total billed charges,101.7,90,,81.36,percent of total billed charges,90% of total billed charges,84.75,75,,67.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,32.77,29,,26.216,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,75.71,67,,60.568,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,90.4,80,,72.32,percent of total billed charges,80% of total billed charges,73.45,65,,58.76,percent of total billed charges,65% of total billed charges,40.31,35.67,,32.248,percent of total billed charges,35.67% of total billed charges,32.77,101.7,
SURGIGUT 3-0 SUTURE **,27000304,CDM,272,RC,,,outpatient,,,50,20.00,,42.5,85,,34,percent of total billed charges,85% of total billed charges,38.5,77,,30.8,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,41,82,,32.8,percent of total billed charges,82% of total billed charges,42.5,85,,34,percent of total billed charges,85% of total billed charges,42.5,85,,34,percent of total billed charges,85% of total billed charges,42.5,85,,34,percent of total billed charges,85% of total billed charges,45,90,,36,percent of total billed charges,90% of total billed charges,40,80,,32,percent of total billed charges,80% of total billed charges,45,90,,36,percent of total billed charges,90% of total billed charges,37.5,75,,30,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,14.5,29,,11.6,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,33.5,67,,26.8,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,40,80,,32,percent of total billed charges,80% of total billed charges,32.5,65,,26,percent of total billed charges,65% of total billed charges,17.84,35.67,,14.272,percent of total billed charges,35.67% of total billed charges,14.5,45,
SUTURE POLYSORB 4-0 27,27000305,CDM,272,RC,,,outpatient,,,120,48.00,,102,85,,81.6,percent of total billed charges,85% of total billed charges,92.4,77,,73.92,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,98.4,82,,78.72,percent of total billed charges,82% of total billed charges,102,85,,81.6,percent of total billed charges,85% of total billed charges,102,85,,81.6,percent of total billed charges,85% of total billed charges,102,85,,81.6,percent of total billed charges,85% of total billed charges,108,90,,86.4,percent of total billed charges,90% of total billed charges,96,80,,76.8,percent of total billed charges,80% of total billed charges,108,90,,86.4,percent of total billed charges,90% of total billed charges,90,75,,72,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,34.8,29,,27.84,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,80.4,67,,64.32,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,96,80,,76.8,percent of total billed charges,80% of total billed charges,78,65,,62.4,percent of total billed charges,65% of total billed charges,42.8,35.67,,34.24,percent of total billed charges,35.67% of total billed charges,34.8,108,
POLYSORB 0 SUTURE **,27000307,CDM,272,RC,,,outpatient,,,38,15.20,,32.3,85,,25.84,percent of total billed charges,85% of total billed charges,29.26,77,,23.41,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,31.16,82,,24.928,percent of total billed charges,82% of total billed charges,32.3,85,,25.84,percent of total billed charges,85% of total billed charges,32.3,85,,25.84,percent of total billed charges,85% of total billed charges,32.3,85,,25.84,percent of total billed charges,85% of total billed charges,34.2,90,,27.36,percent of total billed charges,90% of total billed charges,30.4,80,,24.32,percent of total billed charges,80% of total billed charges,34.2,90,,27.36,percent of total billed charges,90% of total billed charges,28.5,75,,22.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,11.02,29,,8.816,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,25.46,67,,20.368,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,30.4,80,,24.32,percent of total billed charges,80% of total billed charges,24.7,65,,19.76,percent of total billed charges,65% of total billed charges,13.55,35.67,,10.84,percent of total billed charges,35.67% of total billed charges,11.02,34.2,
SUTURE POLYSORB 0 36,27000309,CDM,272,RC,,,outpatient,,,64,25.60,,54.4,85,,43.52,percent of total billed charges,85% of total billed charges,49.28,77,,39.42,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,52.48,82,,41.984,percent of total billed charges,82% of total billed charges,54.4,85,,43.52,percent of total billed charges,85% of total billed charges,54.4,85,,43.52,percent of total billed charges,85% of total billed charges,54.4,85,,43.52,percent of total billed charges,85% of total billed charges,57.6,90,,46.08,percent of total billed charges,90% of total billed charges,51.2,80,,40.96,percent of total billed charges,80% of total billed charges,57.6,90,,46.08,percent of total billed charges,90% of total billed charges,48,75,,38.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,18.56,29,,14.848,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,42.88,67,,34.304,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,51.2,80,,40.96,percent of total billed charges,80% of total billed charges,41.6,65,,33.28,percent of total billed charges,65% of total billed charges,22.83,35.67,,18.264,percent of total billed charges,35.67% of total billed charges,18.56,57.6,
POLYSORB 1 SUTURE,27000310,CDM,272,RC,,,outpatient,,,49,19.60,,41.65,85,,33.32,percent of total billed charges,85% of total billed charges,37.73,77,,30.18,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,40.18,82,,32.144,percent of total billed charges,82% of total billed charges,41.65,85,,33.32,percent of total billed charges,85% of total billed charges,41.65,85,,33.32,percent of total billed charges,85% of total billed charges,41.65,85,,33.32,percent of total billed charges,85% of total billed charges,44.1,90,,35.28,percent of total billed charges,90% of total billed charges,39.2,80,,31.36,percent of total billed charges,80% of total billed charges,44.1,90,,35.28,percent of total billed charges,90% of total billed charges,36.75,75,,29.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,14.21,29,,11.368,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,32.83,67,,26.264,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,39.2,80,,31.36,percent of total billed charges,80% of total billed charges,31.85,65,,25.48,percent of total billed charges,65% of total billed charges,17.48,35.67,,13.984,percent of total billed charges,35.67% of total billed charges,14.21,44.1,
SUTURE POLYSORB 2-0 30,27000311,CDM,272,RC,,,outpatient,,,93,37.20,,79.05,85,,63.24,percent of total billed charges,85% of total billed charges,71.61,77,,57.29,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,76.26,82,,61.008,percent of total billed charges,82% of total billed charges,79.05,85,,63.24,percent of total billed charges,85% of total billed charges,79.05,85,,63.24,percent of total billed charges,85% of total billed charges,79.05,85,,63.24,percent of total billed charges,85% of total billed charges,83.7,90,,66.96,percent of total billed charges,90% of total billed charges,74.4,80,,59.52,percent of total billed charges,80% of total billed charges,83.7,90,,66.96,percent of total billed charges,90% of total billed charges,69.75,75,,55.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,26.97,29,,21.576,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,62.31,67,,49.848,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,74.4,80,,59.52,percent of total billed charges,80% of total billed charges,60.45,65,,48.36,percent of total billed charges,65% of total billed charges,33.17,35.67,,26.536,percent of total billed charges,35.67% of total billed charges,26.97,83.7,
SUTURE POLYSORB 3-0 27,27000315,CDM,272,RC,,,outpatient,,,83,33.20,,70.55,85,,56.44,percent of total billed charges,85% of total billed charges,63.91,77,,51.13,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,68.06,82,,54.448,percent of total billed charges,82% of total billed charges,70.55,85,,56.44,percent of total billed charges,85% of total billed charges,70.55,85,,56.44,percent of total billed charges,85% of total billed charges,70.55,85,,56.44,percent of total billed charges,85% of total billed charges,74.7,90,,59.76,percent of total billed charges,90% of total billed charges,66.4,80,,53.12,percent of total billed charges,80% of total billed charges,74.7,90,,59.76,percent of total billed charges,90% of total billed charges,62.25,75,,49.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,24.07,29,,19.256,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,55.61,67,,44.488,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,66.4,80,,53.12,percent of total billed charges,80% of total billed charges,53.95,65,,43.16,percent of total billed charges,65% of total billed charges,29.61,35.67,,23.688,percent of total billed charges,35.67% of total billed charges,24.07,74.7,
SUTURE POLYSORB 3-0 27 **,27000316,CDM,272,RC,,,outpatient,,,43,17.20,,36.55,85,,29.24,percent of total billed charges,85% of total billed charges,33.11,77,,26.49,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,35.26,82,,28.208,percent of total billed charges,82% of total billed charges,36.55,85,,29.24,percent of total billed charges,85% of total billed charges,36.55,85,,29.24,percent of total billed charges,85% of total billed charges,36.55,85,,29.24,percent of total billed charges,85% of total billed charges,38.7,90,,30.96,percent of total billed charges,90% of total billed charges,34.4,80,,27.52,percent of total billed charges,80% of total billed charges,38.7,90,,30.96,percent of total billed charges,90% of total billed charges,32.25,75,,25.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,12.47,29,,9.976,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,28.81,67,,23.048,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,34.4,80,,27.52,percent of total billed charges,80% of total billed charges,27.95,65,,22.36,percent of total billed charges,65% of total billed charges,15.34,35.67,,12.272,percent of total billed charges,35.67% of total billed charges,12.47,38.7,
SUTURE POLYSORB 8-0 12 **,27000318,CDM,272,RC,,,outpatient,,,256,102.40,,217.6,85,,174.08,percent of total billed charges,85% of total billed charges,197.12,77,,157.7,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,209.92,82,,167.936,percent of total billed charges,82% of total billed charges,217.6,85,,174.08,percent of total billed charges,85% of total billed charges,217.6,85,,174.08,percent of total billed charges,85% of total billed charges,217.6,85,,174.08,percent of total billed charges,85% of total billed charges,230.4,90,,184.32,percent of total billed charges,90% of total billed charges,204.8,80,,163.84,percent of total billed charges,80% of total billed charges,230.4,90,,184.32,percent of total billed charges,90% of total billed charges,192,75,,153.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,74.24,29,,59.392,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,171.52,67,,137.216,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,204.8,80,,163.84,percent of total billed charges,80% of total billed charges,166.4,65,,133.12,percent of total billed charges,65% of total billed charges,91.32,35.67,,73.056,percent of total billed charges,35.67% of total billed charges,74.24,230.4,
SUTURE POLYSORB 2-0 18,27000319,CDM,272,RC,,,outpatient,,,225,90.00,,191.25,85,,153,percent of total billed charges,85% of total billed charges,173.25,77,,138.6,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,184.5,82,,147.6,percent of total billed charges,82% of total billed charges,191.25,85,,153,percent of total billed charges,85% of total billed charges,191.25,85,,153,percent of total billed charges,85% of total billed charges,191.25,85,,153,percent of total billed charges,85% of total billed charges,202.5,90,,162,percent of total billed charges,90% of total billed charges,180,80,,144,percent of total billed charges,80% of total billed charges,202.5,90,,162,percent of total billed charges,90% of total billed charges,168.75,75,,135,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,65.25,29,,52.2,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,150.75,67,,120.6,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,180,80,,144,percent of total billed charges,80% of total billed charges,146.25,65,,117,percent of total billed charges,65% of total billed charges,80.26,35.67,,64.208,percent of total billed charges,35.67% of total billed charges,65.25,202.5,
SUTURE POLYSORB 0 18,27000320,CDM,272,RC,,,outpatient,,,150,60.00,,127.5,85,,102,percent of total billed charges,85% of total billed charges,115.5,77,,92.4,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,123,82,,98.4,percent of total billed charges,82% of total billed charges,127.5,85,,102,percent of total billed charges,85% of total billed charges,127.5,85,,102,percent of total billed charges,85% of total billed charges,127.5,85,,102,percent of total billed charges,85% of total billed charges,135,90,,108,percent of total billed charges,90% of total billed charges,120,80,,96,percent of total billed charges,80% of total billed charges,135,90,,108,percent of total billed charges,90% of total billed charges,112.5,75,,90,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,43.5,29,,34.8,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,100.5,67,,80.4,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,120,80,,96,percent of total billed charges,80% of total billed charges,97.5,65,,78,percent of total billed charges,65% of total billed charges,53.51,35.67,,42.808,percent of total billed charges,35.67% of total billed charges,43.5,135,
SUTURE POLYSORB 0 18,27000322,CDM,272,RC,,,outpatient,,,305,122.00,,259.25,85,,207.4,percent of total billed charges,85% of total billed charges,234.85,77,,187.88,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,250.1,82,,200.08,percent of total billed charges,82% of total billed charges,259.25,85,,207.4,percent of total billed charges,85% of total billed charges,259.25,85,,207.4,percent of total billed charges,85% of total billed charges,259.25,85,,207.4,percent of total billed charges,85% of total billed charges,274.5,90,,219.6,percent of total billed charges,90% of total billed charges,244,80,,195.2,percent of total billed charges,80% of total billed charges,274.5,90,,219.6,percent of total billed charges,90% of total billed charges,228.75,75,,183,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,88.45,29,,70.76,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,204.35,67,,163.48,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,244,80,,195.2,percent of total billed charges,80% of total billed charges,198.25,65,,158.6,percent of total billed charges,65% of total billed charges,108.79,35.67,,87.032,percent of total billed charges,35.67% of total billed charges,88.45,274.5,
SUTURE POLYSORB 4-0 18,27000323,CDM,272,RC,,,outpatient,,,236,94.40,,200.6,85,,160.48,percent of total billed charges,85% of total billed charges,181.72,77,,145.38,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,193.52,82,,154.816,percent of total billed charges,82% of total billed charges,200.6,85,,160.48,percent of total billed charges,85% of total billed charges,200.6,85,,160.48,percent of total billed charges,85% of total billed charges,200.6,85,,160.48,percent of total billed charges,85% of total billed charges,212.4,90,,169.92,percent of total billed charges,90% of total billed charges,188.8,80,,151.04,percent of total billed charges,80% of total billed charges,212.4,90,,169.92,percent of total billed charges,90% of total billed charges,177,75,,141.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,68.44,29,,54.752,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,158.12,67,,126.496,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,188.8,80,,151.04,percent of total billed charges,80% of total billed charges,153.4,65,,122.72,percent of total billed charges,65% of total billed charges,84.18,35.67,,67.344,percent of total billed charges,35.67% of total billed charges,68.44,212.4,
SUTURE POLYSORB 2-0 18,27000324,CDM,272,RC,,,outpatient,,,208,83.20,,176.8,85,,141.44,percent of total billed charges,85% of total billed charges,160.16,77,,128.13,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,170.56,82,,136.448,percent of total billed charges,82% of total billed charges,176.8,85,,141.44,percent of total billed charges,85% of total billed charges,176.8,85,,141.44,percent of total billed charges,85% of total billed charges,176.8,85,,141.44,percent of total billed charges,85% of total billed charges,187.2,90,,149.76,percent of total billed charges,90% of total billed charges,166.4,80,,133.12,percent of total billed charges,80% of total billed charges,187.2,90,,149.76,percent of total billed charges,90% of total billed charges,156,75,,124.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,60.32,29,,48.256,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,139.36,67,,111.488,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,166.4,80,,133.12,percent of total billed charges,80% of total billed charges,135.2,65,,108.16,percent of total billed charges,65% of total billed charges,74.19,35.67,,59.352,percent of total billed charges,35.67% of total billed charges,60.32,187.2,
SOFSILK SUTURE 3-0 30,27000325,CDM,272,RC,,,outpatient,,,63,25.20,,53.55,85,,42.84,percent of total billed charges,85% of total billed charges,48.51,77,,38.81,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,51.66,82,,41.328,percent of total billed charges,82% of total billed charges,53.55,85,,42.84,percent of total billed charges,85% of total billed charges,53.55,85,,42.84,percent of total billed charges,85% of total billed charges,53.55,85,,42.84,percent of total billed charges,85% of total billed charges,56.7,90,,45.36,percent of total billed charges,90% of total billed charges,50.4,80,,40.32,percent of total billed charges,80% of total billed charges,56.7,90,,45.36,percent of total billed charges,90% of total billed charges,47.25,75,,37.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,18.27,29,,14.616,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,42.21,67,,33.768,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,50.4,80,,40.32,percent of total billed charges,80% of total billed charges,40.95,65,,32.76,percent of total billed charges,65% of total billed charges,22.47,35.67,,17.976,percent of total billed charges,35.67% of total billed charges,18.27,56.7,
SUTURE SOFSILK 2-0 18,27000333,CDM,272,RC,,,outpatient,,,70,28.00,,59.5,85,,47.6,percent of total billed charges,85% of total billed charges,53.9,77,,43.12,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,57.4,82,,45.92,percent of total billed charges,82% of total billed charges,59.5,85,,47.6,percent of total billed charges,85% of total billed charges,59.5,85,,47.6,percent of total billed charges,85% of total billed charges,59.5,85,,47.6,percent of total billed charges,85% of total billed charges,63,90,,50.4,percent of total billed charges,90% of total billed charges,56,80,,44.8,percent of total billed charges,80% of total billed charges,63,90,,50.4,percent of total billed charges,90% of total billed charges,52.5,75,,42,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,20.3,29,,16.24,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,46.9,67,,37.52,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,56,80,,44.8,percent of total billed charges,80% of total billed charges,45.5,65,,36.4,percent of total billed charges,65% of total billed charges,24.97,35.67,,19.976,percent of total billed charges,35.67% of total billed charges,20.3,63,
UMBILICAL TAPE,27000335,CDM,272,RC,,,outpatient,,,44,17.60,,37.4,85,,29.92,percent of total billed charges,85% of total billed charges,33.88,77,,27.1,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,36.08,82,,28.864,percent of total billed charges,82% of total billed charges,37.4,85,,29.92,percent of total billed charges,85% of total billed charges,37.4,85,,29.92,percent of total billed charges,85% of total billed charges,37.4,85,,29.92,percent of total billed charges,85% of total billed charges,39.6,90,,31.68,percent of total billed charges,90% of total billed charges,35.2,80,,28.16,percent of total billed charges,80% of total billed charges,39.6,90,,31.68,percent of total billed charges,90% of total billed charges,33,75,,26.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,12.76,29,,10.208,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,29.48,67,,23.584,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,35.2,80,,28.16,percent of total billed charges,80% of total billed charges,28.6,65,,22.88,percent of total billed charges,65% of total billed charges,15.69,35.67,,12.552,percent of total billed charges,35.67% of total billed charges,12.76,39.6,
SUTURE CHROMIC 0 30 **,27000337,CDM,272,RC,,,outpatient,,,49,19.60,,41.65,85,,33.32,percent of total billed charges,85% of total billed charges,37.73,77,,30.18,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,40.18,82,,32.144,percent of total billed charges,82% of total billed charges,41.65,85,,33.32,percent of total billed charges,85% of total billed charges,41.65,85,,33.32,percent of total billed charges,85% of total billed charges,41.65,85,,33.32,percent of total billed charges,85% of total billed charges,44.1,90,,35.28,percent of total billed charges,90% of total billed charges,39.2,80,,31.36,percent of total billed charges,80% of total billed charges,44.1,90,,35.28,percent of total billed charges,90% of total billed charges,36.75,75,,29.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,14.21,29,,11.368,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,32.83,67,,26.264,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,39.2,80,,31.36,percent of total billed charges,80% of total billed charges,31.85,65,,25.48,percent of total billed charges,65% of total billed charges,17.48,35.67,,13.984,percent of total billed charges,35.67% of total billed charges,14.21,44.1,
BULB WOUND DRAIN 14,27000453,CDM,272,RC,,,outpatient,,,84,33.60,,71.4,85,,57.12,percent of total billed charges,85% of total billed charges,64.68,77,,51.74,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,68.88,82,,55.104,percent of total billed charges,82% of total billed charges,71.4,85,,57.12,percent of total billed charges,85% of total billed charges,71.4,85,,57.12,percent of total billed charges,85% of total billed charges,71.4,85,,57.12,percent of total billed charges,85% of total billed charges,75.6,90,,60.48,percent of total billed charges,90% of total billed charges,67.2,80,,53.76,percent of total billed charges,80% of total billed charges,75.6,90,,60.48,percent of total billed charges,90% of total billed charges,63,75,,50.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,24.36,29,,19.488,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,56.28,67,,45.024,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,67.2,80,,53.76,percent of total billed charges,80% of total billed charges,54.6,65,,43.68,percent of total billed charges,65% of total billed charges,29.96,35.67,,23.968,percent of total billed charges,35.67% of total billed charges,24.36,75.6,
MINI-EVACUATOR WOUND DRAIN **,27000454,CDM,272,RC,,,outpatient,,,175,70.00,,148.75,85,,119,percent of total billed charges,85% of total billed charges,134.75,77,,107.8,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,143.5,82,,114.8,percent of total billed charges,82% of total billed charges,148.75,85,,119,percent of total billed charges,85% of total billed charges,148.75,85,,119,percent of total billed charges,85% of total billed charges,148.75,85,,119,percent of total billed charges,85% of total billed charges,157.5,90,,126,percent of total billed charges,90% of total billed charges,140,80,,112,percent of total billed charges,80% of total billed charges,157.5,90,,126,percent of total billed charges,90% of total billed charges,131.25,75,,105,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,50.75,29,,40.6,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,117.25,67,,93.8,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,140,80,,112,percent of total billed charges,80% of total billed charges,113.75,65,,91,percent of total billed charges,65% of total billed charges,62.42,35.67,,49.936,percent of total billed charges,35.67% of total billed charges,50.75,157.5,
EYE PAD SMALL OVAL,27000461,CDM,272,RC,,,outpatient,,,7,2.80,,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.39,77,,4.31,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,5.74,82,,4.592,percent of total billed charges,82% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.25,75,,4.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.03,29,,1.624,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4.69,67,,3.752,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,4.55,65,,3.64,percent of total billed charges,65% of total billed charges,2.5,35.67,,2,percent of total billed charges,35.67% of total billed charges,2.03,6.3,
URINE METER,27000484,CDM,272,RC,,,outpatient,,,80,32.00,,68,85,,54.4,percent of total billed charges,85% of total billed charges,61.6,77,,49.28,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,65.6,82,,52.48,percent of total billed charges,82% of total billed charges,68,85,,54.4,percent of total billed charges,85% of total billed charges,68,85,,54.4,percent of total billed charges,85% of total billed charges,68,85,,54.4,percent of total billed charges,85% of total billed charges,72,90,,57.6,percent of total billed charges,90% of total billed charges,64,80,,51.2,percent of total billed charges,80% of total billed charges,72,90,,57.6,percent of total billed charges,90% of total billed charges,60,75,,48,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,23.2,29,,18.56,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,53.6,67,,42.88,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,64,80,,51.2,percent of total billed charges,80% of total billed charges,52,65,,41.6,percent of total billed charges,65% of total billed charges,28.54,35.67,,22.832,percent of total billed charges,35.67% of total billed charges,23.2,72,
BLADDER IRRIGATION SET,27000485,CDM,272,RC,,,outpatient,,,113,45.20,,96.05,85,,76.84,percent of total billed charges,85% of total billed charges,87.01,77,,69.61,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,92.66,82,,74.128,percent of total billed charges,82% of total billed charges,96.05,85,,76.84,percent of total billed charges,85% of total billed charges,96.05,85,,76.84,percent of total billed charges,85% of total billed charges,96.05,85,,76.84,percent of total billed charges,85% of total billed charges,101.7,90,,81.36,percent of total billed charges,90% of total billed charges,90.4,80,,72.32,percent of total billed charges,80% of total billed charges,101.7,90,,81.36,percent of total billed charges,90% of total billed charges,84.75,75,,67.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,32.77,29,,26.216,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,75.71,67,,60.568,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,90.4,80,,72.32,percent of total billed charges,80% of total billed charges,73.45,65,,58.76,percent of total billed charges,65% of total billed charges,40.31,35.67,,32.248,percent of total billed charges,35.67% of total billed charges,32.77,101.7,
HYDRASORB STERILE DRESSING,27000494,CDM,272,RC,,,outpatient,,,18,7.20,,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,13.86,77,,11.09,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,14.76,82,,11.808,percent of total billed charges,82% of total billed charges,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,16.2,90,,12.96,percent of total billed charges,90% of total billed charges,14.4,80,,11.52,percent of total billed charges,80% of total billed charges,16.2,90,,12.96,percent of total billed charges,90% of total billed charges,13.5,75,,10.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,5.22,29,,4.176,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,12.06,67,,9.648,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,14.4,80,,11.52,percent of total billed charges,80% of total billed charges,11.7,65,,9.36,percent of total billed charges,65% of total billed charges,6.42,35.67,,5.136,percent of total billed charges,35.67% of total billed charges,5.22,16.2,
PLEUR-EVAC CHEST DRAIN UNIT,27000508,CDM,272,RC,,,outpatient,,,254,101.60,,215.9,85,,172.72,percent of total billed charges,85% of total billed charges,195.58,77,,156.46,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,208.28,82,,166.624,percent of total billed charges,82% of total billed charges,215.9,85,,172.72,percent of total billed charges,85% of total billed charges,215.9,85,,172.72,percent of total billed charges,85% of total billed charges,215.9,85,,172.72,percent of total billed charges,85% of total billed charges,228.6,90,,182.88,percent of total billed charges,90% of total billed charges,203.2,80,,162.56,percent of total billed charges,80% of total billed charges,228.6,90,,182.88,percent of total billed charges,90% of total billed charges,190.5,75,,152.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,73.66,29,,58.928,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,170.18,67,,136.144,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,203.2,80,,162.56,percent of total billed charges,80% of total billed charges,165.1,65,,132.08,percent of total billed charges,65% of total billed charges,90.6,35.67,,72.48,percent of total billed charges,35.67% of total billed charges,73.66,228.6,
ABDOMINAL PAD,27000536,CDM,272,RC,,,outpatient,,,10,4.00,,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,7.7,77,,6.16,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,8.2,82,,6.56,percent of total billed charges,82% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,9,90,,7.2,percent of total billed charges,90% of total billed charges,8,80,,6.4,percent of total billed charges,80% of total billed charges,9,90,,7.2,percent of total billed charges,90% of total billed charges,7.5,75,,6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.9,29,,2.32,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,6.7,67,,5.36,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,8,80,,6.4,percent of total billed charges,80% of total billed charges,6.5,65,,5.2,percent of total billed charges,65% of total billed charges,3.57,35.67,,2.856,percent of total billed charges,35.67% of total billed charges,2.9,9,
KERLIX ROLL LG,27000542,CDM,272,RC,,,outpatient,,,13,5.20,,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,10.01,77,,8.01,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,10.66,82,,8.528,percent of total billed charges,82% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,11.7,90,,9.36,percent of total billed charges,90% of total billed charges,10.4,80,,8.32,percent of total billed charges,80% of total billed charges,11.7,90,,9.36,percent of total billed charges,90% of total billed charges,9.75,75,,7.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,3.77,29,,3.016,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,8.71,67,,6.968,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,10.4,80,,8.32,percent of total billed charges,80% of total billed charges,8.45,65,,6.76,percent of total billed charges,65% of total billed charges,4.64,35.67,,3.712,percent of total billed charges,35.67% of total billed charges,3.77,11.7,
SUCTION TUBING ARGYLE,27000543,CDM,272,RC,,,outpatient,,,10,4.00,,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,7.7,77,,6.16,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,8.2,82,,6.56,percent of total billed charges,82% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,9,90,,7.2,percent of total billed charges,90% of total billed charges,8,80,,6.4,percent of total billed charges,80% of total billed charges,9,90,,7.2,percent of total billed charges,90% of total billed charges,7.5,75,,6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.9,29,,2.32,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,6.7,67,,5.36,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,8,80,,6.4,percent of total billed charges,80% of total billed charges,6.5,65,,5.2,percent of total billed charges,65% of total billed charges,3.57,35.67,,2.856,percent of total billed charges,35.67% of total billed charges,2.9,9,
IV CATHETER 16G,27000552,CDM,272,RC,,,outpatient,,,47,18.80,,39.95,85,,31.96,percent of total billed charges,85% of total billed charges,36.19,77,,28.95,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,38.54,82,,30.832,percent of total billed charges,82% of total billed charges,39.95,85,,31.96,percent of total billed charges,85% of total billed charges,39.95,85,,31.96,percent of total billed charges,85% of total billed charges,39.95,85,,31.96,percent of total billed charges,85% of total billed charges,42.3,90,,33.84,percent of total billed charges,90% of total billed charges,37.6,80,,30.08,percent of total billed charges,80% of total billed charges,42.3,90,,33.84,percent of total billed charges,90% of total billed charges,35.25,75,,28.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,13.63,29,,10.904,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,31.49,67,,25.192,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,37.6,80,,30.08,percent of total billed charges,80% of total billed charges,30.55,65,,24.44,percent of total billed charges,65% of total billed charges,16.76,35.67,,13.408,percent of total billed charges,35.67% of total billed charges,13.63,42.3,
LUMBAR PUNCTURE TRAY INFANT,27000573,CDM,272,RC,,,outpatient,,,124,49.60,,105.4,85,,84.32,percent of total billed charges,85% of total billed charges,95.48,77,,76.38,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,101.68,82,,81.344,percent of total billed charges,82% of total billed charges,105.4,85,,84.32,percent of total billed charges,85% of total billed charges,105.4,85,,84.32,percent of total billed charges,85% of total billed charges,105.4,85,,84.32,percent of total billed charges,85% of total billed charges,111.6,90,,89.28,percent of total billed charges,90% of total billed charges,99.2,80,,79.36,percent of total billed charges,80% of total billed charges,111.6,90,,89.28,percent of total billed charges,90% of total billed charges,93,75,,74.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,35.96,29,,28.768,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,83.08,67,,66.464,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,99.2,80,,79.36,percent of total billed charges,80% of total billed charges,80.6,65,,64.48,percent of total billed charges,65% of total billed charges,44.23,35.67,,35.384,percent of total billed charges,35.67% of total billed charges,35.96,111.6,
ELECTRODE EKG PEDI,27000580,CDM,272,RC,,,outpatient,,,10,4.00,,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,7.7,77,,6.16,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,8.2,82,,6.56,percent of total billed charges,82% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,9,90,,7.2,percent of total billed charges,90% of total billed charges,8,80,,6.4,percent of total billed charges,80% of total billed charges,9,90,,7.2,percent of total billed charges,90% of total billed charges,7.5,75,,6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.9,29,,2.32,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,6.7,67,,5.36,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,8,80,,6.4,percent of total billed charges,80% of total billed charges,6.5,65,,5.2,percent of total billed charges,65% of total billed charges,3.57,35.67,,2.856,percent of total billed charges,35.67% of total billed charges,2.9,9,
ABSORBABLE HEMOSTAT,27000584,CDM,272,RC,,,outpatient,,,400,160.00,,340,85,,272,percent of total billed charges,85% of total billed charges,308,77,,246.4,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,328,82,,262.4,percent of total billed charges,82% of total billed charges,340,85,,272,percent of total billed charges,85% of total billed charges,340,85,,272,percent of total billed charges,85% of total billed charges,340,85,,272,percent of total billed charges,85% of total billed charges,360,90,,288,percent of total billed charges,90% of total billed charges,320,80,,256,percent of total billed charges,80% of total billed charges,360,90,,288,percent of total billed charges,90% of total billed charges,300,75,,240,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,116,29,,92.8,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,268,67,,214.4,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,320,80,,256,percent of total billed charges,80% of total billed charges,260,65,,208,percent of total billed charges,65% of total billed charges,142.68,35.67,,114.144,percent of total billed charges,35.67% of total billed charges,116,360,
SURGICAL EYE SPEARS,27000586,CDM,272,RC,,,outpatient,,,18,7.20,,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,13.86,77,,11.09,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,14.76,82,,11.808,percent of total billed charges,82% of total billed charges,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,16.2,90,,12.96,percent of total billed charges,90% of total billed charges,14.4,80,,11.52,percent of total billed charges,80% of total billed charges,16.2,90,,12.96,percent of total billed charges,90% of total billed charges,13.5,75,,10.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,5.22,29,,4.176,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,12.06,67,,9.648,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,14.4,80,,11.52,percent of total billed charges,80% of total billed charges,11.7,65,,9.36,percent of total billed charges,65% of total billed charges,6.42,35.67,,5.136,percent of total billed charges,35.67% of total billed charges,5.22,16.2,
SUCTION CATHETER 14 FR,27000601,CDM,272,RC,,,outpatient,,,10,4.00,,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,7.7,77,,6.16,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,8.2,82,,6.56,percent of total billed charges,82% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,9,90,,7.2,percent of total billed charges,90% of total billed charges,8,80,,6.4,percent of total billed charges,80% of total billed charges,9,90,,7.2,percent of total billed charges,90% of total billed charges,7.5,75,,6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.9,29,,2.32,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,6.7,67,,5.36,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,8,80,,6.4,percent of total billed charges,80% of total billed charges,6.5,65,,5.2,percent of total billed charges,65% of total billed charges,3.57,35.67,,2.856,percent of total billed charges,35.67% of total billed charges,2.9,9,
SUCTION CATHETER 18 FR,27000602,CDM,272,RC,,,outpatient,,,10,4.00,,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,7.7,77,,6.16,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,8.2,82,,6.56,percent of total billed charges,82% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,9,90,,7.2,percent of total billed charges,90% of total billed charges,8,80,,6.4,percent of total billed charges,80% of total billed charges,9,90,,7.2,percent of total billed charges,90% of total billed charges,7.5,75,,6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.9,29,,2.32,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,6.7,67,,5.36,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,8,80,,6.4,percent of total billed charges,80% of total billed charges,6.5,65,,5.2,percent of total billed charges,65% of total billed charges,3.57,35.67,,2.856,percent of total billed charges,35.67% of total billed charges,2.9,9,
SUCTION CATHETER 12 FR,27000603,CDM,272,RC,,,outpatient,,,10,4.00,,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,7.7,77,,6.16,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,8.2,82,,6.56,percent of total billed charges,82% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,9,90,,7.2,percent of total billed charges,90% of total billed charges,8,80,,6.4,percent of total billed charges,80% of total billed charges,9,90,,7.2,percent of total billed charges,90% of total billed charges,7.5,75,,6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.9,29,,2.32,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,6.7,67,,5.36,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,8,80,,6.4,percent of total billed charges,80% of total billed charges,6.5,65,,5.2,percent of total billed charges,65% of total billed charges,3.57,35.67,,2.856,percent of total billed charges,35.67% of total billed charges,2.9,9,
URINE CATH KIT 8FR,27000607,CDM,272,RC,,,outpatient,,,60,24.00,,51,85,,40.8,percent of total billed charges,85% of total billed charges,46.2,77,,36.96,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,49.2,82,,39.36,percent of total billed charges,82% of total billed charges,51,85,,40.8,percent of total billed charges,85% of total billed charges,51,85,,40.8,percent of total billed charges,85% of total billed charges,51,85,,40.8,percent of total billed charges,85% of total billed charges,54,90,,43.2,percent of total billed charges,90% of total billed charges,48,80,,38.4,percent of total billed charges,80% of total billed charges,54,90,,43.2,percent of total billed charges,90% of total billed charges,45,75,,36,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,17.4,29,,13.92,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,40.2,67,,32.16,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,48,80,,38.4,percent of total billed charges,80% of total billed charges,39,65,,31.2,percent of total billed charges,65% of total billed charges,21.4,35.67,,17.12,percent of total billed charges,35.67% of total billed charges,17.4,54,
SPINAL NEEDLE 22G 1 1/2,27000610,CDM,272,RC,,,outpatient,,,22,8.80,,18.7,85,,14.96,percent of total billed charges,85% of total billed charges,16.94,77,,13.55,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,18.04,82,,14.432,percent of total billed charges,82% of total billed charges,18.7,85,,14.96,percent of total billed charges,85% of total billed charges,18.7,85,,14.96,percent of total billed charges,85% of total billed charges,18.7,85,,14.96,percent of total billed charges,85% of total billed charges,19.8,90,,15.84,percent of total billed charges,90% of total billed charges,17.6,80,,14.08,percent of total billed charges,80% of total billed charges,19.8,90,,15.84,percent of total billed charges,90% of total billed charges,16.5,75,,13.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,6.38,29,,5.104,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,14.74,67,,11.792,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,17.6,80,,14.08,percent of total billed charges,80% of total billed charges,14.3,65,,11.44,percent of total billed charges,65% of total billed charges,7.85,35.67,,6.28,percent of total billed charges,35.67% of total billed charges,6.38,19.8,
SPINAL NEEDLE 20G 3 1/2,27000611,CDM,272,RC,,,outpatient,,,20,8.00,,17,85,,13.6,percent of total billed charges,85% of total billed charges,15.4,77,,12.32,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,16.4,82,,13.12,percent of total billed charges,82% of total billed charges,17,85,,13.6,percent of total billed charges,85% of total billed charges,17,85,,13.6,percent of total billed charges,85% of total billed charges,17,85,,13.6,percent of total billed charges,85% of total billed charges,18,90,,14.4,percent of total billed charges,90% of total billed charges,16,80,,12.8,percent of total billed charges,80% of total billed charges,18,90,,14.4,percent of total billed charges,90% of total billed charges,15,75,,12,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,5.8,29,,4.64,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,13.4,67,,10.72,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,16,80,,12.8,percent of total billed charges,80% of total billed charges,13,65,,10.4,percent of total billed charges,65% of total billed charges,7.13,35.67,,5.704,percent of total billed charges,35.67% of total billed charges,5.8,18,
FOLEY CATHETER 24FR 5CC,27000612,CDM,272,RC,,,outpatient,,,58,23.20,,49.3,85,,39.44,percent of total billed charges,85% of total billed charges,44.66,77,,35.73,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,47.56,82,,38.048,percent of total billed charges,82% of total billed charges,49.3,85,,39.44,percent of total billed charges,85% of total billed charges,49.3,85,,39.44,percent of total billed charges,85% of total billed charges,49.3,85,,39.44,percent of total billed charges,85% of total billed charges,52.2,90,,41.76,percent of total billed charges,90% of total billed charges,46.4,80,,37.12,percent of total billed charges,80% of total billed charges,52.2,90,,41.76,percent of total billed charges,90% of total billed charges,43.5,75,,34.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,16.82,29,,13.456,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,38.86,67,,31.088,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,46.4,80,,37.12,percent of total billed charges,80% of total billed charges,37.7,65,,30.16,percent of total billed charges,65% of total billed charges,20.69,35.67,,16.552,percent of total billed charges,35.67% of total billed charges,16.82,52.2,
FOLEY CATHETER 24FR 30CC,27000613,CDM,272,RC,,,outpatient,,,58,23.20,,49.3,85,,39.44,percent of total billed charges,85% of total billed charges,44.66,77,,35.73,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,47.56,82,,38.048,percent of total billed charges,82% of total billed charges,49.3,85,,39.44,percent of total billed charges,85% of total billed charges,49.3,85,,39.44,percent of total billed charges,85% of total billed charges,49.3,85,,39.44,percent of total billed charges,85% of total billed charges,52.2,90,,41.76,percent of total billed charges,90% of total billed charges,46.4,80,,37.12,percent of total billed charges,80% of total billed charges,52.2,90,,41.76,percent of total billed charges,90% of total billed charges,43.5,75,,34.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,16.82,29,,13.456,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,38.86,67,,31.088,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,46.4,80,,37.12,percent of total billed charges,80% of total billed charges,37.7,65,,30.16,percent of total billed charges,65% of total billed charges,20.69,35.67,,16.552,percent of total billed charges,35.67% of total billed charges,16.82,52.2,
POVIDONE IODINE E-Z SPONGE,27000614,CDM,272,RC,,,outpatient,,,13,5.20,,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,10.01,77,,8.01,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,10.66,82,,8.528,percent of total billed charges,82% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,11.7,90,,9.36,percent of total billed charges,90% of total billed charges,10.4,80,,8.32,percent of total billed charges,80% of total billed charges,11.7,90,,9.36,percent of total billed charges,90% of total billed charges,9.75,75,,7.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,3.77,29,,3.016,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,8.71,67,,6.968,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,10.4,80,,8.32,percent of total billed charges,80% of total billed charges,8.45,65,,6.76,percent of total billed charges,65% of total billed charges,4.64,35.67,,3.712,percent of total billed charges,35.67% of total billed charges,3.77,11.7,
FOLEY CATHETER 20FR 5CC,27000615,CDM,272,RC,,,outpatient,,,98,39.20,,83.3,85,,66.64,percent of total billed charges,85% of total billed charges,75.46,77,,60.37,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,80.36,82,,64.288,percent of total billed charges,82% of total billed charges,83.3,85,,66.64,percent of total billed charges,85% of total billed charges,83.3,85,,66.64,percent of total billed charges,85% of total billed charges,83.3,85,,66.64,percent of total billed charges,85% of total billed charges,88.2,90,,70.56,percent of total billed charges,90% of total billed charges,78.4,80,,62.72,percent of total billed charges,80% of total billed charges,88.2,90,,70.56,percent of total billed charges,90% of total billed charges,73.5,75,,58.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,28.42,29,,22.736,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,65.66,67,,52.528,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,78.4,80,,62.72,percent of total billed charges,80% of total billed charges,63.7,65,,50.96,percent of total billed charges,65% of total billed charges,34.96,35.67,,27.968,percent of total billed charges,35.67% of total billed charges,28.42,88.2,
FOLEY CATHETER 24FR 30CC,27000617,CDM,272,RC,,,outpatient,,,106,42.40,,90.1,85,,72.08,percent of total billed charges,85% of total billed charges,81.62,77,,65.3,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,86.92,82,,69.536,percent of total billed charges,82% of total billed charges,90.1,85,,72.08,percent of total billed charges,85% of total billed charges,90.1,85,,72.08,percent of total billed charges,85% of total billed charges,90.1,85,,72.08,percent of total billed charges,85% of total billed charges,95.4,90,,76.32,percent of total billed charges,90% of total billed charges,84.8,80,,67.84,percent of total billed charges,80% of total billed charges,95.4,90,,76.32,percent of total billed charges,90% of total billed charges,79.5,75,,63.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,30.74,29,,24.592,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,71.02,67,,56.816,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,84.8,80,,67.84,percent of total billed charges,80% of total billed charges,68.9,65,,55.12,percent of total billed charges,65% of total billed charges,37.81,35.67,,30.248,percent of total billed charges,35.67% of total billed charges,30.74,95.4,
FOLEY CATHETER 8FR 3CC,27000618,CDM,272,RC,,,outpatient,,,87,34.80,,73.95,85,,59.16,percent of total billed charges,85% of total billed charges,66.99,77,,53.59,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,71.34,82,,57.072,percent of total billed charges,82% of total billed charges,73.95,85,,59.16,percent of total billed charges,85% of total billed charges,73.95,85,,59.16,percent of total billed charges,85% of total billed charges,73.95,85,,59.16,percent of total billed charges,85% of total billed charges,78.3,90,,62.64,percent of total billed charges,90% of total billed charges,69.6,80,,55.68,percent of total billed charges,80% of total billed charges,78.3,90,,62.64,percent of total billed charges,90% of total billed charges,65.25,75,,52.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,25.23,29,,20.184,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,58.29,67,,46.632,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,69.6,80,,55.68,percent of total billed charges,80% of total billed charges,56.55,65,,45.24,percent of total billed charges,65% of total billed charges,31.03,35.67,,24.824,percent of total billed charges,35.67% of total billed charges,25.23,78.3,
FOLEY CATHETER KIT 16FR 5CC **,27000619,CDM,272,RC,,,outpatient,,,82,32.80,,69.7,85,,55.76,percent of total billed charges,85% of total billed charges,63.14,77,,50.51,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,67.24,82,,53.792,percent of total billed charges,82% of total billed charges,69.7,85,,55.76,percent of total billed charges,85% of total billed charges,69.7,85,,55.76,percent of total billed charges,85% of total billed charges,69.7,85,,55.76,percent of total billed charges,85% of total billed charges,73.8,90,,59.04,percent of total billed charges,90% of total billed charges,65.6,80,,52.48,percent of total billed charges,80% of total billed charges,73.8,90,,59.04,percent of total billed charges,90% of total billed charges,61.5,75,,49.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,23.78,29,,19.024,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,54.94,67,,43.952,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,65.6,80,,52.48,percent of total billed charges,80% of total billed charges,53.3,65,,42.64,percent of total billed charges,65% of total billed charges,29.25,35.67,,23.4,percent of total billed charges,35.67% of total billed charges,23.78,73.8,
FOLEY CATHETER KIT 18FR 5CC **,27000620,CDM,272,RC,,,outpatient,,,67,26.80,,56.95,85,,45.56,percent of total billed charges,85% of total billed charges,51.59,77,,41.27,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,54.94,82,,43.952,percent of total billed charges,82% of total billed charges,56.95,85,,45.56,percent of total billed charges,85% of total billed charges,56.95,85,,45.56,percent of total billed charges,85% of total billed charges,56.95,85,,45.56,percent of total billed charges,85% of total billed charges,60.3,90,,48.24,percent of total billed charges,90% of total billed charges,53.6,80,,42.88,percent of total billed charges,80% of total billed charges,60.3,90,,48.24,percent of total billed charges,90% of total billed charges,50.25,75,,40.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,19.43,29,,15.544,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,44.89,67,,35.912,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,53.6,80,,42.88,percent of total billed charges,80% of total billed charges,43.55,65,,34.84,percent of total billed charges,65% of total billed charges,23.9,35.67,,19.12,percent of total billed charges,35.67% of total billed charges,19.43,60.3,
FOLEY CATHETER KIT 10FR 3CC,27000621,CDM,272,RC,,,outpatient,,,166,66.40,,141.1,85,,112.88,percent of total billed charges,85% of total billed charges,127.82,77,,102.26,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,136.12,82,,108.896,percent of total billed charges,82% of total billed charges,141.1,85,,112.88,percent of total billed charges,85% of total billed charges,141.1,85,,112.88,percent of total billed charges,85% of total billed charges,141.1,85,,112.88,percent of total billed charges,85% of total billed charges,149.4,90,,119.52,percent of total billed charges,90% of total billed charges,132.8,80,,106.24,percent of total billed charges,80% of total billed charges,149.4,90,,119.52,percent of total billed charges,90% of total billed charges,124.5,75,,99.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,48.14,29,,38.512,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,111.22,67,,88.976,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,132.8,80,,106.24,percent of total billed charges,80% of total billed charges,107.9,65,,86.32,percent of total billed charges,65% of total billed charges,59.21,35.67,,47.368,percent of total billed charges,35.67% of total billed charges,48.14,149.4,
SCARLET RED DRESSING **,27000628,CDM,272,RC,,,outpatient,,,22,8.80,,18.7,85,,14.96,percent of total billed charges,85% of total billed charges,16.94,77,,13.55,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,18.04,82,,14.432,percent of total billed charges,82% of total billed charges,18.7,85,,14.96,percent of total billed charges,85% of total billed charges,18.7,85,,14.96,percent of total billed charges,85% of total billed charges,18.7,85,,14.96,percent of total billed charges,85% of total billed charges,19.8,90,,15.84,percent of total billed charges,90% of total billed charges,17.6,80,,14.08,percent of total billed charges,80% of total billed charges,19.8,90,,15.84,percent of total billed charges,90% of total billed charges,16.5,75,,13.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,6.38,29,,5.104,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,14.74,67,,11.792,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,17.6,80,,14.08,percent of total billed charges,80% of total billed charges,14.3,65,,11.44,percent of total billed charges,65% of total billed charges,7.85,35.67,,6.28,percent of total billed charges,35.67% of total billed charges,6.38,19.8,
SURGICAL SITE MARKER,27000632,CDM,272,RC,,,outpatient,,,14,5.60,,11.9,85,,9.52,percent of total billed charges,85% of total billed charges,10.78,77,,8.62,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,11.48,82,,9.184,percent of total billed charges,82% of total billed charges,11.9,85,,9.52,percent of total billed charges,85% of total billed charges,11.9,85,,9.52,percent of total billed charges,85% of total billed charges,11.9,85,,9.52,percent of total billed charges,85% of total billed charges,12.6,90,,10.08,percent of total billed charges,90% of total billed charges,11.2,80,,8.96,percent of total billed charges,80% of total billed charges,12.6,90,,10.08,percent of total billed charges,90% of total billed charges,10.5,75,,8.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,4.06,29,,3.248,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,9.38,67,,7.504,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,11.2,80,,8.96,percent of total billed charges,80% of total billed charges,9.1,65,,7.28,percent of total billed charges,65% of total billed charges,4.99,35.67,,3.992,percent of total billed charges,35.67% of total billed charges,4.06,12.6,
VAGINAL IRRIGATION SET **,27000635,CDM,272,RC,,,outpatient,,,18,7.20,,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,13.86,77,,11.09,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,14.76,82,,11.808,percent of total billed charges,82% of total billed charges,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,16.2,90,,12.96,percent of total billed charges,90% of total billed charges,14.4,80,,11.52,percent of total billed charges,80% of total billed charges,16.2,90,,12.96,percent of total billed charges,90% of total billed charges,13.5,75,,10.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,5.22,29,,4.176,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,12.06,67,,9.648,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,14.4,80,,11.52,percent of total billed charges,80% of total billed charges,11.7,65,,9.36,percent of total billed charges,65% of total billed charges,6.42,35.67,,5.136,percent of total billed charges,35.67% of total billed charges,5.22,16.2,
PEANUT SPONGES,27000638,CDM,272,RC,,,outpatient,,,17,6.80,,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,13.09,77,,10.47,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,13.94,82,,11.152,percent of total billed charges,82% of total billed charges,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,15.3,90,,12.24,percent of total billed charges,90% of total billed charges,13.6,80,,10.88,percent of total billed charges,80% of total billed charges,15.3,90,,12.24,percent of total billed charges,90% of total billed charges,12.75,75,,10.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,4.93,29,,3.944,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,11.39,67,,9.112,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,13.6,80,,10.88,percent of total billed charges,80% of total billed charges,11.05,65,,8.84,percent of total billed charges,65% of total billed charges,6.06,35.67,,4.848,percent of total billed charges,35.67% of total billed charges,4.93,15.3,
OSTOMY WAFER,27000652,CDM,272,RC,,,outpatient,,,10,4.00,,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,7.7,77,,6.16,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,8.2,82,,6.56,percent of total billed charges,82% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,9,90,,7.2,percent of total billed charges,90% of total billed charges,8,80,,6.4,percent of total billed charges,80% of total billed charges,9,90,,7.2,percent of total billed charges,90% of total billed charges,7.5,75,,6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.9,29,,2.32,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,6.7,67,,5.36,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,8,80,,6.4,percent of total billed charges,80% of total billed charges,6.5,65,,5.2,percent of total billed charges,65% of total billed charges,3.57,35.67,,2.856,percent of total billed charges,35.67% of total billed charges,2.9,9,
OSTOMY WAFER,27000653,CDM,272,RC,,,outpatient,,,31,12.40,,26.35,85,,21.08,percent of total billed charges,85% of total billed charges,23.87,77,,19.1,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,25.42,82,,20.336,percent of total billed charges,82% of total billed charges,26.35,85,,21.08,percent of total billed charges,85% of total billed charges,26.35,85,,21.08,percent of total billed charges,85% of total billed charges,26.35,85,,21.08,percent of total billed charges,85% of total billed charges,27.9,90,,22.32,percent of total billed charges,90% of total billed charges,24.8,80,,19.84,percent of total billed charges,80% of total billed charges,27.9,90,,22.32,percent of total billed charges,90% of total billed charges,23.25,75,,18.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,8.99,29,,7.192,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,20.77,67,,16.616,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,24.8,80,,19.84,percent of total billed charges,80% of total billed charges,20.15,65,,16.12,percent of total billed charges,65% of total billed charges,11.06,35.67,,8.848,percent of total billed charges,35.67% of total billed charges,8.99,27.9,
OSTOMY IRRIGATION SET,27000660,CDM,272,RC,,,outpatient,,,181,72.40,,153.85,85,,123.08,percent of total billed charges,85% of total billed charges,139.37,77,,111.5,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,148.42,82,,118.736,percent of total billed charges,82% of total billed charges,153.85,85,,123.08,percent of total billed charges,85% of total billed charges,153.85,85,,123.08,percent of total billed charges,85% of total billed charges,153.85,85,,123.08,percent of total billed charges,85% of total billed charges,162.9,90,,130.32,percent of total billed charges,90% of total billed charges,144.8,80,,115.84,percent of total billed charges,80% of total billed charges,162.9,90,,130.32,percent of total billed charges,90% of total billed charges,135.75,75,,108.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,52.49,29,,41.992,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,121.27,67,,97.016,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,144.8,80,,115.84,percent of total billed charges,80% of total billed charges,117.65,65,,94.12,percent of total billed charges,65% of total billed charges,64.56,35.67,,51.648,percent of total billed charges,35.67% of total billed charges,52.49,162.9,
OSTOMY IRRIG STARTER SET **,27000661,CDM,272,RC,,,outpatient,,,385,154.00,,327.25,85,,261.8,percent of total billed charges,85% of total billed charges,296.45,77,,237.16,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,315.7,82,,252.56,percent of total billed charges,82% of total billed charges,327.25,85,,261.8,percent of total billed charges,85% of total billed charges,327.25,85,,261.8,percent of total billed charges,85% of total billed charges,327.25,85,,261.8,percent of total billed charges,85% of total billed charges,346.5,90,,277.2,percent of total billed charges,90% of total billed charges,308,80,,246.4,percent of total billed charges,80% of total billed charges,346.5,90,,277.2,percent of total billed charges,90% of total billed charges,288.75,75,,231,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,111.65,29,,89.32,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,257.95,67,,206.36,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,308,80,,246.4,percent of total billed charges,80% of total billed charges,250.25,65,,200.2,percent of total billed charges,65% of total billed charges,137.33,35.67,,109.864,percent of total billed charges,35.67% of total billed charges,111.65,346.5,
OSTOMY STOMA WAFER 2 1/4,27000663,CDM,272,RC,,,outpatient,,,31,12.40,,26.35,85,,21.08,percent of total billed charges,85% of total billed charges,23.87,77,,19.1,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,25.42,82,,20.336,percent of total billed charges,82% of total billed charges,26.35,85,,21.08,percent of total billed charges,85% of total billed charges,26.35,85,,21.08,percent of total billed charges,85% of total billed charges,26.35,85,,21.08,percent of total billed charges,85% of total billed charges,27.9,90,,22.32,percent of total billed charges,90% of total billed charges,24.8,80,,19.84,percent of total billed charges,80% of total billed charges,27.9,90,,22.32,percent of total billed charges,90% of total billed charges,23.25,75,,18.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,8.99,29,,7.192,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,20.77,67,,16.616,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,24.8,80,,19.84,percent of total billed charges,80% of total billed charges,20.15,65,,16.12,percent of total billed charges,65% of total billed charges,11.06,35.67,,8.848,percent of total billed charges,35.67% of total billed charges,8.99,27.9,
OSTOMY IRRIG SLEEVE 2 3/4 **,27000665,CDM,272,RC,,,outpatient,,,54,21.60,,45.9,85,,36.72,percent of total billed charges,85% of total billed charges,41.58,77,,33.26,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,44.28,82,,35.424,percent of total billed charges,82% of total billed charges,45.9,85,,36.72,percent of total billed charges,85% of total billed charges,45.9,85,,36.72,percent of total billed charges,85% of total billed charges,45.9,85,,36.72,percent of total billed charges,85% of total billed charges,48.6,90,,38.88,percent of total billed charges,90% of total billed charges,43.2,80,,34.56,percent of total billed charges,80% of total billed charges,48.6,90,,38.88,percent of total billed charges,90% of total billed charges,40.5,75,,32.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,15.66,29,,12.528,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,36.18,67,,28.944,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,43.2,80,,34.56,percent of total billed charges,80% of total billed charges,35.1,65,,28.08,percent of total billed charges,65% of total billed charges,19.26,35.67,,15.408,percent of total billed charges,35.67% of total billed charges,15.66,48.6,
SKIN PREP BARRIER WIPES **,27000669,CDM,272,RC,,,outpatient,,,7,2.80,,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.39,77,,4.31,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,5.74,82,,4.592,percent of total billed charges,82% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.25,75,,4.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.03,29,,1.624,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4.69,67,,3.752,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,4.55,65,,3.64,percent of total billed charges,65% of total billed charges,2.5,35.67,,2,percent of total billed charges,35.67% of total billed charges,2.03,6.3,
RECTAL TUBE 24 FR,27000680,CDM,272,RC,,,outpatient,,,14,5.60,,11.9,85,,9.52,percent of total billed charges,85% of total billed charges,10.78,77,,8.62,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,11.48,82,,9.184,percent of total billed charges,82% of total billed charges,11.9,85,,9.52,percent of total billed charges,85% of total billed charges,11.9,85,,9.52,percent of total billed charges,85% of total billed charges,11.9,85,,9.52,percent of total billed charges,85% of total billed charges,12.6,90,,10.08,percent of total billed charges,90% of total billed charges,11.2,80,,8.96,percent of total billed charges,80% of total billed charges,12.6,90,,10.08,percent of total billed charges,90% of total billed charges,10.5,75,,8.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,4.06,29,,3.248,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,9.38,67,,7.504,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,11.2,80,,8.96,percent of total billed charges,80% of total billed charges,9.1,65,,7.28,percent of total billed charges,65% of total billed charges,4.99,35.67,,3.992,percent of total billed charges,35.67% of total billed charges,4.06,12.6,
CATHETER PLUG,27000682,CDM,272,RC,,,outpatient,,,10,4.00,,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,7.7,77,,6.16,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,8.2,82,,6.56,percent of total billed charges,82% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,9,90,,7.2,percent of total billed charges,90% of total billed charges,8,80,,6.4,percent of total billed charges,80% of total billed charges,9,90,,7.2,percent of total billed charges,90% of total billed charges,7.5,75,,6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.9,29,,2.32,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,6.7,67,,5.36,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,8,80,,6.4,percent of total billed charges,80% of total billed charges,6.5,65,,5.2,percent of total billed charges,65% of total billed charges,3.57,35.67,,2.856,percent of total billed charges,35.67% of total billed charges,2.9,9,
GRAVITY FEEDING SET **,27000686,CDM,272,RC,,,outpatient,,,30,12.00,,25.5,85,,20.4,percent of total billed charges,85% of total billed charges,23.1,77,,18.48,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,24.6,82,,19.68,percent of total billed charges,82% of total billed charges,25.5,85,,20.4,percent of total billed charges,85% of total billed charges,25.5,85,,20.4,percent of total billed charges,85% of total billed charges,25.5,85,,20.4,percent of total billed charges,85% of total billed charges,27,90,,21.6,percent of total billed charges,90% of total billed charges,24,80,,19.2,percent of total billed charges,80% of total billed charges,27,90,,21.6,percent of total billed charges,90% of total billed charges,22.5,75,,18,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,8.7,29,,6.96,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,20.1,67,,16.08,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,24,80,,19.2,percent of total billed charges,80% of total billed charges,19.5,65,,15.6,percent of total billed charges,65% of total billed charges,10.7,35.67,,8.56,percent of total billed charges,35.67% of total billed charges,8.7,27,
BULB SYRINGE,27000688,CDM,272,RC,,,outpatient,,,58,23.20,,49.3,85,,39.44,percent of total billed charges,85% of total billed charges,44.66,77,,35.73,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,47.56,82,,38.048,percent of total billed charges,82% of total billed charges,49.3,85,,39.44,percent of total billed charges,85% of total billed charges,49.3,85,,39.44,percent of total billed charges,85% of total billed charges,49.3,85,,39.44,percent of total billed charges,85% of total billed charges,52.2,90,,41.76,percent of total billed charges,90% of total billed charges,46.4,80,,37.12,percent of total billed charges,80% of total billed charges,52.2,90,,41.76,percent of total billed charges,90% of total billed charges,43.5,75,,34.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,16.82,29,,13.456,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,38.86,67,,31.088,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,46.4,80,,37.12,percent of total billed charges,80% of total billed charges,37.7,65,,30.16,percent of total billed charges,65% of total billed charges,20.69,35.67,,16.552,percent of total billed charges,35.67% of total billed charges,16.82,52.2,
SUCTION CATHETER 10FR,27000691,CDM,272,RC,,,outpatient,,,10,4.00,,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,7.7,77,,6.16,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,8.2,82,,6.56,percent of total billed charges,82% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,9,90,,7.2,percent of total billed charges,90% of total billed charges,8,80,,6.4,percent of total billed charges,80% of total billed charges,9,90,,7.2,percent of total billed charges,90% of total billed charges,7.5,75,,6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.9,29,,2.32,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,6.7,67,,5.36,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,8,80,,6.4,percent of total billed charges,80% of total billed charges,6.5,65,,5.2,percent of total billed charges,65% of total billed charges,3.57,35.67,,2.856,percent of total billed charges,35.67% of total billed charges,2.9,9,
FLATUS BAG 24 FR **,27000693,CDM,272,RC,,,outpatient,,,13,5.20,,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,10.01,77,,8.01,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,10.66,82,,8.528,percent of total billed charges,82% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,11.7,90,,9.36,percent of total billed charges,90% of total billed charges,10.4,80,,8.32,percent of total billed charges,80% of total billed charges,11.7,90,,9.36,percent of total billed charges,90% of total billed charges,9.75,75,,7.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,3.77,29,,3.016,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,8.71,67,,6.968,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,10.4,80,,8.32,percent of total billed charges,80% of total billed charges,8.45,65,,6.76,percent of total billed charges,65% of total billed charges,4.64,35.67,,3.712,percent of total billed charges,35.67% of total billed charges,3.77,11.7,
TUR SYSTEM FLOW POUCH **,27000694,CDM,272,RC,,,outpatient,,,93,37.20,,79.05,85,,63.24,percent of total billed charges,85% of total billed charges,71.61,77,,57.29,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,76.26,82,,61.008,percent of total billed charges,82% of total billed charges,79.05,85,,63.24,percent of total billed charges,85% of total billed charges,79.05,85,,63.24,percent of total billed charges,85% of total billed charges,79.05,85,,63.24,percent of total billed charges,85% of total billed charges,83.7,90,,66.96,percent of total billed charges,90% of total billed charges,74.4,80,,59.52,percent of total billed charges,80% of total billed charges,83.7,90,,66.96,percent of total billed charges,90% of total billed charges,69.75,75,,55.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,26.97,29,,21.576,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,62.31,67,,49.848,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,74.4,80,,59.52,percent of total billed charges,80% of total billed charges,60.45,65,,48.36,percent of total billed charges,65% of total billed charges,33.17,35.67,,26.536,percent of total billed charges,35.67% of total billed charges,26.97,83.7,
CVP DRESSING TRAY,27000695,CDM,272,RC,,,outpatient,,,57,22.80,,48.45,85,,38.76,percent of total billed charges,85% of total billed charges,43.89,77,,35.11,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,46.74,82,,37.392,percent of total billed charges,82% of total billed charges,48.45,85,,38.76,percent of total billed charges,85% of total billed charges,48.45,85,,38.76,percent of total billed charges,85% of total billed charges,48.45,85,,38.76,percent of total billed charges,85% of total billed charges,51.3,90,,41.04,percent of total billed charges,90% of total billed charges,45.6,80,,36.48,percent of total billed charges,80% of total billed charges,51.3,90,,41.04,percent of total billed charges,90% of total billed charges,42.75,75,,34.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,16.53,29,,13.224,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,38.19,67,,30.552,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,45.6,80,,36.48,percent of total billed charges,80% of total billed charges,37.05,65,,29.64,percent of total billed charges,65% of total billed charges,20.33,35.67,,16.264,percent of total billed charges,35.67% of total billed charges,16.53,51.3,
CUTDOWN CATHETER 16G **,27000697,CDM,272,RC,,,outpatient,,,46,18.40,,39.1,85,,31.28,percent of total billed charges,85% of total billed charges,35.42,77,,28.34,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,37.72,82,,30.176,percent of total billed charges,82% of total billed charges,39.1,85,,31.28,percent of total billed charges,85% of total billed charges,39.1,85,,31.28,percent of total billed charges,85% of total billed charges,39.1,85,,31.28,percent of total billed charges,85% of total billed charges,41.4,90,,33.12,percent of total billed charges,90% of total billed charges,36.8,80,,29.44,percent of total billed charges,80% of total billed charges,41.4,90,,33.12,percent of total billed charges,90% of total billed charges,34.5,75,,27.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,13.34,29,,10.672,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,30.82,67,,24.656,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,36.8,80,,29.44,percent of total billed charges,80% of total billed charges,29.9,65,,23.92,percent of total billed charges,65% of total billed charges,16.41,35.67,,13.128,percent of total billed charges,35.67% of total billed charges,13.34,41.4,
EYE PRESS PATCH **,27000699,CDM,272,RC,,,outpatient,,,64,25.60,,54.4,85,,43.52,percent of total billed charges,85% of total billed charges,49.28,77,,39.42,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,52.48,82,,41.984,percent of total billed charges,82% of total billed charges,54.4,85,,43.52,percent of total billed charges,85% of total billed charges,54.4,85,,43.52,percent of total billed charges,85% of total billed charges,54.4,85,,43.52,percent of total billed charges,85% of total billed charges,57.6,90,,46.08,percent of total billed charges,90% of total billed charges,51.2,80,,40.96,percent of total billed charges,80% of total billed charges,57.6,90,,46.08,percent of total billed charges,90% of total billed charges,48,75,,38.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,18.56,29,,14.848,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,42.88,67,,34.304,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,51.2,80,,40.96,percent of total billed charges,80% of total billed charges,41.6,65,,33.28,percent of total billed charges,65% of total billed charges,22.83,35.67,,18.264,percent of total billed charges,35.67% of total billed charges,18.56,57.6,
PENROSE DRAIN 18 x 1/2,27000701,CDM,272,RC,,,outpatient,,,27,10.80,,22.95,85,,18.36,percent of total billed charges,85% of total billed charges,20.79,77,,16.63,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,22.14,82,,17.712,percent of total billed charges,82% of total billed charges,22.95,85,,18.36,percent of total billed charges,85% of total billed charges,22.95,85,,18.36,percent of total billed charges,85% of total billed charges,22.95,85,,18.36,percent of total billed charges,85% of total billed charges,24.3,90,,19.44,percent of total billed charges,90% of total billed charges,21.6,80,,17.28,percent of total billed charges,80% of total billed charges,24.3,90,,19.44,percent of total billed charges,90% of total billed charges,20.25,75,,16.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,7.83,29,,6.264,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,18.09,67,,14.472,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,21.6,80,,17.28,percent of total billed charges,80% of total billed charges,17.55,65,,14.04,percent of total billed charges,65% of total billed charges,9.63,35.67,,7.704,percent of total billed charges,35.67% of total billed charges,7.83,24.3,
SYRINGE 60CC,27000702,CDM,272,RC,,,outpatient,,,8,3.20,,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,6.16,77,,4.93,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,6.56,82,,5.248,percent of total billed charges,82% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,7.2,90,,5.76,percent of total billed charges,90% of total billed charges,6.4,80,,5.12,percent of total billed charges,80% of total billed charges,7.2,90,,5.76,percent of total billed charges,90% of total billed charges,6,75,,4.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.32,29,,1.856,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,5.36,67,,4.288,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,6.4,80,,5.12,percent of total billed charges,80% of total billed charges,5.2,65,,4.16,percent of total billed charges,65% of total billed charges,2.85,35.67,,2.28,percent of total billed charges,35.67% of total billed charges,2.32,7.2,
CORD CLAMP,27000705,CDM,272,RC,,,outpatient,,,13,5.20,,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,10.01,77,,8.01,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,10.66,82,,8.528,percent of total billed charges,82% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,11.7,90,,9.36,percent of total billed charges,90% of total billed charges,10.4,80,,8.32,percent of total billed charges,80% of total billed charges,11.7,90,,9.36,percent of total billed charges,90% of total billed charges,9.75,75,,7.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,3.77,29,,3.016,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,8.71,67,,6.968,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,10.4,80,,8.32,percent of total billed charges,80% of total billed charges,8.45,65,,6.76,percent of total billed charges,65% of total billed charges,4.64,35.67,,3.712,percent of total billed charges,35.67% of total billed charges,3.77,11.7,
AMNIHOOK,27000706,CDM,272,RC,,,outpatient,,,25,10.00,,21.25,85,,17,percent of total billed charges,85% of total billed charges,19.25,77,,15.4,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,20.5,82,,16.4,percent of total billed charges,82% of total billed charges,21.25,85,,17,percent of total billed charges,85% of total billed charges,21.25,85,,17,percent of total billed charges,85% of total billed charges,21.25,85,,17,percent of total billed charges,85% of total billed charges,22.5,90,,18,percent of total billed charges,90% of total billed charges,20,80,,16,percent of total billed charges,80% of total billed charges,22.5,90,,18,percent of total billed charges,90% of total billed charges,18.75,75,,15,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,7.25,29,,5.8,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,16.75,67,,13.4,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,20,80,,16,percent of total billed charges,80% of total billed charges,16.25,65,,13,percent of total billed charges,65% of total billed charges,8.92,35.67,,7.136,percent of total billed charges,35.67% of total billed charges,7.25,22.5,
TUBE CONNECTOR,27000712,CDM,272,RC,,,outpatient,,,15,6.00,,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,11.55,77,,9.24,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,12.3,82,,9.84,percent of total billed charges,82% of total billed charges,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,13.5,90,,10.8,percent of total billed charges,90% of total billed charges,12,80,,9.6,percent of total billed charges,80% of total billed charges,13.5,90,,10.8,percent of total billed charges,90% of total billed charges,11.25,75,,9,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,4.35,29,,3.48,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,10.05,67,,8.04,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,12,80,,9.6,percent of total billed charges,80% of total billed charges,9.75,65,,7.8,percent of total billed charges,65% of total billed charges,5.35,35.67,,4.28,percent of total billed charges,35.67% of total billed charges,4.35,13.5,
TWIN CATH 20/22,27000721,CDM,272,RC,,,outpatient,,,139,55.60,,118.15,85,,94.52,percent of total billed charges,85% of total billed charges,107.03,77,,85.62,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,113.98,82,,91.184,percent of total billed charges,82% of total billed charges,118.15,85,,94.52,percent of total billed charges,85% of total billed charges,118.15,85,,94.52,percent of total billed charges,85% of total billed charges,118.15,85,,94.52,percent of total billed charges,85% of total billed charges,125.1,90,,100.08,percent of total billed charges,90% of total billed charges,111.2,80,,88.96,percent of total billed charges,80% of total billed charges,125.1,90,,100.08,percent of total billed charges,90% of total billed charges,104.25,75,,83.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,40.31,29,,32.248,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,93.13,67,,74.504,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,111.2,80,,88.96,percent of total billed charges,80% of total billed charges,90.35,65,,72.28,percent of total billed charges,65% of total billed charges,49.58,35.67,,39.664,percent of total billed charges,35.67% of total billed charges,40.31,125.1,
CATHETER TRAY SUPR 12FR,27000724,CDM,272,RC,,,outpatient,,,432,172.80,,367.2,85,,293.76,percent of total billed charges,85% of total billed charges,332.64,77,,266.11,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,354.24,82,,283.392,percent of total billed charges,82% of total billed charges,367.2,85,,293.76,percent of total billed charges,85% of total billed charges,367.2,85,,293.76,percent of total billed charges,85% of total billed charges,367.2,85,,293.76,percent of total billed charges,85% of total billed charges,388.8,90,,311.04,percent of total billed charges,90% of total billed charges,345.6,80,,276.48,percent of total billed charges,80% of total billed charges,388.8,90,,311.04,percent of total billed charges,90% of total billed charges,324,75,,259.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,125.28,29,,100.224,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,289.44,67,,231.552,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,345.6,80,,276.48,percent of total billed charges,80% of total billed charges,280.8,65,,224.64,percent of total billed charges,65% of total billed charges,154.09,35.67,,123.272,percent of total billed charges,35.67% of total billed charges,125.28,388.8,
MORGAN MEDI-FLOW LENS,27000726,CDM,272,RC,,,outpatient,,,216,86.40,,183.6,85,,146.88,percent of total billed charges,85% of total billed charges,166.32,77,,133.06,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,177.12,82,,141.696,percent of total billed charges,82% of total billed charges,183.6,85,,146.88,percent of total billed charges,85% of total billed charges,183.6,85,,146.88,percent of total billed charges,85% of total billed charges,183.6,85,,146.88,percent of total billed charges,85% of total billed charges,194.4,90,,155.52,percent of total billed charges,90% of total billed charges,172.8,80,,138.24,percent of total billed charges,80% of total billed charges,194.4,90,,155.52,percent of total billed charges,90% of total billed charges,162,75,,129.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,62.64,29,,50.112,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,144.72,67,,115.776,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,172.8,80,,138.24,percent of total billed charges,80% of total billed charges,140.4,65,,112.32,percent of total billed charges,65% of total billed charges,77.05,35.67,,61.64,percent of total billed charges,35.67% of total billed charges,62.64,194.4,
NASAL PACKING 8.0,27000728,CDM,272,RC,,,outpatient,,,74,29.60,,62.9,85,,50.32,percent of total billed charges,85% of total billed charges,56.98,77,,45.58,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,60.68,82,,48.544,percent of total billed charges,82% of total billed charges,62.9,85,,50.32,percent of total billed charges,85% of total billed charges,62.9,85,,50.32,percent of total billed charges,85% of total billed charges,62.9,85,,50.32,percent of total billed charges,85% of total billed charges,66.6,90,,53.28,percent of total billed charges,90% of total billed charges,59.2,80,,47.36,percent of total billed charges,80% of total billed charges,66.6,90,,53.28,percent of total billed charges,90% of total billed charges,55.5,75,,44.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,21.46,29,,17.168,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,49.58,67,,39.664,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,59.2,80,,47.36,percent of total billed charges,80% of total billed charges,48.1,65,,38.48,percent of total billed charges,65% of total billed charges,26.4,35.67,,21.12,percent of total billed charges,35.67% of total billed charges,21.46,66.6,
XEROFORM PETRO DRESSING 1X8,27000733,CDM,272,RC,,,outpatient,,,10,4.00,,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,7.7,77,,6.16,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,8.2,82,,6.56,percent of total billed charges,82% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,9,90,,7.2,percent of total billed charges,90% of total billed charges,8,80,,6.4,percent of total billed charges,80% of total billed charges,9,90,,7.2,percent of total billed charges,90% of total billed charges,7.5,75,,6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.9,29,,2.32,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,6.7,67,,5.36,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,8,80,,6.4,percent of total billed charges,80% of total billed charges,6.5,65,,5.2,percent of total billed charges,65% of total billed charges,3.57,35.67,,2.856,percent of total billed charges,35.67% of total billed charges,2.9,9,
XEROFORM PETRO DRESSING 2X2,27000734,CDM,272,RC,,,outpatient,,,10,4.00,,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,7.7,77,,6.16,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,8.2,82,,6.56,percent of total billed charges,82% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,9,90,,7.2,percent of total billed charges,90% of total billed charges,8,80,,6.4,percent of total billed charges,80% of total billed charges,9,90,,7.2,percent of total billed charges,90% of total billed charges,7.5,75,,6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.9,29,,2.32,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,6.7,67,,5.36,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,8,80,,6.4,percent of total billed charges,80% of total billed charges,6.5,65,,5.2,percent of total billed charges,65% of total billed charges,3.57,35.67,,2.856,percent of total billed charges,35.67% of total billed charges,2.9,9,
XEROFORM PETRO DRESSING 4X4,27000735,CDM,272,RC,,,outpatient,,,13,5.20,,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,10.01,77,,8.01,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,10.66,82,,8.528,percent of total billed charges,82% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,11.7,90,,9.36,percent of total billed charges,90% of total billed charges,10.4,80,,8.32,percent of total billed charges,80% of total billed charges,11.7,90,,9.36,percent of total billed charges,90% of total billed charges,9.75,75,,7.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,3.77,29,,3.016,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,8.71,67,,6.968,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,10.4,80,,8.32,percent of total billed charges,80% of total billed charges,8.45,65,,6.76,percent of total billed charges,65% of total billed charges,4.64,35.67,,3.712,percent of total billed charges,35.67% of total billed charges,3.77,11.7,
BREAST SHIELD REGULAR,27000750,CDM,272,RC,,,outpatient,,,53,21.20,,45.05,85,,36.04,percent of total billed charges,85% of total billed charges,40.81,77,,32.65,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,43.46,82,,34.768,percent of total billed charges,82% of total billed charges,45.05,85,,36.04,percent of total billed charges,85% of total billed charges,45.05,85,,36.04,percent of total billed charges,85% of total billed charges,45.05,85,,36.04,percent of total billed charges,85% of total billed charges,47.7,90,,38.16,percent of total billed charges,90% of total billed charges,42.4,80,,33.92,percent of total billed charges,80% of total billed charges,47.7,90,,38.16,percent of total billed charges,90% of total billed charges,39.75,75,,31.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,15.37,29,,12.296,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,35.51,67,,28.408,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,42.4,80,,33.92,percent of total billed charges,80% of total billed charges,34.45,65,,27.56,percent of total billed charges,65% of total billed charges,18.91,35.67,,15.128,percent of total billed charges,35.67% of total billed charges,15.37,47.7,
TEGADERM DRESSING SMALL,27000779,CDM,272,RC,,,outpatient,,,7,2.80,,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.39,77,,4.31,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,5.74,82,,4.592,percent of total billed charges,82% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.25,75,,4.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.03,29,,1.624,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4.69,67,,3.752,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,4.55,65,,3.64,percent of total billed charges,65% of total billed charges,2.5,35.67,,2,percent of total billed charges,35.67% of total billed charges,2.03,6.3,
TEGADERM DRESSING MEDIUM,27000780,CDM,272,RC,,,outpatient,,,13,5.20,,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,10.01,77,,8.01,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,10.66,82,,8.528,percent of total billed charges,82% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,11.7,90,,9.36,percent of total billed charges,90% of total billed charges,10.4,80,,8.32,percent of total billed charges,80% of total billed charges,11.7,90,,9.36,percent of total billed charges,90% of total billed charges,9.75,75,,7.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,3.77,29,,3.016,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,8.71,67,,6.968,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,10.4,80,,8.32,percent of total billed charges,80% of total billed charges,8.45,65,,6.76,percent of total billed charges,65% of total billed charges,4.64,35.67,,3.712,percent of total billed charges,35.67% of total billed charges,3.77,11.7,
TEGADERM DRESSING LG,27000781,CDM,272,RC,,,outpatient,,,23,9.20,,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,17.71,77,,14.17,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,18.86,82,,15.088,percent of total billed charges,82% of total billed charges,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,20.7,90,,16.56,percent of total billed charges,90% of total billed charges,18.4,80,,14.72,percent of total billed charges,80% of total billed charges,20.7,90,,16.56,percent of total billed charges,90% of total billed charges,17.25,75,,13.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,6.67,29,,5.336,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,15.41,67,,12.328,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,18.4,80,,14.72,percent of total billed charges,80% of total billed charges,14.95,65,,11.96,percent of total billed charges,65% of total billed charges,8.2,35.67,,6.56,percent of total billed charges,35.67% of total billed charges,6.67,20.7,
PLAIN PACKING GAUZE 1/2,27000792,CDM,272,RC,,,outpatient,,,31,12.40,,26.35,85,,21.08,percent of total billed charges,85% of total billed charges,23.87,77,,19.1,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,25.42,82,,20.336,percent of total billed charges,82% of total billed charges,26.35,85,,21.08,percent of total billed charges,85% of total billed charges,26.35,85,,21.08,percent of total billed charges,85% of total billed charges,26.35,85,,21.08,percent of total billed charges,85% of total billed charges,27.9,90,,22.32,percent of total billed charges,90% of total billed charges,24.8,80,,19.84,percent of total billed charges,80% of total billed charges,27.9,90,,22.32,percent of total billed charges,90% of total billed charges,23.25,75,,18.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,8.99,29,,7.192,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,20.77,67,,16.616,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,24.8,80,,19.84,percent of total billed charges,80% of total billed charges,20.15,65,,16.12,percent of total billed charges,65% of total billed charges,11.06,35.67,,8.848,percent of total billed charges,35.67% of total billed charges,8.99,27.9,
PLAIN PACKING GAUZE 1,27000793,CDM,272,RC,,,outpatient,,,38,15.20,,32.3,85,,25.84,percent of total billed charges,85% of total billed charges,29.26,77,,23.41,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,31.16,82,,24.928,percent of total billed charges,82% of total billed charges,32.3,85,,25.84,percent of total billed charges,85% of total billed charges,32.3,85,,25.84,percent of total billed charges,85% of total billed charges,32.3,85,,25.84,percent of total billed charges,85% of total billed charges,34.2,90,,27.36,percent of total billed charges,90% of total billed charges,30.4,80,,24.32,percent of total billed charges,80% of total billed charges,34.2,90,,27.36,percent of total billed charges,90% of total billed charges,28.5,75,,22.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,11.02,29,,8.816,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,25.46,67,,20.368,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,30.4,80,,24.32,percent of total billed charges,80% of total billed charges,24.7,65,,19.76,percent of total billed charges,65% of total billed charges,13.55,35.67,,10.84,percent of total billed charges,35.67% of total billed charges,11.02,34.2,
IODOFORM PACKING GUAZE 1/2,27000794,CDM,272,RC,,,outpatient,,,40,16.00,,34,85,,27.2,percent of total billed charges,85% of total billed charges,30.8,77,,24.64,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,32.8,82,,26.24,percent of total billed charges,82% of total billed charges,34,85,,27.2,percent of total billed charges,85% of total billed charges,34,85,,27.2,percent of total billed charges,85% of total billed charges,34,85,,27.2,percent of total billed charges,85% of total billed charges,36,90,,28.8,percent of total billed charges,90% of total billed charges,32,80,,25.6,percent of total billed charges,80% of total billed charges,36,90,,28.8,percent of total billed charges,90% of total billed charges,30,75,,24,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,11.6,29,,9.28,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,26.8,67,,21.44,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,32,80,,25.6,percent of total billed charges,80% of total billed charges,26,65,,20.8,percent of total billed charges,65% of total billed charges,14.27,35.67,,11.416,percent of total billed charges,35.67% of total billed charges,11.6,36,
IODOFORM PACKING GAUZE 1,27000795,CDM,272,RC,,,outpatient,,,43,17.20,,36.55,85,,29.24,percent of total billed charges,85% of total billed charges,33.11,77,,26.49,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,35.26,82,,28.208,percent of total billed charges,82% of total billed charges,36.55,85,,29.24,percent of total billed charges,85% of total billed charges,36.55,85,,29.24,percent of total billed charges,85% of total billed charges,36.55,85,,29.24,percent of total billed charges,85% of total billed charges,38.7,90,,30.96,percent of total billed charges,90% of total billed charges,34.4,80,,27.52,percent of total billed charges,80% of total billed charges,38.7,90,,30.96,percent of total billed charges,90% of total billed charges,32.25,75,,25.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,12.47,29,,9.976,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,28.81,67,,23.048,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,34.4,80,,27.52,percent of total billed charges,80% of total billed charges,27.95,65,,22.36,percent of total billed charges,65% of total billed charges,15.34,35.67,,12.272,percent of total billed charges,35.67% of total billed charges,12.47,38.7,
IODOFORM PACKING GAUZE 2,27000796,CDM,272,RC,,,outpatient,,,56,22.40,,47.6,85,,38.08,percent of total billed charges,85% of total billed charges,43.12,77,,34.5,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,45.92,82,,36.736,percent of total billed charges,82% of total billed charges,47.6,85,,38.08,percent of total billed charges,85% of total billed charges,47.6,85,,38.08,percent of total billed charges,85% of total billed charges,47.6,85,,38.08,percent of total billed charges,85% of total billed charges,50.4,90,,40.32,percent of total billed charges,90% of total billed charges,44.8,80,,35.84,percent of total billed charges,80% of total billed charges,50.4,90,,40.32,percent of total billed charges,90% of total billed charges,42,75,,33.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,16.24,29,,12.992,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,37.52,67,,30.016,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,44.8,80,,35.84,percent of total billed charges,80% of total billed charges,36.4,65,,29.12,percent of total billed charges,65% of total billed charges,19.98,35.67,,15.984,percent of total billed charges,35.67% of total billed charges,16.24,50.4,
DEFIBRILLATION PAD **,27000797,CDM,272,RC,,,outpatient,,,66,26.40,,56.1,85,,44.88,percent of total billed charges,85% of total billed charges,50.82,77,,40.66,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,54.12,82,,43.296,percent of total billed charges,82% of total billed charges,56.1,85,,44.88,percent of total billed charges,85% of total billed charges,56.1,85,,44.88,percent of total billed charges,85% of total billed charges,56.1,85,,44.88,percent of total billed charges,85% of total billed charges,59.4,90,,47.52,percent of total billed charges,90% of total billed charges,52.8,80,,42.24,percent of total billed charges,80% of total billed charges,59.4,90,,47.52,percent of total billed charges,90% of total billed charges,49.5,75,,39.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,19.14,29,,15.312,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,44.22,67,,35.376,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,52.8,80,,42.24,percent of total billed charges,80% of total billed charges,42.9,65,,34.32,percent of total billed charges,65% of total billed charges,23.54,35.67,,18.832,percent of total billed charges,35.67% of total billed charges,19.14,59.4,
QUICK PACE PACING ELECTRODE,27000798,CDM,272,RC,,,outpatient,,,445,178.00,,378.25,85,,302.6,percent of total billed charges,85% of total billed charges,342.65,77,,274.12,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,364.9,82,,291.92,percent of total billed charges,82% of total billed charges,378.25,85,,302.6,percent of total billed charges,85% of total billed charges,378.25,85,,302.6,percent of total billed charges,85% of total billed charges,378.25,85,,302.6,percent of total billed charges,85% of total billed charges,400.5,90,,320.4,percent of total billed charges,90% of total billed charges,356,80,,284.8,percent of total billed charges,80% of total billed charges,400.5,90,,320.4,percent of total billed charges,90% of total billed charges,333.75,75,,267,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,129.05,29,,103.24,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,298.15,67,,238.52,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,356,80,,284.8,percent of total billed charges,80% of total billed charges,289.25,65,,231.4,percent of total billed charges,65% of total billed charges,158.73,35.67,,126.984,percent of total billed charges,35.67% of total billed charges,129.05,400.5,
ENDOMETRIAL SUCTION CURRETT,27000799,CDM,272,RC,,,outpatient,,,105,42.00,,89.25,85,,71.4,percent of total billed charges,85% of total billed charges,80.85,77,,64.68,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,86.1,82,,68.88,percent of total billed charges,82% of total billed charges,89.25,85,,71.4,percent of total billed charges,85% of total billed charges,89.25,85,,71.4,percent of total billed charges,85% of total billed charges,89.25,85,,71.4,percent of total billed charges,85% of total billed charges,94.5,90,,75.6,percent of total billed charges,90% of total billed charges,84,80,,67.2,percent of total billed charges,80% of total billed charges,94.5,90,,75.6,percent of total billed charges,90% of total billed charges,78.75,75,,63,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,30.45,29,,24.36,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,70.35,67,,56.28,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,84,80,,67.2,percent of total billed charges,80% of total billed charges,68.25,65,,54.6,percent of total billed charges,65% of total billed charges,37.45,35.67,,29.96,percent of total billed charges,35.67% of total billed charges,30.45,94.5,
BUTTERFLY NEEDLE 21G **,27000802,CDM,272,RC,,,outpatient,,,10,4.00,,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,7.7,77,,6.16,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,8.2,82,,6.56,percent of total billed charges,82% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,9,90,,7.2,percent of total billed charges,90% of total billed charges,8,80,,6.4,percent of total billed charges,80% of total billed charges,9,90,,7.2,percent of total billed charges,90% of total billed charges,7.5,75,,6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.9,29,,2.32,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,6.7,67,,5.36,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,8,80,,6.4,percent of total billed charges,80% of total billed charges,6.5,65,,5.2,percent of total billed charges,65% of total billed charges,3.57,35.67,,2.856,percent of total billed charges,35.67% of total billed charges,2.9,9,
BUTTERFLY NEEDLE 23G X 3/4,27000803,CDM,272,RC,,,outpatient,,,17,6.80,,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,13.09,77,,10.47,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,13.94,82,,11.152,percent of total billed charges,82% of total billed charges,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,15.3,90,,12.24,percent of total billed charges,90% of total billed charges,13.6,80,,10.88,percent of total billed charges,80% of total billed charges,15.3,90,,12.24,percent of total billed charges,90% of total billed charges,12.75,75,,10.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,4.93,29,,3.944,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,11.39,67,,9.112,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,13.6,80,,10.88,percent of total billed charges,80% of total billed charges,11.05,65,,8.84,percent of total billed charges,65% of total billed charges,6.06,35.67,,4.848,percent of total billed charges,35.67% of total billed charges,4.93,15.3,
BUTTERFLY NEEDLE 25G 3/8 **,27000804,CDM,272,RC,,,outpatient,,,16,6.40,,13.6,85,,10.88,percent of total billed charges,85% of total billed charges,12.32,77,,9.86,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,13.12,82,,10.496,percent of total billed charges,82% of total billed charges,13.6,85,,10.88,percent of total billed charges,85% of total billed charges,13.6,85,,10.88,percent of total billed charges,85% of total billed charges,13.6,85,,10.88,percent of total billed charges,85% of total billed charges,14.4,90,,11.52,percent of total billed charges,90% of total billed charges,12.8,80,,10.24,percent of total billed charges,80% of total billed charges,14.4,90,,11.52,percent of total billed charges,90% of total billed charges,12,75,,9.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,4.64,29,,3.712,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,10.72,67,,8.576,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,12.8,80,,10.24,percent of total billed charges,80% of total billed charges,10.4,65,,8.32,percent of total billed charges,65% of total billed charges,5.71,35.67,,4.568,percent of total billed charges,35.67% of total billed charges,4.64,14.4,
BUTTERFLY NEEDLE 25G 3/4,27000805,CDM,272,RC,,,outpatient,,,31,12.40,,26.35,85,,21.08,percent of total billed charges,85% of total billed charges,23.87,77,,19.1,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,25.42,82,,20.336,percent of total billed charges,82% of total billed charges,26.35,85,,21.08,percent of total billed charges,85% of total billed charges,26.35,85,,21.08,percent of total billed charges,85% of total billed charges,26.35,85,,21.08,percent of total billed charges,85% of total billed charges,27.9,90,,22.32,percent of total billed charges,90% of total billed charges,24.8,80,,19.84,percent of total billed charges,80% of total billed charges,27.9,90,,22.32,percent of total billed charges,90% of total billed charges,23.25,75,,18.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,8.99,29,,7.192,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,20.77,67,,16.616,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,24.8,80,,19.84,percent of total billed charges,80% of total billed charges,20.15,65,,16.12,percent of total billed charges,65% of total billed charges,11.06,35.67,,8.848,percent of total billed charges,35.67% of total billed charges,8.99,27.9,
TRACH CLEANING TRAY,27000813,CDM,272,RC,,,outpatient,,,47,18.80,,39.95,85,,31.96,percent of total billed charges,85% of total billed charges,36.19,77,,28.95,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,38.54,82,,30.832,percent of total billed charges,82% of total billed charges,39.95,85,,31.96,percent of total billed charges,85% of total billed charges,39.95,85,,31.96,percent of total billed charges,85% of total billed charges,39.95,85,,31.96,percent of total billed charges,85% of total billed charges,42.3,90,,33.84,percent of total billed charges,90% of total billed charges,37.6,80,,30.08,percent of total billed charges,80% of total billed charges,42.3,90,,33.84,percent of total billed charges,90% of total billed charges,35.25,75,,28.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,13.63,29,,10.904,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,31.49,67,,25.192,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,37.6,80,,30.08,percent of total billed charges,80% of total billed charges,30.55,65,,24.44,percent of total billed charges,65% of total billed charges,16.76,35.67,,13.408,percent of total billed charges,35.67% of total billed charges,13.63,42.3,
DOBBHOFF FEEDING TUBE,27000817,CDM,272,RC,,,outpatient,,,109,43.60,,92.65,85,,74.12,percent of total billed charges,85% of total billed charges,83.93,77,,67.14,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,89.38,82,,71.504,percent of total billed charges,82% of total billed charges,92.65,85,,74.12,percent of total billed charges,85% of total billed charges,92.65,85,,74.12,percent of total billed charges,85% of total billed charges,92.65,85,,74.12,percent of total billed charges,85% of total billed charges,98.1,90,,78.48,percent of total billed charges,90% of total billed charges,87.2,80,,69.76,percent of total billed charges,80% of total billed charges,98.1,90,,78.48,percent of total billed charges,90% of total billed charges,81.75,75,,65.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,31.61,29,,25.288,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,73.03,67,,58.424,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,87.2,80,,69.76,percent of total billed charges,80% of total billed charges,70.85,65,,56.68,percent of total billed charges,65% of total billed charges,38.88,35.67,,31.104,percent of total billed charges,35.67% of total billed charges,31.61,98.1,
IV EXTENSION SET,27000820,CDM,272,RC,,,outpatient,,,13,5.20,,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,10.01,77,,8.01,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,10.66,82,,8.528,percent of total billed charges,82% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,11.7,90,,9.36,percent of total billed charges,90% of total billed charges,10.4,80,,8.32,percent of total billed charges,80% of total billed charges,11.7,90,,9.36,percent of total billed charges,90% of total billed charges,9.75,75,,7.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,3.77,29,,3.016,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,8.71,67,,6.968,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,10.4,80,,8.32,percent of total billed charges,80% of total billed charges,8.45,65,,6.76,percent of total billed charges,65% of total billed charges,4.64,35.67,,3.712,percent of total billed charges,35.67% of total billed charges,3.77,11.7,
RED CELL FILTER,27000823,CDM,272,RC,,,outpatient,,,59,23.60,,50.15,85,,40.12,percent of total billed charges,85% of total billed charges,45.43,77,,36.34,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,48.38,82,,38.704,percent of total billed charges,82% of total billed charges,50.15,85,,40.12,percent of total billed charges,85% of total billed charges,50.15,85,,40.12,percent of total billed charges,85% of total billed charges,50.15,85,,40.12,percent of total billed charges,85% of total billed charges,53.1,90,,42.48,percent of total billed charges,90% of total billed charges,47.2,80,,37.76,percent of total billed charges,80% of total billed charges,53.1,90,,42.48,percent of total billed charges,90% of total billed charges,44.25,75,,35.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,17.11,29,,13.688,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,39.53,67,,31.624,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,47.2,80,,37.76,percent of total billed charges,80% of total billed charges,38.35,65,,30.68,percent of total billed charges,65% of total billed charges,21.05,35.67,,16.84,percent of total billed charges,35.67% of total billed charges,17.11,53.1,
STOMACH TUBE 12FR,27000825,CDM,272,RC,,,outpatient,,,10,4.00,,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,7.7,77,,6.16,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,8.2,82,,6.56,percent of total billed charges,82% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,9,90,,7.2,percent of total billed charges,90% of total billed charges,8,80,,6.4,percent of total billed charges,80% of total billed charges,9,90,,7.2,percent of total billed charges,90% of total billed charges,7.5,75,,6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.9,29,,2.32,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,6.7,67,,5.36,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,8,80,,6.4,percent of total billed charges,80% of total billed charges,6.5,65,,5.2,percent of total billed charges,65% of total billed charges,3.57,35.67,,2.856,percent of total billed charges,35.67% of total billed charges,2.9,9,
FEEDING TUBE 8 FR,27000826,CDM,272,RC,,,outpatient,,,14,5.60,,11.9,85,,9.52,percent of total billed charges,85% of total billed charges,10.78,77,,8.62,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,11.48,82,,9.184,percent of total billed charges,82% of total billed charges,11.9,85,,9.52,percent of total billed charges,85% of total billed charges,11.9,85,,9.52,percent of total billed charges,85% of total billed charges,11.9,85,,9.52,percent of total billed charges,85% of total billed charges,12.6,90,,10.08,percent of total billed charges,90% of total billed charges,11.2,80,,8.96,percent of total billed charges,80% of total billed charges,12.6,90,,10.08,percent of total billed charges,90% of total billed charges,10.5,75,,8.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,4.06,29,,3.248,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,9.38,67,,7.504,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,11.2,80,,8.96,percent of total billed charges,80% of total billed charges,9.1,65,,7.28,percent of total billed charges,65% of total billed charges,4.99,35.67,,3.992,percent of total billed charges,35.67% of total billed charges,4.06,12.6,
STOMACH TUBE 14FR,27000827,CDM,272,RC,,,outpatient,,,18,7.20,,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,13.86,77,,11.09,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,14.76,82,,11.808,percent of total billed charges,82% of total billed charges,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,16.2,90,,12.96,percent of total billed charges,90% of total billed charges,14.4,80,,11.52,percent of total billed charges,80% of total billed charges,16.2,90,,12.96,percent of total billed charges,90% of total billed charges,13.5,75,,10.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,5.22,29,,4.176,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,12.06,67,,9.648,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,14.4,80,,11.52,percent of total billed charges,80% of total billed charges,11.7,65,,9.36,percent of total billed charges,65% of total billed charges,6.42,35.67,,5.136,percent of total billed charges,35.67% of total billed charges,5.22,16.2,
STOMACH TUBE 16 FR,27000828,CDM,272,RC,,,outpatient,,,10,4.00,,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,7.7,77,,6.16,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,8.2,82,,6.56,percent of total billed charges,82% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,9,90,,7.2,percent of total billed charges,90% of total billed charges,8,80,,6.4,percent of total billed charges,80% of total billed charges,9,90,,7.2,percent of total billed charges,90% of total billed charges,7.5,75,,6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.9,29,,2.32,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,6.7,67,,5.36,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,8,80,,6.4,percent of total billed charges,80% of total billed charges,6.5,65,,5.2,percent of total billed charges,65% of total billed charges,3.57,35.67,,2.856,percent of total billed charges,35.67% of total billed charges,2.9,9,
SALUM SUMP TUBE 18FR,27000829,CDM,272,RC,,,outpatient,,,21,8.40,,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,16.17,77,,12.94,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,17.22,82,,13.776,percent of total billed charges,82% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,18.9,90,,15.12,percent of total billed charges,90% of total billed charges,16.8,80,,13.44,percent of total billed charges,80% of total billed charges,18.9,90,,15.12,percent of total billed charges,90% of total billed charges,15.75,75,,12.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,6.09,29,,4.872,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,14.07,67,,11.256,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,16.8,80,,13.44,percent of total billed charges,80% of total billed charges,13.65,65,,10.92,percent of total billed charges,65% of total billed charges,7.49,35.67,,5.992,percent of total billed charges,35.67% of total billed charges,6.09,18.9,
SALUM SUMP TUBE 18FR,27000830,CDM,272,RC,,,outpatient,,,21,8.40,,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,16.17,77,,12.94,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,17.22,82,,13.776,percent of total billed charges,82% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,18.9,90,,15.12,percent of total billed charges,90% of total billed charges,16.8,80,,13.44,percent of total billed charges,80% of total billed charges,18.9,90,,15.12,percent of total billed charges,90% of total billed charges,15.75,75,,12.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,6.09,29,,4.872,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,14.07,67,,11.256,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,16.8,80,,13.44,percent of total billed charges,80% of total billed charges,13.65,65,,10.92,percent of total billed charges,65% of total billed charges,7.49,35.67,,5.992,percent of total billed charges,35.67% of total billed charges,6.09,18.9,
THORACIC CATHETER 16 FR,27000872,CDM,272,RC,,,outpatient,,,52,20.80,,44.2,85,,35.36,percent of total billed charges,85% of total billed charges,40.04,77,,32.03,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,42.64,82,,34.112,percent of total billed charges,82% of total billed charges,44.2,85,,35.36,percent of total billed charges,85% of total billed charges,44.2,85,,35.36,percent of total billed charges,85% of total billed charges,44.2,85,,35.36,percent of total billed charges,85% of total billed charges,46.8,90,,37.44,percent of total billed charges,90% of total billed charges,41.6,80,,33.28,percent of total billed charges,80% of total billed charges,46.8,90,,37.44,percent of total billed charges,90% of total billed charges,39,75,,31.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,15.08,29,,12.064,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,34.84,67,,27.872,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,41.6,80,,33.28,percent of total billed charges,80% of total billed charges,33.8,65,,27.04,percent of total billed charges,65% of total billed charges,18.55,35.67,,14.84,percent of total billed charges,35.67% of total billed charges,15.08,46.8,
THORACIC CATHETER 20 FR **,27000873,CDM,272,RC,,,outpatient,,,44,17.60,,37.4,85,,29.92,percent of total billed charges,85% of total billed charges,33.88,77,,27.1,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,36.08,82,,28.864,percent of total billed charges,82% of total billed charges,37.4,85,,29.92,percent of total billed charges,85% of total billed charges,37.4,85,,29.92,percent of total billed charges,85% of total billed charges,37.4,85,,29.92,percent of total billed charges,85% of total billed charges,39.6,90,,31.68,percent of total billed charges,90% of total billed charges,35.2,80,,28.16,percent of total billed charges,80% of total billed charges,39.6,90,,31.68,percent of total billed charges,90% of total billed charges,33,75,,26.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,12.76,29,,10.208,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,29.48,67,,23.584,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,35.2,80,,28.16,percent of total billed charges,80% of total billed charges,28.6,65,,22.88,percent of total billed charges,65% of total billed charges,15.69,35.67,,12.552,percent of total billed charges,35.67% of total billed charges,12.76,39.6,
THORACIC CATHETER 24 FR,27000874,CDM,272,RC,,,outpatient,,,52,20.80,,44.2,85,,35.36,percent of total billed charges,85% of total billed charges,40.04,77,,32.03,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,42.64,82,,34.112,percent of total billed charges,82% of total billed charges,44.2,85,,35.36,percent of total billed charges,85% of total billed charges,44.2,85,,35.36,percent of total billed charges,85% of total billed charges,44.2,85,,35.36,percent of total billed charges,85% of total billed charges,46.8,90,,37.44,percent of total billed charges,90% of total billed charges,41.6,80,,33.28,percent of total billed charges,80% of total billed charges,46.8,90,,37.44,percent of total billed charges,90% of total billed charges,39,75,,31.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,15.08,29,,12.064,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,34.84,67,,27.872,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,41.6,80,,33.28,percent of total billed charges,80% of total billed charges,33.8,65,,27.04,percent of total billed charges,65% of total billed charges,18.55,35.67,,14.84,percent of total billed charges,35.67% of total billed charges,15.08,46.8,
THORACIC CATHETER 32 FR,27000875,CDM,272,RC,,,outpatient,,,52,20.80,,44.2,85,,35.36,percent of total billed charges,85% of total billed charges,40.04,77,,32.03,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,42.64,82,,34.112,percent of total billed charges,82% of total billed charges,44.2,85,,35.36,percent of total billed charges,85% of total billed charges,44.2,85,,35.36,percent of total billed charges,85% of total billed charges,44.2,85,,35.36,percent of total billed charges,85% of total billed charges,46.8,90,,37.44,percent of total billed charges,90% of total billed charges,41.6,80,,33.28,percent of total billed charges,80% of total billed charges,46.8,90,,37.44,percent of total billed charges,90% of total billed charges,39,75,,31.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,15.08,29,,12.064,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,34.84,67,,27.872,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,41.6,80,,33.28,percent of total billed charges,80% of total billed charges,33.8,65,,27.04,percent of total billed charges,65% of total billed charges,18.55,35.67,,14.84,percent of total billed charges,35.67% of total billed charges,15.08,46.8,
TROCAR CATHETER 20 FR **,27000877,CDM,272,RC,,,outpatient,,,96,38.40,,81.6,85,,65.28,percent of total billed charges,85% of total billed charges,73.92,77,,59.14,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,78.72,82,,62.976,percent of total billed charges,82% of total billed charges,81.6,85,,65.28,percent of total billed charges,85% of total billed charges,81.6,85,,65.28,percent of total billed charges,85% of total billed charges,81.6,85,,65.28,percent of total billed charges,85% of total billed charges,86.4,90,,69.12,percent of total billed charges,90% of total billed charges,76.8,80,,61.44,percent of total billed charges,80% of total billed charges,86.4,90,,69.12,percent of total billed charges,90% of total billed charges,72,75,,57.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,27.84,29,,22.272,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,64.32,67,,51.456,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,76.8,80,,61.44,percent of total billed charges,80% of total billed charges,62.4,65,,49.92,percent of total billed charges,65% of total billed charges,34.24,35.67,,27.392,percent of total billed charges,35.67% of total billed charges,27.84,86.4,
TROCAR CATHETER 24 FR,27000878,CDM,272,RC,,,outpatient,,,167,66.80,,141.95,85,,113.56,percent of total billed charges,85% of total billed charges,128.59,77,,102.87,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,136.94,82,,109.552,percent of total billed charges,82% of total billed charges,141.95,85,,113.56,percent of total billed charges,85% of total billed charges,141.95,85,,113.56,percent of total billed charges,85% of total billed charges,141.95,85,,113.56,percent of total billed charges,85% of total billed charges,150.3,90,,120.24,percent of total billed charges,90% of total billed charges,133.6,80,,106.88,percent of total billed charges,80% of total billed charges,150.3,90,,120.24,percent of total billed charges,90% of total billed charges,125.25,75,,100.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,48.43,29,,38.744,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,111.89,67,,89.512,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,133.6,80,,106.88,percent of total billed charges,80% of total billed charges,108.55,65,,86.84,percent of total billed charges,65% of total billed charges,59.57,35.67,,47.656,percent of total billed charges,35.67% of total billed charges,48.43,150.3,
TROCAR CATHETER 28 FR,27000879,CDM,272,RC,,,outpatient,,,140,56.00,,119,85,,95.2,percent of total billed charges,85% of total billed charges,107.8,77,,86.24,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,114.8,82,,91.84,percent of total billed charges,82% of total billed charges,119,85,,95.2,percent of total billed charges,85% of total billed charges,119,85,,95.2,percent of total billed charges,85% of total billed charges,119,85,,95.2,percent of total billed charges,85% of total billed charges,126,90,,100.8,percent of total billed charges,90% of total billed charges,112,80,,89.6,percent of total billed charges,80% of total billed charges,126,90,,100.8,percent of total billed charges,90% of total billed charges,105,75,,84,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,40.6,29,,32.48,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,93.8,67,,75.04,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,112,80,,89.6,percent of total billed charges,80% of total billed charges,91,65,,72.8,percent of total billed charges,65% of total billed charges,49.94,35.67,,39.952,percent of total billed charges,35.67% of total billed charges,40.6,126,
TROCAR CATHETER 32 FR,27000880,CDM,272,RC,,,outpatient,,,144,57.60,,122.4,85,,97.92,percent of total billed charges,85% of total billed charges,110.88,77,,88.7,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,118.08,82,,94.464,percent of total billed charges,82% of total billed charges,122.4,85,,97.92,percent of total billed charges,85% of total billed charges,122.4,85,,97.92,percent of total billed charges,85% of total billed charges,122.4,85,,97.92,percent of total billed charges,85% of total billed charges,129.6,90,,103.68,percent of total billed charges,90% of total billed charges,115.2,80,,92.16,percent of total billed charges,80% of total billed charges,129.6,90,,103.68,percent of total billed charges,90% of total billed charges,108,75,,86.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,41.76,29,,33.408,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,96.48,67,,77.184,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,115.2,80,,92.16,percent of total billed charges,80% of total billed charges,93.6,65,,74.88,percent of total billed charges,65% of total billed charges,51.36,35.67,,41.088,percent of total billed charges,35.67% of total billed charges,41.76,129.6,
UMBILICAL CATHETER 5 FR,27000881,CDM,272,RC,,,outpatient,,,133,53.20,,113.05,85,,90.44,percent of total billed charges,85% of total billed charges,102.41,77,,81.93,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,109.06,82,,87.248,percent of total billed charges,82% of total billed charges,113.05,85,,90.44,percent of total billed charges,85% of total billed charges,113.05,85,,90.44,percent of total billed charges,85% of total billed charges,113.05,85,,90.44,percent of total billed charges,85% of total billed charges,119.7,90,,95.76,percent of total billed charges,90% of total billed charges,106.4,80,,85.12,percent of total billed charges,80% of total billed charges,119.7,90,,95.76,percent of total billed charges,90% of total billed charges,99.75,75,,79.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,38.57,29,,30.856,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,89.11,67,,71.288,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,106.4,80,,85.12,percent of total billed charges,80% of total billed charges,86.45,65,,69.16,percent of total billed charges,65% of total billed charges,47.44,35.67,,37.952,percent of total billed charges,35.67% of total billed charges,38.57,119.7,
UMBILICAL CATHETER 3.5 FR,27000882,CDM,272,RC,,,outpatient,,,186,74.40,,158.1,85,,126.48,percent of total billed charges,85% of total billed charges,143.22,77,,114.58,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,152.52,82,,122.016,percent of total billed charges,82% of total billed charges,158.1,85,,126.48,percent of total billed charges,85% of total billed charges,158.1,85,,126.48,percent of total billed charges,85% of total billed charges,158.1,85,,126.48,percent of total billed charges,85% of total billed charges,167.4,90,,133.92,percent of total billed charges,90% of total billed charges,148.8,80,,119.04,percent of total billed charges,80% of total billed charges,167.4,90,,133.92,percent of total billed charges,90% of total billed charges,139.5,75,,111.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,53.94,29,,43.152,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,124.62,67,,99.696,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,148.8,80,,119.04,percent of total billed charges,80% of total billed charges,120.9,65,,96.72,percent of total billed charges,65% of total billed charges,66.35,35.67,,53.08,percent of total billed charges,35.67% of total billed charges,53.94,167.4,
T-TUBE 18 FR,27000886,CDM,272,RC,,,outpatient,,,103,41.20,,87.55,85,,70.04,percent of total billed charges,85% of total billed charges,79.31,77,,63.45,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,84.46,82,,67.568,percent of total billed charges,82% of total billed charges,87.55,85,,70.04,percent of total billed charges,85% of total billed charges,87.55,85,,70.04,percent of total billed charges,85% of total billed charges,87.55,85,,70.04,percent of total billed charges,85% of total billed charges,92.7,90,,74.16,percent of total billed charges,90% of total billed charges,82.4,80,,65.92,percent of total billed charges,80% of total billed charges,92.7,90,,74.16,percent of total billed charges,90% of total billed charges,77.25,75,,61.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,29.87,29,,23.896,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,69.01,67,,55.208,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,82.4,80,,65.92,percent of total billed charges,80% of total billed charges,66.95,65,,53.56,percent of total billed charges,65% of total billed charges,36.74,35.67,,29.392,percent of total billed charges,35.67% of total billed charges,29.87,92.7,
T-TUBE 10 FR,27000887,CDM,272,RC,,,outpatient,,,102,40.80,,86.7,85,,69.36,percent of total billed charges,85% of total billed charges,78.54,77,,62.83,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,83.64,82,,66.912,percent of total billed charges,82% of total billed charges,86.7,85,,69.36,percent of total billed charges,85% of total billed charges,86.7,85,,69.36,percent of total billed charges,85% of total billed charges,86.7,85,,69.36,percent of total billed charges,85% of total billed charges,91.8,90,,73.44,percent of total billed charges,90% of total billed charges,81.6,80,,65.28,percent of total billed charges,80% of total billed charges,91.8,90,,73.44,percent of total billed charges,90% of total billed charges,76.5,75,,61.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,29.58,29,,23.664,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,68.34,67,,54.672,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,81.6,80,,65.28,percent of total billed charges,80% of total billed charges,66.3,65,,53.04,percent of total billed charges,65% of total billed charges,36.38,35.67,,29.104,percent of total billed charges,35.67% of total billed charges,29.58,91.8,
T-TUBE 14 FR,27000888,CDM,272,RC,,,outpatient,,,102,40.80,,86.7,85,,69.36,percent of total billed charges,85% of total billed charges,78.54,77,,62.83,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,83.64,82,,66.912,percent of total billed charges,82% of total billed charges,86.7,85,,69.36,percent of total billed charges,85% of total billed charges,86.7,85,,69.36,percent of total billed charges,85% of total billed charges,86.7,85,,69.36,percent of total billed charges,85% of total billed charges,91.8,90,,73.44,percent of total billed charges,90% of total billed charges,81.6,80,,65.28,percent of total billed charges,80% of total billed charges,91.8,90,,73.44,percent of total billed charges,90% of total billed charges,76.5,75,,61.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,29.58,29,,23.664,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,68.34,67,,54.672,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,81.6,80,,65.28,percent of total billed charges,80% of total billed charges,66.3,65,,53.04,percent of total billed charges,65% of total billed charges,36.38,35.67,,29.104,percent of total billed charges,35.67% of total billed charges,29.58,91.8,
T-TUBE 16 FR,27000889,CDM,272,RC,,,outpatient,,,115,46.00,,97.75,85,,78.2,percent of total billed charges,85% of total billed charges,88.55,77,,70.84,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,94.3,82,,75.44,percent of total billed charges,82% of total billed charges,97.75,85,,78.2,percent of total billed charges,85% of total billed charges,97.75,85,,78.2,percent of total billed charges,85% of total billed charges,97.75,85,,78.2,percent of total billed charges,85% of total billed charges,103.5,90,,82.8,percent of total billed charges,90% of total billed charges,92,80,,73.6,percent of total billed charges,80% of total billed charges,103.5,90,,82.8,percent of total billed charges,90% of total billed charges,86.25,75,,69,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,33.35,29,,26.68,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,77.05,67,,61.64,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,92,80,,73.6,percent of total billed charges,80% of total billed charges,74.75,65,,59.8,percent of total billed charges,65% of total billed charges,41.02,35.67,,32.816,percent of total billed charges,35.67% of total billed charges,33.35,103.5,
WEBRIL UNDERCAST PADDING 4,27000909,CDM,272,RC,,,outpatient,,,18,7.20,,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,13.86,77,,11.09,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,14.76,82,,11.808,percent of total billed charges,82% of total billed charges,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,16.2,90,,12.96,percent of total billed charges,90% of total billed charges,14.4,80,,11.52,percent of total billed charges,80% of total billed charges,16.2,90,,12.96,percent of total billed charges,90% of total billed charges,13.5,75,,10.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,5.22,29,,4.176,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,12.06,67,,9.648,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,14.4,80,,11.52,percent of total billed charges,80% of total billed charges,11.7,65,,9.36,percent of total billed charges,65% of total billed charges,6.42,35.67,,5.136,percent of total billed charges,35.67% of total billed charges,5.22,16.2,
PEDI CVP CATH KIT,27000928,CDM,272,RC,,,outpatient,,,266,106.40,,226.1,85,,180.88,percent of total billed charges,85% of total billed charges,204.82,77,,163.86,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,218.12,82,,174.496,percent of total billed charges,82% of total billed charges,226.1,85,,180.88,percent of total billed charges,85% of total billed charges,226.1,85,,180.88,percent of total billed charges,85% of total billed charges,226.1,85,,180.88,percent of total billed charges,85% of total billed charges,239.4,90,,191.52,percent of total billed charges,90% of total billed charges,212.8,80,,170.24,percent of total billed charges,80% of total billed charges,239.4,90,,191.52,percent of total billed charges,90% of total billed charges,199.5,75,,159.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,77.14,29,,61.712,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,178.22,67,,142.576,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,212.8,80,,170.24,percent of total billed charges,80% of total billed charges,172.9,65,,138.32,percent of total billed charges,65% of total billed charges,94.88,35.67,,75.904,percent of total billed charges,35.67% of total billed charges,77.14,239.4,
BASIC DRAPE PACK,27000932,CDM,272,RC,,,outpatient,,,121,48.40,,102.85,85,,82.28,percent of total billed charges,85% of total billed charges,93.17,77,,74.54,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,99.22,82,,79.376,percent of total billed charges,82% of total billed charges,102.85,85,,82.28,percent of total billed charges,85% of total billed charges,102.85,85,,82.28,percent of total billed charges,85% of total billed charges,102.85,85,,82.28,percent of total billed charges,85% of total billed charges,108.9,90,,87.12,percent of total billed charges,90% of total billed charges,96.8,80,,77.44,percent of total billed charges,80% of total billed charges,108.9,90,,87.12,percent of total billed charges,90% of total billed charges,90.75,75,,72.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,35.09,29,,28.072,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,81.07,67,,64.856,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,96.8,80,,77.44,percent of total billed charges,80% of total billed charges,78.65,65,,62.92,percent of total billed charges,65% of total billed charges,43.16,35.67,,34.528,percent of total billed charges,35.67% of total billed charges,35.09,108.9,
MECONIUM ASPIRATOR,27000934,CDM,272,RC,,,outpatient,,,53,21.20,,45.05,85,,36.04,percent of total billed charges,85% of total billed charges,40.81,77,,32.65,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,43.46,82,,34.768,percent of total billed charges,82% of total billed charges,45.05,85,,36.04,percent of total billed charges,85% of total billed charges,45.05,85,,36.04,percent of total billed charges,85% of total billed charges,45.05,85,,36.04,percent of total billed charges,85% of total billed charges,47.7,90,,38.16,percent of total billed charges,90% of total billed charges,42.4,80,,33.92,percent of total billed charges,80% of total billed charges,47.7,90,,38.16,percent of total billed charges,90% of total billed charges,39.75,75,,31.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,15.37,29,,12.296,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,35.51,67,,28.408,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,42.4,80,,33.92,percent of total billed charges,80% of total billed charges,34.45,65,,27.56,percent of total billed charges,65% of total billed charges,18.91,35.67,,15.128,percent of total billed charges,35.67% of total billed charges,15.37,47.7,
ADAPTIC DRESSING 3X3,27000944,CDM,272,RC,,,outpatient,,,10,4.00,,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,7.7,77,,6.16,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,8.2,82,,6.56,percent of total billed charges,82% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,9,90,,7.2,percent of total billed charges,90% of total billed charges,8,80,,6.4,percent of total billed charges,80% of total billed charges,9,90,,7.2,percent of total billed charges,90% of total billed charges,7.5,75,,6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.9,29,,2.32,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,6.7,67,,5.36,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,8,80,,6.4,percent of total billed charges,80% of total billed charges,6.5,65,,5.2,percent of total billed charges,65% of total billed charges,3.57,35.67,,2.856,percent of total billed charges,35.67% of total billed charges,2.9,9,
RADIAL ARTERY CATHETER 22G,27001142,CDM,272,RC,,,outpatient,,,139,55.60,,118.15,85,,94.52,percent of total billed charges,85% of total billed charges,107.03,77,,85.62,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,113.98,82,,91.184,percent of total billed charges,82% of total billed charges,118.15,85,,94.52,percent of total billed charges,85% of total billed charges,118.15,85,,94.52,percent of total billed charges,85% of total billed charges,118.15,85,,94.52,percent of total billed charges,85% of total billed charges,125.1,90,,100.08,percent of total billed charges,90% of total billed charges,111.2,80,,88.96,percent of total billed charges,80% of total billed charges,125.1,90,,100.08,percent of total billed charges,90% of total billed charges,104.25,75,,83.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,40.31,29,,32.248,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,93.13,67,,74.504,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,111.2,80,,88.96,percent of total billed charges,80% of total billed charges,90.35,65,,72.28,percent of total billed charges,65% of total billed charges,49.58,35.67,,39.664,percent of total billed charges,35.67% of total billed charges,40.31,125.1,
RADIAL ARTERY CATH 20 GAUGE **,27001143,CDM,272,RC,,,outpatient,,,132,52.80,,112.2,85,,89.76,percent of total billed charges,85% of total billed charges,101.64,77,,81.31,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,108.24,82,,86.592,percent of total billed charges,82% of total billed charges,112.2,85,,89.76,percent of total billed charges,85% of total billed charges,112.2,85,,89.76,percent of total billed charges,85% of total billed charges,112.2,85,,89.76,percent of total billed charges,85% of total billed charges,118.8,90,,95.04,percent of total billed charges,90% of total billed charges,105.6,80,,84.48,percent of total billed charges,80% of total billed charges,118.8,90,,95.04,percent of total billed charges,90% of total billed charges,99,75,,79.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,38.28,29,,30.624,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,88.44,67,,70.752,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,105.6,80,,84.48,percent of total billed charges,80% of total billed charges,85.8,65,,68.64,percent of total billed charges,65% of total billed charges,47.08,35.67,,37.664,percent of total billed charges,35.67% of total billed charges,38.28,118.8,
NEEDLE 1MAYO 1/2 CIR TP,27001282,CDM,272,RC,,,outpatient,,,31,12.40,,26.35,85,,21.08,percent of total billed charges,85% of total billed charges,23.87,77,,19.1,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,25.42,82,,20.336,percent of total billed charges,82% of total billed charges,26.35,85,,21.08,percent of total billed charges,85% of total billed charges,26.35,85,,21.08,percent of total billed charges,85% of total billed charges,26.35,85,,21.08,percent of total billed charges,85% of total billed charges,27.9,90,,22.32,percent of total billed charges,90% of total billed charges,24.8,80,,19.84,percent of total billed charges,80% of total billed charges,27.9,90,,22.32,percent of total billed charges,90% of total billed charges,23.25,75,,18.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,8.99,29,,7.192,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,20.77,67,,16.616,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,24.8,80,,19.84,percent of total billed charges,80% of total billed charges,20.15,65,,16.12,percent of total billed charges,65% of total billed charges,11.06,35.67,,8.848,percent of total billed charges,35.67% of total billed charges,8.99,27.9,
STAPLES INTERNAL PI30,27001297,CDM,272,RC,,,outpatient,,,838,335.20,,712.3,85,,569.84,percent of total billed charges,85% of total billed charges,645.26,77,,516.21,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,687.16,82,,549.728,percent of total billed charges,82% of total billed charges,712.3,85,,569.84,percent of total billed charges,85% of total billed charges,712.3,85,,569.84,percent of total billed charges,85% of total billed charges,712.3,85,,569.84,percent of total billed charges,85% of total billed charges,754.2,90,,603.36,percent of total billed charges,90% of total billed charges,670.4,80,,536.32,percent of total billed charges,80% of total billed charges,754.2,90,,603.36,percent of total billed charges,90% of total billed charges,628.5,75,,502.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,243.02,29,,194.416,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,561.46,67,,449.168,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,670.4,80,,536.32,percent of total billed charges,80% of total billed charges,544.7,65,,435.76,percent of total billed charges,65% of total billed charges,298.91,35.67,,239.128,percent of total billed charges,35.67% of total billed charges,243.02,754.2,
COVER-ROLL BANDAGE,27001329,CDM,272,RC,A4454,HCPCS,outpatient,,,34,13.60,,28.9,85,,23.12,percent of total billed charges,85% of total billed charges,26.18,77,,20.94,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,27.88,82,,22.304,percent of total billed charges,82% of total billed charges,28.9,85,,23.12,percent of total billed charges,85% of total billed charges,28.9,85,,23.12,percent of total billed charges,85% of total billed charges,28.9,85,,23.12,percent of total billed charges,85% of total billed charges,30.6,90,,24.48,percent of total billed charges,90% of total billed charges,27.2,80,,21.76,percent of total billed charges,80% of total billed charges,30.6,90,,24.48,percent of total billed charges,90% of total billed charges,25.5,75,,20.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,9.86,29,,7.888,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,22.78,67,,18.224,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,27.2,80,,21.76,percent of total billed charges,80% of total billed charges,22.1,65,,17.68,percent of total billed charges,65% of total billed charges,12.13,35.67,,9.704,percent of total billed charges,35.67% of total billed charges,9.86,30.6,
SEXUAL ASSAULT EVIDENCE KIT **,27001391,CDM,272,RC,,,outpatient,,,120,48.00,,102,85,,81.6,percent of total billed charges,85% of total billed charges,92.4,77,,73.92,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,98.4,82,,78.72,percent of total billed charges,82% of total billed charges,102,85,,81.6,percent of total billed charges,85% of total billed charges,102,85,,81.6,percent of total billed charges,85% of total billed charges,102,85,,81.6,percent of total billed charges,85% of total billed charges,108,90,,86.4,percent of total billed charges,90% of total billed charges,96,80,,76.8,percent of total billed charges,80% of total billed charges,108,90,,86.4,percent of total billed charges,90% of total billed charges,90,75,,72,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,34.8,29,,27.84,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,80.4,67,,64.32,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,96,80,,76.8,percent of total billed charges,80% of total billed charges,78,65,,62.4,percent of total billed charges,65% of total billed charges,42.8,35.67,,34.24,percent of total billed charges,35.67% of total billed charges,34.8,108,
MEROCEL NASAL PACKING 4.5CM **,27001420,CDM,272,RC,,,outpatient,,,79,31.60,,67.15,85,,53.72,percent of total billed charges,85% of total billed charges,60.83,77,,48.66,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,64.78,82,,51.824,percent of total billed charges,82% of total billed charges,67.15,85,,53.72,percent of total billed charges,85% of total billed charges,67.15,85,,53.72,percent of total billed charges,85% of total billed charges,67.15,85,,53.72,percent of total billed charges,85% of total billed charges,71.1,90,,56.88,percent of total billed charges,90% of total billed charges,63.2,80,,50.56,percent of total billed charges,80% of total billed charges,71.1,90,,56.88,percent of total billed charges,90% of total billed charges,59.25,75,,47.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,22.91,29,,18.328,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,52.93,67,,42.344,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,63.2,80,,50.56,percent of total billed charges,80% of total billed charges,51.35,65,,41.08,percent of total billed charges,65% of total billed charges,28.18,35.67,,22.544,percent of total billed charges,35.67% of total billed charges,22.91,71.1,
SUCTION COAGULATOR,27001421,CDM,272,RC,,,outpatient,,,129,51.60,,109.65,85,,87.72,percent of total billed charges,85% of total billed charges,99.33,77,,79.46,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,105.78,82,,84.624,percent of total billed charges,82% of total billed charges,109.65,85,,87.72,percent of total billed charges,85% of total billed charges,109.65,85,,87.72,percent of total billed charges,85% of total billed charges,109.65,85,,87.72,percent of total billed charges,85% of total billed charges,116.1,90,,92.88,percent of total billed charges,90% of total billed charges,103.2,80,,82.56,percent of total billed charges,80% of total billed charges,116.1,90,,92.88,percent of total billed charges,90% of total billed charges,96.75,75,,77.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,37.41,29,,29.928,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,86.43,67,,69.144,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,103.2,80,,82.56,percent of total billed charges,80% of total billed charges,83.85,65,,67.08,percent of total billed charges,65% of total billed charges,46.01,35.67,,36.808,percent of total billed charges,35.67% of total billed charges,37.41,116.1,
RED VASCULAR TIES,27001529,CDM,272,RC,,,outpatient,,,38,15.20,,32.3,85,,25.84,percent of total billed charges,85% of total billed charges,29.26,77,,23.41,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,31.16,82,,24.928,percent of total billed charges,82% of total billed charges,32.3,85,,25.84,percent of total billed charges,85% of total billed charges,32.3,85,,25.84,percent of total billed charges,85% of total billed charges,32.3,85,,25.84,percent of total billed charges,85% of total billed charges,34.2,90,,27.36,percent of total billed charges,90% of total billed charges,30.4,80,,24.32,percent of total billed charges,80% of total billed charges,34.2,90,,27.36,percent of total billed charges,90% of total billed charges,28.5,75,,22.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,11.02,29,,8.816,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,25.46,67,,20.368,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,30.4,80,,24.32,percent of total billed charges,80% of total billed charges,24.7,65,,19.76,percent of total billed charges,65% of total billed charges,13.55,35.67,,10.84,percent of total billed charges,35.67% of total billed charges,11.02,34.2,
LEEP ELECTRODE 15MM X 12MM,27001611,CDM,272,RC,,,outpatient,,,155,62.00,,131.75,85,,105.4,percent of total billed charges,85% of total billed charges,119.35,77,,95.48,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,127.1,82,,101.68,percent of total billed charges,82% of total billed charges,131.75,85,,105.4,percent of total billed charges,85% of total billed charges,131.75,85,,105.4,percent of total billed charges,85% of total billed charges,131.75,85,,105.4,percent of total billed charges,85% of total billed charges,139.5,90,,111.6,percent of total billed charges,90% of total billed charges,124,80,,99.2,percent of total billed charges,80% of total billed charges,139.5,90,,111.6,percent of total billed charges,90% of total billed charges,116.25,75,,93,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,44.95,29,,35.96,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,103.85,67,,83.08,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,124,80,,99.2,percent of total billed charges,80% of total billed charges,100.75,65,,80.6,percent of total billed charges,65% of total billed charges,55.29,35.67,,44.232,percent of total billed charges,35.67% of total billed charges,44.95,139.5,
LEEP ELECTRODE 125MMX8MM,27001612,CDM,272,RC,,,outpatient,,,180,72.00,,153,85,,122.4,percent of total billed charges,85% of total billed charges,138.6,77,,110.88,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,147.6,82,,118.08,percent of total billed charges,82% of total billed charges,153,85,,122.4,percent of total billed charges,85% of total billed charges,153,85,,122.4,percent of total billed charges,85% of total billed charges,153,85,,122.4,percent of total billed charges,85% of total billed charges,162,90,,129.6,percent of total billed charges,90% of total billed charges,144,80,,115.2,percent of total billed charges,80% of total billed charges,162,90,,129.6,percent of total billed charges,90% of total billed charges,135,75,,108,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,52.2,29,,41.76,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,120.6,67,,96.48,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,144,80,,115.2,percent of total billed charges,80% of total billed charges,117,65,,93.6,percent of total billed charges,65% of total billed charges,64.21,35.67,,51.368,percent of total billed charges,35.67% of total billed charges,52.2,162,
LAP CHOLE CHOLANG CATH,27001648,CDM,272,RC,,,outpatient,,,630,252.00,,535.5,85,,428.4,percent of total billed charges,85% of total billed charges,485.1,77,,388.08,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,516.6,82,,413.28,percent of total billed charges,82% of total billed charges,535.5,85,,428.4,percent of total billed charges,85% of total billed charges,535.5,85,,428.4,percent of total billed charges,85% of total billed charges,535.5,85,,428.4,percent of total billed charges,85% of total billed charges,567,90,,453.6,percent of total billed charges,90% of total billed charges,504,80,,403.2,percent of total billed charges,80% of total billed charges,567,90,,453.6,percent of total billed charges,90% of total billed charges,472.5,75,,378,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,182.7,29,,146.16,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,422.1,67,,337.68,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,504,80,,403.2,percent of total billed charges,80% of total billed charges,409.5,65,,327.6,percent of total billed charges,65% of total billed charges,224.72,35.67,,179.776,percent of total billed charges,35.67% of total billed charges,182.7,567,
STAPLE INTERNAL ILA-52,27001654,CDM,272,RC,,,outpatient,,,1295,518.00,,1100.75,85,,880.6,percent of total billed charges,85% of total billed charges,997.15,77,,797.72,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,1061.9,82,,849.52,percent of total billed charges,82% of total billed charges,1100.75,85,,880.6,percent of total billed charges,85% of total billed charges,1100.75,85,,880.6,percent of total billed charges,85% of total billed charges,1100.75,85,,880.6,percent of total billed charges,85% of total billed charges,1165.5,90,,932.4,percent of total billed charges,90% of total billed charges,1036,80,,828.8,percent of total billed charges,80% of total billed charges,1165.5,90,,932.4,percent of total billed charges,90% of total billed charges,971.25,75,,777,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,375.55,29,,300.44,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,867.65,67,,694.12,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1036,80,,828.8,percent of total billed charges,80% of total billed charges,841.75,65,,673.4,percent of total billed charges,65% of total billed charges,461.93,35.67,,369.544,percent of total billed charges,35.67% of total billed charges,375.55,1165.5,
INTERNAL STAPLER PI55,27001656,CDM,272,RC,,,outpatient,,,894,357.60,,759.9,85,,607.92,percent of total billed charges,85% of total billed charges,688.38,77,,550.7,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,733.08,82,,586.464,percent of total billed charges,82% of total billed charges,759.9,85,,607.92,percent of total billed charges,85% of total billed charges,759.9,85,,607.92,percent of total billed charges,85% of total billed charges,759.9,85,,607.92,percent of total billed charges,85% of total billed charges,804.6,90,,643.68,percent of total billed charges,90% of total billed charges,715.2,80,,572.16,percent of total billed charges,80% of total billed charges,804.6,90,,643.68,percent of total billed charges,90% of total billed charges,670.5,75,,536.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,259.26,29,,207.408,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,598.98,67,,479.184,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,715.2,80,,572.16,percent of total billed charges,80% of total billed charges,581.1,65,,464.88,percent of total billed charges,65% of total billed charges,318.89,35.67,,255.112,percent of total billed charges,35.67% of total billed charges,259.26,804.6,
SURGIPRO 0 SUTURE,27001663,CDM,272,RC,,,outpatient,,,64,25.60,,54.4,85,,43.52,percent of total billed charges,85% of total billed charges,49.28,77,,39.42,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,52.48,82,,41.984,percent of total billed charges,82% of total billed charges,54.4,85,,43.52,percent of total billed charges,85% of total billed charges,54.4,85,,43.52,percent of total billed charges,85% of total billed charges,54.4,85,,43.52,percent of total billed charges,85% of total billed charges,57.6,90,,46.08,percent of total billed charges,90% of total billed charges,51.2,80,,40.96,percent of total billed charges,80% of total billed charges,57.6,90,,46.08,percent of total billed charges,90% of total billed charges,48,75,,38.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,18.56,29,,14.848,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,42.88,67,,34.304,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,51.2,80,,40.96,percent of total billed charges,80% of total billed charges,41.6,65,,33.28,percent of total billed charges,65% of total billed charges,22.83,35.67,,18.264,percent of total billed charges,35.67% of total billed charges,18.56,57.6,
SOFSILK 3-0 SUTURE,27001665,CDM,272,RC,,,outpatient,,,105,42.00,,89.25,85,,71.4,percent of total billed charges,85% of total billed charges,80.85,77,,64.68,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,86.1,82,,68.88,percent of total billed charges,82% of total billed charges,89.25,85,,71.4,percent of total billed charges,85% of total billed charges,89.25,85,,71.4,percent of total billed charges,85% of total billed charges,89.25,85,,71.4,percent of total billed charges,85% of total billed charges,94.5,90,,75.6,percent of total billed charges,90% of total billed charges,84,80,,67.2,percent of total billed charges,80% of total billed charges,94.5,90,,75.6,percent of total billed charges,90% of total billed charges,78.75,75,,63,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,30.45,29,,24.36,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,70.35,67,,56.28,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,84,80,,67.2,percent of total billed charges,80% of total billed charges,68.25,65,,54.6,percent of total billed charges,65% of total billed charges,37.45,35.67,,29.96,percent of total billed charges,35.67% of total billed charges,30.45,94.5,
JEJUNOSTOMY 16FR **,27001666,CDM,272,RC,,,outpatient,,,2294,917.60,,1949.9,85,,1559.92,percent of total billed charges,85% of total billed charges,1766.38,77,,1413.1,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,1881.08,82,,1504.864,percent of total billed charges,82% of total billed charges,1949.9,85,,1559.92,percent of total billed charges,85% of total billed charges,1949.9,85,,1559.92,percent of total billed charges,85% of total billed charges,1949.9,85,,1559.92,percent of total billed charges,85% of total billed charges,2064.6,90,,1651.68,percent of total billed charges,90% of total billed charges,1835.2,80,,1468.16,percent of total billed charges,80% of total billed charges,2064.6,90,,1651.68,percent of total billed charges,90% of total billed charges,1720.5,75,,1376.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,665.26,29,,532.208,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1536.98,67,,1229.584,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1835.2,80,,1468.16,percent of total billed charges,80% of total billed charges,1491.1,65,,1192.88,percent of total billed charges,65% of total billed charges,818.27,35.67,,654.616,percent of total billed charges,35.67% of total billed charges,665.26,2064.6,
FOLEY COUDE 12FR 5CC,27001667,CDM,272,RC,,,outpatient,,,122,48.80,,103.7,85,,82.96,percent of total billed charges,85% of total billed charges,93.94,77,,75.15,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,100.04,82,,80.032,percent of total billed charges,82% of total billed charges,103.7,85,,82.96,percent of total billed charges,85% of total billed charges,103.7,85,,82.96,percent of total billed charges,85% of total billed charges,103.7,85,,82.96,percent of total billed charges,85% of total billed charges,109.8,90,,87.84,percent of total billed charges,90% of total billed charges,97.6,80,,78.08,percent of total billed charges,80% of total billed charges,109.8,90,,87.84,percent of total billed charges,90% of total billed charges,91.5,75,,73.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,35.38,29,,28.304,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,81.74,67,,65.392,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,97.6,80,,78.08,percent of total billed charges,80% of total billed charges,79.3,65,,63.44,percent of total billed charges,65% of total billed charges,43.52,35.67,,34.816,percent of total billed charges,35.67% of total billed charges,35.38,109.8,
FOLEY COUDE 16FR 5CC,27001668,CDM,272,RC,,,outpatient,,,99,39.60,,84.15,85,,67.32,percent of total billed charges,85% of total billed charges,76.23,77,,60.98,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,81.18,82,,64.944,percent of total billed charges,82% of total billed charges,84.15,85,,67.32,percent of total billed charges,85% of total billed charges,84.15,85,,67.32,percent of total billed charges,85% of total billed charges,84.15,85,,67.32,percent of total billed charges,85% of total billed charges,89.1,90,,71.28,percent of total billed charges,90% of total billed charges,79.2,80,,63.36,percent of total billed charges,80% of total billed charges,89.1,90,,71.28,percent of total billed charges,90% of total billed charges,74.25,75,,59.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,28.71,29,,22.968,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,66.33,67,,53.064,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,79.2,80,,63.36,percent of total billed charges,80% of total billed charges,64.35,65,,51.48,percent of total billed charges,65% of total billed charges,35.31,35.67,,28.248,percent of total billed charges,35.67% of total billed charges,28.71,89.1,
FOLEY COUDE 20FR 5CC,27001669,CDM,272,RC,,,outpatient,,,99,39.60,,84.15,85,,67.32,percent of total billed charges,85% of total billed charges,76.23,77,,60.98,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,81.18,82,,64.944,percent of total billed charges,82% of total billed charges,84.15,85,,67.32,percent of total billed charges,85% of total billed charges,84.15,85,,67.32,percent of total billed charges,85% of total billed charges,84.15,85,,67.32,percent of total billed charges,85% of total billed charges,89.1,90,,71.28,percent of total billed charges,90% of total billed charges,79.2,80,,63.36,percent of total billed charges,80% of total billed charges,89.1,90,,71.28,percent of total billed charges,90% of total billed charges,74.25,75,,59.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,28.71,29,,22.968,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,66.33,67,,53.064,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,79.2,80,,63.36,percent of total billed charges,80% of total billed charges,64.35,65,,51.48,percent of total billed charges,65% of total billed charges,35.31,35.67,,28.248,percent of total billed charges,35.67% of total billed charges,28.71,89.1,
FOLEY COUDE 12FR 30CC,27001670,CDM,272,RC,,,outpatient,,,122,48.80,,103.7,85,,82.96,percent of total billed charges,85% of total billed charges,93.94,77,,75.15,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,100.04,82,,80.032,percent of total billed charges,82% of total billed charges,103.7,85,,82.96,percent of total billed charges,85% of total billed charges,103.7,85,,82.96,percent of total billed charges,85% of total billed charges,103.7,85,,82.96,percent of total billed charges,85% of total billed charges,109.8,90,,87.84,percent of total billed charges,90% of total billed charges,97.6,80,,78.08,percent of total billed charges,80% of total billed charges,109.8,90,,87.84,percent of total billed charges,90% of total billed charges,91.5,75,,73.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,35.38,29,,28.304,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,81.74,67,,65.392,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,97.6,80,,78.08,percent of total billed charges,80% of total billed charges,79.3,65,,63.44,percent of total billed charges,65% of total billed charges,43.52,35.67,,34.816,percent of total billed charges,35.67% of total billed charges,35.38,109.8,
FOLEY COUDE 16FR 30CC,27001671,CDM,272,RC,,,outpatient,,,99,39.60,,84.15,85,,67.32,percent of total billed charges,85% of total billed charges,76.23,77,,60.98,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,81.18,82,,64.944,percent of total billed charges,82% of total billed charges,84.15,85,,67.32,percent of total billed charges,85% of total billed charges,84.15,85,,67.32,percent of total billed charges,85% of total billed charges,84.15,85,,67.32,percent of total billed charges,85% of total billed charges,89.1,90,,71.28,percent of total billed charges,90% of total billed charges,79.2,80,,63.36,percent of total billed charges,80% of total billed charges,89.1,90,,71.28,percent of total billed charges,90% of total billed charges,74.25,75,,59.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,28.71,29,,22.968,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,66.33,67,,53.064,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,79.2,80,,63.36,percent of total billed charges,80% of total billed charges,64.35,65,,51.48,percent of total billed charges,65% of total billed charges,35.31,35.67,,28.248,percent of total billed charges,35.67% of total billed charges,28.71,89.1,
FOLEY COUDE 20FR 30CC,27001672,CDM,272,RC,,,outpatient,,,131,52.40,,111.35,85,,89.08,percent of total billed charges,85% of total billed charges,100.87,77,,80.7,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,107.42,82,,85.936,percent of total billed charges,82% of total billed charges,111.35,85,,89.08,percent of total billed charges,85% of total billed charges,111.35,85,,89.08,percent of total billed charges,85% of total billed charges,111.35,85,,89.08,percent of total billed charges,85% of total billed charges,117.9,90,,94.32,percent of total billed charges,90% of total billed charges,104.8,80,,83.84,percent of total billed charges,80% of total billed charges,117.9,90,,94.32,percent of total billed charges,90% of total billed charges,98.25,75,,78.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,37.99,29,,30.392,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,87.77,67,,70.216,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,104.8,80,,83.84,percent of total billed charges,80% of total billed charges,85.15,65,,68.12,percent of total billed charges,65% of total billed charges,46.73,35.67,,37.384,percent of total billed charges,35.67% of total billed charges,37.99,117.9,
TRACH TUBE 6MM,27001732,CDM,272,RC,,,outpatient,,,215,86.00,,182.75,85,,146.2,percent of total billed charges,85% of total billed charges,165.55,77,,132.44,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,176.3,82,,141.04,percent of total billed charges,82% of total billed charges,182.75,85,,146.2,percent of total billed charges,85% of total billed charges,182.75,85,,146.2,percent of total billed charges,85% of total billed charges,182.75,85,,146.2,percent of total billed charges,85% of total billed charges,193.5,90,,154.8,percent of total billed charges,90% of total billed charges,172,80,,137.6,percent of total billed charges,80% of total billed charges,193.5,90,,154.8,percent of total billed charges,90% of total billed charges,161.25,75,,129,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,62.35,29,,49.88,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,144.05,67,,115.24,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,172,80,,137.6,percent of total billed charges,80% of total billed charges,139.75,65,,111.8,percent of total billed charges,65% of total billed charges,76.69,35.67,,61.352,percent of total billed charges,35.67% of total billed charges,62.35,193.5,
TRACH TUBE 7 MM,27001733,CDM,272,RC,,,outpatient,,,406,162.40,,345.1,85,,276.08,percent of total billed charges,85% of total billed charges,312.62,77,,250.1,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,332.92,82,,266.336,percent of total billed charges,82% of total billed charges,345.1,85,,276.08,percent of total billed charges,85% of total billed charges,345.1,85,,276.08,percent of total billed charges,85% of total billed charges,345.1,85,,276.08,percent of total billed charges,85% of total billed charges,365.4,90,,292.32,percent of total billed charges,90% of total billed charges,324.8,80,,259.84,percent of total billed charges,80% of total billed charges,365.4,90,,292.32,percent of total billed charges,90% of total billed charges,304.5,75,,243.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,117.74,29,,94.192,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,272.02,67,,217.616,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,324.8,80,,259.84,percent of total billed charges,80% of total billed charges,263.9,65,,211.12,percent of total billed charges,65% of total billed charges,144.82,35.67,,115.856,percent of total billed charges,35.67% of total billed charges,117.74,365.4,
TRACH TUBE 8 MM **,27001734,CDM,272,RC,,,outpatient,,,58,23.20,,49.3,85,,39.44,percent of total billed charges,85% of total billed charges,44.66,77,,35.73,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,47.56,82,,38.048,percent of total billed charges,82% of total billed charges,49.3,85,,39.44,percent of total billed charges,85% of total billed charges,49.3,85,,39.44,percent of total billed charges,85% of total billed charges,49.3,85,,39.44,percent of total billed charges,85% of total billed charges,52.2,90,,41.76,percent of total billed charges,90% of total billed charges,46.4,80,,37.12,percent of total billed charges,80% of total billed charges,52.2,90,,41.76,percent of total billed charges,90% of total billed charges,43.5,75,,34.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,16.82,29,,13.456,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,38.86,67,,31.088,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,46.4,80,,37.12,percent of total billed charges,80% of total billed charges,37.7,65,,30.16,percent of total billed charges,65% of total billed charges,20.69,35.67,,16.552,percent of total billed charges,35.67% of total billed charges,16.82,52.2,
TRACH INNER CANNULA 6MM,27001735,CDM,272,RC,,,outpatient,,,29,11.60,,24.65,85,,19.72,percent of total billed charges,85% of total billed charges,22.33,77,,17.86,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,23.78,82,,19.024,percent of total billed charges,82% of total billed charges,24.65,85,,19.72,percent of total billed charges,85% of total billed charges,24.65,85,,19.72,percent of total billed charges,85% of total billed charges,24.65,85,,19.72,percent of total billed charges,85% of total billed charges,26.1,90,,20.88,percent of total billed charges,90% of total billed charges,23.2,80,,18.56,percent of total billed charges,80% of total billed charges,26.1,90,,20.88,percent of total billed charges,90% of total billed charges,21.75,75,,17.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,8.41,29,,6.728,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,19.43,67,,15.544,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,23.2,80,,18.56,percent of total billed charges,80% of total billed charges,18.85,65,,15.08,percent of total billed charges,65% of total billed charges,10.34,35.67,,8.272,percent of total billed charges,35.67% of total billed charges,8.41,26.1,
TRACH INNER CANNULA 7MM,27001736,CDM,272,RC,,,outpatient,,,29,11.60,,24.65,85,,19.72,percent of total billed charges,85% of total billed charges,22.33,77,,17.86,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,23.78,82,,19.024,percent of total billed charges,82% of total billed charges,24.65,85,,19.72,percent of total billed charges,85% of total billed charges,24.65,85,,19.72,percent of total billed charges,85% of total billed charges,24.65,85,,19.72,percent of total billed charges,85% of total billed charges,26.1,90,,20.88,percent of total billed charges,90% of total billed charges,23.2,80,,18.56,percent of total billed charges,80% of total billed charges,26.1,90,,20.88,percent of total billed charges,90% of total billed charges,21.75,75,,17.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,8.41,29,,6.728,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,19.43,67,,15.544,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,23.2,80,,18.56,percent of total billed charges,80% of total billed charges,18.85,65,,15.08,percent of total billed charges,65% of total billed charges,10.34,35.67,,8.272,percent of total billed charges,35.67% of total billed charges,8.41,26.1,
TRACH INNER CANNULA 8MM,27001737,CDM,272,RC,,,outpatient,,,29,11.60,,24.65,85,,19.72,percent of total billed charges,85% of total billed charges,22.33,77,,17.86,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,23.78,82,,19.024,percent of total billed charges,82% of total billed charges,24.65,85,,19.72,percent of total billed charges,85% of total billed charges,24.65,85,,19.72,percent of total billed charges,85% of total billed charges,24.65,85,,19.72,percent of total billed charges,85% of total billed charges,26.1,90,,20.88,percent of total billed charges,90% of total billed charges,23.2,80,,18.56,percent of total billed charges,80% of total billed charges,26.1,90,,20.88,percent of total billed charges,90% of total billed charges,21.75,75,,17.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,8.41,29,,6.728,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,19.43,67,,15.544,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,23.2,80,,18.56,percent of total billed charges,80% of total billed charges,18.85,65,,15.08,percent of total billed charges,65% of total billed charges,10.34,35.67,,8.272,percent of total billed charges,35.67% of total billed charges,8.41,26.1,
CATHETHER FOLEY LATEX 16FR,270017420,CDM,272,RC,,,outpatient,,,7,2.80,,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.39,77,,4.31,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,5.74,82,,4.592,percent of total billed charges,82% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.25,75,,4.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.03,29,,1.624,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4.69,67,,3.752,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,4.55,65,,3.64,percent of total billed charges,65% of total billed charges,2.5,35.67,,2,percent of total billed charges,35.67% of total billed charges,2.03,6.3,
DISPOSABLE KNIFE MYRINGOTOMY,27001745,CDM,272,RC,,,outpatient,,,103,41.20,,87.55,85,,70.04,percent of total billed charges,85% of total billed charges,79.31,77,,63.45,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,84.46,82,,67.568,percent of total billed charges,82% of total billed charges,87.55,85,,70.04,percent of total billed charges,85% of total billed charges,87.55,85,,70.04,percent of total billed charges,85% of total billed charges,87.55,85,,70.04,percent of total billed charges,85% of total billed charges,92.7,90,,74.16,percent of total billed charges,90% of total billed charges,82.4,80,,65.92,percent of total billed charges,80% of total billed charges,92.7,90,,74.16,percent of total billed charges,90% of total billed charges,77.25,75,,61.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,29.87,29,,23.896,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,69.01,67,,55.208,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,82.4,80,,65.92,percent of total billed charges,80% of total billed charges,66.95,65,,53.56,percent of total billed charges,65% of total billed charges,36.74,35.67,,29.392,percent of total billed charges,35.67% of total billed charges,29.87,92.7,
SURGIGRIP TORCAR THREADS 5MM**,27001843,CDM,272,RC,,,outpatient,,,63,25.20,,53.55,85,,42.84,percent of total billed charges,85% of total billed charges,48.51,77,,38.81,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,51.66,82,,41.328,percent of total billed charges,82% of total billed charges,53.55,85,,42.84,percent of total billed charges,85% of total billed charges,53.55,85,,42.84,percent of total billed charges,85% of total billed charges,53.55,85,,42.84,percent of total billed charges,85% of total billed charges,56.7,90,,45.36,percent of total billed charges,90% of total billed charges,50.4,80,,40.32,percent of total billed charges,80% of total billed charges,56.7,90,,45.36,percent of total billed charges,90% of total billed charges,47.25,75,,37.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,18.27,29,,14.616,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,42.21,67,,33.768,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,50.4,80,,40.32,percent of total billed charges,80% of total billed charges,40.95,65,,32.76,percent of total billed charges,65% of total billed charges,22.47,35.67,,17.976,percent of total billed charges,35.67% of total billed charges,18.27,56.7,
ENDO CLINCH II 5MM,27001851,CDM,272,RC,,,outpatient,,,1135,454.00,,964.75,85,,771.8,percent of total billed charges,85% of total billed charges,873.95,77,,699.16,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,930.7,82,,744.56,percent of total billed charges,82% of total billed charges,964.75,85,,771.8,percent of total billed charges,85% of total billed charges,964.75,85,,771.8,percent of total billed charges,85% of total billed charges,964.75,85,,771.8,percent of total billed charges,85% of total billed charges,1021.5,90,,817.2,percent of total billed charges,90% of total billed charges,908,80,,726.4,percent of total billed charges,80% of total billed charges,1021.5,90,,817.2,percent of total billed charges,90% of total billed charges,851.25,75,,681,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,329.15,29,,263.32,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,760.45,67,,608.36,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,908,80,,726.4,percent of total billed charges,80% of total billed charges,737.75,65,,590.2,percent of total billed charges,65% of total billed charges,404.85,35.67,,323.88,percent of total billed charges,35.67% of total billed charges,329.15,1021.5,
SKIN STAPLER 35 WD,27001854,CDM,272,RC,,,outpatient,,,84,33.60,,71.4,85,,57.12,percent of total billed charges,85% of total billed charges,64.68,77,,51.74,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,68.88,82,,55.104,percent of total billed charges,82% of total billed charges,71.4,85,,57.12,percent of total billed charges,85% of total billed charges,71.4,85,,57.12,percent of total billed charges,85% of total billed charges,71.4,85,,57.12,percent of total billed charges,85% of total billed charges,75.6,90,,60.48,percent of total billed charges,90% of total billed charges,67.2,80,,53.76,percent of total billed charges,80% of total billed charges,75.6,90,,60.48,percent of total billed charges,90% of total billed charges,63,75,,50.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,24.36,29,,19.488,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,56.28,67,,45.024,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,67.2,80,,53.76,percent of total billed charges,80% of total billed charges,54.6,65,,43.68,percent of total billed charges,65% of total billed charges,29.96,35.67,,23.968,percent of total billed charges,35.67% of total billed charges,24.36,75.6,
THORACIC CATHETER 28FR,27001869,CDM,272,RC,,,outpatient,,,52,20.80,,44.2,85,,35.36,percent of total billed charges,85% of total billed charges,40.04,77,,32.03,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,42.64,82,,34.112,percent of total billed charges,82% of total billed charges,44.2,85,,35.36,percent of total billed charges,85% of total billed charges,44.2,85,,35.36,percent of total billed charges,85% of total billed charges,44.2,85,,35.36,percent of total billed charges,85% of total billed charges,46.8,90,,37.44,percent of total billed charges,90% of total billed charges,41.6,80,,33.28,percent of total billed charges,80% of total billed charges,46.8,90,,37.44,percent of total billed charges,90% of total billed charges,39,75,,31.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,15.08,29,,12.064,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,34.84,67,,27.872,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,41.6,80,,33.28,percent of total billed charges,80% of total billed charges,33.8,65,,27.04,percent of total billed charges,65% of total billed charges,18.55,35.67,,14.84,percent of total billed charges,35.67% of total billed charges,15.08,46.8,
THORACIC CATHETER 36FR **,27001871,CDM,272,RC,,,outpatient,,,44,17.60,,37.4,85,,29.92,percent of total billed charges,85% of total billed charges,33.88,77,,27.1,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,36.08,82,,28.864,percent of total billed charges,82% of total billed charges,37.4,85,,29.92,percent of total billed charges,85% of total billed charges,37.4,85,,29.92,percent of total billed charges,85% of total billed charges,37.4,85,,29.92,percent of total billed charges,85% of total billed charges,39.6,90,,31.68,percent of total billed charges,90% of total billed charges,35.2,80,,28.16,percent of total billed charges,80% of total billed charges,39.6,90,,31.68,percent of total billed charges,90% of total billed charges,33,75,,26.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,12.76,29,,10.208,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,29.48,67,,23.584,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,35.2,80,,28.16,percent of total billed charges,80% of total billed charges,28.6,65,,22.88,percent of total billed charges,65% of total billed charges,15.69,35.67,,12.552,percent of total billed charges,35.67% of total billed charges,12.76,39.6,
URETHRAL CATHETER 12FR,27001930,CDM,272,RC,,,outpatient,,,43,17.20,,36.55,85,,29.24,percent of total billed charges,85% of total billed charges,33.11,77,,26.49,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,35.26,82,,28.208,percent of total billed charges,82% of total billed charges,36.55,85,,29.24,percent of total billed charges,85% of total billed charges,36.55,85,,29.24,percent of total billed charges,85% of total billed charges,36.55,85,,29.24,percent of total billed charges,85% of total billed charges,38.7,90,,30.96,percent of total billed charges,90% of total billed charges,34.4,80,,27.52,percent of total billed charges,80% of total billed charges,38.7,90,,30.96,percent of total billed charges,90% of total billed charges,32.25,75,,25.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,12.47,29,,9.976,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,28.81,67,,23.048,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,34.4,80,,27.52,percent of total billed charges,80% of total billed charges,27.95,65,,22.36,percent of total billed charges,65% of total billed charges,15.34,35.67,,12.272,percent of total billed charges,35.67% of total billed charges,12.47,38.7,
URETHRAL CATHETER 14FR,27001931,CDM,272,RC,,,outpatient,,,43,17.20,,36.55,85,,29.24,percent of total billed charges,85% of total billed charges,33.11,77,,26.49,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,35.26,82,,28.208,percent of total billed charges,82% of total billed charges,36.55,85,,29.24,percent of total billed charges,85% of total billed charges,36.55,85,,29.24,percent of total billed charges,85% of total billed charges,36.55,85,,29.24,percent of total billed charges,85% of total billed charges,38.7,90,,30.96,percent of total billed charges,90% of total billed charges,34.4,80,,27.52,percent of total billed charges,80% of total billed charges,38.7,90,,30.96,percent of total billed charges,90% of total billed charges,32.25,75,,25.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,12.47,29,,9.976,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,28.81,67,,23.048,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,34.4,80,,27.52,percent of total billed charges,80% of total billed charges,27.95,65,,22.36,percent of total billed charges,65% of total billed charges,15.34,35.67,,12.272,percent of total billed charges,35.67% of total billed charges,12.47,38.7,
URETHERAL CATHETER 16FR,27001948,CDM,272,RC,,,outpatient,,,43,17.20,,36.55,85,,29.24,percent of total billed charges,85% of total billed charges,33.11,77,,26.49,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,35.26,82,,28.208,percent of total billed charges,82% of total billed charges,36.55,85,,29.24,percent of total billed charges,85% of total billed charges,36.55,85,,29.24,percent of total billed charges,85% of total billed charges,36.55,85,,29.24,percent of total billed charges,85% of total billed charges,38.7,90,,30.96,percent of total billed charges,90% of total billed charges,34.4,80,,27.52,percent of total billed charges,80% of total billed charges,38.7,90,,30.96,percent of total billed charges,90% of total billed charges,32.25,75,,25.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,12.47,29,,9.976,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,28.81,67,,23.048,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,34.4,80,,27.52,percent of total billed charges,80% of total billed charges,27.95,65,,22.36,percent of total billed charges,65% of total billed charges,15.34,35.67,,12.272,percent of total billed charges,35.67% of total billed charges,12.47,38.7,
URETHERAL CATHETER 18FR **,27001949,CDM,272,RC,,,outpatient,,,10,4.00,,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,7.7,77,,6.16,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,8.2,82,,6.56,percent of total billed charges,82% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,9,90,,7.2,percent of total billed charges,90% of total billed charges,8,80,,6.4,percent of total billed charges,80% of total billed charges,9,90,,7.2,percent of total billed charges,90% of total billed charges,7.5,75,,6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.9,29,,2.32,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,6.7,67,,5.36,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,8,80,,6.4,percent of total billed charges,80% of total billed charges,6.5,65,,5.2,percent of total billed charges,65% of total billed charges,3.57,35.67,,2.856,percent of total billed charges,35.67% of total billed charges,2.9,9,
ENDOTRACHEAL TUBE CUFFED 3.5,27001959,CDM,272,RC,,,outpatient,,,23,9.20,,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,17.71,77,,14.17,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,18.86,82,,15.088,percent of total billed charges,82% of total billed charges,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,20.7,90,,16.56,percent of total billed charges,90% of total billed charges,18.4,80,,14.72,percent of total billed charges,80% of total billed charges,20.7,90,,16.56,percent of total billed charges,90% of total billed charges,17.25,75,,13.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,6.67,29,,5.336,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,15.41,67,,12.328,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,18.4,80,,14.72,percent of total billed charges,80% of total billed charges,14.95,65,,11.96,percent of total billed charges,65% of total billed charges,8.2,35.67,,6.56,percent of total billed charges,35.67% of total billed charges,6.67,20.7,
ENDOTRACHEAL TUBE CUFFED 4.0,27001960,CDM,272,RC,,,outpatient,,,23,9.20,,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,17.71,77,,14.17,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,18.86,82,,15.088,percent of total billed charges,82% of total billed charges,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,20.7,90,,16.56,percent of total billed charges,90% of total billed charges,18.4,80,,14.72,percent of total billed charges,80% of total billed charges,20.7,90,,16.56,percent of total billed charges,90% of total billed charges,17.25,75,,13.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,6.67,29,,5.336,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,15.41,67,,12.328,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,18.4,80,,14.72,percent of total billed charges,80% of total billed charges,14.95,65,,11.96,percent of total billed charges,65% of total billed charges,8.2,35.67,,6.56,percent of total billed charges,35.67% of total billed charges,6.67,20.7,
ENDOTRACHEAL TUBE CUFFED 4.5,27001961,CDM,272,RC,,,outpatient,,,22,8.80,,18.7,85,,14.96,percent of total billed charges,85% of total billed charges,16.94,77,,13.55,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,18.04,82,,14.432,percent of total billed charges,82% of total billed charges,18.7,85,,14.96,percent of total billed charges,85% of total billed charges,18.7,85,,14.96,percent of total billed charges,85% of total billed charges,18.7,85,,14.96,percent of total billed charges,85% of total billed charges,19.8,90,,15.84,percent of total billed charges,90% of total billed charges,17.6,80,,14.08,percent of total billed charges,80% of total billed charges,19.8,90,,15.84,percent of total billed charges,90% of total billed charges,16.5,75,,13.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,6.38,29,,5.104,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,14.74,67,,11.792,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,17.6,80,,14.08,percent of total billed charges,80% of total billed charges,14.3,65,,11.44,percent of total billed charges,65% of total billed charges,7.85,35.67,,6.28,percent of total billed charges,35.67% of total billed charges,6.38,19.8,
INSUFLATION TUBING,27001976,CDM,272,RC,,,outpatient,,,56,22.40,,47.6,85,,38.08,percent of total billed charges,85% of total billed charges,43.12,77,,34.5,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,45.92,82,,36.736,percent of total billed charges,82% of total billed charges,47.6,85,,38.08,percent of total billed charges,85% of total billed charges,47.6,85,,38.08,percent of total billed charges,85% of total billed charges,47.6,85,,38.08,percent of total billed charges,85% of total billed charges,50.4,90,,40.32,percent of total billed charges,90% of total billed charges,44.8,80,,35.84,percent of total billed charges,80% of total billed charges,50.4,90,,40.32,percent of total billed charges,90% of total billed charges,42,75,,33.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,16.24,29,,12.992,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,37.52,67,,30.016,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,44.8,80,,35.84,percent of total billed charges,80% of total billed charges,36.4,65,,29.12,percent of total billed charges,65% of total billed charges,19.98,35.67,,15.984,percent of total billed charges,35.67% of total billed charges,16.24,50.4,
QUALTEX SUTURE BOOT STD,27002097,CDM,272,RC,,,outpatient,,,21,8.40,,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,16.17,77,,12.94,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,17.22,82,,13.776,percent of total billed charges,82% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,18.9,90,,15.12,percent of total billed charges,90% of total billed charges,16.8,80,,13.44,percent of total billed charges,80% of total billed charges,18.9,90,,15.12,percent of total billed charges,90% of total billed charges,15.75,75,,12.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,6.09,29,,4.872,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,14.07,67,,11.256,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,16.8,80,,13.44,percent of total billed charges,80% of total billed charges,13.65,65,,10.92,percent of total billed charges,65% of total billed charges,7.49,35.67,,5.992,percent of total billed charges,35.67% of total billed charges,6.09,18.9,
"SURGICLIP, MEDIUM 9.75 **",27002101,CDM,272,RC,,,outpatient,,,414,165.60,,351.9,85,,281.52,percent of total billed charges,85% of total billed charges,318.78,77,,255.02,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,339.48,82,,271.584,percent of total billed charges,82% of total billed charges,351.9,85,,281.52,percent of total billed charges,85% of total billed charges,351.9,85,,281.52,percent of total billed charges,85% of total billed charges,351.9,85,,281.52,percent of total billed charges,85% of total billed charges,372.6,90,,298.08,percent of total billed charges,90% of total billed charges,331.2,80,,264.96,percent of total billed charges,80% of total billed charges,372.6,90,,298.08,percent of total billed charges,90% of total billed charges,310.5,75,,248.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,120.06,29,,96.048,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,277.38,67,,221.904,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,331.2,80,,264.96,percent of total billed charges,80% of total billed charges,269.1,65,,215.28,percent of total billed charges,65% of total billed charges,147.67,35.67,,118.136,percent of total billed charges,35.67% of total billed charges,120.06,372.6,
SURGICLIP MEDIUM 11.5,27002102,CDM,272,RC,,,outpatient,,,1720,688.00,,1462,85,,1169.6,percent of total billed charges,85% of total billed charges,1324.4,77,,1059.52,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,1410.4,82,,1128.32,percent of total billed charges,82% of total billed charges,1462,85,,1169.6,percent of total billed charges,85% of total billed charges,1462,85,,1169.6,percent of total billed charges,85% of total billed charges,1462,85,,1169.6,percent of total billed charges,85% of total billed charges,1548,90,,1238.4,percent of total billed charges,90% of total billed charges,1376,80,,1100.8,percent of total billed charges,80% of total billed charges,1548,90,,1238.4,percent of total billed charges,90% of total billed charges,1290,75,,1032,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,498.8,29,,399.04,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1152.4,67,,921.92,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1376,80,,1100.8,percent of total billed charges,80% of total billed charges,1118,65,,894.4,percent of total billed charges,65% of total billed charges,613.52,35.67,,490.816,percent of total billed charges,35.67% of total billed charges,498.8,1548,
SURGICLIP LARGE 13.0,27002103,CDM,272,RC,,,outpatient,,,1567,626.80,,1331.95,85,,1065.56,percent of total billed charges,85% of total billed charges,1206.59,77,,965.27,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,1284.94,82,,1027.952,percent of total billed charges,82% of total billed charges,1331.95,85,,1065.56,percent of total billed charges,85% of total billed charges,1331.95,85,,1065.56,percent of total billed charges,85% of total billed charges,1331.95,85,,1065.56,percent of total billed charges,85% of total billed charges,1410.3,90,,1128.24,percent of total billed charges,90% of total billed charges,1253.6,80,,1002.88,percent of total billed charges,80% of total billed charges,1410.3,90,,1128.24,percent of total billed charges,90% of total billed charges,1175.25,75,,940.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,454.43,29,,363.544,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1049.89,67,,839.912,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1253.6,80,,1002.88,percent of total billed charges,80% of total billed charges,1018.55,65,,814.84,percent of total billed charges,65% of total billed charges,558.95,35.67,,447.16,percent of total billed charges,35.67% of total billed charges,454.43,1410.3,
ENDO PEANUT HAND INST **,27002104,CDM,272,RC,,,outpatient,,,240,96.00,,204,85,,163.2,percent of total billed charges,85% of total billed charges,184.8,77,,147.84,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,196.8,82,,157.44,percent of total billed charges,82% of total billed charges,204,85,,163.2,percent of total billed charges,85% of total billed charges,204,85,,163.2,percent of total billed charges,85% of total billed charges,204,85,,163.2,percent of total billed charges,85% of total billed charges,216,90,,172.8,percent of total billed charges,90% of total billed charges,192,80,,153.6,percent of total billed charges,80% of total billed charges,216,90,,172.8,percent of total billed charges,90% of total billed charges,180,75,,144,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,69.6,29,,55.68,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,160.8,67,,128.64,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,192,80,,153.6,percent of total billed charges,80% of total billed charges,156,65,,124.8,percent of total billed charges,65% of total billed charges,85.61,35.67,,68.488,percent of total billed charges,35.67% of total billed charges,69.6,216,
JAMSHIDI NEEDLE 15G,27002166,CDM,272,RC,,,outpatient,,,121,48.40,,102.85,85,,82.28,percent of total billed charges,85% of total billed charges,93.17,77,,74.54,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,99.22,82,,79.376,percent of total billed charges,82% of total billed charges,102.85,85,,82.28,percent of total billed charges,85% of total billed charges,102.85,85,,82.28,percent of total billed charges,85% of total billed charges,102.85,85,,82.28,percent of total billed charges,85% of total billed charges,108.9,90,,87.12,percent of total billed charges,90% of total billed charges,96.8,80,,77.44,percent of total billed charges,80% of total billed charges,108.9,90,,87.12,percent of total billed charges,90% of total billed charges,90.75,75,,72.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,35.09,29,,28.072,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,81.07,67,,64.856,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,96.8,80,,77.44,percent of total billed charges,80% of total billed charges,78.65,65,,62.92,percent of total billed charges,65% of total billed charges,43.16,35.67,,34.528,percent of total billed charges,35.67% of total billed charges,35.09,108.9,
JAMSHIDI NEEDLE 18G **,27002167,CDM,272,RC,,,outpatient,,,124,49.60,,105.4,85,,84.32,percent of total billed charges,85% of total billed charges,95.48,77,,76.38,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,101.68,82,,81.344,percent of total billed charges,82% of total billed charges,105.4,85,,84.32,percent of total billed charges,85% of total billed charges,105.4,85,,84.32,percent of total billed charges,85% of total billed charges,105.4,85,,84.32,percent of total billed charges,85% of total billed charges,111.6,90,,89.28,percent of total billed charges,90% of total billed charges,99.2,80,,79.36,percent of total billed charges,80% of total billed charges,111.6,90,,89.28,percent of total billed charges,90% of total billed charges,93,75,,74.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,35.96,29,,28.768,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,83.08,67,,66.464,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,99.2,80,,79.36,percent of total billed charges,80% of total billed charges,80.6,65,,64.48,percent of total billed charges,65% of total billed charges,44.23,35.67,,35.384,percent of total billed charges,35.67% of total billed charges,35.96,111.6,
INFANT FEEDING TUBE 8 FR,27002174,CDM,272,RC,,,outpatient,,,7,2.80,,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.39,77,,4.31,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,5.74,82,,4.592,percent of total billed charges,82% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.25,75,,4.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.03,29,,1.624,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4.69,67,,3.752,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,4.55,65,,3.64,percent of total billed charges,65% of total billed charges,2.5,35.67,,2,percent of total billed charges,35.67% of total billed charges,2.03,6.3,
BLAKE DRAIN FULL FLUTE 10MM,27002268,CDM,272,RC,C1729,HCPCS,outpatient,,,321,128.40,,272.85,85,,218.28,percent of total billed charges,85% of total billed charges,247.17,77,,197.74,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,263.22,82,,210.576,percent of total billed charges,82% of total billed charges,272.85,85,,218.28,percent of total billed charges,85% of total billed charges,272.85,85,,218.28,percent of total billed charges,85% of total billed charges,272.85,85,,218.28,percent of total billed charges,85% of total billed charges,288.9,90,,231.12,percent of total billed charges,90% of total billed charges,256.8,80,,205.44,percent of total billed charges,80% of total billed charges,288.9,90,,231.12,percent of total billed charges,90% of total billed charges,240.75,75,,192.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,93.09,29,,74.472,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,215.07,67,,172.056,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,256.8,80,,205.44,percent of total billed charges,80% of total billed charges,208.65,65,,166.92,percent of total billed charges,65% of total billed charges,114.5,35.67,,91.6,percent of total billed charges,35.67% of total billed charges,93.09,288.9,
STAPLER ENDO GIA 30 2.5,27002339,CDM,272,RC,,,outpatient,,,3824,1529.60,,3250.4,85,,2600.32,percent of total billed charges,85% of total billed charges,2944.48,77,,2355.58,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,3135.68,82,,2508.544,percent of total billed charges,82% of total billed charges,3250.4,85,,2600.32,percent of total billed charges,85% of total billed charges,3250.4,85,,2600.32,percent of total billed charges,85% of total billed charges,3250.4,85,,2600.32,percent of total billed charges,85% of total billed charges,3441.6,90,,2753.28,percent of total billed charges,90% of total billed charges,3059.2,80,,2447.36,percent of total billed charges,80% of total billed charges,3441.6,90,,2753.28,percent of total billed charges,90% of total billed charges,2868,75,,2294.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,1108.96,29,,887.168,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,2562.08,67,,2049.664,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,3059.2,80,,2447.36,percent of total billed charges,80% of total billed charges,2485.6,65,,1988.48,percent of total billed charges,65% of total billed charges,1364.02,35.67,,1091.216,percent of total billed charges,35.67% of total billed charges,1108.96,3441.6,
ESMARK BANDAGE 3X3YRD **,27002391,CDM,272,RC,,,outpatient,,,65,26.00,,55.25,85,,44.2,percent of total billed charges,85% of total billed charges,50.05,77,,40.04,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,53.3,82,,42.64,percent of total billed charges,82% of total billed charges,55.25,85,,44.2,percent of total billed charges,85% of total billed charges,55.25,85,,44.2,percent of total billed charges,85% of total billed charges,55.25,85,,44.2,percent of total billed charges,85% of total billed charges,58.5,90,,46.8,percent of total billed charges,90% of total billed charges,52,80,,41.6,percent of total billed charges,80% of total billed charges,58.5,90,,46.8,percent of total billed charges,90% of total billed charges,48.75,75,,39,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,18.85,29,,15.08,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,43.55,67,,34.84,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,52,80,,41.6,percent of total billed charges,80% of total billed charges,42.25,65,,33.8,percent of total billed charges,65% of total billed charges,23.19,35.67,,18.552,percent of total billed charges,35.67% of total billed charges,18.85,58.5,
ESMARK BANDAGE 4 X 9 YRD,27002392,CDM,272,RC,,,outpatient,,,28,11.20,,23.8,85,,19.04,percent of total billed charges,85% of total billed charges,21.56,77,,17.25,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,22.96,82,,18.368,percent of total billed charges,82% of total billed charges,23.8,85,,19.04,percent of total billed charges,85% of total billed charges,23.8,85,,19.04,percent of total billed charges,85% of total billed charges,23.8,85,,19.04,percent of total billed charges,85% of total billed charges,25.2,90,,20.16,percent of total billed charges,90% of total billed charges,22.4,80,,17.92,percent of total billed charges,80% of total billed charges,25.2,90,,20.16,percent of total billed charges,90% of total billed charges,21,75,,16.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,8.12,29,,6.496,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,18.76,67,,15.008,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,22.4,80,,17.92,percent of total billed charges,80% of total billed charges,18.2,65,,14.56,percent of total billed charges,65% of total billed charges,9.99,35.67,,7.992,percent of total billed charges,35.67% of total billed charges,8.12,25.2,
ELECTRODE DEFIB QUICK COMBO,27002459,CDM,272,RC,,,outpatient,,,230,92.00,,195.5,85,,156.4,percent of total billed charges,85% of total billed charges,177.1,77,,141.68,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,188.6,82,,150.88,percent of total billed charges,82% of total billed charges,195.5,85,,156.4,percent of total billed charges,85% of total billed charges,195.5,85,,156.4,percent of total billed charges,85% of total billed charges,195.5,85,,156.4,percent of total billed charges,85% of total billed charges,207,90,,165.6,percent of total billed charges,90% of total billed charges,184,80,,147.2,percent of total billed charges,80% of total billed charges,207,90,,165.6,percent of total billed charges,90% of total billed charges,172.5,75,,138,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,66.7,29,,53.36,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,154.1,67,,123.28,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,184,80,,147.2,percent of total billed charges,80% of total billed charges,149.5,65,,119.6,percent of total billed charges,65% of total billed charges,82.04,35.67,,65.632,percent of total billed charges,35.67% of total billed charges,66.7,207,
BULB IRRIGATION SYRINGE,27002550,CDM,272,RC,,,outpatient,,,10,4.00,,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,7.7,77,,6.16,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,8.2,82,,6.56,percent of total billed charges,82% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,9,90,,7.2,percent of total billed charges,90% of total billed charges,8,80,,6.4,percent of total billed charges,80% of total billed charges,9,90,,7.2,percent of total billed charges,90% of total billed charges,7.5,75,,6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.9,29,,2.32,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,6.7,67,,5.36,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,8,80,,6.4,percent of total billed charges,80% of total billed charges,6.5,65,,5.2,percent of total billed charges,65% of total billed charges,3.57,35.67,,2.856,percent of total billed charges,35.67% of total billed charges,2.9,9,
FENESTRATED DRAPE 18X26,27002568,CDM,272,RC,,,outpatient,,,10,4.00,,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,7.7,77,,6.16,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,8.2,82,,6.56,percent of total billed charges,82% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,9,90,,7.2,percent of total billed charges,90% of total billed charges,8,80,,6.4,percent of total billed charges,80% of total billed charges,9,90,,7.2,percent of total billed charges,90% of total billed charges,7.5,75,,6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.9,29,,2.32,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,6.7,67,,5.36,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,8,80,,6.4,percent of total billed charges,80% of total billed charges,6.5,65,,5.2,percent of total billed charges,65% of total billed charges,3.57,35.67,,2.856,percent of total billed charges,35.67% of total billed charges,2.9,9,
IV CATHETER ANGIO 14G,27002579,CDM,272,RC,,,outpatient,,,204,81.60,,173.4,85,,138.72,percent of total billed charges,85% of total billed charges,157.08,77,,125.66,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,167.28,82,,133.824,percent of total billed charges,82% of total billed charges,173.4,85,,138.72,percent of total billed charges,85% of total billed charges,173.4,85,,138.72,percent of total billed charges,85% of total billed charges,173.4,85,,138.72,percent of total billed charges,85% of total billed charges,183.6,90,,146.88,percent of total billed charges,90% of total billed charges,163.2,80,,130.56,percent of total billed charges,80% of total billed charges,183.6,90,,146.88,percent of total billed charges,90% of total billed charges,153,75,,122.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,59.16,29,,47.328,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,136.68,67,,109.344,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,163.2,80,,130.56,percent of total billed charges,80% of total billed charges,132.6,65,,106.08,percent of total billed charges,65% of total billed charges,72.77,35.67,,58.216,percent of total billed charges,35.67% of total billed charges,59.16,183.6,
CODMAN VEIN STRIPPER **,27002654,CDM,272,RC,,,outpatient,,,133,53.20,,113.05,85,,90.44,percent of total billed charges,85% of total billed charges,102.41,77,,81.93,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,109.06,82,,87.248,percent of total billed charges,82% of total billed charges,113.05,85,,90.44,percent of total billed charges,85% of total billed charges,113.05,85,,90.44,percent of total billed charges,85% of total billed charges,113.05,85,,90.44,percent of total billed charges,85% of total billed charges,119.7,90,,95.76,percent of total billed charges,90% of total billed charges,106.4,80,,85.12,percent of total billed charges,80% of total billed charges,119.7,90,,95.76,percent of total billed charges,90% of total billed charges,99.75,75,,79.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,38.57,29,,30.856,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,89.11,67,,71.288,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,106.4,80,,85.12,percent of total billed charges,80% of total billed charges,86.45,65,,69.16,percent of total billed charges,65% of total billed charges,47.44,35.67,,37.952,percent of total billed charges,35.67% of total billed charges,38.57,119.7,
ENDOCATCH 10MM,27002730,CDM,272,RC,,,outpatient,,,1016,406.40,,863.6,85,,690.88,percent of total billed charges,85% of total billed charges,782.32,77,,625.86,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,833.12,82,,666.496,percent of total billed charges,82% of total billed charges,863.6,85,,690.88,percent of total billed charges,85% of total billed charges,863.6,85,,690.88,percent of total billed charges,85% of total billed charges,863.6,85,,690.88,percent of total billed charges,85% of total billed charges,914.4,90,,731.52,percent of total billed charges,90% of total billed charges,812.8,80,,650.24,percent of total billed charges,80% of total billed charges,914.4,90,,731.52,percent of total billed charges,90% of total billed charges,762,75,,609.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,294.64,29,,235.712,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,680.72,67,,544.576,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,812.8,80,,650.24,percent of total billed charges,80% of total billed charges,660.4,65,,528.32,percent of total billed charges,65% of total billed charges,362.41,35.67,,289.928,percent of total billed charges,35.67% of total billed charges,294.64,914.4,
ENDOCLIP APPLIER LG,27002731,CDM,272,RC,,,outpatient,,,1516,606.40,,1288.6,85,,1030.88,percent of total billed charges,85% of total billed charges,1167.32,77,,933.86,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,1243.12,82,,994.496,percent of total billed charges,82% of total billed charges,1288.6,85,,1030.88,percent of total billed charges,85% of total billed charges,1288.6,85,,1030.88,percent of total billed charges,85% of total billed charges,1288.6,85,,1030.88,percent of total billed charges,85% of total billed charges,1364.4,90,,1091.52,percent of total billed charges,90% of total billed charges,1212.8,80,,970.24,percent of total billed charges,80% of total billed charges,1364.4,90,,1091.52,percent of total billed charges,90% of total billed charges,1137,75,,909.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,439.64,29,,351.712,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1015.72,67,,812.576,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1212.8,80,,970.24,percent of total billed charges,80% of total billed charges,985.4,65,,788.32,percent of total billed charges,65% of total billed charges,540.76,35.67,,432.608,percent of total billed charges,35.67% of total billed charges,439.64,1364.4,
PHACO TUBING **,27002736,CDM,272,RC,,,outpatient,,,277,110.80,,235.45,85,,188.36,percent of total billed charges,85% of total billed charges,213.29,77,,170.63,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,227.14,82,,181.712,percent of total billed charges,82% of total billed charges,235.45,85,,188.36,percent of total billed charges,85% of total billed charges,235.45,85,,188.36,percent of total billed charges,85% of total billed charges,235.45,85,,188.36,percent of total billed charges,85% of total billed charges,249.3,90,,199.44,percent of total billed charges,90% of total billed charges,221.6,80,,177.28,percent of total billed charges,80% of total billed charges,249.3,90,,199.44,percent of total billed charges,90% of total billed charges,207.75,75,,166.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,80.33,29,,64.264,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,185.59,67,,148.472,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,221.6,80,,177.28,percent of total billed charges,80% of total billed charges,180.05,65,,144.04,percent of total billed charges,65% of total billed charges,98.81,35.67,,79.048,percent of total billed charges,35.67% of total billed charges,80.33,249.3,
BLUNTPORT DISPOSABLE TROCAR,27002772,CDM,272,RC,,,outpatient,,,819,327.60,,696.15,85,,556.92,percent of total billed charges,85% of total billed charges,630.63,77,,504.5,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,671.58,82,,537.264,percent of total billed charges,82% of total billed charges,696.15,85,,556.92,percent of total billed charges,85% of total billed charges,696.15,85,,556.92,percent of total billed charges,85% of total billed charges,696.15,85,,556.92,percent of total billed charges,85% of total billed charges,737.1,90,,589.68,percent of total billed charges,90% of total billed charges,655.2,80,,524.16,percent of total billed charges,80% of total billed charges,737.1,90,,589.68,percent of total billed charges,90% of total billed charges,614.25,75,,491.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,237.51,29,,190.008,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,548.73,67,,438.984,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,655.2,80,,524.16,percent of total billed charges,80% of total billed charges,532.35,65,,425.88,percent of total billed charges,65% of total billed charges,292.14,35.67,,233.712,percent of total billed charges,35.67% of total billed charges,237.51,737.1,
CHEST TUBE,27002805,CDM,272,RC,,,outpatient,,,140,56.00,,119,85,,95.2,percent of total billed charges,85% of total billed charges,107.8,77,,86.24,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,114.8,82,,91.84,percent of total billed charges,82% of total billed charges,119,85,,95.2,percent of total billed charges,85% of total billed charges,119,85,,95.2,percent of total billed charges,85% of total billed charges,119,85,,95.2,percent of total billed charges,85% of total billed charges,126,90,,100.8,percent of total billed charges,90% of total billed charges,112,80,,89.6,percent of total billed charges,80% of total billed charges,126,90,,100.8,percent of total billed charges,90% of total billed charges,105,75,,84,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,40.6,29,,32.48,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,93.8,67,,75.04,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,112,80,,89.6,percent of total billed charges,80% of total billed charges,91,65,,72.8,percent of total billed charges,65% of total billed charges,49.94,35.67,,39.952,percent of total billed charges,35.67% of total billed charges,40.6,126,
CHEST TUBE AND TROCAR 12FR,27002806,CDM,272,RC,,,outpatient,,,133,53.20,,113.05,85,,90.44,percent of total billed charges,85% of total billed charges,102.41,77,,81.93,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,109.06,82,,87.248,percent of total billed charges,82% of total billed charges,113.05,85,,90.44,percent of total billed charges,85% of total billed charges,113.05,85,,90.44,percent of total billed charges,85% of total billed charges,113.05,85,,90.44,percent of total billed charges,85% of total billed charges,119.7,90,,95.76,percent of total billed charges,90% of total billed charges,106.4,80,,85.12,percent of total billed charges,80% of total billed charges,119.7,90,,95.76,percent of total billed charges,90% of total billed charges,99.75,75,,79.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,38.57,29,,30.856,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,89.11,67,,71.288,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,106.4,80,,85.12,percent of total billed charges,80% of total billed charges,86.45,65,,69.16,percent of total billed charges,65% of total billed charges,47.44,35.67,,37.952,percent of total billed charges,35.67% of total billed charges,38.57,119.7,
CLIPPER BLADE ASSEMBLY,27002823,CDM,272,RC,,,outpatient,,,44,17.60,,37.4,85,,29.92,percent of total billed charges,85% of total billed charges,33.88,77,,27.1,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,36.08,82,,28.864,percent of total billed charges,82% of total billed charges,37.4,85,,29.92,percent of total billed charges,85% of total billed charges,37.4,85,,29.92,percent of total billed charges,85% of total billed charges,37.4,85,,29.92,percent of total billed charges,85% of total billed charges,39.6,90,,31.68,percent of total billed charges,90% of total billed charges,35.2,80,,28.16,percent of total billed charges,80% of total billed charges,39.6,90,,31.68,percent of total billed charges,90% of total billed charges,33,75,,26.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,12.76,29,,10.208,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,29.48,67,,23.584,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,35.2,80,,28.16,percent of total billed charges,80% of total billed charges,28.6,65,,22.88,percent of total billed charges,65% of total billed charges,15.69,35.67,,12.552,percent of total billed charges,35.67% of total billed charges,12.76,39.6,
FEEDING TUBE 5 FR,27002829,CDM,272,RC,,,outpatient,,,19,7.60,,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,14.63,77,,11.7,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,15.58,82,,12.464,percent of total billed charges,82% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,15.2,80,,12.16,percent of total billed charges,80% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,14.25,75,,11.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,5.51,29,,4.408,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,12.73,67,,10.184,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,15.2,80,,12.16,percent of total billed charges,80% of total billed charges,12.35,65,,9.88,percent of total billed charges,65% of total billed charges,6.78,35.67,,5.424,percent of total billed charges,35.67% of total billed charges,5.51,17.1,
DOUBLE BREAST PUMP KIT,27002830,CDM,272,RC,,,outpatient,,,205,82.00,,174.25,85,,139.4,percent of total billed charges,85% of total billed charges,157.85,77,,126.28,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,168.1,82,,134.48,percent of total billed charges,82% of total billed charges,174.25,85,,139.4,percent of total billed charges,85% of total billed charges,174.25,85,,139.4,percent of total billed charges,85% of total billed charges,174.25,85,,139.4,percent of total billed charges,85% of total billed charges,184.5,90,,147.6,percent of total billed charges,90% of total billed charges,164,80,,131.2,percent of total billed charges,80% of total billed charges,184.5,90,,147.6,percent of total billed charges,90% of total billed charges,153.75,75,,123,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,59.45,29,,47.56,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,137.35,67,,109.88,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,164,80,,131.2,percent of total billed charges,80% of total billed charges,133.25,65,,106.6,percent of total billed charges,65% of total billed charges,73.12,35.67,,58.496,percent of total billed charges,35.67% of total billed charges,59.45,184.5,
MANUAL SPRING BREAST PUMP,27002835,CDM,272,RC,,,outpatient,,,163,65.20,,138.55,85,,110.84,percent of total billed charges,85% of total billed charges,125.51,77,,100.41,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,133.66,82,,106.928,percent of total billed charges,82% of total billed charges,138.55,85,,110.84,percent of total billed charges,85% of total billed charges,138.55,85,,110.84,percent of total billed charges,85% of total billed charges,138.55,85,,110.84,percent of total billed charges,85% of total billed charges,146.7,90,,117.36,percent of total billed charges,90% of total billed charges,130.4,80,,104.32,percent of total billed charges,80% of total billed charges,146.7,90,,117.36,percent of total billed charges,90% of total billed charges,122.25,75,,97.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,47.27,29,,37.816,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,109.21,67,,87.368,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,130.4,80,,104.32,percent of total billed charges,80% of total billed charges,105.95,65,,84.76,percent of total billed charges,65% of total billed charges,58.14,35.67,,46.512,percent of total billed charges,35.67% of total billed charges,47.27,146.7,
WOUND IRRIGATION SYSTEM,27002837,CDM,272,RC,,,outpatient,,,166,66.40,,141.1,85,,112.88,percent of total billed charges,85% of total billed charges,127.82,77,,102.26,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,136.12,82,,108.896,percent of total billed charges,82% of total billed charges,141.1,85,,112.88,percent of total billed charges,85% of total billed charges,141.1,85,,112.88,percent of total billed charges,85% of total billed charges,141.1,85,,112.88,percent of total billed charges,85% of total billed charges,149.4,90,,119.52,percent of total billed charges,90% of total billed charges,132.8,80,,106.24,percent of total billed charges,80% of total billed charges,149.4,90,,119.52,percent of total billed charges,90% of total billed charges,124.5,75,,99.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,48.14,29,,38.512,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,111.22,67,,88.976,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,132.8,80,,106.24,percent of total billed charges,80% of total billed charges,107.9,65,,86.32,percent of total billed charges,65% of total billed charges,59.21,35.67,,47.368,percent of total billed charges,35.67% of total billed charges,48.14,149.4,
HOT LINE FLUID WARNING SET,27002850,CDM,272,RC,,,outpatient,,,145,58.00,,123.25,85,,98.6,percent of total billed charges,85% of total billed charges,111.65,77,,89.32,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,118.9,82,,95.12,percent of total billed charges,82% of total billed charges,123.25,85,,98.6,percent of total billed charges,85% of total billed charges,123.25,85,,98.6,percent of total billed charges,85% of total billed charges,123.25,85,,98.6,percent of total billed charges,85% of total billed charges,130.5,90,,104.4,percent of total billed charges,90% of total billed charges,116,80,,92.8,percent of total billed charges,80% of total billed charges,130.5,90,,104.4,percent of total billed charges,90% of total billed charges,108.75,75,,87,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,42.05,29,,33.64,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,97.15,67,,77.72,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,116,80,,92.8,percent of total billed charges,80% of total billed charges,94.25,65,,75.4,percent of total billed charges,65% of total billed charges,51.72,35.67,,41.376,percent of total billed charges,35.67% of total billed charges,42.05,130.5,
MULTIFIRE ENDO GIA 2.5,27002853,CDM,272,RC,,,outpatient,,,1763,705.20,,1498.55,85,,1198.84,percent of total billed charges,85% of total billed charges,1357.51,77,,1086.01,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,1445.66,82,,1156.528,percent of total billed charges,82% of total billed charges,1498.55,85,,1198.84,percent of total billed charges,85% of total billed charges,1498.55,85,,1198.84,percent of total billed charges,85% of total billed charges,1498.55,85,,1198.84,percent of total billed charges,85% of total billed charges,1586.7,90,,1269.36,percent of total billed charges,90% of total billed charges,1410.4,80,,1128.32,percent of total billed charges,80% of total billed charges,1586.7,90,,1269.36,percent of total billed charges,90% of total billed charges,1322.25,75,,1057.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,511.27,29,,409.016,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1181.21,67,,944.968,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1410.4,80,,1128.32,percent of total billed charges,80% of total billed charges,1145.95,65,,916.76,percent of total billed charges,65% of total billed charges,628.86,35.67,,503.088,percent of total billed charges,35.67% of total billed charges,511.27,1586.7,
UTERINE CURETTE **,27002856,CDM,272,RC,,,outpatient,,,31,12.40,,26.35,85,,21.08,percent of total billed charges,85% of total billed charges,23.87,77,,19.1,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,25.42,82,,20.336,percent of total billed charges,82% of total billed charges,26.35,85,,21.08,percent of total billed charges,85% of total billed charges,26.35,85,,21.08,percent of total billed charges,85% of total billed charges,26.35,85,,21.08,percent of total billed charges,85% of total billed charges,27.9,90,,22.32,percent of total billed charges,90% of total billed charges,24.8,80,,19.84,percent of total billed charges,80% of total billed charges,27.9,90,,22.32,percent of total billed charges,90% of total billed charges,23.25,75,,18.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,8.99,29,,7.192,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,20.77,67,,16.616,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,24.8,80,,19.84,percent of total billed charges,80% of total billed charges,20.15,65,,16.12,percent of total billed charges,65% of total billed charges,11.06,35.67,,8.848,percent of total billed charges,35.67% of total billed charges,8.99,27.9,
SKIN STAPLE REMOVER,27002858,CDM,272,RC,,,outpatient,,,38,15.20,,32.3,85,,25.84,percent of total billed charges,85% of total billed charges,29.26,77,,23.41,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,31.16,82,,24.928,percent of total billed charges,82% of total billed charges,32.3,85,,25.84,percent of total billed charges,85% of total billed charges,32.3,85,,25.84,percent of total billed charges,85% of total billed charges,32.3,85,,25.84,percent of total billed charges,85% of total billed charges,34.2,90,,27.36,percent of total billed charges,90% of total billed charges,30.4,80,,24.32,percent of total billed charges,80% of total billed charges,34.2,90,,27.36,percent of total billed charges,90% of total billed charges,28.5,75,,22.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,11.02,29,,8.816,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,25.46,67,,20.368,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,30.4,80,,24.32,percent of total billed charges,80% of total billed charges,24.7,65,,19.76,percent of total billed charges,65% of total billed charges,13.55,35.67,,10.84,percent of total billed charges,35.67% of total billed charges,11.02,34.2,
NEEDLE HUBER 20X3/4,27002864,CDM,272,RC,,,outpatient,,,60,24.00,,51,85,,40.8,percent of total billed charges,85% of total billed charges,46.2,77,,36.96,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,49.2,82,,39.36,percent of total billed charges,82% of total billed charges,51,85,,40.8,percent of total billed charges,85% of total billed charges,51,85,,40.8,percent of total billed charges,85% of total billed charges,51,85,,40.8,percent of total billed charges,85% of total billed charges,54,90,,43.2,percent of total billed charges,90% of total billed charges,48,80,,38.4,percent of total billed charges,80% of total billed charges,54,90,,43.2,percent of total billed charges,90% of total billed charges,45,75,,36,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,17.4,29,,13.92,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,40.2,67,,32.16,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,48,80,,38.4,percent of total billed charges,80% of total billed charges,39,65,,31.2,percent of total billed charges,65% of total billed charges,21.4,35.67,,17.12,percent of total billed charges,35.67% of total billed charges,17.4,54,
MULTIFIRE ENDO GIA 3.5,27002873,CDM,272,RC,,,outpatient,,,2139,855.60,,1818.15,85,,1454.52,percent of total billed charges,85% of total billed charges,1647.03,77,,1317.62,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,1753.98,82,,1403.184,percent of total billed charges,82% of total billed charges,1818.15,85,,1454.52,percent of total billed charges,85% of total billed charges,1818.15,85,,1454.52,percent of total billed charges,85% of total billed charges,1818.15,85,,1454.52,percent of total billed charges,85% of total billed charges,1925.1,90,,1540.08,percent of total billed charges,90% of total billed charges,1711.2,80,,1368.96,percent of total billed charges,80% of total billed charges,1925.1,90,,1540.08,percent of total billed charges,90% of total billed charges,1604.25,75,,1283.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,620.31,29,,496.248,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1433.13,67,,1146.504,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1711.2,80,,1368.96,percent of total billed charges,80% of total billed charges,1390.35,65,,1112.28,percent of total billed charges,65% of total billed charges,762.98,35.67,,610.384,percent of total billed charges,35.67% of total billed charges,620.31,1925.1,
CLAMP ENDO BABCOCK 10MM,27002874,CDM,272,RC,,,outpatient,,,1912,764.80,,1625.2,85,,1300.16,percent of total billed charges,85% of total billed charges,1472.24,77,,1177.79,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,1567.84,82,,1254.272,percent of total billed charges,82% of total billed charges,1625.2,85,,1300.16,percent of total billed charges,85% of total billed charges,1625.2,85,,1300.16,percent of total billed charges,85% of total billed charges,1625.2,85,,1300.16,percent of total billed charges,85% of total billed charges,1720.8,90,,1376.64,percent of total billed charges,90% of total billed charges,1529.6,80,,1223.68,percent of total billed charges,80% of total billed charges,1720.8,90,,1376.64,percent of total billed charges,90% of total billed charges,1434,75,,1147.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,554.48,29,,443.584,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1281.04,67,,1024.832,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1529.6,80,,1223.68,percent of total billed charges,80% of total billed charges,1242.8,65,,994.24,percent of total billed charges,65% of total billed charges,682.01,35.67,,545.608,percent of total billed charges,35.67% of total billed charges,554.48,1720.8,
PCA PUMP SET FOR BAG **,27002875,CDM,272,RC,,,outpatient,,,122,48.80,,103.7,85,,82.96,percent of total billed charges,85% of total billed charges,93.94,77,,75.15,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,100.04,82,,80.032,percent of total billed charges,82% of total billed charges,103.7,85,,82.96,percent of total billed charges,85% of total billed charges,103.7,85,,82.96,percent of total billed charges,85% of total billed charges,103.7,85,,82.96,percent of total billed charges,85% of total billed charges,109.8,90,,87.84,percent of total billed charges,90% of total billed charges,97.6,80,,78.08,percent of total billed charges,80% of total billed charges,109.8,90,,87.84,percent of total billed charges,90% of total billed charges,91.5,75,,73.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,35.38,29,,28.304,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,81.74,67,,65.392,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,97.6,80,,78.08,percent of total billed charges,80% of total billed charges,79.3,65,,63.44,percent of total billed charges,65% of total billed charges,43.52,35.67,,34.816,percent of total billed charges,35.67% of total billed charges,35.38,109.8,
MIC GASTROSTOMY TUBE 14 FR,27002876,CDM,272,RC,,,outpatient,,,206,82.40,,175.1,85,,140.08,percent of total billed charges,85% of total billed charges,158.62,77,,126.9,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,168.92,82,,135.136,percent of total billed charges,82% of total billed charges,175.1,85,,140.08,percent of total billed charges,85% of total billed charges,175.1,85,,140.08,percent of total billed charges,85% of total billed charges,175.1,85,,140.08,percent of total billed charges,85% of total billed charges,185.4,90,,148.32,percent of total billed charges,90% of total billed charges,164.8,80,,131.84,percent of total billed charges,80% of total billed charges,185.4,90,,148.32,percent of total billed charges,90% of total billed charges,154.5,75,,123.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,59.74,29,,47.792,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,138.02,67,,110.416,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,164.8,80,,131.84,percent of total billed charges,80% of total billed charges,133.9,65,,107.12,percent of total billed charges,65% of total billed charges,73.48,35.67,,58.784,percent of total billed charges,35.67% of total billed charges,59.74,185.4,
MIC GASTROSTOMY TUBE 18 FR,27002877,CDM,272,RC,,,outpatient,,,206,82.40,,175.1,85,,140.08,percent of total billed charges,85% of total billed charges,158.62,77,,126.9,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,168.92,82,,135.136,percent of total billed charges,82% of total billed charges,175.1,85,,140.08,percent of total billed charges,85% of total billed charges,175.1,85,,140.08,percent of total billed charges,85% of total billed charges,175.1,85,,140.08,percent of total billed charges,85% of total billed charges,185.4,90,,148.32,percent of total billed charges,90% of total billed charges,164.8,80,,131.84,percent of total billed charges,80% of total billed charges,185.4,90,,148.32,percent of total billed charges,90% of total billed charges,154.5,75,,123.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,59.74,29,,47.792,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,138.02,67,,110.416,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,164.8,80,,131.84,percent of total billed charges,80% of total billed charges,133.9,65,,107.12,percent of total billed charges,65% of total billed charges,73.48,35.67,,58.784,percent of total billed charges,35.67% of total billed charges,59.74,185.4,
MIC GASTROSTOMY TUBE 22FR,27002878,CDM,272,RC,,,outpatient,,,206,82.40,,175.1,85,,140.08,percent of total billed charges,85% of total billed charges,158.62,77,,126.9,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,168.92,82,,135.136,percent of total billed charges,82% of total billed charges,175.1,85,,140.08,percent of total billed charges,85% of total billed charges,175.1,85,,140.08,percent of total billed charges,85% of total billed charges,175.1,85,,140.08,percent of total billed charges,85% of total billed charges,185.4,90,,148.32,percent of total billed charges,90% of total billed charges,164.8,80,,131.84,percent of total billed charges,80% of total billed charges,185.4,90,,148.32,percent of total billed charges,90% of total billed charges,154.5,75,,123.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,59.74,29,,47.792,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,138.02,67,,110.416,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,164.8,80,,131.84,percent of total billed charges,80% of total billed charges,133.9,65,,107.12,percent of total billed charges,65% of total billed charges,73.48,35.67,,58.784,percent of total billed charges,35.67% of total billed charges,59.74,185.4,
PARACENTESIS/THORA. TRAY,27002929,CDM,272,RC,,,outpatient,,,279,111.60,,237.15,85,,189.72,percent of total billed charges,85% of total billed charges,214.83,77,,171.86,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,228.78,82,,183.024,percent of total billed charges,82% of total billed charges,237.15,85,,189.72,percent of total billed charges,85% of total billed charges,237.15,85,,189.72,percent of total billed charges,85% of total billed charges,237.15,85,,189.72,percent of total billed charges,85% of total billed charges,251.1,90,,200.88,percent of total billed charges,90% of total billed charges,223.2,80,,178.56,percent of total billed charges,80% of total billed charges,251.1,90,,200.88,percent of total billed charges,90% of total billed charges,209.25,75,,167.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,80.91,29,,64.728,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,186.93,67,,149.544,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,223.2,80,,178.56,percent of total billed charges,80% of total billed charges,181.35,65,,145.08,percent of total billed charges,65% of total billed charges,99.52,35.67,,79.616,percent of total billed charges,35.67% of total billed charges,80.91,251.1,
LEEP REDI KIT,27002945,CDM,272,RC,,,outpatient,,,247,98.80,,209.95,85,,167.96,percent of total billed charges,85% of total billed charges,190.19,77,,152.15,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,202.54,82,,162.032,percent of total billed charges,82% of total billed charges,209.95,85,,167.96,percent of total billed charges,85% of total billed charges,209.95,85,,167.96,percent of total billed charges,85% of total billed charges,209.95,85,,167.96,percent of total billed charges,85% of total billed charges,222.3,90,,177.84,percent of total billed charges,90% of total billed charges,197.6,80,,158.08,percent of total billed charges,80% of total billed charges,222.3,90,,177.84,percent of total billed charges,90% of total billed charges,185.25,75,,148.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,71.63,29,,57.304,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,165.49,67,,132.392,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,197.6,80,,158.08,percent of total billed charges,80% of total billed charges,160.55,65,,128.44,percent of total billed charges,65% of total billed charges,88.1,35.67,,70.48,percent of total billed charges,35.67% of total billed charges,71.63,222.3,
OB PACK II EVOL,27002994,CDM,272,RC,,,outpatient,,,132,52.80,,112.2,85,,89.76,percent of total billed charges,85% of total billed charges,101.64,77,,81.31,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,108.24,82,,86.592,percent of total billed charges,82% of total billed charges,112.2,85,,89.76,percent of total billed charges,85% of total billed charges,112.2,85,,89.76,percent of total billed charges,85% of total billed charges,112.2,85,,89.76,percent of total billed charges,85% of total billed charges,118.8,90,,95.04,percent of total billed charges,90% of total billed charges,105.6,80,,84.48,percent of total billed charges,80% of total billed charges,118.8,90,,95.04,percent of total billed charges,90% of total billed charges,99,75,,79.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,38.28,29,,30.624,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,88.44,67,,70.752,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,105.6,80,,84.48,percent of total billed charges,80% of total billed charges,85.8,65,,68.64,percent of total billed charges,65% of total billed charges,47.08,35.67,,37.664,percent of total billed charges,35.67% of total billed charges,38.28,118.8,
UTERINE MANIPULATOR **,27003128,CDM,272,RC,,,outpatient,,,164,65.60,,139.4,85,,111.52,percent of total billed charges,85% of total billed charges,126.28,77,,101.02,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,134.48,82,,107.584,percent of total billed charges,82% of total billed charges,139.4,85,,111.52,percent of total billed charges,85% of total billed charges,139.4,85,,111.52,percent of total billed charges,85% of total billed charges,139.4,85,,111.52,percent of total billed charges,85% of total billed charges,147.6,90,,118.08,percent of total billed charges,90% of total billed charges,131.2,80,,104.96,percent of total billed charges,80% of total billed charges,147.6,90,,118.08,percent of total billed charges,90% of total billed charges,123,75,,98.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,47.56,29,,38.048,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,109.88,67,,87.904,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,131.2,80,,104.96,percent of total billed charges,80% of total billed charges,106.6,65,,85.28,percent of total billed charges,65% of total billed charges,58.5,35.67,,46.8,percent of total billed charges,35.67% of total billed charges,47.56,147.6,
BONE MARROW BIOPSY TRAY,27003143,CDM,272,RC,,,outpatient,,,243,97.20,,206.55,85,,165.24,percent of total billed charges,85% of total billed charges,187.11,77,,149.69,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,199.26,82,,159.408,percent of total billed charges,82% of total billed charges,206.55,85,,165.24,percent of total billed charges,85% of total billed charges,206.55,85,,165.24,percent of total billed charges,85% of total billed charges,206.55,85,,165.24,percent of total billed charges,85% of total billed charges,218.7,90,,174.96,percent of total billed charges,90% of total billed charges,194.4,80,,155.52,percent of total billed charges,80% of total billed charges,218.7,90,,174.96,percent of total billed charges,90% of total billed charges,182.25,75,,145.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,70.47,29,,56.376,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,162.81,67,,130.248,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,194.4,80,,155.52,percent of total billed charges,80% of total billed charges,157.95,65,,126.36,percent of total billed charges,65% of total billed charges,86.68,35.67,,69.344,percent of total billed charges,35.67% of total billed charges,70.47,218.7,
SKIN STAPLES PI 90,27003158,CDM,272,RC,,,outpatient,,,882,352.80,,749.7,85,,599.76,percent of total billed charges,85% of total billed charges,679.14,77,,543.31,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,723.24,82,,578.592,percent of total billed charges,82% of total billed charges,749.7,85,,599.76,percent of total billed charges,85% of total billed charges,749.7,85,,599.76,percent of total billed charges,85% of total billed charges,749.7,85,,599.76,percent of total billed charges,85% of total billed charges,793.8,90,,635.04,percent of total billed charges,90% of total billed charges,705.6,80,,564.48,percent of total billed charges,80% of total billed charges,793.8,90,,635.04,percent of total billed charges,90% of total billed charges,661.5,75,,529.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,255.78,29,,204.624,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,590.94,67,,472.752,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,705.6,80,,564.48,percent of total billed charges,80% of total billed charges,573.3,65,,458.64,percent of total billed charges,65% of total billed charges,314.61,35.67,,251.688,percent of total billed charges,35.67% of total billed charges,255.78,793.8,
GASTROSTOMY TUBE KIT 20 FR,27003170,CDM,272,RC,,,outpatient,,,294,117.60,,249.9,85,,199.92,percent of total billed charges,85% of total billed charges,226.38,77,,181.1,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,241.08,82,,192.864,percent of total billed charges,82% of total billed charges,249.9,85,,199.92,percent of total billed charges,85% of total billed charges,249.9,85,,199.92,percent of total billed charges,85% of total billed charges,249.9,85,,199.92,percent of total billed charges,85% of total billed charges,264.6,90,,211.68,percent of total billed charges,90% of total billed charges,235.2,80,,188.16,percent of total billed charges,80% of total billed charges,264.6,90,,211.68,percent of total billed charges,90% of total billed charges,220.5,75,,176.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,85.26,29,,68.208,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,196.98,67,,157.584,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,235.2,80,,188.16,percent of total billed charges,80% of total billed charges,191.1,65,,152.88,percent of total billed charges,65% of total billed charges,104.87,35.67,,83.896,percent of total billed charges,35.67% of total billed charges,85.26,264.6,
BIOPSY NEEDLE 14G TW X 6 **,27003173,CDM,272,RC,,,outpatient,,,23,9.20,,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,17.71,77,,14.17,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,18.86,82,,15.088,percent of total billed charges,82% of total billed charges,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,20.7,90,,16.56,percent of total billed charges,90% of total billed charges,18.4,80,,14.72,percent of total billed charges,80% of total billed charges,20.7,90,,16.56,percent of total billed charges,90% of total billed charges,17.25,75,,13.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,6.67,29,,5.336,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,15.41,67,,12.328,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,18.4,80,,14.72,percent of total billed charges,80% of total billed charges,14.95,65,,11.96,percent of total billed charges,65% of total billed charges,8.2,35.67,,6.56,percent of total billed charges,35.67% of total billed charges,6.67,20.7,
DERMATOME BLADE,27003177,CDM,272,RC,,,outpatient,,,1724,689.60,,1465.4,85,,1172.32,percent of total billed charges,85% of total billed charges,1327.48,77,,1061.98,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,1413.68,82,,1130.944,percent of total billed charges,82% of total billed charges,1465.4,85,,1172.32,percent of total billed charges,85% of total billed charges,1465.4,85,,1172.32,percent of total billed charges,85% of total billed charges,1465.4,85,,1172.32,percent of total billed charges,85% of total billed charges,1551.6,90,,1241.28,percent of total billed charges,90% of total billed charges,1379.2,80,,1103.36,percent of total billed charges,80% of total billed charges,1551.6,90,,1241.28,percent of total billed charges,90% of total billed charges,1293,75,,1034.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,499.96,29,,399.968,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1155.08,67,,924.064,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1379.2,80,,1103.36,percent of total billed charges,80% of total billed charges,1120.6,65,,896.48,percent of total billed charges,65% of total billed charges,614.95,35.67,,491.96,percent of total billed charges,35.67% of total billed charges,499.96,1551.6,
EASY GASTRIC LAVAGE SYSTEM,27003182,CDM,272,RC,,,outpatient,,,339,135.60,,288.15,85,,230.52,percent of total billed charges,85% of total billed charges,261.03,77,,208.82,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,277.98,82,,222.384,percent of total billed charges,82% of total billed charges,288.15,85,,230.52,percent of total billed charges,85% of total billed charges,288.15,85,,230.52,percent of total billed charges,85% of total billed charges,288.15,85,,230.52,percent of total billed charges,85% of total billed charges,305.1,90,,244.08,percent of total billed charges,90% of total billed charges,271.2,80,,216.96,percent of total billed charges,80% of total billed charges,305.1,90,,244.08,percent of total billed charges,90% of total billed charges,254.25,75,,203.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,98.31,29,,78.648,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,227.13,67,,181.704,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,271.2,80,,216.96,percent of total billed charges,80% of total billed charges,220.35,65,,176.28,percent of total billed charges,65% of total billed charges,120.92,35.67,,96.736,percent of total billed charges,35.67% of total billed charges,98.31,305.1,
GASTRIC TUBE 28 FR,27003183,CDM,272,RC,,,outpatient,,,113,45.20,,96.05,85,,76.84,percent of total billed charges,85% of total billed charges,87.01,77,,69.61,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,92.66,82,,74.128,percent of total billed charges,82% of total billed charges,96.05,85,,76.84,percent of total billed charges,85% of total billed charges,96.05,85,,76.84,percent of total billed charges,85% of total billed charges,96.05,85,,76.84,percent of total billed charges,85% of total billed charges,101.7,90,,81.36,percent of total billed charges,90% of total billed charges,90.4,80,,72.32,percent of total billed charges,80% of total billed charges,101.7,90,,81.36,percent of total billed charges,90% of total billed charges,84.75,75,,67.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,32.77,29,,26.216,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,75.71,67,,60.568,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,90.4,80,,72.32,percent of total billed charges,80% of total billed charges,73.45,65,,58.76,percent of total billed charges,65% of total billed charges,40.31,35.67,,32.248,percent of total billed charges,35.67% of total billed charges,32.77,101.7,
GASTRIC TUBE,27003184,CDM,272,RC,,,outpatient,,,100,40.00,,85,85,,68,percent of total billed charges,85% of total billed charges,77,77,,61.6,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,82,82,,65.6,percent of total billed charges,82% of total billed charges,85,85,,68,percent of total billed charges,85% of total billed charges,85,85,,68,percent of total billed charges,85% of total billed charges,85,85,,68,percent of total billed charges,85% of total billed charges,90,90,,72,percent of total billed charges,90% of total billed charges,80,80,,64,percent of total billed charges,80% of total billed charges,90,90,,72,percent of total billed charges,90% of total billed charges,75,75,,60,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,29,29,,23.2,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,67,67,,53.6,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,80,80,,64,percent of total billed charges,80% of total billed charges,65,65,,52,percent of total billed charges,65% of total billed charges,35.67,35.67,,28.536,percent of total billed charges,35.67% of total billed charges,29,90,
STRYKER FLOW II,27003190,CDM,272,RC,,,outpatient,,,539,215.60,,458.15,85,,366.52,percent of total billed charges,85% of total billed charges,415.03,77,,332.02,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,441.98,82,,353.584,percent of total billed charges,82% of total billed charges,458.15,85,,366.52,percent of total billed charges,85% of total billed charges,458.15,85,,366.52,percent of total billed charges,85% of total billed charges,458.15,85,,366.52,percent of total billed charges,85% of total billed charges,485.1,90,,388.08,percent of total billed charges,90% of total billed charges,431.2,80,,344.96,percent of total billed charges,80% of total billed charges,485.1,90,,388.08,percent of total billed charges,90% of total billed charges,404.25,75,,323.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,156.31,29,,125.048,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,361.13,67,,288.904,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,431.2,80,,344.96,percent of total billed charges,80% of total billed charges,350.35,65,,280.28,percent of total billed charges,65% of total billed charges,192.26,35.67,,153.808,percent of total billed charges,35.67% of total billed charges,156.31,485.1,
FINGERCOT WITH HOOK,27003193,CDM,272,RC,,,outpatient,,,31,12.40,,26.35,85,,21.08,percent of total billed charges,85% of total billed charges,23.87,77,,19.1,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,25.42,82,,20.336,percent of total billed charges,82% of total billed charges,26.35,85,,21.08,percent of total billed charges,85% of total billed charges,26.35,85,,21.08,percent of total billed charges,85% of total billed charges,26.35,85,,21.08,percent of total billed charges,85% of total billed charges,27.9,90,,22.32,percent of total billed charges,90% of total billed charges,24.8,80,,19.84,percent of total billed charges,80% of total billed charges,27.9,90,,22.32,percent of total billed charges,90% of total billed charges,23.25,75,,18.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,8.99,29,,7.192,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,20.77,67,,16.616,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,24.8,80,,19.84,percent of total billed charges,80% of total billed charges,20.15,65,,16.12,percent of total billed charges,65% of total billed charges,11.06,35.67,,8.848,percent of total billed charges,35.67% of total billed charges,8.99,27.9,
VACUUM DELIVERY KIT 65 MM,27003194,CDM,272,RC,,,outpatient,,,204,81.60,,173.4,85,,138.72,percent of total billed charges,85% of total billed charges,157.08,77,,125.66,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,167.28,82,,133.824,percent of total billed charges,82% of total billed charges,173.4,85,,138.72,percent of total billed charges,85% of total billed charges,173.4,85,,138.72,percent of total billed charges,85% of total billed charges,173.4,85,,138.72,percent of total billed charges,85% of total billed charges,183.6,90,,146.88,percent of total billed charges,90% of total billed charges,163.2,80,,130.56,percent of total billed charges,80% of total billed charges,183.6,90,,146.88,percent of total billed charges,90% of total billed charges,153,75,,122.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,59.16,29,,47.328,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,136.68,67,,109.344,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,163.2,80,,130.56,percent of total billed charges,80% of total billed charges,132.6,65,,106.08,percent of total billed charges,65% of total billed charges,72.77,35.67,,58.216,percent of total billed charges,35.67% of total billed charges,59.16,183.6,
CMI VACUUM PUMP MANUAL,27003196,CDM,272,RC,,,outpatient,,,311,124.40,,264.35,85,,211.48,percent of total billed charges,85% of total billed charges,239.47,77,,191.58,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,255.02,82,,204.016,percent of total billed charges,82% of total billed charges,264.35,85,,211.48,percent of total billed charges,85% of total billed charges,264.35,85,,211.48,percent of total billed charges,85% of total billed charges,264.35,85,,211.48,percent of total billed charges,85% of total billed charges,279.9,90,,223.92,percent of total billed charges,90% of total billed charges,248.8,80,,199.04,percent of total billed charges,80% of total billed charges,279.9,90,,223.92,percent of total billed charges,90% of total billed charges,233.25,75,,186.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,90.19,29,,72.152,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,208.37,67,,166.696,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,248.8,80,,199.04,percent of total billed charges,80% of total billed charges,202.15,65,,161.72,percent of total billed charges,65% of total billed charges,110.93,35.67,,88.744,percent of total billed charges,35.67% of total billed charges,90.19,279.9,
CODMAN VEIN STRIPPER,27003197,CDM,272,RC,,,outpatient,,,173,69.20,,147.05,85,,117.64,percent of total billed charges,85% of total billed charges,133.21,77,,106.57,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,141.86,82,,113.488,percent of total billed charges,82% of total billed charges,147.05,85,,117.64,percent of total billed charges,85% of total billed charges,147.05,85,,117.64,percent of total billed charges,85% of total billed charges,147.05,85,,117.64,percent of total billed charges,85% of total billed charges,155.7,90,,124.56,percent of total billed charges,90% of total billed charges,138.4,80,,110.72,percent of total billed charges,80% of total billed charges,155.7,90,,124.56,percent of total billed charges,90% of total billed charges,129.75,75,,103.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,50.17,29,,40.136,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,115.91,67,,92.728,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,138.4,80,,110.72,percent of total billed charges,80% of total billed charges,112.45,65,,89.96,percent of total billed charges,65% of total billed charges,61.71,35.67,,49.368,percent of total billed charges,35.67% of total billed charges,50.17,155.7,
ARTHROSCOPY PACK ORTHOARTS,27003199,CDM,272,RC,,,outpatient,,,360,144.00,,306,85,,244.8,percent of total billed charges,85% of total billed charges,277.2,77,,221.76,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,295.2,82,,236.16,percent of total billed charges,82% of total billed charges,306,85,,244.8,percent of total billed charges,85% of total billed charges,306,85,,244.8,percent of total billed charges,85% of total billed charges,306,85,,244.8,percent of total billed charges,85% of total billed charges,324,90,,259.2,percent of total billed charges,90% of total billed charges,288,80,,230.4,percent of total billed charges,80% of total billed charges,324,90,,259.2,percent of total billed charges,90% of total billed charges,270,75,,216,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,104.4,29,,83.52,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,241.2,67,,192.96,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,288,80,,230.4,percent of total billed charges,80% of total billed charges,234,65,,187.2,percent of total billed charges,65% of total billed charges,128.41,35.67,,102.728,percent of total billed charges,35.67% of total billed charges,104.4,324,
SAFETOUCH CANISTER,27003205,CDM,272,RC,,,outpatient,,,133,53.20,,113.05,85,,90.44,percent of total billed charges,85% of total billed charges,102.41,77,,81.93,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,109.06,82,,87.248,percent of total billed charges,82% of total billed charges,113.05,85,,90.44,percent of total billed charges,85% of total billed charges,113.05,85,,90.44,percent of total billed charges,85% of total billed charges,113.05,85,,90.44,percent of total billed charges,85% of total billed charges,119.7,90,,95.76,percent of total billed charges,90% of total billed charges,106.4,80,,85.12,percent of total billed charges,80% of total billed charges,119.7,90,,95.76,percent of total billed charges,90% of total billed charges,99.75,75,,79.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,38.57,29,,30.856,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,89.11,67,,71.288,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,106.4,80,,85.12,percent of total billed charges,80% of total billed charges,86.45,65,,69.16,percent of total billed charges,65% of total billed charges,47.44,35.67,,37.952,percent of total billed charges,35.67% of total billed charges,38.57,119.7,
SAGITTAL SAW BLADE SMALL,27003209,CDM,272,RC,,,outpatient,,,94,37.60,,79.9,85,,63.92,percent of total billed charges,85% of total billed charges,72.38,77,,57.9,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,77.08,82,,61.664,percent of total billed charges,82% of total billed charges,79.9,85,,63.92,percent of total billed charges,85% of total billed charges,79.9,85,,63.92,percent of total billed charges,85% of total billed charges,79.9,85,,63.92,percent of total billed charges,85% of total billed charges,84.6,90,,67.68,percent of total billed charges,90% of total billed charges,75.2,80,,60.16,percent of total billed charges,80% of total billed charges,84.6,90,,67.68,percent of total billed charges,90% of total billed charges,70.5,75,,56.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,27.26,29,,21.808,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,62.98,67,,50.384,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,75.2,80,,60.16,percent of total billed charges,80% of total billed charges,61.1,65,,48.88,percent of total billed charges,65% of total billed charges,33.53,35.67,,26.824,percent of total billed charges,35.67% of total billed charges,27.26,84.6,
OSC SAW BLADE SMALL,27003210,CDM,272,RC,,,outpatient,,,147,58.80,,124.95,85,,99.96,percent of total billed charges,85% of total billed charges,113.19,77,,90.55,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,120.54,82,,96.432,percent of total billed charges,82% of total billed charges,124.95,85,,99.96,percent of total billed charges,85% of total billed charges,124.95,85,,99.96,percent of total billed charges,85% of total billed charges,124.95,85,,99.96,percent of total billed charges,85% of total billed charges,132.3,90,,105.84,percent of total billed charges,90% of total billed charges,117.6,80,,94.08,percent of total billed charges,80% of total billed charges,132.3,90,,105.84,percent of total billed charges,90% of total billed charges,110.25,75,,88.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,42.63,29,,34.104,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,98.49,67,,78.792,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,117.6,80,,94.08,percent of total billed charges,80% of total billed charges,95.55,65,,76.44,percent of total billed charges,65% of total billed charges,52.43,35.67,,41.944,percent of total billed charges,35.67% of total billed charges,42.63,132.3,
OSC SAW BLADE SMALL,27003211,CDM,272,RC,,,outpatient,,,147,58.80,,124.95,85,,99.96,percent of total billed charges,85% of total billed charges,113.19,77,,90.55,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,120.54,82,,96.432,percent of total billed charges,82% of total billed charges,124.95,85,,99.96,percent of total billed charges,85% of total billed charges,124.95,85,,99.96,percent of total billed charges,85% of total billed charges,124.95,85,,99.96,percent of total billed charges,85% of total billed charges,132.3,90,,105.84,percent of total billed charges,90% of total billed charges,117.6,80,,94.08,percent of total billed charges,80% of total billed charges,132.3,90,,105.84,percent of total billed charges,90% of total billed charges,110.25,75,,88.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,42.63,29,,34.104,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,98.49,67,,78.792,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,117.6,80,,94.08,percent of total billed charges,80% of total billed charges,95.55,65,,76.44,percent of total billed charges,65% of total billed charges,52.43,35.67,,41.944,percent of total billed charges,35.67% of total billed charges,42.63,132.3,
CARBIDE BUR. OVAL CUTTING,27003212,CDM,272,RC,,,outpatient,,,213,85.20,,181.05,85,,144.84,percent of total billed charges,85% of total billed charges,164.01,77,,131.21,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,174.66,82,,139.728,percent of total billed charges,82% of total billed charges,181.05,85,,144.84,percent of total billed charges,85% of total billed charges,181.05,85,,144.84,percent of total billed charges,85% of total billed charges,181.05,85,,144.84,percent of total billed charges,85% of total billed charges,191.7,90,,153.36,percent of total billed charges,90% of total billed charges,170.4,80,,136.32,percent of total billed charges,80% of total billed charges,191.7,90,,153.36,percent of total billed charges,90% of total billed charges,159.75,75,,127.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,61.77,29,,49.416,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,142.71,67,,114.168,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,170.4,80,,136.32,percent of total billed charges,80% of total billed charges,138.45,65,,110.76,percent of total billed charges,65% of total billed charges,75.98,35.67,,60.784,percent of total billed charges,35.67% of total billed charges,61.77,191.7,
CARBIDE OVAL INSTRUMENT,27003213,CDM,272,RC,,,outpatient,,,175,70.00,,148.75,85,,119,percent of total billed charges,85% of total billed charges,134.75,77,,107.8,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,143.5,82,,114.8,percent of total billed charges,82% of total billed charges,148.75,85,,119,percent of total billed charges,85% of total billed charges,148.75,85,,119,percent of total billed charges,85% of total billed charges,148.75,85,,119,percent of total billed charges,85% of total billed charges,157.5,90,,126,percent of total billed charges,90% of total billed charges,140,80,,112,percent of total billed charges,80% of total billed charges,157.5,90,,126,percent of total billed charges,90% of total billed charges,131.25,75,,105,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,50.75,29,,40.6,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,117.25,67,,93.8,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,140,80,,112,percent of total billed charges,80% of total billed charges,113.75,65,,91,percent of total billed charges,65% of total billed charges,62.42,35.67,,49.936,percent of total billed charges,35.67% of total billed charges,50.75,157.5,
ESMARK BANDAGE 6X3,27003215,CDM,272,RC,,,outpatient,,,62,24.80,,52.7,85,,42.16,percent of total billed charges,85% of total billed charges,47.74,77,,38.19,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,50.84,82,,40.672,percent of total billed charges,82% of total billed charges,52.7,85,,42.16,percent of total billed charges,85% of total billed charges,52.7,85,,42.16,percent of total billed charges,85% of total billed charges,52.7,85,,42.16,percent of total billed charges,85% of total billed charges,55.8,90,,44.64,percent of total billed charges,90% of total billed charges,49.6,80,,39.68,percent of total billed charges,80% of total billed charges,55.8,90,,44.64,percent of total billed charges,90% of total billed charges,46.5,75,,37.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,17.98,29,,14.384,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,41.54,67,,33.232,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,49.6,80,,39.68,percent of total billed charges,80% of total billed charges,40.3,65,,32.24,percent of total billed charges,65% of total billed charges,22.12,35.67,,17.696,percent of total billed charges,35.67% of total billed charges,17.98,55.8,
SAGITTAL SAW BLADE SMALL,27003218,CDM,272,RC,,,outpatient,,,93,37.20,,79.05,85,,63.24,percent of total billed charges,85% of total billed charges,71.61,77,,57.29,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,76.26,82,,61.008,percent of total billed charges,82% of total billed charges,79.05,85,,63.24,percent of total billed charges,85% of total billed charges,79.05,85,,63.24,percent of total billed charges,85% of total billed charges,79.05,85,,63.24,percent of total billed charges,85% of total billed charges,83.7,90,,66.96,percent of total billed charges,90% of total billed charges,74.4,80,,59.52,percent of total billed charges,80% of total billed charges,83.7,90,,66.96,percent of total billed charges,90% of total billed charges,69.75,75,,55.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,26.97,29,,21.576,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,62.31,67,,49.848,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,74.4,80,,59.52,percent of total billed charges,80% of total billed charges,60.45,65,,48.36,percent of total billed charges,65% of total billed charges,33.17,35.67,,26.536,percent of total billed charges,35.67% of total billed charges,26.97,83.7,
ARTHROSCOPY PUMP SET,27003221,CDM,272,RC,,,outpatient,,,430,172.00,,365.5,85,,292.4,percent of total billed charges,85% of total billed charges,331.1,77,,264.88,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,352.6,82,,282.08,percent of total billed charges,82% of total billed charges,365.5,85,,292.4,percent of total billed charges,85% of total billed charges,365.5,85,,292.4,percent of total billed charges,85% of total billed charges,365.5,85,,292.4,percent of total billed charges,85% of total billed charges,387,90,,309.6,percent of total billed charges,90% of total billed charges,344,80,,275.2,percent of total billed charges,80% of total billed charges,387,90,,309.6,percent of total billed charges,90% of total billed charges,322.5,75,,258,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,124.7,29,,99.76,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,288.1,67,,230.48,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,344,80,,275.2,percent of total billed charges,80% of total billed charges,279.5,65,,223.6,percent of total billed charges,65% of total billed charges,153.38,35.67,,122.704,percent of total billed charges,35.67% of total billed charges,124.7,387,
SERFAS PROBE 3.5,27003222,CDM,272,RC,,,outpatient,,,911,364.40,,774.35,85,,619.48,percent of total billed charges,85% of total billed charges,701.47,77,,561.18,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,747.02,82,,597.616,percent of total billed charges,82% of total billed charges,774.35,85,,619.48,percent of total billed charges,85% of total billed charges,774.35,85,,619.48,percent of total billed charges,85% of total billed charges,774.35,85,,619.48,percent of total billed charges,85% of total billed charges,819.9,90,,655.92,percent of total billed charges,90% of total billed charges,728.8,80,,583.04,percent of total billed charges,80% of total billed charges,819.9,90,,655.92,percent of total billed charges,90% of total billed charges,683.25,75,,546.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,264.19,29,,211.352,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,610.37,67,,488.296,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,728.8,80,,583.04,percent of total billed charges,80% of total billed charges,592.15,65,,473.72,percent of total billed charges,65% of total billed charges,324.95,35.67,,259.96,percent of total billed charges,35.67% of total billed charges,264.19,819.9,
SERFAS PROBE **,27003223,CDM,272,RC,,,outpatient,,,997,398.80,,847.45,85,,677.96,percent of total billed charges,85% of total billed charges,767.69,77,,614.15,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,817.54,82,,654.032,percent of total billed charges,82% of total billed charges,847.45,85,,677.96,percent of total billed charges,85% of total billed charges,847.45,85,,677.96,percent of total billed charges,85% of total billed charges,847.45,85,,677.96,percent of total billed charges,85% of total billed charges,897.3,90,,717.84,percent of total billed charges,90% of total billed charges,797.6,80,,638.08,percent of total billed charges,80% of total billed charges,897.3,90,,717.84,percent of total billed charges,90% of total billed charges,747.75,75,,598.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,289.13,29,,231.304,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,667.99,67,,534.392,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,797.6,80,,638.08,percent of total billed charges,80% of total billed charges,648.05,65,,518.44,percent of total billed charges,65% of total billed charges,355.63,35.67,,284.504,percent of total billed charges,35.67% of total billed charges,289.13,897.3,
SERFAS PROBE LAT. 3.5 **,27003224,CDM,272,RC,,,outpatient,,,1001,400.40,,850.85,85,,680.68,percent of total billed charges,85% of total billed charges,770.77,77,,616.62,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,820.82,82,,656.656,percent of total billed charges,82% of total billed charges,850.85,85,,680.68,percent of total billed charges,85% of total billed charges,850.85,85,,680.68,percent of total billed charges,85% of total billed charges,850.85,85,,680.68,percent of total billed charges,85% of total billed charges,900.9,90,,720.72,percent of total billed charges,90% of total billed charges,800.8,80,,640.64,percent of total billed charges,80% of total billed charges,900.9,90,,720.72,percent of total billed charges,90% of total billed charges,750.75,75,,600.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,290.29,29,,232.232,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,670.67,67,,536.536,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,800.8,80,,640.64,percent of total billed charges,80% of total billed charges,650.65,65,,520.52,percent of total billed charges,65% of total billed charges,357.06,35.67,,285.648,percent of total billed charges,35.67% of total billed charges,290.29,900.9,
BARREL BUR 4.0 **,27003225,CDM,272,RC,,,outpatient,,,514,205.60,,436.9,85,,349.52,percent of total billed charges,85% of total billed charges,395.78,77,,316.62,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,421.48,82,,337.184,percent of total billed charges,82% of total billed charges,436.9,85,,349.52,percent of total billed charges,85% of total billed charges,436.9,85,,349.52,percent of total billed charges,85% of total billed charges,436.9,85,,349.52,percent of total billed charges,85% of total billed charges,462.6,90,,370.08,percent of total billed charges,90% of total billed charges,411.2,80,,328.96,percent of total billed charges,80% of total billed charges,462.6,90,,370.08,percent of total billed charges,90% of total billed charges,385.5,75,,308.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,149.06,29,,119.248,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,344.38,67,,275.504,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,411.2,80,,328.96,percent of total billed charges,80% of total billed charges,334.1,65,,267.28,percent of total billed charges,65% of total billed charges,183.34,35.67,,146.672,percent of total billed charges,35.67% of total billed charges,149.06,462.6,
ROUND BUR 3.5 MM **,27003227,CDM,272,RC,,,outpatient,,,376,150.40,,319.6,85,,255.68,percent of total billed charges,85% of total billed charges,289.52,77,,231.62,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,308.32,82,,246.656,percent of total billed charges,82% of total billed charges,319.6,85,,255.68,percent of total billed charges,85% of total billed charges,319.6,85,,255.68,percent of total billed charges,85% of total billed charges,319.6,85,,255.68,percent of total billed charges,85% of total billed charges,338.4,90,,270.72,percent of total billed charges,90% of total billed charges,300.8,80,,240.64,percent of total billed charges,80% of total billed charges,338.4,90,,270.72,percent of total billed charges,90% of total billed charges,282,75,,225.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,109.04,29,,87.232,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,251.92,67,,201.536,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,300.8,80,,240.64,percent of total billed charges,80% of total billed charges,244.4,65,,195.52,percent of total billed charges,65% of total billed charges,134.12,35.67,,107.296,percent of total billed charges,35.67% of total billed charges,109.04,338.4,
RESECTOR CUTTER 4.0,27003228,CDM,272,RC,,,outpatient,,,471,188.40,,400.35,85,,320.28,percent of total billed charges,85% of total billed charges,362.67,77,,290.14,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,386.22,82,,308.976,percent of total billed charges,82% of total billed charges,400.35,85,,320.28,percent of total billed charges,85% of total billed charges,400.35,85,,320.28,percent of total billed charges,85% of total billed charges,400.35,85,,320.28,percent of total billed charges,85% of total billed charges,423.9,90,,339.12,percent of total billed charges,90% of total billed charges,376.8,80,,301.44,percent of total billed charges,80% of total billed charges,423.9,90,,339.12,percent of total billed charges,90% of total billed charges,353.25,75,,282.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,136.59,29,,109.272,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,315.57,67,,252.456,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,376.8,80,,301.44,percent of total billed charges,80% of total billed charges,306.15,65,,244.92,percent of total billed charges,65% of total billed charges,168.01,35.67,,134.408,percent of total billed charges,35.67% of total billed charges,136.59,423.9,
RESECTOR CUTTER 3.5MM **,27003229,CDM,272,RC,,,outpatient,,,534,213.60,,453.9,85,,363.12,percent of total billed charges,85% of total billed charges,411.18,77,,328.94,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,437.88,82,,350.304,percent of total billed charges,82% of total billed charges,453.9,85,,363.12,percent of total billed charges,85% of total billed charges,453.9,85,,363.12,percent of total billed charges,85% of total billed charges,453.9,85,,363.12,percent of total billed charges,85% of total billed charges,480.6,90,,384.48,percent of total billed charges,90% of total billed charges,427.2,80,,341.76,percent of total billed charges,80% of total billed charges,480.6,90,,384.48,percent of total billed charges,90% of total billed charges,400.5,75,,320.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,154.86,29,,123.888,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,357.78,67,,286.224,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,427.2,80,,341.76,percent of total billed charges,80% of total billed charges,347.1,65,,277.68,percent of total billed charges,65% of total billed charges,190.48,35.67,,152.384,percent of total billed charges,35.67% of total billed charges,154.86,480.6,
AGGRESSIVE PLUS CUTTER 4.0,27003230,CDM,272,RC,,,outpatient,,,494,197.60,,419.9,85,,335.92,percent of total billed charges,85% of total billed charges,380.38,77,,304.3,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,405.08,82,,324.064,percent of total billed charges,82% of total billed charges,419.9,85,,335.92,percent of total billed charges,85% of total billed charges,419.9,85,,335.92,percent of total billed charges,85% of total billed charges,419.9,85,,335.92,percent of total billed charges,85% of total billed charges,444.6,90,,355.68,percent of total billed charges,90% of total billed charges,395.2,80,,316.16,percent of total billed charges,80% of total billed charges,444.6,90,,355.68,percent of total billed charges,90% of total billed charges,370.5,75,,296.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,143.26,29,,114.608,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,330.98,67,,264.784,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,395.2,80,,316.16,percent of total billed charges,80% of total billed charges,321.1,65,,256.88,percent of total billed charges,65% of total billed charges,176.21,35.67,,140.968,percent of total billed charges,35.67% of total billed charges,143.26,444.6,
AGGRESSIVE PLUS CUTTER 5.5,27003231,CDM,272,RC,,,outpatient,,,455,182.00,,386.75,85,,309.4,percent of total billed charges,85% of total billed charges,350.35,77,,280.28,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,373.1,82,,298.48,percent of total billed charges,82% of total billed charges,386.75,85,,309.4,percent of total billed charges,85% of total billed charges,386.75,85,,309.4,percent of total billed charges,85% of total billed charges,386.75,85,,309.4,percent of total billed charges,85% of total billed charges,409.5,90,,327.6,percent of total billed charges,90% of total billed charges,364,80,,291.2,percent of total billed charges,80% of total billed charges,409.5,90,,327.6,percent of total billed charges,90% of total billed charges,341.25,75,,273,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,131.95,29,,105.56,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,304.85,67,,243.88,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,364,80,,291.2,percent of total billed charges,80% of total billed charges,295.75,65,,236.6,percent of total billed charges,65% of total billed charges,162.3,35.67,,129.84,percent of total billed charges,35.67% of total billed charges,131.95,409.5,
KERLIX AMD ROLL,27003244,CDM,272,RC,,,outpatient,,,18,7.20,,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,13.86,77,,11.09,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,14.76,82,,11.808,percent of total billed charges,82% of total billed charges,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,16.2,90,,12.96,percent of total billed charges,90% of total billed charges,14.4,80,,11.52,percent of total billed charges,80% of total billed charges,16.2,90,,12.96,percent of total billed charges,90% of total billed charges,13.5,75,,10.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,5.22,29,,4.176,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,12.06,67,,9.648,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,14.4,80,,11.52,percent of total billed charges,80% of total billed charges,11.7,65,,9.36,percent of total billed charges,65% of total billed charges,6.42,35.67,,5.136,percent of total billed charges,35.67% of total billed charges,5.22,16.2,
ALGI HYDROCOLLOID DRESS 4X5 **,27003289,CDM,272,RC,,,outpatient,,,50,20.00,,42.5,85,,34,percent of total billed charges,85% of total billed charges,38.5,77,,30.8,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,41,82,,32.8,percent of total billed charges,82% of total billed charges,42.5,85,,34,percent of total billed charges,85% of total billed charges,42.5,85,,34,percent of total billed charges,85% of total billed charges,42.5,85,,34,percent of total billed charges,85% of total billed charges,45,90,,36,percent of total billed charges,90% of total billed charges,40,80,,32,percent of total billed charges,80% of total billed charges,45,90,,36,percent of total billed charges,90% of total billed charges,37.5,75,,30,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,14.5,29,,11.6,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,33.5,67,,26.8,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,40,80,,32,percent of total billed charges,80% of total billed charges,32.5,65,,26,percent of total billed charges,65% of total billed charges,17.84,35.67,,14.272,percent of total billed charges,35.67% of total billed charges,14.5,45,
ALGINATE HYDROCOLLOID 4X4 **,27003290,CDM,272,RC,,,outpatient,,,36,14.40,,30.6,85,,24.48,percent of total billed charges,85% of total billed charges,27.72,77,,22.18,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,29.52,82,,23.616,percent of total billed charges,82% of total billed charges,30.6,85,,24.48,percent of total billed charges,85% of total billed charges,30.6,85,,24.48,percent of total billed charges,85% of total billed charges,30.6,85,,24.48,percent of total billed charges,85% of total billed charges,32.4,90,,25.92,percent of total billed charges,90% of total billed charges,28.8,80,,23.04,percent of total billed charges,80% of total billed charges,32.4,90,,25.92,percent of total billed charges,90% of total billed charges,27,75,,21.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,10.44,29,,8.352,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,24.12,67,,19.296,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,28.8,80,,23.04,percent of total billed charges,80% of total billed charges,23.4,65,,18.72,percent of total billed charges,65% of total billed charges,12.84,35.67,,10.272,percent of total billed charges,35.67% of total billed charges,10.44,32.4,
SPINAL NEEDLE 24G 3 1/2,27003302,CDM,272,RC,,,outpatient,,,132,52.80,,112.2,85,,89.76,percent of total billed charges,85% of total billed charges,101.64,77,,81.31,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,108.24,82,,86.592,percent of total billed charges,82% of total billed charges,112.2,85,,89.76,percent of total billed charges,85% of total billed charges,112.2,85,,89.76,percent of total billed charges,85% of total billed charges,112.2,85,,89.76,percent of total billed charges,85% of total billed charges,118.8,90,,95.04,percent of total billed charges,90% of total billed charges,105.6,80,,84.48,percent of total billed charges,80% of total billed charges,118.8,90,,95.04,percent of total billed charges,90% of total billed charges,99,75,,79.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,38.28,29,,30.624,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,88.44,67,,70.752,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,105.6,80,,84.48,percent of total billed charges,80% of total billed charges,85.8,65,,68.64,percent of total billed charges,65% of total billed charges,47.08,35.67,,37.664,percent of total billed charges,35.67% of total billed charges,38.28,118.8,
KERLIX AMD,27003304,CDM,272,RC,,,outpatient,,,23,9.20,,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,17.71,77,,14.17,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,18.86,82,,15.088,percent of total billed charges,82% of total billed charges,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,20.7,90,,16.56,percent of total billed charges,90% of total billed charges,18.4,80,,14.72,percent of total billed charges,80% of total billed charges,20.7,90,,16.56,percent of total billed charges,90% of total billed charges,17.25,75,,13.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,6.67,29,,5.336,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,15.41,67,,12.328,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,18.4,80,,14.72,percent of total billed charges,80% of total billed charges,14.95,65,,11.96,percent of total billed charges,65% of total billed charges,8.2,35.67,,6.56,percent of total billed charges,35.67% of total billed charges,6.67,20.7,
HYDROGEL WOUND DRESSING 4X4 **,27003313,CDM,272,RC,,,outpatient,,,28,11.20,,23.8,85,,19.04,percent of total billed charges,85% of total billed charges,21.56,77,,17.25,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,22.96,82,,18.368,percent of total billed charges,82% of total billed charges,23.8,85,,19.04,percent of total billed charges,85% of total billed charges,23.8,85,,19.04,percent of total billed charges,85% of total billed charges,23.8,85,,19.04,percent of total billed charges,85% of total billed charges,25.2,90,,20.16,percent of total billed charges,90% of total billed charges,22.4,80,,17.92,percent of total billed charges,80% of total billed charges,25.2,90,,20.16,percent of total billed charges,90% of total billed charges,21,75,,16.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,8.12,29,,6.496,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,18.76,67,,15.008,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,22.4,80,,17.92,percent of total billed charges,80% of total billed charges,18.2,65,,14.56,percent of total billed charges,65% of total billed charges,9.99,35.67,,7.992,percent of total billed charges,35.67% of total billed charges,8.12,25.2,
CURASORB CALCIUM ALGINATE **,27003314,CDM,272,RC,,,outpatient,,,40,16.00,,34,85,,27.2,percent of total billed charges,85% of total billed charges,30.8,77,,24.64,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,32.8,82,,26.24,percent of total billed charges,82% of total billed charges,34,85,,27.2,percent of total billed charges,85% of total billed charges,34,85,,27.2,percent of total billed charges,85% of total billed charges,34,85,,27.2,percent of total billed charges,85% of total billed charges,36,90,,28.8,percent of total billed charges,90% of total billed charges,32,80,,25.6,percent of total billed charges,80% of total billed charges,36,90,,28.8,percent of total billed charges,90% of total billed charges,30,75,,24,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,11.6,29,,9.28,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,26.8,67,,21.44,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,32,80,,25.6,percent of total billed charges,80% of total billed charges,26,65,,20.8,percent of total billed charges,65% of total billed charges,14.27,35.67,,11.416,percent of total billed charges,35.67% of total billed charges,11.6,36,
WASHING/INJECTION NEEDLE,27003386,CDM,272,RC,,,outpatient,,,245,98.00,,208.25,85,,166.6,percent of total billed charges,85% of total billed charges,188.65,77,,150.92,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,200.9,82,,160.72,percent of total billed charges,82% of total billed charges,208.25,85,,166.6,percent of total billed charges,85% of total billed charges,208.25,85,,166.6,percent of total billed charges,85% of total billed charges,208.25,85,,166.6,percent of total billed charges,85% of total billed charges,220.5,90,,176.4,percent of total billed charges,90% of total billed charges,196,80,,156.8,percent of total billed charges,80% of total billed charges,220.5,90,,176.4,percent of total billed charges,90% of total billed charges,183.75,75,,147,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,71.05,29,,56.84,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,164.15,67,,131.32,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,196,80,,156.8,percent of total billed charges,80% of total billed charges,159.25,65,,127.4,percent of total billed charges,65% of total billed charges,87.39,35.67,,69.912,percent of total billed charges,35.67% of total billed charges,71.05,220.5,
FOGARTY CATHETER 6 FR 23CM,27003632,CDM,272,RC,,,outpatient,,,347,138.80,,294.95,85,,235.96,percent of total billed charges,85% of total billed charges,267.19,77,,213.75,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,284.54,82,,227.632,percent of total billed charges,82% of total billed charges,294.95,85,,235.96,percent of total billed charges,85% of total billed charges,294.95,85,,235.96,percent of total billed charges,85% of total billed charges,294.95,85,,235.96,percent of total billed charges,85% of total billed charges,312.3,90,,249.84,percent of total billed charges,90% of total billed charges,277.6,80,,222.08,percent of total billed charges,80% of total billed charges,312.3,90,,249.84,percent of total billed charges,90% of total billed charges,260.25,75,,208.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,100.63,29,,80.504,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,232.49,67,,185.992,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,277.6,80,,222.08,percent of total billed charges,80% of total billed charges,225.55,65,,180.44,percent of total billed charges,65% of total billed charges,123.77,35.67,,99.016,percent of total billed charges,35.67% of total billed charges,100.63,312.3,
MIC GASTROSTOMY TUBE 28FR,27003680,CDM,272,RC,,,outpatient,,,198,79.20,,168.3,85,,134.64,percent of total billed charges,85% of total billed charges,152.46,77,,121.97,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,162.36,82,,129.888,percent of total billed charges,82% of total billed charges,168.3,85,,134.64,percent of total billed charges,85% of total billed charges,168.3,85,,134.64,percent of total billed charges,85% of total billed charges,168.3,85,,134.64,percent of total billed charges,85% of total billed charges,178.2,90,,142.56,percent of total billed charges,90% of total billed charges,158.4,80,,126.72,percent of total billed charges,80% of total billed charges,178.2,90,,142.56,percent of total billed charges,90% of total billed charges,148.5,75,,118.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,57.42,29,,45.936,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,132.66,67,,106.128,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,158.4,80,,126.72,percent of total billed charges,80% of total billed charges,128.7,65,,102.96,percent of total billed charges,65% of total billed charges,70.63,35.67,,56.504,percent of total billed charges,35.67% of total billed charges,57.42,178.2,
MIC GASTROSTOMY 30 FR,27003681,CDM,272,RC,,,outpatient,,,232,92.80,,197.2,85,,157.76,percent of total billed charges,85% of total billed charges,178.64,77,,142.91,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,190.24,82,,152.192,percent of total billed charges,82% of total billed charges,197.2,85,,157.76,percent of total billed charges,85% of total billed charges,197.2,85,,157.76,percent of total billed charges,85% of total billed charges,197.2,85,,157.76,percent of total billed charges,85% of total billed charges,208.8,90,,167.04,percent of total billed charges,90% of total billed charges,185.6,80,,148.48,percent of total billed charges,80% of total billed charges,208.8,90,,167.04,percent of total billed charges,90% of total billed charges,174,75,,139.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,67.28,29,,53.824,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,155.44,67,,124.352,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,185.6,80,,148.48,percent of total billed charges,80% of total billed charges,150.8,65,,120.64,percent of total billed charges,65% of total billed charges,82.75,35.67,,66.2,percent of total billed charges,35.67% of total billed charges,67.28,208.8,
GUIDE WIRE HS-2020 **,27003849,CDM,272,RC,C1769,HCPCS,outpatient,,,346,138.40,,294.1,85,,235.28,percent of total billed charges,85% of total billed charges,266.42,77,,213.14,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,283.72,82,,226.976,percent of total billed charges,82% of total billed charges,294.1,85,,235.28,percent of total billed charges,85% of total billed charges,294.1,85,,235.28,percent of total billed charges,85% of total billed charges,294.1,85,,235.28,percent of total billed charges,85% of total billed charges,311.4,90,,249.12,percent of total billed charges,90% of total billed charges,276.8,80,,221.44,percent of total billed charges,80% of total billed charges,311.4,90,,249.12,percent of total billed charges,90% of total billed charges,259.5,75,,207.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,100.34,29,,80.272,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,231.82,67,,185.456,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,276.8,80,,221.44,percent of total billed charges,80% of total billed charges,224.9,65,,179.92,percent of total billed charges,65% of total billed charges,123.42,35.67,,98.736,percent of total billed charges,35.67% of total billed charges,100.34,311.4,
SUTURE CV-5 30 **,27003947,CDM,272,RC,,,outpatient,,,168,67.20,,142.8,85,,114.24,percent of total billed charges,85% of total billed charges,129.36,77,,103.49,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,137.76,82,,110.208,percent of total billed charges,82% of total billed charges,142.8,85,,114.24,percent of total billed charges,85% of total billed charges,142.8,85,,114.24,percent of total billed charges,85% of total billed charges,142.8,85,,114.24,percent of total billed charges,85% of total billed charges,151.2,90,,120.96,percent of total billed charges,90% of total billed charges,134.4,80,,107.52,percent of total billed charges,80% of total billed charges,151.2,90,,120.96,percent of total billed charges,90% of total billed charges,126,75,,100.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,48.72,29,,38.976,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,112.56,67,,90.048,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,134.4,80,,107.52,percent of total billed charges,80% of total billed charges,109.2,65,,87.36,percent of total billed charges,65% of total billed charges,59.93,35.67,,47.944,percent of total billed charges,35.67% of total billed charges,48.72,151.2,
WOUND VAC GUN VARICARE,27004199,CDM,272,RC,,,outpatient,,,311,124.40,,264.35,85,,211.48,percent of total billed charges,85% of total billed charges,239.47,77,,191.58,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,255.02,82,,204.016,percent of total billed charges,82% of total billed charges,264.35,85,,211.48,percent of total billed charges,85% of total billed charges,264.35,85,,211.48,percent of total billed charges,85% of total billed charges,264.35,85,,211.48,percent of total billed charges,85% of total billed charges,279.9,90,,223.92,percent of total billed charges,90% of total billed charges,248.8,80,,199.04,percent of total billed charges,80% of total billed charges,279.9,90,,223.92,percent of total billed charges,90% of total billed charges,233.25,75,,186.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,90.19,29,,72.152,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,208.37,67,,166.696,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,248.8,80,,199.04,percent of total billed charges,80% of total billed charges,202.15,65,,161.72,percent of total billed charges,65% of total billed charges,110.93,35.67,,88.744,percent of total billed charges,35.67% of total billed charges,90.19,279.9,
WOUND VAC OPEN TRACK TIP,27004200,CDM,272,RC,,,outpatient,,,170,68.00,,144.5,85,,115.6,percent of total billed charges,85% of total billed charges,130.9,77,,104.72,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,139.4,82,,111.52,percent of total billed charges,82% of total billed charges,144.5,85,,115.6,percent of total billed charges,85% of total billed charges,144.5,85,,115.6,percent of total billed charges,85% of total billed charges,144.5,85,,115.6,percent of total billed charges,85% of total billed charges,153,90,,122.4,percent of total billed charges,90% of total billed charges,136,80,,108.8,percent of total billed charges,80% of total billed charges,153,90,,122.4,percent of total billed charges,90% of total billed charges,127.5,75,,102,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,49.3,29,,39.44,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,113.9,67,,91.12,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,136,80,,108.8,percent of total billed charges,80% of total billed charges,110.5,65,,88.4,percent of total billed charges,65% of total billed charges,60.64,35.67,,48.512,percent of total billed charges,35.67% of total billed charges,49.3,153,
WOUND VAC DIVERTER TIP,27004201,CDM,272,RC,,,outpatient,,,261,104.40,,221.85,85,,177.48,percent of total billed charges,85% of total billed charges,200.97,77,,160.78,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,214.02,82,,171.216,percent of total billed charges,82% of total billed charges,221.85,85,,177.48,percent of total billed charges,85% of total billed charges,221.85,85,,177.48,percent of total billed charges,85% of total billed charges,221.85,85,,177.48,percent of total billed charges,85% of total billed charges,234.9,90,,187.92,percent of total billed charges,90% of total billed charges,208.8,80,,167.04,percent of total billed charges,80% of total billed charges,234.9,90,,187.92,percent of total billed charges,90% of total billed charges,195.75,75,,156.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,75.69,29,,60.552,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,174.87,67,,139.896,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,208.8,80,,167.04,percent of total billed charges,80% of total billed charges,169.65,65,,135.72,percent of total billed charges,65% of total billed charges,93.1,35.67,,74.48,percent of total billed charges,35.67% of total billed charges,75.69,234.9,
MIC GASTROSTOMY TUBE 24FR,27004518,CDM,272,RC,,,outpatient,,,198,79.20,,168.3,85,,134.64,percent of total billed charges,85% of total billed charges,152.46,77,,121.97,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,162.36,82,,129.888,percent of total billed charges,82% of total billed charges,168.3,85,,134.64,percent of total billed charges,85% of total billed charges,168.3,85,,134.64,percent of total billed charges,85% of total billed charges,168.3,85,,134.64,percent of total billed charges,85% of total billed charges,178.2,90,,142.56,percent of total billed charges,90% of total billed charges,158.4,80,,126.72,percent of total billed charges,80% of total billed charges,178.2,90,,142.56,percent of total billed charges,90% of total billed charges,148.5,75,,118.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,57.42,29,,45.936,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,132.66,67,,106.128,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,158.4,80,,126.72,percent of total billed charges,80% of total billed charges,128.7,65,,102.96,percent of total billed charges,65% of total billed charges,70.63,35.67,,56.504,percent of total billed charges,35.67% of total billed charges,57.42,178.2,
SYRINGE TOOMEY 70 CC,27004521,CDM,272,RC,,,outpatient,,,18,7.20,,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,13.86,77,,11.09,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,14.76,82,,11.808,percent of total billed charges,82% of total billed charges,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,16.2,90,,12.96,percent of total billed charges,90% of total billed charges,14.4,80,,11.52,percent of total billed charges,80% of total billed charges,16.2,90,,12.96,percent of total billed charges,90% of total billed charges,13.5,75,,10.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,5.22,29,,4.176,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,12.06,67,,9.648,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,14.4,80,,11.52,percent of total billed charges,80% of total billed charges,11.7,65,,9.36,percent of total billed charges,65% of total billed charges,6.42,35.67,,5.136,percent of total billed charges,35.67% of total billed charges,5.22,16.2,
CRD/GUARDIAN TANDEM TUBE,27004522,CDM,272,RC,,,outpatient,,,12,4.80,,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,9.24,77,,7.39,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,9.84,82,,7.872,percent of total billed charges,82% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,10.8,90,,8.64,percent of total billed charges,90% of total billed charges,9.6,80,,7.68,percent of total billed charges,80% of total billed charges,10.8,90,,8.64,percent of total billed charges,90% of total billed charges,9,75,,7.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,3.48,29,,2.784,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,8.04,67,,6.432,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,9.6,80,,7.68,percent of total billed charges,80% of total billed charges,7.8,65,,6.24,percent of total billed charges,65% of total billed charges,4.28,35.67,,3.424,percent of total billed charges,35.67% of total billed charges,3.48,10.8,
MONARCH II IOL C CARTRIDGE,27004541,CDM,272,RC,,,outpatient,,,204,81.60,,173.4,85,,138.72,percent of total billed charges,85% of total billed charges,157.08,77,,125.66,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,167.28,82,,133.824,percent of total billed charges,82% of total billed charges,173.4,85,,138.72,percent of total billed charges,85% of total billed charges,173.4,85,,138.72,percent of total billed charges,85% of total billed charges,173.4,85,,138.72,percent of total billed charges,85% of total billed charges,183.6,90,,146.88,percent of total billed charges,90% of total billed charges,163.2,80,,130.56,percent of total billed charges,80% of total billed charges,183.6,90,,146.88,percent of total billed charges,90% of total billed charges,153,75,,122.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,59.16,29,,47.328,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,136.68,67,,109.344,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,163.2,80,,130.56,percent of total billed charges,80% of total billed charges,132.6,65,,106.08,percent of total billed charges,65% of total billed charges,72.77,35.67,,58.216,percent of total billed charges,35.67% of total billed charges,59.16,183.6,
MONARCH II IOL B CARTRIDGE,27004542,CDM,272,RC,,,outpatient,,,204,81.60,,173.4,85,,138.72,percent of total billed charges,85% of total billed charges,157.08,77,,125.66,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,167.28,82,,133.824,percent of total billed charges,82% of total billed charges,173.4,85,,138.72,percent of total billed charges,85% of total billed charges,173.4,85,,138.72,percent of total billed charges,85% of total billed charges,173.4,85,,138.72,percent of total billed charges,85% of total billed charges,183.6,90,,146.88,percent of total billed charges,90% of total billed charges,163.2,80,,130.56,percent of total billed charges,80% of total billed charges,183.6,90,,146.88,percent of total billed charges,90% of total billed charges,153,75,,122.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,59.16,29,,47.328,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,136.68,67,,109.344,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,163.2,80,,130.56,percent of total billed charges,80% of total billed charges,132.6,65,,106.08,percent of total billed charges,65% of total billed charges,72.77,35.67,,58.216,percent of total billed charges,35.67% of total billed charges,59.16,183.6,
ANT CHAMBER CANNULA 30G,27004545,CDM,272,RC,,,outpatient,,,89,35.60,,75.65,85,,60.52,percent of total billed charges,85% of total billed charges,68.53,77,,54.82,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,72.98,82,,58.384,percent of total billed charges,82% of total billed charges,75.65,85,,60.52,percent of total billed charges,85% of total billed charges,75.65,85,,60.52,percent of total billed charges,85% of total billed charges,75.65,85,,60.52,percent of total billed charges,85% of total billed charges,80.1,90,,64.08,percent of total billed charges,90% of total billed charges,71.2,80,,56.96,percent of total billed charges,80% of total billed charges,80.1,90,,64.08,percent of total billed charges,90% of total billed charges,66.75,75,,53.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,25.81,29,,20.648,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,59.63,67,,47.704,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,71.2,80,,56.96,percent of total billed charges,80% of total billed charges,57.85,65,,46.28,percent of total billed charges,65% of total billed charges,31.75,35.67,,25.4,percent of total billed charges,35.67% of total billed charges,25.81,80.1,
PHISOHEX,27004546,CDM,272,RC,,,outpatient,,,208,83.20,,176.8,85,,141.44,percent of total billed charges,85% of total billed charges,160.16,77,,128.13,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,170.56,82,,136.448,percent of total billed charges,82% of total billed charges,176.8,85,,141.44,percent of total billed charges,85% of total billed charges,176.8,85,,141.44,percent of total billed charges,85% of total billed charges,176.8,85,,141.44,percent of total billed charges,85% of total billed charges,187.2,90,,149.76,percent of total billed charges,90% of total billed charges,166.4,80,,133.12,percent of total billed charges,80% of total billed charges,187.2,90,,149.76,percent of total billed charges,90% of total billed charges,156,75,,124.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,60.32,29,,48.256,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,139.36,67,,111.488,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,166.4,80,,133.12,percent of total billed charges,80% of total billed charges,135.2,65,,108.16,percent of total billed charges,65% of total billed charges,74.19,35.67,,59.352,percent of total billed charges,35.67% of total billed charges,60.32,187.2,
NEEDLE 2FR SPRING 1/2 CIR,27004552,CDM,272,RC,,,outpatient,,,59,23.60,,50.15,85,,40.12,percent of total billed charges,85% of total billed charges,45.43,77,,36.34,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,48.38,82,,38.704,percent of total billed charges,82% of total billed charges,50.15,85,,40.12,percent of total billed charges,85% of total billed charges,50.15,85,,40.12,percent of total billed charges,85% of total billed charges,50.15,85,,40.12,percent of total billed charges,85% of total billed charges,53.1,90,,42.48,percent of total billed charges,90% of total billed charges,47.2,80,,37.76,percent of total billed charges,80% of total billed charges,53.1,90,,42.48,percent of total billed charges,90% of total billed charges,44.25,75,,35.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,17.11,29,,13.688,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,39.53,67,,31.624,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,47.2,80,,37.76,percent of total billed charges,80% of total billed charges,38.35,65,,30.68,percent of total billed charges,65% of total billed charges,21.05,35.67,,16.84,percent of total billed charges,35.67% of total billed charges,17.11,53.1,
NEEDLE 7REG SURG 1/2 CIR **,27004553,CDM,272,RC,,,outpatient,,,20,8.00,,17,85,,13.6,percent of total billed charges,85% of total billed charges,15.4,77,,12.32,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,16.4,82,,13.12,percent of total billed charges,82% of total billed charges,17,85,,13.6,percent of total billed charges,85% of total billed charges,17,85,,13.6,percent of total billed charges,85% of total billed charges,17,85,,13.6,percent of total billed charges,85% of total billed charges,18,90,,14.4,percent of total billed charges,90% of total billed charges,16,80,,12.8,percent of total billed charges,80% of total billed charges,18,90,,14.4,percent of total billed charges,90% of total billed charges,15,75,,12,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,5.8,29,,4.64,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,13.4,67,,10.72,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,16,80,,12.8,percent of total billed charges,80% of total billed charges,13,65,,10.4,percent of total billed charges,65% of total billed charges,7.13,35.67,,5.704,percent of total billed charges,35.67% of total billed charges,5.8,18,
NEEDLE 5MAYO CATGUT 1/2 CIR,27004554,CDM,272,RC,,,outpatient,,,31,12.40,,26.35,85,,21.08,percent of total billed charges,85% of total billed charges,23.87,77,,19.1,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,25.42,82,,20.336,percent of total billed charges,82% of total billed charges,26.35,85,,21.08,percent of total billed charges,85% of total billed charges,26.35,85,,21.08,percent of total billed charges,85% of total billed charges,26.35,85,,21.08,percent of total billed charges,85% of total billed charges,27.9,90,,22.32,percent of total billed charges,90% of total billed charges,24.8,80,,19.84,percent of total billed charges,80% of total billed charges,27.9,90,,22.32,percent of total billed charges,90% of total billed charges,23.25,75,,18.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,8.99,29,,7.192,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,20.77,67,,16.616,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,24.8,80,,19.84,percent of total billed charges,80% of total billed charges,20.15,65,,16.12,percent of total billed charges,65% of total billed charges,11.06,35.67,,8.848,percent of total billed charges,35.67% of total billed charges,8.99,27.9,
NEEDLE 18 FERGUSON 1/2 CIR **,27004555,CDM,272,RC,,,outpatient,,,20,8.00,,17,85,,13.6,percent of total billed charges,85% of total billed charges,15.4,77,,12.32,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,16.4,82,,13.12,percent of total billed charges,82% of total billed charges,17,85,,13.6,percent of total billed charges,85% of total billed charges,17,85,,13.6,percent of total billed charges,85% of total billed charges,17,85,,13.6,percent of total billed charges,85% of total billed charges,18,90,,14.4,percent of total billed charges,90% of total billed charges,16,80,,12.8,percent of total billed charges,80% of total billed charges,18,90,,14.4,percent of total billed charges,90% of total billed charges,15,75,,12,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,5.8,29,,4.64,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,13.4,67,,10.72,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,16,80,,12.8,percent of total billed charges,80% of total billed charges,13,65,,10.4,percent of total billed charges,65% of total billed charges,7.13,35.67,,5.704,percent of total billed charges,35.67% of total billed charges,5.8,18,
COMBI-TUBE ESOPHAGEAL AIRWAY,27004556,CDM,272,RC,,,outpatient,,,313,125.20,,266.05,85,,212.84,percent of total billed charges,85% of total billed charges,241.01,77,,192.81,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,256.66,82,,205.328,percent of total billed charges,82% of total billed charges,266.05,85,,212.84,percent of total billed charges,85% of total billed charges,266.05,85,,212.84,percent of total billed charges,85% of total billed charges,266.05,85,,212.84,percent of total billed charges,85% of total billed charges,281.7,90,,225.36,percent of total billed charges,90% of total billed charges,250.4,80,,200.32,percent of total billed charges,80% of total billed charges,281.7,90,,225.36,percent of total billed charges,90% of total billed charges,234.75,75,,187.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,90.77,29,,72.616,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,209.71,67,,167.768,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,250.4,80,,200.32,percent of total billed charges,80% of total billed charges,203.45,65,,162.76,percent of total billed charges,65% of total billed charges,111.65,35.67,,89.32,percent of total billed charges,35.67% of total billed charges,90.77,281.7,
ESCHMAN STYLET **,27004557,CDM,272,RC,,,outpatient,,,387,154.80,,328.95,85,,263.16,percent of total billed charges,85% of total billed charges,297.99,77,,238.39,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,317.34,82,,253.872,percent of total billed charges,82% of total billed charges,328.95,85,,263.16,percent of total billed charges,85% of total billed charges,328.95,85,,263.16,percent of total billed charges,85% of total billed charges,328.95,85,,263.16,percent of total billed charges,85% of total billed charges,348.3,90,,278.64,percent of total billed charges,90% of total billed charges,309.6,80,,247.68,percent of total billed charges,80% of total billed charges,348.3,90,,278.64,percent of total billed charges,90% of total billed charges,290.25,75,,232.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,112.23,29,,89.784,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,259.29,67,,207.432,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,309.6,80,,247.68,percent of total billed charges,80% of total billed charges,251.55,65,,201.24,percent of total billed charges,65% of total billed charges,138.04,35.67,,110.432,percent of total billed charges,35.67% of total billed charges,112.23,348.3,
CLO TEST,27004560,CDM,272,RC,,,outpatient,,,71,28.40,,60.35,85,,48.28,percent of total billed charges,85% of total billed charges,54.67,77,,43.74,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,58.22,82,,46.576,percent of total billed charges,82% of total billed charges,60.35,85,,48.28,percent of total billed charges,85% of total billed charges,60.35,85,,48.28,percent of total billed charges,85% of total billed charges,60.35,85,,48.28,percent of total billed charges,85% of total billed charges,63.9,90,,51.12,percent of total billed charges,90% of total billed charges,56.8,80,,45.44,percent of total billed charges,80% of total billed charges,63.9,90,,51.12,percent of total billed charges,90% of total billed charges,53.25,75,,42.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,20.59,29,,16.472,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,47.57,67,,38.056,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,56.8,80,,45.44,percent of total billed charges,80% of total billed charges,46.15,65,,36.92,percent of total billed charges,65% of total billed charges,25.33,35.67,,20.264,percent of total billed charges,35.67% of total billed charges,20.59,63.9,
CHOLARGIOGRAPHY CATH 4 FR,27004562,CDM,272,RC,,,outpatient,,,180,72.00,,153,85,,122.4,percent of total billed charges,85% of total billed charges,138.6,77,,110.88,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,147.6,82,,118.08,percent of total billed charges,82% of total billed charges,153,85,,122.4,percent of total billed charges,85% of total billed charges,153,85,,122.4,percent of total billed charges,85% of total billed charges,153,85,,122.4,percent of total billed charges,85% of total billed charges,162,90,,129.6,percent of total billed charges,90% of total billed charges,144,80,,115.2,percent of total billed charges,80% of total billed charges,162,90,,129.6,percent of total billed charges,90% of total billed charges,135,75,,108,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,52.2,29,,41.76,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,120.6,67,,96.48,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,144,80,,115.2,percent of total billed charges,80% of total billed charges,117,65,,93.6,percent of total billed charges,65% of total billed charges,64.21,35.67,,51.368,percent of total billed charges,35.67% of total billed charges,52.2,162,
CHOLARGIOGRAPHY CATH 6 FR,27004563,CDM,272,RC,,,outpatient,,,180,72.00,,153,85,,122.4,percent of total billed charges,85% of total billed charges,138.6,77,,110.88,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,147.6,82,,118.08,percent of total billed charges,82% of total billed charges,153,85,,122.4,percent of total billed charges,85% of total billed charges,153,85,,122.4,percent of total billed charges,85% of total billed charges,153,85,,122.4,percent of total billed charges,85% of total billed charges,162,90,,129.6,percent of total billed charges,90% of total billed charges,144,80,,115.2,percent of total billed charges,80% of total billed charges,162,90,,129.6,percent of total billed charges,90% of total billed charges,135,75,,108,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,52.2,29,,41.76,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,120.6,67,,96.48,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,144,80,,115.2,percent of total billed charges,80% of total billed charges,117,65,,93.6,percent of total billed charges,65% of total billed charges,64.21,35.67,,51.368,percent of total billed charges,35.67% of total billed charges,52.2,162,
1.5 MINI HEX SCREWDRIVER 52MM,27005708,CDM,272,RC,,,outpatient,,,1385,554.00,,1177.25,85,,941.8,percent of total billed charges,85% of total billed charges,1066.45,77,,853.16,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,1135.7,82,,908.56,percent of total billed charges,82% of total billed charges,1177.25,85,,941.8,percent of total billed charges,85% of total billed charges,1177.25,85,,941.8,percent of total billed charges,85% of total billed charges,1177.25,85,,941.8,percent of total billed charges,85% of total billed charges,1246.5,90,,997.2,percent of total billed charges,90% of total billed charges,1108,80,,886.4,percent of total billed charges,80% of total billed charges,1246.5,90,,997.2,percent of total billed charges,90% of total billed charges,1038.75,75,,831,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,401.65,29,,321.32,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,927.95,67,,742.36,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1108,80,,886.4,percent of total billed charges,80% of total billed charges,900.25,65,,720.2,percent of total billed charges,65% of total billed charges,494.03,35.67,,395.224,percent of total billed charges,35.67% of total billed charges,401.65,1246.5,
CANNULA W/NOSQUIRET CAP 7MM ID,27009482,CDM,272,RC,,,outpatient,,,245,98.00,,208.25,85,,166.6,percent of total billed charges,85% of total billed charges,188.65,77,,150.92,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,200.9,82,,160.72,percent of total billed charges,82% of total billed charges,208.25,85,,166.6,percent of total billed charges,85% of total billed charges,208.25,85,,166.6,percent of total billed charges,85% of total billed charges,208.25,85,,166.6,percent of total billed charges,85% of total billed charges,220.5,90,,176.4,percent of total billed charges,90% of total billed charges,196,80,,156.8,percent of total billed charges,80% of total billed charges,220.5,90,,176.4,percent of total billed charges,90% of total billed charges,183.75,75,,147,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,71.05,29,,56.84,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,164.15,67,,131.32,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,196,80,,156.8,percent of total billed charges,80% of total billed charges,159.25,65,,127.4,percent of total billed charges,65% of total billed charges,87.39,35.67,,69.912,percent of total billed charges,35.67% of total billed charges,71.05,220.5,
FIBERSTICK # 2,27009483,CDM,272,RC,,,outpatient,,,372,148.80,,316.2,85,,252.96,percent of total billed charges,85% of total billed charges,286.44,77,,229.15,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,305.04,82,,244.032,percent of total billed charges,82% of total billed charges,316.2,85,,252.96,percent of total billed charges,85% of total billed charges,316.2,85,,252.96,percent of total billed charges,85% of total billed charges,316.2,85,,252.96,percent of total billed charges,85% of total billed charges,334.8,90,,267.84,percent of total billed charges,90% of total billed charges,297.6,80,,238.08,percent of total billed charges,80% of total billed charges,334.8,90,,267.84,percent of total billed charges,90% of total billed charges,279,75,,223.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,107.88,29,,86.304,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,249.24,67,,199.392,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,297.6,80,,238.08,percent of total billed charges,80% of total billed charges,241.8,65,,193.44,percent of total billed charges,65% of total billed charges,132.69,35.67,,106.152,percent of total billed charges,35.67% of total billed charges,107.88,334.8,
BIT DRILL CALIBRATED 2.8,27011676,CDM,272,RC,C1713,HCPCS,outpatient,,,727,290.80,,617.95,85,,494.36,percent of total billed charges,85% of total billed charges,559.79,77,,447.83,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,596.14,82,,476.912,percent of total billed charges,82% of total billed charges,617.95,85,,494.36,percent of total billed charges,85% of total billed charges,617.95,85,,494.36,percent of total billed charges,85% of total billed charges,617.95,85,,494.36,percent of total billed charges,85% of total billed charges,654.3,90,,523.44,percent of total billed charges,90% of total billed charges,581.6,80,,465.28,percent of total billed charges,80% of total billed charges,654.3,90,,523.44,percent of total billed charges,90% of total billed charges,545.25,75,,436.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,210.83,29,,168.664,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,487.09,67,,389.672,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,581.6,80,,465.28,percent of total billed charges,80% of total billed charges,472.55,65,,378.04,percent of total billed charges,65% of total billed charges,259.32,35.67,,207.456,percent of total billed charges,35.67% of total billed charges,210.83,654.3,
MALYUGIN RING,27012004,CDM,272,RC,,,outpatient,,,701,280.40,,595.85,85,,476.68,percent of total billed charges,85% of total billed charges,539.77,77,,431.82,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,574.82,82,,459.856,percent of total billed charges,82% of total billed charges,595.85,85,,476.68,percent of total billed charges,85% of total billed charges,595.85,85,,476.68,percent of total billed charges,85% of total billed charges,595.85,85,,476.68,percent of total billed charges,85% of total billed charges,630.9,90,,504.72,percent of total billed charges,90% of total billed charges,560.8,80,,448.64,percent of total billed charges,80% of total billed charges,630.9,90,,504.72,percent of total billed charges,90% of total billed charges,525.75,75,,420.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,203.29,29,,162.632,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,469.67,67,,375.736,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,560.8,80,,448.64,percent of total billed charges,80% of total billed charges,455.65,65,,364.52,percent of total billed charges,65% of total billed charges,250.05,35.67,,200.04,percent of total billed charges,35.67% of total billed charges,203.29,630.9,
DURAGEN PLUS MATRIX GRAFT,27013603,CDM,272,RC,,,outpatient,,,2326,930.40,,1977.1,85,,1581.68,percent of total billed charges,85% of total billed charges,1791.02,77,,1432.82,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,1907.32,82,,1525.856,percent of total billed charges,82% of total billed charges,1977.1,85,,1581.68,percent of total billed charges,85% of total billed charges,1977.1,85,,1581.68,percent of total billed charges,85% of total billed charges,1977.1,85,,1581.68,percent of total billed charges,85% of total billed charges,2093.4,90,,1674.72,percent of total billed charges,90% of total billed charges,1860.8,80,,1488.64,percent of total billed charges,80% of total billed charges,2093.4,90,,1674.72,percent of total billed charges,90% of total billed charges,1744.5,75,,1395.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,674.54,29,,539.632,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1558.42,67,,1246.736,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1860.8,80,,1488.64,percent of total billed charges,80% of total billed charges,1511.9,65,,1209.52,percent of total billed charges,65% of total billed charges,829.68,35.67,,663.744,percent of total billed charges,35.67% of total billed charges,674.54,2093.4,
JADA SYSTEM HEMORRHAGE CONTROL,27014702,CDM,272,RC,,,outpatient,,,3693,1477.20,,3139.05,85,,2511.24,percent of total billed charges,85% of total billed charges,2843.61,77,,2274.89,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,3028.26,82,,2422.608,percent of total billed charges,82% of total billed charges,3139.05,85,,2511.24,percent of total billed charges,85% of total billed charges,3139.05,85,,2511.24,percent of total billed charges,85% of total billed charges,3139.05,85,,2511.24,percent of total billed charges,85% of total billed charges,3323.7,90,,2658.96,percent of total billed charges,90% of total billed charges,2954.4,80,,2363.52,percent of total billed charges,80% of total billed charges,3323.7,90,,2658.96,percent of total billed charges,90% of total billed charges,2769.75,75,,2215.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,1070.97,29,,856.776,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,2474.31,67,,1979.448,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,2954.4,80,,2363.52,percent of total billed charges,80% of total billed charges,2400.45,65,,1920.36,percent of total billed charges,65% of total billed charges,1317.29,35.67,,1053.832,percent of total billed charges,35.67% of total billed charges,1070.97,3323.7,
PNEUMOTHORAX TRAY,27017096,CDM,272,RC,,,outpatient,,,714,285.60,,606.9,85,,485.52,percent of total billed charges,85% of total billed charges,549.78,77,,439.82,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,585.48,82,,468.384,percent of total billed charges,82% of total billed charges,606.9,85,,485.52,percent of total billed charges,85% of total billed charges,606.9,85,,485.52,percent of total billed charges,85% of total billed charges,606.9,85,,485.52,percent of total billed charges,85% of total billed charges,642.6,90,,514.08,percent of total billed charges,90% of total billed charges,571.2,80,,456.96,percent of total billed charges,80% of total billed charges,642.6,90,,514.08,percent of total billed charges,90% of total billed charges,535.5,75,,428.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,207.06,29,,165.648,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,478.38,67,,382.704,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,571.2,80,,456.96,percent of total billed charges,80% of total billed charges,464.1,65,,371.28,percent of total billed charges,65% of total billed charges,254.68,35.67,,203.744,percent of total billed charges,35.67% of total billed charges,207.06,642.6,
SURGICAL GOWN XL NONREINFORCED,27017148,CDM,272,RC,,,outpatient,,,34,13.60,,28.9,85,,23.12,percent of total billed charges,85% of total billed charges,26.18,77,,20.94,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,27.88,82,,22.304,percent of total billed charges,82% of total billed charges,28.9,85,,23.12,percent of total billed charges,85% of total billed charges,28.9,85,,23.12,percent of total billed charges,85% of total billed charges,28.9,85,,23.12,percent of total billed charges,85% of total billed charges,30.6,90,,24.48,percent of total billed charges,90% of total billed charges,27.2,80,,21.76,percent of total billed charges,80% of total billed charges,30.6,90,,24.48,percent of total billed charges,90% of total billed charges,25.5,75,,20.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,9.86,29,,7.888,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,22.78,67,,18.224,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,27.2,80,,21.76,percent of total billed charges,80% of total billed charges,22.1,65,,17.68,percent of total billed charges,65% of total billed charges,12.13,35.67,,9.704,percent of total billed charges,35.67% of total billed charges,9.86,30.6,
EXPRESSION SUTURE NEEDLE,27017256,CDM,272,RC,,,outpatient,,,1133,453.20,,963.05,85,,770.44,percent of total billed charges,85% of total billed charges,872.41,77,,697.93,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,929.06,82,,743.248,percent of total billed charges,82% of total billed charges,963.05,85,,770.44,percent of total billed charges,85% of total billed charges,963.05,85,,770.44,percent of total billed charges,85% of total billed charges,963.05,85,,770.44,percent of total billed charges,85% of total billed charges,1019.7,90,,815.76,percent of total billed charges,90% of total billed charges,906.4,80,,725.12,percent of total billed charges,80% of total billed charges,1019.7,90,,815.76,percent of total billed charges,90% of total billed charges,849.75,75,,679.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,328.57,29,,262.856,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,759.11,67,,607.288,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,906.4,80,,725.12,percent of total billed charges,80% of total billed charges,736.45,65,,589.16,percent of total billed charges,65% of total billed charges,404.14,35.67,,323.312,percent of total billed charges,35.67% of total billed charges,328.57,1019.7,
THORACIC CATHETER 40FR PLEUR,27019842,CDM,272,RC,,,outpatient,,,151,60.40,,128.35,85,,102.68,percent of total billed charges,85% of total billed charges,116.27,77,,93.02,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,123.82,82,,99.056,percent of total billed charges,82% of total billed charges,128.35,85,,102.68,percent of total billed charges,85% of total billed charges,128.35,85,,102.68,percent of total billed charges,85% of total billed charges,128.35,85,,102.68,percent of total billed charges,85% of total billed charges,135.9,90,,108.72,percent of total billed charges,90% of total billed charges,120.8,80,,96.64,percent of total billed charges,80% of total billed charges,135.9,90,,108.72,percent of total billed charges,90% of total billed charges,113.25,75,,90.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,43.79,29,,35.032,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,101.17,67,,80.936,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,120.8,80,,96.64,percent of total billed charges,80% of total billed charges,98.15,65,,78.52,percent of total billed charges,65% of total billed charges,53.86,35.67,,43.088,percent of total billed charges,35.67% of total billed charges,43.79,135.9,
ACUTE DUAL LUEN CATHETER TRAY,27021141,CDM,272,RC,,,outpatient,,,223,89.20,,189.55,85,,151.64,percent of total billed charges,85% of total billed charges,171.71,77,,137.37,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,182.86,82,,146.288,percent of total billed charges,82% of total billed charges,189.55,85,,151.64,percent of total billed charges,85% of total billed charges,189.55,85,,151.64,percent of total billed charges,85% of total billed charges,189.55,85,,151.64,percent of total billed charges,85% of total billed charges,200.7,90,,160.56,percent of total billed charges,90% of total billed charges,178.4,80,,142.72,percent of total billed charges,80% of total billed charges,200.7,90,,160.56,percent of total billed charges,90% of total billed charges,167.25,75,,133.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,64.67,29,,51.736,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,149.41,67,,119.528,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,178.4,80,,142.72,percent of total billed charges,80% of total billed charges,144.95,65,,115.96,percent of total billed charges,65% of total billed charges,79.54,35.67,,63.632,percent of total billed charges,35.67% of total billed charges,64.67,200.7,
SILICONE FOLEY CATHETER 16FR,27021918,CDM,272,RC,,,outpatient,,,47,18.80,,39.95,85,,31.96,percent of total billed charges,85% of total billed charges,36.19,77,,28.95,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,38.54,82,,30.832,percent of total billed charges,82% of total billed charges,39.95,85,,31.96,percent of total billed charges,85% of total billed charges,39.95,85,,31.96,percent of total billed charges,85% of total billed charges,39.95,85,,31.96,percent of total billed charges,85% of total billed charges,42.3,90,,33.84,percent of total billed charges,90% of total billed charges,37.6,80,,30.08,percent of total billed charges,80% of total billed charges,42.3,90,,33.84,percent of total billed charges,90% of total billed charges,35.25,75,,28.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,13.63,29,,10.904,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,31.49,67,,25.192,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,37.6,80,,30.08,percent of total billed charges,80% of total billed charges,30.55,65,,24.44,percent of total billed charges,65% of total billed charges,16.76,35.67,,13.408,percent of total billed charges,35.67% of total billed charges,13.63,42.3,
BIOPSY MONOPTY 14GX16CM,2703294,CDM,272,RC,,,outpatient,,,297,118.80,,252.45,85,,201.96,percent of total billed charges,85% of total billed charges,228.69,77,,182.95,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,243.54,82,,194.832,percent of total billed charges,82% of total billed charges,252.45,85,,201.96,percent of total billed charges,85% of total billed charges,252.45,85,,201.96,percent of total billed charges,85% of total billed charges,252.45,85,,201.96,percent of total billed charges,85% of total billed charges,267.3,90,,213.84,percent of total billed charges,90% of total billed charges,237.6,80,,190.08,percent of total billed charges,80% of total billed charges,267.3,90,,213.84,percent of total billed charges,90% of total billed charges,222.75,75,,178.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,86.13,29,,68.904,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,198.99,67,,159.192,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,237.6,80,,190.08,percent of total billed charges,80% of total billed charges,193.05,65,,154.44,percent of total billed charges,65% of total billed charges,105.94,35.67,,84.752,percent of total billed charges,35.67% of total billed charges,86.13,267.3,
SURGILAR IRRIGATION SYSTEM,2703327,CDM,272,RC,,,outpatient,,,397,158.80,,337.45,85,,269.96,percent of total billed charges,85% of total billed charges,305.69,77,,244.55,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,325.54,82,,260.432,percent of total billed charges,82% of total billed charges,337.45,85,,269.96,percent of total billed charges,85% of total billed charges,337.45,85,,269.96,percent of total billed charges,85% of total billed charges,337.45,85,,269.96,percent of total billed charges,85% of total billed charges,357.3,90,,285.84,percent of total billed charges,90% of total billed charges,317.6,80,,254.08,percent of total billed charges,80% of total billed charges,357.3,90,,285.84,percent of total billed charges,90% of total billed charges,297.75,75,,238.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,115.13,29,,92.104,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,265.99,67,,212.792,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,317.6,80,,254.08,percent of total billed charges,80% of total billed charges,258.05,65,,206.44,percent of total billed charges,65% of total billed charges,141.61,35.67,,113.288,percent of total billed charges,35.67% of total billed charges,115.13,357.3,
HOLLISTER 1 3/4 WAFER **,2703387,CDM,272,RC,,,outpatient,,,32,12.80,,27.2,85,,21.76,percent of total billed charges,85% of total billed charges,24.64,77,,19.71,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,26.24,82,,20.992,percent of total billed charges,82% of total billed charges,27.2,85,,21.76,percent of total billed charges,85% of total billed charges,27.2,85,,21.76,percent of total billed charges,85% of total billed charges,27.2,85,,21.76,percent of total billed charges,85% of total billed charges,28.8,90,,23.04,percent of total billed charges,90% of total billed charges,25.6,80,,20.48,percent of total billed charges,80% of total billed charges,28.8,90,,23.04,percent of total billed charges,90% of total billed charges,24,75,,19.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,9.28,29,,7.424,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,21.44,67,,17.152,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,25.6,80,,20.48,percent of total billed charges,80% of total billed charges,20.8,65,,16.64,percent of total billed charges,65% of total billed charges,11.41,35.67,,9.128,percent of total billed charges,35.67% of total billed charges,9.28,28.8,
HOLLISTER 2 1/4 WAFER **,2703388,CDM,272,RC,,,outpatient,,,32,12.80,,27.2,85,,21.76,percent of total billed charges,85% of total billed charges,24.64,77,,19.71,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,26.24,82,,20.992,percent of total billed charges,82% of total billed charges,27.2,85,,21.76,percent of total billed charges,85% of total billed charges,27.2,85,,21.76,percent of total billed charges,85% of total billed charges,27.2,85,,21.76,percent of total billed charges,85% of total billed charges,28.8,90,,23.04,percent of total billed charges,90% of total billed charges,25.6,80,,20.48,percent of total billed charges,80% of total billed charges,28.8,90,,23.04,percent of total billed charges,90% of total billed charges,24,75,,19.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,9.28,29,,7.424,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,21.44,67,,17.152,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,25.6,80,,20.48,percent of total billed charges,80% of total billed charges,20.8,65,,16.64,percent of total billed charges,65% of total billed charges,11.41,35.67,,9.128,percent of total billed charges,35.67% of total billed charges,9.28,28.8,
HOLLISTER 2 1/4 POUCH **,2703389,CDM,272,RC,,,outpatient,,,18,7.20,,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,13.86,77,,11.09,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,14.76,82,,11.808,percent of total billed charges,82% of total billed charges,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,16.2,90,,12.96,percent of total billed charges,90% of total billed charges,14.4,80,,11.52,percent of total billed charges,80% of total billed charges,16.2,90,,12.96,percent of total billed charges,90% of total billed charges,13.5,75,,10.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,5.22,29,,4.176,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,12.06,67,,9.648,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,14.4,80,,11.52,percent of total billed charges,80% of total billed charges,11.7,65,,9.36,percent of total billed charges,65% of total billed charges,6.42,35.67,,5.136,percent of total billed charges,35.67% of total billed charges,5.22,16.2,
BIOPSY GUIDE - XRAY,3200475,CDM,272,RC,,,outpatient,,,31,12.40,,26.35,85,,21.08,percent of total billed charges,85% of total billed charges,23.87,77,,19.1,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,25.42,82,,20.336,percent of total billed charges,82% of total billed charges,26.35,85,,21.08,percent of total billed charges,85% of total billed charges,26.35,85,,21.08,percent of total billed charges,85% of total billed charges,26.35,85,,21.08,percent of total billed charges,85% of total billed charges,27.9,90,,22.32,percent of total billed charges,90% of total billed charges,24.8,80,,19.84,percent of total billed charges,80% of total billed charges,27.9,90,,22.32,percent of total billed charges,90% of total billed charges,23.25,75,,18.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,8.99,29,,7.192,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,20.77,67,,16.616,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,24.8,80,,19.84,percent of total billed charges,80% of total billed charges,20.15,65,,16.12,percent of total billed charges,65% of total billed charges,11.06,35.67,,8.848,percent of total billed charges,35.67% of total billed charges,8.99,27.9,
ANESTH-LOCAL MATERIAL SUPPLIES,3700160,CDM,272,RC,,,outpatient,,,177,70.80,,150.45,85,,120.36,percent of total billed charges,85% of total billed charges,136.29,77,,109.03,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,145.14,82,,116.112,percent of total billed charges,82% of total billed charges,150.45,85,,120.36,percent of total billed charges,85% of total billed charges,150.45,85,,120.36,percent of total billed charges,85% of total billed charges,150.45,85,,120.36,percent of total billed charges,85% of total billed charges,159.3,90,,127.44,percent of total billed charges,90% of total billed charges,141.6,80,,113.28,percent of total billed charges,80% of total billed charges,159.3,90,,127.44,percent of total billed charges,90% of total billed charges,132.75,75,,106.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,51.33,29,,41.064,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,118.59,67,,94.872,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,141.6,80,,113.28,percent of total billed charges,80% of total billed charges,115.05,65,,92.04,percent of total billed charges,65% of total billed charges,63.14,35.67,,50.512,percent of total billed charges,35.67% of total billed charges,51.33,159.3,
AIR CAST ANKLE BRACE RT,27000402,CDM,274,RC,L4361,HCPCS,outpatient,,,188,75.20,RT,131.6,70,,105.28,percent of total billed charges,70% of total billed charges,188,100,,150.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,154.16,82,,123.328,percent of total billed charges,82% of total billed charges,159.8,85,,127.84,percent of total billed charges,85% of total billed charges,159.8,85,,127.84,percent of total billed charges,85% of total billed charges,159.8,85,,127.84,percent of total billed charges,85% of total billed charges,169.2,90,,135.36,percent of total billed charges,90% of total billed charges,150.4,80,,120.32,percent of total billed charges,80% of total billed charges,169.2,90,,135.36,percent of total billed charges,90% of total billed charges,141,75,,112.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,54.52,29,,43.616,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,125.96,67,,100.768,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,131.6,70,,,percent of total billed charges,70% of total billed charges,122.2,65,,97.76,percent of total billed charges,65% of total billed charges,67.06,35.67,,53.648,percent of total billed charges,35.67% of total billed charges,54.52,188,
AIR CAST ANKLE BRACE LEFT,27000403,CDM,274,RC,L4361,HCPCS,outpatient,,,188,75.20,RT,131.6,70,,105.28,percent of total billed charges,70% of total billed charges,188,100,,150.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,154.16,82,,123.328,percent of total billed charges,82% of total billed charges,159.8,85,,127.84,percent of total billed charges,85% of total billed charges,159.8,85,,127.84,percent of total billed charges,85% of total billed charges,159.8,85,,127.84,percent of total billed charges,85% of total billed charges,169.2,90,,135.36,percent of total billed charges,90% of total billed charges,150.4,80,,120.32,percent of total billed charges,80% of total billed charges,169.2,90,,135.36,percent of total billed charges,90% of total billed charges,141,75,,112.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,54.52,29,,43.616,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,125.96,67,,100.768,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,131.6,70,,105.28,percent of total billed charges,70% of total billed charges,122.2,65,,97.76,percent of total billed charges,65% of total billed charges,67.06,35.67,,53.648,percent of total billed charges,35.67% of total billed charges,54.52,188,
KNEE IMMOBILIZER 24,27000409,CDM,274,RC,L1830,HCPCS,outpatient,,,204,81.60,,142.8,70,,114.24,percent of total billed charges,70% of total billed charges,204,100,,163.2,percent of total billed charges,pays based on exceed threshold rate,84.63,100,,,fee schedule,100% of CMS fee schedule,167.28,82,,133.824,percent of total billed charges,82% of total billed charges,173.4,85,,138.72,percent of total billed charges,85% of total billed charges,173.4,85,,138.72,percent of total billed charges,85% of total billed charges,173.4,85,,138.72,percent of total billed charges,85% of total billed charges,183.6,90,,146.88,percent of total billed charges,90% of total billed charges,163.2,80,,130.56,percent of total billed charges,80% of total billed charges,183.6,90,,146.88,percent of total billed charges,90% of total billed charges,153,75,,122.4,percent of total billed charges,75% of total billed charges,103.25,122,,,fee schedule,122% of APC rate,59.16,29,,47.328,percent of total billed charges,29% of total billed charges,84.63,100,,,fee schedule,100% of CMS fee schedule,136.68,67,,109.344,percent of total billed charges,67% of total billed charges,94.31,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,142.8,70,,114.24,percent of total billed charges,70% of total billed charges,132.6,65,,106.08,percent of total billed charges,65% of total billed charges,72.77,35.67,,58.216,percent of total billed charges,35.67% of total billed charges,59.16,204,
KNEE IMMOBILIZER 19,27000410,CDM,274,RC,L1830,HCPCS,outpatient,,,204,81.60,,142.8,70,,114.24,percent of total billed charges,70% of total billed charges,204,100,,163.2,percent of total billed charges,pays based on exceed threshold rate,84.63,100,,,fee schedule,100% of CMS fee schedule,167.28,82,,133.824,percent of total billed charges,82% of total billed charges,173.4,85,,138.72,percent of total billed charges,85% of total billed charges,173.4,85,,138.72,percent of total billed charges,85% of total billed charges,173.4,85,,138.72,percent of total billed charges,85% of total billed charges,183.6,90,,146.88,percent of total billed charges,90% of total billed charges,163.2,80,,130.56,percent of total billed charges,80% of total billed charges,183.6,90,,146.88,percent of total billed charges,90% of total billed charges,153,75,,122.4,percent of total billed charges,75% of total billed charges,103.25,122,,,fee schedule,122% of APC rate,59.16,29,,47.328,percent of total billed charges,29% of total billed charges,84.63,100,,,fee schedule,100% of CMS fee schedule,136.68,67,,109.344,percent of total billed charges,67% of total billed charges,94.31,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,142.8,70,,114.24,percent of total billed charges,70% of total billed charges,132.6,65,,106.08,percent of total billed charges,65% of total billed charges,72.77,35.67,,58.216,percent of total billed charges,35.67% of total billed charges,59.16,204,
COLLES SPLINT YOUTH LEFT,27000413,CDM,274,RC,L3809,HCPCS,outpatient,,,286,114.40,,200.2,70,,160.16,percent of total billed charges,70% of total billed charges,286,100,,228.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,234.52,82,,187.616,percent of total billed charges,82% of total billed charges,243.1,85,,194.48,percent of total billed charges,85% of total billed charges,243.1,85,,194.48,percent of total billed charges,85% of total billed charges,243.1,85,,194.48,percent of total billed charges,85% of total billed charges,257.4,90,,205.92,percent of total billed charges,90% of total billed charges,228.8,80,,183.04,percent of total billed charges,80% of total billed charges,257.4,90,,205.92,percent of total billed charges,90% of total billed charges,214.5,75,,171.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,82.94,29,,66.352,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,191.62,67,,153.296,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,200.2,70,,160.16,percent of total billed charges,70% of total billed charges,185.9,65,,148.72,percent of total billed charges,65% of total billed charges,102.02,35.67,,81.616,percent of total billed charges,35.67% of total billed charges,82.94,286,
COLLES SPLINT YOUTH RT,27000414,CDM,274,RC,L3809,HCPCS,outpatient,,,102,40.80,,71.4,70,,57.12,percent of total billed charges,70% of total billed charges,102,100,,81.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,83.64,82,,66.912,percent of total billed charges,82% of total billed charges,86.7,85,,69.36,percent of total billed charges,85% of total billed charges,86.7,85,,69.36,percent of total billed charges,85% of total billed charges,86.7,85,,69.36,percent of total billed charges,85% of total billed charges,91.8,90,,73.44,percent of total billed charges,90% of total billed charges,81.6,80,,65.28,percent of total billed charges,80% of total billed charges,91.8,90,,73.44,percent of total billed charges,90% of total billed charges,76.5,75,,61.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,29.58,29,,23.664,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,68.34,67,,54.672,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,71.4,70,,57.12,percent of total billed charges,70% of total billed charges,66.3,65,,53.04,percent of total billed charges,65% of total billed charges,36.38,35.67,,29.104,percent of total billed charges,35.67% of total billed charges,29.58,102,
COLLES SPLINT ADULT LEFT,27000415,CDM,274,RC,L3809,HCPCS,outpatient,,,83,33.20,LT,58.1,70,,46.48,percent of total billed charges,70% of total billed charges,83,100,,66.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,68.06,82,,54.448,percent of total billed charges,82% of total billed charges,70.55,85,,56.44,percent of total billed charges,85% of total billed charges,70.55,85,,56.44,percent of total billed charges,85% of total billed charges,70.55,85,,56.44,percent of total billed charges,85% of total billed charges,74.7,90,,59.76,percent of total billed charges,90% of total billed charges,66.4,80,,53.12,percent of total billed charges,80% of total billed charges,74.7,90,,59.76,percent of total billed charges,90% of total billed charges,62.25,75,,49.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,24.07,29,,19.256,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,55.61,67,,44.488,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,58.1,70,,46.48,percent of total billed charges,70% of total billed charges,53.95,65,,43.16,percent of total billed charges,65% of total billed charges,29.61,35.67,,23.688,percent of total billed charges,35.67% of total billed charges,24.07,83,
COLLES SPLINT ADULT RT,27000416,CDM,274,RC,L3809,HCPCS,outpatient,,,83,33.20,RT,58.1,70,,46.48,percent of total billed charges,70% of total billed charges,83,100,,66.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,68.06,82,,54.448,percent of total billed charges,82% of total billed charges,70.55,85,,56.44,percent of total billed charges,85% of total billed charges,70.55,85,,56.44,percent of total billed charges,85% of total billed charges,70.55,85,,56.44,percent of total billed charges,85% of total billed charges,74.7,90,,59.76,percent of total billed charges,90% of total billed charges,66.4,80,,53.12,percent of total billed charges,80% of total billed charges,74.7,90,,59.76,percent of total billed charges,90% of total billed charges,62.25,75,,49.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,24.07,29,,19.256,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,55.61,67,,44.488,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,58.1,70,,46.48,percent of total billed charges,70% of total billed charges,53.95,65,,43.16,percent of total billed charges,65% of total billed charges,29.61,35.67,,23.688,percent of total billed charges,35.67% of total billed charges,24.07,83,
COCKUP WRIST SPLINT SM LEFT,27000417,CDM,274,RC,L3809,HCPCS,outpatient,,,111,44.40,,77.7,70,,62.16,percent of total billed charges,70% of total billed charges,111,100,,88.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,91.02,82,,72.816,percent of total billed charges,82% of total billed charges,94.35,85,,75.48,percent of total billed charges,85% of total billed charges,94.35,85,,75.48,percent of total billed charges,85% of total billed charges,94.35,85,,75.48,percent of total billed charges,85% of total billed charges,99.9,90,,79.92,percent of total billed charges,90% of total billed charges,88.8,80,,71.04,percent of total billed charges,80% of total billed charges,99.9,90,,79.92,percent of total billed charges,90% of total billed charges,83.25,75,,66.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,32.19,29,,25.752,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,74.37,67,,59.496,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,77.7,70,,62.16,percent of total billed charges,70% of total billed charges,72.15,65,,57.72,percent of total billed charges,65% of total billed charges,39.59,35.67,,31.672,percent of total billed charges,35.67% of total billed charges,32.19,111,
COCKUP WRIST SPLINT SM RT,27000418,CDM,274,RC,L3908,HCPCS,outpatient,,,109,43.60,RT,76.3,70,,61.04,percent of total billed charges,70% of total billed charges,109,100,,87.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,89.38,82,,71.504,percent of total billed charges,82% of total billed charges,92.65,85,,74.12,percent of total billed charges,85% of total billed charges,92.65,85,,74.12,percent of total billed charges,85% of total billed charges,92.65,85,,74.12,percent of total billed charges,85% of total billed charges,98.1,90,,78.48,percent of total billed charges,90% of total billed charges,87.2,80,,69.76,percent of total billed charges,80% of total billed charges,98.1,90,,78.48,percent of total billed charges,90% of total billed charges,81.75,75,,65.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,31.61,29,,25.288,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,73.03,67,,58.424,percent of total billed charges,67% of total billed charges,71.1,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,76.3,70,,61.04,percent of total billed charges,70% of total billed charges,70.85,65,,56.68,percent of total billed charges,65% of total billed charges,38.88,35.67,,31.104,percent of total billed charges,35.67% of total billed charges,31.61,109,
COCKUP WRIST SPLINT MD LEFT,27000419,CDM,274,RC,L3908,HCPCS,outpatient,,,102,40.80,LT,71.4,70,,57.12,percent of total billed charges,70% of total billed charges,102,100,,81.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,83.64,82,,66.912,percent of total billed charges,82% of total billed charges,86.7,85,,69.36,percent of total billed charges,85% of total billed charges,86.7,85,,69.36,percent of total billed charges,85% of total billed charges,86.7,85,,69.36,percent of total billed charges,85% of total billed charges,91.8,90,,73.44,percent of total billed charges,90% of total billed charges,81.6,80,,65.28,percent of total billed charges,80% of total billed charges,91.8,90,,73.44,percent of total billed charges,90% of total billed charges,76.5,75,,61.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,29.58,29,,23.664,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,68.34,67,,54.672,percent of total billed charges,67% of total billed charges,71.1,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,71.4,70,,57.12,percent of total billed charges,70% of total billed charges,66.3,65,,53.04,percent of total billed charges,65% of total billed charges,36.38,35.67,,29.104,percent of total billed charges,35.67% of total billed charges,29.58,102,
COCKUP WRIST SPLINT MD RT,27000420,CDM,274,RC,L3908,HCPCS,outpatient,,,109,43.60,RT,76.3,70,,61.04,percent of total billed charges,70% of total billed charges,109,100,,87.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,89.38,82,,71.504,percent of total billed charges,82% of total billed charges,92.65,85,,74.12,percent of total billed charges,85% of total billed charges,92.65,85,,74.12,percent of total billed charges,85% of total billed charges,92.65,85,,74.12,percent of total billed charges,85% of total billed charges,98.1,90,,78.48,percent of total billed charges,90% of total billed charges,87.2,80,,69.76,percent of total billed charges,80% of total billed charges,98.1,90,,78.48,percent of total billed charges,90% of total billed charges,81.75,75,,65.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,31.61,29,,25.288,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,73.03,67,,58.424,percent of total billed charges,67% of total billed charges,71.1,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,76.3,70,,61.04,percent of total billed charges,70% of total billed charges,70.85,65,,56.68,percent of total billed charges,65% of total billed charges,38.88,35.67,,31.104,percent of total billed charges,35.67% of total billed charges,31.61,109,
COCKUP WRIST SPLINT LG RT,27000422,CDM,274,RC,L3908,HCPCS,outpatient,,,109,43.60,RT,76.3,70,,61.04,percent of total billed charges,70% of total billed charges,109,100,,87.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,89.38,82,,71.504,percent of total billed charges,82% of total billed charges,92.65,85,,74.12,percent of total billed charges,85% of total billed charges,92.65,85,,74.12,percent of total billed charges,85% of total billed charges,92.65,85,,74.12,percent of total billed charges,85% of total billed charges,98.1,90,,78.48,percent of total billed charges,90% of total billed charges,87.2,80,,69.76,percent of total billed charges,80% of total billed charges,98.1,90,,78.48,percent of total billed charges,90% of total billed charges,81.75,75,,65.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,31.61,29,,25.288,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,73.03,67,,58.424,percent of total billed charges,67% of total billed charges,71.1,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,76.3,70,,61.04,percent of total billed charges,70% of total billed charges,70.85,65,,56.68,percent of total billed charges,65% of total billed charges,38.88,35.67,,31.104,percent of total billed charges,35.67% of total billed charges,31.61,109,
COCKUP WRIST SPLINT XLG LEFT,27000423,CDM,274,RC,L3908,HCPCS,outpatient,,,109,43.60,LT,76.3,70,,61.04,percent of total billed charges,70% of total billed charges,109,100,,87.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,89.38,82,,71.504,percent of total billed charges,82% of total billed charges,92.65,85,,74.12,percent of total billed charges,85% of total billed charges,92.65,85,,74.12,percent of total billed charges,85% of total billed charges,92.65,85,,74.12,percent of total billed charges,85% of total billed charges,98.1,90,,78.48,percent of total billed charges,90% of total billed charges,87.2,80,,69.76,percent of total billed charges,80% of total billed charges,98.1,90,,78.48,percent of total billed charges,90% of total billed charges,81.75,75,,65.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,31.61,29,,25.288,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,73.03,67,,58.424,percent of total billed charges,67% of total billed charges,71.1,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,76.3,70,,61.04,percent of total billed charges,70% of total billed charges,70.85,65,,56.68,percent of total billed charges,65% of total billed charges,38.88,35.67,,31.104,percent of total billed charges,35.67% of total billed charges,31.61,109,
COCKUP WRIST SPLINT XLG RT,27000424,CDM,274,RC,L3908,HCPCS,outpatient,,,109,43.60,RT,76.3,70,,61.04,percent of total billed charges,70% of total billed charges,109,100,,87.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,89.38,82,,71.504,percent of total billed charges,82% of total billed charges,92.65,85,,74.12,percent of total billed charges,85% of total billed charges,92.65,85,,74.12,percent of total billed charges,85% of total billed charges,92.65,85,,74.12,percent of total billed charges,85% of total billed charges,98.1,90,,78.48,percent of total billed charges,90% of total billed charges,87.2,80,,69.76,percent of total billed charges,80% of total billed charges,98.1,90,,78.48,percent of total billed charges,90% of total billed charges,81.75,75,,65.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,31.61,29,,25.288,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,73.03,67,,58.424,percent of total billed charges,67% of total billed charges,71.1,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,76.3,70,,61.04,percent of total billed charges,70% of total billed charges,70.85,65,,56.68,percent of total billed charges,65% of total billed charges,38.88,35.67,,31.104,percent of total billed charges,35.67% of total billed charges,31.61,109,
WRIST SPLINT PEDI LEFT,27000425,CDM,274,RC,L3807,HCPCS,outpatient,,,62,24.80,,43.4,70,,34.72,percent of total billed charges,70% of total billed charges,62,100,,49.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,50.84,82,,40.672,percent of total billed charges,82% of total billed charges,52.7,85,,42.16,percent of total billed charges,85% of total billed charges,52.7,85,,42.16,percent of total billed charges,85% of total billed charges,52.7,85,,42.16,percent of total billed charges,85% of total billed charges,55.8,90,,44.64,percent of total billed charges,90% of total billed charges,49.6,80,,39.68,percent of total billed charges,80% of total billed charges,55.8,90,,44.64,percent of total billed charges,90% of total billed charges,46.5,75,,37.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,17.98,29,,14.384,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,41.54,67,,33.232,percent of total billed charges,67% of total billed charges,216.03,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,43.4,70,,34.72,percent of total billed charges,70% of total billed charges,40.3,65,,32.24,percent of total billed charges,65% of total billed charges,22.12,35.67,,17.696,percent of total billed charges,35.67% of total billed charges,17.98,216.03,
WRIST SPLINT PEDI RT,27000426,CDM,274,RC,L3807,HCPCS,outpatient,,,91,36.40,,63.7,70,,50.96,percent of total billed charges,70% of total billed charges,91,100,,72.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,74.62,82,,59.696,percent of total billed charges,82% of total billed charges,77.35,85,,61.88,percent of total billed charges,85% of total billed charges,77.35,85,,61.88,percent of total billed charges,85% of total billed charges,77.35,85,,61.88,percent of total billed charges,85% of total billed charges,81.9,90,,65.52,percent of total billed charges,90% of total billed charges,72.8,80,,58.24,percent of total billed charges,80% of total billed charges,81.9,90,,65.52,percent of total billed charges,90% of total billed charges,68.25,75,,54.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,26.39,29,,21.112,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,60.97,67,,48.776,percent of total billed charges,67% of total billed charges,216.03,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,63.7,70,,50.96,percent of total billed charges,70% of total billed charges,59.15,65,,47.32,percent of total billed charges,65% of total billed charges,32.46,35.67,,25.968,percent of total billed charges,35.67% of total billed charges,26.39,216.03,
CERVICAL COLLAR FOAM SMALL,27000427,CDM,274,RC,L0120,HCPCS,outpatient,,,67,26.80,,46.9,70,,37.52,percent of total billed charges,70% of total billed charges,67,100,,53.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,54.94,82,,43.952,percent of total billed charges,82% of total billed charges,56.95,85,,45.56,percent of total billed charges,85% of total billed charges,56.95,85,,45.56,percent of total billed charges,85% of total billed charges,56.95,85,,45.56,percent of total billed charges,85% of total billed charges,60.3,90,,48.24,percent of total billed charges,90% of total billed charges,53.6,80,,42.88,percent of total billed charges,80% of total billed charges,60.3,90,,48.24,percent of total billed charges,90% of total billed charges,50.25,75,,40.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,19.43,29,,15.544,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,44.89,67,,35.912,percent of total billed charges,67% of total billed charges,24.13,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,46.9,70,,37.52,percent of total billed charges,70% of total billed charges,43.55,65,,34.84,percent of total billed charges,65% of total billed charges,23.9,35.67,,19.12,percent of total billed charges,35.67% of total billed charges,19.43,67,
CERVICAL COLLAR FOAM MD,27000428,CDM,274,RC,L0120,HCPCS,outpatient,,,71,28.40,,49.7,70,,39.76,percent of total billed charges,70% of total billed charges,71,100,,56.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,58.22,82,,46.576,percent of total billed charges,82% of total billed charges,60.35,85,,48.28,percent of total billed charges,85% of total billed charges,60.35,85,,48.28,percent of total billed charges,85% of total billed charges,60.35,85,,48.28,percent of total billed charges,85% of total billed charges,63.9,90,,51.12,percent of total billed charges,90% of total billed charges,56.8,80,,45.44,percent of total billed charges,80% of total billed charges,63.9,90,,51.12,percent of total billed charges,90% of total billed charges,53.25,75,,42.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,20.59,29,,16.472,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,47.57,67,,38.056,percent of total billed charges,67% of total billed charges,24.13,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,49.7,70,,39.76,percent of total billed charges,70% of total billed charges,46.15,65,,36.92,percent of total billed charges,65% of total billed charges,25.33,35.67,,20.264,percent of total billed charges,35.67% of total billed charges,20.59,71,
CERVICAL COLLAR FOAM LG,27000429,CDM,274,RC,L0120,HCPCS,outpatient,,,67,26.80,,46.9,70,,37.52,percent of total billed charges,70% of total billed charges,67,100,,53.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,54.94,82,,43.952,percent of total billed charges,82% of total billed charges,56.95,85,,45.56,percent of total billed charges,85% of total billed charges,56.95,85,,45.56,percent of total billed charges,85% of total billed charges,56.95,85,,45.56,percent of total billed charges,85% of total billed charges,60.3,90,,48.24,percent of total billed charges,90% of total billed charges,53.6,80,,42.88,percent of total billed charges,80% of total billed charges,60.3,90,,48.24,percent of total billed charges,90% of total billed charges,50.25,75,,40.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,19.43,29,,15.544,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,44.89,67,,35.912,percent of total billed charges,67% of total billed charges,24.13,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,46.9,70,,37.52,percent of total billed charges,70% of total billed charges,43.55,65,,34.84,percent of total billed charges,65% of total billed charges,23.9,35.67,,19.12,percent of total billed charges,35.67% of total billed charges,19.43,67,
SHOULDER IMMOB MEN MED,27000436,CDM,274,RC,L3650,HCPCS,outpatient,,,102,40.80,,71.4,70,,57.12,percent of total billed charges,70% of total billed charges,102,100,,81.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,83.64,82,,66.912,percent of total billed charges,82% of total billed charges,86.7,85,,69.36,percent of total billed charges,85% of total billed charges,86.7,85,,69.36,percent of total billed charges,85% of total billed charges,86.7,85,,69.36,percent of total billed charges,85% of total billed charges,91.8,90,,73.44,percent of total billed charges,90% of total billed charges,81.6,80,,65.28,percent of total billed charges,80% of total billed charges,91.8,90,,73.44,percent of total billed charges,90% of total billed charges,76.5,75,,61.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,29.58,29,,23.664,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,68.34,67,,54.672,percent of total billed charges,67% of total billed charges,60.62,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,71.4,70,,57.12,percent of total billed charges,70% of total billed charges,66.3,65,,53.04,percent of total billed charges,65% of total billed charges,36.38,35.67,,29.104,percent of total billed charges,35.67% of total billed charges,29.58,102,
SHOULDER IMMOB MEN LG,27000437,CDM,274,RC,L3650,HCPCS,outpatient,,,102,40.80,,71.4,70,,57.12,percent of total billed charges,70% of total billed charges,102,100,,81.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,83.64,82,,66.912,percent of total billed charges,82% of total billed charges,86.7,85,,69.36,percent of total billed charges,85% of total billed charges,86.7,85,,69.36,percent of total billed charges,85% of total billed charges,86.7,85,,69.36,percent of total billed charges,85% of total billed charges,91.8,90,,73.44,percent of total billed charges,90% of total billed charges,81.6,80,,65.28,percent of total billed charges,80% of total billed charges,91.8,90,,73.44,percent of total billed charges,90% of total billed charges,76.5,75,,61.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,29.58,29,,23.664,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,68.34,67,,54.672,percent of total billed charges,67% of total billed charges,60.62,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,71.4,70,,57.12,percent of total billed charges,70% of total billed charges,66.3,65,,53.04,percent of total billed charges,65% of total billed charges,36.38,35.67,,29.104,percent of total billed charges,35.67% of total billed charges,29.58,102,
SHOULDER IMMOB MEN XL,27000438,CDM,274,RC,L3650,HCPCS,outpatient,,,102,40.80,,71.4,70,,57.12,percent of total billed charges,70% of total billed charges,102,100,,81.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,83.64,82,,66.912,percent of total billed charges,82% of total billed charges,86.7,85,,69.36,percent of total billed charges,85% of total billed charges,86.7,85,,69.36,percent of total billed charges,85% of total billed charges,86.7,85,,69.36,percent of total billed charges,85% of total billed charges,91.8,90,,73.44,percent of total billed charges,90% of total billed charges,81.6,80,,65.28,percent of total billed charges,80% of total billed charges,91.8,90,,73.44,percent of total billed charges,90% of total billed charges,76.5,75,,61.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,29.58,29,,23.664,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,68.34,67,,54.672,percent of total billed charges,67% of total billed charges,60.62,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,71.4,70,,57.12,percent of total billed charges,70% of total billed charges,66.3,65,,53.04,percent of total billed charges,65% of total billed charges,36.38,35.67,,29.104,percent of total billed charges,35.67% of total billed charges,29.58,102,
SHOULDER IMMOB WOMEN SM,27000439,CDM,274,RC,L3650,HCPCS,outpatient,,,102,40.80,,71.4,70,,57.12,percent of total billed charges,70% of total billed charges,102,100,,81.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,83.64,82,,66.912,percent of total billed charges,82% of total billed charges,86.7,85,,69.36,percent of total billed charges,85% of total billed charges,86.7,85,,69.36,percent of total billed charges,85% of total billed charges,86.7,85,,69.36,percent of total billed charges,85% of total billed charges,91.8,90,,73.44,percent of total billed charges,90% of total billed charges,81.6,80,,65.28,percent of total billed charges,80% of total billed charges,91.8,90,,73.44,percent of total billed charges,90% of total billed charges,76.5,75,,61.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,29.58,29,,23.664,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,68.34,67,,54.672,percent of total billed charges,67% of total billed charges,60.62,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,71.4,70,,57.12,percent of total billed charges,70% of total billed charges,66.3,65,,53.04,percent of total billed charges,65% of total billed charges,36.38,35.67,,29.104,percent of total billed charges,35.67% of total billed charges,29.58,102,
SHOULDER IMMOB WOMEN MED,27000440,CDM,274,RC,L3650,HCPCS,outpatient,,,70,28.00,,49,70,,39.2,percent of total billed charges,70% of total billed charges,70,100,,56,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,57.4,82,,45.92,percent of total billed charges,82% of total billed charges,59.5,85,,47.6,percent of total billed charges,85% of total billed charges,59.5,85,,47.6,percent of total billed charges,85% of total billed charges,59.5,85,,47.6,percent of total billed charges,85% of total billed charges,63,90,,50.4,percent of total billed charges,90% of total billed charges,56,80,,44.8,percent of total billed charges,80% of total billed charges,63,90,,50.4,percent of total billed charges,90% of total billed charges,52.5,75,,42,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,20.3,29,,16.24,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,46.9,67,,37.52,percent of total billed charges,67% of total billed charges,60.62,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,49,70,,39.2,percent of total billed charges,70% of total billed charges,45.5,65,,36.4,percent of total billed charges,65% of total billed charges,24.97,35.67,,19.976,percent of total billed charges,35.67% of total billed charges,20.3,70,
SHOULDER IMMOB WOMEN LG,27000441,CDM,274,RC,L3650,HCPCS,outpatient,,,102,40.80,,71.4,70,,57.12,percent of total billed charges,70% of total billed charges,102,100,,81.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,83.64,82,,66.912,percent of total billed charges,82% of total billed charges,86.7,85,,69.36,percent of total billed charges,85% of total billed charges,86.7,85,,69.36,percent of total billed charges,85% of total billed charges,86.7,85,,69.36,percent of total billed charges,85% of total billed charges,91.8,90,,73.44,percent of total billed charges,90% of total billed charges,81.6,80,,65.28,percent of total billed charges,80% of total billed charges,91.8,90,,73.44,percent of total billed charges,90% of total billed charges,76.5,75,,61.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,29.58,29,,23.664,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,68.34,67,,54.672,percent of total billed charges,67% of total billed charges,60.62,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,71.4,70,,57.12,percent of total billed charges,70% of total billed charges,66.3,65,,53.04,percent of total billed charges,65% of total billed charges,36.38,35.67,,29.104,percent of total billed charges,35.67% of total billed charges,29.58,102,
SHOULDER IMMOB WOMEN XL,27000442,CDM,274,RC,L3650,HCPCS,outpatient,,,102,40.80,,71.4,70,,57.12,percent of total billed charges,70% of total billed charges,102,100,,81.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,83.64,82,,66.912,percent of total billed charges,82% of total billed charges,86.7,85,,69.36,percent of total billed charges,85% of total billed charges,86.7,85,,69.36,percent of total billed charges,85% of total billed charges,86.7,85,,69.36,percent of total billed charges,85% of total billed charges,91.8,90,,73.44,percent of total billed charges,90% of total billed charges,81.6,80,,65.28,percent of total billed charges,80% of total billed charges,91.8,90,,73.44,percent of total billed charges,90% of total billed charges,76.5,75,,61.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,29.58,29,,23.664,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,68.34,67,,54.672,percent of total billed charges,67% of total billed charges,60.62,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,71.4,70,,57.12,percent of total billed charges,70% of total billed charges,66.3,65,,53.04,percent of total billed charges,65% of total billed charges,36.38,35.67,,29.104,percent of total billed charges,35.67% of total billed charges,29.58,102,
CLAVICLE SPLINT XS,27000443,CDM,274,RC,L3670,HCPCS,outpatient,,,136,54.40,,95.2,70,,76.16,percent of total billed charges,70% of total billed charges,136,100,,108.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,111.52,82,,89.216,percent of total billed charges,82% of total billed charges,115.6,85,,92.48,percent of total billed charges,85% of total billed charges,115.6,85,,92.48,percent of total billed charges,85% of total billed charges,115.6,85,,92.48,percent of total billed charges,85% of total billed charges,122.4,90,,97.92,percent of total billed charges,90% of total billed charges,108.8,80,,87.04,percent of total billed charges,80% of total billed charges,122.4,90,,97.92,percent of total billed charges,90% of total billed charges,102,75,,81.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,39.44,29,,31.552,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,91.12,67,,72.896,percent of total billed charges,67% of total billed charges,119.3,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,95.2,70,,76.16,percent of total billed charges,70% of total billed charges,88.4,65,,70.72,percent of total billed charges,65% of total billed charges,48.51,35.67,,38.808,percent of total billed charges,35.67% of total billed charges,39.44,136,
CLAVICLE SPLINT SM,27000444,CDM,274,RC,L3670,HCPCS,outpatient,,,136,54.40,,95.2,70,,76.16,percent of total billed charges,70% of total billed charges,136,100,,108.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,111.52,82,,89.216,percent of total billed charges,82% of total billed charges,115.6,85,,92.48,percent of total billed charges,85% of total billed charges,115.6,85,,92.48,percent of total billed charges,85% of total billed charges,115.6,85,,92.48,percent of total billed charges,85% of total billed charges,122.4,90,,97.92,percent of total billed charges,90% of total billed charges,108.8,80,,87.04,percent of total billed charges,80% of total billed charges,122.4,90,,97.92,percent of total billed charges,90% of total billed charges,102,75,,81.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,39.44,29,,31.552,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,91.12,67,,72.896,percent of total billed charges,67% of total billed charges,119.3,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,95.2,70,,76.16,percent of total billed charges,70% of total billed charges,88.4,65,,70.72,percent of total billed charges,65% of total billed charges,48.51,35.67,,38.808,percent of total billed charges,35.67% of total billed charges,39.44,136,
CLAVICLE SPLINT MED,27000445,CDM,274,RC,L3670,HCPCS,outpatient,,,136,54.40,,95.2,70,,76.16,percent of total billed charges,70% of total billed charges,136,100,,108.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,111.52,82,,89.216,percent of total billed charges,82% of total billed charges,115.6,85,,92.48,percent of total billed charges,85% of total billed charges,115.6,85,,92.48,percent of total billed charges,85% of total billed charges,115.6,85,,92.48,percent of total billed charges,85% of total billed charges,122.4,90,,97.92,percent of total billed charges,90% of total billed charges,108.8,80,,87.04,percent of total billed charges,80% of total billed charges,122.4,90,,97.92,percent of total billed charges,90% of total billed charges,102,75,,81.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,39.44,29,,31.552,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,91.12,67,,72.896,percent of total billed charges,67% of total billed charges,119.3,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,95.2,70,,76.16,percent of total billed charges,70% of total billed charges,88.4,65,,70.72,percent of total billed charges,65% of total billed charges,48.51,35.67,,38.808,percent of total billed charges,35.67% of total billed charges,39.44,136,
CLAVICLE SPLINT LG,27000446,CDM,274,RC,L3670,HCPCS,outpatient,,,136,54.40,,95.2,70,,76.16,percent of total billed charges,70% of total billed charges,136,100,,108.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,111.52,82,,89.216,percent of total billed charges,82% of total billed charges,115.6,85,,92.48,percent of total billed charges,85% of total billed charges,115.6,85,,92.48,percent of total billed charges,85% of total billed charges,115.6,85,,92.48,percent of total billed charges,85% of total billed charges,122.4,90,,97.92,percent of total billed charges,90% of total billed charges,108.8,80,,87.04,percent of total billed charges,80% of total billed charges,122.4,90,,97.92,percent of total billed charges,90% of total billed charges,102,75,,81.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,39.44,29,,31.552,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,91.12,67,,72.896,percent of total billed charges,67% of total billed charges,119.3,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,95.2,70,,76.16,percent of total billed charges,70% of total billed charges,88.4,65,,70.72,percent of total billed charges,65% of total billed charges,48.51,35.67,,38.808,percent of total billed charges,35.67% of total billed charges,39.44,136,
CLAVICLE SPLINT XL,27000447,CDM,274,RC,L3670,HCPCS,outpatient,,,136,54.40,,95.2,70,,76.16,percent of total billed charges,70% of total billed charges,136,100,,108.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,111.52,82,,89.216,percent of total billed charges,82% of total billed charges,115.6,85,,92.48,percent of total billed charges,85% of total billed charges,115.6,85,,92.48,percent of total billed charges,85% of total billed charges,115.6,85,,92.48,percent of total billed charges,85% of total billed charges,122.4,90,,97.92,percent of total billed charges,90% of total billed charges,108.8,80,,87.04,percent of total billed charges,80% of total billed charges,122.4,90,,97.92,percent of total billed charges,90% of total billed charges,102,75,,81.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,39.44,29,,31.552,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,91.12,67,,72.896,percent of total billed charges,67% of total billed charges,119.3,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,95.2,70,,76.16,percent of total billed charges,70% of total billed charges,88.4,65,,70.72,percent of total billed charges,65% of total billed charges,48.51,35.67,,38.808,percent of total billed charges,35.67% of total billed charges,39.44,136,
DURA STEP ORTHO BOOT MEDIUM,27002445,CDM,274,RC,L4387,HCPCS,outpatient,,,306,122.40,,214.2,70,,171.36,percent of total billed charges,70% of total billed charges,306,100,,244.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,250.92,82,,200.736,percent of total billed charges,82% of total billed charges,260.1,85,,208.08,percent of total billed charges,85% of total billed charges,260.1,85,,208.08,percent of total billed charges,85% of total billed charges,260.1,85,,208.08,percent of total billed charges,85% of total billed charges,275.4,90,,220.32,percent of total billed charges,90% of total billed charges,244.8,80,,195.84,percent of total billed charges,80% of total billed charges,275.4,90,,220.32,percent of total billed charges,90% of total billed charges,229.5,75,,183.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,88.74,29,,70.992,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,205.02,67,,164.016,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,214.2,70,,171.36,percent of total billed charges,70% of total billed charges,198.9,65,,159.12,percent of total billed charges,65% of total billed charges,109.15,35.67,,87.32,percent of total billed charges,35.67% of total billed charges,88.74,306,
CERVICAL COLLAR,27003127,CDM,274,RC,L0120,HCPCS,outpatient,,,91,36.40,,63.7,70,,50.96,percent of total billed charges,70% of total billed charges,91,100,,72.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,74.62,82,,59.696,percent of total billed charges,82% of total billed charges,77.35,85,,61.88,percent of total billed charges,85% of total billed charges,77.35,85,,61.88,percent of total billed charges,85% of total billed charges,77.35,85,,61.88,percent of total billed charges,85% of total billed charges,81.9,90,,65.52,percent of total billed charges,90% of total billed charges,72.8,80,,58.24,percent of total billed charges,80% of total billed charges,81.9,90,,65.52,percent of total billed charges,90% of total billed charges,68.25,75,,54.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,26.39,29,,21.112,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,60.97,67,,48.776,percent of total billed charges,67% of total billed charges,24.13,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,63.7,70,,50.96,percent of total billed charges,70% of total billed charges,59.15,65,,47.32,percent of total billed charges,65% of total billed charges,32.46,35.67,,25.968,percent of total billed charges,35.67% of total billed charges,24.13,91,
SPLINT COLLES PEDI LEFT,27003373,CDM,274,RC,L3809,HCPCS,outpatient,,,53,21.20,,37.1,70,,29.68,percent of total billed charges,70% of total billed charges,53,100,,42.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,43.46,82,,34.768,percent of total billed charges,82% of total billed charges,45.05,85,,36.04,percent of total billed charges,85% of total billed charges,45.05,85,,36.04,percent of total billed charges,85% of total billed charges,45.05,85,,36.04,percent of total billed charges,85% of total billed charges,47.7,90,,38.16,percent of total billed charges,90% of total billed charges,42.4,80,,33.92,percent of total billed charges,80% of total billed charges,47.7,90,,38.16,percent of total billed charges,90% of total billed charges,39.75,75,,31.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,15.37,29,,12.296,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,35.51,67,,28.408,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,37.1,70,,29.68,percent of total billed charges,70% of total billed charges,34.45,65,,27.56,percent of total billed charges,65% of total billed charges,18.91,35.67,,15.128,percent of total billed charges,35.67% of total billed charges,15.37,53,
SPLINT COLLES RIGHT PEDI,27003374,CDM,274,RC,L3809,HCPCS,outpatient,,,58,23.20,,40.6,70,,32.48,percent of total billed charges,70% of total billed charges,58,100,,46.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,47.56,82,,38.048,percent of total billed charges,82% of total billed charges,49.3,85,,39.44,percent of total billed charges,85% of total billed charges,49.3,85,,39.44,percent of total billed charges,85% of total billed charges,49.3,85,,39.44,percent of total billed charges,85% of total billed charges,52.2,90,,41.76,percent of total billed charges,90% of total billed charges,46.4,80,,37.12,percent of total billed charges,80% of total billed charges,52.2,90,,41.76,percent of total billed charges,90% of total billed charges,43.5,75,,34.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,16.82,29,,13.456,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,38.86,67,,31.088,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,40.6,70,,32.48,percent of total billed charges,70% of total billed charges,37.7,65,,30.16,percent of total billed charges,65% of total billed charges,20.69,35.67,,16.552,percent of total billed charges,35.67% of total billed charges,16.82,58,
COLLAR PEDIATRIC,27003702,CDM,274,RC,L0120,HCPCS,outpatient,,,73,29.20,,51.1,70,,40.88,percent of total billed charges,70% of total billed charges,73,100,,58.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,59.86,82,,47.888,percent of total billed charges,82% of total billed charges,62.05,85,,49.64,percent of total billed charges,85% of total billed charges,62.05,85,,49.64,percent of total billed charges,85% of total billed charges,62.05,85,,49.64,percent of total billed charges,85% of total billed charges,65.7,90,,52.56,percent of total billed charges,90% of total billed charges,58.4,80,,46.72,percent of total billed charges,80% of total billed charges,65.7,90,,52.56,percent of total billed charges,90% of total billed charges,54.75,75,,43.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,21.17,29,,16.936,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,48.91,67,,39.128,percent of total billed charges,67% of total billed charges,24.13,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,51.1,70,,40.88,percent of total billed charges,70% of total billed charges,47.45,65,,37.96,percent of total billed charges,65% of total billed charges,26.04,35.67,,20.832,percent of total billed charges,35.67% of total billed charges,21.17,73,
COLLAR INFANT,27003703,CDM,274,RC,,,outpatient,,,84,33.60,,58.8,70,,47.04,percent of total billed charges,70% of total billed charges,84,100,,67.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,68.88,82,,55.104,percent of total billed charges,82% of total billed charges,71.4,85,,57.12,percent of total billed charges,85% of total billed charges,71.4,85,,57.12,percent of total billed charges,85% of total billed charges,71.4,85,,57.12,percent of total billed charges,85% of total billed charges,75.6,90,,60.48,percent of total billed charges,90% of total billed charges,67.2,80,,53.76,percent of total billed charges,80% of total billed charges,75.6,90,,60.48,percent of total billed charges,90% of total billed charges,63,75,,50.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,24.36,29,,19.488,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,56.28,67,,45.024,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,58.8,70,,47.04,percent of total billed charges,70% of total billed charges,54.6,65,,43.68,percent of total billed charges,65% of total billed charges,29.96,35.67,,23.968,percent of total billed charges,35.67% of total billed charges,24.36,84,
PHILADELPHIA CERVICAL COLLAR,27008338,CDM,274,RC,L0172,HCPCS,outpatient,,,312,124.80,,218.4,70,,174.72,percent of total billed charges,70% of total billed charges,312,100,,249.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,255.84,82,,204.672,percent of total billed charges,82% of total billed charges,265.2,85,,212.16,percent of total billed charges,85% of total billed charges,265.2,85,,212.16,percent of total billed charges,85% of total billed charges,265.2,85,,212.16,percent of total billed charges,85% of total billed charges,280.8,90,,224.64,percent of total billed charges,90% of total billed charges,249.6,80,,199.68,percent of total billed charges,80% of total billed charges,280.8,90,,224.64,percent of total billed charges,90% of total billed charges,234,75,,187.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,90.48,29,,72.384,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,209.04,67,,167.232,percent of total billed charges,67% of total billed charges,133.09,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,218.4,70,,174.72,percent of total billed charges,70% of total billed charges,202.8,65,,162.24,percent of total billed charges,65% of total billed charges,111.29,35.67,,89.032,percent of total billed charges,35.67% of total billed charges,90.48,312,
SHOULDER IMMOBILIZER XXL W,27012631,CDM,274,RC,,,outpatient,,,63,25.20,,44.1,70,,35.28,percent of total billed charges,70% of total billed charges,63,100,,50.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,51.66,82,,41.328,percent of total billed charges,82% of total billed charges,53.55,85,,42.84,percent of total billed charges,85% of total billed charges,53.55,85,,42.84,percent of total billed charges,85% of total billed charges,53.55,85,,42.84,percent of total billed charges,85% of total billed charges,56.7,90,,45.36,percent of total billed charges,90% of total billed charges,50.4,80,,40.32,percent of total billed charges,80% of total billed charges,56.7,90,,45.36,percent of total billed charges,90% of total billed charges,47.25,75,,37.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,18.27,29,,14.616,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,42.21,67,,33.768,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,44.1,70,,35.28,percent of total billed charges,70% of total billed charges,40.95,65,,32.76,percent of total billed charges,65% of total billed charges,22.47,35.67,,17.976,percent of total billed charges,35.67% of total billed charges,18.27,63,
SHOULDER IMMOBILIZER XXL M,27012632,CDM,274,RC,,,outpatient,,,63,25.20,,44.1,70,,35.28,percent of total billed charges,70% of total billed charges,63,100,,50.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,51.66,82,,41.328,percent of total billed charges,82% of total billed charges,53.55,85,,42.84,percent of total billed charges,85% of total billed charges,53.55,85,,42.84,percent of total billed charges,85% of total billed charges,53.55,85,,42.84,percent of total billed charges,85% of total billed charges,56.7,90,,45.36,percent of total billed charges,90% of total billed charges,50.4,80,,40.32,percent of total billed charges,80% of total billed charges,56.7,90,,45.36,percent of total billed charges,90% of total billed charges,47.25,75,,37.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,18.27,29,,14.616,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,42.21,67,,33.768,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,44.1,70,,35.28,percent of total billed charges,70% of total billed charges,40.95,65,,32.76,percent of total billed charges,65% of total billed charges,22.47,35.67,,17.976,percent of total billed charges,35.67% of total billed charges,18.27,63,
EXTRA SMALL CROSSLINK,27015909,CDM,274,RC,C1713,HCPCS,outpatient,,,1927,770.80,,1348.9,70,,1079.12,percent of total billed charges,70% of total billed charges,1011.68,52.5,,809.34,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,1580.14,82,,1264.112,percent of total billed charges,82% of total billed charges,1637.95,85,,1310.36,percent of total billed charges,85% of total billed charges,1637.95,85,,1310.36,percent of total billed charges,85% of total billed charges,1637.95,85,,1310.36,percent of total billed charges,85% of total billed charges,1734.3,90,,1387.44,percent of total billed charges,90% of total billed charges,1541.6,80,,1233.28,percent of total billed charges,80% of total billed charges,1734.3,90,,1387.44,percent of total billed charges,90% of total billed charges,1445.25,75,,1156.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,558.83,29,,447.064,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1291.09,67,,1032.872,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1348.9,70,,1079.12,percent of total billed charges,70% of total billed charges,1252.55,65,,1002.04,percent of total billed charges,65% of total billed charges,687.36,35.67,,549.888,percent of total billed charges,35.67% of total billed charges,558.83,1734.3,
CERVICAL COLLAR XL ADJUSTABLE,27020471,CDM,274,RC,L0140,HCPCS,outpatient,,,96,38.40,,67.2,70,,53.76,percent of total billed charges,70% of total billed charges,96,100,,76.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,78.72,82,,62.976,percent of total billed charges,82% of total billed charges,81.6,85,,65.28,percent of total billed charges,85% of total billed charges,81.6,85,,65.28,percent of total billed charges,85% of total billed charges,81.6,85,,65.28,percent of total billed charges,85% of total billed charges,86.4,90,,69.12,percent of total billed charges,90% of total billed charges,76.8,80,,61.44,percent of total billed charges,80% of total billed charges,86.4,90,,69.12,percent of total billed charges,90% of total billed charges,72,75,,57.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,27.84,29,,22.272,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,64.32,67,,51.456,percent of total billed charges,67% of total billed charges,58.22,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,67.2,70,,53.76,percent of total billed charges,70% of total billed charges,62.4,65,,49.92,percent of total billed charges,65% of total billed charges,34.24,35.67,,27.392,percent of total billed charges,35.67% of total billed charges,27.84,96,
BENDABLE LENS,2600171,CDM,276,RC,,,outpatient,,,823,329.20,,576.1,70,,460.88,percent of total billed charges,70% of total billed charges,633.71,77,,506.97,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,674.86,82,,539.888,percent of total billed charges,82% of total billed charges,699.55,85,,559.64,percent of total billed charges,85% of total billed charges,699.55,85,,559.64,percent of total billed charges,85% of total billed charges,699.55,85,,559.64,percent of total billed charges,85% of total billed charges,740.7,90,,592.56,percent of total billed charges,90% of total billed charges,658.4,80,,526.72,percent of total billed charges,80% of total billed charges,740.7,90,,592.56,percent of total billed charges,90% of total billed charges,617.25,75,,493.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,238.67,29,,190.936,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,551.41,67,,441.128,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,576.1,70,,460.88,percent of total billed charges,70% of total billed charges,534.95,65,,427.96,percent of total billed charges,65% of total billed charges,293.56,35.67,,234.848,percent of total billed charges,35.67% of total billed charges,238.67,740.7,
LENS DIOPTER 20.0,27008046,CDM,276,RC,C1780,HCPCS,outpatient,,,789,315.60,,552.3,70,,441.84,percent of total billed charges,70% of total billed charges,607.53,77,,486.02,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,646.98,82,,517.584,percent of total billed charges,82% of total billed charges,670.65,85,,536.52,percent of total billed charges,85% of total billed charges,670.65,85,,536.52,percent of total billed charges,85% of total billed charges,670.65,85,,536.52,percent of total billed charges,85% of total billed charges,710.1,90,,568.08,percent of total billed charges,90% of total billed charges,631.2,80,,504.96,percent of total billed charges,80% of total billed charges,710.1,90,,568.08,percent of total billed charges,90% of total billed charges,591.75,75,,473.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,228.81,29,,183.048,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,528.63,67,,422.904,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,552.3,70,,441.84,percent of total billed charges,70% of total billed charges,512.85,65,,410.28,percent of total billed charges,65% of total billed charges,281.44,35.67,,225.152,percent of total billed charges,35.67% of total billed charges,228.81,710.1,
LENS DIOPTER 21.5,27008049,CDM,276,RC,C1780,HCPCS,outpatient,,,789,315.60,,552.3,70,,441.84,percent of total billed charges,70% of total billed charges,607.53,77,,486.02,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,646.98,82,,517.584,percent of total billed charges,82% of total billed charges,670.65,85,,536.52,percent of total billed charges,85% of total billed charges,670.65,85,,536.52,percent of total billed charges,85% of total billed charges,670.65,85,,536.52,percent of total billed charges,85% of total billed charges,710.1,90,,568.08,percent of total billed charges,90% of total billed charges,631.2,80,,504.96,percent of total billed charges,80% of total billed charges,710.1,90,,568.08,percent of total billed charges,90% of total billed charges,591.75,75,,473.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,228.81,29,,183.048,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,528.63,67,,422.904,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,552.3,70,,441.84,percent of total billed charges,70% of total billed charges,512.85,65,,410.28,percent of total billed charges,65% of total billed charges,281.44,35.67,,225.152,percent of total billed charges,35.67% of total billed charges,228.81,710.1,
LENS DIOPTER 19.0,27008368,CDM,276,RC,C1780,HCPCS,outpatient,,,789,315.60,,552.3,70,,441.84,percent of total billed charges,70% of total billed charges,607.53,77,,486.02,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,646.98,82,,517.584,percent of total billed charges,82% of total billed charges,670.65,85,,536.52,percent of total billed charges,85% of total billed charges,670.65,85,,536.52,percent of total billed charges,85% of total billed charges,670.65,85,,536.52,percent of total billed charges,85% of total billed charges,710.1,90,,568.08,percent of total billed charges,90% of total billed charges,631.2,80,,504.96,percent of total billed charges,80% of total billed charges,710.1,90,,568.08,percent of total billed charges,90% of total billed charges,591.75,75,,473.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,228.81,29,,183.048,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,528.63,67,,422.904,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,552.3,70,,441.84,percent of total billed charges,70% of total billed charges,512.85,65,,410.28,percent of total billed charges,65% of total billed charges,281.44,35.67,,225.152,percent of total billed charges,35.67% of total billed charges,228.81,710.1,
DIOPTER LENS,27009044,CDM,276,RC,C1780,HCPCS,outpatient,,,789,315.60,,552.3,70,,441.84,percent of total billed charges,70% of total billed charges,607.53,77,,486.02,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,646.98,82,,517.584,percent of total billed charges,82% of total billed charges,670.65,85,,536.52,percent of total billed charges,85% of total billed charges,670.65,85,,536.52,percent of total billed charges,85% of total billed charges,670.65,85,,536.52,percent of total billed charges,85% of total billed charges,710.1,90,,568.08,percent of total billed charges,90% of total billed charges,631.2,80,,504.96,percent of total billed charges,80% of total billed charges,710.1,90,,568.08,percent of total billed charges,90% of total billed charges,591.75,75,,473.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,228.81,29,,183.048,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,528.63,67,,422.904,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,552.3,70,,441.84,percent of total billed charges,70% of total billed charges,512.85,65,,410.28,percent of total billed charges,65% of total billed charges,281.44,35.67,,225.152,percent of total billed charges,35.67% of total billed charges,228.81,710.1,
LENS DIOPTER 26.5,27009257,CDM,276,RC,C1780,HCPCS,outpatient,,,789,315.60,,552.3,70,,441.84,percent of total billed charges,70% of total billed charges,607.53,77,,486.02,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,646.98,82,,517.584,percent of total billed charges,82% of total billed charges,670.65,85,,536.52,percent of total billed charges,85% of total billed charges,670.65,85,,536.52,percent of total billed charges,85% of total billed charges,670.65,85,,536.52,percent of total billed charges,85% of total billed charges,710.1,90,,568.08,percent of total billed charges,90% of total billed charges,631.2,80,,504.96,percent of total billed charges,80% of total billed charges,710.1,90,,568.08,percent of total billed charges,90% of total billed charges,591.75,75,,473.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,228.81,29,,183.048,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,528.63,67,,422.904,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,552.3,70,,441.84,percent of total billed charges,70% of total billed charges,512.85,65,,410.28,percent of total billed charges,65% of total billed charges,281.44,35.67,,225.152,percent of total billed charges,35.67% of total billed charges,228.81,710.1,
LENS DIOPTER 20.0,2708046,CDM,276,RC,C1780,HCPCS,outpatient,,,789,315.60,,552.3,70,,441.84,percent of total billed charges,70% of total billed charges,607.53,77,,486.02,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,646.98,82,,517.584,percent of total billed charges,82% of total billed charges,670.65,85,,536.52,percent of total billed charges,85% of total billed charges,670.65,85,,536.52,percent of total billed charges,85% of total billed charges,670.65,85,,536.52,percent of total billed charges,85% of total billed charges,710.1,90,,568.08,percent of total billed charges,90% of total billed charges,631.2,80,,504.96,percent of total billed charges,80% of total billed charges,710.1,90,,568.08,percent of total billed charges,90% of total billed charges,591.75,75,,473.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,228.81,29,,183.048,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,528.63,67,,422.904,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,552.3,70,,441.84,percent of total billed charges,70% of total billed charges,512.85,65,,410.28,percent of total billed charges,65% of total billed charges,281.44,35.67,,225.152,percent of total billed charges,35.67% of total billed charges,228.81,710.1,
4.5 BROAD COMPRESSION PLATE 7H,25005265,CDM,278,RC,C1713,HCPCS,outpatient,,,832,332.80,,582.4,70,,465.92,percent of total billed charges,70% of total billed charges,832,100,,665.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,682.24,82,,545.792,percent of total billed charges,82% of total billed charges,707.2,85,,565.76,percent of total billed charges,85% of total billed charges,707.2,85,,565.76,percent of total billed charges,85% of total billed charges,707.2,85,,565.76,percent of total billed charges,85% of total billed charges,748.8,90,,599.04,percent of total billed charges,90% of total billed charges,665.6,80,,532.48,percent of total billed charges,80% of total billed charges,748.8,90,,599.04,percent of total billed charges,90% of total billed charges,624,75,,499.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,241.28,29,,193.024,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,557.44,67,,445.952,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,582.4,70,,465.92,percent of total billed charges,70% of total billed charges,540.8,65,,432.64,percent of total billed charges,65% of total billed charges,296.77,35.67,,237.416,percent of total billed charges,35.67% of total billed charges,241.28,832,
LOCKING SCREW 2.7,25015414,CDM,278,RC,C1713,HCPCS,outpatient,,,549,219.60,,384.3,70,,307.44,percent of total billed charges,70% of total billed charges,549,100,,439.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,450.18,82,,360.144,percent of total billed charges,82% of total billed charges,466.65,85,,373.32,percent of total billed charges,85% of total billed charges,466.65,85,,373.32,percent of total billed charges,85% of total billed charges,466.65,85,,373.32,percent of total billed charges,85% of total billed charges,494.1,90,,395.28,percent of total billed charges,90% of total billed charges,439.2,80,,351.36,percent of total billed charges,80% of total billed charges,494.1,90,,395.28,percent of total billed charges,90% of total billed charges,411.75,75,,329.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,159.21,29,,127.368,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,367.83,67,,294.264,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,384.3,70,,307.44,percent of total billed charges,70% of total billed charges,356.85,65,,285.48,percent of total billed charges,65% of total billed charges,195.83,35.67,,156.664,percent of total billed charges,35.67% of total billed charges,159.21,549,
PARAGUARD IUD,2600299,CDM,278,RC,J7300,HCPCS,outpatient,,,2360,944.00,,1652,70,,1321.6,percent of total billed charges,70% of total billed charges,1239,52.5,,991.2,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,2845.15,385,,,fee schedule,385% of BCBS fee schedule,2963.39,401,,,fee schedule,401% of BCBS fee schedule,2963.39,401,,,fee schedule,401% of BCBS fee schedule,2963.39,401,,,fee schedule,401% of BCBS fee schedule,2124,90,,1699.2,percent of total billed charges,90% of total billed charges,1888,80,,1510.4,percent of total billed charges,80% of total billed charges,2124,90,,1699.2,percent of total billed charges,90% of total billed charges,1770,75,,1416,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,684.4,29,,547.52,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1581.2,67,,1264.96,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1652,70,,1321.6,percent of total billed charges,70% of total billed charges,1534,65,,1227.2,percent of total billed charges,65% of total billed charges,841.81,35.67,,673.448,percent of total billed charges,35.67% of total billed charges,684.4,2963.39,
COPPER IUD,2600300,CDM,278,RC,J7300,HCPCS,outpatient,,,4024,1609.60,,2816.8,70,,2253.44,percent of total billed charges,70% of total billed charges,2112.6,52.5,,1690.08,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,2845.15,385,,,fee schedule,385% of BCBS fee schedule,2963.39,401,,,fee schedule,401% of BCBS fee schedule,2963.39,401,,,fee schedule,401% of BCBS fee schedule,2963.39,401,,,fee schedule,401% of BCBS fee schedule,3621.6,90,,2897.28,percent of total billed charges,90% of total billed charges,3219.2,80,,2575.36,percent of total billed charges,80% of total billed charges,3621.6,90,,2897.28,percent of total billed charges,90% of total billed charges,3018,75,,2414.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,1166.96,29,,933.568,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,2696.08,67,,2156.864,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,2816.8,70,,2253.44,percent of total billed charges,70% of total billed charges,2615.6,65,,2092.48,percent of total billed charges,65% of total billed charges,1435.36,35.67,,1148.288,percent of total billed charges,35.67% of total billed charges,1166.96,3621.6,
GORETEX PLUS MESH 1MM 285 SQCM,2604000,CDM,278,RC,C1781,HCPCS,outpatient,,,1066,426.40,,746.2,70,,596.96,percent of total billed charges,70% of total billed charges,559.65,52.5,,447.72,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,874.12,82,,699.296,percent of total billed charges,82% of total billed charges,906.1,85,,724.88,percent of total billed charges,85% of total billed charges,906.1,85,,724.88,percent of total billed charges,85% of total billed charges,906.1,85,,724.88,percent of total billed charges,85% of total billed charges,959.4,90,,767.52,percent of total billed charges,90% of total billed charges,852.8,80,,682.24,percent of total billed charges,80% of total billed charges,959.4,90,,767.52,percent of total billed charges,90% of total billed charges,799.5,75,,639.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,309.14,29,,247.312,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,714.22,67,,571.376,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,746.2,70,,596.96,percent of total billed charges,70% of total billed charges,692.9,65,,554.32,percent of total billed charges,65% of total billed charges,380.24,35.67,,304.192,percent of total billed charges,35.67% of total billed charges,309.14,959.4,
CORTICAL SCREW 3.0X20MM,27000217,CDM,278,RC,C1713,HCPCS,outpatient,,,420,168.00,,294,70,,235.2,percent of total billed charges,70% of total billed charges,420,100,,336,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,344.4,82,,275.52,percent of total billed charges,82% of total billed charges,357,85,,285.6,percent of total billed charges,85% of total billed charges,357,85,,285.6,percent of total billed charges,85% of total billed charges,357,85,,285.6,percent of total billed charges,85% of total billed charges,378,90,,302.4,percent of total billed charges,90% of total billed charges,336,80,,268.8,percent of total billed charges,80% of total billed charges,378,90,,302.4,percent of total billed charges,90% of total billed charges,315,75,,252,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,121.8,29,,97.44,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,281.4,67,,225.12,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,294,70,,235.2,percent of total billed charges,70% of total billed charges,273,65,,218.4,percent of total billed charges,65% of total billed charges,149.81,35.67,,119.848,percent of total billed charges,35.67% of total billed charges,121.8,420,
MAX FORCE MTP PLATE,27000218,CDM,278,RC,C1781,HCPCS,outpatient,,,6683,2673.20,,4678.1,70,,3742.48,percent of total billed charges,70% of total billed charges,3508.58,52.5,,2806.86,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,5480.06,82,,4384.048,percent of total billed charges,82% of total billed charges,5680.55,85,,4544.44,percent of total billed charges,85% of total billed charges,5680.55,85,,4544.44,percent of total billed charges,85% of total billed charges,5680.55,85,,4544.44,percent of total billed charges,85% of total billed charges,6014.7,90,,4811.76,percent of total billed charges,90% of total billed charges,5346.4,80,,4277.12,percent of total billed charges,80% of total billed charges,6014.7,90,,4811.76,percent of total billed charges,90% of total billed charges,5012.25,75,,4009.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,1938.07,29,,1550.456,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4477.61,67,,3582.088,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,4678.1,70,,3742.48,percent of total billed charges,70% of total billed charges,4343.95,65,,3475.16,percent of total billed charges,65% of total billed charges,2383.83,35.67,,1907.064,percent of total billed charges,35.67% of total billed charges,1938.07,6014.7,
CERAMENT G 10ML,27000219,CDM,278,RC,C9359,HCPCS,outpatient,,,24411,9764.40,,17087.7,70,,13670.16,percent of total billed charges,70% of total billed charges,12815.78,52.5,,10252.62,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,20017.02,82,,16013.616,percent of total billed charges,82% of total billed charges,20749.35,85,,16599.48,percent of total billed charges,85% of total billed charges,20749.35,85,,16599.48,percent of total billed charges,85% of total billed charges,20749.35,85,,16599.48,percent of total billed charges,85% of total billed charges,21969.9,90,,17575.92,percent of total billed charges,90% of total billed charges,19528.8,80,,15623.04,percent of total billed charges,80% of total billed charges,21969.9,90,,17575.92,percent of total billed charges,90% of total billed charges,18308.25,75,,14646.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,150.09,100,,,fee schedule,100% of ASC tier grouping rate,,,,,other ,not seperately reimbursable,16355.37,67,,13084.296,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,17087.7,70,,13670.16,percent of total billed charges,70% of total billed charges,15867.15,65,,12693.72,percent of total billed charges,65% of total billed charges,184.61,123,,,fee schedule,123% of ASC tier grouping rate,150.09,21969.9,
GROSHONG CATH TRAY 9.5FR **,27000648,CDM,278,RC,C1751,HCPCS,outpatient,,,2944,1177.60,,2060.8,70,,1648.64,percent of total billed charges,70% of total billed charges,1545.6,52.5,,1236.48,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,2414.08,82,,1931.264,percent of total billed charges,82% of total billed charges,2502.4,85,,2001.92,percent of total billed charges,85% of total billed charges,2502.4,85,,2001.92,percent of total billed charges,85% of total billed charges,2502.4,85,,2001.92,percent of total billed charges,85% of total billed charges,2649.6,90,,2119.68,percent of total billed charges,90% of total billed charges,2355.2,80,,1884.16,percent of total billed charges,80% of total billed charges,2649.6,90,,2119.68,percent of total billed charges,90% of total billed charges,2208,75,,1766.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,853.76,29,,683.008,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1972.48,67,,1577.984,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,2060.8,70,,1648.64,percent of total billed charges,70% of total billed charges,1913.6,65,,1530.88,percent of total billed charges,65% of total billed charges,1050.12,35.67,,840.096,percent of total billed charges,35.67% of total billed charges,853.76,2649.6,
GROSHONG CATH TRAY 7.0 FR,27000649,CDM,278,RC,C1751,HCPCS,outpatient,,,2194,877.60,,1535.8,70,,1228.64,percent of total billed charges,70% of total billed charges,1151.85,52.5,,921.48,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,1799.08,82,,1439.264,percent of total billed charges,82% of total billed charges,1864.9,85,,1491.92,percent of total billed charges,85% of total billed charges,1864.9,85,,1491.92,percent of total billed charges,85% of total billed charges,1864.9,85,,1491.92,percent of total billed charges,85% of total billed charges,1974.6,90,,1579.68,percent of total billed charges,90% of total billed charges,1755.2,80,,1404.16,percent of total billed charges,80% of total billed charges,1974.6,90,,1579.68,percent of total billed charges,90% of total billed charges,1645.5,75,,1316.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,636.26,29,,509.008,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1469.98,67,,1175.984,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1535.8,70,,1228.64,percent of total billed charges,70% of total billed charges,1426.1,65,,1140.88,percent of total billed charges,65% of total billed charges,782.6,35.67,,626.08,percent of total billed charges,35.67% of total billed charges,636.26,1974.6,
2.7 LOCKING SCREW 14MM,270010290,CDM,278,RC,C1713,HCPCS,outpatient,,,842,336.80,,589.4,70,,471.52,percent of total billed charges,70% of total billed charges,842,100,,673.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,690.44,82,,552.352,percent of total billed charges,82% of total billed charges,715.7,85,,572.56,percent of total billed charges,85% of total billed charges,715.7,85,,572.56,percent of total billed charges,85% of total billed charges,715.7,85,,572.56,percent of total billed charges,85% of total billed charges,757.8,90,,606.24,percent of total billed charges,90% of total billed charges,673.6,80,,538.88,percent of total billed charges,80% of total billed charges,757.8,90,,606.24,percent of total billed charges,90% of total billed charges,631.5,75,,505.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,244.18,29,,195.344,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,564.14,67,,451.312,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,589.4,70,,471.52,percent of total billed charges,70% of total billed charges,547.3,65,,437.84,percent of total billed charges,65% of total billed charges,300.34,35.67,,240.272,percent of total billed charges,35.67% of total billed charges,244.18,842,
MARLEX SURGICAL MESH 10X14,27001474,CDM,278,RC,C1781,HCPCS,outpatient,,,1317,526.80,,921.9,70,,737.52,percent of total billed charges,70% of total billed charges,691.43,52.5,,553.14,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,1079.94,82,,863.952,percent of total billed charges,82% of total billed charges,1119.45,85,,895.56,percent of total billed charges,85% of total billed charges,1119.45,85,,895.56,percent of total billed charges,85% of total billed charges,1119.45,85,,895.56,percent of total billed charges,85% of total billed charges,1185.3,90,,948.24,percent of total billed charges,90% of total billed charges,1053.6,80,,842.88,percent of total billed charges,80% of total billed charges,1185.3,90,,948.24,percent of total billed charges,90% of total billed charges,987.75,75,,790.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,381.93,29,,305.544,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,882.39,67,,705.912,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,921.9,70,,737.52,percent of total billed charges,70% of total billed charges,856.05,65,,684.84,percent of total billed charges,65% of total billed charges,469.77,35.67,,375.816,percent of total billed charges,35.67% of total billed charges,381.93,1185.3,
SURGICAL GUIDE WIRE,27001536,CDM,278,RC,C1769,HCPCS,outpatient,,,133,53.20,,93.1,70,,74.48,percent of total billed charges,70% of total billed charges,133,100,,106.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,109.06,82,,87.248,percent of total billed charges,82% of total billed charges,113.05,85,,90.44,percent of total billed charges,85% of total billed charges,113.05,85,,90.44,percent of total billed charges,85% of total billed charges,113.05,85,,90.44,percent of total billed charges,85% of total billed charges,119.7,90,,95.76,percent of total billed charges,90% of total billed charges,106.4,80,,85.12,percent of total billed charges,80% of total billed charges,119.7,90,,95.76,percent of total billed charges,90% of total billed charges,99.75,75,,79.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,38.57,29,,30.856,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,89.11,67,,71.288,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,93.1,70,,74.48,percent of total billed charges,70% of total billed charges,86.45,65,,69.16,percent of total billed charges,65% of total billed charges,47.44,35.67,,37.952,percent of total billed charges,35.67% of total billed charges,38.57,133,
CAROTID ARTERY SHUNT,27001958,CDM,278,RC,,,outpatient,,,209,83.60,,146.3,70,,117.04,percent of total billed charges,70% of total billed charges,209,100,,167.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,171.38,82,,137.104,percent of total billed charges,82% of total billed charges,177.65,85,,142.12,percent of total billed charges,85% of total billed charges,177.65,85,,142.12,percent of total billed charges,85% of total billed charges,177.65,85,,142.12,percent of total billed charges,85% of total billed charges,188.1,90,,150.48,percent of total billed charges,90% of total billed charges,167.2,80,,133.76,percent of total billed charges,80% of total billed charges,188.1,90,,150.48,percent of total billed charges,90% of total billed charges,156.75,75,,125.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,60.61,29,,48.488,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,140.03,67,,112.024,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,146.3,70,,117.04,percent of total billed charges,70% of total billed charges,135.85,65,,108.68,percent of total billed charges,65% of total billed charges,74.55,35.67,,59.64,percent of total billed charges,35.67% of total billed charges,60.61,209,
PORT A CATH KIT **,27002124,CDM,278,RC,C1788,HCPCS,outpatient,,,2203,881.20,,1542.1,70,,1233.68,percent of total billed charges,70% of total billed charges,1156.58,52.5,,925.26,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,1806.46,82,,1445.168,percent of total billed charges,82% of total billed charges,1872.55,85,,1498.04,percent of total billed charges,85% of total billed charges,1872.55,85,,1498.04,percent of total billed charges,85% of total billed charges,1872.55,85,,1498.04,percent of total billed charges,85% of total billed charges,1982.7,90,,1586.16,percent of total billed charges,90% of total billed charges,1762.4,80,,1409.92,percent of total billed charges,80% of total billed charges,1982.7,90,,1586.16,percent of total billed charges,90% of total billed charges,1652.25,75,,1321.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,638.87,29,,511.096,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1476.01,67,,1180.808,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1542.1,70,,1233.68,percent of total billed charges,70% of total billed charges,1431.95,65,,1145.56,percent of total billed charges,65% of total billed charges,785.81,35.67,,628.648,percent of total billed charges,35.67% of total billed charges,638.87,1982.7,
TRIPLE LUMEN CATH KIT 7 FR,27002393,CDM,278,RC,C1751,HCPCS,outpatient,,,672,268.80,,470.4,70,,376.32,percent of total billed charges,70% of total billed charges,672,100,,537.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,551.04,82,,440.832,percent of total billed charges,82% of total billed charges,571.2,85,,456.96,percent of total billed charges,85% of total billed charges,571.2,85,,456.96,percent of total billed charges,85% of total billed charges,571.2,85,,456.96,percent of total billed charges,85% of total billed charges,604.8,90,,483.84,percent of total billed charges,90% of total billed charges,537.6,80,,430.08,percent of total billed charges,80% of total billed charges,604.8,90,,483.84,percent of total billed charges,90% of total billed charges,504,75,,403.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,194.88,29,,155.904,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,450.24,67,,360.192,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,470.4,70,,376.32,percent of total billed charges,70% of total billed charges,436.8,65,,349.44,percent of total billed charges,65% of total billed charges,239.7,35.67,,191.76,percent of total billed charges,35.67% of total billed charges,194.88,672,
SURGIPRO MESH PLUG LARGE,27002462,CDM,278,RC,C1781,HCPCS,outpatient,,,2898,1159.20,,2028.6,70,,1622.88,percent of total billed charges,70% of total billed charges,1521.45,52.5,,1217.16,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,2376.36,82,,1901.088,percent of total billed charges,82% of total billed charges,2463.3,85,,1970.64,percent of total billed charges,85% of total billed charges,2463.3,85,,1970.64,percent of total billed charges,85% of total billed charges,2463.3,85,,1970.64,percent of total billed charges,85% of total billed charges,2608.2,90,,2086.56,percent of total billed charges,90% of total billed charges,2318.4,80,,1854.72,percent of total billed charges,80% of total billed charges,2608.2,90,,2086.56,percent of total billed charges,90% of total billed charges,2173.5,75,,1738.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,840.42,29,,672.336,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1941.66,67,,1553.328,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,2028.6,70,,1622.88,percent of total billed charges,70% of total billed charges,1883.7,65,,1506.96,percent of total billed charges,65% of total billed charges,1033.72,35.67,,826.976,percent of total billed charges,35.67% of total billed charges,840.42,2608.2,
SURGIPRO MESH 3 X 5,27002980,CDM,278,RC,C1781,HCPCS,outpatient,,,873,349.20,,611.1,70,,488.88,percent of total billed charges,70% of total billed charges,873,100,,698.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,715.86,82,,572.688,percent of total billed charges,82% of total billed charges,742.05,85,,593.64,percent of total billed charges,85% of total billed charges,742.05,85,,593.64,percent of total billed charges,85% of total billed charges,742.05,85,,593.64,percent of total billed charges,85% of total billed charges,785.7,90,,628.56,percent of total billed charges,90% of total billed charges,698.4,80,,558.72,percent of total billed charges,80% of total billed charges,785.7,90,,628.56,percent of total billed charges,90% of total billed charges,654.75,75,,523.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,253.17,29,,202.536,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,584.91,67,,467.928,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,611.1,70,,488.88,percent of total billed charges,70% of total billed charges,567.45,65,,453.96,percent of total billed charges,65% of total billed charges,311.4,35.67,,249.12,percent of total billed charges,35.67% of total billed charges,253.17,873,
PEG GUIDEWIRE KIT,27002983,CDM,278,RC,C1769,HCPCS,outpatient,,,875,350.00,,612.5,70,,490,percent of total billed charges,70% of total billed charges,875,100,,700,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,717.5,82,,574,percent of total billed charges,82% of total billed charges,743.75,85,,595,percent of total billed charges,85% of total billed charges,743.75,85,,595,percent of total billed charges,85% of total billed charges,743.75,85,,595,percent of total billed charges,85% of total billed charges,787.5,90,,630,percent of total billed charges,90% of total billed charges,700,80,,560,percent of total billed charges,80% of total billed charges,787.5,90,,630,percent of total billed charges,90% of total billed charges,656.25,75,,525,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,253.75,29,,203,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,586.25,67,,469,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,612.5,70,,490,percent of total billed charges,70% of total billed charges,568.75,65,,455,percent of total billed charges,65% of total billed charges,312.11,35.67,,249.688,percent of total billed charges,35.67% of total billed charges,253.75,875,
SILICON DRAIN BLAKE,27003176,CDM,278,RC,C1729,HCPCS,outpatient,,,334,133.60,,233.8,70,,187.04,percent of total billed charges,70% of total billed charges,334,100,,267.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,273.88,82,,219.104,percent of total billed charges,82% of total billed charges,283.9,85,,227.12,percent of total billed charges,85% of total billed charges,283.9,85,,227.12,percent of total billed charges,85% of total billed charges,283.9,85,,227.12,percent of total billed charges,85% of total billed charges,300.6,90,,240.48,percent of total billed charges,90% of total billed charges,267.2,80,,213.76,percent of total billed charges,80% of total billed charges,300.6,90,,240.48,percent of total billed charges,90% of total billed charges,250.5,75,,200.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,96.86,29,,77.488,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,223.78,67,,179.024,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,233.8,70,,187.04,percent of total billed charges,70% of total billed charges,217.1,65,,173.68,percent of total billed charges,65% of total billed charges,119.14,35.67,,95.312,percent of total billed charges,35.67% of total billed charges,96.86,334,
K WIRE 1.1X152MM 6,27003219,CDM,278,RC,C1713,HCPCS,outpatient,,,26,10.40,,18.2,70,,14.56,percent of total billed charges,70% of total billed charges,26,100,,20.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,21.32,82,,17.056,percent of total billed charges,82% of total billed charges,22.1,85,,17.68,percent of total billed charges,85% of total billed charges,22.1,85,,17.68,percent of total billed charges,85% of total billed charges,22.1,85,,17.68,percent of total billed charges,85% of total billed charges,23.4,90,,18.72,percent of total billed charges,90% of total billed charges,20.8,80,,16.64,percent of total billed charges,80% of total billed charges,23.4,90,,18.72,percent of total billed charges,90% of total billed charges,19.5,75,,15.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,7.54,29,,6.032,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,17.42,67,,13.936,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,18.2,70,,14.56,percent of total billed charges,70% of total billed charges,16.9,65,,13.52,percent of total billed charges,65% of total billed charges,9.27,35.67,,7.416,percent of total billed charges,35.67% of total billed charges,7.54,26,
K WIRE 9,27003220,CDM,278,RC,C1713,HCPCS,outpatient,,,26,10.40,,18.2,70,,14.56,percent of total billed charges,70% of total billed charges,26,100,,20.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,21.32,82,,17.056,percent of total billed charges,82% of total billed charges,22.1,85,,17.68,percent of total billed charges,85% of total billed charges,22.1,85,,17.68,percent of total billed charges,85% of total billed charges,22.1,85,,17.68,percent of total billed charges,85% of total billed charges,23.4,90,,18.72,percent of total billed charges,90% of total billed charges,20.8,80,,16.64,percent of total billed charges,80% of total billed charges,23.4,90,,18.72,percent of total billed charges,90% of total billed charges,19.5,75,,15.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,7.54,29,,6.032,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,17.42,67,,13.936,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,18.2,70,,14.56,percent of total billed charges,70% of total billed charges,16.9,65,,13.52,percent of total billed charges,65% of total billed charges,9.27,35.67,,7.416,percent of total billed charges,35.67% of total billed charges,7.54,26,
CENTRAL VENOUS CATH KIT,27003453,CDM,278,RC,C1751,HCPCS,outpatient,,,260,104.00,,182,70,,145.6,percent of total billed charges,70% of total billed charges,260,100,,208,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,213.2,82,,170.56,percent of total billed charges,82% of total billed charges,221,85,,176.8,percent of total billed charges,85% of total billed charges,221,85,,176.8,percent of total billed charges,85% of total billed charges,221,85,,176.8,percent of total billed charges,85% of total billed charges,234,90,,187.2,percent of total billed charges,90% of total billed charges,208,80,,166.4,percent of total billed charges,80% of total billed charges,234,90,,187.2,percent of total billed charges,90% of total billed charges,195,75,,156,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,75.4,29,,60.32,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,174.2,67,,139.36,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,182,70,,145.6,percent of total billed charges,70% of total billed charges,169,65,,135.2,percent of total billed charges,65% of total billed charges,92.74,35.67,,74.192,percent of total billed charges,35.67% of total billed charges,75.4,260,
SUPER REVO KIT 5MM **,27003512,CDM,278,RC,,,outpatient,,,1212,484.80,,848.4,70,,678.72,percent of total billed charges,70% of total billed charges,636.3,52.5,,509.04,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,993.84,82,,795.072,percent of total billed charges,82% of total billed charges,1030.2,85,,824.16,percent of total billed charges,85% of total billed charges,1030.2,85,,824.16,percent of total billed charges,85% of total billed charges,1030.2,85,,824.16,percent of total billed charges,85% of total billed charges,1090.8,90,,872.64,percent of total billed charges,90% of total billed charges,969.6,80,,775.68,percent of total billed charges,80% of total billed charges,1090.8,90,,872.64,percent of total billed charges,90% of total billed charges,909,75,,727.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,351.48,29,,281.184,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,812.04,67,,649.632,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,848.4,70,,678.72,percent of total billed charges,70% of total billed charges,787.8,65,,630.24,percent of total billed charges,65% of total billed charges,432.32,35.67,,345.856,percent of total billed charges,35.67% of total billed charges,351.48,1090.8,
CORTICOL SCREW 2.7 MM 12,27003627,CDM,278,RC,C1713,HCPCS,outpatient,,,173,69.20,,121.1,70,,96.88,percent of total billed charges,70% of total billed charges,173,100,,138.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,141.86,82,,113.488,percent of total billed charges,82% of total billed charges,147.05,85,,117.64,percent of total billed charges,85% of total billed charges,147.05,85,,117.64,percent of total billed charges,85% of total billed charges,147.05,85,,117.64,percent of total billed charges,85% of total billed charges,155.7,90,,124.56,percent of total billed charges,90% of total billed charges,138.4,80,,110.72,percent of total billed charges,80% of total billed charges,155.7,90,,124.56,percent of total billed charges,90% of total billed charges,129.75,75,,103.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,50.17,29,,40.136,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,115.91,67,,92.728,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,121.1,70,,96.88,percent of total billed charges,70% of total billed charges,112.45,65,,89.96,percent of total billed charges,65% of total billed charges,61.71,35.67,,49.368,percent of total billed charges,35.67% of total billed charges,50.17,173,
CORTICOL SCREW 2.7MM 10,27003628,CDM,278,RC,C1713,HCPCS,outpatient,,,173,69.20,,121.1,70,,96.88,percent of total billed charges,70% of total billed charges,173,100,,138.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,141.86,82,,113.488,percent of total billed charges,82% of total billed charges,147.05,85,,117.64,percent of total billed charges,85% of total billed charges,147.05,85,,117.64,percent of total billed charges,85% of total billed charges,147.05,85,,117.64,percent of total billed charges,85% of total billed charges,155.7,90,,124.56,percent of total billed charges,90% of total billed charges,138.4,80,,110.72,percent of total billed charges,80% of total billed charges,155.7,90,,124.56,percent of total billed charges,90% of total billed charges,129.75,75,,103.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,50.17,29,,40.136,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,115.91,67,,92.728,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,121.1,70,,96.88,percent of total billed charges,70% of total billed charges,112.45,65,,89.96,percent of total billed charges,65% of total billed charges,61.71,35.67,,49.368,percent of total billed charges,35.67% of total billed charges,50.17,173,
STRAIGHT PLATE 2.0MM,27003629,CDM,278,RC,C1713,HCPCS,outpatient,,,322,128.80,,225.4,70,,180.32,percent of total billed charges,70% of total billed charges,322,100,,257.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,264.04,82,,211.232,percent of total billed charges,82% of total billed charges,273.7,85,,218.96,percent of total billed charges,85% of total billed charges,273.7,85,,218.96,percent of total billed charges,85% of total billed charges,273.7,85,,218.96,percent of total billed charges,85% of total billed charges,289.8,90,,231.84,percent of total billed charges,90% of total billed charges,257.6,80,,206.08,percent of total billed charges,80% of total billed charges,289.8,90,,231.84,percent of total billed charges,90% of total billed charges,241.5,75,,193.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,93.38,29,,74.704,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,215.74,67,,172.592,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,225.4,70,,180.32,percent of total billed charges,70% of total billed charges,209.3,65,,167.44,percent of total billed charges,65% of total billed charges,114.86,35.67,,91.888,percent of total billed charges,35.67% of total billed charges,93.38,322,
CORTICAL SCREW 2.0,27003651,CDM,278,RC,C1713,HCPCS,outpatient,,,157,62.80,,109.9,70,,87.92,percent of total billed charges,70% of total billed charges,157,100,,125.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,128.74,82,,102.992,percent of total billed charges,82% of total billed charges,133.45,85,,106.76,percent of total billed charges,85% of total billed charges,133.45,85,,106.76,percent of total billed charges,85% of total billed charges,133.45,85,,106.76,percent of total billed charges,85% of total billed charges,141.3,90,,113.04,percent of total billed charges,90% of total billed charges,125.6,80,,100.48,percent of total billed charges,80% of total billed charges,141.3,90,,113.04,percent of total billed charges,90% of total billed charges,117.75,75,,94.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,45.53,29,,36.424,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,105.19,67,,84.152,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,109.9,70,,87.92,percent of total billed charges,70% of total billed charges,102.05,65,,81.64,percent of total billed charges,65% of total billed charges,56,35.67,,44.8,percent of total billed charges,35.67% of total billed charges,45.53,157,
CANCELLOUS SCREW 4.0 MM,27003652,CDM,278,RC,C1713,HCPCS,outpatient,,,137,54.80,,95.9,70,,76.72,percent of total billed charges,70% of total billed charges,137,100,,109.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,112.34,82,,89.872,percent of total billed charges,82% of total billed charges,116.45,85,,93.16,percent of total billed charges,85% of total billed charges,116.45,85,,93.16,percent of total billed charges,85% of total billed charges,116.45,85,,93.16,percent of total billed charges,85% of total billed charges,123.3,90,,98.64,percent of total billed charges,90% of total billed charges,109.6,80,,87.68,percent of total billed charges,80% of total billed charges,123.3,90,,98.64,percent of total billed charges,90% of total billed charges,102.75,75,,82.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,39.73,29,,31.784,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,91.79,67,,73.432,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,95.9,70,,76.72,percent of total billed charges,70% of total billed charges,89.05,65,,71.24,percent of total billed charges,65% of total billed charges,48.87,35.67,,39.096,percent of total billed charges,35.67% of total billed charges,39.73,137,
MELLEOLAR SCREW 4.5 MM 65,27003654,CDM,278,RC,C1713,HCPCS,outpatient,,,225,90.00,,157.5,70,,126,percent of total billed charges,70% of total billed charges,225,100,,180,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,184.5,82,,147.6,percent of total billed charges,82% of total billed charges,191.25,85,,153,percent of total billed charges,85% of total billed charges,191.25,85,,153,percent of total billed charges,85% of total billed charges,191.25,85,,153,percent of total billed charges,85% of total billed charges,202.5,90,,162,percent of total billed charges,90% of total billed charges,180,80,,144,percent of total billed charges,80% of total billed charges,202.5,90,,162,percent of total billed charges,90% of total billed charges,168.75,75,,135,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,65.25,29,,52.2,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,150.75,67,,120.6,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,157.5,70,,126,percent of total billed charges,70% of total billed charges,146.25,65,,117,percent of total billed charges,65% of total billed charges,80.26,35.67,,64.208,percent of total billed charges,35.67% of total billed charges,65.25,225,
5 HOLE 1/3 TUBULAR PLATE,27003655,CDM,278,RC,C1713,HCPCS,outpatient,,,290,116.00,,203,70,,162.4,percent of total billed charges,70% of total billed charges,290,100,,232,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,237.8,82,,190.24,percent of total billed charges,82% of total billed charges,246.5,85,,197.2,percent of total billed charges,85% of total billed charges,246.5,85,,197.2,percent of total billed charges,85% of total billed charges,246.5,85,,197.2,percent of total billed charges,85% of total billed charges,261,90,,208.8,percent of total billed charges,90% of total billed charges,232,80,,185.6,percent of total billed charges,80% of total billed charges,261,90,,208.8,percent of total billed charges,90% of total billed charges,217.5,75,,174,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,84.1,29,,67.28,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,194.3,67,,155.44,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,203,70,,162.4,percent of total billed charges,70% of total billed charges,188.5,65,,150.8,percent of total billed charges,65% of total billed charges,103.44,35.67,,82.752,percent of total billed charges,35.67% of total billed charges,84.1,290,
CORTICAL SCREW 3.5 SZ 14,27003656,CDM,278,RC,C1713,HCPCS,outpatient,,,185,74.00,,129.5,70,,103.6,percent of total billed charges,70% of total billed charges,185,100,,148,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,151.7,82,,121.36,percent of total billed charges,82% of total billed charges,157.25,85,,125.8,percent of total billed charges,85% of total billed charges,157.25,85,,125.8,percent of total billed charges,85% of total billed charges,157.25,85,,125.8,percent of total billed charges,85% of total billed charges,166.5,90,,133.2,percent of total billed charges,90% of total billed charges,148,80,,118.4,percent of total billed charges,80% of total billed charges,166.5,90,,133.2,percent of total billed charges,90% of total billed charges,138.75,75,,111,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,53.65,29,,42.92,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,123.95,67,,99.16,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,129.5,70,,103.6,percent of total billed charges,70% of total billed charges,120.25,65,,96.2,percent of total billed charges,65% of total billed charges,65.99,35.67,,52.792,percent of total billed charges,35.67% of total billed charges,53.65,185,
CORTICAL SCREW 3.5 MM SZ 18,27003657,CDM,278,RC,C1713,HCPCS,outpatient,,,185,74.00,,129.5,70,,103.6,percent of total billed charges,70% of total billed charges,185,100,,148,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,151.7,82,,121.36,percent of total billed charges,82% of total billed charges,157.25,85,,125.8,percent of total billed charges,85% of total billed charges,157.25,85,,125.8,percent of total billed charges,85% of total billed charges,157.25,85,,125.8,percent of total billed charges,85% of total billed charges,166.5,90,,133.2,percent of total billed charges,90% of total billed charges,148,80,,118.4,percent of total billed charges,80% of total billed charges,166.5,90,,133.2,percent of total billed charges,90% of total billed charges,138.75,75,,111,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,53.65,29,,42.92,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,123.95,67,,99.16,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,129.5,70,,103.6,percent of total billed charges,70% of total billed charges,120.25,65,,96.2,percent of total billed charges,65% of total billed charges,65.99,35.67,,52.792,percent of total billed charges,35.67% of total billed charges,53.65,185,
MALLEOLAR SCREW 4.5 MM SZ70,27003658,CDM,278,RC,C1713,HCPCS,outpatient,,,225,90.00,,157.5,70,,126,percent of total billed charges,70% of total billed charges,225,100,,180,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,184.5,82,,147.6,percent of total billed charges,82% of total billed charges,191.25,85,,153,percent of total billed charges,85% of total billed charges,191.25,85,,153,percent of total billed charges,85% of total billed charges,191.25,85,,153,percent of total billed charges,85% of total billed charges,202.5,90,,162,percent of total billed charges,90% of total billed charges,180,80,,144,percent of total billed charges,80% of total billed charges,202.5,90,,162,percent of total billed charges,90% of total billed charges,168.75,75,,135,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,65.25,29,,52.2,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,150.75,67,,120.6,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,157.5,70,,126,percent of total billed charges,70% of total billed charges,146.25,65,,117,percent of total billed charges,65% of total billed charges,80.26,35.67,,64.208,percent of total billed charges,35.67% of total billed charges,65.25,225,
7 HOLE TUBULAR PLATE,27003659,CDM,278,RC,C1713,HCPCS,outpatient,,,326,130.40,,228.2,70,,182.56,percent of total billed charges,70% of total billed charges,326,100,,260.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,267.32,82,,213.856,percent of total billed charges,82% of total billed charges,277.1,85,,221.68,percent of total billed charges,85% of total billed charges,277.1,85,,221.68,percent of total billed charges,85% of total billed charges,277.1,85,,221.68,percent of total billed charges,85% of total billed charges,293.4,90,,234.72,percent of total billed charges,90% of total billed charges,260.8,80,,208.64,percent of total billed charges,80% of total billed charges,293.4,90,,234.72,percent of total billed charges,90% of total billed charges,244.5,75,,195.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,94.54,29,,75.632,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,218.42,67,,174.736,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,228.2,70,,182.56,percent of total billed charges,70% of total billed charges,211.9,65,,169.52,percent of total billed charges,65% of total billed charges,116.28,35.67,,93.024,percent of total billed charges,35.67% of total billed charges,94.54,326,
SELF TAP BONE SCRW 6.5/30M,27003669,CDM,278,RC,C1713,HCPCS,outpatient,,,624,249.60,,436.8,70,,349.44,percent of total billed charges,70% of total billed charges,624,100,,499.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,511.68,82,,409.344,percent of total billed charges,82% of total billed charges,530.4,85,,424.32,percent of total billed charges,85% of total billed charges,530.4,85,,424.32,percent of total billed charges,85% of total billed charges,530.4,85,,424.32,percent of total billed charges,85% of total billed charges,561.6,90,,449.28,percent of total billed charges,90% of total billed charges,499.2,80,,399.36,percent of total billed charges,80% of total billed charges,561.6,90,,449.28,percent of total billed charges,90% of total billed charges,468,75,,374.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,180.96,29,,144.768,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,418.08,67,,334.464,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,436.8,70,,349.44,percent of total billed charges,70% of total billed charges,405.6,65,,324.48,percent of total billed charges,65% of total billed charges,222.58,35.67,,178.064,percent of total billed charges,35.67% of total billed charges,180.96,624,
SELF TAP BONE SCRW 6.5/20M,27003670,CDM,278,RC,C1713,HCPCS,outpatient,,,624,249.60,,436.8,70,,349.44,percent of total billed charges,70% of total billed charges,624,100,,499.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,511.68,82,,409.344,percent of total billed charges,82% of total billed charges,530.4,85,,424.32,percent of total billed charges,85% of total billed charges,530.4,85,,424.32,percent of total billed charges,85% of total billed charges,530.4,85,,424.32,percent of total billed charges,85% of total billed charges,561.6,90,,449.28,percent of total billed charges,90% of total billed charges,499.2,80,,399.36,percent of total billed charges,80% of total billed charges,561.6,90,,449.28,percent of total billed charges,90% of total billed charges,468,75,,374.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,180.96,29,,144.768,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,418.08,67,,334.464,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,436.8,70,,349.44,percent of total billed charges,70% of total billed charges,405.6,65,,324.48,percent of total billed charges,65% of total billed charges,222.58,35.67,,178.064,percent of total billed charges,35.67% of total billed charges,180.96,624,
MINI QUICK ANCHOR 0 SUTURE **,27003675,CDM,278,RC,C1713,HCPCS,outpatient,,,1673,669.20,,1171.1,70,,936.88,percent of total billed charges,70% of total billed charges,878.33,52.5,,702.66,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,1371.86,82,,1097.488,percent of total billed charges,82% of total billed charges,1422.05,85,,1137.64,percent of total billed charges,85% of total billed charges,1422.05,85,,1137.64,percent of total billed charges,85% of total billed charges,1422.05,85,,1137.64,percent of total billed charges,85% of total billed charges,1505.7,90,,1204.56,percent of total billed charges,90% of total billed charges,1338.4,80,,1070.72,percent of total billed charges,80% of total billed charges,1505.7,90,,1204.56,percent of total billed charges,90% of total billed charges,1254.75,75,,1003.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,485.17,29,,388.136,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1120.91,67,,896.728,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1171.1,70,,936.88,percent of total billed charges,70% of total billed charges,1087.45,65,,869.96,percent of total billed charges,65% of total billed charges,596.76,35.67,,477.408,percent of total billed charges,35.67% of total billed charges,485.17,1505.7,
MINI QUICK ANCHOR + 2-0 SUTURE,27003676,CDM,278,RC,C1713,HCPCS,outpatient,,,1394,557.60,,975.8,70,,780.64,percent of total billed charges,70% of total billed charges,731.85,52.5,,585.48,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,1143.08,82,,914.464,percent of total billed charges,82% of total billed charges,1184.9,85,,947.92,percent of total billed charges,85% of total billed charges,1184.9,85,,947.92,percent of total billed charges,85% of total billed charges,1184.9,85,,947.92,percent of total billed charges,85% of total billed charges,1254.6,90,,1003.68,percent of total billed charges,90% of total billed charges,1115.2,80,,892.16,percent of total billed charges,80% of total billed charges,1254.6,90,,1003.68,percent of total billed charges,90% of total billed charges,1045.5,75,,836.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,404.26,29,,323.408,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,933.98,67,,747.184,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,975.8,70,,780.64,percent of total billed charges,70% of total billed charges,906.1,65,,724.88,percent of total billed charges,65% of total billed charges,497.24,35.67,,397.792,percent of total billed charges,35.67% of total billed charges,404.26,1254.6,
CANCELLOUS SCREW 4.0,27003688,CDM,278,RC,C1713,HCPCS,outpatient,,,130,52.00,,91,70,,72.8,percent of total billed charges,70% of total billed charges,130,100,,104,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,106.6,82,,85.28,percent of total billed charges,82% of total billed charges,110.5,85,,88.4,percent of total billed charges,85% of total billed charges,110.5,85,,88.4,percent of total billed charges,85% of total billed charges,110.5,85,,88.4,percent of total billed charges,85% of total billed charges,117,90,,93.6,percent of total billed charges,90% of total billed charges,104,80,,83.2,percent of total billed charges,80% of total billed charges,117,90,,93.6,percent of total billed charges,90% of total billed charges,97.5,75,,78,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,37.7,29,,30.16,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,87.1,67,,69.68,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,91,70,,72.8,percent of total billed charges,70% of total billed charges,84.5,65,,67.6,percent of total billed charges,65% of total billed charges,46.37,35.67,,37.096,percent of total billed charges,35.67% of total billed charges,37.7,130,
CORTICAL SCREW 3.5 16,27003689,CDM,278,RC,C1713,HCPCS,outpatient,,,194,77.60,,135.8,70,,108.64,percent of total billed charges,70% of total billed charges,194,100,,155.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,159.08,82,,127.264,percent of total billed charges,82% of total billed charges,164.9,85,,131.92,percent of total billed charges,85% of total billed charges,164.9,85,,131.92,percent of total billed charges,85% of total billed charges,164.9,85,,131.92,percent of total billed charges,85% of total billed charges,174.6,90,,139.68,percent of total billed charges,90% of total billed charges,155.2,80,,124.16,percent of total billed charges,80% of total billed charges,174.6,90,,139.68,percent of total billed charges,90% of total billed charges,145.5,75,,116.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,56.26,29,,45.008,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,129.98,67,,103.984,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,135.8,70,,108.64,percent of total billed charges,70% of total billed charges,126.1,65,,100.88,percent of total billed charges,65% of total billed charges,69.2,35.67,,55.36,percent of total billed charges,35.67% of total billed charges,56.26,194,
CORTICAL SCREW 3.5 20,27003692,CDM,278,RC,C1713,HCPCS,outpatient,,,185,74.00,,129.5,70,,103.6,percent of total billed charges,70% of total billed charges,185,100,,148,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,151.7,82,,121.36,percent of total billed charges,82% of total billed charges,157.25,85,,125.8,percent of total billed charges,85% of total billed charges,157.25,85,,125.8,percent of total billed charges,85% of total billed charges,157.25,85,,125.8,percent of total billed charges,85% of total billed charges,166.5,90,,133.2,percent of total billed charges,90% of total billed charges,148,80,,118.4,percent of total billed charges,80% of total billed charges,166.5,90,,133.2,percent of total billed charges,90% of total billed charges,138.75,75,,111,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,53.65,29,,42.92,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,123.95,67,,99.16,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,129.5,70,,103.6,percent of total billed charges,70% of total billed charges,120.25,65,,96.2,percent of total billed charges,65% of total billed charges,65.99,35.67,,52.792,percent of total billed charges,35.67% of total billed charges,53.65,185,
CORTICAL SCREWS 3.5 50MM,27003709,CDM,278,RC,C1713,HCPCS,outpatient,,,157,62.80,,109.9,70,,87.92,percent of total billed charges,70% of total billed charges,157,100,,125.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,128.74,82,,102.992,percent of total billed charges,82% of total billed charges,133.45,85,,106.76,percent of total billed charges,85% of total billed charges,133.45,85,,106.76,percent of total billed charges,85% of total billed charges,133.45,85,,106.76,percent of total billed charges,85% of total billed charges,141.3,90,,113.04,percent of total billed charges,90% of total billed charges,125.6,80,,100.48,percent of total billed charges,80% of total billed charges,141.3,90,,113.04,percent of total billed charges,90% of total billed charges,117.75,75,,94.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,45.53,29,,36.424,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,105.19,67,,84.152,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,109.9,70,,87.92,percent of total billed charges,70% of total billed charges,102.05,65,,81.64,percent of total billed charges,65% of total billed charges,56,35.67,,44.8,percent of total billed charges,35.67% of total billed charges,45.53,157,
K-WIRES 2.0 **,27003710,CDM,278,RC,C1713,HCPCS,outpatient,,,60,24.00,,42,70,,33.6,percent of total billed charges,70% of total billed charges,60,100,,48,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,49.2,82,,39.36,percent of total billed charges,82% of total billed charges,51,85,,40.8,percent of total billed charges,85% of total billed charges,51,85,,40.8,percent of total billed charges,85% of total billed charges,51,85,,40.8,percent of total billed charges,85% of total billed charges,54,90,,43.2,percent of total billed charges,90% of total billed charges,48,80,,38.4,percent of total billed charges,80% of total billed charges,54,90,,43.2,percent of total billed charges,90% of total billed charges,45,75,,36,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,17.4,29,,13.92,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,40.2,67,,32.16,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,42,70,,33.6,percent of total billed charges,70% of total billed charges,39,65,,31.2,percent of total billed charges,65% of total billed charges,21.4,35.67,,17.12,percent of total billed charges,35.67% of total billed charges,17.4,60,
CANCELLOUS SCREW 5 MM X50MM,27003712,CDM,278,RC,C1713,HCPCS,outpatient,,,645,258.00,,451.5,70,,361.2,percent of total billed charges,70% of total billed charges,645,100,,516,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,528.9,82,,423.12,percent of total billed charges,82% of total billed charges,548.25,85,,438.6,percent of total billed charges,85% of total billed charges,548.25,85,,438.6,percent of total billed charges,85% of total billed charges,548.25,85,,438.6,percent of total billed charges,85% of total billed charges,580.5,90,,464.4,percent of total billed charges,90% of total billed charges,516,80,,412.8,percent of total billed charges,80% of total billed charges,580.5,90,,464.4,percent of total billed charges,90% of total billed charges,483.75,75,,387,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,187.05,29,,149.64,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,432.15,67,,345.72,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,451.5,70,,361.2,percent of total billed charges,70% of total billed charges,419.25,65,,335.4,percent of total billed charges,65% of total billed charges,230.07,35.67,,184.056,percent of total billed charges,35.67% of total billed charges,187.05,645,
SCREWS PINS 3.3/3.0MM,27003749,CDM,278,RC,C1713,HCPCS,outpatient,,,472,188.80,,330.4,70,,264.32,percent of total billed charges,70% of total billed charges,472,100,,377.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,387.04,82,,309.632,percent of total billed charges,82% of total billed charges,401.2,85,,320.96,percent of total billed charges,85% of total billed charges,401.2,85,,320.96,percent of total billed charges,85% of total billed charges,401.2,85,,320.96,percent of total billed charges,85% of total billed charges,424.8,90,,339.84,percent of total billed charges,90% of total billed charges,377.6,80,,302.08,percent of total billed charges,80% of total billed charges,424.8,90,,339.84,percent of total billed charges,90% of total billed charges,354,75,,283.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,136.88,29,,109.504,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,316.24,67,,252.992,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,330.4,70,,264.32,percent of total billed charges,70% of total billed charges,306.8,65,,245.44,percent of total billed charges,65% of total billed charges,168.36,35.67,,134.688,percent of total billed charges,35.67% of total billed charges,136.88,472,
SCREW 4.5 CORTICAL S/TAP 26,27003755,CDM,278,RC,C1713,HCPCS,outpatient,,,157,62.80,,109.9,70,,87.92,percent of total billed charges,70% of total billed charges,157,100,,125.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,128.74,82,,102.992,percent of total billed charges,82% of total billed charges,133.45,85,,106.76,percent of total billed charges,85% of total billed charges,133.45,85,,106.76,percent of total billed charges,85% of total billed charges,133.45,85,,106.76,percent of total billed charges,85% of total billed charges,141.3,90,,113.04,percent of total billed charges,90% of total billed charges,125.6,80,,100.48,percent of total billed charges,80% of total billed charges,141.3,90,,113.04,percent of total billed charges,90% of total billed charges,117.75,75,,94.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,45.53,29,,36.424,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,105.19,67,,84.152,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,109.9,70,,87.92,percent of total billed charges,70% of total billed charges,102.05,65,,81.64,percent of total billed charges,65% of total billed charges,56,35.67,,44.8,percent of total billed charges,35.67% of total billed charges,45.53,157,
SCREW 4.5 CORTICAL S/TAP 28,27003756,CDM,278,RC,C1713,HCPCS,outpatient,,,157,62.80,,109.9,70,,87.92,percent of total billed charges,70% of total billed charges,157,100,,125.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,128.74,82,,102.992,percent of total billed charges,82% of total billed charges,133.45,85,,106.76,percent of total billed charges,85% of total billed charges,133.45,85,,106.76,percent of total billed charges,85% of total billed charges,133.45,85,,106.76,percent of total billed charges,85% of total billed charges,141.3,90,,113.04,percent of total billed charges,90% of total billed charges,125.6,80,,100.48,percent of total billed charges,80% of total billed charges,141.3,90,,113.04,percent of total billed charges,90% of total billed charges,117.75,75,,94.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,45.53,29,,36.424,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,105.19,67,,84.152,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,109.9,70,,87.92,percent of total billed charges,70% of total billed charges,102.05,65,,81.64,percent of total billed charges,65% of total billed charges,56,35.67,,44.8,percent of total billed charges,35.67% of total billed charges,45.53,157,
SCREW 4.5 CORTICAL S/TAP 30,27003757,CDM,278,RC,C1713,HCPCS,outpatient,,,157,62.80,,109.9,70,,87.92,percent of total billed charges,70% of total billed charges,157,100,,125.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,128.74,82,,102.992,percent of total billed charges,82% of total billed charges,133.45,85,,106.76,percent of total billed charges,85% of total billed charges,133.45,85,,106.76,percent of total billed charges,85% of total billed charges,133.45,85,,106.76,percent of total billed charges,85% of total billed charges,141.3,90,,113.04,percent of total billed charges,90% of total billed charges,125.6,80,,100.48,percent of total billed charges,80% of total billed charges,141.3,90,,113.04,percent of total billed charges,90% of total billed charges,117.75,75,,94.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,45.53,29,,36.424,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,105.19,67,,84.152,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,109.9,70,,87.92,percent of total billed charges,70% of total billed charges,102.05,65,,81.64,percent of total billed charges,65% of total billed charges,56,35.67,,44.8,percent of total billed charges,35.67% of total billed charges,45.53,157,
SCREW 4.5 CORTICAL S/TAP 34,27003758,CDM,278,RC,C1713,HCPCS,outpatient,,,157,62.80,,109.9,70,,87.92,percent of total billed charges,70% of total billed charges,157,100,,125.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,128.74,82,,102.992,percent of total billed charges,82% of total billed charges,133.45,85,,106.76,percent of total billed charges,85% of total billed charges,133.45,85,,106.76,percent of total billed charges,85% of total billed charges,133.45,85,,106.76,percent of total billed charges,85% of total billed charges,141.3,90,,113.04,percent of total billed charges,90% of total billed charges,125.6,80,,100.48,percent of total billed charges,80% of total billed charges,141.3,90,,113.04,percent of total billed charges,90% of total billed charges,117.75,75,,94.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,45.53,29,,36.424,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,105.19,67,,84.152,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,109.9,70,,87.92,percent of total billed charges,70% of total billed charges,102.05,65,,81.64,percent of total billed charges,65% of total billed charges,56,35.67,,44.8,percent of total billed charges,35.67% of total billed charges,45.53,157,
SCREW 4.5 CORTICAL S/TAP 38,27003759,CDM,278,RC,C1713,HCPCS,outpatient,,,157,62.80,,109.9,70,,87.92,percent of total billed charges,70% of total billed charges,157,100,,125.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,128.74,82,,102.992,percent of total billed charges,82% of total billed charges,133.45,85,,106.76,percent of total billed charges,85% of total billed charges,133.45,85,,106.76,percent of total billed charges,85% of total billed charges,133.45,85,,106.76,percent of total billed charges,85% of total billed charges,141.3,90,,113.04,percent of total billed charges,90% of total billed charges,125.6,80,,100.48,percent of total billed charges,80% of total billed charges,141.3,90,,113.04,percent of total billed charges,90% of total billed charges,117.75,75,,94.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,45.53,29,,36.424,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,105.19,67,,84.152,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,109.9,70,,87.92,percent of total billed charges,70% of total billed charges,102.05,65,,81.64,percent of total billed charges,65% of total billed charges,56,35.67,,44.8,percent of total billed charges,35.67% of total billed charges,45.53,157,
COMP PLATE MARROW  4.5 8/H,27003760,CDM,278,RC,C1713,HCPCS,outpatient,,,614,245.60,,429.8,70,,343.84,percent of total billed charges,70% of total billed charges,614,100,,491.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,503.48,82,,402.784,percent of total billed charges,82% of total billed charges,521.9,85,,417.52,percent of total billed charges,85% of total billed charges,521.9,85,,417.52,percent of total billed charges,85% of total billed charges,521.9,85,,417.52,percent of total billed charges,85% of total billed charges,552.6,90,,442.08,percent of total billed charges,90% of total billed charges,491.2,80,,392.96,percent of total billed charges,80% of total billed charges,552.6,90,,442.08,percent of total billed charges,90% of total billed charges,460.5,75,,368.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,178.06,29,,142.448,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,411.38,67,,329.104,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,429.8,70,,343.84,percent of total billed charges,70% of total billed charges,399.1,65,,319.28,percent of total billed charges,65% of total billed charges,219.01,35.67,,175.208,percent of total billed charges,35.67% of total billed charges,178.06,614,
GORETEX VASCULAR GRAFTS 6MM **,27003761,CDM,278,RC,C1768,HCPCS,outpatient,,,3230,1292.00,,2261,70,,1808.8,percent of total billed charges,70% of total billed charges,1695.75,52.5,,1356.6,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,2648.6,82,,2118.88,percent of total billed charges,82% of total billed charges,2745.5,85,,2196.4,percent of total billed charges,85% of total billed charges,2745.5,85,,2196.4,percent of total billed charges,85% of total billed charges,2745.5,85,,2196.4,percent of total billed charges,85% of total billed charges,2907,90,,2325.6,percent of total billed charges,90% of total billed charges,2584,80,,2067.2,percent of total billed charges,80% of total billed charges,2907,90,,2325.6,percent of total billed charges,90% of total billed charges,2422.5,75,,1938,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,936.7,29,,749.36,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,2164.1,67,,1731.28,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,2261,70,,1808.8,percent of total billed charges,70% of total billed charges,2099.5,65,,1679.6,percent of total billed charges,65% of total billed charges,1152.14,35.67,,921.712,percent of total billed charges,35.67% of total billed charges,936.7,2907,
BONE SCREW 20MM **,27003772,CDM,278,RC,C1713,HCPCS,outpatient,,,888,355.20,,621.6,70,,497.28,percent of total billed charges,70% of total billed charges,888,100,,710.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,728.16,82,,582.528,percent of total billed charges,82% of total billed charges,754.8,85,,603.84,percent of total billed charges,85% of total billed charges,754.8,85,,603.84,percent of total billed charges,85% of total billed charges,754.8,85,,603.84,percent of total billed charges,85% of total billed charges,799.2,90,,639.36,percent of total billed charges,90% of total billed charges,710.4,80,,568.32,percent of total billed charges,80% of total billed charges,799.2,90,,639.36,percent of total billed charges,90% of total billed charges,666,75,,532.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,257.52,29,,206.016,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,594.96,67,,475.968,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,621.6,70,,497.28,percent of total billed charges,70% of total billed charges,577.2,65,,461.76,percent of total billed charges,65% of total billed charges,316.75,35.67,,253.4,percent of total billed charges,35.67% of total billed charges,257.52,888,
CORTICAL SCREW 2.7MM SZ 16,27003776,CDM,278,RC,C1713,HCPCS,outpatient,,,157,62.80,,109.9,70,,87.92,percent of total billed charges,70% of total billed charges,157,100,,125.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,128.74,82,,102.992,percent of total billed charges,82% of total billed charges,133.45,85,,106.76,percent of total billed charges,85% of total billed charges,133.45,85,,106.76,percent of total billed charges,85% of total billed charges,133.45,85,,106.76,percent of total billed charges,85% of total billed charges,141.3,90,,113.04,percent of total billed charges,90% of total billed charges,125.6,80,,100.48,percent of total billed charges,80% of total billed charges,141.3,90,,113.04,percent of total billed charges,90% of total billed charges,117.75,75,,94.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,45.53,29,,36.424,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,105.19,67,,84.152,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,109.9,70,,87.92,percent of total billed charges,70% of total billed charges,102.05,65,,81.64,percent of total billed charges,65% of total billed charges,56,35.67,,44.8,percent of total billed charges,35.67% of total billed charges,45.53,157,
CORTICAL SCREW 2.7MM SZ 20,27003777,CDM,278,RC,C1713,HCPCS,outpatient,,,157,62.80,,109.9,70,,87.92,percent of total billed charges,70% of total billed charges,157,100,,125.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,128.74,82,,102.992,percent of total billed charges,82% of total billed charges,133.45,85,,106.76,percent of total billed charges,85% of total billed charges,133.45,85,,106.76,percent of total billed charges,85% of total billed charges,133.45,85,,106.76,percent of total billed charges,85% of total billed charges,141.3,90,,113.04,percent of total billed charges,90% of total billed charges,125.6,80,,100.48,percent of total billed charges,80% of total billed charges,141.3,90,,113.04,percent of total billed charges,90% of total billed charges,117.75,75,,94.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,45.53,29,,36.424,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,105.19,67,,84.152,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,109.9,70,,87.92,percent of total billed charges,70% of total billed charges,102.05,65,,81.64,percent of total billed charges,65% of total billed charges,56,35.67,,44.8,percent of total billed charges,35.67% of total billed charges,45.53,157,
TUBULAR PLATE 1/4 6 HOLE,27003778,CDM,278,RC,C1713,HCPCS,outpatient,,,343,137.20,,240.1,70,,192.08,percent of total billed charges,70% of total billed charges,343,100,,274.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,281.26,82,,225.008,percent of total billed charges,82% of total billed charges,291.55,85,,233.24,percent of total billed charges,85% of total billed charges,291.55,85,,233.24,percent of total billed charges,85% of total billed charges,291.55,85,,233.24,percent of total billed charges,85% of total billed charges,308.7,90,,246.96,percent of total billed charges,90% of total billed charges,274.4,80,,219.52,percent of total billed charges,80% of total billed charges,308.7,90,,246.96,percent of total billed charges,90% of total billed charges,257.25,75,,205.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,99.47,29,,79.576,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,229.81,67,,183.848,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,240.1,70,,192.08,percent of total billed charges,70% of total billed charges,222.95,65,,178.36,percent of total billed charges,65% of total billed charges,122.35,35.67,,97.88,percent of total billed charges,35.67% of total billed charges,99.47,343,
CORTICAL SCREW 2.7MM SZ 14,27003780,CDM,278,RC,C1713,HCPCS,outpatient,,,157,62.80,,109.9,70,,87.92,percent of total billed charges,70% of total billed charges,157,100,,125.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,128.74,82,,102.992,percent of total billed charges,82% of total billed charges,133.45,85,,106.76,percent of total billed charges,85% of total billed charges,133.45,85,,106.76,percent of total billed charges,85% of total billed charges,133.45,85,,106.76,percent of total billed charges,85% of total billed charges,141.3,90,,113.04,percent of total billed charges,90% of total billed charges,125.6,80,,100.48,percent of total billed charges,80% of total billed charges,141.3,90,,113.04,percent of total billed charges,90% of total billed charges,117.75,75,,94.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,45.53,29,,36.424,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,105.19,67,,84.152,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,109.9,70,,87.92,percent of total billed charges,70% of total billed charges,102.05,65,,81.64,percent of total billed charges,65% of total billed charges,56,35.67,,44.8,percent of total billed charges,35.67% of total billed charges,45.53,157,
TUBE/PLATE STAND. 109MM 3H **,27003823,CDM,278,RC,C1713,HCPCS,outpatient,,,1320,528.00,,924,70,,739.2,percent of total billed charges,70% of total billed charges,693,52.5,,554.4,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,1082.4,82,,865.92,percent of total billed charges,82% of total billed charges,1122,85,,897.6,percent of total billed charges,85% of total billed charges,1122,85,,897.6,percent of total billed charges,85% of total billed charges,1122,85,,897.6,percent of total billed charges,85% of total billed charges,1188,90,,950.4,percent of total billed charges,90% of total billed charges,1056,80,,844.8,percent of total billed charges,80% of total billed charges,1188,90,,950.4,percent of total billed charges,90% of total billed charges,990,75,,792,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,382.8,29,,306.24,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,884.4,67,,707.52,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,924,70,,739.2,percent of total billed charges,70% of total billed charges,858,65,,686.4,percent of total billed charges,65% of total billed charges,470.84,35.67,,376.672,percent of total billed charges,35.67% of total billed charges,382.8,1188,
CORTICAL SCREW 4.5 219-033,27003826,CDM,278,RC,C1713,HCPCS,outpatient,,,120,48.00,,84,70,,67.2,percent of total billed charges,70% of total billed charges,120,100,,96,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,98.4,82,,78.72,percent of total billed charges,82% of total billed charges,102,85,,81.6,percent of total billed charges,85% of total billed charges,102,85,,81.6,percent of total billed charges,85% of total billed charges,102,85,,81.6,percent of total billed charges,85% of total billed charges,108,90,,86.4,percent of total billed charges,90% of total billed charges,96,80,,76.8,percent of total billed charges,80% of total billed charges,108,90,,86.4,percent of total billed charges,90% of total billed charges,90,75,,72,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,34.8,29,,27.84,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,80.4,67,,64.32,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,84,70,,67.2,percent of total billed charges,70% of total billed charges,78,65,,62.4,percent of total billed charges,65% of total billed charges,42.8,35.67,,34.24,percent of total billed charges,35.67% of total billed charges,34.8,120,
CORTICAL SCREW 4.5 2319-035,27003827,CDM,278,RC,C1713,HCPCS,outpatient,,,120,48.00,,84,70,,67.2,percent of total billed charges,70% of total billed charges,120,100,,96,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,98.4,82,,78.72,percent of total billed charges,82% of total billed charges,102,85,,81.6,percent of total billed charges,85% of total billed charges,102,85,,81.6,percent of total billed charges,85% of total billed charges,102,85,,81.6,percent of total billed charges,85% of total billed charges,108,90,,86.4,percent of total billed charges,90% of total billed charges,96,80,,76.8,percent of total billed charges,80% of total billed charges,108,90,,86.4,percent of total billed charges,90% of total billed charges,90,75,,72,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,34.8,29,,27.84,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,80.4,67,,64.32,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,84,70,,67.2,percent of total billed charges,70% of total billed charges,78,65,,62.4,percent of total billed charges,65% of total billed charges,42.8,35.67,,34.24,percent of total billed charges,35.67% of total billed charges,34.8,120,
CORITCAL SCREW 4.5 2319-037,27003828,CDM,278,RC,C1713,HCPCS,outpatient,,,120,48.00,,84,70,,67.2,percent of total billed charges,70% of total billed charges,120,100,,96,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,98.4,82,,78.72,percent of total billed charges,82% of total billed charges,102,85,,81.6,percent of total billed charges,85% of total billed charges,102,85,,81.6,percent of total billed charges,85% of total billed charges,102,85,,81.6,percent of total billed charges,85% of total billed charges,108,90,,86.4,percent of total billed charges,90% of total billed charges,96,80,,76.8,percent of total billed charges,80% of total billed charges,108,90,,86.4,percent of total billed charges,90% of total billed charges,90,75,,72,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,34.8,29,,27.84,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,80.4,67,,64.32,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,84,70,,67.2,percent of total billed charges,70% of total billed charges,78,65,,62.4,percent of total billed charges,65% of total billed charges,42.8,35.67,,34.24,percent of total billed charges,35.67% of total billed charges,34.8,120,
CORTICAL NO S/TAP SCREW 3.5,27003838,CDM,278,RC,C1713,HCPCS,outpatient,,,194,77.60,,135.8,70,,108.64,percent of total billed charges,70% of total billed charges,194,100,,155.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,159.08,82,,127.264,percent of total billed charges,82% of total billed charges,164.9,85,,131.92,percent of total billed charges,85% of total billed charges,164.9,85,,131.92,percent of total billed charges,85% of total billed charges,164.9,85,,131.92,percent of total billed charges,85% of total billed charges,174.6,90,,139.68,percent of total billed charges,90% of total billed charges,155.2,80,,124.16,percent of total billed charges,80% of total billed charges,174.6,90,,139.68,percent of total billed charges,90% of total billed charges,145.5,75,,116.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,56.26,29,,45.008,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,129.98,67,,103.984,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,135.8,70,,108.64,percent of total billed charges,70% of total billed charges,126.1,65,,100.88,percent of total billed charges,65% of total billed charges,69.2,35.67,,55.36,percent of total billed charges,35.67% of total billed charges,56.26,194,
K WIRE 1.25 MM,27003839,CDM,278,RC,C1713,HCPCS,outpatient,,,11,4.40,,7.7,70,,6.16,percent of total billed charges,70% of total billed charges,11,100,,8.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,9.02,82,,7.216,percent of total billed charges,82% of total billed charges,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,9.9,90,,7.92,percent of total billed charges,90% of total billed charges,8.8,80,,7.04,percent of total billed charges,80% of total billed charges,9.9,90,,7.92,percent of total billed charges,90% of total billed charges,8.25,75,,6.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,3.19,29,,2.552,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,7.37,67,,5.896,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,7.7,70,,6.16,percent of total billed charges,70% of total billed charges,7.15,65,,5.72,percent of total billed charges,65% of total billed charges,3.92,35.67,,3.136,percent of total billed charges,35.67% of total billed charges,3.19,11,
CORTICAL SCREW 3.5 40 N/ST,27003841,CDM,278,RC,C1713,HCPCS,outpatient,,,157,62.80,,109.9,70,,87.92,percent of total billed charges,70% of total billed charges,157,100,,125.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,128.74,82,,102.992,percent of total billed charges,82% of total billed charges,133.45,85,,106.76,percent of total billed charges,85% of total billed charges,133.45,85,,106.76,percent of total billed charges,85% of total billed charges,133.45,85,,106.76,percent of total billed charges,85% of total billed charges,141.3,90,,113.04,percent of total billed charges,90% of total billed charges,125.6,80,,100.48,percent of total billed charges,80% of total billed charges,141.3,90,,113.04,percent of total billed charges,90% of total billed charges,117.75,75,,94.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,45.53,29,,36.424,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,105.19,67,,84.152,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,109.9,70,,87.92,percent of total billed charges,70% of total billed charges,102.05,65,,81.64,percent of total billed charges,65% of total billed charges,56,35.67,,44.8,percent of total billed charges,35.67% of total billed charges,45.53,157,
ACCELL 10 CC DBM **,27003852,CDM,278,RC,C1776,HCPCS,outpatient,,,9289,3715.60,,6502.3,70,,5201.84,percent of total billed charges,70% of total billed charges,4876.73,52.5,,3901.38,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,7616.98,82,,6093.584,percent of total billed charges,82% of total billed charges,7895.65,85,,6316.52,percent of total billed charges,85% of total billed charges,7895.65,85,,6316.52,percent of total billed charges,85% of total billed charges,7895.65,85,,6316.52,percent of total billed charges,85% of total billed charges,8360.1,90,,6688.08,percent of total billed charges,90% of total billed charges,7431.2,80,,5944.96,percent of total billed charges,80% of total billed charges,8360.1,90,,6688.08,percent of total billed charges,90% of total billed charges,6966.75,75,,5573.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2693.81,29,,2155.048,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,6223.63,67,,4978.904,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,6502.3,70,,5201.84,percent of total billed charges,70% of total billed charges,6037.85,65,,4830.28,percent of total billed charges,65% of total billed charges,3313.39,35.67,,2650.712,percent of total billed charges,35.67% of total billed charges,2693.81,8360.1,
HEALOS 10 CC **,27003856,CDM,278,RC,C1776,HCPCS,outpatient,,,9524,3809.60,,6666.8,70,,5333.44,percent of total billed charges,70% of total billed charges,5000.1,52.5,,4000.08,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,7809.68,82,,6247.744,percent of total billed charges,82% of total billed charges,8095.4,85,,6476.32,percent of total billed charges,85% of total billed charges,8095.4,85,,6476.32,percent of total billed charges,85% of total billed charges,8095.4,85,,6476.32,percent of total billed charges,85% of total billed charges,8571.6,90,,6857.28,percent of total billed charges,90% of total billed charges,7619.2,80,,6095.36,percent of total billed charges,80% of total billed charges,8571.6,90,,6857.28,percent of total billed charges,90% of total billed charges,7143,75,,5714.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2761.96,29,,2209.568,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,6381.08,67,,5104.864,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,6666.8,70,,5333.44,percent of total billed charges,70% of total billed charges,6190.6,65,,4952.48,percent of total billed charges,65% of total billed charges,3397.21,35.67,,2717.768,percent of total billed charges,35.67% of total billed charges,2761.96,8571.6,
CORTICAL SCR 3.5 N/S TAP 34,27003868,CDM,278,RC,C1713,HCPCS,outpatient,,,157,62.80,,109.9,70,,87.92,percent of total billed charges,70% of total billed charges,157,100,,125.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,128.74,82,,102.992,percent of total billed charges,82% of total billed charges,133.45,85,,106.76,percent of total billed charges,85% of total billed charges,133.45,85,,106.76,percent of total billed charges,85% of total billed charges,133.45,85,,106.76,percent of total billed charges,85% of total billed charges,141.3,90,,113.04,percent of total billed charges,90% of total billed charges,125.6,80,,100.48,percent of total billed charges,80% of total billed charges,141.3,90,,113.04,percent of total billed charges,90% of total billed charges,117.75,75,,94.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,45.53,29,,36.424,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,105.19,67,,84.152,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,109.9,70,,87.92,percent of total billed charges,70% of total billed charges,102.05,65,,81.64,percent of total billed charges,65% of total billed charges,56,35.67,,44.8,percent of total billed charges,35.67% of total billed charges,45.53,157,
K WIRE 1.60 MM,27003869,CDM,278,RC,C1713,HCPCS,outpatient,,,97,38.80,,67.9,70,,54.32,percent of total billed charges,70% of total billed charges,97,100,,77.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,79.54,82,,63.632,percent of total billed charges,82% of total billed charges,82.45,85,,65.96,percent of total billed charges,85% of total billed charges,82.45,85,,65.96,percent of total billed charges,85% of total billed charges,82.45,85,,65.96,percent of total billed charges,85% of total billed charges,87.3,90,,69.84,percent of total billed charges,90% of total billed charges,77.6,80,,62.08,percent of total billed charges,80% of total billed charges,87.3,90,,69.84,percent of total billed charges,90% of total billed charges,72.75,75,,58.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,28.13,29,,22.504,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,64.99,67,,51.992,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,67.9,70,,54.32,percent of total billed charges,70% of total billed charges,63.05,65,,50.44,percent of total billed charges,65% of total billed charges,34.6,35.67,,27.68,percent of total billed charges,35.67% of total billed charges,28.13,97,
CERVICAL PLATE 25 MM,27003879,CDM,278,RC,C1713,HCPCS,outpatient,,,3943,1577.20,,2760.1,70,,2208.08,percent of total billed charges,70% of total billed charges,2070.08,52.5,,1656.06,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,3233.26,82,,2586.608,percent of total billed charges,82% of total billed charges,3351.55,85,,2681.24,percent of total billed charges,85% of total billed charges,3351.55,85,,2681.24,percent of total billed charges,85% of total billed charges,3351.55,85,,2681.24,percent of total billed charges,85% of total billed charges,3548.7,90,,2838.96,percent of total billed charges,90% of total billed charges,3154.4,80,,2523.52,percent of total billed charges,80% of total billed charges,3548.7,90,,2838.96,percent of total billed charges,90% of total billed charges,2957.25,75,,2365.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,1143.47,29,,914.776,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,2641.81,67,,2113.448,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,2760.1,70,,2208.08,percent of total billed charges,70% of total billed charges,2562.95,65,,2050.36,percent of total billed charges,65% of total billed charges,1406.47,35.67,,1125.176,percent of total billed charges,35.67% of total billed charges,1143.47,3548.7,
PROXIMAL HUMERUS PLATE 3.5 **,27003888,CDM,278,RC,C1776,HCPCS,outpatient,,,7486,2994.40,,5240.2,70,,4192.16,percent of total billed charges,70% of total billed charges,3930.15,52.5,,3144.12,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,6138.52,82,,4910.816,percent of total billed charges,82% of total billed charges,6363.1,85,,5090.48,percent of total billed charges,85% of total billed charges,6363.1,85,,5090.48,percent of total billed charges,85% of total billed charges,6363.1,85,,5090.48,percent of total billed charges,85% of total billed charges,6737.4,90,,5389.92,percent of total billed charges,90% of total billed charges,5988.8,80,,4791.04,percent of total billed charges,80% of total billed charges,6737.4,90,,5389.92,percent of total billed charges,90% of total billed charges,5614.5,75,,4491.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2170.94,29,,1736.752,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,5015.62,67,,4012.496,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,5240.2,70,,4192.16,percent of total billed charges,70% of total billed charges,4865.9,65,,3892.72,percent of total billed charges,65% of total billed charges,2670.26,35.67,,2136.208,percent of total billed charges,35.67% of total billed charges,2170.94,6737.4,
CORTEX SCREW SZ 26 3.5 MM **,27003889,CDM,278,RC,C1713,HCPCS,outpatient,,,144,57.60,,100.8,70,,80.64,percent of total billed charges,70% of total billed charges,144,100,,115.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,118.08,82,,94.464,percent of total billed charges,82% of total billed charges,122.4,85,,97.92,percent of total billed charges,85% of total billed charges,122.4,85,,97.92,percent of total billed charges,85% of total billed charges,122.4,85,,97.92,percent of total billed charges,85% of total billed charges,129.6,90,,103.68,percent of total billed charges,90% of total billed charges,115.2,80,,92.16,percent of total billed charges,80% of total billed charges,129.6,90,,103.68,percent of total billed charges,90% of total billed charges,108,75,,86.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,41.76,29,,33.408,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,96.48,67,,77.184,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,100.8,70,,80.64,percent of total billed charges,70% of total billed charges,93.6,65,,74.88,percent of total billed charges,65% of total billed charges,51.36,35.67,,41.088,percent of total billed charges,35.67% of total billed charges,41.76,144,
CORTEX SCREW SZ 28 3.5 MM **,27003890,CDM,278,RC,C1713,HCPCS,outpatient,,,144,57.60,,100.8,70,,80.64,percent of total billed charges,70% of total billed charges,144,100,,115.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,118.08,82,,94.464,percent of total billed charges,82% of total billed charges,122.4,85,,97.92,percent of total billed charges,85% of total billed charges,122.4,85,,97.92,percent of total billed charges,85% of total billed charges,122.4,85,,97.92,percent of total billed charges,85% of total billed charges,129.6,90,,103.68,percent of total billed charges,90% of total billed charges,115.2,80,,92.16,percent of total billed charges,80% of total billed charges,129.6,90,,103.68,percent of total billed charges,90% of total billed charges,108,75,,86.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,41.76,29,,33.408,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,96.48,67,,77.184,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,100.8,70,,80.64,percent of total billed charges,70% of total billed charges,93.6,65,,74.88,percent of total billed charges,65% of total billed charges,51.36,35.67,,41.088,percent of total billed charges,35.67% of total billed charges,41.76,144,
CORTEX SCREW SZ 30 3.5 MM **,27003891,CDM,278,RC,C1713,HCPCS,outpatient,,,144,57.60,,100.8,70,,80.64,percent of total billed charges,70% of total billed charges,144,100,,115.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,118.08,82,,94.464,percent of total billed charges,82% of total billed charges,122.4,85,,97.92,percent of total billed charges,85% of total billed charges,122.4,85,,97.92,percent of total billed charges,85% of total billed charges,122.4,85,,97.92,percent of total billed charges,85% of total billed charges,129.6,90,,103.68,percent of total billed charges,90% of total billed charges,115.2,80,,92.16,percent of total billed charges,80% of total billed charges,129.6,90,,103.68,percent of total billed charges,90% of total billed charges,108,75,,86.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,41.76,29,,33.408,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,96.48,67,,77.184,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,100.8,70,,80.64,percent of total billed charges,70% of total billed charges,93.6,65,,74.88,percent of total billed charges,65% of total billed charges,51.36,35.67,,41.088,percent of total billed charges,35.67% of total billed charges,41.76,144,
CORTEX SCREW SZ 32 3.5 MM **,27003892,CDM,278,RC,C1713,HCPCS,outpatient,,,201,80.40,,140.7,70,,112.56,percent of total billed charges,70% of total billed charges,201,100,,160.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,164.82,82,,131.856,percent of total billed charges,82% of total billed charges,170.85,85,,136.68,percent of total billed charges,85% of total billed charges,170.85,85,,136.68,percent of total billed charges,85% of total billed charges,170.85,85,,136.68,percent of total billed charges,85% of total billed charges,180.9,90,,144.72,percent of total billed charges,90% of total billed charges,160.8,80,,128.64,percent of total billed charges,80% of total billed charges,180.9,90,,144.72,percent of total billed charges,90% of total billed charges,150.75,75,,120.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,58.29,29,,46.632,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,134.67,67,,107.736,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,140.7,70,,112.56,percent of total billed charges,70% of total billed charges,130.65,65,,104.52,percent of total billed charges,65% of total billed charges,71.7,35.67,,57.36,percent of total billed charges,35.67% of total billed charges,58.29,201,
CORTEX SCREW SZ 34 3.5 MM **,27003893,CDM,278,RC,C1713,HCPCS,outpatient,,,203,81.20,,142.1,70,,113.68,percent of total billed charges,70% of total billed charges,203,100,,162.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,166.46,82,,133.168,percent of total billed charges,82% of total billed charges,172.55,85,,138.04,percent of total billed charges,85% of total billed charges,172.55,85,,138.04,percent of total billed charges,85% of total billed charges,172.55,85,,138.04,percent of total billed charges,85% of total billed charges,182.7,90,,146.16,percent of total billed charges,90% of total billed charges,162.4,80,,129.92,percent of total billed charges,80% of total billed charges,182.7,90,,146.16,percent of total billed charges,90% of total billed charges,152.25,75,,121.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,58.87,29,,47.096,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,136.01,67,,108.808,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,142.1,70,,113.68,percent of total billed charges,70% of total billed charges,131.95,65,,105.56,percent of total billed charges,65% of total billed charges,72.41,35.67,,57.928,percent of total billed charges,35.67% of total billed charges,58.87,203,
CORTEX SCREW SZ 40 3.5 MM **,27003894,CDM,278,RC,C1713,HCPCS,outpatient,,,195,78.00,,136.5,70,,109.2,percent of total billed charges,70% of total billed charges,195,100,,156,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,159.9,82,,127.92,percent of total billed charges,82% of total billed charges,165.75,85,,132.6,percent of total billed charges,85% of total billed charges,165.75,85,,132.6,percent of total billed charges,85% of total billed charges,165.75,85,,132.6,percent of total billed charges,85% of total billed charges,175.5,90,,140.4,percent of total billed charges,90% of total billed charges,156,80,,124.8,percent of total billed charges,80% of total billed charges,175.5,90,,140.4,percent of total billed charges,90% of total billed charges,146.25,75,,117,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,56.55,29,,45.24,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,130.65,67,,104.52,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,136.5,70,,109.2,percent of total billed charges,70% of total billed charges,126.75,65,,101.4,percent of total billed charges,65% of total billed charges,69.56,35.67,,55.648,percent of total billed charges,35.67% of total billed charges,56.55,195,
LOCKING SCREW SZ 28 3.5 MM **,27003895,CDM,278,RC,C1713,HCPCS,outpatient,,,582,232.80,,407.4,70,,325.92,percent of total billed charges,70% of total billed charges,582,100,,465.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,477.24,82,,381.792,percent of total billed charges,82% of total billed charges,494.7,85,,395.76,percent of total billed charges,85% of total billed charges,494.7,85,,395.76,percent of total billed charges,85% of total billed charges,494.7,85,,395.76,percent of total billed charges,85% of total billed charges,523.8,90,,419.04,percent of total billed charges,90% of total billed charges,465.6,80,,372.48,percent of total billed charges,80% of total billed charges,523.8,90,,419.04,percent of total billed charges,90% of total billed charges,436.5,75,,349.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,168.78,29,,135.024,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,389.94,67,,311.952,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,407.4,70,,325.92,percent of total billed charges,70% of total billed charges,378.3,65,,302.64,percent of total billed charges,65% of total billed charges,207.6,35.67,,166.08,percent of total billed charges,35.67% of total billed charges,168.78,582,
LOCKING SCREW SZ 30 3.5 MM **,27003896,CDM,278,RC,C1713,HCPCS,outpatient,,,804,321.60,,562.8,70,,450.24,percent of total billed charges,70% of total billed charges,804,100,,643.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,659.28,82,,527.424,percent of total billed charges,82% of total billed charges,683.4,85,,546.72,percent of total billed charges,85% of total billed charges,683.4,85,,546.72,percent of total billed charges,85% of total billed charges,683.4,85,,546.72,percent of total billed charges,85% of total billed charges,723.6,90,,578.88,percent of total billed charges,90% of total billed charges,643.2,80,,514.56,percent of total billed charges,80% of total billed charges,723.6,90,,578.88,percent of total billed charges,90% of total billed charges,603,75,,482.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,233.16,29,,186.528,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,538.68,67,,430.944,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,562.8,70,,450.24,percent of total billed charges,70% of total billed charges,522.6,65,,418.08,percent of total billed charges,65% of total billed charges,286.79,35.67,,229.432,percent of total billed charges,35.67% of total billed charges,233.16,804,
LOCKING SCREW SZ 40 3.5 MM **,27003897,CDM,278,RC,C1713,HCPCS,outpatient,,,802,320.80,,561.4,70,,449.12,percent of total billed charges,70% of total billed charges,802,100,,641.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,657.64,82,,526.112,percent of total billed charges,82% of total billed charges,681.7,85,,545.36,percent of total billed charges,85% of total billed charges,681.7,85,,545.36,percent of total billed charges,85% of total billed charges,681.7,85,,545.36,percent of total billed charges,85% of total billed charges,721.8,90,,577.44,percent of total billed charges,90% of total billed charges,641.6,80,,513.28,percent of total billed charges,80% of total billed charges,721.8,90,,577.44,percent of total billed charges,90% of total billed charges,601.5,75,,481.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,232.58,29,,186.064,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,537.34,67,,429.872,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,561.4,70,,449.12,percent of total billed charges,70% of total billed charges,521.3,65,,417.04,percent of total billed charges,65% of total billed charges,286.07,35.67,,228.856,percent of total billed charges,35.67% of total billed charges,232.58,802,
LOCKING SCREW SZ 45 3.5 MM **,27003898,CDM,278,RC,C1713,HCPCS,outpatient,,,582,232.80,,407.4,70,,325.92,percent of total billed charges,70% of total billed charges,582,100,,465.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,477.24,82,,381.792,percent of total billed charges,82% of total billed charges,494.7,85,,395.76,percent of total billed charges,85% of total billed charges,494.7,85,,395.76,percent of total billed charges,85% of total billed charges,494.7,85,,395.76,percent of total billed charges,85% of total billed charges,523.8,90,,419.04,percent of total billed charges,90% of total billed charges,465.6,80,,372.48,percent of total billed charges,80% of total billed charges,523.8,90,,419.04,percent of total billed charges,90% of total billed charges,436.5,75,,349.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,168.78,29,,135.024,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,389.94,67,,311.952,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,407.4,70,,325.92,percent of total billed charges,70% of total billed charges,378.3,65,,302.64,percent of total billed charges,65% of total billed charges,207.6,35.67,,166.08,percent of total billed charges,35.67% of total billed charges,168.78,582,
DORSAL DISTAL RAD PLATE RT,27003899,CDM,278,RC,C1713,HCPCS,outpatient,,,1901,760.40,,1330.7,70,,1064.56,percent of total billed charges,70% of total billed charges,998.03,52.5,,798.42,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,1558.82,82,,1247.056,percent of total billed charges,82% of total billed charges,1615.85,85,,1292.68,percent of total billed charges,85% of total billed charges,1615.85,85,,1292.68,percent of total billed charges,85% of total billed charges,1615.85,85,,1292.68,percent of total billed charges,85% of total billed charges,1710.9,90,,1368.72,percent of total billed charges,90% of total billed charges,1520.8,80,,1216.64,percent of total billed charges,80% of total billed charges,1710.9,90,,1368.72,percent of total billed charges,90% of total billed charges,1425.75,75,,1140.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,551.29,29,,441.032,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1273.67,67,,1018.936,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1330.7,70,,1064.56,percent of total billed charges,70% of total billed charges,1235.65,65,,988.52,percent of total billed charges,65% of total billed charges,678.09,35.67,,542.472,percent of total billed charges,35.67% of total billed charges,551.29,1710.9,
CORTEX SCREW SZ 12 2.4 MM **,27003900,CDM,278,RC,C1713,HCPCS,outpatient,,,268,107.20,,187.6,70,,150.08,percent of total billed charges,70% of total billed charges,268,100,,214.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,219.76,82,,175.808,percent of total billed charges,82% of total billed charges,227.8,85,,182.24,percent of total billed charges,85% of total billed charges,227.8,85,,182.24,percent of total billed charges,85% of total billed charges,227.8,85,,182.24,percent of total billed charges,85% of total billed charges,241.2,90,,192.96,percent of total billed charges,90% of total billed charges,214.4,80,,171.52,percent of total billed charges,80% of total billed charges,241.2,90,,192.96,percent of total billed charges,90% of total billed charges,201,75,,160.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,77.72,29,,62.176,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,179.56,67,,143.648,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,187.6,70,,150.08,percent of total billed charges,70% of total billed charges,174.2,65,,139.36,percent of total billed charges,65% of total billed charges,95.6,35.67,,76.48,percent of total billed charges,35.67% of total billed charges,77.72,268,
CORTEX SCREW SZ 20 2.4 MM **,27003901,CDM,278,RC,C1713,HCPCS,outpatient,,,268,107.20,,187.6,70,,150.08,percent of total billed charges,70% of total billed charges,268,100,,214.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,219.76,82,,175.808,percent of total billed charges,82% of total billed charges,227.8,85,,182.24,percent of total billed charges,85% of total billed charges,227.8,85,,182.24,percent of total billed charges,85% of total billed charges,227.8,85,,182.24,percent of total billed charges,85% of total billed charges,241.2,90,,192.96,percent of total billed charges,90% of total billed charges,214.4,80,,171.52,percent of total billed charges,80% of total billed charges,241.2,90,,192.96,percent of total billed charges,90% of total billed charges,201,75,,160.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,77.72,29,,62.176,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,179.56,67,,143.648,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,187.6,70,,150.08,percent of total billed charges,70% of total billed charges,174.2,65,,139.36,percent of total billed charges,65% of total billed charges,95.6,35.67,,76.48,percent of total billed charges,35.67% of total billed charges,77.72,268,
CORTEX SCREW SZ 24 2.4 MM **,27003902,CDM,278,RC,C1713,HCPCS,outpatient,,,268,107.20,,187.6,70,,150.08,percent of total billed charges,70% of total billed charges,268,100,,214.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,219.76,82,,175.808,percent of total billed charges,82% of total billed charges,227.8,85,,182.24,percent of total billed charges,85% of total billed charges,227.8,85,,182.24,percent of total billed charges,85% of total billed charges,227.8,85,,182.24,percent of total billed charges,85% of total billed charges,241.2,90,,192.96,percent of total billed charges,90% of total billed charges,214.4,80,,171.52,percent of total billed charges,80% of total billed charges,241.2,90,,192.96,percent of total billed charges,90% of total billed charges,201,75,,160.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,77.72,29,,62.176,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,179.56,67,,143.648,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,187.6,70,,150.08,percent of total billed charges,70% of total billed charges,174.2,65,,139.36,percent of total billed charges,65% of total billed charges,95.6,35.67,,76.48,percent of total billed charges,35.67% of total billed charges,77.72,268,
CORTEX SCREW SZ 14 2.7 MM **,27003903,CDM,278,RC,C1713,HCPCS,outpatient,,,144,57.60,,100.8,70,,80.64,percent of total billed charges,70% of total billed charges,144,100,,115.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,118.08,82,,94.464,percent of total billed charges,82% of total billed charges,122.4,85,,97.92,percent of total billed charges,85% of total billed charges,122.4,85,,97.92,percent of total billed charges,85% of total billed charges,122.4,85,,97.92,percent of total billed charges,85% of total billed charges,129.6,90,,103.68,percent of total billed charges,90% of total billed charges,115.2,80,,92.16,percent of total billed charges,80% of total billed charges,129.6,90,,103.68,percent of total billed charges,90% of total billed charges,108,75,,86.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,41.76,29,,33.408,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,96.48,67,,77.184,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,100.8,70,,80.64,percent of total billed charges,70% of total billed charges,93.6,65,,74.88,percent of total billed charges,65% of total billed charges,51.36,35.67,,41.088,percent of total billed charges,35.67% of total billed charges,41.76,144,
CORTEX SCREW SZ 16 2.7 MM **,27003904,CDM,278,RC,C1713,HCPCS,outpatient,,,144,57.60,,100.8,70,,80.64,percent of total billed charges,70% of total billed charges,144,100,,115.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,118.08,82,,94.464,percent of total billed charges,82% of total billed charges,122.4,85,,97.92,percent of total billed charges,85% of total billed charges,122.4,85,,97.92,percent of total billed charges,85% of total billed charges,122.4,85,,97.92,percent of total billed charges,85% of total billed charges,129.6,90,,103.68,percent of total billed charges,90% of total billed charges,115.2,80,,92.16,percent of total billed charges,80% of total billed charges,129.6,90,,103.68,percent of total billed charges,90% of total billed charges,108,75,,86.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,41.76,29,,33.408,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,96.48,67,,77.184,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,100.8,70,,80.64,percent of total billed charges,70% of total billed charges,93.6,65,,74.88,percent of total billed charges,65% of total billed charges,51.36,35.67,,41.088,percent of total billed charges,35.67% of total billed charges,41.76,144,
CORTEX SCREW 2.7MM 18 **,27003905,CDM,278,RC,C1713,HCPCS,outpatient,,,144,57.60,,100.8,70,,80.64,percent of total billed charges,70% of total billed charges,144,100,,115.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,118.08,82,,94.464,percent of total billed charges,82% of total billed charges,122.4,85,,97.92,percent of total billed charges,85% of total billed charges,122.4,85,,97.92,percent of total billed charges,85% of total billed charges,122.4,85,,97.92,percent of total billed charges,85% of total billed charges,129.6,90,,103.68,percent of total billed charges,90% of total billed charges,115.2,80,,92.16,percent of total billed charges,80% of total billed charges,129.6,90,,103.68,percent of total billed charges,90% of total billed charges,108,75,,86.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,41.76,29,,33.408,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,96.48,67,,77.184,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,100.8,70,,80.64,percent of total billed charges,70% of total billed charges,93.6,65,,74.88,percent of total billed charges,65% of total billed charges,51.36,35.67,,41.088,percent of total billed charges,35.67% of total billed charges,41.76,144,
TUBULAR PLATE 1/3 5 HOLE,27003906,CDM,278,RC,C1713,HCPCS,outpatient,,,674,269.60,,471.8,70,,377.44,percent of total billed charges,70% of total billed charges,674,100,,539.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,552.68,82,,442.144,percent of total billed charges,82% of total billed charges,572.9,85,,458.32,percent of total billed charges,85% of total billed charges,572.9,85,,458.32,percent of total billed charges,85% of total billed charges,572.9,85,,458.32,percent of total billed charges,85% of total billed charges,606.6,90,,485.28,percent of total billed charges,90% of total billed charges,539.2,80,,431.36,percent of total billed charges,80% of total billed charges,606.6,90,,485.28,percent of total billed charges,90% of total billed charges,505.5,75,,404.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,195.46,29,,156.368,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,451.58,67,,361.264,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,471.8,70,,377.44,percent of total billed charges,70% of total billed charges,438.1,65,,350.48,percent of total billed charges,65% of total billed charges,240.42,35.67,,192.336,percent of total billed charges,35.67% of total billed charges,195.46,674,
CORTEX SCREW 3.5MM 14 **,27003907,CDM,278,RC,C1713,HCPCS,outpatient,,,245,98.00,,171.5,70,,137.2,percent of total billed charges,70% of total billed charges,245,100,,196,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,200.9,82,,160.72,percent of total billed charges,82% of total billed charges,208.25,85,,166.6,percent of total billed charges,85% of total billed charges,208.25,85,,166.6,percent of total billed charges,85% of total billed charges,208.25,85,,166.6,percent of total billed charges,85% of total billed charges,220.5,90,,176.4,percent of total billed charges,90% of total billed charges,196,80,,156.8,percent of total billed charges,80% of total billed charges,220.5,90,,176.4,percent of total billed charges,90% of total billed charges,183.75,75,,147,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,71.05,29,,56.84,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,164.15,67,,131.32,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,171.5,70,,137.2,percent of total billed charges,70% of total billed charges,159.25,65,,127.4,percent of total billed charges,65% of total billed charges,87.39,35.67,,69.912,percent of total billed charges,35.67% of total billed charges,71.05,245,
CORTEX SCREW 3.5MM 12 **,27003908,CDM,278,RC,C1713,HCPCS,outpatient,,,842,336.80,,589.4,70,,471.52,percent of total billed charges,70% of total billed charges,842,100,,673.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,690.44,82,,552.352,percent of total billed charges,82% of total billed charges,715.7,85,,572.56,percent of total billed charges,85% of total billed charges,715.7,85,,572.56,percent of total billed charges,85% of total billed charges,715.7,85,,572.56,percent of total billed charges,85% of total billed charges,757.8,90,,606.24,percent of total billed charges,90% of total billed charges,673.6,80,,538.88,percent of total billed charges,80% of total billed charges,757.8,90,,606.24,percent of total billed charges,90% of total billed charges,631.5,75,,505.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,244.18,29,,195.344,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,564.14,67,,451.312,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,589.4,70,,471.52,percent of total billed charges,70% of total billed charges,547.3,65,,437.84,percent of total billed charges,65% of total billed charges,300.34,35.67,,240.272,percent of total billed charges,35.67% of total billed charges,244.18,842,
LOCKING SCREW 3.5MM 14 **,27003909,CDM,278,RC,C1713,HCPCS,outpatient,,,802,320.80,,561.4,70,,449.12,percent of total billed charges,70% of total billed charges,802,100,,641.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,657.64,82,,526.112,percent of total billed charges,82% of total billed charges,681.7,85,,545.36,percent of total billed charges,85% of total billed charges,681.7,85,,545.36,percent of total billed charges,85% of total billed charges,681.7,85,,545.36,percent of total billed charges,85% of total billed charges,721.8,90,,577.44,percent of total billed charges,90% of total billed charges,641.6,80,,513.28,percent of total billed charges,80% of total billed charges,721.8,90,,577.44,percent of total billed charges,90% of total billed charges,601.5,75,,481.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,232.58,29,,186.064,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,537.34,67,,429.872,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,561.4,70,,449.12,percent of total billed charges,70% of total billed charges,521.3,65,,417.04,percent of total billed charges,65% of total billed charges,286.07,35.67,,228.856,percent of total billed charges,35.67% of total billed charges,232.58,802,
K-WIRE 1.6MM **,27003910,CDM,278,RC,C1713,HCPCS,outpatient,,,109,43.60,,76.3,70,,61.04,percent of total billed charges,70% of total billed charges,109,100,,87.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,89.38,82,,71.504,percent of total billed charges,82% of total billed charges,92.65,85,,74.12,percent of total billed charges,85% of total billed charges,92.65,85,,74.12,percent of total billed charges,85% of total billed charges,92.65,85,,74.12,percent of total billed charges,85% of total billed charges,98.1,90,,78.48,percent of total billed charges,90% of total billed charges,87.2,80,,69.76,percent of total billed charges,80% of total billed charges,98.1,90,,78.48,percent of total billed charges,90% of total billed charges,81.75,75,,65.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,31.61,29,,25.288,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,73.03,67,,58.424,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,76.3,70,,61.04,percent of total billed charges,70% of total billed charges,70.85,65,,56.68,percent of total billed charges,65% of total billed charges,38.88,35.67,,31.104,percent of total billed charges,35.67% of total billed charges,31.61,109,
K-WIRE 2.0,27003954,CDM,278,RC,C1713,HCPCS,outpatient,,,90,36.00,,63,70,,50.4,percent of total billed charges,70% of total billed charges,90,100,,72,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,73.8,82,,59.04,percent of total billed charges,82% of total billed charges,76.5,85,,61.2,percent of total billed charges,85% of total billed charges,76.5,85,,61.2,percent of total billed charges,85% of total billed charges,76.5,85,,61.2,percent of total billed charges,85% of total billed charges,81,90,,64.8,percent of total billed charges,90% of total billed charges,72,80,,57.6,percent of total billed charges,80% of total billed charges,81,90,,64.8,percent of total billed charges,90% of total billed charges,67.5,75,,54,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,26.1,29,,20.88,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,60.3,67,,48.24,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,63,70,,50.4,percent of total billed charges,70% of total billed charges,58.5,65,,46.8,percent of total billed charges,65% of total billed charges,32.1,35.67,,25.68,percent of total billed charges,35.67% of total billed charges,26.1,90,
CORTICAL SCREW 3.5 SZ 36,27003955,CDM,278,RC,C1713,HCPCS,outpatient,,,188,75.20,,131.6,70,,105.28,percent of total billed charges,70% of total billed charges,188,100,,150.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,154.16,82,,123.328,percent of total billed charges,82% of total billed charges,159.8,85,,127.84,percent of total billed charges,85% of total billed charges,159.8,85,,127.84,percent of total billed charges,85% of total billed charges,159.8,85,,127.84,percent of total billed charges,85% of total billed charges,169.2,90,,135.36,percent of total billed charges,90% of total billed charges,150.4,80,,120.32,percent of total billed charges,80% of total billed charges,169.2,90,,135.36,percent of total billed charges,90% of total billed charges,141,75,,112.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,54.52,29,,43.616,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,125.96,67,,100.768,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,131.6,70,,105.28,percent of total billed charges,70% of total billed charges,122.2,65,,97.76,percent of total billed charges,65% of total billed charges,67.06,35.67,,53.648,percent of total billed charges,35.67% of total billed charges,54.52,188,
CORTICAL SCREW 3.5 SZ 26,27003956,CDM,278,RC,C1713,HCPCS,outpatient,,,185,74.00,,129.5,70,,103.6,percent of total billed charges,70% of total billed charges,185,100,,148,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,151.7,82,,121.36,percent of total billed charges,82% of total billed charges,157.25,85,,125.8,percent of total billed charges,85% of total billed charges,157.25,85,,125.8,percent of total billed charges,85% of total billed charges,157.25,85,,125.8,percent of total billed charges,85% of total billed charges,166.5,90,,133.2,percent of total billed charges,90% of total billed charges,148,80,,118.4,percent of total billed charges,80% of total billed charges,166.5,90,,133.2,percent of total billed charges,90% of total billed charges,138.75,75,,111,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,53.65,29,,42.92,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,123.95,67,,99.16,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,129.5,70,,103.6,percent of total billed charges,70% of total billed charges,120.25,65,,96.2,percent of total billed charges,65% of total billed charges,65.99,35.67,,52.792,percent of total billed charges,35.67% of total billed charges,53.65,185,
SELF TAPPING BONE SCREW 6.5,27003966,CDM,278,RC,C1713,HCPCS,outpatient,,,741,296.40,,518.7,70,,414.96,percent of total billed charges,70% of total billed charges,741,100,,592.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,607.62,82,,486.096,percent of total billed charges,82% of total billed charges,629.85,85,,503.88,percent of total billed charges,85% of total billed charges,629.85,85,,503.88,percent of total billed charges,85% of total billed charges,629.85,85,,503.88,percent of total billed charges,85% of total billed charges,666.9,90,,533.52,percent of total billed charges,90% of total billed charges,592.8,80,,474.24,percent of total billed charges,80% of total billed charges,666.9,90,,533.52,percent of total billed charges,90% of total billed charges,555.75,75,,444.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,214.89,29,,171.912,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,496.47,67,,397.176,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,518.7,70,,414.96,percent of total billed charges,70% of total billed charges,481.65,65,,385.32,percent of total billed charges,65% of total billed charges,264.31,35.67,,211.448,percent of total billed charges,35.67% of total billed charges,214.89,741,
20 DEGREE ELEVATED RIM 28MM **,27003967,CDM,278,RC,C1776,HCPCS,outpatient,,,8765,3506.00,,6135.5,70,,4908.4,percent of total billed charges,70% of total billed charges,4601.63,52.5,,3681.3,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,7187.3,82,,5749.84,percent of total billed charges,82% of total billed charges,7450.25,85,,5960.2,percent of total billed charges,85% of total billed charges,7450.25,85,,5960.2,percent of total billed charges,85% of total billed charges,7450.25,85,,5960.2,percent of total billed charges,85% of total billed charges,7888.5,90,,6310.8,percent of total billed charges,90% of total billed charges,7012,80,,5609.6,percent of total billed charges,80% of total billed charges,7888.5,90,,6310.8,percent of total billed charges,90% of total billed charges,6573.75,75,,5259,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2541.85,29,,2033.48,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,5872.55,67,,4698.04,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,6135.5,70,,4908.4,percent of total billed charges,70% of total billed charges,5697.25,65,,4557.8,percent of total billed charges,65% of total billed charges,3126.48,35.67,,2501.184,percent of total billed charges,35.67% of total billed charges,2541.85,7888.5,
TIBIAL COMPONENT STEMMED 5 **,27003969,CDM,278,RC,C1776,HCPCS,outpatient,,,13810,5524.00,,9667,70,,7733.6,percent of total billed charges,70% of total billed charges,7250.25,52.5,,5800.2,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,11324.2,82,,9059.36,percent of total billed charges,82% of total billed charges,11738.5,85,,9390.8,percent of total billed charges,85% of total billed charges,11738.5,85,,9390.8,percent of total billed charges,85% of total billed charges,11738.5,85,,9390.8,percent of total billed charges,85% of total billed charges,12429,90,,9943.2,percent of total billed charges,90% of total billed charges,11048,80,,8838.4,percent of total billed charges,80% of total billed charges,12429,90,,9943.2,percent of total billed charges,90% of total billed charges,10357.5,75,,8286,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,4004.9,29,,3203.92,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,9252.7,67,,7402.16,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,9667,70,,7733.6,percent of total billed charges,70% of total billed charges,8976.5,65,,7181.2,percent of total billed charges,65% of total billed charges,4926.03,35.67,,3940.824,percent of total billed charges,35.67% of total billed charges,4004.9,12429,
CORTICAL SCREW 4.5 28MM,27003979,CDM,278,RC,C1713,HCPCS,outpatient,,,114,45.60,,79.8,70,,63.84,percent of total billed charges,70% of total billed charges,114,100,,91.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,93.48,82,,74.784,percent of total billed charges,82% of total billed charges,96.9,85,,77.52,percent of total billed charges,85% of total billed charges,96.9,85,,77.52,percent of total billed charges,85% of total billed charges,96.9,85,,77.52,percent of total billed charges,85% of total billed charges,102.6,90,,82.08,percent of total billed charges,90% of total billed charges,91.2,80,,72.96,percent of total billed charges,80% of total billed charges,102.6,90,,82.08,percent of total billed charges,90% of total billed charges,85.5,75,,68.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,33.06,29,,26.448,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,76.38,67,,61.104,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,79.8,70,,63.84,percent of total billed charges,70% of total billed charges,74.1,65,,59.28,percent of total billed charges,65% of total billed charges,40.66,35.67,,32.528,percent of total billed charges,35.67% of total billed charges,33.06,114,
CORTICAL SCREW 4.5 30 MM,27003980,CDM,278,RC,C1713,HCPCS,outpatient,,,114,45.60,,79.8,70,,63.84,percent of total billed charges,70% of total billed charges,114,100,,91.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,93.48,82,,74.784,percent of total billed charges,82% of total billed charges,96.9,85,,77.52,percent of total billed charges,85% of total billed charges,96.9,85,,77.52,percent of total billed charges,85% of total billed charges,96.9,85,,77.52,percent of total billed charges,85% of total billed charges,102.6,90,,82.08,percent of total billed charges,90% of total billed charges,91.2,80,,72.96,percent of total billed charges,80% of total billed charges,102.6,90,,82.08,percent of total billed charges,90% of total billed charges,85.5,75,,68.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,33.06,29,,26.448,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,76.38,67,,61.104,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,79.8,70,,63.84,percent of total billed charges,70% of total billed charges,74.1,65,,59.28,percent of total billed charges,65% of total billed charges,40.66,35.67,,32.528,percent of total billed charges,35.67% of total billed charges,33.06,114,
CORTICAL SCREW 4.5 32MM,27003981,CDM,278,RC,C1713,HCPCS,outpatient,,,114,45.60,,79.8,70,,63.84,percent of total billed charges,70% of total billed charges,114,100,,91.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,93.48,82,,74.784,percent of total billed charges,82% of total billed charges,96.9,85,,77.52,percent of total billed charges,85% of total billed charges,96.9,85,,77.52,percent of total billed charges,85% of total billed charges,96.9,85,,77.52,percent of total billed charges,85% of total billed charges,102.6,90,,82.08,percent of total billed charges,90% of total billed charges,91.2,80,,72.96,percent of total billed charges,80% of total billed charges,102.6,90,,82.08,percent of total billed charges,90% of total billed charges,85.5,75,,68.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,33.06,29,,26.448,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,76.38,67,,61.104,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,79.8,70,,63.84,percent of total billed charges,70% of total billed charges,74.1,65,,59.28,percent of total billed charges,65% of total billed charges,40.66,35.67,,32.528,percent of total billed charges,35.67% of total billed charges,33.06,114,
CORTICAL SCREW 4.5 36 MM,27003982,CDM,278,RC,C1713,HCPCS,outpatient,,,114,45.60,,79.8,70,,63.84,percent of total billed charges,70% of total billed charges,114,100,,91.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,93.48,82,,74.784,percent of total billed charges,82% of total billed charges,96.9,85,,77.52,percent of total billed charges,85% of total billed charges,96.9,85,,77.52,percent of total billed charges,85% of total billed charges,96.9,85,,77.52,percent of total billed charges,85% of total billed charges,102.6,90,,82.08,percent of total billed charges,90% of total billed charges,91.2,80,,72.96,percent of total billed charges,80% of total billed charges,102.6,90,,82.08,percent of total billed charges,90% of total billed charges,85.5,75,,68.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,33.06,29,,26.448,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,76.38,67,,61.104,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,79.8,70,,63.84,percent of total billed charges,70% of total billed charges,74.1,65,,59.28,percent of total billed charges,65% of total billed charges,40.66,35.67,,32.528,percent of total billed charges,35.67% of total billed charges,33.06,114,
CORTICAL SCREW 4.5 38 MM,27003983,CDM,278,RC,C1713,HCPCS,outpatient,,,114,45.60,,79.8,70,,63.84,percent of total billed charges,70% of total billed charges,114,100,,91.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,93.48,82,,74.784,percent of total billed charges,82% of total billed charges,96.9,85,,77.52,percent of total billed charges,85% of total billed charges,96.9,85,,77.52,percent of total billed charges,85% of total billed charges,96.9,85,,77.52,percent of total billed charges,85% of total billed charges,102.6,90,,82.08,percent of total billed charges,90% of total billed charges,91.2,80,,72.96,percent of total billed charges,80% of total billed charges,102.6,90,,82.08,percent of total billed charges,90% of total billed charges,85.5,75,,68.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,33.06,29,,26.448,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,76.38,67,,61.104,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,79.8,70,,63.84,percent of total billed charges,70% of total billed charges,74.1,65,,59.28,percent of total billed charges,65% of total billed charges,40.66,35.67,,32.528,percent of total billed charges,35.67% of total billed charges,33.06,114,
CANCELLOUS SCREW 6.5 SZ 50,27003984,CDM,278,RC,C1713,HCPCS,outpatient,,,199,79.60,,139.3,70,,111.44,percent of total billed charges,70% of total billed charges,199,100,,159.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,163.18,82,,130.544,percent of total billed charges,82% of total billed charges,169.15,85,,135.32,percent of total billed charges,85% of total billed charges,169.15,85,,135.32,percent of total billed charges,85% of total billed charges,169.15,85,,135.32,percent of total billed charges,85% of total billed charges,179.1,90,,143.28,percent of total billed charges,90% of total billed charges,159.2,80,,127.36,percent of total billed charges,80% of total billed charges,179.1,90,,143.28,percent of total billed charges,90% of total billed charges,149.25,75,,119.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,57.71,29,,46.168,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,133.33,67,,106.664,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,139.3,70,,111.44,percent of total billed charges,70% of total billed charges,129.35,65,,103.48,percent of total billed charges,65% of total billed charges,70.98,35.67,,56.784,percent of total billed charges,35.67% of total billed charges,57.71,199,
CANCELLOUS SCREW 6.5 SZ 60,27003985,CDM,278,RC,C1713,HCPCS,outpatient,,,199,79.60,,139.3,70,,111.44,percent of total billed charges,70% of total billed charges,199,100,,159.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,163.18,82,,130.544,percent of total billed charges,82% of total billed charges,169.15,85,,135.32,percent of total billed charges,85% of total billed charges,169.15,85,,135.32,percent of total billed charges,85% of total billed charges,169.15,85,,135.32,percent of total billed charges,85% of total billed charges,179.1,90,,143.28,percent of total billed charges,90% of total billed charges,159.2,80,,127.36,percent of total billed charges,80% of total billed charges,179.1,90,,143.28,percent of total billed charges,90% of total billed charges,149.25,75,,119.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,57.71,29,,46.168,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,133.33,67,,106.664,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,139.3,70,,111.44,percent of total billed charges,70% of total billed charges,129.35,65,,103.48,percent of total billed charges,65% of total billed charges,70.98,35.67,,56.784,percent of total billed charges,35.67% of total billed charges,57.71,199,
CANCELLOUS SCREW SZ 70,27003986,CDM,278,RC,C1713,HCPCS,outpatient,,,199,79.60,,139.3,70,,111.44,percent of total billed charges,70% of total billed charges,199,100,,159.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,163.18,82,,130.544,percent of total billed charges,82% of total billed charges,169.15,85,,135.32,percent of total billed charges,85% of total billed charges,169.15,85,,135.32,percent of total billed charges,85% of total billed charges,169.15,85,,135.32,percent of total billed charges,85% of total billed charges,179.1,90,,143.28,percent of total billed charges,90% of total billed charges,159.2,80,,127.36,percent of total billed charges,80% of total billed charges,179.1,90,,143.28,percent of total billed charges,90% of total billed charges,149.25,75,,119.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,57.71,29,,46.168,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,133.33,67,,106.664,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,139.3,70,,111.44,percent of total billed charges,70% of total billed charges,129.35,65,,103.48,percent of total billed charges,65% of total billed charges,70.98,35.67,,56.784,percent of total billed charges,35.67% of total billed charges,57.71,199,
FULL THREAD SCREW 6.5 SZ 40 **,27003987,CDM,278,RC,C1713,HCPCS,outpatient,,,199,79.60,,139.3,70,,111.44,percent of total billed charges,70% of total billed charges,199,100,,159.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,163.18,82,,130.544,percent of total billed charges,82% of total billed charges,169.15,85,,135.32,percent of total billed charges,85% of total billed charges,169.15,85,,135.32,percent of total billed charges,85% of total billed charges,169.15,85,,135.32,percent of total billed charges,85% of total billed charges,179.1,90,,143.28,percent of total billed charges,90% of total billed charges,159.2,80,,127.36,percent of total billed charges,80% of total billed charges,179.1,90,,143.28,percent of total billed charges,90% of total billed charges,149.25,75,,119.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,57.71,29,,46.168,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,133.33,67,,106.664,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,139.3,70,,111.44,percent of total billed charges,70% of total billed charges,129.35,65,,103.48,percent of total billed charges,65% of total billed charges,70.98,35.67,,56.784,percent of total billed charges,35.67% of total billed charges,57.71,199,
FULL THREAD SCREW 6.5 SZ 45 **,27003988,CDM,278,RC,C1713,HCPCS,outpatient,,,199,79.60,,139.3,70,,111.44,percent of total billed charges,70% of total billed charges,199,100,,159.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,163.18,82,,130.544,percent of total billed charges,82% of total billed charges,169.15,85,,135.32,percent of total billed charges,85% of total billed charges,169.15,85,,135.32,percent of total billed charges,85% of total billed charges,169.15,85,,135.32,percent of total billed charges,85% of total billed charges,179.1,90,,143.28,percent of total billed charges,90% of total billed charges,159.2,80,,127.36,percent of total billed charges,80% of total billed charges,179.1,90,,143.28,percent of total billed charges,90% of total billed charges,149.25,75,,119.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,57.71,29,,46.168,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,133.33,67,,106.664,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,139.3,70,,111.44,percent of total billed charges,70% of total billed charges,129.35,65,,103.48,percent of total billed charges,65% of total billed charges,70.98,35.67,,56.784,percent of total billed charges,35.67% of total billed charges,57.71,199,
FULL THREAD SCREW 6.5 SZ 50 **,27003989,CDM,278,RC,C1713,HCPCS,outpatient,,,199,79.60,,139.3,70,,111.44,percent of total billed charges,70% of total billed charges,199,100,,159.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,163.18,82,,130.544,percent of total billed charges,82% of total billed charges,169.15,85,,135.32,percent of total billed charges,85% of total billed charges,169.15,85,,135.32,percent of total billed charges,85% of total billed charges,169.15,85,,135.32,percent of total billed charges,85% of total billed charges,179.1,90,,143.28,percent of total billed charges,90% of total billed charges,159.2,80,,127.36,percent of total billed charges,80% of total billed charges,179.1,90,,143.28,percent of total billed charges,90% of total billed charges,149.25,75,,119.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,57.71,29,,46.168,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,133.33,67,,106.664,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,139.3,70,,111.44,percent of total billed charges,70% of total billed charges,129.35,65,,103.48,percent of total billed charges,65% of total billed charges,70.98,35.67,,56.784,percent of total billed charges,35.67% of total billed charges,57.71,199,
ARTHOPLASTY LEFT SZ YELLOW **,27003993,CDM,278,RC,C1776,HCPCS,outpatient,,,8048,3219.20,,5633.6,70,,4506.88,percent of total billed charges,70% of total billed charges,4225.2,52.5,,3380.16,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,6599.36,82,,5279.488,percent of total billed charges,82% of total billed charges,6840.8,85,,5472.64,percent of total billed charges,85% of total billed charges,6840.8,85,,5472.64,percent of total billed charges,85% of total billed charges,6840.8,85,,5472.64,percent of total billed charges,85% of total billed charges,7243.2,90,,5794.56,percent of total billed charges,90% of total billed charges,6438.4,80,,5150.72,percent of total billed charges,80% of total billed charges,7243.2,90,,5794.56,percent of total billed charges,90% of total billed charges,6036,75,,4828.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2333.92,29,,1867.136,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,5392.16,67,,4313.728,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,5633.6,70,,4506.88,percent of total billed charges,70% of total billed charges,5231.2,65,,4184.96,percent of total billed charges,65% of total billed charges,2870.72,35.67,,2296.576,percent of total billed charges,35.67% of total billed charges,2333.92,7243.2,
HERNIA SYSTEM LG,27003997,CDM,278,RC,C1781,HCPCS,outpatient,,,2035,814.00,,1424.5,70,,1139.6,percent of total billed charges,70% of total billed charges,1068.38,52.5,,854.7,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,1668.7,82,,1334.96,percent of total billed charges,82% of total billed charges,1729.75,85,,1383.8,percent of total billed charges,85% of total billed charges,1729.75,85,,1383.8,percent of total billed charges,85% of total billed charges,1729.75,85,,1383.8,percent of total billed charges,85% of total billed charges,1831.5,90,,1465.2,percent of total billed charges,90% of total billed charges,1628,80,,1302.4,percent of total billed charges,80% of total billed charges,1831.5,90,,1465.2,percent of total billed charges,90% of total billed charges,1526.25,75,,1221,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,590.15,29,,472.12,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1363.45,67,,1090.76,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1424.5,70,,1139.6,percent of total billed charges,70% of total billed charges,1322.75,65,,1058.2,percent of total billed charges,65% of total billed charges,725.88,35.67,,580.704,percent of total billed charges,35.67% of total billed charges,590.15,1831.5,
HERNIA SYSTEM EXTENDED PHSE,27003998,CDM,278,RC,C1781,HCPCS,outpatient,,,2312,924.80,,1618.4,70,,1294.72,percent of total billed charges,70% of total billed charges,1213.8,52.5,,971.04,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,1895.84,82,,1516.672,percent of total billed charges,82% of total billed charges,1965.2,85,,1572.16,percent of total billed charges,85% of total billed charges,1965.2,85,,1572.16,percent of total billed charges,85% of total billed charges,1965.2,85,,1572.16,percent of total billed charges,85% of total billed charges,2080.8,90,,1664.64,percent of total billed charges,90% of total billed charges,1849.6,80,,1479.68,percent of total billed charges,80% of total billed charges,2080.8,90,,1664.64,percent of total billed charges,90% of total billed charges,1734,75,,1387.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,670.48,29,,536.384,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1549.04,67,,1239.232,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1618.4,70,,1294.72,percent of total billed charges,70% of total billed charges,1502.8,65,,1202.24,percent of total billed charges,65% of total billed charges,824.69,35.67,,659.752,percent of total billed charges,35.67% of total billed charges,670.48,2080.8,
GROSHONG CATH 7 FR LOW PRO **,27003999,CDM,278,RC,C1751,HCPCS,outpatient,,,4677,1870.80,,3273.9,70,,2619.12,percent of total billed charges,70% of total billed charges,2455.43,52.5,,1964.34,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,3835.14,82,,3068.112,percent of total billed charges,82% of total billed charges,3975.45,85,,3180.36,percent of total billed charges,85% of total billed charges,3975.45,85,,3180.36,percent of total billed charges,85% of total billed charges,3975.45,85,,3180.36,percent of total billed charges,85% of total billed charges,4209.3,90,,3367.44,percent of total billed charges,90% of total billed charges,3741.6,80,,2993.28,percent of total billed charges,80% of total billed charges,4209.3,90,,3367.44,percent of total billed charges,90% of total billed charges,3507.75,75,,2806.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,1356.33,29,,1085.064,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,3133.59,67,,2506.872,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,3273.9,70,,2619.12,percent of total billed charges,70% of total billed charges,3040.05,65,,2432.04,percent of total billed charges,65% of total billed charges,1668.29,35.67,,1334.632,percent of total billed charges,35.67% of total billed charges,1356.33,4209.3,
COMPRESSION SCREW **,27004028,CDM,278,RC,C1713,HCPCS,outpatient,,,306,122.40,,214.2,70,,171.36,percent of total billed charges,70% of total billed charges,306,100,,244.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,250.92,82,,200.736,percent of total billed charges,82% of total billed charges,260.1,85,,208.08,percent of total billed charges,85% of total billed charges,260.1,85,,208.08,percent of total billed charges,85% of total billed charges,260.1,85,,208.08,percent of total billed charges,85% of total billed charges,275.4,90,,220.32,percent of total billed charges,90% of total billed charges,244.8,80,,195.84,percent of total billed charges,80% of total billed charges,275.4,90,,220.32,percent of total billed charges,90% of total billed charges,229.5,75,,183.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,88.74,29,,70.992,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,205.02,67,,164.016,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,214.2,70,,171.36,percent of total billed charges,70% of total billed charges,198.9,65,,159.12,percent of total billed charges,65% of total billed charges,109.15,35.67,,87.32,percent of total billed charges,35.67% of total billed charges,88.74,306,
SCREW SZ 42 **,27004029,CDM,278,RC,C1713,HCPCS,outpatient,,,120,48.00,,84,70,,67.2,percent of total billed charges,70% of total billed charges,120,100,,96,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,98.4,82,,78.72,percent of total billed charges,82% of total billed charges,102,85,,81.6,percent of total billed charges,85% of total billed charges,102,85,,81.6,percent of total billed charges,85% of total billed charges,102,85,,81.6,percent of total billed charges,85% of total billed charges,108,90,,86.4,percent of total billed charges,90% of total billed charges,96,80,,76.8,percent of total billed charges,80% of total billed charges,108,90,,86.4,percent of total billed charges,90% of total billed charges,90,75,,72,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,34.8,29,,27.84,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,80.4,67,,64.32,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,84,70,,67.2,percent of total billed charges,70% of total billed charges,78,65,,62.4,percent of total billed charges,65% of total billed charges,42.8,35.67,,34.24,percent of total billed charges,35.67% of total billed charges,34.8,120,
SCREW SZ 46 **,27004030,CDM,278,RC,C1713,HCPCS,outpatient,,,120,48.00,,84,70,,67.2,percent of total billed charges,70% of total billed charges,120,100,,96,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,98.4,82,,78.72,percent of total billed charges,82% of total billed charges,102,85,,81.6,percent of total billed charges,85% of total billed charges,102,85,,81.6,percent of total billed charges,85% of total billed charges,102,85,,81.6,percent of total billed charges,85% of total billed charges,108,90,,86.4,percent of total billed charges,90% of total billed charges,96,80,,76.8,percent of total billed charges,80% of total billed charges,108,90,,86.4,percent of total billed charges,90% of total billed charges,90,75,,72,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,34.8,29,,27.84,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,80.4,67,,64.32,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,84,70,,67.2,percent of total billed charges,70% of total billed charges,78,65,,62.4,percent of total billed charges,65% of total billed charges,42.8,35.67,,34.24,percent of total billed charges,35.67% of total billed charges,34.8,120,
SCREW SZ 60 **,27004031,CDM,278,RC,C1713,HCPCS,outpatient,,,120,48.00,,84,70,,67.2,percent of total billed charges,70% of total billed charges,120,100,,96,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,98.4,82,,78.72,percent of total billed charges,82% of total billed charges,102,85,,81.6,percent of total billed charges,85% of total billed charges,102,85,,81.6,percent of total billed charges,85% of total billed charges,102,85,,81.6,percent of total billed charges,85% of total billed charges,108,90,,86.4,percent of total billed charges,90% of total billed charges,96,80,,76.8,percent of total billed charges,80% of total billed charges,108,90,,86.4,percent of total billed charges,90% of total billed charges,90,75,,72,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,34.8,29,,27.84,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,80.4,67,,64.32,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,84,70,,67.2,percent of total billed charges,70% of total billed charges,78,65,,62.4,percent of total billed charges,65% of total billed charges,42.8,35.67,,34.24,percent of total billed charges,35.67% of total billed charges,34.8,120,
TIBIAL PLATE LEFT MEDIAL RT,27004032,CDM,278,RC,C1776,HCPCS,outpatient,,,4362,1744.80,,3053.4,70,,2442.72,percent of total billed charges,70% of total billed charges,2290.05,52.5,,1832.04,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,3576.84,82,,2861.472,percent of total billed charges,82% of total billed charges,3707.7,85,,2966.16,percent of total billed charges,85% of total billed charges,3707.7,85,,2966.16,percent of total billed charges,85% of total billed charges,3707.7,85,,2966.16,percent of total billed charges,85% of total billed charges,3925.8,90,,3140.64,percent of total billed charges,90% of total billed charges,3489.6,80,,2791.68,percent of total billed charges,80% of total billed charges,3925.8,90,,3140.64,percent of total billed charges,90% of total billed charges,3271.5,75,,2617.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,1264.98,29,,1011.984,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,2922.54,67,,2338.032,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,3053.4,70,,2442.72,percent of total billed charges,70% of total billed charges,2835.3,65,,2268.24,percent of total billed charges,65% of total billed charges,1555.93,35.67,,1244.744,percent of total billed charges,35.67% of total billed charges,1264.98,3925.8,
FEMORAL COMP LT MEDIAL 47MM **,27004034,CDM,278,RC,C1776,HCPCS,outpatient,,,14753,5901.20,,10327.1,70,,8261.68,percent of total billed charges,70% of total billed charges,7745.33,52.5,,6196.26,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,12097.46,82,,9677.968,percent of total billed charges,82% of total billed charges,12540.05,85,,10032.04,percent of total billed charges,85% of total billed charges,12540.05,85,,10032.04,percent of total billed charges,85% of total billed charges,12540.05,85,,10032.04,percent of total billed charges,85% of total billed charges,13277.7,90,,10622.16,percent of total billed charges,90% of total billed charges,11802.4,80,,9441.92,percent of total billed charges,80% of total billed charges,13277.7,90,,10622.16,percent of total billed charges,90% of total billed charges,11064.75,75,,8851.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,4278.37,29,,3422.696,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,9884.51,67,,7907.608,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,10327.1,70,,8261.68,percent of total billed charges,70% of total billed charges,9589.45,65,,7671.56,percent of total billed charges,65% of total billed charges,5262.4,35.67,,4209.92,percent of total billed charges,35.67% of total billed charges,4278.37,13277.7,
GUIDE WIRE **,27004040,CDM,278,RC,C1769,HCPCS,outpatient,,,774,309.60,,541.8,70,,433.44,percent of total billed charges,70% of total billed charges,774,100,,619.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,634.68,82,,507.744,percent of total billed charges,82% of total billed charges,657.9,85,,526.32,percent of total billed charges,85% of total billed charges,657.9,85,,526.32,percent of total billed charges,85% of total billed charges,657.9,85,,526.32,percent of total billed charges,85% of total billed charges,696.6,90,,557.28,percent of total billed charges,90% of total billed charges,619.2,80,,495.36,percent of total billed charges,80% of total billed charges,696.6,90,,557.28,percent of total billed charges,90% of total billed charges,580.5,75,,464.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,224.46,29,,179.568,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,518.58,67,,414.864,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,541.8,70,,433.44,percent of total billed charges,70% of total billed charges,503.1,65,,402.48,percent of total billed charges,65% of total billed charges,276.09,35.67,,220.872,percent of total billed charges,35.67% of total billed charges,224.46,774,
CANNULATED BONESCREW 3.0MM **,27004041,CDM,278,RC,C1713,HCPCS,outpatient,,,2590,1036.00,,1813,70,,1450.4,percent of total billed charges,70% of total billed charges,1359.75,52.5,,1087.8,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,2123.8,82,,1699.04,percent of total billed charges,82% of total billed charges,2201.5,85,,1761.2,percent of total billed charges,85% of total billed charges,2201.5,85,,1761.2,percent of total billed charges,85% of total billed charges,2201.5,85,,1761.2,percent of total billed charges,85% of total billed charges,2331,90,,1864.8,percent of total billed charges,90% of total billed charges,2072,80,,1657.6,percent of total billed charges,80% of total billed charges,2331,90,,1864.8,percent of total billed charges,90% of total billed charges,1942.5,75,,1554,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,751.1,29,,600.88,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1735.3,67,,1388.24,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1813,70,,1450.4,percent of total billed charges,70% of total billed charges,1683.5,65,,1346.8,percent of total billed charges,65% of total billed charges,923.85,35.67,,739.08,percent of total billed charges,35.67% of total billed charges,751.1,2331,
LOCKING SCREWS 3.5 18MM **,27004046,CDM,278,RC,C1713,HCPCS,outpatient,,,723,289.20,,506.1,70,,404.88,percent of total billed charges,70% of total billed charges,723,100,,578.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,592.86,82,,474.288,percent of total billed charges,82% of total billed charges,614.55,85,,491.64,percent of total billed charges,85% of total billed charges,614.55,85,,491.64,percent of total billed charges,85% of total billed charges,614.55,85,,491.64,percent of total billed charges,85% of total billed charges,650.7,90,,520.56,percent of total billed charges,90% of total billed charges,578.4,80,,462.72,percent of total billed charges,80% of total billed charges,650.7,90,,520.56,percent of total billed charges,90% of total billed charges,542.25,75,,433.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,209.67,29,,167.736,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,484.41,67,,387.528,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,506.1,70,,404.88,percent of total billed charges,70% of total billed charges,469.95,65,,375.96,percent of total billed charges,65% of total billed charges,257.89,35.67,,206.312,percent of total billed charges,35.67% of total billed charges,209.67,723,
LOCKINS SCREW 20 MM 3.5 **,27004047,CDM,278,RC,C1713,HCPCS,outpatient,,,842,336.80,,589.4,70,,471.52,percent of total billed charges,70% of total billed charges,842,100,,673.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,690.44,82,,552.352,percent of total billed charges,82% of total billed charges,715.7,85,,572.56,percent of total billed charges,85% of total billed charges,715.7,85,,572.56,percent of total billed charges,85% of total billed charges,715.7,85,,572.56,percent of total billed charges,85% of total billed charges,757.8,90,,606.24,percent of total billed charges,90% of total billed charges,673.6,80,,538.88,percent of total billed charges,80% of total billed charges,757.8,90,,606.24,percent of total billed charges,90% of total billed charges,631.5,75,,505.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,244.18,29,,195.344,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,564.14,67,,451.312,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,589.4,70,,471.52,percent of total billed charges,70% of total billed charges,547.3,65,,437.84,percent of total billed charges,65% of total billed charges,300.34,35.67,,240.272,percent of total billed charges,35.67% of total billed charges,244.18,842,
LOCKING SCREW 24 MM 3.5 MM **,27004048,CDM,278,RC,C1713,HCPCS,outpatient,,,1746,698.40,,1222.2,70,,977.76,percent of total billed charges,70% of total billed charges,916.65,52.5,,733.32,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,1431.72,82,,1145.376,percent of total billed charges,82% of total billed charges,1484.1,85,,1187.28,percent of total billed charges,85% of total billed charges,1484.1,85,,1187.28,percent of total billed charges,85% of total billed charges,1484.1,85,,1187.28,percent of total billed charges,85% of total billed charges,1571.4,90,,1257.12,percent of total billed charges,90% of total billed charges,1396.8,80,,1117.44,percent of total billed charges,80% of total billed charges,1571.4,90,,1257.12,percent of total billed charges,90% of total billed charges,1309.5,75,,1047.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,506.34,29,,405.072,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1169.82,67,,935.856,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1222.2,70,,977.76,percent of total billed charges,70% of total billed charges,1134.9,65,,907.92,percent of total billed charges,65% of total billed charges,622.8,35.67,,498.24,percent of total billed charges,35.67% of total billed charges,506.34,1571.4,
CORTEX SCREW 20 MM 3.5 MM **,27004049,CDM,278,RC,C1713,HCPCS,outpatient,,,144,57.60,,100.8,70,,80.64,percent of total billed charges,70% of total billed charges,144,100,,115.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,118.08,82,,94.464,percent of total billed charges,82% of total billed charges,122.4,85,,97.92,percent of total billed charges,85% of total billed charges,122.4,85,,97.92,percent of total billed charges,85% of total billed charges,122.4,85,,97.92,percent of total billed charges,85% of total billed charges,129.6,90,,103.68,percent of total billed charges,90% of total billed charges,115.2,80,,92.16,percent of total billed charges,80% of total billed charges,129.6,90,,103.68,percent of total billed charges,90% of total billed charges,108,75,,86.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,41.76,29,,33.408,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,96.48,67,,77.184,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,100.8,70,,80.64,percent of total billed charges,70% of total billed charges,93.6,65,,74.88,percent of total billed charges,65% of total billed charges,51.36,35.67,,41.088,percent of total billed charges,35.67% of total billed charges,41.76,144,
T-PLATE 2.7 32MM,27004051,CDM,278,RC,C1713,HCPCS,outpatient,,,335,134.00,,234.5,70,,187.6,percent of total billed charges,70% of total billed charges,335,100,,268,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,274.7,82,,219.76,percent of total billed charges,82% of total billed charges,284.75,85,,227.8,percent of total billed charges,85% of total billed charges,284.75,85,,227.8,percent of total billed charges,85% of total billed charges,284.75,85,,227.8,percent of total billed charges,85% of total billed charges,301.5,90,,241.2,percent of total billed charges,90% of total billed charges,268,80,,214.4,percent of total billed charges,80% of total billed charges,301.5,90,,241.2,percent of total billed charges,90% of total billed charges,251.25,75,,201,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,97.15,29,,77.72,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,224.45,67,,179.56,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,234.5,70,,187.6,percent of total billed charges,70% of total billed charges,217.75,65,,174.2,percent of total billed charges,65% of total billed charges,119.49,35.67,,95.592,percent of total billed charges,35.67% of total billed charges,97.15,335,
CORTICAL SCREW 2.7 18MM,27004052,CDM,278,RC,C1713,HCPCS,outpatient,,,157,62.80,,109.9,70,,87.92,percent of total billed charges,70% of total billed charges,157,100,,125.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,128.74,82,,102.992,percent of total billed charges,82% of total billed charges,133.45,85,,106.76,percent of total billed charges,85% of total billed charges,133.45,85,,106.76,percent of total billed charges,85% of total billed charges,133.45,85,,106.76,percent of total billed charges,85% of total billed charges,141.3,90,,113.04,percent of total billed charges,90% of total billed charges,125.6,80,,100.48,percent of total billed charges,80% of total billed charges,141.3,90,,113.04,percent of total billed charges,90% of total billed charges,117.75,75,,94.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,45.53,29,,36.424,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,105.19,67,,84.152,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,109.9,70,,87.92,percent of total billed charges,70% of total billed charges,102.05,65,,81.64,percent of total billed charges,65% of total billed charges,56,35.67,,44.8,percent of total billed charges,35.67% of total billed charges,45.53,157,
TUBULAR PLATE 1/4 8 HOLE,27004054,CDM,278,RC,C1713,HCPCS,outpatient,,,374,149.60,,261.8,70,,209.44,percent of total billed charges,70% of total billed charges,374,100,,299.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,306.68,82,,245.344,percent of total billed charges,82% of total billed charges,317.9,85,,254.32,percent of total billed charges,85% of total billed charges,317.9,85,,254.32,percent of total billed charges,85% of total billed charges,317.9,85,,254.32,percent of total billed charges,85% of total billed charges,336.6,90,,269.28,percent of total billed charges,90% of total billed charges,299.2,80,,239.36,percent of total billed charges,80% of total billed charges,336.6,90,,269.28,percent of total billed charges,90% of total billed charges,280.5,75,,224.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,108.46,29,,86.768,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,250.58,67,,200.464,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,261.8,70,,209.44,percent of total billed charges,70% of total billed charges,243.1,65,,194.48,percent of total billed charges,65% of total billed charges,133.41,35.67,,106.728,percent of total billed charges,35.67% of total billed charges,108.46,374,
SCREW SURGICAL **,27004062,CDM,278,RC,C1713,HCPCS,outpatient,,,568,227.20,,397.6,70,,318.08,percent of total billed charges,70% of total billed charges,568,100,,454.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,465.76,82,,372.608,percent of total billed charges,82% of total billed charges,482.8,85,,386.24,percent of total billed charges,85% of total billed charges,482.8,85,,386.24,percent of total billed charges,85% of total billed charges,482.8,85,,386.24,percent of total billed charges,85% of total billed charges,511.2,90,,408.96,percent of total billed charges,90% of total billed charges,454.4,80,,363.52,percent of total billed charges,80% of total billed charges,511.2,90,,408.96,percent of total billed charges,90% of total billed charges,426,75,,340.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,164.72,29,,131.776,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,380.56,67,,304.448,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,397.6,70,,318.08,percent of total billed charges,70% of total billed charges,369.2,65,,295.36,percent of total billed charges,65% of total billed charges,202.61,35.67,,162.088,percent of total billed charges,35.67% of total billed charges,164.72,568,
SELF TAPPING SCREW 3.5 45,27004066,CDM,278,RC,C1713,HCPCS,outpatient,,,130,52.00,,91,70,,72.8,percent of total billed charges,70% of total billed charges,130,100,,104,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,106.6,82,,85.28,percent of total billed charges,82% of total billed charges,110.5,85,,88.4,percent of total billed charges,85% of total billed charges,110.5,85,,88.4,percent of total billed charges,85% of total billed charges,110.5,85,,88.4,percent of total billed charges,85% of total billed charges,117,90,,93.6,percent of total billed charges,90% of total billed charges,104,80,,83.2,percent of total billed charges,80% of total billed charges,117,90,,93.6,percent of total billed charges,90% of total billed charges,97.5,75,,78,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,37.7,29,,30.16,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,87.1,67,,69.68,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,91,70,,72.8,percent of total billed charges,70% of total billed charges,84.5,65,,67.6,percent of total billed charges,65% of total billed charges,46.37,35.67,,37.096,percent of total billed charges,35.67% of total billed charges,37.7,130,
CANCELLOUS FULL THREAD 4.0,27004068,CDM,278,RC,C1713,HCPCS,outpatient,,,130,52.00,,91,70,,72.8,percent of total billed charges,70% of total billed charges,130,100,,104,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,106.6,82,,85.28,percent of total billed charges,82% of total billed charges,110.5,85,,88.4,percent of total billed charges,85% of total billed charges,110.5,85,,88.4,percent of total billed charges,85% of total billed charges,110.5,85,,88.4,percent of total billed charges,85% of total billed charges,117,90,,93.6,percent of total billed charges,90% of total billed charges,104,80,,83.2,percent of total billed charges,80% of total billed charges,117,90,,93.6,percent of total billed charges,90% of total billed charges,97.5,75,,78,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,37.7,29,,30.16,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,87.1,67,,69.68,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,91,70,,72.8,percent of total billed charges,70% of total billed charges,84.5,65,,67.6,percent of total billed charges,65% of total billed charges,46.37,35.67,,37.096,percent of total billed charges,35.67% of total billed charges,37.7,130,
CANCELLOUS FULL THREAD 4.0,27004069,CDM,278,RC,C1713,HCPCS,outpatient,,,130,52.00,,91,70,,72.8,percent of total billed charges,70% of total billed charges,130,100,,104,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,106.6,82,,85.28,percent of total billed charges,82% of total billed charges,110.5,85,,88.4,percent of total billed charges,85% of total billed charges,110.5,85,,88.4,percent of total billed charges,85% of total billed charges,110.5,85,,88.4,percent of total billed charges,85% of total billed charges,117,90,,93.6,percent of total billed charges,90% of total billed charges,104,80,,83.2,percent of total billed charges,80% of total billed charges,117,90,,93.6,percent of total billed charges,90% of total billed charges,97.5,75,,78,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,37.7,29,,30.16,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,87.1,67,,69.68,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,91,70,,72.8,percent of total billed charges,70% of total billed charges,84.5,65,,67.6,percent of total billed charges,65% of total billed charges,46.37,35.67,,37.096,percent of total billed charges,35.67% of total billed charges,37.7,130,
CORTICAL S/T SCREW 3.5MM 12,27004075,CDM,278,RC,C1713,HCPCS,outpatient,,,206,82.40,,144.2,70,,115.36,percent of total billed charges,70% of total billed charges,206,100,,164.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,168.92,82,,135.136,percent of total billed charges,82% of total billed charges,175.1,85,,140.08,percent of total billed charges,85% of total billed charges,175.1,85,,140.08,percent of total billed charges,85% of total billed charges,175.1,85,,140.08,percent of total billed charges,85% of total billed charges,185.4,90,,148.32,percent of total billed charges,90% of total billed charges,164.8,80,,131.84,percent of total billed charges,80% of total billed charges,185.4,90,,148.32,percent of total billed charges,90% of total billed charges,154.5,75,,123.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,59.74,29,,47.792,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,138.02,67,,110.416,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,144.2,70,,115.36,percent of total billed charges,70% of total billed charges,133.9,65,,107.12,percent of total billed charges,65% of total billed charges,73.48,35.67,,58.784,percent of total billed charges,35.67% of total billed charges,59.74,206,
CORTICAL S/T SCREW 3.5  14,27004076,CDM,278,RC,C1713,HCPCS,outpatient,,,206,82.40,,144.2,70,,115.36,percent of total billed charges,70% of total billed charges,206,100,,164.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,168.92,82,,135.136,percent of total billed charges,82% of total billed charges,175.1,85,,140.08,percent of total billed charges,85% of total billed charges,175.1,85,,140.08,percent of total billed charges,85% of total billed charges,175.1,85,,140.08,percent of total billed charges,85% of total billed charges,185.4,90,,148.32,percent of total billed charges,90% of total billed charges,164.8,80,,131.84,percent of total billed charges,80% of total billed charges,185.4,90,,148.32,percent of total billed charges,90% of total billed charges,154.5,75,,123.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,59.74,29,,47.792,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,138.02,67,,110.416,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,144.2,70,,115.36,percent of total billed charges,70% of total billed charges,133.9,65,,107.12,percent of total billed charges,65% of total billed charges,73.48,35.67,,58.784,percent of total billed charges,35.67% of total billed charges,59.74,206,
CORTICAL S/T SCREW 3.5  16,27004077,CDM,278,RC,C1713,HCPCS,outpatient,,,206,82.40,,144.2,70,,115.36,percent of total billed charges,70% of total billed charges,206,100,,164.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,168.92,82,,135.136,percent of total billed charges,82% of total billed charges,175.1,85,,140.08,percent of total billed charges,85% of total billed charges,175.1,85,,140.08,percent of total billed charges,85% of total billed charges,175.1,85,,140.08,percent of total billed charges,85% of total billed charges,185.4,90,,148.32,percent of total billed charges,90% of total billed charges,164.8,80,,131.84,percent of total billed charges,80% of total billed charges,185.4,90,,148.32,percent of total billed charges,90% of total billed charges,154.5,75,,123.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,59.74,29,,47.792,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,138.02,67,,110.416,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,144.2,70,,115.36,percent of total billed charges,70% of total billed charges,133.9,65,,107.12,percent of total billed charges,65% of total billed charges,73.48,35.67,,58.784,percent of total billed charges,35.67% of total billed charges,59.74,206,
CORTICAL S/T SCREW 18 3.5,27004083,CDM,278,RC,C1713,HCPCS,outpatient,,,206,82.40,,144.2,70,,115.36,percent of total billed charges,70% of total billed charges,206,100,,164.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,168.92,82,,135.136,percent of total billed charges,82% of total billed charges,175.1,85,,140.08,percent of total billed charges,85% of total billed charges,175.1,85,,140.08,percent of total billed charges,85% of total billed charges,175.1,85,,140.08,percent of total billed charges,85% of total billed charges,185.4,90,,148.32,percent of total billed charges,90% of total billed charges,164.8,80,,131.84,percent of total billed charges,80% of total billed charges,185.4,90,,148.32,percent of total billed charges,90% of total billed charges,154.5,75,,123.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,59.74,29,,47.792,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,138.02,67,,110.416,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,144.2,70,,115.36,percent of total billed charges,70% of total billed charges,133.9,65,,107.12,percent of total billed charges,65% of total billed charges,73.48,35.67,,58.784,percent of total billed charges,35.67% of total billed charges,59.74,206,
CORTICAL S/T SCREW 3.5 26,27004084,CDM,278,RC,C1713,HCPCS,outpatient,,,206,82.40,,144.2,70,,115.36,percent of total billed charges,70% of total billed charges,206,100,,164.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,168.92,82,,135.136,percent of total billed charges,82% of total billed charges,175.1,85,,140.08,percent of total billed charges,85% of total billed charges,175.1,85,,140.08,percent of total billed charges,85% of total billed charges,175.1,85,,140.08,percent of total billed charges,85% of total billed charges,185.4,90,,148.32,percent of total billed charges,90% of total billed charges,164.8,80,,131.84,percent of total billed charges,80% of total billed charges,185.4,90,,148.32,percent of total billed charges,90% of total billed charges,154.5,75,,123.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,59.74,29,,47.792,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,138.02,67,,110.416,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,144.2,70,,115.36,percent of total billed charges,70% of total billed charges,133.9,65,,107.12,percent of total billed charges,65% of total billed charges,73.48,35.67,,58.784,percent of total billed charges,35.67% of total billed charges,59.74,206,
CORTICAL SCREW 4.5 S/TAP,27004090,CDM,278,RC,C1713,HCPCS,outpatient,,,120,48.00,,84,70,,67.2,percent of total billed charges,70% of total billed charges,120,100,,96,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,98.4,82,,78.72,percent of total billed charges,82% of total billed charges,102,85,,81.6,percent of total billed charges,85% of total billed charges,102,85,,81.6,percent of total billed charges,85% of total billed charges,102,85,,81.6,percent of total billed charges,85% of total billed charges,108,90,,86.4,percent of total billed charges,90% of total billed charges,96,80,,76.8,percent of total billed charges,80% of total billed charges,108,90,,86.4,percent of total billed charges,90% of total billed charges,90,75,,72,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,34.8,29,,27.84,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,80.4,67,,64.32,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,84,70,,67.2,percent of total billed charges,70% of total billed charges,78,65,,62.4,percent of total billed charges,65% of total billed charges,42.8,35.67,,34.24,percent of total billed charges,35.67% of total billed charges,34.8,120,
CORTICAL S/T SCREW 3.5MM 32,27004092,CDM,278,RC,C1713,HCPCS,outpatient,,,206,82.40,,144.2,70,,115.36,percent of total billed charges,70% of total billed charges,206,100,,164.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,168.92,82,,135.136,percent of total billed charges,82% of total billed charges,175.1,85,,140.08,percent of total billed charges,85% of total billed charges,175.1,85,,140.08,percent of total billed charges,85% of total billed charges,175.1,85,,140.08,percent of total billed charges,85% of total billed charges,185.4,90,,148.32,percent of total billed charges,90% of total billed charges,164.8,80,,131.84,percent of total billed charges,80% of total billed charges,185.4,90,,148.32,percent of total billed charges,90% of total billed charges,154.5,75,,123.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,59.74,29,,47.792,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,138.02,67,,110.416,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,144.2,70,,115.36,percent of total billed charges,70% of total billed charges,133.9,65,,107.12,percent of total billed charges,65% of total billed charges,73.48,35.67,,58.784,percent of total billed charges,35.67% of total billed charges,59.74,206,
CORTICAL S/T SCREW 3.5MM 34,27004093,CDM,278,RC,C1713,HCPCS,outpatient,,,206,82.40,,144.2,70,,115.36,percent of total billed charges,70% of total billed charges,206,100,,164.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,168.92,82,,135.136,percent of total billed charges,82% of total billed charges,175.1,85,,140.08,percent of total billed charges,85% of total billed charges,175.1,85,,140.08,percent of total billed charges,85% of total billed charges,175.1,85,,140.08,percent of total billed charges,85% of total billed charges,185.4,90,,148.32,percent of total billed charges,90% of total billed charges,164.8,80,,131.84,percent of total billed charges,80% of total billed charges,185.4,90,,148.32,percent of total billed charges,90% of total billed charges,154.5,75,,123.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,59.74,29,,47.792,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,138.02,67,,110.416,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,144.2,70,,115.36,percent of total billed charges,70% of total billed charges,133.9,65,,107.12,percent of total billed charges,65% of total billed charges,73.48,35.67,,58.784,percent of total billed charges,35.67% of total billed charges,59.74,206,
STYKER 8 HOLE PLATE,27004099,CDM,278,RC,C1713,HCPCS,outpatient,,,1972,788.80,,1380.4,70,,1104.32,percent of total billed charges,70% of total billed charges,1035.3,52.5,,828.24,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,1617.04,82,,1293.632,percent of total billed charges,82% of total billed charges,1676.2,85,,1340.96,percent of total billed charges,85% of total billed charges,1676.2,85,,1340.96,percent of total billed charges,85% of total billed charges,1676.2,85,,1340.96,percent of total billed charges,85% of total billed charges,1774.8,90,,1419.84,percent of total billed charges,90% of total billed charges,1577.6,80,,1262.08,percent of total billed charges,80% of total billed charges,1774.8,90,,1419.84,percent of total billed charges,90% of total billed charges,1479,75,,1183.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,571.88,29,,457.504,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1321.24,67,,1056.992,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1380.4,70,,1104.32,percent of total billed charges,70% of total billed charges,1281.8,65,,1025.44,percent of total billed charges,65% of total billed charges,703.41,35.67,,562.728,percent of total billed charges,35.67% of total billed charges,571.88,1774.8,
TUBE/PLATE 5 HOLE 150 DEGREE**,27004113,CDM,278,RC,C1713,HCPCS,outpatient,,,2037,814.80,,1425.9,70,,1140.72,percent of total billed charges,70% of total billed charges,1069.43,52.5,,855.54,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,1670.34,82,,1336.272,percent of total billed charges,82% of total billed charges,1731.45,85,,1385.16,percent of total billed charges,85% of total billed charges,1731.45,85,,1385.16,percent of total billed charges,85% of total billed charges,1731.45,85,,1385.16,percent of total billed charges,85% of total billed charges,1833.3,90,,1466.64,percent of total billed charges,90% of total billed charges,1629.6,80,,1303.68,percent of total billed charges,80% of total billed charges,1833.3,90,,1466.64,percent of total billed charges,90% of total billed charges,1527.75,75,,1222.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,590.73,29,,472.584,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1364.79,67,,1091.832,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1425.9,70,,1140.72,percent of total billed charges,70% of total billed charges,1324.05,65,,1059.24,percent of total billed charges,65% of total billed charges,726.6,35.67,,581.28,percent of total billed charges,35.67% of total billed charges,590.73,1833.3,
LAG SCREW 12.7MM 85 **,27004114,CDM,278,RC,C1713,HCPCS,outpatient,,,1336,534.40,,935.2,70,,748.16,percent of total billed charges,70% of total billed charges,701.4,52.5,,561.12,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,1095.52,82,,876.416,percent of total billed charges,82% of total billed charges,1135.6,85,,908.48,percent of total billed charges,85% of total billed charges,1135.6,85,,908.48,percent of total billed charges,85% of total billed charges,1135.6,85,,908.48,percent of total billed charges,85% of total billed charges,1202.4,90,,961.92,percent of total billed charges,90% of total billed charges,1068.8,80,,855.04,percent of total billed charges,80% of total billed charges,1202.4,90,,961.92,percent of total billed charges,90% of total billed charges,1002,75,,801.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,387.44,29,,309.952,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,895.12,67,,716.096,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,935.2,70,,748.16,percent of total billed charges,70% of total billed charges,868.4,65,,694.72,percent of total billed charges,65% of total billed charges,476.55,35.67,,381.24,percent of total billed charges,35.67% of total billed charges,387.44,1202.4,
GUIDE PIN CALIBRATED **,27004115,CDM,278,RC,C1713,HCPCS,outpatient,,,1082,432.80,,757.4,70,,605.92,percent of total billed charges,70% of total billed charges,568.05,52.5,,454.44,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,887.24,82,,709.792,percent of total billed charges,82% of total billed charges,919.7,85,,735.76,percent of total billed charges,85% of total billed charges,919.7,85,,735.76,percent of total billed charges,85% of total billed charges,919.7,85,,735.76,percent of total billed charges,85% of total billed charges,973.8,90,,779.04,percent of total billed charges,90% of total billed charges,865.6,80,,692.48,percent of total billed charges,80% of total billed charges,973.8,90,,779.04,percent of total billed charges,90% of total billed charges,811.5,75,,649.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,313.78,29,,251.024,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,724.94,67,,579.952,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,757.4,70,,605.92,percent of total billed charges,70% of total billed charges,703.3,65,,562.64,percent of total billed charges,65% of total billed charges,385.95,35.67,,308.76,percent of total billed charges,35.67% of total billed charges,313.78,973.8,
CORTICAL SCREW SELF TAP 4.5,27004116,CDM,278,RC,C1713,HCPCS,outpatient,,,296,118.40,,207.2,70,,165.76,percent of total billed charges,70% of total billed charges,296,100,,236.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,242.72,82,,194.176,percent of total billed charges,82% of total billed charges,251.6,85,,201.28,percent of total billed charges,85% of total billed charges,251.6,85,,201.28,percent of total billed charges,85% of total billed charges,251.6,85,,201.28,percent of total billed charges,85% of total billed charges,266.4,90,,213.12,percent of total billed charges,90% of total billed charges,236.8,80,,189.44,percent of total billed charges,80% of total billed charges,266.4,90,,213.12,percent of total billed charges,90% of total billed charges,222,75,,177.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,85.84,29,,68.672,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,198.32,67,,158.656,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,207.2,70,,165.76,percent of total billed charges,70% of total billed charges,192.4,65,,153.92,percent of total billed charges,65% of total billed charges,105.58,35.67,,84.464,percent of total billed charges,35.67% of total billed charges,85.84,296,
CORTICAL SCREW S/TAP 4.5,27004117,CDM,278,RC,C1713,HCPCS,outpatient,,,296,118.40,,207.2,70,,165.76,percent of total billed charges,70% of total billed charges,296,100,,236.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,242.72,82,,194.176,percent of total billed charges,82% of total billed charges,251.6,85,,201.28,percent of total billed charges,85% of total billed charges,251.6,85,,201.28,percent of total billed charges,85% of total billed charges,251.6,85,,201.28,percent of total billed charges,85% of total billed charges,266.4,90,,213.12,percent of total billed charges,90% of total billed charges,236.8,80,,189.44,percent of total billed charges,80% of total billed charges,266.4,90,,213.12,percent of total billed charges,90% of total billed charges,222,75,,177.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,85.84,29,,68.672,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,198.32,67,,158.656,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,207.2,70,,165.76,percent of total billed charges,70% of total billed charges,192.4,65,,153.92,percent of total billed charges,65% of total billed charges,105.58,35.67,,84.464,percent of total billed charges,35.67% of total billed charges,85.84,296,
CORTICAL SCREW S/TAP 4.5,27004118,CDM,278,RC,C1713,HCPCS,outpatient,,,296,118.40,,207.2,70,,165.76,percent of total billed charges,70% of total billed charges,296,100,,236.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,242.72,82,,194.176,percent of total billed charges,82% of total billed charges,251.6,85,,201.28,percent of total billed charges,85% of total billed charges,251.6,85,,201.28,percent of total billed charges,85% of total billed charges,251.6,85,,201.28,percent of total billed charges,85% of total billed charges,266.4,90,,213.12,percent of total billed charges,90% of total billed charges,236.8,80,,189.44,percent of total billed charges,80% of total billed charges,266.4,90,,213.12,percent of total billed charges,90% of total billed charges,222,75,,177.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,85.84,29,,68.672,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,198.32,67,,158.656,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,207.2,70,,165.76,percent of total billed charges,70% of total billed charges,192.4,65,,153.92,percent of total billed charges,65% of total billed charges,105.58,35.67,,84.464,percent of total billed charges,35.67% of total billed charges,85.84,296,
CORTICAL SCREW 40MM 4.2,27004120,CDM,278,RC,C1713,HCPCS,outpatient,,,663,265.20,,464.1,70,,371.28,percent of total billed charges,70% of total billed charges,663,100,,530.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,543.66,82,,434.928,percent of total billed charges,82% of total billed charges,563.55,85,,450.84,percent of total billed charges,85% of total billed charges,563.55,85,,450.84,percent of total billed charges,85% of total billed charges,563.55,85,,450.84,percent of total billed charges,85% of total billed charges,596.7,90,,477.36,percent of total billed charges,90% of total billed charges,530.4,80,,424.32,percent of total billed charges,80% of total billed charges,596.7,90,,477.36,percent of total billed charges,90% of total billed charges,497.25,75,,397.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,192.27,29,,153.816,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,444.21,67,,355.368,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,464.1,70,,371.28,percent of total billed charges,70% of total billed charges,430.95,65,,344.76,percent of total billed charges,65% of total billed charges,236.49,35.67,,189.192,percent of total billed charges,35.67% of total billed charges,192.27,663,
CORTICAL SCREW 4.2 45MM,27004121,CDM,278,RC,C1713,HCPCS,outpatient,,,663,265.20,,464.1,70,,371.28,percent of total billed charges,70% of total billed charges,663,100,,530.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,543.66,82,,434.928,percent of total billed charges,82% of total billed charges,563.55,85,,450.84,percent of total billed charges,85% of total billed charges,563.55,85,,450.84,percent of total billed charges,85% of total billed charges,563.55,85,,450.84,percent of total billed charges,85% of total billed charges,596.7,90,,477.36,percent of total billed charges,90% of total billed charges,530.4,80,,424.32,percent of total billed charges,80% of total billed charges,596.7,90,,477.36,percent of total billed charges,90% of total billed charges,497.25,75,,397.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,192.27,29,,153.816,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,444.21,67,,355.368,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,464.1,70,,371.28,percent of total billed charges,70% of total billed charges,430.95,65,,344.76,percent of total billed charges,65% of total billed charges,236.49,35.67,,189.192,percent of total billed charges,35.67% of total billed charges,192.27,663,
CORTICAL SCREW 3.7 DIA 3.5,27004123,CDM,278,RC,C1713,HCPCS,outpatient,,,663,265.20,,464.1,70,,371.28,percent of total billed charges,70% of total billed charges,663,100,,530.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,543.66,82,,434.928,percent of total billed charges,82% of total billed charges,563.55,85,,450.84,percent of total billed charges,85% of total billed charges,563.55,85,,450.84,percent of total billed charges,85% of total billed charges,563.55,85,,450.84,percent of total billed charges,85% of total billed charges,596.7,90,,477.36,percent of total billed charges,90% of total billed charges,530.4,80,,424.32,percent of total billed charges,80% of total billed charges,596.7,90,,477.36,percent of total billed charges,90% of total billed charges,497.25,75,,397.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,192.27,29,,153.816,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,444.21,67,,355.368,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,464.1,70,,371.28,percent of total billed charges,70% of total billed charges,430.95,65,,344.76,percent of total billed charges,65% of total billed charges,236.49,35.67,,189.192,percent of total billed charges,35.67% of total billed charges,192.27,663,
CORTICAL SCREW 4.2 / 3.5,27004125,CDM,278,RC,C1713,HCPCS,outpatient,,,663,265.20,,464.1,70,,371.28,percent of total billed charges,70% of total billed charges,663,100,,530.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,543.66,82,,434.928,percent of total billed charges,82% of total billed charges,563.55,85,,450.84,percent of total billed charges,85% of total billed charges,563.55,85,,450.84,percent of total billed charges,85% of total billed charges,563.55,85,,450.84,percent of total billed charges,85% of total billed charges,596.7,90,,477.36,percent of total billed charges,90% of total billed charges,530.4,80,,424.32,percent of total billed charges,80% of total billed charges,596.7,90,,477.36,percent of total billed charges,90% of total billed charges,497.25,75,,397.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,192.27,29,,153.816,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,444.21,67,,355.368,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,464.1,70,,371.28,percent of total billed charges,70% of total billed charges,430.95,65,,344.76,percent of total billed charges,65% of total billed charges,236.49,35.67,,189.192,percent of total billed charges,35.67% of total billed charges,192.27,663,
CORTICAL SCREW SZ 14 2.0 MM,27004128,CDM,278,RC,C1713,HCPCS,outpatient,,,157,62.80,,109.9,70,,87.92,percent of total billed charges,70% of total billed charges,157,100,,125.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,128.74,82,,102.992,percent of total billed charges,82% of total billed charges,133.45,85,,106.76,percent of total billed charges,85% of total billed charges,133.45,85,,106.76,percent of total billed charges,85% of total billed charges,133.45,85,,106.76,percent of total billed charges,85% of total billed charges,141.3,90,,113.04,percent of total billed charges,90% of total billed charges,125.6,80,,100.48,percent of total billed charges,80% of total billed charges,141.3,90,,113.04,percent of total billed charges,90% of total billed charges,117.75,75,,94.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,45.53,29,,36.424,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,105.19,67,,84.152,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,109.9,70,,87.92,percent of total billed charges,70% of total billed charges,102.05,65,,81.64,percent of total billed charges,65% of total billed charges,56,35.67,,44.8,percent of total billed charges,35.67% of total billed charges,45.53,157,
CORTICAL SCREW SZ 22 2.0,27004129,CDM,278,RC,C1713,HCPCS,outpatient,,,157,62.80,,109.9,70,,87.92,percent of total billed charges,70% of total billed charges,157,100,,125.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,128.74,82,,102.992,percent of total billed charges,82% of total billed charges,133.45,85,,106.76,percent of total billed charges,85% of total billed charges,133.45,85,,106.76,percent of total billed charges,85% of total billed charges,133.45,85,,106.76,percent of total billed charges,85% of total billed charges,141.3,90,,113.04,percent of total billed charges,90% of total billed charges,125.6,80,,100.48,percent of total billed charges,80% of total billed charges,141.3,90,,113.04,percent of total billed charges,90% of total billed charges,117.75,75,,94.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,45.53,29,,36.424,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,105.19,67,,84.152,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,109.9,70,,87.92,percent of total billed charges,70% of total billed charges,102.05,65,,81.64,percent of total billed charges,65% of total billed charges,56,35.67,,44.8,percent of total billed charges,35.67% of total billed charges,45.53,157,
CORTICAL SCREW 2.0 S/T 20,27004192,CDM,278,RC,C1713,HCPCS,outpatient,,,157,62.80,,109.9,70,,87.92,percent of total billed charges,70% of total billed charges,157,100,,125.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,128.74,82,,102.992,percent of total billed charges,82% of total billed charges,133.45,85,,106.76,percent of total billed charges,85% of total billed charges,133.45,85,,106.76,percent of total billed charges,85% of total billed charges,133.45,85,,106.76,percent of total billed charges,85% of total billed charges,141.3,90,,113.04,percent of total billed charges,90% of total billed charges,125.6,80,,100.48,percent of total billed charges,80% of total billed charges,141.3,90,,113.04,percent of total billed charges,90% of total billed charges,117.75,75,,94.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,45.53,29,,36.424,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,105.19,67,,84.152,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,109.9,70,,87.92,percent of total billed charges,70% of total billed charges,102.05,65,,81.64,percent of total billed charges,65% of total billed charges,56,35.67,,44.8,percent of total billed charges,35.67% of total billed charges,45.53,157,
CORTICAL SCREW 2.0 S/T 10,27004193,CDM,278,RC,C1713,HCPCS,outpatient,,,157,62.80,,109.9,70,,87.92,percent of total billed charges,70% of total billed charges,157,100,,125.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,128.74,82,,102.992,percent of total billed charges,82% of total billed charges,133.45,85,,106.76,percent of total billed charges,85% of total billed charges,133.45,85,,106.76,percent of total billed charges,85% of total billed charges,133.45,85,,106.76,percent of total billed charges,85% of total billed charges,141.3,90,,113.04,percent of total billed charges,90% of total billed charges,125.6,80,,100.48,percent of total billed charges,80% of total billed charges,141.3,90,,113.04,percent of total billed charges,90% of total billed charges,117.75,75,,94.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,45.53,29,,36.424,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,105.19,67,,84.152,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,109.9,70,,87.92,percent of total billed charges,70% of total billed charges,102.05,65,,81.64,percent of total billed charges,65% of total billed charges,56,35.67,,44.8,percent of total billed charges,35.67% of total billed charges,45.53,157,
CORTICAL S/T SCREW 3.5 28,27004256,CDM,278,RC,C1713,HCPCS,outpatient,,,157,62.80,,109.9,70,,87.92,percent of total billed charges,70% of total billed charges,157,100,,125.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,128.74,82,,102.992,percent of total billed charges,82% of total billed charges,133.45,85,,106.76,percent of total billed charges,85% of total billed charges,133.45,85,,106.76,percent of total billed charges,85% of total billed charges,133.45,85,,106.76,percent of total billed charges,85% of total billed charges,141.3,90,,113.04,percent of total billed charges,90% of total billed charges,125.6,80,,100.48,percent of total billed charges,80% of total billed charges,141.3,90,,113.04,percent of total billed charges,90% of total billed charges,117.75,75,,94.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,45.53,29,,36.424,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,105.19,67,,84.152,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,109.9,70,,87.92,percent of total billed charges,70% of total billed charges,102.05,65,,81.64,percent of total billed charges,65% of total billed charges,56,35.67,,44.8,percent of total billed charges,35.67% of total billed charges,45.53,157,
PLATE L OBLIQUE RIGHT,27004313,CDM,278,RC,C1713,HCPCS,outpatient,,,277,110.80,,193.9,70,,155.12,percent of total billed charges,70% of total billed charges,277,100,,221.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,227.14,82,,181.712,percent of total billed charges,82% of total billed charges,235.45,85,,188.36,percent of total billed charges,85% of total billed charges,235.45,85,,188.36,percent of total billed charges,85% of total billed charges,235.45,85,,188.36,percent of total billed charges,85% of total billed charges,249.3,90,,199.44,percent of total billed charges,90% of total billed charges,221.6,80,,177.28,percent of total billed charges,80% of total billed charges,249.3,90,,199.44,percent of total billed charges,90% of total billed charges,207.75,75,,166.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,80.33,29,,64.264,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,185.59,67,,148.472,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,193.9,70,,155.12,percent of total billed charges,70% of total billed charges,180.05,65,,144.04,percent of total billed charges,65% of total billed charges,98.81,35.67,,79.048,percent of total billed charges,35.67% of total billed charges,80.33,277,
SCREW CORTICAL 2.0 S/T 16,27004314,CDM,278,RC,C1713,HCPCS,outpatient,,,157,62.80,,109.9,70,,87.92,percent of total billed charges,70% of total billed charges,157,100,,125.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,128.74,82,,102.992,percent of total billed charges,82% of total billed charges,133.45,85,,106.76,percent of total billed charges,85% of total billed charges,133.45,85,,106.76,percent of total billed charges,85% of total billed charges,133.45,85,,106.76,percent of total billed charges,85% of total billed charges,141.3,90,,113.04,percent of total billed charges,90% of total billed charges,125.6,80,,100.48,percent of total billed charges,80% of total billed charges,141.3,90,,113.04,percent of total billed charges,90% of total billed charges,117.75,75,,94.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,45.53,29,,36.424,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,105.19,67,,84.152,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,109.9,70,,87.92,percent of total billed charges,70% of total billed charges,102.05,65,,81.64,percent of total billed charges,65% of total billed charges,56,35.67,,44.8,percent of total billed charges,35.67% of total billed charges,45.53,157,
SCREW CORTICAL S/T 2.0 12,27004315,CDM,278,RC,C1713,HCPCS,outpatient,,,157,62.80,,109.9,70,,87.92,percent of total billed charges,70% of total billed charges,157,100,,125.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,128.74,82,,102.992,percent of total billed charges,82% of total billed charges,133.45,85,,106.76,percent of total billed charges,85% of total billed charges,133.45,85,,106.76,percent of total billed charges,85% of total billed charges,133.45,85,,106.76,percent of total billed charges,85% of total billed charges,141.3,90,,113.04,percent of total billed charges,90% of total billed charges,125.6,80,,100.48,percent of total billed charges,80% of total billed charges,141.3,90,,113.04,percent of total billed charges,90% of total billed charges,117.75,75,,94.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,45.53,29,,36.424,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,105.19,67,,84.152,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,109.9,70,,87.92,percent of total billed charges,70% of total billed charges,102.05,65,,81.64,percent of total billed charges,65% of total billed charges,56,35.67,,44.8,percent of total billed charges,35.67% of total billed charges,45.53,157,
PLATE T OBLIQUE 3.5MM 5 HOL,27004376,CDM,278,RC,C1713,HCPCS,outpatient,,,788,315.20,,551.6,70,,441.28,percent of total billed charges,70% of total billed charges,788,100,,630.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,646.16,82,,516.928,percent of total billed charges,82% of total billed charges,669.8,85,,535.84,percent of total billed charges,85% of total billed charges,669.8,85,,535.84,percent of total billed charges,85% of total billed charges,669.8,85,,535.84,percent of total billed charges,85% of total billed charges,709.2,90,,567.36,percent of total billed charges,90% of total billed charges,630.4,80,,504.32,percent of total billed charges,80% of total billed charges,709.2,90,,567.36,percent of total billed charges,90% of total billed charges,591,75,,472.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,228.52,29,,182.816,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,527.96,67,,422.368,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,551.6,70,,441.28,percent of total billed charges,70% of total billed charges,512.2,65,,409.76,percent of total billed charges,65% of total billed charges,281.08,35.67,,224.864,percent of total billed charges,35.67% of total billed charges,228.52,788,
SCREW CANCELLOUS  4.0 MM 24,27004377,CDM,278,RC,C1713,HCPCS,outpatient,,,130,52.00,,91,70,,72.8,percent of total billed charges,70% of total billed charges,130,100,,104,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,106.6,82,,85.28,percent of total billed charges,82% of total billed charges,110.5,85,,88.4,percent of total billed charges,85% of total billed charges,110.5,85,,88.4,percent of total billed charges,85% of total billed charges,110.5,85,,88.4,percent of total billed charges,85% of total billed charges,117,90,,93.6,percent of total billed charges,90% of total billed charges,104,80,,83.2,percent of total billed charges,80% of total billed charges,117,90,,93.6,percent of total billed charges,90% of total billed charges,97.5,75,,78,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,37.7,29,,30.16,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,87.1,67,,69.68,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,91,70,,72.8,percent of total billed charges,70% of total billed charges,84.5,65,,67.6,percent of total billed charges,65% of total billed charges,46.37,35.67,,37.096,percent of total billed charges,35.67% of total billed charges,37.7,130,
SCREW CANCELLOUS  4.0MM 26,27004378,CDM,278,RC,C1713,HCPCS,outpatient,,,130,52.00,,91,70,,72.8,percent of total billed charges,70% of total billed charges,130,100,,104,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,106.6,82,,85.28,percent of total billed charges,82% of total billed charges,110.5,85,,88.4,percent of total billed charges,85% of total billed charges,110.5,85,,88.4,percent of total billed charges,85% of total billed charges,110.5,85,,88.4,percent of total billed charges,85% of total billed charges,117,90,,93.6,percent of total billed charges,90% of total billed charges,104,80,,83.2,percent of total billed charges,80% of total billed charges,117,90,,93.6,percent of total billed charges,90% of total billed charges,97.5,75,,78,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,37.7,29,,30.16,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,87.1,67,,69.68,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,91,70,,72.8,percent of total billed charges,70% of total billed charges,84.5,65,,67.6,percent of total billed charges,65% of total billed charges,46.37,35.67,,37.096,percent of total billed charges,35.67% of total billed charges,37.7,130,
SCREW CORTICAL S/T 3.5MM 28,27004444,CDM,278,RC,C1713,HCPCS,outpatient,,,185,74.00,,129.5,70,,103.6,percent of total billed charges,70% of total billed charges,185,100,,148,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,151.7,82,,121.36,percent of total billed charges,82% of total billed charges,157.25,85,,125.8,percent of total billed charges,85% of total billed charges,157.25,85,,125.8,percent of total billed charges,85% of total billed charges,157.25,85,,125.8,percent of total billed charges,85% of total billed charges,166.5,90,,133.2,percent of total billed charges,90% of total billed charges,148,80,,118.4,percent of total billed charges,80% of total billed charges,166.5,90,,133.2,percent of total billed charges,90% of total billed charges,138.75,75,,111,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,53.65,29,,42.92,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,123.95,67,,99.16,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,129.5,70,,103.6,percent of total billed charges,70% of total billed charges,120.25,65,,96.2,percent of total billed charges,65% of total billed charges,65.99,35.67,,52.792,percent of total billed charges,35.67% of total billed charges,53.65,185,
K WIRE 10/10,27004466,CDM,278,RC,C1713,HCPCS,outpatient,,,182,72.80,,127.4,70,,101.92,percent of total billed charges,70% of total billed charges,182,100,,145.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,149.24,82,,119.392,percent of total billed charges,82% of total billed charges,154.7,85,,123.76,percent of total billed charges,85% of total billed charges,154.7,85,,123.76,percent of total billed charges,85% of total billed charges,154.7,85,,123.76,percent of total billed charges,85% of total billed charges,163.8,90,,131.04,percent of total billed charges,90% of total billed charges,145.6,80,,116.48,percent of total billed charges,80% of total billed charges,163.8,90,,131.04,percent of total billed charges,90% of total billed charges,136.5,75,,109.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,52.78,29,,42.224,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,121.94,67,,97.552,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,127.4,70,,101.92,percent of total billed charges,70% of total billed charges,118.3,65,,94.64,percent of total billed charges,65% of total billed charges,64.92,35.67,,51.936,percent of total billed charges,35.67% of total billed charges,52.78,182,
K WIRE 1.6MM,27004467,CDM,278,RC,C1713,HCPCS,outpatient,,,218,87.20,,152.6,70,,122.08,percent of total billed charges,70% of total billed charges,218,100,,174.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,178.76,82,,143.008,percent of total billed charges,82% of total billed charges,185.3,85,,148.24,percent of total billed charges,85% of total billed charges,185.3,85,,148.24,percent of total billed charges,85% of total billed charges,185.3,85,,148.24,percent of total billed charges,85% of total billed charges,196.2,90,,156.96,percent of total billed charges,90% of total billed charges,174.4,80,,139.52,percent of total billed charges,80% of total billed charges,196.2,90,,156.96,percent of total billed charges,90% of total billed charges,163.5,75,,130.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,63.22,29,,50.576,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,146.06,67,,116.848,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,152.6,70,,122.08,percent of total billed charges,70% of total billed charges,141.7,65,,113.36,percent of total billed charges,65% of total billed charges,77.76,35.67,,62.208,percent of total billed charges,35.67% of total billed charges,63.22,218,
HALU-C PLATE SZ1 RT SURGICAL**,27004468,CDM,278,RC,C1713,HCPCS,outpatient,,,2651,1060.40,,1855.7,70,,1484.56,percent of total billed charges,70% of total billed charges,1391.78,52.5,,1113.42,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,2173.82,82,,1739.056,percent of total billed charges,82% of total billed charges,2253.35,85,,1802.68,percent of total billed charges,85% of total billed charges,2253.35,85,,1802.68,percent of total billed charges,85% of total billed charges,2253.35,85,,1802.68,percent of total billed charges,85% of total billed charges,2385.9,90,,1908.72,percent of total billed charges,90% of total billed charges,2120.8,80,,1696.64,percent of total billed charges,80% of total billed charges,2385.9,90,,1908.72,percent of total billed charges,90% of total billed charges,1988.25,75,,1590.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,768.79,29,,615.032,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1776.17,67,,1420.936,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1855.7,70,,1484.56,percent of total billed charges,70% of total billed charges,1723.15,65,,1378.52,percent of total billed charges,65% of total billed charges,945.61,35.67,,756.488,percent of total billed charges,35.67% of total billed charges,768.79,2385.9,
SCREW SNAP OFF 12MM SURG **,27004469,CDM,278,RC,C1713,HCPCS,outpatient,,,2180,872.00,,1526,70,,1220.8,percent of total billed charges,70% of total billed charges,1144.5,52.5,,915.6,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,1787.6,82,,1430.08,percent of total billed charges,82% of total billed charges,1853,85,,1482.4,percent of total billed charges,85% of total billed charges,1853,85,,1482.4,percent of total billed charges,85% of total billed charges,1853,85,,1482.4,percent of total billed charges,85% of total billed charges,1962,90,,1569.6,percent of total billed charges,90% of total billed charges,1744,80,,1395.2,percent of total billed charges,80% of total billed charges,1962,90,,1569.6,percent of total billed charges,90% of total billed charges,1635,75,,1308,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,632.2,29,,505.76,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1460.6,67,,1168.48,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1526,70,,1220.8,percent of total billed charges,70% of total billed charges,1417,65,,1133.6,percent of total billed charges,65% of total billed charges,777.61,35.67,,622.088,percent of total billed charges,35.67% of total billed charges,632.2,1962,
SCREW SNAP OFF 14 MM SURG **,27004470,CDM,278,RC,C1713,HCPCS,outpatient,,,2180,872.00,,1526,70,,1220.8,percent of total billed charges,70% of total billed charges,1144.5,52.5,,915.6,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,1787.6,82,,1430.08,percent of total billed charges,82% of total billed charges,1853,85,,1482.4,percent of total billed charges,85% of total billed charges,1853,85,,1482.4,percent of total billed charges,85% of total billed charges,1853,85,,1482.4,percent of total billed charges,85% of total billed charges,1962,90,,1569.6,percent of total billed charges,90% of total billed charges,1744,80,,1395.2,percent of total billed charges,80% of total billed charges,1962,90,,1569.6,percent of total billed charges,90% of total billed charges,1635,75,,1308,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,632.2,29,,505.76,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1460.6,67,,1168.48,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1526,70,,1220.8,percent of total billed charges,70% of total billed charges,1417,65,,1133.6,percent of total billed charges,65% of total billed charges,777.61,35.67,,622.088,percent of total billed charges,35.67% of total billed charges,632.2,1962,
SCREW SNAP OFF 16MM SURG **,27004471,CDM,278,RC,C1713,HCPCS,outpatient,,,2180,872.00,,1526,70,,1220.8,percent of total billed charges,70% of total billed charges,1144.5,52.5,,915.6,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,1787.6,82,,1430.08,percent of total billed charges,82% of total billed charges,1853,85,,1482.4,percent of total billed charges,85% of total billed charges,1853,85,,1482.4,percent of total billed charges,85% of total billed charges,1853,85,,1482.4,percent of total billed charges,85% of total billed charges,1962,90,,1569.6,percent of total billed charges,90% of total billed charges,1744,80,,1395.2,percent of total billed charges,80% of total billed charges,1962,90,,1569.6,percent of total billed charges,90% of total billed charges,1635,75,,1308,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,632.2,29,,505.76,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1460.6,67,,1168.48,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1526,70,,1220.8,percent of total billed charges,70% of total billed charges,1417,65,,1133.6,percent of total billed charges,65% of total billed charges,777.61,35.67,,622.088,percent of total billed charges,35.67% of total billed charges,632.2,1962,
SCREW SNAP OFF 18MM SURG **,27004472,CDM,278,RC,C1713,HCPCS,outpatient,,,372,148.80,,260.4,70,,208.32,percent of total billed charges,70% of total billed charges,372,100,,297.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,305.04,82,,244.032,percent of total billed charges,82% of total billed charges,316.2,85,,252.96,percent of total billed charges,85% of total billed charges,316.2,85,,252.96,percent of total billed charges,85% of total billed charges,316.2,85,,252.96,percent of total billed charges,85% of total billed charges,334.8,90,,267.84,percent of total billed charges,90% of total billed charges,297.6,80,,238.08,percent of total billed charges,80% of total billed charges,334.8,90,,267.84,percent of total billed charges,90% of total billed charges,279,75,,223.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,107.88,29,,86.304,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,249.24,67,,199.392,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,260.4,70,,208.32,percent of total billed charges,70% of total billed charges,241.8,65,,193.44,percent of total billed charges,65% of total billed charges,132.69,35.67,,106.152,percent of total billed charges,35.67% of total billed charges,107.88,372,
TOPAZ MICRO DEBRIDER W/CABLE,27004503,CDM,278,RC,,,outpatient,,,1706,682.40,,1194.2,70,,955.36,percent of total billed charges,70% of total billed charges,895.65,52.5,,716.52,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,1398.92,82,,1119.136,percent of total billed charges,82% of total billed charges,1450.1,85,,1160.08,percent of total billed charges,85% of total billed charges,1450.1,85,,1160.08,percent of total billed charges,85% of total billed charges,1450.1,85,,1160.08,percent of total billed charges,85% of total billed charges,1535.4,90,,1228.32,percent of total billed charges,90% of total billed charges,1364.8,80,,1091.84,percent of total billed charges,80% of total billed charges,1535.4,90,,1228.32,percent of total billed charges,90% of total billed charges,1279.5,75,,1023.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,494.74,29,,395.792,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1143.02,67,,914.416,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1194.2,70,,955.36,percent of total billed charges,70% of total billed charges,1108.9,65,,887.12,percent of total billed charges,65% of total billed charges,608.53,35.67,,486.824,percent of total billed charges,35.67% of total billed charges,494.74,1535.4,
K-WIRE 1.0MM,27004523,CDM,278,RC,C1713,HCPCS,outpatient,,,67,26.80,,46.9,70,,37.52,percent of total billed charges,70% of total billed charges,67,100,,53.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,54.94,82,,43.952,percent of total billed charges,82% of total billed charges,56.95,85,,45.56,percent of total billed charges,85% of total billed charges,56.95,85,,45.56,percent of total billed charges,85% of total billed charges,56.95,85,,45.56,percent of total billed charges,85% of total billed charges,60.3,90,,48.24,percent of total billed charges,90% of total billed charges,53.6,80,,42.88,percent of total billed charges,80% of total billed charges,60.3,90,,48.24,percent of total billed charges,90% of total billed charges,50.25,75,,40.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,19.43,29,,15.544,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,44.89,67,,35.912,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,46.9,70,,37.52,percent of total billed charges,70% of total billed charges,43.55,65,,34.84,percent of total billed charges,65% of total billed charges,23.9,35.67,,19.12,percent of total billed charges,35.67% of total billed charges,19.43,67,
CATHETER URETERAL 5FR ST,27004564,CDM,278,RC,C1758,HCPCS,outpatient,,,723,289.20,,506.1,70,,404.88,percent of total billed charges,70% of total billed charges,723,100,,578.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,592.86,82,,474.288,percent of total billed charges,82% of total billed charges,614.55,85,,491.64,percent of total billed charges,85% of total billed charges,614.55,85,,491.64,percent of total billed charges,85% of total billed charges,614.55,85,,491.64,percent of total billed charges,85% of total billed charges,650.7,90,,520.56,percent of total billed charges,90% of total billed charges,578.4,80,,462.72,percent of total billed charges,80% of total billed charges,650.7,90,,520.56,percent of total billed charges,90% of total billed charges,542.25,75,,433.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,209.67,29,,167.736,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,484.41,67,,387.528,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,506.1,70,,404.88,percent of total billed charges,70% of total billed charges,469.95,65,,375.96,percent of total billed charges,65% of total billed charges,257.89,35.67,,206.312,percent of total billed charges,35.67% of total billed charges,209.67,723,
CATHETER URETERAL 5FR SPIRAL,27004565,CDM,278,RC,C1758,HCPCS,outpatient,,,710,284.00,,497,70,,397.6,percent of total billed charges,70% of total billed charges,710,100,,568,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,582.2,82,,465.76,percent of total billed charges,82% of total billed charges,603.5,85,,482.8,percent of total billed charges,85% of total billed charges,603.5,85,,482.8,percent of total billed charges,85% of total billed charges,603.5,85,,482.8,percent of total billed charges,85% of total billed charges,639,90,,511.2,percent of total billed charges,90% of total billed charges,568,80,,454.4,percent of total billed charges,80% of total billed charges,639,90,,511.2,percent of total billed charges,90% of total billed charges,532.5,75,,426,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,205.9,29,,164.72,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,475.7,67,,380.56,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,497,70,,397.6,percent of total billed charges,70% of total billed charges,461.5,65,,369.2,percent of total billed charges,65% of total billed charges,253.26,35.67,,202.608,percent of total billed charges,35.67% of total billed charges,205.9,710,
CATH URETERAL 5 FR WISHARD,27004566,CDM,278,RC,C1758,HCPCS,outpatient,,,1140,456.00,,798,70,,638.4,percent of total billed charges,70% of total billed charges,598.5,52.5,,478.8,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,934.8,82,,747.84,percent of total billed charges,82% of total billed charges,969,85,,775.2,percent of total billed charges,85% of total billed charges,969,85,,775.2,percent of total billed charges,85% of total billed charges,969,85,,775.2,percent of total billed charges,85% of total billed charges,1026,90,,820.8,percent of total billed charges,90% of total billed charges,912,80,,729.6,percent of total billed charges,80% of total billed charges,1026,90,,820.8,percent of total billed charges,90% of total billed charges,855,75,,684,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,330.6,29,,264.48,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,763.8,67,,611.04,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,798,70,,638.4,percent of total billed charges,70% of total billed charges,741,65,,592.8,percent of total billed charges,65% of total billed charges,406.64,35.67,,325.312,percent of total billed charges,35.67% of total billed charges,330.6,1026,
PORT MRI W/OPEN END 8FR CATH,27005153,CDM,278,RC,C1788,HCPCS,outpatient,,,2461,984.40,,1722.7,70,,1378.16,percent of total billed charges,70% of total billed charges,1292.03,52.5,,1033.62,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,2018.02,82,,1614.416,percent of total billed charges,82% of total billed charges,2091.85,85,,1673.48,percent of total billed charges,85% of total billed charges,2091.85,85,,1673.48,percent of total billed charges,85% of total billed charges,2091.85,85,,1673.48,percent of total billed charges,85% of total billed charges,2214.9,90,,1771.92,percent of total billed charges,90% of total billed charges,1968.8,80,,1575.04,percent of total billed charges,80% of total billed charges,2214.9,90,,1771.92,percent of total billed charges,90% of total billed charges,1845.75,75,,1476.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,713.69,29,,570.952,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1648.87,67,,1319.096,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1722.7,70,,1378.16,percent of total billed charges,70% of total billed charges,1599.65,65,,1279.72,percent of total billed charges,65% of total billed charges,877.84,35.67,,702.272,percent of total billed charges,35.67% of total billed charges,713.69,2214.9,
PORT X LOW PROFILE TITAN 6FR,27005154,CDM,278,RC,C1788,HCPCS,outpatient,,,4127,1650.80,,2888.9,70,,2311.12,percent of total billed charges,70% of total billed charges,2166.68,52.5,,1733.34,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,3384.14,82,,2707.312,percent of total billed charges,82% of total billed charges,3507.95,85,,2806.36,percent of total billed charges,85% of total billed charges,3507.95,85,,2806.36,percent of total billed charges,85% of total billed charges,3507.95,85,,2806.36,percent of total billed charges,85% of total billed charges,3714.3,90,,2971.44,percent of total billed charges,90% of total billed charges,3301.6,80,,2641.28,percent of total billed charges,80% of total billed charges,3714.3,90,,2971.44,percent of total billed charges,90% of total billed charges,3095.25,75,,2476.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,1196.83,29,,957.464,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,2765.09,67,,2212.072,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,2888.9,70,,2311.12,percent of total billed charges,70% of total billed charges,2682.55,65,,2146.04,percent of total billed charges,65% of total billed charges,1472.1,35.67,,1177.68,percent of total billed charges,35.67% of total billed charges,1196.83,3714.3,
CORTICAL SCREW 32 MM S/T 3.5,27005227,CDM,278,RC,C1713,HCPCS,outpatient,,,157,62.80,,109.9,70,,87.92,percent of total billed charges,70% of total billed charges,157,100,,125.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,128.74,82,,102.992,percent of total billed charges,82% of total billed charges,133.45,85,,106.76,percent of total billed charges,85% of total billed charges,133.45,85,,106.76,percent of total billed charges,85% of total billed charges,133.45,85,,106.76,percent of total billed charges,85% of total billed charges,141.3,90,,113.04,percent of total billed charges,90% of total billed charges,125.6,80,,100.48,percent of total billed charges,80% of total billed charges,141.3,90,,113.04,percent of total billed charges,90% of total billed charges,117.75,75,,94.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,45.53,29,,36.424,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,105.19,67,,84.152,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,109.9,70,,87.92,percent of total billed charges,70% of total billed charges,102.05,65,,81.64,percent of total billed charges,65% of total billed charges,56,35.67,,44.8,percent of total billed charges,35.67% of total billed charges,45.53,157,
CORKSCREW-BIO JOINT 5.5MM **,27005229,CDM,278,RC,C1776,HCPCS,outpatient,,,2418,967.20,,1692.6,70,,1354.08,percent of total billed charges,70% of total billed charges,1269.45,52.5,,1015.56,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,1982.76,82,,1586.208,percent of total billed charges,82% of total billed charges,2055.3,85,,1644.24,percent of total billed charges,85% of total billed charges,2055.3,85,,1644.24,percent of total billed charges,85% of total billed charges,2055.3,85,,1644.24,percent of total billed charges,85% of total billed charges,2176.2,90,,1740.96,percent of total billed charges,90% of total billed charges,1934.4,80,,1547.52,percent of total billed charges,80% of total billed charges,2176.2,90,,1740.96,percent of total billed charges,90% of total billed charges,1813.5,75,,1450.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,701.22,29,,560.976,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1620.06,67,,1296.048,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1692.6,70,,1354.08,percent of total billed charges,70% of total billed charges,1571.7,65,,1257.36,percent of total billed charges,65% of total billed charges,862.5,35.67,,690,percent of total billed charges,35.67% of total billed charges,701.22,2176.2,
4.0 QC TAPS,27005239,CDM,278,RC,C1713,HCPCS,outpatient,,,399,159.60,,279.3,70,,223.44,percent of total billed charges,70% of total billed charges,399,100,,319.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,327.18,82,,261.744,percent of total billed charges,82% of total billed charges,339.15,85,,271.32,percent of total billed charges,85% of total billed charges,339.15,85,,271.32,percent of total billed charges,85% of total billed charges,339.15,85,,271.32,percent of total billed charges,85% of total billed charges,359.1,90,,287.28,percent of total billed charges,90% of total billed charges,319.2,80,,255.36,percent of total billed charges,80% of total billed charges,359.1,90,,287.28,percent of total billed charges,90% of total billed charges,299.25,75,,239.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,115.71,29,,92.568,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,267.33,67,,213.864,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,279.3,70,,223.44,percent of total billed charges,70% of total billed charges,259.35,65,,207.48,percent of total billed charges,65% of total billed charges,142.32,35.67,,113.856,percent of total billed charges,35.67% of total billed charges,115.71,399,
4.0 CONCELLOUS F/THR SCREW 55,27005240,CDM,278,RC,C1713,HCPCS,outpatient,,,130,52.00,,91,70,,72.8,percent of total billed charges,70% of total billed charges,130,100,,104,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,106.6,82,,85.28,percent of total billed charges,82% of total billed charges,110.5,85,,88.4,percent of total billed charges,85% of total billed charges,110.5,85,,88.4,percent of total billed charges,85% of total billed charges,110.5,85,,88.4,percent of total billed charges,85% of total billed charges,117,90,,93.6,percent of total billed charges,90% of total billed charges,104,80,,83.2,percent of total billed charges,80% of total billed charges,117,90,,93.6,percent of total billed charges,90% of total billed charges,97.5,75,,78,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,37.7,29,,30.16,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,87.1,67,,69.68,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,91,70,,72.8,percent of total billed charges,70% of total billed charges,84.5,65,,67.6,percent of total billed charges,65% of total billed charges,46.37,35.67,,37.096,percent of total billed charges,35.67% of total billed charges,37.7,130,
4.0 CANCELLOUS F/THR SCREW 60,27005241,CDM,278,RC,C1713,HCPCS,outpatient,,,130,52.00,,91,70,,72.8,percent of total billed charges,70% of total billed charges,130,100,,104,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,106.6,82,,85.28,percent of total billed charges,82% of total billed charges,110.5,85,,88.4,percent of total billed charges,85% of total billed charges,110.5,85,,88.4,percent of total billed charges,85% of total billed charges,110.5,85,,88.4,percent of total billed charges,85% of total billed charges,117,90,,93.6,percent of total billed charges,90% of total billed charges,104,80,,83.2,percent of total billed charges,80% of total billed charges,117,90,,93.6,percent of total billed charges,90% of total billed charges,97.5,75,,78,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,37.7,29,,30.16,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,87.1,67,,69.68,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,91,70,,72.8,percent of total billed charges,70% of total billed charges,84.5,65,,67.6,percent of total billed charges,65% of total billed charges,46.37,35.67,,37.096,percent of total billed charges,35.67% of total billed charges,37.7,130,
3.5 CORTICAL S/TAP SCREW SZ 10,27005242,CDM,278,RC,C1713,HCPCS,outpatient,,,209,83.60,,146.3,70,,117.04,percent of total billed charges,70% of total billed charges,209,100,,167.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,171.38,82,,137.104,percent of total billed charges,82% of total billed charges,177.65,85,,142.12,percent of total billed charges,85% of total billed charges,177.65,85,,142.12,percent of total billed charges,85% of total billed charges,177.65,85,,142.12,percent of total billed charges,85% of total billed charges,188.1,90,,150.48,percent of total billed charges,90% of total billed charges,167.2,80,,133.76,percent of total billed charges,80% of total billed charges,188.1,90,,150.48,percent of total billed charges,90% of total billed charges,156.75,75,,125.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,60.61,29,,48.488,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,140.03,67,,112.024,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,146.3,70,,117.04,percent of total billed charges,70% of total billed charges,135.85,65,,108.68,percent of total billed charges,65% of total billed charges,74.55,35.67,,59.64,percent of total billed charges,35.67% of total billed charges,60.61,209,
SCREW 3.5 CORTICAL S/TAP 20,27005243,CDM,278,RC,C1713,HCPCS,outpatient,,,206,82.40,,144.2,70,,115.36,percent of total billed charges,70% of total billed charges,206,100,,164.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,168.92,82,,135.136,percent of total billed charges,82% of total billed charges,175.1,85,,140.08,percent of total billed charges,85% of total billed charges,175.1,85,,140.08,percent of total billed charges,85% of total billed charges,175.1,85,,140.08,percent of total billed charges,85% of total billed charges,185.4,90,,148.32,percent of total billed charges,90% of total billed charges,164.8,80,,131.84,percent of total billed charges,80% of total billed charges,185.4,90,,148.32,percent of total billed charges,90% of total billed charges,154.5,75,,123.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,59.74,29,,47.792,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,138.02,67,,110.416,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,144.2,70,,115.36,percent of total billed charges,70% of total billed charges,133.9,65,,107.12,percent of total billed charges,65% of total billed charges,73.48,35.67,,58.784,percent of total billed charges,35.67% of total billed charges,59.74,206,
SCREW 3.5 CORTICAL S/TAP 22,27005244,CDM,278,RC,C1713,HCPCS,outpatient,,,209,83.60,,146.3,70,,117.04,percent of total billed charges,70% of total billed charges,209,100,,167.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,171.38,82,,137.104,percent of total billed charges,82% of total billed charges,177.65,85,,142.12,percent of total billed charges,85% of total billed charges,177.65,85,,142.12,percent of total billed charges,85% of total billed charges,177.65,85,,142.12,percent of total billed charges,85% of total billed charges,188.1,90,,150.48,percent of total billed charges,90% of total billed charges,167.2,80,,133.76,percent of total billed charges,80% of total billed charges,188.1,90,,150.48,percent of total billed charges,90% of total billed charges,156.75,75,,125.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,60.61,29,,48.488,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,140.03,67,,112.024,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,146.3,70,,117.04,percent of total billed charges,70% of total billed charges,135.85,65,,108.68,percent of total billed charges,65% of total billed charges,74.55,35.67,,59.64,percent of total billed charges,35.67% of total billed charges,60.61,209,
3.5 CORTICAL S.TAP SCREW 24,27005245,CDM,278,RC,C1713,HCPCS,outpatient,,,206,82.40,,144.2,70,,115.36,percent of total billed charges,70% of total billed charges,206,100,,164.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,168.92,82,,135.136,percent of total billed charges,82% of total billed charges,175.1,85,,140.08,percent of total billed charges,85% of total billed charges,175.1,85,,140.08,percent of total billed charges,85% of total billed charges,175.1,85,,140.08,percent of total billed charges,85% of total billed charges,185.4,90,,148.32,percent of total billed charges,90% of total billed charges,164.8,80,,131.84,percent of total billed charges,80% of total billed charges,185.4,90,,148.32,percent of total billed charges,90% of total billed charges,154.5,75,,123.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,59.74,29,,47.792,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,138.02,67,,110.416,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,144.2,70,,115.36,percent of total billed charges,70% of total billed charges,133.9,65,,107.12,percent of total billed charges,65% of total billed charges,73.48,35.67,,58.784,percent of total billed charges,35.67% of total billed charges,59.74,206,
3.5 CORTICAL S.TAP SCREW 3O,27005246,CDM,278,RC,C1713,HCPCS,outpatient,,,206,82.40,,144.2,70,,115.36,percent of total billed charges,70% of total billed charges,206,100,,164.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,168.92,82,,135.136,percent of total billed charges,82% of total billed charges,175.1,85,,140.08,percent of total billed charges,85% of total billed charges,175.1,85,,140.08,percent of total billed charges,85% of total billed charges,175.1,85,,140.08,percent of total billed charges,85% of total billed charges,185.4,90,,148.32,percent of total billed charges,90% of total billed charges,164.8,80,,131.84,percent of total billed charges,80% of total billed charges,185.4,90,,148.32,percent of total billed charges,90% of total billed charges,154.5,75,,123.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,59.74,29,,47.792,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,138.02,67,,110.416,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,144.2,70,,115.36,percent of total billed charges,70% of total billed charges,133.9,65,,107.12,percent of total billed charges,65% of total billed charges,73.48,35.67,,58.784,percent of total billed charges,35.67% of total billed charges,59.74,206,
3.5 CORTICAL S/TAP SCREW 36,27005247,CDM,278,RC,C1713,HCPCS,outpatient,,,206,82.40,,144.2,70,,115.36,percent of total billed charges,70% of total billed charges,206,100,,164.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,168.92,82,,135.136,percent of total billed charges,82% of total billed charges,175.1,85,,140.08,percent of total billed charges,85% of total billed charges,175.1,85,,140.08,percent of total billed charges,85% of total billed charges,175.1,85,,140.08,percent of total billed charges,85% of total billed charges,185.4,90,,148.32,percent of total billed charges,90% of total billed charges,164.8,80,,131.84,percent of total billed charges,80% of total billed charges,185.4,90,,148.32,percent of total billed charges,90% of total billed charges,154.5,75,,123.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,59.74,29,,47.792,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,138.02,67,,110.416,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,144.2,70,,115.36,percent of total billed charges,70% of total billed charges,133.9,65,,107.12,percent of total billed charges,65% of total billed charges,73.48,35.67,,58.784,percent of total billed charges,35.67% of total billed charges,59.74,206,
3.5 CORTICAL S.TAP SCREW 38,27005248,CDM,278,RC,C1713,HCPCS,outpatient,,,206,82.40,,144.2,70,,115.36,percent of total billed charges,70% of total billed charges,206,100,,164.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,168.92,82,,135.136,percent of total billed charges,82% of total billed charges,175.1,85,,140.08,percent of total billed charges,85% of total billed charges,175.1,85,,140.08,percent of total billed charges,85% of total billed charges,175.1,85,,140.08,percent of total billed charges,85% of total billed charges,185.4,90,,148.32,percent of total billed charges,90% of total billed charges,164.8,80,,131.84,percent of total billed charges,80% of total billed charges,185.4,90,,148.32,percent of total billed charges,90% of total billed charges,154.5,75,,123.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,59.74,29,,47.792,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,138.02,67,,110.416,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,144.2,70,,115.36,percent of total billed charges,70% of total billed charges,133.9,65,,107.12,percent of total billed charges,65% of total billed charges,73.48,35.67,,58.784,percent of total billed charges,35.67% of total billed charges,59.74,206,
3.5 CORTICAL S/TAP SCREW 40,27005249,CDM,278,RC,C1713,HCPCS,outpatient,,,206,82.40,,144.2,70,,115.36,percent of total billed charges,70% of total billed charges,206,100,,164.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,168.92,82,,135.136,percent of total billed charges,82% of total billed charges,175.1,85,,140.08,percent of total billed charges,85% of total billed charges,175.1,85,,140.08,percent of total billed charges,85% of total billed charges,175.1,85,,140.08,percent of total billed charges,85% of total billed charges,185.4,90,,148.32,percent of total billed charges,90% of total billed charges,164.8,80,,131.84,percent of total billed charges,80% of total billed charges,185.4,90,,148.32,percent of total billed charges,90% of total billed charges,154.5,75,,123.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,59.74,29,,47.792,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,138.02,67,,110.416,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,144.2,70,,115.36,percent of total billed charges,70% of total billed charges,133.9,65,,107.12,percent of total billed charges,65% of total billed charges,73.48,35.67,,58.784,percent of total billed charges,35.67% of total billed charges,59.74,206,
3.5 CORTICAL S/TAP SCREW 44,27005250,CDM,278,RC,C1713,HCPCS,outpatient,,,206,82.40,,144.2,70,,115.36,percent of total billed charges,70% of total billed charges,206,100,,164.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,168.92,82,,135.136,percent of total billed charges,82% of total billed charges,175.1,85,,140.08,percent of total billed charges,85% of total billed charges,175.1,85,,140.08,percent of total billed charges,85% of total billed charges,175.1,85,,140.08,percent of total billed charges,85% of total billed charges,185.4,90,,148.32,percent of total billed charges,90% of total billed charges,164.8,80,,131.84,percent of total billed charges,80% of total billed charges,185.4,90,,148.32,percent of total billed charges,90% of total billed charges,154.5,75,,123.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,59.74,29,,47.792,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,138.02,67,,110.416,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,144.2,70,,115.36,percent of total billed charges,70% of total billed charges,133.9,65,,107.12,percent of total billed charges,65% of total billed charges,73.48,35.67,,58.784,percent of total billed charges,35.67% of total billed charges,59.74,206,
3.5 CORTICAL S/TAP SCREW 48,27005251,CDM,278,RC,C1713,HCPCS,outpatient,,,206,82.40,,144.2,70,,115.36,percent of total billed charges,70% of total billed charges,206,100,,164.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,168.92,82,,135.136,percent of total billed charges,82% of total billed charges,175.1,85,,140.08,percent of total billed charges,85% of total billed charges,175.1,85,,140.08,percent of total billed charges,85% of total billed charges,175.1,85,,140.08,percent of total billed charges,85% of total billed charges,185.4,90,,148.32,percent of total billed charges,90% of total billed charges,164.8,80,,131.84,percent of total billed charges,80% of total billed charges,185.4,90,,148.32,percent of total billed charges,90% of total billed charges,154.5,75,,123.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,59.74,29,,47.792,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,138.02,67,,110.416,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,144.2,70,,115.36,percent of total billed charges,70% of total billed charges,133.9,65,,107.12,percent of total billed charges,65% of total billed charges,73.48,35.67,,58.784,percent of total billed charges,35.67% of total billed charges,59.74,206,
3.5 CORTICAL S/TAP SCREW 10,27005252,CDM,278,RC,C1713,HCPCS,outpatient,,,157,62.80,,109.9,70,,87.92,percent of total billed charges,70% of total billed charges,157,100,,125.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,128.74,82,,102.992,percent of total billed charges,82% of total billed charges,133.45,85,,106.76,percent of total billed charges,85% of total billed charges,133.45,85,,106.76,percent of total billed charges,85% of total billed charges,133.45,85,,106.76,percent of total billed charges,85% of total billed charges,141.3,90,,113.04,percent of total billed charges,90% of total billed charges,125.6,80,,100.48,percent of total billed charges,80% of total billed charges,141.3,90,,113.04,percent of total billed charges,90% of total billed charges,117.75,75,,94.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,45.53,29,,36.424,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,105.19,67,,84.152,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,109.9,70,,87.92,percent of total billed charges,70% of total billed charges,102.05,65,,81.64,percent of total billed charges,65% of total billed charges,56,35.67,,44.8,percent of total billed charges,35.67% of total billed charges,45.53,157,
CORTICAL SCREW 3.5 N/S TAP 12,27005253,CDM,278,RC,C1713,HCPCS,outpatient,,,185,74.00,,129.5,70,,103.6,percent of total billed charges,70% of total billed charges,185,100,,148,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,151.7,82,,121.36,percent of total billed charges,82% of total billed charges,157.25,85,,125.8,percent of total billed charges,85% of total billed charges,157.25,85,,125.8,percent of total billed charges,85% of total billed charges,157.25,85,,125.8,percent of total billed charges,85% of total billed charges,166.5,90,,133.2,percent of total billed charges,90% of total billed charges,148,80,,118.4,percent of total billed charges,80% of total billed charges,166.5,90,,133.2,percent of total billed charges,90% of total billed charges,138.75,75,,111,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,53.65,29,,42.92,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,123.95,67,,99.16,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,129.5,70,,103.6,percent of total billed charges,70% of total billed charges,120.25,65,,96.2,percent of total billed charges,65% of total billed charges,65.99,35.67,,52.792,percent of total billed charges,35.67% of total billed charges,53.65,185,
3.5 CORTICAL S/TAP SCREW 22,27005254,CDM,278,RC,C1713,HCPCS,outpatient,,,185,74.00,,129.5,70,,103.6,percent of total billed charges,70% of total billed charges,185,100,,148,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,151.7,82,,121.36,percent of total billed charges,82% of total billed charges,157.25,85,,125.8,percent of total billed charges,85% of total billed charges,157.25,85,,125.8,percent of total billed charges,85% of total billed charges,157.25,85,,125.8,percent of total billed charges,85% of total billed charges,166.5,90,,133.2,percent of total billed charges,90% of total billed charges,148,80,,118.4,percent of total billed charges,80% of total billed charges,166.5,90,,133.2,percent of total billed charges,90% of total billed charges,138.75,75,,111,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,53.65,29,,42.92,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,123.95,67,,99.16,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,129.5,70,,103.6,percent of total billed charges,70% of total billed charges,120.25,65,,96.2,percent of total billed charges,65% of total billed charges,65.99,35.67,,52.792,percent of total billed charges,35.67% of total billed charges,53.65,185,
3.5 CORTICAL N/S TAP 24 SCREW,27005255,CDM,278,RC,C1713,HCPCS,outpatient,,,185,74.00,,129.5,70,,103.6,percent of total billed charges,70% of total billed charges,185,100,,148,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,151.7,82,,121.36,percent of total billed charges,82% of total billed charges,157.25,85,,125.8,percent of total billed charges,85% of total billed charges,157.25,85,,125.8,percent of total billed charges,85% of total billed charges,157.25,85,,125.8,percent of total billed charges,85% of total billed charges,166.5,90,,133.2,percent of total billed charges,90% of total billed charges,148,80,,118.4,percent of total billed charges,80% of total billed charges,166.5,90,,133.2,percent of total billed charges,90% of total billed charges,138.75,75,,111,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,53.65,29,,42.92,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,123.95,67,,99.16,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,129.5,70,,103.6,percent of total billed charges,70% of total billed charges,120.25,65,,96.2,percent of total billed charges,65% of total billed charges,65.99,35.67,,52.792,percent of total billed charges,35.67% of total billed charges,53.65,185,
3.5 CORTICAL S/TAP SCREW 38,27005256,CDM,278,RC,C1713,HCPCS,outpatient,,,157,62.80,,109.9,70,,87.92,percent of total billed charges,70% of total billed charges,157,100,,125.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,128.74,82,,102.992,percent of total billed charges,82% of total billed charges,133.45,85,,106.76,percent of total billed charges,85% of total billed charges,133.45,85,,106.76,percent of total billed charges,85% of total billed charges,133.45,85,,106.76,percent of total billed charges,85% of total billed charges,141.3,90,,113.04,percent of total billed charges,90% of total billed charges,125.6,80,,100.48,percent of total billed charges,80% of total billed charges,141.3,90,,113.04,percent of total billed charges,90% of total billed charges,117.75,75,,94.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,45.53,29,,36.424,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,105.19,67,,84.152,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,109.9,70,,87.92,percent of total billed charges,70% of total billed charges,102.05,65,,81.64,percent of total billed charges,65% of total billed charges,56,35.67,,44.8,percent of total billed charges,35.67% of total billed charges,45.53,157,
3.5 CORTICAL S/TAP SCREW 45,27005257,CDM,278,RC,C1713,HCPCS,outpatient,,,157,62.80,,109.9,70,,87.92,percent of total billed charges,70% of total billed charges,157,100,,125.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,128.74,82,,102.992,percent of total billed charges,82% of total billed charges,133.45,85,,106.76,percent of total billed charges,85% of total billed charges,133.45,85,,106.76,percent of total billed charges,85% of total billed charges,133.45,85,,106.76,percent of total billed charges,85% of total billed charges,141.3,90,,113.04,percent of total billed charges,90% of total billed charges,125.6,80,,100.48,percent of total billed charges,80% of total billed charges,141.3,90,,113.04,percent of total billed charges,90% of total billed charges,117.75,75,,94.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,45.53,29,,36.424,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,105.19,67,,84.152,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,109.9,70,,87.92,percent of total billed charges,70% of total billed charges,102.05,65,,81.64,percent of total billed charges,65% of total billed charges,56,35.67,,44.8,percent of total billed charges,35.67% of total billed charges,45.53,157,
3.5 CORTICAL SHAFT SCREW 16,27005258,CDM,278,RC,C1713,HCPCS,outpatient,,,149,59.60,,104.3,70,,83.44,percent of total billed charges,70% of total billed charges,149,100,,119.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,122.18,82,,97.744,percent of total billed charges,82% of total billed charges,126.65,85,,101.32,percent of total billed charges,85% of total billed charges,126.65,85,,101.32,percent of total billed charges,85% of total billed charges,126.65,85,,101.32,percent of total billed charges,85% of total billed charges,134.1,90,,107.28,percent of total billed charges,90% of total billed charges,119.2,80,,95.36,percent of total billed charges,80% of total billed charges,134.1,90,,107.28,percent of total billed charges,90% of total billed charges,111.75,75,,89.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,43.21,29,,34.568,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,99.83,67,,79.864,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,104.3,70,,83.44,percent of total billed charges,70% of total billed charges,96.85,65,,77.48,percent of total billed charges,65% of total billed charges,53.15,35.67,,42.52,percent of total billed charges,35.67% of total billed charges,43.21,149,
3.5 CORTICAL SHAFT SCREW 18,27005259,CDM,278,RC,C1713,HCPCS,outpatient,,,149,59.60,,104.3,70,,83.44,percent of total billed charges,70% of total billed charges,149,100,,119.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,122.18,82,,97.744,percent of total billed charges,82% of total billed charges,126.65,85,,101.32,percent of total billed charges,85% of total billed charges,126.65,85,,101.32,percent of total billed charges,85% of total billed charges,126.65,85,,101.32,percent of total billed charges,85% of total billed charges,134.1,90,,107.28,percent of total billed charges,90% of total billed charges,119.2,80,,95.36,percent of total billed charges,80% of total billed charges,134.1,90,,107.28,percent of total billed charges,90% of total billed charges,111.75,75,,89.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,43.21,29,,34.568,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,99.83,67,,79.864,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,104.3,70,,83.44,percent of total billed charges,70% of total billed charges,96.85,65,,77.48,percent of total billed charges,65% of total billed charges,53.15,35.67,,42.52,percent of total billed charges,35.67% of total billed charges,43.21,149,
3.5 CORTICAL SHAFT SCREW 20,27005260,CDM,278,RC,C1713,HCPCS,outpatient,,,149,59.60,,104.3,70,,83.44,percent of total billed charges,70% of total billed charges,149,100,,119.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,122.18,82,,97.744,percent of total billed charges,82% of total billed charges,126.65,85,,101.32,percent of total billed charges,85% of total billed charges,126.65,85,,101.32,percent of total billed charges,85% of total billed charges,126.65,85,,101.32,percent of total billed charges,85% of total billed charges,134.1,90,,107.28,percent of total billed charges,90% of total billed charges,119.2,80,,95.36,percent of total billed charges,80% of total billed charges,134.1,90,,107.28,percent of total billed charges,90% of total billed charges,111.75,75,,89.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,43.21,29,,34.568,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,99.83,67,,79.864,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,104.3,70,,83.44,percent of total billed charges,70% of total billed charges,96.85,65,,77.48,percent of total billed charges,65% of total billed charges,53.15,35.67,,42.52,percent of total billed charges,35.67% of total billed charges,43.21,149,
3.5 CORTICAL SHAFT SCREW 22,27005261,CDM,278,RC,C1713,HCPCS,outpatient,,,149,59.60,,104.3,70,,83.44,percent of total billed charges,70% of total billed charges,149,100,,119.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,122.18,82,,97.744,percent of total billed charges,82% of total billed charges,126.65,85,,101.32,percent of total billed charges,85% of total billed charges,126.65,85,,101.32,percent of total billed charges,85% of total billed charges,126.65,85,,101.32,percent of total billed charges,85% of total billed charges,134.1,90,,107.28,percent of total billed charges,90% of total billed charges,119.2,80,,95.36,percent of total billed charges,80% of total billed charges,134.1,90,,107.28,percent of total billed charges,90% of total billed charges,111.75,75,,89.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,43.21,29,,34.568,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,99.83,67,,79.864,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,104.3,70,,83.44,percent of total billed charges,70% of total billed charges,96.85,65,,77.48,percent of total billed charges,65% of total billed charges,53.15,35.67,,42.52,percent of total billed charges,35.67% of total billed charges,43.21,149,
3.5 CORTICAL SHAFT SCREW 24,27005262,CDM,278,RC,C1713,HCPCS,outpatient,,,149,59.60,,104.3,70,,83.44,percent of total billed charges,70% of total billed charges,149,100,,119.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,122.18,82,,97.744,percent of total billed charges,82% of total billed charges,126.65,85,,101.32,percent of total billed charges,85% of total billed charges,126.65,85,,101.32,percent of total billed charges,85% of total billed charges,126.65,85,,101.32,percent of total billed charges,85% of total billed charges,134.1,90,,107.28,percent of total billed charges,90% of total billed charges,119.2,80,,95.36,percent of total billed charges,80% of total billed charges,134.1,90,,107.28,percent of total billed charges,90% of total billed charges,111.75,75,,89.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,43.21,29,,34.568,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,99.83,67,,79.864,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,104.3,70,,83.44,percent of total billed charges,70% of total billed charges,96.85,65,,77.48,percent of total billed charges,65% of total billed charges,53.15,35.67,,42.52,percent of total billed charges,35.67% of total billed charges,43.21,149,
4.5 BROAD COMPRESSION PLATE 6H,27005263,CDM,278,RC,C1713,HCPCS,outpatient,,,832,332.80,,582.4,70,,465.92,percent of total billed charges,70% of total billed charges,832,100,,665.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,682.24,82,,545.792,percent of total billed charges,82% of total billed charges,707.2,85,,565.76,percent of total billed charges,85% of total billed charges,707.2,85,,565.76,percent of total billed charges,85% of total billed charges,707.2,85,,565.76,percent of total billed charges,85% of total billed charges,748.8,90,,599.04,percent of total billed charges,90% of total billed charges,665.6,80,,532.48,percent of total billed charges,80% of total billed charges,748.8,90,,599.04,percent of total billed charges,90% of total billed charges,624,75,,499.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,241.28,29,,193.024,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,557.44,67,,445.952,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,582.4,70,,465.92,percent of total billed charges,70% of total billed charges,540.8,65,,432.64,percent of total billed charges,65% of total billed charges,296.77,35.67,,237.416,percent of total billed charges,35.67% of total billed charges,241.28,832,
3.5 CORTICAL SHAFT SCREW 26,27005264,CDM,278,RC,C1713,HCPCS,outpatient,,,149,59.60,,104.3,70,,83.44,percent of total billed charges,70% of total billed charges,149,100,,119.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,122.18,82,,97.744,percent of total billed charges,82% of total billed charges,126.65,85,,101.32,percent of total billed charges,85% of total billed charges,126.65,85,,101.32,percent of total billed charges,85% of total billed charges,126.65,85,,101.32,percent of total billed charges,85% of total billed charges,134.1,90,,107.28,percent of total billed charges,90% of total billed charges,119.2,80,,95.36,percent of total billed charges,80% of total billed charges,134.1,90,,107.28,percent of total billed charges,90% of total billed charges,111.75,75,,89.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,43.21,29,,34.568,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,99.83,67,,79.864,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,104.3,70,,83.44,percent of total billed charges,70% of total billed charges,96.85,65,,77.48,percent of total billed charges,65% of total billed charges,53.15,35.67,,42.52,percent of total billed charges,35.67% of total billed charges,43.21,149,
3.5 CORTICAL SHAFT SCREW 28,27005267,CDM,278,RC,C1713,HCPCS,outpatient,,,149,59.60,,104.3,70,,83.44,percent of total billed charges,70% of total billed charges,149,100,,119.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,122.18,82,,97.744,percent of total billed charges,82% of total billed charges,126.65,85,,101.32,percent of total billed charges,85% of total billed charges,126.65,85,,101.32,percent of total billed charges,85% of total billed charges,126.65,85,,101.32,percent of total billed charges,85% of total billed charges,134.1,90,,107.28,percent of total billed charges,90% of total billed charges,119.2,80,,95.36,percent of total billed charges,80% of total billed charges,134.1,90,,107.28,percent of total billed charges,90% of total billed charges,111.75,75,,89.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,43.21,29,,34.568,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,99.83,67,,79.864,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,104.3,70,,83.44,percent of total billed charges,70% of total billed charges,96.85,65,,77.48,percent of total billed charges,65% of total billed charges,53.15,35.67,,42.52,percent of total billed charges,35.67% of total billed charges,43.21,149,
4.5 BROAD COMPRESSION PLATE 9H,27005268,CDM,278,RC,C1713,HCPCS,outpatient,,,818,327.20,,572.6,70,,458.08,percent of total billed charges,70% of total billed charges,818,100,,654.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,670.76,82,,536.608,percent of total billed charges,82% of total billed charges,695.3,85,,556.24,percent of total billed charges,85% of total billed charges,695.3,85,,556.24,percent of total billed charges,85% of total billed charges,695.3,85,,556.24,percent of total billed charges,85% of total billed charges,736.2,90,,588.96,percent of total billed charges,90% of total billed charges,654.4,80,,523.52,percent of total billed charges,80% of total billed charges,736.2,90,,588.96,percent of total billed charges,90% of total billed charges,613.5,75,,490.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,237.22,29,,189.776,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,548.06,67,,438.448,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,572.6,70,,458.08,percent of total billed charges,70% of total billed charges,531.7,65,,425.36,percent of total billed charges,65% of total billed charges,291.78,35.67,,233.424,percent of total billed charges,35.67% of total billed charges,237.22,818,
3.5 CORTICAL SHAFT SCREW 30,27005269,CDM,278,RC,C1713,HCPCS,outpatient,,,149,59.60,,104.3,70,,83.44,percent of total billed charges,70% of total billed charges,149,100,,119.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,122.18,82,,97.744,percent of total billed charges,82% of total billed charges,126.65,85,,101.32,percent of total billed charges,85% of total billed charges,126.65,85,,101.32,percent of total billed charges,85% of total billed charges,126.65,85,,101.32,percent of total billed charges,85% of total billed charges,134.1,90,,107.28,percent of total billed charges,90% of total billed charges,119.2,80,,95.36,percent of total billed charges,80% of total billed charges,134.1,90,,107.28,percent of total billed charges,90% of total billed charges,111.75,75,,89.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,43.21,29,,34.568,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,99.83,67,,79.864,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,104.3,70,,83.44,percent of total billed charges,70% of total billed charges,96.85,65,,77.48,percent of total billed charges,65% of total billed charges,53.15,35.67,,42.52,percent of total billed charges,35.67% of total billed charges,43.21,149,
3.5 CORTICAL SHAFT SCREW 32,27005270,CDM,278,RC,C1713,HCPCS,outpatient,,,149,59.60,,104.3,70,,83.44,percent of total billed charges,70% of total billed charges,149,100,,119.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,122.18,82,,97.744,percent of total billed charges,82% of total billed charges,126.65,85,,101.32,percent of total billed charges,85% of total billed charges,126.65,85,,101.32,percent of total billed charges,85% of total billed charges,126.65,85,,101.32,percent of total billed charges,85% of total billed charges,134.1,90,,107.28,percent of total billed charges,90% of total billed charges,119.2,80,,95.36,percent of total billed charges,80% of total billed charges,134.1,90,,107.28,percent of total billed charges,90% of total billed charges,111.75,75,,89.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,43.21,29,,34.568,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,99.83,67,,79.864,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,104.3,70,,83.44,percent of total billed charges,70% of total billed charges,96.85,65,,77.48,percent of total billed charges,65% of total billed charges,53.15,35.67,,42.52,percent of total billed charges,35.67% of total billed charges,43.21,149,
4.5 BROAD COMP PLATE 10H,27005271,CDM,278,RC,C1713,HCPCS,outpatient,,,818,327.20,,572.6,70,,458.08,percent of total billed charges,70% of total billed charges,818,100,,654.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,670.76,82,,536.608,percent of total billed charges,82% of total billed charges,695.3,85,,556.24,percent of total billed charges,85% of total billed charges,695.3,85,,556.24,percent of total billed charges,85% of total billed charges,695.3,85,,556.24,percent of total billed charges,85% of total billed charges,736.2,90,,588.96,percent of total billed charges,90% of total billed charges,654.4,80,,523.52,percent of total billed charges,80% of total billed charges,736.2,90,,588.96,percent of total billed charges,90% of total billed charges,613.5,75,,490.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,237.22,29,,189.776,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,548.06,67,,438.448,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,572.6,70,,458.08,percent of total billed charges,70% of total billed charges,531.7,65,,425.36,percent of total billed charges,65% of total billed charges,291.78,35.67,,233.424,percent of total billed charges,35.67% of total billed charges,237.22,818,
3.5 CORTICAL SHAFT SCREW 34,27005272,CDM,278,RC,C1713,HCPCS,outpatient,,,149,59.60,,104.3,70,,83.44,percent of total billed charges,70% of total billed charges,149,100,,119.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,122.18,82,,97.744,percent of total billed charges,82% of total billed charges,126.65,85,,101.32,percent of total billed charges,85% of total billed charges,126.65,85,,101.32,percent of total billed charges,85% of total billed charges,126.65,85,,101.32,percent of total billed charges,85% of total billed charges,134.1,90,,107.28,percent of total billed charges,90% of total billed charges,119.2,80,,95.36,percent of total billed charges,80% of total billed charges,134.1,90,,107.28,percent of total billed charges,90% of total billed charges,111.75,75,,89.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,43.21,29,,34.568,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,99.83,67,,79.864,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,104.3,70,,83.44,percent of total billed charges,70% of total billed charges,96.85,65,,77.48,percent of total billed charges,65% of total billed charges,53.15,35.67,,42.52,percent of total billed charges,35.67% of total billed charges,43.21,149,
4.5 BROAD COMP PLATE 11H,27005273,CDM,278,RC,C1713,HCPCS,outpatient,,,866,346.40,,606.2,70,,484.96,percent of total billed charges,70% of total billed charges,866,100,,692.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,710.12,82,,568.096,percent of total billed charges,82% of total billed charges,736.1,85,,588.88,percent of total billed charges,85% of total billed charges,736.1,85,,588.88,percent of total billed charges,85% of total billed charges,736.1,85,,588.88,percent of total billed charges,85% of total billed charges,779.4,90,,623.52,percent of total billed charges,90% of total billed charges,692.8,80,,554.24,percent of total billed charges,80% of total billed charges,779.4,90,,623.52,percent of total billed charges,90% of total billed charges,649.5,75,,519.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,251.14,29,,200.912,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,580.22,67,,464.176,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,606.2,70,,484.96,percent of total billed charges,70% of total billed charges,562.9,65,,450.32,percent of total billed charges,65% of total billed charges,308.9,35.67,,247.12,percent of total billed charges,35.67% of total billed charges,251.14,866,
3.5 CORTICAL SHAFT SCREW 36,27005274,CDM,278,RC,C1713,HCPCS,outpatient,,,149,59.60,,104.3,70,,83.44,percent of total billed charges,70% of total billed charges,149,100,,119.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,122.18,82,,97.744,percent of total billed charges,82% of total billed charges,126.65,85,,101.32,percent of total billed charges,85% of total billed charges,126.65,85,,101.32,percent of total billed charges,85% of total billed charges,126.65,85,,101.32,percent of total billed charges,85% of total billed charges,134.1,90,,107.28,percent of total billed charges,90% of total billed charges,119.2,80,,95.36,percent of total billed charges,80% of total billed charges,134.1,90,,107.28,percent of total billed charges,90% of total billed charges,111.75,75,,89.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,43.21,29,,34.568,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,99.83,67,,79.864,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,104.3,70,,83.44,percent of total billed charges,70% of total billed charges,96.85,65,,77.48,percent of total billed charges,65% of total billed charges,53.15,35.67,,42.52,percent of total billed charges,35.67% of total billed charges,43.21,149,
4.5 BROAD COMP PLATE 12H,27005275,CDM,278,RC,C1713,HCPCS,outpatient,,,882,352.80,,617.4,70,,493.92,percent of total billed charges,70% of total billed charges,882,100,,705.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,723.24,82,,578.592,percent of total billed charges,82% of total billed charges,749.7,85,,599.76,percent of total billed charges,85% of total billed charges,749.7,85,,599.76,percent of total billed charges,85% of total billed charges,749.7,85,,599.76,percent of total billed charges,85% of total billed charges,793.8,90,,635.04,percent of total billed charges,90% of total billed charges,705.6,80,,564.48,percent of total billed charges,80% of total billed charges,793.8,90,,635.04,percent of total billed charges,90% of total billed charges,661.5,75,,529.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,255.78,29,,204.624,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,590.94,67,,472.752,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,617.4,70,,493.92,percent of total billed charges,70% of total billed charges,573.3,65,,458.64,percent of total billed charges,65% of total billed charges,314.61,35.67,,251.688,percent of total billed charges,35.67% of total billed charges,255.78,882,
3.5 CORTICAL SHAFT SCREW 38,27005276,CDM,278,RC,C1713,HCPCS,outpatient,,,149,59.60,,104.3,70,,83.44,percent of total billed charges,70% of total billed charges,149,100,,119.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,122.18,82,,97.744,percent of total billed charges,82% of total billed charges,126.65,85,,101.32,percent of total billed charges,85% of total billed charges,126.65,85,,101.32,percent of total billed charges,85% of total billed charges,126.65,85,,101.32,percent of total billed charges,85% of total billed charges,134.1,90,,107.28,percent of total billed charges,90% of total billed charges,119.2,80,,95.36,percent of total billed charges,80% of total billed charges,134.1,90,,107.28,percent of total billed charges,90% of total billed charges,111.75,75,,89.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,43.21,29,,34.568,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,99.83,67,,79.864,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,104.3,70,,83.44,percent of total billed charges,70% of total billed charges,96.85,65,,77.48,percent of total billed charges,65% of total billed charges,53.15,35.67,,42.52,percent of total billed charges,35.67% of total billed charges,43.21,149,
3.5 CORTICAL SHAFT SCREW 40,27005277,CDM,278,RC,C1713,HCPCS,outpatient,,,149,59.60,,104.3,70,,83.44,percent of total billed charges,70% of total billed charges,149,100,,119.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,122.18,82,,97.744,percent of total billed charges,82% of total billed charges,126.65,85,,101.32,percent of total billed charges,85% of total billed charges,126.65,85,,101.32,percent of total billed charges,85% of total billed charges,126.65,85,,101.32,percent of total billed charges,85% of total billed charges,134.1,90,,107.28,percent of total billed charges,90% of total billed charges,119.2,80,,95.36,percent of total billed charges,80% of total billed charges,134.1,90,,107.28,percent of total billed charges,90% of total billed charges,111.75,75,,89.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,43.21,29,,34.568,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,99.83,67,,79.864,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,104.3,70,,83.44,percent of total billed charges,70% of total billed charges,96.85,65,,77.48,percent of total billed charges,65% of total billed charges,53.15,35.67,,42.52,percent of total billed charges,35.67% of total billed charges,43.21,149,
4.5 BROAD COMP PLATE 14H,27005278,CDM,278,RC,C1713,HCPCS,outpatient,,,882,352.80,,617.4,70,,493.92,percent of total billed charges,70% of total billed charges,882,100,,705.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,723.24,82,,578.592,percent of total billed charges,82% of total billed charges,749.7,85,,599.76,percent of total billed charges,85% of total billed charges,749.7,85,,599.76,percent of total billed charges,85% of total billed charges,749.7,85,,599.76,percent of total billed charges,85% of total billed charges,793.8,90,,635.04,percent of total billed charges,90% of total billed charges,705.6,80,,564.48,percent of total billed charges,80% of total billed charges,793.8,90,,635.04,percent of total billed charges,90% of total billed charges,661.5,75,,529.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,255.78,29,,204.624,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,590.94,67,,472.752,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,617.4,70,,493.92,percent of total billed charges,70% of total billed charges,573.3,65,,458.64,percent of total billed charges,65% of total billed charges,314.61,35.67,,251.688,percent of total billed charges,35.67% of total billed charges,255.78,882,
3.5 CORTICAL SHAFT SCREW 45,27005279,CDM,278,RC,,,outpatient,,,149,59.60,,104.3,70,,83.44,percent of total billed charges,70% of total billed charges,149,100,,119.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,122.18,82,,97.744,percent of total billed charges,82% of total billed charges,126.65,85,,101.32,percent of total billed charges,85% of total billed charges,126.65,85,,101.32,percent of total billed charges,85% of total billed charges,126.65,85,,101.32,percent of total billed charges,85% of total billed charges,134.1,90,,107.28,percent of total billed charges,90% of total billed charges,119.2,80,,95.36,percent of total billed charges,80% of total billed charges,134.1,90,,107.28,percent of total billed charges,90% of total billed charges,111.75,75,,89.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,43.21,29,,34.568,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,99.83,67,,79.864,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,104.3,70,,83.44,percent of total billed charges,70% of total billed charges,96.85,65,,77.48,percent of total billed charges,65% of total billed charges,53.15,35.67,,42.52,percent of total billed charges,35.67% of total billed charges,43.21,149,
4.5 NARROW COMP PLATE 4H,27005280,CDM,278,RC,C1713,HCPCS,outpatient,,,544,217.60,,380.8,70,,304.64,percent of total billed charges,70% of total billed charges,544,100,,435.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,446.08,82,,356.864,percent of total billed charges,82% of total billed charges,462.4,85,,369.92,percent of total billed charges,85% of total billed charges,462.4,85,,369.92,percent of total billed charges,85% of total billed charges,462.4,85,,369.92,percent of total billed charges,85% of total billed charges,489.6,90,,391.68,percent of total billed charges,90% of total billed charges,435.2,80,,348.16,percent of total billed charges,80% of total billed charges,489.6,90,,391.68,percent of total billed charges,90% of total billed charges,408,75,,326.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,157.76,29,,126.208,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,364.48,67,,291.584,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,380.8,70,,304.64,percent of total billed charges,70% of total billed charges,353.6,65,,282.88,percent of total billed charges,65% of total billed charges,194.04,35.67,,155.232,percent of total billed charges,35.67% of total billed charges,157.76,544,
3.5 CORTICAL SHAFT SCREW 50,27005281,CDM,278,RC,C1713,HCPCS,outpatient,,,149,59.60,,104.3,70,,83.44,percent of total billed charges,70% of total billed charges,149,100,,119.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,122.18,82,,97.744,percent of total billed charges,82% of total billed charges,126.65,85,,101.32,percent of total billed charges,85% of total billed charges,126.65,85,,101.32,percent of total billed charges,85% of total billed charges,126.65,85,,101.32,percent of total billed charges,85% of total billed charges,134.1,90,,107.28,percent of total billed charges,90% of total billed charges,119.2,80,,95.36,percent of total billed charges,80% of total billed charges,134.1,90,,107.28,percent of total billed charges,90% of total billed charges,111.75,75,,89.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,43.21,29,,34.568,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,99.83,67,,79.864,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,104.3,70,,83.44,percent of total billed charges,70% of total billed charges,96.85,65,,77.48,percent of total billed charges,65% of total billed charges,53.15,35.67,,42.52,percent of total billed charges,35.67% of total billed charges,43.21,149,
4.5 NARROW COMP PLATE 5H,27005282,CDM,278,RC,C1713,HCPCS,outpatient,,,544,217.60,,380.8,70,,304.64,percent of total billed charges,70% of total billed charges,544,100,,435.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,446.08,82,,356.864,percent of total billed charges,82% of total billed charges,462.4,85,,369.92,percent of total billed charges,85% of total billed charges,462.4,85,,369.92,percent of total billed charges,85% of total billed charges,462.4,85,,369.92,percent of total billed charges,85% of total billed charges,489.6,90,,391.68,percent of total billed charges,90% of total billed charges,435.2,80,,348.16,percent of total billed charges,80% of total billed charges,489.6,90,,391.68,percent of total billed charges,90% of total billed charges,408,75,,326.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,157.76,29,,126.208,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,364.48,67,,291.584,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,380.8,70,,304.64,percent of total billed charges,70% of total billed charges,353.6,65,,282.88,percent of total billed charges,65% of total billed charges,194.04,35.67,,155.232,percent of total billed charges,35.67% of total billed charges,157.76,544,
4.0 CANCELLOUS SCREW P/THR 10,27005283,CDM,278,RC,C1713,HCPCS,outpatient,,,130,52.00,,91,70,,72.8,percent of total billed charges,70% of total billed charges,130,100,,104,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,106.6,82,,85.28,percent of total billed charges,82% of total billed charges,110.5,85,,88.4,percent of total billed charges,85% of total billed charges,110.5,85,,88.4,percent of total billed charges,85% of total billed charges,110.5,85,,88.4,percent of total billed charges,85% of total billed charges,117,90,,93.6,percent of total billed charges,90% of total billed charges,104,80,,83.2,percent of total billed charges,80% of total billed charges,117,90,,93.6,percent of total billed charges,90% of total billed charges,97.5,75,,78,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,37.7,29,,30.16,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,87.1,67,,69.68,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,91,70,,72.8,percent of total billed charges,70% of total billed charges,84.5,65,,67.6,percent of total billed charges,65% of total billed charges,46.37,35.67,,37.096,percent of total billed charges,35.67% of total billed charges,37.7,130,
4.5 NARROW COMP PLATE 6H,27005284,CDM,278,RC,C1713,HCPCS,outpatient,,,787,314.80,,550.9,70,,440.72,percent of total billed charges,70% of total billed charges,787,100,,629.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,645.34,82,,516.272,percent of total billed charges,82% of total billed charges,668.95,85,,535.16,percent of total billed charges,85% of total billed charges,668.95,85,,535.16,percent of total billed charges,85% of total billed charges,668.95,85,,535.16,percent of total billed charges,85% of total billed charges,708.3,90,,566.64,percent of total billed charges,90% of total billed charges,629.6,80,,503.68,percent of total billed charges,80% of total billed charges,708.3,90,,566.64,percent of total billed charges,90% of total billed charges,590.25,75,,472.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,228.23,29,,182.584,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,527.29,67,,421.832,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,550.9,70,,440.72,percent of total billed charges,70% of total billed charges,511.55,65,,409.24,percent of total billed charges,65% of total billed charges,280.72,35.67,,224.576,percent of total billed charges,35.67% of total billed charges,228.23,787,
4.5 NARROW COMP PLATE 7H,27005285,CDM,278,RC,C1713,HCPCS,outpatient,,,614,245.60,,429.8,70,,343.84,percent of total billed charges,70% of total billed charges,614,100,,491.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,503.48,82,,402.784,percent of total billed charges,82% of total billed charges,521.9,85,,417.52,percent of total billed charges,85% of total billed charges,521.9,85,,417.52,percent of total billed charges,85% of total billed charges,521.9,85,,417.52,percent of total billed charges,85% of total billed charges,552.6,90,,442.08,percent of total billed charges,90% of total billed charges,491.2,80,,392.96,percent of total billed charges,80% of total billed charges,552.6,90,,442.08,percent of total billed charges,90% of total billed charges,460.5,75,,368.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,178.06,29,,142.448,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,411.38,67,,329.104,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,429.8,70,,343.84,percent of total billed charges,70% of total billed charges,399.1,65,,319.28,percent of total billed charges,65% of total billed charges,219.01,35.67,,175.208,percent of total billed charges,35.67% of total billed charges,178.06,614,
4.0 CANCELLOUS SCREW P/THR 12,27005286,CDM,278,RC,C1713,HCPCS,outpatient,,,130,52.00,,91,70,,72.8,percent of total billed charges,70% of total billed charges,130,100,,104,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,106.6,82,,85.28,percent of total billed charges,82% of total billed charges,110.5,85,,88.4,percent of total billed charges,85% of total billed charges,110.5,85,,88.4,percent of total billed charges,85% of total billed charges,110.5,85,,88.4,percent of total billed charges,85% of total billed charges,117,90,,93.6,percent of total billed charges,90% of total billed charges,104,80,,83.2,percent of total billed charges,80% of total billed charges,117,90,,93.6,percent of total billed charges,90% of total billed charges,97.5,75,,78,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,37.7,29,,30.16,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,87.1,67,,69.68,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,91,70,,72.8,percent of total billed charges,70% of total billed charges,84.5,65,,67.6,percent of total billed charges,65% of total billed charges,46.37,35.67,,37.096,percent of total billed charges,35.67% of total billed charges,37.7,130,
4.0 CANCELLOUS SCREW P/THR 14,27005287,CDM,278,RC,C1713,HCPCS,outpatient,,,130,52.00,,91,70,,72.8,percent of total billed charges,70% of total billed charges,130,100,,104,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,106.6,82,,85.28,percent of total billed charges,82% of total billed charges,110.5,85,,88.4,percent of total billed charges,85% of total billed charges,110.5,85,,88.4,percent of total billed charges,85% of total billed charges,110.5,85,,88.4,percent of total billed charges,85% of total billed charges,117,90,,93.6,percent of total billed charges,90% of total billed charges,104,80,,83.2,percent of total billed charges,80% of total billed charges,117,90,,93.6,percent of total billed charges,90% of total billed charges,97.5,75,,78,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,37.7,29,,30.16,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,87.1,67,,69.68,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,91,70,,72.8,percent of total billed charges,70% of total billed charges,84.5,65,,67.6,percent of total billed charges,65% of total billed charges,46.37,35.67,,37.096,percent of total billed charges,35.67% of total billed charges,37.7,130,
4.5 NARROW COMP PLATE 9H,27005288,CDM,278,RC,C1713,HCPCS,outpatient,,,614,245.60,,429.8,70,,343.84,percent of total billed charges,70% of total billed charges,614,100,,491.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,503.48,82,,402.784,percent of total billed charges,82% of total billed charges,521.9,85,,417.52,percent of total billed charges,85% of total billed charges,521.9,85,,417.52,percent of total billed charges,85% of total billed charges,521.9,85,,417.52,percent of total billed charges,85% of total billed charges,552.6,90,,442.08,percent of total billed charges,90% of total billed charges,491.2,80,,392.96,percent of total billed charges,80% of total billed charges,552.6,90,,442.08,percent of total billed charges,90% of total billed charges,460.5,75,,368.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,178.06,29,,142.448,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,411.38,67,,329.104,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,429.8,70,,343.84,percent of total billed charges,70% of total billed charges,399.1,65,,319.28,percent of total billed charges,65% of total billed charges,219.01,35.67,,175.208,percent of total billed charges,35.67% of total billed charges,178.06,614,
4.0 CANCELLOUS SCREW P/THR 16,27005289,CDM,278,RC,C1713,HCPCS,outpatient,,,130,52.00,,91,70,,72.8,percent of total billed charges,70% of total billed charges,130,100,,104,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,106.6,82,,85.28,percent of total billed charges,82% of total billed charges,110.5,85,,88.4,percent of total billed charges,85% of total billed charges,110.5,85,,88.4,percent of total billed charges,85% of total billed charges,110.5,85,,88.4,percent of total billed charges,85% of total billed charges,117,90,,93.6,percent of total billed charges,90% of total billed charges,104,80,,83.2,percent of total billed charges,80% of total billed charges,117,90,,93.6,percent of total billed charges,90% of total billed charges,97.5,75,,78,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,37.7,29,,30.16,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,87.1,67,,69.68,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,91,70,,72.8,percent of total billed charges,70% of total billed charges,84.5,65,,67.6,percent of total billed charges,65% of total billed charges,46.37,35.67,,37.096,percent of total billed charges,35.67% of total billed charges,37.7,130,
4.5 NARROW COMP PLATE 10H,27005290,CDM,278,RC,C1713,HCPCS,outpatient,,,816,326.40,,571.2,70,,456.96,percent of total billed charges,70% of total billed charges,816,100,,652.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,669.12,82,,535.296,percent of total billed charges,82% of total billed charges,693.6,85,,554.88,percent of total billed charges,85% of total billed charges,693.6,85,,554.88,percent of total billed charges,85% of total billed charges,693.6,85,,554.88,percent of total billed charges,85% of total billed charges,734.4,90,,587.52,percent of total billed charges,90% of total billed charges,652.8,80,,522.24,percent of total billed charges,80% of total billed charges,734.4,90,,587.52,percent of total billed charges,90% of total billed charges,612,75,,489.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,236.64,29,,189.312,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,546.72,67,,437.376,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,571.2,70,,456.96,percent of total billed charges,70% of total billed charges,530.4,65,,424.32,percent of total billed charges,65% of total billed charges,291.07,35.67,,232.856,percent of total billed charges,35.67% of total billed charges,236.64,816,
4.0 CANCELLOUS SCREW P/THR 18,27005291,CDM,278,RC,C1713,HCPCS,outpatient,,,130,52.00,,91,70,,72.8,percent of total billed charges,70% of total billed charges,130,100,,104,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,106.6,82,,85.28,percent of total billed charges,82% of total billed charges,110.5,85,,88.4,percent of total billed charges,85% of total billed charges,110.5,85,,88.4,percent of total billed charges,85% of total billed charges,110.5,85,,88.4,percent of total billed charges,85% of total billed charges,117,90,,93.6,percent of total billed charges,90% of total billed charges,104,80,,83.2,percent of total billed charges,80% of total billed charges,117,90,,93.6,percent of total billed charges,90% of total billed charges,97.5,75,,78,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,37.7,29,,30.16,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,87.1,67,,69.68,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,91,70,,72.8,percent of total billed charges,70% of total billed charges,84.5,65,,67.6,percent of total billed charges,65% of total billed charges,46.37,35.67,,37.096,percent of total billed charges,35.67% of total billed charges,37.7,130,
4.5 NARROW COMP PLATE 11H,27005292,CDM,278,RC,C1713,HCPCS,outpatient,,,816,326.40,,571.2,70,,456.96,percent of total billed charges,70% of total billed charges,816,100,,652.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,669.12,82,,535.296,percent of total billed charges,82% of total billed charges,693.6,85,,554.88,percent of total billed charges,85% of total billed charges,693.6,85,,554.88,percent of total billed charges,85% of total billed charges,693.6,85,,554.88,percent of total billed charges,85% of total billed charges,734.4,90,,587.52,percent of total billed charges,90% of total billed charges,652.8,80,,522.24,percent of total billed charges,80% of total billed charges,734.4,90,,587.52,percent of total billed charges,90% of total billed charges,612,75,,489.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,236.64,29,,189.312,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,546.72,67,,437.376,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,571.2,70,,456.96,percent of total billed charges,70% of total billed charges,530.4,65,,424.32,percent of total billed charges,65% of total billed charges,291.07,35.67,,232.856,percent of total billed charges,35.67% of total billed charges,236.64,816,
4.0 CANCELLOUS SCREW P/THR 20,27005293,CDM,278,RC,C1713,HCPCS,outpatient,,,130,52.00,,91,70,,72.8,percent of total billed charges,70% of total billed charges,130,100,,104,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,106.6,82,,85.28,percent of total billed charges,82% of total billed charges,110.5,85,,88.4,percent of total billed charges,85% of total billed charges,110.5,85,,88.4,percent of total billed charges,85% of total billed charges,110.5,85,,88.4,percent of total billed charges,85% of total billed charges,117,90,,93.6,percent of total billed charges,90% of total billed charges,104,80,,83.2,percent of total billed charges,80% of total billed charges,117,90,,93.6,percent of total billed charges,90% of total billed charges,97.5,75,,78,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,37.7,29,,30.16,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,87.1,67,,69.68,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,91,70,,72.8,percent of total billed charges,70% of total billed charges,84.5,65,,67.6,percent of total billed charges,65% of total billed charges,46.37,35.67,,37.096,percent of total billed charges,35.67% of total billed charges,37.7,130,
4.5 NARROW COMP PLATE 12H,27005294,CDM,278,RC,C1713,HCPCS,outpatient,,,816,326.40,,571.2,70,,456.96,percent of total billed charges,70% of total billed charges,816,100,,652.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,669.12,82,,535.296,percent of total billed charges,82% of total billed charges,693.6,85,,554.88,percent of total billed charges,85% of total billed charges,693.6,85,,554.88,percent of total billed charges,85% of total billed charges,693.6,85,,554.88,percent of total billed charges,85% of total billed charges,734.4,90,,587.52,percent of total billed charges,90% of total billed charges,652.8,80,,522.24,percent of total billed charges,80% of total billed charges,734.4,90,,587.52,percent of total billed charges,90% of total billed charges,612,75,,489.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,236.64,29,,189.312,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,546.72,67,,437.376,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,571.2,70,,456.96,percent of total billed charges,70% of total billed charges,530.4,65,,424.32,percent of total billed charges,65% of total billed charges,291.07,35.67,,232.856,percent of total billed charges,35.67% of total billed charges,236.64,816,
4.0 CANCELLOUS SCREW P/THR 22,27005295,CDM,278,RC,,,outpatient,,,130,52.00,,91,70,,72.8,percent of total billed charges,70% of total billed charges,130,100,,104,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,106.6,82,,85.28,percent of total billed charges,82% of total billed charges,110.5,85,,88.4,percent of total billed charges,85% of total billed charges,110.5,85,,88.4,percent of total billed charges,85% of total billed charges,110.5,85,,88.4,percent of total billed charges,85% of total billed charges,117,90,,93.6,percent of total billed charges,90% of total billed charges,104,80,,83.2,percent of total billed charges,80% of total billed charges,117,90,,93.6,percent of total billed charges,90% of total billed charges,97.5,75,,78,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,37.7,29,,30.16,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,87.1,67,,69.68,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,91,70,,72.8,percent of total billed charges,70% of total billed charges,84.5,65,,67.6,percent of total billed charges,65% of total billed charges,46.37,35.67,,37.096,percent of total billed charges,35.67% of total billed charges,37.7,130,
SEMI TUBULAR PLATE 4HOLE,27005296,CDM,278,RC,C1713,HCPCS,outpatient,,,309,123.60,,216.3,70,,173.04,percent of total billed charges,70% of total billed charges,309,100,,247.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,253.38,82,,202.704,percent of total billed charges,82% of total billed charges,262.65,85,,210.12,percent of total billed charges,85% of total billed charges,262.65,85,,210.12,percent of total billed charges,85% of total billed charges,262.65,85,,210.12,percent of total billed charges,85% of total billed charges,278.1,90,,222.48,percent of total billed charges,90% of total billed charges,247.2,80,,197.76,percent of total billed charges,80% of total billed charges,278.1,90,,222.48,percent of total billed charges,90% of total billed charges,231.75,75,,185.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,89.61,29,,71.688,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,207.03,67,,165.624,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,216.3,70,,173.04,percent of total billed charges,70% of total billed charges,200.85,65,,160.68,percent of total billed charges,65% of total billed charges,110.22,35.67,,88.176,percent of total billed charges,35.67% of total billed charges,89.61,309,
4.0 CANCELLOUS SCREW P.THR 24,27005297,CDM,278,RC,C1713,HCPCS,outpatient,,,130,52.00,,91,70,,72.8,percent of total billed charges,70% of total billed charges,130,100,,104,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,106.6,82,,85.28,percent of total billed charges,82% of total billed charges,110.5,85,,88.4,percent of total billed charges,85% of total billed charges,110.5,85,,88.4,percent of total billed charges,85% of total billed charges,110.5,85,,88.4,percent of total billed charges,85% of total billed charges,117,90,,93.6,percent of total billed charges,90% of total billed charges,104,80,,83.2,percent of total billed charges,80% of total billed charges,117,90,,93.6,percent of total billed charges,90% of total billed charges,97.5,75,,78,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,37.7,29,,30.16,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,87.1,67,,69.68,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,91,70,,72.8,percent of total billed charges,70% of total billed charges,84.5,65,,67.6,percent of total billed charges,65% of total billed charges,46.37,35.67,,37.096,percent of total billed charges,35.67% of total billed charges,37.7,130,
SEMI TUBULAR PLATE 5 HOLE,27005298,CDM,278,RC,C1713,HCPCS,outpatient,,,309,123.60,,216.3,70,,173.04,percent of total billed charges,70% of total billed charges,309,100,,247.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,253.38,82,,202.704,percent of total billed charges,82% of total billed charges,262.65,85,,210.12,percent of total billed charges,85% of total billed charges,262.65,85,,210.12,percent of total billed charges,85% of total billed charges,262.65,85,,210.12,percent of total billed charges,85% of total billed charges,278.1,90,,222.48,percent of total billed charges,90% of total billed charges,247.2,80,,197.76,percent of total billed charges,80% of total billed charges,278.1,90,,222.48,percent of total billed charges,90% of total billed charges,231.75,75,,185.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,89.61,29,,71.688,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,207.03,67,,165.624,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,216.3,70,,173.04,percent of total billed charges,70% of total billed charges,200.85,65,,160.68,percent of total billed charges,65% of total billed charges,110.22,35.67,,88.176,percent of total billed charges,35.67% of total billed charges,89.61,309,
4.0 CANCELLOUS SCREW P/THR 26,27005299,CDM,278,RC,C1713,HCPCS,outpatient,,,130,52.00,,91,70,,72.8,percent of total billed charges,70% of total billed charges,130,100,,104,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,106.6,82,,85.28,percent of total billed charges,82% of total billed charges,110.5,85,,88.4,percent of total billed charges,85% of total billed charges,110.5,85,,88.4,percent of total billed charges,85% of total billed charges,110.5,85,,88.4,percent of total billed charges,85% of total billed charges,117,90,,93.6,percent of total billed charges,90% of total billed charges,104,80,,83.2,percent of total billed charges,80% of total billed charges,117,90,,93.6,percent of total billed charges,90% of total billed charges,97.5,75,,78,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,37.7,29,,30.16,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,87.1,67,,69.68,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,91,70,,72.8,percent of total billed charges,70% of total billed charges,84.5,65,,67.6,percent of total billed charges,65% of total billed charges,46.37,35.67,,37.096,percent of total billed charges,35.67% of total billed charges,37.7,130,
SEMI TUBULAR PLATE 6 HOLE,27005300,CDM,278,RC,C1713,HCPCS,outpatient,,,328,131.20,,229.6,70,,183.68,percent of total billed charges,70% of total billed charges,328,100,,262.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,268.96,82,,215.168,percent of total billed charges,82% of total billed charges,278.8,85,,223.04,percent of total billed charges,85% of total billed charges,278.8,85,,223.04,percent of total billed charges,85% of total billed charges,278.8,85,,223.04,percent of total billed charges,85% of total billed charges,295.2,90,,236.16,percent of total billed charges,90% of total billed charges,262.4,80,,209.92,percent of total billed charges,80% of total billed charges,295.2,90,,236.16,percent of total billed charges,90% of total billed charges,246,75,,196.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,95.12,29,,76.096,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,219.76,67,,175.808,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,229.6,70,,183.68,percent of total billed charges,70% of total billed charges,213.2,65,,170.56,percent of total billed charges,65% of total billed charges,117,35.67,,93.6,percent of total billed charges,35.67% of total billed charges,95.12,328,
4.0 CANCELLOUS SCREW P/THR 28,27005301,CDM,278,RC,,,outpatient,,,130,52.00,,91,70,,72.8,percent of total billed charges,70% of total billed charges,130,100,,104,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,106.6,82,,85.28,percent of total billed charges,82% of total billed charges,110.5,85,,88.4,percent of total billed charges,85% of total billed charges,110.5,85,,88.4,percent of total billed charges,85% of total billed charges,110.5,85,,88.4,percent of total billed charges,85% of total billed charges,117,90,,93.6,percent of total billed charges,90% of total billed charges,104,80,,83.2,percent of total billed charges,80% of total billed charges,117,90,,93.6,percent of total billed charges,90% of total billed charges,97.5,75,,78,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,37.7,29,,30.16,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,87.1,67,,69.68,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,91,70,,72.8,percent of total billed charges,70% of total billed charges,84.5,65,,67.6,percent of total billed charges,65% of total billed charges,46.37,35.67,,37.096,percent of total billed charges,35.67% of total billed charges,37.7,130,
SEMI TUBULAR PLATE 7 HOLE,27005302,CDM,278,RC,C1713,HCPCS,outpatient,,,290,116.00,,203,70,,162.4,percent of total billed charges,70% of total billed charges,290,100,,232,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,237.8,82,,190.24,percent of total billed charges,82% of total billed charges,246.5,85,,197.2,percent of total billed charges,85% of total billed charges,246.5,85,,197.2,percent of total billed charges,85% of total billed charges,246.5,85,,197.2,percent of total billed charges,85% of total billed charges,261,90,,208.8,percent of total billed charges,90% of total billed charges,232,80,,185.6,percent of total billed charges,80% of total billed charges,261,90,,208.8,percent of total billed charges,90% of total billed charges,217.5,75,,174,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,84.1,29,,67.28,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,194.3,67,,155.44,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,203,70,,162.4,percent of total billed charges,70% of total billed charges,188.5,65,,150.8,percent of total billed charges,65% of total billed charges,103.44,35.67,,82.752,percent of total billed charges,35.67% of total billed charges,84.1,290,
4.0 CANCELLOUS SCREW P/THR 30,27005303,CDM,278,RC,,,outpatient,,,130,52.00,,91,70,,72.8,percent of total billed charges,70% of total billed charges,130,100,,104,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,106.6,82,,85.28,percent of total billed charges,82% of total billed charges,110.5,85,,88.4,percent of total billed charges,85% of total billed charges,110.5,85,,88.4,percent of total billed charges,85% of total billed charges,110.5,85,,88.4,percent of total billed charges,85% of total billed charges,117,90,,93.6,percent of total billed charges,90% of total billed charges,104,80,,83.2,percent of total billed charges,80% of total billed charges,117,90,,93.6,percent of total billed charges,90% of total billed charges,97.5,75,,78,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,37.7,29,,30.16,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,87.1,67,,69.68,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,91,70,,72.8,percent of total billed charges,70% of total billed charges,84.5,65,,67.6,percent of total billed charges,65% of total billed charges,46.37,35.67,,37.096,percent of total billed charges,35.67% of total billed charges,37.7,130,
4.0 CANCELLOUS SCREW P/THR 35,27005304,CDM,278,RC,,,outpatient,,,130,52.00,,91,70,,72.8,percent of total billed charges,70% of total billed charges,130,100,,104,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,106.6,82,,85.28,percent of total billed charges,82% of total billed charges,110.5,85,,88.4,percent of total billed charges,85% of total billed charges,110.5,85,,88.4,percent of total billed charges,85% of total billed charges,110.5,85,,88.4,percent of total billed charges,85% of total billed charges,117,90,,93.6,percent of total billed charges,90% of total billed charges,104,80,,83.2,percent of total billed charges,80% of total billed charges,117,90,,93.6,percent of total billed charges,90% of total billed charges,97.5,75,,78,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,37.7,29,,30.16,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,87.1,67,,69.68,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,91,70,,72.8,percent of total billed charges,70% of total billed charges,84.5,65,,67.6,percent of total billed charges,65% of total billed charges,46.37,35.67,,37.096,percent of total billed charges,35.67% of total billed charges,37.7,130,
4.5 L-BUTTRESS PLATE LEFT 4H,27005305,CDM,278,RC,C1713,HCPCS,outpatient,,,993,397.20,,695.1,70,,556.08,percent of total billed charges,70% of total billed charges,993,100,,794.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,814.26,82,,651.408,percent of total billed charges,82% of total billed charges,844.05,85,,675.24,percent of total billed charges,85% of total billed charges,844.05,85,,675.24,percent of total billed charges,85% of total billed charges,844.05,85,,675.24,percent of total billed charges,85% of total billed charges,893.7,90,,714.96,percent of total billed charges,90% of total billed charges,794.4,80,,635.52,percent of total billed charges,80% of total billed charges,893.7,90,,714.96,percent of total billed charges,90% of total billed charges,744.75,75,,595.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,287.97,29,,230.376,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,665.31,67,,532.248,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,695.1,70,,556.08,percent of total billed charges,70% of total billed charges,645.45,65,,516.36,percent of total billed charges,65% of total billed charges,354.2,35.67,,283.36,percent of total billed charges,35.67% of total billed charges,287.97,993,
4.0 CANCELLOUS SCREW P/THR 40,27005306,CDM,278,RC,,,outpatient,,,185,74.00,,129.5,70,,103.6,percent of total billed charges,70% of total billed charges,185,100,,148,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,151.7,82,,121.36,percent of total billed charges,82% of total billed charges,157.25,85,,125.8,percent of total billed charges,85% of total billed charges,157.25,85,,125.8,percent of total billed charges,85% of total billed charges,157.25,85,,125.8,percent of total billed charges,85% of total billed charges,166.5,90,,133.2,percent of total billed charges,90% of total billed charges,148,80,,118.4,percent of total billed charges,80% of total billed charges,166.5,90,,133.2,percent of total billed charges,90% of total billed charges,138.75,75,,111,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,53.65,29,,42.92,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,123.95,67,,99.16,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,129.5,70,,103.6,percent of total billed charges,70% of total billed charges,120.25,65,,96.2,percent of total billed charges,65% of total billed charges,65.99,35.67,,52.792,percent of total billed charges,35.67% of total billed charges,53.65,185,
4.0 CANCELLOUS SCREW P/THR 45,27005307,CDM,278,RC,,,outpatient,,,130,52.00,,91,70,,72.8,percent of total billed charges,70% of total billed charges,130,100,,104,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,106.6,82,,85.28,percent of total billed charges,82% of total billed charges,110.5,85,,88.4,percent of total billed charges,85% of total billed charges,110.5,85,,88.4,percent of total billed charges,85% of total billed charges,110.5,85,,88.4,percent of total billed charges,85% of total billed charges,117,90,,93.6,percent of total billed charges,90% of total billed charges,104,80,,83.2,percent of total billed charges,80% of total billed charges,117,90,,93.6,percent of total billed charges,90% of total billed charges,97.5,75,,78,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,37.7,29,,30.16,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,87.1,67,,69.68,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,91,70,,72.8,percent of total billed charges,70% of total billed charges,84.5,65,,67.6,percent of total billed charges,65% of total billed charges,46.37,35.67,,37.096,percent of total billed charges,35.67% of total billed charges,37.7,130,
CANCELLOUS SCREW 4.0 P/THR 50,27005308,CDM,278,RC,,,outpatient,,,188,75.20,,131.6,70,,105.28,percent of total billed charges,70% of total billed charges,188,100,,150.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,154.16,82,,123.328,percent of total billed charges,82% of total billed charges,159.8,85,,127.84,percent of total billed charges,85% of total billed charges,159.8,85,,127.84,percent of total billed charges,85% of total billed charges,159.8,85,,127.84,percent of total billed charges,85% of total billed charges,169.2,90,,135.36,percent of total billed charges,90% of total billed charges,150.4,80,,120.32,percent of total billed charges,80% of total billed charges,169.2,90,,135.36,percent of total billed charges,90% of total billed charges,141,75,,112.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,54.52,29,,43.616,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,125.96,67,,100.768,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,131.6,70,,105.28,percent of total billed charges,70% of total billed charges,122.2,65,,97.76,percent of total billed charges,65% of total billed charges,67.06,35.67,,53.648,percent of total billed charges,35.67% of total billed charges,54.52,188,
4.5 L-BUTTRESS PLATE RIGHT 4H,27005309,CDM,278,RC,C1713,HCPCS,outpatient,,,993,397.20,,695.1,70,,556.08,percent of total billed charges,70% of total billed charges,993,100,,794.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,814.26,82,,651.408,percent of total billed charges,82% of total billed charges,844.05,85,,675.24,percent of total billed charges,85% of total billed charges,844.05,85,,675.24,percent of total billed charges,85% of total billed charges,844.05,85,,675.24,percent of total billed charges,85% of total billed charges,893.7,90,,714.96,percent of total billed charges,90% of total billed charges,794.4,80,,635.52,percent of total billed charges,80% of total billed charges,893.7,90,,714.96,percent of total billed charges,90% of total billed charges,744.75,75,,595.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,287.97,29,,230.376,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,665.31,67,,532.248,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,695.1,70,,556.08,percent of total billed charges,70% of total billed charges,645.45,65,,516.36,percent of total billed charges,65% of total billed charges,354.2,35.67,,283.36,percent of total billed charges,35.67% of total billed charges,287.97,993,
4.0 CANCELLOUS SCREW F/THR 10,27005310,CDM,278,RC,,,outpatient,,,130,52.00,,91,70,,72.8,percent of total billed charges,70% of total billed charges,130,100,,104,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,106.6,82,,85.28,percent of total billed charges,82% of total billed charges,110.5,85,,88.4,percent of total billed charges,85% of total billed charges,110.5,85,,88.4,percent of total billed charges,85% of total billed charges,110.5,85,,88.4,percent of total billed charges,85% of total billed charges,117,90,,93.6,percent of total billed charges,90% of total billed charges,104,80,,83.2,percent of total billed charges,80% of total billed charges,117,90,,93.6,percent of total billed charges,90% of total billed charges,97.5,75,,78,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,37.7,29,,30.16,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,87.1,67,,69.68,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,91,70,,72.8,percent of total billed charges,70% of total billed charges,84.5,65,,67.6,percent of total billed charges,65% of total billed charges,46.37,35.67,,37.096,percent of total billed charges,35.67% of total billed charges,37.7,130,
4.0 CANCELLOUS SCREW F/THR 12,27005311,CDM,278,RC,,,outpatient,,,130,52.00,,91,70,,72.8,percent of total billed charges,70% of total billed charges,130,100,,104,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,106.6,82,,85.28,percent of total billed charges,82% of total billed charges,110.5,85,,88.4,percent of total billed charges,85% of total billed charges,110.5,85,,88.4,percent of total billed charges,85% of total billed charges,110.5,85,,88.4,percent of total billed charges,85% of total billed charges,117,90,,93.6,percent of total billed charges,90% of total billed charges,104,80,,83.2,percent of total billed charges,80% of total billed charges,117,90,,93.6,percent of total billed charges,90% of total billed charges,97.5,75,,78,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,37.7,29,,30.16,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,87.1,67,,69.68,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,91,70,,72.8,percent of total billed charges,70% of total billed charges,84.5,65,,67.6,percent of total billed charges,65% of total billed charges,46.37,35.67,,37.096,percent of total billed charges,35.67% of total billed charges,37.7,130,
4.5 T-BUTTRESS PLATE 4 HOLE,27005312,CDM,278,RC,C1713,HCPCS,outpatient,,,1108,443.20,,775.6,70,,620.48,percent of total billed charges,70% of total billed charges,581.7,52.5,,465.36,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,908.56,82,,726.848,percent of total billed charges,82% of total billed charges,941.8,85,,753.44,percent of total billed charges,85% of total billed charges,941.8,85,,753.44,percent of total billed charges,85% of total billed charges,941.8,85,,753.44,percent of total billed charges,85% of total billed charges,997.2,90,,797.76,percent of total billed charges,90% of total billed charges,886.4,80,,709.12,percent of total billed charges,80% of total billed charges,997.2,90,,797.76,percent of total billed charges,90% of total billed charges,831,75,,664.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,321.32,29,,257.056,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,742.36,67,,593.888,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,775.6,70,,620.48,percent of total billed charges,70% of total billed charges,720.2,65,,576.16,percent of total billed charges,65% of total billed charges,395.22,35.67,,316.176,percent of total billed charges,35.67% of total billed charges,321.32,997.2,
4.0 CANCELLOUS SCREW F/THR 16,27005313,CDM,278,RC,,,outpatient,,,130,52.00,,91,70,,72.8,percent of total billed charges,70% of total billed charges,130,100,,104,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,106.6,82,,85.28,percent of total billed charges,82% of total billed charges,110.5,85,,88.4,percent of total billed charges,85% of total billed charges,110.5,85,,88.4,percent of total billed charges,85% of total billed charges,110.5,85,,88.4,percent of total billed charges,85% of total billed charges,117,90,,93.6,percent of total billed charges,90% of total billed charges,104,80,,83.2,percent of total billed charges,80% of total billed charges,117,90,,93.6,percent of total billed charges,90% of total billed charges,97.5,75,,78,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,37.7,29,,30.16,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,87.1,67,,69.68,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,91,70,,72.8,percent of total billed charges,70% of total billed charges,84.5,65,,67.6,percent of total billed charges,65% of total billed charges,46.37,35.67,,37.096,percent of total billed charges,35.67% of total billed charges,37.7,130,
4.5 T-BUTTRESS PLATE 4 HOLE,27005314,CDM,278,RC,C1713,HCPCS,outpatient,,,768,307.20,,537.6,70,,430.08,percent of total billed charges,70% of total billed charges,768,100,,614.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,629.76,82,,503.808,percent of total billed charges,82% of total billed charges,652.8,85,,522.24,percent of total billed charges,85% of total billed charges,652.8,85,,522.24,percent of total billed charges,85% of total billed charges,652.8,85,,522.24,percent of total billed charges,85% of total billed charges,691.2,90,,552.96,percent of total billed charges,90% of total billed charges,614.4,80,,491.52,percent of total billed charges,80% of total billed charges,691.2,90,,552.96,percent of total billed charges,90% of total billed charges,576,75,,460.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,222.72,29,,178.176,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,514.56,67,,411.648,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,537.6,70,,430.08,percent of total billed charges,70% of total billed charges,499.2,65,,399.36,percent of total billed charges,65% of total billed charges,273.95,35.67,,219.16,percent of total billed charges,35.67% of total billed charges,222.72,768,
4.0 CANCELLOUS SCREW F/THR 28,27005315,CDM,278,RC,,,outpatient,,,130,52.00,,91,70,,72.8,percent of total billed charges,70% of total billed charges,130,100,,104,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,106.6,82,,85.28,percent of total billed charges,82% of total billed charges,110.5,85,,88.4,percent of total billed charges,85% of total billed charges,110.5,85,,88.4,percent of total billed charges,85% of total billed charges,110.5,85,,88.4,percent of total billed charges,85% of total billed charges,117,90,,93.6,percent of total billed charges,90% of total billed charges,104,80,,83.2,percent of total billed charges,80% of total billed charges,117,90,,93.6,percent of total billed charges,90% of total billed charges,97.5,75,,78,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,37.7,29,,30.16,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,87.1,67,,69.68,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,91,70,,72.8,percent of total billed charges,70% of total billed charges,84.5,65,,67.6,percent of total billed charges,65% of total billed charges,46.37,35.67,,37.096,percent of total billed charges,35.67% of total billed charges,37.7,130,
4.5 T-BUTTRESS PLATE 6 HOLE,27005316,CDM,278,RC,C1713,HCPCS,outpatient,,,891,356.40,,623.7,70,,498.96,percent of total billed charges,70% of total billed charges,891,100,,712.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,730.62,82,,584.496,percent of total billed charges,82% of total billed charges,757.35,85,,605.88,percent of total billed charges,85% of total billed charges,757.35,85,,605.88,percent of total billed charges,85% of total billed charges,757.35,85,,605.88,percent of total billed charges,85% of total billed charges,801.9,90,,641.52,percent of total billed charges,90% of total billed charges,712.8,80,,570.24,percent of total billed charges,80% of total billed charges,801.9,90,,641.52,percent of total billed charges,90% of total billed charges,668.25,75,,534.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,258.39,29,,206.712,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,596.97,67,,477.576,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,623.7,70,,498.96,percent of total billed charges,70% of total billed charges,579.15,65,,463.32,percent of total billed charges,65% of total billed charges,317.82,35.67,,254.256,percent of total billed charges,35.67% of total billed charges,258.39,891,
4.0 CANCELLOUS SCREW F/THR 30,27005317,CDM,278,RC,C1713,HCPCS,outpatient,,,130,52.00,,91,70,,72.8,percent of total billed charges,70% of total billed charges,130,100,,104,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,106.6,82,,85.28,percent of total billed charges,82% of total billed charges,110.5,85,,88.4,percent of total billed charges,85% of total billed charges,110.5,85,,88.4,percent of total billed charges,85% of total billed charges,110.5,85,,88.4,percent of total billed charges,85% of total billed charges,117,90,,93.6,percent of total billed charges,90% of total billed charges,104,80,,83.2,percent of total billed charges,80% of total billed charges,117,90,,93.6,percent of total billed charges,90% of total billed charges,97.5,75,,78,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,37.7,29,,30.16,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,87.1,67,,69.68,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,91,70,,72.8,percent of total billed charges,70% of total billed charges,84.5,65,,67.6,percent of total billed charges,65% of total billed charges,46.37,35.67,,37.096,percent of total billed charges,35.67% of total billed charges,37.7,130,
4.0 CANCELLOUS SCREW F/THR 32,27005318,CDM,278,RC,C1713,HCPCS,outpatient,,,130,52.00,,91,70,,72.8,percent of total billed charges,70% of total billed charges,130,100,,104,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,106.6,82,,85.28,percent of total billed charges,82% of total billed charges,110.5,85,,88.4,percent of total billed charges,85% of total billed charges,110.5,85,,88.4,percent of total billed charges,85% of total billed charges,110.5,85,,88.4,percent of total billed charges,85% of total billed charges,117,90,,93.6,percent of total billed charges,90% of total billed charges,104,80,,83.2,percent of total billed charges,80% of total billed charges,117,90,,93.6,percent of total billed charges,90% of total billed charges,97.5,75,,78,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,37.7,29,,30.16,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,87.1,67,,69.68,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,91,70,,72.8,percent of total billed charges,70% of total billed charges,84.5,65,,67.6,percent of total billed charges,65% of total billed charges,46.37,35.67,,37.096,percent of total billed charges,35.67% of total billed charges,37.7,130,
4.5 T-BUTTRESS PLATE 8 HOLE,27005319,CDM,278,RC,C1713,HCPCS,outpatient,,,1230,492.00,,861,70,,688.8,percent of total billed charges,70% of total billed charges,645.75,52.5,,516.6,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,1008.6,82,,806.88,percent of total billed charges,82% of total billed charges,1045.5,85,,836.4,percent of total billed charges,85% of total billed charges,1045.5,85,,836.4,percent of total billed charges,85% of total billed charges,1045.5,85,,836.4,percent of total billed charges,85% of total billed charges,1107,90,,885.6,percent of total billed charges,90% of total billed charges,984,80,,787.2,percent of total billed charges,80% of total billed charges,1107,90,,885.6,percent of total billed charges,90% of total billed charges,922.5,75,,738,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,356.7,29,,285.36,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,824.1,67,,659.28,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,861,70,,688.8,percent of total billed charges,70% of total billed charges,799.5,65,,639.6,percent of total billed charges,65% of total billed charges,438.74,35.67,,350.992,percent of total billed charges,35.67% of total billed charges,356.7,1107,
4.0 CANCELLOUS SCREW F/THR 34,27005320,CDM,278,RC,C1713,HCPCS,outpatient,,,130,52.00,,91,70,,72.8,percent of total billed charges,70% of total billed charges,130,100,,104,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,106.6,82,,85.28,percent of total billed charges,82% of total billed charges,110.5,85,,88.4,percent of total billed charges,85% of total billed charges,110.5,85,,88.4,percent of total billed charges,85% of total billed charges,110.5,85,,88.4,percent of total billed charges,85% of total billed charges,117,90,,93.6,percent of total billed charges,90% of total billed charges,104,80,,83.2,percent of total billed charges,80% of total billed charges,117,90,,93.6,percent of total billed charges,90% of total billed charges,97.5,75,,78,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,37.7,29,,30.16,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,87.1,67,,69.68,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,91,70,,72.8,percent of total billed charges,70% of total billed charges,84.5,65,,67.6,percent of total billed charges,65% of total billed charges,46.37,35.67,,37.096,percent of total billed charges,35.67% of total billed charges,37.7,130,
4.5 T-BUTTRESS PLATE 6 HOLE,27005321,CDM,278,RC,C1713,HCPCS,outpatient,,,911,364.40,,637.7,70,,510.16,percent of total billed charges,70% of total billed charges,911,100,,728.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,747.02,82,,597.616,percent of total billed charges,82% of total billed charges,774.35,85,,619.48,percent of total billed charges,85% of total billed charges,774.35,85,,619.48,percent of total billed charges,85% of total billed charges,774.35,85,,619.48,percent of total billed charges,85% of total billed charges,819.9,90,,655.92,percent of total billed charges,90% of total billed charges,728.8,80,,583.04,percent of total billed charges,80% of total billed charges,819.9,90,,655.92,percent of total billed charges,90% of total billed charges,683.25,75,,546.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,264.19,29,,211.352,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,610.37,67,,488.296,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,637.7,70,,510.16,percent of total billed charges,70% of total billed charges,592.15,65,,473.72,percent of total billed charges,65% of total billed charges,324.95,35.67,,259.96,percent of total billed charges,35.67% of total billed charges,264.19,911,
4.5 T-BUTTRESS PLATE 5 HOLE,27005322,CDM,278,RC,C1713,HCPCS,outpatient,,,848,339.20,,593.6,70,,474.88,percent of total billed charges,70% of total billed charges,848,100,,678.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,695.36,82,,556.288,percent of total billed charges,82% of total billed charges,720.8,85,,576.64,percent of total billed charges,85% of total billed charges,720.8,85,,576.64,percent of total billed charges,85% of total billed charges,720.8,85,,576.64,percent of total billed charges,85% of total billed charges,763.2,90,,610.56,percent of total billed charges,90% of total billed charges,678.4,80,,542.72,percent of total billed charges,80% of total billed charges,763.2,90,,610.56,percent of total billed charges,90% of total billed charges,636,75,,508.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,245.92,29,,196.736,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,568.16,67,,454.528,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,593.6,70,,474.88,percent of total billed charges,70% of total billed charges,551.2,65,,440.96,percent of total billed charges,65% of total billed charges,302.48,35.67,,241.984,percent of total billed charges,35.67% of total billed charges,245.92,848,
4.0 CANCELLOUS SCREW F/THR 36,27005323,CDM,278,RC,C1713,HCPCS,outpatient,,,130,52.00,,91,70,,72.8,percent of total billed charges,70% of total billed charges,130,100,,104,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,106.6,82,,85.28,percent of total billed charges,82% of total billed charges,110.5,85,,88.4,percent of total billed charges,85% of total billed charges,110.5,85,,88.4,percent of total billed charges,85% of total billed charges,110.5,85,,88.4,percent of total billed charges,85% of total billed charges,117,90,,93.6,percent of total billed charges,90% of total billed charges,104,80,,83.2,percent of total billed charges,80% of total billed charges,117,90,,93.6,percent of total billed charges,90% of total billed charges,97.5,75,,78,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,37.7,29,,30.16,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,87.1,67,,69.68,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,91,70,,72.8,percent of total billed charges,70% of total billed charges,84.5,65,,67.6,percent of total billed charges,65% of total billed charges,46.37,35.67,,37.096,percent of total billed charges,35.67% of total billed charges,37.7,130,
4.0 CANCELLOUS SCREW F/THR 38,27005324,CDM,278,RC,C1713,HCPCS,outpatient,,,130,52.00,,91,70,,72.8,percent of total billed charges,70% of total billed charges,130,100,,104,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,106.6,82,,85.28,percent of total billed charges,82% of total billed charges,110.5,85,,88.4,percent of total billed charges,85% of total billed charges,110.5,85,,88.4,percent of total billed charges,85% of total billed charges,110.5,85,,88.4,percent of total billed charges,85% of total billed charges,117,90,,93.6,percent of total billed charges,90% of total billed charges,104,80,,83.2,percent of total billed charges,80% of total billed charges,117,90,,93.6,percent of total billed charges,90% of total billed charges,97.5,75,,78,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,37.7,29,,30.16,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,87.1,67,,69.68,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,91,70,,72.8,percent of total billed charges,70% of total billed charges,84.5,65,,67.6,percent of total billed charges,65% of total billed charges,46.37,35.67,,37.096,percent of total billed charges,35.67% of total billed charges,37.7,130,
4.0 CANCELLOUS SCREW F/THR 40,27005325,CDM,278,RC,C1713,HCPCS,outpatient,,,130,52.00,,91,70,,72.8,percent of total billed charges,70% of total billed charges,130,100,,104,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,106.6,82,,85.28,percent of total billed charges,82% of total billed charges,110.5,85,,88.4,percent of total billed charges,85% of total billed charges,110.5,85,,88.4,percent of total billed charges,85% of total billed charges,110.5,85,,88.4,percent of total billed charges,85% of total billed charges,117,90,,93.6,percent of total billed charges,90% of total billed charges,104,80,,83.2,percent of total billed charges,80% of total billed charges,117,90,,93.6,percent of total billed charges,90% of total billed charges,97.5,75,,78,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,37.7,29,,30.16,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,87.1,67,,69.68,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,91,70,,72.8,percent of total billed charges,70% of total billed charges,84.5,65,,67.6,percent of total billed charges,65% of total billed charges,46.37,35.67,,37.096,percent of total billed charges,35.67% of total billed charges,37.7,130,
4.0 CANCELLOUS SCREW F/THR 45,27005326,CDM,278,RC,C1713,HCPCS,outpatient,,,130,52.00,,91,70,,72.8,percent of total billed charges,70% of total billed charges,130,100,,104,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,106.6,82,,85.28,percent of total billed charges,82% of total billed charges,110.5,85,,88.4,percent of total billed charges,85% of total billed charges,110.5,85,,88.4,percent of total billed charges,85% of total billed charges,110.5,85,,88.4,percent of total billed charges,85% of total billed charges,117,90,,93.6,percent of total billed charges,90% of total billed charges,104,80,,83.2,percent of total billed charges,80% of total billed charges,117,90,,93.6,percent of total billed charges,90% of total billed charges,97.5,75,,78,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,37.7,29,,30.16,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,87.1,67,,69.68,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,91,70,,72.8,percent of total billed charges,70% of total billed charges,84.5,65,,67.6,percent of total billed charges,65% of total billed charges,46.37,35.67,,37.096,percent of total billed charges,35.67% of total billed charges,37.7,130,
4.0 CANCELLOUS SCREW F/THR 50,27005327,CDM,278,RC,C1713,HCPCS,outpatient,,,130,52.00,,91,70,,72.8,percent of total billed charges,70% of total billed charges,130,100,,104,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,106.6,82,,85.28,percent of total billed charges,82% of total billed charges,110.5,85,,88.4,percent of total billed charges,85% of total billed charges,110.5,85,,88.4,percent of total billed charges,85% of total billed charges,110.5,85,,88.4,percent of total billed charges,85% of total billed charges,117,90,,93.6,percent of total billed charges,90% of total billed charges,104,80,,83.2,percent of total billed charges,80% of total billed charges,117,90,,93.6,percent of total billed charges,90% of total billed charges,97.5,75,,78,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,37.7,29,,30.16,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,87.1,67,,69.68,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,91,70,,72.8,percent of total billed charges,70% of total billed charges,84.5,65,,67.6,percent of total billed charges,65% of total billed charges,46.37,35.67,,37.096,percent of total billed charges,35.67% of total billed charges,37.7,130,
3.5 COMPRESSION PLATE 10H,27005328,CDM,278,RC,C1713,HCPCS,outpatient,,,656,262.40,,459.2,70,,367.36,percent of total billed charges,70% of total billed charges,656,100,,524.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,537.92,82,,430.336,percent of total billed charges,82% of total billed charges,557.6,85,,446.08,percent of total billed charges,85% of total billed charges,557.6,85,,446.08,percent of total billed charges,85% of total billed charges,557.6,85,,446.08,percent of total billed charges,85% of total billed charges,590.4,90,,472.32,percent of total billed charges,90% of total billed charges,524.8,80,,419.84,percent of total billed charges,80% of total billed charges,590.4,90,,472.32,percent of total billed charges,90% of total billed charges,492,75,,393.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,190.24,29,,152.192,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,439.52,67,,351.616,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,459.2,70,,367.36,percent of total billed charges,70% of total billed charges,426.4,65,,341.12,percent of total billed charges,65% of total billed charges,234,35.67,,187.2,percent of total billed charges,35.67% of total billed charges,190.24,656,
3.5 COMPRESSION PLATE 9H,27005329,CDM,278,RC,C1713,HCPCS,outpatient,,,635,254.00,,444.5,70,,355.6,percent of total billed charges,70% of total billed charges,635,100,,508,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,520.7,82,,416.56,percent of total billed charges,82% of total billed charges,539.75,85,,431.8,percent of total billed charges,85% of total billed charges,539.75,85,,431.8,percent of total billed charges,85% of total billed charges,539.75,85,,431.8,percent of total billed charges,85% of total billed charges,571.5,90,,457.2,percent of total billed charges,90% of total billed charges,508,80,,406.4,percent of total billed charges,80% of total billed charges,571.5,90,,457.2,percent of total billed charges,90% of total billed charges,476.25,75,,381,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,184.15,29,,147.32,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,425.45,67,,340.36,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,444.5,70,,355.6,percent of total billed charges,70% of total billed charges,412.75,65,,330.2,percent of total billed charges,65% of total billed charges,226.5,35.67,,181.2,percent of total billed charges,35.67% of total billed charges,184.15,635,
3.5 COMPRESSION PLATE 8H,27005330,CDM,278,RC,C1713,HCPCS,outpatient,,,609,243.60,,426.3,70,,341.04,percent of total billed charges,70% of total billed charges,609,100,,487.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,499.38,82,,399.504,percent of total billed charges,82% of total billed charges,517.65,85,,414.12,percent of total billed charges,85% of total billed charges,517.65,85,,414.12,percent of total billed charges,85% of total billed charges,517.65,85,,414.12,percent of total billed charges,85% of total billed charges,548.1,90,,438.48,percent of total billed charges,90% of total billed charges,487.2,80,,389.76,percent of total billed charges,80% of total billed charges,548.1,90,,438.48,percent of total billed charges,90% of total billed charges,456.75,75,,365.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,176.61,29,,141.288,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,408.03,67,,326.424,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,426.3,70,,341.04,percent of total billed charges,70% of total billed charges,395.85,65,,316.68,percent of total billed charges,65% of total billed charges,217.23,35.67,,173.784,percent of total billed charges,35.67% of total billed charges,176.61,609,
3.5 COMPRESSION PLATE 7H,27005331,CDM,278,RC,C1713,HCPCS,outpatient,,,576,230.40,,403.2,70,,322.56,percent of total billed charges,70% of total billed charges,576,100,,460.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,472.32,82,,377.856,percent of total billed charges,82% of total billed charges,489.6,85,,391.68,percent of total billed charges,85% of total billed charges,489.6,85,,391.68,percent of total billed charges,85% of total billed charges,489.6,85,,391.68,percent of total billed charges,85% of total billed charges,518.4,90,,414.72,percent of total billed charges,90% of total billed charges,460.8,80,,368.64,percent of total billed charges,80% of total billed charges,518.4,90,,414.72,percent of total billed charges,90% of total billed charges,432,75,,345.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,167.04,29,,133.632,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,385.92,67,,308.736,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,403.2,70,,322.56,percent of total billed charges,70% of total billed charges,374.4,65,,299.52,percent of total billed charges,65% of total billed charges,205.46,35.67,,164.368,percent of total billed charges,35.67% of total billed charges,167.04,576,
3.5 COMPRESSION PLATE 6H,27005332,CDM,278,RC,C1713,HCPCS,outpatient,,,555,222.00,,388.5,70,,310.8,percent of total billed charges,70% of total billed charges,555,100,,444,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,455.1,82,,364.08,percent of total billed charges,82% of total billed charges,471.75,85,,377.4,percent of total billed charges,85% of total billed charges,471.75,85,,377.4,percent of total billed charges,85% of total billed charges,471.75,85,,377.4,percent of total billed charges,85% of total billed charges,499.5,90,,399.6,percent of total billed charges,90% of total billed charges,444,80,,355.2,percent of total billed charges,80% of total billed charges,499.5,90,,399.6,percent of total billed charges,90% of total billed charges,416.25,75,,333,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,160.95,29,,128.76,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,371.85,67,,297.48,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,388.5,70,,310.8,percent of total billed charges,70% of total billed charges,360.75,65,,288.6,percent of total billed charges,65% of total billed charges,197.97,35.67,,158.376,percent of total billed charges,35.67% of total billed charges,160.95,555,
3.5 T-PLATE 4 HOLE,27005333,CDM,278,RC,C1713,HCPCS,outpatient,,,492,196.80,,344.4,70,,275.52,percent of total billed charges,70% of total billed charges,492,100,,393.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,403.44,82,,322.752,percent of total billed charges,82% of total billed charges,418.2,85,,334.56,percent of total billed charges,85% of total billed charges,418.2,85,,334.56,percent of total billed charges,85% of total billed charges,418.2,85,,334.56,percent of total billed charges,85% of total billed charges,442.8,90,,354.24,percent of total billed charges,90% of total billed charges,393.6,80,,314.88,percent of total billed charges,80% of total billed charges,442.8,90,,354.24,percent of total billed charges,90% of total billed charges,369,75,,295.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,142.68,29,,114.144,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,329.64,67,,263.712,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,344.4,70,,275.52,percent of total billed charges,70% of total billed charges,319.8,65,,255.84,percent of total billed charges,65% of total billed charges,175.5,35.67,,140.4,percent of total billed charges,35.67% of total billed charges,142.68,492,
3.5 T-PLATE 3 HOLE,27005334,CDM,278,RC,C1713,HCPCS,outpatient,,,487,194.80,,340.9,70,,272.72,percent of total billed charges,70% of total billed charges,487,100,,389.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,399.34,82,,319.472,percent of total billed charges,82% of total billed charges,413.95,85,,331.16,percent of total billed charges,85% of total billed charges,413.95,85,,331.16,percent of total billed charges,85% of total billed charges,413.95,85,,331.16,percent of total billed charges,85% of total billed charges,438.3,90,,350.64,percent of total billed charges,90% of total billed charges,389.6,80,,311.68,percent of total billed charges,80% of total billed charges,438.3,90,,350.64,percent of total billed charges,90% of total billed charges,365.25,75,,292.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,141.23,29,,112.984,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,326.29,67,,261.032,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,340.9,70,,272.72,percent of total billed charges,70% of total billed charges,316.55,65,,253.24,percent of total billed charges,65% of total billed charges,173.71,35.67,,138.968,percent of total billed charges,35.67% of total billed charges,141.23,487,
3.5 OBLIQUE T-PLATE 3 HOLE,27005335,CDM,278,RC,C1713,HCPCS,outpatient,,,816,326.40,,571.2,70,,456.96,percent of total billed charges,70% of total billed charges,816,100,,652.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,669.12,82,,535.296,percent of total billed charges,82% of total billed charges,693.6,85,,554.88,percent of total billed charges,85% of total billed charges,693.6,85,,554.88,percent of total billed charges,85% of total billed charges,693.6,85,,554.88,percent of total billed charges,85% of total billed charges,734.4,90,,587.52,percent of total billed charges,90% of total billed charges,652.8,80,,522.24,percent of total billed charges,80% of total billed charges,734.4,90,,587.52,percent of total billed charges,90% of total billed charges,612,75,,489.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,236.64,29,,189.312,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,546.72,67,,437.376,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,571.2,70,,456.96,percent of total billed charges,70% of total billed charges,530.4,65,,424.32,percent of total billed charges,65% of total billed charges,291.07,35.67,,232.856,percent of total billed charges,35.67% of total billed charges,236.64,816,
TUBULAR PLATE 1/3 6 HOLE,27005336,CDM,278,RC,C1713,HCPCS,outpatient,,,326,130.40,,228.2,70,,182.56,percent of total billed charges,70% of total billed charges,326,100,,260.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,267.32,82,,213.856,percent of total billed charges,82% of total billed charges,277.1,85,,221.68,percent of total billed charges,85% of total billed charges,277.1,85,,221.68,percent of total billed charges,85% of total billed charges,277.1,85,,221.68,percent of total billed charges,85% of total billed charges,293.4,90,,234.72,percent of total billed charges,90% of total billed charges,260.8,80,,208.64,percent of total billed charges,80% of total billed charges,293.4,90,,234.72,percent of total billed charges,90% of total billed charges,244.5,75,,195.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,94.54,29,,75.632,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,218.42,67,,174.736,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,228.2,70,,182.56,percent of total billed charges,70% of total billed charges,211.9,65,,169.52,percent of total billed charges,65% of total billed charges,116.28,35.67,,93.024,percent of total billed charges,35.67% of total billed charges,94.54,326,
TUBULAR PLATE 1/3 8 HOLE,27005337,CDM,278,RC,C1713,HCPCS,outpatient,,,295,118.00,,206.5,70,,165.2,percent of total billed charges,70% of total billed charges,295,100,,236,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,241.9,82,,193.52,percent of total billed charges,82% of total billed charges,250.75,85,,200.6,percent of total billed charges,85% of total billed charges,250.75,85,,200.6,percent of total billed charges,85% of total billed charges,250.75,85,,200.6,percent of total billed charges,85% of total billed charges,265.5,90,,212.4,percent of total billed charges,90% of total billed charges,236,80,,188.8,percent of total billed charges,80% of total billed charges,265.5,90,,212.4,percent of total billed charges,90% of total billed charges,221.25,75,,177,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,85.55,29,,68.44,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,197.65,67,,158.12,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,206.5,70,,165.2,percent of total billed charges,70% of total billed charges,191.75,65,,153.4,percent of total billed charges,65% of total billed charges,105.23,35.67,,84.184,percent of total billed charges,35.67% of total billed charges,85.55,295,
TUBULAR PLATE 1/3 10 HOLE,27005338,CDM,278,RC,C1713,HCPCS,outpatient,,,295,118.00,,206.5,70,,165.2,percent of total billed charges,70% of total billed charges,295,100,,236,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,241.9,82,,193.52,percent of total billed charges,82% of total billed charges,250.75,85,,200.6,percent of total billed charges,85% of total billed charges,250.75,85,,200.6,percent of total billed charges,85% of total billed charges,250.75,85,,200.6,percent of total billed charges,85% of total billed charges,265.5,90,,212.4,percent of total billed charges,90% of total billed charges,236,80,,188.8,percent of total billed charges,80% of total billed charges,265.5,90,,212.4,percent of total billed charges,90% of total billed charges,221.25,75,,177,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,85.55,29,,68.44,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,197.65,67,,158.12,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,206.5,70,,165.2,percent of total billed charges,70% of total billed charges,191.75,65,,153.4,percent of total billed charges,65% of total billed charges,105.23,35.67,,84.184,percent of total billed charges,35.67% of total billed charges,85.55,295,
TUBULAR PLATE 1/3 4 HOLE,27005339,CDM,278,RC,C1713,HCPCS,outpatient,,,281,112.40,,196.7,70,,157.36,percent of total billed charges,70% of total billed charges,281,100,,224.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,230.42,82,,184.336,percent of total billed charges,82% of total billed charges,238.85,85,,191.08,percent of total billed charges,85% of total billed charges,238.85,85,,191.08,percent of total billed charges,85% of total billed charges,238.85,85,,191.08,percent of total billed charges,85% of total billed charges,252.9,90,,202.32,percent of total billed charges,90% of total billed charges,224.8,80,,179.84,percent of total billed charges,80% of total billed charges,252.9,90,,202.32,percent of total billed charges,90% of total billed charges,210.75,75,,168.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,81.49,29,,65.192,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,188.27,67,,150.616,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,196.7,70,,157.36,percent of total billed charges,70% of total billed charges,182.65,65,,146.12,percent of total billed charges,65% of total billed charges,100.23,35.67,,80.184,percent of total billed charges,35.67% of total billed charges,81.49,281,
TUBULAR PLATE 1/3 3 HOLE,27005340,CDM,278,RC,C1713,HCPCS,outpatient,,,283,113.20,,198.1,70,,158.48,percent of total billed charges,70% of total billed charges,283,100,,226.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,232.06,82,,185.648,percent of total billed charges,82% of total billed charges,240.55,85,,192.44,percent of total billed charges,85% of total billed charges,240.55,85,,192.44,percent of total billed charges,85% of total billed charges,240.55,85,,192.44,percent of total billed charges,85% of total billed charges,254.7,90,,203.76,percent of total billed charges,90% of total billed charges,226.4,80,,181.12,percent of total billed charges,80% of total billed charges,254.7,90,,203.76,percent of total billed charges,90% of total billed charges,212.25,75,,169.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,82.07,29,,65.656,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,189.61,67,,151.688,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,198.1,70,,158.48,percent of total billed charges,70% of total billed charges,183.95,65,,147.16,percent of total billed charges,65% of total billed charges,100.95,35.67,,80.76,percent of total billed charges,35.67% of total billed charges,82.07,283,
TUBULAR PLATE 1/3 2 HOLE,27005341,CDM,278,RC,C1713,HCPCS,outpatient,,,277,110.80,,193.9,70,,155.12,percent of total billed charges,70% of total billed charges,277,100,,221.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,227.14,82,,181.712,percent of total billed charges,82% of total billed charges,235.45,85,,188.36,percent of total billed charges,85% of total billed charges,235.45,85,,188.36,percent of total billed charges,85% of total billed charges,235.45,85,,188.36,percent of total billed charges,85% of total billed charges,249.3,90,,199.44,percent of total billed charges,90% of total billed charges,221.6,80,,177.28,percent of total billed charges,80% of total billed charges,249.3,90,,199.44,percent of total billed charges,90% of total billed charges,207.75,75,,166.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,80.33,29,,64.264,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,185.59,67,,148.472,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,193.9,70,,155.12,percent of total billed charges,70% of total billed charges,180.05,65,,144.04,percent of total billed charges,65% of total billed charges,98.81,35.67,,79.048,percent of total billed charges,35.67% of total billed charges,80.33,277,
3.5 CLOVERLEAF PLATE 3 HOLE,27005342,CDM,278,RC,C1713,HCPCS,outpatient,,,908,363.20,,635.6,70,,508.48,percent of total billed charges,70% of total billed charges,908,100,,726.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,744.56,82,,595.648,percent of total billed charges,82% of total billed charges,771.8,85,,617.44,percent of total billed charges,85% of total billed charges,771.8,85,,617.44,percent of total billed charges,85% of total billed charges,771.8,85,,617.44,percent of total billed charges,85% of total billed charges,817.2,90,,653.76,percent of total billed charges,90% of total billed charges,726.4,80,,581.12,percent of total billed charges,80% of total billed charges,817.2,90,,653.76,percent of total billed charges,90% of total billed charges,681,75,,544.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,263.32,29,,210.656,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,608.36,67,,486.688,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,635.6,70,,508.48,percent of total billed charges,70% of total billed charges,590.2,65,,472.16,percent of total billed charges,65% of total billed charges,323.88,35.67,,259.104,percent of total billed charges,35.67% of total billed charges,263.32,908,
3.5 CLOVERLEAF PLATE 4 HOLE,27005343,CDM,278,RC,C1713,HCPCS,outpatient,,,971,388.40,,679.7,70,,543.76,percent of total billed charges,70% of total billed charges,971,100,,776.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,796.22,82,,636.976,percent of total billed charges,82% of total billed charges,825.35,85,,660.28,percent of total billed charges,85% of total billed charges,825.35,85,,660.28,percent of total billed charges,85% of total billed charges,825.35,85,,660.28,percent of total billed charges,85% of total billed charges,873.9,90,,699.12,percent of total billed charges,90% of total billed charges,776.8,80,,621.44,percent of total billed charges,80% of total billed charges,873.9,90,,699.12,percent of total billed charges,90% of total billed charges,728.25,75,,582.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,281.59,29,,225.272,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,650.57,67,,520.456,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,679.7,70,,543.76,percent of total billed charges,70% of total billed charges,631.15,65,,504.92,percent of total billed charges,65% of total billed charges,346.36,35.67,,277.088,percent of total billed charges,35.67% of total billed charges,281.59,971,
4.5 CORTICAL SCREW S/TAP 14,27005344,CDM,278,RC,C1713,HCPCS,outpatient,,,157,62.80,,109.9,70,,87.92,percent of total billed charges,70% of total billed charges,157,100,,125.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,128.74,82,,102.992,percent of total billed charges,82% of total billed charges,133.45,85,,106.76,percent of total billed charges,85% of total billed charges,133.45,85,,106.76,percent of total billed charges,85% of total billed charges,133.45,85,,106.76,percent of total billed charges,85% of total billed charges,141.3,90,,113.04,percent of total billed charges,90% of total billed charges,125.6,80,,100.48,percent of total billed charges,80% of total billed charges,141.3,90,,113.04,percent of total billed charges,90% of total billed charges,117.75,75,,94.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,45.53,29,,36.424,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,105.19,67,,84.152,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,109.9,70,,87.92,percent of total billed charges,70% of total billed charges,102.05,65,,81.64,percent of total billed charges,65% of total billed charges,56,35.67,,44.8,percent of total billed charges,35.67% of total billed charges,45.53,157,
4.5 CORTICAL SCREW S/TAP 16,27005345,CDM,278,RC,C1713,HCPCS,outpatient,,,157,62.80,,109.9,70,,87.92,percent of total billed charges,70% of total billed charges,157,100,,125.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,128.74,82,,102.992,percent of total billed charges,82% of total billed charges,133.45,85,,106.76,percent of total billed charges,85% of total billed charges,133.45,85,,106.76,percent of total billed charges,85% of total billed charges,133.45,85,,106.76,percent of total billed charges,85% of total billed charges,141.3,90,,113.04,percent of total billed charges,90% of total billed charges,125.6,80,,100.48,percent of total billed charges,80% of total billed charges,141.3,90,,113.04,percent of total billed charges,90% of total billed charges,117.75,75,,94.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,45.53,29,,36.424,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,105.19,67,,84.152,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,109.9,70,,87.92,percent of total billed charges,70% of total billed charges,102.05,65,,81.64,percent of total billed charges,65% of total billed charges,56,35.67,,44.8,percent of total billed charges,35.67% of total billed charges,45.53,157,
4.5 CORTICAL SCREW S/TAP 18,27005346,CDM,278,RC,C1713,HCPCS,outpatient,,,157,62.80,,109.9,70,,87.92,percent of total billed charges,70% of total billed charges,157,100,,125.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,128.74,82,,102.992,percent of total billed charges,82% of total billed charges,133.45,85,,106.76,percent of total billed charges,85% of total billed charges,133.45,85,,106.76,percent of total billed charges,85% of total billed charges,133.45,85,,106.76,percent of total billed charges,85% of total billed charges,141.3,90,,113.04,percent of total billed charges,90% of total billed charges,125.6,80,,100.48,percent of total billed charges,80% of total billed charges,141.3,90,,113.04,percent of total billed charges,90% of total billed charges,117.75,75,,94.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,45.53,29,,36.424,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,105.19,67,,84.152,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,109.9,70,,87.92,percent of total billed charges,70% of total billed charges,102.05,65,,81.64,percent of total billed charges,65% of total billed charges,56,35.67,,44.8,percent of total billed charges,35.67% of total billed charges,45.53,157,
4.5 CORTICAL SCREW S/TAP 20,27005347,CDM,278,RC,C1713,HCPCS,outpatient,,,157,62.80,,109.9,70,,87.92,percent of total billed charges,70% of total billed charges,157,100,,125.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,128.74,82,,102.992,percent of total billed charges,82% of total billed charges,133.45,85,,106.76,percent of total billed charges,85% of total billed charges,133.45,85,,106.76,percent of total billed charges,85% of total billed charges,133.45,85,,106.76,percent of total billed charges,85% of total billed charges,141.3,90,,113.04,percent of total billed charges,90% of total billed charges,125.6,80,,100.48,percent of total billed charges,80% of total billed charges,141.3,90,,113.04,percent of total billed charges,90% of total billed charges,117.75,75,,94.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,45.53,29,,36.424,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,105.19,67,,84.152,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,109.9,70,,87.92,percent of total billed charges,70% of total billed charges,102.05,65,,81.64,percent of total billed charges,65% of total billed charges,56,35.67,,44.8,percent of total billed charges,35.67% of total billed charges,45.53,157,
4.5 CORTICAL SCREW S/TAP 22,27005348,CDM,278,RC,C1713,HCPCS,outpatient,,,157,62.80,,109.9,70,,87.92,percent of total billed charges,70% of total billed charges,157,100,,125.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,128.74,82,,102.992,percent of total billed charges,82% of total billed charges,133.45,85,,106.76,percent of total billed charges,85% of total billed charges,133.45,85,,106.76,percent of total billed charges,85% of total billed charges,133.45,85,,106.76,percent of total billed charges,85% of total billed charges,141.3,90,,113.04,percent of total billed charges,90% of total billed charges,125.6,80,,100.48,percent of total billed charges,80% of total billed charges,141.3,90,,113.04,percent of total billed charges,90% of total billed charges,117.75,75,,94.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,45.53,29,,36.424,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,105.19,67,,84.152,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,109.9,70,,87.92,percent of total billed charges,70% of total billed charges,102.05,65,,81.64,percent of total billed charges,65% of total billed charges,56,35.67,,44.8,percent of total billed charges,35.67% of total billed charges,45.53,157,
4.5 CORTICAL SCREW S/TAP 24,27005349,CDM,278,RC,C1713,HCPCS,outpatient,,,157,62.80,,109.9,70,,87.92,percent of total billed charges,70% of total billed charges,157,100,,125.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,128.74,82,,102.992,percent of total billed charges,82% of total billed charges,133.45,85,,106.76,percent of total billed charges,85% of total billed charges,133.45,85,,106.76,percent of total billed charges,85% of total billed charges,133.45,85,,106.76,percent of total billed charges,85% of total billed charges,141.3,90,,113.04,percent of total billed charges,90% of total billed charges,125.6,80,,100.48,percent of total billed charges,80% of total billed charges,141.3,90,,113.04,percent of total billed charges,90% of total billed charges,117.75,75,,94.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,45.53,29,,36.424,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,105.19,67,,84.152,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,109.9,70,,87.92,percent of total billed charges,70% of total billed charges,102.05,65,,81.64,percent of total billed charges,65% of total billed charges,56,35.67,,44.8,percent of total billed charges,35.67% of total billed charges,45.53,157,
4.5 CORTICAL SCREW S/TAP 32,27005350,CDM,278,RC,C1713,HCPCS,outpatient,,,157,62.80,,109.9,70,,87.92,percent of total billed charges,70% of total billed charges,157,100,,125.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,128.74,82,,102.992,percent of total billed charges,82% of total billed charges,133.45,85,,106.76,percent of total billed charges,85% of total billed charges,133.45,85,,106.76,percent of total billed charges,85% of total billed charges,133.45,85,,106.76,percent of total billed charges,85% of total billed charges,141.3,90,,113.04,percent of total billed charges,90% of total billed charges,125.6,80,,100.48,percent of total billed charges,80% of total billed charges,141.3,90,,113.04,percent of total billed charges,90% of total billed charges,117.75,75,,94.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,45.53,29,,36.424,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,105.19,67,,84.152,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,109.9,70,,87.92,percent of total billed charges,70% of total billed charges,102.05,65,,81.64,percent of total billed charges,65% of total billed charges,56,35.67,,44.8,percent of total billed charges,35.67% of total billed charges,45.53,157,
4.5 CORTICAL SCREW S/TAP 36,27005351,CDM,278,RC,C1713,HCPCS,outpatient,,,157,62.80,,109.9,70,,87.92,percent of total billed charges,70% of total billed charges,157,100,,125.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,128.74,82,,102.992,percent of total billed charges,82% of total billed charges,133.45,85,,106.76,percent of total billed charges,85% of total billed charges,133.45,85,,106.76,percent of total billed charges,85% of total billed charges,133.45,85,,106.76,percent of total billed charges,85% of total billed charges,141.3,90,,113.04,percent of total billed charges,90% of total billed charges,125.6,80,,100.48,percent of total billed charges,80% of total billed charges,141.3,90,,113.04,percent of total billed charges,90% of total billed charges,117.75,75,,94.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,45.53,29,,36.424,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,105.19,67,,84.152,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,109.9,70,,87.92,percent of total billed charges,70% of total billed charges,102.05,65,,81.64,percent of total billed charges,65% of total billed charges,56,35.67,,44.8,percent of total billed charges,35.67% of total billed charges,45.53,157,
4.5 CORTICAL SCREW S/TAP 40,27005352,CDM,278,RC,C1713,HCPCS,outpatient,,,157,62.80,,109.9,70,,87.92,percent of total billed charges,70% of total billed charges,157,100,,125.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,128.74,82,,102.992,percent of total billed charges,82% of total billed charges,133.45,85,,106.76,percent of total billed charges,85% of total billed charges,133.45,85,,106.76,percent of total billed charges,85% of total billed charges,133.45,85,,106.76,percent of total billed charges,85% of total billed charges,141.3,90,,113.04,percent of total billed charges,90% of total billed charges,125.6,80,,100.48,percent of total billed charges,80% of total billed charges,141.3,90,,113.04,percent of total billed charges,90% of total billed charges,117.75,75,,94.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,45.53,29,,36.424,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,105.19,67,,84.152,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,109.9,70,,87.92,percent of total billed charges,70% of total billed charges,102.05,65,,81.64,percent of total billed charges,65% of total billed charges,56,35.67,,44.8,percent of total billed charges,35.67% of total billed charges,45.53,157,
4.5 CORTICAL SCREW S/TAP 44,27005353,CDM,278,RC,C1713,HCPCS,outpatient,,,157,62.80,,109.9,70,,87.92,percent of total billed charges,70% of total billed charges,157,100,,125.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,128.74,82,,102.992,percent of total billed charges,82% of total billed charges,133.45,85,,106.76,percent of total billed charges,85% of total billed charges,133.45,85,,106.76,percent of total billed charges,85% of total billed charges,133.45,85,,106.76,percent of total billed charges,85% of total billed charges,141.3,90,,113.04,percent of total billed charges,90% of total billed charges,125.6,80,,100.48,percent of total billed charges,80% of total billed charges,141.3,90,,113.04,percent of total billed charges,90% of total billed charges,117.75,75,,94.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,45.53,29,,36.424,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,105.19,67,,84.152,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,109.9,70,,87.92,percent of total billed charges,70% of total billed charges,102.05,65,,81.64,percent of total billed charges,65% of total billed charges,56,35.67,,44.8,percent of total billed charges,35.67% of total billed charges,45.53,157,
4.5 CORTICAL SCREW S/TAP 48,27005354,CDM,278,RC,C1713,HCPCS,outpatient,,,157,62.80,,109.9,70,,87.92,percent of total billed charges,70% of total billed charges,157,100,,125.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,128.74,82,,102.992,percent of total billed charges,82% of total billed charges,133.45,85,,106.76,percent of total billed charges,85% of total billed charges,133.45,85,,106.76,percent of total billed charges,85% of total billed charges,133.45,85,,106.76,percent of total billed charges,85% of total billed charges,141.3,90,,113.04,percent of total billed charges,90% of total billed charges,125.6,80,,100.48,percent of total billed charges,80% of total billed charges,141.3,90,,113.04,percent of total billed charges,90% of total billed charges,117.75,75,,94.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,45.53,29,,36.424,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,105.19,67,,84.152,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,109.9,70,,87.92,percent of total billed charges,70% of total billed charges,102.05,65,,81.64,percent of total billed charges,65% of total billed charges,56,35.67,,44.8,percent of total billed charges,35.67% of total billed charges,45.53,157,
4.5 CORTICAL SCREW S/TAP 50,27005355,CDM,278,RC,C1713,HCPCS,outpatient,,,157,62.80,,109.9,70,,87.92,percent of total billed charges,70% of total billed charges,157,100,,125.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,128.74,82,,102.992,percent of total billed charges,82% of total billed charges,133.45,85,,106.76,percent of total billed charges,85% of total billed charges,133.45,85,,106.76,percent of total billed charges,85% of total billed charges,133.45,85,,106.76,percent of total billed charges,85% of total billed charges,141.3,90,,113.04,percent of total billed charges,90% of total billed charges,125.6,80,,100.48,percent of total billed charges,80% of total billed charges,141.3,90,,113.04,percent of total billed charges,90% of total billed charges,117.75,75,,94.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,45.53,29,,36.424,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,105.19,67,,84.152,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,109.9,70,,87.92,percent of total billed charges,70% of total billed charges,102.05,65,,81.64,percent of total billed charges,65% of total billed charges,56,35.67,,44.8,percent of total billed charges,35.67% of total billed charges,45.53,157,
4.5 CORTICAL SCREW S/TAP 52,27005356,CDM,278,RC,C1713,HCPCS,outpatient,,,157,62.80,,109.9,70,,87.92,percent of total billed charges,70% of total billed charges,157,100,,125.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,128.74,82,,102.992,percent of total billed charges,82% of total billed charges,133.45,85,,106.76,percent of total billed charges,85% of total billed charges,133.45,85,,106.76,percent of total billed charges,85% of total billed charges,133.45,85,,106.76,percent of total billed charges,85% of total billed charges,141.3,90,,113.04,percent of total billed charges,90% of total billed charges,125.6,80,,100.48,percent of total billed charges,80% of total billed charges,141.3,90,,113.04,percent of total billed charges,90% of total billed charges,117.75,75,,94.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,45.53,29,,36.424,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,105.19,67,,84.152,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,109.9,70,,87.92,percent of total billed charges,70% of total billed charges,102.05,65,,81.64,percent of total billed charges,65% of total billed charges,56,35.67,,44.8,percent of total billed charges,35.67% of total billed charges,45.53,157,
4.5 CORTICAL SCREW S/TAP 54,27005357,CDM,278,RC,C1713,HCPCS,outpatient,,,157,62.80,,109.9,70,,87.92,percent of total billed charges,70% of total billed charges,157,100,,125.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,128.74,82,,102.992,percent of total billed charges,82% of total billed charges,133.45,85,,106.76,percent of total billed charges,85% of total billed charges,133.45,85,,106.76,percent of total billed charges,85% of total billed charges,133.45,85,,106.76,percent of total billed charges,85% of total billed charges,141.3,90,,113.04,percent of total billed charges,90% of total billed charges,125.6,80,,100.48,percent of total billed charges,80% of total billed charges,141.3,90,,113.04,percent of total billed charges,90% of total billed charges,117.75,75,,94.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,45.53,29,,36.424,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,105.19,67,,84.152,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,109.9,70,,87.92,percent of total billed charges,70% of total billed charges,102.05,65,,81.64,percent of total billed charges,65% of total billed charges,56,35.67,,44.8,percent of total billed charges,35.67% of total billed charges,45.53,157,
4.5 CORTICAL SCREW S/TAP 56,27005358,CDM,278,RC,C1713,HCPCS,outpatient,,,157,62.80,,109.9,70,,87.92,percent of total billed charges,70% of total billed charges,157,100,,125.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,128.74,82,,102.992,percent of total billed charges,82% of total billed charges,133.45,85,,106.76,percent of total billed charges,85% of total billed charges,133.45,85,,106.76,percent of total billed charges,85% of total billed charges,133.45,85,,106.76,percent of total billed charges,85% of total billed charges,141.3,90,,113.04,percent of total billed charges,90% of total billed charges,125.6,80,,100.48,percent of total billed charges,80% of total billed charges,141.3,90,,113.04,percent of total billed charges,90% of total billed charges,117.75,75,,94.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,45.53,29,,36.424,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,105.19,67,,84.152,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,109.9,70,,87.92,percent of total billed charges,70% of total billed charges,102.05,65,,81.64,percent of total billed charges,65% of total billed charges,56,35.67,,44.8,percent of total billed charges,35.67% of total billed charges,45.53,157,
4.5 CORTICAL SCREW S/TAP 58,27005359,CDM,278,RC,C1713,HCPCS,outpatient,,,157,62.80,,109.9,70,,87.92,percent of total billed charges,70% of total billed charges,157,100,,125.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,128.74,82,,102.992,percent of total billed charges,82% of total billed charges,133.45,85,,106.76,percent of total billed charges,85% of total billed charges,133.45,85,,106.76,percent of total billed charges,85% of total billed charges,133.45,85,,106.76,percent of total billed charges,85% of total billed charges,141.3,90,,113.04,percent of total billed charges,90% of total billed charges,125.6,80,,100.48,percent of total billed charges,80% of total billed charges,141.3,90,,113.04,percent of total billed charges,90% of total billed charges,117.75,75,,94.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,45.53,29,,36.424,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,105.19,67,,84.152,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,109.9,70,,87.92,percent of total billed charges,70% of total billed charges,102.05,65,,81.64,percent of total billed charges,65% of total billed charges,56,35.67,,44.8,percent of total billed charges,35.67% of total billed charges,45.53,157,
4.5 CORTICAL SCREW S/TAP 66,27005363,CDM,278,RC,C1713,HCPCS,outpatient,,,157,62.80,,109.9,70,,87.92,percent of total billed charges,70% of total billed charges,157,100,,125.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,128.74,82,,102.992,percent of total billed charges,82% of total billed charges,133.45,85,,106.76,percent of total billed charges,85% of total billed charges,133.45,85,,106.76,percent of total billed charges,85% of total billed charges,133.45,85,,106.76,percent of total billed charges,85% of total billed charges,141.3,90,,113.04,percent of total billed charges,90% of total billed charges,125.6,80,,100.48,percent of total billed charges,80% of total billed charges,141.3,90,,113.04,percent of total billed charges,90% of total billed charges,117.75,75,,94.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,45.53,29,,36.424,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,105.19,67,,84.152,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,109.9,70,,87.92,percent of total billed charges,70% of total billed charges,102.05,65,,81.64,percent of total billed charges,65% of total billed charges,56,35.67,,44.8,percent of total billed charges,35.67% of total billed charges,45.53,157,
4.5 CORTICAL SCREW S/TAP 68,27005364,CDM,278,RC,C1713,HCPCS,outpatient,,,157,62.80,,109.9,70,,87.92,percent of total billed charges,70% of total billed charges,157,100,,125.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,128.74,82,,102.992,percent of total billed charges,82% of total billed charges,133.45,85,,106.76,percent of total billed charges,85% of total billed charges,133.45,85,,106.76,percent of total billed charges,85% of total billed charges,133.45,85,,106.76,percent of total billed charges,85% of total billed charges,141.3,90,,113.04,percent of total billed charges,90% of total billed charges,125.6,80,,100.48,percent of total billed charges,80% of total billed charges,141.3,90,,113.04,percent of total billed charges,90% of total billed charges,117.75,75,,94.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,45.53,29,,36.424,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,105.19,67,,84.152,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,109.9,70,,87.92,percent of total billed charges,70% of total billed charges,102.05,65,,81.64,percent of total billed charges,65% of total billed charges,56,35.67,,44.8,percent of total billed charges,35.67% of total billed charges,45.53,157,
4.5 CORTICAL SCREW S/TAP 70,27005366,CDM,278,RC,C1713,HCPCS,outpatient,,,157,62.80,,109.9,70,,87.92,percent of total billed charges,70% of total billed charges,157,100,,125.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,128.74,82,,102.992,percent of total billed charges,82% of total billed charges,133.45,85,,106.76,percent of total billed charges,85% of total billed charges,133.45,85,,106.76,percent of total billed charges,85% of total billed charges,133.45,85,,106.76,percent of total billed charges,85% of total billed charges,141.3,90,,113.04,percent of total billed charges,90% of total billed charges,125.6,80,,100.48,percent of total billed charges,80% of total billed charges,141.3,90,,113.04,percent of total billed charges,90% of total billed charges,117.75,75,,94.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,45.53,29,,36.424,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,105.19,67,,84.152,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,109.9,70,,87.92,percent of total billed charges,70% of total billed charges,102.05,65,,81.64,percent of total billed charges,65% of total billed charges,56,35.67,,44.8,percent of total billed charges,35.67% of total billed charges,45.53,157,
WASHER LARGE SURGICAL,27005367,CDM,278,RC,C1713,HCPCS,outpatient,,,173,69.20,,121.1,70,,96.88,percent of total billed charges,70% of total billed charges,173,100,,138.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,141.86,82,,113.488,percent of total billed charges,82% of total billed charges,147.05,85,,117.64,percent of total billed charges,85% of total billed charges,147.05,85,,117.64,percent of total billed charges,85% of total billed charges,147.05,85,,117.64,percent of total billed charges,85% of total billed charges,155.7,90,,124.56,percent of total billed charges,90% of total billed charges,138.4,80,,110.72,percent of total billed charges,80% of total billed charges,155.7,90,,124.56,percent of total billed charges,90% of total billed charges,129.75,75,,103.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,50.17,29,,40.136,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,115.91,67,,92.728,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,121.1,70,,96.88,percent of total billed charges,70% of total billed charges,112.45,65,,89.96,percent of total billed charges,65% of total billed charges,61.71,35.67,,49.368,percent of total billed charges,35.67% of total billed charges,50.17,173,
CORTICAL NUTS SURGICAL,27005368,CDM,278,RC,C1713,HCPCS,outpatient,,,312,124.80,,218.4,70,,174.72,percent of total billed charges,70% of total billed charges,312,100,,249.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,255.84,82,,204.672,percent of total billed charges,82% of total billed charges,265.2,85,,212.16,percent of total billed charges,85% of total billed charges,265.2,85,,212.16,percent of total billed charges,85% of total billed charges,265.2,85,,212.16,percent of total billed charges,85% of total billed charges,280.8,90,,224.64,percent of total billed charges,90% of total billed charges,249.6,80,,199.68,percent of total billed charges,80% of total billed charges,280.8,90,,224.64,percent of total billed charges,90% of total billed charges,234,75,,187.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,90.48,29,,72.384,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,209.04,67,,167.232,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,218.4,70,,174.72,percent of total billed charges,70% of total billed charges,202.8,65,,162.24,percent of total billed charges,65% of total billed charges,111.29,35.67,,89.032,percent of total billed charges,35.67% of total billed charges,90.48,312,
4.5 CORTICAL SHAFT SCREW 22,27005369,CDM,278,RC,C1713,HCPCS,outpatient,,,123,49.20,,86.1,70,,68.88,percent of total billed charges,70% of total billed charges,123,100,,98.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,100.86,82,,80.688,percent of total billed charges,82% of total billed charges,104.55,85,,83.64,percent of total billed charges,85% of total billed charges,104.55,85,,83.64,percent of total billed charges,85% of total billed charges,104.55,85,,83.64,percent of total billed charges,85% of total billed charges,110.7,90,,88.56,percent of total billed charges,90% of total billed charges,98.4,80,,78.72,percent of total billed charges,80% of total billed charges,110.7,90,,88.56,percent of total billed charges,90% of total billed charges,92.25,75,,73.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,35.67,29,,28.536,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,82.41,67,,65.928,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,86.1,70,,68.88,percent of total billed charges,70% of total billed charges,79.95,65,,63.96,percent of total billed charges,65% of total billed charges,43.87,35.67,,35.096,percent of total billed charges,35.67% of total billed charges,35.67,123,
4.5 CORTICAL SHAFT SCREW 24,27005371,CDM,278,RC,C1713,HCPCS,outpatient,,,123,49.20,,86.1,70,,68.88,percent of total billed charges,70% of total billed charges,123,100,,98.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,100.86,82,,80.688,percent of total billed charges,82% of total billed charges,104.55,85,,83.64,percent of total billed charges,85% of total billed charges,104.55,85,,83.64,percent of total billed charges,85% of total billed charges,104.55,85,,83.64,percent of total billed charges,85% of total billed charges,110.7,90,,88.56,percent of total billed charges,90% of total billed charges,98.4,80,,78.72,percent of total billed charges,80% of total billed charges,110.7,90,,88.56,percent of total billed charges,90% of total billed charges,92.25,75,,73.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,35.67,29,,28.536,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,82.41,67,,65.928,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,86.1,70,,68.88,percent of total billed charges,70% of total billed charges,79.95,65,,63.96,percent of total billed charges,65% of total billed charges,43.87,35.67,,35.096,percent of total billed charges,35.67% of total billed charges,35.67,123,
4.5 CORTICAL SHAFT SCREW 26,27005372,CDM,278,RC,C1713,HCPCS,outpatient,,,123,49.20,,86.1,70,,68.88,percent of total billed charges,70% of total billed charges,123,100,,98.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,100.86,82,,80.688,percent of total billed charges,82% of total billed charges,104.55,85,,83.64,percent of total billed charges,85% of total billed charges,104.55,85,,83.64,percent of total billed charges,85% of total billed charges,104.55,85,,83.64,percent of total billed charges,85% of total billed charges,110.7,90,,88.56,percent of total billed charges,90% of total billed charges,98.4,80,,78.72,percent of total billed charges,80% of total billed charges,110.7,90,,88.56,percent of total billed charges,90% of total billed charges,92.25,75,,73.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,35.67,29,,28.536,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,82.41,67,,65.928,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,86.1,70,,68.88,percent of total billed charges,70% of total billed charges,79.95,65,,63.96,percent of total billed charges,65% of total billed charges,43.87,35.67,,35.096,percent of total billed charges,35.67% of total billed charges,35.67,123,
4.5 CORTICAL SHAFT SCREW 28,27005373,CDM,278,RC,C1713,HCPCS,outpatient,,,123,49.20,,86.1,70,,68.88,percent of total billed charges,70% of total billed charges,123,100,,98.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,100.86,82,,80.688,percent of total billed charges,82% of total billed charges,104.55,85,,83.64,percent of total billed charges,85% of total billed charges,104.55,85,,83.64,percent of total billed charges,85% of total billed charges,104.55,85,,83.64,percent of total billed charges,85% of total billed charges,110.7,90,,88.56,percent of total billed charges,90% of total billed charges,98.4,80,,78.72,percent of total billed charges,80% of total billed charges,110.7,90,,88.56,percent of total billed charges,90% of total billed charges,92.25,75,,73.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,35.67,29,,28.536,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,82.41,67,,65.928,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,86.1,70,,68.88,percent of total billed charges,70% of total billed charges,79.95,65,,63.96,percent of total billed charges,65% of total billed charges,43.87,35.67,,35.096,percent of total billed charges,35.67% of total billed charges,35.67,123,
4.5 CORTICAL SHAFT SCREW 30,27005374,CDM,278,RC,C1713,HCPCS,outpatient,,,123,49.20,,86.1,70,,68.88,percent of total billed charges,70% of total billed charges,123,100,,98.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,100.86,82,,80.688,percent of total billed charges,82% of total billed charges,104.55,85,,83.64,percent of total billed charges,85% of total billed charges,104.55,85,,83.64,percent of total billed charges,85% of total billed charges,104.55,85,,83.64,percent of total billed charges,85% of total billed charges,110.7,90,,88.56,percent of total billed charges,90% of total billed charges,98.4,80,,78.72,percent of total billed charges,80% of total billed charges,110.7,90,,88.56,percent of total billed charges,90% of total billed charges,92.25,75,,73.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,35.67,29,,28.536,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,82.41,67,,65.928,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,86.1,70,,68.88,percent of total billed charges,70% of total billed charges,79.95,65,,63.96,percent of total billed charges,65% of total billed charges,43.87,35.67,,35.096,percent of total billed charges,35.67% of total billed charges,35.67,123,
4.5 CORTICAL SHAFT SCREW 32,27005375,CDM,278,RC,C1713,HCPCS,outpatient,,,123,49.20,,86.1,70,,68.88,percent of total billed charges,70% of total billed charges,123,100,,98.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,100.86,82,,80.688,percent of total billed charges,82% of total billed charges,104.55,85,,83.64,percent of total billed charges,85% of total billed charges,104.55,85,,83.64,percent of total billed charges,85% of total billed charges,104.55,85,,83.64,percent of total billed charges,85% of total billed charges,110.7,90,,88.56,percent of total billed charges,90% of total billed charges,98.4,80,,78.72,percent of total billed charges,80% of total billed charges,110.7,90,,88.56,percent of total billed charges,90% of total billed charges,92.25,75,,73.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,35.67,29,,28.536,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,82.41,67,,65.928,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,86.1,70,,68.88,percent of total billed charges,70% of total billed charges,79.95,65,,63.96,percent of total billed charges,65% of total billed charges,43.87,35.67,,35.096,percent of total billed charges,35.67% of total billed charges,35.67,123,
TAPS QC 1.5,27005376,CDM,278,RC,C1713,HCPCS,outpatient,,,438,175.20,,306.6,70,,245.28,percent of total billed charges,70% of total billed charges,438,100,,350.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,359.16,82,,287.328,percent of total billed charges,82% of total billed charges,372.3,85,,297.84,percent of total billed charges,85% of total billed charges,372.3,85,,297.84,percent of total billed charges,85% of total billed charges,372.3,85,,297.84,percent of total billed charges,85% of total billed charges,394.2,90,,315.36,percent of total billed charges,90% of total billed charges,350.4,80,,280.32,percent of total billed charges,80% of total billed charges,394.2,90,,315.36,percent of total billed charges,90% of total billed charges,328.5,75,,262.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,127.02,29,,101.616,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,293.46,67,,234.768,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,306.6,70,,245.28,percent of total billed charges,70% of total billed charges,284.7,65,,227.76,percent of total billed charges,65% of total billed charges,156.23,35.67,,124.984,percent of total billed charges,35.67% of total billed charges,127.02,438,
TAPS QC 2.0,27005378,CDM,278,RC,C1713,HCPCS,outpatient,,,438,175.20,,306.6,70,,245.28,percent of total billed charges,70% of total billed charges,438,100,,350.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,359.16,82,,287.328,percent of total billed charges,82% of total billed charges,372.3,85,,297.84,percent of total billed charges,85% of total billed charges,372.3,85,,297.84,percent of total billed charges,85% of total billed charges,372.3,85,,297.84,percent of total billed charges,85% of total billed charges,394.2,90,,315.36,percent of total billed charges,90% of total billed charges,350.4,80,,280.32,percent of total billed charges,80% of total billed charges,394.2,90,,315.36,percent of total billed charges,90% of total billed charges,328.5,75,,262.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,127.02,29,,101.616,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,293.46,67,,234.768,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,306.6,70,,245.28,percent of total billed charges,70% of total billed charges,284.7,65,,227.76,percent of total billed charges,65% of total billed charges,156.23,35.67,,124.984,percent of total billed charges,35.67% of total billed charges,127.02,438,
4.5 CORTICAL SHAFT SCREW 38,27005379,CDM,278,RC,C1713,HCPCS,outpatient,,,123,49.20,,86.1,70,,68.88,percent of total billed charges,70% of total billed charges,123,100,,98.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,100.86,82,,80.688,percent of total billed charges,82% of total billed charges,104.55,85,,83.64,percent of total billed charges,85% of total billed charges,104.55,85,,83.64,percent of total billed charges,85% of total billed charges,104.55,85,,83.64,percent of total billed charges,85% of total billed charges,110.7,90,,88.56,percent of total billed charges,90% of total billed charges,98.4,80,,78.72,percent of total billed charges,80% of total billed charges,110.7,90,,88.56,percent of total billed charges,90% of total billed charges,92.25,75,,73.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,35.67,29,,28.536,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,82.41,67,,65.928,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,86.1,70,,68.88,percent of total billed charges,70% of total billed charges,79.95,65,,63.96,percent of total billed charges,65% of total billed charges,43.87,35.67,,35.096,percent of total billed charges,35.67% of total billed charges,35.67,123,
4.5 CORTICAL SHAFT SCREW 40,27005380,CDM,278,RC,C1713,HCPCS,outpatient,,,123,49.20,,86.1,70,,68.88,percent of total billed charges,70% of total billed charges,123,100,,98.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,100.86,82,,80.688,percent of total billed charges,82% of total billed charges,104.55,85,,83.64,percent of total billed charges,85% of total billed charges,104.55,85,,83.64,percent of total billed charges,85% of total billed charges,104.55,85,,83.64,percent of total billed charges,85% of total billed charges,110.7,90,,88.56,percent of total billed charges,90% of total billed charges,98.4,80,,78.72,percent of total billed charges,80% of total billed charges,110.7,90,,88.56,percent of total billed charges,90% of total billed charges,92.25,75,,73.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,35.67,29,,28.536,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,82.41,67,,65.928,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,86.1,70,,68.88,percent of total billed charges,70% of total billed charges,79.95,65,,63.96,percent of total billed charges,65% of total billed charges,43.87,35.67,,35.096,percent of total billed charges,35.67% of total billed charges,35.67,123,
TAPS QC 2.7,27005381,CDM,278,RC,C1713,HCPCS,outpatient,,,438,175.20,,306.6,70,,245.28,percent of total billed charges,70% of total billed charges,438,100,,350.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,359.16,82,,287.328,percent of total billed charges,82% of total billed charges,372.3,85,,297.84,percent of total billed charges,85% of total billed charges,372.3,85,,297.84,percent of total billed charges,85% of total billed charges,372.3,85,,297.84,percent of total billed charges,85% of total billed charges,394.2,90,,315.36,percent of total billed charges,90% of total billed charges,350.4,80,,280.32,percent of total billed charges,80% of total billed charges,394.2,90,,315.36,percent of total billed charges,90% of total billed charges,328.5,75,,262.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,127.02,29,,101.616,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,293.46,67,,234.768,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,306.6,70,,245.28,percent of total billed charges,70% of total billed charges,284.7,65,,227.76,percent of total billed charges,65% of total billed charges,156.23,35.67,,124.984,percent of total billed charges,35.67% of total billed charges,127.02,438,
4.5 CORTICAL SHAFT SCREW 36,27005382,CDM,278,RC,,,outpatient,,,123,49.20,,86.1,70,,68.88,percent of total billed charges,70% of total billed charges,123,100,,98.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,100.86,82,,80.688,percent of total billed charges,82% of total billed charges,104.55,85,,83.64,percent of total billed charges,85% of total billed charges,104.55,85,,83.64,percent of total billed charges,85% of total billed charges,104.55,85,,83.64,percent of total billed charges,85% of total billed charges,110.7,90,,88.56,percent of total billed charges,90% of total billed charges,98.4,80,,78.72,percent of total billed charges,80% of total billed charges,110.7,90,,88.56,percent of total billed charges,90% of total billed charges,92.25,75,,73.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,35.67,29,,28.536,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,82.41,67,,65.928,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,86.1,70,,68.88,percent of total billed charges,70% of total billed charges,79.95,65,,63.96,percent of total billed charges,65% of total billed charges,43.87,35.67,,35.096,percent of total billed charges,35.67% of total billed charges,35.67,123,
4.5 CORTICAL SHAFT SCREW 42,27005383,CDM,278,RC,,,outpatient,,,123,49.20,,86.1,70,,68.88,percent of total billed charges,70% of total billed charges,123,100,,98.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,100.86,82,,80.688,percent of total billed charges,82% of total billed charges,104.55,85,,83.64,percent of total billed charges,85% of total billed charges,104.55,85,,83.64,percent of total billed charges,85% of total billed charges,104.55,85,,83.64,percent of total billed charges,85% of total billed charges,110.7,90,,88.56,percent of total billed charges,90% of total billed charges,98.4,80,,78.72,percent of total billed charges,80% of total billed charges,110.7,90,,88.56,percent of total billed charges,90% of total billed charges,92.25,75,,73.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,35.67,29,,28.536,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,82.41,67,,65.928,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,86.1,70,,68.88,percent of total billed charges,70% of total billed charges,79.95,65,,63.96,percent of total billed charges,65% of total billed charges,43.87,35.67,,35.096,percent of total billed charges,35.67% of total billed charges,35.67,123,
4.5 CORTICAL SHAFT SCREW 44,27005384,CDM,278,RC,,,outpatient,,,123,49.20,,86.1,70,,68.88,percent of total billed charges,70% of total billed charges,123,100,,98.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,100.86,82,,80.688,percent of total billed charges,82% of total billed charges,104.55,85,,83.64,percent of total billed charges,85% of total billed charges,104.55,85,,83.64,percent of total billed charges,85% of total billed charges,104.55,85,,83.64,percent of total billed charges,85% of total billed charges,110.7,90,,88.56,percent of total billed charges,90% of total billed charges,98.4,80,,78.72,percent of total billed charges,80% of total billed charges,110.7,90,,88.56,percent of total billed charges,90% of total billed charges,92.25,75,,73.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,35.67,29,,28.536,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,82.41,67,,65.928,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,86.1,70,,68.88,percent of total billed charges,70% of total billed charges,79.95,65,,63.96,percent of total billed charges,65% of total billed charges,43.87,35.67,,35.096,percent of total billed charges,35.67% of total billed charges,35.67,123,
4.5 CORTICAL SHAFT SCREW 46,27005385,CDM,278,RC,,,outpatient,,,123,49.20,,86.1,70,,68.88,percent of total billed charges,70% of total billed charges,123,100,,98.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,100.86,82,,80.688,percent of total billed charges,82% of total billed charges,104.55,85,,83.64,percent of total billed charges,85% of total billed charges,104.55,85,,83.64,percent of total billed charges,85% of total billed charges,104.55,85,,83.64,percent of total billed charges,85% of total billed charges,110.7,90,,88.56,percent of total billed charges,90% of total billed charges,98.4,80,,78.72,percent of total billed charges,80% of total billed charges,110.7,90,,88.56,percent of total billed charges,90% of total billed charges,92.25,75,,73.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,35.67,29,,28.536,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,82.41,67,,65.928,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,86.1,70,,68.88,percent of total billed charges,70% of total billed charges,79.95,65,,63.96,percent of total billed charges,65% of total billed charges,43.87,35.67,,35.096,percent of total billed charges,35.67% of total billed charges,35.67,123,
4.5 CORTICAL SHAFT SCREW 48,27005386,CDM,278,RC,,,outpatient,,,123,49.20,,86.1,70,,68.88,percent of total billed charges,70% of total billed charges,123,100,,98.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,100.86,82,,80.688,percent of total billed charges,82% of total billed charges,104.55,85,,83.64,percent of total billed charges,85% of total billed charges,104.55,85,,83.64,percent of total billed charges,85% of total billed charges,104.55,85,,83.64,percent of total billed charges,85% of total billed charges,110.7,90,,88.56,percent of total billed charges,90% of total billed charges,98.4,80,,78.72,percent of total billed charges,80% of total billed charges,110.7,90,,88.56,percent of total billed charges,90% of total billed charges,92.25,75,,73.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,35.67,29,,28.536,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,82.41,67,,65.928,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,86.1,70,,68.88,percent of total billed charges,70% of total billed charges,79.95,65,,63.96,percent of total billed charges,65% of total billed charges,43.87,35.67,,35.096,percent of total billed charges,35.67% of total billed charges,35.67,123,
4.5 CORTICAL SHAFT SCREW 50,27005387,CDM,278,RC,C1713,HCPCS,outpatient,,,123,49.20,,86.1,70,,68.88,percent of total billed charges,70% of total billed charges,123,100,,98.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,100.86,82,,80.688,percent of total billed charges,82% of total billed charges,104.55,85,,83.64,percent of total billed charges,85% of total billed charges,104.55,85,,83.64,percent of total billed charges,85% of total billed charges,104.55,85,,83.64,percent of total billed charges,85% of total billed charges,110.7,90,,88.56,percent of total billed charges,90% of total billed charges,98.4,80,,78.72,percent of total billed charges,80% of total billed charges,110.7,90,,88.56,percent of total billed charges,90% of total billed charges,92.25,75,,73.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,35.67,29,,28.536,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,82.41,67,,65.928,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,86.1,70,,68.88,percent of total billed charges,70% of total billed charges,79.95,65,,63.96,percent of total billed charges,65% of total billed charges,43.87,35.67,,35.096,percent of total billed charges,35.67% of total billed charges,35.67,123,
1.5 CORTICAL SCREW S/TAP 6MM,27005388,CDM,278,RC,C1713,HCPCS,outpatient,,,157,62.80,,109.9,70,,87.92,percent of total billed charges,70% of total billed charges,157,100,,125.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,128.74,82,,102.992,percent of total billed charges,82% of total billed charges,133.45,85,,106.76,percent of total billed charges,85% of total billed charges,133.45,85,,106.76,percent of total billed charges,85% of total billed charges,133.45,85,,106.76,percent of total billed charges,85% of total billed charges,141.3,90,,113.04,percent of total billed charges,90% of total billed charges,125.6,80,,100.48,percent of total billed charges,80% of total billed charges,141.3,90,,113.04,percent of total billed charges,90% of total billed charges,117.75,75,,94.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,45.53,29,,36.424,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,105.19,67,,84.152,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,109.9,70,,87.92,percent of total billed charges,70% of total billed charges,102.05,65,,81.64,percent of total billed charges,65% of total billed charges,56,35.67,,44.8,percent of total billed charges,35.67% of total billed charges,45.53,157,
1.5 CORTICAL SCREW S/TAP 7MM,27005389,CDM,278,RC,C1713,HCPCS,outpatient,,,157,62.80,,109.9,70,,87.92,percent of total billed charges,70% of total billed charges,157,100,,125.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,128.74,82,,102.992,percent of total billed charges,82% of total billed charges,133.45,85,,106.76,percent of total billed charges,85% of total billed charges,133.45,85,,106.76,percent of total billed charges,85% of total billed charges,133.45,85,,106.76,percent of total billed charges,85% of total billed charges,141.3,90,,113.04,percent of total billed charges,90% of total billed charges,125.6,80,,100.48,percent of total billed charges,80% of total billed charges,141.3,90,,113.04,percent of total billed charges,90% of total billed charges,117.75,75,,94.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,45.53,29,,36.424,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,105.19,67,,84.152,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,109.9,70,,87.92,percent of total billed charges,70% of total billed charges,102.05,65,,81.64,percent of total billed charges,65% of total billed charges,56,35.67,,44.8,percent of total billed charges,35.67% of total billed charges,45.53,157,
1.5 CORTICAL SCREW S/TAP 8 MM,27005390,CDM,278,RC,C1713,HCPCS,outpatient,,,157,62.80,,109.9,70,,87.92,percent of total billed charges,70% of total billed charges,157,100,,125.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,128.74,82,,102.992,percent of total billed charges,82% of total billed charges,133.45,85,,106.76,percent of total billed charges,85% of total billed charges,133.45,85,,106.76,percent of total billed charges,85% of total billed charges,133.45,85,,106.76,percent of total billed charges,85% of total billed charges,141.3,90,,113.04,percent of total billed charges,90% of total billed charges,125.6,80,,100.48,percent of total billed charges,80% of total billed charges,141.3,90,,113.04,percent of total billed charges,90% of total billed charges,117.75,75,,94.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,45.53,29,,36.424,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,105.19,67,,84.152,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,109.9,70,,87.92,percent of total billed charges,70% of total billed charges,102.05,65,,81.64,percent of total billed charges,65% of total billed charges,56,35.67,,44.8,percent of total billed charges,35.67% of total billed charges,45.53,157,
4.5 MALLEOLAR SCREW 25,27005391,CDM,278,RC,C1713,HCPCS,outpatient,,,225,90.00,,157.5,70,,126,percent of total billed charges,70% of total billed charges,225,100,,180,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,184.5,82,,147.6,percent of total billed charges,82% of total billed charges,191.25,85,,153,percent of total billed charges,85% of total billed charges,191.25,85,,153,percent of total billed charges,85% of total billed charges,191.25,85,,153,percent of total billed charges,85% of total billed charges,202.5,90,,162,percent of total billed charges,90% of total billed charges,180,80,,144,percent of total billed charges,80% of total billed charges,202.5,90,,162,percent of total billed charges,90% of total billed charges,168.75,75,,135,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,65.25,29,,52.2,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,150.75,67,,120.6,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,157.5,70,,126,percent of total billed charges,70% of total billed charges,146.25,65,,117,percent of total billed charges,65% of total billed charges,80.26,35.67,,64.208,percent of total billed charges,35.67% of total billed charges,65.25,225,
1.5 CORTICAL SCREW S/TAP 9 MM,27005392,CDM,278,RC,C1713,HCPCS,outpatient,,,157,62.80,,109.9,70,,87.92,percent of total billed charges,70% of total billed charges,157,100,,125.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,128.74,82,,102.992,percent of total billed charges,82% of total billed charges,133.45,85,,106.76,percent of total billed charges,85% of total billed charges,133.45,85,,106.76,percent of total billed charges,85% of total billed charges,133.45,85,,106.76,percent of total billed charges,85% of total billed charges,141.3,90,,113.04,percent of total billed charges,90% of total billed charges,125.6,80,,100.48,percent of total billed charges,80% of total billed charges,141.3,90,,113.04,percent of total billed charges,90% of total billed charges,117.75,75,,94.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,45.53,29,,36.424,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,105.19,67,,84.152,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,109.9,70,,87.92,percent of total billed charges,70% of total billed charges,102.05,65,,81.64,percent of total billed charges,65% of total billed charges,56,35.67,,44.8,percent of total billed charges,35.67% of total billed charges,45.53,157,
1.5 CORTICAL SCREW S/TAP 10MM,27005393,CDM,278,RC,C1713,HCPCS,outpatient,,,157,62.80,,109.9,70,,87.92,percent of total billed charges,70% of total billed charges,157,100,,125.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,128.74,82,,102.992,percent of total billed charges,82% of total billed charges,133.45,85,,106.76,percent of total billed charges,85% of total billed charges,133.45,85,,106.76,percent of total billed charges,85% of total billed charges,133.45,85,,106.76,percent of total billed charges,85% of total billed charges,141.3,90,,113.04,percent of total billed charges,90% of total billed charges,125.6,80,,100.48,percent of total billed charges,80% of total billed charges,141.3,90,,113.04,percent of total billed charges,90% of total billed charges,117.75,75,,94.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,45.53,29,,36.424,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,105.19,67,,84.152,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,109.9,70,,87.92,percent of total billed charges,70% of total billed charges,102.05,65,,81.64,percent of total billed charges,65% of total billed charges,56,35.67,,44.8,percent of total billed charges,35.67% of total billed charges,45.53,157,
4.5 MALLEOLAR SCREW 30,27005394,CDM,278,RC,C1713,HCPCS,outpatient,,,225,90.00,,157.5,70,,126,percent of total billed charges,70% of total billed charges,225,100,,180,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,184.5,82,,147.6,percent of total billed charges,82% of total billed charges,191.25,85,,153,percent of total billed charges,85% of total billed charges,191.25,85,,153,percent of total billed charges,85% of total billed charges,191.25,85,,153,percent of total billed charges,85% of total billed charges,202.5,90,,162,percent of total billed charges,90% of total billed charges,180,80,,144,percent of total billed charges,80% of total billed charges,202.5,90,,162,percent of total billed charges,90% of total billed charges,168.75,75,,135,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,65.25,29,,52.2,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,150.75,67,,120.6,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,157.5,70,,126,percent of total billed charges,70% of total billed charges,146.25,65,,117,percent of total billed charges,65% of total billed charges,80.26,35.67,,64.208,percent of total billed charges,35.67% of total billed charges,65.25,225,
1.5 CORTICAL SCREW S/TAP 11MM,27005395,CDM,278,RC,C1713,HCPCS,outpatient,,,157,62.80,,109.9,70,,87.92,percent of total billed charges,70% of total billed charges,157,100,,125.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,128.74,82,,102.992,percent of total billed charges,82% of total billed charges,133.45,85,,106.76,percent of total billed charges,85% of total billed charges,133.45,85,,106.76,percent of total billed charges,85% of total billed charges,133.45,85,,106.76,percent of total billed charges,85% of total billed charges,141.3,90,,113.04,percent of total billed charges,90% of total billed charges,125.6,80,,100.48,percent of total billed charges,80% of total billed charges,141.3,90,,113.04,percent of total billed charges,90% of total billed charges,117.75,75,,94.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,45.53,29,,36.424,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,105.19,67,,84.152,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,109.9,70,,87.92,percent of total billed charges,70% of total billed charges,102.05,65,,81.64,percent of total billed charges,65% of total billed charges,56,35.67,,44.8,percent of total billed charges,35.67% of total billed charges,45.53,157,
4.5 MALLEOLAR SCREW 35,27005396,CDM,278,RC,C1713,HCPCS,outpatient,,,225,90.00,,157.5,70,,126,percent of total billed charges,70% of total billed charges,225,100,,180,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,184.5,82,,147.6,percent of total billed charges,82% of total billed charges,191.25,85,,153,percent of total billed charges,85% of total billed charges,191.25,85,,153,percent of total billed charges,85% of total billed charges,191.25,85,,153,percent of total billed charges,85% of total billed charges,202.5,90,,162,percent of total billed charges,90% of total billed charges,180,80,,144,percent of total billed charges,80% of total billed charges,202.5,90,,162,percent of total billed charges,90% of total billed charges,168.75,75,,135,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,65.25,29,,52.2,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,150.75,67,,120.6,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,157.5,70,,126,percent of total billed charges,70% of total billed charges,146.25,65,,117,percent of total billed charges,65% of total billed charges,80.26,35.67,,64.208,percent of total billed charges,35.67% of total billed charges,65.25,225,
4.5 MALLEOLAR SCREW 40,27005397,CDM,278,RC,C1713,HCPCS,outpatient,,,225,90.00,,157.5,70,,126,percent of total billed charges,70% of total billed charges,225,100,,180,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,184.5,82,,147.6,percent of total billed charges,82% of total billed charges,191.25,85,,153,percent of total billed charges,85% of total billed charges,191.25,85,,153,percent of total billed charges,85% of total billed charges,191.25,85,,153,percent of total billed charges,85% of total billed charges,202.5,90,,162,percent of total billed charges,90% of total billed charges,180,80,,144,percent of total billed charges,80% of total billed charges,202.5,90,,162,percent of total billed charges,90% of total billed charges,168.75,75,,135,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,65.25,29,,52.2,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,150.75,67,,120.6,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,157.5,70,,126,percent of total billed charges,70% of total billed charges,146.25,65,,117,percent of total billed charges,65% of total billed charges,80.26,35.67,,64.208,percent of total billed charges,35.67% of total billed charges,65.25,225,
4.5 MALLEOLAR SCREW 45,27005398,CDM,278,RC,C1713,HCPCS,outpatient,,,225,90.00,,157.5,70,,126,percent of total billed charges,70% of total billed charges,225,100,,180,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,184.5,82,,147.6,percent of total billed charges,82% of total billed charges,191.25,85,,153,percent of total billed charges,85% of total billed charges,191.25,85,,153,percent of total billed charges,85% of total billed charges,191.25,85,,153,percent of total billed charges,85% of total billed charges,202.5,90,,162,percent of total billed charges,90% of total billed charges,180,80,,144,percent of total billed charges,80% of total billed charges,202.5,90,,162,percent of total billed charges,90% of total billed charges,168.75,75,,135,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,65.25,29,,52.2,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,150.75,67,,120.6,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,157.5,70,,126,percent of total billed charges,70% of total billed charges,146.25,65,,117,percent of total billed charges,65% of total billed charges,80.26,35.67,,64.208,percent of total billed charges,35.67% of total billed charges,65.25,225,
1.5 CORTICAL SCREW S/TAP 12MM,27005399,CDM,278,RC,C1713,HCPCS,outpatient,,,157,62.80,,109.9,70,,87.92,percent of total billed charges,70% of total billed charges,157,100,,125.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,128.74,82,,102.992,percent of total billed charges,82% of total billed charges,133.45,85,,106.76,percent of total billed charges,85% of total billed charges,133.45,85,,106.76,percent of total billed charges,85% of total billed charges,133.45,85,,106.76,percent of total billed charges,85% of total billed charges,141.3,90,,113.04,percent of total billed charges,90% of total billed charges,125.6,80,,100.48,percent of total billed charges,80% of total billed charges,141.3,90,,113.04,percent of total billed charges,90% of total billed charges,117.75,75,,94.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,45.53,29,,36.424,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,105.19,67,,84.152,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,109.9,70,,87.92,percent of total billed charges,70% of total billed charges,102.05,65,,81.64,percent of total billed charges,65% of total billed charges,56,35.67,,44.8,percent of total billed charges,35.67% of total billed charges,45.53,157,
4.5 MALLEOLAR SCREW 50,27005400,CDM,278,RC,C1713,HCPCS,outpatient,,,225,90.00,,157.5,70,,126,percent of total billed charges,70% of total billed charges,225,100,,180,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,184.5,82,,147.6,percent of total billed charges,82% of total billed charges,191.25,85,,153,percent of total billed charges,85% of total billed charges,191.25,85,,153,percent of total billed charges,85% of total billed charges,191.25,85,,153,percent of total billed charges,85% of total billed charges,202.5,90,,162,percent of total billed charges,90% of total billed charges,180,80,,144,percent of total billed charges,80% of total billed charges,202.5,90,,162,percent of total billed charges,90% of total billed charges,168.75,75,,135,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,65.25,29,,52.2,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,150.75,67,,120.6,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,157.5,70,,126,percent of total billed charges,70% of total billed charges,146.25,65,,117,percent of total billed charges,65% of total billed charges,80.26,35.67,,64.208,percent of total billed charges,35.67% of total billed charges,65.25,225,
1.5 CORTICAL SCREW S/TAP 14 MM,27005401,CDM,278,RC,C1713,HCPCS,outpatient,,,157,62.80,,109.9,70,,87.92,percent of total billed charges,70% of total billed charges,157,100,,125.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,128.74,82,,102.992,percent of total billed charges,82% of total billed charges,133.45,85,,106.76,percent of total billed charges,85% of total billed charges,133.45,85,,106.76,percent of total billed charges,85% of total billed charges,133.45,85,,106.76,percent of total billed charges,85% of total billed charges,141.3,90,,113.04,percent of total billed charges,90% of total billed charges,125.6,80,,100.48,percent of total billed charges,80% of total billed charges,141.3,90,,113.04,percent of total billed charges,90% of total billed charges,117.75,75,,94.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,45.53,29,,36.424,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,105.19,67,,84.152,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,109.9,70,,87.92,percent of total billed charges,70% of total billed charges,102.05,65,,81.64,percent of total billed charges,65% of total billed charges,56,35.67,,44.8,percent of total billed charges,35.67% of total billed charges,45.53,157,
1.5 CORTICAL SCREW S/TAP 16MM,27005402,CDM,278,RC,C1713,HCPCS,outpatient,,,157,62.80,,109.9,70,,87.92,percent of total billed charges,70% of total billed charges,157,100,,125.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,128.74,82,,102.992,percent of total billed charges,82% of total billed charges,133.45,85,,106.76,percent of total billed charges,85% of total billed charges,133.45,85,,106.76,percent of total billed charges,85% of total billed charges,133.45,85,,106.76,percent of total billed charges,85% of total billed charges,141.3,90,,113.04,percent of total billed charges,90% of total billed charges,125.6,80,,100.48,percent of total billed charges,80% of total billed charges,141.3,90,,113.04,percent of total billed charges,90% of total billed charges,117.75,75,,94.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,45.53,29,,36.424,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,105.19,67,,84.152,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,109.9,70,,87.92,percent of total billed charges,70% of total billed charges,102.05,65,,81.64,percent of total billed charges,65% of total billed charges,56,35.67,,44.8,percent of total billed charges,35.67% of total billed charges,45.53,157,
4.5 MALLEOLAR SCREW 55,27005403,CDM,278,RC,C1713,HCPCS,outpatient,,,225,90.00,,157.5,70,,126,percent of total billed charges,70% of total billed charges,225,100,,180,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,184.5,82,,147.6,percent of total billed charges,82% of total billed charges,191.25,85,,153,percent of total billed charges,85% of total billed charges,191.25,85,,153,percent of total billed charges,85% of total billed charges,191.25,85,,153,percent of total billed charges,85% of total billed charges,202.5,90,,162,percent of total billed charges,90% of total billed charges,180,80,,144,percent of total billed charges,80% of total billed charges,202.5,90,,162,percent of total billed charges,90% of total billed charges,168.75,75,,135,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,65.25,29,,52.2,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,150.75,67,,120.6,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,157.5,70,,126,percent of total billed charges,70% of total billed charges,146.25,65,,117,percent of total billed charges,65% of total billed charges,80.26,35.67,,64.208,percent of total billed charges,35.67% of total billed charges,65.25,225,
1.5 CORTICAL SCREW S/TAP 18 MM,27005404,CDM,278,RC,C1713,HCPCS,outpatient,,,157,62.80,,109.9,70,,87.92,percent of total billed charges,70% of total billed charges,157,100,,125.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,128.74,82,,102.992,percent of total billed charges,82% of total billed charges,133.45,85,,106.76,percent of total billed charges,85% of total billed charges,133.45,85,,106.76,percent of total billed charges,85% of total billed charges,133.45,85,,106.76,percent of total billed charges,85% of total billed charges,141.3,90,,113.04,percent of total billed charges,90% of total billed charges,125.6,80,,100.48,percent of total billed charges,80% of total billed charges,141.3,90,,113.04,percent of total billed charges,90% of total billed charges,117.75,75,,94.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,45.53,29,,36.424,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,105.19,67,,84.152,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,109.9,70,,87.92,percent of total billed charges,70% of total billed charges,102.05,65,,81.64,percent of total billed charges,65% of total billed charges,56,35.67,,44.8,percent of total billed charges,35.67% of total billed charges,45.53,157,
1.5 CORTICAL SCREW S/TAP 20MM,27005405,CDM,278,RC,C1713,HCPCS,outpatient,,,157,62.80,,109.9,70,,87.92,percent of total billed charges,70% of total billed charges,157,100,,125.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,128.74,82,,102.992,percent of total billed charges,82% of total billed charges,133.45,85,,106.76,percent of total billed charges,85% of total billed charges,133.45,85,,106.76,percent of total billed charges,85% of total billed charges,133.45,85,,106.76,percent of total billed charges,85% of total billed charges,141.3,90,,113.04,percent of total billed charges,90% of total billed charges,125.6,80,,100.48,percent of total billed charges,80% of total billed charges,141.3,90,,113.04,percent of total billed charges,90% of total billed charges,117.75,75,,94.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,45.53,29,,36.424,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,105.19,67,,84.152,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,109.9,70,,87.92,percent of total billed charges,70% of total billed charges,102.05,65,,81.64,percent of total billed charges,65% of total billed charges,56,35.67,,44.8,percent of total billed charges,35.67% of total billed charges,45.53,157,
4.5 MALLEOLAR SCREW 60,27005406,CDM,278,RC,C1713,HCPCS,outpatient,,,225,90.00,,157.5,70,,126,percent of total billed charges,70% of total billed charges,225,100,,180,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,184.5,82,,147.6,percent of total billed charges,82% of total billed charges,191.25,85,,153,percent of total billed charges,85% of total billed charges,191.25,85,,153,percent of total billed charges,85% of total billed charges,191.25,85,,153,percent of total billed charges,85% of total billed charges,202.5,90,,162,percent of total billed charges,90% of total billed charges,180,80,,144,percent of total billed charges,80% of total billed charges,202.5,90,,162,percent of total billed charges,90% of total billed charges,168.75,75,,135,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,65.25,29,,52.2,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,150.75,67,,120.6,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,157.5,70,,126,percent of total billed charges,70% of total billed charges,146.25,65,,117,percent of total billed charges,65% of total billed charges,80.26,35.67,,64.208,percent of total billed charges,35.67% of total billed charges,65.25,225,
6.5 CANCELLOUS 16 SCREW THR 30,27005407,CDM,278,RC,,,outpatient,,,188,75.20,,131.6,70,,105.28,percent of total billed charges,70% of total billed charges,188,100,,150.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,154.16,82,,123.328,percent of total billed charges,82% of total billed charges,159.8,85,,127.84,percent of total billed charges,85% of total billed charges,159.8,85,,127.84,percent of total billed charges,85% of total billed charges,159.8,85,,127.84,percent of total billed charges,85% of total billed charges,169.2,90,,135.36,percent of total billed charges,90% of total billed charges,150.4,80,,120.32,percent of total billed charges,80% of total billed charges,169.2,90,,135.36,percent of total billed charges,90% of total billed charges,141,75,,112.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,54.52,29,,43.616,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,125.96,67,,100.768,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,131.6,70,,105.28,percent of total billed charges,70% of total billed charges,122.2,65,,97.76,percent of total billed charges,65% of total billed charges,67.06,35.67,,53.648,percent of total billed charges,35.67% of total billed charges,54.52,188,
1.5 CORTICAL SCREW S/TAP 22MM,27005408,CDM,278,RC,C1713,HCPCS,outpatient,,,157,62.80,,109.9,70,,87.92,percent of total billed charges,70% of total billed charges,157,100,,125.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,128.74,82,,102.992,percent of total billed charges,82% of total billed charges,133.45,85,,106.76,percent of total billed charges,85% of total billed charges,133.45,85,,106.76,percent of total billed charges,85% of total billed charges,133.45,85,,106.76,percent of total billed charges,85% of total billed charges,141.3,90,,113.04,percent of total billed charges,90% of total billed charges,125.6,80,,100.48,percent of total billed charges,80% of total billed charges,141.3,90,,113.04,percent of total billed charges,90% of total billed charges,117.75,75,,94.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,45.53,29,,36.424,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,105.19,67,,84.152,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,109.9,70,,87.92,percent of total billed charges,70% of total billed charges,102.05,65,,81.64,percent of total billed charges,65% of total billed charges,56,35.67,,44.8,percent of total billed charges,35.67% of total billed charges,45.53,157,
1.5 CORTICAL SCREW S/TAP 24 MM,27005409,CDM,278,RC,C1713,HCPCS,outpatient,,,157,62.80,,109.9,70,,87.92,percent of total billed charges,70% of total billed charges,157,100,,125.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,128.74,82,,102.992,percent of total billed charges,82% of total billed charges,133.45,85,,106.76,percent of total billed charges,85% of total billed charges,133.45,85,,106.76,percent of total billed charges,85% of total billed charges,133.45,85,,106.76,percent of total billed charges,85% of total billed charges,141.3,90,,113.04,percent of total billed charges,90% of total billed charges,125.6,80,,100.48,percent of total billed charges,80% of total billed charges,141.3,90,,113.04,percent of total billed charges,90% of total billed charges,117.75,75,,94.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,45.53,29,,36.424,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,105.19,67,,84.152,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,109.9,70,,87.92,percent of total billed charges,70% of total billed charges,102.05,65,,81.64,percent of total billed charges,65% of total billed charges,56,35.67,,44.8,percent of total billed charges,35.67% of total billed charges,45.53,157,
WASHER MINI SURGICAL,27005410,CDM,278,RC,C1713,HCPCS,outpatient,,,173,69.20,,121.1,70,,96.88,percent of total billed charges,70% of total billed charges,173,100,,138.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,141.86,82,,113.488,percent of total billed charges,82% of total billed charges,147.05,85,,117.64,percent of total billed charges,85% of total billed charges,147.05,85,,117.64,percent of total billed charges,85% of total billed charges,147.05,85,,117.64,percent of total billed charges,85% of total billed charges,155.7,90,,124.56,percent of total billed charges,90% of total billed charges,138.4,80,,110.72,percent of total billed charges,80% of total billed charges,155.7,90,,124.56,percent of total billed charges,90% of total billed charges,129.75,75,,103.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,50.17,29,,40.136,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,115.91,67,,92.728,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,121.1,70,,96.88,percent of total billed charges,70% of total billed charges,112.45,65,,89.96,percent of total billed charges,65% of total billed charges,61.71,35.67,,49.368,percent of total billed charges,35.67% of total billed charges,50.17,173,
6.5 CANCELLOUS CREW 16 THR 35,27005411,CDM,278,RC,,,outpatient,,,188,75.20,,131.6,70,,105.28,percent of total billed charges,70% of total billed charges,188,100,,150.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,154.16,82,,123.328,percent of total billed charges,82% of total billed charges,159.8,85,,127.84,percent of total billed charges,85% of total billed charges,159.8,85,,127.84,percent of total billed charges,85% of total billed charges,159.8,85,,127.84,percent of total billed charges,85% of total billed charges,169.2,90,,135.36,percent of total billed charges,90% of total billed charges,150.4,80,,120.32,percent of total billed charges,80% of total billed charges,169.2,90,,135.36,percent of total billed charges,90% of total billed charges,141,75,,112.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,54.52,29,,43.616,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,125.96,67,,100.768,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,131.6,70,,105.28,percent of total billed charges,70% of total billed charges,122.2,65,,97.76,percent of total billed charges,65% of total billed charges,67.06,35.67,,53.648,percent of total billed charges,35.67% of total billed charges,54.52,188,
6.5 CANCELLOUS SCREW 16 THR 40,27005412,CDM,278,RC,,,outpatient,,,188,75.20,,131.6,70,,105.28,percent of total billed charges,70% of total billed charges,188,100,,150.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,154.16,82,,123.328,percent of total billed charges,82% of total billed charges,159.8,85,,127.84,percent of total billed charges,85% of total billed charges,159.8,85,,127.84,percent of total billed charges,85% of total billed charges,159.8,85,,127.84,percent of total billed charges,85% of total billed charges,169.2,90,,135.36,percent of total billed charges,90% of total billed charges,150.4,80,,120.32,percent of total billed charges,80% of total billed charges,169.2,90,,135.36,percent of total billed charges,90% of total billed charges,141,75,,112.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,54.52,29,,43.616,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,125.96,67,,100.768,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,131.6,70,,105.28,percent of total billed charges,70% of total billed charges,122.2,65,,97.76,percent of total billed charges,65% of total billed charges,67.06,35.67,,53.648,percent of total billed charges,35.67% of total billed charges,54.52,188,
6.5 CANCELLOUS SCREW 16 THR 45,27005413,CDM,278,RC,,,outpatient,,,188,75.20,,131.6,70,,105.28,percent of total billed charges,70% of total billed charges,188,100,,150.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,154.16,82,,123.328,percent of total billed charges,82% of total billed charges,159.8,85,,127.84,percent of total billed charges,85% of total billed charges,159.8,85,,127.84,percent of total billed charges,85% of total billed charges,159.8,85,,127.84,percent of total billed charges,85% of total billed charges,169.2,90,,135.36,percent of total billed charges,90% of total billed charges,150.4,80,,120.32,percent of total billed charges,80% of total billed charges,169.2,90,,135.36,percent of total billed charges,90% of total billed charges,141,75,,112.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,54.52,29,,43.616,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,125.96,67,,100.768,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,131.6,70,,105.28,percent of total billed charges,70% of total billed charges,122.2,65,,97.76,percent of total billed charges,65% of total billed charges,67.06,35.67,,53.648,percent of total billed charges,35.67% of total billed charges,54.52,188,
6.5 CANCELLOUS SCREW 16 THR 50,27005414,CDM,278,RC,,,outpatient,,,188,75.20,,131.6,70,,105.28,percent of total billed charges,70% of total billed charges,188,100,,150.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,154.16,82,,123.328,percent of total billed charges,82% of total billed charges,159.8,85,,127.84,percent of total billed charges,85% of total billed charges,159.8,85,,127.84,percent of total billed charges,85% of total billed charges,159.8,85,,127.84,percent of total billed charges,85% of total billed charges,169.2,90,,135.36,percent of total billed charges,90% of total billed charges,150.4,80,,120.32,percent of total billed charges,80% of total billed charges,169.2,90,,135.36,percent of total billed charges,90% of total billed charges,141,75,,112.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,54.52,29,,43.616,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,125.96,67,,100.768,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,131.6,70,,105.28,percent of total billed charges,70% of total billed charges,122.2,65,,97.76,percent of total billed charges,65% of total billed charges,67.06,35.67,,53.648,percent of total billed charges,35.67% of total billed charges,54.52,188,
6.5 CANCELLOUS SCREW 16 THR 55,27005415,CDM,278,RC,,,outpatient,,,188,75.20,,131.6,70,,105.28,percent of total billed charges,70% of total billed charges,188,100,,150.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,154.16,82,,123.328,percent of total billed charges,82% of total billed charges,159.8,85,,127.84,percent of total billed charges,85% of total billed charges,159.8,85,,127.84,percent of total billed charges,85% of total billed charges,159.8,85,,127.84,percent of total billed charges,85% of total billed charges,169.2,90,,135.36,percent of total billed charges,90% of total billed charges,150.4,80,,120.32,percent of total billed charges,80% of total billed charges,169.2,90,,135.36,percent of total billed charges,90% of total billed charges,141,75,,112.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,54.52,29,,43.616,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,125.96,67,,100.768,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,131.6,70,,105.28,percent of total billed charges,70% of total billed charges,122.2,65,,97.76,percent of total billed charges,65% of total billed charges,67.06,35.67,,53.648,percent of total billed charges,35.67% of total billed charges,54.52,188,
6.5 CANCELLOUS SCREW 16 THR 60,27005416,CDM,278,RC,,,outpatient,,,188,75.20,,131.6,70,,105.28,percent of total billed charges,70% of total billed charges,188,100,,150.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,154.16,82,,123.328,percent of total billed charges,82% of total billed charges,159.8,85,,127.84,percent of total billed charges,85% of total billed charges,159.8,85,,127.84,percent of total billed charges,85% of total billed charges,159.8,85,,127.84,percent of total billed charges,85% of total billed charges,169.2,90,,135.36,percent of total billed charges,90% of total billed charges,150.4,80,,120.32,percent of total billed charges,80% of total billed charges,169.2,90,,135.36,percent of total billed charges,90% of total billed charges,141,75,,112.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,54.52,29,,43.616,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,125.96,67,,100.768,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,131.6,70,,105.28,percent of total billed charges,70% of total billed charges,122.2,65,,97.76,percent of total billed charges,65% of total billed charges,67.06,35.67,,53.648,percent of total billed charges,35.67% of total billed charges,54.52,188,
6.5 CANCELLOUS SCREW 16 THR 65,27005417,CDM,278,RC,,,outpatient,,,188,75.20,,131.6,70,,105.28,percent of total billed charges,70% of total billed charges,188,100,,150.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,154.16,82,,123.328,percent of total billed charges,82% of total billed charges,159.8,85,,127.84,percent of total billed charges,85% of total billed charges,159.8,85,,127.84,percent of total billed charges,85% of total billed charges,159.8,85,,127.84,percent of total billed charges,85% of total billed charges,169.2,90,,135.36,percent of total billed charges,90% of total billed charges,150.4,80,,120.32,percent of total billed charges,80% of total billed charges,169.2,90,,135.36,percent of total billed charges,90% of total billed charges,141,75,,112.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,54.52,29,,43.616,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,125.96,67,,100.768,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,131.6,70,,105.28,percent of total billed charges,70% of total billed charges,122.2,65,,97.76,percent of total billed charges,65% of total billed charges,67.06,35.67,,53.648,percent of total billed charges,35.67% of total billed charges,54.52,188,
6.5 CANCELLOUS SCREW 16 THR 70,27005418,CDM,278,RC,,,outpatient,,,188,75.20,,131.6,70,,105.28,percent of total billed charges,70% of total billed charges,188,100,,150.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,154.16,82,,123.328,percent of total billed charges,82% of total billed charges,159.8,85,,127.84,percent of total billed charges,85% of total billed charges,159.8,85,,127.84,percent of total billed charges,85% of total billed charges,159.8,85,,127.84,percent of total billed charges,85% of total billed charges,169.2,90,,135.36,percent of total billed charges,90% of total billed charges,150.4,80,,120.32,percent of total billed charges,80% of total billed charges,169.2,90,,135.36,percent of total billed charges,90% of total billed charges,141,75,,112.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,54.52,29,,43.616,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,125.96,67,,100.768,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,131.6,70,,105.28,percent of total billed charges,70% of total billed charges,122.2,65,,97.76,percent of total billed charges,65% of total billed charges,67.06,35.67,,53.648,percent of total billed charges,35.67% of total billed charges,54.52,188,
6.5 CANCELLOUS SCREW 16 THR 75,27005419,CDM,278,RC,,,outpatient,,,188,75.20,,131.6,70,,105.28,percent of total billed charges,70% of total billed charges,188,100,,150.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,154.16,82,,123.328,percent of total billed charges,82% of total billed charges,159.8,85,,127.84,percent of total billed charges,85% of total billed charges,159.8,85,,127.84,percent of total billed charges,85% of total billed charges,159.8,85,,127.84,percent of total billed charges,85% of total billed charges,169.2,90,,135.36,percent of total billed charges,90% of total billed charges,150.4,80,,120.32,percent of total billed charges,80% of total billed charges,169.2,90,,135.36,percent of total billed charges,90% of total billed charges,141,75,,112.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,54.52,29,,43.616,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,125.96,67,,100.768,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,131.6,70,,105.28,percent of total billed charges,70% of total billed charges,122.2,65,,97.76,percent of total billed charges,65% of total billed charges,67.06,35.67,,53.648,percent of total billed charges,35.67% of total billed charges,54.52,188,
6.5 CANCELLOUS SCREW 16 THR 85,27005421,CDM,278,RC,C1713,HCPCS,outpatient,,,206,82.40,,144.2,70,,115.36,percent of total billed charges,70% of total billed charges,206,100,,164.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,168.92,82,,135.136,percent of total billed charges,82% of total billed charges,175.1,85,,140.08,percent of total billed charges,85% of total billed charges,175.1,85,,140.08,percent of total billed charges,85% of total billed charges,175.1,85,,140.08,percent of total billed charges,85% of total billed charges,185.4,90,,148.32,percent of total billed charges,90% of total billed charges,164.8,80,,131.84,percent of total billed charges,80% of total billed charges,185.4,90,,148.32,percent of total billed charges,90% of total billed charges,154.5,75,,123.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,59.74,29,,47.792,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,138.02,67,,110.416,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,144.2,70,,115.36,percent of total billed charges,70% of total billed charges,133.9,65,,107.12,percent of total billed charges,65% of total billed charges,73.48,35.67,,58.784,percent of total billed charges,35.67% of total billed charges,59.74,206,
6.5 CANCELLOUS SCREW 16 THR 90,27005422,CDM,278,RC,C1713,HCPCS,outpatient,,,206,82.40,,144.2,70,,115.36,percent of total billed charges,70% of total billed charges,206,100,,164.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,168.92,82,,135.136,percent of total billed charges,82% of total billed charges,175.1,85,,140.08,percent of total billed charges,85% of total billed charges,175.1,85,,140.08,percent of total billed charges,85% of total billed charges,175.1,85,,140.08,percent of total billed charges,85% of total billed charges,185.4,90,,148.32,percent of total billed charges,90% of total billed charges,164.8,80,,131.84,percent of total billed charges,80% of total billed charges,185.4,90,,148.32,percent of total billed charges,90% of total billed charges,154.5,75,,123.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,59.74,29,,47.792,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,138.02,67,,110.416,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,144.2,70,,115.36,percent of total billed charges,70% of total billed charges,133.9,65,,107.12,percent of total billed charges,65% of total billed charges,73.48,35.67,,58.784,percent of total billed charges,35.67% of total billed charges,59.74,206,
6.5 CANCELLOUS SCREW 16 THRU 9,27005423,CDM,278,RC,C1713,HCPCS,outpatient,,,206,82.40,,144.2,70,,115.36,percent of total billed charges,70% of total billed charges,206,100,,164.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,168.92,82,,135.136,percent of total billed charges,82% of total billed charges,175.1,85,,140.08,percent of total billed charges,85% of total billed charges,175.1,85,,140.08,percent of total billed charges,85% of total billed charges,175.1,85,,140.08,percent of total billed charges,85% of total billed charges,185.4,90,,148.32,percent of total billed charges,90% of total billed charges,164.8,80,,131.84,percent of total billed charges,80% of total billed charges,185.4,90,,148.32,percent of total billed charges,90% of total billed charges,154.5,75,,123.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,59.74,29,,47.792,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,138.02,67,,110.416,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,144.2,70,,115.36,percent of total billed charges,70% of total billed charges,133.9,65,,107.12,percent of total billed charges,65% of total billed charges,73.48,35.67,,58.784,percent of total billed charges,35.67% of total billed charges,59.74,206,
6.5 CANCELLOUS SCREW 16 TH 100,27005424,CDM,278,RC,C1713,HCPCS,outpatient,,,206,82.40,,144.2,70,,115.36,percent of total billed charges,70% of total billed charges,206,100,,164.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,168.92,82,,135.136,percent of total billed charges,82% of total billed charges,175.1,85,,140.08,percent of total billed charges,85% of total billed charges,175.1,85,,140.08,percent of total billed charges,85% of total billed charges,175.1,85,,140.08,percent of total billed charges,85% of total billed charges,185.4,90,,148.32,percent of total billed charges,90% of total billed charges,164.8,80,,131.84,percent of total billed charges,80% of total billed charges,185.4,90,,148.32,percent of total billed charges,90% of total billed charges,154.5,75,,123.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,59.74,29,,47.792,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,138.02,67,,110.416,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,144.2,70,,115.36,percent of total billed charges,70% of total billed charges,133.9,65,,107.12,percent of total billed charges,65% of total billed charges,73.48,35.67,,58.784,percent of total billed charges,35.67% of total billed charges,59.74,206,
6.5 CANCELLOUS SCREW 16 TH 105,27005425,CDM,278,RC,C1713,HCPCS,outpatient,,,206,82.40,,144.2,70,,115.36,percent of total billed charges,70% of total billed charges,206,100,,164.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,168.92,82,,135.136,percent of total billed charges,82% of total billed charges,175.1,85,,140.08,percent of total billed charges,85% of total billed charges,175.1,85,,140.08,percent of total billed charges,85% of total billed charges,175.1,85,,140.08,percent of total billed charges,85% of total billed charges,185.4,90,,148.32,percent of total billed charges,90% of total billed charges,164.8,80,,131.84,percent of total billed charges,80% of total billed charges,185.4,90,,148.32,percent of total billed charges,90% of total billed charges,154.5,75,,123.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,59.74,29,,47.792,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,138.02,67,,110.416,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,144.2,70,,115.36,percent of total billed charges,70% of total billed charges,133.9,65,,107.12,percent of total billed charges,65% of total billed charges,73.48,35.67,,58.784,percent of total billed charges,35.67% of total billed charges,59.74,206,
6.5 CANCELLOUS SCREW 16 TH 110,27005426,CDM,278,RC,C1713,HCPCS,outpatient,,,206,82.40,,144.2,70,,115.36,percent of total billed charges,70% of total billed charges,206,100,,164.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,168.92,82,,135.136,percent of total billed charges,82% of total billed charges,175.1,85,,140.08,percent of total billed charges,85% of total billed charges,175.1,85,,140.08,percent of total billed charges,85% of total billed charges,175.1,85,,140.08,percent of total billed charges,85% of total billed charges,185.4,90,,148.32,percent of total billed charges,90% of total billed charges,164.8,80,,131.84,percent of total billed charges,80% of total billed charges,185.4,90,,148.32,percent of total billed charges,90% of total billed charges,154.5,75,,123.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,59.74,29,,47.792,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,138.02,67,,110.416,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,144.2,70,,115.36,percent of total billed charges,70% of total billed charges,133.9,65,,107.12,percent of total billed charges,65% of total billed charges,73.48,35.67,,58.784,percent of total billed charges,35.67% of total billed charges,59.74,206,
6.5 CANCELLOUS SCREW 32 TH 45,27005427,CDM,278,RC,,,outpatient,,,188,75.20,,131.6,70,,105.28,percent of total billed charges,70% of total billed charges,188,100,,150.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,154.16,82,,123.328,percent of total billed charges,82% of total billed charges,159.8,85,,127.84,percent of total billed charges,85% of total billed charges,159.8,85,,127.84,percent of total billed charges,85% of total billed charges,159.8,85,,127.84,percent of total billed charges,85% of total billed charges,169.2,90,,135.36,percent of total billed charges,90% of total billed charges,150.4,80,,120.32,percent of total billed charges,80% of total billed charges,169.2,90,,135.36,percent of total billed charges,90% of total billed charges,141,75,,112.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,54.52,29,,43.616,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,125.96,67,,100.768,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,131.6,70,,105.28,percent of total billed charges,70% of total billed charges,122.2,65,,97.76,percent of total billed charges,65% of total billed charges,67.06,35.67,,53.648,percent of total billed charges,35.67% of total billed charges,54.52,188,
6.5 CANCELLOUS SCREW 32 TH 50,27005428,CDM,278,RC,,,outpatient,,,188,75.20,,131.6,70,,105.28,percent of total billed charges,70% of total billed charges,188,100,,150.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,154.16,82,,123.328,percent of total billed charges,82% of total billed charges,159.8,85,,127.84,percent of total billed charges,85% of total billed charges,159.8,85,,127.84,percent of total billed charges,85% of total billed charges,159.8,85,,127.84,percent of total billed charges,85% of total billed charges,169.2,90,,135.36,percent of total billed charges,90% of total billed charges,150.4,80,,120.32,percent of total billed charges,80% of total billed charges,169.2,90,,135.36,percent of total billed charges,90% of total billed charges,141,75,,112.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,54.52,29,,43.616,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,125.96,67,,100.768,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,131.6,70,,105.28,percent of total billed charges,70% of total billed charges,122.2,65,,97.76,percent of total billed charges,65% of total billed charges,67.06,35.67,,53.648,percent of total billed charges,35.67% of total billed charges,54.52,188,
2.0 CORTICAL SCREW S/TAP 6MM,27005429,CDM,278,RC,C1713,HCPCS,outpatient,,,157,62.80,,109.9,70,,87.92,percent of total billed charges,70% of total billed charges,157,100,,125.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,128.74,82,,102.992,percent of total billed charges,82% of total billed charges,133.45,85,,106.76,percent of total billed charges,85% of total billed charges,133.45,85,,106.76,percent of total billed charges,85% of total billed charges,133.45,85,,106.76,percent of total billed charges,85% of total billed charges,141.3,90,,113.04,percent of total billed charges,90% of total billed charges,125.6,80,,100.48,percent of total billed charges,80% of total billed charges,141.3,90,,113.04,percent of total billed charges,90% of total billed charges,117.75,75,,94.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,45.53,29,,36.424,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,105.19,67,,84.152,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,109.9,70,,87.92,percent of total billed charges,70% of total billed charges,102.05,65,,81.64,percent of total billed charges,65% of total billed charges,56,35.67,,44.8,percent of total billed charges,35.67% of total billed charges,45.53,157,
6.5 CANCELLOUS SCREW 32 TH 60,27005430,CDM,278,RC,,,outpatient,,,188,75.20,,131.6,70,,105.28,percent of total billed charges,70% of total billed charges,188,100,,150.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,154.16,82,,123.328,percent of total billed charges,82% of total billed charges,159.8,85,,127.84,percent of total billed charges,85% of total billed charges,159.8,85,,127.84,percent of total billed charges,85% of total billed charges,159.8,85,,127.84,percent of total billed charges,85% of total billed charges,169.2,90,,135.36,percent of total billed charges,90% of total billed charges,150.4,80,,120.32,percent of total billed charges,80% of total billed charges,169.2,90,,135.36,percent of total billed charges,90% of total billed charges,141,75,,112.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,54.52,29,,43.616,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,125.96,67,,100.768,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,131.6,70,,105.28,percent of total billed charges,70% of total billed charges,122.2,65,,97.76,percent of total billed charges,65% of total billed charges,67.06,35.67,,53.648,percent of total billed charges,35.67% of total billed charges,54.52,188,
SCREW 2.0 CORTICAL S/TAP 8 MM,27005431,CDM,278,RC,C1713,HCPCS,outpatient,,,157,62.80,,109.9,70,,87.92,percent of total billed charges,70% of total billed charges,157,100,,125.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,128.74,82,,102.992,percent of total billed charges,82% of total billed charges,133.45,85,,106.76,percent of total billed charges,85% of total billed charges,133.45,85,,106.76,percent of total billed charges,85% of total billed charges,133.45,85,,106.76,percent of total billed charges,85% of total billed charges,141.3,90,,113.04,percent of total billed charges,90% of total billed charges,125.6,80,,100.48,percent of total billed charges,80% of total billed charges,141.3,90,,113.04,percent of total billed charges,90% of total billed charges,117.75,75,,94.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,45.53,29,,36.424,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,105.19,67,,84.152,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,109.9,70,,87.92,percent of total billed charges,70% of total billed charges,102.05,65,,81.64,percent of total billed charges,65% of total billed charges,56,35.67,,44.8,percent of total billed charges,35.67% of total billed charges,45.53,157,
6.5 CANCELLOUS SCREW 32 TH 55,27005432,CDM,278,RC,,,outpatient,,,188,75.20,,131.6,70,,105.28,percent of total billed charges,70% of total billed charges,188,100,,150.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,154.16,82,,123.328,percent of total billed charges,82% of total billed charges,159.8,85,,127.84,percent of total billed charges,85% of total billed charges,159.8,85,,127.84,percent of total billed charges,85% of total billed charges,159.8,85,,127.84,percent of total billed charges,85% of total billed charges,169.2,90,,135.36,percent of total billed charges,90% of total billed charges,150.4,80,,120.32,percent of total billed charges,80% of total billed charges,169.2,90,,135.36,percent of total billed charges,90% of total billed charges,141,75,,112.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,54.52,29,,43.616,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,125.96,67,,100.768,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,131.6,70,,105.28,percent of total billed charges,70% of total billed charges,122.2,65,,97.76,percent of total billed charges,65% of total billed charges,67.06,35.67,,53.648,percent of total billed charges,35.67% of total billed charges,54.52,188,
2.0 CORTICAL SCREW S/TAP 24MM,27005433,CDM,278,RC,C1713,HCPCS,outpatient,,,157,62.80,,109.9,70,,87.92,percent of total billed charges,70% of total billed charges,157,100,,125.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,128.74,82,,102.992,percent of total billed charges,82% of total billed charges,133.45,85,,106.76,percent of total billed charges,85% of total billed charges,133.45,85,,106.76,percent of total billed charges,85% of total billed charges,133.45,85,,106.76,percent of total billed charges,85% of total billed charges,141.3,90,,113.04,percent of total billed charges,90% of total billed charges,125.6,80,,100.48,percent of total billed charges,80% of total billed charges,141.3,90,,113.04,percent of total billed charges,90% of total billed charges,117.75,75,,94.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,45.53,29,,36.424,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,105.19,67,,84.152,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,109.9,70,,87.92,percent of total billed charges,70% of total billed charges,102.05,65,,81.64,percent of total billed charges,65% of total billed charges,56,35.67,,44.8,percent of total billed charges,35.67% of total billed charges,45.53,157,
6.5 CANCELLOUS SCREW 32 TH 65,27005434,CDM,278,RC,,,outpatient,,,188,75.20,,131.6,70,,105.28,percent of total billed charges,70% of total billed charges,188,100,,150.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,154.16,82,,123.328,percent of total billed charges,82% of total billed charges,159.8,85,,127.84,percent of total billed charges,85% of total billed charges,159.8,85,,127.84,percent of total billed charges,85% of total billed charges,159.8,85,,127.84,percent of total billed charges,85% of total billed charges,169.2,90,,135.36,percent of total billed charges,90% of total billed charges,150.4,80,,120.32,percent of total billed charges,80% of total billed charges,169.2,90,,135.36,percent of total billed charges,90% of total billed charges,141,75,,112.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,54.52,29,,43.616,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,125.96,67,,100.768,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,131.6,70,,105.28,percent of total billed charges,70% of total billed charges,122.2,65,,97.76,percent of total billed charges,65% of total billed charges,67.06,35.67,,53.648,percent of total billed charges,35.67% of total billed charges,54.52,188,
6.5 CANCELLOUS SCREW 32 TH 70,27005435,CDM,278,RC,C1713,HCPCS,outpatient,,,188,75.20,,131.6,70,,105.28,percent of total billed charges,70% of total billed charges,188,100,,150.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,154.16,82,,123.328,percent of total billed charges,82% of total billed charges,159.8,85,,127.84,percent of total billed charges,85% of total billed charges,159.8,85,,127.84,percent of total billed charges,85% of total billed charges,159.8,85,,127.84,percent of total billed charges,85% of total billed charges,169.2,90,,135.36,percent of total billed charges,90% of total billed charges,150.4,80,,120.32,percent of total billed charges,80% of total billed charges,169.2,90,,135.36,percent of total billed charges,90% of total billed charges,141,75,,112.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,54.52,29,,43.616,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,125.96,67,,100.768,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,131.6,70,,105.28,percent of total billed charges,70% of total billed charges,122.2,65,,97.76,percent of total billed charges,65% of total billed charges,67.06,35.67,,53.648,percent of total billed charges,35.67% of total billed charges,54.52,188,
2.7 CORTICAL SCREW S/TAP 6MM,27005436,CDM,278,RC,C1713,HCPCS,outpatient,,,157,62.80,,109.9,70,,87.92,percent of total billed charges,70% of total billed charges,157,100,,125.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,128.74,82,,102.992,percent of total billed charges,82% of total billed charges,133.45,85,,106.76,percent of total billed charges,85% of total billed charges,133.45,85,,106.76,percent of total billed charges,85% of total billed charges,133.45,85,,106.76,percent of total billed charges,85% of total billed charges,141.3,90,,113.04,percent of total billed charges,90% of total billed charges,125.6,80,,100.48,percent of total billed charges,80% of total billed charges,141.3,90,,113.04,percent of total billed charges,90% of total billed charges,117.75,75,,94.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,45.53,29,,36.424,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,105.19,67,,84.152,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,109.9,70,,87.92,percent of total billed charges,70% of total billed charges,102.05,65,,81.64,percent of total billed charges,65% of total billed charges,56,35.67,,44.8,percent of total billed charges,35.67% of total billed charges,45.53,157,
2.7 CORTICAL S/TAP SCREW SZ8MM,27005437,CDM,278,RC,C1713,HCPCS,outpatient,,,157,62.80,,109.9,70,,87.92,percent of total billed charges,70% of total billed charges,157,100,,125.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,128.74,82,,102.992,percent of total billed charges,82% of total billed charges,133.45,85,,106.76,percent of total billed charges,85% of total billed charges,133.45,85,,106.76,percent of total billed charges,85% of total billed charges,133.45,85,,106.76,percent of total billed charges,85% of total billed charges,141.3,90,,113.04,percent of total billed charges,90% of total billed charges,125.6,80,,100.48,percent of total billed charges,80% of total billed charges,141.3,90,,113.04,percent of total billed charges,90% of total billed charges,117.75,75,,94.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,45.53,29,,36.424,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,105.19,67,,84.152,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,109.9,70,,87.92,percent of total billed charges,70% of total billed charges,102.05,65,,81.64,percent of total billed charges,65% of total billed charges,56,35.67,,44.8,percent of total billed charges,35.67% of total billed charges,45.53,157,
2.7 CORTICAL SCREW S/TAP 22MM,27005438,CDM,278,RC,C1713,HCPCS,outpatient,,,157,62.80,,109.9,70,,87.92,percent of total billed charges,70% of total billed charges,157,100,,125.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,128.74,82,,102.992,percent of total billed charges,82% of total billed charges,133.45,85,,106.76,percent of total billed charges,85% of total billed charges,133.45,85,,106.76,percent of total billed charges,85% of total billed charges,133.45,85,,106.76,percent of total billed charges,85% of total billed charges,141.3,90,,113.04,percent of total billed charges,90% of total billed charges,125.6,80,,100.48,percent of total billed charges,80% of total billed charges,141.3,90,,113.04,percent of total billed charges,90% of total billed charges,117.75,75,,94.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,45.53,29,,36.424,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,105.19,67,,84.152,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,109.9,70,,87.92,percent of total billed charges,70% of total billed charges,102.05,65,,81.64,percent of total billed charges,65% of total billed charges,56,35.67,,44.8,percent of total billed charges,35.67% of total billed charges,45.53,157,
SCREW 2.7 CORTICAL S/TAP 24 MM,27005439,CDM,278,RC,C1713,HCPCS,outpatient,,,191,76.40,,133.7,70,,106.96,percent of total billed charges,70% of total billed charges,191,100,,152.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,156.62,82,,125.296,percent of total billed charges,82% of total billed charges,162.35,85,,129.88,percent of total billed charges,85% of total billed charges,162.35,85,,129.88,percent of total billed charges,85% of total billed charges,162.35,85,,129.88,percent of total billed charges,85% of total billed charges,171.9,90,,137.52,percent of total billed charges,90% of total billed charges,152.8,80,,122.24,percent of total billed charges,80% of total billed charges,171.9,90,,137.52,percent of total billed charges,90% of total billed charges,143.25,75,,114.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,55.39,29,,44.312,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,127.97,67,,102.376,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,133.7,70,,106.96,percent of total billed charges,70% of total billed charges,124.15,65,,99.32,percent of total billed charges,65% of total billed charges,68.13,35.67,,54.504,percent of total billed charges,35.67% of total billed charges,55.39,191,
WASHER SMALL SURGICAL,27005440,CDM,278,RC,C1713,HCPCS,outpatient,,,164,65.60,,114.8,70,,91.84,percent of total billed charges,70% of total billed charges,164,100,,131.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,134.48,82,,107.584,percent of total billed charges,82% of total billed charges,139.4,85,,111.52,percent of total billed charges,85% of total billed charges,139.4,85,,111.52,percent of total billed charges,85% of total billed charges,139.4,85,,111.52,percent of total billed charges,85% of total billed charges,147.6,90,,118.08,percent of total billed charges,90% of total billed charges,131.2,80,,104.96,percent of total billed charges,80% of total billed charges,147.6,90,,118.08,percent of total billed charges,90% of total billed charges,123,75,,98.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,47.56,29,,38.048,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,109.88,67,,87.904,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,114.8,70,,91.84,percent of total billed charges,70% of total billed charges,106.6,65,,85.28,percent of total billed charges,65% of total billed charges,58.5,35.67,,46.8,percent of total billed charges,35.67% of total billed charges,47.56,164,
PLATE L 2.0 OBLIQUE LEFT,27005441,CDM,278,RC,C1713,HCPCS,outpatient,,,271,108.40,,189.7,70,,151.76,percent of total billed charges,70% of total billed charges,271,100,,216.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,222.22,82,,177.776,percent of total billed charges,82% of total billed charges,230.35,85,,184.28,percent of total billed charges,85% of total billed charges,230.35,85,,184.28,percent of total billed charges,85% of total billed charges,230.35,85,,184.28,percent of total billed charges,85% of total billed charges,243.9,90,,195.12,percent of total billed charges,90% of total billed charges,216.8,80,,173.44,percent of total billed charges,80% of total billed charges,243.9,90,,195.12,percent of total billed charges,90% of total billed charges,203.25,75,,162.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,78.59,29,,62.872,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,181.57,67,,145.256,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,189.7,70,,151.76,percent of total billed charges,70% of total billed charges,176.15,65,,140.92,percent of total billed charges,65% of total billed charges,96.67,35.67,,77.336,percent of total billed charges,35.67% of total billed charges,78.59,271,
PLATE T 2.0 MM,27005442,CDM,278,RC,C1713,HCPCS,outpatient,,,328,131.20,,229.6,70,,183.68,percent of total billed charges,70% of total billed charges,328,100,,262.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,268.96,82,,215.168,percent of total billed charges,82% of total billed charges,278.8,85,,223.04,percent of total billed charges,85% of total billed charges,278.8,85,,223.04,percent of total billed charges,85% of total billed charges,278.8,85,,223.04,percent of total billed charges,85% of total billed charges,295.2,90,,236.16,percent of total billed charges,90% of total billed charges,262.4,80,,209.92,percent of total billed charges,80% of total billed charges,295.2,90,,236.16,percent of total billed charges,90% of total billed charges,246,75,,196.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,95.12,29,,76.096,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,219.76,67,,175.808,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,229.6,70,,183.68,percent of total billed charges,70% of total billed charges,213.2,65,,170.56,percent of total billed charges,65% of total billed charges,117,35.67,,93.6,percent of total billed charges,35.67% of total billed charges,95.12,328,
6.5 CANCELLOUS SCREW 32 TH 75,27005443,CDM,278,RC,C1713,HCPCS,outpatient,,,188,75.20,,131.6,70,,105.28,percent of total billed charges,70% of total billed charges,188,100,,150.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,154.16,82,,123.328,percent of total billed charges,82% of total billed charges,159.8,85,,127.84,percent of total billed charges,85% of total billed charges,159.8,85,,127.84,percent of total billed charges,85% of total billed charges,159.8,85,,127.84,percent of total billed charges,85% of total billed charges,169.2,90,,135.36,percent of total billed charges,90% of total billed charges,150.4,80,,120.32,percent of total billed charges,80% of total billed charges,169.2,90,,135.36,percent of total billed charges,90% of total billed charges,141,75,,112.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,54.52,29,,43.616,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,125.96,67,,100.768,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,131.6,70,,105.28,percent of total billed charges,70% of total billed charges,122.2,65,,97.76,percent of total billed charges,65% of total billed charges,67.06,35.67,,53.648,percent of total billed charges,35.67% of total billed charges,54.52,188,
6.5 CANCELLOUS SCREW 32 TH 80,27005444,CDM,278,RC,C1713,HCPCS,outpatient,,,188,75.20,,131.6,70,,105.28,percent of total billed charges,70% of total billed charges,188,100,,150.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,154.16,82,,123.328,percent of total billed charges,82% of total billed charges,159.8,85,,127.84,percent of total billed charges,85% of total billed charges,159.8,85,,127.84,percent of total billed charges,85% of total billed charges,159.8,85,,127.84,percent of total billed charges,85% of total billed charges,169.2,90,,135.36,percent of total billed charges,90% of total billed charges,150.4,80,,120.32,percent of total billed charges,80% of total billed charges,169.2,90,,135.36,percent of total billed charges,90% of total billed charges,141,75,,112.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,54.52,29,,43.616,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,125.96,67,,100.768,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,131.6,70,,105.28,percent of total billed charges,70% of total billed charges,122.2,65,,97.76,percent of total billed charges,65% of total billed charges,67.06,35.67,,53.648,percent of total billed charges,35.67% of total billed charges,54.52,188,
6.5 CANCELLOUS SCREW 32 TH 85,27005445,CDM,278,RC,C1713,HCPCS,outpatient,,,283,113.20,,198.1,70,,158.48,percent of total billed charges,70% of total billed charges,283,100,,226.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,232.06,82,,185.648,percent of total billed charges,82% of total billed charges,240.55,85,,192.44,percent of total billed charges,85% of total billed charges,240.55,85,,192.44,percent of total billed charges,85% of total billed charges,240.55,85,,192.44,percent of total billed charges,85% of total billed charges,254.7,90,,203.76,percent of total billed charges,90% of total billed charges,226.4,80,,181.12,percent of total billed charges,80% of total billed charges,254.7,90,,203.76,percent of total billed charges,90% of total billed charges,212.25,75,,169.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,82.07,29,,65.656,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,189.61,67,,151.688,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,198.1,70,,158.48,percent of total billed charges,70% of total billed charges,183.95,65,,147.16,percent of total billed charges,65% of total billed charges,100.95,35.67,,80.76,percent of total billed charges,35.67% of total billed charges,82.07,283,
6.5 CANCELLOUS SCREW 32 TH 90,27005446,CDM,278,RC,C1713,HCPCS,outpatient,,,206,82.40,,144.2,70,,115.36,percent of total billed charges,70% of total billed charges,206,100,,164.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,168.92,82,,135.136,percent of total billed charges,82% of total billed charges,175.1,85,,140.08,percent of total billed charges,85% of total billed charges,175.1,85,,140.08,percent of total billed charges,85% of total billed charges,175.1,85,,140.08,percent of total billed charges,85% of total billed charges,185.4,90,,148.32,percent of total billed charges,90% of total billed charges,164.8,80,,131.84,percent of total billed charges,80% of total billed charges,185.4,90,,148.32,percent of total billed charges,90% of total billed charges,154.5,75,,123.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,59.74,29,,47.792,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,138.02,67,,110.416,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,144.2,70,,115.36,percent of total billed charges,70% of total billed charges,133.9,65,,107.12,percent of total billed charges,65% of total billed charges,73.48,35.67,,58.784,percent of total billed charges,35.67% of total billed charges,59.74,206,
6.5 CANCELLOUS SCREW 32 TH 95,27005447,CDM,278,RC,C1713,HCPCS,outpatient,,,206,82.40,,144.2,70,,115.36,percent of total billed charges,70% of total billed charges,206,100,,164.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,168.92,82,,135.136,percent of total billed charges,82% of total billed charges,175.1,85,,140.08,percent of total billed charges,85% of total billed charges,175.1,85,,140.08,percent of total billed charges,85% of total billed charges,175.1,85,,140.08,percent of total billed charges,85% of total billed charges,185.4,90,,148.32,percent of total billed charges,90% of total billed charges,164.8,80,,131.84,percent of total billed charges,80% of total billed charges,185.4,90,,148.32,percent of total billed charges,90% of total billed charges,154.5,75,,123.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,59.74,29,,47.792,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,138.02,67,,110.416,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,144.2,70,,115.36,percent of total billed charges,70% of total billed charges,133.9,65,,107.12,percent of total billed charges,65% of total billed charges,73.48,35.67,,58.784,percent of total billed charges,35.67% of total billed charges,59.74,206,
6.5 CANCELLOUS SCREW 32 TH 100,27005448,CDM,278,RC,C1713,HCPCS,outpatient,,,206,82.40,,144.2,70,,115.36,percent of total billed charges,70% of total billed charges,206,100,,164.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,168.92,82,,135.136,percent of total billed charges,82% of total billed charges,175.1,85,,140.08,percent of total billed charges,85% of total billed charges,175.1,85,,140.08,percent of total billed charges,85% of total billed charges,175.1,85,,140.08,percent of total billed charges,85% of total billed charges,185.4,90,,148.32,percent of total billed charges,90% of total billed charges,164.8,80,,131.84,percent of total billed charges,80% of total billed charges,185.4,90,,148.32,percent of total billed charges,90% of total billed charges,154.5,75,,123.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,59.74,29,,47.792,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,138.02,67,,110.416,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,144.2,70,,115.36,percent of total billed charges,70% of total billed charges,133.9,65,,107.12,percent of total billed charges,65% of total billed charges,73.48,35.67,,58.784,percent of total billed charges,35.67% of total billed charges,59.74,206,
6.5 CANCELLOUS SCREW 32 TH 105,27005449,CDM,278,RC,C1713,HCPCS,outpatient,,,206,82.40,,144.2,70,,115.36,percent of total billed charges,70% of total billed charges,206,100,,164.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,168.92,82,,135.136,percent of total billed charges,82% of total billed charges,175.1,85,,140.08,percent of total billed charges,85% of total billed charges,175.1,85,,140.08,percent of total billed charges,85% of total billed charges,175.1,85,,140.08,percent of total billed charges,85% of total billed charges,185.4,90,,148.32,percent of total billed charges,90% of total billed charges,164.8,80,,131.84,percent of total billed charges,80% of total billed charges,185.4,90,,148.32,percent of total billed charges,90% of total billed charges,154.5,75,,123.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,59.74,29,,47.792,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,138.02,67,,110.416,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,144.2,70,,115.36,percent of total billed charges,70% of total billed charges,133.9,65,,107.12,percent of total billed charges,65% of total billed charges,73.48,35.67,,58.784,percent of total billed charges,35.67% of total billed charges,59.74,206,
6.5 CANCELLOUS SCREW 32 TH 110,27005450,CDM,278,RC,C1713,HCPCS,outpatient,,,206,82.40,,144.2,70,,115.36,percent of total billed charges,70% of total billed charges,206,100,,164.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,168.92,82,,135.136,percent of total billed charges,82% of total billed charges,175.1,85,,140.08,percent of total billed charges,85% of total billed charges,175.1,85,,140.08,percent of total billed charges,85% of total billed charges,175.1,85,,140.08,percent of total billed charges,85% of total billed charges,185.4,90,,148.32,percent of total billed charges,90% of total billed charges,164.8,80,,131.84,percent of total billed charges,80% of total billed charges,185.4,90,,148.32,percent of total billed charges,90% of total billed charges,154.5,75,,123.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,59.74,29,,47.792,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,138.02,67,,110.416,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,144.2,70,,115.36,percent of total billed charges,70% of total billed charges,133.9,65,,107.12,percent of total billed charges,65% of total billed charges,73.48,35.67,,58.784,percent of total billed charges,35.67% of total billed charges,59.74,206,
6.5 CANCELLOUS SCREW F/THR 20,27005451,CDM,278,RC,,,outpatient,,,188,75.20,,131.6,70,,105.28,percent of total billed charges,70% of total billed charges,188,100,,150.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,154.16,82,,123.328,percent of total billed charges,82% of total billed charges,159.8,85,,127.84,percent of total billed charges,85% of total billed charges,159.8,85,,127.84,percent of total billed charges,85% of total billed charges,159.8,85,,127.84,percent of total billed charges,85% of total billed charges,169.2,90,,135.36,percent of total billed charges,90% of total billed charges,150.4,80,,120.32,percent of total billed charges,80% of total billed charges,169.2,90,,135.36,percent of total billed charges,90% of total billed charges,141,75,,112.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,54.52,29,,43.616,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,125.96,67,,100.768,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,131.6,70,,105.28,percent of total billed charges,70% of total billed charges,122.2,65,,97.76,percent of total billed charges,65% of total billed charges,67.06,35.67,,53.648,percent of total billed charges,35.67% of total billed charges,54.52,188,
6.5 CANCELLOUS SCREW F/THR 25,27005452,CDM,278,RC,,,outpatient,,,174,69.60,,121.8,70,,97.44,percent of total billed charges,70% of total billed charges,174,100,,139.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,142.68,82,,114.144,percent of total billed charges,82% of total billed charges,147.9,85,,118.32,percent of total billed charges,85% of total billed charges,147.9,85,,118.32,percent of total billed charges,85% of total billed charges,147.9,85,,118.32,percent of total billed charges,85% of total billed charges,156.6,90,,125.28,percent of total billed charges,90% of total billed charges,139.2,80,,111.36,percent of total billed charges,80% of total billed charges,156.6,90,,125.28,percent of total billed charges,90% of total billed charges,130.5,75,,104.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,50.46,29,,40.368,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,116.58,67,,93.264,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,121.8,70,,97.44,percent of total billed charges,70% of total billed charges,113.1,65,,90.48,percent of total billed charges,65% of total billed charges,62.07,35.67,,49.656,percent of total billed charges,35.67% of total billed charges,50.46,174,
6.5 CANCELLOUS SCREW F/THR 30,27005453,CDM,278,RC,C1713,HCPCS,outpatient,,,206,82.40,,144.2,70,,115.36,percent of total billed charges,70% of total billed charges,206,100,,164.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,168.92,82,,135.136,percent of total billed charges,82% of total billed charges,175.1,85,,140.08,percent of total billed charges,85% of total billed charges,175.1,85,,140.08,percent of total billed charges,85% of total billed charges,175.1,85,,140.08,percent of total billed charges,85% of total billed charges,185.4,90,,148.32,percent of total billed charges,90% of total billed charges,164.8,80,,131.84,percent of total billed charges,80% of total billed charges,185.4,90,,148.32,percent of total billed charges,90% of total billed charges,154.5,75,,123.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,59.74,29,,47.792,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,138.02,67,,110.416,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,144.2,70,,115.36,percent of total billed charges,70% of total billed charges,133.9,65,,107.12,percent of total billed charges,65% of total billed charges,73.48,35.67,,58.784,percent of total billed charges,35.67% of total billed charges,59.74,206,
6.5 CANCELLOUS SCREW F/THR 35,27005454,CDM,278,RC,C1713,HCPCS,outpatient,,,206,82.40,,144.2,70,,115.36,percent of total billed charges,70% of total billed charges,206,100,,164.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,168.92,82,,135.136,percent of total billed charges,82% of total billed charges,175.1,85,,140.08,percent of total billed charges,85% of total billed charges,175.1,85,,140.08,percent of total billed charges,85% of total billed charges,175.1,85,,140.08,percent of total billed charges,85% of total billed charges,185.4,90,,148.32,percent of total billed charges,90% of total billed charges,164.8,80,,131.84,percent of total billed charges,80% of total billed charges,185.4,90,,148.32,percent of total billed charges,90% of total billed charges,154.5,75,,123.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,59.74,29,,47.792,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,138.02,67,,110.416,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,144.2,70,,115.36,percent of total billed charges,70% of total billed charges,133.9,65,,107.12,percent of total billed charges,65% of total billed charges,73.48,35.67,,58.784,percent of total billed charges,35.67% of total billed charges,59.74,206,
6.5 CANCELLOUS SCREW F/THR 40,27005455,CDM,278,RC,C1713,HCPCS,outpatient,,,206,82.40,,144.2,70,,115.36,percent of total billed charges,70% of total billed charges,206,100,,164.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,168.92,82,,135.136,percent of total billed charges,82% of total billed charges,175.1,85,,140.08,percent of total billed charges,85% of total billed charges,175.1,85,,140.08,percent of total billed charges,85% of total billed charges,175.1,85,,140.08,percent of total billed charges,85% of total billed charges,185.4,90,,148.32,percent of total billed charges,90% of total billed charges,164.8,80,,131.84,percent of total billed charges,80% of total billed charges,185.4,90,,148.32,percent of total billed charges,90% of total billed charges,154.5,75,,123.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,59.74,29,,47.792,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,138.02,67,,110.416,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,144.2,70,,115.36,percent of total billed charges,70% of total billed charges,133.9,65,,107.12,percent of total billed charges,65% of total billed charges,73.48,35.67,,58.784,percent of total billed charges,35.67% of total billed charges,59.74,206,
6.5 CANCELLOUS SCREW F/THR 45,27005456,CDM,278,RC,C1713,HCPCS,outpatient,,,206,82.40,,144.2,70,,115.36,percent of total billed charges,70% of total billed charges,206,100,,164.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,168.92,82,,135.136,percent of total billed charges,82% of total billed charges,175.1,85,,140.08,percent of total billed charges,85% of total billed charges,175.1,85,,140.08,percent of total billed charges,85% of total billed charges,175.1,85,,140.08,percent of total billed charges,85% of total billed charges,185.4,90,,148.32,percent of total billed charges,90% of total billed charges,164.8,80,,131.84,percent of total billed charges,80% of total billed charges,185.4,90,,148.32,percent of total billed charges,90% of total billed charges,154.5,75,,123.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,59.74,29,,47.792,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,138.02,67,,110.416,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,144.2,70,,115.36,percent of total billed charges,70% of total billed charges,133.9,65,,107.12,percent of total billed charges,65% of total billed charges,73.48,35.67,,58.784,percent of total billed charges,35.67% of total billed charges,59.74,206,
6.5 CANCELLOUS SCREW F/THR 50,27005457,CDM,278,RC,C1713,HCPCS,outpatient,,,206,82.40,,144.2,70,,115.36,percent of total billed charges,70% of total billed charges,206,100,,164.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,168.92,82,,135.136,percent of total billed charges,82% of total billed charges,175.1,85,,140.08,percent of total billed charges,85% of total billed charges,175.1,85,,140.08,percent of total billed charges,85% of total billed charges,175.1,85,,140.08,percent of total billed charges,85% of total billed charges,185.4,90,,148.32,percent of total billed charges,90% of total billed charges,164.8,80,,131.84,percent of total billed charges,80% of total billed charges,185.4,90,,148.32,percent of total billed charges,90% of total billed charges,154.5,75,,123.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,59.74,29,,47.792,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,138.02,67,,110.416,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,144.2,70,,115.36,percent of total billed charges,70% of total billed charges,133.9,65,,107.12,percent of total billed charges,65% of total billed charges,73.48,35.67,,58.784,percent of total billed charges,35.67% of total billed charges,59.74,206,
6.5 CANCELLOUS SCREW F/THR 55,27005458,CDM,278,RC,C1713,HCPCS,outpatient,,,206,82.40,,144.2,70,,115.36,percent of total billed charges,70% of total billed charges,206,100,,164.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,168.92,82,,135.136,percent of total billed charges,82% of total billed charges,175.1,85,,140.08,percent of total billed charges,85% of total billed charges,175.1,85,,140.08,percent of total billed charges,85% of total billed charges,175.1,85,,140.08,percent of total billed charges,85% of total billed charges,185.4,90,,148.32,percent of total billed charges,90% of total billed charges,164.8,80,,131.84,percent of total billed charges,80% of total billed charges,185.4,90,,148.32,percent of total billed charges,90% of total billed charges,154.5,75,,123.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,59.74,29,,47.792,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,138.02,67,,110.416,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,144.2,70,,115.36,percent of total billed charges,70% of total billed charges,133.9,65,,107.12,percent of total billed charges,65% of total billed charges,73.48,35.67,,58.784,percent of total billed charges,35.67% of total billed charges,59.74,206,
6.5 CANCELLOUS SCREW F/THR 60,27005459,CDM,278,RC,C1713,HCPCS,outpatient,,,206,82.40,,144.2,70,,115.36,percent of total billed charges,70% of total billed charges,206,100,,164.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,168.92,82,,135.136,percent of total billed charges,82% of total billed charges,175.1,85,,140.08,percent of total billed charges,85% of total billed charges,175.1,85,,140.08,percent of total billed charges,85% of total billed charges,175.1,85,,140.08,percent of total billed charges,85% of total billed charges,185.4,90,,148.32,percent of total billed charges,90% of total billed charges,164.8,80,,131.84,percent of total billed charges,80% of total billed charges,185.4,90,,148.32,percent of total billed charges,90% of total billed charges,154.5,75,,123.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,59.74,29,,47.792,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,138.02,67,,110.416,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,144.2,70,,115.36,percent of total billed charges,70% of total billed charges,133.9,65,,107.12,percent of total billed charges,65% of total billed charges,73.48,35.67,,58.784,percent of total billed charges,35.67% of total billed charges,59.74,206,
H PLATE 2.0MM,27005460,CDM,278,RC,C1713,HCPCS,outpatient,,,646,258.40,,452.2,70,,361.76,percent of total billed charges,70% of total billed charges,646,100,,516.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,529.72,82,,423.776,percent of total billed charges,82% of total billed charges,549.1,85,,439.28,percent of total billed charges,85% of total billed charges,549.1,85,,439.28,percent of total billed charges,85% of total billed charges,549.1,85,,439.28,percent of total billed charges,85% of total billed charges,581.4,90,,465.12,percent of total billed charges,90% of total billed charges,516.8,80,,413.44,percent of total billed charges,80% of total billed charges,581.4,90,,465.12,percent of total billed charges,90% of total billed charges,484.5,75,,387.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,187.34,29,,149.872,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,432.82,67,,346.256,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,452.2,70,,361.76,percent of total billed charges,70% of total billed charges,419.9,65,,335.92,percent of total billed charges,65% of total billed charges,230.43,35.67,,184.344,percent of total billed charges,35.67% of total billed charges,187.34,646,
H PLATE 1.5MM,27005461,CDM,278,RC,C1713,HCPCS,outpatient,,,646,258.40,,452.2,70,,361.76,percent of total billed charges,70% of total billed charges,646,100,,516.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,529.72,82,,423.776,percent of total billed charges,82% of total billed charges,549.1,85,,439.28,percent of total billed charges,85% of total billed charges,549.1,85,,439.28,percent of total billed charges,85% of total billed charges,549.1,85,,439.28,percent of total billed charges,85% of total billed charges,581.4,90,,465.12,percent of total billed charges,90% of total billed charges,516.8,80,,413.44,percent of total billed charges,80% of total billed charges,581.4,90,,465.12,percent of total billed charges,90% of total billed charges,484.5,75,,387.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,187.34,29,,149.872,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,432.82,67,,346.256,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,452.2,70,,361.76,percent of total billed charges,70% of total billed charges,419.9,65,,335.92,percent of total billed charges,65% of total billed charges,230.43,35.67,,184.344,percent of total billed charges,35.67% of total billed charges,187.34,646,
STRAIGHT PLATE 2.0 3 HOLE,27005462,CDM,278,RC,C1713,HCPCS,outpatient,,,271,108.40,,189.7,70,,151.76,percent of total billed charges,70% of total billed charges,271,100,,216.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,222.22,82,,177.776,percent of total billed charges,82% of total billed charges,230.35,85,,184.28,percent of total billed charges,85% of total billed charges,230.35,85,,184.28,percent of total billed charges,85% of total billed charges,230.35,85,,184.28,percent of total billed charges,85% of total billed charges,243.9,90,,195.12,percent of total billed charges,90% of total billed charges,216.8,80,,173.44,percent of total billed charges,80% of total billed charges,243.9,90,,195.12,percent of total billed charges,90% of total billed charges,203.25,75,,162.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,78.59,29,,62.872,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,181.57,67,,145.256,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,189.7,70,,151.76,percent of total billed charges,70% of total billed charges,176.15,65,,140.92,percent of total billed charges,65% of total billed charges,96.67,35.67,,77.336,percent of total billed charges,35.67% of total billed charges,78.59,271,
STRAIGHT PLATE 2.0 4HOLE,27005463,CDM,278,RC,C1713,HCPCS,outpatient,,,303,121.20,,212.1,70,,169.68,percent of total billed charges,70% of total billed charges,303,100,,242.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,248.46,82,,198.768,percent of total billed charges,82% of total billed charges,257.55,85,,206.04,percent of total billed charges,85% of total billed charges,257.55,85,,206.04,percent of total billed charges,85% of total billed charges,257.55,85,,206.04,percent of total billed charges,85% of total billed charges,272.7,90,,218.16,percent of total billed charges,90% of total billed charges,242.4,80,,193.92,percent of total billed charges,80% of total billed charges,272.7,90,,218.16,percent of total billed charges,90% of total billed charges,227.25,75,,181.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,87.87,29,,70.296,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,203.01,67,,162.408,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,212.1,70,,169.68,percent of total billed charges,70% of total billed charges,196.95,65,,157.56,percent of total billed charges,65% of total billed charges,108.08,35.67,,86.464,percent of total billed charges,35.67% of total billed charges,87.87,303,
STRAIGHT PLATE 2.0MM 6H,27005464,CDM,278,RC,C1713,HCPCS,outpatient,,,295,118.00,,206.5,70,,165.2,percent of total billed charges,70% of total billed charges,295,100,,236,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,241.9,82,,193.52,percent of total billed charges,82% of total billed charges,250.75,85,,200.6,percent of total billed charges,85% of total billed charges,250.75,85,,200.6,percent of total billed charges,85% of total billed charges,250.75,85,,200.6,percent of total billed charges,85% of total billed charges,265.5,90,,212.4,percent of total billed charges,90% of total billed charges,236,80,,188.8,percent of total billed charges,80% of total billed charges,265.5,90,,212.4,percent of total billed charges,90% of total billed charges,221.25,75,,177,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,85.55,29,,68.44,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,197.65,67,,158.12,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,206.5,70,,165.2,percent of total billed charges,70% of total billed charges,191.75,65,,153.4,percent of total billed charges,65% of total billed charges,105.23,35.67,,84.184,percent of total billed charges,35.67% of total billed charges,85.55,295,
L PLATE 2.7MM LEFT OBLIQUE,27005465,CDM,278,RC,C1713,HCPCS,outpatient,,,277,110.80,,193.9,70,,155.12,percent of total billed charges,70% of total billed charges,277,100,,221.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,227.14,82,,181.712,percent of total billed charges,82% of total billed charges,235.45,85,,188.36,percent of total billed charges,85% of total billed charges,235.45,85,,188.36,percent of total billed charges,85% of total billed charges,235.45,85,,188.36,percent of total billed charges,85% of total billed charges,249.3,90,,199.44,percent of total billed charges,90% of total billed charges,221.6,80,,177.28,percent of total billed charges,80% of total billed charges,249.3,90,,199.44,percent of total billed charges,90% of total billed charges,207.75,75,,166.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,80.33,29,,64.264,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,185.59,67,,148.472,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,193.9,70,,155.12,percent of total billed charges,70% of total billed charges,180.05,65,,144.04,percent of total billed charges,65% of total billed charges,98.81,35.67,,79.048,percent of total billed charges,35.67% of total billed charges,80.33,277,
L PLATE 2.7MM RIGHT OBLIQUE,27005466,CDM,278,RC,C1713,HCPCS,outpatient,,,303,121.20,,212.1,70,,169.68,percent of total billed charges,70% of total billed charges,303,100,,242.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,248.46,82,,198.768,percent of total billed charges,82% of total billed charges,257.55,85,,206.04,percent of total billed charges,85% of total billed charges,257.55,85,,206.04,percent of total billed charges,85% of total billed charges,257.55,85,,206.04,percent of total billed charges,85% of total billed charges,272.7,90,,218.16,percent of total billed charges,90% of total billed charges,242.4,80,,193.92,percent of total billed charges,80% of total billed charges,272.7,90,,218.16,percent of total billed charges,90% of total billed charges,227.25,75,,181.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,87.87,29,,70.296,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,203.01,67,,162.408,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,212.1,70,,169.68,percent of total billed charges,70% of total billed charges,196.95,65,,157.56,percent of total billed charges,65% of total billed charges,108.08,35.67,,86.464,percent of total billed charges,35.67% of total billed charges,87.87,303,
TUBULAR PLATE 1/4 3 HOLE,27005467,CDM,278,RC,C1713,HCPCS,outpatient,,,322,128.80,,225.4,70,,180.32,percent of total billed charges,70% of total billed charges,322,100,,257.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,264.04,82,,211.232,percent of total billed charges,82% of total billed charges,273.7,85,,218.96,percent of total billed charges,85% of total billed charges,273.7,85,,218.96,percent of total billed charges,85% of total billed charges,273.7,85,,218.96,percent of total billed charges,85% of total billed charges,289.8,90,,231.84,percent of total billed charges,90% of total billed charges,257.6,80,,206.08,percent of total billed charges,80% of total billed charges,289.8,90,,231.84,percent of total billed charges,90% of total billed charges,241.5,75,,193.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,93.38,29,,74.704,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,215.74,67,,172.592,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,225.4,70,,180.32,percent of total billed charges,70% of total billed charges,209.3,65,,167.44,percent of total billed charges,65% of total billed charges,114.86,35.67,,91.888,percent of total billed charges,35.67% of total billed charges,93.38,322,
TUBULAR PLATE 1/4 4 HOLE,27005468,CDM,278,RC,C1713,HCPCS,outpatient,,,335,134.00,,234.5,70,,187.6,percent of total billed charges,70% of total billed charges,335,100,,268,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,274.7,82,,219.76,percent of total billed charges,82% of total billed charges,284.75,85,,227.8,percent of total billed charges,85% of total billed charges,284.75,85,,227.8,percent of total billed charges,85% of total billed charges,284.75,85,,227.8,percent of total billed charges,85% of total billed charges,301.5,90,,241.2,percent of total billed charges,90% of total billed charges,268,80,,214.4,percent of total billed charges,80% of total billed charges,301.5,90,,241.2,percent of total billed charges,90% of total billed charges,251.25,75,,201,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,97.15,29,,77.72,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,224.45,67,,179.56,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,234.5,70,,187.6,percent of total billed charges,70% of total billed charges,217.75,65,,174.2,percent of total billed charges,65% of total billed charges,119.49,35.67,,95.592,percent of total billed charges,35.67% of total billed charges,97.15,335,
TUBULAR PLATE 1/4 5 HOLE,27005469,CDM,278,RC,C1713,HCPCS,outpatient,,,367,146.80,,256.9,70,,205.52,percent of total billed charges,70% of total billed charges,367,100,,293.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,300.94,82,,240.752,percent of total billed charges,82% of total billed charges,311.95,85,,249.56,percent of total billed charges,85% of total billed charges,311.95,85,,249.56,percent of total billed charges,85% of total billed charges,311.95,85,,249.56,percent of total billed charges,85% of total billed charges,330.3,90,,264.24,percent of total billed charges,90% of total billed charges,293.6,80,,234.88,percent of total billed charges,80% of total billed charges,330.3,90,,264.24,percent of total billed charges,90% of total billed charges,275.25,75,,220.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,106.43,29,,85.144,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,245.89,67,,196.712,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,256.9,70,,205.52,percent of total billed charges,70% of total billed charges,238.55,65,,190.84,percent of total billed charges,65% of total billed charges,130.91,35.67,,104.728,percent of total billed charges,35.67% of total billed charges,106.43,367,
TUBULAR PLATE 1/4 7 HOLE,27005470,CDM,278,RC,C1713,HCPCS,outpatient,,,359,143.60,,251.3,70,,201.04,percent of total billed charges,70% of total billed charges,359,100,,287.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,294.38,82,,235.504,percent of total billed charges,82% of total billed charges,305.15,85,,244.12,percent of total billed charges,85% of total billed charges,305.15,85,,244.12,percent of total billed charges,85% of total billed charges,305.15,85,,244.12,percent of total billed charges,85% of total billed charges,323.1,90,,258.48,percent of total billed charges,90% of total billed charges,287.2,80,,229.76,percent of total billed charges,80% of total billed charges,323.1,90,,258.48,percent of total billed charges,90% of total billed charges,269.25,75,,215.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,104.11,29,,83.288,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,240.53,67,,192.424,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,251.3,70,,201.04,percent of total billed charges,70% of total billed charges,233.35,65,,186.68,percent of total billed charges,65% of total billed charges,128.06,35.67,,102.448,percent of total billed charges,35.67% of total billed charges,104.11,359,
GUIDE WIRE 1.6MM X 6 **,27005654,CDM,278,RC,C1769,HCPCS,outpatient,,,164,65.60,,114.8,70,,91.84,percent of total billed charges,70% of total billed charges,164,100,,131.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,134.48,82,,107.584,percent of total billed charges,82% of total billed charges,139.4,85,,111.52,percent of total billed charges,85% of total billed charges,139.4,85,,111.52,percent of total billed charges,85% of total billed charges,139.4,85,,111.52,percent of total billed charges,85% of total billed charges,147.6,90,,118.08,percent of total billed charges,90% of total billed charges,131.2,80,,104.96,percent of total billed charges,80% of total billed charges,147.6,90,,118.08,percent of total billed charges,90% of total billed charges,123,75,,98.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,47.56,29,,38.048,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,109.88,67,,87.904,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,114.8,70,,91.84,percent of total billed charges,70% of total billed charges,106.6,65,,85.28,percent of total billed charges,65% of total billed charges,58.5,35.67,,46.8,percent of total billed charges,35.67% of total billed charges,47.56,164,
SCREW HEAD PROPELLER 4.3/34 **,27005657,CDM,278,RC,C1713,HCPCS,outpatient,,,1082,432.80,,757.4,70,,605.92,percent of total billed charges,70% of total billed charges,568.05,52.5,,454.44,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,887.24,82,,709.792,percent of total billed charges,82% of total billed charges,919.7,85,,735.76,percent of total billed charges,85% of total billed charges,919.7,85,,735.76,percent of total billed charges,85% of total billed charges,919.7,85,,735.76,percent of total billed charges,85% of total billed charges,973.8,90,,779.04,percent of total billed charges,90% of total billed charges,865.6,80,,692.48,percent of total billed charges,80% of total billed charges,973.8,90,,779.04,percent of total billed charges,90% of total billed charges,811.5,75,,649.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,313.78,29,,251.024,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,724.94,67,,579.952,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,757.4,70,,605.92,percent of total billed charges,70% of total billed charges,703.3,65,,562.64,percent of total billed charges,65% of total billed charges,385.95,35.67,,308.76,percent of total billed charges,35.67% of total billed charges,313.78,973.8,
PLATE FOUR HOLE 1.6 MM,27005658,CDM,278,RC,C1713,HCPCS,outpatient,,,4203,1681.20,,2942.1,70,,2353.68,percent of total billed charges,70% of total billed charges,2206.58,52.5,,1765.26,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,3446.46,82,,2757.168,percent of total billed charges,82% of total billed charges,3572.55,85,,2858.04,percent of total billed charges,85% of total billed charges,3572.55,85,,2858.04,percent of total billed charges,85% of total billed charges,3572.55,85,,2858.04,percent of total billed charges,85% of total billed charges,3782.7,90,,3026.16,percent of total billed charges,90% of total billed charges,3362.4,80,,2689.92,percent of total billed charges,80% of total billed charges,3782.7,90,,3026.16,percent of total billed charges,90% of total billed charges,3152.25,75,,2521.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,1218.87,29,,975.096,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,2816.01,67,,2252.808,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,2942.1,70,,2353.68,percent of total billed charges,70% of total billed charges,2731.95,65,,2185.56,percent of total billed charges,65% of total billed charges,1499.21,35.67,,1199.368,percent of total billed charges,35.67% of total billed charges,1218.87,3782.7,
CORTICAL SCREW S/T 14x5,27005659,CDM,278,RC,C1713,HCPCS,outpatient,,,1088,435.20,,761.6,70,,609.28,percent of total billed charges,70% of total billed charges,571.2,52.5,,456.96,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,892.16,82,,713.728,percent of total billed charges,82% of total billed charges,924.8,85,,739.84,percent of total billed charges,85% of total billed charges,924.8,85,,739.84,percent of total billed charges,85% of total billed charges,924.8,85,,739.84,percent of total billed charges,85% of total billed charges,979.2,90,,783.36,percent of total billed charges,90% of total billed charges,870.4,80,,696.32,percent of total billed charges,80% of total billed charges,979.2,90,,783.36,percent of total billed charges,90% of total billed charges,816,75,,652.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,315.52,29,,252.416,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,728.96,67,,583.168,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,761.6,70,,609.28,percent of total billed charges,70% of total billed charges,707.2,65,,565.76,percent of total billed charges,65% of total billed charges,388.09,35.67,,310.472,percent of total billed charges,35.67% of total billed charges,315.52,979.2,
SELF DRILLING SCREW 14x5 **,27005660,CDM,278,RC,C1713,HCPCS,outpatient,,,1847,738.80,,1292.9,70,,1034.32,percent of total billed charges,70% of total billed charges,969.68,52.5,,775.74,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,1514.54,82,,1211.632,percent of total billed charges,82% of total billed charges,1569.95,85,,1255.96,percent of total billed charges,85% of total billed charges,1569.95,85,,1255.96,percent of total billed charges,85% of total billed charges,1569.95,85,,1255.96,percent of total billed charges,85% of total billed charges,1662.3,90,,1329.84,percent of total billed charges,90% of total billed charges,1477.6,80,,1182.08,percent of total billed charges,80% of total billed charges,1662.3,90,,1329.84,percent of total billed charges,90% of total billed charges,1385.25,75,,1108.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,535.63,29,,428.504,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1237.49,67,,989.992,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1292.9,70,,1034.32,percent of total billed charges,70% of total billed charges,1200.55,65,,960.44,percent of total billed charges,65% of total billed charges,658.82,35.67,,527.056,percent of total billed charges,35.67% of total billed charges,535.63,1662.3,
PUTTY DBM 5 CC **,27005661,CDM,278,RC,C1713,HCPCS,outpatient,,,4662,1864.80,,3263.4,70,,2610.72,percent of total billed charges,70% of total billed charges,2447.55,52.5,,1958.04,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,3822.84,82,,3058.272,percent of total billed charges,82% of total billed charges,3962.7,85,,3170.16,percent of total billed charges,85% of total billed charges,3962.7,85,,3170.16,percent of total billed charges,85% of total billed charges,3962.7,85,,3170.16,percent of total billed charges,85% of total billed charges,4195.8,90,,3356.64,percent of total billed charges,90% of total billed charges,3729.6,80,,2983.68,percent of total billed charges,80% of total billed charges,4195.8,90,,3356.64,percent of total billed charges,90% of total billed charges,3496.5,75,,2797.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,1351.98,29,,1081.584,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,3123.54,67,,2498.832,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,3263.4,70,,2610.72,percent of total billed charges,70% of total billed charges,3030.3,65,,2424.24,percent of total billed charges,65% of total billed charges,1662.94,35.67,,1330.352,percent of total billed charges,35.67% of total billed charges,1351.98,4195.8,
3.5 OBLIQUE T-PLATE 5 HOLE,27005702,CDM,278,RC,C1713,HCPCS,outpatient,,,704,281.60,,492.8,70,,394.24,percent of total billed charges,70% of total billed charges,704,100,,563.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,577.28,82,,461.824,percent of total billed charges,82% of total billed charges,598.4,85,,478.72,percent of total billed charges,85% of total billed charges,598.4,85,,478.72,percent of total billed charges,85% of total billed charges,598.4,85,,478.72,percent of total billed charges,85% of total billed charges,633.6,90,,506.88,percent of total billed charges,90% of total billed charges,563.2,80,,450.56,percent of total billed charges,80% of total billed charges,633.6,90,,506.88,percent of total billed charges,90% of total billed charges,528,75,,422.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,204.16,29,,163.328,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,471.68,67,,377.344,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,492.8,70,,394.24,percent of total billed charges,70% of total billed charges,457.6,65,,366.08,percent of total billed charges,65% of total billed charges,251.12,35.67,,200.896,percent of total billed charges,35.67% of total billed charges,204.16,704,
3.5 - 6.5 SCREW FORCEP,27005703,CDM,278,RC,C1713,HCPCS,outpatient,,,338,135.20,,236.6,70,,189.28,percent of total billed charges,70% of total billed charges,338,100,,270.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,277.16,82,,221.728,percent of total billed charges,82% of total billed charges,287.3,85,,229.84,percent of total billed charges,85% of total billed charges,287.3,85,,229.84,percent of total billed charges,85% of total billed charges,287.3,85,,229.84,percent of total billed charges,85% of total billed charges,304.2,90,,243.36,percent of total billed charges,90% of total billed charges,270.4,80,,216.32,percent of total billed charges,80% of total billed charges,304.2,90,,243.36,percent of total billed charges,90% of total billed charges,253.5,75,,202.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,98.02,29,,78.416,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,226.46,67,,181.168,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,236.6,70,,189.28,percent of total billed charges,70% of total billed charges,219.7,65,,175.76,percent of total billed charges,65% of total billed charges,120.56,35.67,,96.448,percent of total billed charges,35.67% of total billed charges,98.02,338,
"SURGIPRO, MESH 6 X 6",27006068,CDM,278,RC,C1781,HCPCS,outpatient,,,672,268.80,,470.4,70,,376.32,percent of total billed charges,70% of total billed charges,672,100,,537.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,551.04,82,,440.832,percent of total billed charges,82% of total billed charges,571.2,85,,456.96,percent of total billed charges,85% of total billed charges,571.2,85,,456.96,percent of total billed charges,85% of total billed charges,571.2,85,,456.96,percent of total billed charges,85% of total billed charges,604.8,90,,483.84,percent of total billed charges,90% of total billed charges,537.6,80,,430.08,percent of total billed charges,80% of total billed charges,604.8,90,,483.84,percent of total billed charges,90% of total billed charges,504,75,,403.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,194.88,29,,155.904,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,450.24,67,,360.192,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,470.4,70,,376.32,percent of total billed charges,70% of total billed charges,436.8,65,,349.44,percent of total billed charges,65% of total billed charges,239.7,35.67,,191.76,percent of total billed charges,35.67% of total billed charges,194.88,672,
"WIRE, SPRING GUIDE",27006606,CDM,278,RC,C1769,HCPCS,outpatient,,,73,29.20,,51.1,70,,40.88,percent of total billed charges,70% of total billed charges,73,100,,58.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,59.86,82,,47.888,percent of total billed charges,82% of total billed charges,62.05,85,,49.64,percent of total billed charges,85% of total billed charges,62.05,85,,49.64,percent of total billed charges,85% of total billed charges,62.05,85,,49.64,percent of total billed charges,85% of total billed charges,65.7,90,,52.56,percent of total billed charges,90% of total billed charges,58.4,80,,46.72,percent of total billed charges,80% of total billed charges,65.7,90,,52.56,percent of total billed charges,90% of total billed charges,54.75,75,,43.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,21.17,29,,16.936,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,48.91,67,,39.128,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,51.1,70,,40.88,percent of total billed charges,70% of total billed charges,47.45,65,,37.96,percent of total billed charges,65% of total billed charges,26.04,35.67,,20.832,percent of total billed charges,35.67% of total billed charges,21.17,73,
HALLUFIX C PLATE LFT,27006620,CDM,278,RC,C1713,HCPCS,outpatient,,,1912,764.80,,1338.4,70,,1070.72,percent of total billed charges,70% of total billed charges,1003.8,52.5,,803.04,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,1567.84,82,,1254.272,percent of total billed charges,82% of total billed charges,1625.2,85,,1300.16,percent of total billed charges,85% of total billed charges,1625.2,85,,1300.16,percent of total billed charges,85% of total billed charges,1625.2,85,,1300.16,percent of total billed charges,85% of total billed charges,1720.8,90,,1376.64,percent of total billed charges,90% of total billed charges,1529.6,80,,1223.68,percent of total billed charges,80% of total billed charges,1720.8,90,,1376.64,percent of total billed charges,90% of total billed charges,1434,75,,1147.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,554.48,29,,443.584,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1281.04,67,,1024.832,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1338.4,70,,1070.72,percent of total billed charges,70% of total billed charges,1242.8,65,,994.24,percent of total billed charges,65% of total billed charges,682.01,35.67,,545.608,percent of total billed charges,35.67% of total billed charges,554.48,1720.8,
SCREW #14 117-014ND,27006621,CDM,278,RC,C1713,HCPCS,outpatient,,,1180,472.00,,826,70,,660.8,percent of total billed charges,70% of total billed charges,619.5,52.5,,495.6,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,967.6,82,,774.08,percent of total billed charges,82% of total billed charges,1003,85,,802.4,percent of total billed charges,85% of total billed charges,1003,85,,802.4,percent of total billed charges,85% of total billed charges,1003,85,,802.4,percent of total billed charges,85% of total billed charges,1062,90,,849.6,percent of total billed charges,90% of total billed charges,944,80,,755.2,percent of total billed charges,80% of total billed charges,1062,90,,849.6,percent of total billed charges,90% of total billed charges,885,75,,708,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,342.2,29,,273.76,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,790.6,67,,632.48,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,826,70,,660.8,percent of total billed charges,70% of total billed charges,767,65,,613.6,percent of total billed charges,65% of total billed charges,420.91,35.67,,336.728,percent of total billed charges,35.67% of total billed charges,342.2,1062,
OMNIPORT 50 MM,27006634,CDM,278,RC,C1751,HCPCS,outpatient,,,2014,805.60,,1409.8,70,,1127.84,percent of total billed charges,70% of total billed charges,1057.35,52.5,,845.88,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,1651.48,82,,1321.184,percent of total billed charges,82% of total billed charges,1711.9,85,,1369.52,percent of total billed charges,85% of total billed charges,1711.9,85,,1369.52,percent of total billed charges,85% of total billed charges,1711.9,85,,1369.52,percent of total billed charges,85% of total billed charges,1812.6,90,,1450.08,percent of total billed charges,90% of total billed charges,1611.2,80,,1288.96,percent of total billed charges,80% of total billed charges,1812.6,90,,1450.08,percent of total billed charges,90% of total billed charges,1510.5,75,,1208.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,584.06,29,,467.248,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1349.38,67,,1079.504,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1409.8,70,,1127.84,percent of total billed charges,70% of total billed charges,1309.1,65,,1047.28,percent of total billed charges,65% of total billed charges,718.39,35.67,,574.712,percent of total billed charges,35.67% of total billed charges,584.06,1812.6,
HALLU-C PLATE LEFT SIZE 2,27006771,CDM,278,RC,C1713,HCPCS,outpatient,,,1912,764.80,,1338.4,70,,1070.72,percent of total billed charges,70% of total billed charges,1003.8,52.5,,803.04,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,1567.84,82,,1254.272,percent of total billed charges,82% of total billed charges,1625.2,85,,1300.16,percent of total billed charges,85% of total billed charges,1625.2,85,,1300.16,percent of total billed charges,85% of total billed charges,1625.2,85,,1300.16,percent of total billed charges,85% of total billed charges,1720.8,90,,1376.64,percent of total billed charges,90% of total billed charges,1529.6,80,,1223.68,percent of total billed charges,80% of total billed charges,1720.8,90,,1376.64,percent of total billed charges,90% of total billed charges,1434,75,,1147.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,554.48,29,,443.584,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1281.04,67,,1024.832,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1338.4,70,,1070.72,percent of total billed charges,70% of total billed charges,1242.8,65,,994.24,percent of total billed charges,65% of total billed charges,682.01,35.67,,545.608,percent of total billed charges,35.67% of total billed charges,554.48,1720.8,
SNAP OFF SCREW 2.7MM 12MM LNGT,27006772,CDM,278,RC,C1713,HCPCS,outpatient,,,1767,706.80,,1236.9,70,,989.52,percent of total billed charges,70% of total billed charges,927.68,52.5,,742.14,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,1448.94,82,,1159.152,percent of total billed charges,82% of total billed charges,1501.95,85,,1201.56,percent of total billed charges,85% of total billed charges,1501.95,85,,1201.56,percent of total billed charges,85% of total billed charges,1501.95,85,,1201.56,percent of total billed charges,85% of total billed charges,1590.3,90,,1272.24,percent of total billed charges,90% of total billed charges,1413.6,80,,1130.88,percent of total billed charges,80% of total billed charges,1590.3,90,,1272.24,percent of total billed charges,90% of total billed charges,1325.25,75,,1060.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,512.43,29,,409.944,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1183.89,67,,947.112,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1236.9,70,,989.52,percent of total billed charges,70% of total billed charges,1148.55,65,,918.84,percent of total billed charges,65% of total billed charges,630.29,35.67,,504.232,percent of total billed charges,35.67% of total billed charges,512.43,1590.3,
K WIRE 2.0 29271E,27006773,CDM,278,RC,C1713,HCPCS,outpatient,,,133,53.20,,93.1,70,,74.48,percent of total billed charges,70% of total billed charges,133,100,,106.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,109.06,82,,87.248,percent of total billed charges,82% of total billed charges,113.05,85,,90.44,percent of total billed charges,85% of total billed charges,113.05,85,,90.44,percent of total billed charges,85% of total billed charges,113.05,85,,90.44,percent of total billed charges,85% of total billed charges,119.7,90,,95.76,percent of total billed charges,90% of total billed charges,106.4,80,,85.12,percent of total billed charges,80% of total billed charges,119.7,90,,95.76,percent of total billed charges,90% of total billed charges,99.75,75,,79.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,38.57,29,,30.856,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,89.11,67,,71.288,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,93.1,70,,74.48,percent of total billed charges,70% of total billed charges,86.45,65,,69.16,percent of total billed charges,65% of total billed charges,47.44,35.67,,37.952,percent of total billed charges,35.67% of total billed charges,38.57,133,
PLATE 5 HOLE 441351,27006774,CDM,278,RC,C1713,HCPCS,outpatient,,,853,341.20,,597.1,70,,477.68,percent of total billed charges,70% of total billed charges,853,100,,682.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,699.46,82,,559.568,percent of total billed charges,82% of total billed charges,725.05,85,,580.04,percent of total billed charges,85% of total billed charges,725.05,85,,580.04,percent of total billed charges,85% of total billed charges,725.05,85,,580.04,percent of total billed charges,85% of total billed charges,767.7,90,,614.16,percent of total billed charges,90% of total billed charges,682.4,80,,545.92,percent of total billed charges,80% of total billed charges,767.7,90,,614.16,percent of total billed charges,90% of total billed charges,639.75,75,,511.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,247.37,29,,197.896,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,571.51,67,,457.208,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,597.1,70,,477.68,percent of total billed charges,70% of total billed charges,554.45,65,,443.56,percent of total billed charges,65% of total billed charges,304.27,35.67,,243.416,percent of total billed charges,35.67% of total billed charges,247.37,853,
CORTICAL SCREW SELF TAPPING 16,27006775,CDM,278,RC,C1713,HCPCS,outpatient,,,220,88.00,,154,70,,123.2,percent of total billed charges,70% of total billed charges,220,100,,176,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,180.4,82,,144.32,percent of total billed charges,82% of total billed charges,187,85,,149.6,percent of total billed charges,85% of total billed charges,187,85,,149.6,percent of total billed charges,85% of total billed charges,187,85,,149.6,percent of total billed charges,85% of total billed charges,198,90,,158.4,percent of total billed charges,90% of total billed charges,176,80,,140.8,percent of total billed charges,80% of total billed charges,198,90,,158.4,percent of total billed charges,90% of total billed charges,165,75,,132,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,63.8,29,,51.04,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,147.4,67,,117.92,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,154,70,,123.2,percent of total billed charges,70% of total billed charges,143,65,,114.4,percent of total billed charges,65% of total billed charges,78.47,35.67,,62.776,percent of total billed charges,35.67% of total billed charges,63.8,220,
CORTICAL SCREW SELF TAPPING 14,27006776,CDM,278,RC,C1713,HCPCS,outpatient,,,220,88.00,,154,70,,123.2,percent of total billed charges,70% of total billed charges,220,100,,176,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,180.4,82,,144.32,percent of total billed charges,82% of total billed charges,187,85,,149.6,percent of total billed charges,85% of total billed charges,187,85,,149.6,percent of total billed charges,85% of total billed charges,187,85,,149.6,percent of total billed charges,85% of total billed charges,198,90,,158.4,percent of total billed charges,90% of total billed charges,176,80,,140.8,percent of total billed charges,80% of total billed charges,198,90,,158.4,percent of total billed charges,90% of total billed charges,165,75,,132,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,63.8,29,,51.04,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,147.4,67,,117.92,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,154,70,,123.2,percent of total billed charges,70% of total billed charges,143,65,,114.4,percent of total billed charges,65% of total billed charges,78.47,35.67,,62.776,percent of total billed charges,35.67% of total billed charges,63.8,220,
SELF TAPPING TL LOCKING SZ 12,27006777,CDM,278,RC,C1713,HCPCS,outpatient,,,735,294.00,,514.5,70,,411.6,percent of total billed charges,70% of total billed charges,735,100,,588,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,602.7,82,,482.16,percent of total billed charges,82% of total billed charges,624.75,85,,499.8,percent of total billed charges,85% of total billed charges,624.75,85,,499.8,percent of total billed charges,85% of total billed charges,624.75,85,,499.8,percent of total billed charges,85% of total billed charges,661.5,90,,529.2,percent of total billed charges,90% of total billed charges,588,80,,470.4,percent of total billed charges,80% of total billed charges,661.5,90,,529.2,percent of total billed charges,90% of total billed charges,551.25,75,,441,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,213.15,29,,170.52,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,492.45,67,,393.96,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,514.5,70,,411.6,percent of total billed charges,70% of total billed charges,477.75,65,,382.2,percent of total billed charges,65% of total billed charges,262.17,35.67,,209.736,percent of total billed charges,35.67% of total billed charges,213.15,735,
SELF TAPPING TL LOCKING SZ 14,27006778,CDM,278,RC,C1713,HCPCS,outpatient,,,735,294.00,,514.5,70,,411.6,percent of total billed charges,70% of total billed charges,735,100,,588,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,602.7,82,,482.16,percent of total billed charges,82% of total billed charges,624.75,85,,499.8,percent of total billed charges,85% of total billed charges,624.75,85,,499.8,percent of total billed charges,85% of total billed charges,624.75,85,,499.8,percent of total billed charges,85% of total billed charges,661.5,90,,529.2,percent of total billed charges,90% of total billed charges,588,80,,470.4,percent of total billed charges,80% of total billed charges,661.5,90,,529.2,percent of total billed charges,90% of total billed charges,551.25,75,,441,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,213.15,29,,170.52,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,492.45,67,,393.96,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,514.5,70,,411.6,percent of total billed charges,70% of total billed charges,477.75,65,,382.2,percent of total billed charges,65% of total billed charges,262.17,35.67,,209.736,percent of total billed charges,35.67% of total billed charges,213.15,735,
SELF TAPPING TL LOCKING SZ 16,27006779,CDM,278,RC,C1713,HCPCS,outpatient,,,735,294.00,,514.5,70,,411.6,percent of total billed charges,70% of total billed charges,735,100,,588,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,602.7,82,,482.16,percent of total billed charges,82% of total billed charges,624.75,85,,499.8,percent of total billed charges,85% of total billed charges,624.75,85,,499.8,percent of total billed charges,85% of total billed charges,624.75,85,,499.8,percent of total billed charges,85% of total billed charges,661.5,90,,529.2,percent of total billed charges,90% of total billed charges,588,80,,470.4,percent of total billed charges,80% of total billed charges,661.5,90,,529.2,percent of total billed charges,90% of total billed charges,551.25,75,,441,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,213.15,29,,170.52,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,492.45,67,,393.96,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,514.5,70,,411.6,percent of total billed charges,70% of total billed charges,477.75,65,,382.2,percent of total billed charges,65% of total billed charges,262.17,35.67,,209.736,percent of total billed charges,35.67% of total billed charges,213.15,735,
"SCREW, CORTEX 2.0 401.816",27007021,CDM,278,RC,C1713,HCPCS,outpatient,,,352,140.80,,246.4,70,,197.12,percent of total billed charges,70% of total billed charges,352,100,,281.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,288.64,82,,230.912,percent of total billed charges,82% of total billed charges,299.2,85,,239.36,percent of total billed charges,85% of total billed charges,299.2,85,,239.36,percent of total billed charges,85% of total billed charges,299.2,85,,239.36,percent of total billed charges,85% of total billed charges,316.8,90,,253.44,percent of total billed charges,90% of total billed charges,281.6,80,,225.28,percent of total billed charges,80% of total billed charges,316.8,90,,253.44,percent of total billed charges,90% of total billed charges,264,75,,211.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,102.08,29,,81.664,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,235.84,67,,188.672,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,246.4,70,,197.12,percent of total billed charges,70% of total billed charges,228.8,65,,183.04,percent of total billed charges,65% of total billed charges,125.56,35.67,,100.448,percent of total billed charges,35.67% of total billed charges,102.08,352,
K WIRE 1.25 292.12,27007022,CDM,278,RC,C1713,HCPCS,outpatient,,,438,175.20,,306.6,70,,245.28,percent of total billed charges,70% of total billed charges,438,100,,350.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,359.16,82,,287.328,percent of total billed charges,82% of total billed charges,372.3,85,,297.84,percent of total billed charges,85% of total billed charges,372.3,85,,297.84,percent of total billed charges,85% of total billed charges,372.3,85,,297.84,percent of total billed charges,85% of total billed charges,394.2,90,,315.36,percent of total billed charges,90% of total billed charges,350.4,80,,280.32,percent of total billed charges,80% of total billed charges,394.2,90,,315.36,percent of total billed charges,90% of total billed charges,328.5,75,,262.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,127.02,29,,101.616,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,293.46,67,,234.768,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,306.6,70,,245.28,percent of total billed charges,70% of total billed charges,284.7,65,,227.76,percent of total billed charges,65% of total billed charges,156.23,35.67,,124.984,percent of total billed charges,35.67% of total billed charges,127.02,438,
IMPLANT SUBTALAR MBA 05-0108,27007175,CDM,278,RC,C1776,HCPCS,outpatient,,,9576,3830.40,,6703.2,70,,5362.56,percent of total billed charges,70% of total billed charges,5027.4,52.5,,4021.92,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,7852.32,82,,6281.856,percent of total billed charges,82% of total billed charges,8139.6,85,,6511.68,percent of total billed charges,85% of total billed charges,8139.6,85,,6511.68,percent of total billed charges,85% of total billed charges,8139.6,85,,6511.68,percent of total billed charges,85% of total billed charges,8618.4,90,,6894.72,percent of total billed charges,90% of total billed charges,7660.8,80,,6128.64,percent of total billed charges,80% of total billed charges,8618.4,90,,6894.72,percent of total billed charges,90% of total billed charges,7182,75,,5745.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2777.04,29,,2221.632,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,6415.92,67,,5132.736,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,6703.2,70,,5362.56,percent of total billed charges,70% of total billed charges,6224.4,65,,4979.52,percent of total billed charges,65% of total billed charges,3415.76,35.67,,2732.608,percent of total billed charges,35.67% of total billed charges,2777.04,8618.4,
FIBER WIRE 2-0 ARTHREX AR 7221,27007176,CDM,278,RC,C1713,HCPCS,outpatient,,,236,94.40,,165.2,70,,132.16,percent of total billed charges,70% of total billed charges,236,100,,188.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,193.52,82,,154.816,percent of total billed charges,82% of total billed charges,200.6,85,,160.48,percent of total billed charges,85% of total billed charges,200.6,85,,160.48,percent of total billed charges,85% of total billed charges,200.6,85,,160.48,percent of total billed charges,85% of total billed charges,212.4,90,,169.92,percent of total billed charges,90% of total billed charges,188.8,80,,151.04,percent of total billed charges,80% of total billed charges,212.4,90,,169.92,percent of total billed charges,90% of total billed charges,177,75,,141.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,68.44,29,,54.752,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,158.12,67,,126.496,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,165.2,70,,132.16,percent of total billed charges,70% of total billed charges,153.4,65,,122.72,percent of total billed charges,65% of total billed charges,84.18,35.67,,67.344,percent of total billed charges,35.67% of total billed charges,68.44,236,
FOUR HOLE PLATE 12MM,27007203,CDM,278,RC,C1713,HCPCS,outpatient,,,9075,3630.00,,6352.5,70,,5082,percent of total billed charges,70% of total billed charges,4764.38,52.5,,3811.5,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,7441.5,82,,5953.2,percent of total billed charges,82% of total billed charges,7713.75,85,,6171,percent of total billed charges,85% of total billed charges,7713.75,85,,6171,percent of total billed charges,85% of total billed charges,7713.75,85,,6171,percent of total billed charges,85% of total billed charges,8167.5,90,,6534,percent of total billed charges,90% of total billed charges,7260,80,,5808,percent of total billed charges,80% of total billed charges,8167.5,90,,6534,percent of total billed charges,90% of total billed charges,6806.25,75,,5445,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2631.75,29,,2105.4,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,6080.25,67,,4864.2,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,6352.5,70,,5082,percent of total billed charges,70% of total billed charges,5898.75,65,,4719,percent of total billed charges,65% of total billed charges,3237.05,35.67,,2589.64,percent of total billed charges,35.67% of total billed charges,2631.75,8167.5,
LONG 12MM SCREW 4.0MM,27007204,CDM,278,RC,C1713,HCPCS,outpatient,,,1988,795.20,,1391.6,70,,1113.28,percent of total billed charges,70% of total billed charges,1043.7,52.5,,834.96,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,1630.16,82,,1304.128,percent of total billed charges,82% of total billed charges,1689.8,85,,1351.84,percent of total billed charges,85% of total billed charges,1689.8,85,,1351.84,percent of total billed charges,85% of total billed charges,1689.8,85,,1351.84,percent of total billed charges,85% of total billed charges,1789.2,90,,1431.36,percent of total billed charges,90% of total billed charges,1590.4,80,,1272.32,percent of total billed charges,80% of total billed charges,1789.2,90,,1431.36,percent of total billed charges,90% of total billed charges,1491,75,,1192.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,576.52,29,,461.216,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1331.96,67,,1065.568,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1391.6,70,,1113.28,percent of total billed charges,70% of total billed charges,1292.2,65,,1033.76,percent of total billed charges,65% of total billed charges,709.12,35.67,,567.296,percent of total billed charges,35.67% of total billed charges,576.52,1789.2,
TITANIUM THREAD 4.0 MM,27007205,CDM,278,RC,C1713,HCPCS,outpatient,,,164,65.60,,114.8,70,,91.84,percent of total billed charges,70% of total billed charges,164,100,,131.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,134.48,82,,107.584,percent of total billed charges,82% of total billed charges,139.4,85,,111.52,percent of total billed charges,85% of total billed charges,139.4,85,,111.52,percent of total billed charges,85% of total billed charges,139.4,85,,111.52,percent of total billed charges,85% of total billed charges,147.6,90,,118.08,percent of total billed charges,90% of total billed charges,131.2,80,,104.96,percent of total billed charges,80% of total billed charges,147.6,90,,118.08,percent of total billed charges,90% of total billed charges,123,75,,98.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,47.56,29,,38.048,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,109.88,67,,87.904,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,114.8,70,,91.84,percent of total billed charges,70% of total billed charges,106.6,65,,85.28,percent of total billed charges,65% of total billed charges,58.5,35.67,,46.8,percent of total billed charges,35.67% of total billed charges,47.56,164,
TITANIUM SCREW 2.7M SLF TPNG,27007206,CDM,278,RC,C1713,HCPCS,outpatient,,,271,108.40,,189.7,70,,151.76,percent of total billed charges,70% of total billed charges,271,100,,216.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,222.22,82,,177.776,percent of total billed charges,82% of total billed charges,230.35,85,,184.28,percent of total billed charges,85% of total billed charges,230.35,85,,184.28,percent of total billed charges,85% of total billed charges,230.35,85,,184.28,percent of total billed charges,85% of total billed charges,243.9,90,,195.12,percent of total billed charges,90% of total billed charges,216.8,80,,173.44,percent of total billed charges,80% of total billed charges,243.9,90,,195.12,percent of total billed charges,90% of total billed charges,203.25,75,,162.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,78.59,29,,62.872,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,181.57,67,,145.256,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,189.7,70,,151.76,percent of total billed charges,70% of total billed charges,176.15,65,,140.92,percent of total billed charges,65% of total billed charges,96.67,35.67,,77.336,percent of total billed charges,35.67% of total billed charges,78.59,271,
K-WIRES 2.0 M,27007207,CDM,278,RC,C1713,HCPCS,outpatient,,,641,256.40,,448.7,70,,358.96,percent of total billed charges,70% of total billed charges,641,100,,512.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,525.62,82,,420.496,percent of total billed charges,82% of total billed charges,544.85,85,,435.88,percent of total billed charges,85% of total billed charges,544.85,85,,435.88,percent of total billed charges,85% of total billed charges,544.85,85,,435.88,percent of total billed charges,85% of total billed charges,576.9,90,,461.52,percent of total billed charges,90% of total billed charges,512.8,80,,410.24,percent of total billed charges,80% of total billed charges,576.9,90,,461.52,percent of total billed charges,90% of total billed charges,480.75,75,,384.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,185.89,29,,148.712,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,429.47,67,,343.576,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,448.7,70,,358.96,percent of total billed charges,70% of total billed charges,416.65,65,,333.32,percent of total billed charges,65% of total billed charges,228.64,35.67,,182.912,percent of total billed charges,35.67% of total billed charges,185.89,641,
HALLU C PLATE SIZE 2 RIGHT,27007504,CDM,278,RC,C1713,HCPCS,outpatient,,,2008,803.20,,1405.6,70,,1124.48,percent of total billed charges,70% of total billed charges,1054.2,52.5,,843.36,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,1646.56,82,,1317.248,percent of total billed charges,82% of total billed charges,1706.8,85,,1365.44,percent of total billed charges,85% of total billed charges,1706.8,85,,1365.44,percent of total billed charges,85% of total billed charges,1706.8,85,,1365.44,percent of total billed charges,85% of total billed charges,1807.2,90,,1445.76,percent of total billed charges,90% of total billed charges,1606.4,80,,1285.12,percent of total billed charges,80% of total billed charges,1807.2,90,,1445.76,percent of total billed charges,90% of total billed charges,1506,75,,1204.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,582.32,29,,465.856,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1345.36,67,,1076.288,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1405.6,70,,1124.48,percent of total billed charges,70% of total billed charges,1305.2,65,,1044.16,percent of total billed charges,65% of total billed charges,716.25,35.67,,573,percent of total billed charges,35.67% of total billed charges,582.32,1807.2,
SNAP OFF 2.7MM SCREW 12MM,27007505,CDM,278,RC,C1713,HCPCS,outpatient,,,1187,474.80,,830.9,70,,664.72,percent of total billed charges,70% of total billed charges,623.18,52.5,,498.54,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,973.34,82,,778.672,percent of total billed charges,82% of total billed charges,1008.95,85,,807.16,percent of total billed charges,85% of total billed charges,1008.95,85,,807.16,percent of total billed charges,85% of total billed charges,1008.95,85,,807.16,percent of total billed charges,85% of total billed charges,1068.3,90,,854.64,percent of total billed charges,90% of total billed charges,949.6,80,,759.68,percent of total billed charges,80% of total billed charges,1068.3,90,,854.64,percent of total billed charges,90% of total billed charges,890.25,75,,712.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,344.23,29,,275.384,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,795.29,67,,636.232,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,830.9,70,,664.72,percent of total billed charges,70% of total billed charges,771.55,65,,617.24,percent of total billed charges,65% of total billed charges,423.4,35.67,,338.72,percent of total billed charges,35.67% of total billed charges,344.23,1068.3,
SNAP OFF 2.7 SCREW 16MM,27007506,CDM,278,RC,C1713,HCPCS,outpatient,,,1857,742.80,,1299.9,70,,1039.92,percent of total billed charges,70% of total billed charges,974.93,52.5,,779.94,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,1522.74,82,,1218.192,percent of total billed charges,82% of total billed charges,1578.45,85,,1262.76,percent of total billed charges,85% of total billed charges,1578.45,85,,1262.76,percent of total billed charges,85% of total billed charges,1578.45,85,,1262.76,percent of total billed charges,85% of total billed charges,1671.3,90,,1337.04,percent of total billed charges,90% of total billed charges,1485.6,80,,1188.48,percent of total billed charges,80% of total billed charges,1671.3,90,,1337.04,percent of total billed charges,90% of total billed charges,1392.75,75,,1114.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,538.53,29,,430.824,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1244.19,67,,995.352,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1299.9,70,,1039.92,percent of total billed charges,70% of total billed charges,1207.05,65,,965.64,percent of total billed charges,65% of total billed charges,662.39,35.67,,529.912,percent of total billed charges,35.67% of total billed charges,538.53,1671.3,
TENDON PROTECTOR SHEET,27007508,CDM,278,RC,,,outpatient,,,8451,3380.40,,5915.7,70,,4732.56,percent of total billed charges,70% of total billed charges,4436.78,52.5,,3549.42,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,6929.82,82,,5543.856,percent of total billed charges,82% of total billed charges,7183.35,85,,5746.68,percent of total billed charges,85% of total billed charges,7183.35,85,,5746.68,percent of total billed charges,85% of total billed charges,7183.35,85,,5746.68,percent of total billed charges,85% of total billed charges,7605.9,90,,6084.72,percent of total billed charges,90% of total billed charges,6760.8,80,,5408.64,percent of total billed charges,80% of total billed charges,7605.9,90,,6084.72,percent of total billed charges,90% of total billed charges,6338.25,75,,5070.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2450.79,29,,1960.632,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,5662.17,67,,4529.736,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,5915.7,70,,4732.56,percent of total billed charges,70% of total billed charges,5493.15,65,,4394.52,percent of total billed charges,65% of total billed charges,3014.47,35.67,,2411.576,percent of total billed charges,35.67% of total billed charges,2450.79,7605.9,
SPIN SCREW DIAM LG 12MM,27007537,CDM,278,RC,C1713,HCPCS,outpatient,,,1730,692.00,,1211,70,,968.8,percent of total billed charges,70% of total billed charges,908.25,52.5,,726.6,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,1418.6,82,,1134.88,percent of total billed charges,82% of total billed charges,1470.5,85,,1176.4,percent of total billed charges,85% of total billed charges,1470.5,85,,1176.4,percent of total billed charges,85% of total billed charges,1470.5,85,,1176.4,percent of total billed charges,85% of total billed charges,1557,90,,1245.6,percent of total billed charges,90% of total billed charges,1384,80,,1107.2,percent of total billed charges,80% of total billed charges,1557,90,,1245.6,percent of total billed charges,90% of total billed charges,1297.5,75,,1038,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,501.7,29,,401.36,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1159.1,67,,927.28,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1211,70,,968.8,percent of total billed charges,70% of total billed charges,1124.5,65,,899.6,percent of total billed charges,65% of total billed charges,617.09,35.67,,493.672,percent of total billed charges,35.67% of total billed charges,501.7,1557,
GEL GRAFTON 5ML,27007558,CDM,278,RC,C1713,HCPCS,outpatient,,,2476,990.40,,1733.2,70,,1386.56,percent of total billed charges,70% of total billed charges,1299.9,52.5,,1039.92,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,2030.32,82,,1624.256,percent of total billed charges,82% of total billed charges,2104.6,85,,1683.68,percent of total billed charges,85% of total billed charges,2104.6,85,,1683.68,percent of total billed charges,85% of total billed charges,2104.6,85,,1683.68,percent of total billed charges,85% of total billed charges,2228.4,90,,1782.72,percent of total billed charges,90% of total billed charges,1980.8,80,,1584.64,percent of total billed charges,80% of total billed charges,2228.4,90,,1782.72,percent of total billed charges,90% of total billed charges,1857,75,,1485.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,718.04,29,,574.432,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1658.92,67,,1327.136,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1733.2,70,,1386.56,percent of total billed charges,70% of total billed charges,1609.4,65,,1287.52,percent of total billed charges,65% of total billed charges,883.19,35.67,,706.552,percent of total billed charges,35.67% of total billed charges,718.04,2228.4,
CORKSCREW SUTURE 4.5X1.5,27007585,CDM,278,RC,C1713,HCPCS,outpatient,,,1278,511.20,,894.6,70,,715.68,percent of total billed charges,70% of total billed charges,670.95,52.5,,536.76,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,1047.96,82,,838.368,percent of total billed charges,82% of total billed charges,1086.3,85,,869.04,percent of total billed charges,85% of total billed charges,1086.3,85,,869.04,percent of total billed charges,85% of total billed charges,1086.3,85,,869.04,percent of total billed charges,85% of total billed charges,1150.2,90,,920.16,percent of total billed charges,90% of total billed charges,1022.4,80,,817.92,percent of total billed charges,80% of total billed charges,1150.2,90,,920.16,percent of total billed charges,90% of total billed charges,958.5,75,,766.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,370.62,29,,296.496,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,856.26,67,,685.008,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,894.6,70,,715.68,percent of total billed charges,70% of total billed charges,830.7,65,,664.56,percent of total billed charges,65% of total billed charges,455.86,35.67,,364.688,percent of total billed charges,35.67% of total billed charges,370.62,1150.2,
MINIRAIL SHORT,27007595,CDM,278,RC,C1713,HCPCS,outpatient,,,6171,2468.40,,4319.7,70,,3455.76,percent of total billed charges,70% of total billed charges,3239.78,52.5,,2591.82,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,5060.22,82,,4048.176,percent of total billed charges,82% of total billed charges,5245.35,85,,4196.28,percent of total billed charges,85% of total billed charges,5245.35,85,,4196.28,percent of total billed charges,85% of total billed charges,5245.35,85,,4196.28,percent of total billed charges,85% of total billed charges,5553.9,90,,4443.12,percent of total billed charges,90% of total billed charges,4936.8,80,,3949.44,percent of total billed charges,80% of total billed charges,5553.9,90,,4443.12,percent of total billed charges,90% of total billed charges,4628.25,75,,3702.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,1789.59,29,,1431.672,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4134.57,67,,3307.656,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,4319.7,70,,3455.76,percent of total billed charges,70% of total billed charges,4011.15,65,,3208.92,percent of total billed charges,65% of total billed charges,2201.2,35.67,,1760.96,percent of total billed charges,35.67% of total billed charges,1789.59,5553.9,
CORTICAL SCREW 60/30,27007596,CDM,278,RC,C1713,HCPCS,outpatient,,,478,191.20,,334.6,70,,267.68,percent of total billed charges,70% of total billed charges,478,100,,382.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,391.96,82,,313.568,percent of total billed charges,82% of total billed charges,406.3,85,,325.04,percent of total billed charges,85% of total billed charges,406.3,85,,325.04,percent of total billed charges,85% of total billed charges,406.3,85,,325.04,percent of total billed charges,85% of total billed charges,430.2,90,,344.16,percent of total billed charges,90% of total billed charges,382.4,80,,305.92,percent of total billed charges,80% of total billed charges,430.2,90,,344.16,percent of total billed charges,90% of total billed charges,358.5,75,,286.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,138.62,29,,110.896,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,320.26,67,,256.208,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,334.6,70,,267.68,percent of total billed charges,70% of total billed charges,310.7,65,,248.56,percent of total billed charges,65% of total billed charges,170.5,35.67,,136.4,percent of total billed charges,35.67% of total billed charges,138.62,478,
CORTICAL SCREW 60/20,27007597,CDM,278,RC,C1713,HCPCS,outpatient,,,478,191.20,,334.6,70,,267.68,percent of total billed charges,70% of total billed charges,478,100,,382.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,391.96,82,,313.568,percent of total billed charges,82% of total billed charges,406.3,85,,325.04,percent of total billed charges,85% of total billed charges,406.3,85,,325.04,percent of total billed charges,85% of total billed charges,406.3,85,,325.04,percent of total billed charges,85% of total billed charges,430.2,90,,344.16,percent of total billed charges,90% of total billed charges,382.4,80,,305.92,percent of total billed charges,80% of total billed charges,430.2,90,,344.16,percent of total billed charges,90% of total billed charges,358.5,75,,286.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,138.62,29,,110.896,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,320.26,67,,256.208,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,334.6,70,,267.68,percent of total billed charges,70% of total billed charges,310.7,65,,248.56,percent of total billed charges,65% of total billed charges,170.5,35.67,,136.4,percent of total billed charges,35.67% of total billed charges,138.62,478,
THREADED WIRE,27007598,CDM,278,RC,C1713,HCPCS,outpatient,,,641,256.40,,448.7,70,,358.96,percent of total billed charges,70% of total billed charges,641,100,,512.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,525.62,82,,420.496,percent of total billed charges,82% of total billed charges,544.85,85,,435.88,percent of total billed charges,85% of total billed charges,544.85,85,,435.88,percent of total billed charges,85% of total billed charges,544.85,85,,435.88,percent of total billed charges,85% of total billed charges,576.9,90,,461.52,percent of total billed charges,90% of total billed charges,512.8,80,,410.24,percent of total billed charges,80% of total billed charges,576.9,90,,461.52,percent of total billed charges,90% of total billed charges,480.75,75,,384.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,185.89,29,,148.712,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,429.47,67,,343.576,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,448.7,70,,358.96,percent of total billed charges,70% of total billed charges,416.65,65,,333.32,percent of total billed charges,65% of total billed charges,228.64,35.67,,182.912,percent of total billed charges,35.67% of total billed charges,185.89,641,
T-WRENCH SCREWS,27007600,CDM,278,RC,C1713,HCPCS,outpatient,,,505,202.00,,353.5,70,,282.8,percent of total billed charges,70% of total billed charges,505,100,,404,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,414.1,82,,331.28,percent of total billed charges,82% of total billed charges,429.25,85,,343.4,percent of total billed charges,85% of total billed charges,429.25,85,,343.4,percent of total billed charges,85% of total billed charges,429.25,85,,343.4,percent of total billed charges,85% of total billed charges,454.5,90,,363.6,percent of total billed charges,90% of total billed charges,404,80,,323.2,percent of total billed charges,80% of total billed charges,454.5,90,,363.6,percent of total billed charges,90% of total billed charges,378.75,75,,303,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,146.45,29,,117.16,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,338.35,67,,270.68,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,353.5,70,,282.8,percent of total billed charges,70% of total billed charges,328.25,65,,262.6,percent of total billed charges,65% of total billed charges,180.13,35.67,,144.104,percent of total billed charges,35.67% of total billed charges,146.45,505,
T-CLAMP,27007603,CDM,278,RC,,,outpatient,,,1212,484.80,,848.4,70,,678.72,percent of total billed charges,70% of total billed charges,636.3,52.5,,509.04,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,993.84,82,,795.072,percent of total billed charges,82% of total billed charges,1030.2,85,,824.16,percent of total billed charges,85% of total billed charges,1030.2,85,,824.16,percent of total billed charges,85% of total billed charges,1030.2,85,,824.16,percent of total billed charges,85% of total billed charges,1090.8,90,,872.64,percent of total billed charges,90% of total billed charges,969.6,80,,775.68,percent of total billed charges,80% of total billed charges,1090.8,90,,872.64,percent of total billed charges,90% of total billed charges,909,75,,727.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,351.48,29,,281.184,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,812.04,67,,649.632,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,848.4,70,,678.72,percent of total billed charges,70% of total billed charges,787.8,65,,630.24,percent of total billed charges,65% of total billed charges,432.32,35.67,,345.856,percent of total billed charges,35.67% of total billed charges,351.48,1090.8,
MINIRAIL STD,27007604,CDM,278,RC,,,outpatient,,,620,248.00,,434,70,,347.2,percent of total billed charges,70% of total billed charges,620,100,,496,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,508.4,82,,406.72,percent of total billed charges,82% of total billed charges,527,85,,421.6,percent of total billed charges,85% of total billed charges,527,85,,421.6,percent of total billed charges,85% of total billed charges,527,85,,421.6,percent of total billed charges,85% of total billed charges,558,90,,446.4,percent of total billed charges,90% of total billed charges,496,80,,396.8,percent of total billed charges,80% of total billed charges,558,90,,446.4,percent of total billed charges,90% of total billed charges,465,75,,372,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,179.8,29,,143.84,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,415.4,67,,332.32,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,434,70,,347.2,percent of total billed charges,70% of total billed charges,403,65,,322.4,percent of total billed charges,65% of total billed charges,221.15,35.67,,176.92,percent of total billed charges,35.67% of total billed charges,179.8,620,
DISTAL RADIUS PLATE RT,27007614,CDM,278,RC,C1713,HCPCS,outpatient,,,2675,1070.00,,1872.5,70,,1498,percent of total billed charges,70% of total billed charges,1404.38,52.5,,1123.5,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,2193.5,82,,1754.8,percent of total billed charges,82% of total billed charges,2273.75,85,,1819,percent of total billed charges,85% of total billed charges,2273.75,85,,1819,percent of total billed charges,85% of total billed charges,2273.75,85,,1819,percent of total billed charges,85% of total billed charges,2407.5,90,,1926,percent of total billed charges,90% of total billed charges,2140,80,,1712,percent of total billed charges,80% of total billed charges,2407.5,90,,1926,percent of total billed charges,90% of total billed charges,2006.25,75,,1605,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,775.75,29,,620.6,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1792.25,67,,1433.8,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1872.5,70,,1498,percent of total billed charges,70% of total billed charges,1738.75,65,,1391,percent of total billed charges,65% of total billed charges,954.17,35.67,,763.336,percent of total billed charges,35.67% of total billed charges,775.75,2407.5,
CORTICAL SCREW 3.5 14MM,27007615,CDM,278,RC,C1713,HCPCS,outpatient,,,450,180.00,,315,70,,252,percent of total billed charges,70% of total billed charges,450,100,,360,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,369,82,,295.2,percent of total billed charges,82% of total billed charges,382.5,85,,306,percent of total billed charges,85% of total billed charges,382.5,85,,306,percent of total billed charges,85% of total billed charges,382.5,85,,306,percent of total billed charges,85% of total billed charges,405,90,,324,percent of total billed charges,90% of total billed charges,360,80,,288,percent of total billed charges,80% of total billed charges,405,90,,324,percent of total billed charges,90% of total billed charges,337.5,75,,270,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,130.5,29,,104.4,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,301.5,67,,241.2,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,315,70,,252,percent of total billed charges,70% of total billed charges,292.5,65,,234,percent of total billed charges,65% of total billed charges,160.52,35.67,,128.416,percent of total billed charges,35.67% of total billed charges,130.5,450,
FULLY THREADED PEG 2.5 24MM,27007616,CDM,278,RC,C1713,HCPCS,outpatient,,,539,215.60,,377.3,70,,301.84,percent of total billed charges,70% of total billed charges,539,100,,431.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,441.98,82,,353.584,percent of total billed charges,82% of total billed charges,458.15,85,,366.52,percent of total billed charges,85% of total billed charges,458.15,85,,366.52,percent of total billed charges,85% of total billed charges,458.15,85,,366.52,percent of total billed charges,85% of total billed charges,485.1,90,,388.08,percent of total billed charges,90% of total billed charges,431.2,80,,344.96,percent of total billed charges,80% of total billed charges,485.1,90,,388.08,percent of total billed charges,90% of total billed charges,404.25,75,,323.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,156.31,29,,125.048,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,361.13,67,,288.904,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,377.3,70,,301.84,percent of total billed charges,70% of total billed charges,350.35,65,,280.28,percent of total billed charges,65% of total billed charges,192.26,35.67,,153.808,percent of total billed charges,35.67% of total billed charges,156.31,539,
SMOOTH PEG 2.0 24MM,27007617,CDM,278,RC,C1713,HCPCS,outpatient,,,539,215.60,,377.3,70,,301.84,percent of total billed charges,70% of total billed charges,539,100,,431.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,441.98,82,,353.584,percent of total billed charges,82% of total billed charges,458.15,85,,366.52,percent of total billed charges,85% of total billed charges,458.15,85,,366.52,percent of total billed charges,85% of total billed charges,458.15,85,,366.52,percent of total billed charges,85% of total billed charges,485.1,90,,388.08,percent of total billed charges,90% of total billed charges,431.2,80,,344.96,percent of total billed charges,80% of total billed charges,485.1,90,,388.08,percent of total billed charges,90% of total billed charges,404.25,75,,323.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,156.31,29,,125.048,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,361.13,67,,288.904,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,377.3,70,,301.84,percent of total billed charges,70% of total billed charges,350.35,65,,280.28,percent of total billed charges,65% of total billed charges,192.26,35.67,,153.808,percent of total billed charges,35.67% of total billed charges,156.31,539,
FULLY THREADED PEG 2.0 22MM,27007618,CDM,278,RC,C1713,HCPCS,outpatient,,,539,215.60,,377.3,70,,301.84,percent of total billed charges,70% of total billed charges,539,100,,431.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,441.98,82,,353.584,percent of total billed charges,82% of total billed charges,458.15,85,,366.52,percent of total billed charges,85% of total billed charges,458.15,85,,366.52,percent of total billed charges,85% of total billed charges,458.15,85,,366.52,percent of total billed charges,85% of total billed charges,485.1,90,,388.08,percent of total billed charges,90% of total billed charges,431.2,80,,344.96,percent of total billed charges,80% of total billed charges,485.1,90,,388.08,percent of total billed charges,90% of total billed charges,404.25,75,,323.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,156.31,29,,125.048,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,361.13,67,,288.904,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,377.3,70,,301.84,percent of total billed charges,70% of total billed charges,350.35,65,,280.28,percent of total billed charges,65% of total billed charges,192.26,35.67,,153.808,percent of total billed charges,35.67% of total billed charges,156.31,539,
SMOOTH PEG 2.0 22MM,27007619,CDM,278,RC,C1713,HCPCS,outpatient,,,539,215.60,,377.3,70,,301.84,percent of total billed charges,70% of total billed charges,539,100,,431.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,441.98,82,,353.584,percent of total billed charges,82% of total billed charges,458.15,85,,366.52,percent of total billed charges,85% of total billed charges,458.15,85,,366.52,percent of total billed charges,85% of total billed charges,458.15,85,,366.52,percent of total billed charges,85% of total billed charges,485.1,90,,388.08,percent of total billed charges,90% of total billed charges,431.2,80,,344.96,percent of total billed charges,80% of total billed charges,485.1,90,,388.08,percent of total billed charges,90% of total billed charges,404.25,75,,323.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,156.31,29,,125.048,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,361.13,67,,288.904,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,377.3,70,,301.84,percent of total billed charges,70% of total billed charges,350.35,65,,280.28,percent of total billed charges,65% of total billed charges,192.26,35.67,,153.808,percent of total billed charges,35.67% of total billed charges,156.31,539,
CORITCAL SCREW 3.5 12MM,27007620,CDM,278,RC,C1713,HCPCS,outpatient,,,450,180.00,,315,70,,252,percent of total billed charges,70% of total billed charges,450,100,,360,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,369,82,,295.2,percent of total billed charges,82% of total billed charges,382.5,85,,306,percent of total billed charges,85% of total billed charges,382.5,85,,306,percent of total billed charges,85% of total billed charges,382.5,85,,306,percent of total billed charges,85% of total billed charges,405,90,,324,percent of total billed charges,90% of total billed charges,360,80,,288,percent of total billed charges,80% of total billed charges,405,90,,324,percent of total billed charges,90% of total billed charges,337.5,75,,270,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,130.5,29,,104.4,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,301.5,67,,241.2,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,315,70,,252,percent of total billed charges,70% of total billed charges,292.5,65,,234,percent of total billed charges,65% of total billed charges,160.52,35.67,,128.416,percent of total billed charges,35.67% of total billed charges,130.5,450,
K-WIRE 0.62,27007623,CDM,278,RC,C1713,HCPCS,outpatient,,,147,58.80,,102.9,70,,82.32,percent of total billed charges,70% of total billed charges,147,100,,117.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,120.54,82,,96.432,percent of total billed charges,82% of total billed charges,124.95,85,,99.96,percent of total billed charges,85% of total billed charges,124.95,85,,99.96,percent of total billed charges,85% of total billed charges,124.95,85,,99.96,percent of total billed charges,85% of total billed charges,132.3,90,,105.84,percent of total billed charges,90% of total billed charges,117.6,80,,94.08,percent of total billed charges,80% of total billed charges,132.3,90,,105.84,percent of total billed charges,90% of total billed charges,110.25,75,,88.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,42.63,29,,34.104,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,98.49,67,,78.792,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,102.9,70,,82.32,percent of total billed charges,70% of total billed charges,95.55,65,,76.44,percent of total billed charges,65% of total billed charges,52.43,35.67,,41.944,percent of total billed charges,35.67% of total billed charges,42.63,147,
PLATE C HALLU FIX 117345ND,27007780,CDM,278,RC,C1713,HCPCS,outpatient,,,2008,803.20,,1405.6,70,,1124.48,percent of total billed charges,70% of total billed charges,1054.2,52.5,,843.36,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,1646.56,82,,1317.248,percent of total billed charges,82% of total billed charges,1706.8,85,,1365.44,percent of total billed charges,85% of total billed charges,1706.8,85,,1365.44,percent of total billed charges,85% of total billed charges,1706.8,85,,1365.44,percent of total billed charges,85% of total billed charges,1807.2,90,,1445.76,percent of total billed charges,90% of total billed charges,1606.4,80,,1285.12,percent of total billed charges,80% of total billed charges,1807.2,90,,1445.76,percent of total billed charges,90% of total billed charges,1506,75,,1204.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,582.32,29,,465.856,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1345.36,67,,1076.288,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1405.6,70,,1124.48,percent of total billed charges,70% of total billed charges,1305.2,65,,1044.16,percent of total billed charges,65% of total billed charges,716.25,35.67,,573,percent of total billed charges,35.67% of total billed charges,582.32,1807.2,
K-WIRE 100 MM 115101ND,27007781,CDM,278,RC,C1713,HCPCS,outpatient,,,305,122.00,,213.5,70,,170.8,percent of total billed charges,70% of total billed charges,305,100,,244,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,250.1,82,,200.08,percent of total billed charges,82% of total billed charges,259.25,85,,207.4,percent of total billed charges,85% of total billed charges,259.25,85,,207.4,percent of total billed charges,85% of total billed charges,259.25,85,,207.4,percent of total billed charges,85% of total billed charges,274.5,90,,219.6,percent of total billed charges,90% of total billed charges,244,80,,195.2,percent of total billed charges,80% of total billed charges,274.5,90,,219.6,percent of total billed charges,90% of total billed charges,228.75,75,,183,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,88.45,29,,70.76,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,204.35,67,,163.48,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,213.5,70,,170.8,percent of total billed charges,70% of total billed charges,198.25,65,,158.6,percent of total billed charges,65% of total billed charges,108.79,35.67,,87.032,percent of total billed charges,35.67% of total billed charges,88.45,305,
K-WIRE 150MM 11526ND,27007782,CDM,278,RC,C1713,HCPCS,outpatient,,,305,122.00,,213.5,70,,170.8,percent of total billed charges,70% of total billed charges,305,100,,244,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,250.1,82,,200.08,percent of total billed charges,82% of total billed charges,259.25,85,,207.4,percent of total billed charges,85% of total billed charges,259.25,85,,207.4,percent of total billed charges,85% of total billed charges,259.25,85,,207.4,percent of total billed charges,85% of total billed charges,274.5,90,,219.6,percent of total billed charges,90% of total billed charges,244,80,,195.2,percent of total billed charges,80% of total billed charges,274.5,90,,219.6,percent of total billed charges,90% of total billed charges,228.75,75,,183,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,88.45,29,,70.76,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,204.35,67,,163.48,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,213.5,70,,170.8,percent of total billed charges,70% of total billed charges,198.25,65,,158.6,percent of total billed charges,65% of total billed charges,108.79,35.67,,87.032,percent of total billed charges,35.67% of total billed charges,88.45,305,
SCREW LARGE 3MM/18MM 117118ND,27007783,CDM,278,RC,C1713,HCPCS,outpatient,,,2038,815.20,,1426.6,70,,1141.28,percent of total billed charges,70% of total billed charges,1069.95,52.5,,855.96,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,1671.16,82,,1336.928,percent of total billed charges,82% of total billed charges,1732.3,85,,1385.84,percent of total billed charges,85% of total billed charges,1732.3,85,,1385.84,percent of total billed charges,85% of total billed charges,1732.3,85,,1385.84,percent of total billed charges,85% of total billed charges,1834.2,90,,1467.36,percent of total billed charges,90% of total billed charges,1630.4,80,,1304.32,percent of total billed charges,80% of total billed charges,1834.2,90,,1467.36,percent of total billed charges,90% of total billed charges,1528.5,75,,1222.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,591.02,29,,472.816,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1365.46,67,,1092.368,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1426.6,70,,1141.28,percent of total billed charges,70% of total billed charges,1324.7,65,,1059.76,percent of total billed charges,65% of total billed charges,726.95,35.67,,581.56,percent of total billed charges,35.67% of total billed charges,591.02,1834.2,
SCREW LARGE 3 MM/12MM 117112ND,27007784,CDM,278,RC,C1713,HCPCS,outpatient,,,2038,815.20,,1426.6,70,,1141.28,percent of total billed charges,70% of total billed charges,1069.95,52.5,,855.96,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,1671.16,82,,1336.928,percent of total billed charges,82% of total billed charges,1732.3,85,,1385.84,percent of total billed charges,85% of total billed charges,1732.3,85,,1385.84,percent of total billed charges,85% of total billed charges,1732.3,85,,1385.84,percent of total billed charges,85% of total billed charges,1834.2,90,,1467.36,percent of total billed charges,90% of total billed charges,1630.4,80,,1304.32,percent of total billed charges,80% of total billed charges,1834.2,90,,1467.36,percent of total billed charges,90% of total billed charges,1528.5,75,,1222.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,591.02,29,,472.816,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1365.46,67,,1092.368,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1426.6,70,,1141.28,percent of total billed charges,70% of total billed charges,1324.7,65,,1059.76,percent of total billed charges,65% of total billed charges,726.95,35.67,,581.56,percent of total billed charges,35.67% of total billed charges,591.02,1834.2,
SCREW SPIN 14MM 112014ND,27007785,CDM,278,RC,C1713,HCPCS,outpatient,,,1730,692.00,,1211,70,,968.8,percent of total billed charges,70% of total billed charges,908.25,52.5,,726.6,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,1418.6,82,,1134.88,percent of total billed charges,82% of total billed charges,1470.5,85,,1176.4,percent of total billed charges,85% of total billed charges,1470.5,85,,1176.4,percent of total billed charges,85% of total billed charges,1470.5,85,,1176.4,percent of total billed charges,85% of total billed charges,1557,90,,1245.6,percent of total billed charges,90% of total billed charges,1384,80,,1107.2,percent of total billed charges,80% of total billed charges,1557,90,,1245.6,percent of total billed charges,90% of total billed charges,1297.5,75,,1038,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,501.7,29,,401.36,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1159.1,67,,927.28,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1211,70,,968.8,percent of total billed charges,70% of total billed charges,1124.5,65,,899.6,percent of total billed charges,65% of total billed charges,617.09,35.67,,493.672,percent of total billed charges,35.67% of total billed charges,501.7,1557,
GUIDE WIRE THREADED 2.8 MM,27007803,CDM,278,RC,C1769,HCPCS,outpatient,,,345,138.00,,241.5,70,,193.2,percent of total billed charges,70% of total billed charges,345,100,,276,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,282.9,82,,226.32,percent of total billed charges,82% of total billed charges,293.25,85,,234.6,percent of total billed charges,85% of total billed charges,293.25,85,,234.6,percent of total billed charges,85% of total billed charges,293.25,85,,234.6,percent of total billed charges,85% of total billed charges,310.5,90,,248.4,percent of total billed charges,90% of total billed charges,276,80,,220.8,percent of total billed charges,80% of total billed charges,310.5,90,,248.4,percent of total billed charges,90% of total billed charges,258.75,75,,207,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,100.05,29,,80.04,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,231.15,67,,184.92,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,241.5,70,,193.2,percent of total billed charges,70% of total billed charges,224.25,65,,179.4,percent of total billed charges,65% of total billed charges,123.06,35.67,,98.448,percent of total billed charges,35.67% of total billed charges,100.05,345,
ROPE MINI-TIGHT,27007889,CDM,278,RC,C1713,HCPCS,outpatient,,,4529,1811.60,,3170.3,70,,2536.24,percent of total billed charges,70% of total billed charges,2377.73,52.5,,1902.18,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,3713.78,82,,2971.024,percent of total billed charges,82% of total billed charges,3849.65,85,,3079.72,percent of total billed charges,85% of total billed charges,3849.65,85,,3079.72,percent of total billed charges,85% of total billed charges,3849.65,85,,3079.72,percent of total billed charges,85% of total billed charges,4076.1,90,,3260.88,percent of total billed charges,90% of total billed charges,3623.2,80,,2898.56,percent of total billed charges,80% of total billed charges,4076.1,90,,3260.88,percent of total billed charges,90% of total billed charges,3396.75,75,,2717.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,1313.41,29,,1050.728,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,3034.43,67,,2427.544,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,3170.3,70,,2536.24,percent of total billed charges,70% of total billed charges,2943.85,65,,2355.08,percent of total billed charges,65% of total billed charges,1615.49,35.67,,1292.392,percent of total billed charges,35.67% of total billed charges,1313.41,4076.1,
X PLATE LOCKING SMALL 24/2MM,27007909,CDM,278,RC,C1713,HCPCS,outpatient,,,2883,1153.20,,2018.1,70,,1614.48,percent of total billed charges,70% of total billed charges,1513.58,52.5,,1210.86,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,2364.06,82,,1891.248,percent of total billed charges,82% of total billed charges,2450.55,85,,1960.44,percent of total billed charges,85% of total billed charges,2450.55,85,,1960.44,percent of total billed charges,85% of total billed charges,2450.55,85,,1960.44,percent of total billed charges,85% of total billed charges,2594.7,90,,2075.76,percent of total billed charges,90% of total billed charges,2306.4,80,,1845.12,percent of total billed charges,80% of total billed charges,2594.7,90,,2075.76,percent of total billed charges,90% of total billed charges,2162.25,75,,1729.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,836.07,29,,668.856,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1931.61,67,,1545.288,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,2018.1,70,,1614.48,percent of total billed charges,70% of total billed charges,1873.95,65,,1499.16,percent of total billed charges,65% of total billed charges,1028.37,35.67,,822.696,percent of total billed charges,35.67% of total billed charges,836.07,2594.7,
LOCKING SCREW 20 27MM,27007910,CDM,278,RC,C1713,HCPCS,outpatient,,,754,301.60,,527.8,70,,422.24,percent of total billed charges,70% of total billed charges,754,100,,603.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,618.28,82,,494.624,percent of total billed charges,82% of total billed charges,640.9,85,,512.72,percent of total billed charges,85% of total billed charges,640.9,85,,512.72,percent of total billed charges,85% of total billed charges,640.9,85,,512.72,percent of total billed charges,85% of total billed charges,678.6,90,,542.88,percent of total billed charges,90% of total billed charges,603.2,80,,482.56,percent of total billed charges,80% of total billed charges,678.6,90,,542.88,percent of total billed charges,90% of total billed charges,565.5,75,,452.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,218.66,29,,174.928,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,505.18,67,,404.144,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,527.8,70,,422.24,percent of total billed charges,70% of total billed charges,490.1,65,,392.08,percent of total billed charges,65% of total billed charges,268.95,35.67,,215.16,percent of total billed charges,35.67% of total billed charges,218.66,754,
LOCKING SCREW 27 MM 24,27007911,CDM,278,RC,C1713,HCPCS,outpatient,,,797,318.80,,557.9,70,,446.32,percent of total billed charges,70% of total billed charges,797,100,,637.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,653.54,82,,522.832,percent of total billed charges,82% of total billed charges,677.45,85,,541.96,percent of total billed charges,85% of total billed charges,677.45,85,,541.96,percent of total billed charges,85% of total billed charges,677.45,85,,541.96,percent of total billed charges,85% of total billed charges,717.3,90,,573.84,percent of total billed charges,90% of total billed charges,637.6,80,,510.08,percent of total billed charges,80% of total billed charges,717.3,90,,573.84,percent of total billed charges,90% of total billed charges,597.75,75,,478.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,231.13,29,,184.904,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,533.99,67,,427.192,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,557.9,70,,446.32,percent of total billed charges,70% of total billed charges,518.05,65,,414.44,percent of total billed charges,65% of total billed charges,284.29,35.67,,227.432,percent of total billed charges,35.67% of total billed charges,231.13,797,
LOCKING SCREW 27 MM 20,27007912,CDM,278,RC,C1713,HCPCS,outpatient,,,797,318.80,,557.9,70,,446.32,percent of total billed charges,70% of total billed charges,797,100,,637.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,653.54,82,,522.832,percent of total billed charges,82% of total billed charges,677.45,85,,541.96,percent of total billed charges,85% of total billed charges,677.45,85,,541.96,percent of total billed charges,85% of total billed charges,677.45,85,,541.96,percent of total billed charges,85% of total billed charges,717.3,90,,573.84,percent of total billed charges,90% of total billed charges,637.6,80,,510.08,percent of total billed charges,80% of total billed charges,717.3,90,,573.84,percent of total billed charges,90% of total billed charges,597.75,75,,478.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,231.13,29,,184.904,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,533.99,67,,427.192,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,557.9,70,,446.32,percent of total billed charges,70% of total billed charges,518.05,65,,414.44,percent of total billed charges,65% of total billed charges,284.29,35.67,,227.432,percent of total billed charges,35.67% of total billed charges,231.13,797,
CANCELLOUS 6.5 W/16MM THREAD,27007913,CDM,278,RC,C1713,HCPCS,outpatient,,,267,106.80,,186.9,70,,149.52,percent of total billed charges,70% of total billed charges,267,100,,213.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,218.94,82,,175.152,percent of total billed charges,82% of total billed charges,226.95,85,,181.56,percent of total billed charges,85% of total billed charges,226.95,85,,181.56,percent of total billed charges,85% of total billed charges,226.95,85,,181.56,percent of total billed charges,85% of total billed charges,240.3,90,,192.24,percent of total billed charges,90% of total billed charges,213.6,80,,170.88,percent of total billed charges,80% of total billed charges,240.3,90,,192.24,percent of total billed charges,90% of total billed charges,200.25,75,,160.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,77.43,29,,61.944,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,178.89,67,,143.112,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,186.9,70,,149.52,percent of total billed charges,70% of total billed charges,173.55,65,,138.84,percent of total billed charges,65% of total billed charges,95.24,35.67,,76.192,percent of total billed charges,35.67% of total billed charges,77.43,267,
CANCELLOUS SCREW 6.5MM/16MM TH,27007914,CDM,278,RC,C1713,HCPCS,outpatient,,,271,108.40,,189.7,70,,151.76,percent of total billed charges,70% of total billed charges,271,100,,216.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,222.22,82,,177.776,percent of total billed charges,82% of total billed charges,230.35,85,,184.28,percent of total billed charges,85% of total billed charges,230.35,85,,184.28,percent of total billed charges,85% of total billed charges,230.35,85,,184.28,percent of total billed charges,85% of total billed charges,243.9,90,,195.12,percent of total billed charges,90% of total billed charges,216.8,80,,173.44,percent of total billed charges,80% of total billed charges,243.9,90,,195.12,percent of total billed charges,90% of total billed charges,203.25,75,,162.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,78.59,29,,62.872,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,181.57,67,,145.256,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,189.7,70,,151.76,percent of total billed charges,70% of total billed charges,176.15,65,,140.92,percent of total billed charges,65% of total billed charges,96.67,35.67,,77.336,percent of total billed charges,35.67% of total billed charges,78.59,271,
K WIRE NOT THREADED 2.0MM,27007917,CDM,278,RC,C1713,HCPCS,outpatient,,,240,96.00,,168,70,,134.4,percent of total billed charges,70% of total billed charges,240,100,,192,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,196.8,82,,157.44,percent of total billed charges,82% of total billed charges,204,85,,163.2,percent of total billed charges,85% of total billed charges,204,85,,163.2,percent of total billed charges,85% of total billed charges,204,85,,163.2,percent of total billed charges,85% of total billed charges,216,90,,172.8,percent of total billed charges,90% of total billed charges,192,80,,153.6,percent of total billed charges,80% of total billed charges,216,90,,172.8,percent of total billed charges,90% of total billed charges,180,75,,144,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,69.6,29,,55.68,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,160.8,67,,128.64,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,168,70,,134.4,percent of total billed charges,70% of total billed charges,156,65,,124.8,percent of total billed charges,65% of total billed charges,85.61,35.67,,68.488,percent of total billed charges,35.67% of total billed charges,69.6,240,
DBX-DBM PUTTY,27007918,CDM,278,RC,C1713,HCPCS,outpatient,,,1847,738.80,,1292.9,70,,1034.32,percent of total billed charges,70% of total billed charges,969.68,52.5,,775.74,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,1514.54,82,,1211.632,percent of total billed charges,82% of total billed charges,1569.95,85,,1255.96,percent of total billed charges,85% of total billed charges,1569.95,85,,1255.96,percent of total billed charges,85% of total billed charges,1569.95,85,,1255.96,percent of total billed charges,85% of total billed charges,1662.3,90,,1329.84,percent of total billed charges,90% of total billed charges,1477.6,80,,1182.08,percent of total billed charges,80% of total billed charges,1662.3,90,,1329.84,percent of total billed charges,90% of total billed charges,1385.25,75,,1108.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,535.63,29,,428.504,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1237.49,67,,989.992,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1292.9,70,,1034.32,percent of total billed charges,70% of total billed charges,1200.55,65,,960.44,percent of total billed charges,65% of total billed charges,658.82,35.67,,527.056,percent of total billed charges,35.67% of total billed charges,535.63,1662.3,
PLATE 2 HOLE 2.7 MM,27007956,CDM,278,RC,C1713,HCPCS,outpatient,,,1679,671.60,,1175.3,70,,940.24,percent of total billed charges,70% of total billed charges,881.48,52.5,,705.18,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,1376.78,82,,1101.424,percent of total billed charges,82% of total billed charges,1427.15,85,,1141.72,percent of total billed charges,85% of total billed charges,1427.15,85,,1141.72,percent of total billed charges,85% of total billed charges,1427.15,85,,1141.72,percent of total billed charges,85% of total billed charges,1511.1,90,,1208.88,percent of total billed charges,90% of total billed charges,1343.2,80,,1074.56,percent of total billed charges,80% of total billed charges,1511.1,90,,1208.88,percent of total billed charges,90% of total billed charges,1259.25,75,,1007.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,486.91,29,,389.528,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1124.93,67,,899.944,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1175.3,70,,940.24,percent of total billed charges,70% of total billed charges,1091.35,65,,873.08,percent of total billed charges,65% of total billed charges,598.9,35.67,,479.12,percent of total billed charges,35.67% of total billed charges,486.91,1511.1,
SCREW LOCKING 2.7MM 26MM LONG,27007957,CDM,278,RC,C1713,HCPCS,outpatient,,,754,301.60,,527.8,70,,422.24,percent of total billed charges,70% of total billed charges,754,100,,603.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,618.28,82,,494.624,percent of total billed charges,82% of total billed charges,640.9,85,,512.72,percent of total billed charges,85% of total billed charges,640.9,85,,512.72,percent of total billed charges,85% of total billed charges,640.9,85,,512.72,percent of total billed charges,85% of total billed charges,678.6,90,,542.88,percent of total billed charges,90% of total billed charges,603.2,80,,482.56,percent of total billed charges,80% of total billed charges,678.6,90,,542.88,percent of total billed charges,90% of total billed charges,565.5,75,,452.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,218.66,29,,174.928,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,505.18,67,,404.144,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,527.8,70,,422.24,percent of total billed charges,70% of total billed charges,490.1,65,,392.08,percent of total billed charges,65% of total billed charges,268.95,35.67,,215.16,percent of total billed charges,35.67% of total billed charges,218.66,754,
PLATE 2.0MM LCP 5 HOLE,27007958,CDM,278,RC,C1713,HCPCS,outpatient,,,1188,475.20,,831.6,70,,665.28,percent of total billed charges,70% of total billed charges,623.7,52.5,,498.96,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,974.16,82,,779.328,percent of total billed charges,82% of total billed charges,1009.8,85,,807.84,percent of total billed charges,85% of total billed charges,1009.8,85,,807.84,percent of total billed charges,85% of total billed charges,1009.8,85,,807.84,percent of total billed charges,85% of total billed charges,1069.2,90,,855.36,percent of total billed charges,90% of total billed charges,950.4,80,,760.32,percent of total billed charges,80% of total billed charges,1069.2,90,,855.36,percent of total billed charges,90% of total billed charges,891,75,,712.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,344.52,29,,275.616,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,795.96,67,,636.768,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,831.6,70,,665.28,percent of total billed charges,70% of total billed charges,772.2,65,,617.76,percent of total billed charges,65% of total billed charges,423.76,35.67,,339.008,percent of total billed charges,35.67% of total billed charges,344.52,1069.2,
SCREW LOCKING 2.0 MM 16 MM LON,27007959,CDM,278,RC,C1713,HCPCS,outpatient,,,824,329.60,,576.8,70,,461.44,percent of total billed charges,70% of total billed charges,824,100,,659.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,675.68,82,,540.544,percent of total billed charges,82% of total billed charges,700.4,85,,560.32,percent of total billed charges,85% of total billed charges,700.4,85,,560.32,percent of total billed charges,85% of total billed charges,700.4,85,,560.32,percent of total billed charges,85% of total billed charges,741.6,90,,593.28,percent of total billed charges,90% of total billed charges,659.2,80,,527.36,percent of total billed charges,80% of total billed charges,741.6,90,,593.28,percent of total billed charges,90% of total billed charges,618,75,,494.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,238.96,29,,191.168,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,552.08,67,,441.664,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,576.8,70,,461.44,percent of total billed charges,70% of total billed charges,535.6,65,,428.48,percent of total billed charges,65% of total billed charges,293.92,35.67,,235.136,percent of total billed charges,35.67% of total billed charges,238.96,824,
SCREW LOCKING 20MM 18 MM LONG,27007960,CDM,278,RC,C1713,HCPCS,outpatient,,,688,275.20,,481.6,70,,385.28,percent of total billed charges,70% of total billed charges,688,100,,550.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,564.16,82,,451.328,percent of total billed charges,82% of total billed charges,584.8,85,,467.84,percent of total billed charges,85% of total billed charges,584.8,85,,467.84,percent of total billed charges,85% of total billed charges,584.8,85,,467.84,percent of total billed charges,85% of total billed charges,619.2,90,,495.36,percent of total billed charges,90% of total billed charges,550.4,80,,440.32,percent of total billed charges,80% of total billed charges,619.2,90,,495.36,percent of total billed charges,90% of total billed charges,516,75,,412.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,199.52,29,,159.616,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,460.96,67,,368.768,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,481.6,70,,385.28,percent of total billed charges,70% of total billed charges,447.2,65,,357.76,percent of total billed charges,65% of total billed charges,245.41,35.67,,196.328,percent of total billed charges,35.67% of total billed charges,199.52,688,
SCREW LOCKING 2.00MM 22MM LONG,27007961,CDM,278,RC,C1713,HCPCS,outpatient,,,735,294.00,,514.5,70,,411.6,percent of total billed charges,70% of total billed charges,735,100,,588,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,602.7,82,,482.16,percent of total billed charges,82% of total billed charges,624.75,85,,499.8,percent of total billed charges,85% of total billed charges,624.75,85,,499.8,percent of total billed charges,85% of total billed charges,624.75,85,,499.8,percent of total billed charges,85% of total billed charges,661.5,90,,529.2,percent of total billed charges,90% of total billed charges,588,80,,470.4,percent of total billed charges,80% of total billed charges,661.5,90,,529.2,percent of total billed charges,90% of total billed charges,551.25,75,,441,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,213.15,29,,170.52,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,492.45,67,,393.96,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,514.5,70,,411.6,percent of total billed charges,70% of total billed charges,477.75,65,,382.2,percent of total billed charges,65% of total billed charges,262.17,35.67,,209.736,percent of total billed charges,35.67% of total billed charges,213.15,735,
SCREW LOCKING 2.0MM 24MM LONG,27007962,CDM,278,RC,C1713,HCPCS,outpatient,,,735,294.00,,514.5,70,,411.6,percent of total billed charges,70% of total billed charges,735,100,,588,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,602.7,82,,482.16,percent of total billed charges,82% of total billed charges,624.75,85,,499.8,percent of total billed charges,85% of total billed charges,624.75,85,,499.8,percent of total billed charges,85% of total billed charges,624.75,85,,499.8,percent of total billed charges,85% of total billed charges,661.5,90,,529.2,percent of total billed charges,90% of total billed charges,588,80,,470.4,percent of total billed charges,80% of total billed charges,661.5,90,,529.2,percent of total billed charges,90% of total billed charges,551.25,75,,441,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,213.15,29,,170.52,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,492.45,67,,393.96,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,514.5,70,,411.6,percent of total billed charges,70% of total billed charges,477.75,65,,382.2,percent of total billed charges,65% of total billed charges,262.17,35.67,,209.736,percent of total billed charges,35.67% of total billed charges,213.15,735,
MINI TIGHT ROPE FT,27007969,CDM,278,RC,C1713,HCPCS,outpatient,,,2617,1046.80,,1831.9,70,,1465.52,percent of total billed charges,70% of total billed charges,1373.93,52.5,,1099.14,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,2145.94,82,,1716.752,percent of total billed charges,82% of total billed charges,2224.45,85,,1779.56,percent of total billed charges,85% of total billed charges,2224.45,85,,1779.56,percent of total billed charges,85% of total billed charges,2224.45,85,,1779.56,percent of total billed charges,85% of total billed charges,2355.3,90,,1884.24,percent of total billed charges,90% of total billed charges,2093.6,80,,1674.88,percent of total billed charges,80% of total billed charges,2355.3,90,,1884.24,percent of total billed charges,90% of total billed charges,1962.75,75,,1570.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,758.93,29,,607.144,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1753.39,67,,1402.712,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1831.9,70,,1465.52,percent of total billed charges,70% of total billed charges,1701.05,65,,1360.84,percent of total billed charges,65% of total billed charges,933.48,35.67,,746.784,percent of total billed charges,35.67% of total billed charges,758.93,2355.3,
LOCKING SCREW 2.0MM 10MM S-TAP,27007986,CDM,278,RC,C1713,HCPCS,outpatient,,,824,329.60,,576.8,70,,461.44,percent of total billed charges,70% of total billed charges,824,100,,659.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,675.68,82,,540.544,percent of total billed charges,82% of total billed charges,700.4,85,,560.32,percent of total billed charges,85% of total billed charges,700.4,85,,560.32,percent of total billed charges,85% of total billed charges,700.4,85,,560.32,percent of total billed charges,85% of total billed charges,741.6,90,,593.28,percent of total billed charges,90% of total billed charges,659.2,80,,527.36,percent of total billed charges,80% of total billed charges,741.6,90,,593.28,percent of total billed charges,90% of total billed charges,618,75,,494.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,238.96,29,,191.168,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,552.08,67,,441.664,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,576.8,70,,461.44,percent of total billed charges,70% of total billed charges,535.6,65,,428.48,percent of total billed charges,65% of total billed charges,293.92,35.67,,235.136,percent of total billed charges,35.67% of total billed charges,238.96,824,
LOCKING SCREW 2.0MM 11MM S-TAP,27007987,CDM,278,RC,C1713,HCPCS,outpatient,,,824,329.60,,576.8,70,,461.44,percent of total billed charges,70% of total billed charges,824,100,,659.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,675.68,82,,540.544,percent of total billed charges,82% of total billed charges,700.4,85,,560.32,percent of total billed charges,85% of total billed charges,700.4,85,,560.32,percent of total billed charges,85% of total billed charges,700.4,85,,560.32,percent of total billed charges,85% of total billed charges,741.6,90,,593.28,percent of total billed charges,90% of total billed charges,659.2,80,,527.36,percent of total billed charges,80% of total billed charges,741.6,90,,593.28,percent of total billed charges,90% of total billed charges,618,75,,494.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,238.96,29,,191.168,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,552.08,67,,441.664,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,576.8,70,,461.44,percent of total billed charges,70% of total billed charges,535.6,65,,428.48,percent of total billed charges,65% of total billed charges,293.92,35.67,,235.136,percent of total billed charges,35.67% of total billed charges,238.96,824,
LOCKING SCREW 2.0MM 12MM S-TAP,27007988,CDM,278,RC,C1713,HCPCS,outpatient,,,824,329.60,,576.8,70,,461.44,percent of total billed charges,70% of total billed charges,824,100,,659.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,675.68,82,,540.544,percent of total billed charges,82% of total billed charges,700.4,85,,560.32,percent of total billed charges,85% of total billed charges,700.4,85,,560.32,percent of total billed charges,85% of total billed charges,700.4,85,,560.32,percent of total billed charges,85% of total billed charges,741.6,90,,593.28,percent of total billed charges,90% of total billed charges,659.2,80,,527.36,percent of total billed charges,80% of total billed charges,741.6,90,,593.28,percent of total billed charges,90% of total billed charges,618,75,,494.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,238.96,29,,191.168,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,552.08,67,,441.664,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,576.8,70,,461.44,percent of total billed charges,70% of total billed charges,535.6,65,,428.48,percent of total billed charges,65% of total billed charges,293.92,35.67,,235.136,percent of total billed charges,35.67% of total billed charges,238.96,824,
PLATE LCP ADAPTION 2.0 MM,27007989,CDM,278,RC,C1713,HCPCS,outpatient,,,1806,722.40,,1264.2,70,,1011.36,percent of total billed charges,70% of total billed charges,948.15,52.5,,758.52,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,1480.92,82,,1184.736,percent of total billed charges,82% of total billed charges,1535.1,85,,1228.08,percent of total billed charges,85% of total billed charges,1535.1,85,,1228.08,percent of total billed charges,85% of total billed charges,1535.1,85,,1228.08,percent of total billed charges,85% of total billed charges,1625.4,90,,1300.32,percent of total billed charges,90% of total billed charges,1444.8,80,,1155.84,percent of total billed charges,80% of total billed charges,1625.4,90,,1300.32,percent of total billed charges,90% of total billed charges,1354.5,75,,1083.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,523.74,29,,418.992,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1210.02,67,,968.016,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1264.2,70,,1011.36,percent of total billed charges,70% of total billed charges,1173.9,65,,939.12,percent of total billed charges,65% of total billed charges,644.2,35.67,,515.36,percent of total billed charges,35.67% of total billed charges,523.74,1625.4,
CORTEX SCREW 2.0 12MM S-TAP,27007991,CDM,278,RC,C1713,HCPCS,outpatient,,,537,214.80,,375.9,70,,300.72,percent of total billed charges,70% of total billed charges,537,100,,429.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,440.34,82,,352.272,percent of total billed charges,82% of total billed charges,456.45,85,,365.16,percent of total billed charges,85% of total billed charges,456.45,85,,365.16,percent of total billed charges,85% of total billed charges,456.45,85,,365.16,percent of total billed charges,85% of total billed charges,483.3,90,,386.64,percent of total billed charges,90% of total billed charges,429.6,80,,343.68,percent of total billed charges,80% of total billed charges,483.3,90,,386.64,percent of total billed charges,90% of total billed charges,402.75,75,,322.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,155.73,29,,124.584,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,359.79,67,,287.832,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,375.9,70,,300.72,percent of total billed charges,70% of total billed charges,349.05,65,,279.24,percent of total billed charges,65% of total billed charges,191.55,35.67,,153.24,percent of total billed charges,35.67% of total billed charges,155.73,537,
SCREW CORTEX 2.0MM 12,27008000,CDM,278,RC,C1713,HCPCS,outpatient,,,270,108.00,,189,70,,151.2,percent of total billed charges,70% of total billed charges,270,100,,216,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,221.4,82,,177.12,percent of total billed charges,82% of total billed charges,229.5,85,,183.6,percent of total billed charges,85% of total billed charges,229.5,85,,183.6,percent of total billed charges,85% of total billed charges,229.5,85,,183.6,percent of total billed charges,85% of total billed charges,243,90,,194.4,percent of total billed charges,90% of total billed charges,216,80,,172.8,percent of total billed charges,80% of total billed charges,243,90,,194.4,percent of total billed charges,90% of total billed charges,202.5,75,,162,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,78.3,29,,62.64,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,180.9,67,,144.72,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,189,70,,151.2,percent of total billed charges,70% of total billed charges,175.5,65,,140.4,percent of total billed charges,65% of total billed charges,96.31,35.67,,77.048,percent of total billed charges,35.67% of total billed charges,78.3,270,
SCREW CORTEX 2.0MM 14,27008001,CDM,278,RC,C1713,HCPCS,outpatient,,,270,108.00,,189,70,,151.2,percent of total billed charges,70% of total billed charges,270,100,,216,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,221.4,82,,177.12,percent of total billed charges,82% of total billed charges,229.5,85,,183.6,percent of total billed charges,85% of total billed charges,229.5,85,,183.6,percent of total billed charges,85% of total billed charges,229.5,85,,183.6,percent of total billed charges,85% of total billed charges,243,90,,194.4,percent of total billed charges,90% of total billed charges,216,80,,172.8,percent of total billed charges,80% of total billed charges,243,90,,194.4,percent of total billed charges,90% of total billed charges,202.5,75,,162,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,78.3,29,,62.64,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,180.9,67,,144.72,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,189,70,,151.2,percent of total billed charges,70% of total billed charges,175.5,65,,140.4,percent of total billed charges,65% of total billed charges,96.31,35.67,,77.048,percent of total billed charges,35.67% of total billed charges,78.3,270,
SCREW CORTEX 24MM 16,27008002,CDM,278,RC,C1713,HCPCS,outpatient,,,372,148.80,,260.4,70,,208.32,percent of total billed charges,70% of total billed charges,372,100,,297.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,305.04,82,,244.032,percent of total billed charges,82% of total billed charges,316.2,85,,252.96,percent of total billed charges,85% of total billed charges,316.2,85,,252.96,percent of total billed charges,85% of total billed charges,316.2,85,,252.96,percent of total billed charges,85% of total billed charges,334.8,90,,267.84,percent of total billed charges,90% of total billed charges,297.6,80,,238.08,percent of total billed charges,80% of total billed charges,334.8,90,,267.84,percent of total billed charges,90% of total billed charges,279,75,,223.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,107.88,29,,86.304,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,249.24,67,,199.392,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,260.4,70,,208.32,percent of total billed charges,70% of total billed charges,241.8,65,,193.44,percent of total billed charges,65% of total billed charges,132.69,35.67,,106.152,percent of total billed charges,35.67% of total billed charges,107.88,372,
LENS DIOPTER,27008045,CDM,278,RC,C1780,HCPCS,outpatient,,,789,315.60,,552.3,70,,441.84,percent of total billed charges,70% of total billed charges,789,100,,631.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,646.98,82,,517.584,percent of total billed charges,82% of total billed charges,670.65,85,,536.52,percent of total billed charges,85% of total billed charges,670.65,85,,536.52,percent of total billed charges,85% of total billed charges,670.65,85,,536.52,percent of total billed charges,85% of total billed charges,710.1,90,,568.08,percent of total billed charges,90% of total billed charges,631.2,80,,504.96,percent of total billed charges,80% of total billed charges,710.1,90,,568.08,percent of total billed charges,90% of total billed charges,591.75,75,,473.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,228.81,29,,183.048,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,528.63,67,,422.904,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,552.3,70,,441.84,percent of total billed charges,70% of total billed charges,512.85,65,,410.28,percent of total billed charges,65% of total billed charges,281.44,35.67,,225.152,percent of total billed charges,35.67% of total billed charges,228.81,789,
2.4 LOCKING SCREWS 20 MM,27008056,CDM,278,RC,C1713,HCPCS,outpatient,,,736,294.40,,515.2,70,,412.16,percent of total billed charges,70% of total billed charges,736,100,,588.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,603.52,82,,482.816,percent of total billed charges,82% of total billed charges,625.6,85,,500.48,percent of total billed charges,85% of total billed charges,625.6,85,,500.48,percent of total billed charges,85% of total billed charges,625.6,85,,500.48,percent of total billed charges,85% of total billed charges,662.4,90,,529.92,percent of total billed charges,90% of total billed charges,588.8,80,,471.04,percent of total billed charges,80% of total billed charges,662.4,90,,529.92,percent of total billed charges,90% of total billed charges,552,75,,441.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,213.44,29,,170.752,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,493.12,67,,394.496,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,515.2,70,,412.16,percent of total billed charges,70% of total billed charges,478.4,65,,382.72,percent of total billed charges,65% of total billed charges,262.53,35.67,,210.024,percent of total billed charges,35.67% of total billed charges,213.44,736,
LOCKING SCREW S/TAP 22MM X 2.4,27008057,CDM,278,RC,C1713,HCPCS,outpatient,,,736,294.40,,515.2,70,,412.16,percent of total billed charges,70% of total billed charges,736,100,,588.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,603.52,82,,482.816,percent of total billed charges,82% of total billed charges,625.6,85,,500.48,percent of total billed charges,85% of total billed charges,625.6,85,,500.48,percent of total billed charges,85% of total billed charges,625.6,85,,500.48,percent of total billed charges,85% of total billed charges,662.4,90,,529.92,percent of total billed charges,90% of total billed charges,588.8,80,,471.04,percent of total billed charges,80% of total billed charges,662.4,90,,529.92,percent of total billed charges,90% of total billed charges,552,75,,441.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,213.44,29,,170.752,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,493.12,67,,394.496,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,515.2,70,,412.16,percent of total billed charges,70% of total billed charges,478.4,65,,382.72,percent of total billed charges,65% of total billed charges,262.53,35.67,,210.024,percent of total billed charges,35.67% of total billed charges,213.44,736,
SCREW 2.7MM CORTEX 510 12MM,27008058,CDM,278,RC,C1713,HCPCS,outpatient,,,325,130.00,,227.5,70,,182,percent of total billed charges,70% of total billed charges,325,100,,260,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,266.5,82,,213.2,percent of total billed charges,82% of total billed charges,276.25,85,,221,percent of total billed charges,85% of total billed charges,276.25,85,,221,percent of total billed charges,85% of total billed charges,276.25,85,,221,percent of total billed charges,85% of total billed charges,292.5,90,,234,percent of total billed charges,90% of total billed charges,260,80,,208,percent of total billed charges,80% of total billed charges,292.5,90,,234,percent of total billed charges,90% of total billed charges,243.75,75,,195,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,94.25,29,,75.4,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,217.75,67,,174.2,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,227.5,70,,182,percent of total billed charges,70% of total billed charges,211.25,65,,169,percent of total billed charges,65% of total billed charges,115.93,35.67,,92.744,percent of total billed charges,35.67% of total billed charges,94.25,325,
PLATE X LOCKING 2.4MM/2.7MM,27008130,CDM,278,RC,C1713,HCPCS,outpatient,,,2920,1168.00,,2044,70,,1635.2,percent of total billed charges,70% of total billed charges,1533,52.5,,1226.4,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,2394.4,82,,1915.52,percent of total billed charges,82% of total billed charges,2482,85,,1985.6,percent of total billed charges,85% of total billed charges,2482,85,,1985.6,percent of total billed charges,85% of total billed charges,2482,85,,1985.6,percent of total billed charges,85% of total billed charges,2628,90,,2102.4,percent of total billed charges,90% of total billed charges,2336,80,,1868.8,percent of total billed charges,80% of total billed charges,2628,90,,2102.4,percent of total billed charges,90% of total billed charges,2190,75,,1752,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,846.8,29,,677.44,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1956.4,67,,1565.12,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,2044,70,,1635.2,percent of total billed charges,70% of total billed charges,1898,65,,1518.4,percent of total billed charges,65% of total billed charges,1041.56,35.67,,833.248,percent of total billed charges,35.67% of total billed charges,846.8,2628,
CORTEX SCREW 40 2.7MM,27008131,CDM,278,RC,C1713,HCPCS,outpatient,,,271,108.40,,189.7,70,,151.76,percent of total billed charges,70% of total billed charges,271,100,,216.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,222.22,82,,177.776,percent of total billed charges,82% of total billed charges,230.35,85,,184.28,percent of total billed charges,85% of total billed charges,230.35,85,,184.28,percent of total billed charges,85% of total billed charges,230.35,85,,184.28,percent of total billed charges,85% of total billed charges,243.9,90,,195.12,percent of total billed charges,90% of total billed charges,216.8,80,,173.44,percent of total billed charges,80% of total billed charges,243.9,90,,195.12,percent of total billed charges,90% of total billed charges,203.25,75,,162.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,78.59,29,,62.872,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,181.57,67,,145.256,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,189.7,70,,151.76,percent of total billed charges,70% of total billed charges,176.15,65,,140.92,percent of total billed charges,65% of total billed charges,96.67,35.67,,77.336,percent of total billed charges,35.67% of total billed charges,78.59,271,
CORTEX SCREW 34 2.7MM,27008132,CDM,278,RC,C1713,HCPCS,outpatient,,,325,130.00,,227.5,70,,182,percent of total billed charges,70% of total billed charges,325,100,,260,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,266.5,82,,213.2,percent of total billed charges,82% of total billed charges,276.25,85,,221,percent of total billed charges,85% of total billed charges,276.25,85,,221,percent of total billed charges,85% of total billed charges,276.25,85,,221,percent of total billed charges,85% of total billed charges,292.5,90,,234,percent of total billed charges,90% of total billed charges,260,80,,208,percent of total billed charges,80% of total billed charges,292.5,90,,234,percent of total billed charges,90% of total billed charges,243.75,75,,195,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,94.25,29,,75.4,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,217.75,67,,174.2,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,227.5,70,,182,percent of total billed charges,70% of total billed charges,211.25,65,,169,percent of total billed charges,65% of total billed charges,115.93,35.67,,92.744,percent of total billed charges,35.67% of total billed charges,94.25,325,
LOCKING SCREW 42 2.7MM,27008133,CDM,278,RC,C1713,HCPCS,outpatient,,,754,301.60,,527.8,70,,422.24,percent of total billed charges,70% of total billed charges,754,100,,603.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,618.28,82,,494.624,percent of total billed charges,82% of total billed charges,640.9,85,,512.72,percent of total billed charges,85% of total billed charges,640.9,85,,512.72,percent of total billed charges,85% of total billed charges,640.9,85,,512.72,percent of total billed charges,85% of total billed charges,678.6,90,,542.88,percent of total billed charges,90% of total billed charges,603.2,80,,482.56,percent of total billed charges,80% of total billed charges,678.6,90,,542.88,percent of total billed charges,90% of total billed charges,565.5,75,,452.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,218.66,29,,174.928,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,505.18,67,,404.144,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,527.8,70,,422.24,percent of total billed charges,70% of total billed charges,490.1,65,,392.08,percent of total billed charges,65% of total billed charges,268.95,35.67,,215.16,percent of total billed charges,35.67% of total billed charges,218.66,754,
PINS MI607015,27008139,CDM,278,RC,C1713,HCPCS,outpatient,,,902,360.80,,631.4,70,,505.12,percent of total billed charges,70% of total billed charges,902,100,,721.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,739.64,82,,591.712,percent of total billed charges,82% of total billed charges,766.7,85,,613.36,percent of total billed charges,85% of total billed charges,766.7,85,,613.36,percent of total billed charges,85% of total billed charges,766.7,85,,613.36,percent of total billed charges,85% of total billed charges,811.8,90,,649.44,percent of total billed charges,90% of total billed charges,721.6,80,,577.28,percent of total billed charges,80% of total billed charges,811.8,90,,649.44,percent of total billed charges,90% of total billed charges,676.5,75,,541.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,261.58,29,,209.264,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,604.34,67,,483.472,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,631.4,70,,505.12,percent of total billed charges,70% of total billed charges,586.3,65,,469.04,percent of total billed charges,65% of total billed charges,321.74,35.67,,257.392,percent of total billed charges,35.67% of total billed charges,261.58,902,
MINIFIXATOR COMPL MEDIUM 07010,27008140,CDM,278,RC,C1713,HCPCS,outpatient,,,10483,4193.20,,7338.1,70,,5870.48,percent of total billed charges,70% of total billed charges,5503.58,52.5,,4402.86,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,8596.06,82,,6876.848,percent of total billed charges,82% of total billed charges,8910.55,85,,7128.44,percent of total billed charges,85% of total billed charges,8910.55,85,,7128.44,percent of total billed charges,85% of total billed charges,8910.55,85,,7128.44,percent of total billed charges,85% of total billed charges,9434.7,90,,7547.76,percent of total billed charges,90% of total billed charges,8386.4,80,,6709.12,percent of total billed charges,80% of total billed charges,9434.7,90,,7547.76,percent of total billed charges,90% of total billed charges,7862.25,75,,6289.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,3040.07,29,,2432.056,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,7023.61,67,,5618.888,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,7338.1,70,,5870.48,percent of total billed charges,70% of total billed charges,6813.95,65,,5451.16,percent of total billed charges,65% of total billed charges,3739.29,35.67,,2991.432,percent of total billed charges,35.67% of total billed charges,3040.07,9434.7,
MINI FIXATOR LG LOT# 426670,27008177,CDM,278,RC,C1713,HCPCS,outpatient,,,10917,4366.80,,7641.9,70,,6113.52,percent of total billed charges,70% of total billed charges,5731.43,52.5,,4585.14,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,8951.94,82,,7161.552,percent of total billed charges,82% of total billed charges,9279.45,85,,7423.56,percent of total billed charges,85% of total billed charges,9279.45,85,,7423.56,percent of total billed charges,85% of total billed charges,9279.45,85,,7423.56,percent of total billed charges,85% of total billed charges,9825.3,90,,7860.24,percent of total billed charges,90% of total billed charges,8733.6,80,,6986.88,percent of total billed charges,80% of total billed charges,9825.3,90,,7860.24,percent of total billed charges,90% of total billed charges,8187.75,75,,6550.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,3165.93,29,,2532.744,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,7314.39,67,,5851.512,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,7641.9,70,,6113.52,percent of total billed charges,70% of total billed charges,7096.05,65,,5676.84,percent of total billed charges,65% of total billed charges,3894.09,35.67,,3115.272,percent of total billed charges,35.67% of total billed charges,3165.93,9825.3,
SCREWS 50/18 X 3.0,27008178,CDM,278,RC,C1713,HCPCS,outpatient,,,3196,1278.40,,2237.2,70,,1789.76,percent of total billed charges,70% of total billed charges,1677.9,52.5,,1342.32,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,2620.72,82,,2096.576,percent of total billed charges,82% of total billed charges,2716.6,85,,2173.28,percent of total billed charges,85% of total billed charges,2716.6,85,,2173.28,percent of total billed charges,85% of total billed charges,2716.6,85,,2173.28,percent of total billed charges,85% of total billed charges,2876.4,90,,2301.12,percent of total billed charges,90% of total billed charges,2556.8,80,,2045.44,percent of total billed charges,80% of total billed charges,2876.4,90,,2301.12,percent of total billed charges,90% of total billed charges,2397,75,,1917.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,926.84,29,,741.472,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,2141.32,67,,1713.056,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,2237.2,70,,1789.76,percent of total billed charges,70% of total billed charges,2077.4,65,,1661.92,percent of total billed charges,65% of total billed charges,1140.01,35.67,,912.008,percent of total billed charges,35.67% of total billed charges,926.84,2876.4,
SCREWS 60/20 X 3.0,27008179,CDM,278,RC,C1713,HCPCS,outpatient,,,1599,639.60,,1119.3,70,,895.44,percent of total billed charges,70% of total billed charges,839.48,52.5,,671.58,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,1311.18,82,,1048.944,percent of total billed charges,82% of total billed charges,1359.15,85,,1087.32,percent of total billed charges,85% of total billed charges,1359.15,85,,1087.32,percent of total billed charges,85% of total billed charges,1359.15,85,,1087.32,percent of total billed charges,85% of total billed charges,1439.1,90,,1151.28,percent of total billed charges,90% of total billed charges,1279.2,80,,1023.36,percent of total billed charges,80% of total billed charges,1439.1,90,,1151.28,percent of total billed charges,90% of total billed charges,1199.25,75,,959.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,463.71,29,,370.968,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1071.33,67,,857.064,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1119.3,70,,895.44,percent of total billed charges,70% of total billed charges,1039.35,65,,831.48,percent of total billed charges,65% of total billed charges,570.36,35.67,,456.288,percent of total billed charges,35.67% of total billed charges,463.71,1439.1,
BIO TENODESIS SCREW 5.5X15MM,27008223,CDM,278,RC,C1713,HCPCS,outpatient,,,2485,994.00,,1739.5,70,,1391.6,percent of total billed charges,70% of total billed charges,1304.63,52.5,,1043.7,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,2037.7,82,,1630.16,percent of total billed charges,82% of total billed charges,2112.25,85,,1689.8,percent of total billed charges,85% of total billed charges,2112.25,85,,1689.8,percent of total billed charges,85% of total billed charges,2112.25,85,,1689.8,percent of total billed charges,85% of total billed charges,2236.5,90,,1789.2,percent of total billed charges,90% of total billed charges,1988,80,,1590.4,percent of total billed charges,80% of total billed charges,2236.5,90,,1789.2,percent of total billed charges,90% of total billed charges,1863.75,75,,1491,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,720.65,29,,576.52,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1664.95,67,,1331.96,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1739.5,70,,1391.6,percent of total billed charges,70% of total billed charges,1615.25,65,,1292.2,percent of total billed charges,65% of total billed charges,886.4,35.67,,709.12,percent of total billed charges,35.67% of total billed charges,720.65,2236.5,
SCREW 2.0 14 MM,27008251,CDM,278,RC,C1713,HCPCS,outpatient,,,781,312.40,,546.7,70,,437.36,percent of total billed charges,70% of total billed charges,781,100,,624.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,640.42,82,,512.336,percent of total billed charges,82% of total billed charges,663.85,85,,531.08,percent of total billed charges,85% of total billed charges,663.85,85,,531.08,percent of total billed charges,85% of total billed charges,663.85,85,,531.08,percent of total billed charges,85% of total billed charges,702.9,90,,562.32,percent of total billed charges,90% of total billed charges,624.8,80,,499.84,percent of total billed charges,80% of total billed charges,702.9,90,,562.32,percent of total billed charges,90% of total billed charges,585.75,75,,468.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,226.49,29,,181.192,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,523.27,67,,418.616,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,546.7,70,,437.36,percent of total billed charges,70% of total billed charges,507.65,65,,406.12,percent of total billed charges,65% of total billed charges,278.58,35.67,,222.864,percent of total billed charges,35.67% of total billed charges,226.49,781,
PLATE CONDYLOR 2.0 LCP-7HOLE,27008252,CDM,278,RC,C1713,HCPCS,outpatient,,,2682,1072.80,,1877.4,70,,1501.92,percent of total billed charges,70% of total billed charges,1408.05,52.5,,1126.44,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,2199.24,82,,1759.392,percent of total billed charges,82% of total billed charges,2279.7,85,,1823.76,percent of total billed charges,85% of total billed charges,2279.7,85,,1823.76,percent of total billed charges,85% of total billed charges,2279.7,85,,1823.76,percent of total billed charges,85% of total billed charges,2413.8,90,,1931.04,percent of total billed charges,90% of total billed charges,2145.6,80,,1716.48,percent of total billed charges,80% of total billed charges,2413.8,90,,1931.04,percent of total billed charges,90% of total billed charges,2011.5,75,,1609.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,777.78,29,,622.224,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1796.94,67,,1437.552,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1877.4,70,,1501.92,percent of total billed charges,70% of total billed charges,1743.3,65,,1394.64,percent of total billed charges,65% of total billed charges,956.67,35.67,,765.336,percent of total billed charges,35.67% of total billed charges,777.78,2413.8,
SUBTOLAR MBA IMPLANT,27008490,CDM,278,RC,,,outpatient,,,10760,4304.00,,7532,70,,6025.6,percent of total billed charges,70% of total billed charges,5649,52.5,,4519.2,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,8823.2,82,,7058.56,percent of total billed charges,82% of total billed charges,9146,85,,7316.8,percent of total billed charges,85% of total billed charges,9146,85,,7316.8,percent of total billed charges,85% of total billed charges,9146,85,,7316.8,percent of total billed charges,85% of total billed charges,9684,90,,7747.2,percent of total billed charges,90% of total billed charges,8608,80,,6886.4,percent of total billed charges,80% of total billed charges,9684,90,,7747.2,percent of total billed charges,90% of total billed charges,8070,75,,6456,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,3120.4,29,,2496.32,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,7209.2,67,,5767.36,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,7532,70,,6025.6,percent of total billed charges,70% of total billed charges,6994,65,,5595.2,percent of total billed charges,65% of total billed charges,3838.09,35.67,,3070.472,percent of total billed charges,35.67% of total billed charges,3120.4,9684,
SHAFT SCREW TI 3.5MM 18 MM,27008585,CDM,278,RC,C1713,HCPCS,outpatient,,,225,90.00,,157.5,70,,126,percent of total billed charges,70% of total billed charges,225,100,,180,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,184.5,82,,147.6,percent of total billed charges,82% of total billed charges,191.25,85,,153,percent of total billed charges,85% of total billed charges,191.25,85,,153,percent of total billed charges,85% of total billed charges,191.25,85,,153,percent of total billed charges,85% of total billed charges,202.5,90,,162,percent of total billed charges,90% of total billed charges,180,80,,144,percent of total billed charges,80% of total billed charges,202.5,90,,162,percent of total billed charges,90% of total billed charges,168.75,75,,135,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,65.25,29,,52.2,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,150.75,67,,120.6,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,157.5,70,,126,percent of total billed charges,70% of total billed charges,146.25,65,,117,percent of total billed charges,65% of total billed charges,80.26,35.67,,64.208,percent of total billed charges,35.67% of total billed charges,65.25,225,
SHAFT SCREW TI 3.5MM  32 MM,27008586,CDM,278,RC,C1713,HCPCS,outpatient,,,225,90.00,,157.5,70,,126,percent of total billed charges,70% of total billed charges,225,100,,180,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,184.5,82,,147.6,percent of total billed charges,82% of total billed charges,191.25,85,,153,percent of total billed charges,85% of total billed charges,191.25,85,,153,percent of total billed charges,85% of total billed charges,191.25,85,,153,percent of total billed charges,85% of total billed charges,202.5,90,,162,percent of total billed charges,90% of total billed charges,180,80,,144,percent of total billed charges,80% of total billed charges,202.5,90,,162,percent of total billed charges,90% of total billed charges,168.75,75,,135,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,65.25,29,,52.2,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,150.75,67,,120.6,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,157.5,70,,126,percent of total billed charges,70% of total billed charges,146.25,65,,117,percent of total billed charges,65% of total billed charges,80.26,35.67,,64.208,percent of total billed charges,35.67% of total billed charges,65.25,225,
CORTEX SCREW S/TAP TI3.5/14MM,27008587,CDM,278,RC,C1713,HCPCS,outpatient,,,198,79.20,,138.6,70,,110.88,percent of total billed charges,70% of total billed charges,198,100,,158.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,162.36,82,,129.888,percent of total billed charges,82% of total billed charges,168.3,85,,134.64,percent of total billed charges,85% of total billed charges,168.3,85,,134.64,percent of total billed charges,85% of total billed charges,168.3,85,,134.64,percent of total billed charges,85% of total billed charges,178.2,90,,142.56,percent of total billed charges,90% of total billed charges,158.4,80,,126.72,percent of total billed charges,80% of total billed charges,178.2,90,,142.56,percent of total billed charges,90% of total billed charges,148.5,75,,118.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,57.42,29,,45.936,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,132.66,67,,106.128,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,138.6,70,,110.88,percent of total billed charges,70% of total billed charges,128.7,65,,102.96,percent of total billed charges,65% of total billed charges,70.63,35.67,,56.504,percent of total billed charges,35.67% of total billed charges,57.42,198,
CORTEX SCREW S/TAP TI3.5/16MM,27008588,CDM,278,RC,C1713,HCPCS,outpatient,,,198,79.20,,138.6,70,,110.88,percent of total billed charges,70% of total billed charges,198,100,,158.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,162.36,82,,129.888,percent of total billed charges,82% of total billed charges,168.3,85,,134.64,percent of total billed charges,85% of total billed charges,168.3,85,,134.64,percent of total billed charges,85% of total billed charges,168.3,85,,134.64,percent of total billed charges,85% of total billed charges,178.2,90,,142.56,percent of total billed charges,90% of total billed charges,158.4,80,,126.72,percent of total billed charges,80% of total billed charges,178.2,90,,142.56,percent of total billed charges,90% of total billed charges,148.5,75,,118.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,57.42,29,,45.936,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,132.66,67,,106.128,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,138.6,70,,110.88,percent of total billed charges,70% of total billed charges,128.7,65,,102.96,percent of total billed charges,65% of total billed charges,70.63,35.67,,56.504,percent of total billed charges,35.67% of total billed charges,57.42,198,
CORTEX SCREW S/TAP TI 3.5/18MM,27008589,CDM,278,RC,C1713,HCPCS,outpatient,,,198,79.20,,138.6,70,,110.88,percent of total billed charges,70% of total billed charges,198,100,,158.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,162.36,82,,129.888,percent of total billed charges,82% of total billed charges,168.3,85,,134.64,percent of total billed charges,85% of total billed charges,168.3,85,,134.64,percent of total billed charges,85% of total billed charges,168.3,85,,134.64,percent of total billed charges,85% of total billed charges,178.2,90,,142.56,percent of total billed charges,90% of total billed charges,158.4,80,,126.72,percent of total billed charges,80% of total billed charges,178.2,90,,142.56,percent of total billed charges,90% of total billed charges,148.5,75,,118.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,57.42,29,,45.936,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,132.66,67,,106.128,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,138.6,70,,110.88,percent of total billed charges,70% of total billed charges,128.7,65,,102.96,percent of total billed charges,65% of total billed charges,70.63,35.67,,56.504,percent of total billed charges,35.67% of total billed charges,57.42,198,
CORTEX SCREW S/TAP TI3.5/20MM,27008590,CDM,278,RC,C1713,HCPCS,outpatient,,,198,79.20,,138.6,70,,110.88,percent of total billed charges,70% of total billed charges,198,100,,158.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,162.36,82,,129.888,percent of total billed charges,82% of total billed charges,168.3,85,,134.64,percent of total billed charges,85% of total billed charges,168.3,85,,134.64,percent of total billed charges,85% of total billed charges,168.3,85,,134.64,percent of total billed charges,85% of total billed charges,178.2,90,,142.56,percent of total billed charges,90% of total billed charges,158.4,80,,126.72,percent of total billed charges,80% of total billed charges,178.2,90,,142.56,percent of total billed charges,90% of total billed charges,148.5,75,,118.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,57.42,29,,45.936,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,132.66,67,,106.128,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,138.6,70,,110.88,percent of total billed charges,70% of total billed charges,128.7,65,,102.96,percent of total billed charges,65% of total billed charges,70.63,35.67,,56.504,percent of total billed charges,35.67% of total billed charges,57.42,198,
CORTEX SCREW S/TAP TI 3.5/24MM,27008591,CDM,278,RC,C1713,HCPCS,outpatient,,,198,79.20,,138.6,70,,110.88,percent of total billed charges,70% of total billed charges,198,100,,158.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,162.36,82,,129.888,percent of total billed charges,82% of total billed charges,168.3,85,,134.64,percent of total billed charges,85% of total billed charges,168.3,85,,134.64,percent of total billed charges,85% of total billed charges,168.3,85,,134.64,percent of total billed charges,85% of total billed charges,178.2,90,,142.56,percent of total billed charges,90% of total billed charges,158.4,80,,126.72,percent of total billed charges,80% of total billed charges,178.2,90,,142.56,percent of total billed charges,90% of total billed charges,148.5,75,,118.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,57.42,29,,45.936,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,132.66,67,,106.128,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,138.6,70,,110.88,percent of total billed charges,70% of total billed charges,128.7,65,,102.96,percent of total billed charges,65% of total billed charges,70.63,35.67,,56.504,percent of total billed charges,35.67% of total billed charges,57.42,198,
CAUCELLOUS BONE TI SCREW 4.0MM,27008592,CDM,278,RC,C1713,HCPCS,outpatient,,,198,79.20,,138.6,70,,110.88,percent of total billed charges,70% of total billed charges,198,100,,158.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,162.36,82,,129.888,percent of total billed charges,82% of total billed charges,168.3,85,,134.64,percent of total billed charges,85% of total billed charges,168.3,85,,134.64,percent of total billed charges,85% of total billed charges,168.3,85,,134.64,percent of total billed charges,85% of total billed charges,178.2,90,,142.56,percent of total billed charges,90% of total billed charges,158.4,80,,126.72,percent of total billed charges,80% of total billed charges,178.2,90,,142.56,percent of total billed charges,90% of total billed charges,148.5,75,,118.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,57.42,29,,45.936,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,132.66,67,,106.128,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,138.6,70,,110.88,percent of total billed charges,70% of total billed charges,128.7,65,,102.96,percent of total billed charges,65% of total billed charges,70.63,35.67,,56.504,percent of total billed charges,35.67% of total billed charges,57.42,198,
TUBULAR PLATE TI 1./W/COLLAR,27008593,CDM,278,RC,C1713,HCPCS,outpatient,,,462,184.80,,323.4,70,,258.72,percent of total billed charges,70% of total billed charges,462,100,,369.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,378.84,82,,303.072,percent of total billed charges,82% of total billed charges,392.7,85,,314.16,percent of total billed charges,85% of total billed charges,392.7,85,,314.16,percent of total billed charges,85% of total billed charges,392.7,85,,314.16,percent of total billed charges,85% of total billed charges,415.8,90,,332.64,percent of total billed charges,90% of total billed charges,369.6,80,,295.68,percent of total billed charges,80% of total billed charges,415.8,90,,332.64,percent of total billed charges,90% of total billed charges,346.5,75,,277.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,133.98,29,,107.184,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,309.54,67,,247.632,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,323.4,70,,258.72,percent of total billed charges,70% of total billed charges,300.3,65,,240.24,percent of total billed charges,65% of total billed charges,164.8,35.67,,131.84,percent of total billed charges,35.67% of total billed charges,133.98,462,
TUBULAR PLATE TI 1/3 WITH HOLE,27008594,CDM,278,RC,C1713,HCPCS,outpatient,,,484,193.60,,338.8,70,,271.04,percent of total billed charges,70% of total billed charges,484,100,,387.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,396.88,82,,317.504,percent of total billed charges,82% of total billed charges,411.4,85,,329.12,percent of total billed charges,85% of total billed charges,411.4,85,,329.12,percent of total billed charges,85% of total billed charges,411.4,85,,329.12,percent of total billed charges,85% of total billed charges,435.6,90,,348.48,percent of total billed charges,90% of total billed charges,387.2,80,,309.76,percent of total billed charges,80% of total billed charges,435.6,90,,348.48,percent of total billed charges,90% of total billed charges,363,75,,290.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,140.36,29,,112.288,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,324.28,67,,259.424,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,338.8,70,,271.04,percent of total billed charges,70% of total billed charges,314.6,65,,251.68,percent of total billed charges,65% of total billed charges,172.64,35.67,,138.112,percent of total billed charges,35.67% of total billed charges,140.36,484,
JWIRE 2.0MM TI KIRSCHNER 150MM,27008595,CDM,278,RC,C1713,HCPCS,outpatient,,,133,53.20,,93.1,70,,74.48,percent of total billed charges,70% of total billed charges,133,100,,106.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,109.06,82,,87.248,percent of total billed charges,82% of total billed charges,113.05,85,,90.44,percent of total billed charges,85% of total billed charges,113.05,85,,90.44,percent of total billed charges,85% of total billed charges,113.05,85,,90.44,percent of total billed charges,85% of total billed charges,119.7,90,,95.76,percent of total billed charges,90% of total billed charges,106.4,80,,85.12,percent of total billed charges,80% of total billed charges,119.7,90,,95.76,percent of total billed charges,90% of total billed charges,99.75,75,,79.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,38.57,29,,30.856,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,89.11,67,,71.288,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,93.1,70,,74.48,percent of total billed charges,70% of total billed charges,86.45,65,,69.16,percent of total billed charges,65% of total billed charges,47.44,35.67,,37.952,percent of total billed charges,35.67% of total billed charges,38.57,133,
TIGHTROPE SYNDESMOSIS CAN KIT,27008718,CDM,278,RC,C1713,HCPCS,outpatient,,,4662,1864.80,,3263.4,70,,2610.72,percent of total billed charges,70% of total billed charges,2447.55,52.5,,1958.04,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,3822.84,82,,3058.272,percent of total billed charges,82% of total billed charges,3962.7,85,,3170.16,percent of total billed charges,85% of total billed charges,3962.7,85,,3170.16,percent of total billed charges,85% of total billed charges,3962.7,85,,3170.16,percent of total billed charges,85% of total billed charges,4195.8,90,,3356.64,percent of total billed charges,90% of total billed charges,3729.6,80,,2983.68,percent of total billed charges,80% of total billed charges,4195.8,90,,3356.64,percent of total billed charges,90% of total billed charges,3496.5,75,,2797.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,1351.98,29,,1081.584,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,3123.54,67,,2498.832,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,3263.4,70,,2610.72,percent of total billed charges,70% of total billed charges,3030.3,65,,2424.24,percent of total billed charges,65% of total billed charges,1662.94,35.67,,1330.352,percent of total billed charges,35.67% of total billed charges,1351.98,4195.8,
SUBTABULAR MBA IMPLANT 10MM,27008791,CDM,278,RC,C1776,HCPCS,outpatient,,,7535,3014.00,,5274.5,70,,4219.6,percent of total billed charges,70% of total billed charges,3955.88,52.5,,3164.7,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,6178.7,82,,4942.96,percent of total billed charges,82% of total billed charges,6404.75,85,,5123.8,percent of total billed charges,85% of total billed charges,6404.75,85,,5123.8,percent of total billed charges,85% of total billed charges,6404.75,85,,5123.8,percent of total billed charges,85% of total billed charges,6781.5,90,,5425.2,percent of total billed charges,90% of total billed charges,6028,80,,4822.4,percent of total billed charges,80% of total billed charges,6781.5,90,,5425.2,percent of total billed charges,90% of total billed charges,5651.25,75,,4521,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2185.15,29,,1748.12,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,5048.45,67,,4038.76,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,5274.5,70,,4219.6,percent of total billed charges,70% of total billed charges,4897.75,65,,3918.2,percent of total billed charges,65% of total billed charges,2687.73,35.67,,2150.184,percent of total billed charges,35.67% of total billed charges,2185.15,6781.5,
CORTEX SCREW 27MM #28,27008806,CDM,278,RC,C1713,HCPCS,outpatient,,,303,121.20,,212.1,70,,169.68,percent of total billed charges,70% of total billed charges,303,100,,242.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,248.46,82,,198.768,percent of total billed charges,82% of total billed charges,257.55,85,,206.04,percent of total billed charges,85% of total billed charges,257.55,85,,206.04,percent of total billed charges,85% of total billed charges,257.55,85,,206.04,percent of total billed charges,85% of total billed charges,272.7,90,,218.16,percent of total billed charges,90% of total billed charges,242.4,80,,193.92,percent of total billed charges,80% of total billed charges,272.7,90,,218.16,percent of total billed charges,90% of total billed charges,227.25,75,,181.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,87.87,29,,70.296,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,203.01,67,,162.408,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,212.1,70,,169.68,percent of total billed charges,70% of total billed charges,196.95,65,,157.56,percent of total billed charges,65% of total billed charges,108.08,35.67,,86.464,percent of total billed charges,35.67% of total billed charges,87.87,303,
CORTEX SCREW 27MM # 46,27008808,CDM,278,RC,C1713,HCPCS,outpatient,,,303,121.20,,212.1,70,,169.68,percent of total billed charges,70% of total billed charges,303,100,,242.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,248.46,82,,198.768,percent of total billed charges,82% of total billed charges,257.55,85,,206.04,percent of total billed charges,85% of total billed charges,257.55,85,,206.04,percent of total billed charges,85% of total billed charges,257.55,85,,206.04,percent of total billed charges,85% of total billed charges,272.7,90,,218.16,percent of total billed charges,90% of total billed charges,242.4,80,,193.92,percent of total billed charges,80% of total billed charges,272.7,90,,218.16,percent of total billed charges,90% of total billed charges,227.25,75,,181.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,87.87,29,,70.296,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,203.01,67,,162.408,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,212.1,70,,169.68,percent of total billed charges,70% of total billed charges,196.95,65,,157.56,percent of total billed charges,65% of total billed charges,108.08,35.67,,86.464,percent of total billed charges,35.67% of total billed charges,87.87,303,
CORTEX SCREW 27MM #20,27008810,CDM,278,RC,C1713,HCPCS,outpatient,,,303,121.20,,212.1,70,,169.68,percent of total billed charges,70% of total billed charges,303,100,,242.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,248.46,82,,198.768,percent of total billed charges,82% of total billed charges,257.55,85,,206.04,percent of total billed charges,85% of total billed charges,257.55,85,,206.04,percent of total billed charges,85% of total billed charges,257.55,85,,206.04,percent of total billed charges,85% of total billed charges,272.7,90,,218.16,percent of total billed charges,90% of total billed charges,242.4,80,,193.92,percent of total billed charges,80% of total billed charges,272.7,90,,218.16,percent of total billed charges,90% of total billed charges,227.25,75,,181.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,87.87,29,,70.296,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,203.01,67,,162.408,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,212.1,70,,169.68,percent of total billed charges,70% of total billed charges,196.95,65,,157.56,percent of total billed charges,65% of total billed charges,108.08,35.67,,86.464,percent of total billed charges,35.67% of total billed charges,87.87,303,
CORTEX SCREW 27MM #18,27008811,CDM,278,RC,C1713,HCPCS,outpatient,,,303,121.20,,212.1,70,,169.68,percent of total billed charges,70% of total billed charges,303,100,,242.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,248.46,82,,198.768,percent of total billed charges,82% of total billed charges,257.55,85,,206.04,percent of total billed charges,85% of total billed charges,257.55,85,,206.04,percent of total billed charges,85% of total billed charges,257.55,85,,206.04,percent of total billed charges,85% of total billed charges,272.7,90,,218.16,percent of total billed charges,90% of total billed charges,242.4,80,,193.92,percent of total billed charges,80% of total billed charges,272.7,90,,218.16,percent of total billed charges,90% of total billed charges,227.25,75,,181.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,87.87,29,,70.296,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,203.01,67,,162.408,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,212.1,70,,169.68,percent of total billed charges,70% of total billed charges,196.95,65,,157.56,percent of total billed charges,65% of total billed charges,108.08,35.67,,86.464,percent of total billed charges,35.67% of total billed charges,87.87,303,
ARTHREX SYNDESMOSIS TIGHTROPE,27008870,CDM,278,RC,C1776,HCPCS,outpatient,,,2216,886.40,,1551.2,70,,1240.96,percent of total billed charges,70% of total billed charges,1163.4,52.5,,930.72,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,1817.12,82,,1453.696,percent of total billed charges,82% of total billed charges,1883.6,85,,1506.88,percent of total billed charges,85% of total billed charges,1883.6,85,,1506.88,percent of total billed charges,85% of total billed charges,1883.6,85,,1506.88,percent of total billed charges,85% of total billed charges,1994.4,90,,1595.52,percent of total billed charges,90% of total billed charges,1772.8,80,,1418.24,percent of total billed charges,80% of total billed charges,1994.4,90,,1595.52,percent of total billed charges,90% of total billed charges,1662,75,,1329.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,642.64,29,,514.112,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1484.72,67,,1187.776,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1551.2,70,,1240.96,percent of total billed charges,70% of total billed charges,1440.4,65,,1152.32,percent of total billed charges,65% of total billed charges,790.45,35.67,,632.36,percent of total billed charges,35.67% of total billed charges,642.64,1994.4,
CORTEX SCREW 3.5MM,27008921,CDM,278,RC,,,outpatient,,,181,72.40,,126.7,70,,101.36,percent of total billed charges,70% of total billed charges,181,100,,144.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,148.42,82,,118.736,percent of total billed charges,82% of total billed charges,153.85,85,,123.08,percent of total billed charges,85% of total billed charges,153.85,85,,123.08,percent of total billed charges,85% of total billed charges,153.85,85,,123.08,percent of total billed charges,85% of total billed charges,162.9,90,,130.32,percent of total billed charges,90% of total billed charges,144.8,80,,115.84,percent of total billed charges,80% of total billed charges,162.9,90,,130.32,percent of total billed charges,90% of total billed charges,135.75,75,,108.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,52.49,29,,41.992,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,121.27,67,,97.016,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,126.7,70,,101.36,percent of total billed charges,70% of total billed charges,117.65,65,,94.12,percent of total billed charges,65% of total billed charges,64.56,35.67,,51.648,percent of total billed charges,35.67% of total billed charges,52.49,181,
CORTEX SCREW 3.5 MM # 45,27008922,CDM,278,RC,C1713,HCPCS,outpatient,,,201,80.40,,140.7,70,,112.56,percent of total billed charges,70% of total billed charges,201,100,,160.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,164.82,82,,131.856,percent of total billed charges,82% of total billed charges,170.85,85,,136.68,percent of total billed charges,85% of total billed charges,170.85,85,,136.68,percent of total billed charges,85% of total billed charges,170.85,85,,136.68,percent of total billed charges,85% of total billed charges,180.9,90,,144.72,percent of total billed charges,90% of total billed charges,160.8,80,,128.64,percent of total billed charges,80% of total billed charges,180.9,90,,144.72,percent of total billed charges,90% of total billed charges,150.75,75,,120.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,58.29,29,,46.632,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,134.67,67,,107.736,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,140.7,70,,112.56,percent of total billed charges,70% of total billed charges,130.65,65,,104.52,percent of total billed charges,65% of total billed charges,71.7,35.67,,57.36,percent of total billed charges,35.67% of total billed charges,58.29,201,
LCP PLATE 4 HOLE 2.4MM,27008923,CDM,278,RC,C1713,HCPCS,outpatient,,,1903,761.20,,1332.1,70,,1065.68,percent of total billed charges,70% of total billed charges,999.08,52.5,,799.26,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,1560.46,82,,1248.368,percent of total billed charges,82% of total billed charges,1617.55,85,,1294.04,percent of total billed charges,85% of total billed charges,1617.55,85,,1294.04,percent of total billed charges,85% of total billed charges,1617.55,85,,1294.04,percent of total billed charges,85% of total billed charges,1712.7,90,,1370.16,percent of total billed charges,90% of total billed charges,1522.4,80,,1217.92,percent of total billed charges,80% of total billed charges,1712.7,90,,1370.16,percent of total billed charges,90% of total billed charges,1427.25,75,,1141.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,551.87,29,,441.496,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1275.01,67,,1020.008,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1332.1,70,,1065.68,percent of total billed charges,70% of total billed charges,1236.95,65,,989.56,percent of total billed charges,65% of total billed charges,678.8,35.67,,543.04,percent of total billed charges,35.67% of total billed charges,551.87,1712.7,
LOCKING SCREW 2.4MM #26,27008924,CDM,278,RC,C1713,HCPCS,outpatient,,,736,294.40,,515.2,70,,412.16,percent of total billed charges,70% of total billed charges,736,100,,588.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,603.52,82,,482.816,percent of total billed charges,82% of total billed charges,625.6,85,,500.48,percent of total billed charges,85% of total billed charges,625.6,85,,500.48,percent of total billed charges,85% of total billed charges,625.6,85,,500.48,percent of total billed charges,85% of total billed charges,662.4,90,,529.92,percent of total billed charges,90% of total billed charges,588.8,80,,471.04,percent of total billed charges,80% of total billed charges,662.4,90,,529.92,percent of total billed charges,90% of total billed charges,552,75,,441.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,213.44,29,,170.752,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,493.12,67,,394.496,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,515.2,70,,412.16,percent of total billed charges,70% of total billed charges,478.4,65,,382.72,percent of total billed charges,65% of total billed charges,262.53,35.67,,210.024,percent of total billed charges,35.67% of total billed charges,213.44,736,
LOCKING SCREW 24MM #12,27008925,CDM,278,RC,C1713,HCPCS,outpatient,,,691,276.40,,483.7,70,,386.96,percent of total billed charges,70% of total billed charges,691,100,,552.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,566.62,82,,453.296,percent of total billed charges,82% of total billed charges,587.35,85,,469.88,percent of total billed charges,85% of total billed charges,587.35,85,,469.88,percent of total billed charges,85% of total billed charges,587.35,85,,469.88,percent of total billed charges,85% of total billed charges,621.9,90,,497.52,percent of total billed charges,90% of total billed charges,552.8,80,,442.24,percent of total billed charges,80% of total billed charges,621.9,90,,497.52,percent of total billed charges,90% of total billed charges,518.25,75,,414.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,200.39,29,,160.312,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,462.97,67,,370.376,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,483.7,70,,386.96,percent of total billed charges,70% of total billed charges,449.15,65,,359.32,percent of total billed charges,65% of total billed charges,246.48,35.67,,197.184,percent of total billed charges,35.67% of total billed charges,200.39,691,
CORTEX SCREW 2.4MM #10,27008926,CDM,278,RC,C1713,HCPCS,outpatient,,,327,130.80,,228.9,70,,183.12,percent of total billed charges,70% of total billed charges,327,100,,261.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,268.14,82,,214.512,percent of total billed charges,82% of total billed charges,277.95,85,,222.36,percent of total billed charges,85% of total billed charges,277.95,85,,222.36,percent of total billed charges,85% of total billed charges,277.95,85,,222.36,percent of total billed charges,85% of total billed charges,294.3,90,,235.44,percent of total billed charges,90% of total billed charges,261.6,80,,209.28,percent of total billed charges,80% of total billed charges,294.3,90,,235.44,percent of total billed charges,90% of total billed charges,245.25,75,,196.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,94.83,29,,75.864,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,219.09,67,,175.272,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,228.9,70,,183.12,percent of total billed charges,70% of total billed charges,212.55,65,,170.04,percent of total billed charges,65% of total billed charges,116.64,35.67,,93.312,percent of total billed charges,35.67% of total billed charges,94.83,327,
CACELLOUS SCREW PRIL THRD 4.0,27008927,CDM,278,RC,C1713,HCPCS,outpatient,,,200,80.00,,140,70,,112,percent of total billed charges,70% of total billed charges,200,100,,160,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,164,82,,131.2,percent of total billed charges,82% of total billed charges,170,85,,136,percent of total billed charges,85% of total billed charges,170,85,,136,percent of total billed charges,85% of total billed charges,170,85,,136,percent of total billed charges,85% of total billed charges,180,90,,144,percent of total billed charges,90% of total billed charges,160,80,,128,percent of total billed charges,80% of total billed charges,180,90,,144,percent of total billed charges,90% of total billed charges,150,75,,120,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,58,29,,46.4,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,134,67,,107.2,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,140,70,,112,percent of total billed charges,70% of total billed charges,130,65,,104,percent of total billed charges,65% of total billed charges,71.34,35.67,,57.072,percent of total billed charges,35.67% of total billed charges,58,200,
"CORTEX SCREW 2.4,, #38",27008928,CDM,278,RC,C1713,HCPCS,outpatient,,,327,130.80,,228.9,70,,183.12,percent of total billed charges,70% of total billed charges,327,100,,261.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,268.14,82,,214.512,percent of total billed charges,82% of total billed charges,277.95,85,,222.36,percent of total billed charges,85% of total billed charges,277.95,85,,222.36,percent of total billed charges,85% of total billed charges,277.95,85,,222.36,percent of total billed charges,85% of total billed charges,294.3,90,,235.44,percent of total billed charges,90% of total billed charges,261.6,80,,209.28,percent of total billed charges,80% of total billed charges,294.3,90,,235.44,percent of total billed charges,90% of total billed charges,245.25,75,,196.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,94.83,29,,75.864,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,219.09,67,,175.272,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,228.9,70,,183.12,percent of total billed charges,70% of total billed charges,212.55,65,,170.04,percent of total billed charges,65% of total billed charges,116.64,35.67,,93.312,percent of total billed charges,35.67% of total billed charges,94.83,327,
LOCKING SCREW SZ 27 MM-28,27008929,CDM,278,RC,C1713,HCPCS,outpatient,,,712,284.80,,498.4,70,,398.72,percent of total billed charges,70% of total billed charges,712,100,,569.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,583.84,82,,467.072,percent of total billed charges,82% of total billed charges,605.2,85,,484.16,percent of total billed charges,85% of total billed charges,605.2,85,,484.16,percent of total billed charges,85% of total billed charges,605.2,85,,484.16,percent of total billed charges,85% of total billed charges,640.8,90,,512.64,percent of total billed charges,90% of total billed charges,569.6,80,,455.68,percent of total billed charges,80% of total billed charges,640.8,90,,512.64,percent of total billed charges,90% of total billed charges,534,75,,427.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,206.48,29,,165.184,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,477.04,67,,381.632,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,498.4,70,,398.72,percent of total billed charges,70% of total billed charges,462.8,65,,370.24,percent of total billed charges,65% of total billed charges,253.97,35.67,,203.176,percent of total billed charges,35.67% of total billed charges,206.48,712,
TRINITY EVOLUTION 5 CC,27008930,CDM,278,RC,C1776,HCPCS,outpatient,,,7732,3092.80,,5412.4,70,,4329.92,percent of total billed charges,70% of total billed charges,4059.3,52.5,,3247.44,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,6340.24,82,,5072.192,percent of total billed charges,82% of total billed charges,6572.2,85,,5257.76,percent of total billed charges,85% of total billed charges,6572.2,85,,5257.76,percent of total billed charges,85% of total billed charges,6572.2,85,,5257.76,percent of total billed charges,85% of total billed charges,6958.8,90,,5567.04,percent of total billed charges,90% of total billed charges,6185.6,80,,4948.48,percent of total billed charges,80% of total billed charges,6958.8,90,,5567.04,percent of total billed charges,90% of total billed charges,5799,75,,4639.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2242.28,29,,1793.824,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,5180.44,67,,4144.352,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,5412.4,70,,4329.92,percent of total billed charges,70% of total billed charges,5025.8,65,,4020.64,percent of total billed charges,65% of total billed charges,2758,35.67,,2206.4,percent of total billed charges,35.67% of total billed charges,2242.28,6958.8,
CORTEX SCREW 2.0MM 34 MM,27008936,CDM,278,RC,C1713,HCPCS,outpatient,,,259,103.60,,181.3,70,,145.04,percent of total billed charges,70% of total billed charges,259,100,,207.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,212.38,82,,169.904,percent of total billed charges,82% of total billed charges,220.15,85,,176.12,percent of total billed charges,85% of total billed charges,220.15,85,,176.12,percent of total billed charges,85% of total billed charges,220.15,85,,176.12,percent of total billed charges,85% of total billed charges,233.1,90,,186.48,percent of total billed charges,90% of total billed charges,207.2,80,,165.76,percent of total billed charges,80% of total billed charges,233.1,90,,186.48,percent of total billed charges,90% of total billed charges,194.25,75,,155.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,75.11,29,,60.088,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,173.53,67,,138.824,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,181.3,70,,145.04,percent of total billed charges,70% of total billed charges,168.35,65,,134.68,percent of total billed charges,65% of total billed charges,92.39,35.67,,73.912,percent of total billed charges,35.67% of total billed charges,75.11,259,
CORTEX SCREW 2.0MM 36 MM,27008937,CDM,278,RC,C1713,HCPCS,outpatient,,,259,103.60,,181.3,70,,145.04,percent of total billed charges,70% of total billed charges,259,100,,207.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,212.38,82,,169.904,percent of total billed charges,82% of total billed charges,220.15,85,,176.12,percent of total billed charges,85% of total billed charges,220.15,85,,176.12,percent of total billed charges,85% of total billed charges,220.15,85,,176.12,percent of total billed charges,85% of total billed charges,233.1,90,,186.48,percent of total billed charges,90% of total billed charges,207.2,80,,165.76,percent of total billed charges,80% of total billed charges,233.1,90,,186.48,percent of total billed charges,90% of total billed charges,194.25,75,,155.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,75.11,29,,60.088,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,173.53,67,,138.824,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,181.3,70,,145.04,percent of total billed charges,70% of total billed charges,168.35,65,,134.68,percent of total billed charges,65% of total billed charges,92.39,35.67,,73.912,percent of total billed charges,35.67% of total billed charges,75.11,259,
KIRSCHNER WIRE W/ TROCAR 1.6MM,27008938,CDM,278,RC,C1713,HCPCS,outpatient,,,109,43.60,,76.3,70,,61.04,percent of total billed charges,70% of total billed charges,109,100,,87.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,89.38,82,,71.504,percent of total billed charges,82% of total billed charges,92.65,85,,74.12,percent of total billed charges,85% of total billed charges,92.65,85,,74.12,percent of total billed charges,85% of total billed charges,92.65,85,,74.12,percent of total billed charges,85% of total billed charges,98.1,90,,78.48,percent of total billed charges,90% of total billed charges,87.2,80,,69.76,percent of total billed charges,80% of total billed charges,98.1,90,,78.48,percent of total billed charges,90% of total billed charges,81.75,75,,65.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,31.61,29,,25.288,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,73.03,67,,58.424,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,76.3,70,,61.04,percent of total billed charges,70% of total billed charges,70.85,65,,56.68,percent of total billed charges,65% of total billed charges,38.88,35.67,,31.104,percent of total billed charges,35.67% of total billed charges,31.61,109,
BIOCOMPOSITE-TENODESIS SCREW,27009080,CDM,278,RC,C1713,HCPCS,outpatient,,,2014,805.60,,1409.8,70,,1127.84,percent of total billed charges,70% of total billed charges,1057.35,52.5,,845.88,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,1651.48,82,,1321.184,percent of total billed charges,82% of total billed charges,1711.9,85,,1369.52,percent of total billed charges,85% of total billed charges,1711.9,85,,1369.52,percent of total billed charges,85% of total billed charges,1711.9,85,,1369.52,percent of total billed charges,85% of total billed charges,1812.6,90,,1450.08,percent of total billed charges,90% of total billed charges,1611.2,80,,1288.96,percent of total billed charges,80% of total billed charges,1812.6,90,,1450.08,percent of total billed charges,90% of total billed charges,1510.5,75,,1208.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,584.06,29,,467.248,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1349.38,67,,1079.504,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1409.8,70,,1127.84,percent of total billed charges,70% of total billed charges,1309.1,65,,1047.28,percent of total billed charges,65% of total billed charges,718.39,35.67,,574.712,percent of total billed charges,35.67% of total billed charges,584.06,1812.6,
SCREW CORTEX 2.7MM # 36,27009099,CDM,278,RC,C1713,HCPCS,outpatient,,,286,114.40,,200.2,70,,160.16,percent of total billed charges,70% of total billed charges,286,100,,228.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,234.52,82,,187.616,percent of total billed charges,82% of total billed charges,243.1,85,,194.48,percent of total billed charges,85% of total billed charges,243.1,85,,194.48,percent of total billed charges,85% of total billed charges,243.1,85,,194.48,percent of total billed charges,85% of total billed charges,257.4,90,,205.92,percent of total billed charges,90% of total billed charges,228.8,80,,183.04,percent of total billed charges,80% of total billed charges,257.4,90,,205.92,percent of total billed charges,90% of total billed charges,214.5,75,,171.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,82.94,29,,66.352,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,191.62,67,,153.296,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,200.2,70,,160.16,percent of total billed charges,70% of total billed charges,185.9,65,,148.72,percent of total billed charges,65% of total billed charges,102.02,35.67,,81.616,percent of total billed charges,35.67% of total billed charges,82.94,286,
SURGIMESH WN OVAL T1115-8,27009104,CDM,278,RC,C1781,HCPCS,outpatient,,,1791,716.40,,1253.7,70,,1002.96,percent of total billed charges,70% of total billed charges,940.28,52.5,,752.22,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,1468.62,82,,1174.896,percent of total billed charges,82% of total billed charges,1522.35,85,,1217.88,percent of total billed charges,85% of total billed charges,1522.35,85,,1217.88,percent of total billed charges,85% of total billed charges,1522.35,85,,1217.88,percent of total billed charges,85% of total billed charges,1611.9,90,,1289.52,percent of total billed charges,90% of total billed charges,1432.8,80,,1146.24,percent of total billed charges,80% of total billed charges,1611.9,90,,1289.52,percent of total billed charges,90% of total billed charges,1343.25,75,,1074.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,519.39,29,,415.512,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1199.97,67,,959.976,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1253.7,70,,1002.96,percent of total billed charges,70% of total billed charges,1164.15,65,,931.32,percent of total billed charges,65% of total billed charges,638.85,35.67,,511.08,percent of total billed charges,35.67% of total billed charges,519.39,1611.9,
SURGIMESH WN EASYPLUG,27009113,CDM,278,RC,C1781,HCPCS,outpatient,,,1567,626.80,,1096.9,70,,877.52,percent of total billed charges,70% of total billed charges,822.68,52.5,,658.14,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,1284.94,82,,1027.952,percent of total billed charges,82% of total billed charges,1331.95,85,,1065.56,percent of total billed charges,85% of total billed charges,1331.95,85,,1065.56,percent of total billed charges,85% of total billed charges,1331.95,85,,1065.56,percent of total billed charges,85% of total billed charges,1410.3,90,,1128.24,percent of total billed charges,90% of total billed charges,1253.6,80,,1002.88,percent of total billed charges,80% of total billed charges,1410.3,90,,1128.24,percent of total billed charges,90% of total billed charges,1175.25,75,,940.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,454.43,29,,363.544,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1049.89,67,,839.912,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1096.9,70,,877.52,percent of total billed charges,70% of total billed charges,1018.55,65,,814.84,percent of total billed charges,65% of total billed charges,558.95,35.67,,447.16,percent of total billed charges,35.67% of total billed charges,454.43,1410.3,
TIGHTROPE DISPOSABLE IMPLANT,27009149,CDM,278,RC,,,outpatient,,,2378,951.20,,1664.6,70,,1331.68,percent of total billed charges,70% of total billed charges,1248.45,52.5,,998.76,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,1949.96,82,,1559.968,percent of total billed charges,82% of total billed charges,2021.3,85,,1617.04,percent of total billed charges,85% of total billed charges,2021.3,85,,1617.04,percent of total billed charges,85% of total billed charges,2021.3,85,,1617.04,percent of total billed charges,85% of total billed charges,2140.2,90,,1712.16,percent of total billed charges,90% of total billed charges,1902.4,80,,1521.92,percent of total billed charges,80% of total billed charges,2140.2,90,,1712.16,percent of total billed charges,90% of total billed charges,1783.5,75,,1426.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,689.62,29,,551.696,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1593.26,67,,1274.608,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1664.6,70,,1331.68,percent of total billed charges,70% of total billed charges,1545.7,65,,1236.56,percent of total billed charges,65% of total billed charges,848.23,35.67,,678.584,percent of total billed charges,35.67% of total billed charges,689.62,2140.2,
CORTEX SCREW 2.7 MM # 30,27009175,CDM,278,RC,C1713,HCPCS,outpatient,,,286,114.40,,200.2,70,,160.16,percent of total billed charges,70% of total billed charges,286,100,,228.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,234.52,82,,187.616,percent of total billed charges,82% of total billed charges,243.1,85,,194.48,percent of total billed charges,85% of total billed charges,243.1,85,,194.48,percent of total billed charges,85% of total billed charges,243.1,85,,194.48,percent of total billed charges,85% of total billed charges,257.4,90,,205.92,percent of total billed charges,90% of total billed charges,228.8,80,,183.04,percent of total billed charges,80% of total billed charges,257.4,90,,205.92,percent of total billed charges,90% of total billed charges,214.5,75,,171.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,82.94,29,,66.352,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,191.62,67,,153.296,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,200.2,70,,160.16,percent of total billed charges,70% of total billed charges,185.9,65,,148.72,percent of total billed charges,65% of total billed charges,102.02,35.67,,81.616,percent of total billed charges,35.67% of total billed charges,82.94,286,
K-WIRE 1.25MM,27009176,CDM,278,RC,C1713,HCPCS,outpatient,,,226,90.40,,158.2,70,,126.56,percent of total billed charges,70% of total billed charges,226,100,,180.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,185.32,82,,148.256,percent of total billed charges,82% of total billed charges,192.1,85,,153.68,percent of total billed charges,85% of total billed charges,192.1,85,,153.68,percent of total billed charges,85% of total billed charges,192.1,85,,153.68,percent of total billed charges,85% of total billed charges,203.4,90,,162.72,percent of total billed charges,90% of total billed charges,180.8,80,,144.64,percent of total billed charges,80% of total billed charges,203.4,90,,162.72,percent of total billed charges,90% of total billed charges,169.5,75,,135.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,65.54,29,,52.432,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,151.42,67,,121.136,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,158.2,70,,126.56,percent of total billed charges,70% of total billed charges,146.9,65,,117.52,percent of total billed charges,65% of total billed charges,80.61,35.67,,64.488,percent of total billed charges,35.67% of total billed charges,65.54,226,
LLP VOLAR DISTAL RADIUS 24 MM,27009236,CDM,278,RC,C1776,HCPCS,outpatient,,,2913,1165.20,,2039.1,70,,1631.28,percent of total billed charges,70% of total billed charges,1529.33,52.5,,1223.46,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,2388.66,82,,1910.928,percent of total billed charges,82% of total billed charges,2476.05,85,,1980.84,percent of total billed charges,85% of total billed charges,2476.05,85,,1980.84,percent of total billed charges,85% of total billed charges,2476.05,85,,1980.84,percent of total billed charges,85% of total billed charges,2621.7,90,,2097.36,percent of total billed charges,90% of total billed charges,2330.4,80,,1864.32,percent of total billed charges,80% of total billed charges,2621.7,90,,2097.36,percent of total billed charges,90% of total billed charges,2184.75,75,,1747.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,844.77,29,,675.816,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1951.71,67,,1561.368,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,2039.1,70,,1631.28,percent of total billed charges,70% of total billed charges,1893.45,65,,1514.76,percent of total billed charges,65% of total billed charges,1039.07,35.67,,831.256,percent of total billed charges,35.67% of total billed charges,844.77,2621.7,
LOCKING 24MM SCREW 16,27009237,CDM,278,RC,C1713,HCPCS,outpatient,,,736,294.40,,515.2,70,,412.16,percent of total billed charges,70% of total billed charges,736,100,,588.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,603.52,82,,482.816,percent of total billed charges,82% of total billed charges,625.6,85,,500.48,percent of total billed charges,85% of total billed charges,625.6,85,,500.48,percent of total billed charges,85% of total billed charges,625.6,85,,500.48,percent of total billed charges,85% of total billed charges,662.4,90,,529.92,percent of total billed charges,90% of total billed charges,588.8,80,,471.04,percent of total billed charges,80% of total billed charges,662.4,90,,529.92,percent of total billed charges,90% of total billed charges,552,75,,441.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,213.44,29,,170.752,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,493.12,67,,394.496,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,515.2,70,,412.16,percent of total billed charges,70% of total billed charges,478.4,65,,382.72,percent of total billed charges,65% of total billed charges,262.53,35.67,,210.024,percent of total billed charges,35.67% of total billed charges,213.44,736,
SCREW CORTEX 27MM 14,27009238,CDM,278,RC,C1713,HCPCS,outpatient,,,260,104.00,,182,70,,145.6,percent of total billed charges,70% of total billed charges,260,100,,208,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,213.2,82,,170.56,percent of total billed charges,82% of total billed charges,221,85,,176.8,percent of total billed charges,85% of total billed charges,221,85,,176.8,percent of total billed charges,85% of total billed charges,221,85,,176.8,percent of total billed charges,85% of total billed charges,234,90,,187.2,percent of total billed charges,90% of total billed charges,208,80,,166.4,percent of total billed charges,80% of total billed charges,234,90,,187.2,percent of total billed charges,90% of total billed charges,195,75,,156,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,75.4,29,,60.32,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,174.2,67,,139.36,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,182,70,,145.6,percent of total billed charges,70% of total billed charges,169,65,,135.2,percent of total billed charges,65% of total billed charges,92.74,35.67,,74.192,percent of total billed charges,35.67% of total billed charges,75.4,260,
SCREW CORTEX 27MM 16,27009239,CDM,278,RC,C1713,HCPCS,outpatient,,,286,114.40,,200.2,70,,160.16,percent of total billed charges,70% of total billed charges,286,100,,228.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,234.52,82,,187.616,percent of total billed charges,82% of total billed charges,243.1,85,,194.48,percent of total billed charges,85% of total billed charges,243.1,85,,194.48,percent of total billed charges,85% of total billed charges,243.1,85,,194.48,percent of total billed charges,85% of total billed charges,257.4,90,,205.92,percent of total billed charges,90% of total billed charges,228.8,80,,183.04,percent of total billed charges,80% of total billed charges,257.4,90,,205.92,percent of total billed charges,90% of total billed charges,214.5,75,,171.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,82.94,29,,66.352,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,191.62,67,,153.296,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,200.2,70,,160.16,percent of total billed charges,70% of total billed charges,185.9,65,,148.72,percent of total billed charges,65% of total billed charges,102.02,35.67,,81.616,percent of total billed charges,35.67% of total billed charges,82.94,286,
LLP BUTTRESS 1.8MM 20,27009240,CDM,278,RC,C1713,HCPCS,outpatient,,,691,276.40,,483.7,70,,386.96,percent of total billed charges,70% of total billed charges,691,100,,552.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,566.62,82,,453.296,percent of total billed charges,82% of total billed charges,587.35,85,,469.88,percent of total billed charges,85% of total billed charges,587.35,85,,469.88,percent of total billed charges,85% of total billed charges,587.35,85,,469.88,percent of total billed charges,85% of total billed charges,621.9,90,,497.52,percent of total billed charges,90% of total billed charges,552.8,80,,442.24,percent of total billed charges,80% of total billed charges,621.9,90,,497.52,percent of total billed charges,90% of total billed charges,518.25,75,,414.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,200.39,29,,160.312,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,462.97,67,,370.376,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,483.7,70,,386.96,percent of total billed charges,70% of total billed charges,449.15,65,,359.32,percent of total billed charges,65% of total billed charges,246.48,35.67,,197.184,percent of total billed charges,35.67% of total billed charges,200.39,691,
LLP BUTTRESS 1.8MM 24,27009241,CDM,278,RC,C1713,HCPCS,outpatient,,,691,276.40,,483.7,70,,386.96,percent of total billed charges,70% of total billed charges,691,100,,552.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,566.62,82,,453.296,percent of total billed charges,82% of total billed charges,587.35,85,,469.88,percent of total billed charges,85% of total billed charges,587.35,85,,469.88,percent of total billed charges,85% of total billed charges,587.35,85,,469.88,percent of total billed charges,85% of total billed charges,621.9,90,,497.52,percent of total billed charges,90% of total billed charges,552.8,80,,442.24,percent of total billed charges,80% of total billed charges,621.9,90,,497.52,percent of total billed charges,90% of total billed charges,518.25,75,,414.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,200.39,29,,160.312,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,462.97,67,,370.376,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,483.7,70,,386.96,percent of total billed charges,70% of total billed charges,449.15,65,,359.32,percent of total billed charges,65% of total billed charges,246.48,35.67,,197.184,percent of total billed charges,35.67% of total billed charges,200.39,691,
MBA SUBTALAR IMPLANT 9 MM,27009252,CDM,278,RC,C1713,HCPCS,outpatient,,,7255,2902.00,,5078.5,70,,4062.8,percent of total billed charges,70% of total billed charges,3808.88,52.5,,3047.1,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,5949.1,82,,4759.28,percent of total billed charges,82% of total billed charges,6166.75,85,,4933.4,percent of total billed charges,85% of total billed charges,6166.75,85,,4933.4,percent of total billed charges,85% of total billed charges,6166.75,85,,4933.4,percent of total billed charges,85% of total billed charges,6529.5,90,,5223.6,percent of total billed charges,90% of total billed charges,5804,80,,4643.2,percent of total billed charges,80% of total billed charges,6529.5,90,,5223.6,percent of total billed charges,90% of total billed charges,5441.25,75,,4353,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2103.95,29,,1683.16,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4860.85,67,,3888.68,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,5078.5,70,,4062.8,percent of total billed charges,70% of total billed charges,4715.75,65,,3772.6,percent of total billed charges,65% of total billed charges,2587.86,35.67,,2070.288,percent of total billed charges,35.67% of total billed charges,2103.95,6529.5,
LCP PLATE 2.0MM 4 HOLES,27009298,CDM,278,RC,C1713,HCPCS,outpatient,,,1188,475.20,,831.6,70,,665.28,percent of total billed charges,70% of total billed charges,623.7,52.5,,498.96,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,974.16,82,,779.328,percent of total billed charges,82% of total billed charges,1009.8,85,,807.84,percent of total billed charges,85% of total billed charges,1009.8,85,,807.84,percent of total billed charges,85% of total billed charges,1009.8,85,,807.84,percent of total billed charges,85% of total billed charges,1069.2,90,,855.36,percent of total billed charges,90% of total billed charges,950.4,80,,760.32,percent of total billed charges,80% of total billed charges,1069.2,90,,855.36,percent of total billed charges,90% of total billed charges,891,75,,712.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,344.52,29,,275.616,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,795.96,67,,636.768,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,831.6,70,,665.28,percent of total billed charges,70% of total billed charges,772.2,65,,617.76,percent of total billed charges,65% of total billed charges,423.76,35.67,,339.008,percent of total billed charges,35.67% of total billed charges,344.52,1069.2,
S TAP SCREW 2.0 LOCKING 9MM,27009299,CDM,278,RC,C1713,HCPCS,outpatient,,,685,274.00,,479.5,70,,383.6,percent of total billed charges,70% of total billed charges,685,100,,548,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,561.7,82,,449.36,percent of total billed charges,82% of total billed charges,582.25,85,,465.8,percent of total billed charges,85% of total billed charges,582.25,85,,465.8,percent of total billed charges,85% of total billed charges,582.25,85,,465.8,percent of total billed charges,85% of total billed charges,616.5,90,,493.2,percent of total billed charges,90% of total billed charges,548,80,,438.4,percent of total billed charges,80% of total billed charges,616.5,90,,493.2,percent of total billed charges,90% of total billed charges,513.75,75,,411,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,198.65,29,,158.92,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,458.95,67,,367.16,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,479.5,70,,383.6,percent of total billed charges,70% of total billed charges,445.25,65,,356.2,percent of total billed charges,65% of total billed charges,244.34,35.67,,195.472,percent of total billed charges,35.67% of total billed charges,198.65,685,
S TAP SCREW 2.0MM LOCKING 10MM,27009300,CDM,278,RC,C1713,HCPCS,outpatient,,,685,274.00,,479.5,70,,383.6,percent of total billed charges,70% of total billed charges,685,100,,548,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,561.7,82,,449.36,percent of total billed charges,82% of total billed charges,582.25,85,,465.8,percent of total billed charges,85% of total billed charges,582.25,85,,465.8,percent of total billed charges,85% of total billed charges,582.25,85,,465.8,percent of total billed charges,85% of total billed charges,616.5,90,,493.2,percent of total billed charges,90% of total billed charges,548,80,,438.4,percent of total billed charges,80% of total billed charges,616.5,90,,493.2,percent of total billed charges,90% of total billed charges,513.75,75,,411,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,198.65,29,,158.92,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,458.95,67,,367.16,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,479.5,70,,383.6,percent of total billed charges,70% of total billed charges,445.25,65,,356.2,percent of total billed charges,65% of total billed charges,244.34,35.67,,195.472,percent of total billed charges,35.67% of total billed charges,198.65,685,
S TAP 2.0MM SCREW LOCKING 11MM,27009301,CDM,278,RC,C1713,HCPCS,outpatient,,,685,274.00,,479.5,70,,383.6,percent of total billed charges,70% of total billed charges,685,100,,548,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,561.7,82,,449.36,percent of total billed charges,82% of total billed charges,582.25,85,,465.8,percent of total billed charges,85% of total billed charges,582.25,85,,465.8,percent of total billed charges,85% of total billed charges,582.25,85,,465.8,percent of total billed charges,85% of total billed charges,616.5,90,,493.2,percent of total billed charges,90% of total billed charges,548,80,,438.4,percent of total billed charges,80% of total billed charges,616.5,90,,493.2,percent of total billed charges,90% of total billed charges,513.75,75,,411,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,198.65,29,,158.92,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,458.95,67,,367.16,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,479.5,70,,383.6,percent of total billed charges,70% of total billed charges,445.25,65,,356.2,percent of total billed charges,65% of total billed charges,244.34,35.67,,195.472,percent of total billed charges,35.67% of total billed charges,198.65,685,
S TAP SCREW 2.0MM LOCKING 12MM,27009302,CDM,278,RC,C1713,HCPCS,outpatient,,,685,274.00,,479.5,70,,383.6,percent of total billed charges,70% of total billed charges,685,100,,548,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,561.7,82,,449.36,percent of total billed charges,82% of total billed charges,582.25,85,,465.8,percent of total billed charges,85% of total billed charges,582.25,85,,465.8,percent of total billed charges,85% of total billed charges,582.25,85,,465.8,percent of total billed charges,85% of total billed charges,616.5,90,,493.2,percent of total billed charges,90% of total billed charges,548,80,,438.4,percent of total billed charges,80% of total billed charges,616.5,90,,493.2,percent of total billed charges,90% of total billed charges,513.75,75,,411,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,198.65,29,,158.92,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,458.95,67,,367.16,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,479.5,70,,383.6,percent of total billed charges,70% of total billed charges,445.25,65,,356.2,percent of total billed charges,65% of total billed charges,244.34,35.67,,195.472,percent of total billed charges,35.67% of total billed charges,198.65,685,
CORTEX SCREW 2.OMM S TAP 9MM,27009303,CDM,278,RC,C1713,HCPCS,outpatient,,,259,103.60,,181.3,70,,145.04,percent of total billed charges,70% of total billed charges,259,100,,207.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,212.38,82,,169.904,percent of total billed charges,82% of total billed charges,220.15,85,,176.12,percent of total billed charges,85% of total billed charges,220.15,85,,176.12,percent of total billed charges,85% of total billed charges,220.15,85,,176.12,percent of total billed charges,85% of total billed charges,233.1,90,,186.48,percent of total billed charges,90% of total billed charges,207.2,80,,165.76,percent of total billed charges,80% of total billed charges,233.1,90,,186.48,percent of total billed charges,90% of total billed charges,194.25,75,,155.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,75.11,29,,60.088,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,173.53,67,,138.824,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,181.3,70,,145.04,percent of total billed charges,70% of total billed charges,168.35,65,,134.68,percent of total billed charges,65% of total billed charges,92.39,35.67,,73.912,percent of total billed charges,35.67% of total billed charges,75.11,259,
CORTEX SCREW 2.0MM S TAP 10MM,27009304,CDM,278,RC,C1713,HCPCS,outpatient,,,308,123.20,,215.6,70,,172.48,percent of total billed charges,70% of total billed charges,308,100,,246.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,252.56,82,,202.048,percent of total billed charges,82% of total billed charges,261.8,85,,209.44,percent of total billed charges,85% of total billed charges,261.8,85,,209.44,percent of total billed charges,85% of total billed charges,261.8,85,,209.44,percent of total billed charges,85% of total billed charges,277.2,90,,221.76,percent of total billed charges,90% of total billed charges,246.4,80,,197.12,percent of total billed charges,80% of total billed charges,277.2,90,,221.76,percent of total billed charges,90% of total billed charges,231,75,,184.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,89.32,29,,71.456,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,206.36,67,,165.088,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,215.6,70,,172.48,percent of total billed charges,70% of total billed charges,200.2,65,,160.16,percent of total billed charges,65% of total billed charges,109.86,35.67,,87.888,percent of total billed charges,35.67% of total billed charges,89.32,308,
L SCREW 24 MM S TAP 10MM,27009305,CDM,278,RC,C1713,HCPCS,outpatient,,,691,276.40,,483.7,70,,386.96,percent of total billed charges,70% of total billed charges,691,100,,552.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,566.62,82,,453.296,percent of total billed charges,82% of total billed charges,587.35,85,,469.88,percent of total billed charges,85% of total billed charges,587.35,85,,469.88,percent of total billed charges,85% of total billed charges,587.35,85,,469.88,percent of total billed charges,85% of total billed charges,621.9,90,,497.52,percent of total billed charges,90% of total billed charges,552.8,80,,442.24,percent of total billed charges,80% of total billed charges,621.9,90,,497.52,percent of total billed charges,90% of total billed charges,518.25,75,,414.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,200.39,29,,160.312,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,462.97,67,,370.376,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,483.7,70,,386.96,percent of total billed charges,70% of total billed charges,449.15,65,,359.32,percent of total billed charges,65% of total billed charges,246.48,35.67,,197.184,percent of total billed charges,35.67% of total billed charges,200.39,691,
CORTEX SCREW 24MM S TAP 9MM,27009306,CDM,278,RC,C1713,HCPCS,outpatient,,,327,130.80,,228.9,70,,183.12,percent of total billed charges,70% of total billed charges,327,100,,261.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,268.14,82,,214.512,percent of total billed charges,82% of total billed charges,277.95,85,,222.36,percent of total billed charges,85% of total billed charges,277.95,85,,222.36,percent of total billed charges,85% of total billed charges,277.95,85,,222.36,percent of total billed charges,85% of total billed charges,294.3,90,,235.44,percent of total billed charges,90% of total billed charges,261.6,80,,209.28,percent of total billed charges,80% of total billed charges,294.3,90,,235.44,percent of total billed charges,90% of total billed charges,245.25,75,,196.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,94.83,29,,75.864,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,219.09,67,,175.272,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,228.9,70,,183.12,percent of total billed charges,70% of total billed charges,212.55,65,,170.04,percent of total billed charges,65% of total billed charges,116.64,35.67,,93.312,percent of total billed charges,35.67% of total billed charges,94.83,327,
CORTEX SCREW 24 MM S TAP 12 MM,27009307,CDM,278,RC,C1713,HCPCS,outpatient,,,327,130.80,,228.9,70,,183.12,percent of total billed charges,70% of total billed charges,327,100,,261.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,268.14,82,,214.512,percent of total billed charges,82% of total billed charges,277.95,85,,222.36,percent of total billed charges,85% of total billed charges,277.95,85,,222.36,percent of total billed charges,85% of total billed charges,277.95,85,,222.36,percent of total billed charges,85% of total billed charges,294.3,90,,235.44,percent of total billed charges,90% of total billed charges,261.6,80,,209.28,percent of total billed charges,80% of total billed charges,294.3,90,,235.44,percent of total billed charges,90% of total billed charges,245.25,75,,196.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,94.83,29,,75.864,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,219.09,67,,175.272,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,228.9,70,,183.12,percent of total billed charges,70% of total billed charges,212.55,65,,170.04,percent of total billed charges,65% of total billed charges,116.64,35.67,,93.312,percent of total billed charges,35.67% of total billed charges,94.83,327,
PORCEED SURGICAL MESH 4X6,27009320,CDM,278,RC,C1781,HCPCS,outpatient,,,2160,864.00,,1512,70,,1209.6,percent of total billed charges,70% of total billed charges,1134,52.5,,907.2,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,1771.2,82,,1416.96,percent of total billed charges,82% of total billed charges,1836,85,,1468.8,percent of total billed charges,85% of total billed charges,1836,85,,1468.8,percent of total billed charges,85% of total billed charges,1836,85,,1468.8,percent of total billed charges,85% of total billed charges,1944,90,,1555.2,percent of total billed charges,90% of total billed charges,1728,80,,1382.4,percent of total billed charges,80% of total billed charges,1944,90,,1555.2,percent of total billed charges,90% of total billed charges,1620,75,,1296,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,626.4,29,,501.12,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1447.2,67,,1157.76,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1512,70,,1209.6,percent of total billed charges,70% of total billed charges,1404,65,,1123.2,percent of total billed charges,65% of total billed charges,770.47,35.67,,616.376,percent of total billed charges,35.67% of total billed charges,626.4,1944,
OMNIFIT HEX STEM #6 132 DEGREE,27009322,CDM,278,RC,C1776,HCPCS,outpatient,,,7199,2879.60,,5039.3,70,,4031.44,percent of total billed charges,70% of total billed charges,3779.48,52.5,,3023.58,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,5903.18,82,,4722.544,percent of total billed charges,82% of total billed charges,6119.15,85,,4895.32,percent of total billed charges,85% of total billed charges,6119.15,85,,4895.32,percent of total billed charges,85% of total billed charges,6119.15,85,,4895.32,percent of total billed charges,85% of total billed charges,6479.1,90,,5183.28,percent of total billed charges,90% of total billed charges,5759.2,80,,4607.36,percent of total billed charges,80% of total billed charges,6479.1,90,,5183.28,percent of total billed charges,90% of total billed charges,5399.25,75,,4319.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2087.71,29,,1670.168,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4823.33,67,,3858.664,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,5039.3,70,,4031.44,percent of total billed charges,70% of total billed charges,4679.35,65,,3743.48,percent of total billed charges,65% of total billed charges,2567.88,35.67,,2054.304,percent of total billed charges,35.67% of total billed charges,2087.71,6479.1,
C-TAPER SLEEV 0+ MM,27009323,CDM,278,RC,C1713,HCPCS,outpatient,,,1084,433.60,,758.8,70,,607.04,percent of total billed charges,70% of total billed charges,569.1,52.5,,455.28,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,888.88,82,,711.104,percent of total billed charges,82% of total billed charges,921.4,85,,737.12,percent of total billed charges,85% of total billed charges,921.4,85,,737.12,percent of total billed charges,85% of total billed charges,921.4,85,,737.12,percent of total billed charges,85% of total billed charges,975.6,90,,780.48,percent of total billed charges,90% of total billed charges,867.2,80,,693.76,percent of total billed charges,80% of total billed charges,975.6,90,,780.48,percent of total billed charges,90% of total billed charges,813,75,,650.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,314.36,29,,251.488,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,726.28,67,,581.024,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,758.8,70,,607.04,percent of total billed charges,70% of total billed charges,704.6,65,,563.68,percent of total billed charges,65% of total billed charges,386.66,35.67,,309.328,percent of total billed charges,35.67% of total billed charges,314.36,975.6,
UNITRAC HEAD 44MM,27009324,CDM,278,RC,C1776,HCPCS,outpatient,,,1951,780.40,,1365.7,70,,1092.56,percent of total billed charges,70% of total billed charges,1024.28,52.5,,819.42,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,1599.82,82,,1279.856,percent of total billed charges,82% of total billed charges,1658.35,85,,1326.68,percent of total billed charges,85% of total billed charges,1658.35,85,,1326.68,percent of total billed charges,85% of total billed charges,1658.35,85,,1326.68,percent of total billed charges,85% of total billed charges,1755.9,90,,1404.72,percent of total billed charges,90% of total billed charges,1560.8,80,,1248.64,percent of total billed charges,80% of total billed charges,1755.9,90,,1404.72,percent of total billed charges,90% of total billed charges,1463.25,75,,1170.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,565.79,29,,452.632,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1307.17,67,,1045.736,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1365.7,70,,1092.56,percent of total billed charges,70% of total billed charges,1268.15,65,,1014.52,percent of total billed charges,65% of total billed charges,695.92,35.67,,556.736,percent of total billed charges,35.67% of total billed charges,565.79,1755.9,
TRINITY EVOLUTION 1 CC,27009326,CDM,278,RC,C1713,HCPCS,outpatient,,,1814,725.60,,1269.8,70,,1015.84,percent of total billed charges,70% of total billed charges,952.35,52.5,,761.88,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,1487.48,82,,1189.984,percent of total billed charges,82% of total billed charges,1541.9,85,,1233.52,percent of total billed charges,85% of total billed charges,1541.9,85,,1233.52,percent of total billed charges,85% of total billed charges,1541.9,85,,1233.52,percent of total billed charges,85% of total billed charges,1632.6,90,,1306.08,percent of total billed charges,90% of total billed charges,1451.2,80,,1160.96,percent of total billed charges,80% of total billed charges,1632.6,90,,1306.08,percent of total billed charges,90% of total billed charges,1360.5,75,,1088.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,526.06,29,,420.848,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1215.38,67,,972.304,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1269.8,70,,1015.84,percent of total billed charges,70% of total billed charges,1179.1,65,,943.28,percent of total billed charges,65% of total billed charges,647.05,35.67,,517.64,percent of total billed charges,35.67% of total billed charges,526.06,1632.6,
LOCKING SCREW 24 MM,27009328,CDM,278,RC,C1713,HCPCS,outpatient,,,736,294.40,,515.2,70,,412.16,percent of total billed charges,70% of total billed charges,736,100,,588.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,603.52,82,,482.816,percent of total billed charges,82% of total billed charges,625.6,85,,500.48,percent of total billed charges,85% of total billed charges,625.6,85,,500.48,percent of total billed charges,85% of total billed charges,625.6,85,,500.48,percent of total billed charges,85% of total billed charges,662.4,90,,529.92,percent of total billed charges,90% of total billed charges,588.8,80,,471.04,percent of total billed charges,80% of total billed charges,662.4,90,,529.92,percent of total billed charges,90% of total billed charges,552,75,,441.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,213.44,29,,170.752,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,493.12,67,,394.496,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,515.2,70,,412.16,percent of total billed charges,70% of total billed charges,478.4,65,,382.72,percent of total billed charges,65% of total billed charges,262.53,35.67,,210.024,percent of total billed charges,35.67% of total billed charges,213.44,736,
CORTEX SCREW 17 MM 46,27009329,CDM,278,RC,C1713,HCPCS,outpatient,,,286,114.40,,200.2,70,,160.16,percent of total billed charges,70% of total billed charges,286,100,,228.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,234.52,82,,187.616,percent of total billed charges,82% of total billed charges,243.1,85,,194.48,percent of total billed charges,85% of total billed charges,243.1,85,,194.48,percent of total billed charges,85% of total billed charges,243.1,85,,194.48,percent of total billed charges,85% of total billed charges,257.4,90,,205.92,percent of total billed charges,90% of total billed charges,228.8,80,,183.04,percent of total billed charges,80% of total billed charges,257.4,90,,205.92,percent of total billed charges,90% of total billed charges,214.5,75,,171.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,82.94,29,,66.352,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,191.62,67,,153.296,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,200.2,70,,160.16,percent of total billed charges,70% of total billed charges,185.9,65,,148.72,percent of total billed charges,65% of total billed charges,102.02,35.67,,81.616,percent of total billed charges,35.67% of total billed charges,82.94,286,
TRINITY BONE MATRIX,27009330,CDM,278,RC,C1713,HCPCS,outpatient,,,1746,698.40,,1222.2,70,,977.76,percent of total billed charges,70% of total billed charges,916.65,52.5,,733.32,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,1431.72,82,,1145.376,percent of total billed charges,82% of total billed charges,1484.1,85,,1187.28,percent of total billed charges,85% of total billed charges,1484.1,85,,1187.28,percent of total billed charges,85% of total billed charges,1484.1,85,,1187.28,percent of total billed charges,85% of total billed charges,1571.4,90,,1257.12,percent of total billed charges,90% of total billed charges,1396.8,80,,1117.44,percent of total billed charges,80% of total billed charges,1571.4,90,,1257.12,percent of total billed charges,90% of total billed charges,1309.5,75,,1047.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,506.34,29,,405.072,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1169.82,67,,935.856,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1222.2,70,,977.76,percent of total billed charges,70% of total billed charges,1134.9,65,,907.92,percent of total billed charges,65% of total billed charges,622.8,35.67,,498.24,percent of total billed charges,35.67% of total billed charges,506.34,1571.4,
2.7MM CORTEX SCREW 34 MM,27009350,CDM,278,RC,C1713,HCPCS,outpatient,,,286,114.40,,200.2,70,,160.16,percent of total billed charges,70% of total billed charges,286,100,,228.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,234.52,82,,187.616,percent of total billed charges,82% of total billed charges,243.1,85,,194.48,percent of total billed charges,85% of total billed charges,243.1,85,,194.48,percent of total billed charges,85% of total billed charges,243.1,85,,194.48,percent of total billed charges,85% of total billed charges,257.4,90,,205.92,percent of total billed charges,90% of total billed charges,228.8,80,,183.04,percent of total billed charges,80% of total billed charges,257.4,90,,205.92,percent of total billed charges,90% of total billed charges,214.5,75,,171.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,82.94,29,,66.352,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,191.62,67,,153.296,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,200.2,70,,160.16,percent of total billed charges,70% of total billed charges,185.9,65,,148.72,percent of total billed charges,65% of total billed charges,102.02,35.67,,81.616,percent of total billed charges,35.67% of total billed charges,82.94,286,
HELIX BARREL BUR LEFT 5.5MM GF,27009355,CDM,278,RC,C1713,HCPCS,outpatient,,,523,209.20,,366.1,70,,292.88,percent of total billed charges,70% of total billed charges,523,100,,418.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,428.86,82,,343.088,percent of total billed charges,82% of total billed charges,444.55,85,,355.64,percent of total billed charges,85% of total billed charges,444.55,85,,355.64,percent of total billed charges,85% of total billed charges,444.55,85,,355.64,percent of total billed charges,85% of total billed charges,470.7,90,,376.56,percent of total billed charges,90% of total billed charges,418.4,80,,334.72,percent of total billed charges,80% of total billed charges,470.7,90,,376.56,percent of total billed charges,90% of total billed charges,392.25,75,,313.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,151.67,29,,121.336,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,350.41,67,,280.328,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,366.1,70,,292.88,percent of total billed charges,70% of total billed charges,339.95,65,,271.96,percent of total billed charges,65% of total billed charges,186.55,35.67,,149.24,percent of total billed charges,35.67% of total billed charges,151.67,523,
INTRAFIX TAPERED SCREW 8-10,27009357,CDM,278,RC,C1713,HCPCS,outpatient,,,2069,827.60,,1448.3,70,,1158.64,percent of total billed charges,70% of total billed charges,1086.23,52.5,,868.98,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,1696.58,82,,1357.264,percent of total billed charges,82% of total billed charges,1758.65,85,,1406.92,percent of total billed charges,85% of total billed charges,1758.65,85,,1406.92,percent of total billed charges,85% of total billed charges,1758.65,85,,1406.92,percent of total billed charges,85% of total billed charges,1862.1,90,,1489.68,percent of total billed charges,90% of total billed charges,1655.2,80,,1324.16,percent of total billed charges,80% of total billed charges,1862.1,90,,1489.68,percent of total billed charges,90% of total billed charges,1551.75,75,,1241.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,600.01,29,,480.008,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1386.23,67,,1108.984,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1448.3,70,,1158.64,percent of total billed charges,70% of total billed charges,1344.85,65,,1075.88,percent of total billed charges,65% of total billed charges,738.01,35.67,,590.408,percent of total billed charges,35.67% of total billed charges,600.01,1862.1,
LG BIO INTRAFIX TIBIAL SHEATH,27009358,CDM,278,RC,C1713,HCPCS,outpatient,,,1319,527.60,,923.3,70,,738.64,percent of total billed charges,70% of total billed charges,692.48,52.5,,553.98,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,1081.58,82,,865.264,percent of total billed charges,82% of total billed charges,1121.15,85,,896.92,percent of total billed charges,85% of total billed charges,1121.15,85,,896.92,percent of total billed charges,85% of total billed charges,1121.15,85,,896.92,percent of total billed charges,85% of total billed charges,1187.1,90,,949.68,percent of total billed charges,90% of total billed charges,1055.2,80,,844.16,percent of total billed charges,80% of total billed charges,1187.1,90,,949.68,percent of total billed charges,90% of total billed charges,989.25,75,,791.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,382.51,29,,306.008,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,883.73,67,,706.984,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,923.3,70,,738.64,percent of total billed charges,70% of total billed charges,857.35,65,,685.88,percent of total billed charges,65% of total billed charges,470.49,35.67,,376.392,percent of total billed charges,35.67% of total billed charges,382.51,1187.1,
BIO-TRANSIEX 5MM X 50MM,27009361,CDM,278,RC,C1713,HCPCS,outpatient,,,2773,1109.20,,1941.1,70,,1552.88,percent of total billed charges,70% of total billed charges,1455.83,52.5,,1164.66,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,2273.86,82,,1819.088,percent of total billed charges,82% of total billed charges,2357.05,85,,1885.64,percent of total billed charges,85% of total billed charges,2357.05,85,,1885.64,percent of total billed charges,85% of total billed charges,2357.05,85,,1885.64,percent of total billed charges,85% of total billed charges,2495.7,90,,1996.56,percent of total billed charges,90% of total billed charges,2218.4,80,,1774.72,percent of total billed charges,80% of total billed charges,2495.7,90,,1996.56,percent of total billed charges,90% of total billed charges,2079.75,75,,1663.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,804.17,29,,643.336,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1857.91,67,,1486.328,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1941.1,70,,1552.88,percent of total billed charges,70% of total billed charges,1802.45,65,,1441.96,percent of total billed charges,65% of total billed charges,989.13,35.67,,791.304,percent of total billed charges,35.67% of total billed charges,804.17,2495.7,
OMINIFIT HIP STEM 35MM SZ 10,27009382,CDM,278,RC,C1776,HCPCS,outpatient,,,7199,2879.60,,5039.3,70,,4031.44,percent of total billed charges,70% of total billed charges,3779.48,52.5,,3023.58,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,5903.18,82,,4722.544,percent of total billed charges,82% of total billed charges,6119.15,85,,4895.32,percent of total billed charges,85% of total billed charges,6119.15,85,,4895.32,percent of total billed charges,85% of total billed charges,6119.15,85,,4895.32,percent of total billed charges,85% of total billed charges,6479.1,90,,5183.28,percent of total billed charges,90% of total billed charges,5759.2,80,,4607.36,percent of total billed charges,80% of total billed charges,6479.1,90,,5183.28,percent of total billed charges,90% of total billed charges,5399.25,75,,4319.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2087.71,29,,1670.168,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4823.33,67,,3858.664,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,5039.3,70,,4031.44,percent of total billed charges,70% of total billed charges,4679.35,65,,3743.48,percent of total billed charges,65% of total billed charges,2567.88,35.67,,2054.304,percent of total billed charges,35.67% of total billed charges,2087.71,6479.1,
ENDOPROTHESOS HD COMP 55MM,27009383,CDM,278,RC,C1776,HCPCS,outpatient,,,1951,780.40,,1365.7,70,,1092.56,percent of total billed charges,70% of total billed charges,1024.28,52.5,,819.42,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,1599.82,82,,1279.856,percent of total billed charges,82% of total billed charges,1658.35,85,,1326.68,percent of total billed charges,85% of total billed charges,1658.35,85,,1326.68,percent of total billed charges,85% of total billed charges,1658.35,85,,1326.68,percent of total billed charges,85% of total billed charges,1755.9,90,,1404.72,percent of total billed charges,90% of total billed charges,1560.8,80,,1248.64,percent of total billed charges,80% of total billed charges,1755.9,90,,1404.72,percent of total billed charges,90% of total billed charges,1463.25,75,,1170.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,565.79,29,,452.632,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1307.17,67,,1045.736,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1365.7,70,,1092.56,percent of total billed charges,70% of total billed charges,1268.15,65,,1014.52,percent of total billed charges,65% of total billed charges,695.92,35.67,,556.736,percent of total billed charges,35.67% of total billed charges,565.79,1755.9,
SUBTALAR MBA IMPLANT 9MM,27009393,CDM,278,RC,C1776,HCPCS,outpatient,,,6104,2441.60,,4272.8,70,,3418.24,percent of total billed charges,70% of total billed charges,3204.6,52.5,,2563.68,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,5005.28,82,,4004.224,percent of total billed charges,82% of total billed charges,5188.4,85,,4150.72,percent of total billed charges,85% of total billed charges,5188.4,85,,4150.72,percent of total billed charges,85% of total billed charges,5188.4,85,,4150.72,percent of total billed charges,85% of total billed charges,5493.6,90,,4394.88,percent of total billed charges,90% of total billed charges,4883.2,80,,3906.56,percent of total billed charges,80% of total billed charges,5493.6,90,,4394.88,percent of total billed charges,90% of total billed charges,4578,75,,3662.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,1770.16,29,,1416.128,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4089.68,67,,3271.744,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,4272.8,70,,3418.24,percent of total billed charges,70% of total billed charges,3967.6,65,,3174.08,percent of total billed charges,65% of total billed charges,2177.3,35.67,,1741.84,percent of total billed charges,35.67% of total billed charges,1770.16,5493.6,
SUBTALAR MBA IMPLANT 10MM,27009394,CDM,278,RC,C1776,HCPCS,outpatient,,,6104,2441.60,,4272.8,70,,3418.24,percent of total billed charges,70% of total billed charges,3204.6,52.5,,2563.68,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,5005.28,82,,4004.224,percent of total billed charges,82% of total billed charges,5188.4,85,,4150.72,percent of total billed charges,85% of total billed charges,5188.4,85,,4150.72,percent of total billed charges,85% of total billed charges,5188.4,85,,4150.72,percent of total billed charges,85% of total billed charges,5493.6,90,,4394.88,percent of total billed charges,90% of total billed charges,4883.2,80,,3906.56,percent of total billed charges,80% of total billed charges,5493.6,90,,4394.88,percent of total billed charges,90% of total billed charges,4578,75,,3662.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,1770.16,29,,1416.128,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4089.68,67,,3271.744,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,4272.8,70,,3418.24,percent of total billed charges,70% of total billed charges,3967.6,65,,3174.08,percent of total billed charges,65% of total billed charges,2177.3,35.67,,1741.84,percent of total billed charges,35.67% of total billed charges,1770.16,5493.6,
BONE CEMENT WITH GENTAMICIN,27009424,CDM,278,RC,C1713,HCPCS,outpatient,,,2050,820.00,,1435,70,,1148,percent of total billed charges,70% of total billed charges,1076.25,52.5,,861,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,1681,82,,1344.8,percent of total billed charges,82% of total billed charges,1742.5,85,,1394,percent of total billed charges,85% of total billed charges,1742.5,85,,1394,percent of total billed charges,85% of total billed charges,1742.5,85,,1394,percent of total billed charges,85% of total billed charges,1845,90,,1476,percent of total billed charges,90% of total billed charges,1640,80,,1312,percent of total billed charges,80% of total billed charges,1845,90,,1476,percent of total billed charges,90% of total billed charges,1537.5,75,,1230,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,594.5,29,,475.6,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1373.5,67,,1098.8,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1435,70,,1148,percent of total billed charges,70% of total billed charges,1332.5,65,,1066,percent of total billed charges,65% of total billed charges,731.24,35.67,,584.992,percent of total billed charges,35.67% of total billed charges,594.5,1845,
SCREW CORTEX S TAP 32MM 2.7MM,27009426,CDM,278,RC,C1713,HCPCS,outpatient,,,325,130.00,,227.5,70,,182,percent of total billed charges,70% of total billed charges,325,100,,260,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,266.5,82,,213.2,percent of total billed charges,82% of total billed charges,276.25,85,,221,percent of total billed charges,85% of total billed charges,276.25,85,,221,percent of total billed charges,85% of total billed charges,276.25,85,,221,percent of total billed charges,85% of total billed charges,292.5,90,,234,percent of total billed charges,90% of total billed charges,260,80,,208,percent of total billed charges,80% of total billed charges,292.5,90,,234,percent of total billed charges,90% of total billed charges,243.75,75,,195,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,94.25,29,,75.4,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,217.75,67,,174.2,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,227.5,70,,182,percent of total billed charges,70% of total billed charges,211.25,65,,169,percent of total billed charges,65% of total billed charges,115.93,35.67,,92.744,percent of total billed charges,35.67% of total billed charges,94.25,325,
CORTEX SCREW TI S TAP 1.5MM,27009428,CDM,278,RC,C1713,HCPCS,outpatient,,,316,126.40,,221.2,70,,176.96,percent of total billed charges,70% of total billed charges,316,100,,252.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,259.12,82,,207.296,percent of total billed charges,82% of total billed charges,268.6,85,,214.88,percent of total billed charges,85% of total billed charges,268.6,85,,214.88,percent of total billed charges,85% of total billed charges,268.6,85,,214.88,percent of total billed charges,85% of total billed charges,284.4,90,,227.52,percent of total billed charges,90% of total billed charges,252.8,80,,202.24,percent of total billed charges,80% of total billed charges,284.4,90,,227.52,percent of total billed charges,90% of total billed charges,237,75,,189.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,91.64,29,,73.312,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,211.72,67,,169.376,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,221.2,70,,176.96,percent of total billed charges,70% of total billed charges,205.4,65,,164.32,percent of total billed charges,65% of total billed charges,112.72,35.67,,90.176,percent of total billed charges,35.67% of total billed charges,91.64,316,
CORTEX SCREW S TAP TI 2.7MM 14,27009429,CDM,278,RC,C1713,HCPCS,outpatient,,,271,108.40,,189.7,70,,151.76,percent of total billed charges,70% of total billed charges,271,100,,216.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,222.22,82,,177.776,percent of total billed charges,82% of total billed charges,230.35,85,,184.28,percent of total billed charges,85% of total billed charges,230.35,85,,184.28,percent of total billed charges,85% of total billed charges,230.35,85,,184.28,percent of total billed charges,85% of total billed charges,243.9,90,,195.12,percent of total billed charges,90% of total billed charges,216.8,80,,173.44,percent of total billed charges,80% of total billed charges,243.9,90,,195.12,percent of total billed charges,90% of total billed charges,203.25,75,,162.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,78.59,29,,62.872,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,181.57,67,,145.256,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,189.7,70,,151.76,percent of total billed charges,70% of total billed charges,176.15,65,,140.92,percent of total billed charges,65% of total billed charges,96.67,35.67,,77.336,percent of total billed charges,35.67% of total billed charges,78.59,271,
CORTEX SCREW S TAP TI 2.7MM 16,27009430,CDM,278,RC,C1713,HCPCS,outpatient,,,271,108.40,,189.7,70,,151.76,percent of total billed charges,70% of total billed charges,271,100,,216.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,222.22,82,,177.776,percent of total billed charges,82% of total billed charges,230.35,85,,184.28,percent of total billed charges,85% of total billed charges,230.35,85,,184.28,percent of total billed charges,85% of total billed charges,230.35,85,,184.28,percent of total billed charges,85% of total billed charges,243.9,90,,195.12,percent of total billed charges,90% of total billed charges,216.8,80,,173.44,percent of total billed charges,80% of total billed charges,243.9,90,,195.12,percent of total billed charges,90% of total billed charges,203.25,75,,162.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,78.59,29,,62.872,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,181.57,67,,145.256,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,189.7,70,,151.76,percent of total billed charges,70% of total billed charges,176.15,65,,140.92,percent of total billed charges,65% of total billed charges,96.67,35.67,,77.336,percent of total billed charges,35.67% of total billed charges,78.59,271,
CORTEX SCREW S TAP TI 2.7MM 24,27009431,CDM,278,RC,C1713,HCPCS,outpatient,,,271,108.40,,189.7,70,,151.76,percent of total billed charges,70% of total billed charges,271,100,,216.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,222.22,82,,177.776,percent of total billed charges,82% of total billed charges,230.35,85,,184.28,percent of total billed charges,85% of total billed charges,230.35,85,,184.28,percent of total billed charges,85% of total billed charges,230.35,85,,184.28,percent of total billed charges,85% of total billed charges,243.9,90,,195.12,percent of total billed charges,90% of total billed charges,216.8,80,,173.44,percent of total billed charges,80% of total billed charges,243.9,90,,195.12,percent of total billed charges,90% of total billed charges,203.25,75,,162.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,78.59,29,,62.872,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,181.57,67,,145.256,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,189.7,70,,151.76,percent of total billed charges,70% of total billed charges,176.15,65,,140.92,percent of total billed charges,65% of total billed charges,96.67,35.67,,77.336,percent of total billed charges,35.67% of total billed charges,78.59,271,
TI 1 PLATE 3 HLS 34MM OBLQ 2.7,27009432,CDM,278,RC,C1713,HCPCS,outpatient,,,403,161.20,,282.1,70,,225.68,percent of total billed charges,70% of total billed charges,403,100,,322.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,330.46,82,,264.368,percent of total billed charges,82% of total billed charges,342.55,85,,274.04,percent of total billed charges,85% of total billed charges,342.55,85,,274.04,percent of total billed charges,85% of total billed charges,342.55,85,,274.04,percent of total billed charges,85% of total billed charges,362.7,90,,290.16,percent of total billed charges,90% of total billed charges,322.4,80,,257.92,percent of total billed charges,80% of total billed charges,362.7,90,,290.16,percent of total billed charges,90% of total billed charges,302.25,75,,241.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,116.87,29,,93.496,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,270.01,67,,216.008,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,282.1,70,,225.68,percent of total billed charges,70% of total billed charges,261.95,65,,209.56,percent of total billed charges,65% of total billed charges,143.75,35.67,,115,percent of total billed charges,35.67% of total billed charges,116.87,403,
2.0MM LCP 4-PLATE 3 HOLE HEAD,27009456,CDM,278,RC,C1713,HCPCS,outpatient,,,1873,749.20,,1311.1,70,,1048.88,percent of total billed charges,70% of total billed charges,983.33,52.5,,786.66,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,1535.86,82,,1228.688,percent of total billed charges,82% of total billed charges,1592.05,85,,1273.64,percent of total billed charges,85% of total billed charges,1592.05,85,,1273.64,percent of total billed charges,85% of total billed charges,1592.05,85,,1273.64,percent of total billed charges,85% of total billed charges,1685.7,90,,1348.56,percent of total billed charges,90% of total billed charges,1498.4,80,,1198.72,percent of total billed charges,80% of total billed charges,1685.7,90,,1348.56,percent of total billed charges,90% of total billed charges,1404.75,75,,1123.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,543.17,29,,434.536,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1254.91,67,,1003.928,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1311.1,70,,1048.88,percent of total billed charges,70% of total billed charges,1217.45,65,,973.96,percent of total billed charges,65% of total billed charges,668.1,35.67,,534.48,percent of total billed charges,35.67% of total billed charges,543.17,1685.7,
CORTEX SCREW 18MM 2.0,27009457,CDM,278,RC,C1713,HCPCS,outpatient,,,276,110.40,,193.2,70,,154.56,percent of total billed charges,70% of total billed charges,276,100,,220.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,226.32,82,,181.056,percent of total billed charges,82% of total billed charges,234.6,85,,187.68,percent of total billed charges,85% of total billed charges,234.6,85,,187.68,percent of total billed charges,85% of total billed charges,234.6,85,,187.68,percent of total billed charges,85% of total billed charges,248.4,90,,198.72,percent of total billed charges,90% of total billed charges,220.8,80,,176.64,percent of total billed charges,80% of total billed charges,248.4,90,,198.72,percent of total billed charges,90% of total billed charges,207,75,,165.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,80.04,29,,64.032,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,184.92,67,,147.936,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,193.2,70,,154.56,percent of total billed charges,70% of total billed charges,179.4,65,,143.52,percent of total billed charges,65% of total billed charges,98.45,35.67,,78.76,percent of total billed charges,35.67% of total billed charges,80.04,276,
CORTEX SCREW 30MM 2.4MM,27009458,CDM,278,RC,C1713,HCPCS,outpatient,,,350,140.00,,245,70,,196,percent of total billed charges,70% of total billed charges,350,100,,280,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,287,82,,229.6,percent of total billed charges,82% of total billed charges,297.5,85,,238,percent of total billed charges,85% of total billed charges,297.5,85,,238,percent of total billed charges,85% of total billed charges,297.5,85,,238,percent of total billed charges,85% of total billed charges,315,90,,252,percent of total billed charges,90% of total billed charges,280,80,,224,percent of total billed charges,80% of total billed charges,315,90,,252,percent of total billed charges,90% of total billed charges,262.5,75,,210,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,101.5,29,,81.2,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,234.5,67,,187.6,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,245,70,,196,percent of total billed charges,70% of total billed charges,227.5,65,,182,percent of total billed charges,65% of total billed charges,124.85,35.67,,99.88,percent of total billed charges,35.67% of total billed charges,101.5,350,
CORTEX SCREW 34MM 2.4 MM,27009459,CDM,278,RC,C1713,HCPCS,outpatient,,,350,140.00,,245,70,,196,percent of total billed charges,70% of total billed charges,350,100,,280,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,287,82,,229.6,percent of total billed charges,82% of total billed charges,297.5,85,,238,percent of total billed charges,85% of total billed charges,297.5,85,,238,percent of total billed charges,85% of total billed charges,297.5,85,,238,percent of total billed charges,85% of total billed charges,315,90,,252,percent of total billed charges,90% of total billed charges,280,80,,224,percent of total billed charges,80% of total billed charges,315,90,,252,percent of total billed charges,90% of total billed charges,262.5,75,,210,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,101.5,29,,81.2,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,234.5,67,,187.6,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,245,70,,196,percent of total billed charges,70% of total billed charges,227.5,65,,182,percent of total billed charges,65% of total billed charges,124.85,35.67,,99.88,percent of total billed charges,35.67% of total billed charges,101.5,350,
CORTEX SCREW 2.7MM 36MM,27009460,CDM,278,RC,C1713,HCPCS,outpatient,,,300,120.00,,210,70,,168,percent of total billed charges,70% of total billed charges,300,100,,240,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,246,82,,196.8,percent of total billed charges,82% of total billed charges,255,85,,204,percent of total billed charges,85% of total billed charges,255,85,,204,percent of total billed charges,85% of total billed charges,255,85,,204,percent of total billed charges,85% of total billed charges,270,90,,216,percent of total billed charges,90% of total billed charges,240,80,,192,percent of total billed charges,80% of total billed charges,270,90,,216,percent of total billed charges,90% of total billed charges,225,75,,180,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,87,29,,69.6,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,201,67,,160.8,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,210,70,,168,percent of total billed charges,70% of total billed charges,195,65,,156,percent of total billed charges,65% of total billed charges,107.01,35.67,,85.608,percent of total billed charges,35.67% of total billed charges,87,300,
CORTEX SCREW 2.7 38MM,27009461,CDM,278,RC,C1713,HCPCS,outpatient,,,325,130.00,,227.5,70,,182,percent of total billed charges,70% of total billed charges,325,100,,260,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,266.5,82,,213.2,percent of total billed charges,82% of total billed charges,276.25,85,,221,percent of total billed charges,85% of total billed charges,276.25,85,,221,percent of total billed charges,85% of total billed charges,276.25,85,,221,percent of total billed charges,85% of total billed charges,292.5,90,,234,percent of total billed charges,90% of total billed charges,260,80,,208,percent of total billed charges,80% of total billed charges,292.5,90,,234,percent of total billed charges,90% of total billed charges,243.75,75,,195,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,94.25,29,,75.4,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,217.75,67,,174.2,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,227.5,70,,182,percent of total billed charges,70% of total billed charges,211.25,65,,169,percent of total billed charges,65% of total billed charges,115.93,35.67,,92.744,percent of total billed charges,35.67% of total billed charges,94.25,325,
BIOCOMPOSITE PUSHLOCK 3.5X19.5,27009480,CDM,278,RC,C1713,HCPCS,outpatient,,,1825,730.00,,1277.5,70,,1022,percent of total billed charges,70% of total billed charges,958.13,52.5,,766.5,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,1496.5,82,,1197.2,percent of total billed charges,82% of total billed charges,1551.25,85,,1241,percent of total billed charges,85% of total billed charges,1551.25,85,,1241,percent of total billed charges,85% of total billed charges,1551.25,85,,1241,percent of total billed charges,85% of total billed charges,1642.5,90,,1314,percent of total billed charges,90% of total billed charges,1460,80,,1168,percent of total billed charges,80% of total billed charges,1642.5,90,,1314,percent of total billed charges,90% of total billed charges,1368.75,75,,1095,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,529.25,29,,423.4,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1222.75,67,,978.2,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1277.5,70,,1022,percent of total billed charges,70% of total billed charges,1186.25,65,,949,percent of total billed charges,65% of total billed charges,650.98,35.67,,520.784,percent of total billed charges,35.67% of total billed charges,529.25,1642.5,
SUTURELASO 45DEGREE CURVE LEFT,27009481,CDM,278,RC,C1713,HCPCS,outpatient,,,897,358.80,,627.9,70,,502.32,percent of total billed charges,70% of total billed charges,897,100,,717.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,735.54,82,,588.432,percent of total billed charges,82% of total billed charges,762.45,85,,609.96,percent of total billed charges,85% of total billed charges,762.45,85,,609.96,percent of total billed charges,85% of total billed charges,762.45,85,,609.96,percent of total billed charges,85% of total billed charges,807.3,90,,645.84,percent of total billed charges,90% of total billed charges,717.6,80,,574.08,percent of total billed charges,80% of total billed charges,807.3,90,,645.84,percent of total billed charges,90% of total billed charges,672.75,75,,538.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,260.13,29,,208.104,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,600.99,67,,480.792,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,627.9,70,,502.32,percent of total billed charges,70% of total billed charges,583.05,65,,466.44,percent of total billed charges,65% of total billed charges,319.96,35.67,,255.968,percent of total billed charges,35.67% of total billed charges,260.13,897,
FUSION PLATE 2.4/2.7MM RIGHT,27009522,CDM,278,RC,C1713,HCPCS,outpatient,,,3691,1476.40,,2583.7,70,,2066.96,percent of total billed charges,70% of total billed charges,1937.78,52.5,,1550.22,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,3026.62,82,,2421.296,percent of total billed charges,82% of total billed charges,3137.35,85,,2509.88,percent of total billed charges,85% of total billed charges,3137.35,85,,2509.88,percent of total billed charges,85% of total billed charges,3137.35,85,,2509.88,percent of total billed charges,85% of total billed charges,3321.9,90,,2657.52,percent of total billed charges,90% of total billed charges,2952.8,80,,2362.24,percent of total billed charges,80% of total billed charges,3321.9,90,,2657.52,percent of total billed charges,90% of total billed charges,2768.25,75,,2214.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,1070.39,29,,856.312,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,2472.97,67,,1978.376,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,2583.7,70,,2066.96,percent of total billed charges,70% of total billed charges,2399.15,65,,1919.32,percent of total billed charges,65% of total billed charges,1316.58,35.67,,1053.264,percent of total billed charges,35.67% of total billed charges,1070.39,3321.9,
SCREW 2.7MM LOCKING VA 14MM,27009523,CDM,278,RC,C1713,HCPCS,outpatient,,,886,354.40,,620.2,70,,496.16,percent of total billed charges,70% of total billed charges,886,100,,708.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,726.52,82,,581.216,percent of total billed charges,82% of total billed charges,753.1,85,,602.48,percent of total billed charges,85% of total billed charges,753.1,85,,602.48,percent of total billed charges,85% of total billed charges,753.1,85,,602.48,percent of total billed charges,85% of total billed charges,797.4,90,,637.92,percent of total billed charges,90% of total billed charges,708.8,80,,567.04,percent of total billed charges,80% of total billed charges,797.4,90,,637.92,percent of total billed charges,90% of total billed charges,664.5,75,,531.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,256.94,29,,205.552,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,593.62,67,,474.896,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,620.2,70,,496.16,percent of total billed charges,70% of total billed charges,575.9,65,,460.72,percent of total billed charges,65% of total billed charges,316.04,35.67,,252.832,percent of total billed charges,35.67% of total billed charges,256.94,886,
SCREW 2.7MM LOCKING VA 18MM,27009524,CDM,278,RC,C1713,HCPCS,outpatient,,,886,354.40,,620.2,70,,496.16,percent of total billed charges,70% of total billed charges,886,100,,708.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,726.52,82,,581.216,percent of total billed charges,82% of total billed charges,753.1,85,,602.48,percent of total billed charges,85% of total billed charges,753.1,85,,602.48,percent of total billed charges,85% of total billed charges,753.1,85,,602.48,percent of total billed charges,85% of total billed charges,797.4,90,,637.92,percent of total billed charges,90% of total billed charges,708.8,80,,567.04,percent of total billed charges,80% of total billed charges,797.4,90,,637.92,percent of total billed charges,90% of total billed charges,664.5,75,,531.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,256.94,29,,205.552,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,593.62,67,,474.896,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,620.2,70,,496.16,percent of total billed charges,70% of total billed charges,575.9,65,,460.72,percent of total billed charges,65% of total billed charges,316.04,35.67,,252.832,percent of total billed charges,35.67% of total billed charges,256.94,886,
SCREW 2.7MM LOCKING VA 20MM,27009525,CDM,278,RC,C1713,HCPCS,outpatient,,,886,354.40,,620.2,70,,496.16,percent of total billed charges,70% of total billed charges,886,100,,708.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,726.52,82,,581.216,percent of total billed charges,82% of total billed charges,753.1,85,,602.48,percent of total billed charges,85% of total billed charges,753.1,85,,602.48,percent of total billed charges,85% of total billed charges,753.1,85,,602.48,percent of total billed charges,85% of total billed charges,797.4,90,,637.92,percent of total billed charges,90% of total billed charges,708.8,80,,567.04,percent of total billed charges,80% of total billed charges,797.4,90,,637.92,percent of total billed charges,90% of total billed charges,664.5,75,,531.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,256.94,29,,205.552,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,593.62,67,,474.896,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,620.2,70,,496.16,percent of total billed charges,70% of total billed charges,575.9,65,,460.72,percent of total billed charges,65% of total billed charges,316.04,35.67,,252.832,percent of total billed charges,35.67% of total billed charges,256.94,886,
SCREW 2.7MM LOCKING VA 24MM,27009526,CDM,278,RC,C1713,HCPCS,outpatient,,,881,352.40,,616.7,70,,493.36,percent of total billed charges,70% of total billed charges,881,100,,704.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,722.42,82,,577.936,percent of total billed charges,82% of total billed charges,748.85,85,,599.08,percent of total billed charges,85% of total billed charges,748.85,85,,599.08,percent of total billed charges,85% of total billed charges,748.85,85,,599.08,percent of total billed charges,85% of total billed charges,792.9,90,,634.32,percent of total billed charges,90% of total billed charges,704.8,80,,563.84,percent of total billed charges,80% of total billed charges,792.9,90,,634.32,percent of total billed charges,90% of total billed charges,660.75,75,,528.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,255.49,29,,204.392,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,590.27,67,,472.216,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,616.7,70,,493.36,percent of total billed charges,70% of total billed charges,572.65,65,,458.12,percent of total billed charges,65% of total billed charges,314.25,35.67,,251.4,percent of total billed charges,35.67% of total billed charges,255.49,881,
SCREW 2.7MM LOCKING VA 26MM,27009527,CDM,278,RC,C1713,HCPCS,outpatient,,,881,352.40,,616.7,70,,493.36,percent of total billed charges,70% of total billed charges,881,100,,704.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,722.42,82,,577.936,percent of total billed charges,82% of total billed charges,748.85,85,,599.08,percent of total billed charges,85% of total billed charges,748.85,85,,599.08,percent of total billed charges,85% of total billed charges,748.85,85,,599.08,percent of total billed charges,85% of total billed charges,792.9,90,,634.32,percent of total billed charges,90% of total billed charges,704.8,80,,563.84,percent of total billed charges,80% of total billed charges,792.9,90,,634.32,percent of total billed charges,90% of total billed charges,660.75,75,,528.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,255.49,29,,204.392,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,590.27,67,,472.216,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,616.7,70,,493.36,percent of total billed charges,70% of total billed charges,572.65,65,,458.12,percent of total billed charges,65% of total billed charges,314.25,35.67,,251.4,percent of total billed charges,35.67% of total billed charges,255.49,881,
SCREW 2.7MM LOCKING VA 34MM,27009528,CDM,278,RC,C1713,HCPCS,outpatient,,,881,352.40,,616.7,70,,493.36,percent of total billed charges,70% of total billed charges,881,100,,704.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,722.42,82,,577.936,percent of total billed charges,82% of total billed charges,748.85,85,,599.08,percent of total billed charges,85% of total billed charges,748.85,85,,599.08,percent of total billed charges,85% of total billed charges,748.85,85,,599.08,percent of total billed charges,85% of total billed charges,792.9,90,,634.32,percent of total billed charges,90% of total billed charges,704.8,80,,563.84,percent of total billed charges,80% of total billed charges,792.9,90,,634.32,percent of total billed charges,90% of total billed charges,660.75,75,,528.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,255.49,29,,204.392,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,590.27,67,,472.216,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,616.7,70,,493.36,percent of total billed charges,70% of total billed charges,572.65,65,,458.12,percent of total billed charges,65% of total billed charges,314.25,35.67,,251.4,percent of total billed charges,35.67% of total billed charges,255.49,881,
WIRE COMPRESSION 1.6MM,27009529,CDM,278,RC,C1713,HCPCS,outpatient,,,338,135.20,,236.6,70,,189.28,percent of total billed charges,70% of total billed charges,338,100,,270.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,277.16,82,,221.728,percent of total billed charges,82% of total billed charges,287.3,85,,229.84,percent of total billed charges,85% of total billed charges,287.3,85,,229.84,percent of total billed charges,85% of total billed charges,287.3,85,,229.84,percent of total billed charges,85% of total billed charges,304.2,90,,243.36,percent of total billed charges,90% of total billed charges,270.4,80,,216.32,percent of total billed charges,80% of total billed charges,304.2,90,,243.36,percent of total billed charges,90% of total billed charges,253.5,75,,202.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,98.02,29,,78.416,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,226.46,67,,181.168,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,236.6,70,,189.28,percent of total billed charges,70% of total billed charges,219.7,65,,175.76,percent of total billed charges,65% of total billed charges,120.56,35.67,,96.448,percent of total billed charges,35.67% of total billed charges,98.02,338,
TROCAR K WIRE TIP 1.6MM,27009530,CDM,278,RC,C1713,HCPCS,outpatient,,,668,267.20,,467.6,70,,374.08,percent of total billed charges,70% of total billed charges,668,100,,534.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,547.76,82,,438.208,percent of total billed charges,82% of total billed charges,567.8,85,,454.24,percent of total billed charges,85% of total billed charges,567.8,85,,454.24,percent of total billed charges,85% of total billed charges,567.8,85,,454.24,percent of total billed charges,85% of total billed charges,601.2,90,,480.96,percent of total billed charges,90% of total billed charges,534.4,80,,427.52,percent of total billed charges,80% of total billed charges,601.2,90,,480.96,percent of total billed charges,90% of total billed charges,501,75,,400.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,193.72,29,,154.976,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,447.56,67,,358.048,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,467.6,70,,374.08,percent of total billed charges,70% of total billed charges,434.2,65,,347.36,percent of total billed charges,65% of total billed charges,238.28,35.67,,190.624,percent of total billed charges,35.67% of total billed charges,193.72,668,
PLATE X MEDIUM TI 447 704,27009531,CDM,278,RC,C1713,HCPCS,outpatient,,,2920,1168.00,,2044,70,,1635.2,percent of total billed charges,70% of total billed charges,1533,52.5,,1226.4,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,2394.4,82,,1915.52,percent of total billed charges,82% of total billed charges,2482,85,,1985.6,percent of total billed charges,85% of total billed charges,2482,85,,1985.6,percent of total billed charges,85% of total billed charges,2482,85,,1985.6,percent of total billed charges,85% of total billed charges,2628,90,,2102.4,percent of total billed charges,90% of total billed charges,2336,80,,1868.8,percent of total billed charges,80% of total billed charges,2628,90,,2102.4,percent of total billed charges,90% of total billed charges,2190,75,,1752,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,846.8,29,,677.44,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1956.4,67,,1565.12,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,2044,70,,1635.2,percent of total billed charges,70% of total billed charges,1898,65,,1518.4,percent of total billed charges,65% of total billed charges,1041.56,35.67,,833.248,percent of total billed charges,35.67% of total billed charges,846.8,2628,
SCREW 2.7MM TI LOCKING 24MM,27009532,CDM,278,RC,C1713,HCPCS,outpatient,,,763,305.20,,534.1,70,,427.28,percent of total billed charges,70% of total billed charges,763,100,,610.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,625.66,82,,500.528,percent of total billed charges,82% of total billed charges,648.55,85,,518.84,percent of total billed charges,85% of total billed charges,648.55,85,,518.84,percent of total billed charges,85% of total billed charges,648.55,85,,518.84,percent of total billed charges,85% of total billed charges,686.7,90,,549.36,percent of total billed charges,90% of total billed charges,610.4,80,,488.32,percent of total billed charges,80% of total billed charges,686.7,90,,549.36,percent of total billed charges,90% of total billed charges,572.25,75,,457.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,221.27,29,,177.016,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,511.21,67,,408.968,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,534.1,70,,427.28,percent of total billed charges,70% of total billed charges,495.95,65,,396.76,percent of total billed charges,65% of total billed charges,272.16,35.67,,217.728,percent of total billed charges,35.67% of total billed charges,221.27,763,
SCREW 2.7MM TI LOCKING 30MM,27009533,CDM,278,RC,C1713,HCPCS,outpatient,,,763,305.20,,534.1,70,,427.28,percent of total billed charges,70% of total billed charges,763,100,,610.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,625.66,82,,500.528,percent of total billed charges,82% of total billed charges,648.55,85,,518.84,percent of total billed charges,85% of total billed charges,648.55,85,,518.84,percent of total billed charges,85% of total billed charges,648.55,85,,518.84,percent of total billed charges,85% of total billed charges,686.7,90,,549.36,percent of total billed charges,90% of total billed charges,610.4,80,,488.32,percent of total billed charges,80% of total billed charges,686.7,90,,549.36,percent of total billed charges,90% of total billed charges,572.25,75,,457.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,221.27,29,,177.016,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,511.21,67,,408.968,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,534.1,70,,427.28,percent of total billed charges,70% of total billed charges,495.95,65,,396.76,percent of total billed charges,65% of total billed charges,272.16,35.67,,217.728,percent of total billed charges,35.67% of total billed charges,221.27,763,
SCREW 2.7 TI CORTEX 22MM,27009534,CDM,278,RC,C1713,HCPCS,outpatient,,,367,146.80,,256.9,70,,205.52,percent of total billed charges,70% of total billed charges,367,100,,293.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,300.94,82,,240.752,percent of total billed charges,82% of total billed charges,311.95,85,,249.56,percent of total billed charges,85% of total billed charges,311.95,85,,249.56,percent of total billed charges,85% of total billed charges,311.95,85,,249.56,percent of total billed charges,85% of total billed charges,330.3,90,,264.24,percent of total billed charges,90% of total billed charges,293.6,80,,234.88,percent of total billed charges,80% of total billed charges,330.3,90,,264.24,percent of total billed charges,90% of total billed charges,275.25,75,,220.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,106.43,29,,85.144,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,245.89,67,,196.712,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,256.9,70,,205.52,percent of total billed charges,70% of total billed charges,238.55,65,,190.84,percent of total billed charges,65% of total billed charges,130.91,35.67,,104.728,percent of total billed charges,35.67% of total billed charges,106.43,367,
SCREW 2.7 TI CORTEX 34MM,27009535,CDM,278,RC,C1713,HCPCS,outpatient,,,367,146.80,,256.9,70,,205.52,percent of total billed charges,70% of total billed charges,367,100,,293.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,300.94,82,,240.752,percent of total billed charges,82% of total billed charges,311.95,85,,249.56,percent of total billed charges,85% of total billed charges,311.95,85,,249.56,percent of total billed charges,85% of total billed charges,311.95,85,,249.56,percent of total billed charges,85% of total billed charges,330.3,90,,264.24,percent of total billed charges,90% of total billed charges,293.6,80,,234.88,percent of total billed charges,80% of total billed charges,330.3,90,,264.24,percent of total billed charges,90% of total billed charges,275.25,75,,220.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,106.43,29,,85.144,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,245.89,67,,196.712,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,256.9,70,,205.52,percent of total billed charges,70% of total billed charges,238.55,65,,190.84,percent of total billed charges,65% of total billed charges,130.91,35.67,,104.728,percent of total billed charges,35.67% of total billed charges,106.43,367,
K WIRE TI 2.0MM SMOOTH,27009537,CDM,278,RC,C1713,HCPCS,outpatient,,,133,53.20,,93.1,70,,74.48,percent of total billed charges,70% of total billed charges,133,100,,106.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,109.06,82,,87.248,percent of total billed charges,82% of total billed charges,113.05,85,,90.44,percent of total billed charges,85% of total billed charges,113.05,85,,90.44,percent of total billed charges,85% of total billed charges,113.05,85,,90.44,percent of total billed charges,85% of total billed charges,119.7,90,,95.76,percent of total billed charges,90% of total billed charges,106.4,80,,85.12,percent of total billed charges,80% of total billed charges,119.7,90,,95.76,percent of total billed charges,90% of total billed charges,99.75,75,,79.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,38.57,29,,30.856,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,89.11,67,,71.288,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,93.1,70,,74.48,percent of total billed charges,70% of total billed charges,86.45,65,,69.16,percent of total billed charges,65% of total billed charges,47.44,35.67,,37.952,percent of total billed charges,35.67% of total billed charges,38.57,133,
SCREW LOCKING 3.5 SZ 16 MM,27009541,CDM,278,RC,C1713,HCPCS,outpatient,,,842,336.80,,589.4,70,,471.52,percent of total billed charges,70% of total billed charges,842,100,,673.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,690.44,82,,552.352,percent of total billed charges,82% of total billed charges,715.7,85,,572.56,percent of total billed charges,85% of total billed charges,715.7,85,,572.56,percent of total billed charges,85% of total billed charges,715.7,85,,572.56,percent of total billed charges,85% of total billed charges,757.8,90,,606.24,percent of total billed charges,90% of total billed charges,673.6,80,,538.88,percent of total billed charges,80% of total billed charges,757.8,90,,606.24,percent of total billed charges,90% of total billed charges,631.5,75,,505.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,244.18,29,,195.344,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,564.14,67,,451.312,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,589.4,70,,471.52,percent of total billed charges,70% of total billed charges,547.3,65,,437.84,percent of total billed charges,65% of total billed charges,300.34,35.67,,240.272,percent of total billed charges,35.67% of total billed charges,244.18,842,
SCREW CORTEX 3.5 MM 18MM,27009542,CDM,278,RC,C1713,HCPCS,outpatient,,,195,78.00,,136.5,70,,109.2,percent of total billed charges,70% of total billed charges,195,100,,156,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,159.9,82,,127.92,percent of total billed charges,82% of total billed charges,165.75,85,,132.6,percent of total billed charges,85% of total billed charges,165.75,85,,132.6,percent of total billed charges,85% of total billed charges,165.75,85,,132.6,percent of total billed charges,85% of total billed charges,175.5,90,,140.4,percent of total billed charges,90% of total billed charges,156,80,,124.8,percent of total billed charges,80% of total billed charges,175.5,90,,140.4,percent of total billed charges,90% of total billed charges,146.25,75,,117,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,56.55,29,,45.24,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,130.65,67,,104.52,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,136.5,70,,109.2,percent of total billed charges,70% of total billed charges,126.75,65,,101.4,percent of total billed charges,65% of total billed charges,69.56,35.67,,55.648,percent of total billed charges,35.67% of total billed charges,56.55,195,
SCREW CORTEX 3.5 MM SZ 24 MM,27009543,CDM,278,RC,C1713,HCPCS,outpatient,,,226,90.40,,158.2,70,,126.56,percent of total billed charges,70% of total billed charges,226,100,,180.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,185.32,82,,148.256,percent of total billed charges,82% of total billed charges,192.1,85,,153.68,percent of total billed charges,85% of total billed charges,192.1,85,,153.68,percent of total billed charges,85% of total billed charges,192.1,85,,153.68,percent of total billed charges,85% of total billed charges,203.4,90,,162.72,percent of total billed charges,90% of total billed charges,180.8,80,,144.64,percent of total billed charges,80% of total billed charges,203.4,90,,162.72,percent of total billed charges,90% of total billed charges,169.5,75,,135.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,65.54,29,,52.432,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,151.42,67,,121.136,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,158.2,70,,126.56,percent of total billed charges,70% of total billed charges,146.9,65,,117.52,percent of total billed charges,65% of total billed charges,80.61,35.67,,64.488,percent of total billed charges,35.67% of total billed charges,65.54,226,
SCREW CORTEX 3.5 MM SZ 16MM,27009544,CDM,278,RC,C1713,HCPCS,outpatient,,,215,86.00,,150.5,70,,120.4,percent of total billed charges,70% of total billed charges,215,100,,172,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,176.3,82,,141.04,percent of total billed charges,82% of total billed charges,182.75,85,,146.2,percent of total billed charges,85% of total billed charges,182.75,85,,146.2,percent of total billed charges,85% of total billed charges,182.75,85,,146.2,percent of total billed charges,85% of total billed charges,193.5,90,,154.8,percent of total billed charges,90% of total billed charges,172,80,,137.6,percent of total billed charges,80% of total billed charges,193.5,90,,154.8,percent of total billed charges,90% of total billed charges,161.25,75,,129,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,62.35,29,,49.88,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,144.05,67,,115.24,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,150.5,70,,120.4,percent of total billed charges,70% of total billed charges,139.75,65,,111.8,percent of total billed charges,65% of total billed charges,76.69,35.67,,61.352,percent of total billed charges,35.67% of total billed charges,62.35,215,
SCREW CORTEX 3.5 MM SZ 22,27009545,CDM,278,RC,C1713,HCPCS,outpatient,,,195,78.00,,136.5,70,,109.2,percent of total billed charges,70% of total billed charges,195,100,,156,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,159.9,82,,127.92,percent of total billed charges,82% of total billed charges,165.75,85,,132.6,percent of total billed charges,85% of total billed charges,165.75,85,,132.6,percent of total billed charges,85% of total billed charges,165.75,85,,132.6,percent of total billed charges,85% of total billed charges,175.5,90,,140.4,percent of total billed charges,90% of total billed charges,156,80,,124.8,percent of total billed charges,80% of total billed charges,175.5,90,,140.4,percent of total billed charges,90% of total billed charges,146.25,75,,117,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,56.55,29,,45.24,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,130.65,67,,104.52,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,136.5,70,,109.2,percent of total billed charges,70% of total billed charges,126.75,65,,101.4,percent of total billed charges,65% of total billed charges,69.56,35.67,,55.648,percent of total billed charges,35.67% of total billed charges,56.55,195,
SCREW CONCELLOUS BONE 4.0 60MM,27009546,CDM,278,RC,C1713,HCPCS,outpatient,,,225,90.00,,157.5,70,,126,percent of total billed charges,70% of total billed charges,225,100,,180,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,184.5,82,,147.6,percent of total billed charges,82% of total billed charges,191.25,85,,153,percent of total billed charges,85% of total billed charges,191.25,85,,153,percent of total billed charges,85% of total billed charges,191.25,85,,153,percent of total billed charges,85% of total billed charges,202.5,90,,162,percent of total billed charges,90% of total billed charges,180,80,,144,percent of total billed charges,80% of total billed charges,202.5,90,,162,percent of total billed charges,90% of total billed charges,168.75,75,,135,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,65.25,29,,52.2,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,150.75,67,,120.6,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,157.5,70,,126,percent of total billed charges,70% of total billed charges,146.25,65,,117,percent of total billed charges,65% of total billed charges,80.26,35.67,,64.208,percent of total billed charges,35.67% of total billed charges,65.25,225,
SCREW CANNULATED 4.0MM SZ 50MM,27009547,CDM,278,RC,C1713,HCPCS,outpatient,,,1366,546.40,,956.2,70,,764.96,percent of total billed charges,70% of total billed charges,717.15,52.5,,573.72,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,1120.12,82,,896.096,percent of total billed charges,82% of total billed charges,1161.1,85,,928.88,percent of total billed charges,85% of total billed charges,1161.1,85,,928.88,percent of total billed charges,85% of total billed charges,1161.1,85,,928.88,percent of total billed charges,85% of total billed charges,1229.4,90,,983.52,percent of total billed charges,90% of total billed charges,1092.8,80,,874.24,percent of total billed charges,80% of total billed charges,1229.4,90,,983.52,percent of total billed charges,90% of total billed charges,1024.5,75,,819.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,396.14,29,,316.912,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,915.22,67,,732.176,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,956.2,70,,764.96,percent of total billed charges,70% of total billed charges,887.9,65,,710.32,percent of total billed charges,65% of total billed charges,487.25,35.67,,389.8,percent of total billed charges,35.67% of total billed charges,396.14,1229.4,
SCREW CANNULATED 4.0MM 54MM,27009548,CDM,278,RC,C1713,HCPCS,outpatient,,,1072,428.80,,750.4,70,,600.32,percent of total billed charges,70% of total billed charges,562.8,52.5,,450.24,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,879.04,82,,703.232,percent of total billed charges,82% of total billed charges,911.2,85,,728.96,percent of total billed charges,85% of total billed charges,911.2,85,,728.96,percent of total billed charges,85% of total billed charges,911.2,85,,728.96,percent of total billed charges,85% of total billed charges,964.8,90,,771.84,percent of total billed charges,90% of total billed charges,857.6,80,,686.08,percent of total billed charges,80% of total billed charges,964.8,90,,771.84,percent of total billed charges,90% of total billed charges,804,75,,643.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,310.88,29,,248.704,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,718.24,67,,574.592,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,750.4,70,,600.32,percent of total billed charges,70% of total billed charges,696.8,65,,557.44,percent of total billed charges,65% of total billed charges,382.38,35.67,,305.904,percent of total billed charges,35.67% of total billed charges,310.88,964.8,
TUBLAR LCP PLATE/COLLAR 1/3 81,27009549,CDM,278,RC,C1713,HCPCS,outpatient,,,946,378.40,,662.2,70,,529.76,percent of total billed charges,70% of total billed charges,946,100,,756.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,775.72,82,,620.576,percent of total billed charges,82% of total billed charges,804.1,85,,643.28,percent of total billed charges,85% of total billed charges,804.1,85,,643.28,percent of total billed charges,85% of total billed charges,804.1,85,,643.28,percent of total billed charges,85% of total billed charges,851.4,90,,681.12,percent of total billed charges,90% of total billed charges,756.8,80,,605.44,percent of total billed charges,80% of total billed charges,851.4,90,,681.12,percent of total billed charges,90% of total billed charges,709.5,75,,567.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,274.34,29,,219.472,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,633.82,67,,507.056,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,662.2,70,,529.76,percent of total billed charges,70% of total billed charges,614.9,65,,491.92,percent of total billed charges,65% of total billed charges,337.44,35.67,,269.952,percent of total billed charges,35.67% of total billed charges,274.34,946,
WIRE THREASED GUID 125MM 150MM,27009550,CDM,278,RC,C1769,HCPCS,outpatient,,,240,96.00,,168,70,,134.4,percent of total billed charges,70% of total billed charges,240,100,,192,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,196.8,82,,157.44,percent of total billed charges,82% of total billed charges,204,85,,163.2,percent of total billed charges,85% of total billed charges,204,85,,163.2,percent of total billed charges,85% of total billed charges,204,85,,163.2,percent of total billed charges,85% of total billed charges,216,90,,172.8,percent of total billed charges,90% of total billed charges,192,80,,153.6,percent of total billed charges,80% of total billed charges,216,90,,172.8,percent of total billed charges,90% of total billed charges,180,75,,144,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,69.6,29,,55.68,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,160.8,67,,128.64,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,168,70,,134.4,percent of total billed charges,70% of total billed charges,156,65,,124.8,percent of total billed charges,65% of total billed charges,85.61,35.67,,68.488,percent of total billed charges,35.67% of total billed charges,69.6,240,
HOOK PLATE,27009552,CDM,278,RC,C1713,HCPCS,outpatient,,,1313,525.20,,919.1,70,,735.28,percent of total billed charges,70% of total billed charges,689.33,52.5,,551.46,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,1076.66,82,,861.328,percent of total billed charges,82% of total billed charges,1116.05,85,,892.84,percent of total billed charges,85% of total billed charges,1116.05,85,,892.84,percent of total billed charges,85% of total billed charges,1116.05,85,,892.84,percent of total billed charges,85% of total billed charges,1181.7,90,,945.36,percent of total billed charges,90% of total billed charges,1050.4,80,,840.32,percent of total billed charges,80% of total billed charges,1181.7,90,,945.36,percent of total billed charges,90% of total billed charges,984.75,75,,787.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,380.77,29,,304.616,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,879.71,67,,703.768,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,919.1,70,,735.28,percent of total billed charges,70% of total billed charges,853.45,65,,682.76,percent of total billed charges,65% of total billed charges,468.35,35.67,,374.68,percent of total billed charges,35.67% of total billed charges,380.77,1181.7,
2.0 CORTEX SCREW 16 MM,27009593,CDM,278,RC,C1713,HCPCS,outpatient,,,276,110.40,,193.2,70,,154.56,percent of total billed charges,70% of total billed charges,276,100,,220.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,226.32,82,,181.056,percent of total billed charges,82% of total billed charges,234.6,85,,187.68,percent of total billed charges,85% of total billed charges,234.6,85,,187.68,percent of total billed charges,85% of total billed charges,234.6,85,,187.68,percent of total billed charges,85% of total billed charges,248.4,90,,198.72,percent of total billed charges,90% of total billed charges,220.8,80,,176.64,percent of total billed charges,80% of total billed charges,248.4,90,,198.72,percent of total billed charges,90% of total billed charges,207,75,,165.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,80.04,29,,64.032,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,184.92,67,,147.936,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,193.2,70,,154.56,percent of total billed charges,70% of total billed charges,179.4,65,,143.52,percent of total billed charges,65% of total billed charges,98.45,35.67,,78.76,percent of total billed charges,35.67% of total billed charges,80.04,276,
2.0 CORTEX SCREW 24 MM,27009595,CDM,278,RC,C1713,HCPCS,outpatient,,,276,110.40,,193.2,70,,154.56,percent of total billed charges,70% of total billed charges,276,100,,220.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,226.32,82,,181.056,percent of total billed charges,82% of total billed charges,234.6,85,,187.68,percent of total billed charges,85% of total billed charges,234.6,85,,187.68,percent of total billed charges,85% of total billed charges,234.6,85,,187.68,percent of total billed charges,85% of total billed charges,248.4,90,,198.72,percent of total billed charges,90% of total billed charges,220.8,80,,176.64,percent of total billed charges,80% of total billed charges,248.4,90,,198.72,percent of total billed charges,90% of total billed charges,207,75,,165.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,80.04,29,,64.032,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,184.92,67,,147.936,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,193.2,70,,154.56,percent of total billed charges,70% of total billed charges,179.4,65,,143.52,percent of total billed charges,65% of total billed charges,98.45,35.67,,78.76,percent of total billed charges,35.67% of total billed charges,80.04,276,
PLATE ANATOMIC VOLAR NARROW,27009692,CDM,278,RC,C1713,HCPCS,outpatient,,,3624,1449.60,,2536.8,70,,2029.44,percent of total billed charges,70% of total billed charges,1902.6,52.5,,1522.08,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,2971.68,82,,2377.344,percent of total billed charges,82% of total billed charges,3080.4,85,,2464.32,percent of total billed charges,85% of total billed charges,3080.4,85,,2464.32,percent of total billed charges,85% of total billed charges,3080.4,85,,2464.32,percent of total billed charges,85% of total billed charges,3261.6,90,,2609.28,percent of total billed charges,90% of total billed charges,2899.2,80,,2319.36,percent of total billed charges,80% of total billed charges,3261.6,90,,2609.28,percent of total billed charges,90% of total billed charges,2718,75,,2174.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,1050.96,29,,840.768,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,2428.08,67,,1942.464,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,2536.8,70,,2029.44,percent of total billed charges,70% of total billed charges,2355.6,65,,1884.48,percent of total billed charges,65% of total billed charges,1292.68,35.67,,1034.144,percent of total billed charges,35.67% of total billed charges,1050.96,3261.6,
BONE SCREW 20MM 2.7MM,27009693,CDM,278,RC,C1713,HCPCS,outpatient,,,701,280.40,,490.7,70,,392.56,percent of total billed charges,70% of total billed charges,701,100,,560.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,574.82,82,,459.856,percent of total billed charges,82% of total billed charges,595.85,85,,476.68,percent of total billed charges,85% of total billed charges,595.85,85,,476.68,percent of total billed charges,85% of total billed charges,595.85,85,,476.68,percent of total billed charges,85% of total billed charges,630.9,90,,504.72,percent of total billed charges,90% of total billed charges,560.8,80,,448.64,percent of total billed charges,80% of total billed charges,630.9,90,,504.72,percent of total billed charges,90% of total billed charges,525.75,75,,420.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,203.29,29,,162.632,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,469.67,67,,375.736,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,490.7,70,,392.56,percent of total billed charges,70% of total billed charges,455.65,65,,364.52,percent of total billed charges,65% of total billed charges,250.05,35.67,,200.04,percent of total billed charges,35.67% of total billed charges,203.29,701,
BONE SCREW 18MM 2.7MM,27009694,CDM,278,RC,C1713,HCPCS,outpatient,,,701,280.40,,490.7,70,,392.56,percent of total billed charges,70% of total billed charges,701,100,,560.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,574.82,82,,459.856,percent of total billed charges,82% of total billed charges,595.85,85,,476.68,percent of total billed charges,85% of total billed charges,595.85,85,,476.68,percent of total billed charges,85% of total billed charges,595.85,85,,476.68,percent of total billed charges,85% of total billed charges,630.9,90,,504.72,percent of total billed charges,90% of total billed charges,560.8,80,,448.64,percent of total billed charges,80% of total billed charges,630.9,90,,504.72,percent of total billed charges,90% of total billed charges,525.75,75,,420.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,203.29,29,,162.632,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,469.67,67,,375.736,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,490.7,70,,392.56,percent of total billed charges,70% of total billed charges,455.65,65,,364.52,percent of total billed charges,65% of total billed charges,250.05,35.67,,200.04,percent of total billed charges,35.67% of total billed charges,203.29,701,
BONE SCREW 14MM 2.7MM,27009695,CDM,278,RC,C1713,HCPCS,outpatient,,,701,280.40,,490.7,70,,392.56,percent of total billed charges,70% of total billed charges,701,100,,560.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,574.82,82,,459.856,percent of total billed charges,82% of total billed charges,595.85,85,,476.68,percent of total billed charges,85% of total billed charges,595.85,85,,476.68,percent of total billed charges,85% of total billed charges,595.85,85,,476.68,percent of total billed charges,85% of total billed charges,630.9,90,,504.72,percent of total billed charges,90% of total billed charges,560.8,80,,448.64,percent of total billed charges,80% of total billed charges,630.9,90,,504.72,percent of total billed charges,90% of total billed charges,525.75,75,,420.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,203.29,29,,162.632,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,469.67,67,,375.736,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,490.7,70,,392.56,percent of total billed charges,70% of total billed charges,455.65,65,,364.52,percent of total billed charges,65% of total billed charges,250.05,35.67,,200.04,percent of total billed charges,35.67% of total billed charges,203.29,701,
SCREW LOCK 20MM 2.7MM,27009696,CDM,278,RC,C1713,HCPCS,outpatient,,,679,271.60,,475.3,70,,380.24,percent of total billed charges,70% of total billed charges,679,100,,543.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,556.78,82,,445.424,percent of total billed charges,82% of total billed charges,577.15,85,,461.72,percent of total billed charges,85% of total billed charges,577.15,85,,461.72,percent of total billed charges,85% of total billed charges,577.15,85,,461.72,percent of total billed charges,85% of total billed charges,611.1,90,,488.88,percent of total billed charges,90% of total billed charges,543.2,80,,434.56,percent of total billed charges,80% of total billed charges,611.1,90,,488.88,percent of total billed charges,90% of total billed charges,509.25,75,,407.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,196.91,29,,157.528,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,454.93,67,,363.944,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,475.3,70,,380.24,percent of total billed charges,70% of total billed charges,441.35,65,,353.08,percent of total billed charges,65% of total billed charges,242.2,35.67,,193.76,percent of total billed charges,35.67% of total billed charges,196.91,679,
SCREW BONE 22MM 2.7MM,27009697,CDM,278,RC,C1713,HCPCS,outpatient,,,679,271.60,,475.3,70,,380.24,percent of total billed charges,70% of total billed charges,679,100,,543.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,556.78,82,,445.424,percent of total billed charges,82% of total billed charges,577.15,85,,461.72,percent of total billed charges,85% of total billed charges,577.15,85,,461.72,percent of total billed charges,85% of total billed charges,577.15,85,,461.72,percent of total billed charges,85% of total billed charges,611.1,90,,488.88,percent of total billed charges,90% of total billed charges,543.2,80,,434.56,percent of total billed charges,80% of total billed charges,611.1,90,,488.88,percent of total billed charges,90% of total billed charges,509.25,75,,407.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,196.91,29,,157.528,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,454.93,67,,363.944,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,475.3,70,,380.24,percent of total billed charges,70% of total billed charges,441.35,65,,353.08,percent of total billed charges,65% of total billed charges,242.2,35.67,,193.76,percent of total billed charges,35.67% of total billed charges,196.91,679,
SCREW LOCK 18MM 2.7MM,27009698,CDM,278,RC,C1713,HCPCS,outpatient,,,679,271.60,,475.3,70,,380.24,percent of total billed charges,70% of total billed charges,679,100,,543.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,556.78,82,,445.424,percent of total billed charges,82% of total billed charges,577.15,85,,461.72,percent of total billed charges,85% of total billed charges,577.15,85,,461.72,percent of total billed charges,85% of total billed charges,577.15,85,,461.72,percent of total billed charges,85% of total billed charges,611.1,90,,488.88,percent of total billed charges,90% of total billed charges,543.2,80,,434.56,percent of total billed charges,80% of total billed charges,611.1,90,,488.88,percent of total billed charges,90% of total billed charges,509.25,75,,407.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,196.91,29,,157.528,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,454.93,67,,363.944,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,475.3,70,,380.24,percent of total billed charges,70% of total billed charges,441.35,65,,353.08,percent of total billed charges,65% of total billed charges,242.2,35.67,,193.76,percent of total billed charges,35.67% of total billed charges,196.91,679,
SCREW LOCK 14MM 2.7MM,27009699,CDM,278,RC,C1713,HCPCS,outpatient,,,679,271.60,,475.3,70,,380.24,percent of total billed charges,70% of total billed charges,679,100,,543.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,556.78,82,,445.424,percent of total billed charges,82% of total billed charges,577.15,85,,461.72,percent of total billed charges,85% of total billed charges,577.15,85,,461.72,percent of total billed charges,85% of total billed charges,577.15,85,,461.72,percent of total billed charges,85% of total billed charges,611.1,90,,488.88,percent of total billed charges,90% of total billed charges,543.2,80,,434.56,percent of total billed charges,80% of total billed charges,611.1,90,,488.88,percent of total billed charges,90% of total billed charges,509.25,75,,407.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,196.91,29,,157.528,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,454.93,67,,363.944,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,475.3,70,,380.24,percent of total billed charges,70% of total billed charges,441.35,65,,353.08,percent of total billed charges,65% of total billed charges,242.2,35.67,,193.76,percent of total billed charges,35.67% of total billed charges,196.91,679,
SCREW LOCK 12MM 2.7MM,27009700,CDM,278,RC,C1713,HCPCS,outpatient,,,679,271.60,,475.3,70,,380.24,percent of total billed charges,70% of total billed charges,679,100,,543.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,556.78,82,,445.424,percent of total billed charges,82% of total billed charges,577.15,85,,461.72,percent of total billed charges,85% of total billed charges,577.15,85,,461.72,percent of total billed charges,85% of total billed charges,577.15,85,,461.72,percent of total billed charges,85% of total billed charges,611.1,90,,488.88,percent of total billed charges,90% of total billed charges,543.2,80,,434.56,percent of total billed charges,80% of total billed charges,611.1,90,,488.88,percent of total billed charges,90% of total billed charges,509.25,75,,407.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,196.91,29,,157.528,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,454.93,67,,363.944,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,475.3,70,,380.24,percent of total billed charges,70% of total billed charges,441.35,65,,353.08,percent of total billed charges,65% of total billed charges,242.2,35.67,,193.76,percent of total billed charges,35.67% of total billed charges,196.91,679,
K WIRE W/ OLIVE STOP,27009702,CDM,278,RC,C1713,HCPCS,outpatient,,,210,84.00,,147,70,,117.6,percent of total billed charges,70% of total billed charges,210,100,,168,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,172.2,82,,137.76,percent of total billed charges,82% of total billed charges,178.5,85,,142.8,percent of total billed charges,85% of total billed charges,178.5,85,,142.8,percent of total billed charges,85% of total billed charges,178.5,85,,142.8,percent of total billed charges,85% of total billed charges,189,90,,151.2,percent of total billed charges,90% of total billed charges,168,80,,134.4,percent of total billed charges,80% of total billed charges,189,90,,151.2,percent of total billed charges,90% of total billed charges,157.5,75,,126,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,60.9,29,,48.72,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,140.7,67,,112.56,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,147,70,,117.6,percent of total billed charges,70% of total billed charges,136.5,65,,109.2,percent of total billed charges,65% of total billed charges,74.91,35.67,,59.928,percent of total billed charges,35.67% of total billed charges,60.9,210,
CORKSCREW SUTURE 16 MM,27009710,CDM,278,RC,C1713,HCPCS,outpatient,,,1144,457.60,,800.8,70,,640.64,percent of total billed charges,70% of total billed charges,600.6,52.5,,480.48,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,938.08,82,,750.464,percent of total billed charges,82% of total billed charges,972.4,85,,777.92,percent of total billed charges,85% of total billed charges,972.4,85,,777.92,percent of total billed charges,85% of total billed charges,972.4,85,,777.92,percent of total billed charges,85% of total billed charges,1029.6,90,,823.68,percent of total billed charges,90% of total billed charges,915.2,80,,732.16,percent of total billed charges,80% of total billed charges,1029.6,90,,823.68,percent of total billed charges,90% of total billed charges,858,75,,686.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,331.76,29,,265.408,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,766.48,67,,613.184,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,800.8,70,,640.64,percent of total billed charges,70% of total billed charges,743.6,65,,594.88,percent of total billed charges,65% of total billed charges,408.06,35.67,,326.448,percent of total billed charges,35.67% of total billed charges,331.76,1029.6,
DISP KIT 3.5 PUSH LOCK,27009721,CDM,278,RC,,,outpatient,,,1120,448.00,,784,70,,627.2,percent of total billed charges,70% of total billed charges,588,52.5,,470.4,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,918.4,82,,734.72,percent of total billed charges,82% of total billed charges,952,85,,761.6,percent of total billed charges,85% of total billed charges,952,85,,761.6,percent of total billed charges,85% of total billed charges,952,85,,761.6,percent of total billed charges,85% of total billed charges,1008,90,,806.4,percent of total billed charges,90% of total billed charges,896,80,,716.8,percent of total billed charges,80% of total billed charges,1008,90,,806.4,percent of total billed charges,90% of total billed charges,840,75,,672,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,324.8,29,,259.84,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,750.4,67,,600.32,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,784,70,,627.2,percent of total billed charges,70% of total billed charges,728,65,,582.4,percent of total billed charges,65% of total billed charges,399.5,35.67,,319.6,percent of total billed charges,35.67% of total billed charges,324.8,1008,
SUTURE LASSO 90 DEG,27009722,CDM,278,RC,C1713,HCPCS,outpatient,,,897,358.80,,627.9,70,,502.32,percent of total billed charges,70% of total billed charges,897,100,,717.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,735.54,82,,588.432,percent of total billed charges,82% of total billed charges,762.45,85,,609.96,percent of total billed charges,85% of total billed charges,762.45,85,,609.96,percent of total billed charges,85% of total billed charges,762.45,85,,609.96,percent of total billed charges,85% of total billed charges,807.3,90,,645.84,percent of total billed charges,90% of total billed charges,717.6,80,,574.08,percent of total billed charges,80% of total billed charges,807.3,90,,645.84,percent of total billed charges,90% of total billed charges,672.75,75,,538.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,260.13,29,,208.104,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,600.99,67,,480.792,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,627.9,70,,502.32,percent of total billed charges,70% of total billed charges,583.05,65,,466.44,percent of total billed charges,65% of total billed charges,319.96,35.67,,255.968,percent of total billed charges,35.67% of total billed charges,260.13,897,
CORTEX SCREW 2.0 11MM,27009732,CDM,278,RC,C1713,HCPCS,outpatient,,,276,110.40,,193.2,70,,154.56,percent of total billed charges,70% of total billed charges,276,100,,220.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,226.32,82,,181.056,percent of total billed charges,82% of total billed charges,234.6,85,,187.68,percent of total billed charges,85% of total billed charges,234.6,85,,187.68,percent of total billed charges,85% of total billed charges,234.6,85,,187.68,percent of total billed charges,85% of total billed charges,248.4,90,,198.72,percent of total billed charges,90% of total billed charges,220.8,80,,176.64,percent of total billed charges,80% of total billed charges,248.4,90,,198.72,percent of total billed charges,90% of total billed charges,207,75,,165.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,80.04,29,,64.032,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,184.92,67,,147.936,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,193.2,70,,154.56,percent of total billed charges,70% of total billed charges,179.4,65,,143.52,percent of total billed charges,65% of total billed charges,98.45,35.67,,78.76,percent of total billed charges,35.67% of total billed charges,80.04,276,
CORTEX SCREW 2.0 13MM,27009733,CDM,278,RC,C1713,HCPCS,outpatient,,,276,110.40,,193.2,70,,154.56,percent of total billed charges,70% of total billed charges,276,100,,220.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,226.32,82,,181.056,percent of total billed charges,82% of total billed charges,234.6,85,,187.68,percent of total billed charges,85% of total billed charges,234.6,85,,187.68,percent of total billed charges,85% of total billed charges,234.6,85,,187.68,percent of total billed charges,85% of total billed charges,248.4,90,,198.72,percent of total billed charges,90% of total billed charges,220.8,80,,176.64,percent of total billed charges,80% of total billed charges,248.4,90,,198.72,percent of total billed charges,90% of total billed charges,207,75,,165.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,80.04,29,,64.032,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,184.92,67,,147.936,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,193.2,70,,154.56,percent of total billed charges,70% of total billed charges,179.4,65,,143.52,percent of total billed charges,65% of total billed charges,98.45,35.67,,78.76,percent of total billed charges,35.67% of total billed charges,80.04,276,
CORTEX SCREW 2.0 18MM,27009734,CDM,278,RC,C1713,HCPCS,outpatient,,,276,110.40,,193.2,70,,154.56,percent of total billed charges,70% of total billed charges,276,100,,220.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,226.32,82,,181.056,percent of total billed charges,82% of total billed charges,234.6,85,,187.68,percent of total billed charges,85% of total billed charges,234.6,85,,187.68,percent of total billed charges,85% of total billed charges,234.6,85,,187.68,percent of total billed charges,85% of total billed charges,248.4,90,,198.72,percent of total billed charges,90% of total billed charges,220.8,80,,176.64,percent of total billed charges,80% of total billed charges,248.4,90,,198.72,percent of total billed charges,90% of total billed charges,207,75,,165.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,80.04,29,,64.032,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,184.92,67,,147.936,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,193.2,70,,154.56,percent of total billed charges,70% of total billed charges,179.4,65,,143.52,percent of total billed charges,65% of total billed charges,98.45,35.67,,78.76,percent of total billed charges,35.67% of total billed charges,80.04,276,
CORTEX SCREW 2.0 20MM,27009735,CDM,278,RC,C1713,HCPCS,outpatient,,,276,110.40,,193.2,70,,154.56,percent of total billed charges,70% of total billed charges,276,100,,220.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,226.32,82,,181.056,percent of total billed charges,82% of total billed charges,234.6,85,,187.68,percent of total billed charges,85% of total billed charges,234.6,85,,187.68,percent of total billed charges,85% of total billed charges,234.6,85,,187.68,percent of total billed charges,85% of total billed charges,248.4,90,,198.72,percent of total billed charges,90% of total billed charges,220.8,80,,176.64,percent of total billed charges,80% of total billed charges,248.4,90,,198.72,percent of total billed charges,90% of total billed charges,207,75,,165.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,80.04,29,,64.032,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,184.92,67,,147.936,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,193.2,70,,154.56,percent of total billed charges,70% of total billed charges,179.4,65,,143.52,percent of total billed charges,65% of total billed charges,98.45,35.67,,78.76,percent of total billed charges,35.67% of total billed charges,80.04,276,
LOCKING SCREW 2.0 9MM,27009736,CDM,278,RC,C1713,HCPCS,outpatient,,,736,294.40,,515.2,70,,412.16,percent of total billed charges,70% of total billed charges,736,100,,588.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,603.52,82,,482.816,percent of total billed charges,82% of total billed charges,625.6,85,,500.48,percent of total billed charges,85% of total billed charges,625.6,85,,500.48,percent of total billed charges,85% of total billed charges,625.6,85,,500.48,percent of total billed charges,85% of total billed charges,662.4,90,,529.92,percent of total billed charges,90% of total billed charges,588.8,80,,471.04,percent of total billed charges,80% of total billed charges,662.4,90,,529.92,percent of total billed charges,90% of total billed charges,552,75,,441.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,213.44,29,,170.752,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,493.12,67,,394.496,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,515.2,70,,412.16,percent of total billed charges,70% of total billed charges,478.4,65,,382.72,percent of total billed charges,65% of total billed charges,262.53,35.67,,210.024,percent of total billed charges,35.67% of total billed charges,213.44,736,
LOCKING SCREW 2.0 11MM,27009737,CDM,278,RC,C1713,HCPCS,outpatient,,,736,294.40,,515.2,70,,412.16,percent of total billed charges,70% of total billed charges,736,100,,588.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,603.52,82,,482.816,percent of total billed charges,82% of total billed charges,625.6,85,,500.48,percent of total billed charges,85% of total billed charges,625.6,85,,500.48,percent of total billed charges,85% of total billed charges,625.6,85,,500.48,percent of total billed charges,85% of total billed charges,662.4,90,,529.92,percent of total billed charges,90% of total billed charges,588.8,80,,471.04,percent of total billed charges,80% of total billed charges,662.4,90,,529.92,percent of total billed charges,90% of total billed charges,552,75,,441.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,213.44,29,,170.752,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,493.12,67,,394.496,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,515.2,70,,412.16,percent of total billed charges,70% of total billed charges,478.4,65,,382.72,percent of total billed charges,65% of total billed charges,262.53,35.67,,210.024,percent of total billed charges,35.67% of total billed charges,213.44,736,
LOCKING SCREW 2.0 16MM,27009738,CDM,278,RC,C1713,HCPCS,outpatient,,,736,294.40,,515.2,70,,412.16,percent of total billed charges,70% of total billed charges,736,100,,588.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,603.52,82,,482.816,percent of total billed charges,82% of total billed charges,625.6,85,,500.48,percent of total billed charges,85% of total billed charges,625.6,85,,500.48,percent of total billed charges,85% of total billed charges,625.6,85,,500.48,percent of total billed charges,85% of total billed charges,662.4,90,,529.92,percent of total billed charges,90% of total billed charges,588.8,80,,471.04,percent of total billed charges,80% of total billed charges,662.4,90,,529.92,percent of total billed charges,90% of total billed charges,552,75,,441.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,213.44,29,,170.752,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,493.12,67,,394.496,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,515.2,70,,412.16,percent of total billed charges,70% of total billed charges,478.4,65,,382.72,percent of total billed charges,65% of total billed charges,262.53,35.67,,210.024,percent of total billed charges,35.67% of total billed charges,213.44,736,
LOCKING SCREW 2.0 20 MM,27009739,CDM,278,RC,C1713,HCPCS,outpatient,,,736,294.40,,515.2,70,,412.16,percent of total billed charges,70% of total billed charges,736,100,,588.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,603.52,82,,482.816,percent of total billed charges,82% of total billed charges,625.6,85,,500.48,percent of total billed charges,85% of total billed charges,625.6,85,,500.48,percent of total billed charges,85% of total billed charges,625.6,85,,500.48,percent of total billed charges,85% of total billed charges,662.4,90,,529.92,percent of total billed charges,90% of total billed charges,588.8,80,,471.04,percent of total billed charges,80% of total billed charges,662.4,90,,529.92,percent of total billed charges,90% of total billed charges,552,75,,441.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,213.44,29,,170.752,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,493.12,67,,394.496,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,515.2,70,,412.16,percent of total billed charges,70% of total billed charges,478.4,65,,382.72,percent of total billed charges,65% of total billed charges,262.53,35.67,,210.024,percent of total billed charges,35.67% of total billed charges,213.44,736,
GUIDEWIRE 0.8,27009741,CDM,278,RC,C1769,HCPCS,outpatient,,,495,198.00,,346.5,70,,277.2,percent of total billed charges,70% of total billed charges,495,100,,396,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,405.9,82,,324.72,percent of total billed charges,82% of total billed charges,420.75,85,,336.6,percent of total billed charges,85% of total billed charges,420.75,85,,336.6,percent of total billed charges,85% of total billed charges,420.75,85,,336.6,percent of total billed charges,85% of total billed charges,445.5,90,,356.4,percent of total billed charges,90% of total billed charges,396,80,,316.8,percent of total billed charges,80% of total billed charges,445.5,90,,356.4,percent of total billed charges,90% of total billed charges,371.25,75,,297,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,143.55,29,,114.84,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,331.65,67,,265.32,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,346.5,70,,277.2,percent of total billed charges,70% of total billed charges,321.75,65,,257.4,percent of total billed charges,65% of total billed charges,176.57,35.67,,141.256,percent of total billed charges,35.67% of total billed charges,143.55,495,
PLATE 12 HOLE 2.0,27009742,CDM,278,RC,C1713,HCPCS,outpatient,,,2148,859.20,,1503.6,70,,1202.88,percent of total billed charges,70% of total billed charges,1127.7,52.5,,902.16,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,1761.36,82,,1409.088,percent of total billed charges,82% of total billed charges,1825.8,85,,1460.64,percent of total billed charges,85% of total billed charges,1825.8,85,,1460.64,percent of total billed charges,85% of total billed charges,1825.8,85,,1460.64,percent of total billed charges,85% of total billed charges,1933.2,90,,1546.56,percent of total billed charges,90% of total billed charges,1718.4,80,,1374.72,percent of total billed charges,80% of total billed charges,1933.2,90,,1546.56,percent of total billed charges,90% of total billed charges,1611,75,,1288.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,622.92,29,,498.336,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1439.16,67,,1151.328,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1503.6,70,,1202.88,percent of total billed charges,70% of total billed charges,1396.2,65,,1116.96,percent of total billed charges,65% of total billed charges,766.19,35.67,,612.952,percent of total billed charges,35.67% of total billed charges,622.92,1933.2,
3.5 LOCKING SCREW 34 MM,27009847,CDM,278,RC,C1713,HCPCS,outpatient,,,802,320.80,,561.4,70,,449.12,percent of total billed charges,70% of total billed charges,802,100,,641.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,657.64,82,,526.112,percent of total billed charges,82% of total billed charges,681.7,85,,545.36,percent of total billed charges,85% of total billed charges,681.7,85,,545.36,percent of total billed charges,85% of total billed charges,681.7,85,,545.36,percent of total billed charges,85% of total billed charges,721.8,90,,577.44,percent of total billed charges,90% of total billed charges,641.6,80,,513.28,percent of total billed charges,80% of total billed charges,721.8,90,,577.44,percent of total billed charges,90% of total billed charges,601.5,75,,481.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,232.58,29,,186.064,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,537.34,67,,429.872,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,561.4,70,,449.12,percent of total billed charges,70% of total billed charges,521.3,65,,417.04,percent of total billed charges,65% of total billed charges,286.07,35.67,,228.856,percent of total billed charges,35.67% of total billed charges,232.58,802,
3.5 LOCKING SCREW 36MM,27009848,CDM,278,RC,C1713,HCPCS,outpatient,,,802,320.80,,561.4,70,,449.12,percent of total billed charges,70% of total billed charges,802,100,,641.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,657.64,82,,526.112,percent of total billed charges,82% of total billed charges,681.7,85,,545.36,percent of total billed charges,85% of total billed charges,681.7,85,,545.36,percent of total billed charges,85% of total billed charges,681.7,85,,545.36,percent of total billed charges,85% of total billed charges,721.8,90,,577.44,percent of total billed charges,90% of total billed charges,641.6,80,,513.28,percent of total billed charges,80% of total billed charges,721.8,90,,577.44,percent of total billed charges,90% of total billed charges,601.5,75,,481.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,232.58,29,,186.064,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,537.34,67,,429.872,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,561.4,70,,449.12,percent of total billed charges,70% of total billed charges,521.3,65,,417.04,percent of total billed charges,65% of total billed charges,286.07,35.67,,228.856,percent of total billed charges,35.67% of total billed charges,232.58,802,
3.5 CORTEX SCREW 38MM,27009849,CDM,278,RC,C1713,HCPCS,outpatient,,,195,78.00,,136.5,70,,109.2,percent of total billed charges,70% of total billed charges,195,100,,156,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,159.9,82,,127.92,percent of total billed charges,82% of total billed charges,165.75,85,,132.6,percent of total billed charges,85% of total billed charges,165.75,85,,132.6,percent of total billed charges,85% of total billed charges,165.75,85,,132.6,percent of total billed charges,85% of total billed charges,175.5,90,,140.4,percent of total billed charges,90% of total billed charges,156,80,,124.8,percent of total billed charges,80% of total billed charges,175.5,90,,140.4,percent of total billed charges,90% of total billed charges,146.25,75,,117,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,56.55,29,,45.24,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,130.65,67,,104.52,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,136.5,70,,109.2,percent of total billed charges,70% of total billed charges,126.75,65,,101.4,percent of total billed charges,65% of total billed charges,69.56,35.67,,55.648,percent of total billed charges,35.67% of total billed charges,56.55,195,
4 HOLE DISTAL RADIUS PLATE,27009850,CDM,278,RC,C1713,HCPCS,outpatient,,,3104,1241.60,,2172.8,70,,1738.24,percent of total billed charges,70% of total billed charges,1629.6,52.5,,1303.68,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,2545.28,82,,2036.224,percent of total billed charges,82% of total billed charges,2638.4,85,,2110.72,percent of total billed charges,85% of total billed charges,2638.4,85,,2110.72,percent of total billed charges,85% of total billed charges,2638.4,85,,2110.72,percent of total billed charges,85% of total billed charges,2793.6,90,,2234.88,percent of total billed charges,90% of total billed charges,2483.2,80,,1986.56,percent of total billed charges,80% of total billed charges,2793.6,90,,2234.88,percent of total billed charges,90% of total billed charges,2328,75,,1862.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,900.16,29,,720.128,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,2079.68,67,,1663.744,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,2172.8,70,,1738.24,percent of total billed charges,70% of total billed charges,2017.6,65,,1614.08,percent of total billed charges,65% of total billed charges,1107.2,35.67,,885.76,percent of total billed charges,35.67% of total billed charges,900.16,2793.6,
2.7 CORTEX SCREW 20 MM,27009851,CDM,278,RC,C1713,HCPCS,outpatient,,,286,114.40,,200.2,70,,160.16,percent of total billed charges,70% of total billed charges,286,100,,228.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,234.52,82,,187.616,percent of total billed charges,82% of total billed charges,243.1,85,,194.48,percent of total billed charges,85% of total billed charges,243.1,85,,194.48,percent of total billed charges,85% of total billed charges,243.1,85,,194.48,percent of total billed charges,85% of total billed charges,257.4,90,,205.92,percent of total billed charges,90% of total billed charges,228.8,80,,183.04,percent of total billed charges,80% of total billed charges,257.4,90,,205.92,percent of total billed charges,90% of total billed charges,214.5,75,,171.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,82.94,29,,66.352,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,191.62,67,,153.296,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,200.2,70,,160.16,percent of total billed charges,70% of total billed charges,185.9,65,,148.72,percent of total billed charges,65% of total billed charges,102.02,35.67,,81.616,percent of total billed charges,35.67% of total billed charges,82.94,286,
MINI RIGHT CALCANEAL PLATE,27009852,CDM,278,RC,C1713,HCPCS,outpatient,,,2387,954.80,,1670.9,70,,1336.72,percent of total billed charges,70% of total billed charges,1253.18,52.5,,1002.54,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,1957.34,82,,1565.872,percent of total billed charges,82% of total billed charges,2028.95,85,,1623.16,percent of total billed charges,85% of total billed charges,2028.95,85,,1623.16,percent of total billed charges,85% of total billed charges,2028.95,85,,1623.16,percent of total billed charges,85% of total billed charges,2148.3,90,,1718.64,percent of total billed charges,90% of total billed charges,1909.6,80,,1527.68,percent of total billed charges,80% of total billed charges,2148.3,90,,1718.64,percent of total billed charges,90% of total billed charges,1790.25,75,,1432.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,692.23,29,,553.784,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1599.29,67,,1279.432,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1670.9,70,,1336.72,percent of total billed charges,70% of total billed charges,1551.55,65,,1241.24,percent of total billed charges,65% of total billed charges,851.44,35.67,,681.152,percent of total billed charges,35.67% of total billed charges,692.23,2148.3,
FILSHIE CLIPS,27009903,CDM,278,RC,,,outpatient,,,444,177.60,,310.8,70,,248.64,percent of total billed charges,70% of total billed charges,444,100,,355.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,364.08,82,,291.264,percent of total billed charges,82% of total billed charges,377.4,85,,301.92,percent of total billed charges,85% of total billed charges,377.4,85,,301.92,percent of total billed charges,85% of total billed charges,377.4,85,,301.92,percent of total billed charges,85% of total billed charges,399.6,90,,319.68,percent of total billed charges,90% of total billed charges,355.2,80,,284.16,percent of total billed charges,80% of total billed charges,399.6,90,,319.68,percent of total billed charges,90% of total billed charges,333,75,,266.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,128.76,29,,103.008,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,297.48,67,,237.984,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,310.8,70,,248.64,percent of total billed charges,70% of total billed charges,288.6,65,,230.88,percent of total billed charges,65% of total billed charges,158.37,35.67,,126.696,percent of total billed charges,35.67% of total billed charges,128.76,444,
GUIDE WIRE PTFE W/3CM FEX TIP,27009913,CDM,278,RC,C1769,HCPCS,outpatient,,,226,90.40,,158.2,70,,126.56,percent of total billed charges,70% of total billed charges,226,100,,180.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,185.32,82,,148.256,percent of total billed charges,82% of total billed charges,192.1,85,,153.68,percent of total billed charges,85% of total billed charges,192.1,85,,153.68,percent of total billed charges,85% of total billed charges,192.1,85,,153.68,percent of total billed charges,85% of total billed charges,203.4,90,,162.72,percent of total billed charges,90% of total billed charges,180.8,80,,144.64,percent of total billed charges,80% of total billed charges,203.4,90,,162.72,percent of total billed charges,90% of total billed charges,169.5,75,,135.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,65.54,29,,52.432,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,151.42,67,,121.136,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,158.2,70,,126.56,percent of total billed charges,70% of total billed charges,146.9,65,,117.52,percent of total billed charges,65% of total billed charges,80.61,35.67,,64.488,percent of total billed charges,35.67% of total billed charges,65.54,226,
COOK CUTTING LOOP 24FR WIRE 12,27009925,CDM,278,RC,,,outpatient,,,465,186.00,,325.5,70,,260.4,percent of total billed charges,70% of total billed charges,465,100,,372,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,381.3,82,,305.04,percent of total billed charges,82% of total billed charges,395.25,85,,316.2,percent of total billed charges,85% of total billed charges,395.25,85,,316.2,percent of total billed charges,85% of total billed charges,395.25,85,,316.2,percent of total billed charges,85% of total billed charges,418.5,90,,334.8,percent of total billed charges,90% of total billed charges,372,80,,297.6,percent of total billed charges,80% of total billed charges,418.5,90,,334.8,percent of total billed charges,90% of total billed charges,348.75,75,,279,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,134.85,29,,107.88,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,311.55,67,,249.24,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,325.5,70,,260.4,percent of total billed charges,70% of total billed charges,302.25,65,,241.8,percent of total billed charges,65% of total billed charges,165.87,35.67,,132.696,percent of total billed charges,35.67% of total billed charges,134.85,465,
PLATE ARATRUMIC VOLUR L NARROW,27009934,CDM,278,RC,C1713,HCPCS,outpatient,,,3141,1256.40,,2198.7,70,,1758.96,percent of total billed charges,70% of total billed charges,1649.03,52.5,,1319.22,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,2575.62,82,,2060.496,percent of total billed charges,82% of total billed charges,2669.85,85,,2135.88,percent of total billed charges,85% of total billed charges,2669.85,85,,2135.88,percent of total billed charges,85% of total billed charges,2669.85,85,,2135.88,percent of total billed charges,85% of total billed charges,2826.9,90,,2261.52,percent of total billed charges,90% of total billed charges,2512.8,80,,2010.24,percent of total billed charges,80% of total billed charges,2826.9,90,,2261.52,percent of total billed charges,90% of total billed charges,2355.75,75,,1884.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,910.89,29,,728.712,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,2104.47,67,,1683.576,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,2198.7,70,,1758.96,percent of total billed charges,70% of total billed charges,2041.65,65,,1633.32,percent of total billed charges,65% of total billed charges,1120.39,35.67,,896.312,percent of total billed charges,35.67% of total billed charges,910.89,2826.9,
SCREW BONE 22MM 27,27009935,CDM,278,RC,C1713,HCPCS,outpatient,,,701,280.40,,490.7,70,,392.56,percent of total billed charges,70% of total billed charges,701,100,,560.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,574.82,82,,459.856,percent of total billed charges,82% of total billed charges,595.85,85,,476.68,percent of total billed charges,85% of total billed charges,595.85,85,,476.68,percent of total billed charges,85% of total billed charges,595.85,85,,476.68,percent of total billed charges,85% of total billed charges,630.9,90,,504.72,percent of total billed charges,90% of total billed charges,560.8,80,,448.64,percent of total billed charges,80% of total billed charges,630.9,90,,504.72,percent of total billed charges,90% of total billed charges,525.75,75,,420.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,203.29,29,,162.632,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,469.67,67,,375.736,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,490.7,70,,392.56,percent of total billed charges,70% of total billed charges,455.65,65,,364.52,percent of total billed charges,65% of total billed charges,250.05,35.67,,200.04,percent of total billed charges,35.67% of total billed charges,203.29,701,
SCREW BONE 12MM 27,27009936,CDM,278,RC,C1713,HCPCS,outpatient,,,701,280.40,,490.7,70,,392.56,percent of total billed charges,70% of total billed charges,701,100,,560.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,574.82,82,,459.856,percent of total billed charges,82% of total billed charges,595.85,85,,476.68,percent of total billed charges,85% of total billed charges,595.85,85,,476.68,percent of total billed charges,85% of total billed charges,595.85,85,,476.68,percent of total billed charges,85% of total billed charges,630.9,90,,504.72,percent of total billed charges,90% of total billed charges,560.8,80,,448.64,percent of total billed charges,80% of total billed charges,630.9,90,,504.72,percent of total billed charges,90% of total billed charges,525.75,75,,420.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,203.29,29,,162.632,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,469.67,67,,375.736,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,490.7,70,,392.56,percent of total billed charges,70% of total billed charges,455.65,65,,364.52,percent of total billed charges,65% of total billed charges,250.05,35.67,,200.04,percent of total billed charges,35.67% of total billed charges,203.29,701,
SCREW LOCK 14MM 27,27009937,CDM,278,RC,C1713,HCPCS,outpatient,,,1071,428.40,,749.7,70,,599.76,percent of total billed charges,70% of total billed charges,562.28,52.5,,449.82,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,878.22,82,,702.576,percent of total billed charges,82% of total billed charges,910.35,85,,728.28,percent of total billed charges,85% of total billed charges,910.35,85,,728.28,percent of total billed charges,85% of total billed charges,910.35,85,,728.28,percent of total billed charges,85% of total billed charges,963.9,90,,771.12,percent of total billed charges,90% of total billed charges,856.8,80,,685.44,percent of total billed charges,80% of total billed charges,963.9,90,,771.12,percent of total billed charges,90% of total billed charges,803.25,75,,642.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,310.59,29,,248.472,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,717.57,67,,574.056,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,749.7,70,,599.76,percent of total billed charges,70% of total billed charges,696.15,65,,556.92,percent of total billed charges,65% of total billed charges,382.03,35.67,,305.624,percent of total billed charges,35.67% of total billed charges,310.59,963.9,
SCREW LOCK 12MM 27,27009938,CDM,278,RC,C1713,HCPCS,outpatient,,,719,287.60,,503.3,70,,402.64,percent of total billed charges,70% of total billed charges,719,100,,575.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,589.58,82,,471.664,percent of total billed charges,82% of total billed charges,611.15,85,,488.92,percent of total billed charges,85% of total billed charges,611.15,85,,488.92,percent of total billed charges,85% of total billed charges,611.15,85,,488.92,percent of total billed charges,85% of total billed charges,647.1,90,,517.68,percent of total billed charges,90% of total billed charges,575.2,80,,460.16,percent of total billed charges,80% of total billed charges,647.1,90,,517.68,percent of total billed charges,90% of total billed charges,539.25,75,,431.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,208.51,29,,166.808,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,481.73,67,,385.384,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,503.3,70,,402.64,percent of total billed charges,70% of total billed charges,467.35,65,,373.88,percent of total billed charges,65% of total billed charges,256.47,35.67,,205.176,percent of total billed charges,35.67% of total billed charges,208.51,719,
SCREW LOCK 20MM 27,27009939,CDM,278,RC,C1713,HCPCS,outpatient,,,719,287.60,,503.3,70,,402.64,percent of total billed charges,70% of total billed charges,719,100,,575.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,589.58,82,,471.664,percent of total billed charges,82% of total billed charges,611.15,85,,488.92,percent of total billed charges,85% of total billed charges,611.15,85,,488.92,percent of total billed charges,85% of total billed charges,611.15,85,,488.92,percent of total billed charges,85% of total billed charges,647.1,90,,517.68,percent of total billed charges,90% of total billed charges,575.2,80,,460.16,percent of total billed charges,80% of total billed charges,647.1,90,,517.68,percent of total billed charges,90% of total billed charges,539.25,75,,431.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,208.51,29,,166.808,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,481.73,67,,385.384,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,503.3,70,,402.64,percent of total billed charges,70% of total billed charges,467.35,65,,373.88,percent of total billed charges,65% of total billed charges,256.47,35.67,,205.176,percent of total billed charges,35.67% of total billed charges,208.51,719,
SCREW LOCK 18MM 27,27009940,CDM,278,RC,C1713,HCPCS,outpatient,,,701,280.40,,490.7,70,,392.56,percent of total billed charges,70% of total billed charges,701,100,,560.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,574.82,82,,459.856,percent of total billed charges,82% of total billed charges,595.85,85,,476.68,percent of total billed charges,85% of total billed charges,595.85,85,,476.68,percent of total billed charges,85% of total billed charges,595.85,85,,476.68,percent of total billed charges,85% of total billed charges,630.9,90,,504.72,percent of total billed charges,90% of total billed charges,560.8,80,,448.64,percent of total billed charges,80% of total billed charges,630.9,90,,504.72,percent of total billed charges,90% of total billed charges,525.75,75,,420.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,203.29,29,,162.632,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,469.67,67,,375.736,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,490.7,70,,392.56,percent of total billed charges,70% of total billed charges,455.65,65,,364.52,percent of total billed charges,65% of total billed charges,250.05,35.67,,200.04,percent of total billed charges,35.67% of total billed charges,203.29,701,
K-WIRE OLIVE STOP,27009941,CDM,278,RC,C1769,HCPCS,outpatient,,,234,93.60,,163.8,70,,131.04,percent of total billed charges,70% of total billed charges,234,100,,187.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,191.88,82,,153.504,percent of total billed charges,82% of total billed charges,198.9,85,,159.12,percent of total billed charges,85% of total billed charges,198.9,85,,159.12,percent of total billed charges,85% of total billed charges,198.9,85,,159.12,percent of total billed charges,85% of total billed charges,210.6,90,,168.48,percent of total billed charges,90% of total billed charges,187.2,80,,149.76,percent of total billed charges,80% of total billed charges,210.6,90,,168.48,percent of total billed charges,90% of total billed charges,175.5,75,,140.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,67.86,29,,54.288,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,156.78,67,,125.424,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,163.8,70,,131.04,percent of total billed charges,70% of total billed charges,152.1,65,,121.68,percent of total billed charges,65% of total billed charges,83.47,35.67,,66.776,percent of total billed charges,35.67% of total billed charges,67.86,234,
THREADED K-WIRE 32X300,27009946,CDM,278,RC,C1769,HCPCS,outpatient,,,845,338.00,,591.5,70,,473.2,percent of total billed charges,70% of total billed charges,845,100,,676,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,692.9,82,,554.32,percent of total billed charges,82% of total billed charges,718.25,85,,574.6,percent of total billed charges,85% of total billed charges,718.25,85,,574.6,percent of total billed charges,85% of total billed charges,718.25,85,,574.6,percent of total billed charges,85% of total billed charges,760.5,90,,608.4,percent of total billed charges,90% of total billed charges,676,80,,540.8,percent of total billed charges,80% of total billed charges,760.5,90,,608.4,percent of total billed charges,90% of total billed charges,633.75,75,,507,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,245.05,29,,196.04,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,566.15,67,,452.92,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,591.5,70,,473.2,percent of total billed charges,70% of total billed charges,549.25,65,,439.4,percent of total billed charges,65% of total billed charges,301.41,35.67,,241.128,percent of total billed charges,35.67% of total billed charges,245.05,845,
CANNULATED SCREW PT 95MM 6.5,27009947,CDM,278,RC,C1713,HCPCS,outpatient,,,1582,632.80,,1107.4,70,,885.92,percent of total billed charges,70% of total billed charges,830.55,52.5,,664.44,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,1297.24,82,,1037.792,percent of total billed charges,82% of total billed charges,1344.7,85,,1075.76,percent of total billed charges,85% of total billed charges,1344.7,85,,1075.76,percent of total billed charges,85% of total billed charges,1344.7,85,,1075.76,percent of total billed charges,85% of total billed charges,1423.8,90,,1139.04,percent of total billed charges,90% of total billed charges,1265.6,80,,1012.48,percent of total billed charges,80% of total billed charges,1423.8,90,,1139.04,percent of total billed charges,90% of total billed charges,1186.5,75,,949.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,458.78,29,,367.024,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1059.94,67,,847.952,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1107.4,70,,885.92,percent of total billed charges,70% of total billed charges,1028.3,65,,822.64,percent of total billed charges,65% of total billed charges,564.3,35.67,,451.44,percent of total billed charges,35.67% of total billed charges,458.78,1423.8,
CANNULATED SCREW PT 110MM 6.5,27009948,CDM,278,RC,C1713,HCPCS,outpatient,,,1582,632.80,,1107.4,70,,885.92,percent of total billed charges,70% of total billed charges,830.55,52.5,,664.44,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,1297.24,82,,1037.792,percent of total billed charges,82% of total billed charges,1344.7,85,,1075.76,percent of total billed charges,85% of total billed charges,1344.7,85,,1075.76,percent of total billed charges,85% of total billed charges,1344.7,85,,1075.76,percent of total billed charges,85% of total billed charges,1423.8,90,,1139.04,percent of total billed charges,90% of total billed charges,1265.6,80,,1012.48,percent of total billed charges,80% of total billed charges,1423.8,90,,1139.04,percent of total billed charges,90% of total billed charges,1186.5,75,,949.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,458.78,29,,367.024,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1059.94,67,,847.952,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1107.4,70,,885.92,percent of total billed charges,70% of total billed charges,1028.3,65,,822.64,percent of total billed charges,65% of total billed charges,564.3,35.67,,451.44,percent of total billed charges,35.67% of total billed charges,458.78,1423.8,
CANNULATED SCREW PT 100MM 6.5,27009949,CDM,278,RC,C1713,HCPCS,outpatient,,,1582,632.80,,1107.4,70,,885.92,percent of total billed charges,70% of total billed charges,830.55,52.5,,664.44,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,1297.24,82,,1037.792,percent of total billed charges,82% of total billed charges,1344.7,85,,1075.76,percent of total billed charges,85% of total billed charges,1344.7,85,,1075.76,percent of total billed charges,85% of total billed charges,1344.7,85,,1075.76,percent of total billed charges,85% of total billed charges,1423.8,90,,1139.04,percent of total billed charges,90% of total billed charges,1265.6,80,,1012.48,percent of total billed charges,80% of total billed charges,1423.8,90,,1139.04,percent of total billed charges,90% of total billed charges,1186.5,75,,949.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,458.78,29,,367.024,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1059.94,67,,847.952,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1107.4,70,,885.92,percent of total billed charges,70% of total billed charges,1028.3,65,,822.64,percent of total billed charges,65% of total billed charges,564.3,35.67,,451.44,percent of total billed charges,35.67% of total billed charges,458.78,1423.8,
HOLE STRAIGHT PLAITE 16,27009950,CDM,278,RC,C1713,HCPCS,outpatient,,,1853,741.20,,1297.1,70,,1037.68,percent of total billed charges,70% of total billed charges,972.83,52.5,,778.26,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,1519.46,82,,1215.568,percent of total billed charges,82% of total billed charges,1575.05,85,,1260.04,percent of total billed charges,85% of total billed charges,1575.05,85,,1260.04,percent of total billed charges,85% of total billed charges,1575.05,85,,1260.04,percent of total billed charges,85% of total billed charges,1667.7,90,,1334.16,percent of total billed charges,90% of total billed charges,1482.4,80,,1185.92,percent of total billed charges,80% of total billed charges,1667.7,90,,1334.16,percent of total billed charges,90% of total billed charges,1389.75,75,,1111.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,537.37,29,,429.896,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1241.51,67,,993.208,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1297.1,70,,1037.68,percent of total billed charges,70% of total billed charges,1204.45,65,,963.56,percent of total billed charges,65% of total billed charges,660.97,35.67,,528.776,percent of total billed charges,35.67% of total billed charges,537.37,1667.7,
BONE SCREW 10MM 2.3,27009951,CDM,278,RC,C1713,HCPCS,outpatient,,,586,234.40,,410.2,70,,328.16,percent of total billed charges,70% of total billed charges,586,100,,468.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,480.52,82,,384.416,percent of total billed charges,82% of total billed charges,498.1,85,,398.48,percent of total billed charges,85% of total billed charges,498.1,85,,398.48,percent of total billed charges,85% of total billed charges,498.1,85,,398.48,percent of total billed charges,85% of total billed charges,527.4,90,,421.92,percent of total billed charges,90% of total billed charges,468.8,80,,375.04,percent of total billed charges,80% of total billed charges,527.4,90,,421.92,percent of total billed charges,90% of total billed charges,439.5,75,,351.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,169.94,29,,135.952,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,392.62,67,,314.096,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,410.2,70,,328.16,percent of total billed charges,70% of total billed charges,380.9,65,,304.72,percent of total billed charges,65% of total billed charges,209.03,35.67,,167.224,percent of total billed charges,35.67% of total billed charges,169.94,586,
LOCK SCREW 13MM 2.3,27009952,CDM,278,RC,C1713,HCPCS,outpatient,,,707,282.80,,494.9,70,,395.92,percent of total billed charges,70% of total billed charges,707,100,,565.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,579.74,82,,463.792,percent of total billed charges,82% of total billed charges,600.95,85,,480.76,percent of total billed charges,85% of total billed charges,600.95,85,,480.76,percent of total billed charges,85% of total billed charges,600.95,85,,480.76,percent of total billed charges,85% of total billed charges,636.3,90,,509.04,percent of total billed charges,90% of total billed charges,565.6,80,,452.48,percent of total billed charges,80% of total billed charges,636.3,90,,509.04,percent of total billed charges,90% of total billed charges,530.25,75,,424.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,205.03,29,,164.024,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,473.69,67,,378.952,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,494.9,70,,395.92,percent of total billed charges,70% of total billed charges,459.55,65,,367.64,percent of total billed charges,65% of total billed charges,252.19,35.67,,201.752,percent of total billed charges,35.67% of total billed charges,205.03,707,
LOCK SCREW 13MM 2.3,27009953,CDM,278,RC,C1713,HCPCS,outpatient,,,707,282.80,,494.9,70,,395.92,percent of total billed charges,70% of total billed charges,707,100,,565.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,579.74,82,,463.792,percent of total billed charges,82% of total billed charges,600.95,85,,480.76,percent of total billed charges,85% of total billed charges,600.95,85,,480.76,percent of total billed charges,85% of total billed charges,600.95,85,,480.76,percent of total billed charges,85% of total billed charges,636.3,90,,509.04,percent of total billed charges,90% of total billed charges,565.6,80,,452.48,percent of total billed charges,80% of total billed charges,636.3,90,,509.04,percent of total billed charges,90% of total billed charges,530.25,75,,424.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,205.03,29,,164.024,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,473.69,67,,378.952,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,494.9,70,,395.92,percent of total billed charges,70% of total billed charges,459.55,65,,367.64,percent of total billed charges,65% of total billed charges,252.19,35.67,,201.752,percent of total billed charges,35.67% of total billed charges,205.03,707,
ACCESSORY KIT AMS 800 (R),27009960,CDM,278,RC,C2631,HCPCS,outpatient,,,1763,705.20,,1234.1,70,,987.28,percent of total billed charges,70% of total billed charges,925.58,52.5,,740.46,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,1445.66,82,,1156.528,percent of total billed charges,82% of total billed charges,1498.55,85,,1198.84,percent of total billed charges,85% of total billed charges,1498.55,85,,1198.84,percent of total billed charges,85% of total billed charges,1498.55,85,,1198.84,percent of total billed charges,85% of total billed charges,1586.7,90,,1269.36,percent of total billed charges,90% of total billed charges,1410.4,80,,1128.32,percent of total billed charges,80% of total billed charges,1586.7,90,,1269.36,percent of total billed charges,90% of total billed charges,1322.25,75,,1057.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,511.27,29,,409.016,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1181.21,67,,944.968,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1234.1,70,,987.28,percent of total billed charges,70% of total billed charges,1145.95,65,,916.76,percent of total billed charges,65% of total billed charges,628.86,35.67,,503.088,percent of total billed charges,35.67% of total billed charges,511.27,1586.7,
CUFF 800 WITH 3.5 CM,27009961,CDM,278,RC,C1815,HCPCS,outpatient,,,11535,4614.00,,8074.5,70,,6459.6,percent of total billed charges,70% of total billed charges,6055.88,52.5,,4844.7,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,9458.7,82,,7566.96,percent of total billed charges,82% of total billed charges,9804.75,85,,7843.8,percent of total billed charges,85% of total billed charges,9804.75,85,,7843.8,percent of total billed charges,85% of total billed charges,9804.75,85,,7843.8,percent of total billed charges,85% of total billed charges,10381.5,90,,8305.2,percent of total billed charges,90% of total billed charges,9228,80,,7382.4,percent of total billed charges,80% of total billed charges,10381.5,90,,8305.2,percent of total billed charges,90% of total billed charges,8651.25,75,,6921,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,3345.15,29,,2676.12,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,7728.45,67,,6182.76,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,8074.5,70,,6459.6,percent of total billed charges,70% of total billed charges,7497.75,65,,5998.2,percent of total billed charges,65% of total billed charges,4114.53,35.67,,3291.624,percent of total billed charges,35.67% of total billed charges,3345.15,10381.5,
PRESS REG BALLOON 61-70CM,27009962,CDM,278,RC,,,outpatient,,,5670,2268.00,,3969,70,,3175.2,percent of total billed charges,70% of total billed charges,2976.75,52.5,,2381.4,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,4649.4,82,,3719.52,percent of total billed charges,82% of total billed charges,4819.5,85,,3855.6,percent of total billed charges,85% of total billed charges,4819.5,85,,3855.6,percent of total billed charges,85% of total billed charges,4819.5,85,,3855.6,percent of total billed charges,85% of total billed charges,5103,90,,4082.4,percent of total billed charges,90% of total billed charges,4536,80,,3628.8,percent of total billed charges,80% of total billed charges,5103,90,,4082.4,percent of total billed charges,90% of total billed charges,4252.5,75,,3402,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,1644.3,29,,1315.44,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,3798.9,67,,3039.12,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,3969,70,,3175.2,percent of total billed charges,70% of total billed charges,3685.5,65,,2948.4,percent of total billed charges,65% of total billed charges,2022.49,35.67,,1617.992,percent of total billed charges,35.67% of total billed charges,1644.3,5103,
CONTROL PUMP WITH IZ,27009963,CDM,278,RC,C1815,HCPCS,outpatient,,,11836,4734.40,,8285.2,70,,6628.16,percent of total billed charges,70% of total billed charges,6213.9,52.5,,4971.12,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,9705.52,82,,7764.416,percent of total billed charges,82% of total billed charges,10060.6,85,,8048.48,percent of total billed charges,85% of total billed charges,10060.6,85,,8048.48,percent of total billed charges,85% of total billed charges,10060.6,85,,8048.48,percent of total billed charges,85% of total billed charges,10652.4,90,,8521.92,percent of total billed charges,90% of total billed charges,9468.8,80,,7575.04,percent of total billed charges,80% of total billed charges,10652.4,90,,8521.92,percent of total billed charges,90% of total billed charges,8877,75,,7101.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,3432.44,29,,2745.952,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,7930.12,67,,6344.096,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,8285.2,70,,6628.16,percent of total billed charges,70% of total billed charges,7693.4,65,,6154.72,percent of total billed charges,65% of total billed charges,4221.9,35.67,,3377.52,percent of total billed charges,35.67% of total billed charges,3432.44,10652.4,
BIOCOMPOSITE TNODSIS SCRW 4.75,27009971,CDM,278,RC,C1713,HCPCS,outpatient,,,2014,805.60,,1409.8,70,,1127.84,percent of total billed charges,70% of total billed charges,1057.35,52.5,,845.88,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,1651.48,82,,1321.184,percent of total billed charges,82% of total billed charges,1711.9,85,,1369.52,percent of total billed charges,85% of total billed charges,1711.9,85,,1369.52,percent of total billed charges,85% of total billed charges,1711.9,85,,1369.52,percent of total billed charges,85% of total billed charges,1812.6,90,,1450.08,percent of total billed charges,90% of total billed charges,1611.2,80,,1288.96,percent of total billed charges,80% of total billed charges,1812.6,90,,1450.08,percent of total billed charges,90% of total billed charges,1510.5,75,,1208.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,584.06,29,,467.248,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1349.38,67,,1079.504,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1409.8,70,,1127.84,percent of total billed charges,70% of total billed charges,1309.1,65,,1047.28,percent of total billed charges,65% of total billed charges,718.39,35.67,,574.712,percent of total billed charges,35.67% of total billed charges,584.06,1812.6,
BONE SCREW 22MM 2.7,27009985,CDM,278,RC,C1713,HCPCS,outpatient,,,701,280.40,,490.7,70,,392.56,percent of total billed charges,70% of total billed charges,701,100,,560.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,574.82,82,,459.856,percent of total billed charges,82% of total billed charges,595.85,85,,476.68,percent of total billed charges,85% of total billed charges,595.85,85,,476.68,percent of total billed charges,85% of total billed charges,595.85,85,,476.68,percent of total billed charges,85% of total billed charges,630.9,90,,504.72,percent of total billed charges,90% of total billed charges,560.8,80,,448.64,percent of total billed charges,80% of total billed charges,630.9,90,,504.72,percent of total billed charges,90% of total billed charges,525.75,75,,420.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,203.29,29,,162.632,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,469.67,67,,375.736,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,490.7,70,,392.56,percent of total billed charges,70% of total billed charges,455.65,65,,364.52,percent of total billed charges,65% of total billed charges,250.05,35.67,,200.04,percent of total billed charges,35.67% of total billed charges,203.29,701,
BONE SCREW 14MM 2.7,27009986,CDM,278,RC,C1713,HCPCS,outpatient,,,701,280.40,,490.7,70,,392.56,percent of total billed charges,70% of total billed charges,701,100,,560.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,574.82,82,,459.856,percent of total billed charges,82% of total billed charges,595.85,85,,476.68,percent of total billed charges,85% of total billed charges,595.85,85,,476.68,percent of total billed charges,85% of total billed charges,595.85,85,,476.68,percent of total billed charges,85% of total billed charges,630.9,90,,504.72,percent of total billed charges,90% of total billed charges,560.8,80,,448.64,percent of total billed charges,80% of total billed charges,630.9,90,,504.72,percent of total billed charges,90% of total billed charges,525.75,75,,420.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,203.29,29,,162.632,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,469.67,67,,375.736,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,490.7,70,,392.56,percent of total billed charges,70% of total billed charges,455.65,65,,364.52,percent of total billed charges,65% of total billed charges,250.05,35.67,,200.04,percent of total billed charges,35.67% of total billed charges,203.29,701,
LOCK SCREW 16MM 2.7,27009987,CDM,278,RC,C1713,HCPCS,outpatient,,,719,287.60,,503.3,70,,402.64,percent of total billed charges,70% of total billed charges,719,100,,575.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,589.58,82,,471.664,percent of total billed charges,82% of total billed charges,611.15,85,,488.92,percent of total billed charges,85% of total billed charges,611.15,85,,488.92,percent of total billed charges,85% of total billed charges,611.15,85,,488.92,percent of total billed charges,85% of total billed charges,647.1,90,,517.68,percent of total billed charges,90% of total billed charges,575.2,80,,460.16,percent of total billed charges,80% of total billed charges,647.1,90,,517.68,percent of total billed charges,90% of total billed charges,539.25,75,,431.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,208.51,29,,166.808,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,481.73,67,,385.384,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,503.3,70,,402.64,percent of total billed charges,70% of total billed charges,467.35,65,,373.88,percent of total billed charges,65% of total billed charges,256.47,35.67,,205.176,percent of total billed charges,35.67% of total billed charges,208.51,719,
ELEVATE SYSTEM W/INTE PRO LITE,27010003,CDM,278,RC,C1781,HCPCS,outpatient,,,8216,3286.40,,5751.2,70,,4600.96,percent of total billed charges,70% of total billed charges,4313.4,52.5,,3450.72,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,6737.12,82,,5389.696,percent of total billed charges,82% of total billed charges,6983.6,85,,5586.88,percent of total billed charges,85% of total billed charges,6983.6,85,,5586.88,percent of total billed charges,85% of total billed charges,6983.6,85,,5586.88,percent of total billed charges,85% of total billed charges,7394.4,90,,5915.52,percent of total billed charges,90% of total billed charges,6572.8,80,,5258.24,percent of total billed charges,80% of total billed charges,7394.4,90,,5915.52,percent of total billed charges,90% of total billed charges,6162,75,,4929.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2382.64,29,,1906.112,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,5504.72,67,,4403.776,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,5751.2,70,,4600.96,percent of total billed charges,70% of total billed charges,5340.4,65,,4272.32,percent of total billed charges,65% of total billed charges,2930.65,35.67,,2344.52,percent of total billed charges,35.67% of total billed charges,2382.64,7394.4,
BONE SCREW 18MM 2.7,27010004,CDM,278,RC,C1713,HCPCS,outpatient,,,701,280.40,,490.7,70,,392.56,percent of total billed charges,70% of total billed charges,701,100,,560.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,574.82,82,,459.856,percent of total billed charges,82% of total billed charges,595.85,85,,476.68,percent of total billed charges,85% of total billed charges,595.85,85,,476.68,percent of total billed charges,85% of total billed charges,595.85,85,,476.68,percent of total billed charges,85% of total billed charges,630.9,90,,504.72,percent of total billed charges,90% of total billed charges,560.8,80,,448.64,percent of total billed charges,80% of total billed charges,630.9,90,,504.72,percent of total billed charges,90% of total billed charges,525.75,75,,420.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,203.29,29,,162.632,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,469.67,67,,375.736,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,490.7,70,,392.56,percent of total billed charges,70% of total billed charges,455.65,65,,364.52,percent of total billed charges,65% of total billed charges,250.05,35.67,,200.04,percent of total billed charges,35.67% of total billed charges,203.29,701,
BONE SCREW 22MM 2.7,27010005,CDM,278,RC,C1713,HCPCS,outpatient,,,719,287.60,,503.3,70,,402.64,percent of total billed charges,70% of total billed charges,719,100,,575.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,589.58,82,,471.664,percent of total billed charges,82% of total billed charges,611.15,85,,488.92,percent of total billed charges,85% of total billed charges,611.15,85,,488.92,percent of total billed charges,85% of total billed charges,611.15,85,,488.92,percent of total billed charges,85% of total billed charges,647.1,90,,517.68,percent of total billed charges,90% of total billed charges,575.2,80,,460.16,percent of total billed charges,80% of total billed charges,647.1,90,,517.68,percent of total billed charges,90% of total billed charges,539.25,75,,431.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,208.51,29,,166.808,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,481.73,67,,385.384,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,503.3,70,,402.64,percent of total billed charges,70% of total billed charges,467.35,65,,373.88,percent of total billed charges,65% of total billed charges,256.47,35.67,,205.176,percent of total billed charges,35.67% of total billed charges,208.51,719,
ANATOMIC VOLAR L PLATE STANDAR,27010006,CDM,278,RC,C1713,HCPCS,outpatient,,,3805,1522.00,,2663.5,70,,2130.8,percent of total billed charges,70% of total billed charges,1997.63,52.5,,1598.1,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,3120.1,82,,2496.08,percent of total billed charges,82% of total billed charges,3234.25,85,,2587.4,percent of total billed charges,85% of total billed charges,3234.25,85,,2587.4,percent of total billed charges,85% of total billed charges,3234.25,85,,2587.4,percent of total billed charges,85% of total billed charges,3424.5,90,,2739.6,percent of total billed charges,90% of total billed charges,3044,80,,2435.2,percent of total billed charges,80% of total billed charges,3424.5,90,,2739.6,percent of total billed charges,90% of total billed charges,2853.75,75,,2283,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,1103.45,29,,882.76,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,2549.35,67,,2039.48,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,2663.5,70,,2130.8,percent of total billed charges,70% of total billed charges,2473.25,65,,1978.6,percent of total billed charges,65% of total billed charges,1357.24,35.67,,1085.792,percent of total billed charges,35.67% of total billed charges,1103.45,3424.5,
SCREW 1.0 MM,27010015,CDM,278,RC,C1713,HCPCS,outpatient,,,467,186.80,,326.9,70,,261.52,percent of total billed charges,70% of total billed charges,467,100,,373.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,382.94,82,,306.352,percent of total billed charges,82% of total billed charges,396.95,85,,317.56,percent of total billed charges,85% of total billed charges,396.95,85,,317.56,percent of total billed charges,85% of total billed charges,396.95,85,,317.56,percent of total billed charges,85% of total billed charges,420.3,90,,336.24,percent of total billed charges,90% of total billed charges,373.6,80,,298.88,percent of total billed charges,80% of total billed charges,420.3,90,,336.24,percent of total billed charges,90% of total billed charges,350.25,75,,280.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,135.43,29,,108.344,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,312.89,67,,250.312,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,326.9,70,,261.52,percent of total billed charges,70% of total billed charges,303.55,65,,242.84,percent of total billed charges,65% of total billed charges,166.58,35.67,,133.264,percent of total billed charges,35.67% of total billed charges,135.43,467,
SCREW 1.3 MM # 8,27010016,CDM,278,RC,C1713,HCPCS,outpatient,,,489,195.60,,342.3,70,,273.84,percent of total billed charges,70% of total billed charges,489,100,,391.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,400.98,82,,320.784,percent of total billed charges,82% of total billed charges,415.65,85,,332.52,percent of total billed charges,85% of total billed charges,415.65,85,,332.52,percent of total billed charges,85% of total billed charges,415.65,85,,332.52,percent of total billed charges,85% of total billed charges,440.1,90,,352.08,percent of total billed charges,90% of total billed charges,391.2,80,,312.96,percent of total billed charges,80% of total billed charges,440.1,90,,352.08,percent of total billed charges,90% of total billed charges,366.75,75,,293.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,141.81,29,,113.448,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,327.63,67,,262.104,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,342.3,70,,273.84,percent of total billed charges,70% of total billed charges,317.85,65,,254.28,percent of total billed charges,65% of total billed charges,174.43,35.67,,139.544,percent of total billed charges,35.67% of total billed charges,141.81,489,
SCREW 1.3MM 10#,27010017,CDM,278,RC,C1713,HCPCS,outpatient,,,489,195.60,,342.3,70,,273.84,percent of total billed charges,70% of total billed charges,489,100,,391.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,400.98,82,,320.784,percent of total billed charges,82% of total billed charges,415.65,85,,332.52,percent of total billed charges,85% of total billed charges,415.65,85,,332.52,percent of total billed charges,85% of total billed charges,415.65,85,,332.52,percent of total billed charges,85% of total billed charges,440.1,90,,352.08,percent of total billed charges,90% of total billed charges,391.2,80,,312.96,percent of total billed charges,80% of total billed charges,440.1,90,,352.08,percent of total billed charges,90% of total billed charges,366.75,75,,293.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,141.81,29,,113.448,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,327.63,67,,262.104,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,342.3,70,,273.84,percent of total billed charges,70% of total billed charges,317.85,65,,254.28,percent of total billed charges,65% of total billed charges,174.43,35.67,,139.544,percent of total billed charges,35.67% of total billed charges,141.81,489,
URETERAL CATHETER FLEXI TIP,27010084,CDM,278,RC,C1758,HCPCS,outpatient,,,150,60.00,,105,70,,84,percent of total billed charges,70% of total billed charges,150,100,,120,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,123,82,,98.4,percent of total billed charges,82% of total billed charges,127.5,85,,102,percent of total billed charges,85% of total billed charges,127.5,85,,102,percent of total billed charges,85% of total billed charges,127.5,85,,102,percent of total billed charges,85% of total billed charges,135,90,,108,percent of total billed charges,90% of total billed charges,120,80,,96,percent of total billed charges,80% of total billed charges,135,90,,108,percent of total billed charges,90% of total billed charges,112.5,75,,90,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,43.5,29,,34.8,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,100.5,67,,80.4,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,105,70,,84,percent of total billed charges,70% of total billed charges,97.5,65,,78,percent of total billed charges,65% of total billed charges,53.51,35.67,,42.808,percent of total billed charges,35.67% of total billed charges,43.5,150,
URETERAL STENT AND POSITIONER,27010085,CDM,278,RC,C1758,HCPCS,outpatient,,,726,290.40,,508.2,70,,406.56,percent of total billed charges,70% of total billed charges,726,100,,580.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,595.32,82,,476.256,percent of total billed charges,82% of total billed charges,617.1,85,,493.68,percent of total billed charges,85% of total billed charges,617.1,85,,493.68,percent of total billed charges,85% of total billed charges,617.1,85,,493.68,percent of total billed charges,85% of total billed charges,653.4,90,,522.72,percent of total billed charges,90% of total billed charges,580.8,80,,464.64,percent of total billed charges,80% of total billed charges,653.4,90,,522.72,percent of total billed charges,90% of total billed charges,544.5,75,,435.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,210.54,29,,168.432,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,486.42,67,,389.136,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,508.2,70,,406.56,percent of total billed charges,70% of total billed charges,471.9,65,,377.52,percent of total billed charges,65% of total billed charges,258.96,35.67,,207.168,percent of total billed charges,35.67% of total billed charges,210.54,726,
BIO INTRAFIX SCREW 254660,27010087,CDM,278,RC,C1713,HCPCS,outpatient,,,1344,537.60,,940.8,70,,752.64,percent of total billed charges,70% of total billed charges,705.6,52.5,,564.48,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,1102.08,82,,881.664,percent of total billed charges,82% of total billed charges,1142.4,85,,913.92,percent of total billed charges,85% of total billed charges,1142.4,85,,913.92,percent of total billed charges,85% of total billed charges,1142.4,85,,913.92,percent of total billed charges,85% of total billed charges,1209.6,90,,967.68,percent of total billed charges,90% of total billed charges,1075.2,80,,860.16,percent of total billed charges,80% of total billed charges,1209.6,90,,967.68,percent of total billed charges,90% of total billed charges,1008,75,,806.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,389.76,29,,311.808,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,900.48,67,,720.384,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,940.8,70,,752.64,percent of total billed charges,70% of total billed charges,873.6,65,,698.88,percent of total billed charges,65% of total billed charges,479.4,35.67,,383.52,percent of total billed charges,35.67% of total billed charges,389.76,1209.6,
BIO INTRAFIX SHEATH,27010088,CDM,278,RC,C1781,HCPCS,outpatient,,,1344,537.60,,940.8,70,,752.64,percent of total billed charges,70% of total billed charges,705.6,52.5,,564.48,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,1102.08,82,,881.664,percent of total billed charges,82% of total billed charges,1142.4,85,,913.92,percent of total billed charges,85% of total billed charges,1142.4,85,,913.92,percent of total billed charges,85% of total billed charges,1142.4,85,,913.92,percent of total billed charges,85% of total billed charges,1209.6,90,,967.68,percent of total billed charges,90% of total billed charges,1075.2,80,,860.16,percent of total billed charges,80% of total billed charges,1209.6,90,,967.68,percent of total billed charges,90% of total billed charges,1008,75,,806.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,389.76,29,,311.808,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,900.48,67,,720.384,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,940.8,70,,752.64,percent of total billed charges,70% of total billed charges,873.6,65,,698.88,percent of total billed charges,65% of total billed charges,479.4,35.67,,383.52,percent of total billed charges,35.67% of total billed charges,389.76,1209.6,
BIO INTRAFIX INST KIT,27010089,CDM,278,RC,C1713,HCPCS,outpatient,,,1120,448.00,,784,70,,627.2,percent of total billed charges,70% of total billed charges,588,52.5,,470.4,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,918.4,82,,734.72,percent of total billed charges,82% of total billed charges,952,85,,761.6,percent of total billed charges,85% of total billed charges,952,85,,761.6,percent of total billed charges,85% of total billed charges,952,85,,761.6,percent of total billed charges,85% of total billed charges,1008,90,,806.4,percent of total billed charges,90% of total billed charges,896,80,,716.8,percent of total billed charges,80% of total billed charges,1008,90,,806.4,percent of total billed charges,90% of total billed charges,840,75,,672,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,324.8,29,,259.84,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,750.4,67,,600.32,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,784,70,,627.2,percent of total billed charges,70% of total billed charges,728,65,,582.4,percent of total billed charges,65% of total billed charges,399.5,35.67,,319.6,percent of total billed charges,35.67% of total billed charges,324.8,1008,
WIRE GUIDE BIWIRE NITINOL CORE,27010119,CDM,278,RC,C1769,HCPCS,outpatient,,,316,126.40,,221.2,70,,176.96,percent of total billed charges,70% of total billed charges,316,100,,252.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,259.12,82,,207.296,percent of total billed charges,82% of total billed charges,268.6,85,,214.88,percent of total billed charges,85% of total billed charges,268.6,85,,214.88,percent of total billed charges,85% of total billed charges,268.6,85,,214.88,percent of total billed charges,85% of total billed charges,284.4,90,,227.52,percent of total billed charges,90% of total billed charges,252.8,80,,202.24,percent of total billed charges,80% of total billed charges,284.4,90,,227.52,percent of total billed charges,90% of total billed charges,237,75,,189.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,91.64,29,,73.312,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,211.72,67,,169.376,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,221.2,70,,176.96,percent of total billed charges,70% of total billed charges,205.4,65,,164.32,percent of total billed charges,65% of total billed charges,112.72,35.67,,90.176,percent of total billed charges,35.67% of total billed charges,91.64,316,
COMPRESSION WIRE 1.6 25MM,27010120,CDM,278,RC,C1713,HCPCS,outpatient,,,300,120.00,,210,70,,168,percent of total billed charges,70% of total billed charges,300,100,,240,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,246,82,,196.8,percent of total billed charges,82% of total billed charges,255,85,,204,percent of total billed charges,85% of total billed charges,255,85,,204,percent of total billed charges,85% of total billed charges,255,85,,204,percent of total billed charges,85% of total billed charges,270,90,,216,percent of total billed charges,90% of total billed charges,240,80,,192,percent of total billed charges,80% of total billed charges,270,90,,216,percent of total billed charges,90% of total billed charges,225,75,,180,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,87,29,,69.6,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,201,67,,160.8,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,210,70,,168,percent of total billed charges,70% of total billed charges,195,65,,156,percent of total billed charges,65% of total billed charges,107.01,35.67,,85.608,percent of total billed charges,35.67% of total billed charges,87,300,
OPENING WEDGE PLATE 6 MM,27010121,CDM,278,RC,C1713,HCPCS,outpatient,,,3615,1446.00,,2530.5,70,,2024.4,percent of total billed charges,70% of total billed charges,1897.88,52.5,,1518.3,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,2964.3,82,,2371.44,percent of total billed charges,82% of total billed charges,3072.75,85,,2458.2,percent of total billed charges,85% of total billed charges,3072.75,85,,2458.2,percent of total billed charges,85% of total billed charges,3072.75,85,,2458.2,percent of total billed charges,85% of total billed charges,3253.5,90,,2602.8,percent of total billed charges,90% of total billed charges,2892,80,,2313.6,percent of total billed charges,80% of total billed charges,3253.5,90,,2602.8,percent of total billed charges,90% of total billed charges,2711.25,75,,2169,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,1048.35,29,,838.68,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,2422.05,67,,1937.64,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,2530.5,70,,2024.4,percent of total billed charges,70% of total billed charges,2349.75,65,,1879.8,percent of total billed charges,65% of total billed charges,1289.47,35.67,,1031.576,percent of total billed charges,35.67% of total billed charges,1048.35,3253.5,
CORTEX SCREW 2.7MM 26MM,27010122,CDM,278,RC,C1713,HCPCS,outpatient,,,325,130.00,,227.5,70,,182,percent of total billed charges,70% of total billed charges,325,100,,260,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,266.5,82,,213.2,percent of total billed charges,82% of total billed charges,276.25,85,,221,percent of total billed charges,85% of total billed charges,276.25,85,,221,percent of total billed charges,85% of total billed charges,276.25,85,,221,percent of total billed charges,85% of total billed charges,292.5,90,,234,percent of total billed charges,90% of total billed charges,260,80,,208,percent of total billed charges,80% of total billed charges,292.5,90,,234,percent of total billed charges,90% of total billed charges,243.75,75,,195,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,94.25,29,,75.4,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,217.75,67,,174.2,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,227.5,70,,182,percent of total billed charges,70% of total billed charges,211.25,65,,169,percent of total billed charges,65% of total billed charges,115.93,35.67,,92.744,percent of total billed charges,35.67% of total billed charges,94.25,325,
CORTEX SCREW 2.7 26MM,27010123,CDM,278,RC,C1713,HCPCS,outpatient,,,304,121.60,,212.8,70,,170.24,percent of total billed charges,70% of total billed charges,304,100,,243.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,249.28,82,,199.424,percent of total billed charges,82% of total billed charges,258.4,85,,206.72,percent of total billed charges,85% of total billed charges,258.4,85,,206.72,percent of total billed charges,85% of total billed charges,258.4,85,,206.72,percent of total billed charges,85% of total billed charges,273.6,90,,218.88,percent of total billed charges,90% of total billed charges,243.2,80,,194.56,percent of total billed charges,80% of total billed charges,273.6,90,,218.88,percent of total billed charges,90% of total billed charges,228,75,,182.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,88.16,29,,70.528,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,203.68,67,,162.944,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,212.8,70,,170.24,percent of total billed charges,70% of total billed charges,197.6,65,,158.08,percent of total billed charges,65% of total billed charges,108.44,35.67,,86.752,percent of total billed charges,35.67% of total billed charges,88.16,304,
DBX MIX 2.5 CC,27010124,CDM,278,RC,C1713,HCPCS,outpatient,,,2283,913.20,,1598.1,70,,1278.48,percent of total billed charges,70% of total billed charges,1198.58,52.5,,958.86,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,1872.06,82,,1497.648,percent of total billed charges,82% of total billed charges,1940.55,85,,1552.44,percent of total billed charges,85% of total billed charges,1940.55,85,,1552.44,percent of total billed charges,85% of total billed charges,1940.55,85,,1552.44,percent of total billed charges,85% of total billed charges,2054.7,90,,1643.76,percent of total billed charges,90% of total billed charges,1826.4,80,,1461.12,percent of total billed charges,80% of total billed charges,2054.7,90,,1643.76,percent of total billed charges,90% of total billed charges,1712.25,75,,1369.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,662.07,29,,529.656,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1529.61,67,,1223.688,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1598.1,70,,1278.48,percent of total billed charges,70% of total billed charges,1483.95,65,,1187.16,percent of total billed charges,65% of total billed charges,814.35,35.67,,651.48,percent of total billed charges,35.67% of total billed charges,662.07,2054.7,
SCREW 2.4MM 24 MM,27010155,CDM,278,RC,C1713,HCPCS,outpatient,,,551,220.40,,385.7,70,,308.56,percent of total billed charges,70% of total billed charges,551,100,,440.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,451.82,82,,361.456,percent of total billed charges,82% of total billed charges,468.35,85,,374.68,percent of total billed charges,85% of total billed charges,468.35,85,,374.68,percent of total billed charges,85% of total billed charges,468.35,85,,374.68,percent of total billed charges,85% of total billed charges,495.9,90,,396.72,percent of total billed charges,90% of total billed charges,440.8,80,,352.64,percent of total billed charges,80% of total billed charges,495.9,90,,396.72,percent of total billed charges,90% of total billed charges,413.25,75,,330.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,159.79,29,,127.832,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,369.17,67,,295.336,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,385.7,70,,308.56,percent of total billed charges,70% of total billed charges,358.15,65,,286.52,percent of total billed charges,65% of total billed charges,196.54,35.67,,157.232,percent of total billed charges,35.67% of total billed charges,159.79,551,
SCREW 2.4MM 18MM,27010156,CDM,278,RC,C1713,HCPCS,outpatient,,,551,220.40,,385.7,70,,308.56,percent of total billed charges,70% of total billed charges,551,100,,440.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,451.82,82,,361.456,percent of total billed charges,82% of total billed charges,468.35,85,,374.68,percent of total billed charges,85% of total billed charges,468.35,85,,374.68,percent of total billed charges,85% of total billed charges,468.35,85,,374.68,percent of total billed charges,85% of total billed charges,495.9,90,,396.72,percent of total billed charges,90% of total billed charges,440.8,80,,352.64,percent of total billed charges,80% of total billed charges,495.9,90,,396.72,percent of total billed charges,90% of total billed charges,413.25,75,,330.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,159.79,29,,127.832,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,369.17,67,,295.336,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,385.7,70,,308.56,percent of total billed charges,70% of total billed charges,358.15,65,,286.52,percent of total billed charges,65% of total billed charges,196.54,35.67,,157.232,percent of total billed charges,35.67% of total billed charges,159.79,551,
LOCKING S/TAP 3.5 12MM,27010177,CDM,278,RC,C1713,HCPCS,outpatient,,,674,269.60,,471.8,70,,377.44,percent of total billed charges,70% of total billed charges,674,100,,539.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,552.68,82,,442.144,percent of total billed charges,82% of total billed charges,572.9,85,,458.32,percent of total billed charges,85% of total billed charges,572.9,85,,458.32,percent of total billed charges,85% of total billed charges,572.9,85,,458.32,percent of total billed charges,85% of total billed charges,606.6,90,,485.28,percent of total billed charges,90% of total billed charges,539.2,80,,431.36,percent of total billed charges,80% of total billed charges,606.6,90,,485.28,percent of total billed charges,90% of total billed charges,505.5,75,,404.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,195.46,29,,156.368,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,451.58,67,,361.264,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,471.8,70,,377.44,percent of total billed charges,70% of total billed charges,438.1,65,,350.48,percent of total billed charges,65% of total billed charges,240.42,35.67,,192.336,percent of total billed charges,35.67% of total billed charges,195.46,674,
LOCKING S/TAP 3.5 14MM,27010178,CDM,278,RC,C1713,HCPCS,outpatient,,,674,269.60,,471.8,70,,377.44,percent of total billed charges,70% of total billed charges,674,100,,539.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,552.68,82,,442.144,percent of total billed charges,82% of total billed charges,572.9,85,,458.32,percent of total billed charges,85% of total billed charges,572.9,85,,458.32,percent of total billed charges,85% of total billed charges,572.9,85,,458.32,percent of total billed charges,85% of total billed charges,606.6,90,,485.28,percent of total billed charges,90% of total billed charges,539.2,80,,431.36,percent of total billed charges,80% of total billed charges,606.6,90,,485.28,percent of total billed charges,90% of total billed charges,505.5,75,,404.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,195.46,29,,156.368,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,451.58,67,,361.264,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,471.8,70,,377.44,percent of total billed charges,70% of total billed charges,438.1,65,,350.48,percent of total billed charges,65% of total billed charges,240.42,35.67,,192.336,percent of total billed charges,35.67% of total billed charges,195.46,674,
LOCKING S/TAP 3.5 16MM,27010179,CDM,278,RC,C1713,HCPCS,outpatient,,,674,269.60,,471.8,70,,377.44,percent of total billed charges,70% of total billed charges,674,100,,539.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,552.68,82,,442.144,percent of total billed charges,82% of total billed charges,572.9,85,,458.32,percent of total billed charges,85% of total billed charges,572.9,85,,458.32,percent of total billed charges,85% of total billed charges,572.9,85,,458.32,percent of total billed charges,85% of total billed charges,606.6,90,,485.28,percent of total billed charges,90% of total billed charges,539.2,80,,431.36,percent of total billed charges,80% of total billed charges,606.6,90,,485.28,percent of total billed charges,90% of total billed charges,505.5,75,,404.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,195.46,29,,156.368,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,451.58,67,,361.264,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,471.8,70,,377.44,percent of total billed charges,70% of total billed charges,438.1,65,,350.48,percent of total billed charges,65% of total billed charges,240.42,35.67,,192.336,percent of total billed charges,35.67% of total billed charges,195.46,674,
PLATE W/COL 7 HOL LCP 1/3 81MM,27010180,CDM,278,RC,C1713,HCPCS,outpatient,,,946,378.40,,662.2,70,,529.76,percent of total billed charges,70% of total billed charges,946,100,,756.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,775.72,82,,620.576,percent of total billed charges,82% of total billed charges,804.1,85,,643.28,percent of total billed charges,85% of total billed charges,804.1,85,,643.28,percent of total billed charges,85% of total billed charges,804.1,85,,643.28,percent of total billed charges,85% of total billed charges,851.4,90,,681.12,percent of total billed charges,90% of total billed charges,756.8,80,,605.44,percent of total billed charges,80% of total billed charges,851.4,90,,681.12,percent of total billed charges,90% of total billed charges,709.5,75,,567.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,274.34,29,,219.472,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,633.82,67,,507.056,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,662.2,70,,529.76,percent of total billed charges,70% of total billed charges,614.9,65,,491.92,percent of total billed charges,65% of total billed charges,337.44,35.67,,269.952,percent of total billed charges,35.67% of total billed charges,274.34,946,
K-WIRE 1.25MM,27010182,CDM,278,RC,C1769,HCPCS,outpatient,,,240,96.00,,168,70,,134.4,percent of total billed charges,70% of total billed charges,240,100,,192,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,196.8,82,,157.44,percent of total billed charges,82% of total billed charges,204,85,,163.2,percent of total billed charges,85% of total billed charges,204,85,,163.2,percent of total billed charges,85% of total billed charges,204,85,,163.2,percent of total billed charges,85% of total billed charges,216,90,,172.8,percent of total billed charges,90% of total billed charges,192,80,,153.6,percent of total billed charges,80% of total billed charges,216,90,,172.8,percent of total billed charges,90% of total billed charges,180,75,,144,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,69.6,29,,55.68,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,160.8,67,,128.64,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,168,70,,134.4,percent of total billed charges,70% of total billed charges,156,65,,124.8,percent of total billed charges,65% of total billed charges,85.61,35.67,,68.488,percent of total billed charges,35.67% of total billed charges,69.6,240,
CABBYKATED SCREW 4.0 48MM,27010183,CDM,278,RC,C1713,HCPCS,outpatient,,,1116,446.40,,781.2,70,,624.96,percent of total billed charges,70% of total billed charges,585.9,52.5,,468.72,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,915.12,82,,732.096,percent of total billed charges,82% of total billed charges,948.6,85,,758.88,percent of total billed charges,85% of total billed charges,948.6,85,,758.88,percent of total billed charges,85% of total billed charges,948.6,85,,758.88,percent of total billed charges,85% of total billed charges,1004.4,90,,803.52,percent of total billed charges,90% of total billed charges,892.8,80,,714.24,percent of total billed charges,80% of total billed charges,1004.4,90,,803.52,percent of total billed charges,90% of total billed charges,837,75,,669.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,323.64,29,,258.912,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,747.72,67,,598.176,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,781.2,70,,624.96,percent of total billed charges,70% of total billed charges,725.4,65,,580.32,percent of total billed charges,65% of total billed charges,398.08,35.67,,318.464,percent of total billed charges,35.67% of total billed charges,323.64,1004.4,
CANULATED SCREW 4.0 50MM,27010184,CDM,278,RC,C1713,HCPCS,outpatient,,,1116,446.40,,781.2,70,,624.96,percent of total billed charges,70% of total billed charges,585.9,52.5,,468.72,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,915.12,82,,732.096,percent of total billed charges,82% of total billed charges,948.6,85,,758.88,percent of total billed charges,85% of total billed charges,948.6,85,,758.88,percent of total billed charges,85% of total billed charges,948.6,85,,758.88,percent of total billed charges,85% of total billed charges,1004.4,90,,803.52,percent of total billed charges,90% of total billed charges,892.8,80,,714.24,percent of total billed charges,80% of total billed charges,1004.4,90,,803.52,percent of total billed charges,90% of total billed charges,837,75,,669.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,323.64,29,,258.912,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,747.72,67,,598.176,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,781.2,70,,624.96,percent of total billed charges,70% of total billed charges,725.4,65,,580.32,percent of total billed charges,65% of total billed charges,398.08,35.67,,318.464,percent of total billed charges,35.67% of total billed charges,323.64,1004.4,
SCREW CORTICAL 2.7MM 10MM,27010189,CDM,278,RC,C1713,HCPCS,outpatient,,,286,114.40,,200.2,70,,160.16,percent of total billed charges,70% of total billed charges,286,100,,228.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,234.52,82,,187.616,percent of total billed charges,82% of total billed charges,243.1,85,,194.48,percent of total billed charges,85% of total billed charges,243.1,85,,194.48,percent of total billed charges,85% of total billed charges,243.1,85,,194.48,percent of total billed charges,85% of total billed charges,257.4,90,,205.92,percent of total billed charges,90% of total billed charges,228.8,80,,183.04,percent of total billed charges,80% of total billed charges,257.4,90,,205.92,percent of total billed charges,90% of total billed charges,214.5,75,,171.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,82.94,29,,66.352,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,191.62,67,,153.296,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,200.2,70,,160.16,percent of total billed charges,70% of total billed charges,185.9,65,,148.72,percent of total billed charges,65% of total billed charges,102.02,35.67,,81.616,percent of total billed charges,35.67% of total billed charges,82.94,286,
SCREW CORTICAL 3.5MM,27010190,CDM,278,RC,C1713,HCPCS,outpatient,,,201,80.40,,140.7,70,,112.56,percent of total billed charges,70% of total billed charges,201,100,,160.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,164.82,82,,131.856,percent of total billed charges,82% of total billed charges,170.85,85,,136.68,percent of total billed charges,85% of total billed charges,170.85,85,,136.68,percent of total billed charges,85% of total billed charges,170.85,85,,136.68,percent of total billed charges,85% of total billed charges,180.9,90,,144.72,percent of total billed charges,90% of total billed charges,160.8,80,,128.64,percent of total billed charges,80% of total billed charges,180.9,90,,144.72,percent of total billed charges,90% of total billed charges,150.75,75,,120.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,58.29,29,,46.632,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,134.67,67,,107.736,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,140.7,70,,112.56,percent of total billed charges,70% of total billed charges,130.65,65,,104.52,percent of total billed charges,65% of total billed charges,71.7,35.67,,57.36,percent of total billed charges,35.67% of total billed charges,58.29,201,
GUIDEWIRE PEG KIT PUSH 24FR,27010192,CDM,278,RC,C1769,HCPCS,outpatient,,,520,208.00,,364,70,,291.2,percent of total billed charges,70% of total billed charges,520,100,,416,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,426.4,82,,341.12,percent of total billed charges,82% of total billed charges,442,85,,353.6,percent of total billed charges,85% of total billed charges,442,85,,353.6,percent of total billed charges,85% of total billed charges,442,85,,353.6,percent of total billed charges,85% of total billed charges,468,90,,374.4,percent of total billed charges,90% of total billed charges,416,80,,332.8,percent of total billed charges,80% of total billed charges,468,90,,374.4,percent of total billed charges,90% of total billed charges,390,75,,312,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,150.8,29,,120.64,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,348.4,67,,278.72,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,364,70,,291.2,percent of total billed charges,70% of total billed charges,338,65,,270.4,percent of total billed charges,65% of total billed charges,185.48,35.67,,148.384,percent of total billed charges,35.67% of total billed charges,150.8,520,
ARTICULAR SURFACE 2.5X4.5,27010249,CDM,278,RC,C1776,HCPCS,outpatient,,,8263,3305.20,,5784.1,70,,4627.28,percent of total billed charges,70% of total billed charges,4338.08,52.5,,3470.46,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,6775.66,82,,5420.528,percent of total billed charges,82% of total billed charges,7023.55,85,,5618.84,percent of total billed charges,85% of total billed charges,7023.55,85,,5618.84,percent of total billed charges,85% of total billed charges,7023.55,85,,5618.84,percent of total billed charges,85% of total billed charges,7436.7,90,,5949.36,percent of total billed charges,90% of total billed charges,6610.4,80,,5288.32,percent of total billed charges,80% of total billed charges,7436.7,90,,5949.36,percent of total billed charges,90% of total billed charges,6197.25,75,,4957.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2396.27,29,,1917.016,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,5536.21,67,,4428.968,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,5784.1,70,,4627.28,percent of total billed charges,70% of total billed charges,5370.95,65,,4296.76,percent of total billed charges,65% of total billed charges,2947.41,35.67,,2357.928,percent of total billed charges,35.67% of total billed charges,2396.27,7436.7,
POST 9.5MM,27010250,CDM,278,RC,C1713,HCPCS,outpatient,,,1917,766.80,,1341.9,70,,1073.52,percent of total billed charges,70% of total billed charges,1006.43,52.5,,805.14,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,1571.94,82,,1257.552,percent of total billed charges,82% of total billed charges,1629.45,85,,1303.56,percent of total billed charges,85% of total billed charges,1629.45,85,,1303.56,percent of total billed charges,85% of total billed charges,1629.45,85,,1303.56,percent of total billed charges,85% of total billed charges,1725.3,90,,1380.24,percent of total billed charges,90% of total billed charges,1533.6,80,,1226.88,percent of total billed charges,80% of total billed charges,1725.3,90,,1380.24,percent of total billed charges,90% of total billed charges,1437.75,75,,1150.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,555.93,29,,444.744,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1284.39,67,,1027.512,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1341.9,70,,1073.52,percent of total billed charges,70% of total billed charges,1246.05,65,,996.84,percent of total billed charges,65% of total billed charges,683.79,35.67,,547.032,percent of total billed charges,35.67% of total billed charges,555.93,1725.3,
PUSHLOCK BIOCOMPOSITE 4.5MM,27010276,CDM,278,RC,C1713,HCPCS,outpatient,,,1825,730.00,,1277.5,70,,1022,percent of total billed charges,70% of total billed charges,958.13,52.5,,766.5,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,1496.5,82,,1197.2,percent of total billed charges,82% of total billed charges,1551.25,85,,1241,percent of total billed charges,85% of total billed charges,1551.25,85,,1241,percent of total billed charges,85% of total billed charges,1551.25,85,,1241,percent of total billed charges,85% of total billed charges,1642.5,90,,1314,percent of total billed charges,90% of total billed charges,1460,80,,1168,percent of total billed charges,80% of total billed charges,1642.5,90,,1314,percent of total billed charges,90% of total billed charges,1368.75,75,,1095,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,529.25,29,,423.4,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1222.75,67,,978.2,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1277.5,70,,1022,percent of total billed charges,70% of total billed charges,1186.25,65,,949,percent of total billed charges,65% of total billed charges,650.98,35.67,,520.784,percent of total billed charges,35.67% of total billed charges,529.25,1642.5,
LOCK SWIVEL BIOCOMPOSITE 4.75,27010277,CDM,278,RC,C1713,HCPCS,outpatient,,,2159,863.60,,1511.3,70,,1209.04,percent of total billed charges,70% of total billed charges,1133.48,52.5,,906.78,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,1770.38,82,,1416.304,percent of total billed charges,82% of total billed charges,1835.15,85,,1468.12,percent of total billed charges,85% of total billed charges,1835.15,85,,1468.12,percent of total billed charges,85% of total billed charges,1835.15,85,,1468.12,percent of total billed charges,85% of total billed charges,1943.1,90,,1554.48,percent of total billed charges,90% of total billed charges,1727.2,80,,1381.76,percent of total billed charges,80% of total billed charges,1943.1,90,,1554.48,percent of total billed charges,90% of total billed charges,1619.25,75,,1295.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,626.11,29,,500.888,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1446.53,67,,1157.224,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1511.3,70,,1209.04,percent of total billed charges,70% of total billed charges,1403.35,65,,1122.68,percent of total billed charges,65% of total billed charges,770.12,35.67,,616.096,percent of total billed charges,35.67% of total billed charges,626.11,1943.1,
SCREW 4.0 CANCELLOUS 55 MM,27010278,CDM,278,RC,C1713,HCPCS,outpatient,,,225,90.00,,157.5,70,,126,percent of total billed charges,70% of total billed charges,225,100,,180,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,184.5,82,,147.6,percent of total billed charges,82% of total billed charges,191.25,85,,153,percent of total billed charges,85% of total billed charges,191.25,85,,153,percent of total billed charges,85% of total billed charges,191.25,85,,153,percent of total billed charges,85% of total billed charges,202.5,90,,162,percent of total billed charges,90% of total billed charges,180,80,,144,percent of total billed charges,80% of total billed charges,202.5,90,,162,percent of total billed charges,90% of total billed charges,168.75,75,,135,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,65.25,29,,52.2,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,150.75,67,,120.6,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,157.5,70,,126,percent of total billed charges,70% of total billed charges,146.25,65,,117,percent of total billed charges,65% of total billed charges,80.26,35.67,,64.208,percent of total billed charges,35.67% of total billed charges,65.25,225,
4 HOLE LEFT FIBULA PLATE,27010285,CDM,278,RC,C1713,HCPCS,outpatient,,,2519,1007.60,,1763.3,70,,1410.64,percent of total billed charges,70% of total billed charges,1322.48,52.5,,1057.98,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,2065.58,82,,1652.464,percent of total billed charges,82% of total billed charges,2141.15,85,,1712.92,percent of total billed charges,85% of total billed charges,2141.15,85,,1712.92,percent of total billed charges,85% of total billed charges,2141.15,85,,1712.92,percent of total billed charges,85% of total billed charges,2267.1,90,,1813.68,percent of total billed charges,90% of total billed charges,2015.2,80,,1612.16,percent of total billed charges,80% of total billed charges,2267.1,90,,1813.68,percent of total billed charges,90% of total billed charges,1889.25,75,,1511.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,730.51,29,,584.408,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1687.73,67,,1350.184,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1763.3,70,,1410.64,percent of total billed charges,70% of total billed charges,1637.35,65,,1309.88,percent of total billed charges,65% of total billed charges,898.53,35.67,,718.824,percent of total billed charges,35.67% of total billed charges,730.51,2267.1,
4.0 CANCELLOUS SCREW 50 MM,27010286,CDM,278,RC,C1713,HCPCS,outpatient,,,225,90.00,,157.5,70,,126,percent of total billed charges,70% of total billed charges,225,100,,180,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,184.5,82,,147.6,percent of total billed charges,82% of total billed charges,191.25,85,,153,percent of total billed charges,85% of total billed charges,191.25,85,,153,percent of total billed charges,85% of total billed charges,191.25,85,,153,percent of total billed charges,85% of total billed charges,202.5,90,,162,percent of total billed charges,90% of total billed charges,180,80,,144,percent of total billed charges,80% of total billed charges,202.5,90,,162,percent of total billed charges,90% of total billed charges,168.75,75,,135,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,65.25,29,,52.2,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,150.75,67,,120.6,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,157.5,70,,126,percent of total billed charges,70% of total billed charges,146.25,65,,117,percent of total billed charges,65% of total billed charges,80.26,35.67,,64.208,percent of total billed charges,35.67% of total billed charges,65.25,225,
4.0 CANCELLOUS SCREW 50 MM,27010287,CDM,278,RC,C1713,HCPCS,outpatient,,,225,90.00,,157.5,70,,126,percent of total billed charges,70% of total billed charges,225,100,,180,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,184.5,82,,147.6,percent of total billed charges,82% of total billed charges,191.25,85,,153,percent of total billed charges,85% of total billed charges,191.25,85,,153,percent of total billed charges,85% of total billed charges,191.25,85,,153,percent of total billed charges,85% of total billed charges,202.5,90,,162,percent of total billed charges,90% of total billed charges,180,80,,144,percent of total billed charges,80% of total billed charges,202.5,90,,162,percent of total billed charges,90% of total billed charges,168.75,75,,135,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,65.25,29,,52.2,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,150.75,67,,120.6,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,157.5,70,,126,percent of total billed charges,70% of total billed charges,146.25,65,,117,percent of total billed charges,65% of total billed charges,80.26,35.67,,64.208,percent of total billed charges,35.67% of total billed charges,65.25,225,
2.7 LOCKING SCREW 8MM,27010288,CDM,278,RC,C1713,HCPCS,outpatient,,,797,318.80,,557.9,70,,446.32,percent of total billed charges,70% of total billed charges,797,100,,637.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,653.54,82,,522.832,percent of total billed charges,82% of total billed charges,677.45,85,,541.96,percent of total billed charges,85% of total billed charges,677.45,85,,541.96,percent of total billed charges,85% of total billed charges,677.45,85,,541.96,percent of total billed charges,85% of total billed charges,717.3,90,,573.84,percent of total billed charges,90% of total billed charges,637.6,80,,510.08,percent of total billed charges,80% of total billed charges,717.3,90,,573.84,percent of total billed charges,90% of total billed charges,597.75,75,,478.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,231.13,29,,184.904,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,533.99,67,,427.192,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,557.9,70,,446.32,percent of total billed charges,70% of total billed charges,518.05,65,,414.44,percent of total billed charges,65% of total billed charges,284.29,35.67,,227.432,percent of total billed charges,35.67% of total billed charges,231.13,797,
2.7 LOCKING SCREW 12MM,27010289,CDM,278,RC,C1713,HCPCS,outpatient,,,797,318.80,,557.9,70,,446.32,percent of total billed charges,70% of total billed charges,797,100,,637.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,653.54,82,,522.832,percent of total billed charges,82% of total billed charges,677.45,85,,541.96,percent of total billed charges,85% of total billed charges,677.45,85,,541.96,percent of total billed charges,85% of total billed charges,677.45,85,,541.96,percent of total billed charges,85% of total billed charges,717.3,90,,573.84,percent of total billed charges,90% of total billed charges,637.6,80,,510.08,percent of total billed charges,80% of total billed charges,717.3,90,,573.84,percent of total billed charges,90% of total billed charges,597.75,75,,478.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,231.13,29,,184.904,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,533.99,67,,427.192,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,557.9,70,,446.32,percent of total billed charges,70% of total billed charges,518.05,65,,414.44,percent of total billed charges,65% of total billed charges,284.29,35.67,,227.432,percent of total billed charges,35.67% of total billed charges,231.13,797,
2.7 LOCKING SCREW 14MM,27010290,CDM,278,RC,C1713,HCPCS,outpatient,,,785,314.00,,549.5,70,,439.6,percent of total billed charges,70% of total billed charges,785,100,,628,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,643.7,82,,514.96,percent of total billed charges,82% of total billed charges,667.25,85,,533.8,percent of total billed charges,85% of total billed charges,667.25,85,,533.8,percent of total billed charges,85% of total billed charges,667.25,85,,533.8,percent of total billed charges,85% of total billed charges,706.5,90,,565.2,percent of total billed charges,90% of total billed charges,628,80,,502.4,percent of total billed charges,80% of total billed charges,706.5,90,,565.2,percent of total billed charges,90% of total billed charges,588.75,75,,471,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,227.65,29,,182.12,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,525.95,67,,420.76,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,549.5,70,,439.6,percent of total billed charges,70% of total billed charges,510.25,65,,408.2,percent of total billed charges,65% of total billed charges,280.01,35.67,,224.008,percent of total billed charges,35.67% of total billed charges,227.65,785,
2.7 LOCKING SCREW 16MM,27010291,CDM,278,RC,C1713,HCPCS,outpatient,,,797,318.80,,557.9,70,,446.32,percent of total billed charges,70% of total billed charges,797,100,,637.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,653.54,82,,522.832,percent of total billed charges,82% of total billed charges,677.45,85,,541.96,percent of total billed charges,85% of total billed charges,677.45,85,,541.96,percent of total billed charges,85% of total billed charges,677.45,85,,541.96,percent of total billed charges,85% of total billed charges,717.3,90,,573.84,percent of total billed charges,90% of total billed charges,637.6,80,,510.08,percent of total billed charges,80% of total billed charges,717.3,90,,573.84,percent of total billed charges,90% of total billed charges,597.75,75,,478.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,231.13,29,,184.904,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,533.99,67,,427.192,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,557.9,70,,446.32,percent of total billed charges,70% of total billed charges,518.05,65,,414.44,percent of total billed charges,65% of total billed charges,284.29,35.67,,227.432,percent of total billed charges,35.67% of total billed charges,231.13,797,
3.5 CORTEX SCREW 14MM,27010292,CDM,278,RC,C1713,HCPCS,outpatient,,,201,80.40,,140.7,70,,112.56,percent of total billed charges,70% of total billed charges,201,100,,160.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,164.82,82,,131.856,percent of total billed charges,82% of total billed charges,170.85,85,,136.68,percent of total billed charges,85% of total billed charges,170.85,85,,136.68,percent of total billed charges,85% of total billed charges,170.85,85,,136.68,percent of total billed charges,85% of total billed charges,180.9,90,,144.72,percent of total billed charges,90% of total billed charges,160.8,80,,128.64,percent of total billed charges,80% of total billed charges,180.9,90,,144.72,percent of total billed charges,90% of total billed charges,150.75,75,,120.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,58.29,29,,46.632,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,134.67,67,,107.736,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,140.7,70,,112.56,percent of total billed charges,70% of total billed charges,130.65,65,,104.52,percent of total billed charges,65% of total billed charges,71.7,35.67,,57.36,percent of total billed charges,35.67% of total billed charges,58.29,201,
3.5 LOCKING SCREW 14MM,27010293,CDM,278,RC,C1713,HCPCS,outpatient,,,842,336.80,,589.4,70,,471.52,percent of total billed charges,70% of total billed charges,842,100,,673.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,690.44,82,,552.352,percent of total billed charges,82% of total billed charges,715.7,85,,572.56,percent of total billed charges,85% of total billed charges,715.7,85,,572.56,percent of total billed charges,85% of total billed charges,715.7,85,,572.56,percent of total billed charges,85% of total billed charges,757.8,90,,606.24,percent of total billed charges,90% of total billed charges,673.6,80,,538.88,percent of total billed charges,80% of total billed charges,757.8,90,,606.24,percent of total billed charges,90% of total billed charges,631.5,75,,505.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,244.18,29,,195.344,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,564.14,67,,451.312,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,589.4,70,,471.52,percent of total billed charges,70% of total billed charges,547.3,65,,437.84,percent of total billed charges,65% of total billed charges,300.34,35.67,,240.272,percent of total billed charges,35.67% of total billed charges,244.18,842,
PLATE FIBULA 9 HOLE,27010315,CDM,278,RC,C1713,HCPCS,outpatient,,,2665,1066.00,,1865.5,70,,1492.4,percent of total billed charges,70% of total billed charges,1399.13,52.5,,1119.3,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,2185.3,82,,1748.24,percent of total billed charges,82% of total billed charges,2265.25,85,,1812.2,percent of total billed charges,85% of total billed charges,2265.25,85,,1812.2,percent of total billed charges,85% of total billed charges,2265.25,85,,1812.2,percent of total billed charges,85% of total billed charges,2398.5,90,,1918.8,percent of total billed charges,90% of total billed charges,2132,80,,1705.6,percent of total billed charges,80% of total billed charges,2398.5,90,,1918.8,percent of total billed charges,90% of total billed charges,1998.75,75,,1599,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,772.85,29,,618.28,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1785.55,67,,1428.44,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1865.5,70,,1492.4,percent of total billed charges,70% of total billed charges,1732.25,65,,1385.8,percent of total billed charges,65% of total billed charges,950.61,35.67,,760.488,percent of total billed charges,35.67% of total billed charges,772.85,2398.5,
CORTEX SCREW 3.5 12 MM,27010316,CDM,278,RC,C1713,HCPCS,outpatient,,,201,80.40,,140.7,70,,112.56,percent of total billed charges,70% of total billed charges,201,100,,160.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,164.82,82,,131.856,percent of total billed charges,82% of total billed charges,170.85,85,,136.68,percent of total billed charges,85% of total billed charges,170.85,85,,136.68,percent of total billed charges,85% of total billed charges,170.85,85,,136.68,percent of total billed charges,85% of total billed charges,180.9,90,,144.72,percent of total billed charges,90% of total billed charges,160.8,80,,128.64,percent of total billed charges,80% of total billed charges,180.9,90,,144.72,percent of total billed charges,90% of total billed charges,150.75,75,,120.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,58.29,29,,46.632,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,134.67,67,,107.736,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,140.7,70,,112.56,percent of total billed charges,70% of total billed charges,130.65,65,,104.52,percent of total billed charges,65% of total billed charges,71.7,35.67,,57.36,percent of total billed charges,35.67% of total billed charges,58.29,201,
SCREW BONE 12MM X 2.7MM,27010317,CDM,278,RC,C1713,HCPCS,outpatient,,,587,234.80,,410.9,70,,328.72,percent of total billed charges,70% of total billed charges,587,100,,469.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,481.34,82,,385.072,percent of total billed charges,82% of total billed charges,498.95,85,,399.16,percent of total billed charges,85% of total billed charges,498.95,85,,399.16,percent of total billed charges,85% of total billed charges,498.95,85,,399.16,percent of total billed charges,85% of total billed charges,528.3,90,,422.64,percent of total billed charges,90% of total billed charges,469.6,80,,375.68,percent of total billed charges,80% of total billed charges,528.3,90,,422.64,percent of total billed charges,90% of total billed charges,440.25,75,,352.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,170.23,29,,136.184,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,393.29,67,,314.632,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,410.9,70,,328.72,percent of total billed charges,70% of total billed charges,381.55,65,,305.24,percent of total billed charges,65% of total billed charges,209.38,35.67,,167.504,percent of total billed charges,35.67% of total billed charges,170.23,587,
LOCKING SCREW 2.7 10 MM,27010318,CDM,278,RC,C1713,HCPCS,outpatient,,,797,318.80,,557.9,70,,446.32,percent of total billed charges,70% of total billed charges,797,100,,637.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,653.54,82,,522.832,percent of total billed charges,82% of total billed charges,677.45,85,,541.96,percent of total billed charges,85% of total billed charges,677.45,85,,541.96,percent of total billed charges,85% of total billed charges,677.45,85,,541.96,percent of total billed charges,85% of total billed charges,717.3,90,,573.84,percent of total billed charges,90% of total billed charges,637.6,80,,510.08,percent of total billed charges,80% of total billed charges,717.3,90,,573.84,percent of total billed charges,90% of total billed charges,597.75,75,,478.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,231.13,29,,184.904,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,533.99,67,,427.192,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,557.9,70,,446.32,percent of total billed charges,70% of total billed charges,518.05,65,,414.44,percent of total billed charges,65% of total billed charges,284.29,35.67,,227.432,percent of total billed charges,35.67% of total billed charges,231.13,797,
SCREW BONE 20MM X 2.7MM,27010319,CDM,278,RC,C1713,HCPCS,outpatient,,,587,234.80,,410.9,70,,328.72,percent of total billed charges,70% of total billed charges,587,100,,469.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,481.34,82,,385.072,percent of total billed charges,82% of total billed charges,498.95,85,,399.16,percent of total billed charges,85% of total billed charges,498.95,85,,399.16,percent of total billed charges,85% of total billed charges,498.95,85,,399.16,percent of total billed charges,85% of total billed charges,528.3,90,,422.64,percent of total billed charges,90% of total billed charges,469.6,80,,375.68,percent of total billed charges,80% of total billed charges,528.3,90,,422.64,percent of total billed charges,90% of total billed charges,440.25,75,,352.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,170.23,29,,136.184,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,393.29,67,,314.632,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,410.9,70,,328.72,percent of total billed charges,70% of total billed charges,381.55,65,,305.24,percent of total billed charges,65% of total billed charges,209.38,35.67,,167.504,percent of total billed charges,35.67% of total billed charges,170.23,587,
LOCKING SCREW 3.5 10 MM,27010321,CDM,278,RC,C1713,HCPCS,outpatient,,,842,336.80,,589.4,70,,471.52,percent of total billed charges,70% of total billed charges,842,100,,673.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,690.44,82,,552.352,percent of total billed charges,82% of total billed charges,715.7,85,,572.56,percent of total billed charges,85% of total billed charges,715.7,85,,572.56,percent of total billed charges,85% of total billed charges,715.7,85,,572.56,percent of total billed charges,85% of total billed charges,757.8,90,,606.24,percent of total billed charges,90% of total billed charges,673.6,80,,538.88,percent of total billed charges,80% of total billed charges,757.8,90,,606.24,percent of total billed charges,90% of total billed charges,631.5,75,,505.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,244.18,29,,195.344,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,564.14,67,,451.312,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,589.4,70,,471.52,percent of total billed charges,70% of total billed charges,547.3,65,,437.84,percent of total billed charges,65% of total billed charges,300.34,35.67,,240.272,percent of total billed charges,35.67% of total billed charges,244.18,842,
BONE SCREW 24MM X 2.7MM,27010326,CDM,278,RC,C1713,HCPCS,outpatient,,,570,228.00,,399,70,,319.2,percent of total billed charges,70% of total billed charges,570,100,,456,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,467.4,82,,373.92,percent of total billed charges,82% of total billed charges,484.5,85,,387.6,percent of total billed charges,85% of total billed charges,484.5,85,,387.6,percent of total billed charges,85% of total billed charges,484.5,85,,387.6,percent of total billed charges,85% of total billed charges,513,90,,410.4,percent of total billed charges,90% of total billed charges,456,80,,364.8,percent of total billed charges,80% of total billed charges,513,90,,410.4,percent of total billed charges,90% of total billed charges,427.5,75,,342,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,165.3,29,,132.24,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,381.9,67,,305.52,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,399,70,,319.2,percent of total billed charges,70% of total billed charges,370.5,65,,296.4,percent of total billed charges,65% of total billed charges,203.32,35.67,,162.656,percent of total billed charges,35.67% of total billed charges,165.3,570,
PITON 3.5MM,27010364,CDM,278,RC,C1713,HCPCS,outpatient,,,2100,840.00,,1470,70,,1176,percent of total billed charges,70% of total billed charges,1102.5,52.5,,882,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,1722,82,,1377.6,percent of total billed charges,82% of total billed charges,1785,85,,1428,percent of total billed charges,85% of total billed charges,1785,85,,1428,percent of total billed charges,85% of total billed charges,1785,85,,1428,percent of total billed charges,85% of total billed charges,1890,90,,1512,percent of total billed charges,90% of total billed charges,1680,80,,1344,percent of total billed charges,80% of total billed charges,1890,90,,1512,percent of total billed charges,90% of total billed charges,1575,75,,1260,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,609,29,,487.2,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1407,67,,1125.6,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1470,70,,1176,percent of total billed charges,70% of total billed charges,1365,65,,1092,percent of total billed charges,65% of total billed charges,749.07,35.67,,599.256,percent of total billed charges,35.67% of total billed charges,609,1890,
DEGREE GAMMA NAIL 11X180MMX125,27010366,CDM,278,RC,C1713,HCPCS,outpatient,,,4338,1735.20,,3036.6,70,,2429.28,percent of total billed charges,70% of total billed charges,2277.45,52.5,,1821.96,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,3557.16,82,,2845.728,percent of total billed charges,82% of total billed charges,3687.3,85,,2949.84,percent of total billed charges,85% of total billed charges,3687.3,85,,2949.84,percent of total billed charges,85% of total billed charges,3687.3,85,,2949.84,percent of total billed charges,85% of total billed charges,3904.2,90,,3123.36,percent of total billed charges,90% of total billed charges,3470.4,80,,2776.32,percent of total billed charges,80% of total billed charges,3904.2,90,,3123.36,percent of total billed charges,90% of total billed charges,3253.5,75,,2602.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,1258.02,29,,1006.416,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,2906.46,67,,2325.168,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,3036.6,70,,2429.28,percent of total billed charges,70% of total billed charges,2819.7,65,,2255.76,percent of total billed charges,65% of total billed charges,1547.36,35.67,,1237.888,percent of total billed charges,35.67% of total billed charges,1258.02,3904.2,
LAG SCREW 10.5X80,27010367,CDM,278,RC,C1713,HCPCS,outpatient,,,2171,868.40,,1519.7,70,,1215.76,percent of total billed charges,70% of total billed charges,1139.78,52.5,,911.82,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,1780.22,82,,1424.176,percent of total billed charges,82% of total billed charges,1845.35,85,,1476.28,percent of total billed charges,85% of total billed charges,1845.35,85,,1476.28,percent of total billed charges,85% of total billed charges,1845.35,85,,1476.28,percent of total billed charges,85% of total billed charges,1953.9,90,,1563.12,percent of total billed charges,90% of total billed charges,1736.8,80,,1389.44,percent of total billed charges,80% of total billed charges,1953.9,90,,1563.12,percent of total billed charges,90% of total billed charges,1628.25,75,,1302.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,629.59,29,,503.672,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1454.57,67,,1163.656,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1519.7,70,,1215.76,percent of total billed charges,70% of total billed charges,1411.15,65,,1128.92,percent of total billed charges,65% of total billed charges,774.4,35.67,,619.52,percent of total billed charges,35.67% of total billed charges,629.59,1953.9,
LOCKING SCREW 5X35,27010368,CDM,278,RC,C1713,HCPCS,outpatient,,,897,358.80,,627.9,70,,502.32,percent of total billed charges,70% of total billed charges,897,100,,717.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,735.54,82,,588.432,percent of total billed charges,82% of total billed charges,762.45,85,,609.96,percent of total billed charges,85% of total billed charges,762.45,85,,609.96,percent of total billed charges,85% of total billed charges,762.45,85,,609.96,percent of total billed charges,85% of total billed charges,807.3,90,,645.84,percent of total billed charges,90% of total billed charges,717.6,80,,574.08,percent of total billed charges,80% of total billed charges,807.3,90,,645.84,percent of total billed charges,90% of total billed charges,672.75,75,,538.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,260.13,29,,208.104,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,600.99,67,,480.792,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,627.9,70,,502.32,percent of total billed charges,70% of total billed charges,583.05,65,,466.44,percent of total billed charges,65% of total billed charges,319.96,35.67,,255.968,percent of total billed charges,35.67% of total billed charges,260.13,897,
WIRE 3X285,27010369,CDM,278,RC,C1769,HCPCS,outpatient,,,663,265.20,,464.1,70,,371.28,percent of total billed charges,70% of total billed charges,663,100,,530.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,543.66,82,,434.928,percent of total billed charges,82% of total billed charges,563.55,85,,450.84,percent of total billed charges,85% of total billed charges,563.55,85,,450.84,percent of total billed charges,85% of total billed charges,563.55,85,,450.84,percent of total billed charges,85% of total billed charges,596.7,90,,477.36,percent of total billed charges,90% of total billed charges,530.4,80,,424.32,percent of total billed charges,80% of total billed charges,596.7,90,,477.36,percent of total billed charges,90% of total billed charges,497.25,75,,397.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,192.27,29,,153.816,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,444.21,67,,355.368,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,464.1,70,,371.28,percent of total billed charges,70% of total billed charges,430.95,65,,344.76,percent of total billed charges,65% of total billed charges,236.49,35.67,,189.192,percent of total billed charges,35.67% of total billed charges,192.27,663,
WIRE 3.2X450,27010370,CDM,278,RC,C1769,HCPCS,outpatient,,,795,318.00,,556.5,70,,445.2,percent of total billed charges,70% of total billed charges,795,100,,636,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,651.9,82,,521.52,percent of total billed charges,82% of total billed charges,675.75,85,,540.6,percent of total billed charges,85% of total billed charges,675.75,85,,540.6,percent of total billed charges,85% of total billed charges,675.75,85,,540.6,percent of total billed charges,85% of total billed charges,715.5,90,,572.4,percent of total billed charges,90% of total billed charges,636,80,,508.8,percent of total billed charges,80% of total billed charges,715.5,90,,572.4,percent of total billed charges,90% of total billed charges,596.25,75,,477,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,230.55,29,,184.44,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,532.65,67,,426.12,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,556.5,70,,445.2,percent of total billed charges,70% of total billed charges,516.75,65,,413.4,percent of total billed charges,65% of total billed charges,283.58,35.67,,226.864,percent of total billed charges,35.67% of total billed charges,230.55,795,
BALL TIP WIRE 3x100,27010372,CDM,278,RC,C1713,HCPCS,outpatient,,,915,366.00,,640.5,70,,512.4,percent of total billed charges,70% of total billed charges,915,100,,732,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,750.3,82,,600.24,percent of total billed charges,82% of total billed charges,777.75,85,,622.2,percent of total billed charges,85% of total billed charges,777.75,85,,622.2,percent of total billed charges,85% of total billed charges,777.75,85,,622.2,percent of total billed charges,85% of total billed charges,823.5,90,,658.8,percent of total billed charges,90% of total billed charges,732,80,,585.6,percent of total billed charges,80% of total billed charges,823.5,90,,658.8,percent of total billed charges,90% of total billed charges,686.25,75,,549,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,265.35,29,,212.28,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,613.05,67,,490.44,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,640.5,70,,512.4,percent of total billed charges,70% of total billed charges,594.75,65,,475.8,percent of total billed charges,65% of total billed charges,326.38,35.67,,261.104,percent of total billed charges,35.67% of total billed charges,265.35,915,
SET ULTRATHAN SUPRABUBIC MACLC,27010388,CDM,278,RC,C2627,HCPCS,outpatient,,,454,181.60,,317.8,70,,254.24,percent of total billed charges,70% of total billed charges,454,100,,363.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,372.28,82,,297.824,percent of total billed charges,82% of total billed charges,385.9,85,,308.72,percent of total billed charges,85% of total billed charges,385.9,85,,308.72,percent of total billed charges,85% of total billed charges,385.9,85,,308.72,percent of total billed charges,85% of total billed charges,408.6,90,,326.88,percent of total billed charges,90% of total billed charges,363.2,80,,290.56,percent of total billed charges,80% of total billed charges,408.6,90,,326.88,percent of total billed charges,90% of total billed charges,340.5,75,,272.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,131.66,29,,105.328,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,304.18,67,,243.344,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,317.8,70,,254.24,percent of total billed charges,70% of total billed charges,295.1,65,,236.08,percent of total billed charges,65% of total billed charges,161.94,35.67,,129.552,percent of total billed charges,35.67% of total billed charges,131.66,454,
K-WIRE 1.0,27010389,CDM,278,RC,C1713,HCPCS,outpatient,,,596,238.40,,417.2,70,,333.76,percent of total billed charges,70% of total billed charges,596,100,,476.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,488.72,82,,390.976,percent of total billed charges,82% of total billed charges,506.6,85,,405.28,percent of total billed charges,85% of total billed charges,506.6,85,,405.28,percent of total billed charges,85% of total billed charges,506.6,85,,405.28,percent of total billed charges,85% of total billed charges,536.4,90,,429.12,percent of total billed charges,90% of total billed charges,476.8,80,,381.44,percent of total billed charges,80% of total billed charges,536.4,90,,429.12,percent of total billed charges,90% of total billed charges,447,75,,357.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,172.84,29,,138.272,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,399.32,67,,319.456,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,417.2,70,,333.76,percent of total billed charges,70% of total billed charges,387.4,65,,309.92,percent of total billed charges,65% of total billed charges,212.59,35.67,,170.072,percent of total billed charges,35.67% of total billed charges,172.84,596,
CORTEX 2.7 SCREW 12MM,27010390,CDM,278,RC,C1713,HCPCS,outpatient,,,304,121.60,,212.8,70,,170.24,percent of total billed charges,70% of total billed charges,304,100,,243.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,249.28,82,,199.424,percent of total billed charges,82% of total billed charges,258.4,85,,206.72,percent of total billed charges,85% of total billed charges,258.4,85,,206.72,percent of total billed charges,85% of total billed charges,258.4,85,,206.72,percent of total billed charges,85% of total billed charges,273.6,90,,218.88,percent of total billed charges,90% of total billed charges,243.2,80,,194.56,percent of total billed charges,80% of total billed charges,273.6,90,,218.88,percent of total billed charges,90% of total billed charges,228,75,,182.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,88.16,29,,70.528,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,203.68,67,,162.944,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,212.8,70,,170.24,percent of total billed charges,70% of total billed charges,197.6,65,,158.08,percent of total billed charges,65% of total billed charges,108.44,35.67,,86.752,percent of total billed charges,35.67% of total billed charges,88.16,304,
SCREW CORTEX 2.4 14MM,27010458,CDM,278,RC,C1713,HCPCS,outpatient,,,372,148.80,,260.4,70,,208.32,percent of total billed charges,70% of total billed charges,372,100,,297.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,305.04,82,,244.032,percent of total billed charges,82% of total billed charges,316.2,85,,252.96,percent of total billed charges,85% of total billed charges,316.2,85,,252.96,percent of total billed charges,85% of total billed charges,316.2,85,,252.96,percent of total billed charges,85% of total billed charges,334.8,90,,267.84,percent of total billed charges,90% of total billed charges,297.6,80,,238.08,percent of total billed charges,80% of total billed charges,334.8,90,,267.84,percent of total billed charges,90% of total billed charges,279,75,,223.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,107.88,29,,86.304,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,249.24,67,,199.392,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,260.4,70,,208.32,percent of total billed charges,70% of total billed charges,241.8,65,,193.44,percent of total billed charges,65% of total billed charges,132.69,35.67,,106.152,percent of total billed charges,35.67% of total billed charges,107.88,372,
COMPRESSION WIRE 1.6 15MM,27010480,CDM,278,RC,C1713,HCPCS,outpatient,,,322,128.80,,225.4,70,,180.32,percent of total billed charges,70% of total billed charges,322,100,,257.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,264.04,82,,211.232,percent of total billed charges,82% of total billed charges,273.7,85,,218.96,percent of total billed charges,85% of total billed charges,273.7,85,,218.96,percent of total billed charges,85% of total billed charges,273.7,85,,218.96,percent of total billed charges,85% of total billed charges,289.8,90,,231.84,percent of total billed charges,90% of total billed charges,257.6,80,,206.08,percent of total billed charges,80% of total billed charges,289.8,90,,231.84,percent of total billed charges,90% of total billed charges,241.5,75,,193.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,93.38,29,,74.704,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,215.74,67,,172.592,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,225.4,70,,180.32,percent of total billed charges,70% of total billed charges,209.3,65,,167.44,percent of total billed charges,65% of total billed charges,114.86,35.67,,91.888,percent of total billed charges,35.67% of total billed charges,93.38,322,
COMPRESSION WIRE 1.6 25MM,27010481,CDM,278,RC,C1769,HCPCS,outpatient,,,322,128.80,,225.4,70,,180.32,percent of total billed charges,70% of total billed charges,322,100,,257.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,264.04,82,,211.232,percent of total billed charges,82% of total billed charges,273.7,85,,218.96,percent of total billed charges,85% of total billed charges,273.7,85,,218.96,percent of total billed charges,85% of total billed charges,273.7,85,,218.96,percent of total billed charges,85% of total billed charges,289.8,90,,231.84,percent of total billed charges,90% of total billed charges,257.6,80,,206.08,percent of total billed charges,80% of total billed charges,289.8,90,,231.84,percent of total billed charges,90% of total billed charges,241.5,75,,193.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,93.38,29,,74.704,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,215.74,67,,172.592,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,225.4,70,,180.32,percent of total billed charges,70% of total billed charges,209.3,65,,167.44,percent of total billed charges,65% of total billed charges,114.86,35.67,,91.888,percent of total billed charges,35.67% of total billed charges,93.38,322,
"PLATE, LEFT SMALL 0 DEGREE MTP",27010482,CDM,278,RC,C1713,HCPCS,outpatient,,,3950,1580.00,,2765,70,,2212,percent of total billed charges,70% of total billed charges,2073.75,52.5,,1659,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,3239,82,,2591.2,percent of total billed charges,82% of total billed charges,3357.5,85,,2686,percent of total billed charges,85% of total billed charges,3357.5,85,,2686,percent of total billed charges,85% of total billed charges,3357.5,85,,2686,percent of total billed charges,85% of total billed charges,3555,90,,2844,percent of total billed charges,90% of total billed charges,3160,80,,2528,percent of total billed charges,80% of total billed charges,3555,90,,2844,percent of total billed charges,90% of total billed charges,2962.5,75,,2370,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,1145.5,29,,916.4,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,2646.5,67,,2117.2,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,2765,70,,2212,percent of total billed charges,70% of total billed charges,2567.5,65,,2054,percent of total billed charges,65% of total billed charges,1408.97,35.67,,1127.176,percent of total billed charges,35.67% of total billed charges,1145.5,3555,
LOCKING SCREW 10MM 2.4 UA,27010483,CDM,278,RC,C1713,HCPCS,outpatient,,,710,284.00,,497,70,,397.6,percent of total billed charges,70% of total billed charges,710,100,,568,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,582.2,82,,465.76,percent of total billed charges,82% of total billed charges,603.5,85,,482.8,percent of total billed charges,85% of total billed charges,603.5,85,,482.8,percent of total billed charges,85% of total billed charges,603.5,85,,482.8,percent of total billed charges,85% of total billed charges,639,90,,511.2,percent of total billed charges,90% of total billed charges,568,80,,454.4,percent of total billed charges,80% of total billed charges,639,90,,511.2,percent of total billed charges,90% of total billed charges,532.5,75,,426,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,205.9,29,,164.72,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,475.7,67,,380.56,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,497,70,,397.6,percent of total billed charges,70% of total billed charges,461.5,65,,369.2,percent of total billed charges,65% of total billed charges,253.26,35.67,,202.608,percent of total billed charges,35.67% of total billed charges,205.9,710,
LOCKING SCREW 12MM 2.4 UA,27010484,CDM,278,RC,C1713,HCPCS,outpatient,,,710,284.00,,497,70,,397.6,percent of total billed charges,70% of total billed charges,710,100,,568,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,582.2,82,,465.76,percent of total billed charges,82% of total billed charges,603.5,85,,482.8,percent of total billed charges,85% of total billed charges,603.5,85,,482.8,percent of total billed charges,85% of total billed charges,603.5,85,,482.8,percent of total billed charges,85% of total billed charges,639,90,,511.2,percent of total billed charges,90% of total billed charges,568,80,,454.4,percent of total billed charges,80% of total billed charges,639,90,,511.2,percent of total billed charges,90% of total billed charges,532.5,75,,426,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,205.9,29,,164.72,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,475.7,67,,380.56,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,497,70,,397.6,percent of total billed charges,70% of total billed charges,461.5,65,,369.2,percent of total billed charges,65% of total billed charges,253.26,35.67,,202.608,percent of total billed charges,35.67% of total billed charges,205.9,710,
LOCKING SCREW 14MM 2.4 UA,27010485,CDM,278,RC,C1713,HCPCS,outpatient,,,710,284.00,,497,70,,397.6,percent of total billed charges,70% of total billed charges,710,100,,568,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,582.2,82,,465.76,percent of total billed charges,82% of total billed charges,603.5,85,,482.8,percent of total billed charges,85% of total billed charges,603.5,85,,482.8,percent of total billed charges,85% of total billed charges,603.5,85,,482.8,percent of total billed charges,85% of total billed charges,639,90,,511.2,percent of total billed charges,90% of total billed charges,568,80,,454.4,percent of total billed charges,80% of total billed charges,639,90,,511.2,percent of total billed charges,90% of total billed charges,532.5,75,,426,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,205.9,29,,164.72,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,475.7,67,,380.56,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,497,70,,397.6,percent of total billed charges,70% of total billed charges,461.5,65,,369.2,percent of total billed charges,65% of total billed charges,253.26,35.67,,202.608,percent of total billed charges,35.67% of total billed charges,205.9,710,
LOCKING SCREW 16MM 2.4 UA,27010486,CDM,278,RC,C1713,HCPCS,outpatient,,,759,303.60,,531.3,70,,425.04,percent of total billed charges,70% of total billed charges,759,100,,607.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,622.38,82,,497.904,percent of total billed charges,82% of total billed charges,645.15,85,,516.12,percent of total billed charges,85% of total billed charges,645.15,85,,516.12,percent of total billed charges,85% of total billed charges,645.15,85,,516.12,percent of total billed charges,85% of total billed charges,683.1,90,,546.48,percent of total billed charges,90% of total billed charges,607.2,80,,485.76,percent of total billed charges,80% of total billed charges,683.1,90,,546.48,percent of total billed charges,90% of total billed charges,569.25,75,,455.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,220.11,29,,176.088,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,508.53,67,,406.824,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,531.3,70,,425.04,percent of total billed charges,70% of total billed charges,493.35,65,,394.68,percent of total billed charges,65% of total billed charges,270.74,35.67,,216.592,percent of total billed charges,35.67% of total billed charges,220.11,759,
LOCKING SCREW 20MM 2.4 UA,27010487,CDM,278,RC,C1713,HCPCS,outpatient,,,759,303.60,,531.3,70,,425.04,percent of total billed charges,70% of total billed charges,759,100,,607.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,622.38,82,,497.904,percent of total billed charges,82% of total billed charges,645.15,85,,516.12,percent of total billed charges,85% of total billed charges,645.15,85,,516.12,percent of total billed charges,85% of total billed charges,645.15,85,,516.12,percent of total billed charges,85% of total billed charges,683.1,90,,546.48,percent of total billed charges,90% of total billed charges,607.2,80,,485.76,percent of total billed charges,80% of total billed charges,683.1,90,,546.48,percent of total billed charges,90% of total billed charges,569.25,75,,455.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,220.11,29,,176.088,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,508.53,67,,406.824,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,531.3,70,,425.04,percent of total billed charges,70% of total billed charges,493.35,65,,394.68,percent of total billed charges,65% of total billed charges,270.74,35.67,,216.592,percent of total billed charges,35.67% of total billed charges,220.11,759,
CORTEX SCREW 36 MM 2.4 UA,27010488,CDM,278,RC,C1713,HCPCS,outpatient,,,372,148.80,,260.4,70,,208.32,percent of total billed charges,70% of total billed charges,372,100,,297.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,305.04,82,,244.032,percent of total billed charges,82% of total billed charges,316.2,85,,252.96,percent of total billed charges,85% of total billed charges,316.2,85,,252.96,percent of total billed charges,85% of total billed charges,316.2,85,,252.96,percent of total billed charges,85% of total billed charges,334.8,90,,267.84,percent of total billed charges,90% of total billed charges,297.6,80,,238.08,percent of total billed charges,80% of total billed charges,334.8,90,,267.84,percent of total billed charges,90% of total billed charges,279,75,,223.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,107.88,29,,86.304,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,249.24,67,,199.392,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,260.4,70,,208.32,percent of total billed charges,70% of total billed charges,241.8,65,,193.44,percent of total billed charges,65% of total billed charges,132.69,35.67,,106.152,percent of total billed charges,35.67% of total billed charges,107.88,372,
SUTURE ANCHOR BIO COMP,27010495,CDM,278,RC,C1713,HCPCS,outpatient,,,1825,730.00,,1277.5,70,,1022,percent of total billed charges,70% of total billed charges,958.13,52.5,,766.5,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,1496.5,82,,1197.2,percent of total billed charges,82% of total billed charges,1551.25,85,,1241,percent of total billed charges,85% of total billed charges,1551.25,85,,1241,percent of total billed charges,85% of total billed charges,1551.25,85,,1241,percent of total billed charges,85% of total billed charges,1642.5,90,,1314,percent of total billed charges,90% of total billed charges,1460,80,,1168,percent of total billed charges,80% of total billed charges,1642.5,90,,1314,percent of total billed charges,90% of total billed charges,1368.75,75,,1095,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,529.25,29,,423.4,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1222.75,67,,978.2,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1277.5,70,,1022,percent of total billed charges,70% of total billed charges,1186.25,65,,949,percent of total billed charges,65% of total billed charges,650.98,35.67,,520.784,percent of total billed charges,35.67% of total billed charges,529.25,1642.5,
KIT LEAD MEDTRONIC DUAL,27010516,CDM,278,RC,C1778,HCPCS,outpatient,,,4026,1610.40,,2818.2,70,,2254.56,percent of total billed charges,70% of total billed charges,2113.65,52.5,,1690.92,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,3301.32,82,,2641.056,percent of total billed charges,82% of total billed charges,3422.1,85,,2737.68,percent of total billed charges,85% of total billed charges,3422.1,85,,2737.68,percent of total billed charges,85% of total billed charges,3422.1,85,,2737.68,percent of total billed charges,85% of total billed charges,3623.4,90,,2898.72,percent of total billed charges,90% of total billed charges,3220.8,80,,2576.64,percent of total billed charges,80% of total billed charges,3623.4,90,,2898.72,percent of total billed charges,90% of total billed charges,3019.5,75,,2415.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,1167.54,29,,934.032,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,2697.42,67,,2157.936,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,2818.2,70,,2254.56,percent of total billed charges,70% of total billed charges,2616.9,65,,2093.52,percent of total billed charges,65% of total billed charges,1436.07,35.67,,1148.856,percent of total billed charges,35.67% of total billed charges,1167.54,3623.4,
CORTEX SCREW SELF TAPPING 8 MM,27010566,CDM,278,RC,C1713,HCPCS,outpatient,,,283,113.20,,198.1,70,,158.48,percent of total billed charges,70% of total billed charges,283,100,,226.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,232.06,82,,185.648,percent of total billed charges,82% of total billed charges,240.55,85,,192.44,percent of total billed charges,85% of total billed charges,240.55,85,,192.44,percent of total billed charges,85% of total billed charges,240.55,85,,192.44,percent of total billed charges,85% of total billed charges,254.7,90,,203.76,percent of total billed charges,90% of total billed charges,226.4,80,,181.12,percent of total billed charges,80% of total billed charges,254.7,90,,203.76,percent of total billed charges,90% of total billed charges,212.25,75,,169.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,82.07,29,,65.656,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,189.61,67,,151.688,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,198.1,70,,158.48,percent of total billed charges,70% of total billed charges,183.95,65,,147.16,percent of total billed charges,65% of total billed charges,100.95,35.67,,80.76,percent of total billed charges,35.67% of total billed charges,82.07,283,
CORTEX SCREW SELF TAPPING 10MM,27010567,CDM,278,RC,C1713,HCPCS,outpatient,,,283,113.20,,198.1,70,,158.48,percent of total billed charges,70% of total billed charges,283,100,,226.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,232.06,82,,185.648,percent of total billed charges,82% of total billed charges,240.55,85,,192.44,percent of total billed charges,85% of total billed charges,240.55,85,,192.44,percent of total billed charges,85% of total billed charges,240.55,85,,192.44,percent of total billed charges,85% of total billed charges,254.7,90,,203.76,percent of total billed charges,90% of total billed charges,226.4,80,,181.12,percent of total billed charges,80% of total billed charges,254.7,90,,203.76,percent of total billed charges,90% of total billed charges,212.25,75,,169.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,82.07,29,,65.656,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,189.61,67,,151.688,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,198.1,70,,158.48,percent of total billed charges,70% of total billed charges,183.95,65,,147.16,percent of total billed charges,65% of total billed charges,100.95,35.67,,80.76,percent of total billed charges,35.67% of total billed charges,82.07,283,
TI STRAIGHT PLATE 6 HOLES/29MM,27010568,CDM,278,RC,C1713,HCPCS,outpatient,,,1063,425.20,,744.1,70,,595.28,percent of total billed charges,70% of total billed charges,558.08,52.5,,446.46,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,871.66,82,,697.328,percent of total billed charges,82% of total billed charges,903.55,85,,722.84,percent of total billed charges,85% of total billed charges,903.55,85,,722.84,percent of total billed charges,85% of total billed charges,903.55,85,,722.84,percent of total billed charges,85% of total billed charges,956.7,90,,765.36,percent of total billed charges,90% of total billed charges,850.4,80,,680.32,percent of total billed charges,80% of total billed charges,956.7,90,,765.36,percent of total billed charges,90% of total billed charges,797.25,75,,637.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,308.27,29,,246.616,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,712.21,67,,569.768,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,744.1,70,,595.28,percent of total billed charges,70% of total billed charges,690.95,65,,552.76,percent of total billed charges,65% of total billed charges,379.17,35.67,,303.336,percent of total billed charges,35.67% of total billed charges,308.27,956.7,
SCREW 2.0 # 14,27010577,CDM,278,RC,C1713,HCPCS,outpatient,,,281,112.40,,196.7,70,,157.36,percent of total billed charges,70% of total billed charges,281,100,,224.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,230.42,82,,184.336,percent of total billed charges,82% of total billed charges,238.85,85,,191.08,percent of total billed charges,85% of total billed charges,238.85,85,,191.08,percent of total billed charges,85% of total billed charges,238.85,85,,191.08,percent of total billed charges,85% of total billed charges,252.9,90,,202.32,percent of total billed charges,90% of total billed charges,224.8,80,,179.84,percent of total billed charges,80% of total billed charges,252.9,90,,202.32,percent of total billed charges,90% of total billed charges,210.75,75,,168.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,81.49,29,,65.192,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,188.27,67,,150.616,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,196.7,70,,157.36,percent of total billed charges,70% of total billed charges,182.65,65,,146.12,percent of total billed charges,65% of total billed charges,100.23,35.67,,80.184,percent of total billed charges,35.67% of total billed charges,81.49,281,
SCREW 2.0 # 20,27010578,CDM,278,RC,C1713,HCPCS,outpatient,,,281,112.40,,196.7,70,,157.36,percent of total billed charges,70% of total billed charges,281,100,,224.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,230.42,82,,184.336,percent of total billed charges,82% of total billed charges,238.85,85,,191.08,percent of total billed charges,85% of total billed charges,238.85,85,,191.08,percent of total billed charges,85% of total billed charges,238.85,85,,191.08,percent of total billed charges,85% of total billed charges,252.9,90,,202.32,percent of total billed charges,90% of total billed charges,224.8,80,,179.84,percent of total billed charges,80% of total billed charges,252.9,90,,202.32,percent of total billed charges,90% of total billed charges,210.75,75,,168.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,81.49,29,,65.192,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,188.27,67,,150.616,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,196.7,70,,157.36,percent of total billed charges,70% of total billed charges,182.65,65,,146.12,percent of total billed charges,65% of total billed charges,100.23,35.67,,80.184,percent of total billed charges,35.67% of total billed charges,81.49,281,
SCREW 2.0 # 18,27010579,CDM,278,RC,C1713,HCPCS,outpatient,,,281,112.40,,196.7,70,,157.36,percent of total billed charges,70% of total billed charges,281,100,,224.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,230.42,82,,184.336,percent of total billed charges,82% of total billed charges,238.85,85,,191.08,percent of total billed charges,85% of total billed charges,238.85,85,,191.08,percent of total billed charges,85% of total billed charges,238.85,85,,191.08,percent of total billed charges,85% of total billed charges,252.9,90,,202.32,percent of total billed charges,90% of total billed charges,224.8,80,,179.84,percent of total billed charges,80% of total billed charges,252.9,90,,202.32,percent of total billed charges,90% of total billed charges,210.75,75,,168.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,81.49,29,,65.192,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,188.27,67,,150.616,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,196.7,70,,157.36,percent of total billed charges,70% of total billed charges,182.65,65,,146.12,percent of total billed charges,65% of total billed charges,100.23,35.67,,80.184,percent of total billed charges,35.67% of total billed charges,81.49,281,
PLATE 4 HOLE 2.0,27010580,CDM,278,RC,C1713,HCPCS,outpatient,,,1278,511.20,,894.6,70,,715.68,percent of total billed charges,70% of total billed charges,670.95,52.5,,536.76,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,1047.96,82,,838.368,percent of total billed charges,82% of total billed charges,1086.3,85,,869.04,percent of total billed charges,85% of total billed charges,1086.3,85,,869.04,percent of total billed charges,85% of total billed charges,1086.3,85,,869.04,percent of total billed charges,85% of total billed charges,1150.2,90,,920.16,percent of total billed charges,90% of total billed charges,1022.4,80,,817.92,percent of total billed charges,80% of total billed charges,1150.2,90,,920.16,percent of total billed charges,90% of total billed charges,958.5,75,,766.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,370.62,29,,296.496,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,856.26,67,,685.008,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,894.6,70,,715.68,percent of total billed charges,70% of total billed charges,830.7,65,,664.56,percent of total billed charges,65% of total billed charges,455.86,35.67,,364.688,percent of total billed charges,35.67% of total billed charges,370.62,1150.2,
PLATE MEDIAL HUMERUS 3 HOLE,27010598,CDM,278,RC,C1713,HCPCS,outpatient,,,3737,1494.80,,2615.9,70,,2092.72,percent of total billed charges,70% of total billed charges,1961.93,52.5,,1569.54,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,3064.34,82,,2451.472,percent of total billed charges,82% of total billed charges,3176.45,85,,2541.16,percent of total billed charges,85% of total billed charges,3176.45,85,,2541.16,percent of total billed charges,85% of total billed charges,3176.45,85,,2541.16,percent of total billed charges,85% of total billed charges,3363.3,90,,2690.64,percent of total billed charges,90% of total billed charges,2989.6,80,,2391.68,percent of total billed charges,80% of total billed charges,3363.3,90,,2690.64,percent of total billed charges,90% of total billed charges,2802.75,75,,2242.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,1083.73,29,,866.984,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,2503.79,67,,2003.032,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,2615.9,70,,2092.72,percent of total billed charges,70% of total billed charges,2429.05,65,,1943.24,percent of total billed charges,65% of total billed charges,1332.99,35.67,,1066.392,percent of total billed charges,35.67% of total billed charges,1083.73,3363.3,
PLATE POSTEROLATERAL 3 HOLE,27010599,CDM,278,RC,C1713,HCPCS,outpatient,,,3737,1494.80,,2615.9,70,,2092.72,percent of total billed charges,70% of total billed charges,1961.93,52.5,,1569.54,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,3064.34,82,,2451.472,percent of total billed charges,82% of total billed charges,3176.45,85,,2541.16,percent of total billed charges,85% of total billed charges,3176.45,85,,2541.16,percent of total billed charges,85% of total billed charges,3176.45,85,,2541.16,percent of total billed charges,85% of total billed charges,3363.3,90,,2690.64,percent of total billed charges,90% of total billed charges,2989.6,80,,2391.68,percent of total billed charges,80% of total billed charges,3363.3,90,,2690.64,percent of total billed charges,90% of total billed charges,2802.75,75,,2242.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,1083.73,29,,866.984,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,2503.79,67,,2003.032,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,2615.9,70,,2092.72,percent of total billed charges,70% of total billed charges,2429.05,65,,1943.24,percent of total billed charges,65% of total billed charges,1332.99,35.67,,1066.392,percent of total billed charges,35.67% of total billed charges,1083.73,3363.3,
CORTEX SCREW 3.5 30 MM,27010600,CDM,278,RC,C1713,HCPCS,outpatient,,,201,80.40,,140.7,70,,112.56,percent of total billed charges,70% of total billed charges,201,100,,160.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,164.82,82,,131.856,percent of total billed charges,82% of total billed charges,170.85,85,,136.68,percent of total billed charges,85% of total billed charges,170.85,85,,136.68,percent of total billed charges,85% of total billed charges,170.85,85,,136.68,percent of total billed charges,85% of total billed charges,180.9,90,,144.72,percent of total billed charges,90% of total billed charges,160.8,80,,128.64,percent of total billed charges,80% of total billed charges,180.9,90,,144.72,percent of total billed charges,90% of total billed charges,150.75,75,,120.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,58.29,29,,46.632,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,134.67,67,,107.736,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,140.7,70,,112.56,percent of total billed charges,70% of total billed charges,130.65,65,,104.52,percent of total billed charges,65% of total billed charges,71.7,35.67,,57.36,percent of total billed charges,35.67% of total billed charges,58.29,201,
LOCKING SCREW 2.7 10MM,27010601,CDM,278,RC,C1713,HCPCS,outpatient,,,797,318.80,,557.9,70,,446.32,percent of total billed charges,70% of total billed charges,797,100,,637.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,653.54,82,,522.832,percent of total billed charges,82% of total billed charges,677.45,85,,541.96,percent of total billed charges,85% of total billed charges,677.45,85,,541.96,percent of total billed charges,85% of total billed charges,677.45,85,,541.96,percent of total billed charges,85% of total billed charges,717.3,90,,573.84,percent of total billed charges,90% of total billed charges,637.6,80,,510.08,percent of total billed charges,80% of total billed charges,717.3,90,,573.84,percent of total billed charges,90% of total billed charges,597.75,75,,478.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,231.13,29,,184.904,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,533.99,67,,427.192,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,557.9,70,,446.32,percent of total billed charges,70% of total billed charges,518.05,65,,414.44,percent of total billed charges,65% of total billed charges,284.29,35.67,,227.432,percent of total billed charges,35.67% of total billed charges,231.13,797,
FIXED CORE WIRE GUIDE AMPLATZ,27010627,CDM,278,RC,C1769,HCPCS,outpatient,,,251,100.40,,175.7,70,,140.56,percent of total billed charges,70% of total billed charges,251,100,,200.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,205.82,82,,164.656,percent of total billed charges,82% of total billed charges,213.35,85,,170.68,percent of total billed charges,85% of total billed charges,213.35,85,,170.68,percent of total billed charges,85% of total billed charges,213.35,85,,170.68,percent of total billed charges,85% of total billed charges,225.9,90,,180.72,percent of total billed charges,90% of total billed charges,200.8,80,,160.64,percent of total billed charges,80% of total billed charges,225.9,90,,180.72,percent of total billed charges,90% of total billed charges,188.25,75,,150.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,72.79,29,,58.232,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,168.17,67,,134.536,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,175.7,70,,140.56,percent of total billed charges,70% of total billed charges,163.15,65,,130.52,percent of total billed charges,65% of total billed charges,89.53,35.67,,71.624,percent of total billed charges,35.67% of total billed charges,72.79,251,
HEALIX ADV 4.5,27010634,CDM,278,RC,C1713,HCPCS,outpatient,,,1696,678.40,,1187.2,70,,949.76,percent of total billed charges,70% of total billed charges,890.4,52.5,,712.32,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,1390.72,82,,1112.576,percent of total billed charges,82% of total billed charges,1441.6,85,,1153.28,percent of total billed charges,85% of total billed charges,1441.6,85,,1153.28,percent of total billed charges,85% of total billed charges,1441.6,85,,1153.28,percent of total billed charges,85% of total billed charges,1526.4,90,,1221.12,percent of total billed charges,90% of total billed charges,1356.8,80,,1085.44,percent of total billed charges,80% of total billed charges,1526.4,90,,1221.12,percent of total billed charges,90% of total billed charges,1272,75,,1017.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,491.84,29,,393.472,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1136.32,67,,909.056,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1187.2,70,,949.76,percent of total billed charges,70% of total billed charges,1102.4,65,,881.92,percent of total billed charges,65% of total billed charges,604.96,35.67,,483.968,percent of total billed charges,35.67% of total billed charges,491.84,1526.4,
COBALT HV WITH GENTAMICIN,27010643,CDM,278,RC,C1713,HCPCS,outpatient,,,2059,823.60,,1441.3,70,,1153.04,percent of total billed charges,70% of total billed charges,1080.98,52.5,,864.78,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,1688.38,82,,1350.704,percent of total billed charges,82% of total billed charges,1750.15,85,,1400.12,percent of total billed charges,85% of total billed charges,1750.15,85,,1400.12,percent of total billed charges,85% of total billed charges,1750.15,85,,1400.12,percent of total billed charges,85% of total billed charges,1853.1,90,,1482.48,percent of total billed charges,90% of total billed charges,1647.2,80,,1317.76,percent of total billed charges,80% of total billed charges,1853.1,90,,1482.48,percent of total billed charges,90% of total billed charges,1544.25,75,,1235.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,597.11,29,,477.688,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1379.53,67,,1103.624,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1441.3,70,,1153.04,percent of total billed charges,70% of total billed charges,1338.35,65,,1070.68,percent of total billed charges,65% of total billed charges,734.45,35.67,,587.56,percent of total billed charges,35.67% of total billed charges,597.11,1853.1,
CORTEX SCREW 3.5MM 28MM,27010650,CDM,278,RC,C1713,HCPCS,outpatient,,,203,81.20,,142.1,70,,113.68,percent of total billed charges,70% of total billed charges,203,100,,162.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,166.46,82,,133.168,percent of total billed charges,82% of total billed charges,172.55,85,,138.04,percent of total billed charges,85% of total billed charges,172.55,85,,138.04,percent of total billed charges,85% of total billed charges,172.55,85,,138.04,percent of total billed charges,85% of total billed charges,182.7,90,,146.16,percent of total billed charges,90% of total billed charges,162.4,80,,129.92,percent of total billed charges,80% of total billed charges,182.7,90,,146.16,percent of total billed charges,90% of total billed charges,152.25,75,,121.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,58.87,29,,47.096,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,136.01,67,,108.808,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,142.1,70,,113.68,percent of total billed charges,70% of total billed charges,131.95,65,,105.56,percent of total billed charges,65% of total billed charges,72.41,35.67,,57.928,percent of total billed charges,35.67% of total billed charges,58.87,203,
CONDYLAR PLATE 2.0MM 7 HOLE,27010651,CDM,278,RC,C1713,HCPCS,outpatient,,,3124,1249.60,,2186.8,70,,1749.44,percent of total billed charges,70% of total billed charges,1640.1,52.5,,1312.08,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,2561.68,82,,2049.344,percent of total billed charges,82% of total billed charges,2655.4,85,,2124.32,percent of total billed charges,85% of total billed charges,2655.4,85,,2124.32,percent of total billed charges,85% of total billed charges,2655.4,85,,2124.32,percent of total billed charges,85% of total billed charges,2811.6,90,,2249.28,percent of total billed charges,90% of total billed charges,2499.2,80,,1999.36,percent of total billed charges,80% of total billed charges,2811.6,90,,2249.28,percent of total billed charges,90% of total billed charges,2343,75,,1874.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,905.96,29,,724.768,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,2093.08,67,,1674.464,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,2186.8,70,,1749.44,percent of total billed charges,70% of total billed charges,2030.6,65,,1624.48,percent of total billed charges,65% of total billed charges,1114.33,35.67,,891.464,percent of total billed charges,35.67% of total billed charges,905.96,2811.6,
LOCK SCREW 2.0MM SLF TAP13MM,27010652,CDM,278,RC,C1713,HCPCS,outpatient,,,769,307.60,,538.3,70,,430.64,percent of total billed charges,70% of total billed charges,769,100,,615.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,630.58,82,,504.464,percent of total billed charges,82% of total billed charges,653.65,85,,522.92,percent of total billed charges,85% of total billed charges,653.65,85,,522.92,percent of total billed charges,85% of total billed charges,653.65,85,,522.92,percent of total billed charges,85% of total billed charges,692.1,90,,553.68,percent of total billed charges,90% of total billed charges,615.2,80,,492.16,percent of total billed charges,80% of total billed charges,692.1,90,,553.68,percent of total billed charges,90% of total billed charges,576.75,75,,461.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,223.01,29,,178.408,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,515.23,67,,412.184,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,538.3,70,,430.64,percent of total billed charges,70% of total billed charges,499.85,65,,399.88,percent of total billed charges,65% of total billed charges,274.3,35.67,,219.44,percent of total billed charges,35.67% of total billed charges,223.01,769,
CORTEX SCREW 2.0MM SLF TAP 8MM,27010653,CDM,278,RC,C1713,HCPCS,outpatient,,,289,115.60,,202.3,70,,161.84,percent of total billed charges,70% of total billed charges,289,100,,231.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,236.98,82,,189.584,percent of total billed charges,82% of total billed charges,245.65,85,,196.52,percent of total billed charges,85% of total billed charges,245.65,85,,196.52,percent of total billed charges,85% of total billed charges,245.65,85,,196.52,percent of total billed charges,85% of total billed charges,260.1,90,,208.08,percent of total billed charges,90% of total billed charges,231.2,80,,184.96,percent of total billed charges,80% of total billed charges,260.1,90,,208.08,percent of total billed charges,90% of total billed charges,216.75,75,,173.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,83.81,29,,67.048,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,193.63,67,,154.904,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,202.3,70,,161.84,percent of total billed charges,70% of total billed charges,187.85,65,,150.28,percent of total billed charges,65% of total billed charges,103.09,35.67,,82.472,percent of total billed charges,35.67% of total billed charges,83.81,289,
CORTEX SCREW 2.0MM TAP 13 MM,27010654,CDM,278,RC,C1713,HCPCS,outpatient,,,289,115.60,,202.3,70,,161.84,percent of total billed charges,70% of total billed charges,289,100,,231.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,236.98,82,,189.584,percent of total billed charges,82% of total billed charges,245.65,85,,196.52,percent of total billed charges,85% of total billed charges,245.65,85,,196.52,percent of total billed charges,85% of total billed charges,245.65,85,,196.52,percent of total billed charges,85% of total billed charges,260.1,90,,208.08,percent of total billed charges,90% of total billed charges,231.2,80,,184.96,percent of total billed charges,80% of total billed charges,260.1,90,,208.08,percent of total billed charges,90% of total billed charges,216.75,75,,173.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,83.81,29,,67.048,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,193.63,67,,154.904,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,202.3,70,,161.84,percent of total billed charges,70% of total billed charges,187.85,65,,150.28,percent of total billed charges,65% of total billed charges,103.09,35.67,,82.472,percent of total billed charges,35.67% of total billed charges,83.81,289,
T8 DRIVER SHAFT,27010655,CDM,278,RC,C1713,HCPCS,outpatient,,,1710,684.00,,1197,70,,957.6,percent of total billed charges,70% of total billed charges,897.75,52.5,,718.2,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,1402.2,82,,1121.76,percent of total billed charges,82% of total billed charges,1453.5,85,,1162.8,percent of total billed charges,85% of total billed charges,1453.5,85,,1162.8,percent of total billed charges,85% of total billed charges,1453.5,85,,1162.8,percent of total billed charges,85% of total billed charges,1539,90,,1231.2,percent of total billed charges,90% of total billed charges,1368,80,,1094.4,percent of total billed charges,80% of total billed charges,1539,90,,1231.2,percent of total billed charges,90% of total billed charges,1282.5,75,,1026,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,495.9,29,,396.72,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1145.7,67,,916.56,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1197,70,,957.6,percent of total billed charges,70% of total billed charges,1111.5,65,,889.2,percent of total billed charges,65% of total billed charges,609.96,35.67,,487.968,percent of total billed charges,35.67% of total billed charges,495.9,1539,
T6 DRIVER SHAFT,27010656,CDM,278,RC,C1713,HCPCS,outpatient,,,1925,770.00,,1347.5,70,,1078,percent of total billed charges,70% of total billed charges,1010.63,52.5,,808.5,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,1578.5,82,,1262.8,percent of total billed charges,82% of total billed charges,1636.25,85,,1309,percent of total billed charges,85% of total billed charges,1636.25,85,,1309,percent of total billed charges,85% of total billed charges,1636.25,85,,1309,percent of total billed charges,85% of total billed charges,1732.5,90,,1386,percent of total billed charges,90% of total billed charges,1540,80,,1232,percent of total billed charges,80% of total billed charges,1732.5,90,,1386,percent of total billed charges,90% of total billed charges,1443.75,75,,1155,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,558.25,29,,446.6,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1289.75,67,,1031.8,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1347.5,70,,1078,percent of total billed charges,70% of total billed charges,1251.25,65,,1001,percent of total billed charges,65% of total billed charges,686.65,35.67,,549.32,percent of total billed charges,35.67% of total billed charges,558.25,1732.5,
"LONG NAIL KIT R 1.5,TI, LEFT",27010667,CDM,278,RC,C1713,HCPCS,outpatient,,,8272,3308.80,,5790.4,70,,4632.32,percent of total billed charges,70% of total billed charges,4342.8,52.5,,3474.24,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,6783.04,82,,5426.432,percent of total billed charges,82% of total billed charges,7031.2,85,,5624.96,percent of total billed charges,85% of total billed charges,7031.2,85,,5624.96,percent of total billed charges,85% of total billed charges,7031.2,85,,5624.96,percent of total billed charges,85% of total billed charges,7444.8,90,,5955.84,percent of total billed charges,90% of total billed charges,6617.6,80,,5294.08,percent of total billed charges,80% of total billed charges,7444.8,90,,5955.84,percent of total billed charges,90% of total billed charges,6204,75,,4963.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2398.88,29,,1919.104,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,5542.24,67,,4433.792,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,5790.4,70,,4632.32,percent of total billed charges,70% of total billed charges,5376.8,65,,4301.44,percent of total billed charges,65% of total billed charges,2950.62,35.67,,2360.496,percent of total billed charges,35.67% of total billed charges,2398.88,7444.8,
"REAMER SHAFT, MOD, TRINKLE",27010668,CDM,278,RC,C1713,HCPCS,outpatient,,,1791,716.40,,1253.7,70,,1002.96,percent of total billed charges,70% of total billed charges,940.28,52.5,,752.22,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,1468.62,82,,1174.896,percent of total billed charges,82% of total billed charges,1522.35,85,,1217.88,percent of total billed charges,85% of total billed charges,1522.35,85,,1217.88,percent of total billed charges,85% of total billed charges,1522.35,85,,1217.88,percent of total billed charges,85% of total billed charges,1611.9,90,,1289.52,percent of total billed charges,90% of total billed charges,1432.8,80,,1146.24,percent of total billed charges,80% of total billed charges,1611.9,90,,1289.52,percent of total billed charges,90% of total billed charges,1343.25,75,,1074.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,519.39,29,,415.512,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1199.97,67,,959.976,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1253.7,70,,1002.96,percent of total billed charges,70% of total billed charges,1164.15,65,,931.32,percent of total billed charges,65% of total billed charges,638.85,35.67,,511.08,percent of total billed charges,35.67% of total billed charges,519.39,1611.9,
"GUIDE WIRE, BALL - TIPPED",27010669,CDM,278,RC,C1769,HCPCS,outpatient,,,1178,471.20,,824.6,70,,659.68,percent of total billed charges,70% of total billed charges,618.45,52.5,,494.76,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,965.96,82,,772.768,percent of total billed charges,82% of total billed charges,1001.3,85,,801.04,percent of total billed charges,85% of total billed charges,1001.3,85,,801.04,percent of total billed charges,85% of total billed charges,1001.3,85,,801.04,percent of total billed charges,85% of total billed charges,1060.2,90,,848.16,percent of total billed charges,90% of total billed charges,942.4,80,,753.92,percent of total billed charges,80% of total billed charges,1060.2,90,,848.16,percent of total billed charges,90% of total billed charges,883.5,75,,706.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,341.62,29,,273.296,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,789.26,67,,631.408,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,824.6,70,,659.68,percent of total billed charges,70% of total billed charges,765.7,65,,612.56,percent of total billed charges,65% of total billed charges,420.19,35.67,,336.152,percent of total billed charges,35.67% of total billed charges,341.62,1060.2,
K-WIRE,27010671,CDM,278,RC,C1713,HCPCS,outpatient,,,812,324.80,,568.4,70,,454.72,percent of total billed charges,70% of total billed charges,812,100,,649.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,665.84,82,,532.672,percent of total billed charges,82% of total billed charges,690.2,85,,552.16,percent of total billed charges,85% of total billed charges,690.2,85,,552.16,percent of total billed charges,85% of total billed charges,690.2,85,,552.16,percent of total billed charges,85% of total billed charges,730.8,90,,584.64,percent of total billed charges,90% of total billed charges,649.6,80,,519.68,percent of total billed charges,80% of total billed charges,730.8,90,,584.64,percent of total billed charges,90% of total billed charges,609,75,,487.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,235.48,29,,188.384,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,544.04,67,,435.232,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,568.4,70,,454.72,percent of total billed charges,70% of total billed charges,527.8,65,,422.24,percent of total billed charges,65% of total billed charges,289.64,35.67,,231.712,percent of total billed charges,35.67% of total billed charges,235.48,812,
"LAG SCREW, TI",27010672,CDM,278,RC,C1713,HCPCS,outpatient,,,2169,867.60,,1518.3,70,,1214.64,percent of total billed charges,70% of total billed charges,1138.73,52.5,,910.98,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,1778.58,82,,1422.864,percent of total billed charges,82% of total billed charges,1843.65,85,,1474.92,percent of total billed charges,85% of total billed charges,1843.65,85,,1474.92,percent of total billed charges,85% of total billed charges,1843.65,85,,1474.92,percent of total billed charges,85% of total billed charges,1952.1,90,,1561.68,percent of total billed charges,90% of total billed charges,1735.2,80,,1388.16,percent of total billed charges,80% of total billed charges,1952.1,90,,1561.68,percent of total billed charges,90% of total billed charges,1626.75,75,,1301.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,629.01,29,,503.208,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1453.23,67,,1162.584,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1518.3,70,,1214.64,percent of total billed charges,70% of total billed charges,1409.85,65,,1127.88,percent of total billed charges,65% of total billed charges,773.68,35.67,,618.944,percent of total billed charges,35.67% of total billed charges,629.01,1952.1,
CANNULATED SCREW 55X5.8,27010682,CDM,278,RC,C1713,HCPCS,outpatient,,,1272,508.80,,890.4,70,,712.32,percent of total billed charges,70% of total billed charges,667.8,52.5,,534.24,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,1043.04,82,,834.432,percent of total billed charges,82% of total billed charges,1081.2,85,,864.96,percent of total billed charges,85% of total billed charges,1081.2,85,,864.96,percent of total billed charges,85% of total billed charges,1081.2,85,,864.96,percent of total billed charges,85% of total billed charges,1144.8,90,,915.84,percent of total billed charges,90% of total billed charges,1017.6,80,,814.08,percent of total billed charges,80% of total billed charges,1144.8,90,,915.84,percent of total billed charges,90% of total billed charges,954,75,,763.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,368.88,29,,295.104,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,852.24,67,,681.792,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,890.4,70,,712.32,percent of total billed charges,70% of total billed charges,826.8,65,,661.44,percent of total billed charges,65% of total billed charges,453.72,35.67,,362.976,percent of total billed charges,35.67% of total billed charges,368.88,1144.8,
K-WIRE 1.25,27010700,CDM,278,RC,C1713,HCPCS,outpatient,,,269,107.60,,188.3,70,,150.64,percent of total billed charges,70% of total billed charges,269,100,,215.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,220.58,82,,176.464,percent of total billed charges,82% of total billed charges,228.65,85,,182.92,percent of total billed charges,85% of total billed charges,228.65,85,,182.92,percent of total billed charges,85% of total billed charges,228.65,85,,182.92,percent of total billed charges,85% of total billed charges,242.1,90,,193.68,percent of total billed charges,90% of total billed charges,215.2,80,,172.16,percent of total billed charges,80% of total billed charges,242.1,90,,193.68,percent of total billed charges,90% of total billed charges,201.75,75,,161.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,78.01,29,,62.408,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,180.23,67,,144.184,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,188.3,70,,150.64,percent of total billed charges,70% of total billed charges,174.85,65,,139.88,percent of total billed charges,65% of total billed charges,95.95,35.67,,76.76,percent of total billed charges,35.67% of total billed charges,78.01,269,
CORTEX CORTICAL 2.7MMX22MM,27010702,CDM,278,RC,C1713,HCPCS,outpatient,,,346,138.40,,242.2,70,,193.76,percent of total billed charges,70% of total billed charges,346,100,,276.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,283.72,82,,226.976,percent of total billed charges,82% of total billed charges,294.1,85,,235.28,percent of total billed charges,85% of total billed charges,294.1,85,,235.28,percent of total billed charges,85% of total billed charges,294.1,85,,235.28,percent of total billed charges,85% of total billed charges,311.4,90,,249.12,percent of total billed charges,90% of total billed charges,276.8,80,,221.44,percent of total billed charges,80% of total billed charges,311.4,90,,249.12,percent of total billed charges,90% of total billed charges,259.5,75,,207.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,100.34,29,,80.272,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,231.82,67,,185.456,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,242.2,70,,193.76,percent of total billed charges,70% of total billed charges,224.9,65,,179.92,percent of total billed charges,65% of total billed charges,123.42,35.67,,98.736,percent of total billed charges,35.67% of total billed charges,100.34,346,
CORTEX SCREW 2.0MMX16MM,27010703,CDM,278,RC,C1713,HCPCS,outpatient,,,308,123.20,,215.6,70,,172.48,percent of total billed charges,70% of total billed charges,308,100,,246.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,252.56,82,,202.048,percent of total billed charges,82% of total billed charges,261.8,85,,209.44,percent of total billed charges,85% of total billed charges,261.8,85,,209.44,percent of total billed charges,85% of total billed charges,261.8,85,,209.44,percent of total billed charges,85% of total billed charges,277.2,90,,221.76,percent of total billed charges,90% of total billed charges,246.4,80,,197.12,percent of total billed charges,80% of total billed charges,277.2,90,,221.76,percent of total billed charges,90% of total billed charges,231,75,,184.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,89.32,29,,71.456,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,206.36,67,,165.088,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,215.6,70,,172.48,percent of total billed charges,70% of total billed charges,200.2,65,,160.16,percent of total billed charges,65% of total billed charges,109.86,35.67,,87.888,percent of total billed charges,35.67% of total billed charges,89.32,308,
CORTEX/CORTICAL SCREW 2.7MMX22,27010704,CDM,278,RC,C1713,HCPCS,outpatient,,,325,130.00,,227.5,70,,182,percent of total billed charges,70% of total billed charges,325,100,,260,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,266.5,82,,213.2,percent of total billed charges,82% of total billed charges,276.25,85,,221,percent of total billed charges,85% of total billed charges,276.25,85,,221,percent of total billed charges,85% of total billed charges,276.25,85,,221,percent of total billed charges,85% of total billed charges,292.5,90,,234,percent of total billed charges,90% of total billed charges,260,80,,208,percent of total billed charges,80% of total billed charges,292.5,90,,234,percent of total billed charges,90% of total billed charges,243.75,75,,195,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,94.25,29,,75.4,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,217.75,67,,174.2,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,227.5,70,,182,percent of total billed charges,70% of total billed charges,211.25,65,,169,percent of total billed charges,65% of total billed charges,115.93,35.67,,92.744,percent of total billed charges,35.67% of total billed charges,94.25,325,
2.0 CORTEX 16 MM,27010705,CDM,278,RC,C1713,HCPCS,outpatient,,,308,123.20,,215.6,70,,172.48,percent of total billed charges,70% of total billed charges,308,100,,246.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,252.56,82,,202.048,percent of total billed charges,82% of total billed charges,261.8,85,,209.44,percent of total billed charges,85% of total billed charges,261.8,85,,209.44,percent of total billed charges,85% of total billed charges,261.8,85,,209.44,percent of total billed charges,85% of total billed charges,277.2,90,,221.76,percent of total billed charges,90% of total billed charges,246.4,80,,197.12,percent of total billed charges,80% of total billed charges,277.2,90,,221.76,percent of total billed charges,90% of total billed charges,231,75,,184.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,89.32,29,,71.456,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,206.36,67,,165.088,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,215.6,70,,172.48,percent of total billed charges,70% of total billed charges,200.2,65,,160.16,percent of total billed charges,65% of total billed charges,109.86,35.67,,87.888,percent of total billed charges,35.67% of total billed charges,89.32,308,
CORTEX 2.7 SCREW 34MM,27010729,CDM,278,RC,C1713,HCPCS,outpatient,,,325,130.00,,227.5,70,,182,percent of total billed charges,70% of total billed charges,325,100,,260,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,266.5,82,,213.2,percent of total billed charges,82% of total billed charges,276.25,85,,221,percent of total billed charges,85% of total billed charges,276.25,85,,221,percent of total billed charges,85% of total billed charges,276.25,85,,221,percent of total billed charges,85% of total billed charges,292.5,90,,234,percent of total billed charges,90% of total billed charges,260,80,,208,percent of total billed charges,80% of total billed charges,292.5,90,,234,percent of total billed charges,90% of total billed charges,243.75,75,,195,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,94.25,29,,75.4,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,217.75,67,,174.2,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,227.5,70,,182,percent of total billed charges,70% of total billed charges,211.25,65,,169,percent of total billed charges,65% of total billed charges,115.93,35.67,,92.744,percent of total billed charges,35.67% of total billed charges,94.25,325,
CORTEX 2.4 16MM,27010731,CDM,278,RC,C1713,HCPCS,outpatient,,,398,159.20,,278.6,70,,222.88,percent of total billed charges,70% of total billed charges,398,100,,318.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,326.36,82,,261.088,percent of total billed charges,82% of total billed charges,338.3,85,,270.64,percent of total billed charges,85% of total billed charges,338.3,85,,270.64,percent of total billed charges,85% of total billed charges,338.3,85,,270.64,percent of total billed charges,85% of total billed charges,358.2,90,,286.56,percent of total billed charges,90% of total billed charges,318.4,80,,254.72,percent of total billed charges,80% of total billed charges,358.2,90,,286.56,percent of total billed charges,90% of total billed charges,298.5,75,,238.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,115.42,29,,92.336,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,266.66,67,,213.328,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,278.6,70,,222.88,percent of total billed charges,70% of total billed charges,258.7,65,,206.96,percent of total billed charges,65% of total billed charges,141.97,35.67,,113.576,percent of total billed charges,35.67% of total billed charges,115.42,398,
K-WIRE 1.25MM,27010732,CDM,278,RC,C1713,HCPCS,outpatient,,,641,256.40,,448.7,70,,358.96,percent of total billed charges,70% of total billed charges,641,100,,512.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,525.62,82,,420.496,percent of total billed charges,82% of total billed charges,544.85,85,,435.88,percent of total billed charges,85% of total billed charges,544.85,85,,435.88,percent of total billed charges,85% of total billed charges,544.85,85,,435.88,percent of total billed charges,85% of total billed charges,576.9,90,,461.52,percent of total billed charges,90% of total billed charges,512.8,80,,410.24,percent of total billed charges,80% of total billed charges,576.9,90,,461.52,percent of total billed charges,90% of total billed charges,480.75,75,,384.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,185.89,29,,148.712,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,429.47,67,,343.576,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,448.7,70,,358.96,percent of total billed charges,70% of total billed charges,416.65,65,,333.32,percent of total billed charges,65% of total billed charges,228.64,35.67,,182.912,percent of total billed charges,35.67% of total billed charges,185.89,641,
K-WIRE 2.0 MM,27010733,CDM,278,RC,C1713,HCPCS,outpatient,,,641,256.40,,448.7,70,,358.96,percent of total billed charges,70% of total billed charges,641,100,,512.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,525.62,82,,420.496,percent of total billed charges,82% of total billed charges,544.85,85,,435.88,percent of total billed charges,85% of total billed charges,544.85,85,,435.88,percent of total billed charges,85% of total billed charges,544.85,85,,435.88,percent of total billed charges,85% of total billed charges,576.9,90,,461.52,percent of total billed charges,90% of total billed charges,512.8,80,,410.24,percent of total billed charges,80% of total billed charges,576.9,90,,461.52,percent of total billed charges,90% of total billed charges,480.75,75,,384.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,185.89,29,,148.712,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,429.47,67,,343.576,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,448.7,70,,358.96,percent of total billed charges,70% of total billed charges,416.65,65,,333.32,percent of total billed charges,65% of total billed charges,228.64,35.67,,182.912,percent of total billed charges,35.67% of total billed charges,185.89,641,
CORTEX 2.0 18 MM SCREW,27010734,CDM,278,RC,C1713,HCPCS,outpatient,,,321,128.40,,224.7,70,,179.76,percent of total billed charges,70% of total billed charges,321,100,,256.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,263.22,82,,210.576,percent of total billed charges,82% of total billed charges,272.85,85,,218.28,percent of total billed charges,85% of total billed charges,272.85,85,,218.28,percent of total billed charges,85% of total billed charges,272.85,85,,218.28,percent of total billed charges,85% of total billed charges,288.9,90,,231.12,percent of total billed charges,90% of total billed charges,256.8,80,,205.44,percent of total billed charges,80% of total billed charges,288.9,90,,231.12,percent of total billed charges,90% of total billed charges,240.75,75,,192.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,93.09,29,,74.472,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,215.07,67,,172.056,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,224.7,70,,179.76,percent of total billed charges,70% of total billed charges,208.65,65,,166.92,percent of total billed charges,65% of total billed charges,114.5,35.67,,91.6,percent of total billed charges,35.67% of total billed charges,93.09,321,
SCREW CORTEX 2.7MM/34MM,27010741,CDM,278,RC,C1713,HCPCS,outpatient,,,325,130.00,,227.5,70,,182,percent of total billed charges,70% of total billed charges,325,100,,260,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,266.5,82,,213.2,percent of total billed charges,82% of total billed charges,276.25,85,,221,percent of total billed charges,85% of total billed charges,276.25,85,,221,percent of total billed charges,85% of total billed charges,276.25,85,,221,percent of total billed charges,85% of total billed charges,292.5,90,,234,percent of total billed charges,90% of total billed charges,260,80,,208,percent of total billed charges,80% of total billed charges,292.5,90,,234,percent of total billed charges,90% of total billed charges,243.75,75,,195,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,94.25,29,,75.4,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,217.75,67,,174.2,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,227.5,70,,182,percent of total billed charges,70% of total billed charges,211.25,65,,169,percent of total billed charges,65% of total billed charges,115.93,35.67,,92.744,percent of total billed charges,35.67% of total billed charges,94.25,325,
SINK COUNTER FOR CORTEX SCREW,27010742,CDM,278,RC,C1713,HCPCS,outpatient,,,879,351.60,,615.3,70,,492.24,percent of total billed charges,70% of total billed charges,879,100,,703.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,720.78,82,,576.624,percent of total billed charges,82% of total billed charges,747.15,85,,597.72,percent of total billed charges,85% of total billed charges,747.15,85,,597.72,percent of total billed charges,85% of total billed charges,747.15,85,,597.72,percent of total billed charges,85% of total billed charges,791.1,90,,632.88,percent of total billed charges,90% of total billed charges,703.2,80,,562.56,percent of total billed charges,80% of total billed charges,791.1,90,,632.88,percent of total billed charges,90% of total billed charges,659.25,75,,527.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,254.91,29,,203.928,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,588.93,67,,471.144,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,615.3,70,,492.24,percent of total billed charges,70% of total billed charges,571.35,65,,457.08,percent of total billed charges,65% of total billed charges,313.54,35.67,,250.832,percent of total billed charges,35.67% of total billed charges,254.91,879,
OSTESTOMY G HOLE PLATE 2.7MM,27010783,CDM,278,RC,C1713,HCPCS,outpatient,,,4837,1934.80,,3385.9,70,,2708.72,percent of total billed charges,70% of total billed charges,2539.43,52.5,,2031.54,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,3966.34,82,,3173.072,percent of total billed charges,82% of total billed charges,4111.45,85,,3289.16,percent of total billed charges,85% of total billed charges,4111.45,85,,3289.16,percent of total billed charges,85% of total billed charges,4111.45,85,,3289.16,percent of total billed charges,85% of total billed charges,4353.3,90,,3482.64,percent of total billed charges,90% of total billed charges,3869.6,80,,3095.68,percent of total billed charges,80% of total billed charges,4353.3,90,,3482.64,percent of total billed charges,90% of total billed charges,3627.75,75,,2902.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,1402.73,29,,1122.184,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,3240.79,67,,2592.632,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,3385.9,70,,2708.72,percent of total billed charges,70% of total billed charges,3144.05,65,,2515.24,percent of total billed charges,65% of total billed charges,1725.36,35.67,,1380.288,percent of total billed charges,35.67% of total billed charges,1402.73,4353.3,
K WIRE 2.0 SHORT DEPTH MARKS,27010784,CDM,278,RC,C1713,HCPCS,outpatient,,,303,121.20,,212.1,70,,169.68,percent of total billed charges,70% of total billed charges,303,100,,242.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,248.46,82,,198.768,percent of total billed charges,82% of total billed charges,257.55,85,,206.04,percent of total billed charges,85% of total billed charges,257.55,85,,206.04,percent of total billed charges,85% of total billed charges,257.55,85,,206.04,percent of total billed charges,85% of total billed charges,272.7,90,,218.16,percent of total billed charges,90% of total billed charges,242.4,80,,193.92,percent of total billed charges,80% of total billed charges,272.7,90,,218.16,percent of total billed charges,90% of total billed charges,227.25,75,,181.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,87.87,29,,70.296,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,203.01,67,,162.408,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,212.1,70,,169.68,percent of total billed charges,70% of total billed charges,196.95,65,,157.56,percent of total billed charges,65% of total billed charges,108.08,35.67,,86.464,percent of total billed charges,35.67% of total billed charges,87.87,303,
K WIRE 2.0 LONG W DETH MARKS,27010785,CDM,278,RC,C1713,HCPCS,outpatient,,,303,121.20,,212.1,70,,169.68,percent of total billed charges,70% of total billed charges,303,100,,242.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,248.46,82,,198.768,percent of total billed charges,82% of total billed charges,257.55,85,,206.04,percent of total billed charges,85% of total billed charges,257.55,85,,206.04,percent of total billed charges,85% of total billed charges,257.55,85,,206.04,percent of total billed charges,85% of total billed charges,272.7,90,,218.16,percent of total billed charges,90% of total billed charges,242.4,80,,193.92,percent of total billed charges,80% of total billed charges,272.7,90,,218.16,percent of total billed charges,90% of total billed charges,227.25,75,,181.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,87.87,29,,70.296,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,203.01,67,,162.408,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,212.1,70,,169.68,percent of total billed charges,70% of total billed charges,196.95,65,,157.56,percent of total billed charges,65% of total billed charges,108.08,35.67,,86.464,percent of total billed charges,35.67% of total billed charges,87.87,303,
DEG RT GAMMA 13X420X125,27010825,CDM,278,RC,C1713,HCPCS,outpatient,,,8162,3264.80,,5713.4,70,,4570.72,percent of total billed charges,70% of total billed charges,4285.05,52.5,,3428.04,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,6692.84,82,,5354.272,percent of total billed charges,82% of total billed charges,6937.7,85,,5550.16,percent of total billed charges,85% of total billed charges,6937.7,85,,5550.16,percent of total billed charges,85% of total billed charges,6937.7,85,,5550.16,percent of total billed charges,85% of total billed charges,7345.8,90,,5876.64,percent of total billed charges,90% of total billed charges,6529.6,80,,5223.68,percent of total billed charges,80% of total billed charges,7345.8,90,,5876.64,percent of total billed charges,90% of total billed charges,6121.5,75,,4897.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2366.98,29,,1893.584,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,5468.54,67,,4374.832,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,5713.4,70,,4570.72,percent of total billed charges,70% of total billed charges,5305.3,65,,4244.24,percent of total billed charges,65% of total billed charges,2911.39,35.67,,2329.112,percent of total billed charges,35.67% of total billed charges,2366.98,7345.8,
LAG SCREW 10.5X120,27010826,CDM,278,RC,C1713,HCPCS,outpatient,,,2120,848.00,,1484,70,,1187.2,percent of total billed charges,70% of total billed charges,1113,52.5,,890.4,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,1738.4,82,,1390.72,percent of total billed charges,82% of total billed charges,1802,85,,1441.6,percent of total billed charges,85% of total billed charges,1802,85,,1441.6,percent of total billed charges,85% of total billed charges,1802,85,,1441.6,percent of total billed charges,85% of total billed charges,1908,90,,1526.4,percent of total billed charges,90% of total billed charges,1696,80,,1356.8,percent of total billed charges,80% of total billed charges,1908,90,,1526.4,percent of total billed charges,90% of total billed charges,1590,75,,1272,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,614.8,29,,491.84,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1420.4,67,,1136.32,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1484,70,,1187.2,percent of total billed charges,70% of total billed charges,1378,65,,1102.4,percent of total billed charges,65% of total billed charges,756.2,35.67,,604.96,percent of total billed charges,35.67% of total billed charges,614.8,1908,
K-WIRE 1.1,27010827,CDM,278,RC,C1769,HCPCS,outpatient,,,240,96.00,,168,70,,134.4,percent of total billed charges,70% of total billed charges,240,100,,192,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,196.8,82,,157.44,percent of total billed charges,82% of total billed charges,204,85,,163.2,percent of total billed charges,85% of total billed charges,204,85,,163.2,percent of total billed charges,85% of total billed charges,204,85,,163.2,percent of total billed charges,85% of total billed charges,216,90,,172.8,percent of total billed charges,90% of total billed charges,192,80,,153.6,percent of total billed charges,80% of total billed charges,216,90,,172.8,percent of total billed charges,90% of total billed charges,180,75,,144,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,69.6,29,,55.68,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,160.8,67,,128.64,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,168,70,,134.4,percent of total billed charges,70% of total billed charges,156,65,,124.8,percent of total billed charges,65% of total billed charges,85.61,35.67,,68.488,percent of total billed charges,35.67% of total billed charges,69.6,240,
SCREW DRIVE BLADE 17,27010828,CDM,278,RC,C1713,HCPCS,outpatient,,,1723,689.20,,1206.1,70,,964.88,percent of total billed charges,70% of total billed charges,904.58,52.5,,723.66,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,1412.86,82,,1130.288,percent of total billed charges,82% of total billed charges,1464.55,85,,1171.64,percent of total billed charges,85% of total billed charges,1464.55,85,,1171.64,percent of total billed charges,85% of total billed charges,1464.55,85,,1171.64,percent of total billed charges,85% of total billed charges,1550.7,90,,1240.56,percent of total billed charges,90% of total billed charges,1378.4,80,,1102.72,percent of total billed charges,80% of total billed charges,1550.7,90,,1240.56,percent of total billed charges,90% of total billed charges,1292.25,75,,1033.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,499.67,29,,399.736,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1154.41,67,,923.528,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1206.1,70,,964.88,percent of total billed charges,70% of total billed charges,1119.95,65,,895.96,percent of total billed charges,65% of total billed charges,614.59,35.67,,491.672,percent of total billed charges,35.67% of total billed charges,499.67,1550.7,
LEAD KIT 3778-60,27010834,CDM,278,RC,C1778,HCPCS,outpatient,,,6691,2676.40,,4683.7,70,,3746.96,percent of total billed charges,70% of total billed charges,3512.78,52.5,,2810.22,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,5486.62,82,,4389.296,percent of total billed charges,82% of total billed charges,5687.35,85,,4549.88,percent of total billed charges,85% of total billed charges,5687.35,85,,4549.88,percent of total billed charges,85% of total billed charges,5687.35,85,,4549.88,percent of total billed charges,85% of total billed charges,6021.9,90,,4817.52,percent of total billed charges,90% of total billed charges,5352.8,80,,4282.24,percent of total billed charges,80% of total billed charges,6021.9,90,,4817.52,percent of total billed charges,90% of total billed charges,5018.25,75,,4014.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,1940.39,29,,1552.312,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4482.97,67,,3586.376,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,4683.7,70,,3746.96,percent of total billed charges,70% of total billed charges,4349.15,65,,3479.32,percent of total billed charges,65% of total billed charges,2386.68,35.67,,1909.344,percent of total billed charges,35.67% of total billed charges,1940.39,6021.9,
INJEX ANCHOR 97791,27010837,CDM,278,RC,C1713,HCPCS,outpatient,,,1231,492.40,,861.7,70,,689.36,percent of total billed charges,70% of total billed charges,646.28,52.5,,517.02,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,1009.42,82,,807.536,percent of total billed charges,82% of total billed charges,1046.35,85,,837.08,percent of total billed charges,85% of total billed charges,1046.35,85,,837.08,percent of total billed charges,85% of total billed charges,1046.35,85,,837.08,percent of total billed charges,85% of total billed charges,1107.9,90,,886.32,percent of total billed charges,90% of total billed charges,984.8,80,,787.84,percent of total billed charges,80% of total billed charges,1107.9,90,,886.32,percent of total billed charges,90% of total billed charges,923.25,75,,738.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,356.99,29,,285.592,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,824.77,67,,659.816,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,861.7,70,,689.36,percent of total billed charges,70% of total billed charges,800.15,65,,640.12,percent of total billed charges,65% of total billed charges,439.1,35.67,,351.28,percent of total billed charges,35.67% of total billed charges,356.99,1107.9,
PRIMEADVANCED GENERATOR 37702,27010838,CDM,278,RC,C1820,HCPCS,outpatient,,,41152,16460.80,,28806.4,70,,23045.12,percent of total billed charges,70% of total billed charges,21604.8,52.5,,17283.84,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,33744.64,82,,26995.712,percent of total billed charges,82% of total billed charges,34979.2,85,,27983.36,percent of total billed charges,85% of total billed charges,34979.2,85,,27983.36,percent of total billed charges,85% of total billed charges,34979.2,85,,27983.36,percent of total billed charges,85% of total billed charges,37036.8,90,,29629.44,percent of total billed charges,90% of total billed charges,32921.6,80,,26337.28,percent of total billed charges,80% of total billed charges,37036.8,90,,29629.44,percent of total billed charges,90% of total billed charges,30864,75,,24691.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,11934.08,29,,9547.264,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,27571.84,67,,22057.472,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,28806.4,70,,23045.12,percent of total billed charges,70% of total billed charges,26748.8,65,,21399.04,percent of total billed charges,65% of total billed charges,14678.92,35.67,,11743.136,percent of total billed charges,35.67% of total billed charges,11934.08,37036.8,
ACL KIT,27010848,CDM,278,RC,C1713,HCPCS,outpatient,,,2216,886.40,,1551.2,70,,1240.96,percent of total billed charges,70% of total billed charges,1163.4,52.5,,930.72,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,1817.12,82,,1453.696,percent of total billed charges,82% of total billed charges,1883.6,85,,1506.88,percent of total billed charges,85% of total billed charges,1883.6,85,,1506.88,percent of total billed charges,85% of total billed charges,1883.6,85,,1506.88,percent of total billed charges,85% of total billed charges,1994.4,90,,1595.52,percent of total billed charges,90% of total billed charges,1772.8,80,,1418.24,percent of total billed charges,80% of total billed charges,1994.4,90,,1595.52,percent of total billed charges,90% of total billed charges,1662,75,,1329.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,642.64,29,,514.112,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1484.72,67,,1187.776,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1551.2,70,,1240.96,percent of total billed charges,70% of total billed charges,1440.4,65,,1152.32,percent of total billed charges,65% of total billed charges,790.45,35.67,,632.36,percent of total billed charges,35.67% of total billed charges,642.64,1994.4,
STD FEM 7X7.5X23,27010849,CDM,278,RC,C1776,HCPCS,outpatient,,,1907,762.80,,1334.9,70,,1067.92,percent of total billed charges,70% of total billed charges,1001.18,52.5,,800.94,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,1563.74,82,,1250.992,percent of total billed charges,82% of total billed charges,1620.95,85,,1296.76,percent of total billed charges,85% of total billed charges,1620.95,85,,1296.76,percent of total billed charges,85% of total billed charges,1620.95,85,,1296.76,percent of total billed charges,85% of total billed charges,1716.3,90,,1373.04,percent of total billed charges,90% of total billed charges,1525.6,80,,1220.48,percent of total billed charges,80% of total billed charges,1716.3,90,,1373.04,percent of total billed charges,90% of total billed charges,1430.25,75,,1144.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,553.03,29,,442.424,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1277.69,67,,1022.152,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1334.9,70,,1067.92,percent of total billed charges,70% of total billed charges,1239.55,65,,991.64,percent of total billed charges,65% of total billed charges,680.23,35.67,,544.184,percent of total billed charges,35.67% of total billed charges,553.03,1716.3,
3.5 CORTEX SCREW 36 MM,27010850,CDM,278,RC,C1713,HCPCS,outpatient,,,215,86.00,,150.5,70,,120.4,percent of total billed charges,70% of total billed charges,215,100,,172,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,176.3,82,,141.04,percent of total billed charges,82% of total billed charges,182.75,85,,146.2,percent of total billed charges,85% of total billed charges,182.75,85,,146.2,percent of total billed charges,85% of total billed charges,182.75,85,,146.2,percent of total billed charges,85% of total billed charges,193.5,90,,154.8,percent of total billed charges,90% of total billed charges,172,80,,137.6,percent of total billed charges,80% of total billed charges,193.5,90,,154.8,percent of total billed charges,90% of total billed charges,161.25,75,,129,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,62.35,29,,49.88,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,144.05,67,,115.24,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,150.5,70,,120.4,percent of total billed charges,70% of total billed charges,139.75,65,,111.8,percent of total billed charges,65% of total billed charges,76.69,35.67,,61.352,percent of total billed charges,35.67% of total billed charges,62.35,215,
CORTEX SCREW 32 MM 4.5MM,27010851,CDM,278,RC,C1713,HCPCS,outpatient,,,210,84.00,,147,70,,117.6,percent of total billed charges,70% of total billed charges,210,100,,168,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,172.2,82,,137.76,percent of total billed charges,82% of total billed charges,178.5,85,,142.8,percent of total billed charges,85% of total billed charges,178.5,85,,142.8,percent of total billed charges,85% of total billed charges,178.5,85,,142.8,percent of total billed charges,85% of total billed charges,189,90,,151.2,percent of total billed charges,90% of total billed charges,168,80,,134.4,percent of total billed charges,80% of total billed charges,189,90,,151.2,percent of total billed charges,90% of total billed charges,157.5,75,,126,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,60.9,29,,48.72,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,140.7,67,,112.56,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,147,70,,117.6,percent of total billed charges,70% of total billed charges,136.5,65,,109.2,percent of total billed charges,65% of total billed charges,74.91,35.67,,59.928,percent of total billed charges,35.67% of total billed charges,60.9,210,
LOCKING SCREW 3.5MM 18MM,27010854,CDM,278,RC,C1713,HCPCS,outpatient,,,723,289.20,,506.1,70,,404.88,percent of total billed charges,70% of total billed charges,723,100,,578.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,592.86,82,,474.288,percent of total billed charges,82% of total billed charges,614.55,85,,491.64,percent of total billed charges,85% of total billed charges,614.55,85,,491.64,percent of total billed charges,85% of total billed charges,614.55,85,,491.64,percent of total billed charges,85% of total billed charges,650.7,90,,520.56,percent of total billed charges,90% of total billed charges,578.4,80,,462.72,percent of total billed charges,80% of total billed charges,650.7,90,,520.56,percent of total billed charges,90% of total billed charges,542.25,75,,433.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,209.67,29,,167.736,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,484.41,67,,387.528,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,506.1,70,,404.88,percent of total billed charges,70% of total billed charges,469.95,65,,375.96,percent of total billed charges,65% of total billed charges,257.89,35.67,,206.312,percent of total billed charges,35.67% of total billed charges,209.67,723,
LOCKING SCREW 3.5MM 28MM,27010855,CDM,278,RC,C1713,HCPCS,outpatient,,,723,289.20,,506.1,70,,404.88,percent of total billed charges,70% of total billed charges,723,100,,578.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,592.86,82,,474.288,percent of total billed charges,82% of total billed charges,614.55,85,,491.64,percent of total billed charges,85% of total billed charges,614.55,85,,491.64,percent of total billed charges,85% of total billed charges,614.55,85,,491.64,percent of total billed charges,85% of total billed charges,650.7,90,,520.56,percent of total billed charges,90% of total billed charges,578.4,80,,462.72,percent of total billed charges,80% of total billed charges,650.7,90,,520.56,percent of total billed charges,90% of total billed charges,542.25,75,,433.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,209.67,29,,167.736,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,484.41,67,,387.528,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,506.1,70,,404.88,percent of total billed charges,70% of total billed charges,469.95,65,,375.96,percent of total billed charges,65% of total billed charges,257.89,35.67,,206.312,percent of total billed charges,35.67% of total billed charges,209.67,723,
SCREW LOCKING 3.5 MM,27010856,CDM,278,RC,C1713,HCPCS,outpatient,,,762,304.80,,533.4,70,,426.72,percent of total billed charges,70% of total billed charges,762,100,,609.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,624.84,82,,499.872,percent of total billed charges,82% of total billed charges,647.7,85,,518.16,percent of total billed charges,85% of total billed charges,647.7,85,,518.16,percent of total billed charges,85% of total billed charges,647.7,85,,518.16,percent of total billed charges,85% of total billed charges,685.8,90,,548.64,percent of total billed charges,90% of total billed charges,609.6,80,,487.68,percent of total billed charges,80% of total billed charges,685.8,90,,548.64,percent of total billed charges,90% of total billed charges,571.5,75,,457.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,220.98,29,,176.784,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,510.54,67,,408.432,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,533.4,70,,426.72,percent of total billed charges,70% of total billed charges,495.3,65,,396.24,percent of total billed charges,65% of total billed charges,271.81,35.67,,217.448,percent of total billed charges,35.67% of total billed charges,220.98,762,
CORTEX SCREW 3.5MM 32MM,27010857,CDM,278,RC,C1713,HCPCS,outpatient,,,215,86.00,,150.5,70,,120.4,percent of total billed charges,70% of total billed charges,215,100,,172,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,176.3,82,,141.04,percent of total billed charges,82% of total billed charges,182.75,85,,146.2,percent of total billed charges,85% of total billed charges,182.75,85,,146.2,percent of total billed charges,85% of total billed charges,182.75,85,,146.2,percent of total billed charges,85% of total billed charges,193.5,90,,154.8,percent of total billed charges,90% of total billed charges,172,80,,137.6,percent of total billed charges,80% of total billed charges,193.5,90,,154.8,percent of total billed charges,90% of total billed charges,161.25,75,,129,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,62.35,29,,49.88,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,144.05,67,,115.24,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,150.5,70,,120.4,percent of total billed charges,70% of total billed charges,139.75,65,,111.8,percent of total billed charges,65% of total billed charges,76.69,35.67,,61.352,percent of total billed charges,35.67% of total billed charges,62.35,215,
CANNULATED SCREW 3.7 MM 38MM,27010859,CDM,278,RC,C1713,HCPCS,outpatient,,,1104,441.60,,772.8,70,,618.24,percent of total billed charges,70% of total billed charges,579.6,52.5,,463.68,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,905.28,82,,724.224,percent of total billed charges,82% of total billed charges,938.4,85,,750.72,percent of total billed charges,85% of total billed charges,938.4,85,,750.72,percent of total billed charges,85% of total billed charges,938.4,85,,750.72,percent of total billed charges,85% of total billed charges,993.6,90,,794.88,percent of total billed charges,90% of total billed charges,883.2,80,,706.56,percent of total billed charges,80% of total billed charges,993.6,90,,794.88,percent of total billed charges,90% of total billed charges,828,75,,662.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,320.16,29,,256.128,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,739.68,67,,591.744,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,772.8,70,,618.24,percent of total billed charges,70% of total billed charges,717.6,65,,574.08,percent of total billed charges,65% of total billed charges,393.8,35.67,,315.04,percent of total billed charges,35.67% of total billed charges,320.16,993.6,
CANNULATED SCREW 3.7MM 36MM,27010860,CDM,278,RC,C1713,HCPCS,outpatient,,,1104,441.60,,772.8,70,,618.24,percent of total billed charges,70% of total billed charges,579.6,52.5,,463.68,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,905.28,82,,724.224,percent of total billed charges,82% of total billed charges,938.4,85,,750.72,percent of total billed charges,85% of total billed charges,938.4,85,,750.72,percent of total billed charges,85% of total billed charges,938.4,85,,750.72,percent of total billed charges,85% of total billed charges,993.6,90,,794.88,percent of total billed charges,90% of total billed charges,883.2,80,,706.56,percent of total billed charges,80% of total billed charges,993.6,90,,794.88,percent of total billed charges,90% of total billed charges,828,75,,662.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,320.16,29,,256.128,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,739.68,67,,591.744,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,772.8,70,,618.24,percent of total billed charges,70% of total billed charges,717.6,65,,574.08,percent of total billed charges,65% of total billed charges,393.8,35.67,,315.04,percent of total billed charges,35.67% of total billed charges,320.16,993.6,
CANNULATED SCREW 3.7 34MM,27010861,CDM,278,RC,C1713,HCPCS,outpatient,,,1104,441.60,,772.8,70,,618.24,percent of total billed charges,70% of total billed charges,579.6,52.5,,463.68,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,905.28,82,,724.224,percent of total billed charges,82% of total billed charges,938.4,85,,750.72,percent of total billed charges,85% of total billed charges,938.4,85,,750.72,percent of total billed charges,85% of total billed charges,938.4,85,,750.72,percent of total billed charges,85% of total billed charges,993.6,90,,794.88,percent of total billed charges,90% of total billed charges,883.2,80,,706.56,percent of total billed charges,80% of total billed charges,993.6,90,,794.88,percent of total billed charges,90% of total billed charges,828,75,,662.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,320.16,29,,256.128,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,739.68,67,,591.744,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,772.8,70,,618.24,percent of total billed charges,70% of total billed charges,717.6,65,,574.08,percent of total billed charges,65% of total billed charges,393.8,35.67,,315.04,percent of total billed charges,35.67% of total billed charges,320.16,993.6,
CANNULATED SCREW 3.7MM 38MM,27010862,CDM,278,RC,C1713,HCPCS,outpatient,,,1104,441.60,,772.8,70,,618.24,percent of total billed charges,70% of total billed charges,579.6,52.5,,463.68,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,905.28,82,,724.224,percent of total billed charges,82% of total billed charges,938.4,85,,750.72,percent of total billed charges,85% of total billed charges,938.4,85,,750.72,percent of total billed charges,85% of total billed charges,938.4,85,,750.72,percent of total billed charges,85% of total billed charges,993.6,90,,794.88,percent of total billed charges,90% of total billed charges,883.2,80,,706.56,percent of total billed charges,80% of total billed charges,993.6,90,,794.88,percent of total billed charges,90% of total billed charges,828,75,,662.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,320.16,29,,256.128,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,739.68,67,,591.744,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,772.8,70,,618.24,percent of total billed charges,70% of total billed charges,717.6,65,,574.08,percent of total billed charges,65% of total billed charges,393.8,35.67,,315.04,percent of total billed charges,35.67% of total billed charges,320.16,993.6,
LCP PERIARTICULAR HUMERUS3.5MM,27010863,CDM,278,RC,C1713,HCPCS,outpatient,,,6952,2780.80,,4866.4,70,,3893.12,percent of total billed charges,70% of total billed charges,3649.8,52.5,,2919.84,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,5700.64,82,,4560.512,percent of total billed charges,82% of total billed charges,5909.2,85,,4727.36,percent of total billed charges,85% of total billed charges,5909.2,85,,4727.36,percent of total billed charges,85% of total billed charges,5909.2,85,,4727.36,percent of total billed charges,85% of total billed charges,6256.8,90,,5005.44,percent of total billed charges,90% of total billed charges,5561.6,80,,4449.28,percent of total billed charges,80% of total billed charges,6256.8,90,,5005.44,percent of total billed charges,90% of total billed charges,5214,75,,4171.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2016.08,29,,1612.864,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4657.84,67,,3726.272,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,4866.4,70,,3893.12,percent of total billed charges,70% of total billed charges,4518.8,65,,3615.04,percent of total billed charges,65% of total billed charges,2479.78,35.67,,1983.824,percent of total billed charges,35.67% of total billed charges,2016.08,6256.8,
K-WIRE 2.0,27010913,CDM,278,RC,C1713,HCPCS,outpatient,,,701,280.40,,490.7,70,,392.56,percent of total billed charges,70% of total billed charges,701,100,,560.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,574.82,82,,459.856,percent of total billed charges,82% of total billed charges,595.85,85,,476.68,percent of total billed charges,85% of total billed charges,595.85,85,,476.68,percent of total billed charges,85% of total billed charges,595.85,85,,476.68,percent of total billed charges,85% of total billed charges,630.9,90,,504.72,percent of total billed charges,90% of total billed charges,560.8,80,,448.64,percent of total billed charges,80% of total billed charges,630.9,90,,504.72,percent of total billed charges,90% of total billed charges,525.75,75,,420.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,203.29,29,,162.632,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,469.67,67,,375.736,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,490.7,70,,392.56,percent of total billed charges,70% of total billed charges,455.65,65,,364.52,percent of total billed charges,65% of total billed charges,250.05,35.67,,200.04,percent of total billed charges,35.67% of total billed charges,203.29,701,
CORTEX SELF TAPPING SCREW 45MM,27010914,CDM,278,RC,C1713,HCPCS,outpatient,,,215,86.00,,150.5,70,,120.4,percent of total billed charges,70% of total billed charges,215,100,,172,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,176.3,82,,141.04,percent of total billed charges,82% of total billed charges,182.75,85,,146.2,percent of total billed charges,85% of total billed charges,182.75,85,,146.2,percent of total billed charges,85% of total billed charges,182.75,85,,146.2,percent of total billed charges,85% of total billed charges,193.5,90,,154.8,percent of total billed charges,90% of total billed charges,172,80,,137.6,percent of total billed charges,80% of total billed charges,193.5,90,,154.8,percent of total billed charges,90% of total billed charges,161.25,75,,129,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,62.35,29,,49.88,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,144.05,67,,115.24,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,150.5,70,,120.4,percent of total billed charges,70% of total billed charges,139.75,65,,111.8,percent of total billed charges,65% of total billed charges,76.69,35.67,,61.352,percent of total billed charges,35.67% of total billed charges,62.35,215,
CORTEX SELF TAPPING SCREW 36MM,27010915,CDM,278,RC,C1713,HCPCS,outpatient,,,215,86.00,,150.5,70,,120.4,percent of total billed charges,70% of total billed charges,215,100,,172,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,176.3,82,,141.04,percent of total billed charges,82% of total billed charges,182.75,85,,146.2,percent of total billed charges,85% of total billed charges,182.75,85,,146.2,percent of total billed charges,85% of total billed charges,182.75,85,,146.2,percent of total billed charges,85% of total billed charges,193.5,90,,154.8,percent of total billed charges,90% of total billed charges,172,80,,137.6,percent of total billed charges,80% of total billed charges,193.5,90,,154.8,percent of total billed charges,90% of total billed charges,161.25,75,,129,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,62.35,29,,49.88,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,144.05,67,,115.24,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,150.5,70,,120.4,percent of total billed charges,70% of total billed charges,139.75,65,,111.8,percent of total billed charges,65% of total billed charges,76.69,35.67,,61.352,percent of total billed charges,35.67% of total billed charges,62.35,215,
CORTEX SCREW 2.7 30MM,27010916,CDM,278,RC,C1713,HCPCS,outpatient,,,325,130.00,,227.5,70,,182,percent of total billed charges,70% of total billed charges,325,100,,260,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,266.5,82,,213.2,percent of total billed charges,82% of total billed charges,276.25,85,,221,percent of total billed charges,85% of total billed charges,276.25,85,,221,percent of total billed charges,85% of total billed charges,276.25,85,,221,percent of total billed charges,85% of total billed charges,292.5,90,,234,percent of total billed charges,90% of total billed charges,260,80,,208,percent of total billed charges,80% of total billed charges,292.5,90,,234,percent of total billed charges,90% of total billed charges,243.75,75,,195,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,94.25,29,,75.4,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,217.75,67,,174.2,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,227.5,70,,182,percent of total billed charges,70% of total billed charges,211.25,65,,169,percent of total billed charges,65% of total billed charges,115.93,35.67,,92.744,percent of total billed charges,35.67% of total billed charges,94.25,325,
CORTEX SCREW 2.7 28MM,27010917,CDM,278,RC,C1713,HCPCS,outpatient,,,325,130.00,,227.5,70,,182,percent of total billed charges,70% of total billed charges,325,100,,260,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,266.5,82,,213.2,percent of total billed charges,82% of total billed charges,276.25,85,,221,percent of total billed charges,85% of total billed charges,276.25,85,,221,percent of total billed charges,85% of total billed charges,276.25,85,,221,percent of total billed charges,85% of total billed charges,292.5,90,,234,percent of total billed charges,90% of total billed charges,260,80,,208,percent of total billed charges,80% of total billed charges,292.5,90,,234,percent of total billed charges,90% of total billed charges,243.75,75,,195,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,94.25,29,,75.4,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,217.75,67,,174.2,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,227.5,70,,182,percent of total billed charges,70% of total billed charges,211.25,65,,169,percent of total billed charges,65% of total billed charges,115.93,35.67,,92.744,percent of total billed charges,35.67% of total billed charges,94.25,325,
CORTEX SCREW 2.7 32MM,27010918,CDM,278,RC,C1713,HCPCS,outpatient,,,325,130.00,,227.5,70,,182,percent of total billed charges,70% of total billed charges,325,100,,260,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,266.5,82,,213.2,percent of total billed charges,82% of total billed charges,276.25,85,,221,percent of total billed charges,85% of total billed charges,276.25,85,,221,percent of total billed charges,85% of total billed charges,276.25,85,,221,percent of total billed charges,85% of total billed charges,292.5,90,,234,percent of total billed charges,90% of total billed charges,260,80,,208,percent of total billed charges,80% of total billed charges,292.5,90,,234,percent of total billed charges,90% of total billed charges,243.75,75,,195,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,94.25,29,,75.4,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,217.75,67,,174.2,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,227.5,70,,182,percent of total billed charges,70% of total billed charges,211.25,65,,169,percent of total billed charges,65% of total billed charges,115.93,35.67,,92.744,percent of total billed charges,35.67% of total billed charges,94.25,325,
RIGHT NARROW VDR PLATE,27010928,CDM,278,RC,C1713,HCPCS,outpatient,,,3269,1307.60,,2288.3,70,,1830.64,percent of total billed charges,70% of total billed charges,1716.23,52.5,,1372.98,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,2680.58,82,,2144.464,percent of total billed charges,82% of total billed charges,2778.65,85,,2222.92,percent of total billed charges,85% of total billed charges,2778.65,85,,2222.92,percent of total billed charges,85% of total billed charges,2778.65,85,,2222.92,percent of total billed charges,85% of total billed charges,2942.1,90,,2353.68,percent of total billed charges,90% of total billed charges,2615.2,80,,2092.16,percent of total billed charges,80% of total billed charges,2942.1,90,,2353.68,percent of total billed charges,90% of total billed charges,2451.75,75,,1961.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,948.01,29,,758.408,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,2190.23,67,,1752.184,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,2288.3,70,,1830.64,percent of total billed charges,70% of total billed charges,2124.85,65,,1699.88,percent of total billed charges,65% of total billed charges,1166.05,35.67,,932.84,percent of total billed charges,35.67% of total billed charges,948.01,2942.1,
SCREW CORTICAL 2.7 X 24MM,27010929,CDM,278,RC,C1713,HCPCS,outpatient,,,712,284.80,,498.4,70,,398.72,percent of total billed charges,70% of total billed charges,712,100,,569.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,583.84,82,,467.072,percent of total billed charges,82% of total billed charges,605.2,85,,484.16,percent of total billed charges,85% of total billed charges,605.2,85,,484.16,percent of total billed charges,85% of total billed charges,605.2,85,,484.16,percent of total billed charges,85% of total billed charges,640.8,90,,512.64,percent of total billed charges,90% of total billed charges,569.6,80,,455.68,percent of total billed charges,80% of total billed charges,640.8,90,,512.64,percent of total billed charges,90% of total billed charges,534,75,,427.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,206.48,29,,165.184,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,477.04,67,,381.632,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,498.4,70,,398.72,percent of total billed charges,70% of total billed charges,462.8,65,,370.24,percent of total billed charges,65% of total billed charges,253.97,35.67,,203.176,percent of total billed charges,35.67% of total billed charges,206.48,712,
PLATE CALCANEAL LCP SHORT RT,27010933,CDM,278,RC,C1713,HCPCS,outpatient,,,2977,1190.80,,2083.9,70,,1667.12,percent of total billed charges,70% of total billed charges,1562.93,52.5,,1250.34,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,2441.14,82,,1952.912,percent of total billed charges,82% of total billed charges,2530.45,85,,2024.36,percent of total billed charges,85% of total billed charges,2530.45,85,,2024.36,percent of total billed charges,85% of total billed charges,2530.45,85,,2024.36,percent of total billed charges,85% of total billed charges,2679.3,90,,2143.44,percent of total billed charges,90% of total billed charges,2381.6,80,,1905.28,percent of total billed charges,80% of total billed charges,2679.3,90,,2143.44,percent of total billed charges,90% of total billed charges,2232.75,75,,1786.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,863.33,29,,690.664,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1994.59,67,,1595.672,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,2083.9,70,,1667.12,percent of total billed charges,70% of total billed charges,1935.05,65,,1548.04,percent of total billed charges,65% of total billed charges,1061.9,35.67,,849.52,percent of total billed charges,35.67% of total billed charges,863.33,2679.3,
DBX MIX 5.0,27010934,CDM,278,RC,C1713,HCPCS,outpatient,,,4127,1650.80,,2888.9,70,,2311.12,percent of total billed charges,70% of total billed charges,2166.68,52.5,,1733.34,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,3384.14,82,,2707.312,percent of total billed charges,82% of total billed charges,3507.95,85,,2806.36,percent of total billed charges,85% of total billed charges,3507.95,85,,2806.36,percent of total billed charges,85% of total billed charges,3507.95,85,,2806.36,percent of total billed charges,85% of total billed charges,3714.3,90,,2971.44,percent of total billed charges,90% of total billed charges,3301.6,80,,2641.28,percent of total billed charges,80% of total billed charges,3714.3,90,,2971.44,percent of total billed charges,90% of total billed charges,3095.25,75,,2476.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,1196.83,29,,957.464,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,2765.09,67,,2212.072,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,2888.9,70,,2311.12,percent of total billed charges,70% of total billed charges,2682.55,65,,2146.04,percent of total billed charges,65% of total billed charges,1472.1,35.67,,1177.68,percent of total billed charges,35.67% of total billed charges,1196.83,3714.3,
CORTEX SCREW 2.7MM X 28MM,27010935,CDM,278,RC,C1713,HCPCS,outpatient,,,305,122.00,,213.5,70,,170.8,percent of total billed charges,70% of total billed charges,305,100,,244,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,250.1,82,,200.08,percent of total billed charges,82% of total billed charges,259.25,85,,207.4,percent of total billed charges,85% of total billed charges,259.25,85,,207.4,percent of total billed charges,85% of total billed charges,259.25,85,,207.4,percent of total billed charges,85% of total billed charges,274.5,90,,219.6,percent of total billed charges,90% of total billed charges,244,80,,195.2,percent of total billed charges,80% of total billed charges,274.5,90,,219.6,percent of total billed charges,90% of total billed charges,228.75,75,,183,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,88.45,29,,70.76,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,204.35,67,,163.48,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,213.5,70,,170.8,percent of total billed charges,70% of total billed charges,198.25,65,,158.6,percent of total billed charges,65% of total billed charges,108.79,35.67,,87.032,percent of total billed charges,35.67% of total billed charges,88.45,305,
CORTEX SCREW 2.7MM X 30MM,27010936,CDM,278,RC,C1713,HCPCS,outpatient,,,305,122.00,,213.5,70,,170.8,percent of total billed charges,70% of total billed charges,305,100,,244,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,250.1,82,,200.08,percent of total billed charges,82% of total billed charges,259.25,85,,207.4,percent of total billed charges,85% of total billed charges,259.25,85,,207.4,percent of total billed charges,85% of total billed charges,259.25,85,,207.4,percent of total billed charges,85% of total billed charges,274.5,90,,219.6,percent of total billed charges,90% of total billed charges,244,80,,195.2,percent of total billed charges,80% of total billed charges,274.5,90,,219.6,percent of total billed charges,90% of total billed charges,228.75,75,,183,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,88.45,29,,70.76,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,204.35,67,,163.48,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,213.5,70,,170.8,percent of total billed charges,70% of total billed charges,198.25,65,,158.6,percent of total billed charges,65% of total billed charges,108.79,35.67,,87.032,percent of total billed charges,35.67% of total billed charges,88.45,305,
CORTEX SCREW 2.7MM X 32MM,27010937,CDM,278,RC,C1713,HCPCS,outpatient,,,305,122.00,,213.5,70,,170.8,percent of total billed charges,70% of total billed charges,305,100,,244,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,250.1,82,,200.08,percent of total billed charges,82% of total billed charges,259.25,85,,207.4,percent of total billed charges,85% of total billed charges,259.25,85,,207.4,percent of total billed charges,85% of total billed charges,259.25,85,,207.4,percent of total billed charges,85% of total billed charges,274.5,90,,219.6,percent of total billed charges,90% of total billed charges,244,80,,195.2,percent of total billed charges,80% of total billed charges,274.5,90,,219.6,percent of total billed charges,90% of total billed charges,228.75,75,,183,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,88.45,29,,70.76,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,204.35,67,,163.48,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,213.5,70,,170.8,percent of total billed charges,70% of total billed charges,198.25,65,,158.6,percent of total billed charges,65% of total billed charges,108.79,35.67,,87.032,percent of total billed charges,35.67% of total billed charges,88.45,305,
CORTEX SCREW 2.7MM X 34MM,27010938,CDM,278,RC,C1713,HCPCS,outpatient,,,305,122.00,,213.5,70,,170.8,percent of total billed charges,70% of total billed charges,305,100,,244,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,250.1,82,,200.08,percent of total billed charges,82% of total billed charges,259.25,85,,207.4,percent of total billed charges,85% of total billed charges,259.25,85,,207.4,percent of total billed charges,85% of total billed charges,259.25,85,,207.4,percent of total billed charges,85% of total billed charges,274.5,90,,219.6,percent of total billed charges,90% of total billed charges,244,80,,195.2,percent of total billed charges,80% of total billed charges,274.5,90,,219.6,percent of total billed charges,90% of total billed charges,228.75,75,,183,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,88.45,29,,70.76,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,204.35,67,,163.48,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,213.5,70,,170.8,percent of total billed charges,70% of total billed charges,198.25,65,,158.6,percent of total billed charges,65% of total billed charges,108.79,35.67,,87.032,percent of total billed charges,35.67% of total billed charges,88.45,305,
CORTEX SCREW 2.7MM X 42MM,27010939,CDM,278,RC,C1713,HCPCS,outpatient,,,305,122.00,,213.5,70,,170.8,percent of total billed charges,70% of total billed charges,305,100,,244,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,250.1,82,,200.08,percent of total billed charges,82% of total billed charges,259.25,85,,207.4,percent of total billed charges,85% of total billed charges,259.25,85,,207.4,percent of total billed charges,85% of total billed charges,259.25,85,,207.4,percent of total billed charges,85% of total billed charges,274.5,90,,219.6,percent of total billed charges,90% of total billed charges,244,80,,195.2,percent of total billed charges,80% of total billed charges,274.5,90,,219.6,percent of total billed charges,90% of total billed charges,228.75,75,,183,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,88.45,29,,70.76,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,204.35,67,,163.48,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,213.5,70,,170.8,percent of total billed charges,70% of total billed charges,198.25,65,,158.6,percent of total billed charges,65% of total billed charges,108.79,35.67,,87.032,percent of total billed charges,35.67% of total billed charges,88.45,305,
CORTEX SCREW 2.7MM X 46 MM,27010940,CDM,278,RC,C1713,HCPCS,outpatient,,,305,122.00,,213.5,70,,170.8,percent of total billed charges,70% of total billed charges,305,100,,244,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,250.1,82,,200.08,percent of total billed charges,82% of total billed charges,259.25,85,,207.4,percent of total billed charges,85% of total billed charges,259.25,85,,207.4,percent of total billed charges,85% of total billed charges,259.25,85,,207.4,percent of total billed charges,85% of total billed charges,274.5,90,,219.6,percent of total billed charges,90% of total billed charges,244,80,,195.2,percent of total billed charges,80% of total billed charges,274.5,90,,219.6,percent of total billed charges,90% of total billed charges,228.75,75,,183,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,88.45,29,,70.76,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,204.35,67,,163.48,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,213.5,70,,170.8,percent of total billed charges,70% of total billed charges,198.25,65,,158.6,percent of total billed charges,65% of total billed charges,108.79,35.67,,87.032,percent of total billed charges,35.67% of total billed charges,88.45,305,
LOCKING SCREW 3.5MM X 26MM,27010941,CDM,278,RC,C1713,HCPCS,outpatient,,,723,289.20,,506.1,70,,404.88,percent of total billed charges,70% of total billed charges,723,100,,578.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,592.86,82,,474.288,percent of total billed charges,82% of total billed charges,614.55,85,,491.64,percent of total billed charges,85% of total billed charges,614.55,85,,491.64,percent of total billed charges,85% of total billed charges,614.55,85,,491.64,percent of total billed charges,85% of total billed charges,650.7,90,,520.56,percent of total billed charges,90% of total billed charges,578.4,80,,462.72,percent of total billed charges,80% of total billed charges,650.7,90,,520.56,percent of total billed charges,90% of total billed charges,542.25,75,,433.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,209.67,29,,167.736,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,484.41,67,,387.528,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,506.1,70,,404.88,percent of total billed charges,70% of total billed charges,469.95,65,,375.96,percent of total billed charges,65% of total billed charges,257.89,35.67,,206.312,percent of total billed charges,35.67% of total billed charges,209.67,723,
LOCKING SCREW 3.5MM X 32MM,27010942,CDM,278,RC,C1713,HCPCS,outpatient,,,723,289.20,,506.1,70,,404.88,percent of total billed charges,70% of total billed charges,723,100,,578.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,592.86,82,,474.288,percent of total billed charges,82% of total billed charges,614.55,85,,491.64,percent of total billed charges,85% of total billed charges,614.55,85,,491.64,percent of total billed charges,85% of total billed charges,614.55,85,,491.64,percent of total billed charges,85% of total billed charges,650.7,90,,520.56,percent of total billed charges,90% of total billed charges,578.4,80,,462.72,percent of total billed charges,80% of total billed charges,650.7,90,,520.56,percent of total billed charges,90% of total billed charges,542.25,75,,433.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,209.67,29,,167.736,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,484.41,67,,387.528,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,506.1,70,,404.88,percent of total billed charges,70% of total billed charges,469.95,65,,375.96,percent of total billed charges,65% of total billed charges,257.89,35.67,,206.312,percent of total billed charges,35.67% of total billed charges,209.67,723,
K-WIRE 1.6MM,27010943,CDM,278,RC,C1713,HCPCS,outpatient,,,641,256.40,,448.7,70,,358.96,percent of total billed charges,70% of total billed charges,641,100,,512.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,525.62,82,,420.496,percent of total billed charges,82% of total billed charges,544.85,85,,435.88,percent of total billed charges,85% of total billed charges,544.85,85,,435.88,percent of total billed charges,85% of total billed charges,544.85,85,,435.88,percent of total billed charges,85% of total billed charges,576.9,90,,461.52,percent of total billed charges,90% of total billed charges,512.8,80,,410.24,percent of total billed charges,80% of total billed charges,576.9,90,,461.52,percent of total billed charges,90% of total billed charges,480.75,75,,384.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,185.89,29,,148.712,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,429.47,67,,343.576,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,448.7,70,,358.96,percent of total billed charges,70% of total billed charges,416.65,65,,333.32,percent of total billed charges,65% of total billed charges,228.64,35.67,,182.912,percent of total billed charges,35.67% of total billed charges,185.89,641,
LOCKING SCREW 2.7 X 12MM,27010945,CDM,278,RC,C1713,HCPCS,outpatient,,,641,256.40,,448.7,70,,358.96,percent of total billed charges,70% of total billed charges,641,100,,512.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,525.62,82,,420.496,percent of total billed charges,82% of total billed charges,544.85,85,,435.88,percent of total billed charges,85% of total billed charges,544.85,85,,435.88,percent of total billed charges,85% of total billed charges,544.85,85,,435.88,percent of total billed charges,85% of total billed charges,576.9,90,,461.52,percent of total billed charges,90% of total billed charges,512.8,80,,410.24,percent of total billed charges,80% of total billed charges,576.9,90,,461.52,percent of total billed charges,90% of total billed charges,480.75,75,,384.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,185.89,29,,148.712,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,429.47,67,,343.576,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,448.7,70,,358.96,percent of total billed charges,70% of total billed charges,416.65,65,,333.32,percent of total billed charges,65% of total billed charges,228.64,35.67,,182.912,percent of total billed charges,35.67% of total billed charges,185.89,641,
LOCKING SCREW 2.7X18MM,27010946,CDM,278,RC,C1713,HCPCS,outpatient,,,674,269.60,,471.8,70,,377.44,percent of total billed charges,70% of total billed charges,674,100,,539.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,552.68,82,,442.144,percent of total billed charges,82% of total billed charges,572.9,85,,458.32,percent of total billed charges,85% of total billed charges,572.9,85,,458.32,percent of total billed charges,85% of total billed charges,572.9,85,,458.32,percent of total billed charges,85% of total billed charges,606.6,90,,485.28,percent of total billed charges,90% of total billed charges,539.2,80,,431.36,percent of total billed charges,80% of total billed charges,606.6,90,,485.28,percent of total billed charges,90% of total billed charges,505.5,75,,404.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,195.46,29,,156.368,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,451.58,67,,361.264,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,471.8,70,,377.44,percent of total billed charges,70% of total billed charges,438.1,65,,350.48,percent of total billed charges,65% of total billed charges,240.42,35.67,,192.336,percent of total billed charges,35.67% of total billed charges,195.46,674,
K-WIRE WITH OLIVE 1.6MM,27010947,CDM,278,RC,C1713,HCPCS,outpatient,,,233,93.20,,163.1,70,,130.48,percent of total billed charges,70% of total billed charges,233,100,,186.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,191.06,82,,152.848,percent of total billed charges,82% of total billed charges,198.05,85,,158.44,percent of total billed charges,85% of total billed charges,198.05,85,,158.44,percent of total billed charges,85% of total billed charges,198.05,85,,158.44,percent of total billed charges,85% of total billed charges,209.7,90,,167.76,percent of total billed charges,90% of total billed charges,186.4,80,,149.12,percent of total billed charges,80% of total billed charges,209.7,90,,167.76,percent of total billed charges,90% of total billed charges,174.75,75,,139.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,67.57,29,,54.056,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,156.11,67,,124.888,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,163.1,70,,130.48,percent of total billed charges,70% of total billed charges,151.45,65,,121.16,percent of total billed charges,65% of total billed charges,83.11,35.67,,66.488,percent of total billed charges,35.67% of total billed charges,67.57,233,
THREAD GUIDE WIRE 1.1MM,27010955,CDM,278,RC,C1769,HCPCS,outpatient,,,259,103.60,,181.3,70,,145.04,percent of total billed charges,70% of total billed charges,259,100,,207.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,212.38,82,,169.904,percent of total billed charges,82% of total billed charges,220.15,85,,176.12,percent of total billed charges,85% of total billed charges,220.15,85,,176.12,percent of total billed charges,85% of total billed charges,220.15,85,,176.12,percent of total billed charges,85% of total billed charges,233.1,90,,186.48,percent of total billed charges,90% of total billed charges,207.2,80,,165.76,percent of total billed charges,80% of total billed charges,233.1,90,,186.48,percent of total billed charges,90% of total billed charges,194.25,75,,155.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,75.11,29,,60.088,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,173.53,67,,138.824,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,181.3,70,,145.04,percent of total billed charges,70% of total billed charges,168.35,65,,134.68,percent of total billed charges,65% of total billed charges,92.39,35.67,,73.912,percent of total billed charges,35.67% of total billed charges,75.11,259,
FIRM URETERAL STENT POSITIONER,27010984,CDM,278,RC,,,outpatient,,,927,370.80,,648.9,70,,519.12,percent of total billed charges,70% of total billed charges,927,100,,741.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,760.14,82,,608.112,percent of total billed charges,82% of total billed charges,787.95,85,,630.36,percent of total billed charges,85% of total billed charges,787.95,85,,630.36,percent of total billed charges,85% of total billed charges,787.95,85,,630.36,percent of total billed charges,85% of total billed charges,834.3,90,,667.44,percent of total billed charges,90% of total billed charges,741.6,80,,593.28,percent of total billed charges,80% of total billed charges,834.3,90,,667.44,percent of total billed charges,90% of total billed charges,695.25,75,,556.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,268.83,29,,215.064,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,621.09,67,,496.872,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,648.9,70,,519.12,percent of total billed charges,70% of total billed charges,602.55,65,,482.04,percent of total billed charges,65% of total billed charges,330.66,35.67,,264.528,percent of total billed charges,35.67% of total billed charges,268.83,927,
LENS DIOPTER 12.0,27010992,CDM,278,RC,,,outpatient,,,741,296.40,,518.7,70,,414.96,percent of total billed charges,70% of total billed charges,741,100,,592.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,607.62,82,,486.096,percent of total billed charges,82% of total billed charges,629.85,85,,503.88,percent of total billed charges,85% of total billed charges,629.85,85,,503.88,percent of total billed charges,85% of total billed charges,629.85,85,,503.88,percent of total billed charges,85% of total billed charges,666.9,90,,533.52,percent of total billed charges,90% of total billed charges,592.8,80,,474.24,percent of total billed charges,80% of total billed charges,666.9,90,,533.52,percent of total billed charges,90% of total billed charges,555.75,75,,444.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,214.89,29,,171.912,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,496.47,67,,397.176,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,518.7,70,,414.96,percent of total billed charges,70% of total billed charges,481.65,65,,385.32,percent of total billed charges,65% of total billed charges,264.31,35.67,,211.448,percent of total billed charges,35.67% of total billed charges,214.89,741,
LSUPERIOR CLAVICLE PLATE 3.5MM,27010997,CDM,278,RC,C1713,HCPCS,outpatient,,,4012,1604.80,,2808.4,70,,2246.72,percent of total billed charges,70% of total billed charges,2106.3,52.5,,1685.04,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,3289.84,82,,2631.872,percent of total billed charges,82% of total billed charges,3410.2,85,,2728.16,percent of total billed charges,85% of total billed charges,3410.2,85,,2728.16,percent of total billed charges,85% of total billed charges,3410.2,85,,2728.16,percent of total billed charges,85% of total billed charges,3610.8,90,,2888.64,percent of total billed charges,90% of total billed charges,3209.6,80,,2567.68,percent of total billed charges,80% of total billed charges,3610.8,90,,2888.64,percent of total billed charges,90% of total billed charges,3009,75,,2407.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,1163.48,29,,930.784,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,2688.04,67,,2150.432,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,2808.4,70,,2246.72,percent of total billed charges,70% of total billed charges,2607.8,65,,2086.24,percent of total billed charges,65% of total billed charges,1431.08,35.67,,1144.864,percent of total billed charges,35.67% of total billed charges,1163.48,3610.8,
CORTEX SCREW 70MM 3.5MM,27010998,CDM,278,RC,C1713,HCPCS,outpatient,,,225,90.00,,157.5,70,,126,percent of total billed charges,70% of total billed charges,225,100,,180,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,184.5,82,,147.6,percent of total billed charges,82% of total billed charges,191.25,85,,153,percent of total billed charges,85% of total billed charges,191.25,85,,153,percent of total billed charges,85% of total billed charges,191.25,85,,153,percent of total billed charges,85% of total billed charges,202.5,90,,162,percent of total billed charges,90% of total billed charges,180,80,,144,percent of total billed charges,80% of total billed charges,202.5,90,,162,percent of total billed charges,90% of total billed charges,168.75,75,,135,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,65.25,29,,52.2,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,150.75,67,,120.6,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,157.5,70,,126,percent of total billed charges,70% of total billed charges,146.25,65,,117,percent of total billed charges,65% of total billed charges,80.26,35.67,,64.208,percent of total billed charges,35.67% of total billed charges,65.25,225,
CORTEX SCREW 16MM 3.5MM,27010999,CDM,278,RC,C1713,HCPCS,outpatient,,,215,86.00,,150.5,70,,120.4,percent of total billed charges,70% of total billed charges,215,100,,172,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,176.3,82,,141.04,percent of total billed charges,82% of total billed charges,182.75,85,,146.2,percent of total billed charges,85% of total billed charges,182.75,85,,146.2,percent of total billed charges,85% of total billed charges,182.75,85,,146.2,percent of total billed charges,85% of total billed charges,193.5,90,,154.8,percent of total billed charges,90% of total billed charges,172,80,,137.6,percent of total billed charges,80% of total billed charges,193.5,90,,154.8,percent of total billed charges,90% of total billed charges,161.25,75,,129,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,62.35,29,,49.88,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,144.05,67,,115.24,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,150.5,70,,120.4,percent of total billed charges,70% of total billed charges,139.75,65,,111.8,percent of total billed charges,65% of total billed charges,76.69,35.67,,61.352,percent of total billed charges,35.67% of total billed charges,62.35,215,
LOCKING SCREW 20MM 3.5MM,27011001,CDM,278,RC,C1713,HCPCS,outpatient,,,723,289.20,,506.1,70,,404.88,percent of total billed charges,70% of total billed charges,723,100,,578.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,592.86,82,,474.288,percent of total billed charges,82% of total billed charges,614.55,85,,491.64,percent of total billed charges,85% of total billed charges,614.55,85,,491.64,percent of total billed charges,85% of total billed charges,614.55,85,,491.64,percent of total billed charges,85% of total billed charges,650.7,90,,520.56,percent of total billed charges,90% of total billed charges,578.4,80,,462.72,percent of total billed charges,80% of total billed charges,650.7,90,,520.56,percent of total billed charges,90% of total billed charges,542.25,75,,433.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,209.67,29,,167.736,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,484.41,67,,387.528,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,506.1,70,,404.88,percent of total billed charges,70% of total billed charges,469.95,65,,375.96,percent of total billed charges,65% of total billed charges,257.89,35.67,,206.312,percent of total billed charges,35.67% of total billed charges,209.67,723,
INTRAFIX SCREW 9X10X23 FEM,27011018,CDM,278,RC,C1713,HCPCS,outpatient,,,1907,762.80,,1334.9,70,,1067.92,percent of total billed charges,70% of total billed charges,1001.18,52.5,,800.94,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,1563.74,82,,1250.992,percent of total billed charges,82% of total billed charges,1620.95,85,,1296.76,percent of total billed charges,85% of total billed charges,1620.95,85,,1296.76,percent of total billed charges,85% of total billed charges,1620.95,85,,1296.76,percent of total billed charges,85% of total billed charges,1716.3,90,,1373.04,percent of total billed charges,90% of total billed charges,1525.6,80,,1220.48,percent of total billed charges,80% of total billed charges,1716.3,90,,1373.04,percent of total billed charges,90% of total billed charges,1430.25,75,,1144.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,553.03,29,,442.424,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1277.69,67,,1022.152,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1334.9,70,,1067.92,percent of total billed charges,70% of total billed charges,1239.55,65,,991.64,percent of total billed charges,65% of total billed charges,680.23,35.67,,544.184,percent of total billed charges,35.67% of total billed charges,553.03,1716.3,
CORTEX SCREW 14MM 2.0MM,27011024,CDM,278,RC,C1713,HCPCS,outpatient,,,308,123.20,,215.6,70,,172.48,percent of total billed charges,70% of total billed charges,308,100,,246.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,252.56,82,,202.048,percent of total billed charges,82% of total billed charges,261.8,85,,209.44,percent of total billed charges,85% of total billed charges,261.8,85,,209.44,percent of total billed charges,85% of total billed charges,261.8,85,,209.44,percent of total billed charges,85% of total billed charges,277.2,90,,221.76,percent of total billed charges,90% of total billed charges,246.4,80,,197.12,percent of total billed charges,80% of total billed charges,277.2,90,,221.76,percent of total billed charges,90% of total billed charges,231,75,,184.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,89.32,29,,71.456,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,206.36,67,,165.088,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,215.6,70,,172.48,percent of total billed charges,70% of total billed charges,200.2,65,,160.16,percent of total billed charges,65% of total billed charges,109.86,35.67,,87.888,percent of total billed charges,35.67% of total billed charges,89.32,308,
DISTAL BICEP IMPLANT DEL SYSTM,27011035,CDM,278,RC,C1713,HCPCS,outpatient,,,4076,1630.40,,2853.2,70,,2282.56,percent of total billed charges,70% of total billed charges,2139.9,52.5,,1711.92,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,3342.32,82,,2673.856,percent of total billed charges,82% of total billed charges,3464.6,85,,2771.68,percent of total billed charges,85% of total billed charges,3464.6,85,,2771.68,percent of total billed charges,85% of total billed charges,3464.6,85,,2771.68,percent of total billed charges,85% of total billed charges,3668.4,90,,2934.72,percent of total billed charges,90% of total billed charges,3260.8,80,,2608.64,percent of total billed charges,80% of total billed charges,3668.4,90,,2934.72,percent of total billed charges,90% of total billed charges,3057,75,,2445.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,1182.04,29,,945.632,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,2730.92,67,,2184.736,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,2853.2,70,,2282.56,percent of total billed charges,70% of total billed charges,2649.4,65,,2119.52,percent of total billed charges,65% of total billed charges,1453.91,35.67,,1163.128,percent of total billed charges,35.67% of total billed charges,1182.04,3668.4,
CORTICAL SCREW 2.7X14MM,27011042,CDM,278,RC,C1713,HCPCS,outpatient,,,587,234.80,,410.9,70,,328.72,percent of total billed charges,70% of total billed charges,587,100,,469.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,481.34,82,,385.072,percent of total billed charges,82% of total billed charges,498.95,85,,399.16,percent of total billed charges,85% of total billed charges,498.95,85,,399.16,percent of total billed charges,85% of total billed charges,498.95,85,,399.16,percent of total billed charges,85% of total billed charges,528.3,90,,422.64,percent of total billed charges,90% of total billed charges,469.6,80,,375.68,percent of total billed charges,80% of total billed charges,528.3,90,,422.64,percent of total billed charges,90% of total billed charges,440.25,75,,352.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,170.23,29,,136.184,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,393.29,67,,314.632,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,410.9,70,,328.72,percent of total billed charges,70% of total billed charges,381.55,65,,305.24,percent of total billed charges,65% of total billed charges,209.38,35.67,,167.504,percent of total billed charges,35.67% of total billed charges,170.23,587,
PHYSIOMESH 6X6 ETHICON,2701105,CDM,278,RC,C1781,HCPCS,outpatient,,,2401,960.40,,1680.7,70,,1344.56,percent of total billed charges,70% of total billed charges,1260.53,52.5,,1008.42,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,1968.82,82,,1575.056,percent of total billed charges,82% of total billed charges,2040.85,85,,1632.68,percent of total billed charges,85% of total billed charges,2040.85,85,,1632.68,percent of total billed charges,85% of total billed charges,2040.85,85,,1632.68,percent of total billed charges,85% of total billed charges,2160.9,90,,1728.72,percent of total billed charges,90% of total billed charges,1920.8,80,,1536.64,percent of total billed charges,80% of total billed charges,2160.9,90,,1728.72,percent of total billed charges,90% of total billed charges,1800.75,75,,1440.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,696.29,29,,557.032,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1608.67,67,,1286.936,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1680.7,70,,1344.56,percent of total billed charges,70% of total billed charges,1560.65,65,,1248.52,percent of total billed charges,65% of total billed charges,856.44,35.67,,685.152,percent of total billed charges,35.67% of total billed charges,696.29,2160.9,
DISPOSABLE KIT FOR 2.9 PUSH LK,27011057,CDM,278,RC,C1713,HCPCS,outpatient,,,1120,448.00,,784,70,,627.2,percent of total billed charges,70% of total billed charges,588,52.5,,470.4,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,918.4,82,,734.72,percent of total billed charges,82% of total billed charges,952,85,,761.6,percent of total billed charges,85% of total billed charges,952,85,,761.6,percent of total billed charges,85% of total billed charges,952,85,,761.6,percent of total billed charges,85% of total billed charges,1008,90,,806.4,percent of total billed charges,90% of total billed charges,896,80,,716.8,percent of total billed charges,80% of total billed charges,1008,90,,806.4,percent of total billed charges,90% of total billed charges,840,75,,672,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,324.8,29,,259.84,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,750.4,67,,600.32,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,784,70,,627.2,percent of total billed charges,70% of total billed charges,728,65,,582.4,percent of total billed charges,65% of total billed charges,399.5,35.67,,319.6,percent of total billed charges,35.67% of total billed charges,324.8,1008,
BIO COMPOSITE PUSH LOCK 2.9,27011058,CDM,278,RC,C1713,HCPCS,outpatient,,,1825,730.00,,1277.5,70,,1022,percent of total billed charges,70% of total billed charges,958.13,52.5,,766.5,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,1496.5,82,,1197.2,percent of total billed charges,82% of total billed charges,1551.25,85,,1241,percent of total billed charges,85% of total billed charges,1551.25,85,,1241,percent of total billed charges,85% of total billed charges,1551.25,85,,1241,percent of total billed charges,85% of total billed charges,1642.5,90,,1314,percent of total billed charges,90% of total billed charges,1460,80,,1168,percent of total billed charges,80% of total billed charges,1642.5,90,,1314,percent of total billed charges,90% of total billed charges,1368.75,75,,1095,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,529.25,29,,423.4,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1222.75,67,,978.2,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1277.5,70,,1022,percent of total billed charges,70% of total billed charges,1186.25,65,,949,percent of total billed charges,65% of total billed charges,650.98,35.67,,520.784,percent of total billed charges,35.67% of total billed charges,529.25,1642.5,
SMALL BONE FIXATION SYSTEM,27011065,CDM,278,RC,C1713,HCPCS,outpatient,,,1952,780.80,,1366.4,70,,1093.12,percent of total billed charges,70% of total billed charges,1024.8,52.5,,819.84,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,1600.64,82,,1280.512,percent of total billed charges,82% of total billed charges,1659.2,85,,1327.36,percent of total billed charges,85% of total billed charges,1659.2,85,,1327.36,percent of total billed charges,85% of total billed charges,1659.2,85,,1327.36,percent of total billed charges,85% of total billed charges,1756.8,90,,1405.44,percent of total billed charges,90% of total billed charges,1561.6,80,,1249.28,percent of total billed charges,80% of total billed charges,1756.8,90,,1405.44,percent of total billed charges,90% of total billed charges,1464,75,,1171.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,566.08,29,,452.864,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1307.84,67,,1046.272,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1366.4,70,,1093.12,percent of total billed charges,70% of total billed charges,1268.8,65,,1015.04,percent of total billed charges,65% of total billed charges,696.28,35.67,,557.024,percent of total billed charges,35.67% of total billed charges,566.08,1756.8,
URETERAL STENT & POSITNER SOFT,27011066,CDM,278,RC,C1874,HCPCS,outpatient,,,751,300.40,,525.7,70,,420.56,percent of total billed charges,70% of total billed charges,751,100,,600.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,615.82,82,,492.656,percent of total billed charges,82% of total billed charges,638.35,85,,510.68,percent of total billed charges,85% of total billed charges,638.35,85,,510.68,percent of total billed charges,85% of total billed charges,638.35,85,,510.68,percent of total billed charges,85% of total billed charges,675.9,90,,540.72,percent of total billed charges,90% of total billed charges,600.8,80,,480.64,percent of total billed charges,80% of total billed charges,675.9,90,,540.72,percent of total billed charges,90% of total billed charges,563.25,75,,450.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,217.79,29,,174.232,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,503.17,67,,402.536,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,525.7,70,,420.56,percent of total billed charges,70% of total billed charges,488.15,65,,390.52,percent of total billed charges,65% of total billed charges,267.88,35.67,,214.304,percent of total billed charges,35.67% of total billed charges,217.79,751,
CORTEX SCREW 2.7 36 MM,27011069,CDM,278,RC,C1713,HCPCS,outpatient,,,346,138.40,,242.2,70,,193.76,percent of total billed charges,70% of total billed charges,346,100,,276.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,283.72,82,,226.976,percent of total billed charges,82% of total billed charges,294.1,85,,235.28,percent of total billed charges,85% of total billed charges,294.1,85,,235.28,percent of total billed charges,85% of total billed charges,294.1,85,,235.28,percent of total billed charges,85% of total billed charges,311.4,90,,249.12,percent of total billed charges,90% of total billed charges,276.8,80,,221.44,percent of total billed charges,80% of total billed charges,311.4,90,,249.12,percent of total billed charges,90% of total billed charges,259.5,75,,207.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,100.34,29,,80.272,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,231.82,67,,185.456,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,242.2,70,,193.76,percent of total billed charges,70% of total billed charges,224.9,65,,179.92,percent of total billed charges,65% of total billed charges,123.42,35.67,,98.736,percent of total billed charges,35.67% of total billed charges,100.34,346,
ILIAC CREST WEDGE 14-20MMWIDT,27011098,CDM,278,RC,C1713,HCPCS,outpatient,,,3118,1247.20,,2182.6,70,,1746.08,percent of total billed charges,70% of total billed charges,1636.95,52.5,,1309.56,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,2556.76,82,,2045.408,percent of total billed charges,82% of total billed charges,2650.3,85,,2120.24,percent of total billed charges,85% of total billed charges,2650.3,85,,2120.24,percent of total billed charges,85% of total billed charges,2650.3,85,,2120.24,percent of total billed charges,85% of total billed charges,2806.2,90,,2244.96,percent of total billed charges,90% of total billed charges,2494.4,80,,1995.52,percent of total billed charges,80% of total billed charges,2806.2,90,,2244.96,percent of total billed charges,90% of total billed charges,2338.5,75,,1870.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,904.22,29,,723.376,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,2089.06,67,,1671.248,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,2182.6,70,,1746.08,percent of total billed charges,70% of total billed charges,2026.7,65,,1621.36,percent of total billed charges,65% of total billed charges,1112.19,35.67,,889.752,percent of total billed charges,35.67% of total billed charges,904.22,2806.2,
PLATE X LCP VA MED 2.4-2.7MM,27011109,CDM,278,RC,C1713,HCPCS,outpatient,,,3953,1581.20,,2767.1,70,,2213.68,percent of total billed charges,70% of total billed charges,2075.33,52.5,,1660.26,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,3241.46,82,,2593.168,percent of total billed charges,82% of total billed charges,3360.05,85,,2688.04,percent of total billed charges,85% of total billed charges,3360.05,85,,2688.04,percent of total billed charges,85% of total billed charges,3360.05,85,,2688.04,percent of total billed charges,85% of total billed charges,3557.7,90,,2846.16,percent of total billed charges,90% of total billed charges,3162.4,80,,2529.92,percent of total billed charges,80% of total billed charges,3557.7,90,,2846.16,percent of total billed charges,90% of total billed charges,2964.75,75,,2371.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,1146.37,29,,917.096,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,2648.51,67,,2118.808,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,2767.1,70,,2213.68,percent of total billed charges,70% of total billed charges,2569.45,65,,2055.56,percent of total billed charges,65% of total billed charges,1410.04,35.67,,1128.032,percent of total billed charges,35.67% of total billed charges,1146.37,3557.7,
"PORT, INDWELLING FOR CATH KIT",2701111,CDM,278,RC,C1788,HCPCS,outpatient,,,322,128.80,,225.4,70,,180.32,percent of total billed charges,70% of total billed charges,322,100,,257.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,264.04,82,,211.232,percent of total billed charges,82% of total billed charges,273.7,85,,218.96,percent of total billed charges,85% of total billed charges,273.7,85,,218.96,percent of total billed charges,85% of total billed charges,273.7,85,,218.96,percent of total billed charges,85% of total billed charges,289.8,90,,231.84,percent of total billed charges,90% of total billed charges,257.6,80,,206.08,percent of total billed charges,80% of total billed charges,289.8,90,,231.84,percent of total billed charges,90% of total billed charges,241.5,75,,193.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,93.38,29,,74.704,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,215.74,67,,172.592,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,225.4,70,,180.32,percent of total billed charges,70% of total billed charges,209.3,65,,167.44,percent of total billed charges,65% of total billed charges,114.86,35.67,,91.888,percent of total billed charges,35.67% of total billed charges,93.38,322,
SCREW 2.4 LOCKING VA 22MM,27011110,CDM,278,RC,C1713,HCPCS,outpatient,,,759,303.60,,531.3,70,,425.04,percent of total billed charges,70% of total billed charges,759,100,,607.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,622.38,82,,497.904,percent of total billed charges,82% of total billed charges,645.15,85,,516.12,percent of total billed charges,85% of total billed charges,645.15,85,,516.12,percent of total billed charges,85% of total billed charges,645.15,85,,516.12,percent of total billed charges,85% of total billed charges,683.1,90,,546.48,percent of total billed charges,90% of total billed charges,607.2,80,,485.76,percent of total billed charges,80% of total billed charges,683.1,90,,546.48,percent of total billed charges,90% of total billed charges,569.25,75,,455.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,220.11,29,,176.088,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,508.53,67,,406.824,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,531.3,70,,425.04,percent of total billed charges,70% of total billed charges,493.35,65,,394.68,percent of total billed charges,65% of total billed charges,270.74,35.67,,216.592,percent of total billed charges,35.67% of total billed charges,220.11,759,
LOCKING SCREW 2.4MM VA 26MM,27011111,CDM,278,RC,C1713,HCPCS,outpatient,,,759,303.60,,531.3,70,,425.04,percent of total billed charges,70% of total billed charges,759,100,,607.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,622.38,82,,497.904,percent of total billed charges,82% of total billed charges,645.15,85,,516.12,percent of total billed charges,85% of total billed charges,645.15,85,,516.12,percent of total billed charges,85% of total billed charges,645.15,85,,516.12,percent of total billed charges,85% of total billed charges,683.1,90,,546.48,percent of total billed charges,90% of total billed charges,607.2,80,,485.76,percent of total billed charges,80% of total billed charges,683.1,90,,546.48,percent of total billed charges,90% of total billed charges,569.25,75,,455.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,220.11,29,,176.088,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,508.53,67,,406.824,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,531.3,70,,425.04,percent of total billed charges,70% of total billed charges,493.35,65,,394.68,percent of total billed charges,65% of total billed charges,270.74,35.67,,216.592,percent of total billed charges,35.67% of total billed charges,220.11,759,
INTRODUCER FOR CATH KIT,2701113,CDM,278,RC,C1894,HCPCS,outpatient,,,322,128.80,,225.4,70,,180.32,percent of total billed charges,70% of total billed charges,322,100,,257.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,264.04,82,,211.232,percent of total billed charges,82% of total billed charges,273.7,85,,218.96,percent of total billed charges,85% of total billed charges,273.7,85,,218.96,percent of total billed charges,85% of total billed charges,273.7,85,,218.96,percent of total billed charges,85% of total billed charges,289.8,90,,231.84,percent of total billed charges,90% of total billed charges,257.6,80,,206.08,percent of total billed charges,80% of total billed charges,289.8,90,,231.84,percent of total billed charges,90% of total billed charges,241.5,75,,193.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,93.38,29,,74.704,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,215.74,67,,172.592,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,225.4,70,,180.32,percent of total billed charges,70% of total billed charges,209.3,65,,167.44,percent of total billed charges,65% of total billed charges,114.86,35.67,,91.888,percent of total billed charges,35.67% of total billed charges,93.38,322,
GUIDE WIRE FOR CATH KIT,2701114,CDM,278,RC,C1769,HCPCS,outpatient,,,322,128.80,,225.4,70,,180.32,percent of total billed charges,70% of total billed charges,322,100,,257.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,264.04,82,,211.232,percent of total billed charges,82% of total billed charges,273.7,85,,218.96,percent of total billed charges,85% of total billed charges,273.7,85,,218.96,percent of total billed charges,85% of total billed charges,273.7,85,,218.96,percent of total billed charges,85% of total billed charges,289.8,90,,231.84,percent of total billed charges,90% of total billed charges,257.6,80,,206.08,percent of total billed charges,80% of total billed charges,289.8,90,,231.84,percent of total billed charges,90% of total billed charges,241.5,75,,193.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,93.38,29,,74.704,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,215.74,67,,172.592,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,225.4,70,,180.32,percent of total billed charges,70% of total billed charges,209.3,65,,167.44,percent of total billed charges,65% of total billed charges,114.86,35.67,,91.888,percent of total billed charges,35.67% of total billed charges,93.38,322,
DEG HFX STEM 132 # 8,27011172,CDM,278,RC,C1713,HCPCS,outpatient,,,7607,3042.80,,5324.9,70,,4259.92,percent of total billed charges,70% of total billed charges,3993.68,52.5,,3194.94,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,6237.74,82,,4990.192,percent of total billed charges,82% of total billed charges,6465.95,85,,5172.76,percent of total billed charges,85% of total billed charges,6465.95,85,,5172.76,percent of total billed charges,85% of total billed charges,6465.95,85,,5172.76,percent of total billed charges,85% of total billed charges,6846.3,90,,5477.04,percent of total billed charges,90% of total billed charges,6085.6,80,,4868.48,percent of total billed charges,80% of total billed charges,6846.3,90,,5477.04,percent of total billed charges,90% of total billed charges,5705.25,75,,4564.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2206.03,29,,1764.824,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,5096.69,67,,4077.352,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,5324.9,70,,4259.92,percent of total billed charges,70% of total billed charges,4944.55,65,,3955.64,percent of total billed charges,65% of total billed charges,2713.42,35.67,,2170.736,percent of total billed charges,35.67% of total billed charges,2206.03,6846.3,
UNITRAX SLEEVE 3 MM,27011174,CDM,278,RC,C1713,HCPCS,outpatient,,,919,367.60,,643.3,70,,514.64,percent of total billed charges,70% of total billed charges,919,100,,735.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,753.58,82,,602.864,percent of total billed charges,82% of total billed charges,781.15,85,,624.92,percent of total billed charges,85% of total billed charges,781.15,85,,624.92,percent of total billed charges,85% of total billed charges,781.15,85,,624.92,percent of total billed charges,85% of total billed charges,827.1,90,,661.68,percent of total billed charges,90% of total billed charges,735.2,80,,588.16,percent of total billed charges,80% of total billed charges,827.1,90,,661.68,percent of total billed charges,90% of total billed charges,689.25,75,,551.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,266.51,29,,213.208,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,615.73,67,,492.584,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,643.3,70,,514.64,percent of total billed charges,70% of total billed charges,597.35,65,,477.88,percent of total billed charges,65% of total billed charges,327.81,35.67,,262.248,percent of total billed charges,35.67% of total billed charges,266.51,919,
PLATE X VA LK X SML 2.4 2.7MM,27011181,CDM,278,RC,C1713,HCPCS,outpatient,,,3953,1581.20,,2767.1,70,,2213.68,percent of total billed charges,70% of total billed charges,2075.33,52.5,,1660.26,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,3241.46,82,,2593.168,percent of total billed charges,82% of total billed charges,3360.05,85,,2688.04,percent of total billed charges,85% of total billed charges,3360.05,85,,2688.04,percent of total billed charges,85% of total billed charges,3360.05,85,,2688.04,percent of total billed charges,85% of total billed charges,3557.7,90,,2846.16,percent of total billed charges,90% of total billed charges,3162.4,80,,2529.92,percent of total billed charges,80% of total billed charges,3557.7,90,,2846.16,percent of total billed charges,90% of total billed charges,2964.75,75,,2371.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,1146.37,29,,917.096,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,2648.51,67,,2118.808,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,2767.1,70,,2213.68,percent of total billed charges,70% of total billed charges,2569.45,65,,2055.56,percent of total billed charges,65% of total billed charges,1410.04,35.67,,1128.032,percent of total billed charges,35.67% of total billed charges,1146.37,3557.7,
PLATE X VA LK 2.4 2.7MM SMALL,27011182,CDM,278,RC,C1713,HCPCS,outpatient,,,3953,1581.20,,2767.1,70,,2213.68,percent of total billed charges,70% of total billed charges,2075.33,52.5,,1660.26,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,3241.46,82,,2593.168,percent of total billed charges,82% of total billed charges,3360.05,85,,2688.04,percent of total billed charges,85% of total billed charges,3360.05,85,,2688.04,percent of total billed charges,85% of total billed charges,3360.05,85,,2688.04,percent of total billed charges,85% of total billed charges,3557.7,90,,2846.16,percent of total billed charges,90% of total billed charges,3162.4,80,,2529.92,percent of total billed charges,80% of total billed charges,3557.7,90,,2846.16,percent of total billed charges,90% of total billed charges,2964.75,75,,2371.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,1146.37,29,,917.096,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,2648.51,67,,2118.808,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,2767.1,70,,2213.68,percent of total billed charges,70% of total billed charges,2569.45,65,,2055.56,percent of total billed charges,65% of total billed charges,1410.04,35.67,,1128.032,percent of total billed charges,35.67% of total billed charges,1146.37,3557.7,
CORTEX SCREW S TAP 2.4MM,27011183,CDM,278,RC,C1713,HCPCS,outpatient,,,398,159.20,,278.6,70,,222.88,percent of total billed charges,70% of total billed charges,398,100,,318.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,326.36,82,,261.088,percent of total billed charges,82% of total billed charges,338.3,85,,270.64,percent of total billed charges,85% of total billed charges,338.3,85,,270.64,percent of total billed charges,85% of total billed charges,338.3,85,,270.64,percent of total billed charges,85% of total billed charges,358.2,90,,286.56,percent of total billed charges,90% of total billed charges,318.4,80,,254.72,percent of total billed charges,80% of total billed charges,358.2,90,,286.56,percent of total billed charges,90% of total billed charges,298.5,75,,238.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,115.42,29,,92.336,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,266.66,67,,213.328,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,278.6,70,,222.88,percent of total billed charges,70% of total billed charges,258.7,65,,206.96,percent of total billed charges,65% of total billed charges,141.97,35.67,,113.576,percent of total billed charges,35.67% of total billed charges,115.42,398,
CORTEX SCREW SLF TAP 2.4MM,27011184,CDM,278,RC,C1713,HCPCS,outpatient,,,398,159.20,,278.6,70,,222.88,percent of total billed charges,70% of total billed charges,398,100,,318.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,326.36,82,,261.088,percent of total billed charges,82% of total billed charges,338.3,85,,270.64,percent of total billed charges,85% of total billed charges,338.3,85,,270.64,percent of total billed charges,85% of total billed charges,338.3,85,,270.64,percent of total billed charges,85% of total billed charges,358.2,90,,286.56,percent of total billed charges,90% of total billed charges,318.4,80,,254.72,percent of total billed charges,80% of total billed charges,358.2,90,,286.56,percent of total billed charges,90% of total billed charges,298.5,75,,238.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,115.42,29,,92.336,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,266.66,67,,213.328,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,278.6,70,,222.88,percent of total billed charges,70% of total billed charges,258.7,65,,206.96,percent of total billed charges,65% of total billed charges,141.97,35.67,,113.576,percent of total billed charges,35.67% of total billed charges,115.42,398,
CORTEX 2.4MM SCREW S TAP 22 MM,27011185,CDM,278,RC,C1713,HCPCS,outpatient,,,398,159.20,,278.6,70,,222.88,percent of total billed charges,70% of total billed charges,398,100,,318.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,326.36,82,,261.088,percent of total billed charges,82% of total billed charges,338.3,85,,270.64,percent of total billed charges,85% of total billed charges,338.3,85,,270.64,percent of total billed charges,85% of total billed charges,338.3,85,,270.64,percent of total billed charges,85% of total billed charges,358.2,90,,286.56,percent of total billed charges,90% of total billed charges,318.4,80,,254.72,percent of total billed charges,80% of total billed charges,358.2,90,,286.56,percent of total billed charges,90% of total billed charges,298.5,75,,238.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,115.42,29,,92.336,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,266.66,67,,213.328,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,278.6,70,,222.88,percent of total billed charges,70% of total billed charges,258.7,65,,206.96,percent of total billed charges,65% of total billed charges,141.97,35.67,,113.576,percent of total billed charges,35.67% of total billed charges,115.42,398,
LOCKING SCREW VA SF TAP 2.4,27011186,CDM,278,RC,C1713,HCPCS,outpatient,,,759,303.60,,531.3,70,,425.04,percent of total billed charges,70% of total billed charges,759,100,,607.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,622.38,82,,497.904,percent of total billed charges,82% of total billed charges,645.15,85,,516.12,percent of total billed charges,85% of total billed charges,645.15,85,,516.12,percent of total billed charges,85% of total billed charges,645.15,85,,516.12,percent of total billed charges,85% of total billed charges,683.1,90,,546.48,percent of total billed charges,90% of total billed charges,607.2,80,,485.76,percent of total billed charges,80% of total billed charges,683.1,90,,546.48,percent of total billed charges,90% of total billed charges,569.25,75,,455.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,220.11,29,,176.088,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,508.53,67,,406.824,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,531.3,70,,425.04,percent of total billed charges,70% of total billed charges,493.35,65,,394.68,percent of total billed charges,65% of total billed charges,270.74,35.67,,216.592,percent of total billed charges,35.67% of total billed charges,220.11,759,
CORTEX SCREW 2.0MM # 11,27011198,CDM,278,RC,C1713,HCPCS,outpatient,,,308,123.20,,215.6,70,,172.48,percent of total billed charges,70% of total billed charges,308,100,,246.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,252.56,82,,202.048,percent of total billed charges,82% of total billed charges,261.8,85,,209.44,percent of total billed charges,85% of total billed charges,261.8,85,,209.44,percent of total billed charges,85% of total billed charges,261.8,85,,209.44,percent of total billed charges,85% of total billed charges,277.2,90,,221.76,percent of total billed charges,90% of total billed charges,246.4,80,,197.12,percent of total billed charges,80% of total billed charges,277.2,90,,221.76,percent of total billed charges,90% of total billed charges,231,75,,184.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,89.32,29,,71.456,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,206.36,67,,165.088,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,215.6,70,,172.48,percent of total billed charges,70% of total billed charges,200.2,65,,160.16,percent of total billed charges,65% of total billed charges,109.86,35.67,,87.888,percent of total billed charges,35.67% of total billed charges,89.32,308,
"3.5 LCPR 6 HOLE PLATE, W/LAT E",27011199,CDM,278,RC,C1713,HCPCS,outpatient,,,3909,1563.60,,2736.3,70,,2189.04,percent of total billed charges,70% of total billed charges,2052.23,52.5,,1641.78,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,3205.38,82,,2564.304,percent of total billed charges,82% of total billed charges,3322.65,85,,2658.12,percent of total billed charges,85% of total billed charges,3322.65,85,,2658.12,percent of total billed charges,85% of total billed charges,3322.65,85,,2658.12,percent of total billed charges,85% of total billed charges,3518.1,90,,2814.48,percent of total billed charges,90% of total billed charges,3127.2,80,,2501.76,percent of total billed charges,80% of total billed charges,3518.1,90,,2814.48,percent of total billed charges,90% of total billed charges,2931.75,75,,2345.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,1133.61,29,,906.888,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,2619.03,67,,2095.224,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,2736.3,70,,2189.04,percent of total billed charges,70% of total billed charges,2540.85,65,,2032.68,percent of total billed charges,65% of total billed charges,1394.34,35.67,,1115.472,percent of total billed charges,35.67% of total billed charges,1133.61,3518.1,
URETHERAL STENT SET SFT 6F 24C,27011215,CDM,278,RC,C1874,HCPCS,outpatient,,,751,300.40,,525.7,70,,420.56,percent of total billed charges,70% of total billed charges,751,100,,600.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,615.82,82,,492.656,percent of total billed charges,82% of total billed charges,638.35,85,,510.68,percent of total billed charges,85% of total billed charges,638.35,85,,510.68,percent of total billed charges,85% of total billed charges,638.35,85,,510.68,percent of total billed charges,85% of total billed charges,675.9,90,,540.72,percent of total billed charges,90% of total billed charges,600.8,80,,480.64,percent of total billed charges,80% of total billed charges,675.9,90,,540.72,percent of total billed charges,90% of total billed charges,563.25,75,,450.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,217.79,29,,174.232,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,503.17,67,,402.536,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,525.7,70,,420.56,percent of total billed charges,70% of total billed charges,488.15,65,,390.52,percent of total billed charges,65% of total billed charges,267.88,35.67,,214.304,percent of total billed charges,35.67% of total billed charges,217.79,751,
VA LOCKING SCREW 28MM 2.4,27011220,CDM,278,RC,C1713,HCPCS,outpatient,,,759,303.60,,531.3,70,,425.04,percent of total billed charges,70% of total billed charges,759,100,,607.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,622.38,82,,497.904,percent of total billed charges,82% of total billed charges,645.15,85,,516.12,percent of total billed charges,85% of total billed charges,645.15,85,,516.12,percent of total billed charges,85% of total billed charges,645.15,85,,516.12,percent of total billed charges,85% of total billed charges,683.1,90,,546.48,percent of total billed charges,90% of total billed charges,607.2,80,,485.76,percent of total billed charges,80% of total billed charges,683.1,90,,546.48,percent of total billed charges,90% of total billed charges,569.25,75,,455.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,220.11,29,,176.088,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,508.53,67,,406.824,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,531.3,70,,425.04,percent of total billed charges,70% of total billed charges,493.35,65,,394.68,percent of total billed charges,65% of total billed charges,270.74,35.67,,216.592,percent of total billed charges,35.67% of total billed charges,220.11,759,
VA LOCKING SCREW 36MM 2.4,27011221,CDM,278,RC,C1713,HCPCS,outpatient,,,759,303.60,,531.3,70,,425.04,percent of total billed charges,70% of total billed charges,759,100,,607.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,622.38,82,,497.904,percent of total billed charges,82% of total billed charges,645.15,85,,516.12,percent of total billed charges,85% of total billed charges,645.15,85,,516.12,percent of total billed charges,85% of total billed charges,645.15,85,,516.12,percent of total billed charges,85% of total billed charges,683.1,90,,546.48,percent of total billed charges,90% of total billed charges,607.2,80,,485.76,percent of total billed charges,80% of total billed charges,683.1,90,,546.48,percent of total billed charges,90% of total billed charges,569.25,75,,455.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,220.11,29,,176.088,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,508.53,67,,406.824,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,531.3,70,,425.04,percent of total billed charges,70% of total billed charges,493.35,65,,394.68,percent of total billed charges,65% of total billed charges,270.74,35.67,,216.592,percent of total billed charges,35.67% of total billed charges,220.11,759,
VA LOCKING SCREW 38MM 2.4,27011222,CDM,278,RC,C1713,HCPCS,outpatient,,,759,303.60,,531.3,70,,425.04,percent of total billed charges,70% of total billed charges,759,100,,607.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,622.38,82,,497.904,percent of total billed charges,82% of total billed charges,645.15,85,,516.12,percent of total billed charges,85% of total billed charges,645.15,85,,516.12,percent of total billed charges,85% of total billed charges,645.15,85,,516.12,percent of total billed charges,85% of total billed charges,683.1,90,,546.48,percent of total billed charges,90% of total billed charges,607.2,80,,485.76,percent of total billed charges,80% of total billed charges,683.1,90,,546.48,percent of total billed charges,90% of total billed charges,569.25,75,,455.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,220.11,29,,176.088,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,508.53,67,,406.824,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,531.3,70,,425.04,percent of total billed charges,70% of total billed charges,493.35,65,,394.68,percent of total billed charges,65% of total billed charges,270.74,35.67,,216.592,percent of total billed charges,35.67% of total billed charges,220.11,759,
CORTICAL SCREW 2.7X16MM,27011224,CDM,278,RC,C1713,HCPCS,outpatient,,,570,228.00,,399,70,,319.2,percent of total billed charges,70% of total billed charges,570,100,,456,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,467.4,82,,373.92,percent of total billed charges,82% of total billed charges,484.5,85,,387.6,percent of total billed charges,85% of total billed charges,484.5,85,,387.6,percent of total billed charges,85% of total billed charges,484.5,85,,387.6,percent of total billed charges,85% of total billed charges,513,90,,410.4,percent of total billed charges,90% of total billed charges,456,80,,364.8,percent of total billed charges,80% of total billed charges,513,90,,410.4,percent of total billed charges,90% of total billed charges,427.5,75,,342,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,165.3,29,,132.24,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,381.9,67,,305.52,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,399,70,,319.2,percent of total billed charges,70% of total billed charges,370.5,65,,296.4,percent of total billed charges,65% of total billed charges,203.32,35.67,,162.656,percent of total billed charges,35.67% of total billed charges,165.3,570,
STRAIGHT PLATE 2.0 6 HOLE,27011251,CDM,278,RC,C1713,HCPCS,outpatient,,,1411,564.40,,987.7,70,,790.16,percent of total billed charges,70% of total billed charges,740.78,52.5,,592.62,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,1157.02,82,,925.616,percent of total billed charges,82% of total billed charges,1199.35,85,,959.48,percent of total billed charges,85% of total billed charges,1199.35,85,,959.48,percent of total billed charges,85% of total billed charges,1199.35,85,,959.48,percent of total billed charges,85% of total billed charges,1269.9,90,,1015.92,percent of total billed charges,90% of total billed charges,1128.8,80,,903.04,percent of total billed charges,80% of total billed charges,1269.9,90,,1015.92,percent of total billed charges,90% of total billed charges,1058.25,75,,846.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,409.19,29,,327.352,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,945.37,67,,756.296,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,987.7,70,,790.16,percent of total billed charges,70% of total billed charges,917.15,65,,733.72,percent of total billed charges,65% of total billed charges,503.3,35.67,,402.64,percent of total billed charges,35.67% of total billed charges,409.19,1269.9,
LOCKING SCREW 2.0 8 MM,27011253,CDM,278,RC,C1713,HCPCS,outpatient,,,824,329.60,,576.8,70,,461.44,percent of total billed charges,70% of total billed charges,824,100,,659.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,675.68,82,,540.544,percent of total billed charges,82% of total billed charges,700.4,85,,560.32,percent of total billed charges,85% of total billed charges,700.4,85,,560.32,percent of total billed charges,85% of total billed charges,700.4,85,,560.32,percent of total billed charges,85% of total billed charges,741.6,90,,593.28,percent of total billed charges,90% of total billed charges,659.2,80,,527.36,percent of total billed charges,80% of total billed charges,741.6,90,,593.28,percent of total billed charges,90% of total billed charges,618,75,,494.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,238.96,29,,191.168,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,552.08,67,,441.664,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,576.8,70,,461.44,percent of total billed charges,70% of total billed charges,535.6,65,,428.48,percent of total billed charges,65% of total billed charges,293.92,35.67,,235.136,percent of total billed charges,35.67% of total billed charges,238.96,824,
LOCKING SCREW 2.7 X 14,27011259,CDM,278,RC,C1713,HCPCS,outpatient,,,718,287.20,,502.6,70,,402.08,percent of total billed charges,70% of total billed charges,718,100,,574.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,588.76,82,,471.008,percent of total billed charges,82% of total billed charges,610.3,85,,488.24,percent of total billed charges,85% of total billed charges,610.3,85,,488.24,percent of total billed charges,85% of total billed charges,610.3,85,,488.24,percent of total billed charges,85% of total billed charges,646.2,90,,516.96,percent of total billed charges,90% of total billed charges,574.4,80,,459.52,percent of total billed charges,80% of total billed charges,646.2,90,,516.96,percent of total billed charges,90% of total billed charges,538.5,75,,430.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,208.22,29,,166.576,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,481.06,67,,384.848,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,502.6,70,,402.08,percent of total billed charges,70% of total billed charges,466.7,65,,373.36,percent of total billed charges,65% of total billed charges,256.11,35.67,,204.888,percent of total billed charges,35.67% of total billed charges,208.22,718,
CANNULATED SCREW TI 6.5X105,27011274,CDM,278,RC,C1713,HCPCS,outpatient,,,1315,526.00,,920.5,70,,736.4,percent of total billed charges,70% of total billed charges,690.38,52.5,,552.3,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,1078.3,82,,862.64,percent of total billed charges,82% of total billed charges,1117.75,85,,894.2,percent of total billed charges,85% of total billed charges,1117.75,85,,894.2,percent of total billed charges,85% of total billed charges,1117.75,85,,894.2,percent of total billed charges,85% of total billed charges,1183.5,90,,946.8,percent of total billed charges,90% of total billed charges,1052,80,,841.6,percent of total billed charges,80% of total billed charges,1183.5,90,,946.8,percent of total billed charges,90% of total billed charges,986.25,75,,789,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,381.35,29,,305.08,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,881.05,67,,704.84,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,920.5,70,,736.4,percent of total billed charges,70% of total billed charges,854.75,65,,683.8,percent of total billed charges,65% of total billed charges,469.06,35.67,,375.248,percent of total billed charges,35.67% of total billed charges,381.35,1183.5,
K WIRE 3.2 MM,27011276,CDM,278,RC,C1713,HCPCS,outpatient,,,772,308.80,,540.4,70,,432.32,percent of total billed charges,70% of total billed charges,772,100,,617.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,633.04,82,,506.432,percent of total billed charges,82% of total billed charges,656.2,85,,524.96,percent of total billed charges,85% of total billed charges,656.2,85,,524.96,percent of total billed charges,85% of total billed charges,656.2,85,,524.96,percent of total billed charges,85% of total billed charges,694.8,90,,555.84,percent of total billed charges,90% of total billed charges,617.6,80,,494.08,percent of total billed charges,80% of total billed charges,694.8,90,,555.84,percent of total billed charges,90% of total billed charges,579,75,,463.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,223.88,29,,179.104,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,517.24,67,,413.792,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,540.4,70,,432.32,percent of total billed charges,70% of total billed charges,501.8,65,,401.44,percent of total billed charges,65% of total billed charges,275.37,35.67,,220.296,percent of total billed charges,35.67% of total billed charges,223.88,772,
HEALIX 4.5 AFV 3,27011286,CDM,278,RC,C1713,HCPCS,outpatient,,,2171,868.40,,1519.7,70,,1215.76,percent of total billed charges,70% of total billed charges,1139.78,52.5,,911.82,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,1780.22,82,,1424.176,percent of total billed charges,82% of total billed charges,1845.35,85,,1476.28,percent of total billed charges,85% of total billed charges,1845.35,85,,1476.28,percent of total billed charges,85% of total billed charges,1845.35,85,,1476.28,percent of total billed charges,85% of total billed charges,1953.9,90,,1563.12,percent of total billed charges,90% of total billed charges,1736.8,80,,1389.44,percent of total billed charges,80% of total billed charges,1953.9,90,,1563.12,percent of total billed charges,90% of total billed charges,1628.25,75,,1302.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,629.59,29,,503.672,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1454.57,67,,1163.656,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1519.7,70,,1215.76,percent of total billed charges,70% of total billed charges,1411.15,65,,1128.92,percent of total billed charges,65% of total billed charges,774.4,35.67,,619.52,percent of total billed charges,35.67% of total billed charges,629.59,1953.9,
CORTEX SCREW 2.0MM 20MM IN/OUT,27011300,CDM,278,RC,C1713,HCPCS,outpatient,,,321,128.40,,224.7,70,,179.76,percent of total billed charges,70% of total billed charges,321,100,,256.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,263.22,82,,210.576,percent of total billed charges,82% of total billed charges,272.85,85,,218.28,percent of total billed charges,85% of total billed charges,272.85,85,,218.28,percent of total billed charges,85% of total billed charges,272.85,85,,218.28,percent of total billed charges,85% of total billed charges,288.9,90,,231.12,percent of total billed charges,90% of total billed charges,256.8,80,,205.44,percent of total billed charges,80% of total billed charges,288.9,90,,231.12,percent of total billed charges,90% of total billed charges,240.75,75,,192.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,93.09,29,,74.472,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,215.07,67,,172.056,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,224.7,70,,179.76,percent of total billed charges,70% of total billed charges,208.65,65,,166.92,percent of total billed charges,65% of total billed charges,114.5,35.67,,91.6,percent of total billed charges,35.67% of total billed charges,93.09,321,
CORTEX SCREW 2.4MM 20MM,27011301,CDM,278,RC,C1713,HCPCS,outpatient,,,423,169.20,,296.1,70,,236.88,percent of total billed charges,70% of total billed charges,423,100,,338.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,346.86,82,,277.488,percent of total billed charges,82% of total billed charges,359.55,85,,287.64,percent of total billed charges,85% of total billed charges,359.55,85,,287.64,percent of total billed charges,85% of total billed charges,359.55,85,,287.64,percent of total billed charges,85% of total billed charges,380.7,90,,304.56,percent of total billed charges,90% of total billed charges,338.4,80,,270.72,percent of total billed charges,80% of total billed charges,380.7,90,,304.56,percent of total billed charges,90% of total billed charges,317.25,75,,253.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,122.67,29,,98.136,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,283.41,67,,226.728,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,296.1,70,,236.88,percent of total billed charges,70% of total billed charges,274.95,65,,219.96,percent of total billed charges,65% of total billed charges,150.88,35.67,,120.704,percent of total billed charges,35.67% of total billed charges,122.67,423,
CANNULATED SCREW 6.5X 80S,27011318,CDM,278,RC,C1713,HCPCS,outpatient,,,1315,526.00,,920.5,70,,736.4,percent of total billed charges,70% of total billed charges,690.38,52.5,,552.3,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,1078.3,82,,862.64,percent of total billed charges,82% of total billed charges,1117.75,85,,894.2,percent of total billed charges,85% of total billed charges,1117.75,85,,894.2,percent of total billed charges,85% of total billed charges,1117.75,85,,894.2,percent of total billed charges,85% of total billed charges,1183.5,90,,946.8,percent of total billed charges,90% of total billed charges,1052,80,,841.6,percent of total billed charges,80% of total billed charges,1183.5,90,,946.8,percent of total billed charges,90% of total billed charges,986.25,75,,789,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,381.35,29,,305.08,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,881.05,67,,704.84,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,920.5,70,,736.4,percent of total billed charges,70% of total billed charges,854.75,65,,683.8,percent of total billed charges,65% of total billed charges,469.06,35.67,,375.248,percent of total billed charges,35.67% of total billed charges,381.35,1183.5,
CANNULATED SCREW 6.5 85,27011319,CDM,278,RC,C1713,HCPCS,outpatient,,,1315,526.00,,920.5,70,,736.4,percent of total billed charges,70% of total billed charges,690.38,52.5,,552.3,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,1078.3,82,,862.64,percent of total billed charges,82% of total billed charges,1117.75,85,,894.2,percent of total billed charges,85% of total billed charges,1117.75,85,,894.2,percent of total billed charges,85% of total billed charges,1117.75,85,,894.2,percent of total billed charges,85% of total billed charges,1183.5,90,,946.8,percent of total billed charges,90% of total billed charges,1052,80,,841.6,percent of total billed charges,80% of total billed charges,1183.5,90,,946.8,percent of total billed charges,90% of total billed charges,986.25,75,,789,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,381.35,29,,305.08,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,881.05,67,,704.84,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,920.5,70,,736.4,percent of total billed charges,70% of total billed charges,854.75,65,,683.8,percent of total billed charges,65% of total billed charges,469.06,35.67,,375.248,percent of total billed charges,35.67% of total billed charges,381.35,1183.5,
K WIRE 3.2X300,27011320,CDM,278,RC,C1713,HCPCS,outpatient,,,688,275.20,,481.6,70,,385.28,percent of total billed charges,70% of total billed charges,688,100,,550.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,564.16,82,,451.328,percent of total billed charges,82% of total billed charges,584.8,85,,467.84,percent of total billed charges,85% of total billed charges,584.8,85,,467.84,percent of total billed charges,85% of total billed charges,584.8,85,,467.84,percent of total billed charges,85% of total billed charges,619.2,90,,495.36,percent of total billed charges,90% of total billed charges,550.4,80,,440.32,percent of total billed charges,80% of total billed charges,619.2,90,,495.36,percent of total billed charges,90% of total billed charges,516,75,,412.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,199.52,29,,159.616,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,460.96,67,,368.768,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,481.6,70,,385.28,percent of total billed charges,70% of total billed charges,447.2,65,,357.76,percent of total billed charges,65% of total billed charges,245.41,35.67,,196.328,percent of total billed charges,35.67% of total billed charges,199.52,688,
LEAD KIT,27011336,CDM,278,RC,C1778,HCPCS,outpatient,,,7528,3011.20,,5269.6,70,,4215.68,percent of total billed charges,70% of total billed charges,3952.2,52.5,,3161.76,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,6172.96,82,,4938.368,percent of total billed charges,82% of total billed charges,6398.8,85,,5119.04,percent of total billed charges,85% of total billed charges,6398.8,85,,5119.04,percent of total billed charges,85% of total billed charges,6398.8,85,,5119.04,percent of total billed charges,85% of total billed charges,6775.2,90,,5420.16,percent of total billed charges,90% of total billed charges,6022.4,80,,4817.92,percent of total billed charges,80% of total billed charges,6775.2,90,,5420.16,percent of total billed charges,90% of total billed charges,5646,75,,4516.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2183.12,29,,1746.496,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,5043.76,67,,4035.008,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,5269.6,70,,4215.68,percent of total billed charges,70% of total billed charges,4893.2,65,,3914.56,percent of total billed charges,65% of total billed charges,2685.24,35.67,,2148.192,percent of total billed charges,35.67% of total billed charges,2183.12,6775.2,
THREADED TAK 2.0/2.4MM,27011342,CDM,278,RC,C1713,HCPCS,outpatient,,,338,135.20,,236.6,70,,189.28,percent of total billed charges,70% of total billed charges,338,100,,270.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,277.16,82,,221.728,percent of total billed charges,82% of total billed charges,287.3,85,,229.84,percent of total billed charges,85% of total billed charges,287.3,85,,229.84,percent of total billed charges,85% of total billed charges,287.3,85,,229.84,percent of total billed charges,85% of total billed charges,304.2,90,,243.36,percent of total billed charges,90% of total billed charges,270.4,80,,216.32,percent of total billed charges,80% of total billed charges,304.2,90,,243.36,percent of total billed charges,90% of total billed charges,253.5,75,,202.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,98.02,29,,78.416,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,226.46,67,,181.168,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,236.6,70,,189.28,percent of total billed charges,70% of total billed charges,219.7,65,,175.76,percent of total billed charges,65% of total billed charges,120.56,35.67,,96.448,percent of total billed charges,35.67% of total billed charges,98.02,338,
HOLE STRAIGHT PLATE 2.0MMX6,27011343,CDM,278,RC,C1713,HCPCS,outpatient,,,1634,653.60,,1143.8,70,,915.04,percent of total billed charges,70% of total billed charges,857.85,52.5,,686.28,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,1339.88,82,,1071.904,percent of total billed charges,82% of total billed charges,1388.9,85,,1111.12,percent of total billed charges,85% of total billed charges,1388.9,85,,1111.12,percent of total billed charges,85% of total billed charges,1388.9,85,,1111.12,percent of total billed charges,85% of total billed charges,1470.6,90,,1176.48,percent of total billed charges,90% of total billed charges,1307.2,80,,1045.76,percent of total billed charges,80% of total billed charges,1470.6,90,,1176.48,percent of total billed charges,90% of total billed charges,1225.5,75,,980.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,473.86,29,,379.088,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1094.78,67,,875.824,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1143.8,70,,915.04,percent of total billed charges,70% of total billed charges,1062.1,65,,849.68,percent of total billed charges,65% of total billed charges,582.85,35.67,,466.28,percent of total billed charges,35.67% of total billed charges,473.86,1470.6,
LOCKING SCREW 2.0X14MM,27011344,CDM,278,RC,C1713,HCPCS,outpatient,,,785,314.00,,549.5,70,,439.6,percent of total billed charges,70% of total billed charges,785,100,,628,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,643.7,82,,514.96,percent of total billed charges,82% of total billed charges,667.25,85,,533.8,percent of total billed charges,85% of total billed charges,667.25,85,,533.8,percent of total billed charges,85% of total billed charges,667.25,85,,533.8,percent of total billed charges,85% of total billed charges,706.5,90,,565.2,percent of total billed charges,90% of total billed charges,628,80,,502.4,percent of total billed charges,80% of total billed charges,706.5,90,,565.2,percent of total billed charges,90% of total billed charges,588.75,75,,471,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,227.65,29,,182.12,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,525.95,67,,420.76,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,549.5,70,,439.6,percent of total billed charges,70% of total billed charges,510.25,65,,408.2,percent of total billed charges,65% of total billed charges,280.01,35.67,,224.008,percent of total billed charges,35.67% of total billed charges,227.65,785,
LOCKING SCREW 2.0X13MM,27011345,CDM,278,RC,C1713,HCPCS,outpatient,,,785,314.00,,549.5,70,,439.6,percent of total billed charges,70% of total billed charges,785,100,,628,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,643.7,82,,514.96,percent of total billed charges,82% of total billed charges,667.25,85,,533.8,percent of total billed charges,85% of total billed charges,667.25,85,,533.8,percent of total billed charges,85% of total billed charges,667.25,85,,533.8,percent of total billed charges,85% of total billed charges,706.5,90,,565.2,percent of total billed charges,90% of total billed charges,628,80,,502.4,percent of total billed charges,80% of total billed charges,706.5,90,,565.2,percent of total billed charges,90% of total billed charges,588.75,75,,471,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,227.65,29,,182.12,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,525.95,67,,420.76,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,549.5,70,,439.6,percent of total billed charges,70% of total billed charges,510.25,65,,408.2,percent of total billed charges,65% of total billed charges,280.01,35.67,,224.008,percent of total billed charges,35.67% of total billed charges,227.65,785,
LOCKING SCREW 2.0X12MM,27011346,CDM,278,RC,C1713,HCPCS,outpatient,,,785,314.00,,549.5,70,,439.6,percent of total billed charges,70% of total billed charges,785,100,,628,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,643.7,82,,514.96,percent of total billed charges,82% of total billed charges,667.25,85,,533.8,percent of total billed charges,85% of total billed charges,667.25,85,,533.8,percent of total billed charges,85% of total billed charges,667.25,85,,533.8,percent of total billed charges,85% of total billed charges,706.5,90,,565.2,percent of total billed charges,90% of total billed charges,628,80,,502.4,percent of total billed charges,80% of total billed charges,706.5,90,,565.2,percent of total billed charges,90% of total billed charges,588.75,75,,471,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,227.65,29,,182.12,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,525.95,67,,420.76,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,549.5,70,,439.6,percent of total billed charges,70% of total billed charges,510.25,65,,408.2,percent of total billed charges,65% of total billed charges,280.01,35.67,,224.008,percent of total billed charges,35.67% of total billed charges,227.65,785,
NON-LOCKING SCREW 2.0X16MM,27011347,CDM,278,RC,C1713,HCPCS,outpatient,,,450,180.00,,315,70,,252,percent of total billed charges,70% of total billed charges,450,100,,360,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,369,82,,295.2,percent of total billed charges,82% of total billed charges,382.5,85,,306,percent of total billed charges,85% of total billed charges,382.5,85,,306,percent of total billed charges,85% of total billed charges,382.5,85,,306,percent of total billed charges,85% of total billed charges,405,90,,324,percent of total billed charges,90% of total billed charges,360,80,,288,percent of total billed charges,80% of total billed charges,405,90,,324,percent of total billed charges,90% of total billed charges,337.5,75,,270,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,130.5,29,,104.4,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,301.5,67,,241.2,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,315,70,,252,percent of total billed charges,70% of total billed charges,292.5,65,,234,percent of total billed charges,65% of total billed charges,160.52,35.67,,128.416,percent of total billed charges,35.67% of total billed charges,130.5,450,
NON-LOCKING SCREW 2.0X14MM,27011348,CDM,278,RC,C1713,HCPCS,outpatient,,,450,180.00,,315,70,,252,percent of total billed charges,70% of total billed charges,450,100,,360,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,369,82,,295.2,percent of total billed charges,82% of total billed charges,382.5,85,,306,percent of total billed charges,85% of total billed charges,382.5,85,,306,percent of total billed charges,85% of total billed charges,382.5,85,,306,percent of total billed charges,85% of total billed charges,405,90,,324,percent of total billed charges,90% of total billed charges,360,80,,288,percent of total billed charges,80% of total billed charges,405,90,,324,percent of total billed charges,90% of total billed charges,337.5,75,,270,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,130.5,29,,104.4,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,301.5,67,,241.2,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,315,70,,252,percent of total billed charges,70% of total billed charges,292.5,65,,234,percent of total billed charges,65% of total billed charges,160.52,35.67,,128.416,percent of total billed charges,35.67% of total billed charges,130.5,450,
K-WIRE 045X4,27011349,CDM,278,RC,C1713,HCPCS,outpatient,,,182,72.80,,127.4,70,,101.92,percent of total billed charges,70% of total billed charges,182,100,,145.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,149.24,82,,119.392,percent of total billed charges,82% of total billed charges,154.7,85,,123.76,percent of total billed charges,85% of total billed charges,154.7,85,,123.76,percent of total billed charges,85% of total billed charges,154.7,85,,123.76,percent of total billed charges,85% of total billed charges,163.8,90,,131.04,percent of total billed charges,90% of total billed charges,145.6,80,,116.48,percent of total billed charges,80% of total billed charges,163.8,90,,131.04,percent of total billed charges,90% of total billed charges,136.5,75,,109.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,52.78,29,,42.224,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,121.94,67,,97.552,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,127.4,70,,101.92,percent of total billed charges,70% of total billed charges,118.3,65,,94.64,percent of total billed charges,65% of total billed charges,64.92,35.67,,51.936,percent of total billed charges,35.67% of total billed charges,52.78,182,
HEADLESS CANNULATED SCREW40X52,27011351,CDM,278,RC,C1713,HCPCS,outpatient,,,1567,626.80,,1096.9,70,,877.52,percent of total billed charges,70% of total billed charges,822.68,52.5,,658.14,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,1284.94,82,,1027.952,percent of total billed charges,82% of total billed charges,1331.95,85,,1065.56,percent of total billed charges,85% of total billed charges,1331.95,85,,1065.56,percent of total billed charges,85% of total billed charges,1331.95,85,,1065.56,percent of total billed charges,85% of total billed charges,1410.3,90,,1128.24,percent of total billed charges,90% of total billed charges,1253.6,80,,1002.88,percent of total billed charges,80% of total billed charges,1410.3,90,,1128.24,percent of total billed charges,90% of total billed charges,1175.25,75,,940.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,454.43,29,,363.544,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1049.89,67,,839.912,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1096.9,70,,877.52,percent of total billed charges,70% of total billed charges,1018.55,65,,814.84,percent of total billed charges,65% of total billed charges,558.95,35.67,,447.16,percent of total billed charges,35.67% of total billed charges,454.43,1410.3,
K-WIRE 1.6MM,27011352,CDM,278,RC,C1713,HCPCS,outpatient,,,780,312.00,,546,70,,436.8,percent of total billed charges,70% of total billed charges,780,100,,624,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,639.6,82,,511.68,percent of total billed charges,82% of total billed charges,663,85,,530.4,percent of total billed charges,85% of total billed charges,663,85,,530.4,percent of total billed charges,85% of total billed charges,663,85,,530.4,percent of total billed charges,85% of total billed charges,702,90,,561.6,percent of total billed charges,90% of total billed charges,624,80,,499.2,percent of total billed charges,80% of total billed charges,702,90,,561.6,percent of total billed charges,90% of total billed charges,585,75,,468,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,226.2,29,,180.96,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,522.6,67,,418.08,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,546,70,,436.8,percent of total billed charges,70% of total billed charges,507,65,,405.6,percent of total billed charges,65% of total billed charges,278.23,35.67,,222.584,percent of total billed charges,35.67% of total billed charges,226.2,780,
CORTEX SCREW 2.7 30MM,27011355,CDM,278,RC,C1713,HCPCS,outpatient,,,342,136.80,,239.4,70,,191.52,percent of total billed charges,70% of total billed charges,342,100,,273.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,280.44,82,,224.352,percent of total billed charges,82% of total billed charges,290.7,85,,232.56,percent of total billed charges,85% of total billed charges,290.7,85,,232.56,percent of total billed charges,85% of total billed charges,290.7,85,,232.56,percent of total billed charges,85% of total billed charges,307.8,90,,246.24,percent of total billed charges,90% of total billed charges,273.6,80,,218.88,percent of total billed charges,80% of total billed charges,307.8,90,,246.24,percent of total billed charges,90% of total billed charges,256.5,75,,205.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,99.18,29,,79.344,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,229.14,67,,183.312,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,239.4,70,,191.52,percent of total billed charges,70% of total billed charges,222.3,65,,177.84,percent of total billed charges,65% of total billed charges,121.99,35.67,,97.592,percent of total billed charges,35.67% of total billed charges,99.18,342,
K WIRE 1.25 MM,27011356,CDM,278,RC,C1713,HCPCS,outpatient,,,126,50.40,,88.2,70,,70.56,percent of total billed charges,70% of total billed charges,126,100,,100.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,103.32,82,,82.656,percent of total billed charges,82% of total billed charges,107.1,85,,85.68,percent of total billed charges,85% of total billed charges,107.1,85,,85.68,percent of total billed charges,85% of total billed charges,107.1,85,,85.68,percent of total billed charges,85% of total billed charges,113.4,90,,90.72,percent of total billed charges,90% of total billed charges,100.8,80,,80.64,percent of total billed charges,80% of total billed charges,113.4,90,,90.72,percent of total billed charges,90% of total billed charges,94.5,75,,75.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,36.54,29,,29.232,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,84.42,67,,67.536,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,88.2,70,,70.56,percent of total billed charges,70% of total billed charges,81.9,65,,65.52,percent of total billed charges,65% of total billed charges,44.94,35.67,,35.952,percent of total billed charges,35.67% of total billed charges,36.54,126,
UNIVERSAL HEAD BIPOLAR 54MM,27011368,CDM,278,RC,C1776,HCPCS,outpatient,,,5501,2200.40,,3850.7,70,,3080.56,percent of total billed charges,70% of total billed charges,2888.03,52.5,,2310.42,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,4510.82,82,,3608.656,percent of total billed charges,82% of total billed charges,4675.85,85,,3740.68,percent of total billed charges,85% of total billed charges,4675.85,85,,3740.68,percent of total billed charges,85% of total billed charges,4675.85,85,,3740.68,percent of total billed charges,85% of total billed charges,4950.9,90,,3960.72,percent of total billed charges,90% of total billed charges,4400.8,80,,3520.64,percent of total billed charges,80% of total billed charges,4950.9,90,,3960.72,percent of total billed charges,90% of total billed charges,4125.75,75,,3300.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,1595.29,29,,1276.232,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,3685.67,67,,2948.536,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,3850.7,70,,3080.56,percent of total billed charges,70% of total billed charges,3575.65,65,,2860.52,percent of total billed charges,65% of total billed charges,1962.21,35.67,,1569.768,percent of total billed charges,35.67% of total billed charges,1595.29,4950.9,
DEGREE LT GAMMA 11X320MMX125,27011433,CDM,278,RC,C1713,HCPCS,outpatient,,,7367,2946.80,,5156.9,70,,4125.52,percent of total billed charges,70% of total billed charges,3867.68,52.5,,3094.14,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,6040.94,82,,4832.752,percent of total billed charges,82% of total billed charges,6261.95,85,,5009.56,percent of total billed charges,85% of total billed charges,6261.95,85,,5009.56,percent of total billed charges,85% of total billed charges,6261.95,85,,5009.56,percent of total billed charges,85% of total billed charges,6630.3,90,,5304.24,percent of total billed charges,90% of total billed charges,5893.6,80,,4714.88,percent of total billed charges,80% of total billed charges,6630.3,90,,5304.24,percent of total billed charges,90% of total billed charges,5525.25,75,,4420.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2136.43,29,,1709.144,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4935.89,67,,3948.712,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,5156.9,70,,4125.52,percent of total billed charges,70% of total billed charges,4788.55,65,,3830.84,percent of total billed charges,65% of total billed charges,2627.81,35.67,,2102.248,percent of total billed charges,35.67% of total billed charges,2136.43,6630.3,
LAG SCREW 10.5 X 90MM,27011434,CDM,278,RC,C1713,HCPCS,outpatient,,,2067,826.80,,1446.9,70,,1157.52,percent of total billed charges,70% of total billed charges,1085.18,52.5,,868.14,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,1694.94,82,,1355.952,percent of total billed charges,82% of total billed charges,1756.95,85,,1405.56,percent of total billed charges,85% of total billed charges,1756.95,85,,1405.56,percent of total billed charges,85% of total billed charges,1756.95,85,,1405.56,percent of total billed charges,85% of total billed charges,1860.3,90,,1488.24,percent of total billed charges,90% of total billed charges,1653.6,80,,1322.88,percent of total billed charges,80% of total billed charges,1860.3,90,,1488.24,percent of total billed charges,90% of total billed charges,1550.25,75,,1240.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,599.43,29,,479.544,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1384.89,67,,1107.912,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1446.9,70,,1157.52,percent of total billed charges,70% of total billed charges,1343.55,65,,1074.84,percent of total billed charges,65% of total billed charges,737.3,35.67,,589.84,percent of total billed charges,35.67% of total billed charges,599.43,1860.3,
K WIRE 3X285,27011435,CDM,278,RC,C1713,HCPCS,outpatient,,,764,305.60,,534.8,70,,427.84,percent of total billed charges,70% of total billed charges,764,100,,611.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,626.48,82,,501.184,percent of total billed charges,82% of total billed charges,649.4,85,,519.52,percent of total billed charges,85% of total billed charges,649.4,85,,519.52,percent of total billed charges,85% of total billed charges,649.4,85,,519.52,percent of total billed charges,85% of total billed charges,687.6,90,,550.08,percent of total billed charges,90% of total billed charges,611.2,80,,488.96,percent of total billed charges,80% of total billed charges,687.6,90,,550.08,percent of total billed charges,90% of total billed charges,573,75,,458.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,221.56,29,,177.248,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,511.88,67,,409.504,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,534.8,70,,427.84,percent of total billed charges,70% of total billed charges,496.6,65,,397.28,percent of total billed charges,65% of total billed charges,272.52,35.67,,218.016,percent of total billed charges,35.67% of total billed charges,221.56,764,
BALL TIPPED WIRE 3X1000 MM,27011436,CDM,278,RC,C1713,HCPCS,outpatient,,,972,388.80,,680.4,70,,544.32,percent of total billed charges,70% of total billed charges,972,100,,777.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,797.04,82,,637.632,percent of total billed charges,82% of total billed charges,826.2,85,,660.96,percent of total billed charges,85% of total billed charges,826.2,85,,660.96,percent of total billed charges,85% of total billed charges,826.2,85,,660.96,percent of total billed charges,85% of total billed charges,874.8,90,,699.84,percent of total billed charges,90% of total billed charges,777.6,80,,622.08,percent of total billed charges,80% of total billed charges,874.8,90,,699.84,percent of total billed charges,90% of total billed charges,729,75,,583.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,281.88,29,,225.504,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,651.24,67,,520.992,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,680.4,70,,544.32,percent of total billed charges,70% of total billed charges,631.8,65,,505.44,percent of total billed charges,65% of total billed charges,346.71,35.67,,277.368,percent of total billed charges,35.67% of total billed charges,281.88,972,
DEGREE RT TROCH MAIL 11X380MMX,27011438,CDM,278,RC,C1713,HCPCS,outpatient,,,8760,3504.00,,6132,70,,4905.6,percent of total billed charges,70% of total billed charges,4599,52.5,,3679.2,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,7183.2,82,,5746.56,percent of total billed charges,82% of total billed charges,7446,85,,5956.8,percent of total billed charges,85% of total billed charges,7446,85,,5956.8,percent of total billed charges,85% of total billed charges,7446,85,,5956.8,percent of total billed charges,85% of total billed charges,7884,90,,6307.2,percent of total billed charges,90% of total billed charges,7008,80,,5606.4,percent of total billed charges,80% of total billed charges,7884,90,,6307.2,percent of total billed charges,90% of total billed charges,6570,75,,5256,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2540.4,29,,2032.32,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,5869.2,67,,4695.36,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,6132,70,,4905.6,percent of total billed charges,70% of total billed charges,5694,65,,4555.2,percent of total billed charges,65% of total billed charges,3124.69,35.67,,2499.752,percent of total billed charges,35.67% of total billed charges,2540.4,7884,
"LAG SCREW, TI 10.5X95MM",27011439,CDM,278,RC,C1713,HCPCS,outpatient,,,2067,826.80,,1446.9,70,,1157.52,percent of total billed charges,70% of total billed charges,1085.18,52.5,,868.14,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,1694.94,82,,1355.952,percent of total billed charges,82% of total billed charges,1756.95,85,,1405.56,percent of total billed charges,85% of total billed charges,1756.95,85,,1405.56,percent of total billed charges,85% of total billed charges,1756.95,85,,1405.56,percent of total billed charges,85% of total billed charges,1860.3,90,,1488.24,percent of total billed charges,90% of total billed charges,1653.6,80,,1322.88,percent of total billed charges,80% of total billed charges,1860.3,90,,1488.24,percent of total billed charges,90% of total billed charges,1550.25,75,,1240.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,599.43,29,,479.544,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1384.89,67,,1107.912,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1446.9,70,,1157.52,percent of total billed charges,70% of total billed charges,1343.55,65,,1074.84,percent of total billed charges,65% of total billed charges,737.3,35.67,,589.84,percent of total billed charges,35.67% of total billed charges,599.43,1860.3,
LOCKING SCREW 5X45MM,27011440,CDM,278,RC,C1713,HCPCS,outpatient,,,879,351.60,,615.3,70,,492.24,percent of total billed charges,70% of total billed charges,879,100,,703.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,720.78,82,,576.624,percent of total billed charges,82% of total billed charges,747.15,85,,597.72,percent of total billed charges,85% of total billed charges,747.15,85,,597.72,percent of total billed charges,85% of total billed charges,747.15,85,,597.72,percent of total billed charges,85% of total billed charges,791.1,90,,632.88,percent of total billed charges,90% of total billed charges,703.2,80,,562.56,percent of total billed charges,80% of total billed charges,791.1,90,,632.88,percent of total billed charges,90% of total billed charges,659.25,75,,527.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,254.91,29,,203.928,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,588.93,67,,471.144,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,615.3,70,,492.24,percent of total billed charges,70% of total billed charges,571.35,65,,457.08,percent of total billed charges,65% of total billed charges,313.54,35.67,,250.832,percent of total billed charges,35.67% of total billed charges,254.91,879,
GRYPHEN BRDS,27011450,CDM,278,RC,C1713,HCPCS,outpatient,,,1890,756.00,,1323,70,,1058.4,percent of total billed charges,70% of total billed charges,992.25,52.5,,793.8,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,1549.8,82,,1239.84,percent of total billed charges,82% of total billed charges,1606.5,85,,1285.2,percent of total billed charges,85% of total billed charges,1606.5,85,,1285.2,percent of total billed charges,85% of total billed charges,1606.5,85,,1285.2,percent of total billed charges,85% of total billed charges,1701,90,,1360.8,percent of total billed charges,90% of total billed charges,1512,80,,1209.6,percent of total billed charges,80% of total billed charges,1701,90,,1360.8,percent of total billed charges,90% of total billed charges,1417.5,75,,1134,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,548.1,29,,438.48,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1266.3,67,,1013.04,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1323,70,,1058.4,percent of total billed charges,70% of total billed charges,1228.5,65,,982.8,percent of total billed charges,65% of total billed charges,674.16,35.67,,539.328,percent of total billed charges,35.67% of total billed charges,548.1,1701,
SHOULDER SET,27011451,CDM,278,RC,C1713,HCPCS,outpatient,,,1120,448.00,,784,70,,627.2,percent of total billed charges,70% of total billed charges,588,52.5,,470.4,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,918.4,82,,734.72,percent of total billed charges,82% of total billed charges,952,85,,761.6,percent of total billed charges,85% of total billed charges,952,85,,761.6,percent of total billed charges,85% of total billed charges,952,85,,761.6,percent of total billed charges,85% of total billed charges,1008,90,,806.4,percent of total billed charges,90% of total billed charges,896,80,,716.8,percent of total billed charges,80% of total billed charges,1008,90,,806.4,percent of total billed charges,90% of total billed charges,840,75,,672,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,324.8,29,,259.84,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,750.4,67,,600.32,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,784,70,,627.2,percent of total billed charges,70% of total billed charges,728,65,,582.4,percent of total billed charges,65% of total billed charges,399.5,35.67,,319.6,percent of total billed charges,35.67% of total billed charges,324.8,1008,
CATHETER SUPRAPUBIC 16FR 22 CM,27011470,CDM,278,RC,C2627,HCPCS,outpatient,,,417,166.80,,291.9,70,,233.52,percent of total billed charges,70% of total billed charges,417,100,,333.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,341.94,82,,273.552,percent of total billed charges,82% of total billed charges,354.45,85,,283.56,percent of total billed charges,85% of total billed charges,354.45,85,,283.56,percent of total billed charges,85% of total billed charges,354.45,85,,283.56,percent of total billed charges,85% of total billed charges,375.3,90,,300.24,percent of total billed charges,90% of total billed charges,333.6,80,,266.88,percent of total billed charges,80% of total billed charges,375.3,90,,300.24,percent of total billed charges,90% of total billed charges,312.75,75,,250.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,120.93,29,,96.744,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,279.39,67,,223.512,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,291.9,70,,233.52,percent of total billed charges,70% of total billed charges,271.05,65,,216.84,percent of total billed charges,65% of total billed charges,148.74,35.67,,118.992,percent of total billed charges,35.67% of total billed charges,120.93,417,
SUTURE ANCHOR BIO-COMP2.9X12.5,27011535,CDM,278,RC,C1713,HCPCS,outpatient,,,1957,782.80,,1369.9,70,,1095.92,percent of total billed charges,70% of total billed charges,1027.43,52.5,,821.94,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,1604.74,82,,1283.792,percent of total billed charges,82% of total billed charges,1663.45,85,,1330.76,percent of total billed charges,85% of total billed charges,1663.45,85,,1330.76,percent of total billed charges,85% of total billed charges,1663.45,85,,1330.76,percent of total billed charges,85% of total billed charges,1761.3,90,,1409.04,percent of total billed charges,90% of total billed charges,1565.6,80,,1252.48,percent of total billed charges,80% of total billed charges,1761.3,90,,1409.04,percent of total billed charges,90% of total billed charges,1467.75,75,,1174.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,567.53,29,,454.024,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1311.19,67,,1048.952,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1369.9,70,,1095.92,percent of total billed charges,70% of total billed charges,1272.05,65,,1017.64,percent of total billed charges,65% of total billed charges,698.06,35.67,,558.448,percent of total billed charges,35.67% of total billed charges,567.53,1761.3,
"SUTURE LASSO, 90 DEGREE STRAIG",27011536,CDM,278,RC,C1713,HCPCS,outpatient,,,897,358.80,,627.9,70,,502.32,percent of total billed charges,70% of total billed charges,897,100,,717.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,735.54,82,,588.432,percent of total billed charges,82% of total billed charges,762.45,85,,609.96,percent of total billed charges,85% of total billed charges,762.45,85,,609.96,percent of total billed charges,85% of total billed charges,762.45,85,,609.96,percent of total billed charges,85% of total billed charges,807.3,90,,645.84,percent of total billed charges,90% of total billed charges,717.6,80,,574.08,percent of total billed charges,80% of total billed charges,807.3,90,,645.84,percent of total billed charges,90% of total billed charges,672.75,75,,538.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,260.13,29,,208.104,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,600.99,67,,480.792,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,627.9,70,,502.32,percent of total billed charges,70% of total billed charges,583.05,65,,466.44,percent of total billed charges,65% of total billed charges,319.96,35.67,,255.968,percent of total billed charges,35.67% of total billed charges,260.13,897,
THREADED SCREW # 60 6.5MM,27011575,CDM,278,RC,C1713,HCPCS,outpatient,,,1622,648.80,,1135.4,70,,908.32,percent of total billed charges,70% of total billed charges,851.55,52.5,,681.24,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,1330.04,82,,1064.032,percent of total billed charges,82% of total billed charges,1378.7,85,,1102.96,percent of total billed charges,85% of total billed charges,1378.7,85,,1102.96,percent of total billed charges,85% of total billed charges,1378.7,85,,1102.96,percent of total billed charges,85% of total billed charges,1459.8,90,,1167.84,percent of total billed charges,90% of total billed charges,1297.6,80,,1038.08,percent of total billed charges,80% of total billed charges,1459.8,90,,1167.84,percent of total billed charges,90% of total billed charges,1216.5,75,,973.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,470.38,29,,376.304,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1086.74,67,,869.392,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1135.4,70,,908.32,percent of total billed charges,70% of total billed charges,1054.3,65,,843.44,percent of total billed charges,65% of total billed charges,578.57,35.67,,462.856,percent of total billed charges,35.67% of total billed charges,470.38,1459.8,
CORTEX 2.0 SCREW,27011607,CDM,278,RC,C1713,HCPCS,outpatient,,,262,104.80,,183.4,70,,146.72,percent of total billed charges,70% of total billed charges,262,100,,209.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,214.84,82,,171.872,percent of total billed charges,82% of total billed charges,222.7,85,,178.16,percent of total billed charges,85% of total billed charges,222.7,85,,178.16,percent of total billed charges,85% of total billed charges,222.7,85,,178.16,percent of total billed charges,85% of total billed charges,235.8,90,,188.64,percent of total billed charges,90% of total billed charges,209.6,80,,167.68,percent of total billed charges,80% of total billed charges,235.8,90,,188.64,percent of total billed charges,90% of total billed charges,196.5,75,,157.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,75.98,29,,60.784,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,175.54,67,,140.432,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,183.4,70,,146.72,percent of total billed charges,70% of total billed charges,170.3,65,,136.24,percent of total billed charges,65% of total billed charges,93.46,35.67,,74.768,percent of total billed charges,35.67% of total billed charges,75.98,262,
LOCKING SCREW,27011609,CDM,278,RC,C1713,HCPCS,outpatient,,,1109,443.60,,776.3,70,,621.04,percent of total billed charges,70% of total billed charges,582.23,52.5,,465.78,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,909.38,82,,727.504,percent of total billed charges,82% of total billed charges,942.65,85,,754.12,percent of total billed charges,85% of total billed charges,942.65,85,,754.12,percent of total billed charges,85% of total billed charges,942.65,85,,754.12,percent of total billed charges,85% of total billed charges,998.1,90,,798.48,percent of total billed charges,90% of total billed charges,887.2,80,,709.76,percent of total billed charges,80% of total billed charges,998.1,90,,798.48,percent of total billed charges,90% of total billed charges,831.75,75,,665.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,321.61,29,,257.288,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,743.03,67,,594.424,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,776.3,70,,621.04,percent of total billed charges,70% of total billed charges,720.85,65,,576.68,percent of total billed charges,65% of total billed charges,395.58,35.67,,316.464,percent of total billed charges,35.67% of total billed charges,321.61,998.1,
HOLE PLATE 4,27011610,CDM,278,RC,C1713,HCPCS,outpatient,,,1229,491.60,,860.3,70,,688.24,percent of total billed charges,70% of total billed charges,645.23,52.5,,516.18,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,1007.78,82,,806.224,percent of total billed charges,82% of total billed charges,1044.65,85,,835.72,percent of total billed charges,85% of total billed charges,1044.65,85,,835.72,percent of total billed charges,85% of total billed charges,1044.65,85,,835.72,percent of total billed charges,85% of total billed charges,1106.1,90,,884.88,percent of total billed charges,90% of total billed charges,983.2,80,,786.56,percent of total billed charges,80% of total billed charges,1106.1,90,,884.88,percent of total billed charges,90% of total billed charges,921.75,75,,737.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,356.41,29,,285.128,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,823.43,67,,658.744,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,860.3,70,,688.24,percent of total billed charges,70% of total billed charges,798.85,65,,639.08,percent of total billed charges,65% of total billed charges,438.38,35.67,,350.704,percent of total billed charges,35.67% of total billed charges,356.41,1106.1,
CORTEX SCREW 2.4 SIZE 18,27011616,CDM,278,RC,C1713,HCPCS,outpatient,,,423,169.20,,296.1,70,,236.88,percent of total billed charges,70% of total billed charges,423,100,,338.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,346.86,82,,277.488,percent of total billed charges,82% of total billed charges,359.55,85,,287.64,percent of total billed charges,85% of total billed charges,359.55,85,,287.64,percent of total billed charges,85% of total billed charges,359.55,85,,287.64,percent of total billed charges,85% of total billed charges,380.7,90,,304.56,percent of total billed charges,90% of total billed charges,338.4,80,,270.72,percent of total billed charges,80% of total billed charges,380.7,90,,304.56,percent of total billed charges,90% of total billed charges,317.25,75,,253.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,122.67,29,,98.136,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,283.41,67,,226.728,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,296.1,70,,236.88,percent of total billed charges,70% of total billed charges,274.95,65,,219.96,percent of total billed charges,65% of total billed charges,150.88,35.67,,120.704,percent of total billed charges,35.67% of total billed charges,122.67,423,
LOCKING SCREW VA 2.7 12G,2701164,CDM,278,RC,C1713,HCPCS,outpatient,,,812,324.80,,568.4,70,,454.72,percent of total billed charges,70% of total billed charges,812,100,,649.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,665.84,82,,532.672,percent of total billed charges,82% of total billed charges,690.2,85,,552.16,percent of total billed charges,85% of total billed charges,690.2,85,,552.16,percent of total billed charges,85% of total billed charges,690.2,85,,552.16,percent of total billed charges,85% of total billed charges,730.8,90,,584.64,percent of total billed charges,90% of total billed charges,649.6,80,,519.68,percent of total billed charges,80% of total billed charges,730.8,90,,584.64,percent of total billed charges,90% of total billed charges,609,75,,487.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,235.48,29,,188.384,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,544.04,67,,435.232,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,568.4,70,,454.72,percent of total billed charges,70% of total billed charges,527.8,65,,422.24,percent of total billed charges,65% of total billed charges,289.64,35.67,,231.712,percent of total billed charges,35.67% of total billed charges,235.48,812,
CORTICAL SCREW 2.3 X 30MM,27011649,CDM,278,RC,C1713,HCPCS,outpatient,,,587,234.80,,410.9,70,,328.72,percent of total billed charges,70% of total billed charges,587,100,,469.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,481.34,82,,385.072,percent of total billed charges,82% of total billed charges,498.95,85,,399.16,percent of total billed charges,85% of total billed charges,498.95,85,,399.16,percent of total billed charges,85% of total billed charges,498.95,85,,399.16,percent of total billed charges,85% of total billed charges,528.3,90,,422.64,percent of total billed charges,90% of total billed charges,469.6,80,,375.68,percent of total billed charges,80% of total billed charges,528.3,90,,422.64,percent of total billed charges,90% of total billed charges,440.25,75,,352.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,170.23,29,,136.184,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,393.29,67,,314.632,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,410.9,70,,328.72,percent of total billed charges,70% of total billed charges,381.55,65,,305.24,percent of total billed charges,65% of total billed charges,209.38,35.67,,167.504,percent of total billed charges,35.67% of total billed charges,170.23,587,
"SCREW,CANCELLOUS,LOW PROFILE",27011650,CDM,278,RC,C1713,HCPCS,outpatient,,,719,287.60,,503.3,70,,402.64,percent of total billed charges,70% of total billed charges,719,100,,575.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,589.58,82,,471.664,percent of total billed charges,82% of total billed charges,611.15,85,,488.92,percent of total billed charges,85% of total billed charges,611.15,85,,488.92,percent of total billed charges,85% of total billed charges,611.15,85,,488.92,percent of total billed charges,85% of total billed charges,647.1,90,,517.68,percent of total billed charges,90% of total billed charges,575.2,80,,460.16,percent of total billed charges,80% of total billed charges,647.1,90,,517.68,percent of total billed charges,90% of total billed charges,539.25,75,,431.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,208.51,29,,166.808,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,481.73,67,,385.384,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,503.3,70,,402.64,percent of total billed charges,70% of total billed charges,467.35,65,,373.88,percent of total billed charges,65% of total billed charges,256.47,35.67,,205.176,percent of total billed charges,35.67% of total billed charges,208.51,719,
LOCKING SCREW 2.7 X 24MM,27011652,CDM,278,RC,C1713,HCPCS,outpatient,,,719,287.60,,503.3,70,,402.64,percent of total billed charges,70% of total billed charges,719,100,,575.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,589.58,82,,471.664,percent of total billed charges,82% of total billed charges,611.15,85,,488.92,percent of total billed charges,85% of total billed charges,611.15,85,,488.92,percent of total billed charges,85% of total billed charges,611.15,85,,488.92,percent of total billed charges,85% of total billed charges,647.1,90,,517.68,percent of total billed charges,90% of total billed charges,575.2,80,,460.16,percent of total billed charges,80% of total billed charges,647.1,90,,517.68,percent of total billed charges,90% of total billed charges,539.25,75,,431.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,208.51,29,,166.808,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,481.73,67,,385.384,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,503.3,70,,402.64,percent of total billed charges,70% of total billed charges,467.35,65,,373.88,percent of total billed charges,65% of total billed charges,256.47,35.67,,205.176,percent of total billed charges,35.67% of total billed charges,208.51,719,
TIBIALIS TENDON POSTERIOR,27011653,CDM,278,RC,C1713,HCPCS,outpatient,,,3782,1512.80,,2647.4,70,,2117.92,percent of total billed charges,70% of total billed charges,1985.55,52.5,,1588.44,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,3101.24,82,,2480.992,percent of total billed charges,82% of total billed charges,3214.7,85,,2571.76,percent of total billed charges,85% of total billed charges,3214.7,85,,2571.76,percent of total billed charges,85% of total billed charges,3214.7,85,,2571.76,percent of total billed charges,85% of total billed charges,3403.8,90,,2723.04,percent of total billed charges,90% of total billed charges,3025.6,80,,2420.48,percent of total billed charges,80% of total billed charges,3403.8,90,,2723.04,percent of total billed charges,90% of total billed charges,2836.5,75,,2269.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,1096.78,29,,877.424,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,2533.94,67,,2027.152,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,2647.4,70,,2117.92,percent of total billed charges,70% of total billed charges,2458.3,65,,1966.64,percent of total billed charges,65% of total billed charges,1349.04,35.67,,1079.232,percent of total billed charges,35.67% of total billed charges,1096.78,3403.8,
PLATE FIBULA 2.7/3.5,27011658,CDM,278,RC,C1713,HCPCS,outpatient,,,3770,1508.00,,2639,70,,2111.2,percent of total billed charges,70% of total billed charges,1979.25,52.5,,1583.4,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,3091.4,82,,2473.12,percent of total billed charges,82% of total billed charges,3204.5,85,,2563.6,percent of total billed charges,85% of total billed charges,3204.5,85,,2563.6,percent of total billed charges,85% of total billed charges,3204.5,85,,2563.6,percent of total billed charges,85% of total billed charges,3393,90,,2714.4,percent of total billed charges,90% of total billed charges,3016,80,,2412.8,percent of total billed charges,80% of total billed charges,3393,90,,2714.4,percent of total billed charges,90% of total billed charges,2827.5,75,,2262,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,1093.3,29,,874.64,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,2525.9,67,,2020.72,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,2639,70,,2111.2,percent of total billed charges,70% of total billed charges,2450.5,65,,1960.4,percent of total billed charges,65% of total billed charges,1344.76,35.67,,1075.808,percent of total billed charges,35.67% of total billed charges,1093.3,3393,
PLATE TIBIA MEDIAL DISTAL VA,27011659,CDM,278,RC,C1713,HCPCS,outpatient,,,6601,2640.40,,4620.7,70,,3696.56,percent of total billed charges,70% of total billed charges,3465.53,52.5,,2772.42,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,5412.82,82,,4330.256,percent of total billed charges,82% of total billed charges,5610.85,85,,4488.68,percent of total billed charges,85% of total billed charges,5610.85,85,,4488.68,percent of total billed charges,85% of total billed charges,5610.85,85,,4488.68,percent of total billed charges,85% of total billed charges,5940.9,90,,4752.72,percent of total billed charges,90% of total billed charges,5280.8,80,,4224.64,percent of total billed charges,80% of total billed charges,5940.9,90,,4752.72,percent of total billed charges,90% of total billed charges,4950.75,75,,3960.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,1914.29,29,,1531.432,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4422.67,67,,3538.136,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,4620.7,70,,3696.56,percent of total billed charges,70% of total billed charges,4290.65,65,,3432.52,percent of total billed charges,65% of total billed charges,2354.58,35.67,,1883.664,percent of total billed charges,35.67% of total billed charges,1914.29,5940.9,
LOCKING SCREW VA 3.5 14G,27011660,CDM,278,RC,C1713,HCPCS,outpatient,,,902,360.80,,631.4,70,,505.12,percent of total billed charges,70% of total billed charges,902,100,,721.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,739.64,82,,591.712,percent of total billed charges,82% of total billed charges,766.7,85,,613.36,percent of total billed charges,85% of total billed charges,766.7,85,,613.36,percent of total billed charges,85% of total billed charges,766.7,85,,613.36,percent of total billed charges,85% of total billed charges,811.8,90,,649.44,percent of total billed charges,90% of total billed charges,721.6,80,,577.28,percent of total billed charges,80% of total billed charges,811.8,90,,649.44,percent of total billed charges,90% of total billed charges,676.5,75,,541.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,261.58,29,,209.264,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,604.34,67,,483.472,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,631.4,70,,505.12,percent of total billed charges,70% of total billed charges,586.3,65,,469.04,percent of total billed charges,65% of total billed charges,321.74,35.67,,257.392,percent of total billed charges,35.67% of total billed charges,261.58,902,
LOCKING SCREW VA 3.5 266,27011661,CDM,278,RC,C1713,HCPCS,outpatient,,,902,360.80,,631.4,70,,505.12,percent of total billed charges,70% of total billed charges,902,100,,721.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,739.64,82,,591.712,percent of total billed charges,82% of total billed charges,766.7,85,,613.36,percent of total billed charges,85% of total billed charges,766.7,85,,613.36,percent of total billed charges,85% of total billed charges,766.7,85,,613.36,percent of total billed charges,85% of total billed charges,811.8,90,,649.44,percent of total billed charges,90% of total billed charges,721.6,80,,577.28,percent of total billed charges,80% of total billed charges,811.8,90,,649.44,percent of total billed charges,90% of total billed charges,676.5,75,,541.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,261.58,29,,209.264,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,604.34,67,,483.472,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,631.4,70,,505.12,percent of total billed charges,70% of total billed charges,586.3,65,,469.04,percent of total billed charges,65% of total billed charges,321.74,35.67,,257.392,percent of total billed charges,35.67% of total billed charges,261.58,902,
LOCKING SCREW VA 3.5 30G,27011662,CDM,278,RC,C1713,HCPCS,outpatient,,,902,360.80,,631.4,70,,505.12,percent of total billed charges,70% of total billed charges,902,100,,721.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,739.64,82,,591.712,percent of total billed charges,82% of total billed charges,766.7,85,,613.36,percent of total billed charges,85% of total billed charges,766.7,85,,613.36,percent of total billed charges,85% of total billed charges,766.7,85,,613.36,percent of total billed charges,85% of total billed charges,811.8,90,,649.44,percent of total billed charges,90% of total billed charges,721.6,80,,577.28,percent of total billed charges,80% of total billed charges,811.8,90,,649.44,percent of total billed charges,90% of total billed charges,676.5,75,,541.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,261.58,29,,209.264,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,604.34,67,,483.472,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,631.4,70,,505.12,percent of total billed charges,70% of total billed charges,586.3,65,,469.04,percent of total billed charges,65% of total billed charges,321.74,35.67,,257.392,percent of total billed charges,35.67% of total billed charges,261.58,902,
LOCKING SCREW VA 2.7 10G,27011663,CDM,278,RC,C1713,HCPCS,outpatient,,,763,305.20,,534.1,70,,427.28,percent of total billed charges,70% of total billed charges,763,100,,610.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,625.66,82,,500.528,percent of total billed charges,82% of total billed charges,648.55,85,,518.84,percent of total billed charges,85% of total billed charges,648.55,85,,518.84,percent of total billed charges,85% of total billed charges,648.55,85,,518.84,percent of total billed charges,85% of total billed charges,686.7,90,,549.36,percent of total billed charges,90% of total billed charges,610.4,80,,488.32,percent of total billed charges,80% of total billed charges,686.7,90,,549.36,percent of total billed charges,90% of total billed charges,572.25,75,,457.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,221.27,29,,177.016,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,511.21,67,,408.968,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,534.1,70,,427.28,percent of total billed charges,70% of total billed charges,495.95,65,,396.76,percent of total billed charges,65% of total billed charges,272.16,35.67,,217.728,percent of total billed charges,35.67% of total billed charges,221.27,763,
LOCKING SCREW VA 2.7 12G,27011664,CDM,278,RC,C1713,HCPCS,outpatient,,,853,341.20,,597.1,70,,477.68,percent of total billed charges,70% of total billed charges,853,100,,682.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,699.46,82,,559.568,percent of total billed charges,82% of total billed charges,725.05,85,,580.04,percent of total billed charges,85% of total billed charges,725.05,85,,580.04,percent of total billed charges,85% of total billed charges,725.05,85,,580.04,percent of total billed charges,85% of total billed charges,767.7,90,,614.16,percent of total billed charges,90% of total billed charges,682.4,80,,545.92,percent of total billed charges,80% of total billed charges,767.7,90,,614.16,percent of total billed charges,90% of total billed charges,639.75,75,,511.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,247.37,29,,197.896,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,571.51,67,,457.208,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,597.1,70,,477.68,percent of total billed charges,70% of total billed charges,554.45,65,,443.56,percent of total billed charges,65% of total billed charges,304.27,35.67,,243.416,percent of total billed charges,35.67% of total billed charges,247.37,853,
LOCKING SCREW VA 2.7 16G,27011665,CDM,278,RC,C1713,HCPCS,outpatient,,,853,341.20,,597.1,70,,477.68,percent of total billed charges,70% of total billed charges,853,100,,682.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,699.46,82,,559.568,percent of total billed charges,82% of total billed charges,725.05,85,,580.04,percent of total billed charges,85% of total billed charges,725.05,85,,580.04,percent of total billed charges,85% of total billed charges,725.05,85,,580.04,percent of total billed charges,85% of total billed charges,767.7,90,,614.16,percent of total billed charges,90% of total billed charges,682.4,80,,545.92,percent of total billed charges,80% of total billed charges,767.7,90,,614.16,percent of total billed charges,90% of total billed charges,639.75,75,,511.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,247.37,29,,197.896,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,571.51,67,,457.208,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,597.1,70,,477.68,percent of total billed charges,70% of total billed charges,554.45,65,,443.56,percent of total billed charges,65% of total billed charges,304.27,35.67,,243.416,percent of total billed charges,35.67% of total billed charges,247.37,853,
LOCKING SCREW VA 2.7 30G,27011666,CDM,278,RC,C1713,HCPCS,outpatient,,,853,341.20,,597.1,70,,477.68,percent of total billed charges,70% of total billed charges,853,100,,682.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,699.46,82,,559.568,percent of total billed charges,82% of total billed charges,725.05,85,,580.04,percent of total billed charges,85% of total billed charges,725.05,85,,580.04,percent of total billed charges,85% of total billed charges,725.05,85,,580.04,percent of total billed charges,85% of total billed charges,767.7,90,,614.16,percent of total billed charges,90% of total billed charges,682.4,80,,545.92,percent of total billed charges,80% of total billed charges,767.7,90,,614.16,percent of total billed charges,90% of total billed charges,639.75,75,,511.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,247.37,29,,197.896,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,571.51,67,,457.208,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,597.1,70,,477.68,percent of total billed charges,70% of total billed charges,554.45,65,,443.56,percent of total billed charges,65% of total billed charges,304.27,35.67,,243.416,percent of total billed charges,35.67% of total billed charges,247.37,853,
LOCKING SCREW VA 2.7 36G,27011667,CDM,278,RC,C1713,HCPCS,outpatient,,,853,341.20,,597.1,70,,477.68,percent of total billed charges,70% of total billed charges,853,100,,682.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,699.46,82,,559.568,percent of total billed charges,82% of total billed charges,725.05,85,,580.04,percent of total billed charges,85% of total billed charges,725.05,85,,580.04,percent of total billed charges,85% of total billed charges,725.05,85,,580.04,percent of total billed charges,85% of total billed charges,767.7,90,,614.16,percent of total billed charges,90% of total billed charges,682.4,80,,545.92,percent of total billed charges,80% of total billed charges,767.7,90,,614.16,percent of total billed charges,90% of total billed charges,639.75,75,,511.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,247.37,29,,197.896,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,571.51,67,,457.208,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,597.1,70,,477.68,percent of total billed charges,70% of total billed charges,554.45,65,,443.56,percent of total billed charges,65% of total billed charges,304.27,35.67,,243.416,percent of total billed charges,35.67% of total billed charges,247.37,853,
LOCKING SCREW VA 2.7 40G,27011668,CDM,278,RC,C1713,HCPCS,outpatient,,,853,341.20,,597.1,70,,477.68,percent of total billed charges,70% of total billed charges,853,100,,682.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,699.46,82,,559.568,percent of total billed charges,82% of total billed charges,725.05,85,,580.04,percent of total billed charges,85% of total billed charges,725.05,85,,580.04,percent of total billed charges,85% of total billed charges,725.05,85,,580.04,percent of total billed charges,85% of total billed charges,767.7,90,,614.16,percent of total billed charges,90% of total billed charges,682.4,80,,545.92,percent of total billed charges,80% of total billed charges,767.7,90,,614.16,percent of total billed charges,90% of total billed charges,639.75,75,,511.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,247.37,29,,197.896,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,571.51,67,,457.208,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,597.1,70,,477.68,percent of total billed charges,70% of total billed charges,554.45,65,,443.56,percent of total billed charges,65% of total billed charges,304.27,35.67,,243.416,percent of total billed charges,35.67% of total billed charges,247.37,853,
LOCKING SCREW 2.7 46G,27011669,CDM,278,RC,C1713,HCPCS,outpatient,,,853,341.20,,597.1,70,,477.68,percent of total billed charges,70% of total billed charges,853,100,,682.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,699.46,82,,559.568,percent of total billed charges,82% of total billed charges,725.05,85,,580.04,percent of total billed charges,85% of total billed charges,725.05,85,,580.04,percent of total billed charges,85% of total billed charges,725.05,85,,580.04,percent of total billed charges,85% of total billed charges,767.7,90,,614.16,percent of total billed charges,90% of total billed charges,682.4,80,,545.92,percent of total billed charges,80% of total billed charges,767.7,90,,614.16,percent of total billed charges,90% of total billed charges,639.75,75,,511.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,247.37,29,,197.896,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,571.51,67,,457.208,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,597.1,70,,477.68,percent of total billed charges,70% of total billed charges,554.45,65,,443.56,percent of total billed charges,65% of total billed charges,304.27,35.67,,243.416,percent of total billed charges,35.67% of total billed charges,247.37,853,
LOCKING SCREW VA 2.7 52G,27011670,CDM,278,RC,C1713,HCPCS,outpatient,,,853,341.20,,597.1,70,,477.68,percent of total billed charges,70% of total billed charges,853,100,,682.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,699.46,82,,559.568,percent of total billed charges,82% of total billed charges,725.05,85,,580.04,percent of total billed charges,85% of total billed charges,725.05,85,,580.04,percent of total billed charges,85% of total billed charges,725.05,85,,580.04,percent of total billed charges,85% of total billed charges,767.7,90,,614.16,percent of total billed charges,90% of total billed charges,682.4,80,,545.92,percent of total billed charges,80% of total billed charges,767.7,90,,614.16,percent of total billed charges,90% of total billed charges,639.75,75,,511.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,247.37,29,,197.896,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,571.51,67,,457.208,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,597.1,70,,477.68,percent of total billed charges,70% of total billed charges,554.45,65,,443.56,percent of total billed charges,65% of total billed charges,304.27,35.67,,243.416,percent of total billed charges,35.67% of total billed charges,247.37,853,
SCREW CORTEX S/O L/P 3.5 18G,27011671,CDM,278,RC,C1713,HCPCS,outpatient,,,325,130.00,,227.5,70,,182,percent of total billed charges,70% of total billed charges,325,100,,260,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,266.5,82,,213.2,percent of total billed charges,82% of total billed charges,276.25,85,,221,percent of total billed charges,85% of total billed charges,276.25,85,,221,percent of total billed charges,85% of total billed charges,276.25,85,,221,percent of total billed charges,85% of total billed charges,292.5,90,,234,percent of total billed charges,90% of total billed charges,260,80,,208,percent of total billed charges,80% of total billed charges,292.5,90,,234,percent of total billed charges,90% of total billed charges,243.75,75,,195,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,94.25,29,,75.4,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,217.75,67,,174.2,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,227.5,70,,182,percent of total billed charges,70% of total billed charges,211.25,65,,169,percent of total billed charges,65% of total billed charges,115.93,35.67,,92.744,percent of total billed charges,35.67% of total billed charges,94.25,325,
SCREW CORTEX S/O L/P 3.5 32G,27011672,CDM,278,RC,C1713,HCPCS,outpatient,,,325,130.00,,227.5,70,,182,percent of total billed charges,70% of total billed charges,325,100,,260,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,266.5,82,,213.2,percent of total billed charges,82% of total billed charges,276.25,85,,221,percent of total billed charges,85% of total billed charges,276.25,85,,221,percent of total billed charges,85% of total billed charges,276.25,85,,221,percent of total billed charges,85% of total billed charges,292.5,90,,234,percent of total billed charges,90% of total billed charges,260,80,,208,percent of total billed charges,80% of total billed charges,292.5,90,,234,percent of total billed charges,90% of total billed charges,243.75,75,,195,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,94.25,29,,75.4,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,217.75,67,,174.2,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,227.5,70,,182,percent of total billed charges,70% of total billed charges,211.25,65,,169,percent of total billed charges,65% of total billed charges,115.93,35.67,,92.744,percent of total billed charges,35.67% of total billed charges,94.25,325,
SCREW CORTEX S/O L/P 3.5 42G,27011673,CDM,278,RC,C1713,HCPCS,outpatient,,,325,130.00,,227.5,70,,182,percent of total billed charges,70% of total billed charges,325,100,,260,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,266.5,82,,213.2,percent of total billed charges,82% of total billed charges,276.25,85,,221,percent of total billed charges,85% of total billed charges,276.25,85,,221,percent of total billed charges,85% of total billed charges,276.25,85,,221,percent of total billed charges,85% of total billed charges,292.5,90,,234,percent of total billed charges,90% of total billed charges,260,80,,208,percent of total billed charges,80% of total billed charges,292.5,90,,234,percent of total billed charges,90% of total billed charges,243.75,75,,195,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,94.25,29,,75.4,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,217.75,67,,174.2,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,227.5,70,,182,percent of total billed charges,70% of total billed charges,211.25,65,,169,percent of total billed charges,65% of total billed charges,115.93,35.67,,92.744,percent of total billed charges,35.67% of total billed charges,94.25,325,
SCREW METAPHYSEAL S/T 2.7 46G,27011674,CDM,278,RC,C1713,HCPCS,outpatient,,,345,138.00,,241.5,70,,193.2,percent of total billed charges,70% of total billed charges,345,100,,276,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,282.9,82,,226.32,percent of total billed charges,82% of total billed charges,293.25,85,,234.6,percent of total billed charges,85% of total billed charges,293.25,85,,234.6,percent of total billed charges,85% of total billed charges,293.25,85,,234.6,percent of total billed charges,85% of total billed charges,310.5,90,,248.4,percent of total billed charges,90% of total billed charges,276,80,,220.8,percent of total billed charges,80% of total billed charges,310.5,90,,248.4,percent of total billed charges,90% of total billed charges,258.75,75,,207,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,100.05,29,,80.04,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,231.15,67,,184.92,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,241.5,70,,193.2,percent of total billed charges,70% of total billed charges,224.25,65,,179.4,percent of total billed charges,65% of total billed charges,123.06,35.67,,98.448,percent of total billed charges,35.67% of total billed charges,100.05,345,
SCREW CANNUALTED 4.0 48MM LT,27011675,CDM,278,RC,C1713,HCPCS,outpatient,,,1235,494.00,,864.5,70,,691.6,percent of total billed charges,70% of total billed charges,648.38,52.5,,518.7,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,1012.7,82,,810.16,percent of total billed charges,82% of total billed charges,1049.75,85,,839.8,percent of total billed charges,85% of total billed charges,1049.75,85,,839.8,percent of total billed charges,85% of total billed charges,1049.75,85,,839.8,percent of total billed charges,85% of total billed charges,1111.5,90,,889.2,percent of total billed charges,90% of total billed charges,988,80,,790.4,percent of total billed charges,80% of total billed charges,1111.5,90,,889.2,percent of total billed charges,90% of total billed charges,926.25,75,,741,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,358.15,29,,286.52,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,827.45,67,,661.96,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,864.5,70,,691.6,percent of total billed charges,70% of total billed charges,802.75,65,,642.2,percent of total billed charges,65% of total billed charges,440.52,35.67,,352.416,percent of total billed charges,35.67% of total billed charges,358.15,1111.5,
PLATE T 7 HOLE 2.0,27011705,CDM,278,RC,C1713,HCPCS,outpatient,,,1941,776.40,,1358.7,70,,1086.96,percent of total billed charges,70% of total billed charges,1019.03,52.5,,815.22,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,1591.62,82,,1273.296,percent of total billed charges,82% of total billed charges,1649.85,85,,1319.88,percent of total billed charges,85% of total billed charges,1649.85,85,,1319.88,percent of total billed charges,85% of total billed charges,1649.85,85,,1319.88,percent of total billed charges,85% of total billed charges,1746.9,90,,1397.52,percent of total billed charges,90% of total billed charges,1552.8,80,,1242.24,percent of total billed charges,80% of total billed charges,1746.9,90,,1397.52,percent of total billed charges,90% of total billed charges,1455.75,75,,1164.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,562.89,29,,450.312,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1300.47,67,,1040.376,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1358.7,70,,1086.96,percent of total billed charges,70% of total billed charges,1261.65,65,,1009.32,percent of total billed charges,65% of total billed charges,692.35,35.67,,553.88,percent of total billed charges,35.67% of total billed charges,562.89,1746.9,
SCREW LOCKING 2.0 26MM,27011706,CDM,278,RC,C1713,HCPCS,outpatient,,,1370,548.00,,959,70,,767.2,percent of total billed charges,70% of total billed charges,719.25,52.5,,575.4,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,1123.4,82,,898.72,percent of total billed charges,82% of total billed charges,1164.5,85,,931.6,percent of total billed charges,85% of total billed charges,1164.5,85,,931.6,percent of total billed charges,85% of total billed charges,1164.5,85,,931.6,percent of total billed charges,85% of total billed charges,1233,90,,986.4,percent of total billed charges,90% of total billed charges,1096,80,,876.8,percent of total billed charges,80% of total billed charges,1233,90,,986.4,percent of total billed charges,90% of total billed charges,1027.5,75,,822,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,397.3,29,,317.84,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,917.9,67,,734.32,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,959,70,,767.2,percent of total billed charges,70% of total billed charges,890.5,65,,712.4,percent of total billed charges,65% of total billed charges,488.68,35.67,,390.944,percent of total billed charges,35.67% of total billed charges,397.3,1233,
LOCKING SCREW 2.0 16 MM,27011773,CDM,278,RC,C1713,HCPCS,outpatient,,,688,275.20,,481.6,70,,385.28,percent of total billed charges,70% of total billed charges,688,100,,550.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,564.16,82,,451.328,percent of total billed charges,82% of total billed charges,584.8,85,,467.84,percent of total billed charges,85% of total billed charges,584.8,85,,467.84,percent of total billed charges,85% of total billed charges,584.8,85,,467.84,percent of total billed charges,85% of total billed charges,619.2,90,,495.36,percent of total billed charges,90% of total billed charges,550.4,80,,440.32,percent of total billed charges,80% of total billed charges,619.2,90,,495.36,percent of total billed charges,90% of total billed charges,516,75,,412.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,199.52,29,,159.616,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,460.96,67,,368.768,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,481.6,70,,385.28,percent of total billed charges,70% of total billed charges,447.2,65,,357.76,percent of total billed charges,65% of total billed charges,245.41,35.67,,196.328,percent of total billed charges,35.67% of total billed charges,199.52,688,
COUNTER SINK 2.7,27011774,CDM,278,RC,C1713,HCPCS,outpatient,,,879,351.60,,615.3,70,,492.24,percent of total billed charges,70% of total billed charges,879,100,,703.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,720.78,82,,576.624,percent of total billed charges,82% of total billed charges,747.15,85,,597.72,percent of total billed charges,85% of total billed charges,747.15,85,,597.72,percent of total billed charges,85% of total billed charges,747.15,85,,597.72,percent of total billed charges,85% of total billed charges,791.1,90,,632.88,percent of total billed charges,90% of total billed charges,703.2,80,,562.56,percent of total billed charges,80% of total billed charges,791.1,90,,632.88,percent of total billed charges,90% of total billed charges,659.25,75,,527.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,254.91,29,,203.928,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,588.93,67,,471.144,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,615.3,70,,492.24,percent of total billed charges,70% of total billed charges,571.35,65,,457.08,percent of total billed charges,65% of total billed charges,313.54,35.67,,250.832,percent of total billed charges,35.67% of total billed charges,254.91,879,
DEGREE RT GAMMA 11X340MM,27011798,CDM,278,RC,C1713,HCPCS,outpatient,,,8760,3504.00,,6132,70,,4905.6,percent of total billed charges,70% of total billed charges,4599,52.5,,3679.2,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,7183.2,82,,5746.56,percent of total billed charges,82% of total billed charges,7446,85,,5956.8,percent of total billed charges,85% of total billed charges,7446,85,,5956.8,percent of total billed charges,85% of total billed charges,7446,85,,5956.8,percent of total billed charges,85% of total billed charges,7884,90,,6307.2,percent of total billed charges,90% of total billed charges,7008,80,,5606.4,percent of total billed charges,80% of total billed charges,7884,90,,6307.2,percent of total billed charges,90% of total billed charges,6570,75,,5256,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2540.4,29,,2032.32,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,5869.2,67,,4695.36,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,6132,70,,4905.6,percent of total billed charges,70% of total billed charges,5694,65,,4555.2,percent of total billed charges,65% of total billed charges,3124.69,35.67,,2499.752,percent of total billed charges,35.67% of total billed charges,2540.4,7884,
SCREWS LOCKING 2.0 MM,27011897,CDM,278,RC,C1713,HCPCS,outpatient,,,886,354.40,,620.2,70,,496.16,percent of total billed charges,70% of total billed charges,886,100,,708.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,726.52,82,,581.216,percent of total billed charges,82% of total billed charges,753.1,85,,602.48,percent of total billed charges,85% of total billed charges,753.1,85,,602.48,percent of total billed charges,85% of total billed charges,753.1,85,,602.48,percent of total billed charges,85% of total billed charges,797.4,90,,637.92,percent of total billed charges,90% of total billed charges,708.8,80,,567.04,percent of total billed charges,80% of total billed charges,797.4,90,,637.92,percent of total billed charges,90% of total billed charges,664.5,75,,531.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,256.94,29,,205.552,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,593.62,67,,474.896,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,620.2,70,,496.16,percent of total billed charges,70% of total billed charges,575.9,65,,460.72,percent of total billed charges,65% of total billed charges,316.04,35.67,,252.832,percent of total billed charges,35.67% of total billed charges,256.94,886,
SCREWS LOCKING 2.0 MM #14,27011898,CDM,278,RC,C1713,HCPCS,outpatient,,,886,354.40,,620.2,70,,496.16,percent of total billed charges,70% of total billed charges,886,100,,708.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,726.52,82,,581.216,percent of total billed charges,82% of total billed charges,753.1,85,,602.48,percent of total billed charges,85% of total billed charges,753.1,85,,602.48,percent of total billed charges,85% of total billed charges,753.1,85,,602.48,percent of total billed charges,85% of total billed charges,797.4,90,,637.92,percent of total billed charges,90% of total billed charges,708.8,80,,567.04,percent of total billed charges,80% of total billed charges,797.4,90,,637.92,percent of total billed charges,90% of total billed charges,664.5,75,,531.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,256.94,29,,205.552,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,593.62,67,,474.896,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,620.2,70,,496.16,percent of total billed charges,70% of total billed charges,575.9,65,,460.72,percent of total billed charges,65% of total billed charges,316.04,35.67,,252.832,percent of total billed charges,35.67% of total billed charges,256.94,886,
PLATE STRAIGHT 2.5 MM,27011934,CDM,278,RC,C1713,HCPCS,outpatient,,,2045,818.00,,1431.5,70,,1145.2,percent of total billed charges,70% of total billed charges,1073.63,52.5,,858.9,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,1676.9,82,,1341.52,percent of total billed charges,82% of total billed charges,1738.25,85,,1390.6,percent of total billed charges,85% of total billed charges,1738.25,85,,1390.6,percent of total billed charges,85% of total billed charges,1738.25,85,,1390.6,percent of total billed charges,85% of total billed charges,1840.5,90,,1472.4,percent of total billed charges,90% of total billed charges,1636,80,,1308.8,percent of total billed charges,80% of total billed charges,1840.5,90,,1472.4,percent of total billed charges,90% of total billed charges,1533.75,75,,1227,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,593.05,29,,474.44,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1370.15,67,,1096.12,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1431.5,70,,1145.2,percent of total billed charges,70% of total billed charges,1329.25,65,,1063.4,percent of total billed charges,65% of total billed charges,729.45,35.67,,583.56,percent of total billed charges,35.67% of total billed charges,593.05,1840.5,
NON LOCKING 2.5 MM SCREW,27011937,CDM,278,RC,C1713,HCPCS,outpatient,,,669,267.60,,468.3,70,,374.64,percent of total billed charges,70% of total billed charges,669,100,,535.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,548.58,82,,438.864,percent of total billed charges,82% of total billed charges,568.65,85,,454.92,percent of total billed charges,85% of total billed charges,568.65,85,,454.92,percent of total billed charges,85% of total billed charges,568.65,85,,454.92,percent of total billed charges,85% of total billed charges,602.1,90,,481.68,percent of total billed charges,90% of total billed charges,535.2,80,,428.16,percent of total billed charges,80% of total billed charges,602.1,90,,481.68,percent of total billed charges,90% of total billed charges,501.75,75,,401.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,194.01,29,,155.208,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,448.23,67,,358.584,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,468.3,70,,374.64,percent of total billed charges,70% of total billed charges,434.85,65,,347.88,percent of total billed charges,65% of total billed charges,238.63,35.67,,190.904,percent of total billed charges,35.67% of total billed charges,194.01,669,
NON LOCKIN 2.5 MM 10 MM SCREW,27011938,CDM,278,RC,C1713,HCPCS,outpatient,,,657,262.80,,459.9,70,,367.92,percent of total billed charges,70% of total billed charges,657,100,,525.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,538.74,82,,430.992,percent of total billed charges,82% of total billed charges,558.45,85,,446.76,percent of total billed charges,85% of total billed charges,558.45,85,,446.76,percent of total billed charges,85% of total billed charges,558.45,85,,446.76,percent of total billed charges,85% of total billed charges,591.3,90,,473.04,percent of total billed charges,90% of total billed charges,525.6,80,,420.48,percent of total billed charges,80% of total billed charges,591.3,90,,473.04,percent of total billed charges,90% of total billed charges,492.75,75,,394.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,190.53,29,,152.424,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,440.19,67,,352.152,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,459.9,70,,367.92,percent of total billed charges,70% of total billed charges,427.05,65,,341.64,percent of total billed charges,65% of total billed charges,234.35,35.67,,187.48,percent of total billed charges,35.67% of total billed charges,190.53,657,
LOCKING 2.5 MM 10 MM SCREW,27011939,CDM,278,RC,C1713,HCPCS,outpatient,,,657,262.80,,459.9,70,,367.92,percent of total billed charges,70% of total billed charges,657,100,,525.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,538.74,82,,430.992,percent of total billed charges,82% of total billed charges,558.45,85,,446.76,percent of total billed charges,85% of total billed charges,558.45,85,,446.76,percent of total billed charges,85% of total billed charges,558.45,85,,446.76,percent of total billed charges,85% of total billed charges,591.3,90,,473.04,percent of total billed charges,90% of total billed charges,525.6,80,,420.48,percent of total billed charges,80% of total billed charges,591.3,90,,473.04,percent of total billed charges,90% of total billed charges,492.75,75,,394.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,190.53,29,,152.424,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,440.19,67,,352.152,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,459.9,70,,367.92,percent of total billed charges,70% of total billed charges,427.05,65,,341.64,percent of total billed charges,65% of total billed charges,234.35,35.67,,187.48,percent of total billed charges,35.67% of total billed charges,190.53,657,
ECHO STEM,27011953,CDM,278,RC,C1776,HCPCS,outpatient,,,8794,3517.60,,6155.8,70,,4924.64,percent of total billed charges,70% of total billed charges,4616.85,52.5,,3693.48,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,7211.08,82,,5768.864,percent of total billed charges,82% of total billed charges,7474.9,85,,5979.92,percent of total billed charges,85% of total billed charges,7474.9,85,,5979.92,percent of total billed charges,85% of total billed charges,7474.9,85,,5979.92,percent of total billed charges,85% of total billed charges,7914.6,90,,6331.68,percent of total billed charges,90% of total billed charges,7035.2,80,,5628.16,percent of total billed charges,80% of total billed charges,7914.6,90,,6331.68,percent of total billed charges,90% of total billed charges,6595.5,75,,5276.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2550.26,29,,2040.208,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,5891.98,67,,4713.584,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,6155.8,70,,4924.64,percent of total billed charges,70% of total billed charges,5716.1,65,,4572.88,percent of total billed charges,65% of total billed charges,3136.82,35.67,,2509.456,percent of total billed charges,35.67% of total billed charges,2550.26,7914.6,
ENDO HEAD,27011954,CDM,278,RC,C1713,HCPCS,outpatient,,,2288,915.20,,1601.6,70,,1281.28,percent of total billed charges,70% of total billed charges,1201.2,52.5,,960.96,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,1876.16,82,,1500.928,percent of total billed charges,82% of total billed charges,1944.8,85,,1555.84,percent of total billed charges,85% of total billed charges,1944.8,85,,1555.84,percent of total billed charges,85% of total billed charges,1944.8,85,,1555.84,percent of total billed charges,85% of total billed charges,2059.2,90,,1647.36,percent of total billed charges,90% of total billed charges,1830.4,80,,1464.32,percent of total billed charges,80% of total billed charges,2059.2,90,,1647.36,percent of total billed charges,90% of total billed charges,1716,75,,1372.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,663.52,29,,530.816,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1532.96,67,,1226.368,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1601.6,70,,1281.28,percent of total billed charges,70% of total billed charges,1487.2,65,,1189.76,percent of total billed charges,65% of total billed charges,816.13,35.67,,652.904,percent of total billed charges,35.67% of total billed charges,663.52,2059.2,
PLATE 1/3 TUBULAR,27011971,CDM,278,RC,C1713,HCPCS,outpatient,,,126,50.40,,88.2,70,,70.56,percent of total billed charges,70% of total billed charges,126,100,,100.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,103.32,82,,82.656,percent of total billed charges,82% of total billed charges,107.1,85,,85.68,percent of total billed charges,85% of total billed charges,107.1,85,,85.68,percent of total billed charges,85% of total billed charges,107.1,85,,85.68,percent of total billed charges,85% of total billed charges,113.4,90,,90.72,percent of total billed charges,90% of total billed charges,100.8,80,,80.64,percent of total billed charges,80% of total billed charges,113.4,90,,90.72,percent of total billed charges,90% of total billed charges,94.5,75,,75.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,36.54,29,,29.232,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,84.42,67,,67.536,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,88.2,70,,70.56,percent of total billed charges,70% of total billed charges,81.9,65,,65.52,percent of total billed charges,65% of total billed charges,44.94,35.67,,35.952,percent of total billed charges,35.67% of total billed charges,36.54,126,
CORTICAL SCREW 3.5,27011972,CDM,278,RC,C1713,HCPCS,outpatient,,,156,62.40,,109.2,70,,87.36,percent of total billed charges,70% of total billed charges,156,100,,124.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,127.92,82,,102.336,percent of total billed charges,82% of total billed charges,132.6,85,,106.08,percent of total billed charges,85% of total billed charges,132.6,85,,106.08,percent of total billed charges,85% of total billed charges,132.6,85,,106.08,percent of total billed charges,85% of total billed charges,140.4,90,,112.32,percent of total billed charges,90% of total billed charges,124.8,80,,99.84,percent of total billed charges,80% of total billed charges,140.4,90,,112.32,percent of total billed charges,90% of total billed charges,117,75,,93.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,45.24,29,,36.192,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,104.52,67,,83.616,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,109.2,70,,87.36,percent of total billed charges,70% of total billed charges,101.4,65,,81.12,percent of total billed charges,65% of total billed charges,55.65,35.67,,44.52,percent of total billed charges,35.67% of total billed charges,45.24,156,
CORTICAL SCREW 3.5 14,27011973,CDM,278,RC,C1713,HCPCS,outpatient,,,156,62.40,,109.2,70,,87.36,percent of total billed charges,70% of total billed charges,156,100,,124.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,127.92,82,,102.336,percent of total billed charges,82% of total billed charges,132.6,85,,106.08,percent of total billed charges,85% of total billed charges,132.6,85,,106.08,percent of total billed charges,85% of total billed charges,132.6,85,,106.08,percent of total billed charges,85% of total billed charges,140.4,90,,112.32,percent of total billed charges,90% of total billed charges,124.8,80,,99.84,percent of total billed charges,80% of total billed charges,140.4,90,,112.32,percent of total billed charges,90% of total billed charges,117,75,,93.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,45.24,29,,36.192,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,104.52,67,,83.616,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,109.2,70,,87.36,percent of total billed charges,70% of total billed charges,101.4,65,,81.12,percent of total billed charges,65% of total billed charges,55.65,35.67,,44.52,percent of total billed charges,35.67% of total billed charges,45.24,156,
CACELLOUS SCREW 4.0 24 MM,27011974,CDM,278,RC,C1713,HCPCS,outpatient,,,80,32.00,,56,70,,44.8,percent of total billed charges,70% of total billed charges,80,100,,64,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,65.6,82,,52.48,percent of total billed charges,82% of total billed charges,68,85,,54.4,percent of total billed charges,85% of total billed charges,68,85,,54.4,percent of total billed charges,85% of total billed charges,68,85,,54.4,percent of total billed charges,85% of total billed charges,72,90,,57.6,percent of total billed charges,90% of total billed charges,64,80,,51.2,percent of total billed charges,80% of total billed charges,72,90,,57.6,percent of total billed charges,90% of total billed charges,60,75,,48,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,23.2,29,,18.56,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,53.6,67,,42.88,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,56,70,,44.8,percent of total billed charges,70% of total billed charges,52,65,,41.6,percent of total billed charges,65% of total billed charges,28.54,35.67,,22.832,percent of total billed charges,35.67% of total billed charges,23.2,80,
CANCELLOUS SCREW 4.0 22 MM,27011975,CDM,278,RC,C1713,HCPCS,outpatient,,,80,32.00,,56,70,,44.8,percent of total billed charges,70% of total billed charges,80,100,,64,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,65.6,82,,52.48,percent of total billed charges,82% of total billed charges,68,85,,54.4,percent of total billed charges,85% of total billed charges,68,85,,54.4,percent of total billed charges,85% of total billed charges,68,85,,54.4,percent of total billed charges,85% of total billed charges,72,90,,57.6,percent of total billed charges,90% of total billed charges,64,80,,51.2,percent of total billed charges,80% of total billed charges,72,90,,57.6,percent of total billed charges,90% of total billed charges,60,75,,48,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,23.2,29,,18.56,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,53.6,67,,42.88,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,56,70,,44.8,percent of total billed charges,70% of total billed charges,52,65,,41.6,percent of total billed charges,65% of total billed charges,28.54,35.67,,22.832,percent of total billed charges,35.67% of total billed charges,23.2,80,
4.0 MM CANCELLOUS SCREW,27011980,CDM,278,RC,C1713,HCPCS,outpatient,,,842,336.80,,589.4,70,,471.52,percent of total billed charges,70% of total billed charges,842,100,,673.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,690.44,82,,552.352,percent of total billed charges,82% of total billed charges,715.7,85,,572.56,percent of total billed charges,85% of total billed charges,715.7,85,,572.56,percent of total billed charges,85% of total billed charges,715.7,85,,572.56,percent of total billed charges,85% of total billed charges,757.8,90,,606.24,percent of total billed charges,90% of total billed charges,673.6,80,,538.88,percent of total billed charges,80% of total billed charges,757.8,90,,606.24,percent of total billed charges,90% of total billed charges,631.5,75,,505.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,244.18,29,,195.344,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,564.14,67,,451.312,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,589.4,70,,471.52,percent of total billed charges,70% of total billed charges,547.3,65,,437.84,percent of total billed charges,65% of total billed charges,300.34,35.67,,240.272,percent of total billed charges,35.67% of total billed charges,244.18,842,
PLATE 6 HOLE TUBULAR,27012037,CDM,278,RC,C1713,HCPCS,outpatient,,,2194,877.60,,1535.8,70,,1228.64,percent of total billed charges,70% of total billed charges,1151.85,52.5,,921.48,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,1799.08,82,,1439.264,percent of total billed charges,82% of total billed charges,1864.9,85,,1491.92,percent of total billed charges,85% of total billed charges,1864.9,85,,1491.92,percent of total billed charges,85% of total billed charges,1864.9,85,,1491.92,percent of total billed charges,85% of total billed charges,1974.6,90,,1579.68,percent of total billed charges,90% of total billed charges,1755.2,80,,1404.16,percent of total billed charges,80% of total billed charges,1974.6,90,,1579.68,percent of total billed charges,90% of total billed charges,1645.5,75,,1316.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,636.26,29,,509.008,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1469.98,67,,1175.984,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1535.8,70,,1228.64,percent of total billed charges,70% of total billed charges,1426.1,65,,1140.88,percent of total billed charges,65% of total billed charges,782.6,35.67,,626.08,percent of total billed charges,35.67% of total billed charges,636.26,1974.6,
K WIRE,27012038,CDM,278,RC,C1713,HCPCS,outpatient,,,501,200.40,,350.7,70,,280.56,percent of total billed charges,70% of total billed charges,501,100,,400.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,410.82,82,,328.656,percent of total billed charges,82% of total billed charges,425.85,85,,340.68,percent of total billed charges,85% of total billed charges,425.85,85,,340.68,percent of total billed charges,85% of total billed charges,425.85,85,,340.68,percent of total billed charges,85% of total billed charges,450.9,90,,360.72,percent of total billed charges,90% of total billed charges,400.8,80,,320.64,percent of total billed charges,80% of total billed charges,450.9,90,,360.72,percent of total billed charges,90% of total billed charges,375.75,75,,300.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,145.29,29,,116.232,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,335.67,67,,268.536,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,350.7,70,,280.56,percent of total billed charges,70% of total billed charges,325.65,65,,260.52,percent of total billed charges,65% of total billed charges,178.71,35.67,,142.968,percent of total billed charges,35.67% of total billed charges,145.29,501,
CORTICAL SCREW 6 MM,27012039,CDM,278,RC,C1713,HCPCS,outpatient,,,423,169.20,,296.1,70,,236.88,percent of total billed charges,70% of total billed charges,423,100,,338.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,346.86,82,,277.488,percent of total billed charges,82% of total billed charges,359.55,85,,287.64,percent of total billed charges,85% of total billed charges,359.55,85,,287.64,percent of total billed charges,85% of total billed charges,359.55,85,,287.64,percent of total billed charges,85% of total billed charges,380.7,90,,304.56,percent of total billed charges,90% of total billed charges,338.4,80,,270.72,percent of total billed charges,80% of total billed charges,380.7,90,,304.56,percent of total billed charges,90% of total billed charges,317.25,75,,253.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,122.67,29,,98.136,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,283.41,67,,226.728,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,296.1,70,,236.88,percent of total billed charges,70% of total billed charges,274.95,65,,219.96,percent of total billed charges,65% of total billed charges,150.88,35.67,,120.704,percent of total billed charges,35.67% of total billed charges,122.67,423,
CORTICAL SCREW 14 MM,27012040,CDM,278,RC,C1713,HCPCS,outpatient,,,423,169.20,,296.1,70,,236.88,percent of total billed charges,70% of total billed charges,423,100,,338.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,346.86,82,,277.488,percent of total billed charges,82% of total billed charges,359.55,85,,287.64,percent of total billed charges,85% of total billed charges,359.55,85,,287.64,percent of total billed charges,85% of total billed charges,359.55,85,,287.64,percent of total billed charges,85% of total billed charges,380.7,90,,304.56,percent of total billed charges,90% of total billed charges,338.4,80,,270.72,percent of total billed charges,80% of total billed charges,380.7,90,,304.56,percent of total billed charges,90% of total billed charges,317.25,75,,253.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,122.67,29,,98.136,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,283.41,67,,226.728,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,296.1,70,,236.88,percent of total billed charges,70% of total billed charges,274.95,65,,219.96,percent of total billed charges,65% of total billed charges,150.88,35.67,,120.704,percent of total billed charges,35.67% of total billed charges,122.67,423,
CORTICAL SCREW 24 MM,27012041,CDM,278,RC,C1713,HCPCS,outpatient,,,842,336.80,,589.4,70,,471.52,percent of total billed charges,70% of total billed charges,842,100,,673.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,690.44,82,,552.352,percent of total billed charges,82% of total billed charges,715.7,85,,572.56,percent of total billed charges,85% of total billed charges,715.7,85,,572.56,percent of total billed charges,85% of total billed charges,715.7,85,,572.56,percent of total billed charges,85% of total billed charges,757.8,90,,606.24,percent of total billed charges,90% of total billed charges,673.6,80,,538.88,percent of total billed charges,80% of total billed charges,757.8,90,,606.24,percent of total billed charges,90% of total billed charges,631.5,75,,505.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,244.18,29,,195.344,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,564.14,67,,451.312,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,589.4,70,,471.52,percent of total billed charges,70% of total billed charges,547.3,65,,437.84,percent of total billed charges,65% of total billed charges,300.34,35.67,,240.272,percent of total billed charges,35.67% of total billed charges,244.18,842,
PLATE SHOT LT,27012077,CDM,278,RC,C1713,HCPCS,outpatient,,,3508,1403.20,,2455.6,70,,1964.48,percent of total billed charges,70% of total billed charges,1841.7,52.5,,1473.36,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,2876.56,82,,2301.248,percent of total billed charges,82% of total billed charges,2981.8,85,,2385.44,percent of total billed charges,85% of total billed charges,2981.8,85,,2385.44,percent of total billed charges,85% of total billed charges,2981.8,85,,2385.44,percent of total billed charges,85% of total billed charges,3157.2,90,,2525.76,percent of total billed charges,90% of total billed charges,2806.4,80,,2245.12,percent of total billed charges,80% of total billed charges,3157.2,90,,2525.76,percent of total billed charges,90% of total billed charges,2631,75,,2104.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,1017.32,29,,813.856,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,2350.36,67,,1880.288,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,2455.6,70,,1964.48,percent of total billed charges,70% of total billed charges,2280.2,65,,1824.16,percent of total billed charges,65% of total billed charges,1251.3,35.67,,1001.04,percent of total billed charges,35.67% of total billed charges,1017.32,3157.2,
K WIRE,27012084,CDM,278,RC,C1769,HCPCS,outpatient,,,701,280.40,,490.7,70,,392.56,percent of total billed charges,70% of total billed charges,701,100,,560.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,574.82,82,,459.856,percent of total billed charges,82% of total billed charges,595.85,85,,476.68,percent of total billed charges,85% of total billed charges,595.85,85,,476.68,percent of total billed charges,85% of total billed charges,595.85,85,,476.68,percent of total billed charges,85% of total billed charges,630.9,90,,504.72,percent of total billed charges,90% of total billed charges,560.8,80,,448.64,percent of total billed charges,80% of total billed charges,630.9,90,,504.72,percent of total billed charges,90% of total billed charges,525.75,75,,420.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,203.29,29,,162.632,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,469.67,67,,375.736,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,490.7,70,,392.56,percent of total billed charges,70% of total billed charges,455.65,65,,364.52,percent of total billed charges,65% of total billed charges,250.05,35.67,,200.04,percent of total billed charges,35.67% of total billed charges,203.29,701,
CANCELOUS SCREW 6.5,27012096,CDM,278,RC,C1713,HCPCS,outpatient,,,561,224.40,,392.7,70,,314.16,percent of total billed charges,70% of total billed charges,561,100,,448.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,460.02,82,,368.016,percent of total billed charges,82% of total billed charges,476.85,85,,381.48,percent of total billed charges,85% of total billed charges,476.85,85,,381.48,percent of total billed charges,85% of total billed charges,476.85,85,,381.48,percent of total billed charges,85% of total billed charges,504.9,90,,403.92,percent of total billed charges,90% of total billed charges,448.8,80,,359.04,percent of total billed charges,80% of total billed charges,504.9,90,,403.92,percent of total billed charges,90% of total billed charges,420.75,75,,336.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,162.69,29,,130.152,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,375.87,67,,300.696,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,392.7,70,,314.16,percent of total billed charges,70% of total billed charges,364.65,65,,291.72,percent of total billed charges,65% of total billed charges,200.11,35.67,,160.088,percent of total billed charges,35.67% of total billed charges,162.69,561,
CORTICOSCREW,27012111,CDM,278,RC,C1713,HCPCS,outpatient,,,570,228.00,,399,70,,319.2,percent of total billed charges,70% of total billed charges,570,100,,456,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,467.4,82,,373.92,percent of total billed charges,82% of total billed charges,484.5,85,,387.6,percent of total billed charges,85% of total billed charges,484.5,85,,387.6,percent of total billed charges,85% of total billed charges,484.5,85,,387.6,percent of total billed charges,85% of total billed charges,513,90,,410.4,percent of total billed charges,90% of total billed charges,456,80,,364.8,percent of total billed charges,80% of total billed charges,513,90,,410.4,percent of total billed charges,90% of total billed charges,427.5,75,,342,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,165.3,29,,132.24,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,381.9,67,,305.52,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,399,70,,319.2,percent of total billed charges,70% of total billed charges,370.5,65,,296.4,percent of total billed charges,65% of total billed charges,203.32,35.67,,162.656,percent of total billed charges,35.67% of total billed charges,165.3,570,
K WIRE 1.6 MM OLIVE,27012138,CDM,278,RC,C1713,HCPCS,outpatient,,,561,224.40,,392.7,70,,314.16,percent of total billed charges,70% of total billed charges,561,100,,448.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,460.02,82,,368.016,percent of total billed charges,82% of total billed charges,476.85,85,,381.48,percent of total billed charges,85% of total billed charges,476.85,85,,381.48,percent of total billed charges,85% of total billed charges,476.85,85,,381.48,percent of total billed charges,85% of total billed charges,504.9,90,,403.92,percent of total billed charges,90% of total billed charges,448.8,80,,359.04,percent of total billed charges,80% of total billed charges,504.9,90,,403.92,percent of total billed charges,90% of total billed charges,420.75,75,,336.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,162.69,29,,130.152,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,375.87,67,,300.696,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,392.7,70,,314.16,percent of total billed charges,70% of total billed charges,364.65,65,,291.72,percent of total billed charges,65% of total billed charges,200.11,35.67,,160.088,percent of total billed charges,35.67% of total billed charges,162.69,561,
SCREW LOCKING,27012141,CDM,278,RC,C1713,HCPCS,outpatient,,,875,350.00,,612.5,70,,490,percent of total billed charges,70% of total billed charges,875,100,,700,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,717.5,82,,574,percent of total billed charges,82% of total billed charges,743.75,85,,595,percent of total billed charges,85% of total billed charges,743.75,85,,595,percent of total billed charges,85% of total billed charges,743.75,85,,595,percent of total billed charges,85% of total billed charges,787.5,90,,630,percent of total billed charges,90% of total billed charges,700,80,,560,percent of total billed charges,80% of total billed charges,787.5,90,,630,percent of total billed charges,90% of total billed charges,656.25,75,,525,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,253.75,29,,203,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,586.25,67,,469,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,612.5,70,,490,percent of total billed charges,70% of total billed charges,568.75,65,,455,percent of total billed charges,65% of total billed charges,312.11,35.67,,249.688,percent of total billed charges,35.67% of total billed charges,253.75,875,
SCREW LOCKING,27012142,CDM,278,RC,C1713,HCPCS,outpatient,,,875,350.00,,612.5,70,,490,percent of total billed charges,70% of total billed charges,875,100,,700,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,717.5,82,,574,percent of total billed charges,82% of total billed charges,743.75,85,,595,percent of total billed charges,85% of total billed charges,743.75,85,,595,percent of total billed charges,85% of total billed charges,743.75,85,,595,percent of total billed charges,85% of total billed charges,787.5,90,,630,percent of total billed charges,90% of total billed charges,700,80,,560,percent of total billed charges,80% of total billed charges,787.5,90,,630,percent of total billed charges,90% of total billed charges,656.25,75,,525,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,253.75,29,,203,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,586.25,67,,469,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,612.5,70,,490,percent of total billed charges,70% of total billed charges,568.75,65,,455,percent of total billed charges,65% of total billed charges,312.11,35.67,,249.688,percent of total billed charges,35.67% of total billed charges,253.75,875,
GUIDE WIRE KOCF818,27012143,CDM,278,RC,C1769,HCPCS,outpatient,,,910,364.00,,637,70,,509.6,percent of total billed charges,70% of total billed charges,910,100,,728,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,746.2,82,,596.96,percent of total billed charges,82% of total billed charges,773.5,85,,618.8,percent of total billed charges,85% of total billed charges,773.5,85,,618.8,percent of total billed charges,85% of total billed charges,773.5,85,,618.8,percent of total billed charges,85% of total billed charges,819,90,,655.2,percent of total billed charges,90% of total billed charges,728,80,,582.4,percent of total billed charges,80% of total billed charges,819,90,,655.2,percent of total billed charges,90% of total billed charges,682.5,75,,546,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,263.9,29,,211.12,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,609.7,67,,487.76,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,637,70,,509.6,percent of total billed charges,70% of total billed charges,591.5,65,,473.2,percent of total billed charges,65% of total billed charges,324.6,35.67,,259.68,percent of total billed charges,35.67% of total billed charges,263.9,910,
WIRE BALL TIP,27012144,CDM,278,RC,C1769,HCPCS,outpatient,,,910,364.00,,637,70,,509.6,percent of total billed charges,70% of total billed charges,910,100,,728,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,746.2,82,,596.96,percent of total billed charges,82% of total billed charges,773.5,85,,618.8,percent of total billed charges,85% of total billed charges,773.5,85,,618.8,percent of total billed charges,85% of total billed charges,773.5,85,,618.8,percent of total billed charges,85% of total billed charges,819,90,,655.2,percent of total billed charges,90% of total billed charges,728,80,,582.4,percent of total billed charges,80% of total billed charges,819,90,,655.2,percent of total billed charges,90% of total billed charges,682.5,75,,546,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,263.9,29,,211.12,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,609.7,67,,487.76,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,637,70,,509.6,percent of total billed charges,70% of total billed charges,591.5,65,,473.2,percent of total billed charges,65% of total billed charges,324.6,35.67,,259.68,percent of total billed charges,35.67% of total billed charges,263.9,910,
TUBE TEFLON KOB4CA1,27012145,CDM,278,RC,C1713,HCPCS,outpatient,,,1255,502.00,,878.5,70,,702.8,percent of total billed charges,70% of total billed charges,658.88,52.5,,527.1,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,1029.1,82,,823.28,percent of total billed charges,82% of total billed charges,1066.75,85,,853.4,percent of total billed charges,85% of total billed charges,1066.75,85,,853.4,percent of total billed charges,85% of total billed charges,1066.75,85,,853.4,percent of total billed charges,85% of total billed charges,1129.5,90,,903.6,percent of total billed charges,90% of total billed charges,1004,80,,803.2,percent of total billed charges,80% of total billed charges,1129.5,90,,903.6,percent of total billed charges,90% of total billed charges,941.25,75,,753,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,363.95,29,,291.16,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,840.85,67,,672.68,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,878.5,70,,702.8,percent of total billed charges,70% of total billed charges,815.75,65,,652.6,percent of total billed charges,65% of total billed charges,447.66,35.67,,358.128,percent of total billed charges,35.67% of total billed charges,363.95,1129.5,
NAIL TIBIA,27012146,CDM,278,RC,C1713,HCPCS,outpatient,,,5307,2122.80,,3714.9,70,,2971.92,percent of total billed charges,70% of total billed charges,2786.18,52.5,,2228.94,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,4351.74,82,,3481.392,percent of total billed charges,82% of total billed charges,4510.95,85,,3608.76,percent of total billed charges,85% of total billed charges,4510.95,85,,3608.76,percent of total billed charges,85% of total billed charges,4510.95,85,,3608.76,percent of total billed charges,85% of total billed charges,4776.3,90,,3821.04,percent of total billed charges,90% of total billed charges,4245.6,80,,3396.48,percent of total billed charges,80% of total billed charges,4776.3,90,,3821.04,percent of total billed charges,90% of total billed charges,3980.25,75,,3184.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,1539.03,29,,1231.224,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,3555.69,67,,2844.552,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,3714.9,70,,2971.92,percent of total billed charges,70% of total billed charges,3449.55,65,,2759.64,percent of total billed charges,65% of total billed charges,1893.01,35.67,,1514.408,percent of total billed charges,35.67% of total billed charges,1539.03,4776.3,
ILIAC WEDGE,27012151,CDM,278,RC,C1762,HCPCS,outpatient,,,2350,940.00,,1645,70,,1316,percent of total billed charges,70% of total billed charges,1233.75,52.5,,987,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,1927,82,,1541.6,percent of total billed charges,82% of total billed charges,1997.5,85,,1598,percent of total billed charges,85% of total billed charges,1997.5,85,,1598,percent of total billed charges,85% of total billed charges,1997.5,85,,1598,percent of total billed charges,85% of total billed charges,2115,90,,1692,percent of total billed charges,90% of total billed charges,1880,80,,1504,percent of total billed charges,80% of total billed charges,2115,90,,1692,percent of total billed charges,90% of total billed charges,1762.5,75,,1410,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,681.5,29,,545.2,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1574.5,67,,1259.6,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1645,70,,1316,percent of total billed charges,70% of total billed charges,1527.5,65,,1222,percent of total billed charges,65% of total billed charges,838.25,35.67,,670.6,percent of total billed charges,35.67% of total billed charges,681.5,2115,
CANNULATED SCREW 6.5 X 90 MM,27012162,CDM,278,RC,C1713,HCPCS,outpatient,,,1315,526.00,,920.5,70,,736.4,percent of total billed charges,70% of total billed charges,690.38,52.5,,552.3,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,1078.3,82,,862.64,percent of total billed charges,82% of total billed charges,1117.75,85,,894.2,percent of total billed charges,85% of total billed charges,1117.75,85,,894.2,percent of total billed charges,85% of total billed charges,1117.75,85,,894.2,percent of total billed charges,85% of total billed charges,1183.5,90,,946.8,percent of total billed charges,90% of total billed charges,1052,80,,841.6,percent of total billed charges,80% of total billed charges,1183.5,90,,946.8,percent of total billed charges,90% of total billed charges,986.25,75,,789,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,381.35,29,,305.08,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,881.05,67,,704.84,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,920.5,70,,736.4,percent of total billed charges,70% of total billed charges,854.75,65,,683.8,percent of total billed charges,65% of total billed charges,469.06,35.67,,375.248,percent of total billed charges,35.67% of total billed charges,381.35,1183.5,
CANNULATED SCREW 6.5 X 105 MM,27012163,CDM,278,RC,C1713,HCPCS,outpatient,,,1315,526.00,,920.5,70,,736.4,percent of total billed charges,70% of total billed charges,690.38,52.5,,552.3,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,1078.3,82,,862.64,percent of total billed charges,82% of total billed charges,1117.75,85,,894.2,percent of total billed charges,85% of total billed charges,1117.75,85,,894.2,percent of total billed charges,85% of total billed charges,1117.75,85,,894.2,percent of total billed charges,85% of total billed charges,1183.5,90,,946.8,percent of total billed charges,90% of total billed charges,1052,80,,841.6,percent of total billed charges,80% of total billed charges,1183.5,90,,946.8,percent of total billed charges,90% of total billed charges,986.25,75,,789,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,381.35,29,,305.08,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,881.05,67,,704.84,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,920.5,70,,736.4,percent of total billed charges,70% of total billed charges,854.75,65,,683.8,percent of total billed charges,65% of total billed charges,469.06,35.67,,375.248,percent of total billed charges,35.67% of total billed charges,381.35,1183.5,
T PLATE FOOT,27012164,CDM,278,RC,C1713,HCPCS,outpatient,,,1212,484.80,,848.4,70,,678.72,percent of total billed charges,70% of total billed charges,636.3,52.5,,509.04,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,993.84,82,,795.072,percent of total billed charges,82% of total billed charges,1030.2,85,,824.16,percent of total billed charges,85% of total billed charges,1030.2,85,,824.16,percent of total billed charges,85% of total billed charges,1030.2,85,,824.16,percent of total billed charges,85% of total billed charges,1090.8,90,,872.64,percent of total billed charges,90% of total billed charges,969.6,80,,775.68,percent of total billed charges,80% of total billed charges,1090.8,90,,872.64,percent of total billed charges,90% of total billed charges,909,75,,727.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,351.48,29,,281.184,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,812.04,67,,649.632,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,848.4,70,,678.72,percent of total billed charges,70% of total billed charges,787.8,65,,630.24,percent of total billed charges,65% of total billed charges,432.32,35.67,,345.856,percent of total billed charges,35.67% of total billed charges,351.48,1090.8,
SCHANZ PINS,27012167,CDM,278,RC,C1713,HCPCS,outpatient,,,1093,437.20,,765.1,70,,612.08,percent of total billed charges,70% of total billed charges,573.83,52.5,,459.06,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,896.26,82,,717.008,percent of total billed charges,82% of total billed charges,929.05,85,,743.24,percent of total billed charges,85% of total billed charges,929.05,85,,743.24,percent of total billed charges,85% of total billed charges,929.05,85,,743.24,percent of total billed charges,85% of total billed charges,983.7,90,,786.96,percent of total billed charges,90% of total billed charges,874.4,80,,699.52,percent of total billed charges,80% of total billed charges,983.7,90,,786.96,percent of total billed charges,90% of total billed charges,819.75,75,,655.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,316.97,29,,253.576,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,732.31,67,,585.848,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,765.1,70,,612.08,percent of total billed charges,70% of total billed charges,710.45,65,,568.36,percent of total billed charges,65% of total billed charges,389.87,35.67,,311.896,percent of total billed charges,35.67% of total billed charges,316.97,983.7,
PLATE H STYLE,27012168,CDM,278,RC,C1713,HCPCS,outpatient,,,3976,1590.40,,2783.2,70,,2226.56,percent of total billed charges,70% of total billed charges,2087.4,52.5,,1669.92,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,3260.32,82,,2608.256,percent of total billed charges,82% of total billed charges,3379.6,85,,2703.68,percent of total billed charges,85% of total billed charges,3379.6,85,,2703.68,percent of total billed charges,85% of total billed charges,3379.6,85,,2703.68,percent of total billed charges,85% of total billed charges,3578.4,90,,2862.72,percent of total billed charges,90% of total billed charges,3180.8,80,,2544.64,percent of total billed charges,80% of total billed charges,3578.4,90,,2862.72,percent of total billed charges,90% of total billed charges,2982,75,,2385.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,1153.04,29,,922.432,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,2663.92,67,,2131.136,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,2783.2,70,,2226.56,percent of total billed charges,70% of total billed charges,2584.4,65,,2067.52,percent of total billed charges,65% of total billed charges,1418.24,35.67,,1134.592,percent of total billed charges,35.67% of total billed charges,1153.04,3578.4,
2.7 CORTICAL SCREW,27012169,CDM,278,RC,C1713,HCPCS,outpatient,,,561,224.40,,392.7,70,,314.16,percent of total billed charges,70% of total billed charges,561,100,,448.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,460.02,82,,368.016,percent of total billed charges,82% of total billed charges,476.85,85,,381.48,percent of total billed charges,85% of total billed charges,476.85,85,,381.48,percent of total billed charges,85% of total billed charges,476.85,85,,381.48,percent of total billed charges,85% of total billed charges,504.9,90,,403.92,percent of total billed charges,90% of total billed charges,448.8,80,,359.04,percent of total billed charges,80% of total billed charges,504.9,90,,403.92,percent of total billed charges,90% of total billed charges,420.75,75,,336.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,162.69,29,,130.152,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,375.87,67,,300.696,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,392.7,70,,314.16,percent of total billed charges,70% of total billed charges,364.65,65,,291.72,percent of total billed charges,65% of total billed charges,200.11,35.67,,160.088,percent of total billed charges,35.67% of total billed charges,162.69,561,
2.7 CORTICAL 20 MM SCREW,27012170,CDM,278,RC,C1713,HCPCS,outpatient,,,561,224.40,,392.7,70,,314.16,percent of total billed charges,70% of total billed charges,561,100,,448.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,460.02,82,,368.016,percent of total billed charges,82% of total billed charges,476.85,85,,381.48,percent of total billed charges,85% of total billed charges,476.85,85,,381.48,percent of total billed charges,85% of total billed charges,476.85,85,,381.48,percent of total billed charges,85% of total billed charges,504.9,90,,403.92,percent of total billed charges,90% of total billed charges,448.8,80,,359.04,percent of total billed charges,80% of total billed charges,504.9,90,,403.92,percent of total billed charges,90% of total billed charges,420.75,75,,336.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,162.69,29,,130.152,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,375.87,67,,300.696,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,392.7,70,,314.16,percent of total billed charges,70% of total billed charges,364.65,65,,291.72,percent of total billed charges,65% of total billed charges,200.11,35.67,,160.088,percent of total billed charges,35.67% of total billed charges,162.69,561,
K WIRE GOLD NON THREADED,27012173,CDM,278,RC,C1713,HCPCS,outpatient,,,701,280.40,,490.7,70,,392.56,percent of total billed charges,70% of total billed charges,701,100,,560.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,574.82,82,,459.856,percent of total billed charges,82% of total billed charges,595.85,85,,476.68,percent of total billed charges,85% of total billed charges,595.85,85,,476.68,percent of total billed charges,85% of total billed charges,595.85,85,,476.68,percent of total billed charges,85% of total billed charges,630.9,90,,504.72,percent of total billed charges,90% of total billed charges,560.8,80,,448.64,percent of total billed charges,80% of total billed charges,630.9,90,,504.72,percent of total billed charges,90% of total billed charges,525.75,75,,420.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,203.29,29,,162.632,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,469.67,67,,375.736,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,490.7,70,,392.56,percent of total billed charges,70% of total billed charges,455.65,65,,364.52,percent of total billed charges,65% of total billed charges,250.05,35.67,,200.04,percent of total billed charges,35.67% of total billed charges,203.29,701,
SCREW PARTIALLY THREADED 4.5,27012174,CDM,278,RC,C1713,HCPCS,outpatient,,,1303,521.20,,912.1,70,,729.68,percent of total billed charges,70% of total billed charges,684.08,52.5,,547.26,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,1068.46,82,,854.768,percent of total billed charges,82% of total billed charges,1107.55,85,,886.04,percent of total billed charges,85% of total billed charges,1107.55,85,,886.04,percent of total billed charges,85% of total billed charges,1107.55,85,,886.04,percent of total billed charges,85% of total billed charges,1172.7,90,,938.16,percent of total billed charges,90% of total billed charges,1042.4,80,,833.92,percent of total billed charges,80% of total billed charges,1172.7,90,,938.16,percent of total billed charges,90% of total billed charges,977.25,75,,781.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,377.87,29,,302.296,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,873.01,67,,698.408,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,912.1,70,,729.68,percent of total billed charges,70% of total billed charges,846.95,65,,677.56,percent of total billed charges,65% of total billed charges,464.78,35.67,,371.824,percent of total billed charges,35.67% of total billed charges,377.87,1172.7,
SCREW PARTIAL THREADED 4.5/40,27012175,CDM,278,RC,C1713,HCPCS,outpatient,,,1303,521.20,,912.1,70,,729.68,percent of total billed charges,70% of total billed charges,684.08,52.5,,547.26,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,1068.46,82,,854.768,percent of total billed charges,82% of total billed charges,1107.55,85,,886.04,percent of total billed charges,85% of total billed charges,1107.55,85,,886.04,percent of total billed charges,85% of total billed charges,1107.55,85,,886.04,percent of total billed charges,85% of total billed charges,1172.7,90,,938.16,percent of total billed charges,90% of total billed charges,1042.4,80,,833.92,percent of total billed charges,80% of total billed charges,1172.7,90,,938.16,percent of total billed charges,90% of total billed charges,977.25,75,,781.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,377.87,29,,302.296,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,873.01,67,,698.408,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,912.1,70,,729.68,percent of total billed charges,70% of total billed charges,846.95,65,,677.56,percent of total billed charges,65% of total billed charges,464.78,35.67,,371.824,percent of total billed charges,35.67% of total billed charges,377.87,1172.7,
K WIRE 2.8 THREADED,27012176,CDM,278,RC,C1713,HCPCS,outpatient,,,785,314.00,,549.5,70,,439.6,percent of total billed charges,70% of total billed charges,785,100,,628,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,643.7,82,,514.96,percent of total billed charges,82% of total billed charges,667.25,85,,533.8,percent of total billed charges,85% of total billed charges,667.25,85,,533.8,percent of total billed charges,85% of total billed charges,667.25,85,,533.8,percent of total billed charges,85% of total billed charges,706.5,90,,565.2,percent of total billed charges,90% of total billed charges,628,80,,502.4,percent of total billed charges,80% of total billed charges,706.5,90,,565.2,percent of total billed charges,90% of total billed charges,588.75,75,,471,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,227.65,29,,182.12,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,525.95,67,,420.76,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,549.5,70,,439.6,percent of total billed charges,70% of total billed charges,510.25,65,,408.2,percent of total billed charges,65% of total billed charges,280.01,35.67,,224.008,percent of total billed charges,35.67% of total billed charges,227.65,785,
SCREW 6.5/35 MM,27012177,CDM,278,RC,C1713,HCPCS,outpatient,,,1670,668.00,,1169,70,,935.2,percent of total billed charges,70% of total billed charges,876.75,52.5,,701.4,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,1369.4,82,,1095.52,percent of total billed charges,82% of total billed charges,1419.5,85,,1135.6,percent of total billed charges,85% of total billed charges,1419.5,85,,1135.6,percent of total billed charges,85% of total billed charges,1419.5,85,,1135.6,percent of total billed charges,85% of total billed charges,1503,90,,1202.4,percent of total billed charges,90% of total billed charges,1336,80,,1068.8,percent of total billed charges,80% of total billed charges,1503,90,,1202.4,percent of total billed charges,90% of total billed charges,1252.5,75,,1002,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,484.3,29,,387.44,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1118.9,67,,895.12,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1169,70,,935.2,percent of total billed charges,70% of total billed charges,1085.5,65,,868.4,percent of total billed charges,65% of total billed charges,595.69,35.67,,476.552,percent of total billed charges,35.67% of total billed charges,484.3,1503,
SECURE FIT COLLAR STEM,27012182,CDM,278,RC,C1776,HCPCS,outpatient,,,25581,10232.40,,17906.7,70,,14325.36,percent of total billed charges,70% of total billed charges,13430.03,52.5,,10744.02,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,20976.42,82,,16781.136,percent of total billed charges,82% of total billed charges,21743.85,85,,17395.08,percent of total billed charges,85% of total billed charges,21743.85,85,,17395.08,percent of total billed charges,85% of total billed charges,21743.85,85,,17395.08,percent of total billed charges,85% of total billed charges,23022.9,90,,18418.32,percent of total billed charges,90% of total billed charges,20464.8,80,,16371.84,percent of total billed charges,80% of total billed charges,23022.9,90,,18418.32,percent of total billed charges,90% of total billed charges,19185.75,75,,15348.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,7418.49,29,,5934.792,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,17139.27,67,,13711.416,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,17906.7,70,,14325.36,percent of total billed charges,70% of total billed charges,16627.65,65,,13302.12,percent of total billed charges,65% of total billed charges,9124.74,35.67,,7299.792,percent of total billed charges,35.67% of total billed charges,7418.49,23022.9,
BIPOLAR HEAD 51 MM,27012183,CDM,278,RC,C1776,HCPCS,outpatient,,,5501,2200.40,,3850.7,70,,3080.56,percent of total billed charges,70% of total billed charges,2888.03,52.5,,2310.42,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,4510.82,82,,3608.656,percent of total billed charges,82% of total billed charges,4675.85,85,,3740.68,percent of total billed charges,85% of total billed charges,4675.85,85,,3740.68,percent of total billed charges,85% of total billed charges,4675.85,85,,3740.68,percent of total billed charges,85% of total billed charges,4950.9,90,,3960.72,percent of total billed charges,90% of total billed charges,4400.8,80,,3520.64,percent of total billed charges,80% of total billed charges,4950.9,90,,3960.72,percent of total billed charges,90% of total billed charges,4125.75,75,,3300.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,1595.29,29,,1276.232,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,3685.67,67,,2948.536,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,3850.7,70,,3080.56,percent of total billed charges,70% of total billed charges,3575.65,65,,2860.52,percent of total billed charges,65% of total billed charges,1962.21,35.67,,1569.768,percent of total billed charges,35.67% of total billed charges,1595.29,4950.9,
LOCKING SCREW,27012259,CDM,278,RC,C1713,HCPCS,outpatient,,,804,321.60,,562.8,70,,450.24,percent of total billed charges,70% of total billed charges,804,100,,643.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,659.28,82,,527.424,percent of total billed charges,82% of total billed charges,683.4,85,,546.72,percent of total billed charges,85% of total billed charges,683.4,85,,546.72,percent of total billed charges,85% of total billed charges,683.4,85,,546.72,percent of total billed charges,85% of total billed charges,723.6,90,,578.88,percent of total billed charges,90% of total billed charges,643.2,80,,514.56,percent of total billed charges,80% of total billed charges,723.6,90,,578.88,percent of total billed charges,90% of total billed charges,603,75,,482.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,233.16,29,,186.528,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,538.68,67,,430.944,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,562.8,70,,450.24,percent of total billed charges,70% of total billed charges,522.6,65,,418.08,percent of total billed charges,65% of total billed charges,286.79,35.67,,229.432,percent of total billed charges,35.67% of total billed charges,233.16,804,
6 HOLE PLATE,27012260,CDM,278,RC,C1713,HCPCS,outpatient,,,338,135.20,,236.6,70,,189.28,percent of total billed charges,70% of total billed charges,338,100,,270.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,277.16,82,,221.728,percent of total billed charges,82% of total billed charges,287.3,85,,229.84,percent of total billed charges,85% of total billed charges,287.3,85,,229.84,percent of total billed charges,85% of total billed charges,287.3,85,,229.84,percent of total billed charges,85% of total billed charges,304.2,90,,243.36,percent of total billed charges,90% of total billed charges,270.4,80,,216.32,percent of total billed charges,80% of total billed charges,304.2,90,,243.36,percent of total billed charges,90% of total billed charges,253.5,75,,202.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,98.02,29,,78.416,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,226.46,67,,181.168,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,236.6,70,,189.28,percent of total billed charges,70% of total billed charges,219.7,65,,175.76,percent of total billed charges,65% of total billed charges,120.56,35.67,,96.448,percent of total billed charges,35.67% of total billed charges,98.02,338,
CANCELLOUS SCREW 6.5,27012261,CDM,278,RC,C1713,HCPCS,outpatient,,,842,336.80,,589.4,70,,471.52,percent of total billed charges,70% of total billed charges,842,100,,673.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,690.44,82,,552.352,percent of total billed charges,82% of total billed charges,715.7,85,,572.56,percent of total billed charges,85% of total billed charges,715.7,85,,572.56,percent of total billed charges,85% of total billed charges,715.7,85,,572.56,percent of total billed charges,85% of total billed charges,757.8,90,,606.24,percent of total billed charges,90% of total billed charges,673.6,80,,538.88,percent of total billed charges,80% of total billed charges,757.8,90,,606.24,percent of total billed charges,90% of total billed charges,631.5,75,,505.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,244.18,29,,195.344,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,564.14,67,,451.312,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,589.4,70,,471.52,percent of total billed charges,70% of total billed charges,547.3,65,,437.84,percent of total billed charges,65% of total billed charges,300.34,35.67,,240.272,percent of total billed charges,35.67% of total billed charges,244.18,842,
CANCELLOUS SCREW 6.5 90 MM,27012262,CDM,278,RC,C1713,HCPCS,outpatient,,,842,336.80,,589.4,70,,471.52,percent of total billed charges,70% of total billed charges,842,100,,673.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,690.44,82,,552.352,percent of total billed charges,82% of total billed charges,715.7,85,,572.56,percent of total billed charges,85% of total billed charges,715.7,85,,572.56,percent of total billed charges,85% of total billed charges,715.7,85,,572.56,percent of total billed charges,85% of total billed charges,757.8,90,,606.24,percent of total billed charges,90% of total billed charges,673.6,80,,538.88,percent of total billed charges,80% of total billed charges,757.8,90,,606.24,percent of total billed charges,90% of total billed charges,631.5,75,,505.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,244.18,29,,195.344,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,564.14,67,,451.312,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,589.4,70,,471.52,percent of total billed charges,70% of total billed charges,547.3,65,,437.84,percent of total billed charges,65% of total billed charges,300.34,35.67,,240.272,percent of total billed charges,35.67% of total billed charges,244.18,842,
THREADED CANCELLOUS SCREW,27012263,CDM,278,RC,C1713,HCPCS,outpatient,,,842,336.80,,589.4,70,,471.52,percent of total billed charges,70% of total billed charges,842,100,,673.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,690.44,82,,552.352,percent of total billed charges,82% of total billed charges,715.7,85,,572.56,percent of total billed charges,85% of total billed charges,715.7,85,,572.56,percent of total billed charges,85% of total billed charges,715.7,85,,572.56,percent of total billed charges,85% of total billed charges,757.8,90,,606.24,percent of total billed charges,90% of total billed charges,673.6,80,,538.88,percent of total billed charges,80% of total billed charges,757.8,90,,606.24,percent of total billed charges,90% of total billed charges,631.5,75,,505.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,244.18,29,,195.344,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,564.14,67,,451.312,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,589.4,70,,471.52,percent of total billed charges,70% of total billed charges,547.3,65,,437.84,percent of total billed charges,65% of total billed charges,300.34,35.67,,240.272,percent of total billed charges,35.67% of total billed charges,244.18,842,
K WIRE 1.25 MM,27012273,CDM,278,RC,C1713,HCPCS,outpatient,,,289,115.60,,202.3,70,,161.84,percent of total billed charges,70% of total billed charges,289,100,,231.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,236.98,82,,189.584,percent of total billed charges,82% of total billed charges,245.65,85,,196.52,percent of total billed charges,85% of total billed charges,245.65,85,,196.52,percent of total billed charges,85% of total billed charges,245.65,85,,196.52,percent of total billed charges,85% of total billed charges,260.1,90,,208.08,percent of total billed charges,90% of total billed charges,231.2,80,,184.96,percent of total billed charges,80% of total billed charges,260.1,90,,208.08,percent of total billed charges,90% of total billed charges,216.75,75,,173.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,83.81,29,,67.048,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,193.63,67,,154.904,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,202.3,70,,161.84,percent of total billed charges,70% of total billed charges,187.85,65,,150.28,percent of total billed charges,65% of total billed charges,103.09,35.67,,82.472,percent of total billed charges,35.67% of total billed charges,83.81,289,
FIBULA PLATE 5HLE RIGHT 2.7/3,27012274,CDM,278,RC,C1713,HCPCS,outpatient,,,2910,1164.00,,2037,70,,1629.6,percent of total billed charges,70% of total billed charges,1527.75,52.5,,1222.2,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,2386.2,82,,1908.96,percent of total billed charges,82% of total billed charges,2473.5,85,,1978.8,percent of total billed charges,85% of total billed charges,2473.5,85,,1978.8,percent of total billed charges,85% of total billed charges,2473.5,85,,1978.8,percent of total billed charges,85% of total billed charges,2619,90,,2095.2,percent of total billed charges,90% of total billed charges,2328,80,,1862.4,percent of total billed charges,80% of total billed charges,2619,90,,2095.2,percent of total billed charges,90% of total billed charges,2182.5,75,,1746,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,843.9,29,,675.12,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1949.7,67,,1559.76,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,2037,70,,1629.6,percent of total billed charges,70% of total billed charges,1891.5,65,,1513.2,percent of total billed charges,65% of total billed charges,1038,35.67,,830.4,percent of total billed charges,35.67% of total billed charges,843.9,2619,
LEFT PLATE 1.5 MM,27012280,CDM,278,RC,C1713,HCPCS,outpatient,,,2085,834.00,,1459.5,70,,1167.6,percent of total billed charges,70% of total billed charges,1094.63,52.5,,875.7,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,1709.7,82,,1367.76,percent of total billed charges,82% of total billed charges,1772.25,85,,1417.8,percent of total billed charges,85% of total billed charges,1772.25,85,,1417.8,percent of total billed charges,85% of total billed charges,1772.25,85,,1417.8,percent of total billed charges,85% of total billed charges,1876.5,90,,1501.2,percent of total billed charges,90% of total billed charges,1668,80,,1334.4,percent of total billed charges,80% of total billed charges,1876.5,90,,1501.2,percent of total billed charges,90% of total billed charges,1563.75,75,,1251,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,604.65,29,,483.72,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1396.95,67,,1117.56,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1459.5,70,,1167.6,percent of total billed charges,70% of total billed charges,1355.25,65,,1084.2,percent of total billed charges,65% of total billed charges,743.72,35.67,,594.976,percent of total billed charges,35.67% of total billed charges,604.65,1876.5,
SCREW LOCKING 1.5 MM,27012281,CDM,278,RC,C1713,HCPCS,outpatient,,,688,275.20,,481.6,70,,385.28,percent of total billed charges,70% of total billed charges,688,100,,550.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,564.16,82,,451.328,percent of total billed charges,82% of total billed charges,584.8,85,,467.84,percent of total billed charges,85% of total billed charges,584.8,85,,467.84,percent of total billed charges,85% of total billed charges,584.8,85,,467.84,percent of total billed charges,85% of total billed charges,619.2,90,,495.36,percent of total billed charges,90% of total billed charges,550.4,80,,440.32,percent of total billed charges,80% of total billed charges,619.2,90,,495.36,percent of total billed charges,90% of total billed charges,516,75,,412.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,199.52,29,,159.616,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,460.96,67,,368.768,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,481.6,70,,385.28,percent of total billed charges,70% of total billed charges,447.2,65,,357.76,percent of total billed charges,65% of total billed charges,245.41,35.67,,196.328,percent of total billed charges,35.67% of total billed charges,199.52,688,
SCREW LOCKING 1.5 MM,27012282,CDM,278,RC,C1713,HCPCS,outpatient,,,710,284.00,,497,70,,397.6,percent of total billed charges,70% of total billed charges,710,100,,568,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,582.2,82,,465.76,percent of total billed charges,82% of total billed charges,603.5,85,,482.8,percent of total billed charges,85% of total billed charges,603.5,85,,482.8,percent of total billed charges,85% of total billed charges,603.5,85,,482.8,percent of total billed charges,85% of total billed charges,639,90,,511.2,percent of total billed charges,90% of total billed charges,568,80,,454.4,percent of total billed charges,80% of total billed charges,639,90,,511.2,percent of total billed charges,90% of total billed charges,532.5,75,,426,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,205.9,29,,164.72,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,475.7,67,,380.56,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,497,70,,397.6,percent of total billed charges,70% of total billed charges,461.5,65,,369.2,percent of total billed charges,65% of total billed charges,253.26,35.67,,202.608,percent of total billed charges,35.67% of total billed charges,205.9,710,
SCREW LOCKING 1.55,27012283,CDM,278,RC,C1713,HCPCS,outpatient,,,710,284.00,,497,70,,397.6,percent of total billed charges,70% of total billed charges,710,100,,568,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,582.2,82,,465.76,percent of total billed charges,82% of total billed charges,603.5,85,,482.8,percent of total billed charges,85% of total billed charges,603.5,85,,482.8,percent of total billed charges,85% of total billed charges,603.5,85,,482.8,percent of total billed charges,85% of total billed charges,639,90,,511.2,percent of total billed charges,90% of total billed charges,568,80,,454.4,percent of total billed charges,80% of total billed charges,639,90,,511.2,percent of total billed charges,90% of total billed charges,532.5,75,,426,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,205.9,29,,164.72,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,475.7,67,,380.56,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,497,70,,397.6,percent of total billed charges,70% of total billed charges,461.5,65,,369.2,percent of total billed charges,65% of total billed charges,253.26,35.67,,202.608,percent of total billed charges,35.67% of total billed charges,205.9,710,
SCREW LOCKING 1.5MM,27012284,CDM,278,RC,C1713,HCPCS,outpatient,,,710,284.00,,497,70,,397.6,percent of total billed charges,70% of total billed charges,710,100,,568,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,582.2,82,,465.76,percent of total billed charges,82% of total billed charges,603.5,85,,482.8,percent of total billed charges,85% of total billed charges,603.5,85,,482.8,percent of total billed charges,85% of total billed charges,603.5,85,,482.8,percent of total billed charges,85% of total billed charges,639,90,,511.2,percent of total billed charges,90% of total billed charges,568,80,,454.4,percent of total billed charges,80% of total billed charges,639,90,,511.2,percent of total billed charges,90% of total billed charges,532.5,75,,426,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,205.9,29,,164.72,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,475.7,67,,380.56,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,497,70,,397.6,percent of total billed charges,70% of total billed charges,461.5,65,,369.2,percent of total billed charges,65% of total billed charges,253.26,35.67,,202.608,percent of total billed charges,35.67% of total billed charges,205.9,710,
SCREW CORTEX,27012285,CDM,278,RC,C1713,HCPCS,outpatient,,,350,140.00,,245,70,,196,percent of total billed charges,70% of total billed charges,350,100,,280,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,287,82,,229.6,percent of total billed charges,82% of total billed charges,297.5,85,,238,percent of total billed charges,85% of total billed charges,297.5,85,,238,percent of total billed charges,85% of total billed charges,297.5,85,,238,percent of total billed charges,85% of total billed charges,315,90,,252,percent of total billed charges,90% of total billed charges,280,80,,224,percent of total billed charges,80% of total billed charges,315,90,,252,percent of total billed charges,90% of total billed charges,262.5,75,,210,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,101.5,29,,81.2,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,234.5,67,,187.6,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,245,70,,196,percent of total billed charges,70% of total billed charges,227.5,65,,182,percent of total billed charges,65% of total billed charges,124.85,35.67,,99.88,percent of total billed charges,35.67% of total billed charges,101.5,350,
LOCKING INTERMEDULLARY PLATE,27012305,CDM,278,RC,C1713,HCPCS,outpatient,,,3698,1479.20,,2588.6,70,,2070.88,percent of total billed charges,70% of total billed charges,1941.45,52.5,,1553.16,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,3032.36,82,,2425.888,percent of total billed charges,82% of total billed charges,3143.3,85,,2514.64,percent of total billed charges,85% of total billed charges,3143.3,85,,2514.64,percent of total billed charges,85% of total billed charges,3143.3,85,,2514.64,percent of total billed charges,85% of total billed charges,3328.2,90,,2662.56,percent of total billed charges,90% of total billed charges,2958.4,80,,2366.72,percent of total billed charges,80% of total billed charges,3328.2,90,,2662.56,percent of total billed charges,90% of total billed charges,2773.5,75,,2218.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,1072.42,29,,857.936,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,2477.66,67,,1982.128,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,2588.6,70,,2070.88,percent of total billed charges,70% of total billed charges,2403.7,65,,1922.96,percent of total billed charges,65% of total billed charges,1319.08,35.67,,1055.264,percent of total billed charges,35.67% of total billed charges,1072.42,3328.2,
BIO COMPOSITE 19.5 MM,27012316,CDM,278,RC,,,outpatient,,,2089,835.60,,1462.3,70,,1169.84,percent of total billed charges,70% of total billed charges,1096.73,52.5,,877.38,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,1712.98,82,,1370.384,percent of total billed charges,82% of total billed charges,1775.65,85,,1420.52,percent of total billed charges,85% of total billed charges,1775.65,85,,1420.52,percent of total billed charges,85% of total billed charges,1775.65,85,,1420.52,percent of total billed charges,85% of total billed charges,1880.1,90,,1504.08,percent of total billed charges,90% of total billed charges,1671.2,80,,1336.96,percent of total billed charges,80% of total billed charges,1880.1,90,,1504.08,percent of total billed charges,90% of total billed charges,1566.75,75,,1253.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,605.81,29,,484.648,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1399.63,67,,1119.704,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1462.3,70,,1169.84,percent of total billed charges,70% of total billed charges,1357.85,65,,1086.28,percent of total billed charges,65% of total billed charges,745.15,35.67,,596.12,percent of total billed charges,35.67% of total billed charges,605.81,1880.1,
BIO COMPOSITE 5.5 MM SUT ANCHO,27012317,CDM,278,RC,C1713,HCPCS,outpatient,,,2014,805.60,,1409.8,70,,1127.84,percent of total billed charges,70% of total billed charges,1057.35,52.5,,845.88,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,1651.48,82,,1321.184,percent of total billed charges,82% of total billed charges,1711.9,85,,1369.52,percent of total billed charges,85% of total billed charges,1711.9,85,,1369.52,percent of total billed charges,85% of total billed charges,1711.9,85,,1369.52,percent of total billed charges,85% of total billed charges,1812.6,90,,1450.08,percent of total billed charges,90% of total billed charges,1611.2,80,,1288.96,percent of total billed charges,80% of total billed charges,1812.6,90,,1450.08,percent of total billed charges,90% of total billed charges,1510.5,75,,1208.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,584.06,29,,467.248,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1349.38,67,,1079.504,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1409.8,70,,1127.84,percent of total billed charges,70% of total billed charges,1309.1,65,,1047.28,percent of total billed charges,65% of total billed charges,718.39,35.67,,574.712,percent of total billed charges,35.67% of total billed charges,584.06,1812.6,
ALLOGRAFT BONE GRAFT PUTTY,27012323,CDM,278,RC,C9359,HCPCS,outpatient,,,2238,895.20,,1566.6,70,,1253.28,percent of total billed charges,70% of total billed charges,1174.95,52.5,,939.96,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,1835.16,82,,1468.128,percent of total billed charges,82% of total billed charges,1902.3,85,,1521.84,percent of total billed charges,85% of total billed charges,1902.3,85,,1521.84,percent of total billed charges,85% of total billed charges,1902.3,85,,1521.84,percent of total billed charges,85% of total billed charges,2014.2,90,,1611.36,percent of total billed charges,90% of total billed charges,1790.4,80,,1432.32,percent of total billed charges,80% of total billed charges,2014.2,90,,1611.36,percent of total billed charges,90% of total billed charges,1678.5,75,,1342.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,150.09,100,,,fee schedule,100% of ASC tier grouping rate,,,,,other ,not seperately reimbursable,1499.46,67,,1199.568,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1566.6,70,,1253.28,percent of total billed charges,70% of total billed charges,1454.7,65,,1163.76,percent of total billed charges,65% of total billed charges,184.61,123,,,fee schedule,123% of ASC tier grouping rate,150.09,2014.2,
CERAMENT BONE FILLER,27012324,CDM,278,RC,C9359,HCPCS,outpatient,,,3279,1311.60,,2295.3,70,,1836.24,percent of total billed charges,70% of total billed charges,1721.48,52.5,,1377.18,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,2688.78,82,,2151.024,percent of total billed charges,82% of total billed charges,2787.15,85,,2229.72,percent of total billed charges,85% of total billed charges,2787.15,85,,2229.72,percent of total billed charges,85% of total billed charges,2787.15,85,,2229.72,percent of total billed charges,85% of total billed charges,2951.1,90,,2360.88,percent of total billed charges,90% of total billed charges,2623.2,80,,2098.56,percent of total billed charges,80% of total billed charges,2951.1,90,,2360.88,percent of total billed charges,90% of total billed charges,2459.25,75,,1967.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,150.09,100,,,fee schedule,100% of ASC tier grouping rate,,,,,other ,not seperately reimbursable,2196.93,67,,1757.544,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,2295.3,70,,1836.24,percent of total billed charges,70% of total billed charges,2131.35,65,,1705.08,percent of total billed charges,65% of total billed charges,184.61,123,,,fee schedule,123% of ASC tier grouping rate,150.09,2951.1,
TECNIS DIOPTER 17.0 LENS,2701233,CDM,278,RC,C1780,HCPCS,outpatient,,,309,123.60,,216.3,70,,173.04,percent of total billed charges,70% of total billed charges,309,100,,247.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,253.38,82,,202.704,percent of total billed charges,82% of total billed charges,262.65,85,,210.12,percent of total billed charges,85% of total billed charges,262.65,85,,210.12,percent of total billed charges,85% of total billed charges,262.65,85,,210.12,percent of total billed charges,85% of total billed charges,278.1,90,,222.48,percent of total billed charges,90% of total billed charges,247.2,80,,197.76,percent of total billed charges,80% of total billed charges,278.1,90,,222.48,percent of total billed charges,90% of total billed charges,231.75,75,,185.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,89.61,29,,71.688,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,207.03,67,,165.624,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,216.3,70,,173.04,percent of total billed charges,70% of total billed charges,200.85,65,,160.68,percent of total billed charges,65% of total billed charges,110.22,35.67,,88.176,percent of total billed charges,35.67% of total billed charges,89.61,309,
TMT LEFT PLATE,27012342,CDM,278,RC,C1713,HCPCS,outpatient,,,4981,1992.40,,3486.7,70,,2789.36,percent of total billed charges,70% of total billed charges,2615.03,52.5,,2092.02,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,4084.42,82,,3267.536,percent of total billed charges,82% of total billed charges,4233.85,85,,3387.08,percent of total billed charges,85% of total billed charges,4233.85,85,,3387.08,percent of total billed charges,85% of total billed charges,4233.85,85,,3387.08,percent of total billed charges,85% of total billed charges,4482.9,90,,3586.32,percent of total billed charges,90% of total billed charges,3984.8,80,,3187.84,percent of total billed charges,80% of total billed charges,4482.9,90,,3586.32,percent of total billed charges,90% of total billed charges,3735.75,75,,2988.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,1444.49,29,,1155.592,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,3337.27,67,,2669.816,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,3486.7,70,,2789.36,percent of total billed charges,70% of total billed charges,3237.65,65,,2590.12,percent of total billed charges,65% of total billed charges,1776.72,35.67,,1421.376,percent of total billed charges,35.67% of total billed charges,1444.49,4482.9,
PLATE HOLDER WIRE,27012343,CDM,278,RC,C1713,HCPCS,outpatient,,,842,336.80,,589.4,70,,471.52,percent of total billed charges,70% of total billed charges,842,100,,673.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,690.44,82,,552.352,percent of total billed charges,82% of total billed charges,715.7,85,,572.56,percent of total billed charges,85% of total billed charges,715.7,85,,572.56,percent of total billed charges,85% of total billed charges,715.7,85,,572.56,percent of total billed charges,85% of total billed charges,757.8,90,,606.24,percent of total billed charges,90% of total billed charges,673.6,80,,538.88,percent of total billed charges,80% of total billed charges,757.8,90,,606.24,percent of total billed charges,90% of total billed charges,631.5,75,,505.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,244.18,29,,195.344,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,564.14,67,,451.312,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,589.4,70,,471.52,percent of total billed charges,70% of total billed charges,547.3,65,,437.84,percent of total billed charges,65% of total billed charges,300.34,35.67,,240.272,percent of total billed charges,35.67% of total billed charges,244.18,842,
CORTICAL SCREW,27012344,CDM,278,RC,C1713,HCPCS,outpatient,,,842,336.80,,589.4,70,,471.52,percent of total billed charges,70% of total billed charges,842,100,,673.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,690.44,82,,552.352,percent of total billed charges,82% of total billed charges,715.7,85,,572.56,percent of total billed charges,85% of total billed charges,715.7,85,,572.56,percent of total billed charges,85% of total billed charges,715.7,85,,572.56,percent of total billed charges,85% of total billed charges,757.8,90,,606.24,percent of total billed charges,90% of total billed charges,673.6,80,,538.88,percent of total billed charges,80% of total billed charges,757.8,90,,606.24,percent of total billed charges,90% of total billed charges,631.5,75,,505.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,244.18,29,,195.344,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,564.14,67,,451.312,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,589.4,70,,471.52,percent of total billed charges,70% of total billed charges,547.3,65,,437.84,percent of total billed charges,65% of total billed charges,300.34,35.67,,240.272,percent of total billed charges,35.67% of total billed charges,244.18,842,
CORTICAL SCREW,27012345,CDM,278,RC,C1713,HCPCS,outpatient,,,701,280.40,,490.7,70,,392.56,percent of total billed charges,70% of total billed charges,701,100,,560.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,574.82,82,,459.856,percent of total billed charges,82% of total billed charges,595.85,85,,476.68,percent of total billed charges,85% of total billed charges,595.85,85,,476.68,percent of total billed charges,85% of total billed charges,595.85,85,,476.68,percent of total billed charges,85% of total billed charges,630.9,90,,504.72,percent of total billed charges,90% of total billed charges,560.8,80,,448.64,percent of total billed charges,80% of total billed charges,630.9,90,,504.72,percent of total billed charges,90% of total billed charges,525.75,75,,420.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,203.29,29,,162.632,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,469.67,67,,375.736,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,490.7,70,,392.56,percent of total billed charges,70% of total billed charges,455.65,65,,364.52,percent of total billed charges,65% of total billed charges,250.05,35.67,,200.04,percent of total billed charges,35.67% of total billed charges,203.29,701,
CORTICAL SCREW,27012346,CDM,278,RC,C1713,HCPCS,outpatient,,,842,336.80,,589.4,70,,471.52,percent of total billed charges,70% of total billed charges,842,100,,673.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,690.44,82,,552.352,percent of total billed charges,82% of total billed charges,715.7,85,,572.56,percent of total billed charges,85% of total billed charges,715.7,85,,572.56,percent of total billed charges,85% of total billed charges,715.7,85,,572.56,percent of total billed charges,85% of total billed charges,757.8,90,,606.24,percent of total billed charges,90% of total billed charges,673.6,80,,538.88,percent of total billed charges,80% of total billed charges,757.8,90,,606.24,percent of total billed charges,90% of total billed charges,631.5,75,,505.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,244.18,29,,195.344,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,564.14,67,,451.312,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,589.4,70,,471.52,percent of total billed charges,70% of total billed charges,547.3,65,,437.84,percent of total billed charges,65% of total billed charges,300.34,35.67,,240.272,percent of total billed charges,35.67% of total billed charges,244.18,842,
CORTICAL SCREW,27012347,CDM,278,RC,C1713,HCPCS,outpatient,,,842,336.80,,589.4,70,,471.52,percent of total billed charges,70% of total billed charges,842,100,,673.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,690.44,82,,552.352,percent of total billed charges,82% of total billed charges,715.7,85,,572.56,percent of total billed charges,85% of total billed charges,715.7,85,,572.56,percent of total billed charges,85% of total billed charges,715.7,85,,572.56,percent of total billed charges,85% of total billed charges,757.8,90,,606.24,percent of total billed charges,90% of total billed charges,673.6,80,,538.88,percent of total billed charges,80% of total billed charges,757.8,90,,606.24,percent of total billed charges,90% of total billed charges,631.5,75,,505.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,244.18,29,,195.344,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,564.14,67,,451.312,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,589.4,70,,471.52,percent of total billed charges,70% of total billed charges,547.3,65,,437.84,percent of total billed charges,65% of total billed charges,300.34,35.67,,240.272,percent of total billed charges,35.67% of total billed charges,244.18,842,
CANCELLOUS SCREW,27012348,CDM,278,RC,C1713,HCPCS,outpatient,,,423,169.20,,296.1,70,,236.88,percent of total billed charges,70% of total billed charges,423,100,,338.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,346.86,82,,277.488,percent of total billed charges,82% of total billed charges,359.55,85,,287.64,percent of total billed charges,85% of total billed charges,359.55,85,,287.64,percent of total billed charges,85% of total billed charges,359.55,85,,287.64,percent of total billed charges,85% of total billed charges,380.7,90,,304.56,percent of total billed charges,90% of total billed charges,338.4,80,,270.72,percent of total billed charges,80% of total billed charges,380.7,90,,304.56,percent of total billed charges,90% of total billed charges,317.25,75,,253.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,122.67,29,,98.136,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,283.41,67,,226.728,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,296.1,70,,236.88,percent of total billed charges,70% of total billed charges,274.95,65,,219.96,percent of total billed charges,65% of total billed charges,150.88,35.67,,120.704,percent of total billed charges,35.67% of total billed charges,122.67,423,
CORTICAL SCREW 2.7 MM,27012349,CDM,278,RC,C1713,HCPCS,outpatient,,,842,336.80,,589.4,70,,471.52,percent of total billed charges,70% of total billed charges,842,100,,673.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,690.44,82,,552.352,percent of total billed charges,82% of total billed charges,715.7,85,,572.56,percent of total billed charges,85% of total billed charges,715.7,85,,572.56,percent of total billed charges,85% of total billed charges,715.7,85,,572.56,percent of total billed charges,85% of total billed charges,757.8,90,,606.24,percent of total billed charges,90% of total billed charges,673.6,80,,538.88,percent of total billed charges,80% of total billed charges,757.8,90,,606.24,percent of total billed charges,90% of total billed charges,631.5,75,,505.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,244.18,29,,195.344,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,564.14,67,,451.312,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,589.4,70,,471.52,percent of total billed charges,70% of total billed charges,547.3,65,,437.84,percent of total billed charges,65% of total billed charges,300.34,35.67,,240.272,percent of total billed charges,35.67% of total billed charges,244.18,842,
FIXED CORE WIRE GUID,27012355,CDM,278,RC,C1769,HCPCS,outpatient,,,212,84.80,,148.4,70,,118.72,percent of total billed charges,70% of total billed charges,212,100,,169.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,173.84,82,,139.072,percent of total billed charges,82% of total billed charges,180.2,85,,144.16,percent of total billed charges,85% of total billed charges,180.2,85,,144.16,percent of total billed charges,85% of total billed charges,180.2,85,,144.16,percent of total billed charges,85% of total billed charges,190.8,90,,152.64,percent of total billed charges,90% of total billed charges,169.6,80,,135.68,percent of total billed charges,80% of total billed charges,190.8,90,,152.64,percent of total billed charges,90% of total billed charges,159,75,,127.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,61.48,29,,49.184,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,142.04,67,,113.632,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,148.4,70,,118.72,percent of total billed charges,70% of total billed charges,137.8,65,,110.24,percent of total billed charges,65% of total billed charges,75.62,35.67,,60.496,percent of total billed charges,35.67% of total billed charges,61.48,212,
OPEN END URETERAL STENT,27012356,CDM,278,RC,C2617,HCPCS,outpatient,,,150,60.00,,105,70,,84,percent of total billed charges,70% of total billed charges,150,100,,120,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,123,82,,98.4,percent of total billed charges,82% of total billed charges,127.5,85,,102,percent of total billed charges,85% of total billed charges,127.5,85,,102,percent of total billed charges,85% of total billed charges,127.5,85,,102,percent of total billed charges,85% of total billed charges,135,90,,108,percent of total billed charges,90% of total billed charges,120,80,,96,percent of total billed charges,80% of total billed charges,135,90,,108,percent of total billed charges,90% of total billed charges,112.5,75,,90,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,43.5,29,,34.8,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,100.5,67,,80.4,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,105,70,,84,percent of total billed charges,70% of total billed charges,97.5,65,,78,percent of total billed charges,65% of total billed charges,53.51,35.67,,42.808,percent of total billed charges,35.67% of total billed charges,43.5,150,
"PLATE, VDR",27012373,CDM,278,RC,C1713,HCPCS,outpatient,,,3698,1479.20,,2588.6,70,,2070.88,percent of total billed charges,70% of total billed charges,1941.45,52.5,,1553.16,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,3032.36,82,,2425.888,percent of total billed charges,82% of total billed charges,3143.3,85,,2514.64,percent of total billed charges,85% of total billed charges,3143.3,85,,2514.64,percent of total billed charges,85% of total billed charges,3143.3,85,,2514.64,percent of total billed charges,85% of total billed charges,3328.2,90,,2662.56,percent of total billed charges,90% of total billed charges,2958.4,80,,2366.72,percent of total billed charges,80% of total billed charges,3328.2,90,,2662.56,percent of total billed charges,90% of total billed charges,2773.5,75,,2218.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,1072.42,29,,857.936,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,2477.66,67,,1982.128,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,2588.6,70,,2070.88,percent of total billed charges,70% of total billed charges,2403.7,65,,1922.96,percent of total billed charges,65% of total billed charges,1319.08,35.67,,1055.264,percent of total billed charges,35.67% of total billed charges,1072.42,3328.2,
FIRM URETERAL STENT POSITIONER,27012385,CDM,278,RC,C1758,HCPCS,outpatient,,,394,157.60,,275.8,70,,220.64,percent of total billed charges,70% of total billed charges,394,100,,315.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,323.08,82,,258.464,percent of total billed charges,82% of total billed charges,334.9,85,,267.92,percent of total billed charges,85% of total billed charges,334.9,85,,267.92,percent of total billed charges,85% of total billed charges,334.9,85,,267.92,percent of total billed charges,85% of total billed charges,354.6,90,,283.68,percent of total billed charges,90% of total billed charges,315.2,80,,252.16,percent of total billed charges,80% of total billed charges,354.6,90,,283.68,percent of total billed charges,90% of total billed charges,295.5,75,,236.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,114.26,29,,91.408,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,263.98,67,,211.184,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,275.8,70,,220.64,percent of total billed charges,70% of total billed charges,256.1,65,,204.88,percent of total billed charges,65% of total billed charges,140.54,35.67,,112.432,percent of total billed charges,35.67% of total billed charges,114.26,394,
BENTSON WIRE GUIDE,27012386,CDM,278,RC,C1769,HCPCS,outpatient,,,142,56.80,,99.4,70,,79.52,percent of total billed charges,70% of total billed charges,142,100,,113.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,116.44,82,,93.152,percent of total billed charges,82% of total billed charges,120.7,85,,96.56,percent of total billed charges,85% of total billed charges,120.7,85,,96.56,percent of total billed charges,85% of total billed charges,120.7,85,,96.56,percent of total billed charges,85% of total billed charges,127.8,90,,102.24,percent of total billed charges,90% of total billed charges,113.6,80,,90.88,percent of total billed charges,80% of total billed charges,127.8,90,,102.24,percent of total billed charges,90% of total billed charges,106.5,75,,85.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,41.18,29,,32.944,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,95.14,67,,76.112,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,99.4,70,,79.52,percent of total billed charges,70% of total billed charges,92.3,65,,73.84,percent of total billed charges,65% of total billed charges,50.65,35.67,,40.52,percent of total billed charges,35.67% of total billed charges,41.18,142,
RIGHT PLATE 3 HOLE,27012406,CDM,278,RC,C1713,HCPCS,outpatient,,,2823,1129.20,,1976.1,70,,1580.88,percent of total billed charges,70% of total billed charges,1482.08,52.5,,1185.66,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,2314.86,82,,1851.888,percent of total billed charges,82% of total billed charges,2399.55,85,,1919.64,percent of total billed charges,85% of total billed charges,2399.55,85,,1919.64,percent of total billed charges,85% of total billed charges,2399.55,85,,1919.64,percent of total billed charges,85% of total billed charges,2540.7,90,,2032.56,percent of total billed charges,90% of total billed charges,2258.4,80,,1806.72,percent of total billed charges,80% of total billed charges,2540.7,90,,2032.56,percent of total billed charges,90% of total billed charges,2117.25,75,,1693.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,818.67,29,,654.936,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1891.41,67,,1513.128,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1976.1,70,,1580.88,percent of total billed charges,70% of total billed charges,1834.95,65,,1467.96,percent of total billed charges,65% of total billed charges,1006.96,35.67,,805.568,percent of total billed charges,35.67% of total billed charges,818.67,2540.7,
RIGHT PLATE 3 HOLE,27012407,CDM,278,RC,C1713,HCPCS,outpatient,,,732,292.80,,512.4,70,,409.92,percent of total billed charges,70% of total billed charges,732,100,,585.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,600.24,82,,480.192,percent of total billed charges,82% of total billed charges,622.2,85,,497.76,percent of total billed charges,85% of total billed charges,622.2,85,,497.76,percent of total billed charges,85% of total billed charges,622.2,85,,497.76,percent of total billed charges,85% of total billed charges,658.8,90,,527.04,percent of total billed charges,90% of total billed charges,585.6,80,,468.48,percent of total billed charges,80% of total billed charges,658.8,90,,527.04,percent of total billed charges,90% of total billed charges,549,75,,439.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,212.28,29,,169.824,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,490.44,67,,392.352,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,512.4,70,,409.92,percent of total billed charges,70% of total billed charges,475.8,65,,380.64,percent of total billed charges,65% of total billed charges,261.1,35.67,,208.88,percent of total billed charges,35.67% of total billed charges,212.28,732,
SCREW 2.7 - 10 MM,27012408,CDM,278,RC,C1713,HCPCS,outpatient,,,732,292.80,,512.4,70,,409.92,percent of total billed charges,70% of total billed charges,732,100,,585.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,600.24,82,,480.192,percent of total billed charges,82% of total billed charges,622.2,85,,497.76,percent of total billed charges,85% of total billed charges,622.2,85,,497.76,percent of total billed charges,85% of total billed charges,622.2,85,,497.76,percent of total billed charges,85% of total billed charges,658.8,90,,527.04,percent of total billed charges,90% of total billed charges,585.6,80,,468.48,percent of total billed charges,80% of total billed charges,658.8,90,,527.04,percent of total billed charges,90% of total billed charges,549,75,,439.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,212.28,29,,169.824,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,490.44,67,,392.352,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,512.4,70,,409.92,percent of total billed charges,70% of total billed charges,475.8,65,,380.64,percent of total billed charges,65% of total billed charges,261.1,35.67,,208.88,percent of total billed charges,35.67% of total billed charges,212.28,732,
SCREW 2.7 MM-12 MM,27012409,CDM,278,RC,C1713,HCPCS,outpatient,,,732,292.80,,512.4,70,,409.92,percent of total billed charges,70% of total billed charges,732,100,,585.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,600.24,82,,480.192,percent of total billed charges,82% of total billed charges,622.2,85,,497.76,percent of total billed charges,85% of total billed charges,622.2,85,,497.76,percent of total billed charges,85% of total billed charges,622.2,85,,497.76,percent of total billed charges,85% of total billed charges,658.8,90,,527.04,percent of total billed charges,90% of total billed charges,585.6,80,,468.48,percent of total billed charges,80% of total billed charges,658.8,90,,527.04,percent of total billed charges,90% of total billed charges,549,75,,439.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,212.28,29,,169.824,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,490.44,67,,392.352,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,512.4,70,,409.92,percent of total billed charges,70% of total billed charges,475.8,65,,380.64,percent of total billed charges,65% of total billed charges,261.1,35.67,,208.88,percent of total billed charges,35.67% of total billed charges,212.28,732,
SCREW CANNULATED 4.0/50 MM,2701241,CDM,278,RC,C1713,HCPCS,outpatient,,,1217,486.80,,851.9,70,,681.52,percent of total billed charges,70% of total billed charges,638.93,52.5,,511.14,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,997.94,82,,798.352,percent of total billed charges,82% of total billed charges,1034.45,85,,827.56,percent of total billed charges,85% of total billed charges,1034.45,85,,827.56,percent of total billed charges,85% of total billed charges,1034.45,85,,827.56,percent of total billed charges,85% of total billed charges,1095.3,90,,876.24,percent of total billed charges,90% of total billed charges,973.6,80,,778.88,percent of total billed charges,80% of total billed charges,1095.3,90,,876.24,percent of total billed charges,90% of total billed charges,912.75,75,,730.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,352.93,29,,282.344,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,815.39,67,,652.312,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,851.9,70,,681.52,percent of total billed charges,70% of total billed charges,791.05,65,,632.84,percent of total billed charges,65% of total billed charges,434.1,35.67,,347.28,percent of total billed charges,35.67% of total billed charges,352.93,1095.3,
SCREW CANNULATED 4.0 MM,27012410,CDM,278,RC,C1713,HCPCS,outpatient,,,1278,511.20,,894.6,70,,715.68,percent of total billed charges,70% of total billed charges,670.95,52.5,,536.76,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,1047.96,82,,838.368,percent of total billed charges,82% of total billed charges,1086.3,85,,869.04,percent of total billed charges,85% of total billed charges,1086.3,85,,869.04,percent of total billed charges,85% of total billed charges,1086.3,85,,869.04,percent of total billed charges,85% of total billed charges,1150.2,90,,920.16,percent of total billed charges,90% of total billed charges,1022.4,80,,817.92,percent of total billed charges,80% of total billed charges,1150.2,90,,920.16,percent of total billed charges,90% of total billed charges,958.5,75,,766.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,370.62,29,,296.496,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,856.26,67,,685.008,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,894.6,70,,715.68,percent of total billed charges,70% of total billed charges,830.7,65,,664.56,percent of total billed charges,65% of total billed charges,455.86,35.67,,364.688,percent of total billed charges,35.67% of total billed charges,370.62,1150.2,
COMP BIO SWVLK CLD 5.5,27012466,CDM,278,RC,C1713,HCPCS,outpatient,,,1921,768.40,,1344.7,70,,1075.76,percent of total billed charges,70% of total billed charges,1008.53,52.5,,806.82,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,1575.22,82,,1260.176,percent of total billed charges,82% of total billed charges,1632.85,85,,1306.28,percent of total billed charges,85% of total billed charges,1632.85,85,,1306.28,percent of total billed charges,85% of total billed charges,1632.85,85,,1306.28,percent of total billed charges,85% of total billed charges,1728.9,90,,1383.12,percent of total billed charges,90% of total billed charges,1536.8,80,,1229.44,percent of total billed charges,80% of total billed charges,1728.9,90,,1383.12,percent of total billed charges,90% of total billed charges,1440.75,75,,1152.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,557.09,29,,445.672,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1287.07,67,,1029.656,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1344.7,70,,1075.76,percent of total billed charges,70% of total billed charges,1248.65,65,,998.92,percent of total billed charges,65% of total billed charges,685.22,35.67,,548.176,percent of total billed charges,35.67% of total billed charges,557.09,1728.9,
SYS W BIO COMP SPEEDBRG IMP,27012467,CDM,278,RC,C1713,HCPCS,outpatient,,,8337,3334.80,,5835.9,70,,4668.72,percent of total billed charges,70% of total billed charges,4376.93,52.5,,3501.54,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,6836.34,82,,5469.072,percent of total billed charges,82% of total billed charges,7086.45,85,,5669.16,percent of total billed charges,85% of total billed charges,7086.45,85,,5669.16,percent of total billed charges,85% of total billed charges,7086.45,85,,5669.16,percent of total billed charges,85% of total billed charges,7503.3,90,,6002.64,percent of total billed charges,90% of total billed charges,6669.6,80,,5335.68,percent of total billed charges,80% of total billed charges,7503.3,90,,6002.64,percent of total billed charges,90% of total billed charges,6252.75,75,,5002.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2417.73,29,,1934.184,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,5585.79,67,,4468.632,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,5835.9,70,,4668.72,percent of total billed charges,70% of total billed charges,5419.05,65,,4335.24,percent of total billed charges,65% of total billed charges,2973.81,35.67,,2379.048,percent of total billed charges,35.67% of total billed charges,2417.73,7503.3,
TEND BIO COMP  SWVLK,27012490,CDM,278,RC,C1713,HCPCS,outpatient,,,2089,835.60,,1462.3,70,,1169.84,percent of total billed charges,70% of total billed charges,1096.73,52.5,,877.38,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,1712.98,82,,1370.384,percent of total billed charges,82% of total billed charges,1775.65,85,,1420.52,percent of total billed charges,85% of total billed charges,1775.65,85,,1420.52,percent of total billed charges,85% of total billed charges,1775.65,85,,1420.52,percent of total billed charges,85% of total billed charges,1880.1,90,,1504.08,percent of total billed charges,90% of total billed charges,1671.2,80,,1336.96,percent of total billed charges,80% of total billed charges,1880.1,90,,1504.08,percent of total billed charges,90% of total billed charges,1566.75,75,,1253.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,605.81,29,,484.648,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1399.63,67,,1119.704,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1462.3,70,,1169.84,percent of total billed charges,70% of total billed charges,1357.85,65,,1086.28,percent of total billed charges,65% of total billed charges,745.15,35.67,,596.12,percent of total billed charges,35.67% of total billed charges,605.81,1880.1,
LOOP FIBER - BLUE,27012491,CDM,278,RC,C1713,HCPCS,outpatient,,,363,145.20,,254.1,70,,203.28,percent of total billed charges,70% of total billed charges,363,100,,290.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,297.66,82,,238.128,percent of total billed charges,82% of total billed charges,308.55,85,,246.84,percent of total billed charges,85% of total billed charges,308.55,85,,246.84,percent of total billed charges,85% of total billed charges,308.55,85,,246.84,percent of total billed charges,85% of total billed charges,326.7,90,,261.36,percent of total billed charges,90% of total billed charges,290.4,80,,232.32,percent of total billed charges,80% of total billed charges,326.7,90,,261.36,percent of total billed charges,90% of total billed charges,272.25,75,,217.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,105.27,29,,84.216,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,243.21,67,,194.568,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,254.1,70,,203.28,percent of total billed charges,70% of total billed charges,235.95,65,,188.76,percent of total billed charges,65% of total billed charges,129.48,35.67,,103.584,percent of total billed charges,35.67% of total billed charges,105.27,363,
SCREW CANNULATED 4.0 MM,27012513,CDM,278,RC,C1713,HCPCS,outpatient,,,1393,557.20,,975.1,70,,780.08,percent of total billed charges,70% of total billed charges,731.33,52.5,,585.06,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,1142.26,82,,913.808,percent of total billed charges,82% of total billed charges,1184.05,85,,947.24,percent of total billed charges,85% of total billed charges,1184.05,85,,947.24,percent of total billed charges,85% of total billed charges,1184.05,85,,947.24,percent of total billed charges,85% of total billed charges,1253.7,90,,1002.96,percent of total billed charges,90% of total billed charges,1114.4,80,,891.52,percent of total billed charges,80% of total billed charges,1253.7,90,,1002.96,percent of total billed charges,90% of total billed charges,1044.75,75,,835.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,403.97,29,,323.176,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,933.31,67,,746.648,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,975.1,70,,780.08,percent of total billed charges,70% of total billed charges,905.45,65,,724.36,percent of total billed charges,65% of total billed charges,496.88,35.67,,397.504,percent of total billed charges,35.67% of total billed charges,403.97,1253.7,
SCREW CANNULATED 4.0MM 30 MM,27012514,CDM,278,RC,C1713,HCPCS,outpatient,,,1366,546.40,,956.2,70,,764.96,percent of total billed charges,70% of total billed charges,717.15,52.5,,573.72,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,1120.12,82,,896.096,percent of total billed charges,82% of total billed charges,1161.1,85,,928.88,percent of total billed charges,85% of total billed charges,1161.1,85,,928.88,percent of total billed charges,85% of total billed charges,1161.1,85,,928.88,percent of total billed charges,85% of total billed charges,1229.4,90,,983.52,percent of total billed charges,90% of total billed charges,1092.8,80,,874.24,percent of total billed charges,80% of total billed charges,1229.4,90,,983.52,percent of total billed charges,90% of total billed charges,1024.5,75,,819.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,396.14,29,,316.912,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,915.22,67,,732.176,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,956.2,70,,764.96,percent of total billed charges,70% of total billed charges,887.9,65,,710.32,percent of total billed charges,65% of total billed charges,487.25,35.67,,389.8,percent of total billed charges,35.67% of total billed charges,396.14,1229.4,
SCREW CANNULATED 4.0/32 MM,27012515,CDM,278,RC,C1713,HCPCS,outpatient,,,1366,546.40,,956.2,70,,764.96,percent of total billed charges,70% of total billed charges,717.15,52.5,,573.72,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,1120.12,82,,896.096,percent of total billed charges,82% of total billed charges,1161.1,85,,928.88,percent of total billed charges,85% of total billed charges,1161.1,85,,928.88,percent of total billed charges,85% of total billed charges,1161.1,85,,928.88,percent of total billed charges,85% of total billed charges,1229.4,90,,983.52,percent of total billed charges,90% of total billed charges,1092.8,80,,874.24,percent of total billed charges,80% of total billed charges,1229.4,90,,983.52,percent of total billed charges,90% of total billed charges,1024.5,75,,819.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,396.14,29,,316.912,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,915.22,67,,732.176,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,956.2,70,,764.96,percent of total billed charges,70% of total billed charges,887.9,65,,710.32,percent of total billed charges,65% of total billed charges,487.25,35.67,,389.8,percent of total billed charges,35.67% of total billed charges,396.14,1229.4,
FOOT T PLATE,27012525,CDM,278,RC,C1713,HCPCS,outpatient,,,3976,1590.40,,2783.2,70,,2226.56,percent of total billed charges,70% of total billed charges,2087.4,52.5,,1669.92,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,3260.32,82,,2608.256,percent of total billed charges,82% of total billed charges,3379.6,85,,2703.68,percent of total billed charges,85% of total billed charges,3379.6,85,,2703.68,percent of total billed charges,85% of total billed charges,3379.6,85,,2703.68,percent of total billed charges,85% of total billed charges,3578.4,90,,2862.72,percent of total billed charges,90% of total billed charges,3180.8,80,,2544.64,percent of total billed charges,80% of total billed charges,3578.4,90,,2862.72,percent of total billed charges,90% of total billed charges,2982,75,,2385.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,1153.04,29,,922.432,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,2663.92,67,,2131.136,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,2783.2,70,,2226.56,percent of total billed charges,70% of total billed charges,2584.4,65,,2067.52,percent of total billed charges,65% of total billed charges,1418.24,35.67,,1134.592,percent of total billed charges,35.67% of total billed charges,1153.04,3578.4,
LOCK SCREW 3.0,27012526,CDM,278,RC,C1713,HCPCS,outpatient,,,842,336.80,,589.4,70,,471.52,percent of total billed charges,70% of total billed charges,842,100,,673.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,690.44,82,,552.352,percent of total billed charges,82% of total billed charges,715.7,85,,572.56,percent of total billed charges,85% of total billed charges,715.7,85,,572.56,percent of total billed charges,85% of total billed charges,715.7,85,,572.56,percent of total billed charges,85% of total billed charges,757.8,90,,606.24,percent of total billed charges,90% of total billed charges,673.6,80,,538.88,percent of total billed charges,80% of total billed charges,757.8,90,,606.24,percent of total billed charges,90% of total billed charges,631.5,75,,505.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,244.18,29,,195.344,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,564.14,67,,451.312,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,589.4,70,,471.52,percent of total billed charges,70% of total billed charges,547.3,65,,437.84,percent of total billed charges,65% of total billed charges,300.34,35.67,,240.272,percent of total billed charges,35.67% of total billed charges,244.18,842,
SCREW CORT 30 2.7,27012527,CDM,278,RC,C1713,HCPCS,outpatient,,,561,224.40,,392.7,70,,314.16,percent of total billed charges,70% of total billed charges,561,100,,448.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,460.02,82,,368.016,percent of total billed charges,82% of total billed charges,476.85,85,,381.48,percent of total billed charges,85% of total billed charges,476.85,85,,381.48,percent of total billed charges,85% of total billed charges,476.85,85,,381.48,percent of total billed charges,85% of total billed charges,504.9,90,,403.92,percent of total billed charges,90% of total billed charges,448.8,80,,359.04,percent of total billed charges,80% of total billed charges,504.9,90,,403.92,percent of total billed charges,90% of total billed charges,420.75,75,,336.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,162.69,29,,130.152,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,375.87,67,,300.696,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,392.7,70,,314.16,percent of total billed charges,70% of total billed charges,364.65,65,,291.72,percent of total billed charges,65% of total billed charges,200.11,35.67,,160.088,percent of total billed charges,35.67% of total billed charges,162.69,561,
WIRE K 2.0,27012529,CDM,278,RC,C1713,HCPCS,outpatient,,,423,169.20,,296.1,70,,236.88,percent of total billed charges,70% of total billed charges,423,100,,338.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,346.86,82,,277.488,percent of total billed charges,82% of total billed charges,359.55,85,,287.64,percent of total billed charges,85% of total billed charges,359.55,85,,287.64,percent of total billed charges,85% of total billed charges,359.55,85,,287.64,percent of total billed charges,85% of total billed charges,380.7,90,,304.56,percent of total billed charges,90% of total billed charges,338.4,80,,270.72,percent of total billed charges,80% of total billed charges,380.7,90,,304.56,percent of total billed charges,90% of total billed charges,317.25,75,,253.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,122.67,29,,98.136,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,283.41,67,,226.728,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,296.1,70,,236.88,percent of total billed charges,70% of total billed charges,274.95,65,,219.96,percent of total billed charges,65% of total billed charges,150.88,35.67,,120.704,percent of total billed charges,35.67% of total billed charges,122.67,423,
LOCKING SCREW 20 3.0,27012530,CDM,278,RC,C1713,HCPCS,outpatient,,,842,336.80,,589.4,70,,471.52,percent of total billed charges,70% of total billed charges,842,100,,673.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,690.44,82,,552.352,percent of total billed charges,82% of total billed charges,715.7,85,,572.56,percent of total billed charges,85% of total billed charges,715.7,85,,572.56,percent of total billed charges,85% of total billed charges,715.7,85,,572.56,percent of total billed charges,85% of total billed charges,757.8,90,,606.24,percent of total billed charges,90% of total billed charges,673.6,80,,538.88,percent of total billed charges,80% of total billed charges,757.8,90,,606.24,percent of total billed charges,90% of total billed charges,631.5,75,,505.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,244.18,29,,195.344,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,564.14,67,,451.312,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,589.4,70,,471.52,percent of total billed charges,70% of total billed charges,547.3,65,,437.84,percent of total billed charges,65% of total billed charges,300.34,35.67,,240.272,percent of total billed charges,35.67% of total billed charges,244.18,842,
SCREW CORTICAL 28 2.7,27012531,CDM,278,RC,C1713,HCPCS,outpatient,,,842,336.80,,589.4,70,,471.52,percent of total billed charges,70% of total billed charges,842,100,,673.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,690.44,82,,552.352,percent of total billed charges,82% of total billed charges,715.7,85,,572.56,percent of total billed charges,85% of total billed charges,715.7,85,,572.56,percent of total billed charges,85% of total billed charges,715.7,85,,572.56,percent of total billed charges,85% of total billed charges,757.8,90,,606.24,percent of total billed charges,90% of total billed charges,673.6,80,,538.88,percent of total billed charges,80% of total billed charges,757.8,90,,606.24,percent of total billed charges,90% of total billed charges,631.5,75,,505.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,244.18,29,,195.344,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,564.14,67,,451.312,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,589.4,70,,471.52,percent of total billed charges,70% of total billed charges,547.3,65,,437.84,percent of total billed charges,65% of total billed charges,300.34,35.67,,240.272,percent of total billed charges,35.67% of total billed charges,244.18,842,
PLATE L,27012605,CDM,278,RC,C1713,HCPCS,outpatient,,,3976,1590.40,,2783.2,70,,2226.56,percent of total billed charges,70% of total billed charges,2087.4,52.5,,1669.92,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,3260.32,82,,2608.256,percent of total billed charges,82% of total billed charges,3379.6,85,,2703.68,percent of total billed charges,85% of total billed charges,3379.6,85,,2703.68,percent of total billed charges,85% of total billed charges,3379.6,85,,2703.68,percent of total billed charges,85% of total billed charges,3578.4,90,,2862.72,percent of total billed charges,90% of total billed charges,3180.8,80,,2544.64,percent of total billed charges,80% of total billed charges,3578.4,90,,2862.72,percent of total billed charges,90% of total billed charges,2982,75,,2385.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,1153.04,29,,922.432,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,2663.92,67,,2131.136,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,2783.2,70,,2226.56,percent of total billed charges,70% of total billed charges,2584.4,65,,2067.52,percent of total billed charges,65% of total billed charges,1418.24,35.67,,1134.592,percent of total billed charges,35.67% of total billed charges,1153.04,3578.4,
LOCKING SCREW 16 MM 3.0,27012607,CDM,278,RC,C1713,HCPCS,outpatient,,,804,321.60,,562.8,70,,450.24,percent of total billed charges,70% of total billed charges,804,100,,643.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,659.28,82,,527.424,percent of total billed charges,82% of total billed charges,683.4,85,,546.72,percent of total billed charges,85% of total billed charges,683.4,85,,546.72,percent of total billed charges,85% of total billed charges,683.4,85,,546.72,percent of total billed charges,85% of total billed charges,723.6,90,,578.88,percent of total billed charges,90% of total billed charges,643.2,80,,514.56,percent of total billed charges,80% of total billed charges,723.6,90,,578.88,percent of total billed charges,90% of total billed charges,603,75,,482.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,233.16,29,,186.528,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,538.68,67,,430.944,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,562.8,70,,450.24,percent of total billed charges,70% of total billed charges,522.6,65,,418.08,percent of total billed charges,65% of total billed charges,286.79,35.67,,229.432,percent of total billed charges,35.67% of total billed charges,233.16,804,
CORTICAL SCREW 18 2.8,27012608,CDM,278,RC,C1713,HCPCS,outpatient,,,701,280.40,,490.7,70,,392.56,percent of total billed charges,70% of total billed charges,701,100,,560.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,574.82,82,,459.856,percent of total billed charges,82% of total billed charges,595.85,85,,476.68,percent of total billed charges,85% of total billed charges,595.85,85,,476.68,percent of total billed charges,85% of total billed charges,595.85,85,,476.68,percent of total billed charges,85% of total billed charges,630.9,90,,504.72,percent of total billed charges,90% of total billed charges,560.8,80,,448.64,percent of total billed charges,80% of total billed charges,630.9,90,,504.72,percent of total billed charges,90% of total billed charges,525.75,75,,420.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,203.29,29,,162.632,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,469.67,67,,375.736,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,490.7,70,,392.56,percent of total billed charges,70% of total billed charges,455.65,65,,364.52,percent of total billed charges,65% of total billed charges,250.05,35.67,,200.04,percent of total billed charges,35.67% of total billed charges,203.29,701,
CORTICAL SCREW 12  2.7,27012609,CDM,278,RC,C1713,HCPCS,outpatient,,,701,280.40,,490.7,70,,392.56,percent of total billed charges,70% of total billed charges,701,100,,560.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,574.82,82,,459.856,percent of total billed charges,82% of total billed charges,595.85,85,,476.68,percent of total billed charges,85% of total billed charges,595.85,85,,476.68,percent of total billed charges,85% of total billed charges,595.85,85,,476.68,percent of total billed charges,85% of total billed charges,630.9,90,,504.72,percent of total billed charges,90% of total billed charges,560.8,80,,448.64,percent of total billed charges,80% of total billed charges,630.9,90,,504.72,percent of total billed charges,90% of total billed charges,525.75,75,,420.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,203.29,29,,162.632,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,469.67,67,,375.736,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,490.7,70,,392.56,percent of total billed charges,70% of total billed charges,455.65,65,,364.52,percent of total billed charges,65% of total billed charges,250.05,35.67,,200.04,percent of total billed charges,35.67% of total billed charges,203.29,701,
SEPRAFILM ADHESIVE BARRIER,27012641,CDM,278,RC,C1765,HCPCS,outpatient,,,1244,497.60,,870.8,70,,696.64,percent of total billed charges,70% of total billed charges,653.1,52.5,,522.48,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,1020.08,82,,816.064,percent of total billed charges,82% of total billed charges,1057.4,85,,845.92,percent of total billed charges,85% of total billed charges,1057.4,85,,845.92,percent of total billed charges,85% of total billed charges,1057.4,85,,845.92,percent of total billed charges,85% of total billed charges,1119.6,90,,895.68,percent of total billed charges,90% of total billed charges,995.2,80,,796.16,percent of total billed charges,80% of total billed charges,1119.6,90,,895.68,percent of total billed charges,90% of total billed charges,933,75,,746.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,360.76,29,,288.608,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,833.48,67,,666.784,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,870.8,70,,696.64,percent of total billed charges,70% of total billed charges,808.6,65,,646.88,percent of total billed charges,65% of total billed charges,443.73,35.67,,354.984,percent of total billed charges,35.67% of total billed charges,360.76,1119.6,
SCREW CORTICAL 3.5 MM,27012644,CDM,278,RC,C1713,HCPCS,outpatient,,,842,336.80,,589.4,70,,471.52,percent of total billed charges,70% of total billed charges,842,100,,673.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,690.44,82,,552.352,percent of total billed charges,82% of total billed charges,715.7,85,,572.56,percent of total billed charges,85% of total billed charges,715.7,85,,572.56,percent of total billed charges,85% of total billed charges,715.7,85,,572.56,percent of total billed charges,85% of total billed charges,757.8,90,,606.24,percent of total billed charges,90% of total billed charges,673.6,80,,538.88,percent of total billed charges,80% of total billed charges,757.8,90,,606.24,percent of total billed charges,90% of total billed charges,631.5,75,,505.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,244.18,29,,195.344,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,564.14,67,,451.312,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,589.4,70,,471.52,percent of total billed charges,70% of total billed charges,547.3,65,,437.84,percent of total billed charges,65% of total billed charges,300.34,35.67,,240.272,percent of total billed charges,35.67% of total billed charges,244.18,842,
SCREW CORTICAL 24 MM,27012656,CDM,278,RC,C1713,HCPCS,outpatient,,,842,336.80,,589.4,70,,471.52,percent of total billed charges,70% of total billed charges,842,100,,673.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,690.44,82,,552.352,percent of total billed charges,82% of total billed charges,715.7,85,,572.56,percent of total billed charges,85% of total billed charges,715.7,85,,572.56,percent of total billed charges,85% of total billed charges,715.7,85,,572.56,percent of total billed charges,85% of total billed charges,757.8,90,,606.24,percent of total billed charges,90% of total billed charges,673.6,80,,538.88,percent of total billed charges,80% of total billed charges,757.8,90,,606.24,percent of total billed charges,90% of total billed charges,631.5,75,,505.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,244.18,29,,195.344,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,564.14,67,,451.312,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,589.4,70,,471.52,percent of total billed charges,70% of total billed charges,547.3,65,,437.84,percent of total billed charges,65% of total billed charges,300.34,35.67,,240.272,percent of total billed charges,35.67% of total billed charges,244.18,842,
MESH,27012663,CDM,278,RC,C1781,HCPCS,outpatient,,,6153,2461.20,,4307.1,70,,3445.68,percent of total billed charges,70% of total billed charges,3230.33,52.5,,2584.26,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,5045.46,82,,4036.368,percent of total billed charges,82% of total billed charges,5230.05,85,,4184.04,percent of total billed charges,85% of total billed charges,5230.05,85,,4184.04,percent of total billed charges,85% of total billed charges,5230.05,85,,4184.04,percent of total billed charges,85% of total billed charges,5537.7,90,,4430.16,percent of total billed charges,90% of total billed charges,4922.4,80,,3937.92,percent of total billed charges,80% of total billed charges,5537.7,90,,4430.16,percent of total billed charges,90% of total billed charges,4614.75,75,,3691.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,1784.37,29,,1427.496,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4122.51,67,,3298.008,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,4307.1,70,,3445.68,percent of total billed charges,70% of total billed charges,3999.45,65,,3199.56,percent of total billed charges,65% of total billed charges,2194.78,35.67,,1755.824,percent of total billed charges,35.67% of total billed charges,1784.37,5537.7,
MESH ELLIPSE 8 X 10,27012665,CDM,278,RC,C1781,HCPCS,outpatient,,,6772,2708.80,,4740.4,70,,3792.32,percent of total billed charges,70% of total billed charges,3555.3,52.5,,2844.24,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,5553.04,82,,4442.432,percent of total billed charges,82% of total billed charges,5756.2,85,,4604.96,percent of total billed charges,85% of total billed charges,5756.2,85,,4604.96,percent of total billed charges,85% of total billed charges,5756.2,85,,4604.96,percent of total billed charges,85% of total billed charges,6094.8,90,,4875.84,percent of total billed charges,90% of total billed charges,5417.6,80,,4334.08,percent of total billed charges,80% of total billed charges,6094.8,90,,4875.84,percent of total billed charges,90% of total billed charges,5079,75,,4063.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,1963.88,29,,1571.104,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4537.24,67,,3629.792,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,4740.4,70,,3792.32,percent of total billed charges,70% of total billed charges,4401.8,65,,3521.44,percent of total billed charges,65% of total billed charges,2415.57,35.67,,1932.456,percent of total billed charges,35.67% of total billed charges,1963.88,6094.8,
POWER IMPLANTABLE PORT,27012666,CDM,278,RC,C1788,HCPCS,outpatient,,,3433,1373.20,,2403.1,70,,1922.48,percent of total billed charges,70% of total billed charges,1802.33,52.5,,1441.86,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,2815.06,82,,2252.048,percent of total billed charges,82% of total billed charges,2918.05,85,,2334.44,percent of total billed charges,85% of total billed charges,2918.05,85,,2334.44,percent of total billed charges,85% of total billed charges,2918.05,85,,2334.44,percent of total billed charges,85% of total billed charges,3089.7,90,,2471.76,percent of total billed charges,90% of total billed charges,2746.4,80,,2197.12,percent of total billed charges,80% of total billed charges,3089.7,90,,2471.76,percent of total billed charges,90% of total billed charges,2574.75,75,,2059.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,995.57,29,,796.456,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,2300.11,67,,1840.088,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,2403.1,70,,1922.48,percent of total billed charges,70% of total billed charges,2231.45,65,,1785.16,percent of total billed charges,65% of total billed charges,1224.55,35.67,,979.64,percent of total billed charges,35.67% of total billed charges,995.57,3089.7,
POWER PORT IMPLANTABLE,27012667,CDM,278,RC,C1788,HCPCS,outpatient,,,3667,1466.80,,2566.9,70,,2053.52,percent of total billed charges,70% of total billed charges,1925.18,52.5,,1540.14,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,3006.94,82,,2405.552,percent of total billed charges,82% of total billed charges,3116.95,85,,2493.56,percent of total billed charges,85% of total billed charges,3116.95,85,,2493.56,percent of total billed charges,85% of total billed charges,3116.95,85,,2493.56,percent of total billed charges,85% of total billed charges,3300.3,90,,2640.24,percent of total billed charges,90% of total billed charges,2933.6,80,,2346.88,percent of total billed charges,80% of total billed charges,3300.3,90,,2640.24,percent of total billed charges,90% of total billed charges,2750.25,75,,2200.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,1063.43,29,,850.744,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,2456.89,67,,1965.512,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,2566.9,70,,2053.52,percent of total billed charges,70% of total billed charges,2383.55,65,,1906.84,percent of total billed charges,65% of total billed charges,1308.02,35.67,,1046.416,percent of total billed charges,35.67% of total billed charges,1063.43,3300.3,
CAPSURE PERMANENT FIXATION,27012674,CDM,278,RC,C1781,HCPCS,outpatient,,,2155,862.00,,1508.5,70,,1206.8,percent of total billed charges,70% of total billed charges,1131.38,52.5,,905.1,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,1767.1,82,,1413.68,percent of total billed charges,82% of total billed charges,1831.75,85,,1465.4,percent of total billed charges,85% of total billed charges,1831.75,85,,1465.4,percent of total billed charges,85% of total billed charges,1831.75,85,,1465.4,percent of total billed charges,85% of total billed charges,1939.5,90,,1551.6,percent of total billed charges,90% of total billed charges,1724,80,,1379.2,percent of total billed charges,80% of total billed charges,1939.5,90,,1551.6,percent of total billed charges,90% of total billed charges,1616.25,75,,1293,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,624.95,29,,499.96,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1443.85,67,,1155.08,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1508.5,70,,1206.8,percent of total billed charges,70% of total billed charges,1400.75,65,,1120.6,percent of total billed charges,65% of total billed charges,768.69,35.67,,614.952,percent of total billed charges,35.67% of total billed charges,624.95,1939.5,
SECURE STRAP FIXATION DEVICE,27012675,CDM,278,RC,C1781,HCPCS,outpatient,,,2099,839.60,,1469.3,70,,1175.44,percent of total billed charges,70% of total billed charges,1101.98,52.5,,881.58,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,1721.18,82,,1376.944,percent of total billed charges,82% of total billed charges,1784.15,85,,1427.32,percent of total billed charges,85% of total billed charges,1784.15,85,,1427.32,percent of total billed charges,85% of total billed charges,1784.15,85,,1427.32,percent of total billed charges,85% of total billed charges,1889.1,90,,1511.28,percent of total billed charges,90% of total billed charges,1679.2,80,,1343.36,percent of total billed charges,80% of total billed charges,1889.1,90,,1511.28,percent of total billed charges,90% of total billed charges,1574.25,75,,1259.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,608.71,29,,486.968,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1406.33,67,,1125.064,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1469.3,70,,1175.44,percent of total billed charges,70% of total billed charges,1364.35,65,,1091.48,percent of total billed charges,65% of total billed charges,748.71,35.67,,598.968,percent of total billed charges,35.67% of total billed charges,608.71,1889.1,
PLATE RIGHT NARROW SHORT,27012688,CDM,278,RC,C1713,HCPCS,outpatient,,,3508,1403.20,,2455.6,70,,1964.48,percent of total billed charges,70% of total billed charges,1841.7,52.5,,1473.36,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,2876.56,82,,2301.248,percent of total billed charges,82% of total billed charges,2981.8,85,,2385.44,percent of total billed charges,85% of total billed charges,2981.8,85,,2385.44,percent of total billed charges,85% of total billed charges,2981.8,85,,2385.44,percent of total billed charges,85% of total billed charges,3157.2,90,,2525.76,percent of total billed charges,90% of total billed charges,2806.4,80,,2245.12,percent of total billed charges,80% of total billed charges,3157.2,90,,2525.76,percent of total billed charges,90% of total billed charges,2631,75,,2104.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,1017.32,29,,813.856,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,2350.36,67,,1880.288,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,2455.6,70,,1964.48,percent of total billed charges,70% of total billed charges,2280.2,65,,1824.16,percent of total billed charges,65% of total billed charges,1251.3,35.67,,1001.04,percent of total billed charges,35.67% of total billed charges,1017.32,3157.2,
WASHER,27012743,CDM,278,RC,C1713,HCPCS,outpatient,,,254,101.60,,177.8,70,,142.24,percent of total billed charges,70% of total billed charges,254,100,,203.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,208.28,82,,166.624,percent of total billed charges,82% of total billed charges,215.9,85,,172.72,percent of total billed charges,85% of total billed charges,215.9,85,,172.72,percent of total billed charges,85% of total billed charges,215.9,85,,172.72,percent of total billed charges,85% of total billed charges,228.6,90,,182.88,percent of total billed charges,90% of total billed charges,203.2,80,,162.56,percent of total billed charges,80% of total billed charges,228.6,90,,182.88,percent of total billed charges,90% of total billed charges,190.5,75,,152.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,73.66,29,,58.928,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,170.18,67,,136.144,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,177.8,70,,142.24,percent of total billed charges,70% of total billed charges,165.1,65,,132.08,percent of total billed charges,65% of total billed charges,90.6,35.67,,72.48,percent of total billed charges,35.67% of total billed charges,73.66,254,
RIGHT FIB PLATE,27012744,CDM,278,RC,C1713,HCPCS,outpatient,,,3070,1228.00,,2149,70,,1719.2,percent of total billed charges,70% of total billed charges,1611.75,52.5,,1289.4,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,2517.4,82,,2013.92,percent of total billed charges,82% of total billed charges,2609.5,85,,2087.6,percent of total billed charges,85% of total billed charges,2609.5,85,,2087.6,percent of total billed charges,85% of total billed charges,2609.5,85,,2087.6,percent of total billed charges,85% of total billed charges,2763,90,,2210.4,percent of total billed charges,90% of total billed charges,2456,80,,1964.8,percent of total billed charges,80% of total billed charges,2763,90,,2210.4,percent of total billed charges,90% of total billed charges,2302.5,75,,1842,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,890.3,29,,712.24,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,2056.9,67,,1645.52,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,2149,70,,1719.2,percent of total billed charges,70% of total billed charges,1995.5,65,,1596.4,percent of total billed charges,65% of total billed charges,1095.07,35.67,,876.056,percent of total billed charges,35.67% of total billed charges,890.3,2763,
STEM 12 MM,27012745,CDM,278,RC,C1713,HCPCS,outpatient,,,18058,7223.20,,12640.6,70,,10112.48,percent of total billed charges,70% of total billed charges,9480.45,52.5,,7584.36,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,14807.56,82,,11846.048,percent of total billed charges,82% of total billed charges,15349.3,85,,12279.44,percent of total billed charges,85% of total billed charges,15349.3,85,,12279.44,percent of total billed charges,85% of total billed charges,15349.3,85,,12279.44,percent of total billed charges,85% of total billed charges,16252.2,90,,13001.76,percent of total billed charges,90% of total billed charges,14446.4,80,,11557.12,percent of total billed charges,80% of total billed charges,16252.2,90,,13001.76,percent of total billed charges,90% of total billed charges,13543.5,75,,10834.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,5236.82,29,,4189.456,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,12098.86,67,,9679.088,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,12640.6,70,,10112.48,percent of total billed charges,70% of total billed charges,11737.7,65,,9390.16,percent of total billed charges,65% of total billed charges,6441.29,35.67,,5153.032,percent of total billed charges,35.67% of total billed charges,5236.82,16252.2,
HEAD 42 X 18 MM,27012746,CDM,278,RC,C1713,HCPCS,outpatient,,,7762,3104.80,,5433.4,70,,4346.72,percent of total billed charges,70% of total billed charges,4075.05,52.5,,3260.04,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,6364.84,82,,5091.872,percent of total billed charges,82% of total billed charges,6597.7,85,,5278.16,percent of total billed charges,85% of total billed charges,6597.7,85,,5278.16,percent of total billed charges,85% of total billed charges,6597.7,85,,5278.16,percent of total billed charges,85% of total billed charges,6985.8,90,,5588.64,percent of total billed charges,90% of total billed charges,6209.6,80,,4967.68,percent of total billed charges,80% of total billed charges,6985.8,90,,5588.64,percent of total billed charges,90% of total billed charges,5821.5,75,,4657.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2250.98,29,,1800.784,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,5200.54,67,,4160.432,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,5433.4,70,,4346.72,percent of total billed charges,70% of total billed charges,5045.3,65,,4036.24,percent of total billed charges,65% of total billed charges,2768.71,35.67,,2214.968,percent of total billed charges,35.67% of total billed charges,2250.98,6985.8,
ADAPTER,27012747,CDM,278,RC,C1713,HCPCS,outpatient,,,1100,440.00,,770,70,,616,percent of total billed charges,70% of total billed charges,577.5,52.5,,462,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,902,82,,721.6,percent of total billed charges,82% of total billed charges,935,85,,748,percent of total billed charges,85% of total billed charges,935,85,,748,percent of total billed charges,85% of total billed charges,935,85,,748,percent of total billed charges,85% of total billed charges,990,90,,792,percent of total billed charges,90% of total billed charges,880,80,,704,percent of total billed charges,80% of total billed charges,990,90,,792,percent of total billed charges,90% of total billed charges,825,75,,660,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,319,29,,255.2,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,737,67,,589.6,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,770,70,,616,percent of total billed charges,70% of total billed charges,715,65,,572,percent of total billed charges,65% of total billed charges,392.37,35.67,,313.896,percent of total billed charges,35.67% of total billed charges,319,990,
CEMENT PLUG,27012748,CDM,278,RC,,,outpatient,,,772,308.80,,540.4,70,,432.32,percent of total billed charges,70% of total billed charges,772,100,,617.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,633.04,82,,506.432,percent of total billed charges,82% of total billed charges,656.2,85,,524.96,percent of total billed charges,85% of total billed charges,656.2,85,,524.96,percent of total billed charges,85% of total billed charges,656.2,85,,524.96,percent of total billed charges,85% of total billed charges,694.8,90,,555.84,percent of total billed charges,90% of total billed charges,617.6,80,,494.08,percent of total billed charges,80% of total billed charges,694.8,90,,555.84,percent of total billed charges,90% of total billed charges,579,75,,463.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,223.88,29,,179.104,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,517.24,67,,413.792,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,540.4,70,,432.32,percent of total billed charges,70% of total billed charges,501.8,65,,401.44,percent of total billed charges,65% of total billed charges,275.37,35.67,,220.296,percent of total billed charges,35.67% of total billed charges,223.88,772,
CALIBRATED K WIRE,27012771,CDM,278,RC,C1713,HCPCS,outpatient,,,357,142.80,,249.9,70,,199.92,percent of total billed charges,70% of total billed charges,357,100,,285.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,292.74,82,,234.192,percent of total billed charges,82% of total billed charges,303.45,85,,242.76,percent of total billed charges,85% of total billed charges,303.45,85,,242.76,percent of total billed charges,85% of total billed charges,303.45,85,,242.76,percent of total billed charges,85% of total billed charges,321.3,90,,257.04,percent of total billed charges,90% of total billed charges,285.6,80,,228.48,percent of total billed charges,80% of total billed charges,321.3,90,,257.04,percent of total billed charges,90% of total billed charges,267.75,75,,214.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,103.53,29,,82.824,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,239.19,67,,191.352,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,249.9,70,,199.92,percent of total billed charges,70% of total billed charges,232.05,65,,185.64,percent of total billed charges,65% of total billed charges,127.34,35.67,,101.872,percent of total billed charges,35.67% of total billed charges,103.53,357,
PEG TUBE KIT,27012780,CDM,278,RC,C1769,HCPCS,outpatient,,,2028,811.20,,1419.6,70,,1135.68,percent of total billed charges,70% of total billed charges,1064.7,52.5,,851.76,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,1662.96,82,,1330.368,percent of total billed charges,82% of total billed charges,1723.8,85,,1379.04,percent of total billed charges,85% of total billed charges,1723.8,85,,1379.04,percent of total billed charges,85% of total billed charges,1723.8,85,,1379.04,percent of total billed charges,85% of total billed charges,1825.2,90,,1460.16,percent of total billed charges,90% of total billed charges,1622.4,80,,1297.92,percent of total billed charges,80% of total billed charges,1825.2,90,,1460.16,percent of total billed charges,90% of total billed charges,1521,75,,1216.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,588.12,29,,470.496,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1358.76,67,,1087.008,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1419.6,70,,1135.68,percent of total billed charges,70% of total billed charges,1318.2,65,,1054.56,percent of total billed charges,65% of total billed charges,723.39,35.67,,578.712,percent of total billed charges,35.67% of total billed charges,588.12,1825.2,
SILASTIC IMPLANT,27012791,CDM,278,RC,C1713,HCPCS,outpatient,,,3621,1448.40,,2534.7,70,,2027.76,percent of total billed charges,70% of total billed charges,1901.03,52.5,,1520.82,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,2969.22,82,,2375.376,percent of total billed charges,82% of total billed charges,3077.85,85,,2462.28,percent of total billed charges,85% of total billed charges,3077.85,85,,2462.28,percent of total billed charges,85% of total billed charges,3077.85,85,,2462.28,percent of total billed charges,85% of total billed charges,3258.9,90,,2607.12,percent of total billed charges,90% of total billed charges,2896.8,80,,2317.44,percent of total billed charges,80% of total billed charges,3258.9,90,,2607.12,percent of total billed charges,90% of total billed charges,2715.75,75,,2172.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,1050.09,29,,840.072,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,2426.07,67,,1940.856,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,2534.7,70,,2027.76,percent of total billed charges,70% of total billed charges,2353.65,65,,1882.92,percent of total billed charges,65% of total billed charges,1291.61,35.67,,1033.288,percent of total billed charges,35.67% of total billed charges,1050.09,3258.9,
PLATE LEFT SHORT,27012841,CDM,278,RC,C1713,HCPCS,outpatient,,,3508,1403.20,,2455.6,70,,1964.48,percent of total billed charges,70% of total billed charges,1841.7,52.5,,1473.36,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,2876.56,82,,2301.248,percent of total billed charges,82% of total billed charges,2981.8,85,,2385.44,percent of total billed charges,85% of total billed charges,2981.8,85,,2385.44,percent of total billed charges,85% of total billed charges,2981.8,85,,2385.44,percent of total billed charges,85% of total billed charges,3157.2,90,,2525.76,percent of total billed charges,90% of total billed charges,2806.4,80,,2245.12,percent of total billed charges,80% of total billed charges,3157.2,90,,2525.76,percent of total billed charges,90% of total billed charges,2631,75,,2104.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,1017.32,29,,813.856,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,2350.36,67,,1880.288,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,2455.6,70,,1964.48,percent of total billed charges,70% of total billed charges,2280.2,65,,1824.16,percent of total billed charges,65% of total billed charges,1251.3,35.67,,1001.04,percent of total billed charges,35.67% of total billed charges,1017.32,3157.2,
K WIRE,27012888,CDM,278,RC,C1713,HCPCS,outpatient,,,245,98.00,,171.5,70,,137.2,percent of total billed charges,70% of total billed charges,245,100,,196,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,200.9,82,,160.72,percent of total billed charges,82% of total billed charges,208.25,85,,166.6,percent of total billed charges,85% of total billed charges,208.25,85,,166.6,percent of total billed charges,85% of total billed charges,208.25,85,,166.6,percent of total billed charges,85% of total billed charges,220.5,90,,176.4,percent of total billed charges,90% of total billed charges,196,80,,156.8,percent of total billed charges,80% of total billed charges,220.5,90,,176.4,percent of total billed charges,90% of total billed charges,183.75,75,,147,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,71.05,29,,56.84,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,164.15,67,,131.32,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,171.5,70,,137.2,percent of total billed charges,70% of total billed charges,159.25,65,,127.4,percent of total billed charges,65% of total billed charges,87.39,35.67,,69.912,percent of total billed charges,35.67% of total billed charges,71.05,245,
COMPRESSION SCREW,27012891,CDM,278,RC,C1713,HCPCS,outpatient,,,1729,691.60,,1210.3,70,,968.24,percent of total billed charges,70% of total billed charges,907.73,52.5,,726.18,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,1417.78,82,,1134.224,percent of total billed charges,82% of total billed charges,1469.65,85,,1175.72,percent of total billed charges,85% of total billed charges,1469.65,85,,1175.72,percent of total billed charges,85% of total billed charges,1469.65,85,,1175.72,percent of total billed charges,85% of total billed charges,1556.1,90,,1244.88,percent of total billed charges,90% of total billed charges,1383.2,80,,1106.56,percent of total billed charges,80% of total billed charges,1556.1,90,,1244.88,percent of total billed charges,90% of total billed charges,1296.75,75,,1037.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,501.41,29,,401.128,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1158.43,67,,926.744,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1210.3,70,,968.24,percent of total billed charges,70% of total billed charges,1123.85,65,,899.08,percent of total billed charges,65% of total billed charges,616.73,35.67,,493.384,percent of total billed charges,35.67% of total billed charges,501.41,1556.1,
LOCKING SCREW,27012893,CDM,278,RC,C1713,HCPCS,outpatient,,,712,284.80,,498.4,70,,398.72,percent of total billed charges,70% of total billed charges,712,100,,569.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,583.84,82,,467.072,percent of total billed charges,82% of total billed charges,605.2,85,,484.16,percent of total billed charges,85% of total billed charges,605.2,85,,484.16,percent of total billed charges,85% of total billed charges,605.2,85,,484.16,percent of total billed charges,85% of total billed charges,640.8,90,,512.64,percent of total billed charges,90% of total billed charges,569.6,80,,455.68,percent of total billed charges,80% of total billed charges,640.8,90,,512.64,percent of total billed charges,90% of total billed charges,534,75,,427.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,206.48,29,,165.184,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,477.04,67,,381.632,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,498.4,70,,398.72,percent of total billed charges,70% of total billed charges,462.8,65,,370.24,percent of total billed charges,65% of total billed charges,253.97,35.67,,203.176,percent of total billed charges,35.67% of total billed charges,206.48,712,
SCREW CORTEX,27012901,CDM,278,RC,C1713,HCPCS,outpatient,,,374,149.60,,261.8,70,,209.44,percent of total billed charges,70% of total billed charges,374,100,,299.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,306.68,82,,245.344,percent of total billed charges,82% of total billed charges,317.9,85,,254.32,percent of total billed charges,85% of total billed charges,317.9,85,,254.32,percent of total billed charges,85% of total billed charges,317.9,85,,254.32,percent of total billed charges,85% of total billed charges,336.6,90,,269.28,percent of total billed charges,90% of total billed charges,299.2,80,,239.36,percent of total billed charges,80% of total billed charges,336.6,90,,269.28,percent of total billed charges,90% of total billed charges,280.5,75,,224.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,108.46,29,,86.768,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,250.58,67,,200.464,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,261.8,70,,209.44,percent of total billed charges,70% of total billed charges,243.1,65,,194.48,percent of total billed charges,65% of total billed charges,133.41,35.67,,106.728,percent of total billed charges,35.67% of total billed charges,108.46,374,
SCREW LOCKING,27012902,CDM,278,RC,C1713,HCPCS,outpatient,,,737,294.80,,515.9,70,,412.72,percent of total billed charges,70% of total billed charges,737,100,,589.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,604.34,82,,483.472,percent of total billed charges,82% of total billed charges,626.45,85,,501.16,percent of total billed charges,85% of total billed charges,626.45,85,,501.16,percent of total billed charges,85% of total billed charges,626.45,85,,501.16,percent of total billed charges,85% of total billed charges,663.3,90,,530.64,percent of total billed charges,90% of total billed charges,589.6,80,,471.68,percent of total billed charges,80% of total billed charges,663.3,90,,530.64,percent of total billed charges,90% of total billed charges,552.75,75,,442.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,213.73,29,,170.984,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,493.79,67,,395.032,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,515.9,70,,412.72,percent of total billed charges,70% of total billed charges,479.05,65,,383.24,percent of total billed charges,65% of total billed charges,262.89,35.67,,210.312,percent of total billed charges,35.67% of total billed charges,213.73,737,
SCREW LOCKING,27012903,CDM,278,RC,C1713,HCPCS,outpatient,,,737,294.80,,515.9,70,,412.72,percent of total billed charges,70% of total billed charges,737,100,,589.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,604.34,82,,483.472,percent of total billed charges,82% of total billed charges,626.45,85,,501.16,percent of total billed charges,85% of total billed charges,626.45,85,,501.16,percent of total billed charges,85% of total billed charges,626.45,85,,501.16,percent of total billed charges,85% of total billed charges,663.3,90,,530.64,percent of total billed charges,90% of total billed charges,589.6,80,,471.68,percent of total billed charges,80% of total billed charges,663.3,90,,530.64,percent of total billed charges,90% of total billed charges,552.75,75,,442.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,213.73,29,,170.984,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,493.79,67,,395.032,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,515.9,70,,412.72,percent of total billed charges,70% of total billed charges,479.05,65,,383.24,percent of total billed charges,65% of total billed charges,262.89,35.67,,210.312,percent of total billed charges,35.67% of total billed charges,213.73,737,
PLATE LOCKING SCREW,27012904,CDM,278,RC,C1713,HCPCS,outpatient,,,1447,578.80,,1012.9,70,,810.32,percent of total billed charges,70% of total billed charges,759.68,52.5,,607.74,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,1186.54,82,,949.232,percent of total billed charges,82% of total billed charges,1229.95,85,,983.96,percent of total billed charges,85% of total billed charges,1229.95,85,,983.96,percent of total billed charges,85% of total billed charges,1229.95,85,,983.96,percent of total billed charges,85% of total billed charges,1302.3,90,,1041.84,percent of total billed charges,90% of total billed charges,1157.6,80,,926.08,percent of total billed charges,80% of total billed charges,1302.3,90,,1041.84,percent of total billed charges,90% of total billed charges,1085.25,75,,868.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,419.63,29,,335.704,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,969.49,67,,775.592,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1012.9,70,,810.32,percent of total billed charges,70% of total billed charges,940.55,65,,752.44,percent of total billed charges,65% of total billed charges,516.14,35.67,,412.912,percent of total billed charges,35.67% of total billed charges,419.63,1302.3,
SCREW 28 4.0,27012907,CDM,278,RC,C1713,HCPCS,outpatient,,,842,336.80,,589.4,70,,471.52,percent of total billed charges,70% of total billed charges,842,100,,673.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,690.44,82,,552.352,percent of total billed charges,82% of total billed charges,715.7,85,,572.56,percent of total billed charges,85% of total billed charges,715.7,85,,572.56,percent of total billed charges,85% of total billed charges,715.7,85,,572.56,percent of total billed charges,85% of total billed charges,757.8,90,,606.24,percent of total billed charges,90% of total billed charges,673.6,80,,538.88,percent of total billed charges,80% of total billed charges,757.8,90,,606.24,percent of total billed charges,90% of total billed charges,631.5,75,,505.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,244.18,29,,195.344,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,564.14,67,,451.312,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,589.4,70,,471.52,percent of total billed charges,70% of total billed charges,547.3,65,,437.84,percent of total billed charges,65% of total billed charges,300.34,35.67,,240.272,percent of total billed charges,35.67% of total billed charges,244.18,842,
SCREW,27012908,CDM,278,RC,C1713,HCPCS,outpatient,,,842,336.80,,589.4,70,,471.52,percent of total billed charges,70% of total billed charges,842,100,,673.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,690.44,82,,552.352,percent of total billed charges,82% of total billed charges,715.7,85,,572.56,percent of total billed charges,85% of total billed charges,715.7,85,,572.56,percent of total billed charges,85% of total billed charges,715.7,85,,572.56,percent of total billed charges,85% of total billed charges,757.8,90,,606.24,percent of total billed charges,90% of total billed charges,673.6,80,,538.88,percent of total billed charges,80% of total billed charges,757.8,90,,606.24,percent of total billed charges,90% of total billed charges,631.5,75,,505.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,244.18,29,,195.344,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,564.14,67,,451.312,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,589.4,70,,471.52,percent of total billed charges,70% of total billed charges,547.3,65,,437.84,percent of total billed charges,65% of total billed charges,300.34,35.67,,240.272,percent of total billed charges,35.67% of total billed charges,244.18,842,
WASHER - ORTHO,27012909,CDM,278,RC,C1713,HCPCS,outpatient,,,701,280.40,,490.7,70,,392.56,percent of total billed charges,70% of total billed charges,701,100,,560.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,574.82,82,,459.856,percent of total billed charges,82% of total billed charges,595.85,85,,476.68,percent of total billed charges,85% of total billed charges,595.85,85,,476.68,percent of total billed charges,85% of total billed charges,595.85,85,,476.68,percent of total billed charges,85% of total billed charges,630.9,90,,504.72,percent of total billed charges,90% of total billed charges,560.8,80,,448.64,percent of total billed charges,80% of total billed charges,630.9,90,,504.72,percent of total billed charges,90% of total billed charges,525.75,75,,420.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,203.29,29,,162.632,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,469.67,67,,375.736,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,490.7,70,,392.56,percent of total billed charges,70% of total billed charges,455.65,65,,364.52,percent of total billed charges,65% of total billed charges,250.05,35.67,,200.04,percent of total billed charges,35.67% of total billed charges,203.29,701,
SCREW 4.0 X 4.0,27012910,CDM,278,RC,C1713,HCPCS,outpatient,,,842,336.80,,589.4,70,,471.52,percent of total billed charges,70% of total billed charges,842,100,,673.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,690.44,82,,552.352,percent of total billed charges,82% of total billed charges,715.7,85,,572.56,percent of total billed charges,85% of total billed charges,715.7,85,,572.56,percent of total billed charges,85% of total billed charges,715.7,85,,572.56,percent of total billed charges,85% of total billed charges,757.8,90,,606.24,percent of total billed charges,90% of total billed charges,673.6,80,,538.88,percent of total billed charges,80% of total billed charges,757.8,90,,606.24,percent of total billed charges,90% of total billed charges,631.5,75,,505.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,244.18,29,,195.344,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,564.14,67,,451.312,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,589.4,70,,471.52,percent of total billed charges,70% of total billed charges,547.3,65,,437.84,percent of total billed charges,65% of total billed charges,300.34,35.67,,240.272,percent of total billed charges,35.67% of total billed charges,244.18,842,
APPLIER CLIP IMPLANT,27012925,CDM,278,RC,C1713,HCPCS,outpatient,,,1542,616.80,,1079.4,70,,863.52,percent of total billed charges,70% of total billed charges,809.55,52.5,,647.64,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,1264.44,82,,1011.552,percent of total billed charges,82% of total billed charges,1310.7,85,,1048.56,percent of total billed charges,85% of total billed charges,1310.7,85,,1048.56,percent of total billed charges,85% of total billed charges,1310.7,85,,1048.56,percent of total billed charges,85% of total billed charges,1387.8,90,,1110.24,percent of total billed charges,90% of total billed charges,1233.6,80,,986.88,percent of total billed charges,80% of total billed charges,1387.8,90,,1110.24,percent of total billed charges,90% of total billed charges,1156.5,75,,925.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,447.18,29,,357.744,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1033.14,67,,826.512,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1079.4,70,,863.52,percent of total billed charges,70% of total billed charges,1002.3,65,,801.84,percent of total billed charges,65% of total billed charges,550.03,35.67,,440.024,percent of total billed charges,35.67% of total billed charges,447.18,1387.8,
INTERPHLEX MPJ,27012936,CDM,278,RC,C1713,HCPCS,outpatient,,,1255,502.00,,878.5,70,,702.8,percent of total billed charges,70% of total billed charges,658.88,52.5,,527.1,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,1029.1,82,,823.28,percent of total billed charges,82% of total billed charges,1066.75,85,,853.4,percent of total billed charges,85% of total billed charges,1066.75,85,,853.4,percent of total billed charges,85% of total billed charges,1066.75,85,,853.4,percent of total billed charges,85% of total billed charges,1129.5,90,,903.6,percent of total billed charges,90% of total billed charges,1004,80,,803.2,percent of total billed charges,80% of total billed charges,1129.5,90,,903.6,percent of total billed charges,90% of total billed charges,941.25,75,,753,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,363.95,29,,291.16,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,840.85,67,,672.68,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,878.5,70,,702.8,percent of total billed charges,70% of total billed charges,815.75,65,,652.6,percent of total billed charges,65% of total billed charges,447.66,35.67,,358.128,percent of total billed charges,35.67% of total billed charges,363.95,1129.5,
INTERPHLEX MPJ IMPLANT,27012937,CDM,278,RC,C1713,HCPCS,outpatient,,,2398,959.20,,1678.6,70,,1342.88,percent of total billed charges,70% of total billed charges,1258.95,52.5,,1007.16,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,1966.36,82,,1573.088,percent of total billed charges,82% of total billed charges,2038.3,85,,1630.64,percent of total billed charges,85% of total billed charges,2038.3,85,,1630.64,percent of total billed charges,85% of total billed charges,2038.3,85,,1630.64,percent of total billed charges,85% of total billed charges,2158.2,90,,1726.56,percent of total billed charges,90% of total billed charges,1918.4,80,,1534.72,percent of total billed charges,80% of total billed charges,2158.2,90,,1726.56,percent of total billed charges,90% of total billed charges,1798.5,75,,1438.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,695.42,29,,556.336,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1606.66,67,,1285.328,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1678.6,70,,1342.88,percent of total billed charges,70% of total billed charges,1558.7,65,,1246.96,percent of total billed charges,65% of total billed charges,855.37,35.67,,684.296,percent of total billed charges,35.67% of total billed charges,695.42,2158.2,
INTERPHLEX MPJ,27012938,CDM,278,RC,C1713,HCPCS,outpatient,,,2398,959.20,,1678.6,70,,1342.88,percent of total billed charges,70% of total billed charges,1258.95,52.5,,1007.16,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,1966.36,82,,1573.088,percent of total billed charges,82% of total billed charges,2038.3,85,,1630.64,percent of total billed charges,85% of total billed charges,2038.3,85,,1630.64,percent of total billed charges,85% of total billed charges,2038.3,85,,1630.64,percent of total billed charges,85% of total billed charges,2158.2,90,,1726.56,percent of total billed charges,90% of total billed charges,1918.4,80,,1534.72,percent of total billed charges,80% of total billed charges,2158.2,90,,1726.56,percent of total billed charges,90% of total billed charges,1798.5,75,,1438.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,695.42,29,,556.336,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1606.66,67,,1285.328,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1678.6,70,,1342.88,percent of total billed charges,70% of total billed charges,1558.7,65,,1246.96,percent of total billed charges,65% of total billed charges,855.37,35.67,,684.296,percent of total billed charges,35.67% of total billed charges,695.42,2158.2,
WIREGUIDE,27013003,CDM,278,RC,C1713,HCPCS,outpatient,,,561,224.40,,392.7,70,,314.16,percent of total billed charges,70% of total billed charges,561,100,,448.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,460.02,82,,368.016,percent of total billed charges,82% of total billed charges,476.85,85,,381.48,percent of total billed charges,85% of total billed charges,476.85,85,,381.48,percent of total billed charges,85% of total billed charges,476.85,85,,381.48,percent of total billed charges,85% of total billed charges,504.9,90,,403.92,percent of total billed charges,90% of total billed charges,448.8,80,,359.04,percent of total billed charges,80% of total billed charges,504.9,90,,403.92,percent of total billed charges,90% of total billed charges,420.75,75,,336.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,162.69,29,,130.152,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,375.87,67,,300.696,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,392.7,70,,314.16,percent of total billed charges,70% of total billed charges,364.65,65,,291.72,percent of total billed charges,65% of total billed charges,200.11,35.67,,160.088,percent of total billed charges,35.67% of total billed charges,162.69,561,
SCREWS 30 MM,27013004,CDM,278,RC,C1713,HCPCS,outpatient,,,2059,823.60,,1441.3,70,,1153.04,percent of total billed charges,70% of total billed charges,1080.98,52.5,,864.78,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,1688.38,82,,1350.704,percent of total billed charges,82% of total billed charges,1750.15,85,,1400.12,percent of total billed charges,85% of total billed charges,1750.15,85,,1400.12,percent of total billed charges,85% of total billed charges,1750.15,85,,1400.12,percent of total billed charges,85% of total billed charges,1853.1,90,,1482.48,percent of total billed charges,90% of total billed charges,1647.2,80,,1317.76,percent of total billed charges,80% of total billed charges,1853.1,90,,1482.48,percent of total billed charges,90% of total billed charges,1544.25,75,,1235.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,597.11,29,,477.688,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1379.53,67,,1103.624,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1441.3,70,,1153.04,percent of total billed charges,70% of total billed charges,1338.35,65,,1070.68,percent of total billed charges,65% of total billed charges,734.45,35.67,,587.56,percent of total billed charges,35.67% of total billed charges,597.11,1853.1,
SCREWS 26 MM,27013005,CDM,278,RC,C1713,HCPCS,outpatient,,,2059,823.60,,1441.3,70,,1153.04,percent of total billed charges,70% of total billed charges,1080.98,52.5,,864.78,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,1688.38,82,,1350.704,percent of total billed charges,82% of total billed charges,1750.15,85,,1400.12,percent of total billed charges,85% of total billed charges,1750.15,85,,1400.12,percent of total billed charges,85% of total billed charges,1750.15,85,,1400.12,percent of total billed charges,85% of total billed charges,1853.1,90,,1482.48,percent of total billed charges,90% of total billed charges,1647.2,80,,1317.76,percent of total billed charges,80% of total billed charges,1853.1,90,,1482.48,percent of total billed charges,90% of total billed charges,1544.25,75,,1235.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,597.11,29,,477.688,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1379.53,67,,1103.624,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1441.3,70,,1153.04,percent of total billed charges,70% of total billed charges,1338.35,65,,1070.68,percent of total billed charges,65% of total billed charges,734.45,35.67,,587.56,percent of total billed charges,35.67% of total billed charges,597.11,1853.1,
SCREWS 24 MM,27013006,CDM,278,RC,C1713,HCPCS,outpatient,,,2059,823.60,,1441.3,70,,1153.04,percent of total billed charges,70% of total billed charges,1080.98,52.5,,864.78,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,1688.38,82,,1350.704,percent of total billed charges,82% of total billed charges,1750.15,85,,1400.12,percent of total billed charges,85% of total billed charges,1750.15,85,,1400.12,percent of total billed charges,85% of total billed charges,1750.15,85,,1400.12,percent of total billed charges,85% of total billed charges,1853.1,90,,1482.48,percent of total billed charges,90% of total billed charges,1647.2,80,,1317.76,percent of total billed charges,80% of total billed charges,1853.1,90,,1482.48,percent of total billed charges,90% of total billed charges,1544.25,75,,1235.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,597.11,29,,477.688,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1379.53,67,,1103.624,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1441.3,70,,1153.04,percent of total billed charges,70% of total billed charges,1338.35,65,,1070.68,percent of total billed charges,65% of total billed charges,734.45,35.67,,587.56,percent of total billed charges,35.67% of total billed charges,597.11,1853.1,
BONE CHIPS CANCELLOUS 1-4 MM,27013008,CDM,278,RC,C1762,HCPCS,outpatient,,,842,336.80,,589.4,70,,471.52,percent of total billed charges,70% of total billed charges,842,100,,673.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,690.44,82,,552.352,percent of total billed charges,82% of total billed charges,715.7,85,,572.56,percent of total billed charges,85% of total billed charges,715.7,85,,572.56,percent of total billed charges,85% of total billed charges,715.7,85,,572.56,percent of total billed charges,85% of total billed charges,757.8,90,,606.24,percent of total billed charges,90% of total billed charges,673.6,80,,538.88,percent of total billed charges,80% of total billed charges,757.8,90,,606.24,percent of total billed charges,90% of total billed charges,631.5,75,,505.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,244.18,29,,195.344,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,564.14,67,,451.312,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,589.4,70,,471.52,percent of total billed charges,70% of total billed charges,547.3,65,,437.84,percent of total billed charges,65% of total billed charges,300.34,35.67,,240.272,percent of total billed charges,35.67% of total billed charges,244.18,842,
TIGER STICK SUTURE,27013012,CDM,278,RC,C1713,HCPCS,outpatient,,,403,161.20,,282.1,70,,225.68,percent of total billed charges,70% of total billed charges,403,100,,322.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,330.46,82,,264.368,percent of total billed charges,82% of total billed charges,342.55,85,,274.04,percent of total billed charges,85% of total billed charges,342.55,85,,274.04,percent of total billed charges,85% of total billed charges,342.55,85,,274.04,percent of total billed charges,85% of total billed charges,362.7,90,,290.16,percent of total billed charges,90% of total billed charges,322.4,80,,257.92,percent of total billed charges,80% of total billed charges,362.7,90,,290.16,percent of total billed charges,90% of total billed charges,302.25,75,,241.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,116.87,29,,93.496,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,270.01,67,,216.008,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,282.1,70,,225.68,percent of total billed charges,70% of total billed charges,261.95,65,,209.56,percent of total billed charges,65% of total billed charges,143.75,35.67,,115,percent of total billed charges,35.67% of total billed charges,116.87,403,
LASSO 90 DEGREE,27013013,CDM,278,RC,C1713,HCPCS,outpatient,,,1027,410.80,,718.9,70,,575.12,percent of total billed charges,70% of total billed charges,539.18,52.5,,431.34,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,842.14,82,,673.712,percent of total billed charges,82% of total billed charges,872.95,85,,698.36,percent of total billed charges,85% of total billed charges,872.95,85,,698.36,percent of total billed charges,85% of total billed charges,872.95,85,,698.36,percent of total billed charges,85% of total billed charges,924.3,90,,739.44,percent of total billed charges,90% of total billed charges,821.6,80,,657.28,percent of total billed charges,80% of total billed charges,924.3,90,,739.44,percent of total billed charges,90% of total billed charges,770.25,75,,616.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,297.83,29,,238.264,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,688.09,67,,550.472,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,718.9,70,,575.12,percent of total billed charges,70% of total billed charges,667.55,65,,534.04,percent of total billed charges,65% of total billed charges,366.33,35.67,,293.064,percent of total billed charges,35.67% of total billed charges,297.83,924.3,
PUSHLOCK 2.9,27013014,CDM,278,RC,C1713,HCPCS,outpatient,,,1921,768.40,,1344.7,70,,1075.76,percent of total billed charges,70% of total billed charges,1008.53,52.5,,806.82,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,1575.22,82,,1260.176,percent of total billed charges,82% of total billed charges,1632.85,85,,1306.28,percent of total billed charges,85% of total billed charges,1632.85,85,,1306.28,percent of total billed charges,85% of total billed charges,1632.85,85,,1306.28,percent of total billed charges,85% of total billed charges,1728.9,90,,1383.12,percent of total billed charges,90% of total billed charges,1536.8,80,,1229.44,percent of total billed charges,80% of total billed charges,1728.9,90,,1383.12,percent of total billed charges,90% of total billed charges,1440.75,75,,1152.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,557.09,29,,445.672,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1287.07,67,,1029.656,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1344.7,70,,1075.76,percent of total billed charges,70% of total billed charges,1248.65,65,,998.92,percent of total billed charges,65% of total billed charges,685.22,35.67,,548.176,percent of total billed charges,35.67% of total billed charges,557.09,1728.9,
PUSHLOCK KIT,27013015,CDM,278,RC,C1713,HCPCS,outpatient,,,1120,448.00,,784,70,,627.2,percent of total billed charges,70% of total billed charges,588,52.5,,470.4,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,918.4,82,,734.72,percent of total billed charges,82% of total billed charges,952,85,,761.6,percent of total billed charges,85% of total billed charges,952,85,,761.6,percent of total billed charges,85% of total billed charges,952,85,,761.6,percent of total billed charges,85% of total billed charges,1008,90,,806.4,percent of total billed charges,90% of total billed charges,896,80,,716.8,percent of total billed charges,80% of total billed charges,1008,90,,806.4,percent of total billed charges,90% of total billed charges,840,75,,672,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,324.8,29,,259.84,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,750.4,67,,600.32,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,784,70,,627.2,percent of total billed charges,70% of total billed charges,728,65,,582.4,percent of total billed charges,65% of total billed charges,399.5,35.67,,319.6,percent of total billed charges,35.67% of total billed charges,324.8,1008,
SHOULDER KIT,27013016,CDM,278,RC,C1713,HCPCS,outpatient,,,1120,448.00,,784,70,,627.2,percent of total billed charges,70% of total billed charges,588,52.5,,470.4,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,918.4,82,,734.72,percent of total billed charges,82% of total billed charges,952,85,,761.6,percent of total billed charges,85% of total billed charges,952,85,,761.6,percent of total billed charges,85% of total billed charges,952,85,,761.6,percent of total billed charges,85% of total billed charges,1008,90,,806.4,percent of total billed charges,90% of total billed charges,896,80,,716.8,percent of total billed charges,80% of total billed charges,1008,90,,806.4,percent of total billed charges,90% of total billed charges,840,75,,672,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,324.8,29,,259.84,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,750.4,67,,600.32,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,784,70,,627.2,percent of total billed charges,70% of total billed charges,728,65,,582.4,percent of total billed charges,65% of total billed charges,399.5,35.67,,319.6,percent of total billed charges,35.67% of total billed charges,324.8,1008,
HEAD COMPONENT ENDO II 4.5 MM,27013027,CDM,278,RC,C1713,HCPCS,outpatient,,,2503,1001.20,,1752.1,70,,1401.68,percent of total billed charges,70% of total billed charges,1314.08,52.5,,1051.26,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,2052.46,82,,1641.968,percent of total billed charges,82% of total billed charges,2127.55,85,,1702.04,percent of total billed charges,85% of total billed charges,2127.55,85,,1702.04,percent of total billed charges,85% of total billed charges,2127.55,85,,1702.04,percent of total billed charges,85% of total billed charges,2252.7,90,,1802.16,percent of total billed charges,90% of total billed charges,2002.4,80,,1601.92,percent of total billed charges,80% of total billed charges,2252.7,90,,1802.16,percent of total billed charges,90% of total billed charges,1877.25,75,,1501.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,725.87,29,,580.696,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1677.01,67,,1341.608,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1752.1,70,,1401.68,percent of total billed charges,70% of total billed charges,1626.95,65,,1301.56,percent of total billed charges,65% of total billed charges,892.82,35.67,,714.256,percent of total billed charges,35.67% of total billed charges,725.87,2252.7,
STEM ENDO II 13 X,27013028,CDM,278,RC,C1713,HCPCS,outpatient,,,9750,3900.00,,6825,70,,5460,percent of total billed charges,70% of total billed charges,5118.75,52.5,,4095,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,7995,82,,6396,percent of total billed charges,82% of total billed charges,8287.5,85,,6630,percent of total billed charges,85% of total billed charges,8287.5,85,,6630,percent of total billed charges,85% of total billed charges,8287.5,85,,6630,percent of total billed charges,85% of total billed charges,8775,90,,7020,percent of total billed charges,90% of total billed charges,7800,80,,6240,percent of total billed charges,80% of total billed charges,8775,90,,7020,percent of total billed charges,90% of total billed charges,7312.5,75,,5850,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2827.5,29,,2262,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,6532.5,67,,5226,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,6825,70,,5460,percent of total billed charges,70% of total billed charges,6337.5,65,,5070,percent of total billed charges,65% of total billed charges,3477.83,35.67,,2782.264,percent of total billed charges,35.67% of total billed charges,2827.5,8775,
SCREW 2.0 MM 32/MM,27013036,CDM,278,RC,C1713,HCPCS,outpatient,,,842,336.80,,589.4,70,,471.52,percent of total billed charges,70% of total billed charges,842,100,,673.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,690.44,82,,552.352,percent of total billed charges,82% of total billed charges,715.7,85,,572.56,percent of total billed charges,85% of total billed charges,715.7,85,,572.56,percent of total billed charges,85% of total billed charges,715.7,85,,572.56,percent of total billed charges,85% of total billed charges,757.8,90,,606.24,percent of total billed charges,90% of total billed charges,673.6,80,,538.88,percent of total billed charges,80% of total billed charges,757.8,90,,606.24,percent of total billed charges,90% of total billed charges,631.5,75,,505.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,244.18,29,,195.344,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,564.14,67,,451.312,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,589.4,70,,471.52,percent of total billed charges,70% of total billed charges,547.3,65,,437.84,percent of total billed charges,65% of total billed charges,300.34,35.67,,240.272,percent of total billed charges,35.67% of total billed charges,244.18,842,
SCREW 2.0 MM,27013037,CDM,278,RC,C1713,HCPCS,outpatient,,,842,336.80,,589.4,70,,471.52,percent of total billed charges,70% of total billed charges,842,100,,673.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,690.44,82,,552.352,percent of total billed charges,82% of total billed charges,715.7,85,,572.56,percent of total billed charges,85% of total billed charges,715.7,85,,572.56,percent of total billed charges,85% of total billed charges,715.7,85,,572.56,percent of total billed charges,85% of total billed charges,757.8,90,,606.24,percent of total billed charges,90% of total billed charges,673.6,80,,538.88,percent of total billed charges,80% of total billed charges,757.8,90,,606.24,percent of total billed charges,90% of total billed charges,631.5,75,,505.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,244.18,29,,195.344,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,564.14,67,,451.312,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,589.4,70,,471.52,percent of total billed charges,70% of total billed charges,547.3,65,,437.84,percent of total billed charges,65% of total billed charges,300.34,35.67,,240.272,percent of total billed charges,35.67% of total billed charges,244.18,842,
ECHO FX HIP SYSEM,27013046,CDM,278,RC,,,outpatient,,,12920,5168.00,,9044,70,,7235.2,percent of total billed charges,70% of total billed charges,6783,52.5,,5426.4,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,10594.4,82,,8475.52,percent of total billed charges,82% of total billed charges,10982,85,,8785.6,percent of total billed charges,85% of total billed charges,10982,85,,8785.6,percent of total billed charges,85% of total billed charges,10982,85,,8785.6,percent of total billed charges,85% of total billed charges,11628,90,,9302.4,percent of total billed charges,90% of total billed charges,10336,80,,8268.8,percent of total billed charges,80% of total billed charges,11628,90,,9302.4,percent of total billed charges,90% of total billed charges,9690,75,,7752,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,3746.8,29,,2997.44,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,8656.4,67,,6925.12,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,9044,70,,7235.2,percent of total billed charges,70% of total billed charges,8398,65,,6718.4,percent of total billed charges,65% of total billed charges,4608.56,35.67,,3686.848,percent of total billed charges,35.67% of total billed charges,3746.8,11628,
CORTICAL SCREWS 36 MM,27013082,CDM,278,RC,C1713,HCPCS,outpatient,,,842,336.80,,589.4,70,,471.52,percent of total billed charges,70% of total billed charges,842,100,,673.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,690.44,82,,552.352,percent of total billed charges,82% of total billed charges,715.7,85,,572.56,percent of total billed charges,85% of total billed charges,715.7,85,,572.56,percent of total billed charges,85% of total billed charges,715.7,85,,572.56,percent of total billed charges,85% of total billed charges,757.8,90,,606.24,percent of total billed charges,90% of total billed charges,673.6,80,,538.88,percent of total billed charges,80% of total billed charges,757.8,90,,606.24,percent of total billed charges,90% of total billed charges,631.5,75,,505.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,244.18,29,,195.344,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,564.14,67,,451.312,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,589.4,70,,471.52,percent of total billed charges,70% of total billed charges,547.3,65,,437.84,percent of total billed charges,65% of total billed charges,300.34,35.67,,240.272,percent of total billed charges,35.67% of total billed charges,244.18,842,
CORTICAL SCREW 28 MM,27013083,CDM,278,RC,C1713,HCPCS,outpatient,,,842,336.80,,589.4,70,,471.52,percent of total billed charges,70% of total billed charges,842,100,,673.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,690.44,82,,552.352,percent of total billed charges,82% of total billed charges,715.7,85,,572.56,percent of total billed charges,85% of total billed charges,715.7,85,,572.56,percent of total billed charges,85% of total billed charges,715.7,85,,572.56,percent of total billed charges,85% of total billed charges,757.8,90,,606.24,percent of total billed charges,90% of total billed charges,673.6,80,,538.88,percent of total billed charges,80% of total billed charges,757.8,90,,606.24,percent of total billed charges,90% of total billed charges,631.5,75,,505.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,244.18,29,,195.344,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,564.14,67,,451.312,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,589.4,70,,471.52,percent of total billed charges,70% of total billed charges,547.3,65,,437.84,percent of total billed charges,65% of total billed charges,300.34,35.67,,240.272,percent of total billed charges,35.67% of total billed charges,244.18,842,
CORTICAL SCREW 34 MM,27013084,CDM,278,RC,C1713,HCPCS,outpatient,,,842,336.80,,589.4,70,,471.52,percent of total billed charges,70% of total billed charges,842,100,,673.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,690.44,82,,552.352,percent of total billed charges,82% of total billed charges,715.7,85,,572.56,percent of total billed charges,85% of total billed charges,715.7,85,,572.56,percent of total billed charges,85% of total billed charges,715.7,85,,572.56,percent of total billed charges,85% of total billed charges,757.8,90,,606.24,percent of total billed charges,90% of total billed charges,673.6,80,,538.88,percent of total billed charges,80% of total billed charges,757.8,90,,606.24,percent of total billed charges,90% of total billed charges,631.5,75,,505.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,244.18,29,,195.344,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,564.14,67,,451.312,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,589.4,70,,471.52,percent of total billed charges,70% of total billed charges,547.3,65,,437.84,percent of total billed charges,65% of total billed charges,300.34,35.67,,240.272,percent of total billed charges,35.67% of total billed charges,244.18,842,
CORTICAL SCREW 30 MM,27013085,CDM,278,RC,C1713,HCPCS,outpatient,,,842,336.80,,589.4,70,,471.52,percent of total billed charges,70% of total billed charges,842,100,,673.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,690.44,82,,552.352,percent of total billed charges,82% of total billed charges,715.7,85,,572.56,percent of total billed charges,85% of total billed charges,715.7,85,,572.56,percent of total billed charges,85% of total billed charges,715.7,85,,572.56,percent of total billed charges,85% of total billed charges,757.8,90,,606.24,percent of total billed charges,90% of total billed charges,673.6,80,,538.88,percent of total billed charges,80% of total billed charges,757.8,90,,606.24,percent of total billed charges,90% of total billed charges,631.5,75,,505.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,244.18,29,,195.344,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,564.14,67,,451.312,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,589.4,70,,471.52,percent of total billed charges,70% of total billed charges,547.3,65,,437.84,percent of total billed charges,65% of total billed charges,300.34,35.67,,240.272,percent of total billed charges,35.67% of total billed charges,244.18,842,
PLATE LEFT NARROW ETR SHORT,27013086,CDM,278,RC,C1713,HCPCS,outpatient,,,3508,1403.20,,2455.6,70,,1964.48,percent of total billed charges,70% of total billed charges,1841.7,52.5,,1473.36,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,2876.56,82,,2301.248,percent of total billed charges,82% of total billed charges,2981.8,85,,2385.44,percent of total billed charges,85% of total billed charges,2981.8,85,,2385.44,percent of total billed charges,85% of total billed charges,2981.8,85,,2385.44,percent of total billed charges,85% of total billed charges,3157.2,90,,2525.76,percent of total billed charges,90% of total billed charges,2806.4,80,,2245.12,percent of total billed charges,80% of total billed charges,3157.2,90,,2525.76,percent of total billed charges,90% of total billed charges,2631,75,,2104.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,1017.32,29,,813.856,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,2350.36,67,,1880.288,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,2455.6,70,,1964.48,percent of total billed charges,70% of total billed charges,2280.2,65,,1824.16,percent of total billed charges,65% of total billed charges,1251.3,35.67,,1001.04,percent of total billed charges,35.67% of total billed charges,1017.32,3157.2,
KWIRE,27013151,CDM,278,RC,C1713,HCPCS,outpatient,,,758,303.20,,530.6,70,,424.48,percent of total billed charges,70% of total billed charges,758,100,,606.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,621.56,82,,497.248,percent of total billed charges,82% of total billed charges,644.3,85,,515.44,percent of total billed charges,85% of total billed charges,644.3,85,,515.44,percent of total billed charges,85% of total billed charges,644.3,85,,515.44,percent of total billed charges,85% of total billed charges,682.2,90,,545.76,percent of total billed charges,90% of total billed charges,606.4,80,,485.12,percent of total billed charges,80% of total billed charges,682.2,90,,545.76,percent of total billed charges,90% of total billed charges,568.5,75,,454.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,219.82,29,,175.856,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,507.86,67,,406.288,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,530.6,70,,424.48,percent of total billed charges,70% of total billed charges,492.7,65,,394.16,percent of total billed charges,65% of total billed charges,270.38,35.67,,216.304,percent of total billed charges,35.67% of total billed charges,219.82,758,
SCREW 1.5 MM,27013156,CDM,278,RC,C1713,HCPCS,outpatient,,,842,336.80,,589.4,70,,471.52,percent of total billed charges,70% of total billed charges,842,100,,673.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,690.44,82,,552.352,percent of total billed charges,82% of total billed charges,715.7,85,,572.56,percent of total billed charges,85% of total billed charges,715.7,85,,572.56,percent of total billed charges,85% of total billed charges,715.7,85,,572.56,percent of total billed charges,85% of total billed charges,757.8,90,,606.24,percent of total billed charges,90% of total billed charges,673.6,80,,538.88,percent of total billed charges,80% of total billed charges,757.8,90,,606.24,percent of total billed charges,90% of total billed charges,631.5,75,,505.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,244.18,29,,195.344,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,564.14,67,,451.312,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,589.4,70,,471.52,percent of total billed charges,70% of total billed charges,547.3,65,,437.84,percent of total billed charges,65% of total billed charges,300.34,35.67,,240.272,percent of total billed charges,35.67% of total billed charges,244.18,842,
KWIRE,27013159,CDM,278,RC,C1713,HCPCS,outpatient,,,713,285.20,,499.1,70,,399.28,percent of total billed charges,70% of total billed charges,713,100,,570.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,584.66,82,,467.728,percent of total billed charges,82% of total billed charges,606.05,85,,484.84,percent of total billed charges,85% of total billed charges,606.05,85,,484.84,percent of total billed charges,85% of total billed charges,606.05,85,,484.84,percent of total billed charges,85% of total billed charges,641.7,90,,513.36,percent of total billed charges,90% of total billed charges,570.4,80,,456.32,percent of total billed charges,80% of total billed charges,641.7,90,,513.36,percent of total billed charges,90% of total billed charges,534.75,75,,427.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,206.77,29,,165.416,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,477.71,67,,382.168,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,499.1,70,,399.28,percent of total billed charges,70% of total billed charges,463.45,65,,370.76,percent of total billed charges,65% of total billed charges,254.33,35.67,,203.464,percent of total billed charges,35.67% of total billed charges,206.77,713,
KWIRE,27013160,CDM,278,RC,C1713,HCPCS,outpatient,,,758,303.20,,530.6,70,,424.48,percent of total billed charges,70% of total billed charges,758,100,,606.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,621.56,82,,497.248,percent of total billed charges,82% of total billed charges,644.3,85,,515.44,percent of total billed charges,85% of total billed charges,644.3,85,,515.44,percent of total billed charges,85% of total billed charges,644.3,85,,515.44,percent of total billed charges,85% of total billed charges,682.2,90,,545.76,percent of total billed charges,90% of total billed charges,606.4,80,,485.12,percent of total billed charges,80% of total billed charges,682.2,90,,545.76,percent of total billed charges,90% of total billed charges,568.5,75,,454.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,219.82,29,,175.856,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,507.86,67,,406.288,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,530.6,70,,424.48,percent of total billed charges,70% of total billed charges,492.7,65,,394.16,percent of total billed charges,65% of total billed charges,270.38,35.67,,216.304,percent of total billed charges,35.67% of total billed charges,219.82,758,
KWIRE,27013161,CDM,278,RC,C1713,HCPCS,outpatient,,,713,285.20,,499.1,70,,399.28,percent of total billed charges,70% of total billed charges,713,100,,570.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,584.66,82,,467.728,percent of total billed charges,82% of total billed charges,606.05,85,,484.84,percent of total billed charges,85% of total billed charges,606.05,85,,484.84,percent of total billed charges,85% of total billed charges,606.05,85,,484.84,percent of total billed charges,85% of total billed charges,641.7,90,,513.36,percent of total billed charges,90% of total billed charges,570.4,80,,456.32,percent of total billed charges,80% of total billed charges,641.7,90,,513.36,percent of total billed charges,90% of total billed charges,534.75,75,,427.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,206.77,29,,165.416,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,477.71,67,,382.168,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,499.1,70,,399.28,percent of total billed charges,70% of total billed charges,463.45,65,,370.76,percent of total billed charges,65% of total billed charges,254.33,35.67,,203.464,percent of total billed charges,35.67% of total billed charges,206.77,713,
KWIRE,27013162,CDM,278,RC,C1713,HCPCS,outpatient,,,758,303.20,,530.6,70,,424.48,percent of total billed charges,70% of total billed charges,758,100,,606.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,621.56,82,,497.248,percent of total billed charges,82% of total billed charges,644.3,85,,515.44,percent of total billed charges,85% of total billed charges,644.3,85,,515.44,percent of total billed charges,85% of total billed charges,644.3,85,,515.44,percent of total billed charges,85% of total billed charges,682.2,90,,545.76,percent of total billed charges,90% of total billed charges,606.4,80,,485.12,percent of total billed charges,80% of total billed charges,682.2,90,,545.76,percent of total billed charges,90% of total billed charges,568.5,75,,454.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,219.82,29,,175.856,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,507.86,67,,406.288,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,530.6,70,,424.48,percent of total billed charges,70% of total billed charges,492.7,65,,394.16,percent of total billed charges,65% of total billed charges,270.38,35.67,,216.304,percent of total billed charges,35.67% of total billed charges,219.82,758,
KWIRE,27013163,CDM,278,RC,C1713,HCPCS,outpatient,,,713,285.20,,499.1,70,,399.28,percent of total billed charges,70% of total billed charges,713,100,,570.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,584.66,82,,467.728,percent of total billed charges,82% of total billed charges,606.05,85,,484.84,percent of total billed charges,85% of total billed charges,606.05,85,,484.84,percent of total billed charges,85% of total billed charges,606.05,85,,484.84,percent of total billed charges,85% of total billed charges,641.7,90,,513.36,percent of total billed charges,90% of total billed charges,570.4,80,,456.32,percent of total billed charges,80% of total billed charges,641.7,90,,513.36,percent of total billed charges,90% of total billed charges,534.75,75,,427.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,206.77,29,,165.416,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,477.71,67,,382.168,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,499.1,70,,399.28,percent of total billed charges,70% of total billed charges,463.45,65,,370.76,percent of total billed charges,65% of total billed charges,254.33,35.67,,203.464,percent of total billed charges,35.67% of total billed charges,206.77,713,
KWIRE,27013164,CDM,278,RC,C1713,HCPCS,outpatient,,,758,303.20,,530.6,70,,424.48,percent of total billed charges,70% of total billed charges,758,100,,606.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,621.56,82,,497.248,percent of total billed charges,82% of total billed charges,644.3,85,,515.44,percent of total billed charges,85% of total billed charges,644.3,85,,515.44,percent of total billed charges,85% of total billed charges,644.3,85,,515.44,percent of total billed charges,85% of total billed charges,682.2,90,,545.76,percent of total billed charges,90% of total billed charges,606.4,80,,485.12,percent of total billed charges,80% of total billed charges,682.2,90,,545.76,percent of total billed charges,90% of total billed charges,568.5,75,,454.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,219.82,29,,175.856,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,507.86,67,,406.288,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,530.6,70,,424.48,percent of total billed charges,70% of total billed charges,492.7,65,,394.16,percent of total billed charges,65% of total billed charges,270.38,35.67,,216.304,percent of total billed charges,35.67% of total billed charges,219.82,758,
KWIRE,27013165,CDM,278,RC,C1713,HCPCS,outpatient,,,713,285.20,,499.1,70,,399.28,percent of total billed charges,70% of total billed charges,713,100,,570.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,584.66,82,,467.728,percent of total billed charges,82% of total billed charges,606.05,85,,484.84,percent of total billed charges,85% of total billed charges,606.05,85,,484.84,percent of total billed charges,85% of total billed charges,606.05,85,,484.84,percent of total billed charges,85% of total billed charges,641.7,90,,513.36,percent of total billed charges,90% of total billed charges,570.4,80,,456.32,percent of total billed charges,80% of total billed charges,641.7,90,,513.36,percent of total billed charges,90% of total billed charges,534.75,75,,427.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,206.77,29,,165.416,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,477.71,67,,382.168,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,499.1,70,,399.28,percent of total billed charges,70% of total billed charges,463.45,65,,370.76,percent of total billed charges,65% of total billed charges,254.33,35.67,,203.464,percent of total billed charges,35.67% of total billed charges,206.77,713,
LASSO CURVE STRAIGHT,27013209,CDM,278,RC,C1713,HCPCS,outpatient,,,1027,410.80,,718.9,70,,575.12,percent of total billed charges,70% of total billed charges,539.18,52.5,,431.34,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,842.14,82,,673.712,percent of total billed charges,82% of total billed charges,872.95,85,,698.36,percent of total billed charges,85% of total billed charges,872.95,85,,698.36,percent of total billed charges,85% of total billed charges,872.95,85,,698.36,percent of total billed charges,85% of total billed charges,924.3,90,,739.44,percent of total billed charges,90% of total billed charges,821.6,80,,657.28,percent of total billed charges,80% of total billed charges,924.3,90,,739.44,percent of total billed charges,90% of total billed charges,770.25,75,,616.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,297.83,29,,238.264,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,688.09,67,,550.472,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,718.9,70,,575.12,percent of total billed charges,70% of total billed charges,667.55,65,,534.04,percent of total billed charges,65% of total billed charges,366.33,35.67,,293.064,percent of total billed charges,35.67% of total billed charges,297.83,924.3,
TWIST IN CANNULA,27013210,CDM,278,RC,C1713,HCPCS,outpatient,,,245,98.00,,171.5,70,,137.2,percent of total billed charges,70% of total billed charges,245,100,,196,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,200.9,82,,160.72,percent of total billed charges,82% of total billed charges,208.25,85,,166.6,percent of total billed charges,85% of total billed charges,208.25,85,,166.6,percent of total billed charges,85% of total billed charges,208.25,85,,166.6,percent of total billed charges,85% of total billed charges,220.5,90,,176.4,percent of total billed charges,90% of total billed charges,196,80,,156.8,percent of total billed charges,80% of total billed charges,220.5,90,,176.4,percent of total billed charges,90% of total billed charges,183.75,75,,147,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,71.05,29,,56.84,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,164.15,67,,131.32,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,171.5,70,,137.2,percent of total billed charges,70% of total billed charges,159.25,65,,127.4,percent of total billed charges,65% of total billed charges,87.39,35.67,,69.912,percent of total billed charges,35.67% of total billed charges,71.05,245,
ECHO FRACTURE HIP SYSTEM,27013270,CDM,278,RC,C1776,HCPCS,outpatient,,,9560,3824.00,,6692,70,,5353.6,percent of total billed charges,70% of total billed charges,5019,52.5,,4015.2,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,7839.2,82,,6271.36,percent of total billed charges,82% of total billed charges,8126,85,,6500.8,percent of total billed charges,85% of total billed charges,8126,85,,6500.8,percent of total billed charges,85% of total billed charges,8126,85,,6500.8,percent of total billed charges,85% of total billed charges,8604,90,,6883.2,percent of total billed charges,90% of total billed charges,7648,80,,6118.4,percent of total billed charges,80% of total billed charges,8604,90,,6883.2,percent of total billed charges,90% of total billed charges,7170,75,,5736,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2772.4,29,,2217.92,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,6405.2,67,,5124.16,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,6692,70,,5353.6,percent of total billed charges,70% of total billed charges,6214,65,,4971.2,percent of total billed charges,65% of total billed charges,3410.05,35.67,,2728.04,percent of total billed charges,35.67% of total billed charges,2772.4,8604,
T PLATE,27013278,CDM,278,RC,C1713,HCPCS,outpatient,,,2194,877.60,,1535.8,70,,1228.64,percent of total billed charges,70% of total billed charges,1151.85,52.5,,921.48,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,1799.08,82,,1439.264,percent of total billed charges,82% of total billed charges,1864.9,85,,1491.92,percent of total billed charges,85% of total billed charges,1864.9,85,,1491.92,percent of total billed charges,85% of total billed charges,1864.9,85,,1491.92,percent of total billed charges,85% of total billed charges,1974.6,90,,1579.68,percent of total billed charges,90% of total billed charges,1755.2,80,,1404.16,percent of total billed charges,80% of total billed charges,1974.6,90,,1579.68,percent of total billed charges,90% of total billed charges,1645.5,75,,1316.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,636.26,29,,509.008,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1469.98,67,,1175.984,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1535.8,70,,1228.64,percent of total billed charges,70% of total billed charges,1426.1,65,,1140.88,percent of total billed charges,65% of total billed charges,782.6,35.67,,626.08,percent of total billed charges,35.67% of total billed charges,636.26,1974.6,
SCREW 4.0,27013279,CDM,278,RC,C1713,HCPCS,outpatient,,,824,329.60,,576.8,70,,461.44,percent of total billed charges,70% of total billed charges,824,100,,659.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,675.68,82,,540.544,percent of total billed charges,82% of total billed charges,700.4,85,,560.32,percent of total billed charges,85% of total billed charges,700.4,85,,560.32,percent of total billed charges,85% of total billed charges,700.4,85,,560.32,percent of total billed charges,85% of total billed charges,741.6,90,,593.28,percent of total billed charges,90% of total billed charges,659.2,80,,527.36,percent of total billed charges,80% of total billed charges,741.6,90,,593.28,percent of total billed charges,90% of total billed charges,618,75,,494.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,238.96,29,,191.168,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,552.08,67,,441.664,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,576.8,70,,461.44,percent of total billed charges,70% of total billed charges,535.6,65,,428.48,percent of total billed charges,65% of total billed charges,293.92,35.67,,235.136,percent of total billed charges,35.67% of total billed charges,238.96,824,
SCREW 3.5,27013280,CDM,278,RC,C1713,HCPCS,outpatient,,,824,329.60,,576.8,70,,461.44,percent of total billed charges,70% of total billed charges,824,100,,659.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,675.68,82,,540.544,percent of total billed charges,82% of total billed charges,700.4,85,,560.32,percent of total billed charges,85% of total billed charges,700.4,85,,560.32,percent of total billed charges,85% of total billed charges,700.4,85,,560.32,percent of total billed charges,85% of total billed charges,741.6,90,,593.28,percent of total billed charges,90% of total billed charges,659.2,80,,527.36,percent of total billed charges,80% of total billed charges,741.6,90,,593.28,percent of total billed charges,90% of total billed charges,618,75,,494.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,238.96,29,,191.168,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,552.08,67,,441.664,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,576.8,70,,461.44,percent of total billed charges,70% of total billed charges,535.6,65,,428.48,percent of total billed charges,65% of total billed charges,293.92,35.67,,235.136,percent of total billed charges,35.67% of total billed charges,238.96,824,
SCREW 2.0,27013281,CDM,278,RC,C1713,HCPCS,outpatient,,,824,329.60,,576.8,70,,461.44,percent of total billed charges,70% of total billed charges,824,100,,659.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,675.68,82,,540.544,percent of total billed charges,82% of total billed charges,700.4,85,,560.32,percent of total billed charges,85% of total billed charges,700.4,85,,560.32,percent of total billed charges,85% of total billed charges,700.4,85,,560.32,percent of total billed charges,85% of total billed charges,741.6,90,,593.28,percent of total billed charges,90% of total billed charges,659.2,80,,527.36,percent of total billed charges,80% of total billed charges,741.6,90,,593.28,percent of total billed charges,90% of total billed charges,618,75,,494.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,238.96,29,,191.168,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,552.08,67,,441.664,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,576.8,70,,461.44,percent of total billed charges,70% of total billed charges,535.6,65,,428.48,percent of total billed charges,65% of total billed charges,293.92,35.67,,235.136,percent of total billed charges,35.67% of total billed charges,238.96,824,
SCREW NON LOCKING,27013286,CDM,278,RC,C1713,HCPCS,outpatient,,,316,126.40,,221.2,70,,176.96,percent of total billed charges,70% of total billed charges,316,100,,252.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,259.12,82,,207.296,percent of total billed charges,82% of total billed charges,268.6,85,,214.88,percent of total billed charges,85% of total billed charges,268.6,85,,214.88,percent of total billed charges,85% of total billed charges,268.6,85,,214.88,percent of total billed charges,85% of total billed charges,284.4,90,,227.52,percent of total billed charges,90% of total billed charges,252.8,80,,202.24,percent of total billed charges,80% of total billed charges,284.4,90,,227.52,percent of total billed charges,90% of total billed charges,237,75,,189.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,91.64,29,,73.312,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,211.72,67,,169.376,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,221.2,70,,176.96,percent of total billed charges,70% of total billed charges,205.4,65,,164.32,percent of total billed charges,65% of total billed charges,112.72,35.67,,90.176,percent of total billed charges,35.67% of total billed charges,91.64,316,
SCREW LOCKING,27013287,CDM,278,RC,C1713,HCPCS,outpatient,,,700,280.00,,490,70,,392,percent of total billed charges,70% of total billed charges,700,100,,560,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,574,82,,459.2,percent of total billed charges,82% of total billed charges,595,85,,476,percent of total billed charges,85% of total billed charges,595,85,,476,percent of total billed charges,85% of total billed charges,595,85,,476,percent of total billed charges,85% of total billed charges,630,90,,504,percent of total billed charges,90% of total billed charges,560,80,,448,percent of total billed charges,80% of total billed charges,630,90,,504,percent of total billed charges,90% of total billed charges,525,75,,420,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,203,29,,162.4,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,469,67,,375.2,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,490,70,,392,percent of total billed charges,70% of total billed charges,455,65,,364,percent of total billed charges,65% of total billed charges,249.69,35.67,,199.752,percent of total billed charges,35.67% of total billed charges,203,700,
SCREW LOCKING,27013288,CDM,278,RC,C1713,HCPCS,outpatient,,,700,280.00,,490,70,,392,percent of total billed charges,70% of total billed charges,700,100,,560,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,574,82,,459.2,percent of total billed charges,82% of total billed charges,595,85,,476,percent of total billed charges,85% of total billed charges,595,85,,476,percent of total billed charges,85% of total billed charges,595,85,,476,percent of total billed charges,85% of total billed charges,630,90,,504,percent of total billed charges,90% of total billed charges,560,80,,448,percent of total billed charges,80% of total billed charges,630,90,,504,percent of total billed charges,90% of total billed charges,525,75,,420,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,203,29,,162.4,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,469,67,,375.2,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,490,70,,392,percent of total billed charges,70% of total billed charges,455,65,,364,percent of total billed charges,65% of total billed charges,249.69,35.67,,199.752,percent of total billed charges,35.67% of total billed charges,203,700,
SCREW LOCKING,27013289,CDM,278,RC,C1713,HCPCS,outpatient,,,700,280.00,,490,70,,392,percent of total billed charges,70% of total billed charges,700,100,,560,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,574,82,,459.2,percent of total billed charges,82% of total billed charges,595,85,,476,percent of total billed charges,85% of total billed charges,595,85,,476,percent of total billed charges,85% of total billed charges,595,85,,476,percent of total billed charges,85% of total billed charges,630,90,,504,percent of total billed charges,90% of total billed charges,560,80,,448,percent of total billed charges,80% of total billed charges,630,90,,504,percent of total billed charges,90% of total billed charges,525,75,,420,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,203,29,,162.4,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,469,67,,375.2,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,490,70,,392,percent of total billed charges,70% of total billed charges,455,65,,364,percent of total billed charges,65% of total billed charges,249.69,35.67,,199.752,percent of total billed charges,35.67% of total billed charges,203,700,
SCREW LOCKING,27013290,CDM,278,RC,C1713,HCPCS,outpatient,,,700,280.00,,490,70,,392,percent of total billed charges,70% of total billed charges,700,100,,560,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,574,82,,459.2,percent of total billed charges,82% of total billed charges,595,85,,476,percent of total billed charges,85% of total billed charges,595,85,,476,percent of total billed charges,85% of total billed charges,595,85,,476,percent of total billed charges,85% of total billed charges,630,90,,504,percent of total billed charges,90% of total billed charges,560,80,,448,percent of total billed charges,80% of total billed charges,630,90,,504,percent of total billed charges,90% of total billed charges,525,75,,420,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,203,29,,162.4,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,469,67,,375.2,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,490,70,,392,percent of total billed charges,70% of total billed charges,455,65,,364,percent of total billed charges,65% of total billed charges,249.69,35.67,,199.752,percent of total billed charges,35.67% of total billed charges,203,700,
K WIRE,27013291,CDM,278,RC,C1713,HCPCS,outpatient,,,315,126.00,,220.5,70,,176.4,percent of total billed charges,70% of total billed charges,315,100,,252,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,258.3,82,,206.64,percent of total billed charges,82% of total billed charges,267.75,85,,214.2,percent of total billed charges,85% of total billed charges,267.75,85,,214.2,percent of total billed charges,85% of total billed charges,267.75,85,,214.2,percent of total billed charges,85% of total billed charges,283.5,90,,226.8,percent of total billed charges,90% of total billed charges,252,80,,201.6,percent of total billed charges,80% of total billed charges,283.5,90,,226.8,percent of total billed charges,90% of total billed charges,236.25,75,,189,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,91.35,29,,73.08,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,211.05,67,,168.84,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,220.5,70,,176.4,percent of total billed charges,70% of total billed charges,204.75,65,,163.8,percent of total billed charges,65% of total billed charges,112.36,35.67,,89.888,percent of total billed charges,35.67% of total billed charges,91.35,315,
K WIRE,27013292,CDM,278,RC,C1713,HCPCS,outpatient,,,422,168.80,,295.4,70,,236.32,percent of total billed charges,70% of total billed charges,422,100,,337.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,346.04,82,,276.832,percent of total billed charges,82% of total billed charges,358.7,85,,286.96,percent of total billed charges,85% of total billed charges,358.7,85,,286.96,percent of total billed charges,85% of total billed charges,358.7,85,,286.96,percent of total billed charges,85% of total billed charges,379.8,90,,303.84,percent of total billed charges,90% of total billed charges,337.6,80,,270.08,percent of total billed charges,80% of total billed charges,379.8,90,,303.84,percent of total billed charges,90% of total billed charges,316.5,75,,253.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,122.38,29,,97.904,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,282.74,67,,226.192,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,295.4,70,,236.32,percent of total billed charges,70% of total billed charges,274.3,65,,219.44,percent of total billed charges,65% of total billed charges,150.53,35.67,,120.424,percent of total billed charges,35.67% of total billed charges,122.38,422,
T PLATE,27013293,CDM,278,RC,C1713,HCPCS,outpatient,,,2615,1046.00,,1830.5,70,,1464.4,percent of total billed charges,70% of total billed charges,1372.88,52.5,,1098.3,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,2144.3,82,,1715.44,percent of total billed charges,82% of total billed charges,2222.75,85,,1778.2,percent of total billed charges,85% of total billed charges,2222.75,85,,1778.2,percent of total billed charges,85% of total billed charges,2222.75,85,,1778.2,percent of total billed charges,85% of total billed charges,2353.5,90,,1882.8,percent of total billed charges,90% of total billed charges,2092,80,,1673.6,percent of total billed charges,80% of total billed charges,2353.5,90,,1882.8,percent of total billed charges,90% of total billed charges,1961.25,75,,1569,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,758.35,29,,606.68,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1752.05,67,,1401.64,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1830.5,70,,1464.4,percent of total billed charges,70% of total billed charges,1699.75,65,,1359.8,percent of total billed charges,65% of total billed charges,932.77,35.67,,746.216,percent of total billed charges,35.67% of total billed charges,758.35,2353.5,
SCREW NON LOCKING,27013294,CDM,278,RC,C1713,HCPCS,outpatient,,,316,126.40,,221.2,70,,176.96,percent of total billed charges,70% of total billed charges,316,100,,252.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,259.12,82,,207.296,percent of total billed charges,82% of total billed charges,268.6,85,,214.88,percent of total billed charges,85% of total billed charges,268.6,85,,214.88,percent of total billed charges,85% of total billed charges,268.6,85,,214.88,percent of total billed charges,85% of total billed charges,284.4,90,,227.52,percent of total billed charges,90% of total billed charges,252.8,80,,202.24,percent of total billed charges,80% of total billed charges,284.4,90,,227.52,percent of total billed charges,90% of total billed charges,237,75,,189.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,91.64,29,,73.312,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,211.72,67,,169.376,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,221.2,70,,176.96,percent of total billed charges,70% of total billed charges,205.4,65,,164.32,percent of total billed charges,65% of total billed charges,112.72,35.67,,90.176,percent of total billed charges,35.67% of total billed charges,91.64,316,
SCREW NON LOCKING,27013295,CDM,278,RC,C1713,HCPCS,outpatient,,,316,126.40,,221.2,70,,176.96,percent of total billed charges,70% of total billed charges,316,100,,252.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,259.12,82,,207.296,percent of total billed charges,82% of total billed charges,268.6,85,,214.88,percent of total billed charges,85% of total billed charges,268.6,85,,214.88,percent of total billed charges,85% of total billed charges,268.6,85,,214.88,percent of total billed charges,85% of total billed charges,284.4,90,,227.52,percent of total billed charges,90% of total billed charges,252.8,80,,202.24,percent of total billed charges,80% of total billed charges,284.4,90,,227.52,percent of total billed charges,90% of total billed charges,237,75,,189.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,91.64,29,,73.312,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,211.72,67,,169.376,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,221.2,70,,176.96,percent of total billed charges,70% of total billed charges,205.4,65,,164.32,percent of total billed charges,65% of total billed charges,112.72,35.67,,90.176,percent of total billed charges,35.67% of total billed charges,91.64,316,
SCREW NON LOCKING,27013296,CDM,278,RC,C1713,HCPCS,outpatient,,,316,126.40,,221.2,70,,176.96,percent of total billed charges,70% of total billed charges,316,100,,252.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,259.12,82,,207.296,percent of total billed charges,82% of total billed charges,268.6,85,,214.88,percent of total billed charges,85% of total billed charges,268.6,85,,214.88,percent of total billed charges,85% of total billed charges,268.6,85,,214.88,percent of total billed charges,85% of total billed charges,284.4,90,,227.52,percent of total billed charges,90% of total billed charges,252.8,80,,202.24,percent of total billed charges,80% of total billed charges,284.4,90,,227.52,percent of total billed charges,90% of total billed charges,237,75,,189.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,91.64,29,,73.312,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,211.72,67,,169.376,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,221.2,70,,176.96,percent of total billed charges,70% of total billed charges,205.4,65,,164.32,percent of total billed charges,65% of total billed charges,112.72,35.67,,90.176,percent of total billed charges,35.67% of total billed charges,91.64,316,
SCREW NON LOCKING,27013297,CDM,278,RC,C1713,HCPCS,outpatient,,,316,126.40,,221.2,70,,176.96,percent of total billed charges,70% of total billed charges,316,100,,252.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,259.12,82,,207.296,percent of total billed charges,82% of total billed charges,268.6,85,,214.88,percent of total billed charges,85% of total billed charges,268.6,85,,214.88,percent of total billed charges,85% of total billed charges,268.6,85,,214.88,percent of total billed charges,85% of total billed charges,284.4,90,,227.52,percent of total billed charges,90% of total billed charges,252.8,80,,202.24,percent of total billed charges,80% of total billed charges,284.4,90,,227.52,percent of total billed charges,90% of total billed charges,237,75,,189.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,91.64,29,,73.312,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,211.72,67,,169.376,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,221.2,70,,176.96,percent of total billed charges,70% of total billed charges,205.4,65,,164.32,percent of total billed charges,65% of total billed charges,112.72,35.67,,90.176,percent of total billed charges,35.67% of total billed charges,91.64,316,
SCREW NON LOCKING,27013298,CDM,278,RC,C1713,HCPCS,outpatient,,,316,126.40,,221.2,70,,176.96,percent of total billed charges,70% of total billed charges,316,100,,252.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,259.12,82,,207.296,percent of total billed charges,82% of total billed charges,268.6,85,,214.88,percent of total billed charges,85% of total billed charges,268.6,85,,214.88,percent of total billed charges,85% of total billed charges,268.6,85,,214.88,percent of total billed charges,85% of total billed charges,284.4,90,,227.52,percent of total billed charges,90% of total billed charges,252.8,80,,202.24,percent of total billed charges,80% of total billed charges,284.4,90,,227.52,percent of total billed charges,90% of total billed charges,237,75,,189.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,91.64,29,,73.312,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,211.72,67,,169.376,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,221.2,70,,176.96,percent of total billed charges,70% of total billed charges,205.4,65,,164.32,percent of total billed charges,65% of total billed charges,112.72,35.67,,90.176,percent of total billed charges,35.67% of total billed charges,91.64,316,
SINGLE PORT K WIRE,27013303,CDM,278,RC,C1713,HCPCS,outpatient,,,688,275.20,,481.6,70,,385.28,percent of total billed charges,70% of total billed charges,688,100,,550.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,564.16,82,,451.328,percent of total billed charges,82% of total billed charges,584.8,85,,467.84,percent of total billed charges,85% of total billed charges,584.8,85,,467.84,percent of total billed charges,85% of total billed charges,584.8,85,,467.84,percent of total billed charges,85% of total billed charges,619.2,90,,495.36,percent of total billed charges,90% of total billed charges,550.4,80,,440.32,percent of total billed charges,80% of total billed charges,619.2,90,,495.36,percent of total billed charges,90% of total billed charges,516,75,,412.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,199.52,29,,159.616,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,460.96,67,,368.768,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,481.6,70,,385.28,percent of total billed charges,70% of total billed charges,447.2,65,,357.76,percent of total billed charges,65% of total billed charges,245.41,35.67,,196.328,percent of total billed charges,35.67% of total billed charges,199.52,688,
SINGLE POINT K WIRE 2.0,27013304,CDM,278,RC,C1713,HCPCS,outpatient,,,688,275.20,,481.6,70,,385.28,percent of total billed charges,70% of total billed charges,688,100,,550.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,564.16,82,,451.328,percent of total billed charges,82% of total billed charges,584.8,85,,467.84,percent of total billed charges,85% of total billed charges,584.8,85,,467.84,percent of total billed charges,85% of total billed charges,584.8,85,,467.84,percent of total billed charges,85% of total billed charges,619.2,90,,495.36,percent of total billed charges,90% of total billed charges,550.4,80,,440.32,percent of total billed charges,80% of total billed charges,619.2,90,,495.36,percent of total billed charges,90% of total billed charges,516,75,,412.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,199.52,29,,159.616,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,460.96,67,,368.768,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,481.6,70,,385.28,percent of total billed charges,70% of total billed charges,447.2,65,,357.76,percent of total billed charges,65% of total billed charges,245.41,35.67,,196.328,percent of total billed charges,35.67% of total billed charges,199.52,688,
MM SCREW 3.5,27013305,CDM,278,RC,C1713,HCPCS,outpatient,,,824,329.60,,576.8,70,,461.44,percent of total billed charges,70% of total billed charges,824,100,,659.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,675.68,82,,540.544,percent of total billed charges,82% of total billed charges,700.4,85,,560.32,percent of total billed charges,85% of total billed charges,700.4,85,,560.32,percent of total billed charges,85% of total billed charges,700.4,85,,560.32,percent of total billed charges,85% of total billed charges,741.6,90,,593.28,percent of total billed charges,90% of total billed charges,659.2,80,,527.36,percent of total billed charges,80% of total billed charges,741.6,90,,593.28,percent of total billed charges,90% of total billed charges,618,75,,494.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,238.96,29,,191.168,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,552.08,67,,441.664,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,576.8,70,,461.44,percent of total billed charges,70% of total billed charges,535.6,65,,428.48,percent of total billed charges,65% of total billed charges,293.92,35.67,,235.136,percent of total billed charges,35.67% of total billed charges,238.96,824,
SCREW 2.0,27013306,CDM,278,RC,C1713,HCPCS,outpatient,,,824,329.60,,576.8,70,,461.44,percent of total billed charges,70% of total billed charges,824,100,,659.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,675.68,82,,540.544,percent of total billed charges,82% of total billed charges,700.4,85,,560.32,percent of total billed charges,85% of total billed charges,700.4,85,,560.32,percent of total billed charges,85% of total billed charges,700.4,85,,560.32,percent of total billed charges,85% of total billed charges,741.6,90,,593.28,percent of total billed charges,90% of total billed charges,659.2,80,,527.36,percent of total billed charges,80% of total billed charges,741.6,90,,593.28,percent of total billed charges,90% of total billed charges,618,75,,494.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,238.96,29,,191.168,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,552.08,67,,441.664,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,576.8,70,,461.44,percent of total billed charges,70% of total billed charges,535.6,65,,428.48,percent of total billed charges,65% of total billed charges,293.92,35.67,,235.136,percent of total billed charges,35.67% of total billed charges,238.96,824,
SCREW,27013337,CDM,278,RC,C1713,HCPCS,outpatient,,,824,329.60,,576.8,70,,461.44,percent of total billed charges,70% of total billed charges,824,100,,659.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,675.68,82,,540.544,percent of total billed charges,82% of total billed charges,700.4,85,,560.32,percent of total billed charges,85% of total billed charges,700.4,85,,560.32,percent of total billed charges,85% of total billed charges,700.4,85,,560.32,percent of total billed charges,85% of total billed charges,741.6,90,,593.28,percent of total billed charges,90% of total billed charges,659.2,80,,527.36,percent of total billed charges,80% of total billed charges,741.6,90,,593.28,percent of total billed charges,90% of total billed charges,618,75,,494.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,238.96,29,,191.168,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,552.08,67,,441.664,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,576.8,70,,461.44,percent of total billed charges,70% of total billed charges,535.6,65,,428.48,percent of total billed charges,65% of total billed charges,293.92,35.67,,235.136,percent of total billed charges,35.67% of total billed charges,238.96,824,
SCREW,27013338,CDM,278,RC,C1713,HCPCS,outpatient,,,824,329.60,,576.8,70,,461.44,percent of total billed charges,70% of total billed charges,824,100,,659.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,675.68,82,,540.544,percent of total billed charges,82% of total billed charges,700.4,85,,560.32,percent of total billed charges,85% of total billed charges,700.4,85,,560.32,percent of total billed charges,85% of total billed charges,700.4,85,,560.32,percent of total billed charges,85% of total billed charges,741.6,90,,593.28,percent of total billed charges,90% of total billed charges,659.2,80,,527.36,percent of total billed charges,80% of total billed charges,741.6,90,,593.28,percent of total billed charges,90% of total billed charges,618,75,,494.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,238.96,29,,191.168,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,552.08,67,,441.664,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,576.8,70,,461.44,percent of total billed charges,70% of total billed charges,535.6,65,,428.48,percent of total billed charges,65% of total billed charges,293.92,35.67,,235.136,percent of total billed charges,35.67% of total billed charges,238.96,824,
SCREW,27013339,CDM,278,RC,C1713,HCPCS,outpatient,,,824,329.60,,576.8,70,,461.44,percent of total billed charges,70% of total billed charges,824,100,,659.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,675.68,82,,540.544,percent of total billed charges,82% of total billed charges,700.4,85,,560.32,percent of total billed charges,85% of total billed charges,700.4,85,,560.32,percent of total billed charges,85% of total billed charges,700.4,85,,560.32,percent of total billed charges,85% of total billed charges,741.6,90,,593.28,percent of total billed charges,90% of total billed charges,659.2,80,,527.36,percent of total billed charges,80% of total billed charges,741.6,90,,593.28,percent of total billed charges,90% of total billed charges,618,75,,494.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,238.96,29,,191.168,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,552.08,67,,441.664,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,576.8,70,,461.44,percent of total billed charges,70% of total billed charges,535.6,65,,428.48,percent of total billed charges,65% of total billed charges,293.92,35.67,,235.136,percent of total billed charges,35.67% of total billed charges,238.96,824,
SCREW,27013340,CDM,278,RC,C1713,HCPCS,outpatient,,,824,329.60,,576.8,70,,461.44,percent of total billed charges,70% of total billed charges,824,100,,659.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,675.68,82,,540.544,percent of total billed charges,82% of total billed charges,700.4,85,,560.32,percent of total billed charges,85% of total billed charges,700.4,85,,560.32,percent of total billed charges,85% of total billed charges,700.4,85,,560.32,percent of total billed charges,85% of total billed charges,741.6,90,,593.28,percent of total billed charges,90% of total billed charges,659.2,80,,527.36,percent of total billed charges,80% of total billed charges,741.6,90,,593.28,percent of total billed charges,90% of total billed charges,618,75,,494.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,238.96,29,,191.168,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,552.08,67,,441.664,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,576.8,70,,461.44,percent of total billed charges,70% of total billed charges,535.6,65,,428.48,percent of total billed charges,65% of total billed charges,293.92,35.67,,235.136,percent of total billed charges,35.67% of total billed charges,238.96,824,
SCREW,27013341,CDM,278,RC,C1713,HCPCS,outpatient,,,824,329.60,,576.8,70,,461.44,percent of total billed charges,70% of total billed charges,824,100,,659.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,675.68,82,,540.544,percent of total billed charges,82% of total billed charges,700.4,85,,560.32,percent of total billed charges,85% of total billed charges,700.4,85,,560.32,percent of total billed charges,85% of total billed charges,700.4,85,,560.32,percent of total billed charges,85% of total billed charges,741.6,90,,593.28,percent of total billed charges,90% of total billed charges,659.2,80,,527.36,percent of total billed charges,80% of total billed charges,741.6,90,,593.28,percent of total billed charges,90% of total billed charges,618,75,,494.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,238.96,29,,191.168,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,552.08,67,,441.664,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,576.8,70,,461.44,percent of total billed charges,70% of total billed charges,535.6,65,,428.48,percent of total billed charges,65% of total billed charges,293.92,35.67,,235.136,percent of total billed charges,35.67% of total billed charges,238.96,824,
SCREW,27013342,CDM,278,RC,C1713,HCPCS,outpatient,,,824,329.60,,576.8,70,,461.44,percent of total billed charges,70% of total billed charges,824,100,,659.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,675.68,82,,540.544,percent of total billed charges,82% of total billed charges,700.4,85,,560.32,percent of total billed charges,85% of total billed charges,700.4,85,,560.32,percent of total billed charges,85% of total billed charges,700.4,85,,560.32,percent of total billed charges,85% of total billed charges,741.6,90,,593.28,percent of total billed charges,90% of total billed charges,659.2,80,,527.36,percent of total billed charges,80% of total billed charges,741.6,90,,593.28,percent of total billed charges,90% of total billed charges,618,75,,494.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,238.96,29,,191.168,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,552.08,67,,441.664,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,576.8,70,,461.44,percent of total billed charges,70% of total billed charges,535.6,65,,428.48,percent of total billed charges,65% of total billed charges,293.92,35.67,,235.136,percent of total billed charges,35.67% of total billed charges,238.96,824,
PLATE,27013343,CDM,278,RC,C1713,HCPCS,outpatient,,,2194,877.60,,1535.8,70,,1228.64,percent of total billed charges,70% of total billed charges,1151.85,52.5,,921.48,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,1799.08,82,,1439.264,percent of total billed charges,82% of total billed charges,1864.9,85,,1491.92,percent of total billed charges,85% of total billed charges,1864.9,85,,1491.92,percent of total billed charges,85% of total billed charges,1864.9,85,,1491.92,percent of total billed charges,85% of total billed charges,1974.6,90,,1579.68,percent of total billed charges,90% of total billed charges,1755.2,80,,1404.16,percent of total billed charges,80% of total billed charges,1974.6,90,,1579.68,percent of total billed charges,90% of total billed charges,1645.5,75,,1316.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,636.26,29,,509.008,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1469.98,67,,1175.984,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1535.8,70,,1228.64,percent of total billed charges,70% of total billed charges,1426.1,65,,1140.88,percent of total billed charges,65% of total billed charges,782.6,35.67,,626.08,percent of total billed charges,35.67% of total billed charges,636.26,1974.6,
DISTRACTION SCREW,27013408,CDM,278,RC,C1713,HCPCS,outpatient,,,272,108.80,,190.4,70,,152.32,percent of total billed charges,70% of total billed charges,272,100,,217.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,223.04,82,,178.432,percent of total billed charges,82% of total billed charges,231.2,85,,184.96,percent of total billed charges,85% of total billed charges,231.2,85,,184.96,percent of total billed charges,85% of total billed charges,231.2,85,,184.96,percent of total billed charges,85% of total billed charges,244.8,90,,195.84,percent of total billed charges,90% of total billed charges,217.6,80,,174.08,percent of total billed charges,80% of total billed charges,244.8,90,,195.84,percent of total billed charges,90% of total billed charges,204,75,,163.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,78.88,29,,63.104,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,182.24,67,,145.792,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,190.4,70,,152.32,percent of total billed charges,70% of total billed charges,176.8,65,,141.44,percent of total billed charges,65% of total billed charges,97.02,35.67,,77.616,percent of total billed charges,35.67% of total billed charges,78.88,272,
PLATE ANGLED,27013440,CDM,278,RC,C1713,HCPCS,outpatient,,,2194,877.60,,1535.8,70,,1228.64,percent of total billed charges,70% of total billed charges,1151.85,52.5,,921.48,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,1799.08,82,,1439.264,percent of total billed charges,82% of total billed charges,1864.9,85,,1491.92,percent of total billed charges,85% of total billed charges,1864.9,85,,1491.92,percent of total billed charges,85% of total billed charges,1864.9,85,,1491.92,percent of total billed charges,85% of total billed charges,1974.6,90,,1579.68,percent of total billed charges,90% of total billed charges,1755.2,80,,1404.16,percent of total billed charges,80% of total billed charges,1974.6,90,,1579.68,percent of total billed charges,90% of total billed charges,1645.5,75,,1316.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,636.26,29,,509.008,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1469.98,67,,1175.984,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1535.8,70,,1228.64,percent of total billed charges,70% of total billed charges,1426.1,65,,1140.88,percent of total billed charges,65% of total billed charges,782.6,35.67,,626.08,percent of total billed charges,35.67% of total billed charges,636.26,1974.6,
SCREW 3.5 MM,27013441,CDM,278,RC,C1713,HCPCS,outpatient,,,824,329.60,,576.8,70,,461.44,percent of total billed charges,70% of total billed charges,824,100,,659.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,675.68,82,,540.544,percent of total billed charges,82% of total billed charges,700.4,85,,560.32,percent of total billed charges,85% of total billed charges,700.4,85,,560.32,percent of total billed charges,85% of total billed charges,700.4,85,,560.32,percent of total billed charges,85% of total billed charges,741.6,90,,593.28,percent of total billed charges,90% of total billed charges,659.2,80,,527.36,percent of total billed charges,80% of total billed charges,741.6,90,,593.28,percent of total billed charges,90% of total billed charges,618,75,,494.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,238.96,29,,191.168,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,552.08,67,,441.664,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,576.8,70,,461.44,percent of total billed charges,70% of total billed charges,535.6,65,,428.48,percent of total billed charges,65% of total billed charges,293.92,35.67,,235.136,percent of total billed charges,35.67% of total billed charges,238.96,824,
SCREW 3.5 MM,27013442,CDM,278,RC,C1713,HCPCS,outpatient,,,824,329.60,,576.8,70,,461.44,percent of total billed charges,70% of total billed charges,824,100,,659.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,675.68,82,,540.544,percent of total billed charges,82% of total billed charges,700.4,85,,560.32,percent of total billed charges,85% of total billed charges,700.4,85,,560.32,percent of total billed charges,85% of total billed charges,700.4,85,,560.32,percent of total billed charges,85% of total billed charges,741.6,90,,593.28,percent of total billed charges,90% of total billed charges,659.2,80,,527.36,percent of total billed charges,80% of total billed charges,741.6,90,,593.28,percent of total billed charges,90% of total billed charges,618,75,,494.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,238.96,29,,191.168,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,552.08,67,,441.664,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,576.8,70,,461.44,percent of total billed charges,70% of total billed charges,535.6,65,,428.48,percent of total billed charges,65% of total billed charges,293.92,35.67,,235.136,percent of total billed charges,35.67% of total billed charges,238.96,824,
CANCELLOUS SCREW 80 MM,27013501,CDM,278,RC,C1713,HCPCS,outpatient,,,770,308.00,,539,70,,431.2,percent of total billed charges,70% of total billed charges,770,100,,616,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,631.4,82,,505.12,percent of total billed charges,82% of total billed charges,654.5,85,,523.6,percent of total billed charges,85% of total billed charges,654.5,85,,523.6,percent of total billed charges,85% of total billed charges,654.5,85,,523.6,percent of total billed charges,85% of total billed charges,693,90,,554.4,percent of total billed charges,90% of total billed charges,616,80,,492.8,percent of total billed charges,80% of total billed charges,693,90,,554.4,percent of total billed charges,90% of total billed charges,577.5,75,,462,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,223.3,29,,178.64,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,515.9,67,,412.72,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,539,70,,431.2,percent of total billed charges,70% of total billed charges,500.5,65,,400.4,percent of total billed charges,65% of total billed charges,274.66,35.67,,219.728,percent of total billed charges,35.67% of total billed charges,223.3,770,
CANCELLOUS SCREW 60 MM,27013503,CDM,278,RC,C1713,HCPCS,outpatient,,,770,308.00,,539,70,,431.2,percent of total billed charges,70% of total billed charges,770,100,,616,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,631.4,82,,505.12,percent of total billed charges,82% of total billed charges,654.5,85,,523.6,percent of total billed charges,85% of total billed charges,654.5,85,,523.6,percent of total billed charges,85% of total billed charges,654.5,85,,523.6,percent of total billed charges,85% of total billed charges,693,90,,554.4,percent of total billed charges,90% of total billed charges,616,80,,492.8,percent of total billed charges,80% of total billed charges,693,90,,554.4,percent of total billed charges,90% of total billed charges,577.5,75,,462,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,223.3,29,,178.64,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,515.9,67,,412.72,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,539,70,,431.2,percent of total billed charges,70% of total billed charges,500.5,65,,400.4,percent of total billed charges,65% of total billed charges,274.66,35.67,,219.728,percent of total billed charges,35.67% of total billed charges,223.3,770,
SCREW 22 MM,27013538,CDM,278,RC,C1713,HCPCS,outpatient,,,824,329.60,,576.8,70,,461.44,percent of total billed charges,70% of total billed charges,824,100,,659.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,675.68,82,,540.544,percent of total billed charges,82% of total billed charges,700.4,85,,560.32,percent of total billed charges,85% of total billed charges,700.4,85,,560.32,percent of total billed charges,85% of total billed charges,700.4,85,,560.32,percent of total billed charges,85% of total billed charges,741.6,90,,593.28,percent of total billed charges,90% of total billed charges,659.2,80,,527.36,percent of total billed charges,80% of total billed charges,741.6,90,,593.28,percent of total billed charges,90% of total billed charges,618,75,,494.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,238.96,29,,191.168,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,552.08,67,,441.664,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,576.8,70,,461.44,percent of total billed charges,70% of total billed charges,535.6,65,,428.48,percent of total billed charges,65% of total billed charges,293.92,35.67,,235.136,percent of total billed charges,35.67% of total billed charges,238.96,824,
SCREW 4.0 MM,27013539,CDM,278,RC,C1713,HCPCS,outpatient,,,824,329.60,,576.8,70,,461.44,percent of total billed charges,70% of total billed charges,824,100,,659.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,675.68,82,,540.544,percent of total billed charges,82% of total billed charges,700.4,85,,560.32,percent of total billed charges,85% of total billed charges,700.4,85,,560.32,percent of total billed charges,85% of total billed charges,700.4,85,,560.32,percent of total billed charges,85% of total billed charges,741.6,90,,593.28,percent of total billed charges,90% of total billed charges,659.2,80,,527.36,percent of total billed charges,80% of total billed charges,741.6,90,,593.28,percent of total billed charges,90% of total billed charges,618,75,,494.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,238.96,29,,191.168,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,552.08,67,,441.664,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,576.8,70,,461.44,percent of total billed charges,70% of total billed charges,535.6,65,,428.48,percent of total billed charges,65% of total billed charges,293.92,35.67,,235.136,percent of total billed charges,35.67% of total billed charges,238.96,824,
SCREW 35 MM,27013540,CDM,278,RC,C1713,HCPCS,outpatient,,,824,329.60,,576.8,70,,461.44,percent of total billed charges,70% of total billed charges,824,100,,659.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,675.68,82,,540.544,percent of total billed charges,82% of total billed charges,700.4,85,,560.32,percent of total billed charges,85% of total billed charges,700.4,85,,560.32,percent of total billed charges,85% of total billed charges,700.4,85,,560.32,percent of total billed charges,85% of total billed charges,741.6,90,,593.28,percent of total billed charges,90% of total billed charges,659.2,80,,527.36,percent of total billed charges,80% of total billed charges,741.6,90,,593.28,percent of total billed charges,90% of total billed charges,618,75,,494.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,238.96,29,,191.168,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,552.08,67,,441.664,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,576.8,70,,461.44,percent of total billed charges,70% of total billed charges,535.6,65,,428.48,percent of total billed charges,65% of total billed charges,293.92,35.67,,235.136,percent of total billed charges,35.67% of total billed charges,238.96,824,
SCREW 35 MM,27013541,CDM,278,RC,C1713,HCPCS,outpatient,,,824,329.60,,576.8,70,,461.44,percent of total billed charges,70% of total billed charges,824,100,,659.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,675.68,82,,540.544,percent of total billed charges,82% of total billed charges,700.4,85,,560.32,percent of total billed charges,85% of total billed charges,700.4,85,,560.32,percent of total billed charges,85% of total billed charges,700.4,85,,560.32,percent of total billed charges,85% of total billed charges,741.6,90,,593.28,percent of total billed charges,90% of total billed charges,659.2,80,,527.36,percent of total billed charges,80% of total billed charges,741.6,90,,593.28,percent of total billed charges,90% of total billed charges,618,75,,494.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,238.96,29,,191.168,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,552.08,67,,441.664,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,576.8,70,,461.44,percent of total billed charges,70% of total billed charges,535.6,65,,428.48,percent of total billed charges,65% of total billed charges,293.92,35.67,,235.136,percent of total billed charges,35.67% of total billed charges,238.96,824,
SCREW CANNULATED 6.5,27013557,CDM,278,RC,C1713,HCPCS,outpatient,,,2194,877.60,,1535.8,70,,1228.64,percent of total billed charges,70% of total billed charges,1151.85,52.5,,921.48,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,1799.08,82,,1439.264,percent of total billed charges,82% of total billed charges,1864.9,85,,1491.92,percent of total billed charges,85% of total billed charges,1864.9,85,,1491.92,percent of total billed charges,85% of total billed charges,1864.9,85,,1491.92,percent of total billed charges,85% of total billed charges,1974.6,90,,1579.68,percent of total billed charges,90% of total billed charges,1755.2,80,,1404.16,percent of total billed charges,80% of total billed charges,1974.6,90,,1579.68,percent of total billed charges,90% of total billed charges,1645.5,75,,1316.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,636.26,29,,509.008,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1469.98,67,,1175.984,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1535.8,70,,1228.64,percent of total billed charges,70% of total billed charges,1426.1,65,,1140.88,percent of total billed charges,65% of total billed charges,782.6,35.67,,626.08,percent of total billed charges,35.67% of total billed charges,636.26,1974.6,
SCREW CANNULATED 6.5 X 7 MM,27013558,CDM,278,RC,C1713,HCPCS,outpatient,,,2194,877.60,,1535.8,70,,1228.64,percent of total billed charges,70% of total billed charges,1151.85,52.5,,921.48,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,1799.08,82,,1439.264,percent of total billed charges,82% of total billed charges,1864.9,85,,1491.92,percent of total billed charges,85% of total billed charges,1864.9,85,,1491.92,percent of total billed charges,85% of total billed charges,1864.9,85,,1491.92,percent of total billed charges,85% of total billed charges,1974.6,90,,1579.68,percent of total billed charges,90% of total billed charges,1755.2,80,,1404.16,percent of total billed charges,80% of total billed charges,1974.6,90,,1579.68,percent of total billed charges,90% of total billed charges,1645.5,75,,1316.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,636.26,29,,509.008,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1469.98,67,,1175.984,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1535.8,70,,1228.64,percent of total billed charges,70% of total billed charges,1426.1,65,,1140.88,percent of total billed charges,65% of total billed charges,782.6,35.67,,626.08,percent of total billed charges,35.67% of total billed charges,636.26,1974.6,
SCREW CANNULATED 6.5 X 8 MM,27013559,CDM,278,RC,C1713,HCPCS,outpatient,,,2194,877.60,,1535.8,70,,1228.64,percent of total billed charges,70% of total billed charges,1151.85,52.5,,921.48,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,1799.08,82,,1439.264,percent of total billed charges,82% of total billed charges,1864.9,85,,1491.92,percent of total billed charges,85% of total billed charges,1864.9,85,,1491.92,percent of total billed charges,85% of total billed charges,1864.9,85,,1491.92,percent of total billed charges,85% of total billed charges,1974.6,90,,1579.68,percent of total billed charges,90% of total billed charges,1755.2,80,,1404.16,percent of total billed charges,80% of total billed charges,1974.6,90,,1579.68,percent of total billed charges,90% of total billed charges,1645.5,75,,1316.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,636.26,29,,509.008,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1469.98,67,,1175.984,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1535.8,70,,1228.64,percent of total billed charges,70% of total billed charges,1426.1,65,,1140.88,percent of total billed charges,65% of total billed charges,782.6,35.67,,626.08,percent of total billed charges,35.67% of total billed charges,636.26,1974.6,
ALLOGRAFT TENDON,27013584,CDM,278,RC,C1762,HCPCS,outpatient,,,3782,1512.80,,2647.4,70,,2117.92,percent of total billed charges,70% of total billed charges,1985.55,52.5,,1588.44,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,3101.24,82,,2480.992,percent of total billed charges,82% of total billed charges,3214.7,85,,2571.76,percent of total billed charges,85% of total billed charges,3214.7,85,,2571.76,percent of total billed charges,85% of total billed charges,3214.7,85,,2571.76,percent of total billed charges,85% of total billed charges,3403.8,90,,2723.04,percent of total billed charges,90% of total billed charges,3025.6,80,,2420.48,percent of total billed charges,80% of total billed charges,3403.8,90,,2723.04,percent of total billed charges,90% of total billed charges,2836.5,75,,2269.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,1096.78,29,,877.424,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,2533.94,67,,2027.152,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,2647.4,70,,2117.92,percent of total billed charges,70% of total billed charges,2458.3,65,,1966.64,percent of total billed charges,65% of total billed charges,1349.04,35.67,,1079.232,percent of total billed charges,35.67% of total billed charges,1096.78,3403.8,
CORTICAL SCREW TITAN,27013594,CDM,278,RC,C1713,HCPCS,outpatient,,,824,329.60,,576.8,70,,461.44,percent of total billed charges,70% of total billed charges,824,100,,659.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,675.68,82,,540.544,percent of total billed charges,82% of total billed charges,700.4,85,,560.32,percent of total billed charges,85% of total billed charges,700.4,85,,560.32,percent of total billed charges,85% of total billed charges,700.4,85,,560.32,percent of total billed charges,85% of total billed charges,741.6,90,,593.28,percent of total billed charges,90% of total billed charges,659.2,80,,527.36,percent of total billed charges,80% of total billed charges,741.6,90,,593.28,percent of total billed charges,90% of total billed charges,618,75,,494.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,238.96,29,,191.168,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,552.08,67,,441.664,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,576.8,70,,461.44,percent of total billed charges,70% of total billed charges,535.6,65,,428.48,percent of total billed charges,65% of total billed charges,293.92,35.67,,235.136,percent of total billed charges,35.67% of total billed charges,238.96,824,
CORTICAL SCREW 2.7,27013595,CDM,278,RC,C1713,HCPCS,outpatient,,,824,329.60,,576.8,70,,461.44,percent of total billed charges,70% of total billed charges,824,100,,659.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,675.68,82,,540.544,percent of total billed charges,82% of total billed charges,700.4,85,,560.32,percent of total billed charges,85% of total billed charges,700.4,85,,560.32,percent of total billed charges,85% of total billed charges,700.4,85,,560.32,percent of total billed charges,85% of total billed charges,741.6,90,,593.28,percent of total billed charges,90% of total billed charges,659.2,80,,527.36,percent of total billed charges,80% of total billed charges,741.6,90,,593.28,percent of total billed charges,90% of total billed charges,618,75,,494.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,238.96,29,,191.168,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,552.08,67,,441.664,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,576.8,70,,461.44,percent of total billed charges,70% of total billed charges,535.6,65,,428.48,percent of total billed charges,65% of total billed charges,293.92,35.67,,235.136,percent of total billed charges,35.67% of total billed charges,238.96,824,
CORTICAL SCREW TITAN,27013596,CDM,278,RC,C1713,HCPCS,outpatient,,,824,329.60,,576.8,70,,461.44,percent of total billed charges,70% of total billed charges,824,100,,659.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,675.68,82,,540.544,percent of total billed charges,82% of total billed charges,700.4,85,,560.32,percent of total billed charges,85% of total billed charges,700.4,85,,560.32,percent of total billed charges,85% of total billed charges,700.4,85,,560.32,percent of total billed charges,85% of total billed charges,741.6,90,,593.28,percent of total billed charges,90% of total billed charges,659.2,80,,527.36,percent of total billed charges,80% of total billed charges,741.6,90,,593.28,percent of total billed charges,90% of total billed charges,618,75,,494.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,238.96,29,,191.168,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,552.08,67,,441.664,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,576.8,70,,461.44,percent of total billed charges,70% of total billed charges,535.6,65,,428.48,percent of total billed charges,65% of total billed charges,293.92,35.67,,235.136,percent of total billed charges,35.67% of total billed charges,238.96,824,
CORTICAL SCREW,27013605,CDM,278,RC,C1713,HCPCS,outpatient,,,1159,463.60,,811.3,70,,649.04,percent of total billed charges,70% of total billed charges,608.48,52.5,,486.78,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,950.38,82,,760.304,percent of total billed charges,82% of total billed charges,985.15,85,,788.12,percent of total billed charges,85% of total billed charges,985.15,85,,788.12,percent of total billed charges,85% of total billed charges,985.15,85,,788.12,percent of total billed charges,85% of total billed charges,1043.1,90,,834.48,percent of total billed charges,90% of total billed charges,927.2,80,,741.76,percent of total billed charges,80% of total billed charges,1043.1,90,,834.48,percent of total billed charges,90% of total billed charges,869.25,75,,695.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,336.11,29,,268.888,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,776.53,67,,621.224,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,811.3,70,,649.04,percent of total billed charges,70% of total billed charges,753.35,65,,602.68,percent of total billed charges,65% of total billed charges,413.42,35.67,,330.736,percent of total billed charges,35.67% of total billed charges,336.11,1043.1,
SPIKED WASHER,27013606,CDM,278,RC,C1713,HCPCS,outpatient,,,1940,776.00,,1358,70,,1086.4,percent of total billed charges,70% of total billed charges,1018.5,52.5,,814.8,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,1590.8,82,,1272.64,percent of total billed charges,82% of total billed charges,1649,85,,1319.2,percent of total billed charges,85% of total billed charges,1649,85,,1319.2,percent of total billed charges,85% of total billed charges,1649,85,,1319.2,percent of total billed charges,85% of total billed charges,1746,90,,1396.8,percent of total billed charges,90% of total billed charges,1552,80,,1241.6,percent of total billed charges,80% of total billed charges,1746,90,,1396.8,percent of total billed charges,90% of total billed charges,1455,75,,1164,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,562.6,29,,450.08,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1299.8,67,,1039.84,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1358,70,,1086.4,percent of total billed charges,70% of total billed charges,1261,65,,1008.8,percent of total billed charges,65% of total billed charges,692,35.67,,553.6,percent of total billed charges,35.67% of total billed charges,562.6,1746,
BIO TRANSFIX IMPLANT,27013624,CDM,278,RC,C1781,HCPCS,outpatient,,,2074,829.60,,1451.8,70,,1161.44,percent of total billed charges,70% of total billed charges,1088.85,52.5,,871.08,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,1700.68,82,,1360.544,percent of total billed charges,82% of total billed charges,1762.9,85,,1410.32,percent of total billed charges,85% of total billed charges,1762.9,85,,1410.32,percent of total billed charges,85% of total billed charges,1762.9,85,,1410.32,percent of total billed charges,85% of total billed charges,1866.6,90,,1493.28,percent of total billed charges,90% of total billed charges,1659.2,80,,1327.36,percent of total billed charges,80% of total billed charges,1866.6,90,,1493.28,percent of total billed charges,90% of total billed charges,1555.5,75,,1244.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,601.46,29,,481.168,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1389.58,67,,1111.664,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1451.8,70,,1161.44,percent of total billed charges,70% of total billed charges,1348.1,65,,1078.48,percent of total billed charges,65% of total billed charges,739.8,35.67,,591.84,percent of total billed charges,35.67% of total billed charges,601.46,1866.6,
SCREW 6.5,27013628,CDM,278,RC,C1713,HCPCS,outpatient,,,824,329.60,,576.8,70,,461.44,percent of total billed charges,70% of total billed charges,824,100,,659.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,675.68,82,,540.544,percent of total billed charges,82% of total billed charges,700.4,85,,560.32,percent of total billed charges,85% of total billed charges,700.4,85,,560.32,percent of total billed charges,85% of total billed charges,700.4,85,,560.32,percent of total billed charges,85% of total billed charges,741.6,90,,593.28,percent of total billed charges,90% of total billed charges,659.2,80,,527.36,percent of total billed charges,80% of total billed charges,741.6,90,,593.28,percent of total billed charges,90% of total billed charges,618,75,,494.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,238.96,29,,191.168,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,552.08,67,,441.664,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,576.8,70,,461.44,percent of total billed charges,70% of total billed charges,535.6,65,,428.48,percent of total billed charges,65% of total billed charges,293.92,35.67,,235.136,percent of total billed charges,35.67% of total billed charges,238.96,824,
K WIRE,27013630,CDM,278,RC,C1713,HCPCS,outpatient,,,824,329.60,,576.8,70,,461.44,percent of total billed charges,70% of total billed charges,824,100,,659.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,675.68,82,,540.544,percent of total billed charges,82% of total billed charges,700.4,85,,560.32,percent of total billed charges,85% of total billed charges,700.4,85,,560.32,percent of total billed charges,85% of total billed charges,700.4,85,,560.32,percent of total billed charges,85% of total billed charges,741.6,90,,593.28,percent of total billed charges,90% of total billed charges,659.2,80,,527.36,percent of total billed charges,80% of total billed charges,741.6,90,,593.28,percent of total billed charges,90% of total billed charges,618,75,,494.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,238.96,29,,191.168,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,552.08,67,,441.664,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,576.8,70,,461.44,percent of total billed charges,70% of total billed charges,535.6,65,,428.48,percent of total billed charges,65% of total billed charges,293.92,35.67,,235.136,percent of total billed charges,35.67% of total billed charges,238.96,824,
CANCELLOUS CUBE,27013633,CDM,278,RC,C1762,HCPCS,outpatient,,,1756,702.40,,1229.2,70,,983.36,percent of total billed charges,70% of total billed charges,921.9,52.5,,737.52,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,1439.92,82,,1151.936,percent of total billed charges,82% of total billed charges,1492.6,85,,1194.08,percent of total billed charges,85% of total billed charges,1492.6,85,,1194.08,percent of total billed charges,85% of total billed charges,1492.6,85,,1194.08,percent of total billed charges,85% of total billed charges,1580.4,90,,1264.32,percent of total billed charges,90% of total billed charges,1404.8,80,,1123.84,percent of total billed charges,80% of total billed charges,1580.4,90,,1264.32,percent of total billed charges,90% of total billed charges,1317,75,,1053.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,509.24,29,,407.392,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1176.52,67,,941.216,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1229.2,70,,983.36,percent of total billed charges,70% of total billed charges,1141.4,65,,913.12,percent of total billed charges,65% of total billed charges,626.37,35.67,,501.096,percent of total billed charges,35.67% of total billed charges,509.24,1580.4,
SCREW CANNULATED 50 MM,27013642,CDM,278,RC,C1713,HCPCS,outpatient,,,963,385.20,,674.1,70,,539.28,percent of total billed charges,70% of total billed charges,963,100,,770.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,789.66,82,,631.728,percent of total billed charges,82% of total billed charges,818.55,85,,654.84,percent of total billed charges,85% of total billed charges,818.55,85,,654.84,percent of total billed charges,85% of total billed charges,818.55,85,,654.84,percent of total billed charges,85% of total billed charges,866.7,90,,693.36,percent of total billed charges,90% of total billed charges,770.4,80,,616.32,percent of total billed charges,80% of total billed charges,866.7,90,,693.36,percent of total billed charges,90% of total billed charges,722.25,75,,577.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,279.27,29,,223.416,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,645.21,67,,516.168,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,674.1,70,,539.28,percent of total billed charges,70% of total billed charges,625.95,65,,500.76,percent of total billed charges,65% of total billed charges,343.5,35.67,,274.8,percent of total billed charges,35.67% of total billed charges,279.27,963,
SCREW CANNULATED 44 MM,27013643,CDM,278,RC,C1713,HCPCS,outpatient,,,963,385.20,,674.1,70,,539.28,percent of total billed charges,70% of total billed charges,963,100,,770.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,789.66,82,,631.728,percent of total billed charges,82% of total billed charges,818.55,85,,654.84,percent of total billed charges,85% of total billed charges,818.55,85,,654.84,percent of total billed charges,85% of total billed charges,818.55,85,,654.84,percent of total billed charges,85% of total billed charges,866.7,90,,693.36,percent of total billed charges,90% of total billed charges,770.4,80,,616.32,percent of total billed charges,80% of total billed charges,866.7,90,,693.36,percent of total billed charges,90% of total billed charges,722.25,75,,577.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,279.27,29,,223.416,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,645.21,67,,516.168,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,674.1,70,,539.28,percent of total billed charges,70% of total billed charges,625.95,65,,500.76,percent of total billed charges,65% of total billed charges,343.5,35.67,,274.8,percent of total billed charges,35.67% of total billed charges,279.27,963,
PLATE 3 HOLE,27013644,CDM,278,RC,C1713,HCPCS,outpatient,,,2947,1178.80,,2062.9,70,,1650.32,percent of total billed charges,70% of total billed charges,1547.18,52.5,,1237.74,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,2416.54,82,,1933.232,percent of total billed charges,82% of total billed charges,2504.95,85,,2003.96,percent of total billed charges,85% of total billed charges,2504.95,85,,2003.96,percent of total billed charges,85% of total billed charges,2504.95,85,,2003.96,percent of total billed charges,85% of total billed charges,2652.3,90,,2121.84,percent of total billed charges,90% of total billed charges,2357.6,80,,1886.08,percent of total billed charges,80% of total billed charges,2652.3,90,,2121.84,percent of total billed charges,90% of total billed charges,2210.25,75,,1768.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,854.63,29,,683.704,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1974.49,67,,1579.592,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,2062.9,70,,1650.32,percent of total billed charges,70% of total billed charges,1915.55,65,,1532.44,percent of total billed charges,65% of total billed charges,1051.19,35.67,,840.952,percent of total billed charges,35.67% of total billed charges,854.63,2652.3,
HEAD SELF TAP,27013645,CDM,278,RC,C1713,HCPCS,outpatient,,,266,106.40,,186.2,70,,148.96,percent of total billed charges,70% of total billed charges,266,100,,212.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,218.12,82,,174.496,percent of total billed charges,82% of total billed charges,226.1,85,,180.88,percent of total billed charges,85% of total billed charges,226.1,85,,180.88,percent of total billed charges,85% of total billed charges,226.1,85,,180.88,percent of total billed charges,85% of total billed charges,239.4,90,,191.52,percent of total billed charges,90% of total billed charges,212.8,80,,170.24,percent of total billed charges,80% of total billed charges,239.4,90,,191.52,percent of total billed charges,90% of total billed charges,199.5,75,,159.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,77.14,29,,61.712,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,178.22,67,,142.576,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,186.2,70,,148.96,percent of total billed charges,70% of total billed charges,172.9,65,,138.32,percent of total billed charges,65% of total billed charges,94.88,35.67,,75.904,percent of total billed charges,35.67% of total billed charges,77.14,266,
SCREW LOCKING,27013646,CDM,278,RC,C1713,HCPCS,outpatient,,,696,278.40,,487.2,70,,389.76,percent of total billed charges,70% of total billed charges,696,100,,556.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,570.72,82,,456.576,percent of total billed charges,82% of total billed charges,591.6,85,,473.28,percent of total billed charges,85% of total billed charges,591.6,85,,473.28,percent of total billed charges,85% of total billed charges,591.6,85,,473.28,percent of total billed charges,85% of total billed charges,626.4,90,,501.12,percent of total billed charges,90% of total billed charges,556.8,80,,445.44,percent of total billed charges,80% of total billed charges,626.4,90,,501.12,percent of total billed charges,90% of total billed charges,522,75,,417.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,201.84,29,,161.472,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,466.32,67,,373.056,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,487.2,70,,389.76,percent of total billed charges,70% of total billed charges,452.4,65,,361.92,percent of total billed charges,65% of total billed charges,248.26,35.67,,198.608,percent of total billed charges,35.67% of total billed charges,201.84,696,
SCREW LOCKING 12 MM,27013647,CDM,278,RC,C1713,HCPCS,outpatient,,,696,278.40,,487.2,70,,389.76,percent of total billed charges,70% of total billed charges,696,100,,556.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,570.72,82,,456.576,percent of total billed charges,82% of total billed charges,591.6,85,,473.28,percent of total billed charges,85% of total billed charges,591.6,85,,473.28,percent of total billed charges,85% of total billed charges,591.6,85,,473.28,percent of total billed charges,85% of total billed charges,626.4,90,,501.12,percent of total billed charges,90% of total billed charges,556.8,80,,445.44,percent of total billed charges,80% of total billed charges,626.4,90,,501.12,percent of total billed charges,90% of total billed charges,522,75,,417.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,201.84,29,,161.472,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,466.32,67,,373.056,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,487.2,70,,389.76,percent of total billed charges,70% of total billed charges,452.4,65,,361.92,percent of total billed charges,65% of total billed charges,248.26,35.67,,198.608,percent of total billed charges,35.67% of total billed charges,201.84,696,
SCREW LOCKING 14 MM,27013648,CDM,278,RC,C1713,HCPCS,outpatient,,,696,278.40,,487.2,70,,389.76,percent of total billed charges,70% of total billed charges,696,100,,556.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,570.72,82,,456.576,percent of total billed charges,82% of total billed charges,591.6,85,,473.28,percent of total billed charges,85% of total billed charges,591.6,85,,473.28,percent of total billed charges,85% of total billed charges,591.6,85,,473.28,percent of total billed charges,85% of total billed charges,626.4,90,,501.12,percent of total billed charges,90% of total billed charges,556.8,80,,445.44,percent of total billed charges,80% of total billed charges,626.4,90,,501.12,percent of total billed charges,90% of total billed charges,522,75,,417.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,201.84,29,,161.472,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,466.32,67,,373.056,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,487.2,70,,389.76,percent of total billed charges,70% of total billed charges,452.4,65,,361.92,percent of total billed charges,65% of total billed charges,248.26,35.67,,198.608,percent of total billed charges,35.67% of total billed charges,201.84,696,
DBM PUTTY,27013651,CDM,278,RC,C9359,HCPCS,outpatient,,,4753,1901.20,,3327.1,70,,2661.68,percent of total billed charges,70% of total billed charges,2495.33,52.5,,1996.26,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,3897.46,82,,3117.968,percent of total billed charges,82% of total billed charges,4040.05,85,,3232.04,percent of total billed charges,85% of total billed charges,4040.05,85,,3232.04,percent of total billed charges,85% of total billed charges,4040.05,85,,3232.04,percent of total billed charges,85% of total billed charges,4277.7,90,,3422.16,percent of total billed charges,90% of total billed charges,3802.4,80,,3041.92,percent of total billed charges,80% of total billed charges,4277.7,90,,3422.16,percent of total billed charges,90% of total billed charges,3564.75,75,,2851.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,150.09,100,,,fee schedule,100% of ASC tier grouping rate,,,,,other ,not seperately reimbursable,3184.51,67,,2547.608,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,3327.1,70,,2661.68,percent of total billed charges,70% of total billed charges,3089.45,65,,2471.56,percent of total billed charges,65% of total billed charges,184.61,123,,,fee schedule,123% of ASC tier grouping rate,150.09,4277.7,
OSTEOVIVE 10 CC FIBER COMBO,27013652,CDM,278,RC,C9359,HCPCS,outpatient,,,11701,4680.40,,8190.7,70,,6552.56,percent of total billed charges,70% of total billed charges,6143.03,52.5,,4914.42,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,9594.82,82,,7675.856,percent of total billed charges,82% of total billed charges,9945.85,85,,7956.68,percent of total billed charges,85% of total billed charges,9945.85,85,,7956.68,percent of total billed charges,85% of total billed charges,9945.85,85,,7956.68,percent of total billed charges,85% of total billed charges,10530.9,90,,8424.72,percent of total billed charges,90% of total billed charges,9360.8,80,,7488.64,percent of total billed charges,80% of total billed charges,10530.9,90,,8424.72,percent of total billed charges,90% of total billed charges,8775.75,75,,7020.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,150.09,100,,,fee schedule,100% of ASC tier grouping rate,,,,,other ,not seperately reimbursable,7839.67,67,,6271.736,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,8190.7,70,,6552.56,percent of total billed charges,70% of total billed charges,7605.65,65,,6084.52,percent of total billed charges,65% of total billed charges,184.61,123,,,fee schedule,123% of ASC tier grouping rate,150.09,10530.9,
3 DEMIN BONE STRIPS,27013653,CDM,278,RC,C9359,HCPCS,outpatient,,,5187,2074.80,,3630.9,70,,2904.72,percent of total billed charges,70% of total billed charges,2723.18,52.5,,2178.54,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,4253.34,82,,3402.672,percent of total billed charges,82% of total billed charges,4408.95,85,,3527.16,percent of total billed charges,85% of total billed charges,4408.95,85,,3527.16,percent of total billed charges,85% of total billed charges,4408.95,85,,3527.16,percent of total billed charges,85% of total billed charges,4668.3,90,,3734.64,percent of total billed charges,90% of total billed charges,4149.6,80,,3319.68,percent of total billed charges,80% of total billed charges,4668.3,90,,3734.64,percent of total billed charges,90% of total billed charges,3890.25,75,,3112.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,150.09,100,,,fee schedule,100% of ASC tier grouping rate,,,,,other ,not seperately reimbursable,3475.29,67,,2780.232,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,3630.9,70,,2904.72,percent of total billed charges,70% of total billed charges,3371.55,65,,2697.24,percent of total billed charges,65% of total billed charges,184.61,123,,,fee schedule,123% of ASC tier grouping rate,150.09,4668.3,
LUMBAR INTERBODY IMPLANT,27013657,CDM,278,RC,C1821,HCPCS,outpatient,,,12427,4970.80,,8698.9,70,,6959.12,percent of total billed charges,70% of total billed charges,6524.18,52.5,,5219.34,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,10190.14,82,,8152.112,percent of total billed charges,82% of total billed charges,10562.95,85,,8450.36,percent of total billed charges,85% of total billed charges,10562.95,85,,8450.36,percent of total billed charges,85% of total billed charges,10562.95,85,,8450.36,percent of total billed charges,85% of total billed charges,11184.3,90,,8947.44,percent of total billed charges,90% of total billed charges,9941.6,80,,7953.28,percent of total billed charges,80% of total billed charges,11184.3,90,,8947.44,percent of total billed charges,90% of total billed charges,9320.25,75,,7456.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,3603.83,29,,2883.064,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,8326.09,67,,6660.872,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,8698.9,70,,6959.12,percent of total billed charges,70% of total billed charges,8077.55,65,,6462.04,percent of total billed charges,65% of total billed charges,4432.71,35.67,,3546.168,percent of total billed charges,35.67% of total billed charges,3603.83,11184.3,
SCREW 6.5 X 45,27013658,CDM,278,RC,C1713,HCPCS,outpatient,,,2432,972.80,,1702.4,70,,1361.92,percent of total billed charges,70% of total billed charges,1276.8,52.5,,1021.44,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,1994.24,82,,1595.392,percent of total billed charges,82% of total billed charges,2067.2,85,,1653.76,percent of total billed charges,85% of total billed charges,2067.2,85,,1653.76,percent of total billed charges,85% of total billed charges,2067.2,85,,1653.76,percent of total billed charges,85% of total billed charges,2188.8,90,,1751.04,percent of total billed charges,90% of total billed charges,1945.6,80,,1556.48,percent of total billed charges,80% of total billed charges,2188.8,90,,1751.04,percent of total billed charges,90% of total billed charges,1824,75,,1459.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,705.28,29,,564.224,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1629.44,67,,1303.552,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1702.4,70,,1361.92,percent of total billed charges,70% of total billed charges,1580.8,65,,1264.64,percent of total billed charges,65% of total billed charges,867.49,35.67,,693.992,percent of total billed charges,35.67% of total billed charges,705.28,2188.8,
CIRCULAR LOCK SCREW,27013659,CDM,278,RC,C1713,HCPCS,outpatient,,,1594,637.60,,1115.8,70,,892.64,percent of total billed charges,70% of total billed charges,836.85,52.5,,669.48,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,1307.08,82,,1045.664,percent of total billed charges,82% of total billed charges,1354.9,85,,1083.92,percent of total billed charges,85% of total billed charges,1354.9,85,,1083.92,percent of total billed charges,85% of total billed charges,1354.9,85,,1083.92,percent of total billed charges,85% of total billed charges,1434.6,90,,1147.68,percent of total billed charges,90% of total billed charges,1275.2,80,,1020.16,percent of total billed charges,80% of total billed charges,1434.6,90,,1147.68,percent of total billed charges,90% of total billed charges,1195.5,75,,956.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,462.26,29,,369.808,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1067.98,67,,854.384,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1115.8,70,,892.64,percent of total billed charges,70% of total billed charges,1036.1,65,,828.88,percent of total billed charges,65% of total billed charges,568.58,35.67,,454.864,percent of total billed charges,35.67% of total billed charges,462.26,1434.6,
ROD 40 MM,27013660,CDM,278,RC,C1713,HCPCS,outpatient,,,1744,697.60,,1220.8,70,,976.64,percent of total billed charges,70% of total billed charges,915.6,52.5,,732.48,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,1430.08,82,,1144.064,percent of total billed charges,82% of total billed charges,1482.4,85,,1185.92,percent of total billed charges,85% of total billed charges,1482.4,85,,1185.92,percent of total billed charges,85% of total billed charges,1482.4,85,,1185.92,percent of total billed charges,85% of total billed charges,1569.6,90,,1255.68,percent of total billed charges,90% of total billed charges,1395.2,80,,1116.16,percent of total billed charges,80% of total billed charges,1569.6,90,,1255.68,percent of total billed charges,90% of total billed charges,1308,75,,1046.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,505.76,29,,404.608,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1168.48,67,,934.784,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1220.8,70,,976.64,percent of total billed charges,70% of total billed charges,1133.6,65,,906.88,percent of total billed charges,65% of total billed charges,622.08,35.67,,497.664,percent of total billed charges,35.67% of total billed charges,505.76,1569.6,
OSTEOSPONGE STRIP 40 X 15X5,27013661,CDM,278,RC,C9359,HCPCS,outpatient,,,5187,2074.80,,3630.9,70,,2904.72,percent of total billed charges,70% of total billed charges,2723.18,52.5,,2178.54,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,4253.34,82,,3402.672,percent of total billed charges,82% of total billed charges,4408.95,85,,3527.16,percent of total billed charges,85% of total billed charges,4408.95,85,,3527.16,percent of total billed charges,85% of total billed charges,4408.95,85,,3527.16,percent of total billed charges,85% of total billed charges,4668.3,90,,3734.64,percent of total billed charges,90% of total billed charges,4149.6,80,,3319.68,percent of total billed charges,80% of total billed charges,4668.3,90,,3734.64,percent of total billed charges,90% of total billed charges,3890.25,75,,3112.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,150.09,100,,,fee schedule,100% of ASC tier grouping rate,,,,,other ,not seperately reimbursable,3475.29,67,,2780.232,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,3630.9,70,,2904.72,percent of total billed charges,70% of total billed charges,3371.55,65,,2697.24,percent of total billed charges,65% of total billed charges,184.61,123,,,fee schedule,123% of ASC tier grouping rate,150.09,4668.3,
CORTICAL SCREW,27013692,CDM,278,RC,C1713,HCPCS,outpatient,,,824,329.60,,576.8,70,,461.44,percent of total billed charges,70% of total billed charges,824,100,,659.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,675.68,82,,540.544,percent of total billed charges,82% of total billed charges,700.4,85,,560.32,percent of total billed charges,85% of total billed charges,700.4,85,,560.32,percent of total billed charges,85% of total billed charges,700.4,85,,560.32,percent of total billed charges,85% of total billed charges,741.6,90,,593.28,percent of total billed charges,90% of total billed charges,659.2,80,,527.36,percent of total billed charges,80% of total billed charges,741.6,90,,593.28,percent of total billed charges,90% of total billed charges,618,75,,494.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,238.96,29,,191.168,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,552.08,67,,441.664,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,576.8,70,,461.44,percent of total billed charges,70% of total billed charges,535.6,65,,428.48,percent of total billed charges,65% of total billed charges,293.92,35.67,,235.136,percent of total billed charges,35.67% of total billed charges,238.96,824,
PLATE 4 HOLE,27013694,CDM,278,RC,C1713,HCPCS,outpatient,,,2194,877.60,,1535.8,70,,1228.64,percent of total billed charges,70% of total billed charges,1151.85,52.5,,921.48,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,1799.08,82,,1439.264,percent of total billed charges,82% of total billed charges,1864.9,85,,1491.92,percent of total billed charges,85% of total billed charges,1864.9,85,,1491.92,percent of total billed charges,85% of total billed charges,1864.9,85,,1491.92,percent of total billed charges,85% of total billed charges,1974.6,90,,1579.68,percent of total billed charges,90% of total billed charges,1755.2,80,,1404.16,percent of total billed charges,80% of total billed charges,1974.6,90,,1579.68,percent of total billed charges,90% of total billed charges,1645.5,75,,1316.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,636.26,29,,509.008,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1469.98,67,,1175.984,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1535.8,70,,1228.64,percent of total billed charges,70% of total billed charges,1426.1,65,,1140.88,percent of total billed charges,65% of total billed charges,782.6,35.67,,626.08,percent of total billed charges,35.67% of total billed charges,636.26,1974.6,
LOCKING SCREW,27013702,CDM,278,RC,C1713,HCPCS,outpatient,,,764,305.60,,534.8,70,,427.84,percent of total billed charges,70% of total billed charges,764,100,,611.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,626.48,82,,501.184,percent of total billed charges,82% of total billed charges,649.4,85,,519.52,percent of total billed charges,85% of total billed charges,649.4,85,,519.52,percent of total billed charges,85% of total billed charges,649.4,85,,519.52,percent of total billed charges,85% of total billed charges,687.6,90,,550.08,percent of total billed charges,90% of total billed charges,611.2,80,,488.96,percent of total billed charges,80% of total billed charges,687.6,90,,550.08,percent of total billed charges,90% of total billed charges,573,75,,458.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,221.56,29,,177.248,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,511.88,67,,409.504,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,534.8,70,,427.84,percent of total billed charges,70% of total billed charges,496.6,65,,397.28,percent of total billed charges,65% of total billed charges,272.52,35.67,,218.016,percent of total billed charges,35.67% of total billed charges,221.56,764,
CORTICAL SCREW,27013711,CDM,278,RC,C1713,HCPCS,outpatient,,,879,351.60,,615.3,70,,492.24,percent of total billed charges,70% of total billed charges,879,100,,703.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,720.78,82,,576.624,percent of total billed charges,82% of total billed charges,747.15,85,,597.72,percent of total billed charges,85% of total billed charges,747.15,85,,597.72,percent of total billed charges,85% of total billed charges,747.15,85,,597.72,percent of total billed charges,85% of total billed charges,791.1,90,,632.88,percent of total billed charges,90% of total billed charges,703.2,80,,562.56,percent of total billed charges,80% of total billed charges,791.1,90,,632.88,percent of total billed charges,90% of total billed charges,659.25,75,,527.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,254.91,29,,203.928,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,588.93,67,,471.144,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,615.3,70,,492.24,percent of total billed charges,70% of total billed charges,571.35,65,,457.08,percent of total billed charges,65% of total billed charges,313.54,35.67,,250.832,percent of total billed charges,35.67% of total billed charges,254.91,879,
CORTICAL SCREW,27013712,CDM,278,RC,C1713,HCPCS,outpatient,,,222,88.80,,155.4,70,,124.32,percent of total billed charges,70% of total billed charges,222,100,,177.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,182.04,82,,145.632,percent of total billed charges,82% of total billed charges,188.7,85,,150.96,percent of total billed charges,85% of total billed charges,188.7,85,,150.96,percent of total billed charges,85% of total billed charges,188.7,85,,150.96,percent of total billed charges,85% of total billed charges,199.8,90,,159.84,percent of total billed charges,90% of total billed charges,177.6,80,,142.08,percent of total billed charges,80% of total billed charges,199.8,90,,159.84,percent of total billed charges,90% of total billed charges,166.5,75,,133.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,64.38,29,,51.504,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,148.74,67,,118.992,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,155.4,70,,124.32,percent of total billed charges,70% of total billed charges,144.3,65,,115.44,percent of total billed charges,65% of total billed charges,79.19,35.67,,63.352,percent of total billed charges,35.67% of total billed charges,64.38,222,
PLATE,27013713,CDM,278,RC,C1713,HCPCS,outpatient,,,4384,1753.60,,3068.8,70,,2455.04,percent of total billed charges,70% of total billed charges,2301.6,52.5,,1841.28,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,3594.88,82,,2875.904,percent of total billed charges,82% of total billed charges,3726.4,85,,2981.12,percent of total billed charges,85% of total billed charges,3726.4,85,,2981.12,percent of total billed charges,85% of total billed charges,3726.4,85,,2981.12,percent of total billed charges,85% of total billed charges,3945.6,90,,3156.48,percent of total billed charges,90% of total billed charges,3507.2,80,,2805.76,percent of total billed charges,80% of total billed charges,3945.6,90,,3156.48,percent of total billed charges,90% of total billed charges,3288,75,,2630.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,1271.36,29,,1017.088,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,2937.28,67,,2349.824,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,3068.8,70,,2455.04,percent of total billed charges,70% of total billed charges,2849.6,65,,2279.68,percent of total billed charges,65% of total billed charges,1563.77,35.67,,1251.016,percent of total billed charges,35.67% of total billed charges,1271.36,3945.6,
CANNULATED SCREW,27013766,CDM,278,RC,C1713,HCPCS,outpatient,,,1427,570.80,,998.9,70,,799.12,percent of total billed charges,70% of total billed charges,749.18,52.5,,599.34,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,1170.14,82,,936.112,percent of total billed charges,82% of total billed charges,1212.95,85,,970.36,percent of total billed charges,85% of total billed charges,1212.95,85,,970.36,percent of total billed charges,85% of total billed charges,1212.95,85,,970.36,percent of total billed charges,85% of total billed charges,1284.3,90,,1027.44,percent of total billed charges,90% of total billed charges,1141.6,80,,913.28,percent of total billed charges,80% of total billed charges,1284.3,90,,1027.44,percent of total billed charges,90% of total billed charges,1070.25,75,,856.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,413.83,29,,331.064,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,956.09,67,,764.872,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,998.9,70,,799.12,percent of total billed charges,70% of total billed charges,927.55,65,,742.04,percent of total billed charges,65% of total billed charges,509.01,35.67,,407.208,percent of total billed charges,35.67% of total billed charges,413.83,1284.3,
NON LOCKING SCREW,27013769,CDM,278,RC,C1713,HCPCS,outpatient,,,259,103.60,,181.3,70,,145.04,percent of total billed charges,70% of total billed charges,259,100,,207.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,212.38,82,,169.904,percent of total billed charges,82% of total billed charges,220.15,85,,176.12,percent of total billed charges,85% of total billed charges,220.15,85,,176.12,percent of total billed charges,85% of total billed charges,220.15,85,,176.12,percent of total billed charges,85% of total billed charges,233.1,90,,186.48,percent of total billed charges,90% of total billed charges,207.2,80,,165.76,percent of total billed charges,80% of total billed charges,233.1,90,,186.48,percent of total billed charges,90% of total billed charges,194.25,75,,155.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,75.11,29,,60.088,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,173.53,67,,138.824,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,181.3,70,,145.04,percent of total billed charges,70% of total billed charges,168.35,65,,134.68,percent of total billed charges,65% of total billed charges,92.39,35.67,,73.912,percent of total billed charges,35.67% of total billed charges,75.11,259,
NON LOCKING SCREW,27013770,CDM,278,RC,C1713,HCPCS,outpatient,,,259,103.60,,181.3,70,,145.04,percent of total billed charges,70% of total billed charges,259,100,,207.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,212.38,82,,169.904,percent of total billed charges,82% of total billed charges,220.15,85,,176.12,percent of total billed charges,85% of total billed charges,220.15,85,,176.12,percent of total billed charges,85% of total billed charges,220.15,85,,176.12,percent of total billed charges,85% of total billed charges,233.1,90,,186.48,percent of total billed charges,90% of total billed charges,207.2,80,,165.76,percent of total billed charges,80% of total billed charges,233.1,90,,186.48,percent of total billed charges,90% of total billed charges,194.25,75,,155.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,75.11,29,,60.088,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,173.53,67,,138.824,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,181.3,70,,145.04,percent of total billed charges,70% of total billed charges,168.35,65,,134.68,percent of total billed charges,65% of total billed charges,92.39,35.67,,73.912,percent of total billed charges,35.67% of total billed charges,75.11,259,
NON LOCKING SCREW 3.5 MM,27013771,CDM,278,RC,C1713,HCPCS,outpatient,,,259,103.60,,181.3,70,,145.04,percent of total billed charges,70% of total billed charges,259,100,,207.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,212.38,82,,169.904,percent of total billed charges,82% of total billed charges,220.15,85,,176.12,percent of total billed charges,85% of total billed charges,220.15,85,,176.12,percent of total billed charges,85% of total billed charges,220.15,85,,176.12,percent of total billed charges,85% of total billed charges,233.1,90,,186.48,percent of total billed charges,90% of total billed charges,207.2,80,,165.76,percent of total billed charges,80% of total billed charges,233.1,90,,186.48,percent of total billed charges,90% of total billed charges,194.25,75,,155.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,75.11,29,,60.088,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,173.53,67,,138.824,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,181.3,70,,145.04,percent of total billed charges,70% of total billed charges,168.35,65,,134.68,percent of total billed charges,65% of total billed charges,92.39,35.67,,73.912,percent of total billed charges,35.67% of total billed charges,75.11,259,
LOCKING SCREW 3.5 MM,27013772,CDM,278,RC,C1713,HCPCS,outpatient,,,259,103.60,,181.3,70,,145.04,percent of total billed charges,70% of total billed charges,259,100,,207.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,212.38,82,,169.904,percent of total billed charges,82% of total billed charges,220.15,85,,176.12,percent of total billed charges,85% of total billed charges,220.15,85,,176.12,percent of total billed charges,85% of total billed charges,220.15,85,,176.12,percent of total billed charges,85% of total billed charges,233.1,90,,186.48,percent of total billed charges,90% of total billed charges,207.2,80,,165.76,percent of total billed charges,80% of total billed charges,233.1,90,,186.48,percent of total billed charges,90% of total billed charges,194.25,75,,155.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,75.11,29,,60.088,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,173.53,67,,138.824,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,181.3,70,,145.04,percent of total billed charges,70% of total billed charges,168.35,65,,134.68,percent of total billed charges,65% of total billed charges,92.39,35.67,,73.912,percent of total billed charges,35.67% of total billed charges,75.11,259,
LOCKING SCREW,27013773,CDM,278,RC,C1713,HCPCS,outpatient,,,959,383.60,,671.3,70,,537.04,percent of total billed charges,70% of total billed charges,959,100,,767.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,786.38,82,,629.104,percent of total billed charges,82% of total billed charges,815.15,85,,652.12,percent of total billed charges,85% of total billed charges,815.15,85,,652.12,percent of total billed charges,85% of total billed charges,815.15,85,,652.12,percent of total billed charges,85% of total billed charges,863.1,90,,690.48,percent of total billed charges,90% of total billed charges,767.2,80,,613.76,percent of total billed charges,80% of total billed charges,863.1,90,,690.48,percent of total billed charges,90% of total billed charges,719.25,75,,575.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,278.11,29,,222.488,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,642.53,67,,514.024,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,671.3,70,,537.04,percent of total billed charges,70% of total billed charges,623.35,65,,498.68,percent of total billed charges,65% of total billed charges,342.08,35.67,,273.664,percent of total billed charges,35.67% of total billed charges,278.11,959,
RIGHT FIB PLATE,27013774,CDM,278,RC,C1713,HCPCS,outpatient,,,4555,1822.00,,3188.5,70,,2550.8,percent of total billed charges,70% of total billed charges,2391.38,52.5,,1913.1,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,3735.1,82,,2988.08,percent of total billed charges,82% of total billed charges,3871.75,85,,3097.4,percent of total billed charges,85% of total billed charges,3871.75,85,,3097.4,percent of total billed charges,85% of total billed charges,3871.75,85,,3097.4,percent of total billed charges,85% of total billed charges,4099.5,90,,3279.6,percent of total billed charges,90% of total billed charges,3644,80,,2915.2,percent of total billed charges,80% of total billed charges,4099.5,90,,3279.6,percent of total billed charges,90% of total billed charges,3416.25,75,,2733,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,1320.95,29,,1056.76,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,3051.85,67,,2441.48,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,3188.5,70,,2550.8,percent of total billed charges,70% of total billed charges,2960.75,65,,2368.6,percent of total billed charges,65% of total billed charges,1624.77,35.67,,1299.816,percent of total billed charges,35.67% of total billed charges,1320.95,4099.5,
LOCKING SCREW,27013775,CDM,278,RC,C1713,HCPCS,outpatient,,,606,242.40,,424.2,70,,339.36,percent of total billed charges,70% of total billed charges,606,100,,484.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,496.92,82,,397.536,percent of total billed charges,82% of total billed charges,515.1,85,,412.08,percent of total billed charges,85% of total billed charges,515.1,85,,412.08,percent of total billed charges,85% of total billed charges,515.1,85,,412.08,percent of total billed charges,85% of total billed charges,545.4,90,,436.32,percent of total billed charges,90% of total billed charges,484.8,80,,387.84,percent of total billed charges,80% of total billed charges,545.4,90,,436.32,percent of total billed charges,90% of total billed charges,454.5,75,,363.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,175.74,29,,140.592,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,406.02,67,,324.816,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,424.2,70,,339.36,percent of total billed charges,70% of total billed charges,393.9,65,,315.12,percent of total billed charges,65% of total billed charges,216.16,35.67,,172.928,percent of total billed charges,35.67% of total billed charges,175.74,606,
LOCKING SCREW,27013776,CDM,278,RC,C1713,HCPCS,outpatient,,,606,242.40,,424.2,70,,339.36,percent of total billed charges,70% of total billed charges,606,100,,484.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,496.92,82,,397.536,percent of total billed charges,82% of total billed charges,515.1,85,,412.08,percent of total billed charges,85% of total billed charges,515.1,85,,412.08,percent of total billed charges,85% of total billed charges,515.1,85,,412.08,percent of total billed charges,85% of total billed charges,545.4,90,,436.32,percent of total billed charges,90% of total billed charges,484.8,80,,387.84,percent of total billed charges,80% of total billed charges,545.4,90,,436.32,percent of total billed charges,90% of total billed charges,454.5,75,,363.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,175.74,29,,140.592,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,406.02,67,,324.816,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,424.2,70,,339.36,percent of total billed charges,70% of total billed charges,393.9,65,,315.12,percent of total billed charges,65% of total billed charges,216.16,35.67,,172.928,percent of total billed charges,35.67% of total billed charges,175.74,606,
TAPER POST HEMICAP,27013794,CDM,278,RC,C1713,HCPCS,outpatient,,,1857,742.80,,1299.9,70,,1039.92,percent of total billed charges,70% of total billed charges,974.93,52.5,,779.94,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,1522.74,82,,1218.192,percent of total billed charges,82% of total billed charges,1578.45,85,,1262.76,percent of total billed charges,85% of total billed charges,1578.45,85,,1262.76,percent of total billed charges,85% of total billed charges,1578.45,85,,1262.76,percent of total billed charges,85% of total billed charges,1671.3,90,,1337.04,percent of total billed charges,90% of total billed charges,1485.6,80,,1188.48,percent of total billed charges,80% of total billed charges,1671.3,90,,1337.04,percent of total billed charges,90% of total billed charges,1392.75,75,,1114.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,538.53,29,,430.824,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1244.19,67,,995.352,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1299.9,70,,1039.92,percent of total billed charges,70% of total billed charges,1207.05,65,,965.64,percent of total billed charges,65% of total billed charges,662.39,35.67,,529.912,percent of total billed charges,35.67% of total billed charges,538.53,1671.3,
ARTHOSURFACE DISPOSABLE PIN,27013795,CDM,278,RC,C1713,HCPCS,outpatient,,,529,211.60,,370.3,70,,296.24,percent of total billed charges,70% of total billed charges,529,100,,423.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,433.78,82,,347.024,percent of total billed charges,82% of total billed charges,449.65,85,,359.72,percent of total billed charges,85% of total billed charges,449.65,85,,359.72,percent of total billed charges,85% of total billed charges,449.65,85,,359.72,percent of total billed charges,85% of total billed charges,476.1,90,,380.88,percent of total billed charges,90% of total billed charges,423.2,80,,338.56,percent of total billed charges,80% of total billed charges,476.1,90,,380.88,percent of total billed charges,90% of total billed charges,396.75,75,,317.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,153.41,29,,122.728,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,354.43,67,,283.544,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,370.3,70,,296.24,percent of total billed charges,70% of total billed charges,343.85,65,,275.08,percent of total billed charges,65% of total billed charges,188.69,35.67,,150.952,percent of total billed charges,35.67% of total billed charges,153.41,529,
PLATE TITANIUM,27013801,CDM,278,RC,C1713,HCPCS,outpatient,,,2194,877.60,,1535.8,70,,1228.64,percent of total billed charges,70% of total billed charges,1151.85,52.5,,921.48,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,1799.08,82,,1439.264,percent of total billed charges,82% of total billed charges,1864.9,85,,1491.92,percent of total billed charges,85% of total billed charges,1864.9,85,,1491.92,percent of total billed charges,85% of total billed charges,1864.9,85,,1491.92,percent of total billed charges,85% of total billed charges,1974.6,90,,1579.68,percent of total billed charges,90% of total billed charges,1755.2,80,,1404.16,percent of total billed charges,80% of total billed charges,1974.6,90,,1579.68,percent of total billed charges,90% of total billed charges,1645.5,75,,1316.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,636.26,29,,509.008,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1469.98,67,,1175.984,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1535.8,70,,1228.64,percent of total billed charges,70% of total billed charges,1426.1,65,,1140.88,percent of total billed charges,65% of total billed charges,782.6,35.67,,626.08,percent of total billed charges,35.67% of total billed charges,636.26,1974.6,
CANCELLOUS CHIPS,27013810,CDM,278,RC,C1762,HCPCS,outpatient,,,1811,724.40,,1267.7,70,,1014.16,percent of total billed charges,70% of total billed charges,950.78,52.5,,760.62,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,1485.02,82,,1188.016,percent of total billed charges,82% of total billed charges,1539.35,85,,1231.48,percent of total billed charges,85% of total billed charges,1539.35,85,,1231.48,percent of total billed charges,85% of total billed charges,1539.35,85,,1231.48,percent of total billed charges,85% of total billed charges,1629.9,90,,1303.92,percent of total billed charges,90% of total billed charges,1448.8,80,,1159.04,percent of total billed charges,80% of total billed charges,1629.9,90,,1303.92,percent of total billed charges,90% of total billed charges,1358.25,75,,1086.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,525.19,29,,420.152,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1213.37,67,,970.696,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1267.7,70,,1014.16,percent of total billed charges,70% of total billed charges,1177.15,65,,941.72,percent of total billed charges,65% of total billed charges,645.98,35.67,,516.784,percent of total billed charges,35.67% of total billed charges,525.19,1629.9,
SCREW HEADLESS COMPRESSION,27013811,CDM,278,RC,C1713,HCPCS,outpatient,,,1679,671.60,,1175.3,70,,940.24,percent of total billed charges,70% of total billed charges,881.48,52.5,,705.18,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,1376.78,82,,1101.424,percent of total billed charges,82% of total billed charges,1427.15,85,,1141.72,percent of total billed charges,85% of total billed charges,1427.15,85,,1141.72,percent of total billed charges,85% of total billed charges,1427.15,85,,1141.72,percent of total billed charges,85% of total billed charges,1511.1,90,,1208.88,percent of total billed charges,90% of total billed charges,1343.2,80,,1074.56,percent of total billed charges,80% of total billed charges,1511.1,90,,1208.88,percent of total billed charges,90% of total billed charges,1259.25,75,,1007.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,486.91,29,,389.528,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1124.93,67,,899.944,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1175.3,70,,940.24,percent of total billed charges,70% of total billed charges,1091.35,65,,873.08,percent of total billed charges,65% of total billed charges,598.9,35.67,,479.12,percent of total billed charges,35.67% of total billed charges,486.91,1511.1,
HEADLESS SCREW COMPRESSION,27013812,CDM,278,RC,C1713,HCPCS,outpatient,,,1679,671.60,,1175.3,70,,940.24,percent of total billed charges,70% of total billed charges,881.48,52.5,,705.18,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,1376.78,82,,1101.424,percent of total billed charges,82% of total billed charges,1427.15,85,,1141.72,percent of total billed charges,85% of total billed charges,1427.15,85,,1141.72,percent of total billed charges,85% of total billed charges,1427.15,85,,1141.72,percent of total billed charges,85% of total billed charges,1511.1,90,,1208.88,percent of total billed charges,90% of total billed charges,1343.2,80,,1074.56,percent of total billed charges,80% of total billed charges,1511.1,90,,1208.88,percent of total billed charges,90% of total billed charges,1259.25,75,,1007.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,486.91,29,,389.528,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1124.93,67,,899.944,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1175.3,70,,940.24,percent of total billed charges,70% of total billed charges,1091.35,65,,873.08,percent of total billed charges,65% of total billed charges,598.9,35.67,,479.12,percent of total billed charges,35.67% of total billed charges,486.91,1511.1,
SCREW HEADLESS COMP IN AND OUT,27013813,CDM,278,RC,C1713,HCPCS,outpatient,,,1679,671.60,,1175.3,70,,940.24,percent of total billed charges,70% of total billed charges,881.48,52.5,,705.18,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,1376.78,82,,1101.424,percent of total billed charges,82% of total billed charges,1427.15,85,,1141.72,percent of total billed charges,85% of total billed charges,1427.15,85,,1141.72,percent of total billed charges,85% of total billed charges,1427.15,85,,1141.72,percent of total billed charges,85% of total billed charges,1511.1,90,,1208.88,percent of total billed charges,90% of total billed charges,1343.2,80,,1074.56,percent of total billed charges,80% of total billed charges,1511.1,90,,1208.88,percent of total billed charges,90% of total billed charges,1259.25,75,,1007.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,486.91,29,,389.528,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1124.93,67,,899.944,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1175.3,70,,940.24,percent of total billed charges,70% of total billed charges,1091.35,65,,873.08,percent of total billed charges,65% of total billed charges,598.9,35.67,,479.12,percent of total billed charges,35.67% of total billed charges,486.91,1511.1,
SCREW HEADLESS COMP IN OUT,27013814,CDM,278,RC,C1713,HCPCS,outpatient,,,1679,671.60,,1175.3,70,,940.24,percent of total billed charges,70% of total billed charges,881.48,52.5,,705.18,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,1376.78,82,,1101.424,percent of total billed charges,82% of total billed charges,1427.15,85,,1141.72,percent of total billed charges,85% of total billed charges,1427.15,85,,1141.72,percent of total billed charges,85% of total billed charges,1427.15,85,,1141.72,percent of total billed charges,85% of total billed charges,1511.1,90,,1208.88,percent of total billed charges,90% of total billed charges,1343.2,80,,1074.56,percent of total billed charges,80% of total billed charges,1511.1,90,,1208.88,percent of total billed charges,90% of total billed charges,1259.25,75,,1007.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,486.91,29,,389.528,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1124.93,67,,899.944,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1175.3,70,,940.24,percent of total billed charges,70% of total billed charges,1091.35,65,,873.08,percent of total billed charges,65% of total billed charges,598.9,35.67,,479.12,percent of total billed charges,35.67% of total billed charges,486.91,1511.1,
SCREW CIRCULAR,27013824,CDM,278,RC,C1713,HCPCS,outpatient,,,1594,637.60,,1115.8,70,,892.64,percent of total billed charges,70% of total billed charges,836.85,52.5,,669.48,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,1307.08,82,,1045.664,percent of total billed charges,82% of total billed charges,1354.9,85,,1083.92,percent of total billed charges,85% of total billed charges,1354.9,85,,1083.92,percent of total billed charges,85% of total billed charges,1354.9,85,,1083.92,percent of total billed charges,85% of total billed charges,1434.6,90,,1147.68,percent of total billed charges,90% of total billed charges,1275.2,80,,1020.16,percent of total billed charges,80% of total billed charges,1434.6,90,,1147.68,percent of total billed charges,90% of total billed charges,1195.5,75,,956.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,462.26,29,,369.808,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1067.98,67,,854.384,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1115.8,70,,892.64,percent of total billed charges,70% of total billed charges,1036.1,65,,828.88,percent of total billed charges,65% of total billed charges,568.58,35.67,,454.864,percent of total billed charges,35.67% of total billed charges,462.26,1434.6,
RODS 40 MM,27013825,CDM,278,RC,C1713,HCPCS,outpatient,,,1744,697.60,,1220.8,70,,976.64,percent of total billed charges,70% of total billed charges,915.6,52.5,,732.48,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,1430.08,82,,1144.064,percent of total billed charges,82% of total billed charges,1482.4,85,,1185.92,percent of total billed charges,85% of total billed charges,1482.4,85,,1185.92,percent of total billed charges,85% of total billed charges,1482.4,85,,1185.92,percent of total billed charges,85% of total billed charges,1569.6,90,,1255.68,percent of total billed charges,90% of total billed charges,1395.2,80,,1116.16,percent of total billed charges,80% of total billed charges,1569.6,90,,1255.68,percent of total billed charges,90% of total billed charges,1308,75,,1046.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,505.76,29,,404.608,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1168.48,67,,934.784,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1220.8,70,,976.64,percent of total billed charges,70% of total billed charges,1133.6,65,,906.88,percent of total billed charges,65% of total billed charges,622.08,35.67,,497.664,percent of total billed charges,35.67% of total billed charges,505.76,1569.6,
STRIP DEMIN 50 X 10,27013826,CDM,278,RC,C1713,HCPCS,outpatient,,,3981,1592.40,,2786.7,70,,2229.36,percent of total billed charges,70% of total billed charges,2090.03,52.5,,1672.02,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,3264.42,82,,2611.536,percent of total billed charges,82% of total billed charges,3383.85,85,,2707.08,percent of total billed charges,85% of total billed charges,3383.85,85,,2707.08,percent of total billed charges,85% of total billed charges,3383.85,85,,2707.08,percent of total billed charges,85% of total billed charges,3582.9,90,,2866.32,percent of total billed charges,90% of total billed charges,3184.8,80,,2547.84,percent of total billed charges,80% of total billed charges,3582.9,90,,2866.32,percent of total billed charges,90% of total billed charges,2985.75,75,,2388.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,1154.49,29,,923.592,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,2667.27,67,,2133.816,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,2786.7,70,,2229.36,percent of total billed charges,70% of total billed charges,2587.65,65,,2070.12,percent of total billed charges,65% of total billed charges,1420.02,35.67,,1136.016,percent of total billed charges,35.67% of total billed charges,1154.49,3582.9,
CORTICAL SCREW,27013841,CDM,278,RC,C1713,HCPCS,outpatient,,,824,329.60,,576.8,70,,461.44,percent of total billed charges,70% of total billed charges,824,100,,659.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,675.68,82,,540.544,percent of total billed charges,82% of total billed charges,700.4,85,,560.32,percent of total billed charges,85% of total billed charges,700.4,85,,560.32,percent of total billed charges,85% of total billed charges,700.4,85,,560.32,percent of total billed charges,85% of total billed charges,741.6,90,,593.28,percent of total billed charges,90% of total billed charges,659.2,80,,527.36,percent of total billed charges,80% of total billed charges,741.6,90,,593.28,percent of total billed charges,90% of total billed charges,618,75,,494.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,238.96,29,,191.168,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,552.08,67,,441.664,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,576.8,70,,461.44,percent of total billed charges,70% of total billed charges,535.6,65,,428.48,percent of total billed charges,65% of total billed charges,293.92,35.67,,235.136,percent of total billed charges,35.67% of total billed charges,238.96,824,
PLATE - 3 HOLE,27013844,CDM,278,RC,C1713,HCPCS,outpatient,,,2305,922.00,,1613.5,70,,1290.8,percent of total billed charges,70% of total billed charges,1210.13,52.5,,968.1,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,1890.1,82,,1512.08,percent of total billed charges,82% of total billed charges,1959.25,85,,1567.4,percent of total billed charges,85% of total billed charges,1959.25,85,,1567.4,percent of total billed charges,85% of total billed charges,1959.25,85,,1567.4,percent of total billed charges,85% of total billed charges,2074.5,90,,1659.6,percent of total billed charges,90% of total billed charges,1844,80,,1475.2,percent of total billed charges,80% of total billed charges,2074.5,90,,1659.6,percent of total billed charges,90% of total billed charges,1728.75,75,,1383,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,668.45,29,,534.76,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1544.35,67,,1235.48,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1613.5,70,,1290.8,percent of total billed charges,70% of total billed charges,1498.25,65,,1198.6,percent of total billed charges,65% of total billed charges,822.19,35.67,,657.752,percent of total billed charges,35.67% of total billed charges,668.45,2074.5,
CORTICAL SCREW,27013855,CDM,278,RC,C1713,HCPCS,outpatient,,,824,329.60,,576.8,70,,461.44,percent of total billed charges,70% of total billed charges,824,100,,659.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,675.68,82,,540.544,percent of total billed charges,82% of total billed charges,700.4,85,,560.32,percent of total billed charges,85% of total billed charges,700.4,85,,560.32,percent of total billed charges,85% of total billed charges,700.4,85,,560.32,percent of total billed charges,85% of total billed charges,741.6,90,,593.28,percent of total billed charges,90% of total billed charges,659.2,80,,527.36,percent of total billed charges,80% of total billed charges,741.6,90,,593.28,percent of total billed charges,90% of total billed charges,618,75,,494.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,238.96,29,,191.168,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,552.08,67,,441.664,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,576.8,70,,461.44,percent of total billed charges,70% of total billed charges,535.6,65,,428.48,percent of total billed charges,65% of total billed charges,293.92,35.67,,235.136,percent of total billed charges,35.67% of total billed charges,238.96,824,
CORTICAL SCREW,27013857,CDM,278,RC,C1713,HCPCS,outpatient,,,824,329.60,,576.8,70,,461.44,percent of total billed charges,70% of total billed charges,824,100,,659.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,675.68,82,,540.544,percent of total billed charges,82% of total billed charges,700.4,85,,560.32,percent of total billed charges,85% of total billed charges,700.4,85,,560.32,percent of total billed charges,85% of total billed charges,700.4,85,,560.32,percent of total billed charges,85% of total billed charges,741.6,90,,593.28,percent of total billed charges,90% of total billed charges,659.2,80,,527.36,percent of total billed charges,80% of total billed charges,741.6,90,,593.28,percent of total billed charges,90% of total billed charges,618,75,,494.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,238.96,29,,191.168,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,552.08,67,,441.664,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,576.8,70,,461.44,percent of total billed charges,70% of total billed charges,535.6,65,,428.48,percent of total billed charges,65% of total billed charges,293.92,35.67,,235.136,percent of total billed charges,35.67% of total billed charges,238.96,824,
T5 HOLE PLATE,27013858,CDM,278,RC,C1713,HCPCS,outpatient,,,2194,877.60,,1535.8,70,,1228.64,percent of total billed charges,70% of total billed charges,1151.85,52.5,,921.48,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,1799.08,82,,1439.264,percent of total billed charges,82% of total billed charges,1864.9,85,,1491.92,percent of total billed charges,85% of total billed charges,1864.9,85,,1491.92,percent of total billed charges,85% of total billed charges,1864.9,85,,1491.92,percent of total billed charges,85% of total billed charges,1974.6,90,,1579.68,percent of total billed charges,90% of total billed charges,1755.2,80,,1404.16,percent of total billed charges,80% of total billed charges,1974.6,90,,1579.68,percent of total billed charges,90% of total billed charges,1645.5,75,,1316.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,636.26,29,,509.008,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1469.98,67,,1175.984,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1535.8,70,,1228.64,percent of total billed charges,70% of total billed charges,1426.1,65,,1140.88,percent of total billed charges,65% of total billed charges,782.6,35.67,,626.08,percent of total billed charges,35.67% of total billed charges,636.26,1974.6,
"PLATE, 4 HOLE",27013884,CDM,278,RC,C1713,HCPCS,outpatient,,,4384,1753.60,,3068.8,70,,2455.04,percent of total billed charges,70% of total billed charges,2301.6,52.5,,1841.28,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,3594.88,82,,2875.904,percent of total billed charges,82% of total billed charges,3726.4,85,,2981.12,percent of total billed charges,85% of total billed charges,3726.4,85,,2981.12,percent of total billed charges,85% of total billed charges,3726.4,85,,2981.12,percent of total billed charges,85% of total billed charges,3945.6,90,,3156.48,percent of total billed charges,90% of total billed charges,3507.2,80,,2805.76,percent of total billed charges,80% of total billed charges,3945.6,90,,3156.48,percent of total billed charges,90% of total billed charges,3288,75,,2630.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,1271.36,29,,1017.088,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,2937.28,67,,2349.824,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,3068.8,70,,2455.04,percent of total billed charges,70% of total billed charges,2849.6,65,,2279.68,percent of total billed charges,65% of total billed charges,1563.77,35.67,,1251.016,percent of total billed charges,35.67% of total billed charges,1271.36,3945.6,
CANCELLOUS SCREW,27013886,CDM,278,RC,C1713,HCPCS,outpatient,,,879,351.60,,615.3,70,,492.24,percent of total billed charges,70% of total billed charges,879,100,,703.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,720.78,82,,576.624,percent of total billed charges,82% of total billed charges,747.15,85,,597.72,percent of total billed charges,85% of total billed charges,747.15,85,,597.72,percent of total billed charges,85% of total billed charges,747.15,85,,597.72,percent of total billed charges,85% of total billed charges,791.1,90,,632.88,percent of total billed charges,90% of total billed charges,703.2,80,,562.56,percent of total billed charges,80% of total billed charges,791.1,90,,632.88,percent of total billed charges,90% of total billed charges,659.25,75,,527.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,254.91,29,,203.928,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,588.93,67,,471.144,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,615.3,70,,492.24,percent of total billed charges,70% of total billed charges,571.35,65,,457.08,percent of total billed charges,65% of total billed charges,313.54,35.67,,250.832,percent of total billed charges,35.67% of total billed charges,254.91,879,
CIRCULAR STAR LOCKS,27013894,CDM,278,RC,C1713,HCPCS,outpatient,,,508,203.20,,355.6,70,,284.48,percent of total billed charges,70% of total billed charges,508,100,,406.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,416.56,82,,333.248,percent of total billed charges,82% of total billed charges,431.8,85,,345.44,percent of total billed charges,85% of total billed charges,431.8,85,,345.44,percent of total billed charges,85% of total billed charges,431.8,85,,345.44,percent of total billed charges,85% of total billed charges,457.2,90,,365.76,percent of total billed charges,90% of total billed charges,406.4,80,,325.12,percent of total billed charges,80% of total billed charges,457.2,90,,365.76,percent of total billed charges,90% of total billed charges,381,75,,304.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,147.32,29,,117.856,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,340.36,67,,272.288,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,355.6,70,,284.48,percent of total billed charges,70% of total billed charges,330.2,65,,264.16,percent of total billed charges,65% of total billed charges,181.2,35.67,,144.96,percent of total billed charges,35.67% of total billed charges,147.32,508,
CROSSLINK SMALL,27013895,CDM,278,RC,C1713,HCPCS,outpatient,,,5673,2269.20,,3971.1,70,,3176.88,percent of total billed charges,70% of total billed charges,2978.33,52.5,,2382.66,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,4651.86,82,,3721.488,percent of total billed charges,82% of total billed charges,4822.05,85,,3857.64,percent of total billed charges,85% of total billed charges,4822.05,85,,3857.64,percent of total billed charges,85% of total billed charges,4822.05,85,,3857.64,percent of total billed charges,85% of total billed charges,5105.7,90,,4084.56,percent of total billed charges,90% of total billed charges,4538.4,80,,3630.72,percent of total billed charges,80% of total billed charges,5105.7,90,,4084.56,percent of total billed charges,90% of total billed charges,4254.75,75,,3403.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,1645.17,29,,1316.136,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,3800.91,67,,3040.728,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,3971.1,70,,3176.88,percent of total billed charges,70% of total billed charges,3687.45,65,,2949.96,percent of total billed charges,65% of total billed charges,2023.56,35.67,,1618.848,percent of total billed charges,35.67% of total billed charges,1645.17,5105.7,
OSTEOSELECT PUTTY,27013896,CDM,278,RC,C1713,HCPCS,outpatient,,,2999,1199.60,,2099.3,70,,1679.44,percent of total billed charges,70% of total billed charges,1574.48,52.5,,1259.58,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,2459.18,82,,1967.344,percent of total billed charges,82% of total billed charges,2549.15,85,,2039.32,percent of total billed charges,85% of total billed charges,2549.15,85,,2039.32,percent of total billed charges,85% of total billed charges,2549.15,85,,2039.32,percent of total billed charges,85% of total billed charges,2699.1,90,,2159.28,percent of total billed charges,90% of total billed charges,2399.2,80,,1919.36,percent of total billed charges,80% of total billed charges,2699.1,90,,2159.28,percent of total billed charges,90% of total billed charges,2249.25,75,,1799.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,869.71,29,,695.768,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,2009.33,67,,1607.464,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,2099.3,70,,1679.44,percent of total billed charges,70% of total billed charges,1949.35,65,,1559.48,percent of total billed charges,65% of total billed charges,1069.74,35.67,,855.792,percent of total billed charges,35.67% of total billed charges,869.71,2699.1,
SCREW SMALL FRAGMENTED,27013917,CDM,278,RC,C1713,HCPCS,outpatient,,,824,329.60,,576.8,70,,461.44,percent of total billed charges,70% of total billed charges,824,100,,659.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,675.68,82,,540.544,percent of total billed charges,82% of total billed charges,700.4,85,,560.32,percent of total billed charges,85% of total billed charges,700.4,85,,560.32,percent of total billed charges,85% of total billed charges,700.4,85,,560.32,percent of total billed charges,85% of total billed charges,741.6,90,,593.28,percent of total billed charges,90% of total billed charges,659.2,80,,527.36,percent of total billed charges,80% of total billed charges,741.6,90,,593.28,percent of total billed charges,90% of total billed charges,618,75,,494.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,238.96,29,,191.168,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,552.08,67,,441.664,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,576.8,70,,461.44,percent of total billed charges,70% of total billed charges,535.6,65,,428.48,percent of total billed charges,65% of total billed charges,293.92,35.67,,235.136,percent of total billed charges,35.67% of total billed charges,238.96,824,
SCREW SMALL,27013919,CDM,278,RC,C1713,HCPCS,outpatient,,,824,329.60,,576.8,70,,461.44,percent of total billed charges,70% of total billed charges,824,100,,659.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,675.68,82,,540.544,percent of total billed charges,82% of total billed charges,700.4,85,,560.32,percent of total billed charges,85% of total billed charges,700.4,85,,560.32,percent of total billed charges,85% of total billed charges,700.4,85,,560.32,percent of total billed charges,85% of total billed charges,741.6,90,,593.28,percent of total billed charges,90% of total billed charges,659.2,80,,527.36,percent of total billed charges,80% of total billed charges,741.6,90,,593.28,percent of total billed charges,90% of total billed charges,618,75,,494.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,238.96,29,,191.168,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,552.08,67,,441.664,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,576.8,70,,461.44,percent of total billed charges,70% of total billed charges,535.6,65,,428.48,percent of total billed charges,65% of total billed charges,293.92,35.67,,235.136,percent of total billed charges,35.67% of total billed charges,238.96,824,
SCREW THREADED,27013920,CDM,278,RC,C1713,HCPCS,outpatient,,,824,329.60,,576.8,70,,461.44,percent of total billed charges,70% of total billed charges,824,100,,659.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,675.68,82,,540.544,percent of total billed charges,82% of total billed charges,700.4,85,,560.32,percent of total billed charges,85% of total billed charges,700.4,85,,560.32,percent of total billed charges,85% of total billed charges,700.4,85,,560.32,percent of total billed charges,85% of total billed charges,741.6,90,,593.28,percent of total billed charges,90% of total billed charges,659.2,80,,527.36,percent of total billed charges,80% of total billed charges,741.6,90,,593.28,percent of total billed charges,90% of total billed charges,618,75,,494.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,238.96,29,,191.168,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,552.08,67,,441.664,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,576.8,70,,461.44,percent of total billed charges,70% of total billed charges,535.6,65,,428.48,percent of total billed charges,65% of total billed charges,293.92,35.67,,235.136,percent of total billed charges,35.67% of total billed charges,238.96,824,
CANCELLOUS CUBES 5 X 5,27013925,CDM,278,RC,C1762,HCPCS,outpatient,,,1224,489.60,,856.8,70,,685.44,percent of total billed charges,70% of total billed charges,642.6,52.5,,514.08,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,1003.68,82,,802.944,percent of total billed charges,82% of total billed charges,1040.4,85,,832.32,percent of total billed charges,85% of total billed charges,1040.4,85,,832.32,percent of total billed charges,85% of total billed charges,1040.4,85,,832.32,percent of total billed charges,85% of total billed charges,1101.6,90,,881.28,percent of total billed charges,90% of total billed charges,979.2,80,,783.36,percent of total billed charges,80% of total billed charges,1101.6,90,,881.28,percent of total billed charges,90% of total billed charges,918,75,,734.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,354.96,29,,283.968,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,820.08,67,,656.064,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,856.8,70,,685.44,percent of total billed charges,70% of total billed charges,795.6,65,,636.48,percent of total billed charges,65% of total billed charges,436.6,35.67,,349.28,percent of total billed charges,35.67% of total billed charges,354.96,1101.6,
TITANIUM CORTICAL SCREWS,27013926,CDM,278,RC,C1713,HCPCS,outpatient,,,824,329.60,,576.8,70,,461.44,percent of total billed charges,70% of total billed charges,824,100,,659.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,675.68,82,,540.544,percent of total billed charges,82% of total billed charges,700.4,85,,560.32,percent of total billed charges,85% of total billed charges,700.4,85,,560.32,percent of total billed charges,85% of total billed charges,700.4,85,,560.32,percent of total billed charges,85% of total billed charges,741.6,90,,593.28,percent of total billed charges,90% of total billed charges,659.2,80,,527.36,percent of total billed charges,80% of total billed charges,741.6,90,,593.28,percent of total billed charges,90% of total billed charges,618,75,,494.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,238.96,29,,191.168,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,552.08,67,,441.664,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,576.8,70,,461.44,percent of total billed charges,70% of total billed charges,535.6,65,,428.48,percent of total billed charges,65% of total billed charges,293.92,35.67,,235.136,percent of total billed charges,35.67% of total billed charges,238.96,824,
CORTICAL SCREW,27013927,CDM,278,RC,C1713,HCPCS,outpatient,,,824,329.60,,576.8,70,,461.44,percent of total billed charges,70% of total billed charges,824,100,,659.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,675.68,82,,540.544,percent of total billed charges,82% of total billed charges,700.4,85,,560.32,percent of total billed charges,85% of total billed charges,700.4,85,,560.32,percent of total billed charges,85% of total billed charges,700.4,85,,560.32,percent of total billed charges,85% of total billed charges,741.6,90,,593.28,percent of total billed charges,90% of total billed charges,659.2,80,,527.36,percent of total billed charges,80% of total billed charges,741.6,90,,593.28,percent of total billed charges,90% of total billed charges,618,75,,494.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,238.96,29,,191.168,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,552.08,67,,441.664,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,576.8,70,,461.44,percent of total billed charges,70% of total billed charges,535.6,65,,428.48,percent of total billed charges,65% of total billed charges,293.92,35.67,,235.136,percent of total billed charges,35.67% of total billed charges,238.96,824,
CORTICAL SCREW,27013928,CDM,278,RC,C1713,HCPCS,outpatient,,,824,329.60,,576.8,70,,461.44,percent of total billed charges,70% of total billed charges,824,100,,659.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,675.68,82,,540.544,percent of total billed charges,82% of total billed charges,700.4,85,,560.32,percent of total billed charges,85% of total billed charges,700.4,85,,560.32,percent of total billed charges,85% of total billed charges,700.4,85,,560.32,percent of total billed charges,85% of total billed charges,741.6,90,,593.28,percent of total billed charges,90% of total billed charges,659.2,80,,527.36,percent of total billed charges,80% of total billed charges,741.6,90,,593.28,percent of total billed charges,90% of total billed charges,618,75,,494.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,238.96,29,,191.168,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,552.08,67,,441.664,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,576.8,70,,461.44,percent of total billed charges,70% of total billed charges,535.6,65,,428.48,percent of total billed charges,65% of total billed charges,293.92,35.67,,235.136,percent of total billed charges,35.67% of total billed charges,238.96,824,
CORTICAL SCREW,27013929,CDM,278,RC,C1713,HCPCS,outpatient,,,824,329.60,,576.8,70,,461.44,percent of total billed charges,70% of total billed charges,824,100,,659.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,675.68,82,,540.544,percent of total billed charges,82% of total billed charges,700.4,85,,560.32,percent of total billed charges,85% of total billed charges,700.4,85,,560.32,percent of total billed charges,85% of total billed charges,700.4,85,,560.32,percent of total billed charges,85% of total billed charges,741.6,90,,593.28,percent of total billed charges,90% of total billed charges,659.2,80,,527.36,percent of total billed charges,80% of total billed charges,741.6,90,,593.28,percent of total billed charges,90% of total billed charges,618,75,,494.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,238.96,29,,191.168,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,552.08,67,,441.664,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,576.8,70,,461.44,percent of total billed charges,70% of total billed charges,535.6,65,,428.48,percent of total billed charges,65% of total billed charges,293.92,35.67,,235.136,percent of total billed charges,35.67% of total billed charges,238.96,824,
CORTICAL SCREW,27013930,CDM,278,RC,C1713,HCPCS,outpatient,,,824,329.60,,576.8,70,,461.44,percent of total billed charges,70% of total billed charges,824,100,,659.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,675.68,82,,540.544,percent of total billed charges,82% of total billed charges,700.4,85,,560.32,percent of total billed charges,85% of total billed charges,700.4,85,,560.32,percent of total billed charges,85% of total billed charges,700.4,85,,560.32,percent of total billed charges,85% of total billed charges,741.6,90,,593.28,percent of total billed charges,90% of total billed charges,659.2,80,,527.36,percent of total billed charges,80% of total billed charges,741.6,90,,593.28,percent of total billed charges,90% of total billed charges,618,75,,494.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,238.96,29,,191.168,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,552.08,67,,441.664,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,576.8,70,,461.44,percent of total billed charges,70% of total billed charges,535.6,65,,428.48,percent of total billed charges,65% of total billed charges,293.92,35.67,,235.136,percent of total billed charges,35.67% of total billed charges,238.96,824,
PLATE 4 HOLE,27013933,CDM,278,RC,C1713,HCPCS,outpatient,,,2467,986.80,,1726.9,70,,1381.52,percent of total billed charges,70% of total billed charges,1295.18,52.5,,1036.14,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,2022.94,82,,1618.352,percent of total billed charges,82% of total billed charges,2096.95,85,,1677.56,percent of total billed charges,85% of total billed charges,2096.95,85,,1677.56,percent of total billed charges,85% of total billed charges,2096.95,85,,1677.56,percent of total billed charges,85% of total billed charges,2220.3,90,,1776.24,percent of total billed charges,90% of total billed charges,1973.6,80,,1578.88,percent of total billed charges,80% of total billed charges,2220.3,90,,1776.24,percent of total billed charges,90% of total billed charges,1850.25,75,,1480.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,715.43,29,,572.344,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1652.89,67,,1322.312,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1726.9,70,,1381.52,percent of total billed charges,70% of total billed charges,1603.55,65,,1282.84,percent of total billed charges,65% of total billed charges,879.98,35.67,,703.984,percent of total billed charges,35.67% of total billed charges,715.43,2220.3,
CORTICAL SCREW,27013935,CDM,278,RC,C1713,HCPCS,outpatient,,,824,329.60,,576.8,70,,461.44,percent of total billed charges,70% of total billed charges,824,100,,659.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,675.68,82,,540.544,percent of total billed charges,82% of total billed charges,700.4,85,,560.32,percent of total billed charges,85% of total billed charges,700.4,85,,560.32,percent of total billed charges,85% of total billed charges,700.4,85,,560.32,percent of total billed charges,85% of total billed charges,741.6,90,,593.28,percent of total billed charges,90% of total billed charges,659.2,80,,527.36,percent of total billed charges,80% of total billed charges,741.6,90,,593.28,percent of total billed charges,90% of total billed charges,618,75,,494.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,238.96,29,,191.168,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,552.08,67,,441.664,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,576.8,70,,461.44,percent of total billed charges,70% of total billed charges,535.6,65,,428.48,percent of total billed charges,65% of total billed charges,293.92,35.67,,235.136,percent of total billed charges,35.67% of total billed charges,238.96,824,
DISTRACTION SCREW TITANIUM,27013949,CDM,278,RC,C1713,HCPCS,outpatient,,,196,78.40,,137.2,70,,109.76,percent of total billed charges,70% of total billed charges,196,100,,156.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,160.72,82,,128.576,percent of total billed charges,82% of total billed charges,166.6,85,,133.28,percent of total billed charges,85% of total billed charges,166.6,85,,133.28,percent of total billed charges,85% of total billed charges,166.6,85,,133.28,percent of total billed charges,85% of total billed charges,176.4,90,,141.12,percent of total billed charges,90% of total billed charges,156.8,80,,125.44,percent of total billed charges,80% of total billed charges,176.4,90,,141.12,percent of total billed charges,90% of total billed charges,147,75,,117.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,56.84,29,,45.472,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,131.32,67,,105.056,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,137.2,70,,109.76,percent of total billed charges,70% of total billed charges,127.4,65,,101.92,percent of total billed charges,65% of total billed charges,69.91,35.67,,55.928,percent of total billed charges,35.67% of total billed charges,56.84,196,
ROUND BUR MED CARBINE,27014007,CDM,278,RC,C1713,HCPCS,outpatient,,,454,181.60,,317.8,70,,254.24,percent of total billed charges,70% of total billed charges,454,100,,363.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,372.28,82,,297.824,percent of total billed charges,82% of total billed charges,385.9,85,,308.72,percent of total billed charges,85% of total billed charges,385.9,85,,308.72,percent of total billed charges,85% of total billed charges,385.9,85,,308.72,percent of total billed charges,85% of total billed charges,408.6,90,,326.88,percent of total billed charges,90% of total billed charges,363.2,80,,290.56,percent of total billed charges,80% of total billed charges,408.6,90,,326.88,percent of total billed charges,90% of total billed charges,340.5,75,,272.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,131.66,29,,105.328,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,304.18,67,,243.344,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,317.8,70,,254.24,percent of total billed charges,70% of total billed charges,295.1,65,,236.08,percent of total billed charges,65% of total billed charges,161.94,35.67,,129.552,percent of total billed charges,35.67% of total billed charges,131.66,454,
CORTICAL SCREW 3.5,27014010,CDM,278,RC,C1713,HCPCS,outpatient,,,824,329.60,,576.8,70,,461.44,percent of total billed charges,70% of total billed charges,824,100,,659.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,675.68,82,,540.544,percent of total billed charges,82% of total billed charges,700.4,85,,560.32,percent of total billed charges,85% of total billed charges,700.4,85,,560.32,percent of total billed charges,85% of total billed charges,700.4,85,,560.32,percent of total billed charges,85% of total billed charges,741.6,90,,593.28,percent of total billed charges,90% of total billed charges,659.2,80,,527.36,percent of total billed charges,80% of total billed charges,741.6,90,,593.28,percent of total billed charges,90% of total billed charges,618,75,,494.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,238.96,29,,191.168,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,552.08,67,,441.664,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,576.8,70,,461.44,percent of total billed charges,70% of total billed charges,535.6,65,,428.48,percent of total billed charges,65% of total billed charges,293.92,35.67,,235.136,percent of total billed charges,35.67% of total billed charges,238.96,824,
CORTICAL SCREW,27014011,CDM,278,RC,C1713,HCPCS,outpatient,,,824,329.60,,576.8,70,,461.44,percent of total billed charges,70% of total billed charges,824,100,,659.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,675.68,82,,540.544,percent of total billed charges,82% of total billed charges,700.4,85,,560.32,percent of total billed charges,85% of total billed charges,700.4,85,,560.32,percent of total billed charges,85% of total billed charges,700.4,85,,560.32,percent of total billed charges,85% of total billed charges,741.6,90,,593.28,percent of total billed charges,90% of total billed charges,659.2,80,,527.36,percent of total billed charges,80% of total billed charges,741.6,90,,593.28,percent of total billed charges,90% of total billed charges,618,75,,494.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,238.96,29,,191.168,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,552.08,67,,441.664,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,576.8,70,,461.44,percent of total billed charges,70% of total billed charges,535.6,65,,428.48,percent of total billed charges,65% of total billed charges,293.92,35.67,,235.136,percent of total billed charges,35.67% of total billed charges,238.96,824,
TUBULAR PLATE,27014012,CDM,278,RC,C1713,HCPCS,outpatient,,,2194,877.60,,1535.8,70,,1228.64,percent of total billed charges,70% of total billed charges,1151.85,52.5,,921.48,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,1799.08,82,,1439.264,percent of total billed charges,82% of total billed charges,1864.9,85,,1491.92,percent of total billed charges,85% of total billed charges,1864.9,85,,1491.92,percent of total billed charges,85% of total billed charges,1864.9,85,,1491.92,percent of total billed charges,85% of total billed charges,1974.6,90,,1579.68,percent of total billed charges,90% of total billed charges,1755.2,80,,1404.16,percent of total billed charges,80% of total billed charges,1974.6,90,,1579.68,percent of total billed charges,90% of total billed charges,1645.5,75,,1316.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,636.26,29,,509.008,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1469.98,67,,1175.984,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1535.8,70,,1228.64,percent of total billed charges,70% of total billed charges,1426.1,65,,1140.88,percent of total billed charges,65% of total billed charges,782.6,35.67,,626.08,percent of total billed charges,35.67% of total billed charges,636.26,1974.6,
WASHER,27014028,CDM,278,RC,C1713,HCPCS,outpatient,,,551,220.40,,385.7,70,,308.56,percent of total billed charges,70% of total billed charges,551,100,,440.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,451.82,82,,361.456,percent of total billed charges,82% of total billed charges,468.35,85,,374.68,percent of total billed charges,85% of total billed charges,468.35,85,,374.68,percent of total billed charges,85% of total billed charges,468.35,85,,374.68,percent of total billed charges,85% of total billed charges,495.9,90,,396.72,percent of total billed charges,90% of total billed charges,440.8,80,,352.64,percent of total billed charges,80% of total billed charges,495.9,90,,396.72,percent of total billed charges,90% of total billed charges,413.25,75,,330.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,159.79,29,,127.832,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,369.17,67,,295.336,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,385.7,70,,308.56,percent of total billed charges,70% of total billed charges,358.15,65,,286.52,percent of total billed charges,65% of total billed charges,196.54,35.67,,157.232,percent of total billed charges,35.67% of total billed charges,159.79,551,
CORTICAL SCREW,27014029,CDM,278,RC,C1713,HCPCS,outpatient,,,879,351.60,,615.3,70,,492.24,percent of total billed charges,70% of total billed charges,879,100,,703.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,720.78,82,,576.624,percent of total billed charges,82% of total billed charges,747.15,85,,597.72,percent of total billed charges,85% of total billed charges,747.15,85,,597.72,percent of total billed charges,85% of total billed charges,747.15,85,,597.72,percent of total billed charges,85% of total billed charges,791.1,90,,632.88,percent of total billed charges,90% of total billed charges,703.2,80,,562.56,percent of total billed charges,80% of total billed charges,791.1,90,,632.88,percent of total billed charges,90% of total billed charges,659.25,75,,527.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,254.91,29,,203.928,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,588.93,67,,471.144,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,615.3,70,,492.24,percent of total billed charges,70% of total billed charges,571.35,65,,457.08,percent of total billed charges,65% of total billed charges,313.54,35.67,,250.832,percent of total billed charges,35.67% of total billed charges,254.91,879,
CORTICAL SCREW,27014030,CDM,278,RC,C1713,HCPCS,outpatient,,,879,351.60,,615.3,70,,492.24,percent of total billed charges,70% of total billed charges,879,100,,703.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,720.78,82,,576.624,percent of total billed charges,82% of total billed charges,747.15,85,,597.72,percent of total billed charges,85% of total billed charges,747.15,85,,597.72,percent of total billed charges,85% of total billed charges,747.15,85,,597.72,percent of total billed charges,85% of total billed charges,791.1,90,,632.88,percent of total billed charges,90% of total billed charges,703.2,80,,562.56,percent of total billed charges,80% of total billed charges,791.1,90,,632.88,percent of total billed charges,90% of total billed charges,659.25,75,,527.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,254.91,29,,203.928,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,588.93,67,,471.144,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,615.3,70,,492.24,percent of total billed charges,70% of total billed charges,571.35,65,,457.08,percent of total billed charges,65% of total billed charges,313.54,35.67,,250.832,percent of total billed charges,35.67% of total billed charges,254.91,879,
SCREW LOCKING CORTICAL,27014031,CDM,278,RC,C1713,HCPCS,outpatient,,,879,351.60,,615.3,70,,492.24,percent of total billed charges,70% of total billed charges,879,100,,703.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,720.78,82,,576.624,percent of total billed charges,82% of total billed charges,747.15,85,,597.72,percent of total billed charges,85% of total billed charges,747.15,85,,597.72,percent of total billed charges,85% of total billed charges,747.15,85,,597.72,percent of total billed charges,85% of total billed charges,791.1,90,,632.88,percent of total billed charges,90% of total billed charges,703.2,80,,562.56,percent of total billed charges,80% of total billed charges,791.1,90,,632.88,percent of total billed charges,90% of total billed charges,659.25,75,,527.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,254.91,29,,203.928,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,588.93,67,,471.144,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,615.3,70,,492.24,percent of total billed charges,70% of total billed charges,571.35,65,,457.08,percent of total billed charges,65% of total billed charges,313.54,35.67,,250.832,percent of total billed charges,35.67% of total billed charges,254.91,879,
CORTICAL LOCKING SCREW,27014032,CDM,278,RC,C1713,HCPCS,outpatient,,,879,351.60,,615.3,70,,492.24,percent of total billed charges,70% of total billed charges,879,100,,703.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,720.78,82,,576.624,percent of total billed charges,82% of total billed charges,747.15,85,,597.72,percent of total billed charges,85% of total billed charges,747.15,85,,597.72,percent of total billed charges,85% of total billed charges,747.15,85,,597.72,percent of total billed charges,85% of total billed charges,791.1,90,,632.88,percent of total billed charges,90% of total billed charges,703.2,80,,562.56,percent of total billed charges,80% of total billed charges,791.1,90,,632.88,percent of total billed charges,90% of total billed charges,659.25,75,,527.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,254.91,29,,203.928,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,588.93,67,,471.144,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,615.3,70,,492.24,percent of total billed charges,70% of total billed charges,571.35,65,,457.08,percent of total billed charges,65% of total billed charges,313.54,35.67,,250.832,percent of total billed charges,35.67% of total billed charges,254.91,879,
GUIDE PIN,27014060,CDM,278,RC,C1713,HCPCS,outpatient,,,542,216.80,,379.4,70,,303.52,percent of total billed charges,70% of total billed charges,542,100,,433.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,444.44,82,,355.552,percent of total billed charges,82% of total billed charges,460.7,85,,368.56,percent of total billed charges,85% of total billed charges,460.7,85,,368.56,percent of total billed charges,85% of total billed charges,460.7,85,,368.56,percent of total billed charges,85% of total billed charges,487.8,90,,390.24,percent of total billed charges,90% of total billed charges,433.6,80,,346.88,percent of total billed charges,80% of total billed charges,487.8,90,,390.24,percent of total billed charges,90% of total billed charges,406.5,75,,325.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,157.18,29,,125.744,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,363.14,67,,290.512,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,379.4,70,,303.52,percent of total billed charges,70% of total billed charges,352.3,65,,281.84,percent of total billed charges,65% of total billed charges,193.33,35.67,,154.664,percent of total billed charges,35.67% of total billed charges,157.18,542,
DERMACARRIER,27014061,CDM,278,RC,C1781,HCPCS,outpatient,,,270,108.00,,189,70,,151.2,percent of total billed charges,70% of total billed charges,270,100,,216,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,221.4,82,,177.12,percent of total billed charges,82% of total billed charges,229.5,85,,183.6,percent of total billed charges,85% of total billed charges,229.5,85,,183.6,percent of total billed charges,85% of total billed charges,229.5,85,,183.6,percent of total billed charges,85% of total billed charges,243,90,,194.4,percent of total billed charges,90% of total billed charges,216,80,,172.8,percent of total billed charges,80% of total billed charges,243,90,,194.4,percent of total billed charges,90% of total billed charges,202.5,75,,162,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,78.3,29,,62.64,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,180.9,67,,144.72,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,189,70,,151.2,percent of total billed charges,70% of total billed charges,175.5,65,,140.4,percent of total billed charges,65% of total billed charges,96.31,35.67,,77.048,percent of total billed charges,35.67% of total billed charges,78.3,270,
REDUCTION SCREWS,27014094,CDM,278,RC,C1713,HCPCS,outpatient,,,2534,1013.60,,1773.8,70,,1419.04,percent of total billed charges,70% of total billed charges,1330.35,52.5,,1064.28,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,2077.88,82,,1662.304,percent of total billed charges,82% of total billed charges,2153.9,85,,1723.12,percent of total billed charges,85% of total billed charges,2153.9,85,,1723.12,percent of total billed charges,85% of total billed charges,2153.9,85,,1723.12,percent of total billed charges,85% of total billed charges,2280.6,90,,1824.48,percent of total billed charges,90% of total billed charges,2027.2,80,,1621.76,percent of total billed charges,80% of total billed charges,2280.6,90,,1824.48,percent of total billed charges,90% of total billed charges,1900.5,75,,1520.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,734.86,29,,587.888,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1697.78,67,,1358.224,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1773.8,70,,1419.04,percent of total billed charges,70% of total billed charges,1647.1,65,,1317.68,percent of total billed charges,65% of total billed charges,903.88,35.67,,723.104,percent of total billed charges,35.67% of total billed charges,734.86,2280.6,
CURVED ROD,27014095,CDM,278,RC,C1713,HCPCS,outpatient,,,1744,697.60,,1220.8,70,,976.64,percent of total billed charges,70% of total billed charges,915.6,52.5,,732.48,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,1430.08,82,,1144.064,percent of total billed charges,82% of total billed charges,1482.4,85,,1185.92,percent of total billed charges,85% of total billed charges,1482.4,85,,1185.92,percent of total billed charges,85% of total billed charges,1482.4,85,,1185.92,percent of total billed charges,85% of total billed charges,1569.6,90,,1255.68,percent of total billed charges,90% of total billed charges,1395.2,80,,1116.16,percent of total billed charges,80% of total billed charges,1569.6,90,,1255.68,percent of total billed charges,90% of total billed charges,1308,75,,1046.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,505.76,29,,404.608,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1168.48,67,,934.784,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1220.8,70,,976.64,percent of total billed charges,70% of total billed charges,1133.6,65,,906.88,percent of total billed charges,65% of total billed charges,622.08,35.67,,497.664,percent of total billed charges,35.67% of total billed charges,505.76,1569.6,
CORTICAL SCREW,27014128,CDM,278,RC,C1713,HCPCS,outpatient,,,785,314.00,,549.5,70,,439.6,percent of total billed charges,70% of total billed charges,785,100,,628,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,643.7,82,,514.96,percent of total billed charges,82% of total billed charges,667.25,85,,533.8,percent of total billed charges,85% of total billed charges,667.25,85,,533.8,percent of total billed charges,85% of total billed charges,667.25,85,,533.8,percent of total billed charges,85% of total billed charges,706.5,90,,565.2,percent of total billed charges,90% of total billed charges,628,80,,502.4,percent of total billed charges,80% of total billed charges,706.5,90,,565.2,percent of total billed charges,90% of total billed charges,588.75,75,,471,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,227.65,29,,182.12,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,525.95,67,,420.76,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,549.5,70,,439.6,percent of total billed charges,70% of total billed charges,510.25,65,,408.2,percent of total billed charges,65% of total billed charges,280.01,35.67,,224.008,percent of total billed charges,35.67% of total billed charges,227.65,785,
CORTICAL SCREW,27014129,CDM,278,RC,C1713,HCPCS,outpatient,,,785,314.00,,549.5,70,,439.6,percent of total billed charges,70% of total billed charges,785,100,,628,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,643.7,82,,514.96,percent of total billed charges,82% of total billed charges,667.25,85,,533.8,percent of total billed charges,85% of total billed charges,667.25,85,,533.8,percent of total billed charges,85% of total billed charges,667.25,85,,533.8,percent of total billed charges,85% of total billed charges,706.5,90,,565.2,percent of total billed charges,90% of total billed charges,628,80,,502.4,percent of total billed charges,80% of total billed charges,706.5,90,,565.2,percent of total billed charges,90% of total billed charges,588.75,75,,471,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,227.65,29,,182.12,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,525.95,67,,420.76,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,549.5,70,,439.6,percent of total billed charges,70% of total billed charges,510.25,65,,408.2,percent of total billed charges,65% of total billed charges,280.01,35.67,,224.008,percent of total billed charges,35.67% of total billed charges,227.65,785,
CORTICAL SCREW,27014130,CDM,278,RC,C1713,HCPCS,outpatient,,,785,314.00,,549.5,70,,439.6,percent of total billed charges,70% of total billed charges,785,100,,628,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,643.7,82,,514.96,percent of total billed charges,82% of total billed charges,667.25,85,,533.8,percent of total billed charges,85% of total billed charges,667.25,85,,533.8,percent of total billed charges,85% of total billed charges,667.25,85,,533.8,percent of total billed charges,85% of total billed charges,706.5,90,,565.2,percent of total billed charges,90% of total billed charges,628,80,,502.4,percent of total billed charges,80% of total billed charges,706.5,90,,565.2,percent of total billed charges,90% of total billed charges,588.75,75,,471,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,227.65,29,,182.12,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,525.95,67,,420.76,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,549.5,70,,439.6,percent of total billed charges,70% of total billed charges,510.25,65,,408.2,percent of total billed charges,65% of total billed charges,280.01,35.67,,224.008,percent of total billed charges,35.67% of total billed charges,227.65,785,
SCREW DEMIN CORTICAL,27014134,CDM,278,RC,C1713,HCPCS,outpatient,,,6679,2671.60,,4675.3,70,,3740.24,percent of total billed charges,70% of total billed charges,3506.48,52.5,,2805.18,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,5476.78,82,,4381.424,percent of total billed charges,82% of total billed charges,5677.15,85,,4541.72,percent of total billed charges,85% of total billed charges,5677.15,85,,4541.72,percent of total billed charges,85% of total billed charges,5677.15,85,,4541.72,percent of total billed charges,85% of total billed charges,6011.1,90,,4808.88,percent of total billed charges,90% of total billed charges,5343.2,80,,4274.56,percent of total billed charges,80% of total billed charges,6011.1,90,,4808.88,percent of total billed charges,90% of total billed charges,5009.25,75,,4007.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,1936.91,29,,1549.528,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4474.93,67,,3579.944,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,4675.3,70,,3740.24,percent of total billed charges,70% of total billed charges,4341.35,65,,3473.08,percent of total billed charges,65% of total billed charges,2382.4,35.67,,1905.92,percent of total billed charges,35.67% of total billed charges,1936.91,6011.1,
"PLATE, THREE LEVE",27014136,CDM,278,RC,C1713,HCPCS,outpatient,,,2976,1190.40,,2083.2,70,,1666.56,percent of total billed charges,70% of total billed charges,1562.4,52.5,,1249.92,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,2440.32,82,,1952.256,percent of total billed charges,82% of total billed charges,2529.6,85,,2023.68,percent of total billed charges,85% of total billed charges,2529.6,85,,2023.68,percent of total billed charges,85% of total billed charges,2529.6,85,,2023.68,percent of total billed charges,85% of total billed charges,2678.4,90,,2142.72,percent of total billed charges,90% of total billed charges,2380.8,80,,1904.64,percent of total billed charges,80% of total billed charges,2678.4,90,,2142.72,percent of total billed charges,90% of total billed charges,2232,75,,1785.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,863.04,29,,690.432,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1993.92,67,,1595.136,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,2083.2,70,,1666.56,percent of total billed charges,70% of total billed charges,1934.4,65,,1547.52,percent of total billed charges,65% of total billed charges,1061.54,35.67,,849.232,percent of total billed charges,35.67% of total billed charges,863.04,2678.4,
SCREW 4.25,27014137,CDM,278,RC,C1713,HCPCS,outpatient,,,524,209.60,,366.8,70,,293.44,percent of total billed charges,70% of total billed charges,524,100,,419.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,429.68,82,,343.744,percent of total billed charges,82% of total billed charges,445.4,85,,356.32,percent of total billed charges,85% of total billed charges,445.4,85,,356.32,percent of total billed charges,85% of total billed charges,445.4,85,,356.32,percent of total billed charges,85% of total billed charges,471.6,90,,377.28,percent of total billed charges,90% of total billed charges,419.2,80,,335.36,percent of total billed charges,80% of total billed charges,471.6,90,,377.28,percent of total billed charges,90% of total billed charges,393,75,,314.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,151.96,29,,121.568,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,351.08,67,,280.864,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,366.8,70,,293.44,percent of total billed charges,70% of total billed charges,340.6,65,,272.48,percent of total billed charges,65% of total billed charges,186.91,35.67,,149.528,percent of total billed charges,35.67% of total billed charges,151.96,524,
SCREW 4.25 TIMES,27014138,CDM,278,RC,C1713,HCPCS,outpatient,,,524,209.60,,366.8,70,,293.44,percent of total billed charges,70% of total billed charges,524,100,,419.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,429.68,82,,343.744,percent of total billed charges,82% of total billed charges,445.4,85,,356.32,percent of total billed charges,85% of total billed charges,445.4,85,,356.32,percent of total billed charges,85% of total billed charges,445.4,85,,356.32,percent of total billed charges,85% of total billed charges,471.6,90,,377.28,percent of total billed charges,90% of total billed charges,419.2,80,,335.36,percent of total billed charges,80% of total billed charges,471.6,90,,377.28,percent of total billed charges,90% of total billed charges,393,75,,314.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,151.96,29,,121.568,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,351.08,67,,280.864,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,366.8,70,,293.44,percent of total billed charges,70% of total billed charges,340.6,65,,272.48,percent of total billed charges,65% of total billed charges,186.91,35.67,,149.528,percent of total billed charges,35.67% of total billed charges,151.96,524,
"CAGE, TESERA STAND ALONE SPINE",27014139,CDM,278,RC,C1821,HCPCS,outpatient,,,4286,1714.40,,3000.2,70,,2400.16,percent of total billed charges,70% of total billed charges,2250.15,52.5,,1800.12,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,3514.52,82,,2811.616,percent of total billed charges,82% of total billed charges,3643.1,85,,2914.48,percent of total billed charges,85% of total billed charges,3643.1,85,,2914.48,percent of total billed charges,85% of total billed charges,3643.1,85,,2914.48,percent of total billed charges,85% of total billed charges,3857.4,90,,3085.92,percent of total billed charges,90% of total billed charges,3428.8,80,,2743.04,percent of total billed charges,80% of total billed charges,3857.4,90,,3085.92,percent of total billed charges,90% of total billed charges,3214.5,75,,2571.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,1242.94,29,,994.352,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,2871.62,67,,2297.296,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,3000.2,70,,2400.16,percent of total billed charges,70% of total billed charges,2785.9,65,,2228.72,percent of total billed charges,65% of total billed charges,1528.82,35.67,,1223.056,percent of total billed charges,35.67% of total billed charges,1242.94,3857.4,
"CAGE, TESERA STAND ALONE SPINE",27014140,CDM,278,RC,C1821,HCPCS,outpatient,,,4286,1714.40,,3000.2,70,,2400.16,percent of total billed charges,70% of total billed charges,2250.15,52.5,,1800.12,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,3514.52,82,,2811.616,percent of total billed charges,82% of total billed charges,3643.1,85,,2914.48,percent of total billed charges,85% of total billed charges,3643.1,85,,2914.48,percent of total billed charges,85% of total billed charges,3643.1,85,,2914.48,percent of total billed charges,85% of total billed charges,3857.4,90,,3085.92,percent of total billed charges,90% of total billed charges,3428.8,80,,2743.04,percent of total billed charges,80% of total billed charges,3857.4,90,,3085.92,percent of total billed charges,90% of total billed charges,3214.5,75,,2571.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,1242.94,29,,994.352,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,2871.62,67,,2297.296,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,3000.2,70,,2400.16,percent of total billed charges,70% of total billed charges,2785.9,65,,2228.72,percent of total billed charges,65% of total billed charges,1528.82,35.67,,1223.056,percent of total billed charges,35.67% of total billed charges,1242.94,3857.4,
BONE PUTTY,27014141,CDM,278,RC,C1713,HCPCS,outpatient,,,1931,772.40,,1351.7,70,,1081.36,percent of total billed charges,70% of total billed charges,1013.78,52.5,,811.02,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,1583.42,82,,1266.736,percent of total billed charges,82% of total billed charges,1641.35,85,,1313.08,percent of total billed charges,85% of total billed charges,1641.35,85,,1313.08,percent of total billed charges,85% of total billed charges,1641.35,85,,1313.08,percent of total billed charges,85% of total billed charges,1737.9,90,,1390.32,percent of total billed charges,90% of total billed charges,1544.8,80,,1235.84,percent of total billed charges,80% of total billed charges,1737.9,90,,1390.32,percent of total billed charges,90% of total billed charges,1448.25,75,,1158.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,559.99,29,,447.992,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1293.77,67,,1035.016,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1351.7,70,,1081.36,percent of total billed charges,70% of total billed charges,1255.15,65,,1004.12,percent of total billed charges,65% of total billed charges,688.79,35.67,,551.032,percent of total billed charges,35.67% of total billed charges,559.99,1737.9,
SCREW 3.75,27014142,CDM,278,RC,C1713,HCPCS,outpatient,,,942,376.80,,659.4,70,,527.52,percent of total billed charges,70% of total billed charges,942,100,,753.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,772.44,82,,617.952,percent of total billed charges,82% of total billed charges,800.7,85,,640.56,percent of total billed charges,85% of total billed charges,800.7,85,,640.56,percent of total billed charges,85% of total billed charges,800.7,85,,640.56,percent of total billed charges,85% of total billed charges,847.8,90,,678.24,percent of total billed charges,90% of total billed charges,753.6,80,,602.88,percent of total billed charges,80% of total billed charges,847.8,90,,678.24,percent of total billed charges,90% of total billed charges,706.5,75,,565.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,273.18,29,,218.544,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,631.14,67,,504.912,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,659.4,70,,527.52,percent of total billed charges,70% of total billed charges,612.3,65,,489.84,percent of total billed charges,65% of total billed charges,336.01,35.67,,268.808,percent of total billed charges,35.67% of total billed charges,273.18,942,
CERVICAL CAGE,27014143,CDM,278,RC,C1821,HCPCS,outpatient,,,4285,1714.00,,2999.5,70,,2399.6,percent of total billed charges,70% of total billed charges,2249.63,52.5,,1799.7,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,3513.7,82,,2810.96,percent of total billed charges,82% of total billed charges,3642.25,85,,2913.8,percent of total billed charges,85% of total billed charges,3642.25,85,,2913.8,percent of total billed charges,85% of total billed charges,3642.25,85,,2913.8,percent of total billed charges,85% of total billed charges,3856.5,90,,3085.2,percent of total billed charges,90% of total billed charges,3428,80,,2742.4,percent of total billed charges,80% of total billed charges,3856.5,90,,3085.2,percent of total billed charges,90% of total billed charges,3213.75,75,,2571,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,1242.65,29,,994.12,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,2870.95,67,,2296.76,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,2999.5,70,,2399.6,percent of total billed charges,70% of total billed charges,2785.25,65,,2228.2,percent of total billed charges,65% of total billed charges,1528.46,35.67,,1222.768,percent of total billed charges,35.67% of total billed charges,1242.65,3856.5,
CERVICAL CAGE,27014144,CDM,278,RC,C1821,HCPCS,outpatient,,,4285,1714.00,,2999.5,70,,2399.6,percent of total billed charges,70% of total billed charges,2249.63,52.5,,1799.7,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,3513.7,82,,2810.96,percent of total billed charges,82% of total billed charges,3642.25,85,,2913.8,percent of total billed charges,85% of total billed charges,3642.25,85,,2913.8,percent of total billed charges,85% of total billed charges,3642.25,85,,2913.8,percent of total billed charges,85% of total billed charges,3856.5,90,,3085.2,percent of total billed charges,90% of total billed charges,3428,80,,2742.4,percent of total billed charges,80% of total billed charges,3856.5,90,,3085.2,percent of total billed charges,90% of total billed charges,3213.75,75,,2571,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,1242.65,29,,994.12,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,2870.95,67,,2296.76,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,2999.5,70,,2399.6,percent of total billed charges,70% of total billed charges,2785.25,65,,2228.2,percent of total billed charges,65% of total billed charges,1528.46,35.67,,1222.768,percent of total billed charges,35.67% of total billed charges,1242.65,3856.5,
CORTICAL SCREW,27014189,CDM,278,RC,C1713,HCPCS,outpatient,,,785,314.00,,549.5,70,,439.6,percent of total billed charges,70% of total billed charges,785,100,,628,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,643.7,82,,514.96,percent of total billed charges,82% of total billed charges,667.25,85,,533.8,percent of total billed charges,85% of total billed charges,667.25,85,,533.8,percent of total billed charges,85% of total billed charges,667.25,85,,533.8,percent of total billed charges,85% of total billed charges,706.5,90,,565.2,percent of total billed charges,90% of total billed charges,628,80,,502.4,percent of total billed charges,80% of total billed charges,706.5,90,,565.2,percent of total billed charges,90% of total billed charges,588.75,75,,471,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,227.65,29,,182.12,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,525.95,67,,420.76,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,549.5,70,,439.6,percent of total billed charges,70% of total billed charges,510.25,65,,408.2,percent of total billed charges,65% of total billed charges,280.01,35.67,,224.008,percent of total billed charges,35.67% of total billed charges,227.65,785,
TUBULAR PLATE,27014190,CDM,278,RC,C1713,HCPCS,outpatient,,,2089,835.60,,1462.3,70,,1169.84,percent of total billed charges,70% of total billed charges,1096.73,52.5,,877.38,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,1712.98,82,,1370.384,percent of total billed charges,82% of total billed charges,1775.65,85,,1420.52,percent of total billed charges,85% of total billed charges,1775.65,85,,1420.52,percent of total billed charges,85% of total billed charges,1775.65,85,,1420.52,percent of total billed charges,85% of total billed charges,1880.1,90,,1504.08,percent of total billed charges,90% of total billed charges,1671.2,80,,1336.96,percent of total billed charges,80% of total billed charges,1880.1,90,,1504.08,percent of total billed charges,90% of total billed charges,1566.75,75,,1253.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,605.81,29,,484.648,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1399.63,67,,1119.704,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1462.3,70,,1169.84,percent of total billed charges,70% of total billed charges,1357.85,65,,1086.28,percent of total billed charges,65% of total billed charges,745.15,35.67,,596.12,percent of total billed charges,35.67% of total billed charges,605.81,1880.1,
HUMERUS PLATE,27014193,CDM,278,RC,C1713,HCPCS,outpatient,,,5471,2188.40,,3829.7,70,,3063.76,percent of total billed charges,70% of total billed charges,2872.28,52.5,,2297.82,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,4486.22,82,,3588.976,percent of total billed charges,82% of total billed charges,4650.35,85,,3720.28,percent of total billed charges,85% of total billed charges,4650.35,85,,3720.28,percent of total billed charges,85% of total billed charges,4650.35,85,,3720.28,percent of total billed charges,85% of total billed charges,4923.9,90,,3939.12,percent of total billed charges,90% of total billed charges,4376.8,80,,3501.44,percent of total billed charges,80% of total billed charges,4923.9,90,,3939.12,percent of total billed charges,90% of total billed charges,4103.25,75,,3282.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,1586.59,29,,1269.272,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,3665.57,67,,2932.456,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,3829.7,70,,3063.76,percent of total billed charges,70% of total billed charges,3556.15,65,,2844.92,percent of total billed charges,65% of total billed charges,1951.51,35.67,,1561.208,percent of total billed charges,35.67% of total billed charges,1586.59,4923.9,
LOCKING SCREW,27014194,CDM,278,RC,C1713,HCPCS,outpatient,,,917,366.80,,641.9,70,,513.52,percent of total billed charges,70% of total billed charges,917,100,,733.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,751.94,82,,601.552,percent of total billed charges,82% of total billed charges,779.45,85,,623.56,percent of total billed charges,85% of total billed charges,779.45,85,,623.56,percent of total billed charges,85% of total billed charges,779.45,85,,623.56,percent of total billed charges,85% of total billed charges,825.3,90,,660.24,percent of total billed charges,90% of total billed charges,733.6,80,,586.88,percent of total billed charges,80% of total billed charges,825.3,90,,660.24,percent of total billed charges,90% of total billed charges,687.75,75,,550.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,265.93,29,,212.744,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,614.39,67,,491.512,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,641.9,70,,513.52,percent of total billed charges,70% of total billed charges,596.05,65,,476.84,percent of total billed charges,65% of total billed charges,327.09,35.67,,261.672,percent of total billed charges,35.67% of total billed charges,265.93,917,
LOCKING SCREW,27014195,CDM,278,RC,C1713,HCPCS,outpatient,,,917,366.80,,641.9,70,,513.52,percent of total billed charges,70% of total billed charges,917,100,,733.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,751.94,82,,601.552,percent of total billed charges,82% of total billed charges,779.45,85,,623.56,percent of total billed charges,85% of total billed charges,779.45,85,,623.56,percent of total billed charges,85% of total billed charges,779.45,85,,623.56,percent of total billed charges,85% of total billed charges,825.3,90,,660.24,percent of total billed charges,90% of total billed charges,733.6,80,,586.88,percent of total billed charges,80% of total billed charges,825.3,90,,660.24,percent of total billed charges,90% of total billed charges,687.75,75,,550.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,265.93,29,,212.744,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,614.39,67,,491.512,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,641.9,70,,513.52,percent of total billed charges,70% of total billed charges,596.05,65,,476.84,percent of total billed charges,65% of total billed charges,327.09,35.67,,261.672,percent of total billed charges,35.67% of total billed charges,265.93,917,
LOCKING SCREW,27014196,CDM,278,RC,C1713,HCPCS,outpatient,,,917,366.80,,641.9,70,,513.52,percent of total billed charges,70% of total billed charges,917,100,,733.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,751.94,82,,601.552,percent of total billed charges,82% of total billed charges,779.45,85,,623.56,percent of total billed charges,85% of total billed charges,779.45,85,,623.56,percent of total billed charges,85% of total billed charges,779.45,85,,623.56,percent of total billed charges,85% of total billed charges,825.3,90,,660.24,percent of total billed charges,90% of total billed charges,733.6,80,,586.88,percent of total billed charges,80% of total billed charges,825.3,90,,660.24,percent of total billed charges,90% of total billed charges,687.75,75,,550.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,265.93,29,,212.744,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,614.39,67,,491.512,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,641.9,70,,513.52,percent of total billed charges,70% of total billed charges,596.05,65,,476.84,percent of total billed charges,65% of total billed charges,327.09,35.67,,261.672,percent of total billed charges,35.67% of total billed charges,265.93,917,
LOCKING SCREW,27014197,CDM,278,RC,C1713,HCPCS,outpatient,,,917,366.80,,641.9,70,,513.52,percent of total billed charges,70% of total billed charges,917,100,,733.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,751.94,82,,601.552,percent of total billed charges,82% of total billed charges,779.45,85,,623.56,percent of total billed charges,85% of total billed charges,779.45,85,,623.56,percent of total billed charges,85% of total billed charges,779.45,85,,623.56,percent of total billed charges,85% of total billed charges,825.3,90,,660.24,percent of total billed charges,90% of total billed charges,733.6,80,,586.88,percent of total billed charges,80% of total billed charges,825.3,90,,660.24,percent of total billed charges,90% of total billed charges,687.75,75,,550.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,265.93,29,,212.744,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,614.39,67,,491.512,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,641.9,70,,513.52,percent of total billed charges,70% of total billed charges,596.05,65,,476.84,percent of total billed charges,65% of total billed charges,327.09,35.67,,261.672,percent of total billed charges,35.67% of total billed charges,265.93,917,
GUIDE PIN,27014198,CDM,278,RC,C1713,HCPCS,outpatient,,,309,123.60,,216.3,70,,173.04,percent of total billed charges,70% of total billed charges,309,100,,247.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,253.38,82,,202.704,percent of total billed charges,82% of total billed charges,262.65,85,,210.12,percent of total billed charges,85% of total billed charges,262.65,85,,210.12,percent of total billed charges,85% of total billed charges,262.65,85,,210.12,percent of total billed charges,85% of total billed charges,278.1,90,,222.48,percent of total billed charges,90% of total billed charges,247.2,80,,197.76,percent of total billed charges,80% of total billed charges,278.1,90,,222.48,percent of total billed charges,90% of total billed charges,231.75,75,,185.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,89.61,29,,71.688,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,207.03,67,,165.624,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,216.3,70,,173.04,percent of total billed charges,70% of total billed charges,200.85,65,,160.68,percent of total billed charges,65% of total billed charges,110.22,35.67,,88.176,percent of total billed charges,35.67% of total billed charges,89.61,309,
DEMIN CORTICAL FIBERS,27014210,CDM,278,RC,C1713,HCPCS,outpatient,,,12053,4821.20,,8437.1,70,,6749.68,percent of total billed charges,70% of total billed charges,6327.83,52.5,,5062.26,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,9883.46,82,,7906.768,percent of total billed charges,82% of total billed charges,10245.05,85,,8196.04,percent of total billed charges,85% of total billed charges,10245.05,85,,8196.04,percent of total billed charges,85% of total billed charges,10245.05,85,,8196.04,percent of total billed charges,85% of total billed charges,10847.7,90,,8678.16,percent of total billed charges,90% of total billed charges,9642.4,80,,7713.92,percent of total billed charges,80% of total billed charges,10847.7,90,,8678.16,percent of total billed charges,90% of total billed charges,9039.75,75,,7231.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,3495.37,29,,2796.296,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,8075.51,67,,6460.408,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,8437.1,70,,6749.68,percent of total billed charges,70% of total billed charges,7834.45,65,,6267.56,percent of total billed charges,65% of total billed charges,4299.31,35.67,,3439.448,percent of total billed charges,35.67% of total billed charges,3495.37,10847.7,
DEMIN CORTICAL FIBERS,27014211,CDM,278,RC,C1713,HCPCS,outpatient,,,6679,2671.60,,4675.3,70,,3740.24,percent of total billed charges,70% of total billed charges,3506.48,52.5,,2805.18,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,5476.78,82,,4381.424,percent of total billed charges,82% of total billed charges,5677.15,85,,4541.72,percent of total billed charges,85% of total billed charges,5677.15,85,,4541.72,percent of total billed charges,85% of total billed charges,5677.15,85,,4541.72,percent of total billed charges,85% of total billed charges,6011.1,90,,4808.88,percent of total billed charges,90% of total billed charges,5343.2,80,,4274.56,percent of total billed charges,80% of total billed charges,6011.1,90,,4808.88,percent of total billed charges,90% of total billed charges,5009.25,75,,4007.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,1936.91,29,,1549.528,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4474.93,67,,3579.944,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,4675.3,70,,3740.24,percent of total billed charges,70% of total billed charges,4341.35,65,,3473.08,percent of total billed charges,65% of total billed charges,2382.4,35.67,,1905.92,percent of total billed charges,35.67% of total billed charges,1936.91,6011.1,
ORTHO RODS,27014212,CDM,278,RC,C1713,HCPCS,outpatient,,,754,301.60,,527.8,70,,422.24,percent of total billed charges,70% of total billed charges,754,100,,603.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,618.28,82,,494.624,percent of total billed charges,82% of total billed charges,640.9,85,,512.72,percent of total billed charges,85% of total billed charges,640.9,85,,512.72,percent of total billed charges,85% of total billed charges,640.9,85,,512.72,percent of total billed charges,85% of total billed charges,678.6,90,,542.88,percent of total billed charges,90% of total billed charges,603.2,80,,482.56,percent of total billed charges,80% of total billed charges,678.6,90,,542.88,percent of total billed charges,90% of total billed charges,565.5,75,,452.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,218.66,29,,174.928,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,505.18,67,,404.144,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,527.8,70,,422.24,percent of total billed charges,70% of total billed charges,490.1,65,,392.08,percent of total billed charges,65% of total billed charges,268.95,35.67,,215.16,percent of total billed charges,35.67% of total billed charges,218.66,754,
CROSSLINKS ORTHO,27014213,CDM,278,RC,C1713,HCPCS,outpatient,,,1881,752.40,,1316.7,70,,1053.36,percent of total billed charges,70% of total billed charges,987.53,52.5,,790.02,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,1542.42,82,,1233.936,percent of total billed charges,82% of total billed charges,1598.85,85,,1279.08,percent of total billed charges,85% of total billed charges,1598.85,85,,1279.08,percent of total billed charges,85% of total billed charges,1598.85,85,,1279.08,percent of total billed charges,85% of total billed charges,1692.9,90,,1354.32,percent of total billed charges,90% of total billed charges,1504.8,80,,1203.84,percent of total billed charges,80% of total billed charges,1692.9,90,,1354.32,percent of total billed charges,90% of total billed charges,1410.75,75,,1128.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,545.49,29,,436.392,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1260.27,67,,1008.216,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1316.7,70,,1053.36,percent of total billed charges,70% of total billed charges,1222.65,65,,978.12,percent of total billed charges,65% of total billed charges,670.95,35.67,,536.76,percent of total billed charges,35.67% of total billed charges,545.49,1692.9,
DEMIN CORTICAL FIBERS,27014214,CDM,278,RC,C1713,HCPCS,outpatient,,,6679,2671.60,,4675.3,70,,3740.24,percent of total billed charges,70% of total billed charges,3506.48,52.5,,2805.18,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,5476.78,82,,4381.424,percent of total billed charges,82% of total billed charges,5677.15,85,,4541.72,percent of total billed charges,85% of total billed charges,5677.15,85,,4541.72,percent of total billed charges,85% of total billed charges,5677.15,85,,4541.72,percent of total billed charges,85% of total billed charges,6011.1,90,,4808.88,percent of total billed charges,90% of total billed charges,5343.2,80,,4274.56,percent of total billed charges,80% of total billed charges,6011.1,90,,4808.88,percent of total billed charges,90% of total billed charges,5009.25,75,,4007.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,1936.91,29,,1549.528,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4474.93,67,,3579.944,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,4675.3,70,,3740.24,percent of total billed charges,70% of total billed charges,4341.35,65,,3473.08,percent of total billed charges,65% of total billed charges,2382.4,35.67,,1905.92,percent of total billed charges,35.67% of total billed charges,1936.91,6011.1,
CERVICAL CAGE,27014215,CDM,278,RC,C1821,HCPCS,outpatient,,,4285,1714.00,,2999.5,70,,2399.6,percent of total billed charges,70% of total billed charges,2249.63,52.5,,1799.7,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,3513.7,82,,2810.96,percent of total billed charges,82% of total billed charges,3642.25,85,,2913.8,percent of total billed charges,85% of total billed charges,3642.25,85,,2913.8,percent of total billed charges,85% of total billed charges,3642.25,85,,2913.8,percent of total billed charges,85% of total billed charges,3856.5,90,,3085.2,percent of total billed charges,90% of total billed charges,3428,80,,2742.4,percent of total billed charges,80% of total billed charges,3856.5,90,,3085.2,percent of total billed charges,90% of total billed charges,3213.75,75,,2571,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,1242.65,29,,994.12,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,2870.95,67,,2296.76,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,2999.5,70,,2399.6,percent of total billed charges,70% of total billed charges,2785.25,65,,2228.2,percent of total billed charges,65% of total billed charges,1528.46,35.67,,1222.768,percent of total billed charges,35.67% of total billed charges,1242.65,3856.5,
PLATE 3 LEVEL,27014216,CDM,278,RC,C1713,HCPCS,outpatient,,,2976,1190.40,,2083.2,70,,1666.56,percent of total billed charges,70% of total billed charges,1562.4,52.5,,1249.92,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,2440.32,82,,1952.256,percent of total billed charges,82% of total billed charges,2529.6,85,,2023.68,percent of total billed charges,85% of total billed charges,2529.6,85,,2023.68,percent of total billed charges,85% of total billed charges,2529.6,85,,2023.68,percent of total billed charges,85% of total billed charges,2678.4,90,,2142.72,percent of total billed charges,90% of total billed charges,2380.8,80,,1904.64,percent of total billed charges,80% of total billed charges,2678.4,90,,2142.72,percent of total billed charges,90% of total billed charges,2232,75,,1785.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,863.04,29,,690.432,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1993.92,67,,1595.136,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,2083.2,70,,1666.56,percent of total billed charges,70% of total billed charges,1934.4,65,,1547.52,percent of total billed charges,65% of total billed charges,1061.54,35.67,,849.232,percent of total billed charges,35.67% of total billed charges,863.04,2678.4,
CERVICAL CAGE,27014217,CDM,278,RC,C1821,HCPCS,outpatient,,,4285,1714.00,,2999.5,70,,2399.6,percent of total billed charges,70% of total billed charges,2249.63,52.5,,1799.7,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,3513.7,82,,2810.96,percent of total billed charges,82% of total billed charges,3642.25,85,,2913.8,percent of total billed charges,85% of total billed charges,3642.25,85,,2913.8,percent of total billed charges,85% of total billed charges,3642.25,85,,2913.8,percent of total billed charges,85% of total billed charges,3856.5,90,,3085.2,percent of total billed charges,90% of total billed charges,3428,80,,2742.4,percent of total billed charges,80% of total billed charges,3856.5,90,,3085.2,percent of total billed charges,90% of total billed charges,3213.75,75,,2571,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,1242.65,29,,994.12,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,2870.95,67,,2296.76,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,2999.5,70,,2399.6,percent of total billed charges,70% of total billed charges,2785.25,65,,2228.2,percent of total billed charges,65% of total billed charges,1528.46,35.67,,1222.768,percent of total billed charges,35.67% of total billed charges,1242.65,3856.5,
SCREW 3.75,27014218,CDM,278,RC,C1713,HCPCS,outpatient,,,942,376.80,,659.4,70,,527.52,percent of total billed charges,70% of total billed charges,942,100,,753.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,772.44,82,,617.952,percent of total billed charges,82% of total billed charges,800.7,85,,640.56,percent of total billed charges,85% of total billed charges,800.7,85,,640.56,percent of total billed charges,85% of total billed charges,800.7,85,,640.56,percent of total billed charges,85% of total billed charges,847.8,90,,678.24,percent of total billed charges,90% of total billed charges,753.6,80,,602.88,percent of total billed charges,80% of total billed charges,847.8,90,,678.24,percent of total billed charges,90% of total billed charges,706.5,75,,565.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,273.18,29,,218.544,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,631.14,67,,504.912,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,659.4,70,,527.52,percent of total billed charges,70% of total billed charges,612.3,65,,489.84,percent of total billed charges,65% of total billed charges,336.01,35.67,,268.808,percent of total billed charges,35.67% of total billed charges,273.18,942,
PLATE 3 LEVEL,27014220,CDM,278,RC,C1713,HCPCS,outpatient,,,2976,1190.40,,2083.2,70,,1666.56,percent of total billed charges,70% of total billed charges,1562.4,52.5,,1249.92,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,2440.32,82,,1952.256,percent of total billed charges,82% of total billed charges,2529.6,85,,2023.68,percent of total billed charges,85% of total billed charges,2529.6,85,,2023.68,percent of total billed charges,85% of total billed charges,2529.6,85,,2023.68,percent of total billed charges,85% of total billed charges,2678.4,90,,2142.72,percent of total billed charges,90% of total billed charges,2380.8,80,,1904.64,percent of total billed charges,80% of total billed charges,2678.4,90,,2142.72,percent of total billed charges,90% of total billed charges,2232,75,,1785.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,863.04,29,,690.432,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1993.92,67,,1595.136,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,2083.2,70,,1666.56,percent of total billed charges,70% of total billed charges,1934.4,65,,1547.52,percent of total billed charges,65% of total billed charges,1061.54,35.67,,849.232,percent of total billed charges,35.67% of total billed charges,863.04,2678.4,
SCREW 4.25,27014221,CDM,278,RC,C1713,HCPCS,outpatient,,,524,209.60,,366.8,70,,293.44,percent of total billed charges,70% of total billed charges,524,100,,419.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,429.68,82,,343.744,percent of total billed charges,82% of total billed charges,445.4,85,,356.32,percent of total billed charges,85% of total billed charges,445.4,85,,356.32,percent of total billed charges,85% of total billed charges,445.4,85,,356.32,percent of total billed charges,85% of total billed charges,471.6,90,,377.28,percent of total billed charges,90% of total billed charges,419.2,80,,335.36,percent of total billed charges,80% of total billed charges,471.6,90,,377.28,percent of total billed charges,90% of total billed charges,393,75,,314.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,151.96,29,,121.568,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,351.08,67,,280.864,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,366.8,70,,293.44,percent of total billed charges,70% of total billed charges,340.6,65,,272.48,percent of total billed charges,65% of total billed charges,186.91,35.67,,149.528,percent of total billed charges,35.67% of total billed charges,151.96,524,
RODS,27014222,CDM,278,RC,C1713,HCPCS,outpatient,,,754,301.60,,527.8,70,,422.24,percent of total billed charges,70% of total billed charges,754,100,,603.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,618.28,82,,494.624,percent of total billed charges,82% of total billed charges,640.9,85,,512.72,percent of total billed charges,85% of total billed charges,640.9,85,,512.72,percent of total billed charges,85% of total billed charges,640.9,85,,512.72,percent of total billed charges,85% of total billed charges,678.6,90,,542.88,percent of total billed charges,90% of total billed charges,603.2,80,,482.56,percent of total billed charges,80% of total billed charges,678.6,90,,542.88,percent of total billed charges,90% of total billed charges,565.5,75,,452.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,218.66,29,,174.928,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,505.18,67,,404.144,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,527.8,70,,422.24,percent of total billed charges,70% of total billed charges,490.1,65,,392.08,percent of total billed charges,65% of total billed charges,268.95,35.67,,215.16,percent of total billed charges,35.67% of total billed charges,218.66,754,
LUMBAR INTERBODY IMPLANT,27014223,CDM,278,RC,C1821,HCPCS,outpatient,,,5220,2088.00,,3654,70,,2923.2,percent of total billed charges,70% of total billed charges,2740.5,52.5,,2192.4,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,4280.4,82,,3424.32,percent of total billed charges,82% of total billed charges,4437,85,,3549.6,percent of total billed charges,85% of total billed charges,4437,85,,3549.6,percent of total billed charges,85% of total billed charges,4437,85,,3549.6,percent of total billed charges,85% of total billed charges,4698,90,,3758.4,percent of total billed charges,90% of total billed charges,4176,80,,3340.8,percent of total billed charges,80% of total billed charges,4698,90,,3758.4,percent of total billed charges,90% of total billed charges,3915,75,,3132,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,1513.8,29,,1211.04,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,3497.4,67,,2797.92,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,3654,70,,2923.2,percent of total billed charges,70% of total billed charges,3393,65,,2714.4,percent of total billed charges,65% of total billed charges,1861.97,35.67,,1489.576,percent of total billed charges,35.67% of total billed charges,1513.8,4698,
LUMBAR INTERBODY IMPLANT,27014224,CDM,278,RC,C1821,HCPCS,outpatient,,,5220,2088.00,,3654,70,,2923.2,percent of total billed charges,70% of total billed charges,2740.5,52.5,,2192.4,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,4280.4,82,,3424.32,percent of total billed charges,82% of total billed charges,4437,85,,3549.6,percent of total billed charges,85% of total billed charges,4437,85,,3549.6,percent of total billed charges,85% of total billed charges,4437,85,,3549.6,percent of total billed charges,85% of total billed charges,4698,90,,3758.4,percent of total billed charges,90% of total billed charges,4176,80,,3340.8,percent of total billed charges,80% of total billed charges,4698,90,,3758.4,percent of total billed charges,90% of total billed charges,3915,75,,3132,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,1513.8,29,,1211.04,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,3497.4,67,,2797.92,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,3654,70,,2923.2,percent of total billed charges,70% of total billed charges,3393,65,,2714.4,percent of total billed charges,65% of total billed charges,1861.97,35.67,,1489.576,percent of total billed charges,35.67% of total billed charges,1513.8,4698,
"SCREW, HEADED",27014281,CDM,278,RC,C1713,HCPCS,outpatient,,,1100,440.00,,770,70,,616,percent of total billed charges,70% of total billed charges,577.5,52.5,,462,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,902,82,,721.6,percent of total billed charges,82% of total billed charges,935,85,,748,percent of total billed charges,85% of total billed charges,935,85,,748,percent of total billed charges,85% of total billed charges,935,85,,748,percent of total billed charges,85% of total billed charges,990,90,,792,percent of total billed charges,90% of total billed charges,880,80,,704,percent of total billed charges,80% of total billed charges,990,90,,792,percent of total billed charges,90% of total billed charges,825,75,,660,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,319,29,,255.2,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,737,67,,589.6,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,770,70,,616,percent of total billed charges,70% of total billed charges,715,65,,572,percent of total billed charges,65% of total billed charges,392.37,35.67,,313.896,percent of total billed charges,35.67% of total billed charges,319,990,
"SCREW, HEADEHD",27014282,CDM,278,RC,C1713,HCPCS,outpatient,,,1100,440.00,,770,70,,616,percent of total billed charges,70% of total billed charges,577.5,52.5,,462,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,902,82,,721.6,percent of total billed charges,82% of total billed charges,935,85,,748,percent of total billed charges,85% of total billed charges,935,85,,748,percent of total billed charges,85% of total billed charges,935,85,,748,percent of total billed charges,85% of total billed charges,990,90,,792,percent of total billed charges,90% of total billed charges,880,80,,704,percent of total billed charges,80% of total billed charges,990,90,,792,percent of total billed charges,90% of total billed charges,825,75,,660,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,319,29,,255.2,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,737,67,,589.6,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,770,70,,616,percent of total billed charges,70% of total billed charges,715,65,,572,percent of total billed charges,65% of total billed charges,392.37,35.67,,313.896,percent of total billed charges,35.67% of total billed charges,319,990,
"GUIDEWIRE, SMOOTH",27014283,CDM,278,RC,C1713,HCPCS,outpatient,,,179,71.60,,125.3,70,,100.24,percent of total billed charges,70% of total billed charges,179,100,,143.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,146.78,82,,117.424,percent of total billed charges,82% of total billed charges,152.15,85,,121.72,percent of total billed charges,85% of total billed charges,152.15,85,,121.72,percent of total billed charges,85% of total billed charges,152.15,85,,121.72,percent of total billed charges,85% of total billed charges,161.1,90,,128.88,percent of total billed charges,90% of total billed charges,143.2,80,,114.56,percent of total billed charges,80% of total billed charges,161.1,90,,128.88,percent of total billed charges,90% of total billed charges,134.25,75,,107.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,51.91,29,,41.528,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,119.93,67,,95.944,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,125.3,70,,100.24,percent of total billed charges,70% of total billed charges,116.35,65,,93.08,percent of total billed charges,65% of total billed charges,63.85,35.67,,51.08,percent of total billed charges,35.67% of total billed charges,51.91,179,
"SCREW,HEADLESS",27014284,CDM,278,RC,C1713,HCPCS,outpatient,,,2577,1030.80,,1803.9,70,,1443.12,percent of total billed charges,70% of total billed charges,1352.93,52.5,,1082.34,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,2113.14,82,,1690.512,percent of total billed charges,82% of total billed charges,2190.45,85,,1752.36,percent of total billed charges,85% of total billed charges,2190.45,85,,1752.36,percent of total billed charges,85% of total billed charges,2190.45,85,,1752.36,percent of total billed charges,85% of total billed charges,2319.3,90,,1855.44,percent of total billed charges,90% of total billed charges,2061.6,80,,1649.28,percent of total billed charges,80% of total billed charges,2319.3,90,,1855.44,percent of total billed charges,90% of total billed charges,1932.75,75,,1546.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,747.33,29,,597.864,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1726.59,67,,1381.272,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1803.9,70,,1443.12,percent of total billed charges,70% of total billed charges,1675.05,65,,1340.04,percent of total billed charges,65% of total billed charges,919.22,35.67,,735.376,percent of total billed charges,35.67% of total billed charges,747.33,2319.3,
"GUIDEPIN, SMOOTH",27014285,CDM,278,RC,C1713,HCPCS,outpatient,,,266,106.40,,186.2,70,,148.96,percent of total billed charges,70% of total billed charges,266,100,,212.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,218.12,82,,174.496,percent of total billed charges,82% of total billed charges,226.1,85,,180.88,percent of total billed charges,85% of total billed charges,226.1,85,,180.88,percent of total billed charges,85% of total billed charges,226.1,85,,180.88,percent of total billed charges,85% of total billed charges,239.4,90,,191.52,percent of total billed charges,90% of total billed charges,212.8,80,,170.24,percent of total billed charges,80% of total billed charges,239.4,90,,191.52,percent of total billed charges,90% of total billed charges,199.5,75,,159.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,77.14,29,,61.712,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,178.22,67,,142.576,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,186.2,70,,148.96,percent of total billed charges,70% of total billed charges,172.9,65,,138.32,percent of total billed charges,65% of total billed charges,94.88,35.67,,75.904,percent of total billed charges,35.67% of total billed charges,77.14,266,
Z ALPHA PLATE 15 MM,27014287,CDM,278,RC,C1713,HCPCS,outpatient,,,5908,2363.20,,4135.6,70,,3308.48,percent of total billed charges,70% of total billed charges,3101.7,52.5,,2481.36,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,4844.56,82,,3875.648,percent of total billed charges,82% of total billed charges,5021.8,85,,4017.44,percent of total billed charges,85% of total billed charges,5021.8,85,,4017.44,percent of total billed charges,85% of total billed charges,5021.8,85,,4017.44,percent of total billed charges,85% of total billed charges,5317.2,90,,4253.76,percent of total billed charges,90% of total billed charges,4726.4,80,,3781.12,percent of total billed charges,80% of total billed charges,5317.2,90,,4253.76,percent of total billed charges,90% of total billed charges,4431,75,,3544.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,1713.32,29,,1370.656,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,3958.36,67,,3166.688,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,4135.6,70,,3308.48,percent of total billed charges,70% of total billed charges,3840.2,65,,3072.16,percent of total billed charges,65% of total billed charges,2107.38,35.67,,1685.904,percent of total billed charges,35.67% of total billed charges,1713.32,5317.2,
LOCKING SCREW,27014288,CDM,278,RC,C1713,HCPCS,outpatient,,,1449,579.60,,1014.3,70,,811.44,percent of total billed charges,70% of total billed charges,760.73,52.5,,608.58,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,1188.18,82,,950.544,percent of total billed charges,82% of total billed charges,1231.65,85,,985.32,percent of total billed charges,85% of total billed charges,1231.65,85,,985.32,percent of total billed charges,85% of total billed charges,1231.65,85,,985.32,percent of total billed charges,85% of total billed charges,1304.1,90,,1043.28,percent of total billed charges,90% of total billed charges,1159.2,80,,927.36,percent of total billed charges,80% of total billed charges,1304.1,90,,1043.28,percent of total billed charges,90% of total billed charges,1086.75,75,,869.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,420.21,29,,336.168,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,970.83,67,,776.664,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1014.3,70,,811.44,percent of total billed charges,70% of total billed charges,941.85,65,,753.48,percent of total billed charges,65% of total billed charges,516.86,35.67,,413.488,percent of total billed charges,35.67% of total billed charges,420.21,1304.1,
NON LOCKING SCREW,27014289,CDM,278,RC,C1713,HCPCS,outpatient,,,174,69.60,,121.8,70,,97.44,percent of total billed charges,70% of total billed charges,174,100,,139.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,142.68,82,,114.144,percent of total billed charges,82% of total billed charges,147.9,85,,118.32,percent of total billed charges,85% of total billed charges,147.9,85,,118.32,percent of total billed charges,85% of total billed charges,147.9,85,,118.32,percent of total billed charges,85% of total billed charges,156.6,90,,125.28,percent of total billed charges,90% of total billed charges,139.2,80,,111.36,percent of total billed charges,80% of total billed charges,156.6,90,,125.28,percent of total billed charges,90% of total billed charges,130.5,75,,104.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,50.46,29,,40.368,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,116.58,67,,93.264,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,121.8,70,,97.44,percent of total billed charges,70% of total billed charges,113.1,65,,90.48,percent of total billed charges,65% of total billed charges,62.07,35.67,,49.656,percent of total billed charges,35.67% of total billed charges,50.46,174,
NON LOCKING SCREW,27014290,CDM,278,RC,C1713,HCPCS,outpatient,,,690,276.00,,483,70,,386.4,percent of total billed charges,70% of total billed charges,690,100,,552,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,565.8,82,,452.64,percent of total billed charges,82% of total billed charges,586.5,85,,469.2,percent of total billed charges,85% of total billed charges,586.5,85,,469.2,percent of total billed charges,85% of total billed charges,586.5,85,,469.2,percent of total billed charges,85% of total billed charges,621,90,,496.8,percent of total billed charges,90% of total billed charges,552,80,,441.6,percent of total billed charges,80% of total billed charges,621,90,,496.8,percent of total billed charges,90% of total billed charges,517.5,75,,414,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,200.1,29,,160.08,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,462.3,67,,369.84,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,483,70,,386.4,percent of total billed charges,70% of total billed charges,448.5,65,,358.8,percent of total billed charges,65% of total billed charges,246.12,35.67,,196.896,percent of total billed charges,35.67% of total billed charges,200.1,690,
TIBIALIS TENDON TISSUE GRAFT,27014305,CDM,278,RC,C1713,HCPCS,outpatient,,,2726,1090.40,,1908.2,70,,1526.56,percent of total billed charges,70% of total billed charges,1431.15,52.5,,1144.92,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,2235.32,82,,1788.256,percent of total billed charges,82% of total billed charges,2317.1,85,,1853.68,percent of total billed charges,85% of total billed charges,2317.1,85,,1853.68,percent of total billed charges,85% of total billed charges,2317.1,85,,1853.68,percent of total billed charges,85% of total billed charges,2453.4,90,,1962.72,percent of total billed charges,90% of total billed charges,2180.8,80,,1744.64,percent of total billed charges,80% of total billed charges,2453.4,90,,1962.72,percent of total billed charges,90% of total billed charges,2044.5,75,,1635.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,790.54,29,,632.432,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1826.42,67,,1461.136,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1908.2,70,,1526.56,percent of total billed charges,70% of total billed charges,1771.9,65,,1417.52,percent of total billed charges,65% of total billed charges,972.36,35.67,,777.888,percent of total billed charges,35.67% of total billed charges,790.54,2453.4,
CORTICAL DEMIN FIBERS,27014324,CDM,278,RC,C1713,HCPCS,outpatient,,,6679,2671.60,,4675.3,70,,3740.24,percent of total billed charges,70% of total billed charges,3506.48,52.5,,2805.18,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,5476.78,82,,4381.424,percent of total billed charges,82% of total billed charges,5677.15,85,,4541.72,percent of total billed charges,85% of total billed charges,5677.15,85,,4541.72,percent of total billed charges,85% of total billed charges,5677.15,85,,4541.72,percent of total billed charges,85% of total billed charges,6011.1,90,,4808.88,percent of total billed charges,90% of total billed charges,5343.2,80,,4274.56,percent of total billed charges,80% of total billed charges,6011.1,90,,4808.88,percent of total billed charges,90% of total billed charges,5009.25,75,,4007.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,1936.91,29,,1549.528,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4474.93,67,,3579.944,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,4675.3,70,,3740.24,percent of total billed charges,70% of total billed charges,4341.35,65,,3473.08,percent of total billed charges,65% of total billed charges,2382.4,35.67,,1905.92,percent of total billed charges,35.67% of total billed charges,1936.91,6011.1,
PLATE 30 MM TWO LEVEL,27014325,CDM,278,RC,C1713,HCPCS,outpatient,,,2976,1190.40,,2083.2,70,,1666.56,percent of total billed charges,70% of total billed charges,1562.4,52.5,,1249.92,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,2440.32,82,,1952.256,percent of total billed charges,82% of total billed charges,2529.6,85,,2023.68,percent of total billed charges,85% of total billed charges,2529.6,85,,2023.68,percent of total billed charges,85% of total billed charges,2529.6,85,,2023.68,percent of total billed charges,85% of total billed charges,2678.4,90,,2142.72,percent of total billed charges,90% of total billed charges,2380.8,80,,1904.64,percent of total billed charges,80% of total billed charges,2678.4,90,,2142.72,percent of total billed charges,90% of total billed charges,2232,75,,1785.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,863.04,29,,690.432,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1993.92,67,,1595.136,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,2083.2,70,,1666.56,percent of total billed charges,70% of total billed charges,1934.4,65,,1547.52,percent of total billed charges,65% of total billed charges,1061.54,35.67,,849.232,percent of total billed charges,35.67% of total billed charges,863.04,2678.4,
CERVICAL CAGE,27014326,CDM,278,RC,C1821,HCPCS,outpatient,,,4285,1714.00,,2999.5,70,,2399.6,percent of total billed charges,70% of total billed charges,2249.63,52.5,,1799.7,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,3513.7,82,,2810.96,percent of total billed charges,82% of total billed charges,3642.25,85,,2913.8,percent of total billed charges,85% of total billed charges,3642.25,85,,2913.8,percent of total billed charges,85% of total billed charges,3642.25,85,,2913.8,percent of total billed charges,85% of total billed charges,3856.5,90,,3085.2,percent of total billed charges,90% of total billed charges,3428,80,,2742.4,percent of total billed charges,80% of total billed charges,3856.5,90,,3085.2,percent of total billed charges,90% of total billed charges,3213.75,75,,2571,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,1242.65,29,,994.12,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,2870.95,67,,2296.76,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,2999.5,70,,2399.6,percent of total billed charges,70% of total billed charges,2785.25,65,,2228.2,percent of total billed charges,65% of total billed charges,1528.46,35.67,,1222.768,percent of total billed charges,35.67% of total billed charges,1242.65,3856.5,
PLATE 16 MM ONE LEVEL,27014327,CDM,278,RC,C1713,HCPCS,outpatient,,,2976,1190.40,,2083.2,70,,1666.56,percent of total billed charges,70% of total billed charges,1562.4,52.5,,1249.92,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,2440.32,82,,1952.256,percent of total billed charges,82% of total billed charges,2529.6,85,,2023.68,percent of total billed charges,85% of total billed charges,2529.6,85,,2023.68,percent of total billed charges,85% of total billed charges,2529.6,85,,2023.68,percent of total billed charges,85% of total billed charges,2678.4,90,,2142.72,percent of total billed charges,90% of total billed charges,2380.8,80,,1904.64,percent of total billed charges,80% of total billed charges,2678.4,90,,2142.72,percent of total billed charges,90% of total billed charges,2232,75,,1785.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,863.04,29,,690.432,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1993.92,67,,1595.136,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,2083.2,70,,1666.56,percent of total billed charges,70% of total billed charges,1934.4,65,,1547.52,percent of total billed charges,65% of total billed charges,1061.54,35.67,,849.232,percent of total billed charges,35.67% of total billed charges,863.04,2678.4,
NEUROSTIMULATOR LEAD KIT,27014333,CDM,278,RC,L8680,HCPCS,outpatient,,,2350,940.00,,1645,70,,1316,percent of total billed charges,70% of total billed charges,1233.75,52.5,,987,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,1927,82,,1541.6,percent of total billed charges,82% of total billed charges,1997.5,85,,1598,percent of total billed charges,85% of total billed charges,1997.5,85,,1598,percent of total billed charges,85% of total billed charges,1997.5,85,,1598,percent of total billed charges,85% of total billed charges,2115,90,,1692,percent of total billed charges,90% of total billed charges,1880,80,,1504,percent of total billed charges,80% of total billed charges,2115,90,,1692,percent of total billed charges,90% of total billed charges,1762.5,75,,1410,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,4626.19,100,,,fee schedule,100% of ASC tier grouping rate,,,,,other ,not seperately reimbursable,1574.5,67,,1259.6,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1645,70,,1316,percent of total billed charges,70% of total billed charges,1527.5,65,,1222,percent of total billed charges,65% of total billed charges,5690.21,123,,,fee schedule,123% of ASC tier grouping rate,1233.75,5690.21,
SCREW CANNULATED 4.0,27014339,CDM,278,RC,C1713,HCPCS,outpatient,,,942,376.80,,659.4,70,,527.52,percent of total billed charges,70% of total billed charges,942,100,,753.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,772.44,82,,617.952,percent of total billed charges,82% of total billed charges,800.7,85,,640.56,percent of total billed charges,85% of total billed charges,800.7,85,,640.56,percent of total billed charges,85% of total billed charges,800.7,85,,640.56,percent of total billed charges,85% of total billed charges,847.8,90,,678.24,percent of total billed charges,90% of total billed charges,753.6,80,,602.88,percent of total billed charges,80% of total billed charges,847.8,90,,678.24,percent of total billed charges,90% of total billed charges,706.5,75,,565.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,273.18,29,,218.544,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,631.14,67,,504.912,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,659.4,70,,527.52,percent of total billed charges,70% of total billed charges,612.3,65,,489.84,percent of total billed charges,65% of total billed charges,336.01,35.67,,268.808,percent of total billed charges,35.67% of total billed charges,273.18,942,
SCREW CANNULATED,27014340,CDM,278,RC,C1713,HCPCS,outpatient,,,942,376.80,,659.4,70,,527.52,percent of total billed charges,70% of total billed charges,942,100,,753.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,772.44,82,,617.952,percent of total billed charges,82% of total billed charges,800.7,85,,640.56,percent of total billed charges,85% of total billed charges,800.7,85,,640.56,percent of total billed charges,85% of total billed charges,800.7,85,,640.56,percent of total billed charges,85% of total billed charges,847.8,90,,678.24,percent of total billed charges,90% of total billed charges,753.6,80,,602.88,percent of total billed charges,80% of total billed charges,847.8,90,,678.24,percent of total billed charges,90% of total billed charges,706.5,75,,565.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,273.18,29,,218.544,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,631.14,67,,504.912,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,659.4,70,,527.52,percent of total billed charges,70% of total billed charges,612.3,65,,489.84,percent of total billed charges,65% of total billed charges,336.01,35.67,,268.808,percent of total billed charges,35.67% of total billed charges,273.18,942,
RIGHT 1- HOLD PLATE,27014347,CDM,278,RC,C1713,HCPCS,outpatient,,,3274,1309.60,,2291.8,70,,1833.44,percent of total billed charges,70% of total billed charges,1718.85,52.5,,1375.08,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,2684.68,82,,2147.744,percent of total billed charges,82% of total billed charges,2782.9,85,,2226.32,percent of total billed charges,85% of total billed charges,2782.9,85,,2226.32,percent of total billed charges,85% of total billed charges,2782.9,85,,2226.32,percent of total billed charges,85% of total billed charges,2946.6,90,,2357.28,percent of total billed charges,90% of total billed charges,2619.2,80,,2095.36,percent of total billed charges,80% of total billed charges,2946.6,90,,2357.28,percent of total billed charges,90% of total billed charges,2455.5,75,,1964.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,949.46,29,,759.568,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,2193.58,67,,1754.864,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,2291.8,70,,1833.44,percent of total billed charges,70% of total billed charges,2128.1,65,,1702.48,percent of total billed charges,65% of total billed charges,1167.84,35.67,,934.272,percent of total billed charges,35.67% of total billed charges,949.46,2946.6,
PICC LINE 5 FR,27014357,CDM,278,RC,C1751,HCPCS,outpatient,,,946,378.40,,662.2,70,,529.76,percent of total billed charges,70% of total billed charges,946,100,,756.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,775.72,82,,620.576,percent of total billed charges,82% of total billed charges,804.1,85,,643.28,percent of total billed charges,85% of total billed charges,804.1,85,,643.28,percent of total billed charges,85% of total billed charges,804.1,85,,643.28,percent of total billed charges,85% of total billed charges,851.4,90,,681.12,percent of total billed charges,90% of total billed charges,756.8,80,,605.44,percent of total billed charges,80% of total billed charges,851.4,90,,681.12,percent of total billed charges,90% of total billed charges,709.5,75,,567.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,274.34,29,,219.472,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,633.82,67,,507.056,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,662.2,70,,529.76,percent of total billed charges,70% of total billed charges,614.9,65,,491.92,percent of total billed charges,65% of total billed charges,337.44,35.67,,269.952,percent of total billed charges,35.67% of total billed charges,274.34,946,
PICC LINE SOLO TRIPLE,27014358,CDM,278,RC,C1751,HCPCS,outpatient,,,1185,474.00,,829.5,70,,663.6,percent of total billed charges,70% of total billed charges,622.13,52.5,,497.7,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,971.7,82,,777.36,percent of total billed charges,82% of total billed charges,1007.25,85,,805.8,percent of total billed charges,85% of total billed charges,1007.25,85,,805.8,percent of total billed charges,85% of total billed charges,1007.25,85,,805.8,percent of total billed charges,85% of total billed charges,1066.5,90,,853.2,percent of total billed charges,90% of total billed charges,948,80,,758.4,percent of total billed charges,80% of total billed charges,1066.5,90,,853.2,percent of total billed charges,90% of total billed charges,888.75,75,,711,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,343.65,29,,274.92,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,793.95,67,,635.16,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,829.5,70,,663.6,percent of total billed charges,70% of total billed charges,770.25,65,,616.2,percent of total billed charges,65% of total billed charges,422.69,35.67,,338.152,percent of total billed charges,35.67% of total billed charges,343.65,1066.5,
CANNULATED SCREWS,27014376,CDM,278,RC,C1713,HCPCS,outpatient,,,802,320.80,,561.4,70,,449.12,percent of total billed charges,70% of total billed charges,802,100,,641.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,657.64,82,,526.112,percent of total billed charges,82% of total billed charges,681.7,85,,545.36,percent of total billed charges,85% of total billed charges,681.7,85,,545.36,percent of total billed charges,85% of total billed charges,681.7,85,,545.36,percent of total billed charges,85% of total billed charges,721.8,90,,577.44,percent of total billed charges,90% of total billed charges,641.6,80,,513.28,percent of total billed charges,80% of total billed charges,721.8,90,,577.44,percent of total billed charges,90% of total billed charges,601.5,75,,481.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,232.58,29,,186.064,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,537.34,67,,429.872,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,561.4,70,,449.12,percent of total billed charges,70% of total billed charges,521.3,65,,417.04,percent of total billed charges,65% of total billed charges,286.07,35.67,,228.856,percent of total billed charges,35.67% of total billed charges,232.58,802,
CANNULATED SCREWS,27014377,CDM,278,RC,C1713,HCPCS,outpatient,,,802,320.80,,561.4,70,,449.12,percent of total billed charges,70% of total billed charges,802,100,,641.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,657.64,82,,526.112,percent of total billed charges,82% of total billed charges,681.7,85,,545.36,percent of total billed charges,85% of total billed charges,681.7,85,,545.36,percent of total billed charges,85% of total billed charges,681.7,85,,545.36,percent of total billed charges,85% of total billed charges,721.8,90,,577.44,percent of total billed charges,90% of total billed charges,641.6,80,,513.28,percent of total billed charges,80% of total billed charges,721.8,90,,577.44,percent of total billed charges,90% of total billed charges,601.5,75,,481.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,232.58,29,,186.064,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,537.34,67,,429.872,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,561.4,70,,449.12,percent of total billed charges,70% of total billed charges,521.3,65,,417.04,percent of total billed charges,65% of total billed charges,286.07,35.67,,228.856,percent of total billed charges,35.67% of total billed charges,232.58,802,
"SCREW, CORTEX SELF TAPPING",27014378,CDM,278,RC,C1713,HCPCS,outpatient,,,837,334.80,,585.9,70,,468.72,percent of total billed charges,70% of total billed charges,837,100,,669.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,686.34,82,,549.072,percent of total billed charges,82% of total billed charges,711.45,85,,569.16,percent of total billed charges,85% of total billed charges,711.45,85,,569.16,percent of total billed charges,85% of total billed charges,711.45,85,,569.16,percent of total billed charges,85% of total billed charges,753.3,90,,602.64,percent of total billed charges,90% of total billed charges,669.6,80,,535.68,percent of total billed charges,80% of total billed charges,753.3,90,,602.64,percent of total billed charges,90% of total billed charges,627.75,75,,502.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,242.73,29,,194.184,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,560.79,67,,448.632,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,585.9,70,,468.72,percent of total billed charges,70% of total billed charges,544.05,65,,435.24,percent of total billed charges,65% of total billed charges,298.56,35.67,,238.848,percent of total billed charges,35.67% of total billed charges,242.73,837,
BLUE PERCUTANEOUS LEAD KIT,27014389,CDM,278,RC,C1778,HCPCS,outpatient,,,3132,1252.80,,2192.4,70,,1753.92,percent of total billed charges,70% of total billed charges,1644.3,52.5,,1315.44,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,2568.24,82,,2054.592,percent of total billed charges,82% of total billed charges,2662.2,85,,2129.76,percent of total billed charges,85% of total billed charges,2662.2,85,,2129.76,percent of total billed charges,85% of total billed charges,2662.2,85,,2129.76,percent of total billed charges,85% of total billed charges,2818.8,90,,2255.04,percent of total billed charges,90% of total billed charges,2505.6,80,,2004.48,percent of total billed charges,80% of total billed charges,2818.8,90,,2255.04,percent of total billed charges,90% of total billed charges,2349,75,,1879.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,908.28,29,,726.624,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,2098.44,67,,1678.752,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,2192.4,70,,1753.92,percent of total billed charges,70% of total billed charges,2035.8,65,,1628.64,percent of total billed charges,65% of total billed charges,1117.18,35.67,,893.744,percent of total billed charges,35.67% of total billed charges,908.28,2818.8,
PERM NEUROSTIMULATOR KIT,27014393,CDM,278,RC,C1822,HCPCS,outpatient,,,38346,15338.40,,26842.2,70,,21473.76,percent of total billed charges,70% of total billed charges,20131.65,52.5,,16105.32,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,31443.72,82,,25154.976,percent of total billed charges,82% of total billed charges,32594.1,85,,26075.28,percent of total billed charges,85% of total billed charges,32594.1,85,,26075.28,percent of total billed charges,85% of total billed charges,32594.1,85,,26075.28,percent of total billed charges,85% of total billed charges,34511.4,90,,27609.12,percent of total billed charges,90% of total billed charges,30676.8,80,,24541.44,percent of total billed charges,80% of total billed charges,34511.4,90,,27609.12,percent of total billed charges,90% of total billed charges,28759.5,75,,23007.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,11120.34,29,,8896.272,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,25691.82,67,,20553.456,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,26842.2,70,,21473.76,percent of total billed charges,70% of total billed charges,24924.9,65,,19939.92,percent of total billed charges,65% of total billed charges,13678.02,35.67,,10942.416,percent of total billed charges,35.67% of total billed charges,11120.34,34511.4,
TIGERLOOP,27014396,CDM,278,RC,C1713,HCPCS,outpatient,,,373,149.20,,261.1,70,,208.88,percent of total billed charges,70% of total billed charges,373,100,,298.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,305.86,82,,244.688,percent of total billed charges,82% of total billed charges,317.05,85,,253.64,percent of total billed charges,85% of total billed charges,317.05,85,,253.64,percent of total billed charges,85% of total billed charges,317.05,85,,253.64,percent of total billed charges,85% of total billed charges,335.7,90,,268.56,percent of total billed charges,90% of total billed charges,298.4,80,,238.72,percent of total billed charges,80% of total billed charges,335.7,90,,268.56,percent of total billed charges,90% of total billed charges,279.75,75,,223.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,108.17,29,,86.536,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,249.91,67,,199.928,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,261.1,70,,208.88,percent of total billed charges,70% of total billed charges,242.45,65,,193.96,percent of total billed charges,65% of total billed charges,133.05,35.67,,106.44,percent of total billed charges,35.67% of total billed charges,108.17,373,
INTERFERENCE SCREW,27014398,CDM,278,RC,C1713,HCPCS,outpatient,,,1405,562.00,,983.5,70,,786.8,percent of total billed charges,70% of total billed charges,737.63,52.5,,590.1,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,1152.1,82,,921.68,percent of total billed charges,82% of total billed charges,1194.25,85,,955.4,percent of total billed charges,85% of total billed charges,1194.25,85,,955.4,percent of total billed charges,85% of total billed charges,1194.25,85,,955.4,percent of total billed charges,85% of total billed charges,1264.5,90,,1011.6,percent of total billed charges,90% of total billed charges,1124,80,,899.2,percent of total billed charges,80% of total billed charges,1264.5,90,,1011.6,percent of total billed charges,90% of total billed charges,1053.75,75,,843,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,407.45,29,,325.96,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,941.35,67,,753.08,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,983.5,70,,786.8,percent of total billed charges,70% of total billed charges,913.25,65,,730.6,percent of total billed charges,65% of total billed charges,501.16,35.67,,400.928,percent of total billed charges,35.67% of total billed charges,407.45,1264.5,
INTERFERENCE SCREW,27014399,CDM,278,RC,C1713,HCPCS,outpatient,,,1405,562.00,,983.5,70,,786.8,percent of total billed charges,70% of total billed charges,737.63,52.5,,590.1,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,1152.1,82,,921.68,percent of total billed charges,82% of total billed charges,1194.25,85,,955.4,percent of total billed charges,85% of total billed charges,1194.25,85,,955.4,percent of total billed charges,85% of total billed charges,1194.25,85,,955.4,percent of total billed charges,85% of total billed charges,1264.5,90,,1011.6,percent of total billed charges,90% of total billed charges,1124,80,,899.2,percent of total billed charges,80% of total billed charges,1264.5,90,,1011.6,percent of total billed charges,90% of total billed charges,1053.75,75,,843,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,407.45,29,,325.96,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,941.35,67,,753.08,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,983.5,70,,786.8,percent of total billed charges,70% of total billed charges,913.25,65,,730.6,percent of total billed charges,65% of total billed charges,501.16,35.67,,400.928,percent of total billed charges,35.67% of total billed charges,407.45,1264.5,
BACKUP FIXATION DEVICE,27014400,CDM,278,RC,C1713,HCPCS,outpatient,,,2688,1075.20,,1881.6,70,,1505.28,percent of total billed charges,70% of total billed charges,1411.2,52.5,,1128.96,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,2204.16,82,,1763.328,percent of total billed charges,82% of total billed charges,2284.8,85,,1827.84,percent of total billed charges,85% of total billed charges,2284.8,85,,1827.84,percent of total billed charges,85% of total billed charges,2284.8,85,,1827.84,percent of total billed charges,85% of total billed charges,2419.2,90,,1935.36,percent of total billed charges,90% of total billed charges,2150.4,80,,1720.32,percent of total billed charges,80% of total billed charges,2419.2,90,,1935.36,percent of total billed charges,90% of total billed charges,2016,75,,1612.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,779.52,29,,623.616,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1800.96,67,,1440.768,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1881.6,70,,1505.28,percent of total billed charges,70% of total billed charges,1747.2,65,,1397.76,percent of total billed charges,65% of total billed charges,958.81,35.67,,767.048,percent of total billed charges,35.67% of total billed charges,779.52,2419.2,
TOE IMPLANT JOINT DEVICE,27014414,CDM,278,RC,C1776,HCPCS,outpatient,,,4236,1694.40,,2965.2,70,,2372.16,percent of total billed charges,70% of total billed charges,2223.9,52.5,,1779.12,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,3473.52,82,,2778.816,percent of total billed charges,82% of total billed charges,3600.6,85,,2880.48,percent of total billed charges,85% of total billed charges,3600.6,85,,2880.48,percent of total billed charges,85% of total billed charges,3600.6,85,,2880.48,percent of total billed charges,85% of total billed charges,3812.4,90,,3049.92,percent of total billed charges,90% of total billed charges,3388.8,80,,2711.04,percent of total billed charges,80% of total billed charges,3812.4,90,,3049.92,percent of total billed charges,90% of total billed charges,3177,75,,2541.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,1228.44,29,,982.752,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,2838.12,67,,2270.496,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,2965.2,70,,2372.16,percent of total billed charges,70% of total billed charges,2753.4,65,,2202.72,percent of total billed charges,65% of total billed charges,1510.98,35.67,,1208.784,percent of total billed charges,35.67% of total billed charges,1228.44,3812.4,
URINARY SLING,27014426,CDM,278,RC,C1771,HCPCS,outpatient,,,3492,1396.80,,2444.4,70,,1955.52,percent of total billed charges,70% of total billed charges,1833.3,52.5,,1466.64,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,2863.44,82,,2290.752,percent of total billed charges,82% of total billed charges,2968.2,85,,2374.56,percent of total billed charges,85% of total billed charges,2968.2,85,,2374.56,percent of total billed charges,85% of total billed charges,2968.2,85,,2374.56,percent of total billed charges,85% of total billed charges,3142.8,90,,2514.24,percent of total billed charges,90% of total billed charges,2793.6,80,,2234.88,percent of total billed charges,80% of total billed charges,3142.8,90,,2514.24,percent of total billed charges,90% of total billed charges,2619,75,,2095.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,1012.68,29,,810.144,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,2339.64,67,,1871.712,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,2444.4,70,,1955.52,percent of total billed charges,70% of total billed charges,2269.8,65,,1815.84,percent of total billed charges,65% of total billed charges,1245.6,35.67,,996.48,percent of total billed charges,35.67% of total billed charges,1012.68,3142.8,
PLATE DYNAFORCE,27014430,CDM,278,RC,C1713,HCPCS,outpatient,,,5637,2254.80,,3945.9,70,,3156.72,percent of total billed charges,70% of total billed charges,2959.43,52.5,,2367.54,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,4622.34,82,,3697.872,percent of total billed charges,82% of total billed charges,4791.45,85,,3833.16,percent of total billed charges,85% of total billed charges,4791.45,85,,3833.16,percent of total billed charges,85% of total billed charges,4791.45,85,,3833.16,percent of total billed charges,85% of total billed charges,5073.3,90,,4058.64,percent of total billed charges,90% of total billed charges,4509.6,80,,3607.68,percent of total billed charges,80% of total billed charges,5073.3,90,,4058.64,percent of total billed charges,90% of total billed charges,4227.75,75,,3382.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,1634.73,29,,1307.784,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,3776.79,67,,3021.432,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,3945.9,70,,3156.72,percent of total billed charges,70% of total billed charges,3664.05,65,,2931.24,percent of total billed charges,65% of total billed charges,2010.72,35.67,,1608.576,percent of total billed charges,35.67% of total billed charges,1634.73,5073.3,
SCREW NON LOCKING,27014431,CDM,278,RC,C1713,HCPCS,outpatient,,,785,314.00,,549.5,70,,439.6,percent of total billed charges,70% of total billed charges,785,100,,628,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,643.7,82,,514.96,percent of total billed charges,82% of total billed charges,667.25,85,,533.8,percent of total billed charges,85% of total billed charges,667.25,85,,533.8,percent of total billed charges,85% of total billed charges,667.25,85,,533.8,percent of total billed charges,85% of total billed charges,706.5,90,,565.2,percent of total billed charges,90% of total billed charges,628,80,,502.4,percent of total billed charges,80% of total billed charges,706.5,90,,565.2,percent of total billed charges,90% of total billed charges,588.75,75,,471,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,227.65,29,,182.12,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,525.95,67,,420.76,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,549.5,70,,439.6,percent of total billed charges,70% of total billed charges,510.25,65,,408.2,percent of total billed charges,65% of total billed charges,280.01,35.67,,224.008,percent of total billed charges,35.67% of total billed charges,227.65,785,
SCREW LOCKING,27014432,CDM,278,RC,C1713,HCPCS,outpatient,,,1255,502.00,,878.5,70,,702.8,percent of total billed charges,70% of total billed charges,658.88,52.5,,527.1,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,1029.1,82,,823.28,percent of total billed charges,82% of total billed charges,1066.75,85,,853.4,percent of total billed charges,85% of total billed charges,1066.75,85,,853.4,percent of total billed charges,85% of total billed charges,1066.75,85,,853.4,percent of total billed charges,85% of total billed charges,1129.5,90,,903.6,percent of total billed charges,90% of total billed charges,1004,80,,803.2,percent of total billed charges,80% of total billed charges,1129.5,90,,903.6,percent of total billed charges,90% of total billed charges,941.25,75,,753,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,363.95,29,,291.16,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,840.85,67,,672.68,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,878.5,70,,702.8,percent of total billed charges,70% of total billed charges,815.75,65,,652.6,percent of total billed charges,65% of total billed charges,447.66,35.67,,358.128,percent of total billed charges,35.67% of total billed charges,363.95,1129.5,
SCREW LOCKING,27014433,CDM,278,RC,C1713,HCPCS,outpatient,,,1255,502.00,,878.5,70,,702.8,percent of total billed charges,70% of total billed charges,658.88,52.5,,527.1,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,1029.1,82,,823.28,percent of total billed charges,82% of total billed charges,1066.75,85,,853.4,percent of total billed charges,85% of total billed charges,1066.75,85,,853.4,percent of total billed charges,85% of total billed charges,1066.75,85,,853.4,percent of total billed charges,85% of total billed charges,1129.5,90,,903.6,percent of total billed charges,90% of total billed charges,1004,80,,803.2,percent of total billed charges,80% of total billed charges,1129.5,90,,903.6,percent of total billed charges,90% of total billed charges,941.25,75,,753,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,363.95,29,,291.16,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,840.85,67,,672.68,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,878.5,70,,702.8,percent of total billed charges,70% of total billed charges,815.75,65,,652.6,percent of total billed charges,65% of total billed charges,447.66,35.67,,358.128,percent of total billed charges,35.67% of total billed charges,363.95,1129.5,
SCREW CANNULATED,27014434,CDM,278,RC,C1713,HCPCS,outpatient,,,1100,440.00,,770,70,,616,percent of total billed charges,70% of total billed charges,577.5,52.5,,462,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,902,82,,721.6,percent of total billed charges,82% of total billed charges,935,85,,748,percent of total billed charges,85% of total billed charges,935,85,,748,percent of total billed charges,85% of total billed charges,935,85,,748,percent of total billed charges,85% of total billed charges,990,90,,792,percent of total billed charges,90% of total billed charges,880,80,,704,percent of total billed charges,80% of total billed charges,990,90,,792,percent of total billed charges,90% of total billed charges,825,75,,660,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,319,29,,255.2,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,737,67,,589.6,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,770,70,,616,percent of total billed charges,70% of total billed charges,715,65,,572,percent of total billed charges,65% of total billed charges,392.37,35.67,,313.896,percent of total billed charges,35.67% of total billed charges,319,990,
K WIRE,27014435,CDM,278,RC,C1713,HCPCS,outpatient,,,234,93.60,,163.8,70,,131.04,percent of total billed charges,70% of total billed charges,234,100,,187.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,191.88,82,,153.504,percent of total billed charges,82% of total billed charges,198.9,85,,159.12,percent of total billed charges,85% of total billed charges,198.9,85,,159.12,percent of total billed charges,85% of total billed charges,198.9,85,,159.12,percent of total billed charges,85% of total billed charges,210.6,90,,168.48,percent of total billed charges,90% of total billed charges,187.2,80,,149.76,percent of total billed charges,80% of total billed charges,210.6,90,,168.48,percent of total billed charges,90% of total billed charges,175.5,75,,140.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,67.86,29,,54.288,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,156.78,67,,125.424,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,163.8,70,,131.04,percent of total billed charges,70% of total billed charges,152.1,65,,121.68,percent of total billed charges,65% of total billed charges,83.47,35.67,,66.776,percent of total billed charges,35.67% of total billed charges,67.86,234,
K WIRE,27014436,CDM,278,RC,C1713,HCPCS,outpatient,,,179,71.60,,125.3,70,,100.24,percent of total billed charges,70% of total billed charges,179,100,,143.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,146.78,82,,117.424,percent of total billed charges,82% of total billed charges,152.15,85,,121.72,percent of total billed charges,85% of total billed charges,152.15,85,,121.72,percent of total billed charges,85% of total billed charges,152.15,85,,121.72,percent of total billed charges,85% of total billed charges,161.1,90,,128.88,percent of total billed charges,90% of total billed charges,143.2,80,,114.56,percent of total billed charges,80% of total billed charges,161.1,90,,128.88,percent of total billed charges,90% of total billed charges,134.25,75,,107.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,51.91,29,,41.528,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,119.93,67,,95.944,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,125.3,70,,100.24,percent of total billed charges,70% of total billed charges,116.35,65,,93.08,percent of total billed charges,65% of total billed charges,63.85,35.67,,51.08,percent of total billed charges,35.67% of total billed charges,51.91,179,
MTP FUSION REAMER,27014437,CDM,278,RC,,,outpatient,,,1491,596.40,,1043.7,70,,834.96,percent of total billed charges,70% of total billed charges,782.78,52.5,,626.22,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,1222.62,82,,978.096,percent of total billed charges,82% of total billed charges,1267.35,85,,1013.88,percent of total billed charges,85% of total billed charges,1267.35,85,,1013.88,percent of total billed charges,85% of total billed charges,1267.35,85,,1013.88,percent of total billed charges,85% of total billed charges,1341.9,90,,1073.52,percent of total billed charges,90% of total billed charges,1192.8,80,,954.24,percent of total billed charges,80% of total billed charges,1341.9,90,,1073.52,percent of total billed charges,90% of total billed charges,1118.25,75,,894.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,432.39,29,,345.912,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,998.97,67,,799.176,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1043.7,70,,834.96,percent of total billed charges,70% of total billed charges,969.15,65,,775.32,percent of total billed charges,65% of total billed charges,531.84,35.67,,425.472,percent of total billed charges,35.67% of total billed charges,432.39,1341.9,
SCREW 2.0 X 10 MM,27014486,CDM,278,RC,C1713,HCPCS,outpatient,,,524,209.60,,366.8,70,,293.44,percent of total billed charges,70% of total billed charges,524,100,,419.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,429.68,82,,343.744,percent of total billed charges,82% of total billed charges,445.4,85,,356.32,percent of total billed charges,85% of total billed charges,445.4,85,,356.32,percent of total billed charges,85% of total billed charges,445.4,85,,356.32,percent of total billed charges,85% of total billed charges,471.6,90,,377.28,percent of total billed charges,90% of total billed charges,419.2,80,,335.36,percent of total billed charges,80% of total billed charges,471.6,90,,377.28,percent of total billed charges,90% of total billed charges,393,75,,314.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,151.96,29,,121.568,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,351.08,67,,280.864,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,366.8,70,,293.44,percent of total billed charges,70% of total billed charges,340.6,65,,272.48,percent of total billed charges,65% of total billed charges,186.91,35.67,,149.528,percent of total billed charges,35.67% of total billed charges,151.96,524,
SCREW 2.0 X 18 MM,27014488,CDM,278,RC,C1713,HCPCS,outpatient,,,524,209.60,,366.8,70,,293.44,percent of total billed charges,70% of total billed charges,524,100,,419.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,429.68,82,,343.744,percent of total billed charges,82% of total billed charges,445.4,85,,356.32,percent of total billed charges,85% of total billed charges,445.4,85,,356.32,percent of total billed charges,85% of total billed charges,445.4,85,,356.32,percent of total billed charges,85% of total billed charges,471.6,90,,377.28,percent of total billed charges,90% of total billed charges,419.2,80,,335.36,percent of total billed charges,80% of total billed charges,471.6,90,,377.28,percent of total billed charges,90% of total billed charges,393,75,,314.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,151.96,29,,121.568,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,351.08,67,,280.864,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,366.8,70,,293.44,percent of total billed charges,70% of total billed charges,340.6,65,,272.48,percent of total billed charges,65% of total billed charges,186.91,35.67,,149.528,percent of total billed charges,35.67% of total billed charges,151.96,524,
HEADED SCREW WITH REAMER,27014491,CDM,278,RC,C1713,HCPCS,outpatient,,,1672,668.80,,1170.4,70,,936.32,percent of total billed charges,70% of total billed charges,877.8,52.5,,702.24,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,1371.04,82,,1096.832,percent of total billed charges,82% of total billed charges,1421.2,85,,1136.96,percent of total billed charges,85% of total billed charges,1421.2,85,,1136.96,percent of total billed charges,85% of total billed charges,1421.2,85,,1136.96,percent of total billed charges,85% of total billed charges,1504.8,90,,1203.84,percent of total billed charges,90% of total billed charges,1337.6,80,,1070.08,percent of total billed charges,80% of total billed charges,1504.8,90,,1203.84,percent of total billed charges,90% of total billed charges,1254,75,,1003.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,484.88,29,,387.904,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1120.24,67,,896.192,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1170.4,70,,936.32,percent of total billed charges,70% of total billed charges,1086.8,65,,869.44,percent of total billed charges,65% of total billed charges,596.4,35.67,,477.12,percent of total billed charges,35.67% of total billed charges,484.88,1504.8,
SCREW 4.0,27014492,CDM,278,RC,C1713,HCPCS,outpatient,,,1672,668.80,,1170.4,70,,936.32,percent of total billed charges,70% of total billed charges,877.8,52.5,,702.24,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,1371.04,82,,1096.832,percent of total billed charges,82% of total billed charges,1421.2,85,,1136.96,percent of total billed charges,85% of total billed charges,1421.2,85,,1136.96,percent of total billed charges,85% of total billed charges,1421.2,85,,1136.96,percent of total billed charges,85% of total billed charges,1504.8,90,,1203.84,percent of total billed charges,90% of total billed charges,1337.6,80,,1070.08,percent of total billed charges,80% of total billed charges,1504.8,90,,1203.84,percent of total billed charges,90% of total billed charges,1254,75,,1003.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,484.88,29,,387.904,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1120.24,67,,896.192,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1170.4,70,,936.32,percent of total billed charges,70% of total billed charges,1086.8,65,,869.44,percent of total billed charges,65% of total billed charges,596.4,35.67,,477.12,percent of total billed charges,35.67% of total billed charges,484.88,1504.8,
SCREW LOCKING,27014493,CDM,278,RC,C1713,HCPCS,outpatient,,,800,320.00,,560,70,,448,percent of total billed charges,70% of total billed charges,800,100,,640,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,656,82,,524.8,percent of total billed charges,82% of total billed charges,680,85,,544,percent of total billed charges,85% of total billed charges,680,85,,544,percent of total billed charges,85% of total billed charges,680,85,,544,percent of total billed charges,85% of total billed charges,720,90,,576,percent of total billed charges,90% of total billed charges,640,80,,512,percent of total billed charges,80% of total billed charges,720,90,,576,percent of total billed charges,90% of total billed charges,600,75,,480,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,232,29,,185.6,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,536,67,,428.8,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,560,70,,448,percent of total billed charges,70% of total billed charges,520,65,,416,percent of total billed charges,65% of total billed charges,285.36,35.67,,228.288,percent of total billed charges,35.67% of total billed charges,232,800,
SCREW NONLOCKING,27014494,CDM,278,RC,C1713,HCPCS,outpatient,,,800,320.00,,560,70,,448,percent of total billed charges,70% of total billed charges,800,100,,640,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,656,82,,524.8,percent of total billed charges,82% of total billed charges,680,85,,544,percent of total billed charges,85% of total billed charges,680,85,,544,percent of total billed charges,85% of total billed charges,680,85,,544,percent of total billed charges,85% of total billed charges,720,90,,576,percent of total billed charges,90% of total billed charges,640,80,,512,percent of total billed charges,80% of total billed charges,720,90,,576,percent of total billed charges,90% of total billed charges,600,75,,480,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,232,29,,185.6,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,536,67,,428.8,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,560,70,,448,percent of total billed charges,70% of total billed charges,520,65,,416,percent of total billed charges,65% of total billed charges,285.36,35.67,,228.288,percent of total billed charges,35.67% of total billed charges,232,800,
SCREW LOCKING,27014495,CDM,278,RC,C1713,HCPCS,outpatient,,,1255,502.00,,878.5,70,,702.8,percent of total billed charges,70% of total billed charges,658.88,52.5,,527.1,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,1029.1,82,,823.28,percent of total billed charges,82% of total billed charges,1066.75,85,,853.4,percent of total billed charges,85% of total billed charges,1066.75,85,,853.4,percent of total billed charges,85% of total billed charges,1066.75,85,,853.4,percent of total billed charges,85% of total billed charges,1129.5,90,,903.6,percent of total billed charges,90% of total billed charges,1004,80,,803.2,percent of total billed charges,80% of total billed charges,1129.5,90,,903.6,percent of total billed charges,90% of total billed charges,941.25,75,,753,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,363.95,29,,291.16,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,840.85,67,,672.68,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,878.5,70,,702.8,percent of total billed charges,70% of total billed charges,815.75,65,,652.6,percent of total billed charges,65% of total billed charges,447.66,35.67,,358.128,percent of total billed charges,35.67% of total billed charges,363.95,1129.5,
SCREW LOCKING,27014496,CDM,278,RC,C1713,HCPCS,outpatient,,,1255,502.00,,878.5,70,,702.8,percent of total billed charges,70% of total billed charges,658.88,52.5,,527.1,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,1029.1,82,,823.28,percent of total billed charges,82% of total billed charges,1066.75,85,,853.4,percent of total billed charges,85% of total billed charges,1066.75,85,,853.4,percent of total billed charges,85% of total billed charges,1066.75,85,,853.4,percent of total billed charges,85% of total billed charges,1129.5,90,,903.6,percent of total billed charges,90% of total billed charges,1004,80,,803.2,percent of total billed charges,80% of total billed charges,1129.5,90,,903.6,percent of total billed charges,90% of total billed charges,941.25,75,,753,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,363.95,29,,291.16,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,840.85,67,,672.68,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,878.5,70,,702.8,percent of total billed charges,70% of total billed charges,815.75,65,,652.6,percent of total billed charges,65% of total billed charges,447.66,35.67,,358.128,percent of total billed charges,35.67% of total billed charges,363.95,1129.5,
PLATE RIGHT 5 DEGREE,27014497,CDM,278,RC,C1713,HCPCS,outpatient,,,5745,2298.00,,4021.5,70,,3217.2,percent of total billed charges,70% of total billed charges,3016.13,52.5,,2412.9,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,4710.9,82,,3768.72,percent of total billed charges,82% of total billed charges,4883.25,85,,3906.6,percent of total billed charges,85% of total billed charges,4883.25,85,,3906.6,percent of total billed charges,85% of total billed charges,4883.25,85,,3906.6,percent of total billed charges,85% of total billed charges,5170.5,90,,4136.4,percent of total billed charges,90% of total billed charges,4596,80,,3676.8,percent of total billed charges,80% of total billed charges,5170.5,90,,4136.4,percent of total billed charges,90% of total billed charges,4308.75,75,,3447,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,1666.05,29,,1332.84,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,3849.15,67,,3079.32,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,4021.5,70,,3217.2,percent of total billed charges,70% of total billed charges,3734.25,65,,2987.4,percent of total billed charges,65% of total billed charges,2049.24,35.67,,1639.392,percent of total billed charges,35.67% of total billed charges,1666.05,5170.5,
LOCKING SCREW,27014499,CDM,278,RC,C1713,HCPCS,outpatient,,,879,351.60,,615.3,70,,492.24,percent of total billed charges,70% of total billed charges,879,100,,703.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,720.78,82,,576.624,percent of total billed charges,82% of total billed charges,747.15,85,,597.72,percent of total billed charges,85% of total billed charges,747.15,85,,597.72,percent of total billed charges,85% of total billed charges,747.15,85,,597.72,percent of total billed charges,85% of total billed charges,791.1,90,,632.88,percent of total billed charges,90% of total billed charges,703.2,80,,562.56,percent of total billed charges,80% of total billed charges,791.1,90,,632.88,percent of total billed charges,90% of total billed charges,659.25,75,,527.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,254.91,29,,203.928,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,588.93,67,,471.144,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,615.3,70,,492.24,percent of total billed charges,70% of total billed charges,571.35,65,,457.08,percent of total billed charges,65% of total billed charges,313.54,35.67,,250.832,percent of total billed charges,35.67% of total billed charges,254.91,879,
STRATOGEN FLOW 10 CC,27014501,CDM,278,RC,Q4162,HCPCS,outpatient,,,11188,4475.20,,7831.6,70,,6265.28,percent of total billed charges,70% of total billed charges,5873.7,52.5,,4698.96,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,9174.16,82,,7339.328,percent of total billed charges,82% of total billed charges,9509.8,85,,7607.84,percent of total billed charges,85% of total billed charges,9509.8,85,,7607.84,percent of total billed charges,85% of total billed charges,9509.8,85,,7607.84,percent of total billed charges,85% of total billed charges,10069.2,90,,8055.36,percent of total billed charges,90% of total billed charges,8950.4,80,,7160.32,percent of total billed charges,80% of total billed charges,10069.2,90,,8055.36,percent of total billed charges,90% of total billed charges,8391,75,,6712.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,3244.52,29,,2595.616,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,7495.96,67,,5996.768,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,7831.6,70,,6265.28,percent of total billed charges,70% of total billed charges,7272.2,65,,5817.76,percent of total billed charges,65% of total billed charges,3990.76,35.67,,3192.608,percent of total billed charges,35.67% of total billed charges,3244.52,10069.2,
STROFUSE DBM 10 CC,27014502,CDM,278,RC,C1762,HCPCS,outpatient,,,3089,1235.60,,2162.3,70,,1729.84,percent of total billed charges,70% of total billed charges,1621.73,52.5,,1297.38,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,2532.98,82,,2026.384,percent of total billed charges,82% of total billed charges,2625.65,85,,2100.52,percent of total billed charges,85% of total billed charges,2625.65,85,,2100.52,percent of total billed charges,85% of total billed charges,2625.65,85,,2100.52,percent of total billed charges,85% of total billed charges,2780.1,90,,2224.08,percent of total billed charges,90% of total billed charges,2471.2,80,,1976.96,percent of total billed charges,80% of total billed charges,2780.1,90,,2224.08,percent of total billed charges,90% of total billed charges,2316.75,75,,1853.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,895.81,29,,716.648,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,2069.63,67,,1655.704,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,2162.3,70,,1729.84,percent of total billed charges,70% of total billed charges,2007.85,65,,1606.28,percent of total billed charges,65% of total billed charges,1101.85,35.67,,881.48,percent of total billed charges,35.67% of total billed charges,895.81,2780.1,
CORTICAL FIBERS,27014503,CDM,278,RC,C1713,HCPCS,outpatient,,,2924,1169.60,,2046.8,70,,1637.44,percent of total billed charges,70% of total billed charges,1535.1,52.5,,1228.08,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,2397.68,82,,1918.144,percent of total billed charges,82% of total billed charges,2485.4,85,,1988.32,percent of total billed charges,85% of total billed charges,2485.4,85,,1988.32,percent of total billed charges,85% of total billed charges,2485.4,85,,1988.32,percent of total billed charges,85% of total billed charges,2631.6,90,,2105.28,percent of total billed charges,90% of total billed charges,2339.2,80,,1871.36,percent of total billed charges,80% of total billed charges,2631.6,90,,2105.28,percent of total billed charges,90% of total billed charges,2193,75,,1754.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,847.96,29,,678.368,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1959.08,67,,1567.264,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,2046.8,70,,1637.44,percent of total billed charges,70% of total billed charges,1900.6,65,,1520.48,percent of total billed charges,65% of total billed charges,1042.99,35.67,,834.392,percent of total billed charges,35.67% of total billed charges,847.96,2631.6,
STRATOFUSE SPONGE 20 X 20,27014504,CDM,278,RC,C1762,HCPCS,outpatient,,,4844,1937.60,,3390.8,70,,2712.64,percent of total billed charges,70% of total billed charges,2543.1,52.5,,2034.48,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,3972.08,82,,3177.664,percent of total billed charges,82% of total billed charges,4117.4,85,,3293.92,percent of total billed charges,85% of total billed charges,4117.4,85,,3293.92,percent of total billed charges,85% of total billed charges,4117.4,85,,3293.92,percent of total billed charges,85% of total billed charges,4359.6,90,,3487.68,percent of total billed charges,90% of total billed charges,3875.2,80,,3100.16,percent of total billed charges,80% of total billed charges,4359.6,90,,3487.68,percent of total billed charges,90% of total billed charges,3633,75,,2906.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,1404.76,29,,1123.808,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,3245.48,67,,2596.384,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,3390.8,70,,2712.64,percent of total billed charges,70% of total billed charges,3148.6,65,,2518.88,percent of total billed charges,65% of total billed charges,1727.85,35.67,,1382.28,percent of total billed charges,35.67% of total billed charges,1404.76,4359.6,
SCREW 7.5 X 50,27014505,CDM,278,RC,C1713,HCPCS,outpatient,,,2147,858.80,,1502.9,70,,1202.32,percent of total billed charges,70% of total billed charges,1127.18,52.5,,901.74,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,1760.54,82,,1408.432,percent of total billed charges,82% of total billed charges,1824.95,85,,1459.96,percent of total billed charges,85% of total billed charges,1824.95,85,,1459.96,percent of total billed charges,85% of total billed charges,1824.95,85,,1459.96,percent of total billed charges,85% of total billed charges,1932.3,90,,1545.84,percent of total billed charges,90% of total billed charges,1717.6,80,,1374.08,percent of total billed charges,80% of total billed charges,1932.3,90,,1545.84,percent of total billed charges,90% of total billed charges,1610.25,75,,1288.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,622.63,29,,498.104,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1438.49,67,,1150.792,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1502.9,70,,1202.32,percent of total billed charges,70% of total billed charges,1395.55,65,,1116.44,percent of total billed charges,65% of total billed charges,765.83,35.67,,612.664,percent of total billed charges,35.67% of total billed charges,622.63,1932.3,
LUMBAR IMPLANT INTERBODY,27014506,CDM,278,RC,C1821,HCPCS,outpatient,,,4697,1878.80,,3287.9,70,,2630.32,percent of total billed charges,70% of total billed charges,2465.93,52.5,,1972.74,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,3851.54,82,,3081.232,percent of total billed charges,82% of total billed charges,3992.45,85,,3193.96,percent of total billed charges,85% of total billed charges,3992.45,85,,3193.96,percent of total billed charges,85% of total billed charges,3992.45,85,,3193.96,percent of total billed charges,85% of total billed charges,4227.3,90,,3381.84,percent of total billed charges,90% of total billed charges,3757.6,80,,3006.08,percent of total billed charges,80% of total billed charges,4227.3,90,,3381.84,percent of total billed charges,90% of total billed charges,3522.75,75,,2818.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,1362.13,29,,1089.704,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,3146.99,67,,2517.592,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,3287.9,70,,2630.32,percent of total billed charges,70% of total billed charges,3053.05,65,,2442.44,percent of total billed charges,65% of total billed charges,1675.42,35.67,,1340.336,percent of total billed charges,35.67% of total billed charges,1362.13,4227.3,
INTERBODY IMPLANT LUMBAR,27014508,CDM,278,RC,C1821,HCPCS,outpatient,,,9392,3756.80,,6574.4,70,,5259.52,percent of total billed charges,70% of total billed charges,4930.8,52.5,,3944.64,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,7701.44,82,,6161.152,percent of total billed charges,82% of total billed charges,7983.2,85,,6386.56,percent of total billed charges,85% of total billed charges,7983.2,85,,6386.56,percent of total billed charges,85% of total billed charges,7983.2,85,,6386.56,percent of total billed charges,85% of total billed charges,8452.8,90,,6762.24,percent of total billed charges,90% of total billed charges,7513.6,80,,6010.88,percent of total billed charges,80% of total billed charges,8452.8,90,,6762.24,percent of total billed charges,90% of total billed charges,7044,75,,5635.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2723.68,29,,2178.944,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,6292.64,67,,5034.112,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,6574.4,70,,5259.52,percent of total billed charges,70% of total billed charges,6104.8,65,,4883.84,percent of total billed charges,65% of total billed charges,3350.13,35.67,,2680.104,percent of total billed charges,35.67% of total billed charges,2723.68,8452.8,
RODS,27014509,CDM,278,RC,C1713,HCPCS,outpatient,,,472,188.80,,330.4,70,,264.32,percent of total billed charges,70% of total billed charges,472,100,,377.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,387.04,82,,309.632,percent of total billed charges,82% of total billed charges,401.2,85,,320.96,percent of total billed charges,85% of total billed charges,401.2,85,,320.96,percent of total billed charges,85% of total billed charges,401.2,85,,320.96,percent of total billed charges,85% of total billed charges,424.8,90,,339.84,percent of total billed charges,90% of total billed charges,377.6,80,,302.08,percent of total billed charges,80% of total billed charges,424.8,90,,339.84,percent of total billed charges,90% of total billed charges,354,75,,283.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,136.88,29,,109.504,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,316.24,67,,252.992,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,330.4,70,,264.32,percent of total billed charges,70% of total billed charges,306.8,65,,245.44,percent of total billed charges,65% of total billed charges,168.36,35.67,,134.688,percent of total billed charges,35.67% of total billed charges,136.88,472,
PLATE 14 MM,27014582,CDM,278,RC,C1713,HCPCS,outpatient,,,2976,1190.40,,2083.2,70,,1666.56,percent of total billed charges,70% of total billed charges,1562.4,52.5,,1249.92,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,2440.32,82,,1952.256,percent of total billed charges,82% of total billed charges,2529.6,85,,2023.68,percent of total billed charges,85% of total billed charges,2529.6,85,,2023.68,percent of total billed charges,85% of total billed charges,2529.6,85,,2023.68,percent of total billed charges,85% of total billed charges,2678.4,90,,2142.72,percent of total billed charges,90% of total billed charges,2380.8,80,,1904.64,percent of total billed charges,80% of total billed charges,2678.4,90,,2142.72,percent of total billed charges,90% of total billed charges,2232,75,,1785.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,863.04,29,,690.432,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1993.92,67,,1595.136,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,2083.2,70,,1666.56,percent of total billed charges,70% of total billed charges,1934.4,65,,1547.52,percent of total billed charges,65% of total billed charges,1061.54,35.67,,849.232,percent of total billed charges,35.67% of total billed charges,863.04,2678.4,
CORTICAL FIBERS,27014618,CDM,278,RC,C1713,HCPCS,outpatient,,,6679,2671.60,,4675.3,70,,3740.24,percent of total billed charges,70% of total billed charges,3506.48,52.5,,2805.18,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,5476.78,82,,4381.424,percent of total billed charges,82% of total billed charges,5677.15,85,,4541.72,percent of total billed charges,85% of total billed charges,5677.15,85,,4541.72,percent of total billed charges,85% of total billed charges,5677.15,85,,4541.72,percent of total billed charges,85% of total billed charges,6011.1,90,,4808.88,percent of total billed charges,90% of total billed charges,5343.2,80,,4274.56,percent of total billed charges,80% of total billed charges,6011.1,90,,4808.88,percent of total billed charges,90% of total billed charges,5009.25,75,,4007.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,1936.91,29,,1549.528,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4474.93,67,,3579.944,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,4675.3,70,,3740.24,percent of total billed charges,70% of total billed charges,4341.35,65,,3473.08,percent of total billed charges,65% of total billed charges,2382.4,35.67,,1905.92,percent of total billed charges,35.67% of total billed charges,1936.91,6011.1,
LOCKING SCREW,27014629,CDM,278,RC,C1713,HCPCS,outpatient,,,1255,502.00,,878.5,70,,702.8,percent of total billed charges,70% of total billed charges,658.88,52.5,,527.1,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,1029.1,82,,823.28,percent of total billed charges,82% of total billed charges,1066.75,85,,853.4,percent of total billed charges,85% of total billed charges,1066.75,85,,853.4,percent of total billed charges,85% of total billed charges,1066.75,85,,853.4,percent of total billed charges,85% of total billed charges,1129.5,90,,903.6,percent of total billed charges,90% of total billed charges,1004,80,,803.2,percent of total billed charges,80% of total billed charges,1129.5,90,,903.6,percent of total billed charges,90% of total billed charges,941.25,75,,753,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,363.95,29,,291.16,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,840.85,67,,672.68,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,878.5,70,,702.8,percent of total billed charges,70% of total billed charges,815.75,65,,652.6,percent of total billed charges,65% of total billed charges,447.66,35.67,,358.128,percent of total billed charges,35.67% of total billed charges,363.95,1129.5,
LOCKING SCREW,27014630,CDM,278,RC,C1713,HCPCS,outpatient,,,1255,502.00,,878.5,70,,702.8,percent of total billed charges,70% of total billed charges,658.88,52.5,,527.1,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,1029.1,82,,823.28,percent of total billed charges,82% of total billed charges,1066.75,85,,853.4,percent of total billed charges,85% of total billed charges,1066.75,85,,853.4,percent of total billed charges,85% of total billed charges,1066.75,85,,853.4,percent of total billed charges,85% of total billed charges,1129.5,90,,903.6,percent of total billed charges,90% of total billed charges,1004,80,,803.2,percent of total billed charges,80% of total billed charges,1129.5,90,,903.6,percent of total billed charges,90% of total billed charges,941.25,75,,753,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,363.95,29,,291.16,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,840.85,67,,672.68,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,878.5,70,,702.8,percent of total billed charges,70% of total billed charges,815.75,65,,652.6,percent of total billed charges,65% of total billed charges,447.66,35.67,,358.128,percent of total billed charges,35.67% of total billed charges,363.95,1129.5,
CANNULATED SCREW HEADED,27014632,CDM,278,RC,C1713,HCPCS,outpatient,,,1255,502.00,,878.5,70,,702.8,percent of total billed charges,70% of total billed charges,658.88,52.5,,527.1,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,1029.1,82,,823.28,percent of total billed charges,82% of total billed charges,1066.75,85,,853.4,percent of total billed charges,85% of total billed charges,1066.75,85,,853.4,percent of total billed charges,85% of total billed charges,1066.75,85,,853.4,percent of total billed charges,85% of total billed charges,1129.5,90,,903.6,percent of total billed charges,90% of total billed charges,1004,80,,803.2,percent of total billed charges,80% of total billed charges,1129.5,90,,903.6,percent of total billed charges,90% of total billed charges,941.25,75,,753,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,363.95,29,,291.16,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,840.85,67,,672.68,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,878.5,70,,702.8,percent of total billed charges,70% of total billed charges,815.75,65,,652.6,percent of total billed charges,65% of total billed charges,447.66,35.67,,358.128,percent of total billed charges,35.67% of total billed charges,363.95,1129.5,
NON THREADED GUIDEWIRE,27014633,CDM,278,RC,C1713,HCPCS,outpatient,,,179,71.60,,125.3,70,,100.24,percent of total billed charges,70% of total billed charges,179,100,,143.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,146.78,82,,117.424,percent of total billed charges,82% of total billed charges,152.15,85,,121.72,percent of total billed charges,85% of total billed charges,152.15,85,,121.72,percent of total billed charges,85% of total billed charges,152.15,85,,121.72,percent of total billed charges,85% of total billed charges,161.1,90,,128.88,percent of total billed charges,90% of total billed charges,143.2,80,,114.56,percent of total billed charges,80% of total billed charges,161.1,90,,128.88,percent of total billed charges,90% of total billed charges,134.25,75,,107.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,51.91,29,,41.528,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,119.93,67,,95.944,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,125.3,70,,100.24,percent of total billed charges,70% of total billed charges,116.35,65,,93.08,percent of total billed charges,65% of total billed charges,63.85,35.67,,51.08,percent of total billed charges,35.67% of total billed charges,51.91,179,
PLATE,27014648,CDM,278,RC,C1713,HCPCS,outpatient,,,785,314.00,,549.5,70,,439.6,percent of total billed charges,70% of total billed charges,785,100,,628,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,643.7,82,,514.96,percent of total billed charges,82% of total billed charges,667.25,85,,533.8,percent of total billed charges,85% of total billed charges,667.25,85,,533.8,percent of total billed charges,85% of total billed charges,667.25,85,,533.8,percent of total billed charges,85% of total billed charges,706.5,90,,565.2,percent of total billed charges,90% of total billed charges,628,80,,502.4,percent of total billed charges,80% of total billed charges,706.5,90,,565.2,percent of total billed charges,90% of total billed charges,588.75,75,,471,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,227.65,29,,182.12,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,525.95,67,,420.76,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,549.5,70,,439.6,percent of total billed charges,70% of total billed charges,510.25,65,,408.2,percent of total billed charges,65% of total billed charges,280.01,35.67,,224.008,percent of total billed charges,35.67% of total billed charges,227.65,785,
SCREW 4.0,27014649,CDM,278,RC,C1713,HCPCS,outpatient,,,1255,502.00,,878.5,70,,702.8,percent of total billed charges,70% of total billed charges,658.88,52.5,,527.1,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,1029.1,82,,823.28,percent of total billed charges,82% of total billed charges,1066.75,85,,853.4,percent of total billed charges,85% of total billed charges,1066.75,85,,853.4,percent of total billed charges,85% of total billed charges,1066.75,85,,853.4,percent of total billed charges,85% of total billed charges,1129.5,90,,903.6,percent of total billed charges,90% of total billed charges,1004,80,,803.2,percent of total billed charges,80% of total billed charges,1129.5,90,,903.6,percent of total billed charges,90% of total billed charges,941.25,75,,753,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,363.95,29,,291.16,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,840.85,67,,672.68,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,878.5,70,,702.8,percent of total billed charges,70% of total billed charges,815.75,65,,652.6,percent of total billed charges,65% of total billed charges,447.66,35.67,,358.128,percent of total billed charges,35.67% of total billed charges,363.95,1129.5,
SCREW CANNULATED HEAD,27014650,CDM,278,RC,C1713,HCPCS,outpatient,,,1255,502.00,,878.5,70,,702.8,percent of total billed charges,70% of total billed charges,658.88,52.5,,527.1,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,1029.1,82,,823.28,percent of total billed charges,82% of total billed charges,1066.75,85,,853.4,percent of total billed charges,85% of total billed charges,1066.75,85,,853.4,percent of total billed charges,85% of total billed charges,1066.75,85,,853.4,percent of total billed charges,85% of total billed charges,1129.5,90,,903.6,percent of total billed charges,90% of total billed charges,1004,80,,803.2,percent of total billed charges,80% of total billed charges,1129.5,90,,903.6,percent of total billed charges,90% of total billed charges,941.25,75,,753,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,363.95,29,,291.16,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,840.85,67,,672.68,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,878.5,70,,702.8,percent of total billed charges,70% of total billed charges,815.75,65,,652.6,percent of total billed charges,65% of total billed charges,447.66,35.67,,358.128,percent of total billed charges,35.67% of total billed charges,363.95,1129.5,
CERVICAL CAGE 17 MM X 9 MM,27014670,CDM,278,RC,C1821,HCPCS,outpatient,,,9392,3756.80,,6574.4,70,,5259.52,percent of total billed charges,70% of total billed charges,4930.8,52.5,,3944.64,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,7701.44,82,,6161.152,percent of total billed charges,82% of total billed charges,7983.2,85,,6386.56,percent of total billed charges,85% of total billed charges,7983.2,85,,6386.56,percent of total billed charges,85% of total billed charges,7983.2,85,,6386.56,percent of total billed charges,85% of total billed charges,8452.8,90,,6762.24,percent of total billed charges,90% of total billed charges,7513.6,80,,6010.88,percent of total billed charges,80% of total billed charges,8452.8,90,,6762.24,percent of total billed charges,90% of total billed charges,7044,75,,5635.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2723.68,29,,2178.944,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,6292.64,67,,5034.112,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,6574.4,70,,5259.52,percent of total billed charges,70% of total billed charges,6104.8,65,,4883.84,percent of total billed charges,65% of total billed charges,3350.13,35.67,,2680.104,percent of total billed charges,35.67% of total billed charges,2723.68,8452.8,
CERVICAL CAGE 17 MM X 9MM X50,27014671,CDM,278,RC,C1821,HCPCS,outpatient,,,9392,3756.80,,6574.4,70,,5259.52,percent of total billed charges,70% of total billed charges,4930.8,52.5,,3944.64,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,7701.44,82,,6161.152,percent of total billed charges,82% of total billed charges,7983.2,85,,6386.56,percent of total billed charges,85% of total billed charges,7983.2,85,,6386.56,percent of total billed charges,85% of total billed charges,7983.2,85,,6386.56,percent of total billed charges,85% of total billed charges,8452.8,90,,6762.24,percent of total billed charges,90% of total billed charges,7513.6,80,,6010.88,percent of total billed charges,80% of total billed charges,8452.8,90,,6762.24,percent of total billed charges,90% of total billed charges,7044,75,,5635.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2723.68,29,,2178.944,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,6292.64,67,,5034.112,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,6574.4,70,,5259.52,percent of total billed charges,70% of total billed charges,6104.8,65,,4883.84,percent of total billed charges,65% of total billed charges,3350.13,35.67,,2680.104,percent of total billed charges,35.67% of total billed charges,2723.68,8452.8,
CORTICAL FIBERS OSTEOVIVE,27014672,CDM,278,RC,C1713,HCPCS,outpatient,,,12053,4821.20,,8437.1,70,,6749.68,percent of total billed charges,70% of total billed charges,6327.83,52.5,,5062.26,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,9883.46,82,,7906.768,percent of total billed charges,82% of total billed charges,10245.05,85,,8196.04,percent of total billed charges,85% of total billed charges,10245.05,85,,8196.04,percent of total billed charges,85% of total billed charges,10245.05,85,,8196.04,percent of total billed charges,85% of total billed charges,10847.7,90,,8678.16,percent of total billed charges,90% of total billed charges,9642.4,80,,7713.92,percent of total billed charges,80% of total billed charges,10847.7,90,,8678.16,percent of total billed charges,90% of total billed charges,9039.75,75,,7231.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,3495.37,29,,2796.296,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,8075.51,67,,6460.408,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,8437.1,70,,6749.68,percent of total billed charges,70% of total billed charges,7834.45,65,,6267.56,percent of total billed charges,65% of total billed charges,4299.31,35.67,,3439.448,percent of total billed charges,35.67% of total billed charges,3495.37,10847.7,
CORTICAL FIBERS OSTEOVIVE,27014673,CDM,278,RC,C1713,HCPCS,outpatient,,,12053,4821.20,,8437.1,70,,6749.68,percent of total billed charges,70% of total billed charges,6327.83,52.5,,5062.26,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,9883.46,82,,7906.768,percent of total billed charges,82% of total billed charges,10245.05,85,,8196.04,percent of total billed charges,85% of total billed charges,10245.05,85,,8196.04,percent of total billed charges,85% of total billed charges,10245.05,85,,8196.04,percent of total billed charges,85% of total billed charges,10847.7,90,,8678.16,percent of total billed charges,90% of total billed charges,9642.4,80,,7713.92,percent of total billed charges,80% of total billed charges,10847.7,90,,8678.16,percent of total billed charges,90% of total billed charges,9039.75,75,,7231.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,3495.37,29,,2796.296,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,8075.51,67,,6460.408,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,8437.1,70,,6749.68,percent of total billed charges,70% of total billed charges,7834.45,65,,6267.56,percent of total billed charges,65% of total billed charges,4299.31,35.67,,3439.448,percent of total billed charges,35.67% of total billed charges,3495.37,10847.7,
CORTICAL FIBERS OSTEOVIVE,27014674,CDM,278,RC,C1713,HCPCS,outpatient,,,12053,4821.20,,8437.1,70,,6749.68,percent of total billed charges,70% of total billed charges,6327.83,52.5,,5062.26,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,9883.46,82,,7906.768,percent of total billed charges,82% of total billed charges,10245.05,85,,8196.04,percent of total billed charges,85% of total billed charges,10245.05,85,,8196.04,percent of total billed charges,85% of total billed charges,10245.05,85,,8196.04,percent of total billed charges,85% of total billed charges,10847.7,90,,8678.16,percent of total billed charges,90% of total billed charges,9642.4,80,,7713.92,percent of total billed charges,80% of total billed charges,10847.7,90,,8678.16,percent of total billed charges,90% of total billed charges,9039.75,75,,7231.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,3495.37,29,,2796.296,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,8075.51,67,,6460.408,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,8437.1,70,,6749.68,percent of total billed charges,70% of total billed charges,7834.45,65,,6267.56,percent of total billed charges,65% of total billed charges,4299.31,35.67,,3439.448,percent of total billed charges,35.67% of total billed charges,3495.37,10847.7,
CORTICAL FIBERS OSTEOVIVE,27014675,CDM,278,RC,C1713,HCPCS,outpatient,,,12053,4821.20,,8437.1,70,,6749.68,percent of total billed charges,70% of total billed charges,6327.83,52.5,,5062.26,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,9883.46,82,,7906.768,percent of total billed charges,82% of total billed charges,10245.05,85,,8196.04,percent of total billed charges,85% of total billed charges,10245.05,85,,8196.04,percent of total billed charges,85% of total billed charges,10245.05,85,,8196.04,percent of total billed charges,85% of total billed charges,10847.7,90,,8678.16,percent of total billed charges,90% of total billed charges,9642.4,80,,7713.92,percent of total billed charges,80% of total billed charges,10847.7,90,,8678.16,percent of total billed charges,90% of total billed charges,9039.75,75,,7231.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,3495.37,29,,2796.296,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,8075.51,67,,6460.408,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,8437.1,70,,6749.68,percent of total billed charges,70% of total billed charges,7834.45,65,,6267.56,percent of total billed charges,65% of total billed charges,4299.31,35.67,,3439.448,percent of total billed charges,35.67% of total billed charges,3495.37,10847.7,
CORTICAL FIBERS DEMIN,27014676,CDM,278,RC,C1713,HCPCS,outpatient,,,3289,1315.60,,2302.3,70,,1841.84,percent of total billed charges,70% of total billed charges,1726.73,52.5,,1381.38,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,2696.98,82,,2157.584,percent of total billed charges,82% of total billed charges,2795.65,85,,2236.52,percent of total billed charges,85% of total billed charges,2795.65,85,,2236.52,percent of total billed charges,85% of total billed charges,2795.65,85,,2236.52,percent of total billed charges,85% of total billed charges,2960.1,90,,2368.08,percent of total billed charges,90% of total billed charges,2631.2,80,,2104.96,percent of total billed charges,80% of total billed charges,2960.1,90,,2368.08,percent of total billed charges,90% of total billed charges,2466.75,75,,1973.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,953.81,29,,763.048,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,2203.63,67,,1762.904,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,2302.3,70,,1841.84,percent of total billed charges,70% of total billed charges,2137.85,65,,1710.28,percent of total billed charges,65% of total billed charges,1173.19,35.67,,938.552,percent of total billed charges,35.67% of total billed charges,953.81,2960.1,
PLATE THREE LEVEL 52 MM,27014677,CDM,278,RC,C1713,HCPCS,outpatient,,,3601,1440.40,,2520.7,70,,2016.56,percent of total billed charges,70% of total billed charges,1890.53,52.5,,1512.42,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,2952.82,82,,2362.256,percent of total billed charges,82% of total billed charges,3060.85,85,,2448.68,percent of total billed charges,85% of total billed charges,3060.85,85,,2448.68,percent of total billed charges,85% of total billed charges,3060.85,85,,2448.68,percent of total billed charges,85% of total billed charges,3240.9,90,,2592.72,percent of total billed charges,90% of total billed charges,2880.8,80,,2304.64,percent of total billed charges,80% of total billed charges,3240.9,90,,2592.72,percent of total billed charges,90% of total billed charges,2700.75,75,,2160.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,1044.29,29,,835.432,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,2412.67,67,,1930.136,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,2520.7,70,,2016.56,percent of total billed charges,70% of total billed charges,2340.65,65,,1872.52,percent of total billed charges,65% of total billed charges,1284.48,35.67,,1027.584,percent of total billed charges,35.67% of total billed charges,1044.29,3240.9,
CORTICAL DEMIN FIBERS OSTEOVIV,27014678,CDM,278,RC,C1713,HCPCS,outpatient,,,12053,4821.20,,8437.1,70,,6749.68,percent of total billed charges,70% of total billed charges,6327.83,52.5,,5062.26,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,9883.46,82,,7906.768,percent of total billed charges,82% of total billed charges,10245.05,85,,8196.04,percent of total billed charges,85% of total billed charges,10245.05,85,,8196.04,percent of total billed charges,85% of total billed charges,10245.05,85,,8196.04,percent of total billed charges,85% of total billed charges,10847.7,90,,8678.16,percent of total billed charges,90% of total billed charges,9642.4,80,,7713.92,percent of total billed charges,80% of total billed charges,10847.7,90,,8678.16,percent of total billed charges,90% of total billed charges,9039.75,75,,7231.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,3495.37,29,,2796.296,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,8075.51,67,,6460.408,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,8437.1,70,,6749.68,percent of total billed charges,70% of total billed charges,7834.45,65,,6267.56,percent of total billed charges,65% of total billed charges,4299.31,35.67,,3439.448,percent of total billed charges,35.67% of total billed charges,3495.37,10847.7,
CERVICAL CAGE 16 MM,27014679,CDM,278,RC,C1821,HCPCS,outpatient,,,6889,2755.60,,4822.3,70,,3857.84,percent of total billed charges,70% of total billed charges,3616.73,52.5,,2893.38,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,5648.98,82,,4519.184,percent of total billed charges,82% of total billed charges,5855.65,85,,4684.52,percent of total billed charges,85% of total billed charges,5855.65,85,,4684.52,percent of total billed charges,85% of total billed charges,5855.65,85,,4684.52,percent of total billed charges,85% of total billed charges,6200.1,90,,4960.08,percent of total billed charges,90% of total billed charges,5511.2,80,,4408.96,percent of total billed charges,80% of total billed charges,6200.1,90,,4960.08,percent of total billed charges,90% of total billed charges,5166.75,75,,4133.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,1997.81,29,,1598.248,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4615.63,67,,3692.504,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,4822.3,70,,3857.84,percent of total billed charges,70% of total billed charges,4477.85,65,,3582.28,percent of total billed charges,65% of total billed charges,2457.31,35.67,,1965.848,percent of total billed charges,35.67% of total billed charges,1997.81,6200.1,
PLATE 16.MM,27014680,CDM,278,RC,C1713,HCPCS,outpatient,,,3132,1252.80,,2192.4,70,,1753.92,percent of total billed charges,70% of total billed charges,1644.3,52.5,,1315.44,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,2568.24,82,,2054.592,percent of total billed charges,82% of total billed charges,2662.2,85,,2129.76,percent of total billed charges,85% of total billed charges,2662.2,85,,2129.76,percent of total billed charges,85% of total billed charges,2662.2,85,,2129.76,percent of total billed charges,85% of total billed charges,2818.8,90,,2255.04,percent of total billed charges,90% of total billed charges,2505.6,80,,2004.48,percent of total billed charges,80% of total billed charges,2818.8,90,,2255.04,percent of total billed charges,90% of total billed charges,2349,75,,1879.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,908.28,29,,726.624,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,2098.44,67,,1678.752,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,2192.4,70,,1753.92,percent of total billed charges,70% of total billed charges,2035.8,65,,1628.64,percent of total billed charges,65% of total billed charges,1117.18,35.67,,893.744,percent of total billed charges,35.67% of total billed charges,908.28,2818.8,
CORTICAL FIBERS,27014681,CDM,278,RC,C1713,HCPCS,outpatient,,,6679,2671.60,,4675.3,70,,3740.24,percent of total billed charges,70% of total billed charges,3506.48,52.5,,2805.18,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,5476.78,82,,4381.424,percent of total billed charges,82% of total billed charges,5677.15,85,,4541.72,percent of total billed charges,85% of total billed charges,5677.15,85,,4541.72,percent of total billed charges,85% of total billed charges,5677.15,85,,4541.72,percent of total billed charges,85% of total billed charges,6011.1,90,,4808.88,percent of total billed charges,90% of total billed charges,5343.2,80,,4274.56,percent of total billed charges,80% of total billed charges,6011.1,90,,4808.88,percent of total billed charges,90% of total billed charges,5009.25,75,,4007.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,1936.91,29,,1549.528,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4474.93,67,,3579.944,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,4675.3,70,,3740.24,percent of total billed charges,70% of total billed charges,4341.35,65,,3473.08,percent of total billed charges,65% of total billed charges,2382.4,35.67,,1905.92,percent of total billed charges,35.67% of total billed charges,1936.91,6011.1,
PROXIMAL HUMERUS PLATE,27014692,CDM,278,RC,C1713,HCPCS,outpatient,,,3756,1502.40,,2629.2,70,,2103.36,percent of total billed charges,70% of total billed charges,1971.9,52.5,,1577.52,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,3079.92,82,,2463.936,percent of total billed charges,82% of total billed charges,3192.6,85,,2554.08,percent of total billed charges,85% of total billed charges,3192.6,85,,2554.08,percent of total billed charges,85% of total billed charges,3192.6,85,,2554.08,percent of total billed charges,85% of total billed charges,3380.4,90,,2704.32,percent of total billed charges,90% of total billed charges,3004.8,80,,2403.84,percent of total billed charges,80% of total billed charges,3380.4,90,,2704.32,percent of total billed charges,90% of total billed charges,2817,75,,2253.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,1089.24,29,,871.392,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,2516.52,67,,2013.216,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,2629.2,70,,2103.36,percent of total billed charges,70% of total billed charges,2441.4,65,,1953.12,percent of total billed charges,65% of total billed charges,1339.77,35.67,,1071.816,percent of total billed charges,35.67% of total billed charges,1089.24,3380.4,
CANNULATED SCREW,27014693,CDM,278,RC,C1713,HCPCS,outpatient,,,946,378.40,,662.2,70,,529.76,percent of total billed charges,70% of total billed charges,946,100,,756.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,775.72,82,,620.576,percent of total billed charges,82% of total billed charges,804.1,85,,643.28,percent of total billed charges,85% of total billed charges,804.1,85,,643.28,percent of total billed charges,85% of total billed charges,804.1,85,,643.28,percent of total billed charges,85% of total billed charges,851.4,90,,681.12,percent of total billed charges,90% of total billed charges,756.8,80,,605.44,percent of total billed charges,80% of total billed charges,851.4,90,,681.12,percent of total billed charges,90% of total billed charges,709.5,75,,567.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,274.34,29,,219.472,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,633.82,67,,507.056,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,662.2,70,,529.76,percent of total billed charges,70% of total billed charges,614.9,65,,491.92,percent of total billed charges,65% of total billed charges,337.44,35.67,,269.952,percent of total billed charges,35.67% of total billed charges,274.34,946,
CANNULATED SCREW,27014694,CDM,278,RC,C1713,HCPCS,outpatient,,,946,378.40,,662.2,70,,529.76,percent of total billed charges,70% of total billed charges,946,100,,756.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,775.72,82,,620.576,percent of total billed charges,82% of total billed charges,804.1,85,,643.28,percent of total billed charges,85% of total billed charges,804.1,85,,643.28,percent of total billed charges,85% of total billed charges,804.1,85,,643.28,percent of total billed charges,85% of total billed charges,851.4,90,,681.12,percent of total billed charges,90% of total billed charges,756.8,80,,605.44,percent of total billed charges,80% of total billed charges,851.4,90,,681.12,percent of total billed charges,90% of total billed charges,709.5,75,,567.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,274.34,29,,219.472,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,633.82,67,,507.056,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,662.2,70,,529.76,percent of total billed charges,70% of total billed charges,614.9,65,,491.92,percent of total billed charges,65% of total billed charges,337.44,35.67,,269.952,percent of total billed charges,35.67% of total billed charges,274.34,946,
CANNULATED SCREW,27014695,CDM,278,RC,C1713,HCPCS,outpatient,,,946,378.40,,662.2,70,,529.76,percent of total billed charges,70% of total billed charges,946,100,,756.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,775.72,82,,620.576,percent of total billed charges,82% of total billed charges,804.1,85,,643.28,percent of total billed charges,85% of total billed charges,804.1,85,,643.28,percent of total billed charges,85% of total billed charges,804.1,85,,643.28,percent of total billed charges,85% of total billed charges,851.4,90,,681.12,percent of total billed charges,90% of total billed charges,756.8,80,,605.44,percent of total billed charges,80% of total billed charges,851.4,90,,681.12,percent of total billed charges,90% of total billed charges,709.5,75,,567.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,274.34,29,,219.472,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,633.82,67,,507.056,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,662.2,70,,529.76,percent of total billed charges,70% of total billed charges,614.9,65,,491.92,percent of total billed charges,65% of total billed charges,337.44,35.67,,269.952,percent of total billed charges,35.67% of total billed charges,274.34,946,
LOCKING SCREW,27014696,CDM,278,RC,C1713,HCPCS,outpatient,,,785,314.00,,549.5,70,,439.6,percent of total billed charges,70% of total billed charges,785,100,,628,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,643.7,82,,514.96,percent of total billed charges,82% of total billed charges,667.25,85,,533.8,percent of total billed charges,85% of total billed charges,667.25,85,,533.8,percent of total billed charges,85% of total billed charges,667.25,85,,533.8,percent of total billed charges,85% of total billed charges,706.5,90,,565.2,percent of total billed charges,90% of total billed charges,628,80,,502.4,percent of total billed charges,80% of total billed charges,706.5,90,,565.2,percent of total billed charges,90% of total billed charges,588.75,75,,471,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,227.65,29,,182.12,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,525.95,67,,420.76,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,549.5,70,,439.6,percent of total billed charges,70% of total billed charges,510.25,65,,408.2,percent of total billed charges,65% of total billed charges,280.01,35.67,,224.008,percent of total billed charges,35.67% of total billed charges,227.65,785,
LOCKING SCREW,27014697,CDM,278,RC,C1713,HCPCS,outpatient,,,785,314.00,,549.5,70,,439.6,percent of total billed charges,70% of total billed charges,785,100,,628,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,643.7,82,,514.96,percent of total billed charges,82% of total billed charges,667.25,85,,533.8,percent of total billed charges,85% of total billed charges,667.25,85,,533.8,percent of total billed charges,85% of total billed charges,667.25,85,,533.8,percent of total billed charges,85% of total billed charges,706.5,90,,565.2,percent of total billed charges,90% of total billed charges,628,80,,502.4,percent of total billed charges,80% of total billed charges,706.5,90,,565.2,percent of total billed charges,90% of total billed charges,588.75,75,,471,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,227.65,29,,182.12,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,525.95,67,,420.76,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,549.5,70,,439.6,percent of total billed charges,70% of total billed charges,510.25,65,,408.2,percent of total billed charges,65% of total billed charges,280.01,35.67,,224.008,percent of total billed charges,35.67% of total billed charges,227.65,785,
CORTEX SCREW,27014698,CDM,278,RC,C1713,HCPCS,outpatient,,,160,64.00,,112,70,,89.6,percent of total billed charges,70% of total billed charges,160,100,,128,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,131.2,82,,104.96,percent of total billed charges,82% of total billed charges,136,85,,108.8,percent of total billed charges,85% of total billed charges,136,85,,108.8,percent of total billed charges,85% of total billed charges,136,85,,108.8,percent of total billed charges,85% of total billed charges,144,90,,115.2,percent of total billed charges,90% of total billed charges,128,80,,102.4,percent of total billed charges,80% of total billed charges,144,90,,115.2,percent of total billed charges,90% of total billed charges,120,75,,96,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,46.4,29,,37.12,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,107.2,67,,85.76,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,112,70,,89.6,percent of total billed charges,70% of total billed charges,104,65,,83.2,percent of total billed charges,65% of total billed charges,57.07,35.67,,45.656,percent of total billed charges,35.67% of total billed charges,46.4,160,
GUIDE PIN,27014701,CDM,278,RC,C1713,HCPCS,outpatient,,,278,111.20,,194.6,70,,155.68,percent of total billed charges,70% of total billed charges,278,100,,222.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,227.96,82,,182.368,percent of total billed charges,82% of total billed charges,236.3,85,,189.04,percent of total billed charges,85% of total billed charges,236.3,85,,189.04,percent of total billed charges,85% of total billed charges,236.3,85,,189.04,percent of total billed charges,85% of total billed charges,250.2,90,,200.16,percent of total billed charges,90% of total billed charges,222.4,80,,177.92,percent of total billed charges,80% of total billed charges,250.2,90,,200.16,percent of total billed charges,90% of total billed charges,208.5,75,,166.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,80.62,29,,64.496,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,186.26,67,,149.008,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,194.6,70,,155.68,percent of total billed charges,70% of total billed charges,180.7,65,,144.56,percent of total billed charges,65% of total billed charges,99.16,35.67,,79.328,percent of total billed charges,35.67% of total billed charges,80.62,278,
ROD,27014747,CDM,278,RC,C1713,HCPCS,outpatient,,,837,334.80,,585.9,70,,468.72,percent of total billed charges,70% of total billed charges,837,100,,669.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,686.34,82,,549.072,percent of total billed charges,82% of total billed charges,711.45,85,,569.16,percent of total billed charges,85% of total billed charges,711.45,85,,569.16,percent of total billed charges,85% of total billed charges,711.45,85,,569.16,percent of total billed charges,85% of total billed charges,753.3,90,,602.64,percent of total billed charges,90% of total billed charges,669.6,80,,535.68,percent of total billed charges,80% of total billed charges,753.3,90,,602.64,percent of total billed charges,90% of total billed charges,627.75,75,,502.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,242.73,29,,194.184,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,560.79,67,,448.632,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,585.9,70,,468.72,percent of total billed charges,70% of total billed charges,544.05,65,,435.24,percent of total billed charges,65% of total billed charges,298.56,35.67,,238.848,percent of total billed charges,35.67% of total billed charges,242.73,837,
CROSS LINK LARGE,27014748,CDM,278,RC,C1713,HCPCS,outpatient,,,1881,752.40,,1316.7,70,,1053.36,percent of total billed charges,70% of total billed charges,987.53,52.5,,790.02,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,1542.42,82,,1233.936,percent of total billed charges,82% of total billed charges,1598.85,85,,1279.08,percent of total billed charges,85% of total billed charges,1598.85,85,,1279.08,percent of total billed charges,85% of total billed charges,1598.85,85,,1279.08,percent of total billed charges,85% of total billed charges,1692.9,90,,1354.32,percent of total billed charges,90% of total billed charges,1504.8,80,,1203.84,percent of total billed charges,80% of total billed charges,1692.9,90,,1354.32,percent of total billed charges,90% of total billed charges,1410.75,75,,1128.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,545.49,29,,436.392,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1260.27,67,,1008.216,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1316.7,70,,1053.36,percent of total billed charges,70% of total billed charges,1222.65,65,,978.12,percent of total billed charges,65% of total billed charges,670.95,35.67,,536.76,percent of total billed charges,35.67% of total billed charges,545.49,1692.9,
CORTICAL FIBERS 3D,27014750,CDM,278,RC,C1713,HCPCS,outpatient,,,12053,4821.20,,8437.1,70,,6749.68,percent of total billed charges,70% of total billed charges,6327.83,52.5,,5062.26,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,9883.46,82,,7906.768,percent of total billed charges,82% of total billed charges,10245.05,85,,8196.04,percent of total billed charges,85% of total billed charges,10245.05,85,,8196.04,percent of total billed charges,85% of total billed charges,10245.05,85,,8196.04,percent of total billed charges,85% of total billed charges,10847.7,90,,8678.16,percent of total billed charges,90% of total billed charges,9642.4,80,,7713.92,percent of total billed charges,80% of total billed charges,10847.7,90,,8678.16,percent of total billed charges,90% of total billed charges,9039.75,75,,7231.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,3495.37,29,,2796.296,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,8075.51,67,,6460.408,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,8437.1,70,,6749.68,percent of total billed charges,70% of total billed charges,7834.45,65,,6267.56,percent of total billed charges,65% of total billed charges,4299.31,35.67,,3439.448,percent of total billed charges,35.67% of total billed charges,3495.37,10847.7,
COUNTERSINK CANNULATED,27014765,CDM,278,RC,C1713,HCPCS,outpatient,,,837,334.80,,585.9,70,,468.72,percent of total billed charges,70% of total billed charges,837,100,,669.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,686.34,82,,549.072,percent of total billed charges,82% of total billed charges,711.45,85,,569.16,percent of total billed charges,85% of total billed charges,711.45,85,,569.16,percent of total billed charges,85% of total billed charges,711.45,85,,569.16,percent of total billed charges,85% of total billed charges,753.3,90,,602.64,percent of total billed charges,90% of total billed charges,669.6,80,,535.68,percent of total billed charges,80% of total billed charges,753.3,90,,602.64,percent of total billed charges,90% of total billed charges,627.75,75,,502.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,242.73,29,,194.184,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,560.79,67,,448.632,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,585.9,70,,468.72,percent of total billed charges,70% of total billed charges,544.05,65,,435.24,percent of total billed charges,65% of total billed charges,298.56,35.67,,238.848,percent of total billed charges,35.67% of total billed charges,242.73,837,
PLATE MTP FUSION,27014766,CDM,278,RC,C1713,HCPCS,outpatient,,,4844,1937.60,,3390.8,70,,2712.64,percent of total billed charges,70% of total billed charges,2543.1,52.5,,2034.48,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,3972.08,82,,3177.664,percent of total billed charges,82% of total billed charges,4117.4,85,,3293.92,percent of total billed charges,85% of total billed charges,4117.4,85,,3293.92,percent of total billed charges,85% of total billed charges,4117.4,85,,3293.92,percent of total billed charges,85% of total billed charges,4359.6,90,,3487.68,percent of total billed charges,90% of total billed charges,3875.2,80,,3100.16,percent of total billed charges,80% of total billed charges,4359.6,90,,3487.68,percent of total billed charges,90% of total billed charges,3633,75,,2906.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,1404.76,29,,1123.808,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,3245.48,67,,2596.384,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,3390.8,70,,2712.64,percent of total billed charges,70% of total billed charges,3148.6,65,,2518.88,percent of total billed charges,65% of total billed charges,1727.85,35.67,,1382.28,percent of total billed charges,35.67% of total billed charges,1404.76,4359.6,
SCREW,27014767,CDM,278,RC,C1713,HCPCS,outpatient,,,1087,434.80,,760.9,70,,608.72,percent of total billed charges,70% of total billed charges,570.68,52.5,,456.54,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,891.34,82,,713.072,percent of total billed charges,82% of total billed charges,923.95,85,,739.16,percent of total billed charges,85% of total billed charges,923.95,85,,739.16,percent of total billed charges,85% of total billed charges,923.95,85,,739.16,percent of total billed charges,85% of total billed charges,978.3,90,,782.64,percent of total billed charges,90% of total billed charges,869.6,80,,695.68,percent of total billed charges,80% of total billed charges,978.3,90,,782.64,percent of total billed charges,90% of total billed charges,815.25,75,,652.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,315.23,29,,252.184,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,728.29,67,,582.632,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,760.9,70,,608.72,percent of total billed charges,70% of total billed charges,706.55,65,,565.24,percent of total billed charges,65% of total billed charges,387.73,35.67,,310.184,percent of total billed charges,35.67% of total billed charges,315.23,978.3,
SCREW,27014768,CDM,278,RC,C1713,HCPCS,outpatient,,,1087,434.80,,760.9,70,,608.72,percent of total billed charges,70% of total billed charges,570.68,52.5,,456.54,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,891.34,82,,713.072,percent of total billed charges,82% of total billed charges,923.95,85,,739.16,percent of total billed charges,85% of total billed charges,923.95,85,,739.16,percent of total billed charges,85% of total billed charges,923.95,85,,739.16,percent of total billed charges,85% of total billed charges,978.3,90,,782.64,percent of total billed charges,90% of total billed charges,869.6,80,,695.68,percent of total billed charges,80% of total billed charges,978.3,90,,782.64,percent of total billed charges,90% of total billed charges,815.25,75,,652.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,315.23,29,,252.184,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,728.29,67,,582.632,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,760.9,70,,608.72,percent of total billed charges,70% of total billed charges,706.55,65,,565.24,percent of total billed charges,65% of total billed charges,387.73,35.67,,310.184,percent of total billed charges,35.67% of total billed charges,315.23,978.3,
SCREW,27014769,CDM,278,RC,C1713,HCPCS,outpatient,,,1087,434.80,,760.9,70,,608.72,percent of total billed charges,70% of total billed charges,570.68,52.5,,456.54,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,891.34,82,,713.072,percent of total billed charges,82% of total billed charges,923.95,85,,739.16,percent of total billed charges,85% of total billed charges,923.95,85,,739.16,percent of total billed charges,85% of total billed charges,923.95,85,,739.16,percent of total billed charges,85% of total billed charges,978.3,90,,782.64,percent of total billed charges,90% of total billed charges,869.6,80,,695.68,percent of total billed charges,80% of total billed charges,978.3,90,,782.64,percent of total billed charges,90% of total billed charges,815.25,75,,652.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,315.23,29,,252.184,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,728.29,67,,582.632,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,760.9,70,,608.72,percent of total billed charges,70% of total billed charges,706.55,65,,565.24,percent of total billed charges,65% of total billed charges,387.73,35.67,,310.184,percent of total billed charges,35.67% of total billed charges,315.23,978.3,
SCREW,27014770,CDM,278,RC,C1713,HCPCS,outpatient,,,1087,434.80,,760.9,70,,608.72,percent of total billed charges,70% of total billed charges,570.68,52.5,,456.54,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,891.34,82,,713.072,percent of total billed charges,82% of total billed charges,923.95,85,,739.16,percent of total billed charges,85% of total billed charges,923.95,85,,739.16,percent of total billed charges,85% of total billed charges,923.95,85,,739.16,percent of total billed charges,85% of total billed charges,978.3,90,,782.64,percent of total billed charges,90% of total billed charges,869.6,80,,695.68,percent of total billed charges,80% of total billed charges,978.3,90,,782.64,percent of total billed charges,90% of total billed charges,815.25,75,,652.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,315.23,29,,252.184,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,728.29,67,,582.632,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,760.9,70,,608.72,percent of total billed charges,70% of total billed charges,706.55,65,,565.24,percent of total billed charges,65% of total billed charges,387.73,35.67,,310.184,percent of total billed charges,35.67% of total billed charges,315.23,978.3,
SCREW,27014771,CDM,278,RC,C1713,HCPCS,outpatient,,,1087,434.80,,760.9,70,,608.72,percent of total billed charges,70% of total billed charges,570.68,52.5,,456.54,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,891.34,82,,713.072,percent of total billed charges,82% of total billed charges,923.95,85,,739.16,percent of total billed charges,85% of total billed charges,923.95,85,,739.16,percent of total billed charges,85% of total billed charges,923.95,85,,739.16,percent of total billed charges,85% of total billed charges,978.3,90,,782.64,percent of total billed charges,90% of total billed charges,869.6,80,,695.68,percent of total billed charges,80% of total billed charges,978.3,90,,782.64,percent of total billed charges,90% of total billed charges,815.25,75,,652.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,315.23,29,,252.184,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,728.29,67,,582.632,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,760.9,70,,608.72,percent of total billed charges,70% of total billed charges,706.55,65,,565.24,percent of total billed charges,65% of total billed charges,387.73,35.67,,310.184,percent of total billed charges,35.67% of total billed charges,315.23,978.3,
NONLOCKING SCREW 2.7X16MM,27014772,CDM,278,RC,C1713,HCPCS,outpatient,,,921,368.40,,644.7,70,,515.76,percent of total billed charges,70% of total billed charges,921,100,,736.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,755.22,82,,604.176,percent of total billed charges,82% of total billed charges,782.85,85,,626.28,percent of total billed charges,85% of total billed charges,782.85,85,,626.28,percent of total billed charges,85% of total billed charges,782.85,85,,626.28,percent of total billed charges,85% of total billed charges,828.9,90,,663.12,percent of total billed charges,90% of total billed charges,736.8,80,,589.44,percent of total billed charges,80% of total billed charges,828.9,90,,663.12,percent of total billed charges,90% of total billed charges,690.75,75,,552.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,267.09,29,,213.672,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,617.07,67,,493.656,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,644.7,70,,515.76,percent of total billed charges,70% of total billed charges,598.65,65,,478.92,percent of total billed charges,65% of total billed charges,328.52,35.67,,262.816,percent of total billed charges,35.67% of total billed charges,267.09,921,
SCREW,27014773,CDM,278,RC,C1713,HCPCS,outpatient,,,921,368.40,,644.7,70,,515.76,percent of total billed charges,70% of total billed charges,921,100,,736.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,755.22,82,,604.176,percent of total billed charges,82% of total billed charges,782.85,85,,626.28,percent of total billed charges,85% of total billed charges,782.85,85,,626.28,percent of total billed charges,85% of total billed charges,782.85,85,,626.28,percent of total billed charges,85% of total billed charges,828.9,90,,663.12,percent of total billed charges,90% of total billed charges,736.8,80,,589.44,percent of total billed charges,80% of total billed charges,828.9,90,,663.12,percent of total billed charges,90% of total billed charges,690.75,75,,552.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,267.09,29,,213.672,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,617.07,67,,493.656,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,644.7,70,,515.76,percent of total billed charges,70% of total billed charges,598.65,65,,478.92,percent of total billed charges,65% of total billed charges,328.52,35.67,,262.816,percent of total billed charges,35.67% of total billed charges,267.09,921,
NONLOCKING SCREW 2.7X30MM,27014774,CDM,278,RC,C1713,HCPCS,outpatient,,,921,368.40,,644.7,70,,515.76,percent of total billed charges,70% of total billed charges,921,100,,736.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,755.22,82,,604.176,percent of total billed charges,82% of total billed charges,782.85,85,,626.28,percent of total billed charges,85% of total billed charges,782.85,85,,626.28,percent of total billed charges,85% of total billed charges,782.85,85,,626.28,percent of total billed charges,85% of total billed charges,828.9,90,,663.12,percent of total billed charges,90% of total billed charges,736.8,80,,589.44,percent of total billed charges,80% of total billed charges,828.9,90,,663.12,percent of total billed charges,90% of total billed charges,690.75,75,,552.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,267.09,29,,213.672,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,617.07,67,,493.656,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,644.7,70,,515.76,percent of total billed charges,70% of total billed charges,598.65,65,,478.92,percent of total billed charges,65% of total billed charges,328.52,35.67,,262.816,percent of total billed charges,35.67% of total billed charges,267.09,921,
CANCELLOUS SCREW,27014775,CDM,278,RC,C1713,HCPCS,outpatient,,,524,209.60,,366.8,70,,293.44,percent of total billed charges,70% of total billed charges,524,100,,419.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,429.68,82,,343.744,percent of total billed charges,82% of total billed charges,445.4,85,,356.32,percent of total billed charges,85% of total billed charges,445.4,85,,356.32,percent of total billed charges,85% of total billed charges,445.4,85,,356.32,percent of total billed charges,85% of total billed charges,471.6,90,,377.28,percent of total billed charges,90% of total billed charges,419.2,80,,335.36,percent of total billed charges,80% of total billed charges,471.6,90,,377.28,percent of total billed charges,90% of total billed charges,393,75,,314.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,151.96,29,,121.568,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,351.08,67,,280.864,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,366.8,70,,293.44,percent of total billed charges,70% of total billed charges,340.6,65,,272.48,percent of total billed charges,65% of total billed charges,186.91,35.67,,149.528,percent of total billed charges,35.67% of total billed charges,151.96,524,
T PLATE,27014798,CDM,278,RC,C1713,HCPCS,outpatient,,,2027,810.80,,1418.9,70,,1135.12,percent of total billed charges,70% of total billed charges,1064.18,52.5,,851.34,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,1662.14,82,,1329.712,percent of total billed charges,82% of total billed charges,1722.95,85,,1378.36,percent of total billed charges,85% of total billed charges,1722.95,85,,1378.36,percent of total billed charges,85% of total billed charges,1722.95,85,,1378.36,percent of total billed charges,85% of total billed charges,1824.3,90,,1459.44,percent of total billed charges,90% of total billed charges,1621.6,80,,1297.28,percent of total billed charges,80% of total billed charges,1824.3,90,,1459.44,percent of total billed charges,90% of total billed charges,1520.25,75,,1216.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,587.83,29,,470.264,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1358.09,67,,1086.472,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1418.9,70,,1135.12,percent of total billed charges,70% of total billed charges,1317.55,65,,1054.04,percent of total billed charges,65% of total billed charges,723.03,35.67,,578.424,percent of total billed charges,35.67% of total billed charges,587.83,1824.3,
SCREW NON LOCKING,27014799,CDM,278,RC,C1713,HCPCS,outpatient,,,588,235.20,,411.6,70,,329.28,percent of total billed charges,70% of total billed charges,588,100,,470.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,482.16,82,,385.728,percent of total billed charges,82% of total billed charges,499.8,85,,399.84,percent of total billed charges,85% of total billed charges,499.8,85,,399.84,percent of total billed charges,85% of total billed charges,499.8,85,,399.84,percent of total billed charges,85% of total billed charges,529.2,90,,423.36,percent of total billed charges,90% of total billed charges,470.4,80,,376.32,percent of total billed charges,80% of total billed charges,529.2,90,,423.36,percent of total billed charges,90% of total billed charges,441,75,,352.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,170.52,29,,136.416,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,393.96,67,,315.168,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,411.6,70,,329.28,percent of total billed charges,70% of total billed charges,382.2,65,,305.76,percent of total billed charges,65% of total billed charges,209.74,35.67,,167.792,percent of total billed charges,35.67% of total billed charges,170.52,588,
SCREW NON LOCKING 1.8,27014800,CDM,278,RC,C1713,HCPCS,outpatient,,,295,118.00,,206.5,70,,165.2,percent of total billed charges,70% of total billed charges,295,100,,236,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,241.9,82,,193.52,percent of total billed charges,82% of total billed charges,250.75,85,,200.6,percent of total billed charges,85% of total billed charges,250.75,85,,200.6,percent of total billed charges,85% of total billed charges,250.75,85,,200.6,percent of total billed charges,85% of total billed charges,265.5,90,,212.4,percent of total billed charges,90% of total billed charges,236,80,,188.8,percent of total billed charges,80% of total billed charges,265.5,90,,212.4,percent of total billed charges,90% of total billed charges,221.25,75,,177,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,85.55,29,,68.44,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,197.65,67,,158.12,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,206.5,70,,165.2,percent of total billed charges,70% of total billed charges,191.75,65,,153.4,percent of total billed charges,65% of total billed charges,105.23,35.67,,84.184,percent of total billed charges,35.67% of total billed charges,85.55,295,
SCREW LOCKING,27014801,CDM,278,RC,C1713,HCPCS,outpatient,,,650,260.00,,455,70,,364,percent of total billed charges,70% of total billed charges,650,100,,520,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,533,82,,426.4,percent of total billed charges,82% of total billed charges,552.5,85,,442,percent of total billed charges,85% of total billed charges,552.5,85,,442,percent of total billed charges,85% of total billed charges,552.5,85,,442,percent of total billed charges,85% of total billed charges,585,90,,468,percent of total billed charges,90% of total billed charges,520,80,,416,percent of total billed charges,80% of total billed charges,585,90,,468,percent of total billed charges,90% of total billed charges,487.5,75,,390,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,188.5,29,,150.8,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,435.5,67,,348.4,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,455,70,,364,percent of total billed charges,70% of total billed charges,422.5,65,,338,percent of total billed charges,65% of total billed charges,231.86,35.67,,185.488,percent of total billed charges,35.67% of total billed charges,188.5,650,
SCREW LOCKING 2.3 MM,27014802,CDM,278,RC,C1713,HCPCS,outpatient,,,650,260.00,,455,70,,364,percent of total billed charges,70% of total billed charges,650,100,,520,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,533,82,,426.4,percent of total billed charges,82% of total billed charges,552.5,85,,442,percent of total billed charges,85% of total billed charges,552.5,85,,442,percent of total billed charges,85% of total billed charges,552.5,85,,442,percent of total billed charges,85% of total billed charges,585,90,,468,percent of total billed charges,90% of total billed charges,520,80,,416,percent of total billed charges,80% of total billed charges,585,90,,468,percent of total billed charges,90% of total billed charges,487.5,75,,390,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,188.5,29,,150.8,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,435.5,67,,348.4,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,455,70,,364,percent of total billed charges,70% of total billed charges,422.5,65,,338,percent of total billed charges,65% of total billed charges,231.86,35.67,,185.488,percent of total billed charges,35.67% of total billed charges,188.5,650,
CEMENT AUTOPLEX,27014809,CDM,278,RC,C1713,HCPCS,outpatient,,,2273,909.20,,1591.1,70,,1272.88,percent of total billed charges,70% of total billed charges,1193.33,52.5,,954.66,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,1863.86,82,,1491.088,percent of total billed charges,82% of total billed charges,1932.05,85,,1545.64,percent of total billed charges,85% of total billed charges,1932.05,85,,1545.64,percent of total billed charges,85% of total billed charges,1932.05,85,,1545.64,percent of total billed charges,85% of total billed charges,2045.7,90,,1636.56,percent of total billed charges,90% of total billed charges,1818.4,80,,1454.72,percent of total billed charges,80% of total billed charges,2045.7,90,,1636.56,percent of total billed charges,90% of total billed charges,1704.75,75,,1363.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,659.17,29,,527.336,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1522.91,67,,1218.328,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1591.1,70,,1272.88,percent of total billed charges,70% of total billed charges,1477.45,65,,1181.96,percent of total billed charges,65% of total billed charges,810.78,35.67,,648.624,percent of total billed charges,35.67% of total billed charges,659.17,2045.7,
CANCELLOUS CUBES 7 X 7 30CC,27014815,CDM,278,RC,C1762,HCPCS,outpatient,,,1646,658.40,,1152.2,70,,921.76,percent of total billed charges,70% of total billed charges,864.15,52.5,,691.32,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,1349.72,82,,1079.776,percent of total billed charges,82% of total billed charges,1399.1,85,,1119.28,percent of total billed charges,85% of total billed charges,1399.1,85,,1119.28,percent of total billed charges,85% of total billed charges,1399.1,85,,1119.28,percent of total billed charges,85% of total billed charges,1481.4,90,,1185.12,percent of total billed charges,90% of total billed charges,1316.8,80,,1053.44,percent of total billed charges,80% of total billed charges,1481.4,90,,1185.12,percent of total billed charges,90% of total billed charges,1234.5,75,,987.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,477.34,29,,381.872,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1102.82,67,,882.256,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1152.2,70,,921.76,percent of total billed charges,70% of total billed charges,1069.9,65,,855.92,percent of total billed charges,65% of total billed charges,587.13,35.67,,469.704,percent of total billed charges,35.67% of total billed charges,477.34,1481.4,
CANCELLOUS SCREW,27014836,CDM,278,RC,C1713,HCPCS,outpatient,,,508,203.20,,355.6,70,,284.48,percent of total billed charges,70% of total billed charges,508,100,,406.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,416.56,82,,333.248,percent of total billed charges,82% of total billed charges,431.8,85,,345.44,percent of total billed charges,85% of total billed charges,431.8,85,,345.44,percent of total billed charges,85% of total billed charges,431.8,85,,345.44,percent of total billed charges,85% of total billed charges,457.2,90,,365.76,percent of total billed charges,90% of total billed charges,406.4,80,,325.12,percent of total billed charges,80% of total billed charges,457.2,90,,365.76,percent of total billed charges,90% of total billed charges,381,75,,304.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,147.32,29,,117.856,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,340.36,67,,272.288,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,355.6,70,,284.48,percent of total billed charges,70% of total billed charges,330.2,65,,264.16,percent of total billed charges,65% of total billed charges,181.2,35.67,,144.96,percent of total billed charges,35.67% of total billed charges,147.32,508,
CANCELLOUS SCREW,27014837,CDM,278,RC,C1713,HCPCS,outpatient,,,508,203.20,,355.6,70,,284.48,percent of total billed charges,70% of total billed charges,508,100,,406.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,416.56,82,,333.248,percent of total billed charges,82% of total billed charges,431.8,85,,345.44,percent of total billed charges,85% of total billed charges,431.8,85,,345.44,percent of total billed charges,85% of total billed charges,431.8,85,,345.44,percent of total billed charges,85% of total billed charges,457.2,90,,365.76,percent of total billed charges,90% of total billed charges,406.4,80,,325.12,percent of total billed charges,80% of total billed charges,457.2,90,,365.76,percent of total billed charges,90% of total billed charges,381,75,,304.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,147.32,29,,117.856,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,340.36,67,,272.288,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,355.6,70,,284.48,percent of total billed charges,70% of total billed charges,330.2,65,,264.16,percent of total billed charges,65% of total billed charges,181.2,35.67,,144.96,percent of total billed charges,35.67% of total billed charges,147.32,508,
PANTOM INSULATED DILATOR,27014839,CDM,278,RC,C1713,HCPCS,outpatient,,,4090,1636.00,,2863,70,,2290.4,percent of total billed charges,70% of total billed charges,2147.25,52.5,,1717.8,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,3353.8,82,,2683.04,percent of total billed charges,82% of total billed charges,3476.5,85,,2781.2,percent of total billed charges,85% of total billed charges,3476.5,85,,2781.2,percent of total billed charges,85% of total billed charges,3476.5,85,,2781.2,percent of total billed charges,85% of total billed charges,3681,90,,2944.8,percent of total billed charges,90% of total billed charges,3272,80,,2617.6,percent of total billed charges,80% of total billed charges,3681,90,,2944.8,percent of total billed charges,90% of total billed charges,3067.5,75,,2454,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,1186.1,29,,948.88,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,2740.3,67,,2192.24,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,2863,70,,2290.4,percent of total billed charges,70% of total billed charges,2658.5,65,,2126.8,percent of total billed charges,65% of total billed charges,1458.9,35.67,,1167.12,percent of total billed charges,35.67% of total billed charges,1186.1,3681,
K WIRE,27014841,CDM,278,RC,C1713,HCPCS,outpatient,,,727,290.80,,508.9,70,,407.12,percent of total billed charges,70% of total billed charges,727,100,,581.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,596.14,82,,476.912,percent of total billed charges,82% of total billed charges,617.95,85,,494.36,percent of total billed charges,85% of total billed charges,617.95,85,,494.36,percent of total billed charges,85% of total billed charges,617.95,85,,494.36,percent of total billed charges,85% of total billed charges,654.3,90,,523.44,percent of total billed charges,90% of total billed charges,581.6,80,,465.28,percent of total billed charges,80% of total billed charges,654.3,90,,523.44,percent of total billed charges,90% of total billed charges,545.25,75,,436.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,210.83,29,,168.664,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,487.09,67,,389.672,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,508.9,70,,407.12,percent of total billed charges,70% of total billed charges,472.55,65,,378.04,percent of total billed charges,65% of total billed charges,259.32,35.67,,207.456,percent of total billed charges,35.67% of total billed charges,210.83,727,
K WIRE,27014842,CDM,278,RC,C1713,HCPCS,outpatient,,,727,290.80,,508.9,70,,407.12,percent of total billed charges,70% of total billed charges,727,100,,581.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,596.14,82,,476.912,percent of total billed charges,82% of total billed charges,617.95,85,,494.36,percent of total billed charges,85% of total billed charges,617.95,85,,494.36,percent of total billed charges,85% of total billed charges,617.95,85,,494.36,percent of total billed charges,85% of total billed charges,654.3,90,,523.44,percent of total billed charges,90% of total billed charges,581.6,80,,465.28,percent of total billed charges,80% of total billed charges,654.3,90,,523.44,percent of total billed charges,90% of total billed charges,545.25,75,,436.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,210.83,29,,168.664,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,487.09,67,,389.672,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,508.9,70,,407.12,percent of total billed charges,70% of total billed charges,472.55,65,,378.04,percent of total billed charges,65% of total billed charges,259.32,35.67,,207.456,percent of total billed charges,35.67% of total billed charges,210.83,727,
OLIF 9 MM,27014843,CDM,278,RC,C1713,HCPCS,outpatient,,,9118,3647.20,,6382.6,70,,5106.08,percent of total billed charges,70% of total billed charges,4786.95,52.5,,3829.56,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,7476.76,82,,5981.408,percent of total billed charges,82% of total billed charges,7750.3,85,,6200.24,percent of total billed charges,85% of total billed charges,7750.3,85,,6200.24,percent of total billed charges,85% of total billed charges,7750.3,85,,6200.24,percent of total billed charges,85% of total billed charges,8206.2,90,,6564.96,percent of total billed charges,90% of total billed charges,7294.4,80,,5835.52,percent of total billed charges,80% of total billed charges,8206.2,90,,6564.96,percent of total billed charges,90% of total billed charges,6838.5,75,,5470.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2644.22,29,,2115.376,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,6109.06,67,,4887.248,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,6382.6,70,,5106.08,percent of total billed charges,70% of total billed charges,5926.7,65,,4741.36,percent of total billed charges,65% of total billed charges,3252.39,35.67,,2601.912,percent of total billed charges,35.67% of total billed charges,2644.22,8206.2,
OLIF 9 MM,27014845,CDM,278,RC,C1713,HCPCS,outpatient,,,9118,3647.20,,6382.6,70,,5106.08,percent of total billed charges,70% of total billed charges,4786.95,52.5,,3829.56,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,7476.76,82,,5981.408,percent of total billed charges,82% of total billed charges,7750.3,85,,6200.24,percent of total billed charges,85% of total billed charges,7750.3,85,,6200.24,percent of total billed charges,85% of total billed charges,7750.3,85,,6200.24,percent of total billed charges,85% of total billed charges,8206.2,90,,6564.96,percent of total billed charges,90% of total billed charges,7294.4,80,,5835.52,percent of total billed charges,80% of total billed charges,8206.2,90,,6564.96,percent of total billed charges,90% of total billed charges,6838.5,75,,5470.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2644.22,29,,2115.376,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,6109.06,67,,4887.248,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,6382.6,70,,5106.08,percent of total billed charges,70% of total billed charges,5926.7,65,,4741.36,percent of total billed charges,65% of total billed charges,3252.39,35.67,,2601.912,percent of total billed charges,35.67% of total billed charges,2644.22,8206.2,
OLIF 9 MM,27014848,CDM,278,RC,C1713,HCPCS,outpatient,,,9118,3647.20,,6382.6,70,,5106.08,percent of total billed charges,70% of total billed charges,4786.95,52.5,,3829.56,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,7476.76,82,,5981.408,percent of total billed charges,82% of total billed charges,7750.3,85,,6200.24,percent of total billed charges,85% of total billed charges,7750.3,85,,6200.24,percent of total billed charges,85% of total billed charges,7750.3,85,,6200.24,percent of total billed charges,85% of total billed charges,8206.2,90,,6564.96,percent of total billed charges,90% of total billed charges,7294.4,80,,5835.52,percent of total billed charges,80% of total billed charges,8206.2,90,,6564.96,percent of total billed charges,90% of total billed charges,6838.5,75,,5470.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2644.22,29,,2115.376,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,6109.06,67,,4887.248,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,6382.6,70,,5106.08,percent of total billed charges,70% of total billed charges,5926.7,65,,4741.36,percent of total billed charges,65% of total billed charges,3252.39,35.67,,2601.912,percent of total billed charges,35.67% of total billed charges,2644.22,8206.2,
ROD 40 MM,27014849,CDM,278,RC,C1713,HCPCS,outpatient,,,812,324.80,,568.4,70,,454.72,percent of total billed charges,70% of total billed charges,812,100,,649.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,665.84,82,,532.672,percent of total billed charges,82% of total billed charges,690.2,85,,552.16,percent of total billed charges,85% of total billed charges,690.2,85,,552.16,percent of total billed charges,85% of total billed charges,690.2,85,,552.16,percent of total billed charges,85% of total billed charges,730.8,90,,584.64,percent of total billed charges,90% of total billed charges,649.6,80,,519.68,percent of total billed charges,80% of total billed charges,730.8,90,,584.64,percent of total billed charges,90% of total billed charges,609,75,,487.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,235.48,29,,188.384,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,544.04,67,,435.232,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,568.4,70,,454.72,percent of total billed charges,70% of total billed charges,527.8,65,,422.24,percent of total billed charges,65% of total billed charges,289.64,35.67,,231.712,percent of total billed charges,35.67% of total billed charges,235.48,812,
NEUROSTIMULATOR TRIAL LEAD,27014877,CDM,278,RC,L8680,HCPCS,outpatient,,,2281,912.40,,1596.7,70,,1277.36,percent of total billed charges,70% of total billed charges,1197.53,52.5,,958.02,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,1870.42,82,,1496.336,percent of total billed charges,82% of total billed charges,1938.85,85,,1551.08,percent of total billed charges,85% of total billed charges,1938.85,85,,1551.08,percent of total billed charges,85% of total billed charges,1938.85,85,,1551.08,percent of total billed charges,85% of total billed charges,2052.9,90,,1642.32,percent of total billed charges,90% of total billed charges,1824.8,80,,1459.84,percent of total billed charges,80% of total billed charges,2052.9,90,,1642.32,percent of total billed charges,90% of total billed charges,1710.75,75,,1368.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,4626.19,100,,,fee schedule,100% of ASC tier grouping rate,,,,,other ,not seperately reimbursable,1528.27,67,,1222.616,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1596.7,70,,1277.36,percent of total billed charges,70% of total billed charges,1482.65,65,,1186.12,percent of total billed charges,65% of total billed charges,5690.21,123,,,fee schedule,123% of ASC tier grouping rate,1197.53,5690.21,
CORTICAL SCREW,27014878,CDM,278,RC,C1713,HCPCS,outpatient,,,1493,597.20,,1045.1,70,,836.08,percent of total billed charges,70% of total billed charges,783.83,52.5,,627.06,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,1224.26,82,,979.408,percent of total billed charges,82% of total billed charges,1269.05,85,,1015.24,percent of total billed charges,85% of total billed charges,1269.05,85,,1015.24,percent of total billed charges,85% of total billed charges,1269.05,85,,1015.24,percent of total billed charges,85% of total billed charges,1343.7,90,,1074.96,percent of total billed charges,90% of total billed charges,1194.4,80,,955.52,percent of total billed charges,80% of total billed charges,1343.7,90,,1074.96,percent of total billed charges,90% of total billed charges,1119.75,75,,895.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,432.97,29,,346.376,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1000.31,67,,800.248,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1045.1,70,,836.08,percent of total billed charges,70% of total billed charges,970.45,65,,776.36,percent of total billed charges,65% of total billed charges,532.55,35.67,,426.04,percent of total billed charges,35.67% of total billed charges,432.97,1343.7,
WASHER SPIKED,27014879,CDM,278,RC,C1713,HCPCS,outpatient,,,1612,644.80,,1128.4,70,,902.72,percent of total billed charges,70% of total billed charges,846.3,52.5,,677.04,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,1321.84,82,,1057.472,percent of total billed charges,82% of total billed charges,1370.2,85,,1096.16,percent of total billed charges,85% of total billed charges,1370.2,85,,1096.16,percent of total billed charges,85% of total billed charges,1370.2,85,,1096.16,percent of total billed charges,85% of total billed charges,1450.8,90,,1160.64,percent of total billed charges,90% of total billed charges,1289.6,80,,1031.68,percent of total billed charges,80% of total billed charges,1450.8,90,,1160.64,percent of total billed charges,90% of total billed charges,1209,75,,967.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,467.48,29,,373.984,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1080.04,67,,864.032,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1128.4,70,,902.72,percent of total billed charges,70% of total billed charges,1047.8,65,,838.24,percent of total billed charges,65% of total billed charges,575,35.67,,460,percent of total billed charges,35.67% of total billed charges,467.48,1450.8,
ENDO TAPER INSERT ORTHO,27014882,CDM,278,RC,C1713,HCPCS,outpatient,,,894,357.60,,625.8,70,,500.64,percent of total billed charges,70% of total billed charges,894,100,,715.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,733.08,82,,586.464,percent of total billed charges,82% of total billed charges,759.9,85,,607.92,percent of total billed charges,85% of total billed charges,759.9,85,,607.92,percent of total billed charges,85% of total billed charges,759.9,85,,607.92,percent of total billed charges,85% of total billed charges,804.6,90,,643.68,percent of total billed charges,90% of total billed charges,715.2,80,,572.16,percent of total billed charges,80% of total billed charges,804.6,90,,643.68,percent of total billed charges,90% of total billed charges,670.5,75,,536.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,259.26,29,,207.408,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,598.98,67,,479.184,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,625.8,70,,500.64,percent of total billed charges,70% of total billed charges,581.1,65,,464.88,percent of total billed charges,65% of total billed charges,318.89,35.67,,255.112,percent of total billed charges,35.67% of total billed charges,259.26,894,
ENDO TAPER INSERT ORTHO,27014884,CDM,278,RC,C1713,HCPCS,outpatient,,,894,357.60,,625.8,70,,500.64,percent of total billed charges,70% of total billed charges,894,100,,715.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,733.08,82,,586.464,percent of total billed charges,82% of total billed charges,759.9,85,,607.92,percent of total billed charges,85% of total billed charges,759.9,85,,607.92,percent of total billed charges,85% of total billed charges,759.9,85,,607.92,percent of total billed charges,85% of total billed charges,804.6,90,,643.68,percent of total billed charges,90% of total billed charges,715.2,80,,572.16,percent of total billed charges,80% of total billed charges,804.6,90,,643.68,percent of total billed charges,90% of total billed charges,670.5,75,,536.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,259.26,29,,207.408,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,598.98,67,,479.184,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,625.8,70,,500.64,percent of total billed charges,70% of total billed charges,581.1,65,,464.88,percent of total billed charges,65% of total billed charges,318.89,35.67,,255.112,percent of total billed charges,35.67% of total billed charges,259.26,894,
CANCELLOUS SCREW,27014906,CDM,278,RC,C1713,HCPCS,outpatient,,,508,203.20,,355.6,70,,284.48,percent of total billed charges,70% of total billed charges,508,100,,406.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,416.56,82,,333.248,percent of total billed charges,82% of total billed charges,431.8,85,,345.44,percent of total billed charges,85% of total billed charges,431.8,85,,345.44,percent of total billed charges,85% of total billed charges,431.8,85,,345.44,percent of total billed charges,85% of total billed charges,457.2,90,,365.76,percent of total billed charges,90% of total billed charges,406.4,80,,325.12,percent of total billed charges,80% of total billed charges,457.2,90,,365.76,percent of total billed charges,90% of total billed charges,381,75,,304.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,147.32,29,,117.856,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,340.36,67,,272.288,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,355.6,70,,284.48,percent of total billed charges,70% of total billed charges,330.2,65,,264.16,percent of total billed charges,65% of total billed charges,181.2,35.67,,144.96,percent of total billed charges,35.67% of total billed charges,147.32,508,
SCREW 1.5 X 16,27014923,CDM,278,RC,C1713,HCPCS,outpatient,,,508,203.20,,355.6,70,,284.48,percent of total billed charges,70% of total billed charges,508,100,,406.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,416.56,82,,333.248,percent of total billed charges,82% of total billed charges,431.8,85,,345.44,percent of total billed charges,85% of total billed charges,431.8,85,,345.44,percent of total billed charges,85% of total billed charges,431.8,85,,345.44,percent of total billed charges,85% of total billed charges,457.2,90,,365.76,percent of total billed charges,90% of total billed charges,406.4,80,,325.12,percent of total billed charges,80% of total billed charges,457.2,90,,365.76,percent of total billed charges,90% of total billed charges,381,75,,304.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,147.32,29,,117.856,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,340.36,67,,272.288,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,355.6,70,,284.48,percent of total billed charges,70% of total billed charges,330.2,65,,264.16,percent of total billed charges,65% of total billed charges,181.2,35.67,,144.96,percent of total billed charges,35.67% of total billed charges,147.32,508,
SCREWS,27014928,CDM,278,RC,C1713,HCPCS,outpatient,,,2432,972.80,,1702.4,70,,1361.92,percent of total billed charges,70% of total billed charges,1276.8,52.5,,1021.44,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,1994.24,82,,1595.392,percent of total billed charges,82% of total billed charges,2067.2,85,,1653.76,percent of total billed charges,85% of total billed charges,2067.2,85,,1653.76,percent of total billed charges,85% of total billed charges,2067.2,85,,1653.76,percent of total billed charges,85% of total billed charges,2188.8,90,,1751.04,percent of total billed charges,90% of total billed charges,1945.6,80,,1556.48,percent of total billed charges,80% of total billed charges,2188.8,90,,1751.04,percent of total billed charges,90% of total billed charges,1824,75,,1459.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,705.28,29,,564.224,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1629.44,67,,1303.552,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1702.4,70,,1361.92,percent of total billed charges,70% of total billed charges,1580.8,65,,1264.64,percent of total billed charges,65% of total billed charges,867.49,35.67,,693.992,percent of total billed charges,35.67% of total billed charges,705.28,2188.8,
SCREWS,27014929,CDM,278,RC,C1713,HCPCS,outpatient,,,2432,972.80,,1702.4,70,,1361.92,percent of total billed charges,70% of total billed charges,1276.8,52.5,,1021.44,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,1994.24,82,,1595.392,percent of total billed charges,82% of total billed charges,2067.2,85,,1653.76,percent of total billed charges,85% of total billed charges,2067.2,85,,1653.76,percent of total billed charges,85% of total billed charges,2067.2,85,,1653.76,percent of total billed charges,85% of total billed charges,2188.8,90,,1751.04,percent of total billed charges,90% of total billed charges,1945.6,80,,1556.48,percent of total billed charges,80% of total billed charges,2188.8,90,,1751.04,percent of total billed charges,90% of total billed charges,1824,75,,1459.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,705.28,29,,564.224,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1629.44,67,,1303.552,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1702.4,70,,1361.92,percent of total billed charges,70% of total billed charges,1580.8,65,,1264.64,percent of total billed charges,65% of total billed charges,867.49,35.67,,693.992,percent of total billed charges,35.67% of total billed charges,705.28,2188.8,
CORTICAL FIBERS 10.0CC,27014930,CDM,278,RC,C1713,HCPCS,outpatient,,,11701,4680.40,,8190.7,70,,6552.56,percent of total billed charges,70% of total billed charges,6143.03,52.5,,4914.42,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,9594.82,82,,7675.856,percent of total billed charges,82% of total billed charges,9945.85,85,,7956.68,percent of total billed charges,85% of total billed charges,9945.85,85,,7956.68,percent of total billed charges,85% of total billed charges,9945.85,85,,7956.68,percent of total billed charges,85% of total billed charges,10530.9,90,,8424.72,percent of total billed charges,90% of total billed charges,9360.8,80,,7488.64,percent of total billed charges,80% of total billed charges,10530.9,90,,8424.72,percent of total billed charges,90% of total billed charges,8775.75,75,,7020.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,3393.29,29,,2714.632,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,7839.67,67,,6271.736,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,8190.7,70,,6552.56,percent of total billed charges,70% of total billed charges,7605.65,65,,6084.52,percent of total billed charges,65% of total billed charges,4173.75,35.67,,3339,percent of total billed charges,35.67% of total billed charges,3393.29,10530.9,
"RODS, 70 MM",27014931,CDM,278,RC,C1713,HCPCS,outpatient,,,812,324.80,,568.4,70,,454.72,percent of total billed charges,70% of total billed charges,812,100,,649.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,665.84,82,,532.672,percent of total billed charges,82% of total billed charges,690.2,85,,552.16,percent of total billed charges,85% of total billed charges,690.2,85,,552.16,percent of total billed charges,85% of total billed charges,690.2,85,,552.16,percent of total billed charges,85% of total billed charges,730.8,90,,584.64,percent of total billed charges,90% of total billed charges,649.6,80,,519.68,percent of total billed charges,80% of total billed charges,730.8,90,,584.64,percent of total billed charges,90% of total billed charges,609,75,,487.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,235.48,29,,188.384,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,544.04,67,,435.232,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,568.4,70,,454.72,percent of total billed charges,70% of total billed charges,527.8,65,,422.24,percent of total billed charges,65% of total billed charges,289.64,35.67,,231.712,percent of total billed charges,35.67% of total billed charges,235.48,812,
INTERBODY FUSION DEVICE ZEUS,27014934,CDM,278,RC,C1821,HCPCS,outpatient,,,1562,624.80,,1093.4,70,,874.72,percent of total billed charges,70% of total billed charges,820.05,52.5,,656.04,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,1280.84,82,,1024.672,percent of total billed charges,82% of total billed charges,1327.7,85,,1062.16,percent of total billed charges,85% of total billed charges,1327.7,85,,1062.16,percent of total billed charges,85% of total billed charges,1327.7,85,,1062.16,percent of total billed charges,85% of total billed charges,1405.8,90,,1124.64,percent of total billed charges,90% of total billed charges,1249.6,80,,999.68,percent of total billed charges,80% of total billed charges,1405.8,90,,1124.64,percent of total billed charges,90% of total billed charges,1171.5,75,,937.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,452.98,29,,362.384,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1046.54,67,,837.232,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1093.4,70,,874.72,percent of total billed charges,70% of total billed charges,1015.3,65,,812.24,percent of total billed charges,65% of total billed charges,557.17,35.67,,445.736,percent of total billed charges,35.67% of total billed charges,452.98,1405.8,
K WIRE AMENDIA,27014935,CDM,278,RC,C1713,HCPCS,outpatient,,,727,290.80,,508.9,70,,407.12,percent of total billed charges,70% of total billed charges,727,100,,581.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,596.14,82,,476.912,percent of total billed charges,82% of total billed charges,617.95,85,,494.36,percent of total billed charges,85% of total billed charges,617.95,85,,494.36,percent of total billed charges,85% of total billed charges,617.95,85,,494.36,percent of total billed charges,85% of total billed charges,654.3,90,,523.44,percent of total billed charges,90% of total billed charges,581.6,80,,465.28,percent of total billed charges,80% of total billed charges,654.3,90,,523.44,percent of total billed charges,90% of total billed charges,545.25,75,,436.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,210.83,29,,168.664,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,487.09,67,,389.672,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,508.9,70,,407.12,percent of total billed charges,70% of total billed charges,472.55,65,,378.04,percent of total billed charges,65% of total billed charges,259.32,35.67,,207.456,percent of total billed charges,35.67% of total billed charges,210.83,727,
K WIRE AMENDIA,27014936,CDM,278,RC,C1713,HCPCS,outpatient,,,727,290.80,,508.9,70,,407.12,percent of total billed charges,70% of total billed charges,727,100,,581.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,596.14,82,,476.912,percent of total billed charges,82% of total billed charges,617.95,85,,494.36,percent of total billed charges,85% of total billed charges,617.95,85,,494.36,percent of total billed charges,85% of total billed charges,617.95,85,,494.36,percent of total billed charges,85% of total billed charges,654.3,90,,523.44,percent of total billed charges,90% of total billed charges,581.6,80,,465.28,percent of total billed charges,80% of total billed charges,654.3,90,,523.44,percent of total billed charges,90% of total billed charges,545.25,75,,436.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,210.83,29,,168.664,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,487.09,67,,389.672,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,508.9,70,,407.12,percent of total billed charges,70% of total billed charges,472.55,65,,378.04,percent of total billed charges,65% of total billed charges,259.32,35.67,,207.456,percent of total billed charges,35.67% of total billed charges,210.83,727,
INTERBODY FUSION DEVICE,27014939,CDM,278,RC,C1821,HCPCS,outpatient,,,9118,3647.20,,6382.6,70,,5106.08,percent of total billed charges,70% of total billed charges,4786.95,52.5,,3829.56,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,7476.76,82,,5981.408,percent of total billed charges,82% of total billed charges,7750.3,85,,6200.24,percent of total billed charges,85% of total billed charges,7750.3,85,,6200.24,percent of total billed charges,85% of total billed charges,7750.3,85,,6200.24,percent of total billed charges,85% of total billed charges,8206.2,90,,6564.96,percent of total billed charges,90% of total billed charges,7294.4,80,,5835.52,percent of total billed charges,80% of total billed charges,8206.2,90,,6564.96,percent of total billed charges,90% of total billed charges,6838.5,75,,5470.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2644.22,29,,2115.376,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,6109.06,67,,4887.248,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,6382.6,70,,5106.08,percent of total billed charges,70% of total billed charges,5926.7,65,,4741.36,percent of total billed charges,65% of total billed charges,3252.39,35.67,,2601.912,percent of total billed charges,35.67% of total billed charges,2644.22,8206.2,
INTERBODY FUSION DEVICE,27014940,CDM,278,RC,C1821,HCPCS,outpatient,,,1562,624.80,,1093.4,70,,874.72,percent of total billed charges,70% of total billed charges,820.05,52.5,,656.04,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,1280.84,82,,1024.672,percent of total billed charges,82% of total billed charges,1327.7,85,,1062.16,percent of total billed charges,85% of total billed charges,1327.7,85,,1062.16,percent of total billed charges,85% of total billed charges,1327.7,85,,1062.16,percent of total billed charges,85% of total billed charges,1405.8,90,,1124.64,percent of total billed charges,90% of total billed charges,1249.6,80,,999.68,percent of total billed charges,80% of total billed charges,1405.8,90,,1124.64,percent of total billed charges,90% of total billed charges,1171.5,75,,937.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,452.98,29,,362.384,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1046.54,67,,837.232,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1093.4,70,,874.72,percent of total billed charges,70% of total billed charges,1015.3,65,,812.24,percent of total billed charges,65% of total billed charges,557.17,35.67,,445.736,percent of total billed charges,35.67% of total billed charges,452.98,1405.8,
EXPANDABLE LUMBAR INTERBODY,27014941,CDM,278,RC,C1821,HCPCS,outpatient,,,9118,3647.20,,6382.6,70,,5106.08,percent of total billed charges,70% of total billed charges,4786.95,52.5,,3829.56,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,7476.76,82,,5981.408,percent of total billed charges,82% of total billed charges,7750.3,85,,6200.24,percent of total billed charges,85% of total billed charges,7750.3,85,,6200.24,percent of total billed charges,85% of total billed charges,7750.3,85,,6200.24,percent of total billed charges,85% of total billed charges,8206.2,90,,6564.96,percent of total billed charges,90% of total billed charges,7294.4,80,,5835.52,percent of total billed charges,80% of total billed charges,8206.2,90,,6564.96,percent of total billed charges,90% of total billed charges,6838.5,75,,5470.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2644.22,29,,2115.376,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,6109.06,67,,4887.248,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,6382.6,70,,5106.08,percent of total billed charges,70% of total billed charges,5926.7,65,,4741.36,percent of total billed charges,65% of total billed charges,3252.39,35.67,,2601.912,percent of total billed charges,35.67% of total billed charges,2644.22,8206.2,
EXPANDABLE LUMBAR INTERBODY,27014942,CDM,278,RC,C1821,HCPCS,outpatient,,,9118,3647.20,,6382.6,70,,5106.08,percent of total billed charges,70% of total billed charges,4786.95,52.5,,3829.56,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,7476.76,82,,5981.408,percent of total billed charges,82% of total billed charges,7750.3,85,,6200.24,percent of total billed charges,85% of total billed charges,7750.3,85,,6200.24,percent of total billed charges,85% of total billed charges,7750.3,85,,6200.24,percent of total billed charges,85% of total billed charges,8206.2,90,,6564.96,percent of total billed charges,90% of total billed charges,7294.4,80,,5835.52,percent of total billed charges,80% of total billed charges,8206.2,90,,6564.96,percent of total billed charges,90% of total billed charges,6838.5,75,,5470.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2644.22,29,,2115.376,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,6109.06,67,,4887.248,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,6382.6,70,,5106.08,percent of total billed charges,70% of total billed charges,5926.7,65,,4741.36,percent of total billed charges,65% of total billed charges,3252.39,35.67,,2601.912,percent of total billed charges,35.67% of total billed charges,2644.22,8206.2,
OBLIQUE LUMBAR FUSION DEVICE,27014943,CDM,278,RC,C1821,HCPCS,outpatient,,,9118,3647.20,,6382.6,70,,5106.08,percent of total billed charges,70% of total billed charges,4786.95,52.5,,3829.56,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,7476.76,82,,5981.408,percent of total billed charges,82% of total billed charges,7750.3,85,,6200.24,percent of total billed charges,85% of total billed charges,7750.3,85,,6200.24,percent of total billed charges,85% of total billed charges,7750.3,85,,6200.24,percent of total billed charges,85% of total billed charges,8206.2,90,,6564.96,percent of total billed charges,90% of total billed charges,7294.4,80,,5835.52,percent of total billed charges,80% of total billed charges,8206.2,90,,6564.96,percent of total billed charges,90% of total billed charges,6838.5,75,,5470.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2644.22,29,,2115.376,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,6109.06,67,,4887.248,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,6382.6,70,,5106.08,percent of total billed charges,70% of total billed charges,5926.7,65,,4741.36,percent of total billed charges,65% of total billed charges,3252.39,35.67,,2601.912,percent of total billed charges,35.67% of total billed charges,2644.22,8206.2,
EXPANDABLE LUMBAR INTERBODY,27014945,CDM,278,RC,C1821,HCPCS,outpatient,,,9118,3647.20,,6382.6,70,,5106.08,percent of total billed charges,70% of total billed charges,4786.95,52.5,,3829.56,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,7476.76,82,,5981.408,percent of total billed charges,82% of total billed charges,7750.3,85,,6200.24,percent of total billed charges,85% of total billed charges,7750.3,85,,6200.24,percent of total billed charges,85% of total billed charges,7750.3,85,,6200.24,percent of total billed charges,85% of total billed charges,8206.2,90,,6564.96,percent of total billed charges,90% of total billed charges,7294.4,80,,5835.52,percent of total billed charges,80% of total billed charges,8206.2,90,,6564.96,percent of total billed charges,90% of total billed charges,6838.5,75,,5470.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2644.22,29,,2115.376,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,6109.06,67,,4887.248,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,6382.6,70,,5106.08,percent of total billed charges,70% of total billed charges,5926.7,65,,4741.36,percent of total billed charges,65% of total billed charges,3252.39,35.67,,2601.912,percent of total billed charges,35.67% of total billed charges,2644.22,8206.2,
LOCKING SCREW POLYAXIAL,27014954,CDM,278,RC,C1713,HCPCS,outpatient,,,1055,422.00,,738.5,70,,590.8,percent of total billed charges,70% of total billed charges,553.88,52.5,,443.1,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,865.1,82,,692.08,percent of total billed charges,82% of total billed charges,896.75,85,,717.4,percent of total billed charges,85% of total billed charges,896.75,85,,717.4,percent of total billed charges,85% of total billed charges,896.75,85,,717.4,percent of total billed charges,85% of total billed charges,949.5,90,,759.6,percent of total billed charges,90% of total billed charges,844,80,,675.2,percent of total billed charges,80% of total billed charges,949.5,90,,759.6,percent of total billed charges,90% of total billed charges,791.25,75,,633,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,305.95,29,,244.76,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,706.85,67,,565.48,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,738.5,70,,590.8,percent of total billed charges,70% of total billed charges,685.75,65,,548.6,percent of total billed charges,65% of total billed charges,376.32,35.67,,301.056,percent of total billed charges,35.67% of total billed charges,305.95,949.5,
LOCKING SCREW,27014955,CDM,278,RC,C1713,HCPCS,outpatient,,,1055,422.00,,738.5,70,,590.8,percent of total billed charges,70% of total billed charges,553.88,52.5,,443.1,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,865.1,82,,692.08,percent of total billed charges,82% of total billed charges,896.75,85,,717.4,percent of total billed charges,85% of total billed charges,896.75,85,,717.4,percent of total billed charges,85% of total billed charges,896.75,85,,717.4,percent of total billed charges,85% of total billed charges,949.5,90,,759.6,percent of total billed charges,90% of total billed charges,844,80,,675.2,percent of total billed charges,80% of total billed charges,949.5,90,,759.6,percent of total billed charges,90% of total billed charges,791.25,75,,633,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,305.95,29,,244.76,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,706.85,67,,565.48,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,738.5,70,,590.8,percent of total billed charges,70% of total billed charges,685.75,65,,548.6,percent of total billed charges,65% of total billed charges,376.32,35.67,,301.056,percent of total billed charges,35.67% of total billed charges,305.95,949.5,
NONLOCKING SCREW,27014956,CDM,278,RC,C1713,HCPCS,outpatient,,,894,357.60,,625.8,70,,500.64,percent of total billed charges,70% of total billed charges,894,100,,715.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,733.08,82,,586.464,percent of total billed charges,82% of total billed charges,759.9,85,,607.92,percent of total billed charges,85% of total billed charges,759.9,85,,607.92,percent of total billed charges,85% of total billed charges,759.9,85,,607.92,percent of total billed charges,85% of total billed charges,804.6,90,,643.68,percent of total billed charges,90% of total billed charges,715.2,80,,572.16,percent of total billed charges,80% of total billed charges,804.6,90,,643.68,percent of total billed charges,90% of total billed charges,670.5,75,,536.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,259.26,29,,207.408,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,598.98,67,,479.184,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,625.8,70,,500.64,percent of total billed charges,70% of total billed charges,581.1,65,,464.88,percent of total billed charges,65% of total billed charges,318.89,35.67,,255.112,percent of total billed charges,35.67% of total billed charges,259.26,894,
NONLOCKING SCREW 3.5X32MM,27014957,CDM,278,RC,C1713,HCPCS,outpatient,,,894,357.60,,625.8,70,,500.64,percent of total billed charges,70% of total billed charges,894,100,,715.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,733.08,82,,586.464,percent of total billed charges,82% of total billed charges,759.9,85,,607.92,percent of total billed charges,85% of total billed charges,759.9,85,,607.92,percent of total billed charges,85% of total billed charges,759.9,85,,607.92,percent of total billed charges,85% of total billed charges,804.6,90,,643.68,percent of total billed charges,90% of total billed charges,715.2,80,,572.16,percent of total billed charges,80% of total billed charges,804.6,90,,643.68,percent of total billed charges,90% of total billed charges,670.5,75,,536.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,259.26,29,,207.408,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,598.98,67,,479.184,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,625.8,70,,500.64,percent of total billed charges,70% of total billed charges,581.1,65,,464.88,percent of total billed charges,65% of total billed charges,318.89,35.67,,255.112,percent of total billed charges,35.67% of total billed charges,259.26,894,
NONLOCKING SCREW,27014958,CDM,278,RC,C1713,HCPCS,outpatient,,,894,357.60,,625.8,70,,500.64,percent of total billed charges,70% of total billed charges,894,100,,715.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,733.08,82,,586.464,percent of total billed charges,82% of total billed charges,759.9,85,,607.92,percent of total billed charges,85% of total billed charges,759.9,85,,607.92,percent of total billed charges,85% of total billed charges,759.9,85,,607.92,percent of total billed charges,85% of total billed charges,804.6,90,,643.68,percent of total billed charges,90% of total billed charges,715.2,80,,572.16,percent of total billed charges,80% of total billed charges,804.6,90,,643.68,percent of total billed charges,90% of total billed charges,670.5,75,,536.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,259.26,29,,207.408,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,598.98,67,,479.184,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,625.8,70,,500.64,percent of total billed charges,70% of total billed charges,581.1,65,,464.88,percent of total billed charges,65% of total billed charges,318.89,35.67,,255.112,percent of total billed charges,35.67% of total billed charges,259.26,894,
LAPIDUS PLATE,27014960,CDM,278,RC,C1713,HCPCS,outpatient,,,5472,2188.80,,3830.4,70,,3064.32,percent of total billed charges,70% of total billed charges,2872.8,52.5,,2298.24,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,4487.04,82,,3589.632,percent of total billed charges,82% of total billed charges,4651.2,85,,3720.96,percent of total billed charges,85% of total billed charges,4651.2,85,,3720.96,percent of total billed charges,85% of total billed charges,4651.2,85,,3720.96,percent of total billed charges,85% of total billed charges,4924.8,90,,3939.84,percent of total billed charges,90% of total billed charges,4377.6,80,,3502.08,percent of total billed charges,80% of total billed charges,4924.8,90,,3939.84,percent of total billed charges,90% of total billed charges,4104,75,,3283.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,1586.88,29,,1269.504,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,3666.24,67,,2932.992,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,3830.4,70,,3064.32,percent of total billed charges,70% of total billed charges,3556.8,65,,2845.44,percent of total billed charges,65% of total billed charges,1951.86,35.67,,1561.488,percent of total billed charges,35.67% of total billed charges,1586.88,4924.8,
GUIDE WIRE,27014969,CDM,278,RC,C1769,HCPCS,outpatient,,,102,40.80,,71.4,70,,57.12,percent of total billed charges,70% of total billed charges,102,100,,81.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,83.64,82,,66.912,percent of total billed charges,82% of total billed charges,86.7,85,,69.36,percent of total billed charges,85% of total billed charges,86.7,85,,69.36,percent of total billed charges,85% of total billed charges,86.7,85,,69.36,percent of total billed charges,85% of total billed charges,91.8,90,,73.44,percent of total billed charges,90% of total billed charges,81.6,80,,65.28,percent of total billed charges,80% of total billed charges,91.8,90,,73.44,percent of total billed charges,90% of total billed charges,76.5,75,,61.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,29.58,29,,23.664,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,68.34,67,,54.672,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,71.4,70,,57.12,percent of total billed charges,70% of total billed charges,66.3,65,,53.04,percent of total billed charges,65% of total billed charges,36.38,35.67,,29.104,percent of total billed charges,35.67% of total billed charges,29.58,102,
SUPER QUICKANCHOR PLUS DS,27014973,CDM,278,RC,C1713,HCPCS,outpatient,,,1826,730.40,,1278.2,70,,1022.56,percent of total billed charges,70% of total billed charges,958.65,52.5,,766.92,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,1497.32,82,,1197.856,percent of total billed charges,82% of total billed charges,1552.1,85,,1241.68,percent of total billed charges,85% of total billed charges,1552.1,85,,1241.68,percent of total billed charges,85% of total billed charges,1552.1,85,,1241.68,percent of total billed charges,85% of total billed charges,1643.4,90,,1314.72,percent of total billed charges,90% of total billed charges,1460.8,80,,1168.64,percent of total billed charges,80% of total billed charges,1643.4,90,,1314.72,percent of total billed charges,90% of total billed charges,1369.5,75,,1095.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,529.54,29,,423.632,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1223.42,67,,978.736,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1278.2,70,,1022.56,percent of total billed charges,70% of total billed charges,1186.9,65,,949.52,percent of total billed charges,65% of total billed charges,651.33,35.67,,521.064,percent of total billed charges,35.67% of total billed charges,529.54,1643.4,
SUPER QUICK ANCHOR PLUS,27014974,CDM,278,RC,C1713,HCPCS,outpatient,,,1917,766.80,,1341.9,70,,1073.52,percent of total billed charges,70% of total billed charges,1006.43,52.5,,805.14,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,1571.94,82,,1257.552,percent of total billed charges,82% of total billed charges,1629.45,85,,1303.56,percent of total billed charges,85% of total billed charges,1629.45,85,,1303.56,percent of total billed charges,85% of total billed charges,1629.45,85,,1303.56,percent of total billed charges,85% of total billed charges,1725.3,90,,1380.24,percent of total billed charges,90% of total billed charges,1533.6,80,,1226.88,percent of total billed charges,80% of total billed charges,1725.3,90,,1380.24,percent of total billed charges,90% of total billed charges,1437.75,75,,1150.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,555.93,29,,444.744,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1284.39,67,,1027.512,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1341.9,70,,1073.52,percent of total billed charges,70% of total billed charges,1246.05,65,,996.84,percent of total billed charges,65% of total billed charges,683.79,35.67,,547.032,percent of total billed charges,35.67% of total billed charges,555.93,1725.3,
RODS 120 MM,27014984,CDM,278,RC,C1713,HCPCS,outpatient,,,812,324.80,,568.4,70,,454.72,percent of total billed charges,70% of total billed charges,812,100,,649.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,665.84,82,,532.672,percent of total billed charges,82% of total billed charges,690.2,85,,552.16,percent of total billed charges,85% of total billed charges,690.2,85,,552.16,percent of total billed charges,85% of total billed charges,690.2,85,,552.16,percent of total billed charges,85% of total billed charges,730.8,90,,584.64,percent of total billed charges,90% of total billed charges,649.6,80,,519.68,percent of total billed charges,80% of total billed charges,730.8,90,,584.64,percent of total billed charges,90% of total billed charges,609,75,,487.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,235.48,29,,188.384,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,544.04,67,,435.232,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,568.4,70,,454.72,percent of total billed charges,70% of total billed charges,527.8,65,,422.24,percent of total billed charges,65% of total billed charges,289.64,35.67,,231.712,percent of total billed charges,35.67% of total billed charges,235.48,812,
ROD 140 MM,27014992,CDM,278,RC,C1713,HCPCS,outpatient,,,812,324.80,,568.4,70,,454.72,percent of total billed charges,70% of total billed charges,812,100,,649.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,665.84,82,,532.672,percent of total billed charges,82% of total billed charges,690.2,85,,552.16,percent of total billed charges,85% of total billed charges,690.2,85,,552.16,percent of total billed charges,85% of total billed charges,690.2,85,,552.16,percent of total billed charges,85% of total billed charges,730.8,90,,584.64,percent of total billed charges,90% of total billed charges,649.6,80,,519.68,percent of total billed charges,80% of total billed charges,730.8,90,,584.64,percent of total billed charges,90% of total billed charges,609,75,,487.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,235.48,29,,188.384,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,544.04,67,,435.232,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,568.4,70,,454.72,percent of total billed charges,70% of total billed charges,527.8,65,,422.24,percent of total billed charges,65% of total billed charges,289.64,35.67,,231.712,percent of total billed charges,35.67% of total billed charges,235.48,812,
ROD 90 MM,27014996,CDM,278,RC,C1713,HCPCS,outpatient,,,812,324.80,,568.4,70,,454.72,percent of total billed charges,70% of total billed charges,812,100,,649.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,665.84,82,,532.672,percent of total billed charges,82% of total billed charges,690.2,85,,552.16,percent of total billed charges,85% of total billed charges,690.2,85,,552.16,percent of total billed charges,85% of total billed charges,690.2,85,,552.16,percent of total billed charges,85% of total billed charges,730.8,90,,584.64,percent of total billed charges,90% of total billed charges,649.6,80,,519.68,percent of total billed charges,80% of total billed charges,730.8,90,,584.64,percent of total billed charges,90% of total billed charges,609,75,,487.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,235.48,29,,188.384,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,544.04,67,,435.232,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,568.4,70,,454.72,percent of total billed charges,70% of total billed charges,527.8,65,,422.24,percent of total billed charges,65% of total billed charges,289.64,35.67,,231.712,percent of total billed charges,35.67% of total billed charges,235.48,812,
LOCK CIRCULAR STAR,27014997,CDM,278,RC,C1713,HCPCS,outpatient,,,357,142.80,,249.9,70,,199.92,percent of total billed charges,70% of total billed charges,357,100,,285.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,292.74,82,,234.192,percent of total billed charges,82% of total billed charges,303.45,85,,242.76,percent of total billed charges,85% of total billed charges,303.45,85,,242.76,percent of total billed charges,85% of total billed charges,303.45,85,,242.76,percent of total billed charges,85% of total billed charges,321.3,90,,257.04,percent of total billed charges,90% of total billed charges,285.6,80,,228.48,percent of total billed charges,80% of total billed charges,321.3,90,,257.04,percent of total billed charges,90% of total billed charges,267.75,75,,214.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,103.53,29,,82.824,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,239.19,67,,191.352,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,249.9,70,,199.92,percent of total billed charges,70% of total billed charges,232.05,65,,185.64,percent of total billed charges,65% of total billed charges,127.34,35.67,,101.872,percent of total billed charges,35.67% of total billed charges,103.53,357,
ZEUS OLLIF LUMBAR FUSION,27015017,CDM,278,RC,C1821,HCPCS,outpatient,,,9118,3647.20,,6382.6,70,,5106.08,percent of total billed charges,70% of total billed charges,4786.95,52.5,,3829.56,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,7476.76,82,,5981.408,percent of total billed charges,82% of total billed charges,7750.3,85,,6200.24,percent of total billed charges,85% of total billed charges,7750.3,85,,6200.24,percent of total billed charges,85% of total billed charges,7750.3,85,,6200.24,percent of total billed charges,85% of total billed charges,8206.2,90,,6564.96,percent of total billed charges,90% of total billed charges,7294.4,80,,5835.52,percent of total billed charges,80% of total billed charges,8206.2,90,,6564.96,percent of total billed charges,90% of total billed charges,6838.5,75,,5470.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2644.22,29,,2115.376,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,6109.06,67,,4887.248,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,6382.6,70,,5106.08,percent of total billed charges,70% of total billed charges,5926.7,65,,4741.36,percent of total billed charges,65% of total billed charges,3252.39,35.67,,2601.912,percent of total billed charges,35.67% of total billed charges,2644.22,8206.2,
SCREW 2.7 MM,27015029,CDM,278,RC,C1713,HCPCS,outpatient,,,508,203.20,,355.6,70,,284.48,percent of total billed charges,70% of total billed charges,508,100,,406.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,416.56,82,,333.248,percent of total billed charges,82% of total billed charges,431.8,85,,345.44,percent of total billed charges,85% of total billed charges,431.8,85,,345.44,percent of total billed charges,85% of total billed charges,431.8,85,,345.44,percent of total billed charges,85% of total billed charges,457.2,90,,365.76,percent of total billed charges,90% of total billed charges,406.4,80,,325.12,percent of total billed charges,80% of total billed charges,457.2,90,,365.76,percent of total billed charges,90% of total billed charges,381,75,,304.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,147.32,29,,117.856,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,340.36,67,,272.288,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,355.6,70,,284.48,percent of total billed charges,70% of total billed charges,330.2,65,,264.16,percent of total billed charges,65% of total billed charges,181.2,35.67,,144.96,percent of total billed charges,35.67% of total billed charges,147.32,508,
FUSION MTP PLATE,27015030,CDM,278,RC,C1713,HCPCS,outpatient,,,4378,1751.20,,3064.6,70,,2451.68,percent of total billed charges,70% of total billed charges,2298.45,52.5,,1838.76,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,3589.96,82,,2871.968,percent of total billed charges,82% of total billed charges,3721.3,85,,2977.04,percent of total billed charges,85% of total billed charges,3721.3,85,,2977.04,percent of total billed charges,85% of total billed charges,3721.3,85,,2977.04,percent of total billed charges,85% of total billed charges,3940.2,90,,3152.16,percent of total billed charges,90% of total billed charges,3502.4,80,,2801.92,percent of total billed charges,80% of total billed charges,3940.2,90,,3152.16,percent of total billed charges,90% of total billed charges,3283.5,75,,2626.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,1269.62,29,,1015.696,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,2933.26,67,,2346.608,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,3064.6,70,,2451.68,percent of total billed charges,70% of total billed charges,2845.7,65,,2276.56,percent of total billed charges,65% of total billed charges,1561.63,35.67,,1249.304,percent of total billed charges,35.67% of total billed charges,1269.62,3940.2,
SCREW POLYAXIAL LOCKING,27015031,CDM,278,RC,C1713,HCPCS,outpatient,,,1055,422.00,,738.5,70,,590.8,percent of total billed charges,70% of total billed charges,553.88,52.5,,443.1,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,865.1,82,,692.08,percent of total billed charges,82% of total billed charges,896.75,85,,717.4,percent of total billed charges,85% of total billed charges,896.75,85,,717.4,percent of total billed charges,85% of total billed charges,896.75,85,,717.4,percent of total billed charges,85% of total billed charges,949.5,90,,759.6,percent of total billed charges,90% of total billed charges,844,80,,675.2,percent of total billed charges,80% of total billed charges,949.5,90,,759.6,percent of total billed charges,90% of total billed charges,791.25,75,,633,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,305.95,29,,244.76,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,706.85,67,,565.48,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,738.5,70,,590.8,percent of total billed charges,70% of total billed charges,685.75,65,,548.6,percent of total billed charges,65% of total billed charges,376.32,35.67,,301.056,percent of total billed charges,35.67% of total billed charges,305.95,949.5,
SCREW POLYAXIAL LOCKING,27015032,CDM,278,RC,C1713,HCPCS,outpatient,,,1055,422.00,,738.5,70,,590.8,percent of total billed charges,70% of total billed charges,553.88,52.5,,443.1,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,865.1,82,,692.08,percent of total billed charges,82% of total billed charges,896.75,85,,717.4,percent of total billed charges,85% of total billed charges,896.75,85,,717.4,percent of total billed charges,85% of total billed charges,896.75,85,,717.4,percent of total billed charges,85% of total billed charges,949.5,90,,759.6,percent of total billed charges,90% of total billed charges,844,80,,675.2,percent of total billed charges,80% of total billed charges,949.5,90,,759.6,percent of total billed charges,90% of total billed charges,791.25,75,,633,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,305.95,29,,244.76,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,706.85,67,,565.48,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,738.5,70,,590.8,percent of total billed charges,70% of total billed charges,685.75,65,,548.6,percent of total billed charges,65% of total billed charges,376.32,35.67,,301.056,percent of total billed charges,35.67% of total billed charges,305.95,949.5,
SCREW NON LOCKING 2.7 X 14MM,27015033,CDM,278,RC,C1713,HCPCS,outpatient,,,894,357.60,,625.8,70,,500.64,percent of total billed charges,70% of total billed charges,894,100,,715.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,733.08,82,,586.464,percent of total billed charges,82% of total billed charges,759.9,85,,607.92,percent of total billed charges,85% of total billed charges,759.9,85,,607.92,percent of total billed charges,85% of total billed charges,759.9,85,,607.92,percent of total billed charges,85% of total billed charges,804.6,90,,643.68,percent of total billed charges,90% of total billed charges,715.2,80,,572.16,percent of total billed charges,80% of total billed charges,804.6,90,,643.68,percent of total billed charges,90% of total billed charges,670.5,75,,536.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,259.26,29,,207.408,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,598.98,67,,479.184,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,625.8,70,,500.64,percent of total billed charges,70% of total billed charges,581.1,65,,464.88,percent of total billed charges,65% of total billed charges,318.89,35.67,,255.112,percent of total billed charges,35.67% of total billed charges,259.26,894,
SCREW NON LOCKING 2.7,27015034,CDM,278,RC,C1713,HCPCS,outpatient,,,894,357.60,,625.8,70,,500.64,percent of total billed charges,70% of total billed charges,894,100,,715.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,733.08,82,,586.464,percent of total billed charges,82% of total billed charges,759.9,85,,607.92,percent of total billed charges,85% of total billed charges,759.9,85,,607.92,percent of total billed charges,85% of total billed charges,759.9,85,,607.92,percent of total billed charges,85% of total billed charges,804.6,90,,643.68,percent of total billed charges,90% of total billed charges,715.2,80,,572.16,percent of total billed charges,80% of total billed charges,804.6,90,,643.68,percent of total billed charges,90% of total billed charges,670.5,75,,536.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,259.26,29,,207.408,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,598.98,67,,479.184,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,625.8,70,,500.64,percent of total billed charges,70% of total billed charges,581.1,65,,464.88,percent of total billed charges,65% of total billed charges,318.89,35.67,,255.112,percent of total billed charges,35.67% of total billed charges,259.26,894,
PHANTOM ISULATED DILATOR,27015066,CDM,278,RC,C1713,HCPCS,outpatient,,,1583,633.20,,1108.1,70,,886.48,percent of total billed charges,70% of total billed charges,831.08,52.5,,664.86,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,1298.06,82,,1038.448,percent of total billed charges,82% of total billed charges,1345.55,85,,1076.44,percent of total billed charges,85% of total billed charges,1345.55,85,,1076.44,percent of total billed charges,85% of total billed charges,1345.55,85,,1076.44,percent of total billed charges,85% of total billed charges,1424.7,90,,1139.76,percent of total billed charges,90% of total billed charges,1266.4,80,,1013.12,percent of total billed charges,80% of total billed charges,1424.7,90,,1139.76,percent of total billed charges,90% of total billed charges,1187.25,75,,949.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,459.07,29,,367.256,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1060.61,67,,848.488,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1108.1,70,,886.48,percent of total billed charges,70% of total billed charges,1028.95,65,,823.16,percent of total billed charges,65% of total billed charges,564.66,35.67,,451.728,percent of total billed charges,35.67% of total billed charges,459.07,1424.7,
ZEUS OLLIF,27015067,CDM,278,RC,C1713,HCPCS,outpatient,,,9118,3647.20,,6382.6,70,,5106.08,percent of total billed charges,70% of total billed charges,4786.95,52.5,,3829.56,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,7476.76,82,,5981.408,percent of total billed charges,82% of total billed charges,7750.3,85,,6200.24,percent of total billed charges,85% of total billed charges,7750.3,85,,6200.24,percent of total billed charges,85% of total billed charges,7750.3,85,,6200.24,percent of total billed charges,85% of total billed charges,8206.2,90,,6564.96,percent of total billed charges,90% of total billed charges,7294.4,80,,5835.52,percent of total billed charges,80% of total billed charges,8206.2,90,,6564.96,percent of total billed charges,90% of total billed charges,6838.5,75,,5470.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2644.22,29,,2115.376,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,6109.06,67,,4887.248,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,6382.6,70,,5106.08,percent of total billed charges,70% of total billed charges,5926.7,65,,4741.36,percent of total billed charges,65% of total billed charges,3252.39,35.67,,2601.912,percent of total billed charges,35.67% of total billed charges,2644.22,8206.2,
PLATE SET 2 HOLE RIGHT,27015069,CDM,278,RC,C1713,HCPCS,outpatient,,,5467,2186.80,,3826.9,70,,3061.52,percent of total billed charges,70% of total billed charges,2870.18,52.5,,2296.14,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,4482.94,82,,3586.352,percent of total billed charges,82% of total billed charges,4646.95,85,,3717.56,percent of total billed charges,85% of total billed charges,4646.95,85,,3717.56,percent of total billed charges,85% of total billed charges,4646.95,85,,3717.56,percent of total billed charges,85% of total billed charges,4920.3,90,,3936.24,percent of total billed charges,90% of total billed charges,4373.6,80,,3498.88,percent of total billed charges,80% of total billed charges,4920.3,90,,3936.24,percent of total billed charges,90% of total billed charges,4100.25,75,,3280.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,1585.43,29,,1268.344,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,3662.89,67,,2930.312,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,3826.9,70,,3061.52,percent of total billed charges,70% of total billed charges,3553.55,65,,2842.84,percent of total billed charges,65% of total billed charges,1950.08,35.67,,1560.064,percent of total billed charges,35.67% of total billed charges,1585.43,4920.3,
WIRE 1.6 MM,27015070,CDM,278,RC,C1713,HCPCS,outpatient,,,821,328.40,,574.7,70,,459.76,percent of total billed charges,70% of total billed charges,821,100,,656.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,673.22,82,,538.576,percent of total billed charges,82% of total billed charges,697.85,85,,558.28,percent of total billed charges,85% of total billed charges,697.85,85,,558.28,percent of total billed charges,85% of total billed charges,697.85,85,,558.28,percent of total billed charges,85% of total billed charges,738.9,90,,591.12,percent of total billed charges,90% of total billed charges,656.8,80,,525.44,percent of total billed charges,80% of total billed charges,738.9,90,,591.12,percent of total billed charges,90% of total billed charges,615.75,75,,492.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,238.09,29,,190.472,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,550.07,67,,440.056,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,574.7,70,,459.76,percent of total billed charges,70% of total billed charges,533.65,65,,426.92,percent of total billed charges,65% of total billed charges,292.85,35.67,,234.28,percent of total billed charges,35.67% of total billed charges,238.09,821,
SCREWS 6.5,27015073,CDM,278,RC,C1713,HCPCS,outpatient,,,2432,972.80,,1702.4,70,,1361.92,percent of total billed charges,70% of total billed charges,1276.8,52.5,,1021.44,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,1994.24,82,,1595.392,percent of total billed charges,82% of total billed charges,2067.2,85,,1653.76,percent of total billed charges,85% of total billed charges,2067.2,85,,1653.76,percent of total billed charges,85% of total billed charges,2067.2,85,,1653.76,percent of total billed charges,85% of total billed charges,2188.8,90,,1751.04,percent of total billed charges,90% of total billed charges,1945.6,80,,1556.48,percent of total billed charges,80% of total billed charges,2188.8,90,,1751.04,percent of total billed charges,90% of total billed charges,1824,75,,1459.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,705.28,29,,564.224,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1629.44,67,,1303.552,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1702.4,70,,1361.92,percent of total billed charges,70% of total billed charges,1580.8,65,,1264.64,percent of total billed charges,65% of total billed charges,867.49,35.67,,693.992,percent of total billed charges,35.67% of total billed charges,705.28,2188.8,
65 MM ROD,27015074,CDM,278,RC,C1713,HCPCS,outpatient,,,1826,730.40,,1278.2,70,,1022.56,percent of total billed charges,70% of total billed charges,958.65,52.5,,766.92,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,1497.32,82,,1197.856,percent of total billed charges,82% of total billed charges,1552.1,85,,1241.68,percent of total billed charges,85% of total billed charges,1552.1,85,,1241.68,percent of total billed charges,85% of total billed charges,1552.1,85,,1241.68,percent of total billed charges,85% of total billed charges,1643.4,90,,1314.72,percent of total billed charges,90% of total billed charges,1460.8,80,,1168.64,percent of total billed charges,80% of total billed charges,1643.4,90,,1314.72,percent of total billed charges,90% of total billed charges,1369.5,75,,1095.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,529.54,29,,423.632,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1223.42,67,,978.736,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1278.2,70,,1022.56,percent of total billed charges,70% of total billed charges,1186.9,65,,949.52,percent of total billed charges,65% of total billed charges,651.33,35.67,,521.064,percent of total billed charges,35.67% of total billed charges,529.54,1643.4,
IMPLANT ZEUS 10X8X28 MM,27015114,CDM,278,RC,C1713,HCPCS,outpatient,,,13705,5482.00,,9593.5,70,,7674.8,percent of total billed charges,70% of total billed charges,7195.13,52.5,,5756.1,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,11238.1,82,,8990.48,percent of total billed charges,82% of total billed charges,11649.25,85,,9319.4,percent of total billed charges,85% of total billed charges,11649.25,85,,9319.4,percent of total billed charges,85% of total billed charges,11649.25,85,,9319.4,percent of total billed charges,85% of total billed charges,12334.5,90,,9867.6,percent of total billed charges,90% of total billed charges,10964,80,,8771.2,percent of total billed charges,80% of total billed charges,12334.5,90,,9867.6,percent of total billed charges,90% of total billed charges,10278.75,75,,8223,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,3974.45,29,,3179.56,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,9182.35,67,,7345.88,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,9593.5,70,,7674.8,percent of total billed charges,70% of total billed charges,8908.25,65,,7126.6,percent of total billed charges,65% of total billed charges,4888.57,35.67,,3910.856,percent of total billed charges,35.67% of total billed charges,3974.45,12334.5,
GRAFTLINK 9X65 FGL LIFENET,27015119,CDM,278,RC,C1713,HCPCS,outpatient,,,5675,2270.00,,3972.5,70,,3178,percent of total billed charges,70% of total billed charges,2979.38,52.5,,2383.5,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,4653.5,82,,3722.8,percent of total billed charges,82% of total billed charges,4823.75,85,,3859,percent of total billed charges,85% of total billed charges,4823.75,85,,3859,percent of total billed charges,85% of total billed charges,4823.75,85,,3859,percent of total billed charges,85% of total billed charges,5107.5,90,,4086,percent of total billed charges,90% of total billed charges,4540,80,,3632,percent of total billed charges,80% of total billed charges,5107.5,90,,4086,percent of total billed charges,90% of total billed charges,4256.25,75,,3405,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,1645.75,29,,1316.6,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,3802.25,67,,3041.8,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,3972.5,70,,3178,percent of total billed charges,70% of total billed charges,3688.75,65,,2951,percent of total billed charges,65% of total billed charges,2024.27,35.67,,1619.416,percent of total billed charges,35.67% of total billed charges,1645.75,5107.5,
TIGHTROPE BTB,27015124,CDM,278,RC,C1713,HCPCS,outpatient,,,1850,740.00,,1295,70,,1036,percent of total billed charges,70% of total billed charges,971.25,52.5,,777,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,1517,82,,1213.6,percent of total billed charges,82% of total billed charges,1572.5,85,,1258,percent of total billed charges,85% of total billed charges,1572.5,85,,1258,percent of total billed charges,85% of total billed charges,1572.5,85,,1258,percent of total billed charges,85% of total billed charges,1665,90,,1332,percent of total billed charges,90% of total billed charges,1480,80,,1184,percent of total billed charges,80% of total billed charges,1665,90,,1332,percent of total billed charges,90% of total billed charges,1387.5,75,,1110,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,536.5,29,,429.2,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1239.5,67,,991.6,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1295,70,,1036,percent of total billed charges,70% of total billed charges,1202.5,65,,962,percent of total billed charges,65% of total billed charges,659.9,35.67,,527.92,percent of total billed charges,35.67% of total billed charges,536.5,1665,
ACL TIGHTROPE RIGHT,27015125,CDM,278,RC,C1713,HCPCS,outpatient,,,2028,811.20,,1419.6,70,,1135.68,percent of total billed charges,70% of total billed charges,1064.7,52.5,,851.76,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,1662.96,82,,1330.368,percent of total billed charges,82% of total billed charges,1723.8,85,,1379.04,percent of total billed charges,85% of total billed charges,1723.8,85,,1379.04,percent of total billed charges,85% of total billed charges,1723.8,85,,1379.04,percent of total billed charges,85% of total billed charges,1825.2,90,,1460.16,percent of total billed charges,90% of total billed charges,1622.4,80,,1297.92,percent of total billed charges,80% of total billed charges,1825.2,90,,1460.16,percent of total billed charges,90% of total billed charges,1521,75,,1216.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,588.12,29,,470.496,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1358.76,67,,1087.008,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1419.6,70,,1135.68,percent of total billed charges,70% of total billed charges,1318.2,65,,1054.56,percent of total billed charges,65% of total billed charges,723.39,35.67,,578.712,percent of total billed charges,35.67% of total billed charges,588.12,1825.2,
TIGHTROPE ABD 14 MM BUTTON,27015126,CDM,278,RC,C1713,HCPCS,outpatient,,,1244,497.60,,870.8,70,,696.64,percent of total billed charges,70% of total billed charges,653.1,52.5,,522.48,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,1020.08,82,,816.064,percent of total billed charges,82% of total billed charges,1057.4,85,,845.92,percent of total billed charges,85% of total billed charges,1057.4,85,,845.92,percent of total billed charges,85% of total billed charges,1057.4,85,,845.92,percent of total billed charges,85% of total billed charges,1119.6,90,,895.68,percent of total billed charges,90% of total billed charges,995.2,80,,796.16,percent of total billed charges,80% of total billed charges,1119.6,90,,895.68,percent of total billed charges,90% of total billed charges,933,75,,746.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,360.76,29,,288.608,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,833.48,67,,666.784,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,870.8,70,,696.64,percent of total billed charges,70% of total billed charges,808.6,65,,646.88,percent of total billed charges,65% of total billed charges,443.73,35.67,,354.984,percent of total billed charges,35.67% of total billed charges,360.76,1119.6,
THIGHTROPE ABS IMPLANT,27015127,CDM,278,RC,C1713,HCPCS,outpatient,,,1218,487.20,,852.6,70,,682.08,percent of total billed charges,70% of total billed charges,639.45,52.5,,511.56,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,998.76,82,,799.008,percent of total billed charges,82% of total billed charges,1035.3,85,,828.24,percent of total billed charges,85% of total billed charges,1035.3,85,,828.24,percent of total billed charges,85% of total billed charges,1035.3,85,,828.24,percent of total billed charges,85% of total billed charges,1096.2,90,,876.96,percent of total billed charges,90% of total billed charges,974.4,80,,779.52,percent of total billed charges,80% of total billed charges,1096.2,90,,876.96,percent of total billed charges,90% of total billed charges,913.5,75,,730.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,353.22,29,,282.576,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,816.06,67,,652.848,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,852.6,70,,682.08,percent of total billed charges,70% of total billed charges,791.7,65,,633.36,percent of total billed charges,65% of total billed charges,434.46,35.67,,347.568,percent of total billed charges,35.67% of total billed charges,353.22,1096.2,
FIBERSNARE FIBERWIRE #2,27015128,CDM,278,RC,C1713,HCPCS,outpatient,,,762,304.80,,533.4,70,,426.72,percent of total billed charges,70% of total billed charges,762,100,,609.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,624.84,82,,499.872,percent of total billed charges,82% of total billed charges,647.7,85,,518.16,percent of total billed charges,85% of total billed charges,647.7,85,,518.16,percent of total billed charges,85% of total billed charges,647.7,85,,518.16,percent of total billed charges,85% of total billed charges,685.8,90,,548.64,percent of total billed charges,90% of total billed charges,609.6,80,,487.68,percent of total billed charges,80% of total billed charges,685.8,90,,548.64,percent of total billed charges,90% of total billed charges,571.5,75,,457.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,220.98,29,,176.784,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,510.54,67,,408.432,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,533.4,70,,426.72,percent of total billed charges,70% of total billed charges,495.3,65,,396.24,percent of total billed charges,65% of total billed charges,271.81,35.67,,217.448,percent of total billed charges,35.67% of total billed charges,220.98,762,
SCREW CORTEX 2.0 MM,27015139,CDM,278,RC,C1713,HCPCS,outpatient,,,262,104.80,,183.4,70,,146.72,percent of total billed charges,70% of total billed charges,262,100,,209.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,214.84,82,,171.872,percent of total billed charges,82% of total billed charges,222.7,85,,178.16,percent of total billed charges,85% of total billed charges,222.7,85,,178.16,percent of total billed charges,85% of total billed charges,222.7,85,,178.16,percent of total billed charges,85% of total billed charges,235.8,90,,188.64,percent of total billed charges,90% of total billed charges,209.6,80,,167.68,percent of total billed charges,80% of total billed charges,235.8,90,,188.64,percent of total billed charges,90% of total billed charges,196.5,75,,157.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,75.98,29,,60.784,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,175.54,67,,140.432,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,183.4,70,,146.72,percent of total billed charges,70% of total billed charges,170.3,65,,136.24,percent of total billed charges,65% of total billed charges,93.46,35.67,,74.768,percent of total billed charges,35.67% of total billed charges,75.98,262,
SCREW CORTEX 2.00 RECESS,27015140,CDM,278,RC,C1713,HCPCS,outpatient,,,737,294.80,,515.9,70,,412.72,percent of total billed charges,70% of total billed charges,737,100,,589.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,604.34,82,,483.472,percent of total billed charges,82% of total billed charges,626.45,85,,501.16,percent of total billed charges,85% of total billed charges,626.45,85,,501.16,percent of total billed charges,85% of total billed charges,626.45,85,,501.16,percent of total billed charges,85% of total billed charges,663.3,90,,530.64,percent of total billed charges,90% of total billed charges,589.6,80,,471.68,percent of total billed charges,80% of total billed charges,663.3,90,,530.64,percent of total billed charges,90% of total billed charges,552.75,75,,442.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,213.73,29,,170.984,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,493.79,67,,395.032,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,515.9,70,,412.72,percent of total billed charges,70% of total billed charges,479.05,65,,383.24,percent of total billed charges,65% of total billed charges,262.89,35.67,,210.312,percent of total billed charges,35.67% of total billed charges,213.73,737,
SCREW CANCELLOUS 6.5 MM,27015166,CDM,278,RC,C1713,HCPCS,outpatient,,,812,324.80,,568.4,70,,454.72,percent of total billed charges,70% of total billed charges,812,100,,649.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,665.84,82,,532.672,percent of total billed charges,82% of total billed charges,690.2,85,,552.16,percent of total billed charges,85% of total billed charges,690.2,85,,552.16,percent of total billed charges,85% of total billed charges,690.2,85,,552.16,percent of total billed charges,85% of total billed charges,730.8,90,,584.64,percent of total billed charges,90% of total billed charges,649.6,80,,519.68,percent of total billed charges,80% of total billed charges,730.8,90,,584.64,percent of total billed charges,90% of total billed charges,609,75,,487.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,235.48,29,,188.384,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,544.04,67,,435.232,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,568.4,70,,454.72,percent of total billed charges,70% of total billed charges,527.8,65,,422.24,percent of total billed charges,65% of total billed charges,289.64,35.67,,231.712,percent of total billed charges,35.67% of total billed charges,235.48,812,
K WIRE 1.4 MM,27015167,CDM,278,RC,C1713,HCPCS,outpatient,,,727,290.80,,508.9,70,,407.12,percent of total billed charges,70% of total billed charges,727,100,,581.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,596.14,82,,476.912,percent of total billed charges,82% of total billed charges,617.95,85,,494.36,percent of total billed charges,85% of total billed charges,617.95,85,,494.36,percent of total billed charges,85% of total billed charges,617.95,85,,494.36,percent of total billed charges,85% of total billed charges,654.3,90,,523.44,percent of total billed charges,90% of total billed charges,581.6,80,,465.28,percent of total billed charges,80% of total billed charges,654.3,90,,523.44,percent of total billed charges,90% of total billed charges,545.25,75,,436.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,210.83,29,,168.664,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,487.09,67,,389.672,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,508.9,70,,407.12,percent of total billed charges,70% of total billed charges,472.55,65,,378.04,percent of total billed charges,65% of total billed charges,259.32,35.67,,207.456,percent of total billed charges,35.67% of total billed charges,210.83,727,
IMPLANT ZEUS OLLIF,27015168,CDM,278,RC,C1713,HCPCS,outpatient,,,9118,3647.20,,6382.6,70,,5106.08,percent of total billed charges,70% of total billed charges,4786.95,52.5,,3829.56,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,7476.76,82,,5981.408,percent of total billed charges,82% of total billed charges,7750.3,85,,6200.24,percent of total billed charges,85% of total billed charges,7750.3,85,,6200.24,percent of total billed charges,85% of total billed charges,7750.3,85,,6200.24,percent of total billed charges,85% of total billed charges,8206.2,90,,6564.96,percent of total billed charges,90% of total billed charges,7294.4,80,,5835.52,percent of total billed charges,80% of total billed charges,8206.2,90,,6564.96,percent of total billed charges,90% of total billed charges,6838.5,75,,5470.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2644.22,29,,2115.376,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,6109.06,67,,4887.248,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,6382.6,70,,5106.08,percent of total billed charges,70% of total billed charges,5926.7,65,,4741.36,percent of total billed charges,65% of total billed charges,3252.39,35.67,,2601.912,percent of total billed charges,35.67% of total billed charges,2644.22,8206.2,
SCREW 7.5 MM,27015222,CDM,278,RC,C1713,HCPCS,outpatient,,,2432,972.80,,1702.4,70,,1361.92,percent of total billed charges,70% of total billed charges,1276.8,52.5,,1021.44,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,1994.24,82,,1595.392,percent of total billed charges,82% of total billed charges,2067.2,85,,1653.76,percent of total billed charges,85% of total billed charges,2067.2,85,,1653.76,percent of total billed charges,85% of total billed charges,2067.2,85,,1653.76,percent of total billed charges,85% of total billed charges,2188.8,90,,1751.04,percent of total billed charges,90% of total billed charges,1945.6,80,,1556.48,percent of total billed charges,80% of total billed charges,2188.8,90,,1751.04,percent of total billed charges,90% of total billed charges,1824,75,,1459.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,705.28,29,,564.224,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1629.44,67,,1303.552,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1702.4,70,,1361.92,percent of total billed charges,70% of total billed charges,1580.8,65,,1264.64,percent of total billed charges,65% of total billed charges,867.49,35.67,,693.992,percent of total billed charges,35.67% of total billed charges,705.28,2188.8,
ROD 90 MM,27015223,CDM,278,RC,C1713,HCPCS,outpatient,,,812,324.80,,568.4,70,,454.72,percent of total billed charges,70% of total billed charges,812,100,,649.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,665.84,82,,532.672,percent of total billed charges,82% of total billed charges,690.2,85,,552.16,percent of total billed charges,85% of total billed charges,690.2,85,,552.16,percent of total billed charges,85% of total billed charges,690.2,85,,552.16,percent of total billed charges,85% of total billed charges,730.8,90,,584.64,percent of total billed charges,90% of total billed charges,649.6,80,,519.68,percent of total billed charges,80% of total billed charges,730.8,90,,584.64,percent of total billed charges,90% of total billed charges,609,75,,487.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,235.48,29,,188.384,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,544.04,67,,435.232,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,568.4,70,,454.72,percent of total billed charges,70% of total billed charges,527.8,65,,422.24,percent of total billed charges,65% of total billed charges,289.64,35.67,,231.712,percent of total billed charges,35.67% of total billed charges,235.48,812,
KWIRE,27015239,CDM,278,RC,C1713,HCPCS,outpatient,,,610,244.00,,427,70,,341.6,percent of total billed charges,70% of total billed charges,610,100,,488,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,500.2,82,,400.16,percent of total billed charges,82% of total billed charges,518.5,85,,414.8,percent of total billed charges,85% of total billed charges,518.5,85,,414.8,percent of total billed charges,85% of total billed charges,518.5,85,,414.8,percent of total billed charges,85% of total billed charges,549,90,,439.2,percent of total billed charges,90% of total billed charges,488,80,,390.4,percent of total billed charges,80% of total billed charges,549,90,,439.2,percent of total billed charges,90% of total billed charges,457.5,75,,366,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,176.9,29,,141.52,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,408.7,67,,326.96,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,427,70,,341.6,percent of total billed charges,70% of total billed charges,396.5,65,,317.2,percent of total billed charges,65% of total billed charges,217.59,35.67,,174.072,percent of total billed charges,35.67% of total billed charges,176.9,610,
BONE CEMENT,27015260,CDM,278,RC,C1713,HCPCS,outpatient,,,4372,1748.80,,3060.4,70,,2448.32,percent of total billed charges,70% of total billed charges,2295.3,52.5,,1836.24,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,3585.04,82,,2868.032,percent of total billed charges,82% of total billed charges,3716.2,85,,2972.96,percent of total billed charges,85% of total billed charges,3716.2,85,,2972.96,percent of total billed charges,85% of total billed charges,3716.2,85,,2972.96,percent of total billed charges,85% of total billed charges,3934.8,90,,3147.84,percent of total billed charges,90% of total billed charges,3497.6,80,,2798.08,percent of total billed charges,80% of total billed charges,3934.8,90,,3147.84,percent of total billed charges,90% of total billed charges,3279,75,,2623.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,1267.88,29,,1014.304,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,2929.24,67,,2343.392,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,3060.4,70,,2448.32,percent of total billed charges,70% of total billed charges,2841.8,65,,2273.44,percent of total billed charges,65% of total billed charges,1559.49,35.67,,1247.592,percent of total billed charges,35.67% of total billed charges,1267.88,3934.8,
LUMBAR FUSION IMPLANT,27015380,CDM,278,RC,C1821,HCPCS,outpatient,,,9118,3647.20,,6382.6,70,,5106.08,percent of total billed charges,70% of total billed charges,4786.95,52.5,,3829.56,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,7476.76,82,,5981.408,percent of total billed charges,82% of total billed charges,7750.3,85,,6200.24,percent of total billed charges,85% of total billed charges,7750.3,85,,6200.24,percent of total billed charges,85% of total billed charges,7750.3,85,,6200.24,percent of total billed charges,85% of total billed charges,8206.2,90,,6564.96,percent of total billed charges,90% of total billed charges,7294.4,80,,5835.52,percent of total billed charges,80% of total billed charges,8206.2,90,,6564.96,percent of total billed charges,90% of total billed charges,6838.5,75,,5470.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2644.22,29,,2115.376,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,6109.06,67,,4887.248,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,6382.6,70,,5106.08,percent of total billed charges,70% of total billed charges,5926.7,65,,4741.36,percent of total billed charges,65% of total billed charges,3252.39,35.67,,2601.912,percent of total billed charges,35.67% of total billed charges,2644.22,8206.2,
LUMBAR FUSION IMPLANT,27015381,CDM,278,RC,C1820,HCPCS,outpatient,,,9118,3647.20,,6382.6,70,,5106.08,percent of total billed charges,70% of total billed charges,4786.95,52.5,,3829.56,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,7476.76,82,,5981.408,percent of total billed charges,82% of total billed charges,7750.3,85,,6200.24,percent of total billed charges,85% of total billed charges,7750.3,85,,6200.24,percent of total billed charges,85% of total billed charges,7750.3,85,,6200.24,percent of total billed charges,85% of total billed charges,8206.2,90,,6564.96,percent of total billed charges,90% of total billed charges,7294.4,80,,5835.52,percent of total billed charges,80% of total billed charges,8206.2,90,,6564.96,percent of total billed charges,90% of total billed charges,6838.5,75,,5470.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2644.22,29,,2115.376,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,6109.06,67,,4887.248,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,6382.6,70,,5106.08,percent of total billed charges,70% of total billed charges,5926.7,65,,4741.36,percent of total billed charges,65% of total billed charges,3252.39,35.67,,2601.912,percent of total billed charges,35.67% of total billed charges,2644.22,8206.2,
PLATE LAPIDUS REVISION,27015409,CDM,278,RC,C1713,HCPCS,outpatient,,,2531,1012.40,,1771.7,70,,1417.36,percent of total billed charges,70% of total billed charges,1328.78,52.5,,1063.02,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,2075.42,82,,1660.336,percent of total billed charges,82% of total billed charges,2151.35,85,,1721.08,percent of total billed charges,85% of total billed charges,2151.35,85,,1721.08,percent of total billed charges,85% of total billed charges,2151.35,85,,1721.08,percent of total billed charges,85% of total billed charges,2277.9,90,,1822.32,percent of total billed charges,90% of total billed charges,2024.8,80,,1619.84,percent of total billed charges,80% of total billed charges,2277.9,90,,1822.32,percent of total billed charges,90% of total billed charges,1898.25,75,,1518.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,733.99,29,,587.192,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1695.77,67,,1356.616,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1771.7,70,,1417.36,percent of total billed charges,70% of total billed charges,1645.15,65,,1316.12,percent of total billed charges,65% of total billed charges,902.81,35.67,,722.248,percent of total billed charges,35.67% of total billed charges,733.99,2277.9,
WASHER HEADED SCREW,27015410,CDM,278,RC,C1713,HCPCS,outpatient,,,357,142.80,,249.9,70,,199.92,percent of total billed charges,70% of total billed charges,357,100,,285.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,292.74,82,,234.192,percent of total billed charges,82% of total billed charges,303.45,85,,242.76,percent of total billed charges,85% of total billed charges,303.45,85,,242.76,percent of total billed charges,85% of total billed charges,303.45,85,,242.76,percent of total billed charges,85% of total billed charges,321.3,90,,257.04,percent of total billed charges,90% of total billed charges,285.6,80,,228.48,percent of total billed charges,80% of total billed charges,321.3,90,,257.04,percent of total billed charges,90% of total billed charges,267.75,75,,214.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,103.53,29,,82.824,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,239.19,67,,191.352,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,249.9,70,,199.92,percent of total billed charges,70% of total billed charges,232.05,65,,185.64,percent of total billed charges,65% of total billed charges,127.34,35.67,,101.872,percent of total billed charges,35.67% of total billed charges,103.53,357,
NON LOCKING SCREW 2.7X26MM,27015412,CDM,278,RC,C1713,HCPCS,outpatient,,,555,222.00,,388.5,70,,310.8,percent of total billed charges,70% of total billed charges,555,100,,444,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,455.1,82,,364.08,percent of total billed charges,82% of total billed charges,471.75,85,,377.4,percent of total billed charges,85% of total billed charges,471.75,85,,377.4,percent of total billed charges,85% of total billed charges,471.75,85,,377.4,percent of total billed charges,85% of total billed charges,499.5,90,,399.6,percent of total billed charges,90% of total billed charges,444,80,,355.2,percent of total billed charges,80% of total billed charges,499.5,90,,399.6,percent of total billed charges,90% of total billed charges,416.25,75,,333,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,160.95,29,,128.76,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,371.85,67,,297.48,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,388.5,70,,310.8,percent of total billed charges,70% of total billed charges,360.75,65,,288.6,percent of total billed charges,65% of total billed charges,197.97,35.67,,158.376,percent of total billed charges,35.67% of total billed charges,160.95,555,
NON LOCKING SCREW 2.7,27015413,CDM,278,RC,C1713,HCPCS,outpatient,,,535,214.00,,374.5,70,,299.6,percent of total billed charges,70% of total billed charges,535,100,,428,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,438.7,82,,350.96,percent of total billed charges,82% of total billed charges,454.75,85,,363.8,percent of total billed charges,85% of total billed charges,454.75,85,,363.8,percent of total billed charges,85% of total billed charges,454.75,85,,363.8,percent of total billed charges,85% of total billed charges,481.5,90,,385.2,percent of total billed charges,90% of total billed charges,428,80,,342.4,percent of total billed charges,80% of total billed charges,481.5,90,,385.2,percent of total billed charges,90% of total billed charges,401.25,75,,321,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,155.15,29,,124.12,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,358.45,67,,286.76,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,374.5,70,,299.6,percent of total billed charges,70% of total billed charges,347.75,65,,278.2,percent of total billed charges,65% of total billed charges,190.83,35.67,,152.664,percent of total billed charges,35.67% of total billed charges,155.15,535,
LOCKING SCREW 2.7,27015414,CDM,278,RC,C1713,HCPCS,outpatient,,,575,230.00,,402.5,70,,322,percent of total billed charges,70% of total billed charges,575,100,,460,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,471.5,82,,377.2,percent of total billed charges,82% of total billed charges,488.75,85,,391,percent of total billed charges,85% of total billed charges,488.75,85,,391,percent of total billed charges,85% of total billed charges,488.75,85,,391,percent of total billed charges,85% of total billed charges,517.5,90,,414,percent of total billed charges,90% of total billed charges,460,80,,368,percent of total billed charges,80% of total billed charges,517.5,90,,414,percent of total billed charges,90% of total billed charges,431.25,75,,345,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,166.75,29,,133.4,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,385.25,67,,308.2,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,402.5,70,,322,percent of total billed charges,70% of total billed charges,373.75,65,,299,percent of total billed charges,65% of total billed charges,205.1,35.67,,164.08,percent of total billed charges,35.67% of total billed charges,166.75,575,
NON LOCKING SCREW,27015415,CDM,278,RC,C1713,HCPCS,outpatient,,,535,214.00,,374.5,70,,299.6,percent of total billed charges,70% of total billed charges,535,100,,428,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,438.7,82,,350.96,percent of total billed charges,82% of total billed charges,454.75,85,,363.8,percent of total billed charges,85% of total billed charges,454.75,85,,363.8,percent of total billed charges,85% of total billed charges,454.75,85,,363.8,percent of total billed charges,85% of total billed charges,481.5,90,,385.2,percent of total billed charges,90% of total billed charges,428,80,,342.4,percent of total billed charges,80% of total billed charges,481.5,90,,385.2,percent of total billed charges,90% of total billed charges,401.25,75,,321,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,155.15,29,,124.12,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,358.45,67,,286.76,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,374.5,70,,299.6,percent of total billed charges,70% of total billed charges,347.75,65,,278.2,percent of total billed charges,65% of total billed charges,190.83,35.67,,152.664,percent of total billed charges,35.67% of total billed charges,155.15,535,
LOCKING SCREW 3.5X26MM,27015416,CDM,278,RC,C1713,HCPCS,outpatient,,,559,223.60,,391.3,70,,313.04,percent of total billed charges,70% of total billed charges,559,100,,447.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,458.38,82,,366.704,percent of total billed charges,82% of total billed charges,475.15,85,,380.12,percent of total billed charges,85% of total billed charges,475.15,85,,380.12,percent of total billed charges,85% of total billed charges,475.15,85,,380.12,percent of total billed charges,85% of total billed charges,503.1,90,,402.48,percent of total billed charges,90% of total billed charges,447.2,80,,357.76,percent of total billed charges,80% of total billed charges,503.1,90,,402.48,percent of total billed charges,90% of total billed charges,419.25,75,,335.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,162.11,29,,129.688,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,374.53,67,,299.624,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,391.3,70,,313.04,percent of total billed charges,70% of total billed charges,363.35,65,,290.68,percent of total billed charges,65% of total billed charges,199.4,35.67,,159.52,percent of total billed charges,35.67% of total billed charges,162.11,559,
NON LOCKING SCREW 4. MM,27015419,CDM,278,RC,C1713,HCPCS,outpatient,,,559,223.60,,391.3,70,,313.04,percent of total billed charges,70% of total billed charges,559,100,,447.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,458.38,82,,366.704,percent of total billed charges,82% of total billed charges,475.15,85,,380.12,percent of total billed charges,85% of total billed charges,475.15,85,,380.12,percent of total billed charges,85% of total billed charges,475.15,85,,380.12,percent of total billed charges,85% of total billed charges,503.1,90,,402.48,percent of total billed charges,90% of total billed charges,447.2,80,,357.76,percent of total billed charges,80% of total billed charges,503.1,90,,402.48,percent of total billed charges,90% of total billed charges,419.25,75,,335.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,162.11,29,,129.688,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,374.53,67,,299.624,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,391.3,70,,313.04,percent of total billed charges,70% of total billed charges,363.35,65,,290.68,percent of total billed charges,65% of total billed charges,199.4,35.67,,159.52,percent of total billed charges,35.67% of total billed charges,162.11,559,
BONE PUTTY 2.5CC,27015427,CDM,278,RC,C1713,HCPCS,outpatient,,,1598,639.20,,1118.6,70,,894.88,percent of total billed charges,70% of total billed charges,838.95,52.5,,671.16,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,1310.36,82,,1048.288,percent of total billed charges,82% of total billed charges,1358.3,85,,1086.64,percent of total billed charges,85% of total billed charges,1358.3,85,,1086.64,percent of total billed charges,85% of total billed charges,1358.3,85,,1086.64,percent of total billed charges,85% of total billed charges,1438.2,90,,1150.56,percent of total billed charges,90% of total billed charges,1278.4,80,,1022.72,percent of total billed charges,80% of total billed charges,1438.2,90,,1150.56,percent of total billed charges,90% of total billed charges,1198.5,75,,958.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,463.42,29,,370.736,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1070.66,67,,856.528,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1118.6,70,,894.88,percent of total billed charges,70% of total billed charges,1038.7,65,,830.96,percent of total billed charges,65% of total billed charges,570.01,35.67,,456.008,percent of total billed charges,35.67% of total billed charges,463.42,1438.2,
PLATE MIDDLE COLUMN,27015433,CDM,278,RC,C1713,HCPCS,outpatient,,,2960,1184.00,,2072,70,,1657.6,percent of total billed charges,70% of total billed charges,1554,52.5,,1243.2,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,2427.2,82,,1941.76,percent of total billed charges,82% of total billed charges,2516,85,,2012.8,percent of total billed charges,85% of total billed charges,2516,85,,2012.8,percent of total billed charges,85% of total billed charges,2516,85,,2012.8,percent of total billed charges,85% of total billed charges,2664,90,,2131.2,percent of total billed charges,90% of total billed charges,2368,80,,1894.4,percent of total billed charges,80% of total billed charges,2664,90,,2131.2,percent of total billed charges,90% of total billed charges,2220,75,,1776,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,858.4,29,,686.72,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1983.2,67,,1586.56,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,2072,70,,1657.6,percent of total billed charges,70% of total billed charges,1924,65,,1539.2,percent of total billed charges,65% of total billed charges,1055.83,35.67,,844.664,percent of total billed charges,35.67% of total billed charges,858.4,2664,
SCREW NON LOCKING,27015434,CDM,278,RC,C1713,HCPCS,outpatient,,,524,209.60,,366.8,70,,293.44,percent of total billed charges,70% of total billed charges,524,100,,419.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,429.68,82,,343.744,percent of total billed charges,82% of total billed charges,445.4,85,,356.32,percent of total billed charges,85% of total billed charges,445.4,85,,356.32,percent of total billed charges,85% of total billed charges,445.4,85,,356.32,percent of total billed charges,85% of total billed charges,471.6,90,,377.28,percent of total billed charges,90% of total billed charges,419.2,80,,335.36,percent of total billed charges,80% of total billed charges,471.6,90,,377.28,percent of total billed charges,90% of total billed charges,393,75,,314.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,151.96,29,,121.568,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,351.08,67,,280.864,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,366.8,70,,293.44,percent of total billed charges,70% of total billed charges,340.6,65,,272.48,percent of total billed charges,65% of total billed charges,186.91,35.67,,149.528,percent of total billed charges,35.67% of total billed charges,151.96,524,
SCREW LOCKING 3.5,27015435,CDM,278,RC,C1713,HCPCS,outpatient,,,646,258.40,,452.2,70,,361.76,percent of total billed charges,70% of total billed charges,646,100,,516.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,529.72,82,,423.776,percent of total billed charges,82% of total billed charges,549.1,85,,439.28,percent of total billed charges,85% of total billed charges,549.1,85,,439.28,percent of total billed charges,85% of total billed charges,549.1,85,,439.28,percent of total billed charges,85% of total billed charges,581.4,90,,465.12,percent of total billed charges,90% of total billed charges,516.8,80,,413.44,percent of total billed charges,80% of total billed charges,581.4,90,,465.12,percent of total billed charges,90% of total billed charges,484.5,75,,387.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,187.34,29,,149.872,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,432.82,67,,346.256,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,452.2,70,,361.76,percent of total billed charges,70% of total billed charges,419.9,65,,335.92,percent of total billed charges,65% of total billed charges,230.43,35.67,,184.344,percent of total billed charges,35.67% of total billed charges,187.34,646,
SCREW LOCKING 3.5,27015437,CDM,278,RC,C1713,HCPCS,outpatient,,,363,145.20,,254.1,70,,203.28,percent of total billed charges,70% of total billed charges,363,100,,290.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,297.66,82,,238.128,percent of total billed charges,82% of total billed charges,308.55,85,,246.84,percent of total billed charges,85% of total billed charges,308.55,85,,246.84,percent of total billed charges,85% of total billed charges,308.55,85,,246.84,percent of total billed charges,85% of total billed charges,326.7,90,,261.36,percent of total billed charges,90% of total billed charges,290.4,80,,232.32,percent of total billed charges,80% of total billed charges,326.7,90,,261.36,percent of total billed charges,90% of total billed charges,272.25,75,,217.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,105.27,29,,84.216,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,243.21,67,,194.568,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,254.1,70,,203.28,percent of total billed charges,70% of total billed charges,235.95,65,,188.76,percent of total billed charges,65% of total billed charges,129.48,35.67,,103.584,percent of total billed charges,35.67% of total billed charges,105.27,363,
MTP FUSION REAMER PHAL 18MM,27015475,CDM,278,RC,C1776,HCPCS,outpatient,,,1530,612.00,,1071,70,,856.8,percent of total billed charges,70% of total billed charges,803.25,52.5,,642.6,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,1254.6,82,,1003.68,percent of total billed charges,82% of total billed charges,1300.5,85,,1040.4,percent of total billed charges,85% of total billed charges,1300.5,85,,1040.4,percent of total billed charges,85% of total billed charges,1300.5,85,,1040.4,percent of total billed charges,85% of total billed charges,1377,90,,1101.6,percent of total billed charges,90% of total billed charges,1224,80,,979.2,percent of total billed charges,80% of total billed charges,1377,90,,1101.6,percent of total billed charges,90% of total billed charges,1147.5,75,,918,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,443.7,29,,354.96,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1025.1,67,,820.08,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1071,70,,856.8,percent of total billed charges,70% of total billed charges,994.5,65,,795.6,percent of total billed charges,65% of total billed charges,545.75,35.67,,436.6,percent of total billed charges,35.67% of total billed charges,443.7,1377,
SCREW CANNULATED HEADED,27015478,CDM,278,RC,C1713,HCPCS,outpatient,,,701,280.40,,490.7,70,,392.56,percent of total billed charges,70% of total billed charges,701,100,,560.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,574.82,82,,459.856,percent of total billed charges,82% of total billed charges,595.85,85,,476.68,percent of total billed charges,85% of total billed charges,595.85,85,,476.68,percent of total billed charges,85% of total billed charges,595.85,85,,476.68,percent of total billed charges,85% of total billed charges,630.9,90,,504.72,percent of total billed charges,90% of total billed charges,560.8,80,,448.64,percent of total billed charges,80% of total billed charges,630.9,90,,504.72,percent of total billed charges,90% of total billed charges,525.75,75,,420.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,203.29,29,,162.632,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,469.67,67,,375.736,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,490.7,70,,392.56,percent of total billed charges,70% of total billed charges,455.65,65,,364.52,percent of total billed charges,65% of total billed charges,250.05,35.67,,200.04,percent of total billed charges,35.67% of total billed charges,203.29,701,
"PLATE, MTP FUSION DEG",27015479,CDM,278,RC,C1713,HCPCS,outpatient,,,4290,1716.00,,3003,70,,2402.4,percent of total billed charges,70% of total billed charges,2252.25,52.5,,1801.8,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,3517.8,82,,2814.24,percent of total billed charges,82% of total billed charges,3646.5,85,,2917.2,percent of total billed charges,85% of total billed charges,3646.5,85,,2917.2,percent of total billed charges,85% of total billed charges,3646.5,85,,2917.2,percent of total billed charges,85% of total billed charges,3861,90,,3088.8,percent of total billed charges,90% of total billed charges,3432,80,,2745.6,percent of total billed charges,80% of total billed charges,3861,90,,3088.8,percent of total billed charges,90% of total billed charges,3217.5,75,,2574,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,1244.1,29,,995.28,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,2874.3,67,,2299.44,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,3003,70,,2402.4,percent of total billed charges,70% of total billed charges,2788.5,65,,2230.8,percent of total billed charges,65% of total billed charges,1530.24,35.67,,1224.192,percent of total billed charges,35.67% of total billed charges,1244.1,3861,
SCREW NON LOCKING,27015480,CDM,278,RC,C1713,HCPCS,outpatient,,,544,217.60,,380.8,70,,304.64,percent of total billed charges,70% of total billed charges,544,100,,435.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,446.08,82,,356.864,percent of total billed charges,82% of total billed charges,462.4,85,,369.92,percent of total billed charges,85% of total billed charges,462.4,85,,369.92,percent of total billed charges,85% of total billed charges,462.4,85,,369.92,percent of total billed charges,85% of total billed charges,489.6,90,,391.68,percent of total billed charges,90% of total billed charges,435.2,80,,348.16,percent of total billed charges,80% of total billed charges,489.6,90,,391.68,percent of total billed charges,90% of total billed charges,408,75,,326.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,157.76,29,,126.208,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,364.48,67,,291.584,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,380.8,70,,304.64,percent of total billed charges,70% of total billed charges,353.6,65,,282.88,percent of total billed charges,65% of total billed charges,194.04,35.67,,155.232,percent of total billed charges,35.67% of total billed charges,157.76,544,
SCREW CORTICAL,27015495,CDM,278,RC,C1713,HCPCS,outpatient,,,549,219.60,,384.3,70,,307.44,percent of total billed charges,70% of total billed charges,549,100,,439.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,450.18,82,,360.144,percent of total billed charges,82% of total billed charges,466.65,85,,373.32,percent of total billed charges,85% of total billed charges,466.65,85,,373.32,percent of total billed charges,85% of total billed charges,466.65,85,,373.32,percent of total billed charges,85% of total billed charges,494.1,90,,395.28,percent of total billed charges,90% of total billed charges,439.2,80,,351.36,percent of total billed charges,80% of total billed charges,494.1,90,,395.28,percent of total billed charges,90% of total billed charges,411.75,75,,329.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,159.21,29,,127.368,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,367.83,67,,294.264,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,384.3,70,,307.44,percent of total billed charges,70% of total billed charges,356.85,65,,285.48,percent of total billed charges,65% of total billed charges,195.83,35.67,,156.664,percent of total billed charges,35.67% of total billed charges,159.21,549,
SCREW CORTICAL,27015496,CDM,278,RC,C1713,HCPCS,outpatient,,,549,219.60,,384.3,70,,307.44,percent of total billed charges,70% of total billed charges,549,100,,439.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,450.18,82,,360.144,percent of total billed charges,82% of total billed charges,466.65,85,,373.32,percent of total billed charges,85% of total billed charges,466.65,85,,373.32,percent of total billed charges,85% of total billed charges,466.65,85,,373.32,percent of total billed charges,85% of total billed charges,494.1,90,,395.28,percent of total billed charges,90% of total billed charges,439.2,80,,351.36,percent of total billed charges,80% of total billed charges,494.1,90,,395.28,percent of total billed charges,90% of total billed charges,411.75,75,,329.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,159.21,29,,127.368,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,367.83,67,,294.264,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,384.3,70,,307.44,percent of total billed charges,70% of total billed charges,356.85,65,,285.48,percent of total billed charges,65% of total billed charges,195.83,35.67,,156.664,percent of total billed charges,35.67% of total billed charges,159.21,549,
SCREW CORTICAL,27015497,CDM,278,RC,C1713,HCPCS,outpatient,,,549,219.60,,384.3,70,,307.44,percent of total billed charges,70% of total billed charges,549,100,,439.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,450.18,82,,360.144,percent of total billed charges,82% of total billed charges,466.65,85,,373.32,percent of total billed charges,85% of total billed charges,466.65,85,,373.32,percent of total billed charges,85% of total billed charges,466.65,85,,373.32,percent of total billed charges,85% of total billed charges,494.1,90,,395.28,percent of total billed charges,90% of total billed charges,439.2,80,,351.36,percent of total billed charges,80% of total billed charges,494.1,90,,395.28,percent of total billed charges,90% of total billed charges,411.75,75,,329.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,159.21,29,,127.368,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,367.83,67,,294.264,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,384.3,70,,307.44,percent of total billed charges,70% of total billed charges,356.85,65,,285.48,percent of total billed charges,65% of total billed charges,195.83,35.67,,156.664,percent of total billed charges,35.67% of total billed charges,159.21,549,
K WIRE 1.1MM,27015500,CDM,278,RC,C1713,HCPCS,outpatient,,,341,136.40,,238.7,70,,190.96,percent of total billed charges,70% of total billed charges,341,100,,272.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,279.62,82,,223.696,percent of total billed charges,82% of total billed charges,289.85,85,,231.88,percent of total billed charges,85% of total billed charges,289.85,85,,231.88,percent of total billed charges,85% of total billed charges,289.85,85,,231.88,percent of total billed charges,85% of total billed charges,306.9,90,,245.52,percent of total billed charges,90% of total billed charges,272.8,80,,218.24,percent of total billed charges,80% of total billed charges,306.9,90,,245.52,percent of total billed charges,90% of total billed charges,255.75,75,,204.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,98.89,29,,79.112,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,228.47,67,,182.776,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,238.7,70,,190.96,percent of total billed charges,70% of total billed charges,221.65,65,,177.32,percent of total billed charges,65% of total billed charges,121.63,35.67,,97.304,percent of total billed charges,35.67% of total billed charges,98.89,341,
SCREW LOCKING,27015502,CDM,278,RC,C1713,HCPCS,outpatient,,,751,300.40,,525.7,70,,420.56,percent of total billed charges,70% of total billed charges,751,100,,600.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,615.82,82,,492.656,percent of total billed charges,82% of total billed charges,638.35,85,,510.68,percent of total billed charges,85% of total billed charges,638.35,85,,510.68,percent of total billed charges,85% of total billed charges,638.35,85,,510.68,percent of total billed charges,85% of total billed charges,675.9,90,,540.72,percent of total billed charges,90% of total billed charges,600.8,80,,480.64,percent of total billed charges,80% of total billed charges,675.9,90,,540.72,percent of total billed charges,90% of total billed charges,563.25,75,,450.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,217.79,29,,174.232,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,503.17,67,,402.536,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,525.7,70,,420.56,percent of total billed charges,70% of total billed charges,488.15,65,,390.52,percent of total billed charges,65% of total billed charges,267.88,35.67,,214.304,percent of total billed charges,35.67% of total billed charges,217.79,751,
SCREW LOCKING 2.7,27015503,CDM,278,RC,C1713,HCPCS,outpatient,,,751,300.40,,525.7,70,,420.56,percent of total billed charges,70% of total billed charges,751,100,,600.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,615.82,82,,492.656,percent of total billed charges,82% of total billed charges,638.35,85,,510.68,percent of total billed charges,85% of total billed charges,638.35,85,,510.68,percent of total billed charges,85% of total billed charges,638.35,85,,510.68,percent of total billed charges,85% of total billed charges,675.9,90,,540.72,percent of total billed charges,90% of total billed charges,600.8,80,,480.64,percent of total billed charges,80% of total billed charges,675.9,90,,540.72,percent of total billed charges,90% of total billed charges,563.25,75,,450.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,217.79,29,,174.232,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,503.17,67,,402.536,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,525.7,70,,420.56,percent of total billed charges,70% of total billed charges,488.15,65,,390.52,percent of total billed charges,65% of total billed charges,267.88,35.67,,214.304,percent of total billed charges,35.67% of total billed charges,217.79,751,
SCREW LOCKING,27015504,CDM,278,RC,C1713,HCPCS,outpatient,,,751,300.40,,525.7,70,,420.56,percent of total billed charges,70% of total billed charges,751,100,,600.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,615.82,82,,492.656,percent of total billed charges,82% of total billed charges,638.35,85,,510.68,percent of total billed charges,85% of total billed charges,638.35,85,,510.68,percent of total billed charges,85% of total billed charges,638.35,85,,510.68,percent of total billed charges,85% of total billed charges,675.9,90,,540.72,percent of total billed charges,90% of total billed charges,600.8,80,,480.64,percent of total billed charges,80% of total billed charges,675.9,90,,540.72,percent of total billed charges,90% of total billed charges,563.25,75,,450.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,217.79,29,,174.232,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,503.17,67,,402.536,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,525.7,70,,420.56,percent of total billed charges,70% of total billed charges,488.15,65,,390.52,percent of total billed charges,65% of total billed charges,267.88,35.67,,214.304,percent of total billed charges,35.67% of total billed charges,217.79,751,
SCREW LOCKING,27015505,CDM,278,RC,C1713,HCPCS,outpatient,,,751,300.40,,525.7,70,,420.56,percent of total billed charges,70% of total billed charges,751,100,,600.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,615.82,82,,492.656,percent of total billed charges,82% of total billed charges,638.35,85,,510.68,percent of total billed charges,85% of total billed charges,638.35,85,,510.68,percent of total billed charges,85% of total billed charges,638.35,85,,510.68,percent of total billed charges,85% of total billed charges,675.9,90,,540.72,percent of total billed charges,90% of total billed charges,600.8,80,,480.64,percent of total billed charges,80% of total billed charges,675.9,90,,540.72,percent of total billed charges,90% of total billed charges,563.25,75,,450.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,217.79,29,,174.232,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,503.17,67,,402.536,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,525.7,70,,420.56,percent of total billed charges,70% of total billed charges,488.15,65,,390.52,percent of total billed charges,65% of total billed charges,267.88,35.67,,214.304,percent of total billed charges,35.67% of total billed charges,217.79,751,
SCREW LOCKING,27015506,CDM,278,RC,C1713,HCPCS,outpatient,,,751,300.40,,525.7,70,,420.56,percent of total billed charges,70% of total billed charges,751,100,,600.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,615.82,82,,492.656,percent of total billed charges,82% of total billed charges,638.35,85,,510.68,percent of total billed charges,85% of total billed charges,638.35,85,,510.68,percent of total billed charges,85% of total billed charges,638.35,85,,510.68,percent of total billed charges,85% of total billed charges,675.9,90,,540.72,percent of total billed charges,90% of total billed charges,600.8,80,,480.64,percent of total billed charges,80% of total billed charges,675.9,90,,540.72,percent of total billed charges,90% of total billed charges,563.25,75,,450.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,217.79,29,,174.232,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,503.17,67,,402.536,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,525.7,70,,420.56,percent of total billed charges,70% of total billed charges,488.15,65,,390.52,percent of total billed charges,65% of total billed charges,267.88,35.67,,214.304,percent of total billed charges,35.67% of total billed charges,217.79,751,
SCREW LOCKING,27015507,CDM,278,RC,C1713,HCPCS,outpatient,,,751,300.40,,525.7,70,,420.56,percent of total billed charges,70% of total billed charges,751,100,,600.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,615.82,82,,492.656,percent of total billed charges,82% of total billed charges,638.35,85,,510.68,percent of total billed charges,85% of total billed charges,638.35,85,,510.68,percent of total billed charges,85% of total billed charges,638.35,85,,510.68,percent of total billed charges,85% of total billed charges,675.9,90,,540.72,percent of total billed charges,90% of total billed charges,600.8,80,,480.64,percent of total billed charges,80% of total billed charges,675.9,90,,540.72,percent of total billed charges,90% of total billed charges,563.25,75,,450.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,217.79,29,,174.232,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,503.17,67,,402.536,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,525.7,70,,420.56,percent of total billed charges,70% of total billed charges,488.15,65,,390.52,percent of total billed charges,65% of total billed charges,267.88,35.67,,214.304,percent of total billed charges,35.67% of total billed charges,217.79,751,
CAMCELLOUS SCREW,27015559,CDM,278,RC,C1713,HCPCS,outpatient,,,812,324.80,,568.4,70,,454.72,percent of total billed charges,70% of total billed charges,812,100,,649.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,665.84,82,,532.672,percent of total billed charges,82% of total billed charges,690.2,85,,552.16,percent of total billed charges,85% of total billed charges,690.2,85,,552.16,percent of total billed charges,85% of total billed charges,690.2,85,,552.16,percent of total billed charges,85% of total billed charges,730.8,90,,584.64,percent of total billed charges,90% of total billed charges,649.6,80,,519.68,percent of total billed charges,80% of total billed charges,730.8,90,,584.64,percent of total billed charges,90% of total billed charges,609,75,,487.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,235.48,29,,188.384,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,544.04,67,,435.232,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,568.4,70,,454.72,percent of total billed charges,70% of total billed charges,527.8,65,,422.24,percent of total billed charges,65% of total billed charges,289.64,35.67,,231.712,percent of total billed charges,35.67% of total billed charges,235.48,812,
SCREW LONG THREADED,27015560,CDM,278,RC,C1713,HCPCS,outpatient,,,812,324.80,,568.4,70,,454.72,percent of total billed charges,70% of total billed charges,812,100,,649.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,665.84,82,,532.672,percent of total billed charges,82% of total billed charges,690.2,85,,552.16,percent of total billed charges,85% of total billed charges,690.2,85,,552.16,percent of total billed charges,85% of total billed charges,690.2,85,,552.16,percent of total billed charges,85% of total billed charges,730.8,90,,584.64,percent of total billed charges,90% of total billed charges,649.6,80,,519.68,percent of total billed charges,80% of total billed charges,730.8,90,,584.64,percent of total billed charges,90% of total billed charges,609,75,,487.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,235.48,29,,188.384,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,544.04,67,,435.232,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,568.4,70,,454.72,percent of total billed charges,70% of total billed charges,527.8,65,,422.24,percent of total billed charges,65% of total billed charges,289.64,35.67,,231.712,percent of total billed charges,35.67% of total billed charges,235.48,812,
PLATE EVANS NO WEDGE,27015562,CDM,278,RC,C1713,HCPCS,outpatient,,,2063,825.20,,1444.1,70,,1155.28,percent of total billed charges,70% of total billed charges,1083.08,52.5,,866.46,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,1691.66,82,,1353.328,percent of total billed charges,82% of total billed charges,1753.55,85,,1402.84,percent of total billed charges,85% of total billed charges,1753.55,85,,1402.84,percent of total billed charges,85% of total billed charges,1753.55,85,,1402.84,percent of total billed charges,85% of total billed charges,1856.7,90,,1485.36,percent of total billed charges,90% of total billed charges,1650.4,80,,1320.32,percent of total billed charges,80% of total billed charges,1856.7,90,,1485.36,percent of total billed charges,90% of total billed charges,1547.25,75,,1237.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,598.27,29,,478.616,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1382.21,67,,1105.768,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1444.1,70,,1155.28,percent of total billed charges,70% of total billed charges,1340.95,65,,1072.76,percent of total billed charges,65% of total billed charges,735.87,35.67,,588.696,percent of total billed charges,35.67% of total billed charges,598.27,1856.7,
NONLOCKING SCREW,27015563,CDM,278,RC,C1713,HCPCS,outpatient,,,573,229.20,,401.1,70,,320.88,percent of total billed charges,70% of total billed charges,573,100,,458.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,469.86,82,,375.888,percent of total billed charges,82% of total billed charges,487.05,85,,389.64,percent of total billed charges,85% of total billed charges,487.05,85,,389.64,percent of total billed charges,85% of total billed charges,487.05,85,,389.64,percent of total billed charges,85% of total billed charges,515.7,90,,412.56,percent of total billed charges,90% of total billed charges,458.4,80,,366.72,percent of total billed charges,80% of total billed charges,515.7,90,,412.56,percent of total billed charges,90% of total billed charges,429.75,75,,343.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,166.17,29,,132.936,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,383.91,67,,307.128,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,401.1,70,,320.88,percent of total billed charges,70% of total billed charges,372.45,65,,297.96,percent of total billed charges,65% of total billed charges,204.39,35.67,,163.512,percent of total billed charges,35.67% of total billed charges,166.17,573,
LOCKING POLYAXIAL SCREW,27015564,CDM,278,RC,C1713,HCPCS,outpatient,,,570,228.00,,399,70,,319.2,percent of total billed charges,70% of total billed charges,570,100,,456,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,467.4,82,,373.92,percent of total billed charges,82% of total billed charges,484.5,85,,387.6,percent of total billed charges,85% of total billed charges,484.5,85,,387.6,percent of total billed charges,85% of total billed charges,484.5,85,,387.6,percent of total billed charges,85% of total billed charges,513,90,,410.4,percent of total billed charges,90% of total billed charges,456,80,,364.8,percent of total billed charges,80% of total billed charges,513,90,,410.4,percent of total billed charges,90% of total billed charges,427.5,75,,342,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,165.3,29,,132.24,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,381.9,67,,305.52,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,399,70,,319.2,percent of total billed charges,70% of total billed charges,370.5,65,,296.4,percent of total billed charges,65% of total billed charges,203.32,35.67,,162.656,percent of total billed charges,35.67% of total billed charges,165.3,570,
NON LOCKING SCREW,27015565,CDM,278,RC,C1713,HCPCS,outpatient,,,362,144.80,,253.4,70,,202.72,percent of total billed charges,70% of total billed charges,362,100,,289.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,296.84,82,,237.472,percent of total billed charges,82% of total billed charges,307.7,85,,246.16,percent of total billed charges,85% of total billed charges,307.7,85,,246.16,percent of total billed charges,85% of total billed charges,307.7,85,,246.16,percent of total billed charges,85% of total billed charges,325.8,90,,260.64,percent of total billed charges,90% of total billed charges,289.6,80,,231.68,percent of total billed charges,80% of total billed charges,325.8,90,,260.64,percent of total billed charges,90% of total billed charges,271.5,75,,217.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,104.98,29,,83.984,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,242.54,67,,194.032,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,253.4,70,,202.72,percent of total billed charges,70% of total billed charges,235.3,65,,188.24,percent of total billed charges,65% of total billed charges,129.13,35.67,,103.304,percent of total billed charges,35.67% of total billed charges,104.98,362,
K WIRE,27015610,CDM,278,RC,C1713,HCPCS,outpatient,,,508,203.20,,355.6,70,,284.48,percent of total billed charges,70% of total billed charges,508,100,,406.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,416.56,82,,333.248,percent of total billed charges,82% of total billed charges,431.8,85,,345.44,percent of total billed charges,85% of total billed charges,431.8,85,,345.44,percent of total billed charges,85% of total billed charges,431.8,85,,345.44,percent of total billed charges,85% of total billed charges,457.2,90,,365.76,percent of total billed charges,90% of total billed charges,406.4,80,,325.12,percent of total billed charges,80% of total billed charges,457.2,90,,365.76,percent of total billed charges,90% of total billed charges,381,75,,304.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,147.32,29,,117.856,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,340.36,67,,272.288,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,355.6,70,,284.48,percent of total billed charges,70% of total billed charges,330.2,65,,264.16,percent of total billed charges,65% of total billed charges,181.2,35.67,,144.96,percent of total billed charges,35.67% of total billed charges,147.32,508,
SCREW 2.0 X 18,27015612,CDM,278,RC,C1713,HCPCS,outpatient,,,508,203.20,,355.6,70,,284.48,percent of total billed charges,70% of total billed charges,508,100,,406.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,416.56,82,,333.248,percent of total billed charges,82% of total billed charges,431.8,85,,345.44,percent of total billed charges,85% of total billed charges,431.8,85,,345.44,percent of total billed charges,85% of total billed charges,431.8,85,,345.44,percent of total billed charges,85% of total billed charges,457.2,90,,365.76,percent of total billed charges,90% of total billed charges,406.4,80,,325.12,percent of total billed charges,80% of total billed charges,457.2,90,,365.76,percent of total billed charges,90% of total billed charges,381,75,,304.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,147.32,29,,117.856,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,340.36,67,,272.288,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,355.6,70,,284.48,percent of total billed charges,70% of total billed charges,330.2,65,,264.16,percent of total billed charges,65% of total billed charges,181.2,35.67,,144.96,percent of total billed charges,35.67% of total billed charges,147.32,508,
PIN,27015646,CDM,278,RC,C1713,HCPCS,outpatient,,,245,98.00,,171.5,70,,137.2,percent of total billed charges,70% of total billed charges,245,100,,196,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,200.9,82,,160.72,percent of total billed charges,82% of total billed charges,208.25,85,,166.6,percent of total billed charges,85% of total billed charges,208.25,85,,166.6,percent of total billed charges,85% of total billed charges,208.25,85,,166.6,percent of total billed charges,85% of total billed charges,220.5,90,,176.4,percent of total billed charges,90% of total billed charges,196,80,,156.8,percent of total billed charges,80% of total billed charges,220.5,90,,176.4,percent of total billed charges,90% of total billed charges,183.75,75,,147,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,71.05,29,,56.84,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,164.15,67,,131.32,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,171.5,70,,137.2,percent of total billed charges,70% of total billed charges,159.25,65,,127.4,percent of total billed charges,65% of total billed charges,87.39,35.67,,69.912,percent of total billed charges,35.67% of total billed charges,71.05,245,
CORTICAL SCREW 2.0 X 14,27016018,CDM,278,RC,C1713,HCPCS,outpatient,,,508,203.20,,355.6,70,,284.48,percent of total billed charges,70% of total billed charges,508,100,,406.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,416.56,82,,333.248,percent of total billed charges,82% of total billed charges,431.8,85,,345.44,percent of total billed charges,85% of total billed charges,431.8,85,,345.44,percent of total billed charges,85% of total billed charges,431.8,85,,345.44,percent of total billed charges,85% of total billed charges,457.2,90,,365.76,percent of total billed charges,90% of total billed charges,406.4,80,,325.12,percent of total billed charges,80% of total billed charges,457.2,90,,365.76,percent of total billed charges,90% of total billed charges,381,75,,304.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,147.32,29,,117.856,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,340.36,67,,272.288,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,355.6,70,,284.48,percent of total billed charges,70% of total billed charges,330.2,65,,264.16,percent of total billed charges,65% of total billed charges,181.2,35.67,,144.96,percent of total billed charges,35.67% of total billed charges,147.32,508,
REDUCTION SCREW,27016053,CDM,278,RC,C1713,HCPCS,outpatient,,,2432,972.80,,1702.4,70,,1361.92,percent of total billed charges,70% of total billed charges,1276.8,52.5,,1021.44,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,1994.24,82,,1595.392,percent of total billed charges,82% of total billed charges,2067.2,85,,1653.76,percent of total billed charges,85% of total billed charges,2067.2,85,,1653.76,percent of total billed charges,85% of total billed charges,2067.2,85,,1653.76,percent of total billed charges,85% of total billed charges,2188.8,90,,1751.04,percent of total billed charges,90% of total billed charges,1945.6,80,,1556.48,percent of total billed charges,80% of total billed charges,2188.8,90,,1751.04,percent of total billed charges,90% of total billed charges,1824,75,,1459.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,705.28,29,,564.224,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1629.44,67,,1303.552,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1702.4,70,,1361.92,percent of total billed charges,70% of total billed charges,1580.8,65,,1264.64,percent of total billed charges,65% of total billed charges,867.49,35.67,,693.992,percent of total billed charges,35.67% of total billed charges,705.28,2188.8,
LOCKING CAP,27016054,CDM,278,RC,C1713,HCPCS,outpatient,,,508,203.20,,355.6,70,,284.48,percent of total billed charges,70% of total billed charges,508,100,,406.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,416.56,82,,333.248,percent of total billed charges,82% of total billed charges,431.8,85,,345.44,percent of total billed charges,85% of total billed charges,431.8,85,,345.44,percent of total billed charges,85% of total billed charges,431.8,85,,345.44,percent of total billed charges,85% of total billed charges,457.2,90,,365.76,percent of total billed charges,90% of total billed charges,406.4,80,,325.12,percent of total billed charges,80% of total billed charges,457.2,90,,365.76,percent of total billed charges,90% of total billed charges,381,75,,304.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,147.32,29,,117.856,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,340.36,67,,272.288,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,355.6,70,,284.48,percent of total billed charges,70% of total billed charges,330.2,65,,264.16,percent of total billed charges,65% of total billed charges,181.2,35.67,,144.96,percent of total billed charges,35.67% of total billed charges,147.32,508,
60 MM PREBENT ROD,27016055,CDM,278,RC,C1713,HCPCS,outpatient,,,812,324.80,,568.4,70,,454.72,percent of total billed charges,70% of total billed charges,812,100,,649.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,665.84,82,,532.672,percent of total billed charges,82% of total billed charges,690.2,85,,552.16,percent of total billed charges,85% of total billed charges,690.2,85,,552.16,percent of total billed charges,85% of total billed charges,690.2,85,,552.16,percent of total billed charges,85% of total billed charges,730.8,90,,584.64,percent of total billed charges,90% of total billed charges,649.6,80,,519.68,percent of total billed charges,80% of total billed charges,730.8,90,,584.64,percent of total billed charges,90% of total billed charges,609,75,,487.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,235.48,29,,188.384,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,544.04,67,,435.232,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,568.4,70,,454.72,percent of total billed charges,70% of total billed charges,527.8,65,,422.24,percent of total billed charges,65% of total billed charges,289.64,35.67,,231.712,percent of total billed charges,35.67% of total billed charges,235.48,812,
LARGE VARIABLE CROSSLINK,27016056,CDM,278,RC,C1713,HCPCS,outpatient,,,1927,770.80,,1348.9,70,,1079.12,percent of total billed charges,70% of total billed charges,1011.68,52.5,,809.34,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,1580.14,82,,1264.112,percent of total billed charges,82% of total billed charges,1637.95,85,,1310.36,percent of total billed charges,85% of total billed charges,1637.95,85,,1310.36,percent of total billed charges,85% of total billed charges,1637.95,85,,1310.36,percent of total billed charges,85% of total billed charges,1734.3,90,,1387.44,percent of total billed charges,90% of total billed charges,1541.6,80,,1233.28,percent of total billed charges,80% of total billed charges,1734.3,90,,1387.44,percent of total billed charges,90% of total billed charges,1445.25,75,,1156.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,558.83,29,,447.064,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1291.09,67,,1032.872,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1348.9,70,,1079.12,percent of total billed charges,70% of total billed charges,1252.55,65,,1002.04,percent of total billed charges,65% of total billed charges,687.36,35.67,,549.888,percent of total billed charges,35.67% of total billed charges,558.83,1734.3,
SLING SYSTEM DESARA,27016099,CDM,278,RC,C1771,HCPCS,outpatient,,,3394,1357.60,,2375.8,70,,1900.64,percent of total billed charges,70% of total billed charges,1781.85,52.5,,1425.48,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,2783.08,82,,2226.464,percent of total billed charges,82% of total billed charges,2884.9,85,,2307.92,percent of total billed charges,85% of total billed charges,2884.9,85,,2307.92,percent of total billed charges,85% of total billed charges,2884.9,85,,2307.92,percent of total billed charges,85% of total billed charges,3054.6,90,,2443.68,percent of total billed charges,90% of total billed charges,2715.2,80,,2172.16,percent of total billed charges,80% of total billed charges,3054.6,90,,2443.68,percent of total billed charges,90% of total billed charges,2545.5,75,,2036.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,984.26,29,,787.408,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,2273.98,67,,1819.184,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,2375.8,70,,1900.64,percent of total billed charges,70% of total billed charges,2206.1,65,,1764.88,percent of total billed charges,65% of total billed charges,1210.64,35.67,,968.512,percent of total billed charges,35.67% of total billed charges,984.26,3054.6,
SCREW 3.5 VA,27016139,CDM,278,RC,C1713,HCPCS,outpatient,,,728,291.20,,509.6,70,,407.68,percent of total billed charges,70% of total billed charges,728,100,,582.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,596.96,82,,477.568,percent of total billed charges,82% of total billed charges,618.8,85,,495.04,percent of total billed charges,85% of total billed charges,618.8,85,,495.04,percent of total billed charges,85% of total billed charges,618.8,85,,495.04,percent of total billed charges,85% of total billed charges,655.2,90,,524.16,percent of total billed charges,90% of total billed charges,582.4,80,,465.92,percent of total billed charges,80% of total billed charges,655.2,90,,524.16,percent of total billed charges,90% of total billed charges,546,75,,436.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,211.12,29,,168.896,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,487.76,67,,390.208,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,509.6,70,,407.68,percent of total billed charges,70% of total billed charges,473.2,65,,378.56,percent of total billed charges,65% of total billed charges,259.68,35.67,,207.744,percent of total billed charges,35.67% of total billed charges,211.12,728,
METAPHYSEAL SCREW,27016140,CDM,278,RC,C1713,HCPCS,outpatient,,,276,110.40,,193.2,70,,154.56,percent of total billed charges,70% of total billed charges,276,100,,220.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,226.32,82,,181.056,percent of total billed charges,82% of total billed charges,234.6,85,,187.68,percent of total billed charges,85% of total billed charges,234.6,85,,187.68,percent of total billed charges,85% of total billed charges,234.6,85,,187.68,percent of total billed charges,85% of total billed charges,248.4,90,,198.72,percent of total billed charges,90% of total billed charges,220.8,80,,176.64,percent of total billed charges,80% of total billed charges,248.4,90,,198.72,percent of total billed charges,90% of total billed charges,207,75,,165.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,80.04,29,,64.032,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,184.92,67,,147.936,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,193.2,70,,154.56,percent of total billed charges,70% of total billed charges,179.4,65,,143.52,percent of total billed charges,65% of total billed charges,98.45,35.67,,78.76,percent of total billed charges,35.67% of total billed charges,80.04,276,
SCREW 3.5 CORTEX,27016141,CDM,278,RC,C1713,HCPCS,outpatient,,,276,110.40,,193.2,70,,154.56,percent of total billed charges,70% of total billed charges,276,100,,220.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,226.32,82,,181.056,percent of total billed charges,82% of total billed charges,234.6,85,,187.68,percent of total billed charges,85% of total billed charges,234.6,85,,187.68,percent of total billed charges,85% of total billed charges,234.6,85,,187.68,percent of total billed charges,85% of total billed charges,248.4,90,,198.72,percent of total billed charges,90% of total billed charges,220.8,80,,176.64,percent of total billed charges,80% of total billed charges,248.4,90,,198.72,percent of total billed charges,90% of total billed charges,207,75,,165.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,80.04,29,,64.032,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,184.92,67,,147.936,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,193.2,70,,154.56,percent of total billed charges,70% of total billed charges,179.4,65,,143.52,percent of total billed charges,65% of total billed charges,98.45,35.67,,78.76,percent of total billed charges,35.67% of total billed charges,80.04,276,
CORTEX SCFEW 28 MM,27016142,CDM,278,RC,C1713,HCPCS,outpatient,,,262,104.80,,183.4,70,,146.72,percent of total billed charges,70% of total billed charges,262,100,,209.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,214.84,82,,171.872,percent of total billed charges,82% of total billed charges,222.7,85,,178.16,percent of total billed charges,85% of total billed charges,222.7,85,,178.16,percent of total billed charges,85% of total billed charges,222.7,85,,178.16,percent of total billed charges,85% of total billed charges,235.8,90,,188.64,percent of total billed charges,90% of total billed charges,209.6,80,,167.68,percent of total billed charges,80% of total billed charges,235.8,90,,188.64,percent of total billed charges,90% of total billed charges,196.5,75,,157.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,75.98,29,,60.784,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,175.54,67,,140.432,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,183.4,70,,146.72,percent of total billed charges,70% of total billed charges,170.3,65,,136.24,percent of total billed charges,65% of total billed charges,93.46,35.67,,74.768,percent of total billed charges,35.67% of total billed charges,75.98,262,
PLATE DISTAL FIBULA,27016145,CDM,278,RC,C1713,HCPCS,outpatient,,,5632,2252.80,,3942.4,70,,3153.92,percent of total billed charges,70% of total billed charges,2956.8,52.5,,2365.44,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,4618.24,82,,3694.592,percent of total billed charges,82% of total billed charges,4787.2,85,,3829.76,percent of total billed charges,85% of total billed charges,4787.2,85,,3829.76,percent of total billed charges,85% of total billed charges,4787.2,85,,3829.76,percent of total billed charges,85% of total billed charges,5068.8,90,,4055.04,percent of total billed charges,90% of total billed charges,4505.6,80,,3604.48,percent of total billed charges,80% of total billed charges,5068.8,90,,4055.04,percent of total billed charges,90% of total billed charges,4224,75,,3379.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,1633.28,29,,1306.624,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,3773.44,67,,3018.752,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,3942.4,70,,3153.92,percent of total billed charges,70% of total billed charges,3660.8,65,,2928.64,percent of total billed charges,65% of total billed charges,2008.93,35.67,,1607.144,percent of total billed charges,35.67% of total billed charges,1633.28,5068.8,
PLATE VA FIBULA,27016146,CDM,278,RC,C1713,HCPCS,outpatient,,,2896,1158.40,,2027.2,70,,1621.76,percent of total billed charges,70% of total billed charges,1520.4,52.5,,1216.32,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,2374.72,82,,1899.776,percent of total billed charges,82% of total billed charges,2461.6,85,,1969.28,percent of total billed charges,85% of total billed charges,2461.6,85,,1969.28,percent of total billed charges,85% of total billed charges,2461.6,85,,1969.28,percent of total billed charges,85% of total billed charges,2606.4,90,,2085.12,percent of total billed charges,90% of total billed charges,2316.8,80,,1853.44,percent of total billed charges,80% of total billed charges,2606.4,90,,2085.12,percent of total billed charges,90% of total billed charges,2172,75,,1737.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,839.84,29,,671.872,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1940.32,67,,1552.256,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,2027.2,70,,1621.76,percent of total billed charges,70% of total billed charges,1882.4,65,,1505.92,percent of total billed charges,65% of total billed charges,1033,35.67,,826.4,percent of total billed charges,35.67% of total billed charges,839.84,2606.4,
SCREW 18 MM,27016147,CDM,278,RC,C1713,HCPCS,outpatient,,,683,273.20,,478.1,70,,382.48,percent of total billed charges,70% of total billed charges,683,100,,546.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,560.06,82,,448.048,percent of total billed charges,82% of total billed charges,580.55,85,,464.44,percent of total billed charges,85% of total billed charges,580.55,85,,464.44,percent of total billed charges,85% of total billed charges,580.55,85,,464.44,percent of total billed charges,85% of total billed charges,614.7,90,,491.76,percent of total billed charges,90% of total billed charges,546.4,80,,437.12,percent of total billed charges,80% of total billed charges,614.7,90,,491.76,percent of total billed charges,90% of total billed charges,512.25,75,,409.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,198.07,29,,158.456,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,457.61,67,,366.088,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,478.1,70,,382.48,percent of total billed charges,70% of total billed charges,443.95,65,,355.16,percent of total billed charges,65% of total billed charges,243.63,35.67,,194.904,percent of total billed charges,35.67% of total billed charges,198.07,683,
SCREW 26 MM,27016148,CDM,278,RC,C1713,HCPCS,outpatient,,,683,273.20,,478.1,70,,382.48,percent of total billed charges,70% of total billed charges,683,100,,546.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,560.06,82,,448.048,percent of total billed charges,82% of total billed charges,580.55,85,,464.44,percent of total billed charges,85% of total billed charges,580.55,85,,464.44,percent of total billed charges,85% of total billed charges,580.55,85,,464.44,percent of total billed charges,85% of total billed charges,614.7,90,,491.76,percent of total billed charges,90% of total billed charges,546.4,80,,437.12,percent of total billed charges,80% of total billed charges,614.7,90,,491.76,percent of total billed charges,90% of total billed charges,512.25,75,,409.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,198.07,29,,158.456,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,457.61,67,,366.088,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,478.1,70,,382.48,percent of total billed charges,70% of total billed charges,443.95,65,,355.16,percent of total billed charges,65% of total billed charges,243.63,35.67,,194.904,percent of total billed charges,35.67% of total billed charges,198.07,683,
SCREW 26 MM,27016149,CDM,278,RC,C1713,HCPCS,outpatient,,,683,273.20,,478.1,70,,382.48,percent of total billed charges,70% of total billed charges,683,100,,546.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,560.06,82,,448.048,percent of total billed charges,82% of total billed charges,580.55,85,,464.44,percent of total billed charges,85% of total billed charges,580.55,85,,464.44,percent of total billed charges,85% of total billed charges,580.55,85,,464.44,percent of total billed charges,85% of total billed charges,614.7,90,,491.76,percent of total billed charges,90% of total billed charges,546.4,80,,437.12,percent of total billed charges,80% of total billed charges,614.7,90,,491.76,percent of total billed charges,90% of total billed charges,512.25,75,,409.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,198.07,29,,158.456,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,457.61,67,,366.088,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,478.1,70,,382.48,percent of total billed charges,70% of total billed charges,443.95,65,,355.16,percent of total billed charges,65% of total billed charges,243.63,35.67,,194.904,percent of total billed charges,35.67% of total billed charges,198.07,683,
SCREW 30 MM,27016150,CDM,278,RC,C1713,HCPCS,outpatient,,,683,273.20,,478.1,70,,382.48,percent of total billed charges,70% of total billed charges,683,100,,546.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,560.06,82,,448.048,percent of total billed charges,82% of total billed charges,580.55,85,,464.44,percent of total billed charges,85% of total billed charges,580.55,85,,464.44,percent of total billed charges,85% of total billed charges,580.55,85,,464.44,percent of total billed charges,85% of total billed charges,614.7,90,,491.76,percent of total billed charges,90% of total billed charges,546.4,80,,437.12,percent of total billed charges,80% of total billed charges,614.7,90,,491.76,percent of total billed charges,90% of total billed charges,512.25,75,,409.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,198.07,29,,158.456,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,457.61,67,,366.088,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,478.1,70,,382.48,percent of total billed charges,70% of total billed charges,443.95,65,,355.16,percent of total billed charges,65% of total billed charges,243.63,35.67,,194.904,percent of total billed charges,35.67% of total billed charges,198.07,683,
SCREW 36 MM,27016151,CDM,278,RC,C1713,HCPCS,outpatient,,,683,273.20,,478.1,70,,382.48,percent of total billed charges,70% of total billed charges,683,100,,546.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,560.06,82,,448.048,percent of total billed charges,82% of total billed charges,580.55,85,,464.44,percent of total billed charges,85% of total billed charges,580.55,85,,464.44,percent of total billed charges,85% of total billed charges,580.55,85,,464.44,percent of total billed charges,85% of total billed charges,614.7,90,,491.76,percent of total billed charges,90% of total billed charges,546.4,80,,437.12,percent of total billed charges,80% of total billed charges,614.7,90,,491.76,percent of total billed charges,90% of total billed charges,512.25,75,,409.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,198.07,29,,158.456,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,457.61,67,,366.088,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,478.1,70,,382.48,percent of total billed charges,70% of total billed charges,443.95,65,,355.16,percent of total billed charges,65% of total billed charges,243.63,35.67,,194.904,percent of total billed charges,35.67% of total billed charges,198.07,683,
ROD 80 MM,27016270,CDM,278,RC,C1713,HCPCS,outpatient,,,1218,487.20,,852.6,70,,682.08,percent of total billed charges,70% of total billed charges,639.45,52.5,,511.56,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,998.76,82,,799.008,percent of total billed charges,82% of total billed charges,1035.3,85,,828.24,percent of total billed charges,85% of total billed charges,1035.3,85,,828.24,percent of total billed charges,85% of total billed charges,1035.3,85,,828.24,percent of total billed charges,85% of total billed charges,1096.2,90,,876.96,percent of total billed charges,90% of total billed charges,974.4,80,,779.52,percent of total billed charges,80% of total billed charges,1096.2,90,,876.96,percent of total billed charges,90% of total billed charges,913.5,75,,730.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,353.22,29,,282.576,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,816.06,67,,652.848,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,852.6,70,,682.08,percent of total billed charges,70% of total billed charges,791.7,65,,633.36,percent of total billed charges,65% of total billed charges,434.46,35.67,,347.568,percent of total billed charges,35.67% of total billed charges,353.22,1096.2,
DEMIN 10.CC CORTICAL FIBERS,27016271,CDM,278,RC,C1713,HCPCS,outpatient,,,11701,4680.40,,8190.7,70,,6552.56,percent of total billed charges,70% of total billed charges,6143.03,52.5,,4914.42,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,9594.82,82,,7675.856,percent of total billed charges,82% of total billed charges,9945.85,85,,7956.68,percent of total billed charges,85% of total billed charges,9945.85,85,,7956.68,percent of total billed charges,85% of total billed charges,9945.85,85,,7956.68,percent of total billed charges,85% of total billed charges,10530.9,90,,8424.72,percent of total billed charges,90% of total billed charges,9360.8,80,,7488.64,percent of total billed charges,80% of total billed charges,10530.9,90,,8424.72,percent of total billed charges,90% of total billed charges,8775.75,75,,7020.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,3393.29,29,,2714.632,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,7839.67,67,,6271.736,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,8190.7,70,,6552.56,percent of total billed charges,70% of total billed charges,7605.65,65,,6084.52,percent of total billed charges,65% of total billed charges,4173.75,35.67,,3339,percent of total billed charges,35.67% of total billed charges,3393.29,10530.9,
PLATE TMT OFFSET,27016318,CDM,278,RC,C1713,HCPCS,outpatient,,,5320,2128.00,,3724,70,,2979.2,percent of total billed charges,70% of total billed charges,2793,52.5,,2234.4,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,4362.4,82,,3489.92,percent of total billed charges,82% of total billed charges,4522,85,,3617.6,percent of total billed charges,85% of total billed charges,4522,85,,3617.6,percent of total billed charges,85% of total billed charges,4522,85,,3617.6,percent of total billed charges,85% of total billed charges,4788,90,,3830.4,percent of total billed charges,90% of total billed charges,4256,80,,3404.8,percent of total billed charges,80% of total billed charges,4788,90,,3830.4,percent of total billed charges,90% of total billed charges,3990,75,,3192,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,1542.8,29,,1234.24,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,3564.4,67,,2851.52,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,3724,70,,2979.2,percent of total billed charges,70% of total billed charges,3458,65,,2766.4,percent of total billed charges,65% of total billed charges,1897.64,35.67,,1518.112,percent of total billed charges,35.67% of total billed charges,1542.8,4788,
LOCKING SCREW 3.5,27016319,CDM,278,RC,C1713,HCPCS,outpatient,,,923,369.20,,646.1,70,,516.88,percent of total billed charges,70% of total billed charges,923,100,,738.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,756.86,82,,605.488,percent of total billed charges,82% of total billed charges,784.55,85,,627.64,percent of total billed charges,85% of total billed charges,784.55,85,,627.64,percent of total billed charges,85% of total billed charges,784.55,85,,627.64,percent of total billed charges,85% of total billed charges,830.7,90,,664.56,percent of total billed charges,90% of total billed charges,738.4,80,,590.72,percent of total billed charges,80% of total billed charges,830.7,90,,664.56,percent of total billed charges,90% of total billed charges,692.25,75,,553.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,267.67,29,,214.136,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,618.41,67,,494.728,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,646.1,70,,516.88,percent of total billed charges,70% of total billed charges,599.95,65,,479.96,percent of total billed charges,65% of total billed charges,329.23,35.67,,263.384,percent of total billed charges,35.67% of total billed charges,267.67,923,
LOCKING SCREW 3.5,27016320,CDM,278,RC,C1713,HCPCS,outpatient,,,923,369.20,,646.1,70,,516.88,percent of total billed charges,70% of total billed charges,923,100,,738.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,756.86,82,,605.488,percent of total billed charges,82% of total billed charges,784.55,85,,627.64,percent of total billed charges,85% of total billed charges,784.55,85,,627.64,percent of total billed charges,85% of total billed charges,784.55,85,,627.64,percent of total billed charges,85% of total billed charges,830.7,90,,664.56,percent of total billed charges,90% of total billed charges,738.4,80,,590.72,percent of total billed charges,80% of total billed charges,830.7,90,,664.56,percent of total billed charges,90% of total billed charges,692.25,75,,553.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,267.67,29,,214.136,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,618.41,67,,494.728,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,646.1,70,,516.88,percent of total billed charges,70% of total billed charges,599.95,65,,479.96,percent of total billed charges,65% of total billed charges,329.23,35.67,,263.384,percent of total billed charges,35.67% of total billed charges,267.67,923,
SCREW 1.6,27016365,CDM,278,RC,C1713,HCPCS,outpatient,,,508,203.20,,355.6,70,,284.48,percent of total billed charges,70% of total billed charges,508,100,,406.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,416.56,82,,333.248,percent of total billed charges,82% of total billed charges,431.8,85,,345.44,percent of total billed charges,85% of total billed charges,431.8,85,,345.44,percent of total billed charges,85% of total billed charges,431.8,85,,345.44,percent of total billed charges,85% of total billed charges,457.2,90,,365.76,percent of total billed charges,90% of total billed charges,406.4,80,,325.12,percent of total billed charges,80% of total billed charges,457.2,90,,365.76,percent of total billed charges,90% of total billed charges,381,75,,304.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,147.32,29,,117.856,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,340.36,67,,272.288,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,355.6,70,,284.48,percent of total billed charges,70% of total billed charges,330.2,65,,264.16,percent of total billed charges,65% of total billed charges,181.2,35.67,,144.96,percent of total billed charges,35.67% of total billed charges,147.32,508,
SCREW,27016504,CDM,278,RC,C1713,HCPCS,outpatient,,,564,225.60,,394.8,70,,315.84,percent of total billed charges,70% of total billed charges,564,100,,451.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,462.48,82,,369.984,percent of total billed charges,82% of total billed charges,479.4,85,,383.52,percent of total billed charges,85% of total billed charges,479.4,85,,383.52,percent of total billed charges,85% of total billed charges,479.4,85,,383.52,percent of total billed charges,85% of total billed charges,507.6,90,,406.08,percent of total billed charges,90% of total billed charges,451.2,80,,360.96,percent of total billed charges,80% of total billed charges,507.6,90,,406.08,percent of total billed charges,90% of total billed charges,423,75,,338.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,163.56,29,,130.848,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,377.88,67,,302.304,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,394.8,70,,315.84,percent of total billed charges,70% of total billed charges,366.6,65,,293.28,percent of total billed charges,65% of total billed charges,201.18,35.67,,160.944,percent of total billed charges,35.67% of total billed charges,163.56,564,
SCREW,27016505,CDM,278,RC,C1713,HCPCS,outpatient,,,564,225.60,,394.8,70,,315.84,percent of total billed charges,70% of total billed charges,564,100,,451.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,462.48,82,,369.984,percent of total billed charges,82% of total billed charges,479.4,85,,383.52,percent of total billed charges,85% of total billed charges,479.4,85,,383.52,percent of total billed charges,85% of total billed charges,479.4,85,,383.52,percent of total billed charges,85% of total billed charges,507.6,90,,406.08,percent of total billed charges,90% of total billed charges,451.2,80,,360.96,percent of total billed charges,80% of total billed charges,507.6,90,,406.08,percent of total billed charges,90% of total billed charges,423,75,,338.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,163.56,29,,130.848,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,377.88,67,,302.304,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,394.8,70,,315.84,percent of total billed charges,70% of total billed charges,366.6,65,,293.28,percent of total billed charges,65% of total billed charges,201.18,35.67,,160.944,percent of total billed charges,35.67% of total billed charges,163.56,564,
GRAFT BIOACTIVE PUTTY,27016620,CDM,278,RC,C1713,HCPCS,outpatient,,,4611,1844.40,,3227.7,70,,2582.16,percent of total billed charges,70% of total billed charges,2420.78,52.5,,1936.62,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,3781.02,82,,3024.816,percent of total billed charges,82% of total billed charges,3919.35,85,,3135.48,percent of total billed charges,85% of total billed charges,3919.35,85,,3135.48,percent of total billed charges,85% of total billed charges,3919.35,85,,3135.48,percent of total billed charges,85% of total billed charges,4149.9,90,,3319.92,percent of total billed charges,90% of total billed charges,3688.8,80,,2951.04,percent of total billed charges,80% of total billed charges,4149.9,90,,3319.92,percent of total billed charges,90% of total billed charges,3458.25,75,,2766.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,1337.19,29,,1069.752,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,3089.37,67,,2471.496,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,3227.7,70,,2582.16,percent of total billed charges,70% of total billed charges,2997.15,65,,2397.72,percent of total billed charges,65% of total billed charges,1644.74,35.67,,1315.792,percent of total billed charges,35.67% of total billed charges,1337.19,4149.9,
PLATE FOR FUSION LARGE,27016621,CDM,278,RC,C1713,HCPCS,outpatient,,,4572,1828.80,,3200.4,70,,2560.32,percent of total billed charges,70% of total billed charges,2400.3,52.5,,1920.24,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,3749.04,82,,2999.232,percent of total billed charges,82% of total billed charges,3886.2,85,,3108.96,percent of total billed charges,85% of total billed charges,3886.2,85,,3108.96,percent of total billed charges,85% of total billed charges,3886.2,85,,3108.96,percent of total billed charges,85% of total billed charges,4114.8,90,,3291.84,percent of total billed charges,90% of total billed charges,3657.6,80,,2926.08,percent of total billed charges,80% of total billed charges,4114.8,90,,3291.84,percent of total billed charges,90% of total billed charges,3429,75,,2743.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,1325.88,29,,1060.704,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,3063.24,67,,2450.592,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,3200.4,70,,2560.32,percent of total billed charges,70% of total billed charges,2971.8,65,,2377.44,percent of total billed charges,65% of total billed charges,1630.83,35.67,,1304.664,percent of total billed charges,35.67% of total billed charges,1325.88,4114.8,
SCREW POLYAXIAL,27016622,CDM,278,RC,C1713,HCPCS,outpatient,,,1024,409.60,,716.8,70,,573.44,percent of total billed charges,70% of total billed charges,537.6,52.5,,430.08,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,839.68,82,,671.744,percent of total billed charges,82% of total billed charges,870.4,85,,696.32,percent of total billed charges,85% of total billed charges,870.4,85,,696.32,percent of total billed charges,85% of total billed charges,870.4,85,,696.32,percent of total billed charges,85% of total billed charges,921.6,90,,737.28,percent of total billed charges,90% of total billed charges,819.2,80,,655.36,percent of total billed charges,80% of total billed charges,921.6,90,,737.28,percent of total billed charges,90% of total billed charges,768,75,,614.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,296.96,29,,237.568,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,686.08,67,,548.864,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,716.8,70,,573.44,percent of total billed charges,70% of total billed charges,665.6,65,,532.48,percent of total billed charges,65% of total billed charges,365.26,35.67,,292.208,percent of total billed charges,35.67% of total billed charges,296.96,921.6,
SCREW NON LOCKING,27016623,CDM,278,RC,C1713,HCPCS,outpatient,,,867,346.80,,606.9,70,,485.52,percent of total billed charges,70% of total billed charges,867,100,,693.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,710.94,82,,568.752,percent of total billed charges,82% of total billed charges,736.95,85,,589.56,percent of total billed charges,85% of total billed charges,736.95,85,,589.56,percent of total billed charges,85% of total billed charges,736.95,85,,589.56,percent of total billed charges,85% of total billed charges,780.3,90,,624.24,percent of total billed charges,90% of total billed charges,693.6,80,,554.88,percent of total billed charges,80% of total billed charges,780.3,90,,624.24,percent of total billed charges,90% of total billed charges,650.25,75,,520.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,251.43,29,,201.144,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,580.89,67,,464.712,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,606.9,70,,485.52,percent of total billed charges,70% of total billed charges,563.55,65,,450.84,percent of total billed charges,65% of total billed charges,309.26,35.67,,247.408,percent of total billed charges,35.67% of total billed charges,251.43,867,
SCREW POLYAXIAL LOCKING,27016624,CDM,278,RC,C1713,HCPCS,outpatient,,,902,360.80,,631.4,70,,505.12,percent of total billed charges,70% of total billed charges,902,100,,721.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,739.64,82,,591.712,percent of total billed charges,82% of total billed charges,766.7,85,,613.36,percent of total billed charges,85% of total billed charges,766.7,85,,613.36,percent of total billed charges,85% of total billed charges,766.7,85,,613.36,percent of total billed charges,85% of total billed charges,811.8,90,,649.44,percent of total billed charges,90% of total billed charges,721.6,80,,577.28,percent of total billed charges,80% of total billed charges,811.8,90,,649.44,percent of total billed charges,90% of total billed charges,676.5,75,,541.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,261.58,29,,209.264,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,604.34,67,,483.472,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,631.4,70,,505.12,percent of total billed charges,70% of total billed charges,586.3,65,,469.04,percent of total billed charges,65% of total billed charges,321.74,35.67,,257.392,percent of total billed charges,35.67% of total billed charges,261.58,902,
SCREW CANNULATED,27016915,CDM,278,RC,C1713,HCPCS,outpatient,,,1024,409.60,,716.8,70,,573.44,percent of total billed charges,70% of total billed charges,537.6,52.5,,430.08,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,839.68,82,,671.744,percent of total billed charges,82% of total billed charges,870.4,85,,696.32,percent of total billed charges,85% of total billed charges,870.4,85,,696.32,percent of total billed charges,85% of total billed charges,870.4,85,,696.32,percent of total billed charges,85% of total billed charges,921.6,90,,737.28,percent of total billed charges,90% of total billed charges,819.2,80,,655.36,percent of total billed charges,80% of total billed charges,921.6,90,,737.28,percent of total billed charges,90% of total billed charges,768,75,,614.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,296.96,29,,237.568,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,686.08,67,,548.864,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,716.8,70,,573.44,percent of total billed charges,70% of total billed charges,665.6,65,,532.48,percent of total billed charges,65% of total billed charges,365.26,35.67,,292.208,percent of total billed charges,35.67% of total billed charges,296.96,921.6,
PLATE MTP FUSION,27016916,CDM,278,RC,C1713,HCPCS,outpatient,,,6384,2553.60,,4468.8,70,,3575.04,percent of total billed charges,70% of total billed charges,3351.6,52.5,,2681.28,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,5234.88,82,,4187.904,percent of total billed charges,82% of total billed charges,5426.4,85,,4341.12,percent of total billed charges,85% of total billed charges,5426.4,85,,4341.12,percent of total billed charges,85% of total billed charges,5426.4,85,,4341.12,percent of total billed charges,85% of total billed charges,5745.6,90,,4596.48,percent of total billed charges,90% of total billed charges,5107.2,80,,4085.76,percent of total billed charges,80% of total billed charges,5745.6,90,,4596.48,percent of total billed charges,90% of total billed charges,4788,75,,3830.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,1851.36,29,,1481.088,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4277.28,67,,3421.824,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,4468.8,70,,3575.04,percent of total billed charges,70% of total billed charges,4149.6,65,,3319.68,percent of total billed charges,65% of total billed charges,2277.17,35.67,,1821.736,percent of total billed charges,35.67% of total billed charges,1851.36,5745.6,
SCREW NON LOCKING,27016917,CDM,278,RC,C1713,HCPCS,outpatient,,,867,346.80,,606.9,70,,485.52,percent of total billed charges,70% of total billed charges,867,100,,693.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,710.94,82,,568.752,percent of total billed charges,82% of total billed charges,736.95,85,,589.56,percent of total billed charges,85% of total billed charges,736.95,85,,589.56,percent of total billed charges,85% of total billed charges,736.95,85,,589.56,percent of total billed charges,85% of total billed charges,780.3,90,,624.24,percent of total billed charges,90% of total billed charges,693.6,80,,554.88,percent of total billed charges,80% of total billed charges,780.3,90,,624.24,percent of total billed charges,90% of total billed charges,650.25,75,,520.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,251.43,29,,201.144,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,580.89,67,,464.712,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,606.9,70,,485.52,percent of total billed charges,70% of total billed charges,563.55,65,,450.84,percent of total billed charges,65% of total billed charges,309.26,35.67,,247.408,percent of total billed charges,35.67% of total billed charges,251.43,867,
SCREW NON LOCKING 3.5,27016918,CDM,278,RC,C1713,HCPCS,outpatient,,,867,346.80,,606.9,70,,485.52,percent of total billed charges,70% of total billed charges,867,100,,693.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,710.94,82,,568.752,percent of total billed charges,82% of total billed charges,736.95,85,,589.56,percent of total billed charges,85% of total billed charges,736.95,85,,589.56,percent of total billed charges,85% of total billed charges,736.95,85,,589.56,percent of total billed charges,85% of total billed charges,780.3,90,,624.24,percent of total billed charges,90% of total billed charges,693.6,80,,554.88,percent of total billed charges,80% of total billed charges,780.3,90,,624.24,percent of total billed charges,90% of total billed charges,650.25,75,,520.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,251.43,29,,201.144,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,580.89,67,,464.712,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,606.9,70,,485.52,percent of total billed charges,70% of total billed charges,563.55,65,,450.84,percent of total billed charges,65% of total billed charges,309.26,35.67,,247.408,percent of total billed charges,35.67% of total billed charges,251.43,867,
SCREW LOCKING POLYAXIAL 2.7,27016919,CDM,278,RC,C1713,HCPCS,outpatient,,,1024,409.60,,716.8,70,,573.44,percent of total billed charges,70% of total billed charges,537.6,52.5,,430.08,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,839.68,82,,671.744,percent of total billed charges,82% of total billed charges,870.4,85,,696.32,percent of total billed charges,85% of total billed charges,870.4,85,,696.32,percent of total billed charges,85% of total billed charges,870.4,85,,696.32,percent of total billed charges,85% of total billed charges,921.6,90,,737.28,percent of total billed charges,90% of total billed charges,819.2,80,,655.36,percent of total billed charges,80% of total billed charges,921.6,90,,737.28,percent of total billed charges,90% of total billed charges,768,75,,614.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,296.96,29,,237.568,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,686.08,67,,548.864,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,716.8,70,,573.44,percent of total billed charges,70% of total billed charges,665.6,65,,532.48,percent of total billed charges,65% of total billed charges,365.26,35.67,,292.208,percent of total billed charges,35.67% of total billed charges,296.96,921.6,
CORTICAL SCREWS,27016943,CDM,278,RC,C1713,HCPCS,outpatient,,,564,225.60,,394.8,70,,315.84,percent of total billed charges,70% of total billed charges,564,100,,451.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,462.48,82,,369.984,percent of total billed charges,82% of total billed charges,479.4,85,,383.52,percent of total billed charges,85% of total billed charges,479.4,85,,383.52,percent of total billed charges,85% of total billed charges,479.4,85,,383.52,percent of total billed charges,85% of total billed charges,507.6,90,,406.08,percent of total billed charges,90% of total billed charges,451.2,80,,360.96,percent of total billed charges,80% of total billed charges,507.6,90,,406.08,percent of total billed charges,90% of total billed charges,423,75,,338.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,163.56,29,,130.848,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,377.88,67,,302.304,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,394.8,70,,315.84,percent of total billed charges,70% of total billed charges,366.6,65,,293.28,percent of total billed charges,65% of total billed charges,201.18,35.67,,160.944,percent of total billed charges,35.67% of total billed charges,163.56,564,
BICEP IMPLANT,27016973,CDM,278,RC,C1713,HCPCS,outpatient,,,3716,1486.40,,2601.2,70,,2080.96,percent of total billed charges,70% of total billed charges,1950.9,52.5,,1560.72,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,3047.12,82,,2437.696,percent of total billed charges,82% of total billed charges,3158.6,85,,2526.88,percent of total billed charges,85% of total billed charges,3158.6,85,,2526.88,percent of total billed charges,85% of total billed charges,3158.6,85,,2526.88,percent of total billed charges,85% of total billed charges,3344.4,90,,2675.52,percent of total billed charges,90% of total billed charges,2972.8,80,,2378.24,percent of total billed charges,80% of total billed charges,3344.4,90,,2675.52,percent of total billed charges,90% of total billed charges,2787,75,,2229.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,1077.64,29,,862.112,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,2489.72,67,,1991.776,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,2601.2,70,,2080.96,percent of total billed charges,70% of total billed charges,2415.4,65,,1932.32,percent of total billed charges,65% of total billed charges,1325.5,35.67,,1060.4,percent of total billed charges,35.67% of total billed charges,1077.64,3344.4,
T PLATE,27016995,CDM,278,RC,C1713,HCPCS,outpatient,,,2252,900.80,,1576.4,70,,1261.12,percent of total billed charges,70% of total billed charges,1182.3,52.5,,945.84,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,1846.64,82,,1477.312,percent of total billed charges,82% of total billed charges,1914.2,85,,1531.36,percent of total billed charges,85% of total billed charges,1914.2,85,,1531.36,percent of total billed charges,85% of total billed charges,1914.2,85,,1531.36,percent of total billed charges,85% of total billed charges,2026.8,90,,1621.44,percent of total billed charges,90% of total billed charges,1801.6,80,,1441.28,percent of total billed charges,80% of total billed charges,2026.8,90,,1621.44,percent of total billed charges,90% of total billed charges,1689,75,,1351.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,653.08,29,,522.464,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1508.84,67,,1207.072,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1576.4,70,,1261.12,percent of total billed charges,70% of total billed charges,1463.8,65,,1171.04,percent of total billed charges,65% of total billed charges,803.29,35.67,,642.632,percent of total billed charges,35.67% of total billed charges,653.08,2026.8,
SCREW CORTICAL,27016996,CDM,278,RC,C1713,HCPCS,outpatient,,,564,225.60,,394.8,70,,315.84,percent of total billed charges,70% of total billed charges,564,100,,451.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,462.48,82,,369.984,percent of total billed charges,82% of total billed charges,479.4,85,,383.52,percent of total billed charges,85% of total billed charges,479.4,85,,383.52,percent of total billed charges,85% of total billed charges,479.4,85,,383.52,percent of total billed charges,85% of total billed charges,507.6,90,,406.08,percent of total billed charges,90% of total billed charges,451.2,80,,360.96,percent of total billed charges,80% of total billed charges,507.6,90,,406.08,percent of total billed charges,90% of total billed charges,423,75,,338.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,163.56,29,,130.848,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,377.88,67,,302.304,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,394.8,70,,315.84,percent of total billed charges,70% of total billed charges,366.6,65,,293.28,percent of total billed charges,65% of total billed charges,201.18,35.67,,160.944,percent of total billed charges,35.67% of total billed charges,163.56,564,
SCREW CORTICAL,27016997,CDM,278,RC,C1713,HCPCS,outpatient,,,564,225.60,,394.8,70,,315.84,percent of total billed charges,70% of total billed charges,564,100,,451.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,462.48,82,,369.984,percent of total billed charges,82% of total billed charges,479.4,85,,383.52,percent of total billed charges,85% of total billed charges,479.4,85,,383.52,percent of total billed charges,85% of total billed charges,479.4,85,,383.52,percent of total billed charges,85% of total billed charges,507.6,90,,406.08,percent of total billed charges,90% of total billed charges,451.2,80,,360.96,percent of total billed charges,80% of total billed charges,507.6,90,,406.08,percent of total billed charges,90% of total billed charges,423,75,,338.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,163.56,29,,130.848,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,377.88,67,,302.304,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,394.8,70,,315.84,percent of total billed charges,70% of total billed charges,366.6,65,,293.28,percent of total billed charges,65% of total billed charges,201.18,35.67,,160.944,percent of total billed charges,35.67% of total billed charges,163.56,564,
SCREW CORTICAL,27016998,CDM,278,RC,C1713,HCPCS,outpatient,,,564,225.60,,394.8,70,,315.84,percent of total billed charges,70% of total billed charges,564,100,,451.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,462.48,82,,369.984,percent of total billed charges,82% of total billed charges,479.4,85,,383.52,percent of total billed charges,85% of total billed charges,479.4,85,,383.52,percent of total billed charges,85% of total billed charges,479.4,85,,383.52,percent of total billed charges,85% of total billed charges,507.6,90,,406.08,percent of total billed charges,90% of total billed charges,451.2,80,,360.96,percent of total billed charges,80% of total billed charges,507.6,90,,406.08,percent of total billed charges,90% of total billed charges,423,75,,338.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,163.56,29,,130.848,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,377.88,67,,302.304,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,394.8,70,,315.84,percent of total billed charges,70% of total billed charges,366.6,65,,293.28,percent of total billed charges,65% of total billed charges,201.18,35.67,,160.944,percent of total billed charges,35.67% of total billed charges,163.56,564,
SCREW CORTICAL,27016999,CDM,278,RC,C1713,HCPCS,outpatient,,,564,225.60,,394.8,70,,315.84,percent of total billed charges,70% of total billed charges,564,100,,451.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,462.48,82,,369.984,percent of total billed charges,82% of total billed charges,479.4,85,,383.52,percent of total billed charges,85% of total billed charges,479.4,85,,383.52,percent of total billed charges,85% of total billed charges,479.4,85,,383.52,percent of total billed charges,85% of total billed charges,507.6,90,,406.08,percent of total billed charges,90% of total billed charges,451.2,80,,360.96,percent of total billed charges,80% of total billed charges,507.6,90,,406.08,percent of total billed charges,90% of total billed charges,423,75,,338.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,163.56,29,,130.848,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,377.88,67,,302.304,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,394.8,70,,315.84,percent of total billed charges,70% of total billed charges,366.6,65,,293.28,percent of total billed charges,65% of total billed charges,201.18,35.67,,160.944,percent of total billed charges,35.67% of total billed charges,163.56,564,
SCREW CORTICAL,27017000,CDM,278,RC,C1713,HCPCS,outpatient,,,564,225.60,,394.8,70,,315.84,percent of total billed charges,70% of total billed charges,564,100,,451.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,462.48,82,,369.984,percent of total billed charges,82% of total billed charges,479.4,85,,383.52,percent of total billed charges,85% of total billed charges,479.4,85,,383.52,percent of total billed charges,85% of total billed charges,479.4,85,,383.52,percent of total billed charges,85% of total billed charges,507.6,90,,406.08,percent of total billed charges,90% of total billed charges,451.2,80,,360.96,percent of total billed charges,80% of total billed charges,507.6,90,,406.08,percent of total billed charges,90% of total billed charges,423,75,,338.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,163.56,29,,130.848,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,377.88,67,,302.304,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,394.8,70,,315.84,percent of total billed charges,70% of total billed charges,366.6,65,,293.28,percent of total billed charges,65% of total billed charges,201.18,35.67,,160.944,percent of total billed charges,35.67% of total billed charges,163.56,564,
BONE CEMENT WITH GENTAMICIN,27017054,CDM,278,RC,C1713,HCPCS,outpatient,,,1465,586.00,,1025.5,70,,820.4,percent of total billed charges,70% of total billed charges,769.13,52.5,,615.3,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,1201.3,82,,961.04,percent of total billed charges,82% of total billed charges,1245.25,85,,996.2,percent of total billed charges,85% of total billed charges,1245.25,85,,996.2,percent of total billed charges,85% of total billed charges,1245.25,85,,996.2,percent of total billed charges,85% of total billed charges,1318.5,90,,1054.8,percent of total billed charges,90% of total billed charges,1172,80,,937.6,percent of total billed charges,80% of total billed charges,1318.5,90,,1054.8,percent of total billed charges,90% of total billed charges,1098.75,75,,879,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,424.85,29,,339.88,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,981.55,67,,785.24,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1025.5,70,,820.4,percent of total billed charges,70% of total billed charges,952.25,65,,761.8,percent of total billed charges,65% of total billed charges,522.57,35.67,,418.056,percent of total billed charges,35.67% of total billed charges,424.85,1318.5,
TECTOSET IMPLANT,2701722,CDM,278,RC,C9359,HCPCS,outpatient,,,6305,2522.00,,4413.5,70,,3530.8,percent of total billed charges,70% of total billed charges,3310.13,52.5,,2648.1,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,5170.1,82,,4136.08,percent of total billed charges,82% of total billed charges,5359.25,85,,4287.4,percent of total billed charges,85% of total billed charges,5359.25,85,,4287.4,percent of total billed charges,85% of total billed charges,5359.25,85,,4287.4,percent of total billed charges,85% of total billed charges,5674.5,90,,4539.6,percent of total billed charges,90% of total billed charges,5044,80,,4035.2,percent of total billed charges,80% of total billed charges,5674.5,90,,4539.6,percent of total billed charges,90% of total billed charges,4728.75,75,,3783,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,150.09,100,,,fee schedule,100% of ASC tier grouping rate,,,,,other ,not seperately reimbursable,4224.35,67,,3379.48,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,4413.5,70,,3530.8,percent of total billed charges,70% of total billed charges,4098.25,65,,3278.6,percent of total billed charges,65% of total billed charges,184.61,123,,,fee schedule,123% of ASC tier grouping rate,150.09,5674.5,
DYNAFORCE SHORT PLATE 18 MM,27017224,CDM,278,RC,C1713,HCPCS,outpatient,,,6079,2431.60,,4255.3,70,,3404.24,percent of total billed charges,70% of total billed charges,3191.48,52.5,,2553.18,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,4984.78,82,,3987.824,percent of total billed charges,82% of total billed charges,5167.15,85,,4133.72,percent of total billed charges,85% of total billed charges,5167.15,85,,4133.72,percent of total billed charges,85% of total billed charges,5167.15,85,,4133.72,percent of total billed charges,85% of total billed charges,5471.1,90,,4376.88,percent of total billed charges,90% of total billed charges,4863.2,80,,3890.56,percent of total billed charges,80% of total billed charges,5471.1,90,,4376.88,percent of total billed charges,90% of total billed charges,4559.25,75,,3647.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,1762.91,29,,1410.328,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4072.93,67,,3258.344,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,4255.3,70,,3404.24,percent of total billed charges,70% of total billed charges,3951.35,65,,3161.08,percent of total billed charges,65% of total billed charges,2168.38,35.67,,1734.704,percent of total billed charges,35.67% of total billed charges,1762.91,5471.1,
DYNA FORCE PLATE KIT,27017226,CDM,278,RC,C1713,HCPCS,outpatient,,,1802,720.80,,1261.4,70,,1009.12,percent of total billed charges,70% of total billed charges,946.05,52.5,,756.84,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,1477.64,82,,1182.112,percent of total billed charges,82% of total billed charges,1531.7,85,,1225.36,percent of total billed charges,85% of total billed charges,1531.7,85,,1225.36,percent of total billed charges,85% of total billed charges,1531.7,85,,1225.36,percent of total billed charges,85% of total billed charges,1621.8,90,,1297.44,percent of total billed charges,90% of total billed charges,1441.6,80,,1153.28,percent of total billed charges,80% of total billed charges,1621.8,90,,1297.44,percent of total billed charges,90% of total billed charges,1351.5,75,,1081.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,522.58,29,,418.064,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1207.34,67,,965.872,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1261.4,70,,1009.12,percent of total billed charges,70% of total billed charges,1171.3,65,,937.04,percent of total billed charges,65% of total billed charges,642.77,35.67,,514.216,percent of total billed charges,35.67% of total billed charges,522.58,1621.8,
K WIRE,27017227,CDM,278,RC,C1713,HCPCS,outpatient,,,564,225.60,,394.8,70,,315.84,percent of total billed charges,70% of total billed charges,564,100,,451.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,462.48,82,,369.984,percent of total billed charges,82% of total billed charges,479.4,85,,383.52,percent of total billed charges,85% of total billed charges,479.4,85,,383.52,percent of total billed charges,85% of total billed charges,479.4,85,,383.52,percent of total billed charges,85% of total billed charges,507.6,90,,406.08,percent of total billed charges,90% of total billed charges,451.2,80,,360.96,percent of total billed charges,80% of total billed charges,507.6,90,,406.08,percent of total billed charges,90% of total billed charges,423,75,,338.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,163.56,29,,130.848,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,377.88,67,,302.304,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,394.8,70,,315.84,percent of total billed charges,70% of total billed charges,366.6,65,,293.28,percent of total billed charges,65% of total billed charges,201.18,35.67,,160.944,percent of total billed charges,35.67% of total billed charges,163.56,564,
SCREW LOCKING 3 MM,27017228,CDM,278,RC,C1713,HCPCS,outpatient,,,1353,541.20,,947.1,70,,757.68,percent of total billed charges,70% of total billed charges,710.33,52.5,,568.26,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,1109.46,82,,887.568,percent of total billed charges,82% of total billed charges,1150.05,85,,920.04,percent of total billed charges,85% of total billed charges,1150.05,85,,920.04,percent of total billed charges,85% of total billed charges,1150.05,85,,920.04,percent of total billed charges,85% of total billed charges,1217.7,90,,974.16,percent of total billed charges,90% of total billed charges,1082.4,80,,865.92,percent of total billed charges,80% of total billed charges,1217.7,90,,974.16,percent of total billed charges,90% of total billed charges,1014.75,75,,811.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,392.37,29,,313.896,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,906.51,67,,725.208,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,947.1,70,,757.68,percent of total billed charges,70% of total billed charges,879.45,65,,703.56,percent of total billed charges,65% of total billed charges,482.62,35.67,,386.096,percent of total billed charges,35.67% of total billed charges,392.37,1217.7,
SCREW LOCKING 3.0 MM,27017229,CDM,278,RC,C1713,HCPCS,outpatient,,,1353,541.20,,947.1,70,,757.68,percent of total billed charges,70% of total billed charges,710.33,52.5,,568.26,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,1109.46,82,,887.568,percent of total billed charges,82% of total billed charges,1150.05,85,,920.04,percent of total billed charges,85% of total billed charges,1150.05,85,,920.04,percent of total billed charges,85% of total billed charges,1150.05,85,,920.04,percent of total billed charges,85% of total billed charges,1217.7,90,,974.16,percent of total billed charges,90% of total billed charges,1082.4,80,,865.92,percent of total billed charges,80% of total billed charges,1217.7,90,,974.16,percent of total billed charges,90% of total billed charges,1014.75,75,,811.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,392.37,29,,313.896,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,906.51,67,,725.208,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,947.1,70,,757.68,percent of total billed charges,70% of total billed charges,879.45,65,,703.56,percent of total billed charges,65% of total billed charges,482.62,35.67,,386.096,percent of total billed charges,35.67% of total billed charges,392.37,1217.7,
FHL FLEXOR HALLUCIS LONGUS IMP,2701723,CDM,278,RC,C1713,HCPCS,outpatient,,,4153,1661.20,,2907.1,70,,2325.68,percent of total billed charges,70% of total billed charges,2180.33,52.5,,1744.26,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,3405.46,82,,2724.368,percent of total billed charges,82% of total billed charges,3530.05,85,,2824.04,percent of total billed charges,85% of total billed charges,3530.05,85,,2824.04,percent of total billed charges,85% of total billed charges,3530.05,85,,2824.04,percent of total billed charges,85% of total billed charges,3737.7,90,,2990.16,percent of total billed charges,90% of total billed charges,3322.4,80,,2657.92,percent of total billed charges,80% of total billed charges,3737.7,90,,2990.16,percent of total billed charges,90% of total billed charges,3114.75,75,,2491.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,1204.37,29,,963.496,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,2782.51,67,,2226.008,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,2907.1,70,,2325.68,percent of total billed charges,70% of total billed charges,2699.45,65,,2159.56,percent of total billed charges,65% of total billed charges,1481.38,35.67,,1185.104,percent of total billed charges,35.67% of total billed charges,1204.37,3737.7,
SCREW LOCKING 3 MM,27017230,CDM,278,RC,C1713,HCPCS,outpatient,,,1353,541.20,,947.1,70,,757.68,percent of total billed charges,70% of total billed charges,710.33,52.5,,568.26,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,1109.46,82,,887.568,percent of total billed charges,82% of total billed charges,1150.05,85,,920.04,percent of total billed charges,85% of total billed charges,1150.05,85,,920.04,percent of total billed charges,85% of total billed charges,1150.05,85,,920.04,percent of total billed charges,85% of total billed charges,1217.7,90,,974.16,percent of total billed charges,90% of total billed charges,1082.4,80,,865.92,percent of total billed charges,80% of total billed charges,1217.7,90,,974.16,percent of total billed charges,90% of total billed charges,1014.75,75,,811.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,392.37,29,,313.896,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,906.51,67,,725.208,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,947.1,70,,757.68,percent of total billed charges,70% of total billed charges,879.45,65,,703.56,percent of total billed charges,65% of total billed charges,482.62,35.67,,386.096,percent of total billed charges,35.67% of total billed charges,392.37,1217.7,
HEALIX SUTURE WITH ANCHOR,27017255,CDM,278,RC,C1713,HCPCS,outpatient,,,2291,916.40,,1603.7,70,,1282.96,percent of total billed charges,70% of total billed charges,1202.78,52.5,,962.22,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,1878.62,82,,1502.896,percent of total billed charges,82% of total billed charges,1947.35,85,,1557.88,percent of total billed charges,85% of total billed charges,1947.35,85,,1557.88,percent of total billed charges,85% of total billed charges,1947.35,85,,1557.88,percent of total billed charges,85% of total billed charges,2061.9,90,,1649.52,percent of total billed charges,90% of total billed charges,1832.8,80,,1466.24,percent of total billed charges,80% of total billed charges,2061.9,90,,1649.52,percent of total billed charges,90% of total billed charges,1718.25,75,,1374.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,664.39,29,,531.512,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1534.97,67,,1227.976,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1603.7,70,,1282.96,percent of total billed charges,70% of total billed charges,1489.15,65,,1191.32,percent of total billed charges,65% of total billed charges,817.2,35.67,,653.76,percent of total billed charges,35.67% of total billed charges,664.39,2061.9,
TACTOSET IMPLANT,27017272,CDM,278,RC,C9359,HCPCS,outpatient,,,6427,2570.80,,4498.9,70,,3599.12,percent of total billed charges,70% of total billed charges,3374.18,52.5,,2699.34,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,5270.14,82,,4216.112,percent of total billed charges,82% of total billed charges,5462.95,85,,4370.36,percent of total billed charges,85% of total billed charges,5462.95,85,,4370.36,percent of total billed charges,85% of total billed charges,5462.95,85,,4370.36,percent of total billed charges,85% of total billed charges,5784.3,90,,4627.44,percent of total billed charges,90% of total billed charges,5141.6,80,,4113.28,percent of total billed charges,80% of total billed charges,5784.3,90,,4627.44,percent of total billed charges,90% of total billed charges,4820.25,75,,3856.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,150.09,100,,,fee schedule,100% of ASC tier grouping rate,,,,,other ,not seperately reimbursable,4306.09,67,,3444.872,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,4498.9,70,,3599.12,percent of total billed charges,70% of total billed charges,4177.55,65,,3342.04,percent of total billed charges,65% of total billed charges,184.61,123,,,fee schedule,123% of ASC tier grouping rate,150.09,5784.3,
SUBTABLAR MBA 8MM IMPLANT,27017290,CDM,278,RC,,,outpatient,,,9956,3982.40,,6969.2,70,,5575.36,percent of total billed charges,70% of total billed charges,5226.9,52.5,,4181.52,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,8163.92,82,,6531.136,percent of total billed charges,82% of total billed charges,8462.6,85,,6770.08,percent of total billed charges,85% of total billed charges,8462.6,85,,6770.08,percent of total billed charges,85% of total billed charges,8462.6,85,,6770.08,percent of total billed charges,85% of total billed charges,8960.4,90,,7168.32,percent of total billed charges,90% of total billed charges,7964.8,80,,6371.84,percent of total billed charges,80% of total billed charges,8960.4,90,,7168.32,percent of total billed charges,90% of total billed charges,7467,75,,5973.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2887.24,29,,2309.792,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,6670.52,67,,5336.416,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,6969.2,70,,5575.36,percent of total billed charges,70% of total billed charges,6471.4,65,,5177.12,percent of total billed charges,65% of total billed charges,3551.31,35.67,,2841.048,percent of total billed charges,35.67% of total billed charges,2887.24,8960.4,
SCREW LOCKING,27017363,CDM,278,RC,C1713,HCPCS,outpatient,,,835,334.00,,584.5,70,,467.6,percent of total billed charges,70% of total billed charges,835,100,,668,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,684.7,82,,547.76,percent of total billed charges,82% of total billed charges,709.75,85,,567.8,percent of total billed charges,85% of total billed charges,709.75,85,,567.8,percent of total billed charges,85% of total billed charges,709.75,85,,567.8,percent of total billed charges,85% of total billed charges,751.5,90,,601.2,percent of total billed charges,90% of total billed charges,668,80,,534.4,percent of total billed charges,80% of total billed charges,751.5,90,,601.2,percent of total billed charges,90% of total billed charges,626.25,75,,501,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,242.15,29,,193.72,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,559.45,67,,447.56,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,584.5,70,,467.6,percent of total billed charges,70% of total billed charges,542.75,65,,434.2,percent of total billed charges,65% of total billed charges,297.84,35.67,,238.272,percent of total billed charges,35.67% of total billed charges,242.15,835,
SCREW LOCKING,27017364,CDM,278,RC,C1713,HCPCS,outpatient,,,835,334.00,,584.5,70,,467.6,percent of total billed charges,70% of total billed charges,835,100,,668,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,684.7,82,,547.76,percent of total billed charges,82% of total billed charges,709.75,85,,567.8,percent of total billed charges,85% of total billed charges,709.75,85,,567.8,percent of total billed charges,85% of total billed charges,709.75,85,,567.8,percent of total billed charges,85% of total billed charges,751.5,90,,601.2,percent of total billed charges,90% of total billed charges,668,80,,534.4,percent of total billed charges,80% of total billed charges,751.5,90,,601.2,percent of total billed charges,90% of total billed charges,626.25,75,,501,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,242.15,29,,193.72,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,559.45,67,,447.56,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,584.5,70,,467.6,percent of total billed charges,70% of total billed charges,542.75,65,,434.2,percent of total billed charges,65% of total billed charges,297.84,35.67,,238.272,percent of total billed charges,35.67% of total billed charges,242.15,835,
SCREW CORTICAL,27017365,CDM,278,RC,C1713,HCPCS,outpatient,,,610,244.00,,427,70,,341.6,percent of total billed charges,70% of total billed charges,610,100,,488,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,500.2,82,,400.16,percent of total billed charges,82% of total billed charges,518.5,85,,414.8,percent of total billed charges,85% of total billed charges,518.5,85,,414.8,percent of total billed charges,85% of total billed charges,518.5,85,,414.8,percent of total billed charges,85% of total billed charges,549,90,,439.2,percent of total billed charges,90% of total billed charges,488,80,,390.4,percent of total billed charges,80% of total billed charges,549,90,,439.2,percent of total billed charges,90% of total billed charges,457.5,75,,366,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,176.9,29,,141.52,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,408.7,67,,326.96,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,427,70,,341.6,percent of total billed charges,70% of total billed charges,396.5,65,,317.2,percent of total billed charges,65% of total billed charges,217.59,35.67,,174.072,percent of total billed charges,35.67% of total billed charges,176.9,610,
SCREW CORTICAL,27017366,CDM,278,RC,C1713,HCPCS,outpatient,,,610,244.00,,427,70,,341.6,percent of total billed charges,70% of total billed charges,610,100,,488,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,500.2,82,,400.16,percent of total billed charges,82% of total billed charges,518.5,85,,414.8,percent of total billed charges,85% of total billed charges,518.5,85,,414.8,percent of total billed charges,85% of total billed charges,518.5,85,,414.8,percent of total billed charges,85% of total billed charges,549,90,,439.2,percent of total billed charges,90% of total billed charges,488,80,,390.4,percent of total billed charges,80% of total billed charges,549,90,,439.2,percent of total billed charges,90% of total billed charges,457.5,75,,366,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,176.9,29,,141.52,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,408.7,67,,326.96,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,427,70,,341.6,percent of total billed charges,70% of total billed charges,396.5,65,,317.2,percent of total billed charges,65% of total billed charges,217.59,35.67,,174.072,percent of total billed charges,35.67% of total billed charges,176.9,610,
IMPLYSYS 2NDDRY FIXATION,27018306,CDM,278,RC,C1713,HCPCS,outpatient,,,2429,971.60,,1700.3,70,,1360.24,percent of total billed charges,70% of total billed charges,1275.23,52.5,,1020.18,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,1991.78,82,,1593.424,percent of total billed charges,82% of total billed charges,2064.65,85,,1651.72,percent of total billed charges,85% of total billed charges,2064.65,85,,1651.72,percent of total billed charges,85% of total billed charges,2064.65,85,,1651.72,percent of total billed charges,85% of total billed charges,2186.1,90,,1748.88,percent of total billed charges,90% of total billed charges,1943.2,80,,1554.56,percent of total billed charges,80% of total billed charges,2186.1,90,,1748.88,percent of total billed charges,90% of total billed charges,1821.75,75,,1457.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,704.41,29,,563.528,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1627.43,67,,1301.944,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1700.3,70,,1360.24,percent of total billed charges,70% of total billed charges,1578.85,65,,1263.08,percent of total billed charges,65% of total billed charges,866.42,35.67,,693.136,percent of total billed charges,35.67% of total billed charges,704.41,2186.1,
"PLATE, MTP FUSION, SML, RIGHT",27018734,CDM,278,RC,C1713,HCPCS,outpatient,,,7725,3090.00,,5407.5,70,,4326,percent of total billed charges,70% of total billed charges,4055.63,52.5,,3244.5,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,6334.5,82,,5067.6,percent of total billed charges,82% of total billed charges,6566.25,85,,5253,percent of total billed charges,85% of total billed charges,6566.25,85,,5253,percent of total billed charges,85% of total billed charges,6566.25,85,,5253,percent of total billed charges,85% of total billed charges,6952.5,90,,5562,percent of total billed charges,90% of total billed charges,6180,80,,4944,percent of total billed charges,80% of total billed charges,6952.5,90,,5562,percent of total billed charges,90% of total billed charges,5793.75,75,,4635,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2240.25,29,,1792.2,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,5175.75,67,,4140.6,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,5407.5,70,,4326,percent of total billed charges,70% of total billed charges,5021.25,65,,4017,percent of total billed charges,65% of total billed charges,2755.51,35.67,,2204.408,percent of total billed charges,35.67% of total billed charges,2240.25,6952.5,
SCREW NON LOCKING 2.7 X 18MM,27018735,CDM,278,RC,C1713,HCPCS,outpatient,,,850,340.00,,595,70,,476,percent of total billed charges,70% of total billed charges,850,100,,680,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,697,82,,557.6,percent of total billed charges,82% of total billed charges,722.5,85,,578,percent of total billed charges,85% of total billed charges,722.5,85,,578,percent of total billed charges,85% of total billed charges,722.5,85,,578,percent of total billed charges,85% of total billed charges,765,90,,612,percent of total billed charges,90% of total billed charges,680,80,,544,percent of total billed charges,80% of total billed charges,765,90,,612,percent of total billed charges,90% of total billed charges,637.5,75,,510,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,246.5,29,,197.2,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,569.5,67,,455.6,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,595,70,,476,percent of total billed charges,70% of total billed charges,552.5,65,,442,percent of total billed charges,65% of total billed charges,303.2,35.67,,242.56,percent of total billed charges,35.67% of total billed charges,246.5,850,
BONE SUBSTITUTE INJECTABLE,27018757,CDM,278,RC,C1713,HCPCS,outpatient,,,1236,494.40,,865.2,70,,692.16,percent of total billed charges,70% of total billed charges,648.9,52.5,,519.12,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,1013.52,82,,810.816,percent of total billed charges,82% of total billed charges,1050.6,85,,840.48,percent of total billed charges,85% of total billed charges,1050.6,85,,840.48,percent of total billed charges,85% of total billed charges,1050.6,85,,840.48,percent of total billed charges,85% of total billed charges,1112.4,90,,889.92,percent of total billed charges,90% of total billed charges,988.8,80,,791.04,percent of total billed charges,80% of total billed charges,1112.4,90,,889.92,percent of total billed charges,90% of total billed charges,927,75,,741.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,358.44,29,,286.752,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,828.12,67,,662.496,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,865.2,70,,692.16,percent of total billed charges,70% of total billed charges,803.4,65,,642.72,percent of total billed charges,65% of total billed charges,440.88,35.67,,352.704,percent of total billed charges,35.67% of total billed charges,358.44,1112.4,
TACTOSET,27018758,CDM,278,RC,C9359,HCPCS,outpatient,,,7416,2966.40,,5191.2,70,,4152.96,percent of total billed charges,70% of total billed charges,3893.4,52.5,,3114.72,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,6081.12,82,,4864.896,percent of total billed charges,82% of total billed charges,6303.6,85,,5042.88,percent of total billed charges,85% of total billed charges,6303.6,85,,5042.88,percent of total billed charges,85% of total billed charges,6303.6,85,,5042.88,percent of total billed charges,85% of total billed charges,6674.4,90,,5339.52,percent of total billed charges,90% of total billed charges,5932.8,80,,4746.24,percent of total billed charges,80% of total billed charges,6674.4,90,,5339.52,percent of total billed charges,90% of total billed charges,5562,75,,4449.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,150.09,100,,,fee schedule,100% of ASC tier grouping rate,,,,,other ,not seperately reimbursable,4968.72,67,,3974.976,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,5191.2,70,,4152.96,percent of total billed charges,70% of total billed charges,4820.4,65,,3856.32,percent of total billed charges,65% of total billed charges,184.61,123,,,fee schedule,123% of ASC tier grouping rate,150.09,6674.4,
SCREW 3MM X 18,27019458,CDM,278,RC,C1713,HCPCS,outpatient,,,369,147.60,,258.3,70,,206.64,percent of total billed charges,70% of total billed charges,369,100,,295.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,302.58,82,,242.064,percent of total billed charges,82% of total billed charges,313.65,85,,250.92,percent of total billed charges,85% of total billed charges,313.65,85,,250.92,percent of total billed charges,85% of total billed charges,313.65,85,,250.92,percent of total billed charges,85% of total billed charges,332.1,90,,265.68,percent of total billed charges,90% of total billed charges,295.2,80,,236.16,percent of total billed charges,80% of total billed charges,332.1,90,,265.68,percent of total billed charges,90% of total billed charges,276.75,75,,221.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,107.01,29,,85.608,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,247.23,67,,197.784,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,258.3,70,,206.64,percent of total billed charges,70% of total billed charges,239.85,65,,191.88,percent of total billed charges,65% of total billed charges,131.62,35.67,,105.296,percent of total billed charges,35.67% of total billed charges,107.01,369,
GUIDEWIRE 1.35MM TROCAR TIP,27019460,CDM,278,RC,C1781,HCPCS,outpatient,,,51,20.40,,35.7,70,,28.56,percent of total billed charges,70% of total billed charges,51,100,,40.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,41.82,82,,33.456,percent of total billed charges,82% of total billed charges,43.35,85,,34.68,percent of total billed charges,85% of total billed charges,43.35,85,,34.68,percent of total billed charges,85% of total billed charges,43.35,85,,34.68,percent of total billed charges,85% of total billed charges,45.9,90,,36.72,percent of total billed charges,90% of total billed charges,40.8,80,,32.64,percent of total billed charges,80% of total billed charges,45.9,90,,36.72,percent of total billed charges,90% of total billed charges,38.25,75,,30.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,14.79,29,,11.832,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,34.17,67,,27.336,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,35.7,70,,28.56,percent of total billed charges,70% of total billed charges,33.15,65,,26.52,percent of total billed charges,65% of total billed charges,18.19,35.67,,14.552,percent of total billed charges,35.67% of total billed charges,14.79,51,
CANCELLOUS SCREW 4MMX46MM,27019462,CDM,278,RC,C1713,HCPCS,outpatient,,,554,221.60,,387.8,70,,310.24,percent of total billed charges,70% of total billed charges,554,100,,443.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,454.28,82,,363.424,percent of total billed charges,82% of total billed charges,470.9,85,,376.72,percent of total billed charges,85% of total billed charges,470.9,85,,376.72,percent of total billed charges,85% of total billed charges,470.9,85,,376.72,percent of total billed charges,85% of total billed charges,498.6,90,,398.88,percent of total billed charges,90% of total billed charges,443.2,80,,354.56,percent of total billed charges,80% of total billed charges,498.6,90,,398.88,percent of total billed charges,90% of total billed charges,415.5,75,,332.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,160.66,29,,128.528,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,371.18,67,,296.944,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,387.8,70,,310.24,percent of total billed charges,70% of total billed charges,360.1,65,,288.08,percent of total billed charges,65% of total billed charges,197.61,35.67,,158.088,percent of total billed charges,35.67% of total billed charges,160.66,554,
SCREW LOCKING POLYAXIAL,27019498,CDM,278,RC,C1713,HCPCS,outpatient,,,603,241.20,,422.1,70,,337.68,percent of total billed charges,70% of total billed charges,603,100,,482.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,494.46,82,,395.568,percent of total billed charges,82% of total billed charges,512.55,85,,410.04,percent of total billed charges,85% of total billed charges,512.55,85,,410.04,percent of total billed charges,85% of total billed charges,512.55,85,,410.04,percent of total billed charges,85% of total billed charges,542.7,90,,434.16,percent of total billed charges,90% of total billed charges,482.4,80,,385.92,percent of total billed charges,80% of total billed charges,542.7,90,,434.16,percent of total billed charges,90% of total billed charges,452.25,75,,361.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,174.87,29,,139.896,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,404.01,67,,323.208,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,422.1,70,,337.68,percent of total billed charges,70% of total billed charges,391.95,65,,313.56,percent of total billed charges,65% of total billed charges,215.09,35.67,,172.072,percent of total billed charges,35.67% of total billed charges,174.87,603,
SCREW POLYAXIAL LOCKING 2.7X16,27019499,CDM,278,RC,C1713,HCPCS,outpatient,,,1082,432.80,,757.4,70,,605.92,percent of total billed charges,70% of total billed charges,568.05,52.5,,454.44,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,887.24,82,,709.792,percent of total billed charges,82% of total billed charges,919.7,85,,735.76,percent of total billed charges,85% of total billed charges,919.7,85,,735.76,percent of total billed charges,85% of total billed charges,919.7,85,,735.76,percent of total billed charges,85% of total billed charges,973.8,90,,779.04,percent of total billed charges,90% of total billed charges,865.6,80,,692.48,percent of total billed charges,80% of total billed charges,973.8,90,,779.04,percent of total billed charges,90% of total billed charges,811.5,75,,649.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,313.78,29,,251.024,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,724.94,67,,579.952,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,757.4,70,,605.92,percent of total billed charges,70% of total billed charges,703.3,65,,562.64,percent of total billed charges,65% of total billed charges,385.95,35.67,,308.76,percent of total billed charges,35.67% of total billed charges,313.78,973.8,
"PLATE,MTP FUSION,0 DEG,MED,RT",27019500,CDM,278,RC,C1781,HCPCS,outpatient,,,5562,2224.80,,3893.4,70,,3114.72,percent of total billed charges,70% of total billed charges,2920.05,52.5,,2336.04,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,4560.84,82,,3648.672,percent of total billed charges,82% of total billed charges,4727.7,85,,3782.16,percent of total billed charges,85% of total billed charges,4727.7,85,,3782.16,percent of total billed charges,85% of total billed charges,4727.7,85,,3782.16,percent of total billed charges,85% of total billed charges,5005.8,90,,4004.64,percent of total billed charges,90% of total billed charges,4449.6,80,,3559.68,percent of total billed charges,80% of total billed charges,5005.8,90,,4004.64,percent of total billed charges,90% of total billed charges,4171.5,75,,3337.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,1612.98,29,,1290.384,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,3726.54,67,,2981.232,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,3893.4,70,,3114.72,percent of total billed charges,70% of total billed charges,3615.3,65,,2892.24,percent of total billed charges,65% of total billed charges,1983.97,35.67,,1587.176,percent of total billed charges,35.67% of total billed charges,1612.98,5005.8,
BB TAK,27019525,CDM,278,RC,C1713,HCPCS,outpatient,,,167,66.80,,116.9,70,,93.52,percent of total billed charges,70% of total billed charges,167,100,,133.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,136.94,82,,109.552,percent of total billed charges,82% of total billed charges,141.95,85,,113.56,percent of total billed charges,85% of total billed charges,141.95,85,,113.56,percent of total billed charges,85% of total billed charges,141.95,85,,113.56,percent of total billed charges,85% of total billed charges,150.3,90,,120.24,percent of total billed charges,90% of total billed charges,133.6,80,,106.88,percent of total billed charges,80% of total billed charges,150.3,90,,120.24,percent of total billed charges,90% of total billed charges,125.25,75,,100.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,48.43,29,,38.744,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,111.89,67,,89.512,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,116.9,70,,93.52,percent of total billed charges,70% of total billed charges,108.55,65,,86.84,percent of total billed charges,65% of total billed charges,59.57,35.67,,47.656,percent of total billed charges,35.67% of total billed charges,48.43,167,
SCREW 2.4X10MM CORTEX LOW PROF,27019526,CDM,278,RC,C1713,HCPCS,outpatient,,,369,147.60,,258.3,70,,206.64,percent of total billed charges,70% of total billed charges,369,100,,295.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,302.58,82,,242.064,percent of total billed charges,82% of total billed charges,313.65,85,,250.92,percent of total billed charges,85% of total billed charges,313.65,85,,250.92,percent of total billed charges,85% of total billed charges,313.65,85,,250.92,percent of total billed charges,85% of total billed charges,332.1,90,,265.68,percent of total billed charges,90% of total billed charges,295.2,80,,236.16,percent of total billed charges,80% of total billed charges,332.1,90,,265.68,percent of total billed charges,90% of total billed charges,276.75,75,,221.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,107.01,29,,85.608,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,247.23,67,,197.784,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,258.3,70,,206.64,percent of total billed charges,70% of total billed charges,239.85,65,,191.88,percent of total billed charges,65% of total billed charges,131.62,35.67,,105.296,percent of total billed charges,35.67% of total billed charges,107.01,369,
SCREW 2.4X12MM CORTEX LOW PROF,27019527,CDM,278,RC,C1713,HCPCS,outpatient,,,369,147.60,,258.3,70,,206.64,percent of total billed charges,70% of total billed charges,369,100,,295.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,302.58,82,,242.064,percent of total billed charges,82% of total billed charges,313.65,85,,250.92,percent of total billed charges,85% of total billed charges,313.65,85,,250.92,percent of total billed charges,85% of total billed charges,313.65,85,,250.92,percent of total billed charges,85% of total billed charges,332.1,90,,265.68,percent of total billed charges,90% of total billed charges,295.2,80,,236.16,percent of total billed charges,80% of total billed charges,332.1,90,,265.68,percent of total billed charges,90% of total billed charges,276.75,75,,221.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,107.01,29,,85.608,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,247.23,67,,197.784,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,258.3,70,,206.64,percent of total billed charges,70% of total billed charges,239.85,65,,191.88,percent of total billed charges,65% of total billed charges,131.62,35.67,,105.296,percent of total billed charges,35.67% of total billed charges,107.01,369,
"VAL SCREW 2.4X14MM,TI",27019529,CDM,278,RC,C1713,HCPCS,outpatient,,,469,187.60,,328.3,70,,262.64,percent of total billed charges,70% of total billed charges,469,100,,375.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,384.58,82,,307.664,percent of total billed charges,82% of total billed charges,398.65,85,,318.92,percent of total billed charges,85% of total billed charges,398.65,85,,318.92,percent of total billed charges,85% of total billed charges,398.65,85,,318.92,percent of total billed charges,85% of total billed charges,422.1,90,,337.68,percent of total billed charges,90% of total billed charges,375.2,80,,300.16,percent of total billed charges,80% of total billed charges,422.1,90,,337.68,percent of total billed charges,90% of total billed charges,351.75,75,,281.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,136.01,29,,108.808,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,314.23,67,,251.384,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,328.3,70,,262.64,percent of total billed charges,70% of total billed charges,304.85,65,,243.88,percent of total billed charges,65% of total billed charges,167.29,35.67,,133.832,percent of total billed charges,35.67% of total billed charges,136.01,469,
"VAL SCREW 2.4X16MM,TI",27019530,CDM,278,RC,C1713,HCPCS,outpatient,,,469,187.60,,328.3,70,,262.64,percent of total billed charges,70% of total billed charges,469,100,,375.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,384.58,82,,307.664,percent of total billed charges,82% of total billed charges,398.65,85,,318.92,percent of total billed charges,85% of total billed charges,398.65,85,,318.92,percent of total billed charges,85% of total billed charges,398.65,85,,318.92,percent of total billed charges,85% of total billed charges,422.1,90,,337.68,percent of total billed charges,90% of total billed charges,375.2,80,,300.16,percent of total billed charges,80% of total billed charges,422.1,90,,337.68,percent of total billed charges,90% of total billed charges,351.75,75,,281.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,136.01,29,,108.808,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,314.23,67,,251.384,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,328.3,70,,262.64,percent of total billed charges,70% of total billed charges,304.85,65,,243.88,percent of total billed charges,65% of total billed charges,167.29,35.67,,133.832,percent of total billed charges,35.67% of total billed charges,136.01,469,
SCREW CANN HEADED 3.5X34MM,27019555,CDM,278,RC,C1713,HCPCS,outpatient,,,464,185.60,,324.8,70,,259.84,percent of total billed charges,70% of total billed charges,464,100,,371.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,380.48,82,,304.384,percent of total billed charges,82% of total billed charges,394.4,85,,315.52,percent of total billed charges,85% of total billed charges,394.4,85,,315.52,percent of total billed charges,85% of total billed charges,394.4,85,,315.52,percent of total billed charges,85% of total billed charges,417.6,90,,334.08,percent of total billed charges,90% of total billed charges,371.2,80,,296.96,percent of total billed charges,80% of total billed charges,417.6,90,,334.08,percent of total billed charges,90% of total billed charges,348,75,,278.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,134.56,29,,107.648,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,310.88,67,,248.704,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,324.8,70,,259.84,percent of total billed charges,70% of total billed charges,301.6,65,,241.28,percent of total billed charges,65% of total billed charges,165.51,35.67,,132.408,percent of total billed charges,35.67% of total billed charges,134.56,464,
FIBERTSTITCH IMPLANT CURVED,27019920,CDM,278,RC,C1713,HCPCS,outpatient,,,1659,663.60,,1161.3,70,,929.04,percent of total billed charges,70% of total billed charges,870.98,52.5,,696.78,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,1360.38,82,,1088.304,percent of total billed charges,82% of total billed charges,1410.15,85,,1128.12,percent of total billed charges,85% of total billed charges,1410.15,85,,1128.12,percent of total billed charges,85% of total billed charges,1410.15,85,,1128.12,percent of total billed charges,85% of total billed charges,1493.1,90,,1194.48,percent of total billed charges,90% of total billed charges,1327.2,80,,1061.76,percent of total billed charges,80% of total billed charges,1493.1,90,,1194.48,percent of total billed charges,90% of total billed charges,1244.25,75,,995.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,481.11,29,,384.888,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1111.53,67,,889.224,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1161.3,70,,929.04,percent of total billed charges,70% of total billed charges,1078.35,65,,862.68,percent of total billed charges,65% of total billed charges,591.77,35.67,,473.416,percent of total billed charges,35.67% of total billed charges,481.11,1493.1,
TRUNODE GAMMA PROBE,27019953,CDM,278,RC,,,outpatient,,,308,123.20,,215.6,70,,172.48,percent of total billed charges,70% of total billed charges,308,100,,246.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,252.56,82,,202.048,percent of total billed charges,82% of total billed charges,261.8,85,,209.44,percent of total billed charges,85% of total billed charges,261.8,85,,209.44,percent of total billed charges,85% of total billed charges,261.8,85,,209.44,percent of total billed charges,85% of total billed charges,277.2,90,,221.76,percent of total billed charges,90% of total billed charges,246.4,80,,197.12,percent of total billed charges,80% of total billed charges,277.2,90,,221.76,percent of total billed charges,90% of total billed charges,231,75,,184.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,89.32,29,,71.456,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,206.36,67,,165.088,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,215.6,70,,172.48,percent of total billed charges,70% of total billed charges,200.2,65,,160.16,percent of total billed charges,65% of total billed charges,109.86,35.67,,87.888,percent of total billed charges,35.67% of total billed charges,89.32,308,
GUIDEWIRE W/TRCR TIP .045,27020248,CDM,278,RC,C1713,HCPCS,outpatient,,,51,20.40,,35.7,70,,28.56,percent of total billed charges,70% of total billed charges,51,100,,40.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,41.82,82,,33.456,percent of total billed charges,82% of total billed charges,43.35,85,,34.68,percent of total billed charges,85% of total billed charges,43.35,85,,34.68,percent of total billed charges,85% of total billed charges,43.35,85,,34.68,percent of total billed charges,85% of total billed charges,45.9,90,,36.72,percent of total billed charges,90% of total billed charges,40.8,80,,32.64,percent of total billed charges,80% of total billed charges,45.9,90,,36.72,percent of total billed charges,90% of total billed charges,38.25,75,,30.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,14.79,29,,11.832,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,34.17,67,,27.336,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,35.7,70,,28.56,percent of total billed charges,70% of total billed charges,33.15,65,,26.52,percent of total billed charges,65% of total billed charges,18.19,35.67,,14.552,percent of total billed charges,35.67% of total billed charges,14.79,51,
CANNULATED SCREW 4.0X32MM,27020250,CDM,278,RC,C1781,HCPCS,outpatient,,,554,221.60,,387.8,70,,310.24,percent of total billed charges,70% of total billed charges,554,100,,443.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,454.28,82,,363.424,percent of total billed charges,82% of total billed charges,470.9,85,,376.72,percent of total billed charges,85% of total billed charges,470.9,85,,376.72,percent of total billed charges,85% of total billed charges,470.9,85,,376.72,percent of total billed charges,85% of total billed charges,498.6,90,,398.88,percent of total billed charges,90% of total billed charges,443.2,80,,354.56,percent of total billed charges,80% of total billed charges,498.6,90,,398.88,percent of total billed charges,90% of total billed charges,415.5,75,,332.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,160.66,29,,128.528,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,371.18,67,,296.944,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,387.8,70,,310.24,percent of total billed charges,70% of total billed charges,360.1,65,,288.08,percent of total billed charges,65% of total billed charges,197.61,35.67,,158.088,percent of total billed charges,35.67% of total billed charges,160.66,554,
SCREW CANNULATED 4.0 X 36MM,27020251,CDM,278,RC,C1713,HCPCS,outpatient,,,554,221.60,,387.8,70,,310.24,percent of total billed charges,70% of total billed charges,554,100,,443.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,454.28,82,,363.424,percent of total billed charges,82% of total billed charges,470.9,85,,376.72,percent of total billed charges,85% of total billed charges,470.9,85,,376.72,percent of total billed charges,85% of total billed charges,470.9,85,,376.72,percent of total billed charges,85% of total billed charges,498.6,90,,398.88,percent of total billed charges,90% of total billed charges,443.2,80,,354.56,percent of total billed charges,80% of total billed charges,498.6,90,,398.88,percent of total billed charges,90% of total billed charges,415.5,75,,332.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,160.66,29,,128.528,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,371.18,67,,296.944,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,387.8,70,,310.24,percent of total billed charges,70% of total billed charges,360.1,65,,288.08,percent of total billed charges,65% of total billed charges,197.61,35.67,,158.088,percent of total billed charges,35.67% of total billed charges,160.66,554,
CORTICAL SCREW 3MMX20MM,27020256,CDM,278,RC,C1713,HCPCS,outpatient,,,369,147.60,,258.3,70,,206.64,percent of total billed charges,70% of total billed charges,369,100,,295.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,302.58,82,,242.064,percent of total billed charges,82% of total billed charges,313.65,85,,250.92,percent of total billed charges,85% of total billed charges,313.65,85,,250.92,percent of total billed charges,85% of total billed charges,313.65,85,,250.92,percent of total billed charges,85% of total billed charges,332.1,90,,265.68,percent of total billed charges,90% of total billed charges,295.2,80,,236.16,percent of total billed charges,80% of total billed charges,332.1,90,,265.68,percent of total billed charges,90% of total billed charges,276.75,75,,221.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,107.01,29,,85.608,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,247.23,67,,197.784,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,258.3,70,,206.64,percent of total billed charges,70% of total billed charges,239.85,65,,191.88,percent of total billed charges,65% of total billed charges,131.62,35.67,,105.296,percent of total billed charges,35.67% of total billed charges,107.01,369,
QCKFIX SCREW 2.0X14MM,27020321,CDM,278,RC,C1781,HCPCS,outpatient,,,446,178.40,,312.2,70,,249.76,percent of total billed charges,70% of total billed charges,446,100,,356.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,365.72,82,,292.576,percent of total billed charges,82% of total billed charges,379.1,85,,303.28,percent of total billed charges,85% of total billed charges,379.1,85,,303.28,percent of total billed charges,85% of total billed charges,379.1,85,,303.28,percent of total billed charges,85% of total billed charges,401.4,90,,321.12,percent of total billed charges,90% of total billed charges,356.8,80,,285.44,percent of total billed charges,80% of total billed charges,401.4,90,,321.12,percent of total billed charges,90% of total billed charges,334.5,75,,267.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,129.34,29,,103.472,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,298.82,67,,239.056,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,312.2,70,,249.76,percent of total billed charges,70% of total billed charges,289.9,65,,231.92,percent of total billed charges,65% of total billed charges,159.09,35.67,,127.272,percent of total billed charges,35.67% of total billed charges,129.34,446,
QCKFIX SCREW 2.0 X 16MM,27020322,CDM,278,RC,C1781,HCPCS,outpatient,,,446,178.40,,312.2,70,,249.76,percent of total billed charges,70% of total billed charges,446,100,,356.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,365.72,82,,292.576,percent of total billed charges,82% of total billed charges,379.1,85,,303.28,percent of total billed charges,85% of total billed charges,379.1,85,,303.28,percent of total billed charges,85% of total billed charges,379.1,85,,303.28,percent of total billed charges,85% of total billed charges,401.4,90,,321.12,percent of total billed charges,90% of total billed charges,356.8,80,,285.44,percent of total billed charges,80% of total billed charges,401.4,90,,321.12,percent of total billed charges,90% of total billed charges,334.5,75,,267.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,129.34,29,,103.472,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,298.82,67,,239.056,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,312.2,70,,249.76,percent of total billed charges,70% of total billed charges,289.9,65,,231.92,percent of total billed charges,65% of total billed charges,159.09,35.67,,127.272,percent of total billed charges,35.67% of total billed charges,129.34,446,
QCKFIX SCREW 3.0 X 32MM,27020323,CDM,278,RC,C1781,HCPCS,outpatient,,,685,274.00,,479.5,70,,383.6,percent of total billed charges,70% of total billed charges,685,100,,548,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,561.7,82,,449.36,percent of total billed charges,82% of total billed charges,582.25,85,,465.8,percent of total billed charges,85% of total billed charges,582.25,85,,465.8,percent of total billed charges,85% of total billed charges,582.25,85,,465.8,percent of total billed charges,85% of total billed charges,616.5,90,,493.2,percent of total billed charges,90% of total billed charges,548,80,,438.4,percent of total billed charges,80% of total billed charges,616.5,90,,493.2,percent of total billed charges,90% of total billed charges,513.75,75,,411,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,198.65,29,,158.92,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,458.95,67,,367.16,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,479.5,70,,383.6,percent of total billed charges,70% of total billed charges,445.25,65,,356.2,percent of total billed charges,65% of total billed charges,244.34,35.67,,195.472,percent of total billed charges,35.67% of total billed charges,198.65,685,
GUIDEWIRE .86MM W/LASER LINE,27020324,CDM,278,RC,C1713,HCPCS,outpatient,,,51,20.40,,35.7,70,,28.56,percent of total billed charges,70% of total billed charges,51,100,,40.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,41.82,82,,33.456,percent of total billed charges,82% of total billed charges,43.35,85,,34.68,percent of total billed charges,85% of total billed charges,43.35,85,,34.68,percent of total billed charges,85% of total billed charges,43.35,85,,34.68,percent of total billed charges,85% of total billed charges,45.9,90,,36.72,percent of total billed charges,90% of total billed charges,40.8,80,,32.64,percent of total billed charges,80% of total billed charges,45.9,90,,36.72,percent of total billed charges,90% of total billed charges,38.25,75,,30.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,14.79,29,,11.832,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,34.17,67,,27.336,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,35.7,70,,28.56,percent of total billed charges,70% of total billed charges,33.15,65,,26.52,percent of total billed charges,65% of total billed charges,18.19,35.67,,14.552,percent of total billed charges,35.67% of total billed charges,14.79,51,
"DRILL BIT 2.5MM, CANNULATED",27020363,CDM,278,RC,C1713,HCPCS,outpatient,,,587,234.80,,410.9,70,,328.72,percent of total billed charges,70% of total billed charges,587,100,,469.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,481.34,82,,385.072,percent of total billed charges,82% of total billed charges,498.95,85,,399.16,percent of total billed charges,85% of total billed charges,498.95,85,,399.16,percent of total billed charges,85% of total billed charges,498.95,85,,399.16,percent of total billed charges,85% of total billed charges,528.3,90,,422.64,percent of total billed charges,90% of total billed charges,469.6,80,,375.68,percent of total billed charges,80% of total billed charges,528.3,90,,422.64,percent of total billed charges,90% of total billed charges,440.25,75,,352.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,170.23,29,,136.184,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,393.29,67,,314.632,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,410.9,70,,328.72,percent of total billed charges,70% of total billed charges,381.55,65,,305.24,percent of total billed charges,65% of total billed charges,209.38,35.67,,167.504,percent of total billed charges,35.67% of total billed charges,170.23,587,
QCKFIX SCREW 4.0X34MM,27020364,CDM,278,RC,C1781,HCPCS,outpatient,,,554,221.60,,387.8,70,,310.24,percent of total billed charges,70% of total billed charges,554,100,,443.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,454.28,82,,363.424,percent of total billed charges,82% of total billed charges,470.9,85,,376.72,percent of total billed charges,85% of total billed charges,470.9,85,,376.72,percent of total billed charges,85% of total billed charges,470.9,85,,376.72,percent of total billed charges,85% of total billed charges,498.6,90,,398.88,percent of total billed charges,90% of total billed charges,443.2,80,,354.56,percent of total billed charges,80% of total billed charges,498.6,90,,398.88,percent of total billed charges,90% of total billed charges,415.5,75,,332.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,160.66,29,,128.528,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,371.18,67,,296.944,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,387.8,70,,310.24,percent of total billed charges,70% of total billed charges,360.1,65,,288.08,percent of total billed charges,65% of total billed charges,197.61,35.67,,158.088,percent of total billed charges,35.67% of total billed charges,160.66,554,
"VAL SCREW 2.4X10MM,TI",27020372,CDM,278,RC,C1713,HCPCS,outpatient,,,469,187.60,,328.3,70,,262.64,percent of total billed charges,70% of total billed charges,469,100,,375.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,384.58,82,,307.664,percent of total billed charges,82% of total billed charges,398.65,85,,318.92,percent of total billed charges,85% of total billed charges,398.65,85,,318.92,percent of total billed charges,85% of total billed charges,398.65,85,,318.92,percent of total billed charges,85% of total billed charges,422.1,90,,337.68,percent of total billed charges,90% of total billed charges,375.2,80,,300.16,percent of total billed charges,80% of total billed charges,422.1,90,,337.68,percent of total billed charges,90% of total billed charges,351.75,75,,281.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,136.01,29,,108.808,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,314.23,67,,251.384,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,328.3,70,,262.64,percent of total billed charges,70% of total billed charges,304.85,65,,243.88,percent of total billed charges,65% of total billed charges,167.29,35.67,,133.832,percent of total billed charges,35.67% of total billed charges,136.01,469,
MESH SURGICAL PROCEED 4X6,27020427,CDM,278,RC,C1781,HCPCS,outpatient,,,1528,611.20,,1069.6,70,,855.68,percent of total billed charges,70% of total billed charges,802.2,52.5,,641.76,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,1252.96,82,,1002.368,percent of total billed charges,82% of total billed charges,1298.8,85,,1039.04,percent of total billed charges,85% of total billed charges,1298.8,85,,1039.04,percent of total billed charges,85% of total billed charges,1298.8,85,,1039.04,percent of total billed charges,85% of total billed charges,1375.2,90,,1100.16,percent of total billed charges,90% of total billed charges,1222.4,80,,977.92,percent of total billed charges,80% of total billed charges,1375.2,90,,1100.16,percent of total billed charges,90% of total billed charges,1146,75,,916.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,443.12,29,,354.496,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1023.76,67,,819.008,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1069.6,70,,855.68,percent of total billed charges,70% of total billed charges,993.2,65,,794.56,percent of total billed charges,65% of total billed charges,545.04,35.67,,436.032,percent of total billed charges,35.67% of total billed charges,443.12,1375.2,
MESH SURGICAL PROCEED 6X6,27020428,CDM,278,RC,C1781,HCPCS,outpatient,,,2831,1132.40,,1981.7,70,,1585.36,percent of total billed charges,70% of total billed charges,1486.28,52.5,,1189.02,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,2321.42,82,,1857.136,percent of total billed charges,82% of total billed charges,2406.35,85,,1925.08,percent of total billed charges,85% of total billed charges,2406.35,85,,1925.08,percent of total billed charges,85% of total billed charges,2406.35,85,,1925.08,percent of total billed charges,85% of total billed charges,2547.9,90,,2038.32,percent of total billed charges,90% of total billed charges,2264.8,80,,1811.84,percent of total billed charges,80% of total billed charges,2547.9,90,,2038.32,percent of total billed charges,90% of total billed charges,2123.25,75,,1698.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,820.99,29,,656.792,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1896.77,67,,1517.416,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1981.7,70,,1585.36,percent of total billed charges,70% of total billed charges,1840.15,65,,1472.12,percent of total billed charges,65% of total billed charges,1009.82,35.67,,807.856,percent of total billed charges,35.67% of total billed charges,820.99,2547.9,
MESH PROGRIP LAPROSCOPIC LEFT,27020429,CDM,278,RC,C1781,HCPCS,outpatient,,,1799,719.60,,1259.3,70,,1007.44,percent of total billed charges,70% of total billed charges,944.48,52.5,,755.58,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,1475.18,82,,1180.144,percent of total billed charges,82% of total billed charges,1529.15,85,,1223.32,percent of total billed charges,85% of total billed charges,1529.15,85,,1223.32,percent of total billed charges,85% of total billed charges,1529.15,85,,1223.32,percent of total billed charges,85% of total billed charges,1619.1,90,,1295.28,percent of total billed charges,90% of total billed charges,1439.2,80,,1151.36,percent of total billed charges,80% of total billed charges,1619.1,90,,1295.28,percent of total billed charges,90% of total billed charges,1349.25,75,,1079.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,521.71,29,,417.368,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1205.33,67,,964.264,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1259.3,70,,1007.44,percent of total billed charges,70% of total billed charges,1169.35,65,,935.48,percent of total billed charges,65% of total billed charges,641.7,35.67,,513.36,percent of total billed charges,35.67% of total billed charges,521.71,1619.1,
MESH PROGRIP LAPAROSCOPIC RIGH,27020430,CDM,278,RC,C1781,HCPCS,outpatient,,,1799,719.60,,1259.3,70,,1007.44,percent of total billed charges,70% of total billed charges,944.48,52.5,,755.58,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,1475.18,82,,1180.144,percent of total billed charges,82% of total billed charges,1529.15,85,,1223.32,percent of total billed charges,85% of total billed charges,1529.15,85,,1223.32,percent of total billed charges,85% of total billed charges,1529.15,85,,1223.32,percent of total billed charges,85% of total billed charges,1619.1,90,,1295.28,percent of total billed charges,90% of total billed charges,1439.2,80,,1151.36,percent of total billed charges,80% of total billed charges,1619.1,90,,1295.28,percent of total billed charges,90% of total billed charges,1349.25,75,,1079.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,521.71,29,,417.368,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1205.33,67,,964.264,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1259.3,70,,1007.44,percent of total billed charges,70% of total billed charges,1169.35,65,,935.48,percent of total billed charges,65% of total billed charges,641.7,35.67,,513.36,percent of total billed charges,35.67% of total billed charges,521.71,1619.1,
MESH ULTRAPRO 14X12 HERNIA,27020431,CDM,278,RC,C1781,HCPCS,outpatient,,,939,375.60,,657.3,70,,525.84,percent of total billed charges,70% of total billed charges,939,100,,751.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,769.98,82,,615.984,percent of total billed charges,82% of total billed charges,798.15,85,,638.52,percent of total billed charges,85% of total billed charges,798.15,85,,638.52,percent of total billed charges,85% of total billed charges,798.15,85,,638.52,percent of total billed charges,85% of total billed charges,845.1,90,,676.08,percent of total billed charges,90% of total billed charges,751.2,80,,600.96,percent of total billed charges,80% of total billed charges,845.1,90,,676.08,percent of total billed charges,90% of total billed charges,704.25,75,,563.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,272.31,29,,217.848,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,629.13,67,,503.304,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,657.3,70,,525.84,percent of total billed charges,70% of total billed charges,610.35,65,,488.28,percent of total billed charges,65% of total billed charges,334.94,35.67,,267.952,percent of total billed charges,35.67% of total billed charges,272.31,939,
MESH ULTRAPRO HERNIA SYSTEM,27020432,CDM,278,RC,C1781,HCPCS,outpatient,,,921,368.40,,644.7,70,,515.76,percent of total billed charges,70% of total billed charges,921,100,,736.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,755.22,82,,604.176,percent of total billed charges,82% of total billed charges,782.85,85,,626.28,percent of total billed charges,85% of total billed charges,782.85,85,,626.28,percent of total billed charges,85% of total billed charges,782.85,85,,626.28,percent of total billed charges,85% of total billed charges,828.9,90,,663.12,percent of total billed charges,90% of total billed charges,736.8,80,,589.44,percent of total billed charges,80% of total billed charges,828.9,90,,663.12,percent of total billed charges,90% of total billed charges,690.75,75,,552.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,267.09,29,,213.672,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,617.07,67,,493.656,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,644.7,70,,515.76,percent of total billed charges,70% of total billed charges,598.65,65,,478.92,percent of total billed charges,65% of total billed charges,328.52,35.67,,262.816,percent of total billed charges,35.67% of total billed charges,267.09,921,
MESH VENTRAL PATCH PROCEED,27020433,CDM,278,RC,C1781,HCPCS,outpatient,,,1491,596.40,,1043.7,70,,834.96,percent of total billed charges,70% of total billed charges,782.78,52.5,,626.22,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,1222.62,82,,978.096,percent of total billed charges,82% of total billed charges,1267.35,85,,1013.88,percent of total billed charges,85% of total billed charges,1267.35,85,,1013.88,percent of total billed charges,85% of total billed charges,1267.35,85,,1013.88,percent of total billed charges,85% of total billed charges,1341.9,90,,1073.52,percent of total billed charges,90% of total billed charges,1192.8,80,,954.24,percent of total billed charges,80% of total billed charges,1341.9,90,,1073.52,percent of total billed charges,90% of total billed charges,1118.25,75,,894.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,432.39,29,,345.912,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,998.97,67,,799.176,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1043.7,70,,834.96,percent of total billed charges,70% of total billed charges,969.15,65,,775.32,percent of total billed charges,65% of total billed charges,531.84,35.67,,425.472,percent of total billed charges,35.67% of total billed charges,432.39,1341.9,
MESH VENTRAL PROCEED 4.3 X 4.3,27020434,CDM,278,RC,C1781,HCPCS,outpatient,,,1249,499.60,,874.3,70,,699.44,percent of total billed charges,70% of total billed charges,655.73,52.5,,524.58,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,1024.18,82,,819.344,percent of total billed charges,82% of total billed charges,1061.65,85,,849.32,percent of total billed charges,85% of total billed charges,1061.65,85,,849.32,percent of total billed charges,85% of total billed charges,1061.65,85,,849.32,percent of total billed charges,85% of total billed charges,1124.1,90,,899.28,percent of total billed charges,90% of total billed charges,999.2,80,,799.36,percent of total billed charges,80% of total billed charges,1124.1,90,,899.28,percent of total billed charges,90% of total billed charges,936.75,75,,749.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,362.21,29,,289.768,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,836.83,67,,669.464,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,874.3,70,,699.44,percent of total billed charges,70% of total billed charges,811.85,65,,649.48,percent of total billed charges,65% of total billed charges,445.52,35.67,,356.416,percent of total billed charges,35.67% of total billed charges,362.21,1124.1,
MESH SURGICAL PROCEED 8X10,27020435,CDM,278,RC,C1781,HCPCS,outpatient,,,4578,1831.20,,3204.6,70,,2563.68,percent of total billed charges,70% of total billed charges,2403.45,52.5,,1922.76,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,3753.96,82,,3003.168,percent of total billed charges,82% of total billed charges,3891.3,85,,3113.04,percent of total billed charges,85% of total billed charges,3891.3,85,,3113.04,percent of total billed charges,85% of total billed charges,3891.3,85,,3113.04,percent of total billed charges,85% of total billed charges,4120.2,90,,3296.16,percent of total billed charges,90% of total billed charges,3662.4,80,,2929.92,percent of total billed charges,80% of total billed charges,4120.2,90,,3296.16,percent of total billed charges,90% of total billed charges,3433.5,75,,2746.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,1327.62,29,,1062.096,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,3067.26,67,,2453.808,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,3204.6,70,,2563.68,percent of total billed charges,70% of total billed charges,2975.7,65,,2380.56,percent of total billed charges,65% of total billed charges,1632.97,35.67,,1306.376,percent of total billed charges,35.67% of total billed charges,1327.62,4120.2,
MESH SYMBOTEX COMPOSITE 12CM,27020436,CDM,278,RC,C1781,HCPCS,outpatient,,,1761,704.40,,1232.7,70,,986.16,percent of total billed charges,70% of total billed charges,924.53,52.5,,739.62,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,1444.02,82,,1155.216,percent of total billed charges,82% of total billed charges,1496.85,85,,1197.48,percent of total billed charges,85% of total billed charges,1496.85,85,,1197.48,percent of total billed charges,85% of total billed charges,1496.85,85,,1197.48,percent of total billed charges,85% of total billed charges,1584.9,90,,1267.92,percent of total billed charges,90% of total billed charges,1408.8,80,,1127.04,percent of total billed charges,80% of total billed charges,1584.9,90,,1267.92,percent of total billed charges,90% of total billed charges,1320.75,75,,1056.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,510.69,29,,408.552,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1179.87,67,,943.896,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1232.7,70,,986.16,percent of total billed charges,70% of total billed charges,1144.65,65,,915.72,percent of total billed charges,65% of total billed charges,628.15,35.67,,502.52,percent of total billed charges,35.67% of total billed charges,510.69,1584.9,
MESH SYMBOTEX 20 X 12CM,27020437,CDM,278,RC,C1781,HCPCS,outpatient,,,2467,986.80,,1726.9,70,,1381.52,percent of total billed charges,70% of total billed charges,1295.18,52.5,,1036.14,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,2022.94,82,,1618.352,percent of total billed charges,82% of total billed charges,2096.95,85,,1677.56,percent of total billed charges,85% of total billed charges,2096.95,85,,1677.56,percent of total billed charges,85% of total billed charges,2096.95,85,,1677.56,percent of total billed charges,85% of total billed charges,2220.3,90,,1776.24,percent of total billed charges,90% of total billed charges,1973.6,80,,1578.88,percent of total billed charges,80% of total billed charges,2220.3,90,,1776.24,percent of total billed charges,90% of total billed charges,1850.25,75,,1480.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,715.43,29,,572.344,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1652.89,67,,1322.312,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1726.9,70,,1381.52,percent of total billed charges,70% of total billed charges,1603.55,65,,1282.84,percent of total billed charges,65% of total billed charges,879.98,35.67,,703.984,percent of total billed charges,35.67% of total billed charges,715.43,2220.3,
MESH SYMBOTEX 20 X 15 CM,27020438,CDM,278,RC,C1781,HCPCS,outpatient,,,2467,986.80,,1726.9,70,,1381.52,percent of total billed charges,70% of total billed charges,1295.18,52.5,,1036.14,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,2022.94,82,,1618.352,percent of total billed charges,82% of total billed charges,2096.95,85,,1677.56,percent of total billed charges,85% of total billed charges,2096.95,85,,1677.56,percent of total billed charges,85% of total billed charges,2096.95,85,,1677.56,percent of total billed charges,85% of total billed charges,2220.3,90,,1776.24,percent of total billed charges,90% of total billed charges,1973.6,80,,1578.88,percent of total billed charges,80% of total billed charges,2220.3,90,,1776.24,percent of total billed charges,90% of total billed charges,1850.25,75,,1480.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,715.43,29,,572.344,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1652.89,67,,1322.312,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1726.9,70,,1381.52,percent of total billed charges,70% of total billed charges,1603.55,65,,1282.84,percent of total billed charges,65% of total billed charges,879.98,35.67,,703.984,percent of total billed charges,35.67% of total billed charges,715.43,2220.3,
MESH SYMBOTEX 25 X 20 CM,27020439,CDM,278,RC,C1781,HCPCS,outpatient,,,3935,1574.00,,2754.5,70,,2203.6,percent of total billed charges,70% of total billed charges,2065.88,52.5,,1652.7,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,3226.7,82,,2581.36,percent of total billed charges,82% of total billed charges,3344.75,85,,2675.8,percent of total billed charges,85% of total billed charges,3344.75,85,,2675.8,percent of total billed charges,85% of total billed charges,3344.75,85,,2675.8,percent of total billed charges,85% of total billed charges,3541.5,90,,2833.2,percent of total billed charges,90% of total billed charges,3148,80,,2518.4,percent of total billed charges,80% of total billed charges,3541.5,90,,2833.2,percent of total billed charges,90% of total billed charges,2951.25,75,,2361,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,1141.15,29,,912.92,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,2636.45,67,,2109.16,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,2754.5,70,,2203.6,percent of total billed charges,70% of total billed charges,2557.75,65,,2046.2,percent of total billed charges,65% of total billed charges,1403.61,35.67,,1122.888,percent of total billed charges,35.67% of total billed charges,1141.15,3541.5,
BB TAK SMALL,27020457,CDM,278,RC,C1781,HCPCS,outpatient,,,503,201.20,,352.1,70,,281.68,percent of total billed charges,70% of total billed charges,503,100,,402.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,412.46,82,,329.968,percent of total billed charges,82% of total billed charges,427.55,85,,342.04,percent of total billed charges,85% of total billed charges,427.55,85,,342.04,percent of total billed charges,85% of total billed charges,427.55,85,,342.04,percent of total billed charges,85% of total billed charges,452.7,90,,362.16,percent of total billed charges,90% of total billed charges,402.4,80,,321.92,percent of total billed charges,80% of total billed charges,452.7,90,,362.16,percent of total billed charges,90% of total billed charges,377.25,75,,301.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,145.87,29,,116.696,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,337.01,67,,269.608,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,352.1,70,,281.68,percent of total billed charges,70% of total billed charges,326.95,65,,261.56,percent of total billed charges,65% of total billed charges,179.42,35.67,,143.536,percent of total billed charges,35.67% of total billed charges,145.87,503,
GUIDE WIRE 2.4 X 200 MM,27020468,CDM,278,RC,C1781,HCPCS,outpatient,,,101,40.40,,70.7,70,,56.56,percent of total billed charges,70% of total billed charges,101,100,,80.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,82.82,82,,66.256,percent of total billed charges,82% of total billed charges,85.85,85,,68.68,percent of total billed charges,85% of total billed charges,85.85,85,,68.68,percent of total billed charges,85% of total billed charges,85.85,85,,68.68,percent of total billed charges,85% of total billed charges,90.9,90,,72.72,percent of total billed charges,90% of total billed charges,80.8,80,,64.64,percent of total billed charges,80% of total billed charges,90.9,90,,72.72,percent of total billed charges,90% of total billed charges,75.75,75,,60.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,29.29,29,,23.432,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,67.67,67,,54.136,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,70.7,70,,56.56,percent of total billed charges,70% of total billed charges,65.65,65,,52.52,percent of total billed charges,65% of total billed charges,36.03,35.67,,28.824,percent of total billed charges,35.67% of total billed charges,29.29,101,
SCREW 2.0 X 32MM,27020623,CDM,278,RC,,,outpatient,,,665,266.00,,465.5,70,,372.4,percent of total billed charges,70% of total billed charges,665,100,,532,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,545.3,82,,436.24,percent of total billed charges,82% of total billed charges,565.25,85,,452.2,percent of total billed charges,85% of total billed charges,565.25,85,,452.2,percent of total billed charges,85% of total billed charges,565.25,85,,452.2,percent of total billed charges,85% of total billed charges,598.5,90,,478.8,percent of total billed charges,90% of total billed charges,532,80,,425.6,percent of total billed charges,80% of total billed charges,598.5,90,,478.8,percent of total billed charges,90% of total billed charges,498.75,75,,399,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,192.85,29,,154.28,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,445.55,67,,356.44,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,465.5,70,,372.4,percent of total billed charges,70% of total billed charges,432.25,65,,345.8,percent of total billed charges,65% of total billed charges,237.21,35.67,,189.768,percent of total billed charges,35.67% of total billed charges,192.85,665,
CANN SCREW 6.7 X 85 MM,27020632,CDM,278,RC,C1781,HCPCS,outpatient,,,1141,456.40,,798.7,70,,638.96,percent of total billed charges,70% of total billed charges,599.03,52.5,,479.22,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,935.62,82,,748.496,percent of total billed charges,82% of total billed charges,969.85,85,,775.88,percent of total billed charges,85% of total billed charges,969.85,85,,775.88,percent of total billed charges,85% of total billed charges,969.85,85,,775.88,percent of total billed charges,85% of total billed charges,1026.9,90,,821.52,percent of total billed charges,90% of total billed charges,912.8,80,,730.24,percent of total billed charges,80% of total billed charges,1026.9,90,,821.52,percent of total billed charges,90% of total billed charges,855.75,75,,684.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,330.89,29,,264.712,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,764.47,67,,611.576,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,798.7,70,,638.96,percent of total billed charges,70% of total billed charges,741.65,65,,593.32,percent of total billed charges,65% of total billed charges,406.99,35.67,,325.592,percent of total billed charges,35.67% of total billed charges,330.89,1026.9,
LOW PRO SCREW 6.7 X 95 MM,27020633,CDM,278,RC,C1781,HCPCS,outpatient,,,1141,456.40,,798.7,70,,638.96,percent of total billed charges,70% of total billed charges,599.03,52.5,,479.22,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,935.62,82,,748.496,percent of total billed charges,82% of total billed charges,969.85,85,,775.88,percent of total billed charges,85% of total billed charges,969.85,85,,775.88,percent of total billed charges,85% of total billed charges,969.85,85,,775.88,percent of total billed charges,85% of total billed charges,1026.9,90,,821.52,percent of total billed charges,90% of total billed charges,912.8,80,,730.24,percent of total billed charges,80% of total billed charges,1026.9,90,,821.52,percent of total billed charges,90% of total billed charges,855.75,75,,684.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,330.89,29,,264.712,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,764.47,67,,611.576,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,798.7,70,,638.96,percent of total billed charges,70% of total billed charges,741.65,65,,593.32,percent of total billed charges,65% of total billed charges,406.99,35.67,,325.592,percent of total billed charges,35.67% of total billed charges,330.89,1026.9,
SCREW 2.5 MICRO 30MM,27020666,CDM,278,RC,C1713,HCPCS,outpatient,,,1115,446.00,,780.5,70,,624.4,percent of total billed charges,70% of total billed charges,585.38,52.5,,468.3,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,914.3,82,,731.44,percent of total billed charges,82% of total billed charges,947.75,85,,758.2,percent of total billed charges,85% of total billed charges,947.75,85,,758.2,percent of total billed charges,85% of total billed charges,947.75,85,,758.2,percent of total billed charges,85% of total billed charges,1003.5,90,,802.8,percent of total billed charges,90% of total billed charges,892,80,,713.6,percent of total billed charges,80% of total billed charges,1003.5,90,,802.8,percent of total billed charges,90% of total billed charges,836.25,75,,669,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,323.35,29,,258.68,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,747.05,67,,597.64,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,780.5,70,,624.4,percent of total billed charges,70% of total billed charges,724.75,65,,579.8,percent of total billed charges,65% of total billed charges,397.72,35.67,,318.176,percent of total billed charges,35.67% of total billed charges,323.35,1003.5,
QCKFIX SCREW 3.0 X 40 MM,27020667,CDM,278,RC,C1781,HCPCS,outpatient,,,478,191.20,,334.6,70,,267.68,percent of total billed charges,70% of total billed charges,478,100,,382.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,391.96,82,,313.568,percent of total billed charges,82% of total billed charges,406.3,85,,325.04,percent of total billed charges,85% of total billed charges,406.3,85,,325.04,percent of total billed charges,85% of total billed charges,406.3,85,,325.04,percent of total billed charges,85% of total billed charges,430.2,90,,344.16,percent of total billed charges,90% of total billed charges,382.4,80,,305.92,percent of total billed charges,80% of total billed charges,430.2,90,,344.16,percent of total billed charges,90% of total billed charges,358.5,75,,286.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,138.62,29,,110.896,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,320.26,67,,256.208,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,334.6,70,,267.68,percent of total billed charges,70% of total billed charges,310.7,65,,248.56,percent of total billed charges,65% of total billed charges,170.5,35.67,,136.4,percent of total billed charges,35.67% of total billed charges,138.62,478,
QCKFIX SCREW 3.0 X 44 MM,27020668,CDM,278,RC,C1781,HCPCS,outpatient,,,478,191.20,,334.6,70,,267.68,percent of total billed charges,70% of total billed charges,478,100,,382.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,391.96,82,,313.568,percent of total billed charges,82% of total billed charges,406.3,85,,325.04,percent of total billed charges,85% of total billed charges,406.3,85,,325.04,percent of total billed charges,85% of total billed charges,406.3,85,,325.04,percent of total billed charges,85% of total billed charges,430.2,90,,344.16,percent of total billed charges,90% of total billed charges,382.4,80,,305.92,percent of total billed charges,80% of total billed charges,430.2,90,,344.16,percent of total billed charges,90% of total billed charges,358.5,75,,286.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,138.62,29,,110.896,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,320.26,67,,256.208,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,334.6,70,,267.68,percent of total billed charges,70% of total billed charges,310.7,65,,248.56,percent of total billed charges,65% of total billed charges,170.5,35.67,,136.4,percent of total billed charges,35.67% of total billed charges,138.62,478,
GUIDEWIRE .86MM TROCAR TIP,27020669,CDM,278,RC,C1781,HCPCS,outpatient,,,71,28.40,,49.7,70,,39.76,percent of total billed charges,70% of total billed charges,71,100,,56.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,58.22,82,,46.576,percent of total billed charges,82% of total billed charges,60.35,85,,48.28,percent of total billed charges,85% of total billed charges,60.35,85,,48.28,percent of total billed charges,85% of total billed charges,60.35,85,,48.28,percent of total billed charges,85% of total billed charges,63.9,90,,51.12,percent of total billed charges,90% of total billed charges,56.8,80,,45.44,percent of total billed charges,80% of total billed charges,63.9,90,,51.12,percent of total billed charges,90% of total billed charges,53.25,75,,42.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,20.59,29,,16.472,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,47.57,67,,38.056,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,49.7,70,,39.76,percent of total billed charges,70% of total billed charges,46.15,65,,36.92,percent of total billed charges,65% of total billed charges,25.33,35.67,,20.264,percent of total billed charges,35.67% of total billed charges,20.59,71,
QCKFIX SCREW 4.0 X 40MM,27020705,CDM,278,RC,C1781,HCPCS,outpatient,,,526,210.40,,368.2,70,,294.56,percent of total billed charges,70% of total billed charges,526,100,,420.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,431.32,82,,345.056,percent of total billed charges,82% of total billed charges,447.1,85,,357.68,percent of total billed charges,85% of total billed charges,447.1,85,,357.68,percent of total billed charges,85% of total billed charges,447.1,85,,357.68,percent of total billed charges,85% of total billed charges,473.4,90,,378.72,percent of total billed charges,90% of total billed charges,420.8,80,,336.64,percent of total billed charges,80% of total billed charges,473.4,90,,378.72,percent of total billed charges,90% of total billed charges,394.5,75,,315.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,152.54,29,,122.032,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,352.42,67,,281.936,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,368.2,70,,294.56,percent of total billed charges,70% of total billed charges,341.9,65,,273.52,percent of total billed charges,65% of total billed charges,187.62,35.67,,150.096,percent of total billed charges,35.67% of total billed charges,152.54,526,
QCKFIX SCREW 4.0 X 44MM,27020706,CDM,278,RC,C1781,HCPCS,outpatient,,,526,210.40,,368.2,70,,294.56,percent of total billed charges,70% of total billed charges,526,100,,420.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,431.32,82,,345.056,percent of total billed charges,82% of total billed charges,447.1,85,,357.68,percent of total billed charges,85% of total billed charges,447.1,85,,357.68,percent of total billed charges,85% of total billed charges,447.1,85,,357.68,percent of total billed charges,85% of total billed charges,473.4,90,,378.72,percent of total billed charges,90% of total billed charges,420.8,80,,336.64,percent of total billed charges,80% of total billed charges,473.4,90,,378.72,percent of total billed charges,90% of total billed charges,394.5,75,,315.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,152.54,29,,122.032,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,352.42,67,,281.936,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,368.2,70,,294.56,percent of total billed charges,70% of total billed charges,341.9,65,,273.52,percent of total billed charges,65% of total billed charges,187.62,35.67,,150.096,percent of total billed charges,35.67% of total billed charges,152.54,526,
LO PRO SCREW 3.0MM X 22MM,27020707,CDM,278,RC,C1781,HCPCS,outpatient,,,351,140.40,,245.7,70,,196.56,percent of total billed charges,70% of total billed charges,351,100,,280.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,287.82,82,,230.256,percent of total billed charges,82% of total billed charges,298.35,85,,238.68,percent of total billed charges,85% of total billed charges,298.35,85,,238.68,percent of total billed charges,85% of total billed charges,298.35,85,,238.68,percent of total billed charges,85% of total billed charges,315.9,90,,252.72,percent of total billed charges,90% of total billed charges,280.8,80,,224.64,percent of total billed charges,80% of total billed charges,315.9,90,,252.72,percent of total billed charges,90% of total billed charges,263.25,75,,210.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,101.79,29,,81.432,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,235.17,67,,188.136,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,245.7,70,,196.56,percent of total billed charges,70% of total billed charges,228.15,65,,182.52,percent of total billed charges,65% of total billed charges,125.2,35.67,,100.16,percent of total billed charges,35.67% of total billed charges,101.79,351,
LO PRO SCREW 3.0MM X 26MM,27020708,CDM,278,RC,C1781,HCPCS,outpatient,,,351,140.40,,245.7,70,,196.56,percent of total billed charges,70% of total billed charges,351,100,,280.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,287.82,82,,230.256,percent of total billed charges,82% of total billed charges,298.35,85,,238.68,percent of total billed charges,85% of total billed charges,298.35,85,,238.68,percent of total billed charges,85% of total billed charges,298.35,85,,238.68,percent of total billed charges,85% of total billed charges,315.9,90,,252.72,percent of total billed charges,90% of total billed charges,280.8,80,,224.64,percent of total billed charges,80% of total billed charges,315.9,90,,252.72,percent of total billed charges,90% of total billed charges,263.25,75,,210.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,101.79,29,,81.432,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,235.17,67,,188.136,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,245.7,70,,196.56,percent of total billed charges,70% of total billed charges,228.15,65,,182.52,percent of total billed charges,65% of total billed charges,125.2,35.67,,100.16,percent of total billed charges,35.67% of total billed charges,101.79,351,
VAL KREULOCK SCREW 3.0 X 18,27020709,CDM,278,RC,C1781,HCPCS,outpatient,,,940,376.00,,658,70,,526.4,percent of total billed charges,70% of total billed charges,940,100,,752,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,770.8,82,,616.64,percent of total billed charges,82% of total billed charges,799,85,,639.2,percent of total billed charges,85% of total billed charges,799,85,,639.2,percent of total billed charges,85% of total billed charges,799,85,,639.2,percent of total billed charges,85% of total billed charges,846,90,,676.8,percent of total billed charges,90% of total billed charges,752,80,,601.6,percent of total billed charges,80% of total billed charges,846,90,,676.8,percent of total billed charges,90% of total billed charges,705,75,,564,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,272.6,29,,218.08,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,629.8,67,,503.84,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,658,70,,526.4,percent of total billed charges,70% of total billed charges,611,65,,488.8,percent of total billed charges,65% of total billed charges,335.3,35.67,,268.24,percent of total billed charges,35.67% of total billed charges,272.6,940,
PLT 3.00MM 4HOLE LO PRO,27020710,CDM,278,RC,C1781,HCPCS,outpatient,,,2547,1018.80,,1782.9,70,,1426.32,percent of total billed charges,70% of total billed charges,1337.18,52.5,,1069.74,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,2088.54,82,,1670.832,percent of total billed charges,82% of total billed charges,2164.95,85,,1731.96,percent of total billed charges,85% of total billed charges,2164.95,85,,1731.96,percent of total billed charges,85% of total billed charges,2164.95,85,,1731.96,percent of total billed charges,85% of total billed charges,2292.3,90,,1833.84,percent of total billed charges,90% of total billed charges,2037.6,80,,1630.08,percent of total billed charges,80% of total billed charges,2292.3,90,,1833.84,percent of total billed charges,90% of total billed charges,1910.25,75,,1528.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,738.63,29,,590.904,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1706.49,67,,1365.192,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1782.9,70,,1426.32,percent of total billed charges,70% of total billed charges,1655.55,65,,1324.44,percent of total billed charges,65% of total billed charges,908.51,35.67,,726.808,percent of total billed charges,35.67% of total billed charges,738.63,2292.3,
ECHELON ENDOPATH BLUE 45MM,27020715,CDM,278,RC,C1781,HCPCS,outpatient,,,398,159.20,,278.6,70,,222.88,percent of total billed charges,70% of total billed charges,398,100,,318.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,326.36,82,,261.088,percent of total billed charges,82% of total billed charges,338.3,85,,270.64,percent of total billed charges,85% of total billed charges,338.3,85,,270.64,percent of total billed charges,85% of total billed charges,338.3,85,,270.64,percent of total billed charges,85% of total billed charges,358.2,90,,286.56,percent of total billed charges,90% of total billed charges,318.4,80,,254.72,percent of total billed charges,80% of total billed charges,358.2,90,,286.56,percent of total billed charges,90% of total billed charges,298.5,75,,238.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,115.42,29,,92.336,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,266.66,67,,213.328,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,278.6,70,,222.88,percent of total billed charges,70% of total billed charges,258.7,65,,206.96,percent of total billed charges,65% of total billed charges,141.97,35.67,,113.576,percent of total billed charges,35.67% of total billed charges,115.42,398,
ECHELON ENDOPATH WHITE 45MM,27020716,CDM,278,RC,C1781,HCPCS,outpatient,,,395,158.00,,276.5,70,,221.2,percent of total billed charges,70% of total billed charges,395,100,,316,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,323.9,82,,259.12,percent of total billed charges,82% of total billed charges,335.75,85,,268.6,percent of total billed charges,85% of total billed charges,335.75,85,,268.6,percent of total billed charges,85% of total billed charges,335.75,85,,268.6,percent of total billed charges,85% of total billed charges,355.5,90,,284.4,percent of total billed charges,90% of total billed charges,316,80,,252.8,percent of total billed charges,80% of total billed charges,355.5,90,,284.4,percent of total billed charges,90% of total billed charges,296.25,75,,237,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,114.55,29,,91.64,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,264.65,67,,211.72,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,276.5,70,,221.2,percent of total billed charges,70% of total billed charges,256.75,65,,205.4,percent of total billed charges,65% of total billed charges,140.9,35.67,,112.72,percent of total billed charges,35.67% of total billed charges,114.55,395,
ECHELON ENDOPATH GREEN 45MM,27020717,CDM,278,RC,C1781,HCPCS,outpatient,,,398,159.20,,278.6,70,,222.88,percent of total billed charges,70% of total billed charges,398,100,,318.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,326.36,82,,261.088,percent of total billed charges,82% of total billed charges,338.3,85,,270.64,percent of total billed charges,85% of total billed charges,338.3,85,,270.64,percent of total billed charges,85% of total billed charges,338.3,85,,270.64,percent of total billed charges,85% of total billed charges,358.2,90,,286.56,percent of total billed charges,90% of total billed charges,318.4,80,,254.72,percent of total billed charges,80% of total billed charges,358.2,90,,286.56,percent of total billed charges,90% of total billed charges,298.5,75,,238.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,115.42,29,,92.336,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,266.66,67,,213.328,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,278.6,70,,222.88,percent of total billed charges,70% of total billed charges,258.7,65,,206.96,percent of total billed charges,65% of total billed charges,141.97,35.67,,113.576,percent of total billed charges,35.67% of total billed charges,115.42,398,
ECHELON ENDOPATH GREEN 60MM,27020718,CDM,278,RC,C1781,HCPCS,outpatient,,,441,176.40,,308.7,70,,246.96,percent of total billed charges,70% of total billed charges,441,100,,352.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,361.62,82,,289.296,percent of total billed charges,82% of total billed charges,374.85,85,,299.88,percent of total billed charges,85% of total billed charges,374.85,85,,299.88,percent of total billed charges,85% of total billed charges,374.85,85,,299.88,percent of total billed charges,85% of total billed charges,396.9,90,,317.52,percent of total billed charges,90% of total billed charges,352.8,80,,282.24,percent of total billed charges,80% of total billed charges,396.9,90,,317.52,percent of total billed charges,90% of total billed charges,330.75,75,,264.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,127.89,29,,102.312,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,295.47,67,,236.376,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,308.7,70,,246.96,percent of total billed charges,70% of total billed charges,286.65,65,,229.32,percent of total billed charges,65% of total billed charges,157.3,35.67,,125.84,percent of total billed charges,35.67% of total billed charges,127.89,441,
ECHELON ENDOPATH WHITE 60MM,27020719,CDM,278,RC,C1781,HCPCS,outpatient,,,387,154.80,,270.9,70,,216.72,percent of total billed charges,70% of total billed charges,387,100,,309.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,317.34,82,,253.872,percent of total billed charges,82% of total billed charges,328.95,85,,263.16,percent of total billed charges,85% of total billed charges,328.95,85,,263.16,percent of total billed charges,85% of total billed charges,328.95,85,,263.16,percent of total billed charges,85% of total billed charges,348.3,90,,278.64,percent of total billed charges,90% of total billed charges,309.6,80,,247.68,percent of total billed charges,80% of total billed charges,348.3,90,,278.64,percent of total billed charges,90% of total billed charges,290.25,75,,232.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,112.23,29,,89.784,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,259.29,67,,207.432,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,270.9,70,,216.72,percent of total billed charges,70% of total billed charges,251.55,65,,201.24,percent of total billed charges,65% of total billed charges,138.04,35.67,,110.432,percent of total billed charges,35.67% of total billed charges,112.23,387,
QCKFIX SCREW 2.0 X 18MM,27020720,CDM,278,RC,C1781,HCPCS,outpatient,,,446,178.40,,312.2,70,,249.76,percent of total billed charges,70% of total billed charges,446,100,,356.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,365.72,82,,292.576,percent of total billed charges,82% of total billed charges,379.1,85,,303.28,percent of total billed charges,85% of total billed charges,379.1,85,,303.28,percent of total billed charges,85% of total billed charges,379.1,85,,303.28,percent of total billed charges,85% of total billed charges,401.4,90,,321.12,percent of total billed charges,90% of total billed charges,356.8,80,,285.44,percent of total billed charges,80% of total billed charges,401.4,90,,321.12,percent of total billed charges,90% of total billed charges,334.5,75,,267.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,129.34,29,,103.472,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,298.82,67,,239.056,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,312.2,70,,249.76,percent of total billed charges,70% of total billed charges,289.9,65,,231.92,percent of total billed charges,65% of total billed charges,159.09,35.67,,127.272,percent of total billed charges,35.67% of total billed charges,129.34,446,
QCKFIX SCREW 4.0 X 28MM,27020721,CDM,278,RC,C1781,HCPCS,outpatient,,,526,210.40,,368.2,70,,294.56,percent of total billed charges,70% of total billed charges,526,100,,420.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,431.32,82,,345.056,percent of total billed charges,82% of total billed charges,447.1,85,,357.68,percent of total billed charges,85% of total billed charges,447.1,85,,357.68,percent of total billed charges,85% of total billed charges,447.1,85,,357.68,percent of total billed charges,85% of total billed charges,473.4,90,,378.72,percent of total billed charges,90% of total billed charges,420.8,80,,336.64,percent of total billed charges,80% of total billed charges,473.4,90,,378.72,percent of total billed charges,90% of total billed charges,394.5,75,,315.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,152.54,29,,122.032,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,352.42,67,,281.936,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,368.2,70,,294.56,percent of total billed charges,70% of total billed charges,341.9,65,,273.52,percent of total billed charges,65% of total billed charges,187.62,35.67,,150.096,percent of total billed charges,35.67% of total billed charges,152.54,526,
SILICONE ELASTOMER RTS,27020735,CDM,278,RC,,,outpatient,,,736,294.40,,515.2,70,,412.16,percent of total billed charges,70% of total billed charges,736,100,,588.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,603.52,82,,482.816,percent of total billed charges,82% of total billed charges,625.6,85,,500.48,percent of total billed charges,85% of total billed charges,625.6,85,,500.48,percent of total billed charges,85% of total billed charges,625.6,85,,500.48,percent of total billed charges,85% of total billed charges,662.4,90,,529.92,percent of total billed charges,90% of total billed charges,588.8,80,,471.04,percent of total billed charges,80% of total billed charges,662.4,90,,529.92,percent of total billed charges,90% of total billed charges,552,75,,441.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,213.44,29,,170.752,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,493.12,67,,394.496,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,515.2,70,,412.16,percent of total billed charges,70% of total billed charges,478.4,65,,382.72,percent of total billed charges,65% of total billed charges,262.53,35.67,,210.024,percent of total billed charges,35.67% of total billed charges,213.44,736,
SILICONE ELASTOMER SIZE 2,27020736,CDM,278,RC,,,outpatient,,,3455,1382.00,,2418.5,70,,1934.8,percent of total billed charges,70% of total billed charges,1813.88,52.5,,1451.1,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,2833.1,82,,2266.48,percent of total billed charges,82% of total billed charges,2936.75,85,,2349.4,percent of total billed charges,85% of total billed charges,2936.75,85,,2349.4,percent of total billed charges,85% of total billed charges,2936.75,85,,2349.4,percent of total billed charges,85% of total billed charges,3109.5,90,,2487.6,percent of total billed charges,90% of total billed charges,2764,80,,2211.2,percent of total billed charges,80% of total billed charges,3109.5,90,,2487.6,percent of total billed charges,90% of total billed charges,2591.25,75,,2073,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,1001.95,29,,801.56,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,2314.85,67,,1851.88,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,2418.5,70,,1934.8,percent of total billed charges,70% of total billed charges,2245.75,65,,1796.6,percent of total billed charges,65% of total billed charges,1232.4,35.67,,985.92,percent of total billed charges,35.67% of total billed charges,1001.95,3109.5,
MESH SURGIMEND 13X25X2,27020751,CDM,278,RC,,,outpatient,,,464,185.60,,324.8,70,,259.84,percent of total billed charges,70% of total billed charges,464,100,,371.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,380.48,82,,304.384,percent of total billed charges,82% of total billed charges,394.4,85,,315.52,percent of total billed charges,85% of total billed charges,394.4,85,,315.52,percent of total billed charges,85% of total billed charges,394.4,85,,315.52,percent of total billed charges,85% of total billed charges,417.6,90,,334.08,percent of total billed charges,90% of total billed charges,371.2,80,,296.96,percent of total billed charges,80% of total billed charges,417.6,90,,334.08,percent of total billed charges,90% of total billed charges,348,75,,278.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,134.56,29,,107.648,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,310.88,67,,248.704,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,324.8,70,,259.84,percent of total billed charges,70% of total billed charges,301.6,65,,241.28,percent of total billed charges,65% of total billed charges,165.51,35.67,,132.408,percent of total billed charges,35.67% of total billed charges,134.56,464,
SCREW 2.5 MICRO 30MM,27020763,CDM,278,RC,,,outpatient,,,1173,469.20,,821.1,70,,656.88,percent of total billed charges,70% of total billed charges,615.83,52.5,,492.66,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,961.86,82,,769.488,percent of total billed charges,82% of total billed charges,997.05,85,,797.64,percent of total billed charges,85% of total billed charges,997.05,85,,797.64,percent of total billed charges,85% of total billed charges,997.05,85,,797.64,percent of total billed charges,85% of total billed charges,1055.7,90,,844.56,percent of total billed charges,90% of total billed charges,938.4,80,,750.72,percent of total billed charges,80% of total billed charges,1055.7,90,,844.56,percent of total billed charges,90% of total billed charges,879.75,75,,703.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,340.17,29,,272.136,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,785.91,67,,628.728,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,821.1,70,,656.88,percent of total billed charges,70% of total billed charges,762.45,65,,609.96,percent of total billed charges,65% of total billed charges,418.41,35.67,,334.728,percent of total billed charges,35.67% of total billed charges,340.17,1055.7,
SCREW 3.5 MINI 40MM,27020764,CDM,278,RC,,,outpatient,,,1082,432.80,,757.4,70,,605.92,percent of total billed charges,70% of total billed charges,568.05,52.5,,454.44,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,887.24,82,,709.792,percent of total billed charges,82% of total billed charges,919.7,85,,735.76,percent of total billed charges,85% of total billed charges,919.7,85,,735.76,percent of total billed charges,85% of total billed charges,919.7,85,,735.76,percent of total billed charges,85% of total billed charges,973.8,90,,779.04,percent of total billed charges,90% of total billed charges,865.6,80,,692.48,percent of total billed charges,80% of total billed charges,973.8,90,,779.04,percent of total billed charges,90% of total billed charges,811.5,75,,649.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,313.78,29,,251.024,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,724.94,67,,579.952,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,757.4,70,,605.92,percent of total billed charges,70% of total billed charges,703.3,65,,562.64,percent of total billed charges,65% of total billed charges,385.95,35.67,,308.76,percent of total billed charges,35.67% of total billed charges,313.78,973.8,
GUIDE WIRE 86MM,27020767,CDM,278,RC,C1769,HCPCS,outpatient,,,201,80.40,,140.7,70,,112.56,percent of total billed charges,70% of total billed charges,201,100,,160.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,164.82,82,,131.856,percent of total billed charges,82% of total billed charges,170.85,85,,136.68,percent of total billed charges,85% of total billed charges,170.85,85,,136.68,percent of total billed charges,85% of total billed charges,170.85,85,,136.68,percent of total billed charges,85% of total billed charges,180.9,90,,144.72,percent of total billed charges,90% of total billed charges,160.8,80,,128.64,percent of total billed charges,80% of total billed charges,180.9,90,,144.72,percent of total billed charges,90% of total billed charges,150.75,75,,120.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,58.29,29,,46.632,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,134.67,67,,107.736,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,140.7,70,,112.56,percent of total billed charges,70% of total billed charges,130.65,65,,104.52,percent of total billed charges,65% of total billed charges,71.7,35.67,,57.36,percent of total billed charges,35.67% of total billed charges,58.29,201,
SCREW QCKFIX CANN 2.0X14MM,27020774,CDM,278,RC,,,outpatient,,,469,187.60,,328.3,70,,262.64,percent of total billed charges,70% of total billed charges,469,100,,375.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,384.58,82,,307.664,percent of total billed charges,82% of total billed charges,398.65,85,,318.92,percent of total billed charges,85% of total billed charges,398.65,85,,318.92,percent of total billed charges,85% of total billed charges,398.65,85,,318.92,percent of total billed charges,85% of total billed charges,422.1,90,,337.68,percent of total billed charges,90% of total billed charges,375.2,80,,300.16,percent of total billed charges,80% of total billed charges,422.1,90,,337.68,percent of total billed charges,90% of total billed charges,351.75,75,,281.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,136.01,29,,108.808,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,314.23,67,,251.384,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,328.3,70,,262.64,percent of total billed charges,70% of total billed charges,304.85,65,,243.88,percent of total billed charges,65% of total billed charges,167.29,35.67,,133.832,percent of total billed charges,35.67% of total billed charges,136.01,469,
QUINTON CURL CATHETER 62CM,27020784,CDM,278,RC,C1752,HCPCS,outpatient,,,161,64.40,,112.7,70,,90.16,percent of total billed charges,70% of total billed charges,161,100,,128.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,132.02,82,,105.616,percent of total billed charges,82% of total billed charges,136.85,85,,109.48,percent of total billed charges,85% of total billed charges,136.85,85,,109.48,percent of total billed charges,85% of total billed charges,136.85,85,,109.48,percent of total billed charges,85% of total billed charges,144.9,90,,115.92,percent of total billed charges,90% of total billed charges,128.8,80,,103.04,percent of total billed charges,80% of total billed charges,144.9,90,,115.92,percent of total billed charges,90% of total billed charges,120.75,75,,96.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,46.69,29,,37.352,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,107.87,67,,86.296,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,112.7,70,,90.16,percent of total billed charges,70% of total billed charges,104.65,65,,83.72,percent of total billed charges,65% of total billed charges,57.43,35.67,,45.944,percent of total billed charges,35.67% of total billed charges,46.69,161,
QUINTON CURL CATHETER 57CM,27020785,CDM,278,RC,C1752,HCPCS,outpatient,,,161,64.40,,112.7,70,,90.16,percent of total billed charges,70% of total billed charges,161,100,,128.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,132.02,82,,105.616,percent of total billed charges,82% of total billed charges,136.85,85,,109.48,percent of total billed charges,85% of total billed charges,136.85,85,,109.48,percent of total billed charges,85% of total billed charges,136.85,85,,109.48,percent of total billed charges,85% of total billed charges,144.9,90,,115.92,percent of total billed charges,90% of total billed charges,128.8,80,,103.04,percent of total billed charges,80% of total billed charges,144.9,90,,115.92,percent of total billed charges,90% of total billed charges,120.75,75,,96.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,46.69,29,,37.352,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,107.87,67,,86.296,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,112.7,70,,90.16,percent of total billed charges,70% of total billed charges,104.65,65,,83.72,percent of total billed charges,65% of total billed charges,57.43,35.67,,45.944,percent of total billed charges,35.67% of total billed charges,46.69,161,
KIT HEMODIALYSIS CATHETER 28CM,27020797,CDM,278,RC,C1750,HCPCS,outpatient,,,763,305.20,,534.1,70,,427.28,percent of total billed charges,70% of total billed charges,763,100,,610.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,625.66,82,,500.528,percent of total billed charges,82% of total billed charges,648.55,85,,518.84,percent of total billed charges,85% of total billed charges,648.55,85,,518.84,percent of total billed charges,85% of total billed charges,648.55,85,,518.84,percent of total billed charges,85% of total billed charges,686.7,90,,549.36,percent of total billed charges,90% of total billed charges,610.4,80,,488.32,percent of total billed charges,80% of total billed charges,686.7,90,,549.36,percent of total billed charges,90% of total billed charges,572.25,75,,457.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,221.27,29,,177.016,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,511.21,67,,408.968,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,534.1,70,,427.28,percent of total billed charges,70% of total billed charges,495.95,65,,396.76,percent of total billed charges,65% of total billed charges,272.16,35.67,,217.728,percent of total billed charges,35.67% of total billed charges,221.27,763,
KIT HEMODIALYSIS CATHETER 32CM,27020798,CDM,278,RC,C1750,HCPCS,outpatient,,,763,305.20,,534.1,70,,427.28,percent of total billed charges,70% of total billed charges,763,100,,610.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,625.66,82,,500.528,percent of total billed charges,82% of total billed charges,648.55,85,,518.84,percent of total billed charges,85% of total billed charges,648.55,85,,518.84,percent of total billed charges,85% of total billed charges,648.55,85,,518.84,percent of total billed charges,85% of total billed charges,686.7,90,,549.36,percent of total billed charges,90% of total billed charges,610.4,80,,488.32,percent of total billed charges,80% of total billed charges,686.7,90,,549.36,percent of total billed charges,90% of total billed charges,572.25,75,,457.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,221.27,29,,177.016,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,511.21,67,,408.968,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,534.1,70,,427.28,percent of total billed charges,70% of total billed charges,495.95,65,,396.76,percent of total billed charges,65% of total billed charges,272.16,35.67,,217.728,percent of total billed charges,35.67% of total billed charges,221.27,763,
KIT HEMODIALYSIS CATHETER 36CM,27020799,CDM,278,RC,C1750,HCPCS,outpatient,,,763,305.20,,534.1,70,,427.28,percent of total billed charges,70% of total billed charges,763,100,,610.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,625.66,82,,500.528,percent of total billed charges,82% of total billed charges,648.55,85,,518.84,percent of total billed charges,85% of total billed charges,648.55,85,,518.84,percent of total billed charges,85% of total billed charges,648.55,85,,518.84,percent of total billed charges,85% of total billed charges,686.7,90,,549.36,percent of total billed charges,90% of total billed charges,610.4,80,,488.32,percent of total billed charges,80% of total billed charges,686.7,90,,549.36,percent of total billed charges,90% of total billed charges,572.25,75,,457.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,221.27,29,,177.016,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,511.21,67,,408.968,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,534.1,70,,427.28,percent of total billed charges,70% of total billed charges,495.95,65,,396.76,percent of total billed charges,65% of total billed charges,272.16,35.67,,217.728,percent of total billed charges,35.67% of total billed charges,221.27,763,
WECK LIGATING CLIP LARGE,27020806,CDM,278,RC,C1781,HCPCS,outpatient,,,219,87.60,,153.3,70,,122.64,percent of total billed charges,70% of total billed charges,219,100,,175.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,179.58,82,,143.664,percent of total billed charges,82% of total billed charges,186.15,85,,148.92,percent of total billed charges,85% of total billed charges,186.15,85,,148.92,percent of total billed charges,85% of total billed charges,186.15,85,,148.92,percent of total billed charges,85% of total billed charges,197.1,90,,157.68,percent of total billed charges,90% of total billed charges,175.2,80,,140.16,percent of total billed charges,80% of total billed charges,197.1,90,,157.68,percent of total billed charges,90% of total billed charges,164.25,75,,131.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,63.51,29,,50.808,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,146.73,67,,117.384,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,153.3,70,,122.64,percent of total billed charges,70% of total billed charges,142.35,65,,113.88,percent of total billed charges,65% of total billed charges,78.12,35.67,,62.496,percent of total billed charges,35.67% of total billed charges,63.51,219,
WECK LIGATING CLIP MED/LAR,27020808,CDM,278,RC,C1781,HCPCS,outpatient,,,219,87.60,,153.3,70,,122.64,percent of total billed charges,70% of total billed charges,219,100,,175.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,179.58,82,,143.664,percent of total billed charges,82% of total billed charges,186.15,85,,148.92,percent of total billed charges,85% of total billed charges,186.15,85,,148.92,percent of total billed charges,85% of total billed charges,186.15,85,,148.92,percent of total billed charges,85% of total billed charges,197.1,90,,157.68,percent of total billed charges,90% of total billed charges,175.2,80,,140.16,percent of total billed charges,80% of total billed charges,197.1,90,,157.68,percent of total billed charges,90% of total billed charges,164.25,75,,131.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,63.51,29,,50.808,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,146.73,67,,117.384,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,153.3,70,,122.64,percent of total billed charges,70% of total billed charges,142.35,65,,113.88,percent of total billed charges,65% of total billed charges,78.12,35.67,,62.496,percent of total billed charges,35.67% of total billed charges,63.51,219,
SCREW 2.5 MICRO 22MM,27020845,CDM,278,RC,C1781,HCPCS,outpatient,,,1209,483.60,,846.3,70,,677.04,percent of total billed charges,70% of total billed charges,634.73,52.5,,507.78,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,991.38,82,,793.104,percent of total billed charges,82% of total billed charges,1027.65,85,,822.12,percent of total billed charges,85% of total billed charges,1027.65,85,,822.12,percent of total billed charges,85% of total billed charges,1027.65,85,,822.12,percent of total billed charges,85% of total billed charges,1088.1,90,,870.48,percent of total billed charges,90% of total billed charges,967.2,80,,773.76,percent of total billed charges,80% of total billed charges,1088.1,90,,870.48,percent of total billed charges,90% of total billed charges,906.75,75,,725.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,350.61,29,,280.488,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,810.03,67,,648.024,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,846.3,70,,677.04,percent of total billed charges,70% of total billed charges,785.85,65,,628.68,percent of total billed charges,65% of total billed charges,431.25,35.67,,345,percent of total billed charges,35.67% of total billed charges,350.61,1088.1,
SCREW 2.5 MICRO 44MM,27020846,CDM,278,RC,C1781,HCPCS,outpatient,,,1209,483.60,,846.3,70,,677.04,percent of total billed charges,70% of total billed charges,634.73,52.5,,507.78,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,991.38,82,,793.104,percent of total billed charges,82% of total billed charges,1027.65,85,,822.12,percent of total billed charges,85% of total billed charges,1027.65,85,,822.12,percent of total billed charges,85% of total billed charges,1027.65,85,,822.12,percent of total billed charges,85% of total billed charges,1088.1,90,,870.48,percent of total billed charges,90% of total billed charges,967.2,80,,773.76,percent of total billed charges,80% of total billed charges,1088.1,90,,870.48,percent of total billed charges,90% of total billed charges,906.75,75,,725.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,350.61,29,,280.488,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,810.03,67,,648.024,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,846.3,70,,677.04,percent of total billed charges,70% of total billed charges,785.85,65,,628.68,percent of total billed charges,65% of total billed charges,431.25,35.67,,345,percent of total billed charges,35.67% of total billed charges,350.61,1088.1,
GUIDE WIRE .45 TROCAR TIP,27020847,CDM,278,RC,C1769,HCPCS,outpatient,,,78,31.20,,54.6,70,,43.68,percent of total billed charges,70% of total billed charges,78,100,,62.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,63.96,82,,51.168,percent of total billed charges,82% of total billed charges,66.3,85,,53.04,percent of total billed charges,85% of total billed charges,66.3,85,,53.04,percent of total billed charges,85% of total billed charges,66.3,85,,53.04,percent of total billed charges,85% of total billed charges,70.2,90,,56.16,percent of total billed charges,90% of total billed charges,62.4,80,,49.92,percent of total billed charges,80% of total billed charges,70.2,90,,56.16,percent of total billed charges,90% of total billed charges,58.5,75,,46.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,22.62,29,,18.096,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,52.26,67,,41.808,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,54.6,70,,43.68,percent of total billed charges,70% of total billed charges,50.7,65,,40.56,percent of total billed charges,65% of total billed charges,27.82,35.67,,22.256,percent of total billed charges,35.67% of total billed charges,22.62,78,
QCKFIX SCREW 4.0 X 56MM,27020848,CDM,278,RC,C1781,HCPCS,outpatient,,,571,228.40,,399.7,70,,319.76,percent of total billed charges,70% of total billed charges,571,100,,456.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,468.22,82,,374.576,percent of total billed charges,82% of total billed charges,485.35,85,,388.28,percent of total billed charges,85% of total billed charges,485.35,85,,388.28,percent of total billed charges,85% of total billed charges,485.35,85,,388.28,percent of total billed charges,85% of total billed charges,513.9,90,,411.12,percent of total billed charges,90% of total billed charges,456.8,80,,365.44,percent of total billed charges,80% of total billed charges,513.9,90,,411.12,percent of total billed charges,90% of total billed charges,428.25,75,,342.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,165.59,29,,132.472,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,382.57,67,,306.056,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,399.7,70,,319.76,percent of total billed charges,70% of total billed charges,371.15,65,,296.92,percent of total billed charges,65% of total billed charges,203.68,35.67,,162.944,percent of total billed charges,35.67% of total billed charges,165.59,571,
LENS CC60WF 20.5,27020853,CDM,278,RC,C1780,HCPCS,outpatient,,,319,127.60,,223.3,70,,178.64,percent of total billed charges,70% of total billed charges,319,100,,255.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,261.58,82,,209.264,percent of total billed charges,82% of total billed charges,271.15,85,,216.92,percent of total billed charges,85% of total billed charges,271.15,85,,216.92,percent of total billed charges,85% of total billed charges,271.15,85,,216.92,percent of total billed charges,85% of total billed charges,287.1,90,,229.68,percent of total billed charges,90% of total billed charges,255.2,80,,204.16,percent of total billed charges,80% of total billed charges,287.1,90,,229.68,percent of total billed charges,90% of total billed charges,239.25,75,,191.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,92.51,29,,74.008,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,213.73,67,,170.984,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,223.3,70,,178.64,percent of total billed charges,70% of total billed charges,207.35,65,,165.88,percent of total billed charges,65% of total billed charges,113.79,35.67,,91.032,percent of total billed charges,35.67% of total billed charges,92.51,319,
LENS CC60WF 18.5,27020854,CDM,278,RC,C1780,HCPCS,outpatient,,,319,127.60,,223.3,70,,178.64,percent of total billed charges,70% of total billed charges,319,100,,255.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,261.58,82,,209.264,percent of total billed charges,82% of total billed charges,271.15,85,,216.92,percent of total billed charges,85% of total billed charges,271.15,85,,216.92,percent of total billed charges,85% of total billed charges,271.15,85,,216.92,percent of total billed charges,85% of total billed charges,287.1,90,,229.68,percent of total billed charges,90% of total billed charges,255.2,80,,204.16,percent of total billed charges,80% of total billed charges,287.1,90,,229.68,percent of total billed charges,90% of total billed charges,239.25,75,,191.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,92.51,29,,74.008,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,213.73,67,,170.984,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,223.3,70,,178.64,percent of total billed charges,70% of total billed charges,207.35,65,,165.88,percent of total billed charges,65% of total billed charges,113.79,35.67,,91.032,percent of total billed charges,35.67% of total billed charges,92.51,319,
PROXIMAL TENODESIS IMPLANT SYS,27020944,CDM,278,RC,C1781,HCPCS,outpatient,,,2261,904.40,,1582.7,70,,1266.16,percent of total billed charges,70% of total billed charges,1187.03,52.5,,949.62,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,1854.02,82,,1483.216,percent of total billed charges,82% of total billed charges,1921.85,85,,1537.48,percent of total billed charges,85% of total billed charges,1921.85,85,,1537.48,percent of total billed charges,85% of total billed charges,1921.85,85,,1537.48,percent of total billed charges,85% of total billed charges,2034.9,90,,1627.92,percent of total billed charges,90% of total billed charges,1808.8,80,,1447.04,percent of total billed charges,80% of total billed charges,2034.9,90,,1627.92,percent of total billed charges,90% of total billed charges,1695.75,75,,1356.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,655.69,29,,524.552,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1514.87,67,,1211.896,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1582.7,70,,1266.16,percent of total billed charges,70% of total billed charges,1469.65,65,,1175.72,percent of total billed charges,65% of total billed charges,806.5,35.67,,645.2,percent of total billed charges,35.67% of total billed charges,655.69,2034.9,
URETERAL STENT AND POSITIONER,27020984,CDM,278,RC,C1781,HCPCS,outpatient,,,927,370.80,,648.9,70,,519.12,percent of total billed charges,70% of total billed charges,927,100,,741.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,760.14,82,,608.112,percent of total billed charges,82% of total billed charges,787.95,85,,630.36,percent of total billed charges,85% of total billed charges,787.95,85,,630.36,percent of total billed charges,85% of total billed charges,787.95,85,,630.36,percent of total billed charges,85% of total billed charges,834.3,90,,667.44,percent of total billed charges,90% of total billed charges,741.6,80,,593.28,percent of total billed charges,80% of total billed charges,834.3,90,,667.44,percent of total billed charges,90% of total billed charges,695.25,75,,556.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,268.83,29,,215.064,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,621.09,67,,496.872,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,648.9,70,,519.12,percent of total billed charges,70% of total billed charges,602.55,65,,482.04,percent of total billed charges,65% of total billed charges,330.66,35.67,,264.528,percent of total billed charges,35.67% of total billed charges,268.83,927,
URETRAL STENT AND POSITIONER,27020999,CDM,278,RC,,,outpatient,,,230,92.00,,161,70,,128.8,percent of total billed charges,70% of total billed charges,230,100,,184,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,188.6,82,,150.88,percent of total billed charges,82% of total billed charges,195.5,85,,156.4,percent of total billed charges,85% of total billed charges,195.5,85,,156.4,percent of total billed charges,85% of total billed charges,195.5,85,,156.4,percent of total billed charges,85% of total billed charges,207,90,,165.6,percent of total billed charges,90% of total billed charges,184,80,,147.2,percent of total billed charges,80% of total billed charges,207,90,,165.6,percent of total billed charges,90% of total billed charges,172.5,75,,138,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,66.7,29,,53.36,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,154.1,67,,123.28,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,161,70,,128.8,percent of total billed charges,70% of total billed charges,149.5,65,,119.6,percent of total billed charges,65% of total billed charges,82.04,35.67,,65.632,percent of total billed charges,35.67% of total billed charges,66.7,230,
TECNIS DIOPTER 16.5,27021037,CDM,278,RC,C1780,HCPCS,outpatient,,,309,123.60,,216.3,70,,173.04,percent of total billed charges,70% of total billed charges,309,100,,247.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,253.38,82,,202.704,percent of total billed charges,82% of total billed charges,262.65,85,,210.12,percent of total billed charges,85% of total billed charges,262.65,85,,210.12,percent of total billed charges,85% of total billed charges,262.65,85,,210.12,percent of total billed charges,85% of total billed charges,278.1,90,,222.48,percent of total billed charges,90% of total billed charges,247.2,80,,197.76,percent of total billed charges,80% of total billed charges,278.1,90,,222.48,percent of total billed charges,90% of total billed charges,231.75,75,,185.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,89.61,29,,71.688,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,207.03,67,,165.624,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,216.3,70,,173.04,percent of total billed charges,70% of total billed charges,200.85,65,,160.68,percent of total billed charges,65% of total billed charges,110.22,35.67,,88.176,percent of total billed charges,35.67% of total billed charges,89.61,309,
TECNIS DIOPTER 18.5,27021038,CDM,278,RC,C1780,HCPCS,outpatient,,,309,123.60,,216.3,70,,173.04,percent of total billed charges,70% of total billed charges,309,100,,247.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,253.38,82,,202.704,percent of total billed charges,82% of total billed charges,262.65,85,,210.12,percent of total billed charges,85% of total billed charges,262.65,85,,210.12,percent of total billed charges,85% of total billed charges,262.65,85,,210.12,percent of total billed charges,85% of total billed charges,278.1,90,,222.48,percent of total billed charges,90% of total billed charges,247.2,80,,197.76,percent of total billed charges,80% of total billed charges,278.1,90,,222.48,percent of total billed charges,90% of total billed charges,231.75,75,,185.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,89.61,29,,71.688,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,207.03,67,,165.624,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,216.3,70,,173.04,percent of total billed charges,70% of total billed charges,200.85,65,,160.68,percent of total billed charges,65% of total billed charges,110.22,35.67,,88.176,percent of total billed charges,35.67% of total billed charges,89.61,309,
TECNIS DIOPTER 15.0,27021039,CDM,278,RC,C1780,HCPCS,outpatient,,,309,123.60,,216.3,70,,173.04,percent of total billed charges,70% of total billed charges,309,100,,247.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,253.38,82,,202.704,percent of total billed charges,82% of total billed charges,262.65,85,,210.12,percent of total billed charges,85% of total billed charges,262.65,85,,210.12,percent of total billed charges,85% of total billed charges,262.65,85,,210.12,percent of total billed charges,85% of total billed charges,278.1,90,,222.48,percent of total billed charges,90% of total billed charges,247.2,80,,197.76,percent of total billed charges,80% of total billed charges,278.1,90,,222.48,percent of total billed charges,90% of total billed charges,231.75,75,,185.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,89.61,29,,71.688,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,207.03,67,,165.624,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,216.3,70,,173.04,percent of total billed charges,70% of total billed charges,200.85,65,,160.68,percent of total billed charges,65% of total billed charges,110.22,35.67,,88.176,percent of total billed charges,35.67% of total billed charges,89.61,309,
TECNIS DIOPTER 25.0,27021040,CDM,278,RC,C1780,HCPCS,outpatient,,,309,123.60,,216.3,70,,173.04,percent of total billed charges,70% of total billed charges,309,100,,247.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,253.38,82,,202.704,percent of total billed charges,82% of total billed charges,262.65,85,,210.12,percent of total billed charges,85% of total billed charges,262.65,85,,210.12,percent of total billed charges,85% of total billed charges,262.65,85,,210.12,percent of total billed charges,85% of total billed charges,278.1,90,,222.48,percent of total billed charges,90% of total billed charges,247.2,80,,197.76,percent of total billed charges,80% of total billed charges,278.1,90,,222.48,percent of total billed charges,90% of total billed charges,231.75,75,,185.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,89.61,29,,71.688,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,207.03,67,,165.624,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,216.3,70,,173.04,percent of total billed charges,70% of total billed charges,200.85,65,,160.68,percent of total billed charges,65% of total billed charges,110.22,35.67,,88.176,percent of total billed charges,35.67% of total billed charges,89.61,309,
TECNIS DIOPTER 22.0,27021041,CDM,278,RC,C1780,HCPCS,outpatient,,,309,123.60,,216.3,70,,173.04,percent of total billed charges,70% of total billed charges,309,100,,247.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,253.38,82,,202.704,percent of total billed charges,82% of total billed charges,262.65,85,,210.12,percent of total billed charges,85% of total billed charges,262.65,85,,210.12,percent of total billed charges,85% of total billed charges,262.65,85,,210.12,percent of total billed charges,85% of total billed charges,278.1,90,,222.48,percent of total billed charges,90% of total billed charges,247.2,80,,197.76,percent of total billed charges,80% of total billed charges,278.1,90,,222.48,percent of total billed charges,90% of total billed charges,231.75,75,,185.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,89.61,29,,71.688,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,207.03,67,,165.624,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,216.3,70,,173.04,percent of total billed charges,70% of total billed charges,200.85,65,,160.68,percent of total billed charges,65% of total billed charges,110.22,35.67,,88.176,percent of total billed charges,35.67% of total billed charges,89.61,309,
LOW PRO SCREW 6.7 X 70 MM,27021058,CDM,278,RC,C1781,HCPCS,outpatient,,,1675,670.00,,1172.5,70,,938,percent of total billed charges,70% of total billed charges,879.38,52.5,,703.5,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,1373.5,82,,1098.8,percent of total billed charges,82% of total billed charges,1423.75,85,,1139,percent of total billed charges,85% of total billed charges,1423.75,85,,1139,percent of total billed charges,85% of total billed charges,1423.75,85,,1139,percent of total billed charges,85% of total billed charges,1507.5,90,,1206,percent of total billed charges,90% of total billed charges,1340,80,,1072,percent of total billed charges,80% of total billed charges,1507.5,90,,1206,percent of total billed charges,90% of total billed charges,1256.25,75,,1005,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,485.75,29,,388.6,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1122.25,67,,897.8,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1172.5,70,,938,percent of total billed charges,70% of total billed charges,1088.75,65,,871,percent of total billed charges,65% of total billed charges,597.47,35.67,,477.976,percent of total billed charges,35.67% of total billed charges,485.75,1507.5,
QCKFIX SCREW 4.0 X 26MM,27021126,CDM,278,RC,C1781,HCPCS,outpatient,,,554,221.60,,387.8,70,,310.24,percent of total billed charges,70% of total billed charges,554,100,,443.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,454.28,82,,363.424,percent of total billed charges,82% of total billed charges,470.9,85,,376.72,percent of total billed charges,85% of total billed charges,470.9,85,,376.72,percent of total billed charges,85% of total billed charges,470.9,85,,376.72,percent of total billed charges,85% of total billed charges,498.6,90,,398.88,percent of total billed charges,90% of total billed charges,443.2,80,,354.56,percent of total billed charges,80% of total billed charges,498.6,90,,398.88,percent of total billed charges,90% of total billed charges,415.5,75,,332.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,160.66,29,,128.528,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,371.18,67,,296.944,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,387.8,70,,310.24,percent of total billed charges,70% of total billed charges,360.1,65,,288.08,percent of total billed charges,65% of total billed charges,197.61,35.67,,158.088,percent of total billed charges,35.67% of total billed charges,160.66,554,
SCREW CORTICAL 1.6 X 12MM,27021137,CDM,278,RC,C1713,HCPCS,outpatient,,,369,147.60,,258.3,70,,206.64,percent of total billed charges,70% of total billed charges,369,100,,295.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,302.58,82,,242.064,percent of total billed charges,82% of total billed charges,313.65,85,,250.92,percent of total billed charges,85% of total billed charges,313.65,85,,250.92,percent of total billed charges,85% of total billed charges,313.65,85,,250.92,percent of total billed charges,85% of total billed charges,332.1,90,,265.68,percent of total billed charges,90% of total billed charges,295.2,80,,236.16,percent of total billed charges,80% of total billed charges,332.1,90,,265.68,percent of total billed charges,90% of total billed charges,276.75,75,,221.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,107.01,29,,85.608,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,247.23,67,,197.784,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,258.3,70,,206.64,percent of total billed charges,70% of total billed charges,239.85,65,,191.88,percent of total billed charges,65% of total billed charges,131.62,35.67,,105.296,percent of total billed charges,35.67% of total billed charges,107.01,369,
SCREW CORTICAL 1.6 X 13MM,27021138,CDM,278,RC,C1713,HCPCS,outpatient,,,369,147.60,,258.3,70,,206.64,percent of total billed charges,70% of total billed charges,369,100,,295.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,302.58,82,,242.064,percent of total billed charges,82% of total billed charges,313.65,85,,250.92,percent of total billed charges,85% of total billed charges,313.65,85,,250.92,percent of total billed charges,85% of total billed charges,313.65,85,,250.92,percent of total billed charges,85% of total billed charges,332.1,90,,265.68,percent of total billed charges,90% of total billed charges,295.2,80,,236.16,percent of total billed charges,80% of total billed charges,332.1,90,,265.68,percent of total billed charges,90% of total billed charges,276.75,75,,221.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,107.01,29,,85.608,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,247.23,67,,197.784,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,258.3,70,,206.64,percent of total billed charges,70% of total billed charges,239.85,65,,191.88,percent of total billed charges,65% of total billed charges,131.62,35.67,,105.296,percent of total billed charges,35.67% of total billed charges,107.01,369,
SCREW CORTICAL 1.6 X 14MM,27021139,CDM,278,RC,C1713,HCPCS,outpatient,,,369,147.60,,258.3,70,,206.64,percent of total billed charges,70% of total billed charges,369,100,,295.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,302.58,82,,242.064,percent of total billed charges,82% of total billed charges,313.65,85,,250.92,percent of total billed charges,85% of total billed charges,313.65,85,,250.92,percent of total billed charges,85% of total billed charges,313.65,85,,250.92,percent of total billed charges,85% of total billed charges,332.1,90,,265.68,percent of total billed charges,90% of total billed charges,295.2,80,,236.16,percent of total billed charges,80% of total billed charges,332.1,90,,265.68,percent of total billed charges,90% of total billed charges,276.75,75,,221.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,107.01,29,,85.608,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,247.23,67,,197.784,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,258.3,70,,206.64,percent of total billed charges,70% of total billed charges,239.85,65,,191.88,percent of total billed charges,65% of total billed charges,131.62,35.67,,105.296,percent of total billed charges,35.67% of total billed charges,107.01,369,
TRIANGULAR PLATE 1.6MM 8 HOLE,27021140,CDM,278,RC,C1713,HCPCS,outpatient,,,2663,1065.20,,1864.1,70,,1491.28,percent of total billed charges,70% of total billed charges,1398.08,52.5,,1118.46,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,2183.66,82,,1746.928,percent of total billed charges,82% of total billed charges,2263.55,85,,1810.84,percent of total billed charges,85% of total billed charges,2263.55,85,,1810.84,percent of total billed charges,85% of total billed charges,2263.55,85,,1810.84,percent of total billed charges,85% of total billed charges,2396.7,90,,1917.36,percent of total billed charges,90% of total billed charges,2130.4,80,,1704.32,percent of total billed charges,80% of total billed charges,2396.7,90,,1917.36,percent of total billed charges,90% of total billed charges,1997.25,75,,1597.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,772.27,29,,617.816,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1784.21,67,,1427.368,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1864.1,70,,1491.28,percent of total billed charges,70% of total billed charges,1730.95,65,,1384.76,percent of total billed charges,65% of total billed charges,949.89,35.67,,759.912,percent of total billed charges,35.67% of total billed charges,772.27,2396.7,
SCREW 1.6 X 10MM,27021142,CDM,278,RC,C1713,HCPCS,outpatient,,,470,188.00,,329,70,,263.2,percent of total billed charges,70% of total billed charges,470,100,,376,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,385.4,82,,308.32,percent of total billed charges,82% of total billed charges,399.5,85,,319.6,percent of total billed charges,85% of total billed charges,399.5,85,,319.6,percent of total billed charges,85% of total billed charges,399.5,85,,319.6,percent of total billed charges,85% of total billed charges,423,90,,338.4,percent of total billed charges,90% of total billed charges,376,80,,300.8,percent of total billed charges,80% of total billed charges,423,90,,338.4,percent of total billed charges,90% of total billed charges,352.5,75,,282,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,136.3,29,,109.04,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,314.9,67,,251.92,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,329,70,,263.2,percent of total billed charges,70% of total billed charges,305.5,65,,244.4,percent of total billed charges,65% of total billed charges,167.65,35.67,,134.12,percent of total billed charges,35.67% of total billed charges,136.3,470,
SCREW 1.6 X 11 MM,27021143,CDM,278,RC,C1713,HCPCS,outpatient,,,470,188.00,,329,70,,263.2,percent of total billed charges,70% of total billed charges,470,100,,376,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,385.4,82,,308.32,percent of total billed charges,82% of total billed charges,399.5,85,,319.6,percent of total billed charges,85% of total billed charges,399.5,85,,319.6,percent of total billed charges,85% of total billed charges,399.5,85,,319.6,percent of total billed charges,85% of total billed charges,423,90,,338.4,percent of total billed charges,90% of total billed charges,376,80,,300.8,percent of total billed charges,80% of total billed charges,423,90,,338.4,percent of total billed charges,90% of total billed charges,352.5,75,,282,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,136.3,29,,109.04,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,314.9,67,,251.92,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,329,70,,263.2,percent of total billed charges,70% of total billed charges,305.5,65,,244.4,percent of total billed charges,65% of total billed charges,167.65,35.67,,134.12,percent of total billed charges,35.67% of total billed charges,136.3,470,
SCREW 1.6 X 12MM,27021144,CDM,278,RC,C1713,HCPCS,outpatient,,,470,188.00,,329,70,,263.2,percent of total billed charges,70% of total billed charges,470,100,,376,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,385.4,82,,308.32,percent of total billed charges,82% of total billed charges,399.5,85,,319.6,percent of total billed charges,85% of total billed charges,399.5,85,,319.6,percent of total billed charges,85% of total billed charges,399.5,85,,319.6,percent of total billed charges,85% of total billed charges,423,90,,338.4,percent of total billed charges,90% of total billed charges,376,80,,300.8,percent of total billed charges,80% of total billed charges,423,90,,338.4,percent of total billed charges,90% of total billed charges,352.5,75,,282,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,136.3,29,,109.04,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,314.9,67,,251.92,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,329,70,,263.2,percent of total billed charges,70% of total billed charges,305.5,65,,244.4,percent of total billed charges,65% of total billed charges,167.65,35.67,,134.12,percent of total billed charges,35.67% of total billed charges,136.3,470,
SCREW 1.6 X 13MM,27021145,CDM,278,RC,C1713,HCPCS,outpatient,,,470,188.00,,329,70,,263.2,percent of total billed charges,70% of total billed charges,470,100,,376,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,385.4,82,,308.32,percent of total billed charges,82% of total billed charges,399.5,85,,319.6,percent of total billed charges,85% of total billed charges,399.5,85,,319.6,percent of total billed charges,85% of total billed charges,399.5,85,,319.6,percent of total billed charges,85% of total billed charges,423,90,,338.4,percent of total billed charges,90% of total billed charges,376,80,,300.8,percent of total billed charges,80% of total billed charges,423,90,,338.4,percent of total billed charges,90% of total billed charges,352.5,75,,282,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,136.3,29,,109.04,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,314.9,67,,251.92,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,329,70,,263.2,percent of total billed charges,70% of total billed charges,305.5,65,,244.4,percent of total billed charges,65% of total billed charges,167.65,35.67,,134.12,percent of total billed charges,35.67% of total billed charges,136.3,470,
SCREW 1.6 X 14MM,27021146,CDM,278,RC,C1713,HCPCS,outpatient,,,470,188.00,,329,70,,263.2,percent of total billed charges,70% of total billed charges,470,100,,376,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,385.4,82,,308.32,percent of total billed charges,82% of total billed charges,399.5,85,,319.6,percent of total billed charges,85% of total billed charges,399.5,85,,319.6,percent of total billed charges,85% of total billed charges,399.5,85,,319.6,percent of total billed charges,85% of total billed charges,423,90,,338.4,percent of total billed charges,90% of total billed charges,376,80,,300.8,percent of total billed charges,80% of total billed charges,423,90,,338.4,percent of total billed charges,90% of total billed charges,352.5,75,,282,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,136.3,29,,109.04,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,314.9,67,,251.92,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,329,70,,263.2,percent of total billed charges,70% of total billed charges,305.5,65,,244.4,percent of total billed charges,65% of total billed charges,167.65,35.67,,134.12,percent of total billed charges,35.67% of total billed charges,136.3,470,
CERAMENT BONE CEMENT,27021148,CDM,278,RC,C1713,HCPCS,outpatient,,,14987,5994.80,,10490.9,70,,8392.72,percent of total billed charges,70% of total billed charges,7868.18,52.5,,6294.54,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,12289.34,82,,9831.472,percent of total billed charges,82% of total billed charges,12738.95,85,,10191.16,percent of total billed charges,85% of total billed charges,12738.95,85,,10191.16,percent of total billed charges,85% of total billed charges,12738.95,85,,10191.16,percent of total billed charges,85% of total billed charges,13488.3,90,,10790.64,percent of total billed charges,90% of total billed charges,11989.6,80,,9591.68,percent of total billed charges,80% of total billed charges,13488.3,90,,10790.64,percent of total billed charges,90% of total billed charges,11240.25,75,,8992.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,4346.23,29,,3476.984,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,10041.29,67,,8033.032,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,10490.9,70,,8392.72,percent of total billed charges,70% of total billed charges,9741.55,65,,7793.24,percent of total billed charges,65% of total billed charges,5345.86,35.67,,4276.688,percent of total billed charges,35.67% of total billed charges,4346.23,13488.3,
SCREW 2.0 X 12MM,27021149,CDM,278,RC,C1713,HCPCS,outpatient,,,470,188.00,,329,70,,263.2,percent of total billed charges,70% of total billed charges,470,100,,376,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,385.4,82,,308.32,percent of total billed charges,82% of total billed charges,399.5,85,,319.6,percent of total billed charges,85% of total billed charges,399.5,85,,319.6,percent of total billed charges,85% of total billed charges,399.5,85,,319.6,percent of total billed charges,85% of total billed charges,423,90,,338.4,percent of total billed charges,90% of total billed charges,376,80,,300.8,percent of total billed charges,80% of total billed charges,423,90,,338.4,percent of total billed charges,90% of total billed charges,352.5,75,,282,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,136.3,29,,109.04,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,314.9,67,,251.92,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,329,70,,263.2,percent of total billed charges,70% of total billed charges,305.5,65,,244.4,percent of total billed charges,65% of total billed charges,167.65,35.67,,134.12,percent of total billed charges,35.67% of total billed charges,136.3,470,
SCREW 4.0 X 24MM,27021151,CDM,278,RC,C1713,HCPCS,outpatient,,,554,221.60,,387.8,70,,310.24,percent of total billed charges,70% of total billed charges,554,100,,443.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,454.28,82,,363.424,percent of total billed charges,82% of total billed charges,470.9,85,,376.72,percent of total billed charges,85% of total billed charges,470.9,85,,376.72,percent of total billed charges,85% of total billed charges,470.9,85,,376.72,percent of total billed charges,85% of total billed charges,498.6,90,,398.88,percent of total billed charges,90% of total billed charges,443.2,80,,354.56,percent of total billed charges,80% of total billed charges,498.6,90,,398.88,percent of total billed charges,90% of total billed charges,415.5,75,,332.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,160.66,29,,128.528,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,371.18,67,,296.944,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,387.8,70,,310.24,percent of total billed charges,70% of total billed charges,360.1,65,,288.08,percent of total billed charges,65% of total billed charges,197.61,35.67,,158.088,percent of total billed charges,35.67% of total billed charges,160.66,554,
SCREW 3.5 X 16MM,27021152,CDM,278,RC,C1713,HCPCS,outpatient,,,201,80.40,,140.7,70,,112.56,percent of total billed charges,70% of total billed charges,201,100,,160.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,164.82,82,,131.856,percent of total billed charges,82% of total billed charges,170.85,85,,136.68,percent of total billed charges,85% of total billed charges,170.85,85,,136.68,percent of total billed charges,85% of total billed charges,170.85,85,,136.68,percent of total billed charges,85% of total billed charges,180.9,90,,144.72,percent of total billed charges,90% of total billed charges,160.8,80,,128.64,percent of total billed charges,80% of total billed charges,180.9,90,,144.72,percent of total billed charges,90% of total billed charges,150.75,75,,120.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,58.29,29,,46.632,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,134.67,67,,107.736,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,140.7,70,,112.56,percent of total billed charges,70% of total billed charges,130.65,65,,104.52,percent of total billed charges,65% of total billed charges,71.7,35.67,,57.36,percent of total billed charges,35.67% of total billed charges,58.29,201,
LAPIDUS PLATE LOW PROFILE,27021153,CDM,278,RC,C1713,HCPCS,outpatient,,,2998,1199.20,,2098.6,70,,1678.88,percent of total billed charges,70% of total billed charges,1573.95,52.5,,1259.16,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,2458.36,82,,1966.688,percent of total billed charges,82% of total billed charges,2548.3,85,,2038.64,percent of total billed charges,85% of total billed charges,2548.3,85,,2038.64,percent of total billed charges,85% of total billed charges,2548.3,85,,2038.64,percent of total billed charges,85% of total billed charges,2698.2,90,,2158.56,percent of total billed charges,90% of total billed charges,2398.4,80,,1918.72,percent of total billed charges,80% of total billed charges,2698.2,90,,2158.56,percent of total billed charges,90% of total billed charges,2248.5,75,,1798.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,869.42,29,,695.536,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,2008.66,67,,1606.928,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,2098.6,70,,1678.88,percent of total billed charges,70% of total billed charges,1948.7,65,,1558.96,percent of total billed charges,65% of total billed charges,1069.39,35.67,,855.512,percent of total billed charges,35.67% of total billed charges,869.42,2698.2,
SCREW 3.5MM X 14MM,27021155,CDM,278,RC,C1713,HCPCS,outpatient,,,504,201.60,,352.8,70,,282.24,percent of total billed charges,70% of total billed charges,504,100,,403.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,413.28,82,,330.624,percent of total billed charges,82% of total billed charges,428.4,85,,342.72,percent of total billed charges,85% of total billed charges,428.4,85,,342.72,percent of total billed charges,85% of total billed charges,428.4,85,,342.72,percent of total billed charges,85% of total billed charges,453.6,90,,362.88,percent of total billed charges,90% of total billed charges,403.2,80,,322.56,percent of total billed charges,80% of total billed charges,453.6,90,,362.88,percent of total billed charges,90% of total billed charges,378,75,,302.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,146.16,29,,116.928,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,337.68,67,,270.144,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,352.8,70,,282.24,percent of total billed charges,70% of total billed charges,327.6,65,,262.08,percent of total billed charges,65% of total billed charges,179.78,35.67,,143.824,percent of total billed charges,35.67% of total billed charges,146.16,504,
SCREW POLYAXIAL LOCKING 10MM,27021224,CDM,278,RC,C1713,HCPCS,outpatient,,,1005,402.00,,703.5,70,,562.8,percent of total billed charges,70% of total billed charges,527.63,52.5,,422.1,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,824.1,82,,659.28,percent of total billed charges,82% of total billed charges,854.25,85,,683.4,percent of total billed charges,85% of total billed charges,854.25,85,,683.4,percent of total billed charges,85% of total billed charges,854.25,85,,683.4,percent of total billed charges,85% of total billed charges,904.5,90,,723.6,percent of total billed charges,90% of total billed charges,804,80,,643.2,percent of total billed charges,80% of total billed charges,904.5,90,,723.6,percent of total billed charges,90% of total billed charges,753.75,75,,603,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,291.45,29,,233.16,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,673.35,67,,538.68,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,703.5,70,,562.8,percent of total billed charges,70% of total billed charges,653.25,65,,522.6,percent of total billed charges,65% of total billed charges,358.48,35.67,,286.784,percent of total billed charges,35.67% of total billed charges,291.45,904.5,
TECNIS DIOPTER 22.5 LENS,27021234,CDM,278,RC,C1780,HCPCS,outpatient,,,309,123.60,,216.3,70,,173.04,percent of total billed charges,70% of total billed charges,309,100,,247.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,253.38,82,,202.704,percent of total billed charges,82% of total billed charges,262.65,85,,210.12,percent of total billed charges,85% of total billed charges,262.65,85,,210.12,percent of total billed charges,85% of total billed charges,262.65,85,,210.12,percent of total billed charges,85% of total billed charges,278.1,90,,222.48,percent of total billed charges,90% of total billed charges,247.2,80,,197.76,percent of total billed charges,80% of total billed charges,278.1,90,,222.48,percent of total billed charges,90% of total billed charges,231.75,75,,185.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,89.61,29,,71.688,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,207.03,67,,165.624,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,216.3,70,,173.04,percent of total billed charges,70% of total billed charges,200.85,65,,160.68,percent of total billed charges,65% of total billed charges,110.22,35.67,,88.176,percent of total billed charges,35.67% of total billed charges,89.61,309,
TECNIS DIOPTER 20.5 LENS,27021235,CDM,278,RC,C1780,HCPCS,outpatient,,,309,123.60,,216.3,70,,173.04,percent of total billed charges,70% of total billed charges,309,100,,247.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,253.38,82,,202.704,percent of total billed charges,82% of total billed charges,262.65,85,,210.12,percent of total billed charges,85% of total billed charges,262.65,85,,210.12,percent of total billed charges,85% of total billed charges,262.65,85,,210.12,percent of total billed charges,85% of total billed charges,278.1,90,,222.48,percent of total billed charges,90% of total billed charges,247.2,80,,197.76,percent of total billed charges,80% of total billed charges,278.1,90,,222.48,percent of total billed charges,90% of total billed charges,231.75,75,,185.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,89.61,29,,71.688,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,207.03,67,,165.624,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,216.3,70,,173.04,percent of total billed charges,70% of total billed charges,200.85,65,,160.68,percent of total billed charges,65% of total billed charges,110.22,35.67,,88.176,percent of total billed charges,35.67% of total billed charges,89.61,309,
URETERAL STENT AND POSITIONER,27021325,CDM,278,RC,,,outpatient,,,309,123.60,,216.3,70,,173.04,percent of total billed charges,70% of total billed charges,309,100,,247.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,253.38,82,,202.704,percent of total billed charges,82% of total billed charges,262.65,85,,210.12,percent of total billed charges,85% of total billed charges,262.65,85,,210.12,percent of total billed charges,85% of total billed charges,262.65,85,,210.12,percent of total billed charges,85% of total billed charges,278.1,90,,222.48,percent of total billed charges,90% of total billed charges,247.2,80,,197.76,percent of total billed charges,80% of total billed charges,278.1,90,,222.48,percent of total billed charges,90% of total billed charges,231.75,75,,185.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,89.61,29,,71.688,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,207.03,67,,165.624,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,216.3,70,,173.04,percent of total billed charges,70% of total billed charges,200.85,65,,160.68,percent of total billed charges,65% of total billed charges,110.22,35.67,,88.176,percent of total billed charges,35.67% of total billed charges,89.61,309,
SCREW 2.4X12MM,27021341,CDM,278,RC,C1713,HCPCS,outpatient,,,469,187.60,,328.3,70,,262.64,percent of total billed charges,70% of total billed charges,469,100,,375.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,384.58,82,,307.664,percent of total billed charges,82% of total billed charges,398.65,85,,318.92,percent of total billed charges,85% of total billed charges,398.65,85,,318.92,percent of total billed charges,85% of total billed charges,398.65,85,,318.92,percent of total billed charges,85% of total billed charges,422.1,90,,337.68,percent of total billed charges,90% of total billed charges,375.2,80,,300.16,percent of total billed charges,80% of total billed charges,422.1,90,,337.68,percent of total billed charges,90% of total billed charges,351.75,75,,281.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,136.01,29,,108.808,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,314.23,67,,251.384,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,328.3,70,,262.64,percent of total billed charges,70% of total billed charges,304.85,65,,243.88,percent of total billed charges,65% of total billed charges,167.29,35.67,,133.832,percent of total billed charges,35.67% of total billed charges,136.01,469,
SCREW 4.0X60MM,27021342,CDM,278,RC,C1713,HCPCS,outpatient,,,554,221.60,,387.8,70,,310.24,percent of total billed charges,70% of total billed charges,554,100,,443.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,454.28,82,,363.424,percent of total billed charges,82% of total billed charges,470.9,85,,376.72,percent of total billed charges,85% of total billed charges,470.9,85,,376.72,percent of total billed charges,85% of total billed charges,470.9,85,,376.72,percent of total billed charges,85% of total billed charges,498.6,90,,398.88,percent of total billed charges,90% of total billed charges,443.2,80,,354.56,percent of total billed charges,80% of total billed charges,498.6,90,,398.88,percent of total billed charges,90% of total billed charges,415.5,75,,332.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,160.66,29,,128.528,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,371.18,67,,296.944,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,387.8,70,,310.24,percent of total billed charges,70% of total billed charges,360.1,65,,288.08,percent of total billed charges,65% of total billed charges,197.61,35.67,,158.088,percent of total billed charges,35.67% of total billed charges,160.66,554,
T PLATE 2.4MM 4 HOLE,27021343,CDM,278,RC,C1713,HCPCS,outpatient,,,2328,931.20,,1629.6,70,,1303.68,percent of total billed charges,70% of total billed charges,1222.2,52.5,,977.76,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,1908.96,82,,1527.168,percent of total billed charges,82% of total billed charges,1978.8,85,,1583.04,percent of total billed charges,85% of total billed charges,1978.8,85,,1583.04,percent of total billed charges,85% of total billed charges,1978.8,85,,1583.04,percent of total billed charges,85% of total billed charges,2095.2,90,,1676.16,percent of total billed charges,90% of total billed charges,1862.4,80,,1489.92,percent of total billed charges,80% of total billed charges,2095.2,90,,1676.16,percent of total billed charges,90% of total billed charges,1746,75,,1396.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,675.12,29,,540.096,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1559.76,67,,1247.808,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1629.6,70,,1303.68,percent of total billed charges,70% of total billed charges,1513.2,65,,1210.56,percent of total billed charges,65% of total billed charges,830.4,35.67,,664.32,percent of total billed charges,35.67% of total billed charges,675.12,2095.2,
GUIDEWIRE 2MMX200MM,27021344,CDM,278,RC,C1713,HCPCS,outpatient,,,84,33.60,,58.8,70,,47.04,percent of total billed charges,70% of total billed charges,84,100,,67.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,68.88,82,,55.104,percent of total billed charges,82% of total billed charges,71.4,85,,57.12,percent of total billed charges,85% of total billed charges,71.4,85,,57.12,percent of total billed charges,85% of total billed charges,71.4,85,,57.12,percent of total billed charges,85% of total billed charges,75.6,90,,60.48,percent of total billed charges,90% of total billed charges,67.2,80,,53.76,percent of total billed charges,80% of total billed charges,75.6,90,,60.48,percent of total billed charges,90% of total billed charges,63,75,,50.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,24.36,29,,19.488,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,56.28,67,,45.024,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,58.8,70,,47.04,percent of total billed charges,70% of total billed charges,54.6,65,,43.68,percent of total billed charges,65% of total billed charges,29.96,35.67,,23.968,percent of total billed charges,35.67% of total billed charges,24.36,84,
SCREW 5MMX55MM,27021345,CDM,278,RC,C1713,HCPCS,outpatient,,,2663,1065.20,,1864.1,70,,1491.28,percent of total billed charges,70% of total billed charges,1398.08,52.5,,1118.46,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,2183.66,82,,1746.928,percent of total billed charges,82% of total billed charges,2263.55,85,,1810.84,percent of total billed charges,85% of total billed charges,2263.55,85,,1810.84,percent of total billed charges,85% of total billed charges,2263.55,85,,1810.84,percent of total billed charges,85% of total billed charges,2396.7,90,,1917.36,percent of total billed charges,90% of total billed charges,2130.4,80,,1704.32,percent of total billed charges,80% of total billed charges,2396.7,90,,1917.36,percent of total billed charges,90% of total billed charges,1997.25,75,,1597.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,772.27,29,,617.816,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1784.21,67,,1427.368,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1864.1,70,,1491.28,percent of total billed charges,70% of total billed charges,1730.95,65,,1384.76,percent of total billed charges,65% of total billed charges,949.89,35.67,,759.912,percent of total billed charges,35.67% of total billed charges,772.27,2396.7,
URETERAL CATHETER,27021347,CDM,278,RC,C1769,HCPCS,outpatient,,,44,17.60,,30.8,70,,24.64,percent of total billed charges,70% of total billed charges,44,100,,35.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,36.08,82,,28.864,percent of total billed charges,82% of total billed charges,37.4,85,,29.92,percent of total billed charges,85% of total billed charges,37.4,85,,29.92,percent of total billed charges,85% of total billed charges,37.4,85,,29.92,percent of total billed charges,85% of total billed charges,39.6,90,,31.68,percent of total billed charges,90% of total billed charges,35.2,80,,28.16,percent of total billed charges,80% of total billed charges,39.6,90,,31.68,percent of total billed charges,90% of total billed charges,33,75,,26.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,12.76,29,,10.208,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,29.48,67,,23.584,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,30.8,70,,24.64,percent of total billed charges,70% of total billed charges,28.6,65,,22.88,percent of total billed charges,65% of total billed charges,15.69,35.67,,12.552,percent of total billed charges,35.67% of total billed charges,12.76,44,
BB TAK MTP,27021422,CDM,278,RC,C1713,HCPCS,outpatient,,,168,67.20,,117.6,70,,94.08,percent of total billed charges,70% of total billed charges,168,100,,134.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,137.76,82,,110.208,percent of total billed charges,82% of total billed charges,142.8,85,,114.24,percent of total billed charges,85% of total billed charges,142.8,85,,114.24,percent of total billed charges,85% of total billed charges,142.8,85,,114.24,percent of total billed charges,85% of total billed charges,151.2,90,,120.96,percent of total billed charges,90% of total billed charges,134.4,80,,107.52,percent of total billed charges,80% of total billed charges,151.2,90,,120.96,percent of total billed charges,90% of total billed charges,126,75,,100.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,48.72,29,,38.976,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,112.56,67,,90.048,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,117.6,70,,94.08,percent of total billed charges,70% of total billed charges,109.2,65,,87.36,percent of total billed charges,65% of total billed charges,59.93,35.67,,47.944,percent of total billed charges,35.67% of total billed charges,48.72,168,
PHALANGEAL REAMER 10MM 10V,27021424,CDM,278,RC,,,outpatient,,,1505,602.00,,1053.5,70,,842.8,percent of total billed charges,70% of total billed charges,790.13,52.5,,632.1,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,1234.1,82,,987.28,percent of total billed charges,82% of total billed charges,1279.25,85,,1023.4,percent of total billed charges,85% of total billed charges,1279.25,85,,1023.4,percent of total billed charges,85% of total billed charges,1279.25,85,,1023.4,percent of total billed charges,85% of total billed charges,1354.5,90,,1083.6,percent of total billed charges,90% of total billed charges,1204,80,,963.2,percent of total billed charges,80% of total billed charges,1354.5,90,,1083.6,percent of total billed charges,90% of total billed charges,1128.75,75,,903,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,436.45,29,,349.16,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1008.35,67,,806.68,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1053.5,70,,842.8,percent of total billed charges,70% of total billed charges,978.25,65,,782.6,percent of total billed charges,65% of total billed charges,536.83,35.67,,429.464,percent of total billed charges,35.67% of total billed charges,436.45,1354.5,
SCREW VAL KREULOCK 3.0X10,27021425,CDM,278,RC,C1713,HCPCS,outpatient,,,986,394.40,,690.2,70,,552.16,percent of total billed charges,70% of total billed charges,986,100,,788.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,808.52,82,,646.816,percent of total billed charges,82% of total billed charges,838.1,85,,670.48,percent of total billed charges,85% of total billed charges,838.1,85,,670.48,percent of total billed charges,85% of total billed charges,838.1,85,,670.48,percent of total billed charges,85% of total billed charges,887.4,90,,709.92,percent of total billed charges,90% of total billed charges,788.8,80,,631.04,percent of total billed charges,80% of total billed charges,887.4,90,,709.92,percent of total billed charges,90% of total billed charges,739.5,75,,591.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,285.94,29,,228.752,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,660.62,67,,528.496,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,690.2,70,,552.16,percent of total billed charges,70% of total billed charges,640.9,65,,512.72,percent of total billed charges,65% of total billed charges,351.71,35.67,,281.368,percent of total billed charges,35.67% of total billed charges,285.94,986,
GUIDE WIRE WITH TROCAR TIP,27021426,CDM,278,RC,C1769,HCPCS,outpatient,,,50,20.00,,35,70,,28,percent of total billed charges,70% of total billed charges,50,100,,40,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,41,82,,32.8,percent of total billed charges,82% of total billed charges,42.5,85,,34,percent of total billed charges,85% of total billed charges,42.5,85,,34,percent of total billed charges,85% of total billed charges,42.5,85,,34,percent of total billed charges,85% of total billed charges,45,90,,36,percent of total billed charges,90% of total billed charges,40,80,,32,percent of total billed charges,80% of total billed charges,45,90,,36,percent of total billed charges,90% of total billed charges,37.5,75,,30,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,14.5,29,,11.6,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,33.5,67,,26.8,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,35,70,,28,percent of total billed charges,70% of total billed charges,32.5,65,,26,percent of total billed charges,65% of total billed charges,17.84,35.67,,14.272,percent of total billed charges,35.67% of total billed charges,14.5,50,
SCREW LP 3.0X14MM,27021427,CDM,278,RC,C1713,HCPCS,outpatient,,,418,167.20,,292.6,70,,234.08,percent of total billed charges,70% of total billed charges,418,100,,334.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,342.76,82,,274.208,percent of total billed charges,82% of total billed charges,355.3,85,,284.24,percent of total billed charges,85% of total billed charges,355.3,85,,284.24,percent of total billed charges,85% of total billed charges,355.3,85,,284.24,percent of total billed charges,85% of total billed charges,376.2,90,,300.96,percent of total billed charges,90% of total billed charges,334.4,80,,267.52,percent of total billed charges,80% of total billed charges,376.2,90,,300.96,percent of total billed charges,90% of total billed charges,313.5,75,,250.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,121.22,29,,96.976,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,280.06,67,,224.048,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,292.6,70,,234.08,percent of total billed charges,70% of total billed charges,271.7,65,,217.36,percent of total billed charges,65% of total billed charges,149.1,35.67,,119.28,percent of total billed charges,35.67% of total billed charges,121.22,418,
SCREW LP 3.0X16MM,27021428,CDM,278,RC,C1713,HCPCS,outpatient,,,418,167.20,,292.6,70,,234.08,percent of total billed charges,70% of total billed charges,418,100,,334.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,342.76,82,,274.208,percent of total billed charges,82% of total billed charges,355.3,85,,284.24,percent of total billed charges,85% of total billed charges,355.3,85,,284.24,percent of total billed charges,85% of total billed charges,355.3,85,,284.24,percent of total billed charges,85% of total billed charges,376.2,90,,300.96,percent of total billed charges,90% of total billed charges,334.4,80,,267.52,percent of total billed charges,80% of total billed charges,376.2,90,,300.96,percent of total billed charges,90% of total billed charges,313.5,75,,250.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,121.22,29,,96.976,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,280.06,67,,224.048,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,292.6,70,,234.08,percent of total billed charges,70% of total billed charges,271.7,65,,217.36,percent of total billed charges,65% of total billed charges,149.1,35.67,,119.28,percent of total billed charges,35.67% of total billed charges,121.22,418,
SCREW LP 3.0X20MM,27021429,CDM,278,RC,C1713,HCPCS,outpatient,,,418,167.20,,292.6,70,,234.08,percent of total billed charges,70% of total billed charges,418,100,,334.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,342.76,82,,274.208,percent of total billed charges,82% of total billed charges,355.3,85,,284.24,percent of total billed charges,85% of total billed charges,355.3,85,,284.24,percent of total billed charges,85% of total billed charges,355.3,85,,284.24,percent of total billed charges,85% of total billed charges,376.2,90,,300.96,percent of total billed charges,90% of total billed charges,334.4,80,,267.52,percent of total billed charges,80% of total billed charges,376.2,90,,300.96,percent of total billed charges,90% of total billed charges,313.5,75,,250.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,121.22,29,,96.976,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,280.06,67,,224.048,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,292.6,70,,234.08,percent of total billed charges,70% of total billed charges,271.7,65,,217.36,percent of total billed charges,65% of total billed charges,149.1,35.67,,119.28,percent of total billed charges,35.67% of total billed charges,121.22,418,
PLATE MAXFORCE MTP 0-0 LEFT,27021430,CDM,278,RC,C1713,HCPCS,outpatient,,,6684,2673.60,,4678.8,70,,3743.04,percent of total billed charges,70% of total billed charges,3509.1,52.5,,2807.28,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,5480.88,82,,4384.704,percent of total billed charges,82% of total billed charges,5681.4,85,,4545.12,percent of total billed charges,85% of total billed charges,5681.4,85,,4545.12,percent of total billed charges,85% of total billed charges,5681.4,85,,4545.12,percent of total billed charges,85% of total billed charges,6015.6,90,,4812.48,percent of total billed charges,90% of total billed charges,5347.2,80,,4277.76,percent of total billed charges,80% of total billed charges,6015.6,90,,4812.48,percent of total billed charges,90% of total billed charges,5013,75,,4010.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,1938.36,29,,1550.688,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4478.28,67,,3582.624,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,4678.8,70,,3743.04,percent of total billed charges,70% of total billed charges,4344.6,65,,3475.68,percent of total billed charges,65% of total billed charges,2384.18,35.67,,1907.344,percent of total billed charges,35.67% of total billed charges,1938.36,6015.6,
IMPLANT ACHILLES SPEED,27021478,CDM,278,RC,C1713,HCPCS,outpatient,,,6683,2673.20,,4678.1,70,,3742.48,percent of total billed charges,70% of total billed charges,3508.58,52.5,,2806.86,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,5480.06,82,,4384.048,percent of total billed charges,82% of total billed charges,5680.55,85,,4544.44,percent of total billed charges,85% of total billed charges,5680.55,85,,4544.44,percent of total billed charges,85% of total billed charges,5680.55,85,,4544.44,percent of total billed charges,85% of total billed charges,6014.7,90,,4811.76,percent of total billed charges,90% of total billed charges,5346.4,80,,4277.12,percent of total billed charges,80% of total billed charges,6014.7,90,,4811.76,percent of total billed charges,90% of total billed charges,5012.25,75,,4009.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,1938.07,29,,1550.456,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4477.61,67,,3582.088,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,4678.1,70,,3742.48,percent of total billed charges,70% of total billed charges,4343.95,65,,3475.16,percent of total billed charges,65% of total billed charges,2383.83,35.67,,1907.064,percent of total billed charges,35.67% of total billed charges,1938.07,6014.7,
TECNIS DIOPTER 19.0 LENS,27021557,CDM,278,RC,C1780,HCPCS,outpatient,,,309,123.60,,216.3,70,,173.04,percent of total billed charges,70% of total billed charges,309,100,,247.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,253.38,82,,202.704,percent of total billed charges,82% of total billed charges,262.65,85,,210.12,percent of total billed charges,85% of total billed charges,262.65,85,,210.12,percent of total billed charges,85% of total billed charges,262.65,85,,210.12,percent of total billed charges,85% of total billed charges,278.1,90,,222.48,percent of total billed charges,90% of total billed charges,247.2,80,,197.76,percent of total billed charges,80% of total billed charges,278.1,90,,222.48,percent of total billed charges,90% of total billed charges,231.75,75,,185.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,89.61,29,,71.688,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,207.03,67,,165.624,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,216.3,70,,173.04,percent of total billed charges,70% of total billed charges,200.85,65,,160.68,percent of total billed charges,65% of total billed charges,110.22,35.67,,88.176,percent of total billed charges,35.67% of total billed charges,89.61,309,
"SCREW,POLYAXIAL,LOCKING 2.7X14",27021562,CDM,278,RC,C1713,HCPCS,outpatient,,,603,241.20,,422.1,70,,337.68,percent of total billed charges,70% of total billed charges,603,100,,482.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,494.46,82,,395.568,percent of total billed charges,82% of total billed charges,512.55,85,,410.04,percent of total billed charges,85% of total billed charges,512.55,85,,410.04,percent of total billed charges,85% of total billed charges,512.55,85,,410.04,percent of total billed charges,85% of total billed charges,542.7,90,,434.16,percent of total billed charges,90% of total billed charges,482.4,80,,385.92,percent of total billed charges,80% of total billed charges,542.7,90,,434.16,percent of total billed charges,90% of total billed charges,452.25,75,,361.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,174.87,29,,139.896,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,404.01,67,,323.208,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,422.1,70,,337.68,percent of total billed charges,70% of total billed charges,391.95,65,,313.56,percent of total billed charges,65% of total billed charges,215.09,35.67,,172.072,percent of total billed charges,35.67% of total billed charges,174.87,603,
"SCREW,NON-LOCKING 2.7X10MM",27021563,CDM,278,RC,C1713,HCPCS,outpatient,,,62,24.80,,43.4,70,,34.72,percent of total billed charges,70% of total billed charges,62,100,,49.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,50.84,82,,40.672,percent of total billed charges,82% of total billed charges,52.7,85,,42.16,percent of total billed charges,85% of total billed charges,52.7,85,,42.16,percent of total billed charges,85% of total billed charges,52.7,85,,42.16,percent of total billed charges,85% of total billed charges,55.8,90,,44.64,percent of total billed charges,90% of total billed charges,49.6,80,,39.68,percent of total billed charges,80% of total billed charges,55.8,90,,44.64,percent of total billed charges,90% of total billed charges,46.5,75,,37.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,17.98,29,,14.384,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,41.54,67,,33.232,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,43.4,70,,34.72,percent of total billed charges,70% of total billed charges,40.3,65,,32.24,percent of total billed charges,65% of total billed charges,22.12,35.67,,17.696,percent of total billed charges,35.67% of total billed charges,17.98,62,
"SCREW,CANN,HEADED 3.5X24MM",27021565,CDM,278,RC,C1713,HCPCS,outpatient,,,464,185.60,,324.8,70,,259.84,percent of total billed charges,70% of total billed charges,464,100,,371.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,380.48,82,,304.384,percent of total billed charges,82% of total billed charges,394.4,85,,315.52,percent of total billed charges,85% of total billed charges,394.4,85,,315.52,percent of total billed charges,85% of total billed charges,394.4,85,,315.52,percent of total billed charges,85% of total billed charges,417.6,90,,334.08,percent of total billed charges,90% of total billed charges,371.2,80,,296.96,percent of total billed charges,80% of total billed charges,417.6,90,,334.08,percent of total billed charges,90% of total billed charges,348,75,,278.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,134.56,29,,107.648,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,310.88,67,,248.704,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,324.8,70,,259.84,percent of total billed charges,70% of total billed charges,301.6,65,,241.28,percent of total billed charges,65% of total billed charges,165.51,35.67,,132.408,percent of total billed charges,35.67% of total billed charges,134.56,464,
"COUNTERSINK,CANN 2.3 HEADED",27021567,CDM,278,RC,C1713,HCPCS,outpatient,,,850,340.00,,595,70,,476,percent of total billed charges,70% of total billed charges,850,100,,680,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,697,82,,557.6,percent of total billed charges,82% of total billed charges,722.5,85,,578,percent of total billed charges,85% of total billed charges,722.5,85,,578,percent of total billed charges,85% of total billed charges,722.5,85,,578,percent of total billed charges,85% of total billed charges,765,90,,612,percent of total billed charges,90% of total billed charges,680,80,,544,percent of total billed charges,80% of total billed charges,765,90,,612,percent of total billed charges,90% of total billed charges,637.5,75,,510,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,246.5,29,,197.2,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,569.5,67,,455.6,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,595,70,,476,percent of total billed charges,70% of total billed charges,552.5,65,,442,percent of total billed charges,65% of total billed charges,303.2,35.67,,242.56,percent of total billed charges,35.67% of total billed charges,246.5,850,
SCREW 3.5 X 22MM,27021622,CDM,278,RC,C1713,HCPCS,outpatient,,,495,198.00,,346.5,70,,277.2,percent of total billed charges,70% of total billed charges,495,100,,396,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,405.9,82,,324.72,percent of total billed charges,82% of total billed charges,420.75,85,,336.6,percent of total billed charges,85% of total billed charges,420.75,85,,336.6,percent of total billed charges,85% of total billed charges,420.75,85,,336.6,percent of total billed charges,85% of total billed charges,445.5,90,,356.4,percent of total billed charges,90% of total billed charges,396,80,,316.8,percent of total billed charges,80% of total billed charges,445.5,90,,356.4,percent of total billed charges,90% of total billed charges,371.25,75,,297,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,143.55,29,,114.84,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,331.65,67,,265.32,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,346.5,70,,277.2,percent of total billed charges,70% of total billed charges,321.75,65,,257.4,percent of total billed charges,65% of total billed charges,176.57,35.67,,141.256,percent of total billed charges,35.67% of total billed charges,143.55,495,
SILICONE ELASTOMER SIZE 3,27021625,CDM,278,RC,,,outpatient,,,3455,1382.00,,2418.5,70,,1934.8,percent of total billed charges,70% of total billed charges,1813.88,52.5,,1451.1,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,2833.1,82,,2266.48,percent of total billed charges,82% of total billed charges,2936.75,85,,2349.4,percent of total billed charges,85% of total billed charges,2936.75,85,,2349.4,percent of total billed charges,85% of total billed charges,2936.75,85,,2349.4,percent of total billed charges,85% of total billed charges,3109.5,90,,2487.6,percent of total billed charges,90% of total billed charges,2764,80,,2211.2,percent of total billed charges,80% of total billed charges,3109.5,90,,2487.6,percent of total billed charges,90% of total billed charges,2591.25,75,,2073,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,1001.95,29,,801.56,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,2314.85,67,,1851.88,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,2418.5,70,,1934.8,percent of total billed charges,70% of total billed charges,2245.75,65,,1796.6,percent of total billed charges,65% of total billed charges,1232.4,35.67,,985.92,percent of total billed charges,35.67% of total billed charges,1001.95,3109.5,
CERAMENT BONE CEMENT 10ML,27021635,CDM,278,RC,C1713,HCPCS,outpatient,,,24411,9764.40,,17087.7,70,,13670.16,percent of total billed charges,70% of total billed charges,12815.78,52.5,,10252.62,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,20017.02,82,,16013.616,percent of total billed charges,82% of total billed charges,20749.35,85,,16599.48,percent of total billed charges,85% of total billed charges,20749.35,85,,16599.48,percent of total billed charges,85% of total billed charges,20749.35,85,,16599.48,percent of total billed charges,85% of total billed charges,21969.9,90,,17575.92,percent of total billed charges,90% of total billed charges,19528.8,80,,15623.04,percent of total billed charges,80% of total billed charges,21969.9,90,,17575.92,percent of total billed charges,90% of total billed charges,18308.25,75,,14646.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,7079.19,29,,5663.352,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,16355.37,67,,13084.296,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,17087.7,70,,13670.16,percent of total billed charges,70% of total billed charges,15867.15,65,,12693.72,percent of total billed charges,65% of total billed charges,8707.4,35.67,,6965.92,percent of total billed charges,35.67% of total billed charges,7079.19,21969.9,
T-ROPE K-LESS W/DRV SNV,27021637,CDM,278,RC,C1713,HCPCS,outpatient,,,5008,2003.20,,3505.6,70,,2804.48,percent of total billed charges,70% of total billed charges,2629.2,52.5,,2103.36,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,4106.56,82,,3285.248,percent of total billed charges,82% of total billed charges,4256.8,85,,3405.44,percent of total billed charges,85% of total billed charges,4256.8,85,,3405.44,percent of total billed charges,85% of total billed charges,4256.8,85,,3405.44,percent of total billed charges,85% of total billed charges,4507.2,90,,3605.76,percent of total billed charges,90% of total billed charges,4006.4,80,,3205.12,percent of total billed charges,80% of total billed charges,4507.2,90,,3605.76,percent of total billed charges,90% of total billed charges,3756,75,,3004.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,1452.32,29,,1161.856,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,3355.36,67,,2684.288,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,3505.6,70,,2804.48,percent of total billed charges,70% of total billed charges,3255.2,65,,2604.16,percent of total billed charges,65% of total billed charges,1786.35,35.67,,1429.08,percent of total billed charges,35.67% of total billed charges,1452.32,4507.2,
VAL KREULOCK SCREW 3.0X18,27021638,CDM,278,RC,C1713,HCPCS,outpatient,,,988,395.20,,691.6,70,,553.28,percent of total billed charges,70% of total billed charges,988,100,,790.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,810.16,82,,648.128,percent of total billed charges,82% of total billed charges,839.8,85,,671.84,percent of total billed charges,85% of total billed charges,839.8,85,,671.84,percent of total billed charges,85% of total billed charges,839.8,85,,671.84,percent of total billed charges,85% of total billed charges,889.2,90,,711.36,percent of total billed charges,90% of total billed charges,790.4,80,,632.32,percent of total billed charges,80% of total billed charges,889.2,90,,711.36,percent of total billed charges,90% of total billed charges,741,75,,592.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,286.52,29,,229.216,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,661.96,67,,529.568,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,691.6,70,,553.28,percent of total billed charges,70% of total billed charges,642.2,65,,513.76,percent of total billed charges,65% of total billed charges,352.42,35.67,,281.936,percent of total billed charges,35.67% of total billed charges,286.52,988,
SCREW LO-PRO 3.5MMX12MM,27021639,CDM,278,RC,C1713,HCPCS,outpatient,,,204,81.60,,142.8,70,,114.24,percent of total billed charges,70% of total billed charges,204,100,,163.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,167.28,82,,133.824,percent of total billed charges,82% of total billed charges,173.4,85,,138.72,percent of total billed charges,85% of total billed charges,173.4,85,,138.72,percent of total billed charges,85% of total billed charges,173.4,85,,138.72,percent of total billed charges,85% of total billed charges,183.6,90,,146.88,percent of total billed charges,90% of total billed charges,163.2,80,,130.56,percent of total billed charges,80% of total billed charges,183.6,90,,146.88,percent of total billed charges,90% of total billed charges,153,75,,122.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,59.16,29,,47.328,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,136.68,67,,109.344,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,142.8,70,,114.24,percent of total billed charges,70% of total billed charges,132.6,65,,106.08,percent of total billed charges,65% of total billed charges,72.77,35.67,,58.216,percent of total billed charges,35.67% of total billed charges,59.16,204,
SCREW LO-PRO 3 5MMX14MM,27021640,CDM,278,RC,C1713,HCPCS,outpatient,,,204,81.60,,142.8,70,,114.24,percent of total billed charges,70% of total billed charges,204,100,,163.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,167.28,82,,133.824,percent of total billed charges,82% of total billed charges,173.4,85,,138.72,percent of total billed charges,85% of total billed charges,173.4,85,,138.72,percent of total billed charges,85% of total billed charges,173.4,85,,138.72,percent of total billed charges,85% of total billed charges,183.6,90,,146.88,percent of total billed charges,90% of total billed charges,163.2,80,,130.56,percent of total billed charges,80% of total billed charges,183.6,90,,146.88,percent of total billed charges,90% of total billed charges,153,75,,122.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,59.16,29,,47.328,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,136.68,67,,109.344,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,142.8,70,,114.24,percent of total billed charges,70% of total billed charges,132.6,65,,106.08,percent of total billed charges,65% of total billed charges,72.77,35.67,,58.216,percent of total billed charges,35.67% of total billed charges,59.16,204,
SCREW KRUELOCK 3.5X12,27021641,CDM,278,RC,C1713,HCPCS,outpatient,,,988,395.20,,691.6,70,,553.28,percent of total billed charges,70% of total billed charges,988,100,,790.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,810.16,82,,648.128,percent of total billed charges,82% of total billed charges,839.8,85,,671.84,percent of total billed charges,85% of total billed charges,839.8,85,,671.84,percent of total billed charges,85% of total billed charges,839.8,85,,671.84,percent of total billed charges,85% of total billed charges,889.2,90,,711.36,percent of total billed charges,90% of total billed charges,790.4,80,,632.32,percent of total billed charges,80% of total billed charges,889.2,90,,711.36,percent of total billed charges,90% of total billed charges,741,75,,592.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,286.52,29,,229.216,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,661.96,67,,529.568,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,691.6,70,,553.28,percent of total billed charges,70% of total billed charges,642.2,65,,513.76,percent of total billed charges,65% of total billed charges,352.42,35.67,,281.936,percent of total billed charges,35.67% of total billed charges,286.52,988,
GUIDE WIRE TROCARE TIP 1.35MM,27021642,CDM,278,RC,C1713,HCPCS,outpatient,,,67,26.80,,46.9,70,,37.52,percent of total billed charges,70% of total billed charges,67,100,,53.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,54.94,82,,43.952,percent of total billed charges,82% of total billed charges,56.95,85,,45.56,percent of total billed charges,85% of total billed charges,56.95,85,,45.56,percent of total billed charges,85% of total billed charges,56.95,85,,45.56,percent of total billed charges,85% of total billed charges,60.3,90,,48.24,percent of total billed charges,90% of total billed charges,53.6,80,,42.88,percent of total billed charges,80% of total billed charges,60.3,90,,48.24,percent of total billed charges,90% of total billed charges,50.25,75,,40.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,19.43,29,,15.544,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,44.89,67,,35.912,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,46.9,70,,37.52,percent of total billed charges,70% of total billed charges,43.55,65,,34.84,percent of total billed charges,65% of total billed charges,23.9,35.67,,19.12,percent of total billed charges,35.67% of total billed charges,19.43,67,
PLATE LOCKING DISTAL FIBULA,27021645,CDM,278,RC,C1713,HCPCS,outpatient,,,2596,1038.40,,1817.2,70,,1453.76,percent of total billed charges,70% of total billed charges,1362.9,52.5,,1090.32,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,2128.72,82,,1702.976,percent of total billed charges,82% of total billed charges,2206.6,85,,1765.28,percent of total billed charges,85% of total billed charges,2206.6,85,,1765.28,percent of total billed charges,85% of total billed charges,2206.6,85,,1765.28,percent of total billed charges,85% of total billed charges,2336.4,90,,1869.12,percent of total billed charges,90% of total billed charges,2076.8,80,,1661.44,percent of total billed charges,80% of total billed charges,2336.4,90,,1869.12,percent of total billed charges,90% of total billed charges,1947,75,,1557.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,752.84,29,,602.272,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1739.32,67,,1391.456,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1817.2,70,,1453.76,percent of total billed charges,70% of total billed charges,1687.4,65,,1349.92,percent of total billed charges,65% of total billed charges,925.99,35.67,,740.792,percent of total billed charges,35.67% of total billed charges,752.84,2336.4,
SCREW QCKFIX 4.0X38MM,27021689,CDM,278,RC,C1713,HCPCS,outpatient,,,554,221.60,,387.8,70,,310.24,percent of total billed charges,70% of total billed charges,554,100,,443.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,454.28,82,,363.424,percent of total billed charges,82% of total billed charges,470.9,85,,376.72,percent of total billed charges,85% of total billed charges,470.9,85,,376.72,percent of total billed charges,85% of total billed charges,470.9,85,,376.72,percent of total billed charges,85% of total billed charges,498.6,90,,398.88,percent of total billed charges,90% of total billed charges,443.2,80,,354.56,percent of total billed charges,80% of total billed charges,498.6,90,,398.88,percent of total billed charges,90% of total billed charges,415.5,75,,332.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,160.66,29,,128.528,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,371.18,67,,296.944,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,387.8,70,,310.24,percent of total billed charges,70% of total billed charges,360.1,65,,288.08,percent of total billed charges,65% of total billed charges,197.61,35.67,,158.088,percent of total billed charges,35.67% of total billed charges,160.66,554,
SCREW CORTICAL 2.4X14MM,27021705,CDM,278,RC,C1713,HCPCS,outpatient,,,368,147.20,,257.6,70,,206.08,percent of total billed charges,70% of total billed charges,368,100,,294.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,301.76,82,,241.408,percent of total billed charges,82% of total billed charges,312.8,85,,250.24,percent of total billed charges,85% of total billed charges,312.8,85,,250.24,percent of total billed charges,85% of total billed charges,312.8,85,,250.24,percent of total billed charges,85% of total billed charges,331.2,90,,264.96,percent of total billed charges,90% of total billed charges,294.4,80,,235.52,percent of total billed charges,80% of total billed charges,331.2,90,,264.96,percent of total billed charges,90% of total billed charges,276,75,,220.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,106.72,29,,85.376,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,246.56,67,,197.248,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,257.6,70,,206.08,percent of total billed charges,70% of total billed charges,239.2,65,,191.36,percent of total billed charges,65% of total billed charges,131.27,35.67,,105.016,percent of total billed charges,35.67% of total billed charges,106.72,368,
SCREW CORTICAL 2.4X18MM,27021706,CDM,278,RC,C1713,HCPCS,outpatient,,,368,147.20,,257.6,70,,206.08,percent of total billed charges,70% of total billed charges,368,100,,294.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,301.76,82,,241.408,percent of total billed charges,82% of total billed charges,312.8,85,,250.24,percent of total billed charges,85% of total billed charges,312.8,85,,250.24,percent of total billed charges,85% of total billed charges,312.8,85,,250.24,percent of total billed charges,85% of total billed charges,331.2,90,,264.96,percent of total billed charges,90% of total billed charges,294.4,80,,235.52,percent of total billed charges,80% of total billed charges,331.2,90,,264.96,percent of total billed charges,90% of total billed charges,276,75,,220.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,106.72,29,,85.376,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,246.56,67,,197.248,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,257.6,70,,206.08,percent of total billed charges,70% of total billed charges,239.2,65,,191.36,percent of total billed charges,65% of total billed charges,131.27,35.67,,105.016,percent of total billed charges,35.67% of total billed charges,106.72,368,
SCREW CORTICAL 2.4X20MM,27021707,CDM,278,RC,C1713,HCPCS,outpatient,,,368,147.20,,257.6,70,,206.08,percent of total billed charges,70% of total billed charges,368,100,,294.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,301.76,82,,241.408,percent of total billed charges,82% of total billed charges,312.8,85,,250.24,percent of total billed charges,85% of total billed charges,312.8,85,,250.24,percent of total billed charges,85% of total billed charges,312.8,85,,250.24,percent of total billed charges,85% of total billed charges,331.2,90,,264.96,percent of total billed charges,90% of total billed charges,294.4,80,,235.52,percent of total billed charges,80% of total billed charges,331.2,90,,264.96,percent of total billed charges,90% of total billed charges,276,75,,220.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,106.72,29,,85.376,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,246.56,67,,197.248,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,257.6,70,,206.08,percent of total billed charges,70% of total billed charges,239.2,65,,191.36,percent of total billed charges,65% of total billed charges,131.27,35.67,,105.016,percent of total billed charges,35.67% of total billed charges,106.72,368,
SCREW CORTICAL 2.4X22MM,27021708,CDM,278,RC,C1713,HCPCS,outpatient,,,368,147.20,,257.6,70,,206.08,percent of total billed charges,70% of total billed charges,368,100,,294.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,301.76,82,,241.408,percent of total billed charges,82% of total billed charges,312.8,85,,250.24,percent of total billed charges,85% of total billed charges,312.8,85,,250.24,percent of total billed charges,85% of total billed charges,312.8,85,,250.24,percent of total billed charges,85% of total billed charges,331.2,90,,264.96,percent of total billed charges,90% of total billed charges,294.4,80,,235.52,percent of total billed charges,80% of total billed charges,331.2,90,,264.96,percent of total billed charges,90% of total billed charges,276,75,,220.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,106.72,29,,85.376,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,246.56,67,,197.248,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,257.6,70,,206.08,percent of total billed charges,70% of total billed charges,239.2,65,,191.36,percent of total billed charges,65% of total billed charges,131.27,35.67,,105.016,percent of total billed charges,35.67% of total billed charges,106.72,368,
SCREW CORTICAL 2.4X24MM,27021709,CDM,278,RC,C1713,HCPCS,outpatient,,,368,147.20,,257.6,70,,206.08,percent of total billed charges,70% of total billed charges,368,100,,294.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,301.76,82,,241.408,percent of total billed charges,82% of total billed charges,312.8,85,,250.24,percent of total billed charges,85% of total billed charges,312.8,85,,250.24,percent of total billed charges,85% of total billed charges,312.8,85,,250.24,percent of total billed charges,85% of total billed charges,331.2,90,,264.96,percent of total billed charges,90% of total billed charges,294.4,80,,235.52,percent of total billed charges,80% of total billed charges,331.2,90,,264.96,percent of total billed charges,90% of total billed charges,276,75,,220.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,106.72,29,,85.376,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,246.56,67,,197.248,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,257.6,70,,206.08,percent of total billed charges,70% of total billed charges,239.2,65,,191.36,percent of total billed charges,65% of total billed charges,131.27,35.67,,105.016,percent of total billed charges,35.67% of total billed charges,106.72,368,
PLATE T 2.4MM 6 HOLE,27021710,CDM,278,RC,C1713,HCPCS,outpatient,,,2663,1065.20,,1864.1,70,,1491.28,percent of total billed charges,70% of total billed charges,1398.08,52.5,,1118.46,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,2183.66,82,,1746.928,percent of total billed charges,82% of total billed charges,2263.55,85,,1810.84,percent of total billed charges,85% of total billed charges,2263.55,85,,1810.84,percent of total billed charges,85% of total billed charges,2263.55,85,,1810.84,percent of total billed charges,85% of total billed charges,2396.7,90,,1917.36,percent of total billed charges,90% of total billed charges,2130.4,80,,1704.32,percent of total billed charges,80% of total billed charges,2396.7,90,,1917.36,percent of total billed charges,90% of total billed charges,1997.25,75,,1597.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,772.27,29,,617.816,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1784.21,67,,1427.368,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1864.1,70,,1491.28,percent of total billed charges,70% of total billed charges,1730.95,65,,1384.76,percent of total billed charges,65% of total billed charges,949.89,35.67,,759.912,percent of total billed charges,35.67% of total billed charges,772.27,2396.7,
SCREW 2.4X16MM,27021711,CDM,278,RC,C1713,HCPCS,outpatient,,,469,187.60,,328.3,70,,262.64,percent of total billed charges,70% of total billed charges,469,100,,375.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,384.58,82,,307.664,percent of total billed charges,82% of total billed charges,398.65,85,,318.92,percent of total billed charges,85% of total billed charges,398.65,85,,318.92,percent of total billed charges,85% of total billed charges,398.65,85,,318.92,percent of total billed charges,85% of total billed charges,422.1,90,,337.68,percent of total billed charges,90% of total billed charges,375.2,80,,300.16,percent of total billed charges,80% of total billed charges,422.1,90,,337.68,percent of total billed charges,90% of total billed charges,351.75,75,,281.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,136.01,29,,108.808,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,314.23,67,,251.384,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,328.3,70,,262.64,percent of total billed charges,70% of total billed charges,304.85,65,,243.88,percent of total billed charges,65% of total billed charges,167.29,35.67,,133.832,percent of total billed charges,35.67% of total billed charges,136.01,469,
SCREW 2.4X18MM,27021712,CDM,278,RC,C1713,HCPCS,outpatient,,,469,187.60,,328.3,70,,262.64,percent of total billed charges,70% of total billed charges,469,100,,375.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,384.58,82,,307.664,percent of total billed charges,82% of total billed charges,398.65,85,,318.92,percent of total billed charges,85% of total billed charges,398.65,85,,318.92,percent of total billed charges,85% of total billed charges,398.65,85,,318.92,percent of total billed charges,85% of total billed charges,422.1,90,,337.68,percent of total billed charges,90% of total billed charges,375.2,80,,300.16,percent of total billed charges,80% of total billed charges,422.1,90,,337.68,percent of total billed charges,90% of total billed charges,351.75,75,,281.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,136.01,29,,108.808,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,314.23,67,,251.384,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,328.3,70,,262.64,percent of total billed charges,70% of total billed charges,304.85,65,,243.88,percent of total billed charges,65% of total billed charges,167.29,35.67,,133.832,percent of total billed charges,35.67% of total billed charges,136.01,469,
K WIRE - GOLD,2702173,CDM,278,RC,C1713,HCPCS,outpatient,,,252,100.80,,176.4,70,,141.12,percent of total billed charges,70% of total billed charges,252,100,,201.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,206.64,82,,165.312,percent of total billed charges,82% of total billed charges,214.2,85,,171.36,percent of total billed charges,85% of total billed charges,214.2,85,,171.36,percent of total billed charges,85% of total billed charges,214.2,85,,171.36,percent of total billed charges,85% of total billed charges,226.8,90,,181.44,percent of total billed charges,90% of total billed charges,201.6,80,,161.28,percent of total billed charges,80% of total billed charges,226.8,90,,181.44,percent of total billed charges,90% of total billed charges,189,75,,151.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,73.08,29,,58.464,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,168.84,67,,135.072,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,176.4,70,,141.12,percent of total billed charges,70% of total billed charges,163.8,65,,131.04,percent of total billed charges,65% of total billed charges,89.89,35.67,,71.912,percent of total billed charges,35.67% of total billed charges,73.08,252,
SCREW 3.0X28MM,27021743,CDM,278,RC,C1713,HCPCS,outpatient,,,501,200.40,,350.7,70,,280.56,percent of total billed charges,70% of total billed charges,501,100,,400.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,410.82,82,,328.656,percent of total billed charges,82% of total billed charges,425.85,85,,340.68,percent of total billed charges,85% of total billed charges,425.85,85,,340.68,percent of total billed charges,85% of total billed charges,425.85,85,,340.68,percent of total billed charges,85% of total billed charges,450.9,90,,360.72,percent of total billed charges,90% of total billed charges,400.8,80,,320.64,percent of total billed charges,80% of total billed charges,450.9,90,,360.72,percent of total billed charges,90% of total billed charges,375.75,75,,300.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,145.29,29,,116.232,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,335.67,67,,268.536,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,350.7,70,,280.56,percent of total billed charges,70% of total billed charges,325.65,65,,260.52,percent of total billed charges,65% of total billed charges,178.71,35.67,,142.968,percent of total billed charges,35.67% of total billed charges,145.29,501,
SCREW 3.5X44MM MINI,27021744,CDM,278,RC,C1713,HCPCS,outpatient,,,1172,468.80,,820.4,70,,656.32,percent of total billed charges,70% of total billed charges,615.3,52.5,,492.24,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,961.04,82,,768.832,percent of total billed charges,82% of total billed charges,996.2,85,,796.96,percent of total billed charges,85% of total billed charges,996.2,85,,796.96,percent of total billed charges,85% of total billed charges,996.2,85,,796.96,percent of total billed charges,85% of total billed charges,1054.8,90,,843.84,percent of total billed charges,90% of total billed charges,937.6,80,,750.08,percent of total billed charges,80% of total billed charges,1054.8,90,,843.84,percent of total billed charges,90% of total billed charges,879,75,,703.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,339.88,29,,271.904,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,785.24,67,,628.192,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,820.4,70,,656.32,percent of total billed charges,70% of total billed charges,761.8,65,,609.44,percent of total billed charges,65% of total billed charges,418.05,35.67,,334.44,percent of total billed charges,35.67% of total billed charges,339.88,1054.8,
GUIDE WIRE .86MM,27021745,CDM,278,RC,C1769,HCPCS,outpatient,,,87,34.80,,60.9,70,,48.72,percent of total billed charges,70% of total billed charges,87,100,,69.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,71.34,82,,57.072,percent of total billed charges,82% of total billed charges,73.95,85,,59.16,percent of total billed charges,85% of total billed charges,73.95,85,,59.16,percent of total billed charges,85% of total billed charges,73.95,85,,59.16,percent of total billed charges,85% of total billed charges,78.3,90,,62.64,percent of total billed charges,90% of total billed charges,69.6,80,,55.68,percent of total billed charges,80% of total billed charges,78.3,90,,62.64,percent of total billed charges,90% of total billed charges,65.25,75,,52.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,25.23,29,,20.184,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,58.29,67,,46.632,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,60.9,70,,48.72,percent of total billed charges,70% of total billed charges,56.55,65,,45.24,percent of total billed charges,65% of total billed charges,31.03,35.67,,24.824,percent of total billed charges,35.67% of total billed charges,25.23,87,
COUNTERSINK 3.0MM,27021746,CDM,278,RC,C1713,HCPCS,outpatient,,,503,201.20,,352.1,70,,281.68,percent of total billed charges,70% of total billed charges,503,100,,402.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,412.46,82,,329.968,percent of total billed charges,82% of total billed charges,427.55,85,,342.04,percent of total billed charges,85% of total billed charges,427.55,85,,342.04,percent of total billed charges,85% of total billed charges,427.55,85,,342.04,percent of total billed charges,85% of total billed charges,452.7,90,,362.16,percent of total billed charges,90% of total billed charges,402.4,80,,321.92,percent of total billed charges,80% of total billed charges,452.7,90,,362.16,percent of total billed charges,90% of total billed charges,377.25,75,,301.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,145.87,29,,116.696,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,337.01,67,,269.608,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,352.1,70,,281.68,percent of total billed charges,70% of total billed charges,326.95,65,,261.56,percent of total billed charges,65% of total billed charges,179.42,35.67,,143.536,percent of total billed charges,35.67% of total billed charges,145.87,503,
SCREW 2.5MM X 33MM,27021752,CDM,278,RC,C1713,HCPCS,outpatient,,,1173,469.20,,821.1,70,,656.88,percent of total billed charges,70% of total billed charges,615.83,52.5,,492.66,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,961.86,82,,769.488,percent of total billed charges,82% of total billed charges,997.05,85,,797.64,percent of total billed charges,85% of total billed charges,997.05,85,,797.64,percent of total billed charges,85% of total billed charges,997.05,85,,797.64,percent of total billed charges,85% of total billed charges,1055.7,90,,844.56,percent of total billed charges,90% of total billed charges,938.4,80,,750.72,percent of total billed charges,80% of total billed charges,1055.7,90,,844.56,percent of total billed charges,90% of total billed charges,879.75,75,,703.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,340.17,29,,272.136,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,785.91,67,,628.728,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,821.1,70,,656.88,percent of total billed charges,70% of total billed charges,762.45,65,,609.96,percent of total billed charges,65% of total billed charges,418.41,35.67,,334.728,percent of total billed charges,35.67% of total billed charges,340.17,1055.7,
SCREW 3.5MM X 32MM,27021753,CDM,278,RC,C1713,HCPCS,outpatient,,,201,80.40,,140.7,70,,112.56,percent of total billed charges,70% of total billed charges,201,100,,160.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,164.82,82,,131.856,percent of total billed charges,82% of total billed charges,170.85,85,,136.68,percent of total billed charges,85% of total billed charges,170.85,85,,136.68,percent of total billed charges,85% of total billed charges,170.85,85,,136.68,percent of total billed charges,85% of total billed charges,180.9,90,,144.72,percent of total billed charges,90% of total billed charges,160.8,80,,128.64,percent of total billed charges,80% of total billed charges,180.9,90,,144.72,percent of total billed charges,90% of total billed charges,150.75,75,,120.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,58.29,29,,46.632,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,134.67,67,,107.736,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,140.7,70,,112.56,percent of total billed charges,70% of total billed charges,130.65,65,,104.52,percent of total billed charges,65% of total billed charges,71.7,35.67,,57.36,percent of total billed charges,35.67% of total billed charges,58.29,201,
SCREW 3.5MM X 38MM,27021754,CDM,278,RC,C1713,HCPCS,outpatient,,,201,80.40,,140.7,70,,112.56,percent of total billed charges,70% of total billed charges,201,100,,160.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,164.82,82,,131.856,percent of total billed charges,82% of total billed charges,170.85,85,,136.68,percent of total billed charges,85% of total billed charges,170.85,85,,136.68,percent of total billed charges,85% of total billed charges,170.85,85,,136.68,percent of total billed charges,85% of total billed charges,180.9,90,,144.72,percent of total billed charges,90% of total billed charges,160.8,80,,128.64,percent of total billed charges,80% of total billed charges,180.9,90,,144.72,percent of total billed charges,90% of total billed charges,150.75,75,,120.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,58.29,29,,46.632,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,134.67,67,,107.736,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,140.7,70,,112.56,percent of total billed charges,70% of total billed charges,130.65,65,,104.52,percent of total billed charges,65% of total billed charges,71.7,35.67,,57.36,percent of total billed charges,35.67% of total billed charges,58.29,201,
SCREW 3.5MM X 40MM,27021755,CDM,278,RC,C1713,HCPCS,outpatient,,,201,80.40,,140.7,70,,112.56,percent of total billed charges,70% of total billed charges,201,100,,160.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,164.82,82,,131.856,percent of total billed charges,82% of total billed charges,170.85,85,,136.68,percent of total billed charges,85% of total billed charges,170.85,85,,136.68,percent of total billed charges,85% of total billed charges,170.85,85,,136.68,percent of total billed charges,85% of total billed charges,180.9,90,,144.72,percent of total billed charges,90% of total billed charges,160.8,80,,128.64,percent of total billed charges,80% of total billed charges,180.9,90,,144.72,percent of total billed charges,90% of total billed charges,150.75,75,,120.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,58.29,29,,46.632,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,134.67,67,,107.736,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,140.7,70,,112.56,percent of total billed charges,70% of total billed charges,130.65,65,,104.52,percent of total billed charges,65% of total billed charges,71.7,35.67,,57.36,percent of total billed charges,35.67% of total billed charges,58.29,201,
SCREW 3.5MM X 44MM,27021756,CDM,278,RC,C1713,HCPCS,outpatient,,,201,80.40,,140.7,70,,112.56,percent of total billed charges,70% of total billed charges,201,100,,160.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,164.82,82,,131.856,percent of total billed charges,82% of total billed charges,170.85,85,,136.68,percent of total billed charges,85% of total billed charges,170.85,85,,136.68,percent of total billed charges,85% of total billed charges,170.85,85,,136.68,percent of total billed charges,85% of total billed charges,180.9,90,,144.72,percent of total billed charges,90% of total billed charges,160.8,80,,128.64,percent of total billed charges,80% of total billed charges,180.9,90,,144.72,percent of total billed charges,90% of total billed charges,150.75,75,,120.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,58.29,29,,46.632,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,134.67,67,,107.736,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,140.7,70,,112.56,percent of total billed charges,70% of total billed charges,130.65,65,,104.52,percent of total billed charges,65% of total billed charges,71.7,35.67,,57.36,percent of total billed charges,35.67% of total billed charges,58.29,201,
SCREW 3.5MM X 26MM,27021757,CDM,278,RC,C1713,HCPCS,outpatient,,,201,80.40,,140.7,70,,112.56,percent of total billed charges,70% of total billed charges,201,100,,160.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,164.82,82,,131.856,percent of total billed charges,82% of total billed charges,170.85,85,,136.68,percent of total billed charges,85% of total billed charges,170.85,85,,136.68,percent of total billed charges,85% of total billed charges,170.85,85,,136.68,percent of total billed charges,85% of total billed charges,180.9,90,,144.72,percent of total billed charges,90% of total billed charges,160.8,80,,128.64,percent of total billed charges,80% of total billed charges,180.9,90,,144.72,percent of total billed charges,90% of total billed charges,150.75,75,,120.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,58.29,29,,46.632,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,134.67,67,,107.736,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,140.7,70,,112.56,percent of total billed charges,70% of total billed charges,130.65,65,,104.52,percent of total billed charges,65% of total billed charges,71.7,35.67,,57.36,percent of total billed charges,35.67% of total billed charges,58.29,201,
SCREW 3.5MM X 26MM,27021758,CDM,278,RC,C1713,HCPCS,outpatient,,,201,80.40,,140.7,70,,112.56,percent of total billed charges,70% of total billed charges,201,100,,160.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,164.82,82,,131.856,percent of total billed charges,82% of total billed charges,170.85,85,,136.68,percent of total billed charges,85% of total billed charges,170.85,85,,136.68,percent of total billed charges,85% of total billed charges,170.85,85,,136.68,percent of total billed charges,85% of total billed charges,180.9,90,,144.72,percent of total billed charges,90% of total billed charges,160.8,80,,128.64,percent of total billed charges,80% of total billed charges,180.9,90,,144.72,percent of total billed charges,90% of total billed charges,150.75,75,,120.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,58.29,29,,46.632,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,134.67,67,,107.736,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,140.7,70,,112.56,percent of total billed charges,70% of total billed charges,130.65,65,,104.52,percent of total billed charges,65% of total billed charges,71.7,35.67,,57.36,percent of total billed charges,35.67% of total billed charges,58.29,201,
SCREW 3.5 MM X 34MM,27021759,CDM,278,RC,C1713,HCPCS,outpatient,,,201,80.40,,140.7,70,,112.56,percent of total billed charges,70% of total billed charges,201,100,,160.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,164.82,82,,131.856,percent of total billed charges,82% of total billed charges,170.85,85,,136.68,percent of total billed charges,85% of total billed charges,170.85,85,,136.68,percent of total billed charges,85% of total billed charges,170.85,85,,136.68,percent of total billed charges,85% of total billed charges,180.9,90,,144.72,percent of total billed charges,90% of total billed charges,160.8,80,,128.64,percent of total billed charges,80% of total billed charges,180.9,90,,144.72,percent of total billed charges,90% of total billed charges,150.75,75,,120.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,58.29,29,,46.632,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,134.67,67,,107.736,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,140.7,70,,112.56,percent of total billed charges,70% of total billed charges,130.65,65,,104.52,percent of total billed charges,65% of total billed charges,71.7,35.67,,57.36,percent of total billed charges,35.67% of total billed charges,58.29,201,
SCREW 1.6X16MM,27021760,CDM,278,RC,C1713,HCPCS,outpatient,,,369,147.60,,258.3,70,,206.64,percent of total billed charges,70% of total billed charges,369,100,,295.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,302.58,82,,242.064,percent of total billed charges,82% of total billed charges,313.65,85,,250.92,percent of total billed charges,85% of total billed charges,313.65,85,,250.92,percent of total billed charges,85% of total billed charges,313.65,85,,250.92,percent of total billed charges,85% of total billed charges,332.1,90,,265.68,percent of total billed charges,90% of total billed charges,295.2,80,,236.16,percent of total billed charges,80% of total billed charges,332.1,90,,265.68,percent of total billed charges,90% of total billed charges,276.75,75,,221.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,107.01,29,,85.608,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,247.23,67,,197.784,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,258.3,70,,206.64,percent of total billed charges,70% of total billed charges,239.85,65,,191.88,percent of total billed charges,65% of total billed charges,131.62,35.67,,105.296,percent of total billed charges,35.67% of total billed charges,107.01,369,
Y PLATE 1.6MM 6 HOLE,27021761,CDM,278,RC,C1781,HCPCS,outpatient,,,2663,1065.20,,1864.1,70,,1491.28,percent of total billed charges,70% of total billed charges,1398.08,52.5,,1118.46,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,2183.66,82,,1746.928,percent of total billed charges,82% of total billed charges,2263.55,85,,1810.84,percent of total billed charges,85% of total billed charges,2263.55,85,,1810.84,percent of total billed charges,85% of total billed charges,2263.55,85,,1810.84,percent of total billed charges,85% of total billed charges,2396.7,90,,1917.36,percent of total billed charges,90% of total billed charges,2130.4,80,,1704.32,percent of total billed charges,80% of total billed charges,2396.7,90,,1917.36,percent of total billed charges,90% of total billed charges,1997.25,75,,1597.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,772.27,29,,617.816,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1784.21,67,,1427.368,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1864.1,70,,1491.28,percent of total billed charges,70% of total billed charges,1730.95,65,,1384.76,percent of total billed charges,65% of total billed charges,949.89,35.67,,759.912,percent of total billed charges,35.67% of total billed charges,772.27,2396.7,
SCREW LO PRO 3X28MM CORT,27021798,CDM,278,RC,C1781,HCPCS,outpatient,,,369,147.60,,258.3,70,,206.64,percent of total billed charges,70% of total billed charges,369,100,,295.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,302.58,82,,242.064,percent of total billed charges,82% of total billed charges,313.65,85,,250.92,percent of total billed charges,85% of total billed charges,313.65,85,,250.92,percent of total billed charges,85% of total billed charges,313.65,85,,250.92,percent of total billed charges,85% of total billed charges,332.1,90,,265.68,percent of total billed charges,90% of total billed charges,295.2,80,,236.16,percent of total billed charges,80% of total billed charges,332.1,90,,265.68,percent of total billed charges,90% of total billed charges,276.75,75,,221.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,107.01,29,,85.608,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,247.23,67,,197.784,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,258.3,70,,206.64,percent of total billed charges,70% of total billed charges,239.85,65,,191.88,percent of total billed charges,65% of total billed charges,131.62,35.67,,105.296,percent of total billed charges,35.67% of total billed charges,107.01,369,
KREULOCK SCREW 3X20,27021799,CDM,278,RC,C1781,HCPCS,outpatient,,,988,395.20,,691.6,70,,553.28,percent of total billed charges,70% of total billed charges,988,100,,790.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,810.16,82,,648.128,percent of total billed charges,82% of total billed charges,839.8,85,,671.84,percent of total billed charges,85% of total billed charges,839.8,85,,671.84,percent of total billed charges,85% of total billed charges,839.8,85,,671.84,percent of total billed charges,85% of total billed charges,889.2,90,,711.36,percent of total billed charges,90% of total billed charges,790.4,80,,632.32,percent of total billed charges,80% of total billed charges,889.2,90,,711.36,percent of total billed charges,90% of total billed charges,741,75,,592.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,286.52,29,,229.216,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,661.96,67,,529.568,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,691.6,70,,553.28,percent of total billed charges,70% of total billed charges,642.2,65,,513.76,percent of total billed charges,65% of total billed charges,352.42,35.67,,281.936,percent of total billed charges,35.67% of total billed charges,286.52,988,
SCREW KREULOCK 3X24,27021800,CDM,278,RC,C1781,HCPCS,outpatient,,,988,395.20,,691.6,70,,553.28,percent of total billed charges,70% of total billed charges,988,100,,790.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,810.16,82,,648.128,percent of total billed charges,82% of total billed charges,839.8,85,,671.84,percent of total billed charges,85% of total billed charges,839.8,85,,671.84,percent of total billed charges,85% of total billed charges,839.8,85,,671.84,percent of total billed charges,85% of total billed charges,889.2,90,,711.36,percent of total billed charges,90% of total billed charges,790.4,80,,632.32,percent of total billed charges,80% of total billed charges,889.2,90,,711.36,percent of total billed charges,90% of total billed charges,741,75,,592.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,286.52,29,,229.216,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,661.96,67,,529.568,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,691.6,70,,553.28,percent of total billed charges,70% of total billed charges,642.2,65,,513.76,percent of total billed charges,65% of total billed charges,352.42,35.67,,281.936,percent of total billed charges,35.67% of total billed charges,286.52,988,
SCREW CORTICAL HYBRID 3X18MM,27021801,CDM,278,RC,C1781,HCPCS,outpatient,,,420,168.00,,294,70,,235.2,percent of total billed charges,70% of total billed charges,420,100,,336,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,344.4,82,,275.52,percent of total billed charges,82% of total billed charges,357,85,,285.6,percent of total billed charges,85% of total billed charges,357,85,,285.6,percent of total billed charges,85% of total billed charges,357,85,,285.6,percent of total billed charges,85% of total billed charges,378,90,,302.4,percent of total billed charges,90% of total billed charges,336,80,,268.8,percent of total billed charges,80% of total billed charges,378,90,,302.4,percent of total billed charges,90% of total billed charges,315,75,,252,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,121.8,29,,97.44,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,281.4,67,,225.12,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,294,70,,235.2,percent of total billed charges,70% of total billed charges,273,65,,218.4,percent of total billed charges,65% of total billed charges,149.81,35.67,,119.848,percent of total billed charges,35.67% of total billed charges,121.8,420,
SCREW CORTICAL HYBRID 3X20MM,27021802,CDM,278,RC,C1781,HCPCS,outpatient,,,838,335.20,,586.6,70,,469.28,percent of total billed charges,70% of total billed charges,838,100,,670.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,687.16,82,,549.728,percent of total billed charges,82% of total billed charges,712.3,85,,569.84,percent of total billed charges,85% of total billed charges,712.3,85,,569.84,percent of total billed charges,85% of total billed charges,712.3,85,,569.84,percent of total billed charges,85% of total billed charges,754.2,90,,603.36,percent of total billed charges,90% of total billed charges,670.4,80,,536.32,percent of total billed charges,80% of total billed charges,754.2,90,,603.36,percent of total billed charges,90% of total billed charges,628.5,75,,502.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,243.02,29,,194.416,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,561.46,67,,449.168,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,586.6,70,,469.28,percent of total billed charges,70% of total billed charges,544.7,65,,435.76,percent of total billed charges,65% of total billed charges,298.91,35.67,,239.128,percent of total billed charges,35.67% of total billed charges,243.02,838,
SCREW CORTICAL HYBRID 3X22MM,27021803,CDM,278,RC,C1781,HCPCS,outpatient,,,420,168.00,,294,70,,235.2,percent of total billed charges,70% of total billed charges,420,100,,336,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,344.4,82,,275.52,percent of total billed charges,82% of total billed charges,357,85,,285.6,percent of total billed charges,85% of total billed charges,357,85,,285.6,percent of total billed charges,85% of total billed charges,357,85,,285.6,percent of total billed charges,85% of total billed charges,378,90,,302.4,percent of total billed charges,90% of total billed charges,336,80,,268.8,percent of total billed charges,80% of total billed charges,378,90,,302.4,percent of total billed charges,90% of total billed charges,315,75,,252,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,121.8,29,,97.44,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,281.4,67,,225.12,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,294,70,,235.2,percent of total billed charges,70% of total billed charges,273,65,,218.4,percent of total billed charges,65% of total billed charges,149.81,35.67,,119.848,percent of total billed charges,35.67% of total billed charges,121.8,420,
PLATE MTP MAXFORCE STD RIGHT,27021804,CDM,278,RC,C1781,HCPCS,outpatient,,,6683,2673.20,,4678.1,70,,3742.48,percent of total billed charges,70% of total billed charges,3508.58,52.5,,2806.86,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,5480.06,82,,4384.048,percent of total billed charges,82% of total billed charges,5680.55,85,,4544.44,percent of total billed charges,85% of total billed charges,5680.55,85,,4544.44,percent of total billed charges,85% of total billed charges,5680.55,85,,4544.44,percent of total billed charges,85% of total billed charges,6014.7,90,,4811.76,percent of total billed charges,90% of total billed charges,5346.4,80,,4277.12,percent of total billed charges,80% of total billed charges,6014.7,90,,4811.76,percent of total billed charges,90% of total billed charges,5012.25,75,,4009.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,1938.07,29,,1550.456,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4477.61,67,,3582.088,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,4678.1,70,,3742.48,percent of total billed charges,70% of total billed charges,4343.95,65,,3475.16,percent of total billed charges,65% of total billed charges,2383.83,35.67,,1907.064,percent of total billed charges,35.67% of total billed charges,1938.07,6014.7,
DERMA PURE ALLOGRAFT 3X4CM,27021829,CDM,278,RC,Q4152,HCPCS,outpatient,,,3278,1311.20,,2294.6,70,,1835.68,percent of total billed charges,70% of total billed charges,1720.95,52.5,,1376.76,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,2687.96,82,,2150.368,percent of total billed charges,82% of total billed charges,2786.3,85,,2229.04,percent of total billed charges,85% of total billed charges,2786.3,85,,2229.04,percent of total billed charges,85% of total billed charges,2786.3,85,,2229.04,percent of total billed charges,85% of total billed charges,2950.2,90,,2360.16,percent of total billed charges,90% of total billed charges,2622.4,80,,2097.92,percent of total billed charges,80% of total billed charges,2950.2,90,,2360.16,percent of total billed charges,90% of total billed charges,2458.5,75,,1966.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,950.62,29,,760.496,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,2196.26,67,,1757.008,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,2294.6,70,,1835.68,percent of total billed charges,70% of total billed charges,2130.7,65,,1704.56,percent of total billed charges,65% of total billed charges,1169.26,35.67,,935.408,percent of total billed charges,35.67% of total billed charges,950.62,2950.2,
SCREW 2.5 MICRO 14MM,27021833,CDM,278,RC,C1713,HCPCS,outpatient,,,1173,469.20,,821.1,70,,656.88,percent of total billed charges,70% of total billed charges,615.83,52.5,,492.66,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,961.86,82,,769.488,percent of total billed charges,82% of total billed charges,997.05,85,,797.64,percent of total billed charges,85% of total billed charges,997.05,85,,797.64,percent of total billed charges,85% of total billed charges,997.05,85,,797.64,percent of total billed charges,85% of total billed charges,1055.7,90,,844.56,percent of total billed charges,90% of total billed charges,938.4,80,,750.72,percent of total billed charges,80% of total billed charges,1055.7,90,,844.56,percent of total billed charges,90% of total billed charges,879.75,75,,703.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,340.17,29,,272.136,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,785.91,67,,628.728,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,821.1,70,,656.88,percent of total billed charges,70% of total billed charges,762.45,65,,609.96,percent of total billed charges,65% of total billed charges,418.41,35.67,,334.728,percent of total billed charges,35.67% of total billed charges,340.17,1055.7,
SCREW 2.5 MICRO 16MM,27021834,CDM,278,RC,,,outpatient,,,1173,469.20,,821.1,70,,656.88,percent of total billed charges,70% of total billed charges,615.83,52.5,,492.66,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,961.86,82,,769.488,percent of total billed charges,82% of total billed charges,997.05,85,,797.64,percent of total billed charges,85% of total billed charges,997.05,85,,797.64,percent of total billed charges,85% of total billed charges,997.05,85,,797.64,percent of total billed charges,85% of total billed charges,1055.7,90,,844.56,percent of total billed charges,90% of total billed charges,938.4,80,,750.72,percent of total billed charges,80% of total billed charges,1055.7,90,,844.56,percent of total billed charges,90% of total billed charges,879.75,75,,703.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,340.17,29,,272.136,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,785.91,67,,628.728,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,821.1,70,,656.88,percent of total billed charges,70% of total billed charges,762.45,65,,609.96,percent of total billed charges,65% of total billed charges,418.41,35.67,,334.728,percent of total billed charges,35.67% of total billed charges,340.17,1055.7,
BB TAK MTP THREADED,27021836,CDM,278,RC,C1781,HCPCS,outpatient,,,570,228.00,,399,70,,319.2,percent of total billed charges,70% of total billed charges,570,100,,456,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,467.4,82,,373.92,percent of total billed charges,82% of total billed charges,484.5,85,,387.6,percent of total billed charges,85% of total billed charges,484.5,85,,387.6,percent of total billed charges,85% of total billed charges,484.5,85,,387.6,percent of total billed charges,85% of total billed charges,513,90,,410.4,percent of total billed charges,90% of total billed charges,456,80,,364.8,percent of total billed charges,80% of total billed charges,513,90,,410.4,percent of total billed charges,90% of total billed charges,427.5,75,,342,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,165.3,29,,132.24,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,381.9,67,,305.52,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,399,70,,319.2,percent of total billed charges,70% of total billed charges,370.5,65,,296.4,percent of total billed charges,65% of total billed charges,203.32,35.67,,162.656,percent of total billed charges,35.67% of total billed charges,165.3,570,
PHALANGEAL REAMER 12MM CONCAVE,27021837,CDM,278,RC,C1776,HCPCS,outpatient,,,1507,602.80,,1054.9,70,,843.92,percent of total billed charges,70% of total billed charges,791.18,52.5,,632.94,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,1235.74,82,,988.592,percent of total billed charges,82% of total billed charges,1280.95,85,,1024.76,percent of total billed charges,85% of total billed charges,1280.95,85,,1024.76,percent of total billed charges,85% of total billed charges,1280.95,85,,1024.76,percent of total billed charges,85% of total billed charges,1356.3,90,,1085.04,percent of total billed charges,90% of total billed charges,1205.6,80,,964.48,percent of total billed charges,80% of total billed charges,1356.3,90,,1085.04,percent of total billed charges,90% of total billed charges,1130.25,75,,904.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,437.03,29,,349.624,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1009.69,67,,807.752,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1054.9,70,,843.92,percent of total billed charges,70% of total billed charges,979.55,65,,783.64,percent of total billed charges,65% of total billed charges,537.55,35.67,,430.04,percent of total billed charges,35.67% of total billed charges,437.03,1356.3,
PHALANGEAL REAMER 12MM CONVEX,27021838,CDM,278,RC,C1776,HCPCS,outpatient,,,1507,602.80,,1054.9,70,,843.92,percent of total billed charges,70% of total billed charges,791.18,52.5,,632.94,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,1235.74,82,,988.592,percent of total billed charges,82% of total billed charges,1280.95,85,,1024.76,percent of total billed charges,85% of total billed charges,1280.95,85,,1024.76,percent of total billed charges,85% of total billed charges,1280.95,85,,1024.76,percent of total billed charges,85% of total billed charges,1356.3,90,,1085.04,percent of total billed charges,90% of total billed charges,1205.6,80,,964.48,percent of total billed charges,80% of total billed charges,1356.3,90,,1085.04,percent of total billed charges,90% of total billed charges,1130.25,75,,904.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,437.03,29,,349.624,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1009.69,67,,807.752,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1054.9,70,,843.92,percent of total billed charges,70% of total billed charges,979.55,65,,783.64,percent of total billed charges,65% of total billed charges,537.55,35.67,,430.04,percent of total billed charges,35.67% of total billed charges,437.03,1356.3,
KREULOCK SCREW 3.0X14,27021839,CDM,278,RC,C1713,HCPCS,outpatient,,,988,395.20,,691.6,70,,553.28,percent of total billed charges,70% of total billed charges,988,100,,790.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,810.16,82,,648.128,percent of total billed charges,82% of total billed charges,839.8,85,,671.84,percent of total billed charges,85% of total billed charges,839.8,85,,671.84,percent of total billed charges,85% of total billed charges,839.8,85,,671.84,percent of total billed charges,85% of total billed charges,889.2,90,,711.36,percent of total billed charges,90% of total billed charges,790.4,80,,632.32,percent of total billed charges,80% of total billed charges,889.2,90,,711.36,percent of total billed charges,90% of total billed charges,741,75,,592.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,286.52,29,,229.216,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,661.96,67,,529.568,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,691.6,70,,553.28,percent of total billed charges,70% of total billed charges,642.2,65,,513.76,percent of total billed charges,65% of total billed charges,352.42,35.67,,281.936,percent of total billed charges,35.67% of total billed charges,286.52,988,
CORTICAL SCREW 3.0X10MM,27021840,CDM,278,RC,C1713,HCPCS,outpatient,,,419,167.60,,293.3,70,,234.64,percent of total billed charges,70% of total billed charges,419,100,,335.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,343.58,82,,274.864,percent of total billed charges,82% of total billed charges,356.15,85,,284.92,percent of total billed charges,85% of total billed charges,356.15,85,,284.92,percent of total billed charges,85% of total billed charges,356.15,85,,284.92,percent of total billed charges,85% of total billed charges,377.1,90,,301.68,percent of total billed charges,90% of total billed charges,335.2,80,,268.16,percent of total billed charges,80% of total billed charges,377.1,90,,301.68,percent of total billed charges,90% of total billed charges,314.25,75,,251.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,121.51,29,,97.208,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,280.73,67,,224.584,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,293.3,70,,234.64,percent of total billed charges,70% of total billed charges,272.35,65,,217.88,percent of total billed charges,65% of total billed charges,149.46,35.67,,119.568,percent of total billed charges,35.67% of total billed charges,121.51,419,
COMPR FT SCREW 3.5 MINI 36MM,27021895,CDM,278,RC,C1713,HCPCS,outpatient,,,1173,469.20,,821.1,70,,656.88,percent of total billed charges,70% of total billed charges,615.83,52.5,,492.66,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,961.86,82,,769.488,percent of total billed charges,82% of total billed charges,997.05,85,,797.64,percent of total billed charges,85% of total billed charges,997.05,85,,797.64,percent of total billed charges,85% of total billed charges,997.05,85,,797.64,percent of total billed charges,85% of total billed charges,1055.7,90,,844.56,percent of total billed charges,90% of total billed charges,938.4,80,,750.72,percent of total billed charges,80% of total billed charges,1055.7,90,,844.56,percent of total billed charges,90% of total billed charges,879.75,75,,703.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,340.17,29,,272.136,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,785.91,67,,628.728,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,821.1,70,,656.88,percent of total billed charges,70% of total billed charges,762.45,65,,609.96,percent of total billed charges,65% of total billed charges,418.41,35.67,,334.728,percent of total billed charges,35.67% of total billed charges,340.17,1055.7,
GUIDE WIRE DOUBLE ENDED TROCAR,27021896,CDM,278,RC,C1769,HCPCS,outpatient,,,101,40.40,,70.7,70,,56.56,percent of total billed charges,70% of total billed charges,101,100,,80.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,82.82,82,,66.256,percent of total billed charges,82% of total billed charges,85.85,85,,68.68,percent of total billed charges,85% of total billed charges,85.85,85,,68.68,percent of total billed charges,85% of total billed charges,85.85,85,,68.68,percent of total billed charges,85% of total billed charges,90.9,90,,72.72,percent of total billed charges,90% of total billed charges,80.8,80,,64.64,percent of total billed charges,80% of total billed charges,90.9,90,,72.72,percent of total billed charges,90% of total billed charges,75.75,75,,60.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,29.29,29,,23.432,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,67.67,67,,54.136,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,70.7,70,,56.56,percent of total billed charges,70% of total billed charges,65.65,65,,52.52,percent of total billed charges,65% of total billed charges,36.03,35.67,,28.824,percent of total billed charges,35.67% of total billed charges,29.29,101,
FLEXSPAN FLEXIBLE HINGE TOE,27021897,CDM,278,RC,,,outpatient,,,6511,2604.40,,4557.7,70,,3646.16,percent of total billed charges,70% of total billed charges,3418.28,52.5,,2734.62,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,5339.02,82,,4271.216,percent of total billed charges,82% of total billed charges,5534.35,85,,4427.48,percent of total billed charges,85% of total billed charges,5534.35,85,,4427.48,percent of total billed charges,85% of total billed charges,5534.35,85,,4427.48,percent of total billed charges,85% of total billed charges,5859.9,90,,4687.92,percent of total billed charges,90% of total billed charges,5208.8,80,,4167.04,percent of total billed charges,80% of total billed charges,5859.9,90,,4687.92,percent of total billed charges,90% of total billed charges,4883.25,75,,3906.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,1888.19,29,,1510.552,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4362.37,67,,3489.896,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,4557.7,70,,3646.16,percent of total billed charges,70% of total billed charges,4232.15,65,,3385.72,percent of total billed charges,65% of total billed charges,2322.47,35.67,,1857.976,percent of total billed charges,35.67% of total billed charges,1888.19,5859.9,
DERMA PURE ALLOGRAFT 4X6 CM,27021913,CDM,278,RC,Q4152,HCPCS,outpatient,,,3278,1311.20,,2294.6,70,,1835.68,percent of total billed charges,70% of total billed charges,1720.95,52.5,,1376.76,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,2687.96,82,,2150.368,percent of total billed charges,82% of total billed charges,2786.3,85,,2229.04,percent of total billed charges,85% of total billed charges,2786.3,85,,2229.04,percent of total billed charges,85% of total billed charges,2786.3,85,,2229.04,percent of total billed charges,85% of total billed charges,2950.2,90,,2360.16,percent of total billed charges,90% of total billed charges,2622.4,80,,2097.92,percent of total billed charges,80% of total billed charges,2950.2,90,,2360.16,percent of total billed charges,90% of total billed charges,2458.5,75,,1966.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,950.62,29,,760.496,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,2196.26,67,,1757.008,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,2294.6,70,,1835.68,percent of total billed charges,70% of total billed charges,2130.7,65,,1704.56,percent of total billed charges,65% of total billed charges,1169.26,35.67,,935.408,percent of total billed charges,35.67% of total billed charges,950.62,2950.2,
SCREW NON LOCKING 2.7X18MM,27021922,CDM,278,RC,C1713,HCPCS,outpatient,,,381,152.40,,266.7,70,,213.36,percent of total billed charges,70% of total billed charges,381,100,,304.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,312.42,82,,249.936,percent of total billed charges,82% of total billed charges,323.85,85,,259.08,percent of total billed charges,85% of total billed charges,323.85,85,,259.08,percent of total billed charges,85% of total billed charges,323.85,85,,259.08,percent of total billed charges,85% of total billed charges,342.9,90,,274.32,percent of total billed charges,90% of total billed charges,304.8,80,,243.84,percent of total billed charges,80% of total billed charges,342.9,90,,274.32,percent of total billed charges,90% of total billed charges,285.75,75,,228.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,110.49,29,,88.392,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,255.27,67,,204.216,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,266.7,70,,213.36,percent of total billed charges,70% of total billed charges,247.65,65,,198.12,percent of total billed charges,65% of total billed charges,135.9,35.67,,108.72,percent of total billed charges,35.67% of total billed charges,110.49,381,
QUICKFIX SCREW 2X11MM,27021929,CDM,278,RC,C1713,HCPCS,outpatient,,,804,321.60,,562.8,70,,450.24,percent of total billed charges,70% of total billed charges,804,100,,643.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,659.28,82,,527.424,percent of total billed charges,82% of total billed charges,683.4,85,,546.72,percent of total billed charges,85% of total billed charges,683.4,85,,546.72,percent of total billed charges,85% of total billed charges,683.4,85,,546.72,percent of total billed charges,85% of total billed charges,723.6,90,,578.88,percent of total billed charges,90% of total billed charges,643.2,80,,514.56,percent of total billed charges,80% of total billed charges,723.6,90,,578.88,percent of total billed charges,90% of total billed charges,603,75,,482.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,233.16,29,,186.528,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,538.68,67,,430.944,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,562.8,70,,450.24,percent of total billed charges,70% of total billed charges,522.6,65,,418.08,percent of total billed charges,65% of total billed charges,286.79,35.67,,229.432,percent of total billed charges,35.67% of total billed charges,233.16,804,
QUICKFIX SCREW 2X13MM,27021930,CDM,278,RC,C1713,HCPCS,outpatient,,,804,321.60,,562.8,70,,450.24,percent of total billed charges,70% of total billed charges,804,100,,643.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,659.28,82,,527.424,percent of total billed charges,82% of total billed charges,683.4,85,,546.72,percent of total billed charges,85% of total billed charges,683.4,85,,546.72,percent of total billed charges,85% of total billed charges,683.4,85,,546.72,percent of total billed charges,85% of total billed charges,723.6,90,,578.88,percent of total billed charges,90% of total billed charges,643.2,80,,514.56,percent of total billed charges,80% of total billed charges,723.6,90,,578.88,percent of total billed charges,90% of total billed charges,603,75,,482.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,233.16,29,,186.528,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,538.68,67,,430.944,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,562.8,70,,450.24,percent of total billed charges,70% of total billed charges,522.6,65,,418.08,percent of total billed charges,65% of total billed charges,286.79,35.67,,229.432,percent of total billed charges,35.67% of total billed charges,233.16,804,
PHALANGEAL REAMER METARSAL 18,27021931,CDM,278,RC,C1776,HCPCS,outpatient,,,1507,602.80,,1054.9,70,,843.92,percent of total billed charges,70% of total billed charges,791.18,52.5,,632.94,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,1235.74,82,,988.592,percent of total billed charges,82% of total billed charges,1280.95,85,,1024.76,percent of total billed charges,85% of total billed charges,1280.95,85,,1024.76,percent of total billed charges,85% of total billed charges,1280.95,85,,1024.76,percent of total billed charges,85% of total billed charges,1356.3,90,,1085.04,percent of total billed charges,90% of total billed charges,1205.6,80,,964.48,percent of total billed charges,80% of total billed charges,1356.3,90,,1085.04,percent of total billed charges,90% of total billed charges,1130.25,75,,904.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,437.03,29,,349.624,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1009.69,67,,807.752,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1054.9,70,,843.92,percent of total billed charges,70% of total billed charges,979.55,65,,783.64,percent of total billed charges,65% of total billed charges,537.55,35.67,,430.04,percent of total billed charges,35.67% of total billed charges,437.03,1356.3,
PHALANGEAL REAMER 18MM,27021932,CDM,278,RC,C1776,HCPCS,outpatient,,,1507,602.80,,1054.9,70,,843.92,percent of total billed charges,70% of total billed charges,791.18,52.5,,632.94,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,1235.74,82,,988.592,percent of total billed charges,82% of total billed charges,1280.95,85,,1024.76,percent of total billed charges,85% of total billed charges,1280.95,85,,1024.76,percent of total billed charges,85% of total billed charges,1280.95,85,,1024.76,percent of total billed charges,85% of total billed charges,1356.3,90,,1085.04,percent of total billed charges,90% of total billed charges,1205.6,80,,964.48,percent of total billed charges,80% of total billed charges,1356.3,90,,1085.04,percent of total billed charges,90% of total billed charges,1130.25,75,,904.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,437.03,29,,349.624,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1009.69,67,,807.752,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1054.9,70,,843.92,percent of total billed charges,70% of total billed charges,979.55,65,,783.64,percent of total billed charges,65% of total billed charges,537.55,35.67,,430.04,percent of total billed charges,35.67% of total billed charges,437.03,1356.3,
SCREW LP 3.0X18MM CORTICAL MTP,27021933,CDM,278,RC,C1713,HCPCS,outpatient,,,419,167.60,,293.3,70,,234.64,percent of total billed charges,70% of total billed charges,419,100,,335.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,343.58,82,,274.864,percent of total billed charges,82% of total billed charges,356.15,85,,284.92,percent of total billed charges,85% of total billed charges,356.15,85,,284.92,percent of total billed charges,85% of total billed charges,356.15,85,,284.92,percent of total billed charges,85% of total billed charges,377.1,90,,301.68,percent of total billed charges,90% of total billed charges,335.2,80,,268.16,percent of total billed charges,80% of total billed charges,377.1,90,,301.68,percent of total billed charges,90% of total billed charges,314.25,75,,251.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,121.51,29,,97.208,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,280.73,67,,224.584,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,293.3,70,,234.64,percent of total billed charges,70% of total billed charges,272.35,65,,217.88,percent of total billed charges,65% of total billed charges,149.46,35.67,,119.568,percent of total billed charges,35.67% of total billed charges,121.51,419,
CORTICAL SCREW 3.0X22MM MTP TI,27021934,CDM,278,RC,C1713,HCPCS,outpatient,,,419,167.60,,293.3,70,,234.64,percent of total billed charges,70% of total billed charges,419,100,,335.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,343.58,82,,274.864,percent of total billed charges,82% of total billed charges,356.15,85,,284.92,percent of total billed charges,85% of total billed charges,356.15,85,,284.92,percent of total billed charges,85% of total billed charges,356.15,85,,284.92,percent of total billed charges,85% of total billed charges,377.1,90,,301.68,percent of total billed charges,90% of total billed charges,335.2,80,,268.16,percent of total billed charges,80% of total billed charges,377.1,90,,301.68,percent of total billed charges,90% of total billed charges,314.25,75,,251.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,121.51,29,,97.208,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,280.73,67,,224.584,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,293.3,70,,234.64,percent of total billed charges,70% of total billed charges,272.35,65,,217.88,percent of total billed charges,65% of total billed charges,149.46,35.67,,119.568,percent of total billed charges,35.67% of total billed charges,121.51,419,
MAXFORCE MTP PLATE PETITE 5-5,27021935,CDM,278,RC,C1713,HCPCS,outpatient,,,6682,2672.80,,4677.4,70,,3741.92,percent of total billed charges,70% of total billed charges,3508.05,52.5,,2806.44,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,5479.24,82,,4383.392,percent of total billed charges,82% of total billed charges,5679.7,85,,4543.76,percent of total billed charges,85% of total billed charges,5679.7,85,,4543.76,percent of total billed charges,85% of total billed charges,5679.7,85,,4543.76,percent of total billed charges,85% of total billed charges,6013.8,90,,4811.04,percent of total billed charges,90% of total billed charges,5345.6,80,,4276.48,percent of total billed charges,80% of total billed charges,6013.8,90,,4811.04,percent of total billed charges,90% of total billed charges,5011.5,75,,4009.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,1937.78,29,,1550.224,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4476.94,67,,3581.552,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,4677.4,70,,3741.92,percent of total billed charges,70% of total billed charges,4343.3,65,,3474.64,percent of total billed charges,65% of total billed charges,2383.47,35.67,,1906.776,percent of total billed charges,35.67% of total billed charges,1937.78,6013.8,
SCREW COMPR FT 3.5 MINI 14MM,27021947,CDM,278,RC,C1713,HCPCS,outpatient,,,1173,469.20,,821.1,70,,656.88,percent of total billed charges,70% of total billed charges,615.83,52.5,,492.66,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,961.86,82,,769.488,percent of total billed charges,82% of total billed charges,997.05,85,,797.64,percent of total billed charges,85% of total billed charges,997.05,85,,797.64,percent of total billed charges,85% of total billed charges,997.05,85,,797.64,percent of total billed charges,85% of total billed charges,1055.7,90,,844.56,percent of total billed charges,90% of total billed charges,938.4,80,,750.72,percent of total billed charges,80% of total billed charges,1055.7,90,,844.56,percent of total billed charges,90% of total billed charges,879.75,75,,703.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,340.17,29,,272.136,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,785.91,67,,628.728,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,821.1,70,,656.88,percent of total billed charges,70% of total billed charges,762.45,65,,609.96,percent of total billed charges,65% of total billed charges,418.41,35.67,,334.728,percent of total billed charges,35.67% of total billed charges,340.17,1055.7,
SCREW COMPR FT 3.5 MINI 18MM,27021948,CDM,278,RC,C1713,HCPCS,outpatient,,,1173,469.20,,821.1,70,,656.88,percent of total billed charges,70% of total billed charges,615.83,52.5,,492.66,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,961.86,82,,769.488,percent of total billed charges,82% of total billed charges,997.05,85,,797.64,percent of total billed charges,85% of total billed charges,997.05,85,,797.64,percent of total billed charges,85% of total billed charges,997.05,85,,797.64,percent of total billed charges,85% of total billed charges,1055.7,90,,844.56,percent of total billed charges,90% of total billed charges,938.4,80,,750.72,percent of total billed charges,80% of total billed charges,1055.7,90,,844.56,percent of total billed charges,90% of total billed charges,879.75,75,,703.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,340.17,29,,272.136,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,785.91,67,,628.728,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,821.1,70,,656.88,percent of total billed charges,70% of total billed charges,762.45,65,,609.96,percent of total billed charges,65% of total billed charges,418.41,35.67,,334.728,percent of total billed charges,35.67% of total billed charges,340.17,1055.7,
MESH SURGIMEND 20X30X2,27027052,CDM,278,RC,,,outpatient,,,464,185.60,,324.8,70,,259.84,percent of total billed charges,70% of total billed charges,464,100,,371.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,380.48,82,,304.384,percent of total billed charges,82% of total billed charges,394.4,85,,315.52,percent of total billed charges,85% of total billed charges,394.4,85,,315.52,percent of total billed charges,85% of total billed charges,394.4,85,,315.52,percent of total billed charges,85% of total billed charges,417.6,90,,334.08,percent of total billed charges,90% of total billed charges,371.2,80,,296.96,percent of total billed charges,80% of total billed charges,417.6,90,,334.08,percent of total billed charges,90% of total billed charges,348,75,,278.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,134.56,29,,107.648,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,310.88,67,,248.704,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,324.8,70,,259.84,percent of total billed charges,70% of total billed charges,301.6,65,,241.28,percent of total billed charges,65% of total billed charges,165.51,35.67,,132.408,percent of total billed charges,35.67% of total billed charges,134.56,464,
HIP SYSTEM **,2703513,CDM,278,RC,C1776,HCPCS,outpatient,,,9996,3998.40,,6997.2,70,,5597.76,percent of total billed charges,70% of total billed charges,5247.9,52.5,,4198.32,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,8196.72,82,,6557.376,percent of total billed charges,82% of total billed charges,8496.6,85,,6797.28,percent of total billed charges,85% of total billed charges,8496.6,85,,6797.28,percent of total billed charges,85% of total billed charges,8496.6,85,,6797.28,percent of total billed charges,85% of total billed charges,8996.4,90,,7197.12,percent of total billed charges,90% of total billed charges,7996.8,80,,6397.44,percent of total billed charges,80% of total billed charges,8996.4,90,,7197.12,percent of total billed charges,90% of total billed charges,7497,75,,5997.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2898.84,29,,2319.072,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,6697.32,67,,5357.856,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,6997.2,70,,5597.76,percent of total billed charges,70% of total billed charges,6497.4,65,,5197.92,percent of total billed charges,65% of total billed charges,3565.57,35.67,,2852.456,percent of total billed charges,35.67% of total billed charges,2898.84,8996.4,
HIP SYSTEM 12/14 **,2703514,CDM,278,RC,C1776,HCPCS,outpatient,,,3068,1227.20,,2147.6,70,,1718.08,percent of total billed charges,70% of total billed charges,1610.7,52.5,,1288.56,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,2515.76,82,,2012.608,percent of total billed charges,82% of total billed charges,2607.8,85,,2086.24,percent of total billed charges,85% of total billed charges,2607.8,85,,2086.24,percent of total billed charges,85% of total billed charges,2607.8,85,,2086.24,percent of total billed charges,85% of total billed charges,2761.2,90,,2208.96,percent of total billed charges,90% of total billed charges,2454.4,80,,1963.52,percent of total billed charges,80% of total billed charges,2761.2,90,,2208.96,percent of total billed charges,90% of total billed charges,2301,75,,1840.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,889.72,29,,711.776,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,2055.56,67,,1644.448,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,2147.6,70,,1718.08,percent of total billed charges,70% of total billed charges,1994.2,65,,1595.36,percent of total billed charges,65% of total billed charges,1094.36,35.67,,875.488,percent of total billed charges,35.67% of total billed charges,889.72,2761.2,
HIP SYSTEM **,2703515,CDM,278,RC,C1776,HCPCS,outpatient,,,635,254.00,,444.5,70,,355.6,percent of total billed charges,70% of total billed charges,635,100,,508,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,520.7,82,,416.56,percent of total billed charges,82% of total billed charges,539.75,85,,431.8,percent of total billed charges,85% of total billed charges,539.75,85,,431.8,percent of total billed charges,85% of total billed charges,539.75,85,,431.8,percent of total billed charges,85% of total billed charges,571.5,90,,457.2,percent of total billed charges,90% of total billed charges,508,80,,406.4,percent of total billed charges,80% of total billed charges,571.5,90,,457.2,percent of total billed charges,90% of total billed charges,476.25,75,,381,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,184.15,29,,147.32,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,425.45,67,,340.36,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,444.5,70,,355.6,percent of total billed charges,70% of total billed charges,412.75,65,,330.2,percent of total billed charges,65% of total billed charges,226.5,35.67,,181.2,percent of total billed charges,35.67% of total billed charges,184.15,635,
CORTICAL SCREWS S/T 4.5 42MM**,2703516,CDM,278,RC,C1713,HCPCS,outpatient,,,150,60.00,,105,70,,84,percent of total billed charges,70% of total billed charges,150,100,,120,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,123,82,,98.4,percent of total billed charges,82% of total billed charges,127.5,85,,102,percent of total billed charges,85% of total billed charges,127.5,85,,102,percent of total billed charges,85% of total billed charges,127.5,85,,102,percent of total billed charges,85% of total billed charges,135,90,,108,percent of total billed charges,90% of total billed charges,120,80,,96,percent of total billed charges,80% of total billed charges,135,90,,108,percent of total billed charges,90% of total billed charges,112.5,75,,90,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,43.5,29,,34.8,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,100.5,67,,80.4,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,105,70,,84,percent of total billed charges,70% of total billed charges,97.5,65,,78,percent of total billed charges,65% of total billed charges,53.51,35.67,,42.808,percent of total billed charges,35.67% of total billed charges,43.5,150,
CORTICAL SCREWS S/T 4.5 46**,2703517,CDM,278,RC,C1713,HCPCS,outpatient,,,150,60.00,,105,70,,84,percent of total billed charges,70% of total billed charges,150,100,,120,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,123,82,,98.4,percent of total billed charges,82% of total billed charges,127.5,85,,102,percent of total billed charges,85% of total billed charges,127.5,85,,102,percent of total billed charges,85% of total billed charges,127.5,85,,102,percent of total billed charges,85% of total billed charges,135,90,,108,percent of total billed charges,90% of total billed charges,120,80,,96,percent of total billed charges,80% of total billed charges,135,90,,108,percent of total billed charges,90% of total billed charges,112.5,75,,90,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,43.5,29,,34.8,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,100.5,67,,80.4,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,105,70,,84,percent of total billed charges,70% of total billed charges,97.5,65,,78,percent of total billed charges,65% of total billed charges,53.51,35.67,,42.808,percent of total billed charges,35.67% of total billed charges,43.5,150,
CORTICAL SCREW S/T 4.5 64 **,2703518,CDM,278,RC,C1713,HCPCS,outpatient,,,150,60.00,,105,70,,84,percent of total billed charges,70% of total billed charges,150,100,,120,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,123,82,,98.4,percent of total billed charges,82% of total billed charges,127.5,85,,102,percent of total billed charges,85% of total billed charges,127.5,85,,102,percent of total billed charges,85% of total billed charges,127.5,85,,102,percent of total billed charges,85% of total billed charges,135,90,,108,percent of total billed charges,90% of total billed charges,120,80,,96,percent of total billed charges,80% of total billed charges,135,90,,108,percent of total billed charges,90% of total billed charges,112.5,75,,90,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,43.5,29,,34.8,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,100.5,67,,80.4,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,105,70,,84,percent of total billed charges,70% of total billed charges,97.5,65,,78,percent of total billed charges,65% of total billed charges,53.51,35.67,,42.808,percent of total billed charges,35.67% of total billed charges,43.5,150,
CAUCILLOUS SCREW FULL 80MM **,2703519,CDM,278,RC,C1713,HCPCS,outpatient,,,201,80.40,,140.7,70,,112.56,percent of total billed charges,70% of total billed charges,201,100,,160.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,164.82,82,,131.856,percent of total billed charges,82% of total billed charges,170.85,85,,136.68,percent of total billed charges,85% of total billed charges,170.85,85,,136.68,percent of total billed charges,85% of total billed charges,170.85,85,,136.68,percent of total billed charges,85% of total billed charges,180.9,90,,144.72,percent of total billed charges,90% of total billed charges,160.8,80,,128.64,percent of total billed charges,80% of total billed charges,180.9,90,,144.72,percent of total billed charges,90% of total billed charges,150.75,75,,120.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,58.29,29,,46.632,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,134.67,67,,107.736,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,140.7,70,,112.56,percent of total billed charges,70% of total billed charges,130.65,65,,104.52,percent of total billed charges,65% of total billed charges,71.7,35.67,,57.36,percent of total billed charges,35.67% of total billed charges,58.29,201,
PLATE 6 HOLE L/BUTTRESS **,2703520,CDM,278,RC,C1713,HCPCS,outpatient,,,1056,422.40,,739.2,70,,591.36,percent of total billed charges,70% of total billed charges,554.4,52.5,,443.52,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,865.92,82,,692.736,percent of total billed charges,82% of total billed charges,897.6,85,,718.08,percent of total billed charges,85% of total billed charges,897.6,85,,718.08,percent of total billed charges,85% of total billed charges,897.6,85,,718.08,percent of total billed charges,85% of total billed charges,950.4,90,,760.32,percent of total billed charges,90% of total billed charges,844.8,80,,675.84,percent of total billed charges,80% of total billed charges,950.4,90,,760.32,percent of total billed charges,90% of total billed charges,792,75,,633.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,306.24,29,,244.992,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,707.52,67,,566.016,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,739.2,70,,591.36,percent of total billed charges,70% of total billed charges,686.4,65,,549.12,percent of total billed charges,65% of total billed charges,376.68,35.67,,301.344,percent of total billed charges,35.67% of total billed charges,306.24,950.4,
K GUIDED WIRES,2703524,CDM,278,RC,C1769,HCPCS,outpatient,,,114,45.60,,79.8,70,,63.84,percent of total billed charges,70% of total billed charges,114,100,,91.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,93.48,82,,74.784,percent of total billed charges,82% of total billed charges,96.9,85,,77.52,percent of total billed charges,85% of total billed charges,96.9,85,,77.52,percent of total billed charges,85% of total billed charges,96.9,85,,77.52,percent of total billed charges,85% of total billed charges,102.6,90,,82.08,percent of total billed charges,90% of total billed charges,91.2,80,,72.96,percent of total billed charges,80% of total billed charges,102.6,90,,82.08,percent of total billed charges,90% of total billed charges,85.5,75,,68.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,33.06,29,,26.448,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,76.38,67,,61.104,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,79.8,70,,63.84,percent of total billed charges,70% of total billed charges,74.1,65,,59.28,percent of total billed charges,65% of total billed charges,40.66,35.67,,32.528,percent of total billed charges,35.67% of total billed charges,33.06,114,
K WIRES 1.25 X 6,2703525,CDM,278,RC,C1713,HCPCS,outpatient,,,114,45.60,,79.8,70,,63.84,percent of total billed charges,70% of total billed charges,114,100,,91.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,93.48,82,,74.784,percent of total billed charges,82% of total billed charges,96.9,85,,77.52,percent of total billed charges,85% of total billed charges,96.9,85,,77.52,percent of total billed charges,85% of total billed charges,96.9,85,,77.52,percent of total billed charges,85% of total billed charges,102.6,90,,82.08,percent of total billed charges,90% of total billed charges,91.2,80,,72.96,percent of total billed charges,80% of total billed charges,102.6,90,,82.08,percent of total billed charges,90% of total billed charges,85.5,75,,68.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,33.06,29,,26.448,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,76.38,67,,61.104,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,79.8,70,,63.84,percent of total billed charges,70% of total billed charges,74.1,65,,59.28,percent of total billed charges,65% of total billed charges,40.66,35.67,,32.528,percent of total billed charges,35.67% of total billed charges,33.06,114,
CANNULATED SCREW 28 **,2703526,CDM,278,RC,C1713,HCPCS,outpatient,,,866,346.40,,606.2,70,,484.96,percent of total billed charges,70% of total billed charges,866,100,,692.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,710.12,82,,568.096,percent of total billed charges,82% of total billed charges,736.1,85,,588.88,percent of total billed charges,85% of total billed charges,736.1,85,,588.88,percent of total billed charges,85% of total billed charges,736.1,85,,588.88,percent of total billed charges,85% of total billed charges,779.4,90,,623.52,percent of total billed charges,90% of total billed charges,692.8,80,,554.24,percent of total billed charges,80% of total billed charges,779.4,90,,623.52,percent of total billed charges,90% of total billed charges,649.5,75,,519.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,251.14,29,,200.912,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,580.22,67,,464.176,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,606.2,70,,484.96,percent of total billed charges,70% of total billed charges,562.9,65,,450.32,percent of total billed charges,65% of total billed charges,308.9,35.67,,247.12,percent of total billed charges,35.67% of total billed charges,251.14,866,
CANNULATED SCREWS 38 **,2703527,CDM,278,RC,C1713,HCPCS,outpatient,,,866,346.40,,606.2,70,,484.96,percent of total billed charges,70% of total billed charges,866,100,,692.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,710.12,82,,568.096,percent of total billed charges,82% of total billed charges,736.1,85,,588.88,percent of total billed charges,85% of total billed charges,736.1,85,,588.88,percent of total billed charges,85% of total billed charges,736.1,85,,588.88,percent of total billed charges,85% of total billed charges,779.4,90,,623.52,percent of total billed charges,90% of total billed charges,692.8,80,,554.24,percent of total billed charges,80% of total billed charges,779.4,90,,623.52,percent of total billed charges,90% of total billed charges,649.5,75,,519.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,251.14,29,,200.912,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,580.22,67,,464.176,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,606.2,70,,484.96,percent of total billed charges,70% of total billed charges,562.9,65,,450.32,percent of total billed charges,65% of total billed charges,308.9,35.67,,247.12,percent of total billed charges,35.67% of total billed charges,251.14,866,
BREAK OFF SCREWS **,2703577,CDM,278,RC,C1713,HCPCS,outpatient,,,891,356.40,,623.7,70,,498.96,percent of total billed charges,70% of total billed charges,891,100,,712.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,730.62,82,,584.496,percent of total billed charges,82% of total billed charges,757.35,85,,605.88,percent of total billed charges,85% of total billed charges,757.35,85,,605.88,percent of total billed charges,85% of total billed charges,757.35,85,,605.88,percent of total billed charges,85% of total billed charges,801.9,90,,641.52,percent of total billed charges,90% of total billed charges,712.8,80,,570.24,percent of total billed charges,80% of total billed charges,801.9,90,,641.52,percent of total billed charges,90% of total billed charges,668.25,75,,534.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,258.39,29,,206.712,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,596.97,67,,477.576,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,623.7,70,,498.96,percent of total billed charges,70% of total billed charges,579.15,65,,463.32,percent of total billed charges,65% of total billed charges,317.82,35.67,,254.256,percent of total billed charges,35.67% of total billed charges,258.39,891,
DBX PUTTY 5CC 038050,2704124,CDM,278,RC,C1713,HCPCS,outpatient,,,3244,1297.60,,2270.8,70,,1816.64,percent of total billed charges,70% of total billed charges,1703.1,52.5,,1362.48,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,2660.08,82,,2128.064,percent of total billed charges,82% of total billed charges,2757.4,85,,2205.92,percent of total billed charges,85% of total billed charges,2757.4,85,,2205.92,percent of total billed charges,85% of total billed charges,2757.4,85,,2205.92,percent of total billed charges,85% of total billed charges,2919.6,90,,2335.68,percent of total billed charges,90% of total billed charges,2595.2,80,,2076.16,percent of total billed charges,80% of total billed charges,2919.6,90,,2335.68,percent of total billed charges,90% of total billed charges,2433,75,,1946.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,940.76,29,,752.608,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,2173.48,67,,1738.784,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,2270.8,70,,1816.64,percent of total billed charges,70% of total billed charges,2108.6,65,,1686.88,percent of total billed charges,65% of total billed charges,1157.13,35.67,,925.704,percent of total billed charges,35.67% of total billed charges,940.76,2919.6,
4.5 CORTICAL SCREW S/TAP 60,2705360,CDM,278,RC,C1713,HCPCS,outpatient,,,157,62.80,,109.9,70,,87.92,percent of total billed charges,70% of total billed charges,157,100,,125.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,128.74,82,,102.992,percent of total billed charges,82% of total billed charges,133.45,85,,106.76,percent of total billed charges,85% of total billed charges,133.45,85,,106.76,percent of total billed charges,85% of total billed charges,133.45,85,,106.76,percent of total billed charges,85% of total billed charges,141.3,90,,113.04,percent of total billed charges,90% of total billed charges,125.6,80,,100.48,percent of total billed charges,80% of total billed charges,141.3,90,,113.04,percent of total billed charges,90% of total billed charges,117.75,75,,94.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,45.53,29,,36.424,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,105.19,67,,84.152,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,109.9,70,,87.92,percent of total billed charges,70% of total billed charges,102.05,65,,81.64,percent of total billed charges,65% of total billed charges,56,35.67,,44.8,percent of total billed charges,35.67% of total billed charges,45.53,157,
4.5 CORTICAL SCREW S/TAP 62,2705361,CDM,278,RC,C1713,HCPCS,outpatient,,,157,62.80,,109.9,70,,87.92,percent of total billed charges,70% of total billed charges,157,100,,125.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,128.74,82,,102.992,percent of total billed charges,82% of total billed charges,133.45,85,,106.76,percent of total billed charges,85% of total billed charges,133.45,85,,106.76,percent of total billed charges,85% of total billed charges,133.45,85,,106.76,percent of total billed charges,85% of total billed charges,141.3,90,,113.04,percent of total billed charges,90% of total billed charges,125.6,80,,100.48,percent of total billed charges,80% of total billed charges,141.3,90,,113.04,percent of total billed charges,90% of total billed charges,117.75,75,,94.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,45.53,29,,36.424,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,105.19,67,,84.152,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,109.9,70,,87.92,percent of total billed charges,70% of total billed charges,102.05,65,,81.64,percent of total billed charges,65% of total billed charges,56,35.67,,44.8,percent of total billed charges,35.67% of total billed charges,45.53,157,
4.5 CORTICAL SHAFT SCREW 34,2705377,CDM,278,RC,C1713,HCPCS,outpatient,,,123,49.20,,86.1,70,,68.88,percent of total billed charges,70% of total billed charges,123,100,,98.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,100.86,82,,80.688,percent of total billed charges,82% of total billed charges,104.55,85,,83.64,percent of total billed charges,85% of total billed charges,104.55,85,,83.64,percent of total billed charges,85% of total billed charges,104.55,85,,83.64,percent of total billed charges,85% of total billed charges,110.7,90,,88.56,percent of total billed charges,90% of total billed charges,98.4,80,,78.72,percent of total billed charges,80% of total billed charges,110.7,90,,88.56,percent of total billed charges,90% of total billed charges,92.25,75,,73.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,35.67,29,,28.536,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,82.41,67,,65.928,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,86.1,70,,68.88,percent of total billed charges,70% of total billed charges,79.95,65,,63.96,percent of total billed charges,65% of total billed charges,43.87,35.67,,35.096,percent of total billed charges,35.67% of total billed charges,35.67,123,
6.5 CANCELLOUS SCREW 16 THR 80,2705420,CDM,278,RC,C1713,HCPCS,outpatient,,,188,75.20,,131.6,70,,105.28,percent of total billed charges,70% of total billed charges,188,100,,150.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,154.16,82,,123.328,percent of total billed charges,82% of total billed charges,159.8,85,,127.84,percent of total billed charges,85% of total billed charges,159.8,85,,127.84,percent of total billed charges,85% of total billed charges,159.8,85,,127.84,percent of total billed charges,85% of total billed charges,169.2,90,,135.36,percent of total billed charges,90% of total billed charges,150.4,80,,120.32,percent of total billed charges,80% of total billed charges,169.2,90,,135.36,percent of total billed charges,90% of total billed charges,141,75,,112.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,54.52,29,,43.616,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,125.96,67,,100.768,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,131.6,70,,105.28,percent of total billed charges,70% of total billed charges,122.2,65,,97.76,percent of total billed charges,65% of total billed charges,67.06,35.67,,53.648,percent of total billed charges,35.67% of total billed charges,54.52,188,
MESH,2708705,CDM,278,RC,C1781,HCPCS,outpatient,,,1903,761.20,,1332.1,70,,1065.68,percent of total billed charges,70% of total billed charges,999.08,52.5,,799.26,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,1560.46,82,,1248.368,percent of total billed charges,82% of total billed charges,1617.55,85,,1294.04,percent of total billed charges,85% of total billed charges,1617.55,85,,1294.04,percent of total billed charges,85% of total billed charges,1617.55,85,,1294.04,percent of total billed charges,85% of total billed charges,1712.7,90,,1370.16,percent of total billed charges,90% of total billed charges,1522.4,80,,1217.92,percent of total billed charges,80% of total billed charges,1712.7,90,,1370.16,percent of total billed charges,90% of total billed charges,1427.25,75,,1141.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,551.87,29,,441.496,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1275.01,67,,1020.008,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1332.1,70,,1065.68,percent of total billed charges,70% of total billed charges,1236.95,65,,989.56,percent of total billed charges,65% of total billed charges,678.8,35.67,,543.04,percent of total billed charges,35.67% of total billed charges,551.87,1712.7,
ALLGRAFT TENDON,27814851,CDM,278,RC,C1762,HCPCS,outpatient,,,5472,2188.80,,3830.4,70,,3064.32,percent of total billed charges,70% of total billed charges,2872.8,52.5,,2298.24,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,4487.04,82,,3589.632,percent of total billed charges,82% of total billed charges,4651.2,85,,3720.96,percent of total billed charges,85% of total billed charges,4651.2,85,,3720.96,percent of total billed charges,85% of total billed charges,4651.2,85,,3720.96,percent of total billed charges,85% of total billed charges,4924.8,90,,3939.84,percent of total billed charges,90% of total billed charges,4377.6,80,,3502.08,percent of total billed charges,80% of total billed charges,4924.8,90,,3939.84,percent of total billed charges,90% of total billed charges,4104,75,,3283.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,1586.88,29,,1269.504,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,3666.24,67,,2932.992,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,3830.4,70,,3064.32,percent of total billed charges,70% of total billed charges,3556.8,65,,2845.44,percent of total billed charges,65% of total billed charges,1951.86,35.67,,1561.488,percent of total billed charges,35.67% of total billed charges,1586.88,4924.8,
GUIDE WIRE - USED IN XRAY,3201183,CDM,278,RC,C1769,HCPCS,outpatient,,,31,12.40,,21.7,70,,17.36,percent of total billed charges,70% of total billed charges,31,100,,24.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,25.42,82,,20.336,percent of total billed charges,82% of total billed charges,26.35,85,,21.08,percent of total billed charges,85% of total billed charges,26.35,85,,21.08,percent of total billed charges,85% of total billed charges,26.35,85,,21.08,percent of total billed charges,85% of total billed charges,27.9,90,,22.32,percent of total billed charges,90% of total billed charges,24.8,80,,19.84,percent of total billed charges,80% of total billed charges,27.9,90,,22.32,percent of total billed charges,90% of total billed charges,23.25,75,,18.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,8.99,29,,7.192,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,20.77,67,,16.616,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,21.7,70,,17.36,percent of total billed charges,70% of total billed charges,20.15,65,,16.12,percent of total billed charges,65% of total billed charges,11.06,35.67,,8.848,percent of total billed charges,35.67% of total billed charges,8.99,31,
COCKUP WRIST SPLINT LG LEFT,27000421,CDM,290,RC,L3908,HCPCS,outpatient,,,109,43.60,LT,92.65,85,,74.12,percent of total billed charges,85% of total billed charges,83.93,77,,67.14,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,89.38,82,,71.504,percent of total billed charges,82% of total billed charges,92.65,85,,74.12,percent of total billed charges,85% of total billed charges,92.65,85,,74.12,percent of total billed charges,85% of total billed charges,92.65,85,,74.12,percent of total billed charges,85% of total billed charges,98.1,90,,78.48,percent of total billed charges,90% of total billed charges,87.2,80,,69.76,percent of total billed charges,80% of total billed charges,98.1,90,,78.48,percent of total billed charges,90% of total billed charges,81.75,75,,65.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,31.61,29,,25.288,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,73.03,67,,58.424,percent of total billed charges,67% of total billed charges,71.1,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,87.2,80,,69.76,percent of total billed charges,80% of total billed charges,70.85,65,,56.68,percent of total billed charges,65% of total billed charges,38.88,35.67,,31.104,percent of total billed charges,35.67% of total billed charges,31.61,98.1,
FF MASK HEADGEAR AMARA LARGE,270031008,CDM,290,RC,A7031,HCPCS,outpatient,,,412,164.80,NUKX,350.2,85,,280.16,percent of total billed charges,85% of total billed charges,317.24,77,,253.79,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,140.68,385,,,fee schedule,385% of BCBS fee schedule,146.53,401,,,fee schedule,401% of BCBS fee schedule,146.53,401,,,fee schedule,401% of BCBS fee schedule,146.53,401,,,fee schedule,401% of BCBS fee schedule,370.8,90,,296.64,percent of total billed charges,90% of total billed charges,329.6,80,,263.68,percent of total billed charges,80% of total billed charges,370.8,90,,296.64,percent of total billed charges,90% of total billed charges,309,75,,247.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,119.48,29,,95.584,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,276.04,67,,220.832,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,329.6,80,,263.68,percent of total billed charges,80% of total billed charges,267.8,65,,214.24,percent of total billed charges,65% of total billed charges,146.96,35.67,,117.568,percent of total billed charges,35.67% of total billed charges,119.48,370.8,
FF MASK HEADGEAR AMARA MEDIUM,270031009,CDM,290,RC,A7030,HCPCS,outpatient,,,406,162.40,NUKX,345.1,85,,276.08,percent of total billed charges,85% of total billed charges,312.62,77,,250.1,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,369.95,385,,,fee schedule,385% of BCBS fee schedule,385.32,401,,,fee schedule,401% of BCBS fee schedule,385.32,401,,,fee schedule,401% of BCBS fee schedule,385.32,401,,,fee schedule,401% of BCBS fee schedule,365.4,90,,292.32,percent of total billed charges,90% of total billed charges,324.8,80,,259.84,percent of total billed charges,80% of total billed charges,365.4,90,,292.32,percent of total billed charges,90% of total billed charges,304.5,75,,243.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,117.74,29,,94.192,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,272.02,67,,217.616,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,324.8,80,,259.84,percent of total billed charges,80% of total billed charges,263.9,65,,211.12,percent of total billed charges,65% of total billed charges,144.82,35.67,,115.856,percent of total billed charges,35.67% of total billed charges,117.74,385.32,
NEBULIZER (PURCHASE) INSURANCE,27700158,CDM,290,RC,E0570,HCPCS,outpatient,,,165,66.00,NU,140.25,85,,112.2,percent of total billed charges,85% of total billed charges,127.05,77,,101.64,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,23.79,385,,,fee schedule,385% of BCBS fee schedule,24.78,401,,,fee schedule,401% of BCBS fee schedule,24.78,401,,,fee schedule,401% of BCBS fee schedule,24.78,401,,,fee schedule,401% of BCBS fee schedule,148.5,90,,118.8,percent of total billed charges,90% of total billed charges,132,80,,105.6,percent of total billed charges,80% of total billed charges,148.5,90,,118.8,percent of total billed charges,90% of total billed charges,123.75,75,,99,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,47.85,29,,38.28,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,110.55,67,,88.44,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,132,80,,105.6,percent of total billed charges,80% of total billed charges,107.25,65,,85.8,percent of total billed charges,65% of total billed charges,58.86,35.67,,47.088,percent of total billed charges,35.67% of total billed charges,23.79,148.5,
ROLLATOR WALKER,27700159,CDM,290,RC,E0141,HCPCS,outpatient,,,188,75.20,NUKX,159.8,85,,127.84,percent of total billed charges,85% of total billed charges,144.76,77,,115.81,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,194.85,385,,,fee schedule,385% of BCBS fee schedule,202.95,401,,,fee schedule,401% of BCBS fee schedule,202.95,401,,,fee schedule,401% of BCBS fee schedule,202.95,401,,,fee schedule,401% of BCBS fee schedule,169.2,90,,135.36,percent of total billed charges,90% of total billed charges,150.4,80,,120.32,percent of total billed charges,80% of total billed charges,169.2,90,,135.36,percent of total billed charges,90% of total billed charges,141,75,,112.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,54.52,29,,43.616,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,125.96,67,,100.768,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,150.4,80,,120.32,percent of total billed charges,80% of total billed charges,122.2,65,,97.76,percent of total billed charges,65% of total billed charges,67.06,35.67,,53.648,percent of total billed charges,35.67% of total billed charges,54.52,202.95,
ROLLATOR WALKER SEAT,27700160,CDM,290,RC,E0156,HCPCS,outpatient,,,46,18.40,NUKX,39.1,85,,31.28,percent of total billed charges,85% of total billed charges,35.42,77,,28.34,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,64.56,385,,,fee schedule,385% of BCBS fee schedule,67.25,401,,,fee schedule,401% of BCBS fee schedule,67.25,401,,,fee schedule,401% of BCBS fee schedule,67.25,401,,,fee schedule,401% of BCBS fee schedule,41.4,90,,33.12,percent of total billed charges,90% of total billed charges,36.8,80,,29.44,percent of total billed charges,80% of total billed charges,41.4,90,,33.12,percent of total billed charges,90% of total billed charges,34.5,75,,27.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,13.34,29,,10.672,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,30.82,67,,24.656,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,36.8,80,,29.44,percent of total billed charges,80% of total billed charges,29.9,65,,23.92,percent of total billed charges,65% of total billed charges,16.41,35.67,,13.128,percent of total billed charges,35.67% of total billed charges,13.34,67.25,
QUAD CANE SMALL BASE,27700161,CDM,290,RC,E0105,HCPCS,outpatient,,,60,24.00,NUKX,51,85,,40.8,percent of total billed charges,85% of total billed charges,46.2,77,,36.96,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,206.82,385,,,fee schedule,385% of BCBS fee schedule,215.42,401,,,fee schedule,401% of BCBS fee schedule,215.42,401,,,fee schedule,401% of BCBS fee schedule,215.42,401,,,fee schedule,401% of BCBS fee schedule,54,90,,43.2,percent of total billed charges,90% of total billed charges,48,80,,38.4,percent of total billed charges,80% of total billed charges,54,90,,43.2,percent of total billed charges,90% of total billed charges,45,75,,36,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,17.4,29,,13.92,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,40.2,67,,32.16,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,48,80,,38.4,percent of total billed charges,80% of total billed charges,39,65,,31.2,percent of total billed charges,65% of total billed charges,21.4,35.67,,17.12,percent of total billed charges,35.67% of total billed charges,17.4,215.42,
QUAD CANE LARGE BASE,27700162,CDM,290,RC,E0105,HCPCS,outpatient,,,46,18.40,NUKX,39.1,85,,31.28,percent of total billed charges,85% of total billed charges,35.42,77,,28.34,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,206.82,385,,,fee schedule,385% of BCBS fee schedule,215.42,401,,,fee schedule,401% of BCBS fee schedule,215.42,401,,,fee schedule,401% of BCBS fee schedule,215.42,401,,,fee schedule,401% of BCBS fee schedule,41.4,90,,33.12,percent of total billed charges,90% of total billed charges,36.8,80,,29.44,percent of total billed charges,80% of total billed charges,41.4,90,,33.12,percent of total billed charges,90% of total billed charges,34.5,75,,27.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,13.34,29,,10.672,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,30.82,67,,24.656,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,36.8,80,,29.44,percent of total billed charges,80% of total billed charges,29.9,65,,23.92,percent of total billed charges,65% of total billed charges,16.41,35.67,,13.128,percent of total billed charges,35.67% of total billed charges,13.34,215.42,
CANE,27700163,CDM,290,RC,E0100,HCPCS,outpatient,,,51,20.40,NUKX,43.35,85,,34.68,percent of total billed charges,85% of total billed charges,39.27,77,,31.42,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,84.89,385,,,fee schedule,385% of BCBS fee schedule,88.42,401,,,fee schedule,401% of BCBS fee schedule,88.42,401,,,fee schedule,401% of BCBS fee schedule,88.42,401,,,fee schedule,401% of BCBS fee schedule,45.9,90,,36.72,percent of total billed charges,90% of total billed charges,40.8,80,,32.64,percent of total billed charges,80% of total billed charges,45.9,90,,36.72,percent of total billed charges,90% of total billed charges,38.25,75,,30.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,14.79,29,,11.832,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,34.17,67,,27.336,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,40.8,80,,32.64,percent of total billed charges,80% of total billed charges,33.15,65,,26.52,percent of total billed charges,65% of total billed charges,18.19,35.67,,14.552,percent of total billed charges,35.67% of total billed charges,14.79,88.42,
PAIR CRUTCHES ALUMINIUM INS,27700164,CDM,290,RC,E0114,HCPCS,outpatient,,,90,36.00,NUKX,76.5,85,,61.2,percent of total billed charges,85% of total billed charges,69.3,77,,55.44,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,178.41,385,,,fee schedule,385% of BCBS fee schedule,185.82,401,,,fee schedule,401% of BCBS fee schedule,185.82,401,,,fee schedule,401% of BCBS fee schedule,185.82,401,,,fee schedule,401% of BCBS fee schedule,81,90,,64.8,percent of total billed charges,90% of total billed charges,72,80,,57.6,percent of total billed charges,80% of total billed charges,81,90,,64.8,percent of total billed charges,90% of total billed charges,67.5,75,,54,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,26.1,29,,20.88,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,60.3,67,,48.24,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,72,80,,57.6,percent of total billed charges,80% of total billed charges,58.5,65,,46.8,percent of total billed charges,65% of total billed charges,32.1,35.67,,25.68,percent of total billed charges,35.67% of total billed charges,26.1,185.82,
PR CRUTCHES PURCHASE SELF-PAY,27700165,CDM,290,RC,E0114,HCPCS,outpatient,,,46,18.40,NUKX,39.1,85,,31.28,percent of total billed charges,85% of total billed charges,35.42,77,,28.34,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,178.41,385,,,fee schedule,385% of BCBS fee schedule,185.82,401,,,fee schedule,401% of BCBS fee schedule,185.82,401,,,fee schedule,401% of BCBS fee schedule,185.82,401,,,fee schedule,401% of BCBS fee schedule,41.4,90,,33.12,percent of total billed charges,90% of total billed charges,36.8,80,,29.44,percent of total billed charges,80% of total billed charges,41.4,90,,33.12,percent of total billed charges,90% of total billed charges,34.5,75,,27.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,13.34,29,,10.672,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,30.82,67,,24.656,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,36.8,80,,29.44,percent of total billed charges,80% of total billed charges,29.9,65,,23.92,percent of total billed charges,65% of total billed charges,16.41,35.67,,13.128,percent of total billed charges,35.67% of total billed charges,13.34,185.82,
PAIR CRUTCHES ALL SZS SP,27700166,CDM,290,RC,E0114,HCPCS,outpatient,,,52,20.80,NUKX,44.2,85,,35.36,percent of total billed charges,85% of total billed charges,40.04,77,,32.03,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,178.41,385,,,fee schedule,385% of BCBS fee schedule,185.82,401,,,fee schedule,401% of BCBS fee schedule,185.82,401,,,fee schedule,401% of BCBS fee schedule,185.82,401,,,fee schedule,401% of BCBS fee schedule,46.8,90,,37.44,percent of total billed charges,90% of total billed charges,41.6,80,,33.28,percent of total billed charges,80% of total billed charges,46.8,90,,37.44,percent of total billed charges,90% of total billed charges,39,75,,31.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,15.08,29,,12.064,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,34.84,67,,27.872,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,41.6,80,,33.28,percent of total billed charges,80% of total billed charges,33.8,65,,27.04,percent of total billed charges,65% of total billed charges,18.55,35.67,,14.84,percent of total billed charges,35.67% of total billed charges,15.08,185.82,
BEDSIDE COMMODE,27700167,CDM,290,RC,E0163,HCPCS,outpatient,,,114,45.60,NUKX,96.9,85,,77.52,percent of total billed charges,85% of total billed charges,87.78,77,,70.22,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,216.76,385,,,fee schedule,385% of BCBS fee schedule,225.76,401,,,fee schedule,401% of BCBS fee schedule,225.76,401,,,fee schedule,401% of BCBS fee schedule,225.76,401,,,fee schedule,401% of BCBS fee schedule,102.6,90,,82.08,percent of total billed charges,90% of total billed charges,91.2,80,,72.96,percent of total billed charges,80% of total billed charges,102.6,90,,82.08,percent of total billed charges,90% of total billed charges,85.5,75,,68.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,33.06,29,,26.448,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,76.38,67,,61.104,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,91.2,80,,72.96,percent of total billed charges,80% of total billed charges,74.1,65,,59.28,percent of total billed charges,65% of total billed charges,40.66,35.67,,32.528,percent of total billed charges,35.67% of total billed charges,33.06,225.76,
FOLDING ADJ WALKER,27700168,CDM,290,RC,E0135,HCPCS,outpatient,,,146,58.40,NUKX,124.1,85,,99.28,percent of total billed charges,85% of total billed charges,112.42,77,,89.94,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,186.99,385,,,fee schedule,385% of BCBS fee schedule,194.77,401,,,fee schedule,401% of BCBS fee schedule,194.77,401,,,fee schedule,401% of BCBS fee schedule,194.77,401,,,fee schedule,401% of BCBS fee schedule,131.4,90,,105.12,percent of total billed charges,90% of total billed charges,116.8,80,,93.44,percent of total billed charges,80% of total billed charges,131.4,90,,105.12,percent of total billed charges,90% of total billed charges,109.5,75,,87.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,42.34,29,,33.872,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,97.82,67,,78.256,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,116.8,80,,93.44,percent of total billed charges,80% of total billed charges,94.9,65,,75.92,percent of total billed charges,65% of total billed charges,52.08,35.67,,41.664,percent of total billed charges,35.67% of total billed charges,42.34,194.77,
FOLDING ADJ WALKER- SELF-PAY,27700169,CDM,290,RC,E0135,HCPCS,outpatient,,,74,29.60,,62.9,85,,50.32,percent of total billed charges,85% of total billed charges,56.98,77,,45.58,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,186.99,385,,,fee schedule,385% of BCBS fee schedule,194.77,401,,,fee schedule,401% of BCBS fee schedule,194.77,401,,,fee schedule,401% of BCBS fee schedule,194.77,401,,,fee schedule,401% of BCBS fee schedule,66.6,90,,53.28,percent of total billed charges,90% of total billed charges,59.2,80,,47.36,percent of total billed charges,80% of total billed charges,66.6,90,,53.28,percent of total billed charges,90% of total billed charges,55.5,75,,44.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,21.46,29,,17.168,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,49.58,67,,39.664,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,59.2,80,,47.36,percent of total billed charges,80% of total billed charges,48.1,65,,38.48,percent of total billed charges,65% of total billed charges,26.4,35.67,,21.12,percent of total billed charges,35.67% of total billed charges,21.46,194.77,
FOLDING ADJ WALKER W/WHEELS,27700170,CDM,290,RC,E0143,HCPCS,outpatient,,,188,75.20,NUKX,159.8,85,,127.84,percent of total billed charges,85% of total billed charges,144.76,77,,115.81,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,194.85,385,,,fee schedule,385% of BCBS fee schedule,202.95,401,,,fee schedule,401% of BCBS fee schedule,202.95,401,,,fee schedule,401% of BCBS fee schedule,202.95,401,,,fee schedule,401% of BCBS fee schedule,169.2,90,,135.36,percent of total billed charges,90% of total billed charges,150.4,80,,120.32,percent of total billed charges,80% of total billed charges,169.2,90,,135.36,percent of total billed charges,90% of total billed charges,141,75,,112.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,54.52,29,,43.616,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,125.96,67,,100.768,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,150.4,80,,120.32,percent of total billed charges,80% of total billed charges,122.2,65,,97.76,percent of total billed charges,65% of total billed charges,67.06,35.67,,53.648,percent of total billed charges,35.67% of total billed charges,54.52,202.95,
FOLD ADJ WALKER WHEELS S-P,27700171,CDM,290,RC,E0143,HCPCS,outpatient,,,84,33.60,,71.4,85,,57.12,percent of total billed charges,85% of total billed charges,64.68,77,,51.74,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,194.85,385,,,fee schedule,385% of BCBS fee schedule,202.95,401,,,fee schedule,401% of BCBS fee schedule,202.95,401,,,fee schedule,401% of BCBS fee schedule,202.95,401,,,fee schedule,401% of BCBS fee schedule,75.6,90,,60.48,percent of total billed charges,90% of total billed charges,67.2,80,,53.76,percent of total billed charges,80% of total billed charges,75.6,90,,60.48,percent of total billed charges,90% of total billed charges,63,75,,50.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,24.36,29,,19.488,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,56.28,67,,45.024,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,67.2,80,,53.76,percent of total billed charges,80% of total billed charges,54.6,65,,43.68,percent of total billed charges,65% of total billed charges,29.96,35.67,,23.968,percent of total billed charges,35.67% of total billed charges,24.36,202.95,
SHOWER CHAIR W/BACK & ARMS,27700172,CDM,290,RC,K0001,HCPCS,outpatient,,,77,30.80,KHRRKX,65.45,85,,52.36,percent of total billed charges,85% of total billed charges,59.29,77,,47.43,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,94.33,385,,,fee schedule,385% of BCBS fee schedule,98.25,401,,,fee schedule,401% of BCBS fee schedule,98.25,401,,,fee schedule,401% of BCBS fee schedule,98.25,401,,,fee schedule,401% of BCBS fee schedule,69.3,90,,55.44,percent of total billed charges,90% of total billed charges,61.6,80,,49.28,percent of total billed charges,80% of total billed charges,69.3,90,,55.44,percent of total billed charges,90% of total billed charges,57.75,75,,46.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,22.33,29,,17.864,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,51.59,67,,41.272,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,61.6,80,,49.28,percent of total billed charges,80% of total billed charges,50.05,65,,40.04,percent of total billed charges,65% of total billed charges,27.47,35.67,,21.976,percent of total billed charges,35.67% of total billed charges,22.33,98.25,
SHOWER CHAIR W/BACK,27700173,CDM,290,RC,E0240,HCPCS,outpatient,,,73,29.20,NUKX,62.05,85,,49.64,percent of total billed charges,85% of total billed charges,56.21,77,,44.97,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,59.86,82,,47.888,percent of total billed charges,82% of total billed charges,62.05,85,,49.64,percent of total billed charges,85% of total billed charges,62.05,85,,49.64,percent of total billed charges,85% of total billed charges,62.05,85,,49.64,percent of total billed charges,85% of total billed charges,65.7,90,,52.56,percent of total billed charges,90% of total billed charges,58.4,80,,46.72,percent of total billed charges,80% of total billed charges,65.7,90,,52.56,percent of total billed charges,90% of total billed charges,54.75,75,,43.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,21.17,29,,16.936,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,48.91,67,,39.128,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,58.4,80,,46.72,percent of total billed charges,80% of total billed charges,47.45,65,,37.96,percent of total billed charges,65% of total billed charges,26.04,35.67,,20.832,percent of total billed charges,35.67% of total billed charges,21.17,65.7,
SHOWER CHAIR W/O BACK,27700174,CDM,290,RC,E0245,HCPCS,outpatient,,,53,21.20,,45.05,85,,36.04,percent of total billed charges,85% of total billed charges,40.81,77,,32.65,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,43.46,82,,34.768,percent of total billed charges,82% of total billed charges,45.05,85,,36.04,percent of total billed charges,85% of total billed charges,45.05,85,,36.04,percent of total billed charges,85% of total billed charges,45.05,85,,36.04,percent of total billed charges,85% of total billed charges,47.7,90,,38.16,percent of total billed charges,90% of total billed charges,42.4,80,,33.92,percent of total billed charges,80% of total billed charges,47.7,90,,38.16,percent of total billed charges,90% of total billed charges,39.75,75,,31.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,15.37,29,,12.296,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,35.51,67,,28.408,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,42.4,80,,33.92,percent of total billed charges,80% of total billed charges,34.45,65,,27.56,percent of total billed charges,65% of total billed charges,18.91,35.67,,15.128,percent of total billed charges,35.67% of total billed charges,15.37,47.7,
TRANSFER BENCH,27700175,CDM,290,RC,E0247,HCPCS,outpatient,,,55,22.00,NU,46.75,85,,37.4,percent of total billed charges,85% of total billed charges,42.35,77,,33.88,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,45.1,82,,36.08,percent of total billed charges,82% of total billed charges,46.75,85,,37.4,percent of total billed charges,85% of total billed charges,46.75,85,,37.4,percent of total billed charges,85% of total billed charges,46.75,85,,37.4,percent of total billed charges,85% of total billed charges,49.5,90,,39.6,percent of total billed charges,90% of total billed charges,44,80,,35.2,percent of total billed charges,80% of total billed charges,49.5,90,,39.6,percent of total billed charges,90% of total billed charges,41.25,75,,33,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,15.95,29,,12.76,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,36.85,67,,29.48,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,44,80,,35.2,percent of total billed charges,80% of total billed charges,35.75,65,,28.6,percent of total billed charges,65% of total billed charges,19.62,35.67,,15.696,percent of total billed charges,35.67% of total billed charges,15.95,49.5,
CPAP PRO W/HUMID INDIGENT,27700176,CDM,290,RC,E0601,HCPCS,outpatient,,,307,122.80,NUKX,260.95,85,,208.76,percent of total billed charges,85% of total billed charges,236.39,77,,189.11,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,169.21,385,,,fee schedule,385% of BCBS fee schedule,176.24,401,,,fee schedule,401% of BCBS fee schedule,176.24,401,,,fee schedule,401% of BCBS fee schedule,176.24,401,,,fee schedule,401% of BCBS fee schedule,276.3,90,,221.04,percent of total billed charges,90% of total billed charges,245.6,80,,196.48,percent of total billed charges,80% of total billed charges,276.3,90,,221.04,percent of total billed charges,90% of total billed charges,230.25,75,,184.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,89.03,29,,71.224,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,205.69,67,,164.552,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,245.6,80,,196.48,percent of total billed charges,80% of total billed charges,199.55,65,,159.64,percent of total billed charges,65% of total billed charges,109.51,35.67,,87.608,percent of total billed charges,35.67% of total billed charges,89.03,276.3,
CPAP PRO W/HUMID 1ST MON RENT,27700177,CDM,290,RC,E0601,HCPCS,outpatient,,,161,64.40,RRKHKX,136.85,85,,109.48,percent of total billed charges,85% of total billed charges,123.97,77,,99.18,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,169.21,385,,,fee schedule,385% of BCBS fee schedule,176.24,401,,,fee schedule,401% of BCBS fee schedule,176.24,401,,,fee schedule,401% of BCBS fee schedule,176.24,401,,,fee schedule,401% of BCBS fee schedule,144.9,90,,115.92,percent of total billed charges,90% of total billed charges,128.8,80,,103.04,percent of total billed charges,80% of total billed charges,144.9,90,,115.92,percent of total billed charges,90% of total billed charges,120.75,75,,96.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,46.69,29,,37.352,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,107.87,67,,86.296,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,128.8,80,,103.04,percent of total billed charges,80% of total billed charges,104.65,65,,83.72,percent of total billed charges,65% of total billed charges,57.43,35.67,,45.944,percent of total billed charges,35.67% of total billed charges,46.69,176.24,
CPAP AUTO INDIGENT,27700178,CDM,290,RC,E0601,HCPCS,outpatient,,,313,125.20,NUKX,266.05,85,,212.84,percent of total billed charges,85% of total billed charges,241.01,77,,192.81,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,169.21,385,,,fee schedule,385% of BCBS fee schedule,176.24,401,,,fee schedule,401% of BCBS fee schedule,176.24,401,,,fee schedule,401% of BCBS fee schedule,176.24,401,,,fee schedule,401% of BCBS fee schedule,281.7,90,,225.36,percent of total billed charges,90% of total billed charges,250.4,80,,200.32,percent of total billed charges,80% of total billed charges,281.7,90,,225.36,percent of total billed charges,90% of total billed charges,234.75,75,,187.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,90.77,29,,72.616,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,209.71,67,,167.768,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,250.4,80,,200.32,percent of total billed charges,80% of total billed charges,203.45,65,,162.76,percent of total billed charges,65% of total billed charges,111.65,35.67,,89.32,percent of total billed charges,35.67% of total billed charges,90.77,281.7,
CPAP AUTO HUMID RENT ALLIED,27700179,CDM,290,RC,E0601,HCPCS,outpatient,,,159,63.60,RR,135.15,85,,108.12,percent of total billed charges,85% of total billed charges,122.43,77,,97.94,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,169.21,385,,,fee schedule,385% of BCBS fee schedule,176.24,401,,,fee schedule,401% of BCBS fee schedule,176.24,401,,,fee schedule,401% of BCBS fee schedule,176.24,401,,,fee schedule,401% of BCBS fee schedule,143.1,90,,114.48,percent of total billed charges,90% of total billed charges,127.2,80,,101.76,percent of total billed charges,80% of total billed charges,143.1,90,,114.48,percent of total billed charges,90% of total billed charges,119.25,75,,95.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,46.11,29,,36.888,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,106.53,67,,85.224,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,127.2,80,,101.76,percent of total billed charges,80% of total billed charges,103.35,65,,82.68,percent of total billed charges,65% of total billed charges,56.72,35.67,,45.376,percent of total billed charges,35.67% of total billed charges,46.11,176.24,
BIPAP HTD HUMID (PURCHASE),27700180,CDM,290,RC,E0470,HCPCS,outpatient,,,2207,882.80,,1875.95,85,,1500.76,percent of total billed charges,85% of total billed charges,1699.39,77,,1359.51,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,444.17,385,,,fee schedule,385% of BCBS fee schedule,462.63,401,,,fee schedule,401% of BCBS fee schedule,462.63,401,,,fee schedule,401% of BCBS fee schedule,462.63,401,,,fee schedule,401% of BCBS fee schedule,1986.3,90,,1589.04,percent of total billed charges,90% of total billed charges,1765.6,80,,1412.48,percent of total billed charges,80% of total billed charges,1986.3,90,,1589.04,percent of total billed charges,90% of total billed charges,1655.25,75,,1324.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,640.03,29,,512.024,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1478.69,67,,1182.952,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1765.6,80,,1412.48,percent of total billed charges,80% of total billed charges,1434.55,65,,1147.64,percent of total billed charges,65% of total billed charges,787.24,35.67,,629.792,percent of total billed charges,35.67% of total billed charges,444.17,1986.3,
BIPAP AUTO 1ST MONTH RENT,27700181,CDM,290,RC,E0470,HCPCS,outpatient,,,411,164.40,RRKHKX,349.35,85,,279.48,percent of total billed charges,85% of total billed charges,316.47,77,,253.18,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,444.17,385,,,fee schedule,385% of BCBS fee schedule,462.63,401,,,fee schedule,401% of BCBS fee schedule,462.63,401,,,fee schedule,401% of BCBS fee schedule,462.63,401,,,fee schedule,401% of BCBS fee schedule,369.9,90,,295.92,percent of total billed charges,90% of total billed charges,328.8,80,,263.04,percent of total billed charges,80% of total billed charges,369.9,90,,295.92,percent of total billed charges,90% of total billed charges,308.25,75,,246.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,119.19,29,,95.352,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,275.37,67,,220.296,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,328.8,80,,263.04,percent of total billed charges,80% of total billed charges,267.15,65,,213.72,percent of total billed charges,65% of total billed charges,146.6,35.67,,117.28,percent of total billed charges,35.67% of total billed charges,119.19,462.63,
POST-OP SHOE,27700182,CDM,290,RC,L3260,HCPCS,outpatient,,,43,17.20,,36.55,85,,29.24,percent of total billed charges,85% of total billed charges,33.11,77,,26.49,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,35.26,82,,28.208,percent of total billed charges,82% of total billed charges,36.55,85,,29.24,percent of total billed charges,85% of total billed charges,36.55,85,,29.24,percent of total billed charges,85% of total billed charges,36.55,85,,29.24,percent of total billed charges,85% of total billed charges,38.7,90,,30.96,percent of total billed charges,90% of total billed charges,34.4,80,,27.52,percent of total billed charges,80% of total billed charges,38.7,90,,30.96,percent of total billed charges,90% of total billed charges,32.25,75,,25.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,12.47,29,,9.976,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,28.81,67,,23.048,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,34.4,80,,27.52,percent of total billed charges,80% of total billed charges,27.95,65,,22.36,percent of total billed charges,65% of total billed charges,15.34,35.67,,12.272,percent of total billed charges,35.67% of total billed charges,12.47,38.7,
WALKING CAST BOOT INDIGENT,27700183,CDM,290,RC,L4387,HCPCS,outpatient,,,30,12.00,LTKX,25.5,85,,20.4,percent of total billed charges,85% of total billed charges,23.1,77,,18.48,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,24.6,82,,19.68,percent of total billed charges,82% of total billed charges,25.5,85,,20.4,percent of total billed charges,85% of total billed charges,25.5,85,,20.4,percent of total billed charges,85% of total billed charges,25.5,85,,20.4,percent of total billed charges,85% of total billed charges,27,90,,21.6,percent of total billed charges,90% of total billed charges,24,80,,19.2,percent of total billed charges,80% of total billed charges,27,90,,21.6,percent of total billed charges,90% of total billed charges,22.5,75,,18,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,8.7,29,,6.96,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,20.1,67,,16.08,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,24,80,,19.2,percent of total billed charges,80% of total billed charges,19.5,65,,15.6,percent of total billed charges,65% of total billed charges,10.7,35.67,,8.56,percent of total billed charges,35.67% of total billed charges,8.7,27,
DRESSING GAUZE 4X4 NONSTERILE,27700528,CDM,290,RC,A6216,HCPCS,outpatient,,,42,16.80,,35.7,85,,28.56,percent of total billed charges,85% of total billed charges,32.34,77,,25.87,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,0.19,385,,,fee schedule,385% of BCBS fee schedule,0.2,401,,,fee schedule,401% of BCBS fee schedule,0.2,401,,,fee schedule,401% of BCBS fee schedule,0.2,401,,,fee schedule,401% of BCBS fee schedule,37.8,90,,30.24,percent of total billed charges,90% of total billed charges,33.6,80,,26.88,percent of total billed charges,80% of total billed charges,37.8,90,,30.24,percent of total billed charges,90% of total billed charges,31.5,75,,25.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,12.18,29,,9.744,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,28.14,67,,22.512,percent of total billed charges,67% of total billed charges,0.05,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,33.6,80,,26.88,percent of total billed charges,80% of total billed charges,27.3,65,,21.84,percent of total billed charges,65% of total billed charges,14.98,35.67,,11.984,percent of total billed charges,35.67% of total billed charges,0.05,37.8,
DRESSING CONFORM GAUZE 4,27700541,CDM,290,RC,A6402,HCPCS,outpatient,,,7,2.80,,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.39,77,,4.31,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,0.5,385,,,fee schedule,385% of BCBS fee schedule,0.52,401,,,fee schedule,401% of BCBS fee schedule,0.52,401,,,fee schedule,401% of BCBS fee schedule,0.52,401,,,fee schedule,401% of BCBS fee schedule,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.25,75,,4.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.03,29,,1.624,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4.69,67,,3.752,percent of total billed charges,67% of total billed charges,0.14,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,4.55,65,,3.64,percent of total billed charges,65% of total billed charges,2.5,35.67,,2,percent of total billed charges,35.67% of total billed charges,0.14,6.3,
BIPAP HTD HUMID 5TH TO 13TH MO,27700614,CDM,290,RC,E0470,HCPCS,outpatient,,,401,160.40,KJRRKX,340.85,85,,272.68,percent of total billed charges,85% of total billed charges,308.77,77,,247.02,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,444.17,385,,,fee schedule,385% of BCBS fee schedule,462.63,401,,,fee schedule,401% of BCBS fee schedule,462.63,401,,,fee schedule,401% of BCBS fee schedule,462.63,401,,,fee schedule,401% of BCBS fee schedule,360.9,90,,288.72,percent of total billed charges,90% of total billed charges,320.8,80,,256.64,percent of total billed charges,80% of total billed charges,360.9,90,,288.72,percent of total billed charges,90% of total billed charges,300.75,75,,240.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,116.29,29,,93.032,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,268.67,67,,214.936,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,320.8,80,,256.64,percent of total billed charges,80% of total billed charges,260.65,65,,208.52,percent of total billed charges,65% of total billed charges,143.04,35.67,,114.432,percent of total billed charges,35.67% of total billed charges,116.29,462.63,
BARIATRIC FOLDING ADJ WALKER,27700615,CDM,290,RC,E0149,HCPCS,outpatient,,,155,62.00,NUKX,131.75,85,,105.4,percent of total billed charges,85% of total billed charges,119.35,77,,95.48,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,48.13,385,,,fee schedule,385% of BCBS fee schedule,50.13,401,,,fee schedule,401% of BCBS fee schedule,50.13,401,,,fee schedule,401% of BCBS fee schedule,50.13,401,,,fee schedule,401% of BCBS fee schedule,139.5,90,,111.6,percent of total billed charges,90% of total billed charges,124,80,,99.2,percent of total billed charges,80% of total billed charges,139.5,90,,111.6,percent of total billed charges,90% of total billed charges,116.25,75,,93,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,44.95,29,,35.96,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,103.85,67,,83.08,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,124,80,,99.2,percent of total billed charges,80% of total billed charges,100.75,65,,80.6,percent of total billed charges,65% of total billed charges,55.29,35.67,,44.232,percent of total billed charges,35.67% of total billed charges,44.95,139.5,
WALL GRAB BAR 24 IN,277031010,CDM,290,RC,,,outpatient,,,46,18.40,,39.1,85,,31.28,percent of total billed charges,85% of total billed charges,35.42,77,,28.34,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,37.72,82,,30.176,percent of total billed charges,82% of total billed charges,39.1,85,,31.28,percent of total billed charges,85% of total billed charges,39.1,85,,31.28,percent of total billed charges,85% of total billed charges,39.1,85,,31.28,percent of total billed charges,85% of total billed charges,41.4,90,,33.12,percent of total billed charges,90% of total billed charges,36.8,80,,29.44,percent of total billed charges,80% of total billed charges,41.4,90,,33.12,percent of total billed charges,90% of total billed charges,34.5,75,,27.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,13.34,29,,10.672,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,30.82,67,,24.656,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,36.8,80,,29.44,percent of total billed charges,80% of total billed charges,29.9,65,,23.92,percent of total billed charges,65% of total billed charges,16.41,35.67,,13.128,percent of total billed charges,35.67% of total billed charges,13.34,41.4,
WALL GRAB BAR 18 INCH,277031011,CDM,290,RC,,,outpatient,,,34,13.60,,28.9,85,,23.12,percent of total billed charges,85% of total billed charges,26.18,77,,20.94,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,27.88,82,,22.304,percent of total billed charges,82% of total billed charges,28.9,85,,23.12,percent of total billed charges,85% of total billed charges,28.9,85,,23.12,percent of total billed charges,85% of total billed charges,28.9,85,,23.12,percent of total billed charges,85% of total billed charges,30.6,90,,24.48,percent of total billed charges,90% of total billed charges,27.2,80,,21.76,percent of total billed charges,80% of total billed charges,30.6,90,,24.48,percent of total billed charges,90% of total billed charges,25.5,75,,20.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,9.86,29,,7.888,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,22.78,67,,18.224,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,27.2,80,,21.76,percent of total billed charges,80% of total billed charges,22.1,65,,17.68,percent of total billed charges,65% of total billed charges,12.13,35.67,,9.704,percent of total billed charges,35.67% of total billed charges,9.86,30.6,
POST-OP SHOE ALL SZ EMPLOYEE,27703183,CDM,290,RC,,,outpatient,,,15,6.00,,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,11.55,77,,9.24,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,12.3,82,,9.84,percent of total billed charges,82% of total billed charges,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,13.5,90,,10.8,percent of total billed charges,90% of total billed charges,12,80,,9.6,percent of total billed charges,80% of total billed charges,13.5,90,,10.8,percent of total billed charges,90% of total billed charges,11.25,75,,9,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,4.35,29,,3.48,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,10.05,67,,8.04,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,12,80,,9.6,percent of total billed charges,80% of total billed charges,9.75,65,,7.8,percent of total billed charges,65% of total billed charges,5.35,35.67,,4.28,percent of total billed charges,35.67% of total billed charges,4.35,13.5,
F&P MED FF MASK- JD DAVIS,277034000,CDM,290,RC,A7030,HCPCS,outpatient,,,94,37.60,NUKX,79.9,85,,63.92,percent of total billed charges,85% of total billed charges,72.38,77,,57.9,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,369.95,385,,,fee schedule,385% of BCBS fee schedule,385.32,401,,,fee schedule,401% of BCBS fee schedule,385.32,401,,,fee schedule,401% of BCBS fee schedule,385.32,401,,,fee schedule,401% of BCBS fee schedule,84.6,90,,67.68,percent of total billed charges,90% of total billed charges,75.2,80,,60.16,percent of total billed charges,80% of total billed charges,84.6,90,,67.68,percent of total billed charges,90% of total billed charges,70.5,75,,56.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,27.26,29,,21.808,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,62.98,67,,50.384,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,75.2,80,,60.16,percent of total billed charges,80% of total billed charges,61.1,65,,48.88,percent of total billed charges,65% of total billed charges,33.53,35.67,,26.824,percent of total billed charges,35.67% of total billed charges,27.26,385.32,
WHEELCHAIR LITE WEIGHT 16IN,27703558,CDM,290,RC,K0001,HCPCS,outpatient,,,176,70.40,KIRRKX,149.6,85,,119.68,percent of total billed charges,85% of total billed charges,135.52,77,,108.42,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,94.33,385,,,fee schedule,385% of BCBS fee schedule,98.25,401,,,fee schedule,401% of BCBS fee schedule,98.25,401,,,fee schedule,401% of BCBS fee schedule,98.25,401,,,fee schedule,401% of BCBS fee schedule,158.4,90,,126.72,percent of total billed charges,90% of total billed charges,140.8,80,,112.64,percent of total billed charges,80% of total billed charges,158.4,90,,126.72,percent of total billed charges,90% of total billed charges,132,75,,105.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,51.04,29,,40.832,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,117.92,67,,94.336,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,140.8,80,,112.64,percent of total billed charges,80% of total billed charges,114.4,65,,91.52,percent of total billed charges,65% of total billed charges,62.78,35.67,,50.224,percent of total billed charges,35.67% of total billed charges,51.04,158.4,
WHEELCHAIR 3RD MONTH RENTAL,27703559,CDM,290,RC,K0001,HCPCS,outpatient,,,61,24.40,KIRRKX,51.85,85,,41.48,percent of total billed charges,85% of total billed charges,46.97,77,,37.58,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,94.33,385,,,fee schedule,385% of BCBS fee schedule,98.25,401,,,fee schedule,401% of BCBS fee schedule,98.25,401,,,fee schedule,401% of BCBS fee schedule,98.25,401,,,fee schedule,401% of BCBS fee schedule,54.9,90,,43.92,percent of total billed charges,90% of total billed charges,48.8,80,,39.04,percent of total billed charges,80% of total billed charges,54.9,90,,43.92,percent of total billed charges,90% of total billed charges,45.75,75,,36.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,17.69,29,,14.152,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,40.87,67,,32.696,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,48.8,80,,39.04,percent of total billed charges,80% of total billed charges,39.65,65,,31.72,percent of total billed charges,65% of total billed charges,21.76,35.67,,17.408,percent of total billed charges,35.67% of total billed charges,17.69,98.25,
WHEELCHAIR 4TH MONTH RENTAL,27703560,CDM,290,RC,K0001,HCPCS,outpatient,,,31,12.40,KJRRKX,26.35,85,,21.08,percent of total billed charges,85% of total billed charges,23.87,77,,19.1,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,94.33,385,,,fee schedule,385% of BCBS fee schedule,98.25,401,,,fee schedule,401% of BCBS fee schedule,98.25,401,,,fee schedule,401% of BCBS fee schedule,98.25,401,,,fee schedule,401% of BCBS fee schedule,27.9,90,,22.32,percent of total billed charges,90% of total billed charges,24.8,80,,19.84,percent of total billed charges,80% of total billed charges,27.9,90,,22.32,percent of total billed charges,90% of total billed charges,23.25,75,,18.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,8.99,29,,7.192,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,20.77,67,,16.616,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,24.8,80,,19.84,percent of total billed charges,80% of total billed charges,20.15,65,,16.12,percent of total billed charges,65% of total billed charges,11.06,35.67,,8.848,percent of total billed charges,35.67% of total billed charges,8.99,98.25,
WHEELCHAIR 5TH MONTH RENTAL,27703561,CDM,290,RC,K0001,HCPCS,outpatient,,,61,24.40,KJRRKX,51.85,85,,41.48,percent of total billed charges,85% of total billed charges,46.97,77,,37.58,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,94.33,385,,,fee schedule,385% of BCBS fee schedule,98.25,401,,,fee schedule,401% of BCBS fee schedule,98.25,401,,,fee schedule,401% of BCBS fee schedule,98.25,401,,,fee schedule,401% of BCBS fee schedule,54.9,90,,43.92,percent of total billed charges,90% of total billed charges,48.8,80,,39.04,percent of total billed charges,80% of total billed charges,54.9,90,,43.92,percent of total billed charges,90% of total billed charges,45.75,75,,36.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,17.69,29,,14.152,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,40.87,67,,32.696,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,48.8,80,,39.04,percent of total billed charges,80% of total billed charges,39.65,65,,31.72,percent of total billed charges,65% of total billed charges,21.76,35.67,,17.408,percent of total billed charges,35.67% of total billed charges,17.69,98.25,
WHEELCHAIR 6TH MONTH RENTAL,27703562,CDM,290,RC,K0001,HCPCS,outpatient,,,61,24.40,KJRRKX,51.85,85,,41.48,percent of total billed charges,85% of total billed charges,46.97,77,,37.58,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,94.33,385,,,fee schedule,385% of BCBS fee schedule,98.25,401,,,fee schedule,401% of BCBS fee schedule,98.25,401,,,fee schedule,401% of BCBS fee schedule,98.25,401,,,fee schedule,401% of BCBS fee schedule,54.9,90,,43.92,percent of total billed charges,90% of total billed charges,48.8,80,,39.04,percent of total billed charges,80% of total billed charges,54.9,90,,43.92,percent of total billed charges,90% of total billed charges,45.75,75,,36.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,17.69,29,,14.152,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,40.87,67,,32.696,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,48.8,80,,39.04,percent of total billed charges,80% of total billed charges,39.65,65,,31.72,percent of total billed charges,65% of total billed charges,21.76,35.67,,17.408,percent of total billed charges,35.67% of total billed charges,17.69,98.25,
WHEELCHAIR 7TH MONTH RENTAL,27703563,CDM,290,RC,K0001,HCPCS,outpatient,,,61,24.40,KJRRKX,51.85,85,,41.48,percent of total billed charges,85% of total billed charges,46.97,77,,37.58,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,94.33,385,,,fee schedule,385% of BCBS fee schedule,98.25,401,,,fee schedule,401% of BCBS fee schedule,98.25,401,,,fee schedule,401% of BCBS fee schedule,98.25,401,,,fee schedule,401% of BCBS fee schedule,54.9,90,,43.92,percent of total billed charges,90% of total billed charges,48.8,80,,39.04,percent of total billed charges,80% of total billed charges,54.9,90,,43.92,percent of total billed charges,90% of total billed charges,45.75,75,,36.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,17.69,29,,14.152,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,40.87,67,,32.696,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,48.8,80,,39.04,percent of total billed charges,80% of total billed charges,39.65,65,,31.72,percent of total billed charges,65% of total billed charges,21.76,35.67,,17.408,percent of total billed charges,35.67% of total billed charges,17.69,98.25,
WHEELCHAIR 8TH MONTH RENTAL,27703564,CDM,290,RC,K0001,HCPCS,outpatient,,,31,12.40,KJRRKX,26.35,85,,21.08,percent of total billed charges,85% of total billed charges,23.87,77,,19.1,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,94.33,385,,,fee schedule,385% of BCBS fee schedule,98.25,401,,,fee schedule,401% of BCBS fee schedule,98.25,401,,,fee schedule,401% of BCBS fee schedule,98.25,401,,,fee schedule,401% of BCBS fee schedule,27.9,90,,22.32,percent of total billed charges,90% of total billed charges,24.8,80,,19.84,percent of total billed charges,80% of total billed charges,27.9,90,,22.32,percent of total billed charges,90% of total billed charges,23.25,75,,18.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,8.99,29,,7.192,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,20.77,67,,16.616,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,24.8,80,,19.84,percent of total billed charges,80% of total billed charges,20.15,65,,16.12,percent of total billed charges,65% of total billed charges,11.06,35.67,,8.848,percent of total billed charges,35.67% of total billed charges,8.99,98.25,
WHEELCHAIR 9TH MONTH RENTAL,27703565,CDM,290,RC,K0001,HCPCS,outpatient,,,31,12.40,KJRRKX,26.35,85,,21.08,percent of total billed charges,85% of total billed charges,23.87,77,,19.1,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,94.33,385,,,fee schedule,385% of BCBS fee schedule,98.25,401,,,fee schedule,401% of BCBS fee schedule,98.25,401,,,fee schedule,401% of BCBS fee schedule,98.25,401,,,fee schedule,401% of BCBS fee schedule,27.9,90,,22.32,percent of total billed charges,90% of total billed charges,24.8,80,,19.84,percent of total billed charges,80% of total billed charges,27.9,90,,22.32,percent of total billed charges,90% of total billed charges,23.25,75,,18.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,8.99,29,,7.192,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,20.77,67,,16.616,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,24.8,80,,19.84,percent of total billed charges,80% of total billed charges,20.15,65,,16.12,percent of total billed charges,65% of total billed charges,11.06,35.67,,8.848,percent of total billed charges,35.67% of total billed charges,8.99,98.25,
WHEELCHAIR 10TH MONTH RENTAL,27703566,CDM,290,RC,K0001,HCPCS,outpatient,,,31,12.40,KJRRKX,26.35,85,,21.08,percent of total billed charges,85% of total billed charges,23.87,77,,19.1,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,94.33,385,,,fee schedule,385% of BCBS fee schedule,98.25,401,,,fee schedule,401% of BCBS fee schedule,98.25,401,,,fee schedule,401% of BCBS fee schedule,98.25,401,,,fee schedule,401% of BCBS fee schedule,27.9,90,,22.32,percent of total billed charges,90% of total billed charges,24.8,80,,19.84,percent of total billed charges,80% of total billed charges,27.9,90,,22.32,percent of total billed charges,90% of total billed charges,23.25,75,,18.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,8.99,29,,7.192,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,20.77,67,,16.616,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,24.8,80,,19.84,percent of total billed charges,80% of total billed charges,20.15,65,,16.12,percent of total billed charges,65% of total billed charges,11.06,35.67,,8.848,percent of total billed charges,35.67% of total billed charges,8.99,98.25,
WHEELCHAIR 11TH MONTH RENTAL,27703567,CDM,290,RC,K0001,HCPCS,outpatient,,,31,12.40,KJRRKX,26.35,85,,21.08,percent of total billed charges,85% of total billed charges,23.87,77,,19.1,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,94.33,385,,,fee schedule,385% of BCBS fee schedule,98.25,401,,,fee schedule,401% of BCBS fee schedule,98.25,401,,,fee schedule,401% of BCBS fee schedule,98.25,401,,,fee schedule,401% of BCBS fee schedule,27.9,90,,22.32,percent of total billed charges,90% of total billed charges,24.8,80,,19.84,percent of total billed charges,80% of total billed charges,27.9,90,,22.32,percent of total billed charges,90% of total billed charges,23.25,75,,18.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,8.99,29,,7.192,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,20.77,67,,16.616,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,24.8,80,,19.84,percent of total billed charges,80% of total billed charges,20.15,65,,16.12,percent of total billed charges,65% of total billed charges,11.06,35.67,,8.848,percent of total billed charges,35.67% of total billed charges,8.99,98.25,
WHEELCHAIR 12TH MONTH RENTAL,27703568,CDM,290,RC,K0001,HCPCS,outpatient,,,31,12.40,KJRRKX,26.35,85,,21.08,percent of total billed charges,85% of total billed charges,23.87,77,,19.1,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,94.33,385,,,fee schedule,385% of BCBS fee schedule,98.25,401,,,fee schedule,401% of BCBS fee schedule,98.25,401,,,fee schedule,401% of BCBS fee schedule,98.25,401,,,fee schedule,401% of BCBS fee schedule,27.9,90,,22.32,percent of total billed charges,90% of total billed charges,24.8,80,,19.84,percent of total billed charges,80% of total billed charges,27.9,90,,22.32,percent of total billed charges,90% of total billed charges,23.25,75,,18.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,8.99,29,,7.192,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,20.77,67,,16.616,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,24.8,80,,19.84,percent of total billed charges,80% of total billed charges,20.15,65,,16.12,percent of total billed charges,65% of total billed charges,11.06,35.67,,8.848,percent of total billed charges,35.67% of total billed charges,8.99,98.25,
BARIATRIC WHEELCHAIR 13MT RENT,27703570,CDM,290,RC,K0006,HCPCS,outpatient,,,160,64.00,KJRRKX,136,85,,108.8,percent of total billed charges,85% of total billed charges,123.2,77,,98.56,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,258.57,385,,,fee schedule,385% of BCBS fee schedule,269.31,401,,,fee schedule,401% of BCBS fee schedule,269.31,401,,,fee schedule,401% of BCBS fee schedule,269.31,401,,,fee schedule,401% of BCBS fee schedule,144,90,,115.2,percent of total billed charges,90% of total billed charges,128,80,,102.4,percent of total billed charges,80% of total billed charges,144,90,,115.2,percent of total billed charges,90% of total billed charges,120,75,,96,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,46.4,29,,37.12,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,107.2,67,,85.76,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,128,80,,102.4,percent of total billed charges,80% of total billed charges,104,65,,83.2,percent of total billed charges,65% of total billed charges,57.07,35.67,,45.656,percent of total billed charges,35.67% of total billed charges,46.4,269.31,
NEBULIZER 2ND MONTH RENTAL,27703571,CDM,290,RC,E0570,HCPCS,outpatient,,,28,11.20,RRKIKX,23.8,85,,19.04,percent of total billed charges,85% of total billed charges,21.56,77,,17.25,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,23.79,385,,,fee schedule,385% of BCBS fee schedule,24.78,401,,,fee schedule,401% of BCBS fee schedule,24.78,401,,,fee schedule,401% of BCBS fee schedule,24.78,401,,,fee schedule,401% of BCBS fee schedule,25.2,90,,20.16,percent of total billed charges,90% of total billed charges,22.4,80,,17.92,percent of total billed charges,80% of total billed charges,25.2,90,,20.16,percent of total billed charges,90% of total billed charges,21,75,,16.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,8.12,29,,6.496,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,18.76,67,,15.008,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,22.4,80,,17.92,percent of total billed charges,80% of total billed charges,18.2,65,,14.56,percent of total billed charges,65% of total billed charges,9.99,35.67,,7.992,percent of total billed charges,35.67% of total billed charges,8.12,25.2,
NEBULIZER 3RD MONTH RENTAL,27703572,CDM,290,RC,E0570,HCPCS,outpatient,,,28,11.20,RRKIKX,23.8,85,,19.04,percent of total billed charges,85% of total billed charges,21.56,77,,17.25,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,23.79,385,,,fee schedule,385% of BCBS fee schedule,24.78,401,,,fee schedule,401% of BCBS fee schedule,24.78,401,,,fee schedule,401% of BCBS fee schedule,24.78,401,,,fee schedule,401% of BCBS fee schedule,25.2,90,,20.16,percent of total billed charges,90% of total billed charges,22.4,80,,17.92,percent of total billed charges,80% of total billed charges,25.2,90,,20.16,percent of total billed charges,90% of total billed charges,21,75,,16.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,8.12,29,,6.496,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,18.76,67,,15.008,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,22.4,80,,17.92,percent of total billed charges,80% of total billed charges,18.2,65,,14.56,percent of total billed charges,65% of total billed charges,9.99,35.67,,7.992,percent of total billed charges,35.67% of total billed charges,8.12,25.2,
NEBULIZER 4-13 MONTH RENT,27703573,CDM,290,RC,E0570,HCPCS,outpatient,,,28,11.20,RRKJKX,23.8,85,,19.04,percent of total billed charges,85% of total billed charges,21.56,77,,17.25,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,23.79,385,,,fee schedule,385% of BCBS fee schedule,24.78,401,,,fee schedule,401% of BCBS fee schedule,24.78,401,,,fee schedule,401% of BCBS fee schedule,24.78,401,,,fee schedule,401% of BCBS fee schedule,25.2,90,,20.16,percent of total billed charges,90% of total billed charges,22.4,80,,17.92,percent of total billed charges,80% of total billed charges,25.2,90,,20.16,percent of total billed charges,90% of total billed charges,21,75,,16.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,8.12,29,,6.496,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,18.76,67,,15.008,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,22.4,80,,17.92,percent of total billed charges,80% of total billed charges,18.2,65,,14.56,percent of total billed charges,65% of total billed charges,9.99,35.67,,7.992,percent of total billed charges,35.67% of total billed charges,8.12,25.2,
NEBULIZER 5TH MONTH RENTAL,27703574,CDM,290,RC,E0570,HCPCS,outpatient,,,25,10.00,RRKJKX,21.25,85,,17,percent of total billed charges,85% of total billed charges,19.25,77,,15.4,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,23.79,385,,,fee schedule,385% of BCBS fee schedule,24.78,401,,,fee schedule,401% of BCBS fee schedule,24.78,401,,,fee schedule,401% of BCBS fee schedule,24.78,401,,,fee schedule,401% of BCBS fee schedule,22.5,90,,18,percent of total billed charges,90% of total billed charges,20,80,,16,percent of total billed charges,80% of total billed charges,22.5,90,,18,percent of total billed charges,90% of total billed charges,18.75,75,,15,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,7.25,29,,5.8,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,16.75,67,,13.4,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,20,80,,16,percent of total billed charges,80% of total billed charges,16.25,65,,13,percent of total billed charges,65% of total billed charges,8.92,35.67,,7.136,percent of total billed charges,35.67% of total billed charges,7.25,24.78,
NEBULIZER 6TH MONTH RENTAL,27703576,CDM,290,RC,E0570,HCPCS,outpatient,,,25,10.00,RRKJKX,21.25,85,,17,percent of total billed charges,85% of total billed charges,19.25,77,,15.4,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,23.79,385,,,fee schedule,385% of BCBS fee schedule,24.78,401,,,fee schedule,401% of BCBS fee schedule,24.78,401,,,fee schedule,401% of BCBS fee schedule,24.78,401,,,fee schedule,401% of BCBS fee schedule,22.5,90,,18,percent of total billed charges,90% of total billed charges,20,80,,16,percent of total billed charges,80% of total billed charges,22.5,90,,18,percent of total billed charges,90% of total billed charges,18.75,75,,15,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,7.25,29,,5.8,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,16.75,67,,13.4,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,20,80,,16,percent of total billed charges,80% of total billed charges,16.25,65,,13,percent of total billed charges,65% of total billed charges,8.92,35.67,,7.136,percent of total billed charges,35.67% of total billed charges,7.25,24.78,
NEBULIZER 7TH MONTH RENTAL,27703577,CDM,290,RC,E0570,HCPCS,outpatient,,,28,11.20,RRKJKX,23.8,85,,19.04,percent of total billed charges,85% of total billed charges,21.56,77,,17.25,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,23.79,385,,,fee schedule,385% of BCBS fee schedule,24.78,401,,,fee schedule,401% of BCBS fee schedule,24.78,401,,,fee schedule,401% of BCBS fee schedule,24.78,401,,,fee schedule,401% of BCBS fee schedule,25.2,90,,20.16,percent of total billed charges,90% of total billed charges,22.4,80,,17.92,percent of total billed charges,80% of total billed charges,25.2,90,,20.16,percent of total billed charges,90% of total billed charges,21,75,,16.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,8.12,29,,6.496,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,18.76,67,,15.008,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,22.4,80,,17.92,percent of total billed charges,80% of total billed charges,18.2,65,,14.56,percent of total billed charges,65% of total billed charges,9.99,35.67,,7.992,percent of total billed charges,35.67% of total billed charges,8.12,25.2,
NEBULIZER 8TH MONTH RENTAL,27703578,CDM,290,RC,E0570,HCPCS,outpatient,,,25,10.00,RRKJKX,21.25,85,,17,percent of total billed charges,85% of total billed charges,19.25,77,,15.4,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,23.79,385,,,fee schedule,385% of BCBS fee schedule,24.78,401,,,fee schedule,401% of BCBS fee schedule,24.78,401,,,fee schedule,401% of BCBS fee schedule,24.78,401,,,fee schedule,401% of BCBS fee schedule,22.5,90,,18,percent of total billed charges,90% of total billed charges,20,80,,16,percent of total billed charges,80% of total billed charges,22.5,90,,18,percent of total billed charges,90% of total billed charges,18.75,75,,15,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,7.25,29,,5.8,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,16.75,67,,13.4,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,20,80,,16,percent of total billed charges,80% of total billed charges,16.25,65,,13,percent of total billed charges,65% of total billed charges,8.92,35.67,,7.136,percent of total billed charges,35.67% of total billed charges,7.25,24.78,
NEBULIZER 9TH MONTH RENTAL,27703579,CDM,290,RC,E0570,HCPCS,outpatient,,,25,10.00,RRKJKX,21.25,85,,17,percent of total billed charges,85% of total billed charges,19.25,77,,15.4,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,23.79,385,,,fee schedule,385% of BCBS fee schedule,24.78,401,,,fee schedule,401% of BCBS fee schedule,24.78,401,,,fee schedule,401% of BCBS fee schedule,24.78,401,,,fee schedule,401% of BCBS fee schedule,22.5,90,,18,percent of total billed charges,90% of total billed charges,20,80,,16,percent of total billed charges,80% of total billed charges,22.5,90,,18,percent of total billed charges,90% of total billed charges,18.75,75,,15,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,7.25,29,,5.8,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,16.75,67,,13.4,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,20,80,,16,percent of total billed charges,80% of total billed charges,16.25,65,,13,percent of total billed charges,65% of total billed charges,8.92,35.67,,7.136,percent of total billed charges,35.67% of total billed charges,7.25,24.78,
NEBULIZER 10TH MONTH RENTAL,27703580,CDM,290,RC,E0570,HCPCS,outpatient,,,25,10.00,RRKJKX,21.25,85,,17,percent of total billed charges,85% of total billed charges,19.25,77,,15.4,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,23.79,385,,,fee schedule,385% of BCBS fee schedule,24.78,401,,,fee schedule,401% of BCBS fee schedule,24.78,401,,,fee schedule,401% of BCBS fee schedule,24.78,401,,,fee schedule,401% of BCBS fee schedule,22.5,90,,18,percent of total billed charges,90% of total billed charges,20,80,,16,percent of total billed charges,80% of total billed charges,22.5,90,,18,percent of total billed charges,90% of total billed charges,18.75,75,,15,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,7.25,29,,5.8,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,16.75,67,,13.4,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,20,80,,16,percent of total billed charges,80% of total billed charges,16.25,65,,13,percent of total billed charges,65% of total billed charges,8.92,35.67,,7.136,percent of total billed charges,35.67% of total billed charges,7.25,24.78,
NEBULIZER 11TH MONTH RENTAL,27703581,CDM,290,RC,E0570,HCPCS,outpatient,,,25,10.00,RRKJKX,21.25,85,,17,percent of total billed charges,85% of total billed charges,19.25,77,,15.4,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,23.79,385,,,fee schedule,385% of BCBS fee schedule,24.78,401,,,fee schedule,401% of BCBS fee schedule,24.78,401,,,fee schedule,401% of BCBS fee schedule,24.78,401,,,fee schedule,401% of BCBS fee schedule,22.5,90,,18,percent of total billed charges,90% of total billed charges,20,80,,16,percent of total billed charges,80% of total billed charges,22.5,90,,18,percent of total billed charges,90% of total billed charges,18.75,75,,15,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,7.25,29,,5.8,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,16.75,67,,13.4,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,20,80,,16,percent of total billed charges,80% of total billed charges,16.25,65,,13,percent of total billed charges,65% of total billed charges,8.92,35.67,,7.136,percent of total billed charges,35.67% of total billed charges,7.25,24.78,
NEBULIZER PURCHASE CASH,27703583,CDM,290,RC,E0570,HCPCS,outpatient,,,54,21.60,RRKJKX,45.9,85,,36.72,percent of total billed charges,85% of total billed charges,41.58,77,,33.26,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,23.79,385,,,fee schedule,385% of BCBS fee schedule,24.78,401,,,fee schedule,401% of BCBS fee schedule,24.78,401,,,fee schedule,401% of BCBS fee schedule,24.78,401,,,fee schedule,401% of BCBS fee schedule,48.6,90,,38.88,percent of total billed charges,90% of total billed charges,43.2,80,,34.56,percent of total billed charges,80% of total billed charges,48.6,90,,38.88,percent of total billed charges,90% of total billed charges,40.5,75,,32.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,15.66,29,,12.528,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,36.18,67,,28.944,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,43.2,80,,34.56,percent of total billed charges,80% of total billed charges,35.1,65,,28.08,percent of total billed charges,65% of total billed charges,19.26,35.67,,15.408,percent of total billed charges,35.67% of total billed charges,15.66,48.6,
CPAP PRO HUMID 2ND MONTH RENT,27703584,CDM,290,RC,E0601,HCPCS,outpatient,,,161,64.40,RRKIKX,136.85,85,,109.48,percent of total billed charges,85% of total billed charges,123.97,77,,99.18,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,169.21,385,,,fee schedule,385% of BCBS fee schedule,176.24,401,,,fee schedule,401% of BCBS fee schedule,176.24,401,,,fee schedule,401% of BCBS fee schedule,176.24,401,,,fee schedule,401% of BCBS fee schedule,144.9,90,,115.92,percent of total billed charges,90% of total billed charges,128.8,80,,103.04,percent of total billed charges,80% of total billed charges,144.9,90,,115.92,percent of total billed charges,90% of total billed charges,120.75,75,,96.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,46.69,29,,37.352,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,107.87,67,,86.296,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,128.8,80,,103.04,percent of total billed charges,80% of total billed charges,104.65,65,,83.72,percent of total billed charges,65% of total billed charges,57.43,35.67,,45.944,percent of total billed charges,35.67% of total billed charges,46.69,176.24,
CPAP PRO HUMID 3RD MONTH RENT,27703585,CDM,290,RC,E0601,HCPCS,outpatient,,,161,64.40,RRKIKX,136.85,85,,109.48,percent of total billed charges,85% of total billed charges,123.97,77,,99.18,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,169.21,385,,,fee schedule,385% of BCBS fee schedule,176.24,401,,,fee schedule,401% of BCBS fee schedule,176.24,401,,,fee schedule,401% of BCBS fee schedule,176.24,401,,,fee schedule,401% of BCBS fee schedule,144.9,90,,115.92,percent of total billed charges,90% of total billed charges,128.8,80,,103.04,percent of total billed charges,80% of total billed charges,144.9,90,,115.92,percent of total billed charges,90% of total billed charges,120.75,75,,96.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,46.69,29,,37.352,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,107.87,67,,86.296,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,128.8,80,,103.04,percent of total billed charges,80% of total billed charges,104.65,65,,83.72,percent of total billed charges,65% of total billed charges,57.43,35.67,,45.944,percent of total billed charges,35.67% of total billed charges,46.69,176.24,
CPAP PRO HUMID 4TH MONTH RENT,27703586,CDM,290,RC,E0601,HCPCS,outpatient,,,84,33.60,RRKJKX,71.4,85,,57.12,percent of total billed charges,85% of total billed charges,64.68,77,,51.74,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,169.21,385,,,fee schedule,385% of BCBS fee schedule,176.24,401,,,fee schedule,401% of BCBS fee schedule,176.24,401,,,fee schedule,401% of BCBS fee schedule,176.24,401,,,fee schedule,401% of BCBS fee schedule,75.6,90,,60.48,percent of total billed charges,90% of total billed charges,67.2,80,,53.76,percent of total billed charges,80% of total billed charges,75.6,90,,60.48,percent of total billed charges,90% of total billed charges,63,75,,50.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,24.36,29,,19.488,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,56.28,67,,45.024,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,67.2,80,,53.76,percent of total billed charges,80% of total billed charges,54.6,65,,43.68,percent of total billed charges,65% of total billed charges,29.96,35.67,,23.968,percent of total billed charges,35.67% of total billed charges,24.36,176.24,
CPAP PRO HUMID 5TH MONTH RENT,27703587,CDM,290,RC,E0601,HCPCS,outpatient,,,84,33.60,RRKJKX,71.4,85,,57.12,percent of total billed charges,85% of total billed charges,64.68,77,,51.74,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,169.21,385,,,fee schedule,385% of BCBS fee schedule,176.24,401,,,fee schedule,401% of BCBS fee schedule,176.24,401,,,fee schedule,401% of BCBS fee schedule,176.24,401,,,fee schedule,401% of BCBS fee schedule,75.6,90,,60.48,percent of total billed charges,90% of total billed charges,67.2,80,,53.76,percent of total billed charges,80% of total billed charges,75.6,90,,60.48,percent of total billed charges,90% of total billed charges,63,75,,50.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,24.36,29,,19.488,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,56.28,67,,45.024,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,67.2,80,,53.76,percent of total billed charges,80% of total billed charges,54.6,65,,43.68,percent of total billed charges,65% of total billed charges,29.96,35.67,,23.968,percent of total billed charges,35.67% of total billed charges,24.36,176.24,
CPAP PRO HUMID 4 THRU 13,27703588,CDM,290,RC,E0601,HCPCS,outpatient,,,161,64.40,RRKJKX,136.85,85,,109.48,percent of total billed charges,85% of total billed charges,123.97,77,,99.18,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,169.21,385,,,fee schedule,385% of BCBS fee schedule,176.24,401,,,fee schedule,401% of BCBS fee schedule,176.24,401,,,fee schedule,401% of BCBS fee schedule,176.24,401,,,fee schedule,401% of BCBS fee schedule,144.9,90,,115.92,percent of total billed charges,90% of total billed charges,128.8,80,,103.04,percent of total billed charges,80% of total billed charges,144.9,90,,115.92,percent of total billed charges,90% of total billed charges,120.75,75,,96.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,46.69,29,,37.352,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,107.87,67,,86.296,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,128.8,80,,103.04,percent of total billed charges,80% of total billed charges,104.65,65,,83.72,percent of total billed charges,65% of total billed charges,57.43,35.67,,45.944,percent of total billed charges,35.67% of total billed charges,46.69,176.24,
CPAP PRO HUMID 7TH MONTH RENT,27703589,CDM,290,RC,E0601,HCPCS,outpatient,,,84,33.60,RRKJKX,71.4,85,,57.12,percent of total billed charges,85% of total billed charges,64.68,77,,51.74,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,169.21,385,,,fee schedule,385% of BCBS fee schedule,176.24,401,,,fee schedule,401% of BCBS fee schedule,176.24,401,,,fee schedule,401% of BCBS fee schedule,176.24,401,,,fee schedule,401% of BCBS fee schedule,75.6,90,,60.48,percent of total billed charges,90% of total billed charges,67.2,80,,53.76,percent of total billed charges,80% of total billed charges,75.6,90,,60.48,percent of total billed charges,90% of total billed charges,63,75,,50.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,24.36,29,,19.488,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,56.28,67,,45.024,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,67.2,80,,53.76,percent of total billed charges,80% of total billed charges,54.6,65,,43.68,percent of total billed charges,65% of total billed charges,29.96,35.67,,23.968,percent of total billed charges,35.67% of total billed charges,24.36,176.24,
CPAP PRO HUMID 8TH MONTH RENT,27703590,CDM,290,RC,E0601,HCPCS,outpatient,,,82,32.80,RRKJKX,69.7,85,,55.76,percent of total billed charges,85% of total billed charges,63.14,77,,50.51,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,169.21,385,,,fee schedule,385% of BCBS fee schedule,176.24,401,,,fee schedule,401% of BCBS fee schedule,176.24,401,,,fee schedule,401% of BCBS fee schedule,176.24,401,,,fee schedule,401% of BCBS fee schedule,73.8,90,,59.04,percent of total billed charges,90% of total billed charges,65.6,80,,52.48,percent of total billed charges,80% of total billed charges,73.8,90,,59.04,percent of total billed charges,90% of total billed charges,61.5,75,,49.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,23.78,29,,19.024,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,54.94,67,,43.952,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,65.6,80,,52.48,percent of total billed charges,80% of total billed charges,53.3,65,,42.64,percent of total billed charges,65% of total billed charges,29.25,35.67,,23.4,percent of total billed charges,35.67% of total billed charges,23.78,176.24,
CPAP PRO HUMID 9TH MONTH RENT,27703591,CDM,290,RC,E0601,HCPCS,outpatient,,,82,32.80,RRKJKX,69.7,85,,55.76,percent of total billed charges,85% of total billed charges,63.14,77,,50.51,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,169.21,385,,,fee schedule,385% of BCBS fee schedule,176.24,401,,,fee schedule,401% of BCBS fee schedule,176.24,401,,,fee schedule,401% of BCBS fee schedule,176.24,401,,,fee schedule,401% of BCBS fee schedule,73.8,90,,59.04,percent of total billed charges,90% of total billed charges,65.6,80,,52.48,percent of total billed charges,80% of total billed charges,73.8,90,,59.04,percent of total billed charges,90% of total billed charges,61.5,75,,49.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,23.78,29,,19.024,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,54.94,67,,43.952,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,65.6,80,,52.48,percent of total billed charges,80% of total billed charges,53.3,65,,42.64,percent of total billed charges,65% of total billed charges,29.25,35.67,,23.4,percent of total billed charges,35.67% of total billed charges,23.78,176.24,
CPAP PRO HUMID 10TH MONTH RENT,27703592,CDM,290,RC,E0601,HCPCS,outpatient,,,82,32.80,RRKJKX,69.7,85,,55.76,percent of total billed charges,85% of total billed charges,63.14,77,,50.51,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,169.21,385,,,fee schedule,385% of BCBS fee schedule,176.24,401,,,fee schedule,401% of BCBS fee schedule,176.24,401,,,fee schedule,401% of BCBS fee schedule,176.24,401,,,fee schedule,401% of BCBS fee schedule,73.8,90,,59.04,percent of total billed charges,90% of total billed charges,65.6,80,,52.48,percent of total billed charges,80% of total billed charges,73.8,90,,59.04,percent of total billed charges,90% of total billed charges,61.5,75,,49.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,23.78,29,,19.024,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,54.94,67,,43.952,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,65.6,80,,52.48,percent of total billed charges,80% of total billed charges,53.3,65,,42.64,percent of total billed charges,65% of total billed charges,29.25,35.67,,23.4,percent of total billed charges,35.67% of total billed charges,23.78,176.24,
CPAP PRO HUMID 11TH MONTH RENT,27703593,CDM,290,RC,E0601,HCPCS,outpatient,,,84,33.60,RRKJKX,71.4,85,,57.12,percent of total billed charges,85% of total billed charges,64.68,77,,51.74,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,169.21,385,,,fee schedule,385% of BCBS fee schedule,176.24,401,,,fee schedule,401% of BCBS fee schedule,176.24,401,,,fee schedule,401% of BCBS fee schedule,176.24,401,,,fee schedule,401% of BCBS fee schedule,75.6,90,,60.48,percent of total billed charges,90% of total billed charges,67.2,80,,53.76,percent of total billed charges,80% of total billed charges,75.6,90,,60.48,percent of total billed charges,90% of total billed charges,63,75,,50.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,24.36,29,,19.488,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,56.28,67,,45.024,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,67.2,80,,53.76,percent of total billed charges,80% of total billed charges,54.6,65,,43.68,percent of total billed charges,65% of total billed charges,29.96,35.67,,23.968,percent of total billed charges,35.67% of total billed charges,24.36,176.24,
CPAP PRO HUMID 12TH MONTH RENT,27703594,CDM,290,RC,E0601,HCPCS,outpatient,,,61,24.40,RRKJKX,51.85,85,,41.48,percent of total billed charges,85% of total billed charges,46.97,77,,37.58,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,169.21,385,,,fee schedule,385% of BCBS fee schedule,176.24,401,,,fee schedule,401% of BCBS fee schedule,176.24,401,,,fee schedule,401% of BCBS fee schedule,176.24,401,,,fee schedule,401% of BCBS fee schedule,54.9,90,,43.92,percent of total billed charges,90% of total billed charges,48.8,80,,39.04,percent of total billed charges,80% of total billed charges,54.9,90,,43.92,percent of total billed charges,90% of total billed charges,45.75,75,,36.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,17.69,29,,14.152,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,40.87,67,,32.696,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,48.8,80,,39.04,percent of total billed charges,80% of total billed charges,39.65,65,,31.72,percent of total billed charges,65% of total billed charges,21.76,35.67,,17.408,percent of total billed charges,35.67% of total billed charges,17.69,176.24,
CPAP PRO HUMID 13TH MONTH RENT,27703595,CDM,290,RC,E0601,HCPCS,outpatient,,,61,24.40,RRKJKX,51.85,85,,41.48,percent of total billed charges,85% of total billed charges,46.97,77,,37.58,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,169.21,385,,,fee schedule,385% of BCBS fee schedule,176.24,401,,,fee schedule,401% of BCBS fee schedule,176.24,401,,,fee schedule,401% of BCBS fee schedule,176.24,401,,,fee schedule,401% of BCBS fee schedule,54.9,90,,43.92,percent of total billed charges,90% of total billed charges,48.8,80,,39.04,percent of total billed charges,80% of total billed charges,54.9,90,,43.92,percent of total billed charges,90% of total billed charges,45.75,75,,36.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,17.69,29,,14.152,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,40.87,67,,32.696,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,48.8,80,,39.04,percent of total billed charges,80% of total billed charges,39.65,65,,31.72,percent of total billed charges,65% of total billed charges,21.76,35.67,,17.408,percent of total billed charges,35.67% of total billed charges,17.69,176.24,
CPAP AUTO HUMID 2ND MONTH RENT,27703596,CDM,290,RC,E0601,HCPCS,outpatient,,,161,64.40,KIRRKX,136.85,85,,109.48,percent of total billed charges,85% of total billed charges,123.97,77,,99.18,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,169.21,385,,,fee schedule,385% of BCBS fee schedule,176.24,401,,,fee schedule,401% of BCBS fee schedule,176.24,401,,,fee schedule,401% of BCBS fee schedule,176.24,401,,,fee schedule,401% of BCBS fee schedule,144.9,90,,115.92,percent of total billed charges,90% of total billed charges,128.8,80,,103.04,percent of total billed charges,80% of total billed charges,144.9,90,,115.92,percent of total billed charges,90% of total billed charges,120.75,75,,96.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,46.69,29,,37.352,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,107.87,67,,86.296,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,128.8,80,,103.04,percent of total billed charges,80% of total billed charges,104.65,65,,83.72,percent of total billed charges,65% of total billed charges,57.43,35.67,,45.944,percent of total billed charges,35.67% of total billed charges,46.69,176.24,
CPAP AUTO HUMID 3RD MONTH RENT,27703597,CDM,290,RC,E0601,HCPCS,outpatient,,,163,65.20,KIRRKX,138.55,85,,110.84,percent of total billed charges,85% of total billed charges,125.51,77,,100.41,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,169.21,385,,,fee schedule,385% of BCBS fee schedule,176.24,401,,,fee schedule,401% of BCBS fee schedule,176.24,401,,,fee schedule,401% of BCBS fee schedule,176.24,401,,,fee schedule,401% of BCBS fee schedule,146.7,90,,117.36,percent of total billed charges,90% of total billed charges,130.4,80,,104.32,percent of total billed charges,80% of total billed charges,146.7,90,,117.36,percent of total billed charges,90% of total billed charges,122.25,75,,97.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,47.27,29,,37.816,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,109.21,67,,87.368,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,130.4,80,,104.32,percent of total billed charges,80% of total billed charges,105.95,65,,84.76,percent of total billed charges,65% of total billed charges,58.14,35.67,,46.512,percent of total billed charges,35.67% of total billed charges,47.27,176.24,
CPAP AUTO HUMID 4-13 MONTH,27703598,CDM,290,RC,E0601,HCPCS,outpatient,,,163,65.20,KJRRKX,138.55,85,,110.84,percent of total billed charges,85% of total billed charges,125.51,77,,100.41,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,169.21,385,,,fee schedule,385% of BCBS fee schedule,176.24,401,,,fee schedule,401% of BCBS fee schedule,176.24,401,,,fee schedule,401% of BCBS fee schedule,176.24,401,,,fee schedule,401% of BCBS fee schedule,146.7,90,,117.36,percent of total billed charges,90% of total billed charges,130.4,80,,104.32,percent of total billed charges,80% of total billed charges,146.7,90,,117.36,percent of total billed charges,90% of total billed charges,122.25,75,,97.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,47.27,29,,37.816,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,109.21,67,,87.368,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,130.4,80,,104.32,percent of total billed charges,80% of total billed charges,105.95,65,,84.76,percent of total billed charges,65% of total billed charges,58.14,35.67,,46.512,percent of total billed charges,35.67% of total billed charges,47.27,176.24,
CPAP AUTO HEAT HUMID 1ST MONTH,27703599,CDM,290,RC,E0562,HCPCS,outpatient,,,41,16.40,KHRRKX,34.85,85,,27.88,percent of total billed charges,85% of total billed charges,31.57,77,,25.26,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,568.53,385,,,fee schedule,385% of BCBS fee schedule,592.16,401,,,fee schedule,401% of BCBS fee schedule,592.16,401,,,fee schedule,401% of BCBS fee schedule,592.16,401,,,fee schedule,401% of BCBS fee schedule,36.9,90,,29.52,percent of total billed charges,90% of total billed charges,32.8,80,,26.24,percent of total billed charges,80% of total billed charges,36.9,90,,29.52,percent of total billed charges,90% of total billed charges,30.75,75,,24.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,11.89,29,,9.512,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,27.47,67,,21.976,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,32.8,80,,26.24,percent of total billed charges,80% of total billed charges,26.65,65,,21.32,percent of total billed charges,65% of total billed charges,14.62,35.67,,11.696,percent of total billed charges,35.67% of total billed charges,11.89,592.16,
CPAP AUTO HEAT HUMID 4-13 MONT,27703600,CDM,290,RC,E0562,HCPCS,outpatient,,,41,16.40,KJRRKX,34.85,85,,27.88,percent of total billed charges,85% of total billed charges,31.57,77,,25.26,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,568.53,385,,,fee schedule,385% of BCBS fee schedule,592.16,401,,,fee schedule,401% of BCBS fee schedule,592.16,401,,,fee schedule,401% of BCBS fee schedule,592.16,401,,,fee schedule,401% of BCBS fee schedule,36.9,90,,29.52,percent of total billed charges,90% of total billed charges,32.8,80,,26.24,percent of total billed charges,80% of total billed charges,36.9,90,,29.52,percent of total billed charges,90% of total billed charges,30.75,75,,24.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,11.89,29,,9.512,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,27.47,67,,21.976,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,32.8,80,,26.24,percent of total billed charges,80% of total billed charges,26.65,65,,21.32,percent of total billed charges,65% of total billed charges,14.62,35.67,,11.696,percent of total billed charges,35.67% of total billed charges,11.89,592.16,
CPAP AUTO HUMID 7TH MONTH RENT,27703601,CDM,290,RC,E0601,HCPCS,outpatient,,,61,24.40,KJRRKX,51.85,85,,41.48,percent of total billed charges,85% of total billed charges,46.97,77,,37.58,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,169.21,385,,,fee schedule,385% of BCBS fee schedule,176.24,401,,,fee schedule,401% of BCBS fee schedule,176.24,401,,,fee schedule,401% of BCBS fee schedule,176.24,401,,,fee schedule,401% of BCBS fee schedule,54.9,90,,43.92,percent of total billed charges,90% of total billed charges,48.8,80,,39.04,percent of total billed charges,80% of total billed charges,54.9,90,,43.92,percent of total billed charges,90% of total billed charges,45.75,75,,36.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,17.69,29,,14.152,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,40.87,67,,32.696,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,48.8,80,,39.04,percent of total billed charges,80% of total billed charges,39.65,65,,31.72,percent of total billed charges,65% of total billed charges,21.76,35.67,,17.408,percent of total billed charges,35.67% of total billed charges,17.69,176.24,
CPAP AUTO HUMID 8TH MONTH RENT,27703602,CDM,290,RC,E0601,HCPCS,outpatient,,,61,24.40,KJRRKX,51.85,85,,41.48,percent of total billed charges,85% of total billed charges,46.97,77,,37.58,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,169.21,385,,,fee schedule,385% of BCBS fee schedule,176.24,401,,,fee schedule,401% of BCBS fee schedule,176.24,401,,,fee schedule,401% of BCBS fee schedule,176.24,401,,,fee schedule,401% of BCBS fee schedule,54.9,90,,43.92,percent of total billed charges,90% of total billed charges,48.8,80,,39.04,percent of total billed charges,80% of total billed charges,54.9,90,,43.92,percent of total billed charges,90% of total billed charges,45.75,75,,36.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,17.69,29,,14.152,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,40.87,67,,32.696,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,48.8,80,,39.04,percent of total billed charges,80% of total billed charges,39.65,65,,31.72,percent of total billed charges,65% of total billed charges,21.76,35.67,,17.408,percent of total billed charges,35.67% of total billed charges,17.69,176.24,
CPAP HUMIDIFIER HEATED BCBS,27703604,CDM,290,RC,E0562,HCPCS,outpatient,,,623,249.20,NUKX,529.55,85,,423.64,percent of total billed charges,85% of total billed charges,479.71,77,,383.77,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,568.53,385,,,fee schedule,385% of BCBS fee schedule,592.16,401,,,fee schedule,401% of BCBS fee schedule,592.16,401,,,fee schedule,401% of BCBS fee schedule,592.16,401,,,fee schedule,401% of BCBS fee schedule,560.7,90,,448.56,percent of total billed charges,90% of total billed charges,498.4,80,,398.72,percent of total billed charges,80% of total billed charges,560.7,90,,448.56,percent of total billed charges,90% of total billed charges,467.25,75,,373.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,180.67,29,,144.536,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,417.41,67,,333.928,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,498.4,80,,398.72,percent of total billed charges,80% of total billed charges,404.95,65,,323.96,percent of total billed charges,65% of total billed charges,222.22,35.67,,177.776,percent of total billed charges,35.67% of total billed charges,180.67,592.16,
CPAP AUTO HEAT HUMID 2ND MONTH,27703605,CDM,290,RC,E0562,HCPCS,outpatient,,,41,16.40,KIRRKX,34.85,85,,27.88,percent of total billed charges,85% of total billed charges,31.57,77,,25.26,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,568.53,385,,,fee schedule,385% of BCBS fee schedule,592.16,401,,,fee schedule,401% of BCBS fee schedule,592.16,401,,,fee schedule,401% of BCBS fee schedule,592.16,401,,,fee schedule,401% of BCBS fee schedule,36.9,90,,29.52,percent of total billed charges,90% of total billed charges,32.8,80,,26.24,percent of total billed charges,80% of total billed charges,36.9,90,,29.52,percent of total billed charges,90% of total billed charges,30.75,75,,24.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,11.89,29,,9.512,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,27.47,67,,21.976,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,32.8,80,,26.24,percent of total billed charges,80% of total billed charges,26.65,65,,21.32,percent of total billed charges,65% of total billed charges,14.62,35.67,,11.696,percent of total billed charges,35.67% of total billed charges,11.89,592.16,
CPAP AUTO HEAT HUMID 3RD MONTH,27703606,CDM,290,RC,E0562,HCPCS,outpatient,,,41,16.40,KIRRKX,34.85,85,,27.88,percent of total billed charges,85% of total billed charges,31.57,77,,25.26,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,568.53,385,,,fee schedule,385% of BCBS fee schedule,592.16,401,,,fee schedule,401% of BCBS fee schedule,592.16,401,,,fee schedule,401% of BCBS fee schedule,592.16,401,,,fee schedule,401% of BCBS fee schedule,36.9,90,,29.52,percent of total billed charges,90% of total billed charges,32.8,80,,26.24,percent of total billed charges,80% of total billed charges,36.9,90,,29.52,percent of total billed charges,90% of total billed charges,30.75,75,,24.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,11.89,29,,9.512,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,27.47,67,,21.976,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,32.8,80,,26.24,percent of total billed charges,80% of total billed charges,26.65,65,,21.32,percent of total billed charges,65% of total billed charges,14.62,35.67,,11.696,percent of total billed charges,35.67% of total billed charges,11.89,592.16,
CPAP AUTO HUMID 1ST MONTH RENT,27703607,CDM,290,RC,E0601,HCPCS,outpatient,,,163,65.20,KHRRKX,138.55,85,,110.84,percent of total billed charges,85% of total billed charges,125.51,77,,100.41,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,169.21,385,,,fee schedule,385% of BCBS fee schedule,176.24,401,,,fee schedule,401% of BCBS fee schedule,176.24,401,,,fee schedule,401% of BCBS fee schedule,176.24,401,,,fee schedule,401% of BCBS fee schedule,146.7,90,,117.36,percent of total billed charges,90% of total billed charges,130.4,80,,104.32,percent of total billed charges,80% of total billed charges,146.7,90,,117.36,percent of total billed charges,90% of total billed charges,122.25,75,,97.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,47.27,29,,37.816,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,109.21,67,,87.368,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,130.4,80,,104.32,percent of total billed charges,80% of total billed charges,105.95,65,,84.76,percent of total billed charges,65% of total billed charges,58.14,35.67,,46.512,percent of total billed charges,35.67% of total billed charges,47.27,176.24,
PEDIATRIC MASK,27703608,CDM,290,RC,A7015,HCPCS,outpatient,,,8,3.20,NU,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,6.16,77,,4.93,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,5.24,385,,,fee schedule,385% of BCBS fee schedule,5.45,401,,,fee schedule,401% of BCBS fee schedule,5.45,401,,,fee schedule,401% of BCBS fee schedule,5.45,401,,,fee schedule,401% of BCBS fee schedule,7.2,90,,5.76,percent of total billed charges,90% of total billed charges,6.4,80,,5.12,percent of total billed charges,80% of total billed charges,7.2,90,,5.76,percent of total billed charges,90% of total billed charges,6,75,,4.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.32,29,,1.856,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,5.36,67,,4.288,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,6.4,80,,5.12,percent of total billed charges,80% of total billed charges,5.2,65,,4.16,percent of total billed charges,65% of total billed charges,2.85,35.67,,2.28,percent of total billed charges,35.67% of total billed charges,2.32,7.2,
ADULT AEROSOL MASK,27703609,CDM,290,RC,A7015,HCPCS,outpatient,,,6,2.40,NU,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,4.62,77,,3.7,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,5.24,385,,,fee schedule,385% of BCBS fee schedule,5.45,401,,,fee schedule,401% of BCBS fee schedule,5.45,401,,,fee schedule,401% of BCBS fee schedule,5.45,401,,,fee schedule,401% of BCBS fee schedule,5.4,90,,4.32,percent of total billed charges,90% of total billed charges,4.8,80,,3.84,percent of total billed charges,80% of total billed charges,5.4,90,,4.32,percent of total billed charges,90% of total billed charges,4.5,75,,3.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,1.74,29,,1.392,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4.02,67,,3.216,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,4.8,80,,3.84,percent of total billed charges,80% of total billed charges,3.9,65,,3.12,percent of total billed charges,65% of total billed charges,2.14,35.67,,1.712,percent of total billed charges,35.67% of total billed charges,1.74,5.45,
BIPAP AUTO 2ND MONTH RENT,27703611,CDM,290,RC,E0470,HCPCS,outpatient,,,411,164.40,KIRRKX,349.35,85,,279.48,percent of total billed charges,85% of total billed charges,316.47,77,,253.18,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,444.17,385,,,fee schedule,385% of BCBS fee schedule,462.63,401,,,fee schedule,401% of BCBS fee schedule,462.63,401,,,fee schedule,401% of BCBS fee schedule,462.63,401,,,fee schedule,401% of BCBS fee schedule,369.9,90,,295.92,percent of total billed charges,90% of total billed charges,328.8,80,,263.04,percent of total billed charges,80% of total billed charges,369.9,90,,295.92,percent of total billed charges,90% of total billed charges,308.25,75,,246.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,119.19,29,,95.352,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,275.37,67,,220.296,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,328.8,80,,263.04,percent of total billed charges,80% of total billed charges,267.15,65,,213.72,percent of total billed charges,65% of total billed charges,146.6,35.67,,117.28,percent of total billed charges,35.67% of total billed charges,119.19,462.63,
BIPAP AUTO 3RD MONTH RENT,27703612,CDM,290,RC,E0470,HCPCS,outpatient,,,411,164.40,KIRRKX,349.35,85,,279.48,percent of total billed charges,85% of total billed charges,316.47,77,,253.18,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,444.17,385,,,fee schedule,385% of BCBS fee schedule,462.63,401,,,fee schedule,401% of BCBS fee schedule,462.63,401,,,fee schedule,401% of BCBS fee schedule,462.63,401,,,fee schedule,401% of BCBS fee schedule,369.9,90,,295.92,percent of total billed charges,90% of total billed charges,328.8,80,,263.04,percent of total billed charges,80% of total billed charges,369.9,90,,295.92,percent of total billed charges,90% of total billed charges,308.25,75,,246.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,119.19,29,,95.352,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,275.37,67,,220.296,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,328.8,80,,263.04,percent of total billed charges,80% of total billed charges,267.15,65,,213.72,percent of total billed charges,65% of total billed charges,146.6,35.67,,117.28,percent of total billed charges,35.67% of total billed charges,119.19,462.63,
BIPAP HTD HUMID 4TH MONTH RENT,27703613,CDM,290,RC,E0470,HCPCS,outpatient,,,144,57.60,KJRRKX,122.4,85,,97.92,percent of total billed charges,85% of total billed charges,110.88,77,,88.7,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,444.17,385,,,fee schedule,385% of BCBS fee schedule,462.63,401,,,fee schedule,401% of BCBS fee schedule,462.63,401,,,fee schedule,401% of BCBS fee schedule,462.63,401,,,fee schedule,401% of BCBS fee schedule,129.6,90,,103.68,percent of total billed charges,90% of total billed charges,115.2,80,,92.16,percent of total billed charges,80% of total billed charges,129.6,90,,103.68,percent of total billed charges,90% of total billed charges,108,75,,86.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,41.76,29,,33.408,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,96.48,67,,77.184,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,115.2,80,,92.16,percent of total billed charges,80% of total billed charges,93.6,65,,74.88,percent of total billed charges,65% of total billed charges,51.36,35.67,,41.088,percent of total billed charges,35.67% of total billed charges,41.76,462.63,
BIPAP HTD HUMID 6TH MONTH RENT,27703615,CDM,290,RC,E0470,HCPCS,outpatient,,,144,57.60,KJRRKX,122.4,85,,97.92,percent of total billed charges,85% of total billed charges,110.88,77,,88.7,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,444.17,385,,,fee schedule,385% of BCBS fee schedule,462.63,401,,,fee schedule,401% of BCBS fee schedule,462.63,401,,,fee schedule,401% of BCBS fee schedule,462.63,401,,,fee schedule,401% of BCBS fee schedule,129.6,90,,103.68,percent of total billed charges,90% of total billed charges,115.2,80,,92.16,percent of total billed charges,80% of total billed charges,129.6,90,,103.68,percent of total billed charges,90% of total billed charges,108,75,,86.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,41.76,29,,33.408,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,96.48,67,,77.184,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,115.2,80,,92.16,percent of total billed charges,80% of total billed charges,93.6,65,,74.88,percent of total billed charges,65% of total billed charges,51.36,35.67,,41.088,percent of total billed charges,35.67% of total billed charges,41.76,462.63,
BIPAP HTD HUMID 7TH MONTH RENT,27703616,CDM,290,RC,E0470,HCPCS,outpatient,,,144,57.60,KJRRKX,122.4,85,,97.92,percent of total billed charges,85% of total billed charges,110.88,77,,88.7,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,444.17,385,,,fee schedule,385% of BCBS fee schedule,462.63,401,,,fee schedule,401% of BCBS fee schedule,462.63,401,,,fee schedule,401% of BCBS fee schedule,462.63,401,,,fee schedule,401% of BCBS fee schedule,129.6,90,,103.68,percent of total billed charges,90% of total billed charges,115.2,80,,92.16,percent of total billed charges,80% of total billed charges,129.6,90,,103.68,percent of total billed charges,90% of total billed charges,108,75,,86.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,41.76,29,,33.408,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,96.48,67,,77.184,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,115.2,80,,92.16,percent of total billed charges,80% of total billed charges,93.6,65,,74.88,percent of total billed charges,65% of total billed charges,51.36,35.67,,41.088,percent of total billed charges,35.67% of total billed charges,41.76,462.63,
BIPAP HTD HUMID 8TH MONTH RENT,27703617,CDM,290,RC,E0470,HCPCS,outpatient,,,144,57.60,KJRRKX,122.4,85,,97.92,percent of total billed charges,85% of total billed charges,110.88,77,,88.7,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,444.17,385,,,fee schedule,385% of BCBS fee schedule,462.63,401,,,fee schedule,401% of BCBS fee schedule,462.63,401,,,fee schedule,401% of BCBS fee schedule,462.63,401,,,fee schedule,401% of BCBS fee schedule,129.6,90,,103.68,percent of total billed charges,90% of total billed charges,115.2,80,,92.16,percent of total billed charges,80% of total billed charges,129.6,90,,103.68,percent of total billed charges,90% of total billed charges,108,75,,86.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,41.76,29,,33.408,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,96.48,67,,77.184,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,115.2,80,,92.16,percent of total billed charges,80% of total billed charges,93.6,65,,74.88,percent of total billed charges,65% of total billed charges,51.36,35.67,,41.088,percent of total billed charges,35.67% of total billed charges,41.76,462.63,
BIPAP HTD HUMID 9TH MONTH RENT,27703618,CDM,290,RC,E0470,HCPCS,outpatient,,,144,57.60,KJRRKX,122.4,85,,97.92,percent of total billed charges,85% of total billed charges,110.88,77,,88.7,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,444.17,385,,,fee schedule,385% of BCBS fee schedule,462.63,401,,,fee schedule,401% of BCBS fee schedule,462.63,401,,,fee schedule,401% of BCBS fee schedule,462.63,401,,,fee schedule,401% of BCBS fee schedule,129.6,90,,103.68,percent of total billed charges,90% of total billed charges,115.2,80,,92.16,percent of total billed charges,80% of total billed charges,129.6,90,,103.68,percent of total billed charges,90% of total billed charges,108,75,,86.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,41.76,29,,33.408,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,96.48,67,,77.184,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,115.2,80,,92.16,percent of total billed charges,80% of total billed charges,93.6,65,,74.88,percent of total billed charges,65% of total billed charges,51.36,35.67,,41.088,percent of total billed charges,35.67% of total billed charges,41.76,462.63,
BIPAP HTD HUMID 10TH MON RENT,27703619,CDM,290,RC,E0470,HCPCS,outpatient,,,144,57.60,KJRRKX,122.4,85,,97.92,percent of total billed charges,85% of total billed charges,110.88,77,,88.7,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,444.17,385,,,fee schedule,385% of BCBS fee schedule,462.63,401,,,fee schedule,401% of BCBS fee schedule,462.63,401,,,fee schedule,401% of BCBS fee schedule,462.63,401,,,fee schedule,401% of BCBS fee schedule,129.6,90,,103.68,percent of total billed charges,90% of total billed charges,115.2,80,,92.16,percent of total billed charges,80% of total billed charges,129.6,90,,103.68,percent of total billed charges,90% of total billed charges,108,75,,86.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,41.76,29,,33.408,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,96.48,67,,77.184,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,115.2,80,,92.16,percent of total billed charges,80% of total billed charges,93.6,65,,74.88,percent of total billed charges,65% of total billed charges,51.36,35.67,,41.088,percent of total billed charges,35.67% of total billed charges,41.76,462.63,
BIPAP HTD HUMID 11TH MON RENT,27703620,CDM,290,RC,E0470,HCPCS,outpatient,,,144,57.60,KJRRKX,122.4,85,,97.92,percent of total billed charges,85% of total billed charges,110.88,77,,88.7,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,444.17,385,,,fee schedule,385% of BCBS fee schedule,462.63,401,,,fee schedule,401% of BCBS fee schedule,462.63,401,,,fee schedule,401% of BCBS fee schedule,462.63,401,,,fee schedule,401% of BCBS fee schedule,129.6,90,,103.68,percent of total billed charges,90% of total billed charges,115.2,80,,92.16,percent of total billed charges,80% of total billed charges,129.6,90,,103.68,percent of total billed charges,90% of total billed charges,108,75,,86.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,41.76,29,,33.408,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,96.48,67,,77.184,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,115.2,80,,92.16,percent of total billed charges,80% of total billed charges,93.6,65,,74.88,percent of total billed charges,65% of total billed charges,51.36,35.67,,41.088,percent of total billed charges,35.67% of total billed charges,41.76,462.63,
BIPAP HTD HUMID 12TH MON RENT,27703621,CDM,290,RC,E0470,HCPCS,outpatient,,,144,57.60,KJRRKX,122.4,85,,97.92,percent of total billed charges,85% of total billed charges,110.88,77,,88.7,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,444.17,385,,,fee schedule,385% of BCBS fee schedule,462.63,401,,,fee schedule,401% of BCBS fee schedule,462.63,401,,,fee schedule,401% of BCBS fee schedule,462.63,401,,,fee schedule,401% of BCBS fee schedule,129.6,90,,103.68,percent of total billed charges,90% of total billed charges,115.2,80,,92.16,percent of total billed charges,80% of total billed charges,129.6,90,,103.68,percent of total billed charges,90% of total billed charges,108,75,,86.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,41.76,29,,33.408,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,96.48,67,,77.184,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,115.2,80,,92.16,percent of total billed charges,80% of total billed charges,93.6,65,,74.88,percent of total billed charges,65% of total billed charges,51.36,35.67,,41.088,percent of total billed charges,35.67% of total billed charges,41.76,462.63,
BIPAP HTD HUMID 13TH MON RENT,27703622,CDM,290,RC,E0470,HCPCS,outpatient,,,144,57.60,KJRRKX,122.4,85,,97.92,percent of total billed charges,85% of total billed charges,110.88,77,,88.7,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,444.17,385,,,fee schedule,385% of BCBS fee schedule,462.63,401,,,fee schedule,401% of BCBS fee schedule,462.63,401,,,fee schedule,401% of BCBS fee schedule,462.63,401,,,fee schedule,401% of BCBS fee schedule,129.6,90,,103.68,percent of total billed charges,90% of total billed charges,115.2,80,,92.16,percent of total billed charges,80% of total billed charges,129.6,90,,103.68,percent of total billed charges,90% of total billed charges,108,75,,86.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,41.76,29,,33.408,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,96.48,67,,77.184,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,115.2,80,,92.16,percent of total billed charges,80% of total billed charges,93.6,65,,74.88,percent of total billed charges,65% of total billed charges,51.36,35.67,,41.088,percent of total billed charges,35.67% of total billed charges,41.76,462.63,
JOBST RELIEF 30-40 THIGH OT,27703623,CDM,290,RC,A6530,HCPCS,outpatient,,,101,40.40,NU,85.85,85,,68.68,percent of total billed charges,85% of total billed charges,77.77,77,,62.22,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,82.82,82,,66.256,percent of total billed charges,82% of total billed charges,85.85,85,,68.68,percent of total billed charges,85% of total billed charges,85.85,85,,68.68,percent of total billed charges,85% of total billed charges,85.85,85,,68.68,percent of total billed charges,85% of total billed charges,90.9,90,,72.72,percent of total billed charges,90% of total billed charges,80.8,80,,64.64,percent of total billed charges,80% of total billed charges,90.9,90,,72.72,percent of total billed charges,90% of total billed charges,75.75,75,,60.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,29.29,29,,23.432,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,67.67,67,,54.136,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,80.8,80,,64.64,percent of total billed charges,80% of total billed charges,65.65,65,,52.52,percent of total billed charges,65% of total billed charges,36.03,35.67,,28.824,percent of total billed charges,35.67% of total billed charges,29.29,90.9,
AIRFIT N10 COMPLETE MASK SMALL,27703624,CDM,290,RC,A7034,HCPCS,outpatient,,,235,94.00,NUKX,199.75,85,,159.8,percent of total billed charges,85% of total billed charges,180.95,77,,144.76,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,231.46,385,,,fee schedule,385% of BCBS fee schedule,241.08,401,,,fee schedule,401% of BCBS fee schedule,241.08,401,,,fee schedule,401% of BCBS fee schedule,241.08,401,,,fee schedule,401% of BCBS fee schedule,211.5,90,,169.2,percent of total billed charges,90% of total billed charges,188,80,,150.4,percent of total billed charges,80% of total billed charges,211.5,90,,169.2,percent of total billed charges,90% of total billed charges,176.25,75,,141,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,68.15,29,,54.52,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,157.45,67,,125.96,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,188,80,,150.4,percent of total billed charges,80% of total billed charges,152.75,65,,122.2,percent of total billed charges,65% of total billed charges,83.82,35.67,,67.056,percent of total billed charges,35.67% of total billed charges,68.15,241.08,
AIRFIT N10 COMPLETE MASK STD,27703625,CDM,290,RC,A7034,HCPCS,outpatient,,,235,94.00,NUKX,199.75,85,,159.8,percent of total billed charges,85% of total billed charges,180.95,77,,144.76,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,231.46,385,,,fee schedule,385% of BCBS fee schedule,241.08,401,,,fee schedule,401% of BCBS fee schedule,241.08,401,,,fee schedule,401% of BCBS fee schedule,241.08,401,,,fee schedule,401% of BCBS fee schedule,211.5,90,,169.2,percent of total billed charges,90% of total billed charges,188,80,,150.4,percent of total billed charges,80% of total billed charges,211.5,90,,169.2,percent of total billed charges,90% of total billed charges,176.25,75,,141,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,68.15,29,,54.52,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,157.45,67,,125.96,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,188,80,,150.4,percent of total billed charges,80% of total billed charges,152.75,65,,122.2,percent of total billed charges,65% of total billed charges,83.82,35.67,,67.056,percent of total billed charges,35.67% of total billed charges,68.15,241.08,
AIRFIT N10 COMPLETE MASK WIDE,27703626,CDM,290,RC,A7034,HCPCS,outpatient,,,235,94.00,NUKX,199.75,85,,159.8,percent of total billed charges,85% of total billed charges,180.95,77,,144.76,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,231.46,385,,,fee schedule,385% of BCBS fee schedule,241.08,401,,,fee schedule,401% of BCBS fee schedule,241.08,401,,,fee schedule,401% of BCBS fee schedule,241.08,401,,,fee schedule,401% of BCBS fee schedule,211.5,90,,169.2,percent of total billed charges,90% of total billed charges,188,80,,150.4,percent of total billed charges,80% of total billed charges,211.5,90,,169.2,percent of total billed charges,90% of total billed charges,176.25,75,,141,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,68.15,29,,54.52,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,157.45,67,,125.96,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,188,80,,150.4,percent of total billed charges,80% of total billed charges,152.75,65,,122.2,percent of total billed charges,65% of total billed charges,83.82,35.67,,67.056,percent of total billed charges,35.67% of total billed charges,68.15,241.08,
MIRAGE LIB COMPLETE MASK LARGE,27703627,CDM,290,RC,A7027,HCPCS,outpatient,,,297,118.80,NUKX,252.45,85,,201.96,percent of total billed charges,85% of total billed charges,228.69,77,,182.95,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,496.88,385,,,fee schedule,385% of BCBS fee schedule,517.53,401,,,fee schedule,401% of BCBS fee schedule,517.53,401,,,fee schedule,401% of BCBS fee schedule,517.53,401,,,fee schedule,401% of BCBS fee schedule,267.3,90,,213.84,percent of total billed charges,90% of total billed charges,237.6,80,,190.08,percent of total billed charges,80% of total billed charges,267.3,90,,213.84,percent of total billed charges,90% of total billed charges,222.75,75,,178.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,86.13,29,,68.904,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,198.99,67,,159.192,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,237.6,80,,190.08,percent of total billed charges,80% of total billed charges,193.05,65,,154.44,percent of total billed charges,65% of total billed charges,105.94,35.67,,84.752,percent of total billed charges,35.67% of total billed charges,86.13,517.53,
MIRAGE LIB COMPLETE MASK SMALL,27703628,CDM,290,RC,A7027,HCPCS,outpatient,,,297,118.80,NUKX,252.45,85,,201.96,percent of total billed charges,85% of total billed charges,228.69,77,,182.95,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,496.88,385,,,fee schedule,385% of BCBS fee schedule,517.53,401,,,fee schedule,401% of BCBS fee schedule,517.53,401,,,fee schedule,401% of BCBS fee schedule,517.53,401,,,fee schedule,401% of BCBS fee schedule,267.3,90,,213.84,percent of total billed charges,90% of total billed charges,237.6,80,,190.08,percent of total billed charges,80% of total billed charges,267.3,90,,213.84,percent of total billed charges,90% of total billed charges,222.75,75,,178.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,86.13,29,,68.904,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,198.99,67,,159.192,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,237.6,80,,190.08,percent of total billed charges,80% of total billed charges,193.05,65,,154.44,percent of total billed charges,65% of total billed charges,105.94,35.67,,84.752,percent of total billed charges,35.67% of total billed charges,86.13,517.53,
MIRAGE QUATTRO FF MASK -INDIG,27703629,CDM,290,RC,A7030,HCPCS,outpatient,,,160,64.00,NUKX,136,85,,108.8,percent of total billed charges,85% of total billed charges,123.2,77,,98.56,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,369.95,385,,,fee schedule,385% of BCBS fee schedule,385.32,401,,,fee schedule,401% of BCBS fee schedule,385.32,401,,,fee schedule,401% of BCBS fee schedule,385.32,401,,,fee schedule,401% of BCBS fee schedule,144,90,,115.2,percent of total billed charges,90% of total billed charges,128,80,,102.4,percent of total billed charges,80% of total billed charges,144,90,,115.2,percent of total billed charges,90% of total billed charges,120,75,,96,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,46.4,29,,37.12,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,107.2,67,,85.76,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,128,80,,102.4,percent of total billed charges,80% of total billed charges,104,65,,83.2,percent of total billed charges,65% of total billed charges,57.07,35.67,,45.656,percent of total billed charges,35.67% of total billed charges,46.4,385.32,
FF MASK HEADGEAR ALL SIZES,27703630,CDM,290,RC,A7030,HCPCS,outpatient,,,412,164.80,NUKX,350.2,85,,280.16,percent of total billed charges,85% of total billed charges,317.24,77,,253.79,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,369.95,385,,,fee schedule,385% of BCBS fee schedule,385.32,401,,,fee schedule,401% of BCBS fee schedule,385.32,401,,,fee schedule,401% of BCBS fee schedule,385.32,401,,,fee schedule,401% of BCBS fee schedule,370.8,90,,296.64,percent of total billed charges,90% of total billed charges,329.6,80,,263.68,percent of total billed charges,80% of total billed charges,370.8,90,,296.64,percent of total billed charges,90% of total billed charges,309,75,,247.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,119.48,29,,95.584,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,276.04,67,,220.832,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,329.6,80,,263.68,percent of total billed charges,80% of total billed charges,267.8,65,,214.24,percent of total billed charges,65% of total billed charges,146.96,35.67,,117.568,percent of total billed charges,35.67% of total billed charges,119.48,385.32,
MIRAGE SM MASK W/MED HEADGEAR,27703631,CDM,290,RC,A7030,HCPCS,outpatient,,,297,118.80,NUKX,252.45,85,,201.96,percent of total billed charges,85% of total billed charges,228.69,77,,182.95,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,369.95,385,,,fee schedule,385% of BCBS fee schedule,385.32,401,,,fee schedule,401% of BCBS fee schedule,385.32,401,,,fee schedule,401% of BCBS fee schedule,385.32,401,,,fee schedule,401% of BCBS fee schedule,267.3,90,,213.84,percent of total billed charges,90% of total billed charges,237.6,80,,190.08,percent of total billed charges,80% of total billed charges,267.3,90,,213.84,percent of total billed charges,90% of total billed charges,222.75,75,,178.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,86.13,29,,68.904,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,198.99,67,,159.192,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,237.6,80,,190.08,percent of total billed charges,80% of total billed charges,193.05,65,,154.44,percent of total billed charges,65% of total billed charges,105.94,35.67,,84.752,percent of total billed charges,35.67% of total billed charges,86.13,385.32,
BREVIDA AIRPILLOW SEAL M-L,27703632,CDM,290,RC,A7033,HCPCS,outpatient,,,73,29.20,NUKX,62.05,85,,49.64,percent of total billed charges,85% of total billed charges,56.21,77,,44.97,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,64.53,385,,,fee schedule,385% of BCBS fee schedule,67.21,401,,,fee schedule,401% of BCBS fee schedule,67.21,401,,,fee schedule,401% of BCBS fee schedule,67.21,401,,,fee schedule,401% of BCBS fee schedule,65.7,90,,52.56,percent of total billed charges,90% of total billed charges,58.4,80,,46.72,percent of total billed charges,80% of total billed charges,65.7,90,,52.56,percent of total billed charges,90% of total billed charges,54.75,75,,43.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,21.17,29,,16.936,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,48.91,67,,39.128,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,58.4,80,,46.72,percent of total billed charges,80% of total billed charges,47.45,65,,37.96,percent of total billed charges,65% of total billed charges,26.04,35.67,,20.832,percent of total billed charges,35.67% of total billed charges,21.17,67.21,
MIRAGE CUSHION & CLIP MEDIUM,27703633,CDM,290,RC,A7031,HCPCS,outpatient,,,80,32.00,NUKX,68,85,,54.4,percent of total billed charges,85% of total billed charges,61.6,77,,49.28,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,140.68,385,,,fee schedule,385% of BCBS fee schedule,146.53,401,,,fee schedule,401% of BCBS fee schedule,146.53,401,,,fee schedule,401% of BCBS fee schedule,146.53,401,,,fee schedule,401% of BCBS fee schedule,72,90,,57.6,percent of total billed charges,90% of total billed charges,64,80,,51.2,percent of total billed charges,80% of total billed charges,72,90,,57.6,percent of total billed charges,90% of total billed charges,60,75,,48,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,23.2,29,,18.56,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,53.6,67,,42.88,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,64,80,,51.2,percent of total billed charges,80% of total billed charges,52,65,,41.6,percent of total billed charges,65% of total billed charges,28.54,35.67,,22.832,percent of total billed charges,35.67% of total billed charges,23.2,146.53,
CUSHION / CLIP REPLACE A7031,27703634,CDM,290,RC,A7031,HCPCS,outpatient,,,158,63.20,NUKX,134.3,85,,107.44,percent of total billed charges,85% of total billed charges,121.66,77,,97.33,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,140.68,385,,,fee schedule,385% of BCBS fee schedule,146.53,401,,,fee schedule,401% of BCBS fee schedule,146.53,401,,,fee schedule,401% of BCBS fee schedule,146.53,401,,,fee schedule,401% of BCBS fee schedule,142.2,90,,113.76,percent of total billed charges,90% of total billed charges,126.4,80,,101.12,percent of total billed charges,80% of total billed charges,142.2,90,,113.76,percent of total billed charges,90% of total billed charges,118.5,75,,94.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,45.82,29,,36.656,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,105.86,67,,84.688,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,126.4,80,,101.12,percent of total billed charges,80% of total billed charges,102.7,65,,82.16,percent of total billed charges,65% of total billed charges,56.36,35.67,,45.088,percent of total billed charges,35.67% of total billed charges,45.82,146.53,
NASAL MASK/GEL PILLOW SYSTEM,27703635,CDM,290,RC,A7034,HCPCS,outpatient,,,259,103.60,NUKX,220.15,85,,176.12,percent of total billed charges,85% of total billed charges,199.43,77,,159.54,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,231.46,385,,,fee schedule,385% of BCBS fee schedule,241.08,401,,,fee schedule,401% of BCBS fee schedule,241.08,401,,,fee schedule,401% of BCBS fee schedule,241.08,401,,,fee schedule,401% of BCBS fee schedule,233.1,90,,186.48,percent of total billed charges,90% of total billed charges,207.2,80,,165.76,percent of total billed charges,80% of total billed charges,233.1,90,,186.48,percent of total billed charges,90% of total billed charges,194.25,75,,155.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,75.11,29,,60.088,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,173.53,67,,138.824,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,207.2,80,,165.76,percent of total billed charges,80% of total billed charges,168.35,65,,134.68,percent of total billed charges,65% of total billed charges,92.39,35.67,,73.912,percent of total billed charges,35.67% of total billed charges,75.11,241.08,
TUBING GRAY RIBBED/ SLIM TUBE,27703636,CDM,290,RC,A7037,HCPCS,outpatient,,,41,16.40,NUKX,34.85,85,,27.88,percent of total billed charges,85% of total billed charges,31.57,77,,25.26,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,49.47,385,,,fee schedule,385% of BCBS fee schedule,51.53,401,,,fee schedule,401% of BCBS fee schedule,51.53,401,,,fee schedule,401% of BCBS fee schedule,51.53,401,,,fee schedule,401% of BCBS fee schedule,36.9,90,,29.52,percent of total billed charges,90% of total billed charges,32.8,80,,26.24,percent of total billed charges,80% of total billed charges,36.9,90,,29.52,percent of total billed charges,90% of total billed charges,30.75,75,,24.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,11.89,29,,9.512,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,27.47,67,,21.976,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,32.8,80,,26.24,percent of total billed charges,80% of total billed charges,26.65,65,,21.32,percent of total billed charges,65% of total billed charges,14.62,35.67,,11.696,percent of total billed charges,35.67% of total billed charges,11.89,51.53,
ROUND SHOWER STOOL,27703637,CDM,290,RC,E0245,HCPCS,outpatient,,,46,18.40,NU,39.1,85,,31.28,percent of total billed charges,85% of total billed charges,35.42,77,,28.34,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,37.72,82,,30.176,percent of total billed charges,82% of total billed charges,39.1,85,,31.28,percent of total billed charges,85% of total billed charges,39.1,85,,31.28,percent of total billed charges,85% of total billed charges,39.1,85,,31.28,percent of total billed charges,85% of total billed charges,41.4,90,,33.12,percent of total billed charges,90% of total billed charges,36.8,80,,29.44,percent of total billed charges,80% of total billed charges,41.4,90,,33.12,percent of total billed charges,90% of total billed charges,34.5,75,,27.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,13.34,29,,10.672,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,30.82,67,,24.656,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,36.8,80,,29.44,percent of total billed charges,80% of total billed charges,29.9,65,,23.92,percent of total billed charges,65% of total billed charges,16.41,35.67,,13.128,percent of total billed charges,35.67% of total billed charges,13.34,41.4,
NEBULIZER 1ST MONTH RENTAL,27703638,CDM,290,RC,E0570,HCPCS,outpatient,,,28,11.20,RRKHKX,23.8,85,,19.04,percent of total billed charges,85% of total billed charges,21.56,77,,17.25,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,23.79,385,,,fee schedule,385% of BCBS fee schedule,24.78,401,,,fee schedule,401% of BCBS fee schedule,24.78,401,,,fee schedule,401% of BCBS fee schedule,24.78,401,,,fee schedule,401% of BCBS fee schedule,25.2,90,,20.16,percent of total billed charges,90% of total billed charges,22.4,80,,17.92,percent of total billed charges,80% of total billed charges,25.2,90,,20.16,percent of total billed charges,90% of total billed charges,21,75,,16.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,8.12,29,,6.496,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,18.76,67,,15.008,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,22.4,80,,17.92,percent of total billed charges,80% of total billed charges,18.2,65,,14.56,percent of total billed charges,65% of total billed charges,9.99,35.67,,7.992,percent of total billed charges,35.67% of total billed charges,8.12,25.2,
REDDIE KNEE BRACE ALL SZS CASH,27703639,CDM,290,RC,L1820,HCPCS,outpatient,,,68,27.20,RTKX,57.8,85,,46.24,percent of total billed charges,85% of total billed charges,52.36,77,,41.89,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,55.76,82,,44.608,percent of total billed charges,82% of total billed charges,57.8,85,,46.24,percent of total billed charges,85% of total billed charges,57.8,85,,46.24,percent of total billed charges,85% of total billed charges,57.8,85,,46.24,percent of total billed charges,85% of total billed charges,61.2,90,,48.96,percent of total billed charges,90% of total billed charges,54.4,80,,43.52,percent of total billed charges,80% of total billed charges,61.2,90,,48.96,percent of total billed charges,90% of total billed charges,51,75,,40.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,19.72,29,,15.776,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,45.56,67,,36.448,percent of total billed charges,67% of total billed charges,133.85,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,54.4,80,,43.52,percent of total billed charges,80% of total billed charges,44.2,65,,35.36,percent of total billed charges,65% of total billed charges,24.26,35.67,,19.408,percent of total billed charges,35.67% of total billed charges,19.72,133.85,
REDDIE HINGED KNEE BRACE LEFT,27703640,CDM,290,RC,L1820,HCPCS,outpatient,,,305,122.00,LTKX,259.25,85,,207.4,percent of total billed charges,85% of total billed charges,234.85,77,,187.88,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,250.1,82,,200.08,percent of total billed charges,82% of total billed charges,259.25,85,,207.4,percent of total billed charges,85% of total billed charges,259.25,85,,207.4,percent of total billed charges,85% of total billed charges,259.25,85,,207.4,percent of total billed charges,85% of total billed charges,274.5,90,,219.6,percent of total billed charges,90% of total billed charges,244,80,,195.2,percent of total billed charges,80% of total billed charges,274.5,90,,219.6,percent of total billed charges,90% of total billed charges,228.75,75,,183,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,88.45,29,,70.76,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,204.35,67,,163.48,percent of total billed charges,67% of total billed charges,133.85,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,244,80,,195.2,percent of total billed charges,80% of total billed charges,198.25,65,,158.6,percent of total billed charges,65% of total billed charges,108.79,35.67,,87.032,percent of total billed charges,35.67% of total billed charges,88.45,274.5,
PAIR CRUTCH/CANE TIPS,27703641,CDM,290,RC,A9270,HCPCS,outpatient,,,9,3.60,,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,6.93,77,,5.54,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,7.38,82,,5.904,percent of total billed charges,82% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,8.1,90,,6.48,percent of total billed charges,90% of total billed charges,7.2,80,,5.76,percent of total billed charges,80% of total billed charges,8.1,90,,6.48,percent of total billed charges,90% of total billed charges,6.75,75,,5.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.61,29,,2.088,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,6.03,67,,4.824,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,7.2,80,,5.76,percent of total billed charges,80% of total billed charges,5.85,65,,4.68,percent of total billed charges,65% of total billed charges,3.21,35.67,,2.568,percent of total billed charges,35.67% of total billed charges,2.61,8.1,
WALKER GLIDE TIPS,27703642,CDM,290,RC,A9270,HCPCS,outpatient,,,12,4.80,,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,9.24,77,,7.39,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,9.84,82,,7.872,percent of total billed charges,82% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,10.8,90,,8.64,percent of total billed charges,90% of total billed charges,9.6,80,,7.68,percent of total billed charges,80% of total billed charges,10.8,90,,8.64,percent of total billed charges,90% of total billed charges,9,75,,7.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,3.48,29,,2.784,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,8.04,67,,6.432,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,9.6,80,,7.68,percent of total billed charges,80% of total billed charges,7.8,65,,6.24,percent of total billed charges,65% of total billed charges,4.28,35.67,,3.424,percent of total billed charges,35.67% of total billed charges,3.48,10.8,
CRUTCH UNDERARM PADS,27703643,CDM,290,RC,A9270,HCPCS,outpatient,,,11,4.40,,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,8.47,77,,6.78,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,9.02,82,,7.216,percent of total billed charges,82% of total billed charges,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,9.9,90,,7.92,percent of total billed charges,90% of total billed charges,8.8,80,,7.04,percent of total billed charges,80% of total billed charges,9.9,90,,7.92,percent of total billed charges,90% of total billed charges,8.25,75,,6.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,3.19,29,,2.552,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,7.37,67,,5.896,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,8.8,80,,7.04,percent of total billed charges,80% of total billed charges,7.15,65,,5.72,percent of total billed charges,65% of total billed charges,3.92,35.67,,3.136,percent of total billed charges,35.67% of total billed charges,3.19,9.9,
ROM ADJ KNEE BRACE LARGE,27703646,CDM,290,RC,L1833,HCPCS,outpatient,,,52,20.80,NUKX,44.2,85,,35.36,percent of total billed charges,85% of total billed charges,40.04,77,,32.03,percent of total billed charges,77% of total billed charges,597.39,100,,,fee schedule,100% of CMS fee schedule,42.64,82,,34.112,percent of total billed charges,82% of total billed charges,44.2,85,,35.36,percent of total billed charges,85% of total billed charges,44.2,85,,35.36,percent of total billed charges,85% of total billed charges,44.2,85,,35.36,percent of total billed charges,85% of total billed charges,46.8,90,,37.44,percent of total billed charges,90% of total billed charges,41.6,80,,33.28,percent of total billed charges,80% of total billed charges,46.8,90,,37.44,percent of total billed charges,90% of total billed charges,39,75,,31.2,percent of total billed charges,75% of total billed charges,728.82,122,,,fee schedule,122% of APC rate,15.08,29,,12.064,percent of total billed charges,29% of total billed charges,597.39,100,,,fee schedule,100% of CMS fee schedule,34.84,67,,27.872,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,41.6,80,,33.28,percent of total billed charges,80% of total billed charges,33.8,65,,27.04,percent of total billed charges,65% of total billed charges,18.55,35.67,,14.84,percent of total billed charges,35.67% of total billed charges,15.08,728.82,
REDDIE HINGED KNEE BRACE RT,27703647,CDM,290,RC,L1820,HCPCS,outpatient,,,311,124.40,RTKX,264.35,85,,211.48,percent of total billed charges,85% of total billed charges,239.47,77,,191.58,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,255.02,82,,204.016,percent of total billed charges,82% of total billed charges,264.35,85,,211.48,percent of total billed charges,85% of total billed charges,264.35,85,,211.48,percent of total billed charges,85% of total billed charges,264.35,85,,211.48,percent of total billed charges,85% of total billed charges,279.9,90,,223.92,percent of total billed charges,90% of total billed charges,248.8,80,,199.04,percent of total billed charges,80% of total billed charges,279.9,90,,223.92,percent of total billed charges,90% of total billed charges,233.25,75,,186.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,90.19,29,,72.152,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,208.37,67,,166.696,percent of total billed charges,67% of total billed charges,133.85,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,248.8,80,,199.04,percent of total billed charges,80% of total billed charges,202.15,65,,161.72,percent of total billed charges,65% of total billed charges,110.93,35.67,,88.744,percent of total billed charges,35.67% of total billed charges,90.19,279.9,
SUNMARK TRANSFER BENCH,27703648,CDM,290,RC,E0247,HCPCS,outpatient,,,63,25.20,NU,53.55,85,,42.84,percent of total billed charges,85% of total billed charges,48.51,77,,38.81,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,51.66,82,,41.328,percent of total billed charges,82% of total billed charges,53.55,85,,42.84,percent of total billed charges,85% of total billed charges,53.55,85,,42.84,percent of total billed charges,85% of total billed charges,53.55,85,,42.84,percent of total billed charges,85% of total billed charges,56.7,90,,45.36,percent of total billed charges,90% of total billed charges,50.4,80,,40.32,percent of total billed charges,80% of total billed charges,56.7,90,,45.36,percent of total billed charges,90% of total billed charges,47.25,75,,37.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,18.27,29,,14.616,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,42.21,67,,33.768,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,50.4,80,,40.32,percent of total billed charges,80% of total billed charges,40.95,65,,32.76,percent of total billed charges,65% of total billed charges,22.47,35.67,,17.976,percent of total billed charges,35.67% of total billed charges,18.27,56.7,
ROLLATOR WALKER HD MEDICARE,27703649,CDM,290,RC,E0147,HCPCS,outpatient,,,558,223.20,NUKX,474.3,85,,379.44,percent of total billed charges,85% of total billed charges,429.66,77,,343.73,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,1627.7,385,,,fee schedule,385% of BCBS fee schedule,1695.35,401,,,fee schedule,401% of BCBS fee schedule,1695.35,401,,,fee schedule,401% of BCBS fee schedule,1695.35,401,,,fee schedule,401% of BCBS fee schedule,502.2,90,,401.76,percent of total billed charges,90% of total billed charges,446.4,80,,357.12,percent of total billed charges,80% of total billed charges,502.2,90,,401.76,percent of total billed charges,90% of total billed charges,418.5,75,,334.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,161.82,29,,129.456,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,373.86,67,,299.088,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,446.4,80,,357.12,percent of total billed charges,80% of total billed charges,362.7,65,,290.16,percent of total billed charges,65% of total billed charges,199.04,35.67,,159.232,percent of total billed charges,35.67% of total billed charges,161.82,1695.35,
HEAVY DUTY WALKER 2ND MON RENT,27703650,CDM,290,RC,E0147,HCPCS,outpatient,,,57,22.80,RRKIKX,48.45,85,,38.76,percent of total billed charges,85% of total billed charges,43.89,77,,35.11,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,1627.7,385,,,fee schedule,385% of BCBS fee schedule,1695.35,401,,,fee schedule,401% of BCBS fee schedule,1695.35,401,,,fee schedule,401% of BCBS fee schedule,1695.35,401,,,fee schedule,401% of BCBS fee schedule,51.3,90,,41.04,percent of total billed charges,90% of total billed charges,45.6,80,,36.48,percent of total billed charges,80% of total billed charges,51.3,90,,41.04,percent of total billed charges,90% of total billed charges,42.75,75,,34.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,16.53,29,,13.224,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,38.19,67,,30.552,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,45.6,80,,36.48,percent of total billed charges,80% of total billed charges,37.05,65,,29.64,percent of total billed charges,65% of total billed charges,20.33,35.67,,16.264,percent of total billed charges,35.67% of total billed charges,16.53,1695.35,
HEAVY DUTY WALKER 3RD MON RENT,27703651,CDM,290,RC,E0147,HCPCS,outpatient,,,57,22.80,RRKIKX,48.45,85,,38.76,percent of total billed charges,85% of total billed charges,43.89,77,,35.11,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,1627.7,385,,,fee schedule,385% of BCBS fee schedule,1695.35,401,,,fee schedule,401% of BCBS fee schedule,1695.35,401,,,fee schedule,401% of BCBS fee schedule,1695.35,401,,,fee schedule,401% of BCBS fee schedule,51.3,90,,41.04,percent of total billed charges,90% of total billed charges,45.6,80,,36.48,percent of total billed charges,80% of total billed charges,51.3,90,,41.04,percent of total billed charges,90% of total billed charges,42.75,75,,34.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,16.53,29,,13.224,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,38.19,67,,30.552,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,45.6,80,,36.48,percent of total billed charges,80% of total billed charges,37.05,65,,29.64,percent of total billed charges,65% of total billed charges,20.33,35.67,,16.264,percent of total billed charges,35.67% of total billed charges,16.53,1695.35,
HEAVY DUTY WALKER 4TH MON RENT,27703652,CDM,290,RC,E0147,HCPCS,outpatient,,,57,22.80,RRKJKX,48.45,85,,38.76,percent of total billed charges,85% of total billed charges,43.89,77,,35.11,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,1627.7,385,,,fee schedule,385% of BCBS fee schedule,1695.35,401,,,fee schedule,401% of BCBS fee schedule,1695.35,401,,,fee schedule,401% of BCBS fee schedule,1695.35,401,,,fee schedule,401% of BCBS fee schedule,51.3,90,,41.04,percent of total billed charges,90% of total billed charges,45.6,80,,36.48,percent of total billed charges,80% of total billed charges,51.3,90,,41.04,percent of total billed charges,90% of total billed charges,42.75,75,,34.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,16.53,29,,13.224,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,38.19,67,,30.552,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,45.6,80,,36.48,percent of total billed charges,80% of total billed charges,37.05,65,,29.64,percent of total billed charges,65% of total billed charges,20.33,35.67,,16.264,percent of total billed charges,35.67% of total billed charges,16.53,1695.35,
HEAVY DUTY WALKER BRAKES 4-13,27703653,CDM,290,RC,E0149,HCPCS,outpatient,,,57,22.80,RRKJKX,48.45,85,,38.76,percent of total billed charges,85% of total billed charges,43.89,77,,35.11,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,48.13,385,,,fee schedule,385% of BCBS fee schedule,50.13,401,,,fee schedule,401% of BCBS fee schedule,50.13,401,,,fee schedule,401% of BCBS fee schedule,50.13,401,,,fee schedule,401% of BCBS fee schedule,51.3,90,,41.04,percent of total billed charges,90% of total billed charges,45.6,80,,36.48,percent of total billed charges,80% of total billed charges,51.3,90,,41.04,percent of total billed charges,90% of total billed charges,42.75,75,,34.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,16.53,29,,13.224,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,38.19,67,,30.552,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,45.6,80,,36.48,percent of total billed charges,80% of total billed charges,37.05,65,,29.64,percent of total billed charges,65% of total billed charges,20.33,35.67,,16.264,percent of total billed charges,35.67% of total billed charges,16.53,51.3,
HEAVY WALKER BRAKES WILLIAMS,27703654,CDM,290,RC,E0149,HCPCS,outpatient,,,57,22.80,RRKJKX,48.45,85,,38.76,percent of total billed charges,85% of total billed charges,43.89,77,,35.11,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,48.13,385,,,fee schedule,385% of BCBS fee schedule,50.13,401,,,fee schedule,401% of BCBS fee schedule,50.13,401,,,fee schedule,401% of BCBS fee schedule,50.13,401,,,fee schedule,401% of BCBS fee schedule,51.3,90,,41.04,percent of total billed charges,90% of total billed charges,45.6,80,,36.48,percent of total billed charges,80% of total billed charges,51.3,90,,41.04,percent of total billed charges,90% of total billed charges,42.75,75,,34.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,16.53,29,,13.224,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,38.19,67,,30.552,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,45.6,80,,36.48,percent of total billed charges,80% of total billed charges,37.05,65,,29.64,percent of total billed charges,65% of total billed charges,20.33,35.67,,16.264,percent of total billed charges,35.67% of total billed charges,16.53,51.3,
"HEAVY DUTY ROLLATOR, SEAT",27703656,CDM,290,RC,E0147,HCPCS,outpatient,,,137,54.80,KJRRKX,116.45,85,,93.16,percent of total billed charges,85% of total billed charges,105.49,77,,84.39,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,1627.7,385,,,fee schedule,385% of BCBS fee schedule,1695.35,401,,,fee schedule,401% of BCBS fee schedule,1695.35,401,,,fee schedule,401% of BCBS fee schedule,1695.35,401,,,fee schedule,401% of BCBS fee schedule,123.3,90,,98.64,percent of total billed charges,90% of total billed charges,109.6,80,,87.68,percent of total billed charges,80% of total billed charges,123.3,90,,98.64,percent of total billed charges,90% of total billed charges,102.75,75,,82.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,39.73,29,,31.784,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,91.79,67,,73.432,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,109.6,80,,87.68,percent of total billed charges,80% of total billed charges,89.05,65,,71.24,percent of total billed charges,65% of total billed charges,48.87,35.67,,39.096,percent of total billed charges,35.67% of total billed charges,39.73,1695.35,
EX-WIDE BEDSIDE COMMODE,27703657,CDM,290,RC,E0168,HCPCS,outpatient,,,332,132.80,NUKX,282.2,85,,225.76,percent of total billed charges,85% of total billed charges,255.64,77,,204.51,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,480.63,385,,,fee schedule,385% of BCBS fee schedule,500.61,401,,,fee schedule,401% of BCBS fee schedule,500.61,401,,,fee schedule,401% of BCBS fee schedule,500.61,401,,,fee schedule,401% of BCBS fee schedule,298.8,90,,239.04,percent of total billed charges,90% of total billed charges,265.6,80,,212.48,percent of total billed charges,80% of total billed charges,298.8,90,,239.04,percent of total billed charges,90% of total billed charges,249,75,,199.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,96.28,29,,77.024,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,222.44,67,,177.952,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,265.6,80,,212.48,percent of total billed charges,80% of total billed charges,215.8,65,,172.64,percent of total billed charges,65% of total billed charges,118.42,35.67,,94.736,percent of total billed charges,35.67% of total billed charges,96.28,500.61,
HEAVY DUTY ROLLATOR MEDICARE,27703658,CDM,290,RC,E0147,HCPCS,outpatient,,,551,220.40,NUKX,468.35,85,,374.68,percent of total billed charges,85% of total billed charges,424.27,77,,339.42,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,1627.7,385,,,fee schedule,385% of BCBS fee schedule,1695.35,401,,,fee schedule,401% of BCBS fee schedule,1695.35,401,,,fee schedule,401% of BCBS fee schedule,1695.35,401,,,fee schedule,401% of BCBS fee schedule,495.9,90,,396.72,percent of total billed charges,90% of total billed charges,440.8,80,,352.64,percent of total billed charges,80% of total billed charges,495.9,90,,396.72,percent of total billed charges,90% of total billed charges,413.25,75,,330.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,159.79,29,,127.832,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,369.17,67,,295.336,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,440.8,80,,352.64,percent of total billed charges,80% of total billed charges,358.15,65,,286.52,percent of total billed charges,65% of total billed charges,196.54,35.67,,157.232,percent of total billed charges,35.67% of total billed charges,159.79,1695.35,
HEAVY DUTY WALKER BRAKES 11TH,27703659,CDM,290,RC,E0147,HCPCS,outpatient,,,57,22.80,KJRRKX,48.45,85,,38.76,percent of total billed charges,85% of total billed charges,43.89,77,,35.11,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,1627.7,385,,,fee schedule,385% of BCBS fee schedule,1695.35,401,,,fee schedule,401% of BCBS fee schedule,1695.35,401,,,fee schedule,401% of BCBS fee schedule,1695.35,401,,,fee schedule,401% of BCBS fee schedule,51.3,90,,41.04,percent of total billed charges,90% of total billed charges,45.6,80,,36.48,percent of total billed charges,80% of total billed charges,51.3,90,,41.04,percent of total billed charges,90% of total billed charges,42.75,75,,34.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,16.53,29,,13.224,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,38.19,67,,30.552,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,45.6,80,,36.48,percent of total billed charges,80% of total billed charges,37.05,65,,29.64,percent of total billed charges,65% of total billed charges,20.33,35.67,,16.264,percent of total billed charges,35.67% of total billed charges,16.53,1695.35,
KNEE IMMOBILIZER 24 IN,27703662,CDM,290,RC,L1830,HCPCS,outpatient,,,187,74.80,NU,158.95,85,,127.16,percent of total billed charges,85% of total billed charges,143.99,77,,115.19,percent of total billed charges,77% of total billed charges,84.63,100,,,fee schedule,100% of CMS fee schedule,153.34,82,,122.672,percent of total billed charges,82% of total billed charges,158.95,85,,127.16,percent of total billed charges,85% of total billed charges,158.95,85,,127.16,percent of total billed charges,85% of total billed charges,158.95,85,,127.16,percent of total billed charges,85% of total billed charges,168.3,90,,134.64,percent of total billed charges,90% of total billed charges,149.6,80,,119.68,percent of total billed charges,80% of total billed charges,168.3,90,,134.64,percent of total billed charges,90% of total billed charges,140.25,75,,112.2,percent of total billed charges,75% of total billed charges,103.25,122,,,fee schedule,122% of APC rate,54.23,29,,43.384,percent of total billed charges,29% of total billed charges,84.63,100,,,fee schedule,100% of CMS fee schedule,125.29,67,,100.232,percent of total billed charges,67% of total billed charges,94.31,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,149.6,80,,119.68,percent of total billed charges,80% of total billed charges,121.55,65,,97.24,percent of total billed charges,65% of total billed charges,66.7,35.67,,53.36,percent of total billed charges,35.67% of total billed charges,54.23,168.3,
CANE TIPS,27703663,CDM,290,RC,A9270,HCPCS,outpatient,,,9,3.60,,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,6.93,77,,5.54,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,7.38,82,,5.904,percent of total billed charges,82% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,8.1,90,,6.48,percent of total billed charges,90% of total billed charges,7.2,80,,5.76,percent of total billed charges,80% of total billed charges,8.1,90,,6.48,percent of total billed charges,90% of total billed charges,6.75,75,,5.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.61,29,,2.088,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,6.03,67,,4.824,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,7.2,80,,5.76,percent of total billed charges,80% of total billed charges,5.85,65,,4.68,percent of total billed charges,65% of total billed charges,3.21,35.67,,2.568,percent of total billed charges,35.67% of total billed charges,2.61,8.1,
PAIR WALKER GLIDE SKI,27703665,CDM,290,RC,E0159,HCPCS,outpatient,,,11,4.40,,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,8.47,77,,6.78,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,60.21,385,,,fee schedule,385% of BCBS fee schedule,62.72,401,,,fee schedule,401% of BCBS fee schedule,62.72,401,,,fee schedule,401% of BCBS fee schedule,62.72,401,,,fee schedule,401% of BCBS fee schedule,9.9,90,,7.92,percent of total billed charges,90% of total billed charges,8.8,80,,7.04,percent of total billed charges,80% of total billed charges,9.9,90,,7.92,percent of total billed charges,90% of total billed charges,8.25,75,,6.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,3.19,29,,2.552,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,7.37,67,,5.896,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,8.8,80,,7.04,percent of total billed charges,80% of total billed charges,7.15,65,,5.72,percent of total billed charges,65% of total billed charges,3.92,35.67,,3.136,percent of total billed charges,35.67% of total billed charges,3.19,62.72,
CRUTCH ACCESSORY KIT,27703667,CDM,290,RC,A9270,HCPCS,outpatient,,,15,6.00,,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,11.55,77,,9.24,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,12.3,82,,9.84,percent of total billed charges,82% of total billed charges,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,13.5,90,,10.8,percent of total billed charges,90% of total billed charges,12,80,,9.6,percent of total billed charges,80% of total billed charges,13.5,90,,10.8,percent of total billed charges,90% of total billed charges,11.25,75,,9,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,4.35,29,,3.48,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,10.05,67,,8.04,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,12,80,,9.6,percent of total billed charges,80% of total billed charges,9.75,65,,7.8,percent of total billed charges,65% of total billed charges,5.35,35.67,,4.28,percent of total billed charges,35.67% of total billed charges,4.35,13.5,
WALKER CAST BOOT PNEUMATIC LT,27703668,CDM,290,RC,L4361,HCPCS,outpatient,,,596,238.40,LTKX,506.6,85,,405.28,percent of total billed charges,85% of total billed charges,458.92,77,,367.14,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,488.72,82,,390.976,percent of total billed charges,82% of total billed charges,506.6,85,,405.28,percent of total billed charges,85% of total billed charges,506.6,85,,405.28,percent of total billed charges,85% of total billed charges,506.6,85,,405.28,percent of total billed charges,85% of total billed charges,536.4,90,,429.12,percent of total billed charges,90% of total billed charges,476.8,80,,381.44,percent of total billed charges,80% of total billed charges,536.4,90,,429.12,percent of total billed charges,90% of total billed charges,447,75,,357.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,172.84,29,,138.272,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,399.32,67,,319.456,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,476.8,80,,381.44,percent of total billed charges,80% of total billed charges,387.4,65,,309.92,percent of total billed charges,65% of total billed charges,212.59,35.67,,170.072,percent of total billed charges,35.67% of total billed charges,172.84,536.4,
WALKER CAST BOOT- EMPLOYEE,27703669,CDM,290,RC,L4361,HCPCS,outpatient,,,89,35.60,RTKX,75.65,85,,60.52,percent of total billed charges,85% of total billed charges,68.53,77,,54.82,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,72.98,82,,58.384,percent of total billed charges,82% of total billed charges,75.65,85,,60.52,percent of total billed charges,85% of total billed charges,75.65,85,,60.52,percent of total billed charges,85% of total billed charges,75.65,85,,60.52,percent of total billed charges,85% of total billed charges,80.1,90,,64.08,percent of total billed charges,90% of total billed charges,71.2,80,,56.96,percent of total billed charges,80% of total billed charges,80.1,90,,64.08,percent of total billed charges,90% of total billed charges,66.75,75,,53.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,25.81,29,,20.648,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,59.63,67,,47.704,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,71.2,80,,56.96,percent of total billed charges,80% of total billed charges,57.85,65,,46.28,percent of total billed charges,65% of total billed charges,31.75,35.67,,25.4,percent of total billed charges,35.67% of total billed charges,25.81,80.1,
WALKER CAST BOOT ALL SZ-CASH,27703670,CDM,290,RC,L4361,HCPCS,outpatient,,,116,46.40,RTKX,98.6,85,,78.88,percent of total billed charges,85% of total billed charges,89.32,77,,71.46,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,95.12,82,,76.096,percent of total billed charges,82% of total billed charges,98.6,85,,78.88,percent of total billed charges,85% of total billed charges,98.6,85,,78.88,percent of total billed charges,85% of total billed charges,98.6,85,,78.88,percent of total billed charges,85% of total billed charges,104.4,90,,83.52,percent of total billed charges,90% of total billed charges,92.8,80,,74.24,percent of total billed charges,80% of total billed charges,104.4,90,,83.52,percent of total billed charges,90% of total billed charges,87,75,,69.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,33.64,29,,26.912,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,77.72,67,,62.176,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,92.8,80,,74.24,percent of total billed charges,80% of total billed charges,75.4,65,,60.32,percent of total billed charges,65% of total billed charges,41.38,35.67,,33.104,percent of total billed charges,35.67% of total billed charges,33.64,104.4,
WALKING CAST BOOT PNEUMATIC RT,27703671,CDM,290,RC,L4361,HCPCS,outpatient,,,596,238.40,RTKX,506.6,85,,405.28,percent of total billed charges,85% of total billed charges,458.92,77,,367.14,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,488.72,82,,390.976,percent of total billed charges,82% of total billed charges,506.6,85,,405.28,percent of total billed charges,85% of total billed charges,506.6,85,,405.28,percent of total billed charges,85% of total billed charges,506.6,85,,405.28,percent of total billed charges,85% of total billed charges,536.4,90,,429.12,percent of total billed charges,90% of total billed charges,476.8,80,,381.44,percent of total billed charges,80% of total billed charges,536.4,90,,429.12,percent of total billed charges,90% of total billed charges,447,75,,357.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,172.84,29,,138.272,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,399.32,67,,319.456,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,476.8,80,,381.44,percent of total billed charges,80% of total billed charges,387.4,65,,309.92,percent of total billed charges,65% of total billed charges,212.59,35.67,,170.072,percent of total billed charges,35.67% of total billed charges,172.84,536.4,
WHEELCHAIR 18 & 20 INS BCBS,27703672,CDM,290,RC,K0001,HCPCS,outpatient,,,762,304.80,NU,647.7,85,,518.16,percent of total billed charges,85% of total billed charges,586.74,77,,469.39,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,94.33,385,,,fee schedule,385% of BCBS fee schedule,98.25,401,,,fee schedule,401% of BCBS fee schedule,98.25,401,,,fee schedule,401% of BCBS fee schedule,98.25,401,,,fee schedule,401% of BCBS fee schedule,685.8,90,,548.64,percent of total billed charges,90% of total billed charges,609.6,80,,487.68,percent of total billed charges,80% of total billed charges,685.8,90,,548.64,percent of total billed charges,90% of total billed charges,571.5,75,,457.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,220.98,29,,176.784,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,510.54,67,,408.432,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,609.6,80,,487.68,percent of total billed charges,80% of total billed charges,495.3,65,,396.24,percent of total billed charges,65% of total billed charges,271.81,35.67,,217.448,percent of total billed charges,35.67% of total billed charges,94.33,685.8,
WHEELCHAIR 20IN PURCHASE SP,27703673,CDM,290,RC,K0001,HCPCS,outpatient,,,428,171.20,,363.8,85,,291.04,percent of total billed charges,85% of total billed charges,329.56,77,,263.65,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,94.33,385,,,fee schedule,385% of BCBS fee schedule,98.25,401,,,fee schedule,401% of BCBS fee schedule,98.25,401,,,fee schedule,401% of BCBS fee schedule,98.25,401,,,fee schedule,401% of BCBS fee schedule,385.2,90,,308.16,percent of total billed charges,90% of total billed charges,342.4,80,,273.92,percent of total billed charges,80% of total billed charges,385.2,90,,308.16,percent of total billed charges,90% of total billed charges,321,75,,256.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,124.12,29,,99.296,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,286.76,67,,229.408,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,342.4,80,,273.92,percent of total billed charges,80% of total billed charges,278.2,65,,222.56,percent of total billed charges,65% of total billed charges,152.67,35.67,,122.136,percent of total billed charges,35.67% of total billed charges,94.33,385.2,
WHEELCHAIR 16IN LW 1ST MONTH,27703674,CDM,290,RC,K0003,HCPCS,outpatient,,,156,62.40,RRKHKX,132.6,85,,106.08,percent of total billed charges,85% of total billed charges,120.12,77,,96.1,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,141.41,385,,,fee schedule,385% of BCBS fee schedule,147.29,401,,,fee schedule,401% of BCBS fee schedule,147.29,401,,,fee schedule,401% of BCBS fee schedule,147.29,401,,,fee schedule,401% of BCBS fee schedule,140.4,90,,112.32,percent of total billed charges,90% of total billed charges,124.8,80,,99.84,percent of total billed charges,80% of total billed charges,140.4,90,,112.32,percent of total billed charges,90% of total billed charges,117,75,,93.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,45.24,29,,36.192,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,104.52,67,,83.616,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,124.8,80,,99.84,percent of total billed charges,80% of total billed charges,101.4,65,,81.12,percent of total billed charges,65% of total billed charges,55.65,35.67,,44.52,percent of total billed charges,35.67% of total billed charges,45.24,147.29,
WHEELCHAIR 16IN LW 2ND MONTH,27703675,CDM,290,RC,K0003,HCPCS,outpatient,,,156,62.40,RRKIKX,132.6,85,,106.08,percent of total billed charges,85% of total billed charges,120.12,77,,96.1,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,141.41,385,,,fee schedule,385% of BCBS fee schedule,147.29,401,,,fee schedule,401% of BCBS fee schedule,147.29,401,,,fee schedule,401% of BCBS fee schedule,147.29,401,,,fee schedule,401% of BCBS fee schedule,140.4,90,,112.32,percent of total billed charges,90% of total billed charges,124.8,80,,99.84,percent of total billed charges,80% of total billed charges,140.4,90,,112.32,percent of total billed charges,90% of total billed charges,117,75,,93.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,45.24,29,,36.192,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,104.52,67,,83.616,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,124.8,80,,99.84,percent of total billed charges,80% of total billed charges,101.4,65,,81.12,percent of total billed charges,65% of total billed charges,55.65,35.67,,44.52,percent of total billed charges,35.67% of total billed charges,45.24,147.29,
WHEELCHAIR 16IN LW 3RD MONTH,27703676,CDM,290,RC,K0003,HCPCS,outpatient,,,156,62.40,RRKIKX,132.6,85,,106.08,percent of total billed charges,85% of total billed charges,120.12,77,,96.1,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,141.41,385,,,fee schedule,385% of BCBS fee schedule,147.29,401,,,fee schedule,401% of BCBS fee schedule,147.29,401,,,fee schedule,401% of BCBS fee schedule,147.29,401,,,fee schedule,401% of BCBS fee schedule,140.4,90,,112.32,percent of total billed charges,90% of total billed charges,124.8,80,,99.84,percent of total billed charges,80% of total billed charges,140.4,90,,112.32,percent of total billed charges,90% of total billed charges,117,75,,93.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,45.24,29,,36.192,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,104.52,67,,83.616,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,124.8,80,,99.84,percent of total billed charges,80% of total billed charges,101.4,65,,81.12,percent of total billed charges,65% of total billed charges,55.65,35.67,,44.52,percent of total billed charges,35.67% of total billed charges,45.24,147.29,
WHEELCHAIR 16IN LW 4-13 MONTHS,27703677,CDM,290,RC,K0003,HCPCS,outpatient,,,158,63.20,RRKJKX,134.3,85,,107.44,percent of total billed charges,85% of total billed charges,121.66,77,,97.33,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,141.41,385,,,fee schedule,385% of BCBS fee schedule,147.29,401,,,fee schedule,401% of BCBS fee schedule,147.29,401,,,fee schedule,401% of BCBS fee schedule,147.29,401,,,fee schedule,401% of BCBS fee schedule,142.2,90,,113.76,percent of total billed charges,90% of total billed charges,126.4,80,,101.12,percent of total billed charges,80% of total billed charges,142.2,90,,113.76,percent of total billed charges,90% of total billed charges,118.5,75,,94.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,45.82,29,,36.656,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,105.86,67,,84.688,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,126.4,80,,101.12,percent of total billed charges,80% of total billed charges,102.7,65,,82.16,percent of total billed charges,65% of total billed charges,56.36,35.67,,45.088,percent of total billed charges,35.67% of total billed charges,45.82,147.29,
WHEELCHAIR 24IN 7TH MONTH RENT,27703678,CDM,290,RC,K0007,HCPCS,outpatient,,,116,46.40,RRKJKX,98.6,85,,78.88,percent of total billed charges,85% of total billed charges,89.32,77,,71.46,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,363.13,385,,,fee schedule,385% of BCBS fee schedule,378.22,401,,,fee schedule,401% of BCBS fee schedule,378.22,401,,,fee schedule,401% of BCBS fee schedule,378.22,401,,,fee schedule,401% of BCBS fee schedule,104.4,90,,83.52,percent of total billed charges,90% of total billed charges,92.8,80,,74.24,percent of total billed charges,80% of total billed charges,104.4,90,,83.52,percent of total billed charges,90% of total billed charges,87,75,,69.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,33.64,29,,26.912,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,77.72,67,,62.176,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,92.8,80,,74.24,percent of total billed charges,80% of total billed charges,75.4,65,,60.32,percent of total billed charges,65% of total billed charges,41.38,35.67,,33.104,percent of total billed charges,35.67% of total billed charges,33.64,378.22,
TRANSFER BOARD,27703679,CDM,290,RC,E0705,HCPCS,outpatient,,,64,25.60,,54.4,85,,43.52,percent of total billed charges,85% of total billed charges,49.28,77,,39.42,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,203.05,385,,,fee schedule,385% of BCBS fee schedule,211.49,401,,,fee schedule,401% of BCBS fee schedule,211.49,401,,,fee schedule,401% of BCBS fee schedule,211.49,401,,,fee schedule,401% of BCBS fee schedule,57.6,90,,46.08,percent of total billed charges,90% of total billed charges,51.2,80,,40.96,percent of total billed charges,80% of total billed charges,57.6,90,,46.08,percent of total billed charges,90% of total billed charges,48,75,,38.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,18.56,29,,14.848,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,42.88,67,,34.304,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,51.2,80,,40.96,percent of total billed charges,80% of total billed charges,41.6,65,,33.28,percent of total billed charges,65% of total billed charges,22.83,35.67,,18.264,percent of total billed charges,35.67% of total billed charges,18.56,211.49,
WHEELCHAIR 18IN FR PURCHASE,27703680,CDM,290,RC,K0001,HCPCS,outpatient,,,411,164.40,,349.35,85,,279.48,percent of total billed charges,85% of total billed charges,316.47,77,,253.18,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,94.33,385,,,fee schedule,385% of BCBS fee schedule,98.25,401,,,fee schedule,401% of BCBS fee schedule,98.25,401,,,fee schedule,401% of BCBS fee schedule,98.25,401,,,fee schedule,401% of BCBS fee schedule,369.9,90,,295.92,percent of total billed charges,90% of total billed charges,328.8,80,,263.04,percent of total billed charges,80% of total billed charges,369.9,90,,295.92,percent of total billed charges,90% of total billed charges,308.25,75,,246.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,119.19,29,,95.352,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,275.37,67,,220.296,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,328.8,80,,263.04,percent of total billed charges,80% of total billed charges,267.15,65,,213.72,percent of total billed charges,65% of total billed charges,146.6,35.67,,117.28,percent of total billed charges,35.67% of total billed charges,94.33,369.9,
W/CHAIR 24IN 10TH MONTH RENT,27703681,CDM,290,RC,K0007,HCPCS,outpatient,,,116,46.40,RRKJKX,98.6,85,,78.88,percent of total billed charges,85% of total billed charges,89.32,77,,71.46,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,363.13,385,,,fee schedule,385% of BCBS fee schedule,378.22,401,,,fee schedule,401% of BCBS fee schedule,378.22,401,,,fee schedule,401% of BCBS fee schedule,378.22,401,,,fee schedule,401% of BCBS fee schedule,104.4,90,,83.52,percent of total billed charges,90% of total billed charges,92.8,80,,74.24,percent of total billed charges,80% of total billed charges,104.4,90,,83.52,percent of total billed charges,90% of total billed charges,87,75,,69.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,33.64,29,,26.912,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,77.72,67,,62.176,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,92.8,80,,74.24,percent of total billed charges,80% of total billed charges,75.4,65,,60.32,percent of total billed charges,65% of total billed charges,41.38,35.67,,33.104,percent of total billed charges,35.67% of total billed charges,33.64,378.22,
W/CHAIR 11TH MONTH RENT,27703682,CDM,290,RC,K0007,HCPCS,outpatient,,,116,46.40,RRKJKX,98.6,85,,78.88,percent of total billed charges,85% of total billed charges,89.32,77,,71.46,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,363.13,385,,,fee schedule,385% of BCBS fee schedule,378.22,401,,,fee schedule,401% of BCBS fee schedule,378.22,401,,,fee schedule,401% of BCBS fee schedule,378.22,401,,,fee schedule,401% of BCBS fee schedule,104.4,90,,83.52,percent of total billed charges,90% of total billed charges,92.8,80,,74.24,percent of total billed charges,80% of total billed charges,104.4,90,,83.52,percent of total billed charges,90% of total billed charges,87,75,,69.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,33.64,29,,26.912,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,77.72,67,,62.176,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,92.8,80,,74.24,percent of total billed charges,80% of total billed charges,75.4,65,,60.32,percent of total billed charges,65% of total billed charges,41.38,35.67,,33.104,percent of total billed charges,35.67% of total billed charges,33.64,378.22,
W/CHAIR 24IN 12TH MONTH RENT,27703683,CDM,290,RC,K0007,HCPCS,outpatient,,,116,46.40,RRKJKX,98.6,85,,78.88,percent of total billed charges,85% of total billed charges,89.32,77,,71.46,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,363.13,385,,,fee schedule,385% of BCBS fee schedule,378.22,401,,,fee schedule,401% of BCBS fee schedule,378.22,401,,,fee schedule,401% of BCBS fee schedule,378.22,401,,,fee schedule,401% of BCBS fee schedule,104.4,90,,83.52,percent of total billed charges,90% of total billed charges,92.8,80,,74.24,percent of total billed charges,80% of total billed charges,104.4,90,,83.52,percent of total billed charges,90% of total billed charges,87,75,,69.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,33.64,29,,26.912,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,77.72,67,,62.176,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,92.8,80,,74.24,percent of total billed charges,80% of total billed charges,75.4,65,,60.32,percent of total billed charges,65% of total billed charges,41.38,35.67,,33.104,percent of total billed charges,35.67% of total billed charges,33.64,378.22,
W/CHAIR 24IN 13TH MONTH RENT,27703684,CDM,290,RC,K0007,HCPCS,outpatient,,,116,46.40,RRKJKX,98.6,85,,78.88,percent of total billed charges,85% of total billed charges,89.32,77,,71.46,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,363.13,385,,,fee schedule,385% of BCBS fee schedule,378.22,401,,,fee schedule,401% of BCBS fee schedule,378.22,401,,,fee schedule,401% of BCBS fee schedule,378.22,401,,,fee schedule,401% of BCBS fee schedule,104.4,90,,83.52,percent of total billed charges,90% of total billed charges,92.8,80,,74.24,percent of total billed charges,80% of total billed charges,104.4,90,,83.52,percent of total billed charges,90% of total billed charges,87,75,,69.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,33.64,29,,26.912,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,77.72,67,,62.176,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,92.8,80,,74.24,percent of total billed charges,80% of total billed charges,75.4,65,,60.32,percent of total billed charges,65% of total billed charges,41.38,35.67,,33.104,percent of total billed charges,35.67% of total billed charges,33.64,378.22,
ELEVATE LEGREST 1ST MONTH RENT,27703685,CDM,290,RC,K0195,HCPCS,outpatient,,,38,15.20,RRKHKX,32.3,85,,25.84,percent of total billed charges,85% of total billed charges,29.26,77,,23.41,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,44.04,385,,,fee schedule,385% of BCBS fee schedule,45.87,401,,,fee schedule,401% of BCBS fee schedule,45.87,401,,,fee schedule,401% of BCBS fee schedule,45.87,401,,,fee schedule,401% of BCBS fee schedule,34.2,90,,27.36,percent of total billed charges,90% of total billed charges,30.4,80,,24.32,percent of total billed charges,80% of total billed charges,34.2,90,,27.36,percent of total billed charges,90% of total billed charges,28.5,75,,22.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,11.02,29,,8.816,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,25.46,67,,20.368,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,30.4,80,,24.32,percent of total billed charges,80% of total billed charges,24.7,65,,19.76,percent of total billed charges,65% of total billed charges,13.55,35.67,,10.84,percent of total billed charges,35.67% of total billed charges,11.02,45.87,
ELEVATE LEGREST 2ND MONTH RENT,27703686,CDM,290,RC,K0195,HCPCS,outpatient,,,38,15.20,RRKIKX,32.3,85,,25.84,percent of total billed charges,85% of total billed charges,29.26,77,,23.41,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,44.04,385,,,fee schedule,385% of BCBS fee schedule,45.87,401,,,fee schedule,401% of BCBS fee schedule,45.87,401,,,fee schedule,401% of BCBS fee schedule,45.87,401,,,fee schedule,401% of BCBS fee schedule,34.2,90,,27.36,percent of total billed charges,90% of total billed charges,30.4,80,,24.32,percent of total billed charges,80% of total billed charges,34.2,90,,27.36,percent of total billed charges,90% of total billed charges,28.5,75,,22.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,11.02,29,,8.816,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,25.46,67,,20.368,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,30.4,80,,24.32,percent of total billed charges,80% of total billed charges,24.7,65,,19.76,percent of total billed charges,65% of total billed charges,13.55,35.67,,10.84,percent of total billed charges,35.67% of total billed charges,11.02,45.87,
ELEVATE LEGREST 3RD MONTH RENT,27703687,CDM,290,RC,K0195,HCPCS,outpatient,,,38,15.20,RRKIKX,32.3,85,,25.84,percent of total billed charges,85% of total billed charges,29.26,77,,23.41,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,44.04,385,,,fee schedule,385% of BCBS fee schedule,45.87,401,,,fee schedule,401% of BCBS fee schedule,45.87,401,,,fee schedule,401% of BCBS fee schedule,45.87,401,,,fee schedule,401% of BCBS fee schedule,34.2,90,,27.36,percent of total billed charges,90% of total billed charges,30.4,80,,24.32,percent of total billed charges,80% of total billed charges,34.2,90,,27.36,percent of total billed charges,90% of total billed charges,28.5,75,,22.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,11.02,29,,8.816,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,25.46,67,,20.368,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,30.4,80,,24.32,percent of total billed charges,80% of total billed charges,24.7,65,,19.76,percent of total billed charges,65% of total billed charges,13.55,35.67,,10.84,percent of total billed charges,35.67% of total billed charges,11.02,45.87,
ELEVATE LR 4TH THRU 13TH MONTH,27703688,CDM,290,RC,K0195,HCPCS,outpatient,,,38,15.20,RRKJKX,32.3,85,,25.84,percent of total billed charges,85% of total billed charges,29.26,77,,23.41,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,44.04,385,,,fee schedule,385% of BCBS fee schedule,45.87,401,,,fee schedule,401% of BCBS fee schedule,45.87,401,,,fee schedule,401% of BCBS fee schedule,45.87,401,,,fee schedule,401% of BCBS fee schedule,34.2,90,,27.36,percent of total billed charges,90% of total billed charges,30.4,80,,24.32,percent of total billed charges,80% of total billed charges,34.2,90,,27.36,percent of total billed charges,90% of total billed charges,28.5,75,,22.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,11.02,29,,8.816,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,25.46,67,,20.368,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,30.4,80,,24.32,percent of total billed charges,80% of total billed charges,24.7,65,,19.76,percent of total billed charges,65% of total billed charges,13.55,35.67,,10.84,percent of total billed charges,35.67% of total billed charges,11.02,45.87,
ELEVATE LEGREST 5TH MONTH RENT,27703689,CDM,290,RC,K0195,HCPCS,outpatient,,,25,10.00,RRKJKX,21.25,85,,17,percent of total billed charges,85% of total billed charges,19.25,77,,15.4,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,44.04,385,,,fee schedule,385% of BCBS fee schedule,45.87,401,,,fee schedule,401% of BCBS fee schedule,45.87,401,,,fee schedule,401% of BCBS fee schedule,45.87,401,,,fee schedule,401% of BCBS fee schedule,22.5,90,,18,percent of total billed charges,90% of total billed charges,20,80,,16,percent of total billed charges,80% of total billed charges,22.5,90,,18,percent of total billed charges,90% of total billed charges,18.75,75,,15,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,7.25,29,,5.8,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,16.75,67,,13.4,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,20,80,,16,percent of total billed charges,80% of total billed charges,16.25,65,,13,percent of total billed charges,65% of total billed charges,8.92,35.67,,7.136,percent of total billed charges,35.67% of total billed charges,7.25,45.87,
ELEVATE LEGREST 6TH MONTH RENT,27703690,CDM,290,RC,K0195,HCPCS,outpatient,,,25,10.00,RRKJKX,21.25,85,,17,percent of total billed charges,85% of total billed charges,19.25,77,,15.4,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,44.04,385,,,fee schedule,385% of BCBS fee schedule,45.87,401,,,fee schedule,401% of BCBS fee schedule,45.87,401,,,fee schedule,401% of BCBS fee schedule,45.87,401,,,fee schedule,401% of BCBS fee schedule,22.5,90,,18,percent of total billed charges,90% of total billed charges,20,80,,16,percent of total billed charges,80% of total billed charges,22.5,90,,18,percent of total billed charges,90% of total billed charges,18.75,75,,15,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,7.25,29,,5.8,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,16.75,67,,13.4,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,20,80,,16,percent of total billed charges,80% of total billed charges,16.25,65,,13,percent of total billed charges,65% of total billed charges,8.92,35.67,,7.136,percent of total billed charges,35.67% of total billed charges,7.25,45.87,
ELEVATE LEGREST 7TH MONTH RENT,27703691,CDM,290,RC,K0195,HCPCS,outpatient,,,25,10.00,RRKJKX,21.25,85,,17,percent of total billed charges,85% of total billed charges,19.25,77,,15.4,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,44.04,385,,,fee schedule,385% of BCBS fee schedule,45.87,401,,,fee schedule,401% of BCBS fee schedule,45.87,401,,,fee schedule,401% of BCBS fee schedule,45.87,401,,,fee schedule,401% of BCBS fee schedule,22.5,90,,18,percent of total billed charges,90% of total billed charges,20,80,,16,percent of total billed charges,80% of total billed charges,22.5,90,,18,percent of total billed charges,90% of total billed charges,18.75,75,,15,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,7.25,29,,5.8,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,16.75,67,,13.4,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,20,80,,16,percent of total billed charges,80% of total billed charges,16.25,65,,13,percent of total billed charges,65% of total billed charges,8.92,35.67,,7.136,percent of total billed charges,35.67% of total billed charges,7.25,45.87,
ELEVATE LEGREST 8TH MONTH RENT,27703692,CDM,290,RC,K0195,HCPCS,outpatient,,,25,10.00,RRKJKX,21.25,85,,17,percent of total billed charges,85% of total billed charges,19.25,77,,15.4,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,44.04,385,,,fee schedule,385% of BCBS fee schedule,45.87,401,,,fee schedule,401% of BCBS fee schedule,45.87,401,,,fee schedule,401% of BCBS fee schedule,45.87,401,,,fee schedule,401% of BCBS fee schedule,22.5,90,,18,percent of total billed charges,90% of total billed charges,20,80,,16,percent of total billed charges,80% of total billed charges,22.5,90,,18,percent of total billed charges,90% of total billed charges,18.75,75,,15,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,7.25,29,,5.8,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,16.75,67,,13.4,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,20,80,,16,percent of total billed charges,80% of total billed charges,16.25,65,,13,percent of total billed charges,65% of total billed charges,8.92,35.67,,7.136,percent of total billed charges,35.67% of total billed charges,7.25,45.87,
ELEVATE LEGREST 9TH MONTH RENT,27703693,CDM,290,RC,K0195,HCPCS,outpatient,,,25,10.00,RRKJKX,21.25,85,,17,percent of total billed charges,85% of total billed charges,19.25,77,,15.4,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,44.04,385,,,fee schedule,385% of BCBS fee schedule,45.87,401,,,fee schedule,401% of BCBS fee schedule,45.87,401,,,fee schedule,401% of BCBS fee schedule,45.87,401,,,fee schedule,401% of BCBS fee schedule,22.5,90,,18,percent of total billed charges,90% of total billed charges,20,80,,16,percent of total billed charges,80% of total billed charges,22.5,90,,18,percent of total billed charges,90% of total billed charges,18.75,75,,15,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,7.25,29,,5.8,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,16.75,67,,13.4,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,20,80,,16,percent of total billed charges,80% of total billed charges,16.25,65,,13,percent of total billed charges,65% of total billed charges,8.92,35.67,,7.136,percent of total billed charges,35.67% of total billed charges,7.25,45.87,
ELEVATE LEGREST 10TH MON RENT,27703694,CDM,290,RC,K0195,HCPCS,outpatient,,,25,10.00,RRKJKX,21.25,85,,17,percent of total billed charges,85% of total billed charges,19.25,77,,15.4,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,44.04,385,,,fee schedule,385% of BCBS fee schedule,45.87,401,,,fee schedule,401% of BCBS fee schedule,45.87,401,,,fee schedule,401% of BCBS fee schedule,45.87,401,,,fee schedule,401% of BCBS fee schedule,22.5,90,,18,percent of total billed charges,90% of total billed charges,20,80,,16,percent of total billed charges,80% of total billed charges,22.5,90,,18,percent of total billed charges,90% of total billed charges,18.75,75,,15,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,7.25,29,,5.8,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,16.75,67,,13.4,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,20,80,,16,percent of total billed charges,80% of total billed charges,16.25,65,,13,percent of total billed charges,65% of total billed charges,8.92,35.67,,7.136,percent of total billed charges,35.67% of total billed charges,7.25,45.87,
ELEVATE LEGREST 11TH MON RENT,27703695,CDM,290,RC,K0195,HCPCS,outpatient,,,25,10.00,RRKJKX,21.25,85,,17,percent of total billed charges,85% of total billed charges,19.25,77,,15.4,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,44.04,385,,,fee schedule,385% of BCBS fee schedule,45.87,401,,,fee schedule,401% of BCBS fee schedule,45.87,401,,,fee schedule,401% of BCBS fee schedule,45.87,401,,,fee schedule,401% of BCBS fee schedule,22.5,90,,18,percent of total billed charges,90% of total billed charges,20,80,,16,percent of total billed charges,80% of total billed charges,22.5,90,,18,percent of total billed charges,90% of total billed charges,18.75,75,,15,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,7.25,29,,5.8,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,16.75,67,,13.4,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,20,80,,16,percent of total billed charges,80% of total billed charges,16.25,65,,13,percent of total billed charges,65% of total billed charges,8.92,35.67,,7.136,percent of total billed charges,35.67% of total billed charges,7.25,45.87,
ELEVATE LEGREST 12TH MON RENT,27703696,CDM,290,RC,K0195,HCPCS,outpatient,,,25,10.00,RRKJKX,21.25,85,,17,percent of total billed charges,85% of total billed charges,19.25,77,,15.4,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,44.04,385,,,fee schedule,385% of BCBS fee schedule,45.87,401,,,fee schedule,401% of BCBS fee schedule,45.87,401,,,fee schedule,401% of BCBS fee schedule,45.87,401,,,fee schedule,401% of BCBS fee schedule,22.5,90,,18,percent of total billed charges,90% of total billed charges,20,80,,16,percent of total billed charges,80% of total billed charges,22.5,90,,18,percent of total billed charges,90% of total billed charges,18.75,75,,15,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,7.25,29,,5.8,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,16.75,67,,13.4,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,20,80,,16,percent of total billed charges,80% of total billed charges,16.25,65,,13,percent of total billed charges,65% of total billed charges,8.92,35.67,,7.136,percent of total billed charges,35.67% of total billed charges,7.25,45.87,
ELEVATE LEGREST 13TH MON RENT,27703697,CDM,290,RC,K0195,HCPCS,outpatient,,,25,10.00,RRKJKX,21.25,85,,17,percent of total billed charges,85% of total billed charges,19.25,77,,15.4,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,44.04,385,,,fee schedule,385% of BCBS fee schedule,45.87,401,,,fee schedule,401% of BCBS fee schedule,45.87,401,,,fee schedule,401% of BCBS fee schedule,45.87,401,,,fee schedule,401% of BCBS fee schedule,22.5,90,,18,percent of total billed charges,90% of total billed charges,20,80,,16,percent of total billed charges,80% of total billed charges,22.5,90,,18,percent of total billed charges,90% of total billed charges,18.75,75,,15,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,7.25,29,,5.8,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,16.75,67,,13.4,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,20,80,,16,percent of total billed charges,80% of total billed charges,16.25,65,,13,percent of total billed charges,65% of total billed charges,8.92,35.67,,7.136,percent of total billed charges,35.67% of total billed charges,7.25,45.87,
F&P BREVIDA SEAL,27703702,CDM,290,RC,A7033,HCPCS,outpatient,,,73,29.20,NUKX,62.05,85,,49.64,percent of total billed charges,85% of total billed charges,56.21,77,,44.97,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,64.53,385,,,fee schedule,385% of BCBS fee schedule,67.21,401,,,fee schedule,401% of BCBS fee schedule,67.21,401,,,fee schedule,401% of BCBS fee schedule,67.21,401,,,fee schedule,401% of BCBS fee schedule,65.7,90,,52.56,percent of total billed charges,90% of total billed charges,58.4,80,,46.72,percent of total billed charges,80% of total billed charges,65.7,90,,52.56,percent of total billed charges,90% of total billed charges,54.75,75,,43.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,21.17,29,,16.936,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,48.91,67,,39.128,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,58.4,80,,46.72,percent of total billed charges,80% of total billed charges,47.45,65,,37.96,percent of total billed charges,65% of total billed charges,26.04,35.67,,20.832,percent of total billed charges,35.67% of total billed charges,21.17,67.21,
QUAD CANE TIPS BX 4,27703704,CDM,290,RC,A9270,HCPCS,outpatient,,,9,3.60,,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,6.93,77,,5.54,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,7.38,82,,5.904,percent of total billed charges,82% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,8.1,90,,6.48,percent of total billed charges,90% of total billed charges,7.2,80,,5.76,percent of total billed charges,80% of total billed charges,8.1,90,,6.48,percent of total billed charges,90% of total billed charges,6.75,75,,5.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.61,29,,2.088,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,6.03,67,,4.824,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,7.2,80,,5.76,percent of total billed charges,80% of total billed charges,5.85,65,,4.68,percent of total billed charges,65% of total billed charges,3.21,35.67,,2.568,percent of total billed charges,35.67% of total billed charges,2.61,8.1,
SOCK AID,27703705,CDM,290,RC,A9270,HCPCS,outpatient,,,17,6.80,,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,13.09,77,,10.47,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,13.94,82,,11.152,percent of total billed charges,82% of total billed charges,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,15.3,90,,12.24,percent of total billed charges,90% of total billed charges,13.6,80,,10.88,percent of total billed charges,80% of total billed charges,15.3,90,,12.24,percent of total billed charges,90% of total billed charges,12.75,75,,10.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,4.93,29,,3.944,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,11.39,67,,9.112,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,13.6,80,,10.88,percent of total billed charges,80% of total billed charges,11.05,65,,8.84,percent of total billed charges,65% of total billed charges,6.06,35.67,,4.848,percent of total billed charges,35.67% of total billed charges,4.93,15.3,
INCENTIVE SPIROMETER,27703706,CDM,290,RC,94014,HCPCS,outpatient,,,28,11.20,,23.8,85,,19.04,percent of total billed charges,85% of total billed charges,21.56,77,,17.25,percent of total billed charges,77% of total billed charges,348.44,100,,,fee schedule,100% of CMS OPPS rate,1415.74,429,,,fee schedule,429% of BCBS fee schedule,1475.14,401,,,fee schedule,401% of BCBS fee schedule,1475.14,401,,,fee schedule,401% of BCBS fee schedule,1475.14,401,,,fee schedule,401% of BCBS fee schedule,25.2,90,,20.16,percent of total billed charges,90% of total billed charges,22.4,80,,17.92,percent of total billed charges,80% of total billed charges,25.2,90,,20.16,percent of total billed charges,90% of total billed charges,21,75,,16.8,percent of total billed charges,75% of total billed charges,425.1,122,,,fee schedule,122% of APC rate,8.12,29,,6.496,percent of total billed charges,29% of total billed charges,348.44,100,,,fee schedule,100% of CMS OPPS rate,18.76,67,,15.008,percent of total billed charges,67% of total billed charges,48.24,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,22.4,80,,17.92,percent of total billed charges,80% of total billed charges,18.2,65,,14.56,percent of total billed charges,65% of total billed charges,9.99,35.67,,7.992,percent of total billed charges,35.67% of total billed charges,8.12,1475.14,
REUSABLE CPAP FILTER,27703707,CDM,290,RC,A7039,HCPCS,outpatient,,,16,6.40,NUKX,13.6,85,,10.88,percent of total billed charges,85% of total billed charges,12.32,77,,9.86,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,25.18,385,,,fee schedule,385% of BCBS fee schedule,26.23,401,,,fee schedule,401% of BCBS fee schedule,26.23,401,,,fee schedule,401% of BCBS fee schedule,26.23,401,,,fee schedule,401% of BCBS fee schedule,14.4,90,,11.52,percent of total billed charges,90% of total billed charges,12.8,80,,10.24,percent of total billed charges,80% of total billed charges,14.4,90,,11.52,percent of total billed charges,90% of total billed charges,12,75,,9.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,4.64,29,,3.712,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,10.72,67,,8.576,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,12.8,80,,10.24,percent of total billed charges,80% of total billed charges,10.4,65,,8.32,percent of total billed charges,65% of total billed charges,5.71,35.67,,4.568,percent of total billed charges,35.67% of total billed charges,4.64,26.23,
DISPOSABLE CPAP FILTER,27703708,CDM,290,RC,A7038,HCPCS,outpatient,,,9,3.60,NUKX,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,6.93,77,,5.54,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,8.7,385,,,fee schedule,385% of BCBS fee schedule,9.06,401,,,fee schedule,401% of BCBS fee schedule,9.06,401,,,fee schedule,401% of BCBS fee schedule,9.06,401,,,fee schedule,401% of BCBS fee schedule,8.1,90,,6.48,percent of total billed charges,90% of total billed charges,7.2,80,,5.76,percent of total billed charges,80% of total billed charges,8.1,90,,6.48,percent of total billed charges,90% of total billed charges,6.75,75,,5.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.61,29,,2.088,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,6.03,67,,4.824,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,7.2,80,,5.76,percent of total billed charges,80% of total billed charges,5.85,65,,4.68,percent of total billed charges,65% of total billed charges,3.21,35.67,,2.568,percent of total billed charges,35.67% of total billed charges,2.61,9.06,
QUAD CANE TIP,27703709,CDM,290,RC,A9270,HCPCS,outpatient,,,6,2.40,,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,4.62,77,,3.7,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,4.92,82,,3.936,percent of total billed charges,82% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,5.4,90,,4.32,percent of total billed charges,90% of total billed charges,4.8,80,,3.84,percent of total billed charges,80% of total billed charges,5.4,90,,4.32,percent of total billed charges,90% of total billed charges,4.5,75,,3.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,1.74,29,,1.392,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4.02,67,,3.216,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,4.8,80,,3.84,percent of total billed charges,80% of total billed charges,3.9,65,,3.12,percent of total billed charges,65% of total billed charges,2.14,35.67,,1.712,percent of total billed charges,35.67% of total billed charges,1.74,5.4,
CPAP WATER TRAY,27703710,CDM,290,RC,A7046,HCPCS,outpatient,,,62,24.80,NUKX,52.7,85,,42.16,percent of total billed charges,85% of total billed charges,47.74,77,,38.19,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,55.36,385,,,fee schedule,385% of BCBS fee schedule,57.66,401,,,fee schedule,401% of BCBS fee schedule,57.66,401,,,fee schedule,401% of BCBS fee schedule,57.66,401,,,fee schedule,401% of BCBS fee schedule,55.8,90,,44.64,percent of total billed charges,90% of total billed charges,49.6,80,,39.68,percent of total billed charges,80% of total billed charges,55.8,90,,44.64,percent of total billed charges,90% of total billed charges,46.5,75,,37.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,17.98,29,,14.384,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,41.54,67,,33.232,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,49.6,80,,39.68,percent of total billed charges,80% of total billed charges,40.3,65,,32.24,percent of total billed charges,65% of total billed charges,22.12,35.67,,17.696,percent of total billed charges,35.67% of total billed charges,17.98,57.66,
WHEELCHAIR 18 & 20IN 1ST MONTH,27703711,CDM,290,RC,K0001,HCPCS,outpatient,,,97,38.80,RRKHKX,82.45,85,,65.96,percent of total billed charges,85% of total billed charges,74.69,77,,59.75,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,94.33,385,,,fee schedule,385% of BCBS fee schedule,98.25,401,,,fee schedule,401% of BCBS fee schedule,98.25,401,,,fee schedule,401% of BCBS fee schedule,98.25,401,,,fee schedule,401% of BCBS fee schedule,87.3,90,,69.84,percent of total billed charges,90% of total billed charges,77.6,80,,62.08,percent of total billed charges,80% of total billed charges,87.3,90,,69.84,percent of total billed charges,90% of total billed charges,72.75,75,,58.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,28.13,29,,22.504,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,64.99,67,,51.992,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,77.6,80,,62.08,percent of total billed charges,80% of total billed charges,63.05,65,,50.44,percent of total billed charges,65% of total billed charges,34.6,35.67,,27.68,percent of total billed charges,35.67% of total billed charges,28.13,98.25,
WHEELCHAIR 18 & 20IN 2ND MONTH,27703712,CDM,290,RC,K0001,HCPCS,outpatient,,,97,38.80,RRKIKX,82.45,85,,65.96,percent of total billed charges,85% of total billed charges,74.69,77,,59.75,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,94.33,385,,,fee schedule,385% of BCBS fee schedule,98.25,401,,,fee schedule,401% of BCBS fee schedule,98.25,401,,,fee schedule,401% of BCBS fee schedule,98.25,401,,,fee schedule,401% of BCBS fee schedule,87.3,90,,69.84,percent of total billed charges,90% of total billed charges,77.6,80,,62.08,percent of total billed charges,80% of total billed charges,87.3,90,,69.84,percent of total billed charges,90% of total billed charges,72.75,75,,58.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,28.13,29,,22.504,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,64.99,67,,51.992,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,77.6,80,,62.08,percent of total billed charges,80% of total billed charges,63.05,65,,50.44,percent of total billed charges,65% of total billed charges,34.6,35.67,,27.68,percent of total billed charges,35.67% of total billed charges,28.13,98.25,
WHEELCHAIR 18 & 20IN 3RD MONTH,27703713,CDM,290,RC,K0001,HCPCS,outpatient,,,97,38.80,RRKIKX,82.45,85,,65.96,percent of total billed charges,85% of total billed charges,74.69,77,,59.75,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,94.33,385,,,fee schedule,385% of BCBS fee schedule,98.25,401,,,fee schedule,401% of BCBS fee schedule,98.25,401,,,fee schedule,401% of BCBS fee schedule,98.25,401,,,fee schedule,401% of BCBS fee schedule,87.3,90,,69.84,percent of total billed charges,90% of total billed charges,77.6,80,,62.08,percent of total billed charges,80% of total billed charges,87.3,90,,69.84,percent of total billed charges,90% of total billed charges,72.75,75,,58.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,28.13,29,,22.504,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,64.99,67,,51.992,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,77.6,80,,62.08,percent of total billed charges,80% of total billed charges,63.05,65,,50.44,percent of total billed charges,65% of total billed charges,34.6,35.67,,27.68,percent of total billed charges,35.67% of total billed charges,28.13,98.25,
WHEELCHAIR 18 & 20IN 4-13MONTH,27703714,CDM,290,RC,K0001,HCPCS,outpatient,,,97,38.80,RRKJKX,82.45,85,,65.96,percent of total billed charges,85% of total billed charges,74.69,77,,59.75,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,94.33,385,,,fee schedule,385% of BCBS fee schedule,98.25,401,,,fee schedule,401% of BCBS fee schedule,98.25,401,,,fee schedule,401% of BCBS fee schedule,98.25,401,,,fee schedule,401% of BCBS fee schedule,87.3,90,,69.84,percent of total billed charges,90% of total billed charges,77.6,80,,62.08,percent of total billed charges,80% of total billed charges,87.3,90,,69.84,percent of total billed charges,90% of total billed charges,72.75,75,,58.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,28.13,29,,22.504,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,64.99,67,,51.992,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,77.6,80,,62.08,percent of total billed charges,80% of total billed charges,63.05,65,,50.44,percent of total billed charges,65% of total billed charges,34.6,35.67,,27.68,percent of total billed charges,35.67% of total billed charges,28.13,98.25,
WHEELCHAIR LIGHTWEIGHT BCBS,27703715,CDM,290,RC,K0003,HCPCS,outpatient,,,762,304.80,NU,647.7,85,,518.16,percent of total billed charges,85% of total billed charges,586.74,77,,469.39,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,141.41,385,,,fee schedule,385% of BCBS fee schedule,147.29,401,,,fee schedule,401% of BCBS fee schedule,147.29,401,,,fee schedule,401% of BCBS fee schedule,147.29,401,,,fee schedule,401% of BCBS fee schedule,685.8,90,,548.64,percent of total billed charges,90% of total billed charges,609.6,80,,487.68,percent of total billed charges,80% of total billed charges,685.8,90,,548.64,percent of total billed charges,90% of total billed charges,571.5,75,,457.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,220.98,29,,176.784,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,510.54,67,,408.432,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,609.6,80,,487.68,percent of total billed charges,80% of total billed charges,495.3,65,,396.24,percent of total billed charges,65% of total billed charges,271.81,35.67,,217.448,percent of total billed charges,35.67% of total billed charges,141.41,685.8,
WHEELCHAIR FR 6TH MONTH RENT,27703716,CDM,290,RC,K0001,HCPCS,outpatient,,,93,37.20,RRKJKX,79.05,85,,63.24,percent of total billed charges,85% of total billed charges,71.61,77,,57.29,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,94.33,385,,,fee schedule,385% of BCBS fee schedule,98.25,401,,,fee schedule,401% of BCBS fee schedule,98.25,401,,,fee schedule,401% of BCBS fee schedule,98.25,401,,,fee schedule,401% of BCBS fee schedule,83.7,90,,66.96,percent of total billed charges,90% of total billed charges,74.4,80,,59.52,percent of total billed charges,80% of total billed charges,83.7,90,,66.96,percent of total billed charges,90% of total billed charges,69.75,75,,55.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,26.97,29,,21.576,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,62.31,67,,49.848,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,74.4,80,,59.52,percent of total billed charges,80% of total billed charges,60.45,65,,48.36,percent of total billed charges,65% of total billed charges,33.17,35.67,,26.536,percent of total billed charges,35.67% of total billed charges,26.97,98.25,
WHEELCHAIR FR 7TH MONTH RENT,27703717,CDM,290,RC,K0001,HCPCS,outpatient,,,93,37.20,RRKJKX,79.05,85,,63.24,percent of total billed charges,85% of total billed charges,71.61,77,,57.29,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,94.33,385,,,fee schedule,385% of BCBS fee schedule,98.25,401,,,fee schedule,401% of BCBS fee schedule,98.25,401,,,fee schedule,401% of BCBS fee schedule,98.25,401,,,fee schedule,401% of BCBS fee schedule,83.7,90,,66.96,percent of total billed charges,90% of total billed charges,74.4,80,,59.52,percent of total billed charges,80% of total billed charges,83.7,90,,66.96,percent of total billed charges,90% of total billed charges,69.75,75,,55.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,26.97,29,,21.576,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,62.31,67,,49.848,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,74.4,80,,59.52,percent of total billed charges,80% of total billed charges,60.45,65,,48.36,percent of total billed charges,65% of total billed charges,33.17,35.67,,26.536,percent of total billed charges,35.67% of total billed charges,26.97,98.25,
WHEELCHAIR FR 8TH MONTH RENT,27703718,CDM,290,RC,K0001,HCPCS,outpatient,,,93,37.20,RRKJKX,79.05,85,,63.24,percent of total billed charges,85% of total billed charges,71.61,77,,57.29,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,94.33,385,,,fee schedule,385% of BCBS fee schedule,98.25,401,,,fee schedule,401% of BCBS fee schedule,98.25,401,,,fee schedule,401% of BCBS fee schedule,98.25,401,,,fee schedule,401% of BCBS fee schedule,83.7,90,,66.96,percent of total billed charges,90% of total billed charges,74.4,80,,59.52,percent of total billed charges,80% of total billed charges,83.7,90,,66.96,percent of total billed charges,90% of total billed charges,69.75,75,,55.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,26.97,29,,21.576,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,62.31,67,,49.848,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,74.4,80,,59.52,percent of total billed charges,80% of total billed charges,60.45,65,,48.36,percent of total billed charges,65% of total billed charges,33.17,35.67,,26.536,percent of total billed charges,35.67% of total billed charges,26.97,98.25,
WHEELCHAIR FR 10TH MONTH RENT,27703720,CDM,290,RC,K0001,HCPCS,outpatient,,,93,37.20,RRKJKX,79.05,85,,63.24,percent of total billed charges,85% of total billed charges,71.61,77,,57.29,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,94.33,385,,,fee schedule,385% of BCBS fee schedule,98.25,401,,,fee schedule,401% of BCBS fee schedule,98.25,401,,,fee schedule,401% of BCBS fee schedule,98.25,401,,,fee schedule,401% of BCBS fee schedule,83.7,90,,66.96,percent of total billed charges,90% of total billed charges,74.4,80,,59.52,percent of total billed charges,80% of total billed charges,83.7,90,,66.96,percent of total billed charges,90% of total billed charges,69.75,75,,55.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,26.97,29,,21.576,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,62.31,67,,49.848,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,74.4,80,,59.52,percent of total billed charges,80% of total billed charges,60.45,65,,48.36,percent of total billed charges,65% of total billed charges,33.17,35.67,,26.536,percent of total billed charges,35.67% of total billed charges,26.97,98.25,
WHEELCHAIR FR 11TH MONTH RENT,27703721,CDM,290,RC,K0001,HCPCS,outpatient,,,93,37.20,RRKJKX,79.05,85,,63.24,percent of total billed charges,85% of total billed charges,71.61,77,,57.29,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,94.33,385,,,fee schedule,385% of BCBS fee schedule,98.25,401,,,fee schedule,401% of BCBS fee schedule,98.25,401,,,fee schedule,401% of BCBS fee schedule,98.25,401,,,fee schedule,401% of BCBS fee schedule,83.7,90,,66.96,percent of total billed charges,90% of total billed charges,74.4,80,,59.52,percent of total billed charges,80% of total billed charges,83.7,90,,66.96,percent of total billed charges,90% of total billed charges,69.75,75,,55.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,26.97,29,,21.576,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,62.31,67,,49.848,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,74.4,80,,59.52,percent of total billed charges,80% of total billed charges,60.45,65,,48.36,percent of total billed charges,65% of total billed charges,33.17,35.67,,26.536,percent of total billed charges,35.67% of total billed charges,26.97,98.25,
WHEELCHAIR FR 12TH MONTH RENT,27703722,CDM,290,RC,K0001,HCPCS,outpatient,,,93,37.20,RRKJKX,79.05,85,,63.24,percent of total billed charges,85% of total billed charges,71.61,77,,57.29,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,94.33,385,,,fee schedule,385% of BCBS fee schedule,98.25,401,,,fee schedule,401% of BCBS fee schedule,98.25,401,,,fee schedule,401% of BCBS fee schedule,98.25,401,,,fee schedule,401% of BCBS fee schedule,83.7,90,,66.96,percent of total billed charges,90% of total billed charges,74.4,80,,59.52,percent of total billed charges,80% of total billed charges,83.7,90,,66.96,percent of total billed charges,90% of total billed charges,69.75,75,,55.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,26.97,29,,21.576,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,62.31,67,,49.848,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,74.4,80,,59.52,percent of total billed charges,80% of total billed charges,60.45,65,,48.36,percent of total billed charges,65% of total billed charges,33.17,35.67,,26.536,percent of total billed charges,35.67% of total billed charges,26.97,98.25,
WHEELCHAIR FR 13TH MONTH RENT,27703723,CDM,290,RC,K0001,HCPCS,outpatient,,,93,37.20,RRKJKX,79.05,85,,63.24,percent of total billed charges,85% of total billed charges,71.61,77,,57.29,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,94.33,385,,,fee schedule,385% of BCBS fee schedule,98.25,401,,,fee schedule,401% of BCBS fee schedule,98.25,401,,,fee schedule,401% of BCBS fee schedule,98.25,401,,,fee schedule,401% of BCBS fee schedule,83.7,90,,66.96,percent of total billed charges,90% of total billed charges,74.4,80,,59.52,percent of total billed charges,80% of total billed charges,83.7,90,,66.96,percent of total billed charges,90% of total billed charges,69.75,75,,55.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,26.97,29,,21.576,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,62.31,67,,49.848,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,74.4,80,,59.52,percent of total billed charges,80% of total billed charges,60.45,65,,48.36,percent of total billed charges,65% of total billed charges,33.17,35.67,,26.536,percent of total billed charges,35.67% of total billed charges,26.97,98.25,
KNEE IMMOBILIZER 19 IN,27703724,CDM,290,RC,L1830,HCPCS,outpatient,,,187,74.80,LTKX,158.95,85,,127.16,percent of total billed charges,85% of total billed charges,143.99,77,,115.19,percent of total billed charges,77% of total billed charges,84.63,100,,,fee schedule,100% of CMS fee schedule,153.34,82,,122.672,percent of total billed charges,82% of total billed charges,158.95,85,,127.16,percent of total billed charges,85% of total billed charges,158.95,85,,127.16,percent of total billed charges,85% of total billed charges,158.95,85,,127.16,percent of total billed charges,85% of total billed charges,168.3,90,,134.64,percent of total billed charges,90% of total billed charges,149.6,80,,119.68,percent of total billed charges,80% of total billed charges,168.3,90,,134.64,percent of total billed charges,90% of total billed charges,140.25,75,,112.2,percent of total billed charges,75% of total billed charges,103.25,122,,,fee schedule,122% of APC rate,54.23,29,,43.384,percent of total billed charges,29% of total billed charges,84.63,100,,,fee schedule,100% of CMS fee schedule,125.29,67,,100.232,percent of total billed charges,67% of total billed charges,94.31,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,149.6,80,,119.68,percent of total billed charges,80% of total billed charges,121.55,65,,97.24,percent of total billed charges,65% of total billed charges,66.7,35.67,,53.36,percent of total billed charges,35.67% of total billed charges,54.23,168.3,
DISPOSE FILTERS CPAP S9/AIR10,27703726,CDM,290,RC,A7038,HCPCS,outpatient,,,8,3.20,NUKX,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,6.16,77,,4.93,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,8.7,385,,,fee schedule,385% of BCBS fee schedule,9.06,401,,,fee schedule,401% of BCBS fee schedule,9.06,401,,,fee schedule,401% of BCBS fee schedule,9.06,401,,,fee schedule,401% of BCBS fee schedule,7.2,90,,5.76,percent of total billed charges,90% of total billed charges,6.4,80,,5.12,percent of total billed charges,80% of total billed charges,7.2,90,,5.76,percent of total billed charges,90% of total billed charges,6,75,,4.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.32,29,,1.856,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,5.36,67,,4.288,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,6.4,80,,5.12,percent of total billed charges,80% of total billed charges,5.2,65,,4.16,percent of total billed charges,65% of total billed charges,2.85,35.67,,2.28,percent of total billed charges,35.67% of total billed charges,2.32,9.06,
CHIN STRAP,27703727,CDM,290,RC,A7036,HCPCS,outpatient,,,30,12.00,NU,25.5,85,,20.4,percent of total billed charges,85% of total billed charges,23.1,77,,18.48,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,43.97,385,,,fee schedule,385% of BCBS fee schedule,45.79,401,,,fee schedule,401% of BCBS fee schedule,45.79,401,,,fee schedule,401% of BCBS fee schedule,45.79,401,,,fee schedule,401% of BCBS fee schedule,27,90,,21.6,percent of total billed charges,90% of total billed charges,24,80,,19.2,percent of total billed charges,80% of total billed charges,27,90,,21.6,percent of total billed charges,90% of total billed charges,22.5,75,,18,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,8.7,29,,6.96,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,20.1,67,,16.08,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,24,80,,19.2,percent of total billed charges,80% of total billed charges,19.5,65,,15.6,percent of total billed charges,65% of total billed charges,10.7,35.67,,8.56,percent of total billed charges,35.67% of total billed charges,8.7,45.79,
OMRON BP MONITOR,27703728,CDM,290,RC,A4670,HCPCS,outpatient,,,73,29.20,,62.05,85,,49.64,percent of total billed charges,85% of total billed charges,56.21,77,,44.97,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,59.86,82,,47.888,percent of total billed charges,82% of total billed charges,62.05,85,,49.64,percent of total billed charges,85% of total billed charges,62.05,85,,49.64,percent of total billed charges,85% of total billed charges,62.05,85,,49.64,percent of total billed charges,85% of total billed charges,65.7,90,,52.56,percent of total billed charges,90% of total billed charges,58.4,80,,46.72,percent of total billed charges,80% of total billed charges,65.7,90,,52.56,percent of total billed charges,90% of total billed charges,54.75,75,,43.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,21.17,29,,16.936,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,48.91,67,,39.128,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,58.4,80,,46.72,percent of total billed charges,80% of total billed charges,47.45,65,,37.96,percent of total billed charges,65% of total billed charges,26.04,35.67,,20.832,percent of total billed charges,35.67% of total billed charges,21.17,65.7,
REPLACE NASAL CUSHION A7032,27703731,CDM,290,RC,A7032,HCPCS,outpatient,,,89,35.60,NUKX,75.65,85,,60.52,percent of total billed charges,85% of total billed charges,68.53,77,,54.82,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,78.66,385,,,fee schedule,385% of BCBS fee schedule,81.92,401,,,fee schedule,401% of BCBS fee schedule,81.92,401,,,fee schedule,401% of BCBS fee schedule,81.92,401,,,fee schedule,401% of BCBS fee schedule,80.1,90,,64.08,percent of total billed charges,90% of total billed charges,71.2,80,,56.96,percent of total billed charges,80% of total billed charges,80.1,90,,64.08,percent of total billed charges,90% of total billed charges,66.75,75,,53.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,25.81,29,,20.648,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,59.63,67,,47.704,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,71.2,80,,56.96,percent of total billed charges,80% of total billed charges,57.85,65,,46.28,percent of total billed charges,65% of total billed charges,31.75,35.67,,25.4,percent of total billed charges,35.67% of total billed charges,25.81,81.92,
JOBST COMPRESSION HOSE 20-30,27703732,CDM,290,RC,A6530,HCPCS,outpatient,,,94,37.60,,79.9,85,,63.92,percent of total billed charges,85% of total billed charges,72.38,77,,57.9,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,77.08,82,,61.664,percent of total billed charges,82% of total billed charges,79.9,85,,63.92,percent of total billed charges,85% of total billed charges,79.9,85,,63.92,percent of total billed charges,85% of total billed charges,79.9,85,,63.92,percent of total billed charges,85% of total billed charges,84.6,90,,67.68,percent of total billed charges,90% of total billed charges,75.2,80,,60.16,percent of total billed charges,80% of total billed charges,84.6,90,,67.68,percent of total billed charges,90% of total billed charges,70.5,75,,56.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,27.26,29,,21.808,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,62.98,67,,50.384,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,75.2,80,,60.16,percent of total billed charges,80% of total billed charges,61.1,65,,48.88,percent of total billed charges,65% of total billed charges,33.53,35.67,,26.824,percent of total billed charges,35.67% of total billed charges,27.26,84.6,
REPLACE NASAL PILLOW A7033,27703733,CDM,290,RC,A7033,HCPCS,outpatient,,,74,29.60,NUKX,62.9,85,,50.32,percent of total billed charges,85% of total billed charges,56.98,77,,45.58,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,64.53,385,,,fee schedule,385% of BCBS fee schedule,67.21,401,,,fee schedule,401% of BCBS fee schedule,67.21,401,,,fee schedule,401% of BCBS fee schedule,67.21,401,,,fee schedule,401% of BCBS fee schedule,66.6,90,,53.28,percent of total billed charges,90% of total billed charges,59.2,80,,47.36,percent of total billed charges,80% of total billed charges,66.6,90,,53.28,percent of total billed charges,90% of total billed charges,55.5,75,,44.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,21.46,29,,17.168,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,49.58,67,,39.664,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,59.2,80,,47.36,percent of total billed charges,80% of total billed charges,48.1,65,,38.48,percent of total billed charges,65% of total billed charges,26.4,35.67,,21.12,percent of total billed charges,35.67% of total billed charges,21.46,67.21,
KNEE WALKER RENTAL- CASH,27703734,CDM,290,RC,E0118,HCPCS,outpatient,,,58,23.20,NUKX,49.3,85,,39.44,percent of total billed charges,85% of total billed charges,44.66,77,,35.73,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,47.56,82,,38.048,percent of total billed charges,82% of total billed charges,49.3,85,,39.44,percent of total billed charges,85% of total billed charges,49.3,85,,39.44,percent of total billed charges,85% of total billed charges,49.3,85,,39.44,percent of total billed charges,85% of total billed charges,52.2,90,,41.76,percent of total billed charges,90% of total billed charges,46.4,80,,37.12,percent of total billed charges,80% of total billed charges,52.2,90,,41.76,percent of total billed charges,90% of total billed charges,43.5,75,,34.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,16.82,29,,13.456,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,38.86,67,,31.088,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,46.4,80,,37.12,percent of total billed charges,80% of total billed charges,37.7,65,,30.16,percent of total billed charges,65% of total billed charges,20.69,35.67,,16.552,percent of total billed charges,35.67% of total billed charges,16.82,52.2,
PROCARE SLEEVE KNEE BRACE MED,27703736,CDM,290,RC,A4467,HCPCS,outpatient,,,18,7.20,,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,13.86,77,,11.09,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,14.76,82,,11.808,percent of total billed charges,82% of total billed charges,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,16.2,90,,12.96,percent of total billed charges,90% of total billed charges,14.4,80,,11.52,percent of total billed charges,80% of total billed charges,16.2,90,,12.96,percent of total billed charges,90% of total billed charges,13.5,75,,10.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,5.22,29,,4.176,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,12.06,67,,9.648,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,14.4,80,,11.52,percent of total billed charges,80% of total billed charges,11.7,65,,9.36,percent of total billed charges,65% of total billed charges,6.42,35.67,,5.136,percent of total billed charges,35.67% of total billed charges,5.22,16.2,
PROCARE SLEEVE KNEE BRACE,27703737,CDM,290,RC,A4467,HCPCS,outpatient,,,38,15.20,,32.3,85,,25.84,percent of total billed charges,85% of total billed charges,29.26,77,,23.41,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,31.16,82,,24.928,percent of total billed charges,82% of total billed charges,32.3,85,,25.84,percent of total billed charges,85% of total billed charges,32.3,85,,25.84,percent of total billed charges,85% of total billed charges,32.3,85,,25.84,percent of total billed charges,85% of total billed charges,34.2,90,,27.36,percent of total billed charges,90% of total billed charges,30.4,80,,24.32,percent of total billed charges,80% of total billed charges,34.2,90,,27.36,percent of total billed charges,90% of total billed charges,28.5,75,,22.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,11.02,29,,8.816,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,25.46,67,,20.368,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,30.4,80,,24.32,percent of total billed charges,80% of total billed charges,24.7,65,,19.76,percent of total billed charges,65% of total billed charges,13.55,35.67,,10.84,percent of total billed charges,35.67% of total billed charges,11.02,34.2,
PROCARE KNEE BRACE SLEEVE XL,27703738,CDM,290,RC,A4467,HCPCS,outpatient,,,66,26.40,,56.1,85,,44.88,percent of total billed charges,85% of total billed charges,50.82,77,,40.66,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,54.12,82,,43.296,percent of total billed charges,82% of total billed charges,56.1,85,,44.88,percent of total billed charges,85% of total billed charges,56.1,85,,44.88,percent of total billed charges,85% of total billed charges,56.1,85,,44.88,percent of total billed charges,85% of total billed charges,59.4,90,,47.52,percent of total billed charges,90% of total billed charges,52.8,80,,42.24,percent of total billed charges,80% of total billed charges,59.4,90,,47.52,percent of total billed charges,90% of total billed charges,49.5,75,,39.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,19.14,29,,15.312,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,44.22,67,,35.376,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,52.8,80,,42.24,percent of total billed charges,80% of total billed charges,42.9,65,,34.32,percent of total billed charges,65% of total billed charges,23.54,35.67,,18.832,percent of total billed charges,35.67% of total billed charges,19.14,59.4,
KNEE WALKER STEERABLE DRIVE,27703739,CDM,290,RC,E0118,HCPCS,outpatient,,,208,83.20,NUBP,176.8,85,,141.44,percent of total billed charges,85% of total billed charges,160.16,77,,128.13,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,170.56,82,,136.448,percent of total billed charges,82% of total billed charges,176.8,85,,141.44,percent of total billed charges,85% of total billed charges,176.8,85,,141.44,percent of total billed charges,85% of total billed charges,176.8,85,,141.44,percent of total billed charges,85% of total billed charges,187.2,90,,149.76,percent of total billed charges,90% of total billed charges,166.4,80,,133.12,percent of total billed charges,80% of total billed charges,187.2,90,,149.76,percent of total billed charges,90% of total billed charges,156,75,,124.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,60.32,29,,48.256,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,139.36,67,,111.488,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,166.4,80,,133.12,percent of total billed charges,80% of total billed charges,135.2,65,,108.16,percent of total billed charges,65% of total billed charges,74.19,35.67,,59.352,percent of total billed charges,35.67% of total billed charges,60.32,187.2,
ROLLATOR WALKER DRIVE PURCHASE,27703740,CDM,290,RC,E0143,HCPCS,outpatient,,,144,57.60,NU,122.4,85,,97.92,percent of total billed charges,85% of total billed charges,110.88,77,,88.7,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,194.85,385,,,fee schedule,385% of BCBS fee schedule,202.95,401,,,fee schedule,401% of BCBS fee schedule,202.95,401,,,fee schedule,401% of BCBS fee schedule,202.95,401,,,fee schedule,401% of BCBS fee schedule,129.6,90,,103.68,percent of total billed charges,90% of total billed charges,115.2,80,,92.16,percent of total billed charges,80% of total billed charges,129.6,90,,103.68,percent of total billed charges,90% of total billed charges,108,75,,86.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,41.76,29,,33.408,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,96.48,67,,77.184,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,115.2,80,,92.16,percent of total billed charges,80% of total billed charges,93.6,65,,74.88,percent of total billed charges,65% of total billed charges,51.36,35.67,,41.088,percent of total billed charges,35.67% of total billed charges,41.76,202.95,
DRESSING STICK,27703742,CDM,290,RC,A9281,HCPCS,outpatient,,,18,7.20,,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,13.86,77,,11.09,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,14.76,82,,11.808,percent of total billed charges,82% of total billed charges,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,16.2,90,,12.96,percent of total billed charges,90% of total billed charges,14.4,80,,11.52,percent of total billed charges,80% of total billed charges,16.2,90,,12.96,percent of total billed charges,90% of total billed charges,13.5,75,,10.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,5.22,29,,4.176,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,12.06,67,,9.648,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,14.4,80,,11.52,percent of total billed charges,80% of total billed charges,11.7,65,,9.36,percent of total billed charges,65% of total billed charges,6.42,35.67,,5.136,percent of total billed charges,35.67% of total billed charges,5.22,16.2,
ARM COMPRESSION SLEEVE,27703743,CDM,290,RC,L8220,HCPCS,outpatient,,,61,24.40,,51.85,85,,41.48,percent of total billed charges,85% of total billed charges,46.97,77,,37.58,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,50.02,82,,40.016,percent of total billed charges,82% of total billed charges,51.85,85,,41.48,percent of total billed charges,85% of total billed charges,51.85,85,,41.48,percent of total billed charges,85% of total billed charges,51.85,85,,41.48,percent of total billed charges,85% of total billed charges,54.9,90,,43.92,percent of total billed charges,90% of total billed charges,48.8,80,,39.04,percent of total billed charges,80% of total billed charges,54.9,90,,43.92,percent of total billed charges,90% of total billed charges,45.75,75,,36.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,17.69,29,,14.152,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,40.87,67,,32.696,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,48.8,80,,39.04,percent of total billed charges,80% of total billed charges,39.65,65,,31.72,percent of total billed charges,65% of total billed charges,21.76,35.67,,17.408,percent of total billed charges,35.67% of total billed charges,17.69,54.9,
TENS UNIT,27703744,CDM,290,RC,E0730,HCPCS,outpatient,,,66,26.40,NUKX,56.1,85,,44.88,percent of total billed charges,85% of total billed charges,50.82,77,,40.66,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,277.62,385,,,fee schedule,385% of BCBS fee schedule,289.16,401,,,fee schedule,401% of BCBS fee schedule,289.16,401,,,fee schedule,401% of BCBS fee schedule,289.16,401,,,fee schedule,401% of BCBS fee schedule,59.4,90,,47.52,percent of total billed charges,90% of total billed charges,52.8,80,,42.24,percent of total billed charges,80% of total billed charges,59.4,90,,47.52,percent of total billed charges,90% of total billed charges,49.5,75,,39.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,19.14,29,,15.312,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,44.22,67,,35.376,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,52.8,80,,42.24,percent of total billed charges,80% of total billed charges,42.9,65,,34.32,percent of total billed charges,65% of total billed charges,23.54,35.67,,18.832,percent of total billed charges,35.67% of total billed charges,19.14,289.16,
HEMI WALKER,27703746,CDM,290,RC,E0143,HCPCS,outpatient,,,110,44.00,NU,93.5,85,,74.8,percent of total billed charges,85% of total billed charges,84.7,77,,67.76,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,194.85,385,,,fee schedule,385% of BCBS fee schedule,202.95,401,,,fee schedule,401% of BCBS fee schedule,202.95,401,,,fee schedule,401% of BCBS fee schedule,202.95,401,,,fee schedule,401% of BCBS fee schedule,99,90,,79.2,percent of total billed charges,90% of total billed charges,88,80,,70.4,percent of total billed charges,80% of total billed charges,99,90,,79.2,percent of total billed charges,90% of total billed charges,82.5,75,,66,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,31.9,29,,25.52,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,73.7,67,,58.96,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,88,80,,70.4,percent of total billed charges,80% of total billed charges,71.5,65,,57.2,percent of total billed charges,65% of total billed charges,39.24,35.67,,31.392,percent of total billed charges,35.67% of total billed charges,31.9,202.95,
OVER-BED TABLE,27703749,CDM,290,RC,E0274,HCPCS,outpatient,,,162,64.80,,137.7,85,,110.16,percent of total billed charges,85% of total billed charges,124.74,77,,99.79,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,132.84,82,,106.272,percent of total billed charges,82% of total billed charges,137.7,85,,110.16,percent of total billed charges,85% of total billed charges,137.7,85,,110.16,percent of total billed charges,85% of total billed charges,137.7,85,,110.16,percent of total billed charges,85% of total billed charges,145.8,90,,116.64,percent of total billed charges,90% of total billed charges,129.6,80,,103.68,percent of total billed charges,80% of total billed charges,145.8,90,,116.64,percent of total billed charges,90% of total billed charges,121.5,75,,97.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,46.98,29,,37.584,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,108.54,67,,86.832,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,129.6,80,,103.68,percent of total billed charges,80% of total billed charges,105.3,65,,84.24,percent of total billed charges,65% of total billed charges,57.79,35.67,,46.232,percent of total billed charges,35.67% of total billed charges,46.98,145.8,
CPAP CONT PRESSURE DEVICE BCBS,27703753,CDM,290,RC,E0601,HCPCS,outpatient,,,398,159.20,NUKX,338.3,85,,270.64,percent of total billed charges,85% of total billed charges,306.46,77,,245.17,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,169.21,385,,,fee schedule,385% of BCBS fee schedule,176.24,401,,,fee schedule,401% of BCBS fee schedule,176.24,401,,,fee schedule,401% of BCBS fee schedule,176.24,401,,,fee schedule,401% of BCBS fee schedule,358.2,90,,286.56,percent of total billed charges,90% of total billed charges,318.4,80,,254.72,percent of total billed charges,80% of total billed charges,358.2,90,,286.56,percent of total billed charges,90% of total billed charges,298.5,75,,238.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,115.42,29,,92.336,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,266.66,67,,213.328,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,318.4,80,,254.72,percent of total billed charges,80% of total billed charges,258.7,65,,206.96,percent of total billed charges,65% of total billed charges,141.97,35.67,,113.576,percent of total billed charges,35.67% of total billed charges,115.42,358.2,
KNEE WALKER RENTAL INS,27703754,CDM,290,RC,E0118,HCPCS,outpatient,,,58,23.20,RR,49.3,85,,39.44,percent of total billed charges,85% of total billed charges,44.66,77,,35.73,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,47.56,82,,38.048,percent of total billed charges,82% of total billed charges,49.3,85,,39.44,percent of total billed charges,85% of total billed charges,49.3,85,,39.44,percent of total billed charges,85% of total billed charges,49.3,85,,39.44,percent of total billed charges,85% of total billed charges,52.2,90,,41.76,percent of total billed charges,90% of total billed charges,46.4,80,,37.12,percent of total billed charges,80% of total billed charges,52.2,90,,41.76,percent of total billed charges,90% of total billed charges,43.5,75,,34.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,16.82,29,,13.456,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,38.86,67,,31.088,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,46.4,80,,37.12,percent of total billed charges,80% of total billed charges,37.7,65,,30.16,percent of total billed charges,65% of total billed charges,20.69,35.67,,16.552,percent of total billed charges,35.67% of total billed charges,16.82,52.2,
WHEELCHAIR 18IN ELR PURCHASE,27703757,CDM,290,RC,K0001,HCPCS,outpatient,,,640,256.00,NU,544,85,,435.2,percent of total billed charges,85% of total billed charges,492.8,77,,394.24,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,94.33,385,,,fee schedule,385% of BCBS fee schedule,98.25,401,,,fee schedule,401% of BCBS fee schedule,98.25,401,,,fee schedule,401% of BCBS fee schedule,98.25,401,,,fee schedule,401% of BCBS fee schedule,576,90,,460.8,percent of total billed charges,90% of total billed charges,512,80,,409.6,percent of total billed charges,80% of total billed charges,576,90,,460.8,percent of total billed charges,90% of total billed charges,480,75,,384,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,185.6,29,,148.48,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,428.8,67,,343.04,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,512,80,,409.6,percent of total billed charges,80% of total billed charges,416,65,,332.8,percent of total billed charges,65% of total billed charges,228.29,35.67,,182.632,percent of total billed charges,35.67% of total billed charges,94.33,576,
BARIATRIC COMMODE DROP-ARM,27703758,CDM,290,RC,E0168,HCPCS,outpatient,,,165,66.00,NU,140.25,85,,112.2,percent of total billed charges,85% of total billed charges,127.05,77,,101.64,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,480.63,385,,,fee schedule,385% of BCBS fee schedule,500.61,401,,,fee schedule,401% of BCBS fee schedule,500.61,401,,,fee schedule,401% of BCBS fee schedule,500.61,401,,,fee schedule,401% of BCBS fee schedule,148.5,90,,118.8,percent of total billed charges,90% of total billed charges,132,80,,105.6,percent of total billed charges,80% of total billed charges,148.5,90,,118.8,percent of total billed charges,90% of total billed charges,123.75,75,,99,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,47.85,29,,38.28,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,110.55,67,,88.44,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,132,80,,105.6,percent of total billed charges,80% of total billed charges,107.25,65,,85.8,percent of total billed charges,65% of total billed charges,58.86,35.67,,47.088,percent of total billed charges,35.67% of total billed charges,47.85,500.61,
WRIST SPLINT COCK-UP LEFT,27703759,CDM,290,RC,L3908,HCPCS,outpatient,,,121,48.40,LTKX,102.85,85,,82.28,percent of total billed charges,85% of total billed charges,93.17,77,,74.54,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,99.22,82,,79.376,percent of total billed charges,82% of total billed charges,102.85,85,,82.28,percent of total billed charges,85% of total billed charges,102.85,85,,82.28,percent of total billed charges,85% of total billed charges,102.85,85,,82.28,percent of total billed charges,85% of total billed charges,108.9,90,,87.12,percent of total billed charges,90% of total billed charges,96.8,80,,77.44,percent of total billed charges,80% of total billed charges,108.9,90,,87.12,percent of total billed charges,90% of total billed charges,90.75,75,,72.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,35.09,29,,28.072,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,81.07,67,,64.856,percent of total billed charges,67% of total billed charges,71.1,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,96.8,80,,77.44,percent of total billed charges,80% of total billed charges,78.65,65,,62.92,percent of total billed charges,65% of total billed charges,43.16,35.67,,34.528,percent of total billed charges,35.67% of total billed charges,35.09,108.9,
WRIST SPLINT COCK-UP RIGHT,27703760,CDM,290,RC,L3908,HCPCS,outpatient,,,121,48.40,RTKX,102.85,85,,82.28,percent of total billed charges,85% of total billed charges,93.17,77,,74.54,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,99.22,82,,79.376,percent of total billed charges,82% of total billed charges,102.85,85,,82.28,percent of total billed charges,85% of total billed charges,102.85,85,,82.28,percent of total billed charges,85% of total billed charges,102.85,85,,82.28,percent of total billed charges,85% of total billed charges,108.9,90,,87.12,percent of total billed charges,90% of total billed charges,96.8,80,,77.44,percent of total billed charges,80% of total billed charges,108.9,90,,87.12,percent of total billed charges,90% of total billed charges,90.75,75,,72.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,35.09,29,,28.072,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,81.07,67,,64.856,percent of total billed charges,67% of total billed charges,71.1,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,96.8,80,,77.44,percent of total billed charges,80% of total billed charges,78.65,65,,62.92,percent of total billed charges,65% of total billed charges,43.16,35.67,,34.528,percent of total billed charges,35.67% of total billed charges,35.09,108.9,
WRIST BRACES ALL SIZES CASH,27703761,CDM,290,RC,L3908,HCPCS,outpatient,,,29,11.60,,24.65,85,,19.72,percent of total billed charges,85% of total billed charges,22.33,77,,17.86,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,23.78,82,,19.024,percent of total billed charges,82% of total billed charges,24.65,85,,19.72,percent of total billed charges,85% of total billed charges,24.65,85,,19.72,percent of total billed charges,85% of total billed charges,24.65,85,,19.72,percent of total billed charges,85% of total billed charges,26.1,90,,20.88,percent of total billed charges,90% of total billed charges,23.2,80,,18.56,percent of total billed charges,80% of total billed charges,26.1,90,,20.88,percent of total billed charges,90% of total billed charges,21.75,75,,17.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,8.41,29,,6.728,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,19.43,67,,15.544,percent of total billed charges,67% of total billed charges,71.1,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,23.2,80,,18.56,percent of total billed charges,80% of total billed charges,18.85,65,,15.08,percent of total billed charges,65% of total billed charges,10.34,35.67,,8.272,percent of total billed charges,35.67% of total billed charges,8.41,71.1,
MASK OXYGEN ADULT 7' TUBING,27703764,CDM,290,RC,A4616,HCPCS,outpatient,,,10,4.00,,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,7.7,77,,6.16,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,0.27,385,,,fee schedule,385% of BCBS fee schedule,0.28,401,,,fee schedule,401% of BCBS fee schedule,0.28,401,,,fee schedule,401% of BCBS fee schedule,0.28,401,,,fee schedule,401% of BCBS fee schedule,9,90,,7.2,percent of total billed charges,90% of total billed charges,8,80,,6.4,percent of total billed charges,80% of total billed charges,9,90,,7.2,percent of total billed charges,90% of total billed charges,7.5,75,,6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.9,29,,2.32,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,6.7,67,,5.36,percent of total billed charges,67% of total billed charges,0.07,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,8,80,,6.4,percent of total billed charges,80% of total billed charges,6.5,65,,5.2,percent of total billed charges,65% of total billed charges,3.57,35.67,,2.856,percent of total billed charges,35.67% of total billed charges,0.07,9,
BARIATRIC ROLLING WALKER,27703765,CDM,290,RC,E0149,HCPCS,outpatient,,,130,52.00,NUKX,110.5,85,,88.4,percent of total billed charges,85% of total billed charges,100.1,77,,80.08,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,48.13,385,,,fee schedule,385% of BCBS fee schedule,50.13,401,,,fee schedule,401% of BCBS fee schedule,50.13,401,,,fee schedule,401% of BCBS fee schedule,50.13,401,,,fee schedule,401% of BCBS fee schedule,117,90,,93.6,percent of total billed charges,90% of total billed charges,104,80,,83.2,percent of total billed charges,80% of total billed charges,117,90,,93.6,percent of total billed charges,90% of total billed charges,97.5,75,,78,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,37.7,29,,30.16,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,87.1,67,,69.68,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,104,80,,83.2,percent of total billed charges,80% of total billed charges,84.5,65,,67.6,percent of total billed charges,65% of total billed charges,46.37,35.67,,37.096,percent of total billed charges,35.67% of total billed charges,37.7,117,
WALKER/COMMODE/SHOWER TIPS,27703766,CDM,290,RC,A9270,HCPCS,outpatient,,,11,4.40,,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,8.47,77,,6.78,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,9.02,82,,7.216,percent of total billed charges,82% of total billed charges,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,9.9,90,,7.92,percent of total billed charges,90% of total billed charges,8.8,80,,7.04,percent of total billed charges,80% of total billed charges,9.9,90,,7.92,percent of total billed charges,90% of total billed charges,8.25,75,,6.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,3.19,29,,2.552,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,7.37,67,,5.896,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,8.8,80,,7.04,percent of total billed charges,80% of total billed charges,7.15,65,,5.72,percent of total billed charges,65% of total billed charges,3.92,35.67,,3.136,percent of total billed charges,35.67% of total billed charges,3.19,9.9,
EVENUP BALANCER ALL SIZES,27703768,CDM,290,RC,A9270,HCPCS,outpatient,,,41,16.40,,34.85,85,,27.88,percent of total billed charges,85% of total billed charges,31.57,77,,25.26,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,33.62,82,,26.896,percent of total billed charges,82% of total billed charges,34.85,85,,27.88,percent of total billed charges,85% of total billed charges,34.85,85,,27.88,percent of total billed charges,85% of total billed charges,34.85,85,,27.88,percent of total billed charges,85% of total billed charges,36.9,90,,29.52,percent of total billed charges,90% of total billed charges,32.8,80,,26.24,percent of total billed charges,80% of total billed charges,36.9,90,,29.52,percent of total billed charges,90% of total billed charges,30.75,75,,24.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,11.89,29,,9.512,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,27.47,67,,21.976,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,32.8,80,,26.24,percent of total billed charges,80% of total billed charges,26.65,65,,21.32,percent of total billed charges,65% of total billed charges,14.62,35.67,,11.696,percent of total billed charges,35.67% of total billed charges,11.89,36.9,
CPAP HEATED HOSE,27703769,CDM,290,RC,A4604,HCPCS,outpatient,,,186,74.40,NUKX,158.1,85,,126.48,percent of total billed charges,85% of total billed charges,143.22,77,,114.58,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,165.7,385,,,fee schedule,385% of BCBS fee schedule,172.59,401,,,fee schedule,401% of BCBS fee schedule,172.59,401,,,fee schedule,401% of BCBS fee schedule,172.59,401,,,fee schedule,401% of BCBS fee schedule,167.4,90,,133.92,percent of total billed charges,90% of total billed charges,148.8,80,,119.04,percent of total billed charges,80% of total billed charges,167.4,90,,133.92,percent of total billed charges,90% of total billed charges,139.5,75,,111.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,53.94,29,,43.152,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,124.62,67,,99.696,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,148.8,80,,119.04,percent of total billed charges,80% of total billed charges,120.9,65,,96.72,percent of total billed charges,65% of total billed charges,66.35,35.67,,53.08,percent of total billed charges,35.67% of total billed charges,53.94,172.59,
DIGITAL WRIST BP MONITOR,27703773,CDM,290,RC,A4670,HCPCS,outpatient,,,66,26.40,,56.1,85,,44.88,percent of total billed charges,85% of total billed charges,50.82,77,,40.66,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,54.12,82,,43.296,percent of total billed charges,82% of total billed charges,56.1,85,,44.88,percent of total billed charges,85% of total billed charges,56.1,85,,44.88,percent of total billed charges,85% of total billed charges,56.1,85,,44.88,percent of total billed charges,85% of total billed charges,59.4,90,,47.52,percent of total billed charges,90% of total billed charges,52.8,80,,42.24,percent of total billed charges,80% of total billed charges,59.4,90,,47.52,percent of total billed charges,90% of total billed charges,49.5,75,,39.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,19.14,29,,15.312,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,44.22,67,,35.376,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,52.8,80,,42.24,percent of total billed charges,80% of total billed charges,42.9,65,,34.32,percent of total billed charges,65% of total billed charges,23.54,35.67,,18.832,percent of total billed charges,35.67% of total billed charges,19.14,59.4,
BIPAP AUTO 4-13 MONTH RENTAL,27703775,CDM,290,RC,E0470,HCPCS,outpatient,,,419,167.60,RRKJKX,356.15,85,,284.92,percent of total billed charges,85% of total billed charges,322.63,77,,258.1,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,444.17,385,,,fee schedule,385% of BCBS fee schedule,462.63,401,,,fee schedule,401% of BCBS fee schedule,462.63,401,,,fee schedule,401% of BCBS fee schedule,462.63,401,,,fee schedule,401% of BCBS fee schedule,377.1,90,,301.68,percent of total billed charges,90% of total billed charges,335.2,80,,268.16,percent of total billed charges,80% of total billed charges,377.1,90,,301.68,percent of total billed charges,90% of total billed charges,314.25,75,,251.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,121.51,29,,97.208,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,280.73,67,,224.584,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,335.2,80,,268.16,percent of total billed charges,80% of total billed charges,272.35,65,,217.88,percent of total billed charges,65% of total billed charges,149.46,35.67,,119.568,percent of total billed charges,35.67% of total billed charges,121.51,462.63,
REACHER 32 INCH,27703778,CDM,290,RC,A9281,HCPCS,outpatient,,,22,8.80,,18.7,85,,14.96,percent of total billed charges,85% of total billed charges,16.94,77,,13.55,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,18.04,82,,14.432,percent of total billed charges,82% of total billed charges,18.7,85,,14.96,percent of total billed charges,85% of total billed charges,18.7,85,,14.96,percent of total billed charges,85% of total billed charges,18.7,85,,14.96,percent of total billed charges,85% of total billed charges,19.8,90,,15.84,percent of total billed charges,90% of total billed charges,17.6,80,,14.08,percent of total billed charges,80% of total billed charges,19.8,90,,15.84,percent of total billed charges,90% of total billed charges,16.5,75,,13.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,6.38,29,,5.104,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,14.74,67,,11.792,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,17.6,80,,14.08,percent of total billed charges,80% of total billed charges,14.3,65,,11.44,percent of total billed charges,65% of total billed charges,7.85,35.67,,6.28,percent of total billed charges,35.67% of total billed charges,6.38,19.8,
SHORT WALK BOOT,27703779,CDM,290,RC,L4361,HCPCS,outpatient,,,80,32.00,,68,85,,54.4,percent of total billed charges,85% of total billed charges,61.6,77,,49.28,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,65.6,82,,52.48,percent of total billed charges,82% of total billed charges,68,85,,54.4,percent of total billed charges,85% of total billed charges,68,85,,54.4,percent of total billed charges,85% of total billed charges,68,85,,54.4,percent of total billed charges,85% of total billed charges,72,90,,57.6,percent of total billed charges,90% of total billed charges,64,80,,51.2,percent of total billed charges,80% of total billed charges,72,90,,57.6,percent of total billed charges,90% of total billed charges,60,75,,48,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,23.2,29,,18.56,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,53.6,67,,42.88,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,64,80,,51.2,percent of total billed charges,80% of total billed charges,52,65,,41.6,percent of total billed charges,65% of total billed charges,28.54,35.67,,22.832,percent of total billed charges,35.67% of total billed charges,23.2,72,
HEAD GEAR FOR CPAP- CASH PRICE,27703780,CDM,290,RC,A7035,HCPCS,outpatient,,,46,18.40,,39.1,85,,31.28,percent of total billed charges,85% of total billed charges,35.42,77,,28.34,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,76.54,385,,,fee schedule,385% of BCBS fee schedule,79.72,401,,,fee schedule,401% of BCBS fee schedule,79.72,401,,,fee schedule,401% of BCBS fee schedule,79.72,401,,,fee schedule,401% of BCBS fee schedule,41.4,90,,33.12,percent of total billed charges,90% of total billed charges,36.8,80,,29.44,percent of total billed charges,80% of total billed charges,41.4,90,,33.12,percent of total billed charges,90% of total billed charges,34.5,75,,27.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,13.34,29,,10.672,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,30.82,67,,24.656,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,36.8,80,,29.44,percent of total billed charges,80% of total billed charges,29.9,65,,23.92,percent of total billed charges,65% of total billed charges,16.41,35.67,,13.128,percent of total billed charges,35.67% of total billed charges,13.34,79.72,
WALKER BASKET,27703783,CDM,290,RC,A9270,HCPCS,outpatient,,,49,19.60,,41.65,85,,33.32,percent of total billed charges,85% of total billed charges,37.73,77,,30.18,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,40.18,82,,32.144,percent of total billed charges,82% of total billed charges,41.65,85,,33.32,percent of total billed charges,85% of total billed charges,41.65,85,,33.32,percent of total billed charges,85% of total billed charges,41.65,85,,33.32,percent of total billed charges,85% of total billed charges,44.1,90,,35.28,percent of total billed charges,90% of total billed charges,39.2,80,,31.36,percent of total billed charges,80% of total billed charges,44.1,90,,35.28,percent of total billed charges,90% of total billed charges,36.75,75,,29.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,14.21,29,,11.368,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,32.83,67,,26.264,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,39.2,80,,31.36,percent of total billed charges,80% of total billed charges,31.85,65,,25.48,percent of total billed charges,65% of total billed charges,17.48,35.67,,13.984,percent of total billed charges,35.67% of total billed charges,14.21,44.1,
CPAP AUTO MACHINE,27703785,CDM,290,RC,E0601,HCPCS,outpatient,,,824,329.60,RRKHKX,700.4,85,,560.32,percent of total billed charges,85% of total billed charges,634.48,77,,507.58,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,169.21,385,,,fee schedule,385% of BCBS fee schedule,176.24,401,,,fee schedule,401% of BCBS fee schedule,176.24,401,,,fee schedule,401% of BCBS fee schedule,176.24,401,,,fee schedule,401% of BCBS fee schedule,741.6,90,,593.28,percent of total billed charges,90% of total billed charges,659.2,80,,527.36,percent of total billed charges,80% of total billed charges,741.6,90,,593.28,percent of total billed charges,90% of total billed charges,618,75,,494.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,238.96,29,,191.168,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,552.08,67,,441.664,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,659.2,80,,527.36,percent of total billed charges,80% of total billed charges,535.6,65,,428.48,percent of total billed charges,65% of total billed charges,293.92,35.67,,235.136,percent of total billed charges,35.67% of total billed charges,169.21,741.6,
WATER CHAMBER/TUB FOR CPAP,27703786,CDM,290,RC,A7046,HCPCS,outpatient,,,62,24.80,NUKX,52.7,85,,42.16,percent of total billed charges,85% of total billed charges,47.74,77,,38.19,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,55.36,385,,,fee schedule,385% of BCBS fee schedule,57.66,401,,,fee schedule,401% of BCBS fee schedule,57.66,401,,,fee schedule,401% of BCBS fee schedule,57.66,401,,,fee schedule,401% of BCBS fee schedule,55.8,90,,44.64,percent of total billed charges,90% of total billed charges,49.6,80,,39.68,percent of total billed charges,80% of total billed charges,55.8,90,,44.64,percent of total billed charges,90% of total billed charges,46.5,75,,37.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,17.98,29,,14.384,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,41.54,67,,33.232,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,49.6,80,,39.68,percent of total billed charges,80% of total billed charges,40.3,65,,32.24,percent of total billed charges,65% of total billed charges,22.12,35.67,,17.696,percent of total billed charges,35.67% of total billed charges,17.98,57.66,
HEADGEAR STRAP,27703787,CDM,290,RC,A7035,HCPCS,outpatient,,,86,34.40,NUKX,73.1,85,,58.48,percent of total billed charges,85% of total billed charges,66.22,77,,52.98,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,76.54,385,,,fee schedule,385% of BCBS fee schedule,79.72,401,,,fee schedule,401% of BCBS fee schedule,79.72,401,,,fee schedule,401% of BCBS fee schedule,79.72,401,,,fee schedule,401% of BCBS fee schedule,77.4,90,,61.92,percent of total billed charges,90% of total billed charges,68.8,80,,55.04,percent of total billed charges,80% of total billed charges,77.4,90,,61.92,percent of total billed charges,90% of total billed charges,64.5,75,,51.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,24.94,29,,19.952,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,57.62,67,,46.096,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,68.8,80,,55.04,percent of total billed charges,80% of total billed charges,55.9,65,,44.72,percent of total billed charges,65% of total billed charges,30.68,35.67,,24.544,percent of total billed charges,35.67% of total billed charges,24.94,79.72,
F&P SIMPLUS FF MASK LARGE,27703788,CDM,290,RC,A7030,HCPCS,outpatient,,,297,118.80,NUKX,252.45,85,,201.96,percent of total billed charges,85% of total billed charges,228.69,77,,182.95,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,369.95,385,,,fee schedule,385% of BCBS fee schedule,385.32,401,,,fee schedule,401% of BCBS fee schedule,385.32,401,,,fee schedule,401% of BCBS fee schedule,385.32,401,,,fee schedule,401% of BCBS fee schedule,267.3,90,,213.84,percent of total billed charges,90% of total billed charges,237.6,80,,190.08,percent of total billed charges,80% of total billed charges,267.3,90,,213.84,percent of total billed charges,90% of total billed charges,222.75,75,,178.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,86.13,29,,68.904,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,198.99,67,,159.192,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,237.6,80,,190.08,percent of total billed charges,80% of total billed charges,193.05,65,,154.44,percent of total billed charges,65% of total billed charges,105.94,35.67,,84.752,percent of total billed charges,35.67% of total billed charges,86.13,385.32,
BREAST PUMP ELECTRIC,27703790,CDM,290,RC,E0603,HCPCS,outpatient,,,225,90.00,NUKX,191.25,85,,153,percent of total billed charges,85% of total billed charges,173.25,77,,138.6,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,184.5,82,,147.6,percent of total billed charges,82% of total billed charges,191.25,85,,153,percent of total billed charges,85% of total billed charges,191.25,85,,153,percent of total billed charges,85% of total billed charges,191.25,85,,153,percent of total billed charges,85% of total billed charges,202.5,90,,162,percent of total billed charges,90% of total billed charges,180,80,,144,percent of total billed charges,80% of total billed charges,202.5,90,,162,percent of total billed charges,90% of total billed charges,168.75,75,,135,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,65.25,29,,52.2,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,150.75,67,,120.6,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,180,80,,144,percent of total billed charges,80% of total billed charges,146.25,65,,117,percent of total billed charges,65% of total billed charges,80.26,35.67,,64.208,percent of total billed charges,35.67% of total billed charges,65.25,202.5,
JOBST HOSE THIGH HI,27703791,CDM,290,RC,A6549,HCPCS,outpatient,,,15,6.00,,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,11.55,77,,9.24,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,12.3,82,,9.84,percent of total billed charges,82% of total billed charges,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,13.5,90,,10.8,percent of total billed charges,90% of total billed charges,12,80,,9.6,percent of total billed charges,80% of total billed charges,13.5,90,,10.8,percent of total billed charges,90% of total billed charges,11.25,75,,9,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,4.35,29,,3.48,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,10.05,67,,8.04,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,12,80,,9.6,percent of total billed charges,80% of total billed charges,9.75,65,,7.8,percent of total billed charges,65% of total billed charges,5.35,35.67,,4.28,percent of total billed charges,35.67% of total billed charges,4.35,13.5,
KNEE BRACE PTO,27703793,CDM,290,RC,L1812,HCPCS,outpatient,,,221,88.40,LTKX,187.85,85,,150.28,percent of total billed charges,85% of total billed charges,170.17,77,,136.14,percent of total billed charges,77% of total billed charges,99.35,100,,,fee schedule,100% of CMS fee schedule,181.22,82,,144.976,percent of total billed charges,82% of total billed charges,187.85,85,,150.28,percent of total billed charges,85% of total billed charges,187.85,85,,150.28,percent of total billed charges,85% of total billed charges,187.85,85,,150.28,percent of total billed charges,85% of total billed charges,198.9,90,,159.12,percent of total billed charges,90% of total billed charges,176.8,80,,141.44,percent of total billed charges,80% of total billed charges,198.9,90,,159.12,percent of total billed charges,90% of total billed charges,165.75,75,,132.6,percent of total billed charges,75% of total billed charges,121.21,122,,,fee schedule,122% of APC rate,64.09,29,,51.272,percent of total billed charges,29% of total billed charges,99.35,100,,,fee schedule,100% of CMS fee schedule,148.07,67,,118.456,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,176.8,80,,141.44,percent of total billed charges,80% of total billed charges,143.65,65,,114.92,percent of total billed charges,65% of total billed charges,78.83,35.67,,63.064,percent of total billed charges,35.67% of total billed charges,64.09,198.9,
BREG KNEE BRACE PTO,27703796,CDM,290,RC,L1810,HCPCS,outpatient,,,115,46.00,NUKX,97.75,85,,78.2,percent of total billed charges,85% of total billed charges,88.55,77,,70.84,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,94.3,82,,75.44,percent of total billed charges,82% of total billed charges,97.75,85,,78.2,percent of total billed charges,85% of total billed charges,97.75,85,,78.2,percent of total billed charges,85% of total billed charges,97.75,85,,78.2,percent of total billed charges,85% of total billed charges,103.5,90,,82.8,percent of total billed charges,90% of total billed charges,92,80,,73.6,percent of total billed charges,80% of total billed charges,103.5,90,,82.8,percent of total billed charges,90% of total billed charges,86.25,75,,69,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,33.35,29,,26.68,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,77.05,67,,61.64,percent of total billed charges,67% of total billed charges,97.69,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,92,80,,73.6,percent of total billed charges,80% of total billed charges,74.75,65,,59.8,percent of total billed charges,65% of total billed charges,41.02,35.67,,32.816,percent of total billed charges,35.67% of total billed charges,33.35,103.5,
WHEELCHAIR CUSHION,27703880,CDM,290,RC,E2603,HCPCS,outpatient,,,46,18.40,,39.1,85,,31.28,percent of total billed charges,85% of total billed charges,35.42,77,,28.34,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,566.1,385,,,fee schedule,385% of BCBS fee schedule,589.63,401,,,fee schedule,401% of BCBS fee schedule,589.63,401,,,fee schedule,401% of BCBS fee schedule,589.63,401,,,fee schedule,401% of BCBS fee schedule,41.4,90,,33.12,percent of total billed charges,90% of total billed charges,36.8,80,,29.44,percent of total billed charges,80% of total billed charges,41.4,90,,33.12,percent of total billed charges,90% of total billed charges,34.5,75,,27.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,13.34,29,,10.672,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,30.82,67,,24.656,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,36.8,80,,29.44,percent of total billed charges,80% of total billed charges,29.9,65,,23.92,percent of total billed charges,65% of total billed charges,16.41,35.67,,13.128,percent of total billed charges,35.67% of total billed charges,13.34,589.63,
GAIT BELT,27703881,CDM,290,RC,E0700,HCPCS,outpatient,,,29,11.60,,24.65,85,,19.72,percent of total billed charges,85% of total billed charges,22.33,77,,17.86,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,23.78,82,,19.024,percent of total billed charges,82% of total billed charges,24.65,85,,19.72,percent of total billed charges,85% of total billed charges,24.65,85,,19.72,percent of total billed charges,85% of total billed charges,24.65,85,,19.72,percent of total billed charges,85% of total billed charges,26.1,90,,20.88,percent of total billed charges,90% of total billed charges,23.2,80,,18.56,percent of total billed charges,80% of total billed charges,26.1,90,,20.88,percent of total billed charges,90% of total billed charges,21.75,75,,17.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,8.41,29,,6.728,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,19.43,67,,15.544,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,23.2,80,,18.56,percent of total billed charges,80% of total billed charges,18.85,65,,15.08,percent of total billed charges,65% of total billed charges,10.34,35.67,,8.272,percent of total billed charges,35.67% of total billed charges,8.41,26.1,
MIRAGE SOFT-GEL MEDIUM,27703883,CDM,290,RC,A7034,HCPCS,outpatient,,,225,90.00,NUKX,191.25,85,,153,percent of total billed charges,85% of total billed charges,173.25,77,,138.6,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,231.46,385,,,fee schedule,385% of BCBS fee schedule,241.08,401,,,fee schedule,401% of BCBS fee schedule,241.08,401,,,fee schedule,401% of BCBS fee schedule,241.08,401,,,fee schedule,401% of BCBS fee schedule,202.5,90,,162,percent of total billed charges,90% of total billed charges,180,80,,144,percent of total billed charges,80% of total billed charges,202.5,90,,162,percent of total billed charges,90% of total billed charges,168.75,75,,135,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,65.25,29,,52.2,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,150.75,67,,120.6,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,180,80,,144,percent of total billed charges,80% of total billed charges,146.25,65,,117,percent of total billed charges,65% of total billed charges,80.26,35.67,,64.208,percent of total billed charges,35.67% of total billed charges,65.25,241.08,
ELECTRODES TENS UNIT 4CT,27703884,CDM,290,RC,A4556,HCPCS,outpatient,,,13,5.20,,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,10.01,77,,8.01,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,52.63,385,,,fee schedule,385% of BCBS fee schedule,54.82,401,,,fee schedule,401% of BCBS fee schedule,54.82,401,,,fee schedule,401% of BCBS fee schedule,54.82,401,,,fee schedule,401% of BCBS fee schedule,11.7,90,,9.36,percent of total billed charges,90% of total billed charges,10.4,80,,8.32,percent of total billed charges,80% of total billed charges,11.7,90,,9.36,percent of total billed charges,90% of total billed charges,9.75,75,,7.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,3.77,29,,3.016,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,8.71,67,,6.968,percent of total billed charges,67% of total billed charges,13.7,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,10.4,80,,8.32,percent of total billed charges,80% of total billed charges,8.45,65,,6.76,percent of total billed charges,65% of total billed charges,4.64,35.67,,3.712,percent of total billed charges,35.67% of total billed charges,3.77,54.82,
KNEE SUPPORT MED SAFE-T,27703886,CDM,290,RC,L1825,HCPCS,outpatient,,,50,20.00,,42.5,85,,34,percent of total billed charges,85% of total billed charges,38.5,77,,30.8,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,41,82,,32.8,percent of total billed charges,82% of total billed charges,42.5,85,,34,percent of total billed charges,85% of total billed charges,42.5,85,,34,percent of total billed charges,85% of total billed charges,42.5,85,,34,percent of total billed charges,85% of total billed charges,45,90,,36,percent of total billed charges,90% of total billed charges,40,80,,32,percent of total billed charges,80% of total billed charges,45,90,,36,percent of total billed charges,90% of total billed charges,37.5,75,,30,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,14.5,29,,11.6,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,33.5,67,,26.8,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,40,80,,32,percent of total billed charges,80% of total billed charges,32.5,65,,26,percent of total billed charges,65% of total billed charges,17.84,35.67,,14.272,percent of total billed charges,35.67% of total billed charges,14.5,45,
QUATTRO FX FF MASK,27703887,CDM,290,RC,A7030,HCPCS,outpatient,,,297,118.80,NUKX,252.45,85,,201.96,percent of total billed charges,85% of total billed charges,228.69,77,,182.95,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,369.95,385,,,fee schedule,385% of BCBS fee schedule,385.32,401,,,fee schedule,401% of BCBS fee schedule,385.32,401,,,fee schedule,401% of BCBS fee schedule,385.32,401,,,fee schedule,401% of BCBS fee schedule,267.3,90,,213.84,percent of total billed charges,90% of total billed charges,237.6,80,,190.08,percent of total billed charges,80% of total billed charges,267.3,90,,213.84,percent of total billed charges,90% of total billed charges,222.75,75,,178.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,86.13,29,,68.904,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,198.99,67,,159.192,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,237.6,80,,190.08,percent of total billed charges,80% of total billed charges,193.05,65,,154.44,percent of total billed charges,65% of total billed charges,105.94,35.67,,84.752,percent of total billed charges,35.67% of total billed charges,86.13,385.32,
DONJOY FULLFORCE KNEE BRACE LT,27703888,CDM,290,RC,L1852,HCPCS,outpatient,,,951,380.40,LTKX,808.35,85,,646.68,percent of total billed charges,85% of total billed charges,732.27,77,,585.82,percent of total billed charges,77% of total billed charges,846.35,100,,,fee schedule,100% of CMS fee schedule,779.82,82,,623.856,percent of total billed charges,82% of total billed charges,808.35,85,,646.68,percent of total billed charges,85% of total billed charges,808.35,85,,646.68,percent of total billed charges,85% of total billed charges,808.35,85,,646.68,percent of total billed charges,85% of total billed charges,855.9,90,,684.72,percent of total billed charges,90% of total billed charges,760.8,80,,608.64,percent of total billed charges,80% of total billed charges,855.9,90,,684.72,percent of total billed charges,90% of total billed charges,713.25,75,,570.6,percent of total billed charges,75% of total billed charges,1032.55,122,,,fee schedule,122% of APC rate,275.79,29,,220.632,percent of total billed charges,29% of total billed charges,846.35,100,,,fee schedule,100% of CMS fee schedule,637.17,67,,509.736,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,760.8,80,,608.64,percent of total billed charges,80% of total billed charges,618.15,65,,494.52,percent of total billed charges,65% of total billed charges,339.22,35.67,,271.376,percent of total billed charges,35.67% of total billed charges,275.79,1032.55,
DONJOY FULLFORCE KNEE BRACE RT,277038889,CDM,290,RC,L1852,HCPCS,outpatient,,,951,380.40,RTKX,808.35,85,,646.68,percent of total billed charges,85% of total billed charges,732.27,77,,585.82,percent of total billed charges,77% of total billed charges,846.35,100,,,fee schedule,100% of CMS fee schedule,779.82,82,,623.856,percent of total billed charges,82% of total billed charges,808.35,85,,646.68,percent of total billed charges,85% of total billed charges,808.35,85,,646.68,percent of total billed charges,85% of total billed charges,808.35,85,,646.68,percent of total billed charges,85% of total billed charges,855.9,90,,684.72,percent of total billed charges,90% of total billed charges,760.8,80,,608.64,percent of total billed charges,80% of total billed charges,855.9,90,,684.72,percent of total billed charges,90% of total billed charges,713.25,75,,570.6,percent of total billed charges,75% of total billed charges,1032.55,122,,,fee schedule,122% of APC rate,275.79,29,,220.632,percent of total billed charges,29% of total billed charges,846.35,100,,,fee schedule,100% of CMS fee schedule,637.17,67,,509.736,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,760.8,80,,608.64,percent of total billed charges,80% of total billed charges,618.15,65,,494.52,percent of total billed charges,65% of total billed charges,339.22,35.67,,271.376,percent of total billed charges,35.67% of total billed charges,275.79,1032.55,
HEAVY DUTY WALKER FRONT WHEELS,27703889,CDM,290,RC,E0149,HCPCS,outpatient,,,41,16.40,RRKJKX,34.85,85,,27.88,percent of total billed charges,85% of total billed charges,31.57,77,,25.26,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,48.13,385,,,fee schedule,385% of BCBS fee schedule,50.13,401,,,fee schedule,401% of BCBS fee schedule,50.13,401,,,fee schedule,401% of BCBS fee schedule,50.13,401,,,fee schedule,401% of BCBS fee schedule,36.9,90,,29.52,percent of total billed charges,90% of total billed charges,32.8,80,,26.24,percent of total billed charges,80% of total billed charges,36.9,90,,29.52,percent of total billed charges,90% of total billed charges,30.75,75,,24.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,11.89,29,,9.512,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,27.47,67,,21.976,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,32.8,80,,26.24,percent of total billed charges,80% of total billed charges,26.65,65,,21.32,percent of total billed charges,65% of total billed charges,14.62,35.67,,11.696,percent of total billed charges,35.67% of total billed charges,11.89,50.13,
COMPRESSION SLEEVE/STOCKING,277038890,CDM,290,RC,A6549,HCPCS,outpatient,,,190,76.00,,161.5,85,,129.2,percent of total billed charges,85% of total billed charges,146.3,77,,117.04,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,155.8,82,,124.64,percent of total billed charges,82% of total billed charges,161.5,85,,129.2,percent of total billed charges,85% of total billed charges,161.5,85,,129.2,percent of total billed charges,85% of total billed charges,161.5,85,,129.2,percent of total billed charges,85% of total billed charges,171,90,,136.8,percent of total billed charges,90% of total billed charges,152,80,,121.6,percent of total billed charges,80% of total billed charges,171,90,,136.8,percent of total billed charges,90% of total billed charges,142.5,75,,114,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,55.1,29,,44.08,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,127.3,67,,101.84,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,152,80,,121.6,percent of total billed charges,80% of total billed charges,123.5,65,,98.8,percent of total billed charges,65% of total billed charges,67.77,35.67,,54.216,percent of total billed charges,35.67% of total billed charges,55.1,171,
GAUNTLET GRADIENT READYMADE,277038891,CDM,290,RC,S8428,HCPCS,outpatient,,,83,33.20,,70.55,85,,56.44,percent of total billed charges,85% of total billed charges,63.91,77,,51.13,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,68.06,82,,54.448,percent of total billed charges,82% of total billed charges,70.55,85,,56.44,percent of total billed charges,85% of total billed charges,70.55,85,,56.44,percent of total billed charges,85% of total billed charges,70.55,85,,56.44,percent of total billed charges,85% of total billed charges,74.7,90,,59.76,percent of total billed charges,90% of total billed charges,66.4,80,,53.12,percent of total billed charges,80% of total billed charges,74.7,90,,59.76,percent of total billed charges,90% of total billed charges,62.25,75,,49.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,24.07,29,,19.256,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,55.61,67,,44.488,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,66.4,80,,53.12,percent of total billed charges,80% of total billed charges,53.95,65,,43.16,percent of total billed charges,65% of total billed charges,29.61,35.67,,23.688,percent of total billed charges,35.67% of total billed charges,24.07,74.7,
THERAHONEY GEL,27703892,CDM,290,RC,,,outpatient,,,14,5.60,,11.9,85,,9.52,percent of total billed charges,85% of total billed charges,10.78,77,,8.62,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,11.48,82,,9.184,percent of total billed charges,82% of total billed charges,11.9,85,,9.52,percent of total billed charges,85% of total billed charges,11.9,85,,9.52,percent of total billed charges,85% of total billed charges,11.9,85,,9.52,percent of total billed charges,85% of total billed charges,12.6,90,,10.08,percent of total billed charges,90% of total billed charges,11.2,80,,8.96,percent of total billed charges,80% of total billed charges,12.6,90,,10.08,percent of total billed charges,90% of total billed charges,10.5,75,,8.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,4.06,29,,3.248,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,9.38,67,,7.504,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,11.2,80,,8.96,percent of total billed charges,80% of total billed charges,9.1,65,,7.28,percent of total billed charges,65% of total billed charges,4.99,35.67,,3.992,percent of total billed charges,35.67% of total billed charges,4.06,12.6,
BREVIDA NASAL PILLOW MASK,27703893,CDM,290,RC,A7034,HCPCS,outpatient,,,71,28.40,,60.35,85,,48.28,percent of total billed charges,85% of total billed charges,54.67,77,,43.74,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,231.46,385,,,fee schedule,385% of BCBS fee schedule,241.08,401,,,fee schedule,401% of BCBS fee schedule,241.08,401,,,fee schedule,401% of BCBS fee schedule,241.08,401,,,fee schedule,401% of BCBS fee schedule,63.9,90,,51.12,percent of total billed charges,90% of total billed charges,56.8,80,,45.44,percent of total billed charges,80% of total billed charges,63.9,90,,51.12,percent of total billed charges,90% of total billed charges,53.25,75,,42.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,20.59,29,,16.472,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,47.57,67,,38.056,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,56.8,80,,45.44,percent of total billed charges,80% of total billed charges,46.15,65,,36.92,percent of total billed charges,65% of total billed charges,25.33,35.67,,20.264,percent of total billed charges,35.67% of total billed charges,20.59,241.08,
F&P FULL MASK,27703894,CDM,290,RC,A7030,HCPCS,outpatient,,,80,32.00,,68,85,,54.4,percent of total billed charges,85% of total billed charges,61.6,77,,49.28,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,369.95,385,,,fee schedule,385% of BCBS fee schedule,385.32,401,,,fee schedule,401% of BCBS fee schedule,385.32,401,,,fee schedule,401% of BCBS fee schedule,385.32,401,,,fee schedule,401% of BCBS fee schedule,72,90,,57.6,percent of total billed charges,90% of total billed charges,64,80,,51.2,percent of total billed charges,80% of total billed charges,72,90,,57.6,percent of total billed charges,90% of total billed charges,60,75,,48,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,23.2,29,,18.56,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,53.6,67,,42.88,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,64,80,,51.2,percent of total billed charges,80% of total billed charges,52,65,,41.6,percent of total billed charges,65% of total billed charges,28.54,35.67,,22.832,percent of total billed charges,35.67% of total billed charges,23.2,385.32,
FUSION OA KNEE BRACE,27703895,CDM,290,RC,L1852,HCPCS,outpatient,,,303,121.20,,257.55,85,,206.04,percent of total billed charges,85% of total billed charges,233.31,77,,186.65,percent of total billed charges,77% of total billed charges,846.35,100,,,fee schedule,100% of CMS fee schedule,248.46,82,,198.768,percent of total billed charges,82% of total billed charges,257.55,85,,206.04,percent of total billed charges,85% of total billed charges,257.55,85,,206.04,percent of total billed charges,85% of total billed charges,257.55,85,,206.04,percent of total billed charges,85% of total billed charges,272.7,90,,218.16,percent of total billed charges,90% of total billed charges,242.4,80,,193.92,percent of total billed charges,80% of total billed charges,272.7,90,,218.16,percent of total billed charges,90% of total billed charges,227.25,75,,181.8,percent of total billed charges,75% of total billed charges,1032.55,122,,,fee schedule,122% of APC rate,87.87,29,,70.296,percent of total billed charges,29% of total billed charges,846.35,100,,,fee schedule,100% of CMS fee schedule,203.01,67,,162.408,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,242.4,80,,193.92,percent of total billed charges,80% of total billed charges,196.95,65,,157.56,percent of total billed charges,65% of total billed charges,108.08,35.67,,86.464,percent of total billed charges,35.67% of total billed charges,87.87,1032.55,
CRUTCHES,27703902,CDM,290,RC,E0114,HCPCS,outpatient,,,53,21.20,,45.05,85,,36.04,percent of total billed charges,85% of total billed charges,40.81,77,,32.65,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,178.41,385,,,fee schedule,385% of BCBS fee schedule,185.82,401,,,fee schedule,401% of BCBS fee schedule,185.82,401,,,fee schedule,401% of BCBS fee schedule,185.82,401,,,fee schedule,401% of BCBS fee schedule,47.7,90,,38.16,percent of total billed charges,90% of total billed charges,42.4,80,,33.92,percent of total billed charges,80% of total billed charges,47.7,90,,38.16,percent of total billed charges,90% of total billed charges,39.75,75,,31.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,15.37,29,,12.296,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,35.51,67,,28.408,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,42.4,80,,33.92,percent of total billed charges,80% of total billed charges,34.45,65,,27.56,percent of total billed charges,65% of total billed charges,18.91,35.67,,15.128,percent of total billed charges,35.67% of total billed charges,15.37,185.82,
WHEELCHAIR FR 9TH MONTH RENT,27703919,CDM,290,RC,K0001,HCPCS,outpatient,,,93,37.20,KJRRKX,79.05,85,,63.24,percent of total billed charges,85% of total billed charges,71.61,77,,57.29,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,94.33,385,,,fee schedule,385% of BCBS fee schedule,98.25,401,,,fee schedule,401% of BCBS fee schedule,98.25,401,,,fee schedule,401% of BCBS fee schedule,98.25,401,,,fee schedule,401% of BCBS fee schedule,83.7,90,,66.96,percent of total billed charges,90% of total billed charges,74.4,80,,59.52,percent of total billed charges,80% of total billed charges,83.7,90,,66.96,percent of total billed charges,90% of total billed charges,69.75,75,,55.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,26.97,29,,21.576,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,62.31,67,,49.848,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,74.4,80,,59.52,percent of total billed charges,80% of total billed charges,60.45,65,,48.36,percent of total billed charges,65% of total billed charges,33.17,35.67,,26.536,percent of total billed charges,35.67% of total billed charges,26.97,98.25,
SPICA THUMB SPLINT RT,27703975,CDM,290,RC,L3924,HCPCS,outpatient,,,174,69.60,RTKX,147.9,85,,118.32,percent of total billed charges,85% of total billed charges,133.98,77,,107.18,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,142.68,82,,114.144,percent of total billed charges,82% of total billed charges,147.9,85,,118.32,percent of total billed charges,85% of total billed charges,147.9,85,,118.32,percent of total billed charges,85% of total billed charges,147.9,85,,118.32,percent of total billed charges,85% of total billed charges,156.6,90,,125.28,percent of total billed charges,90% of total billed charges,139.2,80,,111.36,percent of total billed charges,80% of total billed charges,156.6,90,,125.28,percent of total billed charges,90% of total billed charges,130.5,75,,104.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,50.46,29,,40.368,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,116.58,67,,93.264,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,139.2,80,,111.36,percent of total billed charges,80% of total billed charges,113.1,65,,90.48,percent of total billed charges,65% of total billed charges,62.07,35.67,,49.656,percent of total billed charges,35.67% of total billed charges,50.46,156.6,
DONUT CUSHION,27703990,CDM,290,RC,E0190,HCPCS,outpatient,,,29,11.60,,24.65,85,,19.72,percent of total billed charges,85% of total billed charges,22.33,77,,17.86,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,23.78,82,,19.024,percent of total billed charges,82% of total billed charges,24.65,85,,19.72,percent of total billed charges,85% of total billed charges,24.65,85,,19.72,percent of total billed charges,85% of total billed charges,24.65,85,,19.72,percent of total billed charges,85% of total billed charges,26.1,90,,20.88,percent of total billed charges,90% of total billed charges,23.2,80,,18.56,percent of total billed charges,80% of total billed charges,26.1,90,,20.88,percent of total billed charges,90% of total billed charges,21.75,75,,17.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,8.41,29,,6.728,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,19.43,67,,15.544,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,23.2,80,,18.56,percent of total billed charges,80% of total billed charges,18.85,65,,15.08,percent of total billed charges,65% of total billed charges,10.34,35.67,,8.272,percent of total billed charges,35.67% of total billed charges,8.41,26.1,
TRANSFER BENCH PADDED,27703991,CDM,290,RC,E0247,HCPCS,outpatient,,,223,89.20,,189.55,85,,151.64,percent of total billed charges,85% of total billed charges,171.71,77,,137.37,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,182.86,82,,146.288,percent of total billed charges,82% of total billed charges,189.55,85,,151.64,percent of total billed charges,85% of total billed charges,189.55,85,,151.64,percent of total billed charges,85% of total billed charges,189.55,85,,151.64,percent of total billed charges,85% of total billed charges,200.7,90,,160.56,percent of total billed charges,90% of total billed charges,178.4,80,,142.72,percent of total billed charges,80% of total billed charges,200.7,90,,160.56,percent of total billed charges,90% of total billed charges,167.25,75,,133.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,64.67,29,,51.736,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,149.41,67,,119.528,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,178.4,80,,142.72,percent of total billed charges,80% of total billed charges,144.95,65,,115.96,percent of total billed charges,65% of total billed charges,79.54,35.67,,63.632,percent of total billed charges,35.67% of total billed charges,64.67,200.7,
ARM SLING ALL SIZES,27703992,CDM,290,RC,A4565,HCPCS,outpatient,,,15,6.00,,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,11.55,77,,9.24,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,33.34,385,,,fee schedule,385% of BCBS fee schedule,34.73,401,,,fee schedule,401% of BCBS fee schedule,34.73,401,,,fee schedule,401% of BCBS fee schedule,34.73,401,,,fee schedule,401% of BCBS fee schedule,13.5,90,,10.8,percent of total billed charges,90% of total billed charges,12,80,,9.6,percent of total billed charges,80% of total billed charges,13.5,90,,10.8,percent of total billed charges,90% of total billed charges,11.25,75,,9,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,4.35,29,,3.48,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,10.05,67,,8.04,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,12,80,,9.6,percent of total billed charges,80% of total billed charges,9.75,65,,7.8,percent of total billed charges,65% of total billed charges,5.35,35.67,,4.28,percent of total billed charges,35.67% of total billed charges,4.35,34.73,
AIRFIT F20 FF MASK,27703993,CDM,290,RC,A7030,HCPCS,outpatient,,,297,118.80,NUKX,252.45,85,,201.96,percent of total billed charges,85% of total billed charges,228.69,77,,182.95,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,369.95,385,,,fee schedule,385% of BCBS fee schedule,385.32,401,,,fee schedule,401% of BCBS fee schedule,385.32,401,,,fee schedule,401% of BCBS fee schedule,385.32,401,,,fee schedule,401% of BCBS fee schedule,267.3,90,,213.84,percent of total billed charges,90% of total billed charges,237.6,80,,190.08,percent of total billed charges,80% of total billed charges,267.3,90,,213.84,percent of total billed charges,90% of total billed charges,222.75,75,,178.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,86.13,29,,68.904,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,198.99,67,,159.192,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,237.6,80,,190.08,percent of total billed charges,80% of total billed charges,193.05,65,,154.44,percent of total billed charges,65% of total billed charges,105.94,35.67,,84.752,percent of total billed charges,35.67% of total billed charges,86.13,385.32,
DREAMWARE FF MASK,27703995,CDM,290,RC,A7030,HCPCS,outpatient,,,196,78.40,NUKX,166.6,85,,133.28,percent of total billed charges,85% of total billed charges,150.92,77,,120.74,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,369.95,385,,,fee schedule,385% of BCBS fee schedule,385.32,401,,,fee schedule,401% of BCBS fee schedule,385.32,401,,,fee schedule,401% of BCBS fee schedule,385.32,401,,,fee schedule,401% of BCBS fee schedule,176.4,90,,141.12,percent of total billed charges,90% of total billed charges,156.8,80,,125.44,percent of total billed charges,80% of total billed charges,176.4,90,,141.12,percent of total billed charges,90% of total billed charges,147,75,,117.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,56.84,29,,45.472,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,131.32,67,,105.056,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,156.8,80,,125.44,percent of total billed charges,80% of total billed charges,127.4,65,,101.92,percent of total billed charges,65% of total billed charges,69.91,35.67,,55.928,percent of total billed charges,35.67% of total billed charges,56.84,385.32,
WALKER TENNIS BALLS,27703997,CDM,290,RC,A9270,HCPCS,outpatient,,,25,10.00,,21.25,85,,17,percent of total billed charges,85% of total billed charges,19.25,77,,15.4,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,20.5,82,,16.4,percent of total billed charges,82% of total billed charges,21.25,85,,17,percent of total billed charges,85% of total billed charges,21.25,85,,17,percent of total billed charges,85% of total billed charges,21.25,85,,17,percent of total billed charges,85% of total billed charges,22.5,90,,18,percent of total billed charges,90% of total billed charges,20,80,,16,percent of total billed charges,80% of total billed charges,22.5,90,,18,percent of total billed charges,90% of total billed charges,18.75,75,,15,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,7.25,29,,5.8,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,16.75,67,,13.4,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,20,80,,16,percent of total billed charges,80% of total billed charges,16.25,65,,13,percent of total billed charges,65% of total billed charges,8.92,35.67,,7.136,percent of total billed charges,35.67% of total billed charges,7.25,22.5,
AIRFIT F10 FRAME LARGE,27704000,CDM,290,RC,A7030,HCPCS,outpatient,,,242,96.80,,205.7,85,,164.56,percent of total billed charges,85% of total billed charges,186.34,77,,149.07,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,369.95,385,,,fee schedule,385% of BCBS fee schedule,385.32,401,,,fee schedule,401% of BCBS fee schedule,385.32,401,,,fee schedule,401% of BCBS fee schedule,385.32,401,,,fee schedule,401% of BCBS fee schedule,217.8,90,,174.24,percent of total billed charges,90% of total billed charges,193.6,80,,154.88,percent of total billed charges,80% of total billed charges,217.8,90,,174.24,percent of total billed charges,90% of total billed charges,181.5,75,,145.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,70.18,29,,56.144,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,162.14,67,,129.712,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,193.6,80,,154.88,percent of total billed charges,80% of total billed charges,157.3,65,,125.84,percent of total billed charges,65% of total billed charges,86.32,35.67,,69.056,percent of total billed charges,35.67% of total billed charges,70.18,385.32,
"WALKER,FOLDING,WHEELED,ADJUST",27710000,CDM,290,RC,E0143,HCPCS,outpatient,,,461,184.40,NUKX,391.85,85,,313.48,percent of total billed charges,85% of total billed charges,354.97,77,,283.98,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,194.85,385,,,fee schedule,385% of BCBS fee schedule,202.95,401,,,fee schedule,401% of BCBS fee schedule,202.95,401,,,fee schedule,401% of BCBS fee schedule,202.95,401,,,fee schedule,401% of BCBS fee schedule,414.9,90,,331.92,percent of total billed charges,90% of total billed charges,368.8,80,,295.04,percent of total billed charges,80% of total billed charges,414.9,90,,331.92,percent of total billed charges,90% of total billed charges,345.75,75,,276.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,133.69,29,,106.952,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,308.87,67,,247.096,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,368.8,80,,295.04,percent of total billed charges,80% of total billed charges,299.65,65,,239.72,percent of total billed charges,65% of total billed charges,164.44,35.67,,131.552,percent of total billed charges,35.67% of total billed charges,133.69,414.9,
ANKLE BRACE POR LITE,27710002,CDM,290,RC,L1902,HCPCS,outpatient,,,60,24.00,,51,85,,40.8,percent of total billed charges,85% of total billed charges,46.2,77,,36.96,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,49.2,82,,39.36,percent of total billed charges,82% of total billed charges,51,85,,40.8,percent of total billed charges,85% of total billed charges,51,85,,40.8,percent of total billed charges,85% of total billed charges,51,85,,40.8,percent of total billed charges,85% of total billed charges,54,90,,43.2,percent of total billed charges,90% of total billed charges,48,80,,38.4,percent of total billed charges,80% of total billed charges,54,90,,43.2,percent of total billed charges,90% of total billed charges,45,75,,36,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,17.4,29,,13.92,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,40.2,67,,32.16,percent of total billed charges,67% of total billed charges,95,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,48,80,,38.4,percent of total billed charges,80% of total billed charges,39,65,,31.2,percent of total billed charges,65% of total billed charges,21.4,35.67,,17.12,percent of total billed charges,35.67% of total billed charges,17.4,95,
WHEELCHAIR 22IN 2-3 MONTH RENT,27710003,CDM,290,RC,K0007,HCPCS,outpatient,,,57,22.80,RRKI,48.45,85,,38.76,percent of total billed charges,85% of total billed charges,43.89,77,,35.11,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,363.13,385,,,fee schedule,385% of BCBS fee schedule,378.22,401,,,fee schedule,401% of BCBS fee schedule,378.22,401,,,fee schedule,401% of BCBS fee schedule,378.22,401,,,fee schedule,401% of BCBS fee schedule,51.3,90,,41.04,percent of total billed charges,90% of total billed charges,45.6,80,,36.48,percent of total billed charges,80% of total billed charges,51.3,90,,41.04,percent of total billed charges,90% of total billed charges,42.75,75,,34.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,16.53,29,,13.224,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,38.19,67,,30.552,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,45.6,80,,36.48,percent of total billed charges,80% of total billed charges,37.05,65,,29.64,percent of total billed charges,65% of total billed charges,20.33,35.67,,16.264,percent of total billed charges,35.67% of total billed charges,16.53,378.22,
WHEELCHAIR 22IN 4-13 RENT,27710004,CDM,290,RC,K0007,HCPCS,outpatient,,,57,22.80,RRKJKX,48.45,85,,38.76,percent of total billed charges,85% of total billed charges,43.89,77,,35.11,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,363.13,385,,,fee schedule,385% of BCBS fee schedule,378.22,401,,,fee schedule,401% of BCBS fee schedule,378.22,401,,,fee schedule,401% of BCBS fee schedule,378.22,401,,,fee schedule,401% of BCBS fee schedule,51.3,90,,41.04,percent of total billed charges,90% of total billed charges,45.6,80,,36.48,percent of total billed charges,80% of total billed charges,51.3,90,,41.04,percent of total billed charges,90% of total billed charges,42.75,75,,34.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,16.53,29,,13.224,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,38.19,67,,30.552,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,45.6,80,,36.48,percent of total billed charges,80% of total billed charges,37.05,65,,29.64,percent of total billed charges,65% of total billed charges,20.33,35.67,,16.264,percent of total billed charges,35.67% of total billed charges,16.53,378.22,
TRAPEZE BARS - MCKESSON,27710005,CDM,290,RC,E0910,HCPCS,outpatient,,,493,197.20,,419.05,85,,335.24,percent of total billed charges,85% of total billed charges,379.61,77,,303.69,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,45.55,385,,,fee schedule,385% of BCBS fee schedule,47.44,401,,,fee schedule,401% of BCBS fee schedule,47.44,401,,,fee schedule,401% of BCBS fee schedule,47.44,401,,,fee schedule,401% of BCBS fee schedule,443.7,90,,354.96,percent of total billed charges,90% of total billed charges,394.4,80,,315.52,percent of total billed charges,80% of total billed charges,443.7,90,,354.96,percent of total billed charges,90% of total billed charges,369.75,75,,295.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,142.97,29,,114.376,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,330.31,67,,264.248,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,394.4,80,,315.52,percent of total billed charges,80% of total billed charges,320.45,65,,256.36,percent of total billed charges,65% of total billed charges,175.85,35.67,,140.68,percent of total billed charges,35.67% of total billed charges,45.55,443.7,
CHIN RESTRAINT,27710006,CDM,290,RC,A7036,HCPCS,outpatient,,,28,11.20,,23.8,85,,19.04,percent of total billed charges,85% of total billed charges,21.56,77,,17.25,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,43.97,385,,,fee schedule,385% of BCBS fee schedule,45.79,401,,,fee schedule,401% of BCBS fee schedule,45.79,401,,,fee schedule,401% of BCBS fee schedule,45.79,401,,,fee schedule,401% of BCBS fee schedule,25.2,90,,20.16,percent of total billed charges,90% of total billed charges,22.4,80,,17.92,percent of total billed charges,80% of total billed charges,25.2,90,,20.16,percent of total billed charges,90% of total billed charges,21,75,,16.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,8.12,29,,6.496,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,18.76,67,,15.008,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,22.4,80,,17.92,percent of total billed charges,80% of total billed charges,18.2,65,,14.56,percent of total billed charges,65% of total billed charges,9.99,35.67,,7.992,percent of total billed charges,35.67% of total billed charges,8.12,45.79,
EVORA FULL FACE MASK,27710007,CDM,290,RC,A7030,HCPCS,outpatient,,,238,95.20,,202.3,85,,161.84,percent of total billed charges,85% of total billed charges,183.26,77,,146.61,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,369.95,385,,,fee schedule,385% of BCBS fee schedule,385.32,401,,,fee schedule,401% of BCBS fee schedule,385.32,401,,,fee schedule,401% of BCBS fee schedule,385.32,401,,,fee schedule,401% of BCBS fee schedule,214.2,90,,171.36,percent of total billed charges,90% of total billed charges,190.4,80,,152.32,percent of total billed charges,80% of total billed charges,214.2,90,,171.36,percent of total billed charges,90% of total billed charges,178.5,75,,142.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,69.02,29,,55.216,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,159.46,67,,127.568,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,190.4,80,,152.32,percent of total billed charges,80% of total billed charges,154.7,65,,123.76,percent of total billed charges,65% of total billed charges,84.89,35.67,,67.912,percent of total billed charges,35.67% of total billed charges,69.02,385.32,
FULL FACE MASK REPLACEMENT,27710008,CDM,290,RC,A7031,HCPCS,outpatient,,,167,66.80,,141.95,85,,113.56,percent of total billed charges,85% of total billed charges,128.59,77,,102.87,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,140.68,385,,,fee schedule,385% of BCBS fee schedule,146.53,401,,,fee schedule,401% of BCBS fee schedule,146.53,401,,,fee schedule,401% of BCBS fee schedule,146.53,401,,,fee schedule,401% of BCBS fee schedule,150.3,90,,120.24,percent of total billed charges,90% of total billed charges,133.6,80,,106.88,percent of total billed charges,80% of total billed charges,150.3,90,,120.24,percent of total billed charges,90% of total billed charges,125.25,75,,100.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,48.43,29,,38.744,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,111.89,67,,89.512,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,133.6,80,,106.88,percent of total billed charges,80% of total billed charges,108.55,65,,86.84,percent of total billed charges,65% of total billed charges,59.57,35.67,,47.656,percent of total billed charges,35.67% of total billed charges,48.43,150.3,
WHEELCHAIR 22IN 1ST MONTH RENT,2771001,CDM,290,RC,K0007,HCPCS,outpatient,,,57,22.80,RRKHKX,48.45,85,,38.76,percent of total billed charges,85% of total billed charges,43.89,77,,35.11,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,363.13,385,,,fee schedule,385% of BCBS fee schedule,378.22,401,,,fee schedule,401% of BCBS fee schedule,378.22,401,,,fee schedule,401% of BCBS fee schedule,378.22,401,,,fee schedule,401% of BCBS fee schedule,51.3,90,,41.04,percent of total billed charges,90% of total billed charges,45.6,80,,36.48,percent of total billed charges,80% of total billed charges,51.3,90,,41.04,percent of total billed charges,90% of total billed charges,42.75,75,,34.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,16.53,29,,13.224,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,38.19,67,,30.552,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,45.6,80,,36.48,percent of total billed charges,80% of total billed charges,37.05,65,,29.64,percent of total billed charges,65% of total billed charges,20.33,35.67,,16.264,percent of total billed charges,35.67% of total billed charges,16.53,378.22,
SEAT CUSHION FOAM 16X16X2,2900001,CDM,290,RC,E2601,HCPCS,outpatient,,,109,43.60,,92.65,85,,74.12,percent of total billed charges,85% of total billed charges,83.93,77,,67.14,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,228.42,385,,,fee schedule,385% of BCBS fee schedule,237.91,401,,,fee schedule,401% of BCBS fee schedule,237.91,401,,,fee schedule,401% of BCBS fee schedule,237.91,401,,,fee schedule,401% of BCBS fee schedule,98.1,90,,78.48,percent of total billed charges,90% of total billed charges,87.2,80,,69.76,percent of total billed charges,80% of total billed charges,98.1,90,,78.48,percent of total billed charges,90% of total billed charges,81.75,75,,65.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,31.61,29,,25.288,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,73.03,67,,58.424,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,87.2,80,,69.76,percent of total billed charges,80% of total billed charges,70.85,65,,56.68,percent of total billed charges,65% of total billed charges,38.88,35.67,,31.104,percent of total billed charges,35.67% of total billed charges,31.61,237.91,
LIGHTWEIGHT WC 16 INCH NONRENT,2900002,CDM,290,RC,K0003,HCPCS,outpatient,,,598,239.20,,508.3,85,,406.64,percent of total billed charges,85% of total billed charges,460.46,77,,368.37,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,141.41,385,,,fee schedule,385% of BCBS fee schedule,147.29,401,,,fee schedule,401% of BCBS fee schedule,147.29,401,,,fee schedule,401% of BCBS fee schedule,147.29,401,,,fee schedule,401% of BCBS fee schedule,538.2,90,,430.56,percent of total billed charges,90% of total billed charges,478.4,80,,382.72,percent of total billed charges,80% of total billed charges,538.2,90,,430.56,percent of total billed charges,90% of total billed charges,448.5,75,,358.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,173.42,29,,138.736,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,400.66,67,,320.528,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,478.4,80,,382.72,percent of total billed charges,80% of total billed charges,388.7,65,,310.96,percent of total billed charges,65% of total billed charges,213.31,35.67,,170.648,percent of total billed charges,35.67% of total billed charges,141.41,538.2,
TB SKIN TEST INJ,2509970,CDM,300,RC,86580,HCPCS,outpatient,,,11,4.40,,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,8.47,77,,6.78,percent of total billed charges,77% of total billed charges,26.03,100,,,fee schedule,100% of CMS OPPS rate,61.15,350,,,fee schedule,350% of BCBS fee schedule,63.59,364,,,fee schedule,364% of BCBS fee schedule,63.59,364,,,fee schedule,364% of BCBS fee schedule,63.59,364,,,fee schedule,364% of BCBS fee schedule,9.9,90,,7.92,percent of total billed charges,90% of total billed charges,8.8,80,,7.04,percent of total billed charges,80% of total billed charges,9.9,90,,7.92,percent of total billed charges,90% of total billed charges,8.25,75,,6.6,percent of total billed charges,75% of total billed charges,31.76,122,,,fee schedule,122% of APC rate,3.19,29,,2.552,percent of total billed charges,29% of total billed charges,26.03,100,,,fee schedule,100% of CMS OPPS rate,7.37,67,,5.896,percent of total billed charges,67% of total billed charges,5.3,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,8.8,80,,7.04,percent of total billed charges,80% of total billed charges,7.15,65,,5.72,percent of total billed charges,65% of total billed charges,3.92,35.67,,3.136,percent of total billed charges,35.67% of total billed charges,3.19,63.59,
GLUCOCHECKS,2600020,CDM,300,RC,82962,HCPCS,outpatient,,,34,13.60,,28.9,85,,23.12,percent of total billed charges,85% of total billed charges,26.18,77,,20.94,percent of total billed charges,77% of total billed charges,3.28,100,,,fee schedule,100% of CMS fee schedule,11.48,350,,,fee schedule,350% of BCBS fee schedule,11.94,364,,,fee schedule,364% of BCBS fee schedule,11.94,364,,,fee schedule,364% of BCBS fee schedule,11.94,364,,,fee schedule,364% of BCBS fee schedule,30.6,90,,24.48,percent of total billed charges,90% of total billed charges,27.2,80,,21.76,percent of total billed charges,80% of total billed charges,30.6,90,,24.48,percent of total billed charges,90% of total billed charges,25.5,75,,20.4,percent of total billed charges,75% of total billed charges,4,122,,,fee schedule,122% of APC rate,9.86,29,,7.888,percent of total billed charges,29% of total billed charges,3.28,100,,,fee schedule,100% of CMS fee schedule,22.78,67,,18.224,percent of total billed charges,67% of total billed charges,3.23,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,27.2,80,,21.76,percent of total billed charges,80% of total billed charges,22.1,65,,17.68,percent of total billed charges,65% of total billed charges,12.13,35.67,,9.704,percent of total billed charges,35.67% of total billed charges,3.23,30.6,
GLUCOSE FINGER STICK,2600021,CDM,300,RC,82962,HCPCS,outpatient,,,34,13.60,,28.9,85,,23.12,percent of total billed charges,85% of total billed charges,26.18,77,,20.94,percent of total billed charges,77% of total billed charges,3.28,100,,,fee schedule,100% of CMS fee schedule,11.48,350,,,fee schedule,350% of BCBS fee schedule,11.94,364,,,fee schedule,364% of BCBS fee schedule,11.94,364,,,fee schedule,364% of BCBS fee schedule,11.94,364,,,fee schedule,364% of BCBS fee schedule,30.6,90,,24.48,percent of total billed charges,90% of total billed charges,27.2,80,,21.76,percent of total billed charges,80% of total billed charges,30.6,90,,24.48,percent of total billed charges,90% of total billed charges,25.5,75,,20.4,percent of total billed charges,75% of total billed charges,4,122,,,fee schedule,122% of APC rate,9.86,29,,7.888,percent of total billed charges,29% of total billed charges,3.28,100,,,fee schedule,100% of CMS fee schedule,22.78,67,,18.224,percent of total billed charges,67% of total billed charges,3.23,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,27.2,80,,21.76,percent of total billed charges,80% of total billed charges,22.1,65,,17.68,percent of total billed charges,65% of total billed charges,12.13,35.67,,9.704,percent of total billed charges,35.67% of total billed charges,3.23,30.6,
CLO TEST (UREASE) **,27001258,CDM,300,RC,87076,HCPCS,outpatient,,,96,38.40,,81.6,85,,65.28,percent of total billed charges,85% of total billed charges,73.92,77,,59.14,percent of total billed charges,77% of total billed charges,8.08,100,,,fee schedule,100% of CMS fee schedule,34.9,350,,,fee schedule,350% of BCBS fee schedule,36.29,364,,,fee schedule,364% of BCBS fee schedule,36.29,364,,,fee schedule,364% of BCBS fee schedule,36.29,364,,,fee schedule,364% of BCBS fee schedule,86.4,90,,69.12,percent of total billed charges,90% of total billed charges,76.8,80,,61.44,percent of total billed charges,80% of total billed charges,86.4,90,,69.12,percent of total billed charges,90% of total billed charges,72,75,,57.6,percent of total billed charges,75% of total billed charges,9.85,122,,,fee schedule,122% of APC rate,27.84,29,,22.272,percent of total billed charges,29% of total billed charges,8.08,100,,,fee schedule,100% of CMS fee schedule,64.32,67,,51.456,percent of total billed charges,67% of total billed charges,12.02,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,76.8,80,,61.44,percent of total billed charges,80% of total billed charges,62.4,65,,49.92,percent of total billed charges,65% of total billed charges,34.24,35.67,,27.392,percent of total billed charges,35.67% of total billed charges,8.08,86.4,
5-HIAA,3000100,CDM,300,RC,83497,HCPCS,outpatient,,,87,34.80,,73.95,85,,59.16,percent of total billed charges,85% of total billed charges,66.99,77,,53.59,percent of total billed charges,77% of total billed charges,12.9,100,,,fee schedule,100% of CMS fee schedule,55.72,350,,,fee schedule,350% of BCBS fee schedule,57.95,364,,,fee schedule,364% of BCBS fee schedule,57.95,364,,,fee schedule,364% of BCBS fee schedule,57.95,364,,,fee schedule,364% of BCBS fee schedule,78.3,90,,62.64,percent of total billed charges,90% of total billed charges,69.6,80,,55.68,percent of total billed charges,80% of total billed charges,78.3,90,,62.64,percent of total billed charges,90% of total billed charges,65.25,75,,52.2,percent of total billed charges,75% of total billed charges,15.73,122,,,fee schedule,122% of APC rate,25.23,29,,20.184,percent of total billed charges,29% of total billed charges,12.9,100,,,fee schedule,100% of CMS fee schedule,58.29,67,,46.632,percent of total billed charges,67% of total billed charges,19.17,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,69.6,80,,55.68,percent of total billed charges,80% of total billed charges,56.55,65,,45.24,percent of total billed charges,65% of total billed charges,31.03,35.67,,24.824,percent of total billed charges,35.67% of total billed charges,12.9,78.3,
5-NUCLEOTIDASE,3000120,CDM,300,RC,83915,HCPCS,outpatient,,,151,60.40,,128.35,85,,102.68,percent of total billed charges,85% of total billed charges,116.27,77,,93.02,percent of total billed charges,77% of total billed charges,11.15,100,,,fee schedule,100% of CMS fee schedule,48.2,350,,,fee schedule,350% of BCBS fee schedule,50.12,364,,,fee schedule,364% of BCBS fee schedule,50.12,364,,,fee schedule,364% of BCBS fee schedule,50.12,364,,,fee schedule,364% of BCBS fee schedule,135.9,90,,108.72,percent of total billed charges,90% of total billed charges,120.8,80,,96.64,percent of total billed charges,80% of total billed charges,135.9,90,,108.72,percent of total billed charges,90% of total billed charges,113.25,75,,90.6,percent of total billed charges,75% of total billed charges,13.6,122,,,fee schedule,122% of APC rate,43.79,29,,35.032,percent of total billed charges,29% of total billed charges,11.15,100,,,fee schedule,100% of CMS fee schedule,101.17,67,,80.936,percent of total billed charges,67% of total billed charges,16.59,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,120.8,80,,96.64,percent of total billed charges,80% of total billed charges,98.15,65,,78.52,percent of total billed charges,65% of total billed charges,53.86,35.67,,43.088,percent of total billed charges,35.67% of total billed charges,11.15,135.9,
17 - HYDROXYPROGESTERONE,3000160,CDM,300,RC,83498,HCPCS,outpatient,,,166,66.40,,141.1,85,,112.88,percent of total billed charges,85% of total billed charges,127.82,77,,102.26,percent of total billed charges,77% of total billed charges,27.17,100,,,fee schedule,100% of CMS fee schedule,117.39,350,,,fee schedule,350% of BCBS fee schedule,122.09,364,,,fee schedule,364% of BCBS fee schedule,122.09,364,,,fee schedule,364% of BCBS fee schedule,122.09,364,,,fee schedule,364% of BCBS fee schedule,149.4,90,,119.52,percent of total billed charges,90% of total billed charges,132.8,80,,106.24,percent of total billed charges,80% of total billed charges,149.4,90,,119.52,percent of total billed charges,90% of total billed charges,124.5,75,,99.6,percent of total billed charges,75% of total billed charges,33.14,122,,,fee schedule,122% of APC rate,48.14,29,,38.512,percent of total billed charges,29% of total billed charges,27.17,100,,,fee schedule,100% of CMS fee schedule,111.22,67,,88.976,percent of total billed charges,67% of total billed charges,40.4,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,132.8,80,,106.24,percent of total billed charges,80% of total billed charges,107.9,65,,86.32,percent of total billed charges,65% of total billed charges,59.21,35.67,,47.368,percent of total billed charges,35.67% of total billed charges,27.17,149.4,
17-KETOSTEROIDS,3000180,CDM,300,RC,83586,HCPCS,outpatient,,,85,34.00,,72.25,85,,57.8,percent of total billed charges,85% of total billed charges,65.45,77,,52.36,percent of total billed charges,77% of total billed charges,12.8,100,,,fee schedule,100% of CMS fee schedule,55.3,350,,,fee schedule,350% of BCBS fee schedule,57.51,364,,,fee schedule,364% of BCBS fee schedule,57.51,364,,,fee schedule,364% of BCBS fee schedule,57.51,364,,,fee schedule,364% of BCBS fee schedule,76.5,90,,61.2,percent of total billed charges,90% of total billed charges,68,80,,54.4,percent of total billed charges,80% of total billed charges,76.5,90,,61.2,percent of total billed charges,90% of total billed charges,63.75,75,,51,percent of total billed charges,75% of total billed charges,15.61,122,,,fee schedule,122% of APC rate,24.65,29,,19.72,percent of total billed charges,29% of total billed charges,12.8,100,,,fee schedule,100% of CMS fee schedule,56.95,67,,45.56,percent of total billed charges,67% of total billed charges,13.84,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,68,80,,54.4,percent of total billed charges,80% of total billed charges,55.25,65,,44.2,percent of total billed charges,65% of total billed charges,30.32,35.67,,24.256,percent of total billed charges,35.67% of total billed charges,12.8,76.5,
ABSOLUTE CD4 AND CD8,3000185,CDM,300,RC,86361,HCPCS,outpatient,,,180,72.00,,153,85,,122.4,percent of total billed charges,85% of total billed charges,138.6,77,,110.88,percent of total billed charges,77% of total billed charges,26.78,100,,,fee schedule,100% of CMS fee schedule,115.71,350,,,fee schedule,350% of BCBS fee schedule,120.34,364,,,fee schedule,364% of BCBS fee schedule,120.34,364,,,fee schedule,364% of BCBS fee schedule,120.34,364,,,fee schedule,364% of BCBS fee schedule,162,90,,129.6,percent of total billed charges,90% of total billed charges,144,80,,115.2,percent of total billed charges,80% of total billed charges,162,90,,129.6,percent of total billed charges,90% of total billed charges,135,75,,108,percent of total billed charges,75% of total billed charges,32.67,122,,,fee schedule,122% of APC rate,52.2,29,,41.76,percent of total billed charges,29% of total billed charges,26.78,100,,,fee schedule,100% of CMS fee schedule,120.6,67,,96.48,percent of total billed charges,67% of total billed charges,39.81,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,144,80,,115.2,percent of total billed charges,80% of total billed charges,117,65,,93.6,percent of total billed charges,65% of total billed charges,64.21,35.67,,51.368,percent of total billed charges,35.67% of total billed charges,26.78,162,
ABSOLUTE CD4 COUNT,3000186,CDM,300,RC,86361,HCPCS,outpatient,,,87,34.80,,73.95,85,,59.16,percent of total billed charges,85% of total billed charges,66.99,77,,53.59,percent of total billed charges,77% of total billed charges,26.78,100,,,fee schedule,100% of CMS fee schedule,115.71,350,,,fee schedule,350% of BCBS fee schedule,120.34,364,,,fee schedule,364% of BCBS fee schedule,120.34,364,,,fee schedule,364% of BCBS fee schedule,120.34,364,,,fee schedule,364% of BCBS fee schedule,78.3,90,,62.64,percent of total billed charges,90% of total billed charges,69.6,80,,55.68,percent of total billed charges,80% of total billed charges,78.3,90,,62.64,percent of total billed charges,90% of total billed charges,65.25,75,,52.2,percent of total billed charges,75% of total billed charges,32.67,122,,,fee schedule,122% of APC rate,25.23,29,,20.184,percent of total billed charges,29% of total billed charges,26.78,100,,,fee schedule,100% of CMS fee schedule,58.29,67,,46.632,percent of total billed charges,67% of total billed charges,39.81,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,69.6,80,,55.68,percent of total billed charges,80% of total billed charges,56.55,65,,45.24,percent of total billed charges,65% of total billed charges,31.03,35.67,,24.824,percent of total billed charges,35.67% of total billed charges,25.23,120.34,
ACETAMINOPHEN LEVEL,3000200,CDM,300,RC,80143,HCPCS,outpatient,,,446,178.40,,379.1,85,,303.28,percent of total billed charges,85% of total billed charges,343.42,77,,274.74,percent of total billed charges,77% of total billed charges,18.64,100,,,fee schedule,100% of CMS fee schedule,65.24,350,,,fee schedule,350% of BCBS fee schedule,67.85,364,,,fee schedule,364% of BCBS fee schedule,67.85,364,,,fee schedule,364% of BCBS fee schedule,67.85,364,,,fee schedule,364% of BCBS fee schedule,401.4,90,,321.12,percent of total billed charges,90% of total billed charges,356.8,80,,285.44,percent of total billed charges,80% of total billed charges,401.4,90,,321.12,percent of total billed charges,90% of total billed charges,334.5,75,,267.6,percent of total billed charges,75% of total billed charges,22.74,122,,,fee schedule,122% of APC rate,129.34,29,,103.472,percent of total billed charges,29% of total billed charges,18.64,100,,,fee schedule,100% of CMS fee schedule,298.82,67,,239.056,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,356.8,80,,285.44,percent of total billed charges,80% of total billed charges,289.9,65,,231.92,percent of total billed charges,65% of total billed charges,159.09,35.67,,127.272,percent of total billed charges,35.67% of total billed charges,18.64,401.4,
ACETAMINOPHEN REPEAT SAME DAY,3000201,CDM,300,RC,80329,HCPCS,outpatient,,,151,60.40,91,128.35,85,,102.68,percent of total billed charges,85% of total billed charges,116.27,77,,93.02,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,123.82,82,,99.056,percent of total billed charges,82% of total billed charges,128.35,85,,102.68,percent of total billed charges,85% of total billed charges,128.35,85,,102.68,percent of total billed charges,85% of total billed charges,128.35,85,,102.68,percent of total billed charges,85% of total billed charges,135.9,90,,108.72,percent of total billed charges,90% of total billed charges,120.8,80,,96.64,percent of total billed charges,80% of total billed charges,135.9,90,,108.72,percent of total billed charges,90% of total billed charges,113.25,75,,90.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,43.79,29,,35.032,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,101.17,67,,80.936,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,120.8,80,,96.64,percent of total billed charges,80% of total billed charges,98.15,65,,78.52,percent of total billed charges,65% of total billed charges,53.86,35.67,,43.088,percent of total billed charges,35.67% of total billed charges,43.79,135.9,
"ACETONE, SERUM",3000220,CDM,300,RC,82009,HCPCS,outpatient,,,70,28.00,,59.5,85,,47.6,percent of total billed charges,85% of total billed charges,53.9,77,,43.12,percent of total billed charges,77% of total billed charges,4.51,100,,,fee schedule,100% of CMS fee schedule,19.53,350,,,fee schedule,350% of BCBS fee schedule,20.31,364,,,fee schedule,364% of BCBS fee schedule,20.31,364,,,fee schedule,364% of BCBS fee schedule,20.31,364,,,fee schedule,364% of BCBS fee schedule,63,90,,50.4,percent of total billed charges,90% of total billed charges,56,80,,44.8,percent of total billed charges,80% of total billed charges,63,90,,50.4,percent of total billed charges,90% of total billed charges,52.5,75,,42,percent of total billed charges,75% of total billed charges,5.51,122,,,fee schedule,122% of APC rate,20.3,29,,16.24,percent of total billed charges,29% of total billed charges,4.51,100,,,fee schedule,100% of CMS fee schedule,46.9,67,,37.52,percent of total billed charges,67% of total billed charges,6.72,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,56,80,,44.8,percent of total billed charges,80% of total billed charges,45.5,65,,36.4,percent of total billed charges,65% of total billed charges,24.97,35.67,,19.976,percent of total billed charges,35.67% of total billed charges,4.51,63,
"ACETONE, URINE",3000221,CDM,300,RC,82009,HCPCS,outpatient,,,70,28.00,,59.5,85,,47.6,percent of total billed charges,85% of total billed charges,53.9,77,,43.12,percent of total billed charges,77% of total billed charges,4.51,100,,,fee schedule,100% of CMS fee schedule,19.53,350,,,fee schedule,350% of BCBS fee schedule,20.31,364,,,fee schedule,364% of BCBS fee schedule,20.31,364,,,fee schedule,364% of BCBS fee schedule,20.31,364,,,fee schedule,364% of BCBS fee schedule,63,90,,50.4,percent of total billed charges,90% of total billed charges,56,80,,44.8,percent of total billed charges,80% of total billed charges,63,90,,50.4,percent of total billed charges,90% of total billed charges,52.5,75,,42,percent of total billed charges,75% of total billed charges,5.51,122,,,fee schedule,122% of APC rate,20.3,29,,16.24,percent of total billed charges,29% of total billed charges,4.51,100,,,fee schedule,100% of CMS fee schedule,46.9,67,,37.52,percent of total billed charges,67% of total billed charges,6.72,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,56,80,,44.8,percent of total billed charges,80% of total billed charges,45.5,65,,36.4,percent of total billed charges,65% of total billed charges,24.97,35.67,,19.976,percent of total billed charges,35.67% of total billed charges,4.51,63,
"ACID PHOS, TOTAL",3000260,CDM,300,RC,84060,HCPCS,outpatient,,,44,17.60,,37.4,85,,29.92,percent of total billed charges,85% of total billed charges,33.88,77,,27.1,percent of total billed charges,77% of total billed charges,7.64,100,,,fee schedule,100% of CMS fee schedule,31.92,350,,,fee schedule,350% of BCBS fee schedule,33.2,364,,,fee schedule,364% of BCBS fee schedule,33.2,364,,,fee schedule,364% of BCBS fee schedule,33.2,364,,,fee schedule,364% of BCBS fee schedule,39.6,90,,31.68,percent of total billed charges,90% of total billed charges,35.2,80,,28.16,percent of total billed charges,80% of total billed charges,39.6,90,,31.68,percent of total billed charges,90% of total billed charges,33,75,,26.4,percent of total billed charges,75% of total billed charges,9.32,122,,,fee schedule,122% of APC rate,12.76,29,,10.208,percent of total billed charges,29% of total billed charges,7.64,100,,,fee schedule,100% of CMS fee schedule,29.48,67,,23.584,percent of total billed charges,67% of total billed charges,10.98,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,35.2,80,,28.16,percent of total billed charges,80% of total billed charges,28.6,65,,22.88,percent of total billed charges,65% of total billed charges,15.69,35.67,,12.552,percent of total billed charges,35.67% of total billed charges,7.64,39.6,
ACTH,3000280,CDM,300,RC,82024,HCPCS,outpatient,,,206,82.40,,175.1,85,,140.08,percent of total billed charges,85% of total billed charges,158.62,77,,126.9,percent of total billed charges,77% of total billed charges,38.61,100,,,fee schedule,100% of CMS fee schedule,166.88,350,,,fee schedule,350% of BCBS fee schedule,173.56,364,,,fee schedule,364% of BCBS fee schedule,173.56,364,,,fee schedule,364% of BCBS fee schedule,173.56,364,,,fee schedule,364% of BCBS fee schedule,185.4,90,,148.32,percent of total billed charges,90% of total billed charges,164.8,80,,131.84,percent of total billed charges,80% of total billed charges,185.4,90,,148.32,percent of total billed charges,90% of total billed charges,154.5,75,,123.6,percent of total billed charges,75% of total billed charges,47.11,122,,,fee schedule,122% of APC rate,59.74,29,,47.792,percent of total billed charges,29% of total billed charges,38.61,100,,,fee schedule,100% of CMS fee schedule,138.02,67,,110.416,percent of total billed charges,67% of total billed charges,57.44,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,164.8,80,,131.84,percent of total billed charges,80% of total billed charges,133.9,65,,107.12,percent of total billed charges,65% of total billed charges,73.48,35.67,,58.784,percent of total billed charges,35.67% of total billed charges,38.61,185.4,
ACTH STIMULATION TEST,3000281,CDM,300,RC,80400,HCPCS,outpatient,,,132,52.80,,112.2,85,,89.76,percent of total billed charges,85% of total billed charges,101.64,77,,81.31,percent of total billed charges,77% of total billed charges,32.61,100,,,fee schedule,100% of CMS fee schedule,140.95,350,,,fee schedule,350% of BCBS fee schedule,146.58,364,,,fee schedule,364% of BCBS fee schedule,146.58,364,,,fee schedule,364% of BCBS fee schedule,146.58,364,,,fee schedule,364% of BCBS fee schedule,118.8,90,,95.04,percent of total billed charges,90% of total billed charges,105.6,80,,84.48,percent of total billed charges,80% of total billed charges,118.8,90,,95.04,percent of total billed charges,90% of total billed charges,99,75,,79.2,percent of total billed charges,75% of total billed charges,39.79,122,,,fee schedule,122% of APC rate,38.28,29,,30.624,percent of total billed charges,29% of total billed charges,32.61,100,,,fee schedule,100% of CMS fee schedule,88.44,67,,70.752,percent of total billed charges,67% of total billed charges,48.51,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,105.6,80,,84.48,percent of total billed charges,80% of total billed charges,85.8,65,,68.64,percent of total billed charges,65% of total billed charges,47.08,35.67,,37.664,percent of total billed charges,35.67% of total billed charges,32.61,146.58,
COVID19 SPECIMEN COLLECTION,3000288,CDM,300,RC,C9803,HCPCS,outpatient,,,27,10.80,,22.95,85,,18.36,percent of total billed charges,85% of total billed charges,20.79,77,,16.63,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,82.11,350,,,fee schedule,350% of BCBS fee schedule,85.39,364,,,fee schedule,364% of BCBS fee schedule,85.39,364,,,fee schedule,364% of BCBS fee schedule,85.39,364,,,fee schedule,364% of BCBS fee schedule,24.3,90,,19.44,percent of total billed charges,90% of total billed charges,21.6,80,,17.28,percent of total billed charges,80% of total billed charges,24.3,90,,19.44,percent of total billed charges,90% of total billed charges,20.25,75,,16.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,7.83,29,,6.264,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,18.09,67,,14.472,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,21.6,80,,17.28,percent of total billed charges,80% of total billed charges,17.55,65,,14.04,percent of total billed charges,65% of total billed charges,9.63,35.67,,7.704,percent of total billed charges,35.67% of total billed charges,7.83,85.39,
ADENOVIRUS,3000290,CDM,300,RC,87809,HCPCS,outpatient,,,84,33.60,,71.4,85,,57.12,percent of total billed charges,85% of total billed charges,64.68,77,,51.74,percent of total billed charges,77% of total billed charges,21.76,100,,,fee schedule,100% of CMS fee schedule,76.16,350,,,fee schedule,350% of BCBS fee schedule,79.21,364,,,fee schedule,364% of BCBS fee schedule,79.21,364,,,fee schedule,364% of BCBS fee schedule,79.21,364,,,fee schedule,364% of BCBS fee schedule,75.6,90,,60.48,percent of total billed charges,90% of total billed charges,67.2,80,,53.76,percent of total billed charges,80% of total billed charges,75.6,90,,60.48,percent of total billed charges,90% of total billed charges,63,75,,50.4,percent of total billed charges,75% of total billed charges,26.54,122,,,fee schedule,122% of APC rate,24.36,29,,19.488,percent of total billed charges,29% of total billed charges,21.76,100,,,fee schedule,100% of CMS fee schedule,56.28,67,,45.024,percent of total billed charges,67% of total billed charges,15.41,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,67.2,80,,53.76,percent of total billed charges,80% of total billed charges,54.6,65,,43.68,percent of total billed charges,65% of total billed charges,29.96,35.67,,23.968,percent of total billed charges,35.67% of total billed charges,15.41,79.21,
ALBUMIN-SERUM EXP,3000300,CDM,300,RC,82040,HCPCS,outpatient,,,42,16.80,,35.7,85,,28.56,percent of total billed charges,85% of total billed charges,32.34,77,,25.87,percent of total billed charges,77% of total billed charges,4.95,100,,,fee schedule,100% of CMS fee schedule,21.39,350,,,fee schedule,350% of BCBS fee schedule,22.24,364,,,fee schedule,364% of BCBS fee schedule,22.24,364,,,fee schedule,364% of BCBS fee schedule,22.24,364,,,fee schedule,364% of BCBS fee schedule,37.8,90,,30.24,percent of total billed charges,90% of total billed charges,33.6,80,,26.88,percent of total billed charges,80% of total billed charges,37.8,90,,30.24,percent of total billed charges,90% of total billed charges,31.5,75,,25.2,percent of total billed charges,75% of total billed charges,6.03,122,,,fee schedule,122% of APC rate,12.18,29,,9.744,percent of total billed charges,29% of total billed charges,4.95,100,,,fee schedule,100% of CMS fee schedule,28.14,67,,22.512,percent of total billed charges,67% of total billed charges,7.36,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,33.6,80,,26.88,percent of total billed charges,80% of total billed charges,27.3,65,,21.84,percent of total billed charges,65% of total billed charges,14.98,35.67,,11.984,percent of total billed charges,35.67% of total billed charges,4.95,37.8,
ALBUMIN URINE QUANT,3000302,CDM,300,RC,82043,HCPCS,outpatient,,,161,64.40,,136.85,85,,109.48,percent of total billed charges,85% of total billed charges,123.97,77,,99.18,percent of total billed charges,77% of total billed charges,5.78,100,,,fee schedule,100% of CMS fee schedule,24.99,350,,,fee schedule,350% of BCBS fee schedule,25.99,364,,,fee schedule,364% of BCBS fee schedule,25.99,364,,,fee schedule,364% of BCBS fee schedule,25.99,364,,,fee schedule,364% of BCBS fee schedule,144.9,90,,115.92,percent of total billed charges,90% of total billed charges,128.8,80,,103.04,percent of total billed charges,80% of total billed charges,144.9,90,,115.92,percent of total billed charges,90% of total billed charges,120.75,75,,96.6,percent of total billed charges,75% of total billed charges,7.05,122,,,fee schedule,122% of APC rate,46.69,29,,37.352,percent of total billed charges,29% of total billed charges,5.78,100,,,fee schedule,100% of CMS fee schedule,107.87,67,,86.296,percent of total billed charges,67% of total billed charges,8.59,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,128.8,80,,103.04,percent of total billed charges,80% of total billed charges,104.65,65,,83.72,percent of total billed charges,65% of total billed charges,57.43,35.67,,45.944,percent of total billed charges,35.67% of total billed charges,5.78,144.9,
ALBUMIN - CSF,3000303,CDM,300,RC,82042,HCPCS,outpatient,,,34,13.60,,28.9,85,,23.12,percent of total billed charges,85% of total billed charges,26.18,77,,20.94,percent of total billed charges,77% of total billed charges,7.78,100,,,fee schedule,100% of CMS fee schedule,27.23,350,,,fee schedule,350% of BCBS fee schedule,28.32,364,,,fee schedule,364% of BCBS fee schedule,28.32,364,,,fee schedule,364% of BCBS fee schedule,28.32,364,,,fee schedule,364% of BCBS fee schedule,30.6,90,,24.48,percent of total billed charges,90% of total billed charges,27.2,80,,21.76,percent of total billed charges,80% of total billed charges,30.6,90,,24.48,percent of total billed charges,90% of total billed charges,25.5,75,,20.4,percent of total billed charges,75% of total billed charges,9.49,122,,,fee schedule,122% of APC rate,9.86,29,,7.888,percent of total billed charges,29% of total billed charges,7.78,100,,,fee schedule,100% of CMS fee schedule,22.78,67,,18.224,percent of total billed charges,67% of total billed charges,4.28,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,27.2,80,,21.76,percent of total billed charges,80% of total billed charges,22.1,65,,17.68,percent of total billed charges,65% of total billed charges,12.13,35.67,,9.704,percent of total billed charges,35.67% of total billed charges,4.28,30.6,
ALDOLASE,3000420,CDM,300,RC,82085,HCPCS,outpatient,,,64,25.60,,54.4,85,,43.52,percent of total billed charges,85% of total billed charges,49.28,77,,39.42,percent of total billed charges,77% of total billed charges,9.71,100,,,fee schedule,100% of CMS fee schedule,41.97,350,,,fee schedule,350% of BCBS fee schedule,43.64,364,,,fee schedule,364% of BCBS fee schedule,43.64,364,,,fee schedule,364% of BCBS fee schedule,43.64,364,,,fee schedule,364% of BCBS fee schedule,57.6,90,,46.08,percent of total billed charges,90% of total billed charges,51.2,80,,40.96,percent of total billed charges,80% of total billed charges,57.6,90,,46.08,percent of total billed charges,90% of total billed charges,48,75,,38.4,percent of total billed charges,75% of total billed charges,11.84,122,,,fee schedule,122% of APC rate,18.56,29,,14.848,percent of total billed charges,29% of total billed charges,9.71,100,,,fee schedule,100% of CMS fee schedule,42.88,67,,34.304,percent of total billed charges,67% of total billed charges,14.43,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,51.2,80,,40.96,percent of total billed charges,80% of total billed charges,41.6,65,,33.28,percent of total billed charges,65% of total billed charges,22.83,35.67,,18.264,percent of total billed charges,35.67% of total billed charges,9.71,57.6,
LIPOPROTEIN,3000425,CDM,300,RC,83695,HCPCS,outpatient,,,204,81.60,,173.4,85,,138.72,percent of total billed charges,85% of total billed charges,157.08,77,,125.66,percent of total billed charges,77% of total billed charges,14.32,100,,,fee schedule,100% of CMS fee schedule,55.93,350,,,fee schedule,350% of BCBS fee schedule,58.17,364,,,fee schedule,364% of BCBS fee schedule,58.17,364,,,fee schedule,364% of BCBS fee schedule,58.17,364,,,fee schedule,364% of BCBS fee schedule,183.6,90,,146.88,percent of total billed charges,90% of total billed charges,163.2,80,,130.56,percent of total billed charges,80% of total billed charges,183.6,90,,146.88,percent of total billed charges,90% of total billed charges,153,75,,122.4,percent of total billed charges,75% of total billed charges,17.47,122,,,fee schedule,122% of APC rate,59.16,29,,47.328,percent of total billed charges,29% of total billed charges,14.32,100,,,fee schedule,100% of CMS fee schedule,136.68,67,,109.344,percent of total billed charges,67% of total billed charges,19.25,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,163.2,80,,130.56,percent of total billed charges,80% of total billed charges,132.6,65,,106.08,percent of total billed charges,65% of total billed charges,72.77,35.67,,58.216,percent of total billed charges,35.67% of total billed charges,14.32,183.6,
ALDOSTERONE SERUM,3000440,CDM,300,RC,82088,HCPCS,outpatient,,,226,90.40,,192.1,85,,153.68,percent of total billed charges,85% of total billed charges,174.02,77,,139.22,percent of total billed charges,77% of total billed charges,40.75,100,,,fee schedule,100% of CMS fee schedule,176.09,350,,,fee schedule,350% of BCBS fee schedule,183.13,364,,,fee schedule,364% of BCBS fee schedule,183.13,364,,,fee schedule,364% of BCBS fee schedule,183.13,364,,,fee schedule,364% of BCBS fee schedule,203.4,90,,162.72,percent of total billed charges,90% of total billed charges,180.8,80,,144.64,percent of total billed charges,80% of total billed charges,203.4,90,,162.72,percent of total billed charges,90% of total billed charges,169.5,75,,135.6,percent of total billed charges,75% of total billed charges,49.71,122,,,fee schedule,122% of APC rate,65.54,29,,52.432,percent of total billed charges,29% of total billed charges,40.75,100,,,fee schedule,100% of CMS fee schedule,151.42,67,,121.136,percent of total billed charges,67% of total billed charges,60.6,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,180.8,80,,144.64,percent of total billed charges,80% of total billed charges,146.9,65,,117.52,percent of total billed charges,65% of total billed charges,80.61,35.67,,64.488,percent of total billed charges,35.67% of total billed charges,40.75,203.4,
"ALDOSTERONE, URINE",3000460,CDM,300,RC,82088,HCPCS,outpatient,,,222,88.80,,188.7,85,,150.96,percent of total billed charges,85% of total billed charges,170.94,77,,136.75,percent of total billed charges,77% of total billed charges,40.75,100,,,fee schedule,100% of CMS fee schedule,176.09,350,,,fee schedule,350% of BCBS fee schedule,183.13,364,,,fee schedule,364% of BCBS fee schedule,183.13,364,,,fee schedule,364% of BCBS fee schedule,183.13,364,,,fee schedule,364% of BCBS fee schedule,199.8,90,,159.84,percent of total billed charges,90% of total billed charges,177.6,80,,142.08,percent of total billed charges,80% of total billed charges,199.8,90,,159.84,percent of total billed charges,90% of total billed charges,166.5,75,,133.2,percent of total billed charges,75% of total billed charges,49.71,122,,,fee schedule,122% of APC rate,64.38,29,,51.504,percent of total billed charges,29% of total billed charges,40.75,100,,,fee schedule,100% of CMS fee schedule,148.74,67,,118.992,percent of total billed charges,67% of total billed charges,60.6,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,177.6,80,,142.08,percent of total billed charges,80% of total billed charges,144.3,65,,115.44,percent of total billed charges,65% of total billed charges,79.19,35.67,,63.352,percent of total billed charges,35.67% of total billed charges,40.75,199.8,
ALKALINE PHOSPHATASE,3000480,CDM,300,RC,84075,HCPCS,outpatient,,,48,19.20,,40.8,85,,32.64,percent of total billed charges,85% of total billed charges,36.96,77,,29.57,percent of total billed charges,77% of total billed charges,5.18,100,,,fee schedule,100% of CMS fee schedule,22.37,350,,,fee schedule,350% of BCBS fee schedule,23.26,364,,,fee schedule,364% of BCBS fee schedule,23.26,364,,,fee schedule,364% of BCBS fee schedule,23.26,364,,,fee schedule,364% of BCBS fee schedule,43.2,90,,34.56,percent of total billed charges,90% of total billed charges,38.4,80,,30.72,percent of total billed charges,80% of total billed charges,43.2,90,,34.56,percent of total billed charges,90% of total billed charges,36,75,,28.8,percent of total billed charges,75% of total billed charges,6.31,122,,,fee schedule,122% of APC rate,13.92,29,,11.136,percent of total billed charges,29% of total billed charges,5.18,100,,,fee schedule,100% of CMS fee schedule,32.16,67,,25.728,percent of total billed charges,67% of total billed charges,7.69,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,38.4,80,,30.72,percent of total billed charges,80% of total billed charges,31.2,65,,24.96,percent of total billed charges,65% of total billed charges,17.12,35.67,,13.696,percent of total billed charges,35.67% of total billed charges,5.18,43.2,
ALKALINE PHOSPHATASE ISO,3000500,CDM,300,RC,84080,HCPCS,outpatient,,,93,37.20,,79.05,85,,63.24,percent of total billed charges,85% of total billed charges,71.61,77,,57.29,percent of total billed charges,77% of total billed charges,14.78,100,,,fee schedule,100% of CMS fee schedule,63.88,350,,,fee schedule,350% of BCBS fee schedule,66.43,364,,,fee schedule,364% of BCBS fee schedule,66.43,364,,,fee schedule,364% of BCBS fee schedule,66.43,364,,,fee schedule,364% of BCBS fee schedule,83.7,90,,66.96,percent of total billed charges,90% of total billed charges,74.4,80,,59.52,percent of total billed charges,80% of total billed charges,83.7,90,,66.96,percent of total billed charges,90% of total billed charges,69.75,75,,55.8,percent of total billed charges,75% of total billed charges,18.03,122,,,fee schedule,122% of APC rate,26.97,29,,21.576,percent of total billed charges,29% of total billed charges,14.78,100,,,fee schedule,100% of CMS fee schedule,62.31,67,,49.848,percent of total billed charges,67% of total billed charges,13,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,74.4,80,,59.52,percent of total billed charges,80% of total billed charges,60.45,65,,48.36,percent of total billed charges,65% of total billed charges,33.17,35.67,,26.536,percent of total billed charges,35.67% of total billed charges,13,83.7,
ALLERGAN SPECIFIC IgG EACH,3000519,CDM,300,RC,86001,HCPCS,outpatient,,,53,21.20,,45.05,85,,36.04,percent of total billed charges,85% of total billed charges,40.81,77,,32.65,percent of total billed charges,77% of total billed charges,7.82,100,,,fee schedule,100% of CMS fee schedule,27.37,350,,,fee schedule,350% of BCBS fee schedule,28.46,364,,,fee schedule,364% of BCBS fee schedule,28.46,364,,,fee schedule,364% of BCBS fee schedule,28.46,364,,,fee schedule,364% of BCBS fee schedule,47.7,90,,38.16,percent of total billed charges,90% of total billed charges,42.4,80,,33.92,percent of total billed charges,80% of total billed charges,47.7,90,,38.16,percent of total billed charges,90% of total billed charges,39.75,75,,31.8,percent of total billed charges,75% of total billed charges,9.54,122,,,fee schedule,122% of APC rate,15.37,29,,12.296,percent of total billed charges,29% of total billed charges,7.82,100,,,fee schedule,100% of CMS fee schedule,35.51,67,,28.408,percent of total billed charges,67% of total billed charges,7.42,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,42.4,80,,33.92,percent of total billed charges,80% of total billed charges,34.45,65,,27.56,percent of total billed charges,65% of total billed charges,18.91,35.67,,15.128,percent of total billed charges,35.67% of total billed charges,7.42,47.7,
ALPHA-1-ANTITRYPSIN,3000520,CDM,300,RC,82103,HCPCS,outpatient,,,93,37.20,,79.05,85,,63.24,percent of total billed charges,85% of total billed charges,71.61,77,,57.29,percent of total billed charges,77% of total billed charges,13.44,100,,,fee schedule,100% of CMS fee schedule,58.07,350,,,fee schedule,350% of BCBS fee schedule,60.39,364,,,fee schedule,364% of BCBS fee schedule,60.39,364,,,fee schedule,364% of BCBS fee schedule,60.39,364,,,fee schedule,364% of BCBS fee schedule,83.7,90,,66.96,percent of total billed charges,90% of total billed charges,74.4,80,,59.52,percent of total billed charges,80% of total billed charges,83.7,90,,66.96,percent of total billed charges,90% of total billed charges,69.75,75,,55.8,percent of total billed charges,75% of total billed charges,16.39,122,,,fee schedule,122% of APC rate,26.97,29,,21.576,percent of total billed charges,29% of total billed charges,13.44,100,,,fee schedule,100% of CMS fee schedule,62.31,67,,49.848,percent of total billed charges,67% of total billed charges,19.98,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,74.4,80,,59.52,percent of total billed charges,80% of total billed charges,60.45,65,,48.36,percent of total billed charges,65% of total billed charges,33.17,35.67,,26.536,percent of total billed charges,35.67% of total billed charges,13.44,83.7,
ALPHA-FETOPROTEIN SERUM,3000540,CDM,300,RC,82105,HCPCS,outpatient,,,125,50.00,,106.25,85,,85,percent of total billed charges,85% of total billed charges,96.25,77,,77,percent of total billed charges,77% of total billed charges,16.77,100,,,fee schedule,100% of CMS fee schedule,72.49,350,,,fee schedule,350% of BCBS fee schedule,75.38,364,,,fee schedule,364% of BCBS fee schedule,75.38,364,,,fee schedule,364% of BCBS fee schedule,75.38,364,,,fee schedule,364% of BCBS fee schedule,112.5,90,,90,percent of total billed charges,90% of total billed charges,100,80,,80,percent of total billed charges,80% of total billed charges,112.5,90,,90,percent of total billed charges,90% of total billed charges,93.75,75,,75,percent of total billed charges,75% of total billed charges,20.45,122,,,fee schedule,122% of APC rate,36.25,29,,29,percent of total billed charges,29% of total billed charges,16.77,100,,,fee schedule,100% of CMS fee schedule,83.75,67,,67,percent of total billed charges,67% of total billed charges,24.94,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,100,80,,80,percent of total billed charges,80% of total billed charges,81.25,65,,65,percent of total billed charges,65% of total billed charges,44.59,35.67,,35.672,percent of total billed charges,35.67% of total billed charges,16.77,112.5,
AFP TOTAL & L3,3000541,CDM,300,RC,82107,HCPCS,outpatient,,,204,81.60,,173.4,85,,138.72,percent of total billed charges,85% of total billed charges,157.08,77,,125.66,percent of total billed charges,77% of total billed charges,64.41,100,,,fee schedule,100% of CMS fee schedule,278.32,350,,,fee schedule,350% of BCBS fee schedule,289.45,364,,,fee schedule,364% of BCBS fee schedule,289.45,364,,,fee schedule,364% of BCBS fee schedule,289.45,364,,,fee schedule,364% of BCBS fee schedule,183.6,90,,146.88,percent of total billed charges,90% of total billed charges,163.2,80,,130.56,percent of total billed charges,80% of total billed charges,183.6,90,,146.88,percent of total billed charges,90% of total billed charges,153,75,,122.4,percent of total billed charges,75% of total billed charges,78.58,122,,,fee schedule,122% of APC rate,59.16,29,,47.328,percent of total billed charges,29% of total billed charges,64.41,100,,,fee schedule,100% of CMS fee schedule,136.68,67,,109.344,percent of total billed charges,67% of total billed charges,93.56,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,163.2,80,,130.56,percent of total billed charges,80% of total billed charges,132.6,65,,106.08,percent of total billed charges,65% of total billed charges,72.77,35.67,,58.216,percent of total billed charges,35.67% of total billed charges,59.16,289.45,
ALPRAZOLAM (XANAX),3000560,CDM,300,RC,80346,HCPCS,outpatient,,,427,170.80,,362.95,85,,290.36,percent of total billed charges,85% of total billed charges,328.79,77,,263.03,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,350.14,82,,280.112,percent of total billed charges,82% of total billed charges,362.95,85,,290.36,percent of total billed charges,85% of total billed charges,362.95,85,,290.36,percent of total billed charges,85% of total billed charges,362.95,85,,290.36,percent of total billed charges,85% of total billed charges,384.3,90,,307.44,percent of total billed charges,90% of total billed charges,341.6,80,,273.28,percent of total billed charges,80% of total billed charges,384.3,90,,307.44,percent of total billed charges,90% of total billed charges,320.25,75,,256.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,123.83,29,,99.064,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,286.09,67,,228.872,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,341.6,80,,273.28,percent of total billed charges,80% of total billed charges,277.55,65,,222.04,percent of total billed charges,65% of total billed charges,152.31,35.67,,121.848,percent of total billed charges,35.67% of total billed charges,123.83,384.3,
HEAVY METALS SCREENING,3000593,CDM,300,RC,82525,HCPCS,outpatient,,,62,24.80,,52.7,85,,42.16,percent of total billed charges,85% of total billed charges,47.74,77,,38.19,percent of total billed charges,77% of total billed charges,12.41,100,,,fee schedule,100% of CMS fee schedule,53.62,350,,,fee schedule,350% of BCBS fee schedule,55.76,364,,,fee schedule,364% of BCBS fee schedule,55.76,364,,,fee schedule,364% of BCBS fee schedule,55.76,364,,,fee schedule,364% of BCBS fee schedule,55.8,90,,44.64,percent of total billed charges,90% of total billed charges,49.6,80,,39.68,percent of total billed charges,80% of total billed charges,55.8,90,,44.64,percent of total billed charges,90% of total billed charges,46.5,75,,37.2,percent of total billed charges,75% of total billed charges,15.14,122,,,fee schedule,122% of APC rate,17.98,29,,14.384,percent of total billed charges,29% of total billed charges,12.41,100,,,fee schedule,100% of CMS fee schedule,41.54,67,,33.232,percent of total billed charges,67% of total billed charges,18.45,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,49.6,80,,39.68,percent of total billed charges,80% of total billed charges,40.3,65,,32.24,percent of total billed charges,65% of total billed charges,22.12,35.67,,17.696,percent of total billed charges,35.67% of total billed charges,12.41,55.8,
AMIKACIN - TROUGH,3000600,CDM,300,RC,80150,HCPCS,outpatient,,,96,38.40,,81.6,85,,65.28,percent of total billed charges,85% of total billed charges,73.92,77,,59.14,percent of total billed charges,77% of total billed charges,15.08,100,,,fee schedule,100% of CMS fee schedule,65.14,350,,,fee schedule,350% of BCBS fee schedule,67.74,364,,,fee schedule,364% of BCBS fee schedule,67.74,364,,,fee schedule,364% of BCBS fee schedule,67.74,364,,,fee schedule,364% of BCBS fee schedule,86.4,90,,69.12,percent of total billed charges,90% of total billed charges,76.8,80,,61.44,percent of total billed charges,80% of total billed charges,86.4,90,,69.12,percent of total billed charges,90% of total billed charges,72,75,,57.6,percent of total billed charges,75% of total billed charges,18.39,122,,,fee schedule,122% of APC rate,27.84,29,,22.272,percent of total billed charges,29% of total billed charges,15.08,100,,,fee schedule,100% of CMS fee schedule,64.32,67,,51.456,percent of total billed charges,67% of total billed charges,22.41,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,76.8,80,,61.44,percent of total billed charges,80% of total billed charges,62.4,65,,49.92,percent of total billed charges,65% of total billed charges,34.24,35.67,,27.392,percent of total billed charges,35.67% of total billed charges,15.08,86.4,
AMIKACIN PEAK,3000620,CDM,300,RC,80150,HCPCS,outpatient,,,96,38.40,,81.6,85,,65.28,percent of total billed charges,85% of total billed charges,73.92,77,,59.14,percent of total billed charges,77% of total billed charges,15.08,100,,,fee schedule,100% of CMS fee schedule,65.14,350,,,fee schedule,350% of BCBS fee schedule,67.74,364,,,fee schedule,364% of BCBS fee schedule,67.74,364,,,fee schedule,364% of BCBS fee schedule,67.74,364,,,fee schedule,364% of BCBS fee schedule,86.4,90,,69.12,percent of total billed charges,90% of total billed charges,76.8,80,,61.44,percent of total billed charges,80% of total billed charges,86.4,90,,69.12,percent of total billed charges,90% of total billed charges,72,75,,57.6,percent of total billed charges,75% of total billed charges,18.39,122,,,fee schedule,122% of APC rate,27.84,29,,22.272,percent of total billed charges,29% of total billed charges,15.08,100,,,fee schedule,100% of CMS fee schedule,64.32,67,,51.456,percent of total billed charges,67% of total billed charges,22.41,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,76.8,80,,61.44,percent of total billed charges,80% of total billed charges,62.4,65,,49.92,percent of total billed charges,65% of total billed charges,34.24,35.67,,27.392,percent of total billed charges,35.67% of total billed charges,15.08,86.4,
AMINO ACID,3000640,CDM,300,RC,82128,HCPCS,outpatient,,,101,40.40,,85.85,85,,68.68,percent of total billed charges,85% of total billed charges,77.77,77,,62.22,percent of total billed charges,77% of total billed charges,13.87,100,,,fee schedule,100% of CMS fee schedule,59.96,350,,,fee schedule,350% of BCBS fee schedule,62.35,364,,,fee schedule,364% of BCBS fee schedule,62.35,364,,,fee schedule,364% of BCBS fee schedule,62.35,364,,,fee schedule,364% of BCBS fee schedule,90.9,90,,72.72,percent of total billed charges,90% of total billed charges,80.8,80,,64.64,percent of total billed charges,80% of total billed charges,90.9,90,,72.72,percent of total billed charges,90% of total billed charges,75.75,75,,60.6,percent of total billed charges,75% of total billed charges,16.92,122,,,fee schedule,122% of APC rate,29.29,29,,23.432,percent of total billed charges,29% of total billed charges,13.87,100,,,fee schedule,100% of CMS fee schedule,67.67,67,,54.136,percent of total billed charges,67% of total billed charges,16.03,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,80.8,80,,64.64,percent of total billed charges,80% of total billed charges,65.65,65,,52.52,percent of total billed charges,65% of total billed charges,36.03,35.67,,28.824,percent of total billed charges,35.67% of total billed charges,13.87,90.9,
AMIODARONE/CORDARONE LEVEL,3000645,CDM,300,RC,80151,HCPCS,outpatient,,,137,54.80,,116.45,85,,93.16,percent of total billed charges,85% of total billed charges,105.49,77,,84.39,percent of total billed charges,77% of total billed charges,18.64,100,,,fee schedule,100% of CMS fee schedule,65.24,350,,,fee schedule,350% of BCBS fee schedule,67.85,364,,,fee schedule,364% of BCBS fee schedule,67.85,364,,,fee schedule,364% of BCBS fee schedule,67.85,364,,,fee schedule,364% of BCBS fee schedule,123.3,90,,98.64,percent of total billed charges,90% of total billed charges,109.6,80,,87.68,percent of total billed charges,80% of total billed charges,123.3,90,,98.64,percent of total billed charges,90% of total billed charges,102.75,75,,82.2,percent of total billed charges,75% of total billed charges,22.74,122,,,fee schedule,122% of APC rate,39.73,29,,31.784,percent of total billed charges,29% of total billed charges,18.64,100,,,fee schedule,100% of CMS fee schedule,91.79,67,,73.432,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,109.6,80,,87.68,percent of total billed charges,80% of total billed charges,89.05,65,,71.24,percent of total billed charges,65% of total billed charges,48.87,35.67,,39.096,percent of total billed charges,35.67% of total billed charges,18.64,123.3,
AMITRIPTYLINE,3000650,CDM,300,RC,80335,HCPCS,outpatient,,,98,39.20,,83.3,85,,66.64,percent of total billed charges,85% of total billed charges,75.46,77,,60.37,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,80.36,82,,64.288,percent of total billed charges,82% of total billed charges,83.3,85,,66.64,percent of total billed charges,85% of total billed charges,83.3,85,,66.64,percent of total billed charges,85% of total billed charges,83.3,85,,66.64,percent of total billed charges,85% of total billed charges,88.2,90,,70.56,percent of total billed charges,90% of total billed charges,78.4,80,,62.72,percent of total billed charges,80% of total billed charges,88.2,90,,70.56,percent of total billed charges,90% of total billed charges,73.5,75,,58.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,28.42,29,,22.736,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,65.66,67,,52.528,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,78.4,80,,62.72,percent of total billed charges,80% of total billed charges,63.7,65,,50.96,percent of total billed charges,65% of total billed charges,34.96,35.67,,27.968,percent of total billed charges,35.67% of total billed charges,28.42,88.2,
AMMONIA,3000660,CDM,300,RC,82140,HCPCS,outpatient,,,128,51.20,,108.8,85,,87.04,percent of total billed charges,85% of total billed charges,98.56,77,,78.85,percent of total billed charges,77% of total billed charges,14.57,100,,,fee schedule,100% of CMS fee schedule,62.97,350,,,fee schedule,350% of BCBS fee schedule,65.48,364,,,fee schedule,364% of BCBS fee schedule,65.48,364,,,fee schedule,364% of BCBS fee schedule,65.48,364,,,fee schedule,364% of BCBS fee schedule,115.2,90,,92.16,percent of total billed charges,90% of total billed charges,102.4,80,,81.92,percent of total billed charges,80% of total billed charges,115.2,90,,92.16,percent of total billed charges,90% of total billed charges,96,75,,76.8,percent of total billed charges,75% of total billed charges,17.77,122,,,fee schedule,122% of APC rate,37.12,29,,29.696,percent of total billed charges,29% of total billed charges,14.57,100,,,fee schedule,100% of CMS fee schedule,85.76,67,,68.608,percent of total billed charges,67% of total billed charges,21.67,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,102.4,80,,81.92,percent of total billed charges,80% of total billed charges,83.2,65,,66.56,percent of total billed charges,65% of total billed charges,45.66,35.67,,36.528,percent of total billed charges,35.67% of total billed charges,14.57,115.2,
AMOXAPINE,3000680,CDM,300,RC,80299,HCPCS,outpatient,,,105,42.00,,89.25,85,,71.4,percent of total billed charges,85% of total billed charges,80.85,77,,64.68,percent of total billed charges,77% of total billed charges,18.64,100,,,fee schedule,100% of CMS fee schedule,65.24,350,,,fee schedule,350% of BCBS fee schedule,67.85,364,,,fee schedule,364% of BCBS fee schedule,67.85,364,,,fee schedule,364% of BCBS fee schedule,67.85,364,,,fee schedule,364% of BCBS fee schedule,94.5,90,,75.6,percent of total billed charges,90% of total billed charges,84,80,,67.2,percent of total billed charges,80% of total billed charges,94.5,90,,75.6,percent of total billed charges,90% of total billed charges,78.75,75,,63,percent of total billed charges,75% of total billed charges,22.74,122,,,fee schedule,122% of APC rate,30.45,29,,24.36,percent of total billed charges,29% of total billed charges,18.64,100,,,fee schedule,100% of CMS fee schedule,70.35,67,,56.28,percent of total billed charges,67% of total billed charges,20.36,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,84,80,,67.2,percent of total billed charges,80% of total billed charges,68.25,65,,54.6,percent of total billed charges,65% of total billed charges,37.45,35.67,,29.96,percent of total billed charges,35.67% of total billed charges,18.64,94.5,
AMOEBA HAI,3000685,CDM,300,RC,86280,HCPCS,outpatient,,,126,50.40,,107.1,85,,85.68,percent of total billed charges,85% of total billed charges,97.02,77,,77.62,percent of total billed charges,77% of total billed charges,8.19,100,,,fee schedule,100% of CMS fee schedule,35.42,350,,,fee schedule,350% of BCBS fee schedule,36.84,364,,,fee schedule,364% of BCBS fee schedule,36.84,364,,,fee schedule,364% of BCBS fee schedule,36.84,364,,,fee schedule,364% of BCBS fee schedule,113.4,90,,90.72,percent of total billed charges,90% of total billed charges,100.8,80,,80.64,percent of total billed charges,80% of total billed charges,113.4,90,,90.72,percent of total billed charges,90% of total billed charges,94.5,75,,75.6,percent of total billed charges,75% of total billed charges,9.99,122,,,fee schedule,122% of APC rate,36.54,29,,29.232,percent of total billed charges,29% of total billed charges,8.19,100,,,fee schedule,100% of CMS fee schedule,84.42,67,,67.536,percent of total billed charges,67% of total billed charges,12.18,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,100.8,80,,80.64,percent of total billed charges,80% of total billed charges,81.9,65,,65.52,percent of total billed charges,65% of total billed charges,44.94,35.67,,35.952,percent of total billed charges,35.67% of total billed charges,8.19,113.4,
AMYLASE,3000700,CDM,300,RC,82150,HCPCS,outpatient,,,78,31.20,,66.3,85,,53.04,percent of total billed charges,85% of total billed charges,60.06,77,,48.05,percent of total billed charges,77% of total billed charges,6.48,100,,,fee schedule,100% of CMS fee schedule,28,350,,,fee schedule,350% of BCBS fee schedule,29.12,364,,,fee schedule,364% of BCBS fee schedule,29.12,364,,,fee schedule,364% of BCBS fee schedule,29.12,364,,,fee schedule,364% of BCBS fee schedule,70.2,90,,56.16,percent of total billed charges,90% of total billed charges,62.4,80,,49.92,percent of total billed charges,80% of total billed charges,70.2,90,,56.16,percent of total billed charges,90% of total billed charges,58.5,75,,46.8,percent of total billed charges,75% of total billed charges,7.9,122,,,fee schedule,122% of APC rate,22.62,29,,18.096,percent of total billed charges,29% of total billed charges,6.48,100,,,fee schedule,100% of CMS fee schedule,52.26,67,,41.808,percent of total billed charges,67% of total billed charges,9.63,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,62.4,80,,49.92,percent of total billed charges,80% of total billed charges,50.7,65,,40.56,percent of total billed charges,65% of total billed charges,27.82,35.67,,22.256,percent of total billed charges,35.67% of total billed charges,6.48,70.2,
AMYLASE URINE 24 HRS,3000710,CDM,300,RC,82150,HCPCS,outpatient,,,77,30.80,,65.45,85,,52.36,percent of total billed charges,85% of total billed charges,59.29,77,,47.43,percent of total billed charges,77% of total billed charges,6.48,100,,,fee schedule,100% of CMS fee schedule,28,350,,,fee schedule,350% of BCBS fee schedule,29.12,364,,,fee schedule,364% of BCBS fee schedule,29.12,364,,,fee schedule,364% of BCBS fee schedule,29.12,364,,,fee schedule,364% of BCBS fee schedule,69.3,90,,55.44,percent of total billed charges,90% of total billed charges,61.6,80,,49.28,percent of total billed charges,80% of total billed charges,69.3,90,,55.44,percent of total billed charges,90% of total billed charges,57.75,75,,46.2,percent of total billed charges,75% of total billed charges,7.9,122,,,fee schedule,122% of APC rate,22.33,29,,17.864,percent of total billed charges,29% of total billed charges,6.48,100,,,fee schedule,100% of CMS fee schedule,51.59,67,,41.272,percent of total billed charges,67% of total billed charges,9.63,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,61.6,80,,49.28,percent of total billed charges,80% of total billed charges,50.05,65,,40.04,percent of total billed charges,65% of total billed charges,27.47,35.67,,21.976,percent of total billed charges,35.67% of total billed charges,6.48,69.3,
AMYLASE PERITONEAL FLD,3000760,CDM,300,RC,82150,HCPCS,outpatient,,,77,30.80,,65.45,85,,52.36,percent of total billed charges,85% of total billed charges,59.29,77,,47.43,percent of total billed charges,77% of total billed charges,6.48,100,,,fee schedule,100% of CMS fee schedule,28,350,,,fee schedule,350% of BCBS fee schedule,29.12,364,,,fee schedule,364% of BCBS fee schedule,29.12,364,,,fee schedule,364% of BCBS fee schedule,29.12,364,,,fee schedule,364% of BCBS fee schedule,69.3,90,,55.44,percent of total billed charges,90% of total billed charges,61.6,80,,49.28,percent of total billed charges,80% of total billed charges,69.3,90,,55.44,percent of total billed charges,90% of total billed charges,57.75,75,,46.2,percent of total billed charges,75% of total billed charges,7.9,122,,,fee schedule,122% of APC rate,22.33,29,,17.864,percent of total billed charges,29% of total billed charges,6.48,100,,,fee schedule,100% of CMS fee schedule,51.59,67,,41.272,percent of total billed charges,67% of total billed charges,9.63,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,61.6,80,,49.28,percent of total billed charges,80% of total billed charges,50.05,65,,40.04,percent of total billed charges,65% of total billed charges,27.47,35.67,,21.976,percent of total billed charges,35.67% of total billed charges,6.48,69.3,
AMYLASE PLEURAL FLD,3000780,CDM,300,RC,82150,HCPCS,outpatient,,,77,30.80,,65.45,85,,52.36,percent of total billed charges,85% of total billed charges,59.29,77,,47.43,percent of total billed charges,77% of total billed charges,6.48,100,,,fee schedule,100% of CMS fee schedule,28,350,,,fee schedule,350% of BCBS fee schedule,29.12,364,,,fee schedule,364% of BCBS fee schedule,29.12,364,,,fee schedule,364% of BCBS fee schedule,29.12,364,,,fee schedule,364% of BCBS fee schedule,69.3,90,,55.44,percent of total billed charges,90% of total billed charges,61.6,80,,49.28,percent of total billed charges,80% of total billed charges,69.3,90,,55.44,percent of total billed charges,90% of total billed charges,57.75,75,,46.2,percent of total billed charges,75% of total billed charges,7.9,122,,,fee schedule,122% of APC rate,22.33,29,,17.864,percent of total billed charges,29% of total billed charges,6.48,100,,,fee schedule,100% of CMS fee schedule,51.59,67,,41.272,percent of total billed charges,67% of total billed charges,9.63,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,61.6,80,,49.28,percent of total billed charges,80% of total billed charges,50.05,65,,40.04,percent of total billed charges,65% of total billed charges,27.47,35.67,,21.976,percent of total billed charges,35.67% of total billed charges,6.48,69.3,
AMYLASE SYNOVIAL FLD,3000800,CDM,300,RC,82150,HCPCS,outpatient,,,77,30.80,,65.45,85,,52.36,percent of total billed charges,85% of total billed charges,59.29,77,,47.43,percent of total billed charges,77% of total billed charges,6.48,100,,,fee schedule,100% of CMS fee schedule,28,350,,,fee schedule,350% of BCBS fee schedule,29.12,364,,,fee schedule,364% of BCBS fee schedule,29.12,364,,,fee schedule,364% of BCBS fee schedule,29.12,364,,,fee schedule,364% of BCBS fee schedule,69.3,90,,55.44,percent of total billed charges,90% of total billed charges,61.6,80,,49.28,percent of total billed charges,80% of total billed charges,69.3,90,,55.44,percent of total billed charges,90% of total billed charges,57.75,75,,46.2,percent of total billed charges,75% of total billed charges,7.9,122,,,fee schedule,122% of APC rate,22.33,29,,17.864,percent of total billed charges,29% of total billed charges,6.48,100,,,fee schedule,100% of CMS fee schedule,51.59,67,,41.272,percent of total billed charges,67% of total billed charges,9.63,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,61.6,80,,49.28,percent of total billed charges,80% of total billed charges,50.05,65,,40.04,percent of total billed charges,65% of total billed charges,27.47,35.67,,21.976,percent of total billed charges,35.67% of total billed charges,6.48,69.3,
AMYLASE URINE 24 HOUR,3000820,CDM,300,RC,82150,HCPCS,outpatient,,,77,30.80,,65.45,85,,52.36,percent of total billed charges,85% of total billed charges,59.29,77,,47.43,percent of total billed charges,77% of total billed charges,6.48,100,,,fee schedule,100% of CMS fee schedule,28,350,,,fee schedule,350% of BCBS fee schedule,29.12,364,,,fee schedule,364% of BCBS fee schedule,29.12,364,,,fee schedule,364% of BCBS fee schedule,29.12,364,,,fee schedule,364% of BCBS fee schedule,69.3,90,,55.44,percent of total billed charges,90% of total billed charges,61.6,80,,49.28,percent of total billed charges,80% of total billed charges,69.3,90,,55.44,percent of total billed charges,90% of total billed charges,57.75,75,,46.2,percent of total billed charges,75% of total billed charges,7.9,122,,,fee schedule,122% of APC rate,22.33,29,,17.864,percent of total billed charges,29% of total billed charges,6.48,100,,,fee schedule,100% of CMS fee schedule,51.59,67,,41.272,percent of total billed charges,67% of total billed charges,9.63,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,61.6,80,,49.28,percent of total billed charges,80% of total billed charges,50.05,65,,40.04,percent of total billed charges,65% of total billed charges,27.47,35.67,,21.976,percent of total billed charges,35.67% of total billed charges,6.48,69.3,
ANAEROBIC CULT,3000865,CDM,300,RC,87075,HCPCS,outpatient,,,152,60.80,,129.2,85,,103.36,percent of total billed charges,85% of total billed charges,117.04,77,,93.63,percent of total billed charges,77% of total billed charges,9.47,100,,,fee schedule,100% of CMS fee schedule,40.92,350,,,fee schedule,350% of BCBS fee schedule,42.55,364,,,fee schedule,364% of BCBS fee schedule,42.55,364,,,fee schedule,364% of BCBS fee schedule,42.55,364,,,fee schedule,364% of BCBS fee schedule,136.8,90,,109.44,percent of total billed charges,90% of total billed charges,121.6,80,,97.28,percent of total billed charges,80% of total billed charges,136.8,90,,109.44,percent of total billed charges,90% of total billed charges,114,75,,91.2,percent of total billed charges,75% of total billed charges,11.55,122,,,fee schedule,122% of APC rate,44.08,29,,35.264,percent of total billed charges,29% of total billed charges,9.47,100,,,fee schedule,100% of CMS fee schedule,101.84,67,,81.472,percent of total billed charges,67% of total billed charges,14.07,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,121.6,80,,97.28,percent of total billed charges,80% of total billed charges,98.8,65,,79.04,percent of total billed charges,65% of total billed charges,54.22,35.67,,43.376,percent of total billed charges,35.67% of total billed charges,9.47,136.8,
ANDROSTENEDIONE/ANDROGEN,3000880,CDM,300,RC,82157,HCPCS,outpatient,,,144,57.60,,122.4,85,,97.92,percent of total billed charges,85% of total billed charges,110.88,77,,88.7,percent of total billed charges,77% of total billed charges,29.28,100,,,fee schedule,100% of CMS fee schedule,126.49,350,,,fee schedule,350% of BCBS fee schedule,131.55,364,,,fee schedule,364% of BCBS fee schedule,131.55,364,,,fee schedule,364% of BCBS fee schedule,131.55,364,,,fee schedule,364% of BCBS fee schedule,129.6,90,,103.68,percent of total billed charges,90% of total billed charges,115.2,80,,92.16,percent of total billed charges,80% of total billed charges,129.6,90,,103.68,percent of total billed charges,90% of total billed charges,108,75,,86.4,percent of total billed charges,75% of total billed charges,35.72,122,,,fee schedule,122% of APC rate,41.76,29,,33.408,percent of total billed charges,29% of total billed charges,29.28,100,,,fee schedule,100% of CMS fee schedule,96.48,67,,77.184,percent of total billed charges,67% of total billed charges,43.53,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,115.2,80,,92.16,percent of total billed charges,80% of total billed charges,93.6,65,,74.88,percent of total billed charges,65% of total billed charges,51.36,35.67,,41.088,percent of total billed charges,35.67% of total billed charges,29.28,131.55,
ANGIOTENSIN CONVERTING EN,3000900,CDM,300,RC,82164,HCPCS,outpatient,,,95,38.00,,80.75,85,,64.6,percent of total billed charges,85% of total billed charges,73.15,77,,58.52,percent of total billed charges,77% of total billed charges,14.6,100,,,fee schedule,100% of CMS fee schedule,63.11,350,,,fee schedule,350% of BCBS fee schedule,65.63,364,,,fee schedule,364% of BCBS fee schedule,65.63,364,,,fee schedule,364% of BCBS fee schedule,65.63,364,,,fee schedule,364% of BCBS fee schedule,85.5,90,,68.4,percent of total billed charges,90% of total billed charges,76,80,,60.8,percent of total billed charges,80% of total billed charges,85.5,90,,68.4,percent of total billed charges,90% of total billed charges,71.25,75,,57,percent of total billed charges,75% of total billed charges,17.81,122,,,fee schedule,122% of APC rate,27.55,29,,22.04,percent of total billed charges,29% of total billed charges,14.6,100,,,fee schedule,100% of CMS fee schedule,63.65,67,,50.92,percent of total billed charges,67% of total billed charges,21.71,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,76,80,,60.8,percent of total billed charges,80% of total billed charges,61.75,65,,49.4,percent of total billed charges,65% of total billed charges,33.89,35.67,,27.112,percent of total billed charges,35.67% of total billed charges,14.6,85.5,
ANTINEUROPHIL CYTO AUTOANTIBOD,3000945,CDM,300,RC,,,outpatient,,,120,48.00,,102,85,,81.6,percent of total billed charges,85% of total billed charges,92.4,77,,73.92,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,98.4,82,,78.72,percent of total billed charges,82% of total billed charges,102,85,,81.6,percent of total billed charges,85% of total billed charges,102,85,,81.6,percent of total billed charges,85% of total billed charges,102,85,,81.6,percent of total billed charges,85% of total billed charges,108,90,,86.4,percent of total billed charges,90% of total billed charges,96,80,,76.8,percent of total billed charges,80% of total billed charges,108,90,,86.4,percent of total billed charges,90% of total billed charges,90,75,,72,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,34.8,29,,27.84,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,80.4,67,,64.32,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,96,80,,76.8,percent of total billed charges,80% of total billed charges,78,65,,62.4,percent of total billed charges,65% of total billed charges,42.8,35.67,,34.24,percent of total billed charges,35.67% of total billed charges,34.8,108,
ANTI DNA AB SINGLE STRAND,3000960,CDM,300,RC,86226,HCPCS,outpatient,,,129,51.60,,109.65,85,,87.72,percent of total billed charges,85% of total billed charges,99.33,77,,79.46,percent of total billed charges,77% of total billed charges,12.11,100,,,fee schedule,100% of CMS fee schedule,52.33,350,,,fee schedule,350% of BCBS fee schedule,54.42,364,,,fee schedule,364% of BCBS fee schedule,54.42,364,,,fee schedule,364% of BCBS fee schedule,54.42,364,,,fee schedule,364% of BCBS fee schedule,116.1,90,,92.88,percent of total billed charges,90% of total billed charges,103.2,80,,82.56,percent of total billed charges,80% of total billed charges,116.1,90,,92.88,percent of total billed charges,90% of total billed charges,96.75,75,,77.4,percent of total billed charges,75% of total billed charges,14.77,122,,,fee schedule,122% of APC rate,37.41,29,,29.928,percent of total billed charges,29% of total billed charges,12.11,100,,,fee schedule,100% of CMS fee schedule,86.43,67,,69.144,percent of total billed charges,67% of total billed charges,18,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,103.2,80,,82.56,percent of total billed charges,80% of total billed charges,83.85,65,,67.08,percent of total billed charges,65% of total billed charges,46.01,35.67,,36.808,percent of total billed charges,35.67% of total billed charges,12.11,116.1,
ANTI ENA ANTIBODIES/SMITH AB,3000980,CDM,300,RC,86235,HCPCS,outpatient,,,113,45.20,,96.05,85,,76.84,percent of total billed charges,85% of total billed charges,87.01,77,,69.61,percent of total billed charges,77% of total billed charges,17.93,100,,,fee schedule,100% of CMS fee schedule,77.49,350,,,fee schedule,350% of BCBS fee schedule,80.59,364,,,fee schedule,364% of BCBS fee schedule,80.59,364,,,fee schedule,364% of BCBS fee schedule,80.59,364,,,fee schedule,364% of BCBS fee schedule,101.7,90,,81.36,percent of total billed charges,90% of total billed charges,90.4,80,,72.32,percent of total billed charges,80% of total billed charges,101.7,90,,81.36,percent of total billed charges,90% of total billed charges,84.75,75,,67.8,percent of total billed charges,75% of total billed charges,21.87,122,,,fee schedule,122% of APC rate,32.77,29,,26.216,percent of total billed charges,29% of total billed charges,17.93,100,,,fee schedule,100% of CMS fee schedule,75.71,67,,60.568,percent of total billed charges,67% of total billed charges,26.67,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,90.4,80,,72.32,percent of total billed charges,80% of total billed charges,73.45,65,,58.76,percent of total billed charges,65% of total billed charges,40.31,35.67,,32.248,percent of total billed charges,35.67% of total billed charges,17.93,101.7,
ANTI GLOM BASEMENT AB,3001000,CDM,300,RC,83520,HCPCS,outpatient,,,152,60.80,,129.2,85,,103.36,percent of total billed charges,85% of total billed charges,117.04,77,,93.63,percent of total billed charges,77% of total billed charges,17.27,100,,,fee schedule,100% of CMS fee schedule,60.45,350,,,fee schedule,350% of BCBS fee schedule,62.86,364,,,fee schedule,364% of BCBS fee schedule,62.86,364,,,fee schedule,364% of BCBS fee schedule,62.86,364,,,fee schedule,364% of BCBS fee schedule,136.8,90,,109.44,percent of total billed charges,90% of total billed charges,121.6,80,,97.28,percent of total billed charges,80% of total billed charges,136.8,90,,109.44,percent of total billed charges,90% of total billed charges,114,75,,91.2,percent of total billed charges,75% of total billed charges,21.06,122,,,fee schedule,122% of APC rate,44.08,29,,35.264,percent of total billed charges,29% of total billed charges,17.27,100,,,fee schedule,100% of CMS fee schedule,101.84,67,,81.472,percent of total billed charges,67% of total billed charges,19.25,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,121.6,80,,97.28,percent of total billed charges,80% of total billed charges,98.8,65,,79.04,percent of total billed charges,65% of total billed charges,54.22,35.67,,43.376,percent of total billed charges,35.67% of total billed charges,17.27,136.8,
ANTIGIADIN ANTIBODIES II,3001017,CDM,300,RC,83520,HCPCS,outpatient,,,155,62.00,,131.75,85,,105.4,percent of total billed charges,85% of total billed charges,119.35,77,,95.48,percent of total billed charges,77% of total billed charges,17.27,100,,,fee schedule,100% of CMS fee schedule,60.45,350,,,fee schedule,350% of BCBS fee schedule,62.86,364,,,fee schedule,364% of BCBS fee schedule,62.86,364,,,fee schedule,364% of BCBS fee schedule,62.86,364,,,fee schedule,364% of BCBS fee schedule,139.5,90,,111.6,percent of total billed charges,90% of total billed charges,124,80,,99.2,percent of total billed charges,80% of total billed charges,139.5,90,,111.6,percent of total billed charges,90% of total billed charges,116.25,75,,93,percent of total billed charges,75% of total billed charges,21.06,122,,,fee schedule,122% of APC rate,44.95,29,,35.96,percent of total billed charges,29% of total billed charges,17.27,100,,,fee schedule,100% of CMS fee schedule,103.85,67,,83.08,percent of total billed charges,67% of total billed charges,19.25,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,124,80,,99.2,percent of total billed charges,80% of total billed charges,100.75,65,,80.6,percent of total billed charges,65% of total billed charges,55.29,35.67,,44.232,percent of total billed charges,35.67% of total billed charges,17.27,139.5,
ANTIGIADIN ANTIBODIES,3001018,CDM,300,RC,83520,HCPCS,outpatient,,,155,62.00,,131.75,85,,105.4,percent of total billed charges,85% of total billed charges,119.35,77,,95.48,percent of total billed charges,77% of total billed charges,17.27,100,,,fee schedule,100% of CMS fee schedule,60.45,350,,,fee schedule,350% of BCBS fee schedule,62.86,364,,,fee schedule,364% of BCBS fee schedule,62.86,364,,,fee schedule,364% of BCBS fee schedule,62.86,364,,,fee schedule,364% of BCBS fee schedule,139.5,90,,111.6,percent of total billed charges,90% of total billed charges,124,80,,99.2,percent of total billed charges,80% of total billed charges,139.5,90,,111.6,percent of total billed charges,90% of total billed charges,116.25,75,,93,percent of total billed charges,75% of total billed charges,21.06,122,,,fee schedule,122% of APC rate,44.95,29,,35.96,percent of total billed charges,29% of total billed charges,17.27,100,,,fee schedule,100% of CMS fee schedule,103.85,67,,83.08,percent of total billed charges,67% of total billed charges,19.25,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,124,80,,99.2,percent of total billed charges,80% of total billed charges,100.75,65,,80.6,percent of total billed charges,65% of total billed charges,55.29,35.67,,44.232,percent of total billed charges,35.67% of total billed charges,17.27,139.5,
ANTIGIADIN ANTIBODIES/PANEL,3001019,CDM,300,RC,83520,HCPCS,outpatient,,,152,60.80,,129.2,85,,103.36,percent of total billed charges,85% of total billed charges,117.04,77,,93.63,percent of total billed charges,77% of total billed charges,17.27,100,,,fee schedule,100% of CMS fee schedule,60.45,350,,,fee schedule,350% of BCBS fee schedule,62.86,364,,,fee schedule,364% of BCBS fee schedule,62.86,364,,,fee schedule,364% of BCBS fee schedule,62.86,364,,,fee schedule,364% of BCBS fee schedule,136.8,90,,109.44,percent of total billed charges,90% of total billed charges,121.6,80,,97.28,percent of total billed charges,80% of total billed charges,136.8,90,,109.44,percent of total billed charges,90% of total billed charges,114,75,,91.2,percent of total billed charges,75% of total billed charges,21.06,122,,,fee schedule,122% of APC rate,44.08,29,,35.264,percent of total billed charges,29% of total billed charges,17.27,100,,,fee schedule,100% of CMS fee schedule,101.84,67,,81.472,percent of total billed charges,67% of total billed charges,19.25,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,121.6,80,,97.28,percent of total billed charges,80% of total billed charges,98.8,65,,79.04,percent of total billed charges,65% of total billed charges,54.22,35.67,,43.376,percent of total billed charges,35.67% of total billed charges,17.27,136.8,
ANTI HIV-1 ANTIGEN,3001020,CDM,300,RC,87389,HCPCS,outpatient,,,131,52.40,,111.35,85,,89.08,percent of total billed charges,85% of total billed charges,100.87,77,,80.7,percent of total billed charges,77% of total billed charges,24.08,100,,,fee schedule,100% of CMS fee schedule,104.06,350,,,fee schedule,350% of BCBS fee schedule,108.22,364,,,fee schedule,364% of BCBS fee schedule,108.22,364,,,fee schedule,364% of BCBS fee schedule,108.22,364,,,fee schedule,364% of BCBS fee schedule,117.9,90,,94.32,percent of total billed charges,90% of total billed charges,104.8,80,,83.84,percent of total billed charges,80% of total billed charges,117.9,90,,94.32,percent of total billed charges,90% of total billed charges,98.25,75,,78.6,percent of total billed charges,75% of total billed charges,29.37,122,,,fee schedule,122% of APC rate,37.99,29,,30.392,percent of total billed charges,29% of total billed charges,24.08,100,,,fee schedule,100% of CMS fee schedule,87.77,67,,70.216,percent of total billed charges,67% of total billed charges,35.82,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,104.8,80,,83.84,percent of total billed charges,80% of total billed charges,85.15,65,,68.12,percent of total billed charges,65% of total billed charges,46.73,35.67,,37.384,percent of total billed charges,35.67% of total billed charges,24.08,117.9,
ANTI MITOCHONDRIAL AB,3001040,CDM,300,RC,86256,HCPCS,outpatient,,,115,46.00,,97.75,85,,78.2,percent of total billed charges,85% of total billed charges,88.55,77,,70.84,percent of total billed charges,77% of total billed charges,12.05,100,,,fee schedule,100% of CMS fee schedule,52.08,350,,,fee schedule,350% of BCBS fee schedule,54.16,364,,,fee schedule,364% of BCBS fee schedule,54.16,364,,,fee schedule,364% of BCBS fee schedule,54.16,364,,,fee schedule,364% of BCBS fee schedule,103.5,90,,82.8,percent of total billed charges,90% of total billed charges,92,80,,73.6,percent of total billed charges,80% of total billed charges,103.5,90,,82.8,percent of total billed charges,90% of total billed charges,86.25,75,,69,percent of total billed charges,75% of total billed charges,14.7,122,,,fee schedule,122% of APC rate,33.35,29,,26.68,percent of total billed charges,29% of total billed charges,12.05,100,,,fee schedule,100% of CMS fee schedule,77.05,67,,61.64,percent of total billed charges,67% of total billed charges,17.92,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,92,80,,73.6,percent of total billed charges,80% of total billed charges,74.75,65,,59.8,percent of total billed charges,65% of total billed charges,41.02,35.67,,32.816,percent of total billed charges,35.67% of total billed charges,12.05,103.5,
ANTINEUTROPHILIC CYTO. ANTIBDY,3001050,CDM,300,RC,,,outpatient,,,120,48.00,,102,85,,81.6,percent of total billed charges,85% of total billed charges,92.4,77,,73.92,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,98.4,82,,78.72,percent of total billed charges,82% of total billed charges,102,85,,81.6,percent of total billed charges,85% of total billed charges,102,85,,81.6,percent of total billed charges,85% of total billed charges,102,85,,81.6,percent of total billed charges,85% of total billed charges,108,90,,86.4,percent of total billed charges,90% of total billed charges,96,80,,76.8,percent of total billed charges,80% of total billed charges,108,90,,86.4,percent of total billed charges,90% of total billed charges,90,75,,72,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,34.8,29,,27.84,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,80.4,67,,64.32,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,96,80,,76.8,percent of total billed charges,80% of total billed charges,78,65,,62.4,percent of total billed charges,65% of total billed charges,42.8,35.67,,34.24,percent of total billed charges,35.67% of total billed charges,34.8,108,
ANTI PLATELET ANTIBODY,3001055,CDM,300,RC,86023,HCPCS,outpatient,,,372,148.80,,316.2,85,,252.96,percent of total billed charges,85% of total billed charges,286.44,77,,229.15,percent of total billed charges,77% of total billed charges,12.46,100,,,fee schedule,100% of CMS fee schedule,53.83,350,,,fee schedule,350% of BCBS fee schedule,55.98,364,,,fee schedule,364% of BCBS fee schedule,55.98,364,,,fee schedule,364% of BCBS fee schedule,55.98,364,,,fee schedule,364% of BCBS fee schedule,334.8,90,,267.84,percent of total billed charges,90% of total billed charges,297.6,80,,238.08,percent of total billed charges,80% of total billed charges,334.8,90,,267.84,percent of total billed charges,90% of total billed charges,279,75,,223.2,percent of total billed charges,75% of total billed charges,15.2,122,,,fee schedule,122% of APC rate,107.88,29,,86.304,percent of total billed charges,29% of total billed charges,12.46,100,,,fee schedule,100% of CMS fee schedule,249.24,67,,199.392,percent of total billed charges,67% of total billed charges,18.52,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,297.6,80,,238.08,percent of total billed charges,80% of total billed charges,241.8,65,,193.44,percent of total billed charges,65% of total billed charges,132.69,35.67,,106.152,percent of total billed charges,35.67% of total billed charges,12.46,334.8,
ANTI SJOGREN'S,3001060,CDM,300,RC,86320,HCPCS,outpatient,,,202,80.80,,171.7,85,,137.36,percent of total billed charges,85% of total billed charges,155.54,77,,124.43,percent of total billed charges,77% of total billed charges,29.92,100,,,fee schedule,100% of CMS fee schedule,104.72,350,,,fee schedule,350% of BCBS fee schedule,108.91,364,,,fee schedule,364% of BCBS fee schedule,108.91,364,,,fee schedule,364% of BCBS fee schedule,108.91,364,,,fee schedule,364% of BCBS fee schedule,181.8,90,,145.44,percent of total billed charges,90% of total billed charges,161.6,80,,129.28,percent of total billed charges,80% of total billed charges,181.8,90,,145.44,percent of total billed charges,90% of total billed charges,151.5,75,,121.2,percent of total billed charges,75% of total billed charges,36.5,122,,,fee schedule,122% of APC rate,58.58,29,,46.864,percent of total billed charges,29% of total billed charges,29.92,100,,,fee schedule,100% of CMS fee schedule,135.34,67,,108.272,percent of total billed charges,67% of total billed charges,33.33,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,161.6,80,,129.28,percent of total billed charges,80% of total billed charges,131.3,65,,105.04,percent of total billed charges,65% of total billed charges,72.05,35.67,,57.64,percent of total billed charges,35.67% of total billed charges,29.92,181.8,
ANTI SMOOTH MUSCLE AB,3001080,CDM,300,RC,86256,HCPCS,outpatient,,,115,46.00,,97.75,85,,78.2,percent of total billed charges,85% of total billed charges,88.55,77,,70.84,percent of total billed charges,77% of total billed charges,12.05,100,,,fee schedule,100% of CMS fee schedule,52.08,350,,,fee schedule,350% of BCBS fee schedule,54.16,364,,,fee schedule,364% of BCBS fee schedule,54.16,364,,,fee schedule,364% of BCBS fee schedule,54.16,364,,,fee schedule,364% of BCBS fee schedule,103.5,90,,82.8,percent of total billed charges,90% of total billed charges,92,80,,73.6,percent of total billed charges,80% of total billed charges,103.5,90,,82.8,percent of total billed charges,90% of total billed charges,86.25,75,,69,percent of total billed charges,75% of total billed charges,14.7,122,,,fee schedule,122% of APC rate,33.35,29,,26.68,percent of total billed charges,29% of total billed charges,12.05,100,,,fee schedule,100% of CMS fee schedule,77.05,67,,61.64,percent of total billed charges,67% of total billed charges,17.92,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,92,80,,73.6,percent of total billed charges,80% of total billed charges,74.75,65,,59.8,percent of total billed charges,65% of total billed charges,41.02,35.67,,32.816,percent of total billed charges,35.67% of total billed charges,12.05,103.5,
ANTI THYROID ANTIBODY,3001100,CDM,300,RC,86376,HCPCS,outpatient,,,101,40.40,,85.85,85,,68.68,percent of total billed charges,85% of total billed charges,77.77,77,,62.22,percent of total billed charges,77% of total billed charges,14.55,100,,,fee schedule,100% of CMS fee schedule,62.86,350,,,fee schedule,350% of BCBS fee schedule,65.37,364,,,fee schedule,364% of BCBS fee schedule,65.37,364,,,fee schedule,364% of BCBS fee schedule,65.37,364,,,fee schedule,364% of BCBS fee schedule,90.9,90,,72.72,percent of total billed charges,90% of total billed charges,80.8,80,,64.64,percent of total billed charges,80% of total billed charges,90.9,90,,72.72,percent of total billed charges,90% of total billed charges,75.75,75,,60.6,percent of total billed charges,75% of total billed charges,17.75,122,,,fee schedule,122% of APC rate,29.29,29,,23.432,percent of total billed charges,29% of total billed charges,14.55,100,,,fee schedule,100% of CMS fee schedule,67.67,67,,54.136,percent of total billed charges,67% of total billed charges,21.64,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,80.8,80,,64.64,percent of total billed charges,80% of total billed charges,65.65,65,,52.52,percent of total billed charges,65% of total billed charges,36.03,35.67,,28.824,percent of total billed charges,35.67% of total billed charges,14.55,90.9,
ANTIBODY ELUTION (RBC): EACH,3001111,CDM,300,RC,86860,HCPCS,outpatient,,,495,198.00,,420.75,85,,336.6,percent of total billed charges,85% of total billed charges,381.15,77,,304.92,percent of total billed charges,77% of total billed charges,149.37,100,,,fee schedule,100% of CMS OPPS rate,452.13,350,,,fee schedule,350% of BCBS fee schedule,470.22,364,,,fee schedule,364% of BCBS fee schedule,470.22,364,,,fee schedule,364% of BCBS fee schedule,470.22,364,,,fee schedule,364% of BCBS fee schedule,445.5,90,,356.4,percent of total billed charges,90% of total billed charges,396,80,,316.8,percent of total billed charges,80% of total billed charges,445.5,90,,356.4,percent of total billed charges,90% of total billed charges,371.25,75,,297,percent of total billed charges,75% of total billed charges,182.23,122,,,fee schedule,122% of APC rate,143.55,29,,114.84,percent of total billed charges,29% of total billed charges,149.37,100,,,fee schedule,100% of CMS OPPS rate,331.65,67,,265.32,percent of total billed charges,67% of total billed charges,23.18,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,396,80,,316.8,percent of total billed charges,80% of total billed charges,321.75,65,,257.4,percent of total billed charges,65% of total billed charges,176.57,35.67,,141.256,percent of total billed charges,35.67% of total billed charges,23.18,470.22,
ANTIBODY IDENTIFICATION RBC EA,3001112,CDM,300,RC,86870,HCPCS,outpatient,,,826,330.40,,702.1,85,,561.68,percent of total billed charges,85% of total billed charges,636.02,77,,508.82,percent of total billed charges,77% of total billed charges,314.34,100,,,fee schedule,100% of CMS OPPS rate,754.01,350,,,fee schedule,350% of BCBS fee schedule,784.17,364,,,fee schedule,364% of BCBS fee schedule,784.17,364,,,fee schedule,364% of BCBS fee schedule,784.17,364,,,fee schedule,364% of BCBS fee schedule,743.4,90,,594.72,percent of total billed charges,90% of total billed charges,660.8,80,,528.64,percent of total billed charges,80% of total billed charges,743.4,90,,594.72,percent of total billed charges,90% of total billed charges,619.5,75,,495.6,percent of total billed charges,75% of total billed charges,383.5,122,,,fee schedule,122% of APC rate,239.54,29,,191.632,percent of total billed charges,29% of total billed charges,314.34,100,,,fee schedule,100% of CMS OPPS rate,553.42,67,,442.736,percent of total billed charges,67% of total billed charges,23.18,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,660.8,80,,528.64,percent of total billed charges,80% of total billed charges,536.9,65,,429.52,percent of total billed charges,65% of total billed charges,294.63,35.67,,235.704,percent of total billed charges,35.67% of total billed charges,23.18,784.17,
ANTIBODY SCREENING,3001120,CDM,300,RC,86850,HCPCS,outpatient,,,181,72.40,,153.85,85,,123.08,percent of total billed charges,85% of total billed charges,139.37,77,,111.5,percent of total billed charges,77% of total billed charges,47.38,100,,,fee schedule,100% of CMS OPPS rate,156.45,350,,,fee schedule,350% of BCBS fee schedule,162.71,364,,,fee schedule,364% of BCBS fee schedule,162.71,364,,,fee schedule,364% of BCBS fee schedule,162.71,364,,,fee schedule,364% of BCBS fee schedule,162.9,90,,130.32,percent of total billed charges,90% of total billed charges,144.8,80,,115.84,percent of total billed charges,80% of total billed charges,162.9,90,,130.32,percent of total billed charges,90% of total billed charges,135.75,75,,108.6,percent of total billed charges,75% of total billed charges,57.81,122,,,fee schedule,122% of APC rate,52.49,29,,41.992,percent of total billed charges,29% of total billed charges,47.38,100,,,fee schedule,100% of CMS OPPS rate,121.27,67,,97.016,percent of total billed charges,67% of total billed charges,13.91,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,144.8,80,,115.84,percent of total billed charges,80% of total billed charges,117.65,65,,94.12,percent of total billed charges,65% of total billed charges,64.56,35.67,,51.648,percent of total billed charges,35.67% of total billed charges,13.91,162.9,
ANTIBODY CONSULTATION,3001140,CDM,300,RC,86885,HCPCS,outpatient,,,495,198.00,,420.75,85,,336.6,percent of total billed charges,85% of total billed charges,381.15,77,,304.92,percent of total billed charges,77% of total billed charges,149.37,100,,,fee schedule,100% of CMS OPPS rate,452.13,350,,,fee schedule,350% of BCBS fee schedule,470.22,364,,,fee schedule,364% of BCBS fee schedule,470.22,364,,,fee schedule,364% of BCBS fee schedule,470.22,364,,,fee schedule,364% of BCBS fee schedule,445.5,90,,356.4,percent of total billed charges,90% of total billed charges,396,80,,316.8,percent of total billed charges,80% of total billed charges,445.5,90,,356.4,percent of total billed charges,90% of total billed charges,371.25,75,,297,percent of total billed charges,75% of total billed charges,182.23,122,,,fee schedule,122% of APC rate,143.55,29,,114.84,percent of total billed charges,29% of total billed charges,149.37,100,,,fee schedule,100% of CMS OPPS rate,331.65,67,,265.32,percent of total billed charges,67% of total billed charges,7.17,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,396,80,,316.8,percent of total billed charges,80% of total billed charges,321.75,65,,257.4,percent of total billed charges,65% of total billed charges,176.57,35.67,,141.256,percent of total billed charges,35.67% of total billed charges,7.17,470.22,
ANTIDIURETIC HORMONE,3001160,CDM,300,RC,84588,HCPCS,outpatient,,,218,87.20,,185.3,85,,148.24,percent of total billed charges,85% of total billed charges,167.86,77,,134.29,percent of total billed charges,77% of total billed charges,33.94,100,,,fee schedule,100% of CMS fee schedule,146.65,350,,,fee schedule,350% of BCBS fee schedule,152.52,364,,,fee schedule,364% of BCBS fee schedule,152.52,364,,,fee schedule,364% of BCBS fee schedule,152.52,364,,,fee schedule,364% of BCBS fee schedule,196.2,90,,156.96,percent of total billed charges,90% of total billed charges,174.4,80,,139.52,percent of total billed charges,80% of total billed charges,196.2,90,,156.96,percent of total billed charges,90% of total billed charges,163.5,75,,130.8,percent of total billed charges,75% of total billed charges,41.4,122,,,fee schedule,122% of APC rate,63.22,29,,50.576,percent of total billed charges,29% of total billed charges,33.94,100,,,fee schedule,100% of CMS fee schedule,146.06,67,,116.848,percent of total billed charges,67% of total billed charges,50.48,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,174.4,80,,139.52,percent of total billed charges,80% of total billed charges,141.7,65,,113.36,percent of total billed charges,65% of total billed charges,77.76,35.67,,62.208,percent of total billed charges,35.67% of total billed charges,33.94,196.2,
ANTINUCLEAR ANTIBODIES ANA,3001180,CDM,300,RC,86038,HCPCS,outpatient,,,94,37.60,,79.9,85,,63.92,percent of total billed charges,85% of total billed charges,72.38,77,,57.9,percent of total billed charges,77% of total billed charges,12.09,100,,,fee schedule,100% of CMS fee schedule,52.22,350,,,fee schedule,350% of BCBS fee schedule,54.31,364,,,fee schedule,364% of BCBS fee schedule,54.31,364,,,fee schedule,364% of BCBS fee schedule,54.31,364,,,fee schedule,364% of BCBS fee schedule,84.6,90,,67.68,percent of total billed charges,90% of total billed charges,75.2,80,,60.16,percent of total billed charges,80% of total billed charges,84.6,90,,67.68,percent of total billed charges,90% of total billed charges,70.5,75,,56.4,percent of total billed charges,75% of total billed charges,14.74,122,,,fee schedule,122% of APC rate,27.26,29,,21.808,percent of total billed charges,29% of total billed charges,12.09,100,,,fee schedule,100% of CMS fee schedule,62.98,67,,50.384,percent of total billed charges,67% of total billed charges,17.97,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,75.2,80,,60.16,percent of total billed charges,80% of total billed charges,61.1,65,,48.88,percent of total billed charges,65% of total billed charges,33.53,35.67,,26.824,percent of total billed charges,35.67% of total billed charges,12.09,84.6,
ANTINUCLEAR ANTIBODY TITER,3001190,CDM,300,RC,86039,HCPCS,outpatient,,,157,62.80,,133.45,85,,106.76,percent of total billed charges,85% of total billed charges,120.89,77,,96.71,percent of total billed charges,77% of total billed charges,11.16,100,,,fee schedule,100% of CMS fee schedule,48.23,350,,,fee schedule,350% of BCBS fee schedule,50.16,364,,,fee schedule,364% of BCBS fee schedule,50.16,364,,,fee schedule,364% of BCBS fee schedule,50.16,364,,,fee schedule,364% of BCBS fee schedule,141.3,90,,113.04,percent of total billed charges,90% of total billed charges,125.6,80,,100.48,percent of total billed charges,80% of total billed charges,141.3,90,,113.04,percent of total billed charges,90% of total billed charges,117.75,75,,94.2,percent of total billed charges,75% of total billed charges,13.61,122,,,fee schedule,122% of APC rate,45.53,29,,36.424,percent of total billed charges,29% of total billed charges,11.16,100,,,fee schedule,100% of CMS fee schedule,105.19,67,,84.152,percent of total billed charges,67% of total billed charges,16.6,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,125.6,80,,100.48,percent of total billed charges,80% of total billed charges,102.05,65,,81.64,percent of total billed charges,65% of total billed charges,56,35.67,,44.8,percent of total billed charges,35.67% of total billed charges,11.16,141.3,
ANTISTREPTOLYSIN RECEPTOR AB,3001200,CDM,300,RC,86060,HCPCS,outpatient,,,60,24.00,,51,85,,40.8,percent of total billed charges,85% of total billed charges,46.2,77,,36.96,percent of total billed charges,77% of total billed charges,7.3,100,,,fee schedule,100% of CMS fee schedule,31.54,350,,,fee schedule,350% of BCBS fee schedule,32.8,364,,,fee schedule,364% of BCBS fee schedule,32.8,364,,,fee schedule,364% of BCBS fee schedule,32.8,364,,,fee schedule,364% of BCBS fee schedule,54,90,,43.2,percent of total billed charges,90% of total billed charges,48,80,,38.4,percent of total billed charges,80% of total billed charges,54,90,,43.2,percent of total billed charges,90% of total billed charges,45,75,,36,percent of total billed charges,75% of total billed charges,8.9,122,,,fee schedule,122% of APC rate,17.4,29,,13.92,percent of total billed charges,29% of total billed charges,7.3,100,,,fee schedule,100% of CMS fee schedule,40.2,67,,32.16,percent of total billed charges,67% of total billed charges,10.85,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,48,80,,38.4,percent of total billed charges,80% of total billed charges,39,65,,31.2,percent of total billed charges,65% of total billed charges,21.4,35.67,,17.12,percent of total billed charges,35.67% of total billed charges,7.3,54,
ARBOVIRUS,3001220,CDM,300,RC,86256,HCPCS,outpatient,,,464,185.60,,394.4,85,,315.52,percent of total billed charges,85% of total billed charges,357.28,77,,285.82,percent of total billed charges,77% of total billed charges,12.05,100,,,fee schedule,100% of CMS fee schedule,52.08,350,,,fee schedule,350% of BCBS fee schedule,54.16,364,,,fee schedule,364% of BCBS fee schedule,54.16,364,,,fee schedule,364% of BCBS fee schedule,54.16,364,,,fee schedule,364% of BCBS fee schedule,417.6,90,,334.08,percent of total billed charges,90% of total billed charges,371.2,80,,296.96,percent of total billed charges,80% of total billed charges,417.6,90,,334.08,percent of total billed charges,90% of total billed charges,348,75,,278.4,percent of total billed charges,75% of total billed charges,14.7,122,,,fee schedule,122% of APC rate,134.56,29,,107.648,percent of total billed charges,29% of total billed charges,12.05,100,,,fee schedule,100% of CMS fee schedule,310.88,67,,248.704,percent of total billed charges,67% of total billed charges,17.92,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,371.2,80,,296.96,percent of total billed charges,80% of total billed charges,301.6,65,,241.28,percent of total billed charges,65% of total billed charges,165.51,35.67,,132.408,percent of total billed charges,35.67% of total billed charges,12.05,417.6,
ANTI THROMBIN ANTIBODY,3001225,CDM,300,RC,85300,HCPCS,outpatient,,,157,62.80,,133.45,85,,106.76,percent of total billed charges,85% of total billed charges,120.89,77,,96.71,percent of total billed charges,77% of total billed charges,11.85,100,,,fee schedule,100% of CMS fee schedule,51.21,350,,,fee schedule,350% of BCBS fee schedule,53.25,364,,,fee schedule,364% of BCBS fee schedule,53.25,364,,,fee schedule,364% of BCBS fee schedule,53.25,364,,,fee schedule,364% of BCBS fee schedule,141.3,90,,113.04,percent of total billed charges,90% of total billed charges,125.6,80,,100.48,percent of total billed charges,80% of total billed charges,141.3,90,,113.04,percent of total billed charges,90% of total billed charges,117.75,75,,94.2,percent of total billed charges,75% of total billed charges,14.45,122,,,fee schedule,122% of APC rate,45.53,29,,36.424,percent of total billed charges,29% of total billed charges,11.85,100,,,fee schedule,100% of CMS fee schedule,105.19,67,,84.152,percent of total billed charges,67% of total billed charges,13,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,125.6,80,,100.48,percent of total billed charges,80% of total billed charges,102.05,65,,81.64,percent of total billed charges,65% of total billed charges,56,35.67,,44.8,percent of total billed charges,35.67% of total billed charges,11.85,141.3,
ARSENIC,3001240,CDM,300,RC,82175,HCPCS,outpatient,,,96,38.40,,81.6,85,,65.28,percent of total billed charges,85% of total billed charges,73.92,77,,59.14,percent of total billed charges,77% of total billed charges,18.97,100,,,fee schedule,100% of CMS fee schedule,81.97,350,,,fee schedule,350% of BCBS fee schedule,85.25,364,,,fee schedule,364% of BCBS fee schedule,85.25,364,,,fee schedule,364% of BCBS fee schedule,85.25,364,,,fee schedule,364% of BCBS fee schedule,86.4,90,,69.12,percent of total billed charges,90% of total billed charges,76.8,80,,61.44,percent of total billed charges,80% of total billed charges,86.4,90,,69.12,percent of total billed charges,90% of total billed charges,72,75,,57.6,percent of total billed charges,75% of total billed charges,23.14,122,,,fee schedule,122% of APC rate,27.84,29,,22.272,percent of total billed charges,29% of total billed charges,18.97,100,,,fee schedule,100% of CMS fee schedule,64.32,67,,51.456,percent of total billed charges,67% of total billed charges,28.21,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,76.8,80,,61.44,percent of total billed charges,80% of total billed charges,62.4,65,,49.92,percent of total billed charges,65% of total billed charges,34.24,35.67,,27.392,percent of total billed charges,35.67% of total billed charges,18.97,86.4,
ARTHRITIS PROFILE,3001250,CDM,300,RC,,,outpatient,,,166,66.40,,141.1,85,,112.88,percent of total billed charges,85% of total billed charges,127.82,77,,102.26,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,136.12,82,,108.896,percent of total billed charges,82% of total billed charges,141.1,85,,112.88,percent of total billed charges,85% of total billed charges,141.1,85,,112.88,percent of total billed charges,85% of total billed charges,141.1,85,,112.88,percent of total billed charges,85% of total billed charges,149.4,90,,119.52,percent of total billed charges,90% of total billed charges,132.8,80,,106.24,percent of total billed charges,80% of total billed charges,149.4,90,,119.52,percent of total billed charges,90% of total billed charges,124.5,75,,99.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,48.14,29,,38.512,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,111.22,67,,88.976,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,132.8,80,,106.24,percent of total billed charges,80% of total billed charges,107.9,65,,86.32,percent of total billed charges,65% of total billed charges,59.21,35.67,,47.368,percent of total billed charges,35.67% of total billed charges,48.14,149.4,
AUTO ABSORPTION OF SERUM,3001251,CDM,300,RC,86978,HCPCS,outpatient,,,97,38.80,,82.45,85,,65.96,percent of total billed charges,85% of total billed charges,74.69,77,,59.75,percent of total billed charges,77% of total billed charges,53.49,100,,,fee schedule,100% of CMS OPPS rate,111.3,350,,,fee schedule,350% of BCBS fee schedule,115.75,364,,,fee schedule,364% of BCBS fee schedule,115.75,364,,,fee schedule,364% of BCBS fee schedule,115.75,364,,,fee schedule,364% of BCBS fee schedule,87.3,90,,69.84,percent of total billed charges,90% of total billed charges,77.6,80,,62.08,percent of total billed charges,80% of total billed charges,87.3,90,,69.84,percent of total billed charges,90% of total billed charges,72.75,75,,58.2,percent of total billed charges,75% of total billed charges,65.26,122,,,fee schedule,122% of APC rate,28.13,29,,22.504,percent of total billed charges,29% of total billed charges,53.49,100,,,fee schedule,100% of CMS OPPS rate,64.99,67,,51.992,percent of total billed charges,67% of total billed charges,23.18,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,77.6,80,,62.08,percent of total billed charges,80% of total billed charges,63.05,65,,50.44,percent of total billed charges,65% of total billed charges,34.6,35.67,,27.68,percent of total billed charges,35.67% of total billed charges,23.18,115.75,
AUTOIMMUNE ANTIBODIES,3001252,CDM,300,RC,86235,HCPCS,outpatient,,,120,48.00,,102,85,,81.6,percent of total billed charges,85% of total billed charges,92.4,77,,73.92,percent of total billed charges,77% of total billed charges,17.93,100,,,fee schedule,100% of CMS fee schedule,77.49,350,,,fee schedule,350% of BCBS fee schedule,80.59,364,,,fee schedule,364% of BCBS fee schedule,80.59,364,,,fee schedule,364% of BCBS fee schedule,80.59,364,,,fee schedule,364% of BCBS fee schedule,108,90,,86.4,percent of total billed charges,90% of total billed charges,96,80,,76.8,percent of total billed charges,80% of total billed charges,108,90,,86.4,percent of total billed charges,90% of total billed charges,90,75,,72,percent of total billed charges,75% of total billed charges,21.87,122,,,fee schedule,122% of APC rate,34.8,29,,27.84,percent of total billed charges,29% of total billed charges,17.93,100,,,fee schedule,100% of CMS fee schedule,80.4,67,,64.32,percent of total billed charges,67% of total billed charges,26.67,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,96,80,,76.8,percent of total billed charges,80% of total billed charges,78,65,,62.4,percent of total billed charges,65% of total billed charges,42.8,35.67,,34.24,percent of total billed charges,35.67% of total billed charges,17.93,108,
ASPERGILLIS TITER,3001260,CDM,300,RC,86606,HCPCS,outpatient,,,76,30.40,,64.6,85,,51.68,percent of total billed charges,85% of total billed charges,58.52,77,,46.82,percent of total billed charges,77% of total billed charges,15.05,100,,,fee schedule,100% of CMS fee schedule,65.07,350,,,fee schedule,350% of BCBS fee schedule,67.67,364,,,fee schedule,364% of BCBS fee schedule,67.67,364,,,fee schedule,364% of BCBS fee schedule,67.67,364,,,fee schedule,364% of BCBS fee schedule,68.4,90,,54.72,percent of total billed charges,90% of total billed charges,60.8,80,,48.64,percent of total billed charges,80% of total billed charges,68.4,90,,54.72,percent of total billed charges,90% of total billed charges,57,75,,45.6,percent of total billed charges,75% of total billed charges,18.36,122,,,fee schedule,122% of APC rate,22.04,29,,17.632,percent of total billed charges,29% of total billed charges,15.05,100,,,fee schedule,100% of CMS fee schedule,50.92,67,,40.736,percent of total billed charges,67% of total billed charges,8.64,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,60.8,80,,48.64,percent of total billed charges,80% of total billed charges,49.4,65,,39.52,percent of total billed charges,65% of total billed charges,27.11,35.67,,21.688,percent of total billed charges,35.67% of total billed charges,8.64,68.4,
ASPERGILLUS ANTIBODIES,3001261,CDM,300,RC,86606,HCPCS,outpatient,,,83,33.20,,70.55,85,,56.44,percent of total billed charges,85% of total billed charges,63.91,77,,51.13,percent of total billed charges,77% of total billed charges,15.05,100,,,fee schedule,100% of CMS fee schedule,65.07,350,,,fee schedule,350% of BCBS fee schedule,67.67,364,,,fee schedule,364% of BCBS fee schedule,67.67,364,,,fee schedule,364% of BCBS fee schedule,67.67,364,,,fee schedule,364% of BCBS fee schedule,74.7,90,,59.76,percent of total billed charges,90% of total billed charges,66.4,80,,53.12,percent of total billed charges,80% of total billed charges,74.7,90,,59.76,percent of total billed charges,90% of total billed charges,62.25,75,,49.8,percent of total billed charges,75% of total billed charges,18.36,122,,,fee schedule,122% of APC rate,24.07,29,,19.256,percent of total billed charges,29% of total billed charges,15.05,100,,,fee schedule,100% of CMS fee schedule,55.61,67,,44.488,percent of total billed charges,67% of total billed charges,8.64,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,66.4,80,,53.12,percent of total billed charges,80% of total billed charges,53.95,65,,43.16,percent of total billed charges,65% of total billed charges,29.61,35.67,,23.688,percent of total billed charges,35.67% of total billed charges,8.64,74.7,
BABESIA,3001268,CDM,300,RC,86753,HCPCS,outpatient,,,212,84.80,,180.2,85,,144.16,percent of total billed charges,85% of total billed charges,163.24,77,,130.59,percent of total billed charges,77% of total billed charges,12.39,100,,,fee schedule,100% of CMS fee schedule,53.52,350,,,fee schedule,350% of BCBS fee schedule,55.66,364,,,fee schedule,364% of BCBS fee schedule,55.66,364,,,fee schedule,364% of BCBS fee schedule,55.66,364,,,fee schedule,364% of BCBS fee schedule,190.8,90,,152.64,percent of total billed charges,90% of total billed charges,169.6,80,,135.68,percent of total billed charges,80% of total billed charges,190.8,90,,152.64,percent of total billed charges,90% of total billed charges,159,75,,127.2,percent of total billed charges,75% of total billed charges,15.11,122,,,fee schedule,122% of APC rate,61.48,29,,49.184,percent of total billed charges,29% of total billed charges,12.39,100,,,fee schedule,100% of CMS fee schedule,142.04,67,,113.632,percent of total billed charges,67% of total billed charges,8.64,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,169.6,80,,135.68,percent of total billed charges,80% of total billed charges,137.8,65,,110.24,percent of total billed charges,65% of total billed charges,75.62,35.67,,60.496,percent of total billed charges,35.67% of total billed charges,8.64,190.8,
BARTONELLA HENSELAE FORPANEL 2,3001269,CDM,300,RC,86317,HCPCS,outpatient,,,283,113.20,91,240.55,85,,192.44,percent of total billed charges,85% of total billed charges,217.91,77,,174.33,percent of total billed charges,77% of total billed charges,14.99,100,,,fee schedule,100% of CMS fee schedule,64.75,350,,,fee schedule,350% of BCBS fee schedule,67.34,364,,,fee schedule,364% of BCBS fee schedule,67.34,364,,,fee schedule,364% of BCBS fee schedule,67.34,364,,,fee schedule,364% of BCBS fee schedule,254.7,90,,203.76,percent of total billed charges,90% of total billed charges,226.4,80,,181.12,percent of total billed charges,80% of total billed charges,254.7,90,,203.76,percent of total billed charges,90% of total billed charges,212.25,75,,169.8,percent of total billed charges,75% of total billed charges,18.28,122,,,fee schedule,122% of APC rate,82.07,29,,65.656,percent of total billed charges,29% of total billed charges,14.99,100,,,fee schedule,100% of CMS fee schedule,189.61,67,,151.688,percent of total billed charges,67% of total billed charges,22.3,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,226.4,80,,181.12,percent of total billed charges,80% of total billed charges,183.95,65,,147.16,percent of total billed charges,65% of total billed charges,100.95,35.67,,80.76,percent of total billed charges,35.67% of total billed charges,14.99,254.7,
BACTERIAL ID ANEROBIC,3001270,CDM,300,RC,87076,HCPCS,outpatient,,,89,35.60,,75.65,85,,60.52,percent of total billed charges,85% of total billed charges,68.53,77,,54.82,percent of total billed charges,77% of total billed charges,8.08,100,,,fee schedule,100% of CMS fee schedule,34.9,350,,,fee schedule,350% of BCBS fee schedule,36.29,364,,,fee schedule,364% of BCBS fee schedule,36.29,364,,,fee schedule,364% of BCBS fee schedule,36.29,364,,,fee schedule,364% of BCBS fee schedule,80.1,90,,64.08,percent of total billed charges,90% of total billed charges,71.2,80,,56.96,percent of total billed charges,80% of total billed charges,80.1,90,,64.08,percent of total billed charges,90% of total billed charges,66.75,75,,53.4,percent of total billed charges,75% of total billed charges,9.85,122,,,fee schedule,122% of APC rate,25.81,29,,20.648,percent of total billed charges,29% of total billed charges,8.08,100,,,fee schedule,100% of CMS fee schedule,59.63,67,,47.704,percent of total billed charges,67% of total billed charges,12.02,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,71.2,80,,56.96,percent of total billed charges,80% of total billed charges,57.85,65,,46.28,percent of total billed charges,65% of total billed charges,31.75,35.67,,25.4,percent of total billed charges,35.67% of total billed charges,8.08,80.1,
BACTERIUM NOT SPECIFIED PANEL,3001271,CDM,300,RC,86609,HCPCS,outpatient,,,77,30.80,,65.45,85,,52.36,percent of total billed charges,85% of total billed charges,59.29,77,,47.43,percent of total billed charges,77% of total billed charges,12.88,100,,,fee schedule,100% of CMS fee schedule,55.65,350,,,fee schedule,350% of BCBS fee schedule,57.88,364,,,fee schedule,364% of BCBS fee schedule,57.88,364,,,fee schedule,364% of BCBS fee schedule,57.88,364,,,fee schedule,364% of BCBS fee schedule,69.3,90,,55.44,percent of total billed charges,90% of total billed charges,61.6,80,,49.28,percent of total billed charges,80% of total billed charges,69.3,90,,55.44,percent of total billed charges,90% of total billed charges,57.75,75,,46.2,percent of total billed charges,75% of total billed charges,15.71,122,,,fee schedule,122% of APC rate,22.33,29,,17.864,percent of total billed charges,29% of total billed charges,12.88,100,,,fee schedule,100% of CMS fee schedule,51.59,67,,41.272,percent of total billed charges,67% of total billed charges,8.64,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,61.6,80,,49.28,percent of total billed charges,80% of total billed charges,50.05,65,,40.04,percent of total billed charges,65% of total billed charges,27.47,35.67,,21.976,percent of total billed charges,35.67% of total billed charges,8.64,69.3,
BACTERIAL ID OR PANEL,3001272,CDM,300,RC,86609,HCPCS,outpatient,,,132,52.80,,112.2,85,,89.76,percent of total billed charges,85% of total billed charges,101.64,77,,81.31,percent of total billed charges,77% of total billed charges,12.88,100,,,fee schedule,100% of CMS fee schedule,55.65,350,,,fee schedule,350% of BCBS fee schedule,57.88,364,,,fee schedule,364% of BCBS fee schedule,57.88,364,,,fee schedule,364% of BCBS fee schedule,57.88,364,,,fee schedule,364% of BCBS fee schedule,118.8,90,,95.04,percent of total billed charges,90% of total billed charges,105.6,80,,84.48,percent of total billed charges,80% of total billed charges,118.8,90,,95.04,percent of total billed charges,90% of total billed charges,99,75,,79.2,percent of total billed charges,75% of total billed charges,15.71,122,,,fee schedule,122% of APC rate,38.28,29,,30.624,percent of total billed charges,29% of total billed charges,12.88,100,,,fee schedule,100% of CMS fee schedule,88.44,67,,70.752,percent of total billed charges,67% of total billed charges,8.64,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,105.6,80,,84.48,percent of total billed charges,80% of total billed charges,85.8,65,,68.64,percent of total billed charges,65% of total billed charges,47.08,35.67,,37.664,percent of total billed charges,35.67% of total billed charges,8.64,118.8,
BNP - BRAIN N. PEPTIDE,3001273,CDM,300,RC,83880,HCPCS,outpatient,,,163,65.20,,138.55,85,,110.84,percent of total billed charges,85% of total billed charges,125.51,77,,100.41,percent of total billed charges,77% of total billed charges,39.26,100,,,fee schedule,100% of CMS fee schedule,146.65,350,,,fee schedule,350% of BCBS fee schedule,152.52,364,,,fee schedule,364% of BCBS fee schedule,152.52,364,,,fee schedule,364% of BCBS fee schedule,152.52,364,,,fee schedule,364% of BCBS fee schedule,146.7,90,,117.36,percent of total billed charges,90% of total billed charges,130.4,80,,104.32,percent of total billed charges,80% of total billed charges,146.7,90,,117.36,percent of total billed charges,90% of total billed charges,122.25,75,,97.8,percent of total billed charges,75% of total billed charges,47.89,122,,,fee schedule,122% of APC rate,47.27,29,,37.816,percent of total billed charges,29% of total billed charges,39.26,100,,,fee schedule,100% of CMS fee schedule,109.21,67,,87.368,percent of total billed charges,67% of total billed charges,50.48,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,130.4,80,,104.32,percent of total billed charges,80% of total billed charges,105.95,65,,84.76,percent of total billed charges,65% of total billed charges,58.14,35.67,,46.512,percent of total billed charges,35.67% of total billed charges,39.26,152.52,
NT PRO BNP,3001274,CDM,300,RC,83880,HCPCS,outpatient,,,68,27.20,,57.8,85,,46.24,percent of total billed charges,85% of total billed charges,52.36,77,,41.89,percent of total billed charges,77% of total billed charges,39.26,100,,,fee schedule,100% of CMS fee schedule,146.65,350,,,fee schedule,350% of BCBS fee schedule,152.52,364,,,fee schedule,364% of BCBS fee schedule,152.52,364,,,fee schedule,364% of BCBS fee schedule,152.52,364,,,fee schedule,364% of BCBS fee schedule,61.2,90,,48.96,percent of total billed charges,90% of total billed charges,54.4,80,,43.52,percent of total billed charges,80% of total billed charges,61.2,90,,48.96,percent of total billed charges,90% of total billed charges,51,75,,40.8,percent of total billed charges,75% of total billed charges,47.89,122,,,fee schedule,122% of APC rate,19.72,29,,15.776,percent of total billed charges,29% of total billed charges,39.26,100,,,fee schedule,100% of CMS fee schedule,45.56,67,,36.448,percent of total billed charges,67% of total billed charges,50.48,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,54.4,80,,43.52,percent of total billed charges,80% of total billed charges,44.2,65,,35.36,percent of total billed charges,65% of total billed charges,24.26,35.67,,19.408,percent of total billed charges,35.67% of total billed charges,19.72,152.52,
BARTONELLA HENSELAE IgG/IgM,3001276,CDM,300,RC,86317,HCPCS,outpatient,,,96,38.40,,81.6,85,,65.28,percent of total billed charges,85% of total billed charges,73.92,77,,59.14,percent of total billed charges,77% of total billed charges,14.99,100,,,fee schedule,100% of CMS fee schedule,64.75,350,,,fee schedule,350% of BCBS fee schedule,67.34,364,,,fee schedule,364% of BCBS fee schedule,67.34,364,,,fee schedule,364% of BCBS fee schedule,67.34,364,,,fee schedule,364% of BCBS fee schedule,86.4,90,,69.12,percent of total billed charges,90% of total billed charges,76.8,80,,61.44,percent of total billed charges,80% of total billed charges,86.4,90,,69.12,percent of total billed charges,90% of total billed charges,72,75,,57.6,percent of total billed charges,75% of total billed charges,18.28,122,,,fee schedule,122% of APC rate,27.84,29,,22.272,percent of total billed charges,29% of total billed charges,14.99,100,,,fee schedule,100% of CMS fee schedule,64.32,67,,51.456,percent of total billed charges,67% of total billed charges,22.3,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,76.8,80,,61.44,percent of total billed charges,80% of total billed charges,62.4,65,,49.92,percent of total billed charges,65% of total billed charges,34.24,35.67,,27.392,percent of total billed charges,35.67% of total billed charges,14.99,86.4,
BENCE JONES PROTEIN,3001278,CDM,300,RC,84165,HCPCS,outpatient,,,246,98.40,,209.1,85,,167.28,percent of total billed charges,85% of total billed charges,189.42,77,,151.54,percent of total billed charges,77% of total billed charges,10.74,100,,,fee schedule,100% of CMS fee schedule,46.41,350,,,fee schedule,350% of BCBS fee schedule,48.27,364,,,fee schedule,364% of BCBS fee schedule,48.27,364,,,fee schedule,364% of BCBS fee schedule,48.27,364,,,fee schedule,364% of BCBS fee schedule,221.4,90,,177.12,percent of total billed charges,90% of total billed charges,196.8,80,,157.44,percent of total billed charges,80% of total billed charges,221.4,90,,177.12,percent of total billed charges,90% of total billed charges,184.5,75,,147.6,percent of total billed charges,75% of total billed charges,13.1,122,,,fee schedule,122% of APC rate,71.34,29,,57.072,percent of total billed charges,29% of total billed charges,10.74,100,,,fee schedule,100% of CMS fee schedule,164.82,67,,131.856,percent of total billed charges,67% of total billed charges,15.97,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,196.8,80,,157.44,percent of total billed charges,80% of total billed charges,159.9,65,,127.92,percent of total billed charges,65% of total billed charges,87.75,35.67,,70.2,percent of total billed charges,35.67% of total billed charges,10.74,221.4,
BARTONELLA HENSELAE FOR PANELI,3001279,CDM,300,RC,86317,HCPCS,outpatient,,,283,113.20,,240.55,85,,192.44,percent of total billed charges,85% of total billed charges,217.91,77,,174.33,percent of total billed charges,77% of total billed charges,14.99,100,,,fee schedule,100% of CMS fee schedule,64.75,350,,,fee schedule,350% of BCBS fee schedule,67.34,364,,,fee schedule,364% of BCBS fee schedule,67.34,364,,,fee schedule,364% of BCBS fee schedule,67.34,364,,,fee schedule,364% of BCBS fee schedule,254.7,90,,203.76,percent of total billed charges,90% of total billed charges,226.4,80,,181.12,percent of total billed charges,80% of total billed charges,254.7,90,,203.76,percent of total billed charges,90% of total billed charges,212.25,75,,169.8,percent of total billed charges,75% of total billed charges,18.28,122,,,fee schedule,122% of APC rate,82.07,29,,65.656,percent of total billed charges,29% of total billed charges,14.99,100,,,fee schedule,100% of CMS fee schedule,189.61,67,,151.688,percent of total billed charges,67% of total billed charges,22.3,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,226.4,80,,181.12,percent of total billed charges,80% of total billed charges,183.95,65,,147.16,percent of total billed charges,65% of total billed charges,100.95,35.67,,80.76,percent of total billed charges,35.67% of total billed charges,14.99,254.7,
HCG QUANTITATIVE-BETA,3001300,CDM,300,RC,84702,HCPCS,outpatient,,,167,66.80,,141.95,85,,113.56,percent of total billed charges,85% of total billed charges,128.59,77,,102.87,percent of total billed charges,77% of total billed charges,15.05,100,,,fee schedule,100% of CMS fee schedule,65.07,350,,,fee schedule,350% of BCBS fee schedule,67.67,364,,,fee schedule,364% of BCBS fee schedule,67.67,364,,,fee schedule,364% of BCBS fee schedule,67.67,364,,,fee schedule,364% of BCBS fee schedule,150.3,90,,120.24,percent of total billed charges,90% of total billed charges,133.6,80,,106.88,percent of total billed charges,80% of total billed charges,150.3,90,,120.24,percent of total billed charges,90% of total billed charges,125.25,75,,100.2,percent of total billed charges,75% of total billed charges,18.36,122,,,fee schedule,122% of APC rate,48.43,29,,38.744,percent of total billed charges,29% of total billed charges,15.05,100,,,fee schedule,100% of CMS fee schedule,111.89,67,,89.512,percent of total billed charges,67% of total billed charges,22.39,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,133.6,80,,106.88,percent of total billed charges,80% of total billed charges,108.55,65,,86.84,percent of total billed charges,65% of total billed charges,59.57,35.67,,47.656,percent of total billed charges,35.67% of total billed charges,15.05,150.3,
"BILIRUBIN, DIRECT",3001360,CDM,300,RC,82248,HCPCS,outpatient,,,63,25.20,,53.55,85,,42.84,percent of total billed charges,85% of total billed charges,48.51,77,,38.81,percent of total billed charges,77% of total billed charges,5.01,100,,,fee schedule,100% of CMS fee schedule,21.67,350,,,fee schedule,350% of BCBS fee schedule,22.53,364,,,fee schedule,364% of BCBS fee schedule,22.53,364,,,fee schedule,364% of BCBS fee schedule,22.53,364,,,fee schedule,364% of BCBS fee schedule,56.7,90,,45.36,percent of total billed charges,90% of total billed charges,50.4,80,,40.32,percent of total billed charges,80% of total billed charges,56.7,90,,45.36,percent of total billed charges,90% of total billed charges,47.25,75,,37.8,percent of total billed charges,75% of total billed charges,6.12,122,,,fee schedule,122% of APC rate,18.27,29,,14.616,percent of total billed charges,29% of total billed charges,5.01,100,,,fee schedule,100% of CMS fee schedule,42.21,67,,33.768,percent of total billed charges,67% of total billed charges,7.45,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,50.4,80,,40.32,percent of total billed charges,80% of total billed charges,40.95,65,,32.76,percent of total billed charges,65% of total billed charges,22.47,35.67,,17.976,percent of total billed charges,35.67% of total billed charges,5.01,56.7,
BILIRUBIN TOTAL,3001420,CDM,300,RC,82247,HCPCS,outpatient,,,53,21.20,,45.05,85,,36.04,percent of total billed charges,85% of total billed charges,40.81,77,,32.65,percent of total billed charges,77% of total billed charges,5.01,100,,,fee schedule,100% of CMS fee schedule,21.67,350,,,fee schedule,350% of BCBS fee schedule,22.53,364,,,fee schedule,364% of BCBS fee schedule,22.53,364,,,fee schedule,364% of BCBS fee schedule,22.53,364,,,fee schedule,364% of BCBS fee schedule,47.7,90,,38.16,percent of total billed charges,90% of total billed charges,42.4,80,,33.92,percent of total billed charges,80% of total billed charges,47.7,90,,38.16,percent of total billed charges,90% of total billed charges,39.75,75,,31.8,percent of total billed charges,75% of total billed charges,6.12,122,,,fee schedule,122% of APC rate,15.37,29,,12.296,percent of total billed charges,29% of total billed charges,5.01,100,,,fee schedule,100% of CMS fee schedule,35.51,67,,28.408,percent of total billed charges,67% of total billed charges,7.45,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,42.4,80,,33.92,percent of total billed charges,80% of total billed charges,34.45,65,,27.56,percent of total billed charges,65% of total billed charges,18.91,35.67,,15.128,percent of total billed charges,35.67% of total billed charges,5.01,47.7,
BLASTOMYCES TITER,3001430,CDM,300,RC,86612,HCPCS,outpatient,,,83,33.20,,70.55,85,,56.44,percent of total billed charges,85% of total billed charges,63.91,77,,51.13,percent of total billed charges,77% of total billed charges,12.9,100,,,fee schedule,100% of CMS fee schedule,55.76,350,,,fee schedule,350% of BCBS fee schedule,57.99,364,,,fee schedule,364% of BCBS fee schedule,57.99,364,,,fee schedule,364% of BCBS fee schedule,57.99,364,,,fee schedule,364% of BCBS fee schedule,74.7,90,,59.76,percent of total billed charges,90% of total billed charges,66.4,80,,53.12,percent of total billed charges,80% of total billed charges,74.7,90,,59.76,percent of total billed charges,90% of total billed charges,62.25,75,,49.8,percent of total billed charges,75% of total billed charges,15.73,122,,,fee schedule,122% of APC rate,24.07,29,,19.256,percent of total billed charges,29% of total billed charges,12.9,100,,,fee schedule,100% of CMS fee schedule,55.61,67,,44.488,percent of total billed charges,67% of total billed charges,8.64,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,66.4,80,,53.12,percent of total billed charges,80% of total billed charges,53.95,65,,43.16,percent of total billed charges,65% of total billed charges,29.61,35.67,,23.688,percent of total billed charges,35.67% of total billed charges,8.64,74.7,
BLEEDING TIME,3001440,CDM,300,RC,85002,HCPCS,outpatient,,,74,29.60,,62.9,85,,50.32,percent of total billed charges,85% of total billed charges,56.98,77,,45.58,percent of total billed charges,77% of total billed charges,4.82,100,,,fee schedule,100% of CMS fee schedule,19.5,350,,,fee schedule,350% of BCBS fee schedule,20.27,364,,,fee schedule,364% of BCBS fee schedule,20.27,364,,,fee schedule,364% of BCBS fee schedule,20.27,364,,,fee schedule,364% of BCBS fee schedule,66.6,90,,53.28,percent of total billed charges,90% of total billed charges,59.2,80,,47.36,percent of total billed charges,80% of total billed charges,66.6,90,,53.28,percent of total billed charges,90% of total billed charges,55.5,75,,44.4,percent of total billed charges,75% of total billed charges,5.88,122,,,fee schedule,122% of APC rate,21.46,29,,17.168,percent of total billed charges,29% of total billed charges,4.82,100,,,fee schedule,100% of CMS fee schedule,49.58,67,,39.664,percent of total billed charges,67% of total billed charges,6.69,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,59.2,80,,47.36,percent of total billed charges,80% of total billed charges,48.1,65,,38.48,percent of total billed charges,65% of total billed charges,26.4,35.67,,21.12,percent of total billed charges,35.67% of total billed charges,4.82,66.6,
BLOOD GAS WITH CO-OXIMETRY,3001460,CDM,300,RC,82805,HCPCS,outpatient,,,311,124.40,,264.35,85,,211.48,percent of total billed charges,85% of total billed charges,239.47,77,,191.58,percent of total billed charges,77% of total billed charges,78.77,100,,,fee schedule,100% of CMS fee schedule,275.7,350,,,fee schedule,350% of BCBS fee schedule,286.72,364,,,fee schedule,364% of BCBS fee schedule,286.72,364,,,fee schedule,364% of BCBS fee schedule,286.72,364,,,fee schedule,364% of BCBS fee schedule,279.9,90,,223.92,percent of total billed charges,90% of total billed charges,248.8,80,,199.04,percent of total billed charges,80% of total billed charges,279.9,90,,223.92,percent of total billed charges,90% of total billed charges,233.25,75,,186.6,percent of total billed charges,75% of total billed charges,96.09,122,,,fee schedule,122% of APC rate,90.19,29,,72.152,percent of total billed charges,29% of total billed charges,78.77,100,,,fee schedule,100% of CMS fee schedule,208.37,67,,166.696,percent of total billed charges,67% of total billed charges,42.21,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,248.8,80,,199.04,percent of total billed charges,80% of total billed charges,202.15,65,,161.72,percent of total billed charges,65% of total billed charges,110.93,35.67,,88.744,percent of total billed charges,35.67% of total billed charges,42.21,286.72,
BLOOD GAS ARTERIAL FOR PANEL,3001470,CDM,300,RC,82805,HCPCS,outpatient,,,311,124.40,,264.35,85,,211.48,percent of total billed charges,85% of total billed charges,239.47,77,,191.58,percent of total billed charges,77% of total billed charges,78.77,100,,,fee schedule,100% of CMS fee schedule,275.7,350,,,fee schedule,350% of BCBS fee schedule,286.72,364,,,fee schedule,364% of BCBS fee schedule,286.72,364,,,fee schedule,364% of BCBS fee schedule,286.72,364,,,fee schedule,364% of BCBS fee schedule,279.9,90,,223.92,percent of total billed charges,90% of total billed charges,248.8,80,,199.04,percent of total billed charges,80% of total billed charges,279.9,90,,223.92,percent of total billed charges,90% of total billed charges,233.25,75,,186.6,percent of total billed charges,75% of total billed charges,96.09,122,,,fee schedule,122% of APC rate,90.19,29,,72.152,percent of total billed charges,29% of total billed charges,78.77,100,,,fee schedule,100% of CMS fee schedule,208.37,67,,166.696,percent of total billed charges,67% of total billed charges,42.21,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,248.8,80,,199.04,percent of total billed charges,80% of total billed charges,202.15,65,,161.72,percent of total billed charges,65% of total billed charges,110.93,35.67,,88.744,percent of total billed charges,35.67% of total billed charges,42.21,286.72,
BLOOD GAS VENOUS PH,3001480,CDM,300,RC,82800,HCPCS,outpatient,,,84,33.60,,71.4,85,,57.12,percent of total billed charges,85% of total billed charges,64.68,77,,51.74,percent of total billed charges,77% of total billed charges,11,100,,,fee schedule,100% of CMS fee schedule,38.5,350,,,fee schedule,350% of BCBS fee schedule,40.04,364,,,fee schedule,364% of BCBS fee schedule,40.04,364,,,fee schedule,364% of BCBS fee schedule,40.04,364,,,fee schedule,364% of BCBS fee schedule,75.6,90,,60.48,percent of total billed charges,90% of total billed charges,67.2,80,,53.76,percent of total billed charges,80% of total billed charges,75.6,90,,60.48,percent of total billed charges,90% of total billed charges,63,75,,50.4,percent of total billed charges,75% of total billed charges,13.42,122,,,fee schedule,122% of APC rate,24.36,29,,19.488,percent of total billed charges,29% of total billed charges,11,100,,,fee schedule,100% of CMS fee schedule,56.28,67,,45.024,percent of total billed charges,67% of total billed charges,12.58,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,67.2,80,,53.76,percent of total billed charges,80% of total billed charges,54.6,65,,43.68,percent of total billed charges,65% of total billed charges,29.96,35.67,,23.968,percent of total billed charges,35.67% of total billed charges,11,75.6,
BLOOD DRUG SCREEN COLL SENDOUT,3001485,CDM,300,RC,,,outpatient,,,53,21.20,,45.05,85,,36.04,percent of total billed charges,85% of total billed charges,40.81,77,,32.65,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,43.46,82,,34.768,percent of total billed charges,82% of total billed charges,45.05,85,,36.04,percent of total billed charges,85% of total billed charges,45.05,85,,36.04,percent of total billed charges,85% of total billed charges,45.05,85,,36.04,percent of total billed charges,85% of total billed charges,47.7,90,,38.16,percent of total billed charges,90% of total billed charges,42.4,80,,33.92,percent of total billed charges,80% of total billed charges,47.7,90,,38.16,percent of total billed charges,90% of total billed charges,39.75,75,,31.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,15.37,29,,12.296,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,35.51,67,,28.408,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,42.4,80,,33.92,percent of total billed charges,80% of total billed charges,34.45,65,,27.56,percent of total billed charges,65% of total billed charges,18.91,35.67,,15.128,percent of total billed charges,35.67% of total billed charges,15.37,47.7,
BLOOD RH,3001490,CDM,300,RC,86901,HCPCS,outpatient,,,127,50.80,,107.95,85,,86.36,percent of total billed charges,85% of total billed charges,97.79,77,,78.23,percent of total billed charges,77% of total billed charges,35.07,100,,,fee schedule,100% of CMS OPPS rate,111.3,350,,,fee schedule,350% of BCBS fee schedule,115.75,364,,,fee schedule,364% of BCBS fee schedule,115.75,364,,,fee schedule,364% of BCBS fee schedule,115.75,364,,,fee schedule,364% of BCBS fee schedule,114.3,90,,91.44,percent of total billed charges,90% of total billed charges,101.6,80,,81.28,percent of total billed charges,80% of total billed charges,114.3,90,,91.44,percent of total billed charges,90% of total billed charges,95.25,75,,76.2,percent of total billed charges,75% of total billed charges,42.78,122,,,fee schedule,122% of APC rate,36.83,29,,29.464,percent of total billed charges,29% of total billed charges,35.07,100,,,fee schedule,100% of CMS OPPS rate,85.09,67,,68.072,percent of total billed charges,67% of total billed charges,7.17,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,101.6,80,,81.28,percent of total billed charges,80% of total billed charges,82.55,65,,66.04,percent of total billed charges,65% of total billed charges,45.3,35.67,,36.24,percent of total billed charges,35.67% of total billed charges,7.17,115.75,
BORDETELLA PERTUSSIS IGG IGA A,3001491,CDM,300,RC,86615,HCPCS,outpatient,,,686,274.40,,583.1,85,,466.48,percent of total billed charges,85% of total billed charges,528.22,77,,422.58,percent of total billed charges,77% of total billed charges,13.19,100,,,fee schedule,100% of CMS fee schedule,56.98,350,,,fee schedule,350% of BCBS fee schedule,59.26,364,,,fee schedule,364% of BCBS fee schedule,59.26,364,,,fee schedule,364% of BCBS fee schedule,59.26,364,,,fee schedule,364% of BCBS fee schedule,617.4,90,,493.92,percent of total billed charges,90% of total billed charges,548.8,80,,439.04,percent of total billed charges,80% of total billed charges,617.4,90,,493.92,percent of total billed charges,90% of total billed charges,514.5,75,,411.6,percent of total billed charges,75% of total billed charges,16.09,122,,,fee schedule,122% of APC rate,198.94,29,,159.152,percent of total billed charges,29% of total billed charges,13.19,100,,,fee schedule,100% of CMS fee schedule,459.62,67,,367.696,percent of total billed charges,67% of total billed charges,19.61,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,548.8,80,,439.04,percent of total billed charges,80% of total billed charges,445.9,65,,356.72,percent of total billed charges,65% of total billed charges,244.7,35.67,,195.76,percent of total billed charges,35.67% of total billed charges,13.19,617.4,
BORDETELLA PERTUSSIS PCR,3001492,CDM,300,RC,87798,HCPCS,outpatient,,,158,63.20,,134.3,85,,107.44,percent of total billed charges,85% of total billed charges,121.66,77,,97.33,percent of total billed charges,77% of total billed charges,35.09,100,,,fee schedule,100% of CMS fee schedule,151.66,350,,,fee schedule,350% of BCBS fee schedule,157.72,364,,,fee schedule,364% of BCBS fee schedule,157.72,364,,,fee schedule,364% of BCBS fee schedule,157.72,364,,,fee schedule,364% of BCBS fee schedule,142.2,90,,113.76,percent of total billed charges,90% of total billed charges,126.4,80,,101.12,percent of total billed charges,80% of total billed charges,142.2,90,,113.76,percent of total billed charges,90% of total billed charges,118.5,75,,94.8,percent of total billed charges,75% of total billed charges,42.8,122,,,fee schedule,122% of APC rate,45.82,29,,36.656,percent of total billed charges,29% of total billed charges,35.09,100,,,fee schedule,100% of CMS fee schedule,105.86,67,,84.688,percent of total billed charges,67% of total billed charges,52.19,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,126.4,80,,101.12,percent of total billed charges,80% of total billed charges,102.7,65,,82.16,percent of total billed charges,65% of total billed charges,56.36,35.67,,45.088,percent of total billed charges,35.67% of total billed charges,35.09,157.72,
BORDETELLA PARAPERTUSS,3001493,CDM,300,RC,87798,HCPCS,outpatient,,,158,63.20,,134.3,85,,107.44,percent of total billed charges,85% of total billed charges,121.66,77,,97.33,percent of total billed charges,77% of total billed charges,35.09,100,,,fee schedule,100% of CMS fee schedule,151.66,350,,,fee schedule,350% of BCBS fee schedule,157.72,364,,,fee schedule,364% of BCBS fee schedule,157.72,364,,,fee schedule,364% of BCBS fee schedule,157.72,364,,,fee schedule,364% of BCBS fee schedule,142.2,90,,113.76,percent of total billed charges,90% of total billed charges,126.4,80,,101.12,percent of total billed charges,80% of total billed charges,142.2,90,,113.76,percent of total billed charges,90% of total billed charges,118.5,75,,94.8,percent of total billed charges,75% of total billed charges,42.8,122,,,fee schedule,122% of APC rate,45.82,29,,36.656,percent of total billed charges,29% of total billed charges,35.09,100,,,fee schedule,100% of CMS fee schedule,105.86,67,,84.688,percent of total billed charges,67% of total billed charges,52.19,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,126.4,80,,101.12,percent of total billed charges,80% of total billed charges,102.7,65,,82.16,percent of total billed charges,65% of total billed charges,56.36,35.67,,45.088,percent of total billed charges,35.67% of total billed charges,35.09,157.72,
BORRELIA BORGDORFERI TEST,3001494,CDM,300,RC,86618,HCPCS,outpatient,,,132,52.80,,112.2,85,,89.76,percent of total billed charges,85% of total billed charges,101.64,77,,81.31,percent of total billed charges,77% of total billed charges,17.03,100,,,fee schedule,100% of CMS fee schedule,73.57,350,,,fee schedule,350% of BCBS fee schedule,76.51,364,,,fee schedule,364% of BCBS fee schedule,76.51,364,,,fee schedule,364% of BCBS fee schedule,76.51,364,,,fee schedule,364% of BCBS fee schedule,118.8,90,,95.04,percent of total billed charges,90% of total billed charges,105.6,80,,84.48,percent of total billed charges,80% of total billed charges,118.8,90,,95.04,percent of total billed charges,90% of total billed charges,99,75,,79.2,percent of total billed charges,75% of total billed charges,20.77,122,,,fee schedule,122% of APC rate,38.28,29,,30.624,percent of total billed charges,29% of total billed charges,17.03,100,,,fee schedule,100% of CMS fee schedule,88.44,67,,70.752,percent of total billed charges,67% of total billed charges,25.32,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,105.6,80,,84.48,percent of total billed charges,80% of total billed charges,85.8,65,,68.64,percent of total billed charges,65% of total billed charges,47.08,35.67,,37.664,percent of total billed charges,35.67% of total billed charges,17.03,118.8,
BREAST CANCER ANTIGEN,3001497,CDM,300,RC,86300,HCPCS,outpatient,,,121,48.40,,102.85,85,,82.28,percent of total billed charges,85% of total billed charges,93.17,77,,74.54,percent of total billed charges,77% of total billed charges,20.81,100,,,fee schedule,100% of CMS fee schedule,89.95,350,,,fee schedule,350% of BCBS fee schedule,93.55,364,,,fee schedule,364% of BCBS fee schedule,93.55,364,,,fee schedule,364% of BCBS fee schedule,93.55,364,,,fee schedule,364% of BCBS fee schedule,108.9,90,,87.12,percent of total billed charges,90% of total billed charges,96.8,80,,77.44,percent of total billed charges,80% of total billed charges,108.9,90,,87.12,percent of total billed charges,90% of total billed charges,90.75,75,,72.6,percent of total billed charges,75% of total billed charges,25.38,122,,,fee schedule,122% of APC rate,35.09,29,,28.072,percent of total billed charges,29% of total billed charges,20.81,100,,,fee schedule,100% of CMS fee schedule,81.07,67,,64.856,percent of total billed charges,67% of total billed charges,30.95,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,96.8,80,,77.44,percent of total billed charges,80% of total billed charges,78.65,65,,62.92,percent of total billed charges,65% of total billed charges,43.16,35.67,,34.528,percent of total billed charges,35.67% of total billed charges,20.81,108.9,
TRICHOMONAS URINE AMP IN HOUSE,30015049,CDM,300,RC,87661,HCPCS,outpatient,,,208,83.20,,176.8,85,,141.44,percent of total billed charges,85% of total billed charges,160.16,77,,128.13,percent of total billed charges,77% of total billed charges,35.09,100,,,fee schedule,100% of CMS fee schedule,151.66,350,,,fee schedule,350% of BCBS fee schedule,157.72,364,,,fee schedule,364% of BCBS fee schedule,157.72,364,,,fee schedule,364% of BCBS fee schedule,157.72,364,,,fee schedule,364% of BCBS fee schedule,187.2,90,,149.76,percent of total billed charges,90% of total billed charges,166.4,80,,133.12,percent of total billed charges,80% of total billed charges,187.2,90,,149.76,percent of total billed charges,90% of total billed charges,156,75,,124.8,percent of total billed charges,75% of total billed charges,42.8,122,,,fee schedule,122% of APC rate,60.32,29,,48.256,percent of total billed charges,29% of total billed charges,35.09,100,,,fee schedule,100% of CMS fee schedule,139.36,67,,111.488,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,166.4,80,,133.12,percent of total billed charges,80% of total billed charges,135.2,65,,108.16,percent of total billed charges,65% of total billed charges,74.19,35.67,,59.352,percent of total billed charges,35.67% of total billed charges,35.09,187.2,
BRUCELLA ANTIBODY,3001515,CDM,300,RC,86622,HCPCS,outpatient,,,250,100.00,,212.5,85,,170,percent of total billed charges,85% of total billed charges,192.5,77,,154,percent of total billed charges,77% of total billed charges,8.93,100,,,fee schedule,100% of CMS fee schedule,38.61,350,,,fee schedule,350% of BCBS fee schedule,40.15,364,,,fee schedule,364% of BCBS fee schedule,40.15,364,,,fee schedule,364% of BCBS fee schedule,40.15,364,,,fee schedule,364% of BCBS fee schedule,225,90,,180,percent of total billed charges,90% of total billed charges,200,80,,160,percent of total billed charges,80% of total billed charges,225,90,,180,percent of total billed charges,90% of total billed charges,187.5,75,,150,percent of total billed charges,75% of total billed charges,10.89,122,,,fee schedule,122% of APC rate,72.5,29,,58,percent of total billed charges,29% of total billed charges,8.93,100,,,fee schedule,100% of CMS fee schedule,167.5,67,,134,percent of total billed charges,67% of total billed charges,8.64,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,200,80,,160,percent of total billed charges,80% of total billed charges,162.5,65,,130,percent of total billed charges,65% of total billed charges,89.18,35.67,,71.344,percent of total billed charges,35.67% of total billed charges,8.64,225,
BUN,3001520,CDM,300,RC,84520,HCPCS,outpatient,,,39,15.60,,33.15,85,,26.52,percent of total billed charges,85% of total billed charges,30.03,77,,24.02,percent of total billed charges,77% of total billed charges,3.95,100,,,fee schedule,100% of CMS fee schedule,17.08,350,,,fee schedule,350% of BCBS fee schedule,17.76,364,,,fee schedule,364% of BCBS fee schedule,17.76,364,,,fee schedule,364% of BCBS fee schedule,17.76,364,,,fee schedule,364% of BCBS fee schedule,35.1,90,,28.08,percent of total billed charges,90% of total billed charges,31.2,80,,24.96,percent of total billed charges,80% of total billed charges,35.1,90,,28.08,percent of total billed charges,90% of total billed charges,29.25,75,,23.4,percent of total billed charges,75% of total billed charges,4.81,122,,,fee schedule,122% of APC rate,11.31,29,,9.048,percent of total billed charges,29% of total billed charges,3.95,100,,,fee schedule,100% of CMS fee schedule,26.13,67,,20.904,percent of total billed charges,67% of total billed charges,5.86,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,31.2,80,,24.96,percent of total billed charges,80% of total billed charges,25.35,65,,20.28,percent of total billed charges,65% of total billed charges,13.91,35.67,,11.128,percent of total billed charges,35.67% of total billed charges,3.95,35.1,
CD4/CD8 RATIO,3001585,CDM,300,RC,86360,HCPCS,outpatient,,,231,92.40,,196.35,85,,157.08,percent of total billed charges,85% of total billed charges,177.87,77,,142.3,percent of total billed charges,77% of total billed charges,46.98,100,,,fee schedule,100% of CMS fee schedule,203.04,350,,,fee schedule,350% of BCBS fee schedule,211.16,364,,,fee schedule,364% of BCBS fee schedule,211.16,364,,,fee schedule,364% of BCBS fee schedule,211.16,364,,,fee schedule,364% of BCBS fee schedule,207.9,90,,166.32,percent of total billed charges,90% of total billed charges,184.8,80,,147.84,percent of total billed charges,80% of total billed charges,207.9,90,,166.32,percent of total billed charges,90% of total billed charges,173.25,75,,138.6,percent of total billed charges,75% of total billed charges,57.31,122,,,fee schedule,122% of APC rate,66.99,29,,53.592,percent of total billed charges,29% of total billed charges,46.98,100,,,fee schedule,100% of CMS fee schedule,154.77,67,,123.816,percent of total billed charges,67% of total billed charges,69.87,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,184.8,80,,147.84,percent of total billed charges,80% of total billed charges,150.15,65,,120.12,percent of total billed charges,65% of total billed charges,82.4,35.67,,65.92,percent of total billed charges,35.67% of total billed charges,46.98,211.16,
C-REACTIVE PROTEIN,3001620,CDM,300,RC,86140,HCPCS,outpatient,,,85,34.00,,72.25,85,,57.8,percent of total billed charges,85% of total billed charges,65.45,77,,52.36,percent of total billed charges,77% of total billed charges,5.18,100,,,fee schedule,100% of CMS fee schedule,22.37,350,,,fee schedule,350% of BCBS fee schedule,23.26,364,,,fee schedule,364% of BCBS fee schedule,23.26,364,,,fee schedule,364% of BCBS fee schedule,23.26,364,,,fee schedule,364% of BCBS fee schedule,76.5,90,,61.2,percent of total billed charges,90% of total billed charges,68,80,,54.4,percent of total billed charges,80% of total billed charges,76.5,90,,61.2,percent of total billed charges,90% of total billed charges,63.75,75,,51,percent of total billed charges,75% of total billed charges,6.31,122,,,fee schedule,122% of APC rate,24.65,29,,19.72,percent of total billed charges,29% of total billed charges,5.18,100,,,fee schedule,100% of CMS fee schedule,56.95,67,,45.56,percent of total billed charges,67% of total billed charges,7.69,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,68,80,,54.4,percent of total billed charges,80% of total billed charges,55.25,65,,44.2,percent of total billed charges,65% of total billed charges,30.32,35.67,,24.256,percent of total billed charges,35.67% of total billed charges,5.18,76.5,
C-REACTIVE PROTEIN ULTRAQUANT,3001621,CDM,300,RC,86140,HCPCS,outpatient,,,213,85.20,,181.05,85,,144.84,percent of total billed charges,85% of total billed charges,164.01,77,,131.21,percent of total billed charges,77% of total billed charges,5.18,100,,,fee schedule,100% of CMS fee schedule,22.37,350,,,fee schedule,350% of BCBS fee schedule,23.26,364,,,fee schedule,364% of BCBS fee schedule,23.26,364,,,fee schedule,364% of BCBS fee schedule,23.26,364,,,fee schedule,364% of BCBS fee schedule,191.7,90,,153.36,percent of total billed charges,90% of total billed charges,170.4,80,,136.32,percent of total billed charges,80% of total billed charges,191.7,90,,153.36,percent of total billed charges,90% of total billed charges,159.75,75,,127.8,percent of total billed charges,75% of total billed charges,6.31,122,,,fee schedule,122% of APC rate,61.77,29,,49.416,percent of total billed charges,29% of total billed charges,5.18,100,,,fee schedule,100% of CMS fee schedule,142.71,67,,114.168,percent of total billed charges,67% of total billed charges,7.69,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,170.4,80,,136.32,percent of total billed charges,80% of total billed charges,138.45,65,,110.76,percent of total billed charges,65% of total billed charges,75.98,35.67,,60.784,percent of total billed charges,35.67% of total billed charges,5.18,191.7,
GLIADIN AB,3001622,CDM,300,RC,86258,HCPCS,outpatient,,,40,16.00,,34,85,,27.2,percent of total billed charges,85% of total billed charges,30.8,77,,24.64,percent of total billed charges,77% of total billed charges,12.05,100,,,fee schedule,100% of CMS fee schedule,40.36,350,,,fee schedule,350% of BCBS fee schedule,41.97,364,,,fee schedule,364% of BCBS fee schedule,41.97,364,,,fee schedule,364% of BCBS fee schedule,41.97,364,,,fee schedule,364% of BCBS fee schedule,36,90,,28.8,percent of total billed charges,90% of total billed charges,32,80,,25.6,percent of total billed charges,80% of total billed charges,36,90,,28.8,percent of total billed charges,90% of total billed charges,30,75,,24,percent of total billed charges,75% of total billed charges,14.7,122,,,fee schedule,122% of APC rate,11.6,29,,9.28,percent of total billed charges,29% of total billed charges,12.05,100,,,fee schedule,100% of CMS fee schedule,26.8,67,,21.44,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,32,80,,25.6,percent of total billed charges,80% of total billed charges,26,65,,20.8,percent of total billed charges,65% of total billed charges,14.27,35.67,,11.416,percent of total billed charges,35.67% of total billed charges,11.6,41.97,
C1 ESTERASE,3001640,CDM,300,RC,86161,HCPCS,outpatient,,,121,48.40,,102.85,85,,82.28,percent of total billed charges,85% of total billed charges,93.17,77,,74.54,percent of total billed charges,77% of total billed charges,12,100,,,fee schedule,100% of CMS fee schedule,51.84,350,,,fee schedule,350% of BCBS fee schedule,53.91,364,,,fee schedule,364% of BCBS fee schedule,53.91,364,,,fee schedule,364% of BCBS fee schedule,53.91,364,,,fee schedule,364% of BCBS fee schedule,108.9,90,,87.12,percent of total billed charges,90% of total billed charges,96.8,80,,77.44,percent of total billed charges,80% of total billed charges,108.9,90,,87.12,percent of total billed charges,90% of total billed charges,90.75,75,,72.6,percent of total billed charges,75% of total billed charges,14.64,122,,,fee schedule,122% of APC rate,35.09,29,,28.072,percent of total billed charges,29% of total billed charges,12,100,,,fee schedule,100% of CMS fee schedule,81.07,67,,64.856,percent of total billed charges,67% of total billed charges,17.86,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,96.8,80,,77.44,percent of total billed charges,80% of total billed charges,78.65,65,,62.92,percent of total billed charges,65% of total billed charges,43.16,35.67,,34.528,percent of total billed charges,35.67% of total billed charges,12,108.9,
CA 125,3001660,CDM,300,RC,86304,HCPCS,outpatient,,,133,53.20,,113.05,85,,90.44,percent of total billed charges,85% of total billed charges,102.41,77,,81.93,percent of total billed charges,77% of total billed charges,20.81,100,,,fee schedule,100% of CMS fee schedule,89.95,350,,,fee schedule,350% of BCBS fee schedule,93.55,364,,,fee schedule,364% of BCBS fee schedule,93.55,364,,,fee schedule,364% of BCBS fee schedule,93.55,364,,,fee schedule,364% of BCBS fee schedule,119.7,90,,95.76,percent of total billed charges,90% of total billed charges,106.4,80,,85.12,percent of total billed charges,80% of total billed charges,119.7,90,,95.76,percent of total billed charges,90% of total billed charges,99.75,75,,79.8,percent of total billed charges,75% of total billed charges,25.38,122,,,fee schedule,122% of APC rate,38.57,29,,30.856,percent of total billed charges,29% of total billed charges,20.81,100,,,fee schedule,100% of CMS fee schedule,89.11,67,,71.288,percent of total billed charges,67% of total billed charges,30.95,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,106.4,80,,85.12,percent of total billed charges,80% of total billed charges,86.45,65,,69.16,percent of total billed charges,65% of total billed charges,47.44,35.67,,37.952,percent of total billed charges,35.67% of total billed charges,20.81,119.7,
CA 15-3,3001680,CDM,300,RC,86300,HCPCS,outpatient,,,131,52.40,,111.35,85,,89.08,percent of total billed charges,85% of total billed charges,100.87,77,,80.7,percent of total billed charges,77% of total billed charges,20.81,100,,,fee schedule,100% of CMS fee schedule,89.95,350,,,fee schedule,350% of BCBS fee schedule,93.55,364,,,fee schedule,364% of BCBS fee schedule,93.55,364,,,fee schedule,364% of BCBS fee schedule,93.55,364,,,fee schedule,364% of BCBS fee schedule,117.9,90,,94.32,percent of total billed charges,90% of total billed charges,104.8,80,,83.84,percent of total billed charges,80% of total billed charges,117.9,90,,94.32,percent of total billed charges,90% of total billed charges,98.25,75,,78.6,percent of total billed charges,75% of total billed charges,25.38,122,,,fee schedule,122% of APC rate,37.99,29,,30.392,percent of total billed charges,29% of total billed charges,20.81,100,,,fee schedule,100% of CMS fee schedule,87.77,67,,70.216,percent of total billed charges,67% of total billed charges,30.95,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,104.8,80,,83.84,percent of total billed charges,80% of total billed charges,85.15,65,,68.12,percent of total billed charges,65% of total billed charges,46.73,35.67,,37.384,percent of total billed charges,35.67% of total billed charges,20.81,117.9,
CA 19-9,3001700,CDM,300,RC,86301,HCPCS,outpatient,,,131,52.40,,111.35,85,,89.08,percent of total billed charges,85% of total billed charges,100.87,77,,80.7,percent of total billed charges,77% of total billed charges,20.81,100,,,fee schedule,100% of CMS fee schedule,89.95,350,,,fee schedule,350% of BCBS fee schedule,93.55,364,,,fee schedule,364% of BCBS fee schedule,93.55,364,,,fee schedule,364% of BCBS fee schedule,93.55,364,,,fee schedule,364% of BCBS fee schedule,117.9,90,,94.32,percent of total billed charges,90% of total billed charges,104.8,80,,83.84,percent of total billed charges,80% of total billed charges,117.9,90,,94.32,percent of total billed charges,90% of total billed charges,98.25,75,,78.6,percent of total billed charges,75% of total billed charges,25.38,122,,,fee schedule,122% of APC rate,37.99,29,,30.392,percent of total billed charges,29% of total billed charges,20.81,100,,,fee schedule,100% of CMS fee schedule,87.77,67,,70.216,percent of total billed charges,67% of total billed charges,30.95,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,104.8,80,,83.84,percent of total billed charges,80% of total billed charges,85.15,65,,68.12,percent of total billed charges,65% of total billed charges,46.73,35.67,,37.384,percent of total billed charges,35.67% of total billed charges,20.81,117.9,
CALCITONIN,3001740,CDM,300,RC,82308,HCPCS,outpatient,,,151,60.40,,128.35,85,,102.68,percent of total billed charges,85% of total billed charges,116.27,77,,93.02,percent of total billed charges,77% of total billed charges,26.79,100,,,fee schedule,100% of CMS fee schedule,115.78,350,,,fee schedule,350% of BCBS fee schedule,120.41,364,,,fee schedule,364% of BCBS fee schedule,120.41,364,,,fee schedule,364% of BCBS fee schedule,120.41,364,,,fee schedule,364% of BCBS fee schedule,135.9,90,,108.72,percent of total billed charges,90% of total billed charges,120.8,80,,96.64,percent of total billed charges,80% of total billed charges,135.9,90,,108.72,percent of total billed charges,90% of total billed charges,113.25,75,,90.6,percent of total billed charges,75% of total billed charges,32.68,122,,,fee schedule,122% of APC rate,43.79,29,,35.032,percent of total billed charges,29% of total billed charges,26.79,100,,,fee schedule,100% of CMS fee schedule,101.17,67,,80.936,percent of total billed charges,67% of total billed charges,39.82,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,120.8,80,,96.64,percent of total billed charges,80% of total billed charges,98.15,65,,78.52,percent of total billed charges,65% of total billed charges,53.86,35.67,,43.088,percent of total billed charges,35.67% of total billed charges,26.79,135.9,
CALCIUM,3001760,CDM,300,RC,82310,HCPCS,outpatient,,,48,19.20,,40.8,85,,32.64,percent of total billed charges,85% of total billed charges,36.96,77,,29.57,percent of total billed charges,77% of total billed charges,5.16,100,,,fee schedule,100% of CMS fee schedule,22.3,350,,,fee schedule,350% of BCBS fee schedule,23.19,364,,,fee schedule,364% of BCBS fee schedule,23.19,364,,,fee schedule,364% of BCBS fee schedule,23.19,364,,,fee schedule,364% of BCBS fee schedule,43.2,90,,34.56,percent of total billed charges,90% of total billed charges,38.4,80,,30.72,percent of total billed charges,80% of total billed charges,43.2,90,,34.56,percent of total billed charges,90% of total billed charges,36,75,,28.8,percent of total billed charges,75% of total billed charges,6.29,122,,,fee schedule,122% of APC rate,13.92,29,,11.136,percent of total billed charges,29% of total billed charges,5.16,100,,,fee schedule,100% of CMS fee schedule,32.16,67,,25.728,percent of total billed charges,67% of total billed charges,7.66,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,38.4,80,,30.72,percent of total billed charges,80% of total billed charges,31.2,65,,24.96,percent of total billed charges,65% of total billed charges,17.12,35.67,,13.696,percent of total billed charges,35.67% of total billed charges,5.16,43.2,
CALCIUM URINE QUANT,3001800,CDM,300,RC,82340,HCPCS,outpatient,,,50,20.00,,42.5,85,,34,percent of total billed charges,85% of total billed charges,38.5,77,,30.8,percent of total billed charges,77% of total billed charges,6.03,100,,,fee schedule,100% of CMS fee schedule,26.04,350,,,fee schedule,350% of BCBS fee schedule,27.08,364,,,fee schedule,364% of BCBS fee schedule,27.08,364,,,fee schedule,364% of BCBS fee schedule,27.08,364,,,fee schedule,364% of BCBS fee schedule,45,90,,36,percent of total billed charges,90% of total billed charges,40,80,,32,percent of total billed charges,80% of total billed charges,45,90,,36,percent of total billed charges,90% of total billed charges,37.5,75,,30,percent of total billed charges,75% of total billed charges,7.35,122,,,fee schedule,122% of APC rate,14.5,29,,11.6,percent of total billed charges,29% of total billed charges,6.03,100,,,fee schedule,100% of CMS fee schedule,33.5,67,,26.8,percent of total billed charges,67% of total billed charges,8.96,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,40,80,,32,percent of total billed charges,80% of total billed charges,32.5,65,,26,percent of total billed charges,65% of total billed charges,17.84,35.67,,14.272,percent of total billed charges,35.67% of total billed charges,6.03,45,
CALCULI URINARY - ANALYSIS,3001815,CDM,300,RC,82360,HCPCS,outpatient,,,84,33.60,,71.4,85,,57.12,percent of total billed charges,85% of total billed charges,64.68,77,,51.74,percent of total billed charges,77% of total billed charges,12.87,100,,,fee schedule,100% of CMS fee schedule,55.62,350,,,fee schedule,350% of BCBS fee schedule,57.84,364,,,fee schedule,364% of BCBS fee schedule,57.84,364,,,fee schedule,364% of BCBS fee schedule,57.84,364,,,fee schedule,364% of BCBS fee schedule,75.6,90,,60.48,percent of total billed charges,90% of total billed charges,67.2,80,,53.76,percent of total billed charges,80% of total billed charges,75.6,90,,60.48,percent of total billed charges,90% of total billed charges,63,75,,50.4,percent of total billed charges,75% of total billed charges,15.7,122,,,fee schedule,122% of APC rate,24.36,29,,19.488,percent of total billed charges,29% of total billed charges,12.87,100,,,fee schedule,100% of CMS fee schedule,56.28,67,,45.024,percent of total billed charges,67% of total billed charges,19.14,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,67.2,80,,53.76,percent of total billed charges,80% of total billed charges,54.6,65,,43.68,percent of total billed charges,65% of total billed charges,29.96,35.67,,23.968,percent of total billed charges,35.67% of total billed charges,12.87,75.6,
CANDIDA SPECIES DIRECT PROBE,3001817,CDM,300,RC,87480,HCPCS,outpatient,,,98,39.20,,83.3,85,,66.64,percent of total billed charges,85% of total billed charges,75.46,77,,60.37,percent of total billed charges,77% of total billed charges,20.05,100,,,fee schedule,100% of CMS fee schedule,86.66,350,,,fee schedule,350% of BCBS fee schedule,90.13,364,,,fee schedule,364% of BCBS fee schedule,90.13,364,,,fee schedule,364% of BCBS fee schedule,90.13,364,,,fee schedule,364% of BCBS fee schedule,88.2,90,,70.56,percent of total billed charges,90% of total billed charges,78.4,80,,62.72,percent of total billed charges,80% of total billed charges,88.2,90,,70.56,percent of total billed charges,90% of total billed charges,73.5,75,,58.8,percent of total billed charges,75% of total billed charges,24.46,122,,,fee schedule,122% of APC rate,28.42,29,,22.736,percent of total billed charges,29% of total billed charges,20.05,100,,,fee schedule,100% of CMS fee schedule,65.66,67,,52.528,percent of total billed charges,67% of total billed charges,29.82,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,78.4,80,,62.72,percent of total billed charges,80% of total billed charges,63.7,65,,50.96,percent of total billed charges,65% of total billed charges,34.96,35.67,,27.968,percent of total billed charges,35.67% of total billed charges,20.05,90.13,
CAMPLYLOBACTER STOOL,3001818,CDM,300,RC,87046,HCPCS,outpatient,,,100,40.00,,85,85,,68,percent of total billed charges,85% of total billed charges,77,77,,61.6,percent of total billed charges,77% of total billed charges,9.44,100,,,fee schedule,100% of CMS fee schedule,40.81,350,,,fee schedule,350% of BCBS fee schedule,42.44,364,,,fee schedule,364% of BCBS fee schedule,42.44,364,,,fee schedule,364% of BCBS fee schedule,42.44,364,,,fee schedule,364% of BCBS fee schedule,90,90,,72,percent of total billed charges,90% of total billed charges,80,80,,64,percent of total billed charges,80% of total billed charges,90,90,,72,percent of total billed charges,90% of total billed charges,75,75,,60,percent of total billed charges,75% of total billed charges,11.51,122,,,fee schedule,122% of APC rate,29,29,,23.2,percent of total billed charges,29% of total billed charges,9.44,100,,,fee schedule,100% of CMS fee schedule,67,67,,53.6,percent of total billed charges,67% of total billed charges,14.02,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,80,80,,64,percent of total billed charges,80% of total billed charges,65,65,,52,percent of total billed charges,65% of total billed charges,35.67,35.67,,28.536,percent of total billed charges,35.67% of total billed charges,9.44,90,
CANDIDA ANTIGEN,3001819,CDM,300,RC,87449,HCPCS,outpatient,,,59,23.60,,50.15,85,,40.12,percent of total billed charges,85% of total billed charges,45.43,77,,36.34,percent of total billed charges,77% of total billed charges,11.98,100,,,fee schedule,100% of CMS fee schedule,51.8,350,,,fee schedule,350% of BCBS fee schedule,53.87,364,,,fee schedule,364% of BCBS fee schedule,53.87,364,,,fee schedule,364% of BCBS fee schedule,53.87,364,,,fee schedule,364% of BCBS fee schedule,53.1,90,,42.48,percent of total billed charges,90% of total billed charges,47.2,80,,37.76,percent of total billed charges,80% of total billed charges,53.1,90,,42.48,percent of total billed charges,90% of total billed charges,44.25,75,,35.4,percent of total billed charges,75% of total billed charges,14.61,122,,,fee schedule,122% of APC rate,17.11,29,,13.688,percent of total billed charges,29% of total billed charges,11.98,100,,,fee schedule,100% of CMS fee schedule,39.53,67,,31.624,percent of total billed charges,67% of total billed charges,15.41,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,47.2,80,,37.76,percent of total billed charges,80% of total billed charges,38.35,65,,30.68,percent of total billed charges,65% of total billed charges,21.05,35.67,,16.84,percent of total billed charges,35.67% of total billed charges,11.98,53.87,
CARBAMAZEPINE (TEGRETOL),3001820,CDM,300,RC,80161,HCPCS,outpatient,,,95,38.00,,80.75,85,,64.6,percent of total billed charges,85% of total billed charges,73.15,77,,58.52,percent of total billed charges,77% of total billed charges,18.64,100,,,fee schedule,100% of CMS fee schedule,65.24,350,,,fee schedule,350% of BCBS fee schedule,67.85,364,,,fee schedule,364% of BCBS fee schedule,67.85,364,,,fee schedule,364% of BCBS fee schedule,67.85,364,,,fee schedule,364% of BCBS fee schedule,85.5,90,,68.4,percent of total billed charges,90% of total billed charges,76,80,,60.8,percent of total billed charges,80% of total billed charges,85.5,90,,68.4,percent of total billed charges,90% of total billed charges,71.25,75,,57,percent of total billed charges,75% of total billed charges,22.74,122,,,fee schedule,122% of APC rate,27.55,29,,22.04,percent of total billed charges,29% of total billed charges,18.64,100,,,fee schedule,100% of CMS fee schedule,63.65,67,,50.92,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,76,80,,60.8,percent of total billed charges,80% of total billed charges,61.75,65,,49.4,percent of total billed charges,65% of total billed charges,33.89,35.67,,27.112,percent of total billed charges,35.67% of total billed charges,18.64,85.5,
CANDIDA SKIN TEST,3001821,CDM,300,RC,86485,HCPCS,outpatient,,,410,164.00,,348.5,85,,278.8,percent of total billed charges,85% of total billed charges,315.7,77,,252.56,percent of total billed charges,77% of total billed charges,26.03,100,,,fee schedule,100% of CMS OPPS rate,111.3,350,,,fee schedule,350% of BCBS fee schedule,115.75,364,,,fee schedule,364% of BCBS fee schedule,115.75,364,,,fee schedule,364% of BCBS fee schedule,115.75,364,,,fee schedule,364% of BCBS fee schedule,369,90,,295.2,percent of total billed charges,90% of total billed charges,328,80,,262.4,percent of total billed charges,80% of total billed charges,369,90,,295.2,percent of total billed charges,90% of total billed charges,307.5,75,,246,percent of total billed charges,75% of total billed charges,31.76,122,,,fee schedule,122% of APC rate,118.9,29,,95.12,percent of total billed charges,29% of total billed charges,26.03,100,,,fee schedule,100% of CMS OPPS rate,274.7,67,,219.76,percent of total billed charges,67% of total billed charges,5.3,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,328,80,,262.4,percent of total billed charges,80% of total billed charges,266.5,65,,213.2,percent of total billed charges,65% of total billed charges,146.25,35.67,,117,percent of total billed charges,35.67% of total billed charges,5.3,369,
STOOL PATHOGEN PANEL BY PCR,3001830,CDM,300,RC,87507,HCPCS,outpatient,,,1289,515.60,,1095.65,85,,876.52,percent of total billed charges,85% of total billed charges,992.53,77,,794.02,percent of total billed charges,77% of total billed charges,416.78,100,,,fee schedule,100% of CMS fee schedule,1800.93,350,,,fee schedule,350% of BCBS fee schedule,1872.96,364,,,fee schedule,364% of BCBS fee schedule,1872.96,364,,,fee schedule,364% of BCBS fee schedule,1872.96,364,,,fee schedule,364% of BCBS fee schedule,1160.1,90,,928.08,percent of total billed charges,90% of total billed charges,1031.2,80,,824.96,percent of total billed charges,80% of total billed charges,1160.1,90,,928.08,percent of total billed charges,90% of total billed charges,966.75,75,,773.4,percent of total billed charges,75% of total billed charges,508.47,122,,,fee schedule,122% of APC rate,373.81,29,,299.048,percent of total billed charges,29% of total billed charges,416.78,100,,,fee schedule,100% of CMS fee schedule,863.63,67,,690.904,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1031.2,80,,824.96,percent of total billed charges,80% of total billed charges,837.85,65,,670.28,percent of total billed charges,65% of total billed charges,459.79,35.67,,367.832,percent of total billed charges,35.67% of total billed charges,373.81,1872.96,
CARBON DIOXIDE,3001840,CDM,300,RC,82374,HCPCS,outpatient,,,25,10.00,,21.25,85,,17,percent of total billed charges,85% of total billed charges,19.25,77,,15.4,percent of total billed charges,77% of total billed charges,4.88,100,,,fee schedule,100% of CMS fee schedule,21.11,350,,,fee schedule,350% of BCBS fee schedule,21.95,364,,,fee schedule,364% of BCBS fee schedule,21.95,364,,,fee schedule,364% of BCBS fee schedule,21.95,364,,,fee schedule,364% of BCBS fee schedule,22.5,90,,18,percent of total billed charges,90% of total billed charges,20,80,,16,percent of total billed charges,80% of total billed charges,22.5,90,,18,percent of total billed charges,90% of total billed charges,18.75,75,,15,percent of total billed charges,75% of total billed charges,5.95,122,,,fee schedule,122% of APC rate,7.25,29,,5.8,percent of total billed charges,29% of total billed charges,4.88,100,,,fee schedule,100% of CMS fee schedule,16.75,67,,13.4,percent of total billed charges,67% of total billed charges,7.27,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,20,80,,16,percent of total billed charges,80% of total billed charges,16.25,65,,13,percent of total billed charges,65% of total billed charges,8.92,35.67,,7.136,percent of total billed charges,35.67% of total billed charges,4.88,22.5,
CARDIAC PROFILE-REPEAT SAMEDAY,3001848,CDM,300,RC,,,outpatient,,,371,148.40,,315.35,85,,252.28,percent of total billed charges,85% of total billed charges,285.67,77,,228.54,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,304.22,82,,243.376,percent of total billed charges,82% of total billed charges,315.35,85,,252.28,percent of total billed charges,85% of total billed charges,315.35,85,,252.28,percent of total billed charges,85% of total billed charges,315.35,85,,252.28,percent of total billed charges,85% of total billed charges,333.9,90,,267.12,percent of total billed charges,90% of total billed charges,296.8,80,,237.44,percent of total billed charges,80% of total billed charges,333.9,90,,267.12,percent of total billed charges,90% of total billed charges,278.25,75,,222.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,107.59,29,,86.072,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,248.57,67,,198.856,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,296.8,80,,237.44,percent of total billed charges,80% of total billed charges,241.15,65,,192.92,percent of total billed charges,65% of total billed charges,132.34,35.67,,105.872,percent of total billed charges,35.67% of total billed charges,107.59,333.9,
CARBOXYHEMOGLOBIN,3001860,CDM,300,RC,82375,HCPCS,outpatient,,,76,30.40,,64.6,85,,51.68,percent of total billed charges,85% of total billed charges,58.52,77,,46.82,percent of total billed charges,77% of total billed charges,12.32,100,,,fee schedule,100% of CMS fee schedule,53.24,350,,,fee schedule,350% of BCBS fee schedule,55.36,364,,,fee schedule,364% of BCBS fee schedule,55.36,364,,,fee schedule,364% of BCBS fee schedule,55.36,364,,,fee schedule,364% of BCBS fee schedule,68.4,90,,54.72,percent of total billed charges,90% of total billed charges,60.8,80,,48.64,percent of total billed charges,80% of total billed charges,68.4,90,,54.72,percent of total billed charges,90% of total billed charges,57,75,,45.6,percent of total billed charges,75% of total billed charges,15.03,122,,,fee schedule,122% of APC rate,22.04,29,,17.632,percent of total billed charges,29% of total billed charges,12.32,100,,,fee schedule,100% of CMS fee schedule,50.92,67,,40.736,percent of total billed charges,67% of total billed charges,18.33,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,60.8,80,,48.64,percent of total billed charges,80% of total billed charges,49.4,65,,39.52,percent of total billed charges,65% of total billed charges,27.11,35.67,,21.688,percent of total billed charges,35.67% of total billed charges,12.32,68.4,
CARBOHYDRATE DEF. TRANSFERRIN,3001861,CDM,300,RC,82373,HCPCS,outpatient,,,240,96.00,,204,85,,163.2,percent of total billed charges,85% of total billed charges,184.8,77,,147.84,percent of total billed charges,77% of total billed charges,18.05,100,,,fee schedule,100% of CMS fee schedule,78.02,350,,,fee schedule,350% of BCBS fee schedule,81.14,364,,,fee schedule,364% of BCBS fee schedule,81.14,364,,,fee schedule,364% of BCBS fee schedule,81.14,364,,,fee schedule,364% of BCBS fee schedule,216,90,,172.8,percent of total billed charges,90% of total billed charges,192,80,,153.6,percent of total billed charges,80% of total billed charges,216,90,,172.8,percent of total billed charges,90% of total billed charges,180,75,,144,percent of total billed charges,75% of total billed charges,22.03,122,,,fee schedule,122% of APC rate,69.6,29,,55.68,percent of total billed charges,29% of total billed charges,18.05,100,,,fee schedule,100% of CMS fee schedule,160.8,67,,128.64,percent of total billed charges,67% of total billed charges,26.84,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,192,80,,153.6,percent of total billed charges,80% of total billed charges,156,65,,124.8,percent of total billed charges,65% of total billed charges,85.61,35.67,,68.488,percent of total billed charges,35.67% of total billed charges,18.05,216,
CAROTENE,3001880,CDM,300,RC,82380,HCPCS,outpatient,,,59,23.60,,50.15,85,,40.12,percent of total billed charges,85% of total billed charges,45.43,77,,36.34,percent of total billed charges,77% of total billed charges,9.22,100,,,fee schedule,100% of CMS fee schedule,39.87,350,,,fee schedule,350% of BCBS fee schedule,41.46,364,,,fee schedule,364% of BCBS fee schedule,41.46,364,,,fee schedule,364% of BCBS fee schedule,41.46,364,,,fee schedule,364% of BCBS fee schedule,53.1,90,,42.48,percent of total billed charges,90% of total billed charges,47.2,80,,37.76,percent of total billed charges,80% of total billed charges,53.1,90,,42.48,percent of total billed charges,90% of total billed charges,44.25,75,,35.4,percent of total billed charges,75% of total billed charges,11.24,122,,,fee schedule,122% of APC rate,17.11,29,,13.688,percent of total billed charges,29% of total billed charges,9.22,100,,,fee schedule,100% of CMS fee schedule,39.53,67,,31.624,percent of total billed charges,67% of total billed charges,13.71,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,47.2,80,,37.76,percent of total billed charges,80% of total billed charges,38.35,65,,30.68,percent of total billed charges,65% of total billed charges,21.05,35.67,,16.84,percent of total billed charges,35.67% of total billed charges,9.22,53.1,
CATECHOLAMINES TOTAL,3001900,CDM,300,RC,82382,HCPCS,outpatient,,,146,58.40,,124.1,85,,99.28,percent of total billed charges,85% of total billed charges,112.42,77,,89.94,percent of total billed charges,77% of total billed charges,27.3,100,,,fee schedule,100% of CMS fee schedule,95.55,350,,,fee schedule,350% of BCBS fee schedule,99.37,364,,,fee schedule,364% of BCBS fee schedule,99.37,364,,,fee schedule,364% of BCBS fee schedule,99.37,364,,,fee schedule,364% of BCBS fee schedule,131.4,90,,105.12,percent of total billed charges,90% of total billed charges,116.8,80,,93.44,percent of total billed charges,80% of total billed charges,131.4,90,,105.12,percent of total billed charges,90% of total billed charges,109.5,75,,87.6,percent of total billed charges,75% of total billed charges,33.3,122,,,fee schedule,122% of APC rate,42.34,29,,33.872,percent of total billed charges,29% of total billed charges,27.3,100,,,fee schedule,100% of CMS fee schedule,97.82,67,,78.256,percent of total billed charges,67% of total billed charges,25.47,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,116.8,80,,93.44,percent of total billed charges,80% of total billed charges,94.9,65,,75.92,percent of total billed charges,65% of total billed charges,52.08,35.67,,41.664,percent of total billed charges,35.67% of total billed charges,25.47,131.4,
CATECHOLAMINES PLASMA,3001901,CDM,300,RC,82384,HCPCS,outpatient,,,168,67.20,,142.8,85,,114.24,percent of total billed charges,85% of total billed charges,129.36,77,,103.49,percent of total billed charges,77% of total billed charges,25.25,100,,,fee schedule,100% of CMS fee schedule,109.13,350,,,fee schedule,350% of BCBS fee schedule,113.5,364,,,fee schedule,364% of BCBS fee schedule,113.5,364,,,fee schedule,364% of BCBS fee schedule,113.5,364,,,fee schedule,364% of BCBS fee schedule,151.2,90,,120.96,percent of total billed charges,90% of total billed charges,134.4,80,,107.52,percent of total billed charges,80% of total billed charges,151.2,90,,120.96,percent of total billed charges,90% of total billed charges,126,75,,100.8,percent of total billed charges,75% of total billed charges,30.8,122,,,fee schedule,122% of APC rate,48.72,29,,38.976,percent of total billed charges,29% of total billed charges,25.25,100,,,fee schedule,100% of CMS fee schedule,112.56,67,,90.048,percent of total billed charges,67% of total billed charges,25.47,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,134.4,80,,107.52,percent of total billed charges,80% of total billed charges,109.2,65,,87.36,percent of total billed charges,65% of total billed charges,59.93,35.67,,47.944,percent of total billed charges,35.67% of total billed charges,25.25,151.2,
CEA,3001920,CDM,300,RC,82378,HCPCS,outpatient,,,128,51.20,,108.8,85,,87.04,percent of total billed charges,85% of total billed charges,98.56,77,,78.85,percent of total billed charges,77% of total billed charges,18.96,100,,,fee schedule,100% of CMS fee schedule,81.94,350,,,fee schedule,350% of BCBS fee schedule,85.21,364,,,fee schedule,364% of BCBS fee schedule,85.21,364,,,fee schedule,364% of BCBS fee schedule,85.21,364,,,fee schedule,364% of BCBS fee schedule,115.2,90,,92.16,percent of total billed charges,90% of total billed charges,102.4,80,,81.92,percent of total billed charges,80% of total billed charges,115.2,90,,92.16,percent of total billed charges,90% of total billed charges,96,75,,76.8,percent of total billed charges,75% of total billed charges,23.13,122,,,fee schedule,122% of APC rate,37.12,29,,29.696,percent of total billed charges,29% of total billed charges,18.96,100,,,fee schedule,100% of CMS fee schedule,85.76,67,,68.608,percent of total billed charges,67% of total billed charges,28.21,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,102.4,80,,81.92,percent of total billed charges,80% of total billed charges,83.2,65,,66.56,percent of total billed charges,65% of total billed charges,45.66,35.67,,36.528,percent of total billed charges,35.67% of total billed charges,18.96,115.2,
CELL CT/DIFF CSF,3001940,CDM,300,RC,89051,HCPCS,outpatient,,,84,33.60,,71.4,85,,57.12,percent of total billed charges,85% of total billed charges,64.68,77,,51.74,percent of total billed charges,77% of total billed charges,5.6,100,,,fee schedule,100% of CMS fee schedule,23.8,350,,,fee schedule,350% of BCBS fee schedule,24.75,364,,,fee schedule,364% of BCBS fee schedule,24.75,364,,,fee schedule,364% of BCBS fee schedule,24.75,364,,,fee schedule,364% of BCBS fee schedule,75.6,90,,60.48,percent of total billed charges,90% of total billed charges,67.2,80,,53.76,percent of total billed charges,80% of total billed charges,75.6,90,,60.48,percent of total billed charges,90% of total billed charges,63,75,,50.4,percent of total billed charges,75% of total billed charges,6.83,122,,,fee schedule,122% of APC rate,24.36,29,,19.488,percent of total billed charges,29% of total billed charges,5.6,100,,,fee schedule,100% of CMS fee schedule,56.28,67,,45.024,percent of total billed charges,67% of total billed charges,6.38,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,67.2,80,,53.76,percent of total billed charges,80% of total billed charges,54.6,65,,43.68,percent of total billed charges,65% of total billed charges,29.96,35.67,,23.968,percent of total billed charges,35.67% of total billed charges,5.6,75.6,
CELL CT/DIFF BODY FLUIDS,3001980,CDM,300,RC,89051,HCPCS,outpatient,,,85,34.00,,72.25,85,,57.8,percent of total billed charges,85% of total billed charges,65.45,77,,52.36,percent of total billed charges,77% of total billed charges,5.6,100,,,fee schedule,100% of CMS fee schedule,23.8,350,,,fee schedule,350% of BCBS fee schedule,24.75,364,,,fee schedule,364% of BCBS fee schedule,24.75,364,,,fee schedule,364% of BCBS fee schedule,24.75,364,,,fee schedule,364% of BCBS fee schedule,76.5,90,,61.2,percent of total billed charges,90% of total billed charges,68,80,,54.4,percent of total billed charges,80% of total billed charges,76.5,90,,61.2,percent of total billed charges,90% of total billed charges,63.75,75,,51,percent of total billed charges,75% of total billed charges,6.83,122,,,fee schedule,122% of APC rate,24.65,29,,19.72,percent of total billed charges,29% of total billed charges,5.6,100,,,fee schedule,100% of CMS fee schedule,56.95,67,,45.56,percent of total billed charges,67% of total billed charges,6.38,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,68,80,,54.4,percent of total billed charges,80% of total billed charges,55.25,65,,44.2,percent of total billed charges,65% of total billed charges,30.32,35.67,,24.256,percent of total billed charges,35.67% of total billed charges,5.6,76.5,
INFECTIOUS AGENT NUC ACID EXP,3001997,CDM,300,RC,87633,HCPCS,outpatient,,,558,223.20,,474.3,85,,379.44,percent of total billed charges,85% of total billed charges,429.66,77,,343.73,percent of total billed charges,77% of total billed charges,416.78,100,,,fee schedule,100% of CMS fee schedule,1800.93,350,,,fee schedule,350% of BCBS fee schedule,1872.96,364,,,fee schedule,364% of BCBS fee schedule,1872.96,364,,,fee schedule,364% of BCBS fee schedule,1872.96,364,,,fee schedule,364% of BCBS fee schedule,502.2,90,,401.76,percent of total billed charges,90% of total billed charges,446.4,80,,357.12,percent of total billed charges,80% of total billed charges,502.2,90,,401.76,percent of total billed charges,90% of total billed charges,418.5,75,,334.8,percent of total billed charges,75% of total billed charges,508.47,122,,,fee schedule,122% of APC rate,161.82,29,,129.456,percent of total billed charges,29% of total billed charges,416.78,100,,,fee schedule,100% of CMS fee schedule,373.86,67,,299.088,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,446.4,80,,357.12,percent of total billed charges,80% of total billed charges,362.7,65,,290.16,percent of total billed charges,65% of total billed charges,199.04,35.67,,159.232,percent of total billed charges,35.67% of total billed charges,161.82,1872.96,
RESPIR PATHOGEN BY PCR PANEL,3001998,CDM,300,RC,87633,HCPCS,outpatient,,,997,398.80,,847.45,85,,677.96,percent of total billed charges,85% of total billed charges,767.69,77,,614.15,percent of total billed charges,77% of total billed charges,416.78,100,,,fee schedule,100% of CMS fee schedule,1800.93,350,,,fee schedule,350% of BCBS fee schedule,1872.96,364,,,fee schedule,364% of BCBS fee schedule,1872.96,364,,,fee schedule,364% of BCBS fee schedule,1872.96,364,,,fee schedule,364% of BCBS fee schedule,897.3,90,,717.84,percent of total billed charges,90% of total billed charges,797.6,80,,638.08,percent of total billed charges,80% of total billed charges,897.3,90,,717.84,percent of total billed charges,90% of total billed charges,747.75,75,,598.2,percent of total billed charges,75% of total billed charges,508.47,122,,,fee schedule,122% of APC rate,289.13,29,,231.304,percent of total billed charges,29% of total billed charges,416.78,100,,,fee schedule,100% of CMS fee schedule,667.99,67,,534.392,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,797.6,80,,638.08,percent of total billed charges,80% of total billed charges,648.05,65,,518.44,percent of total billed charges,65% of total billed charges,355.63,35.67,,284.504,percent of total billed charges,35.67% of total billed charges,289.13,1872.96,
INFECTIOUS AGENT DNA/RNA  EXP,3001999,CDM,300,RC,87486,HCPCS,outpatient,,,446,178.40,,379.1,85,,303.28,percent of total billed charges,85% of total billed charges,343.42,77,,274.74,percent of total billed charges,77% of total billed charges,35.09,100,,,fee schedule,100% of CMS fee schedule,151.66,350,,,fee schedule,350% of BCBS fee schedule,157.72,364,,,fee schedule,364% of BCBS fee schedule,157.72,364,,,fee schedule,364% of BCBS fee schedule,157.72,364,,,fee schedule,364% of BCBS fee schedule,401.4,90,,321.12,percent of total billed charges,90% of total billed charges,356.8,80,,285.44,percent of total billed charges,80% of total billed charges,401.4,90,,321.12,percent of total billed charges,90% of total billed charges,334.5,75,,267.6,percent of total billed charges,75% of total billed charges,42.8,122,,,fee schedule,122% of APC rate,129.34,29,,103.472,percent of total billed charges,29% of total billed charges,35.09,100,,,fee schedule,100% of CMS fee schedule,298.82,67,,239.056,percent of total billed charges,67% of total billed charges,52.19,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,356.8,80,,285.44,percent of total billed charges,80% of total billed charges,289.9,65,,231.92,percent of total billed charges,65% of total billed charges,159.09,35.67,,127.272,percent of total billed charges,35.67% of total billed charges,35.09,401.4,
CELL CT/DIFF PLEURAL FLD,3002000,CDM,300,RC,89051,HCPCS,outpatient,,,85,34.00,,72.25,85,,57.8,percent of total billed charges,85% of total billed charges,65.45,77,,52.36,percent of total billed charges,77% of total billed charges,5.6,100,,,fee schedule,100% of CMS fee schedule,23.8,350,,,fee schedule,350% of BCBS fee schedule,24.75,364,,,fee schedule,364% of BCBS fee schedule,24.75,364,,,fee schedule,364% of BCBS fee schedule,24.75,364,,,fee schedule,364% of BCBS fee schedule,76.5,90,,61.2,percent of total billed charges,90% of total billed charges,68,80,,54.4,percent of total billed charges,80% of total billed charges,76.5,90,,61.2,percent of total billed charges,90% of total billed charges,63.75,75,,51,percent of total billed charges,75% of total billed charges,6.83,122,,,fee schedule,122% of APC rate,24.65,29,,19.72,percent of total billed charges,29% of total billed charges,5.6,100,,,fee schedule,100% of CMS fee schedule,56.95,67,,45.56,percent of total billed charges,67% of total billed charges,6.38,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,68,80,,54.4,percent of total billed charges,80% of total billed charges,55.25,65,,44.2,percent of total billed charges,65% of total billed charges,30.32,35.67,,24.256,percent of total billed charges,35.67% of total billed charges,5.6,76.5,
CELL CT/DIFF SYNOVIAL FLD,3002020,CDM,300,RC,89051,HCPCS,outpatient,,,85,34.00,,72.25,85,,57.8,percent of total billed charges,85% of total billed charges,65.45,77,,52.36,percent of total billed charges,77% of total billed charges,5.6,100,,,fee schedule,100% of CMS fee schedule,23.8,350,,,fee schedule,350% of BCBS fee schedule,24.75,364,,,fee schedule,364% of BCBS fee schedule,24.75,364,,,fee schedule,364% of BCBS fee schedule,24.75,364,,,fee schedule,364% of BCBS fee schedule,76.5,90,,61.2,percent of total billed charges,90% of total billed charges,68,80,,54.4,percent of total billed charges,80% of total billed charges,76.5,90,,61.2,percent of total billed charges,90% of total billed charges,63.75,75,,51,percent of total billed charges,75% of total billed charges,6.83,122,,,fee schedule,122% of APC rate,24.65,29,,19.72,percent of total billed charges,29% of total billed charges,5.6,100,,,fee schedule,100% of CMS fee schedule,56.95,67,,45.56,percent of total billed charges,67% of total billed charges,6.38,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,68,80,,54.4,percent of total billed charges,80% of total billed charges,55.25,65,,44.2,percent of total billed charges,65% of total billed charges,30.32,35.67,,24.256,percent of total billed charges,35.67% of total billed charges,5.6,76.5,
CELL INDICES,3002025,CDM,300,RC,,,outpatient,,,32,12.80,,27.2,85,,21.76,percent of total billed charges,85% of total billed charges,24.64,77,,19.71,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,26.24,82,,20.992,percent of total billed charges,82% of total billed charges,27.2,85,,21.76,percent of total billed charges,85% of total billed charges,27.2,85,,21.76,percent of total billed charges,85% of total billed charges,27.2,85,,21.76,percent of total billed charges,85% of total billed charges,28.8,90,,23.04,percent of total billed charges,90% of total billed charges,25.6,80,,20.48,percent of total billed charges,80% of total billed charges,28.8,90,,23.04,percent of total billed charges,90% of total billed charges,24,75,,19.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,9.28,29,,7.424,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,21.44,67,,17.152,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,25.6,80,,20.48,percent of total billed charges,80% of total billed charges,20.8,65,,16.64,percent of total billed charges,65% of total billed charges,11.41,35.67,,9.128,percent of total billed charges,35.67% of total billed charges,9.28,28.8,
CELLULAR IMMUNE PANEL,3002030,CDM,300,RC,88182,HCPCS,outpatient,,,356,142.40,,302.6,85,,242.08,percent of total billed charges,85% of total billed charges,274.12,77,,219.3,percent of total billed charges,77% of total billed charges,47.38,100,,,fee schedule,100% of CMS OPPS rate,156.45,350,,,fee schedule,350% of BCBS fee schedule,162.71,364,,,fee schedule,364% of BCBS fee schedule,162.71,364,,,fee schedule,364% of BCBS fee schedule,162.71,364,,,fee schedule,364% of BCBS fee schedule,320.4,90,,256.32,percent of total billed charges,90% of total billed charges,284.8,80,,227.84,percent of total billed charges,80% of total billed charges,320.4,90,,256.32,percent of total billed charges,90% of total billed charges,267,75,,213.6,percent of total billed charges,75% of total billed charges,57.81,122,,,fee schedule,122% of APC rate,103.24,29,,82.592,percent of total billed charges,29% of total billed charges,47.38,100,,,fee schedule,100% of CMS OPPS rate,238.52,67,,190.816,percent of total billed charges,67% of total billed charges,34.31,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,284.8,80,,227.84,percent of total billed charges,80% of total billed charges,231.4,65,,185.12,percent of total billed charges,65% of total billed charges,126.99,35.67,,101.592,percent of total billed charges,35.67% of total billed charges,34.31,320.4,
CENTROMERE AND HISTONE,3002031,CDM,300,RC,83516,HCPCS,outpatient,,,547,218.80,,464.95,85,,371.96,percent of total billed charges,85% of total billed charges,421.19,77,,336.95,percent of total billed charges,77% of total billed charges,11.53,100,,,fee schedule,100% of CMS fee schedule,49.84,350,,,fee schedule,350% of BCBS fee schedule,51.83,364,,,fee schedule,364% of BCBS fee schedule,51.83,364,,,fee schedule,364% of BCBS fee schedule,51.83,364,,,fee schedule,364% of BCBS fee schedule,492.3,90,,393.84,percent of total billed charges,90% of total billed charges,437.6,80,,350.08,percent of total billed charges,80% of total billed charges,492.3,90,,393.84,percent of total billed charges,90% of total billed charges,410.25,75,,328.2,percent of total billed charges,75% of total billed charges,14.06,122,,,fee schedule,122% of APC rate,158.63,29,,126.904,percent of total billed charges,29% of total billed charges,11.53,100,,,fee schedule,100% of CMS fee schedule,366.49,67,,293.192,percent of total billed charges,67% of total billed charges,14.62,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,437.6,80,,350.08,percent of total billed charges,80% of total billed charges,355.55,65,,284.44,percent of total billed charges,65% of total billed charges,195.11,35.67,,156.088,percent of total billed charges,35.67% of total billed charges,11.53,492.3,
CERULOPLASMIN,3002040,CDM,300,RC,82390,HCPCS,outpatient,,,78,31.20,,66.3,85,,53.04,percent of total billed charges,85% of total billed charges,60.06,77,,48.05,percent of total billed charges,77% of total billed charges,10.74,100,,,fee schedule,100% of CMS fee schedule,46.41,350,,,fee schedule,350% of BCBS fee schedule,48.27,364,,,fee schedule,364% of BCBS fee schedule,48.27,364,,,fee schedule,364% of BCBS fee schedule,48.27,364,,,fee schedule,364% of BCBS fee schedule,70.2,90,,56.16,percent of total billed charges,90% of total billed charges,62.4,80,,49.92,percent of total billed charges,80% of total billed charges,70.2,90,,56.16,percent of total billed charges,90% of total billed charges,58.5,75,,46.8,percent of total billed charges,75% of total billed charges,13.1,122,,,fee schedule,122% of APC rate,22.62,29,,18.096,percent of total billed charges,29% of total billed charges,10.74,100,,,fee schedule,100% of CMS fee schedule,52.26,67,,41.808,percent of total billed charges,67% of total billed charges,11.2,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,62.4,80,,49.92,percent of total billed charges,80% of total billed charges,50.7,65,,40.56,percent of total billed charges,65% of total billed charges,27.82,35.67,,22.256,percent of total billed charges,35.67% of total billed charges,10.74,70.2,
CHLAMYDIA TITER,3002041,CDM,300,RC,,,outpatient,,,467,186.80,,396.95,85,,317.56,percent of total billed charges,85% of total billed charges,359.59,77,,287.67,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,382.94,82,,306.352,percent of total billed charges,82% of total billed charges,396.95,85,,317.56,percent of total billed charges,85% of total billed charges,396.95,85,,317.56,percent of total billed charges,85% of total billed charges,396.95,85,,317.56,percent of total billed charges,85% of total billed charges,420.3,90,,336.24,percent of total billed charges,90% of total billed charges,373.6,80,,298.88,percent of total billed charges,80% of total billed charges,420.3,90,,336.24,percent of total billed charges,90% of total billed charges,350.25,75,,280.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,135.43,29,,108.344,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,312.89,67,,250.312,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,373.6,80,,298.88,percent of total billed charges,80% of total billed charges,303.55,65,,242.84,percent of total billed charges,65% of total billed charges,166.58,35.67,,133.264,percent of total billed charges,35.67% of total billed charges,135.43,420.3,
CHLAMYDIA,3002042,CDM,300,RC,86631,HCPCS,outpatient,,,68,27.20,,57.8,85,,46.24,percent of total billed charges,85% of total billed charges,52.36,77,,41.89,percent of total billed charges,77% of total billed charges,11.82,100,,,fee schedule,100% of CMS fee schedule,51.1,350,,,fee schedule,350% of BCBS fee schedule,53.14,364,,,fee schedule,364% of BCBS fee schedule,53.14,364,,,fee schedule,364% of BCBS fee schedule,53.14,364,,,fee schedule,364% of BCBS fee schedule,61.2,90,,48.96,percent of total billed charges,90% of total billed charges,54.4,80,,43.52,percent of total billed charges,80% of total billed charges,61.2,90,,48.96,percent of total billed charges,90% of total billed charges,51,75,,40.8,percent of total billed charges,75% of total billed charges,14.42,122,,,fee schedule,122% of APC rate,19.72,29,,15.776,percent of total billed charges,29% of total billed charges,11.82,100,,,fee schedule,100% of CMS fee schedule,45.56,67,,36.448,percent of total billed charges,67% of total billed charges,8.64,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,54.4,80,,43.52,percent of total billed charges,80% of total billed charges,44.2,65,,35.36,percent of total billed charges,65% of total billed charges,24.26,35.67,,19.408,percent of total billed charges,35.67% of total billed charges,8.64,61.2,
CHLAMYDIA IgM,3002043,CDM,300,RC,86632,HCPCS,outpatient,,,68,27.20,,57.8,85,,46.24,percent of total billed charges,85% of total billed charges,52.36,77,,41.89,percent of total billed charges,77% of total billed charges,12.68,100,,,fee schedule,100% of CMS fee schedule,54.81,350,,,fee schedule,350% of BCBS fee schedule,57,364,,,fee schedule,364% of BCBS fee schedule,57,364,,,fee schedule,364% of BCBS fee schedule,57,364,,,fee schedule,364% of BCBS fee schedule,61.2,90,,48.96,percent of total billed charges,90% of total billed charges,54.4,80,,43.52,percent of total billed charges,80% of total billed charges,61.2,90,,48.96,percent of total billed charges,90% of total billed charges,51,75,,40.8,percent of total billed charges,75% of total billed charges,15.46,122,,,fee schedule,122% of APC rate,19.72,29,,15.776,percent of total billed charges,29% of total billed charges,12.68,100,,,fee schedule,100% of CMS fee schedule,45.56,67,,36.448,percent of total billed charges,67% of total billed charges,8.64,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,54.4,80,,43.52,percent of total billed charges,80% of total billed charges,44.2,65,,35.36,percent of total billed charges,65% of total billed charges,24.26,35.67,,19.408,percent of total billed charges,35.67% of total billed charges,8.64,61.2,
"BMP - CALCIUM, IONIZED",3002079,CDM,300,RC,80047,HCPCS,outpatient,,,126,50.40,,107.1,85,,85.68,percent of total billed charges,85% of total billed charges,97.02,77,,77.62,percent of total billed charges,77% of total billed charges,13.73,100,,,fee schedule,100% of CMS fee schedule,48.06,350,,,fee schedule,350% of BCBS fee schedule,49.98,364,,,fee schedule,364% of BCBS fee schedule,49.98,364,,,fee schedule,364% of BCBS fee schedule,49.98,364,,,fee schedule,364% of BCBS fee schedule,113.4,90,,90.72,percent of total billed charges,90% of total billed charges,100.8,80,,80.64,percent of total billed charges,80% of total billed charges,113.4,90,,90.72,percent of total billed charges,90% of total billed charges,94.5,75,,75.6,percent of total billed charges,75% of total billed charges,16.75,122,,,fee schedule,122% of APC rate,36.54,29,,29.232,percent of total billed charges,29% of total billed charges,13.73,100,,,fee schedule,100% of CMS fee schedule,84.42,67,,67.536,percent of total billed charges,67% of total billed charges,9.5,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,100.8,80,,80.64,percent of total billed charges,80% of total billed charges,81.9,65,,65.52,percent of total billed charges,65% of total billed charges,44.94,35.67,,35.952,percent of total billed charges,35.67% of total billed charges,9.5,113.4,
BASIC METABOLIC PANEL - C 7,3002080,CDM,300,RC,80048,HCPCS,outpatient,,,130,52.00,,110.5,85,,88.4,percent of total billed charges,85% of total billed charges,100.1,77,,80.08,percent of total billed charges,77% of total billed charges,8.46,100,,,fee schedule,100% of CMS fee schedule,36.54,350,,,fee schedule,350% of BCBS fee schedule,38,364,,,fee schedule,364% of BCBS fee schedule,38,364,,,fee schedule,364% of BCBS fee schedule,38,364,,,fee schedule,364% of BCBS fee schedule,117,90,,93.6,percent of total billed charges,90% of total billed charges,104,80,,83.2,percent of total billed charges,80% of total billed charges,117,90,,93.6,percent of total billed charges,90% of total billed charges,97.5,75,,78,percent of total billed charges,75% of total billed charges,10.32,122,,,fee schedule,122% of APC rate,37.7,29,,30.16,percent of total billed charges,29% of total billed charges,8.46,100,,,fee schedule,100% of CMS fee schedule,87.1,67,,69.68,percent of total billed charges,67% of total billed charges,9.5,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,104,80,,83.2,percent of total billed charges,80% of total billed charges,84.5,65,,67.6,percent of total billed charges,65% of total billed charges,46.37,35.67,,37.096,percent of total billed charges,35.67% of total billed charges,8.46,117,
CHARCUT-MARIE TOOTH PROFILE,3002101,CDM,300,RC,81324,HCPCS,outpatient,,,1261,504.40,,1071.85,85,,857.48,percent of total billed charges,85% of total billed charges,970.97,77,,776.78,percent of total billed charges,77% of total billed charges,758.36,100,,,fee schedule,100% of CMS fee schedule,2654.26,350,,,fee schedule,350% of BCBS fee schedule,2760.43,364,,,fee schedule,364% of BCBS fee schedule,2760.43,364,,,fee schedule,364% of BCBS fee schedule,2760.43,364,,,fee schedule,364% of BCBS fee schedule,1134.9,90,,907.92,percent of total billed charges,90% of total billed charges,1008.8,80,,807.04,percent of total billed charges,80% of total billed charges,1134.9,90,,907.92,percent of total billed charges,90% of total billed charges,945.75,75,,756.6,percent of total billed charges,75% of total billed charges,925.19,122,,,fee schedule,122% of APC rate,365.69,29,,292.552,percent of total billed charges,29% of total billed charges,758.36,100,,,fee schedule,100% of CMS fee schedule,844.87,67,,675.896,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1008.8,80,,807.04,percent of total billed charges,80% of total billed charges,819.65,65,,655.72,percent of total billed charges,65% of total billed charges,449.8,35.67,,359.84,percent of total billed charges,35.67% of total billed charges,365.69,2760.43,
CHEMILUMINESCENT ASSAY,3002102,CDM,300,RC,82397,HCPCS,outpatient,,,126,50.40,,107.1,85,,85.68,percent of total billed charges,85% of total billed charges,97.02,77,,77.62,percent of total billed charges,77% of total billed charges,14.12,100,,,fee schedule,100% of CMS fee schedule,61.01,350,,,fee schedule,350% of BCBS fee schedule,63.45,364,,,fee schedule,364% of BCBS fee schedule,63.45,364,,,fee schedule,364% of BCBS fee schedule,63.45,364,,,fee schedule,364% of BCBS fee schedule,113.4,90,,90.72,percent of total billed charges,90% of total billed charges,100.8,80,,80.64,percent of total billed charges,80% of total billed charges,113.4,90,,90.72,percent of total billed charges,90% of total billed charges,94.5,75,,75.6,percent of total billed charges,75% of total billed charges,17.22,122,,,fee schedule,122% of APC rate,36.54,29,,29.232,percent of total billed charges,29% of total billed charges,14.12,100,,,fee schedule,100% of CMS fee schedule,84.42,67,,67.536,percent of total billed charges,67% of total billed charges,21.01,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,100.8,80,,80.64,percent of total billed charges,80% of total billed charges,81.9,65,,65.52,percent of total billed charges,65% of total billed charges,44.94,35.67,,35.952,percent of total billed charges,35.67% of total billed charges,14.12,113.4,
CHLORAZEPATE (TRANXENE),3002140,CDM,300,RC,80299,HCPCS,outpatient,,,147,58.80,,124.95,85,,99.96,percent of total billed charges,85% of total billed charges,113.19,77,,90.55,percent of total billed charges,77% of total billed charges,18.64,100,,,fee schedule,100% of CMS fee schedule,65.24,350,,,fee schedule,350% of BCBS fee schedule,67.85,364,,,fee schedule,364% of BCBS fee schedule,67.85,364,,,fee schedule,364% of BCBS fee schedule,67.85,364,,,fee schedule,364% of BCBS fee schedule,132.3,90,,105.84,percent of total billed charges,90% of total billed charges,117.6,80,,94.08,percent of total billed charges,80% of total billed charges,132.3,90,,105.84,percent of total billed charges,90% of total billed charges,110.25,75,,88.2,percent of total billed charges,75% of total billed charges,22.74,122,,,fee schedule,122% of APC rate,42.63,29,,34.104,percent of total billed charges,29% of total billed charges,18.64,100,,,fee schedule,100% of CMS fee schedule,98.49,67,,78.792,percent of total billed charges,67% of total billed charges,20.36,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,117.6,80,,94.08,percent of total billed charges,80% of total billed charges,95.55,65,,76.44,percent of total billed charges,65% of total billed charges,52.43,35.67,,41.944,percent of total billed charges,35.67% of total billed charges,18.64,132.3,
CHLORDIAZEPOXIDE-LIBRIUM,3002160,CDM,300,RC,80299,HCPCS,outpatient,,,147,58.80,,124.95,85,,99.96,percent of total billed charges,85% of total billed charges,113.19,77,,90.55,percent of total billed charges,77% of total billed charges,18.64,100,,,fee schedule,100% of CMS fee schedule,65.24,350,,,fee schedule,350% of BCBS fee schedule,67.85,364,,,fee schedule,364% of BCBS fee schedule,67.85,364,,,fee schedule,364% of BCBS fee schedule,67.85,364,,,fee schedule,364% of BCBS fee schedule,132.3,90,,105.84,percent of total billed charges,90% of total billed charges,117.6,80,,94.08,percent of total billed charges,80% of total billed charges,132.3,90,,105.84,percent of total billed charges,90% of total billed charges,110.25,75,,88.2,percent of total billed charges,75% of total billed charges,22.74,122,,,fee schedule,122% of APC rate,42.63,29,,34.104,percent of total billed charges,29% of total billed charges,18.64,100,,,fee schedule,100% of CMS fee schedule,98.49,67,,78.792,percent of total billed charges,67% of total billed charges,20.36,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,117.6,80,,94.08,percent of total billed charges,80% of total billed charges,95.55,65,,76.44,percent of total billed charges,65% of total billed charges,52.43,35.67,,41.944,percent of total billed charges,35.67% of total billed charges,18.64,132.3,
CHLORIDE,3002180,CDM,300,RC,82435,HCPCS,outpatient,,,38,15.20,,32.3,85,,25.84,percent of total billed charges,85% of total billed charges,29.26,77,,23.41,percent of total billed charges,77% of total billed charges,4.59,100,,,fee schedule,100% of CMS fee schedule,19.88,350,,,fee schedule,350% of BCBS fee schedule,20.68,364,,,fee schedule,364% of BCBS fee schedule,20.68,364,,,fee schedule,364% of BCBS fee schedule,20.68,364,,,fee schedule,364% of BCBS fee schedule,34.2,90,,27.36,percent of total billed charges,90% of total billed charges,30.4,80,,24.32,percent of total billed charges,80% of total billed charges,34.2,90,,27.36,percent of total billed charges,90% of total billed charges,28.5,75,,22.8,percent of total billed charges,75% of total billed charges,5.61,122,,,fee schedule,122% of APC rate,11.02,29,,8.816,percent of total billed charges,29% of total billed charges,4.59,100,,,fee schedule,100% of CMS fee schedule,25.46,67,,20.368,percent of total billed charges,67% of total billed charges,6.83,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,30.4,80,,24.32,percent of total billed charges,80% of total billed charges,24.7,65,,19.76,percent of total billed charges,65% of total billed charges,13.55,35.67,,10.84,percent of total billed charges,35.67% of total billed charges,4.59,34.2,
CHLORIDE CSF,3002200,CDM,300,RC,82438,HCPCS,outpatient,,,29,11.60,,24.65,85,,19.72,percent of total billed charges,85% of total billed charges,22.33,77,,17.86,percent of total billed charges,77% of total billed charges,5,100,,,fee schedule,100% of CMS fee schedule,21.11,350,,,fee schedule,350% of BCBS fee schedule,21.95,364,,,fee schedule,364% of BCBS fee schedule,21.95,364,,,fee schedule,364% of BCBS fee schedule,21.95,364,,,fee schedule,364% of BCBS fee schedule,26.1,90,,20.88,percent of total billed charges,90% of total billed charges,23.2,80,,18.56,percent of total billed charges,80% of total billed charges,26.1,90,,20.88,percent of total billed charges,90% of total billed charges,21.75,75,,17.4,percent of total billed charges,75% of total billed charges,6.1,122,,,fee schedule,122% of APC rate,8.41,29,,6.728,percent of total billed charges,29% of total billed charges,5,100,,,fee schedule,100% of CMS fee schedule,19.43,67,,15.544,percent of total billed charges,67% of total billed charges,3.59,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,23.2,80,,18.56,percent of total billed charges,80% of total billed charges,18.85,65,,15.08,percent of total billed charges,65% of total billed charges,10.34,35.67,,8.272,percent of total billed charges,35.67% of total billed charges,3.59,26.1,
CHLORIDE URINE,3002240,CDM,300,RC,82436,HCPCS,outpatient,,,71,28.40,,60.35,85,,48.28,percent of total billed charges,85% of total billed charges,54.67,77,,43.74,percent of total billed charges,77% of total billed charges,5.75,100,,,fee schedule,100% of CMS fee schedule,21.74,350,,,fee schedule,350% of BCBS fee schedule,22.6,364,,,fee schedule,364% of BCBS fee schedule,22.6,364,,,fee schedule,364% of BCBS fee schedule,22.6,364,,,fee schedule,364% of BCBS fee schedule,63.9,90,,51.12,percent of total billed charges,90% of total billed charges,56.8,80,,45.44,percent of total billed charges,80% of total billed charges,63.9,90,,51.12,percent of total billed charges,90% of total billed charges,53.25,75,,42.6,percent of total billed charges,75% of total billed charges,7.01,122,,,fee schedule,122% of APC rate,20.59,29,,16.472,percent of total billed charges,29% of total billed charges,5.75,100,,,fee schedule,100% of CMS fee schedule,47.57,67,,38.056,percent of total billed charges,67% of total billed charges,3.59,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,56.8,80,,45.44,percent of total billed charges,80% of total billed charges,46.15,65,,36.92,percent of total billed charges,65% of total billed charges,25.33,35.67,,20.264,percent of total billed charges,35.67% of total billed charges,3.59,63.9,
CHLORPROMAZINE-THORAZINE,3002260,CDM,300,RC,80342,HCPCS,outpatient,,,438,175.20,,372.3,85,,297.84,percent of total billed charges,85% of total billed charges,337.26,77,,269.81,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,359.16,82,,287.328,percent of total billed charges,82% of total billed charges,372.3,85,,297.84,percent of total billed charges,85% of total billed charges,372.3,85,,297.84,percent of total billed charges,85% of total billed charges,372.3,85,,297.84,percent of total billed charges,85% of total billed charges,394.2,90,,315.36,percent of total billed charges,90% of total billed charges,350.4,80,,280.32,percent of total billed charges,80% of total billed charges,394.2,90,,315.36,percent of total billed charges,90% of total billed charges,328.5,75,,262.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,127.02,29,,101.616,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,293.46,67,,234.768,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,350.4,80,,280.32,percent of total billed charges,80% of total billed charges,284.7,65,,227.76,percent of total billed charges,65% of total billed charges,156.23,35.67,,124.984,percent of total billed charges,35.67% of total billed charges,127.02,394.2,
CHOLESTEROL,3002280,CDM,300,RC,82465,HCPCS,outpatient,,,52,20.80,,44.2,85,,35.36,percent of total billed charges,85% of total billed charges,40.04,77,,32.03,percent of total billed charges,77% of total billed charges,4.34,100,,,fee schedule,100% of CMS fee schedule,18.8,350,,,fee schedule,350% of BCBS fee schedule,19.55,364,,,fee schedule,364% of BCBS fee schedule,19.55,364,,,fee schedule,364% of BCBS fee schedule,19.55,364,,,fee schedule,364% of BCBS fee schedule,46.8,90,,37.44,percent of total billed charges,90% of total billed charges,41.6,80,,33.28,percent of total billed charges,80% of total billed charges,46.8,90,,37.44,percent of total billed charges,90% of total billed charges,39,75,,31.2,percent of total billed charges,75% of total billed charges,5.3,122,,,fee schedule,122% of APC rate,15.08,29,,12.064,percent of total billed charges,29% of total billed charges,4.34,100,,,fee schedule,100% of CMS fee schedule,34.84,67,,27.872,percent of total billed charges,67% of total billed charges,6.46,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,41.6,80,,33.28,percent of total billed charges,80% of total billed charges,33.8,65,,27.04,percent of total billed charges,65% of total billed charges,18.55,35.67,,14.84,percent of total billed charges,35.67% of total billed charges,4.34,46.8,
CHOLINESTERASE,3002300,CDM,300,RC,82480,HCPCS,outpatient,,,68,27.20,,57.8,85,,46.24,percent of total billed charges,85% of total billed charges,52.36,77,,41.89,percent of total billed charges,77% of total billed charges,7.87,100,,,fee schedule,100% of CMS fee schedule,34.02,350,,,fee schedule,350% of BCBS fee schedule,35.38,364,,,fee schedule,364% of BCBS fee schedule,35.38,364,,,fee schedule,364% of BCBS fee schedule,35.38,364,,,fee schedule,364% of BCBS fee schedule,61.2,90,,48.96,percent of total billed charges,90% of total billed charges,54.4,80,,43.52,percent of total billed charges,80% of total billed charges,61.2,90,,48.96,percent of total billed charges,90% of total billed charges,51,75,,40.8,percent of total billed charges,75% of total billed charges,9.6,122,,,fee schedule,122% of APC rate,19.72,29,,15.776,percent of total billed charges,29% of total billed charges,7.87,100,,,fee schedule,100% of CMS fee schedule,45.56,67,,36.448,percent of total billed charges,67% of total billed charges,11.71,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,54.4,80,,43.52,percent of total billed charges,80% of total billed charges,44.2,65,,35.36,percent of total billed charges,65% of total billed charges,24.26,35.67,,19.408,percent of total billed charges,35.67% of total billed charges,7.87,61.2,
"CHOLESTEROL, PLEURAL FLD",3002360,CDM,300,RC,84311,HCPCS,outpatient,,,67,26.80,,56.95,85,,45.56,percent of total billed charges,85% of total billed charges,51.59,77,,41.27,percent of total billed charges,77% of total billed charges,8.1,100,,,fee schedule,100% of CMS fee schedule,30.21,350,,,fee schedule,350% of BCBS fee schedule,31.41,364,,,fee schedule,364% of BCBS fee schedule,31.41,364,,,fee schedule,364% of BCBS fee schedule,31.41,364,,,fee schedule,364% of BCBS fee schedule,60.3,90,,48.24,percent of total billed charges,90% of total billed charges,53.6,80,,42.88,percent of total billed charges,80% of total billed charges,60.3,90,,48.24,percent of total billed charges,90% of total billed charges,50.25,75,,40.2,percent of total billed charges,75% of total billed charges,9.88,122,,,fee schedule,122% of APC rate,19.43,29,,15.544,percent of total billed charges,29% of total billed charges,8.1,100,,,fee schedule,100% of CMS fee schedule,44.89,67,,35.912,percent of total billed charges,67% of total billed charges,10.39,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,53.6,80,,42.88,percent of total billed charges,80% of total billed charges,43.55,65,,34.84,percent of total billed charges,65% of total billed charges,23.9,35.67,,19.12,percent of total billed charges,35.67% of total billed charges,8.1,60.3,
CIE,3002410,CDM,300,RC,86403,HCPCS,outpatient,,,544,217.60,,462.4,85,,369.92,percent of total billed charges,85% of total billed charges,418.88,77,,335.1,percent of total billed charges,77% of total billed charges,11.54,100,,,fee schedule,100% of CMS fee schedule,44.03,350,,,fee schedule,350% of BCBS fee schedule,45.79,364,,,fee schedule,364% of BCBS fee schedule,45.79,364,,,fee schedule,364% of BCBS fee schedule,45.79,364,,,fee schedule,364% of BCBS fee schedule,489.6,90,,391.68,percent of total billed charges,90% of total billed charges,435.2,80,,348.16,percent of total billed charges,80% of total billed charges,489.6,90,,391.68,percent of total billed charges,90% of total billed charges,408,75,,326.4,percent of total billed charges,75% of total billed charges,14.07,122,,,fee schedule,122% of APC rate,157.76,29,,126.208,percent of total billed charges,29% of total billed charges,11.54,100,,,fee schedule,100% of CMS fee schedule,364.48,67,,291.584,percent of total billed charges,67% of total billed charges,15.16,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,435.2,80,,348.16,percent of total billed charges,80% of total billed charges,353.6,65,,282.88,percent of total billed charges,65% of total billed charges,194.04,35.67,,155.232,percent of total billed charges,35.67% of total billed charges,11.54,489.6,
CIMETIDINE (TAGAMET),3002420,CDM,300,RC,80299,HCPCS,outpatient,,,147,58.80,,124.95,85,,99.96,percent of total billed charges,85% of total billed charges,113.19,77,,90.55,percent of total billed charges,77% of total billed charges,18.64,100,,,fee schedule,100% of CMS fee schedule,65.24,350,,,fee schedule,350% of BCBS fee schedule,67.85,364,,,fee schedule,364% of BCBS fee schedule,67.85,364,,,fee schedule,364% of BCBS fee schedule,67.85,364,,,fee schedule,364% of BCBS fee schedule,132.3,90,,105.84,percent of total billed charges,90% of total billed charges,117.6,80,,94.08,percent of total billed charges,80% of total billed charges,132.3,90,,105.84,percent of total billed charges,90% of total billed charges,110.25,75,,88.2,percent of total billed charges,75% of total billed charges,22.74,122,,,fee schedule,122% of APC rate,42.63,29,,34.104,percent of total billed charges,29% of total billed charges,18.64,100,,,fee schedule,100% of CMS fee schedule,98.49,67,,78.792,percent of total billed charges,67% of total billed charges,20.36,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,117.6,80,,94.08,percent of total billed charges,80% of total billed charges,95.55,65,,76.44,percent of total billed charges,65% of total billed charges,52.43,35.67,,41.944,percent of total billed charges,35.67% of total billed charges,18.64,132.3,
DEXAMETHASONE,3002421,CDM,300,RC,80299,HCPCS,outpatient,,,147,58.80,,124.95,85,,99.96,percent of total billed charges,85% of total billed charges,113.19,77,,90.55,percent of total billed charges,77% of total billed charges,18.64,100,,,fee schedule,100% of CMS fee schedule,65.24,350,,,fee schedule,350% of BCBS fee schedule,67.85,364,,,fee schedule,364% of BCBS fee schedule,67.85,364,,,fee schedule,364% of BCBS fee schedule,67.85,364,,,fee schedule,364% of BCBS fee schedule,132.3,90,,105.84,percent of total billed charges,90% of total billed charges,117.6,80,,94.08,percent of total billed charges,80% of total billed charges,132.3,90,,105.84,percent of total billed charges,90% of total billed charges,110.25,75,,88.2,percent of total billed charges,75% of total billed charges,22.74,122,,,fee schedule,122% of APC rate,42.63,29,,34.104,percent of total billed charges,29% of total billed charges,18.64,100,,,fee schedule,100% of CMS fee schedule,98.49,67,,78.792,percent of total billed charges,67% of total billed charges,20.36,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,117.6,80,,94.08,percent of total billed charges,80% of total billed charges,95.55,65,,76.44,percent of total billed charges,65% of total billed charges,52.43,35.67,,41.944,percent of total billed charges,35.67% of total billed charges,18.64,132.3,
CKMB REPEAT SAME DAY,3002439,CDM,300,RC,82553,HCPCS,outpatient,,,161,64.40,91,136.85,85,,109.48,percent of total billed charges,85% of total billed charges,123.97,77,,99.18,percent of total billed charges,77% of total billed charges,11.55,100,,,fee schedule,100% of CMS fee schedule,49.91,350,,,fee schedule,350% of BCBS fee schedule,51.91,364,,,fee schedule,364% of BCBS fee schedule,51.91,364,,,fee schedule,364% of BCBS fee schedule,51.91,364,,,fee schedule,364% of BCBS fee schedule,144.9,90,,115.92,percent of total billed charges,90% of total billed charges,128.8,80,,103.04,percent of total billed charges,80% of total billed charges,144.9,90,,115.92,percent of total billed charges,90% of total billed charges,120.75,75,,96.6,percent of total billed charges,75% of total billed charges,14.09,122,,,fee schedule,122% of APC rate,46.69,29,,37.352,percent of total billed charges,29% of total billed charges,11.55,100,,,fee schedule,100% of CMS fee schedule,107.87,67,,86.296,percent of total billed charges,67% of total billed charges,9.15,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,128.8,80,,103.04,percent of total billed charges,80% of total billed charges,104.65,65,,83.72,percent of total billed charges,65% of total billed charges,57.43,35.67,,45.944,percent of total billed charges,35.67% of total billed charges,9.15,144.9,
CKMB,3002441,CDM,300,RC,82553,HCPCS,outpatient,,,163,65.20,,138.55,85,,110.84,percent of total billed charges,85% of total billed charges,125.51,77,,100.41,percent of total billed charges,77% of total billed charges,11.55,100,,,fee schedule,100% of CMS fee schedule,49.91,350,,,fee schedule,350% of BCBS fee schedule,51.91,364,,,fee schedule,364% of BCBS fee schedule,51.91,364,,,fee schedule,364% of BCBS fee schedule,51.91,364,,,fee schedule,364% of BCBS fee schedule,146.7,90,,117.36,percent of total billed charges,90% of total billed charges,130.4,80,,104.32,percent of total billed charges,80% of total billed charges,146.7,90,,117.36,percent of total billed charges,90% of total billed charges,122.25,75,,97.8,percent of total billed charges,75% of total billed charges,14.09,122,,,fee schedule,122% of APC rate,47.27,29,,37.816,percent of total billed charges,29% of total billed charges,11.55,100,,,fee schedule,100% of CMS fee schedule,109.21,67,,87.368,percent of total billed charges,67% of total billed charges,9.15,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,130.4,80,,104.32,percent of total billed charges,80% of total billed charges,105.95,65,,84.76,percent of total billed charges,65% of total billed charges,58.14,35.67,,46.512,percent of total billed charges,35.67% of total billed charges,9.15,146.7,
CLONAZEPAM (CLONOPIN),3002460,CDM,300,RC,80346,HCPCS,outpatient,,,67,26.80,,56.95,85,,45.56,percent of total billed charges,85% of total billed charges,51.59,77,,41.27,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,54.94,82,,43.952,percent of total billed charges,82% of total billed charges,56.95,85,,45.56,percent of total billed charges,85% of total billed charges,56.95,85,,45.56,percent of total billed charges,85% of total billed charges,56.95,85,,45.56,percent of total billed charges,85% of total billed charges,60.3,90,,48.24,percent of total billed charges,90% of total billed charges,53.6,80,,42.88,percent of total billed charges,80% of total billed charges,60.3,90,,48.24,percent of total billed charges,90% of total billed charges,50.25,75,,40.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,19.43,29,,15.544,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,44.89,67,,35.912,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,53.6,80,,42.88,percent of total billed charges,80% of total billed charges,43.55,65,,34.84,percent of total billed charges,65% of total billed charges,23.9,35.67,,19.12,percent of total billed charges,35.67% of total billed charges,19.43,60.3,
CLOSTRIDIUM DEF,3002470,CDM,300,RC,87230,HCPCS,outpatient,,,139,55.60,,118.15,85,,94.52,percent of total billed charges,85% of total billed charges,107.03,77,,85.62,percent of total billed charges,77% of total billed charges,19.73,100,,,fee schedule,100% of CMS fee schedule,85.3,350,,,fee schedule,350% of BCBS fee schedule,88.71,364,,,fee schedule,364% of BCBS fee schedule,88.71,364,,,fee schedule,364% of BCBS fee schedule,88.71,364,,,fee schedule,364% of BCBS fee schedule,125.1,90,,100.08,percent of total billed charges,90% of total billed charges,111.2,80,,88.96,percent of total billed charges,80% of total billed charges,125.1,90,,100.08,percent of total billed charges,90% of total billed charges,104.25,75,,83.4,percent of total billed charges,75% of total billed charges,24.08,122,,,fee schedule,122% of APC rate,40.31,29,,32.248,percent of total billed charges,29% of total billed charges,19.73,100,,,fee schedule,100% of CMS fee schedule,93.13,67,,74.504,percent of total billed charges,67% of total billed charges,27,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,111.2,80,,88.96,percent of total billed charges,80% of total billed charges,90.35,65,,72.28,percent of total billed charges,65% of total billed charges,49.58,35.67,,39.664,percent of total billed charges,35.67% of total billed charges,19.73,125.1,
CLOSTRIDIUM DIFF REFLEX BY PCR,3002471,CDM,300,RC,87493,HCPCS,outpatient,,,117,46.80,,99.45,85,,79.56,percent of total billed charges,85% of total billed charges,90.09,77,,72.07,percent of total billed charges,77% of total billed charges,37.27,100,,,fee schedule,100% of CMS fee schedule,151.66,350,,,fee schedule,350% of BCBS fee schedule,157.72,364,,,fee schedule,364% of BCBS fee schedule,157.72,364,,,fee schedule,364% of BCBS fee schedule,157.72,364,,,fee schedule,364% of BCBS fee schedule,105.3,90,,84.24,percent of total billed charges,90% of total billed charges,93.6,80,,74.88,percent of total billed charges,80% of total billed charges,105.3,90,,84.24,percent of total billed charges,90% of total billed charges,87.75,75,,70.2,percent of total billed charges,75% of total billed charges,45.46,122,,,fee schedule,122% of APC rate,33.93,29,,27.144,percent of total billed charges,29% of total billed charges,37.27,100,,,fee schedule,100% of CMS fee schedule,78.39,67,,62.712,percent of total billed charges,67% of total billed charges,52.19,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,93.6,80,,74.88,percent of total billed charges,80% of total billed charges,76.05,65,,60.84,percent of total billed charges,65% of total billed charges,41.73,35.67,,33.384,percent of total billed charges,35.67% of total billed charges,33.93,157.72,
CLOSTRIDIUM DIFF PCR IN HOUSE,3002472,CDM,300,RC,87493,HCPCS,outpatient,,,117,46.80,,99.45,85,,79.56,percent of total billed charges,85% of total billed charges,90.09,77,,72.07,percent of total billed charges,77% of total billed charges,37.27,100,,,fee schedule,100% of CMS fee schedule,151.66,350,,,fee schedule,350% of BCBS fee schedule,157.72,364,,,fee schedule,364% of BCBS fee schedule,157.72,364,,,fee schedule,364% of BCBS fee schedule,157.72,364,,,fee schedule,364% of BCBS fee schedule,105.3,90,,84.24,percent of total billed charges,90% of total billed charges,93.6,80,,74.88,percent of total billed charges,80% of total billed charges,105.3,90,,84.24,percent of total billed charges,90% of total billed charges,87.75,75,,70.2,percent of total billed charges,75% of total billed charges,45.46,122,,,fee schedule,122% of APC rate,33.93,29,,27.144,percent of total billed charges,29% of total billed charges,37.27,100,,,fee schedule,100% of CMS fee schedule,78.39,67,,62.712,percent of total billed charges,67% of total billed charges,52.19,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,93.6,80,,74.88,percent of total billed charges,80% of total billed charges,76.05,65,,60.84,percent of total billed charges,65% of total billed charges,41.73,35.67,,33.384,percent of total billed charges,35.67% of total billed charges,33.93,157.72,
CLOT RETRACTION,3002475,CDM,300,RC,85170,HCPCS,outpatient,,,65,26.00,,55.25,85,,44.2,percent of total billed charges,85% of total billed charges,50.05,77,,40.04,percent of total billed charges,77% of total billed charges,16.3,100,,,fee schedule,100% of CMS fee schedule,57.05,350,,,fee schedule,350% of BCBS fee schedule,59.33,364,,,fee schedule,364% of BCBS fee schedule,59.33,364,,,fee schedule,364% of BCBS fee schedule,59.33,364,,,fee schedule,364% of BCBS fee schedule,58.5,90,,46.8,percent of total billed charges,90% of total billed charges,52,80,,41.6,percent of total billed charges,80% of total billed charges,58.5,90,,46.8,percent of total billed charges,90% of total billed charges,48.75,75,,39,percent of total billed charges,75% of total billed charges,19.88,122,,,fee schedule,122% of APC rate,18.85,29,,15.08,percent of total billed charges,29% of total billed charges,16.3,100,,,fee schedule,100% of CMS fee schedule,43.55,67,,34.84,percent of total billed charges,67% of total billed charges,5.37,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,52,80,,41.6,percent of total billed charges,80% of total billed charges,42.25,65,,33.8,percent of total billed charges,65% of total billed charges,23.19,35.67,,18.552,percent of total billed charges,35.67% of total billed charges,5.37,59.33,
CLO TEST (LAB),3002476,CDM,300,RC,87077,HCPCS,outpatient,,,129,51.60,QW,109.65,85,,87.72,percent of total billed charges,85% of total billed charges,99.33,77,,79.46,percent of total billed charges,77% of total billed charges,8.08,100,,,fee schedule,100% of CMS fee schedule,34.9,350,,,fee schedule,350% of BCBS fee schedule,36.29,364,,,fee schedule,364% of BCBS fee schedule,36.29,364,,,fee schedule,364% of BCBS fee schedule,36.29,364,,,fee schedule,364% of BCBS fee schedule,116.1,90,,92.88,percent of total billed charges,90% of total billed charges,103.2,80,,82.56,percent of total billed charges,80% of total billed charges,116.1,90,,92.88,percent of total billed charges,90% of total billed charges,96.75,75,,77.4,percent of total billed charges,75% of total billed charges,9.85,122,,,fee schedule,122% of APC rate,37.41,29,,29.928,percent of total billed charges,29% of total billed charges,8.08,100,,,fee schedule,100% of CMS fee schedule,86.43,67,,69.144,percent of total billed charges,67% of total billed charges,12.02,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,103.2,80,,82.56,percent of total billed charges,80% of total billed charges,83.85,65,,67.08,percent of total billed charges,65% of total billed charges,46.01,35.67,,36.808,percent of total billed charges,35.67% of total billed charges,8.08,116.1,
CMV,3002480,CDM,300,RC,86644,HCPCS,outpatient,,,359,143.60,,305.15,85,,244.12,percent of total billed charges,85% of total billed charges,276.43,77,,221.14,percent of total billed charges,77% of total billed charges,14.39,100,,,fee schedule,100% of CMS fee schedule,62.2,350,,,fee schedule,350% of BCBS fee schedule,64.68,364,,,fee schedule,364% of BCBS fee schedule,64.68,364,,,fee schedule,364% of BCBS fee schedule,64.68,364,,,fee schedule,364% of BCBS fee schedule,323.1,90,,258.48,percent of total billed charges,90% of total billed charges,287.2,80,,229.76,percent of total billed charges,80% of total billed charges,323.1,90,,258.48,percent of total billed charges,90% of total billed charges,269.25,75,,215.4,percent of total billed charges,75% of total billed charges,17.55,122,,,fee schedule,122% of APC rate,104.11,29,,83.288,percent of total billed charges,29% of total billed charges,14.39,100,,,fee schedule,100% of CMS fee schedule,240.53,67,,192.424,percent of total billed charges,67% of total billed charges,21.4,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,287.2,80,,229.76,percent of total billed charges,80% of total billed charges,233.35,65,,186.68,percent of total billed charges,65% of total billed charges,128.06,35.67,,102.448,percent of total billed charges,35.67% of total billed charges,14.39,323.1,
CMV IgM AB BY EIA,3002500,CDM,300,RC,86645,HCPCS,outpatient,,,92,36.80,,78.2,85,,62.56,percent of total billed charges,85% of total billed charges,70.84,77,,56.67,percent of total billed charges,77% of total billed charges,16.85,100,,,fee schedule,100% of CMS fee schedule,72.8,350,,,fee schedule,350% of BCBS fee schedule,75.71,364,,,fee schedule,364% of BCBS fee schedule,75.71,364,,,fee schedule,364% of BCBS fee schedule,75.71,364,,,fee schedule,364% of BCBS fee schedule,82.8,90,,66.24,percent of total billed charges,90% of total billed charges,73.6,80,,58.88,percent of total billed charges,80% of total billed charges,82.8,90,,66.24,percent of total billed charges,90% of total billed charges,69,75,,55.2,percent of total billed charges,75% of total billed charges,20.55,122,,,fee schedule,122% of APC rate,26.68,29,,21.344,percent of total billed charges,29% of total billed charges,16.85,100,,,fee schedule,100% of CMS fee schedule,61.64,67,,49.312,percent of total billed charges,67% of total billed charges,8.64,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,73.6,80,,58.88,percent of total billed charges,80% of total billed charges,59.8,65,,47.84,percent of total billed charges,65% of total billed charges,32.82,35.67,,26.256,percent of total billed charges,35.67% of total billed charges,8.64,82.8,
CO 2,3002510,CDM,300,RC,82374,HCPCS,outpatient,,,45,18.00,,38.25,85,,30.6,percent of total billed charges,85% of total billed charges,34.65,77,,27.72,percent of total billed charges,77% of total billed charges,4.88,100,,,fee schedule,100% of CMS fee schedule,21.11,350,,,fee schedule,350% of BCBS fee schedule,21.95,364,,,fee schedule,364% of BCBS fee schedule,21.95,364,,,fee schedule,364% of BCBS fee schedule,21.95,364,,,fee schedule,364% of BCBS fee schedule,40.5,90,,32.4,percent of total billed charges,90% of total billed charges,36,80,,28.8,percent of total billed charges,80% of total billed charges,40.5,90,,32.4,percent of total billed charges,90% of total billed charges,33.75,75,,27,percent of total billed charges,75% of total billed charges,5.95,122,,,fee schedule,122% of APC rate,13.05,29,,10.44,percent of total billed charges,29% of total billed charges,4.88,100,,,fee schedule,100% of CMS fee schedule,30.15,67,,24.12,percent of total billed charges,67% of total billed charges,7.27,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,36,80,,28.8,percent of total billed charges,80% of total billed charges,29.25,65,,23.4,percent of total billed charges,65% of total billed charges,16.05,35.67,,12.84,percent of total billed charges,35.67% of total billed charges,4.88,40.5,
CORTISOL; FREE,3002515,CDM,300,RC,82530,HCPCS,outpatient,,,256,102.40,,217.6,85,,174.08,percent of total billed charges,85% of total billed charges,197.12,77,,157.7,percent of total billed charges,77% of total billed charges,16.71,100,,,fee schedule,100% of CMS fee schedule,72.21,350,,,fee schedule,350% of BCBS fee schedule,75.09,364,,,fee schedule,364% of BCBS fee schedule,75.09,364,,,fee schedule,364% of BCBS fee schedule,75.09,364,,,fee schedule,364% of BCBS fee schedule,230.4,90,,184.32,percent of total billed charges,90% of total billed charges,204.8,80,,163.84,percent of total billed charges,80% of total billed charges,230.4,90,,184.32,percent of total billed charges,90% of total billed charges,192,75,,153.6,percent of total billed charges,75% of total billed charges,20.38,122,,,fee schedule,122% of APC rate,74.24,29,,59.392,percent of total billed charges,29% of total billed charges,16.71,100,,,fee schedule,100% of CMS fee schedule,171.52,67,,137.216,percent of total billed charges,67% of total billed charges,24.85,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,204.8,80,,163.84,percent of total billed charges,80% of total billed charges,166.4,65,,133.12,percent of total billed charges,65% of total billed charges,91.32,35.67,,73.056,percent of total billed charges,35.67% of total billed charges,16.71,230.4,
ELECTROLYTES - 4 CHEM TESTS,3002520,CDM,300,RC,80051,HCPCS,outpatient,,,74,29.60,,62.9,85,,50.32,percent of total billed charges,85% of total billed charges,56.98,77,,45.58,percent of total billed charges,77% of total billed charges,7.01,100,,,fee schedule,100% of CMS fee schedule,30.31,350,,,fee schedule,350% of BCBS fee schedule,31.52,364,,,fee schedule,364% of BCBS fee schedule,31.52,364,,,fee schedule,364% of BCBS fee schedule,31.52,364,,,fee schedule,364% of BCBS fee schedule,66.6,90,,53.28,percent of total billed charges,90% of total billed charges,59.2,80,,47.36,percent of total billed charges,80% of total billed charges,66.6,90,,53.28,percent of total billed charges,90% of total billed charges,55.5,75,,44.4,percent of total billed charges,75% of total billed charges,8.55,122,,,fee schedule,122% of APC rate,21.46,29,,17.168,percent of total billed charges,29% of total billed charges,7.01,100,,,fee schedule,100% of CMS fee schedule,49.58,67,,39.664,percent of total billed charges,67% of total billed charges,7.93,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,59.2,80,,47.36,percent of total billed charges,80% of total billed charges,48.1,65,,38.48,percent of total billed charges,65% of total billed charges,26.4,35.67,,21.12,percent of total billed charges,35.67% of total billed charges,7.01,66.6,
COAGULATION FACTOR II,3002525,CDM,300,RC,85210,HCPCS,outpatient,,,116,46.40,,98.6,85,,78.88,percent of total billed charges,85% of total billed charges,89.32,77,,71.46,percent of total billed charges,77% of total billed charges,12.98,100,,,fee schedule,100% of CMS fee schedule,56.11,350,,,fee schedule,350% of BCBS fee schedule,58.35,364,,,fee schedule,364% of BCBS fee schedule,58.35,364,,,fee schedule,364% of BCBS fee schedule,58.35,364,,,fee schedule,364% of BCBS fee schedule,104.4,90,,83.52,percent of total billed charges,90% of total billed charges,92.8,80,,74.24,percent of total billed charges,80% of total billed charges,104.4,90,,83.52,percent of total billed charges,90% of total billed charges,87,75,,69.6,percent of total billed charges,75% of total billed charges,15.83,122,,,fee schedule,122% of APC rate,33.64,29,,26.912,percent of total billed charges,29% of total billed charges,12.98,100,,,fee schedule,100% of CMS fee schedule,77.72,67,,62.176,percent of total billed charges,67% of total billed charges,19.3,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,92.8,80,,74.24,percent of total billed charges,80% of total billed charges,75.4,65,,60.32,percent of total billed charges,65% of total billed charges,41.38,35.67,,33.104,percent of total billed charges,35.67% of total billed charges,12.98,104.4,
COAGULATION FACTOR IX,3002540,CDM,300,RC,85250,HCPCS,outpatient,,,200,80.00,,170,85,,136,percent of total billed charges,85% of total billed charges,154,77,,123.2,percent of total billed charges,77% of total billed charges,19.04,100,,,fee schedule,100% of CMS fee schedule,82.29,350,,,fee schedule,350% of BCBS fee schedule,85.58,364,,,fee schedule,364% of BCBS fee schedule,85.58,364,,,fee schedule,364% of BCBS fee schedule,85.58,364,,,fee schedule,364% of BCBS fee schedule,180,90,,144,percent of total billed charges,90% of total billed charges,160,80,,128,percent of total billed charges,80% of total billed charges,180,90,,144,percent of total billed charges,90% of total billed charges,150,75,,120,percent of total billed charges,75% of total billed charges,23.22,122,,,fee schedule,122% of APC rate,58,29,,46.4,percent of total billed charges,29% of total billed charges,19.04,100,,,fee schedule,100% of CMS fee schedule,134,67,,107.2,percent of total billed charges,67% of total billed charges,27.55,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,160,80,,128,percent of total billed charges,80% of total billed charges,130,65,,104,percent of total billed charges,65% of total billed charges,71.34,35.67,,57.072,percent of total billed charges,35.67% of total billed charges,19.04,180,
COAGULATION FACTOR V,3002560,CDM,300,RC,85220,HCPCS,outpatient,,,203,81.20,,172.55,85,,138.04,percent of total billed charges,85% of total billed charges,156.31,77,,125.05,percent of total billed charges,77% of total billed charges,17.64,100,,,fee schedule,100% of CMS fee schedule,76.27,350,,,fee schedule,350% of BCBS fee schedule,79.32,364,,,fee schedule,364% of BCBS fee schedule,79.32,364,,,fee schedule,364% of BCBS fee schedule,79.32,364,,,fee schedule,364% of BCBS fee schedule,182.7,90,,146.16,percent of total billed charges,90% of total billed charges,162.4,80,,129.92,percent of total billed charges,80% of total billed charges,182.7,90,,146.16,percent of total billed charges,90% of total billed charges,152.25,75,,121.8,percent of total billed charges,75% of total billed charges,21.53,122,,,fee schedule,122% of APC rate,58.87,29,,47.096,percent of total billed charges,29% of total billed charges,17.64,100,,,fee schedule,100% of CMS fee schedule,136.01,67,,108.808,percent of total billed charges,67% of total billed charges,26.25,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,162.4,80,,129.92,percent of total billed charges,80% of total billed charges,131.95,65,,105.56,percent of total billed charges,65% of total billed charges,72.41,35.67,,57.928,percent of total billed charges,35.67% of total billed charges,17.64,182.7,
COAGULATION FACTOR VII,3002580,CDM,300,RC,85230,HCPCS,outpatient,,,200,80.00,,170,85,,136,percent of total billed charges,85% of total billed charges,154,77,,123.2,percent of total billed charges,77% of total billed charges,17.89,100,,,fee schedule,100% of CMS fee schedule,77.35,350,,,fee schedule,350% of BCBS fee schedule,80.44,364,,,fee schedule,364% of BCBS fee schedule,80.44,364,,,fee schedule,364% of BCBS fee schedule,80.44,364,,,fee schedule,364% of BCBS fee schedule,180,90,,144,percent of total billed charges,90% of total billed charges,160,80,,128,percent of total billed charges,80% of total billed charges,180,90,,144,percent of total billed charges,90% of total billed charges,150,75,,120,percent of total billed charges,75% of total billed charges,21.83,122,,,fee schedule,122% of APC rate,58,29,,46.4,percent of total billed charges,29% of total billed charges,17.89,100,,,fee schedule,100% of CMS fee schedule,134,67,,107.2,percent of total billed charges,67% of total billed charges,26.62,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,160,80,,128,percent of total billed charges,80% of total billed charges,130,65,,104,percent of total billed charges,65% of total billed charges,71.34,35.67,,57.072,percent of total billed charges,35.67% of total billed charges,17.89,180,
COAGULATION FACTOR VIII,3002600,CDM,300,RC,85240,HCPCS,outpatient,,,196,78.40,,166.6,85,,133.28,percent of total billed charges,85% of total billed charges,150.92,77,,120.74,percent of total billed charges,77% of total billed charges,17.89,100,,,fee schedule,100% of CMS fee schedule,77.35,350,,,fee schedule,350% of BCBS fee schedule,80.44,364,,,fee schedule,364% of BCBS fee schedule,80.44,364,,,fee schedule,364% of BCBS fee schedule,80.44,364,,,fee schedule,364% of BCBS fee schedule,176.4,90,,141.12,percent of total billed charges,90% of total billed charges,156.8,80,,125.44,percent of total billed charges,80% of total billed charges,176.4,90,,141.12,percent of total billed charges,90% of total billed charges,147,75,,117.6,percent of total billed charges,75% of total billed charges,21.83,122,,,fee schedule,122% of APC rate,56.84,29,,45.472,percent of total billed charges,29% of total billed charges,17.89,100,,,fee schedule,100% of CMS fee schedule,131.32,67,,105.056,percent of total billed charges,67% of total billed charges,13,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,156.8,80,,125.44,percent of total billed charges,80% of total billed charges,127.4,65,,101.92,percent of total billed charges,65% of total billed charges,69.91,35.67,,55.928,percent of total billed charges,35.67% of total billed charges,13,176.4,
COAGULATION FACTOR XII,3002620,CDM,300,RC,85280,HCPCS,outpatient,,,200,80.00,,170,85,,136,percent of total billed charges,85% of total billed charges,154,77,,123.2,percent of total billed charges,77% of total billed charges,19.35,100,,,fee schedule,100% of CMS fee schedule,83.62,350,,,fee schedule,350% of BCBS fee schedule,86.96,364,,,fee schedule,364% of BCBS fee schedule,86.96,364,,,fee schedule,364% of BCBS fee schedule,86.96,364,,,fee schedule,364% of BCBS fee schedule,180,90,,144,percent of total billed charges,90% of total billed charges,160,80,,128,percent of total billed charges,80% of total billed charges,180,90,,144,percent of total billed charges,90% of total billed charges,150,75,,120,percent of total billed charges,75% of total billed charges,23.6,122,,,fee schedule,122% of APC rate,58,29,,46.4,percent of total billed charges,29% of total billed charges,19.35,100,,,fee schedule,100% of CMS fee schedule,134,67,,107.2,percent of total billed charges,67% of total billed charges,27.55,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,160,80,,128,percent of total billed charges,80% of total billed charges,130,65,,104,percent of total billed charges,65% of total billed charges,71.34,35.67,,57.072,percent of total billed charges,35.67% of total billed charges,19.35,180,
JAK 2 MUTATION,3002621,CDM,300,RC,81279,HCPCS,outpatient,,,699,279.60,,594.15,85,,475.32,percent of total billed charges,85% of total billed charges,538.23,77,,430.58,percent of total billed charges,77% of total billed charges,185.2,100,,,fee schedule,100% of CMS fee schedule,648.2,350,,,fee schedule,350% of BCBS fee schedule,674.13,364,,,fee schedule,364% of BCBS fee schedule,674.13,364,,,fee schedule,364% of BCBS fee schedule,674.13,364,,,fee schedule,364% of BCBS fee schedule,629.1,90,,503.28,percent of total billed charges,90% of total billed charges,559.2,80,,447.36,percent of total billed charges,80% of total billed charges,629.1,90,,503.28,percent of total billed charges,90% of total billed charges,524.25,75,,419.4,percent of total billed charges,75% of total billed charges,225.94,122,,,fee schedule,122% of APC rate,202.71,29,,162.168,percent of total billed charges,29% of total billed charges,185.2,100,,,fee schedule,100% of CMS fee schedule,468.33,67,,374.664,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,559.2,80,,447.36,percent of total billed charges,80% of total billed charges,454.35,65,,363.48,percent of total billed charges,65% of total billed charges,249.33,35.67,,199.464,percent of total billed charges,35.67% of total billed charges,185.2,674.13,
COAG TIME CAP,3002625,CDM,300,RC,85348,HCPCS,outpatient,,,29,11.60,,24.65,85,,19.72,percent of total billed charges,85% of total billed charges,22.33,77,,17.86,percent of total billed charges,77% of total billed charges,4.49,100,,,fee schedule,100% of CMS fee schedule,16.1,350,,,fee schedule,350% of BCBS fee schedule,16.74,364,,,fee schedule,364% of BCBS fee schedule,16.74,364,,,fee schedule,364% of BCBS fee schedule,16.74,364,,,fee schedule,364% of BCBS fee schedule,26.1,90,,20.88,percent of total billed charges,90% of total billed charges,23.2,80,,18.56,percent of total billed charges,80% of total billed charges,26.1,90,,20.88,percent of total billed charges,90% of total billed charges,21.75,75,,17.4,percent of total billed charges,75% of total billed charges,5.47,122,,,fee schedule,122% of APC rate,8.41,29,,6.728,percent of total billed charges,29% of total billed charges,4.49,100,,,fee schedule,100% of CMS fee schedule,19.43,67,,15.544,percent of total billed charges,67% of total billed charges,5.54,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,23.2,80,,18.56,percent of total billed charges,80% of total billed charges,18.85,65,,15.08,percent of total billed charges,65% of total billed charges,10.34,35.67,,8.272,percent of total billed charges,35.67% of total billed charges,4.49,26.1,
COAG TIME LEE-WHITE,3002630,CDM,300,RC,,,outpatient,,,150,60.00,,127.5,85,,102,percent of total billed charges,85% of total billed charges,115.5,77,,92.4,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,123,82,,98.4,percent of total billed charges,82% of total billed charges,127.5,85,,102,percent of total billed charges,85% of total billed charges,127.5,85,,102,percent of total billed charges,85% of total billed charges,127.5,85,,102,percent of total billed charges,85% of total billed charges,135,90,,108,percent of total billed charges,90% of total billed charges,120,80,,96,percent of total billed charges,80% of total billed charges,135,90,,108,percent of total billed charges,90% of total billed charges,112.5,75,,90,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,43.5,29,,34.8,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,100.5,67,,80.4,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,120,80,,96,percent of total billed charges,80% of total billed charges,97.5,65,,78,percent of total billed charges,65% of total billed charges,53.51,35.67,,42.808,percent of total billed charges,35.67% of total billed charges,43.5,135,
COCCIDIOIDES TITER,3002635,CDM,300,RC,86635,HCPCS,outpatient,,,70,28.00,,59.5,85,,47.6,percent of total billed charges,85% of total billed charges,53.9,77,,43.12,percent of total billed charges,77% of total billed charges,11.47,100,,,fee schedule,100% of CMS fee schedule,49.6,350,,,fee schedule,350% of BCBS fee schedule,51.58,364,,,fee schedule,364% of BCBS fee schedule,51.58,364,,,fee schedule,364% of BCBS fee schedule,51.58,364,,,fee schedule,364% of BCBS fee schedule,63,90,,50.4,percent of total billed charges,90% of total billed charges,56,80,,44.8,percent of total billed charges,80% of total billed charges,63,90,,50.4,percent of total billed charges,90% of total billed charges,52.5,75,,42,percent of total billed charges,75% of total billed charges,13.99,122,,,fee schedule,122% of APC rate,20.3,29,,16.24,percent of total billed charges,29% of total billed charges,11.47,100,,,fee schedule,100% of CMS fee schedule,46.9,67,,37.52,percent of total billed charges,67% of total billed charges,8.64,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,56,80,,44.8,percent of total billed charges,80% of total billed charges,45.5,65,,36.4,percent of total billed charges,65% of total billed charges,24.97,35.67,,19.976,percent of total billed charges,35.67% of total billed charges,8.64,63,
COCCIDIOIDES ANTIBODIES,3002636,CDM,300,RC,86635,HCPCS,outpatient,,,70,28.00,,59.5,85,,47.6,percent of total billed charges,85% of total billed charges,53.9,77,,43.12,percent of total billed charges,77% of total billed charges,11.47,100,,,fee schedule,100% of CMS fee schedule,49.6,350,,,fee schedule,350% of BCBS fee schedule,51.58,364,,,fee schedule,364% of BCBS fee schedule,51.58,364,,,fee schedule,364% of BCBS fee schedule,51.58,364,,,fee schedule,364% of BCBS fee schedule,63,90,,50.4,percent of total billed charges,90% of total billed charges,56,80,,44.8,percent of total billed charges,80% of total billed charges,63,90,,50.4,percent of total billed charges,90% of total billed charges,52.5,75,,42,percent of total billed charges,75% of total billed charges,13.99,122,,,fee schedule,122% of APC rate,20.3,29,,16.24,percent of total billed charges,29% of total billed charges,11.47,100,,,fee schedule,100% of CMS fee schedule,46.9,67,,37.52,percent of total billed charges,67% of total billed charges,8.64,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,56,80,,44.8,percent of total billed charges,80% of total billed charges,45.5,65,,36.4,percent of total billed charges,65% of total billed charges,24.97,35.67,,19.976,percent of total billed charges,35.67% of total billed charges,8.64,63,
COLD AGGLUTININS,3002640,CDM,300,RC,86157,HCPCS,outpatient,,,64,25.60,,54.4,85,,43.52,percent of total billed charges,85% of total billed charges,49.28,77,,39.42,percent of total billed charges,77% of total billed charges,8.06,100,,,fee schedule,100% of CMS fee schedule,34.83,350,,,fee schedule,350% of BCBS fee schedule,36.22,364,,,fee schedule,364% of BCBS fee schedule,36.22,364,,,fee schedule,364% of BCBS fee schedule,36.22,364,,,fee schedule,364% of BCBS fee schedule,57.6,90,,46.08,percent of total billed charges,90% of total billed charges,51.2,80,,40.96,percent of total billed charges,80% of total billed charges,57.6,90,,46.08,percent of total billed charges,90% of total billed charges,48,75,,38.4,percent of total billed charges,75% of total billed charges,9.83,122,,,fee schedule,122% of APC rate,18.56,29,,14.848,percent of total billed charges,29% of total billed charges,8.06,100,,,fee schedule,100% of CMS fee schedule,42.88,67,,34.304,percent of total billed charges,67% of total billed charges,8.64,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,51.2,80,,40.96,percent of total billed charges,80% of total billed charges,41.6,65,,33.28,percent of total billed charges,65% of total billed charges,22.83,35.67,,18.264,percent of total billed charges,35.67% of total billed charges,8.06,57.6,
COLITIS - CROHN'S PROFILE,3002641,CDM,300,RC,86671,HCPCS,outpatient,,,640,256.00,,544,85,,435.2,percent of total billed charges,85% of total billed charges,492.8,77,,394.24,percent of total billed charges,77% of total billed charges,12.25,100,,,fee schedule,100% of CMS fee schedule,52.96,350,,,fee schedule,350% of BCBS fee schedule,55.07,364,,,fee schedule,364% of BCBS fee schedule,55.07,364,,,fee schedule,364% of BCBS fee schedule,55.07,364,,,fee schedule,364% of BCBS fee schedule,576,90,,460.8,percent of total billed charges,90% of total billed charges,512,80,,409.6,percent of total billed charges,80% of total billed charges,576,90,,460.8,percent of total billed charges,90% of total billed charges,480,75,,384,percent of total billed charges,75% of total billed charges,14.94,122,,,fee schedule,122% of APC rate,185.6,29,,148.48,percent of total billed charges,29% of total billed charges,12.25,100,,,fee schedule,100% of CMS fee schedule,428.8,67,,343.04,percent of total billed charges,67% of total billed charges,7.56,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,512,80,,409.6,percent of total billed charges,80% of total billed charges,416,65,,332.8,percent of total billed charges,65% of total billed charges,228.29,35.67,,182.632,percent of total billed charges,35.67% of total billed charges,7.56,576,
COMPLEMENT C3,3002660,CDM,300,RC,86160,HCPCS,outpatient,,,140,56.00,,119,85,,95.2,percent of total billed charges,85% of total billed charges,107.8,77,,86.24,percent of total billed charges,77% of total billed charges,12,100,,,fee schedule,100% of CMS fee schedule,51.84,350,,,fee schedule,350% of BCBS fee schedule,53.91,364,,,fee schedule,364% of BCBS fee schedule,53.91,364,,,fee schedule,364% of BCBS fee schedule,53.91,364,,,fee schedule,364% of BCBS fee schedule,126,90,,100.8,percent of total billed charges,90% of total billed charges,112,80,,89.6,percent of total billed charges,80% of total billed charges,126,90,,100.8,percent of total billed charges,90% of total billed charges,105,75,,84,percent of total billed charges,75% of total billed charges,14.64,122,,,fee schedule,122% of APC rate,40.6,29,,32.48,percent of total billed charges,29% of total billed charges,12,100,,,fee schedule,100% of CMS fee schedule,93.8,67,,75.04,percent of total billed charges,67% of total billed charges,17.86,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,112,80,,89.6,percent of total billed charges,80% of total billed charges,91,65,,72.8,percent of total billed charges,65% of total billed charges,49.94,35.67,,39.952,percent of total billed charges,35.67% of total billed charges,12,126,
"C1 EST INH, QUANT",3002661,CDM,300,RC,86160,HCPCS,outpatient,,,40,16.00,,34,85,,27.2,percent of total billed charges,85% of total billed charges,30.8,77,,24.64,percent of total billed charges,77% of total billed charges,12,100,,,fee schedule,100% of CMS fee schedule,51.84,350,,,fee schedule,350% of BCBS fee schedule,53.91,364,,,fee schedule,364% of BCBS fee schedule,53.91,364,,,fee schedule,364% of BCBS fee schedule,53.91,364,,,fee schedule,364% of BCBS fee schedule,36,90,,28.8,percent of total billed charges,90% of total billed charges,32,80,,25.6,percent of total billed charges,80% of total billed charges,36,90,,28.8,percent of total billed charges,90% of total billed charges,30,75,,24,percent of total billed charges,75% of total billed charges,14.64,122,,,fee schedule,122% of APC rate,11.6,29,,9.28,percent of total billed charges,29% of total billed charges,12,100,,,fee schedule,100% of CMS fee schedule,26.8,67,,21.44,percent of total billed charges,67% of total billed charges,17.86,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,32,80,,25.6,percent of total billed charges,80% of total billed charges,26,65,,20.8,percent of total billed charges,65% of total billed charges,14.27,35.67,,11.416,percent of total billed charges,35.67% of total billed charges,11.6,53.91,
COMPLEMENT C4,3002680,CDM,300,RC,86161,HCPCS,outpatient,,,121,48.40,,102.85,85,,82.28,percent of total billed charges,85% of total billed charges,93.17,77,,74.54,percent of total billed charges,77% of total billed charges,12,100,,,fee schedule,100% of CMS fee schedule,51.84,350,,,fee schedule,350% of BCBS fee schedule,53.91,364,,,fee schedule,364% of BCBS fee schedule,53.91,364,,,fee schedule,364% of BCBS fee schedule,53.91,364,,,fee schedule,364% of BCBS fee schedule,108.9,90,,87.12,percent of total billed charges,90% of total billed charges,96.8,80,,77.44,percent of total billed charges,80% of total billed charges,108.9,90,,87.12,percent of total billed charges,90% of total billed charges,90.75,75,,72.6,percent of total billed charges,75% of total billed charges,14.64,122,,,fee schedule,122% of APC rate,35.09,29,,28.072,percent of total billed charges,29% of total billed charges,12,100,,,fee schedule,100% of CMS fee schedule,81.07,67,,64.856,percent of total billed charges,67% of total billed charges,17.86,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,96.8,80,,77.44,percent of total billed charges,80% of total billed charges,78.65,65,,62.92,percent of total billed charges,65% of total billed charges,43.16,35.67,,34.528,percent of total billed charges,35.67% of total billed charges,12,108.9,
COMPLEMENT TOTAL (CH5O),3002700,CDM,300,RC,86162,HCPCS,outpatient,,,163,65.20,,138.55,85,,110.84,percent of total billed charges,85% of total billed charges,125.51,77,,100.41,percent of total billed charges,77% of total billed charges,20.32,100,,,fee schedule,100% of CMS fee schedule,87.82,350,,,fee schedule,350% of BCBS fee schedule,91.33,364,,,fee schedule,364% of BCBS fee schedule,91.33,364,,,fee schedule,364% of BCBS fee schedule,91.33,364,,,fee schedule,364% of BCBS fee schedule,146.7,90,,117.36,percent of total billed charges,90% of total billed charges,130.4,80,,104.32,percent of total billed charges,80% of total billed charges,146.7,90,,117.36,percent of total billed charges,90% of total billed charges,122.25,75,,97.8,percent of total billed charges,75% of total billed charges,24.79,122,,,fee schedule,122% of APC rate,47.27,29,,37.816,percent of total billed charges,29% of total billed charges,20.32,100,,,fee schedule,100% of CMS fee schedule,109.21,67,,87.368,percent of total billed charges,67% of total billed charges,30.21,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,130.4,80,,104.32,percent of total billed charges,80% of total billed charges,105.95,65,,84.76,percent of total billed charges,65% of total billed charges,58.14,35.67,,46.512,percent of total billed charges,35.67% of total billed charges,20.32,146.7,
COMPLETE BLOOD CT w/AUTO DIFF,3002720,CDM,300,RC,85025,HCPCS,outpatient,,,87,34.80,,73.95,85,,59.16,percent of total billed charges,85% of total billed charges,66.99,77,,53.59,percent of total billed charges,77% of total billed charges,7.77,100,,,fee schedule,100% of CMS fee schedule,33.57,350,,,fee schedule,350% of BCBS fee schedule,34.91,364,,,fee schedule,364% of BCBS fee schedule,34.91,364,,,fee schedule,364% of BCBS fee schedule,34.91,364,,,fee schedule,364% of BCBS fee schedule,78.3,90,,62.64,percent of total billed charges,90% of total billed charges,69.6,80,,55.68,percent of total billed charges,80% of total billed charges,78.3,90,,62.64,percent of total billed charges,90% of total billed charges,65.25,75,,52.2,percent of total billed charges,75% of total billed charges,9.47,122,,,fee schedule,122% of APC rate,25.23,29,,20.184,percent of total billed charges,29% of total billed charges,7.77,100,,,fee schedule,100% of CMS fee schedule,58.29,67,,46.632,percent of total billed charges,67% of total billed charges,11.57,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,69.6,80,,55.68,percent of total billed charges,80% of total billed charges,56.55,65,,45.24,percent of total billed charges,65% of total billed charges,31.03,35.67,,24.824,percent of total billed charges,35.67% of total billed charges,7.77,78.3,
CBC -  REPEAT SAME DAY,3002721,CDM,300,RC,85025,HCPCS,outpatient,,,86,34.40,91,73.1,85,,58.48,percent of total billed charges,85% of total billed charges,66.22,77,,52.98,percent of total billed charges,77% of total billed charges,7.77,100,,,fee schedule,100% of CMS fee schedule,33.57,350,,,fee schedule,350% of BCBS fee schedule,34.91,364,,,fee schedule,364% of BCBS fee schedule,34.91,364,,,fee schedule,364% of BCBS fee schedule,34.91,364,,,fee schedule,364% of BCBS fee schedule,77.4,90,,61.92,percent of total billed charges,90% of total billed charges,68.8,80,,55.04,percent of total billed charges,80% of total billed charges,77.4,90,,61.92,percent of total billed charges,90% of total billed charges,64.5,75,,51.6,percent of total billed charges,75% of total billed charges,9.47,122,,,fee schedule,122% of APC rate,24.94,29,,19.952,percent of total billed charges,29% of total billed charges,7.77,100,,,fee schedule,100% of CMS fee schedule,57.62,67,,46.096,percent of total billed charges,67% of total billed charges,11.57,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,68.8,80,,55.04,percent of total billed charges,80% of total billed charges,55.9,65,,44.72,percent of total billed charges,65% of total billed charges,30.68,35.67,,24.544,percent of total billed charges,35.67% of total billed charges,7.77,77.4,
COMPREHENSIVE METABOLIC PANEL,3002725,CDM,300,RC,80053,HCPCS,outpatient,,,170,68.00,,144.5,85,,115.6,percent of total billed charges,85% of total billed charges,130.9,77,,104.72,percent of total billed charges,77% of total billed charges,10.56,100,,,fee schedule,100% of CMS fee schedule,45.64,350,,,fee schedule,350% of BCBS fee schedule,47.47,364,,,fee schedule,364% of BCBS fee schedule,47.47,364,,,fee schedule,364% of BCBS fee schedule,47.47,364,,,fee schedule,364% of BCBS fee schedule,153,90,,122.4,percent of total billed charges,90% of total billed charges,136,80,,108.8,percent of total billed charges,80% of total billed charges,153,90,,122.4,percent of total billed charges,90% of total billed charges,127.5,75,,102,percent of total billed charges,75% of total billed charges,12.88,122,,,fee schedule,122% of APC rate,49.3,29,,39.44,percent of total billed charges,29% of total billed charges,10.56,100,,,fee schedule,100% of CMS fee schedule,113.9,67,,91.12,percent of total billed charges,67% of total billed charges,14.21,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,136,80,,108.8,percent of total billed charges,80% of total billed charges,110.5,65,,88.4,percent of total billed charges,65% of total billed charges,60.64,35.67,,48.512,percent of total billed charges,35.67% of total billed charges,10.56,153,
"CBC,COMPLETE WITHOUT DIFF'S",3002727,CDM,300,RC,85027,HCPCS,outpatient,,,82,32.80,,69.7,85,,55.76,percent of total billed charges,85% of total billed charges,63.14,77,,50.51,percent of total billed charges,77% of total billed charges,6.47,100,,,fee schedule,100% of CMS fee schedule,27.93,350,,,fee schedule,350% of BCBS fee schedule,29.05,364,,,fee schedule,364% of BCBS fee schedule,29.05,364,,,fee schedule,364% of BCBS fee schedule,29.05,364,,,fee schedule,364% of BCBS fee schedule,73.8,90,,59.04,percent of total billed charges,90% of total billed charges,65.6,80,,52.48,percent of total billed charges,80% of total billed charges,73.8,90,,59.04,percent of total billed charges,90% of total billed charges,61.5,75,,49.2,percent of total billed charges,75% of total billed charges,7.89,122,,,fee schedule,122% of APC rate,23.78,29,,19.024,percent of total billed charges,29% of total billed charges,6.47,100,,,fee schedule,100% of CMS fee schedule,54.94,67,,43.952,percent of total billed charges,67% of total billed charges,8.64,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,65.6,80,,52.48,percent of total billed charges,80% of total billed charges,53.3,65,,42.64,percent of total billed charges,65% of total billed charges,29.25,35.67,,23.4,percent of total billed charges,35.67% of total billed charges,6.47,73.8,
"MANUAL DIFF, BLOOD SMEAR",3002728,CDM,300,RC,85007,HCPCS,outpatient,,,51,20.40,,43.35,85,,34.68,percent of total billed charges,85% of total billed charges,39.27,77,,31.42,percent of total billed charges,77% of total billed charges,3.8,100,,,fee schedule,100% of CMS fee schedule,14.84,350,,,fee schedule,350% of BCBS fee schedule,15.43,364,,,fee schedule,364% of BCBS fee schedule,15.43,364,,,fee schedule,364% of BCBS fee schedule,15.43,364,,,fee schedule,364% of BCBS fee schedule,45.9,90,,36.72,percent of total billed charges,90% of total billed charges,40.8,80,,32.64,percent of total billed charges,80% of total billed charges,45.9,90,,36.72,percent of total billed charges,90% of total billed charges,38.25,75,,30.6,percent of total billed charges,75% of total billed charges,4.63,122,,,fee schedule,122% of APC rate,14.79,29,,11.832,percent of total billed charges,29% of total billed charges,3.8,100,,,fee schedule,100% of CMS fee schedule,34.17,67,,27.336,percent of total billed charges,67% of total billed charges,5.11,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,40.8,80,,32.64,percent of total billed charges,80% of total billed charges,33.15,65,,26.52,percent of total billed charges,65% of total billed charges,18.19,35.67,,14.552,percent of total billed charges,35.67% of total billed charges,3.8,45.9,
COOMBS DIRECT,3002730,CDM,300,RC,86880,HCPCS,outpatient,,,158,63.20,,134.3,85,,107.44,percent of total billed charges,85% of total billed charges,121.66,77,,97.33,percent of total billed charges,77% of total billed charges,53.49,100,,,fee schedule,100% of CMS OPPS rate,111.3,350,,,fee schedule,350% of BCBS fee schedule,115.75,364,,,fee schedule,364% of BCBS fee schedule,115.75,364,,,fee schedule,364% of BCBS fee schedule,115.75,364,,,fee schedule,364% of BCBS fee schedule,142.2,90,,113.76,percent of total billed charges,90% of total billed charges,126.4,80,,101.12,percent of total billed charges,80% of total billed charges,142.2,90,,113.76,percent of total billed charges,90% of total billed charges,118.5,75,,94.8,percent of total billed charges,75% of total billed charges,65.26,122,,,fee schedule,122% of APC rate,45.82,29,,36.656,percent of total billed charges,29% of total billed charges,53.49,100,,,fee schedule,100% of CMS OPPS rate,105.86,67,,84.688,percent of total billed charges,67% of total billed charges,7.17,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,126.4,80,,101.12,percent of total billed charges,80% of total billed charges,102.7,65,,82.16,percent of total billed charges,65% of total billed charges,56.36,35.67,,45.088,percent of total billed charges,35.67% of total billed charges,7.17,142.2,
COOMBS INDIRECT,3002735,CDM,300,RC,86885,HCPCS,outpatient,,,505,202.00,,429.25,85,,343.4,percent of total billed charges,85% of total billed charges,388.85,77,,311.08,percent of total billed charges,77% of total billed charges,149.37,100,,,fee schedule,100% of CMS OPPS rate,452.13,350,,,fee schedule,350% of BCBS fee schedule,470.22,364,,,fee schedule,364% of BCBS fee schedule,470.22,364,,,fee schedule,364% of BCBS fee schedule,470.22,364,,,fee schedule,364% of BCBS fee schedule,454.5,90,,363.6,percent of total billed charges,90% of total billed charges,404,80,,323.2,percent of total billed charges,80% of total billed charges,454.5,90,,363.6,percent of total billed charges,90% of total billed charges,378.75,75,,303,percent of total billed charges,75% of total billed charges,182.23,122,,,fee schedule,122% of APC rate,146.45,29,,117.16,percent of total billed charges,29% of total billed charges,149.37,100,,,fee schedule,100% of CMS OPPS rate,338.35,67,,270.68,percent of total billed charges,67% of total billed charges,7.17,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,404,80,,323.2,percent of total billed charges,80% of total billed charges,328.25,65,,262.6,percent of total billed charges,65% of total billed charges,180.13,35.67,,144.104,percent of total billed charges,35.67% of total billed charges,7.17,470.22,
COPPER,3002740,CDM,300,RC,82525,HCPCS,outpatient,,,65,26.00,,55.25,85,,44.2,percent of total billed charges,85% of total billed charges,50.05,77,,40.04,percent of total billed charges,77% of total billed charges,12.41,100,,,fee schedule,100% of CMS fee schedule,53.62,350,,,fee schedule,350% of BCBS fee schedule,55.76,364,,,fee schedule,364% of BCBS fee schedule,55.76,364,,,fee schedule,364% of BCBS fee schedule,55.76,364,,,fee schedule,364% of BCBS fee schedule,58.5,90,,46.8,percent of total billed charges,90% of total billed charges,52,80,,41.6,percent of total billed charges,80% of total billed charges,58.5,90,,46.8,percent of total billed charges,90% of total billed charges,48.75,75,,39,percent of total billed charges,75% of total billed charges,15.14,122,,,fee schedule,122% of APC rate,18.85,29,,15.08,percent of total billed charges,29% of total billed charges,12.41,100,,,fee schedule,100% of CMS fee schedule,43.55,67,,34.84,percent of total billed charges,67% of total billed charges,18.45,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,52,80,,41.6,percent of total billed charges,80% of total billed charges,42.25,65,,33.8,percent of total billed charges,65% of total billed charges,23.19,35.67,,18.552,percent of total billed charges,35.67% of total billed charges,12.41,58.5,
CORTISOL,3002760,CDM,300,RC,82533,HCPCS,outpatient,,,83,33.20,,70.55,85,,56.44,percent of total billed charges,85% of total billed charges,63.91,77,,51.13,percent of total billed charges,77% of total billed charges,16.3,100,,,fee schedule,100% of CMS fee schedule,70.42,350,,,fee schedule,350% of BCBS fee schedule,73.24,364,,,fee schedule,364% of BCBS fee schedule,73.24,364,,,fee schedule,364% of BCBS fee schedule,73.24,364,,,fee schedule,364% of BCBS fee schedule,74.7,90,,59.76,percent of total billed charges,90% of total billed charges,66.4,80,,53.12,percent of total billed charges,80% of total billed charges,74.7,90,,59.76,percent of total billed charges,90% of total billed charges,62.25,75,,49.8,percent of total billed charges,75% of total billed charges,19.88,122,,,fee schedule,122% of APC rate,24.07,29,,19.256,percent of total billed charges,29% of total billed charges,16.3,100,,,fee schedule,100% of CMS fee schedule,55.61,67,,44.488,percent of total billed charges,67% of total billed charges,24.25,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,66.4,80,,53.12,percent of total billed charges,80% of total billed charges,53.95,65,,43.16,percent of total billed charges,65% of total billed charges,29.61,35.67,,23.688,percent of total billed charges,35.67% of total billed charges,16.3,74.7,
CORTISOL PM,3002762,CDM,300,RC,82533,HCPCS,outpatient,,,83,33.20,,70.55,85,,56.44,percent of total billed charges,85% of total billed charges,63.91,77,,51.13,percent of total billed charges,77% of total billed charges,16.3,100,,,fee schedule,100% of CMS fee schedule,70.42,350,,,fee schedule,350% of BCBS fee schedule,73.24,364,,,fee schedule,364% of BCBS fee schedule,73.24,364,,,fee schedule,364% of BCBS fee schedule,73.24,364,,,fee schedule,364% of BCBS fee schedule,74.7,90,,59.76,percent of total billed charges,90% of total billed charges,66.4,80,,53.12,percent of total billed charges,80% of total billed charges,74.7,90,,59.76,percent of total billed charges,90% of total billed charges,62.25,75,,49.8,percent of total billed charges,75% of total billed charges,19.88,122,,,fee schedule,122% of APC rate,24.07,29,,19.256,percent of total billed charges,29% of total billed charges,16.3,100,,,fee schedule,100% of CMS fee schedule,55.61,67,,44.488,percent of total billed charges,67% of total billed charges,24.25,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,66.4,80,,53.12,percent of total billed charges,80% of total billed charges,53.95,65,,43.16,percent of total billed charges,65% of total billed charges,29.61,35.67,,23.688,percent of total billed charges,35.67% of total billed charges,16.3,74.7,
COXSACKIE,3002765,CDM,300,RC,86658,HCPCS,outpatient,,,215,86.00,,182.75,85,,146.2,percent of total billed charges,85% of total billed charges,165.55,77,,132.44,percent of total billed charges,77% of total billed charges,13.03,100,,,fee schedule,100% of CMS fee schedule,56.28,350,,,fee schedule,350% of BCBS fee schedule,58.53,364,,,fee schedule,364% of BCBS fee schedule,58.53,364,,,fee schedule,364% of BCBS fee schedule,58.53,364,,,fee schedule,364% of BCBS fee schedule,193.5,90,,154.8,percent of total billed charges,90% of total billed charges,172,80,,137.6,percent of total billed charges,80% of total billed charges,193.5,90,,154.8,percent of total billed charges,90% of total billed charges,161.25,75,,129,percent of total billed charges,75% of total billed charges,15.89,122,,,fee schedule,122% of APC rate,62.35,29,,49.88,percent of total billed charges,29% of total billed charges,13.03,100,,,fee schedule,100% of CMS fee schedule,144.05,67,,115.24,percent of total billed charges,67% of total billed charges,8.64,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,172,80,,137.6,percent of total billed charges,80% of total billed charges,139.75,65,,111.8,percent of total billed charges,65% of total billed charges,76.69,35.67,,61.352,percent of total billed charges,35.67% of total billed charges,8.64,193.5,
CPK,3002780,CDM,300,RC,82550,HCPCS,outpatient,,,83,33.20,,70.55,85,,56.44,percent of total billed charges,85% of total billed charges,63.91,77,,51.13,percent of total billed charges,77% of total billed charges,6.51,100,,,fee schedule,100% of CMS fee schedule,28.14,350,,,fee schedule,350% of BCBS fee schedule,29.27,364,,,fee schedule,364% of BCBS fee schedule,29.27,364,,,fee schedule,364% of BCBS fee schedule,29.27,364,,,fee schedule,364% of BCBS fee schedule,74.7,90,,59.76,percent of total billed charges,90% of total billed charges,66.4,80,,53.12,percent of total billed charges,80% of total billed charges,74.7,90,,59.76,percent of total billed charges,90% of total billed charges,62.25,75,,49.8,percent of total billed charges,75% of total billed charges,7.94,122,,,fee schedule,122% of APC rate,24.07,29,,19.256,percent of total billed charges,29% of total billed charges,6.51,100,,,fee schedule,100% of CMS fee schedule,55.61,67,,44.488,percent of total billed charges,67% of total billed charges,9.69,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,66.4,80,,53.12,percent of total billed charges,80% of total billed charges,53.95,65,,43.16,percent of total billed charges,65% of total billed charges,29.61,35.67,,23.688,percent of total billed charges,35.67% of total billed charges,6.51,74.7,
CPK ISOENZYMES,3002800,CDM,300,RC,82552,HCPCS,outpatient,,,79,31.60,,67.15,85,,53.72,percent of total billed charges,85% of total billed charges,60.83,77,,48.66,percent of total billed charges,77% of total billed charges,13.39,100,,,fee schedule,100% of CMS fee schedule,57.86,350,,,fee schedule,350% of BCBS fee schedule,60.17,364,,,fee schedule,364% of BCBS fee schedule,60.17,364,,,fee schedule,364% of BCBS fee schedule,60.17,364,,,fee schedule,364% of BCBS fee schedule,71.1,90,,56.88,percent of total billed charges,90% of total billed charges,63.2,80,,50.56,percent of total billed charges,80% of total billed charges,71.1,90,,56.88,percent of total billed charges,90% of total billed charges,59.25,75,,47.4,percent of total billed charges,75% of total billed charges,16.33,122,,,fee schedule,122% of APC rate,22.91,29,,18.328,percent of total billed charges,29% of total billed charges,13.39,100,,,fee schedule,100% of CMS fee schedule,52.93,67,,42.344,percent of total billed charges,67% of total billed charges,13,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,63.2,80,,50.56,percent of total billed charges,80% of total billed charges,51.35,65,,41.08,percent of total billed charges,65% of total billed charges,28.18,35.67,,22.544,percent of total billed charges,35.67% of total billed charges,13,71.1,
CPK TOTAL REPEAT SAME DAY,3002821,CDM,300,RC,82550,HCPCS,outpatient,,,54,21.60,91,45.9,85,,36.72,percent of total billed charges,85% of total billed charges,41.58,77,,33.26,percent of total billed charges,77% of total billed charges,6.51,100,,,fee schedule,100% of CMS fee schedule,28.14,350,,,fee schedule,350% of BCBS fee schedule,29.27,364,,,fee schedule,364% of BCBS fee schedule,29.27,364,,,fee schedule,364% of BCBS fee schedule,29.27,364,,,fee schedule,364% of BCBS fee schedule,48.6,90,,38.88,percent of total billed charges,90% of total billed charges,43.2,80,,34.56,percent of total billed charges,80% of total billed charges,48.6,90,,38.88,percent of total billed charges,90% of total billed charges,40.5,75,,32.4,percent of total billed charges,75% of total billed charges,7.94,122,,,fee schedule,122% of APC rate,15.66,29,,12.528,percent of total billed charges,29% of total billed charges,6.51,100,,,fee schedule,100% of CMS fee schedule,36.18,67,,28.944,percent of total billed charges,67% of total billed charges,9.69,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,43.2,80,,34.56,percent of total billed charges,80% of total billed charges,35.1,65,,28.08,percent of total billed charges,65% of total billed charges,19.26,35.67,,15.408,percent of total billed charges,35.67% of total billed charges,6.51,48.6,
CREATININE SERUM,3002840,CDM,300,RC,82565,HCPCS,outpatient,,,48,19.20,,40.8,85,,32.64,percent of total billed charges,85% of total billed charges,36.96,77,,29.57,percent of total billed charges,77% of total billed charges,5.12,100,,,fee schedule,100% of CMS fee schedule,22.16,350,,,fee schedule,350% of BCBS fee schedule,23.04,364,,,fee schedule,364% of BCBS fee schedule,23.04,364,,,fee schedule,364% of BCBS fee schedule,23.04,364,,,fee schedule,364% of BCBS fee schedule,43.2,90,,34.56,percent of total billed charges,90% of total billed charges,38.4,80,,30.72,percent of total billed charges,80% of total billed charges,43.2,90,,34.56,percent of total billed charges,90% of total billed charges,36,75,,28.8,percent of total billed charges,75% of total billed charges,6.24,122,,,fee schedule,122% of APC rate,13.92,29,,11.136,percent of total billed charges,29% of total billed charges,5.12,100,,,fee schedule,100% of CMS fee schedule,32.16,67,,25.728,percent of total billed charges,67% of total billed charges,7.62,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,38.4,80,,30.72,percent of total billed charges,80% of total billed charges,31.2,65,,24.96,percent of total billed charges,65% of total billed charges,17.12,35.67,,13.696,percent of total billed charges,35.67% of total billed charges,5.12,43.2,
CREATININE CLEARANCE-URINE,3002860,CDM,300,RC,82575,HCPCS,outpatient,,,65,26.00,,55.25,85,,44.2,percent of total billed charges,85% of total billed charges,50.05,77,,40.04,percent of total billed charges,77% of total billed charges,9.46,100,,,fee schedule,100% of CMS fee schedule,40.85,350,,,fee schedule,350% of BCBS fee schedule,42.48,364,,,fee schedule,364% of BCBS fee schedule,42.48,364,,,fee schedule,364% of BCBS fee schedule,42.48,364,,,fee schedule,364% of BCBS fee schedule,58.5,90,,46.8,percent of total billed charges,90% of total billed charges,52,80,,41.6,percent of total billed charges,80% of total billed charges,58.5,90,,46.8,percent of total billed charges,90% of total billed charges,48.75,75,,39,percent of total billed charges,75% of total billed charges,11.54,122,,,fee schedule,122% of APC rate,18.85,29,,15.08,percent of total billed charges,29% of total billed charges,9.46,100,,,fee schedule,100% of CMS fee schedule,43.55,67,,34.84,percent of total billed charges,67% of total billed charges,14.05,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,52,80,,41.6,percent of total billed charges,80% of total billed charges,42.25,65,,33.8,percent of total billed charges,65% of total billed charges,23.19,35.67,,18.552,percent of total billed charges,35.67% of total billed charges,9.46,58.5,
CROSSMATCH AHG EA UNIT,3002870,CDM,300,RC,86922,HCPCS,outpatient,,,423,169.20,,359.55,85,,287.64,percent of total billed charges,85% of total billed charges,325.71,77,,260.57,percent of total billed charges,77% of total billed charges,149.37,100,,,fee schedule,100% of CMS OPPS rate,452.13,350,,,fee schedule,350% of BCBS fee schedule,470.22,364,,,fee schedule,364% of BCBS fee schedule,470.22,364,,,fee schedule,364% of BCBS fee schedule,470.22,364,,,fee schedule,364% of BCBS fee schedule,380.7,90,,304.56,percent of total billed charges,90% of total billed charges,338.4,80,,270.72,percent of total billed charges,80% of total billed charges,380.7,90,,304.56,percent of total billed charges,90% of total billed charges,317.25,75,,253.8,percent of total billed charges,75% of total billed charges,182.23,122,,,fee schedule,122% of APC rate,122.67,29,,98.136,percent of total billed charges,29% of total billed charges,149.37,100,,,fee schedule,100% of CMS OPPS rate,283.41,67,,226.728,percent of total billed charges,67% of total billed charges,23.18,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,338.4,80,,270.72,percent of total billed charges,80% of total billed charges,274.95,65,,219.96,percent of total billed charges,65% of total billed charges,150.88,35.67,,120.704,percent of total billed charges,35.67% of total billed charges,23.18,470.22,
CREATININE URINE RANDOM,3002880,CDM,300,RC,82570,HCPCS,outpatient,,,63,25.20,,53.55,85,,42.84,percent of total billed charges,85% of total billed charges,48.51,77,,38.81,percent of total billed charges,77% of total billed charges,5.18,100,,,fee schedule,100% of CMS fee schedule,22.37,350,,,fee schedule,350% of BCBS fee schedule,23.26,364,,,fee schedule,364% of BCBS fee schedule,23.26,364,,,fee schedule,364% of BCBS fee schedule,23.26,364,,,fee schedule,364% of BCBS fee schedule,56.7,90,,45.36,percent of total billed charges,90% of total billed charges,50.4,80,,40.32,percent of total billed charges,80% of total billed charges,56.7,90,,45.36,percent of total billed charges,90% of total billed charges,47.25,75,,37.8,percent of total billed charges,75% of total billed charges,6.31,122,,,fee schedule,122% of APC rate,18.27,29,,14.616,percent of total billed charges,29% of total billed charges,5.18,100,,,fee schedule,100% of CMS fee schedule,42.21,67,,33.768,percent of total billed charges,67% of total billed charges,7.69,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,50.4,80,,40.32,percent of total billed charges,80% of total billed charges,40.95,65,,32.76,percent of total billed charges,65% of total billed charges,22.47,35.67,,17.976,percent of total billed charges,35.67% of total billed charges,5.18,56.7,
COVID ANTIBODY BLOOD TEST,3002884,CDM,300,RC,86769,HCPCS,outpatient,,,97,38.80,,82.45,85,,65.96,percent of total billed charges,85% of total billed charges,74.69,77,,59.75,percent of total billed charges,77% of total billed charges,42.13,100,,,fee schedule,100% of CMS fee schedule,147.46,350,,,fee schedule,350% of BCBS fee schedule,153.35,364,,,fee schedule,364% of BCBS fee schedule,153.35,364,,,fee schedule,364% of BCBS fee schedule,153.35,364,,,fee schedule,364% of BCBS fee schedule,87.3,90,,69.84,percent of total billed charges,90% of total billed charges,77.6,80,,62.08,percent of total billed charges,80% of total billed charges,87.3,90,,69.84,percent of total billed charges,90% of total billed charges,72.75,75,,58.2,percent of total billed charges,75% of total billed charges,51.39,122,,,fee schedule,122% of APC rate,28.13,29,,22.504,percent of total billed charges,29% of total billed charges,42.13,100,,,fee schedule,100% of CMS fee schedule,64.99,67,,51.992,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,77.6,80,,62.08,percent of total billed charges,80% of total billed charges,63.05,65,,50.44,percent of total billed charges,65% of total billed charges,34.6,35.67,,27.68,percent of total billed charges,35.67% of total billed charges,28.13,153.35,
COVID ANTIGEN RAPID TEST,3002885,CDM,300,RC,87426,HCPCS,outpatient,,,83,33.20,,70.55,85,,56.44,percent of total billed charges,85% of total billed charges,63.91,77,,51.13,percent of total billed charges,77% of total billed charges,35.33,100,,,fee schedule,100% of CMS fee schedule,158.31,350,,,fee schedule,350% of BCBS fee schedule,164.64,364,,,fee schedule,364% of BCBS fee schedule,164.64,364,,,fee schedule,364% of BCBS fee schedule,164.64,364,,,fee schedule,364% of BCBS fee schedule,74.7,90,,59.76,percent of total billed charges,90% of total billed charges,66.4,80,,53.12,percent of total billed charges,80% of total billed charges,74.7,90,,59.76,percent of total billed charges,90% of total billed charges,62.25,75,,49.8,percent of total billed charges,75% of total billed charges,43.1,122,,,fee schedule,122% of APC rate,24.07,29,,19.256,percent of total billed charges,29% of total billed charges,35.33,100,,,fee schedule,100% of CMS fee schedule,55.61,67,,44.488,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,66.4,80,,53.12,percent of total billed charges,80% of total billed charges,53.95,65,,43.16,percent of total billed charges,65% of total billed charges,29.61,35.67,,23.688,percent of total billed charges,35.67% of total billed charges,24.07,164.64,
COVID PCR TST,3002887,CDM,300,RC,87635,HCPCS,outpatient,,,93,37.20,,79.05,85,,63.24,percent of total billed charges,85% of total billed charges,71.61,77,,57.29,percent of total billed charges,77% of total billed charges,51.31,100,,,fee schedule,100% of CMS fee schedule,179.59,350,,,fee schedule,350% of BCBS fee schedule,186.77,364,,,fee schedule,364% of BCBS fee schedule,186.77,364,,,fee schedule,364% of BCBS fee schedule,186.77,364,,,fee schedule,364% of BCBS fee schedule,83.7,90,,66.96,percent of total billed charges,90% of total billed charges,74.4,80,,59.52,percent of total billed charges,80% of total billed charges,83.7,90,,66.96,percent of total billed charges,90% of total billed charges,69.75,75,,55.8,percent of total billed charges,75% of total billed charges,62.59,122,,,fee schedule,122% of APC rate,26.97,29,,21.576,percent of total billed charges,29% of total billed charges,51.31,100,,,fee schedule,100% of CMS fee schedule,62.31,67,,49.848,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,74.4,80,,59.52,percent of total billed charges,80% of total billed charges,60.45,65,,48.36,percent of total billed charges,65% of total billed charges,33.17,35.67,,26.536,percent of total billed charges,35.67% of total billed charges,26.97,186.77,
COVID COMBO FLU-RSV-COVID,3002888,CDM,300,RC,87637,HCPCS,outpatient,,,317,126.80,,269.45,85,,215.56,percent of total billed charges,85% of total billed charges,244.09,77,,195.27,percent of total billed charges,77% of total billed charges,142.63,100,,,fee schedule,100% of CMS fee schedule,499.21,350,,,fee schedule,350% of BCBS fee schedule,519.17,364,,,fee schedule,364% of BCBS fee schedule,519.17,364,,,fee schedule,364% of BCBS fee schedule,519.17,364,,,fee schedule,364% of BCBS fee schedule,285.3,90,,228.24,percent of total billed charges,90% of total billed charges,253.6,80,,202.88,percent of total billed charges,80% of total billed charges,285.3,90,,228.24,percent of total billed charges,90% of total billed charges,237.75,75,,190.2,percent of total billed charges,75% of total billed charges,174,122,,,fee schedule,122% of APC rate,91.93,29,,73.544,percent of total billed charges,29% of total billed charges,142.63,100,,,fee schedule,100% of CMS fee schedule,212.39,67,,169.912,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,253.6,80,,202.88,percent of total billed charges,80% of total billed charges,206.05,65,,164.84,percent of total billed charges,65% of total billed charges,113.07,35.67,,90.456,percent of total billed charges,35.67% of total billed charges,91.93,519.17,
COVID COMBO FLU-RSV-COVID-COLL,3002890,CDM,300,RC,,,outpatient,,,311,124.40,,264.35,85,,211.48,percent of total billed charges,85% of total billed charges,239.47,77,,191.58,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,255.02,82,,204.016,percent of total billed charges,82% of total billed charges,264.35,85,,211.48,percent of total billed charges,85% of total billed charges,264.35,85,,211.48,percent of total billed charges,85% of total billed charges,264.35,85,,211.48,percent of total billed charges,85% of total billed charges,279.9,90,,223.92,percent of total billed charges,90% of total billed charges,248.8,80,,199.04,percent of total billed charges,80% of total billed charges,279.9,90,,223.92,percent of total billed charges,90% of total billed charges,233.25,75,,186.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,90.19,29,,72.152,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,208.37,67,,166.696,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,248.8,80,,199.04,percent of total billed charges,80% of total billed charges,202.15,65,,161.72,percent of total billed charges,65% of total billed charges,110.93,35.67,,88.744,percent of total billed charges,35.67% of total billed charges,90.19,279.9,
COVID ANTIBODY IgG Ab N PROTEI,3002891,CDM,300,RC,86769,HCPCS,outpatient,,,97,38.80,,82.45,85,,65.96,percent of total billed charges,85% of total billed charges,74.69,77,,59.75,percent of total billed charges,77% of total billed charges,42.13,100,,,fee schedule,100% of CMS fee schedule,147.46,350,,,fee schedule,350% of BCBS fee schedule,153.35,364,,,fee schedule,364% of BCBS fee schedule,153.35,364,,,fee schedule,364% of BCBS fee schedule,153.35,364,,,fee schedule,364% of BCBS fee schedule,87.3,90,,69.84,percent of total billed charges,90% of total billed charges,77.6,80,,62.08,percent of total billed charges,80% of total billed charges,87.3,90,,69.84,percent of total billed charges,90% of total billed charges,72.75,75,,58.2,percent of total billed charges,75% of total billed charges,51.39,122,,,fee schedule,122% of APC rate,28.13,29,,22.504,percent of total billed charges,29% of total billed charges,42.13,100,,,fee schedule,100% of CMS fee schedule,64.99,67,,51.992,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,77.6,80,,62.08,percent of total billed charges,80% of total billed charges,63.05,65,,50.44,percent of total billed charges,65% of total billed charges,34.6,35.67,,27.68,percent of total billed charges,35.67% of total billed charges,28.13,153.35,
COVID ANTIBODY TOTAL AB S PROT,3002892,CDM,300,RC,86769,HCPCS,outpatient,,,97,38.80,,82.45,85,,65.96,percent of total billed charges,85% of total billed charges,74.69,77,,59.75,percent of total billed charges,77% of total billed charges,42.13,100,,,fee schedule,100% of CMS fee schedule,147.46,350,,,fee schedule,350% of BCBS fee schedule,153.35,364,,,fee schedule,364% of BCBS fee schedule,153.35,364,,,fee schedule,364% of BCBS fee schedule,153.35,364,,,fee schedule,364% of BCBS fee schedule,87.3,90,,69.84,percent of total billed charges,90% of total billed charges,77.6,80,,62.08,percent of total billed charges,80% of total billed charges,87.3,90,,69.84,percent of total billed charges,90% of total billed charges,72.75,75,,58.2,percent of total billed charges,75% of total billed charges,51.39,122,,,fee schedule,122% of APC rate,28.13,29,,22.504,percent of total billed charges,29% of total billed charges,42.13,100,,,fee schedule,100% of CMS fee schedule,64.99,67,,51.992,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,77.6,80,,62.08,percent of total billed charges,80% of total billed charges,63.05,65,,50.44,percent of total billed charges,65% of total billed charges,34.6,35.67,,27.68,percent of total billed charges,35.67% of total billed charges,28.13,153.35,
CHLAMYDIA FOR PANEL,3002910,CDM,300,RC,86631,HCPCS,outpatient,,,170,68.00,,144.5,85,,115.6,percent of total billed charges,85% of total billed charges,130.9,77,,104.72,percent of total billed charges,77% of total billed charges,11.82,100,,,fee schedule,100% of CMS fee schedule,51.1,350,,,fee schedule,350% of BCBS fee schedule,53.14,364,,,fee schedule,364% of BCBS fee schedule,53.14,364,,,fee schedule,364% of BCBS fee schedule,53.14,364,,,fee schedule,364% of BCBS fee schedule,153,90,,122.4,percent of total billed charges,90% of total billed charges,136,80,,108.8,percent of total billed charges,80% of total billed charges,153,90,,122.4,percent of total billed charges,90% of total billed charges,127.5,75,,102,percent of total billed charges,75% of total billed charges,14.42,122,,,fee schedule,122% of APC rate,49.3,29,,39.44,percent of total billed charges,29% of total billed charges,11.82,100,,,fee schedule,100% of CMS fee schedule,113.9,67,,91.12,percent of total billed charges,67% of total billed charges,8.64,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,136,80,,108.8,percent of total billed charges,80% of total billed charges,110.5,65,,88.4,percent of total billed charges,65% of total billed charges,60.64,35.67,,48.512,percent of total billed charges,35.67% of total billed charges,8.64,153,
ASPERGILLUS FOR PANEL,3002911,CDM,300,RC,86606,HCPCS,outpatient,,,170,68.00,,144.5,85,,115.6,percent of total billed charges,85% of total billed charges,130.9,77,,104.72,percent of total billed charges,77% of total billed charges,15.05,100,,,fee schedule,100% of CMS fee schedule,65.07,350,,,fee schedule,350% of BCBS fee schedule,67.67,364,,,fee schedule,364% of BCBS fee schedule,67.67,364,,,fee schedule,364% of BCBS fee schedule,67.67,364,,,fee schedule,364% of BCBS fee schedule,153,90,,122.4,percent of total billed charges,90% of total billed charges,136,80,,108.8,percent of total billed charges,80% of total billed charges,153,90,,122.4,percent of total billed charges,90% of total billed charges,127.5,75,,102,percent of total billed charges,75% of total billed charges,18.36,122,,,fee schedule,122% of APC rate,49.3,29,,39.44,percent of total billed charges,29% of total billed charges,15.05,100,,,fee schedule,100% of CMS fee schedule,113.9,67,,91.12,percent of total billed charges,67% of total billed charges,8.64,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,136,80,,108.8,percent of total billed charges,80% of total billed charges,110.5,65,,88.4,percent of total billed charges,65% of total billed charges,60.64,35.67,,48.512,percent of total billed charges,35.67% of total billed charges,8.64,153,
CRYOGLOBULINS,3002920,CDM,300,RC,82595,HCPCS,outpatient,,,61,24.40,,51.85,85,,41.48,percent of total billed charges,85% of total billed charges,46.97,77,,37.58,percent of total billed charges,77% of total billed charges,6.47,100,,,fee schedule,100% of CMS fee schedule,27.93,350,,,fee schedule,350% of BCBS fee schedule,29.05,364,,,fee schedule,364% of BCBS fee schedule,29.05,364,,,fee schedule,364% of BCBS fee schedule,29.05,364,,,fee schedule,364% of BCBS fee schedule,54.9,90,,43.92,percent of total billed charges,90% of total billed charges,48.8,80,,39.04,percent of total billed charges,80% of total billed charges,54.9,90,,43.92,percent of total billed charges,90% of total billed charges,45.75,75,,36.6,percent of total billed charges,75% of total billed charges,7.89,122,,,fee schedule,122% of APC rate,17.69,29,,14.152,percent of total billed charges,29% of total billed charges,6.47,100,,,fee schedule,100% of CMS fee schedule,40.87,67,,32.696,percent of total billed charges,67% of total billed charges,9.62,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,48.8,80,,39.04,percent of total billed charges,80% of total billed charges,39.65,65,,31.72,percent of total billed charges,65% of total billed charges,21.76,35.67,,17.408,percent of total billed charges,35.67% of total billed charges,6.47,54.9,
CRYPTOCOCCAL ANTIGEN,3002940,CDM,300,RC,86641,HCPCS,outpatient,,,116,46.40,,98.6,85,,78.88,percent of total billed charges,85% of total billed charges,89.32,77,,71.46,percent of total billed charges,77% of total billed charges,14.41,100,,,fee schedule,100% of CMS fee schedule,62.27,350,,,fee schedule,350% of BCBS fee schedule,64.76,364,,,fee schedule,364% of BCBS fee schedule,64.76,364,,,fee schedule,364% of BCBS fee schedule,64.76,364,,,fee schedule,364% of BCBS fee schedule,104.4,90,,83.52,percent of total billed charges,90% of total billed charges,92.8,80,,74.24,percent of total billed charges,80% of total billed charges,104.4,90,,83.52,percent of total billed charges,90% of total billed charges,87,75,,69.6,percent of total billed charges,75% of total billed charges,17.58,122,,,fee schedule,122% of APC rate,33.64,29,,26.912,percent of total billed charges,29% of total billed charges,14.41,100,,,fee schedule,100% of CMS fee schedule,77.72,67,,62.176,percent of total billed charges,67% of total billed charges,8.64,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,92.8,80,,74.24,percent of total billed charges,80% of total billed charges,75.4,65,,60.32,percent of total billed charges,65% of total billed charges,41.38,35.67,,33.104,percent of total billed charges,35.67% of total billed charges,8.64,104.4,
CRYSTALS SYNOVIAL FLD EXP,3002960,CDM,300,RC,89060,HCPCS,outpatient,,,60,24.00,,51,85,,40.8,percent of total billed charges,85% of total billed charges,46.2,77,,36.96,percent of total billed charges,77% of total billed charges,7.33,100,,,fee schedule,100% of CMS fee schedule,30.91,350,,,fee schedule,350% of BCBS fee schedule,32.14,364,,,fee schedule,364% of BCBS fee schedule,32.14,364,,,fee schedule,364% of BCBS fee schedule,32.14,364,,,fee schedule,364% of BCBS fee schedule,54,90,,43.2,percent of total billed charges,90% of total billed charges,48,80,,38.4,percent of total billed charges,80% of total billed charges,54,90,,43.2,percent of total billed charges,90% of total billed charges,45,75,,36,percent of total billed charges,75% of total billed charges,8.94,122,,,fee schedule,122% of APC rate,17.4,29,,13.92,percent of total billed charges,29% of total billed charges,7.33,100,,,fee schedule,100% of CMS fee schedule,40.2,67,,32.16,percent of total billed charges,67% of total billed charges,10.63,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,48,80,,38.4,percent of total billed charges,80% of total billed charges,39,65,,31.2,percent of total billed charges,65% of total billed charges,21.4,35.67,,17.12,percent of total billed charges,35.67% of total billed charges,7.33,54,
CSF IgG SYNTHESIS,3002964,CDM,300,RC,,,outpatient,,,137,54.80,,116.45,85,,93.16,percent of total billed charges,85% of total billed charges,105.49,77,,84.39,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,112.34,82,,89.872,percent of total billed charges,82% of total billed charges,116.45,85,,93.16,percent of total billed charges,85% of total billed charges,116.45,85,,93.16,percent of total billed charges,85% of total billed charges,116.45,85,,93.16,percent of total billed charges,85% of total billed charges,123.3,90,,98.64,percent of total billed charges,90% of total billed charges,109.6,80,,87.68,percent of total billed charges,80% of total billed charges,123.3,90,,98.64,percent of total billed charges,90% of total billed charges,102.75,75,,82.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,39.73,29,,31.784,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,91.79,67,,73.432,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,109.6,80,,87.68,percent of total billed charges,80% of total billed charges,89.05,65,,71.24,percent of total billed charges,65% of total billed charges,48.87,35.67,,39.096,percent of total billed charges,35.67% of total billed charges,39.73,123.3,
CSF PROFILE,3002965,CDM,300,RC,,,outpatient,,,517,206.80,,439.45,85,,351.56,percent of total billed charges,85% of total billed charges,398.09,77,,318.47,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,423.94,82,,339.152,percent of total billed charges,82% of total billed charges,439.45,85,,351.56,percent of total billed charges,85% of total billed charges,439.45,85,,351.56,percent of total billed charges,85% of total billed charges,439.45,85,,351.56,percent of total billed charges,85% of total billed charges,465.3,90,,372.24,percent of total billed charges,90% of total billed charges,413.6,80,,330.88,percent of total billed charges,80% of total billed charges,465.3,90,,372.24,percent of total billed charges,90% of total billed charges,387.75,75,,310.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,149.93,29,,119.944,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,346.39,67,,277.112,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,413.6,80,,330.88,percent of total billed charges,80% of total billed charges,336.05,65,,268.84,percent of total billed charges,65% of total billed charges,184.41,35.67,,147.528,percent of total billed charges,35.67% of total billed charges,149.93,465.3,
CSF MYELIN BASIC PROTEIN EXP,3002966,CDM,300,RC,83873,HCPCS,outpatient,,,182,72.80,,154.7,85,,123.76,percent of total billed charges,85% of total billed charges,140.14,77,,112.11,percent of total billed charges,77% of total billed charges,17.2,100,,,fee schedule,100% of CMS fee schedule,74.34,350,,,fee schedule,350% of BCBS fee schedule,77.31,364,,,fee schedule,364% of BCBS fee schedule,77.31,364,,,fee schedule,364% of BCBS fee schedule,77.31,364,,,fee schedule,364% of BCBS fee schedule,163.8,90,,131.04,percent of total billed charges,90% of total billed charges,145.6,80,,116.48,percent of total billed charges,80% of total billed charges,163.8,90,,131.04,percent of total billed charges,90% of total billed charges,136.5,75,,109.2,percent of total billed charges,75% of total billed charges,20.98,122,,,fee schedule,122% of APC rate,52.78,29,,42.224,percent of total billed charges,29% of total billed charges,17.2,100,,,fee schedule,100% of CMS fee schedule,121.94,67,,97.552,percent of total billed charges,67% of total billed charges,25.58,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,145.6,80,,116.48,percent of total billed charges,80% of total billed charges,118.3,65,,94.64,percent of total billed charges,65% of total billed charges,64.92,35.67,,51.936,percent of total billed charges,35.67% of total billed charges,17.2,163.8,
CULTURE AFB,3003000,CDM,300,RC,87116,HCPCS,outpatient,,,106,42.40,,90.1,85,,72.08,percent of total billed charges,85% of total billed charges,81.62,77,,65.3,percent of total billed charges,77% of total billed charges,10.8,100,,,fee schedule,100% of CMS fee schedule,46.69,350,,,fee schedule,350% of BCBS fee schedule,48.56,364,,,fee schedule,364% of BCBS fee schedule,48.56,364,,,fee schedule,364% of BCBS fee schedule,48.56,364,,,fee schedule,364% of BCBS fee schedule,95.4,90,,76.32,percent of total billed charges,90% of total billed charges,84.8,80,,67.84,percent of total billed charges,80% of total billed charges,95.4,90,,76.32,percent of total billed charges,90% of total billed charges,79.5,75,,63.6,percent of total billed charges,75% of total billed charges,13.17,122,,,fee schedule,122% of APC rate,30.74,29,,24.592,percent of total billed charges,29% of total billed charges,10.8,100,,,fee schedule,100% of CMS fee schedule,71.02,67,,56.816,percent of total billed charges,67% of total billed charges,16.06,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,84.8,80,,67.84,percent of total billed charges,80% of total billed charges,68.9,65,,55.12,percent of total billed charges,65% of total billed charges,37.81,35.67,,30.248,percent of total billed charges,35.67% of total billed charges,10.8,95.4,
CULTURE ROUTINE,3003020,CDM,300,RC,87070,HCPCS,outpatient,,,76,30.40,,64.6,85,,51.68,percent of total billed charges,85% of total billed charges,58.52,77,,46.82,percent of total billed charges,77% of total billed charges,8.61,100,,,fee schedule,100% of CMS fee schedule,37.24,350,,,fee schedule,350% of BCBS fee schedule,38.73,364,,,fee schedule,364% of BCBS fee schedule,38.73,364,,,fee schedule,364% of BCBS fee schedule,38.73,364,,,fee schedule,364% of BCBS fee schedule,68.4,90,,54.72,percent of total billed charges,90% of total billed charges,60.8,80,,48.64,percent of total billed charges,80% of total billed charges,68.4,90,,54.72,percent of total billed charges,90% of total billed charges,57,75,,45.6,percent of total billed charges,75% of total billed charges,10.51,122,,,fee schedule,122% of APC rate,22.04,29,,17.632,percent of total billed charges,29% of total billed charges,8.61,100,,,fee schedule,100% of CMS fee schedule,50.92,67,,40.736,percent of total billed charges,67% of total billed charges,12.81,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,60.8,80,,48.64,percent of total billed charges,80% of total billed charges,49.4,65,,39.52,percent of total billed charges,65% of total billed charges,27.11,35.67,,21.688,percent of total billed charges,35.67% of total billed charges,8.61,68.4,
CULTURE SPUTUM,3003040,CDM,300,RC,87070,HCPCS,outpatient,,,83,33.20,,70.55,85,,56.44,percent of total billed charges,85% of total billed charges,63.91,77,,51.13,percent of total billed charges,77% of total billed charges,8.61,100,,,fee schedule,100% of CMS fee schedule,37.24,350,,,fee schedule,350% of BCBS fee schedule,38.73,364,,,fee schedule,364% of BCBS fee schedule,38.73,364,,,fee schedule,364% of BCBS fee schedule,38.73,364,,,fee schedule,364% of BCBS fee schedule,74.7,90,,59.76,percent of total billed charges,90% of total billed charges,66.4,80,,53.12,percent of total billed charges,80% of total billed charges,74.7,90,,59.76,percent of total billed charges,90% of total billed charges,62.25,75,,49.8,percent of total billed charges,75% of total billed charges,10.51,122,,,fee schedule,122% of APC rate,24.07,29,,19.256,percent of total billed charges,29% of total billed charges,8.61,100,,,fee schedule,100% of CMS fee schedule,55.61,67,,44.488,percent of total billed charges,67% of total billed charges,12.81,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,66.4,80,,53.12,percent of total billed charges,80% of total billed charges,53.95,65,,43.16,percent of total billed charges,65% of total billed charges,29.61,35.67,,23.688,percent of total billed charges,35.67% of total billed charges,8.61,74.7,
CULTURE BLOOD,3003180,CDM,300,RC,87040,HCPCS,outpatient,,,106,42.40,,90.1,85,,72.08,percent of total billed charges,85% of total billed charges,81.62,77,,65.3,percent of total billed charges,77% of total billed charges,10.32,100,,,fee schedule,100% of CMS fee schedule,44.59,350,,,fee schedule,350% of BCBS fee schedule,46.37,364,,,fee schedule,364% of BCBS fee schedule,46.37,364,,,fee schedule,364% of BCBS fee schedule,46.37,364,,,fee schedule,364% of BCBS fee schedule,95.4,90,,76.32,percent of total billed charges,90% of total billed charges,84.8,80,,67.84,percent of total billed charges,80% of total billed charges,95.4,90,,76.32,percent of total billed charges,90% of total billed charges,79.5,75,,63.6,percent of total billed charges,75% of total billed charges,12.59,122,,,fee schedule,122% of APC rate,30.74,29,,24.592,percent of total billed charges,29% of total billed charges,10.32,100,,,fee schedule,100% of CMS fee schedule,71.02,67,,56.816,percent of total billed charges,67% of total billed charges,13,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,84.8,80,,67.84,percent of total billed charges,80% of total billed charges,68.9,65,,55.12,percent of total billed charges,65% of total billed charges,37.81,35.67,,30.248,percent of total billed charges,35.67% of total billed charges,10.32,95.4,
CULTURE CATHETER TIP,3003200,CDM,300,RC,87070,HCPCS,outpatient,,,82,32.80,,69.7,85,,55.76,percent of total billed charges,85% of total billed charges,63.14,77,,50.51,percent of total billed charges,77% of total billed charges,8.61,100,,,fee schedule,100% of CMS fee schedule,37.24,350,,,fee schedule,350% of BCBS fee schedule,38.73,364,,,fee schedule,364% of BCBS fee schedule,38.73,364,,,fee schedule,364% of BCBS fee schedule,38.73,364,,,fee schedule,364% of BCBS fee schedule,73.8,90,,59.04,percent of total billed charges,90% of total billed charges,65.6,80,,52.48,percent of total billed charges,80% of total billed charges,73.8,90,,59.04,percent of total billed charges,90% of total billed charges,61.5,75,,49.2,percent of total billed charges,75% of total billed charges,10.51,122,,,fee schedule,122% of APC rate,23.78,29,,19.024,percent of total billed charges,29% of total billed charges,8.61,100,,,fee schedule,100% of CMS fee schedule,54.94,67,,43.952,percent of total billed charges,67% of total billed charges,12.81,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,65.6,80,,52.48,percent of total billed charges,80% of total billed charges,53.3,65,,42.64,percent of total billed charges,65% of total billed charges,29.25,35.67,,23.4,percent of total billed charges,35.67% of total billed charges,8.61,73.8,
CULTURE CHLAMYDIA TRACHOMATIS,3003220,CDM,300,RC,87110,HCPCS,outpatient,,,106,42.40,,90.1,85,,72.08,percent of total billed charges,85% of total billed charges,81.62,77,,65.3,percent of total billed charges,77% of total billed charges,19.6,100,,,fee schedule,100% of CMS fee schedule,84.67,350,,,fee schedule,350% of BCBS fee schedule,88.05,364,,,fee schedule,364% of BCBS fee schedule,88.05,364,,,fee schedule,364% of BCBS fee schedule,88.05,364,,,fee schedule,364% of BCBS fee schedule,95.4,90,,76.32,percent of total billed charges,90% of total billed charges,84.8,80,,67.84,percent of total billed charges,80% of total billed charges,95.4,90,,76.32,percent of total billed charges,90% of total billed charges,79.5,75,,63.6,percent of total billed charges,75% of total billed charges,23.91,122,,,fee schedule,122% of APC rate,30.74,29,,24.592,percent of total billed charges,29% of total billed charges,19.6,100,,,fee schedule,100% of CMS fee schedule,71.02,67,,56.816,percent of total billed charges,67% of total billed charges,12.33,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,84.8,80,,67.84,percent of total billed charges,80% of total billed charges,68.9,65,,55.12,percent of total billed charges,65% of total billed charges,37.81,35.67,,30.248,percent of total billed charges,35.67% of total billed charges,12.33,95.4,
CULTURE CLOSTRIDIUM DIFFICILE,3003240,CDM,300,RC,87324,HCPCS,outpatient,,,101,40.40,,85.85,85,,68.68,percent of total billed charges,85% of total billed charges,77.77,77,,62.22,percent of total billed charges,77% of total billed charges,11.98,100,,,fee schedule,100% of CMS fee schedule,51.8,350,,,fee schedule,350% of BCBS fee schedule,53.87,364,,,fee schedule,364% of BCBS fee schedule,53.87,364,,,fee schedule,364% of BCBS fee schedule,53.87,364,,,fee schedule,364% of BCBS fee schedule,90.9,90,,72.72,percent of total billed charges,90% of total billed charges,80.8,80,,64.64,percent of total billed charges,80% of total billed charges,90.9,90,,72.72,percent of total billed charges,90% of total billed charges,75.75,75,,60.6,percent of total billed charges,75% of total billed charges,14.61,122,,,fee schedule,122% of APC rate,29.29,29,,23.432,percent of total billed charges,29% of total billed charges,11.98,100,,,fee schedule,100% of CMS fee schedule,67.67,67,,54.136,percent of total billed charges,67% of total billed charges,15.41,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,80.8,80,,64.64,percent of total billed charges,80% of total billed charges,65.65,65,,52.52,percent of total billed charges,65% of total billed charges,36.03,35.67,,28.824,percent of total billed charges,35.67% of total billed charges,11.98,90.9,
CULTURE EYE,3003300,CDM,300,RC,87070,HCPCS,outpatient,,,82,32.80,,69.7,85,,55.76,percent of total billed charges,85% of total billed charges,63.14,77,,50.51,percent of total billed charges,77% of total billed charges,8.61,100,,,fee schedule,100% of CMS fee schedule,37.24,350,,,fee schedule,350% of BCBS fee schedule,38.73,364,,,fee schedule,364% of BCBS fee schedule,38.73,364,,,fee schedule,364% of BCBS fee schedule,38.73,364,,,fee schedule,364% of BCBS fee schedule,73.8,90,,59.04,percent of total billed charges,90% of total billed charges,65.6,80,,52.48,percent of total billed charges,80% of total billed charges,73.8,90,,59.04,percent of total billed charges,90% of total billed charges,61.5,75,,49.2,percent of total billed charges,75% of total billed charges,10.51,122,,,fee schedule,122% of APC rate,23.78,29,,19.024,percent of total billed charges,29% of total billed charges,8.61,100,,,fee schedule,100% of CMS fee schedule,54.94,67,,43.952,percent of total billed charges,67% of total billed charges,12.81,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,65.6,80,,52.48,percent of total billed charges,80% of total billed charges,53.3,65,,42.64,percent of total billed charges,65% of total billed charges,29.25,35.67,,23.4,percent of total billed charges,35.67% of total billed charges,8.61,73.8,
CULTURE FUNGAL - NOT BLOOD,3003320,CDM,300,RC,87102,HCPCS,outpatient,,,83,33.20,,70.55,85,,56.44,percent of total billed charges,85% of total billed charges,63.91,77,,51.13,percent of total billed charges,77% of total billed charges,8.41,100,,,fee schedule,100% of CMS fee schedule,36.33,350,,,fee schedule,350% of BCBS fee schedule,37.78,364,,,fee schedule,364% of BCBS fee schedule,37.78,364,,,fee schedule,364% of BCBS fee schedule,37.78,364,,,fee schedule,364% of BCBS fee schedule,74.7,90,,59.76,percent of total billed charges,90% of total billed charges,66.4,80,,53.12,percent of total billed charges,80% of total billed charges,74.7,90,,59.76,percent of total billed charges,90% of total billed charges,62.25,75,,49.8,percent of total billed charges,75% of total billed charges,10.26,122,,,fee schedule,122% of APC rate,24.07,29,,19.256,percent of total billed charges,29% of total billed charges,8.41,100,,,fee schedule,100% of CMS fee schedule,55.61,67,,44.488,percent of total billed charges,67% of total billed charges,12.49,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,66.4,80,,53.12,percent of total billed charges,80% of total billed charges,53.95,65,,43.16,percent of total billed charges,65% of total billed charges,29.61,35.67,,23.688,percent of total billed charges,35.67% of total billed charges,8.41,74.7,
CULTURE CHLAMYDIA BY DNA,3003341,CDM,300,RC,87491,HCPCS,outpatient,,,171,68.40,,145.35,85,,116.28,percent of total billed charges,85% of total billed charges,131.67,77,,105.34,percent of total billed charges,77% of total billed charges,35.09,100,,,fee schedule,100% of CMS fee schedule,151.66,350,,,fee schedule,350% of BCBS fee schedule,157.72,364,,,fee schedule,364% of BCBS fee schedule,157.72,364,,,fee schedule,364% of BCBS fee schedule,157.72,364,,,fee schedule,364% of BCBS fee schedule,153.9,90,,123.12,percent of total billed charges,90% of total billed charges,136.8,80,,109.44,percent of total billed charges,80% of total billed charges,153.9,90,,123.12,percent of total billed charges,90% of total billed charges,128.25,75,,102.6,percent of total billed charges,75% of total billed charges,42.8,122,,,fee schedule,122% of APC rate,49.59,29,,39.672,percent of total billed charges,29% of total billed charges,35.09,100,,,fee schedule,100% of CMS fee schedule,114.57,67,,91.656,percent of total billed charges,67% of total billed charges,52.19,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,136.8,80,,109.44,percent of total billed charges,80% of total billed charges,111.15,65,,88.92,percent of total billed charges,65% of total billed charges,61,35.67,,48.8,percent of total billed charges,35.67% of total billed charges,35.09,157.72,
CULTURE GC/NUCLEIC ACID PROBE,3003342,CDM,300,RC,87591,HCPCS,outpatient,,,171,68.40,,145.35,85,,116.28,percent of total billed charges,85% of total billed charges,131.67,77,,105.34,percent of total billed charges,77% of total billed charges,35.09,100,,,fee schedule,100% of CMS fee schedule,151.66,350,,,fee schedule,350% of BCBS fee schedule,157.72,364,,,fee schedule,364% of BCBS fee schedule,157.72,364,,,fee schedule,364% of BCBS fee schedule,157.72,364,,,fee schedule,364% of BCBS fee schedule,153.9,90,,123.12,percent of total billed charges,90% of total billed charges,136.8,80,,109.44,percent of total billed charges,80% of total billed charges,153.9,90,,123.12,percent of total billed charges,90% of total billed charges,128.25,75,,102.6,percent of total billed charges,75% of total billed charges,42.8,122,,,fee schedule,122% of APC rate,49.59,29,,39.672,percent of total billed charges,29% of total billed charges,35.09,100,,,fee schedule,100% of CMS fee schedule,114.57,67,,91.656,percent of total billed charges,67% of total billed charges,52.19,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,136.8,80,,109.44,percent of total billed charges,80% of total billed charges,111.15,65,,88.92,percent of total billed charges,65% of total billed charges,61,35.67,,48.8,percent of total billed charges,35.67% of total billed charges,35.09,157.72,
CULTURE CHLAMYDIA DNA IN HOUSE,3003343,CDM,300,RC,87491,HCPCS,outpatient,,,175,70.00,,148.75,85,,119,percent of total billed charges,85% of total billed charges,134.75,77,,107.8,percent of total billed charges,77% of total billed charges,35.09,100,,,fee schedule,100% of CMS fee schedule,151.66,350,,,fee schedule,350% of BCBS fee schedule,157.72,364,,,fee schedule,364% of BCBS fee schedule,157.72,364,,,fee schedule,364% of BCBS fee schedule,157.72,364,,,fee schedule,364% of BCBS fee schedule,157.5,90,,126,percent of total billed charges,90% of total billed charges,140,80,,112,percent of total billed charges,80% of total billed charges,157.5,90,,126,percent of total billed charges,90% of total billed charges,131.25,75,,105,percent of total billed charges,75% of total billed charges,42.8,122,,,fee schedule,122% of APC rate,50.75,29,,40.6,percent of total billed charges,29% of total billed charges,35.09,100,,,fee schedule,100% of CMS fee schedule,117.25,67,,93.8,percent of total billed charges,67% of total billed charges,52.19,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,140,80,,112,percent of total billed charges,80% of total billed charges,113.75,65,,91,percent of total billed charges,65% of total billed charges,62.42,35.67,,49.936,percent of total billed charges,35.67% of total billed charges,35.09,157.72,
CULTURE GC/NUCLEIC IN HOUSE,3003344,CDM,300,RC,87591,HCPCS,outpatient,,,166,66.40,,141.1,85,,112.88,percent of total billed charges,85% of total billed charges,127.82,77,,102.26,percent of total billed charges,77% of total billed charges,35.09,100,,,fee schedule,100% of CMS fee schedule,151.66,350,,,fee schedule,350% of BCBS fee schedule,157.72,364,,,fee schedule,364% of BCBS fee schedule,157.72,364,,,fee schedule,364% of BCBS fee schedule,157.72,364,,,fee schedule,364% of BCBS fee schedule,149.4,90,,119.52,percent of total billed charges,90% of total billed charges,132.8,80,,106.24,percent of total billed charges,80% of total billed charges,149.4,90,,119.52,percent of total billed charges,90% of total billed charges,124.5,75,,99.6,percent of total billed charges,75% of total billed charges,42.8,122,,,fee schedule,122% of APC rate,48.14,29,,38.512,percent of total billed charges,29% of total billed charges,35.09,100,,,fee schedule,100% of CMS fee schedule,111.22,67,,88.976,percent of total billed charges,67% of total billed charges,52.19,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,132.8,80,,106.24,percent of total billed charges,80% of total billed charges,107.9,65,,86.32,percent of total billed charges,65% of total billed charges,59.21,35.67,,47.368,percent of total billed charges,35.67% of total billed charges,35.09,157.72,
CULTURE GENITAL/VAGINAL,3003360,CDM,300,RC,87070,HCPCS,outpatient,,,83,33.20,,70.55,85,,56.44,percent of total billed charges,85% of total billed charges,63.91,77,,51.13,percent of total billed charges,77% of total billed charges,8.61,100,,,fee schedule,100% of CMS fee schedule,37.24,350,,,fee schedule,350% of BCBS fee schedule,38.73,364,,,fee schedule,364% of BCBS fee schedule,38.73,364,,,fee schedule,364% of BCBS fee schedule,38.73,364,,,fee schedule,364% of BCBS fee schedule,74.7,90,,59.76,percent of total billed charges,90% of total billed charges,66.4,80,,53.12,percent of total billed charges,80% of total billed charges,74.7,90,,59.76,percent of total billed charges,90% of total billed charges,62.25,75,,49.8,percent of total billed charges,75% of total billed charges,10.51,122,,,fee schedule,122% of APC rate,24.07,29,,19.256,percent of total billed charges,29% of total billed charges,8.61,100,,,fee schedule,100% of CMS fee schedule,55.61,67,,44.488,percent of total billed charges,67% of total billed charges,12.81,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,66.4,80,,53.12,percent of total billed charges,80% of total billed charges,53.95,65,,43.16,percent of total billed charges,65% of total billed charges,29.61,35.67,,23.688,percent of total billed charges,35.67% of total billed charges,8.61,74.7,
CULTURE HERPES,3003380,CDM,300,RC,87077,HCPCS,outpatient,,,74,29.60,,62.9,85,,50.32,percent of total billed charges,85% of total billed charges,56.98,77,,45.58,percent of total billed charges,77% of total billed charges,8.08,100,,,fee schedule,100% of CMS fee schedule,34.9,350,,,fee schedule,350% of BCBS fee schedule,36.29,364,,,fee schedule,364% of BCBS fee schedule,36.29,364,,,fee schedule,364% of BCBS fee schedule,36.29,364,,,fee schedule,364% of BCBS fee schedule,66.6,90,,53.28,percent of total billed charges,90% of total billed charges,59.2,80,,47.36,percent of total billed charges,80% of total billed charges,66.6,90,,53.28,percent of total billed charges,90% of total billed charges,55.5,75,,44.4,percent of total billed charges,75% of total billed charges,9.85,122,,,fee schedule,122% of APC rate,21.46,29,,17.168,percent of total billed charges,29% of total billed charges,8.08,100,,,fee schedule,100% of CMS fee schedule,49.58,67,,39.664,percent of total billed charges,67% of total billed charges,12.02,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,59.2,80,,47.36,percent of total billed charges,80% of total billed charges,48.1,65,,38.48,percent of total billed charges,65% of total billed charges,26.4,35.67,,21.12,percent of total billed charges,35.67% of total billed charges,8.08,66.6,
CULTURE NOSE,3003420,CDM,300,RC,87070,HCPCS,outpatient,,,83,33.20,,70.55,85,,56.44,percent of total billed charges,85% of total billed charges,63.91,77,,51.13,percent of total billed charges,77% of total billed charges,8.61,100,,,fee schedule,100% of CMS fee schedule,37.24,350,,,fee schedule,350% of BCBS fee schedule,38.73,364,,,fee schedule,364% of BCBS fee schedule,38.73,364,,,fee schedule,364% of BCBS fee schedule,38.73,364,,,fee schedule,364% of BCBS fee schedule,74.7,90,,59.76,percent of total billed charges,90% of total billed charges,66.4,80,,53.12,percent of total billed charges,80% of total billed charges,74.7,90,,59.76,percent of total billed charges,90% of total billed charges,62.25,75,,49.8,percent of total billed charges,75% of total billed charges,10.51,122,,,fee schedule,122% of APC rate,24.07,29,,19.256,percent of total billed charges,29% of total billed charges,8.61,100,,,fee schedule,100% of CMS fee schedule,55.61,67,,44.488,percent of total billed charges,67% of total billed charges,12.81,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,66.4,80,,53.12,percent of total billed charges,80% of total billed charges,53.95,65,,43.16,percent of total billed charges,65% of total billed charges,29.61,35.67,,23.688,percent of total billed charges,35.67% of total billed charges,8.61,74.7,
CULTURE OTHER,3003440,CDM,300,RC,87081,HCPCS,outpatient,,,86,34.40,,73.1,85,,58.48,percent of total billed charges,85% of total billed charges,66.22,77,,52.98,percent of total billed charges,77% of total billed charges,6.63,100,,,fee schedule,100% of CMS fee schedule,28.63,350,,,fee schedule,350% of BCBS fee schedule,29.78,364,,,fee schedule,364% of BCBS fee schedule,29.78,364,,,fee schedule,364% of BCBS fee schedule,29.78,364,,,fee schedule,364% of BCBS fee schedule,77.4,90,,61.92,percent of total billed charges,90% of total billed charges,68.8,80,,55.04,percent of total billed charges,80% of total billed charges,77.4,90,,61.92,percent of total billed charges,90% of total billed charges,64.5,75,,51.6,percent of total billed charges,75% of total billed charges,8.08,122,,,fee schedule,122% of APC rate,24.94,29,,19.952,percent of total billed charges,29% of total billed charges,6.63,100,,,fee schedule,100% of CMS fee schedule,57.62,67,,46.096,percent of total billed charges,67% of total billed charges,9.85,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,68.8,80,,55.04,percent of total billed charges,80% of total billed charges,55.9,65,,44.72,percent of total billed charges,65% of total billed charges,30.68,35.67,,24.544,percent of total billed charges,35.67% of total billed charges,6.63,77.4,
CULTURE SPINAL FLUID,3003480,CDM,300,RC,87070,HCPCS,outpatient,,,82,32.80,,69.7,85,,55.76,percent of total billed charges,85% of total billed charges,63.14,77,,50.51,percent of total billed charges,77% of total billed charges,8.61,100,,,fee schedule,100% of CMS fee schedule,37.24,350,,,fee schedule,350% of BCBS fee schedule,38.73,364,,,fee schedule,364% of BCBS fee schedule,38.73,364,,,fee schedule,364% of BCBS fee schedule,38.73,364,,,fee schedule,364% of BCBS fee schedule,73.8,90,,59.04,percent of total billed charges,90% of total billed charges,65.6,80,,52.48,percent of total billed charges,80% of total billed charges,73.8,90,,59.04,percent of total billed charges,90% of total billed charges,61.5,75,,49.2,percent of total billed charges,75% of total billed charges,10.51,122,,,fee schedule,122% of APC rate,23.78,29,,19.024,percent of total billed charges,29% of total billed charges,8.61,100,,,fee schedule,100% of CMS fee schedule,54.94,67,,43.952,percent of total billed charges,67% of total billed charges,12.81,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,65.6,80,,52.48,percent of total billed charges,80% of total billed charges,53.3,65,,42.64,percent of total billed charges,65% of total billed charges,29.25,35.67,,23.4,percent of total billed charges,35.67% of total billed charges,8.61,73.8,
CULTURE STOOL,3003500,CDM,300,RC,87045,HCPCS,outpatient,,,83,33.20,,70.55,85,,56.44,percent of total billed charges,85% of total billed charges,63.91,77,,51.13,percent of total billed charges,77% of total billed charges,9.44,100,,,fee schedule,100% of CMS fee schedule,40.81,350,,,fee schedule,350% of BCBS fee schedule,42.44,364,,,fee schedule,364% of BCBS fee schedule,42.44,364,,,fee schedule,364% of BCBS fee schedule,42.44,364,,,fee schedule,364% of BCBS fee schedule,74.7,90,,59.76,percent of total billed charges,90% of total billed charges,66.4,80,,53.12,percent of total billed charges,80% of total billed charges,74.7,90,,59.76,percent of total billed charges,90% of total billed charges,62.25,75,,49.8,percent of total billed charges,75% of total billed charges,11.51,122,,,fee schedule,122% of APC rate,24.07,29,,19.256,percent of total billed charges,29% of total billed charges,9.44,100,,,fee schedule,100% of CMS fee schedule,55.61,67,,44.488,percent of total billed charges,67% of total billed charges,14.02,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,66.4,80,,53.12,percent of total billed charges,80% of total billed charges,53.95,65,,43.16,percent of total billed charges,65% of total billed charges,29.61,35.67,,23.688,percent of total billed charges,35.67% of total billed charges,9.44,74.7,
CULTURE THROAT,3003520,CDM,300,RC,87070,HCPCS,outpatient,,,82,32.80,,69.7,85,,55.76,percent of total billed charges,85% of total billed charges,63.14,77,,50.51,percent of total billed charges,77% of total billed charges,8.61,100,,,fee schedule,100% of CMS fee schedule,37.24,350,,,fee schedule,350% of BCBS fee schedule,38.73,364,,,fee schedule,364% of BCBS fee schedule,38.73,364,,,fee schedule,364% of BCBS fee schedule,38.73,364,,,fee schedule,364% of BCBS fee schedule,73.8,90,,59.04,percent of total billed charges,90% of total billed charges,65.6,80,,52.48,percent of total billed charges,80% of total billed charges,73.8,90,,59.04,percent of total billed charges,90% of total billed charges,61.5,75,,49.2,percent of total billed charges,75% of total billed charges,10.51,122,,,fee schedule,122% of APC rate,23.78,29,,19.024,percent of total billed charges,29% of total billed charges,8.61,100,,,fee schedule,100% of CMS fee schedule,54.94,67,,43.952,percent of total billed charges,67% of total billed charges,12.81,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,65.6,80,,52.48,percent of total billed charges,80% of total billed charges,53.3,65,,42.64,percent of total billed charges,65% of total billed charges,29.25,35.67,,23.4,percent of total billed charges,35.67% of total billed charges,8.61,73.8,
CULTURE URINE & COLONY CNT,3003540,CDM,300,RC,87086,HCPCS,outpatient,,,83,33.20,,70.55,85,,56.44,percent of total billed charges,85% of total billed charges,63.91,77,,51.13,percent of total billed charges,77% of total billed charges,8.07,100,,,fee schedule,100% of CMS fee schedule,34.86,350,,,fee schedule,350% of BCBS fee schedule,36.25,364,,,fee schedule,364% of BCBS fee schedule,36.25,364,,,fee schedule,364% of BCBS fee schedule,36.25,364,,,fee schedule,364% of BCBS fee schedule,74.7,90,,59.76,percent of total billed charges,90% of total billed charges,66.4,80,,53.12,percent of total billed charges,80% of total billed charges,74.7,90,,59.76,percent of total billed charges,90% of total billed charges,62.25,75,,49.8,percent of total billed charges,75% of total billed charges,9.84,122,,,fee schedule,122% of APC rate,24.07,29,,19.256,percent of total billed charges,29% of total billed charges,8.07,100,,,fee schedule,100% of CMS fee schedule,55.61,67,,44.488,percent of total billed charges,67% of total billed charges,12,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,66.4,80,,53.12,percent of total billed charges,80% of total billed charges,53.95,65,,43.16,percent of total billed charges,65% of total billed charges,29.61,35.67,,23.688,percent of total billed charges,35.67% of total billed charges,8.07,74.7,
CULTURE VIRAL,3003560,CDM,300,RC,87252,HCPCS,outpatient,,,238,95.20,,202.3,85,,161.84,percent of total billed charges,85% of total billed charges,183.26,77,,146.61,percent of total billed charges,77% of total billed charges,26.07,100,,,fee schedule,100% of CMS fee schedule,112.63,350,,,fee schedule,350% of BCBS fee schedule,117.14,364,,,fee schedule,364% of BCBS fee schedule,117.14,364,,,fee schedule,364% of BCBS fee schedule,117.14,364,,,fee schedule,364% of BCBS fee schedule,214.2,90,,171.36,percent of total billed charges,90% of total billed charges,190.4,80,,152.32,percent of total billed charges,80% of total billed charges,214.2,90,,171.36,percent of total billed charges,90% of total billed charges,178.5,75,,142.8,percent of total billed charges,75% of total billed charges,31.8,122,,,fee schedule,122% of APC rate,69.02,29,,55.216,percent of total billed charges,29% of total billed charges,26.07,100,,,fee schedule,100% of CMS fee schedule,159.46,67,,127.568,percent of total billed charges,67% of total billed charges,25.26,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,190.4,80,,152.32,percent of total billed charges,80% of total billed charges,154.7,65,,123.76,percent of total billed charges,65% of total billed charges,84.89,35.67,,67.912,percent of total billed charges,35.67% of total billed charges,25.26,214.2,
CULTURE WOUND,3003580,CDM,300,RC,87070,HCPCS,outpatient,,,83,33.20,,70.55,85,,56.44,percent of total billed charges,85% of total billed charges,63.91,77,,51.13,percent of total billed charges,77% of total billed charges,8.61,100,,,fee schedule,100% of CMS fee schedule,37.24,350,,,fee schedule,350% of BCBS fee schedule,38.73,364,,,fee schedule,364% of BCBS fee schedule,38.73,364,,,fee schedule,364% of BCBS fee schedule,38.73,364,,,fee schedule,364% of BCBS fee schedule,74.7,90,,59.76,percent of total billed charges,90% of total billed charges,66.4,80,,53.12,percent of total billed charges,80% of total billed charges,74.7,90,,59.76,percent of total billed charges,90% of total billed charges,62.25,75,,49.8,percent of total billed charges,75% of total billed charges,10.51,122,,,fee schedule,122% of APC rate,24.07,29,,19.256,percent of total billed charges,29% of total billed charges,8.61,100,,,fee schedule,100% of CMS fee schedule,55.61,67,,44.488,percent of total billed charges,67% of total billed charges,12.81,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,66.4,80,,53.12,percent of total billed charges,80% of total billed charges,53.95,65,,43.16,percent of total billed charges,65% of total billed charges,29.61,35.67,,23.688,percent of total billed charges,35.67% of total billed charges,8.61,74.7,
CULTURE FUNGAL-SKIN HAIR NAILS,3003581,CDM,300,RC,87101,HCPCS,outpatient,,,168,67.20,,142.8,85,,114.24,percent of total billed charges,85% of total billed charges,129.36,77,,103.49,percent of total billed charges,77% of total billed charges,7.71,100,,,fee schedule,100% of CMS fee schedule,33.29,350,,,fee schedule,350% of BCBS fee schedule,34.62,364,,,fee schedule,364% of BCBS fee schedule,34.62,364,,,fee schedule,364% of BCBS fee schedule,34.62,364,,,fee schedule,364% of BCBS fee schedule,151.2,90,,120.96,percent of total billed charges,90% of total billed charges,134.4,80,,107.52,percent of total billed charges,80% of total billed charges,151.2,90,,120.96,percent of total billed charges,90% of total billed charges,126,75,,100.8,percent of total billed charges,75% of total billed charges,9.4,122,,,fee schedule,122% of APC rate,48.72,29,,38.976,percent of total billed charges,29% of total billed charges,7.71,100,,,fee schedule,100% of CMS fee schedule,112.56,67,,90.048,percent of total billed charges,67% of total billed charges,11.47,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,134.4,80,,107.52,percent of total billed charges,80% of total billed charges,109.2,65,,87.36,percent of total billed charges,65% of total billed charges,59.93,35.67,,47.944,percent of total billed charges,35.67% of total billed charges,7.71,151.2,
CULTURE FUNGAL - BLOOD,3003582,CDM,300,RC,87103,HCPCS,outpatient,,,132,52.80,,112.2,85,,89.76,percent of total billed charges,85% of total billed charges,101.64,77,,81.31,percent of total billed charges,77% of total billed charges,20.46,100,,,fee schedule,100% of CMS fee schedule,71.61,350,,,fee schedule,350% of BCBS fee schedule,74.47,364,,,fee schedule,364% of BCBS fee schedule,74.47,364,,,fee schedule,364% of BCBS fee schedule,74.47,364,,,fee schedule,364% of BCBS fee schedule,118.8,90,,95.04,percent of total billed charges,90% of total billed charges,105.6,80,,84.48,percent of total billed charges,80% of total billed charges,118.8,90,,95.04,percent of total billed charges,90% of total billed charges,99,75,,79.2,percent of total billed charges,75% of total billed charges,24.96,122,,,fee schedule,122% of APC rate,38.28,29,,30.624,percent of total billed charges,29% of total billed charges,20.46,100,,,fee schedule,100% of CMS fee schedule,88.44,67,,70.752,percent of total billed charges,67% of total billed charges,13.4,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,105.6,80,,84.48,percent of total billed charges,80% of total billed charges,85.8,65,,68.64,percent of total billed charges,65% of total billed charges,47.08,35.67,,37.664,percent of total billed charges,35.67% of total billed charges,13.4,118.8,
SPEC CONCENTRATION INFECT AGNT,3003583,CDM,300,RC,87015,HCPCS,outpatient,,,87,34.80,,73.95,85,,59.16,percent of total billed charges,85% of total billed charges,66.99,77,,53.59,percent of total billed charges,77% of total billed charges,6.68,100,,,fee schedule,100% of CMS fee schedule,28.84,350,,,fee schedule,350% of BCBS fee schedule,29.99,364,,,fee schedule,364% of BCBS fee schedule,29.99,364,,,fee schedule,364% of BCBS fee schedule,29.99,364,,,fee schedule,364% of BCBS fee schedule,78.3,90,,62.64,percent of total billed charges,90% of total billed charges,69.6,80,,55.68,percent of total billed charges,80% of total billed charges,78.3,90,,62.64,percent of total billed charges,90% of total billed charges,65.25,75,,52.2,percent of total billed charges,75% of total billed charges,8.14,122,,,fee schedule,122% of APC rate,25.23,29,,20.184,percent of total billed charges,29% of total billed charges,6.68,100,,,fee schedule,100% of CMS fee schedule,58.29,67,,46.632,percent of total billed charges,67% of total billed charges,9.93,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,69.6,80,,55.68,percent of total billed charges,80% of total billed charges,56.55,65,,45.24,percent of total billed charges,65% of total billed charges,31.03,35.67,,24.824,percent of total billed charges,35.67% of total billed charges,6.68,78.3,
AFB SMEAR,3003584,CDM,300,RC,87206,HCPCS,outpatient,,,123,49.20,,104.55,85,,83.64,percent of total billed charges,85% of total billed charges,94.71,77,,75.77,percent of total billed charges,77% of total billed charges,5.39,100,,,fee schedule,100% of CMS fee schedule,23.28,350,,,fee schedule,350% of BCBS fee schedule,24.21,364,,,fee schedule,364% of BCBS fee schedule,24.21,364,,,fee schedule,364% of BCBS fee schedule,24.21,364,,,fee schedule,364% of BCBS fee schedule,110.7,90,,88.56,percent of total billed charges,90% of total billed charges,98.4,80,,78.72,percent of total billed charges,80% of total billed charges,110.7,90,,88.56,percent of total billed charges,90% of total billed charges,92.25,75,,73.8,percent of total billed charges,75% of total billed charges,6.57,122,,,fee schedule,122% of APC rate,35.67,29,,28.536,percent of total billed charges,29% of total billed charges,5.39,100,,,fee schedule,100% of CMS fee schedule,82.41,67,,65.928,percent of total billed charges,67% of total billed charges,7.99,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,98.4,80,,78.72,percent of total billed charges,80% of total billed charges,79.95,65,,63.96,percent of total billed charges,65% of total billed charges,43.87,35.67,,35.096,percent of total billed charges,35.67% of total billed charges,5.39,110.7,
CULTURE BODY FLUID,3003585,CDM,300,RC,87070,HCPCS,outpatient,,,229,91.60,,194.65,85,,155.72,percent of total billed charges,85% of total billed charges,176.33,77,,141.06,percent of total billed charges,77% of total billed charges,8.61,100,,,fee schedule,100% of CMS fee schedule,37.24,350,,,fee schedule,350% of BCBS fee schedule,38.73,364,,,fee schedule,364% of BCBS fee schedule,38.73,364,,,fee schedule,364% of BCBS fee schedule,38.73,364,,,fee schedule,364% of BCBS fee schedule,206.1,90,,164.88,percent of total billed charges,90% of total billed charges,183.2,80,,146.56,percent of total billed charges,80% of total billed charges,206.1,90,,164.88,percent of total billed charges,90% of total billed charges,171.75,75,,137.4,percent of total billed charges,75% of total billed charges,10.51,122,,,fee schedule,122% of APC rate,66.41,29,,53.128,percent of total billed charges,29% of total billed charges,8.61,100,,,fee schedule,100% of CMS fee schedule,153.43,67,,122.744,percent of total billed charges,67% of total billed charges,12.81,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,183.2,80,,146.56,percent of total billed charges,80% of total billed charges,148.85,65,,119.08,percent of total billed charges,65% of total billed charges,81.68,35.67,,65.344,percent of total billed charges,35.67% of total billed charges,8.61,206.1,
SMEAR COMPLEX STAIN,3003586,CDM,300,RC,87209,HCPCS,outpatient,,,134,53.60,,113.9,85,,91.12,percent of total billed charges,85% of total billed charges,103.18,77,,82.54,percent of total billed charges,77% of total billed charges,17.98,100,,,fee schedule,100% of CMS fee schedule,77.67,350,,,fee schedule,350% of BCBS fee schedule,80.77,364,,,fee schedule,364% of BCBS fee schedule,80.77,364,,,fee schedule,364% of BCBS fee schedule,80.77,364,,,fee schedule,364% of BCBS fee schedule,120.6,90,,96.48,percent of total billed charges,90% of total billed charges,107.2,80,,85.76,percent of total billed charges,80% of total billed charges,120.6,90,,96.48,percent of total billed charges,90% of total billed charges,100.5,75,,80.4,percent of total billed charges,75% of total billed charges,21.93,122,,,fee schedule,122% of APC rate,38.86,29,,31.088,percent of total billed charges,29% of total billed charges,17.98,100,,,fee schedule,100% of CMS fee schedule,89.78,67,,71.824,percent of total billed charges,67% of total billed charges,26.73,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,107.2,80,,85.76,percent of total billed charges,80% of total billed charges,87.1,65,,69.68,percent of total billed charges,65% of total billed charges,47.8,35.67,,38.24,percent of total billed charges,35.67% of total billed charges,17.98,120.6,
CROSSMATCH IMM SPIN EA UNIT,3003588,CDM,300,RC,86920,HCPCS,outpatient,,,321,128.40,,272.85,85,,218.28,percent of total billed charges,85% of total billed charges,247.17,77,,197.74,percent of total billed charges,77% of total billed charges,149.37,100,,,fee schedule,100% of CMS OPPS rate,452.13,350,,,fee schedule,350% of BCBS fee schedule,470.22,364,,,fee schedule,364% of BCBS fee schedule,470.22,364,,,fee schedule,364% of BCBS fee schedule,470.22,364,,,fee schedule,364% of BCBS fee schedule,288.9,90,,231.12,percent of total billed charges,90% of total billed charges,256.8,80,,205.44,percent of total billed charges,80% of total billed charges,288.9,90,,231.12,percent of total billed charges,90% of total billed charges,240.75,75,,192.6,percent of total billed charges,75% of total billed charges,182.23,122,,,fee schedule,122% of APC rate,93.09,29,,74.472,percent of total billed charges,29% of total billed charges,149.37,100,,,fee schedule,100% of CMS OPPS rate,215.07,67,,172.056,percent of total billed charges,67% of total billed charges,13.91,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,256.8,80,,205.44,percent of total billed charges,80% of total billed charges,208.65,65,,166.92,percent of total billed charges,65% of total billed charges,114.5,35.67,,91.6,percent of total billed charges,35.67% of total billed charges,13.91,470.22,
CROSSMATCH 37 DEG EA UNIT,3003589,CDM,300,RC,86921,HCPCS,outpatient,,,240,96.00,,204,85,,163.2,percent of total billed charges,85% of total billed charges,184.8,77,,147.84,percent of total billed charges,77% of total billed charges,149.37,100,,,fee schedule,100% of CMS OPPS rate,452.13,350,,,fee schedule,350% of BCBS fee schedule,470.22,364,,,fee schedule,364% of BCBS fee schedule,470.22,364,,,fee schedule,364% of BCBS fee schedule,470.22,364,,,fee schedule,364% of BCBS fee schedule,216,90,,172.8,percent of total billed charges,90% of total billed charges,192,80,,153.6,percent of total billed charges,80% of total billed charges,216,90,,172.8,percent of total billed charges,90% of total billed charges,180,75,,144,percent of total billed charges,75% of total billed charges,182.23,122,,,fee schedule,122% of APC rate,69.6,29,,55.68,percent of total billed charges,29% of total billed charges,149.37,100,,,fee schedule,100% of CMS OPPS rate,160.8,67,,128.64,percent of total billed charges,67% of total billed charges,13.91,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,192,80,,153.6,percent of total billed charges,80% of total billed charges,156,65,,124.8,percent of total billed charges,65% of total billed charges,85.61,35.67,,68.488,percent of total billed charges,35.67% of total billed charges,13.91,470.22,
PATIENT ANTIGEN TYPING,3003590,CDM,300,RC,86905,HCPCS,outpatient,,,316,126.40,,268.6,85,,214.88,percent of total billed charges,85% of total billed charges,243.32,77,,194.66,percent of total billed charges,77% of total billed charges,314.34,100,,,fee schedule,100% of CMS OPPS rate,754.01,350,,,fee schedule,350% of BCBS fee schedule,784.17,364,,,fee schedule,364% of BCBS fee schedule,784.17,364,,,fee schedule,364% of BCBS fee schedule,784.17,364,,,fee schedule,364% of BCBS fee schedule,284.4,90,,227.52,percent of total billed charges,90% of total billed charges,252.8,80,,202.24,percent of total billed charges,80% of total billed charges,284.4,90,,227.52,percent of total billed charges,90% of total billed charges,237,75,,189.6,percent of total billed charges,75% of total billed charges,383.5,122,,,fee schedule,122% of APC rate,91.64,29,,73.312,percent of total billed charges,29% of total billed charges,314.34,100,,,fee schedule,100% of CMS OPPS rate,211.72,67,,169.376,percent of total billed charges,67% of total billed charges,13.91,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,252.8,80,,202.24,percent of total billed charges,80% of total billed charges,205.4,65,,164.32,percent of total billed charges,65% of total billed charges,112.72,35.67,,90.176,percent of total billed charges,35.67% of total billed charges,13.91,784.17,
ANCA SCREEN EACH ANTIBODY,3003593,CDM,300,RC,,,outpatient,,,174,69.60,,147.9,85,,118.32,percent of total billed charges,85% of total billed charges,133.98,77,,107.18,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,142.68,82,,114.144,percent of total billed charges,82% of total billed charges,147.9,85,,118.32,percent of total billed charges,85% of total billed charges,147.9,85,,118.32,percent of total billed charges,85% of total billed charges,147.9,85,,118.32,percent of total billed charges,85% of total billed charges,156.6,90,,125.28,percent of total billed charges,90% of total billed charges,139.2,80,,111.36,percent of total billed charges,80% of total billed charges,156.6,90,,125.28,percent of total billed charges,90% of total billed charges,130.5,75,,104.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,50.46,29,,40.368,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,116.58,67,,93.264,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,139.2,80,,111.36,percent of total billed charges,80% of total billed charges,113.1,65,,90.48,percent of total billed charges,65% of total billed charges,62.07,35.67,,49.656,percent of total billed charges,35.67% of total billed charges,50.46,156.6,
ANCA TITER EACH ANTIBODY,3003594,CDM,300,RC,,,outpatient,,,136,54.40,,115.6,85,,92.48,percent of total billed charges,85% of total billed charges,104.72,77,,83.78,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,111.52,82,,89.216,percent of total billed charges,82% of total billed charges,115.6,85,,92.48,percent of total billed charges,85% of total billed charges,115.6,85,,92.48,percent of total billed charges,85% of total billed charges,115.6,85,,92.48,percent of total billed charges,85% of total billed charges,122.4,90,,97.92,percent of total billed charges,90% of total billed charges,108.8,80,,87.04,percent of total billed charges,80% of total billed charges,122.4,90,,97.92,percent of total billed charges,90% of total billed charges,102,75,,81.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,39.44,29,,31.552,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,91.12,67,,72.896,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,108.8,80,,87.04,percent of total billed charges,80% of total billed charges,88.4,65,,70.72,percent of total billed charges,65% of total billed charges,48.51,35.67,,38.808,percent of total billed charges,35.67% of total billed charges,39.44,122.4,
ESTROGEN ASSAY,3003595,CDM,300,RC,,,outpatient,,,313,125.20,,266.05,85,,212.84,percent of total billed charges,85% of total billed charges,241.01,77,,192.81,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,256.66,82,,205.328,percent of total billed charges,82% of total billed charges,266.05,85,,212.84,percent of total billed charges,85% of total billed charges,266.05,85,,212.84,percent of total billed charges,85% of total billed charges,266.05,85,,212.84,percent of total billed charges,85% of total billed charges,281.7,90,,225.36,percent of total billed charges,90% of total billed charges,250.4,80,,200.32,percent of total billed charges,80% of total billed charges,281.7,90,,225.36,percent of total billed charges,90% of total billed charges,234.75,75,,187.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,90.77,29,,72.616,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,209.71,67,,167.768,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,250.4,80,,200.32,percent of total billed charges,80% of total billed charges,203.45,65,,162.76,percent of total billed charges,65% of total billed charges,111.65,35.67,,89.32,percent of total billed charges,35.67% of total billed charges,90.77,281.7,
PANCREATIC ELAST-1 FECAL QUANT,3003596,CDM,300,RC,,,outpatient,,,246,98.40,,209.1,85,,167.28,percent of total billed charges,85% of total billed charges,189.42,77,,151.54,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,201.72,82,,161.376,percent of total billed charges,82% of total billed charges,209.1,85,,167.28,percent of total billed charges,85% of total billed charges,209.1,85,,167.28,percent of total billed charges,85% of total billed charges,209.1,85,,167.28,percent of total billed charges,85% of total billed charges,221.4,90,,177.12,percent of total billed charges,90% of total billed charges,196.8,80,,157.44,percent of total billed charges,80% of total billed charges,221.4,90,,177.12,percent of total billed charges,90% of total billed charges,184.5,75,,147.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,71.34,29,,57.072,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,164.82,67,,131.856,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,196.8,80,,157.44,percent of total billed charges,80% of total billed charges,159.9,65,,127.92,percent of total billed charges,65% of total billed charges,87.75,35.67,,70.2,percent of total billed charges,35.67% of total billed charges,71.34,221.4,
PHOSPHORUS URINE ASSAY,3003597,CDM,300,RC,,,outpatient,,,82,32.80,,69.7,85,,55.76,percent of total billed charges,85% of total billed charges,63.14,77,,50.51,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,67.24,82,,53.792,percent of total billed charges,82% of total billed charges,69.7,85,,55.76,percent of total billed charges,85% of total billed charges,69.7,85,,55.76,percent of total billed charges,85% of total billed charges,69.7,85,,55.76,percent of total billed charges,85% of total billed charges,73.8,90,,59.04,percent of total billed charges,90% of total billed charges,65.6,80,,52.48,percent of total billed charges,80% of total billed charges,73.8,90,,59.04,percent of total billed charges,90% of total billed charges,61.5,75,,49.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,23.78,29,,19.024,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,54.94,67,,43.952,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,65.6,80,,52.48,percent of total billed charges,80% of total billed charges,53.3,65,,42.64,percent of total billed charges,65% of total billed charges,29.25,35.67,,23.4,percent of total billed charges,35.67% of total billed charges,23.78,73.8,
NOROVIRUS PCR,3003598,CDM,300,RC,,,outpatient,,,300,120.00,,255,85,,204,percent of total billed charges,85% of total billed charges,231,77,,184.8,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,246,82,,196.8,percent of total billed charges,82% of total billed charges,255,85,,204,percent of total billed charges,85% of total billed charges,255,85,,204,percent of total billed charges,85% of total billed charges,255,85,,204,percent of total billed charges,85% of total billed charges,270,90,,216,percent of total billed charges,90% of total billed charges,240,80,,192,percent of total billed charges,80% of total billed charges,270,90,,216,percent of total billed charges,90% of total billed charges,225,75,,180,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,87,29,,69.6,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,201,67,,160.8,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,240,80,,192,percent of total billed charges,80% of total billed charges,195,65,,156,percent of total billed charges,65% of total billed charges,107.01,35.67,,85.608,percent of total billed charges,35.67% of total billed charges,87,270,
CYCLOSPORINE,3003600,CDM,300,RC,80158,HCPCS,outpatient,,,218,87.20,,185.3,85,,148.24,percent of total billed charges,85% of total billed charges,167.86,77,,134.29,percent of total billed charges,77% of total billed charges,18.05,100,,,fee schedule,100% of CMS fee schedule,77.98,350,,,fee schedule,350% of BCBS fee schedule,81.1,364,,,fee schedule,364% of BCBS fee schedule,81.1,364,,,fee schedule,364% of BCBS fee schedule,81.1,364,,,fee schedule,364% of BCBS fee schedule,196.2,90,,156.96,percent of total billed charges,90% of total billed charges,174.4,80,,139.52,percent of total billed charges,80% of total billed charges,196.2,90,,156.96,percent of total billed charges,90% of total billed charges,163.5,75,,130.8,percent of total billed charges,75% of total billed charges,22.02,122,,,fee schedule,122% of APC rate,63.22,29,,50.576,percent of total billed charges,29% of total billed charges,18.05,100,,,fee schedule,100% of CMS fee schedule,146.06,67,,116.848,percent of total billed charges,67% of total billed charges,26.84,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,174.4,80,,139.52,percent of total billed charges,80% of total billed charges,141.7,65,,113.36,percent of total billed charges,65% of total billed charges,77.76,35.67,,62.208,percent of total billed charges,35.67% of total billed charges,18.05,196.2,
CYSTIC FIBROSIS PANEL,3003601,CDM,300,RC,81220,HCPCS,outpatient,,,2077,830.80,,1765.45,85,,1412.36,percent of total billed charges,85% of total billed charges,1599.29,77,,1279.43,percent of total billed charges,77% of total billed charges,556.6,100,,,fee schedule,100% of CMS fee schedule,1948.1,350,,,fee schedule,350% of BCBS fee schedule,2026.02,364,,,fee schedule,364% of BCBS fee schedule,2026.02,364,,,fee schedule,364% of BCBS fee schedule,2026.02,364,,,fee schedule,364% of BCBS fee schedule,1869.3,90,,1495.44,percent of total billed charges,90% of total billed charges,1661.6,80,,1329.28,percent of total billed charges,80% of total billed charges,1869.3,90,,1495.44,percent of total billed charges,90% of total billed charges,1557.75,75,,1246.2,percent of total billed charges,75% of total billed charges,679.05,122,,,fee schedule,122% of APC rate,602.33,29,,481.864,percent of total billed charges,29% of total billed charges,556.6,100,,,fee schedule,100% of CMS fee schedule,1391.59,67,,1113.272,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1661.6,80,,1329.28,percent of total billed charges,80% of total billed charges,1350.05,65,,1080.04,percent of total billed charges,65% of total billed charges,740.87,35.67,,592.696,percent of total billed charges,35.67% of total billed charges,556.6,2026.02,
FACTOR V ANAL LEIDEN,3003603,CDM,300,RC,81241,HCPCS,outpatient,,,233,93.20,,198.05,85,,158.44,percent of total billed charges,85% of total billed charges,179.41,77,,143.53,percent of total billed charges,77% of total billed charges,73.37,100,,,fee schedule,100% of CMS fee schedule,264.04,350,,,fee schedule,350% of BCBS fee schedule,274.6,364,,,fee schedule,364% of BCBS fee schedule,274.6,364,,,fee schedule,364% of BCBS fee schedule,274.6,364,,,fee schedule,364% of BCBS fee schedule,209.7,90,,167.76,percent of total billed charges,90% of total billed charges,186.4,80,,149.12,percent of total billed charges,80% of total billed charges,209.7,90,,167.76,percent of total billed charges,90% of total billed charges,174.75,75,,139.8,percent of total billed charges,75% of total billed charges,89.51,122,,,fee schedule,122% of APC rate,67.57,29,,54.056,percent of total billed charges,29% of total billed charges,73.37,100,,,fee schedule,100% of CMS fee schedule,156.11,67,,124.888,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,186.4,80,,149.12,percent of total billed charges,80% of total billed charges,151.45,65,,121.16,percent of total billed charges,65% of total billed charges,83.11,35.67,,66.488,percent of total billed charges,35.67% of total billed charges,67.57,274.6,
CHROMOSOME ANALYSIS 5 CELLS,3003620,CDM,300,RC,88261,HCPCS,outpatient,,,782,312.80,,664.7,85,,531.76,percent of total billed charges,85% of total billed charges,602.14,77,,481.71,percent of total billed charges,77% of total billed charges,264.33,100,,,fee schedule,100% of CMS fee schedule,925.19,350,,,fee schedule,350% of BCBS fee schedule,962.2,364,,,fee schedule,364% of BCBS fee schedule,962.2,364,,,fee schedule,364% of BCBS fee schedule,962.2,364,,,fee schedule,364% of BCBS fee schedule,703.8,90,,563.04,percent of total billed charges,90% of total billed charges,625.6,80,,500.48,percent of total billed charges,80% of total billed charges,703.8,90,,563.04,percent of total billed charges,90% of total billed charges,586.5,75,,469.2,percent of total billed charges,75% of total billed charges,322.49,122,,,fee schedule,122% of APC rate,226.78,29,,181.424,percent of total billed charges,29% of total billed charges,264.33,100,,,fee schedule,100% of CMS fee schedule,523.94,67,,419.152,percent of total billed charges,67% of total billed charges,262.83,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,625.6,80,,500.48,percent of total billed charges,80% of total billed charges,508.3,65,,406.64,percent of total billed charges,65% of total billed charges,278.94,35.67,,223.152,percent of total billed charges,35.67% of total billed charges,226.78,962.2,
CYTOMEGLOVIRUS DNA ULTRAQUANT,3003630,CDM,300,RC,87497,HCPCS,outpatient,,,643,257.20,,546.55,85,,437.24,percent of total billed charges,85% of total billed charges,495.11,77,,396.09,percent of total billed charges,77% of total billed charges,42.84,100,,,fee schedule,100% of CMS fee schedule,185.08,350,,,fee schedule,350% of BCBS fee schedule,192.48,364,,,fee schedule,364% of BCBS fee schedule,192.48,364,,,fee schedule,364% of BCBS fee schedule,192.48,364,,,fee schedule,364% of BCBS fee schedule,578.7,90,,462.96,percent of total billed charges,90% of total billed charges,514.4,80,,411.52,percent of total billed charges,80% of total billed charges,578.7,90,,462.96,percent of total billed charges,90% of total billed charges,482.25,75,,385.8,percent of total billed charges,75% of total billed charges,52.26,122,,,fee schedule,122% of APC rate,186.47,29,,149.176,percent of total billed charges,29% of total billed charges,42.84,100,,,fee schedule,100% of CMS fee schedule,430.81,67,,344.648,percent of total billed charges,67% of total billed charges,63.7,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,514.4,80,,411.52,percent of total billed charges,80% of total billed charges,417.95,65,,334.36,percent of total billed charges,65% of total billed charges,229.36,35.67,,183.488,percent of total billed charges,35.67% of total billed charges,42.84,578.7,
"CYTOMEGALOVIRUS,URINE",3003631,CDM,300,RC,87496,HCPCS,outpatient,,,302,120.80,,256.7,85,,205.36,percent of total billed charges,85% of total billed charges,232.54,77,,186.03,percent of total billed charges,77% of total billed charges,35.09,100,,,fee schedule,100% of CMS fee schedule,151.66,350,,,fee schedule,350% of BCBS fee schedule,157.72,364,,,fee schedule,364% of BCBS fee schedule,157.72,364,,,fee schedule,364% of BCBS fee schedule,157.72,364,,,fee schedule,364% of BCBS fee schedule,271.8,90,,217.44,percent of total billed charges,90% of total billed charges,241.6,80,,193.28,percent of total billed charges,80% of total billed charges,271.8,90,,217.44,percent of total billed charges,90% of total billed charges,226.5,75,,181.2,percent of total billed charges,75% of total billed charges,42.8,122,,,fee schedule,122% of APC rate,87.58,29,,70.064,percent of total billed charges,29% of total billed charges,35.09,100,,,fee schedule,100% of CMS fee schedule,202.34,67,,161.872,percent of total billed charges,67% of total billed charges,52.19,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,241.6,80,,193.28,percent of total billed charges,80% of total billed charges,196.3,65,,157.04,percent of total billed charges,65% of total billed charges,107.72,35.67,,86.176,percent of total billed charges,35.67% of total billed charges,35.09,271.8,
D - DIMER FIBRIN DEGRADATION,3003635,CDM,300,RC,85380,HCPCS,outpatient,,,97,38.80,,82.45,85,,65.96,percent of total billed charges,85% of total billed charges,74.69,77,,59.75,percent of total billed charges,77% of total billed charges,10.18,100,,,fee schedule,100% of CMS fee schedule,43.96,350,,,fee schedule,350% of BCBS fee schedule,45.72,364,,,fee schedule,364% of BCBS fee schedule,45.72,364,,,fee schedule,364% of BCBS fee schedule,45.72,364,,,fee schedule,364% of BCBS fee schedule,87.3,90,,69.84,percent of total billed charges,90% of total billed charges,77.6,80,,62.08,percent of total billed charges,80% of total billed charges,87.3,90,,69.84,percent of total billed charges,90% of total billed charges,72.75,75,,58.2,percent of total billed charges,75% of total billed charges,12.41,122,,,fee schedule,122% of APC rate,28.13,29,,22.504,percent of total billed charges,29% of total billed charges,10.18,100,,,fee schedule,100% of CMS fee schedule,64.99,67,,51.992,percent of total billed charges,67% of total billed charges,12.05,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,77.6,80,,62.08,percent of total billed charges,80% of total billed charges,63.05,65,,50.44,percent of total billed charges,65% of total billed charges,34.6,35.67,,27.68,percent of total billed charges,35.67% of total billed charges,10.18,87.3,
DELTA AMINOLEVULINIC ACID,3003640,CDM,300,RC,82135,HCPCS,outpatient,,,131,52.40,,111.35,85,,89.08,percent of total billed charges,85% of total billed charges,100.87,77,,80.7,percent of total billed charges,77% of total billed charges,16.45,100,,,fee schedule,100% of CMS fee schedule,71.09,350,,,fee schedule,350% of BCBS fee schedule,73.93,364,,,fee schedule,364% of BCBS fee schedule,73.93,364,,,fee schedule,364% of BCBS fee schedule,73.93,364,,,fee schedule,364% of BCBS fee schedule,117.9,90,,94.32,percent of total billed charges,90% of total billed charges,104.8,80,,83.84,percent of total billed charges,80% of total billed charges,117.9,90,,94.32,percent of total billed charges,90% of total billed charges,98.25,75,,78.6,percent of total billed charges,75% of total billed charges,20.06,122,,,fee schedule,122% of APC rate,37.99,29,,30.392,percent of total billed charges,29% of total billed charges,16.45,100,,,fee schedule,100% of CMS fee schedule,87.77,67,,70.216,percent of total billed charges,67% of total billed charges,24.47,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,104.8,80,,83.84,percent of total billed charges,80% of total billed charges,85.15,65,,68.12,percent of total billed charges,65% of total billed charges,46.73,35.67,,37.384,percent of total billed charges,35.67% of total billed charges,16.45,117.9,
DENGUE FEVER,3003654,CDM,300,RC,86790,HCPCS,outpatient,,,102,40.80,,86.7,85,,69.36,percent of total billed charges,85% of total billed charges,78.54,77,,62.83,percent of total billed charges,77% of total billed charges,12.88,100,,,fee schedule,100% of CMS fee schedule,55.65,350,,,fee schedule,350% of BCBS fee schedule,57.88,364,,,fee schedule,364% of BCBS fee schedule,57.88,364,,,fee schedule,364% of BCBS fee schedule,57.88,364,,,fee schedule,364% of BCBS fee schedule,91.8,90,,73.44,percent of total billed charges,90% of total billed charges,81.6,80,,65.28,percent of total billed charges,80% of total billed charges,91.8,90,,73.44,percent of total billed charges,90% of total billed charges,76.5,75,,61.2,percent of total billed charges,75% of total billed charges,15.71,122,,,fee schedule,122% of APC rate,29.58,29,,23.664,percent of total billed charges,29% of total billed charges,12.88,100,,,fee schedule,100% of CMS fee schedule,68.34,67,,54.672,percent of total billed charges,67% of total billed charges,8.64,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,81.6,80,,65.28,percent of total billed charges,80% of total billed charges,66.3,65,,53.04,percent of total billed charges,65% of total billed charges,36.38,35.67,,29.104,percent of total billed charges,35.67% of total billed charges,8.64,91.8,
DHEA SULFATE,3003680,CDM,300,RC,82627,HCPCS,outpatient,,,141,56.40,,119.85,85,,95.88,percent of total billed charges,85% of total billed charges,108.57,77,,86.86,percent of total billed charges,77% of total billed charges,22.23,100,,,fee schedule,100% of CMS fee schedule,96.08,350,,,fee schedule,350% of BCBS fee schedule,99.92,364,,,fee schedule,364% of BCBS fee schedule,99.92,364,,,fee schedule,364% of BCBS fee schedule,99.92,364,,,fee schedule,364% of BCBS fee schedule,126.9,90,,101.52,percent of total billed charges,90% of total billed charges,112.8,80,,90.24,percent of total billed charges,80% of total billed charges,126.9,90,,101.52,percent of total billed charges,90% of total billed charges,105.75,75,,84.6,percent of total billed charges,75% of total billed charges,27.12,122,,,fee schedule,122% of APC rate,40.89,29,,32.712,percent of total billed charges,29% of total billed charges,22.23,100,,,fee schedule,100% of CMS fee schedule,94.47,67,,75.576,percent of total billed charges,67% of total billed charges,33.06,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,112.8,80,,90.24,percent of total billed charges,80% of total billed charges,91.65,65,,73.32,percent of total billed charges,65% of total billed charges,50.29,35.67,,40.232,percent of total billed charges,35.67% of total billed charges,22.23,126.9,
DEXAMETHASONE SUPPRESSION TEST,3003681,CDM,300,RC,82533,HCPCS,outpatient,,,94,37.60,,79.9,85,,63.92,percent of total billed charges,85% of total billed charges,72.38,77,,57.9,percent of total billed charges,77% of total billed charges,16.3,100,,,fee schedule,100% of CMS fee schedule,70.42,350,,,fee schedule,350% of BCBS fee schedule,73.24,364,,,fee schedule,364% of BCBS fee schedule,73.24,364,,,fee schedule,364% of BCBS fee schedule,73.24,364,,,fee schedule,364% of BCBS fee schedule,84.6,90,,67.68,percent of total billed charges,90% of total billed charges,75.2,80,,60.16,percent of total billed charges,80% of total billed charges,84.6,90,,67.68,percent of total billed charges,90% of total billed charges,70.5,75,,56.4,percent of total billed charges,75% of total billed charges,19.88,122,,,fee schedule,122% of APC rate,27.26,29,,21.808,percent of total billed charges,29% of total billed charges,16.3,100,,,fee schedule,100% of CMS fee schedule,62.98,67,,50.384,percent of total billed charges,67% of total billed charges,24.25,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,75.2,80,,60.16,percent of total billed charges,80% of total billed charges,61.1,65,,48.88,percent of total billed charges,65% of total billed charges,33.53,35.67,,26.824,percent of total billed charges,35.67% of total billed charges,16.3,84.6,
DIAZEPAM (VALIUM) LEVEL,3003700,CDM,300,RC,80346,HCPCS,outpatient,,,90,36.00,,76.5,85,,61.2,percent of total billed charges,85% of total billed charges,69.3,77,,55.44,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,73.8,82,,59.04,percent of total billed charges,82% of total billed charges,76.5,85,,61.2,percent of total billed charges,85% of total billed charges,76.5,85,,61.2,percent of total billed charges,85% of total billed charges,76.5,85,,61.2,percent of total billed charges,85% of total billed charges,81,90,,64.8,percent of total billed charges,90% of total billed charges,72,80,,57.6,percent of total billed charges,80% of total billed charges,81,90,,64.8,percent of total billed charges,90% of total billed charges,67.5,75,,54,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,26.1,29,,20.88,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,60.3,67,,48.24,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,72,80,,57.6,percent of total billed charges,80% of total billed charges,58.5,65,,46.8,percent of total billed charges,65% of total billed charges,32.1,35.67,,25.68,percent of total billed charges,35.67% of total billed charges,26.1,81,
DIHYDROTESTOSTERONE LEVEL,3003701,CDM,300,RC,82642,HCPCS,outpatient,,,185,74.00,,157.25,85,,125.8,percent of total billed charges,85% of total billed charges,142.45,77,,113.96,percent of total billed charges,77% of total billed charges,29.28,100,,,fee schedule,100% of CMS fee schedule,113.86,350,,,fee schedule,350% of BCBS fee schedule,118.41,364,,,fee schedule,364% of BCBS fee schedule,118.41,364,,,fee schedule,364% of BCBS fee schedule,118.41,364,,,fee schedule,364% of BCBS fee schedule,166.5,90,,133.2,percent of total billed charges,90% of total billed charges,148,80,,118.4,percent of total billed charges,80% of total billed charges,166.5,90,,133.2,percent of total billed charges,90% of total billed charges,138.75,75,,111,percent of total billed charges,75% of total billed charges,35.72,122,,,fee schedule,122% of APC rate,53.65,29,,42.92,percent of total billed charges,29% of total billed charges,29.28,100,,,fee schedule,100% of CMS fee schedule,123.95,67,,99.16,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,148,80,,118.4,percent of total billed charges,80% of total billed charges,120.25,65,,96.2,percent of total billed charges,65% of total billed charges,65.99,35.67,,52.792,percent of total billed charges,35.67% of total billed charges,29.28,166.5,
DIGOXIN LEVEL,3003760,CDM,300,RC,80162,HCPCS,outpatient,,,91,36.40,,77.35,85,,61.88,percent of total billed charges,85% of total billed charges,70.07,77,,56.06,percent of total billed charges,77% of total billed charges,13.28,100,,,fee schedule,100% of CMS fee schedule,57.37,350,,,fee schedule,350% of BCBS fee schedule,59.66,364,,,fee schedule,364% of BCBS fee schedule,59.66,364,,,fee schedule,364% of BCBS fee schedule,59.66,364,,,fee schedule,364% of BCBS fee schedule,81.9,90,,65.52,percent of total billed charges,90% of total billed charges,72.8,80,,58.24,percent of total billed charges,80% of total billed charges,81.9,90,,65.52,percent of total billed charges,90% of total billed charges,68.25,75,,54.6,percent of total billed charges,75% of total billed charges,16.2,122,,,fee schedule,122% of APC rate,26.39,29,,21.112,percent of total billed charges,29% of total billed charges,13.28,100,,,fee schedule,100% of CMS fee schedule,60.97,67,,48.776,percent of total billed charges,67% of total billed charges,19.74,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,72.8,80,,58.24,percent of total billed charges,80% of total billed charges,59.15,65,,47.32,percent of total billed charges,65% of total billed charges,32.46,35.67,,25.968,percent of total billed charges,35.67% of total billed charges,13.28,81.9,
DIPHENHYDRAMINE-BENADRYL,3003780,CDM,300,RC,80299,HCPCS,outpatient,,,147,58.80,,124.95,85,,99.96,percent of total billed charges,85% of total billed charges,113.19,77,,90.55,percent of total billed charges,77% of total billed charges,18.64,100,,,fee schedule,100% of CMS fee schedule,65.24,350,,,fee schedule,350% of BCBS fee schedule,67.85,364,,,fee schedule,364% of BCBS fee schedule,67.85,364,,,fee schedule,364% of BCBS fee schedule,67.85,364,,,fee schedule,364% of BCBS fee schedule,132.3,90,,105.84,percent of total billed charges,90% of total billed charges,117.6,80,,94.08,percent of total billed charges,80% of total billed charges,132.3,90,,105.84,percent of total billed charges,90% of total billed charges,110.25,75,,88.2,percent of total billed charges,75% of total billed charges,22.74,122,,,fee schedule,122% of APC rate,42.63,29,,34.104,percent of total billed charges,29% of total billed charges,18.64,100,,,fee schedule,100% of CMS fee schedule,98.49,67,,78.792,percent of total billed charges,67% of total billed charges,20.36,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,117.6,80,,94.08,percent of total billed charges,80% of total billed charges,95.55,65,,76.44,percent of total billed charges,65% of total billed charges,52.43,35.67,,41.944,percent of total billed charges,35.67% of total billed charges,18.64,132.3,
DISOPRYAMIDE (NORPACE),3003800,CDM,300,RC,80299,HCPCS,outpatient,,,147,58.80,,124.95,85,,99.96,percent of total billed charges,85% of total billed charges,113.19,77,,90.55,percent of total billed charges,77% of total billed charges,18.64,100,,,fee schedule,100% of CMS fee schedule,65.24,350,,,fee schedule,350% of BCBS fee schedule,67.85,364,,,fee schedule,364% of BCBS fee schedule,67.85,364,,,fee schedule,364% of BCBS fee schedule,67.85,364,,,fee schedule,364% of BCBS fee schedule,132.3,90,,105.84,percent of total billed charges,90% of total billed charges,117.6,80,,94.08,percent of total billed charges,80% of total billed charges,132.3,90,,105.84,percent of total billed charges,90% of total billed charges,110.25,75,,88.2,percent of total billed charges,75% of total billed charges,22.74,122,,,fee schedule,122% of APC rate,42.63,29,,34.104,percent of total billed charges,29% of total billed charges,18.64,100,,,fee schedule,100% of CMS fee schedule,98.49,67,,78.792,percent of total billed charges,67% of total billed charges,20.36,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,117.6,80,,94.08,percent of total billed charges,80% of total billed charges,95.55,65,,76.44,percent of total billed charges,65% of total billed charges,52.43,35.67,,41.944,percent of total billed charges,35.67% of total billed charges,18.64,132.3,
TRANSFUSION REACTION,3003801,CDM,300,RC,86078,HCPCS,outpatient,,,495,198.00,,420.75,85,,336.6,percent of total billed charges,85% of total billed charges,381.15,77,,304.92,percent of total billed charges,77% of total billed charges,149.37,100,,,fee schedule,100% of CMS OPPS rate,452.13,350,,,fee schedule,350% of BCBS fee schedule,470.22,364,,,fee schedule,364% of BCBS fee schedule,470.22,364,,,fee schedule,364% of BCBS fee schedule,470.22,364,,,fee schedule,364% of BCBS fee schedule,445.5,90,,356.4,percent of total billed charges,90% of total billed charges,396,80,,316.8,percent of total billed charges,80% of total billed charges,445.5,90,,356.4,percent of total billed charges,90% of total billed charges,371.25,75,,297,percent of total billed charges,75% of total billed charges,182.23,122,,,fee schedule,122% of APC rate,143.55,29,,114.84,percent of total billed charges,29% of total billed charges,149.37,100,,,fee schedule,100% of CMS OPPS rate,331.65,67,,265.32,percent of total billed charges,67% of total billed charges,34.31,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,396,80,,316.8,percent of total billed charges,80% of total billed charges,321.75,65,,257.4,percent of total billed charges,65% of total billed charges,176.57,35.67,,141.256,percent of total billed charges,35.67% of total billed charges,34.31,470.22,
DNA CELL CYCLE ANALYSIS,3003810,CDM,300,RC,88182,HCPCS,outpatient,,,345,138.00,,293.25,85,,234.6,percent of total billed charges,85% of total billed charges,265.65,77,,212.52,percent of total billed charges,77% of total billed charges,47.38,100,,,fee schedule,100% of CMS OPPS rate,156.45,350,,,fee schedule,350% of BCBS fee schedule,162.71,364,,,fee schedule,364% of BCBS fee schedule,162.71,364,,,fee schedule,364% of BCBS fee schedule,162.71,364,,,fee schedule,364% of BCBS fee schedule,310.5,90,,248.4,percent of total billed charges,90% of total billed charges,276,80,,220.8,percent of total billed charges,80% of total billed charges,310.5,90,,248.4,percent of total billed charges,90% of total billed charges,258.75,75,,207,percent of total billed charges,75% of total billed charges,57.81,122,,,fee schedule,122% of APC rate,100.05,29,,80.04,percent of total billed charges,29% of total billed charges,47.38,100,,,fee schedule,100% of CMS OPPS rate,231.15,67,,184.92,percent of total billed charges,67% of total billed charges,34.31,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,276,80,,220.8,percent of total billed charges,80% of total billed charges,224.25,65,,179.4,percent of total billed charges,65% of total billed charges,123.06,35.67,,98.448,percent of total billed charges,35.67% of total billed charges,34.31,310.5,
DOUBLE STRANDED DNA/HEMOTOMO.,3003812,CDM,300,RC,86225,HCPCS,outpatient,,,312,124.80,,265.2,85,,212.16,percent of total billed charges,85% of total billed charges,240.24,77,,192.19,percent of total billed charges,77% of total billed charges,13.74,100,,,fee schedule,100% of CMS fee schedule,59.4,350,,,fee schedule,350% of BCBS fee schedule,61.77,364,,,fee schedule,364% of BCBS fee schedule,61.77,364,,,fee schedule,364% of BCBS fee schedule,61.77,364,,,fee schedule,364% of BCBS fee schedule,280.8,90,,224.64,percent of total billed charges,90% of total billed charges,249.6,80,,199.68,percent of total billed charges,80% of total billed charges,280.8,90,,224.64,percent of total billed charges,90% of total billed charges,234,75,,187.2,percent of total billed charges,75% of total billed charges,16.76,122,,,fee schedule,122% of APC rate,90.48,29,,72.384,percent of total billed charges,29% of total billed charges,13.74,100,,,fee schedule,100% of CMS fee schedule,209.04,67,,167.232,percent of total billed charges,67% of total billed charges,20.42,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,249.6,80,,199.68,percent of total billed charges,80% of total billed charges,202.8,65,,162.24,percent of total billed charges,65% of total billed charges,111.29,35.67,,89.032,percent of total billed charges,35.67% of total billed charges,13.74,280.8,
DOXEPINE,3003820,CDM,300,RC,80335,HCPCS,outpatient,,,438,175.20,,372.3,85,,297.84,percent of total billed charges,85% of total billed charges,337.26,77,,269.81,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,359.16,82,,287.328,percent of total billed charges,82% of total billed charges,372.3,85,,297.84,percent of total billed charges,85% of total billed charges,372.3,85,,297.84,percent of total billed charges,85% of total billed charges,372.3,85,,297.84,percent of total billed charges,85% of total billed charges,394.2,90,,315.36,percent of total billed charges,90% of total billed charges,350.4,80,,280.32,percent of total billed charges,80% of total billed charges,394.2,90,,315.36,percent of total billed charges,90% of total billed charges,328.5,75,,262.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,127.02,29,,101.616,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,293.46,67,,234.768,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,350.4,80,,280.32,percent of total billed charges,80% of total billed charges,284.7,65,,227.76,percent of total billed charges,65% of total billed charges,156.23,35.67,,124.984,percent of total billed charges,35.67% of total billed charges,127.02,394.2,
DRUG QUANTITATIVE-OTHER,3003830,CDM,300,RC,80305,HCPCS,outpatient,,,84,33.60,,71.4,85,,57.12,percent of total billed charges,85% of total billed charges,64.68,77,,51.74,percent of total billed charges,77% of total billed charges,12.6,100,,,fee schedule,100% of CMS fee schedule,47.11,350,,,fee schedule,350% of BCBS fee schedule,48.99,364,,,fee schedule,364% of BCBS fee schedule,48.99,364,,,fee schedule,364% of BCBS fee schedule,48.99,364,,,fee schedule,364% of BCBS fee schedule,75.6,90,,60.48,percent of total billed charges,90% of total billed charges,67.2,80,,53.76,percent of total billed charges,80% of total billed charges,75.6,90,,60.48,percent of total billed charges,90% of total billed charges,63,75,,50.4,percent of total billed charges,75% of total billed charges,15.37,122,,,fee schedule,122% of APC rate,24.36,29,,19.488,percent of total billed charges,29% of total billed charges,12.6,100,,,fee schedule,100% of CMS fee schedule,56.28,67,,45.024,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,67.2,80,,53.76,percent of total billed charges,80% of total billed charges,54.6,65,,43.68,percent of total billed charges,65% of total billed charges,29.96,35.67,,23.968,percent of total billed charges,35.67% of total billed charges,12.6,75.6,
DRUG SCREEN CONFIRMATION EACH,3003840,CDM,300,RC,80307,HCPCS,outpatient,,,285,114.00,,242.25,85,,193.8,percent of total billed charges,85% of total billed charges,219.45,77,,175.56,percent of total billed charges,77% of total billed charges,62.14,100,,,fee schedule,100% of CMS fee schedule,251.41,350,,,fee schedule,350% of BCBS fee schedule,261.46,364,,,fee schedule,364% of BCBS fee schedule,261.46,364,,,fee schedule,364% of BCBS fee schedule,261.46,364,,,fee schedule,364% of BCBS fee schedule,256.5,90,,205.2,percent of total billed charges,90% of total billed charges,228,80,,182.4,percent of total billed charges,80% of total billed charges,256.5,90,,205.2,percent of total billed charges,90% of total billed charges,213.75,75,,171,percent of total billed charges,75% of total billed charges,75.81,122,,,fee schedule,122% of APC rate,82.65,29,,66.12,percent of total billed charges,29% of total billed charges,62.14,100,,,fee schedule,100% of CMS fee schedule,190.95,67,,152.76,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,228,80,,182.4,percent of total billed charges,80% of total billed charges,185.25,65,,148.2,percent of total billed charges,65% of total billed charges,101.66,35.67,,81.328,percent of total billed charges,35.67% of total billed charges,62.14,261.46,
"DRUG SCREEN, SERUM OR MECON",3003880,CDM,300,RC,80307,HCPCS,outpatient,,,305,122.00,,259.25,85,,207.4,percent of total billed charges,85% of total billed charges,234.85,77,,187.88,percent of total billed charges,77% of total billed charges,62.14,100,,,fee schedule,100% of CMS fee schedule,251.41,350,,,fee schedule,350% of BCBS fee schedule,261.46,364,,,fee schedule,364% of BCBS fee schedule,261.46,364,,,fee schedule,364% of BCBS fee schedule,261.46,364,,,fee schedule,364% of BCBS fee schedule,274.5,90,,219.6,percent of total billed charges,90% of total billed charges,244,80,,195.2,percent of total billed charges,80% of total billed charges,274.5,90,,219.6,percent of total billed charges,90% of total billed charges,228.75,75,,183,percent of total billed charges,75% of total billed charges,75.81,122,,,fee schedule,122% of APC rate,88.45,29,,70.76,percent of total billed charges,29% of total billed charges,62.14,100,,,fee schedule,100% of CMS fee schedule,204.35,67,,163.48,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,244,80,,195.2,percent of total billed charges,80% of total billed charges,198.25,65,,158.6,percent of total billed charges,65% of total billed charges,108.79,35.67,,87.032,percent of total billed charges,35.67% of total billed charges,62.14,274.5,
DRUG SCREEN CONFIRM PROPOXYPHE,3003888,CDM,300,RC,80367,HCPCS,outpatient,,,188,75.20,,159.8,85,,127.84,percent of total billed charges,85% of total billed charges,144.76,77,,115.81,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,154.16,82,,123.328,percent of total billed charges,82% of total billed charges,159.8,85,,127.84,percent of total billed charges,85% of total billed charges,159.8,85,,127.84,percent of total billed charges,85% of total billed charges,159.8,85,,127.84,percent of total billed charges,85% of total billed charges,169.2,90,,135.36,percent of total billed charges,90% of total billed charges,150.4,80,,120.32,percent of total billed charges,80% of total billed charges,169.2,90,,135.36,percent of total billed charges,90% of total billed charges,141,75,,112.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,54.52,29,,43.616,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,125.96,67,,100.768,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,150.4,80,,120.32,percent of total billed charges,80% of total billed charges,122.2,65,,97.76,percent of total billed charges,65% of total billed charges,67.06,35.67,,53.648,percent of total billed charges,35.67% of total billed charges,54.52,169.2,
DRUG SCREEN CONFIRM AMPHETAMIN,3003890,CDM,300,RC,80324,HCPCS,outpatient,,,446,178.40,,379.1,85,,303.28,percent of total billed charges,85% of total billed charges,343.42,77,,274.74,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,365.72,82,,292.576,percent of total billed charges,82% of total billed charges,379.1,85,,303.28,percent of total billed charges,85% of total billed charges,379.1,85,,303.28,percent of total billed charges,85% of total billed charges,379.1,85,,303.28,percent of total billed charges,85% of total billed charges,401.4,90,,321.12,percent of total billed charges,90% of total billed charges,356.8,80,,285.44,percent of total billed charges,80% of total billed charges,401.4,90,,321.12,percent of total billed charges,90% of total billed charges,334.5,75,,267.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,129.34,29,,103.472,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,298.82,67,,239.056,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,356.8,80,,285.44,percent of total billed charges,80% of total billed charges,289.9,65,,231.92,percent of total billed charges,65% of total billed charges,159.09,35.67,,127.272,percent of total billed charges,35.67% of total billed charges,129.34,401.4,
DRUG SCREEN CONFIRM BARBITUATE,3003891,CDM,300,RC,80345,HCPCS,outpatient,,,438,175.20,,372.3,85,,297.84,percent of total billed charges,85% of total billed charges,337.26,77,,269.81,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,359.16,82,,287.328,percent of total billed charges,82% of total billed charges,372.3,85,,297.84,percent of total billed charges,85% of total billed charges,372.3,85,,297.84,percent of total billed charges,85% of total billed charges,372.3,85,,297.84,percent of total billed charges,85% of total billed charges,394.2,90,,315.36,percent of total billed charges,90% of total billed charges,350.4,80,,280.32,percent of total billed charges,80% of total billed charges,394.2,90,,315.36,percent of total billed charges,90% of total billed charges,328.5,75,,262.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,127.02,29,,101.616,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,293.46,67,,234.768,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,350.4,80,,280.32,percent of total billed charges,80% of total billed charges,284.7,65,,227.76,percent of total billed charges,65% of total billed charges,156.23,35.67,,124.984,percent of total billed charges,35.67% of total billed charges,127.02,394.2,
DRUG SCREEN CONFIRM BENZO,3003892,CDM,300,RC,G0480,HCPCS,outpatient,,,191,76.40,,162.35,85,,129.88,percent of total billed charges,85% of total billed charges,147.07,77,,117.66,percent of total billed charges,77% of total billed charges,114.43,100,,,fee schedule,100% of CMS fee schedule,400.51,350,,,fee schedule,350% of BCBS fee schedule,416.53,364,,,fee schedule,364% of BCBS fee schedule,416.53,364,,,fee schedule,364% of BCBS fee schedule,416.53,364,,,fee schedule,364% of BCBS fee schedule,171.9,90,,137.52,percent of total billed charges,90% of total billed charges,152.8,80,,122.24,percent of total billed charges,80% of total billed charges,171.9,90,,137.52,percent of total billed charges,90% of total billed charges,143.25,75,,114.6,percent of total billed charges,75% of total billed charges,139.6,122,,,fee schedule,122% of APC rate,55.39,29,,44.312,percent of total billed charges,29% of total billed charges,114.43,100,,,fee schedule,100% of CMS fee schedule,127.97,67,,102.376,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,152.8,80,,122.24,percent of total billed charges,80% of total billed charges,124.15,65,,99.32,percent of total billed charges,65% of total billed charges,68.13,35.67,,54.504,percent of total billed charges,35.67% of total billed charges,55.39,416.53,
DRUG SCREEN CONFIRM THC,3003893,CDM,300,RC,80349,HCPCS,outpatient,,,188,75.20,,159.8,85,,127.84,percent of total billed charges,85% of total billed charges,144.76,77,,115.81,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,154.16,82,,123.328,percent of total billed charges,82% of total billed charges,159.8,85,,127.84,percent of total billed charges,85% of total billed charges,159.8,85,,127.84,percent of total billed charges,85% of total billed charges,159.8,85,,127.84,percent of total billed charges,85% of total billed charges,169.2,90,,135.36,percent of total billed charges,90% of total billed charges,150.4,80,,120.32,percent of total billed charges,80% of total billed charges,169.2,90,,135.36,percent of total billed charges,90% of total billed charges,141,75,,112.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,54.52,29,,43.616,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,125.96,67,,100.768,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,150.4,80,,120.32,percent of total billed charges,80% of total billed charges,122.2,65,,97.76,percent of total billed charges,65% of total billed charges,67.06,35.67,,53.648,percent of total billed charges,35.67% of total billed charges,54.52,169.2,
DRUG SCREEN CONFIRM COCAINE,3003894,CDM,300,RC,80353,HCPCS,outpatient,,,191,76.40,,162.35,85,,129.88,percent of total billed charges,85% of total billed charges,147.07,77,,117.66,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,156.62,82,,125.296,percent of total billed charges,82% of total billed charges,162.35,85,,129.88,percent of total billed charges,85% of total billed charges,162.35,85,,129.88,percent of total billed charges,85% of total billed charges,162.35,85,,129.88,percent of total billed charges,85% of total billed charges,171.9,90,,137.52,percent of total billed charges,90% of total billed charges,152.8,80,,122.24,percent of total billed charges,80% of total billed charges,171.9,90,,137.52,percent of total billed charges,90% of total billed charges,143.25,75,,114.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,55.39,29,,44.312,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,127.97,67,,102.376,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,152.8,80,,122.24,percent of total billed charges,80% of total billed charges,124.15,65,,99.32,percent of total billed charges,65% of total billed charges,68.13,35.67,,54.504,percent of total billed charges,35.67% of total billed charges,55.39,171.9,
DRUG SCREEN CONF METHADONE,3003895,CDM,300,RC,80358,HCPCS,outpatient,,,191,76.40,,162.35,85,,129.88,percent of total billed charges,85% of total billed charges,147.07,77,,117.66,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,156.62,82,,125.296,percent of total billed charges,82% of total billed charges,162.35,85,,129.88,percent of total billed charges,85% of total billed charges,162.35,85,,129.88,percent of total billed charges,85% of total billed charges,162.35,85,,129.88,percent of total billed charges,85% of total billed charges,171.9,90,,137.52,percent of total billed charges,90% of total billed charges,152.8,80,,122.24,percent of total billed charges,80% of total billed charges,171.9,90,,137.52,percent of total billed charges,90% of total billed charges,143.25,75,,114.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,55.39,29,,44.312,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,127.97,67,,102.376,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,152.8,80,,122.24,percent of total billed charges,80% of total billed charges,124.15,65,,99.32,percent of total billed charges,65% of total billed charges,68.13,35.67,,54.504,percent of total billed charges,35.67% of total billed charges,55.39,171.9,
DRUG SCREEN CONF OPIATE,3003896,CDM,300,RC,80361,HCPCS,outpatient,,,188,75.20,,159.8,85,,127.84,percent of total billed charges,85% of total billed charges,144.76,77,,115.81,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,154.16,82,,123.328,percent of total billed charges,82% of total billed charges,159.8,85,,127.84,percent of total billed charges,85% of total billed charges,159.8,85,,127.84,percent of total billed charges,85% of total billed charges,159.8,85,,127.84,percent of total billed charges,85% of total billed charges,169.2,90,,135.36,percent of total billed charges,90% of total billed charges,150.4,80,,120.32,percent of total billed charges,80% of total billed charges,169.2,90,,135.36,percent of total billed charges,90% of total billed charges,141,75,,112.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,54.52,29,,43.616,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,125.96,67,,100.768,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,150.4,80,,120.32,percent of total billed charges,80% of total billed charges,122.2,65,,97.76,percent of total billed charges,65% of total billed charges,67.06,35.67,,53.648,percent of total billed charges,35.67% of total billed charges,54.52,169.2,
DRUG SCREEN CONF PHENCYC,3003897,CDM,300,RC,83992,HCPCS,outpatient,,,191,76.40,,162.35,85,,129.88,percent of total billed charges,85% of total billed charges,147.07,77,,117.66,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,89.18,350,,,fee schedule,350% of BCBS fee schedule,92.75,364,,,fee schedule,364% of BCBS fee schedule,92.75,364,,,fee schedule,364% of BCBS fee schedule,92.75,364,,,fee schedule,364% of BCBS fee schedule,171.9,90,,137.52,percent of total billed charges,90% of total billed charges,152.8,80,,122.24,percent of total billed charges,80% of total billed charges,171.9,90,,137.52,percent of total billed charges,90% of total billed charges,143.25,75,,114.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,55.39,29,,44.312,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,127.97,67,,102.376,percent of total billed charges,67% of total billed charges,21.86,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,152.8,80,,122.24,percent of total billed charges,80% of total billed charges,124.15,65,,99.32,percent of total billed charges,65% of total billed charges,68.13,35.67,,54.504,percent of total billed charges,35.67% of total billed charges,21.86,171.9,
DRUG SCREEN CONFIRM METHAMPH,3003898,CDM,300,RC,80359,HCPCS,outpatient,,,191,76.40,,162.35,85,,129.88,percent of total billed charges,85% of total billed charges,147.07,77,,117.66,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,156.62,82,,125.296,percent of total billed charges,82% of total billed charges,162.35,85,,129.88,percent of total billed charges,85% of total billed charges,162.35,85,,129.88,percent of total billed charges,85% of total billed charges,162.35,85,,129.88,percent of total billed charges,85% of total billed charges,171.9,90,,137.52,percent of total billed charges,90% of total billed charges,152.8,80,,122.24,percent of total billed charges,80% of total billed charges,171.9,90,,137.52,percent of total billed charges,90% of total billed charges,143.25,75,,114.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,55.39,29,,44.312,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,127.97,67,,102.376,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,152.8,80,,122.24,percent of total billed charges,80% of total billed charges,124.15,65,,99.32,percent of total billed charges,65% of total billed charges,68.13,35.67,,54.504,percent of total billed charges,35.67% of total billed charges,55.39,171.9,
DRUG SCREEN URINE CONF CHROMO,3003899,CDM,300,RC,82542,HCPCS,outpatient,,,502,200.80,,426.7,85,,341.36,percent of total billed charges,85% of total billed charges,386.54,77,,309.23,percent of total billed charges,77% of total billed charges,24.09,100,,,fee schedule,100% of CMS fee schedule,84.32,350,,,fee schedule,350% of BCBS fee schedule,87.69,364,,,fee schedule,364% of BCBS fee schedule,87.69,364,,,fee schedule,364% of BCBS fee schedule,87.69,364,,,fee schedule,364% of BCBS fee schedule,451.8,90,,361.44,percent of total billed charges,90% of total billed charges,401.6,80,,321.28,percent of total billed charges,80% of total billed charges,451.8,90,,361.44,percent of total billed charges,90% of total billed charges,376.5,75,,301.2,percent of total billed charges,75% of total billed charges,29.38,122,,,fee schedule,122% of APC rate,145.58,29,,116.464,percent of total billed charges,29% of total billed charges,24.09,100,,,fee schedule,100% of CMS fee schedule,336.34,67,,269.072,percent of total billed charges,67% of total billed charges,26.84,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,401.6,80,,321.28,percent of total billed charges,80% of total billed charges,326.3,65,,261.04,percent of total billed charges,65% of total billed charges,179.06,35.67,,143.248,percent of total billed charges,35.67% of total billed charges,24.09,451.8,
DRUG SCREEN URINE COLLECTION,3003900,CDM,300,RC,80307,HCPCS,outpatient,,,117,46.80,,99.45,85,,79.56,percent of total billed charges,85% of total billed charges,90.09,77,,72.07,percent of total billed charges,77% of total billed charges,62.14,100,,,fee schedule,100% of CMS fee schedule,251.41,350,,,fee schedule,350% of BCBS fee schedule,261.46,364,,,fee schedule,364% of BCBS fee schedule,261.46,364,,,fee schedule,364% of BCBS fee schedule,261.46,364,,,fee schedule,364% of BCBS fee schedule,105.3,90,,84.24,percent of total billed charges,90% of total billed charges,93.6,80,,74.88,percent of total billed charges,80% of total billed charges,105.3,90,,84.24,percent of total billed charges,90% of total billed charges,87.75,75,,70.2,percent of total billed charges,75% of total billed charges,75.81,122,,,fee schedule,122% of APC rate,33.93,29,,27.144,percent of total billed charges,29% of total billed charges,62.14,100,,,fee schedule,100% of CMS fee schedule,78.39,67,,62.712,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,93.6,80,,74.88,percent of total billed charges,80% of total billed charges,76.05,65,,60.84,percent of total billed charges,65% of total billed charges,41.73,35.67,,33.384,percent of total billed charges,35.67% of total billed charges,33.93,261.46,
DRUG SCREEN URINE INHOUSE *,3003901,CDM,300,RC,80305,HCPCS,outpatient,,,158,63.20,,134.3,85,,107.44,percent of total billed charges,85% of total billed charges,121.66,77,,97.33,percent of total billed charges,77% of total billed charges,12.6,100,,,fee schedule,100% of CMS fee schedule,47.11,350,,,fee schedule,350% of BCBS fee schedule,48.99,364,,,fee schedule,364% of BCBS fee schedule,48.99,364,,,fee schedule,364% of BCBS fee schedule,48.99,364,,,fee schedule,364% of BCBS fee schedule,142.2,90,,113.76,percent of total billed charges,90% of total billed charges,126.4,80,,101.12,percent of total billed charges,80% of total billed charges,142.2,90,,113.76,percent of total billed charges,90% of total billed charges,118.5,75,,94.8,percent of total billed charges,75% of total billed charges,15.37,122,,,fee schedule,122% of APC rate,45.82,29,,36.656,percent of total billed charges,29% of total billed charges,12.6,100,,,fee schedule,100% of CMS fee schedule,105.86,67,,84.688,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,126.4,80,,101.12,percent of total billed charges,80% of total billed charges,102.7,65,,82.16,percent of total billed charges,65% of total billed charges,56.36,35.67,,45.088,percent of total billed charges,35.67% of total billed charges,12.6,142.2,
DRUG SCREEN URINE CCH INHOUSE,3003905,CDM,300,RC,80305,HCPCS,outpatient,,,154,61.60,,130.9,85,,104.72,percent of total billed charges,85% of total billed charges,118.58,77,,94.86,percent of total billed charges,77% of total billed charges,12.6,100,,,fee schedule,100% of CMS fee schedule,47.11,350,,,fee schedule,350% of BCBS fee schedule,48.99,364,,,fee schedule,364% of BCBS fee schedule,48.99,364,,,fee schedule,364% of BCBS fee schedule,48.99,364,,,fee schedule,364% of BCBS fee schedule,138.6,90,,110.88,percent of total billed charges,90% of total billed charges,123.2,80,,98.56,percent of total billed charges,80% of total billed charges,138.6,90,,110.88,percent of total billed charges,90% of total billed charges,115.5,75,,92.4,percent of total billed charges,75% of total billed charges,15.37,122,,,fee schedule,122% of APC rate,44.66,29,,35.728,percent of total billed charges,29% of total billed charges,12.6,100,,,fee schedule,100% of CMS fee schedule,103.18,67,,82.544,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,123.2,80,,98.56,percent of total billed charges,80% of total billed charges,100.1,65,,80.08,percent of total billed charges,65% of total billed charges,54.93,35.67,,43.944,percent of total billed charges,35.67% of total billed charges,12.6,138.6,
EFFEXOR LEVEL,3003921,CDM,300,RC,80299,HCPCS,outpatient,,,130,52.00,,110.5,85,,88.4,percent of total billed charges,85% of total billed charges,100.1,77,,80.08,percent of total billed charges,77% of total billed charges,18.64,100,,,fee schedule,100% of CMS fee schedule,65.24,350,,,fee schedule,350% of BCBS fee schedule,67.85,364,,,fee schedule,364% of BCBS fee schedule,67.85,364,,,fee schedule,364% of BCBS fee schedule,67.85,364,,,fee schedule,364% of BCBS fee schedule,117,90,,93.6,percent of total billed charges,90% of total billed charges,104,80,,83.2,percent of total billed charges,80% of total billed charges,117,90,,93.6,percent of total billed charges,90% of total billed charges,97.5,75,,78,percent of total billed charges,75% of total billed charges,22.74,122,,,fee schedule,122% of APC rate,37.7,29,,30.16,percent of total billed charges,29% of total billed charges,18.64,100,,,fee schedule,100% of CMS fee schedule,87.1,67,,69.68,percent of total billed charges,67% of total billed charges,20.36,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,104,80,,83.2,percent of total billed charges,80% of total billed charges,84.5,65,,67.6,percent of total billed charges,65% of total billed charges,46.37,35.67,,37.096,percent of total billed charges,35.67% of total billed charges,18.64,117,
"EHRLICHIOSIS - IgG, IgM",3003922,CDM,300,RC,86666,HCPCS,outpatient,,,243,97.20,,206.55,85,,165.24,percent of total billed charges,85% of total billed charges,187.11,77,,149.69,percent of total billed charges,77% of total billed charges,10.18,100,,,fee schedule,100% of CMS fee schedule,43.96,350,,,fee schedule,350% of BCBS fee schedule,45.72,364,,,fee schedule,364% of BCBS fee schedule,45.72,364,,,fee schedule,364% of BCBS fee schedule,45.72,364,,,fee schedule,364% of BCBS fee schedule,218.7,90,,174.96,percent of total billed charges,90% of total billed charges,194.4,80,,155.52,percent of total billed charges,80% of total billed charges,218.7,90,,174.96,percent of total billed charges,90% of total billed charges,182.25,75,,145.8,percent of total billed charges,75% of total billed charges,12.41,122,,,fee schedule,122% of APC rate,70.47,29,,56.376,percent of total billed charges,29% of total billed charges,10.18,100,,,fee schedule,100% of CMS fee schedule,162.81,67,,130.248,percent of total billed charges,67% of total billed charges,8.64,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,194.4,80,,155.52,percent of total billed charges,80% of total billed charges,157.95,65,,126.36,percent of total billed charges,65% of total billed charges,86.68,35.67,,69.344,percent of total billed charges,35.67% of total billed charges,8.64,218.7,
ENTEROVIRUS,3003935,CDM,300,RC,86658,HCPCS,outpatient,,,76,30.40,,64.6,85,,51.68,percent of total billed charges,85% of total billed charges,58.52,77,,46.82,percent of total billed charges,77% of total billed charges,13.03,100,,,fee schedule,100% of CMS fee schedule,56.28,350,,,fee schedule,350% of BCBS fee schedule,58.53,364,,,fee schedule,364% of BCBS fee schedule,58.53,364,,,fee schedule,364% of BCBS fee schedule,58.53,364,,,fee schedule,364% of BCBS fee schedule,68.4,90,,54.72,percent of total billed charges,90% of total billed charges,60.8,80,,48.64,percent of total billed charges,80% of total billed charges,68.4,90,,54.72,percent of total billed charges,90% of total billed charges,57,75,,45.6,percent of total billed charges,75% of total billed charges,15.89,122,,,fee schedule,122% of APC rate,22.04,29,,17.632,percent of total billed charges,29% of total billed charges,13.03,100,,,fee schedule,100% of CMS fee schedule,50.92,67,,40.736,percent of total billed charges,67% of total billed charges,8.64,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,60.8,80,,48.64,percent of total billed charges,80% of total billed charges,49.4,65,,39.52,percent of total billed charges,65% of total billed charges,27.11,35.67,,21.688,percent of total billed charges,35.67% of total billed charges,8.64,68.4,
EOSINOPHIL COUNT,3003940,CDM,300,RC,89190,HCPCS,outpatient,,,24,9.60,,20.4,85,,16.32,percent of total billed charges,85% of total billed charges,18.48,77,,14.78,percent of total billed charges,77% of total billed charges,5.79,100,,,fee schedule,100% of CMS fee schedule,20.51,350,,,fee schedule,350% of BCBS fee schedule,21.33,364,,,fee schedule,364% of BCBS fee schedule,21.33,364,,,fee schedule,364% of BCBS fee schedule,21.33,364,,,fee schedule,364% of BCBS fee schedule,21.6,90,,17.28,percent of total billed charges,90% of total billed charges,19.2,80,,15.36,percent of total billed charges,80% of total billed charges,21.6,90,,17.28,percent of total billed charges,90% of total billed charges,18,75,,14.4,percent of total billed charges,75% of total billed charges,7.06,122,,,fee schedule,122% of APC rate,6.96,29,,5.568,percent of total billed charges,29% of total billed charges,5.79,100,,,fee schedule,100% of CMS fee schedule,16.08,67,,12.864,percent of total billed charges,67% of total billed charges,7.06,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,19.2,80,,15.36,percent of total billed charges,80% of total billed charges,15.6,65,,12.48,percent of total billed charges,65% of total billed charges,8.56,35.67,,6.848,percent of total billed charges,35.67% of total billed charges,5.79,21.6,
DRUG SCREEN INDIGENT/CRH EMP,3003950,CDM,300,RC,80305,HCPCS,outpatient,,,65,26.00,,55.25,85,,44.2,percent of total billed charges,85% of total billed charges,50.05,77,,40.04,percent of total billed charges,77% of total billed charges,12.6,100,,,fee schedule,100% of CMS fee schedule,47.11,350,,,fee schedule,350% of BCBS fee schedule,48.99,364,,,fee schedule,364% of BCBS fee schedule,48.99,364,,,fee schedule,364% of BCBS fee schedule,48.99,364,,,fee schedule,364% of BCBS fee schedule,58.5,90,,46.8,percent of total billed charges,90% of total billed charges,52,80,,41.6,percent of total billed charges,80% of total billed charges,58.5,90,,46.8,percent of total billed charges,90% of total billed charges,48.75,75,,39,percent of total billed charges,75% of total billed charges,15.37,122,,,fee schedule,122% of APC rate,18.85,29,,15.08,percent of total billed charges,29% of total billed charges,12.6,100,,,fee schedule,100% of CMS fee schedule,43.55,67,,34.84,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,52,80,,41.6,percent of total billed charges,80% of total billed charges,42.25,65,,33.8,percent of total billed charges,65% of total billed charges,23.19,35.67,,18.552,percent of total billed charges,35.67% of total billed charges,12.6,58.5,
EOSINOPHILS URINE,3003960,CDM,300,RC,81099,HCPCS,outpatient,,,24,9.60,,20.4,85,,16.32,percent of total billed charges,85% of total billed charges,18.48,77,,14.78,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,19.68,82,,15.744,percent of total billed charges,82% of total billed charges,20.4,85,,16.32,percent of total billed charges,85% of total billed charges,20.4,85,,16.32,percent of total billed charges,85% of total billed charges,20.4,85,,16.32,percent of total billed charges,85% of total billed charges,21.6,90,,17.28,percent of total billed charges,90% of total billed charges,19.2,80,,15.36,percent of total billed charges,80% of total billed charges,21.6,90,,17.28,percent of total billed charges,90% of total billed charges,18,75,,14.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,6.96,29,,5.568,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,16.08,67,,12.864,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,19.2,80,,15.36,percent of total billed charges,80% of total billed charges,15.6,65,,12.48,percent of total billed charges,65% of total billed charges,8.56,35.67,,6.848,percent of total billed charges,35.67% of total billed charges,6.96,21.6,
EPSTEIN-BARR VIR EARLY AN  EXP,3003981,CDM,300,RC,86663,HCPCS,outpatient,,,63,25.20,,53.55,85,,42.84,percent of total billed charges,85% of total billed charges,48.51,77,,38.81,percent of total billed charges,77% of total billed charges,13.12,100,,,fee schedule,100% of CMS fee schedule,56.7,350,,,fee schedule,350% of BCBS fee schedule,58.97,364,,,fee schedule,364% of BCBS fee schedule,58.97,364,,,fee schedule,364% of BCBS fee schedule,58.97,364,,,fee schedule,364% of BCBS fee schedule,56.7,90,,45.36,percent of total billed charges,90% of total billed charges,50.4,80,,40.32,percent of total billed charges,80% of total billed charges,56.7,90,,45.36,percent of total billed charges,90% of total billed charges,47.25,75,,37.8,percent of total billed charges,75% of total billed charges,16,122,,,fee schedule,122% of APC rate,18.27,29,,14.616,percent of total billed charges,29% of total billed charges,13.12,100,,,fee schedule,100% of CMS fee schedule,42.21,67,,33.768,percent of total billed charges,67% of total billed charges,19.5,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,50.4,80,,40.32,percent of total billed charges,80% of total billed charges,40.95,65,,32.76,percent of total billed charges,65% of total billed charges,22.47,35.67,,17.976,percent of total billed charges,35.67% of total billed charges,13.12,58.97,
EPSTEIN-BARR VIRUS NUC ANT EXP,3003982,CDM,300,RC,86664,HCPCS,outpatient,,,78,31.20,,66.3,85,,53.04,percent of total billed charges,85% of total billed charges,60.06,77,,48.05,percent of total billed charges,77% of total billed charges,15.29,100,,,fee schedule,100% of CMS fee schedule,66.08,350,,,fee schedule,350% of BCBS fee schedule,68.72,364,,,fee schedule,364% of BCBS fee schedule,68.72,364,,,fee schedule,364% of BCBS fee schedule,68.72,364,,,fee schedule,364% of BCBS fee schedule,70.2,90,,56.16,percent of total billed charges,90% of total billed charges,62.4,80,,49.92,percent of total billed charges,80% of total billed charges,70.2,90,,56.16,percent of total billed charges,90% of total billed charges,58.5,75,,46.8,percent of total billed charges,75% of total billed charges,18.65,122,,,fee schedule,122% of APC rate,22.62,29,,18.096,percent of total billed charges,29% of total billed charges,15.29,100,,,fee schedule,100% of CMS fee schedule,52.26,67,,41.808,percent of total billed charges,67% of total billed charges,22.75,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,62.4,80,,49.92,percent of total billed charges,80% of total billed charges,50.7,65,,40.56,percent of total billed charges,65% of total billed charges,27.82,35.67,,22.256,percent of total billed charges,35.67% of total billed charges,15.29,70.2,
EPSTEIN BARR VIRUS VIRAL EXP,3003983,CDM,300,RC,86665,HCPCS,outpatient,,,444,177.60,,377.4,85,,301.92,percent of total billed charges,85% of total billed charges,341.88,77,,273.5,percent of total billed charges,77% of total billed charges,18.14,100,,,fee schedule,100% of CMS fee schedule,78.4,350,,,fee schedule,350% of BCBS fee schedule,81.54,364,,,fee schedule,364% of BCBS fee schedule,81.54,364,,,fee schedule,364% of BCBS fee schedule,81.54,364,,,fee schedule,364% of BCBS fee schedule,399.6,90,,319.68,percent of total billed charges,90% of total billed charges,355.2,80,,284.16,percent of total billed charges,80% of total billed charges,399.6,90,,319.68,percent of total billed charges,90% of total billed charges,333,75,,266.4,percent of total billed charges,75% of total billed charges,22.13,122,,,fee schedule,122% of APC rate,128.76,29,,103.008,percent of total billed charges,29% of total billed charges,18.14,100,,,fee schedule,100% of CMS fee schedule,297.48,67,,237.984,percent of total billed charges,67% of total billed charges,26.97,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,355.2,80,,284.16,percent of total billed charges,80% of total billed charges,288.6,65,,230.88,percent of total billed charges,65% of total billed charges,158.37,35.67,,126.696,percent of total billed charges,35.67% of total billed charges,18.14,399.6,
CYCLIC CITRULLINATED PEPTIDE,3003990,CDM,300,RC,86200,HCPCS,outpatient,,,125,50.00,,106.25,85,,85,percent of total billed charges,85% of total billed charges,96.25,77,,77,percent of total billed charges,77% of total billed charges,12.95,100,,,fee schedule,100% of CMS fee schedule,55.93,350,,,fee schedule,350% of BCBS fee schedule,58.17,364,,,fee schedule,364% of BCBS fee schedule,58.17,364,,,fee schedule,364% of BCBS fee schedule,58.17,364,,,fee schedule,364% of BCBS fee schedule,112.5,90,,90,percent of total billed charges,90% of total billed charges,100,80,,80,percent of total billed charges,80% of total billed charges,112.5,90,,90,percent of total billed charges,90% of total billed charges,93.75,75,,75,percent of total billed charges,75% of total billed charges,15.79,122,,,fee schedule,122% of APC rate,36.25,29,,29,percent of total billed charges,29% of total billed charges,12.95,100,,,fee schedule,100% of CMS fee schedule,83.75,67,,67,percent of total billed charges,67% of total billed charges,19.25,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,100,80,,80,percent of total billed charges,80% of total billed charges,81.25,65,,65,percent of total billed charges,65% of total billed charges,44.59,35.67,,35.672,percent of total billed charges,35.67% of total billed charges,12.95,112.5,
FECAL CALPROTECTIN,3004001,CDM,300,RC,83993,HCPCS,outpatient,,,327,130.80,,277.95,85,,222.36,percent of total billed charges,85% of total billed charges,251.79,77,,201.43,percent of total billed charges,77% of total billed charges,19.63,100,,,fee schedule,100% of CMS fee schedule,84.84,350,,,fee schedule,350% of BCBS fee schedule,88.23,364,,,fee schedule,364% of BCBS fee schedule,88.23,364,,,fee schedule,364% of BCBS fee schedule,88.23,364,,,fee schedule,364% of BCBS fee schedule,294.3,90,,235.44,percent of total billed charges,90% of total billed charges,261.6,80,,209.28,percent of total billed charges,80% of total billed charges,294.3,90,,235.44,percent of total billed charges,90% of total billed charges,245.25,75,,196.2,percent of total billed charges,75% of total billed charges,23.94,122,,,fee schedule,122% of APC rate,94.83,29,,75.864,percent of total billed charges,29% of total billed charges,19.63,100,,,fee schedule,100% of CMS fee schedule,219.09,67,,175.272,percent of total billed charges,67% of total billed charges,29.19,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,261.6,80,,209.28,percent of total billed charges,80% of total billed charges,212.55,65,,170.04,percent of total billed charges,65% of total billed charges,116.64,35.67,,93.312,percent of total billed charges,35.67% of total billed charges,19.63,294.3,
THYROID STIMULATING IMM,3004002,CDM,300,RC,84445,HCPCS,outpatient,,,471,188.40,,400.35,85,,320.28,percent of total billed charges,85% of total billed charges,362.67,77,,290.14,percent of total billed charges,77% of total billed charges,50.86,100,,,fee schedule,100% of CMS fee schedule,219.73,350,,,fee schedule,350% of BCBS fee schedule,228.52,364,,,fee schedule,364% of BCBS fee schedule,228.52,364,,,fee schedule,364% of BCBS fee schedule,228.52,364,,,fee schedule,364% of BCBS fee schedule,423.9,90,,339.12,percent of total billed charges,90% of total billed charges,376.8,80,,301.44,percent of total billed charges,80% of total billed charges,423.9,90,,339.12,percent of total billed charges,90% of total billed charges,353.25,75,,282.6,percent of total billed charges,75% of total billed charges,62.04,122,,,fee schedule,122% of APC rate,136.59,29,,109.272,percent of total billed charges,29% of total billed charges,50.86,100,,,fee schedule,100% of CMS fee schedule,315.57,67,,252.456,percent of total billed charges,67% of total billed charges,75.62,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,376.8,80,,301.44,percent of total billed charges,80% of total billed charges,306.15,65,,244.92,percent of total billed charges,65% of total billed charges,168.01,35.67,,134.408,percent of total billed charges,35.67% of total billed charges,50.86,423.9,
GONADOTROPIN RELEASING HORMONE,3004004,CDM,300,RC,83727,HCPCS,outpatient,,,470,188.00,,399.5,85,,319.6,percent of total billed charges,85% of total billed charges,361.9,77,,289.52,percent of total billed charges,77% of total billed charges,17.19,100,,,fee schedule,100% of CMS fee schedule,74.27,350,,,fee schedule,350% of BCBS fee schedule,77.24,364,,,fee schedule,364% of BCBS fee schedule,77.24,364,,,fee schedule,364% of BCBS fee schedule,77.24,364,,,fee schedule,364% of BCBS fee schedule,423,90,,338.4,percent of total billed charges,90% of total billed charges,376,80,,300.8,percent of total billed charges,80% of total billed charges,423,90,,338.4,percent of total billed charges,90% of total billed charges,352.5,75,,282,percent of total billed charges,75% of total billed charges,20.97,122,,,fee schedule,122% of APC rate,136.3,29,,109.04,percent of total billed charges,29% of total billed charges,17.19,100,,,fee schedule,100% of CMS fee schedule,314.9,67,,251.92,percent of total billed charges,67% of total billed charges,25.56,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,376,80,,300.8,percent of total billed charges,80% of total billed charges,305.5,65,,244.4,percent of total billed charges,65% of total billed charges,167.65,35.67,,134.12,percent of total billed charges,35.67% of total billed charges,17.19,423,
VITAMIN B6,3004005,CDM,300,RC,84207,HCPCS,outpatient,,,263,105.20,,223.55,85,,178.84,percent of total billed charges,85% of total billed charges,202.51,77,,162.01,percent of total billed charges,77% of total billed charges,28.1,100,,,fee schedule,100% of CMS fee schedule,121.42,350,,,fee schedule,350% of BCBS fee schedule,126.27,364,,,fee schedule,364% of BCBS fee schedule,126.27,364,,,fee schedule,364% of BCBS fee schedule,126.27,364,,,fee schedule,364% of BCBS fee schedule,236.7,90,,189.36,percent of total billed charges,90% of total billed charges,210.4,80,,168.32,percent of total billed charges,80% of total billed charges,236.7,90,,189.36,percent of total billed charges,90% of total billed charges,197.25,75,,157.8,percent of total billed charges,75% of total billed charges,34.28,122,,,fee schedule,122% of APC rate,76.27,29,,61.016,percent of total billed charges,29% of total billed charges,28.1,100,,,fee schedule,100% of CMS fee schedule,176.21,67,,140.968,percent of total billed charges,67% of total billed charges,41.79,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,210.4,80,,168.32,percent of total billed charges,80% of total billed charges,170.95,65,,136.76,percent of total billed charges,65% of total billed charges,93.81,35.67,,75.048,percent of total billed charges,35.67% of total billed charges,28.1,236.7,
CHROMOGRANIN A,3004006,CDM,300,RC,86316,HCPCS,outpatient,,,239,95.60,,203.15,85,,162.52,percent of total billed charges,85% of total billed charges,184.03,77,,147.22,percent of total billed charges,77% of total billed charges,20.81,100,,,fee schedule,100% of CMS fee schedule,89.95,350,,,fee schedule,350% of BCBS fee schedule,93.55,364,,,fee schedule,364% of BCBS fee schedule,93.55,364,,,fee schedule,364% of BCBS fee schedule,93.55,364,,,fee schedule,364% of BCBS fee schedule,215.1,90,,172.08,percent of total billed charges,90% of total billed charges,191.2,80,,152.96,percent of total billed charges,80% of total billed charges,215.1,90,,172.08,percent of total billed charges,90% of total billed charges,179.25,75,,143.4,percent of total billed charges,75% of total billed charges,25.38,122,,,fee schedule,122% of APC rate,69.31,29,,55.448,percent of total billed charges,29% of total billed charges,20.81,100,,,fee schedule,100% of CMS fee schedule,160.13,67,,128.104,percent of total billed charges,67% of total billed charges,30.95,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,191.2,80,,152.96,percent of total billed charges,80% of total billed charges,155.35,65,,124.28,percent of total billed charges,65% of total billed charges,85.25,35.67,,68.2,percent of total billed charges,35.67% of total billed charges,20.81,215.1,
MITOCHONDRIAL M2 ANTIBODY,3004007,CDM,300,RC,86381,HCPCS,outpatient,,,179,71.60,,152.15,85,,121.72,percent of total billed charges,85% of total billed charges,137.83,77,,110.26,percent of total billed charges,77% of total billed charges,25.45,100,,,fee schedule,100% of CMS fee schedule,89.08,350,,,fee schedule,350% of BCBS fee schedule,92.64,364,,,fee schedule,364% of BCBS fee schedule,92.64,364,,,fee schedule,364% of BCBS fee schedule,92.64,364,,,fee schedule,364% of BCBS fee schedule,161.1,90,,128.88,percent of total billed charges,90% of total billed charges,143.2,80,,114.56,percent of total billed charges,80% of total billed charges,161.1,90,,128.88,percent of total billed charges,90% of total billed charges,134.25,75,,107.4,percent of total billed charges,75% of total billed charges,31.04,122,,,fee schedule,122% of APC rate,51.91,29,,41.528,percent of total billed charges,29% of total billed charges,25.45,100,,,fee schedule,100% of CMS fee schedule,119.93,67,,95.944,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,143.2,80,,114.56,percent of total billed charges,80% of total billed charges,116.35,65,,93.08,percent of total billed charges,65% of total billed charges,63.85,35.67,,51.08,percent of total billed charges,35.67% of total billed charges,25.45,161.1,
HUMAN HERPESVIRUS 6 (HHV-6),3004008,CDM,300,RC,87533,HCPCS,outpatient,,,665,266.00,,565.25,85,,452.2,percent of total billed charges,85% of total billed charges,512.05,77,,409.64,percent of total billed charges,77% of total billed charges,41.76,100,,,fee schedule,100% of CMS fee schedule,180.43,350,,,fee schedule,350% of BCBS fee schedule,187.64,364,,,fee schedule,364% of BCBS fee schedule,187.64,364,,,fee schedule,364% of BCBS fee schedule,187.64,364,,,fee schedule,364% of BCBS fee schedule,598.5,90,,478.8,percent of total billed charges,90% of total billed charges,532,80,,425.6,percent of total billed charges,80% of total billed charges,598.5,90,,478.8,percent of total billed charges,90% of total billed charges,498.75,75,,399,percent of total billed charges,75% of total billed charges,50.94,122,,,fee schedule,122% of APC rate,192.85,29,,154.28,percent of total billed charges,29% of total billed charges,41.76,100,,,fee schedule,100% of CMS fee schedule,445.55,67,,356.44,percent of total billed charges,67% of total billed charges,62.08,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,532,80,,425.6,percent of total billed charges,80% of total billed charges,432.25,65,,345.8,percent of total billed charges,65% of total billed charges,237.21,35.67,,189.768,percent of total billed charges,35.67% of total billed charges,41.76,598.5,
CRYPTOSOSPORIDIUM ANTIGEN,3004009,CDM,300,RC,87328,HCPCS,outpatient,,,139,55.60,,118.15,85,,94.52,percent of total billed charges,85% of total billed charges,107.03,77,,85.62,percent of total billed charges,77% of total billed charges,13.82,100,,,fee schedule,100% of CMS fee schedule,51.8,350,,,fee schedule,350% of BCBS fee schedule,53.87,364,,,fee schedule,364% of BCBS fee schedule,53.87,364,,,fee schedule,364% of BCBS fee schedule,53.87,364,,,fee schedule,364% of BCBS fee schedule,125.1,90,,100.08,percent of total billed charges,90% of total billed charges,111.2,80,,88.96,percent of total billed charges,80% of total billed charges,125.1,90,,100.08,percent of total billed charges,90% of total billed charges,104.25,75,,83.4,percent of total billed charges,75% of total billed charges,16.86,122,,,fee schedule,122% of APC rate,40.31,29,,32.248,percent of total billed charges,29% of total billed charges,13.82,100,,,fee schedule,100% of CMS fee schedule,93.13,67,,74.504,percent of total billed charges,67% of total billed charges,15.41,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,111.2,80,,88.96,percent of total billed charges,80% of total billed charges,90.35,65,,72.28,percent of total billed charges,65% of total billed charges,49.58,35.67,,39.664,percent of total billed charges,35.67% of total billed charges,13.82,125.1,
VITAMIN B2 RIBOFLAVIN,3004010,CDM,300,RC,84252,HCPCS,outpatient,,,237,94.80,,201.45,85,,161.16,percent of total billed charges,85% of total billed charges,182.49,77,,145.99,percent of total billed charges,77% of total billed charges,20.23,100,,,fee schedule,100% of CMS fee schedule,87.43,350,,,fee schedule,350% of BCBS fee schedule,90.93,364,,,fee schedule,364% of BCBS fee schedule,90.93,364,,,fee schedule,364% of BCBS fee schedule,90.93,364,,,fee schedule,364% of BCBS fee schedule,213.3,90,,170.64,percent of total billed charges,90% of total billed charges,189.6,80,,151.68,percent of total billed charges,80% of total billed charges,213.3,90,,170.64,percent of total billed charges,90% of total billed charges,177.75,75,,142.2,percent of total billed charges,75% of total billed charges,24.69,122,,,fee schedule,122% of APC rate,68.73,29,,54.984,percent of total billed charges,29% of total billed charges,20.23,100,,,fee schedule,100% of CMS fee schedule,158.79,67,,127.032,percent of total billed charges,67% of total billed charges,30.09,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,189.6,80,,151.68,percent of total billed charges,80% of total billed charges,154.05,65,,123.24,percent of total billed charges,65% of total billed charges,84.54,35.67,,67.632,percent of total billed charges,35.67% of total billed charges,20.23,213.3,
CORTISONE,3004011,CDM,300,RC,83491,HCPCS,outpatient,,,56,22.40,,47.6,85,,38.08,percent of total billed charges,85% of total billed charges,43.12,77,,34.5,percent of total billed charges,77% of total billed charges,17.89,100,,,fee schedule,100% of CMS fee schedule,75.74,350,,,fee schedule,350% of BCBS fee schedule,78.77,364,,,fee schedule,364% of BCBS fee schedule,78.77,364,,,fee schedule,364% of BCBS fee schedule,78.77,364,,,fee schedule,364% of BCBS fee schedule,50.4,90,,40.32,percent of total billed charges,90% of total billed charges,44.8,80,,35.84,percent of total billed charges,80% of total billed charges,50.4,90,,40.32,percent of total billed charges,90% of total billed charges,42,75,,33.6,percent of total billed charges,75% of total billed charges,21.83,122,,,fee schedule,122% of APC rate,16.24,29,,12.992,percent of total billed charges,29% of total billed charges,17.89,100,,,fee schedule,100% of CMS fee schedule,37.52,67,,30.016,percent of total billed charges,67% of total billed charges,26.05,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,44.8,80,,35.84,percent of total billed charges,80% of total billed charges,36.4,65,,29.12,percent of total billed charges,65% of total billed charges,19.98,35.67,,15.984,percent of total billed charges,35.67% of total billed charges,16.24,78.77,
ACTIN AB EACH,3004012,CDM,300,RC,86015,HCPCS,outpatient,,,145,58.00,,123.25,85,,98.6,percent of total billed charges,85% of total billed charges,111.65,77,,89.32,percent of total billed charges,77% of total billed charges,12.05,100,,,fee schedule,100% of CMS fee schedule,40.36,350,,,fee schedule,350% of BCBS fee schedule,41.97,364,,,fee schedule,364% of BCBS fee schedule,41.97,364,,,fee schedule,364% of BCBS fee schedule,41.97,364,,,fee schedule,364% of BCBS fee schedule,130.5,90,,104.4,percent of total billed charges,90% of total billed charges,116,80,,92.8,percent of total billed charges,80% of total billed charges,130.5,90,,104.4,percent of total billed charges,90% of total billed charges,108.75,75,,87,percent of total billed charges,75% of total billed charges,14.7,122,,,fee schedule,122% of APC rate,42.05,29,,33.64,percent of total billed charges,29% of total billed charges,12.05,100,,,fee schedule,100% of CMS fee schedule,97.15,67,,77.72,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,116,80,,92.8,percent of total billed charges,80% of total billed charges,94.25,65,,75.4,percent of total billed charges,65% of total billed charges,51.72,35.67,,41.376,percent of total billed charges,35.67% of total billed charges,12.05,130.5,
PROTEIN WESTERN BLOT,3004013,CDM,300,RC,84182,HCPCS,outpatient,,,210,84.00,,178.5,85,,142.8,percent of total billed charges,85% of total billed charges,161.7,77,,129.36,percent of total billed charges,77% of total billed charges,29.21,100,,,fee schedule,100% of CMS fee schedule,102.24,350,,,fee schedule,350% of BCBS fee schedule,106.32,364,,,fee schedule,364% of BCBS fee schedule,106.32,364,,,fee schedule,364% of BCBS fee schedule,106.32,364,,,fee schedule,364% of BCBS fee schedule,189,90,,151.2,percent of total billed charges,90% of total billed charges,168,80,,134.4,percent of total billed charges,80% of total billed charges,189,90,,151.2,percent of total billed charges,90% of total billed charges,157.5,75,,126,percent of total billed charges,75% of total billed charges,35.63,122,,,fee schedule,122% of APC rate,60.9,29,,48.72,percent of total billed charges,29% of total billed charges,29.21,100,,,fee schedule,100% of CMS fee schedule,140.7,67,,112.56,percent of total billed charges,67% of total billed charges,26.76,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,168,80,,134.4,percent of total billed charges,80% of total billed charges,136.5,65,,109.2,percent of total billed charges,65% of total billed charges,74.91,35.67,,59.928,percent of total billed charges,35.67% of total billed charges,26.76,189,
REPTILASE TIME,3004019,CDM,300,RC,85635,HCPCS,outpatient,,,326,130.40,,277.1,85,,221.68,percent of total billed charges,85% of total billed charges,251.02,77,,200.82,percent of total billed charges,77% of total billed charges,9.85,100,,,fee schedule,100% of CMS fee schedule,42.56,350,,,fee schedule,350% of BCBS fee schedule,44.26,364,,,fee schedule,364% of BCBS fee schedule,44.26,364,,,fee schedule,364% of BCBS fee schedule,44.26,364,,,fee schedule,364% of BCBS fee schedule,293.4,90,,234.72,percent of total billed charges,90% of total billed charges,260.8,80,,208.64,percent of total billed charges,80% of total billed charges,293.4,90,,234.72,percent of total billed charges,90% of total billed charges,244.5,75,,195.6,percent of total billed charges,75% of total billed charges,12.01,122,,,fee schedule,122% of APC rate,94.54,29,,75.632,percent of total billed charges,29% of total billed charges,9.85,100,,,fee schedule,100% of CMS fee schedule,218.42,67,,174.736,percent of total billed charges,67% of total billed charges,14.64,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,260.8,80,,208.64,percent of total billed charges,80% of total billed charges,211.9,65,,169.52,percent of total billed charges,65% of total billed charges,116.28,35.67,,93.024,percent of total billed charges,35.67% of total billed charges,9.85,293.4,
HEPARIN NEUTRALIZATION,3004020,CDM,300,RC,85525,HCPCS,outpatient,,,132,52.80,,112.2,85,,89.76,percent of total billed charges,85% of total billed charges,101.64,77,,81.31,percent of total billed charges,77% of total billed charges,11.84,100,,,fee schedule,100% of CMS fee schedule,51.17,350,,,fee schedule,350% of BCBS fee schedule,53.22,364,,,fee schedule,364% of BCBS fee schedule,53.22,364,,,fee schedule,364% of BCBS fee schedule,53.22,364,,,fee schedule,364% of BCBS fee schedule,118.8,90,,95.04,percent of total billed charges,90% of total billed charges,105.6,80,,84.48,percent of total billed charges,80% of total billed charges,118.8,90,,95.04,percent of total billed charges,90% of total billed charges,99,75,,79.2,percent of total billed charges,75% of total billed charges,14.44,122,,,fee schedule,122% of APC rate,38.28,29,,30.624,percent of total billed charges,29% of total billed charges,11.84,100,,,fee schedule,100% of CMS fee schedule,88.44,67,,70.752,percent of total billed charges,67% of total billed charges,17.61,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,105.6,80,,84.48,percent of total billed charges,80% of total billed charges,85.8,65,,68.64,percent of total billed charges,65% of total billed charges,47.08,35.67,,37.664,percent of total billed charges,35.67% of total billed charges,11.84,118.8,
HEXAGNAL PHOSPH PLT NEUTRL,3004021,CDM,300,RC,85598,HCPCS,outpatient,,,205,82.00,,174.25,85,,139.4,percent of total billed charges,85% of total billed charges,157.85,77,,126.28,percent of total billed charges,77% of total billed charges,17.98,100,,,fee schedule,100% of CMS fee schedule,77.67,350,,,fee schedule,350% of BCBS fee schedule,80.77,364,,,fee schedule,364% of BCBS fee schedule,80.77,364,,,fee schedule,364% of BCBS fee schedule,80.77,364,,,fee schedule,364% of BCBS fee schedule,184.5,90,,147.6,percent of total billed charges,90% of total billed charges,164,80,,131.2,percent of total billed charges,80% of total billed charges,184.5,90,,147.6,percent of total billed charges,90% of total billed charges,153.75,75,,123,percent of total billed charges,75% of total billed charges,21.93,122,,,fee schedule,122% of APC rate,59.45,29,,47.56,percent of total billed charges,29% of total billed charges,17.98,100,,,fee schedule,100% of CMS fee schedule,137.35,67,,109.88,percent of total billed charges,67% of total billed charges,21.58,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,164,80,,131.2,percent of total billed charges,80% of total billed charges,133.25,65,,106.6,percent of total billed charges,65% of total billed charges,73.12,35.67,,58.496,percent of total billed charges,35.67% of total billed charges,17.98,184.5,
IMMUNOFIXATION ELECTRO NONBLD,3004022,CDM,300,RC,86335,HCPCS,outpatient,,,354,141.60,,300.9,85,,240.72,percent of total billed charges,85% of total billed charges,272.58,77,,218.06,percent of total billed charges,77% of total billed charges,29.35,100,,,fee schedule,100% of CMS fee schedule,126.81,350,,,fee schedule,350% of BCBS fee schedule,131.88,364,,,fee schedule,364% of BCBS fee schedule,131.88,364,,,fee schedule,364% of BCBS fee schedule,131.88,364,,,fee schedule,364% of BCBS fee schedule,318.6,90,,254.88,percent of total billed charges,90% of total billed charges,283.2,80,,226.56,percent of total billed charges,80% of total billed charges,318.6,90,,254.88,percent of total billed charges,90% of total billed charges,265.5,75,,212.4,percent of total billed charges,75% of total billed charges,35.8,122,,,fee schedule,122% of APC rate,102.66,29,,82.128,percent of total billed charges,29% of total billed charges,29.35,100,,,fee schedule,100% of CMS fee schedule,237.18,67,,189.744,percent of total billed charges,67% of total billed charges,43.64,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,283.2,80,,226.56,percent of total billed charges,80% of total billed charges,230.1,65,,184.08,percent of total billed charges,65% of total billed charges,126.27,35.67,,101.016,percent of total billed charges,35.67% of total billed charges,29.35,318.6,
B CELLS TOTAL COUNT,3004023,CDM,300,RC,86355,HCPCS,outpatient,,,299,119.60,,254.15,85,,203.32,percent of total billed charges,85% of total billed charges,230.23,77,,184.18,percent of total billed charges,77% of total billed charges,37.72,100,,,fee schedule,100% of CMS fee schedule,163.03,350,,,fee schedule,350% of BCBS fee schedule,169.55,364,,,fee schedule,364% of BCBS fee schedule,169.55,364,,,fee schedule,364% of BCBS fee schedule,169.55,364,,,fee schedule,364% of BCBS fee schedule,269.1,90,,215.28,percent of total billed charges,90% of total billed charges,239.2,80,,191.36,percent of total billed charges,80% of total billed charges,269.1,90,,215.28,percent of total billed charges,90% of total billed charges,224.25,75,,179.4,percent of total billed charges,75% of total billed charges,46.03,122,,,fee schedule,122% of APC rate,86.71,29,,69.368,percent of total billed charges,29% of total billed charges,37.72,100,,,fee schedule,100% of CMS fee schedule,200.33,67,,160.264,percent of total billed charges,67% of total billed charges,56.1,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,239.2,80,,191.36,percent of total billed charges,80% of total billed charges,194.35,65,,155.48,percent of total billed charges,65% of total billed charges,106.65,35.67,,85.32,percent of total billed charges,35.67% of total billed charges,37.72,269.1,
NK CELLS TOTAL COUNT,3004024,CDM,300,RC,86357,HCPCS,outpatient,,,273,109.20,,232.05,85,,185.64,percent of total billed charges,85% of total billed charges,210.21,77,,168.17,percent of total billed charges,77% of total billed charges,37.72,100,,,fee schedule,100% of CMS fee schedule,163.03,350,,,fee schedule,350% of BCBS fee schedule,169.55,364,,,fee schedule,364% of BCBS fee schedule,169.55,364,,,fee schedule,364% of BCBS fee schedule,169.55,364,,,fee schedule,364% of BCBS fee schedule,245.7,90,,196.56,percent of total billed charges,90% of total billed charges,218.4,80,,174.72,percent of total billed charges,80% of total billed charges,245.7,90,,196.56,percent of total billed charges,90% of total billed charges,204.75,75,,163.8,percent of total billed charges,75% of total billed charges,46.03,122,,,fee schedule,122% of APC rate,79.17,29,,63.336,percent of total billed charges,29% of total billed charges,37.72,100,,,fee schedule,100% of CMS fee schedule,182.91,67,,146.328,percent of total billed charges,67% of total billed charges,56.1,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,218.4,80,,174.72,percent of total billed charges,80% of total billed charges,177.45,65,,141.96,percent of total billed charges,65% of total billed charges,97.38,35.67,,77.904,percent of total billed charges,35.67% of total billed charges,37.72,245.7,
Bacterial ID Aerobic,3004026,CDM,300,RC,87077,HCPCS,outpatient,,,128,51.20,,108.8,85,,87.04,percent of total billed charges,85% of total billed charges,98.56,77,,78.85,percent of total billed charges,77% of total billed charges,8.08,100,,,fee schedule,100% of CMS fee schedule,34.9,350,,,fee schedule,350% of BCBS fee schedule,36.29,364,,,fee schedule,364% of BCBS fee schedule,36.29,364,,,fee schedule,364% of BCBS fee schedule,36.29,364,,,fee schedule,364% of BCBS fee schedule,115.2,90,,92.16,percent of total billed charges,90% of total billed charges,102.4,80,,81.92,percent of total billed charges,80% of total billed charges,115.2,90,,92.16,percent of total billed charges,90% of total billed charges,96,75,,76.8,percent of total billed charges,75% of total billed charges,9.85,122,,,fee schedule,122% of APC rate,37.12,29,,29.696,percent of total billed charges,29% of total billed charges,8.08,100,,,fee schedule,100% of CMS fee schedule,85.76,67,,68.608,percent of total billed charges,67% of total billed charges,12.02,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,102.4,80,,81.92,percent of total billed charges,80% of total billed charges,83.2,65,,66.56,percent of total billed charges,65% of total billed charges,45.66,35.67,,36.528,percent of total billed charges,35.67% of total billed charges,8.08,115.2,
Drug Screen Conf Oxycodone,3004027,CDM,300,RC,80365,HCPCS,outpatient,,,70,28.00,,59.5,85,,47.6,percent of total billed charges,85% of total billed charges,53.9,77,,43.12,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,57.4,82,,45.92,percent of total billed charges,82% of total billed charges,59.5,85,,47.6,percent of total billed charges,85% of total billed charges,59.5,85,,47.6,percent of total billed charges,85% of total billed charges,59.5,85,,47.6,percent of total billed charges,85% of total billed charges,63,90,,50.4,percent of total billed charges,90% of total billed charges,56,80,,44.8,percent of total billed charges,80% of total billed charges,63,90,,50.4,percent of total billed charges,90% of total billed charges,52.5,75,,42,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,20.3,29,,16.24,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,46.9,67,,37.52,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,56,80,,44.8,percent of total billed charges,80% of total billed charges,45.5,65,,36.4,percent of total billed charges,65% of total billed charges,24.97,35.67,,19.976,percent of total billed charges,35.67% of total billed charges,20.3,63,
Drug Screen Conf Buprenorphine,3004028,CDM,300,RC,80348,HCPCS,outpatient,,,54,21.60,,45.9,85,,36.72,percent of total billed charges,85% of total billed charges,41.58,77,,33.26,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,44.28,82,,35.424,percent of total billed charges,82% of total billed charges,45.9,85,,36.72,percent of total billed charges,85% of total billed charges,45.9,85,,36.72,percent of total billed charges,85% of total billed charges,45.9,85,,36.72,percent of total billed charges,85% of total billed charges,48.6,90,,38.88,percent of total billed charges,90% of total billed charges,43.2,80,,34.56,percent of total billed charges,80% of total billed charges,48.6,90,,38.88,percent of total billed charges,90% of total billed charges,40.5,75,,32.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,15.66,29,,12.528,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,36.18,67,,28.944,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,43.2,80,,34.56,percent of total billed charges,80% of total billed charges,35.1,65,,28.08,percent of total billed charges,65% of total billed charges,19.26,35.67,,15.408,percent of total billed charges,35.67% of total billed charges,15.66,48.6,
Protein C Resistance,3004030,CDM,300,RC,85307,HCPCS,outpatient,,,373,149.20,,317.05,85,,253.64,percent of total billed charges,85% of total billed charges,287.21,77,,229.77,percent of total billed charges,77% of total billed charges,15.32,100,,,fee schedule,100% of CMS fee schedule,66.22,350,,,fee schedule,350% of BCBS fee schedule,68.87,364,,,fee schedule,364% of BCBS fee schedule,68.87,364,,,fee schedule,364% of BCBS fee schedule,68.87,364,,,fee schedule,364% of BCBS fee schedule,335.7,90,,268.56,percent of total billed charges,90% of total billed charges,298.4,80,,238.72,percent of total billed charges,80% of total billed charges,335.7,90,,268.56,percent of total billed charges,90% of total billed charges,279.75,75,,223.8,percent of total billed charges,75% of total billed charges,18.69,122,,,fee schedule,122% of APC rate,108.17,29,,86.536,percent of total billed charges,29% of total billed charges,15.32,100,,,fee schedule,100% of CMS fee schedule,249.91,67,,199.928,percent of total billed charges,67% of total billed charges,21.25,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,298.4,80,,238.72,percent of total billed charges,80% of total billed charges,242.45,65,,193.96,percent of total billed charges,65% of total billed charges,133.05,35.67,,106.44,percent of total billed charges,35.67% of total billed charges,15.32,335.7,
Anti Phospholipid Ab Ea.,3004031,CDM,300,RC,86148,HCPCS,outpatient,,,183,73.20,,155.55,85,,124.44,percent of total billed charges,85% of total billed charges,140.91,77,,112.73,percent of total billed charges,77% of total billed charges,16.07,100,,,fee schedule,100% of CMS fee schedule,69.44,350,,,fee schedule,350% of BCBS fee schedule,72.22,364,,,fee schedule,364% of BCBS fee schedule,72.22,364,,,fee schedule,364% of BCBS fee schedule,72.22,364,,,fee schedule,364% of BCBS fee schedule,164.7,90,,131.76,percent of total billed charges,90% of total billed charges,146.4,80,,117.12,percent of total billed charges,80% of total billed charges,164.7,90,,131.76,percent of total billed charges,90% of total billed charges,137.25,75,,109.8,percent of total billed charges,75% of total billed charges,19.6,122,,,fee schedule,122% of APC rate,53.07,29,,42.456,percent of total billed charges,29% of total billed charges,16.07,100,,,fee schedule,100% of CMS fee schedule,122.61,67,,98.088,percent of total billed charges,67% of total billed charges,23.89,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,146.4,80,,117.12,percent of total billed charges,80% of total billed charges,118.95,65,,95.16,percent of total billed charges,65% of total billed charges,65.28,35.67,,52.224,percent of total billed charges,35.67% of total billed charges,16.07,164.7,
Stool Culture Presumptive ID,3004033,CDM,300,RC,87046,HCPCS,outpatient,,,103,41.20,,87.55,85,,70.04,percent of total billed charges,85% of total billed charges,79.31,77,,63.45,percent of total billed charges,77% of total billed charges,9.44,100,,,fee schedule,100% of CMS fee schedule,40.81,350,,,fee schedule,350% of BCBS fee schedule,42.44,364,,,fee schedule,364% of BCBS fee schedule,42.44,364,,,fee schedule,364% of BCBS fee schedule,42.44,364,,,fee schedule,364% of BCBS fee schedule,92.7,90,,74.16,percent of total billed charges,90% of total billed charges,82.4,80,,65.92,percent of total billed charges,80% of total billed charges,92.7,90,,74.16,percent of total billed charges,90% of total billed charges,77.25,75,,61.8,percent of total billed charges,75% of total billed charges,11.51,122,,,fee schedule,122% of APC rate,29.87,29,,23.896,percent of total billed charges,29% of total billed charges,9.44,100,,,fee schedule,100% of CMS fee schedule,69.01,67,,55.208,percent of total billed charges,67% of total billed charges,14.02,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,82.4,80,,65.92,percent of total billed charges,80% of total billed charges,66.95,65,,53.56,percent of total billed charges,65% of total billed charges,36.74,35.67,,29.392,percent of total billed charges,35.67% of total billed charges,9.44,92.7,
DHEA NON-SULFATE,3004034,CDM,300,RC,82626,HCPCS,outpatient,,,178,71.20,,151.3,85,,121.04,percent of total billed charges,85% of total billed charges,137.06,77,,109.65,percent of total billed charges,77% of total billed charges,25.27,100,,,fee schedule,100% of CMS fee schedule,109.2,350,,,fee schedule,350% of BCBS fee schedule,113.57,364,,,fee schedule,364% of BCBS fee schedule,113.57,364,,,fee schedule,364% of BCBS fee schedule,113.57,364,,,fee schedule,364% of BCBS fee schedule,160.2,90,,128.16,percent of total billed charges,90% of total billed charges,142.4,80,,113.92,percent of total billed charges,80% of total billed charges,160.2,90,,128.16,percent of total billed charges,90% of total billed charges,133.5,75,,106.8,percent of total billed charges,75% of total billed charges,30.82,122,,,fee schedule,122% of APC rate,51.62,29,,41.296,percent of total billed charges,29% of total billed charges,25.27,100,,,fee schedule,100% of CMS fee schedule,119.26,67,,95.408,percent of total billed charges,67% of total billed charges,37.57,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,142.4,80,,113.92,percent of total billed charges,80% of total billed charges,115.7,65,,92.56,percent of total billed charges,65% of total billed charges,63.49,35.67,,50.792,percent of total billed charges,35.67% of total billed charges,25.27,160.2,
"TPMT ACTIVITY, RBC",3004035,CDM,300,RC,84433,HCPCS,outpatient,,,501,200.40,,425.85,85,,340.68,percent of total billed charges,85% of total billed charges,385.77,77,,308.62,percent of total billed charges,77% of total billed charges,22.17,100,,,fee schedule,100% of CMS fee schedule,410.82,82,,328.656,percent of total billed charges,82% of total billed charges,425.85,85,,340.68,percent of total billed charges,85% of total billed charges,425.85,85,,340.68,percent of total billed charges,85% of total billed charges,425.85,85,,340.68,percent of total billed charges,85% of total billed charges,450.9,90,,360.72,percent of total billed charges,90% of total billed charges,400.8,80,,320.64,percent of total billed charges,80% of total billed charges,450.9,90,,360.72,percent of total billed charges,90% of total billed charges,375.75,75,,300.6,percent of total billed charges,75% of total billed charges,27.04,122,,,fee schedule,122% of APC rate,145.29,29,,116.232,percent of total billed charges,29% of total billed charges,22.17,100,,,fee schedule,100% of CMS fee schedule,335.67,67,,268.536,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,400.8,80,,320.64,percent of total billed charges,80% of total billed charges,325.65,65,,260.52,percent of total billed charges,65% of total billed charges,178.71,35.67,,142.968,percent of total billed charges,35.67% of total billed charges,22.17,450.9,
ERYTHROPOIETIN,3004040,CDM,300,RC,82668,HCPCS,outpatient,,,121,48.40,,102.85,85,,82.28,percent of total billed charges,85% of total billed charges,93.17,77,,74.54,percent of total billed charges,77% of total billed charges,18.79,100,,,fee schedule,100% of CMS fee schedule,81.2,350,,,fee schedule,350% of BCBS fee schedule,84.45,364,,,fee schedule,364% of BCBS fee schedule,84.45,364,,,fee schedule,364% of BCBS fee schedule,84.45,364,,,fee schedule,364% of BCBS fee schedule,108.9,90,,87.12,percent of total billed charges,90% of total billed charges,96.8,80,,77.44,percent of total billed charges,80% of total billed charges,108.9,90,,87.12,percent of total billed charges,90% of total billed charges,90.75,75,,72.6,percent of total billed charges,75% of total billed charges,22.92,122,,,fee schedule,122% of APC rate,35.09,29,,28.072,percent of total billed charges,29% of total billed charges,18.79,100,,,fee schedule,100% of CMS fee schedule,81.07,67,,64.856,percent of total billed charges,67% of total billed charges,27.96,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,96.8,80,,77.44,percent of total billed charges,80% of total billed charges,78.65,65,,62.92,percent of total billed charges,65% of total billed charges,43.16,35.67,,34.528,percent of total billed charges,35.67% of total billed charges,18.79,108.9,
HIGH SENSITIVITY CRP,3004044,CDM,300,RC,86141,HCPCS,outpatient,,,186,74.40,,158.1,85,,126.48,percent of total billed charges,85% of total billed charges,143.22,77,,114.58,percent of total billed charges,77% of total billed charges,12.95,100,,,fee schedule,100% of CMS fee schedule,55.93,350,,,fee schedule,350% of BCBS fee schedule,58.17,364,,,fee schedule,364% of BCBS fee schedule,58.17,364,,,fee schedule,364% of BCBS fee schedule,58.17,364,,,fee schedule,364% of BCBS fee schedule,167.4,90,,133.92,percent of total billed charges,90% of total billed charges,148.8,80,,119.04,percent of total billed charges,80% of total billed charges,167.4,90,,133.92,percent of total billed charges,90% of total billed charges,139.5,75,,111.6,percent of total billed charges,75% of total billed charges,15.79,122,,,fee schedule,122% of APC rate,53.94,29,,43.152,percent of total billed charges,29% of total billed charges,12.95,100,,,fee schedule,100% of CMS fee schedule,124.62,67,,99.696,percent of total billed charges,67% of total billed charges,19.25,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,148.8,80,,119.04,percent of total billed charges,80% of total billed charges,120.9,65,,96.72,percent of total billed charges,65% of total billed charges,66.35,35.67,,53.08,percent of total billed charges,35.67% of total billed charges,12.95,167.4,
ESTROGEN RECEPTOR,3004045,CDM,300,RC,84233,HCPCS,outpatient,,,348,139.20,,295.8,85,,236.64,percent of total billed charges,85% of total billed charges,267.96,77,,214.37,percent of total billed charges,77% of total billed charges,87.88,100,,,fee schedule,100% of CMS fee schedule,307.58,350,,,fee schedule,350% of BCBS fee schedule,319.88,364,,,fee schedule,364% of BCBS fee schedule,319.88,364,,,fee schedule,364% of BCBS fee schedule,319.88,364,,,fee schedule,364% of BCBS fee schedule,313.2,90,,250.56,percent of total billed charges,90% of total billed charges,278.4,80,,222.72,percent of total billed charges,80% of total billed charges,313.2,90,,250.56,percent of total billed charges,90% of total billed charges,261,75,,208.8,percent of total billed charges,75% of total billed charges,107.21,122,,,fee schedule,122% of APC rate,100.92,29,,80.736,percent of total billed charges,29% of total billed charges,87.88,100,,,fee schedule,100% of CMS fee schedule,233.16,67,,186.528,percent of total billed charges,67% of total billed charges,93.56,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,278.4,80,,222.72,percent of total billed charges,80% of total billed charges,226.2,65,,180.96,percent of total billed charges,65% of total billed charges,124.13,35.67,,99.304,percent of total billed charges,35.67% of total billed charges,87.88,319.88,
PROGESTERONE RECEPTOR,3004046,CDM,300,RC,84234,HCPCS,outpatient,,,317,126.80,,269.45,85,,215.56,percent of total billed charges,85% of total billed charges,244.09,77,,195.27,percent of total billed charges,77% of total billed charges,64.88,100,,,fee schedule,100% of CMS fee schedule,280.35,350,,,fee schedule,350% of BCBS fee schedule,291.56,364,,,fee schedule,364% of BCBS fee schedule,291.56,364,,,fee schedule,364% of BCBS fee schedule,291.56,364,,,fee schedule,364% of BCBS fee schedule,285.3,90,,228.24,percent of total billed charges,90% of total billed charges,253.6,80,,202.88,percent of total billed charges,80% of total billed charges,285.3,90,,228.24,percent of total billed charges,90% of total billed charges,237.75,75,,190.2,percent of total billed charges,75% of total billed charges,79.15,122,,,fee schedule,122% of APC rate,91.93,29,,73.544,percent of total billed charges,29% of total billed charges,64.88,100,,,fee schedule,100% of CMS fee schedule,212.39,67,,169.912,percent of total billed charges,67% of total billed charges,96.48,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,253.6,80,,202.88,percent of total billed charges,80% of total billed charges,206.05,65,,164.84,percent of total billed charges,65% of total billed charges,113.07,35.67,,90.456,percent of total billed charges,35.67% of total billed charges,64.88,291.56,
PROGRAF-TACROLIMUS,3004047,CDM,300,RC,80197,HCPCS,outpatient,,,116,46.40,,98.6,85,,78.88,percent of total billed charges,85% of total billed charges,89.32,77,,71.46,percent of total billed charges,77% of total billed charges,13.73,100,,,fee schedule,100% of CMS fee schedule,59.36,350,,,fee schedule,350% of BCBS fee schedule,61.73,364,,,fee schedule,364% of BCBS fee schedule,61.73,364,,,fee schedule,364% of BCBS fee schedule,61.73,364,,,fee schedule,364% of BCBS fee schedule,104.4,90,,83.52,percent of total billed charges,90% of total billed charges,92.8,80,,74.24,percent of total billed charges,80% of total billed charges,104.4,90,,83.52,percent of total billed charges,90% of total billed charges,87,75,,69.6,percent of total billed charges,75% of total billed charges,16.75,122,,,fee schedule,122% of APC rate,33.64,29,,26.912,percent of total billed charges,29% of total billed charges,13.73,100,,,fee schedule,100% of CMS fee schedule,77.72,67,,62.176,percent of total billed charges,67% of total billed charges,20.42,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,92.8,80,,74.24,percent of total billed charges,80% of total billed charges,75.4,65,,60.32,percent of total billed charges,65% of total billed charges,41.38,35.67,,33.104,percent of total billed charges,35.67% of total billed charges,13.73,104.4,
ORGANIC ACIDS URINE,3004050,CDM,300,RC,83918,HCPCS,outpatient,,,709,283.60,,602.65,85,,482.12,percent of total billed charges,85% of total billed charges,545.93,77,,436.74,percent of total billed charges,77% of total billed charges,23.6,100,,,fee schedule,100% of CMS fee schedule,82.6,350,,,fee schedule,350% of BCBS fee schedule,85.9,364,,,fee schedule,364% of BCBS fee schedule,85.9,364,,,fee schedule,364% of BCBS fee schedule,85.9,364,,,fee schedule,364% of BCBS fee schedule,638.1,90,,510.48,percent of total billed charges,90% of total billed charges,567.2,80,,453.76,percent of total billed charges,80% of total billed charges,638.1,90,,510.48,percent of total billed charges,90% of total billed charges,531.75,75,,425.4,percent of total billed charges,75% of total billed charges,28.79,122,,,fee schedule,122% of APC rate,205.61,29,,164.488,percent of total billed charges,29% of total billed charges,23.6,100,,,fee schedule,100% of CMS fee schedule,475.03,67,,380.024,percent of total billed charges,67% of total billed charges,24.47,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,567.2,80,,453.76,percent of total billed charges,80% of total billed charges,460.85,65,,368.68,percent of total billed charges,65% of total billed charges,252.9,35.67,,202.32,percent of total billed charges,35.67% of total billed charges,23.6,638.1,
ACYLCARNITINE PROFILE,3004051,CDM,300,RC,82017,HCPCS,outpatient,,,462,184.80,,392.7,85,,314.16,percent of total billed charges,85% of total billed charges,355.74,77,,284.59,percent of total billed charges,77% of total billed charges,16.87,100,,,fee schedule,100% of CMS fee schedule,72.91,350,,,fee schedule,350% of BCBS fee schedule,75.82,364,,,fee schedule,364% of BCBS fee schedule,75.82,364,,,fee schedule,364% of BCBS fee schedule,75.82,364,,,fee schedule,364% of BCBS fee schedule,415.8,90,,332.64,percent of total billed charges,90% of total billed charges,369.6,80,,295.68,percent of total billed charges,80% of total billed charges,415.8,90,,332.64,percent of total billed charges,90% of total billed charges,346.5,75,,277.2,percent of total billed charges,75% of total billed charges,20.58,122,,,fee schedule,122% of APC rate,133.98,29,,107.184,percent of total billed charges,29% of total billed charges,16.87,100,,,fee schedule,100% of CMS fee schedule,309.54,67,,247.632,percent of total billed charges,67% of total billed charges,21.43,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,369.6,80,,295.68,percent of total billed charges,80% of total billed charges,300.3,65,,240.24,percent of total billed charges,65% of total billed charges,164.8,35.67,,131.84,percent of total billed charges,35.67% of total billed charges,16.87,415.8,
CARNITINE,3004052,CDM,300,RC,82379,HCPCS,outpatient,,,329,131.60,,279.65,85,,223.72,percent of total billed charges,85% of total billed charges,253.33,77,,202.66,percent of total billed charges,77% of total billed charges,16.87,100,,,fee schedule,100% of CMS fee schedule,72.91,350,,,fee schedule,350% of BCBS fee schedule,75.82,364,,,fee schedule,364% of BCBS fee schedule,75.82,364,,,fee schedule,364% of BCBS fee schedule,75.82,364,,,fee schedule,364% of BCBS fee schedule,296.1,90,,236.88,percent of total billed charges,90% of total billed charges,263.2,80,,210.56,percent of total billed charges,80% of total billed charges,296.1,90,,236.88,percent of total billed charges,90% of total billed charges,246.75,75,,197.4,percent of total billed charges,75% of total billed charges,20.58,122,,,fee schedule,122% of APC rate,95.41,29,,76.328,percent of total billed charges,29% of total billed charges,16.87,100,,,fee schedule,100% of CMS fee schedule,220.43,67,,176.344,percent of total billed charges,67% of total billed charges,21.43,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,263.2,80,,210.56,percent of total billed charges,80% of total billed charges,213.85,65,,171.08,percent of total billed charges,65% of total billed charges,117.35,35.67,,93.88,percent of total billed charges,35.67% of total billed charges,16.87,296.1,
Multiplex Vaginal Panel,3004053,CDM,300,RC,0352U,HCPCS,outpatient,,,449,179.60,QW,381.65,85,,305.32,percent of total billed charges,85% of total billed charges,345.73,77,,276.58,percent of total billed charges,77% of total billed charges,142.63,100,,,fee schedule,100% of CMS fee schedule,499.21,350,,,fee schedule,350% of BCBS fee schedule,519.17,364,,,fee schedule,364% of BCBS fee schedule,519.17,364,,,fee schedule,364% of BCBS fee schedule,519.17,364,,,fee schedule,364% of BCBS fee schedule,404.1,90,,323.28,percent of total billed charges,90% of total billed charges,359.2,80,,287.36,percent of total billed charges,80% of total billed charges,404.1,90,,323.28,percent of total billed charges,90% of total billed charges,336.75,75,,269.4,percent of total billed charges,75% of total billed charges,174,122,,,fee schedule,122% of APC rate,130.21,29,,104.168,percent of total billed charges,29% of total billed charges,142.63,100,,,fee schedule,100% of CMS fee schedule,300.83,67,,240.664,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,359.2,80,,287.36,percent of total billed charges,80% of total billed charges,291.85,65,,233.48,percent of total billed charges,65% of total billed charges,160.16,35.67,,128.128,percent of total billed charges,35.67% of total billed charges,130.21,519.17,
ESTRADIOL LEVEL,3004059,CDM,300,RC,82670,HCPCS,outpatient,,,245,98.00,,208.25,85,,166.6,percent of total billed charges,85% of total billed charges,188.65,77,,150.92,percent of total billed charges,77% of total billed charges,27.94,100,,,fee schedule,100% of CMS fee schedule,120.72,350,,,fee schedule,350% of BCBS fee schedule,125.54,364,,,fee schedule,364% of BCBS fee schedule,125.54,364,,,fee schedule,364% of BCBS fee schedule,125.54,364,,,fee schedule,364% of BCBS fee schedule,220.5,90,,176.4,percent of total billed charges,90% of total billed charges,196,80,,156.8,percent of total billed charges,80% of total billed charges,220.5,90,,176.4,percent of total billed charges,90% of total billed charges,183.75,75,,147,percent of total billed charges,75% of total billed charges,34.08,122,,,fee schedule,122% of APC rate,71.05,29,,56.84,percent of total billed charges,29% of total billed charges,27.94,100,,,fee schedule,100% of CMS fee schedule,164.15,67,,131.32,percent of total billed charges,67% of total billed charges,41.55,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,196,80,,156.8,percent of total billed charges,80% of total billed charges,159.25,65,,127.4,percent of total billed charges,65% of total billed charges,87.39,35.67,,69.912,percent of total billed charges,35.67% of total billed charges,27.94,220.5,
ESTROGENS,3004060,CDM,300,RC,82671,HCPCS,outpatient,,,152,60.80,,129.2,85,,103.36,percent of total billed charges,85% of total billed charges,117.04,77,,93.63,percent of total billed charges,77% of total billed charges,32.29,100,,,fee schedule,100% of CMS fee schedule,139.58,350,,,fee schedule,350% of BCBS fee schedule,145.16,364,,,fee schedule,364% of BCBS fee schedule,145.16,364,,,fee schedule,364% of BCBS fee schedule,145.16,364,,,fee schedule,364% of BCBS fee schedule,136.8,90,,109.44,percent of total billed charges,90% of total billed charges,121.6,80,,97.28,percent of total billed charges,80% of total billed charges,136.8,90,,109.44,percent of total billed charges,90% of total billed charges,114,75,,91.2,percent of total billed charges,75% of total billed charges,39.4,122,,,fee schedule,122% of APC rate,44.08,29,,35.264,percent of total billed charges,29% of total billed charges,32.29,100,,,fee schedule,100% of CMS fee schedule,101.84,67,,81.472,percent of total billed charges,67% of total billed charges,48.03,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,121.6,80,,97.28,percent of total billed charges,80% of total billed charges,98.8,65,,79.04,percent of total billed charges,65% of total billed charges,54.22,35.67,,43.376,percent of total billed charges,35.67% of total billed charges,32.29,145.16,
ESTRIOL,3004061,CDM,300,RC,82677,HCPCS,outpatient,,,119,47.60,,101.15,85,,80.92,percent of total billed charges,85% of total billed charges,91.63,77,,73.3,percent of total billed charges,77% of total billed charges,24.18,100,,,fee schedule,100% of CMS fee schedule,104.48,350,,,fee schedule,350% of BCBS fee schedule,108.65,364,,,fee schedule,364% of BCBS fee schedule,108.65,364,,,fee schedule,364% of BCBS fee schedule,108.65,364,,,fee schedule,364% of BCBS fee schedule,107.1,90,,85.68,percent of total billed charges,90% of total billed charges,95.2,80,,76.16,percent of total billed charges,80% of total billed charges,107.1,90,,85.68,percent of total billed charges,90% of total billed charges,89.25,75,,71.4,percent of total billed charges,75% of total billed charges,29.49,122,,,fee schedule,122% of APC rate,34.51,29,,27.608,percent of total billed charges,29% of total billed charges,24.18,100,,,fee schedule,100% of CMS fee schedule,79.73,67,,63.784,percent of total billed charges,67% of total billed charges,35.96,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,95.2,80,,76.16,percent of total billed charges,80% of total billed charges,77.35,65,,61.88,percent of total billed charges,65% of total billed charges,42.45,35.67,,33.96,percent of total billed charges,35.67% of total billed charges,24.18,108.65,
ESTRONE,3004062,CDM,300,RC,82679,HCPCS,outpatient,,,81,32.40,,68.85,85,,55.08,percent of total billed charges,85% of total billed charges,62.37,77,,49.9,percent of total billed charges,77% of total billed charges,24.95,100,,,fee schedule,100% of CMS fee schedule,107.84,350,,,fee schedule,350% of BCBS fee schedule,112.15,364,,,fee schedule,364% of BCBS fee schedule,112.15,364,,,fee schedule,364% of BCBS fee schedule,112.15,364,,,fee schedule,364% of BCBS fee schedule,72.9,90,,58.32,percent of total billed charges,90% of total billed charges,64.8,80,,51.84,percent of total billed charges,80% of total billed charges,72.9,90,,58.32,percent of total billed charges,90% of total billed charges,60.75,75,,48.6,percent of total billed charges,75% of total billed charges,30.43,122,,,fee schedule,122% of APC rate,23.49,29,,18.792,percent of total billed charges,29% of total billed charges,24.95,100,,,fee schedule,100% of CMS fee schedule,54.27,67,,43.416,percent of total billed charges,67% of total billed charges,37.11,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,64.8,80,,51.84,percent of total billed charges,80% of total billed charges,52.65,65,,42.12,percent of total billed charges,65% of total billed charges,28.89,35.67,,23.112,percent of total billed charges,35.67% of total billed charges,23.49,112.15,
ETHOSUXIMIDE (ZARONTIN),3004080,CDM,300,RC,80168,HCPCS,outpatient,,,82,32.80,,69.7,85,,55.76,percent of total billed charges,85% of total billed charges,63.14,77,,50.51,percent of total billed charges,77% of total billed charges,16.34,100,,,fee schedule,100% of CMS fee schedule,70.6,350,,,fee schedule,350% of BCBS fee schedule,73.42,364,,,fee schedule,364% of BCBS fee schedule,73.42,364,,,fee schedule,364% of BCBS fee schedule,73.42,364,,,fee schedule,364% of BCBS fee schedule,73.8,90,,59.04,percent of total billed charges,90% of total billed charges,65.6,80,,52.48,percent of total billed charges,80% of total billed charges,73.8,90,,59.04,percent of total billed charges,90% of total billed charges,61.5,75,,49.2,percent of total billed charges,75% of total billed charges,19.93,122,,,fee schedule,122% of APC rate,23.78,29,,19.024,percent of total billed charges,29% of total billed charges,16.34,100,,,fee schedule,100% of CMS fee schedule,54.94,67,,43.952,percent of total billed charges,67% of total billed charges,24.3,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,65.6,80,,52.48,percent of total billed charges,80% of total billed charges,53.3,65,,42.64,percent of total billed charges,65% of total billed charges,29.25,35.67,,23.4,percent of total billed charges,35.67% of total billed charges,16.34,73.8,
EXTRACTION - CHROMOSOME,3004081,CDM,300,RC,83890,HCPCS,outpatient,,,64,25.60,,54.4,85,,43.52,percent of total billed charges,85% of total billed charges,49.28,77,,39.42,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,52.48,82,,41.984,percent of total billed charges,82% of total billed charges,54.4,85,,43.52,percent of total billed charges,85% of total billed charges,54.4,85,,43.52,percent of total billed charges,85% of total billed charges,54.4,85,,43.52,percent of total billed charges,85% of total billed charges,57.6,90,,46.08,percent of total billed charges,90% of total billed charges,51.2,80,,40.96,percent of total billed charges,80% of total billed charges,57.6,90,,46.08,percent of total billed charges,90% of total billed charges,48,75,,38.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,18.56,29,,14.848,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,42.88,67,,34.304,percent of total billed charges,67% of total billed charges,5.96,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,51.2,80,,40.96,percent of total billed charges,80% of total billed charges,41.6,65,,33.28,percent of total billed charges,65% of total billed charges,22.83,35.67,,18.264,percent of total billed charges,35.67% of total billed charges,5.96,57.6,
ETHYL ALCOHOL,3004100,CDM,300,RC,80320,HCPCS,outpatient,,,446,178.40,,379.1,85,,303.28,percent of total billed charges,85% of total billed charges,343.42,77,,274.74,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,365.72,82,,292.576,percent of total billed charges,82% of total billed charges,379.1,85,,303.28,percent of total billed charges,85% of total billed charges,379.1,85,,303.28,percent of total billed charges,85% of total billed charges,379.1,85,,303.28,percent of total billed charges,85% of total billed charges,401.4,90,,321.12,percent of total billed charges,90% of total billed charges,356.8,80,,285.44,percent of total billed charges,80% of total billed charges,401.4,90,,321.12,percent of total billed charges,90% of total billed charges,334.5,75,,267.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,129.34,29,,103.472,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,298.82,67,,239.056,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,356.8,80,,285.44,percent of total billed charges,80% of total billed charges,289.9,65,,231.92,percent of total billed charges,65% of total billed charges,159.09,35.67,,127.272,percent of total billed charges,35.67% of total billed charges,129.34,401.4,
FACTOR VIII TEST,3004104,CDM,300,RC,85240,HCPCS,outpatient,,,196,78.40,,166.6,85,,133.28,percent of total billed charges,85% of total billed charges,150.92,77,,120.74,percent of total billed charges,77% of total billed charges,17.89,100,,,fee schedule,100% of CMS fee schedule,77.35,350,,,fee schedule,350% of BCBS fee schedule,80.44,364,,,fee schedule,364% of BCBS fee schedule,80.44,364,,,fee schedule,364% of BCBS fee schedule,80.44,364,,,fee schedule,364% of BCBS fee schedule,176.4,90,,141.12,percent of total billed charges,90% of total billed charges,156.8,80,,125.44,percent of total billed charges,80% of total billed charges,176.4,90,,141.12,percent of total billed charges,90% of total billed charges,147,75,,117.6,percent of total billed charges,75% of total billed charges,21.83,122,,,fee schedule,122% of APC rate,56.84,29,,45.472,percent of total billed charges,29% of total billed charges,17.89,100,,,fee schedule,100% of CMS fee schedule,131.32,67,,105.056,percent of total billed charges,67% of total billed charges,13,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,156.8,80,,125.44,percent of total billed charges,80% of total billed charges,127.4,65,,101.92,percent of total billed charges,65% of total billed charges,69.91,35.67,,55.928,percent of total billed charges,35.67% of total billed charges,13,176.4,
FACTOR DEFICIENCY DETECTOR,3004105,CDM,300,RC,,,outpatient,,,558,223.20,,474.3,85,,379.44,percent of total billed charges,85% of total billed charges,429.66,77,,343.73,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,457.56,82,,366.048,percent of total billed charges,82% of total billed charges,474.3,85,,379.44,percent of total billed charges,85% of total billed charges,474.3,85,,379.44,percent of total billed charges,85% of total billed charges,474.3,85,,379.44,percent of total billed charges,85% of total billed charges,502.2,90,,401.76,percent of total billed charges,90% of total billed charges,446.4,80,,357.12,percent of total billed charges,80% of total billed charges,502.2,90,,401.76,percent of total billed charges,90% of total billed charges,418.5,75,,334.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,161.82,29,,129.456,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,373.86,67,,299.088,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,446.4,80,,357.12,percent of total billed charges,80% of total billed charges,362.7,65,,290.16,percent of total billed charges,65% of total billed charges,199.04,35.67,,159.232,percent of total billed charges,35.67% of total billed charges,161.82,502.2,
FACTOR XI,3004106,CDM,300,RC,85270,HCPCS,outpatient,,,219,87.60,,186.15,85,,148.92,percent of total billed charges,85% of total billed charges,168.63,77,,134.9,percent of total billed charges,77% of total billed charges,17.89,100,,,fee schedule,100% of CMS fee schedule,77.35,350,,,fee schedule,350% of BCBS fee schedule,80.44,364,,,fee schedule,364% of BCBS fee schedule,80.44,364,,,fee schedule,364% of BCBS fee schedule,80.44,364,,,fee schedule,364% of BCBS fee schedule,197.1,90,,157.68,percent of total billed charges,90% of total billed charges,175.2,80,,140.16,percent of total billed charges,80% of total billed charges,197.1,90,,157.68,percent of total billed charges,90% of total billed charges,164.25,75,,131.4,percent of total billed charges,75% of total billed charges,21.83,122,,,fee schedule,122% of APC rate,63.51,29,,50.808,percent of total billed charges,29% of total billed charges,17.89,100,,,fee schedule,100% of CMS fee schedule,146.73,67,,117.384,percent of total billed charges,67% of total billed charges,26.62,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,175.2,80,,140.16,percent of total billed charges,80% of total billed charges,142.35,65,,113.88,percent of total billed charges,65% of total billed charges,78.12,35.67,,62.496,percent of total billed charges,35.67% of total billed charges,17.89,197.1,
FAT QUALITATIVE,3004110,CDM,300,RC,82705,HCPCS,outpatient,,,27,10.80,,22.95,85,,18.36,percent of total billed charges,85% of total billed charges,20.79,77,,16.63,percent of total billed charges,77% of total billed charges,5.09,100,,,fee schedule,100% of CMS fee schedule,22.02,350,,,fee schedule,350% of BCBS fee schedule,22.9,364,,,fee schedule,364% of BCBS fee schedule,22.9,364,,,fee schedule,364% of BCBS fee schedule,22.9,364,,,fee schedule,364% of BCBS fee schedule,24.3,90,,19.44,percent of total billed charges,90% of total billed charges,21.6,80,,17.28,percent of total billed charges,80% of total billed charges,24.3,90,,19.44,percent of total billed charges,90% of total billed charges,20.25,75,,16.2,percent of total billed charges,75% of total billed charges,6.22,122,,,fee schedule,122% of APC rate,7.83,29,,6.264,percent of total billed charges,29% of total billed charges,5.09,100,,,fee schedule,100% of CMS fee schedule,18.09,67,,14.472,percent of total billed charges,67% of total billed charges,7.57,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,21.6,80,,17.28,percent of total billed charges,80% of total billed charges,17.55,65,,14.04,percent of total billed charges,65% of total billed charges,9.63,35.67,,7.704,percent of total billed charges,35.67% of total billed charges,5.09,24.3,
FEBRILE AGGLUTININS,3004120,CDM,300,RC,86000,HCPCS,outpatient,,,115,46.00,,97.75,85,,78.2,percent of total billed charges,85% of total billed charges,88.55,77,,70.84,percent of total billed charges,77% of total billed charges,6.98,100,,,fee schedule,100% of CMS fee schedule,30.17,350,,,fee schedule,350% of BCBS fee schedule,31.38,364,,,fee schedule,364% of BCBS fee schedule,31.38,364,,,fee schedule,364% of BCBS fee schedule,31.38,364,,,fee schedule,364% of BCBS fee schedule,103.5,90,,82.8,percent of total billed charges,90% of total billed charges,92,80,,73.6,percent of total billed charges,80% of total billed charges,103.5,90,,82.8,percent of total billed charges,90% of total billed charges,86.25,75,,69,percent of total billed charges,75% of total billed charges,8.51,122,,,fee schedule,122% of APC rate,33.35,29,,26.68,percent of total billed charges,29% of total billed charges,6.98,100,,,fee schedule,100% of CMS fee schedule,77.05,67,,61.64,percent of total billed charges,67% of total billed charges,10.38,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,92,80,,73.6,percent of total billed charges,80% of total billed charges,74.75,65,,59.8,percent of total billed charges,65% of total billed charges,41.02,35.67,,32.816,percent of total billed charges,35.67% of total billed charges,6.98,103.5,
FECAL FATS,3004140,CDM,300,RC,82710,HCPCS,outpatient,,,114,45.60,,96.9,85,,77.52,percent of total billed charges,85% of total billed charges,87.78,77,,70.22,percent of total billed charges,77% of total billed charges,16.8,100,,,fee schedule,100% of CMS fee schedule,72.63,350,,,fee schedule,350% of BCBS fee schedule,75.53,364,,,fee schedule,364% of BCBS fee schedule,75.53,364,,,fee schedule,364% of BCBS fee schedule,75.53,364,,,fee schedule,364% of BCBS fee schedule,102.6,90,,82.08,percent of total billed charges,90% of total billed charges,91.2,80,,72.96,percent of total billed charges,80% of total billed charges,102.6,90,,82.08,percent of total billed charges,90% of total billed charges,85.5,75,,68.4,percent of total billed charges,75% of total billed charges,20.49,122,,,fee schedule,122% of APC rate,33.06,29,,26.448,percent of total billed charges,29% of total billed charges,16.8,100,,,fee schedule,100% of CMS fee schedule,76.38,67,,61.104,percent of total billed charges,67% of total billed charges,24.99,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,91.2,80,,72.96,percent of total billed charges,80% of total billed charges,74.1,65,,59.28,percent of total billed charges,65% of total billed charges,40.66,35.67,,32.528,percent of total billed charges,35.67% of total billed charges,16.8,102.6,
FECAL WBC,3004160,CDM,300,RC,87205,HCPCS,outpatient,,,31,12.40,,26.35,85,,21.08,percent of total billed charges,85% of total billed charges,23.87,77,,19.1,percent of total billed charges,77% of total billed charges,4.26,100,,,fee schedule,100% of CMS fee schedule,18.45,350,,,fee schedule,350% of BCBS fee schedule,19.18,364,,,fee schedule,364% of BCBS fee schedule,19.18,364,,,fee schedule,364% of BCBS fee schedule,19.18,364,,,fee schedule,364% of BCBS fee schedule,27.9,90,,22.32,percent of total billed charges,90% of total billed charges,24.8,80,,19.84,percent of total billed charges,80% of total billed charges,27.9,90,,22.32,percent of total billed charges,90% of total billed charges,23.25,75,,18.6,percent of total billed charges,75% of total billed charges,5.2,122,,,fee schedule,122% of APC rate,8.99,29,,7.192,percent of total billed charges,29% of total billed charges,4.26,100,,,fee schedule,100% of CMS fee schedule,20.77,67,,16.616,percent of total billed charges,67% of total billed charges,6.35,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,24.8,80,,19.84,percent of total billed charges,80% of total billed charges,20.15,65,,16.12,percent of total billed charges,65% of total billed charges,11.06,35.67,,8.848,percent of total billed charges,35.67% of total billed charges,4.26,27.9,
FERRITIN,3004180,CDM,300,RC,82728,HCPCS,outpatient,,,90,36.00,,76.5,85,,61.2,percent of total billed charges,85% of total billed charges,69.3,77,,55.44,percent of total billed charges,77% of total billed charges,13.63,100,,,fee schedule,100% of CMS fee schedule,58.91,350,,,fee schedule,350% of BCBS fee schedule,61.26,364,,,fee schedule,364% of BCBS fee schedule,61.26,364,,,fee schedule,364% of BCBS fee schedule,61.26,364,,,fee schedule,364% of BCBS fee schedule,81,90,,64.8,percent of total billed charges,90% of total billed charges,72,80,,57.6,percent of total billed charges,80% of total billed charges,81,90,,64.8,percent of total billed charges,90% of total billed charges,67.5,75,,54,percent of total billed charges,75% of total billed charges,16.62,122,,,fee schedule,122% of APC rate,26.1,29,,20.88,percent of total billed charges,29% of total billed charges,13.63,100,,,fee schedule,100% of CMS fee schedule,60.3,67,,48.24,percent of total billed charges,67% of total billed charges,20.26,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,72,80,,57.6,percent of total billed charges,80% of total billed charges,58.5,65,,46.8,percent of total billed charges,65% of total billed charges,32.1,35.67,,25.68,percent of total billed charges,35.67% of total billed charges,13.63,81,
FETAL SCREEN,3004200,CDM,300,RC,85460,HCPCS,outpatient,,,164,65.60,,139.4,85,,111.52,percent of total billed charges,85% of total billed charges,126.28,77,,101.02,percent of total billed charges,77% of total billed charges,7.73,100,,,fee schedule,100% of CMS fee schedule,33.43,350,,,fee schedule,350% of BCBS fee schedule,34.76,364,,,fee schedule,364% of BCBS fee schedule,34.76,364,,,fee schedule,364% of BCBS fee schedule,34.76,364,,,fee schedule,364% of BCBS fee schedule,147.6,90,,118.08,percent of total billed charges,90% of total billed charges,131.2,80,,104.96,percent of total billed charges,80% of total billed charges,147.6,90,,118.08,percent of total billed charges,90% of total billed charges,123,75,,98.4,percent of total billed charges,75% of total billed charges,9.43,122,,,fee schedule,122% of APC rate,47.56,29,,38.048,percent of total billed charges,29% of total billed charges,7.73,100,,,fee schedule,100% of CMS fee schedule,109.88,67,,87.904,percent of total billed charges,67% of total billed charges,11.51,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,131.2,80,,104.96,percent of total billed charges,80% of total billed charges,106.6,65,,85.28,percent of total billed charges,65% of total billed charges,58.5,35.67,,46.8,percent of total billed charges,35.67% of total billed charges,7.73,147.6,
FERNING,3004201,CDM,300,RC,87210,HCPCS,outpatient,,,111,44.40,,94.35,85,,75.48,percent of total billed charges,85% of total billed charges,85.47,77,,68.38,percent of total billed charges,77% of total billed charges,5.82,100,,,fee schedule,100% of CMS fee schedule,20.37,350,,,fee schedule,350% of BCBS fee schedule,21.18,364,,,fee schedule,364% of BCBS fee schedule,21.18,364,,,fee schedule,364% of BCBS fee schedule,21.18,364,,,fee schedule,364% of BCBS fee schedule,99.9,90,,79.92,percent of total billed charges,90% of total billed charges,88.8,80,,71.04,percent of total billed charges,80% of total billed charges,99.9,90,,79.92,percent of total billed charges,90% of total billed charges,83.25,75,,66.6,percent of total billed charges,75% of total billed charges,7.1,122,,,fee schedule,122% of APC rate,32.19,29,,25.752,percent of total billed charges,29% of total billed charges,5.82,100,,,fee schedule,100% of CMS fee schedule,74.37,67,,59.496,percent of total billed charges,67% of total billed charges,6.35,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,88.8,80,,71.04,percent of total billed charges,80% of total billed charges,72.15,65,,57.72,percent of total billed charges,65% of total billed charges,39.59,35.67,,31.672,percent of total billed charges,35.67% of total billed charges,5.82,99.9,
FETAL FIBRONECTIN,3004210,CDM,300,RC,82731,HCPCS,outpatient,,,482,192.80,,409.7,85,,327.76,percent of total billed charges,85% of total billed charges,371.14,77,,296.91,percent of total billed charges,77% of total billed charges,64.41,100,,,fee schedule,100% of CMS fee schedule,278.32,350,,,fee schedule,350% of BCBS fee schedule,289.45,364,,,fee schedule,364% of BCBS fee schedule,289.45,364,,,fee schedule,364% of BCBS fee schedule,289.45,364,,,fee schedule,364% of BCBS fee schedule,433.8,90,,347.04,percent of total billed charges,90% of total billed charges,385.6,80,,308.48,percent of total billed charges,80% of total billed charges,433.8,90,,347.04,percent of total billed charges,90% of total billed charges,361.5,75,,289.2,percent of total billed charges,75% of total billed charges,78.58,122,,,fee schedule,122% of APC rate,139.78,29,,111.824,percent of total billed charges,29% of total billed charges,64.41,100,,,fee schedule,100% of CMS fee schedule,322.94,67,,258.352,percent of total billed charges,67% of total billed charges,93.56,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,385.6,80,,308.48,percent of total billed charges,80% of total billed charges,313.3,65,,250.64,percent of total billed charges,65% of total billed charges,171.93,35.67,,137.544,percent of total billed charges,35.67% of total billed charges,64.41,433.8,
FIBRIN DEGRADATION PROD,3004240,CDM,300,RC,85362,HCPCS,outpatient,,,77,30.80,,65.45,85,,52.36,percent of total billed charges,85% of total billed charges,59.29,77,,47.43,percent of total billed charges,77% of total billed charges,6.89,100,,,fee schedule,100% of CMS fee schedule,29.79,350,,,fee schedule,350% of BCBS fee schedule,30.98,364,,,fee schedule,364% of BCBS fee schedule,30.98,364,,,fee schedule,364% of BCBS fee schedule,30.98,364,,,fee schedule,364% of BCBS fee schedule,69.3,90,,55.44,percent of total billed charges,90% of total billed charges,61.6,80,,49.28,percent of total billed charges,80% of total billed charges,69.3,90,,55.44,percent of total billed charges,90% of total billed charges,57.75,75,,46.2,percent of total billed charges,75% of total billed charges,8.4,122,,,fee schedule,122% of APC rate,22.33,29,,17.864,percent of total billed charges,29% of total billed charges,6.89,100,,,fee schedule,100% of CMS fee schedule,51.59,67,,41.272,percent of total billed charges,67% of total billed charges,10.24,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,61.6,80,,49.28,percent of total billed charges,80% of total billed charges,50.05,65,,40.04,percent of total billed charges,65% of total billed charges,27.47,35.67,,21.976,percent of total billed charges,35.67% of total billed charges,6.89,69.3,
FREE LIGHT CHAINS,3004241,CDM,300,RC,83883,HCPCS,outpatient,,,180,72.00,,153,85,,122.4,percent of total billed charges,85% of total billed charges,138.6,77,,110.88,percent of total billed charges,77% of total billed charges,13.6,100,,,fee schedule,100% of CMS fee schedule,58.77,350,,,fee schedule,350% of BCBS fee schedule,61.12,364,,,fee schedule,364% of BCBS fee schedule,61.12,364,,,fee schedule,364% of BCBS fee schedule,61.12,364,,,fee schedule,364% of BCBS fee schedule,162,90,,129.6,percent of total billed charges,90% of total billed charges,144,80,,115.2,percent of total billed charges,80% of total billed charges,162,90,,129.6,percent of total billed charges,90% of total billed charges,135,75,,108,percent of total billed charges,75% of total billed charges,16.59,122,,,fee schedule,122% of APC rate,52.2,29,,41.76,percent of total billed charges,29% of total billed charges,13.6,100,,,fee schedule,100% of CMS fee schedule,120.6,67,,96.48,percent of total billed charges,67% of total billed charges,20.21,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,144,80,,115.2,percent of total billed charges,80% of total billed charges,117,65,,93.6,percent of total billed charges,65% of total billed charges,64.21,35.67,,51.368,percent of total billed charges,35.67% of total billed charges,13.6,162,
IGG4-FILARIA AB,3004250,CDM,300,RC,86682,HCPCS,outpatient,,,164,65.60,,139.4,85,,111.52,percent of total billed charges,85% of total billed charges,126.28,77,,101.02,percent of total billed charges,77% of total billed charges,13.01,100,,,fee schedule,100% of CMS fee schedule,56.21,350,,,fee schedule,350% of BCBS fee schedule,58.46,364,,,fee schedule,364% of BCBS fee schedule,58.46,364,,,fee schedule,364% of BCBS fee schedule,58.46,364,,,fee schedule,364% of BCBS fee schedule,147.6,90,,118.08,percent of total billed charges,90% of total billed charges,131.2,80,,104.96,percent of total billed charges,80% of total billed charges,147.6,90,,118.08,percent of total billed charges,90% of total billed charges,123,75,,98.4,percent of total billed charges,75% of total billed charges,15.87,122,,,fee schedule,122% of APC rate,47.56,29,,38.048,percent of total billed charges,29% of total billed charges,13.01,100,,,fee schedule,100% of CMS fee schedule,109.88,67,,87.904,percent of total billed charges,67% of total billed charges,8.64,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,131.2,80,,104.96,percent of total billed charges,80% of total billed charges,106.6,65,,85.28,percent of total billed charges,65% of total billed charges,58.5,35.67,,46.8,percent of total billed charges,35.67% of total billed charges,8.64,147.6,
FIBRINOGEN,3004260,CDM,300,RC,85384,HCPCS,outpatient,,,101,40.40,,85.85,85,,68.68,percent of total billed charges,85% of total billed charges,77.77,77,,62.22,percent of total billed charges,77% of total billed charges,9.72,100,,,fee schedule,100% of CMS fee schedule,36.72,350,,,fee schedule,350% of BCBS fee schedule,38.18,364,,,fee schedule,364% of BCBS fee schedule,38.18,364,,,fee schedule,364% of BCBS fee schedule,38.18,364,,,fee schedule,364% of BCBS fee schedule,90.9,90,,72.72,percent of total billed charges,90% of total billed charges,80.8,80,,64.64,percent of total billed charges,80% of total billed charges,90.9,90,,72.72,percent of total billed charges,90% of total billed charges,75.75,75,,60.6,percent of total billed charges,75% of total billed charges,11.85,122,,,fee schedule,122% of APC rate,29.29,29,,23.432,percent of total billed charges,29% of total billed charges,9.72,100,,,fee schedule,100% of CMS fee schedule,67.67,67,,54.136,percent of total billed charges,67% of total billed charges,12.63,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,80.8,80,,64.64,percent of total billed charges,80% of total billed charges,65.65,65,,52.52,percent of total billed charges,65% of total billed charges,36.03,35.67,,28.824,percent of total billed charges,35.67% of total billed charges,9.72,90.9,
FIBRINOGEN REPEAT SAME DAY,3004261,CDM,300,RC,85384,HCPCS,outpatient,,,100,40.00,91,85,85,,68,percent of total billed charges,85% of total billed charges,77,77,,61.6,percent of total billed charges,77% of total billed charges,9.72,100,,,fee schedule,100% of CMS fee schedule,36.72,350,,,fee schedule,350% of BCBS fee schedule,38.18,364,,,fee schedule,364% of BCBS fee schedule,38.18,364,,,fee schedule,364% of BCBS fee schedule,38.18,364,,,fee schedule,364% of BCBS fee schedule,90,90,,72,percent of total billed charges,90% of total billed charges,80,80,,64,percent of total billed charges,80% of total billed charges,90,90,,72,percent of total billed charges,90% of total billed charges,75,75,,60,percent of total billed charges,75% of total billed charges,11.85,122,,,fee schedule,122% of APC rate,29,29,,23.2,percent of total billed charges,29% of total billed charges,9.72,100,,,fee schedule,100% of CMS fee schedule,67,67,,53.6,percent of total billed charges,67% of total billed charges,12.63,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,80,80,,64,percent of total billed charges,80% of total billed charges,65,65,,52,percent of total billed charges,65% of total billed charges,35.67,35.67,,28.536,percent of total billed charges,35.67% of total billed charges,9.72,90,
FLECAINIDE,3004280,CDM,300,RC,80181,HCPCS,outpatient,,,147,58.80,,124.95,85,,99.96,percent of total billed charges,85% of total billed charges,113.19,77,,90.55,percent of total billed charges,77% of total billed charges,18.64,100,,,fee schedule,100% of CMS fee schedule,65.24,350,,,fee schedule,350% of BCBS fee schedule,67.85,364,,,fee schedule,364% of BCBS fee schedule,67.85,364,,,fee schedule,364% of BCBS fee schedule,67.85,364,,,fee schedule,364% of BCBS fee schedule,132.3,90,,105.84,percent of total billed charges,90% of total billed charges,117.6,80,,94.08,percent of total billed charges,80% of total billed charges,132.3,90,,105.84,percent of total billed charges,90% of total billed charges,110.25,75,,88.2,percent of total billed charges,75% of total billed charges,22.74,122,,,fee schedule,122% of APC rate,42.63,29,,34.104,percent of total billed charges,29% of total billed charges,18.64,100,,,fee schedule,100% of CMS fee schedule,98.49,67,,78.792,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,117.6,80,,94.08,percent of total billed charges,80% of total billed charges,95.55,65,,76.44,percent of total billed charges,65% of total billed charges,52.43,35.67,,41.944,percent of total billed charges,35.67% of total billed charges,18.64,132.3,
FLOW CYTOMETRY EACH CELL,3004284,CDM,300,RC,86356,HCPCS,outpatient,,,131,52.40,,111.35,85,,89.08,percent of total billed charges,85% of total billed charges,100.87,77,,80.7,percent of total billed charges,77% of total billed charges,26.78,100,,,fee schedule,100% of CMS fee schedule,115.71,350,,,fee schedule,350% of BCBS fee schedule,120.34,364,,,fee schedule,364% of BCBS fee schedule,120.34,364,,,fee schedule,364% of BCBS fee schedule,120.34,364,,,fee schedule,364% of BCBS fee schedule,117.9,90,,94.32,percent of total billed charges,90% of total billed charges,104.8,80,,83.84,percent of total billed charges,80% of total billed charges,117.9,90,,94.32,percent of total billed charges,90% of total billed charges,98.25,75,,78.6,percent of total billed charges,75% of total billed charges,32.67,122,,,fee schedule,122% of APC rate,37.99,29,,30.392,percent of total billed charges,29% of total billed charges,26.78,100,,,fee schedule,100% of CMS fee schedule,87.77,67,,70.216,percent of total billed charges,67% of total billed charges,39.81,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,104.8,80,,83.84,percent of total billed charges,80% of total billed charges,85.15,65,,68.12,percent of total billed charges,65% of total billed charges,46.73,35.67,,37.384,percent of total billed charges,35.67% of total billed charges,26.78,120.34,
FLUID ANALYSIS,3004285,CDM,300,RC,,,outpatient,,,382,152.80,,324.7,85,,259.76,percent of total billed charges,85% of total billed charges,294.14,77,,235.31,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,313.24,82,,250.592,percent of total billed charges,82% of total billed charges,324.7,85,,259.76,percent of total billed charges,85% of total billed charges,324.7,85,,259.76,percent of total billed charges,85% of total billed charges,324.7,85,,259.76,percent of total billed charges,85% of total billed charges,343.8,90,,275.04,percent of total billed charges,90% of total billed charges,305.6,80,,244.48,percent of total billed charges,80% of total billed charges,343.8,90,,275.04,percent of total billed charges,90% of total billed charges,286.5,75,,229.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,110.78,29,,88.624,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,255.94,67,,204.752,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,305.6,80,,244.48,percent of total billed charges,80% of total billed charges,248.3,65,,198.64,percent of total billed charges,65% of total billed charges,136.26,35.67,,109.008,percent of total billed charges,35.67% of total billed charges,110.78,343.8,
INFLUENZA A ANTIGEN,3004287,CDM,300,RC,87804,HCPCS,outpatient,,,97,38.80,QW,82.45,85,,65.96,percent of total billed charges,85% of total billed charges,74.69,77,,59.75,percent of total billed charges,77% of total billed charges,16.55,100,,,fee schedule,100% of CMS fee schedule,57.93,350,,,fee schedule,350% of BCBS fee schedule,60.24,364,,,fee schedule,364% of BCBS fee schedule,60.24,364,,,fee schedule,364% of BCBS fee schedule,60.24,364,,,fee schedule,364% of BCBS fee schedule,87.3,90,,69.84,percent of total billed charges,90% of total billed charges,77.6,80,,62.08,percent of total billed charges,80% of total billed charges,87.3,90,,69.84,percent of total billed charges,90% of total billed charges,72.75,75,,58.2,percent of total billed charges,75% of total billed charges,20.19,122,,,fee schedule,122% of APC rate,28.13,29,,22.504,percent of total billed charges,29% of total billed charges,16.55,100,,,fee schedule,100% of CMS fee schedule,64.99,67,,51.992,percent of total billed charges,67% of total billed charges,15.41,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,77.6,80,,62.08,percent of total billed charges,80% of total billed charges,63.05,65,,50.44,percent of total billed charges,65% of total billed charges,34.6,35.67,,27.68,percent of total billed charges,35.67% of total billed charges,15.41,87.3,
INFLUENZA B ANTIGEN,3004288,CDM,300,RC,87804,HCPCS,outpatient,,,97,38.80,,82.45,85,,65.96,percent of total billed charges,85% of total billed charges,74.69,77,,59.75,percent of total billed charges,77% of total billed charges,16.55,100,,,fee schedule,100% of CMS fee schedule,57.93,350,,,fee schedule,350% of BCBS fee schedule,60.24,364,,,fee schedule,364% of BCBS fee schedule,60.24,364,,,fee schedule,364% of BCBS fee schedule,60.24,364,,,fee schedule,364% of BCBS fee schedule,87.3,90,,69.84,percent of total billed charges,90% of total billed charges,77.6,80,,62.08,percent of total billed charges,80% of total billed charges,87.3,90,,69.84,percent of total billed charges,90% of total billed charges,72.75,75,,58.2,percent of total billed charges,75% of total billed charges,20.19,122,,,fee schedule,122% of APC rate,28.13,29,,22.504,percent of total billed charges,29% of total billed charges,16.55,100,,,fee schedule,100% of CMS fee schedule,64.99,67,,51.992,percent of total billed charges,67% of total billed charges,15.41,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,77.6,80,,62.08,percent of total billed charges,80% of total billed charges,63.05,65,,50.44,percent of total billed charges,65% of total billed charges,34.6,35.67,,27.68,percent of total billed charges,35.67% of total billed charges,15.41,87.3,
FLUORESCENT TITER FOR PANEL,3004301,CDM,300,RC,86256,HCPCS,outpatient,,,113,45.20,,96.05,85,,76.84,percent of total billed charges,85% of total billed charges,87.01,77,,69.61,percent of total billed charges,77% of total billed charges,12.05,100,,,fee schedule,100% of CMS fee schedule,52.08,350,,,fee schedule,350% of BCBS fee schedule,54.16,364,,,fee schedule,364% of BCBS fee schedule,54.16,364,,,fee schedule,364% of BCBS fee schedule,54.16,364,,,fee schedule,364% of BCBS fee schedule,101.7,90,,81.36,percent of total billed charges,90% of total billed charges,90.4,80,,72.32,percent of total billed charges,80% of total billed charges,101.7,90,,81.36,percent of total billed charges,90% of total billed charges,84.75,75,,67.8,percent of total billed charges,75% of total billed charges,14.7,122,,,fee schedule,122% of APC rate,32.77,29,,26.216,percent of total billed charges,29% of total billed charges,12.05,100,,,fee schedule,100% of CMS fee schedule,75.71,67,,60.568,percent of total billed charges,67% of total billed charges,17.92,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,90.4,80,,72.32,percent of total billed charges,80% of total billed charges,73.45,65,,58.76,percent of total billed charges,65% of total billed charges,40.31,35.67,,32.248,percent of total billed charges,35.67% of total billed charges,12.05,101.7,
FLUPHENAZINE,3004320,CDM,300,RC,80299,HCPCS,outpatient,,,147,58.80,,124.95,85,,99.96,percent of total billed charges,85% of total billed charges,113.19,77,,90.55,percent of total billed charges,77% of total billed charges,18.64,100,,,fee schedule,100% of CMS fee schedule,65.24,350,,,fee schedule,350% of BCBS fee schedule,67.85,364,,,fee schedule,364% of BCBS fee schedule,67.85,364,,,fee schedule,364% of BCBS fee schedule,67.85,364,,,fee schedule,364% of BCBS fee schedule,132.3,90,,105.84,percent of total billed charges,90% of total billed charges,117.6,80,,94.08,percent of total billed charges,80% of total billed charges,132.3,90,,105.84,percent of total billed charges,90% of total billed charges,110.25,75,,88.2,percent of total billed charges,75% of total billed charges,22.74,122,,,fee schedule,122% of APC rate,42.63,29,,34.104,percent of total billed charges,29% of total billed charges,18.64,100,,,fee schedule,100% of CMS fee schedule,98.49,67,,78.792,percent of total billed charges,67% of total billed charges,20.36,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,117.6,80,,94.08,percent of total billed charges,80% of total billed charges,95.55,65,,76.44,percent of total billed charges,65% of total billed charges,52.43,35.67,,41.944,percent of total billed charges,35.67% of total billed charges,18.64,132.3,
FOLIC ACID,3004360,CDM,300,RC,82746,HCPCS,outpatient,,,74,29.60,,62.9,85,,50.32,percent of total billed charges,85% of total billed charges,56.98,77,,45.58,percent of total billed charges,77% of total billed charges,14.7,100,,,fee schedule,100% of CMS fee schedule,63.53,350,,,fee schedule,350% of BCBS fee schedule,66.07,364,,,fee schedule,364% of BCBS fee schedule,66.07,364,,,fee schedule,364% of BCBS fee schedule,66.07,364,,,fee schedule,364% of BCBS fee schedule,66.6,90,,53.28,percent of total billed charges,90% of total billed charges,59.2,80,,47.36,percent of total billed charges,80% of total billed charges,66.6,90,,53.28,percent of total billed charges,90% of total billed charges,55.5,75,,44.4,percent of total billed charges,75% of total billed charges,17.93,122,,,fee schedule,122% of APC rate,21.46,29,,17.168,percent of total billed charges,29% of total billed charges,14.7,100,,,fee schedule,100% of CMS fee schedule,49.58,67,,39.664,percent of total billed charges,67% of total billed charges,21.86,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,59.2,80,,47.36,percent of total billed charges,80% of total billed charges,48.1,65,,38.48,percent of total billed charges,65% of total billed charges,26.4,35.67,,21.12,percent of total billed charges,35.67% of total billed charges,14.7,66.6,
FOLIC ACID RBC,3004380,CDM,300,RC,82747,HCPCS,outpatient,,,125,50.00,,106.25,85,,85,percent of total billed charges,85% of total billed charges,96.25,77,,77,percent of total billed charges,77% of total billed charges,17.64,100,,,fee schedule,100% of CMS fee schedule,74.83,350,,,fee schedule,350% of BCBS fee schedule,77.82,364,,,fee schedule,364% of BCBS fee schedule,77.82,364,,,fee schedule,364% of BCBS fee schedule,77.82,364,,,fee schedule,364% of BCBS fee schedule,112.5,90,,90,percent of total billed charges,90% of total billed charges,100,80,,80,percent of total billed charges,80% of total billed charges,112.5,90,,90,percent of total billed charges,90% of total billed charges,93.75,75,,75,percent of total billed charges,75% of total billed charges,21.53,122,,,fee schedule,122% of APC rate,36.25,29,,29,percent of total billed charges,29% of total billed charges,17.64,100,,,fee schedule,100% of CMS fee schedule,83.75,67,,67,percent of total billed charges,67% of total billed charges,17.31,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,100,80,,80,percent of total billed charges,80% of total billed charges,81.25,65,,65,percent of total billed charges,65% of total billed charges,44.59,35.67,,35.672,percent of total billed charges,35.67% of total billed charges,17.31,112.5,
FLOWCYTOMETRY TC 1 MARKER,3004381,CDM,300,RC,88184,HCPCS,outpatient,,,728,291.20,,618.8,85,,495.04,percent of total billed charges,85% of total billed charges,560.56,77,,448.45,percent of total billed charges,77% of total billed charges,314.34,100,,,fee schedule,100% of CMS OPPS rate,754.01,350,,,fee schedule,350% of BCBS fee schedule,784.17,364,,,fee schedule,364% of BCBS fee schedule,784.17,364,,,fee schedule,364% of BCBS fee schedule,784.17,364,,,fee schedule,364% of BCBS fee schedule,655.2,90,,524.16,percent of total billed charges,90% of total billed charges,582.4,80,,465.92,percent of total billed charges,80% of total billed charges,655.2,90,,524.16,percent of total billed charges,90% of total billed charges,546,75,,436.8,percent of total billed charges,75% of total billed charges,383.5,122,,,fee schedule,122% of APC rate,211.12,29,,168.896,percent of total billed charges,29% of total billed charges,314.34,100,,,fee schedule,100% of CMS OPPS rate,487.76,67,,390.208,percent of total billed charges,67% of total billed charges,15.91,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,582.4,80,,465.92,percent of total billed charges,80% of total billed charges,473.2,65,,378.56,percent of total billed charges,65% of total billed charges,259.68,35.67,,207.744,percent of total billed charges,35.67% of total billed charges,15.91,784.17,
FLOWCYTOMETRY TC ADD ON MARKER,3004382,CDM,300,RC,88185,HCPCS,outpatient,,,189,75.60,,160.65,85,,128.52,percent of total billed charges,85% of total billed charges,145.53,77,,116.42,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,106.79,350,,,fee schedule,350% of BCBS fee schedule,111.06,364,,,fee schedule,364% of BCBS fee schedule,111.06,364,,,fee schedule,364% of BCBS fee schedule,111.06,364,,,fee schedule,364% of BCBS fee schedule,170.1,90,,136.08,percent of total billed charges,90% of total billed charges,151.2,80,,120.96,percent of total billed charges,80% of total billed charges,170.1,90,,136.08,percent of total billed charges,90% of total billed charges,141.75,75,,113.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,54.81,29,,43.848,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,126.63,67,,101.304,percent of total billed charges,67% of total billed charges,15.91,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,151.2,80,,120.96,percent of total billed charges,80% of total billed charges,122.85,65,,98.28,percent of total billed charges,65% of total billed charges,67.42,35.67,,53.936,percent of total billed charges,35.67% of total billed charges,15.91,170.1,
FREE T3,3004400,CDM,300,RC,84481,HCPCS,outpatient,,,109,43.60,,92.65,85,,74.12,percent of total billed charges,85% of total billed charges,83.93,77,,67.14,percent of total billed charges,77% of total billed charges,16.94,100,,,fee schedule,100% of CMS fee schedule,73.22,350,,,fee schedule,350% of BCBS fee schedule,76.15,364,,,fee schedule,364% of BCBS fee schedule,76.15,364,,,fee schedule,364% of BCBS fee schedule,76.15,364,,,fee schedule,364% of BCBS fee schedule,98.1,90,,78.48,percent of total billed charges,90% of total billed charges,87.2,80,,69.76,percent of total billed charges,80% of total billed charges,98.1,90,,78.48,percent of total billed charges,90% of total billed charges,81.75,75,,65.4,percent of total billed charges,75% of total billed charges,20.66,122,,,fee schedule,122% of APC rate,31.61,29,,25.288,percent of total billed charges,29% of total billed charges,16.94,100,,,fee schedule,100% of CMS fee schedule,73.03,67,,58.424,percent of total billed charges,67% of total billed charges,25.2,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,87.2,80,,69.76,percent of total billed charges,80% of total billed charges,70.85,65,,56.68,percent of total billed charges,65% of total billed charges,38.88,35.67,,31.104,percent of total billed charges,35.67% of total billed charges,16.94,98.1,
FREE T4,3004420,CDM,300,RC,84439,HCPCS,outpatient,,,87,34.80,,73.95,85,,59.16,percent of total billed charges,85% of total billed charges,66.99,77,,53.59,percent of total billed charges,77% of total billed charges,9.02,100,,,fee schedule,100% of CMS fee schedule,38.96,350,,,fee schedule,350% of BCBS fee schedule,40.51,364,,,fee schedule,364% of BCBS fee schedule,40.51,364,,,fee schedule,364% of BCBS fee schedule,40.51,364,,,fee schedule,364% of BCBS fee schedule,78.3,90,,62.64,percent of total billed charges,90% of total billed charges,69.6,80,,55.68,percent of total billed charges,80% of total billed charges,78.3,90,,62.64,percent of total billed charges,90% of total billed charges,65.25,75,,52.2,percent of total billed charges,75% of total billed charges,11,122,,,fee schedule,122% of APC rate,25.23,29,,20.184,percent of total billed charges,29% of total billed charges,9.02,100,,,fee schedule,100% of CMS fee schedule,58.29,67,,46.632,percent of total billed charges,67% of total billed charges,13.4,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,69.6,80,,55.68,percent of total billed charges,80% of total billed charges,56.55,65,,45.24,percent of total billed charges,65% of total billed charges,31.03,35.67,,24.824,percent of total billed charges,35.67% of total billed charges,9.02,78.3,
FREE VALPROIC ACID,3004421,CDM,300,RC,80164,HCPCS,outpatient,,,66,26.40,,56.1,85,,44.88,percent of total billed charges,85% of total billed charges,50.82,77,,40.66,percent of total billed charges,77% of total billed charges,13.54,100,,,fee schedule,100% of CMS fee schedule,58.52,350,,,fee schedule,350% of BCBS fee schedule,60.86,364,,,fee schedule,364% of BCBS fee schedule,60.86,364,,,fee schedule,364% of BCBS fee schedule,60.86,364,,,fee schedule,364% of BCBS fee schedule,59.4,90,,47.52,percent of total billed charges,90% of total billed charges,52.8,80,,42.24,percent of total billed charges,80% of total billed charges,59.4,90,,47.52,percent of total billed charges,90% of total billed charges,49.5,75,,39.6,percent of total billed charges,75% of total billed charges,16.51,122,,,fee schedule,122% of APC rate,19.14,29,,15.312,percent of total billed charges,29% of total billed charges,13.54,100,,,fee schedule,100% of CMS fee schedule,44.22,67,,35.376,percent of total billed charges,67% of total billed charges,20.14,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,52.8,80,,42.24,percent of total billed charges,80% of total billed charges,42.9,65,,34.32,percent of total billed charges,65% of total billed charges,23.54,35.67,,18.832,percent of total billed charges,35.67% of total billed charges,13.54,60.86,
PSA FREE,3004430,CDM,300,RC,84154,HCPCS,outpatient,,,181,72.40,,153.85,85,,123.08,percent of total billed charges,85% of total billed charges,139.37,77,,111.5,percent of total billed charges,77% of total billed charges,18.39,100,,,fee schedule,100% of CMS fee schedule,79.49,350,,,fee schedule,350% of BCBS fee schedule,82.66,364,,,fee schedule,364% of BCBS fee schedule,82.66,364,,,fee schedule,364% of BCBS fee schedule,82.66,364,,,fee schedule,364% of BCBS fee schedule,162.9,90,,130.32,percent of total billed charges,90% of total billed charges,144.8,80,,115.84,percent of total billed charges,80% of total billed charges,162.9,90,,130.32,percent of total billed charges,90% of total billed charges,135.75,75,,108.6,percent of total billed charges,75% of total billed charges,22.43,122,,,fee schedule,122% of APC rate,52.49,29,,41.992,percent of total billed charges,29% of total billed charges,18.39,100,,,fee schedule,100% of CMS fee schedule,121.27,67,,97.016,percent of total billed charges,67% of total billed charges,27.36,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,144.8,80,,115.84,percent of total billed charges,80% of total billed charges,117.65,65,,94.12,percent of total billed charges,65% of total billed charges,64.56,35.67,,51.648,percent of total billed charges,35.67% of total billed charges,18.39,162.9,
FREE THYROXIN INDEX,3004440,CDM,300,RC,84439,HCPCS,outpatient,,,58,23.20,,49.3,85,,39.44,percent of total billed charges,85% of total billed charges,44.66,77,,35.73,percent of total billed charges,77% of total billed charges,9.02,100,,,fee schedule,100% of CMS fee schedule,38.96,350,,,fee schedule,350% of BCBS fee schedule,40.51,364,,,fee schedule,364% of BCBS fee schedule,40.51,364,,,fee schedule,364% of BCBS fee schedule,40.51,364,,,fee schedule,364% of BCBS fee schedule,52.2,90,,41.76,percent of total billed charges,90% of total billed charges,46.4,80,,37.12,percent of total billed charges,80% of total billed charges,52.2,90,,41.76,percent of total billed charges,90% of total billed charges,43.5,75,,34.8,percent of total billed charges,75% of total billed charges,11,122,,,fee schedule,122% of APC rate,16.82,29,,13.456,percent of total billed charges,29% of total billed charges,9.02,100,,,fee schedule,100% of CMS fee schedule,38.86,67,,31.088,percent of total billed charges,67% of total billed charges,13.4,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,46.4,80,,37.12,percent of total billed charges,80% of total billed charges,37.7,65,,30.16,percent of total billed charges,65% of total billed charges,20.69,35.67,,16.552,percent of total billed charges,35.67% of total billed charges,9.02,52.2,
FIBRINOLYSIN QUALITATIVE,3004441,CDM,300,RC,85390,HCPCS,outpatient,,,62,24.80,,52.7,85,,42.16,percent of total billed charges,85% of total billed charges,47.74,77,,38.19,percent of total billed charges,77% of total billed charges,15.48,100,,,fee schedule,100% of CMS fee schedule,54.18,350,,,fee schedule,350% of BCBS fee schedule,56.35,364,,,fee schedule,364% of BCBS fee schedule,56.35,364,,,fee schedule,364% of BCBS fee schedule,56.35,364,,,fee schedule,364% of BCBS fee schedule,55.8,90,,44.64,percent of total billed charges,90% of total billed charges,49.6,80,,39.68,percent of total billed charges,80% of total billed charges,55.8,90,,44.64,percent of total billed charges,90% of total billed charges,46.5,75,,37.2,percent of total billed charges,75% of total billed charges,18.88,122,,,fee schedule,122% of APC rate,17.98,29,,14.384,percent of total billed charges,29% of total billed charges,15.48,100,,,fee schedule,100% of CMS fee schedule,41.54,67,,33.232,percent of total billed charges,67% of total billed charges,7.68,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,49.6,80,,39.68,percent of total billed charges,80% of total billed charges,40.3,65,,32.24,percent of total billed charges,65% of total billed charges,22.12,35.67,,17.696,percent of total billed charges,35.67% of total billed charges,7.68,56.35,
FIBRINOLYSIN QUANTITATIVE,3004445,CDM,300,RC,85390,HCPCS,outpatient,,,33,13.20,,28.05,85,,22.44,percent of total billed charges,85% of total billed charges,25.41,77,,20.33,percent of total billed charges,77% of total billed charges,15.48,100,,,fee schedule,100% of CMS fee schedule,54.18,350,,,fee schedule,350% of BCBS fee schedule,56.35,364,,,fee schedule,364% of BCBS fee schedule,56.35,364,,,fee schedule,364% of BCBS fee schedule,56.35,364,,,fee schedule,364% of BCBS fee schedule,29.7,90,,23.76,percent of total billed charges,90% of total billed charges,26.4,80,,21.12,percent of total billed charges,80% of total billed charges,29.7,90,,23.76,percent of total billed charges,90% of total billed charges,24.75,75,,19.8,percent of total billed charges,75% of total billed charges,18.88,122,,,fee schedule,122% of APC rate,9.57,29,,7.656,percent of total billed charges,29% of total billed charges,15.48,100,,,fee schedule,100% of CMS fee schedule,22.11,67,,17.688,percent of total billed charges,67% of total billed charges,7.68,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,26.4,80,,21.12,percent of total billed charges,80% of total billed charges,21.45,65,,17.16,percent of total billed charges,65% of total billed charges,11.77,35.67,,9.416,percent of total billed charges,35.67% of total billed charges,7.68,56.35,
FSH,3004460,CDM,300,RC,83001,HCPCS,outpatient,,,152,60.80,,129.2,85,,103.36,percent of total billed charges,85% of total billed charges,117.04,77,,93.63,percent of total billed charges,77% of total billed charges,18.57,100,,,fee schedule,100% of CMS fee schedule,80.29,350,,,fee schedule,350% of BCBS fee schedule,83.5,364,,,fee schedule,364% of BCBS fee schedule,83.5,364,,,fee schedule,364% of BCBS fee schedule,83.5,364,,,fee schedule,364% of BCBS fee schedule,136.8,90,,109.44,percent of total billed charges,90% of total billed charges,121.6,80,,97.28,percent of total billed charges,80% of total billed charges,136.8,90,,109.44,percent of total billed charges,90% of total billed charges,114,75,,91.2,percent of total billed charges,75% of total billed charges,22.66,122,,,fee schedule,122% of APC rate,44.08,29,,35.264,percent of total billed charges,29% of total billed charges,18.57,100,,,fee schedule,100% of CMS fee schedule,101.84,67,,81.472,percent of total billed charges,67% of total billed charges,27.63,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,121.6,80,,97.28,percent of total billed charges,80% of total billed charges,98.8,65,,79.04,percent of total billed charges,65% of total billed charges,54.22,35.67,,43.376,percent of total billed charges,35.67% of total billed charges,18.57,136.8,
GASTROCCULT,3004461,CDM,300,RC,82271,HCPCS,outpatient,,,43,17.20,,36.55,85,,29.24,percent of total billed charges,85% of total billed charges,33.11,77,,26.49,percent of total billed charges,77% of total billed charges,5.32,100,,,fee schedule,100% of CMS fee schedule,18.62,350,,,fee schedule,350% of BCBS fee schedule,19.36,364,,,fee schedule,364% of BCBS fee schedule,19.36,364,,,fee schedule,364% of BCBS fee schedule,19.36,364,,,fee schedule,364% of BCBS fee schedule,38.7,90,,30.96,percent of total billed charges,90% of total billed charges,34.4,80,,27.52,percent of total billed charges,80% of total billed charges,38.7,90,,30.96,percent of total billed charges,90% of total billed charges,32.25,75,,25.8,percent of total billed charges,75% of total billed charges,6.49,122,,,fee schedule,122% of APC rate,12.47,29,,9.976,percent of total billed charges,29% of total billed charges,5.32,100,,,fee schedule,100% of CMS fee schedule,28.81,67,,23.048,percent of total billed charges,67% of total billed charges,4.84,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,34.4,80,,27.52,percent of total billed charges,80% of total billed charges,27.95,65,,22.36,percent of total billed charges,65% of total billed charges,15.34,35.67,,12.272,percent of total billed charges,35.67% of total billed charges,4.84,38.7,
ANA,3004465,CDM,300,RC,86038,HCPCS,outpatient,,,61,24.40,,51.85,85,,41.48,percent of total billed charges,85% of total billed charges,46.97,77,,37.58,percent of total billed charges,77% of total billed charges,12.09,100,,,fee schedule,100% of CMS fee schedule,52.22,350,,,fee schedule,350% of BCBS fee schedule,54.31,364,,,fee schedule,364% of BCBS fee schedule,54.31,364,,,fee schedule,364% of BCBS fee schedule,54.31,364,,,fee schedule,364% of BCBS fee schedule,54.9,90,,43.92,percent of total billed charges,90% of total billed charges,48.8,80,,39.04,percent of total billed charges,80% of total billed charges,54.9,90,,43.92,percent of total billed charges,90% of total billed charges,45.75,75,,36.6,percent of total billed charges,75% of total billed charges,14.74,122,,,fee schedule,122% of APC rate,17.69,29,,14.152,percent of total billed charges,29% of total billed charges,12.09,100,,,fee schedule,100% of CMS fee schedule,40.87,67,,32.696,percent of total billed charges,67% of total billed charges,17.97,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,48.8,80,,39.04,percent of total billed charges,80% of total billed charges,39.65,65,,31.72,percent of total billed charges,65% of total billed charges,21.76,35.67,,17.408,percent of total billed charges,35.67% of total billed charges,12.09,54.9,
GAMMA GLUTAMYL TRASFERASE,3004480,CDM,300,RC,82977,HCPCS,outpatient,,,53,21.20,,45.05,85,,36.04,percent of total billed charges,85% of total billed charges,40.81,77,,32.65,percent of total billed charges,77% of total billed charges,7.2,100,,,fee schedule,100% of CMS fee schedule,31.12,350,,,fee schedule,350% of BCBS fee schedule,32.36,364,,,fee schedule,364% of BCBS fee schedule,32.36,364,,,fee schedule,364% of BCBS fee schedule,32.36,364,,,fee schedule,364% of BCBS fee schedule,47.7,90,,38.16,percent of total billed charges,90% of total billed charges,42.4,80,,33.92,percent of total billed charges,80% of total billed charges,47.7,90,,38.16,percent of total billed charges,90% of total billed charges,39.75,75,,31.8,percent of total billed charges,75% of total billed charges,8.78,122,,,fee schedule,122% of APC rate,15.37,29,,12.296,percent of total billed charges,29% of total billed charges,7.2,100,,,fee schedule,100% of CMS fee schedule,35.51,67,,28.408,percent of total billed charges,67% of total billed charges,10.71,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,42.4,80,,33.92,percent of total billed charges,80% of total billed charges,34.45,65,,27.56,percent of total billed charges,65% of total billed charges,18.91,35.67,,15.128,percent of total billed charges,35.67% of total billed charges,7.2,47.7,
GARDNERELLA VAGINALIS DIRECT,3004490,CDM,300,RC,87510,HCPCS,outpatient,,,98,39.20,,83.3,85,,66.64,percent of total billed charges,85% of total billed charges,75.46,77,,60.37,percent of total billed charges,77% of total billed charges,20.05,100,,,fee schedule,100% of CMS fee schedule,86.66,350,,,fee schedule,350% of BCBS fee schedule,90.13,364,,,fee schedule,364% of BCBS fee schedule,90.13,364,,,fee schedule,364% of BCBS fee schedule,90.13,364,,,fee schedule,364% of BCBS fee schedule,88.2,90,,70.56,percent of total billed charges,90% of total billed charges,78.4,80,,62.72,percent of total billed charges,80% of total billed charges,88.2,90,,70.56,percent of total billed charges,90% of total billed charges,73.5,75,,58.8,percent of total billed charges,75% of total billed charges,24.46,122,,,fee schedule,122% of APC rate,28.42,29,,22.736,percent of total billed charges,29% of total billed charges,20.05,100,,,fee schedule,100% of CMS fee schedule,65.66,67,,52.528,percent of total billed charges,67% of total billed charges,29.82,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,78.4,80,,62.72,percent of total billed charges,80% of total billed charges,63.7,65,,50.96,percent of total billed charges,65% of total billed charges,34.96,35.67,,27.968,percent of total billed charges,35.67% of total billed charges,20.05,90.13,
GASTRIN,3004500,CDM,300,RC,82941,HCPCS,outpatient,,,97,38.80,,82.45,85,,65.96,percent of total billed charges,85% of total billed charges,74.69,77,,59.75,percent of total billed charges,77% of total billed charges,17.63,100,,,fee schedule,100% of CMS fee schedule,76.2,350,,,fee schedule,350% of BCBS fee schedule,79.24,364,,,fee schedule,364% of BCBS fee schedule,79.24,364,,,fee schedule,364% of BCBS fee schedule,79.24,364,,,fee schedule,364% of BCBS fee schedule,87.3,90,,69.84,percent of total billed charges,90% of total billed charges,77.6,80,,62.08,percent of total billed charges,80% of total billed charges,87.3,90,,69.84,percent of total billed charges,90% of total billed charges,72.75,75,,58.2,percent of total billed charges,75% of total billed charges,21.5,122,,,fee schedule,122% of APC rate,28.13,29,,22.504,percent of total billed charges,29% of total billed charges,17.63,100,,,fee schedule,100% of CMS fee schedule,64.99,67,,51.992,percent of total billed charges,67% of total billed charges,26.22,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,77.6,80,,62.08,percent of total billed charges,80% of total billed charges,63.05,65,,50.44,percent of total billed charges,65% of total billed charges,34.6,35.67,,27.68,percent of total billed charges,35.67% of total billed charges,17.63,87.3,
GENTAMAYCIN,3004521,CDM,300,RC,80170,HCPCS,outpatient,,,93,37.20,,79.05,85,,63.24,percent of total billed charges,85% of total billed charges,71.61,77,,57.29,percent of total billed charges,77% of total billed charges,16.38,100,,,fee schedule,100% of CMS fee schedule,70.77,350,,,fee schedule,350% of BCBS fee schedule,73.6,364,,,fee schedule,364% of BCBS fee schedule,73.6,364,,,fee schedule,364% of BCBS fee schedule,73.6,364,,,fee schedule,364% of BCBS fee schedule,83.7,90,,66.96,percent of total billed charges,90% of total billed charges,74.4,80,,59.52,percent of total billed charges,80% of total billed charges,83.7,90,,66.96,percent of total billed charges,90% of total billed charges,69.75,75,,55.8,percent of total billed charges,75% of total billed charges,19.98,122,,,fee schedule,122% of APC rate,26.97,29,,21.576,percent of total billed charges,29% of total billed charges,16.38,100,,,fee schedule,100% of CMS fee schedule,62.31,67,,49.848,percent of total billed charges,67% of total billed charges,24.37,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,74.4,80,,59.52,percent of total billed charges,80% of total billed charges,60.45,65,,48.36,percent of total billed charges,65% of total billed charges,33.17,35.67,,26.536,percent of total billed charges,35.67% of total billed charges,16.38,83.7,
GENTAMICIN PEAK,3004522,CDM,300,RC,80170,HCPCS,outpatient,,,93,37.20,,79.05,85,,63.24,percent of total billed charges,85% of total billed charges,71.61,77,,57.29,percent of total billed charges,77% of total billed charges,16.38,100,,,fee schedule,100% of CMS fee schedule,70.77,350,,,fee schedule,350% of BCBS fee schedule,73.6,364,,,fee schedule,364% of BCBS fee schedule,73.6,364,,,fee schedule,364% of BCBS fee schedule,73.6,364,,,fee schedule,364% of BCBS fee schedule,83.7,90,,66.96,percent of total billed charges,90% of total billed charges,74.4,80,,59.52,percent of total billed charges,80% of total billed charges,83.7,90,,66.96,percent of total billed charges,90% of total billed charges,69.75,75,,55.8,percent of total billed charges,75% of total billed charges,19.98,122,,,fee schedule,122% of APC rate,26.97,29,,21.576,percent of total billed charges,29% of total billed charges,16.38,100,,,fee schedule,100% of CMS fee schedule,62.31,67,,49.848,percent of total billed charges,67% of total billed charges,24.37,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,74.4,80,,59.52,percent of total billed charges,80% of total billed charges,60.45,65,,48.36,percent of total billed charges,65% of total billed charges,33.17,35.67,,26.536,percent of total billed charges,35.67% of total billed charges,16.38,83.7,
GENTAMICIN TROUGH,3004523,CDM,300,RC,80170,HCPCS,outpatient,,,93,37.20,,79.05,85,,63.24,percent of total billed charges,85% of total billed charges,71.61,77,,57.29,percent of total billed charges,77% of total billed charges,16.38,100,,,fee schedule,100% of CMS fee schedule,70.77,350,,,fee schedule,350% of BCBS fee schedule,73.6,364,,,fee schedule,364% of BCBS fee schedule,73.6,364,,,fee schedule,364% of BCBS fee schedule,73.6,364,,,fee schedule,364% of BCBS fee schedule,83.7,90,,66.96,percent of total billed charges,90% of total billed charges,74.4,80,,59.52,percent of total billed charges,80% of total billed charges,83.7,90,,66.96,percent of total billed charges,90% of total billed charges,69.75,75,,55.8,percent of total billed charges,75% of total billed charges,19.98,122,,,fee schedule,122% of APC rate,26.97,29,,21.576,percent of total billed charges,29% of total billed charges,16.38,100,,,fee schedule,100% of CMS fee schedule,62.31,67,,49.848,percent of total billed charges,67% of total billed charges,24.37,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,74.4,80,,59.52,percent of total billed charges,80% of total billed charges,60.45,65,,48.36,percent of total billed charges,65% of total billed charges,33.17,35.67,,26.536,percent of total billed charges,35.67% of total billed charges,16.38,83.7,
GENETIC TESTING,3004541,CDM,300,RC,,,outpatient,,,843,337.20,,716.55,85,,573.24,percent of total billed charges,85% of total billed charges,649.11,77,,519.29,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,691.26,82,,553.008,percent of total billed charges,82% of total billed charges,716.55,85,,573.24,percent of total billed charges,85% of total billed charges,716.55,85,,573.24,percent of total billed charges,85% of total billed charges,716.55,85,,573.24,percent of total billed charges,85% of total billed charges,758.7,90,,606.96,percent of total billed charges,90% of total billed charges,674.4,80,,539.52,percent of total billed charges,80% of total billed charges,758.7,90,,606.96,percent of total billed charges,90% of total billed charges,632.25,75,,505.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,244.47,29,,195.576,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,564.81,67,,451.848,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,674.4,80,,539.52,percent of total billed charges,80% of total billed charges,547.95,65,,438.36,percent of total billed charges,65% of total billed charges,300.7,35.67,,240.56,percent of total billed charges,35.67% of total billed charges,244.47,758.7,
GENERAL HEALTH SCREEN,3004542,CDM,300,RC,,,outpatient,,,350,140.00,,297.5,85,,238,percent of total billed charges,85% of total billed charges,269.5,77,,215.6,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,287,82,,229.6,percent of total billed charges,82% of total billed charges,297.5,85,,238,percent of total billed charges,85% of total billed charges,297.5,85,,238,percent of total billed charges,85% of total billed charges,297.5,85,,238,percent of total billed charges,85% of total billed charges,315,90,,252,percent of total billed charges,90% of total billed charges,280,80,,224,percent of total billed charges,80% of total billed charges,315,90,,252,percent of total billed charges,90% of total billed charges,262.5,75,,210,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,101.5,29,,81.2,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,234.5,67,,187.6,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,280,80,,224,percent of total billed charges,80% of total billed charges,227.5,65,,182,percent of total billed charges,65% of total billed charges,124.85,35.67,,99.88,percent of total billed charges,35.67% of total billed charges,101.5,315,
GIARDIA ANTIGEN - STOOL,3004551,CDM,300,RC,87449,HCPCS,outpatient,,,128,51.20,,108.8,85,,87.04,percent of total billed charges,85% of total billed charges,98.56,77,,78.85,percent of total billed charges,77% of total billed charges,11.98,100,,,fee schedule,100% of CMS fee schedule,51.8,350,,,fee schedule,350% of BCBS fee schedule,53.87,364,,,fee schedule,364% of BCBS fee schedule,53.87,364,,,fee schedule,364% of BCBS fee schedule,53.87,364,,,fee schedule,364% of BCBS fee schedule,115.2,90,,92.16,percent of total billed charges,90% of total billed charges,102.4,80,,81.92,percent of total billed charges,80% of total billed charges,115.2,90,,92.16,percent of total billed charges,90% of total billed charges,96,75,,76.8,percent of total billed charges,75% of total billed charges,14.61,122,,,fee schedule,122% of APC rate,37.12,29,,29.696,percent of total billed charges,29% of total billed charges,11.98,100,,,fee schedule,100% of CMS fee schedule,85.76,67,,68.608,percent of total billed charges,67% of total billed charges,15.41,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,102.4,80,,81.92,percent of total billed charges,80% of total billed charges,83.2,65,,66.56,percent of total billed charges,65% of total billed charges,45.66,35.67,,36.528,percent of total billed charges,35.67% of total billed charges,11.98,115.2,
GLUCOSE 2HR PP,3004580,CDM,300,RC,82947,HCPCS,outpatient,,,52,20.80,,44.2,85,,35.36,percent of total billed charges,85% of total billed charges,40.04,77,,32.03,percent of total billed charges,77% of total billed charges,3.93,100,,,fee schedule,100% of CMS fee schedule,16.98,350,,,fee schedule,350% of BCBS fee schedule,17.65,364,,,fee schedule,364% of BCBS fee schedule,17.65,364,,,fee schedule,364% of BCBS fee schedule,17.65,364,,,fee schedule,364% of BCBS fee schedule,46.8,90,,37.44,percent of total billed charges,90% of total billed charges,41.6,80,,33.28,percent of total billed charges,80% of total billed charges,46.8,90,,37.44,percent of total billed charges,90% of total billed charges,39,75,,31.2,percent of total billed charges,75% of total billed charges,4.79,122,,,fee schedule,122% of APC rate,15.08,29,,12.064,percent of total billed charges,29% of total billed charges,3.93,100,,,fee schedule,100% of CMS fee schedule,34.84,67,,27.872,percent of total billed charges,67% of total billed charges,5.83,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,41.6,80,,33.28,percent of total billed charges,80% of total billed charges,33.8,65,,27.04,percent of total billed charges,65% of total billed charges,18.55,35.67,,14.84,percent of total billed charges,35.67% of total billed charges,3.93,46.8,
GLUCOSE TOLERANCE 3HR,3004600,CDM,300,RC,82951,HCPCS,outpatient,,,133,53.20,,113.05,85,,90.44,percent of total billed charges,85% of total billed charges,102.41,77,,81.93,percent of total billed charges,77% of total billed charges,12.87,100,,,fee schedule,100% of CMS fee schedule,55.62,350,,,fee schedule,350% of BCBS fee schedule,57.84,364,,,fee schedule,364% of BCBS fee schedule,57.84,364,,,fee schedule,364% of BCBS fee schedule,57.84,364,,,fee schedule,364% of BCBS fee schedule,119.7,90,,95.76,percent of total billed charges,90% of total billed charges,106.4,80,,85.12,percent of total billed charges,80% of total billed charges,119.7,90,,95.76,percent of total billed charges,90% of total billed charges,99.75,75,,79.8,percent of total billed charges,75% of total billed charges,15.7,122,,,fee schedule,122% of APC rate,38.57,29,,30.856,percent of total billed charges,29% of total billed charges,12.87,100,,,fee schedule,100% of CMS fee schedule,89.11,67,,71.288,percent of total billed charges,67% of total billed charges,19.14,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,106.4,80,,85.12,percent of total billed charges,80% of total billed charges,86.45,65,,69.16,percent of total billed charges,65% of total billed charges,47.44,35.67,,37.952,percent of total billed charges,35.67% of total billed charges,12.87,119.7,
GLUCOSE OB TOLERANCE 3 HR,3004601,CDM,300,RC,82951,HCPCS,outpatient,,,133,53.20,,113.05,85,,90.44,percent of total billed charges,85% of total billed charges,102.41,77,,81.93,percent of total billed charges,77% of total billed charges,12.87,100,,,fee schedule,100% of CMS fee schedule,55.62,350,,,fee schedule,350% of BCBS fee schedule,57.84,364,,,fee schedule,364% of BCBS fee schedule,57.84,364,,,fee schedule,364% of BCBS fee schedule,57.84,364,,,fee schedule,364% of BCBS fee schedule,119.7,90,,95.76,percent of total billed charges,90% of total billed charges,106.4,80,,85.12,percent of total billed charges,80% of total billed charges,119.7,90,,95.76,percent of total billed charges,90% of total billed charges,99.75,75,,79.8,percent of total billed charges,75% of total billed charges,15.7,122,,,fee schedule,122% of APC rate,38.57,29,,30.856,percent of total billed charges,29% of total billed charges,12.87,100,,,fee schedule,100% of CMS fee schedule,89.11,67,,71.288,percent of total billed charges,67% of total billed charges,19.14,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,106.4,80,,85.12,percent of total billed charges,80% of total billed charges,86.45,65,,69.16,percent of total billed charges,65% of total billed charges,47.44,35.67,,37.952,percent of total billed charges,35.67% of total billed charges,12.87,119.7,
GLUCOSE TOLERANCE 4HR,3004620,CDM,300,RC,82952,HCPCS,outpatient,,,47,18.80,,39.95,85,,31.96,percent of total billed charges,85% of total billed charges,36.19,77,,28.95,percent of total billed charges,77% of total billed charges,3.92,100,,,fee schedule,100% of CMS fee schedule,16.94,350,,,fee schedule,350% of BCBS fee schedule,17.62,364,,,fee schedule,364% of BCBS fee schedule,17.62,364,,,fee schedule,364% of BCBS fee schedule,17.62,364,,,fee schedule,364% of BCBS fee schedule,42.3,90,,33.84,percent of total billed charges,90% of total billed charges,37.6,80,,30.08,percent of total billed charges,80% of total billed charges,42.3,90,,33.84,percent of total billed charges,90% of total billed charges,35.25,75,,28.2,percent of total billed charges,75% of total billed charges,4.78,122,,,fee schedule,122% of APC rate,13.63,29,,10.904,percent of total billed charges,29% of total billed charges,3.92,100,,,fee schedule,100% of CMS fee schedule,31.49,67,,25.192,percent of total billed charges,67% of total billed charges,4.28,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,37.6,80,,30.08,percent of total billed charges,80% of total billed charges,30.55,65,,24.44,percent of total billed charges,65% of total billed charges,16.76,35.67,,13.408,percent of total billed charges,35.67% of total billed charges,3.92,42.3,
GLUCOSE CSF,3004680,CDM,300,RC,82945,HCPCS,outpatient,,,57,22.80,,48.45,85,,38.76,percent of total billed charges,85% of total billed charges,43.89,77,,35.11,percent of total billed charges,77% of total billed charges,3.93,100,,,fee schedule,100% of CMS fee schedule,16.98,350,,,fee schedule,350% of BCBS fee schedule,17.65,364,,,fee schedule,364% of BCBS fee schedule,17.65,364,,,fee schedule,364% of BCBS fee schedule,17.65,364,,,fee schedule,364% of BCBS fee schedule,51.3,90,,41.04,percent of total billed charges,90% of total billed charges,45.6,80,,36.48,percent of total billed charges,80% of total billed charges,51.3,90,,41.04,percent of total billed charges,90% of total billed charges,42.75,75,,34.2,percent of total billed charges,75% of total billed charges,4.79,122,,,fee schedule,122% of APC rate,16.53,29,,13.224,percent of total billed charges,29% of total billed charges,3.93,100,,,fee schedule,100% of CMS fee schedule,38.19,67,,30.552,percent of total billed charges,67% of total billed charges,5.83,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,45.6,80,,36.48,percent of total billed charges,80% of total billed charges,37.05,65,,29.64,percent of total billed charges,65% of total billed charges,20.33,35.67,,16.264,percent of total billed charges,35.67% of total billed charges,3.93,51.3,
GLUCOSE FASTING,3004700,CDM,300,RC,82947,HCPCS,outpatient,,,52,20.80,,44.2,85,,35.36,percent of total billed charges,85% of total billed charges,40.04,77,,32.03,percent of total billed charges,77% of total billed charges,3.93,100,,,fee schedule,100% of CMS fee schedule,16.98,350,,,fee schedule,350% of BCBS fee schedule,17.65,364,,,fee schedule,364% of BCBS fee schedule,17.65,364,,,fee schedule,364% of BCBS fee schedule,17.65,364,,,fee schedule,364% of BCBS fee schedule,46.8,90,,37.44,percent of total billed charges,90% of total billed charges,41.6,80,,33.28,percent of total billed charges,80% of total billed charges,46.8,90,,37.44,percent of total billed charges,90% of total billed charges,39,75,,31.2,percent of total billed charges,75% of total billed charges,4.79,122,,,fee schedule,122% of APC rate,15.08,29,,12.064,percent of total billed charges,29% of total billed charges,3.93,100,,,fee schedule,100% of CMS fee schedule,34.84,67,,27.872,percent of total billed charges,67% of total billed charges,5.83,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,41.6,80,,33.28,percent of total billed charges,80% of total billed charges,33.8,65,,27.04,percent of total billed charges,65% of total billed charges,18.55,35.67,,14.84,percent of total billed charges,35.67% of total billed charges,3.93,46.8,
GLUCOSE BODY FLUID,3004780,CDM,300,RC,82945,HCPCS,outpatient,,,70,28.00,,59.5,85,,47.6,percent of total billed charges,85% of total billed charges,53.9,77,,43.12,percent of total billed charges,77% of total billed charges,3.93,100,,,fee schedule,100% of CMS fee schedule,16.98,350,,,fee schedule,350% of BCBS fee schedule,17.65,364,,,fee schedule,364% of BCBS fee schedule,17.65,364,,,fee schedule,364% of BCBS fee schedule,17.65,364,,,fee schedule,364% of BCBS fee schedule,63,90,,50.4,percent of total billed charges,90% of total billed charges,56,80,,44.8,percent of total billed charges,80% of total billed charges,63,90,,50.4,percent of total billed charges,90% of total billed charges,52.5,75,,42,percent of total billed charges,75% of total billed charges,4.79,122,,,fee schedule,122% of APC rate,20.3,29,,16.24,percent of total billed charges,29% of total billed charges,3.93,100,,,fee schedule,100% of CMS fee schedule,46.9,67,,37.52,percent of total billed charges,67% of total billed charges,5.83,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,56,80,,44.8,percent of total billed charges,80% of total billed charges,45.5,65,,36.4,percent of total billed charges,65% of total billed charges,24.97,35.67,,19.976,percent of total billed charges,35.67% of total billed charges,3.93,63,
GLUCOSE RANDOM,3004800,CDM,300,RC,82947,HCPCS,outpatient,,,52,20.80,,44.2,85,,35.36,percent of total billed charges,85% of total billed charges,40.04,77,,32.03,percent of total billed charges,77% of total billed charges,3.93,100,,,fee schedule,100% of CMS fee schedule,16.98,350,,,fee schedule,350% of BCBS fee schedule,17.65,364,,,fee schedule,364% of BCBS fee schedule,17.65,364,,,fee schedule,364% of BCBS fee schedule,17.65,364,,,fee schedule,364% of BCBS fee schedule,46.8,90,,37.44,percent of total billed charges,90% of total billed charges,41.6,80,,33.28,percent of total billed charges,80% of total billed charges,46.8,90,,37.44,percent of total billed charges,90% of total billed charges,39,75,,31.2,percent of total billed charges,75% of total billed charges,4.79,122,,,fee schedule,122% of APC rate,15.08,29,,12.064,percent of total billed charges,29% of total billed charges,3.93,100,,,fee schedule,100% of CMS fee schedule,34.84,67,,27.872,percent of total billed charges,67% of total billed charges,5.83,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,41.6,80,,33.28,percent of total billed charges,80% of total billed charges,33.8,65,,27.04,percent of total billed charges,65% of total billed charges,18.55,35.67,,14.84,percent of total billed charges,35.67% of total billed charges,3.93,46.8,
GLUCOSE 1 HR TOLERANCE,3004810,CDM,300,RC,82950,HCPCS,outpatient,,,65,26.00,,55.25,85,,44.2,percent of total billed charges,85% of total billed charges,50.05,77,,40.04,percent of total billed charges,77% of total billed charges,4.75,100,,,fee schedule,100% of CMS fee schedule,20.51,350,,,fee schedule,350% of BCBS fee schedule,21.33,364,,,fee schedule,364% of BCBS fee schedule,21.33,364,,,fee schedule,364% of BCBS fee schedule,21.33,364,,,fee schedule,364% of BCBS fee schedule,58.5,90,,46.8,percent of total billed charges,90% of total billed charges,52,80,,41.6,percent of total billed charges,80% of total billed charges,58.5,90,,46.8,percent of total billed charges,90% of total billed charges,48.75,75,,39,percent of total billed charges,75% of total billed charges,5.79,122,,,fee schedule,122% of APC rate,18.85,29,,15.08,percent of total billed charges,29% of total billed charges,4.75,100,,,fee schedule,100% of CMS fee schedule,43.55,67,,34.84,percent of total billed charges,67% of total billed charges,7.06,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,52,80,,41.6,percent of total billed charges,80% of total billed charges,42.25,65,,33.8,percent of total billed charges,65% of total billed charges,23.19,35.67,,18.552,percent of total billed charges,35.67% of total billed charges,4.75,58.5,
GLUCOSE URINE RANDOM,3004840,CDM,300,RC,82945,HCPCS,outpatient,,,68,27.20,,57.8,85,,46.24,percent of total billed charges,85% of total billed charges,52.36,77,,41.89,percent of total billed charges,77% of total billed charges,3.93,100,,,fee schedule,100% of CMS fee schedule,16.98,350,,,fee schedule,350% of BCBS fee schedule,17.65,364,,,fee schedule,364% of BCBS fee schedule,17.65,364,,,fee schedule,364% of BCBS fee schedule,17.65,364,,,fee schedule,364% of BCBS fee schedule,61.2,90,,48.96,percent of total billed charges,90% of total billed charges,54.4,80,,43.52,percent of total billed charges,80% of total billed charges,61.2,90,,48.96,percent of total billed charges,90% of total billed charges,51,75,,40.8,percent of total billed charges,75% of total billed charges,4.79,122,,,fee schedule,122% of APC rate,19.72,29,,15.776,percent of total billed charges,29% of total billed charges,3.93,100,,,fee schedule,100% of CMS fee schedule,45.56,67,,36.448,percent of total billed charges,67% of total billed charges,5.83,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,54.4,80,,43.52,percent of total billed charges,80% of total billed charges,44.2,65,,35.36,percent of total billed charges,65% of total billed charges,24.26,35.67,,19.408,percent of total billed charges,35.67% of total billed charges,3.93,61.2,
GLUCOSE-6-PHOS DEHYDROGEN,3004880,CDM,300,RC,82960,HCPCS,outpatient,,,83,33.20,,70.55,85,,56.44,percent of total billed charges,85% of total billed charges,63.91,77,,51.13,percent of total billed charges,77% of total billed charges,6.05,100,,,fee schedule,100% of CMS fee schedule,26.15,350,,,fee schedule,350% of BCBS fee schedule,27.19,364,,,fee schedule,364% of BCBS fee schedule,27.19,364,,,fee schedule,364% of BCBS fee schedule,27.19,364,,,fee schedule,364% of BCBS fee schedule,74.7,90,,59.76,percent of total billed charges,90% of total billed charges,66.4,80,,53.12,percent of total billed charges,80% of total billed charges,74.7,90,,59.76,percent of total billed charges,90% of total billed charges,62.25,75,,49.8,percent of total billed charges,75% of total billed charges,7.38,122,,,fee schedule,122% of APC rate,24.07,29,,19.256,percent of total billed charges,29% of total billed charges,6.05,100,,,fee schedule,100% of CMS fee schedule,55.61,67,,44.488,percent of total billed charges,67% of total billed charges,8.64,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,66.4,80,,53.12,percent of total billed charges,80% of total billed charges,53.95,65,,43.16,percent of total billed charges,65% of total billed charges,29.61,35.67,,23.688,percent of total billed charges,35.67% of total billed charges,6.05,74.7,
GLYCOHEMOGLOBIN (A1C),3004920,CDM,300,RC,83036,HCPCS,outpatient,,,95,38.00,,80.75,85,,64.6,percent of total billed charges,85% of total billed charges,73.15,77,,58.52,percent of total billed charges,77% of total billed charges,9.71,100,,,fee schedule,100% of CMS fee schedule,41.97,350,,,fee schedule,350% of BCBS fee schedule,43.64,364,,,fee schedule,364% of BCBS fee schedule,43.64,364,,,fee schedule,364% of BCBS fee schedule,43.64,364,,,fee schedule,364% of BCBS fee schedule,85.5,90,,68.4,percent of total billed charges,90% of total billed charges,76,80,,60.8,percent of total billed charges,80% of total billed charges,85.5,90,,68.4,percent of total billed charges,90% of total billed charges,71.25,75,,57,percent of total billed charges,75% of total billed charges,11.84,122,,,fee schedule,122% of APC rate,27.55,29,,22.04,percent of total billed charges,29% of total billed charges,9.71,100,,,fee schedule,100% of CMS fee schedule,63.65,67,,50.92,percent of total billed charges,67% of total billed charges,14.43,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,76,80,,60.8,percent of total billed charges,80% of total billed charges,61.75,65,,49.4,percent of total billed charges,65% of total billed charges,33.89,35.67,,27.112,percent of total billed charges,35.67% of total billed charges,9.71,85.5,
GLYCOHGB WITH CALCULATION,3004921,CDM,300,RC,83036,HCPCS,outpatient,,,98,39.20,,83.3,85,,66.64,percent of total billed charges,85% of total billed charges,75.46,77,,60.37,percent of total billed charges,77% of total billed charges,9.71,100,,,fee schedule,100% of CMS fee schedule,41.97,350,,,fee schedule,350% of BCBS fee schedule,43.64,364,,,fee schedule,364% of BCBS fee schedule,43.64,364,,,fee schedule,364% of BCBS fee schedule,43.64,364,,,fee schedule,364% of BCBS fee schedule,88.2,90,,70.56,percent of total billed charges,90% of total billed charges,78.4,80,,62.72,percent of total billed charges,80% of total billed charges,88.2,90,,70.56,percent of total billed charges,90% of total billed charges,73.5,75,,58.8,percent of total billed charges,75% of total billed charges,11.84,122,,,fee schedule,122% of APC rate,28.42,29,,22.736,percent of total billed charges,29% of total billed charges,9.71,100,,,fee schedule,100% of CMS fee schedule,65.66,67,,52.528,percent of total billed charges,67% of total billed charges,14.43,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,78.4,80,,62.72,percent of total billed charges,80% of total billed charges,63.7,65,,50.96,percent of total billed charges,65% of total billed charges,34.96,35.67,,27.968,percent of total billed charges,35.67% of total billed charges,9.71,88.2,
GONADOTRODIN PITUIT,3004940,CDM,300,RC,83001,HCPCS,outpatient,,,113,45.20,,96.05,85,,76.84,percent of total billed charges,85% of total billed charges,87.01,77,,69.61,percent of total billed charges,77% of total billed charges,18.57,100,,,fee schedule,100% of CMS fee schedule,80.29,350,,,fee schedule,350% of BCBS fee schedule,83.5,364,,,fee schedule,364% of BCBS fee schedule,83.5,364,,,fee schedule,364% of BCBS fee schedule,83.5,364,,,fee schedule,364% of BCBS fee schedule,101.7,90,,81.36,percent of total billed charges,90% of total billed charges,90.4,80,,72.32,percent of total billed charges,80% of total billed charges,101.7,90,,81.36,percent of total billed charges,90% of total billed charges,84.75,75,,67.8,percent of total billed charges,75% of total billed charges,22.66,122,,,fee schedule,122% of APC rate,32.77,29,,26.216,percent of total billed charges,29% of total billed charges,18.57,100,,,fee schedule,100% of CMS fee schedule,75.71,67,,60.568,percent of total billed charges,67% of total billed charges,27.63,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,90.4,80,,72.32,percent of total billed charges,80% of total billed charges,73.45,65,,58.76,percent of total billed charges,65% of total billed charges,40.31,35.67,,32.248,percent of total billed charges,35.67% of total billed charges,18.57,101.7,
GONADOTROPIN hCG QUANTITATIVE,3004941,CDM,300,RC,84702,HCPCS,outpatient,,,66,26.40,,56.1,85,,44.88,percent of total billed charges,85% of total billed charges,50.82,77,,40.66,percent of total billed charges,77% of total billed charges,15.05,100,,,fee schedule,100% of CMS fee schedule,65.07,350,,,fee schedule,350% of BCBS fee schedule,67.67,364,,,fee schedule,364% of BCBS fee schedule,67.67,364,,,fee schedule,364% of BCBS fee schedule,67.67,364,,,fee schedule,364% of BCBS fee schedule,59.4,90,,47.52,percent of total billed charges,90% of total billed charges,52.8,80,,42.24,percent of total billed charges,80% of total billed charges,59.4,90,,47.52,percent of total billed charges,90% of total billed charges,49.5,75,,39.6,percent of total billed charges,75% of total billed charges,18.36,122,,,fee schedule,122% of APC rate,19.14,29,,15.312,percent of total billed charges,29% of total billed charges,15.05,100,,,fee schedule,100% of CMS fee schedule,44.22,67,,35.376,percent of total billed charges,67% of total billed charges,22.39,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,52.8,80,,42.24,percent of total billed charges,80% of total billed charges,42.9,65,,34.32,percent of total billed charges,65% of total billed charges,23.54,35.67,,18.832,percent of total billed charges,35.67% of total billed charges,15.05,67.67,
GRAM STAIN,3004960,CDM,300,RC,87205,HCPCS,outpatient,,,43,17.20,,36.55,85,,29.24,percent of total billed charges,85% of total billed charges,33.11,77,,26.49,percent of total billed charges,77% of total billed charges,4.26,100,,,fee schedule,100% of CMS fee schedule,18.45,350,,,fee schedule,350% of BCBS fee schedule,19.18,364,,,fee schedule,364% of BCBS fee schedule,19.18,364,,,fee schedule,364% of BCBS fee schedule,19.18,364,,,fee schedule,364% of BCBS fee schedule,38.7,90,,30.96,percent of total billed charges,90% of total billed charges,34.4,80,,27.52,percent of total billed charges,80% of total billed charges,38.7,90,,30.96,percent of total billed charges,90% of total billed charges,32.25,75,,25.8,percent of total billed charges,75% of total billed charges,5.2,122,,,fee schedule,122% of APC rate,12.47,29,,9.976,percent of total billed charges,29% of total billed charges,4.26,100,,,fee schedule,100% of CMS fee schedule,28.81,67,,23.048,percent of total billed charges,67% of total billed charges,6.35,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,34.4,80,,27.52,percent of total billed charges,80% of total billed charges,27.95,65,,22.36,percent of total billed charges,65% of total billed charges,15.34,35.67,,12.272,percent of total billed charges,35.67% of total billed charges,4.26,38.7,
HALOPERIDOL (HALDOL),3004980,CDM,300,RC,80173,HCPCS,outpatient,,,103,41.20,,87.55,85,,70.04,percent of total billed charges,85% of total billed charges,79.31,77,,63.45,percent of total billed charges,77% of total billed charges,15.78,100,,,fee schedule,100% of CMS fee schedule,62.93,350,,,fee schedule,350% of BCBS fee schedule,65.45,364,,,fee schedule,364% of BCBS fee schedule,65.45,364,,,fee schedule,364% of BCBS fee schedule,65.45,364,,,fee schedule,364% of BCBS fee schedule,92.7,90,,74.16,percent of total billed charges,90% of total billed charges,82.4,80,,65.92,percent of total billed charges,80% of total billed charges,92.7,90,,74.16,percent of total billed charges,90% of total billed charges,77.25,75,,61.8,percent of total billed charges,75% of total billed charges,19.25,122,,,fee schedule,122% of APC rate,29.87,29,,23.896,percent of total billed charges,29% of total billed charges,15.78,100,,,fee schedule,100% of CMS fee schedule,69.01,67,,55.208,percent of total billed charges,67% of total billed charges,17.45,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,82.4,80,,65.92,percent of total billed charges,80% of total billed charges,66.95,65,,53.56,percent of total billed charges,65% of total billed charges,36.74,35.67,,29.392,percent of total billed charges,35.67% of total billed charges,15.78,92.7,
HAM TEST,3005000,CDM,300,RC,86940,HCPCS,outpatient,,,218,87.20,,185.3,85,,148.24,percent of total billed charges,85% of total billed charges,167.86,77,,134.29,percent of total billed charges,77% of total billed charges,8.77,100,,,fee schedule,100% of CMS fee schedule,35.46,350,,,fee schedule,350% of BCBS fee schedule,36.87,364,,,fee schedule,364% of BCBS fee schedule,36.87,364,,,fee schedule,364% of BCBS fee schedule,36.87,364,,,fee schedule,364% of BCBS fee schedule,196.2,90,,156.96,percent of total billed charges,90% of total billed charges,174.4,80,,139.52,percent of total billed charges,80% of total billed charges,196.2,90,,156.96,percent of total billed charges,90% of total billed charges,163.5,75,,130.8,percent of total billed charges,75% of total billed charges,10.69,122,,,fee schedule,122% of APC rate,63.22,29,,50.576,percent of total billed charges,29% of total billed charges,8.77,100,,,fee schedule,100% of CMS fee schedule,146.06,67,,116.848,percent of total billed charges,67% of total billed charges,12.19,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,174.4,80,,139.52,percent of total billed charges,80% of total billed charges,141.7,65,,113.36,percent of total billed charges,65% of total billed charges,77.76,35.67,,62.208,percent of total billed charges,35.67% of total billed charges,8.77,196.2,
HAPTOGLOBIN,3005020,CDM,300,RC,83010,HCPCS,outpatient,,,71,28.40,,60.35,85,,48.28,percent of total billed charges,85% of total billed charges,54.67,77,,43.74,percent of total billed charges,77% of total billed charges,12.58,100,,,fee schedule,100% of CMS fee schedule,54.36,350,,,fee schedule,350% of BCBS fee schedule,56.53,364,,,fee schedule,364% of BCBS fee schedule,56.53,364,,,fee schedule,364% of BCBS fee schedule,56.53,364,,,fee schedule,364% of BCBS fee schedule,63.9,90,,51.12,percent of total billed charges,90% of total billed charges,56.8,80,,45.44,percent of total billed charges,80% of total billed charges,63.9,90,,51.12,percent of total billed charges,90% of total billed charges,53.25,75,,42.6,percent of total billed charges,75% of total billed charges,15.34,122,,,fee schedule,122% of APC rate,20.59,29,,16.472,percent of total billed charges,29% of total billed charges,12.58,100,,,fee schedule,100% of CMS fee schedule,47.57,67,,38.056,percent of total billed charges,67% of total billed charges,18.71,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,56.8,80,,45.44,percent of total billed charges,80% of total billed charges,46.15,65,,36.92,percent of total billed charges,65% of total billed charges,25.33,35.67,,20.264,percent of total billed charges,35.67% of total billed charges,12.58,63.9,
HCV BY RNA VIA PCR,3005021,CDM,300,RC,87522,HCPCS,outpatient,,,376,150.40,,319.6,85,,255.68,percent of total billed charges,85% of total billed charges,289.52,77,,231.62,percent of total billed charges,77% of total billed charges,42.84,100,,,fee schedule,100% of CMS fee schedule,185.08,350,,,fee schedule,350% of BCBS fee schedule,192.48,364,,,fee schedule,364% of BCBS fee schedule,192.48,364,,,fee schedule,364% of BCBS fee schedule,192.48,364,,,fee schedule,364% of BCBS fee schedule,338.4,90,,270.72,percent of total billed charges,90% of total billed charges,300.8,80,,240.64,percent of total billed charges,80% of total billed charges,338.4,90,,270.72,percent of total billed charges,90% of total billed charges,282,75,,225.6,percent of total billed charges,75% of total billed charges,52.26,122,,,fee schedule,122% of APC rate,109.04,29,,87.232,percent of total billed charges,29% of total billed charges,42.84,100,,,fee schedule,100% of CMS fee schedule,251.92,67,,201.536,percent of total billed charges,67% of total billed charges,63.7,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,300.8,80,,240.64,percent of total billed charges,80% of total billed charges,244.4,65,,195.52,percent of total billed charges,65% of total billed charges,134.12,35.67,,107.296,percent of total billed charges,35.67% of total billed charges,42.84,338.4,
HCG SERUM,3005040,CDM,300,RC,84703,HCPCS,outpatient,,,86,34.40,,73.1,85,,58.48,percent of total billed charges,85% of total billed charges,66.22,77,,52.98,percent of total billed charges,77% of total billed charges,7.52,100,,,fee schedule,100% of CMS fee schedule,32.52,350,,,fee schedule,350% of BCBS fee schedule,33.82,364,,,fee schedule,364% of BCBS fee schedule,33.82,364,,,fee schedule,364% of BCBS fee schedule,33.82,364,,,fee schedule,364% of BCBS fee schedule,77.4,90,,61.92,percent of total billed charges,90% of total billed charges,68.8,80,,55.04,percent of total billed charges,80% of total billed charges,77.4,90,,61.92,percent of total billed charges,90% of total billed charges,64.5,75,,51.6,percent of total billed charges,75% of total billed charges,9.17,122,,,fee schedule,122% of APC rate,24.94,29,,19.952,percent of total billed charges,29% of total billed charges,7.52,100,,,fee schedule,100% of CMS fee schedule,57.62,67,,46.096,percent of total billed charges,67% of total billed charges,11.17,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,68.8,80,,55.04,percent of total billed charges,80% of total billed charges,55.9,65,,44.72,percent of total billed charges,65% of total billed charges,30.68,35.67,,24.544,percent of total billed charges,35.67% of total billed charges,7.52,77.4,
HDL CHOLESTEROL,3005060,CDM,300,RC,83718,HCPCS,outpatient,,,66,26.40,,56.1,85,,44.88,percent of total billed charges,85% of total billed charges,50.82,77,,40.66,percent of total billed charges,77% of total billed charges,8.19,100,,,fee schedule,100% of CMS fee schedule,35.42,350,,,fee schedule,350% of BCBS fee schedule,36.84,364,,,fee schedule,364% of BCBS fee schedule,36.84,364,,,fee schedule,364% of BCBS fee schedule,36.84,364,,,fee schedule,364% of BCBS fee schedule,59.4,90,,47.52,percent of total billed charges,90% of total billed charges,52.8,80,,42.24,percent of total billed charges,80% of total billed charges,59.4,90,,47.52,percent of total billed charges,90% of total billed charges,49.5,75,,39.6,percent of total billed charges,75% of total billed charges,9.99,122,,,fee schedule,122% of APC rate,19.14,29,,15.312,percent of total billed charges,29% of total billed charges,8.19,100,,,fee schedule,100% of CMS fee schedule,44.22,67,,35.376,percent of total billed charges,67% of total billed charges,12.18,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,52.8,80,,42.24,percent of total billed charges,80% of total billed charges,42.9,65,,34.32,percent of total billed charges,65% of total billed charges,23.54,35.67,,18.832,percent of total billed charges,35.67% of total billed charges,8.19,59.4,
HDL SC CHOLESTEROL,3005061,CDM,300,RC,83718,HCPCS,outpatient,,,66,26.40,,56.1,85,,44.88,percent of total billed charges,85% of total billed charges,50.82,77,,40.66,percent of total billed charges,77% of total billed charges,8.19,100,,,fee schedule,100% of CMS fee schedule,35.42,350,,,fee schedule,350% of BCBS fee schedule,36.84,364,,,fee schedule,364% of BCBS fee schedule,36.84,364,,,fee schedule,364% of BCBS fee schedule,36.84,364,,,fee schedule,364% of BCBS fee schedule,59.4,90,,47.52,percent of total billed charges,90% of total billed charges,52.8,80,,42.24,percent of total billed charges,80% of total billed charges,59.4,90,,47.52,percent of total billed charges,90% of total billed charges,49.5,75,,39.6,percent of total billed charges,75% of total billed charges,9.99,122,,,fee schedule,122% of APC rate,19.14,29,,15.312,percent of total billed charges,29% of total billed charges,8.19,100,,,fee schedule,100% of CMS fee schedule,44.22,67,,35.376,percent of total billed charges,67% of total billed charges,12.18,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,52.8,80,,42.24,percent of total billed charges,80% of total billed charges,42.9,65,,34.32,percent of total billed charges,65% of total billed charges,23.54,35.67,,18.832,percent of total billed charges,35.67% of total billed charges,8.19,59.4,
HEAVY METALS URINE,3005070,CDM,300,RC,,,outpatient,,,205,82.00,,174.25,85,,139.4,percent of total billed charges,85% of total billed charges,157.85,77,,126.28,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,168.1,82,,134.48,percent of total billed charges,82% of total billed charges,174.25,85,,139.4,percent of total billed charges,85% of total billed charges,174.25,85,,139.4,percent of total billed charges,85% of total billed charges,174.25,85,,139.4,percent of total billed charges,85% of total billed charges,184.5,90,,147.6,percent of total billed charges,90% of total billed charges,164,80,,131.2,percent of total billed charges,80% of total billed charges,184.5,90,,147.6,percent of total billed charges,90% of total billed charges,153.75,75,,123,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,59.45,29,,47.56,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,137.35,67,,109.88,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,164,80,,131.2,percent of total billed charges,80% of total billed charges,133.25,65,,106.6,percent of total billed charges,65% of total billed charges,73.12,35.67,,58.496,percent of total billed charges,35.67% of total billed charges,59.45,184.5,
HEAVY METALS SCREENING,3005071,CDM,300,RC,83015,HCPCS,outpatient,,,220,88.00,,187,85,,149.6,percent of total billed charges,85% of total billed charges,169.4,77,,135.52,percent of total billed charges,77% of total billed charges,20.94,100,,,fee schedule,100% of CMS fee schedule,81.38,350,,,fee schedule,350% of BCBS fee schedule,84.63,364,,,fee schedule,364% of BCBS fee schedule,84.63,364,,,fee schedule,364% of BCBS fee schedule,84.63,364,,,fee schedule,364% of BCBS fee schedule,198,90,,158.4,percent of total billed charges,90% of total billed charges,176,80,,140.8,percent of total billed charges,80% of total billed charges,198,90,,158.4,percent of total billed charges,90% of total billed charges,165,75,,132,percent of total billed charges,75% of total billed charges,25.54,122,,,fee schedule,122% of APC rate,63.8,29,,51.04,percent of total billed charges,29% of total billed charges,20.94,100,,,fee schedule,100% of CMS fee schedule,147.4,67,,117.92,percent of total billed charges,67% of total billed charges,28,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,176,80,,140.8,percent of total billed charges,80% of total billed charges,143,65,,114.4,percent of total billed charges,65% of total billed charges,78.47,35.67,,62.776,percent of total billed charges,35.67% of total billed charges,20.94,198,
H PYLORI LESS THAN 18 YRS,3005072,CDM,300,RC,86677,HCPCS,outpatient,,,71,28.40,,60.35,85,,48.28,percent of total billed charges,85% of total billed charges,54.67,77,,43.74,percent of total billed charges,77% of total billed charges,16.85,100,,,fee schedule,100% of CMS fee schedule,62.69,350,,,fee schedule,350% of BCBS fee schedule,65.19,364,,,fee schedule,364% of BCBS fee schedule,65.19,364,,,fee schedule,364% of BCBS fee schedule,65.19,364,,,fee schedule,364% of BCBS fee schedule,63.9,90,,51.12,percent of total billed charges,90% of total billed charges,56.8,80,,45.44,percent of total billed charges,80% of total billed charges,63.9,90,,51.12,percent of total billed charges,90% of total billed charges,53.25,75,,42.6,percent of total billed charges,75% of total billed charges,20.55,122,,,fee schedule,122% of APC rate,20.59,29,,16.472,percent of total billed charges,29% of total billed charges,16.85,100,,,fee schedule,100% of CMS fee schedule,47.57,67,,38.056,percent of total billed charges,67% of total billed charges,8.64,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,56.8,80,,45.44,percent of total billed charges,80% of total billed charges,46.15,65,,36.92,percent of total billed charges,65% of total billed charges,25.33,35.67,,20.264,percent of total billed charges,35.67% of total billed charges,8.64,65.19,
H PYLORI IGG - SERUM,3005075,CDM,300,RC,86318,HCPCS,outpatient,,,133,53.20,,113.05,85,,90.44,percent of total billed charges,85% of total billed charges,102.41,77,,81.93,percent of total billed charges,77% of total billed charges,18.09,100,,,fee schedule,100% of CMS fee schedule,158.31,350,,,fee schedule,350% of BCBS fee schedule,164.64,364,,,fee schedule,364% of BCBS fee schedule,164.64,364,,,fee schedule,364% of BCBS fee schedule,164.64,364,,,fee schedule,364% of BCBS fee schedule,119.7,90,,95.76,percent of total billed charges,90% of total billed charges,106.4,80,,85.12,percent of total billed charges,80% of total billed charges,119.7,90,,95.76,percent of total billed charges,90% of total billed charges,99.75,75,,79.8,percent of total billed charges,75% of total billed charges,22.06,122,,,fee schedule,122% of APC rate,38.57,29,,30.856,percent of total billed charges,29% of total billed charges,18.09,100,,,fee schedule,100% of CMS fee schedule,89.11,67,,71.288,percent of total billed charges,67% of total billed charges,19.25,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,106.4,80,,85.12,percent of total billed charges,80% of total billed charges,86.45,65,,69.16,percent of total billed charges,65% of total billed charges,47.44,35.67,,37.952,percent of total billed charges,35.67% of total billed charges,18.09,164.64,
HELICOBACTER PYL IGM,3005076,CDM,300,RC,86318,HCPCS,outpatient,,,131,52.40,,111.35,85,,89.08,percent of total billed charges,85% of total billed charges,100.87,77,,80.7,percent of total billed charges,77% of total billed charges,18.09,100,,,fee schedule,100% of CMS fee schedule,158.31,350,,,fee schedule,350% of BCBS fee schedule,164.64,364,,,fee schedule,364% of BCBS fee schedule,164.64,364,,,fee schedule,364% of BCBS fee schedule,164.64,364,,,fee schedule,364% of BCBS fee schedule,117.9,90,,94.32,percent of total billed charges,90% of total billed charges,104.8,80,,83.84,percent of total billed charges,80% of total billed charges,117.9,90,,94.32,percent of total billed charges,90% of total billed charges,98.25,75,,78.6,percent of total billed charges,75% of total billed charges,22.06,122,,,fee schedule,122% of APC rate,37.99,29,,30.392,percent of total billed charges,29% of total billed charges,18.09,100,,,fee schedule,100% of CMS fee schedule,87.77,67,,70.216,percent of total billed charges,67% of total billed charges,19.25,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,104.8,80,,83.84,percent of total billed charges,80% of total billed charges,85.15,65,,68.12,percent of total billed charges,65% of total billed charges,46.73,35.67,,37.384,percent of total billed charges,35.67% of total billed charges,18.09,164.64,
HEMATOCRIT,3005080,CDM,300,RC,85014,HCPCS,outpatient,,,33,13.20,,28.05,85,,22.44,percent of total billed charges,85% of total billed charges,25.41,77,,20.33,percent of total billed charges,77% of total billed charges,2.37,100,,,fee schedule,100% of CMS fee schedule,10.26,350,,,fee schedule,350% of BCBS fee schedule,10.67,364,,,fee schedule,364% of BCBS fee schedule,10.67,364,,,fee schedule,364% of BCBS fee schedule,10.67,364,,,fee schedule,364% of BCBS fee schedule,29.7,90,,23.76,percent of total billed charges,90% of total billed charges,26.4,80,,21.12,percent of total billed charges,80% of total billed charges,29.7,90,,23.76,percent of total billed charges,90% of total billed charges,24.75,75,,19.8,percent of total billed charges,75% of total billed charges,2.89,122,,,fee schedule,122% of APC rate,9.57,29,,7.656,percent of total billed charges,29% of total billed charges,2.37,100,,,fee schedule,100% of CMS fee schedule,22.11,67,,17.688,percent of total billed charges,67% of total billed charges,3.51,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,26.4,80,,21.12,percent of total billed charges,80% of total billed charges,21.45,65,,17.16,percent of total billed charges,65% of total billed charges,11.77,35.67,,9.416,percent of total billed charges,35.67% of total billed charges,2.37,29.7,
HEMATOCRIT REPEAT SAME DAY,3005082,CDM,300,RC,85014,HCPCS,outpatient,,,33,13.20,91,28.05,85,,22.44,percent of total billed charges,85% of total billed charges,25.41,77,,20.33,percent of total billed charges,77% of total billed charges,2.37,100,,,fee schedule,100% of CMS fee schedule,10.26,350,,,fee schedule,350% of BCBS fee schedule,10.67,364,,,fee schedule,364% of BCBS fee schedule,10.67,364,,,fee schedule,364% of BCBS fee schedule,10.67,364,,,fee schedule,364% of BCBS fee schedule,29.7,90,,23.76,percent of total billed charges,90% of total billed charges,26.4,80,,21.12,percent of total billed charges,80% of total billed charges,29.7,90,,23.76,percent of total billed charges,90% of total billed charges,24.75,75,,19.8,percent of total billed charges,75% of total billed charges,2.89,122,,,fee schedule,122% of APC rate,9.57,29,,7.656,percent of total billed charges,29% of total billed charges,2.37,100,,,fee schedule,100% of CMS fee schedule,22.11,67,,17.688,percent of total billed charges,67% of total billed charges,3.51,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,26.4,80,,21.12,percent of total billed charges,80% of total billed charges,21.45,65,,17.16,percent of total billed charges,65% of total billed charges,11.77,35.67,,9.416,percent of total billed charges,35.67% of total billed charges,2.37,29.7,
ARSENIC URINE - X,3005090,CDM,300,RC,82175,HCPCS,outpatient,,,94,37.60,,79.9,85,,63.92,percent of total billed charges,85% of total billed charges,72.38,77,,57.9,percent of total billed charges,77% of total billed charges,18.97,100,,,fee schedule,100% of CMS fee schedule,81.97,350,,,fee schedule,350% of BCBS fee schedule,85.25,364,,,fee schedule,364% of BCBS fee schedule,85.25,364,,,fee schedule,364% of BCBS fee schedule,85.25,364,,,fee schedule,364% of BCBS fee schedule,84.6,90,,67.68,percent of total billed charges,90% of total billed charges,75.2,80,,60.16,percent of total billed charges,80% of total billed charges,84.6,90,,67.68,percent of total billed charges,90% of total billed charges,70.5,75,,56.4,percent of total billed charges,75% of total billed charges,23.14,122,,,fee schedule,122% of APC rate,27.26,29,,21.808,percent of total billed charges,29% of total billed charges,18.97,100,,,fee schedule,100% of CMS fee schedule,62.98,67,,50.384,percent of total billed charges,67% of total billed charges,28.21,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,75.2,80,,60.16,percent of total billed charges,80% of total billed charges,61.1,65,,48.88,percent of total billed charges,65% of total billed charges,33.53,35.67,,26.824,percent of total billed charges,35.67% of total billed charges,18.97,85.25,
CADMIUM URINE,3005091,CDM,300,RC,82300,HCPCS,outpatient,,,117,46.80,,99.45,85,,79.56,percent of total billed charges,85% of total billed charges,90.09,77,,72.07,percent of total billed charges,77% of total billed charges,23.64,100,,,fee schedule,100% of CMS fee schedule,100.03,350,,,fee schedule,350% of BCBS fee schedule,104.03,364,,,fee schedule,364% of BCBS fee schedule,104.03,364,,,fee schedule,364% of BCBS fee schedule,104.03,364,,,fee schedule,364% of BCBS fee schedule,105.3,90,,84.24,percent of total billed charges,90% of total billed charges,93.6,80,,74.88,percent of total billed charges,80% of total billed charges,105.3,90,,84.24,percent of total billed charges,90% of total billed charges,87.75,75,,70.2,percent of total billed charges,75% of total billed charges,28.84,122,,,fee schedule,122% of APC rate,33.93,29,,27.144,percent of total billed charges,29% of total billed charges,23.64,100,,,fee schedule,100% of CMS fee schedule,78.39,67,,62.712,percent of total billed charges,67% of total billed charges,21.84,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,93.6,80,,74.88,percent of total billed charges,80% of total billed charges,76.05,65,,60.84,percent of total billed charges,65% of total billed charges,41.73,35.67,,33.384,percent of total billed charges,35.67% of total billed charges,21.84,105.3,
COPPER URINE,3005092,CDM,300,RC,82525,HCPCS,outpatient,,,62,24.80,,52.7,85,,42.16,percent of total billed charges,85% of total billed charges,47.74,77,,38.19,percent of total billed charges,77% of total billed charges,12.41,100,,,fee schedule,100% of CMS fee schedule,53.62,350,,,fee schedule,350% of BCBS fee schedule,55.76,364,,,fee schedule,364% of BCBS fee schedule,55.76,364,,,fee schedule,364% of BCBS fee schedule,55.76,364,,,fee schedule,364% of BCBS fee schedule,55.8,90,,44.64,percent of total billed charges,90% of total billed charges,49.6,80,,39.68,percent of total billed charges,80% of total billed charges,55.8,90,,44.64,percent of total billed charges,90% of total billed charges,46.5,75,,37.2,percent of total billed charges,75% of total billed charges,15.14,122,,,fee schedule,122% of APC rate,17.98,29,,14.384,percent of total billed charges,29% of total billed charges,12.41,100,,,fee schedule,100% of CMS fee schedule,41.54,67,,33.232,percent of total billed charges,67% of total billed charges,18.45,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,49.6,80,,39.68,percent of total billed charges,80% of total billed charges,40.3,65,,32.24,percent of total billed charges,65% of total billed charges,22.12,35.67,,17.696,percent of total billed charges,35.67% of total billed charges,12.41,55.8,
"LEAD, URINE",3005093,CDM,300,RC,83655,HCPCS,outpatient,,,61,24.40,,51.85,85,,41.48,percent of total billed charges,85% of total billed charges,46.97,77,,37.58,percent of total billed charges,77% of total billed charges,12.11,100,,,fee schedule,100% of CMS fee schedule,52.33,350,,,fee schedule,350% of BCBS fee schedule,54.42,364,,,fee schedule,364% of BCBS fee schedule,54.42,364,,,fee schedule,364% of BCBS fee schedule,54.42,364,,,fee schedule,364% of BCBS fee schedule,54.9,90,,43.92,percent of total billed charges,90% of total billed charges,48.8,80,,39.04,percent of total billed charges,80% of total billed charges,54.9,90,,43.92,percent of total billed charges,90% of total billed charges,45.75,75,,36.6,percent of total billed charges,75% of total billed charges,14.77,122,,,fee schedule,122% of APC rate,17.69,29,,14.152,percent of total billed charges,29% of total billed charges,12.11,100,,,fee schedule,100% of CMS fee schedule,40.87,67,,32.696,percent of total billed charges,67% of total billed charges,18,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,48.8,80,,39.04,percent of total billed charges,80% of total billed charges,39.65,65,,31.72,percent of total billed charges,65% of total billed charges,21.76,35.67,,17.408,percent of total billed charges,35.67% of total billed charges,12.11,54.9,
"MERCURY, URINE",3005094,CDM,300,RC,83825,HCPCS,outpatient,,,83,33.20,,70.55,85,,56.44,percent of total billed charges,85% of total billed charges,63.91,77,,51.13,percent of total billed charges,77% of total billed charges,16.26,100,,,fee schedule,100% of CMS fee schedule,70.25,350,,,fee schedule,350% of BCBS fee schedule,73.05,364,,,fee schedule,364% of BCBS fee schedule,73.05,364,,,fee schedule,364% of BCBS fee schedule,73.05,364,,,fee schedule,364% of BCBS fee schedule,74.7,90,,59.76,percent of total billed charges,90% of total billed charges,66.4,80,,53.12,percent of total billed charges,80% of total billed charges,74.7,90,,59.76,percent of total billed charges,90% of total billed charges,62.25,75,,49.8,percent of total billed charges,75% of total billed charges,19.83,122,,,fee schedule,122% of APC rate,24.07,29,,19.256,percent of total billed charges,29% of total billed charges,16.26,100,,,fee schedule,100% of CMS fee schedule,55.61,67,,44.488,percent of total billed charges,67% of total billed charges,24.18,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,66.4,80,,53.12,percent of total billed charges,80% of total billed charges,53.95,65,,43.16,percent of total billed charges,65% of total billed charges,29.61,35.67,,23.688,percent of total billed charges,35.67% of total billed charges,16.26,74.7,
"ZINC, URINE",3005095,CDM,300,RC,84630,HCPCS,outpatient,,,57,22.80,,48.45,85,,38.76,percent of total billed charges,85% of total billed charges,43.89,77,,35.11,percent of total billed charges,77% of total billed charges,11.39,100,,,fee schedule,100% of CMS fee schedule,49.21,350,,,fee schedule,350% of BCBS fee schedule,51.18,364,,,fee schedule,364% of BCBS fee schedule,51.18,364,,,fee schedule,364% of BCBS fee schedule,51.18,364,,,fee schedule,364% of BCBS fee schedule,51.3,90,,41.04,percent of total billed charges,90% of total billed charges,45.6,80,,36.48,percent of total billed charges,80% of total billed charges,51.3,90,,41.04,percent of total billed charges,90% of total billed charges,42.75,75,,34.2,percent of total billed charges,75% of total billed charges,13.89,122,,,fee schedule,122% of APC rate,16.53,29,,13.224,percent of total billed charges,29% of total billed charges,11.39,100,,,fee schedule,100% of CMS fee schedule,38.19,67,,30.552,percent of total billed charges,67% of total billed charges,10.95,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,45.6,80,,36.48,percent of total billed charges,80% of total billed charges,37.05,65,,29.64,percent of total billed charges,65% of total billed charges,20.33,35.67,,16.264,percent of total billed charges,35.67% of total billed charges,10.95,51.3,
HEMOGLOBIN,3005100,CDM,300,RC,85018,HCPCS,outpatient,,,41,16.40,,34.85,85,,27.88,percent of total billed charges,85% of total billed charges,31.57,77,,25.26,percent of total billed charges,77% of total billed charges,2.37,100,,,fee schedule,100% of CMS fee schedule,10.26,350,,,fee schedule,350% of BCBS fee schedule,10.67,364,,,fee schedule,364% of BCBS fee schedule,10.67,364,,,fee schedule,364% of BCBS fee schedule,10.67,364,,,fee schedule,364% of BCBS fee schedule,36.9,90,,29.52,percent of total billed charges,90% of total billed charges,32.8,80,,26.24,percent of total billed charges,80% of total billed charges,36.9,90,,29.52,percent of total billed charges,90% of total billed charges,30.75,75,,24.6,percent of total billed charges,75% of total billed charges,2.89,122,,,fee schedule,122% of APC rate,11.89,29,,9.512,percent of total billed charges,29% of total billed charges,2.37,100,,,fee schedule,100% of CMS fee schedule,27.47,67,,21.976,percent of total billed charges,67% of total billed charges,3.51,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,32.8,80,,26.24,percent of total billed charges,80% of total billed charges,26.65,65,,21.32,percent of total billed charges,65% of total billed charges,14.62,35.67,,11.696,percent of total billed charges,35.67% of total billed charges,2.37,36.9,
HEMOGLOBIN REPEAT SAME DAY,3005101,CDM,300,RC,85018,HCPCS,outpatient,,,33,13.20,91,28.05,85,,22.44,percent of total billed charges,85% of total billed charges,25.41,77,,20.33,percent of total billed charges,77% of total billed charges,2.37,100,,,fee schedule,100% of CMS fee schedule,10.26,350,,,fee schedule,350% of BCBS fee schedule,10.67,364,,,fee schedule,364% of BCBS fee schedule,10.67,364,,,fee schedule,364% of BCBS fee schedule,10.67,364,,,fee schedule,364% of BCBS fee schedule,29.7,90,,23.76,percent of total billed charges,90% of total billed charges,26.4,80,,21.12,percent of total billed charges,80% of total billed charges,29.7,90,,23.76,percent of total billed charges,90% of total billed charges,24.75,75,,19.8,percent of total billed charges,75% of total billed charges,2.89,122,,,fee schedule,122% of APC rate,9.57,29,,7.656,percent of total billed charges,29% of total billed charges,2.37,100,,,fee schedule,100% of CMS fee schedule,22.11,67,,17.688,percent of total billed charges,67% of total billed charges,3.51,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,26.4,80,,21.12,percent of total billed charges,80% of total billed charges,21.45,65,,17.16,percent of total billed charges,65% of total billed charges,11.77,35.67,,9.416,percent of total billed charges,35.67% of total billed charges,2.37,29.7,
H PYLORI BREATH TEST,3005103,CDM,300,RC,83013,HCPCS,outpatient,,,336,134.40,,285.6,85,,228.48,percent of total billed charges,85% of total billed charges,258.72,77,,206.98,percent of total billed charges,77% of total billed charges,67.36,100,,,fee schedule,100% of CMS fee schedule,291.06,350,,,fee schedule,350% of BCBS fee schedule,302.7,364,,,fee schedule,364% of BCBS fee schedule,302.7,364,,,fee schedule,364% of BCBS fee schedule,302.7,364,,,fee schedule,364% of BCBS fee schedule,302.4,90,,241.92,percent of total billed charges,90% of total billed charges,268.8,80,,215.04,percent of total billed charges,80% of total billed charges,302.4,90,,241.92,percent of total billed charges,90% of total billed charges,252,75,,201.6,percent of total billed charges,75% of total billed charges,82.17,122,,,fee schedule,122% of APC rate,97.44,29,,77.952,percent of total billed charges,29% of total billed charges,67.36,100,,,fee schedule,100% of CMS fee schedule,225.12,67,,180.096,percent of total billed charges,67% of total billed charges,100.17,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,268.8,80,,215.04,percent of total billed charges,80% of total billed charges,218.4,65,,174.72,percent of total billed charges,65% of total billed charges,119.85,35.67,,95.88,percent of total billed charges,35.67% of total billed charges,67.36,302.7,
H&H  REPEAT SAME DAY,3005104,CDM,300,RC,,,outpatient,,,65,26.00,,55.25,85,,44.2,percent of total billed charges,85% of total billed charges,50.05,77,,40.04,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,53.3,82,,42.64,percent of total billed charges,82% of total billed charges,55.25,85,,44.2,percent of total billed charges,85% of total billed charges,55.25,85,,44.2,percent of total billed charges,85% of total billed charges,55.25,85,,44.2,percent of total billed charges,85% of total billed charges,58.5,90,,46.8,percent of total billed charges,90% of total billed charges,52,80,,41.6,percent of total billed charges,80% of total billed charges,58.5,90,,46.8,percent of total billed charges,90% of total billed charges,48.75,75,,39,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,18.85,29,,15.08,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,43.55,67,,34.84,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,52,80,,41.6,percent of total billed charges,80% of total billed charges,42.25,65,,33.8,percent of total billed charges,65% of total billed charges,23.19,35.67,,18.552,percent of total billed charges,35.67% of total billed charges,18.85,58.5,
HEMOGLOBIN - URINE FREE,3005106,CDM,300,RC,83069,HCPCS,outpatient,,,25,10.00,,21.25,85,,17,percent of total billed charges,85% of total billed charges,19.25,77,,15.4,percent of total billed charges,77% of total billed charges,3.95,100,,,fee schedule,100% of CMS fee schedule,17.08,350,,,fee schedule,350% of BCBS fee schedule,17.76,364,,,fee schedule,364% of BCBS fee schedule,17.76,364,,,fee schedule,364% of BCBS fee schedule,17.76,364,,,fee schedule,364% of BCBS fee schedule,22.5,90,,18,percent of total billed charges,90% of total billed charges,20,80,,16,percent of total billed charges,80% of total billed charges,22.5,90,,18,percent of total billed charges,90% of total billed charges,18.75,75,,15,percent of total billed charges,75% of total billed charges,4.81,122,,,fee schedule,122% of APC rate,7.25,29,,5.8,percent of total billed charges,29% of total billed charges,3.95,100,,,fee schedule,100% of CMS fee schedule,16.75,67,,13.4,percent of total billed charges,67% of total billed charges,5.18,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,20,80,,16,percent of total billed charges,80% of total billed charges,16.25,65,,13,percent of total billed charges,65% of total billed charges,8.92,35.67,,7.136,percent of total billed charges,35.67% of total billed charges,3.95,22.5,
HEMOSIDERIN,3005120,CDM,300,RC,83070,HCPCS,outpatient,,,42,16.80,,35.7,85,,28.56,percent of total billed charges,85% of total billed charges,32.34,77,,25.87,percent of total billed charges,77% of total billed charges,4.75,100,,,fee schedule,100% of CMS fee schedule,20.51,350,,,fee schedule,350% of BCBS fee schedule,21.33,364,,,fee schedule,364% of BCBS fee schedule,21.33,364,,,fee schedule,364% of BCBS fee schedule,21.33,364,,,fee schedule,364% of BCBS fee schedule,37.8,90,,30.24,percent of total billed charges,90% of total billed charges,33.6,80,,26.88,percent of total billed charges,80% of total billed charges,37.8,90,,30.24,percent of total billed charges,90% of total billed charges,31.5,75,,25.2,percent of total billed charges,75% of total billed charges,5.79,122,,,fee schedule,122% of APC rate,12.18,29,,9.744,percent of total billed charges,29% of total billed charges,4.75,100,,,fee schedule,100% of CMS fee schedule,28.14,67,,22.512,percent of total billed charges,67% of total billed charges,7.06,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,33.6,80,,26.88,percent of total billed charges,80% of total billed charges,27.3,65,,21.84,percent of total billed charges,65% of total billed charges,14.98,35.67,,11.984,percent of total billed charges,35.67% of total billed charges,4.75,37.8,
HEPARIN FACTOR Xa,3005122,CDM,300,RC,85130,HCPCS,outpatient,,,159,63.60,,135.15,85,,108.12,percent of total billed charges,85% of total billed charges,122.43,77,,97.94,percent of total billed charges,77% of total billed charges,11.89,100,,,fee schedule,100% of CMS fee schedule,51.38,350,,,fee schedule,350% of BCBS fee schedule,53.44,364,,,fee schedule,364% of BCBS fee schedule,53.44,364,,,fee schedule,364% of BCBS fee schedule,53.44,364,,,fee schedule,364% of BCBS fee schedule,143.1,90,,114.48,percent of total billed charges,90% of total billed charges,127.2,80,,101.76,percent of total billed charges,80% of total billed charges,143.1,90,,114.48,percent of total billed charges,90% of total billed charges,119.25,75,,95.4,percent of total billed charges,75% of total billed charges,14.5,122,,,fee schedule,122% of APC rate,46.11,29,,36.888,percent of total billed charges,29% of total billed charges,11.89,100,,,fee schedule,100% of CMS fee schedule,106.53,67,,85.224,percent of total billed charges,67% of total billed charges,17.69,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,127.2,80,,101.76,percent of total billed charges,80% of total billed charges,103.35,65,,82.68,percent of total billed charges,65% of total billed charges,56.72,35.67,,45.376,percent of total billed charges,35.67% of total billed charges,11.89,143.1,
HEPARIN COFACTOR II,3005123,CDM,300,RC,85300,HCPCS,outpatient,,,155,62.00,,131.75,85,,105.4,percent of total billed charges,85% of total billed charges,119.35,77,,95.48,percent of total billed charges,77% of total billed charges,11.85,100,,,fee schedule,100% of CMS fee schedule,51.21,350,,,fee schedule,350% of BCBS fee schedule,53.25,364,,,fee schedule,364% of BCBS fee schedule,53.25,364,,,fee schedule,364% of BCBS fee schedule,53.25,364,,,fee schedule,364% of BCBS fee schedule,139.5,90,,111.6,percent of total billed charges,90% of total billed charges,124,80,,99.2,percent of total billed charges,80% of total billed charges,139.5,90,,111.6,percent of total billed charges,90% of total billed charges,116.25,75,,93,percent of total billed charges,75% of total billed charges,14.45,122,,,fee schedule,122% of APC rate,44.95,29,,35.96,percent of total billed charges,29% of total billed charges,11.85,100,,,fee schedule,100% of CMS fee schedule,103.85,67,,83.08,percent of total billed charges,67% of total billed charges,13,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,124,80,,99.2,percent of total billed charges,80% of total billed charges,100.75,65,,80.6,percent of total billed charges,65% of total billed charges,55.29,35.67,,44.232,percent of total billed charges,35.67% of total billed charges,11.85,139.5,
HEPATITIS ACUTE PANEL,3005125,CDM,300,RC,80074,HCPCS,outpatient,,,224,89.60,,190.4,85,,152.32,percent of total billed charges,85% of total billed charges,172.48,77,,137.98,percent of total billed charges,77% of total billed charges,47.63,100,,,fee schedule,100% of CMS fee schedule,205.84,350,,,fee schedule,350% of BCBS fee schedule,214.07,364,,,fee schedule,364% of BCBS fee schedule,214.07,364,,,fee schedule,364% of BCBS fee schedule,214.07,364,,,fee schedule,364% of BCBS fee schedule,201.6,90,,161.28,percent of total billed charges,90% of total billed charges,179.2,80,,143.36,percent of total billed charges,80% of total billed charges,201.6,90,,161.28,percent of total billed charges,90% of total billed charges,168,75,,134.4,percent of total billed charges,75% of total billed charges,58.1,122,,,fee schedule,122% of APC rate,64.96,29,,51.968,percent of total billed charges,29% of total billed charges,47.63,100,,,fee schedule,100% of CMS fee schedule,150.08,67,,120.064,percent of total billed charges,67% of total billed charges,70.84,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,179.2,80,,143.36,percent of total billed charges,80% of total billed charges,145.6,65,,116.48,percent of total billed charges,65% of total billed charges,79.9,35.67,,63.92,percent of total billed charges,35.67% of total billed charges,47.63,214.07,
"HEPATITIS A,B,C PROFILE",3005127,CDM,300,RC,,,outpatient,,,424,169.60,,360.4,85,,288.32,percent of total billed charges,85% of total billed charges,326.48,77,,261.18,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,347.68,82,,278.144,percent of total billed charges,82% of total billed charges,360.4,85,,288.32,percent of total billed charges,85% of total billed charges,360.4,85,,288.32,percent of total billed charges,85% of total billed charges,360.4,85,,288.32,percent of total billed charges,85% of total billed charges,381.6,90,,305.28,percent of total billed charges,90% of total billed charges,339.2,80,,271.36,percent of total billed charges,80% of total billed charges,381.6,90,,305.28,percent of total billed charges,90% of total billed charges,318,75,,254.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,122.96,29,,98.368,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,284.08,67,,227.264,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,339.2,80,,271.36,percent of total billed charges,80% of total billed charges,275.6,65,,220.48,percent of total billed charges,65% of total billed charges,151.24,35.67,,120.992,percent of total billed charges,35.67% of total billed charges,122.96,381.6,
HEPATITIS A VIRUS IgG & IgM,3005140,CDM,300,RC,86708,HCPCS,outpatient,,,92,36.80,,78.2,85,,62.56,percent of total billed charges,85% of total billed charges,70.84,77,,56.67,percent of total billed charges,77% of total billed charges,12.39,100,,,fee schedule,100% of CMS fee schedule,53.52,350,,,fee schedule,350% of BCBS fee schedule,55.66,364,,,fee schedule,364% of BCBS fee schedule,55.66,364,,,fee schedule,364% of BCBS fee schedule,55.66,364,,,fee schedule,364% of BCBS fee schedule,82.8,90,,66.24,percent of total billed charges,90% of total billed charges,73.6,80,,58.88,percent of total billed charges,80% of total billed charges,82.8,90,,66.24,percent of total billed charges,90% of total billed charges,69,75,,55.2,percent of total billed charges,75% of total billed charges,15.11,122,,,fee schedule,122% of APC rate,26.68,29,,21.344,percent of total billed charges,29% of total billed charges,12.39,100,,,fee schedule,100% of CMS fee schedule,61.64,67,,49.312,percent of total billed charges,67% of total billed charges,18.42,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,73.6,80,,58.88,percent of total billed charges,80% of total billed charges,59.8,65,,47.84,percent of total billed charges,65% of total billed charges,32.82,35.67,,26.256,percent of total billed charges,35.67% of total billed charges,12.39,82.8,
HEPATITIS A VIRUS IGM ANTIBODY,3005145,CDM,300,RC,86709,HCPCS,outpatient,,,62,24.80,,52.7,85,,42.16,percent of total billed charges,85% of total billed charges,47.74,77,,38.19,percent of total billed charges,77% of total billed charges,11.26,100,,,fee schedule,100% of CMS fee schedule,48.65,350,,,fee schedule,350% of BCBS fee schedule,50.6,364,,,fee schedule,364% of BCBS fee schedule,50.6,364,,,fee schedule,364% of BCBS fee schedule,50.6,364,,,fee schedule,364% of BCBS fee schedule,55.8,90,,44.64,percent of total billed charges,90% of total billed charges,49.6,80,,39.68,percent of total billed charges,80% of total billed charges,55.8,90,,44.64,percent of total billed charges,90% of total billed charges,46.5,75,,37.2,percent of total billed charges,75% of total billed charges,13.73,122,,,fee schedule,122% of APC rate,17.98,29,,14.384,percent of total billed charges,29% of total billed charges,11.26,100,,,fee schedule,100% of CMS fee schedule,41.54,67,,33.232,percent of total billed charges,67% of total billed charges,16.74,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,49.6,80,,39.68,percent of total billed charges,80% of total billed charges,40.3,65,,32.24,percent of total billed charges,65% of total billed charges,22.12,35.67,,17.696,percent of total billed charges,35.67% of total billed charges,11.26,55.8,
HEPATITIS B COR ANTIBODY,3005160,CDM,300,RC,86704,HCPCS,outpatient,,,92,36.80,,78.2,85,,62.56,percent of total billed charges,85% of total billed charges,70.84,77,,56.67,percent of total billed charges,77% of total billed charges,12.05,100,,,fee schedule,100% of CMS fee schedule,52.08,350,,,fee schedule,350% of BCBS fee schedule,54.16,364,,,fee schedule,364% of BCBS fee schedule,54.16,364,,,fee schedule,364% of BCBS fee schedule,54.16,364,,,fee schedule,364% of BCBS fee schedule,82.8,90,,66.24,percent of total billed charges,90% of total billed charges,73.6,80,,58.88,percent of total billed charges,80% of total billed charges,82.8,90,,66.24,percent of total billed charges,90% of total billed charges,69,75,,55.2,percent of total billed charges,75% of total billed charges,14.7,122,,,fee schedule,122% of APC rate,26.68,29,,21.344,percent of total billed charges,29% of total billed charges,12.05,100,,,fee schedule,100% of CMS fee schedule,61.64,67,,49.312,percent of total billed charges,67% of total billed charges,17.92,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,73.6,80,,58.88,percent of total billed charges,80% of total billed charges,59.8,65,,47.84,percent of total billed charges,65% of total billed charges,32.82,35.67,,26.256,percent of total billed charges,35.67% of total billed charges,12.05,82.8,
HEPATITIS B SURFACE ANTIBODY,3005180,CDM,300,RC,86706,HCPCS,outpatient,,,92,36.80,,78.2,85,,62.56,percent of total billed charges,85% of total billed charges,70.84,77,,56.67,percent of total billed charges,77% of total billed charges,10.74,100,,,fee schedule,100% of CMS fee schedule,46.41,350,,,fee schedule,350% of BCBS fee schedule,48.27,364,,,fee schedule,364% of BCBS fee schedule,48.27,364,,,fee schedule,364% of BCBS fee schedule,48.27,364,,,fee schedule,364% of BCBS fee schedule,82.8,90,,66.24,percent of total billed charges,90% of total billed charges,73.6,80,,58.88,percent of total billed charges,80% of total billed charges,82.8,90,,66.24,percent of total billed charges,90% of total billed charges,69,75,,55.2,percent of total billed charges,75% of total billed charges,13.1,122,,,fee schedule,122% of APC rate,26.68,29,,21.344,percent of total billed charges,29% of total billed charges,10.74,100,,,fee schedule,100% of CMS fee schedule,61.64,67,,49.312,percent of total billed charges,67% of total billed charges,15.97,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,73.6,80,,58.88,percent of total billed charges,80% of total billed charges,59.8,65,,47.84,percent of total billed charges,65% of total billed charges,32.82,35.67,,26.256,percent of total billed charges,35.67% of total billed charges,10.74,82.8,
HEPATITIS B AB QUANT,3005181,CDM,300,RC,86706,HCPCS,outpatient,,,36,14.40,,30.6,85,,24.48,percent of total billed charges,85% of total billed charges,27.72,77,,22.18,percent of total billed charges,77% of total billed charges,10.74,100,,,fee schedule,100% of CMS fee schedule,46.41,350,,,fee schedule,350% of BCBS fee schedule,48.27,364,,,fee schedule,364% of BCBS fee schedule,48.27,364,,,fee schedule,364% of BCBS fee schedule,48.27,364,,,fee schedule,364% of BCBS fee schedule,32.4,90,,25.92,percent of total billed charges,90% of total billed charges,28.8,80,,23.04,percent of total billed charges,80% of total billed charges,32.4,90,,25.92,percent of total billed charges,90% of total billed charges,27,75,,21.6,percent of total billed charges,75% of total billed charges,13.1,122,,,fee schedule,122% of APC rate,10.44,29,,8.352,percent of total billed charges,29% of total billed charges,10.74,100,,,fee schedule,100% of CMS fee schedule,24.12,67,,19.296,percent of total billed charges,67% of total billed charges,15.97,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,28.8,80,,23.04,percent of total billed charges,80% of total billed charges,23.4,65,,18.72,percent of total billed charges,65% of total billed charges,12.84,35.67,,10.272,percent of total billed charges,35.67% of total billed charges,10.44,48.27,
HEPATITIS B SURFACE ANTIGEN,3005200,CDM,300,RC,87340,HCPCS,outpatient,,,92,36.80,,78.2,85,,62.56,percent of total billed charges,85% of total billed charges,70.84,77,,56.67,percent of total billed charges,77% of total billed charges,10.33,100,,,fee schedule,100% of CMS fee schedule,44.63,350,,,fee schedule,350% of BCBS fee schedule,46.41,364,,,fee schedule,364% of BCBS fee schedule,46.41,364,,,fee schedule,364% of BCBS fee schedule,46.41,364,,,fee schedule,364% of BCBS fee schedule,82.8,90,,66.24,percent of total billed charges,90% of total billed charges,73.6,80,,58.88,percent of total billed charges,80% of total billed charges,82.8,90,,66.24,percent of total billed charges,90% of total billed charges,69,75,,55.2,percent of total billed charges,75% of total billed charges,12.6,122,,,fee schedule,122% of APC rate,26.68,29,,21.344,percent of total billed charges,29% of total billed charges,10.33,100,,,fee schedule,100% of CMS fee schedule,61.64,67,,49.312,percent of total billed charges,67% of total billed charges,15.36,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,73.6,80,,58.88,percent of total billed charges,80% of total billed charges,59.8,65,,47.84,percent of total billed charges,65% of total billed charges,32.82,35.67,,26.256,percent of total billed charges,35.67% of total billed charges,10.33,82.8,
INF ANTIGENT DETECTION EXP,3005201,CDM,300,RC,87274,HCPCS,outpatient,,,36,14.40,,30.6,85,,24.48,percent of total billed charges,85% of total billed charges,27.72,77,,22.18,percent of total billed charges,77% of total billed charges,11.98,100,,,fee schedule,100% of CMS fee schedule,51.8,350,,,fee schedule,350% of BCBS fee schedule,53.87,364,,,fee schedule,364% of BCBS fee schedule,53.87,364,,,fee schedule,364% of BCBS fee schedule,53.87,364,,,fee schedule,364% of BCBS fee schedule,32.4,90,,25.92,percent of total billed charges,90% of total billed charges,28.8,80,,23.04,percent of total billed charges,80% of total billed charges,32.4,90,,25.92,percent of total billed charges,90% of total billed charges,27,75,,21.6,percent of total billed charges,75% of total billed charges,14.61,122,,,fee schedule,122% of APC rate,10.44,29,,8.352,percent of total billed charges,29% of total billed charges,11.98,100,,,fee schedule,100% of CMS fee schedule,24.12,67,,19.296,percent of total billed charges,67% of total billed charges,15.41,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,28.8,80,,23.04,percent of total billed charges,80% of total billed charges,23.4,65,,18.72,percent of total billed charges,65% of total billed charges,12.84,35.67,,10.272,percent of total billed charges,35.67% of total billed charges,10.44,53.87,
INF ANT DETECTION IMMUNO EXP,3005202,CDM,300,RC,87273,HCPCS,outpatient,,,36,14.40,,30.6,85,,24.48,percent of total billed charges,85% of total billed charges,27.72,77,,22.18,percent of total billed charges,77% of total billed charges,11.98,100,,,fee schedule,100% of CMS fee schedule,51.8,350,,,fee schedule,350% of BCBS fee schedule,53.87,364,,,fee schedule,364% of BCBS fee schedule,53.87,364,,,fee schedule,364% of BCBS fee schedule,53.87,364,,,fee schedule,364% of BCBS fee schedule,32.4,90,,25.92,percent of total billed charges,90% of total billed charges,28.8,80,,23.04,percent of total billed charges,80% of total billed charges,32.4,90,,25.92,percent of total billed charges,90% of total billed charges,27,75,,21.6,percent of total billed charges,75% of total billed charges,14.61,122,,,fee schedule,122% of APC rate,10.44,29,,8.352,percent of total billed charges,29% of total billed charges,11.98,100,,,fee schedule,100% of CMS fee schedule,24.12,67,,19.296,percent of total billed charges,67% of total billed charges,15.41,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,28.8,80,,23.04,percent of total billed charges,80% of total billed charges,23.4,65,,18.72,percent of total billed charges,65% of total billed charges,12.84,35.67,,10.272,percent of total billed charges,35.67% of total billed charges,10.44,53.87,
HEPATITIS Be ANTIGEN/AB,3005220,CDM,300,RC,87350,HCPCS,outpatient,,,84,33.60,,71.4,85,,57.12,percent of total billed charges,85% of total billed charges,64.68,77,,51.74,percent of total billed charges,77% of total billed charges,11.53,100,,,fee schedule,100% of CMS fee schedule,49.81,350,,,fee schedule,350% of BCBS fee schedule,51.8,364,,,fee schedule,364% of BCBS fee schedule,51.8,364,,,fee schedule,364% of BCBS fee schedule,51.8,364,,,fee schedule,364% of BCBS fee schedule,75.6,90,,60.48,percent of total billed charges,90% of total billed charges,67.2,80,,53.76,percent of total billed charges,80% of total billed charges,75.6,90,,60.48,percent of total billed charges,90% of total billed charges,63,75,,50.4,percent of total billed charges,75% of total billed charges,14.06,122,,,fee schedule,122% of APC rate,24.36,29,,19.488,percent of total billed charges,29% of total billed charges,11.53,100,,,fee schedule,100% of CMS fee schedule,56.28,67,,45.024,percent of total billed charges,67% of total billed charges,17.13,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,67.2,80,,53.76,percent of total billed charges,80% of total billed charges,54.6,65,,43.68,percent of total billed charges,65% of total billed charges,29.96,35.67,,23.968,percent of total billed charges,35.67% of total billed charges,11.53,75.6,
HEPATITIS C VIRUS AB,3005240,CDM,300,RC,86803,HCPCS,outpatient,,,92,36.80,,78.2,85,,62.56,percent of total billed charges,85% of total billed charges,70.84,77,,56.67,percent of total billed charges,77% of total billed charges,14.27,100,,,fee schedule,100% of CMS fee schedule,61.64,350,,,fee schedule,350% of BCBS fee schedule,64.1,364,,,fee schedule,364% of BCBS fee schedule,64.1,364,,,fee schedule,364% of BCBS fee schedule,64.1,364,,,fee schedule,364% of BCBS fee schedule,82.8,90,,66.24,percent of total billed charges,90% of total billed charges,73.6,80,,58.88,percent of total billed charges,80% of total billed charges,82.8,90,,66.24,percent of total billed charges,90% of total billed charges,69,75,,55.2,percent of total billed charges,75% of total billed charges,17.4,122,,,fee schedule,122% of APC rate,26.68,29,,21.344,percent of total billed charges,29% of total billed charges,14.27,100,,,fee schedule,100% of CMS fee schedule,61.64,67,,49.312,percent of total billed charges,67% of total billed charges,21.23,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,73.6,80,,58.88,percent of total billed charges,80% of total billed charges,59.8,65,,47.84,percent of total billed charges,65% of total billed charges,32.82,35.67,,26.256,percent of total billed charges,35.67% of total billed charges,14.27,82.8,
HEPATITIS C VIRUS GENOTYPE,3005242,CDM,300,RC,87902,HCPCS,outpatient,,,376,150.40,,319.6,85,,255.68,percent of total billed charges,85% of total billed charges,289.52,77,,231.62,percent of total billed charges,77% of total billed charges,257.45,100,,,fee schedule,100% of CMS fee schedule,1112.44,350,,,fee schedule,350% of BCBS fee schedule,1156.94,364,,,fee schedule,364% of BCBS fee schedule,1156.94,364,,,fee schedule,364% of BCBS fee schedule,1156.94,364,,,fee schedule,364% of BCBS fee schedule,338.4,90,,270.72,percent of total billed charges,90% of total billed charges,300.8,80,,240.64,percent of total billed charges,80% of total billed charges,338.4,90,,270.72,percent of total billed charges,90% of total billed charges,282,75,,225.6,percent of total billed charges,75% of total billed charges,314.08,122,,,fee schedule,122% of APC rate,109.04,29,,87.232,percent of total billed charges,29% of total billed charges,257.45,100,,,fee schedule,100% of CMS fee schedule,251.92,67,,201.536,percent of total billed charges,67% of total billed charges,382.87,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,300.8,80,,240.64,percent of total billed charges,80% of total billed charges,244.4,65,,195.52,percent of total billed charges,65% of total billed charges,134.12,35.67,,107.296,percent of total billed charges,35.67% of total billed charges,109.04,1156.94,
HEPATITIS DELTA AGENT AB,3005260,CDM,300,RC,87380,HCPCS,outpatient,,,64,25.60,,54.4,85,,43.52,percent of total billed charges,85% of total billed charges,49.28,77,,39.42,percent of total billed charges,77% of total billed charges,18.36,100,,,fee schedule,100% of CMS fee schedule,70.91,350,,,fee schedule,350% of BCBS fee schedule,73.75,364,,,fee schedule,364% of BCBS fee schedule,73.75,364,,,fee schedule,364% of BCBS fee schedule,73.75,364,,,fee schedule,364% of BCBS fee schedule,57.6,90,,46.08,percent of total billed charges,90% of total billed charges,51.2,80,,40.96,percent of total billed charges,80% of total billed charges,57.6,90,,46.08,percent of total billed charges,90% of total billed charges,48,75,,38.4,percent of total billed charges,75% of total billed charges,22.39,122,,,fee schedule,122% of APC rate,18.56,29,,14.848,percent of total billed charges,29% of total billed charges,18.36,100,,,fee schedule,100% of CMS fee schedule,42.88,67,,34.304,percent of total billed charges,67% of total billed charges,24.41,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,51.2,80,,40.96,percent of total billed charges,80% of total billed charges,41.6,65,,33.28,percent of total billed charges,65% of total billed charges,22.83,35.67,,18.264,percent of total billed charges,35.67% of total billed charges,18.36,73.75,
HERPES SIMPLEX VIRUS DNA,3005267,CDM,300,RC,87529,HCPCS,outpatient,,,239,95.60,,203.15,85,,162.52,percent of total billed charges,85% of total billed charges,184.03,77,,147.22,percent of total billed charges,77% of total billed charges,35.09,100,,,fee schedule,100% of CMS fee schedule,151.66,350,,,fee schedule,350% of BCBS fee schedule,157.72,364,,,fee schedule,364% of BCBS fee schedule,157.72,364,,,fee schedule,364% of BCBS fee schedule,157.72,364,,,fee schedule,364% of BCBS fee schedule,215.1,90,,172.08,percent of total billed charges,90% of total billed charges,191.2,80,,152.96,percent of total billed charges,80% of total billed charges,215.1,90,,172.08,percent of total billed charges,90% of total billed charges,179.25,75,,143.4,percent of total billed charges,75% of total billed charges,42.8,122,,,fee schedule,122% of APC rate,69.31,29,,55.448,percent of total billed charges,29% of total billed charges,35.09,100,,,fee schedule,100% of CMS fee schedule,160.13,67,,128.104,percent of total billed charges,67% of total billed charges,52.19,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,191.2,80,,152.96,percent of total billed charges,80% of total billed charges,155.35,65,,124.28,percent of total billed charges,65% of total billed charges,85.25,35.67,,68.2,percent of total billed charges,35.67% of total billed charges,35.09,215.1,
HERPES VIRUS DNA DET,3005268,CDM,300,RC,87532,HCPCS,outpatient,,,239,95.60,,203.15,85,,162.52,percent of total billed charges,85% of total billed charges,184.03,77,,147.22,percent of total billed charges,77% of total billed charges,35.09,100,,,fee schedule,100% of CMS fee schedule,151.66,350,,,fee schedule,350% of BCBS fee schedule,157.72,364,,,fee schedule,364% of BCBS fee schedule,157.72,364,,,fee schedule,364% of BCBS fee schedule,157.72,364,,,fee schedule,364% of BCBS fee schedule,215.1,90,,172.08,percent of total billed charges,90% of total billed charges,191.2,80,,152.96,percent of total billed charges,80% of total billed charges,215.1,90,,172.08,percent of total billed charges,90% of total billed charges,179.25,75,,143.4,percent of total billed charges,75% of total billed charges,42.8,122,,,fee schedule,122% of APC rate,69.31,29,,55.448,percent of total billed charges,29% of total billed charges,35.09,100,,,fee schedule,100% of CMS fee schedule,160.13,67,,128.104,percent of total billed charges,67% of total billed charges,52.19,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,191.2,80,,152.96,percent of total billed charges,80% of total billed charges,155.35,65,,124.28,percent of total billed charges,65% of total billed charges,85.25,35.67,,68.2,percent of total billed charges,35.67% of total billed charges,35.09,215.1,
HERPES SIMPLEX IgG,3005269,CDM,300,RC,86694,HCPCS,outpatient,,,89,35.60,,75.65,85,,60.52,percent of total billed charges,85% of total billed charges,68.53,77,,54.82,percent of total billed charges,77% of total billed charges,14.39,100,,,fee schedule,100% of CMS fee schedule,62.2,350,,,fee schedule,350% of BCBS fee schedule,64.68,364,,,fee schedule,364% of BCBS fee schedule,64.68,364,,,fee schedule,364% of BCBS fee schedule,64.68,364,,,fee schedule,364% of BCBS fee schedule,80.1,90,,64.08,percent of total billed charges,90% of total billed charges,71.2,80,,56.96,percent of total billed charges,80% of total billed charges,80.1,90,,64.08,percent of total billed charges,90% of total billed charges,66.75,75,,53.4,percent of total billed charges,75% of total billed charges,17.55,122,,,fee schedule,122% of APC rate,25.81,29,,20.648,percent of total billed charges,29% of total billed charges,14.39,100,,,fee schedule,100% of CMS fee schedule,59.63,67,,47.704,percent of total billed charges,67% of total billed charges,21.4,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,71.2,80,,56.96,percent of total billed charges,80% of total billed charges,57.85,65,,46.28,percent of total billed charges,65% of total billed charges,31.75,35.67,,25.4,percent of total billed charges,35.67% of total billed charges,14.39,80.1,
HERPES SIMPLEX IGM,3005270,CDM,300,RC,86694,HCPCS,outpatient,,,89,35.60,,75.65,85,,60.52,percent of total billed charges,85% of total billed charges,68.53,77,,54.82,percent of total billed charges,77% of total billed charges,14.39,100,,,fee schedule,100% of CMS fee schedule,62.2,350,,,fee schedule,350% of BCBS fee schedule,64.68,364,,,fee schedule,364% of BCBS fee schedule,64.68,364,,,fee schedule,364% of BCBS fee schedule,64.68,364,,,fee schedule,364% of BCBS fee schedule,80.1,90,,64.08,percent of total billed charges,90% of total billed charges,71.2,80,,56.96,percent of total billed charges,80% of total billed charges,80.1,90,,64.08,percent of total billed charges,90% of total billed charges,66.75,75,,53.4,percent of total billed charges,75% of total billed charges,17.55,122,,,fee schedule,122% of APC rate,25.81,29,,20.648,percent of total billed charges,29% of total billed charges,14.39,100,,,fee schedule,100% of CMS fee schedule,59.63,67,,47.704,percent of total billed charges,67% of total billed charges,21.4,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,71.2,80,,56.96,percent of total billed charges,80% of total billed charges,57.85,65,,46.28,percent of total billed charges,65% of total billed charges,31.75,35.67,,25.4,percent of total billed charges,35.67% of total billed charges,14.39,80.1,
HERPES SIMPLEX I II AND IGM,3005271,CDM,300,RC,86790,HCPCS,outpatient,,,102,40.80,,86.7,85,,69.36,percent of total billed charges,85% of total billed charges,78.54,77,,62.83,percent of total billed charges,77% of total billed charges,12.88,100,,,fee schedule,100% of CMS fee schedule,55.65,350,,,fee schedule,350% of BCBS fee schedule,57.88,364,,,fee schedule,364% of BCBS fee schedule,57.88,364,,,fee schedule,364% of BCBS fee schedule,57.88,364,,,fee schedule,364% of BCBS fee schedule,91.8,90,,73.44,percent of total billed charges,90% of total billed charges,81.6,80,,65.28,percent of total billed charges,80% of total billed charges,91.8,90,,73.44,percent of total billed charges,90% of total billed charges,76.5,75,,61.2,percent of total billed charges,75% of total billed charges,15.71,122,,,fee schedule,122% of APC rate,29.58,29,,23.664,percent of total billed charges,29% of total billed charges,12.88,100,,,fee schedule,100% of CMS fee schedule,68.34,67,,54.672,percent of total billed charges,67% of total billed charges,8.64,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,81.6,80,,65.28,percent of total billed charges,80% of total billed charges,66.3,65,,53.04,percent of total billed charges,65% of total billed charges,36.38,35.67,,29.104,percent of total billed charges,35.67% of total billed charges,8.64,91.8,
"HERPES SIMPLEX 1,2 IgM & IgG",3005272,CDM,300,RC,,,outpatient,,,200,80.00,,170,85,,136,percent of total billed charges,85% of total billed charges,154,77,,123.2,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,164,82,,131.2,percent of total billed charges,82% of total billed charges,170,85,,136,percent of total billed charges,85% of total billed charges,170,85,,136,percent of total billed charges,85% of total billed charges,170,85,,136,percent of total billed charges,85% of total billed charges,180,90,,144,percent of total billed charges,90% of total billed charges,160,80,,128,percent of total billed charges,80% of total billed charges,180,90,,144,percent of total billed charges,90% of total billed charges,150,75,,120,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,58,29,,46.4,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,134,67,,107.2,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,160,80,,128,percent of total billed charges,80% of total billed charges,130,65,,104,percent of total billed charges,65% of total billed charges,71.34,35.67,,57.072,percent of total billed charges,35.67% of total billed charges,58,180,
HERPES VIRUS NON SPEC. I,3005273,CDM,300,RC,86694,HCPCS,outpatient,,,88,35.20,,74.8,85,,59.84,percent of total billed charges,85% of total billed charges,67.76,77,,54.21,percent of total billed charges,77% of total billed charges,14.39,100,,,fee schedule,100% of CMS fee schedule,62.2,350,,,fee schedule,350% of BCBS fee schedule,64.68,364,,,fee schedule,364% of BCBS fee schedule,64.68,364,,,fee schedule,364% of BCBS fee schedule,64.68,364,,,fee schedule,364% of BCBS fee schedule,79.2,90,,63.36,percent of total billed charges,90% of total billed charges,70.4,80,,56.32,percent of total billed charges,80% of total billed charges,79.2,90,,63.36,percent of total billed charges,90% of total billed charges,66,75,,52.8,percent of total billed charges,75% of total billed charges,17.55,122,,,fee schedule,122% of APC rate,25.52,29,,20.416,percent of total billed charges,29% of total billed charges,14.39,100,,,fee schedule,100% of CMS fee schedule,58.96,67,,47.168,percent of total billed charges,67% of total billed charges,21.4,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,70.4,80,,56.32,percent of total billed charges,80% of total billed charges,57.2,65,,45.76,percent of total billed charges,65% of total billed charges,31.39,35.67,,25.112,percent of total billed charges,35.67% of total billed charges,14.39,79.2,
HERPES SIMPLEX CULTURE,3005274,CDM,300,RC,87255,HCPCS,outpatient,,,48,19.20,,40.8,85,,32.64,percent of total billed charges,85% of total billed charges,36.96,77,,29.57,percent of total billed charges,77% of total billed charges,33.86,100,,,fee schedule,100% of CMS fee schedule,146.34,350,,,fee schedule,350% of BCBS fee schedule,152.19,364,,,fee schedule,364% of BCBS fee schedule,152.19,364,,,fee schedule,364% of BCBS fee schedule,152.19,364,,,fee schedule,364% of BCBS fee schedule,43.2,90,,34.56,percent of total billed charges,90% of total billed charges,38.4,80,,30.72,percent of total billed charges,80% of total billed charges,43.2,90,,34.56,percent of total billed charges,90% of total billed charges,36,75,,28.8,percent of total billed charges,75% of total billed charges,41.3,122,,,fee schedule,122% of APC rate,13.92,29,,11.136,percent of total billed charges,29% of total billed charges,33.86,100,,,fee schedule,100% of CMS fee schedule,32.16,67,,25.728,percent of total billed charges,67% of total billed charges,50.36,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,38.4,80,,30.72,percent of total billed charges,80% of total billed charges,31.2,65,,24.96,percent of total billed charges,65% of total billed charges,17.12,35.67,,13.696,percent of total billed charges,35.67% of total billed charges,13.92,152.19,
HERPES TEST 1 FOR PANEL,3005275,CDM,300,RC,86695,HCPCS,outpatient,,,85,34.00,,72.25,85,,57.8,percent of total billed charges,85% of total billed charges,65.45,77,,52.36,percent of total billed charges,77% of total billed charges,13.19,100,,,fee schedule,100% of CMS fee schedule,56.98,350,,,fee schedule,350% of BCBS fee schedule,59.26,364,,,fee schedule,364% of BCBS fee schedule,59.26,364,,,fee schedule,364% of BCBS fee schedule,59.26,364,,,fee schedule,364% of BCBS fee schedule,76.5,90,,61.2,percent of total billed charges,90% of total billed charges,68,80,,54.4,percent of total billed charges,80% of total billed charges,76.5,90,,61.2,percent of total billed charges,90% of total billed charges,63.75,75,,51,percent of total billed charges,75% of total billed charges,16.09,122,,,fee schedule,122% of APC rate,24.65,29,,19.72,percent of total billed charges,29% of total billed charges,13.19,100,,,fee schedule,100% of CMS fee schedule,56.95,67,,45.56,percent of total billed charges,67% of total billed charges,19.61,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,68,80,,54.4,percent of total billed charges,80% of total billed charges,55.25,65,,44.2,percent of total billed charges,65% of total billed charges,30.32,35.67,,24.256,percent of total billed charges,35.67% of total billed charges,13.19,76.5,
HERPES TEST II FOR PANEL,3005276,CDM,300,RC,86695,HCPCS,outpatient,,,84,33.60,,71.4,85,,57.12,percent of total billed charges,85% of total billed charges,64.68,77,,51.74,percent of total billed charges,77% of total billed charges,13.19,100,,,fee schedule,100% of CMS fee schedule,56.98,350,,,fee schedule,350% of BCBS fee schedule,59.26,364,,,fee schedule,364% of BCBS fee schedule,59.26,364,,,fee schedule,364% of BCBS fee schedule,59.26,364,,,fee schedule,364% of BCBS fee schedule,75.6,90,,60.48,percent of total billed charges,90% of total billed charges,67.2,80,,53.76,percent of total billed charges,80% of total billed charges,75.6,90,,60.48,percent of total billed charges,90% of total billed charges,63,75,,50.4,percent of total billed charges,75% of total billed charges,16.09,122,,,fee schedule,122% of APC rate,24.36,29,,19.488,percent of total billed charges,29% of total billed charges,13.19,100,,,fee schedule,100% of CMS fee schedule,56.28,67,,45.024,percent of total billed charges,67% of total billed charges,19.61,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,67.2,80,,53.76,percent of total billed charges,80% of total billed charges,54.6,65,,43.68,percent of total billed charges,65% of total billed charges,29.96,35.67,,23.968,percent of total billed charges,35.67% of total billed charges,13.19,75.6,
HERPES SIMPLEX FOR PANEL,3005277,CDM,300,RC,86790,HCPCS,outpatient,,,102,40.80,,86.7,85,,69.36,percent of total billed charges,85% of total billed charges,78.54,77,,62.83,percent of total billed charges,77% of total billed charges,12.88,100,,,fee schedule,100% of CMS fee schedule,55.65,350,,,fee schedule,350% of BCBS fee schedule,57.88,364,,,fee schedule,364% of BCBS fee schedule,57.88,364,,,fee schedule,364% of BCBS fee schedule,57.88,364,,,fee schedule,364% of BCBS fee schedule,91.8,90,,73.44,percent of total billed charges,90% of total billed charges,81.6,80,,65.28,percent of total billed charges,80% of total billed charges,91.8,90,,73.44,percent of total billed charges,90% of total billed charges,76.5,75,,61.2,percent of total billed charges,75% of total billed charges,15.71,122,,,fee schedule,122% of APC rate,29.58,29,,23.664,percent of total billed charges,29% of total billed charges,12.88,100,,,fee schedule,100% of CMS fee schedule,68.34,67,,54.672,percent of total billed charges,67% of total billed charges,8.64,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,81.6,80,,65.28,percent of total billed charges,80% of total billed charges,66.3,65,,53.04,percent of total billed charges,65% of total billed charges,36.38,35.67,,29.104,percent of total billed charges,35.67% of total billed charges,8.64,91.8,
HERPES VIRUS - 6,3005279,CDM,300,RC,,,outpatient,,,177,70.80,,150.45,85,,120.36,percent of total billed charges,85% of total billed charges,136.29,77,,109.03,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,145.14,82,,116.112,percent of total billed charges,82% of total billed charges,150.45,85,,120.36,percent of total billed charges,85% of total billed charges,150.45,85,,120.36,percent of total billed charges,85% of total billed charges,150.45,85,,120.36,percent of total billed charges,85% of total billed charges,159.3,90,,127.44,percent of total billed charges,90% of total billed charges,141.6,80,,113.28,percent of total billed charges,80% of total billed charges,159.3,90,,127.44,percent of total billed charges,90% of total billed charges,132.75,75,,106.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,51.33,29,,41.064,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,118.59,67,,94.872,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,141.6,80,,113.28,percent of total billed charges,80% of total billed charges,115.05,65,,92.04,percent of total billed charges,65% of total billed charges,63.14,35.67,,50.512,percent of total billed charges,35.67% of total billed charges,51.33,159.3,
HGB ELECTROPHORESIS,3005280,CDM,300,RC,83020,HCPCS,outpatient,,,129,51.60,,109.65,85,,87.72,percent of total billed charges,85% of total billed charges,99.33,77,,79.46,percent of total billed charges,77% of total billed charges,12.87,100,,,fee schedule,100% of CMS fee schedule,55.62,350,,,fee schedule,350% of BCBS fee schedule,57.84,364,,,fee schedule,364% of BCBS fee schedule,57.84,364,,,fee schedule,364% of BCBS fee schedule,57.84,364,,,fee schedule,364% of BCBS fee schedule,116.1,90,,92.88,percent of total billed charges,90% of total billed charges,103.2,80,,82.56,percent of total billed charges,80% of total billed charges,116.1,90,,92.88,percent of total billed charges,90% of total billed charges,96.75,75,,77.4,percent of total billed charges,75% of total billed charges,15.7,122,,,fee schedule,122% of APC rate,37.41,29,,29.928,percent of total billed charges,29% of total billed charges,12.87,100,,,fee schedule,100% of CMS fee schedule,86.43,67,,69.144,percent of total billed charges,67% of total billed charges,19.14,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,103.2,80,,82.56,percent of total billed charges,80% of total billed charges,83.85,65,,67.08,percent of total billed charges,65% of total billed charges,46.01,35.67,,36.808,percent of total billed charges,35.67% of total billed charges,12.87,116.1,
HISTOPLASMOSIS,3005290,CDM,300,RC,86698,HCPCS,outpatient,,,80,32.00,,68,85,,54.4,percent of total billed charges,85% of total billed charges,61.6,77,,49.28,percent of total billed charges,77% of total billed charges,13.79,100,,,fee schedule,100% of CMS fee schedule,54.01,350,,,fee schedule,350% of BCBS fee schedule,56.17,364,,,fee schedule,364% of BCBS fee schedule,56.17,364,,,fee schedule,364% of BCBS fee schedule,56.17,364,,,fee schedule,364% of BCBS fee schedule,72,90,,57.6,percent of total billed charges,90% of total billed charges,64,80,,51.2,percent of total billed charges,80% of total billed charges,72,90,,57.6,percent of total billed charges,90% of total billed charges,60,75,,48,percent of total billed charges,75% of total billed charges,16.82,122,,,fee schedule,122% of APC rate,23.2,29,,18.56,percent of total billed charges,29% of total billed charges,13.79,100,,,fee schedule,100% of CMS fee schedule,53.6,67,,42.88,percent of total billed charges,67% of total billed charges,16.69,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,64,80,,51.2,percent of total billed charges,80% of total billed charges,52,65,,41.6,percent of total billed charges,65% of total billed charges,28.54,35.67,,22.832,percent of total billed charges,35.67% of total billed charges,13.79,72,
HISTOPLASMA ANTIBODIES,3005291,CDM,300,RC,86698,HCPCS,outpatient,,,80,32.00,,68,85,,54.4,percent of total billed charges,85% of total billed charges,61.6,77,,49.28,percent of total billed charges,77% of total billed charges,13.79,100,,,fee schedule,100% of CMS fee schedule,54.01,350,,,fee schedule,350% of BCBS fee schedule,56.17,364,,,fee schedule,364% of BCBS fee schedule,56.17,364,,,fee schedule,364% of BCBS fee schedule,56.17,364,,,fee schedule,364% of BCBS fee schedule,72,90,,57.6,percent of total billed charges,90% of total billed charges,64,80,,51.2,percent of total billed charges,80% of total billed charges,72,90,,57.6,percent of total billed charges,90% of total billed charges,60,75,,48,percent of total billed charges,75% of total billed charges,16.82,122,,,fee schedule,122% of APC rate,23.2,29,,18.56,percent of total billed charges,29% of total billed charges,13.79,100,,,fee schedule,100% of CMS fee schedule,53.6,67,,42.88,percent of total billed charges,67% of total billed charges,16.69,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,64,80,,51.2,percent of total billed charges,80% of total billed charges,52,65,,41.6,percent of total billed charges,65% of total billed charges,28.54,35.67,,22.832,percent of total billed charges,35.67% of total billed charges,13.79,72,
HLA-B27,3005300,CDM,300,RC,86812,HCPCS,outpatient,,,204,81.60,,173.4,85,,138.72,percent of total billed charges,85% of total billed charges,157.08,77,,125.66,percent of total billed charges,77% of total billed charges,25.81,100,,,fee schedule,100% of CMS fee schedule,111.51,350,,,fee schedule,350% of BCBS fee schedule,115.97,364,,,fee schedule,364% of BCBS fee schedule,115.97,364,,,fee schedule,364% of BCBS fee schedule,115.97,364,,,fee schedule,364% of BCBS fee schedule,183.6,90,,146.88,percent of total billed charges,90% of total billed charges,163.2,80,,130.56,percent of total billed charges,80% of total billed charges,183.6,90,,146.88,percent of total billed charges,90% of total billed charges,153,75,,122.4,percent of total billed charges,75% of total billed charges,31.48,122,,,fee schedule,122% of APC rate,59.16,29,,47.328,percent of total billed charges,29% of total billed charges,25.81,100,,,fee schedule,100% of CMS fee schedule,136.68,67,,109.344,percent of total billed charges,67% of total billed charges,38.38,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,163.2,80,,130.56,percent of total billed charges,80% of total billed charges,132.6,65,,106.08,percent of total billed charges,65% of total billed charges,72.77,35.67,,58.216,percent of total billed charges,35.67% of total billed charges,25.81,183.6,
HYDREXYPROLINE,3005301,CDM,300,RC,83505,HCPCS,outpatient,,,120,48.00,,102,85,,81.6,percent of total billed charges,85% of total billed charges,92.4,77,,73.92,percent of total billed charges,77% of total billed charges,24.3,100,,,fee schedule,100% of CMS fee schedule,105.04,350,,,fee schedule,350% of BCBS fee schedule,109.24,364,,,fee schedule,364% of BCBS fee schedule,109.24,364,,,fee schedule,364% of BCBS fee schedule,109.24,364,,,fee schedule,364% of BCBS fee schedule,108,90,,86.4,percent of total billed charges,90% of total billed charges,96,80,,76.8,percent of total billed charges,80% of total billed charges,108,90,,86.4,percent of total billed charges,90% of total billed charges,90,75,,72,percent of total billed charges,75% of total billed charges,29.64,122,,,fee schedule,122% of APC rate,34.8,29,,27.84,percent of total billed charges,29% of total billed charges,24.3,100,,,fee schedule,100% of CMS fee schedule,80.4,67,,64.32,percent of total billed charges,67% of total billed charges,36.15,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,96,80,,76.8,percent of total billed charges,80% of total billed charges,78,65,,62.4,percent of total billed charges,65% of total billed charges,42.8,35.67,,34.24,percent of total billed charges,35.67% of total billed charges,24.3,109.24,
HYDROXYLYSIN,3005302,CDM,300,RC,82131,HCPCS,outpatient,,,92,36.80,,78.2,85,,62.56,percent of total billed charges,85% of total billed charges,70.84,77,,56.67,percent of total billed charges,77% of total billed charges,22.98,100,,,fee schedule,100% of CMS fee schedule,80.43,350,,,fee schedule,350% of BCBS fee schedule,83.65,364,,,fee schedule,364% of BCBS fee schedule,83.65,364,,,fee schedule,364% of BCBS fee schedule,83.65,364,,,fee schedule,364% of BCBS fee schedule,82.8,90,,66.24,percent of total billed charges,90% of total billed charges,73.6,80,,58.88,percent of total billed charges,80% of total billed charges,82.8,90,,66.24,percent of total billed charges,90% of total billed charges,69,75,,55.2,percent of total billed charges,75% of total billed charges,28.03,122,,,fee schedule,122% of APC rate,26.68,29,,21.344,percent of total billed charges,29% of total billed charges,22.98,100,,,fee schedule,100% of CMS fee schedule,61.64,67,,49.312,percent of total billed charges,67% of total billed charges,25.08,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,73.6,80,,58.88,percent of total billed charges,80% of total billed charges,59.8,65,,47.84,percent of total billed charges,65% of total billed charges,32.82,35.67,,26.256,percent of total billed charges,35.67% of total billed charges,22.98,83.65,
HUMAN GROWTH HORMONE,3005320,CDM,300,RC,83003,HCPCS,outpatient,,,71,28.40,,60.35,85,,48.28,percent of total billed charges,85% of total billed charges,54.67,77,,43.74,percent of total billed charges,77% of total billed charges,16.67,100,,,fee schedule,100% of CMS fee schedule,72.03,350,,,fee schedule,350% of BCBS fee schedule,74.91,364,,,fee schedule,364% of BCBS fee schedule,74.91,364,,,fee schedule,364% of BCBS fee schedule,74.91,364,,,fee schedule,364% of BCBS fee schedule,63.9,90,,51.12,percent of total billed charges,90% of total billed charges,56.8,80,,45.44,percent of total billed charges,80% of total billed charges,63.9,90,,51.12,percent of total billed charges,90% of total billed charges,53.25,75,,42.6,percent of total billed charges,75% of total billed charges,20.33,122,,,fee schedule,122% of APC rate,20.59,29,,16.472,percent of total billed charges,29% of total billed charges,16.67,100,,,fee schedule,100% of CMS fee schedule,47.57,67,,38.056,percent of total billed charges,67% of total billed charges,24.8,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,56.8,80,,45.44,percent of total billed charges,80% of total billed charges,46.15,65,,36.92,percent of total billed charges,65% of total billed charges,25.33,35.67,,20.264,percent of total billed charges,35.67% of total billed charges,16.67,74.91,
IGA,3005322,CDM,300,RC,86329,HCPCS,outpatient,,,115,46.00,,97.75,85,,78.2,percent of total billed charges,85% of total billed charges,88.55,77,,70.84,percent of total billed charges,77% of total billed charges,14.05,100,,,fee schedule,100% of CMS fee schedule,60.69,350,,,fee schedule,350% of BCBS fee schedule,63.12,364,,,fee schedule,364% of BCBS fee schedule,63.12,364,,,fee schedule,364% of BCBS fee schedule,63.12,364,,,fee schedule,364% of BCBS fee schedule,103.5,90,,82.8,percent of total billed charges,90% of total billed charges,92,80,,73.6,percent of total billed charges,80% of total billed charges,103.5,90,,82.8,percent of total billed charges,90% of total billed charges,86.25,75,,69,percent of total billed charges,75% of total billed charges,17.14,122,,,fee schedule,122% of APC rate,33.35,29,,26.68,percent of total billed charges,29% of total billed charges,14.05,100,,,fee schedule,100% of CMS fee schedule,77.05,67,,61.64,percent of total billed charges,67% of total billed charges,20.88,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,92,80,,73.6,percent of total billed charges,80% of total billed charges,74.75,65,,59.8,percent of total billed charges,65% of total billed charges,41.02,35.67,,32.816,percent of total billed charges,35.67% of total billed charges,14.05,103.5,
HUMAN T LYMPHOTROPIC VIRUSI/II,3005323,CDM,300,RC,86790,HCPCS,outpatient,,,102,40.80,,86.7,85,,69.36,percent of total billed charges,85% of total billed charges,78.54,77,,62.83,percent of total billed charges,77% of total billed charges,12.88,100,,,fee schedule,100% of CMS fee schedule,55.65,350,,,fee schedule,350% of BCBS fee schedule,57.88,364,,,fee schedule,364% of BCBS fee schedule,57.88,364,,,fee schedule,364% of BCBS fee schedule,57.88,364,,,fee schedule,364% of BCBS fee schedule,91.8,90,,73.44,percent of total billed charges,90% of total billed charges,81.6,80,,65.28,percent of total billed charges,80% of total billed charges,91.8,90,,73.44,percent of total billed charges,90% of total billed charges,76.5,75,,61.2,percent of total billed charges,75% of total billed charges,15.71,122,,,fee schedule,122% of APC rate,29.58,29,,23.664,percent of total billed charges,29% of total billed charges,12.88,100,,,fee schedule,100% of CMS fee schedule,68.34,67,,54.672,percent of total billed charges,67% of total billed charges,8.64,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,81.6,80,,65.28,percent of total billed charges,80% of total billed charges,66.3,65,,53.04,percent of total billed charges,65% of total billed charges,36.38,35.67,,29.104,percent of total billed charges,35.67% of total billed charges,8.64,91.8,
IGD,3005324,CDM,300,RC,86329,HCPCS,outpatient,,,115,46.00,,97.75,85,,78.2,percent of total billed charges,85% of total billed charges,88.55,77,,70.84,percent of total billed charges,77% of total billed charges,14.05,100,,,fee schedule,100% of CMS fee schedule,60.69,350,,,fee schedule,350% of BCBS fee schedule,63.12,364,,,fee schedule,364% of BCBS fee schedule,63.12,364,,,fee schedule,364% of BCBS fee schedule,63.12,364,,,fee schedule,364% of BCBS fee schedule,103.5,90,,82.8,percent of total billed charges,90% of total billed charges,92,80,,73.6,percent of total billed charges,80% of total billed charges,103.5,90,,82.8,percent of total billed charges,90% of total billed charges,86.25,75,,69,percent of total billed charges,75% of total billed charges,17.14,122,,,fee schedule,122% of APC rate,33.35,29,,26.68,percent of total billed charges,29% of total billed charges,14.05,100,,,fee schedule,100% of CMS fee schedule,77.05,67,,61.64,percent of total billed charges,67% of total billed charges,20.88,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,92,80,,73.6,percent of total billed charges,80% of total billed charges,74.75,65,,59.8,percent of total billed charges,65% of total billed charges,41.02,35.67,,32.816,percent of total billed charges,35.67% of total billed charges,14.05,103.5,
IGG,3005326,CDM,300,RC,86329,HCPCS,outpatient,,,120,48.00,,102,85,,81.6,percent of total billed charges,85% of total billed charges,92.4,77,,73.92,percent of total billed charges,77% of total billed charges,14.05,100,,,fee schedule,100% of CMS fee schedule,60.69,350,,,fee schedule,350% of BCBS fee schedule,63.12,364,,,fee schedule,364% of BCBS fee schedule,63.12,364,,,fee schedule,364% of BCBS fee schedule,63.12,364,,,fee schedule,364% of BCBS fee schedule,108,90,,86.4,percent of total billed charges,90% of total billed charges,96,80,,76.8,percent of total billed charges,80% of total billed charges,108,90,,86.4,percent of total billed charges,90% of total billed charges,90,75,,72,percent of total billed charges,75% of total billed charges,17.14,122,,,fee schedule,122% of APC rate,34.8,29,,27.84,percent of total billed charges,29% of total billed charges,14.05,100,,,fee schedule,100% of CMS fee schedule,80.4,67,,64.32,percent of total billed charges,67% of total billed charges,20.88,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,96,80,,76.8,percent of total billed charges,80% of total billed charges,78,65,,62.4,percent of total billed charges,65% of total billed charges,42.8,35.67,,34.24,percent of total billed charges,35.67% of total billed charges,14.05,108,
IgG CSF,3005327,CDM,300,RC,82784,HCPCS,outpatient,,,48,19.20,,40.8,85,,32.64,percent of total billed charges,85% of total billed charges,36.96,77,,29.57,percent of total billed charges,77% of total billed charges,9.3,100,,,fee schedule,100% of CMS fee schedule,40.18,350,,,fee schedule,350% of BCBS fee schedule,41.79,364,,,fee schedule,364% of BCBS fee schedule,41.79,364,,,fee schedule,364% of BCBS fee schedule,41.79,364,,,fee schedule,364% of BCBS fee schedule,43.2,90,,34.56,percent of total billed charges,90% of total billed charges,38.4,80,,30.72,percent of total billed charges,80% of total billed charges,43.2,90,,34.56,percent of total billed charges,90% of total billed charges,36,75,,28.8,percent of total billed charges,75% of total billed charges,11.34,122,,,fee schedule,122% of APC rate,13.92,29,,11.136,percent of total billed charges,29% of total billed charges,9.3,100,,,fee schedule,100% of CMS fee schedule,32.16,67,,25.728,percent of total billed charges,67% of total billed charges,13.82,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,38.4,80,,30.72,percent of total billed charges,80% of total billed charges,31.2,65,,24.96,percent of total billed charges,65% of total billed charges,17.12,35.67,,13.696,percent of total billed charges,35.67% of total billed charges,9.3,43.2,
IGG SUBCLASS PANEL,3005328,CDM,300,RC,82787,HCPCS,outpatient,,,216,86.40,,183.6,85,,146.88,percent of total billed charges,85% of total billed charges,166.32,77,,133.06,percent of total billed charges,77% of total billed charges,8.02,100,,,fee schedule,100% of CMS fee schedule,34.65,350,,,fee schedule,350% of BCBS fee schedule,36.04,364,,,fee schedule,364% of BCBS fee schedule,36.04,364,,,fee schedule,364% of BCBS fee schedule,36.04,364,,,fee schedule,364% of BCBS fee schedule,194.4,90,,155.52,percent of total billed charges,90% of total billed charges,172.8,80,,138.24,percent of total billed charges,80% of total billed charges,194.4,90,,155.52,percent of total billed charges,90% of total billed charges,162,75,,129.6,percent of total billed charges,75% of total billed charges,9.78,122,,,fee schedule,122% of APC rate,62.64,29,,50.112,percent of total billed charges,29% of total billed charges,8.02,100,,,fee schedule,100% of CMS fee schedule,144.72,67,,115.776,percent of total billed charges,67% of total billed charges,6.22,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,172.8,80,,138.24,percent of total billed charges,80% of total billed charges,140.4,65,,112.32,percent of total billed charges,65% of total billed charges,77.05,35.67,,61.64,percent of total billed charges,35.67% of total billed charges,6.22,194.4,
IgG SERUM,3005329,CDM,300,RC,82784,HCPCS,outpatient,,,48,19.20,,40.8,85,,32.64,percent of total billed charges,85% of total billed charges,36.96,77,,29.57,percent of total billed charges,77% of total billed charges,9.3,100,,,fee schedule,100% of CMS fee schedule,40.18,350,,,fee schedule,350% of BCBS fee schedule,41.79,364,,,fee schedule,364% of BCBS fee schedule,41.79,364,,,fee schedule,364% of BCBS fee schedule,41.79,364,,,fee schedule,364% of BCBS fee schedule,43.2,90,,34.56,percent of total billed charges,90% of total billed charges,38.4,80,,30.72,percent of total billed charges,80% of total billed charges,43.2,90,,34.56,percent of total billed charges,90% of total billed charges,36,75,,28.8,percent of total billed charges,75% of total billed charges,11.34,122,,,fee schedule,122% of APC rate,13.92,29,,11.136,percent of total billed charges,29% of total billed charges,9.3,100,,,fee schedule,100% of CMS fee schedule,32.16,67,,25.728,percent of total billed charges,67% of total billed charges,13.82,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,38.4,80,,30.72,percent of total billed charges,80% of total billed charges,31.2,65,,24.96,percent of total billed charges,65% of total billed charges,17.12,35.67,,13.696,percent of total billed charges,35.67% of total billed charges,9.3,43.2,
IGM,3005330,CDM,300,RC,86329,HCPCS,outpatient,,,115,46.00,,97.75,85,,78.2,percent of total billed charges,85% of total billed charges,88.55,77,,70.84,percent of total billed charges,77% of total billed charges,14.05,100,,,fee schedule,100% of CMS fee schedule,60.69,350,,,fee schedule,350% of BCBS fee schedule,63.12,364,,,fee schedule,364% of BCBS fee schedule,63.12,364,,,fee schedule,364% of BCBS fee schedule,63.12,364,,,fee schedule,364% of BCBS fee schedule,103.5,90,,82.8,percent of total billed charges,90% of total billed charges,92,80,,73.6,percent of total billed charges,80% of total billed charges,103.5,90,,82.8,percent of total billed charges,90% of total billed charges,86.25,75,,69,percent of total billed charges,75% of total billed charges,17.14,122,,,fee schedule,122% of APC rate,33.35,29,,26.68,percent of total billed charges,29% of total billed charges,14.05,100,,,fee schedule,100% of CMS fee schedule,77.05,67,,61.64,percent of total billed charges,67% of total billed charges,20.88,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,92,80,,73.6,percent of total billed charges,80% of total billed charges,74.75,65,,59.8,percent of total billed charges,65% of total billed charges,41.02,35.67,,32.816,percent of total billed charges,35.67% of total billed charges,14.05,103.5,
IMIPRAMINE (TROFANIL),3005340,CDM,300,RC,80335,HCPCS,outpatient,,,438,175.20,,372.3,85,,297.84,percent of total billed charges,85% of total billed charges,337.26,77,,269.81,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,359.16,82,,287.328,percent of total billed charges,82% of total billed charges,372.3,85,,297.84,percent of total billed charges,85% of total billed charges,372.3,85,,297.84,percent of total billed charges,85% of total billed charges,372.3,85,,297.84,percent of total billed charges,85% of total billed charges,394.2,90,,315.36,percent of total billed charges,90% of total billed charges,350.4,80,,280.32,percent of total billed charges,80% of total billed charges,394.2,90,,315.36,percent of total billed charges,90% of total billed charges,328.5,75,,262.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,127.02,29,,101.616,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,293.46,67,,234.768,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,350.4,80,,280.32,percent of total billed charges,80% of total billed charges,284.7,65,,227.76,percent of total billed charges,65% of total billed charges,156.23,35.67,,124.984,percent of total billed charges,35.67% of total billed charges,127.02,394.2,
IMMUNOELECTROPHORESIS,3005350,CDM,300,RC,86325,HCPCS,outpatient,,,168,67.20,,142.8,85,,114.24,percent of total billed charges,85% of total billed charges,129.36,77,,103.49,percent of total billed charges,77% of total billed charges,23.13,100,,,fee schedule,100% of CMS fee schedule,96.64,350,,,fee schedule,350% of BCBS fee schedule,100.5,364,,,fee schedule,364% of BCBS fee schedule,100.5,364,,,fee schedule,364% of BCBS fee schedule,100.5,364,,,fee schedule,364% of BCBS fee schedule,151.2,90,,120.96,percent of total billed charges,90% of total billed charges,134.4,80,,107.52,percent of total billed charges,80% of total billed charges,151.2,90,,120.96,percent of total billed charges,90% of total billed charges,126,75,,100.8,percent of total billed charges,75% of total billed charges,28.21,122,,,fee schedule,122% of APC rate,48.72,29,,38.976,percent of total billed charges,29% of total billed charges,23.13,100,,,fee schedule,100% of CMS fee schedule,112.56,67,,90.048,percent of total billed charges,67% of total billed charges,33.25,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,134.4,80,,107.52,percent of total billed charges,80% of total billed charges,109.2,65,,87.36,percent of total billed charges,65% of total billed charges,59.93,35.67,,47.944,percent of total billed charges,35.67% of total billed charges,23.13,151.2,
IMMUNOELECTROPHORESIS,3005355,CDM,300,RC,86320,HCPCS,outpatient,,,205,82.00,,174.25,85,,139.4,percent of total billed charges,85% of total billed charges,157.85,77,,126.28,percent of total billed charges,77% of total billed charges,29.92,100,,,fee schedule,100% of CMS fee schedule,104.72,350,,,fee schedule,350% of BCBS fee schedule,108.91,364,,,fee schedule,364% of BCBS fee schedule,108.91,364,,,fee schedule,364% of BCBS fee schedule,108.91,364,,,fee schedule,364% of BCBS fee schedule,184.5,90,,147.6,percent of total billed charges,90% of total billed charges,164,80,,131.2,percent of total billed charges,80% of total billed charges,184.5,90,,147.6,percent of total billed charges,90% of total billed charges,153.75,75,,123,percent of total billed charges,75% of total billed charges,36.5,122,,,fee schedule,122% of APC rate,59.45,29,,47.56,percent of total billed charges,29% of total billed charges,29.92,100,,,fee schedule,100% of CMS fee schedule,137.35,67,,109.88,percent of total billed charges,67% of total billed charges,33.33,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,164,80,,131.2,percent of total billed charges,80% of total billed charges,133.25,65,,106.6,percent of total billed charges,65% of total billed charges,73.12,35.67,,58.496,percent of total billed charges,35.67% of total billed charges,29.92,184.5,
IMMUNOELECTROPHORESIS URINE,3005360,CDM,300,RC,86325,HCPCS,outpatient,,,168,67.20,,142.8,85,,114.24,percent of total billed charges,85% of total billed charges,129.36,77,,103.49,percent of total billed charges,77% of total billed charges,23.13,100,,,fee schedule,100% of CMS fee schedule,96.64,350,,,fee schedule,350% of BCBS fee schedule,100.5,364,,,fee schedule,364% of BCBS fee schedule,100.5,364,,,fee schedule,364% of BCBS fee schedule,100.5,364,,,fee schedule,364% of BCBS fee schedule,151.2,90,,120.96,percent of total billed charges,90% of total billed charges,134.4,80,,107.52,percent of total billed charges,80% of total billed charges,151.2,90,,120.96,percent of total billed charges,90% of total billed charges,126,75,,100.8,percent of total billed charges,75% of total billed charges,28.21,122,,,fee schedule,122% of APC rate,48.72,29,,38.976,percent of total billed charges,29% of total billed charges,23.13,100,,,fee schedule,100% of CMS fee schedule,112.56,67,,90.048,percent of total billed charges,67% of total billed charges,33.25,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,134.4,80,,107.52,percent of total billed charges,80% of total billed charges,109.2,65,,87.36,percent of total billed charges,65% of total billed charges,59.93,35.67,,47.944,percent of total billed charges,35.67% of total billed charges,23.13,151.2,
IMMUNOASSAY FOR PANEL,3005361,CDM,300,RC,83520,HCPCS,outpatient,,,152,60.80,,129.2,85,,103.36,percent of total billed charges,85% of total billed charges,117.04,77,,93.63,percent of total billed charges,77% of total billed charges,17.27,100,,,fee schedule,100% of CMS fee schedule,60.45,350,,,fee schedule,350% of BCBS fee schedule,62.86,364,,,fee schedule,364% of BCBS fee schedule,62.86,364,,,fee schedule,364% of BCBS fee schedule,62.86,364,,,fee schedule,364% of BCBS fee schedule,136.8,90,,109.44,percent of total billed charges,90% of total billed charges,121.6,80,,97.28,percent of total billed charges,80% of total billed charges,136.8,90,,109.44,percent of total billed charges,90% of total billed charges,114,75,,91.2,percent of total billed charges,75% of total billed charges,21.06,122,,,fee schedule,122% of APC rate,44.08,29,,35.264,percent of total billed charges,29% of total billed charges,17.27,100,,,fee schedule,100% of CMS fee schedule,101.84,67,,81.472,percent of total billed charges,67% of total billed charges,19.25,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,121.6,80,,97.28,percent of total billed charges,80% of total billed charges,98.8,65,,79.04,percent of total billed charges,65% of total billed charges,54.22,35.67,,43.376,percent of total billed charges,35.67% of total billed charges,17.27,136.8,
KEPPRA LAB TEST,3005365,CDM,300,RC,80299,HCPCS,outpatient,,,317,126.80,,269.45,85,,215.56,percent of total billed charges,85% of total billed charges,244.09,77,,195.27,percent of total billed charges,77% of total billed charges,18.64,100,,,fee schedule,100% of CMS fee schedule,65.24,350,,,fee schedule,350% of BCBS fee schedule,67.85,364,,,fee schedule,364% of BCBS fee schedule,67.85,364,,,fee schedule,364% of BCBS fee schedule,67.85,364,,,fee schedule,364% of BCBS fee schedule,285.3,90,,228.24,percent of total billed charges,90% of total billed charges,253.6,80,,202.88,percent of total billed charges,80% of total billed charges,285.3,90,,228.24,percent of total billed charges,90% of total billed charges,237.75,75,,190.2,percent of total billed charges,75% of total billed charges,22.74,122,,,fee schedule,122% of APC rate,91.93,29,,73.544,percent of total billed charges,29% of total billed charges,18.64,100,,,fee schedule,100% of CMS fee schedule,212.39,67,,169.912,percent of total billed charges,67% of total billed charges,20.36,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,253.6,80,,202.88,percent of total billed charges,80% of total billed charges,206.05,65,,164.84,percent of total billed charges,65% of total billed charges,113.07,35.67,,90.456,percent of total billed charges,35.67% of total billed charges,18.64,285.3,
HERPES VIRUS NON SPEC TEST II,3005374,CDM,300,RC,86694,HCPCS,outpatient,,,88,35.20,,74.8,85,,59.84,percent of total billed charges,85% of total billed charges,67.76,77,,54.21,percent of total billed charges,77% of total billed charges,14.39,100,,,fee schedule,100% of CMS fee schedule,62.2,350,,,fee schedule,350% of BCBS fee schedule,64.68,364,,,fee schedule,364% of BCBS fee schedule,64.68,364,,,fee schedule,364% of BCBS fee schedule,64.68,364,,,fee schedule,364% of BCBS fee schedule,79.2,90,,63.36,percent of total billed charges,90% of total billed charges,70.4,80,,56.32,percent of total billed charges,80% of total billed charges,79.2,90,,63.36,percent of total billed charges,90% of total billed charges,66,75,,52.8,percent of total billed charges,75% of total billed charges,17.55,122,,,fee schedule,122% of APC rate,25.52,29,,20.416,percent of total billed charges,29% of total billed charges,14.39,100,,,fee schedule,100% of CMS fee schedule,58.96,67,,47.168,percent of total billed charges,67% of total billed charges,21.4,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,70.4,80,,56.32,percent of total billed charges,80% of total billed charges,57.2,65,,45.76,percent of total billed charges,65% of total billed charges,31.39,35.67,,25.112,percent of total billed charges,35.67% of total billed charges,14.39,79.2,
IGE,3005380,CDM,300,RC,82785,HCPCS,outpatient,,,84,33.60,,71.4,85,,57.12,percent of total billed charges,85% of total billed charges,64.68,77,,51.74,percent of total billed charges,77% of total billed charges,16.46,100,,,fee schedule,100% of CMS fee schedule,71.12,350,,,fee schedule,350% of BCBS fee schedule,73.96,364,,,fee schedule,364% of BCBS fee schedule,73.96,364,,,fee schedule,364% of BCBS fee schedule,73.96,364,,,fee schedule,364% of BCBS fee schedule,75.6,90,,60.48,percent of total billed charges,90% of total billed charges,67.2,80,,53.76,percent of total billed charges,80% of total billed charges,75.6,90,,60.48,percent of total billed charges,90% of total billed charges,63,75,,50.4,percent of total billed charges,75% of total billed charges,20.08,122,,,fee schedule,122% of APC rate,24.36,29,,19.488,percent of total billed charges,29% of total billed charges,16.46,100,,,fee schedule,100% of CMS fee schedule,56.28,67,,45.024,percent of total billed charges,67% of total billed charges,24.48,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,67.2,80,,53.76,percent of total billed charges,80% of total billed charges,54.6,65,,43.68,percent of total billed charges,65% of total billed charges,29.96,35.67,,23.968,percent of total billed charges,35.67% of total billed charges,16.46,75.6,
IMMUNOGLOBULIN-G A M EXP,3005400,CDM,300,RC,82784,HCPCS,outpatient,,,88,35.20,,74.8,85,,59.84,percent of total billed charges,85% of total billed charges,67.76,77,,54.21,percent of total billed charges,77% of total billed charges,9.3,100,,,fee schedule,100% of CMS fee schedule,40.18,350,,,fee schedule,350% of BCBS fee schedule,41.79,364,,,fee schedule,364% of BCBS fee schedule,41.79,364,,,fee schedule,364% of BCBS fee schedule,41.79,364,,,fee schedule,364% of BCBS fee schedule,79.2,90,,63.36,percent of total billed charges,90% of total billed charges,70.4,80,,56.32,percent of total billed charges,80% of total billed charges,79.2,90,,63.36,percent of total billed charges,90% of total billed charges,66,75,,52.8,percent of total billed charges,75% of total billed charges,11.34,122,,,fee schedule,122% of APC rate,25.52,29,,20.416,percent of total billed charges,29% of total billed charges,9.3,100,,,fee schedule,100% of CMS fee schedule,58.96,67,,47.168,percent of total billed charges,67% of total billed charges,13.82,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,70.4,80,,56.32,percent of total billed charges,80% of total billed charges,57.2,65,,45.76,percent of total billed charges,65% of total billed charges,31.39,35.67,,25.112,percent of total billed charges,35.67% of total billed charges,9.3,79.2,
IMMUNOFLURO PER SPECIMEN EA AD,3005401,CDM,300,RC,88350,HCPCS,outpatient,,,515,206.00,,437.75,85,,350.2,percent of total billed charges,85% of total billed charges,396.55,77,,317.24,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,152.01,350,,,fee schedule,350% of BCBS fee schedule,158.09,364,,,fee schedule,364% of BCBS fee schedule,158.09,364,,,fee schedule,364% of BCBS fee schedule,158.09,364,,,fee schedule,364% of BCBS fee schedule,463.5,90,,370.8,percent of total billed charges,90% of total billed charges,412,80,,329.6,percent of total billed charges,80% of total billed charges,463.5,90,,370.8,percent of total billed charges,90% of total billed charges,386.25,75,,309,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,149.35,29,,119.48,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,345.05,67,,276.04,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,412,80,,329.6,percent of total billed charges,80% of total billed charges,334.75,65,,267.8,percent of total billed charges,65% of total billed charges,183.7,35.67,,146.96,percent of total billed charges,35.67% of total billed charges,149.35,463.5,
CELIAC REFLEX PANEL,3005402,CDM,300,RC,82784,HCPCS,outpatient,,,29,11.60,,24.65,85,,19.72,percent of total billed charges,85% of total billed charges,22.33,77,,17.86,percent of total billed charges,77% of total billed charges,9.3,100,,,fee schedule,100% of CMS fee schedule,40.18,350,,,fee schedule,350% of BCBS fee schedule,41.79,364,,,fee schedule,364% of BCBS fee schedule,41.79,364,,,fee schedule,364% of BCBS fee schedule,41.79,364,,,fee schedule,364% of BCBS fee schedule,26.1,90,,20.88,percent of total billed charges,90% of total billed charges,23.2,80,,18.56,percent of total billed charges,80% of total billed charges,26.1,90,,20.88,percent of total billed charges,90% of total billed charges,21.75,75,,17.4,percent of total billed charges,75% of total billed charges,11.34,122,,,fee schedule,122% of APC rate,8.41,29,,6.728,percent of total billed charges,29% of total billed charges,9.3,100,,,fee schedule,100% of CMS fee schedule,19.43,67,,15.544,percent of total billed charges,67% of total billed charges,13.82,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,23.2,80,,18.56,percent of total billed charges,80% of total billed charges,18.85,65,,15.08,percent of total billed charges,65% of total billed charges,10.34,35.67,,8.272,percent of total billed charges,35.67% of total billed charges,8.41,41.79,
IGG SUBCLASSES,3005405,CDM,300,RC,,,outpatient,,,296,118.40,,251.6,85,,201.28,percent of total billed charges,85% of total billed charges,227.92,77,,182.34,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,242.72,82,,194.176,percent of total billed charges,82% of total billed charges,251.6,85,,201.28,percent of total billed charges,85% of total billed charges,251.6,85,,201.28,percent of total billed charges,85% of total billed charges,251.6,85,,201.28,percent of total billed charges,85% of total billed charges,266.4,90,,213.12,percent of total billed charges,90% of total billed charges,236.8,80,,189.44,percent of total billed charges,80% of total billed charges,266.4,90,,213.12,percent of total billed charges,90% of total billed charges,222,75,,177.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,85.84,29,,68.672,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,198.32,67,,158.656,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,236.8,80,,189.44,percent of total billed charges,80% of total billed charges,192.4,65,,153.92,percent of total billed charges,65% of total billed charges,105.58,35.67,,84.464,percent of total billed charges,35.67% of total billed charges,85.84,266.4,
IGG FOR PANEL,3005406,CDM,300,RC,83520,HCPCS,outpatient,,,155,62.00,,131.75,85,,105.4,percent of total billed charges,85% of total billed charges,119.35,77,,95.48,percent of total billed charges,77% of total billed charges,17.27,100,,,fee schedule,100% of CMS fee schedule,60.45,350,,,fee schedule,350% of BCBS fee schedule,62.86,364,,,fee schedule,364% of BCBS fee schedule,62.86,364,,,fee schedule,364% of BCBS fee schedule,62.86,364,,,fee schedule,364% of BCBS fee schedule,139.5,90,,111.6,percent of total billed charges,90% of total billed charges,124,80,,99.2,percent of total billed charges,80% of total billed charges,139.5,90,,111.6,percent of total billed charges,90% of total billed charges,116.25,75,,93,percent of total billed charges,75% of total billed charges,21.06,122,,,fee schedule,122% of APC rate,44.95,29,,35.96,percent of total billed charges,29% of total billed charges,17.27,100,,,fee schedule,100% of CMS fee schedule,103.85,67,,83.08,percent of total billed charges,67% of total billed charges,19.25,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,124,80,,99.2,percent of total billed charges,80% of total billed charges,100.75,65,,80.6,percent of total billed charges,65% of total billed charges,55.29,35.67,,44.232,percent of total billed charges,35.67% of total billed charges,17.27,139.5,
IGG FOR PANEL II,3005407,CDM,300,RC,83520,HCPCS,outpatient,,,155,62.00,,131.75,85,,105.4,percent of total billed charges,85% of total billed charges,119.35,77,,95.48,percent of total billed charges,77% of total billed charges,17.27,100,,,fee schedule,100% of CMS fee schedule,60.45,350,,,fee schedule,350% of BCBS fee schedule,62.86,364,,,fee schedule,364% of BCBS fee schedule,62.86,364,,,fee schedule,364% of BCBS fee schedule,62.86,364,,,fee schedule,364% of BCBS fee schedule,139.5,90,,111.6,percent of total billed charges,90% of total billed charges,124,80,,99.2,percent of total billed charges,80% of total billed charges,139.5,90,,111.6,percent of total billed charges,90% of total billed charges,116.25,75,,93,percent of total billed charges,75% of total billed charges,21.06,122,,,fee schedule,122% of APC rate,44.95,29,,35.96,percent of total billed charges,29% of total billed charges,17.27,100,,,fee schedule,100% of CMS fee schedule,103.85,67,,83.08,percent of total billed charges,67% of total billed charges,19.25,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,124,80,,99.2,percent of total billed charges,80% of total billed charges,100.75,65,,80.6,percent of total billed charges,65% of total billed charges,55.29,35.67,,44.232,percent of total billed charges,35.67% of total billed charges,17.27,139.5,
INDIRECT IMMNOFLUO. ANTI- IgA,3005417,CDM,300,RC,,,outpatient,,,258,103.20,,219.3,85,,175.44,percent of total billed charges,85% of total billed charges,198.66,77,,158.93,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,211.56,82,,169.248,percent of total billed charges,82% of total billed charges,219.3,85,,175.44,percent of total billed charges,85% of total billed charges,219.3,85,,175.44,percent of total billed charges,85% of total billed charges,219.3,85,,175.44,percent of total billed charges,85% of total billed charges,232.2,90,,185.76,percent of total billed charges,90% of total billed charges,206.4,80,,165.12,percent of total billed charges,80% of total billed charges,232.2,90,,185.76,percent of total billed charges,90% of total billed charges,193.5,75,,154.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,74.82,29,,59.856,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,172.86,67,,138.288,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,206.4,80,,165.12,percent of total billed charges,80% of total billed charges,167.7,65,,134.16,percent of total billed charges,65% of total billed charges,92.03,35.67,,73.624,percent of total billed charges,35.67% of total billed charges,74.82,232.2,
INDIRECT IMMUNOFL WITH ANTIIgA,3005418,CDM,300,RC,88346,HCPCS,outpatient,,,288,115.20,,244.8,85,,195.84,percent of total billed charges,85% of total billed charges,221.76,77,,177.41,percent of total billed charges,77% of total billed charges,149.37,100,,,fee schedule,100% of CMS OPPS rate,754.01,350,,,fee schedule,350% of BCBS fee schedule,784.17,364,,,fee schedule,364% of BCBS fee schedule,784.17,364,,,fee schedule,364% of BCBS fee schedule,784.17,364,,,fee schedule,364% of BCBS fee schedule,259.2,90,,207.36,percent of total billed charges,90% of total billed charges,230.4,80,,184.32,percent of total billed charges,80% of total billed charges,259.2,90,,207.36,percent of total billed charges,90% of total billed charges,216,75,,172.8,percent of total billed charges,75% of total billed charges,182.23,122,,,fee schedule,122% of APC rate,83.52,29,,66.816,percent of total billed charges,29% of total billed charges,149.37,100,,,fee schedule,100% of CMS OPPS rate,192.96,67,,154.368,percent of total billed charges,67% of total billed charges,34.31,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,230.4,80,,184.32,percent of total billed charges,80% of total billed charges,187.2,65,,149.76,percent of total billed charges,65% of total billed charges,102.73,35.67,,82.184,percent of total billed charges,35.67% of total billed charges,34.31,784.17,
IMMUNOFLURO PER SPEC INITIAL,3005419,CDM,300,RC,88346,HCPCS,outpatient,,,515,206.00,,437.75,85,,350.2,percent of total billed charges,85% of total billed charges,396.55,77,,317.24,percent of total billed charges,77% of total billed charges,149.37,100,,,fee schedule,100% of CMS OPPS rate,754.01,350,,,fee schedule,350% of BCBS fee schedule,784.17,364,,,fee schedule,364% of BCBS fee schedule,784.17,364,,,fee schedule,364% of BCBS fee schedule,784.17,364,,,fee schedule,364% of BCBS fee schedule,463.5,90,,370.8,percent of total billed charges,90% of total billed charges,412,80,,329.6,percent of total billed charges,80% of total billed charges,463.5,90,,370.8,percent of total billed charges,90% of total billed charges,386.25,75,,309,percent of total billed charges,75% of total billed charges,182.23,122,,,fee schedule,122% of APC rate,149.35,29,,119.48,percent of total billed charges,29% of total billed charges,149.37,100,,,fee schedule,100% of CMS OPPS rate,345.05,67,,276.04,percent of total billed charges,67% of total billed charges,34.31,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,412,80,,329.6,percent of total billed charges,80% of total billed charges,334.75,65,,267.8,percent of total billed charges,65% of total billed charges,183.7,35.67,,146.96,percent of total billed charges,35.67% of total billed charges,34.31,784.17,
INDIA INK,3005420,CDM,300,RC,87210,HCPCS,outpatient,,,62,24.80,,52.7,85,,42.16,percent of total billed charges,85% of total billed charges,47.74,77,,38.19,percent of total billed charges,77% of total billed charges,5.82,100,,,fee schedule,100% of CMS fee schedule,20.37,350,,,fee schedule,350% of BCBS fee schedule,21.18,364,,,fee schedule,364% of BCBS fee schedule,21.18,364,,,fee schedule,364% of BCBS fee schedule,21.18,364,,,fee schedule,364% of BCBS fee schedule,55.8,90,,44.64,percent of total billed charges,90% of total billed charges,49.6,80,,39.68,percent of total billed charges,80% of total billed charges,55.8,90,,44.64,percent of total billed charges,90% of total billed charges,46.5,75,,37.2,percent of total billed charges,75% of total billed charges,7.1,122,,,fee schedule,122% of APC rate,17.98,29,,14.384,percent of total billed charges,29% of total billed charges,5.82,100,,,fee schedule,100% of CMS fee schedule,41.54,67,,33.232,percent of total billed charges,67% of total billed charges,6.35,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,49.6,80,,39.68,percent of total billed charges,80% of total billed charges,40.3,65,,32.24,percent of total billed charges,65% of total billed charges,22.12,35.67,,17.696,percent of total billed charges,35.67% of total billed charges,5.82,55.8,
INFLUENZA A IgG,3005424,CDM,300,RC,86710,HCPCS,outpatient,,,66,26.40,,56.1,85,,44.88,percent of total billed charges,85% of total billed charges,50.82,77,,40.66,percent of total billed charges,77% of total billed charges,13.55,100,,,fee schedule,100% of CMS fee schedule,58.56,350,,,fee schedule,350% of BCBS fee schedule,60.9,364,,,fee schedule,364% of BCBS fee schedule,60.9,364,,,fee schedule,364% of BCBS fee schedule,60.9,364,,,fee schedule,364% of BCBS fee schedule,59.4,90,,47.52,percent of total billed charges,90% of total billed charges,52.8,80,,42.24,percent of total billed charges,80% of total billed charges,59.4,90,,47.52,percent of total billed charges,90% of total billed charges,49.5,75,,39.6,percent of total billed charges,75% of total billed charges,16.53,122,,,fee schedule,122% of APC rate,19.14,29,,15.312,percent of total billed charges,29% of total billed charges,13.55,100,,,fee schedule,100% of CMS fee schedule,44.22,67,,35.376,percent of total billed charges,67% of total billed charges,20.16,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,52.8,80,,42.24,percent of total billed charges,80% of total billed charges,42.9,65,,34.32,percent of total billed charges,65% of total billed charges,23.54,35.67,,18.832,percent of total billed charges,35.67% of total billed charges,13.55,60.9,
INFLUENZA A IgM,3005425,CDM,300,RC,86710,HCPCS,outpatient,,,66,26.40,,56.1,85,,44.88,percent of total billed charges,85% of total billed charges,50.82,77,,40.66,percent of total billed charges,77% of total billed charges,13.55,100,,,fee schedule,100% of CMS fee schedule,58.56,350,,,fee schedule,350% of BCBS fee schedule,60.9,364,,,fee schedule,364% of BCBS fee schedule,60.9,364,,,fee schedule,364% of BCBS fee schedule,60.9,364,,,fee schedule,364% of BCBS fee schedule,59.4,90,,47.52,percent of total billed charges,90% of total billed charges,52.8,80,,42.24,percent of total billed charges,80% of total billed charges,59.4,90,,47.52,percent of total billed charges,90% of total billed charges,49.5,75,,39.6,percent of total billed charges,75% of total billed charges,16.53,122,,,fee schedule,122% of APC rate,19.14,29,,15.312,percent of total billed charges,29% of total billed charges,13.55,100,,,fee schedule,100% of CMS fee schedule,44.22,67,,35.376,percent of total billed charges,67% of total billed charges,20.16,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,52.8,80,,42.24,percent of total billed charges,80% of total billed charges,42.9,65,,34.32,percent of total billed charges,65% of total billed charges,23.54,35.67,,18.832,percent of total billed charges,35.67% of total billed charges,13.55,60.9,
INFLUENZA A IgA,3005426,CDM,300,RC,86710,HCPCS,outpatient,,,66,26.40,,56.1,85,,44.88,percent of total billed charges,85% of total billed charges,50.82,77,,40.66,percent of total billed charges,77% of total billed charges,13.55,100,,,fee schedule,100% of CMS fee schedule,58.56,350,,,fee schedule,350% of BCBS fee schedule,60.9,364,,,fee schedule,364% of BCBS fee schedule,60.9,364,,,fee schedule,364% of BCBS fee schedule,60.9,364,,,fee schedule,364% of BCBS fee schedule,59.4,90,,47.52,percent of total billed charges,90% of total billed charges,52.8,80,,42.24,percent of total billed charges,80% of total billed charges,59.4,90,,47.52,percent of total billed charges,90% of total billed charges,49.5,75,,39.6,percent of total billed charges,75% of total billed charges,16.53,122,,,fee schedule,122% of APC rate,19.14,29,,15.312,percent of total billed charges,29% of total billed charges,13.55,100,,,fee schedule,100% of CMS fee schedule,44.22,67,,35.376,percent of total billed charges,67% of total billed charges,20.16,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,52.8,80,,42.24,percent of total billed charges,80% of total billed charges,42.9,65,,34.32,percent of total billed charges,65% of total billed charges,23.54,35.67,,18.832,percent of total billed charges,35.67% of total billed charges,13.55,60.9,
INFLUENZA B IgG,3005427,CDM,300,RC,86710,HCPCS,outpatient,,,66,26.40,,56.1,85,,44.88,percent of total billed charges,85% of total billed charges,50.82,77,,40.66,percent of total billed charges,77% of total billed charges,13.55,100,,,fee schedule,100% of CMS fee schedule,58.56,350,,,fee schedule,350% of BCBS fee schedule,60.9,364,,,fee schedule,364% of BCBS fee schedule,60.9,364,,,fee schedule,364% of BCBS fee schedule,60.9,364,,,fee schedule,364% of BCBS fee schedule,59.4,90,,47.52,percent of total billed charges,90% of total billed charges,52.8,80,,42.24,percent of total billed charges,80% of total billed charges,59.4,90,,47.52,percent of total billed charges,90% of total billed charges,49.5,75,,39.6,percent of total billed charges,75% of total billed charges,16.53,122,,,fee schedule,122% of APC rate,19.14,29,,15.312,percent of total billed charges,29% of total billed charges,13.55,100,,,fee schedule,100% of CMS fee schedule,44.22,67,,35.376,percent of total billed charges,67% of total billed charges,20.16,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,52.8,80,,42.24,percent of total billed charges,80% of total billed charges,42.9,65,,34.32,percent of total billed charges,65% of total billed charges,23.54,35.67,,18.832,percent of total billed charges,35.67% of total billed charges,13.55,60.9,
INFLUENZA B IgM,3005428,CDM,300,RC,86710,HCPCS,outpatient,,,66,26.40,,56.1,85,,44.88,percent of total billed charges,85% of total billed charges,50.82,77,,40.66,percent of total billed charges,77% of total billed charges,13.55,100,,,fee schedule,100% of CMS fee schedule,58.56,350,,,fee schedule,350% of BCBS fee schedule,60.9,364,,,fee schedule,364% of BCBS fee schedule,60.9,364,,,fee schedule,364% of BCBS fee schedule,60.9,364,,,fee schedule,364% of BCBS fee schedule,59.4,90,,47.52,percent of total billed charges,90% of total billed charges,52.8,80,,42.24,percent of total billed charges,80% of total billed charges,59.4,90,,47.52,percent of total billed charges,90% of total billed charges,49.5,75,,39.6,percent of total billed charges,75% of total billed charges,16.53,122,,,fee schedule,122% of APC rate,19.14,29,,15.312,percent of total billed charges,29% of total billed charges,13.55,100,,,fee schedule,100% of CMS fee schedule,44.22,67,,35.376,percent of total billed charges,67% of total billed charges,20.16,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,52.8,80,,42.24,percent of total billed charges,80% of total billed charges,42.9,65,,34.32,percent of total billed charges,65% of total billed charges,23.54,35.67,,18.832,percent of total billed charges,35.67% of total billed charges,13.55,60.9,
INFLUENZA B IgA,3005429,CDM,300,RC,86710,HCPCS,outpatient,,,66,26.40,,56.1,85,,44.88,percent of total billed charges,85% of total billed charges,50.82,77,,40.66,percent of total billed charges,77% of total billed charges,13.55,100,,,fee schedule,100% of CMS fee schedule,58.56,350,,,fee schedule,350% of BCBS fee schedule,60.9,364,,,fee schedule,364% of BCBS fee schedule,60.9,364,,,fee schedule,364% of BCBS fee schedule,60.9,364,,,fee schedule,364% of BCBS fee schedule,59.4,90,,47.52,percent of total billed charges,90% of total billed charges,52.8,80,,42.24,percent of total billed charges,80% of total billed charges,59.4,90,,47.52,percent of total billed charges,90% of total billed charges,49.5,75,,39.6,percent of total billed charges,75% of total billed charges,16.53,122,,,fee schedule,122% of APC rate,19.14,29,,15.312,percent of total billed charges,29% of total billed charges,13.55,100,,,fee schedule,100% of CMS fee schedule,44.22,67,,35.376,percent of total billed charges,67% of total billed charges,20.16,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,52.8,80,,42.24,percent of total billed charges,80% of total billed charges,42.9,65,,34.32,percent of total billed charges,65% of total billed charges,23.54,35.67,,18.832,percent of total billed charges,35.67% of total billed charges,13.55,60.9,
INHIBIN A,3005432,CDM,300,RC,86336,HCPCS,outpatient,,,66,26.40,,56.1,85,,44.88,percent of total billed charges,85% of total billed charges,50.82,77,,40.66,percent of total billed charges,77% of total billed charges,15.59,100,,,fee schedule,100% of CMS fee schedule,67.34,350,,,fee schedule,350% of BCBS fee schedule,70.03,364,,,fee schedule,364% of BCBS fee schedule,70.03,364,,,fee schedule,364% of BCBS fee schedule,70.03,364,,,fee schedule,364% of BCBS fee schedule,59.4,90,,47.52,percent of total billed charges,90% of total billed charges,52.8,80,,42.24,percent of total billed charges,80% of total billed charges,59.4,90,,47.52,percent of total billed charges,90% of total billed charges,49.5,75,,39.6,percent of total billed charges,75% of total billed charges,19.01,122,,,fee schedule,122% of APC rate,19.14,29,,15.312,percent of total billed charges,29% of total billed charges,15.59,100,,,fee schedule,100% of CMS fee schedule,44.22,67,,35.376,percent of total billed charges,67% of total billed charges,23.17,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,52.8,80,,42.24,percent of total billed charges,80% of total billed charges,42.9,65,,34.32,percent of total billed charges,65% of total billed charges,23.54,35.67,,18.832,percent of total billed charges,35.67% of total billed charges,15.59,70.03,
INSULIN LEVEL,3005440,CDM,300,RC,86337,HCPCS,outpatient,,,115,46.00,,97.75,85,,78.2,percent of total billed charges,85% of total billed charges,88.55,77,,70.84,percent of total billed charges,77% of total billed charges,21.41,100,,,fee schedule,100% of CMS fee schedule,92.51,350,,,fee schedule,350% of BCBS fee schedule,96.21,364,,,fee schedule,364% of BCBS fee schedule,96.21,364,,,fee schedule,364% of BCBS fee schedule,96.21,364,,,fee schedule,364% of BCBS fee schedule,103.5,90,,82.8,percent of total billed charges,90% of total billed charges,92,80,,73.6,percent of total billed charges,80% of total billed charges,103.5,90,,82.8,percent of total billed charges,90% of total billed charges,86.25,75,,69,percent of total billed charges,75% of total billed charges,26.12,122,,,fee schedule,122% of APC rate,33.35,29,,26.68,percent of total billed charges,29% of total billed charges,21.41,100,,,fee schedule,100% of CMS fee schedule,77.05,67,,61.64,percent of total billed charges,67% of total billed charges,31.84,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,92,80,,73.6,percent of total billed charges,80% of total billed charges,74.75,65,,59.8,percent of total billed charges,65% of total billed charges,41.02,35.67,,32.816,percent of total billed charges,35.67% of total billed charges,21.41,103.5,
INTERPRETATION OF PHIL. CHROM,3005441,CDM,300,RC,88291,HCPCS,outpatient,,,183,73.20,,155.55,85,,124.44,percent of total billed charges,85% of total billed charges,140.91,77,,112.73,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,118.09,350,,,fee schedule,350% of BCBS fee schedule,122.81,364,,,fee schedule,364% of BCBS fee schedule,122.81,364,,,fee schedule,364% of BCBS fee schedule,122.81,364,,,fee schedule,364% of BCBS fee schedule,164.7,90,,131.76,percent of total billed charges,90% of total billed charges,146.4,80,,117.12,percent of total billed charges,80% of total billed charges,164.7,90,,131.76,percent of total billed charges,90% of total billed charges,137.25,75,,109.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,53.07,29,,42.456,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,122.61,67,,98.088,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,146.4,80,,117.12,percent of total billed charges,80% of total billed charges,118.95,65,,95.16,percent of total billed charges,65% of total billed charges,65.28,35.67,,52.224,percent of total billed charges,35.67% of total billed charges,53.07,164.7,
INTRINSIC BLOCKING ANTIBODIES,3005442,CDM,300,RC,86340,HCPCS,outpatient,,,120,48.00,,102,85,,81.6,percent of total billed charges,85% of total billed charges,92.4,77,,73.92,percent of total billed charges,77% of total billed charges,15.08,100,,,fee schedule,100% of CMS fee schedule,65.14,350,,,fee schedule,350% of BCBS fee schedule,67.74,364,,,fee schedule,364% of BCBS fee schedule,67.74,364,,,fee schedule,364% of BCBS fee schedule,67.74,364,,,fee schedule,364% of BCBS fee schedule,108,90,,86.4,percent of total billed charges,90% of total billed charges,96,80,,76.8,percent of total billed charges,80% of total billed charges,108,90,,86.4,percent of total billed charges,90% of total billed charges,90,75,,72,percent of total billed charges,75% of total billed charges,18.39,122,,,fee schedule,122% of APC rate,34.8,29,,27.84,percent of total billed charges,29% of total billed charges,15.08,100,,,fee schedule,100% of CMS fee schedule,80.4,67,,64.32,percent of total billed charges,67% of total billed charges,22.41,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,96,80,,76.8,percent of total billed charges,80% of total billed charges,78,65,,62.4,percent of total billed charges,65% of total billed charges,42.8,35.67,,34.24,percent of total billed charges,35.67% of total billed charges,15.08,108,
CHROMOSOME ANALYSIS 20-25 CELL,3005443,CDM,300,RC,88264,HCPCS,outpatient,,,438,175.20,,372.3,85,,297.84,percent of total billed charges,85% of total billed charges,337.26,77,,269.81,percent of total billed charges,77% of total billed charges,144.61,100,,,fee schedule,100% of CMS fee schedule,538.58,350,,,fee schedule,350% of BCBS fee schedule,560.12,364,,,fee schedule,364% of BCBS fee schedule,560.12,364,,,fee schedule,364% of BCBS fee schedule,560.12,364,,,fee schedule,364% of BCBS fee schedule,394.2,90,,315.36,percent of total billed charges,90% of total billed charges,350.4,80,,280.32,percent of total billed charges,80% of total billed charges,394.2,90,,315.36,percent of total billed charges,90% of total billed charges,328.5,75,,262.8,percent of total billed charges,75% of total billed charges,176.42,122,,,fee schedule,122% of APC rate,127.02,29,,101.616,percent of total billed charges,29% of total billed charges,144.61,100,,,fee schedule,100% of CMS fee schedule,293.46,67,,234.768,percent of total billed charges,67% of total billed charges,185.36,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,350.4,80,,280.32,percent of total billed charges,80% of total billed charges,284.7,65,,227.76,percent of total billed charges,65% of total billed charges,156.23,35.67,,124.984,percent of total billed charges,35.67% of total billed charges,127.02,560.12,
CULTURE NEOPLASTIC BLOOD,3005444,CDM,300,RC,88237,HCPCS,outpatient,,,438,175.20,,372.3,85,,297.84,percent of total billed charges,85% of total billed charges,337.26,77,,269.81,percent of total billed charges,77% of total billed charges,143.75,100,,,fee schedule,100% of CMS fee schedule,545.76,350,,,fee schedule,350% of BCBS fee schedule,567.59,364,,,fee schedule,364% of BCBS fee schedule,567.59,364,,,fee schedule,364% of BCBS fee schedule,567.59,364,,,fee schedule,364% of BCBS fee schedule,394.2,90,,315.36,percent of total billed charges,90% of total billed charges,350.4,80,,280.32,percent of total billed charges,80% of total billed charges,394.2,90,,315.36,percent of total billed charges,90% of total billed charges,328.5,75,,262.8,percent of total billed charges,75% of total billed charges,175.37,122,,,fee schedule,122% of APC rate,127.02,29,,101.616,percent of total billed charges,29% of total billed charges,143.75,100,,,fee schedule,100% of CMS fee schedule,293.46,67,,234.768,percent of total billed charges,67% of total billed charges,38.25,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,350.4,80,,280.32,percent of total billed charges,80% of total billed charges,284.7,65,,227.76,percent of total billed charges,65% of total billed charges,156.23,35.67,,124.984,percent of total billed charges,35.67% of total billed charges,38.25,567.59,
TTG IMMUNOGLOBULIN EACH,3005448,CDM,300,RC,86364,HCPCS,outpatient,,,40,16.00,,34,85,,27.2,percent of total billed charges,85% of total billed charges,30.8,77,,24.64,percent of total billed charges,77% of total billed charges,11.53,100,,,fee schedule,100% of CMS fee schedule,40.36,350,,,fee schedule,350% of BCBS fee schedule,41.97,364,,,fee schedule,364% of BCBS fee schedule,41.97,364,,,fee schedule,364% of BCBS fee schedule,41.97,364,,,fee schedule,364% of BCBS fee schedule,36,90,,28.8,percent of total billed charges,90% of total billed charges,32,80,,25.6,percent of total billed charges,80% of total billed charges,36,90,,28.8,percent of total billed charges,90% of total billed charges,30,75,,24,percent of total billed charges,75% of total billed charges,14.06,122,,,fee schedule,122% of APC rate,11.6,29,,9.28,percent of total billed charges,29% of total billed charges,11.53,100,,,fee schedule,100% of CMS fee schedule,26.8,67,,21.44,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,32,80,,25.6,percent of total billed charges,80% of total billed charges,26,65,,20.8,percent of total billed charges,65% of total billed charges,14.27,35.67,,11.416,percent of total billed charges,35.67% of total billed charges,11.53,41.97,
INFECTIOUS AGENT BY NUCLEIC AC,3005450,CDM,300,RC,87797,HCPCS,outpatient,,,121,48.40,,102.85,85,,82.28,percent of total billed charges,85% of total billed charges,93.17,77,,74.54,percent of total billed charges,77% of total billed charges,30.03,100,,,fee schedule,100% of CMS fee schedule,105.11,350,,,fee schedule,350% of BCBS fee schedule,109.31,364,,,fee schedule,364% of BCBS fee schedule,109.31,364,,,fee schedule,364% of BCBS fee schedule,109.31,364,,,fee schedule,364% of BCBS fee schedule,108.9,90,,87.12,percent of total billed charges,90% of total billed charges,96.8,80,,77.44,percent of total billed charges,80% of total billed charges,108.9,90,,87.12,percent of total billed charges,90% of total billed charges,90.75,75,,72.6,percent of total billed charges,75% of total billed charges,36.63,122,,,fee schedule,122% of APC rate,35.09,29,,28.072,percent of total billed charges,29% of total billed charges,30.03,100,,,fee schedule,100% of CMS fee schedule,81.07,67,,64.856,percent of total billed charges,67% of total billed charges,29.82,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,96.8,80,,77.44,percent of total billed charges,80% of total billed charges,78.65,65,,62.92,percent of total billed charges,65% of total billed charges,43.16,35.67,,34.528,percent of total billed charges,35.67% of total billed charges,29.82,109.31,
IRON BINDING CAPACITY TOTAL,3005460,CDM,300,RC,83550,HCPCS,outpatient,,,62,24.80,,52.7,85,,42.16,percent of total billed charges,85% of total billed charges,47.74,77,,38.19,percent of total billed charges,77% of total billed charges,8.74,100,,,fee schedule,100% of CMS fee schedule,37.77,350,,,fee schedule,350% of BCBS fee schedule,39.28,364,,,fee schedule,364% of BCBS fee schedule,39.28,364,,,fee schedule,364% of BCBS fee schedule,39.28,364,,,fee schedule,364% of BCBS fee schedule,55.8,90,,44.64,percent of total billed charges,90% of total billed charges,49.6,80,,39.68,percent of total billed charges,80% of total billed charges,55.8,90,,44.64,percent of total billed charges,90% of total billed charges,46.5,75,,37.2,percent of total billed charges,75% of total billed charges,10.66,122,,,fee schedule,122% of APC rate,17.98,29,,14.384,percent of total billed charges,29% of total billed charges,8.74,100,,,fee schedule,100% of CMS fee schedule,41.54,67,,33.232,percent of total billed charges,67% of total billed charges,12.99,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,49.6,80,,39.68,percent of total billed charges,80% of total billed charges,40.3,65,,32.24,percent of total billed charges,65% of total billed charges,22.12,35.67,,17.696,percent of total billed charges,35.67% of total billed charges,8.74,55.8,
IRON SERUM,3005480,CDM,300,RC,83540,HCPCS,outpatient,,,52,20.80,,44.2,85,,35.36,percent of total billed charges,85% of total billed charges,40.04,77,,32.03,percent of total billed charges,77% of total billed charges,6.47,100,,,fee schedule,100% of CMS fee schedule,27.97,350,,,fee schedule,350% of BCBS fee schedule,29.08,364,,,fee schedule,364% of BCBS fee schedule,29.08,364,,,fee schedule,364% of BCBS fee schedule,29.08,364,,,fee schedule,364% of BCBS fee schedule,46.8,90,,37.44,percent of total billed charges,90% of total billed charges,41.6,80,,33.28,percent of total billed charges,80% of total billed charges,46.8,90,,37.44,percent of total billed charges,90% of total billed charges,39,75,,31.2,percent of total billed charges,75% of total billed charges,7.89,122,,,fee schedule,122% of APC rate,15.08,29,,12.064,percent of total billed charges,29% of total billed charges,6.47,100,,,fee schedule,100% of CMS fee schedule,34.84,67,,27.872,percent of total billed charges,67% of total billed charges,9.63,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,41.6,80,,33.28,percent of total billed charges,80% of total billed charges,33.8,65,,27.04,percent of total billed charges,65% of total billed charges,18.55,35.67,,14.84,percent of total billed charges,35.67% of total billed charges,6.47,46.8,
ISLET CELL AUTOANTIBODY,3005482,CDM,300,RC,,,outpatient,,,534,213.60,,453.9,85,,363.12,percent of total billed charges,85% of total billed charges,411.18,77,,328.94,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,437.88,82,,350.304,percent of total billed charges,82% of total billed charges,453.9,85,,363.12,percent of total billed charges,85% of total billed charges,453.9,85,,363.12,percent of total billed charges,85% of total billed charges,453.9,85,,363.12,percent of total billed charges,85% of total billed charges,480.6,90,,384.48,percent of total billed charges,90% of total billed charges,427.2,80,,341.76,percent of total billed charges,80% of total billed charges,480.6,90,,384.48,percent of total billed charges,90% of total billed charges,400.5,75,,320.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,154.86,29,,123.888,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,357.78,67,,286.224,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,427.2,80,,341.76,percent of total billed charges,80% of total billed charges,347.1,65,,277.68,percent of total billed charges,65% of total billed charges,190.48,35.67,,152.384,percent of total billed charges,35.67% of total billed charges,154.86,480.6,
ISLET CELL AUTOANTIBODY CF,3005483,CDM,300,RC,86341,HCPCS,outpatient,,,166,66.40,,141.1,85,,112.88,percent of total billed charges,85% of total billed charges,127.82,77,,102.26,percent of total billed charges,77% of total billed charges,23.57,100,,,fee schedule,100% of CMS fee schedule,85.51,350,,,fee schedule,350% of BCBS fee schedule,88.93,364,,,fee schedule,364% of BCBS fee schedule,88.93,364,,,fee schedule,364% of BCBS fee schedule,88.93,364,,,fee schedule,364% of BCBS fee schedule,149.4,90,,119.52,percent of total billed charges,90% of total billed charges,132.8,80,,106.24,percent of total billed charges,80% of total billed charges,149.4,90,,119.52,percent of total billed charges,90% of total billed charges,124.5,75,,99.6,percent of total billed charges,75% of total billed charges,28.75,122,,,fee schedule,122% of APC rate,48.14,29,,38.512,percent of total billed charges,29% of total billed charges,23.57,100,,,fee schedule,100% of CMS fee schedule,111.22,67,,88.976,percent of total billed charges,67% of total billed charges,29.42,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,132.8,80,,106.24,percent of total billed charges,80% of total billed charges,107.9,65,,86.32,percent of total billed charges,65% of total billed charges,59.21,35.67,,47.368,percent of total billed charges,35.67% of total billed charges,23.57,149.4,
ISLET CELL AUTOANTIBODY IgG,3005484,CDM,300,RC,86341,HCPCS,outpatient,,,166,66.40,,141.1,85,,112.88,percent of total billed charges,85% of total billed charges,127.82,77,,102.26,percent of total billed charges,77% of total billed charges,23.57,100,,,fee schedule,100% of CMS fee schedule,85.51,350,,,fee schedule,350% of BCBS fee schedule,88.93,364,,,fee schedule,364% of BCBS fee schedule,88.93,364,,,fee schedule,364% of BCBS fee schedule,88.93,364,,,fee schedule,364% of BCBS fee schedule,149.4,90,,119.52,percent of total billed charges,90% of total billed charges,132.8,80,,106.24,percent of total billed charges,80% of total billed charges,149.4,90,,119.52,percent of total billed charges,90% of total billed charges,124.5,75,,99.6,percent of total billed charges,75% of total billed charges,28.75,122,,,fee schedule,122% of APC rate,48.14,29,,38.512,percent of total billed charges,29% of total billed charges,23.57,100,,,fee schedule,100% of CMS fee schedule,111.22,67,,88.976,percent of total billed charges,67% of total billed charges,29.42,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,132.8,80,,106.24,percent of total billed charges,80% of total billed charges,107.9,65,,86.32,percent of total billed charges,65% of total billed charges,59.21,35.67,,47.368,percent of total billed charges,35.67% of total billed charges,23.57,149.4,
ZINC TRANSPORTER 8,3005485,CDM,300,RC,86341,HCPCS,outpatient,,,78,31.20,,66.3,85,,53.04,percent of total billed charges,85% of total billed charges,60.06,77,,48.05,percent of total billed charges,77% of total billed charges,23.57,100,,,fee schedule,100% of CMS fee schedule,85.51,350,,,fee schedule,350% of BCBS fee schedule,88.93,364,,,fee schedule,364% of BCBS fee schedule,88.93,364,,,fee schedule,364% of BCBS fee schedule,88.93,364,,,fee schedule,364% of BCBS fee schedule,70.2,90,,56.16,percent of total billed charges,90% of total billed charges,62.4,80,,49.92,percent of total billed charges,80% of total billed charges,70.2,90,,56.16,percent of total billed charges,90% of total billed charges,58.5,75,,46.8,percent of total billed charges,75% of total billed charges,28.75,122,,,fee schedule,122% of APC rate,22.62,29,,18.096,percent of total billed charges,29% of total billed charges,23.57,100,,,fee schedule,100% of CMS fee schedule,52.26,67,,41.808,percent of total billed charges,67% of total billed charges,29.42,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,62.4,80,,49.92,percent of total billed charges,80% of total billed charges,50.7,65,,40.56,percent of total billed charges,65% of total billed charges,27.82,35.67,,22.256,percent of total billed charges,35.67% of total billed charges,22.62,88.93,
KOH PREP,3005500,CDM,300,RC,87210,HCPCS,outpatient,,,63,25.20,,53.55,85,,42.84,percent of total billed charges,85% of total billed charges,48.51,77,,38.81,percent of total billed charges,77% of total billed charges,5.82,100,,,fee schedule,100% of CMS fee schedule,20.37,350,,,fee schedule,350% of BCBS fee schedule,21.18,364,,,fee schedule,364% of BCBS fee schedule,21.18,364,,,fee schedule,364% of BCBS fee schedule,21.18,364,,,fee schedule,364% of BCBS fee schedule,56.7,90,,45.36,percent of total billed charges,90% of total billed charges,50.4,80,,40.32,percent of total billed charges,80% of total billed charges,56.7,90,,45.36,percent of total billed charges,90% of total billed charges,47.25,75,,37.8,percent of total billed charges,75% of total billed charges,7.1,122,,,fee schedule,122% of APC rate,18.27,29,,14.616,percent of total billed charges,29% of total billed charges,5.82,100,,,fee schedule,100% of CMS fee schedule,42.21,67,,33.768,percent of total billed charges,67% of total billed charges,6.35,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,50.4,80,,40.32,percent of total billed charges,80% of total billed charges,40.95,65,,32.76,percent of total billed charges,65% of total billed charges,22.47,35.67,,17.976,percent of total billed charges,35.67% of total billed charges,5.82,56.7,
LIVER KIDNEY MICROSOMAL ANTI.,3005509,CDM,300,RC,86376,HCPCS,outpatient,,,102,40.80,,86.7,85,,69.36,percent of total billed charges,85% of total billed charges,78.54,77,,62.83,percent of total billed charges,77% of total billed charges,14.55,100,,,fee schedule,100% of CMS fee schedule,62.86,350,,,fee schedule,350% of BCBS fee schedule,65.37,364,,,fee schedule,364% of BCBS fee schedule,65.37,364,,,fee schedule,364% of BCBS fee schedule,65.37,364,,,fee schedule,364% of BCBS fee schedule,91.8,90,,73.44,percent of total billed charges,90% of total billed charges,81.6,80,,65.28,percent of total billed charges,80% of total billed charges,91.8,90,,73.44,percent of total billed charges,90% of total billed charges,76.5,75,,61.2,percent of total billed charges,75% of total billed charges,17.75,122,,,fee schedule,122% of APC rate,29.58,29,,23.664,percent of total billed charges,29% of total billed charges,14.55,100,,,fee schedule,100% of CMS fee schedule,68.34,67,,54.672,percent of total billed charges,67% of total billed charges,21.64,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,81.6,80,,65.28,percent of total billed charges,80% of total billed charges,66.3,65,,53.04,percent of total billed charges,65% of total billed charges,36.38,35.67,,29.104,percent of total billed charges,35.67% of total billed charges,14.55,91.8,
LAB HANDLING NB SERUM OTHER,3005510,CDM,300,RC,99001,HCPCS,outpatient,,,47,18.80,,39.95,85,,31.96,percent of total billed charges,85% of total billed charges,36.19,77,,28.95,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,21.35,350,,,fee schedule,350% of BCBS fee schedule,22.2,364,,,fee schedule,364% of BCBS fee schedule,22.2,364,,,fee schedule,364% of BCBS fee schedule,22.2,364,,,fee schedule,364% of BCBS fee schedule,42.3,90,,33.84,percent of total billed charges,90% of total billed charges,37.6,80,,30.08,percent of total billed charges,80% of total billed charges,42.3,90,,33.84,percent of total billed charges,90% of total billed charges,35.25,75,,28.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,13.63,29,,10.904,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,31.49,67,,25.192,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,37.6,80,,30.08,percent of total billed charges,80% of total billed charges,30.55,65,,24.44,percent of total billed charges,65% of total billed charges,16.76,35.67,,13.408,percent of total billed charges,35.67% of total billed charges,13.63,42.3,
LAB HANDLING OTHER,3005511,CDM,300,RC,99001,HCPCS,outpatient,,,47,18.80,,39.95,85,,31.96,percent of total billed charges,85% of total billed charges,36.19,77,,28.95,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,21.35,350,,,fee schedule,350% of BCBS fee schedule,22.2,364,,,fee schedule,364% of BCBS fee schedule,22.2,364,,,fee schedule,364% of BCBS fee schedule,22.2,364,,,fee schedule,364% of BCBS fee schedule,42.3,90,,33.84,percent of total billed charges,90% of total billed charges,37.6,80,,30.08,percent of total billed charges,80% of total billed charges,42.3,90,,33.84,percent of total billed charges,90% of total billed charges,35.25,75,,28.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,13.63,29,,10.904,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,31.49,67,,25.192,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,37.6,80,,30.08,percent of total billed charges,80% of total billed charges,30.55,65,,24.44,percent of total billed charges,65% of total billed charges,16.76,35.67,,13.408,percent of total billed charges,35.67% of total billed charges,13.63,42.3,
LAB HANDLING TISSUE,3005512,CDM,300,RC,99001,HCPCS,outpatient,,,47,18.80,,39.95,85,,31.96,percent of total billed charges,85% of total billed charges,36.19,77,,28.95,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,21.35,350,,,fee schedule,350% of BCBS fee schedule,22.2,364,,,fee schedule,364% of BCBS fee schedule,22.2,364,,,fee schedule,364% of BCBS fee schedule,22.2,364,,,fee schedule,364% of BCBS fee schedule,42.3,90,,33.84,percent of total billed charges,90% of total billed charges,37.6,80,,30.08,percent of total billed charges,80% of total billed charges,42.3,90,,33.84,percent of total billed charges,90% of total billed charges,35.25,75,,28.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,13.63,29,,10.904,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,31.49,67,,25.192,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,37.6,80,,30.08,percent of total billed charges,80% of total billed charges,30.55,65,,24.44,percent of total billed charges,65% of total billed charges,16.76,35.67,,13.408,percent of total billed charges,35.67% of total billed charges,13.63,42.3,
LAB HANDLING - SPECIAL EXAM,3005513,CDM,300,RC,99001,HCPCS,outpatient,,,47,18.80,,39.95,85,,31.96,percent of total billed charges,85% of total billed charges,36.19,77,,28.95,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,21.35,350,,,fee schedule,350% of BCBS fee schedule,22.2,364,,,fee schedule,364% of BCBS fee schedule,22.2,364,,,fee schedule,364% of BCBS fee schedule,22.2,364,,,fee schedule,364% of BCBS fee schedule,42.3,90,,33.84,percent of total billed charges,90% of total billed charges,37.6,80,,30.08,percent of total billed charges,80% of total billed charges,42.3,90,,33.84,percent of total billed charges,90% of total billed charges,35.25,75,,28.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,13.63,29,,10.904,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,31.49,67,,25.192,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,37.6,80,,30.08,percent of total billed charges,80% of total billed charges,30.55,65,,24.44,percent of total billed charges,65% of total billed charges,16.76,35.67,,13.408,percent of total billed charges,35.67% of total billed charges,13.63,42.3,
LAB ONE DROP OFF FEE,3005516,CDM,300,RC,,,outpatient,,,12,4.80,,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,9.24,77,,7.39,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,9.84,82,,7.872,percent of total billed charges,82% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,10.8,90,,8.64,percent of total billed charges,90% of total billed charges,9.6,80,,7.68,percent of total billed charges,80% of total billed charges,10.8,90,,8.64,percent of total billed charges,90% of total billed charges,9,75,,7.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,3.48,29,,2.784,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,8.04,67,,6.432,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,9.6,80,,7.68,percent of total billed charges,80% of total billed charges,7.8,65,,6.24,percent of total billed charges,65% of total billed charges,4.28,35.67,,3.424,percent of total billed charges,35.67% of total billed charges,3.48,10.8,
LACTIC ACID,3005520,CDM,300,RC,83605,HCPCS,outpatient,,,82,32.80,,69.7,85,,55.76,percent of total billed charges,85% of total billed charges,63.14,77,,50.51,percent of total billed charges,77% of total billed charges,11.57,100,,,fee schedule,100% of CMS fee schedule,46.17,350,,,fee schedule,350% of BCBS fee schedule,48.01,364,,,fee schedule,364% of BCBS fee schedule,48.01,364,,,fee schedule,364% of BCBS fee schedule,48.01,364,,,fee schedule,364% of BCBS fee schedule,73.8,90,,59.04,percent of total billed charges,90% of total billed charges,65.6,80,,52.48,percent of total billed charges,80% of total billed charges,73.8,90,,59.04,percent of total billed charges,90% of total billed charges,61.5,75,,49.2,percent of total billed charges,75% of total billed charges,14.11,122,,,fee schedule,122% of APC rate,23.78,29,,19.024,percent of total billed charges,29% of total billed charges,11.57,100,,,fee schedule,100% of CMS fee schedule,54.94,67,,43.952,percent of total billed charges,67% of total billed charges,12.85,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,65.6,80,,52.48,percent of total billed charges,80% of total billed charges,53.3,65,,42.64,percent of total billed charges,65% of total billed charges,29.25,35.67,,23.4,percent of total billed charges,35.67% of total billed charges,11.57,73.8,
LACOSAMIDE (VIMPAT) LEVEL,3005525,CDM,300,RC,80299,HCPCS,outpatient,,,317,126.80,,269.45,85,,215.56,percent of total billed charges,85% of total billed charges,244.09,77,,195.27,percent of total billed charges,77% of total billed charges,18.64,100,,,fee schedule,100% of CMS fee schedule,65.24,350,,,fee schedule,350% of BCBS fee schedule,67.85,364,,,fee schedule,364% of BCBS fee schedule,67.85,364,,,fee schedule,364% of BCBS fee schedule,67.85,364,,,fee schedule,364% of BCBS fee schedule,285.3,90,,228.24,percent of total billed charges,90% of total billed charges,253.6,80,,202.88,percent of total billed charges,80% of total billed charges,285.3,90,,228.24,percent of total billed charges,90% of total billed charges,237.75,75,,190.2,percent of total billed charges,75% of total billed charges,22.74,122,,,fee schedule,122% of APC rate,91.93,29,,73.544,percent of total billed charges,29% of total billed charges,18.64,100,,,fee schedule,100% of CMS fee schedule,212.39,67,,169.912,percent of total billed charges,67% of total billed charges,20.36,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,253.6,80,,202.88,percent of total billed charges,80% of total billed charges,206.05,65,,164.84,percent of total billed charges,65% of total billed charges,113.07,35.67,,90.456,percent of total billed charges,35.67% of total billed charges,18.64,285.3,
LAMICTAL DRUG LEVEL,3005541,CDM,300,RC,80175,HCPCS,outpatient,,,146,58.40,,124.1,85,,99.28,percent of total billed charges,85% of total billed charges,112.42,77,,89.94,percent of total billed charges,77% of total billed charges,13.25,100,,,fee schedule,100% of CMS fee schedule,57.26,350,,,fee schedule,350% of BCBS fee schedule,59.55,364,,,fee schedule,364% of BCBS fee schedule,59.55,364,,,fee schedule,364% of BCBS fee schedule,59.55,364,,,fee schedule,364% of BCBS fee schedule,131.4,90,,105.12,percent of total billed charges,90% of total billed charges,116.8,80,,93.44,percent of total billed charges,80% of total billed charges,131.4,90,,105.12,percent of total billed charges,90% of total billed charges,109.5,75,,87.6,percent of total billed charges,75% of total billed charges,16.16,122,,,fee schedule,122% of APC rate,42.34,29,,33.872,percent of total billed charges,29% of total billed charges,13.25,100,,,fee schedule,100% of CMS fee schedule,97.82,67,,78.256,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,116.8,80,,93.44,percent of total billed charges,80% of total billed charges,94.9,65,,75.92,percent of total billed charges,65% of total billed charges,52.08,35.67,,41.664,percent of total billed charges,35.67% of total billed charges,13.25,131.4,
LEGIONELA SMEAR,3005542,CDM,300,RC,87278,HCPCS,outpatient,,,86,34.40,,73.1,85,,58.48,percent of total billed charges,85% of total billed charges,66.22,77,,52.98,percent of total billed charges,77% of total billed charges,15.6,100,,,fee schedule,100% of CMS fee schedule,54.6,350,,,fee schedule,350% of BCBS fee schedule,56.78,364,,,fee schedule,364% of BCBS fee schedule,56.78,364,,,fee schedule,364% of BCBS fee schedule,56.78,364,,,fee schedule,364% of BCBS fee schedule,77.4,90,,61.92,percent of total billed charges,90% of total billed charges,68.8,80,,55.04,percent of total billed charges,80% of total billed charges,77.4,90,,61.92,percent of total billed charges,90% of total billed charges,64.5,75,,51.6,percent of total billed charges,75% of total billed charges,19.03,122,,,fee schedule,122% of APC rate,24.94,29,,19.952,percent of total billed charges,29% of total billed charges,15.6,100,,,fee schedule,100% of CMS fee schedule,57.62,67,,46.096,percent of total billed charges,67% of total billed charges,15.41,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,68.8,80,,55.04,percent of total billed charges,80% of total billed charges,55.9,65,,44.72,percent of total billed charges,65% of total billed charges,30.68,35.67,,24.544,percent of total billed charges,35.67% of total billed charges,15.41,77.4,
LDH,3005560,CDM,300,RC,83615,HCPCS,outpatient,,,70,28.00,,59.5,85,,47.6,percent of total billed charges,85% of total billed charges,53.9,77,,43.12,percent of total billed charges,77% of total billed charges,6.04,100,,,fee schedule,100% of CMS fee schedule,26.08,350,,,fee schedule,350% of BCBS fee schedule,27.12,364,,,fee schedule,364% of BCBS fee schedule,27.12,364,,,fee schedule,364% of BCBS fee schedule,27.12,364,,,fee schedule,364% of BCBS fee schedule,63,90,,50.4,percent of total billed charges,90% of total billed charges,56,80,,44.8,percent of total billed charges,80% of total billed charges,63,90,,50.4,percent of total billed charges,90% of total billed charges,52.5,75,,42,percent of total billed charges,75% of total billed charges,7.36,122,,,fee schedule,122% of APC rate,20.3,29,,16.24,percent of total billed charges,29% of total billed charges,6.04,100,,,fee schedule,100% of CMS fee schedule,46.9,67,,37.52,percent of total billed charges,67% of total billed charges,8.97,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,56,80,,44.8,percent of total billed charges,80% of total billed charges,45.5,65,,36.4,percent of total billed charges,65% of total billed charges,24.97,35.67,,19.976,percent of total billed charges,35.67% of total billed charges,6.04,63,
LDL DIRECT,3005600,CDM,300,RC,83721,HCPCS,outpatient,,,49,19.60,,41.65,85,,33.32,percent of total billed charges,85% of total billed charges,37.73,77,,30.18,percent of total billed charges,77% of total billed charges,10.5,100,,,fee schedule,100% of CMS fee schedule,41.23,350,,,fee schedule,350% of BCBS fee schedule,42.88,364,,,fee schedule,364% of BCBS fee schedule,42.88,364,,,fee schedule,364% of BCBS fee schedule,42.88,364,,,fee schedule,364% of BCBS fee schedule,44.1,90,,35.28,percent of total billed charges,90% of total billed charges,39.2,80,,31.36,percent of total billed charges,80% of total billed charges,44.1,90,,35.28,percent of total billed charges,90% of total billed charges,36.75,75,,29.4,percent of total billed charges,75% of total billed charges,12.81,122,,,fee schedule,122% of APC rate,14.21,29,,11.368,percent of total billed charges,29% of total billed charges,10.5,100,,,fee schedule,100% of CMS fee schedule,32.83,67,,26.264,percent of total billed charges,67% of total billed charges,14.18,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,39.2,80,,31.36,percent of total billed charges,80% of total billed charges,31.85,65,,25.48,percent of total billed charges,65% of total billed charges,17.48,35.67,,13.984,percent of total billed charges,35.67% of total billed charges,10.5,44.1,
ASSAY OF LDH ISOENZYMES,3005682,CDM,300,RC,83625,HCPCS,outpatient,,,43,17.20,,36.55,85,,29.24,percent of total billed charges,85% of total billed charges,33.11,77,,26.49,percent of total billed charges,77% of total billed charges,12.79,100,,,fee schedule,100% of CMS fee schedule,55.3,350,,,fee schedule,350% of BCBS fee schedule,57.51,364,,,fee schedule,364% of BCBS fee schedule,57.51,364,,,fee schedule,364% of BCBS fee schedule,57.51,364,,,fee schedule,364% of BCBS fee schedule,38.7,90,,30.96,percent of total billed charges,90% of total billed charges,34.4,80,,27.52,percent of total billed charges,80% of total billed charges,38.7,90,,30.96,percent of total billed charges,90% of total billed charges,32.25,75,,25.8,percent of total billed charges,75% of total billed charges,15.6,122,,,fee schedule,122% of APC rate,12.47,29,,9.976,percent of total billed charges,29% of total billed charges,12.79,100,,,fee schedule,100% of CMS fee schedule,28.81,67,,23.048,percent of total billed charges,67% of total billed charges,13,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,34.4,80,,27.52,percent of total billed charges,80% of total billed charges,27.95,65,,22.36,percent of total billed charges,65% of total billed charges,15.34,35.67,,12.272,percent of total billed charges,35.67% of total billed charges,12.47,57.51,
LE CELL PRECIPITATION,3005700,CDM,300,RC,86403,HCPCS,outpatient,,,103,41.20,,87.55,85,,70.04,percent of total billed charges,85% of total billed charges,79.31,77,,63.45,percent of total billed charges,77% of total billed charges,11.54,100,,,fee schedule,100% of CMS fee schedule,44.03,350,,,fee schedule,350% of BCBS fee schedule,45.79,364,,,fee schedule,364% of BCBS fee schedule,45.79,364,,,fee schedule,364% of BCBS fee schedule,45.79,364,,,fee schedule,364% of BCBS fee schedule,92.7,90,,74.16,percent of total billed charges,90% of total billed charges,82.4,80,,65.92,percent of total billed charges,80% of total billed charges,92.7,90,,74.16,percent of total billed charges,90% of total billed charges,77.25,75,,61.8,percent of total billed charges,75% of total billed charges,14.07,122,,,fee schedule,122% of APC rate,29.87,29,,23.896,percent of total billed charges,29% of total billed charges,11.54,100,,,fee schedule,100% of CMS fee schedule,69.01,67,,55.208,percent of total billed charges,67% of total billed charges,15.16,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,82.4,80,,65.92,percent of total billed charges,80% of total billed charges,66.95,65,,53.56,percent of total billed charges,65% of total billed charges,36.74,35.67,,29.392,percent of total billed charges,35.67% of total billed charges,11.54,92.7,
LEAD SERUM,3005720,CDM,300,RC,83655,HCPCS,outpatient,,,84,33.60,,71.4,85,,57.12,percent of total billed charges,85% of total billed charges,64.68,77,,51.74,percent of total billed charges,77% of total billed charges,12.11,100,,,fee schedule,100% of CMS fee schedule,52.33,350,,,fee schedule,350% of BCBS fee schedule,54.42,364,,,fee schedule,364% of BCBS fee schedule,54.42,364,,,fee schedule,364% of BCBS fee schedule,54.42,364,,,fee schedule,364% of BCBS fee schedule,75.6,90,,60.48,percent of total billed charges,90% of total billed charges,67.2,80,,53.76,percent of total billed charges,80% of total billed charges,75.6,90,,60.48,percent of total billed charges,90% of total billed charges,63,75,,50.4,percent of total billed charges,75% of total billed charges,14.77,122,,,fee schedule,122% of APC rate,24.36,29,,19.488,percent of total billed charges,29% of total billed charges,12.11,100,,,fee schedule,100% of CMS fee schedule,56.28,67,,45.024,percent of total billed charges,67% of total billed charges,18,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,67.2,80,,53.76,percent of total billed charges,80% of total billed charges,54.6,65,,43.68,percent of total billed charges,65% of total billed charges,29.96,35.67,,23.968,percent of total billed charges,35.67% of total billed charges,12.11,75.6,
LEAD URINE,3005740,CDM,300,RC,83655,HCPCS,outpatient,,,83,33.20,,70.55,85,,56.44,percent of total billed charges,85% of total billed charges,63.91,77,,51.13,percent of total billed charges,77% of total billed charges,12.11,100,,,fee schedule,100% of CMS fee schedule,52.33,350,,,fee schedule,350% of BCBS fee schedule,54.42,364,,,fee schedule,364% of BCBS fee schedule,54.42,364,,,fee schedule,364% of BCBS fee schedule,54.42,364,,,fee schedule,364% of BCBS fee schedule,74.7,90,,59.76,percent of total billed charges,90% of total billed charges,66.4,80,,53.12,percent of total billed charges,80% of total billed charges,74.7,90,,59.76,percent of total billed charges,90% of total billed charges,62.25,75,,49.8,percent of total billed charges,75% of total billed charges,14.77,122,,,fee schedule,122% of APC rate,24.07,29,,19.256,percent of total billed charges,29% of total billed charges,12.11,100,,,fee schedule,100% of CMS fee schedule,55.61,67,,44.488,percent of total billed charges,67% of total billed charges,18,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,66.4,80,,53.12,percent of total billed charges,80% of total billed charges,53.95,65,,43.16,percent of total billed charges,65% of total billed charges,29.61,35.67,,23.688,percent of total billed charges,35.67% of total billed charges,12.11,74.7,
LEGIONELLA ANTIBODY,3005760,CDM,300,RC,86713,HCPCS,outpatient,,,188,75.20,,159.8,85,,127.84,percent of total billed charges,85% of total billed charges,144.76,77,,115.81,percent of total billed charges,77% of total billed charges,15.3,100,,,fee schedule,100% of CMS fee schedule,66.12,350,,,fee schedule,350% of BCBS fee schedule,68.76,364,,,fee schedule,364% of BCBS fee schedule,68.76,364,,,fee schedule,364% of BCBS fee schedule,68.76,364,,,fee schedule,364% of BCBS fee schedule,169.2,90,,135.36,percent of total billed charges,90% of total billed charges,150.4,80,,120.32,percent of total billed charges,80% of total billed charges,169.2,90,,135.36,percent of total billed charges,90% of total billed charges,141,75,,112.8,percent of total billed charges,75% of total billed charges,18.66,122,,,fee schedule,122% of APC rate,54.52,29,,43.616,percent of total billed charges,29% of total billed charges,15.3,100,,,fee schedule,100% of CMS fee schedule,125.96,67,,100.768,percent of total billed charges,67% of total billed charges,22.75,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,150.4,80,,120.32,percent of total billed charges,80% of total billed charges,122.2,65,,97.76,percent of total billed charges,65% of total billed charges,67.06,35.67,,53.648,percent of total billed charges,35.67% of total billed charges,15.3,169.2,
LEPTOSPIRA AGGLUTINATION,3005770,CDM,300,RC,86000,HCPCS,outpatient,,,115,46.00,,97.75,85,,78.2,percent of total billed charges,85% of total billed charges,88.55,77,,70.84,percent of total billed charges,77% of total billed charges,6.98,100,,,fee schedule,100% of CMS fee schedule,30.17,350,,,fee schedule,350% of BCBS fee schedule,31.38,364,,,fee schedule,364% of BCBS fee schedule,31.38,364,,,fee schedule,364% of BCBS fee schedule,31.38,364,,,fee schedule,364% of BCBS fee schedule,103.5,90,,82.8,percent of total billed charges,90% of total billed charges,92,80,,73.6,percent of total billed charges,80% of total billed charges,103.5,90,,82.8,percent of total billed charges,90% of total billed charges,86.25,75,,69,percent of total billed charges,75% of total billed charges,8.51,122,,,fee schedule,122% of APC rate,33.35,29,,26.68,percent of total billed charges,29% of total billed charges,6.98,100,,,fee schedule,100% of CMS fee schedule,77.05,67,,61.64,percent of total billed charges,67% of total billed charges,10.38,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,92,80,,73.6,percent of total billed charges,80% of total billed charges,74.75,65,,59.8,percent of total billed charges,65% of total billed charges,41.02,35.67,,32.816,percent of total billed charges,35.67% of total billed charges,6.98,103.5,
LE SCREEN,3005775,CDM,300,RC,86403,HCPCS,outpatient,,,52,20.80,,44.2,85,,35.36,percent of total billed charges,85% of total billed charges,40.04,77,,32.03,percent of total billed charges,77% of total billed charges,11.54,100,,,fee schedule,100% of CMS fee schedule,44.03,350,,,fee schedule,350% of BCBS fee schedule,45.79,364,,,fee schedule,364% of BCBS fee schedule,45.79,364,,,fee schedule,364% of BCBS fee schedule,45.79,364,,,fee schedule,364% of BCBS fee schedule,46.8,90,,37.44,percent of total billed charges,90% of total billed charges,41.6,80,,33.28,percent of total billed charges,80% of total billed charges,46.8,90,,37.44,percent of total billed charges,90% of total billed charges,39,75,,31.2,percent of total billed charges,75% of total billed charges,14.07,122,,,fee schedule,122% of APC rate,15.08,29,,12.064,percent of total billed charges,29% of total billed charges,11.54,100,,,fee schedule,100% of CMS fee schedule,34.84,67,,27.872,percent of total billed charges,67% of total billed charges,15.16,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,41.6,80,,33.28,percent of total billed charges,80% of total billed charges,33.8,65,,27.04,percent of total billed charges,65% of total billed charges,18.55,35.67,,14.84,percent of total billed charges,35.67% of total billed charges,11.54,46.8,
LEUCINE AMINOPEPTIDASE(LAP),3005780,CDM,300,RC,83670,HCPCS,outpatient,,,48,19.20,,40.8,85,,32.64,percent of total billed charges,85% of total billed charges,36.96,77,,29.57,percent of total billed charges,77% of total billed charges,9.81,100,,,fee schedule,100% of CMS fee schedule,39.59,350,,,fee schedule,350% of BCBS fee schedule,41.17,364,,,fee schedule,364% of BCBS fee schedule,41.17,364,,,fee schedule,364% of BCBS fee schedule,41.17,364,,,fee schedule,364% of BCBS fee schedule,43.2,90,,34.56,percent of total billed charges,90% of total billed charges,38.4,80,,30.72,percent of total billed charges,80% of total billed charges,43.2,90,,34.56,percent of total billed charges,90% of total billed charges,36,75,,28.8,percent of total billed charges,75% of total billed charges,11.96,122,,,fee schedule,122% of APC rate,13.92,29,,11.136,percent of total billed charges,29% of total billed charges,9.81,100,,,fee schedule,100% of CMS fee schedule,32.16,67,,25.728,percent of total billed charges,67% of total billed charges,10.64,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,38.4,80,,30.72,percent of total billed charges,80% of total billed charges,31.2,65,,24.96,percent of total billed charges,65% of total billed charges,17.12,35.67,,13.696,percent of total billed charges,35.67% of total billed charges,9.81,43.2,
LEUKOCYTE ALK PHOS,3005800,CDM,300,RC,85540,HCPCS,outpatient,,,93,37.20,,79.05,85,,63.24,percent of total billed charges,85% of total billed charges,71.61,77,,57.29,percent of total billed charges,77% of total billed charges,8.6,100,,,fee schedule,100% of CMS fee schedule,37.17,350,,,fee schedule,350% of BCBS fee schedule,38.66,364,,,fee schedule,364% of BCBS fee schedule,38.66,364,,,fee schedule,364% of BCBS fee schedule,38.66,364,,,fee schedule,364% of BCBS fee schedule,83.7,90,,66.96,percent of total billed charges,90% of total billed charges,74.4,80,,59.52,percent of total billed charges,80% of total billed charges,83.7,90,,66.96,percent of total billed charges,90% of total billed charges,69.75,75,,55.8,percent of total billed charges,75% of total billed charges,10.49,122,,,fee schedule,122% of APC rate,26.97,29,,21.576,percent of total billed charges,29% of total billed charges,8.6,100,,,fee schedule,100% of CMS fee schedule,62.31,67,,49.848,percent of total billed charges,67% of total billed charges,12.79,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,74.4,80,,59.52,percent of total billed charges,80% of total billed charges,60.45,65,,48.36,percent of total billed charges,65% of total billed charges,33.17,35.67,,26.536,percent of total billed charges,35.67% of total billed charges,8.6,83.7,
LIDOCAINE LAB TEST,3005820,CDM,300,RC,80176,HCPCS,outpatient,,,96,38.40,,81.6,85,,65.28,percent of total billed charges,85% of total billed charges,73.92,77,,59.14,percent of total billed charges,77% of total billed charges,14.69,100,,,fee schedule,100% of CMS fee schedule,63.49,350,,,fee schedule,350% of BCBS fee schedule,66.03,364,,,fee schedule,364% of BCBS fee schedule,66.03,364,,,fee schedule,364% of BCBS fee schedule,66.03,364,,,fee schedule,364% of BCBS fee schedule,86.4,90,,69.12,percent of total billed charges,90% of total billed charges,76.8,80,,61.44,percent of total billed charges,80% of total billed charges,86.4,90,,69.12,percent of total billed charges,90% of total billed charges,72,75,,57.6,percent of total billed charges,75% of total billed charges,17.92,122,,,fee schedule,122% of APC rate,27.84,29,,22.272,percent of total billed charges,29% of total billed charges,14.69,100,,,fee schedule,100% of CMS fee schedule,64.32,67,,51.456,percent of total billed charges,67% of total billed charges,21.84,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,76.8,80,,61.44,percent of total billed charges,80% of total billed charges,62.4,65,,49.92,percent of total billed charges,65% of total billed charges,34.24,35.67,,27.392,percent of total billed charges,35.67% of total billed charges,14.69,86.4,
LIPASE,3005840,CDM,300,RC,83690,HCPCS,outpatient,,,99,39.60,,84.15,85,,67.32,percent of total billed charges,85% of total billed charges,76.23,77,,60.98,percent of total billed charges,77% of total billed charges,6.89,100,,,fee schedule,100% of CMS fee schedule,29.79,350,,,fee schedule,350% of BCBS fee schedule,30.98,364,,,fee schedule,364% of BCBS fee schedule,30.98,364,,,fee schedule,364% of BCBS fee schedule,30.98,364,,,fee schedule,364% of BCBS fee schedule,89.1,90,,71.28,percent of total billed charges,90% of total billed charges,79.2,80,,63.36,percent of total billed charges,80% of total billed charges,89.1,90,,71.28,percent of total billed charges,90% of total billed charges,74.25,75,,59.4,percent of total billed charges,75% of total billed charges,8.4,122,,,fee schedule,122% of APC rate,28.71,29,,22.968,percent of total billed charges,29% of total billed charges,6.89,100,,,fee schedule,100% of CMS fee schedule,66.33,67,,53.064,percent of total billed charges,67% of total billed charges,8.64,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,79.2,80,,63.36,percent of total billed charges,80% of total billed charges,64.35,65,,51.48,percent of total billed charges,65% of total billed charges,35.31,35.67,,28.248,percent of total billed charges,35.67% of total billed charges,6.89,89.1,
LIPID PROFILE,3005845,CDM,300,RC,80061,HCPCS,outpatient,,,129,51.60,,109.65,85,,87.72,percent of total billed charges,85% of total billed charges,99.33,77,,79.46,percent of total billed charges,77% of total billed charges,13.39,100,,,fee schedule,100% of CMS fee schedule,57.86,350,,,fee schedule,350% of BCBS fee schedule,60.17,364,,,fee schedule,364% of BCBS fee schedule,60.17,364,,,fee schedule,364% of BCBS fee schedule,60.17,364,,,fee schedule,364% of BCBS fee schedule,116.1,90,,92.88,percent of total billed charges,90% of total billed charges,103.2,80,,82.56,percent of total billed charges,80% of total billed charges,116.1,90,,92.88,percent of total billed charges,90% of total billed charges,96.75,75,,77.4,percent of total billed charges,75% of total billed charges,16.33,122,,,fee schedule,122% of APC rate,37.41,29,,29.928,percent of total billed charges,29% of total billed charges,13.39,100,,,fee schedule,100% of CMS fee schedule,86.43,67,,69.144,percent of total billed charges,67% of total billed charges,19.91,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,103.2,80,,82.56,percent of total billed charges,80% of total billed charges,83.85,65,,67.08,percent of total billed charges,65% of total billed charges,46.01,35.67,,36.808,percent of total billed charges,35.67% of total billed charges,13.39,116.1,
LIPOPROTEIN A OR B,3005847,CDM,300,RC,83695,HCPCS,outpatient,,,135,54.00,,114.75,85,,91.8,percent of total billed charges,85% of total billed charges,103.95,77,,83.16,percent of total billed charges,77% of total billed charges,14.32,100,,,fee schedule,100% of CMS fee schedule,55.93,350,,,fee schedule,350% of BCBS fee schedule,58.17,364,,,fee schedule,364% of BCBS fee schedule,58.17,364,,,fee schedule,364% of BCBS fee schedule,58.17,364,,,fee schedule,364% of BCBS fee schedule,121.5,90,,97.2,percent of total billed charges,90% of total billed charges,108,80,,86.4,percent of total billed charges,80% of total billed charges,121.5,90,,97.2,percent of total billed charges,90% of total billed charges,101.25,75,,81,percent of total billed charges,75% of total billed charges,17.47,122,,,fee schedule,122% of APC rate,39.15,29,,31.32,percent of total billed charges,29% of total billed charges,14.32,100,,,fee schedule,100% of CMS fee schedule,90.45,67,,72.36,percent of total billed charges,67% of total billed charges,19.25,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,108,80,,86.4,percent of total billed charges,80% of total billed charges,87.75,65,,70.2,percent of total billed charges,65% of total billed charges,48.15,35.67,,38.52,percent of total billed charges,35.67% of total billed charges,14.32,121.5,
LIPOPROTEIN ELECTRO,3005848,CDM,300,RC,83700,HCPCS,outpatient,,,90,36.00,,76.5,85,,61.2,percent of total billed charges,85% of total billed charges,69.3,77,,55.44,percent of total billed charges,77% of total billed charges,11.26,100,,,fee schedule,100% of CMS fee schedule,48.65,350,,,fee schedule,350% of BCBS fee schedule,50.6,364,,,fee schedule,364% of BCBS fee schedule,50.6,364,,,fee schedule,364% of BCBS fee schedule,50.6,364,,,fee schedule,364% of BCBS fee schedule,81,90,,64.8,percent of total billed charges,90% of total billed charges,72,80,,57.6,percent of total billed charges,80% of total billed charges,81,90,,64.8,percent of total billed charges,90% of total billed charges,67.5,75,,54,percent of total billed charges,75% of total billed charges,13.73,122,,,fee schedule,122% of APC rate,26.1,29,,20.88,percent of total billed charges,29% of total billed charges,11.26,100,,,fee schedule,100% of CMS fee schedule,60.3,67,,48.24,percent of total billed charges,67% of total billed charges,16.74,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,72,80,,57.6,percent of total billed charges,80% of total billed charges,58.5,65,,46.8,percent of total billed charges,65% of total billed charges,32.1,35.67,,25.68,percent of total billed charges,35.67% of total billed charges,11.26,81,
LISTERIA IGG ANTIBODY,3005850,CDM,300,RC,86723,HCPCS,outpatient,,,135,54.00,,114.75,85,,91.8,percent of total billed charges,85% of total billed charges,103.95,77,,83.16,percent of total billed charges,77% of total billed charges,13.19,100,,,fee schedule,100% of CMS fee schedule,56.98,350,,,fee schedule,350% of BCBS fee schedule,59.26,364,,,fee schedule,364% of BCBS fee schedule,59.26,364,,,fee schedule,364% of BCBS fee schedule,59.26,364,,,fee schedule,364% of BCBS fee schedule,121.5,90,,97.2,percent of total billed charges,90% of total billed charges,108,80,,86.4,percent of total billed charges,80% of total billed charges,121.5,90,,97.2,percent of total billed charges,90% of total billed charges,101.25,75,,81,percent of total billed charges,75% of total billed charges,16.09,122,,,fee schedule,122% of APC rate,39.15,29,,31.32,percent of total billed charges,29% of total billed charges,13.19,100,,,fee schedule,100% of CMS fee schedule,90.45,67,,72.36,percent of total billed charges,67% of total billed charges,8.64,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,108,80,,86.4,percent of total billed charges,80% of total billed charges,87.75,65,,70.2,percent of total billed charges,65% of total billed charges,48.15,35.67,,38.52,percent of total billed charges,35.67% of total billed charges,8.64,121.5,
LITHIUM,3005860,CDM,300,RC,80178,HCPCS,outpatient,,,55,22.00,,46.75,85,,37.4,percent of total billed charges,85% of total billed charges,42.35,77,,33.88,percent of total billed charges,77% of total billed charges,6.61,100,,,fee schedule,100% of CMS fee schedule,28.56,350,,,fee schedule,350% of BCBS fee schedule,29.7,364,,,fee schedule,364% of BCBS fee schedule,29.7,364,,,fee schedule,364% of BCBS fee schedule,29.7,364,,,fee schedule,364% of BCBS fee schedule,49.5,90,,39.6,percent of total billed charges,90% of total billed charges,44,80,,35.2,percent of total billed charges,80% of total billed charges,49.5,90,,39.6,percent of total billed charges,90% of total billed charges,41.25,75,,33,percent of total billed charges,75% of total billed charges,8.06,122,,,fee schedule,122% of APC rate,15.95,29,,12.76,percent of total billed charges,29% of total billed charges,6.61,100,,,fee schedule,100% of CMS fee schedule,36.85,67,,29.48,percent of total billed charges,67% of total billed charges,9.82,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,44,80,,35.2,percent of total billed charges,80% of total billed charges,35.75,65,,28.6,percent of total billed charges,65% of total billed charges,19.62,35.67,,15.696,percent of total billed charges,35.67% of total billed charges,6.61,49.5,
LEGIONELLA URINARY ANTIGEN,3005861,CDM,300,RC,87449,HCPCS,outpatient,,,34,13.60,,28.9,85,,23.12,percent of total billed charges,85% of total billed charges,26.18,77,,20.94,percent of total billed charges,77% of total billed charges,11.98,100,,,fee schedule,100% of CMS fee schedule,51.8,350,,,fee schedule,350% of BCBS fee schedule,53.87,364,,,fee schedule,364% of BCBS fee schedule,53.87,364,,,fee schedule,364% of BCBS fee schedule,53.87,364,,,fee schedule,364% of BCBS fee schedule,30.6,90,,24.48,percent of total billed charges,90% of total billed charges,27.2,80,,21.76,percent of total billed charges,80% of total billed charges,30.6,90,,24.48,percent of total billed charges,90% of total billed charges,25.5,75,,20.4,percent of total billed charges,75% of total billed charges,14.61,122,,,fee schedule,122% of APC rate,9.86,29,,7.888,percent of total billed charges,29% of total billed charges,11.98,100,,,fee schedule,100% of CMS fee schedule,22.78,67,,18.224,percent of total billed charges,67% of total billed charges,15.41,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,27.2,80,,21.76,percent of total billed charges,80% of total billed charges,22.1,65,,17.68,percent of total billed charges,65% of total billed charges,12.13,35.67,,9.704,percent of total billed charges,35.67% of total billed charges,9.86,53.87,
LIVER PANEL - HEPATIC FUNCTION,3005880,CDM,300,RC,80076,HCPCS,outpatient,,,144,57.60,,122.4,85,,97.92,percent of total billed charges,85% of total billed charges,110.88,77,,88.7,percent of total billed charges,77% of total billed charges,8.17,100,,,fee schedule,100% of CMS fee schedule,35.32,350,,,fee schedule,350% of BCBS fee schedule,36.73,364,,,fee schedule,364% of BCBS fee schedule,36.73,364,,,fee schedule,364% of BCBS fee schedule,36.73,364,,,fee schedule,364% of BCBS fee schedule,129.6,90,,103.68,percent of total billed charges,90% of total billed charges,115.2,80,,92.16,percent of total billed charges,80% of total billed charges,129.6,90,,103.68,percent of total billed charges,90% of total billed charges,108,75,,86.4,percent of total billed charges,75% of total billed charges,9.96,122,,,fee schedule,122% of APC rate,41.76,29,,33.408,percent of total billed charges,29% of total billed charges,8.17,100,,,fee schedule,100% of CMS fee schedule,96.48,67,,77.184,percent of total billed charges,67% of total billed charges,9.5,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,115.2,80,,92.16,percent of total billed charges,80% of total billed charges,93.6,65,,74.88,percent of total billed charges,65% of total billed charges,51.36,35.67,,41.088,percent of total billed charges,35.67% of total billed charges,8.17,129.6,
LEUKEMIA/LYMPHOMA PHENOTYPE,3005881,CDM,300,RC,88184,HCPCS,outpatient,,,870,348.00,,739.5,85,,591.6,percent of total billed charges,85% of total billed charges,669.9,77,,535.92,percent of total billed charges,77% of total billed charges,314.34,100,,,fee schedule,100% of CMS OPPS rate,754.01,350,,,fee schedule,350% of BCBS fee schedule,784.17,364,,,fee schedule,364% of BCBS fee schedule,784.17,364,,,fee schedule,364% of BCBS fee schedule,784.17,364,,,fee schedule,364% of BCBS fee schedule,783,90,,626.4,percent of total billed charges,90% of total billed charges,696,80,,556.8,percent of total billed charges,80% of total billed charges,783,90,,626.4,percent of total billed charges,90% of total billed charges,652.5,75,,522,percent of total billed charges,75% of total billed charges,383.5,122,,,fee schedule,122% of APC rate,252.3,29,,201.84,percent of total billed charges,29% of total billed charges,314.34,100,,,fee schedule,100% of CMS OPPS rate,582.9,67,,466.32,percent of total billed charges,67% of total billed charges,15.91,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,696,80,,556.8,percent of total billed charges,80% of total billed charges,565.5,65,,452.4,percent of total billed charges,65% of total billed charges,310.33,35.67,,248.264,percent of total billed charges,35.67% of total billed charges,15.91,784.17,
MICROSOMAL ANTIBODY,3005887,CDM,300,RC,86376,HCPCS,outpatient,,,282,112.80,,239.7,85,,191.76,percent of total billed charges,85% of total billed charges,217.14,77,,173.71,percent of total billed charges,77% of total billed charges,14.55,100,,,fee schedule,100% of CMS fee schedule,62.86,350,,,fee schedule,350% of BCBS fee schedule,65.37,364,,,fee schedule,364% of BCBS fee schedule,65.37,364,,,fee schedule,364% of BCBS fee schedule,65.37,364,,,fee schedule,364% of BCBS fee schedule,253.8,90,,203.04,percent of total billed charges,90% of total billed charges,225.6,80,,180.48,percent of total billed charges,80% of total billed charges,253.8,90,,203.04,percent of total billed charges,90% of total billed charges,211.5,75,,169.2,percent of total billed charges,75% of total billed charges,17.75,122,,,fee schedule,122% of APC rate,81.78,29,,65.424,percent of total billed charges,29% of total billed charges,14.55,100,,,fee schedule,100% of CMS fee schedule,188.94,67,,151.152,percent of total billed charges,67% of total billed charges,21.64,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,225.6,80,,180.48,percent of total billed charges,80% of total billed charges,183.3,65,,146.64,percent of total billed charges,65% of total billed charges,100.59,35.67,,80.472,percent of total billed charges,35.67% of total billed charges,14.55,253.8,
"COMPLIMENT ANTIBODY, EACH",3005888,CDM,300,RC,86161,HCPCS,outpatient,,,547,218.80,,464.95,85,,371.96,percent of total billed charges,85% of total billed charges,421.19,77,,336.95,percent of total billed charges,77% of total billed charges,12,100,,,fee schedule,100% of CMS fee schedule,51.84,350,,,fee schedule,350% of BCBS fee schedule,53.91,364,,,fee schedule,364% of BCBS fee schedule,53.91,364,,,fee schedule,364% of BCBS fee schedule,53.91,364,,,fee schedule,364% of BCBS fee schedule,492.3,90,,393.84,percent of total billed charges,90% of total billed charges,437.6,80,,350.08,percent of total billed charges,80% of total billed charges,492.3,90,,393.84,percent of total billed charges,90% of total billed charges,410.25,75,,328.2,percent of total billed charges,75% of total billed charges,14.64,122,,,fee schedule,122% of APC rate,158.63,29,,126.904,percent of total billed charges,29% of total billed charges,12,100,,,fee schedule,100% of CMS fee schedule,366.49,67,,293.192,percent of total billed charges,67% of total billed charges,17.86,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,437.6,80,,350.08,percent of total billed charges,80% of total billed charges,355.55,65,,284.44,percent of total billed charges,65% of total billed charges,195.11,35.67,,156.088,percent of total billed charges,35.67% of total billed charges,12,492.3,
DNA ANTIBODY,3005889,CDM,300,RC,86225,HCPCS,outpatient,,,282,112.80,,239.7,85,,191.76,percent of total billed charges,85% of total billed charges,217.14,77,,173.71,percent of total billed charges,77% of total billed charges,13.74,100,,,fee schedule,100% of CMS fee schedule,59.4,350,,,fee schedule,350% of BCBS fee schedule,61.77,364,,,fee schedule,364% of BCBS fee schedule,61.77,364,,,fee schedule,364% of BCBS fee schedule,61.77,364,,,fee schedule,364% of BCBS fee schedule,253.8,90,,203.04,percent of total billed charges,90% of total billed charges,225.6,80,,180.48,percent of total billed charges,80% of total billed charges,253.8,90,,203.04,percent of total billed charges,90% of total billed charges,211.5,75,,169.2,percent of total billed charges,75% of total billed charges,16.76,122,,,fee schedule,122% of APC rate,81.78,29,,65.424,percent of total billed charges,29% of total billed charges,13.74,100,,,fee schedule,100% of CMS fee schedule,188.94,67,,151.152,percent of total billed charges,67% of total billed charges,20.42,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,225.6,80,,180.48,percent of total billed charges,80% of total billed charges,183.3,65,,146.64,percent of total billed charges,65% of total billed charges,100.59,35.67,,80.472,percent of total billed charges,35.67% of total billed charges,13.74,253.8,
CRYSTAL ANALYSIS,3005901,CDM,300,RC,89060,HCPCS,outpatient,,,87,34.80,,73.95,85,,59.16,percent of total billed charges,85% of total billed charges,66.99,77,,53.59,percent of total billed charges,77% of total billed charges,7.33,100,,,fee schedule,100% of CMS fee schedule,30.91,350,,,fee schedule,350% of BCBS fee schedule,32.14,364,,,fee schedule,364% of BCBS fee schedule,32.14,364,,,fee schedule,364% of BCBS fee schedule,32.14,364,,,fee schedule,364% of BCBS fee schedule,78.3,90,,62.64,percent of total billed charges,90% of total billed charges,69.6,80,,55.68,percent of total billed charges,80% of total billed charges,78.3,90,,62.64,percent of total billed charges,90% of total billed charges,65.25,75,,52.2,percent of total billed charges,75% of total billed charges,8.94,122,,,fee schedule,122% of APC rate,25.23,29,,20.184,percent of total billed charges,29% of total billed charges,7.33,100,,,fee schedule,100% of CMS fee schedule,58.29,67,,46.632,percent of total billed charges,67% of total billed charges,10.63,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,69.6,80,,55.68,percent of total billed charges,80% of total billed charges,56.55,65,,45.24,percent of total billed charges,65% of total billed charges,31.03,35.67,,24.824,percent of total billed charges,35.67% of total billed charges,7.33,78.3,
LIPOPROTEIN SUBSET ANALYSIS,3005902,CDM,300,RC,83704,HCPCS,outpatient,,,132,52.80,,112.2,85,,89.76,percent of total billed charges,85% of total billed charges,101.64,77,,81.31,percent of total billed charges,77% of total billed charges,34.19,100,,,fee schedule,100% of CMS fee schedule,136.33,350,,,fee schedule,350% of BCBS fee schedule,141.78,364,,,fee schedule,364% of BCBS fee schedule,141.78,364,,,fee schedule,364% of BCBS fee schedule,141.78,364,,,fee schedule,364% of BCBS fee schedule,118.8,90,,95.04,percent of total billed charges,90% of total billed charges,105.6,80,,84.48,percent of total billed charges,80% of total billed charges,118.8,90,,95.04,percent of total billed charges,90% of total billed charges,99,75,,79.2,percent of total billed charges,75% of total billed charges,41.71,122,,,fee schedule,122% of APC rate,38.28,29,,30.624,percent of total billed charges,29% of total billed charges,34.19,100,,,fee schedule,100% of CMS fee schedule,88.44,67,,70.752,percent of total billed charges,67% of total billed charges,30.24,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,105.6,80,,84.48,percent of total billed charges,80% of total billed charges,85.8,65,,68.64,percent of total billed charges,65% of total billed charges,47.08,35.67,,37.664,percent of total billed charges,35.67% of total billed charges,30.24,141.78,
NMR 8 PANEL,3005903,CDM,300,RC,83704,HCPCS,outpatient,,,110,44.00,,93.5,85,,74.8,percent of total billed charges,85% of total billed charges,84.7,77,,67.76,percent of total billed charges,77% of total billed charges,34.19,100,,,fee schedule,100% of CMS fee schedule,136.33,350,,,fee schedule,350% of BCBS fee schedule,141.78,364,,,fee schedule,364% of BCBS fee schedule,141.78,364,,,fee schedule,364% of BCBS fee schedule,141.78,364,,,fee schedule,364% of BCBS fee schedule,99,90,,79.2,percent of total billed charges,90% of total billed charges,88,80,,70.4,percent of total billed charges,80% of total billed charges,99,90,,79.2,percent of total billed charges,90% of total billed charges,82.5,75,,66,percent of total billed charges,75% of total billed charges,41.71,122,,,fee schedule,122% of APC rate,31.9,29,,25.52,percent of total billed charges,29% of total billed charges,34.19,100,,,fee schedule,100% of CMS fee schedule,73.7,67,,58.96,percent of total billed charges,67% of total billed charges,30.24,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,88,80,,70.4,percent of total billed charges,80% of total billed charges,71.5,65,,57.2,percent of total billed charges,65% of total billed charges,39.24,35.67,,31.392,percent of total billed charges,35.67% of total billed charges,30.24,141.78,
LUTENIZING HORMONE,3005920,CDM,300,RC,83002,HCPCS,outpatient,,,84,33.60,,71.4,85,,57.12,percent of total billed charges,85% of total billed charges,64.68,77,,51.74,percent of total billed charges,77% of total billed charges,18.52,100,,,fee schedule,100% of CMS fee schedule,80.01,350,,,fee schedule,350% of BCBS fee schedule,83.21,364,,,fee schedule,364% of BCBS fee schedule,83.21,364,,,fee schedule,364% of BCBS fee schedule,83.21,364,,,fee schedule,364% of BCBS fee schedule,75.6,90,,60.48,percent of total billed charges,90% of total billed charges,67.2,80,,53.76,percent of total billed charges,80% of total billed charges,75.6,90,,60.48,percent of total billed charges,90% of total billed charges,63,75,,50.4,percent of total billed charges,75% of total billed charges,22.59,122,,,fee schedule,122% of APC rate,24.36,29,,19.488,percent of total billed charges,29% of total billed charges,18.52,100,,,fee schedule,100% of CMS fee schedule,56.28,67,,45.024,percent of total billed charges,67% of total billed charges,27.54,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,67.2,80,,53.76,percent of total billed charges,80% of total billed charges,54.6,65,,43.68,percent of total billed charges,65% of total billed charges,29.96,35.67,,23.968,percent of total billed charges,35.67% of total billed charges,18.52,83.21,
LUVOX/FLUBOXAMINE LEVEL,3005921,CDM,300,RC,80299,HCPCS,outpatient,,,129,51.60,,109.65,85,,87.72,percent of total billed charges,85% of total billed charges,99.33,77,,79.46,percent of total billed charges,77% of total billed charges,18.64,100,,,fee schedule,100% of CMS fee schedule,65.24,350,,,fee schedule,350% of BCBS fee schedule,67.85,364,,,fee schedule,364% of BCBS fee schedule,67.85,364,,,fee schedule,364% of BCBS fee schedule,67.85,364,,,fee schedule,364% of BCBS fee schedule,116.1,90,,92.88,percent of total billed charges,90% of total billed charges,103.2,80,,82.56,percent of total billed charges,80% of total billed charges,116.1,90,,92.88,percent of total billed charges,90% of total billed charges,96.75,75,,77.4,percent of total billed charges,75% of total billed charges,22.74,122,,,fee schedule,122% of APC rate,37.41,29,,29.928,percent of total billed charges,29% of total billed charges,18.64,100,,,fee schedule,100% of CMS fee schedule,86.43,67,,69.144,percent of total billed charges,67% of total billed charges,20.36,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,103.2,80,,82.56,percent of total billed charges,80% of total billed charges,83.85,65,,67.08,percent of total billed charges,65% of total billed charges,46.01,35.67,,36.808,percent of total billed charges,35.67% of total billed charges,18.64,116.1,
LYME DISEASE ANTIBODIES/TITER,3005940,CDM,300,RC,86617,HCPCS,outpatient,,,147,58.80,,124.95,85,,99.96,percent of total billed charges,85% of total billed charges,113.19,77,,90.55,percent of total billed charges,77% of total billed charges,15.49,100,,,fee schedule,100% of CMS fee schedule,66.96,350,,,fee schedule,350% of BCBS fee schedule,69.63,364,,,fee schedule,364% of BCBS fee schedule,69.63,364,,,fee schedule,364% of BCBS fee schedule,69.63,364,,,fee schedule,364% of BCBS fee schedule,132.3,90,,105.84,percent of total billed charges,90% of total billed charges,117.6,80,,94.08,percent of total billed charges,80% of total billed charges,132.3,90,,105.84,percent of total billed charges,90% of total billed charges,110.25,75,,88.2,percent of total billed charges,75% of total billed charges,18.89,122,,,fee schedule,122% of APC rate,42.63,29,,34.104,percent of total billed charges,29% of total billed charges,15.49,100,,,fee schedule,100% of CMS fee schedule,98.49,67,,78.792,percent of total billed charges,67% of total billed charges,23.03,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,117.6,80,,94.08,percent of total billed charges,80% of total billed charges,95.55,65,,76.44,percent of total billed charges,65% of total billed charges,52.43,35.67,,41.944,percent of total billed charges,35.67% of total billed charges,15.49,132.3,
LYMPHOCYTE STIM. MULTIPLE MIT.,3005946,CDM,300,RC,86353,HCPCS,outpatient,,,258,103.20,,219.3,85,,175.44,percent of total billed charges,85% of total billed charges,198.66,77,,158.93,percent of total billed charges,77% of total billed charges,49.03,100,,,fee schedule,100% of CMS fee schedule,211.86,350,,,fee schedule,350% of BCBS fee schedule,220.33,364,,,fee schedule,364% of BCBS fee schedule,220.33,364,,,fee schedule,364% of BCBS fee schedule,220.33,364,,,fee schedule,364% of BCBS fee schedule,232.2,90,,185.76,percent of total billed charges,90% of total billed charges,206.4,80,,165.12,percent of total billed charges,80% of total billed charges,232.2,90,,185.76,percent of total billed charges,90% of total billed charges,193.5,75,,154.8,percent of total billed charges,75% of total billed charges,59.81,122,,,fee schedule,122% of APC rate,74.82,29,,59.856,percent of total billed charges,29% of total billed charges,49.03,100,,,fee schedule,100% of CMS fee schedule,172.86,67,,138.288,percent of total billed charges,67% of total billed charges,72.91,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,206.4,80,,165.12,percent of total billed charges,80% of total billed charges,167.7,65,,134.16,percent of total billed charges,65% of total billed charges,92.03,35.67,,73.624,percent of total billed charges,35.67% of total billed charges,49.03,232.2,
LYMPHOCYTE ENUMERATION BASIC,3005947,CDM,300,RC,86360,HCPCS,outpatient,,,296,118.40,,251.6,85,,201.28,percent of total billed charges,85% of total billed charges,227.92,77,,182.34,percent of total billed charges,77% of total billed charges,46.98,100,,,fee schedule,100% of CMS fee schedule,203.04,350,,,fee schedule,350% of BCBS fee schedule,211.16,364,,,fee schedule,364% of BCBS fee schedule,211.16,364,,,fee schedule,364% of BCBS fee schedule,211.16,364,,,fee schedule,364% of BCBS fee schedule,266.4,90,,213.12,percent of total billed charges,90% of total billed charges,236.8,80,,189.44,percent of total billed charges,80% of total billed charges,266.4,90,,213.12,percent of total billed charges,90% of total billed charges,222,75,,177.6,percent of total billed charges,75% of total billed charges,57.31,122,,,fee schedule,122% of APC rate,85.84,29,,68.672,percent of total billed charges,29% of total billed charges,46.98,100,,,fee schedule,100% of CMS fee schedule,198.32,67,,158.656,percent of total billed charges,67% of total billed charges,69.87,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,236.8,80,,189.44,percent of total billed charges,80% of total billed charges,192.4,65,,153.92,percent of total billed charges,65% of total billed charges,105.58,35.67,,84.464,percent of total billed charges,35.67% of total billed charges,46.98,266.4,
MACROGLOBULIN,3005950,CDM,300,RC,86329,HCPCS,outpatient,,,113,45.20,,96.05,85,,76.84,percent of total billed charges,85% of total billed charges,87.01,77,,69.61,percent of total billed charges,77% of total billed charges,14.05,100,,,fee schedule,100% of CMS fee schedule,60.69,350,,,fee schedule,350% of BCBS fee schedule,63.12,364,,,fee schedule,364% of BCBS fee schedule,63.12,364,,,fee schedule,364% of BCBS fee schedule,63.12,364,,,fee schedule,364% of BCBS fee schedule,101.7,90,,81.36,percent of total billed charges,90% of total billed charges,90.4,80,,72.32,percent of total billed charges,80% of total billed charges,101.7,90,,81.36,percent of total billed charges,90% of total billed charges,84.75,75,,67.8,percent of total billed charges,75% of total billed charges,17.14,122,,,fee schedule,122% of APC rate,32.77,29,,26.216,percent of total billed charges,29% of total billed charges,14.05,100,,,fee schedule,100% of CMS fee schedule,75.71,67,,60.568,percent of total billed charges,67% of total billed charges,20.88,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,90.4,80,,72.32,percent of total billed charges,80% of total billed charges,73.45,65,,58.76,percent of total billed charges,65% of total billed charges,40.31,35.67,,32.248,percent of total billed charges,35.67% of total billed charges,14.05,101.7,
PHOSPHOLIPID NEUT PLATELET X,3005952,CDM,300,RC,85597,HCPCS,outpatient,,,89,35.60,,75.65,85,,60.52,percent of total billed charges,85% of total billed charges,68.53,77,,54.82,percent of total billed charges,77% of total billed charges,17.98,100,,,fee schedule,100% of CMS fee schedule,77.67,350,,,fee schedule,350% of BCBS fee schedule,80.77,364,,,fee schedule,364% of BCBS fee schedule,80.77,364,,,fee schedule,364% of BCBS fee schedule,80.77,364,,,fee schedule,364% of BCBS fee schedule,80.1,90,,64.08,percent of total billed charges,90% of total billed charges,71.2,80,,56.96,percent of total billed charges,80% of total billed charges,80.1,90,,64.08,percent of total billed charges,90% of total billed charges,66.75,75,,53.4,percent of total billed charges,75% of total billed charges,21.93,122,,,fee schedule,122% of APC rate,25.81,29,,20.648,percent of total billed charges,29% of total billed charges,17.98,100,,,fee schedule,100% of CMS fee schedule,59.63,67,,47.704,percent of total billed charges,67% of total billed charges,21.58,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,71.2,80,,56.96,percent of total billed charges,80% of total billed charges,57.85,65,,46.28,percent of total billed charges,65% of total billed charges,31.75,35.67,,25.4,percent of total billed charges,35.67% of total billed charges,17.98,80.77,
PTT SUBSTITUTION PLASM FRAC X,3005953,CDM,300,RC,85732,HCPCS,outpatient,,,58,23.20,,49.3,85,,39.44,percent of total billed charges,85% of total billed charges,44.66,77,,35.73,percent of total billed charges,77% of total billed charges,6.47,100,,,fee schedule,100% of CMS fee schedule,27.93,350,,,fee schedule,350% of BCBS fee schedule,29.05,364,,,fee schedule,364% of BCBS fee schedule,29.05,364,,,fee schedule,364% of BCBS fee schedule,29.05,364,,,fee schedule,364% of BCBS fee schedule,52.2,90,,41.76,percent of total billed charges,90% of total billed charges,46.4,80,,37.12,percent of total billed charges,80% of total billed charges,52.2,90,,41.76,percent of total billed charges,90% of total billed charges,43.5,75,,34.8,percent of total billed charges,75% of total billed charges,7.89,122,,,fee schedule,122% of APC rate,16.82,29,,13.456,percent of total billed charges,29% of total billed charges,6.47,100,,,fee schedule,100% of CMS fee schedule,38.86,67,,31.088,percent of total billed charges,67% of total billed charges,9.62,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,46.4,80,,37.12,percent of total billed charges,80% of total billed charges,37.7,65,,30.16,percent of total billed charges,65% of total billed charges,20.69,35.67,,16.552,percent of total billed charges,35.67% of total billed charges,6.47,52.2,
MAGNESIUM,3005960,CDM,300,RC,83735,HCPCS,outpatient,,,58,23.20,,49.3,85,,39.44,percent of total billed charges,85% of total billed charges,44.66,77,,35.73,percent of total billed charges,77% of total billed charges,6.7,100,,,fee schedule,100% of CMS fee schedule,28.95,350,,,fee schedule,350% of BCBS fee schedule,30.1,364,,,fee schedule,364% of BCBS fee schedule,30.1,364,,,fee schedule,364% of BCBS fee schedule,30.1,364,,,fee schedule,364% of BCBS fee schedule,52.2,90,,41.76,percent of total billed charges,90% of total billed charges,46.4,80,,37.12,percent of total billed charges,80% of total billed charges,52.2,90,,41.76,percent of total billed charges,90% of total billed charges,43.5,75,,34.8,percent of total billed charges,75% of total billed charges,8.17,122,,,fee schedule,122% of APC rate,16.82,29,,13.456,percent of total billed charges,29% of total billed charges,6.7,100,,,fee schedule,100% of CMS fee schedule,38.86,67,,31.088,percent of total billed charges,67% of total billed charges,9.96,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,46.4,80,,37.12,percent of total billed charges,80% of total billed charges,37.7,65,,30.16,percent of total billed charges,65% of total billed charges,20.69,35.67,,16.552,percent of total billed charges,35.67% of total billed charges,6.7,52.2,
MALARIA ANTIBODY,3005970,CDM,300,RC,86750,HCPCS,outpatient,,,165,66.00,,140.25,85,,112.2,percent of total billed charges,85% of total billed charges,127.05,77,,101.64,percent of total billed charges,77% of total billed charges,13.19,100,,,fee schedule,100% of CMS fee schedule,56.98,350,,,fee schedule,350% of BCBS fee schedule,59.26,364,,,fee schedule,364% of BCBS fee schedule,59.26,364,,,fee schedule,364% of BCBS fee schedule,59.26,364,,,fee schedule,364% of BCBS fee schedule,148.5,90,,118.8,percent of total billed charges,90% of total billed charges,132,80,,105.6,percent of total billed charges,80% of total billed charges,148.5,90,,118.8,percent of total billed charges,90% of total billed charges,123.75,75,,99,percent of total billed charges,75% of total billed charges,16.09,122,,,fee schedule,122% of APC rate,47.85,29,,38.28,percent of total billed charges,29% of total billed charges,13.19,100,,,fee schedule,100% of CMS fee schedule,110.55,67,,88.44,percent of total billed charges,67% of total billed charges,19.61,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,132,80,,105.6,percent of total billed charges,80% of total billed charges,107.25,65,,85.8,percent of total billed charges,65% of total billed charges,58.86,35.67,,47.088,percent of total billed charges,35.67% of total billed charges,13.19,148.5,
MALARIAL THICK/THIN SMEAR,3005980,CDM,300,RC,87207,HCPCS,outpatient,,,31,12.40,,26.35,85,,21.08,percent of total billed charges,85% of total billed charges,23.87,77,,19.1,percent of total billed charges,77% of total billed charges,5.99,100,,,fee schedule,100% of CMS fee schedule,25.9,350,,,fee schedule,350% of BCBS fee schedule,26.94,364,,,fee schedule,364% of BCBS fee schedule,26.94,364,,,fee schedule,364% of BCBS fee schedule,26.94,364,,,fee schedule,364% of BCBS fee schedule,27.9,90,,22.32,percent of total billed charges,90% of total billed charges,24.8,80,,19.84,percent of total billed charges,80% of total billed charges,27.9,90,,22.32,percent of total billed charges,90% of total billed charges,23.25,75,,18.6,percent of total billed charges,75% of total billed charges,7.3,122,,,fee schedule,122% of APC rate,8.99,29,,7.192,percent of total billed charges,29% of total billed charges,5.99,100,,,fee schedule,100% of CMS fee schedule,20.77,67,,16.616,percent of total billed charges,67% of total billed charges,8.91,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,24.8,80,,19.84,percent of total billed charges,80% of total billed charges,20.15,65,,16.12,percent of total billed charges,65% of total billed charges,11.06,35.67,,8.848,percent of total billed charges,35.67% of total billed charges,5.99,27.9,
"ALBUMIN,URINE FOR PANEL",3006001,CDM,300,RC,82042,HCPCS,outpatient,,,59,23.60,,50.15,85,,40.12,percent of total billed charges,85% of total billed charges,45.43,77,,36.34,percent of total billed charges,77% of total billed charges,7.78,100,,,fee schedule,100% of CMS fee schedule,27.23,350,,,fee schedule,350% of BCBS fee schedule,28.32,364,,,fee schedule,364% of BCBS fee schedule,28.32,364,,,fee schedule,364% of BCBS fee schedule,28.32,364,,,fee schedule,364% of BCBS fee schedule,53.1,90,,42.48,percent of total billed charges,90% of total billed charges,47.2,80,,37.76,percent of total billed charges,80% of total billed charges,53.1,90,,42.48,percent of total billed charges,90% of total billed charges,44.25,75,,35.4,percent of total billed charges,75% of total billed charges,9.49,122,,,fee schedule,122% of APC rate,17.11,29,,13.688,percent of total billed charges,29% of total billed charges,7.78,100,,,fee schedule,100% of CMS fee schedule,39.53,67,,31.624,percent of total billed charges,67% of total billed charges,4.28,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,47.2,80,,37.76,percent of total billed charges,80% of total billed charges,38.35,65,,30.68,percent of total billed charges,65% of total billed charges,21.05,35.67,,16.84,percent of total billed charges,35.67% of total billed charges,4.28,53.1,
MATERNAL TRIPLE SERUM PROFILE,3006010,CDM,300,RC,,,outpatient,,,235,94.00,,199.75,85,,159.8,percent of total billed charges,85% of total billed charges,180.95,77,,144.76,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,192.7,82,,154.16,percent of total billed charges,82% of total billed charges,199.75,85,,159.8,percent of total billed charges,85% of total billed charges,199.75,85,,159.8,percent of total billed charges,85% of total billed charges,199.75,85,,159.8,percent of total billed charges,85% of total billed charges,211.5,90,,169.2,percent of total billed charges,90% of total billed charges,188,80,,150.4,percent of total billed charges,80% of total billed charges,211.5,90,,169.2,percent of total billed charges,90% of total billed charges,176.25,75,,141,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,68.15,29,,54.52,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,157.45,67,,125.96,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,188,80,,150.4,percent of total billed charges,80% of total billed charges,152.75,65,,122.2,percent of total billed charges,65% of total billed charges,83.82,35.67,,67.056,percent of total billed charges,35.67% of total billed charges,68.15,211.5,
MATERNAL QUAD SCREEN PROFILE,3006011,CDM,300,RC,,,outpatient,,,415,166.00,,352.75,85,,282.2,percent of total billed charges,85% of total billed charges,319.55,77,,255.64,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,340.3,82,,272.24,percent of total billed charges,82% of total billed charges,352.75,85,,282.2,percent of total billed charges,85% of total billed charges,352.75,85,,282.2,percent of total billed charges,85% of total billed charges,352.75,85,,282.2,percent of total billed charges,85% of total billed charges,373.5,90,,298.8,percent of total billed charges,90% of total billed charges,332,80,,265.6,percent of total billed charges,80% of total billed charges,373.5,90,,298.8,percent of total billed charges,90% of total billed charges,311.25,75,,249,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,120.35,29,,96.28,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,278.05,67,,222.44,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,332,80,,265.6,percent of total billed charges,80% of total billed charges,269.75,65,,215.8,percent of total billed charges,65% of total billed charges,148.03,35.67,,118.424,percent of total billed charges,35.67% of total billed charges,120.35,373.5,
ACETYLCHOLINE RECEPTOR BINDING,3006015,CDM,300,RC,83519,HCPCS,outpatient,,,192,76.80,,163.2,85,,130.56,percent of total billed charges,85% of total billed charges,147.84,77,,118.27,percent of total billed charges,77% of total billed charges,18.39,100,,,fee schedule,100% of CMS fee schedule,64.4,350,,,fee schedule,350% of BCBS fee schedule,66.98,364,,,fee schedule,364% of BCBS fee schedule,66.98,364,,,fee schedule,364% of BCBS fee schedule,66.98,364,,,fee schedule,364% of BCBS fee schedule,172.8,90,,138.24,percent of total billed charges,90% of total billed charges,153.6,80,,122.88,percent of total billed charges,80% of total billed charges,172.8,90,,138.24,percent of total billed charges,90% of total billed charges,144,75,,115.2,percent of total billed charges,75% of total billed charges,22.44,122,,,fee schedule,122% of APC rate,55.68,29,,44.544,percent of total billed charges,29% of total billed charges,18.39,100,,,fee schedule,100% of CMS fee schedule,128.64,67,,102.912,percent of total billed charges,67% of total billed charges,20.09,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,153.6,80,,122.88,percent of total billed charges,80% of total billed charges,124.8,65,,99.84,percent of total billed charges,65% of total billed charges,68.49,35.67,,54.792,percent of total billed charges,35.67% of total billed charges,18.39,172.8,
ANTI-STRIATED MUSCLE ANTIBODIE,3006016,CDM,300,RC,86255,HCPCS,outpatient,,,113,45.20,,96.05,85,,76.84,percent of total billed charges,85% of total billed charges,87.01,77,,69.61,percent of total billed charges,77% of total billed charges,12.05,100,,,fee schedule,100% of CMS fee schedule,52.08,350,,,fee schedule,350% of BCBS fee schedule,54.16,364,,,fee schedule,364% of BCBS fee schedule,54.16,364,,,fee schedule,364% of BCBS fee schedule,54.16,364,,,fee schedule,364% of BCBS fee schedule,101.7,90,,81.36,percent of total billed charges,90% of total billed charges,90.4,80,,72.32,percent of total billed charges,80% of total billed charges,101.7,90,,81.36,percent of total billed charges,90% of total billed charges,84.75,75,,67.8,percent of total billed charges,75% of total billed charges,14.7,122,,,fee schedule,122% of APC rate,32.77,29,,26.216,percent of total billed charges,29% of total billed charges,12.05,100,,,fee schedule,100% of CMS fee schedule,75.71,67,,60.568,percent of total billed charges,67% of total billed charges,17.92,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,90.4,80,,72.32,percent of total billed charges,80% of total billed charges,73.45,65,,58.76,percent of total billed charges,65% of total billed charges,40.31,35.67,,32.248,percent of total billed charges,35.67% of total billed charges,12.05,101.7,
APOLIPOPROTEIN A,3006017,CDM,300,RC,82172,HCPCS,outpatient,,,231,92.40,,196.35,85,,157.08,percent of total billed charges,85% of total billed charges,177.87,77,,142.3,percent of total billed charges,77% of total billed charges,21.09,100,,,fee schedule,100% of CMS fee schedule,73.82,350,,,fee schedule,350% of BCBS fee schedule,76.77,364,,,fee schedule,364% of BCBS fee schedule,76.77,364,,,fee schedule,364% of BCBS fee schedule,76.77,364,,,fee schedule,364% of BCBS fee schedule,207.9,90,,166.32,percent of total billed charges,90% of total billed charges,184.8,80,,147.84,percent of total billed charges,80% of total billed charges,207.9,90,,166.32,percent of total billed charges,90% of total billed charges,173.25,75,,138.6,percent of total billed charges,75% of total billed charges,25.72,122,,,fee schedule,122% of APC rate,66.99,29,,53.592,percent of total billed charges,29% of total billed charges,21.09,100,,,fee schedule,100% of CMS fee schedule,154.77,67,,123.816,percent of total billed charges,67% of total billed charges,23.04,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,184.8,80,,147.84,percent of total billed charges,80% of total billed charges,150.15,65,,120.12,percent of total billed charges,65% of total billed charges,82.4,35.67,,65.92,percent of total billed charges,35.67% of total billed charges,21.09,207.9,
MELANOCYSTIC STIM HORMONE,3006019,CDM,300,RC,83519,HCPCS,outpatient,,,168,67.20,,142.8,85,,114.24,percent of total billed charges,85% of total billed charges,129.36,77,,103.49,percent of total billed charges,77% of total billed charges,18.39,100,,,fee schedule,100% of CMS fee schedule,64.4,350,,,fee schedule,350% of BCBS fee schedule,66.98,364,,,fee schedule,364% of BCBS fee schedule,66.98,364,,,fee schedule,364% of BCBS fee schedule,66.98,364,,,fee schedule,364% of BCBS fee schedule,151.2,90,,120.96,percent of total billed charges,90% of total billed charges,134.4,80,,107.52,percent of total billed charges,80% of total billed charges,151.2,90,,120.96,percent of total billed charges,90% of total billed charges,126,75,,100.8,percent of total billed charges,75% of total billed charges,22.44,122,,,fee schedule,122% of APC rate,48.72,29,,38.976,percent of total billed charges,29% of total billed charges,18.39,100,,,fee schedule,100% of CMS fee schedule,112.56,67,,90.048,percent of total billed charges,67% of total billed charges,20.09,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,134.4,80,,107.52,percent of total billed charges,80% of total billed charges,109.2,65,,87.36,percent of total billed charges,65% of total billed charges,59.93,35.67,,47.944,percent of total billed charges,35.67% of total billed charges,18.39,151.2,
MERCURY-URINE,3006040,CDM,300,RC,83825,HCPCS,outpatient,,,68,27.20,,57.8,85,,46.24,percent of total billed charges,85% of total billed charges,52.36,77,,41.89,percent of total billed charges,77% of total billed charges,16.26,100,,,fee schedule,100% of CMS fee schedule,70.25,350,,,fee schedule,350% of BCBS fee schedule,73.05,364,,,fee schedule,364% of BCBS fee schedule,73.05,364,,,fee schedule,364% of BCBS fee schedule,73.05,364,,,fee schedule,364% of BCBS fee schedule,61.2,90,,48.96,percent of total billed charges,90% of total billed charges,54.4,80,,43.52,percent of total billed charges,80% of total billed charges,61.2,90,,48.96,percent of total billed charges,90% of total billed charges,51,75,,40.8,percent of total billed charges,75% of total billed charges,19.83,122,,,fee schedule,122% of APC rate,19.72,29,,15.776,percent of total billed charges,29% of total billed charges,16.26,100,,,fee schedule,100% of CMS fee schedule,45.56,67,,36.448,percent of total billed charges,67% of total billed charges,24.18,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,54.4,80,,43.52,percent of total billed charges,80% of total billed charges,44.2,65,,35.36,percent of total billed charges,65% of total billed charges,24.26,35.67,,19.408,percent of total billed charges,35.67% of total billed charges,16.26,73.05,
METANEPHRINES (TOTAL),3006060,CDM,300,RC,83835,HCPCS,outpatient,,,194,77.60,,164.9,85,,131.92,percent of total billed charges,85% of total billed charges,149.38,77,,119.5,percent of total billed charges,77% of total billed charges,16.94,100,,,fee schedule,100% of CMS fee schedule,73.22,350,,,fee schedule,350% of BCBS fee schedule,76.15,364,,,fee schedule,364% of BCBS fee schedule,76.15,364,,,fee schedule,364% of BCBS fee schedule,76.15,364,,,fee schedule,364% of BCBS fee schedule,174.6,90,,139.68,percent of total billed charges,90% of total billed charges,155.2,80,,124.16,percent of total billed charges,80% of total billed charges,174.6,90,,139.68,percent of total billed charges,90% of total billed charges,145.5,75,,116.4,percent of total billed charges,75% of total billed charges,20.66,122,,,fee schedule,122% of APC rate,56.26,29,,45.008,percent of total billed charges,29% of total billed charges,16.94,100,,,fee schedule,100% of CMS fee schedule,129.98,67,,103.984,percent of total billed charges,67% of total billed charges,25.2,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,155.2,80,,124.16,percent of total billed charges,80% of total billed charges,126.1,65,,100.88,percent of total billed charges,65% of total billed charges,69.2,35.67,,55.36,percent of total billed charges,35.67% of total billed charges,16.94,174.6,
METHEMOGLOBIN,3006080,CDM,300,RC,85018,HCPCS,outpatient,,,40,16.00,,34,85,,27.2,percent of total billed charges,85% of total billed charges,30.8,77,,24.64,percent of total billed charges,77% of total billed charges,2.37,100,,,fee schedule,100% of CMS fee schedule,10.26,350,,,fee schedule,350% of BCBS fee schedule,10.67,364,,,fee schedule,364% of BCBS fee schedule,10.67,364,,,fee schedule,364% of BCBS fee schedule,10.67,364,,,fee schedule,364% of BCBS fee schedule,36,90,,28.8,percent of total billed charges,90% of total billed charges,32,80,,25.6,percent of total billed charges,80% of total billed charges,36,90,,28.8,percent of total billed charges,90% of total billed charges,30,75,,24,percent of total billed charges,75% of total billed charges,2.89,122,,,fee schedule,122% of APC rate,11.6,29,,9.28,percent of total billed charges,29% of total billed charges,2.37,100,,,fee schedule,100% of CMS fee schedule,26.8,67,,21.44,percent of total billed charges,67% of total billed charges,3.51,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,32,80,,25.6,percent of total billed charges,80% of total billed charges,26,65,,20.8,percent of total billed charges,65% of total billed charges,14.27,35.67,,11.416,percent of total billed charges,35.67% of total billed charges,2.37,36,
METHYLMALONIC ACID,3006119,CDM,300,RC,83918,HCPCS,outpatient,,,154,61.60,,130.9,85,,104.72,percent of total billed charges,85% of total billed charges,118.58,77,,94.86,percent of total billed charges,77% of total billed charges,23.6,100,,,fee schedule,100% of CMS fee schedule,82.6,350,,,fee schedule,350% of BCBS fee schedule,85.9,364,,,fee schedule,364% of BCBS fee schedule,85.9,364,,,fee schedule,364% of BCBS fee schedule,85.9,364,,,fee schedule,364% of BCBS fee schedule,138.6,90,,110.88,percent of total billed charges,90% of total billed charges,123.2,80,,98.56,percent of total billed charges,80% of total billed charges,138.6,90,,110.88,percent of total billed charges,90% of total billed charges,115.5,75,,92.4,percent of total billed charges,75% of total billed charges,28.79,122,,,fee schedule,122% of APC rate,44.66,29,,35.728,percent of total billed charges,29% of total billed charges,23.6,100,,,fee schedule,100% of CMS fee schedule,103.18,67,,82.544,percent of total billed charges,67% of total billed charges,24.47,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,123.2,80,,98.56,percent of total billed charges,80% of total billed charges,100.1,65,,80.08,percent of total billed charges,65% of total billed charges,54.93,35.67,,43.944,percent of total billed charges,35.67% of total billed charges,23.6,138.6,
MEXITIL,3006130,CDM,300,RC,80299,HCPCS,outpatient,,,147,58.80,,124.95,85,,99.96,percent of total billed charges,85% of total billed charges,113.19,77,,90.55,percent of total billed charges,77% of total billed charges,18.64,100,,,fee schedule,100% of CMS fee schedule,65.24,350,,,fee schedule,350% of BCBS fee schedule,67.85,364,,,fee schedule,364% of BCBS fee schedule,67.85,364,,,fee schedule,364% of BCBS fee schedule,67.85,364,,,fee schedule,364% of BCBS fee schedule,132.3,90,,105.84,percent of total billed charges,90% of total billed charges,117.6,80,,94.08,percent of total billed charges,80% of total billed charges,132.3,90,,105.84,percent of total billed charges,90% of total billed charges,110.25,75,,88.2,percent of total billed charges,75% of total billed charges,22.74,122,,,fee schedule,122% of APC rate,42.63,29,,34.104,percent of total billed charges,29% of total billed charges,18.64,100,,,fee schedule,100% of CMS fee schedule,98.49,67,,78.792,percent of total billed charges,67% of total billed charges,20.36,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,117.6,80,,94.08,percent of total billed charges,80% of total billed charges,95.55,65,,76.44,percent of total billed charges,65% of total billed charges,52.43,35.67,,41.944,percent of total billed charges,35.67% of total billed charges,18.64,132.3,
MHA-TP,3006140,CDM,300,RC,86780,HCPCS,outpatient,,,79,31.60,,67.15,85,,53.72,percent of total billed charges,85% of total billed charges,60.83,77,,48.66,percent of total billed charges,77% of total billed charges,13.24,100,,,fee schedule,100% of CMS fee schedule,57.19,350,,,fee schedule,350% of BCBS fee schedule,59.48,364,,,fee schedule,364% of BCBS fee schedule,59.48,364,,,fee schedule,364% of BCBS fee schedule,59.48,364,,,fee schedule,364% of BCBS fee schedule,71.1,90,,56.88,percent of total billed charges,90% of total billed charges,63.2,80,,50.56,percent of total billed charges,80% of total billed charges,71.1,90,,56.88,percent of total billed charges,90% of total billed charges,59.25,75,,47.4,percent of total billed charges,75% of total billed charges,16.15,122,,,fee schedule,122% of APC rate,22.91,29,,18.328,percent of total billed charges,29% of total billed charges,13.24,100,,,fee schedule,100% of CMS fee schedule,52.93,67,,42.344,percent of total billed charges,67% of total billed charges,19.68,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,63.2,80,,50.56,percent of total billed charges,80% of total billed charges,51.35,65,,41.08,percent of total billed charges,65% of total billed charges,28.18,35.67,,22.544,percent of total billed charges,35.67% of total billed charges,13.24,71.1,
MIC GRAM NEGATIVE,3006152,CDM,300,RC,,,outpatient,,,98,39.20,,83.3,85,,66.64,percent of total billed charges,85% of total billed charges,75.46,77,,60.37,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,80.36,82,,64.288,percent of total billed charges,82% of total billed charges,83.3,85,,66.64,percent of total billed charges,85% of total billed charges,83.3,85,,66.64,percent of total billed charges,85% of total billed charges,83.3,85,,66.64,percent of total billed charges,85% of total billed charges,88.2,90,,70.56,percent of total billed charges,90% of total billed charges,78.4,80,,62.72,percent of total billed charges,80% of total billed charges,88.2,90,,70.56,percent of total billed charges,90% of total billed charges,73.5,75,,58.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,28.42,29,,22.736,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,65.66,67,,52.528,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,78.4,80,,62.72,percent of total billed charges,80% of total billed charges,63.7,65,,50.96,percent of total billed charges,65% of total billed charges,34.96,35.67,,27.968,percent of total billed charges,35.67% of total billed charges,28.42,88.2,
MONOSCREEN,3006180,CDM,300,RC,86308,HCPCS,outpatient,,,51,20.40,,43.35,85,,34.68,percent of total billed charges,85% of total billed charges,39.27,77,,31.42,percent of total billed charges,77% of total billed charges,5.18,100,,,fee schedule,100% of CMS fee schedule,22.37,350,,,fee schedule,350% of BCBS fee schedule,23.26,364,,,fee schedule,364% of BCBS fee schedule,23.26,364,,,fee schedule,364% of BCBS fee schedule,23.26,364,,,fee schedule,364% of BCBS fee schedule,45.9,90,,36.72,percent of total billed charges,90% of total billed charges,40.8,80,,32.64,percent of total billed charges,80% of total billed charges,45.9,90,,36.72,percent of total billed charges,90% of total billed charges,38.25,75,,30.6,percent of total billed charges,75% of total billed charges,6.31,122,,,fee schedule,122% of APC rate,14.79,29,,11.832,percent of total billed charges,29% of total billed charges,5.18,100,,,fee schedule,100% of CMS fee schedule,34.17,67,,27.336,percent of total billed charges,67% of total billed charges,7.69,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,40.8,80,,32.64,percent of total billed charges,80% of total billed charges,33.15,65,,26.52,percent of total billed charges,65% of total billed charges,18.19,35.67,,14.552,percent of total billed charges,35.67% of total billed charges,5.18,45.9,
MONOCLONAL GAMMA.,3006181,CDM,300,RC,86334,HCPCS,outpatient,,,141,56.40,,119.85,85,,95.88,percent of total billed charges,85% of total billed charges,108.57,77,,86.86,percent of total billed charges,77% of total billed charges,22.34,100,,,fee schedule,100% of CMS fee schedule,96.57,350,,,fee schedule,350% of BCBS fee schedule,100.43,364,,,fee schedule,364% of BCBS fee schedule,100.43,364,,,fee schedule,364% of BCBS fee schedule,100.43,364,,,fee schedule,364% of BCBS fee schedule,126.9,90,,101.52,percent of total billed charges,90% of total billed charges,112.8,80,,90.24,percent of total billed charges,80% of total billed charges,126.9,90,,101.52,percent of total billed charges,90% of total billed charges,105.75,75,,84.6,percent of total billed charges,75% of total billed charges,27.25,122,,,fee schedule,122% of APC rate,40.89,29,,32.712,percent of total billed charges,29% of total billed charges,22.34,100,,,fee schedule,100% of CMS fee schedule,94.47,67,,75.576,percent of total billed charges,67% of total billed charges,33.22,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,112.8,80,,90.24,percent of total billed charges,80% of total billed charges,91.65,65,,73.32,percent of total billed charges,65% of total billed charges,50.29,35.67,,40.232,percent of total billed charges,35.67% of total billed charges,22.34,126.9,
MISC LAB TEST - INPT SP,3006182,CDM,300,RC,,,outpatient,,,1145,458.00,,973.25,85,,778.6,percent of total billed charges,85% of total billed charges,881.65,77,,705.32,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,938.9,82,,751.12,percent of total billed charges,82% of total billed charges,973.25,85,,778.6,percent of total billed charges,85% of total billed charges,973.25,85,,778.6,percent of total billed charges,85% of total billed charges,973.25,85,,778.6,percent of total billed charges,85% of total billed charges,1030.5,90,,824.4,percent of total billed charges,90% of total billed charges,916,80,,732.8,percent of total billed charges,80% of total billed charges,1030.5,90,,824.4,percent of total billed charges,90% of total billed charges,858.75,75,,687,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,332.05,29,,265.64,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,767.15,67,,613.72,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,916,80,,732.8,percent of total billed charges,80% of total billed charges,744.25,65,,595.4,percent of total billed charges,65% of total billed charges,408.42,35.67,,326.736,percent of total billed charges,35.67% of total billed charges,332.05,1030.5,
MORPHINE DRUG SCREEN - SERUM,3006185,CDM,300,RC,80361,HCPCS,outpatient,,,103,41.20,,87.55,85,,70.04,percent of total billed charges,85% of total billed charges,79.31,77,,63.45,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,84.46,82,,67.568,percent of total billed charges,82% of total billed charges,87.55,85,,70.04,percent of total billed charges,85% of total billed charges,87.55,85,,70.04,percent of total billed charges,85% of total billed charges,87.55,85,,70.04,percent of total billed charges,85% of total billed charges,92.7,90,,74.16,percent of total billed charges,90% of total billed charges,82.4,80,,65.92,percent of total billed charges,80% of total billed charges,92.7,90,,74.16,percent of total billed charges,90% of total billed charges,77.25,75,,61.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,29.87,29,,23.896,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,69.01,67,,55.208,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,82.4,80,,65.92,percent of total billed charges,80% of total billed charges,66.95,65,,53.56,percent of total billed charges,65% of total billed charges,36.74,35.67,,29.392,percent of total billed charges,35.67% of total billed charges,29.87,92.7,
MRSA DNA AMP PROBE (IN HOUSE),3006186,CDM,300,RC,87641,HCPCS,outpatient,,,117,46.80,,99.45,85,,79.56,percent of total billed charges,85% of total billed charges,90.09,77,,72.07,percent of total billed charges,77% of total billed charges,35.09,100,,,fee schedule,100% of CMS fee schedule,151.66,350,,,fee schedule,350% of BCBS fee schedule,157.72,364,,,fee schedule,364% of BCBS fee schedule,157.72,364,,,fee schedule,364% of BCBS fee schedule,157.72,364,,,fee schedule,364% of BCBS fee schedule,105.3,90,,84.24,percent of total billed charges,90% of total billed charges,93.6,80,,74.88,percent of total billed charges,80% of total billed charges,105.3,90,,84.24,percent of total billed charges,90% of total billed charges,87.75,75,,70.2,percent of total billed charges,75% of total billed charges,42.8,122,,,fee schedule,122% of APC rate,33.93,29,,27.144,percent of total billed charges,29% of total billed charges,35.09,100,,,fee schedule,100% of CMS fee schedule,78.39,67,,62.712,percent of total billed charges,67% of total billed charges,52.19,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,93.6,80,,74.88,percent of total billed charges,80% of total billed charges,76.05,65,,60.84,percent of total billed charges,65% of total billed charges,41.73,35.67,,33.384,percent of total billed charges,35.67% of total billed charges,33.93,157.72,
MUMPS VIRUS ANTIBODY,3006240,CDM,300,RC,86735,HCPCS,outpatient,,,90,36.00,,76.5,85,,61.2,percent of total billed charges,85% of total billed charges,69.3,77,,55.44,percent of total billed charges,77% of total billed charges,13.05,100,,,fee schedule,100% of CMS fee schedule,56.39,350,,,fee schedule,350% of BCBS fee schedule,58.64,364,,,fee schedule,364% of BCBS fee schedule,58.64,364,,,fee schedule,364% of BCBS fee schedule,58.64,364,,,fee schedule,364% of BCBS fee schedule,81,90,,64.8,percent of total billed charges,90% of total billed charges,72,80,,57.6,percent of total billed charges,80% of total billed charges,81,90,,64.8,percent of total billed charges,90% of total billed charges,67.5,75,,54,percent of total billed charges,75% of total billed charges,15.92,122,,,fee schedule,122% of APC rate,26.1,29,,20.88,percent of total billed charges,29% of total billed charges,13.05,100,,,fee schedule,100% of CMS fee schedule,60.3,67,,48.24,percent of total billed charges,67% of total billed charges,19.41,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,72,80,,57.6,percent of total billed charges,80% of total billed charges,58.5,65,,46.8,percent of total billed charges,65% of total billed charges,32.1,35.67,,25.68,percent of total billed charges,35.67% of total billed charges,13.05,81,
MYASTHENIA GRAVIS EVALUATION,3006250,CDM,300,RC,,,outpatient,,,273,109.20,,232.05,85,,185.64,percent of total billed charges,85% of total billed charges,210.21,77,,168.17,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,223.86,82,,179.088,percent of total billed charges,82% of total billed charges,232.05,85,,185.64,percent of total billed charges,85% of total billed charges,232.05,85,,185.64,percent of total billed charges,85% of total billed charges,232.05,85,,185.64,percent of total billed charges,85% of total billed charges,245.7,90,,196.56,percent of total billed charges,90% of total billed charges,218.4,80,,174.72,percent of total billed charges,80% of total billed charges,245.7,90,,196.56,percent of total billed charges,90% of total billed charges,204.75,75,,163.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,79.17,29,,63.336,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,182.91,67,,146.328,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,218.4,80,,174.72,percent of total billed charges,80% of total billed charges,177.45,65,,141.96,percent of total billed charges,65% of total billed charges,97.38,35.67,,77.904,percent of total billed charges,35.67% of total billed charges,79.17,245.7,
MYASTHENIA GRAVIS - ADD TEST,3006251,CDM,300,RC,86256,HCPCS,outpatient,,,113,45.20,,96.05,85,,76.84,percent of total billed charges,85% of total billed charges,87.01,77,,69.61,percent of total billed charges,77% of total billed charges,12.05,100,,,fee schedule,100% of CMS fee schedule,52.08,350,,,fee schedule,350% of BCBS fee schedule,54.16,364,,,fee schedule,364% of BCBS fee schedule,54.16,364,,,fee schedule,364% of BCBS fee schedule,54.16,364,,,fee schedule,364% of BCBS fee schedule,101.7,90,,81.36,percent of total billed charges,90% of total billed charges,90.4,80,,72.32,percent of total billed charges,80% of total billed charges,101.7,90,,81.36,percent of total billed charges,90% of total billed charges,84.75,75,,67.8,percent of total billed charges,75% of total billed charges,14.7,122,,,fee schedule,122% of APC rate,32.77,29,,26.216,percent of total billed charges,29% of total billed charges,12.05,100,,,fee schedule,100% of CMS fee schedule,75.71,67,,60.568,percent of total billed charges,67% of total billed charges,17.92,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,90.4,80,,72.32,percent of total billed charges,80% of total billed charges,73.45,65,,58.76,percent of total billed charges,65% of total billed charges,40.31,35.67,,32.248,percent of total billed charges,35.67% of total billed charges,12.05,101.7,
MYCOPLASMA PNEUMONIAE AB,3006260,CDM,300,RC,86738,HCPCS,outpatient,,,109,43.60,,92.65,85,,74.12,percent of total billed charges,85% of total billed charges,83.93,77,,67.14,percent of total billed charges,77% of total billed charges,13.24,100,,,fee schedule,100% of CMS fee schedule,57.19,350,,,fee schedule,350% of BCBS fee schedule,59.48,364,,,fee schedule,364% of BCBS fee schedule,59.48,364,,,fee schedule,364% of BCBS fee schedule,59.48,364,,,fee schedule,364% of BCBS fee schedule,98.1,90,,78.48,percent of total billed charges,90% of total billed charges,87.2,80,,69.76,percent of total billed charges,80% of total billed charges,98.1,90,,78.48,percent of total billed charges,90% of total billed charges,81.75,75,,65.4,percent of total billed charges,75% of total billed charges,16.15,122,,,fee schedule,122% of APC rate,31.61,29,,25.288,percent of total billed charges,29% of total billed charges,13.24,100,,,fee schedule,100% of CMS fee schedule,73.03,67,,58.424,percent of total billed charges,67% of total billed charges,19.69,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,87.2,80,,69.76,percent of total billed charges,80% of total billed charges,70.85,65,,56.68,percent of total billed charges,65% of total billed charges,38.88,35.67,,31.104,percent of total billed charges,35.67% of total billed charges,13.24,98.1,
MYOGLOBIN,3006280,CDM,300,RC,83874,HCPCS,outpatient,,,168,67.20,,142.8,85,,114.24,percent of total billed charges,85% of total billed charges,129.36,77,,103.49,percent of total billed charges,77% of total billed charges,12.92,100,,,fee schedule,100% of CMS fee schedule,55.83,350,,,fee schedule,350% of BCBS fee schedule,58.06,364,,,fee schedule,364% of BCBS fee schedule,58.06,364,,,fee schedule,364% of BCBS fee schedule,58.06,364,,,fee schedule,364% of BCBS fee schedule,151.2,90,,120.96,percent of total billed charges,90% of total billed charges,134.4,80,,107.52,percent of total billed charges,80% of total billed charges,151.2,90,,120.96,percent of total billed charges,90% of total billed charges,126,75,,100.8,percent of total billed charges,75% of total billed charges,15.76,122,,,fee schedule,122% of APC rate,48.72,29,,38.976,percent of total billed charges,29% of total billed charges,12.92,100,,,fee schedule,100% of CMS fee schedule,112.56,67,,90.048,percent of total billed charges,67% of total billed charges,17.71,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,134.4,80,,107.52,percent of total billed charges,80% of total billed charges,109.2,65,,87.36,percent of total billed charges,65% of total billed charges,59.93,35.67,,47.944,percent of total billed charges,35.67% of total billed charges,12.92,151.2,
MYOGLOBIN URINE,3006281,CDM,300,RC,83874,HCPCS,outpatient,,,85,34.00,,72.25,85,,57.8,percent of total billed charges,85% of total billed charges,65.45,77,,52.36,percent of total billed charges,77% of total billed charges,12.92,100,,,fee schedule,100% of CMS fee schedule,55.83,350,,,fee schedule,350% of BCBS fee schedule,58.06,364,,,fee schedule,364% of BCBS fee schedule,58.06,364,,,fee schedule,364% of BCBS fee schedule,58.06,364,,,fee schedule,364% of BCBS fee schedule,76.5,90,,61.2,percent of total billed charges,90% of total billed charges,68,80,,54.4,percent of total billed charges,80% of total billed charges,76.5,90,,61.2,percent of total billed charges,90% of total billed charges,63.75,75,,51,percent of total billed charges,75% of total billed charges,15.76,122,,,fee schedule,122% of APC rate,24.65,29,,19.72,percent of total billed charges,29% of total billed charges,12.92,100,,,fee schedule,100% of CMS fee schedule,56.95,67,,45.56,percent of total billed charges,67% of total billed charges,17.71,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,68,80,,54.4,percent of total billed charges,80% of total billed charges,55.25,65,,44.2,percent of total billed charges,65% of total billed charges,30.32,35.67,,24.256,percent of total billed charges,35.67% of total billed charges,12.92,76.5,
NAPA & PROCAINAMIDE,3006300,CDM,300,RC,80192,HCPCS,outpatient,,,130,52.00,,110.5,85,,88.4,percent of total billed charges,85% of total billed charges,100.1,77,,80.08,percent of total billed charges,77% of total billed charges,16.75,100,,,fee schedule,100% of CMS fee schedule,72.38,350,,,fee schedule,350% of BCBS fee schedule,75.28,364,,,fee schedule,364% of BCBS fee schedule,75.28,364,,,fee schedule,364% of BCBS fee schedule,75.28,364,,,fee schedule,364% of BCBS fee schedule,117,90,,93.6,percent of total billed charges,90% of total billed charges,104,80,,83.2,percent of total billed charges,80% of total billed charges,117,90,,93.6,percent of total billed charges,90% of total billed charges,97.5,75,,78,percent of total billed charges,75% of total billed charges,20.43,122,,,fee schedule,122% of APC rate,37.7,29,,30.16,percent of total billed charges,29% of total billed charges,16.75,100,,,fee schedule,100% of CMS fee schedule,87.1,67,,69.68,percent of total billed charges,67% of total billed charges,24.9,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,104,80,,83.2,percent of total billed charges,80% of total billed charges,84.5,65,,67.6,percent of total billed charges,65% of total billed charges,46.37,35.67,,37.096,percent of total billed charges,35.67% of total billed charges,16.75,117,
N- TELOPEPTIDES WITH CREAT,3006302,CDM,300,RC,82523,HCPCS,outpatient,,,85,34.00,,72.25,85,,57.8,percent of total billed charges,85% of total billed charges,65.45,77,,52.36,percent of total billed charges,77% of total billed charges,18.68,100,,,fee schedule,100% of CMS fee schedule,80.75,350,,,fee schedule,350% of BCBS fee schedule,83.97,364,,,fee schedule,364% of BCBS fee schedule,83.97,364,,,fee schedule,364% of BCBS fee schedule,83.97,364,,,fee schedule,364% of BCBS fee schedule,76.5,90,,61.2,percent of total billed charges,90% of total billed charges,68,80,,54.4,percent of total billed charges,80% of total billed charges,76.5,90,,61.2,percent of total billed charges,90% of total billed charges,63.75,75,,51,percent of total billed charges,75% of total billed charges,22.78,122,,,fee schedule,122% of APC rate,24.65,29,,19.72,percent of total billed charges,29% of total billed charges,18.68,100,,,fee schedule,100% of CMS fee schedule,56.95,67,,45.56,percent of total billed charges,67% of total billed charges,27.8,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,68,80,,54.4,percent of total billed charges,80% of total billed charges,55.25,65,,44.2,percent of total billed charges,65% of total billed charges,30.32,35.67,,24.256,percent of total billed charges,35.67% of total billed charges,18.68,83.97,
NEURONTIN LEVEL - THERAPEUTIC,3006305,CDM,300,RC,80171,HCPCS,outpatient,,,167,66.80,,141.95,85,,113.56,percent of total billed charges,85% of total billed charges,128.59,77,,102.87,percent of total billed charges,77% of total billed charges,21.67,100,,,fee schedule,100% of CMS fee schedule,75.85,350,,,fee schedule,350% of BCBS fee schedule,78.88,364,,,fee schedule,364% of BCBS fee schedule,78.88,364,,,fee schedule,364% of BCBS fee schedule,78.88,364,,,fee schedule,364% of BCBS fee schedule,150.3,90,,120.24,percent of total billed charges,90% of total billed charges,133.6,80,,106.88,percent of total billed charges,80% of total billed charges,150.3,90,,120.24,percent of total billed charges,90% of total billed charges,125.25,75,,100.2,percent of total billed charges,75% of total billed charges,26.43,122,,,fee schedule,122% of APC rate,48.43,29,,38.744,percent of total billed charges,29% of total billed charges,21.67,100,,,fee schedule,100% of CMS fee schedule,111.89,67,,89.512,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,133.6,80,,106.88,percent of total billed charges,80% of total billed charges,108.55,65,,86.84,percent of total billed charges,65% of total billed charges,59.57,35.67,,47.656,percent of total billed charges,35.67% of total billed charges,21.67,150.3,
NEPHELOMETRY EACH ANALYTE EXP,3006306,CDM,300,RC,83883,HCPCS,outpatient,,,76,30.40,,64.6,85,,51.68,percent of total billed charges,85% of total billed charges,58.52,77,,46.82,percent of total billed charges,77% of total billed charges,13.6,100,,,fee schedule,100% of CMS fee schedule,58.77,350,,,fee schedule,350% of BCBS fee schedule,61.12,364,,,fee schedule,364% of BCBS fee schedule,61.12,364,,,fee schedule,364% of BCBS fee schedule,61.12,364,,,fee schedule,364% of BCBS fee schedule,68.4,90,,54.72,percent of total billed charges,90% of total billed charges,60.8,80,,48.64,percent of total billed charges,80% of total billed charges,68.4,90,,54.72,percent of total billed charges,90% of total billed charges,57,75,,45.6,percent of total billed charges,75% of total billed charges,16.59,122,,,fee schedule,122% of APC rate,22.04,29,,17.632,percent of total billed charges,29% of total billed charges,13.6,100,,,fee schedule,100% of CMS fee schedule,50.92,67,,40.736,percent of total billed charges,67% of total billed charges,20.21,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,60.8,80,,48.64,percent of total billed charges,80% of total billed charges,49.4,65,,39.52,percent of total billed charges,65% of total billed charges,27.11,35.67,,21.688,percent of total billed charges,35.67% of total billed charges,13.6,68.4,
NICOTINE,3006310,CDM,300,RC,80323,HCPCS,outpatient,,,446,178.40,,379.1,85,,303.28,percent of total billed charges,85% of total billed charges,343.42,77,,274.74,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,365.72,82,,292.576,percent of total billed charges,82% of total billed charges,379.1,85,,303.28,percent of total billed charges,85% of total billed charges,379.1,85,,303.28,percent of total billed charges,85% of total billed charges,379.1,85,,303.28,percent of total billed charges,85% of total billed charges,401.4,90,,321.12,percent of total billed charges,90% of total billed charges,356.8,80,,285.44,percent of total billed charges,80% of total billed charges,401.4,90,,321.12,percent of total billed charges,90% of total billed charges,334.5,75,,267.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,129.34,29,,103.472,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,298.82,67,,239.056,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,356.8,80,,285.44,percent of total billed charges,80% of total billed charges,289.9,65,,231.92,percent of total billed charges,65% of total billed charges,159.09,35.67,,127.272,percent of total billed charges,35.67% of total billed charges,129.34,401.4,
NOCARDIA IgG SEROLOGY,3006315,CDM,300,RC,86744,HCPCS,outpatient,,,137,54.80,,116.45,85,,93.16,percent of total billed charges,85% of total billed charges,105.49,77,,84.39,percent of total billed charges,77% of total billed charges,15.99,100,,,fee schedule,100% of CMS fee schedule,56.98,350,,,fee schedule,350% of BCBS fee schedule,59.26,364,,,fee schedule,364% of BCBS fee schedule,59.26,364,,,fee schedule,364% of BCBS fee schedule,59.26,364,,,fee schedule,364% of BCBS fee schedule,123.3,90,,98.64,percent of total billed charges,90% of total billed charges,109.6,80,,87.68,percent of total billed charges,80% of total billed charges,123.3,90,,98.64,percent of total billed charges,90% of total billed charges,102.75,75,,82.2,percent of total billed charges,75% of total billed charges,19.5,122,,,fee schedule,122% of APC rate,39.73,29,,31.784,percent of total billed charges,29% of total billed charges,15.99,100,,,fee schedule,100% of CMS fee schedule,91.79,67,,73.432,percent of total billed charges,67% of total billed charges,8.64,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,109.6,80,,87.68,percent of total billed charges,80% of total billed charges,89.05,65,,71.24,percent of total billed charges,65% of total billed charges,48.87,35.67,,39.096,percent of total billed charges,35.67% of total billed charges,8.64,123.3,
NORPACE,3006320,CDM,300,RC,80299,HCPCS,outpatient,,,147,58.80,,124.95,85,,99.96,percent of total billed charges,85% of total billed charges,113.19,77,,90.55,percent of total billed charges,77% of total billed charges,18.64,100,,,fee schedule,100% of CMS fee schedule,65.24,350,,,fee schedule,350% of BCBS fee schedule,67.85,364,,,fee schedule,364% of BCBS fee schedule,67.85,364,,,fee schedule,364% of BCBS fee schedule,67.85,364,,,fee schedule,364% of BCBS fee schedule,132.3,90,,105.84,percent of total billed charges,90% of total billed charges,117.6,80,,94.08,percent of total billed charges,80% of total billed charges,132.3,90,,105.84,percent of total billed charges,90% of total billed charges,110.25,75,,88.2,percent of total billed charges,75% of total billed charges,22.74,122,,,fee schedule,122% of APC rate,42.63,29,,34.104,percent of total billed charges,29% of total billed charges,18.64,100,,,fee schedule,100% of CMS fee schedule,98.49,67,,78.792,percent of total billed charges,67% of total billed charges,20.36,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,117.6,80,,94.08,percent of total billed charges,80% of total billed charges,95.55,65,,76.44,percent of total billed charges,65% of total billed charges,52.43,35.67,,41.944,percent of total billed charges,35.67% of total billed charges,18.64,132.3,
NORTRIPTYLINE (AVENTYL),3006340,CDM,300,RC,80335,HCPCS,outpatient,,,446,178.40,,379.1,85,,303.28,percent of total billed charges,85% of total billed charges,343.42,77,,274.74,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,365.72,82,,292.576,percent of total billed charges,82% of total billed charges,379.1,85,,303.28,percent of total billed charges,85% of total billed charges,379.1,85,,303.28,percent of total billed charges,85% of total billed charges,379.1,85,,303.28,percent of total billed charges,85% of total billed charges,401.4,90,,321.12,percent of total billed charges,90% of total billed charges,356.8,80,,285.44,percent of total billed charges,80% of total billed charges,401.4,90,,321.12,percent of total billed charges,90% of total billed charges,334.5,75,,267.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,129.34,29,,103.472,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,298.82,67,,239.056,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,356.8,80,,285.44,percent of total billed charges,80% of total billed charges,289.9,65,,231.92,percent of total billed charges,65% of total billed charges,159.09,35.67,,127.272,percent of total billed charges,35.67% of total billed charges,129.34,401.4,
NORWALK VIRUS,3006341,CDM,300,RC,87449,HCPCS,outpatient,,,332,132.80,,282.2,85,,225.76,percent of total billed charges,85% of total billed charges,255.64,77,,204.51,percent of total billed charges,77% of total billed charges,11.98,100,,,fee schedule,100% of CMS fee schedule,51.8,350,,,fee schedule,350% of BCBS fee schedule,53.87,364,,,fee schedule,364% of BCBS fee schedule,53.87,364,,,fee schedule,364% of BCBS fee schedule,53.87,364,,,fee schedule,364% of BCBS fee schedule,298.8,90,,239.04,percent of total billed charges,90% of total billed charges,265.6,80,,212.48,percent of total billed charges,80% of total billed charges,298.8,90,,239.04,percent of total billed charges,90% of total billed charges,249,75,,199.2,percent of total billed charges,75% of total billed charges,14.61,122,,,fee schedule,122% of APC rate,96.28,29,,77.024,percent of total billed charges,29% of total billed charges,11.98,100,,,fee schedule,100% of CMS fee schedule,222.44,67,,177.952,percent of total billed charges,67% of total billed charges,15.41,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,265.6,80,,212.48,percent of total billed charges,80% of total billed charges,215.8,65,,172.64,percent of total billed charges,65% of total billed charges,118.42,35.67,,94.736,percent of total billed charges,35.67% of total billed charges,11.98,298.8,
OB PANEL,3006346,CDM,300,RC,80055,HCPCS,outpatient,,,753,301.20,,640.05,85,,512.04,percent of total billed charges,85% of total billed charges,579.81,77,,463.85,percent of total billed charges,77% of total billed charges,47.81,100,,,fee schedule,100% of CMS fee schedule,206.57,350,,,fee schedule,350% of BCBS fee schedule,214.83,364,,,fee schedule,364% of BCBS fee schedule,214.83,364,,,fee schedule,364% of BCBS fee schedule,214.83,364,,,fee schedule,364% of BCBS fee schedule,677.7,90,,542.16,percent of total billed charges,90% of total billed charges,602.4,80,,481.92,percent of total billed charges,80% of total billed charges,677.7,90,,542.16,percent of total billed charges,90% of total billed charges,564.75,75,,451.8,percent of total billed charges,75% of total billed charges,58.32,122,,,fee schedule,122% of APC rate,218.37,29,,174.696,percent of total billed charges,29% of total billed charges,47.81,100,,,fee schedule,100% of CMS fee schedule,504.51,67,,403.608,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,602.4,80,,481.92,percent of total billed charges,80% of total billed charges,489.45,65,,391.56,percent of total billed charges,65% of total billed charges,268.6,35.67,,214.88,percent of total billed charges,35.67% of total billed charges,47.81,677.7,
FUNGITELL,3006348,CDM,300,RC,87449,HCPCS,outpatient,,,40,16.00,,34,85,,27.2,percent of total billed charges,85% of total billed charges,30.8,77,,24.64,percent of total billed charges,77% of total billed charges,11.98,100,,,fee schedule,100% of CMS fee schedule,51.8,350,,,fee schedule,350% of BCBS fee schedule,53.87,364,,,fee schedule,364% of BCBS fee schedule,53.87,364,,,fee schedule,364% of BCBS fee schedule,53.87,364,,,fee schedule,364% of BCBS fee schedule,36,90,,28.8,percent of total billed charges,90% of total billed charges,32,80,,25.6,percent of total billed charges,80% of total billed charges,36,90,,28.8,percent of total billed charges,90% of total billed charges,30,75,,24,percent of total billed charges,75% of total billed charges,14.61,122,,,fee schedule,122% of APC rate,11.6,29,,9.28,percent of total billed charges,29% of total billed charges,11.98,100,,,fee schedule,100% of CMS fee schedule,26.8,67,,21.44,percent of total billed charges,67% of total billed charges,15.41,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,32,80,,25.6,percent of total billed charges,80% of total billed charges,26,65,,20.8,percent of total billed charges,65% of total billed charges,14.27,35.67,,11.416,percent of total billed charges,35.67% of total billed charges,11.6,53.87,
OCCULT BLOOD URINE,3006350,CDM,300,RC,82271,HCPCS,outpatient,,,19,7.60,,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,14.63,77,,11.7,percent of total billed charges,77% of total billed charges,5.32,100,,,fee schedule,100% of CMS fee schedule,18.62,350,,,fee schedule,350% of BCBS fee schedule,19.36,364,,,fee schedule,364% of BCBS fee schedule,19.36,364,,,fee schedule,364% of BCBS fee schedule,19.36,364,,,fee schedule,364% of BCBS fee schedule,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,15.2,80,,12.16,percent of total billed charges,80% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,14.25,75,,11.4,percent of total billed charges,75% of total billed charges,6.49,122,,,fee schedule,122% of APC rate,5.51,29,,4.408,percent of total billed charges,29% of total billed charges,5.32,100,,,fee schedule,100% of CMS fee schedule,12.73,67,,10.184,percent of total billed charges,67% of total billed charges,4.84,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,15.2,80,,12.16,percent of total billed charges,80% of total billed charges,12.35,65,,9.88,percent of total billed charges,65% of total billed charges,6.78,35.67,,5.424,percent of total billed charges,35.67% of total billed charges,4.84,19.36,
OB PANEL WITH HIV,3006352,CDM,300,RC,80081,HCPCS,outpatient,,,853,341.20,,725.05,85,,580.04,percent of total billed charges,85% of total billed charges,656.81,77,,525.45,percent of total billed charges,77% of total billed charges,74.86,100,,,fee schedule,100% of CMS fee schedule,323.47,350,,,fee schedule,350% of BCBS fee schedule,336.41,364,,,fee schedule,364% of BCBS fee schedule,336.41,364,,,fee schedule,364% of BCBS fee schedule,336.41,364,,,fee schedule,364% of BCBS fee schedule,767.7,90,,614.16,percent of total billed charges,90% of total billed charges,682.4,80,,545.92,percent of total billed charges,80% of total billed charges,767.7,90,,614.16,percent of total billed charges,90% of total billed charges,639.75,75,,511.8,percent of total billed charges,75% of total billed charges,91.32,122,,,fee schedule,122% of APC rate,247.37,29,,197.896,percent of total billed charges,29% of total billed charges,74.86,100,,,fee schedule,100% of CMS fee schedule,571.51,67,,457.208,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,682.4,80,,545.92,percent of total billed charges,80% of total billed charges,554.45,65,,443.56,percent of total billed charges,65% of total billed charges,304.27,35.67,,243.416,percent of total billed charges,35.67% of total billed charges,74.86,767.7,
OLIGOCLONAL BANDS,3006355,CDM,300,RC,83916,HCPCS,outpatient,,,109,43.60,,92.65,85,,74.12,percent of total billed charges,85% of total billed charges,83.93,77,,67.14,percent of total billed charges,77% of total billed charges,27.39,100,,,fee schedule,100% of CMS fee schedule,95.87,350,,,fee schedule,350% of BCBS fee schedule,99.7,364,,,fee schedule,364% of BCBS fee schedule,99.7,364,,,fee schedule,364% of BCBS fee schedule,99.7,364,,,fee schedule,364% of BCBS fee schedule,98.1,90,,78.48,percent of total billed charges,90% of total billed charges,87.2,80,,69.76,percent of total billed charges,80% of total billed charges,98.1,90,,78.48,percent of total billed charges,90% of total billed charges,81.75,75,,65.4,percent of total billed charges,75% of total billed charges,33.41,122,,,fee schedule,122% of APC rate,31.61,29,,25.288,percent of total billed charges,29% of total billed charges,27.39,100,,,fee schedule,100% of CMS fee schedule,73.03,67,,58.424,percent of total billed charges,67% of total billed charges,29.9,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,87.2,80,,69.76,percent of total billed charges,80% of total billed charges,70.85,65,,56.68,percent of total billed charges,65% of total billed charges,38.88,35.67,,31.104,percent of total billed charges,35.67% of total billed charges,27.39,99.7,
OLIGOCLONAL IMMUNOGLOB  EXP,3006358,CDM,300,RC,83916,HCPCS,outpatient,,,233,93.20,,198.05,85,,158.44,percent of total billed charges,85% of total billed charges,179.41,77,,143.53,percent of total billed charges,77% of total billed charges,27.39,100,,,fee schedule,100% of CMS fee schedule,95.87,350,,,fee schedule,350% of BCBS fee schedule,99.7,364,,,fee schedule,364% of BCBS fee schedule,99.7,364,,,fee schedule,364% of BCBS fee schedule,99.7,364,,,fee schedule,364% of BCBS fee schedule,209.7,90,,167.76,percent of total billed charges,90% of total billed charges,186.4,80,,149.12,percent of total billed charges,80% of total billed charges,209.7,90,,167.76,percent of total billed charges,90% of total billed charges,174.75,75,,139.8,percent of total billed charges,75% of total billed charges,33.41,122,,,fee schedule,122% of APC rate,67.57,29,,54.056,percent of total billed charges,29% of total billed charges,27.39,100,,,fee schedule,100% of CMS fee schedule,156.11,67,,124.888,percent of total billed charges,67% of total billed charges,29.9,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,186.4,80,,149.12,percent of total billed charges,80% of total billed charges,151.45,65,,121.16,percent of total billed charges,65% of total billed charges,83.11,35.67,,66.488,percent of total billed charges,35.67% of total billed charges,27.39,209.7,
ORGANIC ACIDS ANALY HGA URINE,3006359,CDM,300,RC,83919,HCPCS,outpatient,,,63,25.20,,53.55,85,,42.84,percent of total billed charges,85% of total billed charges,48.51,77,,38.81,percent of total billed charges,77% of total billed charges,16.45,100,,,fee schedule,100% of CMS fee schedule,71.09,350,,,fee schedule,350% of BCBS fee schedule,73.93,364,,,fee schedule,364% of BCBS fee schedule,73.93,364,,,fee schedule,364% of BCBS fee schedule,73.93,364,,,fee schedule,364% of BCBS fee schedule,56.7,90,,45.36,percent of total billed charges,90% of total billed charges,50.4,80,,40.32,percent of total billed charges,80% of total billed charges,56.7,90,,45.36,percent of total billed charges,90% of total billed charges,47.25,75,,37.8,percent of total billed charges,75% of total billed charges,20.06,122,,,fee schedule,122% of APC rate,18.27,29,,14.616,percent of total billed charges,29% of total billed charges,16.45,100,,,fee schedule,100% of CMS fee schedule,42.21,67,,33.768,percent of total billed charges,67% of total billed charges,24.47,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,50.4,80,,40.32,percent of total billed charges,80% of total billed charges,40.95,65,,32.76,percent of total billed charges,65% of total billed charges,22.47,35.67,,17.976,percent of total billed charges,35.67% of total billed charges,16.45,73.93,
OSMOLALITY SERUM,3006360,CDM,300,RC,83930,HCPCS,outpatient,,,63,25.20,,53.55,85,,42.84,percent of total billed charges,85% of total billed charges,48.51,77,,38.81,percent of total billed charges,77% of total billed charges,6.61,100,,,fee schedule,100% of CMS fee schedule,28.56,350,,,fee schedule,350% of BCBS fee schedule,29.7,364,,,fee schedule,364% of BCBS fee schedule,29.7,364,,,fee schedule,364% of BCBS fee schedule,29.7,364,,,fee schedule,364% of BCBS fee schedule,56.7,90,,45.36,percent of total billed charges,90% of total billed charges,50.4,80,,40.32,percent of total billed charges,80% of total billed charges,56.7,90,,45.36,percent of total billed charges,90% of total billed charges,47.25,75,,37.8,percent of total billed charges,75% of total billed charges,8.06,122,,,fee schedule,122% of APC rate,18.27,29,,14.616,percent of total billed charges,29% of total billed charges,6.61,100,,,fee schedule,100% of CMS fee schedule,42.21,67,,33.768,percent of total billed charges,67% of total billed charges,9.82,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,50.4,80,,40.32,percent of total billed charges,80% of total billed charges,40.95,65,,32.76,percent of total billed charges,65% of total billed charges,22.47,35.67,,17.976,percent of total billed charges,35.67% of total billed charges,6.61,56.7,
OSMOLALITY URINE,3006380,CDM,300,RC,83935,HCPCS,outpatient,,,63,25.20,,53.55,85,,42.84,percent of total billed charges,85% of total billed charges,48.51,77,,38.81,percent of total billed charges,77% of total billed charges,6.82,100,,,fee schedule,100% of CMS fee schedule,29.47,350,,,fee schedule,350% of BCBS fee schedule,30.65,364,,,fee schedule,364% of BCBS fee schedule,30.65,364,,,fee schedule,364% of BCBS fee schedule,30.65,364,,,fee schedule,364% of BCBS fee schedule,56.7,90,,45.36,percent of total billed charges,90% of total billed charges,50.4,80,,40.32,percent of total billed charges,80% of total billed charges,56.7,90,,45.36,percent of total billed charges,90% of total billed charges,47.25,75,,37.8,percent of total billed charges,75% of total billed charges,8.32,122,,,fee schedule,122% of APC rate,18.27,29,,14.616,percent of total billed charges,29% of total billed charges,6.82,100,,,fee schedule,100% of CMS fee schedule,42.21,67,,33.768,percent of total billed charges,67% of total billed charges,10.13,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,50.4,80,,40.32,percent of total billed charges,80% of total billed charges,40.95,65,,32.76,percent of total billed charges,65% of total billed charges,22.47,35.67,,17.976,percent of total billed charges,35.67% of total billed charges,6.82,56.7,
OXIHEMOGLOBIN,3006390,CDM,300,RC,82805,HCPCS,outpatient,,,311,124.40,,264.35,85,,211.48,percent of total billed charges,85% of total billed charges,239.47,77,,191.58,percent of total billed charges,77% of total billed charges,78.77,100,,,fee schedule,100% of CMS fee schedule,275.7,350,,,fee schedule,350% of BCBS fee schedule,286.72,364,,,fee schedule,364% of BCBS fee schedule,286.72,364,,,fee schedule,364% of BCBS fee schedule,286.72,364,,,fee schedule,364% of BCBS fee schedule,279.9,90,,223.92,percent of total billed charges,90% of total billed charges,248.8,80,,199.04,percent of total billed charges,80% of total billed charges,279.9,90,,223.92,percent of total billed charges,90% of total billed charges,233.25,75,,186.6,percent of total billed charges,75% of total billed charges,96.09,122,,,fee schedule,122% of APC rate,90.19,29,,72.152,percent of total billed charges,29% of total billed charges,78.77,100,,,fee schedule,100% of CMS fee schedule,208.37,67,,166.696,percent of total billed charges,67% of total billed charges,42.21,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,248.8,80,,199.04,percent of total billed charges,80% of total billed charges,202.15,65,,161.72,percent of total billed charges,65% of total billed charges,110.93,35.67,,88.744,percent of total billed charges,35.67% of total billed charges,42.21,286.72,
OVA AND PARASITE EXAM,3006400,CDM,300,RC,87177,HCPCS,outpatient,,,50,20.00,,42.5,85,,34,percent of total billed charges,85% of total billed charges,38.5,77,,30.8,percent of total billed charges,77% of total billed charges,8.9,100,,,fee schedule,100% of CMS fee schedule,38.47,350,,,fee schedule,350% of BCBS fee schedule,40,364,,,fee schedule,364% of BCBS fee schedule,40,364,,,fee schedule,364% of BCBS fee schedule,40,364,,,fee schedule,364% of BCBS fee schedule,45,90,,36,percent of total billed charges,90% of total billed charges,40,80,,32,percent of total billed charges,80% of total billed charges,45,90,,36,percent of total billed charges,90% of total billed charges,37.5,75,,30,percent of total billed charges,75% of total billed charges,10.85,122,,,fee schedule,122% of APC rate,14.5,29,,11.6,percent of total billed charges,29% of total billed charges,8.9,100,,,fee schedule,100% of CMS fee schedule,33.5,67,,26.8,percent of total billed charges,67% of total billed charges,13.23,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,40,80,,32,percent of total billed charges,80% of total billed charges,32.5,65,,26,percent of total billed charges,65% of total billed charges,17.84,35.67,,14.272,percent of total billed charges,35.67% of total billed charges,8.9,45,
PANCREATIC ANTIGEN,3006420,CDM,300,RC,86256,HCPCS,outpatient,,,113,45.20,,96.05,85,,76.84,percent of total billed charges,85% of total billed charges,87.01,77,,69.61,percent of total billed charges,77% of total billed charges,12.05,100,,,fee schedule,100% of CMS fee schedule,52.08,350,,,fee schedule,350% of BCBS fee schedule,54.16,364,,,fee schedule,364% of BCBS fee schedule,54.16,364,,,fee schedule,364% of BCBS fee schedule,54.16,364,,,fee schedule,364% of BCBS fee schedule,101.7,90,,81.36,percent of total billed charges,90% of total billed charges,90.4,80,,72.32,percent of total billed charges,80% of total billed charges,101.7,90,,81.36,percent of total billed charges,90% of total billed charges,84.75,75,,67.8,percent of total billed charges,75% of total billed charges,14.7,122,,,fee schedule,122% of APC rate,32.77,29,,26.216,percent of total billed charges,29% of total billed charges,12.05,100,,,fee schedule,100% of CMS fee schedule,75.71,67,,60.568,percent of total billed charges,67% of total billed charges,17.92,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,90.4,80,,72.32,percent of total billed charges,80% of total billed charges,73.45,65,,58.76,percent of total billed charges,65% of total billed charges,40.31,35.67,,32.248,percent of total billed charges,35.67% of total billed charges,12.05,101.7,
PARA-AMINOBENZOIC ACID URINE,3006460,CDM,300,RC,82139,HCPCS,outpatient,,,89,35.60,,75.65,85,,60.52,percent of total billed charges,85% of total billed charges,68.53,77,,54.82,percent of total billed charges,77% of total billed charges,16.87,100,,,fee schedule,100% of CMS fee schedule,72.91,350,,,fee schedule,350% of BCBS fee schedule,75.82,364,,,fee schedule,364% of BCBS fee schedule,75.82,364,,,fee schedule,364% of BCBS fee schedule,75.82,364,,,fee schedule,364% of BCBS fee schedule,80.1,90,,64.08,percent of total billed charges,90% of total billed charges,71.2,80,,56.96,percent of total billed charges,80% of total billed charges,80.1,90,,64.08,percent of total billed charges,90% of total billed charges,66.75,75,,53.4,percent of total billed charges,75% of total billed charges,20.58,122,,,fee schedule,122% of APC rate,25.81,29,,20.648,percent of total billed charges,29% of total billed charges,16.87,100,,,fee schedule,100% of CMS fee schedule,59.63,67,,47.704,percent of total billed charges,67% of total billed charges,21.43,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,71.2,80,,56.96,percent of total billed charges,80% of total billed charges,57.85,65,,46.28,percent of total billed charges,65% of total billed charges,31.75,35.67,,25.4,percent of total billed charges,35.67% of total billed charges,16.87,80.1,
PARAINFLUENZA VIRUS TYPE-SWAB,3006471,CDM,300,RC,87207,HCPCS,outpatient,,,87,34.80,,73.95,85,,59.16,percent of total billed charges,85% of total billed charges,66.99,77,,53.59,percent of total billed charges,77% of total billed charges,5.99,100,,,fee schedule,100% of CMS fee schedule,25.9,350,,,fee schedule,350% of BCBS fee schedule,26.94,364,,,fee schedule,364% of BCBS fee schedule,26.94,364,,,fee schedule,364% of BCBS fee schedule,26.94,364,,,fee schedule,364% of BCBS fee schedule,78.3,90,,62.64,percent of total billed charges,90% of total billed charges,69.6,80,,55.68,percent of total billed charges,80% of total billed charges,78.3,90,,62.64,percent of total billed charges,90% of total billed charges,65.25,75,,52.2,percent of total billed charges,75% of total billed charges,7.3,122,,,fee schedule,122% of APC rate,25.23,29,,20.184,percent of total billed charges,29% of total billed charges,5.99,100,,,fee schedule,100% of CMS fee schedule,58.29,67,,46.632,percent of total billed charges,67% of total billed charges,8.91,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,69.6,80,,55.68,percent of total billed charges,80% of total billed charges,56.55,65,,45.24,percent of total billed charges,65% of total billed charges,31.03,35.67,,24.824,percent of total billed charges,35.67% of total billed charges,5.99,78.3,
PARAINFLUENZA STAIN I EXP,3006472,CDM,300,RC,87207,HCPCS,outpatient,,,87,34.80,,73.95,85,,59.16,percent of total billed charges,85% of total billed charges,66.99,77,,53.59,percent of total billed charges,77% of total billed charges,5.99,100,,,fee schedule,100% of CMS fee schedule,25.9,350,,,fee schedule,350% of BCBS fee schedule,26.94,364,,,fee schedule,364% of BCBS fee schedule,26.94,364,,,fee schedule,364% of BCBS fee schedule,26.94,364,,,fee schedule,364% of BCBS fee schedule,78.3,90,,62.64,percent of total billed charges,90% of total billed charges,69.6,80,,55.68,percent of total billed charges,80% of total billed charges,78.3,90,,62.64,percent of total billed charges,90% of total billed charges,65.25,75,,52.2,percent of total billed charges,75% of total billed charges,7.3,122,,,fee schedule,122% of APC rate,25.23,29,,20.184,percent of total billed charges,29% of total billed charges,5.99,100,,,fee schedule,100% of CMS fee schedule,58.29,67,,46.632,percent of total billed charges,67% of total billed charges,8.91,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,69.6,80,,55.68,percent of total billed charges,80% of total billed charges,56.55,65,,45.24,percent of total billed charges,65% of total billed charges,31.03,35.67,,24.824,percent of total billed charges,35.67% of total billed charges,5.99,78.3,
PARAINFLUENZA STAIN II,3006473,CDM,300,RC,87207,HCPCS,outpatient,,,87,34.80,,73.95,85,,59.16,percent of total billed charges,85% of total billed charges,66.99,77,,53.59,percent of total billed charges,77% of total billed charges,5.99,100,,,fee schedule,100% of CMS fee schedule,25.9,350,,,fee schedule,350% of BCBS fee schedule,26.94,364,,,fee schedule,364% of BCBS fee schedule,26.94,364,,,fee schedule,364% of BCBS fee schedule,26.94,364,,,fee schedule,364% of BCBS fee schedule,78.3,90,,62.64,percent of total billed charges,90% of total billed charges,69.6,80,,55.68,percent of total billed charges,80% of total billed charges,78.3,90,,62.64,percent of total billed charges,90% of total billed charges,65.25,75,,52.2,percent of total billed charges,75% of total billed charges,7.3,122,,,fee schedule,122% of APC rate,25.23,29,,20.184,percent of total billed charges,29% of total billed charges,5.99,100,,,fee schedule,100% of CMS fee schedule,58.29,67,,46.632,percent of total billed charges,67% of total billed charges,8.91,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,69.6,80,,55.68,percent of total billed charges,80% of total billed charges,56.55,65,,45.24,percent of total billed charges,65% of total billed charges,31.03,35.67,,24.824,percent of total billed charges,35.67% of total billed charges,5.99,78.3,
PARAINFLUENZA STAIN III EXP,3006474,CDM,300,RC,87207,HCPCS,outpatient,,,87,34.80,,73.95,85,,59.16,percent of total billed charges,85% of total billed charges,66.99,77,,53.59,percent of total billed charges,77% of total billed charges,5.99,100,,,fee schedule,100% of CMS fee schedule,25.9,350,,,fee schedule,350% of BCBS fee schedule,26.94,364,,,fee schedule,364% of BCBS fee schedule,26.94,364,,,fee schedule,364% of BCBS fee schedule,26.94,364,,,fee schedule,364% of BCBS fee schedule,78.3,90,,62.64,percent of total billed charges,90% of total billed charges,69.6,80,,55.68,percent of total billed charges,80% of total billed charges,78.3,90,,62.64,percent of total billed charges,90% of total billed charges,65.25,75,,52.2,percent of total billed charges,75% of total billed charges,7.3,122,,,fee schedule,122% of APC rate,25.23,29,,20.184,percent of total billed charges,29% of total billed charges,5.99,100,,,fee schedule,100% of CMS fee schedule,58.29,67,,46.632,percent of total billed charges,67% of total billed charges,8.91,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,69.6,80,,55.68,percent of total billed charges,80% of total billed charges,56.55,65,,45.24,percent of total billed charges,65% of total billed charges,31.03,35.67,,24.824,percent of total billed charges,35.67% of total billed charges,5.99,78.3,
"S. PNEUMONIAE AG, URINE",3006475,CDM,300,RC,87899,HCPCS,outpatient,,,60,24.00,,51,85,,40.8,percent of total billed charges,85% of total billed charges,46.2,77,,36.96,percent of total billed charges,77% of total billed charges,16.07,100,,,fee schedule,100% of CMS fee schedule,56.25,350,,,fee schedule,350% of BCBS fee schedule,58.49,364,,,fee schedule,364% of BCBS fee schedule,58.49,364,,,fee schedule,364% of BCBS fee schedule,58.49,364,,,fee schedule,364% of BCBS fee schedule,54,90,,43.2,percent of total billed charges,90% of total billed charges,48,80,,38.4,percent of total billed charges,80% of total billed charges,54,90,,43.2,percent of total billed charges,90% of total billed charges,45,75,,36,percent of total billed charges,75% of total billed charges,19.6,122,,,fee schedule,122% of APC rate,17.4,29,,13.92,percent of total billed charges,29% of total billed charges,16.07,100,,,fee schedule,100% of CMS fee schedule,40.2,67,,32.16,percent of total billed charges,67% of total billed charges,15.41,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,48,80,,38.4,percent of total billed charges,80% of total billed charges,39,65,,31.2,percent of total billed charges,65% of total billed charges,21.4,35.67,,17.12,percent of total billed charges,35.67% of total billed charges,15.41,58.49,
PH URINE,3006480,CDM,300,RC,83986,HCPCS,outpatient,,,50,20.00,,42.5,85,,34,percent of total billed charges,85% of total billed charges,38.5,77,,30.8,percent of total billed charges,77% of total billed charges,3.58,100,,,fee schedule,100% of CMS fee schedule,15.47,350,,,fee schedule,350% of BCBS fee schedule,16.09,364,,,fee schedule,364% of BCBS fee schedule,16.09,364,,,fee schedule,364% of BCBS fee schedule,16.09,364,,,fee schedule,364% of BCBS fee schedule,45,90,,36,percent of total billed charges,90% of total billed charges,40,80,,32,percent of total billed charges,80% of total billed charges,45,90,,36,percent of total billed charges,90% of total billed charges,37.5,75,,30,percent of total billed charges,75% of total billed charges,4.36,122,,,fee schedule,122% of APC rate,14.5,29,,11.6,percent of total billed charges,29% of total billed charges,3.58,100,,,fee schedule,100% of CMS fee schedule,33.5,67,,26.8,percent of total billed charges,67% of total billed charges,4.97,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,40,80,,32,percent of total billed charges,80% of total billed charges,32.5,65,,26,percent of total billed charges,65% of total billed charges,17.84,35.67,,14.272,percent of total billed charges,35.67% of total billed charges,3.58,45,
PHENOBARBITOL,3006500,CDM,300,RC,80184,HCPCS,outpatient,,,65,26.00,,55.25,85,,44.2,percent of total billed charges,85% of total billed charges,50.05,77,,40.04,percent of total billed charges,77% of total billed charges,15.3,100,,,fee schedule,100% of CMS fee schedule,53.55,350,,,fee schedule,350% of BCBS fee schedule,55.69,364,,,fee schedule,364% of BCBS fee schedule,55.69,364,,,fee schedule,364% of BCBS fee schedule,55.69,364,,,fee schedule,364% of BCBS fee schedule,58.5,90,,46.8,percent of total billed charges,90% of total billed charges,52,80,,41.6,percent of total billed charges,80% of total billed charges,58.5,90,,46.8,percent of total billed charges,90% of total billed charges,48.75,75,,39,percent of total billed charges,75% of total billed charges,18.66,122,,,fee schedule,122% of APC rate,18.85,29,,15.08,percent of total billed charges,29% of total billed charges,15.3,100,,,fee schedule,100% of CMS fee schedule,43.55,67,,34.84,percent of total billed charges,67% of total billed charges,17.03,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,52,80,,41.6,percent of total billed charges,80% of total billed charges,42.25,65,,33.8,percent of total billed charges,65% of total billed charges,23.19,35.67,,18.552,percent of total billed charges,35.67% of total billed charges,15.3,58.5,
PHENYTOIN (DILANTIN) TOTAL,3006560,CDM,300,RC,80185,HCPCS,outpatient,,,66,26.40,,56.1,85,,44.88,percent of total billed charges,85% of total billed charges,50.82,77,,40.66,percent of total billed charges,77% of total billed charges,13.25,100,,,fee schedule,100% of CMS fee schedule,57.26,350,,,fee schedule,350% of BCBS fee schedule,59.55,364,,,fee schedule,364% of BCBS fee schedule,59.55,364,,,fee schedule,364% of BCBS fee schedule,59.55,364,,,fee schedule,364% of BCBS fee schedule,59.4,90,,47.52,percent of total billed charges,90% of total billed charges,52.8,80,,42.24,percent of total billed charges,80% of total billed charges,59.4,90,,47.52,percent of total billed charges,90% of total billed charges,49.5,75,,39.6,percent of total billed charges,75% of total billed charges,16.16,122,,,fee schedule,122% of APC rate,19.14,29,,15.312,percent of total billed charges,29% of total billed charges,13.25,100,,,fee schedule,100% of CMS fee schedule,44.22,67,,35.376,percent of total billed charges,67% of total billed charges,19.7,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,52.8,80,,42.24,percent of total billed charges,80% of total billed charges,42.9,65,,34.32,percent of total billed charges,65% of total billed charges,23.54,35.67,,18.832,percent of total billed charges,35.67% of total billed charges,13.25,59.55,
PHOSPHORUS,3006600,CDM,300,RC,84100,HCPCS,outpatient,,,44,17.60,,37.4,85,,29.92,percent of total billed charges,85% of total billed charges,33.88,77,,27.1,percent of total billed charges,77% of total billed charges,4.74,100,,,fee schedule,100% of CMS fee schedule,20.48,350,,,fee schedule,350% of BCBS fee schedule,21.29,364,,,fee schedule,364% of BCBS fee schedule,21.29,364,,,fee schedule,364% of BCBS fee schedule,21.29,364,,,fee schedule,364% of BCBS fee schedule,39.6,90,,31.68,percent of total billed charges,90% of total billed charges,35.2,80,,28.16,percent of total billed charges,80% of total billed charges,39.6,90,,31.68,percent of total billed charges,90% of total billed charges,33,75,,26.4,percent of total billed charges,75% of total billed charges,5.78,122,,,fee schedule,122% of APC rate,12.76,29,,10.208,percent of total billed charges,29% of total billed charges,4.74,100,,,fee schedule,100% of CMS fee schedule,29.48,67,,23.584,percent of total billed charges,67% of total billed charges,7.05,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,35.2,80,,28.16,percent of total billed charges,80% of total billed charges,28.6,65,,22.88,percent of total billed charges,65% of total billed charges,15.69,35.67,,12.552,percent of total billed charges,35.67% of total billed charges,4.74,39.6,
PIN WORM TAPE,3006620,CDM,300,RC,87172,HCPCS,outpatient,,,29,11.60,,24.65,85,,19.72,percent of total billed charges,85% of total billed charges,22.33,77,,17.86,percent of total billed charges,77% of total billed charges,4.26,100,,,fee schedule,100% of CMS fee schedule,18.45,350,,,fee schedule,350% of BCBS fee schedule,19.18,364,,,fee schedule,364% of BCBS fee schedule,19.18,364,,,fee schedule,364% of BCBS fee schedule,19.18,364,,,fee schedule,364% of BCBS fee schedule,26.1,90,,20.88,percent of total billed charges,90% of total billed charges,23.2,80,,18.56,percent of total billed charges,80% of total billed charges,26.1,90,,20.88,percent of total billed charges,90% of total billed charges,21.75,75,,17.4,percent of total billed charges,75% of total billed charges,5.2,122,,,fee schedule,122% of APC rate,8.41,29,,6.728,percent of total billed charges,29% of total billed charges,4.26,100,,,fee schedule,100% of CMS fee schedule,19.43,67,,15.544,percent of total billed charges,67% of total billed charges,6.35,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,23.2,80,,18.56,percent of total billed charges,80% of total billed charges,18.85,65,,15.08,percent of total billed charges,65% of total billed charges,10.34,35.67,,8.272,percent of total billed charges,35.67% of total billed charges,4.26,26.1,
PLATELET COUNT,3006640,CDM,300,RC,85049,HCPCS,outpatient,,,32,12.80,,27.2,85,,21.76,percent of total billed charges,85% of total billed charges,24.64,77,,19.71,percent of total billed charges,77% of total billed charges,4.48,100,,,fee schedule,100% of CMS fee schedule,19.36,350,,,fee schedule,350% of BCBS fee schedule,20.13,364,,,fee schedule,364% of BCBS fee schedule,20.13,364,,,fee schedule,364% of BCBS fee schedule,20.13,364,,,fee schedule,364% of BCBS fee schedule,28.8,90,,23.04,percent of total billed charges,90% of total billed charges,25.6,80,,20.48,percent of total billed charges,80% of total billed charges,28.8,90,,23.04,percent of total billed charges,90% of total billed charges,24,75,,19.2,percent of total billed charges,75% of total billed charges,5.46,122,,,fee schedule,122% of APC rate,9.28,29,,7.424,percent of total billed charges,29% of total billed charges,4.48,100,,,fee schedule,100% of CMS fee schedule,21.44,67,,17.152,percent of total billed charges,67% of total billed charges,6.64,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,25.6,80,,20.48,percent of total billed charges,80% of total billed charges,20.8,65,,16.64,percent of total billed charges,65% of total billed charges,11.41,35.67,,9.128,percent of total billed charges,35.67% of total billed charges,4.48,28.8,
PLAMODIUM ANTIBODY EXP,3006646,CDM,300,RC,,,outpatient,,,324,129.60,,275.4,85,,220.32,percent of total billed charges,85% of total billed charges,249.48,77,,199.58,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,265.68,82,,212.544,percent of total billed charges,82% of total billed charges,275.4,85,,220.32,percent of total billed charges,85% of total billed charges,275.4,85,,220.32,percent of total billed charges,85% of total billed charges,275.4,85,,220.32,percent of total billed charges,85% of total billed charges,291.6,90,,233.28,percent of total billed charges,90% of total billed charges,259.2,80,,207.36,percent of total billed charges,80% of total billed charges,291.6,90,,233.28,percent of total billed charges,90% of total billed charges,243,75,,194.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,93.96,29,,75.168,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,217.08,67,,173.664,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,259.2,80,,207.36,percent of total billed charges,80% of total billed charges,210.6,65,,168.48,percent of total billed charges,65% of total billed charges,115.57,35.67,,92.456,percent of total billed charges,35.67% of total billed charges,93.96,291.6,
PLATELETS AB IND,3006660,CDM,300,RC,86022,HCPCS,outpatient,,,196,78.40,,166.6,85,,133.28,percent of total billed charges,85% of total billed charges,150.92,77,,120.74,percent of total billed charges,77% of total billed charges,18.37,100,,,fee schedule,100% of CMS fee schedule,79.38,350,,,fee schedule,350% of BCBS fee schedule,82.56,364,,,fee schedule,364% of BCBS fee schedule,82.56,364,,,fee schedule,364% of BCBS fee schedule,82.56,364,,,fee schedule,364% of BCBS fee schedule,176.4,90,,141.12,percent of total billed charges,90% of total billed charges,156.8,80,,125.44,percent of total billed charges,80% of total billed charges,176.4,90,,141.12,percent of total billed charges,90% of total billed charges,147,75,,117.6,percent of total billed charges,75% of total billed charges,22.41,122,,,fee schedule,122% of APC rate,56.84,29,,45.472,percent of total billed charges,29% of total billed charges,18.37,100,,,fee schedule,100% of CMS fee schedule,131.32,67,,105.056,percent of total billed charges,67% of total billed charges,27.32,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,156.8,80,,125.44,percent of total billed charges,80% of total billed charges,127.4,65,,101.92,percent of total billed charges,65% of total billed charges,69.91,35.67,,55.928,percent of total billed charges,35.67% of total billed charges,18.37,176.4,
PNEUMOCYSTIS CARINII EXAM,3006680,CDM,300,RC,86255,HCPCS,outpatient,,,127,50.80,,107.95,85,,86.36,percent of total billed charges,85% of total billed charges,97.79,77,,78.23,percent of total billed charges,77% of total billed charges,12.05,100,,,fee schedule,100% of CMS fee schedule,52.08,350,,,fee schedule,350% of BCBS fee schedule,54.16,364,,,fee schedule,364% of BCBS fee schedule,54.16,364,,,fee schedule,364% of BCBS fee schedule,54.16,364,,,fee schedule,364% of BCBS fee schedule,114.3,90,,91.44,percent of total billed charges,90% of total billed charges,101.6,80,,81.28,percent of total billed charges,80% of total billed charges,114.3,90,,91.44,percent of total billed charges,90% of total billed charges,95.25,75,,76.2,percent of total billed charges,75% of total billed charges,14.7,122,,,fee schedule,122% of APC rate,36.83,29,,29.464,percent of total billed charges,29% of total billed charges,12.05,100,,,fee schedule,100% of CMS fee schedule,85.09,67,,68.072,percent of total billed charges,67% of total billed charges,17.92,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,101.6,80,,81.28,percent of total billed charges,80% of total billed charges,82.55,65,,66.04,percent of total billed charges,65% of total billed charges,45.3,35.67,,36.24,percent of total billed charges,35.67% of total billed charges,12.05,114.3,
PORPHOBILINOGEN,3006685,CDM,300,RC,84110,HCPCS,outpatient,,,58,23.20,,49.3,85,,39.44,percent of total billed charges,85% of total billed charges,44.66,77,,35.73,percent of total billed charges,77% of total billed charges,8.44,100,,,fee schedule,100% of CMS fee schedule,36.47,350,,,fee schedule,350% of BCBS fee schedule,37.93,364,,,fee schedule,364% of BCBS fee schedule,37.93,364,,,fee schedule,364% of BCBS fee schedule,37.93,364,,,fee schedule,364% of BCBS fee schedule,52.2,90,,41.76,percent of total billed charges,90% of total billed charges,46.4,80,,37.12,percent of total billed charges,80% of total billed charges,52.2,90,,41.76,percent of total billed charges,90% of total billed charges,43.5,75,,34.8,percent of total billed charges,75% of total billed charges,10.29,122,,,fee schedule,122% of APC rate,16.82,29,,13.456,percent of total billed charges,29% of total billed charges,8.44,100,,,fee schedule,100% of CMS fee schedule,38.86,67,,31.088,percent of total billed charges,67% of total billed charges,12.55,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,46.4,80,,37.12,percent of total billed charges,80% of total billed charges,37.7,65,,30.16,percent of total billed charges,65% of total billed charges,20.69,35.67,,16.552,percent of total billed charges,35.67% of total billed charges,8.44,52.2,
PORPHYRINS QUAN,3006688,CDM,300,RC,84120,HCPCS,outpatient,,,141,56.40,,119.85,85,,95.88,percent of total billed charges,85% of total billed charges,108.57,77,,86.86,percent of total billed charges,77% of total billed charges,14.71,100,,,fee schedule,100% of CMS fee schedule,63.56,350,,,fee schedule,350% of BCBS fee schedule,66.1,364,,,fee schedule,364% of BCBS fee schedule,66.1,364,,,fee schedule,364% of BCBS fee schedule,66.1,364,,,fee schedule,364% of BCBS fee schedule,126.9,90,,101.52,percent of total billed charges,90% of total billed charges,112.8,80,,90.24,percent of total billed charges,80% of total billed charges,126.9,90,,101.52,percent of total billed charges,90% of total billed charges,105.75,75,,84.6,percent of total billed charges,75% of total billed charges,17.94,122,,,fee schedule,122% of APC rate,40.89,29,,32.712,percent of total billed charges,29% of total billed charges,14.71,100,,,fee schedule,100% of CMS fee schedule,94.47,67,,75.576,percent of total billed charges,67% of total billed charges,18.79,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,112.8,80,,90.24,percent of total billed charges,80% of total billed charges,91.65,65,,73.32,percent of total billed charges,65% of total billed charges,50.29,35.67,,40.232,percent of total billed charges,35.67% of total billed charges,14.71,126.9,
PORPHYRINS SCREENING,3006690,CDM,300,RC,84119,HCPCS,outpatient,,,96,38.40,,81.6,85,,65.28,percent of total billed charges,85% of total billed charges,73.92,77,,59.14,percent of total billed charges,77% of total billed charges,13.36,100,,,fee schedule,100% of CMS fee schedule,46.76,350,,,fee schedule,350% of BCBS fee schedule,48.63,364,,,fee schedule,364% of BCBS fee schedule,48.63,364,,,fee schedule,364% of BCBS fee schedule,48.63,364,,,fee schedule,364% of BCBS fee schedule,86.4,90,,69.12,percent of total billed charges,90% of total billed charges,76.8,80,,61.44,percent of total billed charges,80% of total billed charges,86.4,90,,69.12,percent of total billed charges,90% of total billed charges,72,75,,57.6,percent of total billed charges,75% of total billed charges,16.29,122,,,fee schedule,122% of APC rate,27.84,29,,22.272,percent of total billed charges,29% of total billed charges,13.36,100,,,fee schedule,100% of CMS fee schedule,64.32,67,,51.456,percent of total billed charges,67% of total billed charges,12.81,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,76.8,80,,61.44,percent of total billed charges,80% of total billed charges,62.4,65,,49.92,percent of total billed charges,65% of total billed charges,34.24,35.67,,27.392,percent of total billed charges,35.67% of total billed charges,12.81,86.4,
POTASSIUM,3006700,CDM,300,RC,84132,HCPCS,outpatient,,,48,19.20,,40.8,85,,32.64,percent of total billed charges,85% of total billed charges,36.96,77,,29.57,percent of total billed charges,77% of total billed charges,4.76,100,,,fee schedule,100% of CMS fee schedule,19.88,350,,,fee schedule,350% of BCBS fee schedule,20.68,364,,,fee schedule,364% of BCBS fee schedule,20.68,364,,,fee schedule,364% of BCBS fee schedule,20.68,364,,,fee schedule,364% of BCBS fee schedule,43.2,90,,34.56,percent of total billed charges,90% of total billed charges,38.4,80,,30.72,percent of total billed charges,80% of total billed charges,43.2,90,,34.56,percent of total billed charges,90% of total billed charges,36,75,,28.8,percent of total billed charges,75% of total billed charges,5.8,122,,,fee schedule,122% of APC rate,13.92,29,,11.136,percent of total billed charges,29% of total billed charges,4.76,100,,,fee schedule,100% of CMS fee schedule,32.16,67,,25.728,percent of total billed charges,67% of total billed charges,6.83,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,38.4,80,,30.72,percent of total billed charges,80% of total billed charges,31.2,65,,24.96,percent of total billed charges,65% of total billed charges,17.12,35.67,,13.696,percent of total billed charges,35.67% of total billed charges,4.76,43.2,
QUANTITATIVE HCG - SERUM,3006745,CDM,300,RC,84702,HCPCS,outpatient,,,165,66.00,,140.25,85,,112.2,percent of total billed charges,85% of total billed charges,127.05,77,,101.64,percent of total billed charges,77% of total billed charges,15.05,100,,,fee schedule,100% of CMS fee schedule,65.07,350,,,fee schedule,350% of BCBS fee schedule,67.67,364,,,fee schedule,364% of BCBS fee schedule,67.67,364,,,fee schedule,364% of BCBS fee schedule,67.67,364,,,fee schedule,364% of BCBS fee schedule,148.5,90,,118.8,percent of total billed charges,90% of total billed charges,132,80,,105.6,percent of total billed charges,80% of total billed charges,148.5,90,,118.8,percent of total billed charges,90% of total billed charges,123.75,75,,99,percent of total billed charges,75% of total billed charges,18.36,122,,,fee schedule,122% of APC rate,47.85,29,,38.28,percent of total billed charges,29% of total billed charges,15.05,100,,,fee schedule,100% of CMS fee schedule,110.55,67,,88.44,percent of total billed charges,67% of total billed charges,22.39,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,132,80,,105.6,percent of total billed charges,80% of total billed charges,107.25,65,,85.8,percent of total billed charges,65% of total billed charges,58.86,35.67,,47.088,percent of total billed charges,35.67% of total billed charges,15.05,148.5,
QUANTITATIVE HCG - URINE,3006746,CDM,300,RC,81025,HCPCS,outpatient,,,85,34.00,,72.25,85,,57.8,percent of total billed charges,85% of total billed charges,65.45,77,,52.36,percent of total billed charges,77% of total billed charges,8.61,100,,,fee schedule,100% of CMS fee schedule,30.14,350,,,fee schedule,350% of BCBS fee schedule,31.34,364,,,fee schedule,364% of BCBS fee schedule,31.34,364,,,fee schedule,364% of BCBS fee schedule,31.34,364,,,fee schedule,364% of BCBS fee schedule,76.5,90,,61.2,percent of total billed charges,90% of total billed charges,68,80,,54.4,percent of total billed charges,80% of total billed charges,76.5,90,,61.2,percent of total billed charges,90% of total billed charges,63.75,75,,51,percent of total billed charges,75% of total billed charges,10.5,122,,,fee schedule,122% of APC rate,24.65,29,,19.72,percent of total billed charges,29% of total billed charges,8.61,100,,,fee schedule,100% of CMS fee schedule,56.95,67,,45.56,percent of total billed charges,67% of total billed charges,9.4,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,68,80,,54.4,percent of total billed charges,80% of total billed charges,55.25,65,,44.2,percent of total billed charges,65% of total billed charges,30.32,35.67,,24.256,percent of total billed charges,35.67% of total billed charges,8.61,76.5,
PARVOVIRUS,3006747,CDM,300,RC,86747,HCPCS,outpatient,,,162,64.80,,137.7,85,,110.16,percent of total billed charges,85% of total billed charges,124.74,77,,99.79,percent of total billed charges,77% of total billed charges,15.03,100,,,fee schedule,100% of CMS fee schedule,64.96,350,,,fee schedule,350% of BCBS fee schedule,67.56,364,,,fee schedule,364% of BCBS fee schedule,67.56,364,,,fee schedule,364% of BCBS fee schedule,67.56,364,,,fee schedule,364% of BCBS fee schedule,145.8,90,,116.64,percent of total billed charges,90% of total billed charges,129.6,80,,103.68,percent of total billed charges,80% of total billed charges,145.8,90,,116.64,percent of total billed charges,90% of total billed charges,121.5,75,,97.2,percent of total billed charges,75% of total billed charges,18.33,122,,,fee schedule,122% of APC rate,46.98,29,,37.584,percent of total billed charges,29% of total billed charges,15.03,100,,,fee schedule,100% of CMS fee schedule,108.54,67,,86.832,percent of total billed charges,67% of total billed charges,22.36,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,129.6,80,,103.68,percent of total billed charges,80% of total billed charges,105.3,65,,84.24,percent of total billed charges,65% of total billed charges,57.79,35.67,,46.232,percent of total billed charges,35.67% of total billed charges,15.03,145.8,
PARAINFLUENZA VIRUS TYPE 1-3Ab,3006749,CDM,300,RC,86710,HCPCS,outpatient,,,66,26.40,,56.1,85,,44.88,percent of total billed charges,85% of total billed charges,50.82,77,,40.66,percent of total billed charges,77% of total billed charges,13.55,100,,,fee schedule,100% of CMS fee schedule,58.56,350,,,fee schedule,350% of BCBS fee schedule,60.9,364,,,fee schedule,364% of BCBS fee schedule,60.9,364,,,fee schedule,364% of BCBS fee schedule,60.9,364,,,fee schedule,364% of BCBS fee schedule,59.4,90,,47.52,percent of total billed charges,90% of total billed charges,52.8,80,,42.24,percent of total billed charges,80% of total billed charges,59.4,90,,47.52,percent of total billed charges,90% of total billed charges,49.5,75,,39.6,percent of total billed charges,75% of total billed charges,16.53,122,,,fee schedule,122% of APC rate,19.14,29,,15.312,percent of total billed charges,29% of total billed charges,13.55,100,,,fee schedule,100% of CMS fee schedule,44.22,67,,35.376,percent of total billed charges,67% of total billed charges,20.16,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,52.8,80,,42.24,percent of total billed charges,80% of total billed charges,42.9,65,,34.32,percent of total billed charges,65% of total billed charges,23.54,35.67,,18.832,percent of total billed charges,35.67% of total billed charges,13.55,60.9,
PREGNANEDIOL,3006750,CDM,300,RC,84135,HCPCS,outpatient,,,96,38.40,,81.6,85,,65.28,percent of total billed charges,85% of total billed charges,73.92,77,,59.14,percent of total billed charges,77% of total billed charges,21.27,100,,,fee schedule,100% of CMS fee schedule,82.71,350,,,fee schedule,350% of BCBS fee schedule,86.01,364,,,fee schedule,364% of BCBS fee schedule,86.01,364,,,fee schedule,364% of BCBS fee schedule,86.01,364,,,fee schedule,364% of BCBS fee schedule,86.4,90,,69.12,percent of total billed charges,90% of total billed charges,76.8,80,,61.44,percent of total billed charges,80% of total billed charges,86.4,90,,69.12,percent of total billed charges,90% of total billed charges,72,75,,57.6,percent of total billed charges,75% of total billed charges,25.94,122,,,fee schedule,122% of APC rate,27.84,29,,22.272,percent of total billed charges,29% of total billed charges,21.27,100,,,fee schedule,100% of CMS fee schedule,64.32,67,,51.456,percent of total billed charges,67% of total billed charges,28.45,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,76.8,80,,61.44,percent of total billed charges,80% of total billed charges,62.4,65,,49.92,percent of total billed charges,65% of total billed charges,34.24,35.67,,27.392,percent of total billed charges,35.67% of total billed charges,21.27,86.4,
PREALBUMIN,3006751,CDM,300,RC,84134,HCPCS,outpatient,,,99,39.60,,84.15,85,,67.32,percent of total billed charges,85% of total billed charges,76.23,77,,60.98,percent of total billed charges,77% of total billed charges,14.59,100,,,fee schedule,100% of CMS fee schedule,63.04,350,,,fee schedule,350% of BCBS fee schedule,65.56,364,,,fee schedule,364% of BCBS fee schedule,65.56,364,,,fee schedule,364% of BCBS fee schedule,65.56,364,,,fee schedule,364% of BCBS fee schedule,89.1,90,,71.28,percent of total billed charges,90% of total billed charges,79.2,80,,63.36,percent of total billed charges,80% of total billed charges,89.1,90,,71.28,percent of total billed charges,90% of total billed charges,74.25,75,,59.4,percent of total billed charges,75% of total billed charges,17.79,122,,,fee schedule,122% of APC rate,28.71,29,,22.968,percent of total billed charges,29% of total billed charges,14.59,100,,,fee schedule,100% of CMS fee schedule,66.33,67,,53.064,percent of total billed charges,67% of total billed charges,8.3,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,79.2,80,,63.36,percent of total billed charges,80% of total billed charges,64.35,65,,51.48,percent of total billed charges,65% of total billed charges,35.31,35.67,,28.248,percent of total billed charges,35.67% of total billed charges,8.3,89.1,
PREGNENOLONE LEVEL,3006752,CDM,300,RC,84140,HCPCS,outpatient,,,125,50.00,,106.25,85,,85,percent of total billed charges,85% of total billed charges,96.25,77,,77,percent of total billed charges,77% of total billed charges,20.67,100,,,fee schedule,100% of CMS fee schedule,89.32,350,,,fee schedule,350% of BCBS fee schedule,92.89,364,,,fee schedule,364% of BCBS fee schedule,92.89,364,,,fee schedule,364% of BCBS fee schedule,92.89,364,,,fee schedule,364% of BCBS fee schedule,112.5,90,,90,percent of total billed charges,90% of total billed charges,100,80,,80,percent of total billed charges,80% of total billed charges,112.5,90,,90,percent of total billed charges,90% of total billed charges,93.75,75,,75,percent of total billed charges,75% of total billed charges,25.21,122,,,fee schedule,122% of APC rate,36.25,29,,29,percent of total billed charges,29% of total billed charges,20.67,100,,,fee schedule,100% of CMS fee schedule,83.75,67,,67,percent of total billed charges,67% of total billed charges,30.75,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,100,80,,80,percent of total billed charges,80% of total billed charges,81.25,65,,65,percent of total billed charges,65% of total billed charges,44.59,35.67,,35.672,percent of total billed charges,35.67% of total billed charges,20.67,112.5,
PRETREATMENT OF RBC'S FOR RBC,3006754,CDM,300,RC,86971,HCPCS,outpatient,,,826,330.40,,702.1,85,,561.68,percent of total billed charges,85% of total billed charges,636.02,77,,508.82,percent of total billed charges,77% of total billed charges,149.37,100,,,fee schedule,100% of CMS OPPS rate,754.01,350,,,fee schedule,350% of BCBS fee schedule,784.17,364,,,fee schedule,364% of BCBS fee schedule,784.17,364,,,fee schedule,364% of BCBS fee schedule,784.17,364,,,fee schedule,364% of BCBS fee schedule,743.4,90,,594.72,percent of total billed charges,90% of total billed charges,660.8,80,,528.64,percent of total billed charges,80% of total billed charges,743.4,90,,594.72,percent of total billed charges,90% of total billed charges,619.5,75,,495.6,percent of total billed charges,75% of total billed charges,182.23,122,,,fee schedule,122% of APC rate,239.54,29,,191.632,percent of total billed charges,29% of total billed charges,149.37,100,,,fee schedule,100% of CMS OPPS rate,553.42,67,,442.736,percent of total billed charges,67% of total billed charges,13.91,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,660.8,80,,528.64,percent of total billed charges,80% of total billed charges,536.9,65,,429.52,percent of total billed charges,65% of total billed charges,294.63,35.67,,235.704,percent of total billed charges,35.67% of total billed charges,13.91,784.17,
PRIMIDONE (MYSOLINE),3006760,CDM,300,RC,80188,HCPCS,outpatient,,,96,38.40,,81.6,85,,65.28,percent of total billed charges,85% of total billed charges,73.92,77,,59.14,percent of total billed charges,77% of total billed charges,16.59,100,,,fee schedule,100% of CMS fee schedule,71.68,350,,,fee schedule,350% of BCBS fee schedule,74.55,364,,,fee schedule,364% of BCBS fee schedule,74.55,364,,,fee schedule,364% of BCBS fee schedule,74.55,364,,,fee schedule,364% of BCBS fee schedule,86.4,90,,69.12,percent of total billed charges,90% of total billed charges,76.8,80,,61.44,percent of total billed charges,80% of total billed charges,86.4,90,,69.12,percent of total billed charges,90% of total billed charges,72,75,,57.6,percent of total billed charges,75% of total billed charges,20.23,122,,,fee schedule,122% of APC rate,27.84,29,,22.272,percent of total billed charges,29% of total billed charges,16.59,100,,,fee schedule,100% of CMS fee schedule,64.32,67,,51.456,percent of total billed charges,67% of total billed charges,24.68,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,76.8,80,,61.44,percent of total billed charges,80% of total billed charges,62.4,65,,49.92,percent of total billed charges,65% of total billed charges,34.24,35.67,,27.392,percent of total billed charges,35.67% of total billed charges,16.59,86.4,
PROC/NAPA PROFILE,3006780,CDM,300,RC,80192,HCPCS,outpatient,,,130,52.00,,110.5,85,,88.4,percent of total billed charges,85% of total billed charges,100.1,77,,80.08,percent of total billed charges,77% of total billed charges,16.75,100,,,fee schedule,100% of CMS fee schedule,72.38,350,,,fee schedule,350% of BCBS fee schedule,75.28,364,,,fee schedule,364% of BCBS fee schedule,75.28,364,,,fee schedule,364% of BCBS fee schedule,75.28,364,,,fee schedule,364% of BCBS fee schedule,117,90,,93.6,percent of total billed charges,90% of total billed charges,104,80,,83.2,percent of total billed charges,80% of total billed charges,117,90,,93.6,percent of total billed charges,90% of total billed charges,97.5,75,,78,percent of total billed charges,75% of total billed charges,20.43,122,,,fee schedule,122% of APC rate,37.7,29,,30.16,percent of total billed charges,29% of total billed charges,16.75,100,,,fee schedule,100% of CMS fee schedule,87.1,67,,69.68,percent of total billed charges,67% of total billed charges,24.9,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,104,80,,83.2,percent of total billed charges,80% of total billed charges,84.5,65,,67.6,percent of total billed charges,65% of total billed charges,46.37,35.67,,37.096,percent of total billed charges,35.67% of total billed charges,16.75,117,
PROCANINAMIDE LEVEL,3006785,CDM,300,RC,80190,HCPCS,outpatient,,,238,95.20,,202.3,85,,161.84,percent of total billed charges,85% of total billed charges,183.26,77,,146.61,percent of total billed charges,77% of total billed charges,60,100,,,fee schedule,100% of CMS fee schedule,210,350,,,fee schedule,350% of BCBS fee schedule,218.4,364,,,fee schedule,364% of BCBS fee schedule,218.4,364,,,fee schedule,364% of BCBS fee schedule,218.4,364,,,fee schedule,364% of BCBS fee schedule,214.2,90,,171.36,percent of total billed charges,90% of total billed charges,190.4,80,,152.32,percent of total billed charges,80% of total billed charges,214.2,90,,171.36,percent of total billed charges,90% of total billed charges,178.5,75,,142.8,percent of total billed charges,75% of total billed charges,73.2,122,,,fee schedule,122% of APC rate,69.02,29,,55.216,percent of total billed charges,29% of total billed charges,60,100,,,fee schedule,100% of CMS fee schedule,159.46,67,,127.568,percent of total billed charges,67% of total billed charges,24.9,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,190.4,80,,152.32,percent of total billed charges,80% of total billed charges,154.7,65,,123.76,percent of total billed charges,65% of total billed charges,84.89,35.67,,67.912,percent of total billed charges,35.67% of total billed charges,24.9,218.4,
PROCALCITONIN,3006786,CDM,300,RC,84145,HCPCS,outpatient,,,208,83.20,,176.8,85,,141.44,percent of total billed charges,85% of total billed charges,160.16,77,,128.13,percent of total billed charges,77% of total billed charges,27.22,100,,,fee schedule,100% of CMS fee schedule,115.78,350,,,fee schedule,350% of BCBS fee schedule,120.41,364,,,fee schedule,364% of BCBS fee schedule,120.41,364,,,fee schedule,364% of BCBS fee schedule,120.41,364,,,fee schedule,364% of BCBS fee schedule,187.2,90,,149.76,percent of total billed charges,90% of total billed charges,166.4,80,,133.12,percent of total billed charges,80% of total billed charges,187.2,90,,149.76,percent of total billed charges,90% of total billed charges,156,75,,124.8,percent of total billed charges,75% of total billed charges,33.2,122,,,fee schedule,122% of APC rate,60.32,29,,48.256,percent of total billed charges,29% of total billed charges,27.22,100,,,fee schedule,100% of CMS fee schedule,139.36,67,,111.488,percent of total billed charges,67% of total billed charges,39.82,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,166.4,80,,133.12,percent of total billed charges,80% of total billed charges,135.2,65,,108.16,percent of total billed charges,65% of total billed charges,74.19,35.67,,59.352,percent of total billed charges,35.67% of total billed charges,27.22,187.2,
PROGESTERONE,3006800,CDM,300,RC,84144,HCPCS,outpatient,,,102,40.80,,86.7,85,,69.36,percent of total billed charges,85% of total billed charges,78.54,77,,62.83,percent of total billed charges,77% of total billed charges,20.86,100,,,fee schedule,100% of CMS fee schedule,90.16,350,,,fee schedule,350% of BCBS fee schedule,93.77,364,,,fee schedule,364% of BCBS fee schedule,93.77,364,,,fee schedule,364% of BCBS fee schedule,93.77,364,,,fee schedule,364% of BCBS fee schedule,91.8,90,,73.44,percent of total billed charges,90% of total billed charges,81.6,80,,65.28,percent of total billed charges,80% of total billed charges,91.8,90,,73.44,percent of total billed charges,90% of total billed charges,76.5,75,,61.2,percent of total billed charges,75% of total billed charges,25.44,122,,,fee schedule,122% of APC rate,29.58,29,,23.664,percent of total billed charges,29% of total billed charges,20.86,100,,,fee schedule,100% of CMS fee schedule,68.34,67,,54.672,percent of total billed charges,67% of total billed charges,31.02,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,81.6,80,,65.28,percent of total billed charges,80% of total billed charges,66.3,65,,53.04,percent of total billed charges,65% of total billed charges,36.38,35.67,,29.104,percent of total billed charges,35.67% of total billed charges,20.86,93.77,
PROLACTIN,3006820,CDM,300,RC,84146,HCPCS,outpatient,,,97,38.80,,82.45,85,,65.96,percent of total billed charges,85% of total billed charges,74.69,77,,59.75,percent of total billed charges,77% of total billed charges,19.38,100,,,fee schedule,100% of CMS fee schedule,83.72,350,,,fee schedule,350% of BCBS fee schedule,87.07,364,,,fee schedule,364% of BCBS fee schedule,87.07,364,,,fee schedule,364% of BCBS fee schedule,87.07,364,,,fee schedule,364% of BCBS fee schedule,87.3,90,,69.84,percent of total billed charges,90% of total billed charges,77.6,80,,62.08,percent of total billed charges,80% of total billed charges,87.3,90,,69.84,percent of total billed charges,90% of total billed charges,72.75,75,,58.2,percent of total billed charges,75% of total billed charges,23.64,122,,,fee schedule,122% of APC rate,28.13,29,,22.504,percent of total billed charges,29% of total billed charges,19.38,100,,,fee schedule,100% of CMS fee schedule,64.99,67,,51.992,percent of total billed charges,67% of total billed charges,28.82,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,77.6,80,,62.08,percent of total billed charges,80% of total billed charges,63.05,65,,50.44,percent of total billed charges,65% of total billed charges,34.6,35.67,,27.68,percent of total billed charges,35.67% of total billed charges,19.38,87.3,
PROMETHEUS IBD X,3006825,CDM,300,RC,83520,HCPCS,outpatient,,,152,60.80,,129.2,85,,103.36,percent of total billed charges,85% of total billed charges,117.04,77,,93.63,percent of total billed charges,77% of total billed charges,17.27,100,,,fee schedule,100% of CMS fee schedule,60.45,350,,,fee schedule,350% of BCBS fee schedule,62.86,364,,,fee schedule,364% of BCBS fee schedule,62.86,364,,,fee schedule,364% of BCBS fee schedule,62.86,364,,,fee schedule,364% of BCBS fee schedule,136.8,90,,109.44,percent of total billed charges,90% of total billed charges,121.6,80,,97.28,percent of total billed charges,80% of total billed charges,136.8,90,,109.44,percent of total billed charges,90% of total billed charges,114,75,,91.2,percent of total billed charges,75% of total billed charges,21.06,122,,,fee schedule,122% of APC rate,44.08,29,,35.264,percent of total billed charges,29% of total billed charges,17.27,100,,,fee schedule,100% of CMS fee schedule,101.84,67,,81.472,percent of total billed charges,67% of total billed charges,19.25,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,121.6,80,,97.28,percent of total billed charges,80% of total billed charges,98.8,65,,79.04,percent of total billed charges,65% of total billed charges,54.22,35.67,,43.376,percent of total billed charges,35.67% of total billed charges,17.27,136.8,
CHEMILUMINATION ASSAY,3006826,CDM,300,RC,82397,HCPCS,outpatient,,,144,57.60,,122.4,85,,97.92,percent of total billed charges,85% of total billed charges,110.88,77,,88.7,percent of total billed charges,77% of total billed charges,14.12,100,,,fee schedule,100% of CMS fee schedule,61.01,350,,,fee schedule,350% of BCBS fee schedule,63.45,364,,,fee schedule,364% of BCBS fee schedule,63.45,364,,,fee schedule,364% of BCBS fee schedule,63.45,364,,,fee schedule,364% of BCBS fee schedule,129.6,90,,103.68,percent of total billed charges,90% of total billed charges,115.2,80,,92.16,percent of total billed charges,80% of total billed charges,129.6,90,,103.68,percent of total billed charges,90% of total billed charges,108,75,,86.4,percent of total billed charges,75% of total billed charges,17.22,122,,,fee schedule,122% of APC rate,41.76,29,,33.408,percent of total billed charges,29% of total billed charges,14.12,100,,,fee schedule,100% of CMS fee schedule,96.48,67,,77.184,percent of total billed charges,67% of total billed charges,21.01,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,115.2,80,,92.16,percent of total billed charges,80% of total billed charges,93.6,65,,74.88,percent of total billed charges,65% of total billed charges,51.36,35.67,,41.088,percent of total billed charges,35.67% of total billed charges,14.12,129.6,
CRP,3006827,CDM,300,RC,86140,HCPCS,outpatient,,,74,29.60,,62.9,85,,50.32,percent of total billed charges,85% of total billed charges,56.98,77,,45.58,percent of total billed charges,77% of total billed charges,5.18,100,,,fee schedule,100% of CMS fee schedule,22.37,350,,,fee schedule,350% of BCBS fee schedule,23.26,364,,,fee schedule,364% of BCBS fee schedule,23.26,364,,,fee schedule,364% of BCBS fee schedule,23.26,364,,,fee schedule,364% of BCBS fee schedule,66.6,90,,53.28,percent of total billed charges,90% of total billed charges,59.2,80,,47.36,percent of total billed charges,80% of total billed charges,66.6,90,,53.28,percent of total billed charges,90% of total billed charges,55.5,75,,44.4,percent of total billed charges,75% of total billed charges,6.31,122,,,fee schedule,122% of APC rate,21.46,29,,17.168,percent of total billed charges,29% of total billed charges,5.18,100,,,fee schedule,100% of CMS fee schedule,49.58,67,,39.664,percent of total billed charges,67% of total billed charges,7.69,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,59.2,80,,47.36,percent of total billed charges,80% of total billed charges,48.1,65,,38.48,percent of total billed charges,65% of total billed charges,26.4,35.67,,21.12,percent of total billed charges,35.67% of total billed charges,5.18,66.6,
MOLECULAR PATH PROCEDURE X,3006828,CDM,300,RC,81479,HCPCS,outpatient,,,268,107.20,,227.8,85,,182.24,percent of total billed charges,85% of total billed charges,206.36,77,,165.09,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,89.78,350,,,fee schedule,350% of BCBS fee schedule,93.37,364,,,fee schedule,364% of BCBS fee schedule,93.37,364,,,fee schedule,364% of BCBS fee schedule,93.37,364,,,fee schedule,364% of BCBS fee schedule,241.2,90,,192.96,percent of total billed charges,90% of total billed charges,214.4,80,,171.52,percent of total billed charges,80% of total billed charges,241.2,90,,192.96,percent of total billed charges,90% of total billed charges,201,75,,160.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,77.72,29,,62.176,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,179.56,67,,143.648,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,214.4,80,,171.52,percent of total billed charges,80% of total billed charges,174.2,65,,139.36,percent of total billed charges,65% of total billed charges,95.6,35.67,,76.48,percent of total billed charges,35.67% of total billed charges,77.72,241.2,
PROMETHEUS IBD CROHN'S DISEASE,3006831,CDM,300,RC,83520,HCPCS,outpatient,,,152,60.80,,129.2,85,,103.36,percent of total billed charges,85% of total billed charges,117.04,77,,93.63,percent of total billed charges,77% of total billed charges,17.27,100,,,fee schedule,100% of CMS fee schedule,60.45,350,,,fee schedule,350% of BCBS fee schedule,62.86,364,,,fee schedule,364% of BCBS fee schedule,62.86,364,,,fee schedule,364% of BCBS fee schedule,62.86,364,,,fee schedule,364% of BCBS fee schedule,136.8,90,,109.44,percent of total billed charges,90% of total billed charges,121.6,80,,97.28,percent of total billed charges,80% of total billed charges,136.8,90,,109.44,percent of total billed charges,90% of total billed charges,114,75,,91.2,percent of total billed charges,75% of total billed charges,21.06,122,,,fee schedule,122% of APC rate,44.08,29,,35.264,percent of total billed charges,29% of total billed charges,17.27,100,,,fee schedule,100% of CMS fee schedule,101.84,67,,81.472,percent of total billed charges,67% of total billed charges,19.25,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,121.6,80,,97.28,percent of total billed charges,80% of total billed charges,98.8,65,,79.04,percent of total billed charges,65% of total billed charges,54.22,35.67,,43.376,percent of total billed charges,35.67% of total billed charges,17.27,136.8,
PROMETHEUS IBD ULC. COLITIS,3006832,CDM,300,RC,83520,HCPCS,outpatient,,,152,60.80,,129.2,85,,103.36,percent of total billed charges,85% of total billed charges,117.04,77,,93.63,percent of total billed charges,77% of total billed charges,17.27,100,,,fee schedule,100% of CMS fee schedule,60.45,350,,,fee schedule,350% of BCBS fee schedule,62.86,364,,,fee schedule,364% of BCBS fee schedule,62.86,364,,,fee schedule,364% of BCBS fee schedule,62.86,364,,,fee schedule,364% of BCBS fee schedule,136.8,90,,109.44,percent of total billed charges,90% of total billed charges,121.6,80,,97.28,percent of total billed charges,80% of total billed charges,136.8,90,,109.44,percent of total billed charges,90% of total billed charges,114,75,,91.2,percent of total billed charges,75% of total billed charges,21.06,122,,,fee schedule,122% of APC rate,44.08,29,,35.264,percent of total billed charges,29% of total billed charges,17.27,100,,,fee schedule,100% of CMS fee schedule,101.84,67,,81.472,percent of total billed charges,67% of total billed charges,19.25,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,121.6,80,,97.28,percent of total billed charges,80% of total billed charges,98.8,65,,79.04,percent of total billed charges,65% of total billed charges,54.22,35.67,,43.376,percent of total billed charges,35.67% of total billed charges,17.27,136.8,
BETA-2 GLYCOPROTEIN ANTIBODY I,3006850,CDM,300,RC,86146,HCPCS,outpatient,,,82,32.80,,69.7,85,,55.76,percent of total billed charges,85% of total billed charges,63.14,77,,50.51,percent of total billed charges,77% of total billed charges,25.45,100,,,fee schedule,100% of CMS fee schedule,109.97,350,,,fee schedule,350% of BCBS fee schedule,114.37,364,,,fee schedule,364% of BCBS fee schedule,114.37,364,,,fee schedule,364% of BCBS fee schedule,114.37,364,,,fee schedule,364% of BCBS fee schedule,73.8,90,,59.04,percent of total billed charges,90% of total billed charges,65.6,80,,52.48,percent of total billed charges,80% of total billed charges,73.8,90,,59.04,percent of total billed charges,90% of total billed charges,61.5,75,,49.2,percent of total billed charges,75% of total billed charges,31.04,122,,,fee schedule,122% of APC rate,23.78,29,,19.024,percent of total billed charges,29% of total billed charges,25.45,100,,,fee schedule,100% of CMS fee schedule,54.94,67,,43.952,percent of total billed charges,67% of total billed charges,8.64,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,65.6,80,,52.48,percent of total billed charges,80% of total billed charges,53.3,65,,42.64,percent of total billed charges,65% of total billed charges,29.25,35.67,,23.4,percent of total billed charges,35.67% of total billed charges,8.64,114.37,
PROSTATE-SPECIFIC ANTIGEN,3006860,CDM,300,RC,84153,HCPCS,outpatient,,,125,50.00,,106.25,85,,85,percent of total billed charges,85% of total billed charges,96.25,77,,77,percent of total billed charges,77% of total billed charges,18.39,100,,,fee schedule,100% of CMS fee schedule,79.49,350,,,fee schedule,350% of BCBS fee schedule,82.66,364,,,fee schedule,364% of BCBS fee schedule,82.66,364,,,fee schedule,364% of BCBS fee schedule,82.66,364,,,fee schedule,364% of BCBS fee schedule,112.5,90,,90,percent of total billed charges,90% of total billed charges,100,80,,80,percent of total billed charges,80% of total billed charges,112.5,90,,90,percent of total billed charges,90% of total billed charges,93.75,75,,75,percent of total billed charges,75% of total billed charges,22.43,122,,,fee schedule,122% of APC rate,36.25,29,,29,percent of total billed charges,29% of total billed charges,18.39,100,,,fee schedule,100% of CMS fee schedule,83.75,67,,67,percent of total billed charges,67% of total billed charges,27.36,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,100,80,,80,percent of total billed charges,80% of total billed charges,81.25,65,,65,percent of total billed charges,65% of total billed charges,44.59,35.67,,35.672,percent of total billed charges,35.67% of total billed charges,18.39,112.5,
PROSTATE SPEC.ANTIGEN SCREEN,3006865,CDM,300,RC,G0103,HCPCS,outpatient,,,100,40.00,,85,85,,68,percent of total billed charges,85% of total billed charges,77,77,,61.6,percent of total billed charges,77% of total billed charges,19.3,100,,,fee schedule,100% of CMS fee schedule,79.49,350,,,fee schedule,350% of BCBS fee schedule,82.66,364,,,fee schedule,364% of BCBS fee schedule,82.66,364,,,fee schedule,364% of BCBS fee schedule,82.66,364,,,fee schedule,364% of BCBS fee schedule,90,90,,72,percent of total billed charges,90% of total billed charges,80,80,,64,percent of total billed charges,80% of total billed charges,90,90,,72,percent of total billed charges,90% of total billed charges,75,75,,60,percent of total billed charges,75% of total billed charges,23.55,122,,,fee schedule,122% of APC rate,29,29,,23.2,percent of total billed charges,29% of total billed charges,19.3,100,,,fee schedule,100% of CMS fee schedule,67,67,,53.6,percent of total billed charges,67% of total billed charges,27.36,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,80,80,,64,percent of total billed charges,80% of total billed charges,65,65,,52,percent of total billed charges,65% of total billed charges,35.67,35.67,,28.536,percent of total billed charges,35.67% of total billed charges,19.3,90,
PROSTATIC ACID PHOSPHATASE,3006880,CDM,300,RC,84066,HCPCS,outpatient,,,49,19.60,,41.65,85,,33.32,percent of total billed charges,85% of total billed charges,37.73,77,,30.18,percent of total billed charges,77% of total billed charges,9.66,100,,,fee schedule,100% of CMS fee schedule,41.76,350,,,fee schedule,350% of BCBS fee schedule,43.43,364,,,fee schedule,364% of BCBS fee schedule,43.43,364,,,fee schedule,364% of BCBS fee schedule,43.43,364,,,fee schedule,364% of BCBS fee schedule,44.1,90,,35.28,percent of total billed charges,90% of total billed charges,39.2,80,,31.36,percent of total billed charges,80% of total billed charges,44.1,90,,35.28,percent of total billed charges,90% of total billed charges,36.75,75,,29.4,percent of total billed charges,75% of total billed charges,11.78,122,,,fee schedule,122% of APC rate,14.21,29,,11.368,percent of total billed charges,29% of total billed charges,9.66,100,,,fee schedule,100% of CMS fee schedule,32.83,67,,26.264,percent of total billed charges,67% of total billed charges,14.36,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,39.2,80,,31.36,percent of total billed charges,80% of total billed charges,31.85,65,,25.48,percent of total billed charges,65% of total billed charges,17.48,35.67,,13.984,percent of total billed charges,35.67% of total billed charges,9.66,44.1,
PROTEIN C ANTIGEN,3006900,CDM,300,RC,85302,HCPCS,outpatient,,,274,109.60,,232.9,85,,186.32,percent of total billed charges,85% of total billed charges,210.98,77,,168.78,percent of total billed charges,77% of total billed charges,12.01,100,,,fee schedule,100% of CMS fee schedule,51.91,350,,,fee schedule,350% of BCBS fee schedule,53.98,364,,,fee schedule,364% of BCBS fee schedule,53.98,364,,,fee schedule,364% of BCBS fee schedule,53.98,364,,,fee schedule,364% of BCBS fee schedule,246.6,90,,197.28,percent of total billed charges,90% of total billed charges,219.2,80,,175.36,percent of total billed charges,80% of total billed charges,246.6,90,,197.28,percent of total billed charges,90% of total billed charges,205.5,75,,164.4,percent of total billed charges,75% of total billed charges,14.65,122,,,fee schedule,122% of APC rate,79.46,29,,63.568,percent of total billed charges,29% of total billed charges,12.01,100,,,fee schedule,100% of CMS fee schedule,183.58,67,,146.864,percent of total billed charges,67% of total billed charges,17.88,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,219.2,80,,175.36,percent of total billed charges,80% of total billed charges,178.1,65,,142.48,percent of total billed charges,65% of total billed charges,97.74,35.67,,78.192,percent of total billed charges,35.67% of total billed charges,12.01,246.6,
PROTEIN C ACTIVITY,3006901,CDM,300,RC,85303,HCPCS,outpatient,,,176,70.40,,149.6,85,,119.68,percent of total billed charges,85% of total billed charges,135.52,77,,108.42,percent of total billed charges,77% of total billed charges,13.84,100,,,fee schedule,100% of CMS fee schedule,59.78,350,,,fee schedule,350% of BCBS fee schedule,62.17,364,,,fee schedule,364% of BCBS fee schedule,62.17,364,,,fee schedule,364% of BCBS fee schedule,62.17,364,,,fee schedule,364% of BCBS fee schedule,158.4,90,,126.72,percent of total billed charges,90% of total billed charges,140.8,80,,112.64,percent of total billed charges,80% of total billed charges,158.4,90,,126.72,percent of total billed charges,90% of total billed charges,132,75,,105.6,percent of total billed charges,75% of total billed charges,16.88,122,,,fee schedule,122% of APC rate,51.04,29,,40.832,percent of total billed charges,29% of total billed charges,13.84,100,,,fee schedule,100% of CMS fee schedule,117.92,67,,94.336,percent of total billed charges,67% of total billed charges,20.56,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,140.8,80,,112.64,percent of total billed charges,80% of total billed charges,114.4,65,,91.52,percent of total billed charges,65% of total billed charges,62.78,35.67,,50.224,percent of total billed charges,35.67% of total billed charges,13.84,158.4,
PROTEIN ELECTROPHORESIS SERUM,3006920,CDM,300,RC,84165,HCPCS,outpatient,,,109,43.60,,92.65,85,,74.12,percent of total billed charges,85% of total billed charges,83.93,77,,67.14,percent of total billed charges,77% of total billed charges,10.74,100,,,fee schedule,100% of CMS fee schedule,46.41,350,,,fee schedule,350% of BCBS fee schedule,48.27,364,,,fee schedule,364% of BCBS fee schedule,48.27,364,,,fee schedule,364% of BCBS fee schedule,48.27,364,,,fee schedule,364% of BCBS fee schedule,98.1,90,,78.48,percent of total billed charges,90% of total billed charges,87.2,80,,69.76,percent of total billed charges,80% of total billed charges,98.1,90,,78.48,percent of total billed charges,90% of total billed charges,81.75,75,,65.4,percent of total billed charges,75% of total billed charges,13.1,122,,,fee schedule,122% of APC rate,31.61,29,,25.288,percent of total billed charges,29% of total billed charges,10.74,100,,,fee schedule,100% of CMS fee schedule,73.03,67,,58.424,percent of total billed charges,67% of total billed charges,15.97,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,87.2,80,,69.76,percent of total billed charges,80% of total billed charges,70.85,65,,56.68,percent of total billed charges,65% of total billed charges,38.88,35.67,,31.104,percent of total billed charges,35.67% of total billed charges,10.74,98.1,
ANTI ENDOMYSIAL(EMA) AB X,3006930,CDM,300,RC,88346,HCPCS,outpatient,,,356,142.40,,302.6,85,,242.08,percent of total billed charges,85% of total billed charges,274.12,77,,219.3,percent of total billed charges,77% of total billed charges,149.37,100,,,fee schedule,100% of CMS OPPS rate,754.01,350,,,fee schedule,350% of BCBS fee schedule,784.17,364,,,fee schedule,364% of BCBS fee schedule,784.17,364,,,fee schedule,364% of BCBS fee schedule,784.17,364,,,fee schedule,364% of BCBS fee schedule,320.4,90,,256.32,percent of total billed charges,90% of total billed charges,284.8,80,,227.84,percent of total billed charges,80% of total billed charges,320.4,90,,256.32,percent of total billed charges,90% of total billed charges,267,75,,213.6,percent of total billed charges,75% of total billed charges,182.23,122,,,fee schedule,122% of APC rate,103.24,29,,82.592,percent of total billed charges,29% of total billed charges,149.37,100,,,fee schedule,100% of CMS OPPS rate,238.52,67,,190.816,percent of total billed charges,67% of total billed charges,34.31,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,284.8,80,,227.84,percent of total billed charges,80% of total billed charges,231.4,65,,185.12,percent of total billed charges,65% of total billed charges,126.99,35.67,,101.592,percent of total billed charges,35.67% of total billed charges,34.31,784.17,
TOTAL IGA BY NEPHLOMETRY X,3006931,CDM,300,RC,82784,HCPCS,outpatient,,,62,24.80,,52.7,85,,42.16,percent of total billed charges,85% of total billed charges,47.74,77,,38.19,percent of total billed charges,77% of total billed charges,9.3,100,,,fee schedule,100% of CMS fee schedule,40.18,350,,,fee schedule,350% of BCBS fee schedule,41.79,364,,,fee schedule,364% of BCBS fee schedule,41.79,364,,,fee schedule,364% of BCBS fee schedule,41.79,364,,,fee schedule,364% of BCBS fee schedule,55.8,90,,44.64,percent of total billed charges,90% of total billed charges,49.6,80,,39.68,percent of total billed charges,80% of total billed charges,55.8,90,,44.64,percent of total billed charges,90% of total billed charges,46.5,75,,37.2,percent of total billed charges,75% of total billed charges,11.34,122,,,fee schedule,122% of APC rate,17.98,29,,14.384,percent of total billed charges,29% of total billed charges,9.3,100,,,fee schedule,100% of CMS fee schedule,41.54,67,,33.232,percent of total billed charges,67% of total billed charges,13.82,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,49.6,80,,39.68,percent of total billed charges,80% of total billed charges,40.3,65,,32.24,percent of total billed charges,65% of total billed charges,22.12,35.67,,17.696,percent of total billed charges,35.67% of total billed charges,9.3,55.8,
"TTG, DEAMIDATED GLIAD PEPT X",3006932,CDM,300,RC,83520,HCPCS,outpatient,,,273,109.20,,232.05,85,,185.64,percent of total billed charges,85% of total billed charges,210.21,77,,168.17,percent of total billed charges,77% of total billed charges,17.27,100,,,fee schedule,100% of CMS fee schedule,60.45,350,,,fee schedule,350% of BCBS fee schedule,62.86,364,,,fee schedule,364% of BCBS fee schedule,62.86,364,,,fee schedule,364% of BCBS fee schedule,62.86,364,,,fee schedule,364% of BCBS fee schedule,245.7,90,,196.56,percent of total billed charges,90% of total billed charges,218.4,80,,174.72,percent of total billed charges,80% of total billed charges,245.7,90,,196.56,percent of total billed charges,90% of total billed charges,204.75,75,,163.8,percent of total billed charges,75% of total billed charges,21.06,122,,,fee schedule,122% of APC rate,79.17,29,,63.336,percent of total billed charges,29% of total billed charges,17.27,100,,,fee schedule,100% of CMS fee schedule,182.91,67,,146.328,percent of total billed charges,67% of total billed charges,19.25,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,218.4,80,,174.72,percent of total billed charges,80% of total billed charges,177.45,65,,141.96,percent of total billed charges,65% of total billed charges,97.38,35.67,,77.904,percent of total billed charges,35.67% of total billed charges,17.27,245.7,
PROTEIN ELECTROPHORESIS URINE,3006940,CDM,300,RC,84166,HCPCS,outpatient,,,90,36.00,,76.5,85,,61.2,percent of total billed charges,85% of total billed charges,69.3,77,,55.44,percent of total billed charges,77% of total billed charges,17.82,100,,,fee schedule,100% of CMS fee schedule,77.04,350,,,fee schedule,350% of BCBS fee schedule,80.12,364,,,fee schedule,364% of BCBS fee schedule,80.12,364,,,fee schedule,364% of BCBS fee schedule,80.12,364,,,fee schedule,364% of BCBS fee schedule,81,90,,64.8,percent of total billed charges,90% of total billed charges,72,80,,57.6,percent of total billed charges,80% of total billed charges,81,90,,64.8,percent of total billed charges,90% of total billed charges,67.5,75,,54,percent of total billed charges,75% of total billed charges,21.75,122,,,fee schedule,122% of APC rate,26.1,29,,20.88,percent of total billed charges,29% of total billed charges,17.82,100,,,fee schedule,100% of CMS fee schedule,60.3,67,,48.24,percent of total billed charges,67% of total billed charges,26.52,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,72,80,,57.6,percent of total billed charges,80% of total billed charges,58.5,65,,46.8,percent of total billed charges,65% of total billed charges,32.1,35.67,,25.68,percent of total billed charges,35.67% of total billed charges,17.82,81,
PROTEIN ASSAY SERUM,3006960,CDM,300,RC,84155,HCPCS,outpatient,,,47,18.80,,39.95,85,,31.96,percent of total billed charges,85% of total billed charges,36.19,77,,28.95,percent of total billed charges,77% of total billed charges,3.67,100,,,fee schedule,100% of CMS fee schedule,15.86,350,,,fee schedule,350% of BCBS fee schedule,16.49,364,,,fee schedule,364% of BCBS fee schedule,16.49,364,,,fee schedule,364% of BCBS fee schedule,16.49,364,,,fee schedule,364% of BCBS fee schedule,42.3,90,,33.84,percent of total billed charges,90% of total billed charges,37.6,80,,30.08,percent of total billed charges,80% of total billed charges,42.3,90,,33.84,percent of total billed charges,90% of total billed charges,35.25,75,,28.2,percent of total billed charges,75% of total billed charges,4.47,122,,,fee schedule,122% of APC rate,13.63,29,,10.904,percent of total billed charges,29% of total billed charges,3.67,100,,,fee schedule,100% of CMS fee schedule,31.49,67,,25.192,percent of total billed charges,67% of total billed charges,5.44,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,37.6,80,,30.08,percent of total billed charges,80% of total billed charges,30.55,65,,24.44,percent of total billed charges,65% of total billed charges,16.76,35.67,,13.408,percent of total billed charges,35.67% of total billed charges,3.67,42.3,
PROTEIN TOTAL SERUM,3006980,CDM,300,RC,85306,HCPCS,outpatient,,,303,121.20,,257.55,85,,206.04,percent of total billed charges,85% of total billed charges,233.31,77,,186.65,percent of total billed charges,77% of total billed charges,15.32,100,,,fee schedule,100% of CMS fee schedule,66.22,350,,,fee schedule,350% of BCBS fee schedule,68.87,364,,,fee schedule,364% of BCBS fee schedule,68.87,364,,,fee schedule,364% of BCBS fee schedule,68.87,364,,,fee schedule,364% of BCBS fee schedule,272.7,90,,218.16,percent of total billed charges,90% of total billed charges,242.4,80,,193.92,percent of total billed charges,80% of total billed charges,272.7,90,,218.16,percent of total billed charges,90% of total billed charges,227.25,75,,181.8,percent of total billed charges,75% of total billed charges,18.69,122,,,fee schedule,122% of APC rate,87.87,29,,70.296,percent of total billed charges,29% of total billed charges,15.32,100,,,fee schedule,100% of CMS fee schedule,203.01,67,,162.408,percent of total billed charges,67% of total billed charges,21.25,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,242.4,80,,193.92,percent of total billed charges,80% of total billed charges,196.95,65,,157.56,percent of total billed charges,65% of total billed charges,108.08,35.67,,86.464,percent of total billed charges,35.67% of total billed charges,15.32,272.7,
PROTEIN URINE 24 HR,3006985,CDM,300,RC,84156,HCPCS,outpatient,,,57,22.80,,48.45,85,,38.76,percent of total billed charges,85% of total billed charges,43.89,77,,35.11,percent of total billed charges,77% of total billed charges,3.67,100,,,fee schedule,100% of CMS fee schedule,15.86,350,,,fee schedule,350% of BCBS fee schedule,16.49,364,,,fee schedule,364% of BCBS fee schedule,16.49,364,,,fee schedule,364% of BCBS fee schedule,16.49,364,,,fee schedule,364% of BCBS fee schedule,51.3,90,,41.04,percent of total billed charges,90% of total billed charges,45.6,80,,36.48,percent of total billed charges,80% of total billed charges,51.3,90,,41.04,percent of total billed charges,90% of total billed charges,42.75,75,,34.2,percent of total billed charges,75% of total billed charges,4.47,122,,,fee schedule,122% of APC rate,16.53,29,,13.224,percent of total billed charges,29% of total billed charges,3.67,100,,,fee schedule,100% of CMS fee schedule,38.19,67,,30.552,percent of total billed charges,67% of total billed charges,5.44,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,45.6,80,,36.48,percent of total billed charges,80% of total billed charges,37.05,65,,29.64,percent of total billed charges,65% of total billed charges,20.33,35.67,,16.264,percent of total billed charges,35.67% of total billed charges,3.67,51.3,
PROTHROMBIN TIME,3007000,CDM,300,RC,85610,HCPCS,outpatient,,,62,24.80,,52.7,85,,42.16,percent of total billed charges,85% of total billed charges,47.74,77,,38.19,percent of total billed charges,77% of total billed charges,4.29,100,,,fee schedule,100% of CMS fee schedule,16.98,350,,,fee schedule,350% of BCBS fee schedule,17.65,364,,,fee schedule,364% of BCBS fee schedule,17.65,364,,,fee schedule,364% of BCBS fee schedule,17.65,364,,,fee schedule,364% of BCBS fee schedule,55.8,90,,44.64,percent of total billed charges,90% of total billed charges,49.6,80,,39.68,percent of total billed charges,80% of total billed charges,55.8,90,,44.64,percent of total billed charges,90% of total billed charges,46.5,75,,37.2,percent of total billed charges,75% of total billed charges,5.23,122,,,fee schedule,122% of APC rate,17.98,29,,14.384,percent of total billed charges,29% of total billed charges,4.29,100,,,fee schedule,100% of CMS fee schedule,41.54,67,,33.232,percent of total billed charges,67% of total billed charges,5.83,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,49.6,80,,39.68,percent of total billed charges,80% of total billed charges,40.3,65,,32.24,percent of total billed charges,65% of total billed charges,22.12,35.67,,17.696,percent of total billed charges,35.67% of total billed charges,4.29,55.8,
PROTHROMBIN TIME REPEAT TODAY,3007001,CDM,300,RC,85610,HCPCS,outpatient,,,61,24.40,91,51.85,85,,41.48,percent of total billed charges,85% of total billed charges,46.97,77,,37.58,percent of total billed charges,77% of total billed charges,4.29,100,,,fee schedule,100% of CMS fee schedule,16.98,350,,,fee schedule,350% of BCBS fee schedule,17.65,364,,,fee schedule,364% of BCBS fee schedule,17.65,364,,,fee schedule,364% of BCBS fee schedule,17.65,364,,,fee schedule,364% of BCBS fee schedule,54.9,90,,43.92,percent of total billed charges,90% of total billed charges,48.8,80,,39.04,percent of total billed charges,80% of total billed charges,54.9,90,,43.92,percent of total billed charges,90% of total billed charges,45.75,75,,36.6,percent of total billed charges,75% of total billed charges,5.23,122,,,fee schedule,122% of APC rate,17.69,29,,14.152,percent of total billed charges,29% of total billed charges,4.29,100,,,fee schedule,100% of CMS fee schedule,40.87,67,,32.696,percent of total billed charges,67% of total billed charges,5.83,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,48.8,80,,39.04,percent of total billed charges,80% of total billed charges,39.65,65,,31.72,percent of total billed charges,65% of total billed charges,21.76,35.67,,17.408,percent of total billed charges,35.67% of total billed charges,4.29,54.9,
PARTIAL THROMBIN TIME,3007010,CDM,300,RC,85730,HCPCS,outpatient,,,85,34.00,,72.25,85,,57.8,percent of total billed charges,85% of total billed charges,65.45,77,,52.36,percent of total billed charges,77% of total billed charges,6.01,100,,,fee schedule,100% of CMS fee schedule,25.97,350,,,fee schedule,350% of BCBS fee schedule,27.01,364,,,fee schedule,364% of BCBS fee schedule,27.01,364,,,fee schedule,364% of BCBS fee schedule,27.01,364,,,fee schedule,364% of BCBS fee schedule,76.5,90,,61.2,percent of total billed charges,90% of total billed charges,68,80,,54.4,percent of total billed charges,80% of total billed charges,76.5,90,,61.2,percent of total billed charges,90% of total billed charges,63.75,75,,51,percent of total billed charges,75% of total billed charges,7.33,122,,,fee schedule,122% of APC rate,24.65,29,,19.72,percent of total billed charges,29% of total billed charges,6.01,100,,,fee schedule,100% of CMS fee schedule,56.95,67,,45.56,percent of total billed charges,67% of total billed charges,8.92,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,68,80,,54.4,percent of total billed charges,80% of total billed charges,55.25,65,,44.2,percent of total billed charges,65% of total billed charges,30.32,35.67,,24.256,percent of total billed charges,35.67% of total billed charges,6.01,76.5,
PTT  - REPEAT SAME DAY,3007011,CDM,300,RC,85730,HCPCS,outpatient,,,90,36.00,91,76.5,85,,61.2,percent of total billed charges,85% of total billed charges,69.3,77,,55.44,percent of total billed charges,77% of total billed charges,6.01,100,,,fee schedule,100% of CMS fee schedule,25.97,350,,,fee schedule,350% of BCBS fee schedule,27.01,364,,,fee schedule,364% of BCBS fee schedule,27.01,364,,,fee schedule,364% of BCBS fee schedule,27.01,364,,,fee schedule,364% of BCBS fee schedule,81,90,,64.8,percent of total billed charges,90% of total billed charges,72,80,,57.6,percent of total billed charges,80% of total billed charges,81,90,,64.8,percent of total billed charges,90% of total billed charges,67.5,75,,54,percent of total billed charges,75% of total billed charges,7.33,122,,,fee schedule,122% of APC rate,26.1,29,,20.88,percent of total billed charges,29% of total billed charges,6.01,100,,,fee schedule,100% of CMS fee schedule,60.3,67,,48.24,percent of total billed charges,67% of total billed charges,8.92,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,72,80,,57.6,percent of total billed charges,80% of total billed charges,58.5,65,,46.8,percent of total billed charges,65% of total billed charges,32.1,35.67,,25.68,percent of total billed charges,35.67% of total billed charges,6.01,81,
PROTOPORPHYRIN  (FEP),3007025,CDM,300,RC,84202,HCPCS,outpatient,,,84,33.60,,71.4,85,,57.12,percent of total billed charges,85% of total billed charges,64.68,77,,51.74,percent of total billed charges,77% of total billed charges,14.35,100,,,fee schedule,100% of CMS fee schedule,61.99,350,,,fee schedule,350% of BCBS fee schedule,64.46,364,,,fee schedule,364% of BCBS fee schedule,64.46,364,,,fee schedule,364% of BCBS fee schedule,64.46,364,,,fee schedule,364% of BCBS fee schedule,75.6,90,,60.48,percent of total billed charges,90% of total billed charges,67.2,80,,53.76,percent of total billed charges,80% of total billed charges,75.6,90,,60.48,percent of total billed charges,90% of total billed charges,63,75,,50.4,percent of total billed charges,75% of total billed charges,17.5,122,,,fee schedule,122% of APC rate,24.36,29,,19.488,percent of total billed charges,29% of total billed charges,14.35,100,,,fee schedule,100% of CMS fee schedule,56.28,67,,45.024,percent of total billed charges,67% of total billed charges,14.66,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,67.2,80,,53.76,percent of total billed charges,80% of total billed charges,54.6,65,,43.68,percent of total billed charges,65% of total billed charges,29.96,35.67,,23.968,percent of total billed charges,35.67% of total billed charges,14.35,75.6,
PROTOZOA FOR PANEL,3007026,CDM,300,RC,86753,HCPCS,outpatient,,,90,36.00,,76.5,85,,61.2,percent of total billed charges,85% of total billed charges,69.3,77,,55.44,percent of total billed charges,77% of total billed charges,12.39,100,,,fee schedule,100% of CMS fee schedule,53.52,350,,,fee schedule,350% of BCBS fee schedule,55.66,364,,,fee schedule,364% of BCBS fee schedule,55.66,364,,,fee schedule,364% of BCBS fee schedule,55.66,364,,,fee schedule,364% of BCBS fee schedule,81,90,,64.8,percent of total billed charges,90% of total billed charges,72,80,,57.6,percent of total billed charges,80% of total billed charges,81,90,,64.8,percent of total billed charges,90% of total billed charges,67.5,75,,54,percent of total billed charges,75% of total billed charges,15.11,122,,,fee schedule,122% of APC rate,26.1,29,,20.88,percent of total billed charges,29% of total billed charges,12.39,100,,,fee schedule,100% of CMS fee schedule,60.3,67,,48.24,percent of total billed charges,67% of total billed charges,8.64,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,72,80,,57.6,percent of total billed charges,80% of total billed charges,58.5,65,,46.8,percent of total billed charges,65% of total billed charges,32.1,35.67,,25.68,percent of total billed charges,35.67% of total billed charges,8.64,81,
PSITTACOSIS,3007030,CDM,300,RC,86317,HCPCS,outpatient,,,96,38.40,,81.6,85,,65.28,percent of total billed charges,85% of total billed charges,73.92,77,,59.14,percent of total billed charges,77% of total billed charges,14.99,100,,,fee schedule,100% of CMS fee schedule,64.75,350,,,fee schedule,350% of BCBS fee schedule,67.34,364,,,fee schedule,364% of BCBS fee schedule,67.34,364,,,fee schedule,364% of BCBS fee schedule,67.34,364,,,fee schedule,364% of BCBS fee schedule,86.4,90,,69.12,percent of total billed charges,90% of total billed charges,76.8,80,,61.44,percent of total billed charges,80% of total billed charges,86.4,90,,69.12,percent of total billed charges,90% of total billed charges,72,75,,57.6,percent of total billed charges,75% of total billed charges,18.28,122,,,fee schedule,122% of APC rate,27.84,29,,22.272,percent of total billed charges,29% of total billed charges,14.99,100,,,fee schedule,100% of CMS fee schedule,64.32,67,,51.456,percent of total billed charges,67% of total billed charges,22.3,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,76.8,80,,61.44,percent of total billed charges,80% of total billed charges,62.4,65,,49.92,percent of total billed charges,65% of total billed charges,34.24,35.67,,27.392,percent of total billed charges,35.67% of total billed charges,14.99,86.4,
"CULTURE,BACTERIAL; URINE",3007041,CDM,300,RC,87088,HCPCS,outpatient,,,130,52.00,,110.5,85,,88.4,percent of total billed charges,85% of total billed charges,100.1,77,,80.08,percent of total billed charges,77% of total billed charges,8.09,100,,,fee schedule,100% of CMS fee schedule,34.97,350,,,fee schedule,350% of BCBS fee schedule,36.36,364,,,fee schedule,364% of BCBS fee schedule,36.36,364,,,fee schedule,364% of BCBS fee schedule,36.36,364,,,fee schedule,364% of BCBS fee schedule,117,90,,93.6,percent of total billed charges,90% of total billed charges,104,80,,83.2,percent of total billed charges,80% of total billed charges,117,90,,93.6,percent of total billed charges,90% of total billed charges,97.5,75,,78,percent of total billed charges,75% of total billed charges,9.86,122,,,fee schedule,122% of APC rate,37.7,29,,30.16,percent of total billed charges,29% of total billed charges,8.09,100,,,fee schedule,100% of CMS fee schedule,87.1,67,,69.68,percent of total billed charges,67% of total billed charges,12.04,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,104,80,,83.2,percent of total billed charges,80% of total billed charges,84.5,65,,67.6,percent of total billed charges,65% of total billed charges,46.37,35.67,,37.096,percent of total billed charges,35.67% of total billed charges,8.09,117,
"CULTURE,BACTERIAL;BLOOD/STOOL",3007042,CDM,300,RC,87073,HCPCS,outpatient,,,210,84.00,,178.5,85,,142.8,percent of total billed charges,85% of total billed charges,161.7,77,,129.36,percent of total billed charges,77% of total billed charges,9.66,100,,,fee schedule,100% of CMS fee schedule,40.81,350,,,fee schedule,350% of BCBS fee schedule,42.44,364,,,fee schedule,364% of BCBS fee schedule,42.44,364,,,fee schedule,364% of BCBS fee schedule,42.44,364,,,fee schedule,364% of BCBS fee schedule,189,90,,151.2,percent of total billed charges,90% of total billed charges,168,80,,134.4,percent of total billed charges,80% of total billed charges,189,90,,151.2,percent of total billed charges,90% of total billed charges,157.5,75,,126,percent of total billed charges,75% of total billed charges,11.78,122,,,fee schedule,122% of APC rate,60.9,29,,48.72,percent of total billed charges,29% of total billed charges,9.66,100,,,fee schedule,100% of CMS fee schedule,140.7,67,,112.56,percent of total billed charges,67% of total billed charges,14.02,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,168,80,,134.4,percent of total billed charges,80% of total billed charges,136.5,65,,109.2,percent of total billed charges,65% of total billed charges,74.91,35.67,,59.928,percent of total billed charges,35.67% of total billed charges,9.66,189,
"CULTURE,INFECTIOUS DISEASE",3007043,CDM,300,RC,0086U,HCPCS,outpatient,,,863,345.20,,733.55,85,,586.84,percent of total billed charges,85% of total billed charges,664.51,77,,531.61,percent of total billed charges,77% of total billed charges,200,100,,,fee schedule,100% of CMS fee schedule,71.61,350,,,fee schedule,350% of BCBS fee schedule,74.47,364,,,fee schedule,364% of BCBS fee schedule,74.47,364,,,fee schedule,364% of BCBS fee schedule,74.47,364,,,fee schedule,364% of BCBS fee schedule,776.7,90,,621.36,percent of total billed charges,90% of total billed charges,690.4,80,,552.32,percent of total billed charges,80% of total billed charges,776.7,90,,621.36,percent of total billed charges,90% of total billed charges,647.25,75,,517.8,percent of total billed charges,75% of total billed charges,244,122,,,fee schedule,122% of APC rate,250.27,29,,200.216,percent of total billed charges,29% of total billed charges,200,100,,,fee schedule,100% of CMS fee schedule,578.21,67,,462.568,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,690.4,80,,552.32,percent of total billed charges,80% of total billed charges,560.95,65,,448.76,percent of total billed charges,65% of total billed charges,307.83,35.67,,246.264,percent of total billed charges,35.67% of total billed charges,71.61,776.7,
PYRUVIC ACID,3007085,CDM,300,RC,84210,HCPCS,outpatient,,,58,23.20,,49.3,85,,39.44,percent of total billed charges,85% of total billed charges,44.66,77,,35.73,percent of total billed charges,77% of total billed charges,14.48,100,,,fee schedule,100% of CMS fee schedule,50.68,350,,,fee schedule,350% of BCBS fee schedule,52.71,364,,,fee schedule,364% of BCBS fee schedule,52.71,364,,,fee schedule,364% of BCBS fee schedule,52.71,364,,,fee schedule,364% of BCBS fee schedule,52.2,90,,41.76,percent of total billed charges,90% of total billed charges,46.4,80,,37.12,percent of total billed charges,80% of total billed charges,52.2,90,,41.76,percent of total billed charges,90% of total billed charges,43.5,75,,34.8,percent of total billed charges,75% of total billed charges,17.66,122,,,fee schedule,122% of APC rate,16.82,29,,13.456,percent of total billed charges,29% of total billed charges,14.48,100,,,fee schedule,100% of CMS fee schedule,38.86,67,,31.088,percent of total billed charges,67% of total billed charges,16.13,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,46.4,80,,37.12,percent of total billed charges,80% of total billed charges,37.7,65,,30.16,percent of total billed charges,65% of total billed charges,20.69,35.67,,16.552,percent of total billed charges,35.67% of total billed charges,14.48,52.71,
PYRUVATE DEHYDROGENASE,3007086,CDM,300,RC,84210,HCPCS,outpatient,,,155,62.00,,131.75,85,,105.4,percent of total billed charges,85% of total billed charges,119.35,77,,95.48,percent of total billed charges,77% of total billed charges,14.48,100,,,fee schedule,100% of CMS fee schedule,50.68,350,,,fee schedule,350% of BCBS fee schedule,52.71,364,,,fee schedule,364% of BCBS fee schedule,52.71,364,,,fee schedule,364% of BCBS fee schedule,52.71,364,,,fee schedule,364% of BCBS fee schedule,139.5,90,,111.6,percent of total billed charges,90% of total billed charges,124,80,,99.2,percent of total billed charges,80% of total billed charges,139.5,90,,111.6,percent of total billed charges,90% of total billed charges,116.25,75,,93,percent of total billed charges,75% of total billed charges,17.66,122,,,fee schedule,122% of APC rate,44.95,29,,35.96,percent of total billed charges,29% of total billed charges,14.48,100,,,fee schedule,100% of CMS fee schedule,103.85,67,,83.08,percent of total billed charges,67% of total billed charges,16.13,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,124,80,,99.2,percent of total billed charges,80% of total billed charges,100.75,65,,80.6,percent of total billed charges,65% of total billed charges,55.29,35.67,,44.232,percent of total billed charges,35.67% of total billed charges,14.48,139.5,
QUINIDINE,3007100,CDM,300,RC,80194,HCPCS,outpatient,,,73,29.20,,62.05,85,,49.64,percent of total billed charges,85% of total billed charges,56.21,77,,44.97,percent of total billed charges,77% of total billed charges,14.6,100,,,fee schedule,100% of CMS fee schedule,63.11,350,,,fee schedule,350% of BCBS fee schedule,65.63,364,,,fee schedule,364% of BCBS fee schedule,65.63,364,,,fee schedule,364% of BCBS fee schedule,65.63,364,,,fee schedule,364% of BCBS fee schedule,65.7,90,,52.56,percent of total billed charges,90% of total billed charges,58.4,80,,46.72,percent of total billed charges,80% of total billed charges,65.7,90,,52.56,percent of total billed charges,90% of total billed charges,54.75,75,,43.8,percent of total billed charges,75% of total billed charges,17.81,122,,,fee schedule,122% of APC rate,21.17,29,,16.936,percent of total billed charges,29% of total billed charges,14.6,100,,,fee schedule,100% of CMS fee schedule,48.91,67,,39.128,percent of total billed charges,67% of total billed charges,21.71,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,58.4,80,,46.72,percent of total billed charges,80% of total billed charges,47.45,65,,37.96,percent of total billed charges,65% of total billed charges,26.04,35.67,,20.832,percent of total billed charges,35.67% of total billed charges,14.6,65.7,
QUANTIFERON,3007102,CDM,300,RC,86480,HCPCS,outpatient,,,307,122.80,,260.95,85,,208.76,percent of total billed charges,85% of total billed charges,236.39,77,,189.11,percent of total billed charges,77% of total billed charges,61.98,100,,,fee schedule,100% of CMS fee schedule,267.82,350,,,fee schedule,350% of BCBS fee schedule,278.53,364,,,fee schedule,364% of BCBS fee schedule,278.53,364,,,fee schedule,364% of BCBS fee schedule,278.53,364,,,fee schedule,364% of BCBS fee schedule,276.3,90,,221.04,percent of total billed charges,90% of total billed charges,245.6,80,,196.48,percent of total billed charges,80% of total billed charges,276.3,90,,221.04,percent of total billed charges,90% of total billed charges,230.25,75,,184.2,percent of total billed charges,75% of total billed charges,75.61,122,,,fee schedule,122% of APC rate,89.03,29,,71.224,percent of total billed charges,29% of total billed charges,61.98,100,,,fee schedule,100% of CMS fee schedule,205.69,67,,164.552,percent of total billed charges,67% of total billed charges,92.17,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,245.6,80,,196.48,percent of total billed charges,80% of total billed charges,199.55,65,,159.64,percent of total billed charges,65% of total billed charges,109.51,35.67,,87.608,percent of total billed charges,35.67% of total billed charges,61.98,278.53,
RAPID PLASMA REAGIN,3007120,CDM,300,RC,86592,HCPCS,outpatient,,,60,24.00,,51,85,,40.8,percent of total billed charges,85% of total billed charges,46.2,77,,36.96,percent of total billed charges,77% of total billed charges,4.26,100,,,fee schedule,100% of CMS fee schedule,18.45,350,,,fee schedule,350% of BCBS fee schedule,19.18,364,,,fee schedule,364% of BCBS fee schedule,19.18,364,,,fee schedule,364% of BCBS fee schedule,19.18,364,,,fee schedule,364% of BCBS fee schedule,54,90,,43.2,percent of total billed charges,90% of total billed charges,48,80,,38.4,percent of total billed charges,80% of total billed charges,54,90,,43.2,percent of total billed charges,90% of total billed charges,45,75,,36,percent of total billed charges,75% of total billed charges,5.2,122,,,fee schedule,122% of APC rate,17.4,29,,13.92,percent of total billed charges,29% of total billed charges,4.26,100,,,fee schedule,100% of CMS fee schedule,40.2,67,,32.16,percent of total billed charges,67% of total billed charges,6.35,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,48,80,,38.4,percent of total billed charges,80% of total billed charges,39,65,,31.2,percent of total billed charges,65% of total billed charges,21.4,35.67,,17.12,percent of total billed charges,35.67% of total billed charges,4.26,54,
RAPAMUNE,3007121,CDM,300,RC,80299,HCPCS,outpatient,,,190,76.00,,161.5,85,,129.2,percent of total billed charges,85% of total billed charges,146.3,77,,117.04,percent of total billed charges,77% of total billed charges,18.64,100,,,fee schedule,100% of CMS fee schedule,65.24,350,,,fee schedule,350% of BCBS fee schedule,67.85,364,,,fee schedule,364% of BCBS fee schedule,67.85,364,,,fee schedule,364% of BCBS fee schedule,67.85,364,,,fee schedule,364% of BCBS fee schedule,171,90,,136.8,percent of total billed charges,90% of total billed charges,152,80,,121.6,percent of total billed charges,80% of total billed charges,171,90,,136.8,percent of total billed charges,90% of total billed charges,142.5,75,,114,percent of total billed charges,75% of total billed charges,22.74,122,,,fee schedule,122% of APC rate,55.1,29,,44.08,percent of total billed charges,29% of total billed charges,18.64,100,,,fee schedule,100% of CMS fee schedule,127.3,67,,101.84,percent of total billed charges,67% of total billed charges,20.36,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,152,80,,121.6,percent of total billed charges,80% of total billed charges,123.5,65,,98.8,percent of total billed charges,65% of total billed charges,67.77,35.67,,54.216,percent of total billed charges,35.67% of total billed charges,18.64,171,
ALLERGEN SPECIFIC IGE EACH,3007141,CDM,300,RC,86003,HCPCS,outpatient,,,96,38.40,,81.6,85,,65.28,percent of total billed charges,85% of total billed charges,73.92,77,,59.14,percent of total billed charges,77% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,22.54,350,,,fee schedule,350% of BCBS fee schedule,23.44,364,,,fee schedule,364% of BCBS fee schedule,23.44,364,,,fee schedule,364% of BCBS fee schedule,23.44,364,,,fee schedule,364% of BCBS fee schedule,86.4,90,,69.12,percent of total billed charges,90% of total billed charges,76.8,80,,61.44,percent of total billed charges,80% of total billed charges,86.4,90,,69.12,percent of total billed charges,90% of total billed charges,72,75,,57.6,percent of total billed charges,75% of total billed charges,6.36,122,,,fee schedule,122% of APC rate,27.84,29,,22.272,percent of total billed charges,29% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,64.32,67,,51.456,percent of total billed charges,67% of total billed charges,7.42,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,76.8,80,,61.44,percent of total billed charges,80% of total billed charges,62.4,65,,49.92,percent of total billed charges,65% of total billed charges,34.24,35.67,,27.392,percent of total billed charges,35.67% of total billed charges,5.22,86.4,
RBC FOLATE,3007145,CDM,300,RC,82747,HCPCS,outpatient,,,125,50.00,,106.25,85,,85,percent of total billed charges,85% of total billed charges,96.25,77,,77,percent of total billed charges,77% of total billed charges,17.64,100,,,fee schedule,100% of CMS fee schedule,74.83,350,,,fee schedule,350% of BCBS fee schedule,77.82,364,,,fee schedule,364% of BCBS fee schedule,77.82,364,,,fee schedule,364% of BCBS fee schedule,77.82,364,,,fee schedule,364% of BCBS fee schedule,112.5,90,,90,percent of total billed charges,90% of total billed charges,100,80,,80,percent of total billed charges,80% of total billed charges,112.5,90,,90,percent of total billed charges,90% of total billed charges,93.75,75,,75,percent of total billed charges,75% of total billed charges,21.53,122,,,fee schedule,122% of APC rate,36.25,29,,29,percent of total billed charges,29% of total billed charges,17.64,100,,,fee schedule,100% of CMS fee schedule,83.75,67,,67,percent of total billed charges,67% of total billed charges,17.31,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,100,80,,80,percent of total billed charges,80% of total billed charges,81.25,65,,65,percent of total billed charges,65% of total billed charges,44.59,35.67,,35.672,percent of total billed charges,35.67% of total billed charges,17.31,112.5,
RBC MAGNESIUM,3007146,CDM,300,RC,83735,HCPCS,outpatient,,,97,38.80,,82.45,85,,65.96,percent of total billed charges,85% of total billed charges,74.69,77,,59.75,percent of total billed charges,77% of total billed charges,6.7,100,,,fee schedule,100% of CMS fee schedule,28.95,350,,,fee schedule,350% of BCBS fee schedule,30.1,364,,,fee schedule,364% of BCBS fee schedule,30.1,364,,,fee schedule,364% of BCBS fee schedule,30.1,364,,,fee schedule,364% of BCBS fee schedule,87.3,90,,69.84,percent of total billed charges,90% of total billed charges,77.6,80,,62.08,percent of total billed charges,80% of total billed charges,87.3,90,,69.84,percent of total billed charges,90% of total billed charges,72.75,75,,58.2,percent of total billed charges,75% of total billed charges,8.17,122,,,fee schedule,122% of APC rate,28.13,29,,22.504,percent of total billed charges,29% of total billed charges,6.7,100,,,fee schedule,100% of CMS fee schedule,64.99,67,,51.992,percent of total billed charges,67% of total billed charges,9.96,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,77.6,80,,62.08,percent of total billed charges,80% of total billed charges,63.05,65,,50.44,percent of total billed charges,65% of total billed charges,34.6,35.67,,27.68,percent of total billed charges,35.67% of total billed charges,6.7,87.3,
RENIN,3007160,CDM,300,RC,84244,HCPCS,outpatient,,,120,48.00,,102,85,,81.6,percent of total billed charges,85% of total billed charges,92.4,77,,73.92,percent of total billed charges,77% of total billed charges,21.99,100,,,fee schedule,100% of CMS fee schedule,95.03,350,,,fee schedule,350% of BCBS fee schedule,98.83,364,,,fee schedule,364% of BCBS fee schedule,98.83,364,,,fee schedule,364% of BCBS fee schedule,98.83,364,,,fee schedule,364% of BCBS fee schedule,108,90,,86.4,percent of total billed charges,90% of total billed charges,96,80,,76.8,percent of total billed charges,80% of total billed charges,108,90,,86.4,percent of total billed charges,90% of total billed charges,90,75,,72,percent of total billed charges,75% of total billed charges,26.82,122,,,fee schedule,122% of APC rate,34.8,29,,27.84,percent of total billed charges,29% of total billed charges,21.99,100,,,fee schedule,100% of CMS fee schedule,80.4,67,,64.32,percent of total billed charges,67% of total billed charges,32.7,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,96,80,,76.8,percent of total billed charges,80% of total billed charges,78,65,,62.4,percent of total billed charges,65% of total billed charges,42.8,35.67,,34.24,percent of total billed charges,35.67% of total billed charges,21.99,108,
RENAL FUNCTION PANEL,3007165,CDM,300,RC,80069,HCPCS,outpatient,,,141,56.40,,119.85,85,,95.88,percent of total billed charges,85% of total billed charges,108.57,77,,86.86,percent of total billed charges,77% of total billed charges,8.68,100,,,fee schedule,100% of CMS fee schedule,37.52,350,,,fee schedule,350% of BCBS fee schedule,39.02,364,,,fee schedule,364% of BCBS fee schedule,39.02,364,,,fee schedule,364% of BCBS fee schedule,39.02,364,,,fee schedule,364% of BCBS fee schedule,126.9,90,,101.52,percent of total billed charges,90% of total billed charges,112.8,80,,90.24,percent of total billed charges,80% of total billed charges,126.9,90,,101.52,percent of total billed charges,90% of total billed charges,105.75,75,,84.6,percent of total billed charges,75% of total billed charges,10.58,122,,,fee schedule,122% of APC rate,40.89,29,,32.712,percent of total billed charges,29% of total billed charges,8.68,100,,,fee schedule,100% of CMS fee schedule,94.47,67,,75.576,percent of total billed charges,67% of total billed charges,11.91,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,112.8,80,,90.24,percent of total billed charges,80% of total billed charges,91.65,65,,73.32,percent of total billed charges,65% of total billed charges,50.29,35.67,,40.232,percent of total billed charges,35.67% of total billed charges,8.68,126.9,
LIPOPROTEIN SUBSET ANALYSIS,3007166,CDM,300,RC,83704,HCPCS,outpatient,,,137,54.80,,116.45,85,,93.16,percent of total billed charges,85% of total billed charges,105.49,77,,84.39,percent of total billed charges,77% of total billed charges,34.19,100,,,fee schedule,100% of CMS fee schedule,136.33,350,,,fee schedule,350% of BCBS fee schedule,141.78,364,,,fee schedule,364% of BCBS fee schedule,141.78,364,,,fee schedule,364% of BCBS fee schedule,141.78,364,,,fee schedule,364% of BCBS fee schedule,123.3,90,,98.64,percent of total billed charges,90% of total billed charges,109.6,80,,87.68,percent of total billed charges,80% of total billed charges,123.3,90,,98.64,percent of total billed charges,90% of total billed charges,102.75,75,,82.2,percent of total billed charges,75% of total billed charges,41.71,122,,,fee schedule,122% of APC rate,39.73,29,,31.784,percent of total billed charges,29% of total billed charges,34.19,100,,,fee schedule,100% of CMS fee schedule,91.79,67,,73.432,percent of total billed charges,67% of total billed charges,30.24,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,109.6,80,,87.68,percent of total billed charges,80% of total billed charges,89.05,65,,71.24,percent of total billed charges,65% of total billed charges,48.87,35.67,,39.096,percent of total billed charges,35.67% of total billed charges,30.24,141.78,
FRUCTOSAMINE,3007167,CDM,300,RC,82985,HCPCS,outpatient,,,77,30.80,,65.45,85,,52.36,percent of total billed charges,85% of total billed charges,59.29,77,,47.43,percent of total billed charges,77% of total billed charges,16.76,100,,,fee schedule,100% of CMS fee schedule,65.14,350,,,fee schedule,350% of BCBS fee schedule,67.74,364,,,fee schedule,364% of BCBS fee schedule,67.74,364,,,fee schedule,364% of BCBS fee schedule,67.74,364,,,fee schedule,364% of BCBS fee schedule,69.3,90,,55.44,percent of total billed charges,90% of total billed charges,61.6,80,,49.28,percent of total billed charges,80% of total billed charges,69.3,90,,55.44,percent of total billed charges,90% of total billed charges,57.75,75,,46.2,percent of total billed charges,75% of total billed charges,20.44,122,,,fee schedule,122% of APC rate,22.33,29,,17.864,percent of total billed charges,29% of total billed charges,16.76,100,,,fee schedule,100% of CMS fee schedule,51.59,67,,41.272,percent of total billed charges,67% of total billed charges,22.41,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,61.6,80,,49.28,percent of total billed charges,80% of total billed charges,50.05,65,,40.04,percent of total billed charges,65% of total billed charges,27.47,35.67,,21.976,percent of total billed charges,35.67% of total billed charges,16.76,69.3,
INSULIN AB,3007168,CDM,300,RC,86337,HCPCS,outpatient,,,136,54.40,,115.6,85,,92.48,percent of total billed charges,85% of total billed charges,104.72,77,,83.78,percent of total billed charges,77% of total billed charges,21.41,100,,,fee schedule,100% of CMS fee schedule,92.51,350,,,fee schedule,350% of BCBS fee schedule,96.21,364,,,fee schedule,364% of BCBS fee schedule,96.21,364,,,fee schedule,364% of BCBS fee schedule,96.21,364,,,fee schedule,364% of BCBS fee schedule,122.4,90,,97.92,percent of total billed charges,90% of total billed charges,108.8,80,,87.04,percent of total billed charges,80% of total billed charges,122.4,90,,97.92,percent of total billed charges,90% of total billed charges,102,75,,81.6,percent of total billed charges,75% of total billed charges,26.12,122,,,fee schedule,122% of APC rate,39.44,29,,31.552,percent of total billed charges,29% of total billed charges,21.41,100,,,fee schedule,100% of CMS fee schedule,91.12,67,,72.896,percent of total billed charges,67% of total billed charges,31.84,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,108.8,80,,87.04,percent of total billed charges,80% of total billed charges,88.4,65,,70.72,percent of total billed charges,65% of total billed charges,48.51,35.67,,38.808,percent of total billed charges,35.67% of total billed charges,21.41,122.4,
GAD-65,3007169,CDM,300,RC,86341,HCPCS,outpatient,,,160,64.00,,136,85,,108.8,percent of total billed charges,85% of total billed charges,123.2,77,,98.56,percent of total billed charges,77% of total billed charges,23.57,100,,,fee schedule,100% of CMS fee schedule,85.51,350,,,fee schedule,350% of BCBS fee schedule,88.93,364,,,fee schedule,364% of BCBS fee schedule,88.93,364,,,fee schedule,364% of BCBS fee schedule,88.93,364,,,fee schedule,364% of BCBS fee schedule,144,90,,115.2,percent of total billed charges,90% of total billed charges,128,80,,102.4,percent of total billed charges,80% of total billed charges,144,90,,115.2,percent of total billed charges,90% of total billed charges,120,75,,96,percent of total billed charges,75% of total billed charges,28.75,122,,,fee schedule,122% of APC rate,46.4,29,,37.12,percent of total billed charges,29% of total billed charges,23.57,100,,,fee schedule,100% of CMS fee schedule,107.2,67,,85.76,percent of total billed charges,67% of total billed charges,29.42,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,128,80,,102.4,percent of total billed charges,80% of total billed charges,104,65,,83.2,percent of total billed charges,65% of total billed charges,57.07,35.67,,45.656,percent of total billed charges,35.67% of total billed charges,23.57,144,
BETA-HYDROXYBUTYRIC ACID,3007170,CDM,300,RC,82010,HCPCS,outpatient,,,83,33.20,,70.55,85,,56.44,percent of total billed charges,85% of total billed charges,63.91,77,,51.13,percent of total billed charges,77% of total billed charges,8.17,100,,,fee schedule,100% of CMS fee schedule,35.32,350,,,fee schedule,350% of BCBS fee schedule,36.73,364,,,fee schedule,364% of BCBS fee schedule,36.73,364,,,fee schedule,364% of BCBS fee schedule,36.73,364,,,fee schedule,364% of BCBS fee schedule,74.7,90,,59.76,percent of total billed charges,90% of total billed charges,66.4,80,,53.12,percent of total billed charges,80% of total billed charges,74.7,90,,59.76,percent of total billed charges,90% of total billed charges,62.25,75,,49.8,percent of total billed charges,75% of total billed charges,9.96,122,,,fee schedule,122% of APC rate,24.07,29,,19.256,percent of total billed charges,29% of total billed charges,8.17,100,,,fee schedule,100% of CMS fee schedule,55.61,67,,44.488,percent of total billed charges,67% of total billed charges,12.14,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,66.4,80,,53.12,percent of total billed charges,80% of total billed charges,53.95,65,,43.16,percent of total billed charges,65% of total billed charges,29.61,35.67,,23.688,percent of total billed charges,35.67% of total billed charges,8.17,74.7,
PROINSULIN,3007171,CDM,300,RC,84206,HCPCS,outpatient,,,127,50.80,,107.95,85,,86.36,percent of total billed charges,85% of total billed charges,97.79,77,,78.23,percent of total billed charges,77% of total billed charges,26.69,100,,,fee schedule,100% of CMS fee schedule,93.42,350,,,fee schedule,350% of BCBS fee schedule,97.15,364,,,fee schedule,364% of BCBS fee schedule,97.15,364,,,fee schedule,364% of BCBS fee schedule,97.15,364,,,fee schedule,364% of BCBS fee schedule,114.3,90,,91.44,percent of total billed charges,90% of total billed charges,101.6,80,,81.28,percent of total billed charges,80% of total billed charges,114.3,90,,91.44,percent of total billed charges,90% of total billed charges,95.25,75,,76.2,percent of total billed charges,75% of total billed charges,32.56,122,,,fee schedule,122% of APC rate,36.83,29,,29.464,percent of total billed charges,29% of total billed charges,26.69,100,,,fee schedule,100% of CMS fee schedule,85.09,67,,68.072,percent of total billed charges,67% of total billed charges,26.49,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,101.6,80,,81.28,percent of total billed charges,80% of total billed charges,82.55,65,,66.04,percent of total billed charges,65% of total billed charges,45.3,35.67,,36.24,percent of total billed charges,35.67% of total billed charges,26.49,114.3,
IGF-II,3007172,CDM,300,RC,83519,HCPCS,outpatient,,,361,144.40,,306.85,85,,245.48,percent of total billed charges,85% of total billed charges,277.97,77,,222.38,percent of total billed charges,77% of total billed charges,18.39,100,,,fee schedule,100% of CMS fee schedule,64.4,350,,,fee schedule,350% of BCBS fee schedule,66.98,364,,,fee schedule,364% of BCBS fee schedule,66.98,364,,,fee schedule,364% of BCBS fee schedule,66.98,364,,,fee schedule,364% of BCBS fee schedule,324.9,90,,259.92,percent of total billed charges,90% of total billed charges,288.8,80,,231.04,percent of total billed charges,80% of total billed charges,324.9,90,,259.92,percent of total billed charges,90% of total billed charges,270.75,75,,216.6,percent of total billed charges,75% of total billed charges,22.44,122,,,fee schedule,122% of APC rate,104.69,29,,83.752,percent of total billed charges,29% of total billed charges,18.39,100,,,fee schedule,100% of CMS fee schedule,241.87,67,,193.496,percent of total billed charges,67% of total billed charges,20.09,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,288.8,80,,231.04,percent of total billed charges,80% of total billed charges,234.65,65,,187.72,percent of total billed charges,65% of total billed charges,128.77,35.67,,103.016,percent of total billed charges,35.67% of total billed charges,18.39,324.9,
THYROID RECEPTOR AB,3007173,CDM,300,RC,83520,HCPCS,outpatient,,,216,86.40,,183.6,85,,146.88,percent of total billed charges,85% of total billed charges,166.32,77,,133.06,percent of total billed charges,77% of total billed charges,17.27,100,,,fee schedule,100% of CMS fee schedule,60.45,350,,,fee schedule,350% of BCBS fee schedule,62.86,364,,,fee schedule,364% of BCBS fee schedule,62.86,364,,,fee schedule,364% of BCBS fee schedule,62.86,364,,,fee schedule,364% of BCBS fee schedule,194.4,90,,155.52,percent of total billed charges,90% of total billed charges,172.8,80,,138.24,percent of total billed charges,80% of total billed charges,194.4,90,,155.52,percent of total billed charges,90% of total billed charges,162,75,,129.6,percent of total billed charges,75% of total billed charges,21.06,122,,,fee schedule,122% of APC rate,62.64,29,,50.112,percent of total billed charges,29% of total billed charges,17.27,100,,,fee schedule,100% of CMS fee schedule,144.72,67,,115.776,percent of total billed charges,67% of total billed charges,19.25,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,172.8,80,,138.24,percent of total billed charges,80% of total billed charges,140.4,65,,112.32,percent of total billed charges,65% of total billed charges,77.05,35.67,,61.64,percent of total billed charges,35.67% of total billed charges,17.27,194.4,
ALPHA SUBUNIT,3007174,CDM,300,RC,82397,HCPCS,outpatient,,,226,90.40,,192.1,85,,153.68,percent of total billed charges,85% of total billed charges,174.02,77,,139.22,percent of total billed charges,77% of total billed charges,14.12,100,,,fee schedule,100% of CMS fee schedule,61.01,350,,,fee schedule,350% of BCBS fee schedule,63.45,364,,,fee schedule,364% of BCBS fee schedule,63.45,364,,,fee schedule,364% of BCBS fee schedule,63.45,364,,,fee schedule,364% of BCBS fee schedule,203.4,90,,162.72,percent of total billed charges,90% of total billed charges,180.8,80,,144.64,percent of total billed charges,80% of total billed charges,203.4,90,,162.72,percent of total billed charges,90% of total billed charges,169.5,75,,135.6,percent of total billed charges,75% of total billed charges,17.22,122,,,fee schedule,122% of APC rate,65.54,29,,52.432,percent of total billed charges,29% of total billed charges,14.12,100,,,fee schedule,100% of CMS fee schedule,151.42,67,,121.136,percent of total billed charges,67% of total billed charges,21.01,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,180.8,80,,144.64,percent of total billed charges,80% of total billed charges,146.9,65,,117.52,percent of total billed charges,65% of total billed charges,80.61,35.67,,64.488,percent of total billed charges,35.67% of total billed charges,14.12,203.4,
"H PYLORI AG, STOOL",3007175,CDM,300,RC,87338,HCPCS,outpatient,,,129,51.60,,109.65,85,,87.72,percent of total billed charges,85% of total billed charges,99.33,77,,79.46,percent of total billed charges,77% of total billed charges,14.38,100,,,fee schedule,100% of CMS fee schedule,62.16,350,,,fee schedule,350% of BCBS fee schedule,64.65,364,,,fee schedule,364% of BCBS fee schedule,64.65,364,,,fee schedule,364% of BCBS fee schedule,64.65,364,,,fee schedule,364% of BCBS fee schedule,116.1,90,,92.88,percent of total billed charges,90% of total billed charges,103.2,80,,82.56,percent of total billed charges,80% of total billed charges,116.1,90,,92.88,percent of total billed charges,90% of total billed charges,96.75,75,,77.4,percent of total billed charges,75% of total billed charges,17.54,122,,,fee schedule,122% of APC rate,37.41,29,,29.928,percent of total billed charges,29% of total billed charges,14.38,100,,,fee schedule,100% of CMS fee schedule,86.43,67,,69.144,percent of total billed charges,67% of total billed charges,21.38,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,103.2,80,,82.56,percent of total billed charges,80% of total billed charges,83.85,65,,67.08,percent of total billed charges,65% of total billed charges,46.01,35.67,,36.808,percent of total billed charges,35.67% of total billed charges,14.38,116.1,
IGF-1,3007176,CDM,300,RC,84305,HCPCS,outpatient,,,115,46.00,,97.75,85,,78.2,percent of total billed charges,85% of total billed charges,88.55,77,,70.84,percent of total billed charges,77% of total billed charges,21.26,100,,,fee schedule,100% of CMS fee schedule,91.88,350,,,fee schedule,350% of BCBS fee schedule,95.55,364,,,fee schedule,364% of BCBS fee schedule,95.55,364,,,fee schedule,364% of BCBS fee schedule,95.55,364,,,fee schedule,364% of BCBS fee schedule,103.5,90,,82.8,percent of total billed charges,90% of total billed charges,92,80,,73.6,percent of total billed charges,80% of total billed charges,103.5,90,,82.8,percent of total billed charges,90% of total billed charges,86.25,75,,69,percent of total billed charges,75% of total billed charges,25.93,122,,,fee schedule,122% of APC rate,33.35,29,,26.68,percent of total billed charges,29% of total billed charges,21.26,100,,,fee schedule,100% of CMS fee schedule,77.05,67,,61.64,percent of total billed charges,67% of total billed charges,31.61,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,92,80,,73.6,percent of total billed charges,80% of total billed charges,74.75,65,,59.8,percent of total billed charges,65% of total billed charges,41.02,35.67,,32.816,percent of total billed charges,35.67% of total billed charges,21.26,103.5,
PTH RELATED PEPTIDE,3007177,CDM,300,RC,82523,HCPCS,outpatient,,,197,78.80,,167.45,85,,133.96,percent of total billed charges,85% of total billed charges,151.69,77,,121.35,percent of total billed charges,77% of total billed charges,18.68,100,,,fee schedule,100% of CMS fee schedule,80.75,350,,,fee schedule,350% of BCBS fee schedule,83.97,364,,,fee schedule,364% of BCBS fee schedule,83.97,364,,,fee schedule,364% of BCBS fee schedule,83.97,364,,,fee schedule,364% of BCBS fee schedule,177.3,90,,141.84,percent of total billed charges,90% of total billed charges,157.6,80,,126.08,percent of total billed charges,80% of total billed charges,177.3,90,,141.84,percent of total billed charges,90% of total billed charges,147.75,75,,118.2,percent of total billed charges,75% of total billed charges,22.78,122,,,fee schedule,122% of APC rate,57.13,29,,45.704,percent of total billed charges,29% of total billed charges,18.68,100,,,fee schedule,100% of CMS fee schedule,131.99,67,,105.592,percent of total billed charges,67% of total billed charges,27.8,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,157.6,80,,126.08,percent of total billed charges,80% of total billed charges,128.05,65,,102.44,percent of total billed charges,65% of total billed charges,70.27,35.67,,56.216,percent of total billed charges,35.67% of total billed charges,18.68,177.3,
"N-TELOPEPTIDE,CROSSLINKED SER.",3007178,CDM,300,RC,82523,HCPCS,outpatient,,,415,166.00,,352.75,85,,282.2,percent of total billed charges,85% of total billed charges,319.55,77,,255.64,percent of total billed charges,77% of total billed charges,18.68,100,,,fee schedule,100% of CMS fee schedule,80.75,350,,,fee schedule,350% of BCBS fee schedule,83.97,364,,,fee schedule,364% of BCBS fee schedule,83.97,364,,,fee schedule,364% of BCBS fee schedule,83.97,364,,,fee schedule,364% of BCBS fee schedule,373.5,90,,298.8,percent of total billed charges,90% of total billed charges,332,80,,265.6,percent of total billed charges,80% of total billed charges,373.5,90,,298.8,percent of total billed charges,90% of total billed charges,311.25,75,,249,percent of total billed charges,75% of total billed charges,22.78,122,,,fee schedule,122% of APC rate,120.35,29,,96.28,percent of total billed charges,29% of total billed charges,18.68,100,,,fee schedule,100% of CMS fee schedule,278.05,67,,222.44,percent of total billed charges,67% of total billed charges,27.8,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,332,80,,265.6,percent of total billed charges,80% of total billed charges,269.75,65,,215.8,percent of total billed charges,65% of total billed charges,148.03,35.67,,118.424,percent of total billed charges,35.67% of total billed charges,18.68,373.5,
RETICULOCYTE COUNT,3007180,CDM,300,RC,85045,HCPCS,outpatient,,,45,18.00,,38.25,85,,30.6,percent of total billed charges,85% of total billed charges,34.65,77,,27.72,percent of total billed charges,77% of total billed charges,3.99,100,,,fee schedule,100% of CMS fee schedule,17.26,350,,,fee schedule,350% of BCBS fee schedule,17.95,364,,,fee schedule,364% of BCBS fee schedule,17.95,364,,,fee schedule,364% of BCBS fee schedule,17.95,364,,,fee schedule,364% of BCBS fee schedule,40.5,90,,32.4,percent of total billed charges,90% of total billed charges,36,80,,28.8,percent of total billed charges,80% of total billed charges,40.5,90,,32.4,percent of total billed charges,90% of total billed charges,33.75,75,,27,percent of total billed charges,75% of total billed charges,4.86,122,,,fee schedule,122% of APC rate,13.05,29,,10.44,percent of total billed charges,29% of total billed charges,3.99,100,,,fee schedule,100% of CMS fee schedule,30.15,67,,24.12,percent of total billed charges,67% of total billed charges,5.95,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,36,80,,28.8,percent of total billed charges,80% of total billed charges,29.25,65,,23.4,percent of total billed charges,65% of total billed charges,16.05,35.67,,12.84,percent of total billed charges,35.67% of total billed charges,3.99,40.5,
RETICULOCYTE SEPARATION,3007181,CDM,300,RC,85046,HCPCS,outpatient,,,96,38.40,,81.6,85,,65.28,percent of total billed charges,85% of total billed charges,73.92,77,,59.14,percent of total billed charges,77% of total billed charges,5.57,100,,,fee schedule,100% of CMS fee schedule,24.08,350,,,fee schedule,350% of BCBS fee schedule,25.04,364,,,fee schedule,364% of BCBS fee schedule,25.04,364,,,fee schedule,364% of BCBS fee schedule,25.04,364,,,fee schedule,364% of BCBS fee schedule,86.4,90,,69.12,percent of total billed charges,90% of total billed charges,76.8,80,,61.44,percent of total billed charges,80% of total billed charges,86.4,90,,69.12,percent of total billed charges,90% of total billed charges,72,75,,57.6,percent of total billed charges,75% of total billed charges,6.79,122,,,fee schedule,122% of APC rate,27.84,29,,22.272,percent of total billed charges,29% of total billed charges,5.57,100,,,fee schedule,100% of CMS fee schedule,64.32,67,,51.456,percent of total billed charges,67% of total billed charges,8.29,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,76.8,80,,61.44,percent of total billed charges,80% of total billed charges,62.4,65,,49.92,percent of total billed charges,65% of total billed charges,34.24,35.67,,27.392,percent of total billed charges,35.67% of total billed charges,5.57,86.4,
REVERSE T,3007185,CDM,300,RC,,,outpatient,,,51,20.40,,43.35,85,,34.68,percent of total billed charges,85% of total billed charges,39.27,77,,31.42,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,41.82,82,,33.456,percent of total billed charges,82% of total billed charges,43.35,85,,34.68,percent of total billed charges,85% of total billed charges,43.35,85,,34.68,percent of total billed charges,85% of total billed charges,43.35,85,,34.68,percent of total billed charges,85% of total billed charges,45.9,90,,36.72,percent of total billed charges,90% of total billed charges,40.8,80,,32.64,percent of total billed charges,80% of total billed charges,45.9,90,,36.72,percent of total billed charges,90% of total billed charges,38.25,75,,30.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,14.79,29,,11.832,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,34.17,67,,27.336,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,40.8,80,,32.64,percent of total billed charges,80% of total billed charges,33.15,65,,26.52,percent of total billed charges,65% of total billed charges,18.19,35.67,,14.552,percent of total billed charges,35.67% of total billed charges,14.79,45.9,
REVERSE TRIIDOTHYRONIN,3007186,CDM,300,RC,84482,HCPCS,outpatient,,,159,63.60,,135.15,85,,108.12,percent of total billed charges,85% of total billed charges,122.43,77,,97.94,percent of total billed charges,77% of total billed charges,15.76,100,,,fee schedule,100% of CMS fee schedule,68.11,350,,,fee schedule,350% of BCBS fee schedule,70.83,364,,,fee schedule,364% of BCBS fee schedule,70.83,364,,,fee schedule,364% of BCBS fee schedule,70.83,364,,,fee schedule,364% of BCBS fee schedule,143.1,90,,114.48,percent of total billed charges,90% of total billed charges,127.2,80,,101.76,percent of total billed charges,80% of total billed charges,143.1,90,,114.48,percent of total billed charges,90% of total billed charges,119.25,75,,95.4,percent of total billed charges,75% of total billed charges,19.22,122,,,fee schedule,122% of APC rate,46.11,29,,36.888,percent of total billed charges,29% of total billed charges,15.76,100,,,fee schedule,100% of CMS fee schedule,106.53,67,,85.224,percent of total billed charges,67% of total billed charges,11.44,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,127.2,80,,101.76,percent of total billed charges,80% of total billed charges,103.35,65,,82.68,percent of total billed charges,65% of total billed charges,56.72,35.67,,45.376,percent of total billed charges,35.67% of total billed charges,11.44,143.1,
RHEUMATOID-RA LATEX,3007200,CDM,300,RC,86430,HCPCS,outpatient,,,50,20.00,,42.5,85,,34,percent of total billed charges,85% of total billed charges,38.5,77,,30.8,percent of total billed charges,77% of total billed charges,6.14,100,,,fee schedule,100% of CMS fee schedule,24.5,350,,,fee schedule,350% of BCBS fee schedule,25.48,364,,,fee schedule,364% of BCBS fee schedule,25.48,364,,,fee schedule,364% of BCBS fee schedule,25.48,364,,,fee schedule,364% of BCBS fee schedule,45,90,,36,percent of total billed charges,90% of total billed charges,40,80,,32,percent of total billed charges,80% of total billed charges,45,90,,36,percent of total billed charges,90% of total billed charges,37.5,75,,30,percent of total billed charges,75% of total billed charges,7.49,122,,,fee schedule,122% of APC rate,14.5,29,,11.6,percent of total billed charges,29% of total billed charges,6.14,100,,,fee schedule,100% of CMS fee schedule,33.5,67,,26.8,percent of total billed charges,67% of total billed charges,8.44,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,40,80,,32,percent of total billed charges,80% of total billed charges,32.5,65,,26,percent of total billed charges,65% of total billed charges,17.84,35.67,,14.272,percent of total billed charges,35.67% of total billed charges,6.14,45,
RHEUMATOID FACTOR,3007201,CDM,300,RC,86431,HCPCS,outpatient,,,202,80.80,,171.7,85,,137.36,percent of total billed charges,85% of total billed charges,155.54,77,,124.43,percent of total billed charges,77% of total billed charges,5.67,100,,,fee schedule,100% of CMS fee schedule,24.5,350,,,fee schedule,350% of BCBS fee schedule,25.48,364,,,fee schedule,364% of BCBS fee schedule,25.48,364,,,fee schedule,364% of BCBS fee schedule,25.48,364,,,fee schedule,364% of BCBS fee schedule,181.8,90,,145.44,percent of total billed charges,90% of total billed charges,161.6,80,,129.28,percent of total billed charges,80% of total billed charges,181.8,90,,145.44,percent of total billed charges,90% of total billed charges,151.5,75,,121.2,percent of total billed charges,75% of total billed charges,6.91,122,,,fee schedule,122% of APC rate,58.58,29,,46.864,percent of total billed charges,29% of total billed charges,5.67,100,,,fee schedule,100% of CMS fee schedule,135.34,67,,108.272,percent of total billed charges,67% of total billed charges,8.44,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,161.6,80,,129.28,percent of total billed charges,80% of total billed charges,131.3,65,,105.04,percent of total billed charges,65% of total billed charges,72.05,35.67,,57.64,percent of total billed charges,35.67% of total billed charges,5.67,181.8,
RESPIRATORY VIRAL CULTURE,3007221,CDM,300,RC,87252,HCPCS,outpatient,,,281,112.40,,238.85,85,,191.08,percent of total billed charges,85% of total billed charges,216.37,77,,173.1,percent of total billed charges,77% of total billed charges,26.07,100,,,fee schedule,100% of CMS fee schedule,112.63,350,,,fee schedule,350% of BCBS fee schedule,117.14,364,,,fee schedule,364% of BCBS fee schedule,117.14,364,,,fee schedule,364% of BCBS fee schedule,117.14,364,,,fee schedule,364% of BCBS fee schedule,252.9,90,,202.32,percent of total billed charges,90% of total billed charges,224.8,80,,179.84,percent of total billed charges,80% of total billed charges,252.9,90,,202.32,percent of total billed charges,90% of total billed charges,210.75,75,,168.6,percent of total billed charges,75% of total billed charges,31.8,122,,,fee schedule,122% of APC rate,81.49,29,,65.192,percent of total billed charges,29% of total billed charges,26.07,100,,,fee schedule,100% of CMS fee schedule,188.27,67,,150.616,percent of total billed charges,67% of total billed charges,25.26,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,224.8,80,,179.84,percent of total billed charges,80% of total billed charges,182.65,65,,146.12,percent of total billed charges,65% of total billed charges,100.23,35.67,,80.184,percent of total billed charges,35.67% of total billed charges,25.26,252.9,
RIA ASSAY - SHBG,3007223,CDM,300,RC,84270,HCPCS,outpatient,,,100,40.00,,85,85,,68,percent of total billed charges,85% of total billed charges,77,77,,61.6,percent of total billed charges,77% of total billed charges,21.73,100,,,fee schedule,100% of CMS fee schedule,93.91,350,,,fee schedule,350% of BCBS fee schedule,97.66,364,,,fee schedule,364% of BCBS fee schedule,97.66,364,,,fee schedule,364% of BCBS fee schedule,97.66,364,,,fee schedule,364% of BCBS fee schedule,90,90,,72,percent of total billed charges,90% of total billed charges,80,80,,64,percent of total billed charges,80% of total billed charges,90,90,,72,percent of total billed charges,90% of total billed charges,75,75,,60,percent of total billed charges,75% of total billed charges,26.51,122,,,fee schedule,122% of APC rate,29,29,,23.2,percent of total billed charges,29% of total billed charges,21.73,100,,,fee schedule,100% of CMS fee schedule,67,67,,53.6,percent of total billed charges,67% of total billed charges,32.31,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,80,80,,64,percent of total billed charges,80% of total billed charges,65,65,,52,percent of total billed charges,65% of total billed charges,35.67,35.67,,28.536,percent of total billed charges,35.67% of total billed charges,21.73,97.66,
RISPERDAL DRUG LEVEL,3007224,CDM,300,RC,80299,HCPCS,outpatient,,,187,74.80,,158.95,85,,127.16,percent of total billed charges,85% of total billed charges,143.99,77,,115.19,percent of total billed charges,77% of total billed charges,18.64,100,,,fee schedule,100% of CMS fee schedule,65.24,350,,,fee schedule,350% of BCBS fee schedule,67.85,364,,,fee schedule,364% of BCBS fee schedule,67.85,364,,,fee schedule,364% of BCBS fee schedule,67.85,364,,,fee schedule,364% of BCBS fee schedule,168.3,90,,134.64,percent of total billed charges,90% of total billed charges,149.6,80,,119.68,percent of total billed charges,80% of total billed charges,168.3,90,,134.64,percent of total billed charges,90% of total billed charges,140.25,75,,112.2,percent of total billed charges,75% of total billed charges,22.74,122,,,fee schedule,122% of APC rate,54.23,29,,43.384,percent of total billed charges,29% of total billed charges,18.64,100,,,fee schedule,100% of CMS fee schedule,125.29,67,,100.232,percent of total billed charges,67% of total billed charges,20.36,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,149.6,80,,119.68,percent of total billed charges,80% of total billed charges,121.55,65,,97.24,percent of total billed charges,65% of total billed charges,66.7,35.67,,53.36,percent of total billed charges,35.67% of total billed charges,18.64,168.3,
RITALIN,3007225,CDM,300,RC,80299,HCPCS,outpatient,,,147,58.80,,124.95,85,,99.96,percent of total billed charges,85% of total billed charges,113.19,77,,90.55,percent of total billed charges,77% of total billed charges,18.64,100,,,fee schedule,100% of CMS fee schedule,65.24,350,,,fee schedule,350% of BCBS fee schedule,67.85,364,,,fee schedule,364% of BCBS fee schedule,67.85,364,,,fee schedule,364% of BCBS fee schedule,67.85,364,,,fee schedule,364% of BCBS fee schedule,132.3,90,,105.84,percent of total billed charges,90% of total billed charges,117.6,80,,94.08,percent of total billed charges,80% of total billed charges,132.3,90,,105.84,percent of total billed charges,90% of total billed charges,110.25,75,,88.2,percent of total billed charges,75% of total billed charges,22.74,122,,,fee schedule,122% of APC rate,42.63,29,,34.104,percent of total billed charges,29% of total billed charges,18.64,100,,,fee schedule,100% of CMS fee schedule,98.49,67,,78.792,percent of total billed charges,67% of total billed charges,20.36,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,117.6,80,,94.08,percent of total billed charges,80% of total billed charges,95.55,65,,76.44,percent of total billed charges,65% of total billed charges,52.43,35.67,,41.944,percent of total billed charges,35.67% of total billed charges,18.64,132.3,
ROCKY MOUNTAIN SPOTTED FEVER,3007228,CDM,300,RC,86757,HCPCS,outpatient,,,230,92.00,,195.5,85,,156.4,percent of total billed charges,85% of total billed charges,177.1,77,,141.68,percent of total billed charges,77% of total billed charges,19.35,100,,,fee schedule,100% of CMS fee schedule,83.65,350,,,fee schedule,350% of BCBS fee schedule,87,364,,,fee schedule,364% of BCBS fee schedule,87,364,,,fee schedule,364% of BCBS fee schedule,87,364,,,fee schedule,364% of BCBS fee schedule,207,90,,165.6,percent of total billed charges,90% of total billed charges,184,80,,147.2,percent of total billed charges,80% of total billed charges,207,90,,165.6,percent of total billed charges,90% of total billed charges,172.5,75,,138,percent of total billed charges,75% of total billed charges,23.6,122,,,fee schedule,122% of APC rate,66.7,29,,53.36,percent of total billed charges,29% of total billed charges,19.35,100,,,fee schedule,100% of CMS fee schedule,154.1,67,,123.28,percent of total billed charges,67% of total billed charges,28.78,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,184,80,,147.2,percent of total billed charges,80% of total billed charges,149.5,65,,119.6,percent of total billed charges,65% of total billed charges,82.04,35.67,,65.632,percent of total billed charges,35.67% of total billed charges,19.35,207,
ROTA VIRUS ANTIGEN,3007230,CDM,300,RC,87425,HCPCS,outpatient,,,111,44.40,,94.35,85,,75.48,percent of total billed charges,85% of total billed charges,85.47,77,,68.38,percent of total billed charges,77% of total billed charges,11.98,100,,,fee schedule,100% of CMS fee schedule,51.8,350,,,fee schedule,350% of BCBS fee schedule,53.87,364,,,fee schedule,364% of BCBS fee schedule,53.87,364,,,fee schedule,364% of BCBS fee schedule,53.87,364,,,fee schedule,364% of BCBS fee schedule,99.9,90,,79.92,percent of total billed charges,90% of total billed charges,88.8,80,,71.04,percent of total billed charges,80% of total billed charges,99.9,90,,79.92,percent of total billed charges,90% of total billed charges,83.25,75,,66.6,percent of total billed charges,75% of total billed charges,14.61,122,,,fee schedule,122% of APC rate,32.19,29,,25.752,percent of total billed charges,29% of total billed charges,11.98,100,,,fee schedule,100% of CMS fee schedule,74.37,67,,59.496,percent of total billed charges,67% of total billed charges,15.41,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,88.8,80,,71.04,percent of total billed charges,80% of total billed charges,72.15,65,,57.72,percent of total billed charges,65% of total billed charges,39.59,35.67,,31.672,percent of total billed charges,35.67% of total billed charges,11.98,99.9,
RSV-VIRAL STUDY - ANTIGEN,3007235,CDM,300,RC,87420,HCPCS,outpatient,,,91,36.40,,77.35,85,,61.88,percent of total billed charges,85% of total billed charges,70.07,77,,56.06,percent of total billed charges,77% of total billed charges,13.91,100,,,fee schedule,100% of CMS fee schedule,51.8,350,,,fee schedule,350% of BCBS fee schedule,53.87,364,,,fee schedule,364% of BCBS fee schedule,53.87,364,,,fee schedule,364% of BCBS fee schedule,53.87,364,,,fee schedule,364% of BCBS fee schedule,81.9,90,,65.52,percent of total billed charges,90% of total billed charges,72.8,80,,58.24,percent of total billed charges,80% of total billed charges,81.9,90,,65.52,percent of total billed charges,90% of total billed charges,68.25,75,,54.6,percent of total billed charges,75% of total billed charges,16.97,122,,,fee schedule,122% of APC rate,26.39,29,,21.112,percent of total billed charges,29% of total billed charges,13.91,100,,,fee schedule,100% of CMS fee schedule,60.97,67,,48.776,percent of total billed charges,67% of total billed charges,15.41,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,72.8,80,,58.24,percent of total billed charges,80% of total billed charges,59.15,65,,47.32,percent of total billed charges,65% of total billed charges,32.46,35.67,,25.968,percent of total billed charges,35.67% of total billed charges,13.91,81.9,
RUBELLA IgG ANTIBODY,3007240,CDM,300,RC,86762,HCPCS,outpatient,,,208,83.20,,176.8,85,,141.44,percent of total billed charges,85% of total billed charges,160.16,77,,128.13,percent of total billed charges,77% of total billed charges,14.39,100,,,fee schedule,100% of CMS fee schedule,62.2,350,,,fee schedule,350% of BCBS fee schedule,64.68,364,,,fee schedule,364% of BCBS fee schedule,64.68,364,,,fee schedule,364% of BCBS fee schedule,64.68,364,,,fee schedule,364% of BCBS fee schedule,187.2,90,,149.76,percent of total billed charges,90% of total billed charges,166.4,80,,133.12,percent of total billed charges,80% of total billed charges,187.2,90,,149.76,percent of total billed charges,90% of total billed charges,156,75,,124.8,percent of total billed charges,75% of total billed charges,17.55,122,,,fee schedule,122% of APC rate,60.32,29,,48.256,percent of total billed charges,29% of total billed charges,14.39,100,,,fee schedule,100% of CMS fee schedule,139.36,67,,111.488,percent of total billed charges,67% of total billed charges,21.4,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,166.4,80,,133.12,percent of total billed charges,80% of total billed charges,135.2,65,,108.16,percent of total billed charges,65% of total billed charges,74.19,35.67,,59.352,percent of total billed charges,35.67% of total billed charges,14.39,187.2,
RUBEOLA IgG ANTIBODY,3007260,CDM,300,RC,86765,HCPCS,outpatient,,,107,42.80,,90.95,85,,72.76,percent of total billed charges,85% of total billed charges,82.39,77,,65.91,percent of total billed charges,77% of total billed charges,12.88,100,,,fee schedule,100% of CMS fee schedule,55.65,350,,,fee schedule,350% of BCBS fee schedule,57.88,364,,,fee schedule,364% of BCBS fee schedule,57.88,364,,,fee schedule,364% of BCBS fee schedule,57.88,364,,,fee schedule,364% of BCBS fee schedule,96.3,90,,77.04,percent of total billed charges,90% of total billed charges,85.6,80,,68.48,percent of total billed charges,80% of total billed charges,96.3,90,,77.04,percent of total billed charges,90% of total billed charges,80.25,75,,64.2,percent of total billed charges,75% of total billed charges,15.71,122,,,fee schedule,122% of APC rate,31.03,29,,24.824,percent of total billed charges,29% of total billed charges,12.88,100,,,fee schedule,100% of CMS fee schedule,71.69,67,,57.352,percent of total billed charges,67% of total billed charges,19.16,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,85.6,80,,68.48,percent of total billed charges,80% of total billed charges,69.55,65,,55.64,percent of total billed charges,65% of total billed charges,38.17,35.67,,30.536,percent of total billed charges,35.67% of total billed charges,12.88,96.3,
RUSSELL VIPER VENOM,3007261,CDM,300,RC,85613,HCPCS,outpatient,,,115,46.00,,97.75,85,,78.2,percent of total billed charges,85% of total billed charges,88.55,77,,70.84,percent of total billed charges,77% of total billed charges,9.58,100,,,fee schedule,100% of CMS fee schedule,41.41,350,,,fee schedule,350% of BCBS fee schedule,43.06,364,,,fee schedule,364% of BCBS fee schedule,43.06,364,,,fee schedule,364% of BCBS fee schedule,43.06,364,,,fee schedule,364% of BCBS fee schedule,103.5,90,,82.8,percent of total billed charges,90% of total billed charges,92,80,,73.6,percent of total billed charges,80% of total billed charges,103.5,90,,82.8,percent of total billed charges,90% of total billed charges,86.25,75,,69,percent of total billed charges,75% of total billed charges,11.68,122,,,fee schedule,122% of APC rate,33.35,29,,26.68,percent of total billed charges,29% of total billed charges,9.58,100,,,fee schedule,100% of CMS fee schedule,77.05,67,,61.64,percent of total billed charges,67% of total billed charges,8.64,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,92,80,,73.6,percent of total billed charges,80% of total billed charges,74.75,65,,59.8,percent of total billed charges,65% of total billed charges,41.02,35.67,,32.816,percent of total billed charges,35.67% of total billed charges,8.64,103.5,
SALICYLATE LEVEL REPEAT TODAY,3007279,CDM,300,RC,80179,HCPCS,outpatient,,,438,175.20,,372.3,85,,297.84,percent of total billed charges,85% of total billed charges,337.26,77,,269.81,percent of total billed charges,77% of total billed charges,18.64,100,,,fee schedule,100% of CMS fee schedule,65.24,350,,,fee schedule,350% of BCBS fee schedule,67.85,364,,,fee schedule,364% of BCBS fee schedule,67.85,364,,,fee schedule,364% of BCBS fee schedule,67.85,364,,,fee schedule,364% of BCBS fee schedule,394.2,90,,315.36,percent of total billed charges,90% of total billed charges,350.4,80,,280.32,percent of total billed charges,80% of total billed charges,394.2,90,,315.36,percent of total billed charges,90% of total billed charges,328.5,75,,262.8,percent of total billed charges,75% of total billed charges,22.74,122,,,fee schedule,122% of APC rate,127.02,29,,101.616,percent of total billed charges,29% of total billed charges,18.64,100,,,fee schedule,100% of CMS fee schedule,293.46,67,,234.768,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,350.4,80,,280.32,percent of total billed charges,80% of total billed charges,284.7,65,,227.76,percent of total billed charges,65% of total billed charges,156.23,35.67,,124.984,percent of total billed charges,35.67% of total billed charges,18.64,394.2,
SALICYLATE,3007280,CDM,300,RC,80179,HCPCS,outpatient,,,60,24.00,,51,85,,40.8,percent of total billed charges,85% of total billed charges,46.2,77,,36.96,percent of total billed charges,77% of total billed charges,18.64,100,,,fee schedule,100% of CMS fee schedule,65.24,350,,,fee schedule,350% of BCBS fee schedule,67.85,364,,,fee schedule,364% of BCBS fee schedule,67.85,364,,,fee schedule,364% of BCBS fee schedule,67.85,364,,,fee schedule,364% of BCBS fee schedule,54,90,,43.2,percent of total billed charges,90% of total billed charges,48,80,,38.4,percent of total billed charges,80% of total billed charges,54,90,,43.2,percent of total billed charges,90% of total billed charges,45,75,,36,percent of total billed charges,75% of total billed charges,22.74,122,,,fee schedule,122% of APC rate,17.4,29,,13.92,percent of total billed charges,29% of total billed charges,18.64,100,,,fee schedule,100% of CMS fee schedule,40.2,67,,32.16,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,48,80,,38.4,percent of total billed charges,80% of total billed charges,39,65,,31.2,percent of total billed charges,65% of total billed charges,21.4,35.67,,17.12,percent of total billed charges,35.67% of total billed charges,17.4,67.85,
SALMONELLA ANTIBODY FOR PANEL,3007281,CDM,300,RC,86768,HCPCS,outpatient,,,65,26.00,,55.25,85,,44.2,percent of total billed charges,85% of total billed charges,50.05,77,,40.04,percent of total billed charges,77% of total billed charges,13.19,100,,,fee schedule,100% of CMS fee schedule,56.98,350,,,fee schedule,350% of BCBS fee schedule,59.26,364,,,fee schedule,364% of BCBS fee schedule,59.26,364,,,fee schedule,364% of BCBS fee schedule,59.26,364,,,fee schedule,364% of BCBS fee schedule,58.5,90,,46.8,percent of total billed charges,90% of total billed charges,52,80,,41.6,percent of total billed charges,80% of total billed charges,58.5,90,,46.8,percent of total billed charges,90% of total billed charges,48.75,75,,39,percent of total billed charges,75% of total billed charges,16.09,122,,,fee schedule,122% of APC rate,18.85,29,,15.08,percent of total billed charges,29% of total billed charges,13.19,100,,,fee schedule,100% of CMS fee schedule,43.55,67,,34.84,percent of total billed charges,67% of total billed charges,12.15,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,52,80,,41.6,percent of total billed charges,80% of total billed charges,42.25,65,,33.8,percent of total billed charges,65% of total billed charges,23.19,35.67,,18.552,percent of total billed charges,35.67% of total billed charges,12.15,59.26,
SALMONELLA ANTIBODY FOR PANEL,3007282,CDM,300,RC,86768,HCPCS,outpatient,,,65,26.00,,55.25,85,,44.2,percent of total billed charges,85% of total billed charges,50.05,77,,40.04,percent of total billed charges,77% of total billed charges,13.19,100,,,fee schedule,100% of CMS fee schedule,56.98,350,,,fee schedule,350% of BCBS fee schedule,59.26,364,,,fee schedule,364% of BCBS fee schedule,59.26,364,,,fee schedule,364% of BCBS fee schedule,59.26,364,,,fee schedule,364% of BCBS fee schedule,58.5,90,,46.8,percent of total billed charges,90% of total billed charges,52,80,,41.6,percent of total billed charges,80% of total billed charges,58.5,90,,46.8,percent of total billed charges,90% of total billed charges,48.75,75,,39,percent of total billed charges,75% of total billed charges,16.09,122,,,fee schedule,122% of APC rate,18.85,29,,15.08,percent of total billed charges,29% of total billed charges,13.19,100,,,fee schedule,100% of CMS fee schedule,43.55,67,,34.84,percent of total billed charges,67% of total billed charges,12.15,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,52,80,,41.6,percent of total billed charges,80% of total billed charges,42.25,65,,33.8,percent of total billed charges,65% of total billed charges,23.19,35.67,,18.552,percent of total billed charges,35.67% of total billed charges,12.15,59.26,
SALMONELLA ANTIBODY FOR PANEL,3007283,CDM,300,RC,86768,HCPCS,outpatient,,,65,26.00,,55.25,85,,44.2,percent of total billed charges,85% of total billed charges,50.05,77,,40.04,percent of total billed charges,77% of total billed charges,13.19,100,,,fee schedule,100% of CMS fee schedule,56.98,350,,,fee schedule,350% of BCBS fee schedule,59.26,364,,,fee schedule,364% of BCBS fee schedule,59.26,364,,,fee schedule,364% of BCBS fee schedule,59.26,364,,,fee schedule,364% of BCBS fee schedule,58.5,90,,46.8,percent of total billed charges,90% of total billed charges,52,80,,41.6,percent of total billed charges,80% of total billed charges,58.5,90,,46.8,percent of total billed charges,90% of total billed charges,48.75,75,,39,percent of total billed charges,75% of total billed charges,16.09,122,,,fee schedule,122% of APC rate,18.85,29,,15.08,percent of total billed charges,29% of total billed charges,13.19,100,,,fee schedule,100% of CMS fee schedule,43.55,67,,34.84,percent of total billed charges,67% of total billed charges,12.15,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,52,80,,41.6,percent of total billed charges,80% of total billed charges,42.25,65,,33.8,percent of total billed charges,65% of total billed charges,23.19,35.67,,18.552,percent of total billed charges,35.67% of total billed charges,12.15,59.26,
SCAT,3007300,CDM,300,RC,86403,HCPCS,outpatient,,,103,41.20,,87.55,85,,70.04,percent of total billed charges,85% of total billed charges,79.31,77,,63.45,percent of total billed charges,77% of total billed charges,11.54,100,,,fee schedule,100% of CMS fee schedule,44.03,350,,,fee schedule,350% of BCBS fee schedule,45.79,364,,,fee schedule,364% of BCBS fee schedule,45.79,364,,,fee schedule,364% of BCBS fee schedule,45.79,364,,,fee schedule,364% of BCBS fee schedule,92.7,90,,74.16,percent of total billed charges,90% of total billed charges,82.4,80,,65.92,percent of total billed charges,80% of total billed charges,92.7,90,,74.16,percent of total billed charges,90% of total billed charges,77.25,75,,61.8,percent of total billed charges,75% of total billed charges,14.07,122,,,fee schedule,122% of APC rate,29.87,29,,23.896,percent of total billed charges,29% of total billed charges,11.54,100,,,fee schedule,100% of CMS fee schedule,69.01,67,,55.208,percent of total billed charges,67% of total billed charges,15.16,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,82.4,80,,65.92,percent of total billed charges,80% of total billed charges,66.95,65,,53.56,percent of total billed charges,65% of total billed charges,36.74,35.67,,29.392,percent of total billed charges,35.67% of total billed charges,11.54,92.7,
SED RATE,3007340,CDM,300,RC,85651,HCPCS,outpatient,,,27,10.80,,22.95,85,,18.36,percent of total billed charges,85% of total billed charges,20.79,77,,16.63,percent of total billed charges,77% of total billed charges,4.26,100,,,fee schedule,100% of CMS fee schedule,15.33,350,,,fee schedule,350% of BCBS fee schedule,15.94,364,,,fee schedule,364% of BCBS fee schedule,15.94,364,,,fee schedule,364% of BCBS fee schedule,15.94,364,,,fee schedule,364% of BCBS fee schedule,24.3,90,,19.44,percent of total billed charges,90% of total billed charges,21.6,80,,17.28,percent of total billed charges,80% of total billed charges,24.3,90,,19.44,percent of total billed charges,90% of total billed charges,20.25,75,,16.2,percent of total billed charges,75% of total billed charges,5.2,122,,,fee schedule,122% of APC rate,7.83,29,,6.264,percent of total billed charges,29% of total billed charges,4.26,100,,,fee schedule,100% of CMS fee schedule,18.09,67,,14.472,percent of total billed charges,67% of total billed charges,5.27,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,21.6,80,,17.28,percent of total billed charges,80% of total billed charges,17.55,65,,14.04,percent of total billed charges,65% of total billed charges,9.63,35.67,,7.704,percent of total billed charges,35.67% of total billed charges,4.26,24.3,
SELENIUM LEVEL,3007345,CDM,300,RC,84255,HCPCS,outpatient,,,130,52.00,,110.5,85,,88.4,percent of total billed charges,85% of total billed charges,100.1,77,,80.08,percent of total billed charges,77% of total billed charges,25.53,100,,,fee schedule,100% of CMS fee schedule,110.32,350,,,fee schedule,350% of BCBS fee schedule,114.73,364,,,fee schedule,364% of BCBS fee schedule,114.73,364,,,fee schedule,364% of BCBS fee schedule,114.73,364,,,fee schedule,364% of BCBS fee schedule,117,90,,93.6,percent of total billed charges,90% of total billed charges,104,80,,83.2,percent of total billed charges,80% of total billed charges,117,90,,93.6,percent of total billed charges,90% of total billed charges,97.5,75,,78,percent of total billed charges,75% of total billed charges,31.14,122,,,fee schedule,122% of APC rate,37.7,29,,30.16,percent of total billed charges,29% of total billed charges,25.53,100,,,fee schedule,100% of CMS fee schedule,87.1,67,,69.68,percent of total billed charges,67% of total billed charges,37.96,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,104,80,,83.2,percent of total billed charges,80% of total billed charges,84.5,65,,67.6,percent of total billed charges,65% of total billed charges,46.37,35.67,,37.096,percent of total billed charges,35.67% of total billed charges,25.53,117,
SEMEN COUNT,3007363,CDM,300,RC,89310,HCPCS,outpatient,,,48,19.20,,40.8,85,,32.64,percent of total billed charges,85% of total billed charges,36.96,77,,29.57,percent of total billed charges,77% of total billed charges,8.61,100,,,fee schedule,100% of CMS fee schedule,37.21,350,,,fee schedule,350% of BCBS fee schedule,38.69,364,,,fee schedule,364% of BCBS fee schedule,38.69,364,,,fee schedule,364% of BCBS fee schedule,38.69,364,,,fee schedule,364% of BCBS fee schedule,43.2,90,,34.56,percent of total billed charges,90% of total billed charges,38.4,80,,30.72,percent of total billed charges,80% of total billed charges,43.2,90,,34.56,percent of total billed charges,90% of total billed charges,36,75,,28.8,percent of total billed charges,75% of total billed charges,10.5,122,,,fee schedule,122% of APC rate,13.92,29,,11.136,percent of total billed charges,29% of total billed charges,8.61,100,,,fee schedule,100% of CMS fee schedule,32.16,67,,25.728,percent of total billed charges,67% of total billed charges,12.81,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,38.4,80,,30.72,percent of total billed charges,80% of total billed charges,31.2,65,,24.96,percent of total billed charges,65% of total billed charges,17.12,35.67,,13.696,percent of total billed charges,35.67% of total billed charges,8.61,43.2,
SENSITIVITY,3007365,CDM,300,RC,87186,HCPCS,outpatient,,,64,25.60,,54.4,85,,43.52,percent of total billed charges,85% of total billed charges,49.28,77,,39.42,percent of total billed charges,77% of total billed charges,8.65,100,,,fee schedule,100% of CMS fee schedule,37.35,350,,,fee schedule,350% of BCBS fee schedule,38.84,364,,,fee schedule,364% of BCBS fee schedule,38.84,364,,,fee schedule,364% of BCBS fee schedule,38.84,364,,,fee schedule,364% of BCBS fee schedule,57.6,90,,46.08,percent of total billed charges,90% of total billed charges,51.2,80,,40.96,percent of total billed charges,80% of total billed charges,57.6,90,,46.08,percent of total billed charges,90% of total billed charges,48,75,,38.4,percent of total billed charges,75% of total billed charges,10.55,122,,,fee schedule,122% of APC rate,18.56,29,,14.848,percent of total billed charges,29% of total billed charges,8.65,100,,,fee schedule,100% of CMS fee schedule,42.88,67,,34.304,percent of total billed charges,67% of total billed charges,8.64,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,51.2,80,,40.96,percent of total billed charges,80% of total billed charges,41.6,65,,33.28,percent of total billed charges,65% of total billed charges,22.83,35.67,,18.264,percent of total billed charges,35.67% of total billed charges,8.64,57.6,
SEROTONIN,3007380,CDM,300,RC,84260,HCPCS,outpatient,,,152,60.80,,129.2,85,,103.36,percent of total billed charges,85% of total billed charges,117.04,77,,93.63,percent of total billed charges,77% of total billed charges,30.98,100,,,fee schedule,100% of CMS fee schedule,133.88,350,,,fee schedule,350% of BCBS fee schedule,139.23,364,,,fee schedule,364% of BCBS fee schedule,139.23,364,,,fee schedule,364% of BCBS fee schedule,139.23,364,,,fee schedule,364% of BCBS fee schedule,136.8,90,,109.44,percent of total billed charges,90% of total billed charges,121.6,80,,97.28,percent of total billed charges,80% of total billed charges,136.8,90,,109.44,percent of total billed charges,90% of total billed charges,114,75,,91.2,percent of total billed charges,75% of total billed charges,37.79,122,,,fee schedule,122% of APC rate,44.08,29,,35.264,percent of total billed charges,29% of total billed charges,30.98,100,,,fee schedule,100% of CMS fee schedule,101.84,67,,81.472,percent of total billed charges,67% of total billed charges,25.47,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,121.6,80,,97.28,percent of total billed charges,80% of total billed charges,98.8,65,,79.04,percent of total billed charges,65% of total billed charges,54.22,35.67,,43.376,percent of total billed charges,35.67% of total billed charges,25.47,139.23,
SERUM HOMOCYSTEINE,3007385,CDM,300,RC,83090,HCPCS,outpatient,,,228,91.20,,193.8,85,,155.04,percent of total billed charges,85% of total billed charges,175.56,77,,140.45,percent of total billed charges,77% of total billed charges,17.92,100,,,fee schedule,100% of CMS fee schedule,72.91,350,,,fee schedule,350% of BCBS fee schedule,75.82,364,,,fee schedule,364% of BCBS fee schedule,75.82,364,,,fee schedule,364% of BCBS fee schedule,75.82,364,,,fee schedule,364% of BCBS fee schedule,205.2,90,,164.16,percent of total billed charges,90% of total billed charges,182.4,80,,145.92,percent of total billed charges,80% of total billed charges,205.2,90,,164.16,percent of total billed charges,90% of total billed charges,171,75,,136.8,percent of total billed charges,75% of total billed charges,21.86,122,,,fee schedule,122% of APC rate,66.12,29,,52.896,percent of total billed charges,29% of total billed charges,17.92,100,,,fee schedule,100% of CMS fee schedule,152.76,67,,122.208,percent of total billed charges,67% of total billed charges,25.08,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,182.4,80,,145.92,percent of total billed charges,80% of total billed charges,148.2,65,,118.56,percent of total billed charges,65% of total billed charges,81.33,35.67,,65.064,percent of total billed charges,35.67% of total billed charges,17.92,205.2,
SGOT,3007400,CDM,300,RC,84450,HCPCS,outpatient,,,57,22.80,,48.45,85,,38.76,percent of total billed charges,85% of total billed charges,43.89,77,,35.11,percent of total billed charges,77% of total billed charges,5.18,100,,,fee schedule,100% of CMS fee schedule,22.37,350,,,fee schedule,350% of BCBS fee schedule,23.26,364,,,fee schedule,364% of BCBS fee schedule,23.26,364,,,fee schedule,364% of BCBS fee schedule,23.26,364,,,fee schedule,364% of BCBS fee schedule,51.3,90,,41.04,percent of total billed charges,90% of total billed charges,45.6,80,,36.48,percent of total billed charges,80% of total billed charges,51.3,90,,41.04,percent of total billed charges,90% of total billed charges,42.75,75,,34.2,percent of total billed charges,75% of total billed charges,6.31,122,,,fee schedule,122% of APC rate,16.53,29,,13.224,percent of total billed charges,29% of total billed charges,5.18,100,,,fee schedule,100% of CMS fee schedule,38.19,67,,30.552,percent of total billed charges,67% of total billed charges,7.69,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,45.6,80,,36.48,percent of total billed charges,80% of total billed charges,37.05,65,,29.64,percent of total billed charges,65% of total billed charges,20.33,35.67,,16.264,percent of total billed charges,35.67% of total billed charges,5.18,51.3,
SGPT,3007420,CDM,300,RC,84460,HCPCS,outpatient,,,57,22.80,,48.45,85,,38.76,percent of total billed charges,85% of total billed charges,43.89,77,,35.11,percent of total billed charges,77% of total billed charges,5.3,100,,,fee schedule,100% of CMS fee schedule,22.89,350,,,fee schedule,350% of BCBS fee schedule,23.81,364,,,fee schedule,364% of BCBS fee schedule,23.81,364,,,fee schedule,364% of BCBS fee schedule,23.81,364,,,fee schedule,364% of BCBS fee schedule,51.3,90,,41.04,percent of total billed charges,90% of total billed charges,45.6,80,,36.48,percent of total billed charges,80% of total billed charges,51.3,90,,41.04,percent of total billed charges,90% of total billed charges,42.75,75,,34.2,percent of total billed charges,75% of total billed charges,6.46,122,,,fee schedule,122% of APC rate,16.53,29,,13.224,percent of total billed charges,29% of total billed charges,5.3,100,,,fee schedule,100% of CMS fee schedule,38.19,67,,30.552,percent of total billed charges,67% of total billed charges,7.87,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,45.6,80,,36.48,percent of total billed charges,80% of total billed charges,37.05,65,,29.64,percent of total billed charges,65% of total billed charges,20.33,35.67,,16.264,percent of total billed charges,35.67% of total billed charges,5.3,51.3,
SICKLE CELL SCREEN,3007440,CDM,300,RC,85660,HCPCS,outpatient,,,28,11.20,,23.8,85,,19.04,percent of total billed charges,85% of total billed charges,21.56,77,,17.25,percent of total billed charges,77% of total billed charges,5.51,100,,,fee schedule,100% of CMS fee schedule,23.8,350,,,fee schedule,350% of BCBS fee schedule,24.75,364,,,fee schedule,364% of BCBS fee schedule,24.75,364,,,fee schedule,364% of BCBS fee schedule,24.75,364,,,fee schedule,364% of BCBS fee schedule,25.2,90,,20.16,percent of total billed charges,90% of total billed charges,22.4,80,,17.92,percent of total billed charges,80% of total billed charges,25.2,90,,20.16,percent of total billed charges,90% of total billed charges,21,75,,16.8,percent of total billed charges,75% of total billed charges,6.72,122,,,fee schedule,122% of APC rate,8.12,29,,6.496,percent of total billed charges,29% of total billed charges,5.51,100,,,fee schedule,100% of CMS fee schedule,18.76,67,,15.008,percent of total billed charges,67% of total billed charges,6.07,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,22.4,80,,17.92,percent of total billed charges,80% of total billed charges,18.2,65,,14.56,percent of total billed charges,65% of total billed charges,9.99,35.67,,7.992,percent of total billed charges,35.67% of total billed charges,5.51,25.2,
SMEAR PERTUSSIS,3007460,CDM,300,RC,87206,HCPCS,outpatient,,,74,29.60,,62.9,85,,50.32,percent of total billed charges,85% of total billed charges,56.98,77,,45.58,percent of total billed charges,77% of total billed charges,5.39,100,,,fee schedule,100% of CMS fee schedule,23.28,350,,,fee schedule,350% of BCBS fee schedule,24.21,364,,,fee schedule,364% of BCBS fee schedule,24.21,364,,,fee schedule,364% of BCBS fee schedule,24.21,364,,,fee schedule,364% of BCBS fee schedule,66.6,90,,53.28,percent of total billed charges,90% of total billed charges,59.2,80,,47.36,percent of total billed charges,80% of total billed charges,66.6,90,,53.28,percent of total billed charges,90% of total billed charges,55.5,75,,44.4,percent of total billed charges,75% of total billed charges,6.57,122,,,fee schedule,122% of APC rate,21.46,29,,17.168,percent of total billed charges,29% of total billed charges,5.39,100,,,fee schedule,100% of CMS fee schedule,49.58,67,,39.664,percent of total billed charges,67% of total billed charges,7.99,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,59.2,80,,47.36,percent of total billed charges,80% of total billed charges,48.1,65,,38.48,percent of total billed charges,65% of total billed charges,26.4,35.67,,21.12,percent of total billed charges,35.67% of total billed charges,5.39,66.6,
NUCLEAR ANTIGEN ANTIBODY EACH,3007465,CDM,300,RC,86235,HCPCS,outpatient,,,67,26.80,,56.95,85,,45.56,percent of total billed charges,85% of total billed charges,51.59,77,,41.27,percent of total billed charges,77% of total billed charges,17.93,100,,,fee schedule,100% of CMS fee schedule,77.49,350,,,fee schedule,350% of BCBS fee schedule,80.59,364,,,fee schedule,364% of BCBS fee schedule,80.59,364,,,fee schedule,364% of BCBS fee schedule,80.59,364,,,fee schedule,364% of BCBS fee schedule,60.3,90,,48.24,percent of total billed charges,90% of total billed charges,53.6,80,,42.88,percent of total billed charges,80% of total billed charges,60.3,90,,48.24,percent of total billed charges,90% of total billed charges,50.25,75,,40.2,percent of total billed charges,75% of total billed charges,21.87,122,,,fee schedule,122% of APC rate,19.43,29,,15.544,percent of total billed charges,29% of total billed charges,17.93,100,,,fee schedule,100% of CMS fee schedule,44.89,67,,35.912,percent of total billed charges,67% of total billed charges,26.67,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,53.6,80,,42.88,percent of total billed charges,80% of total billed charges,43.55,65,,34.84,percent of total billed charges,65% of total billed charges,23.9,35.67,,19.12,percent of total billed charges,35.67% of total billed charges,17.93,80.59,
SJORGENS ANTIBODY EACH,3007466,CDM,300,RC,86235,HCPCS,outpatient,,,150,60.00,,127.5,85,,102,percent of total billed charges,85% of total billed charges,115.5,77,,92.4,percent of total billed charges,77% of total billed charges,17.93,100,,,fee schedule,100% of CMS fee schedule,77.49,350,,,fee schedule,350% of BCBS fee schedule,80.59,364,,,fee schedule,364% of BCBS fee schedule,80.59,364,,,fee schedule,364% of BCBS fee schedule,80.59,364,,,fee schedule,364% of BCBS fee schedule,135,90,,108,percent of total billed charges,90% of total billed charges,120,80,,96,percent of total billed charges,80% of total billed charges,135,90,,108,percent of total billed charges,90% of total billed charges,112.5,75,,90,percent of total billed charges,75% of total billed charges,21.87,122,,,fee schedule,122% of APC rate,43.5,29,,34.8,percent of total billed charges,29% of total billed charges,17.93,100,,,fee schedule,100% of CMS fee schedule,100.5,67,,80.4,percent of total billed charges,67% of total billed charges,26.67,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,120,80,,96,percent of total billed charges,80% of total billed charges,97.5,65,,78,percent of total billed charges,65% of total billed charges,53.51,35.67,,42.808,percent of total billed charges,35.67% of total billed charges,17.93,135,
CETROMERE B ANTIBODY,3007467,CDM,300,RC,86235,HCPCS,outpatient,,,68,27.20,,57.8,85,,46.24,percent of total billed charges,85% of total billed charges,52.36,77,,41.89,percent of total billed charges,77% of total billed charges,17.93,100,,,fee schedule,100% of CMS fee schedule,77.49,350,,,fee schedule,350% of BCBS fee schedule,80.59,364,,,fee schedule,364% of BCBS fee schedule,80.59,364,,,fee schedule,364% of BCBS fee schedule,80.59,364,,,fee schedule,364% of BCBS fee schedule,61.2,90,,48.96,percent of total billed charges,90% of total billed charges,54.4,80,,43.52,percent of total billed charges,80% of total billed charges,61.2,90,,48.96,percent of total billed charges,90% of total billed charges,51,75,,40.8,percent of total billed charges,75% of total billed charges,21.87,122,,,fee schedule,122% of APC rate,19.72,29,,15.776,percent of total billed charges,29% of total billed charges,17.93,100,,,fee schedule,100% of CMS fee schedule,45.56,67,,36.448,percent of total billed charges,67% of total billed charges,26.67,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,54.4,80,,43.52,percent of total billed charges,80% of total billed charges,44.2,65,,35.36,percent of total billed charges,65% of total billed charges,24.26,35.67,,19.408,percent of total billed charges,35.67% of total billed charges,17.93,80.59,
RNP ANTIBODIES,3007468,CDM,300,RC,86235,HCPCS,outpatient,,,63,25.20,,53.55,85,,42.84,percent of total billed charges,85% of total billed charges,48.51,77,,38.81,percent of total billed charges,77% of total billed charges,17.93,100,,,fee schedule,100% of CMS fee schedule,77.49,350,,,fee schedule,350% of BCBS fee schedule,80.59,364,,,fee schedule,364% of BCBS fee schedule,80.59,364,,,fee schedule,364% of BCBS fee schedule,80.59,364,,,fee schedule,364% of BCBS fee schedule,56.7,90,,45.36,percent of total billed charges,90% of total billed charges,50.4,80,,40.32,percent of total billed charges,80% of total billed charges,56.7,90,,45.36,percent of total billed charges,90% of total billed charges,47.25,75,,37.8,percent of total billed charges,75% of total billed charges,21.87,122,,,fee schedule,122% of APC rate,18.27,29,,14.616,percent of total billed charges,29% of total billed charges,17.93,100,,,fee schedule,100% of CMS fee schedule,42.21,67,,33.768,percent of total billed charges,67% of total billed charges,26.67,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,50.4,80,,40.32,percent of total billed charges,80% of total billed charges,40.95,65,,32.76,percent of total billed charges,65% of total billed charges,22.47,35.67,,17.976,percent of total billed charges,35.67% of total billed charges,17.93,80.59,
SODIUM,3007480,CDM,300,RC,84295,HCPCS,outpatient,,,48,19.20,,40.8,85,,32.64,percent of total billed charges,85% of total billed charges,36.96,77,,29.57,percent of total billed charges,77% of total billed charges,4.8,100,,,fee schedule,100% of CMS fee schedule,20.79,350,,,fee schedule,350% of BCBS fee schedule,21.62,364,,,fee schedule,364% of BCBS fee schedule,21.62,364,,,fee schedule,364% of BCBS fee schedule,21.62,364,,,fee schedule,364% of BCBS fee schedule,43.2,90,,34.56,percent of total billed charges,90% of total billed charges,38.4,80,,30.72,percent of total billed charges,80% of total billed charges,43.2,90,,34.56,percent of total billed charges,90% of total billed charges,36,75,,28.8,percent of total billed charges,75% of total billed charges,5.86,122,,,fee schedule,122% of APC rate,13.92,29,,11.136,percent of total billed charges,29% of total billed charges,4.8,100,,,fee schedule,100% of CMS fee schedule,32.16,67,,25.728,percent of total billed charges,67% of total billed charges,7.16,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,38.4,80,,30.72,percent of total billed charges,80% of total billed charges,31.2,65,,24.96,percent of total billed charges,65% of total billed charges,17.12,35.67,,13.696,percent of total billed charges,35.67% of total billed charges,4.8,43.2,
SODIUM REPEAT SAME DAY,3007481,CDM,300,RC,84295,HCPCS,outpatient,,,48,19.20,91,40.8,85,,32.64,percent of total billed charges,85% of total billed charges,36.96,77,,29.57,percent of total billed charges,77% of total billed charges,4.8,100,,,fee schedule,100% of CMS fee schedule,20.79,350,,,fee schedule,350% of BCBS fee schedule,21.62,364,,,fee schedule,364% of BCBS fee schedule,21.62,364,,,fee schedule,364% of BCBS fee schedule,21.62,364,,,fee schedule,364% of BCBS fee schedule,43.2,90,,34.56,percent of total billed charges,90% of total billed charges,38.4,80,,30.72,percent of total billed charges,80% of total billed charges,43.2,90,,34.56,percent of total billed charges,90% of total billed charges,36,75,,28.8,percent of total billed charges,75% of total billed charges,5.86,122,,,fee schedule,122% of APC rate,13.92,29,,11.136,percent of total billed charges,29% of total billed charges,4.8,100,,,fee schedule,100% of CMS fee schedule,32.16,67,,25.728,percent of total billed charges,67% of total billed charges,7.16,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,38.4,80,,30.72,percent of total billed charges,80% of total billed charges,31.2,65,,24.96,percent of total billed charges,65% of total billed charges,17.12,35.67,,13.696,percent of total billed charges,35.67% of total billed charges,4.8,43.2,
SODIUM URINE 24HR,3007520,CDM,300,RC,84300,HCPCS,outpatient,,,63,25.20,,53.55,85,,42.84,percent of total billed charges,85% of total billed charges,48.51,77,,38.81,percent of total billed charges,77% of total billed charges,5.05,100,,,fee schedule,100% of CMS fee schedule,21,350,,,fee schedule,350% of BCBS fee schedule,21.84,364,,,fee schedule,364% of BCBS fee schedule,21.84,364,,,fee schedule,364% of BCBS fee schedule,21.84,364,,,fee schedule,364% of BCBS fee schedule,56.7,90,,45.36,percent of total billed charges,90% of total billed charges,50.4,80,,40.32,percent of total billed charges,80% of total billed charges,56.7,90,,45.36,percent of total billed charges,90% of total billed charges,47.25,75,,37.8,percent of total billed charges,75% of total billed charges,6.17,122,,,fee schedule,122% of APC rate,18.27,29,,14.616,percent of total billed charges,29% of total billed charges,5.05,100,,,fee schedule,100% of CMS fee schedule,42.21,67,,33.768,percent of total billed charges,67% of total billed charges,7.23,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,50.4,80,,40.32,percent of total billed charges,80% of total billed charges,40.95,65,,32.76,percent of total billed charges,65% of total billed charges,22.47,35.67,,17.976,percent of total billed charges,35.67% of total billed charges,5.05,56.7,
SOLUBLE TRANSFERRIN RECEPTOR,3007522,CDM,300,RC,83520,HCPCS,outpatient,,,152,60.80,,129.2,85,,103.36,percent of total billed charges,85% of total billed charges,117.04,77,,93.63,percent of total billed charges,77% of total billed charges,17.27,100,,,fee schedule,100% of CMS fee schedule,60.45,350,,,fee schedule,350% of BCBS fee schedule,62.86,364,,,fee schedule,364% of BCBS fee schedule,62.86,364,,,fee schedule,364% of BCBS fee schedule,62.86,364,,,fee schedule,364% of BCBS fee schedule,136.8,90,,109.44,percent of total billed charges,90% of total billed charges,121.6,80,,97.28,percent of total billed charges,80% of total billed charges,136.8,90,,109.44,percent of total billed charges,90% of total billed charges,114,75,,91.2,percent of total billed charges,75% of total billed charges,21.06,122,,,fee schedule,122% of APC rate,44.08,29,,35.264,percent of total billed charges,29% of total billed charges,17.27,100,,,fee schedule,100% of CMS fee schedule,101.84,67,,81.472,percent of total billed charges,67% of total billed charges,19.25,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,121.6,80,,97.28,percent of total billed charges,80% of total billed charges,98.8,65,,79.04,percent of total billed charges,65% of total billed charges,54.22,35.67,,43.376,percent of total billed charges,35.67% of total billed charges,17.27,136.8,
INTERLEUKIN-6,3007523,CDM,300,RC,83529,HCPCS,outpatient,,,55,22.00,,46.75,85,,37.4,percent of total billed charges,85% of total billed charges,42.35,77,,33.88,percent of total billed charges,77% of total billed charges,17.27,100,,,fee schedule,100% of CMS fee schedule,60.45,350,,,fee schedule,350% of BCBS fee schedule,62.86,364,,,fee schedule,364% of BCBS fee schedule,62.86,364,,,fee schedule,364% of BCBS fee schedule,62.86,364,,,fee schedule,364% of BCBS fee schedule,49.5,90,,39.6,percent of total billed charges,90% of total billed charges,44,80,,35.2,percent of total billed charges,80% of total billed charges,49.5,90,,39.6,percent of total billed charges,90% of total billed charges,41.25,75,,33,percent of total billed charges,75% of total billed charges,21.06,122,,,fee schedule,122% of APC rate,15.95,29,,12.76,percent of total billed charges,29% of total billed charges,17.27,100,,,fee schedule,100% of CMS fee schedule,36.85,67,,29.48,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,44,80,,35.2,percent of total billed charges,80% of total billed charges,35.75,65,,28.6,percent of total billed charges,65% of total billed charges,19.62,35.67,,15.696,percent of total billed charges,35.67% of total billed charges,15.95,62.86,
SPECIMEN COLLECTION - N HOME,3007559,CDM,300,RC,36415,HCPCS,outpatient,,,13,5.20,,1150,,,,case rate,pays based on per visit,10.01,77,,8.01,percent of total billed charges,77% of total billed charges,8.83,100,,,fee schedule,100% of CMS fee schedule,10.66,82,,8.528,percent of total billed charges,82% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,11.7,90,,9.36,percent of total billed charges,90% of total billed charges,10.4,80,,8.32,percent of total billed charges,80% of total billed charges,11.7,90,,9.36,percent of total billed charges,90% of total billed charges,9.75,75,,7.8,percent of total billed charges,75% of total billed charges,10.77,122,,,fee schedule,122% of APC rate,3.77,29,,3.016,percent of total billed charges,29% of total billed charges,8.83,100,,,fee schedule,100% of CMS fee schedule,8.71,67,,6.968,percent of total billed charges,67% of total billed charges,3.15,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,10.4,80,,8.32,percent of total billed charges,80% of total billed charges,8.45,65,,6.76,percent of total billed charges,65% of total billed charges,4.64,35.67,,3.712,percent of total billed charges,35.67% of total billed charges,3.15,1150,
SPECIFIC GRAVITY SYNOVIAL FLD,3007560,CDM,300,RC,84315,HCPCS,outpatient,,,18,7.20,,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,13.86,77,,11.09,percent of total billed charges,77% of total billed charges,3.28,100,,,fee schedule,100% of CMS fee schedule,11.48,350,,,fee schedule,350% of BCBS fee schedule,11.94,364,,,fee schedule,364% of BCBS fee schedule,11.94,364,,,fee schedule,364% of BCBS fee schedule,11.94,364,,,fee schedule,364% of BCBS fee schedule,16.2,90,,12.96,percent of total billed charges,90% of total billed charges,14.4,80,,11.52,percent of total billed charges,80% of total billed charges,16.2,90,,12.96,percent of total billed charges,90% of total billed charges,13.5,75,,10.8,percent of total billed charges,75% of total billed charges,4,122,,,fee schedule,122% of APC rate,5.22,29,,4.176,percent of total billed charges,29% of total billed charges,3.28,100,,,fee schedule,100% of CMS fee schedule,12.06,67,,9.648,percent of total billed charges,67% of total billed charges,3.72,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,14.4,80,,11.52,percent of total billed charges,80% of total billed charges,11.7,65,,9.36,percent of total billed charges,65% of total billed charges,6.42,35.67,,5.136,percent of total billed charges,35.67% of total billed charges,3.28,16.2,
SPECIFIC GRAVITY URINE,3007580,CDM,300,RC,81000,HCPCS,outpatient,,,18,7.20,,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,13.86,77,,11.09,percent of total billed charges,77% of total billed charges,4.01,100,,,fee schedule,100% of CMS fee schedule,14.07,350,,,fee schedule,350% of BCBS fee schedule,14.63,364,,,fee schedule,364% of BCBS fee schedule,14.63,364,,,fee schedule,364% of BCBS fee schedule,14.63,364,,,fee schedule,364% of BCBS fee schedule,16.2,90,,12.96,percent of total billed charges,90% of total billed charges,14.4,80,,11.52,percent of total billed charges,80% of total billed charges,16.2,90,,12.96,percent of total billed charges,90% of total billed charges,13.5,75,,10.8,percent of total billed charges,75% of total billed charges,4.9,122,,,fee schedule,122% of APC rate,5.22,29,,4.176,percent of total billed charges,29% of total billed charges,4.01,100,,,fee schedule,100% of CMS fee schedule,12.06,67,,9.648,percent of total billed charges,67% of total billed charges,4.7,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,14.4,80,,11.52,percent of total billed charges,80% of total billed charges,11.7,65,,9.36,percent of total billed charges,65% of total billed charges,6.42,35.67,,5.136,percent of total billed charges,35.67% of total billed charges,4.01,16.2,
ST.LOUIS EQUINE ENCEPHALITIS,3007600,CDM,300,RC,86256,HCPCS,outpatient,,,113,45.20,,96.05,85,,76.84,percent of total billed charges,85% of total billed charges,87.01,77,,69.61,percent of total billed charges,77% of total billed charges,12.05,100,,,fee schedule,100% of CMS fee schedule,52.08,350,,,fee schedule,350% of BCBS fee schedule,54.16,364,,,fee schedule,364% of BCBS fee schedule,54.16,364,,,fee schedule,364% of BCBS fee schedule,54.16,364,,,fee schedule,364% of BCBS fee schedule,101.7,90,,81.36,percent of total billed charges,90% of total billed charges,90.4,80,,72.32,percent of total billed charges,80% of total billed charges,101.7,90,,81.36,percent of total billed charges,90% of total billed charges,84.75,75,,67.8,percent of total billed charges,75% of total billed charges,14.7,122,,,fee schedule,122% of APC rate,32.77,29,,26.216,percent of total billed charges,29% of total billed charges,12.05,100,,,fee schedule,100% of CMS fee schedule,75.71,67,,60.568,percent of total billed charges,67% of total billed charges,17.92,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,90.4,80,,72.32,percent of total billed charges,80% of total billed charges,73.45,65,,58.76,percent of total billed charges,65% of total billed charges,40.31,35.67,,32.248,percent of total billed charges,35.67% of total billed charges,12.05,101.7,
STAT LAB FOR HOME BOUND OR NH,3007601,CDM,300,RC,S3601,HCPCS,outpatient,,,58,23.20,,49.3,85,,39.44,percent of total billed charges,85% of total billed charges,44.66,77,,35.73,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,47.56,82,,38.048,percent of total billed charges,82% of total billed charges,49.3,85,,39.44,percent of total billed charges,85% of total billed charges,49.3,85,,39.44,percent of total billed charges,85% of total billed charges,49.3,85,,39.44,percent of total billed charges,85% of total billed charges,52.2,90,,41.76,percent of total billed charges,90% of total billed charges,46.4,80,,37.12,percent of total billed charges,80% of total billed charges,52.2,90,,41.76,percent of total billed charges,90% of total billed charges,43.5,75,,34.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,16.82,29,,13.456,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,38.86,67,,31.088,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,46.4,80,,37.12,percent of total billed charges,80% of total billed charges,37.7,65,,30.16,percent of total billed charges,65% of total billed charges,20.69,35.67,,16.552,percent of total billed charges,35.67% of total billed charges,16.82,52.2,
STAT LAB ALL OTHERS NON NH,3007602,CDM,300,RC,S3600,HCPCS,outpatient,,,58,23.20,,49.3,85,,39.44,percent of total billed charges,85% of total billed charges,44.66,77,,35.73,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,7,350,,,fee schedule,350% of BCBS fee schedule,7.28,364,,,fee schedule,364% of BCBS fee schedule,7.28,364,,,fee schedule,364% of BCBS fee schedule,7.28,364,,,fee schedule,364% of BCBS fee schedule,52.2,90,,41.76,percent of total billed charges,90% of total billed charges,46.4,80,,37.12,percent of total billed charges,80% of total billed charges,52.2,90,,41.76,percent of total billed charges,90% of total billed charges,43.5,75,,34.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,16.82,29,,13.456,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,38.86,67,,31.088,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,46.4,80,,37.12,percent of total billed charges,80% of total billed charges,37.7,65,,30.16,percent of total billed charges,65% of total billed charges,20.69,35.67,,16.552,percent of total billed charges,35.67% of total billed charges,7,52.2,
STOOL FAT QUALITATIVE,3007620,CDM,300,RC,82705,HCPCS,outpatient,,,119,47.60,,101.15,85,,80.92,percent of total billed charges,85% of total billed charges,91.63,77,,73.3,percent of total billed charges,77% of total billed charges,5.09,100,,,fee schedule,100% of CMS fee schedule,22.02,350,,,fee schedule,350% of BCBS fee schedule,22.9,364,,,fee schedule,364% of BCBS fee schedule,22.9,364,,,fee schedule,364% of BCBS fee schedule,22.9,364,,,fee schedule,364% of BCBS fee schedule,107.1,90,,85.68,percent of total billed charges,90% of total billed charges,95.2,80,,76.16,percent of total billed charges,80% of total billed charges,107.1,90,,85.68,percent of total billed charges,90% of total billed charges,89.25,75,,71.4,percent of total billed charges,75% of total billed charges,6.22,122,,,fee schedule,122% of APC rate,34.51,29,,27.608,percent of total billed charges,29% of total billed charges,5.09,100,,,fee schedule,100% of CMS fee schedule,79.73,67,,63.784,percent of total billed charges,67% of total billed charges,7.57,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,95.2,80,,76.16,percent of total billed charges,80% of total billed charges,77.35,65,,61.88,percent of total billed charges,65% of total billed charges,42.45,35.67,,33.96,percent of total billed charges,35.67% of total billed charges,5.09,107.1,
GBS PCR STREP B AMP PROBE,3007621,CDM,300,RC,87653,HCPCS,outpatient,,,97,38.80,,82.45,85,,65.96,percent of total billed charges,85% of total billed charges,74.69,77,,59.75,percent of total billed charges,77% of total billed charges,35.09,100,,,fee schedule,100% of CMS fee schedule,151.66,350,,,fee schedule,350% of BCBS fee schedule,157.72,364,,,fee schedule,364% of BCBS fee schedule,157.72,364,,,fee schedule,364% of BCBS fee schedule,157.72,364,,,fee schedule,364% of BCBS fee schedule,87.3,90,,69.84,percent of total billed charges,90% of total billed charges,77.6,80,,62.08,percent of total billed charges,80% of total billed charges,87.3,90,,69.84,percent of total billed charges,90% of total billed charges,72.75,75,,58.2,percent of total billed charges,75% of total billed charges,42.8,122,,,fee schedule,122% of APC rate,28.13,29,,22.504,percent of total billed charges,29% of total billed charges,35.09,100,,,fee schedule,100% of CMS fee schedule,64.99,67,,51.992,percent of total billed charges,67% of total billed charges,52.19,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,77.6,80,,62.08,percent of total billed charges,80% of total billed charges,63.05,65,,50.44,percent of total billed charges,65% of total billed charges,34.6,35.67,,27.68,percent of total billed charges,35.67% of total billed charges,28.13,157.72,
SEMEN ANALYSIS,3007650,CDM,300,RC,89321,HCPCS,outpatient,,,48,19.20,,40.8,85,,32.64,percent of total billed charges,85% of total billed charges,36.96,77,,29.57,percent of total billed charges,77% of total billed charges,12.05,100,,,fee schedule,100% of CMS fee schedule,52.08,350,,,fee schedule,350% of BCBS fee schedule,54.16,364,,,fee schedule,364% of BCBS fee schedule,54.16,364,,,fee schedule,364% of BCBS fee schedule,54.16,364,,,fee schedule,364% of BCBS fee schedule,43.2,90,,34.56,percent of total billed charges,90% of total billed charges,38.4,80,,30.72,percent of total billed charges,80% of total billed charges,43.2,90,,34.56,percent of total billed charges,90% of total billed charges,36,75,,28.8,percent of total billed charges,75% of total billed charges,14.7,122,,,fee schedule,122% of APC rate,13.92,29,,11.136,percent of total billed charges,29% of total billed charges,12.05,100,,,fee schedule,100% of CMS fee schedule,32.16,67,,25.728,percent of total billed charges,67% of total billed charges,17.92,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,38.4,80,,30.72,percent of total billed charges,80% of total billed charges,31.2,65,,24.96,percent of total billed charges,65% of total billed charges,17.12,35.67,,13.696,percent of total billed charges,35.67% of total billed charges,12.05,54.16,
STONE OXALATE,3007652,CDM,300,RC,83945,HCPCS,outpatient,,,63,25.20,,53.55,85,,42.84,percent of total billed charges,85% of total billed charges,48.51,77,,38.81,percent of total billed charges,77% of total billed charges,14.45,100,,,fee schedule,100% of CMS fee schedule,55.62,350,,,fee schedule,350% of BCBS fee schedule,57.84,364,,,fee schedule,364% of BCBS fee schedule,57.84,364,,,fee schedule,364% of BCBS fee schedule,57.84,364,,,fee schedule,364% of BCBS fee schedule,56.7,90,,45.36,percent of total billed charges,90% of total billed charges,50.4,80,,40.32,percent of total billed charges,80% of total billed charges,56.7,90,,45.36,percent of total billed charges,90% of total billed charges,47.25,75,,37.8,percent of total billed charges,75% of total billed charges,17.62,122,,,fee schedule,122% of APC rate,18.27,29,,14.616,percent of total billed charges,29% of total billed charges,14.45,100,,,fee schedule,100% of CMS fee schedule,42.21,67,,33.768,percent of total billed charges,67% of total billed charges,16.45,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,50.4,80,,40.32,percent of total billed charges,80% of total billed charges,40.95,65,,32.76,percent of total billed charges,65% of total billed charges,22.47,35.67,,17.976,percent of total billed charges,35.67% of total billed charges,14.45,57.84,
STONE CITRATE,3007654,CDM,300,RC,82507,HCPCS,outpatient,,,136,54.40,,115.6,85,,92.48,percent of total billed charges,85% of total billed charges,104.72,77,,83.78,percent of total billed charges,77% of total billed charges,27.8,100,,,fee schedule,100% of CMS fee schedule,120.16,350,,,fee schedule,350% of BCBS fee schedule,124.96,364,,,fee schedule,364% of BCBS fee schedule,124.96,364,,,fee schedule,364% of BCBS fee schedule,124.96,364,,,fee schedule,364% of BCBS fee schedule,122.4,90,,97.92,percent of total billed charges,90% of total billed charges,108.8,80,,87.04,percent of total billed charges,80% of total billed charges,122.4,90,,97.92,percent of total billed charges,90% of total billed charges,102,75,,81.6,percent of total billed charges,75% of total billed charges,33.91,122,,,fee schedule,122% of APC rate,39.44,29,,31.552,percent of total billed charges,29% of total billed charges,27.8,100,,,fee schedule,100% of CMS fee schedule,91.12,67,,72.896,percent of total billed charges,67% of total billed charges,41.34,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,108.8,80,,87.04,percent of total billed charges,80% of total billed charges,88.4,65,,70.72,percent of total billed charges,65% of total billed charges,48.51,35.67,,38.808,percent of total billed charges,35.67% of total billed charges,27.8,124.96,
STONE RISK ANALYSIS,3007655,CDM,300,RC,86999,HCPCS,outpatient,,,149,59.60,,126.65,85,,101.32,percent of total billed charges,85% of total billed charges,114.73,77,,91.78,percent of total billed charges,77% of total billed charges,26.03,100,,,fee schedule,100% of CMS OPPS rate,61.15,350,,,fee schedule,350% of BCBS fee schedule,63.59,364,,,fee schedule,364% of BCBS fee schedule,63.59,364,,,fee schedule,364% of BCBS fee schedule,63.59,364,,,fee schedule,364% of BCBS fee schedule,134.1,90,,107.28,percent of total billed charges,90% of total billed charges,119.2,80,,95.36,percent of total billed charges,80% of total billed charges,134.1,90,,107.28,percent of total billed charges,90% of total billed charges,111.75,75,,89.4,percent of total billed charges,75% of total billed charges,31.76,122,,,fee schedule,122% of APC rate,43.21,29,,34.568,percent of total billed charges,29% of total billed charges,26.03,100,,,fee schedule,100% of CMS OPPS rate,99.83,67,,79.864,percent of total billed charges,67% of total billed charges,13.91,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,119.2,80,,95.36,percent of total billed charges,80% of total billed charges,96.85,65,,77.48,percent of total billed charges,65% of total billed charges,53.15,35.67,,42.52,percent of total billed charges,35.67% of total billed charges,13.91,134.1,
STONE SULFATE,3007659,CDM,300,RC,84392,HCPCS,outpatient,,,36,14.40,,30.6,85,,24.48,percent of total billed charges,85% of total billed charges,27.72,77,,22.18,percent of total billed charges,77% of total billed charges,5.49,100,,,fee schedule,100% of CMS fee schedule,20.51,350,,,fee schedule,350% of BCBS fee schedule,21.33,364,,,fee schedule,364% of BCBS fee schedule,21.33,364,,,fee schedule,364% of BCBS fee schedule,21.33,364,,,fee schedule,364% of BCBS fee schedule,32.4,90,,25.92,percent of total billed charges,90% of total billed charges,28.8,80,,23.04,percent of total billed charges,80% of total billed charges,32.4,90,,25.92,percent of total billed charges,90% of total billed charges,27,75,,21.6,percent of total billed charges,75% of total billed charges,6.69,122,,,fee schedule,122% of APC rate,10.44,29,,8.352,percent of total billed charges,29% of total billed charges,5.49,100,,,fee schedule,100% of CMS fee schedule,24.12,67,,19.296,percent of total billed charges,67% of total billed charges,7.06,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,28.8,80,,23.04,percent of total billed charges,80% of total billed charges,23.4,65,,18.72,percent of total billed charges,65% of total billed charges,12.84,35.67,,10.272,percent of total billed charges,35.67% of total billed charges,5.49,32.4,
STONE PHOSPHORUS,3007660,CDM,300,RC,82355,HCPCS,outpatient,,,58,23.20,,49.3,85,,39.44,percent of total billed charges,85% of total billed charges,44.66,77,,35.73,percent of total billed charges,77% of total billed charges,11.58,100,,,fee schedule,100% of CMS fee schedule,50.02,350,,,fee schedule,350% of BCBS fee schedule,52.02,364,,,fee schedule,364% of BCBS fee schedule,52.02,364,,,fee schedule,364% of BCBS fee schedule,52.02,364,,,fee schedule,364% of BCBS fee schedule,52.2,90,,41.76,percent of total billed charges,90% of total billed charges,46.4,80,,37.12,percent of total billed charges,80% of total billed charges,52.2,90,,41.76,percent of total billed charges,90% of total billed charges,43.5,75,,34.8,percent of total billed charges,75% of total billed charges,14.12,122,,,fee schedule,122% of APC rate,16.82,29,,13.456,percent of total billed charges,29% of total billed charges,11.58,100,,,fee schedule,100% of CMS fee schedule,38.86,67,,31.088,percent of total billed charges,67% of total billed charges,17.2,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,46.4,80,,37.12,percent of total billed charges,80% of total billed charges,37.7,65,,30.16,percent of total billed charges,65% of total billed charges,20.69,35.67,,16.552,percent of total billed charges,35.67% of total billed charges,11.58,52.2,
STONE MAGNESIUM,3007661,CDM,300,RC,83735,HCPCS,outpatient,,,97,38.80,,82.45,85,,65.96,percent of total billed charges,85% of total billed charges,74.69,77,,59.75,percent of total billed charges,77% of total billed charges,6.7,100,,,fee schedule,100% of CMS fee schedule,28.95,350,,,fee schedule,350% of BCBS fee schedule,30.1,364,,,fee schedule,364% of BCBS fee schedule,30.1,364,,,fee schedule,364% of BCBS fee schedule,30.1,364,,,fee schedule,364% of BCBS fee schedule,87.3,90,,69.84,percent of total billed charges,90% of total billed charges,77.6,80,,62.08,percent of total billed charges,80% of total billed charges,87.3,90,,69.84,percent of total billed charges,90% of total billed charges,72.75,75,,58.2,percent of total billed charges,75% of total billed charges,8.17,122,,,fee schedule,122% of APC rate,28.13,29,,22.504,percent of total billed charges,29% of total billed charges,6.7,100,,,fee schedule,100% of CMS fee schedule,64.99,67,,51.992,percent of total billed charges,67% of total billed charges,9.96,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,77.6,80,,62.08,percent of total billed charges,80% of total billed charges,63.05,65,,50.44,percent of total billed charges,65% of total billed charges,34.6,35.67,,27.68,percent of total billed charges,35.67% of total billed charges,6.7,87.3,
STONE CREATININE,3007662,CDM,300,RC,82570,HCPCS,outpatient,,,36,14.40,,30.6,85,,24.48,percent of total billed charges,85% of total billed charges,27.72,77,,22.18,percent of total billed charges,77% of total billed charges,5.18,100,,,fee schedule,100% of CMS fee schedule,22.37,350,,,fee schedule,350% of BCBS fee schedule,23.26,364,,,fee schedule,364% of BCBS fee schedule,23.26,364,,,fee schedule,364% of BCBS fee schedule,23.26,364,,,fee schedule,364% of BCBS fee schedule,32.4,90,,25.92,percent of total billed charges,90% of total billed charges,28.8,80,,23.04,percent of total billed charges,80% of total billed charges,32.4,90,,25.92,percent of total billed charges,90% of total billed charges,27,75,,21.6,percent of total billed charges,75% of total billed charges,6.31,122,,,fee schedule,122% of APC rate,10.44,29,,8.352,percent of total billed charges,29% of total billed charges,5.18,100,,,fee schedule,100% of CMS fee schedule,24.12,67,,19.296,percent of total billed charges,67% of total billed charges,7.69,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,28.8,80,,23.04,percent of total billed charges,80% of total billed charges,23.4,65,,18.72,percent of total billed charges,65% of total billed charges,12.84,35.67,,10.272,percent of total billed charges,35.67% of total billed charges,5.18,32.4,
"BILE ACID, FRACTIONATED",3007663,CDM,300,RC,83789,HCPCS,outpatient,,,78,31.20,,66.3,85,,53.04,percent of total billed charges,85% of total billed charges,60.06,77,,48.05,percent of total billed charges,77% of total billed charges,24.11,100,,,fee schedule,100% of CMS fee schedule,84.39,350,,,fee schedule,350% of BCBS fee schedule,87.76,364,,,fee schedule,364% of BCBS fee schedule,87.76,364,,,fee schedule,364% of BCBS fee schedule,87.76,364,,,fee schedule,364% of BCBS fee schedule,70.2,90,,56.16,percent of total billed charges,90% of total billed charges,62.4,80,,49.92,percent of total billed charges,80% of total billed charges,70.2,90,,56.16,percent of total billed charges,90% of total billed charges,58.5,75,,46.8,percent of total billed charges,75% of total billed charges,29.41,122,,,fee schedule,122% of APC rate,22.62,29,,18.096,percent of total billed charges,29% of total billed charges,24.11,100,,,fee schedule,100% of CMS fee schedule,52.26,67,,41.808,percent of total billed charges,67% of total billed charges,26.84,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,62.4,80,,49.92,percent of total billed charges,80% of total billed charges,50.7,65,,40.56,percent of total billed charges,65% of total billed charges,27.82,35.67,,22.256,percent of total billed charges,35.67% of total billed charges,22.62,87.76,
STONE AMMONIUM,3007664,CDM,300,RC,82140,HCPCS,outpatient,,,79,31.60,,67.15,85,,53.72,percent of total billed charges,85% of total billed charges,60.83,77,,48.66,percent of total billed charges,77% of total billed charges,14.57,100,,,fee schedule,100% of CMS fee schedule,62.97,350,,,fee schedule,350% of BCBS fee schedule,65.48,364,,,fee schedule,364% of BCBS fee schedule,65.48,364,,,fee schedule,364% of BCBS fee schedule,65.48,364,,,fee schedule,364% of BCBS fee schedule,71.1,90,,56.88,percent of total billed charges,90% of total billed charges,63.2,80,,50.56,percent of total billed charges,80% of total billed charges,71.1,90,,56.88,percent of total billed charges,90% of total billed charges,59.25,75,,47.4,percent of total billed charges,75% of total billed charges,17.77,122,,,fee schedule,122% of APC rate,22.91,29,,18.328,percent of total billed charges,29% of total billed charges,14.57,100,,,fee schedule,100% of CMS fee schedule,52.93,67,,42.344,percent of total billed charges,67% of total billed charges,21.67,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,63.2,80,,50.56,percent of total billed charges,80% of total billed charges,51.35,65,,41.08,percent of total billed charges,65% of total billed charges,28.18,35.67,,22.544,percent of total billed charges,35.67% of total billed charges,14.57,71.1,
STONE RELATIVE SUPERSAT RATIO,3007665,CDM,300,RC,80500,HCPCS,outpatient,,,215,86.00,,182.75,85,,146.2,percent of total billed charges,85% of total billed charges,165.55,77,,132.44,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,176.3,82,,141.04,percent of total billed charges,82% of total billed charges,182.75,85,,146.2,percent of total billed charges,85% of total billed charges,182.75,85,,146.2,percent of total billed charges,85% of total billed charges,182.75,85,,146.2,percent of total billed charges,85% of total billed charges,193.5,90,,154.8,percent of total billed charges,90% of total billed charges,172,80,,137.6,percent of total billed charges,80% of total billed charges,193.5,90,,154.8,percent of total billed charges,90% of total billed charges,161.25,75,,129,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,62.35,29,,49.88,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,144.05,67,,115.24,percent of total billed charges,67% of total billed charges,10.39,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,172,80,,137.6,percent of total billed charges,80% of total billed charges,139.75,65,,111.8,percent of total billed charges,65% of total billed charges,76.69,35.67,,61.352,percent of total billed charges,35.67% of total billed charges,10.39,193.5,
STOOL OCCULT BLOOD SCREENING,3007700,CDM,300,RC,82272,HCPCS,outpatient,,,62,24.80,,52.7,85,,42.16,percent of total billed charges,85% of total billed charges,47.74,77,,38.19,percent of total billed charges,77% of total billed charges,4.23,100,,,fee schedule,100% of CMS fee schedule,14.81,350,,,fee schedule,350% of BCBS fee schedule,15.4,364,,,fee schedule,364% of BCBS fee schedule,15.4,364,,,fee schedule,364% of BCBS fee schedule,15.4,364,,,fee schedule,364% of BCBS fee schedule,55.8,90,,44.64,percent of total billed charges,90% of total billed charges,49.6,80,,39.68,percent of total billed charges,80% of total billed charges,55.8,90,,44.64,percent of total billed charges,90% of total billed charges,46.5,75,,37.2,percent of total billed charges,75% of total billed charges,5.16,122,,,fee schedule,122% of APC rate,17.98,29,,14.384,percent of total billed charges,29% of total billed charges,4.23,100,,,fee schedule,100% of CMS fee schedule,41.54,67,,33.232,percent of total billed charges,67% of total billed charges,4.84,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,49.6,80,,39.68,percent of total billed charges,80% of total billed charges,40.3,65,,32.24,percent of total billed charges,65% of total billed charges,22.12,35.67,,17.696,percent of total billed charges,35.67% of total billed charges,4.23,55.8,
OCCULT BLOOD STOOL DIAGNOSTIC,3007702,CDM,300,RC,82270,HCPCS,outpatient,,,62,24.80,,52.7,85,,42.16,percent of total billed charges,85% of total billed charges,47.74,77,,38.19,percent of total billed charges,77% of total billed charges,4.38,100,,,fee schedule,100% of CMS fee schedule,15.33,350,,,fee schedule,350% of BCBS fee schedule,15.94,364,,,fee schedule,364% of BCBS fee schedule,15.94,364,,,fee schedule,364% of BCBS fee schedule,15.94,364,,,fee schedule,364% of BCBS fee schedule,55.8,90,,44.64,percent of total billed charges,90% of total billed charges,49.6,80,,39.68,percent of total billed charges,80% of total billed charges,55.8,90,,44.64,percent of total billed charges,90% of total billed charges,46.5,75,,37.2,percent of total billed charges,75% of total billed charges,5.34,122,,,fee schedule,122% of APC rate,17.98,29,,14.384,percent of total billed charges,29% of total billed charges,4.38,100,,,fee schedule,100% of CMS fee schedule,41.54,67,,33.232,percent of total billed charges,67% of total billed charges,4.84,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,49.6,80,,39.68,percent of total billed charges,80% of total billed charges,40.3,65,,32.24,percent of total billed charges,65% of total billed charges,22.12,35.67,,17.696,percent of total billed charges,35.67% of total billed charges,4.38,55.8,
"STOOL, PH",3007710,CDM,300,RC,83986,HCPCS,outpatient,,,50,20.00,,42.5,85,,34,percent of total billed charges,85% of total billed charges,38.5,77,,30.8,percent of total billed charges,77% of total billed charges,3.58,100,,,fee schedule,100% of CMS fee schedule,15.47,350,,,fee schedule,350% of BCBS fee schedule,16.09,364,,,fee schedule,364% of BCBS fee schedule,16.09,364,,,fee schedule,364% of BCBS fee schedule,16.09,364,,,fee schedule,364% of BCBS fee schedule,45,90,,36,percent of total billed charges,90% of total billed charges,40,80,,32,percent of total billed charges,80% of total billed charges,45,90,,36,percent of total billed charges,90% of total billed charges,37.5,75,,30,percent of total billed charges,75% of total billed charges,4.36,122,,,fee schedule,122% of APC rate,14.5,29,,11.6,percent of total billed charges,29% of total billed charges,3.58,100,,,fee schedule,100% of CMS fee schedule,33.5,67,,26.8,percent of total billed charges,67% of total billed charges,4.97,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,40,80,,32,percent of total billed charges,80% of total billed charges,32.5,65,,26,percent of total billed charges,65% of total billed charges,17.84,35.67,,14.272,percent of total billed charges,35.67% of total billed charges,3.58,45,
STREP SCREEN THROAT,3007720,CDM,300,RC,87880,HCPCS,outpatient,,,66,26.40,QW,56.1,85,,44.88,percent of total billed charges,85% of total billed charges,50.82,77,,40.66,percent of total billed charges,77% of total billed charges,16.53,100,,,fee schedule,100% of CMS fee schedule,57.86,350,,,fee schedule,350% of BCBS fee schedule,60.17,364,,,fee schedule,364% of BCBS fee schedule,60.17,364,,,fee schedule,364% of BCBS fee schedule,60.17,364,,,fee schedule,364% of BCBS fee schedule,59.4,90,,47.52,percent of total billed charges,90% of total billed charges,52.8,80,,42.24,percent of total billed charges,80% of total billed charges,59.4,90,,47.52,percent of total billed charges,90% of total billed charges,49.5,75,,39.6,percent of total billed charges,75% of total billed charges,20.16,122,,,fee schedule,122% of APC rate,19.14,29,,15.312,percent of total billed charges,29% of total billed charges,16.53,100,,,fee schedule,100% of CMS fee schedule,44.22,67,,35.376,percent of total billed charges,67% of total billed charges,15.41,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,52.8,80,,42.24,percent of total billed charges,80% of total billed charges,42.9,65,,34.32,percent of total billed charges,65% of total billed charges,23.54,35.67,,18.832,percent of total billed charges,35.67% of total billed charges,15.41,60.17,
STREP B SCREEN IN HOUSE,3007749,CDM,300,RC,87801,HCPCS,outpatient,,,208,83.20,QW,176.8,85,,141.44,percent of total billed charges,85% of total billed charges,160.16,77,,128.13,percent of total billed charges,77% of total billed charges,70.2,100,,,fee schedule,100% of CMS fee schedule,303.31,350,,,fee schedule,350% of BCBS fee schedule,315.44,364,,,fee schedule,364% of BCBS fee schedule,315.44,364,,,fee schedule,364% of BCBS fee schedule,315.44,364,,,fee schedule,364% of BCBS fee schedule,187.2,90,,149.76,percent of total billed charges,90% of total billed charges,166.4,80,,133.12,percent of total billed charges,80% of total billed charges,187.2,90,,149.76,percent of total billed charges,90% of total billed charges,156,75,,124.8,percent of total billed charges,75% of total billed charges,85.64,122,,,fee schedule,122% of APC rate,60.32,29,,48.256,percent of total billed charges,29% of total billed charges,70.2,100,,,fee schedule,100% of CMS fee schedule,139.36,67,,111.488,percent of total billed charges,67% of total billed charges,104.39,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,166.4,80,,133.12,percent of total billed charges,80% of total billed charges,135.2,65,,108.16,percent of total billed charges,65% of total billed charges,74.19,35.67,,59.352,percent of total billed charges,35.67% of total billed charges,60.32,315.44,
STREP B VAGINAL,3007750,CDM,300,RC,87802,HCPCS,outpatient,,,103,41.20,,87.55,85,,70.04,percent of total billed charges,85% of total billed charges,79.31,77,,63.45,percent of total billed charges,77% of total billed charges,12.73,100,,,fee schedule,100% of CMS fee schedule,51.8,350,,,fee schedule,350% of BCBS fee schedule,53.87,364,,,fee schedule,364% of BCBS fee schedule,53.87,364,,,fee schedule,364% of BCBS fee schedule,53.87,364,,,fee schedule,364% of BCBS fee schedule,92.7,90,,74.16,percent of total billed charges,90% of total billed charges,82.4,80,,65.92,percent of total billed charges,80% of total billed charges,92.7,90,,74.16,percent of total billed charges,90% of total billed charges,77.25,75,,61.8,percent of total billed charges,75% of total billed charges,15.53,122,,,fee schedule,122% of APC rate,29.87,29,,23.896,percent of total billed charges,29% of total billed charges,12.73,100,,,fee schedule,100% of CMS fee schedule,69.01,67,,55.208,percent of total billed charges,67% of total billed charges,15.41,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,82.4,80,,65.92,percent of total billed charges,80% of total billed charges,66.95,65,,53.56,percent of total billed charges,65% of total billed charges,36.74,35.67,,29.392,percent of total billed charges,35.67% of total billed charges,12.73,92.7,
SULFHEMOGLOBIN,3007760,CDM,300,RC,83060,HCPCS,outpatient,,,90,36.00,,76.5,85,,61.2,percent of total billed charges,85% of total billed charges,69.3,77,,55.44,percent of total billed charges,77% of total billed charges,8.8,100,,,fee schedule,100% of CMS fee schedule,35.74,350,,,fee schedule,350% of BCBS fee schedule,37.16,364,,,fee schedule,364% of BCBS fee schedule,37.16,364,,,fee schedule,364% of BCBS fee schedule,37.16,364,,,fee schedule,364% of BCBS fee schedule,81,90,,64.8,percent of total billed charges,90% of total billed charges,72,80,,57.6,percent of total billed charges,80% of total billed charges,81,90,,64.8,percent of total billed charges,90% of total billed charges,67.5,75,,54,percent of total billed charges,75% of total billed charges,10.73,122,,,fee schedule,122% of APC rate,26.1,29,,20.88,percent of total billed charges,29% of total billed charges,8.8,100,,,fee schedule,100% of CMS fee schedule,60.3,67,,48.24,percent of total billed charges,67% of total billed charges,5.18,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,72,80,,57.6,percent of total billed charges,80% of total billed charges,58.5,65,,46.8,percent of total billed charges,65% of total billed charges,32.1,35.67,,25.68,percent of total billed charges,35.67% of total billed charges,5.18,81,
PERITONEAL FLUID CELL COUNT/DF,3007791,CDM,300,RC,89050,HCPCS,outpatient,,,231,92.40,,196.35,85,,157.08,percent of total billed charges,85% of total billed charges,177.87,77,,142.3,percent of total billed charges,77% of total billed charges,4.72,100,,,fee schedule,100% of CMS fee schedule,20.41,350,,,fee schedule,350% of BCBS fee schedule,21.22,364,,,fee schedule,364% of BCBS fee schedule,21.22,364,,,fee schedule,364% of BCBS fee schedule,21.22,364,,,fee schedule,364% of BCBS fee schedule,207.9,90,,166.32,percent of total billed charges,90% of total billed charges,184.8,80,,147.84,percent of total billed charges,80% of total billed charges,207.9,90,,166.32,percent of total billed charges,90% of total billed charges,173.25,75,,138.6,percent of total billed charges,75% of total billed charges,5.75,122,,,fee schedule,122% of APC rate,66.99,29,,53.592,percent of total billed charges,29% of total billed charges,4.72,100,,,fee schedule,100% of CMS fee schedule,154.77,67,,123.816,percent of total billed charges,67% of total billed charges,6.38,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,184.8,80,,147.84,percent of total billed charges,80% of total billed charges,150.15,65,,120.12,percent of total billed charges,65% of total billed charges,82.4,35.67,,65.92,percent of total billed charges,35.67% of total billed charges,4.72,207.9,
SYNOVIAL ALBUMIN,3007792,CDM,300,RC,82042,HCPCS,outpatient,,,33,13.20,,28.05,85,,22.44,percent of total billed charges,85% of total billed charges,25.41,77,,20.33,percent of total billed charges,77% of total billed charges,7.78,100,,,fee schedule,100% of CMS fee schedule,27.23,350,,,fee schedule,350% of BCBS fee schedule,28.32,364,,,fee schedule,364% of BCBS fee schedule,28.32,364,,,fee schedule,364% of BCBS fee schedule,28.32,364,,,fee schedule,364% of BCBS fee schedule,29.7,90,,23.76,percent of total billed charges,90% of total billed charges,26.4,80,,21.12,percent of total billed charges,80% of total billed charges,29.7,90,,23.76,percent of total billed charges,90% of total billed charges,24.75,75,,19.8,percent of total billed charges,75% of total billed charges,9.49,122,,,fee schedule,122% of APC rate,9.57,29,,7.656,percent of total billed charges,29% of total billed charges,7.78,100,,,fee schedule,100% of CMS fee schedule,22.11,67,,17.688,percent of total billed charges,67% of total billed charges,4.28,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,26.4,80,,21.12,percent of total billed charges,80% of total billed charges,21.45,65,,17.16,percent of total billed charges,65% of total billed charges,11.77,35.67,,9.416,percent of total billed charges,35.67% of total billed charges,4.28,29.7,
SYNOVIAL FLUID CHOLESTROL,3007793,CDM,300,RC,82465,HCPCS,outpatient,,,22,8.80,,18.7,85,,14.96,percent of total billed charges,85% of total billed charges,16.94,77,,13.55,percent of total billed charges,77% of total billed charges,4.34,100,,,fee schedule,100% of CMS fee schedule,18.8,350,,,fee schedule,350% of BCBS fee schedule,19.55,364,,,fee schedule,364% of BCBS fee schedule,19.55,364,,,fee schedule,364% of BCBS fee schedule,19.55,364,,,fee schedule,364% of BCBS fee schedule,19.8,90,,15.84,percent of total billed charges,90% of total billed charges,17.6,80,,14.08,percent of total billed charges,80% of total billed charges,19.8,90,,15.84,percent of total billed charges,90% of total billed charges,16.5,75,,13.2,percent of total billed charges,75% of total billed charges,5.3,122,,,fee schedule,122% of APC rate,6.38,29,,5.104,percent of total billed charges,29% of total billed charges,4.34,100,,,fee schedule,100% of CMS fee schedule,14.74,67,,11.792,percent of total billed charges,67% of total billed charges,6.46,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,17.6,80,,14.08,percent of total billed charges,80% of total billed charges,14.3,65,,11.44,percent of total billed charges,65% of total billed charges,7.85,35.67,,6.28,percent of total billed charges,35.67% of total billed charges,4.34,19.8,
TB INTRADERMAL - PPD,3007800,CDM,300,RC,86580,HCPCS,outpatient,,,70,28.00,,59.5,85,,47.6,percent of total billed charges,85% of total billed charges,53.9,77,,43.12,percent of total billed charges,77% of total billed charges,26.03,100,,,fee schedule,100% of CMS OPPS rate,61.15,350,,,fee schedule,350% of BCBS fee schedule,63.59,364,,,fee schedule,364% of BCBS fee schedule,63.59,364,,,fee schedule,364% of BCBS fee schedule,63.59,364,,,fee schedule,364% of BCBS fee schedule,63,90,,50.4,percent of total billed charges,90% of total billed charges,56,80,,44.8,percent of total billed charges,80% of total billed charges,63,90,,50.4,percent of total billed charges,90% of total billed charges,52.5,75,,42,percent of total billed charges,75% of total billed charges,31.76,122,,,fee schedule,122% of APC rate,20.3,29,,16.24,percent of total billed charges,29% of total billed charges,26.03,100,,,fee schedule,100% of CMS OPPS rate,46.9,67,,37.52,percent of total billed charges,67% of total billed charges,5.3,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,56,80,,44.8,percent of total billed charges,80% of total billed charges,45.5,65,,36.4,percent of total billed charges,65% of total billed charges,24.97,35.67,,19.976,percent of total billed charges,35.67% of total billed charges,5.3,63.59,
T CELLS TOTAL COUNT,3007801,CDM,300,RC,86359,HCPCS,outpatient,,,186,74.40,,158.1,85,,126.48,percent of total billed charges,85% of total billed charges,143.22,77,,114.58,percent of total billed charges,77% of total billed charges,37.72,100,,,fee schedule,100% of CMS fee schedule,163.03,350,,,fee schedule,350% of BCBS fee schedule,169.55,364,,,fee schedule,364% of BCBS fee schedule,169.55,364,,,fee schedule,364% of BCBS fee schedule,169.55,364,,,fee schedule,364% of BCBS fee schedule,167.4,90,,133.92,percent of total billed charges,90% of total billed charges,148.8,80,,119.04,percent of total billed charges,80% of total billed charges,167.4,90,,133.92,percent of total billed charges,90% of total billed charges,139.5,75,,111.6,percent of total billed charges,75% of total billed charges,46.03,122,,,fee schedule,122% of APC rate,53.94,29,,43.152,percent of total billed charges,29% of total billed charges,37.72,100,,,fee schedule,100% of CMS fee schedule,124.62,67,,99.696,percent of total billed charges,67% of total billed charges,56.1,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,148.8,80,,119.04,percent of total billed charges,80% of total billed charges,120.9,65,,96.72,percent of total billed charges,65% of total billed charges,66.35,35.67,,53.08,percent of total billed charges,35.67% of total billed charges,37.72,169.55,
TEICHOIC ACID ANTIBODIES,3007810,CDM,300,RC,86331,HCPCS,outpatient,,,73,29.20,,62.05,85,,49.64,percent of total billed charges,85% of total billed charges,56.21,77,,44.97,percent of total billed charges,77% of total billed charges,11.98,100,,,fee schedule,100% of CMS fee schedule,51.77,350,,,fee schedule,350% of BCBS fee schedule,53.84,364,,,fee schedule,364% of BCBS fee schedule,53.84,364,,,fee schedule,364% of BCBS fee schedule,53.84,364,,,fee schedule,364% of BCBS fee schedule,65.7,90,,52.56,percent of total billed charges,90% of total billed charges,58.4,80,,46.72,percent of total billed charges,80% of total billed charges,65.7,90,,52.56,percent of total billed charges,90% of total billed charges,54.75,75,,43.8,percent of total billed charges,75% of total billed charges,14.61,122,,,fee schedule,122% of APC rate,21.17,29,,16.936,percent of total billed charges,29% of total billed charges,11.98,100,,,fee schedule,100% of CMS fee schedule,48.91,67,,39.128,percent of total billed charges,67% of total billed charges,17.82,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,58.4,80,,46.72,percent of total billed charges,80% of total billed charges,47.45,65,,37.96,percent of total billed charges,65% of total billed charges,26.04,35.67,,20.832,percent of total billed charges,35.67% of total billed charges,11.98,65.7,
TESTOSTERONE,3007820,CDM,300,RC,84403,HCPCS,outpatient,,,152,60.80,,129.2,85,,103.36,percent of total billed charges,85% of total billed charges,117.04,77,,93.63,percent of total billed charges,77% of total billed charges,25.81,100,,,fee schedule,100% of CMS fee schedule,111.55,350,,,fee schedule,350% of BCBS fee schedule,116.01,364,,,fee schedule,364% of BCBS fee schedule,116.01,364,,,fee schedule,364% of BCBS fee schedule,116.01,364,,,fee schedule,364% of BCBS fee schedule,136.8,90,,109.44,percent of total billed charges,90% of total billed charges,121.6,80,,97.28,percent of total billed charges,80% of total billed charges,136.8,90,,109.44,percent of total billed charges,90% of total billed charges,114,75,,91.2,percent of total billed charges,75% of total billed charges,31.48,122,,,fee schedule,122% of APC rate,44.08,29,,35.264,percent of total billed charges,29% of total billed charges,25.81,100,,,fee schedule,100% of CMS fee schedule,101.84,67,,81.472,percent of total billed charges,67% of total billed charges,38.39,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,121.6,80,,97.28,percent of total billed charges,80% of total billed charges,98.8,65,,79.04,percent of total billed charges,65% of total billed charges,54.22,35.67,,43.376,percent of total billed charges,35.67% of total billed charges,25.81,136.8,
TESTOSTERONE; FREE,3007841,CDM,300,RC,84402,HCPCS,outpatient,,,149,59.60,,126.65,85,,101.32,percent of total billed charges,85% of total billed charges,114.73,77,,91.78,percent of total billed charges,77% of total billed charges,25.47,100,,,fee schedule,100% of CMS fee schedule,110.08,350,,,fee schedule,350% of BCBS fee schedule,114.48,364,,,fee schedule,364% of BCBS fee schedule,114.48,364,,,fee schedule,364% of BCBS fee schedule,114.48,364,,,fee schedule,364% of BCBS fee schedule,134.1,90,,107.28,percent of total billed charges,90% of total billed charges,119.2,80,,95.36,percent of total billed charges,80% of total billed charges,134.1,90,,107.28,percent of total billed charges,90% of total billed charges,111.75,75,,89.4,percent of total billed charges,75% of total billed charges,31.07,122,,,fee schedule,122% of APC rate,43.21,29,,34.568,percent of total billed charges,29% of total billed charges,25.47,100,,,fee schedule,100% of CMS fee schedule,99.83,67,,79.864,percent of total billed charges,67% of total billed charges,37.87,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,119.2,80,,95.36,percent of total billed charges,80% of total billed charges,96.85,65,,77.48,percent of total billed charges,65% of total billed charges,53.15,35.67,,42.52,percent of total billed charges,35.67% of total billed charges,25.47,134.1,
THEOPHYLLINE,3007860,CDM,300,RC,80198,HCPCS,outpatient,,,70,28.00,,59.5,85,,47.6,percent of total billed charges,85% of total billed charges,53.9,77,,43.12,percent of total billed charges,77% of total billed charges,14.14,100,,,fee schedule,100% of CMS fee schedule,61.11,350,,,fee schedule,350% of BCBS fee schedule,63.55,364,,,fee schedule,364% of BCBS fee schedule,63.55,364,,,fee schedule,364% of BCBS fee schedule,63.55,364,,,fee schedule,364% of BCBS fee schedule,63,90,,50.4,percent of total billed charges,90% of total billed charges,56,80,,44.8,percent of total billed charges,80% of total billed charges,63,90,,50.4,percent of total billed charges,90% of total billed charges,52.5,75,,42,percent of total billed charges,75% of total billed charges,17.25,122,,,fee schedule,122% of APC rate,20.3,29,,16.24,percent of total billed charges,29% of total billed charges,14.14,100,,,fee schedule,100% of CMS fee schedule,46.9,67,,37.52,percent of total billed charges,67% of total billed charges,21.04,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,56,80,,44.8,percent of total billed charges,80% of total billed charges,45.5,65,,36.4,percent of total billed charges,65% of total billed charges,24.97,35.67,,19.976,percent of total billed charges,35.67% of total billed charges,14.14,63.55,
THERAPEUTIC PHLEBOTOMY,3007861,CDM,300,RC,99195,HCPCS,outpatient,,,454,181.60,,385.9,85,,308.72,percent of total billed charges,85% of total billed charges,349.58,77,,279.66,percent of total billed charges,77% of total billed charges,111.71,100,,,fee schedule,100% of CMS OPPS rate,450.62,429,,,fee schedule,429% of BCBS fee schedule,469.53,447,,,fee schedule,447% of BCBS fee schedule,469.53,447,,,fee schedule,447% of BCBS fee schedule,469.53,447,,,fee schedule,447% of BCBS fee schedule,408.6,90,,326.88,percent of total billed charges,90% of total billed charges,363.2,80,,290.56,percent of total billed charges,80% of total billed charges,408.6,90,,326.88,percent of total billed charges,90% of total billed charges,340.5,75,,272.4,percent of total billed charges,75% of total billed charges,136.28,122,,,fee schedule,122% of APC rate,131.66,29,,105.328,percent of total billed charges,29% of total billed charges,111.71,100,,,fee schedule,100% of CMS OPPS rate,304.18,67,,243.344,percent of total billed charges,67% of total billed charges,39.76,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,363.2,80,,290.56,percent of total billed charges,80% of total billed charges,295.1,65,,236.08,percent of total billed charges,65% of total billed charges,161.94,35.67,,129.552,percent of total billed charges,35.67% of total billed charges,39.76,469.53,
THIOCYANATE,3007880,CDM,300,RC,84430,HCPCS,outpatient,,,64,25.60,,54.4,85,,43.52,percent of total billed charges,85% of total billed charges,49.28,77,,39.42,percent of total billed charges,77% of total billed charges,11.63,100,,,fee schedule,100% of CMS fee schedule,50.26,350,,,fee schedule,350% of BCBS fee schedule,52.27,364,,,fee schedule,364% of BCBS fee schedule,52.27,364,,,fee schedule,364% of BCBS fee schedule,52.27,364,,,fee schedule,364% of BCBS fee schedule,57.6,90,,46.08,percent of total billed charges,90% of total billed charges,51.2,80,,40.96,percent of total billed charges,80% of total billed charges,57.6,90,,46.08,percent of total billed charges,90% of total billed charges,48,75,,38.4,percent of total billed charges,75% of total billed charges,14.18,122,,,fee schedule,122% of APC rate,18.56,29,,14.848,percent of total billed charges,29% of total billed charges,11.63,100,,,fee schedule,100% of CMS fee schedule,42.88,67,,34.304,percent of total billed charges,67% of total billed charges,17.3,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,51.2,80,,40.96,percent of total billed charges,80% of total billed charges,41.6,65,,33.28,percent of total billed charges,65% of total billed charges,22.83,35.67,,18.264,percent of total billed charges,35.67% of total billed charges,11.63,57.6,
THYROGLOBULIN,3007881,CDM,300,RC,84432,HCPCS,outpatient,,,49,19.60,,41.65,85,,33.32,percent of total billed charges,85% of total billed charges,37.73,77,,30.18,percent of total billed charges,77% of total billed charges,16.05,100,,,fee schedule,100% of CMS fee schedule,69.41,350,,,fee schedule,350% of BCBS fee schedule,72.18,364,,,fee schedule,364% of BCBS fee schedule,72.18,364,,,fee schedule,364% of BCBS fee schedule,72.18,364,,,fee schedule,364% of BCBS fee schedule,44.1,90,,35.28,percent of total billed charges,90% of total billed charges,39.2,80,,31.36,percent of total billed charges,80% of total billed charges,44.1,90,,35.28,percent of total billed charges,90% of total billed charges,36.75,75,,29.4,percent of total billed charges,75% of total billed charges,19.59,122,,,fee schedule,122% of APC rate,14.21,29,,11.368,percent of total billed charges,29% of total billed charges,16.05,100,,,fee schedule,100% of CMS fee schedule,32.83,67,,26.264,percent of total billed charges,67% of total billed charges,23.89,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,39.2,80,,31.36,percent of total billed charges,80% of total billed charges,31.85,65,,25.48,percent of total billed charges,65% of total billed charges,17.48,35.67,,13.984,percent of total billed charges,35.67% of total billed charges,14.21,72.18,
THIOTHIXENE,3007920,CDM,300,RC,80299,HCPCS,outpatient,,,147,58.80,,124.95,85,,99.96,percent of total billed charges,85% of total billed charges,113.19,77,,90.55,percent of total billed charges,77% of total billed charges,18.64,100,,,fee schedule,100% of CMS fee schedule,65.24,350,,,fee schedule,350% of BCBS fee schedule,67.85,364,,,fee schedule,364% of BCBS fee schedule,67.85,364,,,fee schedule,364% of BCBS fee schedule,67.85,364,,,fee schedule,364% of BCBS fee schedule,132.3,90,,105.84,percent of total billed charges,90% of total billed charges,117.6,80,,94.08,percent of total billed charges,80% of total billed charges,132.3,90,,105.84,percent of total billed charges,90% of total billed charges,110.25,75,,88.2,percent of total billed charges,75% of total billed charges,22.74,122,,,fee schedule,122% of APC rate,42.63,29,,34.104,percent of total billed charges,29% of total billed charges,18.64,100,,,fee schedule,100% of CMS fee schedule,98.49,67,,78.792,percent of total billed charges,67% of total billed charges,20.36,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,117.6,80,,94.08,percent of total billed charges,80% of total billed charges,95.55,65,,76.44,percent of total billed charges,65% of total billed charges,52.43,35.67,,41.944,percent of total billed charges,35.67% of total billed charges,18.64,132.3,
THROMBIN TIME,3007940,CDM,300,RC,85670,HCPCS,outpatient,,,38,15.20,,32.3,85,,25.84,percent of total billed charges,85% of total billed charges,29.26,77,,23.41,percent of total billed charges,77% of total billed charges,5.77,100,,,fee schedule,100% of CMS fee schedule,24.92,350,,,fee schedule,350% of BCBS fee schedule,25.92,364,,,fee schedule,364% of BCBS fee schedule,25.92,364,,,fee schedule,364% of BCBS fee schedule,25.92,364,,,fee schedule,364% of BCBS fee schedule,34.2,90,,27.36,percent of total billed charges,90% of total billed charges,30.4,80,,24.32,percent of total billed charges,80% of total billed charges,34.2,90,,27.36,percent of total billed charges,90% of total billed charges,28.5,75,,22.8,percent of total billed charges,75% of total billed charges,7.03,122,,,fee schedule,122% of APC rate,11.02,29,,8.816,percent of total billed charges,29% of total billed charges,5.77,100,,,fee schedule,100% of CMS fee schedule,25.46,67,,20.368,percent of total billed charges,67% of total billed charges,8.58,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,30.4,80,,24.32,percent of total billed charges,80% of total billed charges,24.7,65,,19.76,percent of total billed charges,65% of total billed charges,13.55,35.67,,10.84,percent of total billed charges,35.67% of total billed charges,5.77,34.2,
THYROGLOBULIN ANTIBODY,3007960,CDM,300,RC,86800,HCPCS,outpatient,,,120,48.00,,102,85,,81.6,percent of total billed charges,85% of total billed charges,92.4,77,,73.92,percent of total billed charges,77% of total billed charges,15.91,100,,,fee schedule,100% of CMS fee schedule,68.74,350,,,fee schedule,350% of BCBS fee schedule,71.49,364,,,fee schedule,364% of BCBS fee schedule,71.49,364,,,fee schedule,364% of BCBS fee schedule,71.49,364,,,fee schedule,364% of BCBS fee schedule,108,90,,86.4,percent of total billed charges,90% of total billed charges,96,80,,76.8,percent of total billed charges,80% of total billed charges,108,90,,86.4,percent of total billed charges,90% of total billed charges,90,75,,72,percent of total billed charges,75% of total billed charges,19.41,122,,,fee schedule,122% of APC rate,34.8,29,,27.84,percent of total billed charges,29% of total billed charges,15.91,100,,,fee schedule,100% of CMS fee schedule,80.4,67,,64.32,percent of total billed charges,67% of total billed charges,23.65,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,96,80,,76.8,percent of total billed charges,80% of total billed charges,78,65,,62.4,percent of total billed charges,65% of total billed charges,42.8,35.67,,34.24,percent of total billed charges,35.67% of total billed charges,15.91,108,
MICROSOMAL ANTIBODIES,3007981,CDM,300,RC,86376,HCPCS,outpatient,,,101,40.40,,85.85,85,,68.68,percent of total billed charges,85% of total billed charges,77.77,77,,62.22,percent of total billed charges,77% of total billed charges,14.55,100,,,fee schedule,100% of CMS fee schedule,62.86,350,,,fee schedule,350% of BCBS fee schedule,65.37,364,,,fee schedule,364% of BCBS fee schedule,65.37,364,,,fee schedule,364% of BCBS fee schedule,65.37,364,,,fee schedule,364% of BCBS fee schedule,90.9,90,,72.72,percent of total billed charges,90% of total billed charges,80.8,80,,64.64,percent of total billed charges,80% of total billed charges,90.9,90,,72.72,percent of total billed charges,90% of total billed charges,75.75,75,,60.6,percent of total billed charges,75% of total billed charges,17.75,122,,,fee schedule,122% of APC rate,29.29,29,,23.432,percent of total billed charges,29% of total billed charges,14.55,100,,,fee schedule,100% of CMS fee schedule,67.67,67,,54.136,percent of total billed charges,67% of total billed charges,21.64,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,80.8,80,,64.64,percent of total billed charges,80% of total billed charges,65.65,65,,52.52,percent of total billed charges,65% of total billed charges,36.03,35.67,,28.824,percent of total billed charges,35.67% of total billed charges,14.55,90.9,
THYROID PEROXIDASE AUTOAB,3007991,CDM,300,RC,86376,HCPCS,outpatient,,,109,43.60,,92.65,85,,74.12,percent of total billed charges,85% of total billed charges,83.93,77,,67.14,percent of total billed charges,77% of total billed charges,14.55,100,,,fee schedule,100% of CMS fee schedule,62.86,350,,,fee schedule,350% of BCBS fee schedule,65.37,364,,,fee schedule,364% of BCBS fee schedule,65.37,364,,,fee schedule,364% of BCBS fee schedule,65.37,364,,,fee schedule,364% of BCBS fee schedule,98.1,90,,78.48,percent of total billed charges,90% of total billed charges,87.2,80,,69.76,percent of total billed charges,80% of total billed charges,98.1,90,,78.48,percent of total billed charges,90% of total billed charges,81.75,75,,65.4,percent of total billed charges,75% of total billed charges,17.75,122,,,fee schedule,122% of APC rate,31.61,29,,25.288,percent of total billed charges,29% of total billed charges,14.55,100,,,fee schedule,100% of CMS fee schedule,73.03,67,,58.424,percent of total billed charges,67% of total billed charges,21.64,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,87.2,80,,69.76,percent of total billed charges,80% of total billed charges,70.85,65,,56.68,percent of total billed charges,65% of total billed charges,38.88,35.67,,31.104,percent of total billed charges,35.67% of total billed charges,14.55,98.1,
THYROID STIMULATING HORMONE,3008000,CDM,300,RC,84443,HCPCS,outpatient,,,144,57.60,,122.4,85,,97.92,percent of total billed charges,85% of total billed charges,110.88,77,,88.7,percent of total billed charges,77% of total billed charges,16.8,100,,,fee schedule,100% of CMS fee schedule,72.63,350,,,fee schedule,350% of BCBS fee schedule,75.53,364,,,fee schedule,364% of BCBS fee schedule,75.53,364,,,fee schedule,364% of BCBS fee schedule,75.53,364,,,fee schedule,364% of BCBS fee schedule,129.6,90,,103.68,percent of total billed charges,90% of total billed charges,115.2,80,,92.16,percent of total billed charges,80% of total billed charges,129.6,90,,103.68,percent of total billed charges,90% of total billed charges,108,75,,86.4,percent of total billed charges,75% of total billed charges,20.49,122,,,fee schedule,122% of APC rate,41.76,29,,33.408,percent of total billed charges,29% of total billed charges,16.8,100,,,fee schedule,100% of CMS fee schedule,96.48,67,,77.184,percent of total billed charges,67% of total billed charges,24.99,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,115.2,80,,92.16,percent of total billed charges,80% of total billed charges,93.6,65,,74.88,percent of total billed charges,65% of total billed charges,51.36,35.67,,41.088,percent of total billed charges,35.67% of total billed charges,16.8,129.6,
T-3,3008010,CDM,300,RC,84479,HCPCS,outpatient,,,51,20.40,,43.35,85,,34.68,percent of total billed charges,85% of total billed charges,39.27,77,,31.42,percent of total billed charges,77% of total billed charges,6.47,100,,,fee schedule,100% of CMS fee schedule,27.93,350,,,fee schedule,350% of BCBS fee schedule,29.05,447,,,fee schedule,447% of BCBS fee schedule,29.05,447,,,fee schedule,447% of BCBS fee schedule,29.05,447,,,fee schedule,447% of BCBS fee schedule,45.9,90,,36.72,percent of total billed charges,90% of total billed charges,40.8,80,,32.64,percent of total billed charges,80% of total billed charges,45.9,90,,36.72,percent of total billed charges,90% of total billed charges,38.25,75,,30.6,percent of total billed charges,75% of total billed charges,7.89,122,,,fee schedule,122% of APC rate,14.79,29,,11.832,percent of total billed charges,29% of total billed charges,6.47,100,,,fee schedule,100% of CMS fee schedule,34.17,67,,27.336,percent of total billed charges,67% of total billed charges,9.62,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,40.8,80,,32.64,percent of total billed charges,80% of total billed charges,33.15,65,,26.52,percent of total billed charges,65% of total billed charges,18.19,35.67,,14.552,percent of total billed charges,35.67% of total billed charges,6.47,45.9,
T-3 RIA,3008015,CDM,300,RC,83519,HCPCS,outpatient,,,70,28.00,,59.5,85,,47.6,percent of total billed charges,85% of total billed charges,53.9,77,,43.12,percent of total billed charges,77% of total billed charges,18.39,100,,,fee schedule,100% of CMS fee schedule,64.4,350,,,fee schedule,350% of BCBS fee schedule,66.98,364,,,fee schedule,364% of BCBS fee schedule,66.98,364,,,fee schedule,364% of BCBS fee schedule,66.98,364,,,fee schedule,364% of BCBS fee schedule,63,90,,50.4,percent of total billed charges,90% of total billed charges,56,80,,44.8,percent of total billed charges,80% of total billed charges,63,90,,50.4,percent of total billed charges,90% of total billed charges,52.5,75,,42,percent of total billed charges,75% of total billed charges,22.44,122,,,fee schedule,122% of APC rate,20.3,29,,16.24,percent of total billed charges,29% of total billed charges,18.39,100,,,fee schedule,100% of CMS fee schedule,46.9,67,,37.52,percent of total billed charges,67% of total billed charges,20.09,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,56,80,,44.8,percent of total billed charges,80% of total billed charges,45.5,65,,36.4,percent of total billed charges,65% of total billed charges,24.97,35.67,,19.976,percent of total billed charges,35.67% of total billed charges,18.39,66.98,
THROMBIN-ANTITHROMBIN COMP,3008016,CDM,300,RC,83520,HCPCS,outpatient,,,55,22.00,,46.75,85,,37.4,percent of total billed charges,85% of total billed charges,42.35,77,,33.88,percent of total billed charges,77% of total billed charges,17.27,100,,,fee schedule,100% of CMS fee schedule,60.45,350,,,fee schedule,350% of BCBS fee schedule,62.86,364,,,fee schedule,364% of BCBS fee schedule,62.86,364,,,fee schedule,364% of BCBS fee schedule,62.86,364,,,fee schedule,364% of BCBS fee schedule,49.5,90,,39.6,percent of total billed charges,90% of total billed charges,44,80,,35.2,percent of total billed charges,80% of total billed charges,49.5,90,,39.6,percent of total billed charges,90% of total billed charges,41.25,75,,33,percent of total billed charges,75% of total billed charges,21.06,122,,,fee schedule,122% of APC rate,15.95,29,,12.76,percent of total billed charges,29% of total billed charges,17.27,100,,,fee schedule,100% of CMS fee schedule,36.85,67,,29.48,percent of total billed charges,67% of total billed charges,19.25,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,44,80,,35.2,percent of total billed charges,80% of total billed charges,35.75,65,,28.6,percent of total billed charges,65% of total billed charges,19.62,35.67,,15.696,percent of total billed charges,35.67% of total billed charges,15.95,62.86,
THYROXINE (T4),3008020,CDM,300,RC,84436,HCPCS,outpatient,,,51,20.40,,43.35,85,,34.68,percent of total billed charges,85% of total billed charges,39.27,77,,31.42,percent of total billed charges,77% of total billed charges,6.87,100,,,fee schedule,100% of CMS fee schedule,29.68,350,,,fee schedule,350% of BCBS fee schedule,30.87,364,,,fee schedule,364% of BCBS fee schedule,30.87,364,,,fee schedule,364% of BCBS fee schedule,30.87,364,,,fee schedule,364% of BCBS fee schedule,45.9,90,,36.72,percent of total billed charges,90% of total billed charges,40.8,80,,32.64,percent of total billed charges,80% of total billed charges,45.9,90,,36.72,percent of total billed charges,90% of total billed charges,38.25,75,,30.6,percent of total billed charges,75% of total billed charges,8.38,122,,,fee schedule,122% of APC rate,14.79,29,,11.832,percent of total billed charges,29% of total billed charges,6.87,100,,,fee schedule,100% of CMS fee schedule,34.17,67,,27.336,percent of total billed charges,67% of total billed charges,10.21,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,40.8,80,,32.64,percent of total billed charges,80% of total billed charges,33.15,65,,26.52,percent of total billed charges,65% of total billed charges,18.19,35.67,,14.552,percent of total billed charges,35.67% of total billed charges,6.87,45.9,
TOBRAMYCIN PEAK,3008040,CDM,300,RC,80200,HCPCS,outpatient,,,158,63.20,,134.3,85,,107.44,percent of total billed charges,85% of total billed charges,121.66,77,,97.33,percent of total billed charges,77% of total billed charges,16.13,100,,,fee schedule,100% of CMS fee schedule,69.69,350,,,fee schedule,350% of BCBS fee schedule,72.47,364,,,fee schedule,364% of BCBS fee schedule,72.47,364,,,fee schedule,364% of BCBS fee schedule,72.47,364,,,fee schedule,364% of BCBS fee schedule,142.2,90,,113.76,percent of total billed charges,90% of total billed charges,126.4,80,,101.12,percent of total billed charges,80% of total billed charges,142.2,90,,113.76,percent of total billed charges,90% of total billed charges,118.5,75,,94.8,percent of total billed charges,75% of total billed charges,19.67,122,,,fee schedule,122% of APC rate,45.82,29,,36.656,percent of total billed charges,29% of total billed charges,16.13,100,,,fee schedule,100% of CMS fee schedule,105.86,67,,84.688,percent of total billed charges,67% of total billed charges,23.97,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,126.4,80,,101.12,percent of total billed charges,80% of total billed charges,102.7,65,,82.16,percent of total billed charges,65% of total billed charges,56.36,35.67,,45.088,percent of total billed charges,35.67% of total billed charges,16.13,142.2,
TOBRAMYCIN TROUGH,3008060,CDM,300,RC,80200,HCPCS,outpatient,,,158,63.20,,134.3,85,,107.44,percent of total billed charges,85% of total billed charges,121.66,77,,97.33,percent of total billed charges,77% of total billed charges,16.13,100,,,fee schedule,100% of CMS fee schedule,69.69,350,,,fee schedule,350% of BCBS fee schedule,72.47,364,,,fee schedule,364% of BCBS fee schedule,72.47,364,,,fee schedule,364% of BCBS fee schedule,72.47,364,,,fee schedule,364% of BCBS fee schedule,142.2,90,,113.76,percent of total billed charges,90% of total billed charges,126.4,80,,101.12,percent of total billed charges,80% of total billed charges,142.2,90,,113.76,percent of total billed charges,90% of total billed charges,118.5,75,,94.8,percent of total billed charges,75% of total billed charges,19.67,122,,,fee schedule,122% of APC rate,45.82,29,,36.656,percent of total billed charges,29% of total billed charges,16.13,100,,,fee schedule,100% of CMS fee schedule,105.86,67,,84.688,percent of total billed charges,67% of total billed charges,23.97,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,126.4,80,,101.12,percent of total billed charges,80% of total billed charges,102.7,65,,82.16,percent of total billed charges,65% of total billed charges,56.36,35.67,,45.088,percent of total billed charges,35.67% of total billed charges,16.13,142.2,
TOPIRAMATE LEVEL,3008084,CDM,300,RC,80201,HCPCS,outpatient,,,312,124.80,,265.2,85,,212.16,percent of total billed charges,85% of total billed charges,240.24,77,,192.19,percent of total billed charges,77% of total billed charges,11.92,100,,,fee schedule,100% of CMS fee schedule,51.52,350,,,fee schedule,350% of BCBS fee schedule,53.58,364,,,fee schedule,364% of BCBS fee schedule,53.58,364,,,fee schedule,364% of BCBS fee schedule,53.58,364,,,fee schedule,364% of BCBS fee schedule,280.8,90,,224.64,percent of total billed charges,90% of total billed charges,249.6,80,,199.68,percent of total billed charges,80% of total billed charges,280.8,90,,224.64,percent of total billed charges,90% of total billed charges,234,75,,187.2,percent of total billed charges,75% of total billed charges,14.54,122,,,fee schedule,122% of APC rate,90.48,29,,72.384,percent of total billed charges,29% of total billed charges,11.92,100,,,fee schedule,100% of CMS fee schedule,209.04,67,,167.232,percent of total billed charges,67% of total billed charges,17.73,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,249.6,80,,199.68,percent of total billed charges,80% of total billed charges,202.8,65,,162.24,percent of total billed charges,65% of total billed charges,111.29,35.67,,89.032,percent of total billed charges,35.67% of total billed charges,11.92,280.8,
TOTAL PROTEIN BODY FLUID,3008120,CDM,300,RC,84157,HCPCS,outpatient,,,43,17.20,,36.55,85,,29.24,percent of total billed charges,85% of total billed charges,33.11,77,,26.49,percent of total billed charges,77% of total billed charges,4,100,,,fee schedule,100% of CMS fee schedule,15.86,350,,,fee schedule,350% of BCBS fee schedule,16.49,364,,,fee schedule,364% of BCBS fee schedule,16.49,364,,,fee schedule,364% of BCBS fee schedule,16.49,364,,,fee schedule,364% of BCBS fee schedule,38.7,90,,30.96,percent of total billed charges,90% of total billed charges,34.4,80,,27.52,percent of total billed charges,80% of total billed charges,38.7,90,,30.96,percent of total billed charges,90% of total billed charges,32.25,75,,25.8,percent of total billed charges,75% of total billed charges,4.88,122,,,fee schedule,122% of APC rate,12.47,29,,9.976,percent of total billed charges,29% of total billed charges,4,100,,,fee schedule,100% of CMS fee schedule,28.81,67,,23.048,percent of total billed charges,67% of total billed charges,5.44,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,34.4,80,,27.52,percent of total billed charges,80% of total billed charges,27.95,65,,22.36,percent of total billed charges,65% of total billed charges,15.34,35.67,,12.272,percent of total billed charges,35.67% of total billed charges,4,38.7,
TISSUE CULTURE FOR NON NEOPLAS,3008230,CDM,300,RC,88230,HCPCS,outpatient,,,398,159.20,,338.3,85,,270.64,percent of total billed charges,85% of total billed charges,306.46,77,,245.17,percent of total billed charges,77% of total billed charges,116.49,100,,,fee schedule,100% of CMS fee schedule,503.37,350,,,fee schedule,350% of BCBS fee schedule,523.5,364,,,fee schedule,364% of BCBS fee schedule,523.5,364,,,fee schedule,364% of BCBS fee schedule,523.5,364,,,fee schedule,364% of BCBS fee schedule,358.2,90,,286.56,percent of total billed charges,90% of total billed charges,318.4,80,,254.72,percent of total billed charges,80% of total billed charges,358.2,90,,286.56,percent of total billed charges,90% of total billed charges,298.5,75,,238.8,percent of total billed charges,75% of total billed charges,142.11,122,,,fee schedule,122% of APC rate,115.42,29,,92.336,percent of total billed charges,29% of total billed charges,116.49,100,,,fee schedule,100% of CMS fee schedule,266.66,67,,213.328,percent of total billed charges,67% of total billed charges,30.55,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,318.4,80,,254.72,percent of total billed charges,80% of total billed charges,258.7,65,,206.96,percent of total billed charges,65% of total billed charges,141.97,35.67,,113.576,percent of total billed charges,35.67% of total billed charges,30.55,523.5,
URINE PROTEIN RANDOM,3008240,CDM,300,RC,84156,HCPCS,outpatient,,,57,22.80,,48.45,85,,38.76,percent of total billed charges,85% of total billed charges,43.89,77,,35.11,percent of total billed charges,77% of total billed charges,3.67,100,,,fee schedule,100% of CMS fee schedule,15.86,350,,,fee schedule,350% of BCBS fee schedule,16.49,364,,,fee schedule,364% of BCBS fee schedule,16.49,364,,,fee schedule,364% of BCBS fee schedule,16.49,364,,,fee schedule,364% of BCBS fee schedule,51.3,90,,41.04,percent of total billed charges,90% of total billed charges,45.6,80,,36.48,percent of total billed charges,80% of total billed charges,51.3,90,,41.04,percent of total billed charges,90% of total billed charges,42.75,75,,34.2,percent of total billed charges,75% of total billed charges,4.47,122,,,fee schedule,122% of APC rate,16.53,29,,13.224,percent of total billed charges,29% of total billed charges,3.67,100,,,fee schedule,100% of CMS fee schedule,38.19,67,,30.552,percent of total billed charges,67% of total billed charges,5.44,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,45.6,80,,36.48,percent of total billed charges,80% of total billed charges,37.05,65,,29.64,percent of total billed charges,65% of total billed charges,20.33,35.67,,16.264,percent of total billed charges,35.67% of total billed charges,3.67,51.3,
GC URINE SET OR SWAB SET,3008245,CDM,300,RC,,,outpatient,,,255,102.00,,216.75,85,,173.4,percent of total billed charges,85% of total billed charges,196.35,77,,157.08,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,209.1,82,,167.28,percent of total billed charges,82% of total billed charges,216.75,85,,173.4,percent of total billed charges,85% of total billed charges,216.75,85,,173.4,percent of total billed charges,85% of total billed charges,216.75,85,,173.4,percent of total billed charges,85% of total billed charges,229.5,90,,183.6,percent of total billed charges,90% of total billed charges,204,80,,163.2,percent of total billed charges,80% of total billed charges,229.5,90,,183.6,percent of total billed charges,90% of total billed charges,191.25,75,,153,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,73.95,29,,59.16,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,170.85,67,,136.68,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,204,80,,163.2,percent of total billed charges,80% of total billed charges,165.75,65,,132.6,percent of total billed charges,65% of total billed charges,90.96,35.67,,72.768,percent of total billed charges,35.67% of total billed charges,73.95,229.5,
TOTAL T3,3008260,CDM,300,RC,84480,HCPCS,outpatient,,,177,70.80,,150.45,85,,120.36,percent of total billed charges,85% of total billed charges,136.29,77,,109.03,percent of total billed charges,77% of total billed charges,14.18,100,,,fee schedule,100% of CMS fee schedule,61.29,350,,,fee schedule,350% of BCBS fee schedule,63.74,364,,,fee schedule,364% of BCBS fee schedule,63.74,364,,,fee schedule,364% of BCBS fee schedule,63.74,364,,,fee schedule,364% of BCBS fee schedule,159.3,90,,127.44,percent of total billed charges,90% of total billed charges,141.6,80,,113.28,percent of total billed charges,80% of total billed charges,159.3,90,,127.44,percent of total billed charges,90% of total billed charges,132.75,75,,106.2,percent of total billed charges,75% of total billed charges,17.29,122,,,fee schedule,122% of APC rate,51.33,29,,41.064,percent of total billed charges,29% of total billed charges,14.18,100,,,fee schedule,100% of CMS fee schedule,118.59,67,,94.872,percent of total billed charges,67% of total billed charges,21.08,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,141.6,80,,113.28,percent of total billed charges,80% of total billed charges,115.05,65,,92.04,percent of total billed charges,65% of total billed charges,63.14,35.67,,50.512,percent of total billed charges,35.67% of total billed charges,14.18,159.3,
CHROMOSOME ANALYSIS 15-20 CELL,3008262,CDM,300,RC,88262,HCPCS,outpatient,,,533,213.20,,453.05,85,,362.44,percent of total billed charges,85% of total billed charges,410.41,77,,328.33,percent of total billed charges,77% of total billed charges,125.49,100,,,fee schedule,100% of CMS fee schedule,538.58,350,,,fee schedule,350% of BCBS fee schedule,560.12,364,,,fee schedule,364% of BCBS fee schedule,560.12,364,,,fee schedule,364% of BCBS fee schedule,560.12,364,,,fee schedule,364% of BCBS fee schedule,479.7,90,,383.76,percent of total billed charges,90% of total billed charges,426.4,80,,341.12,percent of total billed charges,80% of total billed charges,479.7,90,,383.76,percent of total billed charges,90% of total billed charges,399.75,75,,319.8,percent of total billed charges,75% of total billed charges,153.09,122,,,fee schedule,122% of APC rate,154.57,29,,123.656,percent of total billed charges,29% of total billed charges,125.49,100,,,fee schedule,100% of CMS fee schedule,357.11,67,,285.688,percent of total billed charges,67% of total billed charges,185.36,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,426.4,80,,341.12,percent of total billed charges,80% of total billed charges,346.45,65,,277.16,percent of total billed charges,65% of total billed charges,190.12,35.67,,152.096,percent of total billed charges,35.67% of total billed charges,125.49,560.12,
TOXOPLASMA IgM ANTIBODY,3008280,CDM,300,RC,86777,HCPCS,outpatient,,,204,81.60,,173.4,85,,138.72,percent of total billed charges,85% of total billed charges,157.08,77,,125.66,percent of total billed charges,77% of total billed charges,14.39,100,,,fee schedule,100% of CMS fee schedule,62.2,350,,,fee schedule,350% of BCBS fee schedule,64.68,364,,,fee schedule,364% of BCBS fee schedule,64.68,364,,,fee schedule,364% of BCBS fee schedule,64.68,364,,,fee schedule,364% of BCBS fee schedule,183.6,90,,146.88,percent of total billed charges,90% of total billed charges,163.2,80,,130.56,percent of total billed charges,80% of total billed charges,183.6,90,,146.88,percent of total billed charges,90% of total billed charges,153,75,,122.4,percent of total billed charges,75% of total billed charges,17.55,122,,,fee schedule,122% of APC rate,59.16,29,,47.328,percent of total billed charges,29% of total billed charges,14.39,100,,,fee schedule,100% of CMS fee schedule,136.68,67,,109.344,percent of total billed charges,67% of total billed charges,21.4,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,163.2,80,,130.56,percent of total billed charges,80% of total billed charges,132.6,65,,106.08,percent of total billed charges,65% of total billed charges,72.77,35.67,,58.216,percent of total billed charges,35.67% of total billed charges,14.39,183.6,
TOXOPLASMOSIS,3008285,CDM,300,RC,86255,HCPCS,outpatient,,,127,50.80,,107.95,85,,86.36,percent of total billed charges,85% of total billed charges,97.79,77,,78.23,percent of total billed charges,77% of total billed charges,12.05,100,,,fee schedule,100% of CMS fee schedule,52.08,350,,,fee schedule,350% of BCBS fee schedule,54.16,364,,,fee schedule,364% of BCBS fee schedule,54.16,364,,,fee schedule,364% of BCBS fee schedule,54.16,364,,,fee schedule,364% of BCBS fee schedule,114.3,90,,91.44,percent of total billed charges,90% of total billed charges,101.6,80,,81.28,percent of total billed charges,80% of total billed charges,114.3,90,,91.44,percent of total billed charges,90% of total billed charges,95.25,75,,76.2,percent of total billed charges,75% of total billed charges,14.7,122,,,fee schedule,122% of APC rate,36.83,29,,29.464,percent of total billed charges,29% of total billed charges,12.05,100,,,fee schedule,100% of CMS fee schedule,85.09,67,,68.072,percent of total billed charges,67% of total billed charges,17.92,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,101.6,80,,81.28,percent of total billed charges,80% of total billed charges,82.55,65,,66.04,percent of total billed charges,65% of total billed charges,45.3,35.67,,36.24,percent of total billed charges,35.67% of total billed charges,12.05,114.3,
CYTOGENETICS AND MOLECULAR CYT,3008291,CDM,300,RC,88291,HCPCS,outpatient,,,79,31.60,,67.15,85,,53.72,percent of total billed charges,85% of total billed charges,60.83,77,,48.66,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,118.09,350,,,fee schedule,350% of BCBS fee schedule,122.81,364,,,fee schedule,364% of BCBS fee schedule,122.81,364,,,fee schedule,364% of BCBS fee schedule,122.81,364,,,fee schedule,364% of BCBS fee schedule,71.1,90,,56.88,percent of total billed charges,90% of total billed charges,63.2,80,,50.56,percent of total billed charges,80% of total billed charges,71.1,90,,56.88,percent of total billed charges,90% of total billed charges,59.25,75,,47.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,22.91,29,,18.328,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,52.93,67,,42.344,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,63.2,80,,50.56,percent of total billed charges,80% of total billed charges,51.35,65,,41.08,percent of total billed charges,65% of total billed charges,28.18,35.67,,22.544,percent of total billed charges,35.67% of total billed charges,22.91,122.81,
TRANSFERRIN,3008300,CDM,300,RC,84466,HCPCS,outpatient,,,67,26.80,,56.95,85,,45.56,percent of total billed charges,85% of total billed charges,51.59,77,,41.27,percent of total billed charges,77% of total billed charges,12.76,100,,,fee schedule,100% of CMS fee schedule,55.16,350,,,fee schedule,350% of BCBS fee schedule,57.37,364,,,fee schedule,364% of BCBS fee schedule,57.37,364,,,fee schedule,364% of BCBS fee schedule,57.37,364,,,fee schedule,364% of BCBS fee schedule,60.3,90,,48.24,percent of total billed charges,90% of total billed charges,53.6,80,,42.88,percent of total billed charges,80% of total billed charges,60.3,90,,48.24,percent of total billed charges,90% of total billed charges,50.25,75,,40.2,percent of total billed charges,75% of total billed charges,15.56,122,,,fee schedule,122% of APC rate,19.43,29,,15.544,percent of total billed charges,29% of total billed charges,12.76,100,,,fee schedule,100% of CMS fee schedule,44.89,67,,35.912,percent of total billed charges,67% of total billed charges,18.99,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,53.6,80,,42.88,percent of total billed charges,80% of total billed charges,43.55,65,,34.84,percent of total billed charges,65% of total billed charges,23.9,35.67,,19.12,percent of total billed charges,35.67% of total billed charges,12.76,60.3,
LACTOFERRIN FECAL QUAL,3008363,CDM,300,RC,83630,HCPCS,outpatient,,,87,34.80,,73.95,85,,59.16,percent of total billed charges,85% of total billed charges,66.99,77,,53.59,percent of total billed charges,77% of total billed charges,19.7,100,,,fee schedule,100% of CMS fee schedule,84.84,350,,,fee schedule,350% of BCBS fee schedule,88.23,364,,,fee schedule,364% of BCBS fee schedule,88.23,364,,,fee schedule,364% of BCBS fee schedule,88.23,364,,,fee schedule,364% of BCBS fee schedule,78.3,90,,62.64,percent of total billed charges,90% of total billed charges,69.6,80,,55.68,percent of total billed charges,80% of total billed charges,78.3,90,,62.64,percent of total billed charges,90% of total billed charges,65.25,75,,52.2,percent of total billed charges,75% of total billed charges,24.03,122,,,fee schedule,122% of APC rate,25.23,29,,20.184,percent of total billed charges,29% of total billed charges,19.7,100,,,fee schedule,100% of CMS fee schedule,58.29,67,,46.632,percent of total billed charges,67% of total billed charges,29.19,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,69.6,80,,55.68,percent of total billed charges,80% of total billed charges,56.55,65,,45.24,percent of total billed charges,65% of total billed charges,31.03,35.67,,24.824,percent of total billed charges,35.67% of total billed charges,19.7,88.23,
TRIGLYCERIDES,3008460,CDM,300,RC,84478,HCPCS,outpatient,,,65,26.00,,55.25,85,,44.2,percent of total billed charges,85% of total billed charges,50.05,77,,40.04,percent of total billed charges,77% of total billed charges,5.74,100,,,fee schedule,100% of CMS fee schedule,24.82,350,,,fee schedule,350% of BCBS fee schedule,25.81,447,,,fee schedule,447% of BCBS fee schedule,25.81,447,,,fee schedule,447% of BCBS fee schedule,25.81,447,,,fee schedule,447% of BCBS fee schedule,58.5,90,,46.8,percent of total billed charges,90% of total billed charges,52,80,,41.6,percent of total billed charges,80% of total billed charges,58.5,90,,46.8,percent of total billed charges,90% of total billed charges,48.75,75,,39,percent of total billed charges,75% of total billed charges,7,122,,,fee schedule,122% of APC rate,18.85,29,,15.08,percent of total billed charges,29% of total billed charges,5.74,100,,,fee schedule,100% of CMS fee schedule,43.55,67,,34.84,percent of total billed charges,67% of total billed charges,8.55,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,52,80,,41.6,percent of total billed charges,80% of total billed charges,42.25,65,,33.8,percent of total billed charges,65% of total billed charges,23.19,35.67,,18.552,percent of total billed charges,35.67% of total billed charges,5.74,58.5,
TRISOMY PROFILE,3008461,CDM,300,RC,,,outpatient,,,233,93.20,,198.05,85,,158.44,percent of total billed charges,85% of total billed charges,179.41,77,,143.53,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,191.06,82,,152.848,percent of total billed charges,82% of total billed charges,198.05,85,,158.44,percent of total billed charges,85% of total billed charges,198.05,85,,158.44,percent of total billed charges,85% of total billed charges,198.05,85,,158.44,percent of total billed charges,85% of total billed charges,209.7,90,,167.76,percent of total billed charges,90% of total billed charges,186.4,80,,149.12,percent of total billed charges,80% of total billed charges,209.7,90,,167.76,percent of total billed charges,90% of total billed charges,174.75,75,,139.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,67.57,29,,54.056,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,156.11,67,,124.888,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,186.4,80,,149.12,percent of total billed charges,80% of total billed charges,151.45,65,,121.16,percent of total billed charges,65% of total billed charges,83.11,35.67,,66.488,percent of total billed charges,35.67% of total billed charges,67.57,209.7,
TRILEPTA LEVEL,3008462,CDM,300,RC,80183,HCPCS,outpatient,,,137,54.80,,116.45,85,,93.16,percent of total billed charges,85% of total billed charges,105.49,77,,84.39,percent of total billed charges,77% of total billed charges,13.25,100,,,fee schedule,100% of CMS fee schedule,57.26,350,,,fee schedule,350% of BCBS fee schedule,59.55,364,,,fee schedule,364% of BCBS fee schedule,59.55,364,,,fee schedule,364% of BCBS fee schedule,59.55,364,,,fee schedule,364% of BCBS fee schedule,123.3,90,,98.64,percent of total billed charges,90% of total billed charges,109.6,80,,87.68,percent of total billed charges,80% of total billed charges,123.3,90,,98.64,percent of total billed charges,90% of total billed charges,102.75,75,,82.2,percent of total billed charges,75% of total billed charges,16.16,122,,,fee schedule,122% of APC rate,39.73,29,,31.784,percent of total billed charges,29% of total billed charges,13.25,100,,,fee schedule,100% of CMS fee schedule,91.79,67,,73.432,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,109.6,80,,87.68,percent of total billed charges,80% of total billed charges,89.05,65,,71.24,percent of total billed charges,65% of total billed charges,48.87,35.67,,39.096,percent of total billed charges,35.67% of total billed charges,13.25,123.3,
TROPONIN REPEAT SAME DAY,3008464,CDM,300,RC,84484,HCPCS,outpatient,,,161,64.40,91,136.85,85,,109.48,percent of total billed charges,85% of total billed charges,123.97,77,,99.18,percent of total billed charges,77% of total billed charges,12.47,100,,,fee schedule,100% of CMS fee schedule,43.65,350,,,fee schedule,350% of BCBS fee schedule,45.39,364,,,fee schedule,364% of BCBS fee schedule,45.39,364,,,fee schedule,364% of BCBS fee schedule,45.39,364,,,fee schedule,364% of BCBS fee schedule,144.9,90,,115.92,percent of total billed charges,90% of total billed charges,128.8,80,,103.04,percent of total billed charges,80% of total billed charges,144.9,90,,115.92,percent of total billed charges,90% of total billed charges,120.75,75,,96.6,percent of total billed charges,75% of total billed charges,15.21,122,,,fee schedule,122% of APC rate,46.69,29,,37.352,percent of total billed charges,29% of total billed charges,12.47,100,,,fee schedule,100% of CMS fee schedule,107.87,67,,86.296,percent of total billed charges,67% of total billed charges,14.63,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,128.8,80,,103.04,percent of total billed charges,80% of total billed charges,104.65,65,,83.72,percent of total billed charges,65% of total billed charges,57.43,35.67,,45.944,percent of total billed charges,35.67% of total billed charges,12.47,144.9,
TROPONIN,3008465,CDM,300,RC,84484,HCPCS,outpatient,,,163,65.20,,138.55,85,,110.84,percent of total billed charges,85% of total billed charges,125.51,77,,100.41,percent of total billed charges,77% of total billed charges,12.47,100,,,fee schedule,100% of CMS fee schedule,43.65,350,,,fee schedule,350% of BCBS fee schedule,45.39,364,,,fee schedule,364% of BCBS fee schedule,45.39,364,,,fee schedule,364% of BCBS fee schedule,45.39,364,,,fee schedule,364% of BCBS fee schedule,146.7,90,,117.36,percent of total billed charges,90% of total billed charges,130.4,80,,104.32,percent of total billed charges,80% of total billed charges,146.7,90,,117.36,percent of total billed charges,90% of total billed charges,122.25,75,,97.8,percent of total billed charges,75% of total billed charges,15.21,122,,,fee schedule,122% of APC rate,47.27,29,,37.816,percent of total billed charges,29% of total billed charges,12.47,100,,,fee schedule,100% of CMS fee schedule,109.21,67,,87.368,percent of total billed charges,67% of total billed charges,14.63,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,130.4,80,,104.32,percent of total billed charges,80% of total billed charges,105.95,65,,84.76,percent of total billed charges,65% of total billed charges,58.14,35.67,,46.512,percent of total billed charges,35.67% of total billed charges,12.47,146.7,
TROPONIN I,3008466,CDM,300,RC,84484,HCPCS,outpatient,,,163,65.20,,138.55,85,,110.84,percent of total billed charges,85% of total billed charges,125.51,77,,100.41,percent of total billed charges,77% of total billed charges,12.47,100,,,fee schedule,100% of CMS fee schedule,43.65,350,,,fee schedule,350% of BCBS fee schedule,45.39,364,,,fee schedule,364% of BCBS fee schedule,45.39,364,,,fee schedule,364% of BCBS fee schedule,45.39,364,,,fee schedule,364% of BCBS fee schedule,146.7,90,,117.36,percent of total billed charges,90% of total billed charges,130.4,80,,104.32,percent of total billed charges,80% of total billed charges,146.7,90,,117.36,percent of total billed charges,90% of total billed charges,122.25,75,,97.8,percent of total billed charges,75% of total billed charges,15.21,122,,,fee schedule,122% of APC rate,47.27,29,,37.816,percent of total billed charges,29% of total billed charges,12.47,100,,,fee schedule,100% of CMS fee schedule,109.21,67,,87.368,percent of total billed charges,67% of total billed charges,14.63,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,130.4,80,,104.32,percent of total billed charges,80% of total billed charges,105.95,65,,84.76,percent of total billed charges,65% of total billed charges,58.14,35.67,,46.512,percent of total billed charges,35.67% of total billed charges,12.47,146.7,
TRYPTASE LEVEL,3008467,CDM,300,RC,83519,HCPCS,outpatient,,,82,32.80,,69.7,85,,55.76,percent of total billed charges,85% of total billed charges,63.14,77,,50.51,percent of total billed charges,77% of total billed charges,18.39,100,,,fee schedule,100% of CMS fee schedule,64.4,350,,,fee schedule,350% of BCBS fee schedule,66.98,364,,,fee schedule,364% of BCBS fee schedule,66.98,364,,,fee schedule,364% of BCBS fee schedule,66.98,364,,,fee schedule,364% of BCBS fee schedule,73.8,90,,59.04,percent of total billed charges,90% of total billed charges,65.6,80,,52.48,percent of total billed charges,80% of total billed charges,73.8,90,,59.04,percent of total billed charges,90% of total billed charges,61.5,75,,49.2,percent of total billed charges,75% of total billed charges,22.44,122,,,fee schedule,122% of APC rate,23.78,29,,19.024,percent of total billed charges,29% of total billed charges,18.39,100,,,fee schedule,100% of CMS fee schedule,54.94,67,,43.952,percent of total billed charges,67% of total billed charges,20.09,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,65.6,80,,52.48,percent of total billed charges,80% of total billed charges,53.3,65,,42.64,percent of total billed charges,65% of total billed charges,29.25,35.67,,23.4,percent of total billed charges,35.67% of total billed charges,18.39,73.8,
TULAREMIA,3008470,CDM,300,RC,86403,HCPCS,outpatient,,,103,41.20,,87.55,85,,70.04,percent of total billed charges,85% of total billed charges,79.31,77,,63.45,percent of total billed charges,77% of total billed charges,11.54,100,,,fee schedule,100% of CMS fee schedule,44.03,350,,,fee schedule,350% of BCBS fee schedule,45.79,364,,,fee schedule,364% of BCBS fee schedule,45.79,364,,,fee schedule,364% of BCBS fee schedule,45.79,364,,,fee schedule,364% of BCBS fee schedule,92.7,90,,74.16,percent of total billed charges,90% of total billed charges,82.4,80,,65.92,percent of total billed charges,80% of total billed charges,92.7,90,,74.16,percent of total billed charges,90% of total billed charges,77.25,75,,61.8,percent of total billed charges,75% of total billed charges,14.07,122,,,fee schedule,122% of APC rate,29.87,29,,23.896,percent of total billed charges,29% of total billed charges,11.54,100,,,fee schedule,100% of CMS fee schedule,69.01,67,,55.208,percent of total billed charges,67% of total billed charges,15.16,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,82.4,80,,65.92,percent of total billed charges,80% of total billed charges,66.95,65,,53.56,percent of total billed charges,65% of total billed charges,36.74,35.67,,29.392,percent of total billed charges,35.67% of total billed charges,11.54,92.7,
UREA CLEARANCE,3008480,CDM,300,RC,84545,HCPCS,outpatient,,,63,25.20,,53.55,85,,42.84,percent of total billed charges,85% of total billed charges,48.51,77,,38.81,percent of total billed charges,77% of total billed charges,7.2,100,,,fee schedule,100% of CMS fee schedule,28.56,350,,,fee schedule,350% of BCBS fee schedule,29.7,364,,,fee schedule,364% of BCBS fee schedule,29.7,364,,,fee schedule,364% of BCBS fee schedule,29.7,364,,,fee schedule,364% of BCBS fee schedule,56.7,90,,45.36,percent of total billed charges,90% of total billed charges,50.4,80,,40.32,percent of total billed charges,80% of total billed charges,56.7,90,,45.36,percent of total billed charges,90% of total billed charges,47.25,75,,37.8,percent of total billed charges,75% of total billed charges,8.78,122,,,fee schedule,122% of APC rate,18.27,29,,14.616,percent of total billed charges,29% of total billed charges,7.2,100,,,fee schedule,100% of CMS fee schedule,42.21,67,,33.768,percent of total billed charges,67% of total billed charges,9.81,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,50.4,80,,40.32,percent of total billed charges,80% of total billed charges,40.95,65,,32.76,percent of total billed charges,65% of total billed charges,22.47,35.67,,17.976,percent of total billed charges,35.67% of total billed charges,7.2,56.7,
URIC ACID,3008500,CDM,300,RC,84550,HCPCS,outpatient,,,48,19.20,,40.8,85,,32.64,percent of total billed charges,85% of total billed charges,36.96,77,,29.57,percent of total billed charges,77% of total billed charges,4.51,100,,,fee schedule,100% of CMS fee schedule,19.53,350,,,fee schedule,350% of BCBS fee schedule,20.31,364,,,fee schedule,364% of BCBS fee schedule,20.31,364,,,fee schedule,364% of BCBS fee schedule,20.31,364,,,fee schedule,364% of BCBS fee schedule,43.2,90,,34.56,percent of total billed charges,90% of total billed charges,38.4,80,,30.72,percent of total billed charges,80% of total billed charges,43.2,90,,34.56,percent of total billed charges,90% of total billed charges,36,75,,28.8,percent of total billed charges,75% of total billed charges,5.51,122,,,fee schedule,122% of APC rate,13.92,29,,11.136,percent of total billed charges,29% of total billed charges,4.51,100,,,fee schedule,100% of CMS fee schedule,32.16,67,,25.728,percent of total billed charges,67% of total billed charges,6.72,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,38.4,80,,30.72,percent of total billed charges,80% of total billed charges,31.2,65,,24.96,percent of total billed charges,65% of total billed charges,17.12,35.67,,13.696,percent of total billed charges,35.67% of total billed charges,4.51,43.2,
URIC ACID BODY FLUID,3008600,CDM,300,RC,84560,HCPCS,outpatient,,,49,19.60,,41.65,85,,33.32,percent of total billed charges,85% of total billed charges,37.73,77,,30.18,percent of total billed charges,77% of total billed charges,5.08,100,,,fee schedule,100% of CMS fee schedule,20.51,350,,,fee schedule,350% of BCBS fee schedule,21.33,364,,,fee schedule,364% of BCBS fee schedule,21.33,364,,,fee schedule,364% of BCBS fee schedule,21.33,364,,,fee schedule,364% of BCBS fee schedule,44.1,90,,35.28,percent of total billed charges,90% of total billed charges,39.2,80,,31.36,percent of total billed charges,80% of total billed charges,44.1,90,,35.28,percent of total billed charges,90% of total billed charges,36.75,75,,29.4,percent of total billed charges,75% of total billed charges,6.19,122,,,fee schedule,122% of APC rate,14.21,29,,11.368,percent of total billed charges,29% of total billed charges,5.08,100,,,fee schedule,100% of CMS fee schedule,32.83,67,,26.264,percent of total billed charges,67% of total billed charges,7.06,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,39.2,80,,31.36,percent of total billed charges,80% of total billed charges,31.85,65,,25.48,percent of total billed charges,65% of total billed charges,17.48,35.67,,13.984,percent of total billed charges,35.67% of total billed charges,5.08,44.1,
URIC ACID URINE RANDOM,3008620,CDM,300,RC,84560,HCPCS,outpatient,,,49,19.60,,41.65,85,,33.32,percent of total billed charges,85% of total billed charges,37.73,77,,30.18,percent of total billed charges,77% of total billed charges,5.08,100,,,fee schedule,100% of CMS fee schedule,20.51,350,,,fee schedule,350% of BCBS fee schedule,21.33,364,,,fee schedule,364% of BCBS fee schedule,21.33,364,,,fee schedule,364% of BCBS fee schedule,21.33,364,,,fee schedule,364% of BCBS fee schedule,44.1,90,,35.28,percent of total billed charges,90% of total billed charges,39.2,80,,31.36,percent of total billed charges,80% of total billed charges,44.1,90,,35.28,percent of total billed charges,90% of total billed charges,36.75,75,,29.4,percent of total billed charges,75% of total billed charges,6.19,122,,,fee schedule,122% of APC rate,14.21,29,,11.368,percent of total billed charges,29% of total billed charges,5.08,100,,,fee schedule,100% of CMS fee schedule,32.83,67,,26.264,percent of total billed charges,67% of total billed charges,7.06,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,39.2,80,,31.36,percent of total billed charges,80% of total billed charges,31.85,65,,25.48,percent of total billed charges,65% of total billed charges,17.48,35.67,,13.984,percent of total billed charges,35.67% of total billed charges,5.08,44.1,
URIC ACID URINE TIMED,3008640,CDM,300,RC,84560,HCPCS,outpatient,,,49,19.60,,41.65,85,,33.32,percent of total billed charges,85% of total billed charges,37.73,77,,30.18,percent of total billed charges,77% of total billed charges,5.08,100,,,fee schedule,100% of CMS fee schedule,20.51,350,,,fee schedule,350% of BCBS fee schedule,21.33,364,,,fee schedule,364% of BCBS fee schedule,21.33,364,,,fee schedule,364% of BCBS fee schedule,21.33,364,,,fee schedule,364% of BCBS fee schedule,44.1,90,,35.28,percent of total billed charges,90% of total billed charges,39.2,80,,31.36,percent of total billed charges,80% of total billed charges,44.1,90,,35.28,percent of total billed charges,90% of total billed charges,36.75,75,,29.4,percent of total billed charges,75% of total billed charges,6.19,122,,,fee schedule,122% of APC rate,14.21,29,,11.368,percent of total billed charges,29% of total billed charges,5.08,100,,,fee schedule,100% of CMS fee schedule,32.83,67,,26.264,percent of total billed charges,67% of total billed charges,7.06,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,39.2,80,,31.36,percent of total billed charges,80% of total billed charges,31.85,65,,25.48,percent of total billed charges,65% of total billed charges,17.48,35.67,,13.984,percent of total billed charges,35.67% of total billed charges,5.08,44.1,
URINALYSIS REPEAT SAME DAY,3008658,CDM,300,RC,81000,HCPCS,outpatient,,,45,18.00,91,38.25,85,,30.6,percent of total billed charges,85% of total billed charges,34.65,77,,27.72,percent of total billed charges,77% of total billed charges,4.01,100,,,fee schedule,100% of CMS fee schedule,14.07,350,,,fee schedule,350% of BCBS fee schedule,14.63,364,,,fee schedule,364% of BCBS fee schedule,14.63,364,,,fee schedule,364% of BCBS fee schedule,14.63,364,,,fee schedule,364% of BCBS fee schedule,40.5,90,,32.4,percent of total billed charges,90% of total billed charges,36,80,,28.8,percent of total billed charges,80% of total billed charges,40.5,90,,32.4,percent of total billed charges,90% of total billed charges,33.75,75,,27,percent of total billed charges,75% of total billed charges,4.9,122,,,fee schedule,122% of APC rate,13.05,29,,10.44,percent of total billed charges,29% of total billed charges,4.01,100,,,fee schedule,100% of CMS fee schedule,30.15,67,,24.12,percent of total billed charges,67% of total billed charges,4.7,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,36,80,,28.8,percent of total billed charges,80% of total billed charges,29.25,65,,23.4,percent of total billed charges,65% of total billed charges,16.05,35.67,,12.84,percent of total billed charges,35.67% of total billed charges,4.01,40.5,
URINE CYSTINE,3008659,CDM,300,RC,82615,HCPCS,outpatient,,,68,27.20,,57.8,85,,46.24,percent of total billed charges,85% of total billed charges,52.36,77,,41.89,percent of total billed charges,77% of total billed charges,9.55,100,,,fee schedule,100% of CMS fee schedule,35.28,350,,,fee schedule,350% of BCBS fee schedule,36.69,364,,,fee schedule,364% of BCBS fee schedule,36.69,364,,,fee schedule,364% of BCBS fee schedule,36.69,364,,,fee schedule,364% of BCBS fee schedule,61.2,90,,48.96,percent of total billed charges,90% of total billed charges,54.4,80,,43.52,percent of total billed charges,80% of total billed charges,61.2,90,,48.96,percent of total billed charges,90% of total billed charges,51,75,,40.8,percent of total billed charges,75% of total billed charges,11.65,122,,,fee schedule,122% of APC rate,19.72,29,,15.776,percent of total billed charges,29% of total billed charges,9.55,100,,,fee schedule,100% of CMS fee schedule,45.56,67,,36.448,percent of total billed charges,67% of total billed charges,12.13,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,54.4,80,,43.52,percent of total billed charges,80% of total billed charges,44.2,65,,35.36,percent of total billed charges,65% of total billed charges,24.26,35.67,,19.408,percent of total billed charges,35.67% of total billed charges,9.55,61.2,
URINALYSIS/COMPLETE,3008660,CDM,300,RC,81001,HCPCS,outpatient,,,55,22.00,,46.75,85,,37.4,percent of total billed charges,85% of total billed charges,42.35,77,,33.88,percent of total billed charges,77% of total billed charges,3.17,100,,,fee schedule,100% of CMS fee schedule,13.72,350,,,fee schedule,350% of BCBS fee schedule,14.27,364,,,fee schedule,364% of BCBS fee schedule,14.27,364,,,fee schedule,364% of BCBS fee schedule,14.27,364,,,fee schedule,364% of BCBS fee schedule,49.5,90,,39.6,percent of total billed charges,90% of total billed charges,44,80,,35.2,percent of total billed charges,80% of total billed charges,49.5,90,,39.6,percent of total billed charges,90% of total billed charges,41.25,75,,33,percent of total billed charges,75% of total billed charges,3.86,122,,,fee schedule,122% of APC rate,15.95,29,,12.76,percent of total billed charges,29% of total billed charges,3.17,100,,,fee schedule,100% of CMS fee schedule,36.85,67,,29.48,percent of total billed charges,67% of total billed charges,4.7,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,44,80,,35.2,percent of total billed charges,80% of total billed charges,35.75,65,,28.6,percent of total billed charges,65% of total billed charges,19.62,35.67,,15.696,percent of total billed charges,35.67% of total billed charges,3.17,49.5,
URINE CANNABINOIDS,3008661,CDM,300,RC,80350,HCPCS,outpatient,,,44,17.60,,37.4,85,,29.92,percent of total billed charges,85% of total billed charges,33.88,77,,27.1,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,36.08,82,,28.864,percent of total billed charges,82% of total billed charges,37.4,85,,29.92,percent of total billed charges,85% of total billed charges,37.4,85,,29.92,percent of total billed charges,85% of total billed charges,37.4,85,,29.92,percent of total billed charges,85% of total billed charges,39.6,90,,31.68,percent of total billed charges,90% of total billed charges,35.2,80,,28.16,percent of total billed charges,80% of total billed charges,39.6,90,,31.68,percent of total billed charges,90% of total billed charges,33,75,,26.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,12.76,29,,10.208,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,29.48,67,,23.584,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,35.2,80,,28.16,percent of total billed charges,80% of total billed charges,28.6,65,,22.88,percent of total billed charges,65% of total billed charges,15.69,35.67,,12.552,percent of total billed charges,35.67% of total billed charges,12.76,39.6,
URINE COCAINE AND METABOLITES,3008662,CDM,300,RC,80353,HCPCS,outpatient,,,44,17.60,,37.4,85,,29.92,percent of total billed charges,85% of total billed charges,33.88,77,,27.1,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,36.08,82,,28.864,percent of total billed charges,82% of total billed charges,37.4,85,,29.92,percent of total billed charges,85% of total billed charges,37.4,85,,29.92,percent of total billed charges,85% of total billed charges,37.4,85,,29.92,percent of total billed charges,85% of total billed charges,39.6,90,,31.68,percent of total billed charges,90% of total billed charges,35.2,80,,28.16,percent of total billed charges,80% of total billed charges,39.6,90,,31.68,percent of total billed charges,90% of total billed charges,33,75,,26.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,12.76,29,,10.208,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,29.48,67,,23.584,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,35.2,80,,28.16,percent of total billed charges,80% of total billed charges,28.6,65,,22.88,percent of total billed charges,65% of total billed charges,15.69,35.67,,12.552,percent of total billed charges,35.67% of total billed charges,12.76,39.6,
URINE OPIATES,3008663,CDM,300,RC,80361,HCPCS,outpatient,,,44,17.60,,37.4,85,,29.92,percent of total billed charges,85% of total billed charges,33.88,77,,27.1,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,36.08,82,,28.864,percent of total billed charges,82% of total billed charges,37.4,85,,29.92,percent of total billed charges,85% of total billed charges,37.4,85,,29.92,percent of total billed charges,85% of total billed charges,37.4,85,,29.92,percent of total billed charges,85% of total billed charges,39.6,90,,31.68,percent of total billed charges,90% of total billed charges,35.2,80,,28.16,percent of total billed charges,80% of total billed charges,39.6,90,,31.68,percent of total billed charges,90% of total billed charges,33,75,,26.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,12.76,29,,10.208,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,29.48,67,,23.584,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,35.2,80,,28.16,percent of total billed charges,80% of total billed charges,28.6,65,,22.88,percent of total billed charges,65% of total billed charges,15.69,35.67,,12.552,percent of total billed charges,35.67% of total billed charges,12.76,39.6,
URINE PHENCYCLIDINE,3008664,CDM,300,RC,83992,HCPCS,outpatient,,,101,40.40,,85.85,85,,68.68,percent of total billed charges,85% of total billed charges,77.77,77,,62.22,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,89.18,350,,,fee schedule,350% of BCBS fee schedule,92.75,364,,,fee schedule,364% of BCBS fee schedule,92.75,364,,,fee schedule,364% of BCBS fee schedule,92.75,364,,,fee schedule,364% of BCBS fee schedule,90.9,90,,72.72,percent of total billed charges,90% of total billed charges,80.8,80,,64.64,percent of total billed charges,80% of total billed charges,90.9,90,,72.72,percent of total billed charges,90% of total billed charges,75.75,75,,60.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,29.29,29,,23.432,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,67.67,67,,54.136,percent of total billed charges,67% of total billed charges,21.86,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,80.8,80,,64.64,percent of total billed charges,80% of total billed charges,65.65,65,,52.52,percent of total billed charges,65% of total billed charges,36.03,35.67,,28.824,percent of total billed charges,35.67% of total billed charges,21.86,92.75,
URINE LIPASE,3008665,CDM,300,RC,83690,HCPCS,outpatient,,,98,39.20,,83.3,85,,66.64,percent of total billed charges,85% of total billed charges,75.46,77,,60.37,percent of total billed charges,77% of total billed charges,6.89,100,,,fee schedule,100% of CMS fee schedule,29.79,350,,,fee schedule,350% of BCBS fee schedule,30.98,364,,,fee schedule,364% of BCBS fee schedule,30.98,364,,,fee schedule,364% of BCBS fee schedule,30.98,364,,,fee schedule,364% of BCBS fee schedule,88.2,90,,70.56,percent of total billed charges,90% of total billed charges,78.4,80,,62.72,percent of total billed charges,80% of total billed charges,88.2,90,,70.56,percent of total billed charges,90% of total billed charges,73.5,75,,58.8,percent of total billed charges,75% of total billed charges,8.4,122,,,fee schedule,122% of APC rate,28.42,29,,22.736,percent of total billed charges,29% of total billed charges,6.89,100,,,fee schedule,100% of CMS fee schedule,65.66,67,,52.528,percent of total billed charges,67% of total billed charges,8.64,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,78.4,80,,62.72,percent of total billed charges,80% of total billed charges,63.7,65,,50.96,percent of total billed charges,65% of total billed charges,34.96,35.67,,27.968,percent of total billed charges,35.67% of total billed charges,6.89,88.2,
URINE TRICYCLIC ANTIDEPRESSANT,3008666,CDM,300,RC,80299,HCPCS,outpatient,,,76,30.40,,64.6,85,,51.68,percent of total billed charges,85% of total billed charges,58.52,77,,46.82,percent of total billed charges,77% of total billed charges,18.64,100,,,fee schedule,100% of CMS fee schedule,65.24,350,,,fee schedule,350% of BCBS fee schedule,67.85,364,,,fee schedule,364% of BCBS fee schedule,67.85,364,,,fee schedule,364% of BCBS fee schedule,67.85,364,,,fee schedule,364% of BCBS fee schedule,68.4,90,,54.72,percent of total billed charges,90% of total billed charges,60.8,80,,48.64,percent of total billed charges,80% of total billed charges,68.4,90,,54.72,percent of total billed charges,90% of total billed charges,57,75,,45.6,percent of total billed charges,75% of total billed charges,22.74,122,,,fee schedule,122% of APC rate,22.04,29,,17.632,percent of total billed charges,29% of total billed charges,18.64,100,,,fee schedule,100% of CMS fee schedule,50.92,67,,40.736,percent of total billed charges,67% of total billed charges,20.36,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,60.8,80,,48.64,percent of total billed charges,80% of total billed charges,49.4,65,,39.52,percent of total billed charges,65% of total billed charges,27.11,35.67,,21.688,percent of total billed charges,35.67% of total billed charges,18.64,68.4,
URINE MICROSCOPIC ONLY,3008667,CDM,300,RC,81015,HCPCS,outpatient,,,17,6.80,,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,13.09,77,,10.47,percent of total billed charges,77% of total billed charges,3.05,100,,,fee schedule,100% of CMS fee schedule,13.16,350,,,fee schedule,350% of BCBS fee schedule,13.69,364,,,fee schedule,364% of BCBS fee schedule,13.69,364,,,fee schedule,364% of BCBS fee schedule,13.69,364,,,fee schedule,364% of BCBS fee schedule,15.3,90,,12.24,percent of total billed charges,90% of total billed charges,13.6,80,,10.88,percent of total billed charges,80% of total billed charges,15.3,90,,12.24,percent of total billed charges,90% of total billed charges,12.75,75,,10.2,percent of total billed charges,75% of total billed charges,3.72,122,,,fee schedule,122% of APC rate,4.93,29,,3.944,percent of total billed charges,29% of total billed charges,3.05,100,,,fee schedule,100% of CMS fee schedule,11.39,67,,9.112,percent of total billed charges,67% of total billed charges,4.52,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,13.6,80,,10.88,percent of total billed charges,80% of total billed charges,11.05,65,,8.84,percent of total billed charges,65% of total billed charges,6.06,35.67,,4.848,percent of total billed charges,35.67% of total billed charges,3.05,15.3,
URINE  METHAMPHETAMINE QUANT,3008668,CDM,300,RC,80324,HCPCS,outpatient,,,438,175.20,,372.3,85,,297.84,percent of total billed charges,85% of total billed charges,337.26,77,,269.81,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,359.16,82,,287.328,percent of total billed charges,82% of total billed charges,372.3,85,,297.84,percent of total billed charges,85% of total billed charges,372.3,85,,297.84,percent of total billed charges,85% of total billed charges,372.3,85,,297.84,percent of total billed charges,85% of total billed charges,394.2,90,,315.36,percent of total billed charges,90% of total billed charges,350.4,80,,280.32,percent of total billed charges,80% of total billed charges,394.2,90,,315.36,percent of total billed charges,90% of total billed charges,328.5,75,,262.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,127.02,29,,101.616,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,293.46,67,,234.768,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,350.4,80,,280.32,percent of total billed charges,80% of total billed charges,284.7,65,,227.76,percent of total billed charges,65% of total billed charges,156.23,35.67,,124.984,percent of total billed charges,35.67% of total billed charges,127.02,394.2,
URINALYSIS DIPSTICK,3008670,CDM,300,RC,81003,HCPCS,outpatient,,,16,6.40,,13.6,85,,10.88,percent of total billed charges,85% of total billed charges,12.32,77,,9.86,percent of total billed charges,77% of total billed charges,2.25,100,,,fee schedule,100% of CMS fee schedule,9.7,350,,,fee schedule,350% of BCBS fee schedule,10.08,364,,,fee schedule,364% of BCBS fee schedule,10.08,364,,,fee schedule,364% of BCBS fee schedule,10.08,364,,,fee schedule,364% of BCBS fee schedule,14.4,90,,11.52,percent of total billed charges,90% of total billed charges,12.8,80,,10.24,percent of total billed charges,80% of total billed charges,14.4,90,,11.52,percent of total billed charges,90% of total billed charges,12,75,,9.6,percent of total billed charges,75% of total billed charges,2.74,122,,,fee schedule,122% of APC rate,4.64,29,,3.712,percent of total billed charges,29% of total billed charges,2.25,100,,,fee schedule,100% of CMS fee schedule,10.72,67,,8.576,percent of total billed charges,67% of total billed charges,3.33,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,12.8,80,,10.24,percent of total billed charges,80% of total billed charges,10.4,65,,8.32,percent of total billed charges,65% of total billed charges,5.71,35.67,,4.568,percent of total billed charges,35.67% of total billed charges,2.25,14.4,
URINE DIPSTICK GLUCOSE/PROTEIN,3008680,CDM,300,RC,81002,HCPCS,outpatient,,,21,8.40,,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,16.17,77,,12.94,percent of total billed charges,77% of total billed charges,3.48,100,,,fee schedule,100% of CMS fee schedule,12.18,350,,,fee schedule,350% of BCBS fee schedule,12.67,364,,,fee schedule,364% of BCBS fee schedule,12.67,364,,,fee schedule,364% of BCBS fee schedule,12.67,364,,,fee schedule,364% of BCBS fee schedule,18.9,90,,15.12,percent of total billed charges,90% of total billed charges,16.8,80,,13.44,percent of total billed charges,80% of total billed charges,18.9,90,,15.12,percent of total billed charges,90% of total billed charges,15.75,75,,12.6,percent of total billed charges,75% of total billed charges,4.24,122,,,fee schedule,122% of APC rate,6.09,29,,4.872,percent of total billed charges,29% of total billed charges,3.48,100,,,fee schedule,100% of CMS fee schedule,14.07,67,,11.256,percent of total billed charges,67% of total billed charges,3.8,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,16.8,80,,13.44,percent of total billed charges,80% of total billed charges,13.65,65,,10.92,percent of total billed charges,65% of total billed charges,7.49,35.67,,5.992,percent of total billed charges,35.67% of total billed charges,3.48,18.9,
UREA CLEARANCE 24 HR,3008700,CDM,300,RC,84545,HCPCS,outpatient,,,63,25.20,,53.55,85,,42.84,percent of total billed charges,85% of total billed charges,48.51,77,,38.81,percent of total billed charges,77% of total billed charges,7.2,100,,,fee schedule,100% of CMS fee schedule,28.56,350,,,fee schedule,350% of BCBS fee schedule,29.7,364,,,fee schedule,364% of BCBS fee schedule,29.7,364,,,fee schedule,364% of BCBS fee schedule,29.7,364,,,fee schedule,364% of BCBS fee schedule,56.7,90,,45.36,percent of total billed charges,90% of total billed charges,50.4,80,,40.32,percent of total billed charges,80% of total billed charges,56.7,90,,45.36,percent of total billed charges,90% of total billed charges,47.25,75,,37.8,percent of total billed charges,75% of total billed charges,8.78,122,,,fee schedule,122% of APC rate,18.27,29,,14.616,percent of total billed charges,29% of total billed charges,7.2,100,,,fee schedule,100% of CMS fee schedule,42.21,67,,33.768,percent of total billed charges,67% of total billed charges,9.81,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,50.4,80,,40.32,percent of total billed charges,80% of total billed charges,40.95,65,,32.76,percent of total billed charges,65% of total billed charges,22.47,35.67,,17.976,percent of total billed charges,35.67% of total billed charges,7.2,56.7,
URINE CALCIUM 24 HR,3008701,CDM,300,RC,82340,HCPCS,outpatient,,,68,27.20,,57.8,85,,46.24,percent of total billed charges,85% of total billed charges,52.36,77,,41.89,percent of total billed charges,77% of total billed charges,6.03,100,,,fee schedule,100% of CMS fee schedule,26.04,350,,,fee schedule,350% of BCBS fee schedule,27.08,364,,,fee schedule,364% of BCBS fee schedule,27.08,364,,,fee schedule,364% of BCBS fee schedule,27.08,364,,,fee schedule,364% of BCBS fee schedule,61.2,90,,48.96,percent of total billed charges,90% of total billed charges,54.4,80,,43.52,percent of total billed charges,80% of total billed charges,61.2,90,,48.96,percent of total billed charges,90% of total billed charges,51,75,,40.8,percent of total billed charges,75% of total billed charges,7.35,122,,,fee schedule,122% of APC rate,19.72,29,,15.776,percent of total billed charges,29% of total billed charges,6.03,100,,,fee schedule,100% of CMS fee schedule,45.56,67,,36.448,percent of total billed charges,67% of total billed charges,8.96,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,54.4,80,,43.52,percent of total billed charges,80% of total billed charges,44.2,65,,35.36,percent of total billed charges,65% of total billed charges,24.26,35.67,,19.408,percent of total billed charges,35.67% of total billed charges,6.03,61.2,
UROBILINOGEN (24 HR),3008710,CDM,300,RC,84580,HCPCS,outpatient,,,44,17.60,,37.4,85,,29.92,percent of total billed charges,85% of total billed charges,33.88,77,,27.1,percent of total billed charges,77% of total billed charges,9.55,100,,,fee schedule,100% of CMS fee schedule,35.28,350,,,fee schedule,350% of BCBS fee schedule,36.69,364,,,fee schedule,364% of BCBS fee schedule,36.69,364,,,fee schedule,364% of BCBS fee schedule,36.69,364,,,fee schedule,364% of BCBS fee schedule,39.6,90,,31.68,percent of total billed charges,90% of total billed charges,35.2,80,,28.16,percent of total billed charges,80% of total billed charges,39.6,90,,31.68,percent of total billed charges,90% of total billed charges,33,75,,26.4,percent of total billed charges,75% of total billed charges,11.65,122,,,fee schedule,122% of APC rate,12.76,29,,10.208,percent of total billed charges,29% of total billed charges,9.55,100,,,fee schedule,100% of CMS fee schedule,29.48,67,,23.584,percent of total billed charges,67% of total billed charges,6.49,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,35.2,80,,28.16,percent of total billed charges,80% of total billed charges,28.6,65,,22.88,percent of total billed charges,65% of total billed charges,15.69,35.67,,12.552,percent of total billed charges,35.67% of total billed charges,6.49,39.6,
UROBILINOGEN FECAL,3008715,CDM,300,RC,84577,HCPCS,outpatient,,,48,19.20,,40.8,85,,32.64,percent of total billed charges,85% of total billed charges,36.96,77,,29.57,percent of total billed charges,77% of total billed charges,16.8,100,,,fee schedule,100% of CMS fee schedule,72.63,350,,,fee schedule,350% of BCBS fee schedule,75.53,364,,,fee schedule,364% of BCBS fee schedule,75.53,364,,,fee schedule,364% of BCBS fee schedule,75.53,364,,,fee schedule,364% of BCBS fee schedule,43.2,90,,34.56,percent of total billed charges,90% of total billed charges,38.4,80,,30.72,percent of total billed charges,80% of total billed charges,43.2,90,,34.56,percent of total billed charges,90% of total billed charges,36,75,,28.8,percent of total billed charges,75% of total billed charges,20.49,122,,,fee schedule,122% of APC rate,13.92,29,,11.136,percent of total billed charges,29% of total billed charges,16.8,100,,,fee schedule,100% of CMS fee schedule,32.16,67,,25.728,percent of total billed charges,67% of total billed charges,18.55,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,38.4,80,,30.72,percent of total billed charges,80% of total billed charges,31.2,65,,24.96,percent of total billed charges,65% of total billed charges,17.12,35.67,,13.696,percent of total billed charges,35.67% of total billed charges,13.92,75.53,
URINE DRUG SCREEN CISD INHOUSE,3008716,CDM,300,RC,,,outpatient,,,131,52.40,,111.35,85,,89.08,percent of total billed charges,85% of total billed charges,100.87,77,,80.7,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,107.42,82,,85.936,percent of total billed charges,82% of total billed charges,111.35,85,,89.08,percent of total billed charges,85% of total billed charges,111.35,85,,89.08,percent of total billed charges,85% of total billed charges,111.35,85,,89.08,percent of total billed charges,85% of total billed charges,117.9,90,,94.32,percent of total billed charges,90% of total billed charges,104.8,80,,83.84,percent of total billed charges,80% of total billed charges,117.9,90,,94.32,percent of total billed charges,90% of total billed charges,98.25,75,,78.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,37.99,29,,30.392,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,87.77,67,,70.216,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,104.8,80,,83.84,percent of total billed charges,80% of total billed charges,85.15,65,,68.12,percent of total billed charges,65% of total billed charges,46.73,35.67,,37.384,percent of total billed charges,35.67% of total billed charges,37.99,117.9,
VALPROIC ACID (DEPAKATE),3008720,CDM,300,RC,80164,HCPCS,outpatient,,,100,40.00,,85,85,,68,percent of total billed charges,85% of total billed charges,77,77,,61.6,percent of total billed charges,77% of total billed charges,13.54,100,,,fee schedule,100% of CMS fee schedule,58.52,350,,,fee schedule,350% of BCBS fee schedule,60.86,364,,,fee schedule,364% of BCBS fee schedule,60.86,364,,,fee schedule,364% of BCBS fee schedule,60.86,364,,,fee schedule,364% of BCBS fee schedule,90,90,,72,percent of total billed charges,90% of total billed charges,80,80,,64,percent of total billed charges,80% of total billed charges,90,90,,72,percent of total billed charges,90% of total billed charges,75,75,,60,percent of total billed charges,75% of total billed charges,16.51,122,,,fee schedule,122% of APC rate,29,29,,23.2,percent of total billed charges,29% of total billed charges,13.54,100,,,fee schedule,100% of CMS fee schedule,67,67,,53.6,percent of total billed charges,67% of total billed charges,20.14,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,80,80,,64,percent of total billed charges,80% of total billed charges,65,65,,52,percent of total billed charges,65% of total billed charges,35.67,35.67,,28.536,percent of total billed charges,35.67% of total billed charges,13.54,90,
VANCOMYCIN PEAK,3008740,CDM,300,RC,80202,HCPCS,outpatient,,,114,45.60,,96.9,85,,77.52,percent of total billed charges,85% of total billed charges,87.78,77,,70.22,percent of total billed charges,77% of total billed charges,13.54,100,,,fee schedule,100% of CMS fee schedule,58.52,350,,,fee schedule,350% of BCBS fee schedule,60.86,364,,,fee schedule,364% of BCBS fee schedule,60.86,364,,,fee schedule,364% of BCBS fee schedule,60.86,364,,,fee schedule,364% of BCBS fee schedule,102.6,90,,82.08,percent of total billed charges,90% of total billed charges,91.2,80,,72.96,percent of total billed charges,80% of total billed charges,102.6,90,,82.08,percent of total billed charges,90% of total billed charges,85.5,75,,68.4,percent of total billed charges,75% of total billed charges,16.51,122,,,fee schedule,122% of APC rate,33.06,29,,26.448,percent of total billed charges,29% of total billed charges,13.54,100,,,fee schedule,100% of CMS fee schedule,76.38,67,,61.104,percent of total billed charges,67% of total billed charges,20.14,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,91.2,80,,72.96,percent of total billed charges,80% of total billed charges,74.1,65,,59.28,percent of total billed charges,65% of total billed charges,40.66,35.67,,32.528,percent of total billed charges,35.67% of total billed charges,13.54,102.6,
VANCOMYCIN TROUGH,3008760,CDM,300,RC,80202,HCPCS,outpatient,,,116,46.40,,98.6,85,,78.88,percent of total billed charges,85% of total billed charges,89.32,77,,71.46,percent of total billed charges,77% of total billed charges,13.54,100,,,fee schedule,100% of CMS fee schedule,58.52,350,,,fee schedule,350% of BCBS fee schedule,60.86,364,,,fee schedule,364% of BCBS fee schedule,60.86,364,,,fee schedule,364% of BCBS fee schedule,60.86,364,,,fee schedule,364% of BCBS fee schedule,104.4,90,,83.52,percent of total billed charges,90% of total billed charges,92.8,80,,74.24,percent of total billed charges,80% of total billed charges,104.4,90,,83.52,percent of total billed charges,90% of total billed charges,87,75,,69.6,percent of total billed charges,75% of total billed charges,16.51,122,,,fee schedule,122% of APC rate,33.64,29,,26.912,percent of total billed charges,29% of total billed charges,13.54,100,,,fee schedule,100% of CMS fee schedule,77.72,67,,62.176,percent of total billed charges,67% of total billed charges,20.14,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,92.8,80,,74.24,percent of total billed charges,80% of total billed charges,75.4,65,,60.32,percent of total billed charges,65% of total billed charges,41.38,35.67,,33.104,percent of total billed charges,35.67% of total billed charges,13.54,104.4,
DRUG SCREEN QUANT ZONISAMIDE,3008761,CDM,300,RC,80203,HCPCS,outpatient,,,43,17.20,,36.55,85,,29.24,percent of total billed charges,85% of total billed charges,33.11,77,,26.49,percent of total billed charges,77% of total billed charges,13.25,100,,,fee schedule,100% of CMS fee schedule,57.26,350,,,fee schedule,350% of BCBS fee schedule,59.55,364,,,fee schedule,364% of BCBS fee schedule,59.55,364,,,fee schedule,364% of BCBS fee schedule,59.55,364,,,fee schedule,364% of BCBS fee schedule,38.7,90,,30.96,percent of total billed charges,90% of total billed charges,34.4,80,,27.52,percent of total billed charges,80% of total billed charges,38.7,90,,30.96,percent of total billed charges,90% of total billed charges,32.25,75,,25.8,percent of total billed charges,75% of total billed charges,16.16,122,,,fee schedule,122% of APC rate,12.47,29,,9.976,percent of total billed charges,29% of total billed charges,13.25,100,,,fee schedule,100% of CMS fee schedule,28.81,67,,23.048,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,34.4,80,,27.52,percent of total billed charges,80% of total billed charges,27.95,65,,22.36,percent of total billed charges,65% of total billed charges,15.34,35.67,,12.272,percent of total billed charges,35.67% of total billed charges,12.47,59.55,
VARICELLA (HERPES) IGM AB,3008800,CDM,300,RC,86694,HCPCS,outpatient,,,89,35.60,,75.65,85,,60.52,percent of total billed charges,85% of total billed charges,68.53,77,,54.82,percent of total billed charges,77% of total billed charges,14.39,100,,,fee schedule,100% of CMS fee schedule,62.2,350,,,fee schedule,350% of BCBS fee schedule,64.68,364,,,fee schedule,364% of BCBS fee schedule,64.68,364,,,fee schedule,364% of BCBS fee schedule,64.68,364,,,fee schedule,364% of BCBS fee schedule,80.1,90,,64.08,percent of total billed charges,90% of total billed charges,71.2,80,,56.96,percent of total billed charges,80% of total billed charges,80.1,90,,64.08,percent of total billed charges,90% of total billed charges,66.75,75,,53.4,percent of total billed charges,75% of total billed charges,17.55,122,,,fee schedule,122% of APC rate,25.81,29,,20.648,percent of total billed charges,29% of total billed charges,14.39,100,,,fee schedule,100% of CMS fee schedule,59.63,67,,47.704,percent of total billed charges,67% of total billed charges,21.4,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,71.2,80,,56.96,percent of total billed charges,80% of total billed charges,57.85,65,,46.28,percent of total billed charges,65% of total billed charges,31.75,35.67,,25.4,percent of total billed charges,35.67% of total billed charges,14.39,80.1,
VARICELLA (HERPES) IGG,3008805,CDM,300,RC,86694,HCPCS,outpatient,,,88,35.20,,74.8,85,,59.84,percent of total billed charges,85% of total billed charges,67.76,77,,54.21,percent of total billed charges,77% of total billed charges,14.39,100,,,fee schedule,100% of CMS fee schedule,62.2,350,,,fee schedule,350% of BCBS fee schedule,64.68,364,,,fee schedule,364% of BCBS fee schedule,64.68,364,,,fee schedule,364% of BCBS fee schedule,64.68,364,,,fee schedule,364% of BCBS fee schedule,79.2,90,,63.36,percent of total billed charges,90% of total billed charges,70.4,80,,56.32,percent of total billed charges,80% of total billed charges,79.2,90,,63.36,percent of total billed charges,90% of total billed charges,66,75,,52.8,percent of total billed charges,75% of total billed charges,17.55,122,,,fee schedule,122% of APC rate,25.52,29,,20.416,percent of total billed charges,29% of total billed charges,14.39,100,,,fee schedule,100% of CMS fee schedule,58.96,67,,47.168,percent of total billed charges,67% of total billed charges,21.4,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,70.4,80,,56.32,percent of total billed charges,80% of total billed charges,57.2,65,,45.76,percent of total billed charges,65% of total billed charges,31.39,35.67,,25.112,percent of total billed charges,35.67% of total billed charges,14.39,79.2,
VASOACTIVE INT. POLYPEPTIDE,3008810,CDM,300,RC,84586,HCPCS,outpatient,,,292,116.80,,248.2,85,,198.56,percent of total billed charges,85% of total billed charges,224.84,77,,179.87,percent of total billed charges,77% of total billed charges,35.33,100,,,fee schedule,100% of CMS fee schedule,152.67,350,,,fee schedule,350% of BCBS fee schedule,158.78,364,,,fee schedule,364% of BCBS fee schedule,158.78,364,,,fee schedule,364% of BCBS fee schedule,158.78,364,,,fee schedule,364% of BCBS fee schedule,262.8,90,,210.24,percent of total billed charges,90% of total billed charges,233.6,80,,186.88,percent of total billed charges,80% of total billed charges,262.8,90,,210.24,percent of total billed charges,90% of total billed charges,219,75,,175.2,percent of total billed charges,75% of total billed charges,43.1,122,,,fee schedule,122% of APC rate,84.68,29,,67.744,percent of total billed charges,29% of total billed charges,35.33,100,,,fee schedule,100% of CMS fee schedule,195.64,67,,156.512,percent of total billed charges,67% of total billed charges,23.77,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,233.6,80,,186.88,percent of total billed charges,80% of total billed charges,189.8,65,,151.84,percent of total billed charges,65% of total billed charges,104.16,35.67,,83.328,percent of total billed charges,35.67% of total billed charges,23.77,262.8,
VDRL,3008820,CDM,300,RC,86592,HCPCS,outpatient,,,60,24.00,,51,85,,40.8,percent of total billed charges,85% of total billed charges,46.2,77,,36.96,percent of total billed charges,77% of total billed charges,4.26,100,,,fee schedule,100% of CMS fee schedule,18.45,350,,,fee schedule,350% of BCBS fee schedule,19.18,364,,,fee schedule,364% of BCBS fee schedule,19.18,364,,,fee schedule,364% of BCBS fee schedule,19.18,364,,,fee schedule,364% of BCBS fee schedule,54,90,,43.2,percent of total billed charges,90% of total billed charges,48,80,,38.4,percent of total billed charges,80% of total billed charges,54,90,,43.2,percent of total billed charges,90% of total billed charges,45,75,,36,percent of total billed charges,75% of total billed charges,5.2,122,,,fee schedule,122% of APC rate,17.4,29,,13.92,percent of total billed charges,29% of total billed charges,4.26,100,,,fee schedule,100% of CMS fee schedule,40.2,67,,32.16,percent of total billed charges,67% of total billed charges,6.35,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,48,80,,38.4,percent of total billed charges,80% of total billed charges,39,65,,31.2,percent of total billed charges,65% of total billed charges,21.4,35.67,,17.12,percent of total billed charges,35.67% of total billed charges,4.26,54,
VENIPUNCTURE,3008825,CDM,300,RC,36415,HCPCS,outpatient,,,13,5.20,,1150,,,,case rate,pays based on per visit,10.01,77,,8.01,percent of total billed charges,77% of total billed charges,8.83,100,,,fee schedule,100% of CMS fee schedule,10.66,82,,8.528,percent of total billed charges,82% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,11.7,90,,9.36,percent of total billed charges,90% of total billed charges,10.4,80,,8.32,percent of total billed charges,80% of total billed charges,11.7,90,,9.36,percent of total billed charges,90% of total billed charges,9.75,75,,7.8,percent of total billed charges,75% of total billed charges,10.77,122,,,fee schedule,122% of APC rate,3.77,29,,3.016,percent of total billed charges,29% of total billed charges,8.83,100,,,fee schedule,100% of CMS fee schedule,8.71,67,,6.968,percent of total billed charges,67% of total billed charges,3.15,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,10.4,80,,8.32,percent of total billed charges,80% of total billed charges,8.45,65,,6.76,percent of total billed charges,65% of total billed charges,4.64,35.67,,3.712,percent of total billed charges,35.67% of total billed charges,3.15,1150,
VIRAL LOAD,3008827,CDM,300,RC,87536,HCPCS,outpatient,,,403,161.20,,342.55,85,,274.04,percent of total billed charges,85% of total billed charges,310.31,77,,248.25,percent of total billed charges,77% of total billed charges,85.1,100,,,fee schedule,100% of CMS fee schedule,367.71,350,,,fee schedule,350% of BCBS fee schedule,382.42,364,,,fee schedule,364% of BCBS fee schedule,382.42,364,,,fee schedule,364% of BCBS fee schedule,382.42,364,,,fee schedule,364% of BCBS fee schedule,362.7,90,,290.16,percent of total billed charges,90% of total billed charges,322.4,80,,257.92,percent of total billed charges,80% of total billed charges,362.7,90,,290.16,percent of total billed charges,90% of total billed charges,302.25,75,,241.8,percent of total billed charges,75% of total billed charges,103.82,122,,,fee schedule,122% of APC rate,116.87,29,,93.496,percent of total billed charges,29% of total billed charges,85.1,100,,,fee schedule,100% of CMS fee schedule,270.01,67,,216.008,percent of total billed charges,67% of total billed charges,126.54,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,322.4,80,,257.92,percent of total billed charges,80% of total billed charges,261.95,65,,209.56,percent of total billed charges,65% of total billed charges,143.75,35.67,,115,percent of total billed charges,35.67% of total billed charges,85.1,382.42,
BLOOD DRAWN THRU IMPLANT VAD,3008829,CDM,300,RC,36591,HCPCS,outpatient,,,363,145.20,,1150,,,,case rate,pays based on per visit,279.51,77,,223.61,percent of total billed charges,77% of total billed charges,111.71,100,,,fee schedule,100% of CMS OPPS rate,367.64,350,,,fee schedule,350% of BCBS fee schedule,382.35,364,,,fee schedule,364% of BCBS fee schedule,382.35,364,,,fee schedule,364% of BCBS fee schedule,382.35,364,,,fee schedule,364% of BCBS fee schedule,326.7,90,,261.36,percent of total billed charges,90% of total billed charges,290.4,80,,232.32,percent of total billed charges,80% of total billed charges,326.7,90,,261.36,percent of total billed charges,90% of total billed charges,272.25,75,,217.8,percent of total billed charges,75% of total billed charges,136.28,122,,,fee schedule,122% of APC rate,105.27,29,,84.216,percent of total billed charges,29% of total billed charges,111.71,100,,,fee schedule,100% of CMS OPPS rate,243.21,67,,194.568,percent of total billed charges,67% of total billed charges,39.76,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,290.4,80,,232.32,percent of total billed charges,80% of total billed charges,235.95,65,,188.76,percent of total billed charges,65% of total billed charges,129.48,35.67,,103.584,percent of total billed charges,35.67% of total billed charges,39.76,1150,
VITAMIN A,3008830,CDM,300,RC,84590,HCPCS,outpatient,,,97,38.80,,82.45,85,,65.96,percent of total billed charges,85% of total billed charges,74.69,77,,59.75,percent of total billed charges,77% of total billed charges,11.61,100,,,fee schedule,100% of CMS fee schedule,50.16,350,,,fee schedule,350% of BCBS fee schedule,52.16,364,,,fee schedule,364% of BCBS fee schedule,52.16,364,,,fee schedule,364% of BCBS fee schedule,52.16,364,,,fee schedule,364% of BCBS fee schedule,87.3,90,,69.84,percent of total billed charges,90% of total billed charges,77.6,80,,62.08,percent of total billed charges,80% of total billed charges,87.3,90,,69.84,percent of total billed charges,90% of total billed charges,72.75,75,,58.2,percent of total billed charges,75% of total billed charges,14.16,122,,,fee schedule,122% of APC rate,28.13,29,,22.504,percent of total billed charges,29% of total billed charges,11.61,100,,,fee schedule,100% of CMS fee schedule,64.99,67,,51.992,percent of total billed charges,67% of total billed charges,17.25,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,77.6,80,,62.08,percent of total billed charges,80% of total billed charges,63.05,65,,50.44,percent of total billed charges,65% of total billed charges,34.6,35.67,,27.68,percent of total billed charges,35.67% of total billed charges,11.61,87.3,
VITAMIN B-1 (THIAMINE),3008831,CDM,300,RC,84425,HCPCS,outpatient,,,115,46.00,,97.75,85,,78.2,percent of total billed charges,85% of total billed charges,88.55,77,,70.84,percent of total billed charges,77% of total billed charges,21.23,100,,,fee schedule,100% of CMS fee schedule,91.74,350,,,fee schedule,350% of BCBS fee schedule,95.4,364,,,fee schedule,364% of BCBS fee schedule,95.4,364,,,fee schedule,364% of BCBS fee schedule,95.4,364,,,fee schedule,364% of BCBS fee schedule,103.5,90,,82.8,percent of total billed charges,90% of total billed charges,92,80,,73.6,percent of total billed charges,80% of total billed charges,103.5,90,,82.8,percent of total billed charges,90% of total billed charges,86.25,75,,69,percent of total billed charges,75% of total billed charges,25.9,122,,,fee schedule,122% of APC rate,33.35,29,,26.68,percent of total billed charges,29% of total billed charges,21.23,100,,,fee schedule,100% of CMS fee schedule,77.05,67,,61.64,percent of total billed charges,67% of total billed charges,31.57,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,92,80,,73.6,percent of total billed charges,80% of total billed charges,74.75,65,,59.8,percent of total billed charges,65% of total billed charges,41.02,35.67,,32.816,percent of total billed charges,35.67% of total billed charges,21.23,103.5,
VITAMIN C LAB TEST,3008832,CDM,300,RC,82180,HCPCS,outpatient,,,74,29.60,,62.9,85,,50.32,percent of total billed charges,85% of total billed charges,56.98,77,,45.58,percent of total billed charges,77% of total billed charges,9.89,100,,,fee schedule,100% of CMS fee schedule,42.7,350,,,fee schedule,350% of BCBS fee schedule,44.41,364,,,fee schedule,364% of BCBS fee schedule,44.41,364,,,fee schedule,364% of BCBS fee schedule,44.41,364,,,fee schedule,364% of BCBS fee schedule,66.6,90,,53.28,percent of total billed charges,90% of total billed charges,59.2,80,,47.36,percent of total billed charges,80% of total billed charges,66.6,90,,53.28,percent of total billed charges,90% of total billed charges,55.5,75,,44.4,percent of total billed charges,75% of total billed charges,12.06,122,,,fee schedule,122% of APC rate,21.46,29,,17.168,percent of total billed charges,29% of total billed charges,9.89,100,,,fee schedule,100% of CMS fee schedule,49.58,67,,39.664,percent of total billed charges,67% of total billed charges,13.69,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,59.2,80,,47.36,percent of total billed charges,80% of total billed charges,48.1,65,,38.48,percent of total billed charges,65% of total billed charges,26.4,35.67,,21.12,percent of total billed charges,35.67% of total billed charges,9.89,66.6,
HIV NAT VIRAL LOAD,3008833,CDM,300,RC,87536,HCPCS,outpatient,,,361,144.40,,306.85,85,,245.48,percent of total billed charges,85% of total billed charges,277.97,77,,222.38,percent of total billed charges,77% of total billed charges,85.1,100,,,fee schedule,100% of CMS fee schedule,367.71,350,,,fee schedule,350% of BCBS fee schedule,382.42,364,,,fee schedule,364% of BCBS fee schedule,382.42,364,,,fee schedule,364% of BCBS fee schedule,382.42,364,,,fee schedule,364% of BCBS fee schedule,324.9,90,,259.92,percent of total billed charges,90% of total billed charges,288.8,80,,231.04,percent of total billed charges,80% of total billed charges,324.9,90,,259.92,percent of total billed charges,90% of total billed charges,270.75,75,,216.6,percent of total billed charges,75% of total billed charges,103.82,122,,,fee schedule,122% of APC rate,104.69,29,,83.752,percent of total billed charges,29% of total billed charges,85.1,100,,,fee schedule,100% of CMS fee schedule,241.87,67,,193.496,percent of total billed charges,67% of total billed charges,126.54,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,288.8,80,,231.04,percent of total billed charges,80% of total billed charges,234.65,65,,187.72,percent of total billed charges,65% of total billed charges,128.77,35.67,,103.016,percent of total billed charges,35.67% of total billed charges,85.1,382.42,
VIT D 1 25 DIHYDROXY,3008840,CDM,300,RC,82652,HCPCS,outpatient,,,253,101.20,,215.05,85,,172.04,percent of total billed charges,85% of total billed charges,194.81,77,,155.85,percent of total billed charges,77% of total billed charges,38.5,100,,,fee schedule,100% of CMS fee schedule,166.36,350,,,fee schedule,350% of BCBS fee schedule,173.01,364,,,fee schedule,364% of BCBS fee schedule,173.01,364,,,fee schedule,364% of BCBS fee schedule,173.01,364,,,fee schedule,364% of BCBS fee schedule,227.7,90,,182.16,percent of total billed charges,90% of total billed charges,202.4,80,,161.92,percent of total billed charges,80% of total billed charges,227.7,90,,182.16,percent of total billed charges,90% of total billed charges,189.75,75,,151.8,percent of total billed charges,75% of total billed charges,46.97,122,,,fee schedule,122% of APC rate,73.37,29,,58.696,percent of total billed charges,29% of total billed charges,38.5,100,,,fee schedule,100% of CMS fee schedule,169.51,67,,135.608,percent of total billed charges,67% of total billed charges,57.25,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,202.4,80,,161.92,percent of total billed charges,80% of total billed charges,164.45,65,,131.56,percent of total billed charges,65% of total billed charges,90.25,35.67,,72.2,percent of total billed charges,35.67% of total billed charges,38.5,227.7,
"VITAMIN D, 25, HYDROXY",3008845,CDM,300,RC,82306,HCPCS,outpatient,,,183,73.20,,155.55,85,,124.44,percent of total billed charges,85% of total billed charges,140.91,77,,112.73,percent of total billed charges,77% of total billed charges,29.6,100,,,fee schedule,100% of CMS fee schedule,127.93,350,,,fee schedule,350% of BCBS fee schedule,133.04,364,,,fee schedule,364% of BCBS fee schedule,133.04,364,,,fee schedule,364% of BCBS fee schedule,133.04,364,,,fee schedule,364% of BCBS fee schedule,164.7,90,,131.76,percent of total billed charges,90% of total billed charges,146.4,80,,117.12,percent of total billed charges,80% of total billed charges,164.7,90,,131.76,percent of total billed charges,90% of total billed charges,137.25,75,,109.8,percent of total billed charges,75% of total billed charges,36.11,122,,,fee schedule,122% of APC rate,53.07,29,,42.456,percent of total billed charges,29% of total billed charges,29.6,100,,,fee schedule,100% of CMS fee schedule,122.61,67,,98.088,percent of total billed charges,67% of total billed charges,44.03,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,146.4,80,,117.12,percent of total billed charges,80% of total billed charges,118.95,65,,95.16,percent of total billed charges,65% of total billed charges,65.28,35.67,,52.224,percent of total billed charges,35.67% of total billed charges,29.6,164.7,
VIT E,3008860,CDM,300,RC,84446,HCPCS,outpatient,,,87,34.80,,73.95,85,,59.16,percent of total billed charges,85% of total billed charges,66.99,77,,53.59,percent of total billed charges,77% of total billed charges,14.18,100,,,fee schedule,100% of CMS fee schedule,61.29,350,,,fee schedule,350% of BCBS fee schedule,63.74,364,,,fee schedule,364% of BCBS fee schedule,63.74,364,,,fee schedule,364% of BCBS fee schedule,63.74,364,,,fee schedule,364% of BCBS fee schedule,78.3,90,,62.64,percent of total billed charges,90% of total billed charges,69.6,80,,55.68,percent of total billed charges,80% of total billed charges,78.3,90,,62.64,percent of total billed charges,90% of total billed charges,65.25,75,,52.2,percent of total billed charges,75% of total billed charges,17.29,122,,,fee schedule,122% of APC rate,25.23,29,,20.184,percent of total billed charges,29% of total billed charges,14.18,100,,,fee schedule,100% of CMS fee schedule,58.29,67,,46.632,percent of total billed charges,67% of total billed charges,21.08,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,69.6,80,,55.68,percent of total billed charges,80% of total billed charges,56.55,65,,45.24,percent of total billed charges,65% of total billed charges,31.03,35.67,,24.824,percent of total billed charges,35.67% of total billed charges,14.18,78.3,
VITAMIN B12 LEVEL,3008880,CDM,300,RC,82607,HCPCS,outpatient,,,133,53.20,,113.05,85,,90.44,percent of total billed charges,85% of total billed charges,102.41,77,,81.93,percent of total billed charges,77% of total billed charges,15.08,100,,,fee schedule,100% of CMS fee schedule,65.14,350,,,fee schedule,350% of BCBS fee schedule,67.74,364,,,fee schedule,364% of BCBS fee schedule,67.74,364,,,fee schedule,364% of BCBS fee schedule,67.74,364,,,fee schedule,364% of BCBS fee schedule,119.7,90,,95.76,percent of total billed charges,90% of total billed charges,106.4,80,,85.12,percent of total billed charges,80% of total billed charges,119.7,90,,95.76,percent of total billed charges,90% of total billed charges,99.75,75,,79.8,percent of total billed charges,75% of total billed charges,18.39,122,,,fee schedule,122% of APC rate,38.57,29,,30.856,percent of total billed charges,29% of total billed charges,15.08,100,,,fee schedule,100% of CMS fee schedule,89.11,67,,71.288,percent of total billed charges,67% of total billed charges,22.41,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,106.4,80,,85.12,percent of total billed charges,80% of total billed charges,86.45,65,,69.16,percent of total billed charges,65% of total billed charges,47.44,35.67,,37.952,percent of total billed charges,35.67% of total billed charges,15.08,119.7,
VLDL (VERY LOW DENSITY LIP),3008890,CDM,300,RC,83719,HCPCS,outpatient,,,58,23.20,,49.3,85,,39.44,percent of total billed charges,85% of total billed charges,44.66,77,,35.73,percent of total billed charges,77% of total billed charges,12.75,100,,,fee schedule,100% of CMS fee schedule,50.26,350,,,fee schedule,350% of BCBS fee schedule,52.27,364,,,fee schedule,364% of BCBS fee schedule,52.27,364,,,fee schedule,364% of BCBS fee schedule,52.27,364,,,fee schedule,364% of BCBS fee schedule,52.2,90,,41.76,percent of total billed charges,90% of total billed charges,46.4,80,,37.12,percent of total billed charges,80% of total billed charges,52.2,90,,41.76,percent of total billed charges,90% of total billed charges,43.5,75,,34.8,percent of total billed charges,75% of total billed charges,15.55,122,,,fee schedule,122% of APC rate,16.82,29,,13.456,percent of total billed charges,29% of total billed charges,12.75,100,,,fee schedule,100% of CMS fee schedule,38.86,67,,31.088,percent of total billed charges,67% of total billed charges,17.3,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,46.4,80,,37.12,percent of total billed charges,80% of total billed charges,37.7,65,,30.16,percent of total billed charges,65% of total billed charges,20.69,35.67,,16.552,percent of total billed charges,35.67% of total billed charges,12.75,52.27,
VMA-URINE,3008900,CDM,300,RC,84585,HCPCS,outpatient,,,89,35.60,,75.65,85,,60.52,percent of total billed charges,85% of total billed charges,68.53,77,,54.82,percent of total billed charges,77% of total billed charges,15.5,100,,,fee schedule,100% of CMS fee schedule,66.96,350,,,fee schedule,350% of BCBS fee schedule,69.63,364,,,fee schedule,364% of BCBS fee schedule,69.63,364,,,fee schedule,364% of BCBS fee schedule,69.63,364,,,fee schedule,364% of BCBS fee schedule,80.1,90,,64.08,percent of total billed charges,90% of total billed charges,71.2,80,,56.96,percent of total billed charges,80% of total billed charges,80.1,90,,64.08,percent of total billed charges,90% of total billed charges,66.75,75,,53.4,percent of total billed charges,75% of total billed charges,18.91,122,,,fee schedule,122% of APC rate,25.81,29,,20.648,percent of total billed charges,29% of total billed charges,15.5,100,,,fee schedule,100% of CMS fee schedule,59.63,67,,47.704,percent of total billed charges,67% of total billed charges,23.05,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,71.2,80,,56.96,percent of total billed charges,80% of total billed charges,57.85,65,,46.28,percent of total billed charges,65% of total billed charges,31.75,35.67,,25.4,percent of total billed charges,35.67% of total billed charges,15.5,80.1,
SKIN SCRAPING KOH,3008920,CDM,300,RC,87220,HCPCS,outpatient,,,29,11.60,,24.65,85,,19.72,percent of total billed charges,85% of total billed charges,22.33,77,,17.86,percent of total billed charges,77% of total billed charges,4.26,100,,,fee schedule,100% of CMS fee schedule,18.45,350,,,fee schedule,350% of BCBS fee schedule,19.18,364,,,fee schedule,364% of BCBS fee schedule,19.18,364,,,fee schedule,364% of BCBS fee schedule,19.18,364,,,fee schedule,364% of BCBS fee schedule,26.1,90,,20.88,percent of total billed charges,90% of total billed charges,23.2,80,,18.56,percent of total billed charges,80% of total billed charges,26.1,90,,20.88,percent of total billed charges,90% of total billed charges,21.75,75,,17.4,percent of total billed charges,75% of total billed charges,5.2,122,,,fee schedule,122% of APC rate,8.41,29,,6.728,percent of total billed charges,29% of total billed charges,4.26,100,,,fee schedule,100% of CMS fee schedule,19.43,67,,15.544,percent of total billed charges,67% of total billed charges,6.35,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,23.2,80,,18.56,percent of total billed charges,80% of total billed charges,18.85,65,,15.08,percent of total billed charges,65% of total billed charges,10.34,35.67,,8.272,percent of total billed charges,35.67% of total billed charges,4.26,26.1,
WET PREP DNA,3008922,CDM,300,RC,,,outpatient,,,129,51.60,,109.65,85,,87.72,percent of total billed charges,85% of total billed charges,99.33,77,,79.46,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,105.78,82,,84.624,percent of total billed charges,82% of total billed charges,109.65,85,,87.72,percent of total billed charges,85% of total billed charges,109.65,85,,87.72,percent of total billed charges,85% of total billed charges,109.65,85,,87.72,percent of total billed charges,85% of total billed charges,116.1,90,,92.88,percent of total billed charges,90% of total billed charges,103.2,80,,82.56,percent of total billed charges,80% of total billed charges,116.1,90,,92.88,percent of total billed charges,90% of total billed charges,96.75,75,,77.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,37.41,29,,29.928,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,86.43,67,,69.144,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,103.2,80,,82.56,percent of total billed charges,80% of total billed charges,83.85,65,,67.08,percent of total billed charges,65% of total billed charges,46.01,35.67,,36.808,percent of total billed charges,35.67% of total billed charges,37.41,116.1,
WEST NILE VIRUS AB,3008923,CDM,300,RC,86789,HCPCS,outpatient,,,206,82.40,,175.1,85,,140.08,percent of total billed charges,85% of total billed charges,158.62,77,,126.9,percent of total billed charges,77% of total billed charges,14.39,100,,,fee schedule,100% of CMS fee schedule,62.2,350,,,fee schedule,350% of BCBS fee schedule,64.68,364,,,fee schedule,364% of BCBS fee schedule,64.68,364,,,fee schedule,364% of BCBS fee schedule,64.68,364,,,fee schedule,364% of BCBS fee schedule,185.4,90,,148.32,percent of total billed charges,90% of total billed charges,164.8,80,,131.84,percent of total billed charges,80% of total billed charges,185.4,90,,148.32,percent of total billed charges,90% of total billed charges,154.5,75,,123.6,percent of total billed charges,75% of total billed charges,17.55,122,,,fee schedule,122% of APC rate,59.74,29,,47.792,percent of total billed charges,29% of total billed charges,14.39,100,,,fee schedule,100% of CMS fee schedule,138.02,67,,110.416,percent of total billed charges,67% of total billed charges,21.4,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,164.8,80,,131.84,percent of total billed charges,80% of total billed charges,133.9,65,,107.12,percent of total billed charges,65% of total billed charges,73.48,35.67,,58.784,percent of total billed charges,35.67% of total billed charges,14.39,185.4,
WHITE BLOOD COUNT,3008940,CDM,300,RC,85048,HCPCS,outpatient,,,23,9.20,,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,17.71,77,,14.17,percent of total billed charges,77% of total billed charges,2.54,100,,,fee schedule,100% of CMS fee schedule,10.96,350,,,fee schedule,350% of BCBS fee schedule,11.39,364,,,fee schedule,364% of BCBS fee schedule,11.39,364,,,fee schedule,364% of BCBS fee schedule,11.39,364,,,fee schedule,364% of BCBS fee schedule,20.7,90,,16.56,percent of total billed charges,90% of total billed charges,18.4,80,,14.72,percent of total billed charges,80% of total billed charges,20.7,90,,16.56,percent of total billed charges,90% of total billed charges,17.25,75,,13.8,percent of total billed charges,75% of total billed charges,3.09,122,,,fee schedule,122% of APC rate,6.67,29,,5.336,percent of total billed charges,29% of total billed charges,2.54,100,,,fee schedule,100% of CMS fee schedule,15.41,67,,12.328,percent of total billed charges,67% of total billed charges,3.78,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,18.4,80,,14.72,percent of total billed charges,80% of total billed charges,14.95,65,,11.96,percent of total billed charges,65% of total billed charges,8.2,35.67,,6.56,percent of total billed charges,35.67% of total billed charges,2.54,20.7,
YERSINIA ANTIBODY STOOL,3008950,CDM,300,RC,87046,HCPCS,outpatient,,,82,32.80,,69.7,85,,55.76,percent of total billed charges,85% of total billed charges,63.14,77,,50.51,percent of total billed charges,77% of total billed charges,9.44,100,,,fee schedule,100% of CMS fee schedule,40.81,350,,,fee schedule,350% of BCBS fee schedule,42.44,364,,,fee schedule,364% of BCBS fee schedule,42.44,364,,,fee schedule,364% of BCBS fee schedule,42.44,364,,,fee schedule,364% of BCBS fee schedule,73.8,90,,59.04,percent of total billed charges,90% of total billed charges,65.6,80,,52.48,percent of total billed charges,80% of total billed charges,73.8,90,,59.04,percent of total billed charges,90% of total billed charges,61.5,75,,49.2,percent of total billed charges,75% of total billed charges,11.51,122,,,fee schedule,122% of APC rate,23.78,29,,19.024,percent of total billed charges,29% of total billed charges,9.44,100,,,fee schedule,100% of CMS fee schedule,54.94,67,,43.952,percent of total billed charges,67% of total billed charges,14.02,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,65.6,80,,52.48,percent of total billed charges,80% of total billed charges,53.3,65,,42.64,percent of total billed charges,65% of total billed charges,29.25,35.67,,23.4,percent of total billed charges,35.67% of total billed charges,9.44,73.8,
YERSINIA TITER,3008951,CDM,300,RC,86793,HCPCS,outpatient,,,195,78.00,,165.75,85,,132.6,percent of total billed charges,85% of total billed charges,150.15,77,,120.12,percent of total billed charges,77% of total billed charges,13.19,100,,,fee schedule,100% of CMS fee schedule,56.98,350,,,fee schedule,350% of BCBS fee schedule,59.26,364,,,fee schedule,364% of BCBS fee schedule,59.26,364,,,fee schedule,364% of BCBS fee schedule,59.26,364,,,fee schedule,364% of BCBS fee schedule,175.5,90,,140.4,percent of total billed charges,90% of total billed charges,156,80,,124.8,percent of total billed charges,80% of total billed charges,175.5,90,,140.4,percent of total billed charges,90% of total billed charges,146.25,75,,117,percent of total billed charges,75% of total billed charges,16.09,122,,,fee schedule,122% of APC rate,56.55,29,,45.24,percent of total billed charges,29% of total billed charges,13.19,100,,,fee schedule,100% of CMS fee schedule,130.65,67,,104.52,percent of total billed charges,67% of total billed charges,8.64,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,156,80,,124.8,percent of total billed charges,80% of total billed charges,126.75,65,,101.4,percent of total billed charges,65% of total billed charges,69.56,35.67,,55.648,percent of total billed charges,35.67% of total billed charges,8.64,175.5,
YERSINIA TITER FOR PANEL I,3008952,CDM,300,RC,86793,HCPCS,outpatient,,,66,26.40,,56.1,85,,44.88,percent of total billed charges,85% of total billed charges,50.82,77,,40.66,percent of total billed charges,77% of total billed charges,13.19,100,,,fee schedule,100% of CMS fee schedule,56.98,350,,,fee schedule,350% of BCBS fee schedule,59.26,364,,,fee schedule,364% of BCBS fee schedule,59.26,364,,,fee schedule,364% of BCBS fee schedule,59.26,364,,,fee schedule,364% of BCBS fee schedule,59.4,90,,47.52,percent of total billed charges,90% of total billed charges,52.8,80,,42.24,percent of total billed charges,80% of total billed charges,59.4,90,,47.52,percent of total billed charges,90% of total billed charges,49.5,75,,39.6,percent of total billed charges,75% of total billed charges,16.09,122,,,fee schedule,122% of APC rate,19.14,29,,15.312,percent of total billed charges,29% of total billed charges,13.19,100,,,fee schedule,100% of CMS fee schedule,44.22,67,,35.376,percent of total billed charges,67% of total billed charges,8.64,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,52.8,80,,42.24,percent of total billed charges,80% of total billed charges,42.9,65,,34.32,percent of total billed charges,65% of total billed charges,23.54,35.67,,18.832,percent of total billed charges,35.67% of total billed charges,8.64,59.4,
YERSINIA TITER FOR PANEL II,3008953,CDM,300,RC,86793,HCPCS,outpatient,,,66,26.40,,56.1,85,,44.88,percent of total billed charges,85% of total billed charges,50.82,77,,40.66,percent of total billed charges,77% of total billed charges,13.19,100,,,fee schedule,100% of CMS fee schedule,56.98,350,,,fee schedule,350% of BCBS fee schedule,59.26,364,,,fee schedule,364% of BCBS fee schedule,59.26,364,,,fee schedule,364% of BCBS fee schedule,59.26,364,,,fee schedule,364% of BCBS fee schedule,59.4,90,,47.52,percent of total billed charges,90% of total billed charges,52.8,80,,42.24,percent of total billed charges,80% of total billed charges,59.4,90,,47.52,percent of total billed charges,90% of total billed charges,49.5,75,,39.6,percent of total billed charges,75% of total billed charges,16.09,122,,,fee schedule,122% of APC rate,19.14,29,,15.312,percent of total billed charges,29% of total billed charges,13.19,100,,,fee schedule,100% of CMS fee schedule,44.22,67,,35.376,percent of total billed charges,67% of total billed charges,8.64,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,52.8,80,,42.24,percent of total billed charges,80% of total billed charges,42.9,65,,34.32,percent of total billed charges,65% of total billed charges,23.54,35.67,,18.832,percent of total billed charges,35.67% of total billed charges,8.64,59.4,
YERSINIA TITER FOR PANEL III,3008954,CDM,300,RC,86793,HCPCS,outpatient,,,66,26.40,,56.1,85,,44.88,percent of total billed charges,85% of total billed charges,50.82,77,,40.66,percent of total billed charges,77% of total billed charges,13.19,100,,,fee schedule,100% of CMS fee schedule,56.98,350,,,fee schedule,350% of BCBS fee schedule,59.26,364,,,fee schedule,364% of BCBS fee schedule,59.26,364,,,fee schedule,364% of BCBS fee schedule,59.26,364,,,fee schedule,364% of BCBS fee schedule,59.4,90,,47.52,percent of total billed charges,90% of total billed charges,52.8,80,,42.24,percent of total billed charges,80% of total billed charges,59.4,90,,47.52,percent of total billed charges,90% of total billed charges,49.5,75,,39.6,percent of total billed charges,75% of total billed charges,16.09,122,,,fee schedule,122% of APC rate,19.14,29,,15.312,percent of total billed charges,29% of total billed charges,13.19,100,,,fee schedule,100% of CMS fee schedule,44.22,67,,35.376,percent of total billed charges,67% of total billed charges,8.64,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,52.8,80,,42.24,percent of total billed charges,80% of total billed charges,42.9,65,,34.32,percent of total billed charges,65% of total billed charges,23.54,35.67,,18.832,percent of total billed charges,35.67% of total billed charges,8.64,59.4,
ZINC,3008960,CDM,300,RC,84630,HCPCS,outpatient,,,57,22.80,,48.45,85,,38.76,percent of total billed charges,85% of total billed charges,43.89,77,,35.11,percent of total billed charges,77% of total billed charges,11.39,100,,,fee schedule,100% of CMS fee schedule,49.21,350,,,fee schedule,350% of BCBS fee schedule,51.18,364,,,fee schedule,364% of BCBS fee schedule,51.18,364,,,fee schedule,364% of BCBS fee schedule,51.18,364,,,fee schedule,364% of BCBS fee schedule,51.3,90,,41.04,percent of total billed charges,90% of total billed charges,45.6,80,,36.48,percent of total billed charges,80% of total billed charges,51.3,90,,41.04,percent of total billed charges,90% of total billed charges,42.75,75,,34.2,percent of total billed charges,75% of total billed charges,13.89,122,,,fee schedule,122% of APC rate,16.53,29,,13.224,percent of total billed charges,29% of total billed charges,11.39,100,,,fee schedule,100% of CMS fee schedule,38.19,67,,30.552,percent of total billed charges,67% of total billed charges,10.95,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,45.6,80,,36.48,percent of total billed charges,80% of total billed charges,37.05,65,,29.64,percent of total billed charges,65% of total billed charges,20.33,35.67,,16.264,percent of total billed charges,35.67% of total billed charges,10.95,51.3,
XYLOSE,3008980,CDM,300,RC,84620,HCPCS,outpatient,,,149,59.60,,126.65,85,,101.32,percent of total billed charges,85% of total billed charges,114.73,77,,91.78,percent of total billed charges,77% of total billed charges,12.91,100,,,fee schedule,100% of CMS fee schedule,51.21,350,,,fee schedule,350% of BCBS fee schedule,53.25,364,,,fee schedule,364% of BCBS fee schedule,53.25,364,,,fee schedule,364% of BCBS fee schedule,53.25,364,,,fee schedule,364% of BCBS fee schedule,134.1,90,,107.28,percent of total billed charges,90% of total billed charges,119.2,80,,95.36,percent of total billed charges,80% of total billed charges,134.1,90,,107.28,percent of total billed charges,90% of total billed charges,111.75,75,,89.4,percent of total billed charges,75% of total billed charges,15.75,122,,,fee schedule,122% of APC rate,43.21,29,,34.568,percent of total billed charges,29% of total billed charges,12.91,100,,,fee schedule,100% of CMS fee schedule,99.83,67,,79.864,percent of total billed charges,67% of total billed charges,16.45,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,119.2,80,,95.36,percent of total billed charges,80% of total billed charges,96.85,65,,77.48,percent of total billed charges,65% of total billed charges,53.15,35.67,,42.52,percent of total billed charges,35.67% of total billed charges,12.91,134.1,
ZOLOFT,3008985,CDM,300,RC,80299,HCPCS,outpatient,,,147,58.80,,124.95,85,,99.96,percent of total billed charges,85% of total billed charges,113.19,77,,90.55,percent of total billed charges,77% of total billed charges,18.64,100,,,fee schedule,100% of CMS fee schedule,65.24,350,,,fee schedule,350% of BCBS fee schedule,67.85,364,,,fee schedule,364% of BCBS fee schedule,67.85,364,,,fee schedule,364% of BCBS fee schedule,67.85,364,,,fee schedule,364% of BCBS fee schedule,132.3,90,,105.84,percent of total billed charges,90% of total billed charges,117.6,80,,94.08,percent of total billed charges,80% of total billed charges,132.3,90,,105.84,percent of total billed charges,90% of total billed charges,110.25,75,,88.2,percent of total billed charges,75% of total billed charges,22.74,122,,,fee schedule,122% of APC rate,42.63,29,,34.104,percent of total billed charges,29% of total billed charges,18.64,100,,,fee schedule,100% of CMS fee schedule,98.49,67,,78.792,percent of total billed charges,67% of total billed charges,20.36,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,117.6,80,,94.08,percent of total billed charges,80% of total billed charges,95.55,65,,76.44,percent of total billed charges,65% of total billed charges,52.43,35.67,,41.944,percent of total billed charges,35.67% of total billed charges,18.64,132.3,
URINE AMPH/METHAMP QUAN,3008998,CDM,300,RC,80324,HCPCS,outpatient,,,438,175.20,,372.3,85,,297.84,percent of total billed charges,85% of total billed charges,337.26,77,,269.81,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,359.16,82,,287.328,percent of total billed charges,82% of total billed charges,372.3,85,,297.84,percent of total billed charges,85% of total billed charges,372.3,85,,297.84,percent of total billed charges,85% of total billed charges,372.3,85,,297.84,percent of total billed charges,85% of total billed charges,394.2,90,,315.36,percent of total billed charges,90% of total billed charges,350.4,80,,280.32,percent of total billed charges,80% of total billed charges,394.2,90,,315.36,percent of total billed charges,90% of total billed charges,328.5,75,,262.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,127.02,29,,101.616,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,293.46,67,,234.768,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,350.4,80,,280.32,percent of total billed charges,80% of total billed charges,284.7,65,,227.76,percent of total billed charges,65% of total billed charges,156.23,35.67,,124.984,percent of total billed charges,35.67% of total billed charges,127.02,394.2,
URINE AMPHETAMINE QUAN,3008999,CDM,300,RC,80324,HCPCS,outpatient,,,49,19.60,,41.65,85,,33.32,percent of total billed charges,85% of total billed charges,37.73,77,,30.18,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,40.18,82,,32.144,percent of total billed charges,82% of total billed charges,41.65,85,,33.32,percent of total billed charges,85% of total billed charges,41.65,85,,33.32,percent of total billed charges,85% of total billed charges,41.65,85,,33.32,percent of total billed charges,85% of total billed charges,44.1,90,,35.28,percent of total billed charges,90% of total billed charges,39.2,80,,31.36,percent of total billed charges,80% of total billed charges,44.1,90,,35.28,percent of total billed charges,90% of total billed charges,36.75,75,,29.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,14.21,29,,11.368,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,32.83,67,,26.264,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,39.2,80,,31.36,percent of total billed charges,80% of total billed charges,31.85,65,,25.48,percent of total billed charges,65% of total billed charges,17.48,35.67,,13.984,percent of total billed charges,35.67% of total billed charges,14.21,44.1,
IRON IBC AND PERCENT SAT,3009111,CDM,300,RC,,,outpatient,,,277,110.80,,235.45,85,,188.36,percent of total billed charges,85% of total billed charges,213.29,77,,170.63,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,227.14,82,,181.712,percent of total billed charges,82% of total billed charges,235.45,85,,188.36,percent of total billed charges,85% of total billed charges,235.45,85,,188.36,percent of total billed charges,85% of total billed charges,235.45,85,,188.36,percent of total billed charges,85% of total billed charges,249.3,90,,199.44,percent of total billed charges,90% of total billed charges,221.6,80,,177.28,percent of total billed charges,80% of total billed charges,249.3,90,,199.44,percent of total billed charges,90% of total billed charges,207.75,75,,166.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,80.33,29,,64.264,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,185.59,67,,148.472,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,221.6,80,,177.28,percent of total billed charges,80% of total billed charges,180.05,65,,144.04,percent of total billed charges,65% of total billed charges,98.81,35.67,,79.048,percent of total billed charges,35.67% of total billed charges,80.33,249.3,
PROTEIN C & S ACTIVITY PROFILE,3009992,CDM,300,RC,,,outpatient,,,359,143.60,,305.15,85,,244.12,percent of total billed charges,85% of total billed charges,276.43,77,,221.14,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,294.38,82,,235.504,percent of total billed charges,82% of total billed charges,305.15,85,,244.12,percent of total billed charges,85% of total billed charges,305.15,85,,244.12,percent of total billed charges,85% of total billed charges,305.15,85,,244.12,percent of total billed charges,85% of total billed charges,323.1,90,,258.48,percent of total billed charges,90% of total billed charges,287.2,80,,229.76,percent of total billed charges,80% of total billed charges,323.1,90,,258.48,percent of total billed charges,90% of total billed charges,269.25,75,,215.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,104.11,29,,83.288,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,240.53,67,,192.424,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,287.2,80,,229.76,percent of total billed charges,80% of total billed charges,233.35,65,,186.68,percent of total billed charges,65% of total billed charges,128.06,35.67,,102.448,percent of total billed charges,35.67% of total billed charges,104.11,323.1,
LAB TRAVEL - SCHOOL,3009996,CDM,300,RC,,,outpatient,,,27,10.80,,22.95,85,,18.36,percent of total billed charges,85% of total billed charges,20.79,77,,16.63,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,22.14,82,,17.712,percent of total billed charges,82% of total billed charges,22.95,85,,18.36,percent of total billed charges,85% of total billed charges,22.95,85,,18.36,percent of total billed charges,85% of total billed charges,22.95,85,,18.36,percent of total billed charges,85% of total billed charges,24.3,90,,19.44,percent of total billed charges,90% of total billed charges,21.6,80,,17.28,percent of total billed charges,80% of total billed charges,24.3,90,,19.44,percent of total billed charges,90% of total billed charges,20.25,75,,16.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,7.83,29,,6.264,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,18.09,67,,14.472,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,21.6,80,,17.28,percent of total billed charges,80% of total billed charges,17.55,65,,14.04,percent of total billed charges,65% of total billed charges,9.63,35.67,,7.704,percent of total billed charges,35.67% of total billed charges,7.83,24.3,
UNSATURATED PERCENT,3009997,CDM,300,RC,83550,HCPCS,outpatient,,,81,32.40,,68.85,85,,55.08,percent of total billed charges,85% of total billed charges,62.37,77,,49.9,percent of total billed charges,77% of total billed charges,8.74,100,,,fee schedule,100% of CMS fee schedule,37.77,350,,,fee schedule,350% of BCBS fee schedule,39.28,364,,,fee schedule,364% of BCBS fee schedule,39.28,364,,,fee schedule,364% of BCBS fee schedule,39.28,364,,,fee schedule,364% of BCBS fee schedule,72.9,90,,58.32,percent of total billed charges,90% of total billed charges,64.8,80,,51.84,percent of total billed charges,80% of total billed charges,72.9,90,,58.32,percent of total billed charges,90% of total billed charges,60.75,75,,48.6,percent of total billed charges,75% of total billed charges,10.66,122,,,fee schedule,122% of APC rate,23.49,29,,18.792,percent of total billed charges,29% of total billed charges,8.74,100,,,fee schedule,100% of CMS fee schedule,54.27,67,,43.416,percent of total billed charges,67% of total billed charges,12.99,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,64.8,80,,51.84,percent of total billed charges,80% of total billed charges,52.65,65,,42.12,percent of total billed charges,65% of total billed charges,28.89,35.67,,23.112,percent of total billed charges,35.67% of total billed charges,8.74,72.9,
PROTEIN S ACTIVITY,3009998,CDM,300,RC,85306,HCPCS,outpatient,,,176,70.40,,149.6,85,,119.68,percent of total billed charges,85% of total billed charges,135.52,77,,108.42,percent of total billed charges,77% of total billed charges,15.32,100,,,fee schedule,100% of CMS fee schedule,66.22,350,,,fee schedule,350% of BCBS fee schedule,68.87,364,,,fee schedule,364% of BCBS fee schedule,68.87,364,,,fee schedule,364% of BCBS fee schedule,68.87,364,,,fee schedule,364% of BCBS fee schedule,158.4,90,,126.72,percent of total billed charges,90% of total billed charges,140.8,80,,112.64,percent of total billed charges,80% of total billed charges,158.4,90,,126.72,percent of total billed charges,90% of total billed charges,132,75,,105.6,percent of total billed charges,75% of total billed charges,18.69,122,,,fee schedule,122% of APC rate,51.04,29,,40.832,percent of total billed charges,29% of total billed charges,15.32,100,,,fee schedule,100% of CMS fee schedule,117.92,67,,94.336,percent of total billed charges,67% of total billed charges,21.25,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,140.8,80,,112.64,percent of total billed charges,80% of total billed charges,114.4,65,,91.52,percent of total billed charges,65% of total billed charges,62.78,35.67,,50.224,percent of total billed charges,35.67% of total billed charges,15.32,158.4,
BLOOD STAT CHARGE,3009999,CDM,300,RC,85999,HCPCS,outpatient,,,262,104.80,,222.7,85,,178.16,percent of total billed charges,85% of total billed charges,201.74,77,,161.39,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,214.84,82,,171.872,percent of total billed charges,82% of total billed charges,222.7,85,,178.16,percent of total billed charges,85% of total billed charges,222.7,85,,178.16,percent of total billed charges,85% of total billed charges,222.7,85,,178.16,percent of total billed charges,85% of total billed charges,235.8,90,,188.64,percent of total billed charges,90% of total billed charges,209.6,80,,167.68,percent of total billed charges,80% of total billed charges,235.8,90,,188.64,percent of total billed charges,90% of total billed charges,196.5,75,,157.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,75.98,29,,60.784,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,175.54,67,,140.432,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,209.6,80,,167.68,percent of total billed charges,80% of total billed charges,170.3,65,,136.24,percent of total billed charges,65% of total billed charges,93.46,35.67,,74.768,percent of total billed charges,35.67% of total billed charges,75.98,235.8,
ANTIPHOPHOLIPID ANTIBODY,3010000,CDM,300,RC,30100,HCPCS,outpatient,,,2368,947.20,,1150,,,,case rate,pays based on per visit,1823.36,77,,1458.69,percent of total billed charges,77% of total billed charges,1333.69,100,,,fee schedule,100% of CMS OPPS rate,1941.76,82,,1553.408,percent of total billed charges,82% of total billed charges,2012.8,85,,1610.24,percent of total billed charges,85% of total billed charges,2012.8,85,,1610.24,percent of total billed charges,85% of total billed charges,2012.8,85,,1610.24,percent of total billed charges,85% of total billed charges,2131.2,90,,1704.96,percent of total billed charges,90% of total billed charges,1894.4,80,,1515.52,percent of total billed charges,80% of total billed charges,2131.2,90,,1704.96,percent of total billed charges,90% of total billed charges,1776,75,,1420.8,percent of total billed charges,75% of total billed charges,1627.1,122,,,fee schedule,122% of APC rate,88.87,100,,,fee schedule,100% of ASC tier grouping rate,1333.69,100,,,fee schedule,100% of CMS OPPS rate,1586.56,67,,1269.248,percent of total billed charges,67% of total billed charges,486.49,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,1894.4,80,,1515.52,percent of total billed charges,80% of total billed charges,1539.2,65,,1231.36,percent of total billed charges,65% of total billed charges,109.31,123,,,fee schedule,123% of ASC tier grouping rate,88.87,2131.2,
IMMUNOASSAY MULTI STEP EXP,3010001,CDM,300,RC,83516,HCPCS,outpatient,,,145,58.00,,123.25,85,,98.6,percent of total billed charges,85% of total billed charges,111.65,77,,89.32,percent of total billed charges,77% of total billed charges,11.53,100,,,fee schedule,100% of CMS fee schedule,49.84,350,,,fee schedule,350% of BCBS fee schedule,51.83,364,,,fee schedule,364% of BCBS fee schedule,51.83,364,,,fee schedule,364% of BCBS fee schedule,51.83,364,,,fee schedule,364% of BCBS fee schedule,130.5,90,,104.4,percent of total billed charges,90% of total billed charges,116,80,,92.8,percent of total billed charges,80% of total billed charges,130.5,90,,104.4,percent of total billed charges,90% of total billed charges,108.75,75,,87,percent of total billed charges,75% of total billed charges,14.06,122,,,fee schedule,122% of APC rate,42.05,29,,33.64,percent of total billed charges,29% of total billed charges,11.53,100,,,fee schedule,100% of CMS fee schedule,97.15,67,,77.72,percent of total billed charges,67% of total billed charges,14.62,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,116,80,,92.8,percent of total billed charges,80% of total billed charges,94.25,65,,75.4,percent of total billed charges,65% of total billed charges,51.72,35.67,,41.376,percent of total billed charges,35.67% of total billed charges,11.53,130.5,
SOLUBLE LIVER Ag AB,3010004,CDM,300,RC,83516,HCPCS,outpatient,,,40,16.00,,34,85,,27.2,percent of total billed charges,85% of total billed charges,30.8,77,,24.64,percent of total billed charges,77% of total billed charges,11.53,100,,,fee schedule,100% of CMS fee schedule,49.84,350,,,fee schedule,350% of BCBS fee schedule,51.83,364,,,fee schedule,364% of BCBS fee schedule,51.83,364,,,fee schedule,364% of BCBS fee schedule,51.83,364,,,fee schedule,364% of BCBS fee schedule,36,90,,28.8,percent of total billed charges,90% of total billed charges,32,80,,25.6,percent of total billed charges,80% of total billed charges,36,90,,28.8,percent of total billed charges,90% of total billed charges,30,75,,24,percent of total billed charges,75% of total billed charges,14.06,122,,,fee schedule,122% of APC rate,11.6,29,,9.28,percent of total billed charges,29% of total billed charges,11.53,100,,,fee schedule,100% of CMS fee schedule,26.8,67,,21.44,percent of total billed charges,67% of total billed charges,14.62,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,32,80,,25.6,percent of total billed charges,80% of total billed charges,26,65,,20.8,percent of total billed charges,65% of total billed charges,14.27,35.67,,11.416,percent of total billed charges,35.67% of total billed charges,11.53,51.83,
IMMUNOASSAY NONANTIBODY,3010005,CDM,300,RC,83516,HCPCS,outpatient,,,40,16.00,,34,85,,27.2,percent of total billed charges,85% of total billed charges,30.8,77,,24.64,percent of total billed charges,77% of total billed charges,11.53,100,,,fee schedule,100% of CMS fee schedule,49.84,350,,,fee schedule,350% of BCBS fee schedule,51.83,364,,,fee schedule,364% of BCBS fee schedule,51.83,364,,,fee schedule,364% of BCBS fee schedule,51.83,364,,,fee schedule,364% of BCBS fee schedule,36,90,,28.8,percent of total billed charges,90% of total billed charges,32,80,,25.6,percent of total billed charges,80% of total billed charges,36,90,,28.8,percent of total billed charges,90% of total billed charges,30,75,,24,percent of total billed charges,75% of total billed charges,14.06,122,,,fee schedule,122% of APC rate,11.6,29,,9.28,percent of total billed charges,29% of total billed charges,11.53,100,,,fee schedule,100% of CMS fee schedule,26.8,67,,21.44,percent of total billed charges,67% of total billed charges,14.62,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,32,80,,25.6,percent of total billed charges,80% of total billed charges,26,65,,20.8,percent of total billed charges,65% of total billed charges,14.27,35.67,,11.416,percent of total billed charges,35.67% of total billed charges,11.53,51.83,
PHOSPHATIDYL SERINE Ab,3010006,CDM,300,RC,83516,HCPCS,outpatient,,,40,16.00,,34,85,,27.2,percent of total billed charges,85% of total billed charges,30.8,77,,24.64,percent of total billed charges,77% of total billed charges,11.53,100,,,fee schedule,100% of CMS fee schedule,49.84,350,,,fee schedule,350% of BCBS fee schedule,51.83,364,,,fee schedule,364% of BCBS fee schedule,51.83,364,,,fee schedule,364% of BCBS fee schedule,51.83,364,,,fee schedule,364% of BCBS fee schedule,36,90,,28.8,percent of total billed charges,90% of total billed charges,32,80,,25.6,percent of total billed charges,80% of total billed charges,36,90,,28.8,percent of total billed charges,90% of total billed charges,30,75,,24,percent of total billed charges,75% of total billed charges,14.06,122,,,fee schedule,122% of APC rate,11.6,29,,9.28,percent of total billed charges,29% of total billed charges,11.53,100,,,fee schedule,100% of CMS fee schedule,26.8,67,,21.44,percent of total billed charges,67% of total billed charges,14.62,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,32,80,,25.6,percent of total billed charges,80% of total billed charges,26,65,,20.8,percent of total billed charges,65% of total billed charges,14.27,35.67,,11.416,percent of total billed charges,35.67% of total billed charges,11.53,51.83,
"TRICHOMONAS, URINE, AMP",3015050,CDM,300,RC,87661,HCPCS,outpatient,,,204,81.60,,173.4,85,,138.72,percent of total billed charges,85% of total billed charges,157.08,77,,125.66,percent of total billed charges,77% of total billed charges,35.09,100,,,fee schedule,100% of CMS fee schedule,151.66,350,,,fee schedule,350% of BCBS fee schedule,157.72,364,,,fee schedule,364% of BCBS fee schedule,157.72,364,,,fee schedule,364% of BCBS fee schedule,157.72,364,,,fee schedule,364% of BCBS fee schedule,183.6,90,,146.88,percent of total billed charges,90% of total billed charges,163.2,80,,130.56,percent of total billed charges,80% of total billed charges,183.6,90,,146.88,percent of total billed charges,90% of total billed charges,153,75,,122.4,percent of total billed charges,75% of total billed charges,42.8,122,,,fee schedule,122% of APC rate,59.16,29,,47.328,percent of total billed charges,29% of total billed charges,35.09,100,,,fee schedule,100% of CMS fee schedule,136.68,67,,109.344,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,163.2,80,,130.56,percent of total billed charges,80% of total billed charges,132.6,65,,106.08,percent of total billed charges,65% of total billed charges,72.77,35.67,,58.216,percent of total billed charges,35.67% of total billed charges,35.09,183.6,
B  PERTUSSIS/PARA BY PCR *EXP,3015051,CDM,300,RC,,,outpatient,,,315,126.00,,267.75,85,,214.2,percent of total billed charges,85% of total billed charges,242.55,77,,194.04,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,258.3,82,,206.64,percent of total billed charges,82% of total billed charges,267.75,85,,214.2,percent of total billed charges,85% of total billed charges,267.75,85,,214.2,percent of total billed charges,85% of total billed charges,267.75,85,,214.2,percent of total billed charges,85% of total billed charges,283.5,90,,226.8,percent of total billed charges,90% of total billed charges,252,80,,201.6,percent of total billed charges,80% of total billed charges,283.5,90,,226.8,percent of total billed charges,90% of total billed charges,236.25,75,,189,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,91.35,29,,73.08,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,211.05,67,,168.84,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,252,80,,201.6,percent of total billed charges,80% of total billed charges,204.75,65,,163.8,percent of total billed charges,65% of total billed charges,112.36,35.67,,89.888,percent of total billed charges,35.67% of total billed charges,91.35,283.5,
BK K VIRUS PCR QUANT,3015052,CDM,300,RC,87799,HCPCS,outpatient,,,402,160.80,,341.7,85,,273.36,percent of total billed charges,85% of total billed charges,309.54,77,,247.63,percent of total billed charges,77% of total billed charges,42.84,100,,,fee schedule,100% of CMS fee schedule,185.08,350,,,fee schedule,350% of BCBS fee schedule,192.48,364,,,fee schedule,364% of BCBS fee schedule,192.48,364,,,fee schedule,364% of BCBS fee schedule,192.48,364,,,fee schedule,364% of BCBS fee schedule,361.8,90,,289.44,percent of total billed charges,90% of total billed charges,321.6,80,,257.28,percent of total billed charges,80% of total billed charges,361.8,90,,289.44,percent of total billed charges,90% of total billed charges,301.5,75,,241.2,percent of total billed charges,75% of total billed charges,52.26,122,,,fee schedule,122% of APC rate,116.58,29,,93.264,percent of total billed charges,29% of total billed charges,42.84,100,,,fee schedule,100% of CMS fee schedule,269.34,67,,215.472,percent of total billed charges,67% of total billed charges,63.7,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,321.6,80,,257.28,percent of total billed charges,80% of total billed charges,261.3,65,,209.04,percent of total billed charges,65% of total billed charges,143.39,35.67,,114.712,percent of total billed charges,35.67% of total billed charges,42.84,361.8,
ISHA - EACH ADD SINGLE PROBE,3100301,CDM,300,RC,88364,HCPCS,outpatient,,,346,138.40,TC,294.1,85,,235.28,percent of total billed charges,85% of total billed charges,266.42,77,,213.14,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,342.93,350,,,fee schedule,350% of BCBS fee schedule,356.65,364,,,fee schedule,364% of BCBS fee schedule,356.65,364,,,fee schedule,364% of BCBS fee schedule,356.65,364,,,fee schedule,364% of BCBS fee schedule,311.4,90,,249.12,percent of total billed charges,90% of total billed charges,276.8,80,,221.44,percent of total billed charges,80% of total billed charges,311.4,90,,249.12,percent of total billed charges,90% of total billed charges,259.5,75,,207.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,100.34,29,,80.272,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,231.82,67,,185.456,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,276.8,80,,221.44,percent of total billed charges,80% of total billed charges,224.9,65,,179.92,percent of total billed charges,65% of total billed charges,123.42,35.67,,98.736,percent of total billed charges,35.67% of total billed charges,100.34,356.65,
GLUCOSE BLOOD REAGENT STRIP,3190201,CDM,300,RC,82948,HCPCS,outpatient,,,16,6.40,,13.6,85,,10.88,percent of total billed charges,85% of total billed charges,12.32,77,,9.86,percent of total billed charges,77% of total billed charges,5.04,100,,,fee schedule,100% of CMS fee schedule,17.64,350,,,fee schedule,350% of BCBS fee schedule,18.35,364,,,fee schedule,364% of BCBS fee schedule,18.35,364,,,fee schedule,364% of BCBS fee schedule,18.35,364,,,fee schedule,364% of BCBS fee schedule,14.4,90,,11.52,percent of total billed charges,90% of total billed charges,12.8,80,,10.24,percent of total billed charges,80% of total billed charges,14.4,90,,11.52,percent of total billed charges,90% of total billed charges,12,75,,9.6,percent of total billed charges,75% of total billed charges,6.14,122,,,fee schedule,122% of APC rate,4.64,29,,3.712,percent of total billed charges,29% of total billed charges,5.04,100,,,fee schedule,100% of CMS fee schedule,10.72,67,,8.576,percent of total billed charges,67% of total billed charges,4.7,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,12.8,80,,10.24,percent of total billed charges,80% of total billed charges,10.4,65,,8.32,percent of total billed charges,65% of total billed charges,5.71,35.67,,4.568,percent of total billed charges,35.67% of total billed charges,4.64,18.35,
RH BLOOD TYPE,3900100,CDM,300,RC,86901,HCPCS,outpatient,,,129,51.60,,109.65,85,,87.72,percent of total billed charges,85% of total billed charges,99.33,77,,79.46,percent of total billed charges,77% of total billed charges,35.07,100,,,fee schedule,100% of CMS OPPS rate,111.3,350,,,fee schedule,350% of BCBS fee schedule,115.75,364,,,fee schedule,364% of BCBS fee schedule,115.75,364,,,fee schedule,364% of BCBS fee schedule,115.75,364,,,fee schedule,364% of BCBS fee schedule,116.1,90,,92.88,percent of total billed charges,90% of total billed charges,103.2,80,,82.56,percent of total billed charges,80% of total billed charges,116.1,90,,92.88,percent of total billed charges,90% of total billed charges,96.75,75,,77.4,percent of total billed charges,75% of total billed charges,42.78,122,,,fee schedule,122% of APC rate,37.41,29,,29.928,percent of total billed charges,29% of total billed charges,35.07,100,,,fee schedule,100% of CMS OPPS rate,86.43,67,,69.144,percent of total billed charges,67% of total billed charges,7.17,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,103.2,80,,82.56,percent of total billed charges,80% of total billed charges,83.85,65,,67.08,percent of total billed charges,65% of total billed charges,46.01,35.67,,36.808,percent of total billed charges,35.67% of total billed charges,7.17,116.1,
ANTIGEN ID EACH/UNIT,3900250,CDM,300,RC,86902,HCPCS,outpatient,,,851,340.40,,723.35,85,,578.68,percent of total billed charges,85% of total billed charges,655.27,77,,524.22,percent of total billed charges,77% of total billed charges,314.34,100,,,fee schedule,100% of CMS OPPS rate,754.01,350,,,fee schedule,350% of BCBS fee schedule,784.17,364,,,fee schedule,364% of BCBS fee schedule,784.17,364,,,fee schedule,364% of BCBS fee schedule,784.17,364,,,fee schedule,364% of BCBS fee schedule,765.9,90,,612.72,percent of total billed charges,90% of total billed charges,680.8,80,,544.64,percent of total billed charges,80% of total billed charges,765.9,90,,612.72,percent of total billed charges,90% of total billed charges,638.25,75,,510.6,percent of total billed charges,75% of total billed charges,383.5,122,,,fee schedule,122% of APC rate,246.79,29,,197.432,percent of total billed charges,29% of total billed charges,314.34,100,,,fee schedule,100% of CMS OPPS rate,570.17,67,,456.136,percent of total billed charges,67% of total billed charges,13.91,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,680.8,80,,544.64,percent of total billed charges,80% of total billed charges,553.15,65,,442.52,percent of total billed charges,65% of total billed charges,303.55,35.67,,242.84,percent of total billed charges,35.67% of total billed charges,13.91,784.17,
ABO BLOOD TYPE,3900399,CDM,300,RC,86900,HCPCS,outpatient,,,302,120.80,,256.7,85,,205.36,percent of total billed charges,85% of total billed charges,232.54,77,,186.03,percent of total billed charges,77% of total billed charges,111.71,100,,,fee schedule,100% of CMS OPPS rate,367.64,350,,,fee schedule,350% of BCBS fee schedule,382.35,364,,,fee schedule,364% of BCBS fee schedule,382.35,364,,,fee schedule,364% of BCBS fee schedule,382.35,364,,,fee schedule,364% of BCBS fee schedule,271.8,90,,217.44,percent of total billed charges,90% of total billed charges,241.6,80,,193.28,percent of total billed charges,80% of total billed charges,271.8,90,,217.44,percent of total billed charges,90% of total billed charges,226.5,75,,181.2,percent of total billed charges,75% of total billed charges,136.28,122,,,fee schedule,122% of APC rate,87.58,29,,70.064,percent of total billed charges,29% of total billed charges,111.71,100,,,fee schedule,100% of CMS OPPS rate,202.34,67,,161.872,percent of total billed charges,67% of total billed charges,7.17,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,241.6,80,,193.28,percent of total billed charges,80% of total billed charges,196.3,65,,157.04,percent of total billed charges,65% of total billed charges,107.72,35.67,,86.176,percent of total billed charges,35.67% of total billed charges,7.17,382.35,
MISC MILEAGE FOR LAB,3999999,CDM,300,RC,,,outpatient,,,27,10.80,,22.95,85,,18.36,percent of total billed charges,85% of total billed charges,20.79,77,,16.63,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,22.14,82,,17.712,percent of total billed charges,82% of total billed charges,22.95,85,,18.36,percent of total billed charges,85% of total billed charges,22.95,85,,18.36,percent of total billed charges,85% of total billed charges,22.95,85,,18.36,percent of total billed charges,85% of total billed charges,24.3,90,,19.44,percent of total billed charges,90% of total billed charges,21.6,80,,17.28,percent of total billed charges,80% of total billed charges,24.3,90,,19.44,percent of total billed charges,90% of total billed charges,20.25,75,,16.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,7.83,29,,6.264,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,18.09,67,,14.472,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,21.6,80,,17.28,percent of total billed charges,80% of total billed charges,17.55,65,,14.04,percent of total billed charges,65% of total billed charges,9.63,35.67,,7.704,percent of total billed charges,35.67% of total billed charges,7.83,24.3,
ARTERIAL BLOOD GASES,4100010,CDM,300,RC,82805,HCPCS,outpatient,,,317,126.80,,269.45,85,,215.56,percent of total billed charges,85% of total billed charges,244.09,77,,195.27,percent of total billed charges,77% of total billed charges,78.77,100,,,fee schedule,100% of CMS fee schedule,275.7,350,,,fee schedule,350% of BCBS fee schedule,286.72,364,,,fee schedule,364% of BCBS fee schedule,286.72,364,,,fee schedule,364% of BCBS fee schedule,286.72,364,,,fee schedule,364% of BCBS fee schedule,285.3,90,,228.24,percent of total billed charges,90% of total billed charges,253.6,80,,202.88,percent of total billed charges,80% of total billed charges,285.3,90,,228.24,percent of total billed charges,90% of total billed charges,237.75,75,,190.2,percent of total billed charges,75% of total billed charges,96.09,122,,,fee schedule,122% of APC rate,91.93,29,,73.544,percent of total billed charges,29% of total billed charges,78.77,100,,,fee schedule,100% of CMS fee schedule,212.39,67,,169.912,percent of total billed charges,67% of total billed charges,42.21,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,253.6,80,,202.88,percent of total billed charges,80% of total billed charges,206.05,65,,164.84,percent of total billed charges,65% of total billed charges,113.07,35.67,,90.456,percent of total billed charges,35.67% of total billed charges,42.21,286.72,
ARTERIAL PUNCTURE FOR ABG,4100012,CDM,300,RC,36600,HCPCS,outpatient,,,235,94.00,,1150,,,,case rate,pays based on per visit,180.95,77,,144.76,percent of total billed charges,77% of total billed charges,111.71,100,,,fee schedule,100% of CMS OPPS rate,192.7,82,,154.16,percent of total billed charges,82% of total billed charges,199.75,85,,159.8,percent of total billed charges,85% of total billed charges,199.75,85,,159.8,percent of total billed charges,85% of total billed charges,199.75,85,,159.8,percent of total billed charges,85% of total billed charges,211.5,90,,169.2,percent of total billed charges,90% of total billed charges,188,80,,150.4,percent of total billed charges,80% of total billed charges,211.5,90,,169.2,percent of total billed charges,90% of total billed charges,176.25,75,,141,percent of total billed charges,75% of total billed charges,136.28,122,,,fee schedule,122% of APC rate,68.15,29,,54.52,percent of total billed charges,29% of total billed charges,111.71,100,,,fee schedule,100% of CMS OPPS rate,157.45,67,,125.96,percent of total billed charges,67% of total billed charges,17.54,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,188,80,,150.4,percent of total billed charges,80% of total billed charges,152.75,65,,122.2,percent of total billed charges,65% of total billed charges,83.82,35.67,,67.056,percent of total billed charges,35.67% of total billed charges,17.54,1150,
BREATH ALCOHOL TESTING,4100085,CDM,300,RC,82075,HCPCS,outpatient,,,120,48.00,,102,85,,81.6,percent of total billed charges,85% of total billed charges,92.4,77,,73.92,percent of total billed charges,77% of total billed charges,30,100,,,fee schedule,100% of CMS fee schedule,105,350,,,fee schedule,350% of BCBS fee schedule,109.2,364,,,fee schedule,364% of BCBS fee schedule,109.2,364,,,fee schedule,364% of BCBS fee schedule,109.2,364,,,fee schedule,364% of BCBS fee schedule,108,90,,86.4,percent of total billed charges,90% of total billed charges,96,80,,76.8,percent of total billed charges,80% of total billed charges,108,90,,86.4,percent of total billed charges,90% of total billed charges,90,75,,72,percent of total billed charges,75% of total billed charges,36.6,122,,,fee schedule,122% of APC rate,34.8,29,,27.84,percent of total billed charges,29% of total billed charges,30,100,,,fee schedule,100% of CMS fee schedule,80.4,67,,64.32,percent of total billed charges,67% of total billed charges,14.54,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,96,80,,76.8,percent of total billed charges,80% of total billed charges,78,65,,62.4,percent of total billed charges,65% of total billed charges,42.8,35.67,,34.24,percent of total billed charges,35.67% of total billed charges,14.54,109.2,
PH MEASUREMENT,4100245,CDM,300,RC,82800,HCPCS,outpatient,,,91,36.40,,77.35,85,,61.88,percent of total billed charges,85% of total billed charges,70.07,77,,56.06,percent of total billed charges,77% of total billed charges,11,100,,,fee schedule,100% of CMS fee schedule,38.5,350,,,fee schedule,350% of BCBS fee schedule,40.04,364,,,fee schedule,364% of BCBS fee schedule,40.04,364,,,fee schedule,364% of BCBS fee schedule,40.04,364,,,fee schedule,364% of BCBS fee schedule,81.9,90,,65.52,percent of total billed charges,90% of total billed charges,72.8,80,,58.24,percent of total billed charges,80% of total billed charges,81.9,90,,65.52,percent of total billed charges,90% of total billed charges,68.25,75,,54.6,percent of total billed charges,75% of total billed charges,13.42,122,,,fee schedule,122% of APC rate,26.39,29,,21.112,percent of total billed charges,29% of total billed charges,11,100,,,fee schedule,100% of CMS fee schedule,60.97,67,,48.776,percent of total billed charges,67% of total billed charges,12.58,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,72.8,80,,58.24,percent of total billed charges,80% of total billed charges,59.15,65,,47.32,percent of total billed charges,65% of total billed charges,32.46,35.67,,25.968,percent of total billed charges,35.67% of total billed charges,11,81.9,
PH MEASUREMENT - REPEAT TODAY,4100246,CDM,300,RC,82800,HCPCS,outpatient,,,89,35.60,91,75.65,85,,60.52,percent of total billed charges,85% of total billed charges,68.53,77,,54.82,percent of total billed charges,77% of total billed charges,11,100,,,fee schedule,100% of CMS fee schedule,38.5,350,,,fee schedule,350% of BCBS fee schedule,40.04,364,,,fee schedule,364% of BCBS fee schedule,40.04,364,,,fee schedule,364% of BCBS fee schedule,40.04,364,,,fee schedule,364% of BCBS fee schedule,80.1,90,,64.08,percent of total billed charges,90% of total billed charges,71.2,80,,56.96,percent of total billed charges,80% of total billed charges,80.1,90,,64.08,percent of total billed charges,90% of total billed charges,66.75,75,,53.4,percent of total billed charges,75% of total billed charges,13.42,122,,,fee schedule,122% of APC rate,25.81,29,,20.648,percent of total billed charges,29% of total billed charges,11,100,,,fee schedule,100% of CMS fee schedule,59.63,67,,47.704,percent of total billed charges,67% of total billed charges,12.58,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,71.2,80,,56.96,percent of total billed charges,80% of total billed charges,57.85,65,,46.28,percent of total billed charges,65% of total billed charges,31.75,35.67,,25.4,percent of total billed charges,35.67% of total billed charges,11,80.1,
CORD PH,4100247,CDM,300,RC,82800,HCPCS,outpatient,,,89,35.60,,75.65,85,,60.52,percent of total billed charges,85% of total billed charges,68.53,77,,54.82,percent of total billed charges,77% of total billed charges,11,100,,,fee schedule,100% of CMS fee schedule,38.5,350,,,fee schedule,350% of BCBS fee schedule,40.04,364,,,fee schedule,364% of BCBS fee schedule,40.04,364,,,fee schedule,364% of BCBS fee schedule,40.04,364,,,fee schedule,364% of BCBS fee schedule,80.1,90,,64.08,percent of total billed charges,90% of total billed charges,71.2,80,,56.96,percent of total billed charges,80% of total billed charges,80.1,90,,64.08,percent of total billed charges,90% of total billed charges,66.75,75,,53.4,percent of total billed charges,75% of total billed charges,13.42,122,,,fee schedule,122% of APC rate,25.81,29,,20.648,percent of total billed charges,29% of total billed charges,11,100,,,fee schedule,100% of CMS fee schedule,59.63,67,,47.704,percent of total billed charges,67% of total billed charges,12.58,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,71.2,80,,56.96,percent of total billed charges,80% of total billed charges,57.85,65,,46.28,percent of total billed charges,65% of total billed charges,31.75,35.67,,25.4,percent of total billed charges,35.67% of total billed charges,11,80.1,
INSERT STRAIGHT UA CATH SPECIM,4500500,CDM,300,RC,P9612,HCPCS,outpatient,,,16,6.40,,13.6,85,,10.88,percent of total billed charges,85% of total billed charges,12.32,77,,9.86,percent of total billed charges,77% of total billed charges,8.83,100,,,fee schedule,100% of CMS fee schedule,13.12,82,,10.496,percent of total billed charges,82% of total billed charges,13.6,85,,10.88,percent of total billed charges,85% of total billed charges,13.6,85,,10.88,percent of total billed charges,85% of total billed charges,13.6,85,,10.88,percent of total billed charges,85% of total billed charges,14.4,90,,11.52,percent of total billed charges,90% of total billed charges,12.8,80,,10.24,percent of total billed charges,80% of total billed charges,14.4,90,,11.52,percent of total billed charges,90% of total billed charges,12,75,,9.6,percent of total billed charges,75% of total billed charges,10.77,122,,,fee schedule,122% of APC rate,4.64,29,,3.712,percent of total billed charges,29% of total billed charges,8.83,100,,,fee schedule,100% of CMS fee schedule,10.72,67,,8.576,percent of total billed charges,67% of total billed charges,3.15,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,12.8,80,,10.24,percent of total billed charges,80% of total billed charges,10.4,65,,8.32,percent of total billed charges,65% of total billed charges,5.71,35.67,,4.568,percent of total billed charges,35.67% of total billed charges,3.15,14.4,
GLUCOSE - FINGERSTICK,4500890,CDM,300,RC,82962,HCPCS,outpatient,,,36,14.40,,30.6,85,,24.48,percent of total billed charges,85% of total billed charges,27.72,77,,22.18,percent of total billed charges,77% of total billed charges,3.28,100,,,fee schedule,100% of CMS fee schedule,11.48,350,,,fee schedule,350% of BCBS fee schedule,11.94,364,,,fee schedule,364% of BCBS fee schedule,11.94,364,,,fee schedule,364% of BCBS fee schedule,11.94,364,,,fee schedule,364% of BCBS fee schedule,32.4,90,,25.92,percent of total billed charges,90% of total billed charges,28.8,80,,23.04,percent of total billed charges,80% of total billed charges,32.4,90,,25.92,percent of total billed charges,90% of total billed charges,27,75,,21.6,percent of total billed charges,75% of total billed charges,4,122,,,fee schedule,122% of APC rate,10.44,29,,8.352,percent of total billed charges,29% of total billed charges,3.28,100,,,fee schedule,100% of CMS fee schedule,24.12,67,,19.296,percent of total billed charges,67% of total billed charges,3.23,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,28.8,80,,23.04,percent of total billed charges,80% of total billed charges,23.4,65,,18.72,percent of total billed charges,65% of total billed charges,12.84,35.67,,10.272,percent of total billed charges,35.67% of total billed charges,3.23,32.4,
"ALBUMIN, PERITONEAL FLD",3000360,CDM,301,RC,82042,HCPCS,outpatient,,,32,12.80,,27.2,85,,21.76,percent of total billed charges,85% of total billed charges,24.64,77,,19.71,percent of total billed charges,77% of total billed charges,7.78,100,,,fee schedule,100% of CMS fee schedule,27.23,350,,,fee schedule,350% of BCBS fee schedule,28.32,364,,,fee schedule,364% of BCBS fee schedule,28.32,364,,,fee schedule,364% of BCBS fee schedule,28.32,364,,,fee schedule,364% of BCBS fee schedule,28.8,90,,23.04,percent of total billed charges,90% of total billed charges,25.6,80,,20.48,percent of total billed charges,80% of total billed charges,28.8,90,,23.04,percent of total billed charges,90% of total billed charges,24,75,,19.2,percent of total billed charges,75% of total billed charges,9.49,122,,,fee schedule,122% of APC rate,9.28,29,,7.424,percent of total billed charges,29% of total billed charges,7.78,100,,,fee schedule,100% of CMS fee schedule,21.44,67,,17.152,percent of total billed charges,67% of total billed charges,4.28,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,25.6,80,,20.48,percent of total billed charges,80% of total billed charges,20.8,65,,16.64,percent of total billed charges,65% of total billed charges,11.41,35.67,,9.128,percent of total billed charges,35.67% of total billed charges,4.28,28.8,
BETA-2-MICROGLOBIN,3001280,CDM,301,RC,82232,HCPCS,outpatient,,,105,42.00,,89.25,85,,71.4,percent of total billed charges,85% of total billed charges,80.85,77,,64.68,percent of total billed charges,77% of total billed charges,16.18,100,,,fee schedule,100% of CMS fee schedule,69.9,350,,,fee schedule,350% of BCBS fee schedule,72.69,364,,,fee schedule,364% of BCBS fee schedule,72.69,364,,,fee schedule,364% of BCBS fee schedule,72.69,364,,,fee schedule,364% of BCBS fee schedule,94.5,90,,75.6,percent of total billed charges,90% of total billed charges,84,80,,67.2,percent of total billed charges,80% of total billed charges,94.5,90,,75.6,percent of total billed charges,90% of total billed charges,78.75,75,,63,percent of total billed charges,75% of total billed charges,19.73,122,,,fee schedule,122% of APC rate,30.45,29,,24.36,percent of total billed charges,29% of total billed charges,16.18,100,,,fee schedule,100% of CMS fee schedule,70.35,67,,56.28,percent of total billed charges,67% of total billed charges,24.05,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,84,80,,67.2,percent of total billed charges,80% of total billed charges,68.25,65,,54.6,percent of total billed charges,65% of total billed charges,37.45,35.67,,29.96,percent of total billed charges,35.67% of total billed charges,16.18,94.5,
BUTABARBITAL,3001560,CDM,301,RC,80299,HCPCS,outpatient,,,142,56.80,,120.7,85,,96.56,percent of total billed charges,85% of total billed charges,109.34,77,,87.47,percent of total billed charges,77% of total billed charges,18.64,100,,,fee schedule,100% of CMS fee schedule,65.24,350,,,fee schedule,350% of BCBS fee schedule,67.85,364,,,fee schedule,364% of BCBS fee schedule,67.85,364,,,fee schedule,364% of BCBS fee schedule,67.85,364,,,fee schedule,364% of BCBS fee schedule,127.8,90,,102.24,percent of total billed charges,90% of total billed charges,113.6,80,,90.88,percent of total billed charges,80% of total billed charges,127.8,90,,102.24,percent of total billed charges,90% of total billed charges,106.5,75,,85.2,percent of total billed charges,75% of total billed charges,22.74,122,,,fee schedule,122% of APC rate,41.18,29,,32.944,percent of total billed charges,29% of total billed charges,18.64,100,,,fee schedule,100% of CMS fee schedule,95.14,67,,76.112,percent of total billed charges,67% of total billed charges,20.36,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,113.6,80,,90.88,percent of total billed charges,80% of total billed charges,92.3,65,,73.84,percent of total billed charges,65% of total billed charges,50.65,35.67,,40.52,percent of total billed charges,35.67% of total billed charges,18.64,127.8,
C-PEPTIDE,3001600,CDM,301,RC,84681,HCPCS,outpatient,,,147,58.80,,124.95,85,,99.96,percent of total billed charges,85% of total billed charges,113.19,77,,90.55,percent of total billed charges,77% of total billed charges,20.81,100,,,fee schedule,100% of CMS fee schedule,89.95,350,,,fee schedule,350% of BCBS fee schedule,93.55,364,,,fee schedule,364% of BCBS fee schedule,93.55,364,,,fee schedule,364% of BCBS fee schedule,93.55,364,,,fee schedule,364% of BCBS fee schedule,132.3,90,,105.84,percent of total billed charges,90% of total billed charges,117.6,80,,94.08,percent of total billed charges,80% of total billed charges,132.3,90,,105.84,percent of total billed charges,90% of total billed charges,110.25,75,,88.2,percent of total billed charges,75% of total billed charges,25.38,122,,,fee schedule,122% of APC rate,42.63,29,,34.104,percent of total billed charges,29% of total billed charges,20.81,100,,,fee schedule,100% of CMS fee schedule,98.49,67,,78.792,percent of total billed charges,67% of total billed charges,30.94,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,117.6,80,,94.08,percent of total billed charges,80% of total billed charges,95.55,65,,76.44,percent of total billed charges,65% of total billed charges,52.43,35.67,,41.944,percent of total billed charges,35.67% of total billed charges,20.81,132.3,
CALCIUM IONIZED,3001780,CDM,301,RC,82330,HCPCS,outpatient,,,129,51.60,,109.65,85,,87.72,percent of total billed charges,85% of total billed charges,99.33,77,,79.46,percent of total billed charges,77% of total billed charges,13.68,100,,,fee schedule,100% of CMS fee schedule,59.08,350,,,fee schedule,350% of BCBS fee schedule,61.44,364,,,fee schedule,364% of BCBS fee schedule,61.44,364,,,fee schedule,364% of BCBS fee schedule,61.44,364,,,fee schedule,364% of BCBS fee schedule,116.1,90,,92.88,percent of total billed charges,90% of total billed charges,103.2,80,,82.56,percent of total billed charges,80% of total billed charges,116.1,90,,92.88,percent of total billed charges,90% of total billed charges,96.75,75,,77.4,percent of total billed charges,75% of total billed charges,16.68,122,,,fee schedule,122% of APC rate,37.41,29,,29.928,percent of total billed charges,29% of total billed charges,13.68,100,,,fee schedule,100% of CMS fee schedule,86.43,67,,69.144,percent of total billed charges,67% of total billed charges,10.39,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,103.2,80,,82.56,percent of total billed charges,80% of total billed charges,83.85,65,,67.08,percent of total billed charges,65% of total billed charges,46.01,35.67,,36.808,percent of total billed charges,35.67% of total billed charges,10.39,116.1,
CHLORAMPHENICOL,3002120,CDM,301,RC,82415,HCPCS,outpatient,,,82,32.80,,69.7,85,,55.76,percent of total billed charges,85% of total billed charges,63.14,77,,50.51,percent of total billed charges,77% of total billed charges,12.67,100,,,fee schedule,100% of CMS fee schedule,54.74,350,,,fee schedule,350% of BCBS fee schedule,56.93,364,,,fee schedule,364% of BCBS fee schedule,56.93,364,,,fee schedule,364% of BCBS fee schedule,56.93,364,,,fee schedule,364% of BCBS fee schedule,73.8,90,,59.04,percent of total billed charges,90% of total billed charges,65.6,80,,52.48,percent of total billed charges,80% of total billed charges,73.8,90,,59.04,percent of total billed charges,90% of total billed charges,61.5,75,,49.2,percent of total billed charges,75% of total billed charges,15.45,122,,,fee schedule,122% of APC rate,23.78,29,,19.024,percent of total billed charges,29% of total billed charges,12.67,100,,,fee schedule,100% of CMS fee schedule,54.94,67,,43.952,percent of total billed charges,67% of total billed charges,17.45,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,65.6,80,,52.48,percent of total billed charges,80% of total billed charges,53.3,65,,42.64,percent of total billed charges,65% of total billed charges,29.25,35.67,,23.4,percent of total billed charges,35.67% of total billed charges,12.67,73.8,
DESIPRAMINE (NORPRAMINE) LEVEL,3003660,CDM,301,RC,80335,HCPCS,outpatient,,,438,175.20,,372.3,85,,297.84,percent of total billed charges,85% of total billed charges,337.26,77,,269.81,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,359.16,82,,287.328,percent of total billed charges,82% of total billed charges,372.3,85,,297.84,percent of total billed charges,85% of total billed charges,372.3,85,,297.84,percent of total billed charges,85% of total billed charges,372.3,85,,297.84,percent of total billed charges,85% of total billed charges,394.2,90,,315.36,percent of total billed charges,90% of total billed charges,350.4,80,,280.32,percent of total billed charges,80% of total billed charges,394.2,90,,315.36,percent of total billed charges,90% of total billed charges,328.5,75,,262.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,127.02,29,,101.616,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,293.46,67,,234.768,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,350.4,80,,280.32,percent of total billed charges,80% of total billed charges,284.7,65,,227.76,percent of total billed charges,65% of total billed charges,156.23,35.67,,124.984,percent of total billed charges,35.67% of total billed charges,127.02,394.2,
"DRUG SCREEN, GASTRIC",3003860,CDM,301,RC,,,outpatient,,,141,56.40,,119.85,85,,95.88,percent of total billed charges,85% of total billed charges,108.57,77,,86.86,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,115.62,82,,92.496,percent of total billed charges,82% of total billed charges,119.85,85,,95.88,percent of total billed charges,85% of total billed charges,119.85,85,,95.88,percent of total billed charges,85% of total billed charges,119.85,85,,95.88,percent of total billed charges,85% of total billed charges,126.9,90,,101.52,percent of total billed charges,90% of total billed charges,112.8,80,,90.24,percent of total billed charges,80% of total billed charges,126.9,90,,101.52,percent of total billed charges,90% of total billed charges,105.75,75,,84.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,40.89,29,,32.712,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,94.47,67,,75.576,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,112.8,80,,90.24,percent of total billed charges,80% of total billed charges,91.65,65,,73.32,percent of total billed charges,65% of total billed charges,50.29,35.67,,40.232,percent of total billed charges,35.67% of total billed charges,40.89,126.9,
FLUOXETINE (PROZAC),3004300,CDM,301,RC,80299,HCPCS,outpatient,,,142,56.80,,120.7,85,,96.56,percent of total billed charges,85% of total billed charges,109.34,77,,87.47,percent of total billed charges,77% of total billed charges,18.64,100,,,fee schedule,100% of CMS fee schedule,65.24,350,,,fee schedule,350% of BCBS fee schedule,67.85,364,,,fee schedule,364% of BCBS fee schedule,67.85,364,,,fee schedule,364% of BCBS fee schedule,67.85,364,,,fee schedule,364% of BCBS fee schedule,127.8,90,,102.24,percent of total billed charges,90% of total billed charges,113.6,80,,90.88,percent of total billed charges,80% of total billed charges,127.8,90,,102.24,percent of total billed charges,90% of total billed charges,106.5,75,,85.2,percent of total billed charges,75% of total billed charges,22.74,122,,,fee schedule,122% of APC rate,41.18,29,,32.944,percent of total billed charges,29% of total billed charges,18.64,100,,,fee schedule,100% of CMS fee schedule,95.14,67,,76.112,percent of total billed charges,67% of total billed charges,20.36,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,113.6,80,,90.88,percent of total billed charges,80% of total billed charges,92.3,65,,73.84,percent of total billed charges,65% of total billed charges,50.65,35.67,,40.52,percent of total billed charges,35.67% of total billed charges,18.64,127.8,
FLURAZEPAM (DALMANE),3004340,CDM,301,RC,80346,HCPCS,outpatient,,,80,32.00,,68,85,,54.4,percent of total billed charges,85% of total billed charges,61.6,77,,49.28,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,65.6,82,,52.48,percent of total billed charges,82% of total billed charges,68,85,,54.4,percent of total billed charges,85% of total billed charges,68,85,,54.4,percent of total billed charges,85% of total billed charges,68,85,,54.4,percent of total billed charges,85% of total billed charges,72,90,,57.6,percent of total billed charges,90% of total billed charges,64,80,,51.2,percent of total billed charges,80% of total billed charges,72,90,,57.6,percent of total billed charges,90% of total billed charges,60,75,,48,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,23.2,29,,18.56,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,53.6,67,,42.88,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,64,80,,51.2,percent of total billed charges,80% of total billed charges,52,65,,41.6,percent of total billed charges,65% of total billed charges,28.54,35.67,,22.832,percent of total billed charges,35.67% of total billed charges,23.2,72,
GLUCAGON,3004560,CDM,301,RC,82943,HCPCS,outpatient,,,67,26.80,,56.95,85,,45.56,percent of total billed charges,85% of total billed charges,51.59,77,,41.27,percent of total billed charges,77% of total billed charges,14.29,100,,,fee schedule,100% of CMS fee schedule,61.74,350,,,fee schedule,350% of BCBS fee schedule,64.21,364,,,fee schedule,364% of BCBS fee schedule,64.21,364,,,fee schedule,364% of BCBS fee schedule,64.21,364,,,fee schedule,364% of BCBS fee schedule,60.3,90,,48.24,percent of total billed charges,90% of total billed charges,53.6,80,,42.88,percent of total billed charges,80% of total billed charges,60.3,90,,48.24,percent of total billed charges,90% of total billed charges,50.25,75,,40.2,percent of total billed charges,75% of total billed charges,17.43,122,,,fee schedule,122% of APC rate,19.43,29,,15.544,percent of total billed charges,29% of total billed charges,14.29,100,,,fee schedule,100% of CMS fee schedule,44.89,67,,35.912,percent of total billed charges,67% of total billed charges,21.25,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,53.6,80,,42.88,percent of total billed charges,80% of total billed charges,43.55,65,,34.84,percent of total billed charges,65% of total billed charges,23.9,35.67,,19.12,percent of total billed charges,35.67% of total billed charges,14.29,64.21,
GLUCOSE TOLERANCE 5HR,3004640,CDM,301,RC,82952,HCPCS,outpatient,,,45,18.00,,38.25,85,,30.6,percent of total billed charges,85% of total billed charges,34.65,77,,27.72,percent of total billed charges,77% of total billed charges,3.92,100,,,fee schedule,100% of CMS fee schedule,16.94,350,,,fee schedule,350% of BCBS fee schedule,17.62,364,,,fee schedule,364% of BCBS fee schedule,17.62,364,,,fee schedule,364% of BCBS fee schedule,17.62,364,,,fee schedule,364% of BCBS fee schedule,40.5,90,,32.4,percent of total billed charges,90% of total billed charges,36,80,,28.8,percent of total billed charges,80% of total billed charges,40.5,90,,32.4,percent of total billed charges,90% of total billed charges,33.75,75,,27,percent of total billed charges,75% of total billed charges,4.78,122,,,fee schedule,122% of APC rate,13.05,29,,10.44,percent of total billed charges,29% of total billed charges,3.92,100,,,fee schedule,100% of CMS fee schedule,30.15,67,,24.12,percent of total billed charges,67% of total billed charges,4.28,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,36,80,,28.8,percent of total billed charges,80% of total billed charges,29.25,65,,23.4,percent of total billed charges,65% of total billed charges,16.05,35.67,,12.84,percent of total billed charges,35.67% of total billed charges,3.92,40.5,
GLUTETHIMIDE (DORIDEN),3004900,CDM,301,RC,80368,HCPCS,outpatient,,,131,52.40,,111.35,85,,89.08,percent of total billed charges,85% of total billed charges,100.87,77,,80.7,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,107.42,82,,85.936,percent of total billed charges,82% of total billed charges,111.35,85,,89.08,percent of total billed charges,85% of total billed charges,111.35,85,,89.08,percent of total billed charges,85% of total billed charges,111.35,85,,89.08,percent of total billed charges,85% of total billed charges,117.9,90,,94.32,percent of total billed charges,90% of total billed charges,104.8,80,,83.84,percent of total billed charges,80% of total billed charges,117.9,90,,94.32,percent of total billed charges,90% of total billed charges,98.25,75,,78.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,37.99,29,,30.392,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,87.77,67,,70.216,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,104.8,80,,83.84,percent of total billed charges,80% of total billed charges,85.15,65,,68.12,percent of total billed charges,65% of total billed charges,46.73,35.67,,37.384,percent of total billed charges,35.67% of total billed charges,37.99,117.9,
LDH BODY FLUID,3005660,CDM,301,RC,83615,HCPCS,outpatient,,,66,26.40,,56.1,85,,44.88,percent of total billed charges,85% of total billed charges,50.82,77,,40.66,percent of total billed charges,77% of total billed charges,6.04,100,,,fee schedule,100% of CMS fee schedule,26.08,350,,,fee schedule,350% of BCBS fee schedule,27.12,364,,,fee schedule,364% of BCBS fee schedule,27.12,364,,,fee schedule,364% of BCBS fee schedule,27.12,364,,,fee schedule,364% of BCBS fee schedule,59.4,90,,47.52,percent of total billed charges,90% of total billed charges,52.8,80,,42.24,percent of total billed charges,80% of total billed charges,59.4,90,,47.52,percent of total billed charges,90% of total billed charges,49.5,75,,39.6,percent of total billed charges,75% of total billed charges,7.36,122,,,fee schedule,122% of APC rate,19.14,29,,15.312,percent of total billed charges,29% of total billed charges,6.04,100,,,fee schedule,100% of CMS fee schedule,44.22,67,,35.376,percent of total billed charges,67% of total billed charges,8.97,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,52.8,80,,42.24,percent of total billed charges,80% of total billed charges,42.9,65,,34.32,percent of total billed charges,65% of total billed charges,23.54,35.67,,18.832,percent of total billed charges,35.67% of total billed charges,6.04,59.4,
LORAZEPAM (ATIVAN),3005900,CDM,301,RC,80299,HCPCS,outpatient,,,142,56.80,,120.7,85,,96.56,percent of total billed charges,85% of total billed charges,109.34,77,,87.47,percent of total billed charges,77% of total billed charges,18.64,100,,,fee schedule,100% of CMS fee schedule,65.24,350,,,fee schedule,350% of BCBS fee schedule,67.85,364,,,fee schedule,364% of BCBS fee schedule,67.85,364,,,fee schedule,364% of BCBS fee schedule,67.85,364,,,fee schedule,364% of BCBS fee schedule,127.8,90,,102.24,percent of total billed charges,90% of total billed charges,113.6,80,,90.88,percent of total billed charges,80% of total billed charges,127.8,90,,102.24,percent of total billed charges,90% of total billed charges,106.5,75,,85.2,percent of total billed charges,75% of total billed charges,22.74,122,,,fee schedule,122% of APC rate,41.18,29,,32.944,percent of total billed charges,29% of total billed charges,18.64,100,,,fee schedule,100% of CMS fee schedule,95.14,67,,76.112,percent of total billed charges,67% of total billed charges,20.36,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,113.6,80,,90.88,percent of total billed charges,80% of total billed charges,92.3,65,,73.84,percent of total billed charges,65% of total billed charges,50.65,35.67,,40.52,percent of total billed charges,35.67% of total billed charges,18.64,127.8,
MAPROTILINE (LUDIOMIL),3006000,CDM,301,RC,80299,HCPCS,outpatient,,,142,56.80,,120.7,85,,96.56,percent of total billed charges,85% of total billed charges,109.34,77,,87.47,percent of total billed charges,77% of total billed charges,18.64,100,,,fee schedule,100% of CMS fee schedule,65.24,350,,,fee schedule,350% of BCBS fee schedule,67.85,364,,,fee schedule,364% of BCBS fee schedule,67.85,364,,,fee schedule,364% of BCBS fee schedule,67.85,364,,,fee schedule,364% of BCBS fee schedule,127.8,90,,102.24,percent of total billed charges,90% of total billed charges,113.6,80,,90.88,percent of total billed charges,80% of total billed charges,127.8,90,,102.24,percent of total billed charges,90% of total billed charges,106.5,75,,85.2,percent of total billed charges,75% of total billed charges,22.74,122,,,fee schedule,122% of APC rate,41.18,29,,32.944,percent of total billed charges,29% of total billed charges,18.64,100,,,fee schedule,100% of CMS fee schedule,95.14,67,,76.112,percent of total billed charges,67% of total billed charges,20.36,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,113.6,80,,90.88,percent of total billed charges,80% of total billed charges,92.3,65,,73.84,percent of total billed charges,65% of total billed charges,50.65,35.67,,40.52,percent of total billed charges,35.67% of total billed charges,18.64,127.8,
MEPERIDINE (DEMEROL),3006020,CDM,301,RC,80361,HCPCS,outpatient,,,93,37.20,,79.05,85,,63.24,percent of total billed charges,85% of total billed charges,71.61,77,,57.29,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,76.26,82,,61.008,percent of total billed charges,82% of total billed charges,79.05,85,,63.24,percent of total billed charges,85% of total billed charges,79.05,85,,63.24,percent of total billed charges,85% of total billed charges,79.05,85,,63.24,percent of total billed charges,85% of total billed charges,83.7,90,,66.96,percent of total billed charges,90% of total billed charges,74.4,80,,59.52,percent of total billed charges,80% of total billed charges,83.7,90,,66.96,percent of total billed charges,90% of total billed charges,69.75,75,,55.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,26.97,29,,21.576,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,62.31,67,,49.848,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,74.4,80,,59.52,percent of total billed charges,80% of total billed charges,60.45,65,,48.36,percent of total billed charges,65% of total billed charges,33.17,35.67,,26.536,percent of total billed charges,35.67% of total billed charges,26.97,83.7,
METHSUXIMIDE (CELONTIN),3006100,CDM,301,RC,80204,HCPCS,outpatient,,,438,175.20,,372.3,85,,297.84,percent of total billed charges,85% of total billed charges,337.26,77,,269.81,percent of total billed charges,77% of total billed charges,38.57,100,,,fee schedule,100% of CMS fee schedule,135,350,,,fee schedule,350% of BCBS fee schedule,140.39,364,,,fee schedule,364% of BCBS fee schedule,140.39,364,,,fee schedule,364% of BCBS fee schedule,140.39,364,,,fee schedule,364% of BCBS fee schedule,394.2,90,,315.36,percent of total billed charges,90% of total billed charges,350.4,80,,280.32,percent of total billed charges,80% of total billed charges,394.2,90,,315.36,percent of total billed charges,90% of total billed charges,328.5,75,,262.8,percent of total billed charges,75% of total billed charges,47.05,122,,,fee schedule,122% of APC rate,127.02,29,,101.616,percent of total billed charges,29% of total billed charges,38.57,100,,,fee schedule,100% of CMS fee schedule,293.46,67,,234.768,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,350.4,80,,280.32,percent of total billed charges,80% of total billed charges,284.7,65,,227.76,percent of total billed charges,65% of total billed charges,156.23,35.67,,124.984,percent of total billed charges,35.67% of total billed charges,38.57,394.2,
MEXILETINE,3006120,CDM,301,RC,80299,HCPCS,outpatient,,,142,56.80,,120.7,85,,96.56,percent of total billed charges,85% of total billed charges,109.34,77,,87.47,percent of total billed charges,77% of total billed charges,18.64,100,,,fee schedule,100% of CMS fee schedule,65.24,350,,,fee schedule,350% of BCBS fee schedule,67.85,364,,,fee schedule,364% of BCBS fee schedule,67.85,364,,,fee schedule,364% of BCBS fee schedule,67.85,364,,,fee schedule,364% of BCBS fee schedule,127.8,90,,102.24,percent of total billed charges,90% of total billed charges,113.6,80,,90.88,percent of total billed charges,80% of total billed charges,127.8,90,,102.24,percent of total billed charges,90% of total billed charges,106.5,75,,85.2,percent of total billed charges,75% of total billed charges,22.74,122,,,fee schedule,122% of APC rate,41.18,29,,32.944,percent of total billed charges,29% of total billed charges,18.64,100,,,fee schedule,100% of CMS fee schedule,95.14,67,,76.112,percent of total billed charges,67% of total billed charges,20.36,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,113.6,80,,90.88,percent of total billed charges,80% of total billed charges,92.3,65,,73.84,percent of total billed charges,65% of total billed charges,50.65,35.67,,40.52,percent of total billed charges,35.67% of total billed charges,18.64,127.8,
PHENOTHIAZINES URINE,3006520,CDM,301,RC,80342,HCPCS,outpatient,,,438,175.20,,372.3,85,,297.84,percent of total billed charges,85% of total billed charges,337.26,77,,269.81,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,359.16,82,,287.328,percent of total billed charges,82% of total billed charges,372.3,85,,297.84,percent of total billed charges,85% of total billed charges,372.3,85,,297.84,percent of total billed charges,85% of total billed charges,372.3,85,,297.84,percent of total billed charges,85% of total billed charges,394.2,90,,315.36,percent of total billed charges,90% of total billed charges,350.4,80,,280.32,percent of total billed charges,80% of total billed charges,394.2,90,,315.36,percent of total billed charges,90% of total billed charges,328.5,75,,262.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,127.02,29,,101.616,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,293.46,67,,234.768,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,350.4,80,,280.32,percent of total billed charges,80% of total billed charges,284.7,65,,227.76,percent of total billed charges,65% of total billed charges,156.23,35.67,,124.984,percent of total billed charges,35.67% of total billed charges,127.02,394.2,
PKU NEWBORN SCREEN - HANDLING,3006540,CDM,301,RC,99001,HCPCS,outpatient,,,85,34.00,,72.25,85,,57.8,percent of total billed charges,85% of total billed charges,65.45,77,,52.36,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,21.35,350,,,fee schedule,350% of BCBS fee schedule,22.2,364,,,fee schedule,364% of BCBS fee schedule,22.2,364,,,fee schedule,364% of BCBS fee schedule,22.2,364,,,fee schedule,364% of BCBS fee schedule,76.5,90,,61.2,percent of total billed charges,90% of total billed charges,68,80,,54.4,percent of total billed charges,80% of total billed charges,76.5,90,,61.2,percent of total billed charges,90% of total billed charges,63.75,75,,51,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,24.65,29,,19.72,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,56.95,67,,45.56,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,68,80,,54.4,percent of total billed charges,80% of total billed charges,55.25,65,,44.2,percent of total billed charges,65% of total billed charges,30.32,35.67,,24.256,percent of total billed charges,35.67% of total billed charges,21.35,76.5,
POTASSIUM URINE RANDOM,3006720,CDM,301,RC,84133,HCPCS,outpatient,,,28,11.20,,23.8,85,,19.04,percent of total billed charges,85% of total billed charges,21.56,77,,17.25,percent of total billed charges,77% of total billed charges,4.73,100,,,fee schedule,100% of CMS fee schedule,18.62,350,,,fee schedule,350% of BCBS fee schedule,19.36,364,,,fee schedule,364% of BCBS fee schedule,19.36,364,,,fee schedule,364% of BCBS fee schedule,19.36,364,,,fee schedule,364% of BCBS fee schedule,25.2,90,,20.16,percent of total billed charges,90% of total billed charges,22.4,80,,17.92,percent of total billed charges,80% of total billed charges,25.2,90,,20.16,percent of total billed charges,90% of total billed charges,21,75,,16.8,percent of total billed charges,75% of total billed charges,5.77,122,,,fee schedule,122% of APC rate,8.12,29,,6.496,percent of total billed charges,29% of total billed charges,4.73,100,,,fee schedule,100% of CMS fee schedule,18.76,67,,15.008,percent of total billed charges,67% of total billed charges,6.39,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,22.4,80,,17.92,percent of total billed charges,80% of total billed charges,18.2,65,,14.56,percent of total billed charges,65% of total billed charges,9.99,35.67,,7.992,percent of total billed charges,35.67% of total billed charges,4.73,25.2,
POTASSIUM URINE TIMED,3006740,CDM,301,RC,84133,HCPCS,outpatient,,,28,11.20,,23.8,85,,19.04,percent of total billed charges,85% of total billed charges,21.56,77,,17.25,percent of total billed charges,77% of total billed charges,4.73,100,,,fee schedule,100% of CMS fee schedule,18.62,350,,,fee schedule,350% of BCBS fee schedule,19.36,364,,,fee schedule,364% of BCBS fee schedule,19.36,364,,,fee schedule,364% of BCBS fee schedule,19.36,364,,,fee schedule,364% of BCBS fee schedule,25.2,90,,20.16,percent of total billed charges,90% of total billed charges,22.4,80,,17.92,percent of total billed charges,80% of total billed charges,25.2,90,,20.16,percent of total billed charges,90% of total billed charges,21,75,,16.8,percent of total billed charges,75% of total billed charges,5.77,122,,,fee schedule,122% of APC rate,8.12,29,,6.496,percent of total billed charges,29% of total billed charges,4.73,100,,,fee schedule,100% of CMS fee schedule,18.76,67,,15.008,percent of total billed charges,67% of total billed charges,6.39,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,22.4,80,,17.92,percent of total billed charges,80% of total billed charges,18.2,65,,14.56,percent of total billed charges,65% of total billed charges,9.99,35.67,,7.992,percent of total billed charges,35.67% of total billed charges,4.73,25.2,
PROPRANOLOL (INDERAL),3006840,CDM,301,RC,80299,HCPCS,outpatient,,,142,56.80,,120.7,85,,96.56,percent of total billed charges,85% of total billed charges,109.34,77,,87.47,percent of total billed charges,77% of total billed charges,18.64,100,,,fee schedule,100% of CMS fee schedule,65.24,350,,,fee schedule,350% of BCBS fee schedule,67.85,364,,,fee schedule,364% of BCBS fee schedule,67.85,364,,,fee schedule,364% of BCBS fee schedule,67.85,364,,,fee schedule,364% of BCBS fee schedule,127.8,90,,102.24,percent of total billed charges,90% of total billed charges,113.6,80,,90.88,percent of total billed charges,80% of total billed charges,127.8,90,,102.24,percent of total billed charges,90% of total billed charges,106.5,75,,85.2,percent of total billed charges,75% of total billed charges,22.74,122,,,fee schedule,122% of APC rate,41.18,29,,32.944,percent of total billed charges,29% of total billed charges,18.64,100,,,fee schedule,100% of CMS fee schedule,95.14,67,,76.112,percent of total billed charges,67% of total billed charges,20.36,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,113.6,80,,90.88,percent of total billed charges,80% of total billed charges,92.3,65,,73.84,percent of total billed charges,65% of total billed charges,50.65,35.67,,40.52,percent of total billed charges,35.67% of total billed charges,18.64,127.8,
"PTH, INTACT (IRMA)",3007060,CDM,301,RC,83970,HCPCS,outpatient,,,258,103.20,,219.3,85,,175.44,percent of total billed charges,85% of total billed charges,198.66,77,,158.93,percent of total billed charges,77% of total billed charges,41.28,100,,,fee schedule,100% of CMS fee schedule,178.36,350,,,fee schedule,350% of BCBS fee schedule,185.49,364,,,fee schedule,364% of BCBS fee schedule,185.49,364,,,fee schedule,364% of BCBS fee schedule,185.49,364,,,fee schedule,364% of BCBS fee schedule,232.2,90,,185.76,percent of total billed charges,90% of total billed charges,206.4,80,,165.12,percent of total billed charges,80% of total billed charges,232.2,90,,185.76,percent of total billed charges,90% of total billed charges,193.5,75,,154.8,percent of total billed charges,75% of total billed charges,50.36,122,,,fee schedule,122% of APC rate,74.82,29,,59.856,percent of total billed charges,29% of total billed charges,41.28,100,,,fee schedule,100% of CMS fee schedule,172.86,67,,138.288,percent of total billed charges,67% of total billed charges,61.38,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,206.4,80,,165.12,percent of total billed charges,80% of total billed charges,167.7,65,,134.16,percent of total billed charges,65% of total billed charges,92.03,35.67,,73.624,percent of total billed charges,35.67% of total billed charges,41.28,232.2,
SODIUM URINE RANDOM,3007500,CDM,301,RC,84300,HCPCS,outpatient,,,62,24.80,,52.7,85,,42.16,percent of total billed charges,85% of total billed charges,47.74,77,,38.19,percent of total billed charges,77% of total billed charges,5.05,100,,,fee schedule,100% of CMS fee schedule,21,350,,,fee schedule,350% of BCBS fee schedule,21.84,364,,,fee schedule,364% of BCBS fee schedule,21.84,364,,,fee schedule,364% of BCBS fee schedule,21.84,364,,,fee schedule,364% of BCBS fee schedule,55.8,90,,44.64,percent of total billed charges,90% of total billed charges,49.6,80,,39.68,percent of total billed charges,80% of total billed charges,55.8,90,,44.64,percent of total billed charges,90% of total billed charges,46.5,75,,37.2,percent of total billed charges,75% of total billed charges,6.17,122,,,fee schedule,122% of APC rate,17.98,29,,14.384,percent of total billed charges,29% of total billed charges,5.05,100,,,fee schedule,100% of CMS fee schedule,41.54,67,,33.232,percent of total billed charges,67% of total billed charges,7.23,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,49.6,80,,39.68,percent of total billed charges,80% of total billed charges,40.3,65,,32.24,percent of total billed charges,65% of total billed charges,22.12,35.67,,17.696,percent of total billed charges,35.67% of total billed charges,5.05,55.8,
"TESTOSTERONE, FREE/RIA SHBG",3007840,CDM,301,RC,,,outpatient,,,199,79.60,,169.15,85,,135.32,percent of total billed charges,85% of total billed charges,153.23,77,,122.58,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,163.18,82,,130.544,percent of total billed charges,82% of total billed charges,169.15,85,,135.32,percent of total billed charges,85% of total billed charges,169.15,85,,135.32,percent of total billed charges,85% of total billed charges,169.15,85,,135.32,percent of total billed charges,85% of total billed charges,179.1,90,,143.28,percent of total billed charges,90% of total billed charges,159.2,80,,127.36,percent of total billed charges,80% of total billed charges,179.1,90,,143.28,percent of total billed charges,90% of total billed charges,149.25,75,,119.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,57.71,29,,46.168,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,133.33,67,,106.664,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,159.2,80,,127.36,percent of total billed charges,80% of total billed charges,129.35,65,,103.48,percent of total billed charges,65% of total billed charges,70.98,35.67,,56.784,percent of total billed charges,35.67% of total billed charges,57.71,179.1,
THIORIDAZINE (MELLARIL),3007900,CDM,301,RC,80299,HCPCS,outpatient,,,142,56.80,,120.7,85,,96.56,percent of total billed charges,85% of total billed charges,109.34,77,,87.47,percent of total billed charges,77% of total billed charges,18.64,100,,,fee schedule,100% of CMS fee schedule,65.24,350,,,fee schedule,350% of BCBS fee schedule,67.85,364,,,fee schedule,364% of BCBS fee schedule,67.85,364,,,fee schedule,364% of BCBS fee schedule,67.85,364,,,fee schedule,364% of BCBS fee schedule,127.8,90,,102.24,percent of total billed charges,90% of total billed charges,113.6,80,,90.88,percent of total billed charges,80% of total billed charges,127.8,90,,102.24,percent of total billed charges,90% of total billed charges,106.5,75,,85.2,percent of total billed charges,75% of total billed charges,22.74,122,,,fee schedule,122% of APC rate,41.18,29,,32.944,percent of total billed charges,29% of total billed charges,18.64,100,,,fee schedule,100% of CMS fee schedule,95.14,67,,76.112,percent of total billed charges,67% of total billed charges,20.36,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,113.6,80,,90.88,percent of total billed charges,80% of total billed charges,92.3,65,,73.84,percent of total billed charges,65% of total billed charges,50.65,35.67,,40.52,percent of total billed charges,35.67% of total billed charges,18.64,127.8,
TOTAL PROTEIN,3008100,CDM,301,RC,84160,HCPCS,outpatient,,,38,15.20,,32.3,85,,25.84,percent of total billed charges,85% of total billed charges,29.26,77,,23.41,percent of total billed charges,77% of total billed charges,5.61,100,,,fee schedule,100% of CMS fee schedule,22.37,350,,,fee schedule,350% of BCBS fee schedule,23.26,364,,,fee schedule,364% of BCBS fee schedule,23.26,364,,,fee schedule,364% of BCBS fee schedule,23.26,364,,,fee schedule,364% of BCBS fee schedule,34.2,90,,27.36,percent of total billed charges,90% of total billed charges,30.4,80,,24.32,percent of total billed charges,80% of total billed charges,34.2,90,,27.36,percent of total billed charges,90% of total billed charges,28.5,75,,22.8,percent of total billed charges,75% of total billed charges,6.84,122,,,fee schedule,122% of APC rate,11.02,29,,8.816,percent of total billed charges,29% of total billed charges,5.61,100,,,fee schedule,100% of CMS fee schedule,25.46,67,,20.368,percent of total billed charges,67% of total billed charges,7.69,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,30.4,80,,24.32,percent of total billed charges,80% of total billed charges,24.7,65,,19.76,percent of total billed charges,65% of total billed charges,13.55,35.67,,10.84,percent of total billed charges,35.67% of total billed charges,5.61,34.2,
TOTAL PROTEIN PLEURAL FLD,3008200,CDM,301,RC,84160,HCPCS,outpatient,,,38,15.20,,32.3,85,,25.84,percent of total billed charges,85% of total billed charges,29.26,77,,23.41,percent of total billed charges,77% of total billed charges,5.61,100,,,fee schedule,100% of CMS fee schedule,22.37,350,,,fee schedule,350% of BCBS fee schedule,23.26,364,,,fee schedule,364% of BCBS fee schedule,23.26,364,,,fee schedule,364% of BCBS fee schedule,23.26,364,,,fee schedule,364% of BCBS fee schedule,34.2,90,,27.36,percent of total billed charges,90% of total billed charges,30.4,80,,24.32,percent of total billed charges,80% of total billed charges,34.2,90,,27.36,percent of total billed charges,90% of total billed charges,28.5,75,,22.8,percent of total billed charges,75% of total billed charges,6.84,122,,,fee schedule,122% of APC rate,11.02,29,,8.816,percent of total billed charges,29% of total billed charges,5.61,100,,,fee schedule,100% of CMS fee schedule,25.46,67,,20.368,percent of total billed charges,67% of total billed charges,7.69,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,30.4,80,,24.32,percent of total billed charges,80% of total billed charges,24.7,65,,19.76,percent of total billed charges,65% of total billed charges,13.55,35.67,,10.84,percent of total billed charges,35.67% of total billed charges,5.61,34.2,
TOTAL PROTEIN SYNOVIAL FLD,3008220,CDM,301,RC,84165,HCPCS,outpatient,,,105,42.00,,89.25,85,,71.4,percent of total billed charges,85% of total billed charges,80.85,77,,64.68,percent of total billed charges,77% of total billed charges,10.74,100,,,fee schedule,100% of CMS fee schedule,46.41,350,,,fee schedule,350% of BCBS fee schedule,48.27,364,,,fee schedule,364% of BCBS fee schedule,48.27,364,,,fee schedule,364% of BCBS fee schedule,48.27,364,,,fee schedule,364% of BCBS fee schedule,94.5,90,,75.6,percent of total billed charges,90% of total billed charges,84,80,,67.2,percent of total billed charges,80% of total billed charges,94.5,90,,75.6,percent of total billed charges,90% of total billed charges,78.75,75,,63,percent of total billed charges,75% of total billed charges,13.1,122,,,fee schedule,122% of APC rate,30.45,29,,24.36,percent of total billed charges,29% of total billed charges,10.74,100,,,fee schedule,100% of CMS fee schedule,70.35,67,,56.28,percent of total billed charges,67% of total billed charges,15.97,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,84,80,,67.2,percent of total billed charges,80% of total billed charges,68.25,65,,54.6,percent of total billed charges,65% of total billed charges,37.45,35.67,,29.96,percent of total billed charges,35.67% of total billed charges,10.74,94.5,
TRAZODONE,3008320,CDM,301,RC,80299,HCPCS,outpatient,,,142,56.80,,120.7,85,,96.56,percent of total billed charges,85% of total billed charges,109.34,77,,87.47,percent of total billed charges,77% of total billed charges,18.64,100,,,fee schedule,100% of CMS fee schedule,65.24,350,,,fee schedule,350% of BCBS fee schedule,67.85,364,,,fee schedule,364% of BCBS fee schedule,67.85,364,,,fee schedule,364% of BCBS fee schedule,67.85,364,,,fee schedule,364% of BCBS fee schedule,127.8,90,,102.24,percent of total billed charges,90% of total billed charges,113.6,80,,90.88,percent of total billed charges,80% of total billed charges,127.8,90,,102.24,percent of total billed charges,90% of total billed charges,106.5,75,,85.2,percent of total billed charges,75% of total billed charges,22.74,122,,,fee schedule,122% of APC rate,41.18,29,,32.944,percent of total billed charges,29% of total billed charges,18.64,100,,,fee schedule,100% of CMS fee schedule,95.14,67,,76.112,percent of total billed charges,67% of total billed charges,20.36,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,113.6,80,,90.88,percent of total billed charges,80% of total billed charges,92.3,65,,73.84,percent of total billed charges,65% of total billed charges,50.65,35.67,,40.52,percent of total billed charges,35.67% of total billed charges,18.64,127.8,
TRIFLUOPERAZINE,3008340,CDM,301,RC,80299,HCPCS,outpatient,,,142,56.80,,120.7,85,,96.56,percent of total billed charges,85% of total billed charges,109.34,77,,87.47,percent of total billed charges,77% of total billed charges,18.64,100,,,fee schedule,100% of CMS fee schedule,65.24,350,,,fee schedule,350% of BCBS fee schedule,67.85,364,,,fee schedule,364% of BCBS fee schedule,67.85,364,,,fee schedule,364% of BCBS fee schedule,67.85,364,,,fee schedule,364% of BCBS fee schedule,127.8,90,,102.24,percent of total billed charges,90% of total billed charges,113.6,80,,90.88,percent of total billed charges,80% of total billed charges,127.8,90,,102.24,percent of total billed charges,90% of total billed charges,106.5,75,,85.2,percent of total billed charges,75% of total billed charges,22.74,122,,,fee schedule,122% of APC rate,41.18,29,,32.944,percent of total billed charges,29% of total billed charges,18.64,100,,,fee schedule,100% of CMS fee schedule,95.14,67,,76.112,percent of total billed charges,67% of total billed charges,20.36,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,113.6,80,,90.88,percent of total billed charges,80% of total billed charges,92.3,65,,73.84,percent of total billed charges,65% of total billed charges,50.65,35.67,,40.52,percent of total billed charges,35.67% of total billed charges,18.64,127.8,
BLOOD SMEAR REVIEW,3003599,CDM,305,RC,85060,HCPCS,outpatient,,,142,56.80,,120.7,85,,96.56,percent of total billed charges,85% of total billed charges,109.34,77,,87.47,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,89.18,350,,,fee schedule,350% of BCBS fee schedule,92.75,364,,,fee schedule,364% of BCBS fee schedule,92.75,364,,,fee schedule,364% of BCBS fee schedule,92.75,364,,,fee schedule,364% of BCBS fee schedule,127.8,90,,102.24,percent of total billed charges,90% of total billed charges,113.6,80,,90.88,percent of total billed charges,80% of total billed charges,127.8,90,,102.24,percent of total billed charges,90% of total billed charges,106.5,75,,85.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,41.18,29,,32.944,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,95.14,67,,76.112,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,113.6,80,,90.88,percent of total billed charges,80% of total billed charges,92.3,65,,73.84,percent of total billed charges,65% of total billed charges,50.65,35.67,,40.52,percent of total billed charges,35.67% of total billed charges,41.18,127.8,
CRYPTOSPORIDIUM EXAM,3002980,CDM,306,RC,87206,HCPCS,outpatient,,,76,30.40,,64.6,85,,51.68,percent of total billed charges,85% of total billed charges,58.52,77,,46.82,percent of total billed charges,77% of total billed charges,5.39,100,,,fee schedule,100% of CMS fee schedule,23.28,350,,,fee schedule,350% of BCBS fee schedule,24.21,364,,,fee schedule,364% of BCBS fee schedule,24.21,364,,,fee schedule,364% of BCBS fee schedule,24.21,364,,,fee schedule,364% of BCBS fee schedule,68.4,90,,54.72,percent of total billed charges,90% of total billed charges,60.8,80,,48.64,percent of total billed charges,80% of total billed charges,68.4,90,,54.72,percent of total billed charges,90% of total billed charges,57,75,,45.6,percent of total billed charges,75% of total billed charges,6.57,122,,,fee schedule,122% of APC rate,22.04,29,,17.632,percent of total billed charges,29% of total billed charges,5.39,100,,,fee schedule,100% of CMS fee schedule,50.92,67,,40.736,percent of total billed charges,67% of total billed charges,7.99,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,60.8,80,,48.64,percent of total billed charges,80% of total billed charges,49.4,65,,39.52,percent of total billed charges,65% of total billed charges,27.11,35.67,,21.688,percent of total billed charges,35.67% of total billed charges,5.39,68.4,
"CULTURE & SMEAR, LEGIONELLA",3003060,CDM,306,RC,,,outpatient,,,167,66.80,,141.95,85,,113.56,percent of total billed charges,85% of total billed charges,128.59,77,,102.87,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,136.94,82,,109.552,percent of total billed charges,82% of total billed charges,141.95,85,,113.56,percent of total billed charges,85% of total billed charges,141.95,85,,113.56,percent of total billed charges,85% of total billed charges,141.95,85,,113.56,percent of total billed charges,85% of total billed charges,150.3,90,,120.24,percent of total billed charges,90% of total billed charges,133.6,80,,106.88,percent of total billed charges,80% of total billed charges,150.3,90,,120.24,percent of total billed charges,90% of total billed charges,125.25,75,,100.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,48.43,29,,38.744,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,111.89,67,,89.512,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,133.6,80,,106.88,percent of total billed charges,80% of total billed charges,108.55,65,,86.84,percent of total billed charges,65% of total billed charges,59.57,35.67,,47.656,percent of total billed charges,35.67% of total billed charges,48.43,150.3,
CULTURE EAR,3003280,CDM,306,RC,87070,HCPCS,outpatient,,,82,32.80,,69.7,85,,55.76,percent of total billed charges,85% of total billed charges,63.14,77,,50.51,percent of total billed charges,77% of total billed charges,8.61,100,,,fee schedule,100% of CMS fee schedule,37.24,350,,,fee schedule,350% of BCBS fee schedule,38.73,364,,,fee schedule,364% of BCBS fee schedule,38.73,364,,,fee schedule,364% of BCBS fee schedule,38.73,364,,,fee schedule,364% of BCBS fee schedule,73.8,90,,59.04,percent of total billed charges,90% of total billed charges,65.6,80,,52.48,percent of total billed charges,80% of total billed charges,73.8,90,,59.04,percent of total billed charges,90% of total billed charges,61.5,75,,49.2,percent of total billed charges,75% of total billed charges,10.51,122,,,fee schedule,122% of APC rate,23.78,29,,19.024,percent of total billed charges,29% of total billed charges,8.61,100,,,fee schedule,100% of CMS fee schedule,54.94,67,,43.952,percent of total billed charges,67% of total billed charges,12.81,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,65.6,80,,52.48,percent of total billed charges,80% of total billed charges,53.3,65,,42.64,percent of total billed charges,65% of total billed charges,29.25,35.67,,23.4,percent of total billed charges,35.67% of total billed charges,8.61,73.8,
CULTURE GC,3003340,CDM,306,RC,87081,HCPCS,outpatient,,,84,33.60,,71.4,85,,57.12,percent of total billed charges,85% of total billed charges,64.68,77,,51.74,percent of total billed charges,77% of total billed charges,6.63,100,,,fee schedule,100% of CMS fee schedule,28.63,350,,,fee schedule,350% of BCBS fee schedule,29.78,364,,,fee schedule,364% of BCBS fee schedule,29.78,364,,,fee schedule,364% of BCBS fee schedule,29.78,364,,,fee schedule,364% of BCBS fee schedule,75.6,90,,60.48,percent of total billed charges,90% of total billed charges,67.2,80,,53.76,percent of total billed charges,80% of total billed charges,75.6,90,,60.48,percent of total billed charges,90% of total billed charges,63,75,,50.4,percent of total billed charges,75% of total billed charges,8.08,122,,,fee schedule,122% of APC rate,24.36,29,,19.488,percent of total billed charges,29% of total billed charges,6.63,100,,,fee schedule,100% of CMS fee schedule,56.28,67,,45.024,percent of total billed charges,67% of total billed charges,9.85,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,67.2,80,,53.76,percent of total billed charges,80% of total billed charges,54.6,65,,43.68,percent of total billed charges,65% of total billed charges,29.96,35.67,,23.968,percent of total billed charges,35.67% of total billed charges,6.63,75.6,
MIC GRAM POSITIVE,3006151,CDM,306,RC,87186,HCPCS,outpatient,,,123,49.20,,104.55,85,,83.64,percent of total billed charges,85% of total billed charges,94.71,77,,75.77,percent of total billed charges,77% of total billed charges,8.65,100,,,fee schedule,100% of CMS fee schedule,37.35,350,,,fee schedule,350% of BCBS fee schedule,38.84,364,,,fee schedule,364% of BCBS fee schedule,38.84,364,,,fee schedule,364% of BCBS fee schedule,38.84,364,,,fee schedule,364% of BCBS fee schedule,110.7,90,,88.56,percent of total billed charges,90% of total billed charges,98.4,80,,78.72,percent of total billed charges,80% of total billed charges,110.7,90,,88.56,percent of total billed charges,90% of total billed charges,92.25,75,,73.8,percent of total billed charges,75% of total billed charges,10.55,122,,,fee schedule,122% of APC rate,35.67,29,,28.536,percent of total billed charges,29% of total billed charges,8.65,100,,,fee schedule,100% of CMS fee schedule,82.41,67,,65.928,percent of total billed charges,67% of total billed charges,8.64,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,98.4,80,,78.72,percent of total billed charges,80% of total billed charges,79.95,65,,63.96,percent of total billed charges,65% of total billed charges,43.87,35.67,,35.096,percent of total billed charges,35.67% of total billed charges,8.64,110.7,
CARDIOLIPIN AB,3000941,CDM,310,RC,86147,HCPCS,outpatient,,,127,50.80,,107.95,85,,86.36,percent of total billed charges,85% of total billed charges,97.79,77,,78.23,percent of total billed charges,77% of total billed charges,25.45,100,,,fee schedule,100% of CMS fee schedule,109.97,350,,,fee schedule,350% of BCBS fee schedule,114.37,364,,,fee schedule,364% of BCBS fee schedule,114.37,364,,,fee schedule,364% of BCBS fee schedule,114.37,364,,,fee schedule,364% of BCBS fee schedule,114.3,90,,91.44,percent of total billed charges,90% of total billed charges,101.6,80,,81.28,percent of total billed charges,80% of total billed charges,114.3,90,,91.44,percent of total billed charges,90% of total billed charges,95.25,75,,76.2,percent of total billed charges,75% of total billed charges,31.04,122,,,fee schedule,122% of APC rate,36.83,29,,29.464,percent of total billed charges,29% of total billed charges,25.45,100,,,fee schedule,100% of CMS fee schedule,85.09,67,,68.072,percent of total billed charges,67% of total billed charges,8.64,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,101.6,80,,81.28,percent of total billed charges,80% of total billed charges,82.55,65,,66.04,percent of total billed charges,65% of total billed charges,45.3,35.67,,36.24,percent of total billed charges,35.67% of total billed charges,8.64,114.37,
JAK 2 V617F,3002622,CDM,310,RC,81270,HCPCS,outpatient,,,720,288.00,,612,85,,489.6,percent of total billed charges,85% of total billed charges,554.4,77,,443.52,percent of total billed charges,77% of total billed charges,91.66,100,,,fee schedule,100% of CMS fee schedule,396.1,350,,,fee schedule,350% of BCBS fee schedule,411.94,364,,,fee schedule,364% of BCBS fee schedule,411.94,364,,,fee schedule,364% of BCBS fee schedule,411.94,364,,,fee schedule,364% of BCBS fee schedule,648,90,,518.4,percent of total billed charges,90% of total billed charges,576,80,,460.8,percent of total billed charges,80% of total billed charges,648,90,,518.4,percent of total billed charges,90% of total billed charges,540,75,,432,percent of total billed charges,75% of total billed charges,111.82,122,,,fee schedule,122% of APC rate,208.8,29,,167.04,percent of total billed charges,29% of total billed charges,91.66,100,,,fee schedule,100% of CMS fee schedule,482.4,67,,385.92,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,576,80,,460.8,percent of total billed charges,80% of total billed charges,468,65,,374.4,percent of total billed charges,65% of total billed charges,256.82,35.67,,205.456,percent of total billed charges,35.67% of total billed charges,91.66,648,
BCR/ABL1 QUAL,3008681,CDM,310,RC,81206,HCPCS,outpatient,,,523,209.20,,444.55,85,,355.64,percent of total billed charges,85% of total billed charges,402.71,77,,322.17,percent of total billed charges,77% of total billed charges,163.96,100,,,fee schedule,100% of CMS fee schedule,708.47,350,,,fee schedule,350% of BCBS fee schedule,736.81,364,,,fee schedule,364% of BCBS fee schedule,736.81,364,,,fee schedule,364% of BCBS fee schedule,736.81,364,,,fee schedule,364% of BCBS fee schedule,470.7,90,,376.56,percent of total billed charges,90% of total billed charges,418.4,80,,334.72,percent of total billed charges,80% of total billed charges,470.7,90,,376.56,percent of total billed charges,90% of total billed charges,392.25,75,,313.8,percent of total billed charges,75% of total billed charges,200.03,122,,,fee schedule,122% of APC rate,151.67,29,,121.336,percent of total billed charges,29% of total billed charges,163.96,100,,,fee schedule,100% of CMS fee schedule,350.41,67,,280.328,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,418.4,80,,334.72,percent of total billed charges,80% of total billed charges,339.95,65,,271.96,percent of total billed charges,65% of total billed charges,186.55,35.67,,149.24,percent of total billed charges,35.67% of total billed charges,151.67,736.81,
BCR-ABL1 QUAL,3008682,CDM,310,RC,81207,HCPCS,outpatient,,,523,209.20,,444.55,85,,355.64,percent of total billed charges,85% of total billed charges,402.71,77,,322.17,percent of total billed charges,77% of total billed charges,144.84,100,,,fee schedule,100% of CMS fee schedule,625.84,350,,,fee schedule,350% of BCBS fee schedule,650.87,364,,,fee schedule,364% of BCBS fee schedule,650.87,364,,,fee schedule,364% of BCBS fee schedule,650.87,364,,,fee schedule,364% of BCBS fee schedule,470.7,90,,376.56,percent of total billed charges,90% of total billed charges,418.4,80,,334.72,percent of total billed charges,80% of total billed charges,470.7,90,,376.56,percent of total billed charges,90% of total billed charges,392.25,75,,313.8,percent of total billed charges,75% of total billed charges,176.7,122,,,fee schedule,122% of APC rate,151.67,29,,121.336,percent of total billed charges,29% of total billed charges,144.84,100,,,fee schedule,100% of CMS fee schedule,350.41,67,,280.328,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,418.4,80,,334.72,percent of total billed charges,80% of total billed charges,339.95,65,,271.96,percent of total billed charges,65% of total billed charges,186.55,35.67,,149.24,percent of total billed charges,35.67% of total billed charges,144.84,650.87,
CALR BY PCR,3008683,CDM,310,RC,81219,HCPCS,outpatient,,,389,155.60,,330.65,85,,264.52,percent of total billed charges,85% of total billed charges,299.53,77,,239.62,percent of total billed charges,77% of total billed charges,121.63,100,,,fee schedule,100% of CMS fee schedule,525.56,350,,,fee schedule,350% of BCBS fee schedule,546.58,364,,,fee schedule,364% of BCBS fee schedule,546.58,364,,,fee schedule,364% of BCBS fee schedule,546.58,364,,,fee schedule,364% of BCBS fee schedule,350.1,90,,280.08,percent of total billed charges,90% of total billed charges,311.2,80,,248.96,percent of total billed charges,80% of total billed charges,350.1,90,,280.08,percent of total billed charges,90% of total billed charges,291.75,75,,233.4,percent of total billed charges,75% of total billed charges,148.38,122,,,fee schedule,122% of APC rate,112.81,29,,90.248,percent of total billed charges,29% of total billed charges,121.63,100,,,fee schedule,100% of CMS fee schedule,260.63,67,,208.504,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,311.2,80,,248.96,percent of total billed charges,80% of total billed charges,252.85,65,,202.28,percent of total billed charges,65% of total billed charges,138.76,35.67,,111.008,percent of total billed charges,35.67% of total billed charges,112.81,546.58,
MPL 515 MUT,3008684,CDM,310,RC,81338,HCPCS,outpatient,,,478,191.20,,406.3,85,,325.04,percent of total billed charges,85% of total billed charges,368.06,77,,294.45,percent of total billed charges,77% of total billed charges,150.33,100,,,fee schedule,100% of CMS fee schedule,526.16,350,,,fee schedule,350% of BCBS fee schedule,547.2,364,,,fee schedule,364% of BCBS fee schedule,547.2,364,,,fee schedule,364% of BCBS fee schedule,547.2,364,,,fee schedule,364% of BCBS fee schedule,430.2,90,,344.16,percent of total billed charges,90% of total billed charges,382.4,80,,305.92,percent of total billed charges,80% of total billed charges,430.2,90,,344.16,percent of total billed charges,90% of total billed charges,358.5,75,,286.8,percent of total billed charges,75% of total billed charges,183.4,122,,,fee schedule,122% of APC rate,138.62,29,,110.896,percent of total billed charges,29% of total billed charges,150.33,100,,,fee schedule,100% of CMS fee schedule,320.26,67,,256.208,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,382.4,80,,305.92,percent of total billed charges,80% of total billed charges,310.7,65,,248.56,percent of total billed charges,65% of total billed charges,170.5,35.67,,136.4,percent of total billed charges,35.67% of total billed charges,138.62,547.2,
PROTHROMBIN GEN MUT,3008685,CDM,310,RC,81240,HCPCS,outpatient,,,211,84.40,,179.35,85,,143.48,percent of total billed charges,85% of total billed charges,162.47,77,,129.98,percent of total billed charges,77% of total billed charges,65.69,100,,,fee schedule,100% of CMS fee schedule,229.92,350,,,fee schedule,350% of BCBS fee schedule,239.11,364,,,fee schedule,364% of BCBS fee schedule,239.11,364,,,fee schedule,364% of BCBS fee schedule,239.11,364,,,fee schedule,364% of BCBS fee schedule,189.9,90,,151.92,percent of total billed charges,90% of total billed charges,168.8,80,,135.04,percent of total billed charges,80% of total billed charges,189.9,90,,151.92,percent of total billed charges,90% of total billed charges,158.25,75,,126.6,percent of total billed charges,75% of total billed charges,80.14,122,,,fee schedule,122% of APC rate,61.19,29,,48.952,percent of total billed charges,29% of total billed charges,65.69,100,,,fee schedule,100% of CMS fee schedule,141.37,67,,113.096,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,168.8,80,,135.04,percent of total billed charges,80% of total billed charges,137.15,65,,109.72,percent of total billed charges,65% of total billed charges,75.26,35.67,,60.208,percent of total billed charges,35.67% of total billed charges,61.19,239.11,
SURGICAL PATHOLOGY LEVEL II,3100001,CDM,310,RC,88302,HCPCS,outpatient,,,82,32.80,TC,69.7,85,,55.76,percent of total billed charges,85% of total billed charges,63.14,77,,50.51,percent of total billed charges,77% of total billed charges,26.03,100,,,fee schedule,100% of CMS OPPS rate,111.3,350,,,fee schedule,350% of BCBS fee schedule,115.75,364,,,fee schedule,364% of BCBS fee schedule,115.75,364,,,fee schedule,364% of BCBS fee schedule,115.75,364,,,fee schedule,364% of BCBS fee schedule,73.8,90,,59.04,percent of total billed charges,90% of total billed charges,65.6,80,,52.48,percent of total billed charges,80% of total billed charges,73.8,90,,59.04,percent of total billed charges,90% of total billed charges,61.5,75,,49.2,percent of total billed charges,75% of total billed charges,31.76,122,,,fee schedule,122% of APC rate,23.78,29,,19.024,percent of total billed charges,29% of total billed charges,26.03,100,,,fee schedule,100% of CMS OPPS rate,54.94,67,,43.952,percent of total billed charges,67% of total billed charges,15.91,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,65.6,80,,52.48,percent of total billed charges,80% of total billed charges,53.3,65,,42.64,percent of total billed charges,65% of total billed charges,29.25,35.67,,23.4,percent of total billed charges,35.67% of total billed charges,15.91,115.75,
SURGICAL PATHOLOGY LEVEL III,3100002,CDM,310,RC,88304,HCPCS,outpatient,,,121,48.40,TC,102.85,85,,82.28,percent of total billed charges,85% of total billed charges,93.17,77,,74.54,percent of total billed charges,77% of total billed charges,47.38,100,,,fee schedule,100% of CMS OPPS rate,156.45,350,,,fee schedule,350% of BCBS fee schedule,162.71,364,,,fee schedule,364% of BCBS fee schedule,162.71,364,,,fee schedule,364% of BCBS fee schedule,162.71,364,,,fee schedule,364% of BCBS fee schedule,108.9,90,,87.12,percent of total billed charges,90% of total billed charges,96.8,80,,77.44,percent of total billed charges,80% of total billed charges,108.9,90,,87.12,percent of total billed charges,90% of total billed charges,90.75,75,,72.6,percent of total billed charges,75% of total billed charges,57.81,122,,,fee schedule,122% of APC rate,35.09,29,,28.072,percent of total billed charges,29% of total billed charges,47.38,100,,,fee schedule,100% of CMS OPPS rate,81.07,67,,64.856,percent of total billed charges,67% of total billed charges,34.31,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,96.8,80,,77.44,percent of total billed charges,80% of total billed charges,78.65,65,,62.92,percent of total billed charges,65% of total billed charges,43.16,35.67,,34.528,percent of total billed charges,35.67% of total billed charges,34.31,162.71,
TISSUE EXAM PATHOLOGIST LEV IV,3100003,CDM,310,RC,88305,HCPCS,outpatient,,,121,48.40,TC,102.85,85,,82.28,percent of total billed charges,85% of total billed charges,93.17,77,,74.54,percent of total billed charges,77% of total billed charges,47.38,100,,,fee schedule,100% of CMS OPPS rate,156.45,350,,,fee schedule,350% of BCBS fee schedule,162.71,364,,,fee schedule,364% of BCBS fee schedule,162.71,364,,,fee schedule,364% of BCBS fee schedule,162.71,364,,,fee schedule,364% of BCBS fee schedule,108.9,90,,87.12,percent of total billed charges,90% of total billed charges,96.8,80,,77.44,percent of total billed charges,80% of total billed charges,108.9,90,,87.12,percent of total billed charges,90% of total billed charges,90.75,75,,72.6,percent of total billed charges,75% of total billed charges,57.81,122,,,fee schedule,122% of APC rate,35.09,29,,28.072,percent of total billed charges,29% of total billed charges,47.38,100,,,fee schedule,100% of CMS OPPS rate,81.07,67,,64.856,percent of total billed charges,67% of total billed charges,34.31,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,96.8,80,,77.44,percent of total billed charges,80% of total billed charges,78.65,65,,62.92,percent of total billed charges,65% of total billed charges,43.16,35.67,,34.528,percent of total billed charges,35.67% of total billed charges,34.31,162.71,
SURGICAL PATHOLOGY LEVEL V,3100004,CDM,310,RC,88307,HCPCS,outpatient,,,302,120.80,TC,256.7,85,,205.36,percent of total billed charges,85% of total billed charges,232.54,77,,186.03,percent of total billed charges,77% of total billed charges,314.34,100,,,fee schedule,100% of CMS OPPS rate,754.01,350,,,fee schedule,350% of BCBS fee schedule,784.17,364,,,fee schedule,364% of BCBS fee schedule,784.17,364,,,fee schedule,364% of BCBS fee schedule,784.17,364,,,fee schedule,364% of BCBS fee schedule,271.8,90,,217.44,percent of total billed charges,90% of total billed charges,241.6,80,,193.28,percent of total billed charges,80% of total billed charges,271.8,90,,217.44,percent of total billed charges,90% of total billed charges,226.5,75,,181.2,percent of total billed charges,75% of total billed charges,383.5,122,,,fee schedule,122% of APC rate,87.58,29,,70.064,percent of total billed charges,29% of total billed charges,314.34,100,,,fee schedule,100% of CMS OPPS rate,202.34,67,,161.872,percent of total billed charges,67% of total billed charges,53.74,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,241.6,80,,193.28,percent of total billed charges,80% of total billed charges,196.3,65,,157.04,percent of total billed charges,65% of total billed charges,107.72,35.67,,86.176,percent of total billed charges,35.67% of total billed charges,53.74,784.17,
SURGICAL PATHOLOGY LEVEL VI,3100005,CDM,310,RC,88309,HCPCS,outpatient,,,646,258.40,TC,549.1,85,,439.28,percent of total billed charges,85% of total billed charges,497.42,77,,397.94,percent of total billed charges,77% of total billed charges,751.99,100,,,fee schedule,100% of CMS OPPS rate,1893.36,350,,,fee schedule,350% of BCBS fee schedule,1969.09,364,,,fee schedule,364% of BCBS fee schedule,1969.09,364,,,fee schedule,364% of BCBS fee schedule,1969.09,364,,,fee schedule,364% of BCBS fee schedule,581.4,90,,465.12,percent of total billed charges,90% of total billed charges,516.8,80,,413.44,percent of total billed charges,80% of total billed charges,581.4,90,,465.12,percent of total billed charges,90% of total billed charges,484.5,75,,387.6,percent of total billed charges,75% of total billed charges,917.43,122,,,fee schedule,122% of APC rate,187.34,29,,149.872,percent of total billed charges,29% of total billed charges,751.99,100,,,fee schedule,100% of CMS OPPS rate,432.82,67,,346.256,percent of total billed charges,67% of total billed charges,53.74,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,516.8,80,,413.44,percent of total billed charges,80% of total billed charges,419.9,65,,335.92,percent of total billed charges,65% of total billed charges,230.43,35.67,,184.344,percent of total billed charges,35.67% of total billed charges,53.74,1969.09,
DECALCIFICATION PROCEDURE,3100006,CDM,310,RC,88311,HCPCS,outpatient,,,28,11.20,TC,23.8,85,,19.04,percent of total billed charges,85% of total billed charges,21.56,77,,17.25,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,32.66,350,,,fee schedule,350% of BCBS fee schedule,33.96,364,,,fee schedule,364% of BCBS fee schedule,33.96,364,,,fee schedule,364% of BCBS fee schedule,33.96,364,,,fee schedule,364% of BCBS fee schedule,25.2,90,,20.16,percent of total billed charges,90% of total billed charges,22.4,80,,17.92,percent of total billed charges,80% of total billed charges,25.2,90,,20.16,percent of total billed charges,90% of total billed charges,21,75,,16.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,8.12,29,,6.496,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,18.76,67,,15.008,percent of total billed charges,67% of total billed charges,10.39,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,22.4,80,,17.92,percent of total billed charges,80% of total billed charges,18.2,65,,14.56,percent of total billed charges,65% of total billed charges,9.99,35.67,,7.992,percent of total billed charges,35.67% of total billed charges,8.12,33.96,
"SPECIAL STAINS, GROUP I",3100007,CDM,310,RC,88312,HCPCS,outpatient,,,68,27.20,,57.8,85,,46.24,percent of total billed charges,85% of total billed charges,52.36,77,,41.89,percent of total billed charges,77% of total billed charges,47.38,100,,,fee schedule,100% of CMS OPPS rate,156.45,350,,,fee schedule,350% of BCBS fee schedule,162.71,364,,,fee schedule,364% of BCBS fee schedule,162.71,364,,,fee schedule,364% of BCBS fee schedule,162.71,364,,,fee schedule,364% of BCBS fee schedule,61.2,90,,48.96,percent of total billed charges,90% of total billed charges,54.4,80,,43.52,percent of total billed charges,80% of total billed charges,61.2,90,,48.96,percent of total billed charges,90% of total billed charges,51,75,,40.8,percent of total billed charges,75% of total billed charges,57.81,122,,,fee schedule,122% of APC rate,19.72,29,,15.776,percent of total billed charges,29% of total billed charges,47.38,100,,,fee schedule,100% of CMS OPPS rate,45.56,67,,36.448,percent of total billed charges,67% of total billed charges,15.91,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,54.4,80,,43.52,percent of total billed charges,80% of total billed charges,44.2,65,,35.36,percent of total billed charges,65% of total billed charges,24.26,35.67,,19.408,percent of total billed charges,35.67% of total billed charges,15.91,162.71,
SURGICAL PATH LEVEL IV REPEAT,3100010,CDM,310,RC,88305,HCPCS,outpatient,,,92,36.80,TC91,78.2,85,,62.56,percent of total billed charges,85% of total billed charges,70.84,77,,56.67,percent of total billed charges,77% of total billed charges,47.38,100,,,fee schedule,100% of CMS OPPS rate,156.45,350,,,fee schedule,350% of BCBS fee schedule,162.71,364,,,fee schedule,364% of BCBS fee schedule,162.71,364,,,fee schedule,364% of BCBS fee schedule,162.71,364,,,fee schedule,364% of BCBS fee schedule,82.8,90,,66.24,percent of total billed charges,90% of total billed charges,73.6,80,,58.88,percent of total billed charges,80% of total billed charges,82.8,90,,66.24,percent of total billed charges,90% of total billed charges,69,75,,55.2,percent of total billed charges,75% of total billed charges,57.81,122,,,fee schedule,122% of APC rate,26.68,29,,21.344,percent of total billed charges,29% of total billed charges,47.38,100,,,fee schedule,100% of CMS OPPS rate,61.64,67,,49.312,percent of total billed charges,67% of total billed charges,34.31,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,73.6,80,,58.88,percent of total billed charges,80% of total billed charges,59.8,65,,47.84,percent of total billed charges,65% of total billed charges,32.82,35.67,,26.256,percent of total billed charges,35.67% of total billed charges,26.68,162.71,
SURG PATHOLOGY II - BILATERAL,3100011,CDM,310,RC,88302,HCPCS,outpatient,,,86,34.40,TC50,73.1,85,,58.48,percent of total billed charges,85% of total billed charges,66.22,77,,52.98,percent of total billed charges,77% of total billed charges,26.03,100,,,fee schedule,100% of CMS OPPS rate,111.3,350,,,fee schedule,350% of BCBS fee schedule,115.75,364,,,fee schedule,364% of BCBS fee schedule,115.75,364,,,fee schedule,364% of BCBS fee schedule,115.75,364,,,fee schedule,364% of BCBS fee schedule,77.4,90,,61.92,percent of total billed charges,90% of total billed charges,68.8,80,,55.04,percent of total billed charges,80% of total billed charges,77.4,90,,61.92,percent of total billed charges,90% of total billed charges,64.5,75,,51.6,percent of total billed charges,75% of total billed charges,31.76,122,,,fee schedule,122% of APC rate,24.94,29,,19.952,percent of total billed charges,29% of total billed charges,26.03,100,,,fee schedule,100% of CMS OPPS rate,57.62,67,,46.096,percent of total billed charges,67% of total billed charges,15.91,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,68.8,80,,55.04,percent of total billed charges,80% of total billed charges,55.9,65,,44.72,percent of total billed charges,65% of total billed charges,30.68,35.67,,24.544,percent of total billed charges,35.67% of total billed charges,15.91,115.75,
SURG PATH EXAM PROSTATE ND BXS,3100015,CDM,310,RC,G0416,HCPCS,outpatient,,,288,115.20,,244.8,85,,195.84,percent of total billed charges,85% of total billed charges,221.76,77,,177.41,percent of total billed charges,77% of total billed charges,314.34,100,,,fee schedule,100% of CMS OPPS rate,754.01,350,,,fee schedule,350% of BCBS fee schedule,784.17,364,,,fee schedule,364% of BCBS fee schedule,784.17,364,,,fee schedule,364% of BCBS fee schedule,784.17,364,,,fee schedule,364% of BCBS fee schedule,259.2,90,,207.36,percent of total billed charges,90% of total billed charges,230.4,80,,184.32,percent of total billed charges,80% of total billed charges,259.2,90,,207.36,percent of total billed charges,90% of total billed charges,216,75,,172.8,percent of total billed charges,75% of total billed charges,383.5,122,,,fee schedule,122% of APC rate,83.52,29,,66.816,percent of total billed charges,29% of total billed charges,314.34,100,,,fee schedule,100% of CMS OPPS rate,192.96,67,,154.368,percent of total billed charges,67% of total billed charges,153.19,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,230.4,80,,184.32,percent of total billed charges,80% of total billed charges,187.2,65,,149.76,percent of total billed charges,65% of total billed charges,102.73,35.67,,82.184,percent of total billed charges,35.67% of total billed charges,83.52,784.17,
SURGICAL PATH LEVEL III REPEAT,3100022,CDM,310,RC,88304,HCPCS,outpatient,,,92,36.80,TC91,78.2,85,,62.56,percent of total billed charges,85% of total billed charges,70.84,77,,56.67,percent of total billed charges,77% of total billed charges,47.38,100,,,fee schedule,100% of CMS OPPS rate,156.45,350,,,fee schedule,350% of BCBS fee schedule,162.71,364,,,fee schedule,364% of BCBS fee schedule,162.71,364,,,fee schedule,364% of BCBS fee schedule,162.71,364,,,fee schedule,364% of BCBS fee schedule,82.8,90,,66.24,percent of total billed charges,90% of total billed charges,73.6,80,,58.88,percent of total billed charges,80% of total billed charges,82.8,90,,66.24,percent of total billed charges,90% of total billed charges,69,75,,55.2,percent of total billed charges,75% of total billed charges,57.81,122,,,fee schedule,122% of APC rate,26.68,29,,21.344,percent of total billed charges,29% of total billed charges,47.38,100,,,fee schedule,100% of CMS OPPS rate,61.64,67,,49.312,percent of total billed charges,67% of total billed charges,34.31,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,73.6,80,,58.88,percent of total billed charges,80% of total billed charges,59.8,65,,47.84,percent of total billed charges,65% of total billed charges,32.82,35.67,,26.256,percent of total billed charges,35.67% of total billed charges,26.68,162.71,
SURGICAL PATH LEVEL II REPEAT,3100025,CDM,310,RC,88302,HCPCS,outpatient,,,46,18.40,TC91,39.1,85,,31.28,percent of total billed charges,85% of total billed charges,35.42,77,,28.34,percent of total billed charges,77% of total billed charges,26.03,100,,,fee schedule,100% of CMS OPPS rate,111.3,350,,,fee schedule,350% of BCBS fee schedule,115.75,364,,,fee schedule,364% of BCBS fee schedule,115.75,364,,,fee schedule,364% of BCBS fee schedule,115.75,364,,,fee schedule,364% of BCBS fee schedule,41.4,90,,33.12,percent of total billed charges,90% of total billed charges,36.8,80,,29.44,percent of total billed charges,80% of total billed charges,41.4,90,,33.12,percent of total billed charges,90% of total billed charges,34.5,75,,27.6,percent of total billed charges,75% of total billed charges,31.76,122,,,fee schedule,122% of APC rate,13.34,29,,10.672,percent of total billed charges,29% of total billed charges,26.03,100,,,fee schedule,100% of CMS OPPS rate,30.82,67,,24.656,percent of total billed charges,67% of total billed charges,15.91,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,36.8,80,,29.44,percent of total billed charges,80% of total billed charges,29.9,65,,23.92,percent of total billed charges,65% of total billed charges,16.41,35.67,,13.128,percent of total billed charges,35.67% of total billed charges,13.34,115.75,
IMMUNOHISTOCHEMISTRY MULTIPLEX,3100026,CDM,310,RC,88344,HCPCS,outpatient,,,288,115.20,TC,244.8,85,,195.84,percent of total billed charges,85% of total billed charges,221.76,77,,177.41,percent of total billed charges,77% of total billed charges,314.34,100,,,fee schedule,100% of CMS OPPS rate,754.01,350,,,fee schedule,350% of BCBS fee schedule,784.17,364,,,fee schedule,364% of BCBS fee schedule,784.17,364,,,fee schedule,364% of BCBS fee schedule,784.17,364,,,fee schedule,364% of BCBS fee schedule,259.2,90,,207.36,percent of total billed charges,90% of total billed charges,230.4,80,,184.32,percent of total billed charges,80% of total billed charges,259.2,90,,207.36,percent of total billed charges,90% of total billed charges,216,75,,172.8,percent of total billed charges,75% of total billed charges,383.5,122,,,fee schedule,122% of APC rate,83.52,29,,66.816,percent of total billed charges,29% of total billed charges,314.34,100,,,fee schedule,100% of CMS OPPS rate,192.96,67,,154.368,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,230.4,80,,184.32,percent of total billed charges,80% of total billed charges,187.2,65,,149.76,percent of total billed charges,65% of total billed charges,102.73,35.67,,82.184,percent of total billed charges,35.67% of total billed charges,83.52,784.17,
PATH MORPHOMETRIC ANAL EACH MU,3100098,CDM,310,RC,88377,HCPCS,outpatient,,,740,296.00,TC,629,85,,503.2,percent of total billed charges,85% of total billed charges,569.8,77,,455.84,percent of total billed charges,77% of total billed charges,149.37,100,,,fee schedule,100% of CMS OPPS rate,452.13,350,,,fee schedule,350% of BCBS fee schedule,470.22,364,,,fee schedule,364% of BCBS fee schedule,470.22,364,,,fee schedule,364% of BCBS fee schedule,470.22,364,,,fee schedule,364% of BCBS fee schedule,666,90,,532.8,percent of total billed charges,90% of total billed charges,592,80,,473.6,percent of total billed charges,80% of total billed charges,666,90,,532.8,percent of total billed charges,90% of total billed charges,555,75,,444,percent of total billed charges,75% of total billed charges,182.23,122,,,fee schedule,122% of APC rate,214.6,29,,171.68,percent of total billed charges,29% of total billed charges,149.37,100,,,fee schedule,100% of CMS OPPS rate,495.8,67,,396.64,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,592,80,,473.6,percent of total billed charges,80% of total billed charges,481,65,,384.8,percent of total billed charges,65% of total billed charges,263.96,35.67,,211.168,percent of total billed charges,35.67% of total billed charges,149.37,666,
CYTOPATH EVAL FNA REPORT,3100100,CDM,310,RC,88173,HCPCS,outpatient,,,92,36.80,TC,78.2,85,,62.56,percent of total billed charges,85% of total billed charges,70.84,77,,56.67,percent of total billed charges,77% of total billed charges,47.38,100,,,fee schedule,100% of CMS OPPS rate,156.45,350,,,fee schedule,350% of BCBS fee schedule,162.71,364,,,fee schedule,364% of BCBS fee schedule,162.71,364,,,fee schedule,364% of BCBS fee schedule,162.71,364,,,fee schedule,364% of BCBS fee schedule,82.8,90,,66.24,percent of total billed charges,90% of total billed charges,73.6,80,,58.88,percent of total billed charges,80% of total billed charges,82.8,90,,66.24,percent of total billed charges,90% of total billed charges,69,75,,55.2,percent of total billed charges,75% of total billed charges,57.81,122,,,fee schedule,122% of APC rate,26.68,29,,21.344,percent of total billed charges,29% of total billed charges,47.38,100,,,fee schedule,100% of CMS OPPS rate,61.64,67,,49.312,percent of total billed charges,67% of total billed charges,34.31,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,73.6,80,,58.88,percent of total billed charges,80% of total billed charges,59.8,65,,47.84,percent of total billed charges,65% of total billed charges,32.82,35.67,,26.256,percent of total billed charges,35.67% of total billed charges,26.68,162.71,
SCANNING ELECTRON MICROSCOPY,3100110,CDM,310,RC,88348,HCPCS,outpatient,,,646,258.40,TC,549.1,85,,439.28,percent of total billed charges,85% of total billed charges,497.42,77,,397.94,percent of total billed charges,77% of total billed charges,751.99,100,,,fee schedule,100% of CMS OPPS rate,1893.36,350,,,fee schedule,350% of BCBS fee schedule,1969.09,364,,,fee schedule,364% of BCBS fee schedule,1969.09,364,,,fee schedule,364% of BCBS fee schedule,1969.09,364,,,fee schedule,364% of BCBS fee schedule,581.4,90,,465.12,percent of total billed charges,90% of total billed charges,516.8,80,,413.44,percent of total billed charges,80% of total billed charges,581.4,90,,465.12,percent of total billed charges,90% of total billed charges,484.5,75,,387.6,percent of total billed charges,75% of total billed charges,917.43,122,,,fee schedule,122% of APC rate,187.34,29,,149.872,percent of total billed charges,29% of total billed charges,751.99,100,,,fee schedule,100% of CMS OPPS rate,432.82,67,,346.256,percent of total billed charges,67% of total billed charges,153.19,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,516.8,80,,413.44,percent of total billed charges,80% of total billed charges,419.9,65,,335.92,percent of total billed charges,65% of total billed charges,230.43,35.67,,184.344,percent of total billed charges,35.67% of total billed charges,153.19,1969.09,
CYTOPATH FL NONGYN SMEARS,3100120,CDM,310,RC,88104,HCPCS,outpatient,,,56,22.40,TC,47.6,85,,38.08,percent of total billed charges,85% of total billed charges,43.12,77,,34.5,percent of total billed charges,77% of total billed charges,35.07,100,,,fee schedule,100% of CMS OPPS rate,111.3,350,,,fee schedule,350% of BCBS fee schedule,115.75,364,,,fee schedule,364% of BCBS fee schedule,115.75,364,,,fee schedule,364% of BCBS fee schedule,115.75,364,,,fee schedule,364% of BCBS fee schedule,50.4,90,,40.32,percent of total billed charges,90% of total billed charges,44.8,80,,35.84,percent of total billed charges,80% of total billed charges,50.4,90,,40.32,percent of total billed charges,90% of total billed charges,42,75,,33.6,percent of total billed charges,75% of total billed charges,42.78,122,,,fee schedule,122% of APC rate,16.24,29,,12.992,percent of total billed charges,29% of total billed charges,35.07,100,,,fee schedule,100% of CMS OPPS rate,37.52,67,,30.016,percent of total billed charges,67% of total billed charges,15.91,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,44.8,80,,35.84,percent of total billed charges,80% of total billed charges,36.4,65,,29.12,percent of total billed charges,65% of total billed charges,19.98,35.67,,15.984,percent of total billed charges,35.67% of total billed charges,15.91,115.75,
CYTP FNA EVAL EA ADDL,3100130,CDM,310,RC,88177,HCPCS,outpatient,,,13,5.20,TC,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,10.01,77,,8.01,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,27.65,350,,,fee schedule,350% of BCBS fee schedule,28.76,364,,,fee schedule,364% of BCBS fee schedule,28.76,364,,,fee schedule,364% of BCBS fee schedule,28.76,364,,,fee schedule,364% of BCBS fee schedule,11.7,90,,9.36,percent of total billed charges,90% of total billed charges,10.4,80,,8.32,percent of total billed charges,80% of total billed charges,11.7,90,,9.36,percent of total billed charges,90% of total billed charges,9.75,75,,7.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,3.77,29,,3.016,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,8.71,67,,6.968,percent of total billed charges,67% of total billed charges,10.39,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,10.4,80,,8.32,percent of total billed charges,80% of total billed charges,8.45,65,,6.76,percent of total billed charges,65% of total billed charges,4.64,35.67,,3.712,percent of total billed charges,35.67% of total billed charges,3.77,28.76,
HISTOCHEMICAL STAINS ADD-ON,3100140,CDM,310,RC,88314,HCPCS,outpatient,,,80,32.00,TC,68,85,,54.4,percent of total billed charges,85% of total billed charges,61.6,77,,49.28,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,221.06,350,,,fee schedule,350% of BCBS fee schedule,229.9,364,,,fee schedule,364% of BCBS fee schedule,229.9,364,,,fee schedule,364% of BCBS fee schedule,229.9,364,,,fee schedule,364% of BCBS fee schedule,72,90,,57.6,percent of total billed charges,90% of total billed charges,64,80,,51.2,percent of total billed charges,80% of total billed charges,72,90,,57.6,percent of total billed charges,90% of total billed charges,60,75,,48,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,23.2,29,,18.56,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,53.6,67,,42.88,percent of total billed charges,67% of total billed charges,15.91,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,64,80,,51.2,percent of total billed charges,80% of total billed charges,52,65,,41.6,percent of total billed charges,65% of total billed charges,28.54,35.67,,22.832,percent of total billed charges,35.67% of total billed charges,15.91,229.9,
SPECIAL STAINS GROUP 2,3100150,CDM,310,RC,88313,HCPCS,outpatient,,,71,28.40,TC,60.35,85,,48.28,percent of total billed charges,85% of total billed charges,54.67,77,,43.74,percent of total billed charges,77% of total billed charges,53.49,100,,,fee schedule,100% of CMS OPPS rate,111.3,350,,,fee schedule,350% of BCBS fee schedule,115.75,364,,,fee schedule,364% of BCBS fee schedule,115.75,364,,,fee schedule,364% of BCBS fee schedule,115.75,364,,,fee schedule,364% of BCBS fee schedule,63.9,90,,51.12,percent of total billed charges,90% of total billed charges,56.8,80,,45.44,percent of total billed charges,80% of total billed charges,63.9,90,,51.12,percent of total billed charges,90% of total billed charges,53.25,75,,42.6,percent of total billed charges,75% of total billed charges,65.26,122,,,fee schedule,122% of APC rate,20.59,29,,16.472,percent of total billed charges,29% of total billed charges,53.49,100,,,fee schedule,100% of CMS OPPS rate,47.57,67,,38.056,percent of total billed charges,67% of total billed charges,15.91,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,56.8,80,,45.44,percent of total billed charges,80% of total billed charges,46.15,65,,36.92,percent of total billed charges,65% of total billed charges,25.33,35.67,,20.264,percent of total billed charges,35.67% of total billed charges,15.91,115.75,
SPECIAL STAINS GROUP 2 REPEAT,3100151,CDM,310,RC,88313,HCPCS,outpatient,,,71,28.40,TC91,60.35,85,,48.28,percent of total billed charges,85% of total billed charges,54.67,77,,43.74,percent of total billed charges,77% of total billed charges,53.49,100,,,fee schedule,100% of CMS OPPS rate,111.3,350,,,fee schedule,350% of BCBS fee schedule,115.75,364,,,fee schedule,364% of BCBS fee schedule,115.75,364,,,fee schedule,364% of BCBS fee schedule,115.75,364,,,fee schedule,364% of BCBS fee schedule,63.9,90,,51.12,percent of total billed charges,90% of total billed charges,56.8,80,,45.44,percent of total billed charges,80% of total billed charges,63.9,90,,51.12,percent of total billed charges,90% of total billed charges,53.25,75,,42.6,percent of total billed charges,75% of total billed charges,65.26,122,,,fee schedule,122% of APC rate,20.59,29,,16.472,percent of total billed charges,29% of total billed charges,53.49,100,,,fee schedule,100% of CMS OPPS rate,47.57,67,,38.056,percent of total billed charges,67% of total billed charges,15.91,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,56.8,80,,45.44,percent of total billed charges,80% of total billed charges,46.15,65,,36.92,percent of total billed charges,65% of total billed charges,25.33,35.67,,20.264,percent of total billed charges,35.67% of total billed charges,15.91,115.75,
ANALYSIS SKELETAL MUSCLE,3100160,CDM,310,RC,88355,HCPCS,outpatient,,,251,100.40,TC,213.35,85,,170.68,percent of total billed charges,85% of total billed charges,193.27,77,,154.62,percent of total billed charges,77% of total billed charges,149.37,100,,,fee schedule,100% of CMS OPPS rate,452.13,350,,,fee schedule,350% of BCBS fee schedule,470.22,364,,,fee schedule,364% of BCBS fee schedule,470.22,364,,,fee schedule,364% of BCBS fee schedule,470.22,364,,,fee schedule,364% of BCBS fee schedule,225.9,90,,180.72,percent of total billed charges,90% of total billed charges,200.8,80,,160.64,percent of total billed charges,80% of total billed charges,225.9,90,,180.72,percent of total billed charges,90% of total billed charges,188.25,75,,150.6,percent of total billed charges,75% of total billed charges,182.23,122,,,fee schedule,122% of APC rate,72.79,29,,58.232,percent of total billed charges,29% of total billed charges,149.37,100,,,fee schedule,100% of CMS OPPS rate,168.17,67,,134.536,percent of total billed charges,67% of total billed charges,34.31,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,200.8,80,,160.64,percent of total billed charges,80% of total billed charges,163.15,65,,130.52,percent of total billed charges,65% of total billed charges,89.53,35.67,,71.624,percent of total billed charges,35.67% of total billed charges,34.31,470.22,
CYTOPATH CONCENTRATE TECH,3100180,CDM,310,RC,88108,HCPCS,outpatient,,,67,26.80,TC,56.95,85,,45.56,percent of total billed charges,85% of total billed charges,51.59,77,,41.27,percent of total billed charges,77% of total billed charges,35.07,100,,,fee schedule,100% of CMS OPPS rate,111.3,350,,,fee schedule,350% of BCBS fee schedule,115.75,364,,,fee schedule,364% of BCBS fee schedule,115.75,364,,,fee schedule,364% of BCBS fee schedule,115.75,364,,,fee schedule,364% of BCBS fee schedule,60.3,90,,48.24,percent of total billed charges,90% of total billed charges,53.6,80,,42.88,percent of total billed charges,80% of total billed charges,60.3,90,,48.24,percent of total billed charges,90% of total billed charges,50.25,75,,40.2,percent of total billed charges,75% of total billed charges,42.78,122,,,fee schedule,122% of APC rate,19.43,29,,15.544,percent of total billed charges,29% of total billed charges,35.07,100,,,fee schedule,100% of CMS OPPS rate,44.89,67,,35.912,percent of total billed charges,67% of total billed charges,15.91,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,53.6,80,,42.88,percent of total billed charges,80% of total billed charges,43.55,65,,34.84,percent of total billed charges,65% of total billed charges,23.9,35.67,,19.12,percent of total billed charges,35.67% of total billed charges,15.91,115.75,
MICROSLIDE CONSULTATION,3100190,CDM,310,RC,88323,HCPCS,outpatient,,,255,102.00,TC,216.75,85,,173.4,percent of total billed charges,85% of total billed charges,196.35,77,,157.08,percent of total billed charges,77% of total billed charges,47.38,100,,,fee schedule,100% of CMS OPPS rate,156.45,350,,,fee schedule,350% of BCBS fee schedule,162.71,364,,,fee schedule,364% of BCBS fee schedule,162.71,364,,,fee schedule,364% of BCBS fee schedule,162.71,364,,,fee schedule,364% of BCBS fee schedule,229.5,90,,183.6,percent of total billed charges,90% of total billed charges,204,80,,163.2,percent of total billed charges,80% of total billed charges,229.5,90,,183.6,percent of total billed charges,90% of total billed charges,191.25,75,,153,percent of total billed charges,75% of total billed charges,57.81,122,,,fee schedule,122% of APC rate,73.95,29,,59.16,percent of total billed charges,29% of total billed charges,47.38,100,,,fee schedule,100% of CMS OPPS rate,170.85,67,,136.68,percent of total billed charges,67% of total billed charges,34.31,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,204,80,,163.2,percent of total billed charges,80% of total billed charges,165.75,65,,132.6,percent of total billed charges,65% of total billed charges,90.96,35.67,,72.768,percent of total billed charges,35.67% of total billed charges,34.31,229.5,
MICROSLIDE CONSULTATION,3100191,CDM,310,RC,88321,HCPCS,outpatient,,,255,102.00,TC,216.75,85,,173.4,percent of total billed charges,85% of total billed charges,196.35,77,,157.08,percent of total billed charges,77% of total billed charges,35.07,100,,,fee schedule,100% of CMS OPPS rate,111.3,350,,,fee schedule,350% of BCBS fee schedule,115.75,364,,,fee schedule,364% of BCBS fee schedule,115.75,364,,,fee schedule,364% of BCBS fee schedule,115.75,364,,,fee schedule,364% of BCBS fee schedule,229.5,90,,183.6,percent of total billed charges,90% of total billed charges,204,80,,163.2,percent of total billed charges,80% of total billed charges,229.5,90,,183.6,percent of total billed charges,90% of total billed charges,191.25,75,,153,percent of total billed charges,75% of total billed charges,42.78,122,,,fee schedule,122% of APC rate,73.95,29,,59.16,percent of total billed charges,29% of total billed charges,35.07,100,,,fee schedule,100% of CMS OPPS rate,170.85,67,,136.68,percent of total billed charges,67% of total billed charges,15.91,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,204,80,,163.2,percent of total billed charges,80% of total billed charges,165.75,65,,132.6,percent of total billed charges,65% of total billed charges,90.96,35.67,,72.768,percent of total billed charges,35.67% of total billed charges,15.91,229.5,
ANALYSIS TUMOR,3100200,CDM,310,RC,88358,HCPCS,outpatient,,,400,160.00,TC,340,85,,272,percent of total billed charges,85% of total billed charges,308,77,,246.4,percent of total billed charges,77% of total billed charges,149.37,100,,,fee schedule,100% of CMS OPPS rate,754.01,350,,,fee schedule,350% of BCBS fee schedule,784.17,364,,,fee schedule,364% of BCBS fee schedule,784.17,364,,,fee schedule,364% of BCBS fee schedule,784.17,364,,,fee schedule,364% of BCBS fee schedule,360,90,,288,percent of total billed charges,90% of total billed charges,320,80,,256,percent of total billed charges,80% of total billed charges,360,90,,288,percent of total billed charges,90% of total billed charges,300,75,,240,percent of total billed charges,75% of total billed charges,182.23,122,,,fee schedule,122% of APC rate,116,29,,92.8,percent of total billed charges,29% of total billed charges,149.37,100,,,fee schedule,100% of CMS OPPS rate,268,67,,214.4,percent of total billed charges,67% of total billed charges,34.31,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,320,80,,256,percent of total billed charges,80% of total billed charges,260,65,,208,percent of total billed charges,65% of total billed charges,142.68,35.67,,114.144,percent of total billed charges,35.67% of total billed charges,34.31,784.17,
TISS EXAM MOLECULAR STUDY,3100210,CDM,310,RC,88387,HCPCS,outpatient,,,12,4.80,TC,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,9.24,77,,7.39,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,21.35,350,,,fee schedule,350% of BCBS fee schedule,22.2,364,,,fee schedule,364% of BCBS fee schedule,22.2,364,,,fee schedule,364% of BCBS fee schedule,22.2,364,,,fee schedule,364% of BCBS fee schedule,10.8,90,,8.64,percent of total billed charges,90% of total billed charges,9.6,80,,7.68,percent of total billed charges,80% of total billed charges,10.8,90,,8.64,percent of total billed charges,90% of total billed charges,9,75,,7.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,3.48,29,,2.784,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,8.04,67,,6.432,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,9.6,80,,7.68,percent of total billed charges,80% of total billed charges,7.8,65,,6.24,percent of total billed charges,65% of total billed charges,4.28,35.67,,3.424,percent of total billed charges,35.67% of total billed charges,3.48,22.2,
CYTOPATH CELL ENHANCE TECH,3100220,CDM,310,RC,88112,HCPCS,outpatient,,,76,30.40,TC,64.6,85,,51.68,percent of total billed charges,85% of total billed charges,58.52,77,,46.82,percent of total billed charges,77% of total billed charges,47.38,100,,,fee schedule,100% of CMS OPPS rate,156.45,350,,,fee schedule,350% of BCBS fee schedule,162.71,364,,,fee schedule,364% of BCBS fee schedule,162.71,364,,,fee schedule,364% of BCBS fee schedule,162.71,364,,,fee schedule,364% of BCBS fee schedule,68.4,90,,54.72,percent of total billed charges,90% of total billed charges,60.8,80,,48.64,percent of total billed charges,80% of total billed charges,68.4,90,,54.72,percent of total billed charges,90% of total billed charges,57,75,,45.6,percent of total billed charges,75% of total billed charges,57.81,122,,,fee schedule,122% of APC rate,22.04,29,,17.632,percent of total billed charges,29% of total billed charges,47.38,100,,,fee schedule,100% of CMS OPPS rate,50.92,67,,40.736,percent of total billed charges,67% of total billed charges,34.31,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,60.8,80,,48.64,percent of total billed charges,80% of total billed charges,49.4,65,,39.52,percent of total billed charges,65% of total billed charges,27.11,35.67,,21.688,percent of total billed charges,35.67% of total billed charges,22.04,162.71,
SURGICAL PATH GROSS,3100230,CDM,310,RC,88300,HCPCS,outpatient,,,58,23.20,TC,49.3,85,,39.44,percent of total billed charges,85% of total billed charges,44.66,77,,35.73,percent of total billed charges,77% of total billed charges,26.03,100,,,fee schedule,100% of CMS OPPS rate,61.15,350,,,fee schedule,350% of BCBS fee schedule,63.59,364,,,fee schedule,364% of BCBS fee schedule,63.59,364,,,fee schedule,364% of BCBS fee schedule,63.59,364,,,fee schedule,364% of BCBS fee schedule,52.2,90,,41.76,percent of total billed charges,90% of total billed charges,46.4,80,,37.12,percent of total billed charges,80% of total billed charges,52.2,90,,41.76,percent of total billed charges,90% of total billed charges,43.5,75,,34.8,percent of total billed charges,75% of total billed charges,31.76,122,,,fee schedule,122% of APC rate,16.82,29,,13.456,percent of total billed charges,29% of total billed charges,26.03,100,,,fee schedule,100% of CMS OPPS rate,38.86,67,,31.088,percent of total billed charges,67% of total billed charges,10.39,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,46.4,80,,37.12,percent of total billed charges,80% of total billed charges,37.7,65,,30.16,percent of total billed charges,65% of total billed charges,20.69,35.67,,16.552,percent of total billed charges,35.67% of total billed charges,10.39,63.59,
PATH CONSULT INTRAOP 1 BLOC,3100240,CDM,310,RC,88331,HCPCS,outpatient,,,251,100.40,TC,213.35,85,,170.68,percent of total billed charges,85% of total billed charges,193.27,77,,154.62,percent of total billed charges,77% of total billed charges,149.37,100,,,fee schedule,100% of CMS OPPS rate,452.13,350,,,fee schedule,350% of BCBS fee schedule,470.22,364,,,fee schedule,364% of BCBS fee schedule,470.22,364,,,fee schedule,364% of BCBS fee schedule,470.22,364,,,fee schedule,364% of BCBS fee schedule,225.9,90,,180.72,percent of total billed charges,90% of total billed charges,200.8,80,,160.64,percent of total billed charges,80% of total billed charges,225.9,90,,180.72,percent of total billed charges,90% of total billed charges,188.25,75,,150.6,percent of total billed charges,75% of total billed charges,182.23,122,,,fee schedule,122% of APC rate,72.79,29,,58.232,percent of total billed charges,29% of total billed charges,149.37,100,,,fee schedule,100% of CMS OPPS rate,168.17,67,,134.536,percent of total billed charges,67% of total billed charges,34.31,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,200.8,80,,160.64,percent of total billed charges,80% of total billed charges,163.15,65,,130.52,percent of total billed charges,65% of total billed charges,89.53,35.67,,71.624,percent of total billed charges,35.67% of total billed charges,34.31,470.22,
TUMOR IMMUNOHISTOCHEM/MANUAL,3100250,CDM,310,RC,88360,HCPCS,outpatient,,,251,100.40,TC,213.35,85,,170.68,percent of total billed charges,85% of total billed charges,193.27,77,,154.62,percent of total billed charges,77% of total billed charges,149.37,100,,,fee schedule,100% of CMS OPPS rate,754.01,350,,,fee schedule,350% of BCBS fee schedule,784.17,364,,,fee schedule,364% of BCBS fee schedule,784.17,364,,,fee schedule,364% of BCBS fee schedule,784.17,364,,,fee schedule,364% of BCBS fee schedule,225.9,90,,180.72,percent of total billed charges,90% of total billed charges,200.8,80,,160.64,percent of total billed charges,80% of total billed charges,225.9,90,,180.72,percent of total billed charges,90% of total billed charges,188.25,75,,150.6,percent of total billed charges,75% of total billed charges,182.23,122,,,fee schedule,122% of APC rate,72.79,29,,58.232,percent of total billed charges,29% of total billed charges,149.37,100,,,fee schedule,100% of CMS OPPS rate,168.17,67,,134.536,percent of total billed charges,67% of total billed charges,34.31,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,200.8,80,,160.64,percent of total billed charges,80% of total billed charges,163.15,65,,130.52,percent of total billed charges,65% of total billed charges,89.53,35.67,,71.624,percent of total billed charges,35.67% of total billed charges,34.31,784.17,
TISS EX MOLECUL STUDY ADD-ON,3100260,CDM,310,RC,88388,HCPCS,outpatient,,,14,5.60,TC,11.9,85,,9.52,percent of total billed charges,85% of total billed charges,10.78,77,,8.62,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,35.18,350,,,fee schedule,350% of BCBS fee schedule,36.58,364,,,fee schedule,364% of BCBS fee schedule,36.58,364,,,fee schedule,364% of BCBS fee schedule,36.58,364,,,fee schedule,364% of BCBS fee schedule,12.6,90,,10.08,percent of total billed charges,90% of total billed charges,11.2,80,,8.96,percent of total billed charges,80% of total billed charges,12.6,90,,10.08,percent of total billed charges,90% of total billed charges,10.5,75,,8.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,4.06,29,,3.248,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,9.38,67,,7.504,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,11.2,80,,8.96,percent of total billed charges,80% of total billed charges,9.1,65,,7.28,percent of total billed charges,65% of total billed charges,4.99,35.67,,3.992,percent of total billed charges,35.67% of total billed charges,4.06,36.58,
FORENSIC CYTOPATHOLOGY,3100270,CDM,310,RC,88125,HCPCS,outpatient,,,251,100.40,TC,213.35,85,,170.68,percent of total billed charges,85% of total billed charges,193.27,77,,154.62,percent of total billed charges,77% of total billed charges,47.38,100,,,fee schedule,100% of CMS OPPS rate,156.45,350,,,fee schedule,350% of BCBS fee schedule,162.71,364,,,fee schedule,364% of BCBS fee schedule,162.71,364,,,fee schedule,364% of BCBS fee schedule,162.71,364,,,fee schedule,364% of BCBS fee schedule,225.9,90,,180.72,percent of total billed charges,90% of total billed charges,200.8,80,,160.64,percent of total billed charges,80% of total billed charges,225.9,90,,180.72,percent of total billed charges,90% of total billed charges,188.25,75,,150.6,percent of total billed charges,75% of total billed charges,57.81,122,,,fee schedule,122% of APC rate,72.79,29,,58.232,percent of total billed charges,29% of total billed charges,47.38,100,,,fee schedule,100% of CMS OPPS rate,168.17,67,,134.536,percent of total billed charges,67% of total billed charges,15.91,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,200.8,80,,160.64,percent of total billed charges,80% of total billed charges,163.15,65,,130.52,percent of total billed charges,65% of total billed charges,89.53,35.67,,71.624,percent of total billed charges,35.67% of total billed charges,15.91,225.9,
TISSUE EXAM PATHOLOGIST LEV IV,3100280,CDM,310,RC,88305,HCPCS,outpatient,,,94,37.60,TC,79.9,85,,63.92,percent of total billed charges,85% of total billed charges,72.38,77,,57.9,percent of total billed charges,77% of total billed charges,47.38,100,,,fee schedule,100% of CMS OPPS rate,156.45,350,,,fee schedule,350% of BCBS fee schedule,162.71,364,,,fee schedule,364% of BCBS fee schedule,162.71,364,,,fee schedule,364% of BCBS fee schedule,162.71,364,,,fee schedule,364% of BCBS fee schedule,84.6,90,,67.68,percent of total billed charges,90% of total billed charges,75.2,80,,60.16,percent of total billed charges,80% of total billed charges,84.6,90,,67.68,percent of total billed charges,90% of total billed charges,70.5,75,,56.4,percent of total billed charges,75% of total billed charges,57.81,122,,,fee schedule,122% of APC rate,27.26,29,,21.808,percent of total billed charges,29% of total billed charges,47.38,100,,,fee schedule,100% of CMS OPPS rate,62.98,67,,50.384,percent of total billed charges,67% of total billed charges,34.31,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,75.2,80,,60.16,percent of total billed charges,80% of total billed charges,61.1,65,,48.88,percent of total billed charges,65% of total billed charges,33.53,35.67,,26.824,percent of total billed charges,35.67% of total billed charges,27.26,162.71,
INTRAOP CYTO PATH CONSULT 2,3100290,CDM,310,RC,88334,HCPCS,outpatient,,,32,12.80,TC,27.2,85,,21.76,percent of total billed charges,85% of total billed charges,24.64,77,,19.71,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,56.53,350,,,fee schedule,350% of BCBS fee schedule,58.79,364,,,fee schedule,364% of BCBS fee schedule,58.79,364,,,fee schedule,364% of BCBS fee schedule,58.79,364,,,fee schedule,364% of BCBS fee schedule,28.8,90,,23.04,percent of total billed charges,90% of total billed charges,25.6,80,,20.48,percent of total billed charges,80% of total billed charges,28.8,90,,23.04,percent of total billed charges,90% of total billed charges,24,75,,19.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,9.28,29,,7.424,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,21.44,67,,17.152,percent of total billed charges,67% of total billed charges,15.91,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,25.6,80,,20.48,percent of total billed charges,80% of total billed charges,20.8,65,,16.64,percent of total billed charges,65% of total billed charges,11.41,35.67,,9.128,percent of total billed charges,35.67% of total billed charges,9.28,58.79,
INSITU HYBRIDIZATION (FISH),3100300,CDM,310,RC,88365,HCPCS,outpatient,,,339,135.60,TC,288.15,85,,230.52,percent of total billed charges,85% of total billed charges,261.03,77,,208.82,percent of total billed charges,77% of total billed charges,149.37,100,,,fee schedule,100% of CMS OPPS rate,452.13,350,,,fee schedule,350% of BCBS fee schedule,470.22,364,,,fee schedule,364% of BCBS fee schedule,470.22,364,,,fee schedule,364% of BCBS fee schedule,470.22,364,,,fee schedule,364% of BCBS fee schedule,305.1,90,,244.08,percent of total billed charges,90% of total billed charges,271.2,80,,216.96,percent of total billed charges,80% of total billed charges,305.1,90,,244.08,percent of total billed charges,90% of total billed charges,254.25,75,,203.4,percent of total billed charges,75% of total billed charges,182.23,122,,,fee schedule,122% of APC rate,98.31,29,,78.648,percent of total billed charges,29% of total billed charges,149.37,100,,,fee schedule,100% of CMS OPPS rate,227.13,67,,181.704,percent of total billed charges,67% of total billed charges,53.74,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,271.2,80,,216.96,percent of total billed charges,80% of total billed charges,220.35,65,,176.28,percent of total billed charges,65% of total billed charges,120.92,35.67,,96.736,percent of total billed charges,35.67% of total billed charges,53.74,470.22,
CYTP URNE 3-5 PROBES EA SPEC,3100310,CDM,310,RC,88120,HCPCS,outpatient,,,554,221.60,TC,470.9,85,,376.72,percent of total billed charges,85% of total billed charges,426.58,77,,341.26,percent of total billed charges,77% of total billed charges,149.37,100,,,fee schedule,100% of CMS OPPS rate,452.13,350,,,fee schedule,350% of BCBS fee schedule,470.22,364,,,fee schedule,364% of BCBS fee schedule,470.22,364,,,fee schedule,364% of BCBS fee schedule,470.22,364,,,fee schedule,364% of BCBS fee schedule,498.6,90,,398.88,percent of total billed charges,90% of total billed charges,443.2,80,,354.56,percent of total billed charges,80% of total billed charges,498.6,90,,398.88,percent of total billed charges,90% of total billed charges,415.5,75,,332.4,percent of total billed charges,75% of total billed charges,182.23,122,,,fee schedule,122% of APC rate,160.66,29,,128.528,percent of total billed charges,29% of total billed charges,149.37,100,,,fee schedule,100% of CMS OPPS rate,371.18,67,,296.944,percent of total billed charges,67% of total billed charges,53.74,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,443.2,80,,354.56,percent of total billed charges,80% of total billed charges,360.1,65,,288.08,percent of total billed charges,65% of total billed charges,197.61,35.67,,158.088,percent of total billed charges,35.67% of total billed charges,53.74,498.6,
TISSUE EXAM PATHOLOGIST LEV II,3100320,CDM,310,RC,88302,HCPCS,outpatient,,,67,26.80,TC,56.95,85,,45.56,percent of total billed charges,85% of total billed charges,51.59,77,,41.27,percent of total billed charges,77% of total billed charges,26.03,100,,,fee schedule,100% of CMS OPPS rate,111.3,350,,,fee schedule,350% of BCBS fee schedule,115.75,364,,,fee schedule,364% of BCBS fee schedule,115.75,364,,,fee schedule,364% of BCBS fee schedule,115.75,364,,,fee schedule,364% of BCBS fee schedule,60.3,90,,48.24,percent of total billed charges,90% of total billed charges,53.6,80,,42.88,percent of total billed charges,80% of total billed charges,60.3,90,,48.24,percent of total billed charges,90% of total billed charges,50.25,75,,40.2,percent of total billed charges,75% of total billed charges,31.76,122,,,fee schedule,122% of APC rate,19.43,29,,15.544,percent of total billed charges,29% of total billed charges,26.03,100,,,fee schedule,100% of CMS OPPS rate,44.89,67,,35.912,percent of total billed charges,67% of total billed charges,15.91,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,53.6,80,,42.88,percent of total billed charges,80% of total billed charges,43.55,65,,34.84,percent of total billed charges,65% of total billed charges,23.9,35.67,,19.12,percent of total billed charges,35.67% of total billed charges,15.91,115.75,
PATH CONSULT INTRAOP ADDL,3100330,CDM,310,RC,88332,HCPCS,outpatient,,,18,7.20,TC,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,13.86,77,,11.09,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,75.36,350,,,fee schedule,350% of BCBS fee schedule,78.37,364,,,fee schedule,364% of BCBS fee schedule,78.37,364,,,fee schedule,364% of BCBS fee schedule,78.37,364,,,fee schedule,364% of BCBS fee schedule,16.2,90,,12.96,percent of total billed charges,90% of total billed charges,14.4,80,,11.52,percent of total billed charges,80% of total billed charges,16.2,90,,12.96,percent of total billed charges,90% of total billed charges,13.5,75,,10.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,5.22,29,,4.176,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,12.06,67,,9.648,percent of total billed charges,67% of total billed charges,10.39,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,14.4,80,,11.52,percent of total billed charges,80% of total billed charges,11.7,65,,9.36,percent of total billed charges,65% of total billed charges,6.42,35.67,,5.136,percent of total billed charges,35.67% of total billed charges,5.22,78.37,
TUMOR IMMUNOHISTOCHEM/COMPUT,3100340,CDM,310,RC,88361,HCPCS,outpatient,,,299,119.60,TC,254.15,85,,203.32,percent of total billed charges,85% of total billed charges,230.23,77,,184.18,percent of total billed charges,77% of total billed charges,314.34,100,,,fee schedule,100% of CMS OPPS rate,754.01,350,,,fee schedule,350% of BCBS fee schedule,784.17,364,,,fee schedule,364% of BCBS fee schedule,784.17,364,,,fee schedule,364% of BCBS fee schedule,784.17,364,,,fee schedule,364% of BCBS fee schedule,269.1,90,,215.28,percent of total billed charges,90% of total billed charges,239.2,80,,191.36,percent of total billed charges,80% of total billed charges,269.1,90,,215.28,percent of total billed charges,90% of total billed charges,224.25,75,,179.4,percent of total billed charges,75% of total billed charges,383.5,122,,,fee schedule,122% of APC rate,86.71,29,,69.368,percent of total billed charges,29% of total billed charges,314.34,100,,,fee schedule,100% of CMS OPPS rate,200.33,67,,160.264,percent of total billed charges,67% of total billed charges,53.74,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,239.2,80,,191.36,percent of total billed charges,80% of total billed charges,194.35,65,,155.48,percent of total billed charges,65% of total billed charges,106.65,35.67,,85.32,percent of total billed charges,35.67% of total billed charges,53.74,784.17,
CYTOPATH SMEAR OTHER SOURCE,3100350,CDM,310,RC,88160,HCPCS,outpatient,,,46,18.40,TC,39.1,85,,31.28,percent of total billed charges,85% of total billed charges,35.42,77,,28.34,percent of total billed charges,77% of total billed charges,26.03,100,,,fee schedule,100% of CMS OPPS rate,61.15,350,,,fee schedule,350% of BCBS fee schedule,63.59,364,,,fee schedule,364% of BCBS fee schedule,63.59,364,,,fee schedule,364% of BCBS fee schedule,63.59,364,,,fee schedule,364% of BCBS fee schedule,41.4,90,,33.12,percent of total billed charges,90% of total billed charges,36.8,80,,29.44,percent of total billed charges,80% of total billed charges,41.4,90,,33.12,percent of total billed charges,90% of total billed charges,34.5,75,,27.6,percent of total billed charges,75% of total billed charges,31.76,122,,,fee schedule,122% of APC rate,13.34,29,,10.672,percent of total billed charges,29% of total billed charges,26.03,100,,,fee schedule,100% of CMS OPPS rate,30.82,67,,24.656,percent of total billed charges,67% of total billed charges,15.91,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,36.8,80,,29.44,percent of total billed charges,80% of total billed charges,29.9,65,,23.92,percent of total billed charges,65% of total billed charges,16.41,35.67,,13.128,percent of total billed charges,35.67% of total billed charges,13.34,63.59,
TISSUE EXAM PATHOLOGIST LEV V,3100360,CDM,310,RC,88307,HCPCS,outpatient,,,299,119.60,TC,254.15,85,,203.32,percent of total billed charges,85% of total billed charges,230.23,77,,184.18,percent of total billed charges,77% of total billed charges,314.34,100,,,fee schedule,100% of CMS OPPS rate,754.01,350,,,fee schedule,350% of BCBS fee schedule,784.17,364,,,fee schedule,364% of BCBS fee schedule,784.17,364,,,fee schedule,364% of BCBS fee schedule,784.17,364,,,fee schedule,364% of BCBS fee schedule,269.1,90,,215.28,percent of total billed charges,90% of total billed charges,239.2,80,,191.36,percent of total billed charges,80% of total billed charges,269.1,90,,215.28,percent of total billed charges,90% of total billed charges,224.25,75,,179.4,percent of total billed charges,75% of total billed charges,383.5,122,,,fee schedule,122% of APC rate,86.71,29,,69.368,percent of total billed charges,29% of total billed charges,314.34,100,,,fee schedule,100% of CMS OPPS rate,200.33,67,,160.264,percent of total billed charges,67% of total billed charges,53.74,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,239.2,80,,191.36,percent of total billed charges,80% of total billed charges,194.35,65,,155.48,percent of total billed charges,65% of total billed charges,106.65,35.67,,85.32,percent of total billed charges,35.67% of total billed charges,53.74,784.17,
IMMUNOHISTOCHEMISTRY,3100370,CDM,310,RC,88342,HCPCS,outpatient,,,281,112.40,TC,238.85,85,,191.08,percent of total billed charges,85% of total billed charges,216.37,77,,173.1,percent of total billed charges,77% of total billed charges,149.37,100,,,fee schedule,100% of CMS OPPS rate,754.01,350,,,fee schedule,350% of BCBS fee schedule,784.17,364,,,fee schedule,364% of BCBS fee schedule,784.17,364,,,fee schedule,364% of BCBS fee schedule,784.17,364,,,fee schedule,364% of BCBS fee schedule,252.9,90,,202.32,percent of total billed charges,90% of total billed charges,224.8,80,,179.84,percent of total billed charges,80% of total billed charges,252.9,90,,202.32,percent of total billed charges,90% of total billed charges,210.75,75,,168.6,percent of total billed charges,75% of total billed charges,182.23,122,,,fee schedule,122% of APC rate,81.49,29,,65.192,percent of total billed charges,29% of total billed charges,149.37,100,,,fee schedule,100% of CMS OPPS rate,188.27,67,,150.616,percent of total billed charges,67% of total billed charges,34.31,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,224.8,80,,179.84,percent of total billed charges,80% of total billed charges,182.65,65,,146.12,percent of total billed charges,65% of total billed charges,100.23,35.67,,80.184,percent of total billed charges,35.67% of total billed charges,34.31,784.17,
IMMUNOHISTO ANTIBODY SLIDE,3100375,CDM,310,RC,88341,HCPCS,outpatient,,,174,69.60,TC,147.9,85,,118.32,percent of total billed charges,85% of total billed charges,133.98,77,,107.18,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,226.1,350,,,fee schedule,350% of BCBS fee schedule,235.14,364,,,fee schedule,364% of BCBS fee schedule,235.14,364,,,fee schedule,364% of BCBS fee schedule,235.14,364,,,fee schedule,364% of BCBS fee schedule,156.6,90,,125.28,percent of total billed charges,90% of total billed charges,139.2,80,,111.36,percent of total billed charges,80% of total billed charges,156.6,90,,125.28,percent of total billed charges,90% of total billed charges,130.5,75,,104.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,50.46,29,,40.368,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,116.58,67,,93.264,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,139.2,80,,111.36,percent of total billed charges,80% of total billed charges,113.1,65,,90.48,percent of total billed charges,65% of total billed charges,62.07,35.67,,49.656,percent of total billed charges,35.67% of total billed charges,50.46,235.14,
INSITU HYBRIDIZATION AUTO,3100380,CDM,310,RC,88367,HCPCS,outpatient,,,519,207.60,TC,441.15,85,,352.92,percent of total billed charges,85% of total billed charges,399.63,77,,319.7,percent of total billed charges,77% of total billed charges,314.34,100,,,fee schedule,100% of CMS OPPS rate,754.01,350,,,fee schedule,350% of BCBS fee schedule,784.17,364,,,fee schedule,364% of BCBS fee schedule,784.17,364,,,fee schedule,364% of BCBS fee schedule,784.17,364,,,fee schedule,364% of BCBS fee schedule,467.1,90,,373.68,percent of total billed charges,90% of total billed charges,415.2,80,,332.16,percent of total billed charges,80% of total billed charges,467.1,90,,373.68,percent of total billed charges,90% of total billed charges,389.25,75,,311.4,percent of total billed charges,75% of total billed charges,383.5,122,,,fee schedule,122% of APC rate,150.51,29,,120.408,percent of total billed charges,29% of total billed charges,314.34,100,,,fee schedule,100% of CMS OPPS rate,347.73,67,,278.184,percent of total billed charges,67% of total billed charges,34.31,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,415.2,80,,332.16,percent of total billed charges,80% of total billed charges,337.35,65,,269.88,percent of total billed charges,65% of total billed charges,185.13,35.67,,148.104,percent of total billed charges,35.67% of total billed charges,34.31,784.17,
CYTOPATH SMEAR OTHER SOURCE,3100390,CDM,310,RC,88162,HCPCS,outpatient,,,82,32.80,TC,69.7,85,,55.76,percent of total billed charges,85% of total billed charges,63.14,77,,50.51,percent of total billed charges,77% of total billed charges,47.38,100,,,fee schedule,100% of CMS OPPS rate,156.45,350,,,fee schedule,350% of BCBS fee schedule,162.71,364,,,fee schedule,364% of BCBS fee schedule,162.71,364,,,fee schedule,364% of BCBS fee schedule,162.71,364,,,fee schedule,364% of BCBS fee schedule,73.8,90,,59.04,percent of total billed charges,90% of total billed charges,65.6,80,,52.48,percent of total billed charges,80% of total billed charges,73.8,90,,59.04,percent of total billed charges,90% of total billed charges,61.5,75,,49.2,percent of total billed charges,75% of total billed charges,57.81,122,,,fee schedule,122% of APC rate,23.78,29,,19.024,percent of total billed charges,29% of total billed charges,47.38,100,,,fee schedule,100% of CMS OPPS rate,54.94,67,,43.952,percent of total billed charges,67% of total billed charges,34.31,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,65.6,80,,52.48,percent of total billed charges,80% of total billed charges,53.3,65,,42.64,percent of total billed charges,65% of total billed charges,29.25,35.67,,23.4,percent of total billed charges,35.67% of total billed charges,23.78,162.71,
DECALCIFY TISSUE,3100400,CDM,310,RC,88311,HCPCS,outpatient,,,29,11.60,TC,24.65,85,,19.72,percent of total billed charges,85% of total billed charges,22.33,77,,17.86,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,32.66,350,,,fee schedule,350% of BCBS fee schedule,33.96,364,,,fee schedule,364% of BCBS fee schedule,33.96,364,,,fee schedule,364% of BCBS fee schedule,33.96,364,,,fee schedule,364% of BCBS fee schedule,26.1,90,,20.88,percent of total billed charges,90% of total billed charges,23.2,80,,18.56,percent of total billed charges,80% of total billed charges,26.1,90,,20.88,percent of total billed charges,90% of total billed charges,21.75,75,,17.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,8.41,29,,6.728,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,19.43,67,,15.544,percent of total billed charges,67% of total billed charges,10.39,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,23.2,80,,18.56,percent of total billed charges,80% of total billed charges,18.85,65,,15.08,percent of total billed charges,65% of total billed charges,10.34,35.67,,8.272,percent of total billed charges,35.67% of total billed charges,8.41,33.96,
MICRODISSECTION LASER,3100420,CDM,310,RC,88380,HCPCS,outpatient,,,145,58.00,TC,123.25,85,,98.6,percent of total billed charges,85% of total billed charges,111.65,77,,89.32,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,287.67,350,,,fee schedule,350% of BCBS fee schedule,299.17,364,,,fee schedule,364% of BCBS fee schedule,299.17,364,,,fee schedule,364% of BCBS fee schedule,299.17,364,,,fee schedule,364% of BCBS fee schedule,130.5,90,,104.4,percent of total billed charges,90% of total billed charges,116,80,,92.8,percent of total billed charges,80% of total billed charges,130.5,90,,104.4,percent of total billed charges,90% of total billed charges,108.75,75,,87,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,42.05,29,,33.64,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,97.15,67,,77.72,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,116,80,,92.8,percent of total billed charges,80% of total billed charges,94.25,65,,75.4,percent of total billed charges,65% of total billed charges,51.72,35.67,,41.376,percent of total billed charges,35.67% of total billed charges,42.05,299.17,
CYTOPATH FL NONGYN FILTER,3100430,CDM,310,RC,88106,HCPCS,outpatient,,,74,29.60,TC,62.9,85,,50.32,percent of total billed charges,85% of total billed charges,56.98,77,,45.58,percent of total billed charges,77% of total billed charges,26.03,100,,,fee schedule,100% of CMS OPPS rate,61.15,350,,,fee schedule,350% of BCBS fee schedule,63.59,364,,,fee schedule,364% of BCBS fee schedule,63.59,364,,,fee schedule,364% of BCBS fee schedule,63.59,364,,,fee schedule,364% of BCBS fee schedule,66.6,90,,53.28,percent of total billed charges,90% of total billed charges,59.2,80,,47.36,percent of total billed charges,80% of total billed charges,66.6,90,,53.28,percent of total billed charges,90% of total billed charges,55.5,75,,44.4,percent of total billed charges,75% of total billed charges,31.76,122,,,fee schedule,122% of APC rate,21.46,29,,17.168,percent of total billed charges,29% of total billed charges,26.03,100,,,fee schedule,100% of CMS OPPS rate,49.58,67,,39.664,percent of total billed charges,67% of total billed charges,15.91,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,59.2,80,,47.36,percent of total billed charges,80% of total billed charges,48.1,65,,38.48,percent of total billed charges,65% of total billed charges,26.4,35.67,,21.12,percent of total billed charges,35.67% of total billed charges,15.91,66.6,
CELL MARKER STUDY,3100440,CDM,310,RC,88182,HCPCS,outpatient,,,382,152.80,TC,324.7,85,,259.76,percent of total billed charges,85% of total billed charges,294.14,77,,235.31,percent of total billed charges,77% of total billed charges,47.38,100,,,fee schedule,100% of CMS OPPS rate,156.45,350,,,fee schedule,350% of BCBS fee schedule,162.71,364,,,fee schedule,364% of BCBS fee schedule,162.71,364,,,fee schedule,364% of BCBS fee schedule,162.71,364,,,fee schedule,364% of BCBS fee schedule,343.8,90,,275.04,percent of total billed charges,90% of total billed charges,305.6,80,,244.48,percent of total billed charges,80% of total billed charges,343.8,90,,275.04,percent of total billed charges,90% of total billed charges,286.5,75,,229.2,percent of total billed charges,75% of total billed charges,57.81,122,,,fee schedule,122% of APC rate,110.78,29,,88.624,percent of total billed charges,29% of total billed charges,47.38,100,,,fee schedule,100% of CMS OPPS rate,255.94,67,,204.752,percent of total billed charges,67% of total billed charges,34.31,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,305.6,80,,244.48,percent of total billed charges,80% of total billed charges,248.3,65,,198.64,percent of total billed charges,65% of total billed charges,136.26,35.67,,109.008,percent of total billed charges,35.67% of total billed charges,34.31,343.8,
FLOWCYTOMETRY/READ,3100441,CDM,310,RC,88189,HCPCS,outpatient,,,96,38.40,,81.6,85,,65.28,percent of total billed charges,85% of total billed charges,73.92,77,,59.14,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,310.28,350,,,fee schedule,350% of BCBS fee schedule,322.69,364,,,fee schedule,364% of BCBS fee schedule,322.69,364,,,fee schedule,364% of BCBS fee schedule,322.69,364,,,fee schedule,364% of BCBS fee schedule,86.4,90,,69.12,percent of total billed charges,90% of total billed charges,76.8,80,,61.44,percent of total billed charges,80% of total billed charges,86.4,90,,69.12,percent of total billed charges,90% of total billed charges,72,75,,57.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,27.84,29,,22.272,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,64.32,67,,51.456,percent of total billed charges,67% of total billed charges,34.31,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,76.8,80,,61.44,percent of total billed charges,80% of total billed charges,62.4,65,,49.92,percent of total billed charges,65% of total billed charges,34.24,35.67,,27.392,percent of total billed charges,35.67% of total billed charges,27.84,322.69,
ENZYME HISTOCHEMISTRY,3100450,CDM,310,RC,88319,HCPCS,outpatient,,,1161,464.40,TC,986.85,85,,789.48,percent of total billed charges,85% of total billed charges,893.97,77,,715.18,percent of total billed charges,77% of total billed charges,751.99,100,,,fee schedule,100% of CMS OPPS rate,1893.36,350,,,fee schedule,350% of BCBS fee schedule,1969.09,364,,,fee schedule,364% of BCBS fee schedule,1969.09,364,,,fee schedule,364% of BCBS fee schedule,1969.09,364,,,fee schedule,364% of BCBS fee schedule,1044.9,90,,835.92,percent of total billed charges,90% of total billed charges,928.8,80,,743.04,percent of total billed charges,80% of total billed charges,1044.9,90,,835.92,percent of total billed charges,90% of total billed charges,870.75,75,,696.6,percent of total billed charges,75% of total billed charges,917.43,122,,,fee schedule,122% of APC rate,336.69,29,,269.352,percent of total billed charges,29% of total billed charges,751.99,100,,,fee schedule,100% of CMS OPPS rate,777.87,67,,622.296,percent of total billed charges,67% of total billed charges,15.91,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,928.8,80,,743.04,percent of total billed charges,80% of total billed charges,754.65,65,,603.72,percent of total billed charges,65% of total billed charges,414.13,35.67,,331.304,percent of total billed charges,35.67% of total billed charges,15.91,1969.09,
ANALYSIS NERVE,3100460,CDM,310,RC,88356,HCPCS,outpatient,,,194,77.60,TC,164.9,85,,131.92,percent of total billed charges,85% of total billed charges,149.38,77,,119.5,percent of total billed charges,77% of total billed charges,47.38,100,,,fee schedule,100% of CMS OPPS rate,156.45,350,,,fee schedule,350% of BCBS fee schedule,162.71,364,,,fee schedule,364% of BCBS fee schedule,162.71,364,,,fee schedule,364% of BCBS fee schedule,162.71,364,,,fee schedule,364% of BCBS fee schedule,174.6,90,,139.68,percent of total billed charges,90% of total billed charges,155.2,80,,124.16,percent of total billed charges,80% of total billed charges,174.6,90,,139.68,percent of total billed charges,90% of total billed charges,145.5,75,,116.4,percent of total billed charges,75% of total billed charges,57.81,122,,,fee schedule,122% of APC rate,56.26,29,,45.008,percent of total billed charges,29% of total billed charges,47.38,100,,,fee schedule,100% of CMS OPPS rate,129.98,67,,103.984,percent of total billed charges,67% of total billed charges,53.74,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,155.2,80,,124.16,percent of total billed charges,80% of total billed charges,126.1,65,,100.88,percent of total billed charges,65% of total billed charges,69.2,35.67,,55.36,percent of total billed charges,35.67% of total billed charges,47.38,174.6,
CYTP URINE 3-5 PROBES CMPTR,3100480,CDM,310,RC,88121,HCPCS,outpatient,,,477,190.80,TC,405.45,85,,324.36,percent of total billed charges,85% of total billed charges,367.29,77,,293.83,percent of total billed charges,77% of total billed charges,149.37,100,,,fee schedule,100% of CMS OPPS rate,754.01,350,,,fee schedule,350% of BCBS fee schedule,784.17,364,,,fee schedule,364% of BCBS fee schedule,784.17,364,,,fee schedule,364% of BCBS fee schedule,784.17,364,,,fee schedule,364% of BCBS fee schedule,429.3,90,,343.44,percent of total billed charges,90% of total billed charges,381.6,80,,305.28,percent of total billed charges,80% of total billed charges,429.3,90,,343.44,percent of total billed charges,90% of total billed charges,357.75,75,,286.2,percent of total billed charges,75% of total billed charges,182.23,122,,,fee schedule,122% of APC rate,138.33,29,,110.664,percent of total billed charges,29% of total billed charges,149.37,100,,,fee schedule,100% of CMS OPPS rate,319.59,67,,255.672,percent of total billed charges,67% of total billed charges,53.74,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,381.6,80,,305.28,percent of total billed charges,80% of total billed charges,310.05,65,,248.04,percent of total billed charges,65% of total billed charges,170.15,35.67,,136.12,percent of total billed charges,35.67% of total billed charges,53.74,784.17,
TISSUE EXAM PATHOLOGIST LEV 3,3100490,CDM,310,RC,88304,HCPCS,outpatient,,,70,28.00,TC,59.5,85,,47.6,percent of total billed charges,85% of total billed charges,53.9,77,,43.12,percent of total billed charges,77% of total billed charges,47.38,100,,,fee schedule,100% of CMS OPPS rate,156.45,350,,,fee schedule,350% of BCBS fee schedule,162.71,364,,,fee schedule,364% of BCBS fee schedule,162.71,364,,,fee schedule,364% of BCBS fee schedule,162.71,364,,,fee schedule,364% of BCBS fee schedule,63,90,,50.4,percent of total billed charges,90% of total billed charges,56,80,,44.8,percent of total billed charges,80% of total billed charges,63,90,,50.4,percent of total billed charges,90% of total billed charges,52.5,75,,42,percent of total billed charges,75% of total billed charges,57.81,122,,,fee schedule,122% of APC rate,20.3,29,,16.24,percent of total billed charges,29% of total billed charges,47.38,100,,,fee schedule,100% of CMS OPPS rate,46.9,67,,37.52,percent of total billed charges,67% of total billed charges,34.31,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,56,80,,44.8,percent of total billed charges,80% of total billed charges,45.5,65,,36.4,percent of total billed charges,65% of total billed charges,24.97,35.67,,19.976,percent of total billed charges,35.67% of total billed charges,20.3,162.71,
INTRAOP CYTO PATH CONSULT 1,3100500,CDM,310,RC,88333,HCPCS,outpatient,,,1161,464.40,TC,986.85,85,,789.48,percent of total billed charges,85% of total billed charges,893.97,77,,715.18,percent of total billed charges,77% of total billed charges,751.99,100,,,fee schedule,100% of CMS OPPS rate,1893.36,350,,,fee schedule,350% of BCBS fee schedule,1969.09,364,,,fee schedule,364% of BCBS fee schedule,1969.09,364,,,fee schedule,364% of BCBS fee schedule,1969.09,364,,,fee schedule,364% of BCBS fee schedule,1044.9,90,,835.92,percent of total billed charges,90% of total billed charges,928.8,80,,743.04,percent of total billed charges,80% of total billed charges,1044.9,90,,835.92,percent of total billed charges,90% of total billed charges,870.75,75,,696.6,percent of total billed charges,75% of total billed charges,917.43,122,,,fee schedule,122% of APC rate,336.69,29,,269.352,percent of total billed charges,29% of total billed charges,751.99,100,,,fee schedule,100% of CMS OPPS rate,777.87,67,,622.296,percent of total billed charges,67% of total billed charges,15.91,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,928.8,80,,743.04,percent of total billed charges,80% of total billed charges,754.65,65,,603.72,percent of total billed charges,65% of total billed charges,414.13,35.67,,331.304,percent of total billed charges,35.67% of total billed charges,15.91,1969.09,
NERVE TEASING PREPARATIONS,3100510,CDM,310,RC,88362,HCPCS,outpatient,,,646,258.40,TC,549.1,85,,439.28,percent of total billed charges,85% of total billed charges,497.42,77,,397.94,percent of total billed charges,77% of total billed charges,751.99,100,,,fee schedule,100% of CMS OPPS rate,1893.36,350,,,fee schedule,350% of BCBS fee schedule,1969.09,364,,,fee schedule,364% of BCBS fee schedule,1969.09,364,,,fee schedule,364% of BCBS fee schedule,1969.09,364,,,fee schedule,364% of BCBS fee schedule,581.4,90,,465.12,percent of total billed charges,90% of total billed charges,516.8,80,,413.44,percent of total billed charges,80% of total billed charges,581.4,90,,465.12,percent of total billed charges,90% of total billed charges,484.5,75,,387.6,percent of total billed charges,75% of total billed charges,917.43,122,,,fee schedule,122% of APC rate,187.34,29,,149.872,percent of total billed charges,29% of total billed charges,751.99,100,,,fee schedule,100% of CMS OPPS rate,432.82,67,,346.256,percent of total billed charges,67% of total billed charges,53.74,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,516.8,80,,413.44,percent of total billed charges,80% of total billed charges,419.9,65,,335.92,percent of total billed charges,65% of total billed charges,230.43,35.67,,184.344,percent of total billed charges,35.67% of total billed charges,53.74,1969.09,
CYTOPATH SMEAR OTHER SOURCE,3100520,CDM,310,RC,88161,HCPCS,outpatient,,,48,19.20,TC,40.8,85,,32.64,percent of total billed charges,85% of total billed charges,36.96,77,,29.57,percent of total billed charges,77% of total billed charges,26.03,100,,,fee schedule,100% of CMS OPPS rate,111.3,350,,,fee schedule,350% of BCBS fee schedule,115.75,364,,,fee schedule,364% of BCBS fee schedule,115.75,364,,,fee schedule,364% of BCBS fee schedule,115.75,364,,,fee schedule,364% of BCBS fee schedule,43.2,90,,34.56,percent of total billed charges,90% of total billed charges,38.4,80,,30.72,percent of total billed charges,80% of total billed charges,43.2,90,,34.56,percent of total billed charges,90% of total billed charges,36,75,,28.8,percent of total billed charges,75% of total billed charges,31.76,122,,,fee schedule,122% of APC rate,13.92,29,,11.136,percent of total billed charges,29% of total billed charges,26.03,100,,,fee schedule,100% of CMS OPPS rate,32.16,67,,25.728,percent of total billed charges,67% of total billed charges,15.91,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,38.4,80,,30.72,percent of total billed charges,80% of total billed charges,31.2,65,,24.96,percent of total billed charges,65% of total billed charges,17.12,35.67,,13.696,percent of total billed charges,35.67% of total billed charges,13.92,115.75,
TISSUE EXAM PATHOLOGIST LEV VI,3100530,CDM,310,RC,88309,HCPCS,outpatient,,,646,258.40,TC,549.1,85,,439.28,percent of total billed charges,85% of total billed charges,497.42,77,,397.94,percent of total billed charges,77% of total billed charges,751.99,100,,,fee schedule,100% of CMS OPPS rate,1893.36,350,,,fee schedule,350% of BCBS fee schedule,1969.09,364,,,fee schedule,364% of BCBS fee schedule,1969.09,364,,,fee schedule,364% of BCBS fee schedule,1969.09,364,,,fee schedule,364% of BCBS fee schedule,581.4,90,,465.12,percent of total billed charges,90% of total billed charges,516.8,80,,413.44,percent of total billed charges,80% of total billed charges,581.4,90,,465.12,percent of total billed charges,90% of total billed charges,484.5,75,,387.6,percent of total billed charges,75% of total billed charges,917.43,122,,,fee schedule,122% of APC rate,187.34,29,,149.872,percent of total billed charges,29% of total billed charges,751.99,100,,,fee schedule,100% of CMS OPPS rate,432.82,67,,346.256,percent of total billed charges,67% of total billed charges,53.74,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,516.8,80,,413.44,percent of total billed charges,80% of total billed charges,419.9,65,,335.92,percent of total billed charges,65% of total billed charges,230.43,35.67,,184.344,percent of total billed charges,35.67% of total billed charges,53.74,1969.09,
IMMUNOFLUORESCENT STUDY,3100540,CDM,310,RC,88346,HCPCS,outpatient,,,288,115.20,TC,244.8,85,,195.84,percent of total billed charges,85% of total billed charges,221.76,77,,177.41,percent of total billed charges,77% of total billed charges,149.37,100,,,fee schedule,100% of CMS OPPS rate,754.01,350,,,fee schedule,350% of BCBS fee schedule,784.17,364,,,fee schedule,364% of BCBS fee schedule,784.17,364,,,fee schedule,364% of BCBS fee schedule,784.17,364,,,fee schedule,364% of BCBS fee schedule,259.2,90,,207.36,percent of total billed charges,90% of total billed charges,230.4,80,,184.32,percent of total billed charges,80% of total billed charges,259.2,90,,207.36,percent of total billed charges,90% of total billed charges,216,75,,172.8,percent of total billed charges,75% of total billed charges,182.23,122,,,fee schedule,122% of APC rate,83.52,29,,66.816,percent of total billed charges,29% of total billed charges,149.37,100,,,fee schedule,100% of CMS OPPS rate,192.96,67,,154.368,percent of total billed charges,67% of total billed charges,34.31,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,230.4,80,,184.32,percent of total billed charges,80% of total billed charges,187.2,65,,149.76,percent of total billed charges,65% of total billed charges,102.73,35.67,,82.184,percent of total billed charges,35.67% of total billed charges,34.31,784.17,
INSITU HYBRIDIZATION MANUAL,3100550,CDM,310,RC,88368,HCPCS,outpatient,,,528,211.20,TC,448.8,85,,359.04,percent of total billed charges,85% of total billed charges,406.56,77,,325.25,percent of total billed charges,77% of total billed charges,314.34,100,,,fee schedule,100% of CMS OPPS rate,754.01,350,,,fee schedule,350% of BCBS fee schedule,784.17,364,,,fee schedule,364% of BCBS fee schedule,784.17,364,,,fee schedule,364% of BCBS fee schedule,784.17,364,,,fee schedule,364% of BCBS fee schedule,475.2,90,,380.16,percent of total billed charges,90% of total billed charges,422.4,80,,337.92,percent of total billed charges,80% of total billed charges,475.2,90,,380.16,percent of total billed charges,90% of total billed charges,396,75,,316.8,percent of total billed charges,75% of total billed charges,383.5,122,,,fee schedule,122% of APC rate,153.12,29,,122.496,percent of total billed charges,29% of total billed charges,314.34,100,,,fee schedule,100% of CMS OPPS rate,353.76,67,,283.008,percent of total billed charges,67% of total billed charges,53.74,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,422.4,80,,337.92,percent of total billed charges,80% of total billed charges,343.2,65,,274.56,percent of total billed charges,65% of total billed charges,188.34,35.67,,150.672,percent of total billed charges,35.67% of total billed charges,53.74,784.17,
INSITU HYBRID COMPUTER-ASSIST,3100551,CDM,310,RC,88374,HCPCS,outpatient,,,459,183.60,,390.15,85,,312.12,percent of total billed charges,85% of total billed charges,353.43,77,,282.74,percent of total billed charges,77% of total billed charges,149.37,100,,,fee schedule,100% of CMS OPPS rate,452.13,350,,,fee schedule,350% of BCBS fee schedule,470.22,364,,,fee schedule,364% of BCBS fee schedule,470.22,364,,,fee schedule,364% of BCBS fee schedule,470.22,364,,,fee schedule,364% of BCBS fee schedule,413.1,90,,330.48,percent of total billed charges,90% of total billed charges,367.2,80,,293.76,percent of total billed charges,80% of total billed charges,413.1,90,,330.48,percent of total billed charges,90% of total billed charges,344.25,75,,275.4,percent of total billed charges,75% of total billed charges,182.23,122,,,fee schedule,122% of APC rate,133.11,29,,106.488,percent of total billed charges,29% of total billed charges,149.37,100,,,fee schedule,100% of CMS OPPS rate,307.53,67,,246.024,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,367.2,80,,293.76,percent of total billed charges,80% of total billed charges,298.35,65,,238.68,percent of total billed charges,65% of total billed charges,163.73,35.67,,130.984,percent of total billed charges,35.67% of total billed charges,133.11,470.22,
CYTP DX EVAL FNA 1ST EA SITE,3100560,CDM,310,RC,88172,HCPCS,outpatient,,,149,59.60,TC,126.65,85,,101.32,percent of total billed charges,85% of total billed charges,114.73,77,,91.78,percent of total billed charges,77% of total billed charges,149.37,100,,,fee schedule,100% of CMS OPPS rate,452.13,350,,,fee schedule,350% of BCBS fee schedule,470.22,364,,,fee schedule,364% of BCBS fee schedule,470.22,364,,,fee schedule,364% of BCBS fee schedule,470.22,364,,,fee schedule,364% of BCBS fee schedule,134.1,90,,107.28,percent of total billed charges,90% of total billed charges,119.2,80,,95.36,percent of total billed charges,80% of total billed charges,134.1,90,,107.28,percent of total billed charges,90% of total billed charges,111.75,75,,89.4,percent of total billed charges,75% of total billed charges,182.23,122,,,fee schedule,122% of APC rate,43.21,29,,34.568,percent of total billed charges,29% of total billed charges,149.37,100,,,fee schedule,100% of CMS OPPS rate,99.83,67,,79.864,percent of total billed charges,67% of total billed charges,15.91,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,119.2,80,,95.36,percent of total billed charges,80% of total billed charges,96.85,65,,77.48,percent of total billed charges,65% of total billed charges,53.15,35.67,,42.52,percent of total billed charges,35.67% of total billed charges,15.91,470.22,
SPECIAL STAINS GROUP 1,3100570,CDM,310,RC,88312,HCPCS,outpatient,,,92,36.80,TC,78.2,85,,62.56,percent of total billed charges,85% of total billed charges,70.84,77,,56.67,percent of total billed charges,77% of total billed charges,47.38,100,,,fee schedule,100% of CMS OPPS rate,156.45,350,,,fee schedule,350% of BCBS fee schedule,162.71,364,,,fee schedule,364% of BCBS fee schedule,162.71,364,,,fee schedule,364% of BCBS fee schedule,162.71,364,,,fee schedule,364% of BCBS fee schedule,82.8,90,,66.24,percent of total billed charges,90% of total billed charges,73.6,80,,58.88,percent of total billed charges,80% of total billed charges,82.8,90,,66.24,percent of total billed charges,90% of total billed charges,69,75,,55.2,percent of total billed charges,75% of total billed charges,57.81,122,,,fee schedule,122% of APC rate,26.68,29,,21.344,percent of total billed charges,29% of total billed charges,47.38,100,,,fee schedule,100% of CMS OPPS rate,61.64,67,,49.312,percent of total billed charges,67% of total billed charges,15.91,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,73.6,80,,58.88,percent of total billed charges,80% of total billed charges,59.8,65,,47.84,percent of total billed charges,65% of total billed charges,32.82,35.67,,26.256,percent of total billed charges,35.67% of total billed charges,15.91,162.71,
SPECIAL STAINS GRP 1 REPEAT,3100575,CDM,310,RC,88312,HCPCS,outpatient,,,88,35.20,TC91,74.8,85,,59.84,percent of total billed charges,85% of total billed charges,67.76,77,,54.21,percent of total billed charges,77% of total billed charges,47.38,100,,,fee schedule,100% of CMS OPPS rate,156.45,350,,,fee schedule,350% of BCBS fee schedule,162.71,364,,,fee schedule,364% of BCBS fee schedule,162.71,364,,,fee schedule,364% of BCBS fee schedule,162.71,364,,,fee schedule,364% of BCBS fee schedule,79.2,90,,63.36,percent of total billed charges,90% of total billed charges,70.4,80,,56.32,percent of total billed charges,80% of total billed charges,79.2,90,,63.36,percent of total billed charges,90% of total billed charges,66,75,,52.8,percent of total billed charges,75% of total billed charges,57.81,122,,,fee schedule,122% of APC rate,25.52,29,,20.416,percent of total billed charges,29% of total billed charges,47.38,100,,,fee schedule,100% of CMS OPPS rate,58.96,67,,47.168,percent of total billed charges,67% of total billed charges,15.91,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,70.4,80,,56.32,percent of total billed charges,80% of total billed charges,57.2,65,,45.76,percent of total billed charges,65% of total billed charges,31.39,35.67,,25.112,percent of total billed charges,35.67% of total billed charges,15.91,162.71,
ELCTRON MICROSCOPY,3100580,CDM,310,RC,88348,HCPCS,outpatient,,,827,330.80,TC,702.95,85,,562.36,percent of total billed charges,85% of total billed charges,636.79,77,,509.43,percent of total billed charges,77% of total billed charges,751.99,100,,,fee schedule,100% of CMS OPPS rate,1893.36,350,,,fee schedule,350% of BCBS fee schedule,1969.09,364,,,fee schedule,364% of BCBS fee schedule,1969.09,364,,,fee schedule,364% of BCBS fee schedule,1969.09,364,,,fee schedule,364% of BCBS fee schedule,744.3,90,,595.44,percent of total billed charges,90% of total billed charges,661.6,80,,529.28,percent of total billed charges,80% of total billed charges,744.3,90,,595.44,percent of total billed charges,90% of total billed charges,620.25,75,,496.2,percent of total billed charges,75% of total billed charges,917.43,122,,,fee schedule,122% of APC rate,239.83,29,,191.864,percent of total billed charges,29% of total billed charges,751.99,100,,,fee schedule,100% of CMS OPPS rate,554.09,67,,443.272,percent of total billed charges,67% of total billed charges,153.19,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,661.6,80,,529.28,percent of total billed charges,80% of total billed charges,537.55,65,,430.04,percent of total billed charges,65% of total billed charges,294.99,35.67,,235.992,percent of total billed charges,35.67% of total billed charges,153.19,1969.09,
MICRODISSECTION MANUAL,3100590,CDM,310,RC,88381,HCPCS,outpatient,,,149,59.60,TC,126.65,85,,101.32,percent of total billed charges,85% of total billed charges,114.73,77,,91.78,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,344.19,350,,,fee schedule,350% of BCBS fee schedule,357.96,364,,,fee schedule,364% of BCBS fee schedule,357.96,364,,,fee schedule,364% of BCBS fee schedule,357.96,364,,,fee schedule,364% of BCBS fee schedule,134.1,90,,107.28,percent of total billed charges,90% of total billed charges,119.2,80,,95.36,percent of total billed charges,80% of total billed charges,134.1,90,,107.28,percent of total billed charges,90% of total billed charges,111.75,75,,89.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,43.21,29,,34.568,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,99.83,67,,79.864,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,119.2,80,,95.36,percent of total billed charges,80% of total billed charges,96.85,65,,77.48,percent of total billed charges,65% of total billed charges,53.15,35.67,,42.52,percent of total billed charges,35.67% of total billed charges,43.21,357.96,
CYTOPATH CONCENTRATE TECH REPE,3101180,CDM,310,RC,88108,HCPCS,outpatient,,,67,26.80,TC91,56.95,85,,45.56,percent of total billed charges,85% of total billed charges,51.59,77,,41.27,percent of total billed charges,77% of total billed charges,35.07,100,,,fee schedule,100% of CMS OPPS rate,111.3,350,,,fee schedule,350% of BCBS fee schedule,115.75,364,,,fee schedule,364% of BCBS fee schedule,115.75,364,,,fee schedule,364% of BCBS fee schedule,115.75,364,,,fee schedule,364% of BCBS fee schedule,60.3,90,,48.24,percent of total billed charges,90% of total billed charges,53.6,80,,42.88,percent of total billed charges,80% of total billed charges,60.3,90,,48.24,percent of total billed charges,90% of total billed charges,50.25,75,,40.2,percent of total billed charges,75% of total billed charges,42.78,122,,,fee schedule,122% of APC rate,19.43,29,,15.544,percent of total billed charges,29% of total billed charges,35.07,100,,,fee schedule,100% of CMS OPPS rate,44.89,67,,35.912,percent of total billed charges,67% of total billed charges,15.91,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,53.6,80,,42.88,percent of total billed charges,80% of total billed charges,43.55,65,,34.84,percent of total billed charges,65% of total billed charges,23.9,35.67,,19.12,percent of total billed charges,35.67% of total billed charges,15.91,115.75,
FL BARIUM SWALLOW MODIFIED,10072895,CDM,320,RC,74230,HCPCS,outpatient,,,623,249.20,,529.55,85,,423.64,percent of total billed charges,85% of total billed charges,479.71,77,,383.77,percent of total billed charges,77% of total billed charges,160.68,100,,,fee schedule,100% of CMS OPPS rate,440.67,385,,,fee schedule,385% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,560.7,90,,448.56,percent of total billed charges,90% of total billed charges,498.4,80,,398.72,percent of total billed charges,80% of total billed charges,560.7,90,,448.56,percent of total billed charges,90% of total billed charges,467.25,75,,373.8,percent of total billed charges,75% of total billed charges,196.03,122,,,fee schedule,122% of APC rate,180.67,29,,144.536,percent of total billed charges,29% of total billed charges,160.68,100,,,fee schedule,100% of CMS OPPS rate,417.41,67,,333.928,percent of total billed charges,67% of total billed charges,80,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,498.4,80,,398.72,percent of total billed charges,80% of total billed charges,404.95,65,,323.96,percent of total billed charges,65% of total billed charges,222.22,35.67,,177.776,percent of total billed charges,35.67% of total billed charges,80,560.7,
ABDOMEN - (FLAT PLATE) 1 VIEW,3200010,CDM,320,RC,74018,HCPCS,outpatient,,,291,116.40,,247.35,85,,197.88,percent of total billed charges,85% of total billed charges,224.07,77,,179.26,percent of total billed charges,77% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,239.16,385,,,fee schedule,385% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,261.9,90,,209.52,percent of total billed charges,90% of total billed charges,232.8,80,,186.24,percent of total billed charges,80% of total billed charges,261.9,90,,209.52,percent of total billed charges,90% of total billed charges,218.25,75,,174.6,percent of total billed charges,75% of total billed charges,96.95,122,,,fee schedule,122% of APC rate,84.39,29,,67.512,percent of total billed charges,29% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,194.97,67,,155.976,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,232.8,80,,186.24,percent of total billed charges,80% of total billed charges,189.15,65,,151.32,percent of total billed charges,65% of total billed charges,103.8,35.67,,83.04,percent of total billed charges,35.67% of total billed charges,79.46,261.9,
ABDOMEN COMP. ACUTE & PA CHEST,3200015,CDM,320,RC,74022,HCPCS,outpatient,,,531,212.40,,451.35,85,,361.08,percent of total billed charges,85% of total billed charges,408.87,77,,327.1,percent of total billed charges,77% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,440.67,385,,,fee schedule,385% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,477.9,90,,382.32,percent of total billed charges,90% of total billed charges,424.8,80,,339.84,percent of total billed charges,80% of total billed charges,477.9,90,,382.32,percent of total billed charges,90% of total billed charges,398.25,75,,318.6,percent of total billed charges,75% of total billed charges,117.29,122,,,fee schedule,122% of APC rate,153.99,29,,123.192,percent of total billed charges,29% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,355.77,67,,284.616,percent of total billed charges,67% of total billed charges,70.34,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,424.8,80,,339.84,percent of total billed charges,80% of total billed charges,345.15,65,,276.12,percent of total billed charges,65% of total billed charges,189.41,35.67,,151.528,percent of total billed charges,35.67% of total billed charges,70.34,477.9,
ABDOMEN-LAT.DECUB.1 VIEW XRAY,3200020,CDM,320,RC,74018,HCPCS,outpatient,,,286,114.40,,243.1,85,,194.48,percent of total billed charges,85% of total billed charges,220.22,77,,176.18,percent of total billed charges,77% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,239.16,385,,,fee schedule,385% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,257.4,90,,205.92,percent of total billed charges,90% of total billed charges,228.8,80,,183.04,percent of total billed charges,80% of total billed charges,257.4,90,,205.92,percent of total billed charges,90% of total billed charges,214.5,75,,171.6,percent of total billed charges,75% of total billed charges,96.95,122,,,fee schedule,122% of APC rate,82.94,29,,66.352,percent of total billed charges,29% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,191.62,67,,153.296,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,228.8,80,,183.04,percent of total billed charges,80% of total billed charges,185.9,65,,148.72,percent of total billed charges,65% of total billed charges,102.02,35.67,,81.616,percent of total billed charges,35.67% of total billed charges,79.46,257.4,
ABDOMEN-LAT. DECUB.BILAT. XRAY,3200030,CDM,320,RC,74019,HCPCS,outpatient,,,522,208.80,,443.7,85,,354.96,percent of total billed charges,85% of total billed charges,401.94,77,,321.55,percent of total billed charges,77% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,440.67,385,,,fee schedule,385% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,469.8,90,,375.84,percent of total billed charges,90% of total billed charges,417.6,80,,334.08,percent of total billed charges,80% of total billed charges,469.8,90,,375.84,percent of total billed charges,90% of total billed charges,391.5,75,,313.2,percent of total billed charges,75% of total billed charges,117.29,122,,,fee schedule,122% of APC rate,151.38,29,,121.104,percent of total billed charges,29% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,349.74,67,,279.792,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,417.6,80,,334.08,percent of total billed charges,80% of total billed charges,339.3,65,,271.44,percent of total billed charges,65% of total billed charges,186.2,35.67,,148.96,percent of total billed charges,35.67% of total billed charges,96.14,469.8,
ABDOMEN-FLAT AND UPRIGHT XRAY,3200040,CDM,320,RC,74019,HCPCS,outpatient,,,531,212.40,,451.35,85,,361.08,percent of total billed charges,85% of total billed charges,408.87,77,,327.1,percent of total billed charges,77% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,440.67,385,,,fee schedule,385% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,477.9,90,,382.32,percent of total billed charges,90% of total billed charges,424.8,80,,339.84,percent of total billed charges,80% of total billed charges,477.9,90,,382.32,percent of total billed charges,90% of total billed charges,398.25,75,,318.6,percent of total billed charges,75% of total billed charges,117.29,122,,,fee schedule,122% of APC rate,153.99,29,,123.192,percent of total billed charges,29% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,355.77,67,,284.616,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,424.8,80,,339.84,percent of total billed charges,80% of total billed charges,345.15,65,,276.12,percent of total billed charges,65% of total billed charges,189.41,35.67,,151.528,percent of total billed charges,35.67% of total billed charges,96.14,477.9,
ABDOMEN - MULTIPLE VIEWS XRAY,3200060,CDM,320,RC,74021,HCPCS,outpatient,,,522,208.80,,443.7,85,,354.96,percent of total billed charges,85% of total billed charges,401.94,77,,321.55,percent of total billed charges,77% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,440.67,385,,,fee schedule,385% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,469.8,90,,375.84,percent of total billed charges,90% of total billed charges,417.6,80,,334.08,percent of total billed charges,80% of total billed charges,469.8,90,,375.84,percent of total billed charges,90% of total billed charges,391.5,75,,313.2,percent of total billed charges,75% of total billed charges,117.29,122,,,fee schedule,122% of APC rate,151.38,29,,121.104,percent of total billed charges,29% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,349.74,67,,279.792,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,417.6,80,,334.08,percent of total billed charges,80% of total billed charges,339.3,65,,271.44,percent of total billed charges,65% of total billed charges,186.2,35.67,,148.96,percent of total billed charges,35.67% of total billed charges,96.14,469.8,
ABDOMEN - IN O.R. XRAY,3200070,CDM,320,RC,74018,HCPCS,outpatient,,,286,114.40,,243.1,85,,194.48,percent of total billed charges,85% of total billed charges,220.22,77,,176.18,percent of total billed charges,77% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,239.16,385,,,fee schedule,385% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,257.4,90,,205.92,percent of total billed charges,90% of total billed charges,228.8,80,,183.04,percent of total billed charges,80% of total billed charges,257.4,90,,205.92,percent of total billed charges,90% of total billed charges,214.5,75,,171.6,percent of total billed charges,75% of total billed charges,96.95,122,,,fee schedule,122% of APC rate,82.94,29,,66.352,percent of total billed charges,29% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,191.62,67,,153.296,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,228.8,80,,183.04,percent of total billed charges,80% of total billed charges,185.9,65,,148.72,percent of total billed charges,65% of total billed charges,102.02,35.67,,81.616,percent of total billed charges,35.67% of total billed charges,79.46,257.4,
BARIUM SWALLOW WITH ST EVAL,32000871,CDM,320,RC,74230,HCPCS,outpatient,,,623,249.20,,529.55,85,,423.64,percent of total billed charges,85% of total billed charges,479.71,77,,383.77,percent of total billed charges,77% of total billed charges,160.68,100,,,fee schedule,100% of CMS OPPS rate,440.67,385,,,fee schedule,385% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,560.7,90,,448.56,percent of total billed charges,90% of total billed charges,498.4,80,,398.72,percent of total billed charges,80% of total billed charges,560.7,90,,448.56,percent of total billed charges,90% of total billed charges,467.25,75,,373.8,percent of total billed charges,75% of total billed charges,196.03,122,,,fee schedule,122% of APC rate,180.67,29,,144.536,percent of total billed charges,29% of total billed charges,160.68,100,,,fee schedule,100% of CMS OPPS rate,417.41,67,,333.928,percent of total billed charges,67% of total billed charges,80,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,498.4,80,,398.72,percent of total billed charges,80% of total billed charges,404.95,65,,323.96,percent of total billed charges,65% of total billed charges,222.22,35.67,,177.776,percent of total billed charges,35.67% of total billed charges,80,560.7,
ABDOMEN - UPRIGHT - XRAY,3200090,CDM,320,RC,74018,HCPCS,outpatient,,,286,114.40,,243.1,85,,194.48,percent of total billed charges,85% of total billed charges,220.22,77,,176.18,percent of total billed charges,77% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,239.16,385,,,fee schedule,385% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,257.4,90,,205.92,percent of total billed charges,90% of total billed charges,228.8,80,,183.04,percent of total billed charges,80% of total billed charges,257.4,90,,205.92,percent of total billed charges,90% of total billed charges,214.5,75,,171.6,percent of total billed charges,75% of total billed charges,96.95,122,,,fee schedule,122% of APC rate,82.94,29,,66.352,percent of total billed charges,29% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,191.62,67,,153.296,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,228.8,80,,183.04,percent of total billed charges,80% of total billed charges,185.9,65,,148.72,percent of total billed charges,65% of total billed charges,102.02,35.67,,81.616,percent of total billed charges,35.67% of total billed charges,79.46,257.4,
ACROMIOCLAVICULAR JOINTS-XRAY,3200100,CDM,320,RC,73050,HCPCS,outpatient,,,369,147.60,,313.65,85,,250.92,percent of total billed charges,85% of total billed charges,284.13,77,,227.3,percent of total billed charges,77% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,239.16,385,,,fee schedule,385% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,332.1,90,,265.68,percent of total billed charges,90% of total billed charges,295.2,80,,236.16,percent of total billed charges,80% of total billed charges,332.1,90,,265.68,percent of total billed charges,90% of total billed charges,276.75,75,,221.4,percent of total billed charges,75% of total billed charges,96.95,122,,,fee schedule,122% of APC rate,107.01,29,,85.608,percent of total billed charges,29% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,247.23,67,,197.784,percent of total billed charges,67% of total billed charges,41.76,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,295.2,80,,236.16,percent of total billed charges,80% of total billed charges,239.85,65,,191.88,percent of total billed charges,65% of total billed charges,131.62,35.67,,105.296,percent of total billed charges,35.67% of total billed charges,41.76,332.1,
ANKLE LEFT 3 VIEWS,3200120,CDM,320,RC,73610,HCPCS,outpatient,,,360,144.00,LT,306,85,,244.8,percent of total billed charges,85% of total billed charges,277.2,77,,221.76,percent of total billed charges,77% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,239.16,385,,,fee schedule,385% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,324,90,,259.2,percent of total billed charges,90% of total billed charges,288,80,,230.4,percent of total billed charges,80% of total billed charges,324,90,,259.2,percent of total billed charges,90% of total billed charges,270,75,,216,percent of total billed charges,75% of total billed charges,96.95,122,,,fee schedule,122% of APC rate,104.4,29,,83.52,percent of total billed charges,29% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,241.2,67,,192.96,percent of total billed charges,67% of total billed charges,41.76,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,288,80,,230.4,percent of total billed charges,80% of total billed charges,234,65,,187.2,percent of total billed charges,65% of total billed charges,128.41,35.67,,102.728,percent of total billed charges,35.67% of total billed charges,41.76,324,
ANKLE RIGHT 3 VIEWS,3200121,CDM,320,RC,73610,HCPCS,outpatient,,,360,144.00,RT,306,85,,244.8,percent of total billed charges,85% of total billed charges,277.2,77,,221.76,percent of total billed charges,77% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,239.16,385,,,fee schedule,385% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,324,90,,259.2,percent of total billed charges,90% of total billed charges,288,80,,230.4,percent of total billed charges,80% of total billed charges,324,90,,259.2,percent of total billed charges,90% of total billed charges,270,75,,216,percent of total billed charges,75% of total billed charges,96.95,122,,,fee schedule,122% of APC rate,104.4,29,,83.52,percent of total billed charges,29% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,241.2,67,,192.96,percent of total billed charges,67% of total billed charges,41.76,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,288,80,,230.4,percent of total billed charges,80% of total billed charges,234,65,,187.2,percent of total billed charges,65% of total billed charges,128.41,35.67,,102.728,percent of total billed charges,35.67% of total billed charges,41.76,324,
ANKLE LEFT 2 VIEWS,3200126,CDM,320,RC,73600,HCPCS,outpatient,,,291,116.40,LT,247.35,85,,197.88,percent of total billed charges,85% of total billed charges,224.07,77,,179.26,percent of total billed charges,77% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,239.16,385,,,fee schedule,385% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,261.9,90,,209.52,percent of total billed charges,90% of total billed charges,232.8,80,,186.24,percent of total billed charges,80% of total billed charges,261.9,90,,209.52,percent of total billed charges,90% of total billed charges,218.25,75,,174.6,percent of total billed charges,75% of total billed charges,96.95,122,,,fee schedule,122% of APC rate,84.39,29,,67.512,percent of total billed charges,29% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,194.97,67,,155.976,percent of total billed charges,67% of total billed charges,41.76,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,232.8,80,,186.24,percent of total billed charges,80% of total billed charges,189.15,65,,151.32,percent of total billed charges,65% of total billed charges,103.8,35.67,,83.04,percent of total billed charges,35.67% of total billed charges,41.76,261.9,
ANKLE RIGHT TWO VIEWS,3200127,CDM,320,RC,73600,HCPCS,outpatient,,,291,116.40,RT,247.35,85,,197.88,percent of total billed charges,85% of total billed charges,224.07,77,,179.26,percent of total billed charges,77% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,239.16,385,,,fee schedule,385% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,261.9,90,,209.52,percent of total billed charges,90% of total billed charges,232.8,80,,186.24,percent of total billed charges,80% of total billed charges,261.9,90,,209.52,percent of total billed charges,90% of total billed charges,218.25,75,,174.6,percent of total billed charges,75% of total billed charges,96.95,122,,,fee schedule,122% of APC rate,84.39,29,,67.512,percent of total billed charges,29% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,194.97,67,,155.976,percent of total billed charges,67% of total billed charges,41.76,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,232.8,80,,186.24,percent of total billed charges,80% of total billed charges,189.15,65,,151.32,percent of total billed charges,65% of total billed charges,103.8,35.67,,83.04,percent of total billed charges,35.67% of total billed charges,41.76,261.9,
ANKLE LEFT 4 VIEWS,3200130,CDM,320,RC,73610,HCPCS,outpatient,,,360,144.00,LT,306,85,,244.8,percent of total billed charges,85% of total billed charges,277.2,77,,221.76,percent of total billed charges,77% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,239.16,385,,,fee schedule,385% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,324,90,,259.2,percent of total billed charges,90% of total billed charges,288,80,,230.4,percent of total billed charges,80% of total billed charges,324,90,,259.2,percent of total billed charges,90% of total billed charges,270,75,,216,percent of total billed charges,75% of total billed charges,96.95,122,,,fee schedule,122% of APC rate,104.4,29,,83.52,percent of total billed charges,29% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,241.2,67,,192.96,percent of total billed charges,67% of total billed charges,41.76,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,288,80,,230.4,percent of total billed charges,80% of total billed charges,234,65,,187.2,percent of total billed charges,65% of total billed charges,128.41,35.67,,102.728,percent of total billed charges,35.67% of total billed charges,41.76,324,
ANKLE RIGHT 4 VIEWS,3200131,CDM,320,RC,73610,HCPCS,outpatient,,,360,144.00,RT,306,85,,244.8,percent of total billed charges,85% of total billed charges,277.2,77,,221.76,percent of total billed charges,77% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,239.16,385,,,fee schedule,385% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,324,90,,259.2,percent of total billed charges,90% of total billed charges,288,80,,230.4,percent of total billed charges,80% of total billed charges,324,90,,259.2,percent of total billed charges,90% of total billed charges,270,75,,216,percent of total billed charges,75% of total billed charges,96.95,122,,,fee schedule,122% of APC rate,104.4,29,,83.52,percent of total billed charges,29% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,241.2,67,,192.96,percent of total billed charges,67% of total billed charges,41.76,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,288,80,,230.4,percent of total billed charges,80% of total billed charges,234,65,,187.2,percent of total billed charges,65% of total billed charges,128.41,35.67,,102.728,percent of total billed charges,35.67% of total billed charges,41.76,324,
"CHEST,4V,AP,LAT,AP LORDOTIC",3200170,CDM,320,RC,71048,HCPCS,outpatient,,,522,208.80,,443.7,85,,354.96,percent of total billed charges,85% of total billed charges,401.94,77,,321.55,percent of total billed charges,77% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,440.67,385,,,fee schedule,385% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,469.8,90,,375.84,percent of total billed charges,90% of total billed charges,417.6,80,,334.08,percent of total billed charges,80% of total billed charges,469.8,90,,375.84,percent of total billed charges,90% of total billed charges,391.5,75,,313.2,percent of total billed charges,75% of total billed charges,117.29,122,,,fee schedule,122% of APC rate,151.38,29,,121.104,percent of total billed charges,29% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,349.74,67,,279.792,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,417.6,80,,334.08,percent of total billed charges,80% of total billed charges,339.3,65,,271.44,percent of total billed charges,65% of total billed charges,186.2,35.67,,148.96,percent of total billed charges,35.67% of total billed charges,96.14,469.8,
BARIUM ENEMA - XRAY,3200370,CDM,320,RC,74270,HCPCS,outpatient,,,1152,460.80,,979.2,85,,783.36,percent of total billed charges,85% of total billed charges,887.04,77,,709.63,percent of total billed charges,77% of total billed charges,160.68,100,,,fee schedule,100% of CMS OPPS rate,973.05,385,,,fee schedule,385% of BCBS fee schedule,1013.49,401,,,fee schedule,401% of BCBS fee schedule,1013.49,401,,,fee schedule,401% of BCBS fee schedule,1013.49,401,,,fee schedule,401% of BCBS fee schedule,1036.8,90,,829.44,percent of total billed charges,90% of total billed charges,921.6,80,,737.28,percent of total billed charges,80% of total billed charges,1036.8,90,,829.44,percent of total billed charges,90% of total billed charges,864,75,,691.2,percent of total billed charges,75% of total billed charges,196.03,122,,,fee schedule,122% of APC rate,334.08,29,,267.264,percent of total billed charges,29% of total billed charges,160.68,100,,,fee schedule,100% of CMS OPPS rate,771.84,67,,617.472,percent of total billed charges,67% of total billed charges,80,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,921.6,80,,737.28,percent of total billed charges,80% of total billed charges,748.8,65,,599.04,percent of total billed charges,65% of total billed charges,410.92,35.67,,328.736,percent of total billed charges,35.67% of total billed charges,80,1036.8,
BARIUM ENEMA W/AIR CONT. XRAY,3200380,CDM,320,RC,74280,HCPCS,outpatient,,,768,307.20,,652.8,85,,522.24,percent of total billed charges,85% of total billed charges,591.36,77,,473.09,percent of total billed charges,77% of total billed charges,160.68,100,,,fee schedule,100% of CMS OPPS rate,636.98,385,,,fee schedule,385% of BCBS fee schedule,663.45,401,,,fee schedule,401% of BCBS fee schedule,663.45,401,,,fee schedule,401% of BCBS fee schedule,663.45,401,,,fee schedule,401% of BCBS fee schedule,691.2,90,,552.96,percent of total billed charges,90% of total billed charges,614.4,80,,491.52,percent of total billed charges,80% of total billed charges,691.2,90,,552.96,percent of total billed charges,90% of total billed charges,576,75,,460.8,percent of total billed charges,75% of total billed charges,196.03,122,,,fee schedule,122% of APC rate,222.72,29,,178.176,percent of total billed charges,29% of total billed charges,160.68,100,,,fee schedule,100% of CMS OPPS rate,514.56,67,,411.648,percent of total billed charges,67% of total billed charges,132.56,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,614.4,80,,491.52,percent of total billed charges,80% of total billed charges,499.2,65,,399.36,percent of total billed charges,65% of total billed charges,273.95,35.67,,219.16,percent of total billed charges,35.67% of total billed charges,132.56,691.2,
PHARNGEL & SP EVAL CINE RECORD,3200385,CDM,320,RC,70371,HCPCS,outpatient,,,394,157.60,,334.9,85,,267.92,percent of total billed charges,85% of total billed charges,303.38,77,,242.7,percent of total billed charges,77% of total billed charges,214.29,100,,,fee schedule,100% of CMS OPPS rate,894.39,385,,,fee schedule,385% of BCBS fee schedule,931.56,401,,,fee schedule,401% of BCBS fee schedule,931.56,401,,,fee schedule,401% of BCBS fee schedule,931.56,401,,,fee schedule,401% of BCBS fee schedule,354.6,90,,283.68,percent of total billed charges,90% of total billed charges,315.2,80,,252.16,percent of total billed charges,80% of total billed charges,354.6,90,,283.68,percent of total billed charges,90% of total billed charges,295.5,75,,236.4,percent of total billed charges,75% of total billed charges,261.43,122,,,fee schedule,122% of APC rate,114.26,29,,91.408,percent of total billed charges,29% of total billed charges,214.29,100,,,fee schedule,100% of CMS OPPS rate,263.98,67,,211.184,percent of total billed charges,67% of total billed charges,82.15,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,315.2,80,,252.16,percent of total billed charges,80% of total billed charges,256.1,65,,204.88,percent of total billed charges,65% of total billed charges,140.54,35.67,,112.432,percent of total billed charges,35.67% of total billed charges,82.15,931.56,
BARIUM ENEMA W/GASTROGPH. XRAY,3200390,CDM,320,RC,74270,HCPCS,outpatient,,,1152,460.80,,979.2,85,,783.36,percent of total billed charges,85% of total billed charges,887.04,77,,709.63,percent of total billed charges,77% of total billed charges,160.68,100,,,fee schedule,100% of CMS OPPS rate,973.05,385,,,fee schedule,385% of BCBS fee schedule,1013.49,401,,,fee schedule,401% of BCBS fee schedule,1013.49,401,,,fee schedule,401% of BCBS fee schedule,1013.49,401,,,fee schedule,401% of BCBS fee schedule,1036.8,90,,829.44,percent of total billed charges,90% of total billed charges,921.6,80,,737.28,percent of total billed charges,80% of total billed charges,1036.8,90,,829.44,percent of total billed charges,90% of total billed charges,864,75,,691.2,percent of total billed charges,75% of total billed charges,196.03,122,,,fee schedule,122% of APC rate,334.08,29,,267.264,percent of total billed charges,29% of total billed charges,160.68,100,,,fee schedule,100% of CMS OPPS rate,771.84,67,,617.472,percent of total billed charges,67% of total billed charges,80,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,921.6,80,,737.28,percent of total billed charges,80% of total billed charges,748.8,65,,599.04,percent of total billed charges,65% of total billed charges,410.92,35.67,,328.736,percent of total billed charges,35.67% of total billed charges,80,1036.8,
BONE AGE STUDIES - XRAY,3200400,CDM,320,RC,77072,HCPCS,outpatient,,,522,208.80,,443.7,85,,354.96,percent of total billed charges,85% of total billed charges,401.94,77,,321.55,percent of total billed charges,77% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,440.67,385,,,fee schedule,385% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,469.8,90,,375.84,percent of total billed charges,90% of total billed charges,417.6,80,,334.08,percent of total billed charges,80% of total billed charges,469.8,90,,375.84,percent of total billed charges,90% of total billed charges,391.5,75,,313.2,percent of total billed charges,75% of total billed charges,117.29,122,,,fee schedule,122% of APC rate,151.38,29,,121.104,percent of total billed charges,29% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,349.74,67,,279.792,percent of total billed charges,67% of total billed charges,41.76,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,417.6,80,,334.08,percent of total billed charges,80% of total billed charges,339.3,65,,271.44,percent of total billed charges,65% of total billed charges,186.2,35.67,,148.96,percent of total billed charges,35.67% of total billed charges,41.76,469.8,
LUMBAR BENDING FILMS 2 OR 3 V,3200405,CDM,320,RC,72120,HCPCS,outpatient,,,522,208.80,,443.7,85,,354.96,percent of total billed charges,85% of total billed charges,401.94,77,,321.55,percent of total billed charges,77% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,440.67,385,,,fee schedule,385% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,469.8,90,,375.84,percent of total billed charges,90% of total billed charges,417.6,80,,334.08,percent of total billed charges,80% of total billed charges,469.8,90,,375.84,percent of total billed charges,90% of total billed charges,391.5,75,,313.2,percent of total billed charges,75% of total billed charges,117.29,122,,,fee schedule,122% of APC rate,151.38,29,,121.104,percent of total billed charges,29% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,349.74,67,,279.792,percent of total billed charges,67% of total billed charges,41.76,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,417.6,80,,334.08,percent of total billed charges,80% of total billed charges,339.3,65,,271.44,percent of total billed charges,65% of total billed charges,186.2,35.67,,148.96,percent of total billed charges,35.67% of total billed charges,41.76,469.8,
BONE LENGTH STUDY(LG.LEN.)XRAY,3200410,CDM,320,RC,77073,HCPCS,outpatient,,,522,208.80,,443.7,85,,354.96,percent of total billed charges,85% of total billed charges,401.94,77,,321.55,percent of total billed charges,77% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,440.67,385,,,fee schedule,385% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,469.8,90,,375.84,percent of total billed charges,90% of total billed charges,417.6,80,,334.08,percent of total billed charges,80% of total billed charges,469.8,90,,375.84,percent of total billed charges,90% of total billed charges,391.5,75,,313.2,percent of total billed charges,75% of total billed charges,117.29,122,,,fee schedule,122% of APC rate,151.38,29,,121.104,percent of total billed charges,29% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,349.74,67,,279.792,percent of total billed charges,67% of total billed charges,41.76,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,417.6,80,,334.08,percent of total billed charges,80% of total billed charges,339.3,65,,271.44,percent of total billed charges,65% of total billed charges,186.2,35.67,,148.96,percent of total billed charges,35.67% of total billed charges,41.76,469.8,
BARIUM SWALLOW/ESOPHAGRAM,3200470,CDM,320,RC,74220,HCPCS,outpatient,,,1175,470.00,,998.75,85,,799,percent of total billed charges,85% of total billed charges,904.75,77,,723.8,percent of total billed charges,77% of total billed charges,160.68,100,,,fee schedule,100% of CMS OPPS rate,973.05,385,,,fee schedule,385% of BCBS fee schedule,1013.49,401,,,fee schedule,401% of BCBS fee schedule,1013.49,401,,,fee schedule,401% of BCBS fee schedule,1013.49,401,,,fee schedule,401% of BCBS fee schedule,1057.5,90,,846,percent of total billed charges,90% of total billed charges,940,80,,752,percent of total billed charges,80% of total billed charges,1057.5,90,,846,percent of total billed charges,90% of total billed charges,881.25,75,,705,percent of total billed charges,75% of total billed charges,196.03,122,,,fee schedule,122% of APC rate,340.75,29,,272.6,percent of total billed charges,29% of total billed charges,160.68,100,,,fee schedule,100% of CMS OPPS rate,787.25,67,,629.8,percent of total billed charges,67% of total billed charges,80,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,940,80,,752,percent of total billed charges,80% of total billed charges,763.75,65,,611,percent of total billed charges,65% of total billed charges,419.12,35.67,,335.296,percent of total billed charges,35.67% of total billed charges,80,1057.5,
CHOLECYSTOGRAM - GB - XRAY,3200500,CDM,320,RC,74290,HCPCS,outpatient,,,1152,460.80,,979.2,85,,783.36,percent of total billed charges,85% of total billed charges,887.04,77,,709.63,percent of total billed charges,77% of total billed charges,160.68,100,,,fee schedule,100% of CMS OPPS rate,973.05,385,,,fee schedule,385% of BCBS fee schedule,1013.49,401,,,fee schedule,401% of BCBS fee schedule,1013.49,401,,,fee schedule,401% of BCBS fee schedule,1013.49,401,,,fee schedule,401% of BCBS fee schedule,1036.8,90,,829.44,percent of total billed charges,90% of total billed charges,921.6,80,,737.28,percent of total billed charges,80% of total billed charges,1036.8,90,,829.44,percent of total billed charges,90% of total billed charges,864,75,,691.2,percent of total billed charges,75% of total billed charges,196.03,122,,,fee schedule,122% of APC rate,334.08,29,,267.264,percent of total billed charges,29% of total billed charges,160.68,100,,,fee schedule,100% of CMS OPPS rate,771.84,67,,617.472,percent of total billed charges,67% of total billed charges,80,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,921.6,80,,737.28,percent of total billed charges,80% of total billed charges,748.8,65,,599.04,percent of total billed charges,65% of total billed charges,410.92,35.67,,328.736,percent of total billed charges,35.67% of total billed charges,80,1036.8,
CHOLANGIOGRAM - OPERATIVE;XRAY,3200510,CDM,320,RC,74300,HCPCS,outpatient,,,2073,829.20,,1762.05,85,,1409.64,percent of total billed charges,85% of total billed charges,1596.21,77,,1276.97,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,71.84,385,,,fee schedule,385% of BCBS fee schedule,74.83,401,,,fee schedule,401% of BCBS fee schedule,74.83,401,,,fee schedule,401% of BCBS fee schedule,74.83,401,,,fee schedule,401% of BCBS fee schedule,1865.7,90,,1492.56,percent of total billed charges,90% of total billed charges,1658.4,80,,1326.72,percent of total billed charges,80% of total billed charges,1865.7,90,,1492.56,percent of total billed charges,90% of total billed charges,1554.75,75,,1243.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,601.17,29,,480.936,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1388.91,67,,1111.128,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1658.4,80,,1326.72,percent of total billed charges,80% of total billed charges,1347.45,65,,1077.96,percent of total billed charges,65% of total billed charges,739.44,35.67,,591.552,percent of total billed charges,35.67% of total billed charges,71.84,1865.7,
CHOLANGIOGRAM-ADD'L FILMS,3200511,CDM,320,RC,74301,HCPCS,outpatient,,,2073,829.20,,1762.05,85,,1409.64,percent of total billed charges,85% of total billed charges,1596.21,77,,1276.97,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,41.46,385,,,fee schedule,385% of BCBS fee schedule,43.19,401,,,fee schedule,401% of BCBS fee schedule,43.19,401,,,fee schedule,401% of BCBS fee schedule,43.19,401,,,fee schedule,401% of BCBS fee schedule,1865.7,90,,1492.56,percent of total billed charges,90% of total billed charges,1658.4,80,,1326.72,percent of total billed charges,80% of total billed charges,1865.7,90,,1492.56,percent of total billed charges,90% of total billed charges,1554.75,75,,1243.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,601.17,29,,480.936,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1388.91,67,,1111.128,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1658.4,80,,1326.72,percent of total billed charges,80% of total billed charges,1347.45,65,,1077.96,percent of total billed charges,65% of total billed charges,739.44,35.67,,591.552,percent of total billed charges,35.67% of total billed charges,41.46,1865.7,
CHOLANGIOGRAM -T-TUBE - XRAY,3200520,CDM,320,RC,47532,HCPCS,outpatient,,,5634,2253.60,,1150,,,,case rate,pays based on per visit,4338.18,77,,3470.54,percent of total billed charges,77% of total billed charges,3025.57,100,,,fee schedule,100% of CMS OPPS rate,4619.88,82,,3695.904,percent of total billed charges,82% of total billed charges,4788.9,85,,3831.12,percent of total billed charges,85% of total billed charges,4788.9,85,,3831.12,percent of total billed charges,85% of total billed charges,4788.9,85,,3831.12,percent of total billed charges,85% of total billed charges,5070.6,90,,4056.48,percent of total billed charges,90% of total billed charges,4507.2,80,,3605.76,percent of total billed charges,80% of total billed charges,5070.6,90,,4056.48,percent of total billed charges,90% of total billed charges,4225.5,75,,3380.4,percent of total billed charges,75% of total billed charges,3691.2,122,,,fee schedule,122% of APC rate,1633.86,29,,1307.088,percent of total billed charges,29% of total billed charges,3025.57,100,,,fee schedule,100% of CMS OPPS rate,3774.78,67,,3019.824,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,4507.2,80,,3605.76,percent of total billed charges,80% of total billed charges,3662.1,65,,2929.68,percent of total billed charges,65% of total billed charges,2009.65,35.67,,1607.72,percent of total billed charges,35.67% of total billed charges,1150,5070.6,
"CLAVICLE XRAY, LEFT",3200540,CDM,320,RC,73000,HCPCS,outpatient,,,291,116.40,LT,247.35,85,,197.88,percent of total billed charges,85% of total billed charges,224.07,77,,179.26,percent of total billed charges,77% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,239.16,385,,,fee schedule,385% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,261.9,90,,209.52,percent of total billed charges,90% of total billed charges,232.8,80,,186.24,percent of total billed charges,80% of total billed charges,261.9,90,,209.52,percent of total billed charges,90% of total billed charges,218.25,75,,174.6,percent of total billed charges,75% of total billed charges,96.95,122,,,fee schedule,122% of APC rate,84.39,29,,67.512,percent of total billed charges,29% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,194.97,67,,155.976,percent of total billed charges,67% of total billed charges,41.76,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,232.8,80,,186.24,percent of total billed charges,80% of total billed charges,189.15,65,,151.32,percent of total billed charges,65% of total billed charges,103.8,35.67,,83.04,percent of total billed charges,35.67% of total billed charges,41.76,261.9,
"CLAVICLE XRAY, RIGHT",3200541,CDM,320,RC,73000,HCPCS,outpatient,,,291,116.40,RT,247.35,85,,197.88,percent of total billed charges,85% of total billed charges,224.07,77,,179.26,percent of total billed charges,77% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,239.16,385,,,fee schedule,385% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,261.9,90,,209.52,percent of total billed charges,90% of total billed charges,232.8,80,,186.24,percent of total billed charges,80% of total billed charges,261.9,90,,209.52,percent of total billed charges,90% of total billed charges,218.25,75,,174.6,percent of total billed charges,75% of total billed charges,96.95,122,,,fee schedule,122% of APC rate,84.39,29,,67.512,percent of total billed charges,29% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,194.97,67,,155.976,percent of total billed charges,67% of total billed charges,41.76,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,232.8,80,,186.24,percent of total billed charges,80% of total billed charges,189.15,65,,151.32,percent of total billed charges,65% of total billed charges,103.8,35.67,,83.04,percent of total billed charges,35.67% of total billed charges,41.76,261.9,
COCCYX MIN 2 V XRAY,3200580,CDM,320,RC,72220,HCPCS,outpatient,,,522,208.80,,443.7,85,,354.96,percent of total billed charges,85% of total billed charges,401.94,77,,321.55,percent of total billed charges,77% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,239.16,385,,,fee schedule,385% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,469.8,90,,375.84,percent of total billed charges,90% of total billed charges,417.6,80,,334.08,percent of total billed charges,80% of total billed charges,469.8,90,,375.84,percent of total billed charges,90% of total billed charges,391.5,75,,313.2,percent of total billed charges,75% of total billed charges,96.95,122,,,fee schedule,122% of APC rate,151.38,29,,121.104,percent of total billed charges,29% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,349.74,67,,279.792,percent of total billed charges,67% of total billed charges,41.76,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,417.6,80,,334.08,percent of total billed charges,80% of total billed charges,339.3,65,,271.44,percent of total billed charges,65% of total billed charges,186.2,35.67,,148.96,percent of total billed charges,35.67% of total billed charges,41.76,469.8,
CERVICAL SPINE 4 OR 5 VIEWS,3200600,CDM,320,RC,72050,HCPCS,outpatient,,,531,212.40,,451.35,85,,361.08,percent of total billed charges,85% of total billed charges,408.87,77,,327.1,percent of total billed charges,77% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,440.67,385,,,fee schedule,385% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,477.9,90,,382.32,percent of total billed charges,90% of total billed charges,424.8,80,,339.84,percent of total billed charges,80% of total billed charges,477.9,90,,382.32,percent of total billed charges,90% of total billed charges,398.25,75,,318.6,percent of total billed charges,75% of total billed charges,117.29,122,,,fee schedule,122% of APC rate,153.99,29,,123.192,percent of total billed charges,29% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,355.77,67,,284.616,percent of total billed charges,67% of total billed charges,70.34,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,424.8,80,,339.84,percent of total billed charges,80% of total billed charges,345.15,65,,276.12,percent of total billed charges,65% of total billed charges,189.41,35.67,,151.528,percent of total billed charges,35.67% of total billed charges,70.34,477.9,
CERVICAL SPINE FLEX & EXT.XRAY,3200630,CDM,320,RC,72052,HCPCS,outpatient,,,531,212.40,,451.35,85,,361.08,percent of total billed charges,85% of total billed charges,408.87,77,,327.1,percent of total billed charges,77% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,440.67,385,,,fee schedule,385% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,477.9,90,,382.32,percent of total billed charges,90% of total billed charges,424.8,80,,339.84,percent of total billed charges,80% of total billed charges,477.9,90,,382.32,percent of total billed charges,90% of total billed charges,398.25,75,,318.6,percent of total billed charges,75% of total billed charges,117.29,122,,,fee schedule,122% of APC rate,153.99,29,,123.192,percent of total billed charges,29% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,355.77,67,,284.616,percent of total billed charges,67% of total billed charges,70.34,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,424.8,80,,339.84,percent of total billed charges,80% of total billed charges,345.15,65,,276.12,percent of total billed charges,65% of total billed charges,189.41,35.67,,151.528,percent of total billed charges,35.67% of total billed charges,70.34,477.9,
CERVICAL SPINE FLEX & EXT ONLY,3200631,CDM,320,RC,72040,HCPCS,outpatient,,,360,144.00,,306,85,,244.8,percent of total billed charges,85% of total billed charges,277.2,77,,221.76,percent of total billed charges,77% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,239.16,385,,,fee schedule,385% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,324,90,,259.2,percent of total billed charges,90% of total billed charges,288,80,,230.4,percent of total billed charges,80% of total billed charges,324,90,,259.2,percent of total billed charges,90% of total billed charges,270,75,,216,percent of total billed charges,75% of total billed charges,96.95,122,,,fee schedule,122% of APC rate,104.4,29,,83.52,percent of total billed charges,29% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,241.2,67,,192.96,percent of total billed charges,67% of total billed charges,41.76,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,288,80,,230.4,percent of total billed charges,80% of total billed charges,234,65,,187.2,percent of total billed charges,65% of total billed charges,128.41,35.67,,102.728,percent of total billed charges,35.67% of total billed charges,41.76,324,
CERVICAL SPINE 3 VIEWS OR LESS,3200635,CDM,320,RC,72040,HCPCS,outpatient,,,360,144.00,,306,85,,244.8,percent of total billed charges,85% of total billed charges,277.2,77,,221.76,percent of total billed charges,77% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,239.16,385,,,fee schedule,385% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,324,90,,259.2,percent of total billed charges,90% of total billed charges,288,80,,230.4,percent of total billed charges,80% of total billed charges,324,90,,259.2,percent of total billed charges,90% of total billed charges,270,75,,216,percent of total billed charges,75% of total billed charges,96.95,122,,,fee schedule,122% of APC rate,104.4,29,,83.52,percent of total billed charges,29% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,241.2,67,,192.96,percent of total billed charges,67% of total billed charges,41.76,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,288,80,,230.4,percent of total billed charges,80% of total billed charges,234,65,,187.2,percent of total billed charges,65% of total billed charges,128.41,35.67,,102.728,percent of total billed charges,35.67% of total billed charges,41.76,324,
CHEST FLOUROSCOPY- 2 V XRAY,3200640,CDM,320,RC,71046,HCPCS,outpatient,,,319,127.60,,271.15,85,,216.92,percent of total billed charges,85% of total billed charges,245.63,77,,196.5,percent of total billed charges,77% of total billed charges,79.45,100,,,fee schedule,100% of CMS OPPS rate,239.16,385,,,fee schedule,385% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,287.1,90,,229.68,percent of total billed charges,90% of total billed charges,255.2,80,,204.16,percent of total billed charges,80% of total billed charges,287.1,90,,229.68,percent of total billed charges,90% of total billed charges,239.25,75,,191.4,percent of total billed charges,75% of total billed charges,96.94,122,,,fee schedule,122% of APC rate,92.51,29,,74.008,percent of total billed charges,29% of total billed charges,79.45,100,,,fee schedule,100% of CMS OPPS rate,213.73,67,,170.984,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,255.2,80,,204.16,percent of total billed charges,80% of total billed charges,207.35,65,,165.88,percent of total billed charges,65% of total billed charges,113.79,35.67,,91.032,percent of total billed charges,35.67% of total billed charges,79.45,287.1,
CYSTOGRAM - XRAY,3200730,CDM,320,RC,,,outpatient,,,1152,460.80,,979.2,85,,783.36,percent of total billed charges,85% of total billed charges,887.04,77,,709.63,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,944.64,82,,755.712,percent of total billed charges,82% of total billed charges,979.2,85,,783.36,percent of total billed charges,85% of total billed charges,979.2,85,,783.36,percent of total billed charges,85% of total billed charges,979.2,85,,783.36,percent of total billed charges,85% of total billed charges,1036.8,90,,829.44,percent of total billed charges,90% of total billed charges,921.6,80,,737.28,percent of total billed charges,80% of total billed charges,1036.8,90,,829.44,percent of total billed charges,90% of total billed charges,864,75,,691.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,334.08,29,,267.264,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,771.84,67,,617.472,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,921.6,80,,737.28,percent of total billed charges,80% of total billed charges,748.8,65,,599.04,percent of total billed charges,65% of total billed charges,410.92,35.67,,328.736,percent of total billed charges,35.67% of total billed charges,334.08,1036.8,
INJECTION PROC FOR CYSTOGRAM,3200731,CDM,320,RC,51600,HCPCS,outpatient,,,357,142.80,,1150,,,,case rate,pays based on per visit,274.89,77,,219.91,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,292.74,82,,234.192,percent of total billed charges,82% of total billed charges,303.45,85,,242.76,percent of total billed charges,85% of total billed charges,303.45,85,,242.76,percent of total billed charges,85% of total billed charges,303.45,85,,242.76,percent of total billed charges,85% of total billed charges,321.3,90,,257.04,percent of total billed charges,90% of total billed charges,285.6,80,,228.48,percent of total billed charges,80% of total billed charges,321.3,90,,257.04,percent of total billed charges,90% of total billed charges,267.75,75,,214.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,103.53,29,,82.824,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,239.19,67,,191.352,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,285.6,80,,228.48,percent of total billed charges,80% of total billed charges,232.05,65,,185.64,percent of total billed charges,65% of total billed charges,127.34,35.67,,101.872,percent of total billed charges,35.67% of total billed charges,103.53,1150,
CYSTOGRAM XRAY,3200732,CDM,320,RC,74430,HCPCS,outpatient,,,593,237.20,,504.05,85,,403.24,percent of total billed charges,85% of total billed charges,456.61,77,,365.29,percent of total billed charges,77% of total billed charges,336.32,100,,,fee schedule,100% of CMS OPPS rate,973.05,385,,,fee schedule,385% of BCBS fee schedule,1013.49,401,,,fee schedule,401% of BCBS fee schedule,1013.49,401,,,fee schedule,401% of BCBS fee schedule,1013.49,401,,,fee schedule,401% of BCBS fee schedule,533.7,90,,426.96,percent of total billed charges,90% of total billed charges,474.4,80,,379.52,percent of total billed charges,80% of total billed charges,533.7,90,,426.96,percent of total billed charges,90% of total billed charges,444.75,75,,355.8,percent of total billed charges,75% of total billed charges,410.31,122,,,fee schedule,122% of APC rate,171.97,29,,137.576,percent of total billed charges,29% of total billed charges,336.32,100,,,fee schedule,100% of CMS OPPS rate,397.31,67,,317.848,percent of total billed charges,67% of total billed charges,171.39,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,474.4,80,,379.52,percent of total billed charges,80% of total billed charges,385.45,65,,308.36,percent of total billed charges,65% of total billed charges,211.52,35.67,,169.216,percent of total billed charges,35.67% of total billed charges,171.39,1013.49,
CYSTOGRAM - IN O.R. - XRAY,3200740,CDM,320,RC,74430,HCPCS,outpatient,,,1152,460.80,,979.2,85,,783.36,percent of total billed charges,85% of total billed charges,887.04,77,,709.63,percent of total billed charges,77% of total billed charges,336.32,100,,,fee schedule,100% of CMS OPPS rate,973.05,385,,,fee schedule,385% of BCBS fee schedule,1013.49,401,,,fee schedule,401% of BCBS fee schedule,1013.49,401,,,fee schedule,401% of BCBS fee schedule,1013.49,401,,,fee schedule,401% of BCBS fee schedule,1036.8,90,,829.44,percent of total billed charges,90% of total billed charges,921.6,80,,737.28,percent of total billed charges,80% of total billed charges,1036.8,90,,829.44,percent of total billed charges,90% of total billed charges,864,75,,691.2,percent of total billed charges,75% of total billed charges,410.31,122,,,fee schedule,122% of APC rate,334.08,29,,267.264,percent of total billed charges,29% of total billed charges,336.32,100,,,fee schedule,100% of CMS OPPS rate,771.84,67,,617.472,percent of total billed charges,67% of total billed charges,171.39,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,921.6,80,,737.28,percent of total billed charges,80% of total billed charges,748.8,65,,599.04,percent of total billed charges,65% of total billed charges,410.92,35.67,,328.736,percent of total billed charges,35.67% of total billed charges,171.39,1036.8,
CYSTOGRAM - STRESS - XRAY,3200750,CDM,320,RC,74430,HCPCS,outpatient,,,1152,460.80,,979.2,85,,783.36,percent of total billed charges,85% of total billed charges,887.04,77,,709.63,percent of total billed charges,77% of total billed charges,336.32,100,,,fee schedule,100% of CMS OPPS rate,973.05,385,,,fee schedule,385% of BCBS fee schedule,1013.49,401,,,fee schedule,401% of BCBS fee schedule,1013.49,401,,,fee schedule,401% of BCBS fee schedule,1013.49,401,,,fee schedule,401% of BCBS fee schedule,1036.8,90,,829.44,percent of total billed charges,90% of total billed charges,921.6,80,,737.28,percent of total billed charges,80% of total billed charges,1036.8,90,,829.44,percent of total billed charges,90% of total billed charges,864,75,,691.2,percent of total billed charges,75% of total billed charges,410.31,122,,,fee schedule,122% of APC rate,334.08,29,,267.264,percent of total billed charges,29% of total billed charges,336.32,100,,,fee schedule,100% of CMS OPPS rate,771.84,67,,617.472,percent of total billed charges,67% of total billed charges,171.39,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,921.6,80,,737.28,percent of total billed charges,80% of total billed charges,748.8,65,,599.04,percent of total billed charges,65% of total billed charges,410.92,35.67,,328.736,percent of total billed charges,35.67% of total billed charges,171.39,1036.8,
BONE DENSITY HIPS/PELVIS/SPINE,3200755,CDM,320,RC,77080,HCPCS,outpatient,,,517,206.80,,439.45,85,,351.56,percent of total billed charges,85% of total billed charges,398.09,77,,318.47,percent of total billed charges,77% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,124.36,385,,,fee schedule,385% of BCBS fee schedule,129.52,401,,,fee schedule,401% of BCBS fee schedule,129.52,401,,,fee schedule,401% of BCBS fee schedule,129.52,401,,,fee schedule,401% of BCBS fee schedule,465.3,90,,372.24,percent of total billed charges,90% of total billed charges,413.6,80,,330.88,percent of total billed charges,80% of total billed charges,465.3,90,,372.24,percent of total billed charges,90% of total billed charges,387.75,75,,310.2,percent of total billed charges,75% of total billed charges,117.29,122,,,fee schedule,122% of APC rate,149.93,29,,119.944,percent of total billed charges,29% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,346.39,67,,277.112,percent of total billed charges,67% of total billed charges,66.62,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,413.6,80,,330.88,percent of total billed charges,80% of total billed charges,336.05,65,,268.84,percent of total billed charges,65% of total billed charges,184.41,35.67,,147.528,percent of total billed charges,35.67% of total billed charges,66.62,465.3,
"ELBOW 2 VIEWS, LEFT",3200805,CDM,320,RC,73070,HCPCS,outpatient,,,291,116.40,LT,247.35,85,,197.88,percent of total billed charges,85% of total billed charges,224.07,77,,179.26,percent of total billed charges,77% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,239.16,385,,,fee schedule,385% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,261.9,90,,209.52,percent of total billed charges,90% of total billed charges,232.8,80,,186.24,percent of total billed charges,80% of total billed charges,261.9,90,,209.52,percent of total billed charges,90% of total billed charges,218.25,75,,174.6,percent of total billed charges,75% of total billed charges,96.95,122,,,fee schedule,122% of APC rate,84.39,29,,67.512,percent of total billed charges,29% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,194.97,67,,155.976,percent of total billed charges,67% of total billed charges,41.76,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,232.8,80,,186.24,percent of total billed charges,80% of total billed charges,189.15,65,,151.32,percent of total billed charges,65% of total billed charges,103.8,35.67,,83.04,percent of total billed charges,35.67% of total billed charges,41.76,261.9,
"ELBOW RIGHT, TWO VIEWS",3200806,CDM,320,RC,73070,HCPCS,outpatient,,,291,116.40,RT,247.35,85,,197.88,percent of total billed charges,85% of total billed charges,224.07,77,,179.26,percent of total billed charges,77% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,239.16,385,,,fee schedule,385% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,261.9,90,,209.52,percent of total billed charges,90% of total billed charges,232.8,80,,186.24,percent of total billed charges,80% of total billed charges,261.9,90,,209.52,percent of total billed charges,90% of total billed charges,218.25,75,,174.6,percent of total billed charges,75% of total billed charges,96.95,122,,,fee schedule,122% of APC rate,84.39,29,,67.512,percent of total billed charges,29% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,194.97,67,,155.976,percent of total billed charges,67% of total billed charges,41.76,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,232.8,80,,186.24,percent of total billed charges,80% of total billed charges,189.15,65,,151.32,percent of total billed charges,65% of total billed charges,103.8,35.67,,83.04,percent of total billed charges,35.67% of total billed charges,41.76,261.9,
"ELBOW LEFT, 4 VIEWS",3200810,CDM,320,RC,73080,HCPCS,outpatient,,,291,116.40,LT,247.35,85,,197.88,percent of total billed charges,85% of total billed charges,224.07,77,,179.26,percent of total billed charges,77% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,239.16,385,,,fee schedule,385% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,261.9,90,,209.52,percent of total billed charges,90% of total billed charges,232.8,80,,186.24,percent of total billed charges,80% of total billed charges,261.9,90,,209.52,percent of total billed charges,90% of total billed charges,218.25,75,,174.6,percent of total billed charges,75% of total billed charges,96.95,122,,,fee schedule,122% of APC rate,84.39,29,,67.512,percent of total billed charges,29% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,194.97,67,,155.976,percent of total billed charges,67% of total billed charges,41.76,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,232.8,80,,186.24,percent of total billed charges,80% of total billed charges,189.15,65,,151.32,percent of total billed charges,65% of total billed charges,103.8,35.67,,83.04,percent of total billed charges,35.67% of total billed charges,41.76,261.9,
"ELBOW, RIGHT 3-4 V COMPLETE",3200811,CDM,320,RC,73080,HCPCS,outpatient,,,291,116.40,RT,247.35,85,,197.88,percent of total billed charges,85% of total billed charges,224.07,77,,179.26,percent of total billed charges,77% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,239.16,385,,,fee schedule,385% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,261.9,90,,209.52,percent of total billed charges,90% of total billed charges,232.8,80,,186.24,percent of total billed charges,80% of total billed charges,261.9,90,,209.52,percent of total billed charges,90% of total billed charges,218.25,75,,174.6,percent of total billed charges,75% of total billed charges,96.95,122,,,fee schedule,122% of APC rate,84.39,29,,67.512,percent of total billed charges,29% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,194.97,67,,155.976,percent of total billed charges,67% of total billed charges,41.76,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,232.8,80,,186.24,percent of total billed charges,80% of total billed charges,189.15,65,,151.32,percent of total billed charges,65% of total billed charges,103.8,35.67,,83.04,percent of total billed charges,35.67% of total billed charges,41.76,261.9,
ESOPHAGUS FLOUROSCOPY - XRAY,3200880,CDM,320,RC,76496,HCPCS,outpatient,,,364,145.60,,309.4,85,,247.52,percent of total billed charges,85% of total billed charges,280.28,77,,224.22,percent of total billed charges,77% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,239.16,385,,,fee schedule,385% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,327.6,90,,262.08,percent of total billed charges,90% of total billed charges,291.2,80,,232.96,percent of total billed charges,80% of total billed charges,327.6,90,,262.08,percent of total billed charges,90% of total billed charges,273,75,,218.4,percent of total billed charges,75% of total billed charges,96.95,122,,,fee schedule,122% of APC rate,105.56,29,,84.448,percent of total billed charges,29% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,243.88,67,,195.104,percent of total billed charges,67% of total billed charges,82.15,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,291.2,80,,232.96,percent of total billed charges,80% of total billed charges,236.6,65,,189.28,percent of total billed charges,65% of total billed charges,129.84,35.67,,103.872,percent of total billed charges,35.67% of total billed charges,79.46,327.6,
ESOPHAGRAM - XRAY,3200885,CDM,320,RC,74220,HCPCS,outpatient,,,1152,460.80,,979.2,85,,783.36,percent of total billed charges,85% of total billed charges,887.04,77,,709.63,percent of total billed charges,77% of total billed charges,160.68,100,,,fee schedule,100% of CMS OPPS rate,973.05,385,,,fee schedule,385% of BCBS fee schedule,1013.49,401,,,fee schedule,401% of BCBS fee schedule,1013.49,401,,,fee schedule,401% of BCBS fee schedule,1013.49,401,,,fee schedule,401% of BCBS fee schedule,1036.8,90,,829.44,percent of total billed charges,90% of total billed charges,921.6,80,,737.28,percent of total billed charges,80% of total billed charges,1036.8,90,,829.44,percent of total billed charges,90% of total billed charges,864,75,,691.2,percent of total billed charges,75% of total billed charges,196.03,122,,,fee schedule,122% of APC rate,334.08,29,,267.264,percent of total billed charges,29% of total billed charges,160.68,100,,,fee schedule,100% of CMS OPPS rate,771.84,67,,617.472,percent of total billed charges,67% of total billed charges,80,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,921.6,80,,737.28,percent of total billed charges,80% of total billed charges,748.8,65,,599.04,percent of total billed charges,65% of total billed charges,410.92,35.67,,328.736,percent of total billed charges,35.67% of total billed charges,80,1036.8,
FACIAL BONES MIN 3 V,3200890,CDM,320,RC,70150,HCPCS,outpatient,,,531,212.40,,451.35,85,,361.08,percent of total billed charges,85% of total billed charges,408.87,77,,327.1,percent of total billed charges,77% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,440.67,385,,,fee schedule,385% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,477.9,90,,382.32,percent of total billed charges,90% of total billed charges,424.8,80,,339.84,percent of total billed charges,80% of total billed charges,477.9,90,,382.32,percent of total billed charges,90% of total billed charges,398.25,75,,318.6,percent of total billed charges,75% of total billed charges,117.29,122,,,fee schedule,122% of APC rate,153.99,29,,123.192,percent of total billed charges,29% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,355.77,67,,284.616,percent of total billed charges,67% of total billed charges,41.76,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,424.8,80,,339.84,percent of total billed charges,80% of total billed charges,345.15,65,,276.12,percent of total billed charges,65% of total billed charges,189.41,35.67,,151.528,percent of total billed charges,35.67% of total billed charges,41.76,477.9,
FLOUROSCOPY CHARGE  - 1.5 HOUR,3200910,CDM,320,RC,77001,HCPCS,outpatient,,,450,180.00,,382.5,85,,306,percent of total billed charges,85% of total billed charges,346.5,77,,277.2,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,255.6,385,,,fee schedule,385% of BCBS fee schedule,266.22,401,,,fee schedule,401% of BCBS fee schedule,266.22,401,,,fee schedule,401% of BCBS fee schedule,266.22,401,,,fee schedule,401% of BCBS fee schedule,405,90,,324,percent of total billed charges,90% of total billed charges,360,80,,288,percent of total billed charges,80% of total billed charges,405,90,,324,percent of total billed charges,90% of total billed charges,337.5,75,,270,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,130.5,29,,104.4,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,301.5,67,,241.2,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,360,80,,288,percent of total billed charges,80% of total billed charges,292.5,65,,234,percent of total billed charges,65% of total billed charges,160.52,35.67,,128.416,percent of total billed charges,35.67% of total billed charges,130.5,405,
FLUORO MISC LESS 1 HR,3200915,CDM,320,RC,76000,HCPCS,outpatient,,,383,153.20,,325.55,85,,260.44,percent of total billed charges,85% of total billed charges,294.91,77,,235.93,percent of total billed charges,77% of total billed charges,214.29,100,,,fee schedule,100% of CMS OPPS rate,152,385,,,fee schedule,385% of BCBS fee schedule,158.31,401,,,fee schedule,401% of BCBS fee schedule,158.31,401,,,fee schedule,401% of BCBS fee schedule,158.31,401,,,fee schedule,401% of BCBS fee schedule,344.7,90,,275.76,percent of total billed charges,90% of total billed charges,306.4,80,,245.12,percent of total billed charges,80% of total billed charges,344.7,90,,275.76,percent of total billed charges,90% of total billed charges,287.25,75,,229.8,percent of total billed charges,75% of total billed charges,261.43,122,,,fee schedule,122% of APC rate,111.07,29,,88.856,percent of total billed charges,29% of total billed charges,214.29,100,,,fee schedule,100% of CMS OPPS rate,256.61,67,,205.288,percent of total billed charges,67% of total billed charges,82.15,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,306.4,80,,245.12,percent of total billed charges,80% of total billed charges,248.95,65,,199.16,percent of total billed charges,65% of total billed charges,136.62,35.67,,109.296,percent of total billed charges,35.67% of total billed charges,82.15,344.7,
FEMUR MIN 2 V LT,3200920,CDM,320,RC,73552,HCPCS,outpatient,,,291,116.40,LT,247.35,85,,197.88,percent of total billed charges,85% of total billed charges,224.07,77,,179.26,percent of total billed charges,77% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,239.16,385,,,fee schedule,385% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,261.9,90,,209.52,percent of total billed charges,90% of total billed charges,232.8,80,,186.24,percent of total billed charges,80% of total billed charges,261.9,90,,209.52,percent of total billed charges,90% of total billed charges,218.25,75,,174.6,percent of total billed charges,75% of total billed charges,96.95,122,,,fee schedule,122% of APC rate,84.39,29,,67.512,percent of total billed charges,29% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,194.97,67,,155.976,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,232.8,80,,186.24,percent of total billed charges,80% of total billed charges,189.15,65,,151.32,percent of total billed charges,65% of total billed charges,103.8,35.67,,83.04,percent of total billed charges,35.67% of total billed charges,79.46,261.9,
FEMUR MIN 2 V RT,3200921,CDM,320,RC,73552,HCPCS,outpatient,,,291,116.40,RT,247.35,85,,197.88,percent of total billed charges,85% of total billed charges,224.07,77,,179.26,percent of total billed charges,77% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,239.16,385,,,fee schedule,385% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,261.9,90,,209.52,percent of total billed charges,90% of total billed charges,232.8,80,,186.24,percent of total billed charges,80% of total billed charges,261.9,90,,209.52,percent of total billed charges,90% of total billed charges,218.25,75,,174.6,percent of total billed charges,75% of total billed charges,96.95,122,,,fee schedule,122% of APC rate,84.39,29,,67.512,percent of total billed charges,29% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,194.97,67,,155.976,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,232.8,80,,186.24,percent of total billed charges,80% of total billed charges,189.15,65,,151.32,percent of total billed charges,65% of total billed charges,103.8,35.67,,83.04,percent of total billed charges,35.67% of total billed charges,79.46,261.9,
FINGERS 3 V LEFT THUMB,3200970,CDM,320,RC,73140,HCPCS,outpatient,,,286,114.40,FA,243.1,85,,194.48,percent of total billed charges,85% of total billed charges,220.22,77,,176.18,percent of total billed charges,77% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,239.16,385,,,fee schedule,385% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,257.4,90,,205.92,percent of total billed charges,90% of total billed charges,228.8,80,,183.04,percent of total billed charges,80% of total billed charges,257.4,90,,205.92,percent of total billed charges,90% of total billed charges,214.5,75,,171.6,percent of total billed charges,75% of total billed charges,96.95,122,,,fee schedule,122% of APC rate,82.94,29,,66.352,percent of total billed charges,29% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,191.62,67,,153.296,percent of total billed charges,67% of total billed charges,41.76,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,228.8,80,,183.04,percent of total billed charges,80% of total billed charges,185.9,65,,148.72,percent of total billed charges,65% of total billed charges,102.02,35.67,,81.616,percent of total billed charges,35.67% of total billed charges,41.76,257.4,
FINGERS 3V LEFT 2ND DIGIT,3200971,CDM,320,RC,73140,HCPCS,outpatient,,,286,114.40,F1,243.1,85,,194.48,percent of total billed charges,85% of total billed charges,220.22,77,,176.18,percent of total billed charges,77% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,239.16,385,,,fee schedule,385% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,257.4,90,,205.92,percent of total billed charges,90% of total billed charges,228.8,80,,183.04,percent of total billed charges,80% of total billed charges,257.4,90,,205.92,percent of total billed charges,90% of total billed charges,214.5,75,,171.6,percent of total billed charges,75% of total billed charges,96.95,122,,,fee schedule,122% of APC rate,82.94,29,,66.352,percent of total billed charges,29% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,191.62,67,,153.296,percent of total billed charges,67% of total billed charges,41.76,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,228.8,80,,183.04,percent of total billed charges,80% of total billed charges,185.9,65,,148.72,percent of total billed charges,65% of total billed charges,102.02,35.67,,81.616,percent of total billed charges,35.67% of total billed charges,41.76,257.4,
FINGER 3V LEFT FOURTH DIGIT,3200973,CDM,320,RC,73140,HCPCS,outpatient,,,286,114.40,F3,243.1,85,,194.48,percent of total billed charges,85% of total billed charges,220.22,77,,176.18,percent of total billed charges,77% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,239.16,385,,,fee schedule,385% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,257.4,90,,205.92,percent of total billed charges,90% of total billed charges,228.8,80,,183.04,percent of total billed charges,80% of total billed charges,257.4,90,,205.92,percent of total billed charges,90% of total billed charges,214.5,75,,171.6,percent of total billed charges,75% of total billed charges,96.95,122,,,fee schedule,122% of APC rate,82.94,29,,66.352,percent of total billed charges,29% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,191.62,67,,153.296,percent of total billed charges,67% of total billed charges,41.76,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,228.8,80,,183.04,percent of total billed charges,80% of total billed charges,185.9,65,,148.72,percent of total billed charges,65% of total billed charges,102.02,35.67,,81.616,percent of total billed charges,35.67% of total billed charges,41.76,257.4,
FINGER 3 V LEFT FIFTH DIGIT,3200974,CDM,320,RC,73140,HCPCS,outpatient,,,286,114.40,F4,243.1,85,,194.48,percent of total billed charges,85% of total billed charges,220.22,77,,176.18,percent of total billed charges,77% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,239.16,385,,,fee schedule,385% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,257.4,90,,205.92,percent of total billed charges,90% of total billed charges,228.8,80,,183.04,percent of total billed charges,80% of total billed charges,257.4,90,,205.92,percent of total billed charges,90% of total billed charges,214.5,75,,171.6,percent of total billed charges,75% of total billed charges,96.95,122,,,fee schedule,122% of APC rate,82.94,29,,66.352,percent of total billed charges,29% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,191.62,67,,153.296,percent of total billed charges,67% of total billed charges,41.76,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,228.8,80,,183.04,percent of total billed charges,80% of total billed charges,185.9,65,,148.72,percent of total billed charges,65% of total billed charges,102.02,35.67,,81.616,percent of total billed charges,35.67% of total billed charges,41.76,257.4,
FINGER 3 V RIGHT THUMB,3200975,CDM,320,RC,73140,HCPCS,outpatient,,,286,114.40,F5,243.1,85,,194.48,percent of total billed charges,85% of total billed charges,220.22,77,,176.18,percent of total billed charges,77% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,239.16,385,,,fee schedule,385% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,257.4,90,,205.92,percent of total billed charges,90% of total billed charges,228.8,80,,183.04,percent of total billed charges,80% of total billed charges,257.4,90,,205.92,percent of total billed charges,90% of total billed charges,214.5,75,,171.6,percent of total billed charges,75% of total billed charges,96.95,122,,,fee schedule,122% of APC rate,82.94,29,,66.352,percent of total billed charges,29% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,191.62,67,,153.296,percent of total billed charges,67% of total billed charges,41.76,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,228.8,80,,183.04,percent of total billed charges,80% of total billed charges,185.9,65,,148.72,percent of total billed charges,65% of total billed charges,102.02,35.67,,81.616,percent of total billed charges,35.67% of total billed charges,41.76,257.4,
FINGER 3V RIGHT SECOND DIGIT,3200976,CDM,320,RC,73140,HCPCS,outpatient,,,286,114.40,F6,243.1,85,,194.48,percent of total billed charges,85% of total billed charges,220.22,77,,176.18,percent of total billed charges,77% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,239.16,385,,,fee schedule,385% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,257.4,90,,205.92,percent of total billed charges,90% of total billed charges,228.8,80,,183.04,percent of total billed charges,80% of total billed charges,257.4,90,,205.92,percent of total billed charges,90% of total billed charges,214.5,75,,171.6,percent of total billed charges,75% of total billed charges,96.95,122,,,fee schedule,122% of APC rate,82.94,29,,66.352,percent of total billed charges,29% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,191.62,67,,153.296,percent of total billed charges,67% of total billed charges,41.76,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,228.8,80,,183.04,percent of total billed charges,80% of total billed charges,185.9,65,,148.72,percent of total billed charges,65% of total billed charges,102.02,35.67,,81.616,percent of total billed charges,35.67% of total billed charges,41.76,257.4,
FINGER (S) 2 VIEW MINIMUM,3200977,CDM,320,RC,73140,HCPCS,outpatient,,,291,116.40,,247.35,85,,197.88,percent of total billed charges,85% of total billed charges,224.07,77,,179.26,percent of total billed charges,77% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,239.16,385,,,fee schedule,385% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,261.9,90,,209.52,percent of total billed charges,90% of total billed charges,232.8,80,,186.24,percent of total billed charges,80% of total billed charges,261.9,90,,209.52,percent of total billed charges,90% of total billed charges,218.25,75,,174.6,percent of total billed charges,75% of total billed charges,96.95,122,,,fee schedule,122% of APC rate,84.39,29,,67.512,percent of total billed charges,29% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,194.97,67,,155.976,percent of total billed charges,67% of total billed charges,41.76,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,232.8,80,,186.24,percent of total billed charges,80% of total billed charges,189.15,65,,151.32,percent of total billed charges,65% of total billed charges,103.8,35.67,,83.04,percent of total billed charges,35.67% of total billed charges,41.76,261.9,
FINGER 3 V RIGHT FOURTH DIGI,3200978,CDM,320,RC,73140,HCPCS,outpatient,,,286,114.40,F8,243.1,85,,194.48,percent of total billed charges,85% of total billed charges,220.22,77,,176.18,percent of total billed charges,77% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,239.16,385,,,fee schedule,385% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,257.4,90,,205.92,percent of total billed charges,90% of total billed charges,228.8,80,,183.04,percent of total billed charges,80% of total billed charges,257.4,90,,205.92,percent of total billed charges,90% of total billed charges,214.5,75,,171.6,percent of total billed charges,75% of total billed charges,96.95,122,,,fee schedule,122% of APC rate,82.94,29,,66.352,percent of total billed charges,29% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,191.62,67,,153.296,percent of total billed charges,67% of total billed charges,41.76,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,228.8,80,,183.04,percent of total billed charges,80% of total billed charges,185.9,65,,148.72,percent of total billed charges,65% of total billed charges,102.02,35.67,,81.616,percent of total billed charges,35.67% of total billed charges,41.76,257.4,
FINGER 3 V RIGHT FIFTH FINGER,3200979,CDM,320,RC,73140,HCPCS,outpatient,,,286,114.40,F9,243.1,85,,194.48,percent of total billed charges,85% of total billed charges,220.22,77,,176.18,percent of total billed charges,77% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,239.16,385,,,fee schedule,385% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,257.4,90,,205.92,percent of total billed charges,90% of total billed charges,228.8,80,,183.04,percent of total billed charges,80% of total billed charges,257.4,90,,205.92,percent of total billed charges,90% of total billed charges,214.5,75,,171.6,percent of total billed charges,75% of total billed charges,96.95,122,,,fee schedule,122% of APC rate,82.94,29,,66.352,percent of total billed charges,29% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,191.62,67,,153.296,percent of total billed charges,67% of total billed charges,41.76,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,228.8,80,,183.04,percent of total billed charges,80% of total billed charges,185.9,65,,148.72,percent of total billed charges,65% of total billed charges,102.02,35.67,,81.616,percent of total billed charges,35.67% of total billed charges,41.76,257.4,
FISTULAGRAM - XRAY,3201010,CDM,320,RC,76080,HCPCS,outpatient,,,1059,423.60,,900.15,85,,720.12,percent of total billed charges,85% of total billed charges,815.43,77,,652.34,percent of total billed charges,77% of total billed charges,482.45,100,,,fee schedule,100% of CMS OPPS rate,894.39,385,,,fee schedule,385% of BCBS fee schedule,931.56,401,,,fee schedule,401% of BCBS fee schedule,931.56,401,,,fee schedule,401% of BCBS fee schedule,931.56,401,,,fee schedule,401% of BCBS fee schedule,953.1,90,,762.48,percent of total billed charges,90% of total billed charges,847.2,80,,677.76,percent of total billed charges,80% of total billed charges,953.1,90,,762.48,percent of total billed charges,90% of total billed charges,794.25,75,,635.4,percent of total billed charges,75% of total billed charges,588.59,122,,,fee schedule,122% of APC rate,307.11,29,,245.688,percent of total billed charges,29% of total billed charges,482.45,100,,,fee schedule,100% of CMS OPPS rate,709.53,67,,567.624,percent of total billed charges,67% of total billed charges,220.39,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,847.2,80,,677.76,percent of total billed charges,80% of total billed charges,688.35,65,,550.68,percent of total billed charges,65% of total billed charges,377.75,35.67,,302.2,percent of total billed charges,35.67% of total billed charges,220.39,953.1,
FLOUROSCOPY CHARGE - 1 HR XRAY,3201020,CDM,320,RC,76000,HCPCS,outpatient,,,325,130.00,,276.25,85,,221,percent of total billed charges,85% of total billed charges,250.25,77,,200.2,percent of total billed charges,77% of total billed charges,214.29,100,,,fee schedule,100% of CMS OPPS rate,152,385,,,fee schedule,385% of BCBS fee schedule,158.31,401,,,fee schedule,401% of BCBS fee schedule,158.31,401,,,fee schedule,401% of BCBS fee schedule,158.31,401,,,fee schedule,401% of BCBS fee schedule,292.5,90,,234,percent of total billed charges,90% of total billed charges,260,80,,208,percent of total billed charges,80% of total billed charges,292.5,90,,234,percent of total billed charges,90% of total billed charges,243.75,75,,195,percent of total billed charges,75% of total billed charges,261.43,122,,,fee schedule,122% of APC rate,94.25,29,,75.4,percent of total billed charges,29% of total billed charges,214.29,100,,,fee schedule,100% of CMS OPPS rate,217.75,67,,174.2,percent of total billed charges,67% of total billed charges,82.15,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,260,80,,208,percent of total billed charges,80% of total billed charges,211.25,65,,169,percent of total billed charges,65% of total billed charges,115.93,35.67,,92.744,percent of total billed charges,35.67% of total billed charges,82.15,292.5,
FLOUROSCOPY CHARGE OVER 2.5 HR,3201021,CDM,320,RC,76000,HCPCS,outpatient,,,1207,482.80,,1025.95,85,,820.76,percent of total billed charges,85% of total billed charges,929.39,77,,743.51,percent of total billed charges,77% of total billed charges,214.29,100,,,fee schedule,100% of CMS OPPS rate,152,385,,,fee schedule,385% of BCBS fee schedule,158.31,401,,,fee schedule,401% of BCBS fee schedule,158.31,401,,,fee schedule,401% of BCBS fee schedule,158.31,401,,,fee schedule,401% of BCBS fee schedule,1086.3,90,,869.04,percent of total billed charges,90% of total billed charges,965.6,80,,772.48,percent of total billed charges,80% of total billed charges,1086.3,90,,869.04,percent of total billed charges,90% of total billed charges,905.25,75,,724.2,percent of total billed charges,75% of total billed charges,261.43,122,,,fee schedule,122% of APC rate,350.03,29,,280.024,percent of total billed charges,29% of total billed charges,214.29,100,,,fee schedule,100% of CMS OPPS rate,808.69,67,,646.952,percent of total billed charges,67% of total billed charges,82.15,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,965.6,80,,772.48,percent of total billed charges,80% of total billed charges,784.55,65,,627.64,percent of total billed charges,65% of total billed charges,430.54,35.67,,344.432,percent of total billed charges,35.67% of total billed charges,82.15,1086.3,
FLOUROSCOPY CHARGE,3201030,CDM,320,RC,77001,HCPCS,outpatient,,,458,183.20,,389.3,85,,311.44,percent of total billed charges,85% of total billed charges,352.66,77,,282.13,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,255.6,385,,,fee schedule,385% of BCBS fee schedule,266.22,401,,,fee schedule,401% of BCBS fee schedule,266.22,401,,,fee schedule,401% of BCBS fee schedule,266.22,401,,,fee schedule,401% of BCBS fee schedule,412.2,90,,329.76,percent of total billed charges,90% of total billed charges,366.4,80,,293.12,percent of total billed charges,80% of total billed charges,412.2,90,,329.76,percent of total billed charges,90% of total billed charges,343.5,75,,274.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,132.82,29,,106.256,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,306.86,67,,245.488,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,366.4,80,,293.12,percent of total billed charges,80% of total billed charges,297.7,65,,238.16,percent of total billed charges,65% of total billed charges,163.37,35.67,,130.696,percent of total billed charges,35.67% of total billed charges,132.82,412.2,
FLOUROSCOPY CHARGE - 2 HR XRAY,3201040,CDM,320,RC,76000,HCPCS,outpatient,,,657,262.80,,558.45,85,,446.76,percent of total billed charges,85% of total billed charges,505.89,77,,404.71,percent of total billed charges,77% of total billed charges,214.29,100,,,fee schedule,100% of CMS OPPS rate,152,385,,,fee schedule,385% of BCBS fee schedule,158.31,401,,,fee schedule,401% of BCBS fee schedule,158.31,401,,,fee schedule,401% of BCBS fee schedule,158.31,401,,,fee schedule,401% of BCBS fee schedule,591.3,90,,473.04,percent of total billed charges,90% of total billed charges,525.6,80,,420.48,percent of total billed charges,80% of total billed charges,591.3,90,,473.04,percent of total billed charges,90% of total billed charges,492.75,75,,394.2,percent of total billed charges,75% of total billed charges,261.43,122,,,fee schedule,122% of APC rate,190.53,29,,152.424,percent of total billed charges,29% of total billed charges,214.29,100,,,fee schedule,100% of CMS OPPS rate,440.19,67,,352.152,percent of total billed charges,67% of total billed charges,82.15,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,525.6,80,,420.48,percent of total billed charges,80% of total billed charges,427.05,65,,341.64,percent of total billed charges,65% of total billed charges,234.35,35.67,,187.48,percent of total billed charges,35.67% of total billed charges,82.15,591.3,
FLOUROSCOPY EXAM-2.5 HRS XRAY,3201050,CDM,320,RC,76000,HCPCS,outpatient,,,892,356.80,,758.2,85,,606.56,percent of total billed charges,85% of total billed charges,686.84,77,,549.47,percent of total billed charges,77% of total billed charges,214.29,100,,,fee schedule,100% of CMS OPPS rate,152,385,,,fee schedule,385% of BCBS fee schedule,158.31,401,,,fee schedule,401% of BCBS fee schedule,158.31,401,,,fee schedule,401% of BCBS fee schedule,158.31,401,,,fee schedule,401% of BCBS fee schedule,802.8,90,,642.24,percent of total billed charges,90% of total billed charges,713.6,80,,570.88,percent of total billed charges,80% of total billed charges,802.8,90,,642.24,percent of total billed charges,90% of total billed charges,669,75,,535.2,percent of total billed charges,75% of total billed charges,261.43,122,,,fee schedule,122% of APC rate,258.68,29,,206.944,percent of total billed charges,29% of total billed charges,214.29,100,,,fee schedule,100% of CMS OPPS rate,597.64,67,,478.112,percent of total billed charges,67% of total billed charges,82.15,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,713.6,80,,570.88,percent of total billed charges,80% of total billed charges,579.8,65,,463.84,percent of total billed charges,65% of total billed charges,318.18,35.67,,254.544,percent of total billed charges,35.67% of total billed charges,82.15,802.8,
FLOUROSCOPY CHARGE-.5 HRS XRAY,3201060,CDM,320,RC,76000,HCPCS,outpatient,,,314,125.60,,266.9,85,,213.52,percent of total billed charges,85% of total billed charges,241.78,77,,193.42,percent of total billed charges,77% of total billed charges,214.29,100,,,fee schedule,100% of CMS OPPS rate,152,385,,,fee schedule,385% of BCBS fee schedule,158.31,401,,,fee schedule,401% of BCBS fee schedule,158.31,401,,,fee schedule,401% of BCBS fee schedule,158.31,401,,,fee schedule,401% of BCBS fee schedule,282.6,90,,226.08,percent of total billed charges,90% of total billed charges,251.2,80,,200.96,percent of total billed charges,80% of total billed charges,282.6,90,,226.08,percent of total billed charges,90% of total billed charges,235.5,75,,188.4,percent of total billed charges,75% of total billed charges,261.43,122,,,fee schedule,122% of APC rate,91.06,29,,72.848,percent of total billed charges,29% of total billed charges,214.29,100,,,fee schedule,100% of CMS OPPS rate,210.38,67,,168.304,percent of total billed charges,67% of total billed charges,82.15,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,251.2,80,,200.96,percent of total billed charges,80% of total billed charges,204.1,65,,163.28,percent of total billed charges,65% of total billed charges,112,35.67,,89.6,percent of total billed charges,35.67% of total billed charges,82.15,282.6,
FLOUROSCOPY CHARGE FOR ESI,3201070,CDM,320,RC,77003,HCPCS,outpatient,,,535,214.00,,454.75,85,,363.8,percent of total billed charges,85% of total billed charges,411.95,77,,329.56,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,251.48,385,,,fee schedule,385% of BCBS fee schedule,261.93,401,,,fee schedule,401% of BCBS fee schedule,261.93,401,,,fee schedule,401% of BCBS fee schedule,261.93,401,,,fee schedule,401% of BCBS fee schedule,481.5,90,,385.2,percent of total billed charges,90% of total billed charges,428,80,,342.4,percent of total billed charges,80% of total billed charges,481.5,90,,385.2,percent of total billed charges,90% of total billed charges,401.25,75,,321,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,155.15,29,,124.12,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,358.45,67,,286.76,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,428,80,,342.4,percent of total billed charges,80% of total billed charges,347.75,65,,278.2,percent of total billed charges,65% of total billed charges,190.83,35.67,,152.664,percent of total billed charges,35.67% of total billed charges,155.15,481.5,
FLUOROSCOPY FOR CT MYELOGRAM,3201071,CDM,320,RC,77003,HCPCS,outpatient,,,556,222.40,,472.6,85,,378.08,percent of total billed charges,85% of total billed charges,428.12,77,,342.5,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,251.48,385,,,fee schedule,385% of BCBS fee schedule,261.93,401,,,fee schedule,401% of BCBS fee schedule,261.93,401,,,fee schedule,401% of BCBS fee schedule,261.93,401,,,fee schedule,401% of BCBS fee schedule,500.4,90,,400.32,percent of total billed charges,90% of total billed charges,444.8,80,,355.84,percent of total billed charges,80% of total billed charges,500.4,90,,400.32,percent of total billed charges,90% of total billed charges,417,75,,333.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,161.24,29,,128.992,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,372.52,67,,298.016,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,444.8,80,,355.84,percent of total billed charges,80% of total billed charges,361.4,65,,289.12,percent of total billed charges,65% of total billed charges,198.33,35.67,,158.664,percent of total billed charges,35.67% of total billed charges,161.24,500.4,
FOREARM 2 V LT,3201085,CDM,320,RC,73090,HCPCS,outpatient,,,291,116.40,LT,247.35,85,,197.88,percent of total billed charges,85% of total billed charges,224.07,77,,179.26,percent of total billed charges,77% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,239.16,385,,,fee schedule,385% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,261.9,90,,209.52,percent of total billed charges,90% of total billed charges,232.8,80,,186.24,percent of total billed charges,80% of total billed charges,261.9,90,,209.52,percent of total billed charges,90% of total billed charges,218.25,75,,174.6,percent of total billed charges,75% of total billed charges,96.95,122,,,fee schedule,122% of APC rate,84.39,29,,67.512,percent of total billed charges,29% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,194.97,67,,155.976,percent of total billed charges,67% of total billed charges,41.76,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,232.8,80,,186.24,percent of total billed charges,80% of total billed charges,189.15,65,,151.32,percent of total billed charges,65% of total billed charges,103.8,35.67,,83.04,percent of total billed charges,35.67% of total billed charges,41.76,261.9,
FOREARM 2 V RT,3201086,CDM,320,RC,73090,HCPCS,outpatient,,,291,116.40,RT,247.35,85,,197.88,percent of total billed charges,85% of total billed charges,224.07,77,,179.26,percent of total billed charges,77% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,239.16,385,,,fee schedule,385% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,261.9,90,,209.52,percent of total billed charges,90% of total billed charges,232.8,80,,186.24,percent of total billed charges,80% of total billed charges,261.9,90,,209.52,percent of total billed charges,90% of total billed charges,218.25,75,,174.6,percent of total billed charges,75% of total billed charges,96.95,122,,,fee schedule,122% of APC rate,84.39,29,,67.512,percent of total billed charges,29% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,194.97,67,,155.976,percent of total billed charges,67% of total billed charges,41.76,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,232.8,80,,186.24,percent of total billed charges,80% of total billed charges,189.15,65,,151.32,percent of total billed charges,65% of total billed charges,103.8,35.67,,83.04,percent of total billed charges,35.67% of total billed charges,41.76,261.9,
FOOT 3 V  LEFT,3201135,CDM,320,RC,73630,HCPCS,outpatient,,,360,144.00,LT,306,85,,244.8,percent of total billed charges,85% of total billed charges,277.2,77,,221.76,percent of total billed charges,77% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,239.16,385,,,fee schedule,385% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,324,90,,259.2,percent of total billed charges,90% of total billed charges,288,80,,230.4,percent of total billed charges,80% of total billed charges,324,90,,259.2,percent of total billed charges,90% of total billed charges,270,75,,216,percent of total billed charges,75% of total billed charges,96.95,122,,,fee schedule,122% of APC rate,104.4,29,,83.52,percent of total billed charges,29% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,241.2,67,,192.96,percent of total billed charges,67% of total billed charges,41.76,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,288,80,,230.4,percent of total billed charges,80% of total billed charges,234,65,,187.2,percent of total billed charges,65% of total billed charges,128.41,35.67,,102.728,percent of total billed charges,35.67% of total billed charges,41.76,324,
FOOT 3 V RIGHT,3201136,CDM,320,RC,73630,HCPCS,outpatient,,,360,144.00,RT,306,85,,244.8,percent of total billed charges,85% of total billed charges,277.2,77,,221.76,percent of total billed charges,77% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,239.16,385,,,fee schedule,385% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,324,90,,259.2,percent of total billed charges,90% of total billed charges,288,80,,230.4,percent of total billed charges,80% of total billed charges,324,90,,259.2,percent of total billed charges,90% of total billed charges,270,75,,216,percent of total billed charges,75% of total billed charges,96.95,122,,,fee schedule,122% of APC rate,104.4,29,,83.52,percent of total billed charges,29% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,241.2,67,,192.96,percent of total billed charges,67% of total billed charges,41.76,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,288,80,,230.4,percent of total billed charges,80% of total billed charges,234,65,,187.2,percent of total billed charges,65% of total billed charges,128.41,35.67,,102.728,percent of total billed charges,35.67% of total billed charges,41.76,324,
FOOT - LEFT WEIGHT BEARING 3V,3201150,CDM,320,RC,73630,HCPCS,outpatient,,,360,144.00,LT,306,85,,244.8,percent of total billed charges,85% of total billed charges,277.2,77,,221.76,percent of total billed charges,77% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,239.16,385,,,fee schedule,385% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,324,90,,259.2,percent of total billed charges,90% of total billed charges,288,80,,230.4,percent of total billed charges,80% of total billed charges,324,90,,259.2,percent of total billed charges,90% of total billed charges,270,75,,216,percent of total billed charges,75% of total billed charges,96.95,122,,,fee schedule,122% of APC rate,104.4,29,,83.52,percent of total billed charges,29% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,241.2,67,,192.96,percent of total billed charges,67% of total billed charges,41.76,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,288,80,,230.4,percent of total billed charges,80% of total billed charges,234,65,,187.2,percent of total billed charges,65% of total billed charges,128.41,35.67,,102.728,percent of total billed charges,35.67% of total billed charges,41.76,324,
FOOT RIGHT WEIGHT BEARING 3V,3201151,CDM,320,RC,73630,HCPCS,outpatient,,,360,144.00,RT,306,85,,244.8,percent of total billed charges,85% of total billed charges,277.2,77,,221.76,percent of total billed charges,77% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,239.16,385,,,fee schedule,385% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,324,90,,259.2,percent of total billed charges,90% of total billed charges,288,80,,230.4,percent of total billed charges,80% of total billed charges,324,90,,259.2,percent of total billed charges,90% of total billed charges,270,75,,216,percent of total billed charges,75% of total billed charges,96.95,122,,,fee schedule,122% of APC rate,104.4,29,,83.52,percent of total billed charges,29% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,241.2,67,,192.96,percent of total billed charges,67% of total billed charges,41.76,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,288,80,,230.4,percent of total billed charges,80% of total billed charges,234,65,,187.2,percent of total billed charges,65% of total billed charges,128.41,35.67,,102.728,percent of total billed charges,35.67% of total billed charges,41.76,324,
GASTROGRAFIN STUDY - XRAY,3201170,CDM,320,RC,74240,HCPCS,outpatient,,,1175,470.00,,998.75,85,,799,percent of total billed charges,85% of total billed charges,904.75,77,,723.8,percent of total billed charges,77% of total billed charges,160.68,100,,,fee schedule,100% of CMS OPPS rate,973.05,385,,,fee schedule,385% of BCBS fee schedule,1013.49,401,,,fee schedule,401% of BCBS fee schedule,1013.49,401,,,fee schedule,401% of BCBS fee schedule,1013.49,401,,,fee schedule,401% of BCBS fee schedule,1057.5,90,,846,percent of total billed charges,90% of total billed charges,940,80,,752,percent of total billed charges,80% of total billed charges,1057.5,90,,846,percent of total billed charges,90% of total billed charges,881.25,75,,705,percent of total billed charges,75% of total billed charges,196.03,122,,,fee schedule,122% of APC rate,340.75,29,,272.6,percent of total billed charges,29% of total billed charges,160.68,100,,,fee schedule,100% of CMS OPPS rate,787.25,67,,629.8,percent of total billed charges,67% of total billed charges,80,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,940,80,,752,percent of total billed charges,80% of total billed charges,763.75,65,,611,percent of total billed charges,65% of total billed charges,419.12,35.67,,335.296,percent of total billed charges,35.67% of total billed charges,80,1057.5,
GALL BLADDER-CHOLSTGRM. XRAY,3201180,CDM,320,RC,74290,HCPCS,outpatient,,,2073,829.20,,1762.05,85,,1409.64,percent of total billed charges,85% of total billed charges,1596.21,77,,1276.97,percent of total billed charges,77% of total billed charges,160.68,100,,,fee schedule,100% of CMS OPPS rate,973.05,385,,,fee schedule,385% of BCBS fee schedule,1013.49,401,,,fee schedule,401% of BCBS fee schedule,1013.49,401,,,fee schedule,401% of BCBS fee schedule,1013.49,401,,,fee schedule,401% of BCBS fee schedule,1865.7,90,,1492.56,percent of total billed charges,90% of total billed charges,1658.4,80,,1326.72,percent of total billed charges,80% of total billed charges,1865.7,90,,1492.56,percent of total billed charges,90% of total billed charges,1554.75,75,,1243.8,percent of total billed charges,75% of total billed charges,196.03,122,,,fee schedule,122% of APC rate,601.17,29,,480.936,percent of total billed charges,29% of total billed charges,160.68,100,,,fee schedule,100% of CMS OPPS rate,1388.91,67,,1111.128,percent of total billed charges,67% of total billed charges,80,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,1658.4,80,,1326.72,percent of total billed charges,80% of total billed charges,1347.45,65,,1077.96,percent of total billed charges,65% of total billed charges,739.44,35.67,,591.552,percent of total billed charges,35.67% of total billed charges,80,1865.7,
HANDS 3 VIEW MIN LEFT,3201190,CDM,320,RC,73130,HCPCS,outpatient,,,291,116.40,LT,247.35,85,,197.88,percent of total billed charges,85% of total billed charges,224.07,77,,179.26,percent of total billed charges,77% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,239.16,385,,,fee schedule,385% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,261.9,90,,209.52,percent of total billed charges,90% of total billed charges,232.8,80,,186.24,percent of total billed charges,80% of total billed charges,261.9,90,,209.52,percent of total billed charges,90% of total billed charges,218.25,75,,174.6,percent of total billed charges,75% of total billed charges,96.95,122,,,fee schedule,122% of APC rate,84.39,29,,67.512,percent of total billed charges,29% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,194.97,67,,155.976,percent of total billed charges,67% of total billed charges,41.76,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,232.8,80,,186.24,percent of total billed charges,80% of total billed charges,189.15,65,,151.32,percent of total billed charges,65% of total billed charges,103.8,35.67,,83.04,percent of total billed charges,35.67% of total billed charges,41.76,261.9,
HAND 3 V MINIMUM RIGHT,3201191,CDM,320,RC,73130,HCPCS,outpatient,,,291,116.40,RT,247.35,85,,197.88,percent of total billed charges,85% of total billed charges,224.07,77,,179.26,percent of total billed charges,77% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,239.16,385,,,fee schedule,385% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,261.9,90,,209.52,percent of total billed charges,90% of total billed charges,232.8,80,,186.24,percent of total billed charges,80% of total billed charges,261.9,90,,209.52,percent of total billed charges,90% of total billed charges,218.25,75,,174.6,percent of total billed charges,75% of total billed charges,96.95,122,,,fee schedule,122% of APC rate,84.39,29,,67.512,percent of total billed charges,29% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,194.97,67,,155.976,percent of total billed charges,67% of total billed charges,41.76,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,232.8,80,,186.24,percent of total billed charges,80% of total billed charges,189.15,65,,151.32,percent of total billed charges,65% of total billed charges,103.8,35.67,,83.04,percent of total billed charges,35.67% of total billed charges,41.76,261.9,
HEEL MIN 2 V LT,3201220,CDM,320,RC,73650,HCPCS,outpatient,,,291,116.40,LT,247.35,85,,197.88,percent of total billed charges,85% of total billed charges,224.07,77,,179.26,percent of total billed charges,77% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,239.16,385,,,fee schedule,385% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,261.9,90,,209.52,percent of total billed charges,90% of total billed charges,232.8,80,,186.24,percent of total billed charges,80% of total billed charges,261.9,90,,209.52,percent of total billed charges,90% of total billed charges,218.25,75,,174.6,percent of total billed charges,75% of total billed charges,96.95,122,,,fee schedule,122% of APC rate,84.39,29,,67.512,percent of total billed charges,29% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,194.97,67,,155.976,percent of total billed charges,67% of total billed charges,41.76,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,232.8,80,,186.24,percent of total billed charges,80% of total billed charges,189.15,65,,151.32,percent of total billed charges,65% of total billed charges,103.8,35.67,,83.04,percent of total billed charges,35.67% of total billed charges,41.76,261.9,
HEEL MIN 2 V RT,3201221,CDM,320,RC,73650,HCPCS,outpatient,,,291,116.40,RT,247.35,85,,197.88,percent of total billed charges,85% of total billed charges,224.07,77,,179.26,percent of total billed charges,77% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,239.16,385,,,fee schedule,385% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,261.9,90,,209.52,percent of total billed charges,90% of total billed charges,232.8,80,,186.24,percent of total billed charges,80% of total billed charges,261.9,90,,209.52,percent of total billed charges,90% of total billed charges,218.25,75,,174.6,percent of total billed charges,75% of total billed charges,96.95,122,,,fee schedule,122% of APC rate,84.39,29,,67.512,percent of total billed charges,29% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,194.97,67,,155.976,percent of total billed charges,67% of total billed charges,41.76,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,232.8,80,,186.24,percent of total billed charges,80% of total billed charges,189.15,65,,151.32,percent of total billed charges,65% of total billed charges,103.8,35.67,,83.04,percent of total billed charges,35.67% of total billed charges,41.76,261.9,
HIP BILATERAL 3-4 V,3201290,CDM,320,RC,73522,HCPCS,outpatient,,,375,150.00,,318.75,85,,255,percent of total billed charges,85% of total billed charges,288.75,77,,231,percent of total billed charges,77% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,440.67,385,,,fee schedule,385% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,337.5,90,,270,percent of total billed charges,90% of total billed charges,300,80,,240,percent of total billed charges,80% of total billed charges,337.5,90,,270,percent of total billed charges,90% of total billed charges,281.25,75,,225,percent of total billed charges,75% of total billed charges,117.29,122,,,fee schedule,122% of APC rate,108.75,29,,87,percent of total billed charges,29% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,251.25,67,,201,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,300,80,,240,percent of total billed charges,80% of total billed charges,243.75,65,,195,percent of total billed charges,65% of total billed charges,133.76,35.67,,107.008,percent of total billed charges,35.67% of total billed charges,96.14,458.98,
HIP BILATERAL 3-4 V IN OR,3201300,CDM,320,RC,73522,HCPCS,outpatient,,,306,122.40,,260.1,85,,208.08,percent of total billed charges,85% of total billed charges,235.62,77,,188.5,percent of total billed charges,77% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,440.67,385,,,fee schedule,385% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,275.4,90,,220.32,percent of total billed charges,90% of total billed charges,244.8,80,,195.84,percent of total billed charges,80% of total billed charges,275.4,90,,220.32,percent of total billed charges,90% of total billed charges,229.5,75,,183.6,percent of total billed charges,75% of total billed charges,117.29,122,,,fee schedule,122% of APC rate,88.74,29,,70.992,percent of total billed charges,29% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,205.02,67,,164.016,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,244.8,80,,195.84,percent of total billed charges,80% of total billed charges,198.9,65,,159.12,percent of total billed charges,65% of total billed charges,109.15,35.67,,87.32,percent of total billed charges,35.67% of total billed charges,88.74,458.98,
HIP 2-3 V LT,3201320,CDM,320,RC,73502,HCPCS,outpatient,,,291,116.40,LT,247.35,85,,197.88,percent of total billed charges,85% of total billed charges,224.07,77,,179.26,percent of total billed charges,77% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,239.16,385,,,fee schedule,385% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,261.9,90,,209.52,percent of total billed charges,90% of total billed charges,232.8,80,,186.24,percent of total billed charges,80% of total billed charges,261.9,90,,209.52,percent of total billed charges,90% of total billed charges,218.25,75,,174.6,percent of total billed charges,75% of total billed charges,96.95,122,,,fee schedule,122% of APC rate,84.39,29,,67.512,percent of total billed charges,29% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,194.97,67,,155.976,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,232.8,80,,186.24,percent of total billed charges,80% of total billed charges,189.15,65,,151.32,percent of total billed charges,65% of total billed charges,103.8,35.67,,83.04,percent of total billed charges,35.67% of total billed charges,79.46,261.9,
HIP 2-3 V RT,3201321,CDM,320,RC,73502,HCPCS,outpatient,,,291,116.40,RT,247.35,85,,197.88,percent of total billed charges,85% of total billed charges,224.07,77,,179.26,percent of total billed charges,77% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,239.16,385,,,fee schedule,385% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,261.9,90,,209.52,percent of total billed charges,90% of total billed charges,232.8,80,,186.24,percent of total billed charges,80% of total billed charges,261.9,90,,209.52,percent of total billed charges,90% of total billed charges,218.25,75,,174.6,percent of total billed charges,75% of total billed charges,96.95,122,,,fee schedule,122% of APC rate,84.39,29,,67.512,percent of total billed charges,29% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,194.97,67,,155.976,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,232.8,80,,186.24,percent of total billed charges,80% of total billed charges,189.15,65,,151.32,percent of total billed charges,65% of total billed charges,103.8,35.67,,83.04,percent of total billed charges,35.67% of total billed charges,79.46,261.9,
HUMERUS MIN 2 V LT,3201365,CDM,320,RC,73060,HCPCS,outpatient,,,291,116.40,LT,247.35,85,,197.88,percent of total billed charges,85% of total billed charges,224.07,77,,179.26,percent of total billed charges,77% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,239.16,385,,,fee schedule,385% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,261.9,90,,209.52,percent of total billed charges,90% of total billed charges,232.8,80,,186.24,percent of total billed charges,80% of total billed charges,261.9,90,,209.52,percent of total billed charges,90% of total billed charges,218.25,75,,174.6,percent of total billed charges,75% of total billed charges,96.95,122,,,fee schedule,122% of APC rate,84.39,29,,67.512,percent of total billed charges,29% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,194.97,67,,155.976,percent of total billed charges,67% of total billed charges,41.76,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,232.8,80,,186.24,percent of total billed charges,80% of total billed charges,189.15,65,,151.32,percent of total billed charges,65% of total billed charges,103.8,35.67,,83.04,percent of total billed charges,35.67% of total billed charges,41.76,261.9,
HUMERUS MIN 2 V RT,3201366,CDM,320,RC,73060,HCPCS,outpatient,,,291,116.40,RT,247.35,85,,197.88,percent of total billed charges,85% of total billed charges,224.07,77,,179.26,percent of total billed charges,77% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,239.16,385,,,fee schedule,385% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,261.9,90,,209.52,percent of total billed charges,90% of total billed charges,232.8,80,,186.24,percent of total billed charges,80% of total billed charges,261.9,90,,209.52,percent of total billed charges,90% of total billed charges,218.25,75,,174.6,percent of total billed charges,75% of total billed charges,96.95,122,,,fee schedule,122% of APC rate,84.39,29,,67.512,percent of total billed charges,29% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,194.97,67,,155.976,percent of total billed charges,67% of total billed charges,41.76,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,232.8,80,,186.24,percent of total billed charges,80% of total billed charges,189.15,65,,151.32,percent of total billed charges,65% of total billed charges,103.8,35.67,,83.04,percent of total billed charges,35.67% of total billed charges,41.76,261.9,
INJECTION PROC SHOULDER MRI/CT,3201367,CDM,320,RC,23350,HCPCS,outpatient,,,445,178.00,,1150,,,,case rate,pays based on per visit,342.65,77,,274.12,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,364.9,82,,291.92,percent of total billed charges,82% of total billed charges,378.25,85,,302.6,percent of total billed charges,85% of total billed charges,378.25,85,,302.6,percent of total billed charges,85% of total billed charges,378.25,85,,302.6,percent of total billed charges,85% of total billed charges,400.5,90,,320.4,percent of total billed charges,90% of total billed charges,356,80,,284.8,percent of total billed charges,80% of total billed charges,400.5,90,,320.4,percent of total billed charges,90% of total billed charges,333.75,75,,267,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,129.05,29,,103.24,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,298.15,67,,238.52,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,356,80,,284.8,percent of total billed charges,80% of total billed charges,289.25,65,,231.4,percent of total billed charges,65% of total billed charges,158.73,35.67,,126.984,percent of total billed charges,35.67% of total billed charges,129.05,1150,
INJECTION PROCEDURE KNEE,3201368,CDM,320,RC,27369,HCPCS,outpatient,,,445,178.00,,1150,,,,case rate,pays based on per visit,342.65,77,,274.12,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,364.9,82,,291.92,percent of total billed charges,82% of total billed charges,378.25,85,,302.6,percent of total billed charges,85% of total billed charges,378.25,85,,302.6,percent of total billed charges,85% of total billed charges,378.25,85,,302.6,percent of total billed charges,85% of total billed charges,400.5,90,,320.4,percent of total billed charges,90% of total billed charges,356,80,,284.8,percent of total billed charges,80% of total billed charges,400.5,90,,320.4,percent of total billed charges,90% of total billed charges,333.75,75,,267,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,129.05,29,,103.24,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,298.15,67,,238.52,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,356,80,,284.8,percent of total billed charges,80% of total billed charges,289.25,65,,231.4,percent of total billed charges,65% of total billed charges,158.73,35.67,,126.984,percent of total billed charges,35.67% of total billed charges,129.05,1150,
INJECTION PROCEDURE HIP,3201369,CDM,320,RC,27093,HCPCS,outpatient,,,445,178.00,,1150,,,,case rate,pays based on per visit,342.65,77,,274.12,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,364.9,82,,291.92,percent of total billed charges,82% of total billed charges,378.25,85,,302.6,percent of total billed charges,85% of total billed charges,378.25,85,,302.6,percent of total billed charges,85% of total billed charges,378.25,85,,302.6,percent of total billed charges,85% of total billed charges,400.5,90,,320.4,percent of total billed charges,90% of total billed charges,356,80,,284.8,percent of total billed charges,80% of total billed charges,400.5,90,,320.4,percent of total billed charges,90% of total billed charges,333.75,75,,267,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,129.05,29,,103.24,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,298.15,67,,238.52,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,356,80,,284.8,percent of total billed charges,80% of total billed charges,289.25,65,,231.4,percent of total billed charges,65% of total billed charges,158.73,35.67,,126.984,percent of total billed charges,35.67% of total billed charges,129.05,1150,
INTERNAL AUDITORY CANAL - XRAY,3201400,CDM,320,RC,70134,HCPCS,outpatient,,,1059,423.60,,900.15,85,,720.12,percent of total billed charges,85% of total billed charges,815.43,77,,652.34,percent of total billed charges,77% of total billed charges,482.45,100,,,fee schedule,100% of CMS OPPS rate,894.39,385,,,fee schedule,385% of BCBS fee schedule,931.56,401,,,fee schedule,401% of BCBS fee schedule,931.56,401,,,fee schedule,401% of BCBS fee schedule,931.56,401,,,fee schedule,401% of BCBS fee schedule,953.1,90,,762.48,percent of total billed charges,90% of total billed charges,847.2,80,,677.76,percent of total billed charges,80% of total billed charges,953.1,90,,762.48,percent of total billed charges,90% of total billed charges,794.25,75,,635.4,percent of total billed charges,75% of total billed charges,588.59,122,,,fee schedule,122% of APC rate,307.11,29,,245.688,percent of total billed charges,29% of total billed charges,482.45,100,,,fee schedule,100% of CMS OPPS rate,709.53,67,,567.624,percent of total billed charges,67% of total billed charges,70.34,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,847.2,80,,677.76,percent of total billed charges,80% of total billed charges,688.35,65,,550.68,percent of total billed charges,65% of total billed charges,377.75,35.67,,302.2,percent of total billed charges,35.67% of total billed charges,70.34,953.1,
INTRAVENOUS PYELOGRAM - XRAY,3201440,CDM,320,RC,74400,HCPCS,outpatient,,,2073,829.20,,1762.05,85,,1409.64,percent of total billed charges,85% of total billed charges,1596.21,77,,1276.97,percent of total billed charges,77% of total billed charges,160.68,100,,,fee schedule,100% of CMS OPPS rate,331.6,385,,,fee schedule,385% of BCBS fee schedule,345.38,401,,,fee schedule,401% of BCBS fee schedule,345.38,401,,,fee schedule,401% of BCBS fee schedule,345.38,401,,,fee schedule,401% of BCBS fee schedule,1865.7,90,,1492.56,percent of total billed charges,90% of total billed charges,1658.4,80,,1326.72,percent of total billed charges,80% of total billed charges,1865.7,90,,1492.56,percent of total billed charges,90% of total billed charges,1554.75,75,,1243.8,percent of total billed charges,75% of total billed charges,196.02,122,,,fee schedule,122% of APC rate,601.17,29,,480.936,percent of total billed charges,29% of total billed charges,160.68,100,,,fee schedule,100% of CMS OPPS rate,1388.91,67,,1111.128,percent of total billed charges,67% of total billed charges,171.39,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,1658.4,80,,1326.72,percent of total billed charges,80% of total billed charges,1347.45,65,,1077.96,percent of total billed charges,65% of total billed charges,739.44,35.67,,591.552,percent of total billed charges,35.67% of total billed charges,160.68,1865.7,
KNEE RIGHT COMPLETE 4 PLUS V,3201458,CDM,320,RC,73564,HCPCS,outpatient,,,531,212.40,RT,451.35,85,,361.08,percent of total billed charges,85% of total billed charges,408.87,77,,327.1,percent of total billed charges,77% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,440.67,385,,,fee schedule,385% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,477.9,90,,382.32,percent of total billed charges,90% of total billed charges,424.8,80,,339.84,percent of total billed charges,80% of total billed charges,477.9,90,,382.32,percent of total billed charges,90% of total billed charges,398.25,75,,318.6,percent of total billed charges,75% of total billed charges,117.29,122,,,fee schedule,122% of APC rate,153.99,29,,123.192,percent of total billed charges,29% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,355.77,67,,284.616,percent of total billed charges,67% of total billed charges,41.76,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,424.8,80,,339.84,percent of total billed charges,80% of total billed charges,345.15,65,,276.12,percent of total billed charges,65% of total billed charges,189.41,35.67,,151.528,percent of total billed charges,35.67% of total billed charges,41.76,477.9,
KNEE LEFT COMPLETE 4 PLUS V,3201459,CDM,320,RC,73564,HCPCS,outpatient,,,531,212.40,LT,451.35,85,,361.08,percent of total billed charges,85% of total billed charges,408.87,77,,327.1,percent of total billed charges,77% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,440.67,385,,,fee schedule,385% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,477.9,90,,382.32,percent of total billed charges,90% of total billed charges,424.8,80,,339.84,percent of total billed charges,80% of total billed charges,477.9,90,,382.32,percent of total billed charges,90% of total billed charges,398.25,75,,318.6,percent of total billed charges,75% of total billed charges,117.29,122,,,fee schedule,122% of APC rate,153.99,29,,123.192,percent of total billed charges,29% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,355.77,67,,284.616,percent of total billed charges,67% of total billed charges,41.76,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,424.8,80,,339.84,percent of total billed charges,80% of total billed charges,345.15,65,,276.12,percent of total billed charges,65% of total billed charges,189.41,35.67,,151.528,percent of total billed charges,35.67% of total billed charges,41.76,477.9,
JOINT INJECTION (RADIOLOGY),3201464,CDM,320,RC,77002,HCPCS,outpatient,,,611,244.40,,519.35,85,,415.48,percent of total billed charges,85% of total billed charges,470.47,77,,376.38,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,258.37,385,,,fee schedule,385% of BCBS fee schedule,269.11,401,,,fee schedule,401% of BCBS fee schedule,269.11,401,,,fee schedule,401% of BCBS fee schedule,269.11,401,,,fee schedule,401% of BCBS fee schedule,549.9,90,,439.92,percent of total billed charges,90% of total billed charges,488.8,80,,391.04,percent of total billed charges,80% of total billed charges,549.9,90,,439.92,percent of total billed charges,90% of total billed charges,458.25,75,,366.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,177.19,29,,141.752,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,409.37,67,,327.496,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,488.8,80,,391.04,percent of total billed charges,80% of total billed charges,397.15,65,,317.72,percent of total billed charges,65% of total billed charges,217.94,35.67,,174.352,percent of total billed charges,35.67% of total billed charges,177.19,549.9,
JOINT SURVEY 2+ JOINTS 1 VIEW,3201466,CDM,320,RC,77077,HCPCS,outpatient,,,522,208.80,,443.7,85,,354.96,percent of total billed charges,85% of total billed charges,401.94,77,,321.55,percent of total billed charges,77% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,440.67,385,,,fee schedule,385% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,469.8,90,,375.84,percent of total billed charges,90% of total billed charges,417.6,80,,334.08,percent of total billed charges,80% of total billed charges,469.8,90,,375.84,percent of total billed charges,90% of total billed charges,391.5,75,,313.2,percent of total billed charges,75% of total billed charges,117.29,122,,,fee schedule,122% of APC rate,151.38,29,,121.104,percent of total billed charges,29% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,349.74,67,,279.792,percent of total billed charges,67% of total billed charges,41.76,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,417.6,80,,334.08,percent of total billed charges,80% of total billed charges,339.3,65,,271.44,percent of total billed charges,65% of total billed charges,186.2,35.67,,148.96,percent of total billed charges,35.67% of total billed charges,41.76,469.8,
KNEE - BILATERAL - 3 VIEWS,3201470,CDM,320,RC,73564,HCPCS,outpatient,,,375,150.00,50,318.75,85,,255,percent of total billed charges,85% of total billed charges,288.75,77,,231,percent of total billed charges,77% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,440.67,385,,,fee schedule,385% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,337.5,90,,270,percent of total billed charges,90% of total billed charges,300,80,,240,percent of total billed charges,80% of total billed charges,337.5,90,,270,percent of total billed charges,90% of total billed charges,281.25,75,,225,percent of total billed charges,75% of total billed charges,117.29,122,,,fee schedule,122% of APC rate,108.75,29,,87,percent of total billed charges,29% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,251.25,67,,201,percent of total billed charges,67% of total billed charges,41.76,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,300,80,,240,percent of total billed charges,80% of total billed charges,243.75,65,,195,percent of total billed charges,65% of total billed charges,133.76,35.67,,107.008,percent of total billed charges,35.67% of total billed charges,41.76,458.98,
KNEE BILATERAL-AP AND LAT.XRAY,3201475,CDM,320,RC,73564,HCPCS,outpatient,,,375,150.00,50,318.75,85,,255,percent of total billed charges,85% of total billed charges,288.75,77,,231,percent of total billed charges,77% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,440.67,385,,,fee schedule,385% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,337.5,90,,270,percent of total billed charges,90% of total billed charges,300,80,,240,percent of total billed charges,80% of total billed charges,337.5,90,,270,percent of total billed charges,90% of total billed charges,281.25,75,,225,percent of total billed charges,75% of total billed charges,117.29,122,,,fee schedule,122% of APC rate,108.75,29,,87,percent of total billed charges,29% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,251.25,67,,201,percent of total billed charges,67% of total billed charges,41.76,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,300,80,,240,percent of total billed charges,80% of total billed charges,243.75,65,,195,percent of total billed charges,65% of total billed charges,133.76,35.67,,107.008,percent of total billed charges,35.67% of total billed charges,41.76,458.98,
KNEE BILAT. WGHT. BEARING XRAY,3201480,CDM,320,RC,73565,HCPCS,outpatient,,,369,147.60,,313.65,85,,250.92,percent of total billed charges,85% of total billed charges,284.13,77,,227.3,percent of total billed charges,77% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,239.16,385,,,fee schedule,385% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,332.1,90,,265.68,percent of total billed charges,90% of total billed charges,295.2,80,,236.16,percent of total billed charges,80% of total billed charges,332.1,90,,265.68,percent of total billed charges,90% of total billed charges,276.75,75,,221.4,percent of total billed charges,75% of total billed charges,96.95,122,,,fee schedule,122% of APC rate,107.01,29,,85.608,percent of total billed charges,29% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,247.23,67,,197.784,percent of total billed charges,67% of total billed charges,41.76,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,295.2,80,,236.16,percent of total billed charges,80% of total billed charges,239.85,65,,191.88,percent of total billed charges,65% of total billed charges,131.62,35.67,,105.296,percent of total billed charges,35.67% of total billed charges,41.76,332.1,
KNEE - LEFT 1-2 VIEWS,3201490,CDM,320,RC,73560,HCPCS,outpatient,,,291,116.40,LT,247.35,85,,197.88,percent of total billed charges,85% of total billed charges,224.07,77,,179.26,percent of total billed charges,77% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,239.16,385,,,fee schedule,385% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,261.9,90,,209.52,percent of total billed charges,90% of total billed charges,232.8,80,,186.24,percent of total billed charges,80% of total billed charges,261.9,90,,209.52,percent of total billed charges,90% of total billed charges,218.25,75,,174.6,percent of total billed charges,75% of total billed charges,96.95,122,,,fee schedule,122% of APC rate,84.39,29,,67.512,percent of total billed charges,29% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,194.97,67,,155.976,percent of total billed charges,67% of total billed charges,41.76,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,232.8,80,,186.24,percent of total billed charges,80% of total billed charges,189.15,65,,151.32,percent of total billed charges,65% of total billed charges,103.8,35.67,,83.04,percent of total billed charges,35.67% of total billed charges,41.76,261.9,
KNEE RIGHT 1-2 VIEWS,3201491,CDM,320,RC,73560,HCPCS,outpatient,,,286,114.40,RT,243.1,85,,194.48,percent of total billed charges,85% of total billed charges,220.22,77,,176.18,percent of total billed charges,77% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,239.16,385,,,fee schedule,385% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,257.4,90,,205.92,percent of total billed charges,90% of total billed charges,228.8,80,,183.04,percent of total billed charges,80% of total billed charges,257.4,90,,205.92,percent of total billed charges,90% of total billed charges,214.5,75,,171.6,percent of total billed charges,75% of total billed charges,96.95,122,,,fee schedule,122% of APC rate,82.94,29,,66.352,percent of total billed charges,29% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,191.62,67,,153.296,percent of total billed charges,67% of total billed charges,41.76,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,228.8,80,,183.04,percent of total billed charges,80% of total billed charges,185.9,65,,148.72,percent of total billed charges,65% of total billed charges,102.02,35.67,,81.616,percent of total billed charges,35.67% of total billed charges,41.76,257.4,
KNEE RIGHT 3 VIEWS,3201499,CDM,320,RC,73562,HCPCS,outpatient,,,295,118.00,RT,250.75,85,,200.6,percent of total billed charges,85% of total billed charges,227.15,77,,181.72,percent of total billed charges,77% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,239.16,385,,,fee schedule,385% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,265.5,90,,212.4,percent of total billed charges,90% of total billed charges,236,80,,188.8,percent of total billed charges,80% of total billed charges,265.5,90,,212.4,percent of total billed charges,90% of total billed charges,221.25,75,,177,percent of total billed charges,75% of total billed charges,96.95,122,,,fee schedule,122% of APC rate,85.55,29,,68.44,percent of total billed charges,29% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,197.65,67,,158.12,percent of total billed charges,67% of total billed charges,41.76,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,236,80,,188.8,percent of total billed charges,80% of total billed charges,191.75,65,,153.4,percent of total billed charges,65% of total billed charges,105.23,35.67,,84.184,percent of total billed charges,35.67% of total billed charges,41.76,265.5,
KNEE LEFT 3 VIEWS,3201500,CDM,320,RC,73562,HCPCS,outpatient,,,295,118.00,LT,250.75,85,,200.6,percent of total billed charges,85% of total billed charges,227.15,77,,181.72,percent of total billed charges,77% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,239.16,385,,,fee schedule,385% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,265.5,90,,212.4,percent of total billed charges,90% of total billed charges,236,80,,188.8,percent of total billed charges,80% of total billed charges,265.5,90,,212.4,percent of total billed charges,90% of total billed charges,221.25,75,,177,percent of total billed charges,75% of total billed charges,96.95,122,,,fee schedule,122% of APC rate,85.55,29,,68.44,percent of total billed charges,29% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,197.65,67,,158.12,percent of total billed charges,67% of total billed charges,41.76,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,236,80,,188.8,percent of total billed charges,80% of total billed charges,191.75,65,,153.4,percent of total billed charges,65% of total billed charges,105.23,35.67,,84.184,percent of total billed charges,35.67% of total billed charges,41.76,265.5,
KUB 1 V XRAY,3201550,CDM,320,RC,74018,HCPCS,outpatient,,,291,116.40,,247.35,85,,197.88,percent of total billed charges,85% of total billed charges,224.07,77,,179.26,percent of total billed charges,77% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,239.16,385,,,fee schedule,385% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,261.9,90,,209.52,percent of total billed charges,90% of total billed charges,232.8,80,,186.24,percent of total billed charges,80% of total billed charges,261.9,90,,209.52,percent of total billed charges,90% of total billed charges,218.25,75,,174.6,percent of total billed charges,75% of total billed charges,96.95,122,,,fee schedule,122% of APC rate,84.39,29,,67.512,percent of total billed charges,29% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,194.97,67,,155.976,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,232.8,80,,186.24,percent of total billed charges,80% of total billed charges,189.15,65,,151.32,percent of total billed charges,65% of total billed charges,103.8,35.67,,83.04,percent of total billed charges,35.67% of total billed charges,79.46,261.9,
LEG LENGTH SERIES - XRAY,3201580,CDM,320,RC,77073,HCPCS,outpatient,,,522,208.80,,443.7,85,,354.96,percent of total billed charges,85% of total billed charges,401.94,77,,321.55,percent of total billed charges,77% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,440.67,385,,,fee schedule,385% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,469.8,90,,375.84,percent of total billed charges,90% of total billed charges,417.6,80,,334.08,percent of total billed charges,80% of total billed charges,469.8,90,,375.84,percent of total billed charges,90% of total billed charges,391.5,75,,313.2,percent of total billed charges,75% of total billed charges,117.29,122,,,fee schedule,122% of APC rate,151.38,29,,121.104,percent of total billed charges,29% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,349.74,67,,279.792,percent of total billed charges,67% of total billed charges,41.76,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,417.6,80,,334.08,percent of total billed charges,80% of total billed charges,339.3,65,,271.44,percent of total billed charges,65% of total billed charges,186.2,35.67,,148.96,percent of total billed charges,35.67% of total billed charges,41.76,469.8,
LOWER LEG -2 V LT XRAY,3201605,CDM,320,RC,73590,HCPCS,outpatient,,,291,116.40,LT,247.35,85,,197.88,percent of total billed charges,85% of total billed charges,224.07,77,,179.26,percent of total billed charges,77% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,239.16,385,,,fee schedule,385% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,261.9,90,,209.52,percent of total billed charges,90% of total billed charges,232.8,80,,186.24,percent of total billed charges,80% of total billed charges,261.9,90,,209.52,percent of total billed charges,90% of total billed charges,218.25,75,,174.6,percent of total billed charges,75% of total billed charges,96.95,122,,,fee schedule,122% of APC rate,84.39,29,,67.512,percent of total billed charges,29% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,194.97,67,,155.976,percent of total billed charges,67% of total billed charges,41.76,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,232.8,80,,186.24,percent of total billed charges,80% of total billed charges,189.15,65,,151.32,percent of total billed charges,65% of total billed charges,103.8,35.67,,83.04,percent of total billed charges,35.67% of total billed charges,41.76,261.9,
LOWER LEG 2 V RT,3201606,CDM,320,RC,73590,HCPCS,outpatient,,,291,116.40,RT,247.35,85,,197.88,percent of total billed charges,85% of total billed charges,224.07,77,,179.26,percent of total billed charges,77% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,239.16,385,,,fee schedule,385% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,261.9,90,,209.52,percent of total billed charges,90% of total billed charges,232.8,80,,186.24,percent of total billed charges,80% of total billed charges,261.9,90,,209.52,percent of total billed charges,90% of total billed charges,218.25,75,,174.6,percent of total billed charges,75% of total billed charges,96.95,122,,,fee schedule,122% of APC rate,84.39,29,,67.512,percent of total billed charges,29% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,194.97,67,,155.976,percent of total billed charges,67% of total billed charges,41.76,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,232.8,80,,186.24,percent of total billed charges,80% of total billed charges,189.15,65,,151.32,percent of total billed charges,65% of total billed charges,103.8,35.67,,83.04,percent of total billed charges,35.67% of total billed charges,41.76,261.9,
LUMBAR SPINE 2V - XRAY,3201630,CDM,320,RC,72100,HCPCS,outpatient,,,531,212.40,,451.35,85,,361.08,percent of total billed charges,85% of total billed charges,408.87,77,,327.1,percent of total billed charges,77% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,440.67,385,,,fee schedule,385% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,477.9,90,,382.32,percent of total billed charges,90% of total billed charges,424.8,80,,339.84,percent of total billed charges,80% of total billed charges,477.9,90,,382.32,percent of total billed charges,90% of total billed charges,398.25,75,,318.6,percent of total billed charges,75% of total billed charges,117.29,122,,,fee schedule,122% of APC rate,153.99,29,,123.192,percent of total billed charges,29% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,355.77,67,,284.616,percent of total billed charges,67% of total billed charges,41.76,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,424.8,80,,339.84,percent of total billed charges,80% of total billed charges,345.15,65,,276.12,percent of total billed charges,65% of total billed charges,189.41,35.67,,151.528,percent of total billed charges,35.67% of total billed charges,41.76,477.9,
LUMBAR SPINE FLEX & EXT ONLY,3201631,CDM,320,RC,72120,HCPCS,outpatient,,,531,212.40,,451.35,85,,361.08,percent of total billed charges,85% of total billed charges,408.87,77,,327.1,percent of total billed charges,77% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,440.67,385,,,fee schedule,385% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,477.9,90,,382.32,percent of total billed charges,90% of total billed charges,424.8,80,,339.84,percent of total billed charges,80% of total billed charges,477.9,90,,382.32,percent of total billed charges,90% of total billed charges,398.25,75,,318.6,percent of total billed charges,75% of total billed charges,117.29,122,,,fee schedule,122% of APC rate,153.99,29,,123.192,percent of total billed charges,29% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,355.77,67,,284.616,percent of total billed charges,67% of total billed charges,41.76,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,424.8,80,,339.84,percent of total billed charges,80% of total billed charges,345.15,65,,276.12,percent of total billed charges,65% of total billed charges,189.41,35.67,,151.528,percent of total billed charges,35.67% of total billed charges,41.76,477.9,
LUMBAR SPINE 3 VIEWS - XRAY,3201635,CDM,320,RC,72100,HCPCS,outpatient,,,531,212.40,,451.35,85,,361.08,percent of total billed charges,85% of total billed charges,408.87,77,,327.1,percent of total billed charges,77% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,440.67,385,,,fee schedule,385% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,477.9,90,,382.32,percent of total billed charges,90% of total billed charges,424.8,80,,339.84,percent of total billed charges,80% of total billed charges,477.9,90,,382.32,percent of total billed charges,90% of total billed charges,398.25,75,,318.6,percent of total billed charges,75% of total billed charges,117.29,122,,,fee schedule,122% of APC rate,153.99,29,,123.192,percent of total billed charges,29% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,355.77,67,,284.616,percent of total billed charges,67% of total billed charges,41.76,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,424.8,80,,339.84,percent of total billed charges,80% of total billed charges,345.15,65,,276.12,percent of total billed charges,65% of total billed charges,189.41,35.67,,151.528,percent of total billed charges,35.67% of total billed charges,41.76,477.9,
LUMBAR SPINE - 4 VIEWS - XRAY,3201640,CDM,320,RC,72110,HCPCS,outpatient,,,531,212.40,,451.35,85,,361.08,percent of total billed charges,85% of total billed charges,408.87,77,,327.1,percent of total billed charges,77% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,440.67,385,,,fee schedule,385% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,477.9,90,,382.32,percent of total billed charges,90% of total billed charges,424.8,80,,339.84,percent of total billed charges,80% of total billed charges,477.9,90,,382.32,percent of total billed charges,90% of total billed charges,398.25,75,,318.6,percent of total billed charges,75% of total billed charges,117.29,122,,,fee schedule,122% of APC rate,153.99,29,,123.192,percent of total billed charges,29% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,355.77,67,,284.616,percent of total billed charges,67% of total billed charges,70.34,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,424.8,80,,339.84,percent of total billed charges,80% of total billed charges,345.15,65,,276.12,percent of total billed charges,65% of total billed charges,189.41,35.67,,151.528,percent of total billed charges,35.67% of total billed charges,70.34,477.9,
LUMBAR PUNCTURE,3201645,CDM,320,RC,62270,HCPCS,outpatient,,,1287,514.80,,1150,,,,case rate,pays based on per visit,990.99,77,,792.79,percent of total billed charges,77% of total billed charges,604.77,100,,,fee schedule,100% of CMS OPPS rate,1055.34,82,,844.272,percent of total billed charges,82% of total billed charges,1093.95,85,,875.16,percent of total billed charges,85% of total billed charges,1093.95,85,,875.16,percent of total billed charges,85% of total billed charges,1093.95,85,,875.16,percent of total billed charges,85% of total billed charges,1158.3,90,,926.64,percent of total billed charges,90% of total billed charges,1029.6,80,,823.68,percent of total billed charges,80% of total billed charges,1158.3,90,,926.64,percent of total billed charges,90% of total billed charges,965.25,75,,772.2,percent of total billed charges,75% of total billed charges,737.82,122,,,fee schedule,122% of APC rate,262.86,100,,,fee schedule,100% of ASC tier grouping rate,604.77,100,,,fee schedule,100% of CMS OPPS rate,862.29,67,,689.832,percent of total billed charges,67% of total billed charges,254.23,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,1029.6,80,,823.68,percent of total billed charges,80% of total billed charges,836.55,65,,669.24,percent of total billed charges,65% of total billed charges,323.32,123,,,fee schedule,123% of ASC tier grouping rate,254.23,1158.3,
LUMBAR PUNCTURE WITH FLURO/CT,3201646,CDM,320,RC,62328,HCPCS,outpatient,,,1262,504.80,,1150,,,,case rate,pays based on per visit,971.74,77,,777.39,percent of total billed charges,77% of total billed charges,604.77,100,,,fee schedule,100% of CMS OPPS rate,1034.84,82,,827.872,percent of total billed charges,82% of total billed charges,1072.7,85,,858.16,percent of total billed charges,85% of total billed charges,1072.7,85,,858.16,percent of total billed charges,85% of total billed charges,1072.7,85,,858.16,percent of total billed charges,85% of total billed charges,1135.8,90,,908.64,percent of total billed charges,90% of total billed charges,1009.6,80,,807.68,percent of total billed charges,80% of total billed charges,1135.8,90,,908.64,percent of total billed charges,90% of total billed charges,946.5,75,,757.2,percent of total billed charges,75% of total billed charges,737.82,122,,,fee schedule,122% of APC rate,262.86,100,,,fee schedule,100% of ASC tier grouping rate,604.77,100,,,fee schedule,100% of CMS OPPS rate,845.54,67,,676.432,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1009.6,80,,807.68,percent of total billed charges,80% of total billed charges,820.3,65,,656.24,percent of total billed charges,65% of total billed charges,323.32,123,,,fee schedule,123% of ASC tier grouping rate,262.86,1150,
L-SPINE FLEX/EXT COMP MIN 6 VI,3201650,CDM,320,RC,72114,HCPCS,outpatient,,,531,212.40,,451.35,85,,361.08,percent of total billed charges,85% of total billed charges,408.87,77,,327.1,percent of total billed charges,77% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,440.67,385,,,fee schedule,385% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,477.9,90,,382.32,percent of total billed charges,90% of total billed charges,424.8,80,,339.84,percent of total billed charges,80% of total billed charges,477.9,90,,382.32,percent of total billed charges,90% of total billed charges,398.25,75,,318.6,percent of total billed charges,75% of total billed charges,117.29,122,,,fee schedule,122% of APC rate,153.99,29,,123.192,percent of total billed charges,29% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,355.77,67,,284.616,percent of total billed charges,67% of total billed charges,70.34,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,424.8,80,,339.84,percent of total billed charges,80% of total billed charges,345.15,65,,276.12,percent of total billed charges,65% of total billed charges,189.41,35.67,,151.528,percent of total billed charges,35.67% of total billed charges,70.34,477.9,
MANDIBLE 2V - XRAY,3201750,CDM,320,RC,70100,HCPCS,outpatient,,,291,116.40,,247.35,85,,197.88,percent of total billed charges,85% of total billed charges,224.07,77,,179.26,percent of total billed charges,77% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,239.16,385,,,fee schedule,385% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,261.9,90,,209.52,percent of total billed charges,90% of total billed charges,232.8,80,,186.24,percent of total billed charges,80% of total billed charges,261.9,90,,209.52,percent of total billed charges,90% of total billed charges,218.25,75,,174.6,percent of total billed charges,75% of total billed charges,96.95,122,,,fee schedule,122% of APC rate,84.39,29,,67.512,percent of total billed charges,29% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,194.97,67,,155.976,percent of total billed charges,67% of total billed charges,41.76,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,232.8,80,,186.24,percent of total billed charges,80% of total billed charges,189.15,65,,151.32,percent of total billed charges,65% of total billed charges,103.8,35.67,,83.04,percent of total billed charges,35.67% of total billed charges,41.76,261.9,
MANDIBLE COMPLETE MIN 4 VIEWS,3201751,CDM,320,RC,70110,HCPCS,outpatient,,,522,208.80,,443.7,85,,354.96,percent of total billed charges,85% of total billed charges,401.94,77,,321.55,percent of total billed charges,77% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,440.67,385,,,fee schedule,385% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,469.8,90,,375.84,percent of total billed charges,90% of total billed charges,417.6,80,,334.08,percent of total billed charges,80% of total billed charges,469.8,90,,375.84,percent of total billed charges,90% of total billed charges,391.5,75,,313.2,percent of total billed charges,75% of total billed charges,117.29,122,,,fee schedule,122% of APC rate,151.38,29,,121.104,percent of total billed charges,29% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,349.74,67,,279.792,percent of total billed charges,67% of total billed charges,41.76,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,417.6,80,,334.08,percent of total billed charges,80% of total billed charges,339.3,65,,271.44,percent of total billed charges,65% of total billed charges,186.2,35.67,,148.96,percent of total billed charges,35.67% of total billed charges,41.76,469.8,
MANDIBLE LIMITED < 4 V,3201760,CDM,320,RC,70100,HCPCS,outpatient,,,286,114.40,,243.1,85,,194.48,percent of total billed charges,85% of total billed charges,220.22,77,,176.18,percent of total billed charges,77% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,239.16,385,,,fee schedule,385% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,257.4,90,,205.92,percent of total billed charges,90% of total billed charges,228.8,80,,183.04,percent of total billed charges,80% of total billed charges,257.4,90,,205.92,percent of total billed charges,90% of total billed charges,214.5,75,,171.6,percent of total billed charges,75% of total billed charges,96.95,122,,,fee schedule,122% of APC rate,82.94,29,,66.352,percent of total billed charges,29% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,191.62,67,,153.296,percent of total billed charges,67% of total billed charges,41.76,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,228.8,80,,183.04,percent of total billed charges,80% of total billed charges,185.9,65,,148.72,percent of total billed charges,65% of total billed charges,102.02,35.67,,81.616,percent of total billed charges,35.67% of total billed charges,41.76,257.4,
MASTOIDS <3 V PER SIDE,3201790,CDM,320,RC,70120,HCPCS,outpatient,,,522,208.80,,443.7,85,,354.96,percent of total billed charges,85% of total billed charges,401.94,77,,321.55,percent of total billed charges,77% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,440.67,385,,,fee schedule,385% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,469.8,90,,375.84,percent of total billed charges,90% of total billed charges,417.6,80,,334.08,percent of total billed charges,80% of total billed charges,469.8,90,,375.84,percent of total billed charges,90% of total billed charges,391.5,75,,313.2,percent of total billed charges,75% of total billed charges,117.29,122,,,fee schedule,122% of APC rate,151.38,29,,121.104,percent of total billed charges,29% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,349.74,67,,279.792,percent of total billed charges,67% of total billed charges,41.76,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,417.6,80,,334.08,percent of total billed charges,80% of total billed charges,339.3,65,,271.44,percent of total billed charges,65% of total billed charges,186.2,35.67,,148.96,percent of total billed charges,35.67% of total billed charges,41.76,469.8,
MAXILLA <3 V,3201800,CDM,320,RC,70140,HCPCS,outpatient,,,285,114.00,,242.25,85,,193.8,percent of total billed charges,85% of total billed charges,219.45,77,,175.56,percent of total billed charges,77% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,239.16,385,,,fee schedule,385% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,256.5,90,,205.2,percent of total billed charges,90% of total billed charges,228,80,,182.4,percent of total billed charges,80% of total billed charges,256.5,90,,205.2,percent of total billed charges,90% of total billed charges,213.75,75,,171,percent of total billed charges,75% of total billed charges,96.95,122,,,fee schedule,122% of APC rate,82.65,29,,66.12,percent of total billed charges,29% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,190.95,67,,152.76,percent of total billed charges,67% of total billed charges,41.76,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,228,80,,182.4,percent of total billed charges,80% of total billed charges,185.25,65,,148.2,percent of total billed charges,65% of total billed charges,101.66,35.67,,81.328,percent of total billed charges,35.67% of total billed charges,41.76,256.5,
MYELOGRAM - LUMBAR X RAY ONLY,3201830,CDM,320,RC,72265,HCPCS,outpatient,,,1313,525.20,,1116.05,85,,892.84,percent of total billed charges,85% of total billed charges,1011.01,77,,808.81,percent of total billed charges,77% of total billed charges,700.21,100,,,fee schedule,100% of CMS OPPS rate,2625.24,385,,,fee schedule,385% of BCBS fee schedule,2734.34,401,,,fee schedule,401% of BCBS fee schedule,2734.34,401,,,fee schedule,401% of BCBS fee schedule,2734.34,401,,,fee schedule,401% of BCBS fee schedule,1181.7,90,,945.36,percent of total billed charges,90% of total billed charges,1050.4,80,,840.32,percent of total billed charges,80% of total billed charges,1181.7,90,,945.36,percent of total billed charges,90% of total billed charges,984.75,75,,787.8,percent of total billed charges,75% of total billed charges,854.26,122,,,fee schedule,122% of APC rate,380.77,29,,304.616,percent of total billed charges,29% of total billed charges,700.21,100,,,fee schedule,100% of CMS OPPS rate,879.71,67,,703.768,percent of total billed charges,67% of total billed charges,460.81,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,1050.4,80,,840.32,percent of total billed charges,80% of total billed charges,853.45,65,,682.76,percent of total billed charges,65% of total billed charges,468.35,35.67,,374.68,percent of total billed charges,35.67% of total billed charges,380.77,2734.34,
NECK SOFT TISSUE - XRAY,3201880,CDM,320,RC,70360,HCPCS,outpatient,,,291,116.40,,247.35,85,,197.88,percent of total billed charges,85% of total billed charges,224.07,77,,179.26,percent of total billed charges,77% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,239.16,385,,,fee schedule,385% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,261.9,90,,209.52,percent of total billed charges,90% of total billed charges,232.8,80,,186.24,percent of total billed charges,80% of total billed charges,261.9,90,,209.52,percent of total billed charges,90% of total billed charges,218.25,75,,174.6,percent of total billed charges,75% of total billed charges,96.95,122,,,fee schedule,122% of APC rate,84.39,29,,67.512,percent of total billed charges,29% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,194.97,67,,155.976,percent of total billed charges,67% of total billed charges,41.76,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,232.8,80,,186.24,percent of total billed charges,80% of total billed charges,189.15,65,,151.32,percent of total billed charges,65% of total billed charges,103.8,35.67,,83.04,percent of total billed charges,35.67% of total billed charges,41.76,261.9,
NASAL BONES MIN 3 V,3201890,CDM,320,RC,70160,HCPCS,outpatient,,,202,80.80,,171.7,85,,137.36,percent of total billed charges,85% of total billed charges,155.54,77,,124.43,percent of total billed charges,77% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,239.16,385,,,fee schedule,385% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,181.8,90,,145.44,percent of total billed charges,90% of total billed charges,161.6,80,,129.28,percent of total billed charges,80% of total billed charges,181.8,90,,145.44,percent of total billed charges,90% of total billed charges,151.5,75,,121.2,percent of total billed charges,75% of total billed charges,96.95,122,,,fee schedule,122% of APC rate,58.58,29,,46.864,percent of total billed charges,29% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,135.34,67,,108.272,percent of total billed charges,67% of total billed charges,41.76,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,161.6,80,,129.28,percent of total billed charges,80% of total billed charges,131.3,65,,105.04,percent of total billed charges,65% of total billed charges,72.05,35.67,,57.64,percent of total billed charges,35.67% of total billed charges,41.76,249.1,
NAVICULAR MIN 3 V LT,3201910,CDM,320,RC,73110,HCPCS,outpatient,,,360,144.00,LT,306,85,,244.8,percent of total billed charges,85% of total billed charges,277.2,77,,221.76,percent of total billed charges,77% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,239.16,385,,,fee schedule,385% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,324,90,,259.2,percent of total billed charges,90% of total billed charges,288,80,,230.4,percent of total billed charges,80% of total billed charges,324,90,,259.2,percent of total billed charges,90% of total billed charges,270,75,,216,percent of total billed charges,75% of total billed charges,96.95,122,,,fee schedule,122% of APC rate,104.4,29,,83.52,percent of total billed charges,29% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,241.2,67,,192.96,percent of total billed charges,67% of total billed charges,41.76,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,288,80,,230.4,percent of total billed charges,80% of total billed charges,234,65,,187.2,percent of total billed charges,65% of total billed charges,128.41,35.67,,102.728,percent of total billed charges,35.67% of total billed charges,41.76,324,
NAVICULAR MIN 3 V RT,3201911,CDM,320,RC,73110,HCPCS,outpatient,,,360,144.00,RT,306,85,,244.8,percent of total billed charges,85% of total billed charges,277.2,77,,221.76,percent of total billed charges,77% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,239.16,385,,,fee schedule,385% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,324,90,,259.2,percent of total billed charges,90% of total billed charges,288,80,,230.4,percent of total billed charges,80% of total billed charges,324,90,,259.2,percent of total billed charges,90% of total billed charges,270,75,,216,percent of total billed charges,75% of total billed charges,96.95,122,,,fee schedule,122% of APC rate,104.4,29,,83.52,percent of total billed charges,29% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,241.2,67,,192.96,percent of total billed charges,67% of total billed charges,41.76,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,288,80,,230.4,percent of total billed charges,80% of total billed charges,234,65,,187.2,percent of total billed charges,65% of total billed charges,128.41,35.67,,102.728,percent of total billed charges,35.67% of total billed charges,41.76,324,
OPTIC FORAMINA XRAY/ORBIT UNIL,3201950,CDM,320,RC,70190,HCPCS,outpatient,,,286,114.40,,243.1,85,,194.48,percent of total billed charges,85% of total billed charges,220.22,77,,176.18,percent of total billed charges,77% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,239.16,385,,,fee schedule,385% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,257.4,90,,205.92,percent of total billed charges,90% of total billed charges,228.8,80,,183.04,percent of total billed charges,80% of total billed charges,257.4,90,,205.92,percent of total billed charges,90% of total billed charges,214.5,75,,171.6,percent of total billed charges,75% of total billed charges,96.95,122,,,fee schedule,122% of APC rate,82.94,29,,66.352,percent of total billed charges,29% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,191.62,67,,153.296,percent of total billed charges,67% of total billed charges,41.76,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,228.8,80,,183.04,percent of total billed charges,80% of total billed charges,185.9,65,,148.72,percent of total billed charges,65% of total billed charges,102.02,35.67,,81.616,percent of total billed charges,35.67% of total billed charges,41.76,257.4,
ORBITS MIN 4 V,3201990,CDM,320,RC,70200,HCPCS,outpatient,,,522,208.80,,443.7,85,,354.96,percent of total billed charges,85% of total billed charges,401.94,77,,321.55,percent of total billed charges,77% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,440.67,385,,,fee schedule,385% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,469.8,90,,375.84,percent of total billed charges,90% of total billed charges,417.6,80,,334.08,percent of total billed charges,80% of total billed charges,469.8,90,,375.84,percent of total billed charges,90% of total billed charges,391.5,75,,313.2,percent of total billed charges,75% of total billed charges,117.29,122,,,fee schedule,122% of APC rate,151.38,29,,121.104,percent of total billed charges,29% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,349.74,67,,279.792,percent of total billed charges,67% of total billed charges,41.76,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,417.6,80,,334.08,percent of total billed charges,80% of total billed charges,339.3,65,,271.44,percent of total billed charges,65% of total billed charges,186.2,35.67,,148.96,percent of total billed charges,35.67% of total billed charges,41.76,469.8,
OSSEOUS BONE SURVEY COMPLETE,3202019,CDM,320,RC,77075,HCPCS,outpatient,,,531,212.40,,451.35,85,,361.08,percent of total billed charges,85% of total billed charges,408.87,77,,327.1,percent of total billed charges,77% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,440.67,385,,,fee schedule,385% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,477.9,90,,382.32,percent of total billed charges,90% of total billed charges,424.8,80,,339.84,percent of total billed charges,80% of total billed charges,477.9,90,,382.32,percent of total billed charges,90% of total billed charges,398.25,75,,318.6,percent of total billed charges,75% of total billed charges,117.29,122,,,fee schedule,122% of APC rate,153.99,29,,123.192,percent of total billed charges,29% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,355.77,67,,284.616,percent of total billed charges,67% of total billed charges,70.34,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,424.8,80,,339.84,percent of total billed charges,80% of total billed charges,345.15,65,,276.12,percent of total billed charges,65% of total billed charges,189.41,35.67,,151.528,percent of total billed charges,35.67% of total billed charges,70.34,477.9,
PATELLA V LT,3202065,CDM,320,RC,73560,HCPCS,outpatient,,,522,208.80,LT,443.7,85,,354.96,percent of total billed charges,85% of total billed charges,401.94,77,,321.55,percent of total billed charges,77% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,239.16,385,,,fee schedule,385% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,469.8,90,,375.84,percent of total billed charges,90% of total billed charges,417.6,80,,334.08,percent of total billed charges,80% of total billed charges,469.8,90,,375.84,percent of total billed charges,90% of total billed charges,391.5,75,,313.2,percent of total billed charges,75% of total billed charges,96.95,122,,,fee schedule,122% of APC rate,151.38,29,,121.104,percent of total billed charges,29% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,349.74,67,,279.792,percent of total billed charges,67% of total billed charges,41.76,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,417.6,80,,334.08,percent of total billed charges,80% of total billed charges,339.3,65,,271.44,percent of total billed charges,65% of total billed charges,186.2,35.67,,148.96,percent of total billed charges,35.67% of total billed charges,41.76,469.8,
PATELLA V RT,3202066,CDM,320,RC,73560,HCPCS,outpatient,,,522,208.80,RT,443.7,85,,354.96,percent of total billed charges,85% of total billed charges,401.94,77,,321.55,percent of total billed charges,77% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,239.16,385,,,fee schedule,385% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,469.8,90,,375.84,percent of total billed charges,90% of total billed charges,417.6,80,,334.08,percent of total billed charges,80% of total billed charges,469.8,90,,375.84,percent of total billed charges,90% of total billed charges,391.5,75,,313.2,percent of total billed charges,75% of total billed charges,96.95,122,,,fee schedule,122% of APC rate,151.38,29,,121.104,percent of total billed charges,29% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,349.74,67,,279.792,percent of total billed charges,67% of total billed charges,41.76,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,417.6,80,,334.08,percent of total billed charges,80% of total billed charges,339.3,65,,271.44,percent of total billed charges,65% of total billed charges,186.2,35.67,,148.96,percent of total billed charges,35.67% of total billed charges,41.76,469.8,
PELVIS - XRAY 1 OR 2 VIEWS,3202090,CDM,320,RC,72170,HCPCS,outpatient,,,531,212.40,,451.35,85,,361.08,percent of total billed charges,85% of total billed charges,408.87,77,,327.1,percent of total billed charges,77% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,440.67,385,,,fee schedule,385% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,477.9,90,,382.32,percent of total billed charges,90% of total billed charges,424.8,80,,339.84,percent of total billed charges,80% of total billed charges,477.9,90,,382.32,percent of total billed charges,90% of total billed charges,398.25,75,,318.6,percent of total billed charges,75% of total billed charges,117.29,122,,,fee schedule,122% of APC rate,153.99,29,,123.192,percent of total billed charges,29% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,355.77,67,,284.616,percent of total billed charges,67% of total billed charges,41.76,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,424.8,80,,339.84,percent of total billed charges,80% of total billed charges,345.15,65,,276.12,percent of total billed charges,65% of total billed charges,189.41,35.67,,151.528,percent of total billed charges,35.67% of total billed charges,41.76,477.9,
PELVIS COMPLETE 3 VIEWS,3202091,CDM,320,RC,72190,HCPCS,outpatient,,,531,212.40,,451.35,85,,361.08,percent of total billed charges,85% of total billed charges,408.87,77,,327.1,percent of total billed charges,77% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,440.67,385,,,fee schedule,385% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,477.9,90,,382.32,percent of total billed charges,90% of total billed charges,424.8,80,,339.84,percent of total billed charges,80% of total billed charges,477.9,90,,382.32,percent of total billed charges,90% of total billed charges,398.25,75,,318.6,percent of total billed charges,75% of total billed charges,117.29,122,,,fee schedule,122% of APC rate,153.99,29,,123.192,percent of total billed charges,29% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,355.77,67,,284.616,percent of total billed charges,67% of total billed charges,41.76,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,424.8,80,,339.84,percent of total billed charges,80% of total billed charges,345.15,65,,276.12,percent of total billed charges,65% of total billed charges,189.41,35.67,,151.528,percent of total billed charges,35.67% of total billed charges,41.76,477.9,
PETROUS BONES - XRAY,3202110,CDM,320,RC,70134,HCPCS,outpatient,,,1059,423.60,,900.15,85,,720.12,percent of total billed charges,85% of total billed charges,815.43,77,,652.34,percent of total billed charges,77% of total billed charges,482.45,100,,,fee schedule,100% of CMS OPPS rate,894.39,385,,,fee schedule,385% of BCBS fee schedule,931.56,401,,,fee schedule,401% of BCBS fee schedule,931.56,401,,,fee schedule,401% of BCBS fee schedule,931.56,401,,,fee schedule,401% of BCBS fee schedule,953.1,90,,762.48,percent of total billed charges,90% of total billed charges,847.2,80,,677.76,percent of total billed charges,80% of total billed charges,953.1,90,,762.48,percent of total billed charges,90% of total billed charges,794.25,75,,635.4,percent of total billed charges,75% of total billed charges,588.59,122,,,fee schedule,122% of APC rate,307.11,29,,245.688,percent of total billed charges,29% of total billed charges,482.45,100,,,fee schedule,100% of CMS OPPS rate,709.53,67,,567.624,percent of total billed charges,67% of total billed charges,70.34,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,847.2,80,,677.76,percent of total billed charges,80% of total billed charges,688.35,65,,550.68,percent of total billed charges,65% of total billed charges,377.75,35.67,,302.2,percent of total billed charges,35.67% of total billed charges,70.34,953.1,
C ARM/FLUORO USE LESS 1 HR,3202115,CDM,320,RC,76000,HCPCS,outpatient,,,409,163.60,,347.65,85,,278.12,percent of total billed charges,85% of total billed charges,314.93,77,,251.94,percent of total billed charges,77% of total billed charges,214.29,100,,,fee schedule,100% of CMS OPPS rate,152,385,,,fee schedule,385% of BCBS fee schedule,158.31,401,,,fee schedule,401% of BCBS fee schedule,158.31,401,,,fee schedule,401% of BCBS fee schedule,158.31,401,,,fee schedule,401% of BCBS fee schedule,368.1,90,,294.48,percent of total billed charges,90% of total billed charges,327.2,80,,261.76,percent of total billed charges,80% of total billed charges,368.1,90,,294.48,percent of total billed charges,90% of total billed charges,306.75,75,,245.4,percent of total billed charges,75% of total billed charges,261.43,122,,,fee schedule,122% of APC rate,118.61,29,,94.888,percent of total billed charges,29% of total billed charges,214.29,100,,,fee schedule,100% of CMS OPPS rate,274.03,67,,219.224,percent of total billed charges,67% of total billed charges,82.15,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,327.2,80,,261.76,percent of total billed charges,80% of total billed charges,265.85,65,,212.68,percent of total billed charges,65% of total billed charges,145.89,35.67,,116.712,percent of total billed charges,35.67% of total billed charges,82.15,368.1,
C ARM/FLUOROSCOPE FOR CVAD,3202116,CDM,320,RC,77001,HCPCS,outpatient,,,319,127.60,,271.15,85,,216.92,percent of total billed charges,85% of total billed charges,245.63,77,,196.5,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,255.6,385,,,fee schedule,385% of BCBS fee schedule,266.22,401,,,fee schedule,401% of BCBS fee schedule,266.22,401,,,fee schedule,401% of BCBS fee schedule,266.22,401,,,fee schedule,401% of BCBS fee schedule,287.1,90,,229.68,percent of total billed charges,90% of total billed charges,255.2,80,,204.16,percent of total billed charges,80% of total billed charges,287.1,90,,229.68,percent of total billed charges,90% of total billed charges,239.25,75,,191.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,92.51,29,,74.008,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,213.73,67,,170.984,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,255.2,80,,204.16,percent of total billed charges,80% of total billed charges,207.35,65,,165.88,percent of total billed charges,65% of total billed charges,113.79,35.67,,91.032,percent of total billed charges,35.67% of total billed charges,92.51,287.1,
C ARM FLUORO FOR ESI,3202117,CDM,320,RC,77003,HCPCS,outpatient,,,592,236.80,,503.2,85,,402.56,percent of total billed charges,85% of total billed charges,455.84,77,,364.67,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,251.48,385,,,fee schedule,385% of BCBS fee schedule,261.93,401,,,fee schedule,401% of BCBS fee schedule,261.93,401,,,fee schedule,401% of BCBS fee schedule,261.93,401,,,fee schedule,401% of BCBS fee schedule,532.8,90,,426.24,percent of total billed charges,90% of total billed charges,473.6,80,,378.88,percent of total billed charges,80% of total billed charges,532.8,90,,426.24,percent of total billed charges,90% of total billed charges,444,75,,355.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,171.68,29,,137.344,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,396.64,67,,317.312,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,473.6,80,,378.88,percent of total billed charges,80% of total billed charges,384.8,65,,307.84,percent of total billed charges,65% of total billed charges,211.17,35.67,,168.936,percent of total billed charges,35.67% of total billed charges,171.68,532.8,
MEDIPORT PATENCY EVAL BY RAD,3202125,CDM,320,RC,36598,HCPCS,outpatient,,,431,172.40,,1150,,,,case rate,pays based on per visit,331.87,77,,265.5,percent of total billed charges,77% of total billed charges,187.44,100,,,fee schedule,100% of CMS OPPS rate,353.42,82,,282.736,percent of total billed charges,82% of total billed charges,366.35,85,,293.08,percent of total billed charges,85% of total billed charges,366.35,85,,293.08,percent of total billed charges,85% of total billed charges,366.35,85,,293.08,percent of total billed charges,85% of total billed charges,387.9,90,,310.32,percent of total billed charges,90% of total billed charges,344.8,80,,275.84,percent of total billed charges,80% of total billed charges,387.9,90,,310.32,percent of total billed charges,90% of total billed charges,323.25,75,,258.6,percent of total billed charges,75% of total billed charges,228.67,122,,,fee schedule,122% of APC rate,79.46,100,,,fee schedule,100% of ASC tier grouping rate,187.44,100,,,fee schedule,100% of CMS OPPS rate,288.77,67,,231.016,percent of total billed charges,67% of total billed charges,150.36,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,344.8,80,,275.84,percent of total billed charges,80% of total billed charges,280.15,65,,224.12,percent of total billed charges,65% of total billed charges,97.74,123,,,fee schedule,123% of ASC tier grouping rate,79.46,1150,
RIBS 2 V RT,3202138,CDM,320,RC,71100,HCPCS,outpatient,,,291,116.40,RT,247.35,85,,197.88,percent of total billed charges,85% of total billed charges,224.07,77,,179.26,percent of total billed charges,77% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,239.16,385,,,fee schedule,385% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,261.9,90,,209.52,percent of total billed charges,90% of total billed charges,232.8,80,,186.24,percent of total billed charges,80% of total billed charges,261.9,90,,209.52,percent of total billed charges,90% of total billed charges,218.25,75,,174.6,percent of total billed charges,75% of total billed charges,96.95,122,,,fee schedule,122% of APC rate,84.39,29,,67.512,percent of total billed charges,29% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,194.97,67,,155.976,percent of total billed charges,67% of total billed charges,41.76,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,232.8,80,,186.24,percent of total billed charges,80% of total billed charges,189.15,65,,151.32,percent of total billed charges,65% of total billed charges,103.8,35.67,,83.04,percent of total billed charges,35.67% of total billed charges,41.76,261.9,
RIBS 2 V LT,3202139,CDM,320,RC,71100,HCPCS,outpatient,,,291,116.40,LT,247.35,85,,197.88,percent of total billed charges,85% of total billed charges,224.07,77,,179.26,percent of total billed charges,77% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,239.16,385,,,fee schedule,385% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,261.9,90,,209.52,percent of total billed charges,90% of total billed charges,232.8,80,,186.24,percent of total billed charges,80% of total billed charges,261.9,90,,209.52,percent of total billed charges,90% of total billed charges,218.25,75,,174.6,percent of total billed charges,75% of total billed charges,96.95,122,,,fee schedule,122% of APC rate,84.39,29,,67.512,percent of total billed charges,29% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,194.97,67,,155.976,percent of total billed charges,67% of total billed charges,41.76,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,232.8,80,,186.24,percent of total billed charges,80% of total billed charges,189.15,65,,151.32,percent of total billed charges,65% of total billed charges,103.8,35.67,,83.04,percent of total billed charges,35.67% of total billed charges,41.76,261.9,
RIBS 3 V BIL XRAY,3202140,CDM,320,RC,71110,HCPCS,outpatient,,,369,147.60,,313.65,85,,250.92,percent of total billed charges,85% of total billed charges,284.13,77,,227.3,percent of total billed charges,77% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,440.67,385,,,fee schedule,385% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,332.1,90,,265.68,percent of total billed charges,90% of total billed charges,295.2,80,,236.16,percent of total billed charges,80% of total billed charges,332.1,90,,265.68,percent of total billed charges,90% of total billed charges,276.75,75,,221.4,percent of total billed charges,75% of total billed charges,117.29,122,,,fee schedule,122% of APC rate,107.01,29,,85.608,percent of total billed charges,29% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,247.23,67,,197.784,percent of total billed charges,67% of total billed charges,41.76,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,295.2,80,,236.16,percent of total billed charges,80% of total billed charges,239.85,65,,191.88,percent of total billed charges,65% of total billed charges,131.62,35.67,,105.296,percent of total billed charges,35.67% of total billed charges,41.76,458.98,
RETROGRADE UROGRAPHY - XRAY,3202160,CDM,320,RC,74420,HCPCS,outpatient,,,2073,829.20,,1762.05,85,,1409.64,percent of total billed charges,85% of total billed charges,1596.21,77,,1276.97,percent of total billed charges,77% of total billed charges,336.32,100,,,fee schedule,100% of CMS OPPS rate,1752.02,385,,,fee schedule,385% of BCBS fee schedule,1824.83,401,,,fee schedule,401% of BCBS fee schedule,1824.83,401,,,fee schedule,401% of BCBS fee schedule,1824.83,401,,,fee schedule,401% of BCBS fee schedule,1865.7,90,,1492.56,percent of total billed charges,90% of total billed charges,1658.4,80,,1326.72,percent of total billed charges,80% of total billed charges,1865.7,90,,1492.56,percent of total billed charges,90% of total billed charges,1554.75,75,,1243.8,percent of total billed charges,75% of total billed charges,410.31,122,,,fee schedule,122% of APC rate,601.17,29,,480.936,percent of total billed charges,29% of total billed charges,336.32,100,,,fee schedule,100% of CMS OPPS rate,1388.91,67,,1111.128,percent of total billed charges,67% of total billed charges,171.39,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,1658.4,80,,1326.72,percent of total billed charges,80% of total billed charges,1347.45,65,,1077.96,percent of total billed charges,65% of total billed charges,739.44,35.67,,591.552,percent of total billed charges,35.67% of total billed charges,171.39,1865.7,
RHEUMATOID SERIES - XRAY,3202170,CDM,320,RC,73130,HCPCS,outpatient,,,360,144.00,,306,85,,244.8,percent of total billed charges,85% of total billed charges,277.2,77,,221.76,percent of total billed charges,77% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,239.16,385,,,fee schedule,385% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,324,90,,259.2,percent of total billed charges,90% of total billed charges,288,80,,230.4,percent of total billed charges,80% of total billed charges,324,90,,259.2,percent of total billed charges,90% of total billed charges,270,75,,216,percent of total billed charges,75% of total billed charges,96.95,122,,,fee schedule,122% of APC rate,104.4,29,,83.52,percent of total billed charges,29% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,241.2,67,,192.96,percent of total billed charges,67% of total billed charges,41.76,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,288,80,,230.4,percent of total billed charges,80% of total billed charges,234,65,,187.2,percent of total billed charges,65% of total billed charges,128.41,35.67,,102.728,percent of total billed charges,35.67% of total billed charges,41.76,324,
SACRUM MIN 2 V XRAY,3202200,CDM,320,RC,72220,HCPCS,outpatient,,,522,208.80,,443.7,85,,354.96,percent of total billed charges,85% of total billed charges,401.94,77,,321.55,percent of total billed charges,77% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,239.16,385,,,fee schedule,385% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,469.8,90,,375.84,percent of total billed charges,90% of total billed charges,417.6,80,,334.08,percent of total billed charges,80% of total billed charges,469.8,90,,375.84,percent of total billed charges,90% of total billed charges,391.5,75,,313.2,percent of total billed charges,75% of total billed charges,96.95,122,,,fee schedule,122% of APC rate,151.38,29,,121.104,percent of total billed charges,29% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,349.74,67,,279.792,percent of total billed charges,67% of total billed charges,41.76,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,417.6,80,,334.08,percent of total billed charges,80% of total billed charges,339.3,65,,271.44,percent of total billed charges,65% of total billed charges,186.2,35.67,,148.96,percent of total billed charges,35.67% of total billed charges,41.76,469.8,
SACRUM AND COCCYX MIN 2 V XRAY,3202210,CDM,320,RC,72220,HCPCS,outpatient,,,531,212.40,,451.35,85,,361.08,percent of total billed charges,85% of total billed charges,408.87,77,,327.1,percent of total billed charges,77% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,239.16,385,,,fee schedule,385% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,477.9,90,,382.32,percent of total billed charges,90% of total billed charges,424.8,80,,339.84,percent of total billed charges,80% of total billed charges,477.9,90,,382.32,percent of total billed charges,90% of total billed charges,398.25,75,,318.6,percent of total billed charges,75% of total billed charges,96.95,122,,,fee schedule,122% of APC rate,153.99,29,,123.192,percent of total billed charges,29% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,355.77,67,,284.616,percent of total billed charges,67% of total billed charges,41.76,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,424.8,80,,339.84,percent of total billed charges,80% of total billed charges,345.15,65,,276.12,percent of total billed charges,65% of total billed charges,189.41,35.67,,151.528,percent of total billed charges,35.67% of total billed charges,41.76,477.9,
SACROILIAC JOINT 3 OR > V XRAY,3202220,CDM,320,RC,72202,HCPCS,outpatient,,,531,212.40,,451.35,85,,361.08,percent of total billed charges,85% of total billed charges,408.87,77,,327.1,percent of total billed charges,77% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,440.67,385,,,fee schedule,385% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,477.9,90,,382.32,percent of total billed charges,90% of total billed charges,424.8,80,,339.84,percent of total billed charges,80% of total billed charges,477.9,90,,382.32,percent of total billed charges,90% of total billed charges,398.25,75,,318.6,percent of total billed charges,75% of total billed charges,117.29,122,,,fee schedule,122% of APC rate,153.99,29,,123.192,percent of total billed charges,29% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,355.77,67,,284.616,percent of total billed charges,67% of total billed charges,41.76,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,424.8,80,,339.84,percent of total billed charges,80% of total billed charges,345.15,65,,276.12,percent of total billed charges,65% of total billed charges,189.41,35.67,,151.528,percent of total billed charges,35.67% of total billed charges,41.76,477.9,
SMALL BOWEL SERIES - XRAY,3202240,CDM,320,RC,74250,HCPCS,outpatient,,,554,221.60,,470.9,85,,376.72,percent of total billed charges,85% of total billed charges,426.58,77,,341.26,percent of total billed charges,77% of total billed charges,160.68,100,,,fee schedule,100% of CMS OPPS rate,440.67,385,,,fee schedule,385% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,498.6,90,,398.88,percent of total billed charges,90% of total billed charges,443.2,80,,354.56,percent of total billed charges,80% of total billed charges,498.6,90,,398.88,percent of total billed charges,90% of total billed charges,415.5,75,,332.4,percent of total billed charges,75% of total billed charges,196.03,122,,,fee schedule,122% of APC rate,160.66,29,,128.528,percent of total billed charges,29% of total billed charges,160.68,100,,,fee schedule,100% of CMS OPPS rate,371.18,67,,296.944,percent of total billed charges,67% of total billed charges,80,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,443.2,80,,354.56,percent of total billed charges,80% of total billed charges,360.1,65,,288.08,percent of total billed charges,65% of total billed charges,197.61,35.67,,158.088,percent of total billed charges,35.67% of total billed charges,80,498.6,
"SCAPULA, LEFT",3202270,CDM,320,RC,73010,HCPCS,outpatient,,,522,208.80,LT,443.7,85,,354.96,percent of total billed charges,85% of total billed charges,401.94,77,,321.55,percent of total billed charges,77% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,440.67,385,,,fee schedule,385% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,469.8,90,,375.84,percent of total billed charges,90% of total billed charges,417.6,80,,334.08,percent of total billed charges,80% of total billed charges,469.8,90,,375.84,percent of total billed charges,90% of total billed charges,391.5,75,,313.2,percent of total billed charges,75% of total billed charges,117.29,122,,,fee schedule,122% of APC rate,151.38,29,,121.104,percent of total billed charges,29% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,349.74,67,,279.792,percent of total billed charges,67% of total billed charges,41.76,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,417.6,80,,334.08,percent of total billed charges,80% of total billed charges,339.3,65,,271.44,percent of total billed charges,65% of total billed charges,186.2,35.67,,148.96,percent of total billed charges,35.67% of total billed charges,41.76,469.8,
"SCAPULA, RIGHT",3202271,CDM,320,RC,73010,HCPCS,outpatient,,,522,208.80,RT,443.7,85,,354.96,percent of total billed charges,85% of total billed charges,401.94,77,,321.55,percent of total billed charges,77% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,440.67,385,,,fee schedule,385% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,469.8,90,,375.84,percent of total billed charges,90% of total billed charges,417.6,80,,334.08,percent of total billed charges,80% of total billed charges,469.8,90,,375.84,percent of total billed charges,90% of total billed charges,391.5,75,,313.2,percent of total billed charges,75% of total billed charges,117.29,122,,,fee schedule,122% of APC rate,151.38,29,,121.104,percent of total billed charges,29% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,349.74,67,,279.792,percent of total billed charges,67% of total billed charges,41.76,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,417.6,80,,334.08,percent of total billed charges,80% of total billed charges,339.3,65,,271.44,percent of total billed charges,65% of total billed charges,186.2,35.67,,148.96,percent of total billed charges,35.67% of total billed charges,41.76,469.8,
STERNOCLAVICULAR JOINT MIN 3 V,3202290,CDM,320,RC,71130,HCPCS,outpatient,,,286,114.40,,243.1,85,,194.48,percent of total billed charges,85% of total billed charges,220.22,77,,176.18,percent of total billed charges,77% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,239.16,385,,,fee schedule,385% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,257.4,90,,205.92,percent of total billed charges,90% of total billed charges,228.8,80,,183.04,percent of total billed charges,80% of total billed charges,257.4,90,,205.92,percent of total billed charges,90% of total billed charges,214.5,75,,171.6,percent of total billed charges,75% of total billed charges,96.95,122,,,fee schedule,122% of APC rate,82.94,29,,66.352,percent of total billed charges,29% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,191.62,67,,153.296,percent of total billed charges,67% of total billed charges,41.76,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,228.8,80,,183.04,percent of total billed charges,80% of total billed charges,185.9,65,,148.72,percent of total billed charges,65% of total billed charges,102.02,35.67,,81.616,percent of total billed charges,35.67% of total billed charges,41.76,257.4,
SCOLIOSIS SERIES 2/3 V XRAY,3202300,CDM,320,RC,72083,HCPCS,outpatient,,,522,208.80,,443.7,85,,354.96,percent of total billed charges,85% of total billed charges,401.94,77,,321.55,percent of total billed charges,77% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,221.07,385,,,fee schedule,385% of BCBS fee schedule,230.25,401,,,fee schedule,401% of BCBS fee schedule,230.25,401,,,fee schedule,401% of BCBS fee schedule,230.25,401,,,fee schedule,401% of BCBS fee schedule,469.8,90,,375.84,percent of total billed charges,90% of total billed charges,417.6,80,,334.08,percent of total billed charges,80% of total billed charges,469.8,90,,375.84,percent of total billed charges,90% of total billed charges,391.5,75,,313.2,percent of total billed charges,75% of total billed charges,117.29,122,,,fee schedule,122% of APC rate,151.38,29,,121.104,percent of total billed charges,29% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,349.74,67,,279.792,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,417.6,80,,334.08,percent of total billed charges,80% of total billed charges,339.3,65,,271.44,percent of total billed charges,65% of total billed charges,186.2,35.67,,148.96,percent of total billed charges,35.67% of total billed charges,96.14,469.8,
SCAPHOID MIN 3 V LT,3202330,CDM,320,RC,73110,HCPCS,outpatient,,,360,144.00,LT,306,85,,244.8,percent of total billed charges,85% of total billed charges,277.2,77,,221.76,percent of total billed charges,77% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,239.16,385,,,fee schedule,385% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,324,90,,259.2,percent of total billed charges,90% of total billed charges,288,80,,230.4,percent of total billed charges,80% of total billed charges,324,90,,259.2,percent of total billed charges,90% of total billed charges,270,75,,216,percent of total billed charges,75% of total billed charges,96.95,122,,,fee schedule,122% of APC rate,104.4,29,,83.52,percent of total billed charges,29% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,241.2,67,,192.96,percent of total billed charges,67% of total billed charges,41.76,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,288,80,,230.4,percent of total billed charges,80% of total billed charges,234,65,,187.2,percent of total billed charges,65% of total billed charges,128.41,35.67,,102.728,percent of total billed charges,35.67% of total billed charges,41.76,324,
SCAPHOID MIN 3 V RT,3202331,CDM,320,RC,73110,HCPCS,outpatient,,,360,144.00,RT,306,85,,244.8,percent of total billed charges,85% of total billed charges,277.2,77,,221.76,percent of total billed charges,77% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,239.16,385,,,fee schedule,385% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,324,90,,259.2,percent of total billed charges,90% of total billed charges,288,80,,230.4,percent of total billed charges,80% of total billed charges,324,90,,259.2,percent of total billed charges,90% of total billed charges,270,75,,216,percent of total billed charges,75% of total billed charges,96.95,122,,,fee schedule,122% of APC rate,104.4,29,,83.52,percent of total billed charges,29% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,241.2,67,,192.96,percent of total billed charges,67% of total billed charges,41.76,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,288,80,,230.4,percent of total billed charges,80% of total billed charges,234,65,,187.2,percent of total billed charges,65% of total billed charges,128.41,35.67,,102.728,percent of total billed charges,35.67% of total billed charges,41.76,324,
SELLA TURCICA - XRAY,3202350,CDM,320,RC,70240,HCPCS,outpatient,,,286,114.40,,243.1,85,,194.48,percent of total billed charges,85% of total billed charges,220.22,77,,176.18,percent of total billed charges,77% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,239.16,385,,,fee schedule,385% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,257.4,90,,205.92,percent of total billed charges,90% of total billed charges,228.8,80,,183.04,percent of total billed charges,80% of total billed charges,257.4,90,,205.92,percent of total billed charges,90% of total billed charges,214.5,75,,171.6,percent of total billed charges,75% of total billed charges,96.95,122,,,fee schedule,122% of HUMANA fee schedule,82.94,29,,66.352,percent of total billed charges,29% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,191.62,67,,153.296,percent of total billed charges,67% of total billed charges,41.76,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,228.8,80,,183.04,percent of total billed charges,80% of total billed charges,185.9,65,,148.72,percent of total billed charges,65% of total billed charges,102.02,35.67,,81.616,percent of total billed charges,35.67% of total billed charges,41.76,257.4,
SOFT TISSUE FILMS - NECK,3202360,CDM,320,RC,70360,HCPCS,outpatient,,,286,114.40,,243.1,85,,194.48,percent of total billed charges,85% of total billed charges,220.22,77,,176.18,percent of total billed charges,77% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,239.16,385,,,fee schedule,385% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,257.4,90,,205.92,percent of total billed charges,90% of total billed charges,228.8,80,,183.04,percent of total billed charges,80% of total billed charges,257.4,90,,205.92,percent of total billed charges,90% of total billed charges,214.5,75,,171.6,percent of total billed charges,75% of total billed charges,96.95,122,,,fee schedule,122% of HUMANA fee schedule,82.94,29,,66.352,percent of total billed charges,29% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,191.62,67,,153.296,percent of total billed charges,67% of total billed charges,41.76,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,228.8,80,,183.04,percent of total billed charges,80% of total billed charges,185.9,65,,148.72,percent of total billed charges,65% of total billed charges,102.02,35.67,,81.616,percent of total billed charges,35.67% of total billed charges,41.76,257.4,
SHOULDER MIN 2 V LT,3202390,CDM,320,RC,73030,HCPCS,outpatient,,,358,143.20,LT,304.3,85,,243.44,percent of total billed charges,85% of total billed charges,275.66,77,,220.53,percent of total billed charges,77% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,239.16,385,,,fee schedule,385% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,322.2,90,,257.76,percent of total billed charges,90% of total billed charges,286.4,80,,229.12,percent of total billed charges,80% of total billed charges,322.2,90,,257.76,percent of total billed charges,90% of total billed charges,268.5,75,,214.8,percent of total billed charges,75% of total billed charges,96.95,122,,,fee schedule,122% of HUMANA fee schedule,103.82,29,,83.056,percent of total billed charges,29% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,239.86,67,,191.888,percent of total billed charges,67% of total billed charges,41.76,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,286.4,80,,229.12,percent of total billed charges,80% of total billed charges,232.7,65,,186.16,percent of total billed charges,65% of total billed charges,127.7,35.67,,102.16,percent of total billed charges,35.67% of total billed charges,41.76,322.2,
SHOULDER MIN 2 V RT,3202391,CDM,320,RC,73030,HCPCS,outpatient,,,257,102.80,RT,218.45,85,,174.76,percent of total billed charges,85% of total billed charges,197.89,77,,158.31,percent of total billed charges,77% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,239.16,385,,,fee schedule,385% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,231.3,90,,185.04,percent of total billed charges,90% of total billed charges,205.6,80,,164.48,percent of total billed charges,80% of total billed charges,231.3,90,,185.04,percent of total billed charges,90% of total billed charges,192.75,75,,154.2,percent of total billed charges,75% of total billed charges,96.95,122,,,fee schedule,122% of HUMANA fee schedule,74.53,29,,59.624,percent of total billed charges,29% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,172.19,67,,137.752,percent of total billed charges,67% of total billed charges,41.76,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,205.6,80,,164.48,percent of total billed charges,80% of total billed charges,167.05,65,,133.64,percent of total billed charges,65% of total billed charges,91.67,35.67,,73.336,percent of total billed charges,35.67% of total billed charges,41.76,249.1,
SHOULDER-WT.BEARING BILAT.XRAY,3202420,CDM,320,RC,73050,HCPCS,outpatient,,,375,150.00,,318.75,85,,255,percent of total billed charges,85% of total billed charges,288.75,77,,231,percent of total billed charges,77% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,239.16,385,,,fee schedule,385% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,337.5,90,,270,percent of total billed charges,90% of total billed charges,300,80,,240,percent of total billed charges,80% of total billed charges,337.5,90,,270,percent of total billed charges,90% of total billed charges,281.25,75,,225,percent of total billed charges,75% of total billed charges,96.95,122,,,fee schedule,122% of HUMANA fee schedule,108.75,29,,87,percent of total billed charges,29% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,251.25,67,,201,percent of total billed charges,67% of total billed charges,41.76,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,300,80,,240,percent of total billed charges,80% of total billed charges,243.75,65,,195,percent of total billed charges,65% of total billed charges,133.76,35.67,,107.008,percent of total billed charges,35.67% of total billed charges,41.76,337.5,
SHOULDER MIN 2 V WT BEARING LT,3202440,CDM,320,RC,73030,HCPCS,outpatient,,,358,143.20,LT,304.3,85,,243.44,percent of total billed charges,85% of total billed charges,275.66,77,,220.53,percent of total billed charges,77% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,239.16,385,,,fee schedule,385% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,322.2,90,,257.76,percent of total billed charges,90% of total billed charges,286.4,80,,229.12,percent of total billed charges,80% of total billed charges,322.2,90,,257.76,percent of total billed charges,90% of total billed charges,268.5,75,,214.8,percent of total billed charges,75% of total billed charges,96.95,122,,,fee schedule,122% of HUMANA fee schedule,103.82,29,,83.056,percent of total billed charges,29% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,239.86,67,,191.888,percent of total billed charges,67% of total billed charges,41.76,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,286.4,80,,229.12,percent of total billed charges,80% of total billed charges,232.7,65,,186.16,percent of total billed charges,65% of total billed charges,127.7,35.67,,102.16,percent of total billed charges,35.67% of total billed charges,41.76,322.2,
SHOULDER MIN 2 V WT BEARING RT,3202441,CDM,320,RC,73030,HCPCS,outpatient,,,257,102.80,RT,218.45,85,,174.76,percent of total billed charges,85% of total billed charges,197.89,77,,158.31,percent of total billed charges,77% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,239.16,385,,,fee schedule,385% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,231.3,90,,185.04,percent of total billed charges,90% of total billed charges,205.6,80,,164.48,percent of total billed charges,80% of total billed charges,231.3,90,,185.04,percent of total billed charges,90% of total billed charges,192.75,75,,154.2,percent of total billed charges,75% of total billed charges,96.95,122,,,fee schedule,122% of HUMANA fee schedule,74.53,29,,59.624,percent of total billed charges,29% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,172.19,67,,137.752,percent of total billed charges,67% of total billed charges,41.76,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,205.6,80,,164.48,percent of total billed charges,80% of total billed charges,167.05,65,,133.64,percent of total billed charges,65% of total billed charges,91.67,35.67,,73.336,percent of total billed charges,35.67% of total billed charges,41.76,249.1,
SINUS SERIES MIN 3 V XRAY,3202490,CDM,320,RC,70220,HCPCS,outpatient,,,291,116.40,,247.35,85,,197.88,percent of total billed charges,85% of total billed charges,224.07,77,,179.26,percent of total billed charges,77% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,239.16,385,,,fee schedule,385% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,261.9,90,,209.52,percent of total billed charges,90% of total billed charges,232.8,80,,186.24,percent of total billed charges,80% of total billed charges,261.9,90,,209.52,percent of total billed charges,90% of total billed charges,218.25,75,,174.6,percent of total billed charges,75% of total billed charges,96.95,122,,,fee schedule,122% of HUMANA fee schedule,84.39,29,,67.512,percent of total billed charges,29% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,194.97,67,,155.976,percent of total billed charges,67% of total billed charges,41.76,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,232.8,80,,186.24,percent of total billed charges,80% of total billed charges,189.15,65,,151.32,percent of total billed charges,65% of total billed charges,103.8,35.67,,83.04,percent of total billed charges,35.67% of total billed charges,41.76,261.9,
SKULL - ONE VIEW - XRAY,3202500,CDM,320,RC,70250,HCPCS,outpatient,,,522,208.80,,443.7,85,,354.96,percent of total billed charges,85% of total billed charges,401.94,77,,321.55,percent of total billed charges,77% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,440.67,385,,,fee schedule,385% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,469.8,90,,375.84,percent of total billed charges,90% of total billed charges,417.6,80,,334.08,percent of total billed charges,80% of total billed charges,469.8,90,,375.84,percent of total billed charges,90% of total billed charges,391.5,75,,313.2,percent of total billed charges,75% of total billed charges,117.29,122,,,fee schedule,122% of HUMANA fee schedule,151.38,29,,121.104,percent of total billed charges,29% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,349.74,67,,279.792,percent of total billed charges,67% of total billed charges,41.76,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,417.6,80,,334.08,percent of total billed charges,80% of total billed charges,339.3,65,,271.44,percent of total billed charges,65% of total billed charges,186.2,35.67,,148.96,percent of total billed charges,35.67% of total billed charges,41.76,469.8,
SKULL 2 VIEWS - XRAY,3202501,CDM,320,RC,70250,HCPCS,outpatient,,,531,212.40,,451.35,85,,361.08,percent of total billed charges,85% of total billed charges,408.87,77,,327.1,percent of total billed charges,77% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,440.67,385,,,fee schedule,385% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,477.9,90,,382.32,percent of total billed charges,90% of total billed charges,424.8,80,,339.84,percent of total billed charges,80% of total billed charges,477.9,90,,382.32,percent of total billed charges,90% of total billed charges,398.25,75,,318.6,percent of total billed charges,75% of total billed charges,117.29,122,,,fee schedule,122% of HUMANA fee schedule,153.99,29,,123.192,percent of total billed charges,29% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,355.77,67,,284.616,percent of total billed charges,67% of total billed charges,41.76,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,424.8,80,,339.84,percent of total billed charges,80% of total billed charges,345.15,65,,276.12,percent of total billed charges,65% of total billed charges,189.41,35.67,,151.528,percent of total billed charges,35.67% of total billed charges,41.76,477.9,
SKULL MINIMUM 4 VIEWS,3202502,CDM,320,RC,70260,HCPCS,outpatient,,,522,208.80,,443.7,85,,354.96,percent of total billed charges,85% of total billed charges,401.94,77,,321.55,percent of total billed charges,77% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,440.67,385,,,fee schedule,385% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,469.8,90,,375.84,percent of total billed charges,90% of total billed charges,417.6,80,,334.08,percent of total billed charges,80% of total billed charges,469.8,90,,375.84,percent of total billed charges,90% of total billed charges,391.5,75,,313.2,percent of total billed charges,75% of total billed charges,117.29,122,,,fee schedule,122% of HUMANA fee schedule,151.38,29,,121.104,percent of total billed charges,29% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,349.74,67,,279.792,percent of total billed charges,67% of total billed charges,70.34,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,417.6,80,,334.08,percent of total billed charges,80% of total billed charges,339.3,65,,271.44,percent of total billed charges,65% of total billed charges,186.2,35.67,,148.96,percent of total billed charges,35.67% of total billed charges,70.34,469.8,
SURGICAL SPECIMEN - X-RAY,3202510,CDM,320,RC,76098,HCPCS,outpatient,,,2257,902.80,,1918.45,85,,1534.76,percent of total billed charges,85% of total billed charges,1737.89,77,,1390.31,percent of total billed charges,77% of total billed charges,482.45,100,,,fee schedule,100% of CMS OPPS rate,1873.76,385,,,fee schedule,385% of BCBS fee schedule,1951.63,401,,,fee schedule,401% of BCBS fee schedule,1951.63,401,,,fee schedule,401% of BCBS fee schedule,1951.63,401,,,fee schedule,401% of BCBS fee schedule,2031.3,90,,1625.04,percent of total billed charges,90% of total billed charges,1805.6,80,,1444.48,percent of total billed charges,80% of total billed charges,2031.3,90,,1625.04,percent of total billed charges,90% of total billed charges,1692.75,75,,1354.2,percent of total billed charges,75% of total billed charges,588.59,122,,,fee schedule,122% of HUMANA fee schedule,654.53,29,,523.624,percent of total billed charges,29% of total billed charges,482.45,100,,,fee schedule,100% of CMS OPPS rate,1512.19,67,,1209.752,percent of total billed charges,67% of total billed charges,396.22,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,1805.6,80,,1444.48,percent of total billed charges,80% of total billed charges,1467.05,65,,1173.64,percent of total billed charges,65% of total billed charges,805.07,35.67,,644.056,percent of total billed charges,35.67% of total billed charges,396.22,2031.3,
STERNUM MIN 2 V XRAY,3202520,CDM,320,RC,71120,HCPCS,outpatient,,,286,114.40,,243.1,85,,194.48,percent of total billed charges,85% of total billed charges,220.22,77,,176.18,percent of total billed charges,77% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,239.16,385,,,fee schedule,385% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,257.4,90,,205.92,percent of total billed charges,90% of total billed charges,228.8,80,,183.04,percent of total billed charges,80% of total billed charges,257.4,90,,205.92,percent of total billed charges,90% of total billed charges,214.5,75,,171.6,percent of total billed charges,75% of total billed charges,96.95,122,,,fee schedule,122% of HUMANA fee schedule,82.94,29,,66.352,percent of total billed charges,29% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,191.62,67,,153.296,percent of total billed charges,67% of total billed charges,41.76,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,228.8,80,,183.04,percent of total billed charges,80% of total billed charges,185.9,65,,148.72,percent of total billed charges,65% of total billed charges,102.02,35.67,,81.616,percent of total billed charges,35.67% of total billed charges,41.76,257.4,
SINGLE VIEW BODY PART - XRAY,3202560,CDM,320,RC,76100,HCPCS,outpatient,,,522,208.80,,443.7,85,,354.96,percent of total billed charges,85% of total billed charges,401.94,77,,321.55,percent of total billed charges,77% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,440.67,385,,,fee schedule,385% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,469.8,90,,375.84,percent of total billed charges,90% of total billed charges,417.6,80,,334.08,percent of total billed charges,80% of total billed charges,469.8,90,,375.84,percent of total billed charges,90% of total billed charges,391.5,75,,313.2,percent of total billed charges,75% of total billed charges,117.29,122,,,fee schedule,122% of HUMANA fee schedule,151.38,29,,121.104,percent of total billed charges,29% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,349.74,67,,279.792,percent of total billed charges,67% of total billed charges,70.34,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,417.6,80,,334.08,percent of total billed charges,80% of total billed charges,339.3,65,,271.44,percent of total billed charges,65% of total billed charges,186.2,35.67,,148.96,percent of total billed charges,35.67% of total billed charges,70.34,469.8,
TEMPEROMANDIBULAR JOINT - XRAY,3202620,CDM,320,RC,70328,HCPCS,outpatient,,,286,114.40,,243.1,85,,194.48,percent of total billed charges,85% of total billed charges,220.22,77,,176.18,percent of total billed charges,77% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,239.16,385,,,fee schedule,385% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,257.4,90,,205.92,percent of total billed charges,90% of total billed charges,228.8,80,,183.04,percent of total billed charges,80% of total billed charges,257.4,90,,205.92,percent of total billed charges,90% of total billed charges,214.5,75,,171.6,percent of total billed charges,75% of total billed charges,96.95,122,,,fee schedule,122% of HUMANA fee schedule,82.94,29,,66.352,percent of total billed charges,29% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,191.62,67,,153.296,percent of total billed charges,67% of total billed charges,41.76,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,228.8,80,,183.04,percent of total billed charges,80% of total billed charges,185.9,65,,148.72,percent of total billed charges,65% of total billed charges,102.02,35.67,,81.616,percent of total billed charges,35.67% of total billed charges,41.76,257.4,
TOES (S) MINIMUM 2 VIEWS,3202661,CDM,320,RC,73660,HCPCS,outpatient,,,375,150.00,,318.75,85,,255,percent of total billed charges,85% of total billed charges,288.75,77,,231,percent of total billed charges,77% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,239.16,385,,,fee schedule,385% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,337.5,90,,270,percent of total billed charges,90% of total billed charges,300,80,,240,percent of total billed charges,80% of total billed charges,337.5,90,,270,percent of total billed charges,90% of total billed charges,281.25,75,,225,percent of total billed charges,75% of total billed charges,96.95,122,,,fee schedule,122% of HUMANA fee schedule,108.75,29,,87,percent of total billed charges,29% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,251.25,67,,201,percent of total billed charges,67% of total billed charges,41.76,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,300,80,,240,percent of total billed charges,80% of total billed charges,243.75,65,,195,percent of total billed charges,65% of total billed charges,133.76,35.67,,107.008,percent of total billed charges,35.67% of total billed charges,41.76,337.5,
THORACIC SPINE 3 VIEWS,3202700,CDM,320,RC,72072,HCPCS,outpatient,,,531,212.40,,451.35,85,,361.08,percent of total billed charges,85% of total billed charges,408.87,77,,327.1,percent of total billed charges,77% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,440.67,385,,,fee schedule,385% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,477.9,90,,382.32,percent of total billed charges,90% of total billed charges,424.8,80,,339.84,percent of total billed charges,80% of total billed charges,477.9,90,,382.32,percent of total billed charges,90% of total billed charges,398.25,75,,318.6,percent of total billed charges,75% of total billed charges,117.29,122,,,fee schedule,122% of HUMANA fee schedule,153.99,29,,123.192,percent of total billed charges,29% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,355.77,67,,284.616,percent of total billed charges,67% of total billed charges,41.76,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,424.8,80,,339.84,percent of total billed charges,80% of total billed charges,345.15,65,,276.12,percent of total billed charges,65% of total billed charges,189.41,35.67,,151.528,percent of total billed charges,35.67% of total billed charges,41.76,477.9,
THORACENTESIS W/IMAGING GUIDE,3202701,CDM,320,RC,32555,HCPCS,outpatient,,,1149,459.60,,1150,,,,case rate,pays based on per visit,884.73,77,,707.78,percent of total billed charges,77% of total billed charges,549.37,100,,,fee schedule,100% of CMS OPPS rate,942.18,82,,753.744,percent of total billed charges,82% of total billed charges,976.65,85,,781.32,percent of total billed charges,85% of total billed charges,976.65,85,,781.32,percent of total billed charges,85% of total billed charges,976.65,85,,781.32,percent of total billed charges,85% of total billed charges,1034.1,90,,827.28,percent of total billed charges,90% of total billed charges,919.2,80,,735.36,percent of total billed charges,80% of total billed charges,1034.1,90,,827.28,percent of total billed charges,90% of total billed charges,861.75,75,,689.4,percent of total billed charges,75% of total billed charges,670.25,122,,,fee schedule,122% of HUMANA fee schedule,223.75,100,,,fee schedule,100% of ASC tier grouping rate,549.37,100,,,fee schedule,100% of CMS OPPS rate,769.83,67,,615.864,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,919.2,80,,735.36,percent of total billed charges,80% of total billed charges,746.85,65,,597.48,percent of total billed charges,65% of total billed charges,275.21,123,,,fee schedule,123% of ASC tier grouping rate,223.75,1150,
UPPER GI SERIES - XRAY,3202730,CDM,320,RC,74240,HCPCS,outpatient,,,1175,470.00,,998.75,85,,799,percent of total billed charges,85% of total billed charges,904.75,77,,723.8,percent of total billed charges,77% of total billed charges,160.68,100,,,fee schedule,100% of CMS OPPS rate,973.05,385,,,fee schedule,385% of BCBS fee schedule,1013.49,401,,,fee schedule,401% of BCBS fee schedule,1013.49,401,,,fee schedule,401% of BCBS fee schedule,1013.49,401,,,fee schedule,401% of BCBS fee schedule,1057.5,90,,846,percent of total billed charges,90% of total billed charges,940,80,,752,percent of total billed charges,80% of total billed charges,1057.5,90,,846,percent of total billed charges,90% of total billed charges,881.25,75,,705,percent of total billed charges,75% of total billed charges,196.03,122,,,fee schedule,122% of HUMANA fee schedule,340.75,29,,272.6,percent of total billed charges,29% of total billed charges,160.68,100,,,fee schedule,100% of CMS OPPS rate,787.25,67,,629.8,percent of total billed charges,67% of total billed charges,80,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,940,80,,752,percent of total billed charges,80% of total billed charges,763.75,65,,611,percent of total billed charges,65% of total billed charges,419.12,35.67,,335.296,percent of total billed charges,35.67% of total billed charges,80,1057.5,
"UPPER GI, BARIUM SWALLOW",3202745,CDM,320,RC,74246,HCPCS,outpatient,,,1152,460.80,,979.2,85,,783.36,percent of total billed charges,85% of total billed charges,887.04,77,,709.63,percent of total billed charges,77% of total billed charges,160.68,100,,,fee schedule,100% of CMS OPPS rate,973.05,385,,,fee schedule,385% of BCBS fee schedule,1013.49,401,,,fee schedule,401% of BCBS fee schedule,1013.49,401,,,fee schedule,401% of BCBS fee schedule,1013.49,401,,,fee schedule,401% of BCBS fee schedule,1036.8,90,,829.44,percent of total billed charges,90% of total billed charges,921.6,80,,737.28,percent of total billed charges,80% of total billed charges,1036.8,90,,829.44,percent of total billed charges,90% of total billed charges,864,75,,691.2,percent of total billed charges,75% of total billed charges,196.03,122,,,fee schedule,122% of HUMANA fee schedule,334.08,29,,267.264,percent of total billed charges,29% of total billed charges,160.68,100,,,fee schedule,100% of CMS OPPS rate,771.84,67,,617.472,percent of total billed charges,67% of total billed charges,80,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,921.6,80,,737.28,percent of total billed charges,80% of total billed charges,748.8,65,,599.04,percent of total billed charges,65% of total billed charges,410.92,35.67,,328.736,percent of total billed charges,35.67% of total billed charges,80,1036.8,
UPPER GI/SMALL BOWEL - XRAY,3202750,CDM,320,RC,74240,HCPCS,outpatient,,,1076,430.40,,914.6,85,,731.68,percent of total billed charges,85% of total billed charges,828.52,77,,662.82,percent of total billed charges,77% of total billed charges,160.68,100,,,fee schedule,100% of CMS OPPS rate,973.05,385,,,fee schedule,385% of BCBS fee schedule,1013.49,401,,,fee schedule,401% of BCBS fee schedule,1013.49,401,,,fee schedule,401% of BCBS fee schedule,1013.49,401,,,fee schedule,401% of BCBS fee schedule,968.4,90,,774.72,percent of total billed charges,90% of total billed charges,860.8,80,,688.64,percent of total billed charges,80% of total billed charges,968.4,90,,774.72,percent of total billed charges,90% of total billed charges,807,75,,645.6,percent of total billed charges,75% of total billed charges,196.03,122,,,fee schedule,122% of HUMANA fee schedule,312.04,29,,249.632,percent of total billed charges,29% of total billed charges,160.68,100,,,fee schedule,100% of CMS OPPS rate,720.92,67,,576.736,percent of total billed charges,67% of total billed charges,80,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,860.8,80,,688.64,percent of total billed charges,80% of total billed charges,699.4,65,,559.52,percent of total billed charges,65% of total billed charges,383.81,35.67,,307.048,percent of total billed charges,35.67% of total billed charges,80,1013.49,
URETHROGRAM - XRAY,3202770,CDM,320,RC,74450,HCPCS,outpatient,,,1059,423.60,,900.15,85,,720.12,percent of total billed charges,85% of total billed charges,815.43,77,,652.34,percent of total billed charges,77% of total billed charges,214.29,100,,,fee schedule,100% of CMS OPPS rate,894.39,385,,,fee schedule,385% of BCBS fee schedule,931.56,401,,,fee schedule,401% of BCBS fee schedule,931.56,401,,,fee schedule,401% of BCBS fee schedule,931.56,401,,,fee schedule,401% of BCBS fee schedule,953.1,90,,762.48,percent of total billed charges,90% of total billed charges,847.2,80,,677.76,percent of total billed charges,80% of total billed charges,953.1,90,,762.48,percent of total billed charges,90% of total billed charges,794.25,75,,635.4,percent of total billed charges,75% of total billed charges,261.43,122,,,fee schedule,122% of HUMANA fee schedule,307.11,29,,245.688,percent of total billed charges,29% of total billed charges,214.29,100,,,fee schedule,100% of CMS OPPS rate,709.53,67,,567.624,percent of total billed charges,67% of total billed charges,171.39,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,847.2,80,,677.76,percent of total billed charges,80% of total billed charges,688.35,65,,550.68,percent of total billed charges,65% of total billed charges,377.75,35.67,,302.2,percent of total billed charges,35.67% of total billed charges,171.39,953.1,
VOIDING CYSTOURETHROGRAM -XRAY,3202780,CDM,320,RC,74455,HCPCS,outpatient,,,1059,423.60,,900.15,85,,720.12,percent of total billed charges,85% of total billed charges,815.43,77,,652.34,percent of total billed charges,77% of total billed charges,214.29,100,,,fee schedule,100% of CMS OPPS rate,894.39,385,,,fee schedule,385% of BCBS fee schedule,931.56,401,,,fee schedule,401% of BCBS fee schedule,931.56,401,,,fee schedule,401% of BCBS fee schedule,931.56,401,,,fee schedule,401% of BCBS fee schedule,953.1,90,,762.48,percent of total billed charges,90% of total billed charges,847.2,80,,677.76,percent of total billed charges,80% of total billed charges,953.1,90,,762.48,percent of total billed charges,90% of total billed charges,794.25,75,,635.4,percent of total billed charges,75% of total billed charges,261.43,122,,,fee schedule,122% of HUMANA fee schedule,307.11,29,,245.688,percent of total billed charges,29% of total billed charges,214.29,100,,,fee schedule,100% of CMS OPPS rate,709.53,67,,567.624,percent of total billed charges,67% of total billed charges,171.39,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,847.2,80,,677.76,percent of total billed charges,80% of total billed charges,688.35,65,,550.68,percent of total billed charges,65% of total billed charges,377.75,35.67,,302.2,percent of total billed charges,35.67% of total billed charges,171.39,953.1,
WRIST MIN 3 V LT,3202840,CDM,320,RC,73110,HCPCS,outpatient,,,360,144.00,LT,306,85,,244.8,percent of total billed charges,85% of total billed charges,277.2,77,,221.76,percent of total billed charges,77% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,239.16,385,,,fee schedule,385% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,324,90,,259.2,percent of total billed charges,90% of total billed charges,288,80,,230.4,percent of total billed charges,80% of total billed charges,324,90,,259.2,percent of total billed charges,90% of total billed charges,270,75,,216,percent of total billed charges,75% of total billed charges,96.95,122,,,fee schedule,122% of HUMANA fee schedule,104.4,29,,83.52,percent of total billed charges,29% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,241.2,67,,192.96,percent of total billed charges,67% of total billed charges,41.76,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,288,80,,230.4,percent of total billed charges,80% of total billed charges,234,65,,187.2,percent of total billed charges,65% of total billed charges,128.41,35.67,,102.728,percent of total billed charges,35.67% of total billed charges,41.76,324,
WRIST MIN 3 V RT,3202841,CDM,320,RC,73110,HCPCS,outpatient,,,360,144.00,RT,306,85,,244.8,percent of total billed charges,85% of total billed charges,277.2,77,,221.76,percent of total billed charges,77% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,239.16,385,,,fee schedule,385% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,324,90,,259.2,percent of total billed charges,90% of total billed charges,288,80,,230.4,percent of total billed charges,80% of total billed charges,324,90,,259.2,percent of total billed charges,90% of total billed charges,270,75,,216,percent of total billed charges,75% of total billed charges,96.95,122,,,fee schedule,122% of HUMANA fee schedule,104.4,29,,83.52,percent of total billed charges,29% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,241.2,67,,192.96,percent of total billed charges,67% of total billed charges,41.76,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,288,80,,230.4,percent of total billed charges,80% of total billed charges,234,65,,187.2,percent of total billed charges,65% of total billed charges,128.41,35.67,,102.728,percent of total billed charges,35.67% of total billed charges,41.76,324,
WATERS < 3 V XRAY,3202870,CDM,320,RC,70210,HCPCS,outpatient,,,286,114.40,,243.1,85,,194.48,percent of total billed charges,85% of total billed charges,220.22,77,,176.18,percent of total billed charges,77% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,239.16,385,,,fee schedule,385% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,257.4,90,,205.92,percent of total billed charges,90% of total billed charges,228.8,80,,183.04,percent of total billed charges,80% of total billed charges,257.4,90,,205.92,percent of total billed charges,90% of total billed charges,214.5,75,,171.6,percent of total billed charges,75% of total billed charges,96.95,122,,,fee schedule,122% of HUMANA fee schedule,82.94,29,,66.352,percent of total billed charges,29% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,191.62,67,,153.296,percent of total billed charges,67% of total billed charges,41.76,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,228.8,80,,183.04,percent of total billed charges,80% of total billed charges,185.9,65,,148.72,percent of total billed charges,65% of total billed charges,102.02,35.67,,81.616,percent of total billed charges,35.67% of total billed charges,41.76,257.4,
ZYGOMA <3 V,3202890,CDM,320,RC,70140,HCPCS,outpatient,,,285,114.00,,242.25,85,,193.8,percent of total billed charges,85% of total billed charges,219.45,77,,175.56,percent of total billed charges,77% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,239.16,385,,,fee schedule,385% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,256.5,90,,205.2,percent of total billed charges,90% of total billed charges,228,80,,182.4,percent of total billed charges,80% of total billed charges,256.5,90,,205.2,percent of total billed charges,90% of total billed charges,213.75,75,,171,percent of total billed charges,75% of total billed charges,96.95,122,,,fee schedule,122% of HUMANA fee schedule,82.65,29,,66.12,percent of total billed charges,29% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,190.95,67,,152.76,percent of total billed charges,67% of total billed charges,41.76,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,228,80,,182.4,percent of total billed charges,80% of total billed charges,185.25,65,,148.2,percent of total billed charges,65% of total billed charges,101.66,35.67,,81.328,percent of total billed charges,35.67% of total billed charges,41.76,256.5,
ARTHROGRAM INJECTION,3203130,CDM,320,RC,,,outpatient,,,1145,458.00,,973.25,85,,778.6,percent of total billed charges,85% of total billed charges,881.65,77,,705.32,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,938.9,82,,751.12,percent of total billed charges,82% of total billed charges,973.25,85,,778.6,percent of total billed charges,85% of total billed charges,973.25,85,,778.6,percent of total billed charges,85% of total billed charges,973.25,85,,778.6,percent of total billed charges,85% of total billed charges,1030.5,90,,824.4,percent of total billed charges,90% of total billed charges,916,80,,732.8,percent of total billed charges,80% of total billed charges,1030.5,90,,824.4,percent of total billed charges,90% of total billed charges,858.75,75,,687,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,332.05,29,,265.64,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,767.15,67,,613.72,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,916,80,,732.8,percent of total billed charges,80% of total billed charges,744.25,65,,595.4,percent of total billed charges,65% of total billed charges,408.42,35.67,,326.736,percent of total billed charges,35.67% of total billed charges,332.05,1030.5,
"ARTHOGRAM, SHOULDER RIGHT",3203140,CDM,320,RC,73040,HCPCS,outpatient,,,2079,831.60,RT,1767.15,85,,1413.72,percent of total billed charges,85% of total billed charges,1600.83,77,,1280.66,percent of total billed charges,77% of total billed charges,336.32,100,,,fee schedule,100% of CMS OPPS rate,1757.02,385,,,fee schedule,385% of BCBS fee schedule,1830.04,401,,,fee schedule,401% of BCBS fee schedule,1830.04,401,,,fee schedule,401% of BCBS fee schedule,1830.04,401,,,fee schedule,401% of BCBS fee schedule,1871.1,90,,1496.88,percent of total billed charges,90% of total billed charges,1663.2,80,,1330.56,percent of total billed charges,80% of total billed charges,1871.1,90,,1496.88,percent of total billed charges,90% of total billed charges,1559.25,75,,1247.4,percent of total billed charges,75% of total billed charges,410.31,122,,,fee schedule,122% of HUMANA fee schedule,602.91,29,,482.328,percent of total billed charges,29% of total billed charges,336.32,100,,,fee schedule,100% of CMS OPPS rate,1392.93,67,,1114.344,percent of total billed charges,67% of total billed charges,261.55,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,1663.2,80,,1330.56,percent of total billed charges,80% of total billed charges,1351.35,65,,1081.08,percent of total billed charges,65% of total billed charges,741.58,35.67,,593.264,percent of total billed charges,35.67% of total billed charges,261.55,1871.1,
"ARTHROGRAM, SHOULDER LEFT",3203145,CDM,320,RC,73040,HCPCS,outpatient,,,2079,831.60,LT,1767.15,85,,1413.72,percent of total billed charges,85% of total billed charges,1600.83,77,,1280.66,percent of total billed charges,77% of total billed charges,336.32,100,,,fee schedule,100% of CMS OPPS rate,1757.02,385,,,fee schedule,385% of BCBS fee schedule,1830.04,401,,,fee schedule,401% of BCBS fee schedule,1830.04,401,,,fee schedule,401% of BCBS fee schedule,1830.04,401,,,fee schedule,401% of BCBS fee schedule,1871.1,90,,1496.88,percent of total billed charges,90% of total billed charges,1663.2,80,,1330.56,percent of total billed charges,80% of total billed charges,1871.1,90,,1496.88,percent of total billed charges,90% of total billed charges,1559.25,75,,1247.4,percent of total billed charges,75% of total billed charges,410.31,122,,,fee schedule,122% of HUMANA fee schedule,602.91,29,,482.328,percent of total billed charges,29% of total billed charges,336.32,100,,,fee schedule,100% of CMS OPPS rate,1392.93,67,,1114.344,percent of total billed charges,67% of total billed charges,261.55,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,1663.2,80,,1330.56,percent of total billed charges,80% of total billed charges,1351.35,65,,1081.08,percent of total billed charges,65% of total billed charges,741.58,35.67,,593.264,percent of total billed charges,35.67% of total billed charges,261.55,1871.1,
"ARTHROGRAM, KNEE RIGHT",3203150,CDM,320,RC,73580,HCPCS,outpatient,,,2079,831.60,RT,1767.15,85,,1413.72,percent of total billed charges,85% of total billed charges,1600.83,77,,1280.66,percent of total billed charges,77% of total billed charges,336.32,100,,,fee schedule,100% of CMS OPPS rate,1757.02,385,,,fee schedule,385% of BCBS fee schedule,1830.04,401,,,fee schedule,401% of BCBS fee schedule,1830.04,401,,,fee schedule,401% of BCBS fee schedule,1830.04,401,,,fee schedule,401% of BCBS fee schedule,1871.1,90,,1496.88,percent of total billed charges,90% of total billed charges,1663.2,80,,1330.56,percent of total billed charges,80% of total billed charges,1871.1,90,,1496.88,percent of total billed charges,90% of total billed charges,1559.25,75,,1247.4,percent of total billed charges,75% of total billed charges,410.31,122,,,fee schedule,122% of HUMANA fee schedule,602.91,29,,482.328,percent of total billed charges,29% of total billed charges,336.32,100,,,fee schedule,100% of CMS OPPS rate,1392.93,67,,1114.344,percent of total billed charges,67% of total billed charges,261.55,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,1663.2,80,,1330.56,percent of total billed charges,80% of total billed charges,1351.35,65,,1081.08,percent of total billed charges,65% of total billed charges,741.58,35.67,,593.264,percent of total billed charges,35.67% of total billed charges,261.55,1871.1,
"ARTHROGRAM, KNEE LEFT",3203155,CDM,320,RC,73580,HCPCS,outpatient,,,2079,831.60,LT,1767.15,85,,1413.72,percent of total billed charges,85% of total billed charges,1600.83,77,,1280.66,percent of total billed charges,77% of total billed charges,336.32,100,,,fee schedule,100% of CMS OPPS rate,1757.02,385,,,fee schedule,385% of BCBS fee schedule,1830.04,401,,,fee schedule,401% of BCBS fee schedule,1830.04,401,,,fee schedule,401% of BCBS fee schedule,1830.04,401,,,fee schedule,401% of BCBS fee schedule,1871.1,90,,1496.88,percent of total billed charges,90% of total billed charges,1663.2,80,,1330.56,percent of total billed charges,80% of total billed charges,1871.1,90,,1496.88,percent of total billed charges,90% of total billed charges,1559.25,75,,1247.4,percent of total billed charges,75% of total billed charges,410.31,122,,,fee schedule,122% of HUMANA fee schedule,602.91,29,,482.328,percent of total billed charges,29% of total billed charges,336.32,100,,,fee schedule,100% of CMS OPPS rate,1392.93,67,,1114.344,percent of total billed charges,67% of total billed charges,261.55,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,1663.2,80,,1330.56,percent of total billed charges,80% of total billed charges,1351.35,65,,1081.08,percent of total billed charges,65% of total billed charges,741.58,35.67,,593.264,percent of total billed charges,35.67% of total billed charges,261.55,1871.1,
"ARTHROGRAM, HIP RIGHT",3203160,CDM,320,RC,73525,HCPCS,outpatient,,,2079,831.60,RT,1767.15,85,,1413.72,percent of total billed charges,85% of total billed charges,1600.83,77,,1280.66,percent of total billed charges,77% of total billed charges,336.32,100,,,fee schedule,100% of CMS OPPS rate,1757.02,385,,,fee schedule,385% of BCBS fee schedule,1830.04,401,,,fee schedule,401% of BCBS fee schedule,1830.04,401,,,fee schedule,401% of BCBS fee schedule,1830.04,401,,,fee schedule,401% of BCBS fee schedule,1871.1,90,,1496.88,percent of total billed charges,90% of total billed charges,1663.2,80,,1330.56,percent of total billed charges,80% of total billed charges,1871.1,90,,1496.88,percent of total billed charges,90% of total billed charges,1559.25,75,,1247.4,percent of total billed charges,75% of total billed charges,410.31,122,,,fee schedule,122% of HUMANA fee schedule,602.91,29,,482.328,percent of total billed charges,29% of total billed charges,336.32,100,,,fee schedule,100% of CMS OPPS rate,1392.93,67,,1114.344,percent of total billed charges,67% of total billed charges,261.55,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,1663.2,80,,1330.56,percent of total billed charges,80% of total billed charges,1351.35,65,,1081.08,percent of total billed charges,65% of total billed charges,741.58,35.67,,593.264,percent of total billed charges,35.67% of total billed charges,261.55,1871.1,
"ARTHROGRAM, HIP LEFT",3203165,CDM,320,RC,73525,HCPCS,outpatient,,,2079,831.60,LT,1767.15,85,,1413.72,percent of total billed charges,85% of total billed charges,1600.83,77,,1280.66,percent of total billed charges,77% of total billed charges,336.32,100,,,fee schedule,100% of CMS OPPS rate,1757.02,385,,,fee schedule,385% of BCBS fee schedule,1830.04,401,,,fee schedule,401% of BCBS fee schedule,1830.04,401,,,fee schedule,401% of BCBS fee schedule,1830.04,401,,,fee schedule,401% of BCBS fee schedule,1871.1,90,,1496.88,percent of total billed charges,90% of total billed charges,1663.2,80,,1330.56,percent of total billed charges,80% of total billed charges,1871.1,90,,1496.88,percent of total billed charges,90% of total billed charges,1559.25,75,,1247.4,percent of total billed charges,75% of total billed charges,410.31,122,,,fee schedule,122% of HUMANA fee schedule,602.91,29,,482.328,percent of total billed charges,29% of total billed charges,336.32,100,,,fee schedule,100% of CMS OPPS rate,1392.93,67,,1114.344,percent of total billed charges,67% of total billed charges,261.55,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,1663.2,80,,1330.56,percent of total billed charges,80% of total billed charges,1351.35,65,,1081.08,percent of total billed charges,65% of total billed charges,741.58,35.67,,593.264,percent of total billed charges,35.67% of total billed charges,261.55,1871.1,
XR CERVIAL SPINE 1VIEW,3204000,CDM,320,RC,72020,HCPCS,outpatient,,,498,199.20,,423.3,85,,338.64,percent of total billed charges,85% of total billed charges,383.46,77,,306.77,percent of total billed charges,77% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,239.16,385,,,fee schedule,385% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,448.2,90,,358.56,percent of total billed charges,90% of total billed charges,398.4,80,,318.72,percent of total billed charges,80% of total billed charges,448.2,90,,358.56,percent of total billed charges,90% of total billed charges,373.5,75,,298.8,percent of total billed charges,75% of total billed charges,96.95,122,,,fee schedule,122% of HUMANA fee schedule,144.42,29,,115.536,percent of total billed charges,29% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,333.66,67,,266.928,percent of total billed charges,67% of total billed charges,41.76,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,398.4,80,,318.72,percent of total billed charges,80% of total billed charges,323.7,65,,258.96,percent of total billed charges,65% of total billed charges,177.64,35.67,,142.112,percent of total billed charges,35.67% of total billed charges,41.76,448.2,
XR LUMBAR SPINE 1VIEW,32040004,CDM,320,RC,,,outpatient,,,577,230.80,,490.45,85,,392.36,percent of total billed charges,85% of total billed charges,444.29,77,,355.43,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,473.14,82,,378.512,percent of total billed charges,82% of total billed charges,490.45,85,,392.36,percent of total billed charges,85% of total billed charges,490.45,85,,392.36,percent of total billed charges,85% of total billed charges,490.45,85,,392.36,percent of total billed charges,85% of total billed charges,519.3,90,,415.44,percent of total billed charges,90% of total billed charges,461.6,80,,369.28,percent of total billed charges,80% of total billed charges,519.3,90,,415.44,percent of total billed charges,90% of total billed charges,432.75,75,,346.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,167.33,29,,133.864,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,386.59,67,,309.272,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,461.6,80,,369.28,percent of total billed charges,80% of total billed charges,375.05,65,,300.04,percent of total billed charges,65% of total billed charges,205.82,35.67,,164.656,percent of total billed charges,35.67% of total billed charges,167.33,519.3,
XR CLAVICLE BI,3204001,CDM,320,RC,73000,HCPCS,outpatient,,,500,200.00,,425,85,,340,percent of total billed charges,85% of total billed charges,385,77,,308,percent of total billed charges,77% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,239.16,385,,,fee schedule,385% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,450,90,,360,percent of total billed charges,90% of total billed charges,400,80,,320,percent of total billed charges,80% of total billed charges,450,90,,360,percent of total billed charges,90% of total billed charges,375,75,,300,percent of total billed charges,75% of total billed charges,96.95,122,,,fee schedule,122% of HUMANA fee schedule,145,29,,116,percent of total billed charges,29% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,335,67,,268,percent of total billed charges,67% of total billed charges,41.76,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,400,80,,320,percent of total billed charges,80% of total billed charges,325,65,,260,percent of total billed charges,65% of total billed charges,178.35,35.67,,142.68,percent of total billed charges,35.67% of total billed charges,41.76,450,
XR LE INFANT LT MIN 2VIEW,3204002,CDM,320,RC,73592,HCPCS,outpatient,,,246,98.40,LT,209.1,85,,167.28,percent of total billed charges,85% of total billed charges,189.42,77,,151.54,percent of total billed charges,77% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,239.16,385,,,fee schedule,385% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,221.4,90,,177.12,percent of total billed charges,90% of total billed charges,196.8,80,,157.44,percent of total billed charges,80% of total billed charges,221.4,90,,177.12,percent of total billed charges,90% of total billed charges,184.5,75,,147.6,percent of total billed charges,75% of total billed charges,96.95,122,,,fee schedule,122% of HUMANA fee schedule,71.34,29,,57.072,percent of total billed charges,29% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,164.82,67,,131.856,percent of total billed charges,67% of total billed charges,41.76,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,196.8,80,,157.44,percent of total billed charges,80% of total billed charges,159.9,65,,127.92,percent of total billed charges,65% of total billed charges,87.75,35.67,,70.2,percent of total billed charges,35.67% of total billed charges,41.76,249.1,
XR LE INFANT RT MIN 2VIEW,3204003,CDM,320,RC,73592,HCPCS,outpatient,,,246,98.40,RT,209.1,85,,167.28,percent of total billed charges,85% of total billed charges,189.42,77,,151.54,percent of total billed charges,77% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,239.16,385,,,fee schedule,385% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,221.4,90,,177.12,percent of total billed charges,90% of total billed charges,196.8,80,,157.44,percent of total billed charges,80% of total billed charges,221.4,90,,177.12,percent of total billed charges,90% of total billed charges,184.5,75,,147.6,percent of total billed charges,75% of total billed charges,96.95,122,,,fee schedule,122% of HUMANA fee schedule,71.34,29,,57.072,percent of total billed charges,29% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,164.82,67,,131.856,percent of total billed charges,67% of total billed charges,41.76,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,196.8,80,,157.44,percent of total billed charges,80% of total billed charges,159.9,65,,127.92,percent of total billed charges,65% of total billed charges,87.75,35.67,,70.2,percent of total billed charges,35.67% of total billed charges,41.76,249.1,
X-Ray LUMBAR SPINE 1VIEW,3204004,CDM,320,RC,72081,HCPCS,outpatient,,,547,218.80,,464.95,85,,371.96,percent of total billed charges,85% of total billed charges,421.19,77,,336.95,percent of total billed charges,77% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,239.16,385,,,fee schedule,385% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,492.3,90,,393.84,percent of total billed charges,90% of total billed charges,437.6,80,,350.08,percent of total billed charges,80% of total billed charges,492.3,90,,393.84,percent of total billed charges,90% of total billed charges,410.25,75,,328.2,percent of total billed charges,75% of total billed charges,96.95,122,,,fee schedule,122% of HUMANA fee schedule,158.63,29,,126.904,percent of total billed charges,29% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,366.49,67,,293.192,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,437.6,80,,350.08,percent of total billed charges,80% of total billed charges,355.55,65,,284.44,percent of total billed charges,65% of total billed charges,195.11,35.67,,156.088,percent of total billed charges,35.67% of total billed charges,79.46,492.3,
XR LUMBAR SPINE 2-3VIEW,3204005,CDM,320,RC,72082,HCPCS,outpatient,,,852,340.80,,724.2,85,,579.36,percent of total billed charges,85% of total billed charges,656.04,77,,524.83,percent of total billed charges,77% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,440.67,385,,,fee schedule,385% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,766.8,90,,613.44,percent of total billed charges,90% of total billed charges,681.6,80,,545.28,percent of total billed charges,80% of total billed charges,766.8,90,,613.44,percent of total billed charges,90% of total billed charges,639,75,,511.2,percent of total billed charges,75% of total billed charges,117.29,122,,,fee schedule,122% of HUMANA fee schedule,247.08,29,,197.664,percent of total billed charges,29% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,570.84,67,,456.672,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,681.6,80,,545.28,percent of total billed charges,80% of total billed charges,553.8,65,,443.04,percent of total billed charges,65% of total billed charges,303.91,35.67,,243.128,percent of total billed charges,35.67% of total billed charges,96.14,766.8,
XR RIB BI MIN 4V W/CXR1V,3204006,CDM,320,RC,71111,HCPCS,outpatient,,,910,364.00,50,773.5,85,,618.8,percent of total billed charges,85% of total billed charges,700.7,77,,560.56,percent of total billed charges,77% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,440.67,385,,,fee schedule,385% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,819,90,,655.2,percent of total billed charges,90% of total billed charges,728,80,,582.4,percent of total billed charges,80% of total billed charges,819,90,,655.2,percent of total billed charges,90% of total billed charges,682.5,75,,546,percent of total billed charges,75% of total billed charges,117.29,122,,,fee schedule,122% of HUMANA fee schedule,263.9,29,,211.12,percent of total billed charges,29% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,609.7,67,,487.76,percent of total billed charges,67% of total billed charges,70.34,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,728,80,,582.4,percent of total billed charges,80% of total billed charges,591.5,65,,473.2,percent of total billed charges,65% of total billed charges,324.6,35.67,,259.68,percent of total billed charges,35.67% of total billed charges,70.34,819,
XR RIB LT MIN 3V W/CXR1V,3204007,CDM,320,RC,71101,HCPCS,outpatient,,,736,294.40,LT,625.6,85,,500.48,percent of total billed charges,85% of total billed charges,566.72,77,,453.38,percent of total billed charges,77% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,440.67,385,,,fee schedule,385% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,662.4,90,,529.92,percent of total billed charges,90% of total billed charges,588.8,80,,471.04,percent of total billed charges,80% of total billed charges,662.4,90,,529.92,percent of total billed charges,90% of total billed charges,552,75,,441.6,percent of total billed charges,75% of total billed charges,117.29,122,,,fee schedule,122% of HUMANA fee schedule,213.44,29,,170.752,percent of total billed charges,29% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,493.12,67,,394.496,percent of total billed charges,67% of total billed charges,41.76,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,588.8,80,,471.04,percent of total billed charges,80% of total billed charges,478.4,65,,382.72,percent of total billed charges,65% of total billed charges,262.53,35.67,,210.024,percent of total billed charges,35.67% of total billed charges,41.76,662.4,
XR RIB RT MIN 3V W/CXR1V,3204008,CDM,320,RC,71101,HCPCS,outpatient,,,736,294.40,RT,625.6,85,,500.48,percent of total billed charges,85% of total billed charges,566.72,77,,453.38,percent of total billed charges,77% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,440.67,385,,,fee schedule,385% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,662.4,90,,529.92,percent of total billed charges,90% of total billed charges,588.8,80,,471.04,percent of total billed charges,80% of total billed charges,662.4,90,,529.92,percent of total billed charges,90% of total billed charges,552,75,,441.6,percent of total billed charges,75% of total billed charges,117.29,122,,,fee schedule,122% of HUMANA fee schedule,213.44,29,,170.752,percent of total billed charges,29% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,493.12,67,,394.496,percent of total billed charges,67% of total billed charges,41.76,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,588.8,80,,471.04,percent of total billed charges,80% of total billed charges,478.4,65,,382.72,percent of total billed charges,65% of total billed charges,262.53,35.67,,210.024,percent of total billed charges,35.67% of total billed charges,41.76,662.4,
XR UE INFANT LT MIN 2VIEW,3204009,CDM,320,RC,73092,HCPCS,outpatient,,,297,118.80,LT,252.45,85,,201.96,percent of total billed charges,85% of total billed charges,228.69,77,,182.95,percent of total billed charges,77% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,440.67,385,,,fee schedule,385% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,267.3,90,,213.84,percent of total billed charges,90% of total billed charges,237.6,80,,190.08,percent of total billed charges,80% of total billed charges,267.3,90,,213.84,percent of total billed charges,90% of total billed charges,222.75,75,,178.2,percent of total billed charges,75% of total billed charges,117.29,122,,,fee schedule,122% of HUMANA fee schedule,86.13,29,,68.904,percent of total billed charges,29% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,198.99,67,,159.192,percent of total billed charges,67% of total billed charges,41.76,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,237.6,80,,190.08,percent of total billed charges,80% of total billed charges,193.05,65,,154.44,percent of total billed charges,65% of total billed charges,105.94,35.67,,84.752,percent of total billed charges,35.67% of total billed charges,41.76,458.98,
XR UE INFANT RT MIN 2VIEW,3204010,CDM,320,RC,73092,HCPCS,outpatient,,,297,118.80,RT,252.45,85,,201.96,percent of total billed charges,85% of total billed charges,228.69,77,,182.95,percent of total billed charges,77% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,440.67,385,,,fee schedule,385% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,267.3,90,,213.84,percent of total billed charges,90% of total billed charges,237.6,80,,190.08,percent of total billed charges,80% of total billed charges,267.3,90,,213.84,percent of total billed charges,90% of total billed charges,222.75,75,,178.2,percent of total billed charges,75% of total billed charges,117.29,122,,,fee schedule,122% of HUMANA fee schedule,86.13,29,,68.904,percent of total billed charges,29% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,198.99,67,,159.192,percent of total billed charges,67% of total billed charges,41.76,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,237.6,80,,190.08,percent of total billed charges,80% of total billed charges,193.05,65,,154.44,percent of total billed charges,65% of total billed charges,105.94,35.67,,84.752,percent of total billed charges,35.67% of total billed charges,41.76,458.98,
XR WRIST LT 2VIEW,3204011,CDM,320,RC,73110,HCPCS,outpatient,,,580,232.00,LT,493,85,,394.4,percent of total billed charges,85% of total billed charges,446.6,77,,357.28,percent of total billed charges,77% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,239.16,385,,,fee schedule,385% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,522,90,,417.6,percent of total billed charges,90% of total billed charges,464,80,,371.2,percent of total billed charges,80% of total billed charges,522,90,,417.6,percent of total billed charges,90% of total billed charges,435,75,,348,percent of total billed charges,75% of total billed charges,96.95,122,,,fee schedule,122% of HUMANA fee schedule,168.2,29,,134.56,percent of total billed charges,29% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,388.6,67,,310.88,percent of total billed charges,67% of total billed charges,41.76,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,464,80,,371.2,percent of total billed charges,80% of total billed charges,377,65,,301.6,percent of total billed charges,65% of total billed charges,206.89,35.67,,165.512,percent of total billed charges,35.67% of total billed charges,41.76,522,
XR WRIST RT 2VIEW,3204012,CDM,320,RC,73110,HCPCS,outpatient,,,580,232.00,RT,493,85,,394.4,percent of total billed charges,85% of total billed charges,446.6,77,,357.28,percent of total billed charges,77% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,239.16,385,,,fee schedule,385% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,522,90,,417.6,percent of total billed charges,90% of total billed charges,464,80,,371.2,percent of total billed charges,80% of total billed charges,522,90,,417.6,percent of total billed charges,90% of total billed charges,435,75,,348,percent of total billed charges,75% of total billed charges,96.95,122,,,fee schedule,122% of HUMANA fee schedule,168.2,29,,134.56,percent of total billed charges,29% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,388.6,67,,310.88,percent of total billed charges,67% of total billed charges,41.76,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,464,80,,371.2,percent of total billed charges,80% of total billed charges,377,65,,301.6,percent of total billed charges,65% of total billed charges,206.89,35.67,,165.512,percent of total billed charges,35.67% of total billed charges,41.76,522,
FL SB FOLLOW THRU W/GASTRO,3204013,CDM,320,RC,74246,HCPCS,outpatient,,,1152,460.80,,979.2,85,,783.36,percent of total billed charges,85% of total billed charges,887.04,77,,709.63,percent of total billed charges,77% of total billed charges,160.68,100,,,fee schedule,100% of CMS OPPS rate,973.05,385,,,fee schedule,385% of BCBS fee schedule,1013.49,401,,,fee schedule,401% of BCBS fee schedule,1013.49,401,,,fee schedule,401% of BCBS fee schedule,1013.49,401,,,fee schedule,401% of BCBS fee schedule,1036.8,90,,829.44,percent of total billed charges,90% of total billed charges,921.6,80,,737.28,percent of total billed charges,80% of total billed charges,1036.8,90,,829.44,percent of total billed charges,90% of total billed charges,864,75,,691.2,percent of total billed charges,75% of total billed charges,196.03,122,,,fee schedule,122% of HUMANA fee schedule,334.08,29,,267.264,percent of total billed charges,29% of total billed charges,160.68,100,,,fee schedule,100% of CMS OPPS rate,771.84,67,,617.472,percent of total billed charges,67% of total billed charges,80,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,921.6,80,,737.28,percent of total billed charges,80% of total billed charges,748.8,65,,599.04,percent of total billed charges,65% of total billed charges,410.92,35.67,,328.736,percent of total billed charges,35.67% of total billed charges,80,1036.8,
FL UPPER GI W/GASTROGRAFIN,3204014,CDM,320,RC,74240,HCPCS,outpatient,,,1175,470.00,,998.75,85,,799,percent of total billed charges,85% of total billed charges,904.75,77,,723.8,percent of total billed charges,77% of total billed charges,160.68,100,,,fee schedule,100% of CMS OPPS rate,973.05,385,,,fee schedule,385% of BCBS fee schedule,1013.49,401,,,fee schedule,401% of BCBS fee schedule,1013.49,401,,,fee schedule,401% of BCBS fee schedule,1013.49,401,,,fee schedule,401% of BCBS fee schedule,1057.5,90,,846,percent of total billed charges,90% of total billed charges,940,80,,752,percent of total billed charges,80% of total billed charges,1057.5,90,,846,percent of total billed charges,90% of total billed charges,881.25,75,,705,percent of total billed charges,75% of total billed charges,196.03,122,,,fee schedule,122% of HUMANA fee schedule,340.75,29,,272.6,percent of total billed charges,29% of total billed charges,160.68,100,,,fee schedule,100% of CMS OPPS rate,787.25,67,,629.8,percent of total billed charges,67% of total billed charges,80,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,940,80,,752,percent of total billed charges,80% of total billed charges,763.75,65,,611,percent of total billed charges,65% of total billed charges,419.12,35.67,,335.296,percent of total billed charges,35.67% of total billed charges,80,1057.5,
XR DEXA ULNA/RADIUS,3204015,CDM,320,RC,73090,HCPCS,outpatient,,,582,232.80,,494.7,85,,395.76,percent of total billed charges,85% of total billed charges,448.14,77,,358.51,percent of total billed charges,77% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,239.16,385,,,fee schedule,385% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,523.8,90,,419.04,percent of total billed charges,90% of total billed charges,465.6,80,,372.48,percent of total billed charges,80% of total billed charges,523.8,90,,419.04,percent of total billed charges,90% of total billed charges,436.5,75,,349.2,percent of total billed charges,75% of total billed charges,96.95,122,,,fee schedule,122% of HUMANA fee schedule,168.78,29,,135.024,percent of total billed charges,29% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,389.94,67,,311.952,percent of total billed charges,67% of total billed charges,41.76,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,465.6,80,,372.48,percent of total billed charges,80% of total billed charges,378.3,65,,302.64,percent of total billed charges,65% of total billed charges,207.6,35.67,,166.08,percent of total billed charges,35.67% of total billed charges,41.76,523.8,
ABDOMEN FLATE PLATE 1 VIEW,3250010,CDM,320,RC,74018,HCPCS,outpatient,,,277,110.80,,235.45,85,,188.36,percent of total billed charges,85% of total billed charges,213.29,77,,170.63,percent of total billed charges,77% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,239.16,385,,,fee schedule,385% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.3,90,,199.44,percent of total billed charges,90% of total billed charges,221.6,80,,177.28,percent of total billed charges,80% of total billed charges,249.3,90,,199.44,percent of total billed charges,90% of total billed charges,207.75,75,,166.2,percent of total billed charges,75% of total billed charges,96.95,122,,,fee schedule,122% of HUMANA fee schedule,80.33,29,,64.264,percent of total billed charges,29% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,185.59,67,,148.472,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,221.6,80,,177.28,percent of total billed charges,80% of total billed charges,180.05,65,,144.04,percent of total billed charges,65% of total billed charges,98.81,35.67,,79.048,percent of total billed charges,35.67% of total billed charges,79.46,249.3,
ABDOMEN LAT DEC 1 V,3250020,CDM,320,RC,74018,HCPCS,outpatient,,,272,108.80,,231.2,85,,184.96,percent of total billed charges,85% of total billed charges,209.44,77,,167.55,percent of total billed charges,77% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,239.16,385,,,fee schedule,385% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,244.8,90,,195.84,percent of total billed charges,90% of total billed charges,217.6,80,,174.08,percent of total billed charges,80% of total billed charges,244.8,90,,195.84,percent of total billed charges,90% of total billed charges,204,75,,163.2,percent of total billed charges,75% of total billed charges,96.95,122,,,fee schedule,122% of HUMANA fee schedule,78.88,29,,63.104,percent of total billed charges,29% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,182.24,67,,145.792,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,217.6,80,,174.08,percent of total billed charges,80% of total billed charges,176.8,65,,141.44,percent of total billed charges,65% of total billed charges,97.02,35.67,,77.616,percent of total billed charges,35.67% of total billed charges,78.88,249.1,
ABDOMEN LAT DECUB BIL CL,3250030,CDM,320,RC,74019,HCPCS,outpatient,,,498,199.20,,423.3,85,,338.64,percent of total billed charges,85% of total billed charges,383.46,77,,306.77,percent of total billed charges,77% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,440.67,385,,,fee schedule,385% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,448.2,90,,358.56,percent of total billed charges,90% of total billed charges,398.4,80,,318.72,percent of total billed charges,80% of total billed charges,448.2,90,,358.56,percent of total billed charges,90% of total billed charges,373.5,75,,298.8,percent of total billed charges,75% of total billed charges,117.29,122,,,fee schedule,122% of HUMANA fee schedule,144.42,29,,115.536,percent of total billed charges,29% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,333.66,67,,266.928,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,398.4,80,,318.72,percent of total billed charges,80% of total billed charges,323.7,65,,258.96,percent of total billed charges,65% of total billed charges,177.64,35.67,,142.112,percent of total billed charges,35.67% of total billed charges,96.14,458.98,
ABDOMEN FLAT AND UPRIGHT CL,3250040,CDM,320,RC,74019,HCPCS,outpatient,,,506,202.40,,430.1,85,,344.08,percent of total billed charges,85% of total billed charges,389.62,77,,311.7,percent of total billed charges,77% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,440.67,385,,,fee schedule,385% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,455.4,90,,364.32,percent of total billed charges,90% of total billed charges,404.8,80,,323.84,percent of total billed charges,80% of total billed charges,455.4,90,,364.32,percent of total billed charges,90% of total billed charges,379.5,75,,303.6,percent of total billed charges,75% of total billed charges,117.29,122,,,fee schedule,122% of HUMANA fee schedule,146.74,29,,117.392,percent of total billed charges,29% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,339.02,67,,271.216,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,404.8,80,,323.84,percent of total billed charges,80% of total billed charges,328.9,65,,263.12,percent of total billed charges,65% of total billed charges,180.49,35.67,,144.392,percent of total billed charges,35.67% of total billed charges,96.14,458.98,
ABDOMEN MULTIPLE VIEWS CL,3250060,CDM,320,RC,74021,HCPCS,outpatient,,,498,199.20,,423.3,85,,338.64,percent of total billed charges,85% of total billed charges,383.46,77,,306.77,percent of total billed charges,77% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,440.67,385,,,fee schedule,385% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,448.2,90,,358.56,percent of total billed charges,90% of total billed charges,398.4,80,,318.72,percent of total billed charges,80% of total billed charges,448.2,90,,358.56,percent of total billed charges,90% of total billed charges,373.5,75,,298.8,percent of total billed charges,75% of total billed charges,117.29,122,,,fee schedule,122% of HUMANA fee schedule,144.42,29,,115.536,percent of total billed charges,29% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,333.66,67,,266.928,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,398.4,80,,318.72,percent of total billed charges,80% of total billed charges,323.7,65,,258.96,percent of total billed charges,65% of total billed charges,177.64,35.67,,142.112,percent of total billed charges,35.67% of total billed charges,96.14,458.98,
ABDOMEN UPRIGHT XRAY  CL,3250090,CDM,320,RC,74018,HCPCS,outpatient,,,277,110.80,,235.45,85,,188.36,percent of total billed charges,85% of total billed charges,213.29,77,,170.63,percent of total billed charges,77% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,239.16,385,,,fee schedule,385% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.3,90,,199.44,percent of total billed charges,90% of total billed charges,221.6,80,,177.28,percent of total billed charges,80% of total billed charges,249.3,90,,199.44,percent of total billed charges,90% of total billed charges,207.75,75,,166.2,percent of total billed charges,75% of total billed charges,96.95,122,,,fee schedule,122% of HUMANA fee schedule,80.33,29,,64.264,percent of total billed charges,29% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,185.59,67,,148.472,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,221.6,80,,177.28,percent of total billed charges,80% of total billed charges,180.05,65,,144.04,percent of total billed charges,65% of total billed charges,98.81,35.67,,79.048,percent of total billed charges,35.67% of total billed charges,79.46,249.3,
ACROMIOCLAVICULAR JOINTS CL,3250100,CDM,320,RC,73050,HCPCS,outpatient,,,351,140.40,,298.35,85,,238.68,percent of total billed charges,85% of total billed charges,270.27,77,,216.22,percent of total billed charges,77% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,239.16,385,,,fee schedule,385% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,315.9,90,,252.72,percent of total billed charges,90% of total billed charges,280.8,80,,224.64,percent of total billed charges,80% of total billed charges,315.9,90,,252.72,percent of total billed charges,90% of total billed charges,263.25,75,,210.6,percent of total billed charges,75% of total billed charges,96.95,122,,,fee schedule,122% of HUMANA fee schedule,101.79,29,,81.432,percent of total billed charges,29% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,235.17,67,,188.136,percent of total billed charges,67% of total billed charges,41.76,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,280.8,80,,224.64,percent of total billed charges,80% of total billed charges,228.15,65,,182.52,percent of total billed charges,65% of total billed charges,125.2,35.67,,100.16,percent of total billed charges,35.67% of total billed charges,41.76,315.9,
HAND 3 V MINIMUM RT,32501191,CDM,320,RC,73130,HCPCS,outpatient,,,181,72.40,RT,153.85,85,,123.08,percent of total billed charges,85% of total billed charges,139.37,77,,111.5,percent of total billed charges,77% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,239.16,385,,,fee schedule,385% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,162.9,90,,130.32,percent of total billed charges,90% of total billed charges,144.8,80,,115.84,percent of total billed charges,80% of total billed charges,162.9,90,,130.32,percent of total billed charges,90% of total billed charges,135.75,75,,108.6,percent of total billed charges,75% of total billed charges,96.95,122,,,fee schedule,122% of HUMANA fee schedule,52.49,29,,41.992,percent of total billed charges,29% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,121.27,67,,97.016,percent of total billed charges,67% of total billed charges,41.76,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,144.8,80,,115.84,percent of total billed charges,80% of total billed charges,117.65,65,,94.12,percent of total billed charges,65% of total billed charges,64.56,35.67,,51.648,percent of total billed charges,35.67% of total billed charges,41.76,249.1,
ANKLE LEFT 3 VIEWS CL,3250120,CDM,320,RC,73610,HCPCS,outpatient,,,341,136.40,LT,289.85,85,,231.88,percent of total billed charges,85% of total billed charges,262.57,77,,210.06,percent of total billed charges,77% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,239.16,385,,,fee schedule,385% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,306.9,90,,245.52,percent of total billed charges,90% of total billed charges,272.8,80,,218.24,percent of total billed charges,80% of total billed charges,306.9,90,,245.52,percent of total billed charges,90% of total billed charges,255.75,75,,204.6,percent of total billed charges,75% of total billed charges,96.95,122,,,fee schedule,122% of HUMANA fee schedule,98.89,29,,79.112,percent of total billed charges,29% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,228.47,67,,182.776,percent of total billed charges,67% of total billed charges,41.76,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,272.8,80,,218.24,percent of total billed charges,80% of total billed charges,221.65,65,,177.32,percent of total billed charges,65% of total billed charges,121.63,35.67,,97.304,percent of total billed charges,35.67% of total billed charges,41.76,306.9,
ANKLE RIGHT 3 VIEW,3250121,CDM,320,RC,73610,HCPCS,outpatient,,,341,136.40,RT,289.85,85,,231.88,percent of total billed charges,85% of total billed charges,262.57,77,,210.06,percent of total billed charges,77% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,239.16,385,,,fee schedule,385% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,306.9,90,,245.52,percent of total billed charges,90% of total billed charges,272.8,80,,218.24,percent of total billed charges,80% of total billed charges,306.9,90,,245.52,percent of total billed charges,90% of total billed charges,255.75,75,,204.6,percent of total billed charges,75% of total billed charges,96.95,122,,,fee schedule,122% of HUMANA fee schedule,98.89,29,,79.112,percent of total billed charges,29% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,228.47,67,,182.776,percent of total billed charges,67% of total billed charges,41.76,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,272.8,80,,218.24,percent of total billed charges,80% of total billed charges,221.65,65,,177.32,percent of total billed charges,65% of total billed charges,121.63,35.67,,97.304,percent of total billed charges,35.67% of total billed charges,41.76,306.9,
ANKLE LEFT 2 VIEW CL,3250126,CDM,320,RC,73600,HCPCS,outpatient,,,277,110.80,LT,235.45,85,,188.36,percent of total billed charges,85% of total billed charges,213.29,77,,170.63,percent of total billed charges,77% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,239.16,385,,,fee schedule,385% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.3,90,,199.44,percent of total billed charges,90% of total billed charges,221.6,80,,177.28,percent of total billed charges,80% of total billed charges,249.3,90,,199.44,percent of total billed charges,90% of total billed charges,207.75,75,,166.2,percent of total billed charges,75% of total billed charges,96.95,122,,,fee schedule,122% of HUMANA fee schedule,80.33,29,,64.264,percent of total billed charges,29% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,185.59,67,,148.472,percent of total billed charges,67% of total billed charges,41.76,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,221.6,80,,177.28,percent of total billed charges,80% of total billed charges,180.05,65,,144.04,percent of total billed charges,65% of total billed charges,98.81,35.67,,79.048,percent of total billed charges,35.67% of total billed charges,41.76,249.3,
ANKLE RIGHT TWO VIEWS CL,3250127,CDM,320,RC,73600,HCPCS,outpatient,,,277,110.80,RT,235.45,85,,188.36,percent of total billed charges,85% of total billed charges,213.29,77,,170.63,percent of total billed charges,77% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,239.16,385,,,fee schedule,385% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.3,90,,199.44,percent of total billed charges,90% of total billed charges,221.6,80,,177.28,percent of total billed charges,80% of total billed charges,249.3,90,,199.44,percent of total billed charges,90% of total billed charges,207.75,75,,166.2,percent of total billed charges,75% of total billed charges,96.95,122,,,fee schedule,122% of HUMANA fee schedule,80.33,29,,64.264,percent of total billed charges,29% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,185.59,67,,148.472,percent of total billed charges,67% of total billed charges,41.76,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,221.6,80,,177.28,percent of total billed charges,80% of total billed charges,180.05,65,,144.04,percent of total billed charges,65% of total billed charges,98.81,35.67,,79.048,percent of total billed charges,35.67% of total billed charges,41.76,249.3,
ANKLE LEFT 4 VIEWS CL,3250130,CDM,320,RC,73610,HCPCS,outpatient,,,341,136.40,LT,289.85,85,,231.88,percent of total billed charges,85% of total billed charges,262.57,77,,210.06,percent of total billed charges,77% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,239.16,385,,,fee schedule,385% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,306.9,90,,245.52,percent of total billed charges,90% of total billed charges,272.8,80,,218.24,percent of total billed charges,80% of total billed charges,306.9,90,,245.52,percent of total billed charges,90% of total billed charges,255.75,75,,204.6,percent of total billed charges,75% of total billed charges,96.95,122,,,fee schedule,122% of HUMANA fee schedule,98.89,29,,79.112,percent of total billed charges,29% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,228.47,67,,182.776,percent of total billed charges,67% of total billed charges,41.76,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,272.8,80,,218.24,percent of total billed charges,80% of total billed charges,221.65,65,,177.32,percent of total billed charges,65% of total billed charges,121.63,35.67,,97.304,percent of total billed charges,35.67% of total billed charges,41.76,306.9,
ANKLE RIGHT 4 VIEWS,3250131,CDM,320,RC,73610,HCPCS,outpatient,,,341,136.40,RT,289.85,85,,231.88,percent of total billed charges,85% of total billed charges,262.57,77,,210.06,percent of total billed charges,77% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,239.16,385,,,fee schedule,385% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,306.9,90,,245.52,percent of total billed charges,90% of total billed charges,272.8,80,,218.24,percent of total billed charges,80% of total billed charges,306.9,90,,245.52,percent of total billed charges,90% of total billed charges,255.75,75,,204.6,percent of total billed charges,75% of total billed charges,96.95,122,,,fee schedule,122% of HUMANA fee schedule,98.89,29,,79.112,percent of total billed charges,29% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,228.47,67,,182.776,percent of total billed charges,67% of total billed charges,41.76,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,272.8,80,,218.24,percent of total billed charges,80% of total billed charges,221.65,65,,177.32,percent of total billed charges,65% of total billed charges,121.63,35.67,,97.304,percent of total billed charges,35.67% of total billed charges,41.76,306.9,
BONE AGE STUDIES,3250400,CDM,320,RC,77072,HCPCS,outpatient,,,498,199.20,,423.3,85,,338.64,percent of total billed charges,85% of total billed charges,383.46,77,,306.77,percent of total billed charges,77% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,440.67,385,,,fee schedule,385% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,448.2,90,,358.56,percent of total billed charges,90% of total billed charges,398.4,80,,318.72,percent of total billed charges,80% of total billed charges,448.2,90,,358.56,percent of total billed charges,90% of total billed charges,373.5,75,,298.8,percent of total billed charges,75% of total billed charges,117.29,122,,,fee schedule,122% of HUMANA fee schedule,144.42,29,,115.536,percent of total billed charges,29% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,333.66,67,,266.928,percent of total billed charges,67% of total billed charges,41.76,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,398.4,80,,318.72,percent of total billed charges,80% of total billed charges,323.7,65,,258.96,percent of total billed charges,65% of total billed charges,177.64,35.67,,142.112,percent of total billed charges,35.67% of total billed charges,41.76,458.98,
CLAVICLE XRAY LEFT,3250540,CDM,320,RC,73000,HCPCS,outpatient,,,189,75.60,LT,160.65,85,,128.52,percent of total billed charges,85% of total billed charges,145.53,77,,116.42,percent of total billed charges,77% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,239.16,385,,,fee schedule,385% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,170.1,90,,136.08,percent of total billed charges,90% of total billed charges,151.2,80,,120.96,percent of total billed charges,80% of total billed charges,170.1,90,,136.08,percent of total billed charges,90% of total billed charges,141.75,75,,113.4,percent of total billed charges,75% of total billed charges,96.95,122,,,fee schedule,122% of HUMANA fee schedule,54.81,29,,43.848,percent of total billed charges,29% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,126.63,67,,101.304,percent of total billed charges,67% of total billed charges,41.76,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,151.2,80,,120.96,percent of total billed charges,80% of total billed charges,122.85,65,,98.28,percent of total billed charges,65% of total billed charges,67.42,35.67,,53.936,percent of total billed charges,35.67% of total billed charges,41.76,249.1,
CLAVICLE XRAY RIGHT,3250541,CDM,320,RC,73000,HCPCS,outpatient,,,277,110.80,RT,235.45,85,,188.36,percent of total billed charges,85% of total billed charges,213.29,77,,170.63,percent of total billed charges,77% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,239.16,385,,,fee schedule,385% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.3,90,,199.44,percent of total billed charges,90% of total billed charges,221.6,80,,177.28,percent of total billed charges,80% of total billed charges,249.3,90,,199.44,percent of total billed charges,90% of total billed charges,207.75,75,,166.2,percent of total billed charges,75% of total billed charges,96.95,122,,,fee schedule,122% of HUMANA fee schedule,80.33,29,,64.264,percent of total billed charges,29% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,185.59,67,,148.472,percent of total billed charges,67% of total billed charges,41.76,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,221.6,80,,177.28,percent of total billed charges,80% of total billed charges,180.05,65,,144.04,percent of total billed charges,65% of total billed charges,98.81,35.67,,79.048,percent of total billed charges,35.67% of total billed charges,41.76,249.3,
COCCYXMIN 2 V CL,3250580,CDM,320,RC,72220,HCPCS,outpatient,,,506,202.40,,430.1,85,,344.08,percent of total billed charges,85% of total billed charges,389.62,77,,311.7,percent of total billed charges,77% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,239.16,385,,,fee schedule,385% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,455.4,90,,364.32,percent of total billed charges,90% of total billed charges,404.8,80,,323.84,percent of total billed charges,80% of total billed charges,455.4,90,,364.32,percent of total billed charges,90% of total billed charges,379.5,75,,303.6,percent of total billed charges,75% of total billed charges,96.95,122,,,fee schedule,122% of HUMANA fee schedule,146.74,29,,117.392,percent of total billed charges,29% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,339.02,67,,271.216,percent of total billed charges,67% of total billed charges,41.76,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,404.8,80,,323.84,percent of total billed charges,80% of total billed charges,328.9,65,,263.12,percent of total billed charges,65% of total billed charges,180.49,35.67,,144.392,percent of total billed charges,35.67% of total billed charges,41.76,455.4,
CERVICAL SPINE 4 OR 5 VIEWS,3250600,CDM,320,RC,72050,HCPCS,outpatient,,,506,202.40,,430.1,85,,344.08,percent of total billed charges,85% of total billed charges,389.62,77,,311.7,percent of total billed charges,77% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,440.67,385,,,fee schedule,385% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,455.4,90,,364.32,percent of total billed charges,90% of total billed charges,404.8,80,,323.84,percent of total billed charges,80% of total billed charges,455.4,90,,364.32,percent of total billed charges,90% of total billed charges,379.5,75,,303.6,percent of total billed charges,75% of total billed charges,117.29,122,,,fee schedule,122% of HUMANA fee schedule,146.74,29,,117.392,percent of total billed charges,29% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,339.02,67,,271.216,percent of total billed charges,67% of total billed charges,70.34,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,404.8,80,,323.84,percent of total billed charges,80% of total billed charges,328.9,65,,263.12,percent of total billed charges,65% of total billed charges,180.49,35.67,,144.392,percent of total billed charges,35.67% of total billed charges,70.34,458.98,
CERVICAL SPINE FLEX&EXT XRAY,3250630,CDM,320,RC,72052,HCPCS,outpatient,,,506,202.40,,430.1,85,,344.08,percent of total billed charges,85% of total billed charges,389.62,77,,311.7,percent of total billed charges,77% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,440.67,385,,,fee schedule,385% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,455.4,90,,364.32,percent of total billed charges,90% of total billed charges,404.8,80,,323.84,percent of total billed charges,80% of total billed charges,455.4,90,,364.32,percent of total billed charges,90% of total billed charges,379.5,75,,303.6,percent of total billed charges,75% of total billed charges,117.29,122,,,fee schedule,122% of HUMANA fee schedule,146.74,29,,117.392,percent of total billed charges,29% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,339.02,67,,271.216,percent of total billed charges,67% of total billed charges,70.34,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,404.8,80,,323.84,percent of total billed charges,80% of total billed charges,328.9,65,,263.12,percent of total billed charges,65% of total billed charges,180.49,35.67,,144.392,percent of total billed charges,35.67% of total billed charges,70.34,458.98,
CERVICAL SPINE FLEX&EXT ONLY,3250631,CDM,320,RC,72040,HCPCS,outpatient,,,291,116.40,,247.35,85,,197.88,percent of total billed charges,85% of total billed charges,224.07,77,,179.26,percent of total billed charges,77% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,239.16,385,,,fee schedule,385% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,261.9,90,,209.52,percent of total billed charges,90% of total billed charges,232.8,80,,186.24,percent of total billed charges,80% of total billed charges,261.9,90,,209.52,percent of total billed charges,90% of total billed charges,218.25,75,,174.6,percent of total billed charges,75% of total billed charges,96.95,122,,,fee schedule,122% of HUMANA fee schedule,84.39,29,,67.512,percent of total billed charges,29% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,194.97,67,,155.976,percent of total billed charges,67% of total billed charges,41.76,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,232.8,80,,186.24,percent of total billed charges,80% of total billed charges,189.15,65,,151.32,percent of total billed charges,65% of total billed charges,103.8,35.67,,83.04,percent of total billed charges,35.67% of total billed charges,41.76,261.9,
CERVICAL SPINE 3 VIEWS OR LESS,3250635,CDM,320,RC,72040,HCPCS,outpatient,,,341,136.40,,289.85,85,,231.88,percent of total billed charges,85% of total billed charges,262.57,77,,210.06,percent of total billed charges,77% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,239.16,385,,,fee schedule,385% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,306.9,90,,245.52,percent of total billed charges,90% of total billed charges,272.8,80,,218.24,percent of total billed charges,80% of total billed charges,306.9,90,,245.52,percent of total billed charges,90% of total billed charges,255.75,75,,204.6,percent of total billed charges,75% of total billed charges,96.95,122,,,fee schedule,122% of HUMANA fee schedule,98.89,29,,79.112,percent of total billed charges,29% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,228.47,67,,182.776,percent of total billed charges,67% of total billed charges,41.76,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,272.8,80,,218.24,percent of total billed charges,80% of total billed charges,221.65,65,,177.32,percent of total billed charges,65% of total billed charges,121.63,35.67,,97.304,percent of total billed charges,35.67% of total billed charges,41.76,306.9,
CHEST FLOUROSCOPY 2 V CL,3250640,CDM,320,RC,71046,HCPCS,outpatient,,,304,121.60,,258.4,85,,206.72,percent of total billed charges,85% of total billed charges,234.08,77,,187.26,percent of total billed charges,77% of total billed charges,79.45,100,,,fee schedule,100% of CMS OPPS rate,239.16,385,,,fee schedule,385% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,273.6,90,,218.88,percent of total billed charges,90% of total billed charges,243.2,80,,194.56,percent of total billed charges,80% of total billed charges,273.6,90,,218.88,percent of total billed charges,90% of total billed charges,228,75,,182.4,percent of total billed charges,75% of total billed charges,96.94,122,,,fee schedule,122% of HUMANA fee schedule,88.16,29,,70.528,percent of total billed charges,29% of total billed charges,79.45,100,,,fee schedule,100% of CMS OPPS rate,203.68,67,,162.944,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,243.2,80,,194.56,percent of total billed charges,80% of total billed charges,197.6,65,,158.08,percent of total billed charges,65% of total billed charges,108.44,35.67,,86.752,percent of total billed charges,35.67% of total billed charges,79.45,273.6,
ELBOW 2 VIEWS LEFT CL,3250805,CDM,320,RC,73070,HCPCS,outpatient,,,277,110.80,LT,235.45,85,,188.36,percent of total billed charges,85% of total billed charges,213.29,77,,170.63,percent of total billed charges,77% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,239.16,385,,,fee schedule,385% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.3,90,,199.44,percent of total billed charges,90% of total billed charges,221.6,80,,177.28,percent of total billed charges,80% of total billed charges,249.3,90,,199.44,percent of total billed charges,90% of total billed charges,207.75,75,,166.2,percent of total billed charges,75% of total billed charges,96.95,122,,,fee schedule,122% of HUMANA fee schedule,80.33,29,,64.264,percent of total billed charges,29% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,185.59,67,,148.472,percent of total billed charges,67% of total billed charges,41.76,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,221.6,80,,177.28,percent of total billed charges,80% of total billed charges,180.05,65,,144.04,percent of total billed charges,65% of total billed charges,98.81,35.67,,79.048,percent of total billed charges,35.67% of total billed charges,41.76,249.3,
ELBOW RIGHT TWO VIEWS,3250806,CDM,320,RC,73070,HCPCS,outpatient,,,277,110.80,RT,235.45,85,,188.36,percent of total billed charges,85% of total billed charges,213.29,77,,170.63,percent of total billed charges,77% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,239.16,385,,,fee schedule,385% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.3,90,,199.44,percent of total billed charges,90% of total billed charges,221.6,80,,177.28,percent of total billed charges,80% of total billed charges,249.3,90,,199.44,percent of total billed charges,90% of total billed charges,207.75,75,,166.2,percent of total billed charges,75% of total billed charges,96.95,122,,,fee schedule,122% of HUMANA fee schedule,80.33,29,,64.264,percent of total billed charges,29% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,185.59,67,,148.472,percent of total billed charges,67% of total billed charges,41.76,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,221.6,80,,177.28,percent of total billed charges,80% of total billed charges,180.05,65,,144.04,percent of total billed charges,65% of total billed charges,98.81,35.67,,79.048,percent of total billed charges,35.67% of total billed charges,41.76,249.3,
ELBOW LEFT 4 VIEWS,3250810,CDM,320,RC,73080,HCPCS,outpatient,,,277,110.80,LT,235.45,85,,188.36,percent of total billed charges,85% of total billed charges,213.29,77,,170.63,percent of total billed charges,77% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,239.16,385,,,fee schedule,385% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.3,90,,199.44,percent of total billed charges,90% of total billed charges,221.6,80,,177.28,percent of total billed charges,80% of total billed charges,249.3,90,,199.44,percent of total billed charges,90% of total billed charges,207.75,75,,166.2,percent of total billed charges,75% of total billed charges,96.95,122,,,fee schedule,122% of HUMANA fee schedule,80.33,29,,64.264,percent of total billed charges,29% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,185.59,67,,148.472,percent of total billed charges,67% of total billed charges,41.76,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,221.6,80,,177.28,percent of total billed charges,80% of total billed charges,180.05,65,,144.04,percent of total billed charges,65% of total billed charges,98.81,35.67,,79.048,percent of total billed charges,35.67% of total billed charges,41.76,249.3,
ELBOW RIGHT 3-4 V COMPLETE,3250811,CDM,320,RC,73080,HCPCS,outpatient,,,272,108.80,RT,231.2,85,,184.96,percent of total billed charges,85% of total billed charges,209.44,77,,167.55,percent of total billed charges,77% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,239.16,385,,,fee schedule,385% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,244.8,90,,195.84,percent of total billed charges,90% of total billed charges,217.6,80,,174.08,percent of total billed charges,80% of total billed charges,244.8,90,,195.84,percent of total billed charges,90% of total billed charges,204,75,,163.2,percent of total billed charges,75% of total billed charges,96.95,122,,,fee schedule,122% of HUMANA fee schedule,78.88,29,,63.104,percent of total billed charges,29% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,182.24,67,,145.792,percent of total billed charges,67% of total billed charges,41.76,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,217.6,80,,174.08,percent of total billed charges,80% of total billed charges,176.8,65,,141.44,percent of total billed charges,65% of total billed charges,97.02,35.67,,77.616,percent of total billed charges,35.67% of total billed charges,41.76,249.1,
FACIAL BONES MIN 3 V,3250890,CDM,320,RC,70150,HCPCS,outpatient,,,506,202.40,,430.1,85,,344.08,percent of total billed charges,85% of total billed charges,389.62,77,,311.7,percent of total billed charges,77% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,440.67,385,,,fee schedule,385% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,455.4,90,,364.32,percent of total billed charges,90% of total billed charges,404.8,80,,323.84,percent of total billed charges,80% of total billed charges,455.4,90,,364.32,percent of total billed charges,90% of total billed charges,379.5,75,,303.6,percent of total billed charges,75% of total billed charges,117.29,122,,,fee schedule,122% of HUMANA fee schedule,146.74,29,,117.392,percent of total billed charges,29% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,339.02,67,,271.216,percent of total billed charges,67% of total billed charges,41.76,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,404.8,80,,323.84,percent of total billed charges,80% of total billed charges,328.9,65,,263.12,percent of total billed charges,65% of total billed charges,180.49,35.67,,144.392,percent of total billed charges,35.67% of total billed charges,41.76,458.98,
FEMUR MIN 2 V LT,3250920,CDM,320,RC,73552,HCPCS,outpatient,,,272,108.80,LT,231.2,85,,184.96,percent of total billed charges,85% of total billed charges,209.44,77,,167.55,percent of total billed charges,77% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,239.16,385,,,fee schedule,385% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,244.8,90,,195.84,percent of total billed charges,90% of total billed charges,217.6,80,,174.08,percent of total billed charges,80% of total billed charges,244.8,90,,195.84,percent of total billed charges,90% of total billed charges,204,75,,163.2,percent of total billed charges,75% of total billed charges,96.95,122,,,fee schedule,122% of HUMANA fee schedule,78.88,29,,63.104,percent of total billed charges,29% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,182.24,67,,145.792,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,217.6,80,,174.08,percent of total billed charges,80% of total billed charges,176.8,65,,141.44,percent of total billed charges,65% of total billed charges,97.02,35.67,,77.616,percent of total billed charges,35.67% of total billed charges,78.88,249.1,
FEMUR UNILATERAL RIGHT,3250921,CDM,320,RC,73552,HCPCS,outpatient,,,277,110.80,RT,235.45,85,,188.36,percent of total billed charges,85% of total billed charges,213.29,77,,170.63,percent of total billed charges,77% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,239.16,385,,,fee schedule,385% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.3,90,,199.44,percent of total billed charges,90% of total billed charges,221.6,80,,177.28,percent of total billed charges,80% of total billed charges,249.3,90,,199.44,percent of total billed charges,90% of total billed charges,207.75,75,,166.2,percent of total billed charges,75% of total billed charges,96.95,122,,,fee schedule,122% of HUMANA fee schedule,80.33,29,,64.264,percent of total billed charges,29% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,185.59,67,,148.472,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,221.6,80,,177.28,percent of total billed charges,80% of total billed charges,180.05,65,,144.04,percent of total billed charges,65% of total billed charges,98.81,35.67,,79.048,percent of total billed charges,35.67% of total billed charges,79.46,249.3,
FINGER S 2 VIEW MINIMUM,3250977,CDM,320,RC,73140,HCPCS,outpatient,,,277,110.80,,235.45,85,,188.36,percent of total billed charges,85% of total billed charges,213.29,77,,170.63,percent of total billed charges,77% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,239.16,385,,,fee schedule,385% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.3,90,,199.44,percent of total billed charges,90% of total billed charges,221.6,80,,177.28,percent of total billed charges,80% of total billed charges,249.3,90,,199.44,percent of total billed charges,90% of total billed charges,207.75,75,,166.2,percent of total billed charges,75% of total billed charges,96.95,122,,,fee schedule,122% of HUMANA fee schedule,80.33,29,,64.264,percent of total billed charges,29% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,185.59,67,,148.472,percent of total billed charges,67% of total billed charges,41.76,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,221.6,80,,177.28,percent of total billed charges,80% of total billed charges,180.05,65,,144.04,percent of total billed charges,65% of total billed charges,98.81,35.67,,79.048,percent of total billed charges,35.67% of total billed charges,41.76,249.3,
FOREARM 2 V LT,3251085,CDM,320,RC,73090,HCPCS,outpatient,,,277,110.80,LT,235.45,85,,188.36,percent of total billed charges,85% of total billed charges,213.29,77,,170.63,percent of total billed charges,77% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,239.16,385,,,fee schedule,385% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.3,90,,199.44,percent of total billed charges,90% of total billed charges,221.6,80,,177.28,percent of total billed charges,80% of total billed charges,249.3,90,,199.44,percent of total billed charges,90% of total billed charges,207.75,75,,166.2,percent of total billed charges,75% of total billed charges,96.95,122,,,fee schedule,122% of HUMANA fee schedule,80.33,29,,64.264,percent of total billed charges,29% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,185.59,67,,148.472,percent of total billed charges,67% of total billed charges,41.76,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,221.6,80,,177.28,percent of total billed charges,80% of total billed charges,180.05,65,,144.04,percent of total billed charges,65% of total billed charges,98.81,35.67,,79.048,percent of total billed charges,35.67% of total billed charges,41.76,249.3,
FOREARM 2 V RT,3251086,CDM,320,RC,73090,HCPCS,outpatient,,,277,110.80,RT,235.45,85,,188.36,percent of total billed charges,85% of total billed charges,213.29,77,,170.63,percent of total billed charges,77% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,239.16,385,,,fee schedule,385% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.3,90,,199.44,percent of total billed charges,90% of total billed charges,221.6,80,,177.28,percent of total billed charges,80% of total billed charges,249.3,90,,199.44,percent of total billed charges,90% of total billed charges,207.75,75,,166.2,percent of total billed charges,75% of total billed charges,96.95,122,,,fee schedule,122% of HUMANA fee schedule,80.33,29,,64.264,percent of total billed charges,29% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,185.59,67,,148.472,percent of total billed charges,67% of total billed charges,41.76,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,221.6,80,,177.28,percent of total billed charges,80% of total billed charges,180.05,65,,144.04,percent of total billed charges,65% of total billed charges,98.81,35.67,,79.048,percent of total billed charges,35.67% of total billed charges,41.76,249.3,
FOOT 3 V LEFT,3251135,CDM,320,RC,73630,HCPCS,outpatient,,,341,136.40,LT,289.85,85,,231.88,percent of total billed charges,85% of total billed charges,262.57,77,,210.06,percent of total billed charges,77% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,239.16,385,,,fee schedule,385% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,306.9,90,,245.52,percent of total billed charges,90% of total billed charges,272.8,80,,218.24,percent of total billed charges,80% of total billed charges,306.9,90,,245.52,percent of total billed charges,90% of total billed charges,255.75,75,,204.6,percent of total billed charges,75% of total billed charges,96.95,122,,,fee schedule,122% of HUMANA fee schedule,98.89,29,,79.112,percent of total billed charges,29% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,228.47,67,,182.776,percent of total billed charges,67% of total billed charges,41.76,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,272.8,80,,218.24,percent of total billed charges,80% of total billed charges,221.65,65,,177.32,percent of total billed charges,65% of total billed charges,121.63,35.67,,97.304,percent of total billed charges,35.67% of total billed charges,41.76,306.9,
FOOT 3 VIEW RIGHT,3251136,CDM,320,RC,73630,HCPCS,outpatient,,,341,136.40,RT,289.85,85,,231.88,percent of total billed charges,85% of total billed charges,262.57,77,,210.06,percent of total billed charges,77% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,239.16,385,,,fee schedule,385% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,306.9,90,,245.52,percent of total billed charges,90% of total billed charges,272.8,80,,218.24,percent of total billed charges,80% of total billed charges,306.9,90,,245.52,percent of total billed charges,90% of total billed charges,255.75,75,,204.6,percent of total billed charges,75% of total billed charges,96.95,122,,,fee schedule,122% of HUMANA fee schedule,98.89,29,,79.112,percent of total billed charges,29% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,228.47,67,,182.776,percent of total billed charges,67% of total billed charges,41.76,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,272.8,80,,218.24,percent of total billed charges,80% of total billed charges,221.65,65,,177.32,percent of total billed charges,65% of total billed charges,121.63,35.67,,97.304,percent of total billed charges,35.67% of total billed charges,41.76,306.9,
FOOT LEFT WEIGHT BEARING 3V,3251150,CDM,320,RC,73630,HCPCS,outpatient,,,291,116.40,LT,247.35,85,,197.88,percent of total billed charges,85% of total billed charges,224.07,77,,179.26,percent of total billed charges,77% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,239.16,385,,,fee schedule,385% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,261.9,90,,209.52,percent of total billed charges,90% of total billed charges,232.8,80,,186.24,percent of total billed charges,80% of total billed charges,261.9,90,,209.52,percent of total billed charges,90% of total billed charges,218.25,75,,174.6,percent of total billed charges,75% of total billed charges,96.95,122,,,fee schedule,122% of HUMANA fee schedule,84.39,29,,67.512,percent of total billed charges,29% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,194.97,67,,155.976,percent of total billed charges,67% of total billed charges,41.76,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,232.8,80,,186.24,percent of total billed charges,80% of total billed charges,189.15,65,,151.32,percent of total billed charges,65% of total billed charges,103.8,35.67,,83.04,percent of total billed charges,35.67% of total billed charges,41.76,261.9,
FOOT RIGHT WEIGHT BEARING 3V,3251151,CDM,320,RC,73630,HCPCS,outpatient,,,341,136.40,RT,289.85,85,,231.88,percent of total billed charges,85% of total billed charges,262.57,77,,210.06,percent of total billed charges,77% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,239.16,385,,,fee schedule,385% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,306.9,90,,245.52,percent of total billed charges,90% of total billed charges,272.8,80,,218.24,percent of total billed charges,80% of total billed charges,306.9,90,,245.52,percent of total billed charges,90% of total billed charges,255.75,75,,204.6,percent of total billed charges,75% of total billed charges,96.95,122,,,fee schedule,122% of HUMANA fee schedule,98.89,29,,79.112,percent of total billed charges,29% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,228.47,67,,182.776,percent of total billed charges,67% of total billed charges,41.76,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,272.8,80,,218.24,percent of total billed charges,80% of total billed charges,221.65,65,,177.32,percent of total billed charges,65% of total billed charges,121.63,35.67,,97.304,percent of total billed charges,35.67% of total billed charges,41.76,306.9,
HANDS 3 VIEW MIN LEFT,3251190,CDM,320,RC,73130,HCPCS,outpatient,,,277,110.80,LT,235.45,85,,188.36,percent of total billed charges,85% of total billed charges,213.29,77,,170.63,percent of total billed charges,77% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,239.16,385,,,fee schedule,385% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.3,90,,199.44,percent of total billed charges,90% of total billed charges,221.6,80,,177.28,percent of total billed charges,80% of total billed charges,249.3,90,,199.44,percent of total billed charges,90% of total billed charges,207.75,75,,166.2,percent of total billed charges,75% of total billed charges,96.95,122,,,fee schedule,122% of HUMANA fee schedule,80.33,29,,64.264,percent of total billed charges,29% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,185.59,67,,148.472,percent of total billed charges,67% of total billed charges,41.76,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,221.6,80,,177.28,percent of total billed charges,80% of total billed charges,180.05,65,,144.04,percent of total billed charges,65% of total billed charges,98.81,35.67,,79.048,percent of total billed charges,35.67% of total billed charges,41.76,249.3,
HAND 3 V MIN RIGHT CL,3251191,CDM,320,RC,73130,HCPCS,outpatient,,,277,110.80,RT,235.45,85,,188.36,percent of total billed charges,85% of total billed charges,213.29,77,,170.63,percent of total billed charges,77% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,239.16,385,,,fee schedule,385% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.3,90,,199.44,percent of total billed charges,90% of total billed charges,221.6,80,,177.28,percent of total billed charges,80% of total billed charges,249.3,90,,199.44,percent of total billed charges,90% of total billed charges,207.75,75,,166.2,percent of total billed charges,75% of total billed charges,96.95,122,,,fee schedule,122% of HUMANA fee schedule,80.33,29,,64.264,percent of total billed charges,29% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,185.59,67,,148.472,percent of total billed charges,67% of total billed charges,41.76,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,221.6,80,,177.28,percent of total billed charges,80% of total billed charges,180.05,65,,144.04,percent of total billed charges,65% of total billed charges,98.81,35.67,,79.048,percent of total billed charges,35.67% of total billed charges,41.76,249.3,
HEEL MIN 2 V LT,3251220,CDM,320,RC,73650,HCPCS,outpatient,,,272,108.80,LT,231.2,85,,184.96,percent of total billed charges,85% of total billed charges,209.44,77,,167.55,percent of total billed charges,77% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,239.16,385,,,fee schedule,385% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,244.8,90,,195.84,percent of total billed charges,90% of total billed charges,217.6,80,,174.08,percent of total billed charges,80% of total billed charges,244.8,90,,195.84,percent of total billed charges,90% of total billed charges,204,75,,163.2,percent of total billed charges,75% of total billed charges,96.95,122,,,fee schedule,122% of HUMANA fee schedule,78.88,29,,63.104,percent of total billed charges,29% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,182.24,67,,145.792,percent of total billed charges,67% of total billed charges,41.76,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,217.6,80,,174.08,percent of total billed charges,80% of total billed charges,176.8,65,,141.44,percent of total billed charges,65% of total billed charges,97.02,35.67,,77.616,percent of total billed charges,35.67% of total billed charges,41.76,249.1,
HEEL MIN 2 V RT,3251221,CDM,320,RC,73650,HCPCS,outpatient,,,277,110.80,RT,235.45,85,,188.36,percent of total billed charges,85% of total billed charges,213.29,77,,170.63,percent of total billed charges,77% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,239.16,385,,,fee schedule,385% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.3,90,,199.44,percent of total billed charges,90% of total billed charges,221.6,80,,177.28,percent of total billed charges,80% of total billed charges,249.3,90,,199.44,percent of total billed charges,90% of total billed charges,207.75,75,,166.2,percent of total billed charges,75% of total billed charges,96.95,122,,,fee schedule,122% of HUMANA fee schedule,80.33,29,,64.264,percent of total billed charges,29% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,185.59,67,,148.472,percent of total billed charges,67% of total billed charges,41.76,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,221.6,80,,177.28,percent of total billed charges,80% of total billed charges,180.05,65,,144.04,percent of total billed charges,65% of total billed charges,98.81,35.67,,79.048,percent of total billed charges,35.67% of total billed charges,41.76,249.3,
HIP BILAT 3-4 V,3251290,CDM,320,RC,73522,HCPCS,outpatient,,,358,143.20,,304.3,85,,243.44,percent of total billed charges,85% of total billed charges,275.66,77,,220.53,percent of total billed charges,77% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,440.67,385,,,fee schedule,385% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,322.2,90,,257.76,percent of total billed charges,90% of total billed charges,286.4,80,,229.12,percent of total billed charges,80% of total billed charges,322.2,90,,257.76,percent of total billed charges,90% of total billed charges,268.5,75,,214.8,percent of total billed charges,75% of total billed charges,117.29,122,,,fee schedule,122% of HUMANA fee schedule,103.82,29,,83.056,percent of total billed charges,29% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,239.86,67,,191.888,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,286.4,80,,229.12,percent of total billed charges,80% of total billed charges,232.7,65,,186.16,percent of total billed charges,65% of total billed charges,127.7,35.67,,102.16,percent of total billed charges,35.67% of total billed charges,96.14,458.98,
HIP 2-3 V LT,3251320,CDM,320,RC,73502,HCPCS,outpatient,,,277,110.80,LT,235.45,85,,188.36,percent of total billed charges,85% of total billed charges,213.29,77,,170.63,percent of total billed charges,77% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,239.16,385,,,fee schedule,385% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.3,90,,199.44,percent of total billed charges,90% of total billed charges,221.6,80,,177.28,percent of total billed charges,80% of total billed charges,249.3,90,,199.44,percent of total billed charges,90% of total billed charges,207.75,75,,166.2,percent of total billed charges,75% of total billed charges,96.95,122,,,fee schedule,122% of HUMANA fee schedule,80.33,29,,64.264,percent of total billed charges,29% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,185.59,67,,148.472,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,221.6,80,,177.28,percent of total billed charges,80% of total billed charges,180.05,65,,144.04,percent of total billed charges,65% of total billed charges,98.81,35.67,,79.048,percent of total billed charges,35.67% of total billed charges,79.46,249.3,
HIP 2-3 V RT,3251321,CDM,320,RC,73502,HCPCS,outpatient,,,277,110.80,RT,235.45,85,,188.36,percent of total billed charges,85% of total billed charges,213.29,77,,170.63,percent of total billed charges,77% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,239.16,385,,,fee schedule,385% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.3,90,,199.44,percent of total billed charges,90% of total billed charges,221.6,80,,177.28,percent of total billed charges,80% of total billed charges,249.3,90,,199.44,percent of total billed charges,90% of total billed charges,207.75,75,,166.2,percent of total billed charges,75% of total billed charges,96.95,122,,,fee schedule,122% of HUMANA fee schedule,80.33,29,,64.264,percent of total billed charges,29% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,185.59,67,,148.472,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,221.6,80,,177.28,percent of total billed charges,80% of total billed charges,180.05,65,,144.04,percent of total billed charges,65% of total billed charges,98.81,35.67,,79.048,percent of total billed charges,35.67% of total billed charges,79.46,249.3,
HUMERUS MIN 2 V LT,3251365,CDM,320,RC,73060,HCPCS,outpatient,,,277,110.80,LT,235.45,85,,188.36,percent of total billed charges,85% of total billed charges,213.29,77,,170.63,percent of total billed charges,77% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,239.16,385,,,fee schedule,385% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.3,90,,199.44,percent of total billed charges,90% of total billed charges,221.6,80,,177.28,percent of total billed charges,80% of total billed charges,249.3,90,,199.44,percent of total billed charges,90% of total billed charges,207.75,75,,166.2,percent of total billed charges,75% of total billed charges,96.95,122,,,fee schedule,122% of HUMANA fee schedule,80.33,29,,64.264,percent of total billed charges,29% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,185.59,67,,148.472,percent of total billed charges,67% of total billed charges,41.76,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,221.6,80,,177.28,percent of total billed charges,80% of total billed charges,180.05,65,,144.04,percent of total billed charges,65% of total billed charges,98.81,35.67,,79.048,percent of total billed charges,35.67% of total billed charges,41.76,249.3,
HUMERUS MIN 2 V RT,3251366,CDM,320,RC,73060,HCPCS,outpatient,,,272,108.80,RT,231.2,85,,184.96,percent of total billed charges,85% of total billed charges,209.44,77,,167.55,percent of total billed charges,77% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,239.16,385,,,fee schedule,385% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,244.8,90,,195.84,percent of total billed charges,90% of total billed charges,217.6,80,,174.08,percent of total billed charges,80% of total billed charges,244.8,90,,195.84,percent of total billed charges,90% of total billed charges,204,75,,163.2,percent of total billed charges,75% of total billed charges,96.95,122,,,fee schedule,122% of HUMANA fee schedule,78.88,29,,63.104,percent of total billed charges,29% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,182.24,67,,145.792,percent of total billed charges,67% of total billed charges,41.76,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,217.6,80,,174.08,percent of total billed charges,80% of total billed charges,176.8,65,,141.44,percent of total billed charges,65% of total billed charges,97.02,35.67,,77.616,percent of total billed charges,35.67% of total billed charges,41.76,249.1,
INTERNAL AUDITORY CANAL XRAY,3251400,CDM,320,RC,70134,HCPCS,outpatient,,,1008,403.20,,856.8,85,,685.44,percent of total billed charges,85% of total billed charges,776.16,77,,620.93,percent of total billed charges,77% of total billed charges,482.45,100,,,fee schedule,100% of CMS OPPS rate,894.39,385,,,fee schedule,385% of BCBS fee schedule,931.56,401,,,fee schedule,401% of BCBS fee schedule,931.56,401,,,fee schedule,401% of BCBS fee schedule,931.56,401,,,fee schedule,401% of BCBS fee schedule,907.2,90,,725.76,percent of total billed charges,90% of total billed charges,806.4,80,,645.12,percent of total billed charges,80% of total billed charges,907.2,90,,725.76,percent of total billed charges,90% of total billed charges,756,75,,604.8,percent of total billed charges,75% of total billed charges,588.59,122,,,fee schedule,122% of HUMANA fee schedule,292.32,29,,233.856,percent of total billed charges,29% of total billed charges,482.45,100,,,fee schedule,100% of CMS OPPS rate,675.36,67,,540.288,percent of total billed charges,67% of total billed charges,70.34,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,806.4,80,,645.12,percent of total billed charges,80% of total billed charges,655.2,65,,524.16,percent of total billed charges,65% of total billed charges,359.55,35.67,,287.64,percent of total billed charges,35.67% of total billed charges,70.34,931.56,
KNEE RIGHT COMPLETE 4 PLUS CL,3251458,CDM,320,RC,73564,HCPCS,outpatient,,,506,202.40,RT,430.1,85,,344.08,percent of total billed charges,85% of total billed charges,389.62,77,,311.7,percent of total billed charges,77% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,440.67,385,,,fee schedule,385% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,455.4,90,,364.32,percent of total billed charges,90% of total billed charges,404.8,80,,323.84,percent of total billed charges,80% of total billed charges,455.4,90,,364.32,percent of total billed charges,90% of total billed charges,379.5,75,,303.6,percent of total billed charges,75% of total billed charges,117.29,122,,,fee schedule,122% of HUMANA fee schedule,146.74,29,,117.392,percent of total billed charges,29% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,339.02,67,,271.216,percent of total billed charges,67% of total billed charges,41.76,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,404.8,80,,323.84,percent of total billed charges,80% of total billed charges,328.9,65,,263.12,percent of total billed charges,65% of total billed charges,180.49,35.67,,144.392,percent of total billed charges,35.67% of total billed charges,41.76,458.98,
KNEE LEFT COMPLETE SERIES CL,3251459,CDM,320,RC,73564,HCPCS,outpatient,,,506,202.40,LT,430.1,85,,344.08,percent of total billed charges,85% of total billed charges,389.62,77,,311.7,percent of total billed charges,77% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,440.67,385,,,fee schedule,385% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,455.4,90,,364.32,percent of total billed charges,90% of total billed charges,404.8,80,,323.84,percent of total billed charges,80% of total billed charges,455.4,90,,364.32,percent of total billed charges,90% of total billed charges,379.5,75,,303.6,percent of total billed charges,75% of total billed charges,117.29,122,,,fee schedule,122% of HUMANA fee schedule,146.74,29,,117.392,percent of total billed charges,29% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,339.02,67,,271.216,percent of total billed charges,67% of total billed charges,41.76,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,404.8,80,,323.84,percent of total billed charges,80% of total billed charges,328.9,65,,263.12,percent of total billed charges,65% of total billed charges,180.49,35.67,,144.392,percent of total billed charges,35.67% of total billed charges,41.76,458.98,
KNEE BIL 1-2 V XRAY CL,3251475,CDM,320,RC,73560,HCPCS,outpatient,,,358,143.20,50,304.3,85,,243.44,percent of total billed charges,85% of total billed charges,275.66,77,,220.53,percent of total billed charges,77% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,239.16,385,,,fee schedule,385% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,322.2,90,,257.76,percent of total billed charges,90% of total billed charges,286.4,80,,229.12,percent of total billed charges,80% of total billed charges,322.2,90,,257.76,percent of total billed charges,90% of total billed charges,268.5,75,,214.8,percent of total billed charges,75% of total billed charges,96.95,122,,,fee schedule,122% of HUMANA fee schedule,103.82,29,,83.056,percent of total billed charges,29% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,239.86,67,,191.888,percent of total billed charges,67% of total billed charges,41.76,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,286.4,80,,229.12,percent of total billed charges,80% of total billed charges,232.7,65,,186.16,percent of total billed charges,65% of total billed charges,127.7,35.67,,102.16,percent of total billed charges,35.67% of total billed charges,41.76,322.2,
KNEE BIL WT BEARING XRAY CL,3251480,CDM,320,RC,73565,HCPCS,outpatient,,,358,143.20,,304.3,85,,243.44,percent of total billed charges,85% of total billed charges,275.66,77,,220.53,percent of total billed charges,77% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,239.16,385,,,fee schedule,385% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,322.2,90,,257.76,percent of total billed charges,90% of total billed charges,286.4,80,,229.12,percent of total billed charges,80% of total billed charges,322.2,90,,257.76,percent of total billed charges,90% of total billed charges,268.5,75,,214.8,percent of total billed charges,75% of total billed charges,96.95,122,,,fee schedule,122% of HUMANA fee schedule,103.82,29,,83.056,percent of total billed charges,29% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,239.86,67,,191.888,percent of total billed charges,67% of total billed charges,41.76,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,286.4,80,,229.12,percent of total billed charges,80% of total billed charges,232.7,65,,186.16,percent of total billed charges,65% of total billed charges,127.7,35.67,,102.16,percent of total billed charges,35.67% of total billed charges,41.76,322.2,
KNEE LEFT 1-2 VIEW CL,3251490,CDM,320,RC,73560,HCPCS,outpatient,,,277,110.80,LT,235.45,85,,188.36,percent of total billed charges,85% of total billed charges,213.29,77,,170.63,percent of total billed charges,77% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,239.16,385,,,fee schedule,385% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.3,90,,199.44,percent of total billed charges,90% of total billed charges,221.6,80,,177.28,percent of total billed charges,80% of total billed charges,249.3,90,,199.44,percent of total billed charges,90% of total billed charges,207.75,75,,166.2,percent of total billed charges,75% of total billed charges,96.95,122,,,fee schedule,122% of HUMANA fee schedule,80.33,29,,64.264,percent of total billed charges,29% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,185.59,67,,148.472,percent of total billed charges,67% of total billed charges,41.76,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,221.6,80,,177.28,percent of total billed charges,80% of total billed charges,180.05,65,,144.04,percent of total billed charges,65% of total billed charges,98.81,35.67,,79.048,percent of total billed charges,35.67% of total billed charges,41.76,249.3,
KNEE RIGHT 1-2 VIEWS CL,3251491,CDM,320,RC,73560,HCPCS,outpatient,,,277,110.80,RT,235.45,85,,188.36,percent of total billed charges,85% of total billed charges,213.29,77,,170.63,percent of total billed charges,77% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,239.16,385,,,fee schedule,385% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.3,90,,199.44,percent of total billed charges,90% of total billed charges,221.6,80,,177.28,percent of total billed charges,80% of total billed charges,249.3,90,,199.44,percent of total billed charges,90% of total billed charges,207.75,75,,166.2,percent of total billed charges,75% of total billed charges,96.95,122,,,fee schedule,122% of HUMANA fee schedule,80.33,29,,64.264,percent of total billed charges,29% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,185.59,67,,148.472,percent of total billed charges,67% of total billed charges,41.76,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,221.6,80,,177.28,percent of total billed charges,80% of total billed charges,180.05,65,,144.04,percent of total billed charges,65% of total billed charges,98.81,35.67,,79.048,percent of total billed charges,35.67% of total billed charges,41.76,249.3,
KNEE BILATERAL 3 V CL,3251492,CDM,320,RC,73562,HCPCS,outpatient,,,358,143.20,50,304.3,85,,243.44,percent of total billed charges,85% of total billed charges,275.66,77,,220.53,percent of total billed charges,77% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,239.16,385,,,fee schedule,385% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,322.2,90,,257.76,percent of total billed charges,90% of total billed charges,286.4,80,,229.12,percent of total billed charges,80% of total billed charges,322.2,90,,257.76,percent of total billed charges,90% of total billed charges,268.5,75,,214.8,percent of total billed charges,75% of total billed charges,96.95,122,,,fee schedule,122% of HUMANA fee schedule,103.82,29,,83.056,percent of total billed charges,29% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,239.86,67,,191.888,percent of total billed charges,67% of total billed charges,41.76,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,286.4,80,,229.12,percent of total billed charges,80% of total billed charges,232.7,65,,186.16,percent of total billed charges,65% of total billed charges,127.7,35.67,,102.16,percent of total billed charges,35.67% of total billed charges,41.76,322.2,
KUB XRAY  CL,3251550,CDM,320,RC,74018,HCPCS,outpatient,,,277,110.80,,235.45,85,,188.36,percent of total billed charges,85% of total billed charges,213.29,77,,170.63,percent of total billed charges,77% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,239.16,385,,,fee schedule,385% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.3,90,,199.44,percent of total billed charges,90% of total billed charges,221.6,80,,177.28,percent of total billed charges,80% of total billed charges,249.3,90,,199.44,percent of total billed charges,90% of total billed charges,207.75,75,,166.2,percent of total billed charges,75% of total billed charges,96.95,122,,,fee schedule,122% of HUMANA fee schedule,80.33,29,,64.264,percent of total billed charges,29% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,185.59,67,,148.472,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,221.6,80,,177.28,percent of total billed charges,80% of total billed charges,180.05,65,,144.04,percent of total billed charges,65% of total billed charges,98.81,35.67,,79.048,percent of total billed charges,35.67% of total billed charges,79.46,249.3,
LEG LENGTH SERIES XRAY CL,3251580,CDM,320,RC,77073,HCPCS,outpatient,,,498,199.20,,423.3,85,,338.64,percent of total billed charges,85% of total billed charges,383.46,77,,306.77,percent of total billed charges,77% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,440.67,385,,,fee schedule,385% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,448.2,90,,358.56,percent of total billed charges,90% of total billed charges,398.4,80,,318.72,percent of total billed charges,80% of total billed charges,448.2,90,,358.56,percent of total billed charges,90% of total billed charges,373.5,75,,298.8,percent of total billed charges,75% of total billed charges,117.29,122,,,fee schedule,122% of HUMANA fee schedule,144.42,29,,115.536,percent of total billed charges,29% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,333.66,67,,266.928,percent of total billed charges,67% of total billed charges,41.76,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,398.4,80,,318.72,percent of total billed charges,80% of total billed charges,323.7,65,,258.96,percent of total billed charges,65% of total billed charges,177.64,35.67,,142.112,percent of total billed charges,35.67% of total billed charges,41.76,458.98,
LOWER LEG LT 2 V CL,3251605,CDM,320,RC,73590,HCPCS,outpatient,,,277,110.80,LT,235.45,85,,188.36,percent of total billed charges,85% of total billed charges,213.29,77,,170.63,percent of total billed charges,77% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,239.16,385,,,fee schedule,385% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.3,90,,199.44,percent of total billed charges,90% of total billed charges,221.6,80,,177.28,percent of total billed charges,80% of total billed charges,249.3,90,,199.44,percent of total billed charges,90% of total billed charges,207.75,75,,166.2,percent of total billed charges,75% of total billed charges,96.95,122,,,fee schedule,122% of HUMANA fee schedule,80.33,29,,64.264,percent of total billed charges,29% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,185.59,67,,148.472,percent of total billed charges,67% of total billed charges,41.76,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,221.6,80,,177.28,percent of total billed charges,80% of total billed charges,180.05,65,,144.04,percent of total billed charges,65% of total billed charges,98.81,35.67,,79.048,percent of total billed charges,35.67% of total billed charges,41.76,249.3,
LOWER LEG RT 2 V CL,3251606,CDM,320,RC,73590,HCPCS,outpatient,,,277,110.80,RT,235.45,85,,188.36,percent of total billed charges,85% of total billed charges,213.29,77,,170.63,percent of total billed charges,77% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,239.16,385,,,fee schedule,385% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.3,90,,199.44,percent of total billed charges,90% of total billed charges,221.6,80,,177.28,percent of total billed charges,80% of total billed charges,249.3,90,,199.44,percent of total billed charges,90% of total billed charges,207.75,75,,166.2,percent of total billed charges,75% of total billed charges,96.95,122,,,fee schedule,122% of HUMANA fee schedule,80.33,29,,64.264,percent of total billed charges,29% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,185.59,67,,148.472,percent of total billed charges,67% of total billed charges,41.76,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,221.6,80,,177.28,percent of total billed charges,80% of total billed charges,180.05,65,,144.04,percent of total billed charges,65% of total billed charges,98.81,35.67,,79.048,percent of total billed charges,35.67% of total billed charges,41.76,249.3,
LUMBAR SPINE 2 V XRAY CL,3251630,CDM,320,RC,72100,HCPCS,outpatient,,,506,202.40,,430.1,85,,344.08,percent of total billed charges,85% of total billed charges,389.62,77,,311.7,percent of total billed charges,77% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,440.67,385,,,fee schedule,385% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,455.4,90,,364.32,percent of total billed charges,90% of total billed charges,404.8,80,,323.84,percent of total billed charges,80% of total billed charges,455.4,90,,364.32,percent of total billed charges,90% of total billed charges,379.5,75,,303.6,percent of total billed charges,75% of total billed charges,117.29,122,,,fee schedule,122% of HUMANA fee schedule,146.74,29,,117.392,percent of total billed charges,29% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,339.02,67,,271.216,percent of total billed charges,67% of total billed charges,41.76,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,404.8,80,,323.84,percent of total billed charges,80% of total billed charges,328.9,65,,263.12,percent of total billed charges,65% of total billed charges,180.49,35.67,,144.392,percent of total billed charges,35.67% of total billed charges,41.76,458.98,
LUMBAR SPINE FLEX AND EXT ONLY,3251631,CDM,320,RC,72120,HCPCS,outpatient,,,506,202.40,,430.1,85,,344.08,percent of total billed charges,85% of total billed charges,389.62,77,,311.7,percent of total billed charges,77% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,440.67,385,,,fee schedule,385% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,455.4,90,,364.32,percent of total billed charges,90% of total billed charges,404.8,80,,323.84,percent of total billed charges,80% of total billed charges,455.4,90,,364.32,percent of total billed charges,90% of total billed charges,379.5,75,,303.6,percent of total billed charges,75% of total billed charges,117.29,122,,,fee schedule,122% of HUMANA fee schedule,146.74,29,,117.392,percent of total billed charges,29% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,339.02,67,,271.216,percent of total billed charges,67% of total billed charges,41.76,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,404.8,80,,323.84,percent of total billed charges,80% of total billed charges,328.9,65,,263.12,percent of total billed charges,65% of total billed charges,180.49,35.67,,144.392,percent of total billed charges,35.67% of total billed charges,41.76,458.98,
LUMBAR SPINE 3 VIEWS XRAY CL,3251635,CDM,320,RC,72100,HCPCS,outpatient,,,506,202.40,,430.1,85,,344.08,percent of total billed charges,85% of total billed charges,389.62,77,,311.7,percent of total billed charges,77% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,440.67,385,,,fee schedule,385% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,455.4,90,,364.32,percent of total billed charges,90% of total billed charges,404.8,80,,323.84,percent of total billed charges,80% of total billed charges,455.4,90,,364.32,percent of total billed charges,90% of total billed charges,379.5,75,,303.6,percent of total billed charges,75% of total billed charges,117.29,122,,,fee schedule,122% of HUMANA fee schedule,146.74,29,,117.392,percent of total billed charges,29% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,339.02,67,,271.216,percent of total billed charges,67% of total billed charges,41.76,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,404.8,80,,323.84,percent of total billed charges,80% of total billed charges,328.9,65,,263.12,percent of total billed charges,65% of total billed charges,180.49,35.67,,144.392,percent of total billed charges,35.67% of total billed charges,41.76,458.98,
LUMBAR SPINE 4 V CL,3251640,CDM,320,RC,72110,HCPCS,outpatient,,,506,202.40,,430.1,85,,344.08,percent of total billed charges,85% of total billed charges,389.62,77,,311.7,percent of total billed charges,77% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,440.67,385,,,fee schedule,385% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,455.4,90,,364.32,percent of total billed charges,90% of total billed charges,404.8,80,,323.84,percent of total billed charges,80% of total billed charges,455.4,90,,364.32,percent of total billed charges,90% of total billed charges,379.5,75,,303.6,percent of total billed charges,75% of total billed charges,117.29,122,,,fee schedule,122% of HUMANA fee schedule,146.74,29,,117.392,percent of total billed charges,29% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,339.02,67,,271.216,percent of total billed charges,67% of total billed charges,70.34,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,404.8,80,,323.84,percent of total billed charges,80% of total billed charges,328.9,65,,263.12,percent of total billed charges,65% of total billed charges,180.49,35.67,,144.392,percent of total billed charges,35.67% of total billed charges,70.34,458.98,
L SPINE FLEX AND EXT COMP 6 V,3251650,CDM,320,RC,72114,HCPCS,outpatient,,,506,202.40,,430.1,85,,344.08,percent of total billed charges,85% of total billed charges,389.62,77,,311.7,percent of total billed charges,77% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,440.67,385,,,fee schedule,385% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,455.4,90,,364.32,percent of total billed charges,90% of total billed charges,404.8,80,,323.84,percent of total billed charges,80% of total billed charges,455.4,90,,364.32,percent of total billed charges,90% of total billed charges,379.5,75,,303.6,percent of total billed charges,75% of total billed charges,117.29,122,,,fee schedule,122% of HUMANA fee schedule,146.74,29,,117.392,percent of total billed charges,29% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,339.02,67,,271.216,percent of total billed charges,67% of total billed charges,70.34,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,404.8,80,,323.84,percent of total billed charges,80% of total billed charges,328.9,65,,263.12,percent of total billed charges,65% of total billed charges,180.49,35.67,,144.392,percent of total billed charges,35.67% of total billed charges,70.34,458.98,
MANDIBLE 2 V XRAY CL,3251750,CDM,320,RC,70100,HCPCS,outpatient,,,272,108.80,,231.2,85,,184.96,percent of total billed charges,85% of total billed charges,209.44,77,,167.55,percent of total billed charges,77% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,239.16,385,,,fee schedule,385% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,244.8,90,,195.84,percent of total billed charges,90% of total billed charges,217.6,80,,174.08,percent of total billed charges,80% of total billed charges,244.8,90,,195.84,percent of total billed charges,90% of total billed charges,204,75,,163.2,percent of total billed charges,75% of total billed charges,96.95,122,,,fee schedule,122% of HUMANA fee schedule,78.88,29,,63.104,percent of total billed charges,29% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,182.24,67,,145.792,percent of total billed charges,67% of total billed charges,41.76,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,217.6,80,,174.08,percent of total billed charges,80% of total billed charges,176.8,65,,141.44,percent of total billed charges,65% of total billed charges,97.02,35.67,,77.616,percent of total billed charges,35.67% of total billed charges,41.76,249.1,
MANDIBLE COMPLE MIN 4 V  CL,3251751,CDM,320,RC,70110,HCPCS,outpatient,,,498,199.20,,423.3,85,,338.64,percent of total billed charges,85% of total billed charges,383.46,77,,306.77,percent of total billed charges,77% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,440.67,385,,,fee schedule,385% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,448.2,90,,358.56,percent of total billed charges,90% of total billed charges,398.4,80,,318.72,percent of total billed charges,80% of total billed charges,448.2,90,,358.56,percent of total billed charges,90% of total billed charges,373.5,75,,298.8,percent of total billed charges,75% of total billed charges,117.29,122,,,fee schedule,122% of HUMANA fee schedule,144.42,29,,115.536,percent of total billed charges,29% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,333.66,67,,266.928,percent of total billed charges,67% of total billed charges,41.76,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,398.4,80,,318.72,percent of total billed charges,80% of total billed charges,323.7,65,,258.96,percent of total billed charges,65% of total billed charges,177.64,35.67,,142.112,percent of total billed charges,35.67% of total billed charges,41.76,458.98,
MANDIBLE LESS THAN 4 V CL,3251760,CDM,320,RC,70100,HCPCS,outpatient,,,272,108.80,,231.2,85,,184.96,percent of total billed charges,85% of total billed charges,209.44,77,,167.55,percent of total billed charges,77% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,239.16,385,,,fee schedule,385% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,244.8,90,,195.84,percent of total billed charges,90% of total billed charges,217.6,80,,174.08,percent of total billed charges,80% of total billed charges,244.8,90,,195.84,percent of total billed charges,90% of total billed charges,204,75,,163.2,percent of total billed charges,75% of total billed charges,96.95,122,,,fee schedule,122% of HUMANA fee schedule,78.88,29,,63.104,percent of total billed charges,29% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,182.24,67,,145.792,percent of total billed charges,67% of total billed charges,41.76,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,217.6,80,,174.08,percent of total billed charges,80% of total billed charges,176.8,65,,141.44,percent of total billed charges,65% of total billed charges,97.02,35.67,,77.616,percent of total billed charges,35.67% of total billed charges,41.76,249.1,
MASTOIDS LESS THAN 3 V CL,3251790,CDM,320,RC,70120,HCPCS,outpatient,,,498,199.20,,423.3,85,,338.64,percent of total billed charges,85% of total billed charges,383.46,77,,306.77,percent of total billed charges,77% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,440.67,385,,,fee schedule,385% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,448.2,90,,358.56,percent of total billed charges,90% of total billed charges,398.4,80,,318.72,percent of total billed charges,80% of total billed charges,448.2,90,,358.56,percent of total billed charges,90% of total billed charges,373.5,75,,298.8,percent of total billed charges,75% of total billed charges,117.29,122,,,fee schedule,122% of HUMANA fee schedule,144.42,29,,115.536,percent of total billed charges,29% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,333.66,67,,266.928,percent of total billed charges,67% of total billed charges,41.76,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,398.4,80,,318.72,percent of total billed charges,80% of total billed charges,323.7,65,,258.96,percent of total billed charges,65% of total billed charges,177.64,35.67,,142.112,percent of total billed charges,35.67% of total billed charges,41.76,458.98,
MAXILLA LESS THAN 3 V CL,3251800,CDM,320,RC,70140,HCPCS,outpatient,,,271,108.40,,230.35,85,,184.28,percent of total billed charges,85% of total billed charges,208.67,77,,166.94,percent of total billed charges,77% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,239.16,385,,,fee schedule,385% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,243.9,90,,195.12,percent of total billed charges,90% of total billed charges,216.8,80,,173.44,percent of total billed charges,80% of total billed charges,243.9,90,,195.12,percent of total billed charges,90% of total billed charges,203.25,75,,162.6,percent of total billed charges,75% of total billed charges,96.95,122,,,fee schedule,122% of HUMANA fee schedule,78.59,29,,62.872,percent of total billed charges,29% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,181.57,67,,145.256,percent of total billed charges,67% of total billed charges,41.76,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,216.8,80,,173.44,percent of total billed charges,80% of total billed charges,176.15,65,,140.92,percent of total billed charges,65% of total billed charges,96.67,35.67,,77.336,percent of total billed charges,35.67% of total billed charges,41.76,249.1,
NEEDLE BX ASPIRATION XRAY CL,3251850,CDM,320,RC,76499,HCPCS,outpatient,,,315,126.00,,267.75,85,,214.2,percent of total billed charges,85% of total billed charges,242.55,77,,194.04,percent of total billed charges,77% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,239.16,385,,,fee schedule,385% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,283.5,90,,226.8,percent of total billed charges,90% of total billed charges,252,80,,201.6,percent of total billed charges,80% of total billed charges,283.5,90,,226.8,percent of total billed charges,90% of total billed charges,236.25,75,,189,percent of total billed charges,75% of total billed charges,96.95,122,,,fee schedule,122% of HUMANA fee schedule,91.35,29,,73.08,percent of total billed charges,29% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,211.05,67,,168.84,percent of total billed charges,67% of total billed charges,41.76,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,252,80,,201.6,percent of total billed charges,80% of total billed charges,204.75,65,,163.8,percent of total billed charges,65% of total billed charges,112.36,35.67,,89.888,percent of total billed charges,35.67% of total billed charges,41.76,283.5,
NECK SOFT TISSUE CL,3251880,CDM,320,RC,70360,HCPCS,outpatient,,,277,110.80,,235.45,85,,188.36,percent of total billed charges,85% of total billed charges,213.29,77,,170.63,percent of total billed charges,77% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,239.16,385,,,fee schedule,385% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.3,90,,199.44,percent of total billed charges,90% of total billed charges,221.6,80,,177.28,percent of total billed charges,80% of total billed charges,249.3,90,,199.44,percent of total billed charges,90% of total billed charges,207.75,75,,166.2,percent of total billed charges,75% of total billed charges,96.95,122,,,fee schedule,122% of HUMANA fee schedule,80.33,29,,64.264,percent of total billed charges,29% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,185.59,67,,148.472,percent of total billed charges,67% of total billed charges,41.76,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,221.6,80,,177.28,percent of total billed charges,80% of total billed charges,180.05,65,,144.04,percent of total billed charges,65% of total billed charges,98.81,35.67,,79.048,percent of total billed charges,35.67% of total billed charges,41.76,249.3,
NASAL BONES MIN 3 V CL,3251890,CDM,320,RC,70160,HCPCS,outpatient,,,277,110.80,,235.45,85,,188.36,percent of total billed charges,85% of total billed charges,213.29,77,,170.63,percent of total billed charges,77% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,239.16,385,,,fee schedule,385% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.3,90,,199.44,percent of total billed charges,90% of total billed charges,221.6,80,,177.28,percent of total billed charges,80% of total billed charges,249.3,90,,199.44,percent of total billed charges,90% of total billed charges,207.75,75,,166.2,percent of total billed charges,75% of total billed charges,96.95,122,,,fee schedule,122% of HUMANA fee schedule,80.33,29,,64.264,percent of total billed charges,29% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,185.59,67,,148.472,percent of total billed charges,67% of total billed charges,41.76,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,221.6,80,,177.28,percent of total billed charges,80% of total billed charges,180.05,65,,144.04,percent of total billed charges,65% of total billed charges,98.81,35.67,,79.048,percent of total billed charges,35.67% of total billed charges,41.76,249.3,
NAVICULAR MIN 3 V LT CL,3251910,CDM,320,RC,73110,HCPCS,outpatient,,,341,136.40,LT,289.85,85,,231.88,percent of total billed charges,85% of total billed charges,262.57,77,,210.06,percent of total billed charges,77% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,239.16,385,,,fee schedule,385% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,306.9,90,,245.52,percent of total billed charges,90% of total billed charges,272.8,80,,218.24,percent of total billed charges,80% of total billed charges,306.9,90,,245.52,percent of total billed charges,90% of total billed charges,255.75,75,,204.6,percent of total billed charges,75% of total billed charges,96.95,122,,,fee schedule,122% of HUMANA fee schedule,98.89,29,,79.112,percent of total billed charges,29% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,228.47,67,,182.776,percent of total billed charges,67% of total billed charges,41.76,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,272.8,80,,218.24,percent of total billed charges,80% of total billed charges,221.65,65,,177.32,percent of total billed charges,65% of total billed charges,121.63,35.67,,97.304,percent of total billed charges,35.67% of total billed charges,41.76,306.9,
NAVICULAR MIN 3 V RT CL,3251911,CDM,320,RC,73110,HCPCS,outpatient,,,341,136.40,RT,289.85,85,,231.88,percent of total billed charges,85% of total billed charges,262.57,77,,210.06,percent of total billed charges,77% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,239.16,385,,,fee schedule,385% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,306.9,90,,245.52,percent of total billed charges,90% of total billed charges,272.8,80,,218.24,percent of total billed charges,80% of total billed charges,306.9,90,,245.52,percent of total billed charges,90% of total billed charges,255.75,75,,204.6,percent of total billed charges,75% of total billed charges,96.95,122,,,fee schedule,122% of HUMANA fee schedule,98.89,29,,79.112,percent of total billed charges,29% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,228.47,67,,182.776,percent of total billed charges,67% of total billed charges,41.76,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,272.8,80,,218.24,percent of total billed charges,80% of total billed charges,221.65,65,,177.32,percent of total billed charges,65% of total billed charges,121.63,35.67,,97.304,percent of total billed charges,35.67% of total billed charges,41.76,306.9,
OPTIC FORAMINA XRAY ORBIT UNI,3251950,CDM,320,RC,70190,HCPCS,outpatient,,,272,108.80,,231.2,85,,184.96,percent of total billed charges,85% of total billed charges,209.44,77,,167.55,percent of total billed charges,77% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,239.16,385,,,fee schedule,385% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,244.8,90,,195.84,percent of total billed charges,90% of total billed charges,217.6,80,,174.08,percent of total billed charges,80% of total billed charges,244.8,90,,195.84,percent of total billed charges,90% of total billed charges,204,75,,163.2,percent of total billed charges,75% of total billed charges,96.95,122,,,fee schedule,122% of HUMANA fee schedule,78.88,29,,63.104,percent of total billed charges,29% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,182.24,67,,145.792,percent of total billed charges,67% of total billed charges,41.76,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,217.6,80,,174.08,percent of total billed charges,80% of total billed charges,176.8,65,,141.44,percent of total billed charges,65% of total billed charges,97.02,35.67,,77.616,percent of total billed charges,35.67% of total billed charges,41.76,249.1,
ORBITS MIN 4 V CL,3251990,CDM,320,RC,70200,HCPCS,outpatient,,,498,199.20,,423.3,85,,338.64,percent of total billed charges,85% of total billed charges,383.46,77,,306.77,percent of total billed charges,77% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,440.67,385,,,fee schedule,385% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,448.2,90,,358.56,percent of total billed charges,90% of total billed charges,398.4,80,,318.72,percent of total billed charges,80% of total billed charges,448.2,90,,358.56,percent of total billed charges,90% of total billed charges,373.5,75,,298.8,percent of total billed charges,75% of total billed charges,117.29,122,,,fee schedule,122% of HUMANA fee schedule,144.42,29,,115.536,percent of total billed charges,29% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,333.66,67,,266.928,percent of total billed charges,67% of total billed charges,41.76,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,398.4,80,,318.72,percent of total billed charges,80% of total billed charges,323.7,65,,258.96,percent of total billed charges,65% of total billed charges,177.64,35.67,,142.112,percent of total billed charges,35.67% of total billed charges,41.76,458.98,
PATELLA 4 OR>V LT CL,3252065,CDM,320,RC,73564,HCPCS,outpatient,,,498,199.20,LT,423.3,85,,338.64,percent of total billed charges,85% of total billed charges,383.46,77,,306.77,percent of total billed charges,77% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,440.67,385,,,fee schedule,385% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,448.2,90,,358.56,percent of total billed charges,90% of total billed charges,398.4,80,,318.72,percent of total billed charges,80% of total billed charges,448.2,90,,358.56,percent of total billed charges,90% of total billed charges,373.5,75,,298.8,percent of total billed charges,75% of total billed charges,117.29,122,,,fee schedule,122% of HUMANA fee schedule,144.42,29,,115.536,percent of total billed charges,29% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,333.66,67,,266.928,percent of total billed charges,67% of total billed charges,41.76,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,398.4,80,,318.72,percent of total billed charges,80% of total billed charges,323.7,65,,258.96,percent of total billed charges,65% of total billed charges,177.64,35.67,,142.112,percent of total billed charges,35.67% of total billed charges,41.76,458.98,
PATELLA 4 OR > V RT CL,3252066,CDM,320,RC,73564,HCPCS,outpatient,,,498,199.20,RT,423.3,85,,338.64,percent of total billed charges,85% of total billed charges,383.46,77,,306.77,percent of total billed charges,77% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,440.67,385,,,fee schedule,385% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,448.2,90,,358.56,percent of total billed charges,90% of total billed charges,398.4,80,,318.72,percent of total billed charges,80% of total billed charges,448.2,90,,358.56,percent of total billed charges,90% of total billed charges,373.5,75,,298.8,percent of total billed charges,75% of total billed charges,117.29,122,,,fee schedule,122% of HUMANA fee schedule,144.42,29,,115.536,percent of total billed charges,29% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,333.66,67,,266.928,percent of total billed charges,67% of total billed charges,41.76,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,398.4,80,,318.72,percent of total billed charges,80% of total billed charges,323.7,65,,258.96,percent of total billed charges,65% of total billed charges,177.64,35.67,,142.112,percent of total billed charges,35.67% of total billed charges,41.76,458.98,
PELVIS XRAY 1 OR 2 VIEWS,3252090,CDM,320,RC,72170,HCPCS,outpatient,,,506,202.40,,430.1,85,,344.08,percent of total billed charges,85% of total billed charges,389.62,77,,311.7,percent of total billed charges,77% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,440.67,385,,,fee schedule,385% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,455.4,90,,364.32,percent of total billed charges,90% of total billed charges,404.8,80,,323.84,percent of total billed charges,80% of total billed charges,455.4,90,,364.32,percent of total billed charges,90% of total billed charges,379.5,75,,303.6,percent of total billed charges,75% of total billed charges,117.29,122,,,fee schedule,122% of HUMANA fee schedule,146.74,29,,117.392,percent of total billed charges,29% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,339.02,67,,271.216,percent of total billed charges,67% of total billed charges,41.76,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,404.8,80,,323.84,percent of total billed charges,80% of total billed charges,328.9,65,,263.12,percent of total billed charges,65% of total billed charges,180.49,35.67,,144.392,percent of total billed charges,35.67% of total billed charges,41.76,458.98,
PETROUS BONES XRAY CL,3252110,CDM,320,RC,70134,HCPCS,outpatient,,,1008,403.20,,856.8,85,,685.44,percent of total billed charges,85% of total billed charges,776.16,77,,620.93,percent of total billed charges,77% of total billed charges,482.45,100,,,fee schedule,100% of CMS OPPS rate,894.39,385,,,fee schedule,385% of BCBS fee schedule,931.56,401,,,fee schedule,401% of BCBS fee schedule,931.56,401,,,fee schedule,401% of BCBS fee schedule,931.56,401,,,fee schedule,401% of BCBS fee schedule,907.2,90,,725.76,percent of total billed charges,90% of total billed charges,806.4,80,,645.12,percent of total billed charges,80% of total billed charges,907.2,90,,725.76,percent of total billed charges,90% of total billed charges,756,75,,604.8,percent of total billed charges,75% of total billed charges,588.59,122,,,fee schedule,122% of HUMANA fee schedule,292.32,29,,233.856,percent of total billed charges,29% of total billed charges,482.45,100,,,fee schedule,100% of CMS OPPS rate,675.36,67,,540.288,percent of total billed charges,67% of total billed charges,70.34,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,806.4,80,,645.12,percent of total billed charges,80% of total billed charges,655.2,65,,524.16,percent of total billed charges,65% of total billed charges,359.55,35.67,,287.64,percent of total billed charges,35.67% of total billed charges,70.34,931.56,
RIBS 2 V RT CL,3252138,CDM,320,RC,71100,HCPCS,outpatient,,,277,110.80,RT,235.45,85,,188.36,percent of total billed charges,85% of total billed charges,213.29,77,,170.63,percent of total billed charges,77% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,239.16,385,,,fee schedule,385% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.3,90,,199.44,percent of total billed charges,90% of total billed charges,221.6,80,,177.28,percent of total billed charges,80% of total billed charges,249.3,90,,199.44,percent of total billed charges,90% of total billed charges,207.75,75,,166.2,percent of total billed charges,75% of total billed charges,96.95,122,,,fee schedule,122% of HUMANA fee schedule,80.33,29,,64.264,percent of total billed charges,29% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,185.59,67,,148.472,percent of total billed charges,67% of total billed charges,41.76,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,221.6,80,,177.28,percent of total billed charges,80% of total billed charges,180.05,65,,144.04,percent of total billed charges,65% of total billed charges,98.81,35.67,,79.048,percent of total billed charges,35.67% of total billed charges,41.76,249.3,
RIBS 2 V LT CL,3252139,CDM,320,RC,71100,HCPCS,outpatient,,,277,110.80,LT,235.45,85,,188.36,percent of total billed charges,85% of total billed charges,213.29,77,,170.63,percent of total billed charges,77% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,239.16,385,,,fee schedule,385% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.3,90,,199.44,percent of total billed charges,90% of total billed charges,221.6,80,,177.28,percent of total billed charges,80% of total billed charges,249.3,90,,199.44,percent of total billed charges,90% of total billed charges,207.75,75,,166.2,percent of total billed charges,75% of total billed charges,96.95,122,,,fee schedule,122% of HUMANA fee schedule,80.33,29,,64.264,percent of total billed charges,29% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,185.59,67,,148.472,percent of total billed charges,67% of total billed charges,41.76,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,221.6,80,,177.28,percent of total billed charges,80% of total billed charges,180.05,65,,144.04,percent of total billed charges,65% of total billed charges,98.81,35.67,,79.048,percent of total billed charges,35.67% of total billed charges,41.76,249.3,
RIBS 3 V BIL CL,3252140,CDM,320,RC,71110,HCPCS,outpatient,,,358,143.20,,304.3,85,,243.44,percent of total billed charges,85% of total billed charges,275.66,77,,220.53,percent of total billed charges,77% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,440.67,385,,,fee schedule,385% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,322.2,90,,257.76,percent of total billed charges,90% of total billed charges,286.4,80,,229.12,percent of total billed charges,80% of total billed charges,322.2,90,,257.76,percent of total billed charges,90% of total billed charges,268.5,75,,214.8,percent of total billed charges,75% of total billed charges,117.29,122,,,fee schedule,122% of HUMANA fee schedule,103.82,29,,83.056,percent of total billed charges,29% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,239.86,67,,191.888,percent of total billed charges,67% of total billed charges,41.76,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,286.4,80,,229.12,percent of total billed charges,80% of total billed charges,232.7,65,,186.16,percent of total billed charges,65% of total billed charges,127.7,35.67,,102.16,percent of total billed charges,35.67% of total billed charges,41.76,458.98,
SACRUM MIN 2 V CL,3252200,CDM,320,RC,72220,HCPCS,outpatient,,,506,202.40,,430.1,85,,344.08,percent of total billed charges,85% of total billed charges,389.62,77,,311.7,percent of total billed charges,77% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,239.16,385,,,fee schedule,385% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,455.4,90,,364.32,percent of total billed charges,90% of total billed charges,404.8,80,,323.84,percent of total billed charges,80% of total billed charges,455.4,90,,364.32,percent of total billed charges,90% of total billed charges,379.5,75,,303.6,percent of total billed charges,75% of total billed charges,96.95,122,,,fee schedule,122% of HUMANA fee schedule,146.74,29,,117.392,percent of total billed charges,29% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,339.02,67,,271.216,percent of total billed charges,67% of total billed charges,41.76,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,404.8,80,,323.84,percent of total billed charges,80% of total billed charges,328.9,65,,263.12,percent of total billed charges,65% of total billed charges,180.49,35.67,,144.392,percent of total billed charges,35.67% of total billed charges,41.76,455.4,
SACRUM & COCCYX MIN 2 V CL,3252210,CDM,320,RC,72220,HCPCS,outpatient,,,498,199.20,,423.3,85,,338.64,percent of total billed charges,85% of total billed charges,383.46,77,,306.77,percent of total billed charges,77% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,239.16,385,,,fee schedule,385% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,448.2,90,,358.56,percent of total billed charges,90% of total billed charges,398.4,80,,318.72,percent of total billed charges,80% of total billed charges,448.2,90,,358.56,percent of total billed charges,90% of total billed charges,373.5,75,,298.8,percent of total billed charges,75% of total billed charges,96.95,122,,,fee schedule,122% of HUMANA fee schedule,144.42,29,,115.536,percent of total billed charges,29% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,333.66,67,,266.928,percent of total billed charges,67% of total billed charges,41.76,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,398.4,80,,318.72,percent of total billed charges,80% of total billed charges,323.7,65,,258.96,percent of total billed charges,65% of total billed charges,177.64,35.67,,142.112,percent of total billed charges,35.67% of total billed charges,41.76,448.2,
SACROILIAC JT 3 OR > V CL,3252220,CDM,320,RC,72202,HCPCS,outpatient,,,506,202.40,,430.1,85,,344.08,percent of total billed charges,85% of total billed charges,389.62,77,,311.7,percent of total billed charges,77% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,440.67,385,,,fee schedule,385% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,455.4,90,,364.32,percent of total billed charges,90% of total billed charges,404.8,80,,323.84,percent of total billed charges,80% of total billed charges,455.4,90,,364.32,percent of total billed charges,90% of total billed charges,379.5,75,,303.6,percent of total billed charges,75% of total billed charges,117.29,122,,,fee schedule,122% of HUMANA fee schedule,146.74,29,,117.392,percent of total billed charges,29% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,339.02,67,,271.216,percent of total billed charges,67% of total billed charges,41.76,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,404.8,80,,323.84,percent of total billed charges,80% of total billed charges,328.9,65,,263.12,percent of total billed charges,65% of total billed charges,180.49,35.67,,144.392,percent of total billed charges,35.67% of total billed charges,41.76,458.98,
SCAPULA LEFT CL,3252270,CDM,320,RC,73010,HCPCS,outpatient,,,498,199.20,LT,423.3,85,,338.64,percent of total billed charges,85% of total billed charges,383.46,77,,306.77,percent of total billed charges,77% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,440.67,385,,,fee schedule,385% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,448.2,90,,358.56,percent of total billed charges,90% of total billed charges,398.4,80,,318.72,percent of total billed charges,80% of total billed charges,448.2,90,,358.56,percent of total billed charges,90% of total billed charges,373.5,75,,298.8,percent of total billed charges,75% of total billed charges,117.29,122,,,fee schedule,122% of HUMANA fee schedule,144.42,29,,115.536,percent of total billed charges,29% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,333.66,67,,266.928,percent of total billed charges,67% of total billed charges,41.76,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,398.4,80,,318.72,percent of total billed charges,80% of total billed charges,323.7,65,,258.96,percent of total billed charges,65% of total billed charges,177.64,35.67,,142.112,percent of total billed charges,35.67% of total billed charges,41.76,458.98,
"SCAPULA RIGHT, CL",3252271,CDM,320,RC,73010,HCPCS,outpatient,,,192,76.80,RT,163.2,85,,130.56,percent of total billed charges,85% of total billed charges,147.84,77,,118.27,percent of total billed charges,77% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,440.67,385,,,fee schedule,385% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,172.8,90,,138.24,percent of total billed charges,90% of total billed charges,153.6,80,,122.88,percent of total billed charges,80% of total billed charges,172.8,90,,138.24,percent of total billed charges,90% of total billed charges,144,75,,115.2,percent of total billed charges,75% of total billed charges,117.29,122,,,fee schedule,122% of HUMANA fee schedule,55.68,29,,44.544,percent of total billed charges,29% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,128.64,67,,102.912,percent of total billed charges,67% of total billed charges,41.76,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,153.6,80,,122.88,percent of total billed charges,80% of total billed charges,124.8,65,,99.84,percent of total billed charges,65% of total billed charges,68.49,35.67,,54.792,percent of total billed charges,35.67% of total billed charges,41.76,458.98,
STEROCLAVICULAR JT MIN 3 V CL,3252290,CDM,320,RC,71130,HCPCS,outpatient,,,272,108.80,,231.2,85,,184.96,percent of total billed charges,85% of total billed charges,209.44,77,,167.55,percent of total billed charges,77% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,239.16,385,,,fee schedule,385% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,244.8,90,,195.84,percent of total billed charges,90% of total billed charges,217.6,80,,174.08,percent of total billed charges,80% of total billed charges,244.8,90,,195.84,percent of total billed charges,90% of total billed charges,204,75,,163.2,percent of total billed charges,75% of total billed charges,96.95,122,,,fee schedule,122% of HUMANA fee schedule,78.88,29,,63.104,percent of total billed charges,29% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,182.24,67,,145.792,percent of total billed charges,67% of total billed charges,41.76,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,217.6,80,,174.08,percent of total billed charges,80% of total billed charges,176.8,65,,141.44,percent of total billed charges,65% of total billed charges,97.02,35.67,,77.616,percent of total billed charges,35.67% of total billed charges,41.76,249.1,
SCOLIOSIS SERIES 2/3 V CL,3252300,CDM,320,RC,72083,HCPCS,outpatient,,,198,79.20,,168.3,85,,134.64,percent of total billed charges,85% of total billed charges,152.46,77,,121.97,percent of total billed charges,77% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,221.07,385,,,fee schedule,385% of BCBS fee schedule,230.25,401,,,fee schedule,401% of BCBS fee schedule,230.25,401,,,fee schedule,401% of BCBS fee schedule,230.25,401,,,fee schedule,401% of BCBS fee schedule,178.2,90,,142.56,percent of total billed charges,90% of total billed charges,158.4,80,,126.72,percent of total billed charges,80% of total billed charges,178.2,90,,142.56,percent of total billed charges,90% of total billed charges,148.5,75,,118.8,percent of total billed charges,75% of total billed charges,117.29,122,,,fee schedule,122% of HUMANA fee schedule,57.42,29,,45.936,percent of total billed charges,29% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,132.66,67,,106.128,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,158.4,80,,126.72,percent of total billed charges,80% of total billed charges,128.7,65,,102.96,percent of total billed charges,65% of total billed charges,70.63,35.67,,56.504,percent of total billed charges,35.67% of total billed charges,57.42,230.25,
SCAPHOID MIN 3 V LT CL,3252330,CDM,320,RC,73110,HCPCS,outpatient,,,341,136.40,LT,289.85,85,,231.88,percent of total billed charges,85% of total billed charges,262.57,77,,210.06,percent of total billed charges,77% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,239.16,385,,,fee schedule,385% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,306.9,90,,245.52,percent of total billed charges,90% of total billed charges,272.8,80,,218.24,percent of total billed charges,80% of total billed charges,306.9,90,,245.52,percent of total billed charges,90% of total billed charges,255.75,75,,204.6,percent of total billed charges,75% of total billed charges,96.95,122,,,fee schedule,122% of HUMANA fee schedule,98.89,29,,79.112,percent of total billed charges,29% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,228.47,67,,182.776,percent of total billed charges,67% of total billed charges,41.76,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,272.8,80,,218.24,percent of total billed charges,80% of total billed charges,221.65,65,,177.32,percent of total billed charges,65% of total billed charges,121.63,35.67,,97.304,percent of total billed charges,35.67% of total billed charges,41.76,306.9,
SCAPHOID MIN 3 V RT CL,3252331,CDM,320,RC,73110,HCPCS,outpatient,,,341,136.40,RT,289.85,85,,231.88,percent of total billed charges,85% of total billed charges,262.57,77,,210.06,percent of total billed charges,77% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,239.16,385,,,fee schedule,385% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,306.9,90,,245.52,percent of total billed charges,90% of total billed charges,272.8,80,,218.24,percent of total billed charges,80% of total billed charges,306.9,90,,245.52,percent of total billed charges,90% of total billed charges,255.75,75,,204.6,percent of total billed charges,75% of total billed charges,96.95,122,,,fee schedule,122% of HUMANA fee schedule,98.89,29,,79.112,percent of total billed charges,29% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,228.47,67,,182.776,percent of total billed charges,67% of total billed charges,41.76,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,272.8,80,,218.24,percent of total billed charges,80% of total billed charges,221.65,65,,177.32,percent of total billed charges,65% of total billed charges,121.63,35.67,,97.304,percent of total billed charges,35.67% of total billed charges,41.76,306.9,
SELLA TURCICA XRAY CL,3252350,CDM,320,RC,70240,HCPCS,outpatient,,,272,108.80,,231.2,85,,184.96,percent of total billed charges,85% of total billed charges,209.44,77,,167.55,percent of total billed charges,77% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,239.16,385,,,fee schedule,385% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,244.8,90,,195.84,percent of total billed charges,90% of total billed charges,217.6,80,,174.08,percent of total billed charges,80% of total billed charges,244.8,90,,195.84,percent of total billed charges,90% of total billed charges,204,75,,163.2,percent of total billed charges,75% of total billed charges,96.95,122,,,fee schedule,122% of HUMANA fee schedule,78.88,29,,63.104,percent of total billed charges,29% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,182.24,67,,145.792,percent of total billed charges,67% of total billed charges,41.76,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,217.6,80,,174.08,percent of total billed charges,80% of total billed charges,176.8,65,,141.44,percent of total billed charges,65% of total billed charges,97.02,35.67,,77.616,percent of total billed charges,35.67% of total billed charges,41.76,249.1,
SHOULDER MIN 2 V LT,3252390,CDM,320,RC,73030,HCPCS,outpatient,,,340,136.00,LT,289,85,,231.2,percent of total billed charges,85% of total billed charges,261.8,77,,209.44,percent of total billed charges,77% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,239.16,385,,,fee schedule,385% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,306,90,,244.8,percent of total billed charges,90% of total billed charges,272,80,,217.6,percent of total billed charges,80% of total billed charges,306,90,,244.8,percent of total billed charges,90% of total billed charges,255,75,,204,percent of total billed charges,75% of total billed charges,96.95,122,,,fee schedule,122% of HUMANA fee schedule,98.6,29,,78.88,percent of total billed charges,29% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,227.8,67,,182.24,percent of total billed charges,67% of total billed charges,41.76,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,272,80,,217.6,percent of total billed charges,80% of total billed charges,221,65,,176.8,percent of total billed charges,65% of total billed charges,121.28,35.67,,97.024,percent of total billed charges,35.67% of total billed charges,41.76,306,
SHOULDER MIN 2 VRT CL,3252391,CDM,320,RC,73030,HCPCS,outpatient,,,243,97.20,RT,206.55,85,,165.24,percent of total billed charges,85% of total billed charges,187.11,77,,149.69,percent of total billed charges,77% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,239.16,385,,,fee schedule,385% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,218.7,90,,174.96,percent of total billed charges,90% of total billed charges,194.4,80,,155.52,percent of total billed charges,80% of total billed charges,218.7,90,,174.96,percent of total billed charges,90% of total billed charges,182.25,75,,145.8,percent of total billed charges,75% of total billed charges,96.95,122,,,fee schedule,122% of HUMANA fee schedule,70.47,29,,56.376,percent of total billed charges,29% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,162.81,67,,130.248,percent of total billed charges,67% of total billed charges,41.76,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,194.4,80,,155.52,percent of total billed charges,80% of total billed charges,157.95,65,,126.36,percent of total billed charges,65% of total billed charges,86.68,35.67,,69.344,percent of total billed charges,35.67% of total billed charges,41.76,249.1,
SHOULDER WT BEARING BIL CL,3252420,CDM,320,RC,73050,HCPCS,outpatient,,,351,140.40,,298.35,85,,238.68,percent of total billed charges,85% of total billed charges,270.27,77,,216.22,percent of total billed charges,77% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,239.16,385,,,fee schedule,385% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,315.9,90,,252.72,percent of total billed charges,90% of total billed charges,280.8,80,,224.64,percent of total billed charges,80% of total billed charges,315.9,90,,252.72,percent of total billed charges,90% of total billed charges,263.25,75,,210.6,percent of total billed charges,75% of total billed charges,96.95,122,,,fee schedule,122% of HUMANA fee schedule,101.79,29,,81.432,percent of total billed charges,29% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,235.17,67,,188.136,percent of total billed charges,67% of total billed charges,41.76,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,280.8,80,,224.64,percent of total billed charges,80% of total billed charges,228.15,65,,182.52,percent of total billed charges,65% of total billed charges,125.2,35.67,,100.16,percent of total billed charges,35.67% of total billed charges,41.76,315.9,
SHOULDER MIN 2 V WT BEAR LT,3252440,CDM,320,RC,73030,HCPCS,outpatient,,,340,136.00,LT,289,85,,231.2,percent of total billed charges,85% of total billed charges,261.8,77,,209.44,percent of total billed charges,77% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,239.16,385,,,fee schedule,385% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,306,90,,244.8,percent of total billed charges,90% of total billed charges,272,80,,217.6,percent of total billed charges,80% of total billed charges,306,90,,244.8,percent of total billed charges,90% of total billed charges,255,75,,204,percent of total billed charges,75% of total billed charges,96.95,122,,,fee schedule,122% of HUMANA fee schedule,98.6,29,,78.88,percent of total billed charges,29% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,227.8,67,,182.24,percent of total billed charges,67% of total billed charges,41.76,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,272,80,,217.6,percent of total billed charges,80% of total billed charges,221,65,,176.8,percent of total billed charges,65% of total billed charges,121.28,35.67,,97.024,percent of total billed charges,35.67% of total billed charges,41.76,306,
SHOULDEr MIN 2 V WT BEAR RT CL,3252441,CDM,320,RC,73030,HCPCS,outpatient,,,243,97.20,RT,206.55,85,,165.24,percent of total billed charges,85% of total billed charges,187.11,77,,149.69,percent of total billed charges,77% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,239.16,385,,,fee schedule,385% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,218.7,90,,174.96,percent of total billed charges,90% of total billed charges,194.4,80,,155.52,percent of total billed charges,80% of total billed charges,218.7,90,,174.96,percent of total billed charges,90% of total billed charges,182.25,75,,145.8,percent of total billed charges,75% of total billed charges,96.95,122,,,fee schedule,122% of HUMANA fee schedule,70.47,29,,56.376,percent of total billed charges,29% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,162.81,67,,130.248,percent of total billed charges,67% of total billed charges,41.76,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,194.4,80,,155.52,percent of total billed charges,80% of total billed charges,157.95,65,,126.36,percent of total billed charges,65% of total billed charges,86.68,35.67,,69.344,percent of total billed charges,35.67% of total billed charges,41.76,249.1,
SINUS SERIES MIN 3 V CL,3252490,CDM,320,RC,70220,HCPCS,outpatient,,,277,110.80,,235.45,85,,188.36,percent of total billed charges,85% of total billed charges,213.29,77,,170.63,percent of total billed charges,77% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,239.16,385,,,fee schedule,385% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.3,90,,199.44,percent of total billed charges,90% of total billed charges,221.6,80,,177.28,percent of total billed charges,80% of total billed charges,249.3,90,,199.44,percent of total billed charges,90% of total billed charges,207.75,75,,166.2,percent of total billed charges,75% of total billed charges,96.95,122,,,fee schedule,122% of HUMANA fee schedule,80.33,29,,64.264,percent of total billed charges,29% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,185.59,67,,148.472,percent of total billed charges,67% of total billed charges,41.76,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,221.6,80,,177.28,percent of total billed charges,80% of total billed charges,180.05,65,,144.04,percent of total billed charges,65% of total billed charges,98.81,35.67,,79.048,percent of total billed charges,35.67% of total billed charges,41.76,249.3,
SKULL ONE VIEW CL,3252500,CDM,320,RC,70250,HCPCS,outpatient,,,498,199.20,,423.3,85,,338.64,percent of total billed charges,85% of total billed charges,383.46,77,,306.77,percent of total billed charges,77% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,440.67,385,,,fee schedule,385% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,448.2,90,,358.56,percent of total billed charges,90% of total billed charges,398.4,80,,318.72,percent of total billed charges,80% of total billed charges,448.2,90,,358.56,percent of total billed charges,90% of total billed charges,373.5,75,,298.8,percent of total billed charges,75% of total billed charges,117.29,122,,,fee schedule,122% of HUMANA fee schedule,144.42,29,,115.536,percent of total billed charges,29% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,333.66,67,,266.928,percent of total billed charges,67% of total billed charges,41.76,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,398.4,80,,318.72,percent of total billed charges,80% of total billed charges,323.7,65,,258.96,percent of total billed charges,65% of total billed charges,177.64,35.67,,142.112,percent of total billed charges,35.67% of total billed charges,41.76,458.98,
SKULL 2 VIEWS CL,3252501,CDM,320,RC,70250,HCPCS,outpatient,,,498,199.20,,423.3,85,,338.64,percent of total billed charges,85% of total billed charges,383.46,77,,306.77,percent of total billed charges,77% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,440.67,385,,,fee schedule,385% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,448.2,90,,358.56,percent of total billed charges,90% of total billed charges,398.4,80,,318.72,percent of total billed charges,80% of total billed charges,448.2,90,,358.56,percent of total billed charges,90% of total billed charges,373.5,75,,298.8,percent of total billed charges,75% of total billed charges,117.29,122,,,fee schedule,122% of HUMANA fee schedule,144.42,29,,115.536,percent of total billed charges,29% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,333.66,67,,266.928,percent of total billed charges,67% of total billed charges,41.76,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,398.4,80,,318.72,percent of total billed charges,80% of total billed charges,323.7,65,,258.96,percent of total billed charges,65% of total billed charges,177.64,35.67,,142.112,percent of total billed charges,35.67% of total billed charges,41.76,458.98,
SKULL MINIMIAL 4 VIEWS CL,3252502,CDM,320,RC,70260,HCPCS,outpatient,,,506,202.40,,430.1,85,,344.08,percent of total billed charges,85% of total billed charges,389.62,77,,311.7,percent of total billed charges,77% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,440.67,385,,,fee schedule,385% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,455.4,90,,364.32,percent of total billed charges,90% of total billed charges,404.8,80,,323.84,percent of total billed charges,80% of total billed charges,455.4,90,,364.32,percent of total billed charges,90% of total billed charges,379.5,75,,303.6,percent of total billed charges,75% of total billed charges,117.29,122,,,fee schedule,122% of HUMANA fee schedule,146.74,29,,117.392,percent of total billed charges,29% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,339.02,67,,271.216,percent of total billed charges,67% of total billed charges,70.34,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,404.8,80,,323.84,percent of total billed charges,80% of total billed charges,328.9,65,,263.12,percent of total billed charges,65% of total billed charges,180.49,35.67,,144.392,percent of total billed charges,35.67% of total billed charges,70.34,458.98,
STERNUM MIN 2 V CL,3252520,CDM,320,RC,71120,HCPCS,outpatient,,,272,108.80,,231.2,85,,184.96,percent of total billed charges,85% of total billed charges,209.44,77,,167.55,percent of total billed charges,77% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,239.16,385,,,fee schedule,385% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,244.8,90,,195.84,percent of total billed charges,90% of total billed charges,217.6,80,,174.08,percent of total billed charges,80% of total billed charges,244.8,90,,195.84,percent of total billed charges,90% of total billed charges,204,75,,163.2,percent of total billed charges,75% of total billed charges,96.95,122,,,fee schedule,122% of HUMANA fee schedule,78.88,29,,63.104,percent of total billed charges,29% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,182.24,67,,145.792,percent of total billed charges,67% of total billed charges,41.76,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,217.6,80,,174.08,percent of total billed charges,80% of total billed charges,176.8,65,,141.44,percent of total billed charges,65% of total billed charges,97.02,35.67,,77.616,percent of total billed charges,35.67% of total billed charges,41.76,249.1,
SINGLE VIEW BODY PART XRAY CL,3252560,CDM,320,RC,76100,HCPCS,outpatient,,,498,199.20,,423.3,85,,338.64,percent of total billed charges,85% of total billed charges,383.46,77,,306.77,percent of total billed charges,77% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,440.67,385,,,fee schedule,385% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,448.2,90,,358.56,percent of total billed charges,90% of total billed charges,398.4,80,,318.72,percent of total billed charges,80% of total billed charges,448.2,90,,358.56,percent of total billed charges,90% of total billed charges,373.5,75,,298.8,percent of total billed charges,75% of total billed charges,117.29,122,,,fee schedule,122% of HUMANA fee schedule,144.42,29,,115.536,percent of total billed charges,29% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,333.66,67,,266.928,percent of total billed charges,67% of total billed charges,70.34,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,398.4,80,,318.72,percent of total billed charges,80% of total billed charges,323.7,65,,258.96,percent of total billed charges,65% of total billed charges,177.64,35.67,,142.112,percent of total billed charges,35.67% of total billed charges,70.34,458.98,
TEMPEROMANDIBULAR JOINT CL,3252620,CDM,320,RC,70328,HCPCS,outpatient,,,272,108.80,,231.2,85,,184.96,percent of total billed charges,85% of total billed charges,209.44,77,,167.55,percent of total billed charges,77% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,239.16,385,,,fee schedule,385% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,244.8,90,,195.84,percent of total billed charges,90% of total billed charges,217.6,80,,174.08,percent of total billed charges,80% of total billed charges,244.8,90,,195.84,percent of total billed charges,90% of total billed charges,204,75,,163.2,percent of total billed charges,75% of total billed charges,96.95,122,,,fee schedule,122% of HUMANA fee schedule,78.88,29,,63.104,percent of total billed charges,29% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,182.24,67,,145.792,percent of total billed charges,67% of total billed charges,41.76,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,217.6,80,,174.08,percent of total billed charges,80% of total billed charges,176.8,65,,141.44,percent of total billed charges,65% of total billed charges,97.02,35.67,,77.616,percent of total billed charges,35.67% of total billed charges,41.76,249.1,
TOES MIN 2 VIEWS CL,3252661,CDM,320,RC,73660,HCPCS,outpatient,,,358,143.20,,304.3,85,,243.44,percent of total billed charges,85% of total billed charges,275.66,77,,220.53,percent of total billed charges,77% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,239.16,385,,,fee schedule,385% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,322.2,90,,257.76,percent of total billed charges,90% of total billed charges,286.4,80,,229.12,percent of total billed charges,80% of total billed charges,322.2,90,,257.76,percent of total billed charges,90% of total billed charges,268.5,75,,214.8,percent of total billed charges,75% of total billed charges,96.95,122,,,fee schedule,122% of HUMANA fee schedule,103.82,29,,83.056,percent of total billed charges,29% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,239.86,67,,191.888,percent of total billed charges,67% of total billed charges,41.76,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,286.4,80,,229.12,percent of total billed charges,80% of total billed charges,232.7,65,,186.16,percent of total billed charges,65% of total billed charges,127.7,35.67,,102.16,percent of total billed charges,35.67% of total billed charges,41.76,322.2,
THORACIC SPINE 3 VIEWS CL,3252700,CDM,320,RC,72072,HCPCS,outpatient,,,506,202.40,,430.1,85,,344.08,percent of total billed charges,85% of total billed charges,389.62,77,,311.7,percent of total billed charges,77% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,440.67,385,,,fee schedule,385% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,455.4,90,,364.32,percent of total billed charges,90% of total billed charges,404.8,80,,323.84,percent of total billed charges,80% of total billed charges,455.4,90,,364.32,percent of total billed charges,90% of total billed charges,379.5,75,,303.6,percent of total billed charges,75% of total billed charges,117.29,122,,,fee schedule,122% of HUMANA fee schedule,146.74,29,,117.392,percent of total billed charges,29% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,339.02,67,,271.216,percent of total billed charges,67% of total billed charges,41.76,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,404.8,80,,323.84,percent of total billed charges,80% of total billed charges,328.9,65,,263.12,percent of total billed charges,65% of total billed charges,180.49,35.67,,144.392,percent of total billed charges,35.67% of total billed charges,41.76,458.98,
WRIST MIN 3 V LT CL,3252840,CDM,320,RC,73110,HCPCS,outpatient,,,341,136.40,LT,289.85,85,,231.88,percent of total billed charges,85% of total billed charges,262.57,77,,210.06,percent of total billed charges,77% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,239.16,385,,,fee schedule,385% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,306.9,90,,245.52,percent of total billed charges,90% of total billed charges,272.8,80,,218.24,percent of total billed charges,80% of total billed charges,306.9,90,,245.52,percent of total billed charges,90% of total billed charges,255.75,75,,204.6,percent of total billed charges,75% of total billed charges,96.95,122,,,fee schedule,122% of HUMANA fee schedule,98.89,29,,79.112,percent of total billed charges,29% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,228.47,67,,182.776,percent of total billed charges,67% of total billed charges,41.76,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,272.8,80,,218.24,percent of total billed charges,80% of total billed charges,221.65,65,,177.32,percent of total billed charges,65% of total billed charges,121.63,35.67,,97.304,percent of total billed charges,35.67% of total billed charges,41.76,306.9,
WRIST MIN 3 V RT CL,3252841,CDM,320,RC,73110,HCPCS,outpatient,,,341,136.40,RT,289.85,85,,231.88,percent of total billed charges,85% of total billed charges,262.57,77,,210.06,percent of total billed charges,77% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,239.16,385,,,fee schedule,385% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,306.9,90,,245.52,percent of total billed charges,90% of total billed charges,272.8,80,,218.24,percent of total billed charges,80% of total billed charges,306.9,90,,245.52,percent of total billed charges,90% of total billed charges,255.75,75,,204.6,percent of total billed charges,75% of total billed charges,96.95,122,,,fee schedule,122% of HUMANA fee schedule,98.89,29,,79.112,percent of total billed charges,29% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,228.47,67,,182.776,percent of total billed charges,67% of total billed charges,41.76,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,272.8,80,,218.24,percent of total billed charges,80% of total billed charges,221.65,65,,177.32,percent of total billed charges,65% of total billed charges,121.63,35.67,,97.304,percent of total billed charges,35.67% of total billed charges,41.76,306.9,
WATERS LESS THAN 3 V CL,3252870,CDM,320,RC,70210,HCPCS,outpatient,,,272,108.80,,231.2,85,,184.96,percent of total billed charges,85% of total billed charges,209.44,77,,167.55,percent of total billed charges,77% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,239.16,385,,,fee schedule,385% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,244.8,90,,195.84,percent of total billed charges,90% of total billed charges,217.6,80,,174.08,percent of total billed charges,80% of total billed charges,244.8,90,,195.84,percent of total billed charges,90% of total billed charges,204,75,,163.2,percent of total billed charges,75% of total billed charges,96.95,122,,,fee schedule,122% of HUMANA fee schedule,78.88,29,,63.104,percent of total billed charges,29% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,182.24,67,,145.792,percent of total billed charges,67% of total billed charges,41.76,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,217.6,80,,174.08,percent of total billed charges,80% of total billed charges,176.8,65,,141.44,percent of total billed charges,65% of total billed charges,97.02,35.67,,77.616,percent of total billed charges,35.67% of total billed charges,41.76,249.1,
ZYGOMAL LESS THAN 3 V CL,3252890,CDM,320,RC,70140,HCPCS,outpatient,,,276,110.40,,234.6,85,,187.68,percent of total billed charges,85% of total billed charges,212.52,77,,170.02,percent of total billed charges,77% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,239.16,385,,,fee schedule,385% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,248.4,90,,198.72,percent of total billed charges,90% of total billed charges,220.8,80,,176.64,percent of total billed charges,80% of total billed charges,248.4,90,,198.72,percent of total billed charges,90% of total billed charges,207,75,,165.6,percent of total billed charges,75% of total billed charges,96.95,122,,,fee schedule,122% of HUMANA fee schedule,80.04,29,,64.032,percent of total billed charges,29% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,184.92,67,,147.936,percent of total billed charges,67% of total billed charges,41.76,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,220.8,80,,176.64,percent of total billed charges,80% of total billed charges,179.4,65,,143.52,percent of total billed charges,65% of total billed charges,98.45,35.67,,78.76,percent of total billed charges,35.67% of total billed charges,41.76,249.1,
CYSTOGRAM,3400130,CDM,320,RC,78740,HCPCS,outpatient,,,981,392.40,,833.85,85,,667.08,percent of total billed charges,85% of total billed charges,755.37,77,,604.3,percent of total billed charges,77% of total billed charges,360.69,100,,,fee schedule,100% of CMS OPPS rate,775.16,385,,,fee schedule,385% of BCBS fee schedule,807.37,401,,,fee schedule,401% of BCBS fee schedule,807.37,401,,,fee schedule,401% of BCBS fee schedule,807.37,401,,,fee schedule,401% of BCBS fee schedule,882.9,90,,706.32,percent of total billed charges,90% of total billed charges,784.8,80,,627.84,percent of total billed charges,80% of total billed charges,882.9,90,,706.32,percent of total billed charges,90% of total billed charges,735.75,75,,588.6,percent of total billed charges,75% of total billed charges,440.04,122,,,fee schedule,122% of HUMANA fee schedule,284.49,29,,227.592,percent of total billed charges,29% of total billed charges,360.69,100,,,fee schedule,100% of CMS OPPS rate,657.27,67,,525.816,percent of total billed charges,67% of total billed charges,297.04,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,784.8,80,,627.84,percent of total billed charges,80% of total billed charges,637.65,65,,510.12,percent of total billed charges,65% of total billed charges,349.92,35.67,,279.936,percent of total billed charges,35.67% of total billed charges,284.49,882.9,
MAMMOGRAM PLACE  DEVICE 1ST,4010040,CDM,320,RC,19281,HCPCS,outpatient,,,3100,1240.00,,1150,,,,case rate,pays based on per visit,2387,77,,1909.6,percent of total billed charges,77% of total billed charges,1417.86,100,,,fee schedule,100% of CMS OPPS rate,2542,82,,2033.6,percent of total billed charges,82% of total billed charges,2635,85,,2108,percent of total billed charges,85% of total billed charges,2635,85,,2108,percent of total billed charges,85% of total billed charges,2635,85,,2108,percent of total billed charges,85% of total billed charges,2790,90,,2232,percent of total billed charges,90% of total billed charges,2480,80,,1984,percent of total billed charges,80% of total billed charges,2790,90,,2232,percent of total billed charges,90% of total billed charges,2325,75,,1860,percent of total billed charges,75% of total billed charges,1729.79,122,,,fee schedule,122% of HUMANA fee schedule,899,29,,719.2,percent of total billed charges,29% of total billed charges,1417.86,100,,,fee schedule,100% of CMS OPPS rate,2077,67,,1661.6,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,2480,80,,1984,percent of total billed charges,80% of total billed charges,2015,65,,1612,percent of total billed charges,65% of total billed charges,1105.77,35.67,,884.616,percent of total billed charges,35.67% of total billed charges,899,2790,
MAMMOGRAM PLACE DEV EA ADD,4010050,CDM,320,RC,19282,HCPCS,outpatient,,,235,94.00,,1150,,,,case rate,pays based on per visit,180.95,77,,144.76,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,192.7,82,,154.16,percent of total billed charges,82% of total billed charges,199.75,85,,159.8,percent of total billed charges,85% of total billed charges,199.75,85,,159.8,percent of total billed charges,85% of total billed charges,199.75,85,,159.8,percent of total billed charges,85% of total billed charges,211.5,90,,169.2,percent of total billed charges,90% of total billed charges,188,80,,150.4,percent of total billed charges,80% of total billed charges,211.5,90,,169.2,percent of total billed charges,90% of total billed charges,176.25,75,,141,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,68.15,29,,54.52,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,157.45,67,,125.96,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,188,80,,150.4,percent of total billed charges,80% of total billed charges,152.75,65,,122.2,percent of total billed charges,65% of total billed charges,83.82,35.67,,67.056,percent of total billed charges,35.67% of total billed charges,68.15,1150,
US BREAST PLACE LOC DEV 1ST LE,4010060,CDM,320,RC,19285,HCPCS,outpatient,,,3255,1302.00,,1150,,,,case rate,pays based on per visit,2506.35,77,,2005.08,percent of total billed charges,77% of total billed charges,615.29,100,,,fee schedule,100% of CMS OPPS rate,2669.1,82,,2135.28,percent of total billed charges,82% of total billed charges,2766.75,85,,2213.4,percent of total billed charges,85% of total billed charges,2766.75,85,,2213.4,percent of total billed charges,85% of total billed charges,2766.75,85,,2213.4,percent of total billed charges,85% of total billed charges,2929.5,90,,2343.6,percent of total billed charges,90% of total billed charges,2604,80,,2083.2,percent of total billed charges,80% of total billed charges,2929.5,90,,2343.6,percent of total billed charges,90% of total billed charges,2441.25,75,,1953,percent of total billed charges,75% of total billed charges,750.66,122,,,fee schedule,122% of HUMANA fee schedule,943.95,29,,755.16,percent of total billed charges,29% of total billed charges,615.29,100,,,fee schedule,100% of CMS OPPS rate,2180.85,67,,1744.68,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,2604,80,,2083.2,percent of total billed charges,80% of total billed charges,2115.75,65,,1692.6,percent of total billed charges,65% of total billed charges,1161.06,35.67,,928.848,percent of total billed charges,35.67% of total billed charges,615.29,2929.5,
US BREAST PLACE LOC DEV EA ADD,4010070,CDM,320,RC,19286,HCPCS,outpatient,,,243,97.20,,1150,,,,case rate,pays based on per visit,187.11,77,,149.69,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,199.26,82,,159.408,percent of total billed charges,82% of total billed charges,206.55,85,,165.24,percent of total billed charges,85% of total billed charges,206.55,85,,165.24,percent of total billed charges,85% of total billed charges,206.55,85,,165.24,percent of total billed charges,85% of total billed charges,218.7,90,,174.96,percent of total billed charges,90% of total billed charges,194.4,80,,155.52,percent of total billed charges,80% of total billed charges,218.7,90,,174.96,percent of total billed charges,90% of total billed charges,182.25,75,,145.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,70.47,29,,56.376,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,162.81,67,,130.248,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,194.4,80,,155.52,percent of total billed charges,80% of total billed charges,157.95,65,,126.36,percent of total billed charges,65% of total billed charges,86.68,35.67,,69.344,percent of total billed charges,35.67% of total billed charges,70.47,1150,
CHEST - 2 VIEWS - XRAY,3200650,CDM,324,RC,71046,HCPCS,outpatient,,,325,130.00,,276.25,85,,221,percent of total billed charges,85% of total billed charges,250.25,77,,200.2,percent of total billed charges,77% of total billed charges,79.45,100,,,fee schedule,100% of CMS OPPS rate,239.16,385,,,fee schedule,385% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,292.5,90,,234,percent of total billed charges,90% of total billed charges,260,80,,208,percent of total billed charges,80% of total billed charges,292.5,90,,234,percent of total billed charges,90% of total billed charges,243.75,75,,195,percent of total billed charges,75% of total billed charges,96.94,122,,,fee schedule,122% of HUMANA fee schedule,94.25,29,,75.4,percent of total billed charges,29% of total billed charges,79.45,100,,,fee schedule,100% of CMS OPPS rate,217.75,67,,174.2,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,260,80,,208,percent of total billed charges,80% of total billed charges,211.25,65,,169,percent of total billed charges,65% of total billed charges,115.93,35.67,,92.744,percent of total billed charges,35.67% of total billed charges,79.45,292.5,
CHEST - ONE VIEW ONLY,3200660,CDM,324,RC,71045,HCPCS,outpatient,,,291,116.40,,247.35,85,,197.88,percent of total billed charges,85% of total billed charges,224.07,77,,179.26,percent of total billed charges,77% of total billed charges,79.45,100,,,fee schedule,100% of CMS OPPS rate,239.16,385,,,fee schedule,385% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,261.9,90,,209.52,percent of total billed charges,90% of total billed charges,232.8,80,,186.24,percent of total billed charges,80% of total billed charges,261.9,90,,209.52,percent of total billed charges,90% of total billed charges,218.25,75,,174.6,percent of total billed charges,75% of total billed charges,96.94,122,,,fee schedule,122% of HUMANA fee schedule,84.39,29,,67.512,percent of total billed charges,29% of total billed charges,79.45,100,,,fee schedule,100% of CMS OPPS rate,194.97,67,,155.976,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,232.8,80,,186.24,percent of total billed charges,80% of total billed charges,189.15,65,,151.32,percent of total billed charges,65% of total billed charges,103.8,35.67,,83.04,percent of total billed charges,35.67% of total billed charges,79.45,261.9,
CHEST - DECUBITUS 1 VIEW;XRAY,3200680,CDM,324,RC,71045,HCPCS,outpatient,,,286,114.40,,243.1,85,,194.48,percent of total billed charges,85% of total billed charges,220.22,77,,176.18,percent of total billed charges,77% of total billed charges,79.45,100,,,fee schedule,100% of CMS OPPS rate,239.16,385,,,fee schedule,385% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,257.4,90,,205.92,percent of total billed charges,90% of total billed charges,228.8,80,,183.04,percent of total billed charges,80% of total billed charges,257.4,90,,205.92,percent of total billed charges,90% of total billed charges,214.5,75,,171.6,percent of total billed charges,75% of total billed charges,96.94,122,,,fee schedule,122% of HUMANA fee schedule,82.94,29,,66.352,percent of total billed charges,29% of total billed charges,79.45,100,,,fee schedule,100% of CMS OPPS rate,191.62,67,,153.296,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,228.8,80,,183.04,percent of total billed charges,80% of total billed charges,185.9,65,,148.72,percent of total billed charges,65% of total billed charges,102.02,35.67,,81.616,percent of total billed charges,35.67% of total billed charges,79.45,257.4,
CHEST - XRAY - EXPIRATION,3200690,CDM,324,RC,71045,HCPCS,outpatient,,,286,114.40,,243.1,85,,194.48,percent of total billed charges,85% of total billed charges,220.22,77,,176.18,percent of total billed charges,77% of total billed charges,79.45,100,,,fee schedule,100% of CMS OPPS rate,239.16,385,,,fee schedule,385% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,257.4,90,,205.92,percent of total billed charges,90% of total billed charges,228.8,80,,183.04,percent of total billed charges,80% of total billed charges,257.4,90,,205.92,percent of total billed charges,90% of total billed charges,214.5,75,,171.6,percent of total billed charges,75% of total billed charges,96.94,122,,,fee schedule,122% of HUMANA fee schedule,82.94,29,,66.352,percent of total billed charges,29% of total billed charges,79.45,100,,,fee schedule,100% of CMS OPPS rate,191.62,67,,153.296,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,228.8,80,,183.04,percent of total billed charges,80% of total billed charges,185.9,65,,148.72,percent of total billed charges,65% of total billed charges,102.02,35.67,,81.616,percent of total billed charges,35.67% of total billed charges,79.45,257.4,
CHEST W/ LORDOTIC VIEW - XRAY,3200700,CDM,324,RC,71047,HCPCS,outpatient,,,522,208.80,,443.7,85,,354.96,percent of total billed charges,85% of total billed charges,401.94,77,,321.55,percent of total billed charges,77% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,239.16,385,,,fee schedule,385% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,469.8,90,,375.84,percent of total billed charges,90% of total billed charges,417.6,80,,334.08,percent of total billed charges,80% of total billed charges,469.8,90,,375.84,percent of total billed charges,90% of total billed charges,391.5,75,,313.2,percent of total billed charges,75% of total billed charges,96.95,122,,,fee schedule,122% of HUMANA fee schedule,151.38,29,,121.104,percent of total billed charges,29% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,349.74,67,,279.792,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,417.6,80,,334.08,percent of total billed charges,80% of total billed charges,339.3,65,,271.44,percent of total billed charges,65% of total billed charges,186.2,35.67,,148.96,percent of total billed charges,35.67% of total billed charges,79.46,469.8,
CHEST W/ OBLIQUE - XRAY,3200710,CDM,324,RC,71047,HCPCS,outpatient,,,522,208.80,,443.7,85,,354.96,percent of total billed charges,85% of total billed charges,401.94,77,,321.55,percent of total billed charges,77% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,239.16,385,,,fee schedule,385% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,469.8,90,,375.84,percent of total billed charges,90% of total billed charges,417.6,80,,334.08,percent of total billed charges,80% of total billed charges,469.8,90,,375.84,percent of total billed charges,90% of total billed charges,391.5,75,,313.2,percent of total billed charges,75% of total billed charges,96.95,122,,,fee schedule,122% of HUMANA fee schedule,151.38,29,,121.104,percent of total billed charges,29% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,349.74,67,,279.792,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,417.6,80,,334.08,percent of total billed charges,80% of total billed charges,339.3,65,,271.44,percent of total billed charges,65% of total billed charges,186.2,35.67,,148.96,percent of total billed charges,35.67% of total billed charges,79.46,469.8,
CHEST 2 VIEWS CL,3250650,CDM,324,RC,71046,HCPCS,outpatient,,,308,123.20,,261.8,85,,209.44,percent of total billed charges,85% of total billed charges,237.16,77,,189.73,percent of total billed charges,77% of total billed charges,79.45,100,,,fee schedule,100% of CMS OPPS rate,239.16,385,,,fee schedule,385% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,277.2,90,,221.76,percent of total billed charges,90% of total billed charges,246.4,80,,197.12,percent of total billed charges,80% of total billed charges,277.2,90,,221.76,percent of total billed charges,90% of total billed charges,231,75,,184.8,percent of total billed charges,75% of total billed charges,96.94,122,,,fee schedule,122% of HUMANA fee schedule,89.32,29,,71.456,percent of total billed charges,29% of total billed charges,79.45,100,,,fee schedule,100% of CMS OPPS rate,206.36,67,,165.088,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,246.4,80,,197.12,percent of total billed charges,80% of total billed charges,200.2,65,,160.16,percent of total billed charges,65% of total billed charges,109.86,35.67,,87.888,percent of total billed charges,35.67% of total billed charges,79.45,277.2,
CHEST AP ONLY 1 VIEW XRAY,3250660,CDM,324,RC,71045,HCPCS,outpatient,,,277,110.80,,235.45,85,,188.36,percent of total billed charges,85% of total billed charges,213.29,77,,170.63,percent of total billed charges,77% of total billed charges,79.45,100,,,fee schedule,100% of CMS OPPS rate,239.16,385,,,fee schedule,385% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.3,90,,199.44,percent of total billed charges,90% of total billed charges,221.6,80,,177.28,percent of total billed charges,80% of total billed charges,249.3,90,,199.44,percent of total billed charges,90% of total billed charges,207.75,75,,166.2,percent of total billed charges,75% of total billed charges,96.94,122,,,fee schedule,122% of HUMANA fee schedule,80.33,29,,64.264,percent of total billed charges,29% of total billed charges,79.45,100,,,fee schedule,100% of CMS OPPS rate,185.59,67,,148.472,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,221.6,80,,177.28,percent of total billed charges,80% of total billed charges,180.05,65,,144.04,percent of total billed charges,65% of total billed charges,98.81,35.67,,79.048,percent of total billed charges,35.67% of total billed charges,79.45,249.3,
CHEST DECUBITUS 1 VIEW XRAY,3250680,CDM,324,RC,71045,HCPCS,outpatient,,,272,108.80,,231.2,85,,184.96,percent of total billed charges,85% of total billed charges,209.44,77,,167.55,percent of total billed charges,77% of total billed charges,79.45,100,,,fee schedule,100% of CMS OPPS rate,239.16,385,,,fee schedule,385% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,244.8,90,,195.84,percent of total billed charges,90% of total billed charges,217.6,80,,174.08,percent of total billed charges,80% of total billed charges,244.8,90,,195.84,percent of total billed charges,90% of total billed charges,204,75,,163.2,percent of total billed charges,75% of total billed charges,96.94,122,,,fee schedule,122% of HUMANA fee schedule,78.88,29,,63.104,percent of total billed charges,29% of total billed charges,79.45,100,,,fee schedule,100% of CMS OPPS rate,182.24,67,,145.792,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,217.6,80,,174.08,percent of total billed charges,80% of total billed charges,176.8,65,,141.44,percent of total billed charges,65% of total billed charges,97.02,35.67,,77.616,percent of total billed charges,35.67% of total billed charges,78.88,249.1,
CHEST XRAY EXPIRATION,3250690,CDM,324,RC,71045,HCPCS,outpatient,,,272,108.80,,231.2,85,,184.96,percent of total billed charges,85% of total billed charges,209.44,77,,167.55,percent of total billed charges,77% of total billed charges,79.45,100,,,fee schedule,100% of CMS OPPS rate,239.16,385,,,fee schedule,385% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,244.8,90,,195.84,percent of total billed charges,90% of total billed charges,217.6,80,,174.08,percent of total billed charges,80% of total billed charges,244.8,90,,195.84,percent of total billed charges,90% of total billed charges,204,75,,163.2,percent of total billed charges,75% of total billed charges,96.94,122,,,fee schedule,122% of HUMANA fee schedule,78.88,29,,63.104,percent of total billed charges,29% of total billed charges,79.45,100,,,fee schedule,100% of CMS OPPS rate,182.24,67,,145.792,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,217.6,80,,174.08,percent of total billed charges,80% of total billed charges,176.8,65,,141.44,percent of total billed charges,65% of total billed charges,97.02,35.67,,77.616,percent of total billed charges,35.67% of total billed charges,78.88,249.1,
CHEST WITH LORDOTIC CL,3250700,CDM,324,RC,71047,HCPCS,outpatient,,,498,199.20,,423.3,85,,338.64,percent of total billed charges,85% of total billed charges,383.46,77,,306.77,percent of total billed charges,77% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,239.16,385,,,fee schedule,385% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,448.2,90,,358.56,percent of total billed charges,90% of total billed charges,398.4,80,,318.72,percent of total billed charges,80% of total billed charges,448.2,90,,358.56,percent of total billed charges,90% of total billed charges,373.5,75,,298.8,percent of total billed charges,75% of total billed charges,96.95,122,,,fee schedule,122% of HUMANA fee schedule,144.42,29,,115.536,percent of total billed charges,29% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,333.66,67,,266.928,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,398.4,80,,318.72,percent of total billed charges,80% of total billed charges,323.7,65,,258.96,percent of total billed charges,65% of total billed charges,177.64,35.67,,142.112,percent of total billed charges,35.67% of total billed charges,79.46,448.2,
CHEST W/OBLIQUE XRAY,3250710,CDM,324,RC,71047,HCPCS,outpatient,,,498,199.20,,423.3,85,,338.64,percent of total billed charges,85% of total billed charges,383.46,77,,306.77,percent of total billed charges,77% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,239.16,385,,,fee schedule,385% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,448.2,90,,358.56,percent of total billed charges,90% of total billed charges,398.4,80,,318.72,percent of total billed charges,80% of total billed charges,448.2,90,,358.56,percent of total billed charges,90% of total billed charges,373.5,75,,298.8,percent of total billed charges,75% of total billed charges,96.95,122,,,fee schedule,122% of HUMANA fee schedule,144.42,29,,115.536,percent of total billed charges,29% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,333.66,67,,266.928,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,398.4,80,,318.72,percent of total billed charges,80% of total billed charges,323.7,65,,258.96,percent of total billed charges,65% of total billed charges,177.64,35.67,,142.112,percent of total billed charges,35.67% of total billed charges,79.46,448.2,
BLOOD FLOW,3400030,CDM,340,RC,78445,HCPCS,outpatient,,,1123,449.20,,954.55,85,,763.64,percent of total billed charges,85% of total billed charges,864.71,77,,691.77,percent of total billed charges,77% of total billed charges,360.69,100,,,fee schedule,100% of CMS OPPS rate,659.08,385,,,fee schedule,385% of BCBS fee schedule,686.47,401,,,fee schedule,401% of BCBS fee schedule,686.47,401,,,fee schedule,401% of BCBS fee schedule,686.47,401,,,fee schedule,401% of BCBS fee schedule,1010.7,90,,808.56,percent of total billed charges,90% of total billed charges,898.4,80,,718.72,percent of total billed charges,80% of total billed charges,1010.7,90,,808.56,percent of total billed charges,90% of total billed charges,842.25,75,,673.8,percent of total billed charges,75% of total billed charges,440.04,122,,,fee schedule,122% of HUMANA fee schedule,325.67,29,,260.536,percent of total billed charges,29% of total billed charges,360.69,100,,,fee schedule,100% of CMS OPPS rate,752.41,67,,601.928,percent of total billed charges,67% of total billed charges,144.37,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,898.4,80,,718.72,percent of total billed charges,80% of total billed charges,729.95,65,,583.96,percent of total billed charges,65% of total billed charges,400.57,35.67,,320.456,percent of total billed charges,35.67% of total billed charges,144.37,1010.7,
NM WHOLE BODY BONE SCAN,3400035,CDM,340,RC,78306,HCPCS,outpatient,,,1669,667.60,,1418.65,85,,1134.92,percent of total billed charges,85% of total billed charges,1285.13,77,,1028.1,percent of total billed charges,77% of total billed charges,360.69,100,,,fee schedule,100% of CMS OPPS rate,1062.52,385,,,fee schedule,385% of BCBS fee schedule,1106.68,401,,,fee schedule,401% of BCBS fee schedule,1106.68,401,,,fee schedule,401% of BCBS fee schedule,1106.68,401,,,fee schedule,401% of BCBS fee schedule,1502.1,90,,1201.68,percent of total billed charges,90% of total billed charges,1335.2,80,,1068.16,percent of total billed charges,80% of total billed charges,1502.1,90,,1201.68,percent of total billed charges,90% of total billed charges,1251.75,75,,1001.4,percent of total billed charges,75% of total billed charges,440.04,122,,,fee schedule,122% of HUMANA fee schedule,484.01,29,,387.208,percent of total billed charges,29% of total billed charges,360.69,100,,,fee schedule,100% of CMS OPPS rate,1118.23,67,,894.584,percent of total billed charges,67% of total billed charges,230.19,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,1335.2,80,,1068.16,percent of total billed charges,80% of total billed charges,1084.85,65,,867.88,percent of total billed charges,65% of total billed charges,595.33,35.67,,476.264,percent of total billed charges,35.67% of total billed charges,230.19,1502.1,
NM BONE SCAN MULTIPLE AREAS,3400040,CDM,340,RC,78305,HCPCS,outpatient,,,1157,462.80,,983.45,85,,786.76,percent of total billed charges,85% of total billed charges,890.89,77,,712.71,percent of total billed charges,77% of total billed charges,360.69,100,,,fee schedule,100% of CMS OPPS rate,978.25,385,,,fee schedule,385% of BCBS fee schedule,1018.9,401,,,fee schedule,401% of BCBS fee schedule,1018.9,401,,,fee schedule,401% of BCBS fee schedule,1018.9,401,,,fee schedule,401% of BCBS fee schedule,1041.3,90,,833.04,percent of total billed charges,90% of total billed charges,925.6,80,,740.48,percent of total billed charges,80% of total billed charges,1041.3,90,,833.04,percent of total billed charges,90% of total billed charges,867.75,75,,694.2,percent of total billed charges,75% of total billed charges,440.04,122,,,fee schedule,122% of HUMANA fee schedule,335.53,29,,268.424,percent of total billed charges,29% of total billed charges,360.69,100,,,fee schedule,100% of CMS OPPS rate,775.19,67,,620.152,percent of total billed charges,67% of total billed charges,230.19,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,925.6,80,,740.48,percent of total billed charges,80% of total billed charges,752.05,65,,601.64,percent of total billed charges,65% of total billed charges,412.7,35.67,,330.16,percent of total billed charges,35.67% of total billed charges,230.19,1041.3,
NM BONE SCAN THREE PHASE,3400045,CDM,340,RC,78315,HCPCS,outpatient,,,1581,632.40,,1343.85,85,,1075.08,percent of total billed charges,85% of total billed charges,1217.37,77,,973.9,percent of total billed charges,77% of total billed charges,360.69,100,,,fee schedule,100% of CMS OPPS rate,1206.24,385,,,fee schedule,385% of BCBS fee schedule,1256.37,401,,,fee schedule,401% of BCBS fee schedule,1256.37,401,,,fee schedule,401% of BCBS fee schedule,1256.37,401,,,fee schedule,401% of BCBS fee schedule,1422.9,90,,1138.32,percent of total billed charges,90% of total billed charges,1264.8,80,,1011.84,percent of total billed charges,80% of total billed charges,1422.9,90,,1138.32,percent of total billed charges,90% of total billed charges,1185.75,75,,948.6,percent of total billed charges,75% of total billed charges,440.04,122,,,fee schedule,122% of HUMANA fee schedule,458.49,29,,366.792,percent of total billed charges,29% of total billed charges,360.69,100,,,fee schedule,100% of CMS OPPS rate,1059.27,67,,847.416,percent of total billed charges,67% of total billed charges,230.19,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,1264.8,80,,1011.84,percent of total billed charges,80% of total billed charges,1027.65,65,,822.12,percent of total billed charges,65% of total billed charges,563.94,35.67,,451.152,percent of total billed charges,35.67% of total billed charges,230.19,1422.9,
NM BRAIN FLOW VASCULAR,3400070,CDM,340,RC,78610,HCPCS,outpatient,,,506,202.40,,430.1,85,,344.08,percent of total billed charges,85% of total billed charges,389.62,77,,311.7,percent of total billed charges,77% of total billed charges,472.68,100,,,fee schedule,100% of CMS OPPS rate,649.42,385,,,fee schedule,385% of BCBS fee schedule,676.41,401,,,fee schedule,401% of BCBS fee schedule,676.41,401,,,fee schedule,401% of BCBS fee schedule,676.41,401,,,fee schedule,401% of BCBS fee schedule,455.4,90,,364.32,percent of total billed charges,90% of total billed charges,404.8,80,,323.84,percent of total billed charges,80% of total billed charges,455.4,90,,364.32,percent of total billed charges,90% of total billed charges,379.5,75,,303.6,percent of total billed charges,75% of total billed charges,576.66,122,,,fee schedule,122% of HUMANA fee schedule,146.74,29,,117.392,percent of total billed charges,29% of total billed charges,472.68,100,,,fee schedule,100% of CMS OPPS rate,339.02,67,,271.216,percent of total billed charges,67% of total billed charges,224.33,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,404.8,80,,323.84,percent of total billed charges,80% of total billed charges,328.9,65,,263.12,percent of total billed charges,65% of total billed charges,180.49,35.67,,144.392,percent of total billed charges,35.67% of total billed charges,146.74,676.41,
NM BRAIN SCAN SPECT,3400080,CDM,340,RC,,,outpatient,,,1348,539.20,,1145.8,85,,916.64,percent of total billed charges,85% of total billed charges,1037.96,77,,830.37,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,1105.36,82,,884.288,percent of total billed charges,82% of total billed charges,1145.8,85,,916.64,percent of total billed charges,85% of total billed charges,1145.8,85,,916.64,percent of total billed charges,85% of total billed charges,1145.8,85,,916.64,percent of total billed charges,85% of total billed charges,1213.2,90,,970.56,percent of total billed charges,90% of total billed charges,1078.4,80,,862.72,percent of total billed charges,80% of total billed charges,1213.2,90,,970.56,percent of total billed charges,90% of total billed charges,1011,75,,808.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,390.92,29,,312.736,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,903.16,67,,722.528,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1078.4,80,,862.72,percent of total billed charges,80% of total billed charges,876.2,65,,700.96,percent of total billed charges,65% of total billed charges,480.83,35.67,,384.664,percent of total billed charges,35.67% of total billed charges,390.92,1213.2,
CARDIOLITE STRESS TEST,3400111,CDM,340,RC,78452,HCPCS,outpatient,,,3994,1597.60,,3394.9,85,,2715.92,percent of total billed charges,85% of total billed charges,3075.38,77,,2460.3,percent of total billed charges,77% of total billed charges,1241.8,100,,,fee schedule,100% of CMS OPPS rate,2065.41,429,,,fee schedule,429% of BCBS fee schedule,2153.22,515,,,fee schedule,515% of BCBS fee schedule,2153.22,364,,,fee schedule,364% of BCBS fee schedule,2153.22,515,,,fee schedule,515% of BCBS fee schedule,3594.6,90,,2875.68,percent of total billed charges,90% of total billed charges,3195.2,80,,2556.16,percent of total billed charges,80% of total billed charges,3594.6,90,,2875.68,percent of total billed charges,90% of total billed charges,2995.5,75,,2396.4,percent of total billed charges,75% of total billed charges,1514.99,122,,,fee schedule,122% of HUMANA fee schedule,1158.26,29,,926.608,percent of total billed charges,29% of total billed charges,1241.8,100,,,fee schedule,100% of CMS OPPS rate,2675.98,67,,2140.784,percent of total billed charges,67% of total billed charges,626.87,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,3195.2,80,,2556.16,percent of total billed charges,80% of total billed charges,2596.1,65,,2076.88,percent of total billed charges,65% of total billed charges,1424.66,35.67,,1139.728,percent of total billed charges,35.67% of total billed charges,626.87,3594.6,
NM HEPATOBILIARY - GB/HIDA,3400140,CDM,340,RC,78227,HCPCS,outpatient,,,1980,792.00,,1683,85,,1346.4,percent of total billed charges,85% of total billed charges,1524.6,77,,1219.68,percent of total billed charges,77% of total billed charges,472.68,100,,,fee schedule,100% of CMS OPPS rate,1642.87,385,,,fee schedule,385% of BCBS fee schedule,1711.15,401,,,fee schedule,401% of BCBS fee schedule,1711.15,401,,,fee schedule,401% of BCBS fee schedule,1711.15,401,,,fee schedule,401% of BCBS fee schedule,1782,90,,1425.6,percent of total billed charges,90% of total billed charges,1584,80,,1267.2,percent of total billed charges,80% of total billed charges,1782,90,,1425.6,percent of total billed charges,90% of total billed charges,1485,75,,1188,percent of total billed charges,75% of total billed charges,576.66,122,,,fee schedule,122% of HUMANA fee schedule,574.2,29,,459.36,percent of total billed charges,29% of total billed charges,472.68,100,,,fee schedule,100% of CMS OPPS rate,1326.6,67,,1061.28,percent of total billed charges,67% of total billed charges,273.45,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,1584,80,,1267.2,percent of total billed charges,80% of total billed charges,1287,65,,1029.6,percent of total billed charges,65% of total billed charges,706.27,35.67,,565.016,percent of total billed charges,35.67% of total billed charges,273.45,1782,
NM HEPATOBILIARY W/O INTER,3400141,CDM,340,RC,78226,HCPCS,outpatient,,,1159,463.60,,985.15,85,,788.12,percent of total billed charges,85% of total billed charges,892.43,77,,713.94,percent of total billed charges,77% of total billed charges,360.69,100,,,fee schedule,100% of CMS OPPS rate,1197.97,385,,,fee schedule,385% of BCBS fee schedule,1247.75,401,,,fee schedule,401% of BCBS fee schedule,1247.75,401,,,fee schedule,401% of BCBS fee schedule,1247.75,401,,,fee schedule,401% of BCBS fee schedule,1043.1,90,,834.48,percent of total billed charges,90% of total billed charges,927.2,80,,741.76,percent of total billed charges,80% of total billed charges,1043.1,90,,834.48,percent of total billed charges,90% of total billed charges,869.25,75,,695.4,percent of total billed charges,75% of total billed charges,440.04,122,,,fee schedule,122% of HUMANA fee schedule,336.11,29,,268.888,percent of total billed charges,29% of total billed charges,360.69,100,,,fee schedule,100% of CMS OPPS rate,776.53,67,,621.224,percent of total billed charges,67% of total billed charges,273.45,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,927.2,80,,741.76,percent of total billed charges,80% of total billed charges,753.35,65,,602.68,percent of total billed charges,65% of total billed charges,413.42,35.67,,330.736,percent of total billed charges,35.67% of total billed charges,273.45,1247.75,
NM GASTRIC EMPTYING,3400150,CDM,340,RC,78264,HCPCS,outpatient,,,1432,572.80,,1217.2,85,,973.76,percent of total billed charges,85% of total billed charges,1102.64,77,,882.11,percent of total billed charges,77% of total billed charges,360.69,100,,,fee schedule,100% of CMS OPPS rate,1209.02,385,,,fee schedule,385% of BCBS fee schedule,1259.26,401,,,fee schedule,401% of BCBS fee schedule,1259.26,401,,,fee schedule,401% of BCBS fee schedule,1259.26,401,,,fee schedule,401% of BCBS fee schedule,1288.8,90,,1031.04,percent of total billed charges,90% of total billed charges,1145.6,80,,916.48,percent of total billed charges,80% of total billed charges,1288.8,90,,1031.04,percent of total billed charges,90% of total billed charges,1074,75,,859.2,percent of total billed charges,75% of total billed charges,440.04,122,,,fee schedule,122% of HUMANA fee schedule,415.28,29,,332.224,percent of total billed charges,29% of total billed charges,360.69,100,,,fee schedule,100% of CMS OPPS rate,959.44,67,,767.552,percent of total billed charges,67% of total billed charges,227.14,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,1145.6,80,,916.48,percent of total billed charges,80% of total billed charges,930.8,65,,744.64,percent of total billed charges,65% of total billed charges,510.79,35.67,,408.632,percent of total billed charges,35.67% of total billed charges,227.14,1288.8,
NM GASTRIC EMPTYING W/SM BOWEL,3400155,CDM,340,RC,78265,HCPCS,outpatient,,,1588,635.20,,1349.8,85,,1079.84,percent of total billed charges,85% of total billed charges,1222.76,77,,978.21,percent of total billed charges,77% of total billed charges,360.69,100,,,fee schedule,100% of CMS OPPS rate,1341.65,385,,,fee schedule,385% of BCBS fee schedule,1397.4,401,,,fee schedule,401% of BCBS fee schedule,1397.4,401,,,fee schedule,401% of BCBS fee schedule,1397.4,401,,,fee schedule,401% of BCBS fee schedule,1429.2,90,,1143.36,percent of total billed charges,90% of total billed charges,1270.4,80,,1016.32,percent of total billed charges,80% of total billed charges,1429.2,90,,1143.36,percent of total billed charges,90% of total billed charges,1191,75,,952.8,percent of total billed charges,75% of total billed charges,440.04,122,,,fee schedule,122% of HUMANA fee schedule,460.52,29,,368.416,percent of total billed charges,29% of total billed charges,360.69,100,,,fee schedule,100% of CMS OPPS rate,1063.96,67,,851.168,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1270.4,80,,1016.32,percent of total billed charges,80% of total billed charges,1032.2,65,,825.76,percent of total billed charges,65% of total billed charges,566.44,35.67,,453.152,percent of total billed charges,35.67% of total billed charges,360.69,1429.2,
NM GATED HEART WITH 1 PASS,3400170,CDM,340,RC,78468,HCPCS,outpatient,,,1004,401.60,,853.4,85,,682.72,percent of total billed charges,85% of total billed charges,773.08,77,,618.46,percent of total billed charges,77% of total billed charges,472.68,100,,,fee schedule,100% of CMS OPPS rate,804.87,429,,,fee schedule,429% of BCBS fee schedule,839.09,515,,,fee schedule,515% of BCBS fee schedule,839.09,364,,,fee schedule,364% of BCBS fee schedule,839.09,515,,,fee schedule,515% of BCBS fee schedule,903.6,90,,722.88,percent of total billed charges,90% of total billed charges,803.2,80,,642.56,percent of total billed charges,80% of total billed charges,903.6,90,,722.88,percent of total billed charges,90% of total billed charges,753,75,,602.4,percent of total billed charges,75% of total billed charges,576.66,122,,,fee schedule,122% of HUMANA fee schedule,291.16,29,,232.928,percent of total billed charges,29% of total billed charges,472.68,100,,,fee schedule,100% of CMS OPPS rate,672.68,67,,538.144,percent of total billed charges,67% of total billed charges,277.39,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,803.2,80,,642.56,percent of total billed charges,80% of total billed charges,652.6,65,,522.08,percent of total billed charges,65% of total billed charges,358.13,35.67,,286.504,percent of total billed charges,35.67% of total billed charges,277.39,903.6,
NM GI BLEED (TAGGED RBC),3400180,CDM,340,RC,78278,HCPCS,outpatient,,,1457,582.80,,1238.45,85,,990.76,percent of total billed charges,85% of total billed charges,1121.89,77,,897.51,percent of total billed charges,77% of total billed charges,360.69,100,,,fee schedule,100% of CMS OPPS rate,1221.45,385,,,fee schedule,385% of BCBS fee schedule,1272.21,401,,,fee schedule,401% of BCBS fee schedule,1272.21,401,,,fee schedule,401% of BCBS fee schedule,1272.21,401,,,fee schedule,401% of BCBS fee schedule,1311.3,90,,1049.04,percent of total billed charges,90% of total billed charges,1165.6,80,,932.48,percent of total billed charges,80% of total billed charges,1311.3,90,,1049.04,percent of total billed charges,90% of total billed charges,1092.75,75,,874.2,percent of total billed charges,75% of total billed charges,440.04,122,,,fee schedule,122% of HUMANA fee schedule,422.53,29,,338.024,percent of total billed charges,29% of total billed charges,360.69,100,,,fee schedule,100% of CMS OPPS rate,976.19,67,,780.952,percent of total billed charges,67% of total billed charges,227.14,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,1165.6,80,,932.48,percent of total billed charges,80% of total billed charges,947.05,65,,757.64,percent of total billed charges,65% of total billed charges,519.71,35.67,,415.768,percent of total billed charges,35.67% of total billed charges,227.14,1311.3,
NM LIVER SCAN,3400240,CDM,340,RC,78201,HCPCS,outpatient,,,900,360.00,,765,85,,612,percent of total billed charges,85% of total billed charges,693,77,,554.4,percent of total billed charges,77% of total billed charges,472.68,100,,,fee schedule,100% of CMS OPPS rate,683.95,385,,,fee schedule,385% of BCBS fee schedule,712.38,401,,,fee schedule,401% of BCBS fee schedule,712.38,401,,,fee schedule,401% of BCBS fee schedule,712.38,401,,,fee schedule,401% of BCBS fee schedule,810,90,,648,percent of total billed charges,90% of total billed charges,720,80,,576,percent of total billed charges,80% of total billed charges,810,90,,648,percent of total billed charges,90% of total billed charges,675,75,,540,percent of total billed charges,75% of total billed charges,576.66,122,,,fee schedule,122% of HUMANA fee schedule,261,29,,208.8,percent of total billed charges,29% of total billed charges,472.68,100,,,fee schedule,100% of CMS OPPS rate,603,67,,482.4,percent of total billed charges,67% of total billed charges,273.45,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,720,80,,576,percent of total billed charges,80% of total billed charges,585,65,,468,percent of total billed charges,65% of total billed charges,321.03,35.67,,256.824,percent of total billed charges,35.67% of total billed charges,261,810,
NM LIVER/SPLEEN VAS FLOW,3400245,CDM,340,RC,78202,HCPCS,outpatient,,,1591,636.40,,1352.35,85,,1081.88,percent of total billed charges,85% of total billed charges,1225.07,77,,980.06,percent of total billed charges,77% of total billed charges,472.68,100,,,fee schedule,100% of CMS OPPS rate,715.72,385,,,fee schedule,385% of BCBS fee schedule,745.46,401,,,fee schedule,401% of BCBS fee schedule,745.46,401,,,fee schedule,401% of BCBS fee schedule,745.46,401,,,fee schedule,401% of BCBS fee schedule,1431.9,90,,1145.52,percent of total billed charges,90% of total billed charges,1272.8,80,,1018.24,percent of total billed charges,80% of total billed charges,1431.9,90,,1145.52,percent of total billed charges,90% of total billed charges,1193.25,75,,954.6,percent of total billed charges,75% of total billed charges,576.66,122,,,fee schedule,122% of HUMANA fee schedule,461.39,29,,369.112,percent of total billed charges,29% of total billed charges,472.68,100,,,fee schedule,100% of CMS OPPS rate,1065.97,67,,852.776,percent of total billed charges,67% of total billed charges,273.45,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,1272.8,80,,1018.24,percent of total billed charges,80% of total billed charges,1034.15,65,,827.32,percent of total billed charges,65% of total billed charges,567.51,35.67,,454.008,percent of total billed charges,35.67% of total billed charges,273.45,1431.9,
NM LIVER SCAN WITH SPECT,3400250,CDM,340,RC,78803,HCPCS,outpatient,,,2313,925.20,,1966.05,85,,1572.84,percent of total billed charges,85% of total billed charges,1781.01,77,,1424.81,percent of total billed charges,77% of total billed charges,1241.8,100,,,fee schedule,100% of CMS OPPS rate,1184.14,385,,,fee schedule,385% of BCBS fee schedule,1233.36,401,,,fee schedule,401% of BCBS fee schedule,1233.36,401,,,fee schedule,401% of BCBS fee schedule,1233.36,401,,,fee schedule,401% of BCBS fee schedule,2081.7,90,,1665.36,percent of total billed charges,90% of total billed charges,1850.4,80,,1480.32,percent of total billed charges,80% of total billed charges,2081.7,90,,1665.36,percent of total billed charges,90% of total billed charges,1734.75,75,,1387.8,percent of total billed charges,75% of total billed charges,1514.99,122,,,fee schedule,122% of HUMANA fee schedule,670.77,29,,536.616,percent of total billed charges,29% of total billed charges,1241.8,100,,,fee schedule,100% of CMS OPPS rate,1549.71,67,,1239.768,percent of total billed charges,67% of total billed charges,459.22,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,1850.4,80,,1480.32,percent of total billed charges,80% of total billed charges,1503.45,65,,1202.76,percent of total billed charges,65% of total billed charges,825.05,35.67,,660.04,percent of total billed charges,35.67% of total billed charges,459.22,2081.7,
NM LUNG SCAN - PERFUSION ONLY,3400260,CDM,340,RC,78580,HCPCS,outpatient,,,1164,465.60,,989.4,85,,791.52,percent of total billed charges,85% of total billed charges,896.28,77,,717.02,percent of total billed charges,77% of total billed charges,360.69,100,,,fee schedule,100% of CMS OPPS rate,823.52,385,,,fee schedule,385% of BCBS fee schedule,857.74,401,,,fee schedule,401% of BCBS fee schedule,857.74,401,,,fee schedule,401% of BCBS fee schedule,857.74,401,,,fee schedule,401% of BCBS fee schedule,1047.6,90,,838.08,percent of total billed charges,90% of total billed charges,931.2,80,,744.96,percent of total billed charges,80% of total billed charges,1047.6,90,,838.08,percent of total billed charges,90% of total billed charges,873,75,,698.4,percent of total billed charges,75% of total billed charges,440.04,122,,,fee schedule,122% of HUMANA fee schedule,337.56,29,,270.048,percent of total billed charges,29% of total billed charges,360.69,100,,,fee schedule,100% of CMS OPPS rate,779.88,67,,623.904,percent of total billed charges,67% of total billed charges,188.69,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,931.2,80,,744.96,percent of total billed charges,80% of total billed charges,756.6,65,,605.28,percent of total billed charges,65% of total billed charges,415.2,35.67,,332.16,percent of total billed charges,35.67% of total billed charges,188.69,1047.6,
NM LUNG SCAN VENTILATION GAS,3400270,CDM,340,RC,78579,HCPCS,outpatient,,,1144,457.60,,972.4,85,,777.92,percent of total billed charges,85% of total billed charges,880.88,77,,704.7,percent of total billed charges,77% of total billed charges,360.69,100,,,fee schedule,100% of CMS OPPS rate,663.24,385,,,fee schedule,385% of BCBS fee schedule,690.8,401,,,fee schedule,401% of BCBS fee schedule,690.8,401,,,fee schedule,401% of BCBS fee schedule,690.8,401,,,fee schedule,401% of BCBS fee schedule,1029.6,90,,823.68,percent of total billed charges,90% of total billed charges,915.2,80,,732.16,percent of total billed charges,80% of total billed charges,1029.6,90,,823.68,percent of total billed charges,90% of total billed charges,858,75,,686.4,percent of total billed charges,75% of total billed charges,440.04,122,,,fee schedule,122% of HUMANA fee schedule,331.76,29,,265.408,percent of total billed charges,29% of total billed charges,360.69,100,,,fee schedule,100% of CMS OPPS rate,766.48,67,,613.184,percent of total billed charges,67% of total billed charges,188.69,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,915.2,80,,732.16,percent of total billed charges,80% of total billed charges,743.6,65,,594.88,percent of total billed charges,65% of total billed charges,408.06,35.67,,326.448,percent of total billed charges,35.67% of total billed charges,188.69,1029.6,
NM LUNG VQ SCAN,3400271,CDM,340,RC,78598,HCPCS,outpatient,,,1563,625.20,,1328.55,85,,1062.84,percent of total billed charges,85% of total billed charges,1203.51,77,,962.81,percent of total billed charges,77% of total billed charges,472.68,100,,,fee schedule,100% of CMS OPPS rate,1073.61,385,,,fee schedule,385% of BCBS fee schedule,1118.23,401,,,fee schedule,401% of BCBS fee schedule,1118.23,401,,,fee schedule,401% of BCBS fee schedule,1118.23,401,,,fee schedule,401% of BCBS fee schedule,1406.7,90,,1125.36,percent of total billed charges,90% of total billed charges,1250.4,80,,1000.32,percent of total billed charges,80% of total billed charges,1406.7,90,,1125.36,percent of total billed charges,90% of total billed charges,1172.25,75,,937.8,percent of total billed charges,75% of total billed charges,576.66,122,,,fee schedule,122% of HUMANA fee schedule,453.27,29,,362.616,percent of total billed charges,29% of total billed charges,472.68,100,,,fee schedule,100% of CMS OPPS rate,1047.21,67,,837.768,percent of total billed charges,67% of total billed charges,294.88,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,1250.4,80,,1000.32,percent of total billed charges,80% of total billed charges,1015.95,65,,812.76,percent of total billed charges,65% of total billed charges,557.52,35.67,,446.016,percent of total billed charges,35.67% of total billed charges,294.88,1406.7,
NM LOCAL BREAST TUMOR LIMITED,3400272,CDM,340,RC,78800,HCPCS,outpatient,,,981,392.40,,833.85,85,,667.08,percent of total billed charges,85% of total billed charges,755.37,77,,604.3,percent of total billed charges,77% of total billed charges,360.69,100,,,fee schedule,100% of CMS OPPS rate,648.03,385,,,fee schedule,385% of BCBS fee schedule,674.96,401,,,fee schedule,401% of BCBS fee schedule,674.96,401,,,fee schedule,401% of BCBS fee schedule,674.96,401,,,fee schedule,401% of BCBS fee schedule,882.9,90,,706.32,percent of total billed charges,90% of total billed charges,784.8,80,,627.84,percent of total billed charges,80% of total billed charges,882.9,90,,706.32,percent of total billed charges,90% of total billed charges,735.75,75,,588.6,percent of total billed charges,75% of total billed charges,440.04,122,,,fee schedule,122% of HUMANA fee schedule,284.49,29,,227.592,percent of total billed charges,29% of total billed charges,360.69,100,,,fee schedule,100% of CMS OPPS rate,657.27,67,,525.816,percent of total billed charges,67% of total billed charges,261.13,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,784.8,80,,627.84,percent of total billed charges,80% of total billed charges,637.65,65,,510.12,percent of total billed charges,65% of total billed charges,349.92,35.67,,279.936,percent of total billed charges,35.67% of total billed charges,261.13,882.9,
NM LOCAL BREAST TUMOR-MULTIPLE,3400273,CDM,340,RC,78801,HCPCS,outpatient,,,1377,550.80,,1170.45,85,,936.36,percent of total billed charges,85% of total billed charges,1060.29,77,,848.23,percent of total billed charges,77% of total billed charges,360.69,100,,,fee schedule,100% of CMS OPPS rate,896.74,385,,,fee schedule,385% of BCBS fee schedule,934.01,401,,,fee schedule,401% of BCBS fee schedule,934.01,401,,,fee schedule,401% of BCBS fee schedule,934.01,401,,,fee schedule,401% of BCBS fee schedule,1239.3,90,,991.44,percent of total billed charges,90% of total billed charges,1101.6,80,,881.28,percent of total billed charges,80% of total billed charges,1239.3,90,,991.44,percent of total billed charges,90% of total billed charges,1032.75,75,,826.2,percent of total billed charges,75% of total billed charges,440.04,122,,,fee schedule,122% of HUMANA fee schedule,399.33,29,,319.464,percent of total billed charges,29% of total billed charges,360.69,100,,,fee schedule,100% of CMS OPPS rate,922.59,67,,738.072,percent of total billed charges,67% of total billed charges,459.22,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,1101.6,80,,881.28,percent of total billed charges,80% of total billed charges,895.05,65,,716.04,percent of total billed charges,65% of total billed charges,491.18,35.67,,392.944,percent of total billed charges,35.67% of total billed charges,360.69,1239.3,
NM MECKEL'S DIVERTICULUM,3400290,CDM,340,RC,78290,HCPCS,outpatient,,,1433,573.20,,1218.05,85,,974.44,percent of total billed charges,85% of total billed charges,1103.41,77,,882.73,percent of total billed charges,77% of total billed charges,360.69,100,,,fee schedule,100% of CMS OPPS rate,1210.4,385,,,fee schedule,385% of BCBS fee schedule,1260.7,401,,,fee schedule,401% of BCBS fee schedule,1260.7,401,,,fee schedule,401% of BCBS fee schedule,1260.7,401,,,fee schedule,401% of BCBS fee schedule,1289.7,90,,1031.76,percent of total billed charges,90% of total billed charges,1146.4,80,,917.12,percent of total billed charges,80% of total billed charges,1289.7,90,,1031.76,percent of total billed charges,90% of total billed charges,1074.75,75,,859.8,percent of total billed charges,75% of total billed charges,440.04,122,,,fee schedule,122% of HUMANA fee schedule,415.57,29,,332.456,percent of total billed charges,29% of total billed charges,360.69,100,,,fee schedule,100% of CMS OPPS rate,960.11,67,,768.088,percent of total billed charges,67% of total billed charges,227.14,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,1146.4,80,,917.12,percent of total billed charges,80% of total billed charges,931.45,65,,745.16,percent of total billed charges,65% of total billed charges,511.15,35.67,,408.92,percent of total billed charges,35.67% of total billed charges,227.14,1289.7,
NM MYOCARDIAL PERFUSION W/SPEC,3400312,CDM,340,RC,78452,HCPCS,outpatient,,,4071,1628.40,,3460.35,85,,2768.28,percent of total billed charges,85% of total billed charges,3134.67,77,,2507.74,percent of total billed charges,77% of total billed charges,1241.8,100,,,fee schedule,100% of CMS OPPS rate,2065.41,429,,,fee schedule,429% of BCBS fee schedule,2153.22,515,,,fee schedule,515% of BCBS fee schedule,2153.22,364,,,fee schedule,364% of BCBS fee schedule,2153.22,515,,,fee schedule,515% of BCBS fee schedule,3663.9,90,,2931.12,percent of total billed charges,90% of total billed charges,3256.8,80,,2605.44,percent of total billed charges,80% of total billed charges,3663.9,90,,2931.12,percent of total billed charges,90% of total billed charges,3053.25,75,,2442.6,percent of total billed charges,75% of total billed charges,1514.99,122,,,fee schedule,122% of HUMANA fee schedule,1180.59,29,,944.472,percent of total billed charges,29% of total billed charges,1241.8,100,,,fee schedule,100% of CMS OPPS rate,2727.57,67,,2182.056,percent of total billed charges,67% of total billed charges,626.87,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,3256.8,80,,2605.44,percent of total billed charges,80% of total billed charges,2646.15,65,,2116.92,percent of total billed charges,65% of total billed charges,1452.13,35.67,,1161.704,percent of total billed charges,35.67% of total billed charges,626.87,3663.9,
MYOCARDIAL-S-PLANAR TC,3400336,CDM,340,RC,78466,HCPCS,outpatient,,,1032,412.80,,877.2,85,,701.76,percent of total billed charges,85% of total billed charges,794.64,77,,635.71,percent of total billed charges,77% of total billed charges,360.69,100,,,fee schedule,100% of CMS OPPS rate,847.46,429,,,fee schedule,429% of BCBS fee schedule,883.48,515,,,fee schedule,515% of BCBS fee schedule,883.48,364,,,fee schedule,364% of BCBS fee schedule,883.48,515,,,fee schedule,515% of BCBS fee schedule,928.8,90,,743.04,percent of total billed charges,90% of total billed charges,825.6,80,,660.48,percent of total billed charges,80% of total billed charges,928.8,90,,743.04,percent of total billed charges,90% of total billed charges,774,75,,619.2,percent of total billed charges,75% of total billed charges,440.04,122,,,fee schedule,122% of HUMANA fee schedule,299.28,29,,239.424,percent of total billed charges,29% of total billed charges,360.69,100,,,fee schedule,100% of CMS OPPS rate,691.44,67,,553.152,percent of total billed charges,67% of total billed charges,277.39,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,825.6,80,,660.48,percent of total billed charges,80% of total billed charges,670.8,65,,536.64,percent of total billed charges,65% of total billed charges,368.11,35.67,,294.488,percent of total billed charges,35.67% of total billed charges,277.39,928.8,
THALLIUM S+R SPECT,3400360,CDM,340,RC,78452,HCPCS,outpatient,,,3994,1597.60,,3394.9,85,,2715.92,percent of total billed charges,85% of total billed charges,3075.38,77,,2460.3,percent of total billed charges,77% of total billed charges,1241.8,100,,,fee schedule,100% of CMS OPPS rate,2065.41,429,,,fee schedule,429% of BCBS fee schedule,2153.22,515,,,fee schedule,515% of BCBS fee schedule,2153.22,364,,,fee schedule,364% of BCBS fee schedule,2153.22,515,,,fee schedule,515% of BCBS fee schedule,3594.6,90,,2875.68,percent of total billed charges,90% of total billed charges,3195.2,80,,2556.16,percent of total billed charges,80% of total billed charges,3594.6,90,,2875.68,percent of total billed charges,90% of total billed charges,2995.5,75,,2396.4,percent of total billed charges,75% of total billed charges,1514.99,122,,,fee schedule,122% of HUMANA fee schedule,1158.26,29,,926.608,percent of total billed charges,29% of total billed charges,1241.8,100,,,fee schedule,100% of CMS OPPS rate,2675.98,67,,2140.784,percent of total billed charges,67% of total billed charges,626.87,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,3195.2,80,,2556.16,percent of total billed charges,80% of total billed charges,2596.1,65,,2076.88,percent of total billed charges,65% of total billed charges,1424.66,35.67,,1139.728,percent of total billed charges,35.67% of total billed charges,626.87,3594.6,
NM PARATHYROID,3400420,CDM,340,RC,78070,HCPCS,outpatient,,,1392,556.80,,1183.2,85,,946.56,percent of total billed charges,85% of total billed charges,1071.84,77,,857.47,percent of total billed charges,77% of total billed charges,360.69,100,,,fee schedule,100% of CMS OPPS rate,1062.52,385,,,fee schedule,385% of BCBS fee schedule,1106.68,401,,,fee schedule,401% of BCBS fee schedule,1106.68,401,,,fee schedule,401% of BCBS fee schedule,1106.68,401,,,fee schedule,401% of BCBS fee schedule,1252.8,90,,1002.24,percent of total billed charges,90% of total billed charges,1113.6,80,,890.88,percent of total billed charges,80% of total billed charges,1252.8,90,,1002.24,percent of total billed charges,90% of total billed charges,1044,75,,835.2,percent of total billed charges,75% of total billed charges,440.04,122,,,fee schedule,122% of HUMANA fee schedule,403.68,29,,322.944,percent of total billed charges,29% of total billed charges,360.69,100,,,fee schedule,100% of CMS OPPS rate,932.64,67,,746.112,percent of total billed charges,67% of total billed charges,206.11,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,1113.6,80,,890.88,percent of total billed charges,80% of total billed charges,904.8,65,,723.84,percent of total billed charges,65% of total billed charges,496.53,35.67,,397.224,percent of total billed charges,35.67% of total billed charges,206.11,1252.8,
NM RENAL SCAN,3400455,CDM,340,RC,78700,HCPCS,outpatient,,,900,360.00,,765,85,,612,percent of total billed charges,85% of total billed charges,693,77,,554.4,percent of total billed charges,77% of total billed charges,360.69,100,,,fee schedule,100% of CMS OPPS rate,610.73,385,,,fee schedule,385% of BCBS fee schedule,636.11,401,,,fee schedule,401% of BCBS fee schedule,636.11,401,,,fee schedule,401% of BCBS fee schedule,636.11,401,,,fee schedule,401% of BCBS fee schedule,810,90,,648,percent of total billed charges,90% of total billed charges,720,80,,576,percent of total billed charges,80% of total billed charges,810,90,,648,percent of total billed charges,90% of total billed charges,675,75,,540,percent of total billed charges,75% of total billed charges,440.04,122,,,fee schedule,122% of HUMANA fee schedule,261,29,,208.8,percent of total billed charges,29% of total billed charges,360.69,100,,,fee schedule,100% of CMS OPPS rate,603,67,,482.4,percent of total billed charges,67% of total billed charges,297.04,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,720,80,,576,percent of total billed charges,80% of total billed charges,585,65,,468,percent of total billed charges,65% of total billed charges,321.03,35.67,,256.824,percent of total billed charges,35.67% of total billed charges,261,810,
NM RENAL FUNCTION,3400460,CDM,340,RC,78707,HCPCS,outpatient,,,1617,646.80,,1374.45,85,,1099.56,percent of total billed charges,85% of total billed charges,1245.09,77,,996.07,percent of total billed charges,77% of total billed charges,472.68,100,,,fee schedule,100% of CMS OPPS rate,758.57,385,,,fee schedule,385% of BCBS fee schedule,790.09,401,,,fee schedule,401% of BCBS fee schedule,790.09,401,,,fee schedule,401% of BCBS fee schedule,790.09,401,,,fee schedule,401% of BCBS fee schedule,1455.3,90,,1164.24,percent of total billed charges,90% of total billed charges,1293.6,80,,1034.88,percent of total billed charges,80% of total billed charges,1455.3,90,,1164.24,percent of total billed charges,90% of total billed charges,1212.75,75,,970.2,percent of total billed charges,75% of total billed charges,576.66,122,,,fee schedule,122% of HUMANA fee schedule,468.93,29,,375.144,percent of total billed charges,29% of total billed charges,472.68,100,,,fee schedule,100% of CMS OPPS rate,1083.39,67,,866.712,percent of total billed charges,67% of total billed charges,297.04,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,1293.6,80,,1034.88,percent of total billed charges,80% of total billed charges,1051.05,65,,840.84,percent of total billed charges,65% of total billed charges,576.78,35.67,,461.424,percent of total billed charges,35.67% of total billed charges,297.04,1455.3,
NM RENAL FLOW AND FUNCTION,3400465,CDM,340,RC,78707,HCPCS,outpatient,,,1617,646.80,,1374.45,85,,1099.56,percent of total billed charges,85% of total billed charges,1245.09,77,,996.07,percent of total billed charges,77% of total billed charges,472.68,100,,,fee schedule,100% of CMS OPPS rate,758.57,385,,,fee schedule,385% of BCBS fee schedule,790.09,401,,,fee schedule,401% of BCBS fee schedule,790.09,401,,,fee schedule,401% of BCBS fee schedule,790.09,401,,,fee schedule,401% of BCBS fee schedule,1455.3,90,,1164.24,percent of total billed charges,90% of total billed charges,1293.6,80,,1034.88,percent of total billed charges,80% of total billed charges,1455.3,90,,1164.24,percent of total billed charges,90% of total billed charges,1212.75,75,,970.2,percent of total billed charges,75% of total billed charges,576.66,122,,,fee schedule,122% of HUMANA fee schedule,468.93,29,,375.144,percent of total billed charges,29% of total billed charges,472.68,100,,,fee schedule,100% of CMS OPPS rate,1083.39,67,,866.712,percent of total billed charges,67% of total billed charges,297.04,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,1293.6,80,,1034.88,percent of total billed charges,80% of total billed charges,1051.05,65,,840.84,percent of total billed charges,65% of total billed charges,576.78,35.67,,461.424,percent of total billed charges,35.67% of total billed charges,297.04,1455.3,
NM RENAL SPEC SCAN,3400467,CDM,340,RC,78803,HCPCS,outpatient,,,2313,925.20,,1966.05,85,,1572.84,percent of total billed charges,85% of total billed charges,1781.01,77,,1424.81,percent of total billed charges,77% of total billed charges,1241.8,100,,,fee schedule,100% of CMS OPPS rate,1184.14,385,,,fee schedule,385% of BCBS fee schedule,1233.36,401,,,fee schedule,401% of BCBS fee schedule,1233.36,401,,,fee schedule,401% of BCBS fee schedule,1233.36,401,,,fee schedule,401% of BCBS fee schedule,2081.7,90,,1665.36,percent of total billed charges,90% of total billed charges,1850.4,80,,1480.32,percent of total billed charges,80% of total billed charges,2081.7,90,,1665.36,percent of total billed charges,90% of total billed charges,1734.75,75,,1387.8,percent of total billed charges,75% of total billed charges,1514.99,122,,,fee schedule,122% of HUMANA fee schedule,670.77,29,,536.616,percent of total billed charges,29% of total billed charges,1241.8,100,,,fee schedule,100% of CMS OPPS rate,1549.71,67,,1239.768,percent of total billed charges,67% of total billed charges,459.22,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,1850.4,80,,1480.32,percent of total billed charges,80% of total billed charges,1503.45,65,,1202.76,percent of total billed charges,65% of total billed charges,825.05,35.67,,660.04,percent of total billed charges,35.67% of total billed charges,459.22,2081.7,
NM RENAL SCAN WITH PHAR INTERV,3400470,CDM,340,RC,78708,HCPCS,outpatient,,,1172,468.80,,996.2,85,,796.96,percent of total billed charges,85% of total billed charges,902.44,77,,721.95,percent of total billed charges,77% of total billed charges,472.68,100,,,fee schedule,100% of CMS OPPS rate,476.71,385,,,fee schedule,385% of BCBS fee schedule,496.52,401,,,fee schedule,401% of BCBS fee schedule,496.52,401,,,fee schedule,401% of BCBS fee schedule,496.52,401,,,fee schedule,401% of BCBS fee schedule,1054.8,90,,843.84,percent of total billed charges,90% of total billed charges,937.6,80,,750.08,percent of total billed charges,80% of total billed charges,1054.8,90,,843.84,percent of total billed charges,90% of total billed charges,879,75,,703.2,percent of total billed charges,75% of total billed charges,576.66,122,,,fee schedule,122% of HUMANA fee schedule,339.88,29,,271.904,percent of total billed charges,29% of total billed charges,472.68,100,,,fee schedule,100% of CMS OPPS rate,785.24,67,,628.192,percent of total billed charges,67% of total billed charges,297.04,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,937.6,80,,750.08,percent of total billed charges,80% of total billed charges,761.8,65,,609.44,percent of total billed charges,65% of total billed charges,418.05,35.67,,334.44,percent of total billed charges,35.67% of total billed charges,297.04,1054.8,
SPLEEN SCAN,3400490,CDM,340,RC,78185,HCPCS,outpatient,,,900,360.00,,765,85,,612,percent of total billed charges,85% of total billed charges,693,77,,554.4,percent of total billed charges,77% of total billed charges,360.69,100,,,fee schedule,100% of CMS OPPS rate,627.28,385,,,fee schedule,385% of BCBS fee schedule,653.35,401,,,fee schedule,401% of BCBS fee schedule,653.35,401,,,fee schedule,401% of BCBS fee schedule,653.35,401,,,fee schedule,401% of BCBS fee schedule,810,90,,648,percent of total billed charges,90% of total billed charges,720,80,,576,percent of total billed charges,80% of total billed charges,810,90,,648,percent of total billed charges,90% of total billed charges,675,75,,540,percent of total billed charges,75% of total billed charges,440.04,122,,,fee schedule,122% of HUMANA fee schedule,261,29,,208.8,percent of total billed charges,29% of total billed charges,360.69,100,,,fee schedule,100% of CMS OPPS rate,603,67,,482.4,percent of total billed charges,67% of total billed charges,238.49,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,720,80,,576,percent of total billed charges,80% of total billed charges,585,65,,468,percent of total billed charges,65% of total billed charges,321.03,35.67,,256.824,percent of total billed charges,35.67% of total billed charges,238.49,810,
NM LYMPTH SYSTEM,3400491,CDM,340,RC,78195,HCPCS,outpatient,,,1617,646.80,,1374.45,85,,1099.56,percent of total billed charges,85% of total billed charges,1245.09,77,,996.07,percent of total billed charges,77% of total billed charges,472.68,100,,,fee schedule,100% of CMS OPPS rate,1211.75,385,,,fee schedule,385% of BCBS fee schedule,1262.11,401,,,fee schedule,401% of BCBS fee schedule,1262.11,401,,,fee schedule,401% of BCBS fee schedule,1262.11,401,,,fee schedule,401% of BCBS fee schedule,1455.3,90,,1164.24,percent of total billed charges,90% of total billed charges,1293.6,80,,1034.88,percent of total billed charges,80% of total billed charges,1455.3,90,,1164.24,percent of total billed charges,90% of total billed charges,1212.75,75,,970.2,percent of total billed charges,75% of total billed charges,576.66,122,,,fee schedule,122% of HUMANA fee schedule,468.93,29,,375.144,percent of total billed charges,29% of total billed charges,472.68,100,,,fee schedule,100% of CMS OPPS rate,1083.39,67,,866.712,percent of total billed charges,67% of total billed charges,238.49,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,1293.6,80,,1034.88,percent of total billed charges,80% of total billed charges,1051.05,65,,840.84,percent of total billed charges,65% of total billed charges,576.78,35.67,,461.424,percent of total billed charges,35.67% of total billed charges,238.49,1455.3,
NM TESTICULAR W/VASCULAR FLOW,3400495,CDM,340,RC,78761,HCPCS,outpatient,,,1049,419.60,,891.65,85,,713.32,percent of total billed charges,85% of total billed charges,807.73,77,,646.18,percent of total billed charges,77% of total billed charges,360.69,100,,,fee schedule,100% of CMS OPPS rate,712.98,385,,,fee schedule,385% of BCBS fee schedule,742.61,401,,,fee schedule,401% of BCBS fee schedule,742.61,401,,,fee schedule,401% of BCBS fee schedule,742.61,401,,,fee schedule,401% of BCBS fee schedule,944.1,90,,755.28,percent of total billed charges,90% of total billed charges,839.2,80,,671.36,percent of total billed charges,80% of total billed charges,944.1,90,,755.28,percent of total billed charges,90% of total billed charges,786.75,75,,629.4,percent of total billed charges,75% of total billed charges,440.04,122,,,fee schedule,122% of HUMANA fee schedule,304.21,29,,243.368,percent of total billed charges,29% of total billed charges,360.69,100,,,fee schedule,100% of CMS OPPS rate,702.83,67,,562.264,percent of total billed charges,67% of total billed charges,297.04,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,839.2,80,,671.36,percent of total billed charges,80% of total billed charges,681.85,65,,545.48,percent of total billed charges,65% of total billed charges,374.18,35.67,,299.344,percent of total billed charges,35.67% of total billed charges,297.04,944.1,
TESTICULAR SCAN,3400500,CDM,340,RC,78761,HCPCS,outpatient,,,1049,419.60,,891.65,85,,713.32,percent of total billed charges,85% of total billed charges,807.73,77,,646.18,percent of total billed charges,77% of total billed charges,360.69,100,,,fee schedule,100% of CMS OPPS rate,712.98,385,,,fee schedule,385% of BCBS fee schedule,742.61,401,,,fee schedule,401% of BCBS fee schedule,742.61,401,,,fee schedule,401% of BCBS fee schedule,742.61,401,,,fee schedule,401% of BCBS fee schedule,944.1,90,,755.28,percent of total billed charges,90% of total billed charges,839.2,80,,671.36,percent of total billed charges,80% of total billed charges,944.1,90,,755.28,percent of total billed charges,90% of total billed charges,786.75,75,,629.4,percent of total billed charges,75% of total billed charges,440.04,122,,,fee schedule,122% of HUMANA fee schedule,304.21,29,,243.368,percent of total billed charges,29% of total billed charges,360.69,100,,,fee schedule,100% of CMS OPPS rate,702.83,67,,562.264,percent of total billed charges,67% of total billed charges,297.04,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,839.2,80,,671.36,percent of total billed charges,80% of total billed charges,681.85,65,,545.48,percent of total billed charges,65% of total billed charges,374.18,35.67,,299.344,percent of total billed charges,35.67% of total billed charges,297.04,944.1,
NM TESTICULAR SCAN,3400505,CDM,340,RC,78761,HCPCS,outpatient,,,1049,419.60,,891.65,85,,713.32,percent of total billed charges,85% of total billed charges,807.73,77,,646.18,percent of total billed charges,77% of total billed charges,360.69,100,,,fee schedule,100% of CMS OPPS rate,712.98,385,,,fee schedule,385% of BCBS fee schedule,742.61,401,,,fee schedule,401% of BCBS fee schedule,742.61,401,,,fee schedule,401% of BCBS fee schedule,742.61,401,,,fee schedule,401% of BCBS fee schedule,944.1,90,,755.28,percent of total billed charges,90% of total billed charges,839.2,80,,671.36,percent of total billed charges,80% of total billed charges,944.1,90,,755.28,percent of total billed charges,90% of total billed charges,786.75,75,,629.4,percent of total billed charges,75% of total billed charges,440.04,122,,,fee schedule,122% of HUMANA fee schedule,304.21,29,,243.368,percent of total billed charges,29% of total billed charges,360.69,100,,,fee schedule,100% of CMS OPPS rate,702.83,67,,562.264,percent of total billed charges,67% of total billed charges,297.04,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,839.2,80,,671.36,percent of total billed charges,80% of total billed charges,681.85,65,,545.48,percent of total billed charges,65% of total billed charges,374.18,35.67,,299.344,percent of total billed charges,35.67% of total billed charges,297.04,944.1,
NM THYROID UPTAKE & SCAN W 123,3400510,CDM,340,RC,78014,HCPCS,outpatient,,,1265,506.00,,1075.25,85,,860.2,percent of total billed charges,85% of total billed charges,974.05,77,,779.24,percent of total billed charges,77% of total billed charges,360.69,100,,,fee schedule,100% of CMS OPPS rate,881.53,385,,,fee schedule,385% of BCBS fee schedule,918.17,401,,,fee schedule,401% of BCBS fee schedule,918.17,401,,,fee schedule,401% of BCBS fee schedule,918.17,401,,,fee schedule,401% of BCBS fee schedule,1138.5,90,,910.8,percent of total billed charges,90% of total billed charges,1012,80,,809.6,percent of total billed charges,80% of total billed charges,1138.5,90,,910.8,percent of total billed charges,90% of total billed charges,948.75,75,,759,percent of total billed charges,75% of total billed charges,440.04,122,,,fee schedule,122% of HUMANA fee schedule,366.85,29,,293.48,percent of total billed charges,29% of total billed charges,360.69,100,,,fee schedule,100% of CMS OPPS rate,847.55,67,,678.04,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1012,80,,809.6,percent of total billed charges,80% of total billed charges,822.25,65,,657.8,percent of total billed charges,65% of total billed charges,451.23,35.67,,360.984,percent of total billed charges,35.67% of total billed charges,360.69,1138.5,
NM THYROID SCAN W/VAS FLOW,3400515,CDM,340,RC,78013,HCPCS,outpatient,,,1105,442.00,,939.25,85,,751.4,percent of total billed charges,85% of total billed charges,850.85,77,,680.68,percent of total billed charges,77% of total billed charges,360.69,100,,,fee schedule,100% of CMS OPPS rate,706.05,385,,,fee schedule,385% of BCBS fee schedule,735.39,401,,,fee schedule,401% of BCBS fee schedule,735.39,401,,,fee schedule,401% of BCBS fee schedule,735.39,401,,,fee schedule,401% of BCBS fee schedule,994.5,90,,795.6,percent of total billed charges,90% of total billed charges,884,80,,707.2,percent of total billed charges,80% of total billed charges,994.5,90,,795.6,percent of total billed charges,90% of total billed charges,828.75,75,,663,percent of total billed charges,75% of total billed charges,440.04,122,,,fee schedule,122% of HUMANA fee schedule,320.45,29,,256.36,percent of total billed charges,29% of total billed charges,360.69,100,,,fee schedule,100% of CMS OPPS rate,740.35,67,,592.28,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,884,80,,707.2,percent of total billed charges,80% of total billed charges,718.25,65,,574.6,percent of total billed charges,65% of total billed charges,394.15,35.67,,315.32,percent of total billed charges,35.67% of total billed charges,320.45,994.5,
NM THYROID UPTAKE,3400530,CDM,340,RC,78012,HCPCS,outpatient,,,732,292.80,,622.2,85,,497.76,percent of total billed charges,85% of total billed charges,563.64,77,,450.91,percent of total billed charges,77% of total billed charges,360.69,100,,,fee schedule,100% of CMS OPPS rate,290.17,385,,,fee schedule,385% of BCBS fee schedule,302.23,401,,,fee schedule,401% of BCBS fee schedule,302.23,401,,,fee schedule,401% of BCBS fee schedule,302.23,401,,,fee schedule,401% of BCBS fee schedule,658.8,90,,527.04,percent of total billed charges,90% of total billed charges,585.6,80,,468.48,percent of total billed charges,80% of total billed charges,658.8,90,,527.04,percent of total billed charges,90% of total billed charges,549,75,,439.2,percent of total billed charges,75% of total billed charges,440.04,122,,,fee schedule,122% of HUMANA fee schedule,212.28,29,,169.824,percent of total billed charges,29% of total billed charges,360.69,100,,,fee schedule,100% of CMS OPPS rate,490.44,67,,392.352,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,585.6,80,,468.48,percent of total billed charges,80% of total billed charges,475.8,65,,380.64,percent of total billed charges,65% of total billed charges,261.1,35.67,,208.88,percent of total billed charges,35.67% of total billed charges,212.28,658.8,
NM MYOCARDIAL PERF W/EJ FRACT,3400540,CDM,340,RC,78451,HCPCS,outpatient,,,2018,807.20,,1715.3,85,,1372.24,percent of total billed charges,85% of total billed charges,1553.86,77,,1243.09,percent of total billed charges,77% of total billed charges,1241.8,100,,,fee schedule,100% of CMS OPPS rate,1430.72,429,,,fee schedule,429% of BCBS fee schedule,1491.54,515,,,fee schedule,515% of BCBS fee schedule,1491.54,364,,,fee schedule,364% of BCBS fee schedule,1491.54,515,,,fee schedule,515% of BCBS fee schedule,1816.2,90,,1452.96,percent of total billed charges,90% of total billed charges,1614.4,80,,1291.52,percent of total billed charges,80% of total billed charges,1816.2,90,,1452.96,percent of total billed charges,90% of total billed charges,1513.5,75,,1210.8,percent of total billed charges,75% of total billed charges,1514.99,122,,,fee schedule,122% of HUMANA fee schedule,585.22,29,,468.176,percent of total billed charges,29% of total billed charges,1241.8,100,,,fee schedule,100% of CMS OPPS rate,1352.06,67,,1081.648,percent of total billed charges,67% of total billed charges,626.87,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,1614.4,80,,1291.52,percent of total billed charges,80% of total billed charges,1311.7,65,,1049.36,percent of total billed charges,65% of total billed charges,719.82,35.67,,575.856,percent of total billed charges,35.67% of total billed charges,585.22,1816.2,
NM GATED BLOOD POOL - MUGA,3400545,CDM,340,RC,78472,HCPCS,outpatient,,,1123,449.20,,954.55,85,,763.64,percent of total billed charges,85% of total billed charges,864.71,77,,691.77,percent of total billed charges,77% of total billed charges,360.69,100,,,fee schedule,100% of CMS OPPS rate,946.75,429,,,fee schedule,429% of BCBS fee schedule,987,515,,,fee schedule,515% of BCBS fee schedule,987,364,,,fee schedule,364% of BCBS fee schedule,987,515,,,fee schedule,515% of BCBS fee schedule,1010.7,90,,808.56,percent of total billed charges,90% of total billed charges,898.4,80,,718.72,percent of total billed charges,80% of total billed charges,1010.7,90,,808.56,percent of total billed charges,90% of total billed charges,842.25,75,,673.8,percent of total billed charges,75% of total billed charges,440.04,122,,,fee schedule,122% of HUMANA fee schedule,325.67,29,,260.536,percent of total billed charges,29% of total billed charges,360.69,100,,,fee schedule,100% of CMS OPPS rate,752.41,67,,601.928,percent of total billed charges,67% of total billed charges,277.39,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,898.4,80,,718.72,percent of total billed charges,80% of total billed charges,729.95,65,,583.96,percent of total billed charges,65% of total billed charges,400.57,35.67,,320.456,percent of total billed charges,35.67% of total billed charges,277.39,1010.7,
MUGA GATED BLD POOL WMS EF-MUL,3400550,CDM,340,RC,78483,HCPCS,outpatient,,,1456,582.40,,1237.6,85,,990.08,percent of total billed charges,85% of total billed charges,1121.12,77,,896.9,percent of total billed charges,77% of total billed charges,472.68,100,,,fee schedule,100% of CMS OPPS rate,893.55,429,,,fee schedule,429% of BCBS fee schedule,931.53,515,,,fee schedule,515% of BCBS fee schedule,931.53,364,,,fee schedule,364% of BCBS fee schedule,931.53,515,,,fee schedule,515% of BCBS fee schedule,1310.4,90,,1048.32,percent of total billed charges,90% of total billed charges,1164.8,80,,931.84,percent of total billed charges,80% of total billed charges,1310.4,90,,1048.32,percent of total billed charges,90% of total billed charges,1092,75,,873.6,percent of total billed charges,75% of total billed charges,576.66,122,,,fee schedule,122% of HUMANA fee schedule,422.24,29,,337.792,percent of total billed charges,29% of total billed charges,472.68,100,,,fee schedule,100% of CMS OPPS rate,975.52,67,,780.416,percent of total billed charges,67% of total billed charges,277.39,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,1164.8,80,,931.84,percent of total billed charges,80% of total billed charges,946.4,65,,757.12,percent of total billed charges,65% of total billed charges,519.36,35.67,,415.488,percent of total billed charges,35.67% of total billed charges,277.39,1310.4,
FIRST PASS REST OR STRESS 1 V,3400555,CDM,340,RC,78481,HCPCS,outpatient,,,983,393.20,,835.55,85,,668.44,percent of total billed charges,85% of total billed charges,756.91,77,,605.53,percent of total billed charges,77% of total billed charges,472.68,100,,,fee schedule,100% of CMS OPPS rate,666.6,429,,,fee schedule,429% of BCBS fee schedule,694.94,515,,,fee schedule,515% of BCBS fee schedule,694.94,364,,,fee schedule,364% of BCBS fee schedule,694.94,515,,,fee schedule,515% of BCBS fee schedule,884.7,90,,707.76,percent of total billed charges,90% of total billed charges,786.4,80,,629.12,percent of total billed charges,80% of total billed charges,884.7,90,,707.76,percent of total billed charges,90% of total billed charges,737.25,75,,589.8,percent of total billed charges,75% of total billed charges,576.66,122,,,fee schedule,122% of HUMANA fee schedule,285.07,29,,228.056,percent of total billed charges,29% of total billed charges,472.68,100,,,fee schedule,100% of CMS OPPS rate,658.61,67,,526.888,percent of total billed charges,67% of total billed charges,277.39,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,786.4,80,,629.12,percent of total billed charges,80% of total billed charges,638.95,65,,511.16,percent of total billed charges,65% of total billed charges,350.64,35.67,,280.512,percent of total billed charges,35.67% of total billed charges,277.39,884.7,
NM MYOCARDIAL PERF-WALL MOTION,3400561,CDM,340,RC,78451,HCPCS,outpatient,,,2018,807.20,,1715.3,85,,1372.24,percent of total billed charges,85% of total billed charges,1553.86,77,,1243.09,percent of total billed charges,77% of total billed charges,1241.8,100,,,fee schedule,100% of CMS OPPS rate,1430.72,429,,,fee schedule,429% of BCBS fee schedule,1491.54,515,,,fee schedule,515% of BCBS fee schedule,1491.54,364,,,fee schedule,364% of BCBS fee schedule,1491.54,515,,,fee schedule,515% of BCBS fee schedule,1816.2,90,,1452.96,percent of total billed charges,90% of total billed charges,1614.4,80,,1291.52,percent of total billed charges,80% of total billed charges,1816.2,90,,1452.96,percent of total billed charges,90% of total billed charges,1513.5,75,,1210.8,percent of total billed charges,75% of total billed charges,1514.99,122,,,fee schedule,122% of HUMANA fee schedule,585.22,29,,468.176,percent of total billed charges,29% of total billed charges,1241.8,100,,,fee schedule,100% of CMS OPPS rate,1352.06,67,,1081.648,percent of total billed charges,67% of total billed charges,626.87,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,1614.4,80,,1291.52,percent of total billed charges,80% of total billed charges,1311.7,65,,1049.36,percent of total billed charges,65% of total billed charges,719.82,35.67,,575.856,percent of total billed charges,35.67% of total billed charges,585.22,1816.2,
NM MYOCARDIAL PERFUSION SINGLE,3400563,CDM,340,RC,78451,HCPCS,outpatient,,,2018,807.20,,1715.3,85,,1372.24,percent of total billed charges,85% of total billed charges,1553.86,77,,1243.09,percent of total billed charges,77% of total billed charges,1241.8,100,,,fee schedule,100% of CMS OPPS rate,1430.72,429,,,fee schedule,429% of BCBS fee schedule,1491.54,515,,,fee schedule,515% of BCBS fee schedule,1491.54,364,,,fee schedule,364% of BCBS fee schedule,1491.54,515,,,fee schedule,515% of BCBS fee schedule,1816.2,90,,1452.96,percent of total billed charges,90% of total billed charges,1614.4,80,,1291.52,percent of total billed charges,80% of total billed charges,1816.2,90,,1452.96,percent of total billed charges,90% of total billed charges,1513.5,75,,1210.8,percent of total billed charges,75% of total billed charges,1514.99,122,,,fee schedule,122% of HUMANA fee schedule,585.22,29,,468.176,percent of total billed charges,29% of total billed charges,1241.8,100,,,fee schedule,100% of CMS OPPS rate,1352.06,67,,1081.648,percent of total billed charges,67% of total billed charges,626.87,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,1614.4,80,,1291.52,percent of total billed charges,80% of total billed charges,1311.7,65,,1049.36,percent of total billed charges,65% of total billed charges,719.82,35.67,,575.856,percent of total billed charges,35.67% of total billed charges,585.22,1816.2,
NM THYROID SCAN IMAGING ONLY,3400571,CDM,340,RC,78013,HCPCS,outpatient,,,836,334.40,,710.6,85,,568.48,percent of total billed charges,85% of total billed charges,643.72,77,,514.98,percent of total billed charges,77% of total billed charges,360.69,100,,,fee schedule,100% of CMS OPPS rate,706.05,385,,,fee schedule,385% of BCBS fee schedule,735.39,401,,,fee schedule,401% of BCBS fee schedule,735.39,401,,,fee schedule,401% of BCBS fee schedule,735.39,401,,,fee schedule,401% of BCBS fee schedule,752.4,90,,601.92,percent of total billed charges,90% of total billed charges,668.8,80,,535.04,percent of total billed charges,80% of total billed charges,752.4,90,,601.92,percent of total billed charges,90% of total billed charges,627,75,,501.6,percent of total billed charges,75% of total billed charges,440.04,122,,,fee schedule,122% of HUMANA fee schedule,242.44,29,,193.952,percent of total billed charges,29% of total billed charges,360.69,100,,,fee schedule,100% of CMS OPPS rate,560.12,67,,448.096,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,668.8,80,,535.04,percent of total billed charges,80% of total billed charges,543.4,65,,434.72,percent of total billed charges,65% of total billed charges,298.2,35.67,,238.56,percent of total billed charges,35.67% of total billed charges,242.44,752.4,
CARDIOLITE STRESS TEST/EXPLODE,3400810,CDM,340,RC,,,outpatient,,,6282,2512.80,,5339.7,85,,4271.76,percent of total billed charges,85% of total billed charges,4837.14,77,,3869.71,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,5151.24,82,,4120.992,percent of total billed charges,82% of total billed charges,5339.7,85,,4271.76,percent of total billed charges,85% of total billed charges,5339.7,85,,4271.76,percent of total billed charges,85% of total billed charges,5339.7,85,,4271.76,percent of total billed charges,85% of total billed charges,5653.8,90,,4523.04,percent of total billed charges,90% of total billed charges,5025.6,80,,4020.48,percent of total billed charges,80% of total billed charges,5653.8,90,,4523.04,percent of total billed charges,90% of total billed charges,4711.5,75,,3769.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,1821.78,29,,1457.424,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4208.94,67,,3367.152,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,5025.6,80,,4020.48,percent of total billed charges,80% of total billed charges,4083.3,65,,3266.64,percent of total billed charges,65% of total billed charges,2240.79,35.67,,1792.632,percent of total billed charges,35.67% of total billed charges,1821.78,5653.8,
NM MYOCARD PERFUS W/SPEC/EXPLO,3400820,CDM,340,RC,,,outpatient,,,6051,2420.40,,5143.35,85,,4114.68,percent of total billed charges,85% of total billed charges,4659.27,77,,3727.42,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,4961.82,82,,3969.456,percent of total billed charges,82% of total billed charges,5143.35,85,,4114.68,percent of total billed charges,85% of total billed charges,5143.35,85,,4114.68,percent of total billed charges,85% of total billed charges,5143.35,85,,4114.68,percent of total billed charges,85% of total billed charges,5445.9,90,,4356.72,percent of total billed charges,90% of total billed charges,4840.8,80,,3872.64,percent of total billed charges,80% of total billed charges,5445.9,90,,4356.72,percent of total billed charges,90% of total billed charges,4538.25,75,,3630.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,1754.79,29,,1403.832,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4054.17,67,,3243.336,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,4840.8,80,,3872.64,percent of total billed charges,80% of total billed charges,3933.15,65,,3146.52,percent of total billed charges,65% of total billed charges,2158.39,35.67,,1726.712,percent of total billed charges,35.67% of total billed charges,1754.79,5445.9,
NM MYCARD PERF SINGLE/EXPLODED,3400840,CDM,340,RC,,,outpatient,,,3618,1447.20,,3075.3,85,,2460.24,percent of total billed charges,85% of total billed charges,2785.86,77,,2228.69,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,2966.76,82,,2373.408,percent of total billed charges,82% of total billed charges,3075.3,85,,2460.24,percent of total billed charges,85% of total billed charges,3075.3,85,,2460.24,percent of total billed charges,85% of total billed charges,3075.3,85,,2460.24,percent of total billed charges,85% of total billed charges,3256.2,90,,2604.96,percent of total billed charges,90% of total billed charges,2894.4,80,,2315.52,percent of total billed charges,80% of total billed charges,3256.2,90,,2604.96,percent of total billed charges,90% of total billed charges,2713.5,75,,2170.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,1049.22,29,,839.376,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,2424.06,67,,1939.248,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,2894.4,80,,2315.52,percent of total billed charges,80% of total billed charges,2351.7,65,,1881.36,percent of total billed charges,65% of total billed charges,1290.54,35.67,,1032.432,percent of total billed charges,35.67% of total billed charges,1049.22,3256.2,
NM BONE SPECT,3401000,CDM,340,RC,78306,HCPCS,outpatient,,,1669,667.60,,1418.65,85,,1134.92,percent of total billed charges,85% of total billed charges,1285.13,77,,1028.1,percent of total billed charges,77% of total billed charges,360.69,100,,,fee schedule,100% of CMS OPPS rate,1062.52,385,,,fee schedule,385% of BCBS fee schedule,1106.68,401,,,fee schedule,401% of BCBS fee schedule,1106.68,401,,,fee schedule,401% of BCBS fee schedule,1106.68,401,,,fee schedule,401% of BCBS fee schedule,1502.1,90,,1201.68,percent of total billed charges,90% of total billed charges,1335.2,80,,1068.16,percent of total billed charges,80% of total billed charges,1502.1,90,,1201.68,percent of total billed charges,90% of total billed charges,1251.75,75,,1001.4,percent of total billed charges,75% of total billed charges,440.04,122,,,fee schedule,122% of HUMANA fee schedule,484.01,29,,387.208,percent of total billed charges,29% of total billed charges,360.69,100,,,fee schedule,100% of CMS OPPS rate,1118.23,67,,894.584,percent of total billed charges,67% of total billed charges,230.19,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,1335.2,80,,1068.16,percent of total billed charges,80% of total billed charges,1084.85,65,,867.88,percent of total billed charges,65% of total billed charges,595.33,35.67,,476.264,percent of total billed charges,35.67% of total billed charges,230.19,1502.1,
NM PARATHYROID SPECT,3401002,CDM,340,RC,78071,HCPCS,outpatient,,,2505,1002.00,,2129.25,85,,1703.4,percent of total billed charges,85% of total billed charges,1928.85,77,,1543.08,percent of total billed charges,77% of total billed charges,360.69,100,,,fee schedule,100% of CMS OPPS rate,1217.29,385,,,fee schedule,385% of BCBS fee schedule,1267.88,401,,,fee schedule,401% of BCBS fee schedule,1267.88,401,,,fee schedule,401% of BCBS fee schedule,1267.88,401,,,fee schedule,401% of BCBS fee schedule,2254.5,90,,1803.6,percent of total billed charges,90% of total billed charges,2004,80,,1603.2,percent of total billed charges,80% of total billed charges,2254.5,90,,1803.6,percent of total billed charges,90% of total billed charges,1878.75,75,,1503,percent of total billed charges,75% of total billed charges,440.04,122,,,fee schedule,122% of HUMANA fee schedule,726.45,29,,581.16,percent of total billed charges,29% of total billed charges,360.69,100,,,fee schedule,100% of CMS OPPS rate,1678.35,67,,1342.68,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,2004,80,,1603.2,percent of total billed charges,80% of total billed charges,1628.25,65,,1302.6,percent of total billed charges,65% of total billed charges,893.53,35.67,,714.824,percent of total billed charges,35.67% of total billed charges,360.69,2254.5,
MYOCARD PERFUSION INTERP TELE,7800050,CDM,340,RC,78452,HCPCS,outpatient,,,2334,933.60,26,1983.9,85,,1587.12,percent of total billed charges,85% of total billed charges,1797.18,77,,1437.74,percent of total billed charges,77% of total billed charges,1241.8,100,,,fee schedule,100% of CMS OPPS rate,2065.41,429,,,fee schedule,429% of BCBS fee schedule,2153.22,515,,,fee schedule,515% of BCBS fee schedule,2153.22,364,,,fee schedule,364% of BCBS fee schedule,2153.22,515,,,fee schedule,515% of BCBS fee schedule,2100.6,90,,1680.48,percent of total billed charges,90% of total billed charges,1867.2,80,,1493.76,percent of total billed charges,80% of total billed charges,2100.6,90,,1680.48,percent of total billed charges,90% of total billed charges,1750.5,75,,1400.4,percent of total billed charges,75% of total billed charges,1514.99,122,,,fee schedule,122% of HUMANA fee schedule,676.86,29,,541.488,percent of total billed charges,29% of total billed charges,1241.8,100,,,fee schedule,100% of CMS OPPS rate,1563.78,67,,1251.024,percent of total billed charges,67% of total billed charges,626.87,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,1867.2,80,,1493.76,percent of total billed charges,80% of total billed charges,1517.1,65,,1213.68,percent of total billed charges,65% of total billed charges,832.54,35.67,,666.032,percent of total billed charges,35.67% of total billed charges,626.87,2153.22,
NM ESOPHAGEAL MOTILITY,3400077,CDM,341,RC,78258,HCPCS,outpatient,,,908,363.20,,771.8,85,,617.44,percent of total billed charges,85% of total billed charges,699.16,77,,559.33,percent of total billed charges,77% of total billed charges,360.69,100,,,fee schedule,100% of CMS OPPS rate,766.84,385,,,fee schedule,385% of BCBS fee schedule,798.71,401,,,fee schedule,401% of BCBS fee schedule,798.71,401,,,fee schedule,401% of BCBS fee schedule,798.71,401,,,fee schedule,401% of BCBS fee schedule,817.2,90,,653.76,percent of total billed charges,90% of total billed charges,726.4,80,,581.12,percent of total billed charges,80% of total billed charges,817.2,90,,653.76,percent of total billed charges,90% of total billed charges,681,75,,544.8,percent of total billed charges,75% of total billed charges,440.04,122,,,fee schedule,122% of HUMANA fee schedule,263.32,29,,210.656,percent of total billed charges,29% of total billed charges,360.69,100,,,fee schedule,100% of CMS OPPS rate,608.36,67,,486.688,percent of total billed charges,67% of total billed charges,227.14,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,726.4,80,,581.12,percent of total billed charges,80% of total billed charges,590.2,65,,472.16,percent of total billed charges,65% of total billed charges,323.88,35.67,,259.104,percent of total billed charges,35.67% of total billed charges,227.14,817.2,
GALLIUM GA 67 PER MCI,25004141,CDM,343,RC,A9556,HCPCS,outpatient,,,133,53.20,,113.05,85,,90.44,percent of total billed charges,85% of total billed charges,102.41,77,,81.93,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,380.8,385,,,fee schedule,385% of BCBS fee schedule,396.63,401,,,fee schedule,401% of BCBS fee schedule,396.63,401,,,fee schedule,401% of BCBS fee schedule,396.63,401,,,fee schedule,401% of BCBS fee schedule,119.7,90,,95.76,percent of total billed charges,90% of total billed charges,106.4,80,,85.12,percent of total billed charges,80% of total billed charges,119.7,90,,95.76,percent of total billed charges,90% of total billed charges,99.75,75,,79.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,38.57,29,,30.856,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,89.11,67,,71.288,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,106.4,80,,85.12,percent of total billed charges,80% of total billed charges,86.45,65,,69.16,percent of total billed charges,65% of total billed charges,47.44,35.67,,37.952,percent of total billed charges,35.67% of total billed charges,38.57,396.63,
TC 99 MDP MEDRONATE 30 mCi,3400082,CDM,343,RC,A9503,HCPCS,outpatient,,,118,47.20,,100.3,85,,80.24,percent of total billed charges,85% of total billed charges,90.86,77,,72.69,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,49.86,385,,,fee schedule,385% of BCBS fee schedule,51.93,401,,,fee schedule,401% of BCBS fee schedule,51.93,401,,,fee schedule,401% of BCBS fee schedule,51.93,401,,,fee schedule,401% of BCBS fee schedule,106.2,90,,84.96,percent of total billed charges,90% of total billed charges,94.4,80,,75.52,percent of total billed charges,80% of total billed charges,106.2,90,,84.96,percent of total billed charges,90% of total billed charges,88.5,75,,70.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,34.22,29,,27.376,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,79.06,67,,63.248,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,94.4,80,,75.52,percent of total billed charges,80% of total billed charges,76.7,65,,61.36,percent of total billed charges,65% of total billed charges,42.09,35.67,,33.672,percent of total billed charges,35.67% of total billed charges,34.22,106.2,
Tc 99m SESTAMIBI 10 MCI INJ,3400565,CDM,343,RC,A9500,HCPCS,outpatient,,,167,66.80,,141.95,85,,113.56,percent of total billed charges,85% of total billed charges,128.59,77,,102.87,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,524.1,385,,,fee schedule,385% of BCBS fee schedule,545.88,401,,,fee schedule,401% of BCBS fee schedule,545.88,401,,,fee schedule,401% of BCBS fee schedule,545.88,401,,,fee schedule,401% of BCBS fee schedule,150.3,90,,120.24,percent of total billed charges,90% of total billed charges,133.6,80,,106.88,percent of total billed charges,80% of total billed charges,150.3,90,,120.24,percent of total billed charges,90% of total billed charges,125.25,75,,100.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,48.43,29,,38.744,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,111.89,67,,89.512,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,133.6,80,,106.88,percent of total billed charges,80% of total billed charges,108.55,65,,86.84,percent of total billed charges,65% of total billed charges,59.57,35.67,,47.656,percent of total billed charges,35.67% of total billed charges,48.43,545.88,
THALLIUM PER 1 MCI INJ.,3400570,CDM,343,RC,A9505,HCPCS,outpatient,,,192,76.80,,163.2,85,,130.56,percent of total billed charges,85% of total billed charges,147.84,77,,118.27,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,111.77,385,,,fee schedule,385% of BCBS fee schedule,116.41,401,,,fee schedule,401% of BCBS fee schedule,116.41,401,,,fee schedule,401% of BCBS fee schedule,116.41,401,,,fee schedule,401% of BCBS fee schedule,172.8,90,,138.24,percent of total billed charges,90% of total billed charges,153.6,80,,122.88,percent of total billed charges,80% of total billed charges,172.8,90,,138.24,percent of total billed charges,90% of total billed charges,144,75,,115.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,55.68,29,,44.544,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,128.64,67,,102.912,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,153.6,80,,122.88,percent of total billed charges,80% of total billed charges,124.8,65,,99.84,percent of total billed charges,65% of total billed charges,68.49,35.67,,54.792,percent of total billed charges,35.67% of total billed charges,55.68,172.8,
TC 99 PYP,3400575,CDM,343,RC,A9538,HCPCS,outpatient,,,309,123.60,,262.65,85,,210.12,percent of total billed charges,85% of total billed charges,237.93,77,,190.34,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,153.38,385,,,fee schedule,385% of BCBS fee schedule,159.76,401,,,fee schedule,401% of BCBS fee schedule,159.76,401,,,fee schedule,401% of BCBS fee schedule,159.76,401,,,fee schedule,401% of BCBS fee schedule,278.1,90,,222.48,percent of total billed charges,90% of total billed charges,247.2,80,,197.76,percent of total billed charges,80% of total billed charges,278.1,90,,222.48,percent of total billed charges,90% of total billed charges,231.75,75,,185.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,89.61,29,,71.688,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,207.03,67,,165.624,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,247.2,80,,197.76,percent of total billed charges,80% of total billed charges,200.85,65,,160.68,percent of total billed charges,65% of total billed charges,110.22,35.67,,88.176,percent of total billed charges,35.67% of total billed charges,89.61,278.1,
TC 99 MIRALUMA,3400579,CDM,343,RC,A9500,HCPCS,outpatient,,,397,158.80,,337.45,85,,269.96,percent of total billed charges,85% of total billed charges,305.69,77,,244.55,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,524.1,385,,,fee schedule,385% of BCBS fee schedule,545.88,401,,,fee schedule,401% of BCBS fee schedule,545.88,401,,,fee schedule,401% of BCBS fee schedule,545.88,401,,,fee schedule,401% of BCBS fee schedule,357.3,90,,285.84,percent of total billed charges,90% of total billed charges,317.6,80,,254.08,percent of total billed charges,80% of total billed charges,357.3,90,,285.84,percent of total billed charges,90% of total billed charges,297.75,75,,238.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,115.13,29,,92.104,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,265.99,67,,212.792,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,317.6,80,,254.08,percent of total billed charges,80% of total billed charges,258.05,65,,206.44,percent of total billed charges,65% of total billed charges,141.61,35.67,,113.288,percent of total billed charges,35.67% of total billed charges,115.13,545.88,
TC 99 M PERTECHNETATE 10mCI,3400580,CDM,343,RC,A9512,HCPCS,outpatient,,,98,39.20,,83.3,85,,66.64,percent of total billed charges,85% of total billed charges,75.46,77,,60.37,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,15.13,385,,,fee schedule,385% of BCBS fee schedule,15.76,401,,,fee schedule,401% of BCBS fee schedule,15.76,401,,,fee schedule,401% of BCBS fee schedule,15.76,401,,,fee schedule,401% of BCBS fee schedule,88.2,90,,70.56,percent of total billed charges,90% of total billed charges,78.4,80,,62.72,percent of total billed charges,80% of total billed charges,88.2,90,,70.56,percent of total billed charges,90% of total billed charges,73.5,75,,58.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,28.42,29,,22.736,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,65.66,67,,52.528,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,78.4,80,,62.72,percent of total billed charges,80% of total billed charges,63.7,65,,50.96,percent of total billed charges,65% of total billed charges,34.96,35.67,,27.968,percent of total billed charges,35.67% of total billed charges,15.13,88.2,
TC 99 MAA UP TO 10 MCI,3400581,CDM,343,RC,A9540,HCPCS,outpatient,,,149,59.60,,126.65,85,,101.32,percent of total billed charges,85% of total billed charges,114.73,77,,91.78,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,76.5,385,,,fee schedule,385% of BCBS fee schedule,79.68,401,,,fee schedule,401% of BCBS fee schedule,79.68,401,,,fee schedule,401% of BCBS fee schedule,79.68,401,,,fee schedule,401% of BCBS fee schedule,134.1,90,,107.28,percent of total billed charges,90% of total billed charges,119.2,80,,95.36,percent of total billed charges,80% of total billed charges,134.1,90,,107.28,percent of total billed charges,90% of total billed charges,111.75,75,,89.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,43.21,29,,34.568,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,99.83,67,,79.864,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,119.2,80,,95.36,percent of total billed charges,80% of total billed charges,96.85,65,,77.48,percent of total billed charges,65% of total billed charges,53.15,35.67,,42.52,percent of total billed charges,35.67% of total billed charges,43.21,134.1,
KINEVAC/SINCALIRE INJ,3400582,CDM,343,RC,A4641,HCPCS,outpatient,,,133,53.20,,113.05,85,,90.44,percent of total billed charges,85% of total billed charges,102.41,77,,81.93,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,109.06,82,,87.248,percent of total billed charges,82% of total billed charges,113.05,85,,90.44,percent of total billed charges,85% of total billed charges,113.05,85,,90.44,percent of total billed charges,85% of total billed charges,113.05,85,,90.44,percent of total billed charges,85% of total billed charges,119.7,90,,95.76,percent of total billed charges,90% of total billed charges,106.4,80,,85.12,percent of total billed charges,80% of total billed charges,119.7,90,,95.76,percent of total billed charges,90% of total billed charges,99.75,75,,79.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,38.57,29,,30.856,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,89.11,67,,71.288,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,106.4,80,,85.12,percent of total billed charges,80% of total billed charges,86.45,65,,69.16,percent of total billed charges,65% of total billed charges,47.44,35.67,,37.952,percent of total billed charges,35.67% of total billed charges,38.57,119.7,
TC 99 DTPA,3400583,CDM,343,RC,A9539,HCPCS,outpatient,,,149,59.60,,126.65,85,,101.32,percent of total billed charges,85% of total billed charges,114.73,77,,91.78,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,120.16,385,,,fee schedule,385% of BCBS fee schedule,125.15,401,,,fee schedule,401% of BCBS fee schedule,125.15,401,,,fee schedule,401% of BCBS fee schedule,125.15,401,,,fee schedule,401% of BCBS fee schedule,134.1,90,,107.28,percent of total billed charges,90% of total billed charges,119.2,80,,95.36,percent of total billed charges,80% of total billed charges,134.1,90,,107.28,percent of total billed charges,90% of total billed charges,111.75,75,,89.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,43.21,29,,34.568,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,99.83,67,,79.864,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,119.2,80,,95.36,percent of total billed charges,80% of total billed charges,96.85,65,,77.48,percent of total billed charges,65% of total billed charges,53.15,35.67,,42.52,percent of total billed charges,35.67% of total billed charges,43.21,134.1,
TC 99 SULFUR COLLOID TO 20MCI,3400584,CDM,343,RC,A9541,HCPCS,outpatient,,,217,86.80,,184.45,85,,147.56,percent of total billed charges,85% of total billed charges,167.09,77,,133.67,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,205.05,385,,,fee schedule,385% of BCBS fee schedule,213.57,401,,,fee schedule,401% of BCBS fee schedule,213.57,401,,,fee schedule,401% of BCBS fee schedule,213.57,401,,,fee schedule,401% of BCBS fee schedule,195.3,90,,156.24,percent of total billed charges,90% of total billed charges,173.6,80,,138.88,percent of total billed charges,80% of total billed charges,195.3,90,,156.24,percent of total billed charges,90% of total billed charges,162.75,75,,130.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,62.93,29,,50.344,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,145.39,67,,116.312,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,173.6,80,,138.88,percent of total billed charges,80% of total billed charges,141.05,65,,112.84,percent of total billed charges,65% of total billed charges,77.4,35.67,,61.92,percent of total billed charges,35.67% of total billed charges,62.93,213.57,
TC 99 LABELED RBC'S PER 30 MCI,3400585,CDM,343,RC,A9560,HCPCS,outpatient,,,133,53.20,,113.05,85,,90.44,percent of total billed charges,85% of total billed charges,102.41,77,,81.93,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,358.17,385,,,fee schedule,385% of BCBS fee schedule,373.05,401,,,fee schedule,401% of BCBS fee schedule,373.05,401,,,fee schedule,401% of BCBS fee schedule,373.05,401,,,fee schedule,401% of BCBS fee schedule,119.7,90,,95.76,percent of total billed charges,90% of total billed charges,106.4,80,,85.12,percent of total billed charges,80% of total billed charges,119.7,90,,95.76,percent of total billed charges,90% of total billed charges,99.75,75,,79.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,38.57,29,,30.856,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,89.11,67,,71.288,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,106.4,80,,85.12,percent of total billed charges,80% of total billed charges,86.45,65,,69.16,percent of total billed charges,65% of total billed charges,47.44,35.67,,37.952,percent of total billed charges,35.67% of total billed charges,38.57,373.05,
TC 99 CHOLETEC/MEBROFENIN,3400587,CDM,343,RC,A9537,HCPCS,outpatient,,,303,121.20,,257.55,85,,206.04,percent of total billed charges,85% of total billed charges,233.31,77,,186.65,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,212.14,385,,,fee schedule,385% of BCBS fee schedule,220.95,401,,,fee schedule,401% of BCBS fee schedule,220.95,401,,,fee schedule,401% of BCBS fee schedule,220.95,401,,,fee schedule,401% of BCBS fee schedule,272.7,90,,218.16,percent of total billed charges,90% of total billed charges,242.4,80,,193.92,percent of total billed charges,80% of total billed charges,272.7,90,,218.16,percent of total billed charges,90% of total billed charges,227.25,75,,181.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,87.87,29,,70.296,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,203.01,67,,162.408,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,242.4,80,,193.92,percent of total billed charges,80% of total billed charges,196.95,65,,157.56,percent of total billed charges,65% of total billed charges,108.08,35.67,,86.464,percent of total billed charges,35.67% of total billed charges,87.87,272.7,
TC 99 CARDIOLITE/SESTAMIBI,3400591,CDM,343,RC,A9500,HCPCS,outpatient,,,600,240.00,,510,85,,408,percent of total billed charges,85% of total billed charges,462,77,,369.6,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,524.1,385,,,fee schedule,385% of BCBS fee schedule,545.88,401,,,fee schedule,401% of BCBS fee schedule,545.88,401,,,fee schedule,401% of BCBS fee schedule,545.88,401,,,fee schedule,401% of BCBS fee schedule,540,90,,432,percent of total billed charges,90% of total billed charges,480,80,,384,percent of total billed charges,80% of total billed charges,540,90,,432,percent of total billed charges,90% of total billed charges,450,75,,360,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,174,29,,139.2,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,402,67,,321.6,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,480,80,,384,percent of total billed charges,80% of total billed charges,390,65,,312,percent of total billed charges,65% of total billed charges,214.02,35.67,,171.216,percent of total billed charges,35.67% of total billed charges,174,545.88,
IODINE 123 PER 1 MCI,3400593,CDM,343,RC,A9516,HCPCS,outpatient,,,303,121.20,,257.55,85,,206.04,percent of total billed charges,85% of total billed charges,233.31,77,,186.65,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,693.5,385,,,fee schedule,385% of BCBS fee schedule,722.32,401,,,fee schedule,401% of BCBS fee schedule,722.32,401,,,fee schedule,401% of BCBS fee schedule,722.32,401,,,fee schedule,401% of BCBS fee schedule,272.7,90,,218.16,percent of total billed charges,90% of total billed charges,242.4,80,,193.92,percent of total billed charges,80% of total billed charges,272.7,90,,218.16,percent of total billed charges,90% of total billed charges,227.25,75,,181.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,87.87,29,,70.296,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,203.01,67,,162.408,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,242.4,80,,193.92,percent of total billed charges,80% of total billed charges,196.95,65,,157.56,percent of total billed charges,65% of total billed charges,108.08,35.67,,86.464,percent of total billed charges,35.67% of total billed charges,87.87,722.32,
XENON GAS 10 mCI,3400594,CDM,343,RC,A9558,HCPCS,outpatient,,,125,50.00,,106.25,85,,85,percent of total billed charges,85% of total billed charges,96.25,77,,77,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,132.94,385,,,fee schedule,385% of BCBS fee schedule,138.47,401,,,fee schedule,401% of BCBS fee schedule,138.47,401,,,fee schedule,401% of BCBS fee schedule,138.47,401,,,fee schedule,401% of BCBS fee schedule,112.5,90,,90,percent of total billed charges,90% of total billed charges,100,80,,80,percent of total billed charges,80% of total billed charges,112.5,90,,90,percent of total billed charges,90% of total billed charges,93.75,75,,75,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,36.25,29,,29,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,83.75,67,,67,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,100,80,,80,percent of total billed charges,80% of total billed charges,81.25,65,,65,percent of total billed charges,65% of total billed charges,44.59,35.67,,35.672,percent of total billed charges,35.67% of total billed charges,36.25,138.47,
CT 3-D RECONSTRUCTION,3500015,CDM,350,RC,76376,HCPCS,outpatient,,,655,262.00,,550,,,,case rate,pays based on per visit,504.35,77,,403.48,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,67.38,429,,,fee schedule,429% of BCBS fee schedule,70.25,515,,,fee schedule,515% of BCBS fee schedule,70.25,364,,,fee schedule,364% of BCBS fee schedule,70.25,515,,,fee schedule,515% of BCBS fee schedule,589.5,90,,471.6,percent of total billed charges,90% of total billed charges,524,80,,419.2,percent of total billed charges,80% of total billed charges,589.5,90,,471.6,percent of total billed charges,90% of total billed charges,491.25,75,,393,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,189.95,29,,151.96,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,438.85,67,,351.08,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,524,80,,419.2,percent of total billed charges,80% of total billed charges,425.75,65,,340.6,percent of total billed charges,65% of total billed charges,233.64,35.67,,186.912,percent of total billed charges,35.67% of total billed charges,67.38,589.5,
CT ABDOMEN W/WO CONTRAST,3500020,CDM,350,RC,74170,HCPCS,outpatient,,,2962,1184.80,,550,,,,case rate,pays based on per visit,2280.74,77,,1824.59,percent of total billed charges,77% of total billed charges,160.68,100,,,fee schedule,100% of CMS OPPS rate,1248.54,429,,,fee schedule,429% of BCBS fee schedule,1301.61,515,,,fee schedule,515% of BCBS fee schedule,1301.61,364,,,fee schedule,364% of BCBS fee schedule,1301.61,515,,,fee schedule,515% of BCBS fee schedule,2665.8,90,,2132.64,percent of total billed charges,90% of total billed charges,2369.6,80,,1895.68,percent of total billed charges,80% of total billed charges,2665.8,90,,2132.64,percent of total billed charges,90% of total billed charges,2221.5,75,,1777.2,percent of total billed charges,75% of total billed charges,196.02,122,,,fee schedule,122% of HUMANA fee schedule,858.98,29,,687.184,percent of total billed charges,29% of total billed charges,160.68,100,,,fee schedule,100% of CMS OPPS rate,1984.54,67,,1587.632,percent of total billed charges,67% of total billed charges,311.42,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,2369.6,80,,1895.68,percent of total billed charges,80% of total billed charges,1925.3,65,,1540.24,percent of total billed charges,65% of total billed charges,1056.55,35.67,,845.24,percent of total billed charges,35.67% of total billed charges,160.68,2665.8,
CT ABDOMEN - LIMITED,3500030,CDM,350,RC,74150,HCPCS,outpatient,,,1488,595.20,,550,,,,case rate,pays based on per visit,1145.76,77,,916.61,percent of total billed charges,77% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,565.43,429,,,fee schedule,429% of BCBS fee schedule,589.47,515,,,fee schedule,515% of BCBS fee schedule,589.47,364,,,fee schedule,364% of BCBS fee schedule,589.47,515,,,fee schedule,515% of BCBS fee schedule,1339.2,90,,1071.36,percent of total billed charges,90% of total billed charges,1190.4,80,,952.32,percent of total billed charges,80% of total billed charges,1339.2,90,,1071.36,percent of total billed charges,90% of total billed charges,1116,75,,892.8,percent of total billed charges,75% of total billed charges,117.29,122,,,fee schedule,122% of HUMANA fee schedule,431.52,29,,345.216,percent of total billed charges,29% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,996.96,67,,797.568,percent of total billed charges,67% of total billed charges,178.87,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,1190.4,80,,952.32,percent of total billed charges,80% of total billed charges,967.2,65,,773.76,percent of total billed charges,65% of total billed charges,530.77,35.67,,424.616,percent of total billed charges,35.67% of total billed charges,96.14,1339.2,
CT ABDOMEN & PELVIS WITH CONT.,3500031,CDM,350,RC,74177,HCPCS,outpatient,,,3201,1280.40,,550,,,,case rate,pays based on per visit,2464.77,77,,1971.82,percent of total billed charges,77% of total billed charges,336.32,100,,,fee schedule,100% of CMS OPPS rate,1248.54,429,,,fee schedule,429% of BCBS fee schedule,1301.61,515,,,fee schedule,515% of BCBS fee schedule,1301.61,364,,,fee schedule,364% of BCBS fee schedule,1301.61,515,,,fee schedule,515% of BCBS fee schedule,2880.9,90,,2304.72,percent of total billed charges,90% of total billed charges,2560.8,80,,2048.64,percent of total billed charges,80% of total billed charges,2880.9,90,,2304.72,percent of total billed charges,90% of total billed charges,2400.75,75,,1920.6,percent of total billed charges,75% of total billed charges,410.31,122,,,fee schedule,122% of HUMANA fee schedule,928.29,29,,742.632,percent of total billed charges,29% of total billed charges,336.32,100,,,fee schedule,100% of CMS OPPS rate,2144.67,67,,1715.736,percent of total billed charges,67% of total billed charges,541.17,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,2560.8,80,,2048.64,percent of total billed charges,80% of total billed charges,2080.65,65,,1664.52,percent of total billed charges,65% of total billed charges,1141.8,35.67,,913.44,percent of total billed charges,35.67% of total billed charges,336.32,2880.9,
CT ABDOMEN & PELVIS W & W/O,3500032,CDM,350,RC,74178,HCPCS,outpatient,,,2599,1039.60,,550,,,,case rate,pays based on per visit,2001.23,77,,1600.98,percent of total billed charges,77% of total billed charges,336.32,100,,,fee schedule,100% of CMS OPPS rate,1248.54,429,,,fee schedule,429% of BCBS fee schedule,1301.61,515,,,fee schedule,515% of BCBS fee schedule,1301.61,364,,,fee schedule,364% of BCBS fee schedule,1301.61,515,,,fee schedule,515% of BCBS fee schedule,2339.1,90,,1871.28,percent of total billed charges,90% of total billed charges,2079.2,80,,1663.36,percent of total billed charges,80% of total billed charges,2339.1,90,,1871.28,percent of total billed charges,90% of total billed charges,1949.25,75,,1559.4,percent of total billed charges,75% of total billed charges,410.31,122,,,fee schedule,122% of HUMANA fee schedule,753.71,29,,602.968,percent of total billed charges,29% of total billed charges,336.32,100,,,fee schedule,100% of CMS OPPS rate,1741.33,67,,1393.064,percent of total billed charges,67% of total billed charges,541.17,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,2079.2,80,,1663.36,percent of total billed charges,80% of total billed charges,1689.35,65,,1351.48,percent of total billed charges,65% of total billed charges,927.06,35.67,,741.648,percent of total billed charges,35.67% of total billed charges,336.32,2339.1,
CT ABDOMEN & PELVIS WITHOUT,3500033,CDM,350,RC,74176,HCPCS,outpatient,,,2376,950.40,,550,,,,case rate,pays based on per visit,1829.52,77,,1463.62,percent of total billed charges,77% of total billed charges,214.29,100,,,fee schedule,100% of CMS OPPS rate,1147.61,429,,,fee schedule,429% of BCBS fee schedule,1196.4,515,,,fee schedule,515% of BCBS fee schedule,1196.4,364,,,fee schedule,364% of BCBS fee schedule,1196.4,515,,,fee schedule,515% of BCBS fee schedule,2138.4,90,,1710.72,percent of total billed charges,90% of total billed charges,1900.8,80,,1520.64,percent of total billed charges,80% of total billed charges,2138.4,90,,1710.72,percent of total billed charges,90% of total billed charges,1782,75,,1425.6,percent of total billed charges,75% of total billed charges,261.43,122,,,fee schedule,122% of HUMANA fee schedule,689.04,29,,551.232,percent of total billed charges,29% of total billed charges,214.29,100,,,fee schedule,100% of CMS OPPS rate,1591.92,67,,1273.536,percent of total billed charges,67% of total billed charges,377.69,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,1900.8,80,,1520.64,percent of total billed charges,80% of total billed charges,1544.4,65,,1235.52,percent of total billed charges,65% of total billed charges,847.52,35.67,,678.016,percent of total billed charges,35.67% of total billed charges,214.29,2138.4,
CT ABDOMEN WITH CONTRAS,3500040,CDM,350,RC,74160,HCPCS,outpatient,,,2882,1152.80,,550,,,,case rate,pays based on per visit,2219.14,77,,1775.31,percent of total billed charges,77% of total billed charges,160.68,100,,,fee schedule,100% of CMS OPPS rate,1248.54,429,,,fee schedule,429% of BCBS fee schedule,1301.61,515,,,fee schedule,515% of BCBS fee schedule,1301.61,364,,,fee schedule,364% of BCBS fee schedule,1301.61,515,,,fee schedule,515% of BCBS fee schedule,2593.8,90,,2075.04,percent of total billed charges,90% of total billed charges,2305.6,80,,1844.48,percent of total billed charges,80% of total billed charges,2593.8,90,,2075.04,percent of total billed charges,90% of total billed charges,2161.5,75,,1729.2,percent of total billed charges,75% of total billed charges,196.02,122,,,fee schedule,122% of HUMANA fee schedule,835.78,29,,668.624,percent of total billed charges,29% of total billed charges,160.68,100,,,fee schedule,100% of CMS OPPS rate,1930.94,67,,1544.752,percent of total billed charges,67% of total billed charges,280.11,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,2305.6,80,,1844.48,percent of total billed charges,80% of total billed charges,1873.3,65,,1498.64,percent of total billed charges,65% of total billed charges,1028.01,35.67,,822.408,percent of total billed charges,35.67% of total billed charges,160.68,2593.8,
CT ABDOMEN WITHOUT CONTRAST,3500050,CDM,350,RC,74150,HCPCS,outpatient,,,2317,926.80,,550,,,,case rate,pays based on per visit,1784.09,77,,1427.27,percent of total billed charges,77% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,565.43,429,,,fee schedule,429% of BCBS fee schedule,589.47,515,,,fee schedule,515% of BCBS fee schedule,589.47,364,,,fee schedule,364% of BCBS fee schedule,589.47,515,,,fee schedule,515% of BCBS fee schedule,2085.3,90,,1668.24,percent of total billed charges,90% of total billed charges,1853.6,80,,1482.88,percent of total billed charges,80% of total billed charges,2085.3,90,,1668.24,percent of total billed charges,90% of total billed charges,1737.75,75,,1390.2,percent of total billed charges,75% of total billed charges,117.29,122,,,fee schedule,122% of HUMANA fee schedule,671.93,29,,537.544,percent of total billed charges,29% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,1552.39,67,,1241.912,percent of total billed charges,67% of total billed charges,178.87,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,1853.6,80,,1482.88,percent of total billed charges,80% of total billed charges,1506.05,65,,1204.84,percent of total billed charges,65% of total billed charges,826.47,35.67,,661.176,percent of total billed charges,35.67% of total billed charges,96.14,2085.3,
CT ABSCESS DRAINAGE,3500060,CDM,350,RC,,,outpatient,,,1032,412.80,,550,,,,case rate,pays based on per visit,794.64,77,,635.71,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,846.24,82,,676.992,percent of total billed charges,82% of total billed charges,877.2,85,,701.76,percent of total billed charges,85% of total billed charges,877.2,85,,701.76,percent of total billed charges,85% of total billed charges,877.2,85,,701.76,percent of total billed charges,85% of total billed charges,928.8,90,,743.04,percent of total billed charges,90% of total billed charges,825.6,80,,660.48,percent of total billed charges,80% of total billed charges,928.8,90,,743.04,percent of total billed charges,90% of total billed charges,774,75,,619.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,299.28,29,,239.424,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,691.44,67,,553.152,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,825.6,80,,660.48,percent of total billed charges,80% of total billed charges,670.8,65,,536.64,percent of total billed charges,65% of total billed charges,368.11,35.67,,294.488,percent of total billed charges,35.67% of total billed charges,299.28,928.8,
CT CORONARY CALCIFICATION SCRN,3500061,CDM,350,RC,75571,HCPCS,outpatient,,,373,149.20,,550,,,,case rate,pays based on per visit,287.21,77,,229.77,percent of total billed charges,77% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,306.87,429,,,fee schedule,429% of BCBS fee schedule,319.92,515,,,fee schedule,515% of BCBS fee schedule,319.92,364,,,fee schedule,364% of BCBS fee schedule,319.92,515,,,fee schedule,515% of BCBS fee schedule,335.7,90,,268.56,percent of total billed charges,90% of total billed charges,298.4,80,,238.72,percent of total billed charges,80% of total billed charges,335.7,90,,268.56,percent of total billed charges,90% of total billed charges,279.75,75,,223.8,percent of total billed charges,75% of total billed charges,96.95,122,,,fee schedule,122% of HUMANA fee schedule,108.17,29,,86.536,percent of total billed charges,29% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,249.91,67,,199.928,percent of total billed charges,67% of total billed charges,42.55,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,298.4,80,,238.72,percent of total billed charges,80% of total billed charges,242.45,65,,193.96,percent of total billed charges,65% of total billed charges,133.05,35.67,,106.44,percent of total billed charges,35.67% of total billed charges,42.55,550,
CT IMAGING ABSCESS DRAIN,3500081,CDM,350,RC,75989,HCPCS,outpatient,,,1032,412.80,,550,,,,case rate,pays based on per visit,794.64,77,,635.71,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,245.94,385,,,fee schedule,385% of BCBS fee schedule,256.16,401,,,fee schedule,401% of BCBS fee schedule,256.16,401,,,fee schedule,401% of BCBS fee schedule,256.16,401,,,fee schedule,401% of BCBS fee schedule,928.8,90,,743.04,percent of total billed charges,90% of total billed charges,825.6,80,,660.48,percent of total billed charges,80% of total billed charges,928.8,90,,743.04,percent of total billed charges,90% of total billed charges,774,75,,619.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,299.28,29,,239.424,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,691.44,67,,553.152,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,825.6,80,,660.48,percent of total billed charges,80% of total billed charges,670.8,65,,536.64,percent of total billed charges,65% of total billed charges,368.11,35.67,,294.488,percent of total billed charges,35.67% of total billed charges,245.94,928.8,
CT CHEST W/WO CONTRAST,3500130,CDM,350,RC,71270,HCPCS,outpatient,,,2970,1188.00,,550,,,,case rate,pays based on per visit,2286.9,77,,1829.52,percent of total billed charges,77% of total billed charges,160.68,100,,,fee schedule,100% of CMS OPPS rate,1248.54,429,,,fee schedule,429% of BCBS fee schedule,1301.61,515,,,fee schedule,515% of BCBS fee schedule,1301.61,364,,,fee schedule,364% of BCBS fee schedule,1301.61,515,,,fee schedule,515% of BCBS fee schedule,2673,90,,2138.4,percent of total billed charges,90% of total billed charges,2376,80,,1900.8,percent of total billed charges,80% of total billed charges,2673,90,,2138.4,percent of total billed charges,90% of total billed charges,2227.5,75,,1782,percent of total billed charges,75% of total billed charges,196.02,122,,,fee schedule,122% of HUMANA fee schedule,861.3,29,,689.04,percent of total billed charges,29% of total billed charges,160.68,100,,,fee schedule,100% of CMS OPPS rate,1989.9,67,,1591.92,percent of total billed charges,67% of total billed charges,311.42,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,2376,80,,1900.8,percent of total billed charges,80% of total billed charges,1930.5,65,,1544.4,percent of total billed charges,65% of total billed charges,1059.4,35.67,,847.52,percent of total billed charges,35.67% of total billed charges,160.68,2673,
CT CHEST LIMITED,3500140,CDM,350,RC,76380,HCPCS,outpatient,,,1600,640.00,,550,,,,case rate,pays based on per visit,1232,77,,985.6,percent of total billed charges,77% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,306.87,429,,,fee schedule,429% of BCBS fee schedule,319.92,515,,,fee schedule,515% of BCBS fee schedule,319.92,364,,,fee schedule,364% of BCBS fee schedule,319.92,515,,,fee schedule,515% of BCBS fee schedule,1440,90,,1152,percent of total billed charges,90% of total billed charges,1280,80,,1024,percent of total billed charges,80% of total billed charges,1440,90,,1152,percent of total billed charges,90% of total billed charges,1200,75,,960,percent of total billed charges,75% of total billed charges,96.95,122,,,fee schedule,122% of HUMANA fee schedule,464,29,,371.2,percent of total billed charges,29% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,1072,67,,857.6,percent of total billed charges,67% of total billed charges,99.43,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,1280,80,,1024,percent of total billed charges,80% of total billed charges,1040,65,,832,percent of total billed charges,65% of total billed charges,570.72,35.67,,456.576,percent of total billed charges,35.67% of total billed charges,79.46,1440,
CT CHEST WITH CONTRAST,3500150,CDM,350,RC,71260,HCPCS,outpatient,,,2492,996.80,,550,,,,case rate,pays based on per visit,1918.84,77,,1535.07,percent of total billed charges,77% of total billed charges,160.68,100,,,fee schedule,100% of CMS OPPS rate,1248.54,429,,,fee schedule,429% of BCBS fee schedule,1301.61,515,,,fee schedule,515% of BCBS fee schedule,1301.61,364,,,fee schedule,364% of BCBS fee schedule,1301.61,515,,,fee schedule,515% of BCBS fee schedule,2242.8,90,,1794.24,percent of total billed charges,90% of total billed charges,1993.6,80,,1594.88,percent of total billed charges,80% of total billed charges,2242.8,90,,1794.24,percent of total billed charges,90% of total billed charges,1869,75,,1495.2,percent of total billed charges,75% of total billed charges,196.02,122,,,fee schedule,122% of HUMANA fee schedule,722.68,29,,578.144,percent of total billed charges,29% of total billed charges,160.68,100,,,fee schedule,100% of CMS OPPS rate,1669.64,67,,1335.712,percent of total billed charges,67% of total billed charges,280.11,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,1993.6,80,,1594.88,percent of total billed charges,80% of total billed charges,1619.8,65,,1295.84,percent of total billed charges,65% of total billed charges,888.9,35.67,,711.12,percent of total billed charges,35.67% of total billed charges,160.68,2242.8,
CT CHEST WITHOUT CONTRAST,3500160,CDM,350,RC,71250,HCPCS,outpatient,,,2059,823.60,,550,,,,case rate,pays based on per visit,1585.43,77,,1268.34,percent of total billed charges,77% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,565.43,429,,,fee schedule,429% of BCBS fee schedule,589.47,515,,,fee schedule,515% of BCBS fee schedule,589.47,364,,,fee schedule,364% of BCBS fee schedule,589.47,515,,,fee schedule,515% of BCBS fee schedule,1853.1,90,,1482.48,percent of total billed charges,90% of total billed charges,1647.2,80,,1317.76,percent of total billed charges,80% of total billed charges,1853.1,90,,1482.48,percent of total billed charges,90% of total billed charges,1544.25,75,,1235.4,percent of total billed charges,75% of total billed charges,117.29,122,,,fee schedule,122% of HUMANA fee schedule,597.11,29,,477.688,percent of total billed charges,29% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,1379.53,67,,1103.624,percent of total billed charges,67% of total billed charges,178.87,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,1647.2,80,,1317.76,percent of total billed charges,80% of total billed charges,1338.35,65,,1070.68,percent of total billed charges,65% of total billed charges,734.45,35.67,,587.56,percent of total billed charges,35.67% of total billed charges,96.14,1853.1,
CT CERVICAL SPINE W/WO CONTR.,3500180,CDM,350,RC,72127,HCPCS,outpatient,,,3820,1528.00,,550,,,,case rate,pays based on per visit,2941.4,77,,2353.12,percent of total billed charges,77% of total billed charges,160.68,100,,,fee schedule,100% of CMS OPPS rate,1248.54,429,,,fee schedule,429% of BCBS fee schedule,1301.61,515,,,fee schedule,515% of BCBS fee schedule,1301.61,364,,,fee schedule,364% of BCBS fee schedule,1301.61,515,,,fee schedule,515% of BCBS fee schedule,3438,90,,2750.4,percent of total billed charges,90% of total billed charges,3056,80,,2444.8,percent of total billed charges,80% of total billed charges,3438,90,,2750.4,percent of total billed charges,90% of total billed charges,2865,75,,2292,percent of total billed charges,75% of total billed charges,196.02,122,,,fee schedule,122% of HUMANA fee schedule,1107.8,29,,886.24,percent of total billed charges,29% of total billed charges,160.68,100,,,fee schedule,100% of CMS OPPS rate,2559.4,67,,2047.52,percent of total billed charges,67% of total billed charges,311.42,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,3056,80,,2444.8,percent of total billed charges,80% of total billed charges,2483,65,,1986.4,percent of total billed charges,65% of total billed charges,1362.59,35.67,,1090.072,percent of total billed charges,35.67% of total billed charges,160.68,3438,
CT CERVICAL SPINE WITH CONTR.,3500190,CDM,350,RC,72126,HCPCS,outpatient,,,3173,1269.20,,550,,,,case rate,pays based on per visit,2443.21,77,,1954.57,percent of total billed charges,77% of total billed charges,336.32,100,,,fee schedule,100% of CMS OPPS rate,2254.47,429,,,fee schedule,429% of BCBS fee schedule,2350.31,515,,,fee schedule,515% of BCBS fee schedule,2350.31,364,,,fee schedule,364% of BCBS fee schedule,2350.31,515,,,fee schedule,515% of BCBS fee schedule,2855.7,90,,2284.56,percent of total billed charges,90% of total billed charges,2538.4,80,,2030.72,percent of total billed charges,80% of total billed charges,2855.7,90,,2284.56,percent of total billed charges,90% of total billed charges,2379.75,75,,1903.8,percent of total billed charges,75% of total billed charges,410.31,122,,,fee schedule,122% of HUMANA fee schedule,920.17,29,,736.136,percent of total billed charges,29% of total billed charges,336.32,100,,,fee schedule,100% of CMS OPPS rate,2125.91,67,,1700.728,percent of total billed charges,67% of total billed charges,280.11,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,2538.4,80,,2030.72,percent of total billed charges,80% of total billed charges,2062.45,65,,1649.96,percent of total billed charges,65% of total billed charges,1131.81,35.67,,905.448,percent of total billed charges,35.67% of total billed charges,280.11,2855.7,
CT CERVICAL SPINE W/O CONTR.,3500200,CDM,350,RC,72125,HCPCS,outpatient,,,2765,1106.00,,550,,,,case rate,pays based on per visit,2129.05,77,,1703.24,percent of total billed charges,77% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,565.43,429,,,fee schedule,429% of BCBS fee schedule,589.47,515,,,fee schedule,515% of BCBS fee schedule,589.47,364,,,fee schedule,364% of BCBS fee schedule,589.47,515,,,fee schedule,515% of BCBS fee schedule,2488.5,90,,1990.8,percent of total billed charges,90% of total billed charges,2212,80,,1769.6,percent of total billed charges,80% of total billed charges,2488.5,90,,1990.8,percent of total billed charges,90% of total billed charges,2073.75,75,,1659,percent of total billed charges,75% of total billed charges,117.29,122,,,fee schedule,122% of HUMANA fee schedule,801.85,29,,641.48,percent of total billed charges,29% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,1852.55,67,,1482.04,percent of total billed charges,67% of total billed charges,178.87,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,2212,80,,1769.6,percent of total billed charges,80% of total billed charges,1797.25,65,,1437.8,percent of total billed charges,65% of total billed charges,986.28,35.67,,789.024,percent of total billed charges,35.67% of total billed charges,96.14,2488.5,
CT GUIDANCE NEEDLE,3500210,CDM,350,RC,77012,HCPCS,outpatient,,,1367,546.80,,550,,,,case rate,pays based on per visit,1052.59,77,,842.07,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,262.53,385,,,fee schedule,385% of BCBS fee schedule,273.44,401,,,fee schedule,401% of BCBS fee schedule,273.44,401,,,fee schedule,401% of BCBS fee schedule,273.44,401,,,fee schedule,401% of BCBS fee schedule,1230.3,90,,984.24,percent of total billed charges,90% of total billed charges,1093.6,80,,874.88,percent of total billed charges,80% of total billed charges,1230.3,90,,984.24,percent of total billed charges,90% of total billed charges,1025.25,75,,820.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,396.43,29,,317.144,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,915.89,67,,732.712,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1093.6,80,,874.88,percent of total billed charges,80% of total billed charges,888.55,65,,710.84,percent of total billed charges,65% of total billed charges,487.61,35.67,,390.088,percent of total billed charges,35.67% of total billed charges,262.53,1230.3,
CT HEAD WITH/WITHOUT CONTRAST,3500230,CDM,350,RC,70470,HCPCS,outpatient,,,2984,1193.60,,550,,,,case rate,pays based on per visit,2297.68,77,,1838.14,percent of total billed charges,77% of total billed charges,160.68,100,,,fee schedule,100% of CMS OPPS rate,1248.54,429,,,fee schedule,429% of BCBS fee schedule,1301.61,515,,,fee schedule,515% of BCBS fee schedule,1301.61,364,,,fee schedule,364% of BCBS fee schedule,1301.61,515,,,fee schedule,515% of BCBS fee schedule,2685.6,90,,2148.48,percent of total billed charges,90% of total billed charges,2387.2,80,,1909.76,percent of total billed charges,80% of total billed charges,2685.6,90,,2148.48,percent of total billed charges,90% of total billed charges,2238,75,,1790.4,percent of total billed charges,75% of total billed charges,196.02,122,,,fee schedule,122% of HUMANA fee schedule,865.36,29,,692.288,percent of total billed charges,29% of total billed charges,160.68,100,,,fee schedule,100% of CMS OPPS rate,1999.28,67,,1599.424,percent of total billed charges,67% of total billed charges,311.42,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,2387.2,80,,1909.76,percent of total billed charges,80% of total billed charges,1939.6,65,,1551.68,percent of total billed charges,65% of total billed charges,1064.39,35.67,,851.512,percent of total billed charges,35.67% of total billed charges,160.68,2685.6,
CT HEAD WO CONT LIMITED,3500240,CDM,350,RC,70450,HCPCS,outpatient,,,2106,842.40,,550,,,,case rate,pays based on per visit,1621.62,77,,1297.3,percent of total billed charges,77% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,565.43,429,,,fee schedule,429% of BCBS fee schedule,589.47,515,,,fee schedule,515% of BCBS fee schedule,589.47,364,,,fee schedule,364% of BCBS fee schedule,589.47,515,,,fee schedule,515% of BCBS fee schedule,1895.4,90,,1516.32,percent of total billed charges,90% of total billed charges,1684.8,80,,1347.84,percent of total billed charges,80% of total billed charges,1895.4,90,,1516.32,percent of total billed charges,90% of total billed charges,1579.5,75,,1263.6,percent of total billed charges,75% of total billed charges,117.29,122,,,fee schedule,122% of HUMANA fee schedule,610.74,29,,488.592,percent of total billed charges,29% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,1411.02,67,,1128.816,percent of total billed charges,67% of total billed charges,178.87,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,1684.8,80,,1347.84,percent of total billed charges,80% of total billed charges,1368.9,65,,1095.12,percent of total billed charges,65% of total billed charges,751.21,35.67,,600.968,percent of total billed charges,35.67% of total billed charges,96.14,1895.4,
CT HEAD WITH CONTRAST,3500250,CDM,350,RC,70460,HCPCS,outpatient,,,2561,1024.40,,550,,,,case rate,pays based on per visit,1971.97,77,,1577.58,percent of total billed charges,77% of total billed charges,160.68,100,,,fee schedule,100% of CMS OPPS rate,1248.54,429,,,fee schedule,429% of BCBS fee schedule,1301.61,515,,,fee schedule,515% of BCBS fee schedule,1301.61,364,,,fee schedule,364% of BCBS fee schedule,1301.61,515,,,fee schedule,515% of BCBS fee schedule,2304.9,90,,1843.92,percent of total billed charges,90% of total billed charges,2048.8,80,,1639.04,percent of total billed charges,80% of total billed charges,2304.9,90,,1843.92,percent of total billed charges,90% of total billed charges,1920.75,75,,1536.6,percent of total billed charges,75% of total billed charges,196.02,122,,,fee schedule,122% of HUMANA fee schedule,742.69,29,,594.152,percent of total billed charges,29% of total billed charges,160.68,100,,,fee schedule,100% of CMS OPPS rate,1715.87,67,,1372.696,percent of total billed charges,67% of total billed charges,280.11,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,2048.8,80,,1639.04,percent of total billed charges,80% of total billed charges,1664.65,65,,1331.72,percent of total billed charges,65% of total billed charges,913.51,35.67,,730.808,percent of total billed charges,35.67% of total billed charges,160.68,2304.9,
CT HEAD WITHOUT CONTRAST,3500260,CDM,350,RC,70450,HCPCS,outpatient,,,2206,882.40,,550,,,,case rate,pays based on per visit,1698.62,77,,1358.9,percent of total billed charges,77% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,565.43,429,,,fee schedule,429% of BCBS fee schedule,589.47,515,,,fee schedule,515% of BCBS fee schedule,589.47,364,,,fee schedule,364% of BCBS fee schedule,589.47,515,,,fee schedule,515% of BCBS fee schedule,1985.4,90,,1588.32,percent of total billed charges,90% of total billed charges,1764.8,80,,1411.84,percent of total billed charges,80% of total billed charges,1985.4,90,,1588.32,percent of total billed charges,90% of total billed charges,1654.5,75,,1323.6,percent of total billed charges,75% of total billed charges,117.29,122,,,fee schedule,122% of HUMANA fee schedule,639.74,29,,511.792,percent of total billed charges,29% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,1478.02,67,,1182.416,percent of total billed charges,67% of total billed charges,178.87,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,1764.8,80,,1411.84,percent of total billed charges,80% of total billed charges,1433.9,65,,1147.12,percent of total billed charges,65% of total billed charges,786.88,35.67,,629.504,percent of total billed charges,35.67% of total billed charges,96.14,1985.4,
CT EAR - CANAL/OUTER NO CONTRA,3500265,CDM,350,RC,70480,HCPCS,outpatient,,,1644,657.60,,550,,,,case rate,pays based on per visit,1265.88,77,,1012.7,percent of total billed charges,77% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,565.43,429,,,fee schedule,429% of BCBS fee schedule,589.47,515,,,fee schedule,515% of BCBS fee schedule,589.47,364,,,fee schedule,364% of BCBS fee schedule,589.47,515,,,fee schedule,515% of BCBS fee schedule,1479.6,90,,1183.68,percent of total billed charges,90% of total billed charges,1315.2,80,,1052.16,percent of total billed charges,80% of total billed charges,1479.6,90,,1183.68,percent of total billed charges,90% of total billed charges,1233,75,,986.4,percent of total billed charges,75% of total billed charges,117.29,122,,,fee schedule,122% of HUMANA fee schedule,476.76,29,,381.408,percent of total billed charges,29% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,1101.48,67,,881.184,percent of total billed charges,67% of total billed charges,178.87,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,1315.2,80,,1052.16,percent of total billed charges,80% of total billed charges,1068.6,65,,854.88,percent of total billed charges,65% of total billed charges,586.41,35.67,,469.128,percent of total billed charges,35.67% of total billed charges,96.14,1479.6,
"CT EAR, ORBIT ETC. WITH CONT.",3500266,CDM,350,RC,70481,HCPCS,outpatient,,,1778,711.20,,550,,,,case rate,pays based on per visit,1369.06,77,,1095.25,percent of total billed charges,77% of total billed charges,160.68,100,,,fee schedule,100% of CMS OPPS rate,1248.54,429,,,fee schedule,429% of BCBS fee schedule,1301.61,515,,,fee schedule,515% of BCBS fee schedule,1301.61,364,,,fee schedule,364% of BCBS fee schedule,1301.61,515,,,fee schedule,515% of BCBS fee schedule,1600.2,90,,1280.16,percent of total billed charges,90% of total billed charges,1422.4,80,,1137.92,percent of total billed charges,80% of total billed charges,1600.2,90,,1280.16,percent of total billed charges,90% of total billed charges,1333.5,75,,1066.8,percent of total billed charges,75% of total billed charges,196.02,122,,,fee schedule,122% of HUMANA fee schedule,515.62,29,,412.496,percent of total billed charges,29% of total billed charges,160.68,100,,,fee schedule,100% of CMS OPPS rate,1191.26,67,,953.008,percent of total billed charges,67% of total billed charges,280.11,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,1422.4,80,,1137.92,percent of total billed charges,80% of total billed charges,1155.7,65,,924.56,percent of total billed charges,65% of total billed charges,634.21,35.67,,507.368,percent of total billed charges,35.67% of total billed charges,160.68,1600.2,
CT LOWER EXTREMITY WITH CONTR.,3500290,CDM,350,RC,73701,HCPCS,outpatient,,,1509,603.60,,550,,,,case rate,pays based on per visit,1161.93,77,,929.54,percent of total billed charges,77% of total billed charges,160.68,100,,,fee schedule,100% of CMS OPPS rate,1248.54,429,,,fee schedule,429% of BCBS fee schedule,1301.61,515,,,fee schedule,515% of BCBS fee schedule,1301.61,364,,,fee schedule,364% of BCBS fee schedule,1301.61,515,,,fee schedule,515% of BCBS fee schedule,1358.1,90,,1086.48,percent of total billed charges,90% of total billed charges,1207.2,80,,965.76,percent of total billed charges,80% of total billed charges,1358.1,90,,1086.48,percent of total billed charges,90% of total billed charges,1131.75,75,,905.4,percent of total billed charges,75% of total billed charges,196.02,122,,,fee schedule,122% of HUMANA fee schedule,437.61,29,,350.088,percent of total billed charges,29% of total billed charges,160.68,100,,,fee schedule,100% of CMS OPPS rate,1011.03,67,,808.824,percent of total billed charges,67% of total billed charges,280.11,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,1207.2,80,,965.76,percent of total billed charges,80% of total billed charges,980.85,65,,784.68,percent of total billed charges,65% of total billed charges,538.26,35.67,,430.608,percent of total billed charges,35.67% of total billed charges,160.68,1358.1,
CT LOWER EXT. WITHOUT CONTRAST,3500300,CDM,350,RC,73700,HCPCS,outpatient,,,1672,668.80,,550,,,,case rate,pays based on per visit,1287.44,77,,1029.95,percent of total billed charges,77% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,565.43,429,,,fee schedule,429% of BCBS fee schedule,589.47,515,,,fee schedule,515% of BCBS fee schedule,589.47,364,,,fee schedule,364% of BCBS fee schedule,589.47,515,,,fee schedule,515% of BCBS fee schedule,1504.8,90,,1203.84,percent of total billed charges,90% of total billed charges,1337.6,80,,1070.08,percent of total billed charges,80% of total billed charges,1504.8,90,,1203.84,percent of total billed charges,90% of total billed charges,1254,75,,1003.2,percent of total billed charges,75% of total billed charges,117.29,122,,,fee schedule,122% of HUMANA fee schedule,484.88,29,,387.904,percent of total billed charges,29% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,1120.24,67,,896.192,percent of total billed charges,67% of total billed charges,178.87,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,1337.6,80,,1070.08,percent of total billed charges,80% of total billed charges,1086.8,65,,869.44,percent of total billed charges,65% of total billed charges,596.4,35.67,,477.12,percent of total billed charges,35.67% of total billed charges,96.14,1504.8,
CT LOWER EXT W/WO CONTRAST,3500310,CDM,350,RC,73702,HCPCS,outpatient,,,1667,666.80,,550,,,,case rate,pays based on per visit,1283.59,77,,1026.87,percent of total billed charges,77% of total billed charges,160.68,100,,,fee schedule,100% of CMS OPPS rate,1248.54,429,,,fee schedule,429% of BCBS fee schedule,1301.61,515,,,fee schedule,515% of BCBS fee schedule,1301.61,364,,,fee schedule,364% of BCBS fee schedule,1301.61,515,,,fee schedule,515% of BCBS fee schedule,1500.3,90,,1200.24,percent of total billed charges,90% of total billed charges,1333.6,80,,1066.88,percent of total billed charges,80% of total billed charges,1500.3,90,,1200.24,percent of total billed charges,90% of total billed charges,1250.25,75,,1000.2,percent of total billed charges,75% of total billed charges,196.02,122,,,fee schedule,122% of HUMANA fee schedule,483.43,29,,386.744,percent of total billed charges,29% of total billed charges,160.68,100,,,fee schedule,100% of CMS OPPS rate,1116.89,67,,893.512,percent of total billed charges,67% of total billed charges,311.42,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,1333.6,80,,1066.88,percent of total billed charges,80% of total billed charges,1083.55,65,,866.84,percent of total billed charges,65% of total billed charges,594.62,35.67,,475.696,percent of total billed charges,35.67% of total billed charges,160.68,1500.3,
CT LUMBAR SPINE W/O CONTRAST,3500340,CDM,350,RC,72131,HCPCS,outpatient,,,2376,950.40,,550,,,,case rate,pays based on per visit,1829.52,77,,1463.62,percent of total billed charges,77% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,565.43,429,,,fee schedule,429% of BCBS fee schedule,589.47,515,,,fee schedule,515% of BCBS fee schedule,589.47,364,,,fee schedule,364% of BCBS fee schedule,589.47,515,,,fee schedule,515% of BCBS fee schedule,2138.4,90,,1710.72,percent of total billed charges,90% of total billed charges,1900.8,80,,1520.64,percent of total billed charges,80% of total billed charges,2138.4,90,,1710.72,percent of total billed charges,90% of total billed charges,1782,75,,1425.6,percent of total billed charges,75% of total billed charges,117.29,122,,,fee schedule,122% of HUMANA fee schedule,689.04,29,,551.232,percent of total billed charges,29% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,1591.92,67,,1273.536,percent of total billed charges,67% of total billed charges,178.87,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,1900.8,80,,1520.64,percent of total billed charges,80% of total billed charges,1544.4,65,,1235.52,percent of total billed charges,65% of total billed charges,847.52,35.67,,678.016,percent of total billed charges,35.67% of total billed charges,96.14,2138.4,
CT LUMBAR WITH CONTRAST,3500345,CDM,350,RC,72132,HCPCS,outpatient,,,1149,459.60,,550,,,,case rate,pays based on per visit,884.73,77,,707.78,percent of total billed charges,77% of total billed charges,336.32,100,,,fee schedule,100% of CMS OPPS rate,2254.47,429,,,fee schedule,429% of BCBS fee schedule,2350.31,515,,,fee schedule,515% of BCBS fee schedule,2350.31,364,,,fee schedule,364% of BCBS fee schedule,2350.31,515,,,fee schedule,515% of BCBS fee schedule,1034.1,90,,827.28,percent of total billed charges,90% of total billed charges,919.2,80,,735.36,percent of total billed charges,80% of total billed charges,1034.1,90,,827.28,percent of total billed charges,90% of total billed charges,861.75,75,,689.4,percent of total billed charges,75% of total billed charges,410.31,122,,,fee schedule,122% of HUMANA fee schedule,333.21,29,,266.568,percent of total billed charges,29% of total billed charges,336.32,100,,,fee schedule,100% of CMS OPPS rate,769.83,67,,615.864,percent of total billed charges,67% of total billed charges,280.11,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,919.2,80,,735.36,percent of total billed charges,80% of total billed charges,746.85,65,,597.48,percent of total billed charges,65% of total billed charges,409.85,35.67,,327.88,percent of total billed charges,35.67% of total billed charges,280.11,2350.31,
CT MAXILLO FACIAL W/WO CONTR.,3500360,CDM,350,RC,70488,HCPCS,outpatient,,,1481,592.40,,550,,,,case rate,pays based on per visit,1140.37,77,,912.3,percent of total billed charges,77% of total billed charges,160.68,100,,,fee schedule,100% of CMS OPPS rate,1248.54,429,,,fee schedule,429% of BCBS fee schedule,1301.61,515,,,fee schedule,515% of BCBS fee schedule,1301.61,364,,,fee schedule,364% of BCBS fee schedule,1301.61,515,,,fee schedule,515% of BCBS fee schedule,1332.9,90,,1066.32,percent of total billed charges,90% of total billed charges,1184.8,80,,947.84,percent of total billed charges,80% of total billed charges,1332.9,90,,1066.32,percent of total billed charges,90% of total billed charges,1110.75,75,,888.6,percent of total billed charges,75% of total billed charges,196.02,122,,,fee schedule,122% of HUMANA fee schedule,429.49,29,,343.592,percent of total billed charges,29% of total billed charges,160.68,100,,,fee schedule,100% of CMS OPPS rate,992.27,67,,793.816,percent of total billed charges,67% of total billed charges,311.42,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,1184.8,80,,947.84,percent of total billed charges,80% of total billed charges,962.65,65,,770.12,percent of total billed charges,65% of total billed charges,528.27,35.67,,422.616,percent of total billed charges,35.67% of total billed charges,160.68,1332.9,
CT MAXILLO FACIAL WITH CONTR.,3500370,CDM,350,RC,70487,HCPCS,outpatient,,,1774,709.60,,550,,,,case rate,pays based on per visit,1365.98,77,,1092.78,percent of total billed charges,77% of total billed charges,160.68,100,,,fee schedule,100% of CMS OPPS rate,1248.54,429,,,fee schedule,429% of BCBS fee schedule,1301.61,515,,,fee schedule,515% of BCBS fee schedule,1301.61,364,,,fee schedule,364% of BCBS fee schedule,1301.61,515,,,fee schedule,515% of BCBS fee schedule,1596.6,90,,1277.28,percent of total billed charges,90% of total billed charges,1419.2,80,,1135.36,percent of total billed charges,80% of total billed charges,1596.6,90,,1277.28,percent of total billed charges,90% of total billed charges,1330.5,75,,1064.4,percent of total billed charges,75% of total billed charges,196.02,122,,,fee schedule,122% of HUMANA fee schedule,514.46,29,,411.568,percent of total billed charges,29% of total billed charges,160.68,100,,,fee schedule,100% of CMS OPPS rate,1188.58,67,,950.864,percent of total billed charges,67% of total billed charges,280.11,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,1419.2,80,,1135.36,percent of total billed charges,80% of total billed charges,1153.1,65,,922.48,percent of total billed charges,65% of total billed charges,632.79,35.67,,506.232,percent of total billed charges,35.67% of total billed charges,160.68,1596.6,
MYELOGRAM INJ LUMBAR SPINE,3500371,CDM,350,RC,62304,HCPCS,outpatient,,,879,351.60,,1150,,,,case rate,pays based on per visit,676.83,77,,541.46,percent of total billed charges,77% of total billed charges,700.21,100,,,fee schedule,100% of CMS OPPS rate,2925.27,429,,,fee schedule,429% of BCBS fee schedule,3048,447,,,fee schedule,447% of BCBS fee schedule,3048,447,,,fee schedule,447% of BCBS fee schedule,3048,447,,,fee schedule,447% of BCBS fee schedule,791.1,90,,632.88,percent of total billed charges,90% of total billed charges,703.2,80,,562.56,percent of total billed charges,80% of total billed charges,791.1,90,,632.88,percent of total billed charges,90% of total billed charges,659.25,75,,527.4,percent of total billed charges,75% of total billed charges,854.26,122,,,fee schedule,122% of HUMANA fee schedule,254.91,29,,203.928,percent of total billed charges,29% of total billed charges,700.21,100,,,fee schedule,100% of CMS OPPS rate,588.93,67,,471.144,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,703.2,80,,562.56,percent of total billed charges,80% of total billed charges,571.35,65,,457.08,percent of total billed charges,65% of total billed charges,313.54,35.67,,250.832,percent of total billed charges,35.67% of total billed charges,254.91,3048,
MYELOGRAM VIA L/S FOR CERVICAL,3500372,CDM,350,RC,62302,HCPCS,outpatient,,,863,345.20,,1150,,,,case rate,pays based on per visit,664.51,77,,531.61,percent of total billed charges,77% of total billed charges,700.21,100,,,fee schedule,100% of CMS OPPS rate,2925.27,429,,,fee schedule,429% of BCBS fee schedule,3048,447,,,fee schedule,447% of BCBS fee schedule,3048,447,,,fee schedule,447% of BCBS fee schedule,3048,447,,,fee schedule,447% of BCBS fee schedule,776.7,90,,621.36,percent of total billed charges,90% of total billed charges,690.4,80,,552.32,percent of total billed charges,80% of total billed charges,776.7,90,,621.36,percent of total billed charges,90% of total billed charges,647.25,75,,517.8,percent of total billed charges,75% of total billed charges,854.26,122,,,fee schedule,122% of HUMANA fee schedule,250.27,29,,200.216,percent of total billed charges,29% of total billed charges,700.21,100,,,fee schedule,100% of CMS OPPS rate,578.21,67,,462.568,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,690.4,80,,552.32,percent of total billed charges,80% of total billed charges,560.95,65,,448.76,percent of total billed charges,65% of total billed charges,307.83,35.67,,246.264,percent of total billed charges,35.67% of total billed charges,250.27,3048,
CT ORBITS WITHOUT CONTRAST,3500375,CDM,350,RC,70480,HCPCS,outpatient,,,1675,670.00,,550,,,,case rate,pays based on per visit,1289.75,77,,1031.8,percent of total billed charges,77% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,565.43,429,,,fee schedule,429% of BCBS fee schedule,589.47,515,,,fee schedule,515% of BCBS fee schedule,589.47,364,,,fee schedule,364% of BCBS fee schedule,589.47,515,,,fee schedule,515% of BCBS fee schedule,1507.5,90,,1206,percent of total billed charges,90% of total billed charges,1340,80,,1072,percent of total billed charges,80% of total billed charges,1507.5,90,,1206,percent of total billed charges,90% of total billed charges,1256.25,75,,1005,percent of total billed charges,75% of total billed charges,117.29,122,,,fee schedule,122% of HUMANA fee schedule,485.75,29,,388.6,percent of total billed charges,29% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,1122.25,67,,897.8,percent of total billed charges,67% of total billed charges,178.87,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,1340,80,,1072,percent of total billed charges,80% of total billed charges,1088.75,65,,871,percent of total billed charges,65% of total billed charges,597.47,35.67,,477.976,percent of total billed charges,35.67% of total billed charges,96.14,1507.5,
CT ORBITS WITH CONTRAST,3500376,CDM,350,RC,70481,HCPCS,outpatient,,,1778,711.20,,550,,,,case rate,pays based on per visit,1369.06,77,,1095.25,percent of total billed charges,77% of total billed charges,160.68,100,,,fee schedule,100% of CMS OPPS rate,1248.54,429,,,fee schedule,429% of BCBS fee schedule,1301.61,515,,,fee schedule,515% of BCBS fee schedule,1301.61,364,,,fee schedule,364% of BCBS fee schedule,1301.61,515,,,fee schedule,515% of BCBS fee schedule,1600.2,90,,1280.16,percent of total billed charges,90% of total billed charges,1422.4,80,,1137.92,percent of total billed charges,80% of total billed charges,1600.2,90,,1280.16,percent of total billed charges,90% of total billed charges,1333.5,75,,1066.8,percent of total billed charges,75% of total billed charges,196.02,122,,,fee schedule,122% of HUMANA fee schedule,515.62,29,,412.496,percent of total billed charges,29% of total billed charges,160.68,100,,,fee schedule,100% of CMS OPPS rate,1191.26,67,,953.008,percent of total billed charges,67% of total billed charges,280.11,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,1422.4,80,,1137.92,percent of total billed charges,80% of total billed charges,1155.7,65,,924.56,percent of total billed charges,65% of total billed charges,634.21,35.67,,507.368,percent of total billed charges,35.67% of total billed charges,160.68,1600.2,
CT ORBITS W/WITHOUT CONTRAST,3500377,CDM,350,RC,70482,HCPCS,outpatient,,,1478,591.20,,550,,,,case rate,pays based on per visit,1138.06,77,,910.45,percent of total billed charges,77% of total billed charges,160.68,100,,,fee schedule,100% of CMS OPPS rate,1248.54,429,,,fee schedule,429% of BCBS fee schedule,1301.61,515,,,fee schedule,515% of BCBS fee schedule,1301.61,364,,,fee schedule,364% of BCBS fee schedule,1301.61,515,,,fee schedule,515% of BCBS fee schedule,1330.2,90,,1064.16,percent of total billed charges,90% of total billed charges,1182.4,80,,945.92,percent of total billed charges,80% of total billed charges,1330.2,90,,1064.16,percent of total billed charges,90% of total billed charges,1108.5,75,,886.8,percent of total billed charges,75% of total billed charges,196.02,122,,,fee schedule,122% of HUMANA fee schedule,428.62,29,,342.896,percent of total billed charges,29% of total billed charges,160.68,100,,,fee schedule,100% of CMS OPPS rate,990.26,67,,792.208,percent of total billed charges,67% of total billed charges,311.42,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,1182.4,80,,945.92,percent of total billed charges,80% of total billed charges,960.7,65,,768.56,percent of total billed charges,65% of total billed charges,527.2,35.67,,421.76,percent of total billed charges,35.67% of total billed charges,160.68,1330.2,
CT MAXILLO FACIAL W/O CONTR.,3500380,CDM,350,RC,70486,HCPCS,outpatient,,,2072,828.80,,550,,,,case rate,pays based on per visit,1595.44,77,,1276.35,percent of total billed charges,77% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,565.43,429,,,fee schedule,429% of BCBS fee schedule,589.47,515,,,fee schedule,515% of BCBS fee schedule,589.47,364,,,fee schedule,364% of BCBS fee schedule,589.47,515,,,fee schedule,515% of BCBS fee schedule,1864.8,90,,1491.84,percent of total billed charges,90% of total billed charges,1657.6,80,,1326.08,percent of total billed charges,80% of total billed charges,1864.8,90,,1491.84,percent of total billed charges,90% of total billed charges,1554,75,,1243.2,percent of total billed charges,75% of total billed charges,117.29,122,,,fee schedule,122% of HUMANA fee schedule,600.88,29,,480.704,percent of total billed charges,29% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,1388.24,67,,1110.592,percent of total billed charges,67% of total billed charges,178.87,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,1657.6,80,,1326.08,percent of total billed charges,80% of total billed charges,1346.8,65,,1077.44,percent of total billed charges,65% of total billed charges,739.08,35.67,,591.264,percent of total billed charges,35.67% of total billed charges,96.14,1864.8,
CT SOFT TISSUE NECK W/O CONT.,3500390,CDM,350,RC,70490,HCPCS,outpatient,,,1829,731.60,,550,,,,case rate,pays based on per visit,1408.33,77,,1126.66,percent of total billed charges,77% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,565.43,429,,,fee schedule,429% of BCBS fee schedule,589.47,515,,,fee schedule,515% of BCBS fee schedule,589.47,364,,,fee schedule,364% of BCBS fee schedule,589.47,515,,,fee schedule,515% of BCBS fee schedule,1646.1,90,,1316.88,percent of total billed charges,90% of total billed charges,1463.2,80,,1170.56,percent of total billed charges,80% of total billed charges,1646.1,90,,1316.88,percent of total billed charges,90% of total billed charges,1371.75,75,,1097.4,percent of total billed charges,75% of total billed charges,117.29,122,,,fee schedule,122% of HUMANA fee schedule,530.41,29,,424.328,percent of total billed charges,29% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,1225.43,67,,980.344,percent of total billed charges,67% of total billed charges,178.87,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,1463.2,80,,1170.56,percent of total billed charges,80% of total billed charges,1188.85,65,,951.08,percent of total billed charges,65% of total billed charges,652.4,35.67,,521.92,percent of total billed charges,35.67% of total billed charges,96.14,1646.1,
CT SOFT TISSUE NECK W/WO CONT,3500400,CDM,350,RC,70492,HCPCS,outpatient,,,2486,994.40,,550,,,,case rate,pays based on per visit,1914.22,77,,1531.38,percent of total billed charges,77% of total billed charges,160.68,100,,,fee schedule,100% of CMS OPPS rate,1248.54,429,,,fee schedule,429% of BCBS fee schedule,1301.61,515,,,fee schedule,515% of BCBS fee schedule,1301.61,364,,,fee schedule,364% of BCBS fee schedule,1301.61,515,,,fee schedule,515% of BCBS fee schedule,2237.4,90,,1789.92,percent of total billed charges,90% of total billed charges,1988.8,80,,1591.04,percent of total billed charges,80% of total billed charges,2237.4,90,,1789.92,percent of total billed charges,90% of total billed charges,1864.5,75,,1491.6,percent of total billed charges,75% of total billed charges,196.02,122,,,fee schedule,122% of HUMANA fee schedule,720.94,29,,576.752,percent of total billed charges,29% of total billed charges,160.68,100,,,fee schedule,100% of CMS OPPS rate,1665.62,67,,1332.496,percent of total billed charges,67% of total billed charges,311.42,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,1988.8,80,,1591.04,percent of total billed charges,80% of total billed charges,1615.9,65,,1292.72,percent of total billed charges,65% of total billed charges,886.76,35.67,,709.408,percent of total billed charges,35.67% of total billed charges,160.68,2237.4,
CT SOFT TISSUE NECK W/ CONTR.,3500410,CDM,350,RC,70491,HCPCS,outpatient,,,2194,877.60,,550,,,,case rate,pays based on per visit,1689.38,77,,1351.5,percent of total billed charges,77% of total billed charges,160.68,100,,,fee schedule,100% of CMS OPPS rate,1248.54,429,,,fee schedule,429% of BCBS fee schedule,1301.61,515,,,fee schedule,515% of BCBS fee schedule,1301.61,364,,,fee schedule,364% of BCBS fee schedule,1301.61,515,,,fee schedule,515% of BCBS fee schedule,1974.6,90,,1579.68,percent of total billed charges,90% of total billed charges,1755.2,80,,1404.16,percent of total billed charges,80% of total billed charges,1974.6,90,,1579.68,percent of total billed charges,90% of total billed charges,1645.5,75,,1316.4,percent of total billed charges,75% of total billed charges,196.02,122,,,fee schedule,122% of HUMANA fee schedule,636.26,29,,509.008,percent of total billed charges,29% of total billed charges,160.68,100,,,fee schedule,100% of CMS OPPS rate,1469.98,67,,1175.984,percent of total billed charges,67% of total billed charges,280.11,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,1755.2,80,,1404.16,percent of total billed charges,80% of total billed charges,1426.1,65,,1140.88,percent of total billed charges,65% of total billed charges,782.6,35.67,,626.08,percent of total billed charges,35.67% of total billed charges,160.68,1974.6,
CT PELVIS WITH CONTRAST,3500430,CDM,350,RC,72193,HCPCS,outpatient,,,2161,864.40,,550,,,,case rate,pays based on per visit,1663.97,77,,1331.18,percent of total billed charges,77% of total billed charges,160.68,100,,,fee schedule,100% of CMS OPPS rate,1248.54,429,,,fee schedule,429% of BCBS fee schedule,1301.61,515,,,fee schedule,515% of BCBS fee schedule,1301.61,364,,,fee schedule,364% of BCBS fee schedule,1301.61,515,,,fee schedule,515% of BCBS fee schedule,1944.9,90,,1555.92,percent of total billed charges,90% of total billed charges,1728.8,80,,1383.04,percent of total billed charges,80% of total billed charges,1944.9,90,,1555.92,percent of total billed charges,90% of total billed charges,1620.75,75,,1296.6,percent of total billed charges,75% of total billed charges,196.02,122,,,fee schedule,122% of HUMANA fee schedule,626.69,29,,501.352,percent of total billed charges,29% of total billed charges,160.68,100,,,fee schedule,100% of CMS OPPS rate,1447.87,67,,1158.296,percent of total billed charges,67% of total billed charges,280.11,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,1728.8,80,,1383.04,percent of total billed charges,80% of total billed charges,1404.65,65,,1123.72,percent of total billed charges,65% of total billed charges,770.83,35.67,,616.664,percent of total billed charges,35.67% of total billed charges,160.68,1944.9,
CT PELVIS W/WO CONTRAST,3500440,CDM,350,RC,72194,HCPCS,outpatient,,,2244,897.60,,550,,,,case rate,pays based on per visit,1727.88,77,,1382.3,percent of total billed charges,77% of total billed charges,160.68,100,,,fee schedule,100% of CMS OPPS rate,1248.54,429,,,fee schedule,429% of BCBS fee schedule,1301.61,515,,,fee schedule,515% of BCBS fee schedule,1301.61,364,,,fee schedule,364% of BCBS fee schedule,1301.61,515,,,fee schedule,515% of BCBS fee schedule,2019.6,90,,1615.68,percent of total billed charges,90% of total billed charges,1795.2,80,,1436.16,percent of total billed charges,80% of total billed charges,2019.6,90,,1615.68,percent of total billed charges,90% of total billed charges,1683,75,,1346.4,percent of total billed charges,75% of total billed charges,196.02,122,,,fee schedule,122% of HUMANA fee schedule,650.76,29,,520.608,percent of total billed charges,29% of total billed charges,160.68,100,,,fee schedule,100% of CMS OPPS rate,1503.48,67,,1202.784,percent of total billed charges,67% of total billed charges,311.42,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,1795.2,80,,1436.16,percent of total billed charges,80% of total billed charges,1458.6,65,,1166.88,percent of total billed charges,65% of total billed charges,800.43,35.67,,640.344,percent of total billed charges,35.67% of total billed charges,160.68,2019.6,
CT PELVIS WITHOUT CONTRAST,3500470,CDM,350,RC,72192,HCPCS,outpatient,,,1725,690.00,,550,,,,case rate,pays based on per visit,1328.25,77,,1062.6,percent of total billed charges,77% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,565.43,429,,,fee schedule,429% of BCBS fee schedule,589.47,515,,,fee schedule,515% of BCBS fee schedule,589.47,364,,,fee schedule,364% of BCBS fee schedule,589.47,515,,,fee schedule,515% of BCBS fee schedule,1552.5,90,,1242,percent of total billed charges,90% of total billed charges,1380,80,,1104,percent of total billed charges,80% of total billed charges,1552.5,90,,1242,percent of total billed charges,90% of total billed charges,1293.75,75,,1035,percent of total billed charges,75% of total billed charges,117.29,122,,,fee schedule,122% of HUMANA fee schedule,500.25,29,,400.2,percent of total billed charges,29% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,1155.75,67,,924.6,percent of total billed charges,67% of total billed charges,178.87,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,1380,80,,1104,percent of total billed charges,80% of total billed charges,1121.25,65,,897,percent of total billed charges,65% of total billed charges,615.31,35.67,,492.248,percent of total billed charges,35.67% of total billed charges,96.14,1552.5,
CT SINUSES W/O CONTRAST,3500500,CDM,350,RC,70486,HCPCS,outpatient,,,2152,860.80,,550,,,,case rate,pays based on per visit,1657.04,77,,1325.63,percent of total billed charges,77% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,565.43,429,,,fee schedule,429% of BCBS fee schedule,589.47,515,,,fee schedule,515% of BCBS fee schedule,589.47,364,,,fee schedule,364% of BCBS fee schedule,589.47,515,,,fee schedule,515% of BCBS fee schedule,1936.8,90,,1549.44,percent of total billed charges,90% of total billed charges,1721.6,80,,1377.28,percent of total billed charges,80% of total billed charges,1936.8,90,,1549.44,percent of total billed charges,90% of total billed charges,1614,75,,1291.2,percent of total billed charges,75% of total billed charges,117.29,122,,,fee schedule,122% of HUMANA fee schedule,624.08,29,,499.264,percent of total billed charges,29% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,1441.84,67,,1153.472,percent of total billed charges,67% of total billed charges,178.87,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,1721.6,80,,1377.28,percent of total billed charges,80% of total billed charges,1398.8,65,,1119.04,percent of total billed charges,65% of total billed charges,767.62,35.67,,614.096,percent of total billed charges,35.67% of total billed charges,96.14,1936.8,
CT SINUSES W/WO CONTRAST,3500510,CDM,350,RC,70488,HCPCS,outpatient,,,2054,821.60,,550,,,,case rate,pays based on per visit,1581.58,77,,1265.26,percent of total billed charges,77% of total billed charges,160.68,100,,,fee schedule,100% of CMS OPPS rate,1248.54,429,,,fee schedule,429% of BCBS fee schedule,1301.61,515,,,fee schedule,515% of BCBS fee schedule,1301.61,364,,,fee schedule,364% of BCBS fee schedule,1301.61,515,,,fee schedule,515% of BCBS fee schedule,1848.6,90,,1478.88,percent of total billed charges,90% of total billed charges,1643.2,80,,1314.56,percent of total billed charges,80% of total billed charges,1848.6,90,,1478.88,percent of total billed charges,90% of total billed charges,1540.5,75,,1232.4,percent of total billed charges,75% of total billed charges,196.02,122,,,fee schedule,122% of HUMANA fee schedule,595.66,29,,476.528,percent of total billed charges,29% of total billed charges,160.68,100,,,fee schedule,100% of CMS OPPS rate,1376.18,67,,1100.944,percent of total billed charges,67% of total billed charges,311.42,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,1643.2,80,,1314.56,percent of total billed charges,80% of total billed charges,1335.1,65,,1068.08,percent of total billed charges,65% of total billed charges,732.66,35.67,,586.128,percent of total billed charges,35.67% of total billed charges,160.68,1848.6,
CT SINUSES WITH CONTRAST,3500520,CDM,350,RC,70487,HCPCS,outpatient,,,1963,785.20,,550,,,,case rate,pays based on per visit,1511.51,77,,1209.21,percent of total billed charges,77% of total billed charges,160.68,100,,,fee schedule,100% of CMS OPPS rate,1248.54,429,,,fee schedule,429% of BCBS fee schedule,1301.61,515,,,fee schedule,515% of BCBS fee schedule,1301.61,364,,,fee schedule,364% of BCBS fee schedule,1301.61,515,,,fee schedule,515% of BCBS fee schedule,1766.7,90,,1413.36,percent of total billed charges,90% of total billed charges,1570.4,80,,1256.32,percent of total billed charges,80% of total billed charges,1766.7,90,,1413.36,percent of total billed charges,90% of total billed charges,1472.25,75,,1177.8,percent of total billed charges,75% of total billed charges,196.02,122,,,fee schedule,122% of HUMANA fee schedule,569.27,29,,455.416,percent of total billed charges,29% of total billed charges,160.68,100,,,fee schedule,100% of CMS OPPS rate,1315.21,67,,1052.168,percent of total billed charges,67% of total billed charges,280.11,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,1570.4,80,,1256.32,percent of total billed charges,80% of total billed charges,1275.95,65,,1020.76,percent of total billed charges,65% of total billed charges,700.2,35.67,,560.16,percent of total billed charges,35.67% of total billed charges,160.68,1766.7,
CT THORACIC SPINE WITH CONTR.,3500560,CDM,350,RC,72129,HCPCS,outpatient,,,2361,944.40,,550,,,,case rate,pays based on per visit,1817.97,77,,1454.38,percent of total billed charges,77% of total billed charges,160.68,100,,,fee schedule,100% of CMS OPPS rate,1248.54,429,,,fee schedule,429% of BCBS fee schedule,1301.61,515,,,fee schedule,515% of BCBS fee schedule,1301.61,364,,,fee schedule,364% of BCBS fee schedule,1301.61,515,,,fee schedule,515% of BCBS fee schedule,2124.9,90,,1699.92,percent of total billed charges,90% of total billed charges,1888.8,80,,1511.04,percent of total billed charges,80% of total billed charges,2124.9,90,,1699.92,percent of total billed charges,90% of total billed charges,1770.75,75,,1416.6,percent of total billed charges,75% of total billed charges,196.02,122,,,fee schedule,122% of HUMANA fee schedule,684.69,29,,547.752,percent of total billed charges,29% of total billed charges,160.68,100,,,fee schedule,100% of CMS OPPS rate,1581.87,67,,1265.496,percent of total billed charges,67% of total billed charges,280.11,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,1888.8,80,,1511.04,percent of total billed charges,80% of total billed charges,1534.65,65,,1227.72,percent of total billed charges,65% of total billed charges,842.17,35.67,,673.736,percent of total billed charges,35.67% of total billed charges,160.68,2124.9,
CT THORACIC SPINE W/O CONTR.,3500570,CDM,350,RC,72128,HCPCS,outpatient,,,1818,727.20,,550,,,,case rate,pays based on per visit,1399.86,77,,1119.89,percent of total billed charges,77% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,565.43,429,,,fee schedule,429% of BCBS fee schedule,589.47,515,,,fee schedule,515% of BCBS fee schedule,589.47,364,,,fee schedule,364% of BCBS fee schedule,589.47,515,,,fee schedule,515% of BCBS fee schedule,1636.2,90,,1308.96,percent of total billed charges,90% of total billed charges,1454.4,80,,1163.52,percent of total billed charges,80% of total billed charges,1636.2,90,,1308.96,percent of total billed charges,90% of total billed charges,1363.5,75,,1090.8,percent of total billed charges,75% of total billed charges,117.29,122,,,fee schedule,122% of HUMANA fee schedule,527.22,29,,421.776,percent of total billed charges,29% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,1218.06,67,,974.448,percent of total billed charges,67% of total billed charges,178.87,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,1454.4,80,,1163.52,percent of total billed charges,80% of total billed charges,1181.7,65,,945.36,percent of total billed charges,65% of total billed charges,648.48,35.67,,518.784,percent of total billed charges,35.67% of total billed charges,96.14,1636.2,
CT THORACIC SPINE W/O-W CONTRA,3500575,CDM,350,RC,72130,HCPCS,outpatient,,,2838,1135.20,,550,,,,case rate,pays based on per visit,2185.26,77,,1748.21,percent of total billed charges,77% of total billed charges,160.68,100,,,fee schedule,100% of CMS OPPS rate,1248.54,429,,,fee schedule,429% of BCBS fee schedule,1301.61,515,,,fee schedule,515% of BCBS fee schedule,1301.61,364,,,fee schedule,364% of BCBS fee schedule,1301.61,515,,,fee schedule,515% of BCBS fee schedule,2554.2,90,,2043.36,percent of total billed charges,90% of total billed charges,2270.4,80,,1816.32,percent of total billed charges,80% of total billed charges,2554.2,90,,2043.36,percent of total billed charges,90% of total billed charges,2128.5,75,,1702.8,percent of total billed charges,75% of total billed charges,196.02,122,,,fee schedule,122% of HUMANA fee schedule,823.02,29,,658.416,percent of total billed charges,29% of total billed charges,160.68,100,,,fee schedule,100% of CMS OPPS rate,1901.46,67,,1521.168,percent of total billed charges,67% of total billed charges,311.42,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,2270.4,80,,1816.32,percent of total billed charges,80% of total billed charges,1844.7,65,,1475.76,percent of total billed charges,65% of total billed charges,1012.31,35.67,,809.848,percent of total billed charges,35.67% of total billed charges,160.68,2554.2,
CT UPPER EXTREMITY WITH CONT.,3500580,CDM,350,RC,73201,HCPCS,outpatient,,,1741,696.40,,550,,,,case rate,pays based on per visit,1340.57,77,,1072.46,percent of total billed charges,77% of total billed charges,336.32,100,,,fee schedule,100% of CMS OPPS rate,1248.54,429,,,fee schedule,429% of BCBS fee schedule,1301.61,515,,,fee schedule,515% of BCBS fee schedule,1301.61,364,,,fee schedule,364% of BCBS fee schedule,1301.61,515,,,fee schedule,515% of BCBS fee schedule,1566.9,90,,1253.52,percent of total billed charges,90% of total billed charges,1392.8,80,,1114.24,percent of total billed charges,80% of total billed charges,1566.9,90,,1253.52,percent of total billed charges,90% of total billed charges,1305.75,75,,1044.6,percent of total billed charges,75% of total billed charges,410.31,122,,,fee schedule,122% of HUMANA fee schedule,504.89,29,,403.912,percent of total billed charges,29% of total billed charges,336.32,100,,,fee schedule,100% of CMS OPPS rate,1166.47,67,,933.176,percent of total billed charges,67% of total billed charges,280.11,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,1392.8,80,,1114.24,percent of total billed charges,80% of total billed charges,1131.65,65,,905.32,percent of total billed charges,65% of total billed charges,621.01,35.67,,496.808,percent of total billed charges,35.67% of total billed charges,280.11,1566.9,
CT UPPER EXTREMITY W/WO CONTR.,3500590,CDM,350,RC,73202,HCPCS,outpatient,,,1917,766.80,,550,,,,case rate,pays based on per visit,1476.09,77,,1180.87,percent of total billed charges,77% of total billed charges,160.68,100,,,fee schedule,100% of CMS OPPS rate,1248.54,429,,,fee schedule,429% of BCBS fee schedule,1301.61,515,,,fee schedule,515% of BCBS fee schedule,1301.61,364,,,fee schedule,364% of BCBS fee schedule,1301.61,515,,,fee schedule,515% of BCBS fee schedule,1725.3,90,,1380.24,percent of total billed charges,90% of total billed charges,1533.6,80,,1226.88,percent of total billed charges,80% of total billed charges,1725.3,90,,1380.24,percent of total billed charges,90% of total billed charges,1437.75,75,,1150.2,percent of total billed charges,75% of total billed charges,196.02,122,,,fee schedule,122% of HUMANA fee schedule,555.93,29,,444.744,percent of total billed charges,29% of total billed charges,160.68,100,,,fee schedule,100% of CMS OPPS rate,1284.39,67,,1027.512,percent of total billed charges,67% of total billed charges,311.42,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,1533.6,80,,1226.88,percent of total billed charges,80% of total billed charges,1246.05,65,,996.84,percent of total billed charges,65% of total billed charges,683.79,35.67,,547.032,percent of total billed charges,35.67% of total billed charges,160.68,1725.3,
CT UPPER EXTREMITY W/O CONTR,3500610,CDM,350,RC,73200,HCPCS,outpatient,,,1751,700.40,,550,,,,case rate,pays based on per visit,1348.27,77,,1078.62,percent of total billed charges,77% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,565.43,429,,,fee schedule,429% of BCBS fee schedule,589.47,515,,,fee schedule,515% of BCBS fee schedule,589.47,364,,,fee schedule,364% of BCBS fee schedule,589.47,515,,,fee schedule,515% of BCBS fee schedule,1575.9,90,,1260.72,percent of total billed charges,90% of total billed charges,1400.8,80,,1120.64,percent of total billed charges,80% of total billed charges,1575.9,90,,1260.72,percent of total billed charges,90% of total billed charges,1313.25,75,,1050.6,percent of total billed charges,75% of total billed charges,117.29,122,,,fee schedule,122% of HUMANA fee schedule,507.79,29,,406.232,percent of total billed charges,29% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,1173.17,67,,938.536,percent of total billed charges,67% of total billed charges,178.87,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,1400.8,80,,1120.64,percent of total billed charges,80% of total billed charges,1138.15,65,,910.52,percent of total billed charges,65% of total billed charges,624.58,35.67,,499.664,percent of total billed charges,35.67% of total billed charges,96.14,1575.9,
CTA ANGIO HEART W/3D IMAGE,3500611,CDM,350,RC,75574,HCPCS,outpatient,,,2737,1094.80,,550,,,,case rate,pays based on per visit,2107.49,77,,1685.99,percent of total billed charges,77% of total billed charges,160.68,100,,,fee schedule,100% of CMS OPPS rate,1244.58,429,,,fee schedule,429% of BCBS fee schedule,1297.49,515,,,fee schedule,515% of BCBS fee schedule,1297.49,364,,,fee schedule,364% of BCBS fee schedule,1297.49,515,,,fee schedule,515% of BCBS fee schedule,2463.3,90,,1970.64,percent of total billed charges,90% of total billed charges,2189.6,80,,1751.68,percent of total billed charges,80% of total billed charges,2463.3,90,,1970.64,percent of total billed charges,90% of total billed charges,2052.75,75,,1642.2,percent of total billed charges,75% of total billed charges,196.02,122,,,fee schedule,122% of HUMANA fee schedule,793.73,29,,634.984,percent of total billed charges,29% of total billed charges,160.68,100,,,fee schedule,100% of CMS OPPS rate,1833.79,67,,1467.032,percent of total billed charges,67% of total billed charges,243.94,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,2189.6,80,,1751.68,percent of total billed charges,80% of total billed charges,1779.05,65,,1423.24,percent of total billed charges,65% of total billed charges,976.29,35.67,,781.032,percent of total billed charges,35.67% of total billed charges,160.68,2463.3,
CTA/CTV HEAD/COW,3500620,CDM,350,RC,70496,HCPCS,outpatient,,,2574,1029.60,,550,,,,case rate,pays based on per visit,1981.98,77,,1585.58,percent of total billed charges,77% of total billed charges,160.68,100,,,fee schedule,100% of CMS OPPS rate,1248.54,429,,,fee schedule,429% of BCBS fee schedule,1301.61,515,,,fee schedule,515% of BCBS fee schedule,1301.61,364,,,fee schedule,364% of BCBS fee schedule,1301.61,515,,,fee schedule,515% of BCBS fee schedule,2316.6,90,,1853.28,percent of total billed charges,90% of total billed charges,2059.2,80,,1647.36,percent of total billed charges,80% of total billed charges,2316.6,90,,1853.28,percent of total billed charges,90% of total billed charges,1930.5,75,,1544.4,percent of total billed charges,75% of total billed charges,196.02,122,,,fee schedule,122% of HUMANA fee schedule,746.46,29,,597.168,percent of total billed charges,29% of total billed charges,160.68,100,,,fee schedule,100% of CMS OPPS rate,1724.58,67,,1379.664,percent of total billed charges,67% of total billed charges,315.52,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,2059.2,80,,1647.36,percent of total billed charges,80% of total billed charges,1673.1,65,,1338.48,percent of total billed charges,65% of total billed charges,918.15,35.67,,734.52,percent of total billed charges,35.67% of total billed charges,160.68,2316.6,
CTA NECK WO/W CONTRAST,3500630,CDM,350,RC,70498,HCPCS,outpatient,,,2437,974.80,,550,,,,case rate,pays based on per visit,1876.49,77,,1501.19,percent of total billed charges,77% of total billed charges,160.68,100,,,fee schedule,100% of CMS OPPS rate,1248.54,429,,,fee schedule,429% of BCBS fee schedule,1301.61,515,,,fee schedule,515% of BCBS fee schedule,1301.61,364,,,fee schedule,364% of BCBS fee schedule,1301.61,515,,,fee schedule,515% of BCBS fee schedule,2193.3,90,,1754.64,percent of total billed charges,90% of total billed charges,1949.6,80,,1559.68,percent of total billed charges,80% of total billed charges,2193.3,90,,1754.64,percent of total billed charges,90% of total billed charges,1827.75,75,,1462.2,percent of total billed charges,75% of total billed charges,196.02,122,,,fee schedule,122% of HUMANA fee schedule,706.73,29,,565.384,percent of total billed charges,29% of total billed charges,160.68,100,,,fee schedule,100% of CMS OPPS rate,1632.79,67,,1306.232,percent of total billed charges,67% of total billed charges,315.52,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,1949.6,80,,1559.68,percent of total billed charges,80% of total billed charges,1584.05,65,,1267.24,percent of total billed charges,65% of total billed charges,869.28,35.67,,695.424,percent of total billed charges,35.67% of total billed charges,160.68,2193.3,
CTA CHEST WO/W CONTRAST,3500640,CDM,350,RC,71275,HCPCS,outpatient,,,2737,1094.80,,550,,,,case rate,pays based on per visit,2107.49,77,,1685.99,percent of total billed charges,77% of total billed charges,160.68,100,,,fee schedule,100% of CMS OPPS rate,1248.54,429,,,fee schedule,429% of BCBS fee schedule,1301.61,515,,,fee schedule,515% of BCBS fee schedule,1301.61,364,,,fee schedule,364% of BCBS fee schedule,1301.61,515,,,fee schedule,515% of BCBS fee schedule,2463.3,90,,1970.64,percent of total billed charges,90% of total billed charges,2189.6,80,,1751.68,percent of total billed charges,80% of total billed charges,2463.3,90,,1970.64,percent of total billed charges,90% of total billed charges,2052.75,75,,1642.2,percent of total billed charges,75% of total billed charges,196.02,122,,,fee schedule,122% of HUMANA fee schedule,793.73,29,,634.984,percent of total billed charges,29% of total billed charges,160.68,100,,,fee schedule,100% of CMS OPPS rate,1833.79,67,,1467.032,percent of total billed charges,67% of total billed charges,315.52,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,2189.6,80,,1751.68,percent of total billed charges,80% of total billed charges,1779.05,65,,1423.24,percent of total billed charges,65% of total billed charges,976.29,35.67,,781.032,percent of total billed charges,35.67% of total billed charges,160.68,2463.3,
CTA PELVIS WO/W CONTRAST,3500650,CDM,350,RC,72191,HCPCS,outpatient,,,2647,1058.80,,550,,,,case rate,pays based on per visit,2038.19,77,,1630.55,percent of total billed charges,77% of total billed charges,160.68,100,,,fee schedule,100% of CMS OPPS rate,1248.54,429,,,fee schedule,429% of BCBS fee schedule,1301.61,515,,,fee schedule,515% of BCBS fee schedule,1301.61,364,,,fee schedule,364% of BCBS fee schedule,1301.61,515,,,fee schedule,515% of BCBS fee schedule,2382.3,90,,1905.84,percent of total billed charges,90% of total billed charges,2117.6,80,,1694.08,percent of total billed charges,80% of total billed charges,2382.3,90,,1905.84,percent of total billed charges,90% of total billed charges,1985.25,75,,1588.2,percent of total billed charges,75% of total billed charges,196.02,122,,,fee schedule,122% of HUMANA fee schedule,767.63,29,,614.104,percent of total billed charges,29% of total billed charges,160.68,100,,,fee schedule,100% of CMS OPPS rate,1773.49,67,,1418.792,percent of total billed charges,67% of total billed charges,315.52,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,2117.6,80,,1694.08,percent of total billed charges,80% of total billed charges,1720.55,65,,1376.44,percent of total billed charges,65% of total billed charges,944.18,35.67,,755.344,percent of total billed charges,35.67% of total billed charges,160.68,2382.3,
CTA UPPER EXTREMITY WO/W CONT,3500660,CDM,350,RC,73206,HCPCS,outpatient,,,2221,888.40,,550,,,,case rate,pays based on per visit,1710.17,77,,1368.14,percent of total billed charges,77% of total billed charges,160.68,100,,,fee schedule,100% of CMS OPPS rate,1248.54,429,,,fee schedule,429% of BCBS fee schedule,1301.61,515,,,fee schedule,515% of BCBS fee schedule,1301.61,364,,,fee schedule,364% of BCBS fee schedule,1301.61,515,,,fee schedule,515% of BCBS fee schedule,1998.9,90,,1599.12,percent of total billed charges,90% of total billed charges,1776.8,80,,1421.44,percent of total billed charges,80% of total billed charges,1998.9,90,,1599.12,percent of total billed charges,90% of total billed charges,1665.75,75,,1332.6,percent of total billed charges,75% of total billed charges,196.02,122,,,fee schedule,122% of HUMANA fee schedule,644.09,29,,515.272,percent of total billed charges,29% of total billed charges,160.68,100,,,fee schedule,100% of CMS OPPS rate,1488.07,67,,1190.456,percent of total billed charges,67% of total billed charges,315.52,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,1776.8,80,,1421.44,percent of total billed charges,80% of total billed charges,1443.65,65,,1154.92,percent of total billed charges,65% of total billed charges,792.23,35.67,,633.784,percent of total billed charges,35.67% of total billed charges,160.68,1998.9,
CTA LOWER EXTREMITY W/O-W CONT,3500670,CDM,350,RC,73706,HCPCS,outpatient,,,2746,1098.40,,550,,,,case rate,pays based on per visit,2114.42,77,,1691.54,percent of total billed charges,77% of total billed charges,160.68,100,,,fee schedule,100% of CMS OPPS rate,1248.54,429,,,fee schedule,429% of BCBS fee schedule,1301.61,515,,,fee schedule,515% of BCBS fee schedule,1301.61,364,,,fee schedule,364% of BCBS fee schedule,1301.61,515,,,fee schedule,515% of BCBS fee schedule,2471.4,90,,1977.12,percent of total billed charges,90% of total billed charges,2196.8,80,,1757.44,percent of total billed charges,80% of total billed charges,2471.4,90,,1977.12,percent of total billed charges,90% of total billed charges,2059.5,75,,1647.6,percent of total billed charges,75% of total billed charges,196.02,122,,,fee schedule,122% of HUMANA fee schedule,796.34,29,,637.072,percent of total billed charges,29% of total billed charges,160.68,100,,,fee schedule,100% of CMS OPPS rate,1839.82,67,,1471.856,percent of total billed charges,67% of total billed charges,315.52,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,2196.8,80,,1757.44,percent of total billed charges,80% of total billed charges,1784.9,65,,1427.92,percent of total billed charges,65% of total billed charges,979.5,35.67,,783.6,percent of total billed charges,35.67% of total billed charges,160.68,2471.4,
CTA ABDOMEN WO/W CONTRAST,3500680,CDM,350,RC,74175,HCPCS,outpatient,,,2710,1084.00,,550,,,,case rate,pays based on per visit,2086.7,77,,1669.36,percent of total billed charges,77% of total billed charges,160.68,100,,,fee schedule,100% of CMS OPPS rate,1248.54,429,,,fee schedule,429% of BCBS fee schedule,1301.61,515,,,fee schedule,515% of BCBS fee schedule,1301.61,364,,,fee schedule,364% of BCBS fee schedule,1301.61,515,,,fee schedule,515% of BCBS fee schedule,2439,90,,1951.2,percent of total billed charges,90% of total billed charges,2168,80,,1734.4,percent of total billed charges,80% of total billed charges,2439,90,,1951.2,percent of total billed charges,90% of total billed charges,2032.5,75,,1626,percent of total billed charges,75% of total billed charges,196.02,122,,,fee schedule,122% of HUMANA fee schedule,785.9,29,,628.72,percent of total billed charges,29% of total billed charges,160.68,100,,,fee schedule,100% of CMS OPPS rate,1815.7,67,,1452.56,percent of total billed charges,67% of total billed charges,315.52,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,2168,80,,1734.4,percent of total billed charges,80% of total billed charges,1761.5,65,,1409.2,percent of total billed charges,65% of total billed charges,966.66,35.67,,773.328,percent of total billed charges,35.67% of total billed charges,160.68,2439,
CTA ABDOMEN/PELVIS WO/W CONTRA,3500685,CDM,350,RC,74174,HCPCS,outpatient,,,2762,1104.80,,550,,,,case rate,pays based on per visit,2126.74,77,,1701.39,percent of total billed charges,77% of total billed charges,336.32,100,,,fee schedule,100% of CMS OPPS rate,1244.58,429,,,fee schedule,429% of BCBS fee schedule,1297.49,515,,,fee schedule,515% of BCBS fee schedule,1297.49,364,,,fee schedule,364% of BCBS fee schedule,1297.49,515,,,fee schedule,515% of BCBS fee schedule,2485.8,90,,1988.64,percent of total billed charges,90% of total billed charges,2209.6,80,,1767.68,percent of total billed charges,80% of total billed charges,2485.8,90,,1988.64,percent of total billed charges,90% of total billed charges,2071.5,75,,1657.2,percent of total billed charges,75% of total billed charges,410.31,122,,,fee schedule,122% of HUMANA fee schedule,800.98,29,,640.784,percent of total billed charges,29% of total billed charges,336.32,100,,,fee schedule,100% of CMS OPPS rate,1850.54,67,,1480.432,percent of total billed charges,67% of total billed charges,541.17,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,2209.6,80,,1767.68,percent of total billed charges,80% of total billed charges,1795.3,65,,1436.24,percent of total billed charges,65% of total billed charges,985.21,35.67,,788.168,percent of total billed charges,35.67% of total billed charges,336.32,2485.8,
CTA ABD AORTA WITH RUNOFF,3500690,CDM,350,RC,75635,HCPCS,outpatient,,,2675,1070.00,,550,,,,case rate,pays based on per visit,2059.75,77,,1647.8,percent of total billed charges,77% of total billed charges,160.68,100,,,fee schedule,100% of CMS OPPS rate,1248.54,429,,,fee schedule,429% of BCBS fee schedule,1301.61,515,,,fee schedule,515% of BCBS fee schedule,1301.61,364,,,fee schedule,364% of BCBS fee schedule,1301.61,515,,,fee schedule,515% of BCBS fee schedule,2407.5,90,,1926,percent of total billed charges,90% of total billed charges,2140,80,,1712,percent of total billed charges,80% of total billed charges,2407.5,90,,1926,percent of total billed charges,90% of total billed charges,2006.25,75,,1605,percent of total billed charges,75% of total billed charges,196.03,122,,,fee schedule,122% of HUMANA fee schedule,775.75,29,,620.6,percent of total billed charges,29% of total billed charges,160.68,100,,,fee schedule,100% of CMS OPPS rate,1792.25,67,,1433.8,percent of total billed charges,67% of total billed charges,315.52,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,2140,80,,1712,percent of total billed charges,80% of total billed charges,1738.75,65,,1391,percent of total billed charges,65% of total billed charges,954.17,35.67,,763.336,percent of total billed charges,35.67% of total billed charges,160.68,2407.5,
CT LUMBAR SPINE W/O - WITH CON,3500700,CDM,350,RC,72133,HCPCS,outpatient,,,2871,1148.40,,550,,,,case rate,pays based on per visit,2210.67,77,,1768.54,percent of total billed charges,77% of total billed charges,160.68,100,,,fee schedule,100% of CMS OPPS rate,1248.54,429,,,fee schedule,429% of BCBS fee schedule,1301.61,515,,,fee schedule,515% of BCBS fee schedule,1301.61,364,,,fee schedule,364% of BCBS fee schedule,1301.61,515,,,fee schedule,515% of BCBS fee schedule,2583.9,90,,2067.12,percent of total billed charges,90% of total billed charges,2296.8,80,,1837.44,percent of total billed charges,80% of total billed charges,2583.9,90,,2067.12,percent of total billed charges,90% of total billed charges,2153.25,75,,1722.6,percent of total billed charges,75% of total billed charges,196.02,122,,,fee schedule,122% of HUMANA fee schedule,832.59,29,,666.072,percent of total billed charges,29% of total billed charges,160.68,100,,,fee schedule,100% of CMS OPPS rate,1923.57,67,,1538.856,percent of total billed charges,67% of total billed charges,311.42,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,2296.8,80,,1837.44,percent of total billed charges,80% of total billed charges,1866.15,65,,1492.92,percent of total billed charges,65% of total billed charges,1024.09,35.67,,819.272,percent of total billed charges,35.67% of total billed charges,160.68,2583.9,
CT ANGIO FEMUR LT,3501000,CDM,350,RC,73706,HCPCS,outpatient,,,2746,1098.40,LT,550,,,,case rate,pays based on per visit,2114.42,77,,1691.54,percent of total billed charges,77% of total billed charges,160.68,100,,,fee schedule,100% of CMS OPPS rate,1248.54,429,,,fee schedule,429% of BCBS fee schedule,1301.61,515,,,fee schedule,515% of BCBS fee schedule,1301.61,364,,,fee schedule,364% of BCBS fee schedule,1301.61,515,,,fee schedule,515% of BCBS fee schedule,2471.4,90,,1977.12,percent of total billed charges,90% of total billed charges,2196.8,80,,1757.44,percent of total billed charges,80% of total billed charges,2471.4,90,,1977.12,percent of total billed charges,90% of total billed charges,2059.5,75,,1647.6,percent of total billed charges,75% of total billed charges,196.02,122,,,fee schedule,122% of HUMANA fee schedule,796.34,29,,637.072,percent of total billed charges,29% of total billed charges,160.68,100,,,fee schedule,100% of CMS OPPS rate,1839.82,67,,1471.856,percent of total billed charges,67% of total billed charges,315.52,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,2196.8,80,,1757.44,percent of total billed charges,80% of total billed charges,1784.9,65,,1427.92,percent of total billed charges,65% of total billed charges,979.5,35.67,,783.6,percent of total billed charges,35.67% of total billed charges,160.68,2471.4,
CT ANGIO FEMUR RT,3501001,CDM,350,RC,73706,HCPCS,outpatient,,,2746,1098.40,RT,550,,,,case rate,pays based on per visit,2114.42,77,,1691.54,percent of total billed charges,77% of total billed charges,160.68,100,,,fee schedule,100% of CMS OPPS rate,1248.54,429,,,fee schedule,429% of BCBS fee schedule,1301.61,515,,,fee schedule,515% of BCBS fee schedule,1301.61,364,,,fee schedule,364% of BCBS fee schedule,1301.61,515,,,fee schedule,515% of BCBS fee schedule,2471.4,90,,1977.12,percent of total billed charges,90% of total billed charges,2196.8,80,,1757.44,percent of total billed charges,80% of total billed charges,2471.4,90,,1977.12,percent of total billed charges,90% of total billed charges,2059.5,75,,1647.6,percent of total billed charges,75% of total billed charges,196.02,122,,,fee schedule,122% of HUMANA fee schedule,796.34,29,,637.072,percent of total billed charges,29% of total billed charges,160.68,100,,,fee schedule,100% of CMS OPPS rate,1839.82,67,,1471.856,percent of total billed charges,67% of total billed charges,315.52,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,2196.8,80,,1757.44,percent of total billed charges,80% of total billed charges,1784.9,65,,1427.92,percent of total billed charges,65% of total billed charges,979.5,35.67,,783.6,percent of total billed charges,35.67% of total billed charges,160.68,2471.4,
CT ANGIO FOOT LT,3501002,CDM,350,RC,73706,HCPCS,outpatient,,,2746,1098.40,LT,550,,,,case rate,pays based on per visit,2114.42,77,,1691.54,percent of total billed charges,77% of total billed charges,160.68,100,,,fee schedule,100% of CMS OPPS rate,1248.54,429,,,fee schedule,429% of BCBS fee schedule,1301.61,515,,,fee schedule,515% of BCBS fee schedule,1301.61,364,,,fee schedule,364% of BCBS fee schedule,1301.61,515,,,fee schedule,515% of BCBS fee schedule,2471.4,90,,1977.12,percent of total billed charges,90% of total billed charges,2196.8,80,,1757.44,percent of total billed charges,80% of total billed charges,2471.4,90,,1977.12,percent of total billed charges,90% of total billed charges,2059.5,75,,1647.6,percent of total billed charges,75% of total billed charges,196.02,122,,,fee schedule,122% of HUMANA fee schedule,796.34,29,,637.072,percent of total billed charges,29% of total billed charges,160.68,100,,,fee schedule,100% of CMS OPPS rate,1839.82,67,,1471.856,percent of total billed charges,67% of total billed charges,315.52,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,2196.8,80,,1757.44,percent of total billed charges,80% of total billed charges,1784.9,65,,1427.92,percent of total billed charges,65% of total billed charges,979.5,35.67,,783.6,percent of total billed charges,35.67% of total billed charges,160.68,2471.4,
CT ANGIO FOOT RT,3501003,CDM,350,RC,73706,HCPCS,outpatient,,,2746,1098.40,RT,550,,,,case rate,pays based on per visit,2114.42,77,,1691.54,percent of total billed charges,77% of total billed charges,160.68,100,,,fee schedule,100% of CMS OPPS rate,1248.54,429,,,fee schedule,429% of BCBS fee schedule,1301.61,515,,,fee schedule,515% of BCBS fee schedule,1301.61,364,,,fee schedule,364% of BCBS fee schedule,1301.61,515,,,fee schedule,515% of BCBS fee schedule,2471.4,90,,1977.12,percent of total billed charges,90% of total billed charges,2196.8,80,,1757.44,percent of total billed charges,80% of total billed charges,2471.4,90,,1977.12,percent of total billed charges,90% of total billed charges,2059.5,75,,1647.6,percent of total billed charges,75% of total billed charges,196.02,122,,,fee schedule,122% of HUMANA fee schedule,796.34,29,,637.072,percent of total billed charges,29% of total billed charges,160.68,100,,,fee schedule,100% of CMS OPPS rate,1839.82,67,,1471.856,percent of total billed charges,67% of total billed charges,315.52,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,2196.8,80,,1757.44,percent of total billed charges,80% of total billed charges,1784.9,65,,1427.92,percent of total billed charges,65% of total billed charges,979.5,35.67,,783.6,percent of total billed charges,35.67% of total billed charges,160.68,2471.4,
CT ANGIO FOREARM LT,3501004,CDM,350,RC,73206,HCPCS,outpatient,,,2221,888.40,LT,550,,,,case rate,pays based on per visit,1710.17,77,,1368.14,percent of total billed charges,77% of total billed charges,160.68,100,,,fee schedule,100% of CMS OPPS rate,1248.54,429,,,fee schedule,429% of BCBS fee schedule,1301.61,515,,,fee schedule,515% of BCBS fee schedule,1301.61,364,,,fee schedule,364% of BCBS fee schedule,1301.61,515,,,fee schedule,515% of BCBS fee schedule,1998.9,90,,1599.12,percent of total billed charges,90% of total billed charges,1776.8,80,,1421.44,percent of total billed charges,80% of total billed charges,1998.9,90,,1599.12,percent of total billed charges,90% of total billed charges,1665.75,75,,1332.6,percent of total billed charges,75% of total billed charges,196.02,122,,,fee schedule,122% of HUMANA fee schedule,644.09,29,,515.272,percent of total billed charges,29% of total billed charges,160.68,100,,,fee schedule,100% of CMS OPPS rate,1488.07,67,,1190.456,percent of total billed charges,67% of total billed charges,315.52,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,1776.8,80,,1421.44,percent of total billed charges,80% of total billed charges,1443.65,65,,1154.92,percent of total billed charges,65% of total billed charges,792.23,35.67,,633.784,percent of total billed charges,35.67% of total billed charges,160.68,1998.9,
CT ANGIO FOREARM RT,3501005,CDM,350,RC,73206,HCPCS,outpatient,,,2221,888.40,RT,550,,,,case rate,pays based on per visit,1710.17,77,,1368.14,percent of total billed charges,77% of total billed charges,160.68,100,,,fee schedule,100% of CMS OPPS rate,1248.54,429,,,fee schedule,429% of BCBS fee schedule,1301.61,515,,,fee schedule,515% of BCBS fee schedule,1301.61,364,,,fee schedule,364% of BCBS fee schedule,1301.61,515,,,fee schedule,515% of BCBS fee schedule,1998.9,90,,1599.12,percent of total billed charges,90% of total billed charges,1776.8,80,,1421.44,percent of total billed charges,80% of total billed charges,1998.9,90,,1599.12,percent of total billed charges,90% of total billed charges,1665.75,75,,1332.6,percent of total billed charges,75% of total billed charges,196.02,122,,,fee schedule,122% of HUMANA fee schedule,644.09,29,,515.272,percent of total billed charges,29% of total billed charges,160.68,100,,,fee schedule,100% of CMS OPPS rate,1488.07,67,,1190.456,percent of total billed charges,67% of total billed charges,315.52,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,1776.8,80,,1421.44,percent of total billed charges,80% of total billed charges,1443.65,65,,1154.92,percent of total billed charges,65% of total billed charges,792.23,35.67,,633.784,percent of total billed charges,35.67% of total billed charges,160.68,1998.9,
CT ANGIO HAND LT,3501006,CDM,350,RC,73206,HCPCS,outpatient,,,2221,888.40,LT,550,,,,case rate,pays based on per visit,1710.17,77,,1368.14,percent of total billed charges,77% of total billed charges,160.68,100,,,fee schedule,100% of CMS OPPS rate,1248.54,429,,,fee schedule,429% of BCBS fee schedule,1301.61,515,,,fee schedule,515% of BCBS fee schedule,1301.61,364,,,fee schedule,364% of BCBS fee schedule,1301.61,515,,,fee schedule,515% of BCBS fee schedule,1998.9,90,,1599.12,percent of total billed charges,90% of total billed charges,1776.8,80,,1421.44,percent of total billed charges,80% of total billed charges,1998.9,90,,1599.12,percent of total billed charges,90% of total billed charges,1665.75,75,,1332.6,percent of total billed charges,75% of total billed charges,196.02,122,,,fee schedule,122% of HUMANA fee schedule,644.09,29,,515.272,percent of total billed charges,29% of total billed charges,160.68,100,,,fee schedule,100% of CMS OPPS rate,1488.07,67,,1190.456,percent of total billed charges,67% of total billed charges,315.52,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,1776.8,80,,1421.44,percent of total billed charges,80% of total billed charges,1443.65,65,,1154.92,percent of total billed charges,65% of total billed charges,792.23,35.67,,633.784,percent of total billed charges,35.67% of total billed charges,160.68,1998.9,
CT ANGIO HAND RT,3501007,CDM,350,RC,73206,HCPCS,outpatient,,,2221,888.40,RT,550,,,,case rate,pays based on per visit,1710.17,77,,1368.14,percent of total billed charges,77% of total billed charges,160.68,100,,,fee schedule,100% of CMS OPPS rate,1248.54,429,,,fee schedule,429% of BCBS fee schedule,1301.61,515,,,fee schedule,515% of BCBS fee schedule,1301.61,364,,,fee schedule,364% of BCBS fee schedule,1301.61,515,,,fee schedule,515% of BCBS fee schedule,1998.9,90,,1599.12,percent of total billed charges,90% of total billed charges,1776.8,80,,1421.44,percent of total billed charges,80% of total billed charges,1998.9,90,,1599.12,percent of total billed charges,90% of total billed charges,1665.75,75,,1332.6,percent of total billed charges,75% of total billed charges,196.02,122,,,fee schedule,122% of HUMANA fee schedule,644.09,29,,515.272,percent of total billed charges,29% of total billed charges,160.68,100,,,fee schedule,100% of CMS OPPS rate,1488.07,67,,1190.456,percent of total billed charges,67% of total billed charges,315.52,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,1776.8,80,,1421.44,percent of total billed charges,80% of total billed charges,1443.65,65,,1154.92,percent of total billed charges,65% of total billed charges,792.23,35.67,,633.784,percent of total billed charges,35.67% of total billed charges,160.68,1998.9,
CT ANGIO HUMERUS LT,3501008,CDM,350,RC,73206,HCPCS,outpatient,,,2221,888.40,LT,550,,,,case rate,pays based on per visit,1710.17,77,,1368.14,percent of total billed charges,77% of total billed charges,160.68,100,,,fee schedule,100% of CMS OPPS rate,1248.54,429,,,fee schedule,429% of BCBS fee schedule,1301.61,515,,,fee schedule,515% of BCBS fee schedule,1301.61,364,,,fee schedule,364% of BCBS fee schedule,1301.61,515,,,fee schedule,515% of BCBS fee schedule,1998.9,90,,1599.12,percent of total billed charges,90% of total billed charges,1776.8,80,,1421.44,percent of total billed charges,80% of total billed charges,1998.9,90,,1599.12,percent of total billed charges,90% of total billed charges,1665.75,75,,1332.6,percent of total billed charges,75% of total billed charges,196.02,122,,,fee schedule,122% of HUMANA fee schedule,644.09,29,,515.272,percent of total billed charges,29% of total billed charges,160.68,100,,,fee schedule,100% of CMS OPPS rate,1488.07,67,,1190.456,percent of total billed charges,67% of total billed charges,315.52,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,1776.8,80,,1421.44,percent of total billed charges,80% of total billed charges,1443.65,65,,1154.92,percent of total billed charges,65% of total billed charges,792.23,35.67,,633.784,percent of total billed charges,35.67% of total billed charges,160.68,1998.9,
CT ANGIO HUMERUS RT,3501009,CDM,350,RC,73206,HCPCS,outpatient,,,2221,888.40,RT,550,,,,case rate,pays based on per visit,1710.17,77,,1368.14,percent of total billed charges,77% of total billed charges,160.68,100,,,fee schedule,100% of CMS OPPS rate,1248.54,429,,,fee schedule,429% of BCBS fee schedule,1301.61,515,,,fee schedule,515% of BCBS fee schedule,1301.61,364,,,fee schedule,364% of BCBS fee schedule,1301.61,515,,,fee schedule,515% of BCBS fee schedule,1998.9,90,,1599.12,percent of total billed charges,90% of total billed charges,1776.8,80,,1421.44,percent of total billed charges,80% of total billed charges,1998.9,90,,1599.12,percent of total billed charges,90% of total billed charges,1665.75,75,,1332.6,percent of total billed charges,75% of total billed charges,196.02,122,,,fee schedule,122% of HUMANA fee schedule,644.09,29,,515.272,percent of total billed charges,29% of total billed charges,160.68,100,,,fee schedule,100% of CMS OPPS rate,1488.07,67,,1190.456,percent of total billed charges,67% of total billed charges,315.52,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,1776.8,80,,1421.44,percent of total billed charges,80% of total billed charges,1443.65,65,,1154.92,percent of total billed charges,65% of total billed charges,792.23,35.67,,633.784,percent of total billed charges,35.67% of total billed charges,160.68,1998.9,
CT ANGIO LE BI,3501010,CDM,350,RC,73706,HCPCS,outpatient,,,2746,1098.40,50,550,,,,case rate,pays based on per visit,2114.42,77,,1691.54,percent of total billed charges,77% of total billed charges,160.68,100,,,fee schedule,100% of CMS OPPS rate,1248.54,429,,,fee schedule,429% of BCBS fee schedule,1301.61,515,,,fee schedule,515% of BCBS fee schedule,1301.61,364,,,fee schedule,364% of BCBS fee schedule,1301.61,515,,,fee schedule,515% of BCBS fee schedule,2471.4,90,,1977.12,percent of total billed charges,90% of total billed charges,2196.8,80,,1757.44,percent of total billed charges,80% of total billed charges,2471.4,90,,1977.12,percent of total billed charges,90% of total billed charges,2059.5,75,,1647.6,percent of total billed charges,75% of total billed charges,196.02,122,,,fee schedule,122% of HUMANA fee schedule,796.34,29,,637.072,percent of total billed charges,29% of total billed charges,160.68,100,,,fee schedule,100% of CMS OPPS rate,1839.82,67,,1471.856,percent of total billed charges,67% of total billed charges,315.52,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,2196.8,80,,1757.44,percent of total billed charges,80% of total billed charges,1784.9,65,,1427.92,percent of total billed charges,65% of total billed charges,979.5,35.67,,783.6,percent of total billed charges,35.67% of total billed charges,160.68,2471.4,
CT ANKLE LT W/CON,3501011,CDM,350,RC,73701,HCPCS,outpatient,,,1509,603.60,LT,550,,,,case rate,pays based on per visit,1161.93,77,,929.54,percent of total billed charges,77% of total billed charges,160.68,100,,,fee schedule,100% of CMS OPPS rate,1248.54,429,,,fee schedule,429% of BCBS fee schedule,1301.61,515,,,fee schedule,515% of BCBS fee schedule,1301.61,364,,,fee schedule,364% of BCBS fee schedule,1301.61,515,,,fee schedule,515% of BCBS fee schedule,1358.1,90,,1086.48,percent of total billed charges,90% of total billed charges,1207.2,80,,965.76,percent of total billed charges,80% of total billed charges,1358.1,90,,1086.48,percent of total billed charges,90% of total billed charges,1131.75,75,,905.4,percent of total billed charges,75% of total billed charges,196.02,122,,,fee schedule,122% of HUMANA fee schedule,437.61,29,,350.088,percent of total billed charges,29% of total billed charges,160.68,100,,,fee schedule,100% of CMS OPPS rate,1011.03,67,,808.824,percent of total billed charges,67% of total billed charges,280.11,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,1207.2,80,,965.76,percent of total billed charges,80% of total billed charges,980.85,65,,784.68,percent of total billed charges,65% of total billed charges,538.26,35.67,,430.608,percent of total billed charges,35.67% of total billed charges,160.68,1358.1,
CT ANKLE LT W/OUT CONTRAST,3501012,CDM,350,RC,73700,HCPCS,outpatient,,,1672,668.80,LT,550,,,,case rate,pays based on per visit,1287.44,77,,1029.95,percent of total billed charges,77% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,565.43,429,,,fee schedule,429% of BCBS fee schedule,589.47,515,,,fee schedule,515% of BCBS fee schedule,589.47,364,,,fee schedule,364% of BCBS fee schedule,589.47,515,,,fee schedule,515% of BCBS fee schedule,1504.8,90,,1203.84,percent of total billed charges,90% of total billed charges,1337.6,80,,1070.08,percent of total billed charges,80% of total billed charges,1504.8,90,,1203.84,percent of total billed charges,90% of total billed charges,1254,75,,1003.2,percent of total billed charges,75% of total billed charges,117.29,122,,,fee schedule,122% of HUMANA fee schedule,484.88,29,,387.904,percent of total billed charges,29% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,1120.24,67,,896.192,percent of total billed charges,67% of total billed charges,178.87,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,1337.6,80,,1070.08,percent of total billed charges,80% of total billed charges,1086.8,65,,869.44,percent of total billed charges,65% of total billed charges,596.4,35.67,,477.12,percent of total billed charges,35.67% of total billed charges,96.14,1504.8,
CT ANKLE LT W/WO CONTRAST,3501013,CDM,350,RC,73702,HCPCS,outpatient,,,1667,666.80,LT,550,,,,case rate,pays based on per visit,1283.59,77,,1026.87,percent of total billed charges,77% of total billed charges,160.68,100,,,fee schedule,100% of CMS OPPS rate,1248.54,429,,,fee schedule,429% of BCBS fee schedule,1301.61,515,,,fee schedule,515% of BCBS fee schedule,1301.61,364,,,fee schedule,364% of BCBS fee schedule,1301.61,515,,,fee schedule,515% of BCBS fee schedule,1500.3,90,,1200.24,percent of total billed charges,90% of total billed charges,1333.6,80,,1066.88,percent of total billed charges,80% of total billed charges,1500.3,90,,1200.24,percent of total billed charges,90% of total billed charges,1250.25,75,,1000.2,percent of total billed charges,75% of total billed charges,196.02,122,,,fee schedule,122% of HUMANA fee schedule,483.43,29,,386.744,percent of total billed charges,29% of total billed charges,160.68,100,,,fee schedule,100% of CMS OPPS rate,1116.89,67,,893.512,percent of total billed charges,67% of total billed charges,311.42,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,1333.6,80,,1066.88,percent of total billed charges,80% of total billed charges,1083.55,65,,866.84,percent of total billed charges,65% of total billed charges,594.62,35.67,,475.696,percent of total billed charges,35.67% of total billed charges,160.68,1500.3,
CT ANKLE RT W/CONTRAST,3501014,CDM,350,RC,73701,HCPCS,outpatient,,,1509,603.60,RT,550,,,,case rate,pays based on per visit,1161.93,77,,929.54,percent of total billed charges,77% of total billed charges,160.68,100,,,fee schedule,100% of CMS OPPS rate,1248.54,429,,,fee schedule,429% of BCBS fee schedule,1301.61,515,,,fee schedule,515% of BCBS fee schedule,1301.61,364,,,fee schedule,364% of BCBS fee schedule,1301.61,515,,,fee schedule,515% of BCBS fee schedule,1358.1,90,,1086.48,percent of total billed charges,90% of total billed charges,1207.2,80,,965.76,percent of total billed charges,80% of total billed charges,1358.1,90,,1086.48,percent of total billed charges,90% of total billed charges,1131.75,75,,905.4,percent of total billed charges,75% of total billed charges,196.02,122,,,fee schedule,122% of HUMANA fee schedule,437.61,29,,350.088,percent of total billed charges,29% of total billed charges,160.68,100,,,fee schedule,100% of CMS OPPS rate,1011.03,67,,808.824,percent of total billed charges,67% of total billed charges,280.11,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,1207.2,80,,965.76,percent of total billed charges,80% of total billed charges,980.85,65,,784.68,percent of total billed charges,65% of total billed charges,538.26,35.67,,430.608,percent of total billed charges,35.67% of total billed charges,160.68,1358.1,
CT ANKLE RT W/OUT CONTRAST,3501015,CDM,350,RC,73700,HCPCS,outpatient,,,1672,668.80,RT,550,,,,case rate,pays based on per visit,1287.44,77,,1029.95,percent of total billed charges,77% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,565.43,429,,,fee schedule,429% of BCBS fee schedule,589.47,515,,,fee schedule,515% of BCBS fee schedule,589.47,364,,,fee schedule,364% of BCBS fee schedule,589.47,515,,,fee schedule,515% of BCBS fee schedule,1504.8,90,,1203.84,percent of total billed charges,90% of total billed charges,1337.6,80,,1070.08,percent of total billed charges,80% of total billed charges,1504.8,90,,1203.84,percent of total billed charges,90% of total billed charges,1254,75,,1003.2,percent of total billed charges,75% of total billed charges,117.29,122,,,fee schedule,122% of HUMANA fee schedule,484.88,29,,387.904,percent of total billed charges,29% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,1120.24,67,,896.192,percent of total billed charges,67% of total billed charges,178.87,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,1337.6,80,,1070.08,percent of total billed charges,80% of total billed charges,1086.8,65,,869.44,percent of total billed charges,65% of total billed charges,596.4,35.67,,477.12,percent of total billed charges,35.67% of total billed charges,96.14,1504.8,
CT ANKLE RT W/WO CONTRAST,3501016,CDM,350,RC,73702,HCPCS,outpatient,,,1667,666.80,RT,550,,,,case rate,pays based on per visit,1283.59,77,,1026.87,percent of total billed charges,77% of total billed charges,160.68,100,,,fee schedule,100% of CMS OPPS rate,1248.54,429,,,fee schedule,429% of BCBS fee schedule,1301.61,515,,,fee schedule,515% of BCBS fee schedule,1301.61,364,,,fee schedule,364% of BCBS fee schedule,1301.61,515,,,fee schedule,515% of BCBS fee schedule,1500.3,90,,1200.24,percent of total billed charges,90% of total billed charges,1333.6,80,,1066.88,percent of total billed charges,80% of total billed charges,1500.3,90,,1200.24,percent of total billed charges,90% of total billed charges,1250.25,75,,1000.2,percent of total billed charges,75% of total billed charges,196.02,122,,,fee schedule,122% of HUMANA fee schedule,483.43,29,,386.744,percent of total billed charges,29% of total billed charges,160.68,100,,,fee schedule,100% of CMS OPPS rate,1116.89,67,,893.512,percent of total billed charges,67% of total billed charges,311.42,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,1333.6,80,,1066.88,percent of total billed charges,80% of total billed charges,1083.55,65,,866.84,percent of total billed charges,65% of total billed charges,594.62,35.67,,475.696,percent of total billed charges,35.67% of total billed charges,160.68,1500.3,
CT ELBOW LT W/CONTRAST,3501017,CDM,350,RC,73201,HCPCS,outpatient,,,1741,696.40,LT,550,,,,case rate,pays based on per visit,1340.57,77,,1072.46,percent of total billed charges,77% of total billed charges,336.32,100,,,fee schedule,100% of CMS OPPS rate,1248.54,429,,,fee schedule,429% of BCBS fee schedule,1301.61,515,,,fee schedule,515% of BCBS fee schedule,1301.61,364,,,fee schedule,364% of BCBS fee schedule,1301.61,515,,,fee schedule,515% of BCBS fee schedule,1566.9,90,,1253.52,percent of total billed charges,90% of total billed charges,1392.8,80,,1114.24,percent of total billed charges,80% of total billed charges,1566.9,90,,1253.52,percent of total billed charges,90% of total billed charges,1305.75,75,,1044.6,percent of total billed charges,75% of total billed charges,410.31,122,,,fee schedule,122% of HUMANA fee schedule,504.89,29,,403.912,percent of total billed charges,29% of total billed charges,336.32,100,,,fee schedule,100% of CMS OPPS rate,1166.47,67,,933.176,percent of total billed charges,67% of total billed charges,280.11,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,1392.8,80,,1114.24,percent of total billed charges,80% of total billed charges,1131.65,65,,905.32,percent of total billed charges,65% of total billed charges,621.01,35.67,,496.808,percent of total billed charges,35.67% of total billed charges,280.11,1566.9,
CT ELBOW LT W/OUT CONTRAST,3501018,CDM,350,RC,73200,HCPCS,outpatient,,,1751,700.40,LT,550,,,,case rate,pays based on per visit,1348.27,77,,1078.62,percent of total billed charges,77% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,565.43,429,,,fee schedule,429% of BCBS fee schedule,589.47,515,,,fee schedule,515% of BCBS fee schedule,589.47,364,,,fee schedule,364% of BCBS fee schedule,589.47,515,,,fee schedule,515% of BCBS fee schedule,1575.9,90,,1260.72,percent of total billed charges,90% of total billed charges,1400.8,80,,1120.64,percent of total billed charges,80% of total billed charges,1575.9,90,,1260.72,percent of total billed charges,90% of total billed charges,1313.25,75,,1050.6,percent of total billed charges,75% of total billed charges,117.29,122,,,fee schedule,122% of HUMANA fee schedule,507.79,29,,406.232,percent of total billed charges,29% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,1173.17,67,,938.536,percent of total billed charges,67% of total billed charges,178.87,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,1400.8,80,,1120.64,percent of total billed charges,80% of total billed charges,1138.15,65,,910.52,percent of total billed charges,65% of total billed charges,624.58,35.67,,499.664,percent of total billed charges,35.67% of total billed charges,96.14,1575.9,
CT ELBOW LT W/WO CONTRAST,3501019,CDM,350,RC,73202,HCPCS,outpatient,,,1917,766.80,LT,550,,,,case rate,pays based on per visit,1476.09,77,,1180.87,percent of total billed charges,77% of total billed charges,160.68,100,,,fee schedule,100% of CMS OPPS rate,1248.54,429,,,fee schedule,429% of BCBS fee schedule,1301.61,515,,,fee schedule,515% of BCBS fee schedule,1301.61,364,,,fee schedule,364% of BCBS fee schedule,1301.61,515,,,fee schedule,515% of BCBS fee schedule,1725.3,90,,1380.24,percent of total billed charges,90% of total billed charges,1533.6,80,,1226.88,percent of total billed charges,80% of total billed charges,1725.3,90,,1380.24,percent of total billed charges,90% of total billed charges,1437.75,75,,1150.2,percent of total billed charges,75% of total billed charges,196.02,122,,,fee schedule,122% of HUMANA fee schedule,555.93,29,,444.744,percent of total billed charges,29% of total billed charges,160.68,100,,,fee schedule,100% of CMS OPPS rate,1284.39,67,,1027.512,percent of total billed charges,67% of total billed charges,311.42,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,1533.6,80,,1226.88,percent of total billed charges,80% of total billed charges,1246.05,65,,996.84,percent of total billed charges,65% of total billed charges,683.79,35.67,,547.032,percent of total billed charges,35.67% of total billed charges,160.68,1725.3,
CT ELBOW RT W/CONTRAST,3501020,CDM,350,RC,73201,HCPCS,outpatient,,,1741,696.40,RT,550,,,,case rate,pays based on per visit,1340.57,77,,1072.46,percent of total billed charges,77% of total billed charges,336.32,100,,,fee schedule,100% of CMS OPPS rate,1248.54,429,,,fee schedule,429% of BCBS fee schedule,1301.61,515,,,fee schedule,515% of BCBS fee schedule,1301.61,364,,,fee schedule,364% of BCBS fee schedule,1301.61,515,,,fee schedule,515% of BCBS fee schedule,1566.9,90,,1253.52,percent of total billed charges,90% of total billed charges,1392.8,80,,1114.24,percent of total billed charges,80% of total billed charges,1566.9,90,,1253.52,percent of total billed charges,90% of total billed charges,1305.75,75,,1044.6,percent of total billed charges,75% of total billed charges,410.31,122,,,fee schedule,122% of HUMANA fee schedule,504.89,29,,403.912,percent of total billed charges,29% of total billed charges,336.32,100,,,fee schedule,100% of CMS OPPS rate,1166.47,67,,933.176,percent of total billed charges,67% of total billed charges,280.11,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,1392.8,80,,1114.24,percent of total billed charges,80% of total billed charges,1131.65,65,,905.32,percent of total billed charges,65% of total billed charges,621.01,35.67,,496.808,percent of total billed charges,35.67% of total billed charges,280.11,1566.9,
CT ELBOW RT W/OUT CONTRAST,3501021,CDM,350,RC,73200,HCPCS,outpatient,,,1751,700.40,RT,550,,,,case rate,pays based on per visit,1348.27,77,,1078.62,percent of total billed charges,77% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,565.43,429,,,fee schedule,429% of BCBS fee schedule,589.47,515,,,fee schedule,515% of BCBS fee schedule,589.47,364,,,fee schedule,364% of BCBS fee schedule,589.47,515,,,fee schedule,515% of BCBS fee schedule,1575.9,90,,1260.72,percent of total billed charges,90% of total billed charges,1400.8,80,,1120.64,percent of total billed charges,80% of total billed charges,1575.9,90,,1260.72,percent of total billed charges,90% of total billed charges,1313.25,75,,1050.6,percent of total billed charges,75% of total billed charges,117.29,122,,,fee schedule,122% of HUMANA fee schedule,507.79,29,,406.232,percent of total billed charges,29% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,1173.17,67,,938.536,percent of total billed charges,67% of total billed charges,178.87,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,1400.8,80,,1120.64,percent of total billed charges,80% of total billed charges,1138.15,65,,910.52,percent of total billed charges,65% of total billed charges,624.58,35.67,,499.664,percent of total billed charges,35.67% of total billed charges,96.14,1575.9,
CT ELBOW RT W/WO CONTRAST,3501022,CDM,350,RC,73202,HCPCS,outpatient,,,1667,666.80,RT,550,,,,case rate,pays based on per visit,1283.59,77,,1026.87,percent of total billed charges,77% of total billed charges,160.68,100,,,fee schedule,100% of CMS OPPS rate,1248.54,429,,,fee schedule,429% of BCBS fee schedule,1301.61,515,,,fee schedule,515% of BCBS fee schedule,1301.61,364,,,fee schedule,364% of BCBS fee schedule,1301.61,515,,,fee schedule,515% of BCBS fee schedule,1500.3,90,,1200.24,percent of total billed charges,90% of total billed charges,1333.6,80,,1066.88,percent of total billed charges,80% of total billed charges,1500.3,90,,1200.24,percent of total billed charges,90% of total billed charges,1250.25,75,,1000.2,percent of total billed charges,75% of total billed charges,196.02,122,,,fee schedule,122% of HUMANA fee schedule,483.43,29,,386.744,percent of total billed charges,29% of total billed charges,160.68,100,,,fee schedule,100% of CMS OPPS rate,1116.89,67,,893.512,percent of total billed charges,67% of total billed charges,311.42,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,1333.6,80,,1066.88,percent of total billed charges,80% of total billed charges,1083.55,65,,866.84,percent of total billed charges,65% of total billed charges,594.62,35.67,,475.696,percent of total billed charges,35.67% of total billed charges,160.68,1500.3,
CT FEMUR LT W/CONTRAST,3501023,CDM,350,RC,73701,HCPCS,outpatient,,,1509,603.60,LT,550,,,,case rate,pays based on per visit,1161.93,77,,929.54,percent of total billed charges,77% of total billed charges,160.68,100,,,fee schedule,100% of CMS OPPS rate,1248.54,429,,,fee schedule,429% of BCBS fee schedule,1301.61,515,,,fee schedule,515% of BCBS fee schedule,1301.61,364,,,fee schedule,364% of BCBS fee schedule,1301.61,515,,,fee schedule,515% of BCBS fee schedule,1358.1,90,,1086.48,percent of total billed charges,90% of total billed charges,1207.2,80,,965.76,percent of total billed charges,80% of total billed charges,1358.1,90,,1086.48,percent of total billed charges,90% of total billed charges,1131.75,75,,905.4,percent of total billed charges,75% of total billed charges,196.02,122,,,fee schedule,122% of HUMANA fee schedule,437.61,29,,350.088,percent of total billed charges,29% of total billed charges,160.68,100,,,fee schedule,100% of CMS OPPS rate,1011.03,67,,808.824,percent of total billed charges,67% of total billed charges,280.11,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,1207.2,80,,965.76,percent of total billed charges,80% of total billed charges,980.85,65,,784.68,percent of total billed charges,65% of total billed charges,538.26,35.67,,430.608,percent of total billed charges,35.67% of total billed charges,160.68,1358.1,
CT FEMUR LT W/OUT CONTRAST,3501024,CDM,350,RC,73700,HCPCS,outpatient,,,1672,668.80,LT,550,,,,case rate,pays based on per visit,1287.44,77,,1029.95,percent of total billed charges,77% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,565.43,429,,,fee schedule,429% of BCBS fee schedule,589.47,515,,,fee schedule,515% of BCBS fee schedule,589.47,364,,,fee schedule,364% of BCBS fee schedule,589.47,515,,,fee schedule,515% of BCBS fee schedule,1504.8,90,,1203.84,percent of total billed charges,90% of total billed charges,1337.6,80,,1070.08,percent of total billed charges,80% of total billed charges,1504.8,90,,1203.84,percent of total billed charges,90% of total billed charges,1254,75,,1003.2,percent of total billed charges,75% of total billed charges,117.29,122,,,fee schedule,122% of HUMANA fee schedule,484.88,29,,387.904,percent of total billed charges,29% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,1120.24,67,,896.192,percent of total billed charges,67% of total billed charges,178.87,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,1337.6,80,,1070.08,percent of total billed charges,80% of total billed charges,1086.8,65,,869.44,percent of total billed charges,65% of total billed charges,596.4,35.67,,477.12,percent of total billed charges,35.67% of total billed charges,96.14,1504.8,
CT FEMUR LT W/WO CONTRAST,3501025,CDM,350,RC,73702,HCPCS,outpatient,,,1667,666.80,LT,550,,,,case rate,pays based on per visit,1283.59,77,,1026.87,percent of total billed charges,77% of total billed charges,160.68,100,,,fee schedule,100% of CMS OPPS rate,1248.54,429,,,fee schedule,429% of BCBS fee schedule,1301.61,515,,,fee schedule,515% of BCBS fee schedule,1301.61,364,,,fee schedule,364% of BCBS fee schedule,1301.61,515,,,fee schedule,515% of BCBS fee schedule,1500.3,90,,1200.24,percent of total billed charges,90% of total billed charges,1333.6,80,,1066.88,percent of total billed charges,80% of total billed charges,1500.3,90,,1200.24,percent of total billed charges,90% of total billed charges,1250.25,75,,1000.2,percent of total billed charges,75% of total billed charges,196.02,122,,,fee schedule,122% of HUMANA fee schedule,483.43,29,,386.744,percent of total billed charges,29% of total billed charges,160.68,100,,,fee schedule,100% of CMS OPPS rate,1116.89,67,,893.512,percent of total billed charges,67% of total billed charges,311.42,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,1333.6,80,,1066.88,percent of total billed charges,80% of total billed charges,1083.55,65,,866.84,percent of total billed charges,65% of total billed charges,594.62,35.67,,475.696,percent of total billed charges,35.67% of total billed charges,160.68,1500.3,
CT FEMUR RT W/CONTRAST,3501026,CDM,350,RC,73701,HCPCS,outpatient,,,1509,603.60,RT,550,,,,case rate,pays based on per visit,1161.93,77,,929.54,percent of total billed charges,77% of total billed charges,160.68,100,,,fee schedule,100% of CMS OPPS rate,1248.54,429,,,fee schedule,429% of BCBS fee schedule,1301.61,515,,,fee schedule,515% of BCBS fee schedule,1301.61,364,,,fee schedule,364% of BCBS fee schedule,1301.61,515,,,fee schedule,515% of BCBS fee schedule,1358.1,90,,1086.48,percent of total billed charges,90% of total billed charges,1207.2,80,,965.76,percent of total billed charges,80% of total billed charges,1358.1,90,,1086.48,percent of total billed charges,90% of total billed charges,1131.75,75,,905.4,percent of total billed charges,75% of total billed charges,196.02,122,,,fee schedule,122% of HUMANA fee schedule,437.61,29,,350.088,percent of total billed charges,29% of total billed charges,160.68,100,,,fee schedule,100% of CMS OPPS rate,1011.03,67,,808.824,percent of total billed charges,67% of total billed charges,280.11,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,1207.2,80,,965.76,percent of total billed charges,80% of total billed charges,980.85,65,,784.68,percent of total billed charges,65% of total billed charges,538.26,35.67,,430.608,percent of total billed charges,35.67% of total billed charges,160.68,1358.1,
CT FEMUR RT W/OUT CONTRAST,3501027,CDM,350,RC,73700,HCPCS,outpatient,,,1672,668.80,RT,550,,,,case rate,pays based on per visit,1287.44,77,,1029.95,percent of total billed charges,77% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,565.43,429,,,fee schedule,429% of BCBS fee schedule,589.47,515,,,fee schedule,515% of BCBS fee schedule,589.47,364,,,fee schedule,364% of BCBS fee schedule,589.47,515,,,fee schedule,515% of BCBS fee schedule,1504.8,90,,1203.84,percent of total billed charges,90% of total billed charges,1337.6,80,,1070.08,percent of total billed charges,80% of total billed charges,1504.8,90,,1203.84,percent of total billed charges,90% of total billed charges,1254,75,,1003.2,percent of total billed charges,75% of total billed charges,117.29,122,,,fee schedule,122% of HUMANA fee schedule,484.88,29,,387.904,percent of total billed charges,29% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,1120.24,67,,896.192,percent of total billed charges,67% of total billed charges,178.87,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,1337.6,80,,1070.08,percent of total billed charges,80% of total billed charges,1086.8,65,,869.44,percent of total billed charges,65% of total billed charges,596.4,35.67,,477.12,percent of total billed charges,35.67% of total billed charges,96.14,1504.8,
CT FEMUR RT W/WOUT CONTRAST,3501028,CDM,350,RC,73702,HCPCS,outpatient,,,1667,666.80,RT,550,,,,case rate,pays based on per visit,1283.59,77,,1026.87,percent of total billed charges,77% of total billed charges,160.68,100,,,fee schedule,100% of CMS OPPS rate,1248.54,429,,,fee schedule,429% of BCBS fee schedule,1301.61,515,,,fee schedule,515% of BCBS fee schedule,1301.61,364,,,fee schedule,364% of BCBS fee schedule,1301.61,515,,,fee schedule,515% of BCBS fee schedule,1500.3,90,,1200.24,percent of total billed charges,90% of total billed charges,1333.6,80,,1066.88,percent of total billed charges,80% of total billed charges,1500.3,90,,1200.24,percent of total billed charges,90% of total billed charges,1250.25,75,,1000.2,percent of total billed charges,75% of total billed charges,196.02,122,,,fee schedule,122% of HUMANA fee schedule,483.43,29,,386.744,percent of total billed charges,29% of total billed charges,160.68,100,,,fee schedule,100% of CMS OPPS rate,1116.89,67,,893.512,percent of total billed charges,67% of total billed charges,311.42,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,1333.6,80,,1066.88,percent of total billed charges,80% of total billed charges,1083.55,65,,866.84,percent of total billed charges,65% of total billed charges,594.62,35.67,,475.696,percent of total billed charges,35.67% of total billed charges,160.68,1500.3,
CT FOOT LT W/CONTRAST,3501029,CDM,350,RC,73701,HCPCS,outpatient,,,1509,603.60,LT,550,,,,case rate,pays based on per visit,1161.93,77,,929.54,percent of total billed charges,77% of total billed charges,160.68,100,,,fee schedule,100% of CMS OPPS rate,1248.54,429,,,fee schedule,429% of BCBS fee schedule,1301.61,515,,,fee schedule,515% of BCBS fee schedule,1301.61,364,,,fee schedule,364% of BCBS fee schedule,1301.61,515,,,fee schedule,515% of BCBS fee schedule,1358.1,90,,1086.48,percent of total billed charges,90% of total billed charges,1207.2,80,,965.76,percent of total billed charges,80% of total billed charges,1358.1,90,,1086.48,percent of total billed charges,90% of total billed charges,1131.75,75,,905.4,percent of total billed charges,75% of total billed charges,196.02,122,,,fee schedule,122% of HUMANA fee schedule,437.61,29,,350.088,percent of total billed charges,29% of total billed charges,160.68,100,,,fee schedule,100% of CMS OPPS rate,1011.03,67,,808.824,percent of total billed charges,67% of total billed charges,280.11,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,1207.2,80,,965.76,percent of total billed charges,80% of total billed charges,980.85,65,,784.68,percent of total billed charges,65% of total billed charges,538.26,35.67,,430.608,percent of total billed charges,35.67% of total billed charges,160.68,1358.1,
CT FOOT LT W/OUT CONTRAST,3501030,CDM,350,RC,73700,HCPCS,outpatient,,,1672,668.80,LT,550,,,,case rate,pays based on per visit,1287.44,77,,1029.95,percent of total billed charges,77% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,565.43,429,,,fee schedule,429% of BCBS fee schedule,589.47,515,,,fee schedule,515% of BCBS fee schedule,589.47,364,,,fee schedule,364% of BCBS fee schedule,589.47,515,,,fee schedule,515% of BCBS fee schedule,1504.8,90,,1203.84,percent of total billed charges,90% of total billed charges,1337.6,80,,1070.08,percent of total billed charges,80% of total billed charges,1504.8,90,,1203.84,percent of total billed charges,90% of total billed charges,1254,75,,1003.2,percent of total billed charges,75% of total billed charges,117.29,122,,,fee schedule,122% of HUMANA fee schedule,484.88,29,,387.904,percent of total billed charges,29% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,1120.24,67,,896.192,percent of total billed charges,67% of total billed charges,178.87,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,1337.6,80,,1070.08,percent of total billed charges,80% of total billed charges,1086.8,65,,869.44,percent of total billed charges,65% of total billed charges,596.4,35.67,,477.12,percent of total billed charges,35.67% of total billed charges,96.14,1504.8,
CT FOOT LT W/WO CONTRAST,3501031,CDM,350,RC,73702,HCPCS,outpatient,,,1667,666.80,LT,550,,,,case rate,pays based on per visit,1283.59,77,,1026.87,percent of total billed charges,77% of total billed charges,160.68,100,,,fee schedule,100% of CMS OPPS rate,1248.54,429,,,fee schedule,429% of BCBS fee schedule,1301.61,515,,,fee schedule,515% of BCBS fee schedule,1301.61,364,,,fee schedule,364% of BCBS fee schedule,1301.61,515,,,fee schedule,515% of BCBS fee schedule,1500.3,90,,1200.24,percent of total billed charges,90% of total billed charges,1333.6,80,,1066.88,percent of total billed charges,80% of total billed charges,1500.3,90,,1200.24,percent of total billed charges,90% of total billed charges,1250.25,75,,1000.2,percent of total billed charges,75% of total billed charges,196.02,122,,,fee schedule,122% of HUMANA fee schedule,483.43,29,,386.744,percent of total billed charges,29% of total billed charges,160.68,100,,,fee schedule,100% of CMS OPPS rate,1116.89,67,,893.512,percent of total billed charges,67% of total billed charges,311.42,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,1333.6,80,,1066.88,percent of total billed charges,80% of total billed charges,1083.55,65,,866.84,percent of total billed charges,65% of total billed charges,594.62,35.67,,475.696,percent of total billed charges,35.67% of total billed charges,160.68,1500.3,
CT FOOT RT W/CONTRAST,3501032,CDM,350,RC,73701,HCPCS,outpatient,,,1509,603.60,RT,550,,,,case rate,pays based on per visit,1161.93,77,,929.54,percent of total billed charges,77% of total billed charges,160.68,100,,,fee schedule,100% of CMS OPPS rate,1248.54,429,,,fee schedule,429% of BCBS fee schedule,1301.61,515,,,fee schedule,515% of BCBS fee schedule,1301.61,364,,,fee schedule,364% of BCBS fee schedule,1301.61,515,,,fee schedule,515% of BCBS fee schedule,1358.1,90,,1086.48,percent of total billed charges,90% of total billed charges,1207.2,80,,965.76,percent of total billed charges,80% of total billed charges,1358.1,90,,1086.48,percent of total billed charges,90% of total billed charges,1131.75,75,,905.4,percent of total billed charges,75% of total billed charges,196.02,122,,,fee schedule,122% of HUMANA fee schedule,437.61,29,,350.088,percent of total billed charges,29% of total billed charges,160.68,100,,,fee schedule,100% of CMS OPPS rate,1011.03,67,,808.824,percent of total billed charges,67% of total billed charges,280.11,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,1207.2,80,,965.76,percent of total billed charges,80% of total billed charges,980.85,65,,784.68,percent of total billed charges,65% of total billed charges,538.26,35.67,,430.608,percent of total billed charges,35.67% of total billed charges,160.68,1358.1,
CT FOOT RT W/OUT CONTRAST,3501033,CDM,350,RC,73700,HCPCS,outpatient,,,1672,668.80,RT,550,,,,case rate,pays based on per visit,1287.44,77,,1029.95,percent of total billed charges,77% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,565.43,429,,,fee schedule,429% of BCBS fee schedule,589.47,515,,,fee schedule,515% of BCBS fee schedule,589.47,364,,,fee schedule,364% of BCBS fee schedule,589.47,515,,,fee schedule,515% of BCBS fee schedule,1504.8,90,,1203.84,percent of total billed charges,90% of total billed charges,1337.6,80,,1070.08,percent of total billed charges,80% of total billed charges,1504.8,90,,1203.84,percent of total billed charges,90% of total billed charges,1254,75,,1003.2,percent of total billed charges,75% of total billed charges,117.29,122,,,fee schedule,122% of HUMANA fee schedule,484.88,29,,387.904,percent of total billed charges,29% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,1120.24,67,,896.192,percent of total billed charges,67% of total billed charges,178.87,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,1337.6,80,,1070.08,percent of total billed charges,80% of total billed charges,1086.8,65,,869.44,percent of total billed charges,65% of total billed charges,596.4,35.67,,477.12,percent of total billed charges,35.67% of total billed charges,96.14,1504.8,
CT FOOT RT W/WO CONTRAST,3501034,CDM,350,RC,73702,HCPCS,outpatient,,,1667,666.80,RT,550,,,,case rate,pays based on per visit,1283.59,77,,1026.87,percent of total billed charges,77% of total billed charges,160.68,100,,,fee schedule,100% of CMS OPPS rate,1248.54,429,,,fee schedule,429% of BCBS fee schedule,1301.61,515,,,fee schedule,515% of BCBS fee schedule,1301.61,364,,,fee schedule,364% of BCBS fee schedule,1301.61,515,,,fee schedule,515% of BCBS fee schedule,1500.3,90,,1200.24,percent of total billed charges,90% of total billed charges,1333.6,80,,1066.88,percent of total billed charges,80% of total billed charges,1500.3,90,,1200.24,percent of total billed charges,90% of total billed charges,1250.25,75,,1000.2,percent of total billed charges,75% of total billed charges,196.02,122,,,fee schedule,122% of HUMANA fee schedule,483.43,29,,386.744,percent of total billed charges,29% of total billed charges,160.68,100,,,fee schedule,100% of CMS OPPS rate,1116.89,67,,893.512,percent of total billed charges,67% of total billed charges,311.42,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,1333.6,80,,1066.88,percent of total billed charges,80% of total billed charges,1083.55,65,,866.84,percent of total billed charges,65% of total billed charges,594.62,35.67,,475.696,percent of total billed charges,35.67% of total billed charges,160.68,1500.3,
CT FOREARM LT W/CONTRAST,3501035,CDM,350,RC,73201,HCPCS,outpatient,,,1741,696.40,LT,550,,,,case rate,pays based on per visit,1340.57,77,,1072.46,percent of total billed charges,77% of total billed charges,336.32,100,,,fee schedule,100% of CMS OPPS rate,1248.54,429,,,fee schedule,429% of BCBS fee schedule,1301.61,515,,,fee schedule,515% of BCBS fee schedule,1301.61,364,,,fee schedule,364% of BCBS fee schedule,1301.61,515,,,fee schedule,515% of BCBS fee schedule,1566.9,90,,1253.52,percent of total billed charges,90% of total billed charges,1392.8,80,,1114.24,percent of total billed charges,80% of total billed charges,1566.9,90,,1253.52,percent of total billed charges,90% of total billed charges,1305.75,75,,1044.6,percent of total billed charges,75% of total billed charges,410.31,122,,,fee schedule,122% of HUMANA fee schedule,504.89,29,,403.912,percent of total billed charges,29% of total billed charges,336.32,100,,,fee schedule,100% of CMS OPPS rate,1166.47,67,,933.176,percent of total billed charges,67% of total billed charges,280.11,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,1392.8,80,,1114.24,percent of total billed charges,80% of total billed charges,1131.65,65,,905.32,percent of total billed charges,65% of total billed charges,621.01,35.67,,496.808,percent of total billed charges,35.67% of total billed charges,280.11,1566.9,
CT FOREARM LT W/OUT CONTRAST,3501036,CDM,350,RC,73200,HCPCS,outpatient,,,1751,700.40,LT,550,,,,case rate,pays based on per visit,1348.27,77,,1078.62,percent of total billed charges,77% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,565.43,429,,,fee schedule,429% of BCBS fee schedule,589.47,515,,,fee schedule,515% of BCBS fee schedule,589.47,364,,,fee schedule,364% of BCBS fee schedule,589.47,515,,,fee schedule,515% of BCBS fee schedule,1575.9,90,,1260.72,percent of total billed charges,90% of total billed charges,1400.8,80,,1120.64,percent of total billed charges,80% of total billed charges,1575.9,90,,1260.72,percent of total billed charges,90% of total billed charges,1313.25,75,,1050.6,percent of total billed charges,75% of total billed charges,117.29,122,,,fee schedule,122% of HUMANA fee schedule,507.79,29,,406.232,percent of total billed charges,29% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,1173.17,67,,938.536,percent of total billed charges,67% of total billed charges,178.87,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,1400.8,80,,1120.64,percent of total billed charges,80% of total billed charges,1138.15,65,,910.52,percent of total billed charges,65% of total billed charges,624.58,35.67,,499.664,percent of total billed charges,35.67% of total billed charges,96.14,1575.9,
CT FOREARM LT W/WO CONTRAST,3501037,CDM,350,RC,73202,HCPCS,outpatient,,,1917,766.80,LT,550,,,,case rate,pays based on per visit,1476.09,77,,1180.87,percent of total billed charges,77% of total billed charges,160.68,100,,,fee schedule,100% of CMS OPPS rate,1248.54,429,,,fee schedule,429% of BCBS fee schedule,1301.61,515,,,fee schedule,515% of BCBS fee schedule,1301.61,364,,,fee schedule,364% of BCBS fee schedule,1301.61,515,,,fee schedule,515% of BCBS fee schedule,1725.3,90,,1380.24,percent of total billed charges,90% of total billed charges,1533.6,80,,1226.88,percent of total billed charges,80% of total billed charges,1725.3,90,,1380.24,percent of total billed charges,90% of total billed charges,1437.75,75,,1150.2,percent of total billed charges,75% of total billed charges,196.02,122,,,fee schedule,122% of HUMANA fee schedule,555.93,29,,444.744,percent of total billed charges,29% of total billed charges,160.68,100,,,fee schedule,100% of CMS OPPS rate,1284.39,67,,1027.512,percent of total billed charges,67% of total billed charges,311.42,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,1533.6,80,,1226.88,percent of total billed charges,80% of total billed charges,1246.05,65,,996.84,percent of total billed charges,65% of total billed charges,683.79,35.67,,547.032,percent of total billed charges,35.67% of total billed charges,160.68,1725.3,
CT FOREARM RT W/CONTRAST,3501038,CDM,350,RC,73201,HCPCS,outpatient,,,1741,696.40,RT,550,,,,case rate,pays based on per visit,1340.57,77,,1072.46,percent of total billed charges,77% of total billed charges,336.32,100,,,fee schedule,100% of CMS OPPS rate,1248.54,429,,,fee schedule,429% of BCBS fee schedule,1301.61,515,,,fee schedule,515% of BCBS fee schedule,1301.61,364,,,fee schedule,364% of BCBS fee schedule,1301.61,515,,,fee schedule,515% of BCBS fee schedule,1566.9,90,,1253.52,percent of total billed charges,90% of total billed charges,1392.8,80,,1114.24,percent of total billed charges,80% of total billed charges,1566.9,90,,1253.52,percent of total billed charges,90% of total billed charges,1305.75,75,,1044.6,percent of total billed charges,75% of total billed charges,410.31,122,,,fee schedule,122% of HUMANA fee schedule,504.89,29,,403.912,percent of total billed charges,29% of total billed charges,336.32,100,,,fee schedule,100% of CMS OPPS rate,1166.47,67,,933.176,percent of total billed charges,67% of total billed charges,280.11,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,1392.8,80,,1114.24,percent of total billed charges,80% of total billed charges,1131.65,65,,905.32,percent of total billed charges,65% of total billed charges,621.01,35.67,,496.808,percent of total billed charges,35.67% of total billed charges,280.11,1566.9,
CT FOREARM RT W/OUT CONTRAST,3501039,CDM,350,RC,73200,HCPCS,outpatient,,,1751,700.40,RT,550,,,,case rate,pays based on per visit,1348.27,77,,1078.62,percent of total billed charges,77% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,565.43,429,,,fee schedule,429% of BCBS fee schedule,589.47,515,,,fee schedule,515% of BCBS fee schedule,589.47,364,,,fee schedule,364% of BCBS fee schedule,589.47,515,,,fee schedule,515% of BCBS fee schedule,1575.9,90,,1260.72,percent of total billed charges,90% of total billed charges,1400.8,80,,1120.64,percent of total billed charges,80% of total billed charges,1575.9,90,,1260.72,percent of total billed charges,90% of total billed charges,1313.25,75,,1050.6,percent of total billed charges,75% of total billed charges,117.29,122,,,fee schedule,122% of HUMANA fee schedule,507.79,29,,406.232,percent of total billed charges,29% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,1173.17,67,,938.536,percent of total billed charges,67% of total billed charges,178.87,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,1400.8,80,,1120.64,percent of total billed charges,80% of total billed charges,1138.15,65,,910.52,percent of total billed charges,65% of total billed charges,624.58,35.67,,499.664,percent of total billed charges,35.67% of total billed charges,96.14,1575.9,
CT FOREARM RT W/WO CONTRAST,3501040,CDM,350,RC,73202,HCPCS,outpatient,,,1917,766.80,RT,550,,,,case rate,pays based on per visit,1476.09,77,,1180.87,percent of total billed charges,77% of total billed charges,160.68,100,,,fee schedule,100% of CMS OPPS rate,1248.54,429,,,fee schedule,429% of BCBS fee schedule,1301.61,515,,,fee schedule,515% of BCBS fee schedule,1301.61,364,,,fee schedule,364% of BCBS fee schedule,1301.61,515,,,fee schedule,515% of BCBS fee schedule,1725.3,90,,1380.24,percent of total billed charges,90% of total billed charges,1533.6,80,,1226.88,percent of total billed charges,80% of total billed charges,1725.3,90,,1380.24,percent of total billed charges,90% of total billed charges,1437.75,75,,1150.2,percent of total billed charges,75% of total billed charges,196.02,122,,,fee schedule,122% of HUMANA fee schedule,555.93,29,,444.744,percent of total billed charges,29% of total billed charges,160.68,100,,,fee schedule,100% of CMS OPPS rate,1284.39,67,,1027.512,percent of total billed charges,67% of total billed charges,311.42,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,1533.6,80,,1226.88,percent of total billed charges,80% of total billed charges,1246.05,65,,996.84,percent of total billed charges,65% of total billed charges,683.79,35.67,,547.032,percent of total billed charges,35.67% of total billed charges,160.68,1725.3,
CT HAND LT W/CONTRAST,3501041,CDM,350,RC,73201,HCPCS,outpatient,,,1741,696.40,LT,550,,,,case rate,pays based on per visit,1340.57,77,,1072.46,percent of total billed charges,77% of total billed charges,336.32,100,,,fee schedule,100% of CMS OPPS rate,1248.54,429,,,fee schedule,429% of BCBS fee schedule,1301.61,515,,,fee schedule,515% of BCBS fee schedule,1301.61,364,,,fee schedule,364% of BCBS fee schedule,1301.61,515,,,fee schedule,515% of BCBS fee schedule,1566.9,90,,1253.52,percent of total billed charges,90% of total billed charges,1392.8,80,,1114.24,percent of total billed charges,80% of total billed charges,1566.9,90,,1253.52,percent of total billed charges,90% of total billed charges,1305.75,75,,1044.6,percent of total billed charges,75% of total billed charges,410.31,122,,,fee schedule,122% of HUMANA fee schedule,504.89,29,,403.912,percent of total billed charges,29% of total billed charges,336.32,100,,,fee schedule,100% of CMS OPPS rate,1166.47,67,,933.176,percent of total billed charges,67% of total billed charges,280.11,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,1392.8,80,,1114.24,percent of total billed charges,80% of total billed charges,1131.65,65,,905.32,percent of total billed charges,65% of total billed charges,621.01,35.67,,496.808,percent of total billed charges,35.67% of total billed charges,280.11,1566.9,
CT HAND LT W/OUT CONTRAST,3501042,CDM,350,RC,73200,HCPCS,outpatient,,,1751,700.40,LT,550,,,,case rate,pays based on per visit,1348.27,77,,1078.62,percent of total billed charges,77% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,565.43,429,,,fee schedule,429% of BCBS fee schedule,589.47,515,,,fee schedule,515% of BCBS fee schedule,589.47,364,,,fee schedule,364% of BCBS fee schedule,589.47,515,,,fee schedule,515% of BCBS fee schedule,1575.9,90,,1260.72,percent of total billed charges,90% of total billed charges,1400.8,80,,1120.64,percent of total billed charges,80% of total billed charges,1575.9,90,,1260.72,percent of total billed charges,90% of total billed charges,1313.25,75,,1050.6,percent of total billed charges,75% of total billed charges,117.29,122,,,fee schedule,122% of HUMANA fee schedule,507.79,29,,406.232,percent of total billed charges,29% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,1173.17,67,,938.536,percent of total billed charges,67% of total billed charges,178.87,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,1400.8,80,,1120.64,percent of total billed charges,80% of total billed charges,1138.15,65,,910.52,percent of total billed charges,65% of total billed charges,624.58,35.67,,499.664,percent of total billed charges,35.67% of total billed charges,96.14,1575.9,
CT HAND LT W/WO CONTRAST,3501043,CDM,350,RC,73202,HCPCS,outpatient,,,1917,766.80,LT,550,,,,case rate,pays based on per visit,1476.09,77,,1180.87,percent of total billed charges,77% of total billed charges,160.68,100,,,fee schedule,100% of CMS OPPS rate,1248.54,429,,,fee schedule,429% of BCBS fee schedule,1301.61,515,,,fee schedule,515% of BCBS fee schedule,1301.61,364,,,fee schedule,364% of BCBS fee schedule,1301.61,515,,,fee schedule,515% of BCBS fee schedule,1725.3,90,,1380.24,percent of total billed charges,90% of total billed charges,1533.6,80,,1226.88,percent of total billed charges,80% of total billed charges,1725.3,90,,1380.24,percent of total billed charges,90% of total billed charges,1437.75,75,,1150.2,percent of total billed charges,75% of total billed charges,196.02,122,,,fee schedule,122% of HUMANA fee schedule,555.93,29,,444.744,percent of total billed charges,29% of total billed charges,160.68,100,,,fee schedule,100% of CMS OPPS rate,1284.39,67,,1027.512,percent of total billed charges,67% of total billed charges,311.42,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,1533.6,80,,1226.88,percent of total billed charges,80% of total billed charges,1246.05,65,,996.84,percent of total billed charges,65% of total billed charges,683.79,35.67,,547.032,percent of total billed charges,35.67% of total billed charges,160.68,1725.3,
CT HAND RT W/CONTRAST,3501044,CDM,350,RC,73201,HCPCS,outpatient,,,1741,696.40,RT,550,,,,case rate,pays based on per visit,1340.57,77,,1072.46,percent of total billed charges,77% of total billed charges,336.32,100,,,fee schedule,100% of CMS OPPS rate,1248.54,429,,,fee schedule,429% of BCBS fee schedule,1301.61,515,,,fee schedule,515% of BCBS fee schedule,1301.61,364,,,fee schedule,364% of BCBS fee schedule,1301.61,515,,,fee schedule,515% of BCBS fee schedule,1566.9,90,,1253.52,percent of total billed charges,90% of total billed charges,1392.8,80,,1114.24,percent of total billed charges,80% of total billed charges,1566.9,90,,1253.52,percent of total billed charges,90% of total billed charges,1305.75,75,,1044.6,percent of total billed charges,75% of total billed charges,410.31,122,,,fee schedule,122% of HUMANA fee schedule,504.89,29,,403.912,percent of total billed charges,29% of total billed charges,336.32,100,,,fee schedule,100% of CMS OPPS rate,1166.47,67,,933.176,percent of total billed charges,67% of total billed charges,280.11,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,1392.8,80,,1114.24,percent of total billed charges,80% of total billed charges,1131.65,65,,905.32,percent of total billed charges,65% of total billed charges,621.01,35.67,,496.808,percent of total billed charges,35.67% of total billed charges,280.11,1566.9,
CT HAND RT W/OUT CONTRAST,3501045,CDM,350,RC,73200,HCPCS,outpatient,,,1751,700.40,RT,550,,,,case rate,pays based on per visit,1348.27,77,,1078.62,percent of total billed charges,77% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,565.43,429,,,fee schedule,429% of BCBS fee schedule,589.47,515,,,fee schedule,515% of BCBS fee schedule,589.47,364,,,fee schedule,364% of BCBS fee schedule,589.47,515,,,fee schedule,515% of BCBS fee schedule,1575.9,90,,1260.72,percent of total billed charges,90% of total billed charges,1400.8,80,,1120.64,percent of total billed charges,80% of total billed charges,1575.9,90,,1260.72,percent of total billed charges,90% of total billed charges,1313.25,75,,1050.6,percent of total billed charges,75% of total billed charges,117.29,122,,,fee schedule,122% of HUMANA fee schedule,507.79,29,,406.232,percent of total billed charges,29% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,1173.17,67,,938.536,percent of total billed charges,67% of total billed charges,178.87,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,1400.8,80,,1120.64,percent of total billed charges,80% of total billed charges,1138.15,65,,910.52,percent of total billed charges,65% of total billed charges,624.58,35.67,,499.664,percent of total billed charges,35.67% of total billed charges,96.14,1575.9,
CT HAND RT W/WO CONTRAST,3501046,CDM,350,RC,73202,HCPCS,outpatient,,,1917,766.80,RT,550,,,,case rate,pays based on per visit,1476.09,77,,1180.87,percent of total billed charges,77% of total billed charges,160.68,100,,,fee schedule,100% of CMS OPPS rate,1248.54,429,,,fee schedule,429% of BCBS fee schedule,1301.61,515,,,fee schedule,515% of BCBS fee schedule,1301.61,364,,,fee schedule,364% of BCBS fee schedule,1301.61,515,,,fee schedule,515% of BCBS fee schedule,1725.3,90,,1380.24,percent of total billed charges,90% of total billed charges,1533.6,80,,1226.88,percent of total billed charges,80% of total billed charges,1725.3,90,,1380.24,percent of total billed charges,90% of total billed charges,1437.75,75,,1150.2,percent of total billed charges,75% of total billed charges,196.02,122,,,fee schedule,122% of HUMANA fee schedule,555.93,29,,444.744,percent of total billed charges,29% of total billed charges,160.68,100,,,fee schedule,100% of CMS OPPS rate,1284.39,67,,1027.512,percent of total billed charges,67% of total billed charges,311.42,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,1533.6,80,,1226.88,percent of total billed charges,80% of total billed charges,1246.05,65,,996.84,percent of total billed charges,65% of total billed charges,683.79,35.67,,547.032,percent of total billed charges,35.67% of total billed charges,160.68,1725.3,
CT HIP LT W/CONTRAST,3501047,CDM,350,RC,73701,HCPCS,outpatient,,,1509,603.60,LT,550,,,,case rate,pays based on per visit,1161.93,77,,929.54,percent of total billed charges,77% of total billed charges,160.68,100,,,fee schedule,100% of CMS OPPS rate,1248.54,429,,,fee schedule,429% of BCBS fee schedule,1301.61,515,,,fee schedule,515% of BCBS fee schedule,1301.61,364,,,fee schedule,364% of BCBS fee schedule,1301.61,515,,,fee schedule,515% of BCBS fee schedule,1358.1,90,,1086.48,percent of total billed charges,90% of total billed charges,1207.2,80,,965.76,percent of total billed charges,80% of total billed charges,1358.1,90,,1086.48,percent of total billed charges,90% of total billed charges,1131.75,75,,905.4,percent of total billed charges,75% of total billed charges,196.02,122,,,fee schedule,122% of HUMANA fee schedule,437.61,29,,350.088,percent of total billed charges,29% of total billed charges,160.68,100,,,fee schedule,100% of CMS OPPS rate,1011.03,67,,808.824,percent of total billed charges,67% of total billed charges,280.11,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,1207.2,80,,965.76,percent of total billed charges,80% of total billed charges,980.85,65,,784.68,percent of total billed charges,65% of total billed charges,538.26,35.67,,430.608,percent of total billed charges,35.67% of total billed charges,160.68,1358.1,
CT HIP LT W/OUT CONTRAST,3501048,CDM,350,RC,73700,HCPCS,outpatient,,,1672,668.80,LT,550,,,,case rate,pays based on per visit,1287.44,77,,1029.95,percent of total billed charges,77% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,565.43,429,,,fee schedule,429% of BCBS fee schedule,589.47,515,,,fee schedule,515% of BCBS fee schedule,589.47,364,,,fee schedule,364% of BCBS fee schedule,589.47,515,,,fee schedule,515% of BCBS fee schedule,1504.8,90,,1203.84,percent of total billed charges,90% of total billed charges,1337.6,80,,1070.08,percent of total billed charges,80% of total billed charges,1504.8,90,,1203.84,percent of total billed charges,90% of total billed charges,1254,75,,1003.2,percent of total billed charges,75% of total billed charges,117.29,122,,,fee schedule,122% of HUMANA fee schedule,484.88,29,,387.904,percent of total billed charges,29% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,1120.24,67,,896.192,percent of total billed charges,67% of total billed charges,178.87,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,1337.6,80,,1070.08,percent of total billed charges,80% of total billed charges,1086.8,65,,869.44,percent of total billed charges,65% of total billed charges,596.4,35.67,,477.12,percent of total billed charges,35.67% of total billed charges,96.14,1504.8,
CT HIP LT W/WOUT CONTRAST,3501049,CDM,350,RC,73702,HCPCS,outpatient,,,1667,666.80,LT,550,,,,case rate,pays based on per visit,1283.59,77,,1026.87,percent of total billed charges,77% of total billed charges,160.68,100,,,fee schedule,100% of CMS OPPS rate,1248.54,429,,,fee schedule,429% of BCBS fee schedule,1301.61,515,,,fee schedule,515% of BCBS fee schedule,1301.61,364,,,fee schedule,364% of BCBS fee schedule,1301.61,515,,,fee schedule,515% of BCBS fee schedule,1500.3,90,,1200.24,percent of total billed charges,90% of total billed charges,1333.6,80,,1066.88,percent of total billed charges,80% of total billed charges,1500.3,90,,1200.24,percent of total billed charges,90% of total billed charges,1250.25,75,,1000.2,percent of total billed charges,75% of total billed charges,196.02,122,,,fee schedule,122% of HUMANA fee schedule,483.43,29,,386.744,percent of total billed charges,29% of total billed charges,160.68,100,,,fee schedule,100% of CMS OPPS rate,1116.89,67,,893.512,percent of total billed charges,67% of total billed charges,311.42,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,1333.6,80,,1066.88,percent of total billed charges,80% of total billed charges,1083.55,65,,866.84,percent of total billed charges,65% of total billed charges,594.62,35.67,,475.696,percent of total billed charges,35.67% of total billed charges,160.68,1500.3,
CT HIP RT W/CONTRAST,3501050,CDM,350,RC,73701,HCPCS,outpatient,,,1509,603.60,RT,550,,,,case rate,pays based on per visit,1161.93,77,,929.54,percent of total billed charges,77% of total billed charges,160.68,100,,,fee schedule,100% of CMS OPPS rate,1248.54,429,,,fee schedule,429% of BCBS fee schedule,1301.61,515,,,fee schedule,515% of BCBS fee schedule,1301.61,364,,,fee schedule,364% of BCBS fee schedule,1301.61,515,,,fee schedule,515% of BCBS fee schedule,1358.1,90,,1086.48,percent of total billed charges,90% of total billed charges,1207.2,80,,965.76,percent of total billed charges,80% of total billed charges,1358.1,90,,1086.48,percent of total billed charges,90% of total billed charges,1131.75,75,,905.4,percent of total billed charges,75% of total billed charges,196.02,122,,,fee schedule,122% of HUMANA fee schedule,437.61,29,,350.088,percent of total billed charges,29% of total billed charges,160.68,100,,,fee schedule,100% of CMS OPPS rate,1011.03,67,,808.824,percent of total billed charges,67% of total billed charges,280.11,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,1207.2,80,,965.76,percent of total billed charges,80% of total billed charges,980.85,65,,784.68,percent of total billed charges,65% of total billed charges,538.26,35.67,,430.608,percent of total billed charges,35.67% of total billed charges,160.68,1358.1,
CT HIP RT W/OUT CONTRAST,3501051,CDM,350,RC,73700,HCPCS,outpatient,,,1672,668.80,RT,550,,,,case rate,pays based on per visit,1287.44,77,,1029.95,percent of total billed charges,77% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,565.43,429,,,fee schedule,429% of BCBS fee schedule,589.47,515,,,fee schedule,515% of BCBS fee schedule,589.47,364,,,fee schedule,364% of BCBS fee schedule,589.47,515,,,fee schedule,515% of BCBS fee schedule,1504.8,90,,1203.84,percent of total billed charges,90% of total billed charges,1337.6,80,,1070.08,percent of total billed charges,80% of total billed charges,1504.8,90,,1203.84,percent of total billed charges,90% of total billed charges,1254,75,,1003.2,percent of total billed charges,75% of total billed charges,117.29,122,,,fee schedule,122% of HUMANA fee schedule,484.88,29,,387.904,percent of total billed charges,29% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,1120.24,67,,896.192,percent of total billed charges,67% of total billed charges,178.87,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,1337.6,80,,1070.08,percent of total billed charges,80% of total billed charges,1086.8,65,,869.44,percent of total billed charges,65% of total billed charges,596.4,35.67,,477.12,percent of total billed charges,35.67% of total billed charges,96.14,1504.8,
CT HIP RT W/WO CONTRAST,3501052,CDM,350,RC,73702,HCPCS,outpatient,,,1667,666.80,RT,550,,,,case rate,pays based on per visit,1283.59,77,,1026.87,percent of total billed charges,77% of total billed charges,160.68,100,,,fee schedule,100% of CMS OPPS rate,1248.54,429,,,fee schedule,429% of BCBS fee schedule,1301.61,515,,,fee schedule,515% of BCBS fee schedule,1301.61,364,,,fee schedule,364% of BCBS fee schedule,1301.61,515,,,fee schedule,515% of BCBS fee schedule,1500.3,90,,1200.24,percent of total billed charges,90% of total billed charges,1333.6,80,,1066.88,percent of total billed charges,80% of total billed charges,1500.3,90,,1200.24,percent of total billed charges,90% of total billed charges,1250.25,75,,1000.2,percent of total billed charges,75% of total billed charges,196.02,122,,,fee schedule,122% of HUMANA fee schedule,483.43,29,,386.744,percent of total billed charges,29% of total billed charges,160.68,100,,,fee schedule,100% of CMS OPPS rate,1116.89,67,,893.512,percent of total billed charges,67% of total billed charges,311.42,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,1333.6,80,,1066.88,percent of total billed charges,80% of total billed charges,1083.55,65,,866.84,percent of total billed charges,65% of total billed charges,594.62,35.67,,475.696,percent of total billed charges,35.67% of total billed charges,160.68,1500.3,
CT HUMERUS LT W/CONTRAST,3501053,CDM,350,RC,73201,HCPCS,outpatient,,,1741,696.40,LT,550,,,,case rate,pays based on per visit,1340.57,77,,1072.46,percent of total billed charges,77% of total billed charges,336.32,100,,,fee schedule,100% of CMS OPPS rate,1248.54,429,,,fee schedule,429% of BCBS fee schedule,1301.61,515,,,fee schedule,515% of BCBS fee schedule,1301.61,364,,,fee schedule,364% of BCBS fee schedule,1301.61,515,,,fee schedule,515% of BCBS fee schedule,1566.9,90,,1253.52,percent of total billed charges,90% of total billed charges,1392.8,80,,1114.24,percent of total billed charges,80% of total billed charges,1566.9,90,,1253.52,percent of total billed charges,90% of total billed charges,1305.75,75,,1044.6,percent of total billed charges,75% of total billed charges,410.31,122,,,fee schedule,122% of HUMANA fee schedule,504.89,29,,403.912,percent of total billed charges,29% of total billed charges,336.32,100,,,fee schedule,100% of CMS OPPS rate,1166.47,67,,933.176,percent of total billed charges,67% of total billed charges,280.11,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,1392.8,80,,1114.24,percent of total billed charges,80% of total billed charges,1131.65,65,,905.32,percent of total billed charges,65% of total billed charges,621.01,35.67,,496.808,percent of total billed charges,35.67% of total billed charges,280.11,1566.9,
CT HUMERUS LT W/OUT CONTRAST,3501054,CDM,350,RC,73200,HCPCS,outpatient,,,1751,700.40,LT,550,,,,case rate,pays based on per visit,1348.27,77,,1078.62,percent of total billed charges,77% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,565.43,429,,,fee schedule,429% of BCBS fee schedule,589.47,515,,,fee schedule,515% of BCBS fee schedule,589.47,364,,,fee schedule,364% of BCBS fee schedule,589.47,515,,,fee schedule,515% of BCBS fee schedule,1575.9,90,,1260.72,percent of total billed charges,90% of total billed charges,1400.8,80,,1120.64,percent of total billed charges,80% of total billed charges,1575.9,90,,1260.72,percent of total billed charges,90% of total billed charges,1313.25,75,,1050.6,percent of total billed charges,75% of total billed charges,117.29,122,,,fee schedule,122% of HUMANA fee schedule,507.79,29,,406.232,percent of total billed charges,29% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,1173.17,67,,938.536,percent of total billed charges,67% of total billed charges,178.87,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,1400.8,80,,1120.64,percent of total billed charges,80% of total billed charges,1138.15,65,,910.52,percent of total billed charges,65% of total billed charges,624.58,35.67,,499.664,percent of total billed charges,35.67% of total billed charges,96.14,1575.9,
CT HUMERUS LT W/WO CONTRAST,3501055,CDM,350,RC,73202,HCPCS,outpatient,,,1917,766.80,LT,550,,,,case rate,pays based on per visit,1476.09,77,,1180.87,percent of total billed charges,77% of total billed charges,160.68,100,,,fee schedule,100% of CMS OPPS rate,1248.54,429,,,fee schedule,429% of BCBS fee schedule,1301.61,515,,,fee schedule,515% of BCBS fee schedule,1301.61,364,,,fee schedule,364% of BCBS fee schedule,1301.61,515,,,fee schedule,515% of BCBS fee schedule,1725.3,90,,1380.24,percent of total billed charges,90% of total billed charges,1533.6,80,,1226.88,percent of total billed charges,80% of total billed charges,1725.3,90,,1380.24,percent of total billed charges,90% of total billed charges,1437.75,75,,1150.2,percent of total billed charges,75% of total billed charges,196.02,122,,,fee schedule,122% of HUMANA fee schedule,555.93,29,,444.744,percent of total billed charges,29% of total billed charges,160.68,100,,,fee schedule,100% of CMS OPPS rate,1284.39,67,,1027.512,percent of total billed charges,67% of total billed charges,311.42,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,1533.6,80,,1226.88,percent of total billed charges,80% of total billed charges,1246.05,65,,996.84,percent of total billed charges,65% of total billed charges,683.79,35.67,,547.032,percent of total billed charges,35.67% of total billed charges,160.68,1725.3,
CT HUMERUS RT W/CONTRAST,3501056,CDM,350,RC,73201,HCPCS,outpatient,,,1741,696.40,RT,550,,,,case rate,pays based on per visit,1340.57,77,,1072.46,percent of total billed charges,77% of total billed charges,336.32,100,,,fee schedule,100% of CMS OPPS rate,1248.54,429,,,fee schedule,429% of BCBS fee schedule,1301.61,515,,,fee schedule,515% of BCBS fee schedule,1301.61,364,,,fee schedule,364% of BCBS fee schedule,1301.61,515,,,fee schedule,515% of BCBS fee schedule,1566.9,90,,1253.52,percent of total billed charges,90% of total billed charges,1392.8,80,,1114.24,percent of total billed charges,80% of total billed charges,1566.9,90,,1253.52,percent of total billed charges,90% of total billed charges,1305.75,75,,1044.6,percent of total billed charges,75% of total billed charges,410.31,122,,,fee schedule,122% of HUMANA fee schedule,504.89,29,,403.912,percent of total billed charges,29% of total billed charges,336.32,100,,,fee schedule,100% of CMS OPPS rate,1166.47,67,,933.176,percent of total billed charges,67% of total billed charges,280.11,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,1392.8,80,,1114.24,percent of total billed charges,80% of total billed charges,1131.65,65,,905.32,percent of total billed charges,65% of total billed charges,621.01,35.67,,496.808,percent of total billed charges,35.67% of total billed charges,280.11,1566.9,
CT HUMERUS RT W/OUT CONTRAST,3501057,CDM,350,RC,73200,HCPCS,outpatient,,,1751,700.40,RT,550,,,,case rate,pays based on per visit,1348.27,77,,1078.62,percent of total billed charges,77% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,565.43,429,,,fee schedule,429% of BCBS fee schedule,589.47,515,,,fee schedule,515% of BCBS fee schedule,589.47,364,,,fee schedule,364% of BCBS fee schedule,589.47,515,,,fee schedule,515% of BCBS fee schedule,1575.9,90,,1260.72,percent of total billed charges,90% of total billed charges,1400.8,80,,1120.64,percent of total billed charges,80% of total billed charges,1575.9,90,,1260.72,percent of total billed charges,90% of total billed charges,1313.25,75,,1050.6,percent of total billed charges,75% of total billed charges,117.29,122,,,fee schedule,122% of HUMANA fee schedule,507.79,29,,406.232,percent of total billed charges,29% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,1173.17,67,,938.536,percent of total billed charges,67% of total billed charges,178.87,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,1400.8,80,,1120.64,percent of total billed charges,80% of total billed charges,1138.15,65,,910.52,percent of total billed charges,65% of total billed charges,624.58,35.67,,499.664,percent of total billed charges,35.67% of total billed charges,96.14,1575.9,
CT HUMERUS RT W/WOUT CONTRAST,3501058,CDM,350,RC,73202,HCPCS,outpatient,,,1917,766.80,RT,550,,,,case rate,pays based on per visit,1476.09,77,,1180.87,percent of total billed charges,77% of total billed charges,160.68,100,,,fee schedule,100% of CMS OPPS rate,1248.54,429,,,fee schedule,429% of BCBS fee schedule,1301.61,515,,,fee schedule,515% of BCBS fee schedule,1301.61,364,,,fee schedule,364% of BCBS fee schedule,1301.61,515,,,fee schedule,515% of BCBS fee schedule,1725.3,90,,1380.24,percent of total billed charges,90% of total billed charges,1533.6,80,,1226.88,percent of total billed charges,80% of total billed charges,1725.3,90,,1380.24,percent of total billed charges,90% of total billed charges,1437.75,75,,1150.2,percent of total billed charges,75% of total billed charges,196.02,122,,,fee schedule,122% of HUMANA fee schedule,555.93,29,,444.744,percent of total billed charges,29% of total billed charges,160.68,100,,,fee schedule,100% of CMS OPPS rate,1284.39,67,,1027.512,percent of total billed charges,67% of total billed charges,311.42,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,1533.6,80,,1226.88,percent of total billed charges,80% of total billed charges,1246.05,65,,996.84,percent of total billed charges,65% of total billed charges,683.79,35.67,,547.032,percent of total billed charges,35.67% of total billed charges,160.68,1725.3,
CT KNEE LT W/CONTRAST,3501059,CDM,350,RC,73701,HCPCS,outpatient,,,1509,603.60,LT,550,,,,case rate,pays based on per visit,1161.93,77,,929.54,percent of total billed charges,77% of total billed charges,160.68,100,,,fee schedule,100% of CMS OPPS rate,1248.54,429,,,fee schedule,429% of BCBS fee schedule,1301.61,515,,,fee schedule,515% of BCBS fee schedule,1301.61,364,,,fee schedule,364% of BCBS fee schedule,1301.61,515,,,fee schedule,515% of BCBS fee schedule,1358.1,90,,1086.48,percent of total billed charges,90% of total billed charges,1207.2,80,,965.76,percent of total billed charges,80% of total billed charges,1358.1,90,,1086.48,percent of total billed charges,90% of total billed charges,1131.75,75,,905.4,percent of total billed charges,75% of total billed charges,196.02,122,,,fee schedule,122% of HUMANA fee schedule,437.61,29,,350.088,percent of total billed charges,29% of total billed charges,160.68,100,,,fee schedule,100% of CMS OPPS rate,1011.03,67,,808.824,percent of total billed charges,67% of total billed charges,280.11,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,1207.2,80,,965.76,percent of total billed charges,80% of total billed charges,980.85,65,,784.68,percent of total billed charges,65% of total billed charges,538.26,35.67,,430.608,percent of total billed charges,35.67% of total billed charges,160.68,1358.1,
CT KNEE LT W/OUT CONTRAST,3501060,CDM,350,RC,73700,HCPCS,outpatient,,,1672,668.80,LT,550,,,,case rate,pays based on per visit,1287.44,77,,1029.95,percent of total billed charges,77% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,565.43,429,,,fee schedule,429% of BCBS fee schedule,589.47,515,,,fee schedule,515% of BCBS fee schedule,589.47,364,,,fee schedule,364% of BCBS fee schedule,589.47,515,,,fee schedule,515% of BCBS fee schedule,1504.8,90,,1203.84,percent of total billed charges,90% of total billed charges,1337.6,80,,1070.08,percent of total billed charges,80% of total billed charges,1504.8,90,,1203.84,percent of total billed charges,90% of total billed charges,1254,75,,1003.2,percent of total billed charges,75% of total billed charges,117.29,122,,,fee schedule,122% of HUMANA fee schedule,484.88,29,,387.904,percent of total billed charges,29% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,1120.24,67,,896.192,percent of total billed charges,67% of total billed charges,178.87,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,1337.6,80,,1070.08,percent of total billed charges,80% of total billed charges,1086.8,65,,869.44,percent of total billed charges,65% of total billed charges,596.4,35.67,,477.12,percent of total billed charges,35.67% of total billed charges,96.14,1504.8,
CT KNEE LT W/WOUT CONTRAST,3501061,CDM,350,RC,73702,HCPCS,outpatient,,,1667,666.80,LT,550,,,,case rate,pays based on per visit,1283.59,77,,1026.87,percent of total billed charges,77% of total billed charges,160.68,100,,,fee schedule,100% of CMS OPPS rate,1248.54,429,,,fee schedule,429% of BCBS fee schedule,1301.61,515,,,fee schedule,515% of BCBS fee schedule,1301.61,364,,,fee schedule,364% of BCBS fee schedule,1301.61,515,,,fee schedule,515% of BCBS fee schedule,1500.3,90,,1200.24,percent of total billed charges,90% of total billed charges,1333.6,80,,1066.88,percent of total billed charges,80% of total billed charges,1500.3,90,,1200.24,percent of total billed charges,90% of total billed charges,1250.25,75,,1000.2,percent of total billed charges,75% of total billed charges,196.02,122,,,fee schedule,122% of HUMANA fee schedule,483.43,29,,386.744,percent of total billed charges,29% of total billed charges,160.68,100,,,fee schedule,100% of CMS OPPS rate,1116.89,67,,893.512,percent of total billed charges,67% of total billed charges,311.42,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,1333.6,80,,1066.88,percent of total billed charges,80% of total billed charges,1083.55,65,,866.84,percent of total billed charges,65% of total billed charges,594.62,35.67,,475.696,percent of total billed charges,35.67% of total billed charges,160.68,1500.3,
CT KNEE RT W/CONTRAST,3501062,CDM,350,RC,73701,HCPCS,outpatient,,,1509,603.60,RT,550,,,,case rate,pays based on per visit,1161.93,77,,929.54,percent of total billed charges,77% of total billed charges,160.68,100,,,fee schedule,100% of CMS OPPS rate,1248.54,429,,,fee schedule,429% of BCBS fee schedule,1301.61,515,,,fee schedule,515% of BCBS fee schedule,1301.61,364,,,fee schedule,364% of BCBS fee schedule,1301.61,515,,,fee schedule,515% of BCBS fee schedule,1358.1,90,,1086.48,percent of total billed charges,90% of total billed charges,1207.2,80,,965.76,percent of total billed charges,80% of total billed charges,1358.1,90,,1086.48,percent of total billed charges,90% of total billed charges,1131.75,75,,905.4,percent of total billed charges,75% of total billed charges,196.02,122,,,fee schedule,122% of HUMANA fee schedule,437.61,29,,350.088,percent of total billed charges,29% of total billed charges,160.68,100,,,fee schedule,100% of CMS OPPS rate,1011.03,67,,808.824,percent of total billed charges,67% of total billed charges,280.11,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,1207.2,80,,965.76,percent of total billed charges,80% of total billed charges,980.85,65,,784.68,percent of total billed charges,65% of total billed charges,538.26,35.67,,430.608,percent of total billed charges,35.67% of total billed charges,160.68,1358.1,
CT KNEE RT W/OUT CONTRAST,3501063,CDM,350,RC,73700,HCPCS,outpatient,,,1672,668.80,RT,550,,,,case rate,pays based on per visit,1287.44,77,,1029.95,percent of total billed charges,77% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,565.43,429,,,fee schedule,429% of BCBS fee schedule,589.47,515,,,fee schedule,515% of BCBS fee schedule,589.47,364,,,fee schedule,364% of BCBS fee schedule,589.47,515,,,fee schedule,515% of BCBS fee schedule,1504.8,90,,1203.84,percent of total billed charges,90% of total billed charges,1337.6,80,,1070.08,percent of total billed charges,80% of total billed charges,1504.8,90,,1203.84,percent of total billed charges,90% of total billed charges,1254,75,,1003.2,percent of total billed charges,75% of total billed charges,117.29,122,,,fee schedule,122% of HUMANA fee schedule,484.88,29,,387.904,percent of total billed charges,29% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,1120.24,67,,896.192,percent of total billed charges,67% of total billed charges,178.87,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,1337.6,80,,1070.08,percent of total billed charges,80% of total billed charges,1086.8,65,,869.44,percent of total billed charges,65% of total billed charges,596.4,35.67,,477.12,percent of total billed charges,35.67% of total billed charges,96.14,1504.8,
CT KNEE RT W/WOUT CONTRAST,3501064,CDM,350,RC,73702,HCPCS,outpatient,,,1667,666.80,RT,550,,,,case rate,pays based on per visit,1283.59,77,,1026.87,percent of total billed charges,77% of total billed charges,160.68,100,,,fee schedule,100% of CMS OPPS rate,1248.54,429,,,fee schedule,429% of BCBS fee schedule,1301.61,515,,,fee schedule,515% of BCBS fee schedule,1301.61,364,,,fee schedule,364% of BCBS fee schedule,1301.61,515,,,fee schedule,515% of BCBS fee schedule,1500.3,90,,1200.24,percent of total billed charges,90% of total billed charges,1333.6,80,,1066.88,percent of total billed charges,80% of total billed charges,1500.3,90,,1200.24,percent of total billed charges,90% of total billed charges,1250.25,75,,1000.2,percent of total billed charges,75% of total billed charges,196.02,122,,,fee schedule,122% of HUMANA fee schedule,483.43,29,,386.744,percent of total billed charges,29% of total billed charges,160.68,100,,,fee schedule,100% of CMS OPPS rate,1116.89,67,,893.512,percent of total billed charges,67% of total billed charges,311.42,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,1333.6,80,,1066.88,percent of total billed charges,80% of total billed charges,1083.55,65,,866.84,percent of total billed charges,65% of total billed charges,594.62,35.67,,475.696,percent of total billed charges,35.67% of total billed charges,160.68,1500.3,
CT LOWER LEG LT W/CONTRAST,3501065,CDM,350,RC,73701,HCPCS,outpatient,,,1509,603.60,LT,550,,,,case rate,pays based on per visit,1161.93,77,,929.54,percent of total billed charges,77% of total billed charges,160.68,100,,,fee schedule,100% of CMS OPPS rate,1248.54,429,,,fee schedule,429% of BCBS fee schedule,1301.61,515,,,fee schedule,515% of BCBS fee schedule,1301.61,364,,,fee schedule,364% of BCBS fee schedule,1301.61,515,,,fee schedule,515% of BCBS fee schedule,1358.1,90,,1086.48,percent of total billed charges,90% of total billed charges,1207.2,80,,965.76,percent of total billed charges,80% of total billed charges,1358.1,90,,1086.48,percent of total billed charges,90% of total billed charges,1131.75,75,,905.4,percent of total billed charges,75% of total billed charges,196.02,122,,,fee schedule,122% of HUMANA fee schedule,437.61,29,,350.088,percent of total billed charges,29% of total billed charges,160.68,100,,,fee schedule,100% of CMS OPPS rate,1011.03,67,,808.824,percent of total billed charges,67% of total billed charges,280.11,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,1207.2,80,,965.76,percent of total billed charges,80% of total billed charges,980.85,65,,784.68,percent of total billed charges,65% of total billed charges,538.26,35.67,,430.608,percent of total billed charges,35.67% of total billed charges,160.68,1358.1,
CT LOWER LEG LT W/OUT CONTRAST,3501066,CDM,350,RC,73700,HCPCS,outpatient,,,1672,668.80,LT,550,,,,case rate,pays based on per visit,1287.44,77,,1029.95,percent of total billed charges,77% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,565.43,429,,,fee schedule,429% of BCBS fee schedule,589.47,515,,,fee schedule,515% of BCBS fee schedule,589.47,364,,,fee schedule,364% of BCBS fee schedule,589.47,515,,,fee schedule,515% of BCBS fee schedule,1504.8,90,,1203.84,percent of total billed charges,90% of total billed charges,1337.6,80,,1070.08,percent of total billed charges,80% of total billed charges,1504.8,90,,1203.84,percent of total billed charges,90% of total billed charges,1254,75,,1003.2,percent of total billed charges,75% of total billed charges,117.29,122,,,fee schedule,122% of HUMANA fee schedule,484.88,29,,387.904,percent of total billed charges,29% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,1120.24,67,,896.192,percent of total billed charges,67% of total billed charges,178.87,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,1337.6,80,,1070.08,percent of total billed charges,80% of total billed charges,1086.8,65,,869.44,percent of total billed charges,65% of total billed charges,596.4,35.67,,477.12,percent of total billed charges,35.67% of total billed charges,96.14,1504.8,
CT LOWER LEG LT W/WO CONTRAST,3501067,CDM,350,RC,73702,HCPCS,outpatient,,,1667,666.80,LT,550,,,,case rate,pays based on per visit,1283.59,77,,1026.87,percent of total billed charges,77% of total billed charges,160.68,100,,,fee schedule,100% of CMS OPPS rate,1248.54,429,,,fee schedule,429% of BCBS fee schedule,1301.61,515,,,fee schedule,515% of BCBS fee schedule,1301.61,364,,,fee schedule,364% of BCBS fee schedule,1301.61,515,,,fee schedule,515% of BCBS fee schedule,1500.3,90,,1200.24,percent of total billed charges,90% of total billed charges,1333.6,80,,1066.88,percent of total billed charges,80% of total billed charges,1500.3,90,,1200.24,percent of total billed charges,90% of total billed charges,1250.25,75,,1000.2,percent of total billed charges,75% of total billed charges,196.02,122,,,fee schedule,122% of HUMANA fee schedule,483.43,29,,386.744,percent of total billed charges,29% of total billed charges,160.68,100,,,fee schedule,100% of CMS OPPS rate,1116.89,67,,893.512,percent of total billed charges,67% of total billed charges,311.42,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,1333.6,80,,1066.88,percent of total billed charges,80% of total billed charges,1083.55,65,,866.84,percent of total billed charges,65% of total billed charges,594.62,35.67,,475.696,percent of total billed charges,35.67% of total billed charges,160.68,1500.3,
CT LOWER LEG RT W/CONTRAST,3501068,CDM,350,RC,73701,HCPCS,outpatient,,,1509,603.60,RT,550,,,,case rate,pays based on per visit,1161.93,77,,929.54,percent of total billed charges,77% of total billed charges,160.68,100,,,fee schedule,100% of CMS OPPS rate,1248.54,429,,,fee schedule,429% of BCBS fee schedule,1301.61,515,,,fee schedule,515% of BCBS fee schedule,1301.61,364,,,fee schedule,364% of BCBS fee schedule,1301.61,515,,,fee schedule,515% of BCBS fee schedule,1358.1,90,,1086.48,percent of total billed charges,90% of total billed charges,1207.2,80,,965.76,percent of total billed charges,80% of total billed charges,1358.1,90,,1086.48,percent of total billed charges,90% of total billed charges,1131.75,75,,905.4,percent of total billed charges,75% of total billed charges,196.02,122,,,fee schedule,122% of HUMANA fee schedule,437.61,29,,350.088,percent of total billed charges,29% of total billed charges,160.68,100,,,fee schedule,100% of CMS OPPS rate,1011.03,67,,808.824,percent of total billed charges,67% of total billed charges,280.11,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,1207.2,80,,965.76,percent of total billed charges,80% of total billed charges,980.85,65,,784.68,percent of total billed charges,65% of total billed charges,538.26,35.67,,430.608,percent of total billed charges,35.67% of total billed charges,160.68,1358.1,
CT LOWER LEG RT W/OUT CONTRAST,3501069,CDM,350,RC,73700,HCPCS,outpatient,,,1672,668.80,RT,550,,,,case rate,pays based on per visit,1287.44,77,,1029.95,percent of total billed charges,77% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,565.43,429,,,fee schedule,429% of BCBS fee schedule,589.47,515,,,fee schedule,515% of BCBS fee schedule,589.47,364,,,fee schedule,364% of BCBS fee schedule,589.47,515,,,fee schedule,515% of BCBS fee schedule,1504.8,90,,1203.84,percent of total billed charges,90% of total billed charges,1337.6,80,,1070.08,percent of total billed charges,80% of total billed charges,1504.8,90,,1203.84,percent of total billed charges,90% of total billed charges,1254,75,,1003.2,percent of total billed charges,75% of total billed charges,117.29,122,,,fee schedule,122% of HUMANA fee schedule,484.88,29,,387.904,percent of total billed charges,29% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,1120.24,67,,896.192,percent of total billed charges,67% of total billed charges,178.87,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,1337.6,80,,1070.08,percent of total billed charges,80% of total billed charges,1086.8,65,,869.44,percent of total billed charges,65% of total billed charges,596.4,35.67,,477.12,percent of total billed charges,35.67% of total billed charges,96.14,1504.8,
CT LOWER LEG RT W/WO CONTRAST,3501070,CDM,350,RC,73702,HCPCS,outpatient,,,1667,666.80,RT,550,,,,case rate,pays based on per visit,1283.59,77,,1026.87,percent of total billed charges,77% of total billed charges,160.68,100,,,fee schedule,100% of CMS OPPS rate,1248.54,429,,,fee schedule,429% of BCBS fee schedule,1301.61,515,,,fee schedule,515% of BCBS fee schedule,1301.61,364,,,fee schedule,364% of BCBS fee schedule,1301.61,515,,,fee schedule,515% of BCBS fee schedule,1500.3,90,,1200.24,percent of total billed charges,90% of total billed charges,1333.6,80,,1066.88,percent of total billed charges,80% of total billed charges,1500.3,90,,1200.24,percent of total billed charges,90% of total billed charges,1250.25,75,,1000.2,percent of total billed charges,75% of total billed charges,196.02,122,,,fee schedule,122% of HUMANA fee schedule,483.43,29,,386.744,percent of total billed charges,29% of total billed charges,160.68,100,,,fee schedule,100% of CMS OPPS rate,1116.89,67,,893.512,percent of total billed charges,67% of total billed charges,311.42,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,1333.6,80,,1066.88,percent of total billed charges,80% of total billed charges,1083.55,65,,866.84,percent of total billed charges,65% of total billed charges,594.62,35.67,,475.696,percent of total billed charges,35.67% of total billed charges,160.68,1500.3,
CT LUNG SCREENING LOW-DOSE,3501071,CDM,350,RC,71271,HCPCS,outpatient,,,1751,700.40,,550,,,,case rate,pays based on per visit,1348.27,77,,1078.62,percent of total billed charges,77% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,398.21,385,,,fee schedule,385% of BCBS fee schedule,414.75,401,,,fee schedule,401% of BCBS fee schedule,414.75,401,,,fee schedule,401% of BCBS fee schedule,414.75,401,,,fee schedule,401% of BCBS fee schedule,1575.9,90,,1260.72,percent of total billed charges,90% of total billed charges,1400.8,80,,1120.64,percent of total billed charges,80% of total billed charges,1575.9,90,,1260.72,percent of total billed charges,90% of total billed charges,1313.25,75,,1050.6,percent of total billed charges,75% of total billed charges,117.29,122,,,fee schedule,122% of HUMANA fee schedule,507.79,29,,406.232,percent of total billed charges,29% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,1173.17,67,,938.536,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1400.8,80,,1120.64,percent of total billed charges,80% of total billed charges,1138.15,65,,910.52,percent of total billed charges,65% of total billed charges,624.58,35.67,,499.664,percent of total billed charges,35.67% of total billed charges,96.14,1575.9,
CT SACRUM,3501072,CDM,350,RC,73701,HCPCS,outpatient,,,1509,603.60,,550,,,,case rate,pays based on per visit,1161.93,77,,929.54,percent of total billed charges,77% of total billed charges,160.68,100,,,fee schedule,100% of CMS OPPS rate,1248.54,429,,,fee schedule,429% of BCBS fee schedule,1301.61,515,,,fee schedule,515% of BCBS fee schedule,1301.61,364,,,fee schedule,364% of BCBS fee schedule,1301.61,515,,,fee schedule,515% of BCBS fee schedule,1358.1,90,,1086.48,percent of total billed charges,90% of total billed charges,1207.2,80,,965.76,percent of total billed charges,80% of total billed charges,1358.1,90,,1086.48,percent of total billed charges,90% of total billed charges,1131.75,75,,905.4,percent of total billed charges,75% of total billed charges,196.02,122,,,fee schedule,122% of HUMANA fee schedule,437.61,29,,350.088,percent of total billed charges,29% of total billed charges,160.68,100,,,fee schedule,100% of CMS OPPS rate,1011.03,67,,808.824,percent of total billed charges,67% of total billed charges,280.11,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,1207.2,80,,965.76,percent of total billed charges,80% of total billed charges,980.85,65,,784.68,percent of total billed charges,65% of total billed charges,538.26,35.67,,430.608,percent of total billed charges,35.67% of total billed charges,160.68,1358.1,
CT SCAPULA LT,3501073,CDM,350,RC,73201,HCPCS,outpatient,,,1741,696.40,LT,550,,,,case rate,pays based on per visit,1340.57,77,,1072.46,percent of total billed charges,77% of total billed charges,336.32,100,,,fee schedule,100% of CMS OPPS rate,1248.54,429,,,fee schedule,429% of BCBS fee schedule,1301.61,515,,,fee schedule,515% of BCBS fee schedule,1301.61,364,,,fee schedule,364% of BCBS fee schedule,1301.61,515,,,fee schedule,515% of BCBS fee schedule,1566.9,90,,1253.52,percent of total billed charges,90% of total billed charges,1392.8,80,,1114.24,percent of total billed charges,80% of total billed charges,1566.9,90,,1253.52,percent of total billed charges,90% of total billed charges,1305.75,75,,1044.6,percent of total billed charges,75% of total billed charges,410.31,122,,,fee schedule,122% of HUMANA fee schedule,504.89,29,,403.912,percent of total billed charges,29% of total billed charges,336.32,100,,,fee schedule,100% of CMS OPPS rate,1166.47,67,,933.176,percent of total billed charges,67% of total billed charges,280.11,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,1392.8,80,,1114.24,percent of total billed charges,80% of total billed charges,1131.65,65,,905.32,percent of total billed charges,65% of total billed charges,621.01,35.67,,496.808,percent of total billed charges,35.67% of total billed charges,280.11,1566.9,
CT SCAPULA RT,3501074,CDM,350,RC,73201,HCPCS,outpatient,,,1741,696.40,RT,550,,,,case rate,pays based on per visit,1340.57,77,,1072.46,percent of total billed charges,77% of total billed charges,336.32,100,,,fee schedule,100% of CMS OPPS rate,1248.54,429,,,fee schedule,429% of BCBS fee schedule,1301.61,515,,,fee schedule,515% of BCBS fee schedule,1301.61,364,,,fee schedule,364% of BCBS fee schedule,1301.61,515,,,fee schedule,515% of BCBS fee schedule,1566.9,90,,1253.52,percent of total billed charges,90% of total billed charges,1392.8,80,,1114.24,percent of total billed charges,80% of total billed charges,1566.9,90,,1253.52,percent of total billed charges,90% of total billed charges,1305.75,75,,1044.6,percent of total billed charges,75% of total billed charges,410.31,122,,,fee schedule,122% of HUMANA fee schedule,504.89,29,,403.912,percent of total billed charges,29% of total billed charges,336.32,100,,,fee schedule,100% of CMS OPPS rate,1166.47,67,,933.176,percent of total billed charges,67% of total billed charges,280.11,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,1392.8,80,,1114.24,percent of total billed charges,80% of total billed charges,1131.65,65,,905.32,percent of total billed charges,65% of total billed charges,621.01,35.67,,496.808,percent of total billed charges,35.67% of total billed charges,280.11,1566.9,
CT SHOULDER LT W/CONTRAST,3501075,CDM,350,RC,73201,HCPCS,outpatient,,,1741,696.40,LT,550,,,,case rate,pays based on per visit,1340.57,77,,1072.46,percent of total billed charges,77% of total billed charges,336.32,100,,,fee schedule,100% of CMS OPPS rate,1248.54,429,,,fee schedule,429% of BCBS fee schedule,1301.61,515,,,fee schedule,515% of BCBS fee schedule,1301.61,364,,,fee schedule,364% of BCBS fee schedule,1301.61,515,,,fee schedule,515% of BCBS fee schedule,1566.9,90,,1253.52,percent of total billed charges,90% of total billed charges,1392.8,80,,1114.24,percent of total billed charges,80% of total billed charges,1566.9,90,,1253.52,percent of total billed charges,90% of total billed charges,1305.75,75,,1044.6,percent of total billed charges,75% of total billed charges,410.31,122,,,fee schedule,122% of HUMANA fee schedule,504.89,29,,403.912,percent of total billed charges,29% of total billed charges,336.32,100,,,fee schedule,100% of CMS OPPS rate,1166.47,67,,933.176,percent of total billed charges,67% of total billed charges,280.11,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,1392.8,80,,1114.24,percent of total billed charges,80% of total billed charges,1131.65,65,,905.32,percent of total billed charges,65% of total billed charges,621.01,35.67,,496.808,percent of total billed charges,35.67% of total billed charges,280.11,1566.9,
CT SHOULDER LT W/OUT CONTRAST,3501076,CDM,350,RC,73200,HCPCS,outpatient,,,1751,700.40,LT,550,,,,case rate,pays based on per visit,1348.27,77,,1078.62,percent of total billed charges,77% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,565.43,429,,,fee schedule,429% of BCBS fee schedule,589.47,515,,,fee schedule,515% of BCBS fee schedule,589.47,364,,,fee schedule,364% of BCBS fee schedule,589.47,515,,,fee schedule,515% of BCBS fee schedule,1575.9,90,,1260.72,percent of total billed charges,90% of total billed charges,1400.8,80,,1120.64,percent of total billed charges,80% of total billed charges,1575.9,90,,1260.72,percent of total billed charges,90% of total billed charges,1313.25,75,,1050.6,percent of total billed charges,75% of total billed charges,117.29,122,,,fee schedule,122% of HUMANA fee schedule,507.79,29,,406.232,percent of total billed charges,29% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,1173.17,67,,938.536,percent of total billed charges,67% of total billed charges,178.87,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,1400.8,80,,1120.64,percent of total billed charges,80% of total billed charges,1138.15,65,,910.52,percent of total billed charges,65% of total billed charges,624.58,35.67,,499.664,percent of total billed charges,35.67% of total billed charges,96.14,1575.9,
CT SHOULDER LT W/WO CONTRAST,3501077,CDM,350,RC,73202,HCPCS,outpatient,,,1917,766.80,LT,550,,,,case rate,pays based on per visit,1476.09,77,,1180.87,percent of total billed charges,77% of total billed charges,160.68,100,,,fee schedule,100% of CMS OPPS rate,1248.54,429,,,fee schedule,429% of BCBS fee schedule,1301.61,515,,,fee schedule,515% of BCBS fee schedule,1301.61,364,,,fee schedule,364% of BCBS fee schedule,1301.61,515,,,fee schedule,515% of BCBS fee schedule,1725.3,90,,1380.24,percent of total billed charges,90% of total billed charges,1533.6,80,,1226.88,percent of total billed charges,80% of total billed charges,1725.3,90,,1380.24,percent of total billed charges,90% of total billed charges,1437.75,75,,1150.2,percent of total billed charges,75% of total billed charges,196.02,122,,,fee schedule,122% of HUMANA fee schedule,555.93,29,,444.744,percent of total billed charges,29% of total billed charges,160.68,100,,,fee schedule,100% of CMS OPPS rate,1284.39,67,,1027.512,percent of total billed charges,67% of total billed charges,311.42,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,1533.6,80,,1226.88,percent of total billed charges,80% of total billed charges,1246.05,65,,996.84,percent of total billed charges,65% of total billed charges,683.79,35.67,,547.032,percent of total billed charges,35.67% of total billed charges,160.68,1725.3,
CT SHOULDER RT W/CONTRAST,3501078,CDM,350,RC,73201,HCPCS,outpatient,,,1741,696.40,RT,550,,,,case rate,pays based on per visit,1340.57,77,,1072.46,percent of total billed charges,77% of total billed charges,336.32,100,,,fee schedule,100% of CMS OPPS rate,1248.54,429,,,fee schedule,429% of BCBS fee schedule,1301.61,515,,,fee schedule,515% of BCBS fee schedule,1301.61,364,,,fee schedule,364% of BCBS fee schedule,1301.61,515,,,fee schedule,515% of BCBS fee schedule,1566.9,90,,1253.52,percent of total billed charges,90% of total billed charges,1392.8,80,,1114.24,percent of total billed charges,80% of total billed charges,1566.9,90,,1253.52,percent of total billed charges,90% of total billed charges,1305.75,75,,1044.6,percent of total billed charges,75% of total billed charges,410.31,122,,,fee schedule,122% of HUMANA fee schedule,504.89,29,,403.912,percent of total billed charges,29% of total billed charges,336.32,100,,,fee schedule,100% of CMS OPPS rate,1166.47,67,,933.176,percent of total billed charges,67% of total billed charges,280.11,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,1392.8,80,,1114.24,percent of total billed charges,80% of total billed charges,1131.65,65,,905.32,percent of total billed charges,65% of total billed charges,621.01,35.67,,496.808,percent of total billed charges,35.67% of total billed charges,280.11,1566.9,
CT SHOULDER RT W/OUT CONTRAST,3501079,CDM,350,RC,73200,HCPCS,outpatient,,,1751,700.40,RT,550,,,,case rate,pays based on per visit,1348.27,77,,1078.62,percent of total billed charges,77% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,565.43,429,,,fee schedule,429% of BCBS fee schedule,589.47,515,,,fee schedule,515% of BCBS fee schedule,589.47,364,,,fee schedule,364% of BCBS fee schedule,589.47,515,,,fee schedule,515% of BCBS fee schedule,1575.9,90,,1260.72,percent of total billed charges,90% of total billed charges,1400.8,80,,1120.64,percent of total billed charges,80% of total billed charges,1575.9,90,,1260.72,percent of total billed charges,90% of total billed charges,1313.25,75,,1050.6,percent of total billed charges,75% of total billed charges,117.29,122,,,fee schedule,122% of HUMANA fee schedule,507.79,29,,406.232,percent of total billed charges,29% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,1173.17,67,,938.536,percent of total billed charges,67% of total billed charges,178.87,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,1400.8,80,,1120.64,percent of total billed charges,80% of total billed charges,1138.15,65,,910.52,percent of total billed charges,65% of total billed charges,624.58,35.67,,499.664,percent of total billed charges,35.67% of total billed charges,96.14,1575.9,
CT SHOULDER RT W/WO CONTRAST,3501080,CDM,350,RC,73202,HCPCS,outpatient,,,1917,766.80,RT,550,,,,case rate,pays based on per visit,1476.09,77,,1180.87,percent of total billed charges,77% of total billed charges,160.68,100,,,fee schedule,100% of CMS OPPS rate,1248.54,429,,,fee schedule,429% of BCBS fee schedule,1301.61,515,,,fee schedule,515% of BCBS fee schedule,1301.61,364,,,fee schedule,364% of BCBS fee schedule,1301.61,515,,,fee schedule,515% of BCBS fee schedule,1725.3,90,,1380.24,percent of total billed charges,90% of total billed charges,1533.6,80,,1226.88,percent of total billed charges,80% of total billed charges,1725.3,90,,1380.24,percent of total billed charges,90% of total billed charges,1437.75,75,,1150.2,percent of total billed charges,75% of total billed charges,196.02,122,,,fee schedule,122% of HUMANA fee schedule,555.93,29,,444.744,percent of total billed charges,29% of total billed charges,160.68,100,,,fee schedule,100% of CMS OPPS rate,1284.39,67,,1027.512,percent of total billed charges,67% of total billed charges,311.42,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,1533.6,80,,1226.88,percent of total billed charges,80% of total billed charges,1246.05,65,,996.84,percent of total billed charges,65% of total billed charges,683.79,35.67,,547.032,percent of total billed charges,35.67% of total billed charges,160.68,1725.3,
CT TMJ BI W/CONTRAST,3501081,CDM,350,RC,70487,HCPCS,outpatient,,,2072,828.80,50,550,,,,case rate,pays based on per visit,1595.44,77,,1276.35,percent of total billed charges,77% of total billed charges,160.68,100,,,fee schedule,100% of CMS OPPS rate,1248.54,429,,,fee schedule,429% of BCBS fee schedule,1301.61,515,,,fee schedule,515% of BCBS fee schedule,1301.61,364,,,fee schedule,364% of BCBS fee schedule,1301.61,515,,,fee schedule,515% of BCBS fee schedule,1864.8,90,,1491.84,percent of total billed charges,90% of total billed charges,1657.6,80,,1326.08,percent of total billed charges,80% of total billed charges,1864.8,90,,1491.84,percent of total billed charges,90% of total billed charges,1554,75,,1243.2,percent of total billed charges,75% of total billed charges,196.02,122,,,fee schedule,122% of HUMANA fee schedule,600.88,29,,480.704,percent of total billed charges,29% of total billed charges,160.68,100,,,fee schedule,100% of CMS OPPS rate,1388.24,67,,1110.592,percent of total billed charges,67% of total billed charges,280.11,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,1657.6,80,,1326.08,percent of total billed charges,80% of total billed charges,1346.8,65,,1077.44,percent of total billed charges,65% of total billed charges,739.08,35.67,,591.264,percent of total billed charges,35.67% of total billed charges,160.68,1864.8,
CT TMJ BI W/OUT CONTRAST,3501082,CDM,350,RC,70486,HCPCS,outpatient,,,1774,709.60,50,550,,,,case rate,pays based on per visit,1365.98,77,,1092.78,percent of total billed charges,77% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,565.43,429,,,fee schedule,429% of BCBS fee schedule,589.47,515,,,fee schedule,515% of BCBS fee schedule,589.47,364,,,fee schedule,364% of BCBS fee schedule,589.47,515,,,fee schedule,515% of BCBS fee schedule,1596.6,90,,1277.28,percent of total billed charges,90% of total billed charges,1419.2,80,,1135.36,percent of total billed charges,80% of total billed charges,1596.6,90,,1277.28,percent of total billed charges,90% of total billed charges,1330.5,75,,1064.4,percent of total billed charges,75% of total billed charges,117.29,122,,,fee schedule,122% of HUMANA fee schedule,514.46,29,,411.568,percent of total billed charges,29% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,1188.58,67,,950.864,percent of total billed charges,67% of total billed charges,178.87,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,1419.2,80,,1135.36,percent of total billed charges,80% of total billed charges,1153.1,65,,922.48,percent of total billed charges,65% of total billed charges,632.79,35.67,,506.232,percent of total billed charges,35.67% of total billed charges,96.14,1596.6,
CT UROGRAM,3501083,CDM,350,RC,74178,HCPCS,outpatient,,,3201,1280.40,,550,,,,case rate,pays based on per visit,2464.77,77,,1971.82,percent of total billed charges,77% of total billed charges,336.32,100,,,fee schedule,100% of CMS OPPS rate,1248.54,429,,,fee schedule,429% of BCBS fee schedule,1301.61,515,,,fee schedule,515% of BCBS fee schedule,1301.61,364,,,fee schedule,364% of BCBS fee schedule,1301.61,515,,,fee schedule,515% of BCBS fee schedule,2880.9,90,,2304.72,percent of total billed charges,90% of total billed charges,2560.8,80,,2048.64,percent of total billed charges,80% of total billed charges,2880.9,90,,2304.72,percent of total billed charges,90% of total billed charges,2400.75,75,,1920.6,percent of total billed charges,75% of total billed charges,410.31,122,,,fee schedule,122% of HUMANA fee schedule,928.29,29,,742.632,percent of total billed charges,29% of total billed charges,336.32,100,,,fee schedule,100% of CMS OPPS rate,2144.67,67,,1715.736,percent of total billed charges,67% of total billed charges,541.17,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,2560.8,80,,2048.64,percent of total billed charges,80% of total billed charges,2080.65,65,,1664.52,percent of total billed charges,65% of total billed charges,1141.8,35.67,,913.44,percent of total billed charges,35.67% of total billed charges,336.32,2880.9,
CT WRIST LT W/CONTRAST,3501084,CDM,350,RC,73201,HCPCS,outpatient,,,1741,696.40,LT,550,,,,case rate,pays based on per visit,1340.57,77,,1072.46,percent of total billed charges,77% of total billed charges,336.32,100,,,fee schedule,100% of CMS OPPS rate,1248.54,429,,,fee schedule,429% of BCBS fee schedule,1301.61,515,,,fee schedule,515% of BCBS fee schedule,1301.61,364,,,fee schedule,364% of BCBS fee schedule,1301.61,515,,,fee schedule,515% of BCBS fee schedule,1566.9,90,,1253.52,percent of total billed charges,90% of total billed charges,1392.8,80,,1114.24,percent of total billed charges,80% of total billed charges,1566.9,90,,1253.52,percent of total billed charges,90% of total billed charges,1305.75,75,,1044.6,percent of total billed charges,75% of total billed charges,410.31,122,,,fee schedule,122% of HUMANA fee schedule,504.89,29,,403.912,percent of total billed charges,29% of total billed charges,336.32,100,,,fee schedule,100% of CMS OPPS rate,1166.47,67,,933.176,percent of total billed charges,67% of total billed charges,280.11,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,1392.8,80,,1114.24,percent of total billed charges,80% of total billed charges,1131.65,65,,905.32,percent of total billed charges,65% of total billed charges,621.01,35.67,,496.808,percent of total billed charges,35.67% of total billed charges,280.11,1566.9,
CT WRIST LT W/OUT CONTRAST,3501085,CDM,350,RC,73200,HCPCS,outpatient,,,1751,700.40,LT,550,,,,case rate,pays based on per visit,1348.27,77,,1078.62,percent of total billed charges,77% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,565.43,429,,,fee schedule,429% of BCBS fee schedule,589.47,515,,,fee schedule,515% of BCBS fee schedule,589.47,364,,,fee schedule,364% of BCBS fee schedule,589.47,515,,,fee schedule,515% of BCBS fee schedule,1575.9,90,,1260.72,percent of total billed charges,90% of total billed charges,1400.8,80,,1120.64,percent of total billed charges,80% of total billed charges,1575.9,90,,1260.72,percent of total billed charges,90% of total billed charges,1313.25,75,,1050.6,percent of total billed charges,75% of total billed charges,117.29,122,,,fee schedule,122% of HUMANA fee schedule,507.79,29,,406.232,percent of total billed charges,29% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,1173.17,67,,938.536,percent of total billed charges,67% of total billed charges,178.87,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,1400.8,80,,1120.64,percent of total billed charges,80% of total billed charges,1138.15,65,,910.52,percent of total billed charges,65% of total billed charges,624.58,35.67,,499.664,percent of total billed charges,35.67% of total billed charges,96.14,1575.9,
CT WRIST LT W/WO CONTRAST,3501086,CDM,350,RC,73202,HCPCS,outpatient,,,1917,766.80,LT,550,,,,case rate,pays based on per visit,1476.09,77,,1180.87,percent of total billed charges,77% of total billed charges,160.68,100,,,fee schedule,100% of CMS OPPS rate,1248.54,429,,,fee schedule,429% of BCBS fee schedule,1301.61,515,,,fee schedule,515% of BCBS fee schedule,1301.61,364,,,fee schedule,364% of BCBS fee schedule,1301.61,515,,,fee schedule,515% of BCBS fee schedule,1725.3,90,,1380.24,percent of total billed charges,90% of total billed charges,1533.6,80,,1226.88,percent of total billed charges,80% of total billed charges,1725.3,90,,1380.24,percent of total billed charges,90% of total billed charges,1437.75,75,,1150.2,percent of total billed charges,75% of total billed charges,196.02,122,,,fee schedule,122% of HUMANA fee schedule,555.93,29,,444.744,percent of total billed charges,29% of total billed charges,160.68,100,,,fee schedule,100% of CMS OPPS rate,1284.39,67,,1027.512,percent of total billed charges,67% of total billed charges,311.42,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,1533.6,80,,1226.88,percent of total billed charges,80% of total billed charges,1246.05,65,,996.84,percent of total billed charges,65% of total billed charges,683.79,35.67,,547.032,percent of total billed charges,35.67% of total billed charges,160.68,1725.3,
CT WRIST RT W/CONTRAST,3501087,CDM,350,RC,73201,HCPCS,outpatient,,,1741,696.40,RT,550,,,,case rate,pays based on per visit,1340.57,77,,1072.46,percent of total billed charges,77% of total billed charges,336.32,100,,,fee schedule,100% of CMS OPPS rate,1248.54,429,,,fee schedule,429% of BCBS fee schedule,1301.61,515,,,fee schedule,515% of BCBS fee schedule,1301.61,364,,,fee schedule,364% of BCBS fee schedule,1301.61,515,,,fee schedule,515% of BCBS fee schedule,1566.9,90,,1253.52,percent of total billed charges,90% of total billed charges,1392.8,80,,1114.24,percent of total billed charges,80% of total billed charges,1566.9,90,,1253.52,percent of total billed charges,90% of total billed charges,1305.75,75,,1044.6,percent of total billed charges,75% of total billed charges,410.31,122,,,fee schedule,122% of HUMANA fee schedule,504.89,29,,403.912,percent of total billed charges,29% of total billed charges,336.32,100,,,fee schedule,100% of CMS OPPS rate,1166.47,67,,933.176,percent of total billed charges,67% of total billed charges,280.11,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,1392.8,80,,1114.24,percent of total billed charges,80% of total billed charges,1131.65,65,,905.32,percent of total billed charges,65% of total billed charges,621.01,35.67,,496.808,percent of total billed charges,35.67% of total billed charges,280.11,1566.9,
CT WRIST RT W/OUT CONTRAST,3501088,CDM,350,RC,73200,HCPCS,outpatient,,,1751,700.40,RT,550,,,,case rate,pays based on per visit,1348.27,77,,1078.62,percent of total billed charges,77% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,565.43,429,,,fee schedule,429% of BCBS fee schedule,589.47,515,,,fee schedule,515% of BCBS fee schedule,589.47,364,,,fee schedule,364% of BCBS fee schedule,589.47,515,,,fee schedule,515% of BCBS fee schedule,1575.9,90,,1260.72,percent of total billed charges,90% of total billed charges,1400.8,80,,1120.64,percent of total billed charges,80% of total billed charges,1575.9,90,,1260.72,percent of total billed charges,90% of total billed charges,1313.25,75,,1050.6,percent of total billed charges,75% of total billed charges,117.29,122,,,fee schedule,122% of HUMANA fee schedule,507.79,29,,406.232,percent of total billed charges,29% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,1173.17,67,,938.536,percent of total billed charges,67% of total billed charges,178.87,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,1400.8,80,,1120.64,percent of total billed charges,80% of total billed charges,1138.15,65,,910.52,percent of total billed charges,65% of total billed charges,624.58,35.67,,499.664,percent of total billed charges,35.67% of total billed charges,96.14,1575.9,
CT WRIST RT W/WO CONTRAST,3501089,CDM,350,RC,73202,HCPCS,outpatient,,,1917,766.80,RT,550,,,,case rate,pays based on per visit,1476.09,77,,1180.87,percent of total billed charges,77% of total billed charges,160.68,100,,,fee schedule,100% of CMS OPPS rate,1248.54,429,,,fee schedule,429% of BCBS fee schedule,1301.61,515,,,fee schedule,515% of BCBS fee schedule,1301.61,364,,,fee schedule,364% of BCBS fee schedule,1301.61,515,,,fee schedule,515% of BCBS fee schedule,1725.3,90,,1380.24,percent of total billed charges,90% of total billed charges,1533.6,80,,1226.88,percent of total billed charges,80% of total billed charges,1725.3,90,,1380.24,percent of total billed charges,90% of total billed charges,1437.75,75,,1150.2,percent of total billed charges,75% of total billed charges,196.02,122,,,fee schedule,122% of HUMANA fee schedule,555.93,29,,444.744,percent of total billed charges,29% of total billed charges,160.68,100,,,fee schedule,100% of CMS OPPS rate,1284.39,67,,1027.512,percent of total billed charges,67% of total billed charges,311.42,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,1533.6,80,,1226.88,percent of total billed charges,80% of total billed charges,1246.05,65,,996.84,percent of total billed charges,65% of total billed charges,683.79,35.67,,547.032,percent of total billed charges,35.67% of total billed charges,160.68,1725.3,
CT LIVER 3-PHASE,3501090,CDM,350,RC,74177,HCPCS,outpatient,,,3201,1280.40,,550,,,,case rate,pays based on per visit,2464.77,77,,1971.82,percent of total billed charges,77% of total billed charges,336.32,100,,,fee schedule,100% of CMS OPPS rate,1248.54,429,,,fee schedule,429% of BCBS fee schedule,1301.61,515,,,fee schedule,515% of BCBS fee schedule,1301.61,364,,,fee schedule,364% of BCBS fee schedule,1301.61,515,,,fee schedule,515% of BCBS fee schedule,2880.9,90,,2304.72,percent of total billed charges,90% of total billed charges,2560.8,80,,2048.64,percent of total billed charges,80% of total billed charges,2880.9,90,,2304.72,percent of total billed charges,90% of total billed charges,2400.75,75,,1920.6,percent of total billed charges,75% of total billed charges,410.31,122,,,fee schedule,122% of HUMANA fee schedule,928.29,29,,742.632,percent of total billed charges,29% of total billed charges,336.32,100,,,fee schedule,100% of CMS OPPS rate,2144.67,67,,1715.736,percent of total billed charges,67% of total billed charges,541.17,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,2560.8,80,,2048.64,percent of total billed charges,80% of total billed charges,2080.65,65,,1664.52,percent of total billed charges,65% of total billed charges,1141.8,35.67,,913.44,percent of total billed charges,35.67% of total billed charges,336.32,2880.9,
CT ANGIO LOWER LEG LT,3501091,CDM,350,RC,73706,HCPCS,outpatient,,,2746,1098.40,LT,550,,,,case rate,pays based on per visit,2114.42,77,,1691.54,percent of total billed charges,77% of total billed charges,160.68,100,,,fee schedule,100% of CMS OPPS rate,1248.54,429,,,fee schedule,429% of BCBS fee schedule,1301.61,515,,,fee schedule,515% of BCBS fee schedule,1301.61,364,,,fee schedule,364% of BCBS fee schedule,1301.61,515,,,fee schedule,515% of BCBS fee schedule,2471.4,90,,1977.12,percent of total billed charges,90% of total billed charges,2196.8,80,,1757.44,percent of total billed charges,80% of total billed charges,2471.4,90,,1977.12,percent of total billed charges,90% of total billed charges,2059.5,75,,1647.6,percent of total billed charges,75% of total billed charges,196.02,122,,,fee schedule,122% of HUMANA fee schedule,796.34,29,,637.072,percent of total billed charges,29% of total billed charges,160.68,100,,,fee schedule,100% of CMS OPPS rate,1839.82,67,,1471.856,percent of total billed charges,67% of total billed charges,315.52,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,2196.8,80,,1757.44,percent of total billed charges,80% of total billed charges,1784.9,65,,1427.92,percent of total billed charges,65% of total billed charges,979.5,35.67,,783.6,percent of total billed charges,35.67% of total billed charges,160.68,2471.4,
CT ANGIO LOWER LEG RT,3501092,CDM,350,RC,73706,HCPCS,outpatient,,,2746,1098.40,RT,550,,,,case rate,pays based on per visit,2114.42,77,,1691.54,percent of total billed charges,77% of total billed charges,160.68,100,,,fee schedule,100% of CMS OPPS rate,1248.54,429,,,fee schedule,429% of BCBS fee schedule,1301.61,515,,,fee schedule,515% of BCBS fee schedule,1301.61,364,,,fee schedule,364% of BCBS fee schedule,1301.61,515,,,fee schedule,515% of BCBS fee schedule,2471.4,90,,1977.12,percent of total billed charges,90% of total billed charges,2196.8,80,,1757.44,percent of total billed charges,80% of total billed charges,2471.4,90,,1977.12,percent of total billed charges,90% of total billed charges,2059.5,75,,1647.6,percent of total billed charges,75% of total billed charges,196.02,122,,,fee schedule,122% of HUMANA fee schedule,796.34,29,,637.072,percent of total billed charges,29% of total billed charges,160.68,100,,,fee schedule,100% of CMS OPPS rate,1839.82,67,,1471.856,percent of total billed charges,67% of total billed charges,315.52,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,2196.8,80,,1757.44,percent of total billed charges,80% of total billed charges,1784.9,65,,1427.92,percent of total billed charges,65% of total billed charges,979.5,35.67,,783.6,percent of total billed charges,35.67% of total billed charges,160.68,2471.4,
CT ANGIO UE BI,3501093,CDM,350,RC,,,outpatient,,,2221,888.40,,550,,,,case rate,pays based on per visit,1710.17,77,,1368.14,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,1821.22,82,,1456.976,percent of total billed charges,82% of total billed charges,1887.85,85,,1510.28,percent of total billed charges,85% of total billed charges,1887.85,85,,1510.28,percent of total billed charges,85% of total billed charges,1887.85,85,,1510.28,percent of total billed charges,85% of total billed charges,1998.9,90,,1599.12,percent of total billed charges,90% of total billed charges,1776.8,80,,1421.44,percent of total billed charges,80% of total billed charges,1998.9,90,,1599.12,percent of total billed charges,90% of total billed charges,1665.75,75,,1332.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,644.09,29,,515.272,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1488.07,67,,1190.456,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1776.8,80,,1421.44,percent of total billed charges,80% of total billed charges,1443.65,65,,1154.92,percent of total billed charges,65% of total billed charges,792.23,35.67,,633.784,percent of total billed charges,35.67% of total billed charges,550,1998.9,
CT THORACIC SPINE,3501094,CDM,350,RC,,,outpatient,,,2361,944.40,,550,,,,case rate,pays based on per visit,1817.97,77,,1454.38,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,1936.02,82,,1548.816,percent of total billed charges,82% of total billed charges,2006.85,85,,1605.48,percent of total billed charges,85% of total billed charges,2006.85,85,,1605.48,percent of total billed charges,85% of total billed charges,2006.85,85,,1605.48,percent of total billed charges,85% of total billed charges,2124.9,90,,1699.92,percent of total billed charges,90% of total billed charges,1888.8,80,,1511.04,percent of total billed charges,80% of total billed charges,2124.9,90,,1699.92,percent of total billed charges,90% of total billed charges,1770.75,75,,1416.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,684.69,29,,547.752,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1581.87,67,,1265.496,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1888.8,80,,1511.04,percent of total billed charges,80% of total billed charges,1534.65,65,,1227.72,percent of total billed charges,65% of total billed charges,842.17,35.67,,673.736,percent of total billed charges,35.67% of total billed charges,550,2124.9,
CT HEAD WITHOUT CONTRAST (ER),3509260,CDM,350,RC,70450,HCPCS,outpatient,,,2106,842.40,,550,,,,case rate,pays based on per visit,1621.62,77,,1297.3,percent of total billed charges,77% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,565.43,429,,,fee schedule,429% of BCBS fee schedule,589.47,515,,,fee schedule,515% of BCBS fee schedule,589.47,364,,,fee schedule,364% of BCBS fee schedule,589.47,515,,,fee schedule,515% of BCBS fee schedule,1895.4,90,,1516.32,percent of total billed charges,90% of total billed charges,1684.8,80,,1347.84,percent of total billed charges,80% of total billed charges,1895.4,90,,1516.32,percent of total billed charges,90% of total billed charges,1579.5,75,,1263.6,percent of total billed charges,75% of total billed charges,117.29,122,,,fee schedule,122% of HUMANA fee schedule,610.74,29,,488.592,percent of total billed charges,29% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,1411.02,67,,1128.816,percent of total billed charges,67% of total billed charges,178.87,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,1684.8,80,,1347.84,percent of total billed charges,80% of total billed charges,1368.9,65,,1095.12,percent of total billed charges,65% of total billed charges,751.21,35.67,,600.968,percent of total billed charges,35.67% of total billed charges,96.14,1895.4,
CT UPPER EXTREMI W/O CONT (ER),3509610,CDM,350,RC,73200,HCPCS,outpatient,,,1703,681.20,,550,,,,case rate,pays based on per visit,1311.31,77,,1049.05,percent of total billed charges,77% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,565.43,429,,,fee schedule,429% of BCBS fee schedule,589.47,515,,,fee schedule,515% of BCBS fee schedule,589.47,364,,,fee schedule,364% of BCBS fee schedule,589.47,515,,,fee schedule,515% of BCBS fee schedule,1532.7,90,,1226.16,percent of total billed charges,90% of total billed charges,1362.4,80,,1089.92,percent of total billed charges,80% of total billed charges,1532.7,90,,1226.16,percent of total billed charges,90% of total billed charges,1277.25,75,,1021.8,percent of total billed charges,75% of total billed charges,117.29,122,,,fee schedule,122% of HUMANA fee schedule,493.87,29,,395.096,percent of total billed charges,29% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,1141.01,67,,912.808,percent of total billed charges,67% of total billed charges,178.87,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,1362.4,80,,1089.92,percent of total billed charges,80% of total billed charges,1106.95,65,,885.56,percent of total billed charges,65% of total billed charges,607.46,35.67,,485.968,percent of total billed charges,35.67% of total billed charges,96.14,1532.7,
CT PROCEDURE ROOM,3500900,CDM,360,RC,,,outpatient,,,1162,464.80,,987.7,85,,790.16,percent of total billed charges,85% of total billed charges,894.74,77,,715.79,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,952.84,82,,762.272,percent of total billed charges,82% of total billed charges,987.7,85,,790.16,percent of total billed charges,85% of total billed charges,987.7,85,,790.16,percent of total billed charges,85% of total billed charges,987.7,85,,790.16,percent of total billed charges,85% of total billed charges,1045.8,90,,836.64,percent of total billed charges,90% of total billed charges,929.6,80,,743.68,percent of total billed charges,80% of total billed charges,1045.8,90,,836.64,percent of total billed charges,90% of total billed charges,871.5,75,,697.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,336.98,29,,269.584,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,778.54,67,,622.832,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,929.6,80,,743.68,percent of total billed charges,80% of total billed charges,755.3,65,,604.24,percent of total billed charges,65% of total billed charges,414.49,35.67,,331.592,percent of total billed charges,35.67% of total billed charges,336.98,1045.8,
SPLINTING LONG LEG RIGHT (OR),3600069,CDM,360,RC,,,outpatient,,,307,122.80,,260.95,85,,208.76,percent of total billed charges,85% of total billed charges,236.39,77,,189.11,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,251.74,82,,201.392,percent of total billed charges,82% of total billed charges,260.95,85,,208.76,percent of total billed charges,85% of total billed charges,260.95,85,,208.76,percent of total billed charges,85% of total billed charges,260.95,85,,208.76,percent of total billed charges,85% of total billed charges,276.3,90,,221.04,percent of total billed charges,90% of total billed charges,245.6,80,,196.48,percent of total billed charges,80% of total billed charges,276.3,90,,221.04,percent of total billed charges,90% of total billed charges,230.25,75,,184.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,89.03,29,,71.224,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,205.69,67,,164.552,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,245.6,80,,196.48,percent of total billed charges,80% of total billed charges,199.55,65,,159.64,percent of total billed charges,65% of total billed charges,109.51,35.67,,87.608,percent of total billed charges,35.67% of total billed charges,89.03,276.3,
SPLINTING LONG LEFT LEG (OR),3600071,CDM,360,RC,,,outpatient,,,307,122.80,,260.95,85,,208.76,percent of total billed charges,85% of total billed charges,236.39,77,,189.11,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,251.74,82,,201.392,percent of total billed charges,82% of total billed charges,260.95,85,,208.76,percent of total billed charges,85% of total billed charges,260.95,85,,208.76,percent of total billed charges,85% of total billed charges,260.95,85,,208.76,percent of total billed charges,85% of total billed charges,276.3,90,,221.04,percent of total billed charges,90% of total billed charges,245.6,80,,196.48,percent of total billed charges,80% of total billed charges,276.3,90,,221.04,percent of total billed charges,90% of total billed charges,230.25,75,,184.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,89.03,29,,71.224,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,205.69,67,,164.552,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,245.6,80,,196.48,percent of total billed charges,80% of total billed charges,199.55,65,,159.64,percent of total billed charges,65% of total billed charges,109.51,35.67,,87.608,percent of total billed charges,35.67% of total billed charges,89.03,276.3,
SPLINTING SHORT LEG LT OR,3600072,CDM,360,RC,,,outpatient,,,239,95.60,,203.15,85,,162.52,percent of total billed charges,85% of total billed charges,184.03,77,,147.22,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,195.98,82,,156.784,percent of total billed charges,82% of total billed charges,203.15,85,,162.52,percent of total billed charges,85% of total billed charges,203.15,85,,162.52,percent of total billed charges,85% of total billed charges,203.15,85,,162.52,percent of total billed charges,85% of total billed charges,215.1,90,,172.08,percent of total billed charges,90% of total billed charges,191.2,80,,152.96,percent of total billed charges,80% of total billed charges,215.1,90,,172.08,percent of total billed charges,90% of total billed charges,179.25,75,,143.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,69.31,29,,55.448,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,160.13,67,,128.104,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,191.2,80,,152.96,percent of total billed charges,80% of total billed charges,155.35,65,,124.28,percent of total billed charges,65% of total billed charges,85.25,35.67,,68.2,percent of total billed charges,35.67% of total billed charges,69.31,215.1,
SPLINTING LONG ARM RT OR,3600073,CDM,360,RC,,,outpatient,,,307,122.80,,260.95,85,,208.76,percent of total billed charges,85% of total billed charges,236.39,77,,189.11,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,251.74,82,,201.392,percent of total billed charges,82% of total billed charges,260.95,85,,208.76,percent of total billed charges,85% of total billed charges,260.95,85,,208.76,percent of total billed charges,85% of total billed charges,260.95,85,,208.76,percent of total billed charges,85% of total billed charges,276.3,90,,221.04,percent of total billed charges,90% of total billed charges,245.6,80,,196.48,percent of total billed charges,80% of total billed charges,276.3,90,,221.04,percent of total billed charges,90% of total billed charges,230.25,75,,184.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,89.03,29,,71.224,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,205.69,67,,164.552,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,245.6,80,,196.48,percent of total billed charges,80% of total billed charges,199.55,65,,159.64,percent of total billed charges,65% of total billed charges,109.51,35.67,,87.608,percent of total billed charges,35.67% of total billed charges,89.03,276.3,
SPLINTING LONG ARM LT OR,3600074,CDM,360,RC,,,outpatient,,,307,122.80,,260.95,85,,208.76,percent of total billed charges,85% of total billed charges,236.39,77,,189.11,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,251.74,82,,201.392,percent of total billed charges,82% of total billed charges,260.95,85,,208.76,percent of total billed charges,85% of total billed charges,260.95,85,,208.76,percent of total billed charges,85% of total billed charges,260.95,85,,208.76,percent of total billed charges,85% of total billed charges,276.3,90,,221.04,percent of total billed charges,90% of total billed charges,245.6,80,,196.48,percent of total billed charges,80% of total billed charges,276.3,90,,221.04,percent of total billed charges,90% of total billed charges,230.25,75,,184.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,89.03,29,,71.224,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,205.69,67,,164.552,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,245.6,80,,196.48,percent of total billed charges,80% of total billed charges,199.55,65,,159.64,percent of total billed charges,65% of total billed charges,109.51,35.67,,87.608,percent of total billed charges,35.67% of total billed charges,89.03,276.3,
SPLINTING SHORT ARM RT OR,3600075,CDM,360,RC,,,outpatient,,,243,97.20,,206.55,85,,165.24,percent of total billed charges,85% of total billed charges,187.11,77,,149.69,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,199.26,82,,159.408,percent of total billed charges,82% of total billed charges,206.55,85,,165.24,percent of total billed charges,85% of total billed charges,206.55,85,,165.24,percent of total billed charges,85% of total billed charges,206.55,85,,165.24,percent of total billed charges,85% of total billed charges,218.7,90,,174.96,percent of total billed charges,90% of total billed charges,194.4,80,,155.52,percent of total billed charges,80% of total billed charges,218.7,90,,174.96,percent of total billed charges,90% of total billed charges,182.25,75,,145.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,70.47,29,,56.376,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,162.81,67,,130.248,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,194.4,80,,155.52,percent of total billed charges,80% of total billed charges,157.95,65,,126.36,percent of total billed charges,65% of total billed charges,86.68,35.67,,69.344,percent of total billed charges,35.67% of total billed charges,70.47,218.7,
SPLINTING SHORT ARM LT OR,3600076,CDM,360,RC,,,outpatient,,,239,95.60,,203.15,85,,162.52,percent of total billed charges,85% of total billed charges,184.03,77,,147.22,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,195.98,82,,156.784,percent of total billed charges,82% of total billed charges,203.15,85,,162.52,percent of total billed charges,85% of total billed charges,203.15,85,,162.52,percent of total billed charges,85% of total billed charges,203.15,85,,162.52,percent of total billed charges,85% of total billed charges,215.1,90,,172.08,percent of total billed charges,90% of total billed charges,191.2,80,,152.96,percent of total billed charges,80% of total billed charges,215.1,90,,172.08,percent of total billed charges,90% of total billed charges,179.25,75,,143.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,69.31,29,,55.448,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,160.13,67,,128.104,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,191.2,80,,152.96,percent of total billed charges,80% of total billed charges,155.35,65,,124.28,percent of total billed charges,65% of total billed charges,85.25,35.67,,68.2,percent of total billed charges,35.67% of total billed charges,69.31,215.1,
PROCEDURE ROOM EA ADD'L 15 MIN,3600111,CDM,360,RC,,,outpatient,,,212,84.80,,180.2,85,,144.16,percent of total billed charges,85% of total billed charges,163.24,77,,130.59,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,173.84,82,,139.072,percent of total billed charges,82% of total billed charges,180.2,85,,144.16,percent of total billed charges,85% of total billed charges,180.2,85,,144.16,percent of total billed charges,85% of total billed charges,180.2,85,,144.16,percent of total billed charges,85% of total billed charges,190.8,90,,152.64,percent of total billed charges,90% of total billed charges,169.6,80,,135.68,percent of total billed charges,80% of total billed charges,190.8,90,,152.64,percent of total billed charges,90% of total billed charges,159,75,,127.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,61.48,29,,49.184,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,142.04,67,,113.632,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,169.6,80,,135.68,percent of total billed charges,80% of total billed charges,137.8,65,,110.24,percent of total billed charges,65% of total billed charges,75.62,35.67,,60.496,percent of total billed charges,35.67% of total billed charges,61.48,190.8,
ENDOSCOPY RM NON GI 0-30 MIN,3600500,CDM,360,RC,,,outpatient,,,2454,981.60,,2085.9,85,,1668.72,percent of total billed charges,85% of total billed charges,1889.58,77,,1511.66,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,2012.28,82,,1609.824,percent of total billed charges,82% of total billed charges,2085.9,85,,1668.72,percent of total billed charges,85% of total billed charges,2085.9,85,,1668.72,percent of total billed charges,85% of total billed charges,2085.9,85,,1668.72,percent of total billed charges,85% of total billed charges,2208.6,90,,1766.88,percent of total billed charges,90% of total billed charges,1963.2,80,,1570.56,percent of total billed charges,80% of total billed charges,2208.6,90,,1766.88,percent of total billed charges,90% of total billed charges,1840.5,75,,1472.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,711.66,29,,569.328,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1644.18,67,,1315.344,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1963.2,80,,1570.56,percent of total billed charges,80% of total billed charges,1595.1,65,,1276.08,percent of total billed charges,65% of total billed charges,875.34,35.67,,700.272,percent of total billed charges,35.67% of total billed charges,711.66,2208.6,
ENDOSCOPY RM NON GI 31-60 MIN,3600510,CDM,360,RC,,,outpatient,,,3068,1227.20,,2607.8,85,,2086.24,percent of total billed charges,85% of total billed charges,2362.36,77,,1889.89,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,2515.76,82,,2012.608,percent of total billed charges,82% of total billed charges,2607.8,85,,2086.24,percent of total billed charges,85% of total billed charges,2607.8,85,,2086.24,percent of total billed charges,85% of total billed charges,2607.8,85,,2086.24,percent of total billed charges,85% of total billed charges,2761.2,90,,2208.96,percent of total billed charges,90% of total billed charges,2454.4,80,,1963.52,percent of total billed charges,80% of total billed charges,2761.2,90,,2208.96,percent of total billed charges,90% of total billed charges,2301,75,,1840.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,889.72,29,,711.776,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,2055.56,67,,1644.448,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,2454.4,80,,1963.52,percent of total billed charges,80% of total billed charges,1994.2,65,,1595.36,percent of total billed charges,65% of total billed charges,1094.36,35.67,,875.488,percent of total billed charges,35.67% of total billed charges,889.72,2761.2,
ENDOSCOPY RM NON GI 61-90 MIN,3600520,CDM,360,RC,,,outpatient,,,3611,1444.40,,3069.35,85,,2455.48,percent of total billed charges,85% of total billed charges,2780.47,77,,2224.38,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,2961.02,82,,2368.816,percent of total billed charges,82% of total billed charges,3069.35,85,,2455.48,percent of total billed charges,85% of total billed charges,3069.35,85,,2455.48,percent of total billed charges,85% of total billed charges,3069.35,85,,2455.48,percent of total billed charges,85% of total billed charges,3249.9,90,,2599.92,percent of total billed charges,90% of total billed charges,2888.8,80,,2311.04,percent of total billed charges,80% of total billed charges,3249.9,90,,2599.92,percent of total billed charges,90% of total billed charges,2708.25,75,,2166.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,1047.19,29,,837.752,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,2419.37,67,,1935.496,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,2888.8,80,,2311.04,percent of total billed charges,80% of total billed charges,2347.15,65,,1877.72,percent of total billed charges,65% of total billed charges,1288.04,35.67,,1030.432,percent of total billed charges,35.67% of total billed charges,1047.19,3249.9,
ENDOSCOPY RM NON GI EACH ADD'L,3600530,CDM,360,RC,,,outpatient,,,603,241.20,,512.55,85,,410.04,percent of total billed charges,85% of total billed charges,464.31,77,,371.45,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,494.46,82,,395.568,percent of total billed charges,82% of total billed charges,512.55,85,,410.04,percent of total billed charges,85% of total billed charges,512.55,85,,410.04,percent of total billed charges,85% of total billed charges,512.55,85,,410.04,percent of total billed charges,85% of total billed charges,542.7,90,,434.16,percent of total billed charges,90% of total billed charges,482.4,80,,385.92,percent of total billed charges,80% of total billed charges,542.7,90,,434.16,percent of total billed charges,90% of total billed charges,452.25,75,,361.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,174.87,29,,139.896,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,404.01,67,,323.208,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,482.4,80,,385.92,percent of total billed charges,80% of total billed charges,391.95,65,,313.56,percent of total billed charges,65% of total billed charges,215.09,35.67,,172.072,percent of total billed charges,35.67% of total billed charges,174.87,542.7,
EXCISION BENIGN LESION,3600540,CDM,360,RC,11423,HCPCS,outpatient,,,1437,574.80,,1150,,,,case rate,pays based on per visit,1106.49,77,,885.19,percent of total billed charges,77% of total billed charges,1417.86,100,,,fee schedule,100% of CMS OPPS rate,562.46,429,,,fee schedule,429% of BCBS fee schedule,586.66,485,,,fee schedule,485% of ASC tier grouping rates,586.66,485,,,fee schedule,485% of ASC tier grouping rates,586.66,485,,,fee schedule,485% of ASC tier grouping rate,1293.3,90,,1034.64,percent of total billed charges,90% of total billed charges,1149.6,80,,919.68,percent of total billed charges,80% of total billed charges,1293.3,90,,1034.64,percent of total billed charges,90% of total billed charges,1077.75,75,,862.2,percent of total billed charges,75% of total billed charges,1729.79,122,,,fee schedule,122% of HUMANA fee schedule,104.38,100,,,fee schedule,100% of ASC tier grouping rate,1417.86,100,,,fee schedule,100% of CMS OPPS rate,962.79,67,,770.232,percent of total billed charges,67% of total billed charges,1109.05,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,1149.6,80,,919.68,percent of total billed charges,80% of total billed charges,934.05,65,,747.24,percent of total billed charges,65% of total billed charges,128.39,123,,,fee schedule,123% of ASC tier grouping rate,104.38,1729.79,
OR LEVEL 6 CASE,3600798,CDM,360,RC,,,outpatient,,,40912,16364.80,,34775.2,85,,27820.16,percent of total billed charges,85% of total billed charges,31502.24,77,,25201.79,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,33547.84,82,,26838.272,percent of total billed charges,82% of total billed charges,34775.2,85,,27820.16,percent of total billed charges,85% of total billed charges,34775.2,85,,27820.16,percent of total billed charges,85% of total billed charges,34775.2,85,,27820.16,percent of total billed charges,85% of total billed charges,36820.8,90,,29456.64,percent of total billed charges,90% of total billed charges,32729.6,80,,26183.68,percent of total billed charges,80% of total billed charges,36820.8,90,,29456.64,percent of total billed charges,90% of total billed charges,30684,75,,24547.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,11864.48,29,,9491.584,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,27411.04,67,,21928.832,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,32729.6,80,,26183.68,percent of total billed charges,80% of total billed charges,26592.8,65,,21274.24,percent of total billed charges,65% of total billed charges,14593.31,35.67,,11674.648,percent of total billed charges,35.67% of total billed charges,11864.48,36820.8,
OR LEVEL 5 CASE,3600799,CDM,360,RC,,,outpatient,,,30667,12266.80,,26066.95,85,,20853.56,percent of total billed charges,85% of total billed charges,23613.59,77,,18890.87,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,25146.94,82,,20117.552,percent of total billed charges,82% of total billed charges,26066.95,85,,20853.56,percent of total billed charges,85% of total billed charges,26066.95,85,,20853.56,percent of total billed charges,85% of total billed charges,26066.95,85,,20853.56,percent of total billed charges,85% of total billed charges,27600.3,90,,22080.24,percent of total billed charges,90% of total billed charges,24533.6,80,,19626.88,percent of total billed charges,80% of total billed charges,27600.3,90,,22080.24,percent of total billed charges,90% of total billed charges,23000.25,75,,18400.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,8893.43,29,,7114.744,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,20546.89,67,,16437.512,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,24533.6,80,,19626.88,percent of total billed charges,80% of total billed charges,19933.55,65,,15946.84,percent of total billed charges,65% of total billed charges,10938.92,35.67,,8751.136,percent of total billed charges,35.67% of total billed charges,8893.43,27600.3,
OR LEVEL 4 CASE,3600800,CDM,360,RC,,,outpatient,,,22080,8832.00,,18768,85,,15014.4,percent of total billed charges,85% of total billed charges,17001.6,77,,13601.28,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,18105.6,82,,14484.48,percent of total billed charges,82% of total billed charges,18768,85,,15014.4,percent of total billed charges,85% of total billed charges,18768,85,,15014.4,percent of total billed charges,85% of total billed charges,18768,85,,15014.4,percent of total billed charges,85% of total billed charges,19872,90,,15897.6,percent of total billed charges,90% of total billed charges,17664,80,,14131.2,percent of total billed charges,80% of total billed charges,19872,90,,15897.6,percent of total billed charges,90% of total billed charges,16560,75,,13248,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,6403.2,29,,5122.56,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,14793.6,67,,11834.88,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,17664,80,,14131.2,percent of total billed charges,80% of total billed charges,14352,65,,11481.6,percent of total billed charges,65% of total billed charges,7875.94,35.67,,6300.752,percent of total billed charges,35.67% of total billed charges,6403.2,19872,
OR LEVEL 3 CASE,3600801,CDM,360,RC,,,outpatient,,,14720,5888.00,,12512,85,,10009.6,percent of total billed charges,85% of total billed charges,11334.4,77,,9067.52,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,12070.4,82,,9656.32,percent of total billed charges,82% of total billed charges,12512,85,,10009.6,percent of total billed charges,85% of total billed charges,12512,85,,10009.6,percent of total billed charges,85% of total billed charges,12512,85,,10009.6,percent of total billed charges,85% of total billed charges,13248,90,,10598.4,percent of total billed charges,90% of total billed charges,11776,80,,9420.8,percent of total billed charges,80% of total billed charges,13248,90,,10598.4,percent of total billed charges,90% of total billed charges,11040,75,,8832,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,4268.8,29,,3415.04,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,9862.4,67,,7889.92,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,11776,80,,9420.8,percent of total billed charges,80% of total billed charges,9568,65,,7654.4,percent of total billed charges,65% of total billed charges,5250.62,35.67,,4200.496,percent of total billed charges,35.67% of total billed charges,4268.8,13248,
OR LEVEL 2 CASE,3600802,CDM,360,RC,,,outpatient,,,9813,3925.20,,8341.05,85,,6672.84,percent of total billed charges,85% of total billed charges,7556.01,77,,6044.81,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,8046.66,82,,6437.328,percent of total billed charges,82% of total billed charges,8341.05,85,,6672.84,percent of total billed charges,85% of total billed charges,8341.05,85,,6672.84,percent of total billed charges,85% of total billed charges,8341.05,85,,6672.84,percent of total billed charges,85% of total billed charges,8831.7,90,,7065.36,percent of total billed charges,90% of total billed charges,7850.4,80,,6280.32,percent of total billed charges,80% of total billed charges,8831.7,90,,7065.36,percent of total billed charges,90% of total billed charges,7359.75,75,,5887.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2845.77,29,,2276.616,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,6574.71,67,,5259.768,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,7850.4,80,,6280.32,percent of total billed charges,80% of total billed charges,6378.45,65,,5102.76,percent of total billed charges,65% of total billed charges,3500.3,35.67,,2800.24,percent of total billed charges,35.67% of total billed charges,2845.77,8831.7,
OR LEVEL 1 CASE,3600803,CDM,360,RC,,,outpatient,,,6134,2453.60,,5213.9,85,,4171.12,percent of total billed charges,85% of total billed charges,4723.18,77,,3778.54,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,5029.88,82,,4023.904,percent of total billed charges,82% of total billed charges,5213.9,85,,4171.12,percent of total billed charges,85% of total billed charges,5213.9,85,,4171.12,percent of total billed charges,85% of total billed charges,5213.9,85,,4171.12,percent of total billed charges,85% of total billed charges,5520.6,90,,4416.48,percent of total billed charges,90% of total billed charges,4907.2,80,,3925.76,percent of total billed charges,80% of total billed charges,5520.6,90,,4416.48,percent of total billed charges,90% of total billed charges,4600.5,75,,3680.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,1778.86,29,,1423.088,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4109.78,67,,3287.824,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,4907.2,80,,3925.76,percent of total billed charges,80% of total billed charges,3987.1,65,,3189.68,percent of total billed charges,65% of total billed charges,2188,35.67,,1750.4,percent of total billed charges,35.67% of total billed charges,1778.86,5520.6,
"DESTRUCTION, PLANTAR DIG NERVE",3600810,CDM,360,RC,64632,HCPCS,outpatient,,,773,309.20,,1150,,,,case rate,pays based on per visit,595.21,77,,476.17,percent of total billed charges,77% of total billed charges,259.02,100,,,fee schedule,100% of CMS OPPS rate,187.49,429,,,fee schedule,429% of BCBS fee schedule,195.55,485,,,fee schedule,485% of ASC tier grouping rates,195.55,485,,,fee schedule,485% of ASC tier grouping rates,195.55,485,,,fee schedule,485% of ASC tier grouping rate,695.7,90,,556.56,percent of total billed charges,90% of total billed charges,618.4,80,,494.72,percent of total billed charges,80% of total billed charges,695.7,90,,556.56,percent of total billed charges,90% of total billed charges,579.75,75,,463.8,percent of total billed charges,75% of total billed charges,316,122,,,fee schedule,122% of HUMANA fee schedule,36.82,100,,,fee schedule,100% of ASC tier grouping rate,259.02,100,,,fee schedule,100% of CMS OPPS rate,517.91,67,,414.328,percent of total billed charges,67% of total billed charges,170.33,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,618.4,80,,494.72,percent of total billed charges,80% of total billed charges,502.45,65,,401.96,percent of total billed charges,65% of total billed charges,45.29,123,,,fee schedule,123% of ASC tier grouping rate,36.82,1150,
ROBOTIC SURGICAL SYSTEM,39100001,CDM,360,RC,S2900,HCPCS,outpatient,,,0.01,0.00,,0.01,85,,0.01,percent of total billed charges,85% of total billed charges,0.01,77,,0.01,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,14460.48,429,,,fee schedule,429% of BCBS fee schedule,15082.43,485,,,fee schedule,485% of ASC tier grouping rates,15082.43,485,,,fee schedule,485% of ASC tier grouping rates,15082.43,485,,,fee schedule,485% of ASC tier grouping rate,0.01,90,,0.008,percent of total billed charges,90% of total billed charges,0.01,80,,0.008,percent of total billed charges,80% of total billed charges,0.01,90,,0.008,percent of total billed charges,90% of total billed charges,0.01,75,,0.008,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,67,,0.008,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,0.01,80,,0.008,percent of total billed charges,80% of total billed charges,0.01,65,,0.008,percent of total billed charges,65% of total billed charges,,,,,,35.67% of total billed charges,0.01,15082.43,
"CIRCUMCISION, LESS THAN 28DAYS",3910001,CDM,360,RC,54160,HCPCS,outpatient,,,1391,556.40,,1150,,,,case rate,pays based on per visit,1071.07,77,,856.86,percent of total billed charges,77% of total billed charges,597.39,100,,,fee schedule,100% of CMS OPPS rate,7884.91,429,,,fee schedule,429% of BCBS fee schedule,8224.05,485,,,fee schedule,485% of ASC tier grouping rates,8224.05,485,,,fee schedule,485% of ASC tier grouping rates,8224.05,485,,,fee schedule,485% of ASC tier grouping rate,1251.9,90,,1001.52,percent of total billed charges,90% of total billed charges,1112.8,80,,890.24,percent of total billed charges,80% of total billed charges,1251.9,90,,1001.52,percent of total billed charges,90% of total billed charges,1043.25,75,,834.6,percent of total billed charges,75% of total billed charges,728.81,122,,,fee schedule,122% of HUMANA fee schedule,238.15,100,,,fee schedule,100% of ASC tier grouping rate,597.39,100,,,fee schedule,100% of CMS OPPS rate,931.97,67,,745.576,percent of total billed charges,67% of total billed charges,1538.87,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,1112.8,80,,890.24,percent of total billed charges,80% of total billed charges,904.15,65,,723.32,percent of total billed charges,65% of total billed charges,292.92,123,,,fee schedule,123% of ASC tier grouping rate,238.15,8224.05,
"CIRCUMCISION, OVER 28 DAYS",3910004,CDM,360,RC,54161,HCPCS,outpatient,,,4125,1650.00,,1150,,,,case rate,pays based on per visit,3176.25,77,,2541,percent of total billed charges,77% of total billed charges,1781.25,100,,,fee schedule,100% of CMS OPPS rate,7884.91,429,,,fee schedule,429% of BCBS fee schedule,8224.05,485,,,fee schedule,485% of ASC tier grouping rates,8224.05,485,,,fee schedule,485% of ASC tier grouping rates,8224.05,485,,,fee schedule,485% of ASC tier grouping rate,3712.5,90,,2970,percent of total billed charges,90% of total billed charges,3300,80,,2640,percent of total billed charges,80% of total billed charges,3712.5,90,,2970,percent of total billed charges,90% of total billed charges,3093.75,75,,2475,percent of total billed charges,75% of total billed charges,2173.12,122,,,fee schedule,122% of HUMANA fee schedule,652.8,100,,,fee schedule,100% of ASC tier grouping rate,1781.25,100,,,fee schedule,100% of CMS OPPS rate,2763.75,67,,2211,percent of total billed charges,67% of total billed charges,1538.87,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,3300,80,,2640,percent of total billed charges,80% of total billed charges,2681.25,65,,2145,percent of total billed charges,65% of total billed charges,802.94,123,,,fee schedule,123% of ASC tier grouping rate,652.8,8224.05,
NEWBORN PROCEDURE/ROOM,7600015,CDM,360,RC,,,outpatient,,,982,392.80,,834.7,85,,667.76,percent of total billed charges,85% of total billed charges,756.14,77,,604.91,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,805.24,82,,644.192,percent of total billed charges,82% of total billed charges,834.7,85,,667.76,percent of total billed charges,85% of total billed charges,834.7,85,,667.76,percent of total billed charges,85% of total billed charges,834.7,85,,667.76,percent of total billed charges,85% of total billed charges,883.8,90,,707.04,percent of total billed charges,90% of total billed charges,785.6,80,,628.48,percent of total billed charges,80% of total billed charges,883.8,90,,707.04,percent of total billed charges,90% of total billed charges,736.5,75,,589.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,284.78,29,,227.824,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,657.94,67,,526.352,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,785.6,80,,628.48,percent of total billed charges,80% of total billed charges,638.3,65,,510.64,percent of total billed charges,65% of total billed charges,350.28,35.67,,280.224,percent of total billed charges,35.67% of total billed charges,284.78,883.8,
EPIDURAL ANES PROCEDURE,2600174,CDM,370,RC,,,outpatient,,,460,184.00,,391,85,,312.8,percent of total billed charges,85% of total billed charges,354.2,77,,283.36,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,377.2,82,,301.76,percent of total billed charges,82% of total billed charges,391,85,,312.8,percent of total billed charges,85% of total billed charges,391,85,,312.8,percent of total billed charges,85% of total billed charges,391,85,,312.8,percent of total billed charges,85% of total billed charges,414,90,,331.2,percent of total billed charges,90% of total billed charges,368,80,,294.4,percent of total billed charges,80% of total billed charges,414,90,,331.2,percent of total billed charges,90% of total billed charges,345,75,,276,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,133.4,29,,106.72,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,308.2,67,,246.56,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,368,80,,294.4,percent of total billed charges,80% of total billed charges,299,65,,239.2,percent of total billed charges,65% of total billed charges,164.08,35.67,,131.264,percent of total billed charges,35.67% of total billed charges,133.4,414,
ANES EQUIPMENT/MATERIAL 30 MIN,3700100,CDM,370,RC,,,outpatient,,,1075,430.00,,913.75,85,,731,percent of total billed charges,85% of total billed charges,827.75,77,,662.2,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,881.5,82,,705.2,percent of total billed charges,82% of total billed charges,913.75,85,,731,percent of total billed charges,85% of total billed charges,913.75,85,,731,percent of total billed charges,85% of total billed charges,913.75,85,,731,percent of total billed charges,85% of total billed charges,967.5,90,,774,percent of total billed charges,90% of total billed charges,860,80,,688,percent of total billed charges,80% of total billed charges,967.5,90,,774,percent of total billed charges,90% of total billed charges,806.25,75,,645,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,311.75,29,,249.4,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,720.25,67,,576.2,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,860,80,,688,percent of total billed charges,80% of total billed charges,698.75,65,,559,percent of total billed charges,65% of total billed charges,383.45,35.67,,306.76,percent of total billed charges,35.67% of total billed charges,311.75,967.5,
ANES EQUIPMENT/MATERIAL 60 MIN,3700110,CDM,370,RC,,,outpatient,,,1325,530.00,,1126.25,85,,901,percent of total billed charges,85% of total billed charges,1020.25,77,,816.2,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,1086.5,82,,869.2,percent of total billed charges,82% of total billed charges,1126.25,85,,901,percent of total billed charges,85% of total billed charges,1126.25,85,,901,percent of total billed charges,85% of total billed charges,1126.25,85,,901,percent of total billed charges,85% of total billed charges,1192.5,90,,954,percent of total billed charges,90% of total billed charges,1060,80,,848,percent of total billed charges,80% of total billed charges,1192.5,90,,954,percent of total billed charges,90% of total billed charges,993.75,75,,795,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,384.25,29,,307.4,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,887.75,67,,710.2,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1060,80,,848,percent of total billed charges,80% of total billed charges,861.25,65,,689,percent of total billed charges,65% of total billed charges,472.63,35.67,,378.104,percent of total billed charges,35.67% of total billed charges,384.25,1192.5,
ANES EQUIP/MAT EACH ADD 30 MIN,3700120,CDM,370,RC,,,outpatient,,,771,308.40,,655.35,85,,524.28,percent of total billed charges,85% of total billed charges,593.67,77,,474.94,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,632.22,82,,505.776,percent of total billed charges,82% of total billed charges,655.35,85,,524.28,percent of total billed charges,85% of total billed charges,655.35,85,,524.28,percent of total billed charges,85% of total billed charges,655.35,85,,524.28,percent of total billed charges,85% of total billed charges,693.9,90,,555.12,percent of total billed charges,90% of total billed charges,616.8,80,,493.44,percent of total billed charges,80% of total billed charges,693.9,90,,555.12,percent of total billed charges,90% of total billed charges,578.25,75,,462.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,223.59,29,,178.872,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,516.57,67,,413.256,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,616.8,80,,493.44,percent of total billed charges,80% of total billed charges,501.15,65,,400.92,percent of total billed charges,65% of total billed charges,275.02,35.67,,220.016,percent of total billed charges,35.67% of total billed charges,223.59,693.9,
ANESTHESIA - ETHRAN 20 CCS,3700130,CDM,370,RC,,,outpatient,,,67,26.80,,56.95,85,,45.56,percent of total billed charges,85% of total billed charges,51.59,77,,41.27,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,54.94,82,,43.952,percent of total billed charges,82% of total billed charges,56.95,85,,45.56,percent of total billed charges,85% of total billed charges,56.95,85,,45.56,percent of total billed charges,85% of total billed charges,56.95,85,,45.56,percent of total billed charges,85% of total billed charges,60.3,90,,48.24,percent of total billed charges,90% of total billed charges,53.6,80,,42.88,percent of total billed charges,80% of total billed charges,60.3,90,,48.24,percent of total billed charges,90% of total billed charges,50.25,75,,40.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,19.43,29,,15.544,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,44.89,67,,35.912,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,53.6,80,,42.88,percent of total billed charges,80% of total billed charges,43.55,65,,34.84,percent of total billed charges,65% of total billed charges,23.9,35.67,,19.12,percent of total billed charges,35.67% of total billed charges,19.43,60.3,
ANESTHESIA - FORANE 20 CCS,3700140,CDM,370,RC,,,outpatient,,,67,26.80,,56.95,85,,45.56,percent of total billed charges,85% of total billed charges,51.59,77,,41.27,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,54.94,82,,43.952,percent of total billed charges,82% of total billed charges,56.95,85,,45.56,percent of total billed charges,85% of total billed charges,56.95,85,,45.56,percent of total billed charges,85% of total billed charges,56.95,85,,45.56,percent of total billed charges,85% of total billed charges,60.3,90,,48.24,percent of total billed charges,90% of total billed charges,53.6,80,,42.88,percent of total billed charges,80% of total billed charges,60.3,90,,48.24,percent of total billed charges,90% of total billed charges,50.25,75,,40.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,19.43,29,,15.544,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,44.89,67,,35.912,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,53.6,80,,42.88,percent of total billed charges,80% of total billed charges,43.55,65,,34.84,percent of total billed charges,65% of total billed charges,23.9,35.67,,19.12,percent of total billed charges,35.67% of total billed charges,19.43,60.3,
ANESTHESIA - HALOTHANE,3700150,CDM,370,RC,,,outpatient,,,55,22.00,,46.75,85,,37.4,percent of total billed charges,85% of total billed charges,42.35,77,,33.88,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,45.1,82,,36.08,percent of total billed charges,82% of total billed charges,46.75,85,,37.4,percent of total billed charges,85% of total billed charges,46.75,85,,37.4,percent of total billed charges,85% of total billed charges,46.75,85,,37.4,percent of total billed charges,85% of total billed charges,49.5,90,,39.6,percent of total billed charges,90% of total billed charges,44,80,,35.2,percent of total billed charges,80% of total billed charges,49.5,90,,39.6,percent of total billed charges,90% of total billed charges,41.25,75,,33,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,15.95,29,,12.76,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,36.85,67,,29.48,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,44,80,,35.2,percent of total billed charges,80% of total billed charges,35.75,65,,28.6,percent of total billed charges,65% of total billed charges,19.62,35.67,,15.696,percent of total billed charges,35.67% of total billed charges,15.95,49.5,
CONSCIOUS SEDATION 10-22 MIN,4500860,CDM,370,RC,99152,HCPCS,outpatient,,,319,127.60,,271.15,85,,216.92,percent of total billed charges,85% of total billed charges,245.63,77,,196.5,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,55.43,429,,,fee schedule,429% of BCBS fee schedule,57.75,447,,,fee schedule,447% of BCBS fee schedule,57.75,447,,,fee schedule,447% of BCBS fee schedule,57.75,447,,,fee schedule,447% of BCBS fee schedule,287.1,90,,229.68,percent of total billed charges,90% of total billed charges,255.2,80,,204.16,percent of total billed charges,80% of total billed charges,287.1,90,,229.68,percent of total billed charges,90% of total billed charges,239.25,75,,191.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,92.51,29,,74.008,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,213.73,67,,170.984,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,255.2,80,,204.16,percent of total billed charges,80% of total billed charges,207.35,65,,165.88,percent of total billed charges,65% of total billed charges,113.79,35.67,,91.032,percent of total billed charges,35.67% of total billed charges,55.43,287.1,
CONSCIOUS SEDATION EA ADD'L 15,4500870,CDM,370,RC,99153,HCPCS,outpatient,,,127,50.80,,107.95,85,,86.36,percent of total billed charges,85% of total billed charges,97.79,77,,78.23,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,47.75,429,,,fee schedule,429% of BCBS fee schedule,49.75,447,,,fee schedule,447% of BCBS fee schedule,49.75,447,,,fee schedule,447% of BCBS fee schedule,49.75,447,,,fee schedule,447% of BCBS fee schedule,114.3,90,,91.44,percent of total billed charges,90% of total billed charges,101.6,80,,81.28,percent of total billed charges,80% of total billed charges,114.3,90,,91.44,percent of total billed charges,90% of total billed charges,95.25,75,,76.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,36.83,29,,29.464,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,85.09,67,,68.072,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,101.6,80,,81.28,percent of total billed charges,80% of total billed charges,82.55,65,,66.04,percent of total billed charges,65% of total billed charges,45.3,35.67,,36.24,percent of total billed charges,35.67% of total billed charges,36.83,114.3,
RHOGAM WORKUP,3800120,CDM,384,RC,,,outpatient,,,183,73.20,,155.55,85,,124.44,percent of total billed charges,85% of total billed charges,140.91,77,,112.73,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,150.06,82,,120.048,percent of total billed charges,82% of total billed charges,155.55,85,,124.44,percent of total billed charges,85% of total billed charges,155.55,85,,124.44,percent of total billed charges,85% of total billed charges,155.55,85,,124.44,percent of total billed charges,85% of total billed charges,164.7,90,,131.76,percent of total billed charges,90% of total billed charges,146.4,80,,117.12,percent of total billed charges,80% of total billed charges,164.7,90,,131.76,percent of total billed charges,90% of total billed charges,137.25,75,,109.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,53.07,29,,42.456,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,122.61,67,,98.088,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,146.4,80,,117.12,percent of total billed charges,80% of total billed charges,118.95,65,,95.16,percent of total billed charges,65% of total billed charges,65.28,35.67,,52.224,percent of total billed charges,35.67% of total billed charges,53.07,164.7,
PLT APHEREIS IRRADIATED,3006642,CDM,390,RC,P9036,HCPCS,outpatient,,,1223,489.20,,1039.55,85,,831.64,percent of total billed charges,85% of total billed charges,941.71,77,,753.37,percent of total billed charges,77% of total billed charges,559.94,100,,,fee schedule,100% of CMS OPPS rate,1002.86,82,,802.288,percent of total billed charges,82% of total billed charges,1039.55,85,,831.64,percent of total billed charges,85% of total billed charges,1039.55,85,,831.64,percent of total billed charges,85% of total billed charges,1039.55,85,,831.64,percent of total billed charges,85% of total billed charges,1100.7,90,,880.56,percent of total billed charges,90% of total billed charges,978.4,80,,782.72,percent of total billed charges,80% of total billed charges,1100.7,90,,880.56,percent of total billed charges,90% of total billed charges,917.25,75,,733.8,percent of total billed charges,75% of total billed charges,683.12,122,,,fee schedule,122% of HUMANA fee schedule,417.71,100,,,fee schedule,100% of ASC tier grouping rate,559.94,100,,,fee schedule,100% of CMS OPPS rate,819.41,67,,655.528,percent of total billed charges,67% of total billed charges,582.57,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,978.4,80,,782.72,percent of total billed charges,80% of total billed charges,794.95,65,,635.96,percent of total billed charges,65% of total billed charges,513.78,123,,,fee schedule,123% of ASC tier grouping rate,417.71,1100.7,
PLT APHEREIS PROCESSING FEE,3006644,CDM,390,RC,P9036,HCPCS,outpatient,,,701,280.40,,595.85,85,,476.68,percent of total billed charges,85% of total billed charges,539.77,77,,431.82,percent of total billed charges,77% of total billed charges,559.94,100,,,fee schedule,100% of CMS OPPS rate,574.82,82,,459.856,percent of total billed charges,82% of total billed charges,595.85,85,,476.68,percent of total billed charges,85% of total billed charges,595.85,85,,476.68,percent of total billed charges,85% of total billed charges,595.85,85,,476.68,percent of total billed charges,85% of total billed charges,630.9,90,,504.72,percent of total billed charges,90% of total billed charges,560.8,80,,448.64,percent of total billed charges,80% of total billed charges,630.9,90,,504.72,percent of total billed charges,90% of total billed charges,525.75,75,,420.6,percent of total billed charges,75% of total billed charges,683.12,122,,,fee schedule,122% of HUMANA fee schedule,417.71,100,,,fee schedule,100% of ASC tier grouping rate,559.94,100,,,fee schedule,100% of CMS OPPS rate,469.67,67,,375.736,percent of total billed charges,67% of total billed charges,582.57,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,560.8,80,,448.64,percent of total billed charges,80% of total billed charges,455.65,65,,364.52,percent of total billed charges,65% of total billed charges,513.78,123,,,fee schedule,123% of ASC tier grouping rate,417.71,683.12,
PLT APHEREIS & PROCESSING FEE,3006645,CDM,390,RC,P9034,HCPCS,outpatient,,,1091,436.40,,927.35,85,,741.88,percent of total billed charges,85% of total billed charges,840.07,77,,672.06,percent of total billed charges,77% of total billed charges,321.86,100,,,fee schedule,100% of CMS OPPS rate,894.62,82,,715.696,percent of total billed charges,82% of total billed charges,927.35,85,,741.88,percent of total billed charges,85% of total billed charges,927.35,85,,741.88,percent of total billed charges,85% of total billed charges,927.35,85,,741.88,percent of total billed charges,85% of total billed charges,981.9,90,,785.52,percent of total billed charges,90% of total billed charges,872.8,80,,698.24,percent of total billed charges,80% of total billed charges,981.9,90,,785.52,percent of total billed charges,90% of total billed charges,818.25,75,,654.6,percent of total billed charges,75% of total billed charges,392.66,122,,,fee schedule,122% of HUMANA fee schedule,343.82,100,,,fee schedule,100% of ASC tier grouping rate,321.86,100,,,fee schedule,100% of CMS OPPS rate,730.97,67,,584.776,percent of total billed charges,67% of total billed charges,464.15,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,872.8,80,,698.24,percent of total billed charges,80% of total billed charges,709.15,65,,567.32,percent of total billed charges,65% of total billed charges,422.9,123,,,fee schedule,123% of ASC tier grouping rate,321.86,981.9,
CRYOPRECIPITATE UNIT,3800006,CDM,390,RC,P9012,HCPCS,outpatient,,,220,88.00,,187,85,,149.6,percent of total billed charges,85% of total billed charges,169.4,77,,135.52,percent of total billed charges,77% of total billed charges,59.87,100,,,fee schedule,100% of CMS OPPS rate,180.4,82,,144.32,percent of total billed charges,82% of total billed charges,187,85,,149.6,percent of total billed charges,85% of total billed charges,187,85,,149.6,percent of total billed charges,85% of total billed charges,187,85,,149.6,percent of total billed charges,85% of total billed charges,198,90,,158.4,percent of total billed charges,90% of total billed charges,176,80,,140.8,percent of total billed charges,80% of total billed charges,198,90,,158.4,percent of total billed charges,90% of total billed charges,165,75,,132,percent of total billed charges,75% of total billed charges,73.04,122,,,fee schedule,122% of HUMANA fee schedule,63.8,29,,51.04,percent of total billed charges,29% of total billed charges,59.87,100,,,fee schedule,100% of CMS OPPS rate,147.4,67,,117.92,percent of total billed charges,67% of total billed charges,86.9,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,176,80,,140.8,percent of total billed charges,80% of total billed charges,143,65,,114.4,percent of total billed charges,65% of total billed charges,78.47,35.67,,62.776,percent of total billed charges,35.67% of total billed charges,59.87,198,
FILTERED RBC'S & PROCESSING FE,3800042,CDM,390,RC,P9016,HCPCS,outpatient,,,615,246.00,,522.75,85,,418.2,percent of total billed charges,85% of total billed charges,473.55,77,,378.84,percent of total billed charges,77% of total billed charges,180.82,100,,,fee schedule,100% of CMS OPPS rate,504.3,82,,403.44,percent of total billed charges,82% of total billed charges,522.75,85,,418.2,percent of total billed charges,85% of total billed charges,522.75,85,,418.2,percent of total billed charges,85% of total billed charges,522.75,85,,418.2,percent of total billed charges,85% of total billed charges,553.5,90,,442.8,percent of total billed charges,90% of total billed charges,492,80,,393.6,percent of total billed charges,80% of total billed charges,553.5,90,,442.8,percent of total billed charges,90% of total billed charges,461.25,75,,369,percent of total billed charges,75% of total billed charges,220.6,122,,,fee schedule,122% of HUMANA fee schedule,178.35,29,,142.68,percent of total billed charges,29% of total billed charges,180.82,100,,,fee schedule,100% of CMS OPPS rate,412.05,67,,329.64,percent of total billed charges,67% of total billed charges,208.81,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,492,80,,393.6,percent of total billed charges,80% of total billed charges,399.75,65,,319.8,percent of total billed charges,65% of total billed charges,219.37,35.67,,175.496,percent of total billed charges,35.67% of total billed charges,178.35,553.5,
FRESH FROZEN PLASMA & PROCESSI,3800047,CDM,390,RC,P9017,HCPCS,outpatient,,,206,82.40,,175.1,85,,140.08,percent of total billed charges,85% of total billed charges,158.62,77,,126.9,percent of total billed charges,77% of total billed charges,79.95,100,,,fee schedule,100% of CMS OPPS rate,168.92,82,,135.136,percent of total billed charges,82% of total billed charges,175.1,85,,140.08,percent of total billed charges,85% of total billed charges,175.1,85,,140.08,percent of total billed charges,85% of total billed charges,175.1,85,,140.08,percent of total billed charges,85% of total billed charges,185.4,90,,148.32,percent of total billed charges,90% of total billed charges,164.8,80,,131.84,percent of total billed charges,80% of total billed charges,185.4,90,,148.32,percent of total billed charges,90% of total billed charges,154.5,75,,123.6,percent of total billed charges,75% of total billed charges,97.55,122,,,fee schedule,122% of HUMANA fee schedule,59.74,29,,47.792,percent of total billed charges,29% of total billed charges,79.95,100,,,fee schedule,100% of CMS OPPS rate,138.02,67,,110.416,percent of total billed charges,67% of total billed charges,83.86,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,164.8,80,,131.84,percent of total billed charges,80% of total billed charges,133.9,65,,107.12,percent of total billed charges,65% of total billed charges,73.48,35.67,,58.784,percent of total billed charges,35.67% of total billed charges,59.74,185.4,
FRESH FROZEN PLASMA 8-24HRS,3800048,CDM,390,RC,P9059,HCPCS,outpatient,,,206,82.40,,175.1,85,,140.08,percent of total billed charges,85% of total billed charges,158.62,77,,126.9,percent of total billed charges,77% of total billed charges,72.56,100,,,fee schedule,100% of CMS OPPS rate,168.92,82,,135.136,percent of total billed charges,82% of total billed charges,175.1,85,,140.08,percent of total billed charges,85% of total billed charges,175.1,85,,140.08,percent of total billed charges,85% of total billed charges,175.1,85,,140.08,percent of total billed charges,85% of total billed charges,185.4,90,,148.32,percent of total billed charges,90% of total billed charges,164.8,80,,131.84,percent of total billed charges,80% of total billed charges,185.4,90,,148.32,percent of total billed charges,90% of total billed charges,154.5,75,,123.6,percent of total billed charges,75% of total billed charges,88.53,122,,,fee schedule,122% of HUMANA fee schedule,51,100,,,fee schedule,100% of ASC tier grouping rate,72.56,100,,,fee schedule,100% of CMS OPPS rate,138.02,67,,110.416,percent of total billed charges,67% of total billed charges,76.45,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,164.8,80,,131.84,percent of total billed charges,80% of total billed charges,133.9,65,,107.12,percent of total billed charges,65% of total billed charges,62.73,123,,,fee schedule,123% of ASC tier grouping rate,51,185.4,
PACKED CELLS PER UNIT,3800055,CDM,390,RC,P9021,HCPCS,outpatient,,,581,232.40,,493.85,85,,395.08,percent of total billed charges,85% of total billed charges,447.37,77,,357.9,percent of total billed charges,77% of total billed charges,136.51,100,,,fee schedule,100% of CMS OPPS rate,476.42,82,,381.136,percent of total billed charges,82% of total billed charges,493.85,85,,395.08,percent of total billed charges,85% of total billed charges,493.85,85,,395.08,percent of total billed charges,85% of total billed charges,493.85,85,,395.08,percent of total billed charges,85% of total billed charges,522.9,90,,418.32,percent of total billed charges,90% of total billed charges,464.8,80,,371.84,percent of total billed charges,80% of total billed charges,522.9,90,,418.32,percent of total billed charges,90% of total billed charges,435.75,75,,348.6,percent of total billed charges,75% of total billed charges,166.54,122,,,fee schedule,122% of HUMANA fee schedule,168.49,29,,134.792,percent of total billed charges,29% of total billed charges,136.51,100,,,fee schedule,100% of CMS OPPS rate,389.27,67,,311.416,percent of total billed charges,67% of total billed charges,156.58,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,464.8,80,,371.84,percent of total billed charges,80% of total billed charges,377.65,65,,302.12,percent of total billed charges,65% of total billed charges,207.24,35.67,,165.792,percent of total billed charges,35.67% of total billed charges,136.51,522.9,
PACKED CELLS - WASHED,3800065,CDM,390,RC,P9022,HCPCS,outpatient,,,508,203.20,,431.8,85,,345.44,percent of total billed charges,85% of total billed charges,391.16,77,,312.93,percent of total billed charges,77% of total billed charges,397.12,100,,,fee schedule,100% of CMS OPPS rate,416.56,82,,333.248,percent of total billed charges,82% of total billed charges,431.8,85,,345.44,percent of total billed charges,85% of total billed charges,431.8,85,,345.44,percent of total billed charges,85% of total billed charges,431.8,85,,345.44,percent of total billed charges,85% of total billed charges,457.2,90,,365.76,percent of total billed charges,90% of total billed charges,406.4,80,,325.12,percent of total billed charges,80% of total billed charges,457.2,90,,365.76,percent of total billed charges,90% of total billed charges,381,75,,304.8,percent of total billed charges,75% of total billed charges,484.48,122,,,fee schedule,122% of HUMANA fee schedule,147.32,29,,117.856,percent of total billed charges,29% of total billed charges,397.12,100,,,fee schedule,100% of CMS OPPS rate,340.36,67,,272.288,percent of total billed charges,67% of total billed charges,301.69,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,406.4,80,,325.12,percent of total billed charges,80% of total billed charges,330.2,65,,264.16,percent of total billed charges,65% of total billed charges,181.2,35.67,,144.96,percent of total billed charges,35.67% of total billed charges,147.32,484.48,
IRRADIATED RED BLOOD CELLS,3800070,CDM,390,RC,P9038,HCPCS,outpatient,,,556,222.40,,472.6,85,,378.08,percent of total billed charges,85% of total billed charges,428.12,77,,342.5,percent of total billed charges,77% of total billed charges,216.72,100,,,fee schedule,100% of CMS OPPS rate,455.92,82,,364.736,percent of total billed charges,82% of total billed charges,472.6,85,,378.08,percent of total billed charges,85% of total billed charges,472.6,85,,378.08,percent of total billed charges,85% of total billed charges,472.6,85,,378.08,percent of total billed charges,85% of total billed charges,500.4,90,,400.32,percent of total billed charges,90% of total billed charges,444.8,80,,355.84,percent of total billed charges,80% of total billed charges,500.4,90,,400.32,percent of total billed charges,90% of total billed charges,417,75,,333.6,percent of total billed charges,75% of total billed charges,264.39,122,,,fee schedule,122% of HUMANA fee schedule,93.3,100,,,fee schedule,100% of ASC tier grouping rate,216.72,100,,,fee schedule,100% of CMS OPPS rate,372.52,67,,298.016,percent of total billed charges,67% of total billed charges,208.89,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,444.8,80,,355.84,percent of total billed charges,80% of total billed charges,361.4,65,,289.12,percent of total billed charges,65% of total billed charges,114.76,123,,,fee schedule,123% of ASC tier grouping rate,93.3,500.4,
PLATELET PHERESIS LEUKO-REDUC,3900001,CDM,390,RC,,,outpatient,,,2620,1048.00,,2227,85,,1781.6,percent of total billed charges,85% of total billed charges,2017.4,77,,1613.92,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,2148.4,82,,1718.72,percent of total billed charges,82% of total billed charges,2227,85,,1781.6,percent of total billed charges,85% of total billed charges,2227,85,,1781.6,percent of total billed charges,85% of total billed charges,2227,85,,1781.6,percent of total billed charges,85% of total billed charges,2358,90,,1886.4,percent of total billed charges,90% of total billed charges,2096,80,,1676.8,percent of total billed charges,80% of total billed charges,2358,90,,1886.4,percent of total billed charges,90% of total billed charges,1965,75,,1572,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,759.8,29,,607.84,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1755.4,67,,1404.32,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,2096,80,,1676.8,percent of total billed charges,80% of total billed charges,1703,65,,1362.4,percent of total billed charges,65% of total billed charges,934.55,35.67,,747.64,percent of total billed charges,35.67% of total billed charges,759.8,2358,
PLATELET PHERESIS LEUKORED LRR,3900002,CDM,390,RC,,,outpatient,,,2806,1122.40,,2385.1,85,,1908.08,percent of total billed charges,85% of total billed charges,2160.62,77,,1728.5,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,2300.92,82,,1840.736,percent of total billed charges,82% of total billed charges,2385.1,85,,1908.08,percent of total billed charges,85% of total billed charges,2385.1,85,,1908.08,percent of total billed charges,85% of total billed charges,2385.1,85,,1908.08,percent of total billed charges,85% of total billed charges,2525.4,90,,2020.32,percent of total billed charges,90% of total billed charges,2244.8,80,,1795.84,percent of total billed charges,80% of total billed charges,2525.4,90,,2020.32,percent of total billed charges,90% of total billed charges,2104.5,75,,1683.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,813.74,29,,650.992,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1880.02,67,,1504.016,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,2244.8,80,,1795.84,percent of total billed charges,80% of total billed charges,1823.9,65,,1459.12,percent of total billed charges,65% of total billed charges,1000.9,35.67,,800.72,percent of total billed charges,35.67% of total billed charges,813.74,2525.4,
RBC IRRADIATED LEUKO-REDUCED,3900003,CDM,390,RC,,,outpatient,,,1126,450.40,,957.1,85,,765.68,percent of total billed charges,85% of total billed charges,867.02,77,,693.62,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,923.32,82,,738.656,percent of total billed charges,82% of total billed charges,957.1,85,,765.68,percent of total billed charges,85% of total billed charges,957.1,85,,765.68,percent of total billed charges,85% of total billed charges,957.1,85,,765.68,percent of total billed charges,85% of total billed charges,1013.4,90,,810.72,percent of total billed charges,90% of total billed charges,900.8,80,,720.64,percent of total billed charges,80% of total billed charges,1013.4,90,,810.72,percent of total billed charges,90% of total billed charges,844.5,75,,675.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,326.54,29,,261.232,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,754.42,67,,603.536,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,900.8,80,,720.64,percent of total billed charges,80% of total billed charges,731.9,65,,585.52,percent of total billed charges,65% of total billed charges,401.64,35.67,,321.312,percent of total billed charges,35.67% of total billed charges,326.54,1013.4,
RBC WASHED LEUKO-REDUCED,3900004,CDM,390,RC,,,outpatient,,,988,395.20,,839.8,85,,671.84,percent of total billed charges,85% of total billed charges,760.76,77,,608.61,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,810.16,82,,648.128,percent of total billed charges,82% of total billed charges,839.8,85,,671.84,percent of total billed charges,85% of total billed charges,839.8,85,,671.84,percent of total billed charges,85% of total billed charges,839.8,85,,671.84,percent of total billed charges,85% of total billed charges,889.2,90,,711.36,percent of total billed charges,90% of total billed charges,790.4,80,,632.32,percent of total billed charges,80% of total billed charges,889.2,90,,711.36,percent of total billed charges,90% of total billed charges,741,75,,592.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,286.52,29,,229.216,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,661.96,67,,529.568,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,790.4,80,,632.32,percent of total billed charges,80% of total billed charges,642.2,65,,513.76,percent of total billed charges,65% of total billed charges,352.42,35.67,,281.936,percent of total billed charges,35.67% of total billed charges,286.52,889.2,
BLOOD ADMINISTRATION OP,2650000,CDM,391,RC,36430,HCPCS,outpatient,,,950,380.00,,1150,,,,case rate,pays based on per visit,731.5,77,,585.2,percent of total billed charges,77% of total billed charges,379.63,100,,,fee schedule,100% of CMS OPPS rate,779,82,,623.2,percent of total billed charges,82% of total billed charges,807.5,85,,646,percent of total billed charges,85% of total billed charges,807.5,85,,646,percent of total billed charges,85% of total billed charges,807.5,85,,646,percent of total billed charges,85% of total billed charges,855,90,,684,percent of total billed charges,90% of total billed charges,760,80,,608,percent of total billed charges,80% of total billed charges,855,90,,684,percent of total billed charges,90% of total billed charges,712.5,75,,570,percent of total billed charges,75% of total billed charges,463.15,122,,,fee schedule,122% of HUMANA fee schedule,30.73,100,,,fee schedule,100% of ASC tier grouping rate,379.63,100,,,fee schedule,100% of CMS OPPS rate,636.5,67,,509.2,percent of total billed charges,67% of total billed charges,223.6,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,760,80,,608,percent of total billed charges,80% of total billed charges,617.5,65,,494,percent of total billed charges,65% of total billed charges,37.8,123,,,fee schedule,123% of ASC tier grouping rate,30.73,1150,
BLOOD ADMINISTRATION O.R. AUTO,3600035,CDM,391,RC,36430,HCPCS,outpatient,,,950,380.00,,1150,,,,case rate,pays based on per visit,731.5,77,,585.2,percent of total billed charges,77% of total billed charges,379.63,100,,,fee schedule,100% of CMS OPPS rate,779,82,,623.2,percent of total billed charges,82% of total billed charges,807.5,85,,646,percent of total billed charges,85% of total billed charges,807.5,85,,646,percent of total billed charges,85% of total billed charges,807.5,85,,646,percent of total billed charges,85% of total billed charges,855,90,,684,percent of total billed charges,90% of total billed charges,760,80,,608,percent of total billed charges,80% of total billed charges,855,90,,684,percent of total billed charges,90% of total billed charges,712.5,75,,570,percent of total billed charges,75% of total billed charges,463.15,122,,,fee schedule,122% of HUMANA fee schedule,30.73,100,,,fee schedule,100% of ASC tier grouping rate,379.63,100,,,fee schedule,100% of CMS OPPS rate,636.5,67,,509.2,percent of total billed charges,67% of total billed charges,223.6,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,760,80,,608,percent of total billed charges,80% of total billed charges,617.5,65,,494,percent of total billed charges,65% of total billed charges,37.8,123,,,fee schedule,123% of ASC tier grouping rate,30.73,1150,
BLOOD ADMINISTRATION - IP,3910000,CDM,391,RC,36430,HCPCS,outpatient,,,950,380.00,,1150,,,,case rate,pays based on per visit,731.5,77,,585.2,percent of total billed charges,77% of total billed charges,379.63,100,,,fee schedule,100% of CMS OPPS rate,779,82,,623.2,percent of total billed charges,82% of total billed charges,807.5,85,,646,percent of total billed charges,85% of total billed charges,807.5,85,,646,percent of total billed charges,85% of total billed charges,807.5,85,,646,percent of total billed charges,85% of total billed charges,855,90,,684,percent of total billed charges,90% of total billed charges,760,80,,608,percent of total billed charges,80% of total billed charges,855,90,,684,percent of total billed charges,90% of total billed charges,712.5,75,,570,percent of total billed charges,75% of total billed charges,463.15,122,,,fee schedule,122% of HUMANA fee schedule,30.73,100,,,fee schedule,100% of ASC tier grouping rate,379.63,100,,,fee schedule,100% of CMS OPPS rate,636.5,67,,509.2,percent of total billed charges,67% of total billed charges,223.6,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,760,80,,608,percent of total billed charges,80% of total billed charges,617.5,65,,494,percent of total billed charges,65% of total billed charges,37.8,123,,,fee schedule,123% of ASC tier grouping rate,30.73,1150,
BLOOD ADMINISTRATION - ER,3910002,CDM,391,RC,36430,HCPCS,outpatient,,,950,380.00,,1150,,,,case rate,pays based on per visit,731.5,77,,585.2,percent of total billed charges,77% of total billed charges,379.63,100,,,fee schedule,100% of CMS OPPS rate,779,82,,623.2,percent of total billed charges,82% of total billed charges,807.5,85,,646,percent of total billed charges,85% of total billed charges,807.5,85,,646,percent of total billed charges,85% of total billed charges,807.5,85,,646,percent of total billed charges,85% of total billed charges,855,90,,684,percent of total billed charges,90% of total billed charges,760,80,,608,percent of total billed charges,80% of total billed charges,855,90,,684,percent of total billed charges,90% of total billed charges,712.5,75,,570,percent of total billed charges,75% of total billed charges,463.15,122,,,fee schedule,122% of HUMANA fee schedule,30.73,100,,,fee schedule,100% of ASC tier grouping rate,379.63,100,,,fee schedule,100% of CMS OPPS rate,636.5,67,,509.2,percent of total billed charges,67% of total billed charges,223.6,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,760,80,,608,percent of total billed charges,80% of total billed charges,617.5,65,,494,percent of total billed charges,65% of total billed charges,37.8,123,,,fee schedule,123% of ASC tier grouping rate,30.73,1150,
US BREAST COMPLETE LEFT,4000114,CDM,400,RC,76641,HCPCS,outpatient,,,622,248.80,LT,528.7,85,,422.96,percent of total billed charges,85% of total billed charges,478.94,77,,383.15,percent of total billed charges,77% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,440.67,385,,,fee schedule,385% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,559.8,90,,447.84,percent of total billed charges,90% of total billed charges,497.6,80,,398.08,percent of total billed charges,80% of total billed charges,559.8,90,,447.84,percent of total billed charges,90% of total billed charges,466.5,75,,373.2,percent of total billed charges,75% of total billed charges,117.29,122,,,fee schedule,122% of HUMANA fee schedule,180.38,29,,144.304,percent of total billed charges,29% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,416.74,67,,333.392,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,497.6,80,,398.08,percent of total billed charges,80% of total billed charges,404.3,65,,323.44,percent of total billed charges,65% of total billed charges,221.87,35.67,,177.496,percent of total billed charges,35.67% of total billed charges,96.14,559.8,
MAMMOGRAM UNILAT 2D LEFT DIAG,4010002,CDM,401,RC,77065,HCPCS,outpatient,,,423,169.20,LT,359.55,85,,287.64,percent of total billed charges,85% of total billed charges,325.71,77,,260.57,percent of total billed charges,77% of total billed charges,82.78,100,,,fee schedule,100% of CMS fee schedule,368.91,385,,,fee schedule,385% of BCBS fee schedule,384.24,401,,,fee schedule,401% of BCBS fee schedule,384.24,401,,,fee schedule,401% of BCBS fee schedule,384.24,401,,,fee schedule,401% of BCBS fee schedule,380.7,90,,304.56,percent of total billed charges,90% of total billed charges,338.4,80,,270.72,percent of total billed charges,80% of total billed charges,380.7,90,,304.56,percent of total billed charges,90% of total billed charges,317.25,75,,253.8,percent of total billed charges,75% of total billed charges,100.99,122,,,fee schedule,122% of HUMANA fee schedule,122.67,29,,98.136,percent of total billed charges,29% of total billed charges,82.78,100,,,fee schedule,100% of CMS fee schedule,283.41,67,,226.728,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,338.4,80,,270.72,percent of total billed charges,80% of total billed charges,274.95,65,,219.96,percent of total billed charges,65% of total billed charges,150.88,35.67,,120.704,percent of total billed charges,35.67% of total billed charges,82.78,384.24,
MAMMOGRAM UNILAT 2D RIGHT DIAG,4010003,CDM,401,RC,77065,HCPCS,outpatient,,,423,169.20,RT,359.55,85,,287.64,percent of total billed charges,85% of total billed charges,325.71,77,,260.57,percent of total billed charges,77% of total billed charges,82.78,100,,,fee schedule,100% of CMS fee schedule,368.91,385,,,fee schedule,385% of BCBS fee schedule,384.24,401,,,fee schedule,401% of BCBS fee schedule,384.24,401,,,fee schedule,401% of BCBS fee schedule,384.24,401,,,fee schedule,401% of BCBS fee schedule,380.7,90,,304.56,percent of total billed charges,90% of total billed charges,338.4,80,,270.72,percent of total billed charges,80% of total billed charges,380.7,90,,304.56,percent of total billed charges,90% of total billed charges,317.25,75,,253.8,percent of total billed charges,75% of total billed charges,100.99,122,,,fee schedule,122% of HUMANA fee schedule,122.67,29,,98.136,percent of total billed charges,29% of total billed charges,82.78,100,,,fee schedule,100% of CMS fee schedule,283.41,67,,226.728,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,338.4,80,,270.72,percent of total billed charges,80% of total billed charges,274.95,65,,219.96,percent of total billed charges,65% of total billed charges,150.88,35.67,,120.704,percent of total billed charges,35.67% of total billed charges,82.78,384.24,
MAMMO 3D BILATERAL DIAGNOSTIC,4010004,CDM,401,RC,77066,HCPCS,outpatient,,,542,216.80,,460.7,85,,368.56,percent of total billed charges,85% of total billed charges,417.34,77,,333.87,percent of total billed charges,77% of total billed charges,106.12,100,,,fee schedule,100% of CMS fee schedule,471.16,385,,,fee schedule,385% of BCBS fee schedule,490.74,401,,,fee schedule,401% of BCBS fee schedule,490.74,401,,,fee schedule,401% of BCBS fee schedule,490.74,401,,,fee schedule,401% of BCBS fee schedule,487.8,90,,390.24,percent of total billed charges,90% of total billed charges,433.6,80,,346.88,percent of total billed charges,80% of total billed charges,487.8,90,,390.24,percent of total billed charges,90% of total billed charges,406.5,75,,325.2,percent of total billed charges,75% of total billed charges,129.47,122,,,fee schedule,122% of HUMANA fee schedule,157.18,29,,125.744,percent of total billed charges,29% of total billed charges,106.12,100,,,fee schedule,100% of CMS fee schedule,363.14,67,,290.512,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,433.6,80,,346.88,percent of total billed charges,80% of total billed charges,352.3,65,,281.84,percent of total billed charges,65% of total billed charges,193.33,35.67,,154.664,percent of total billed charges,35.67% of total billed charges,106.12,490.74,
DIAGNOSTIC DIG BRST UNI TOMO3D,4010055,CDM,401,RC,77061,HCPCS,outpatient,,,117,46.80,,99.45,85,,79.56,percent of total billed charges,85% of total billed charges,90.09,77,,72.07,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,95.94,82,,76.752,percent of total billed charges,82% of total billed charges,99.45,85,,79.56,percent of total billed charges,85% of total billed charges,99.45,85,,79.56,percent of total billed charges,85% of total billed charges,99.45,85,,79.56,percent of total billed charges,85% of total billed charges,105.3,90,,84.24,percent of total billed charges,90% of total billed charges,93.6,80,,74.88,percent of total billed charges,80% of total billed charges,105.3,90,,84.24,percent of total billed charges,90% of total billed charges,87.75,75,,70.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,33.93,29,,27.144,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,78.39,67,,62.712,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,93.6,80,,74.88,percent of total billed charges,80% of total billed charges,76.05,65,,60.84,percent of total billed charges,65% of total billed charges,41.73,35.67,,33.384,percent of total billed charges,35.67% of total billed charges,33.93,105.3,
DIGNOS DIG BREAST BIL TOMO3D,4010057,CDM,401,RC,77062,HCPCS,outpatient,,,117,46.80,,99.45,85,,79.56,percent of total billed charges,85% of total billed charges,90.09,77,,72.07,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,95.94,82,,76.752,percent of total billed charges,82% of total billed charges,99.45,85,,79.56,percent of total billed charges,85% of total billed charges,99.45,85,,79.56,percent of total billed charges,85% of total billed charges,99.45,85,,79.56,percent of total billed charges,85% of total billed charges,105.3,90,,84.24,percent of total billed charges,90% of total billed charges,93.6,80,,74.88,percent of total billed charges,80% of total billed charges,105.3,90,,84.24,percent of total billed charges,90% of total billed charges,87.75,75,,70.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,33.93,29,,27.144,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,78.39,67,,62.712,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,93.6,80,,74.88,percent of total billed charges,80% of total billed charges,76.05,65,,60.84,percent of total billed charges,65% of total billed charges,41.73,35.67,,33.384,percent of total billed charges,35.67% of total billed charges,33.93,105.3,
ULTRASOUND ABDOMINAL LIMITED,4000010,CDM,402,RC,76705,HCPCS,outpatient,,,541,216.40,,459.85,85,,367.88,percent of total billed charges,85% of total billed charges,416.57,77,,333.26,percent of total billed charges,77% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,440.67,385,,,fee schedule,385% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,486.9,90,,389.52,percent of total billed charges,90% of total billed charges,432.8,80,,346.24,percent of total billed charges,80% of total billed charges,486.9,90,,389.52,percent of total billed charges,90% of total billed charges,405.75,75,,324.6,percent of total billed charges,75% of total billed charges,117.29,122,,,fee schedule,122% of HUMANA fee schedule,156.89,29,,125.512,percent of total billed charges,29% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,362.47,67,,289.976,percent of total billed charges,67% of total billed charges,89.76,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,432.8,80,,346.24,percent of total billed charges,80% of total billed charges,351.65,65,,281.32,percent of total billed charges,65% of total billed charges,192.97,35.67,,154.376,percent of total billed charges,35.67% of total billed charges,89.76,486.9,
ULTRASOUND ABD SOFT TISSUE,4000012,CDM,402,RC,76705,HCPCS,outpatient,,,541,216.40,,459.85,85,,367.88,percent of total billed charges,85% of total billed charges,416.57,77,,333.26,percent of total billed charges,77% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,440.67,385,,,fee schedule,385% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,486.9,90,,389.52,percent of total billed charges,90% of total billed charges,432.8,80,,346.24,percent of total billed charges,80% of total billed charges,486.9,90,,389.52,percent of total billed charges,90% of total billed charges,405.75,75,,324.6,percent of total billed charges,75% of total billed charges,117.29,122,,,fee schedule,122% of HUMANA fee schedule,156.89,29,,125.512,percent of total billed charges,29% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,362.47,67,,289.976,percent of total billed charges,67% of total billed charges,89.76,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,432.8,80,,346.24,percent of total billed charges,80% of total billed charges,351.65,65,,281.32,percent of total billed charges,65% of total billed charges,192.97,35.67,,154.376,percent of total billed charges,35.67% of total billed charges,89.76,486.9,
ULTRASOUND SOFT TISSUE-CHEST,40000120,CDM,402,RC,76604,HCPCS,outpatient,,,531,212.40,,451.35,85,,361.08,percent of total billed charges,85% of total billed charges,408.87,77,,327.1,percent of total billed charges,77% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,440.67,385,,,fee schedule,385% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,477.9,90,,382.32,percent of total billed charges,90% of total billed charges,424.8,80,,339.84,percent of total billed charges,80% of total billed charges,477.9,90,,382.32,percent of total billed charges,90% of total billed charges,398.25,75,,318.6,percent of total billed charges,75% of total billed charges,117.29,122,,,fee schedule,122% of HUMANA fee schedule,153.99,29,,123.192,percent of total billed charges,29% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,355.77,67,,284.616,percent of total billed charges,67% of total billed charges,58.64,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,424.8,80,,339.84,percent of total billed charges,80% of total billed charges,345.15,65,,276.12,percent of total billed charges,65% of total billed charges,189.41,35.67,,151.528,percent of total billed charges,35.67% of total billed charges,58.64,477.9,
ULTRASOUND AAA SCREEN,4000015,CDM,402,RC,76706,HCPCS,outpatient,,,586,234.40,,498.1,85,,398.48,percent of total billed charges,85% of total billed charges,451.22,77,,360.98,percent of total billed charges,77% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,262.53,385,,,fee schedule,385% of BCBS fee schedule,273.44,401,,,fee schedule,401% of BCBS fee schedule,273.44,401,,,fee schedule,401% of BCBS fee schedule,273.44,401,,,fee schedule,401% of BCBS fee schedule,527.4,90,,421.92,percent of total billed charges,90% of total billed charges,468.8,80,,375.04,percent of total billed charges,80% of total billed charges,527.4,90,,421.92,percent of total billed charges,90% of total billed charges,439.5,75,,351.6,percent of total billed charges,75% of total billed charges,117.29,122,,,fee schedule,122% of HUMANA fee schedule,169.94,29,,135.952,percent of total billed charges,29% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,392.62,67,,314.096,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,468.8,80,,375.04,percent of total billed charges,80% of total billed charges,380.9,65,,304.72,percent of total billed charges,65% of total billed charges,209.03,35.67,,167.224,percent of total billed charges,35.67% of total billed charges,96.14,527.4,
ULTRASOUND ABDOMEN MULT. ORGAN,4000020,CDM,402,RC,76700,HCPCS,outpatient,,,717,286.80,,609.45,85,,487.56,percent of total billed charges,85% of total billed charges,552.09,77,,441.67,percent of total billed charges,77% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,440.67,385,,,fee schedule,385% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,645.3,90,,516.24,percent of total billed charges,90% of total billed charges,573.6,80,,458.88,percent of total billed charges,80% of total billed charges,645.3,90,,516.24,percent of total billed charges,90% of total billed charges,537.75,75,,430.2,percent of total billed charges,75% of total billed charges,117.29,122,,,fee schedule,122% of HUMANA fee schedule,207.93,29,,166.344,percent of total billed charges,29% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,480.39,67,,384.312,percent of total billed charges,67% of total billed charges,89.76,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,573.6,80,,458.88,percent of total billed charges,80% of total billed charges,466.05,65,,372.84,percent of total billed charges,65% of total billed charges,255.75,35.67,,204.6,percent of total billed charges,35.67% of total billed charges,89.76,645.3,
ULTRASOUND KIDNEY TRANSPLANT,40000355,CDM,402,RC,76776,HCPCS,outpatient,,,542,216.80,,460.7,85,,368.56,percent of total billed charges,85% of total billed charges,417.34,77,,333.87,percent of total billed charges,77% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,440.67,385,,,fee schedule,385% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,487.8,90,,390.24,percent of total billed charges,90% of total billed charges,433.6,80,,346.88,percent of total billed charges,80% of total billed charges,487.8,90,,390.24,percent of total billed charges,90% of total billed charges,406.5,75,,325.2,percent of total billed charges,75% of total billed charges,117.29,122,,,fee schedule,122% of HUMANA fee schedule,157.18,29,,125.744,percent of total billed charges,29% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,363.14,67,,290.512,percent of total billed charges,67% of total billed charges,89.76,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,433.6,80,,346.88,percent of total billed charges,80% of total billed charges,352.3,65,,281.84,percent of total billed charges,65% of total billed charges,193.33,35.67,,154.664,percent of total billed charges,35.67% of total billed charges,89.76,487.8,
ULTRASOUND AORTA ABD.,4000050,CDM,402,RC,76775,HCPCS,outpatient,,,531,212.40,,451.35,85,,361.08,percent of total billed charges,85% of total billed charges,408.87,77,,327.1,percent of total billed charges,77% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,440.67,385,,,fee schedule,385% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,477.9,90,,382.32,percent of total billed charges,90% of total billed charges,424.8,80,,339.84,percent of total billed charges,80% of total billed charges,477.9,90,,382.32,percent of total billed charges,90% of total billed charges,398.25,75,,318.6,percent of total billed charges,75% of total billed charges,117.29,122,,,fee schedule,122% of HUMANA fee schedule,153.99,29,,123.192,percent of total billed charges,29% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,355.77,67,,284.616,percent of total billed charges,67% of total billed charges,89.76,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,424.8,80,,339.84,percent of total billed charges,80% of total billed charges,345.15,65,,276.12,percent of total billed charges,65% of total billed charges,189.41,35.67,,151.528,percent of total billed charges,35.67% of total billed charges,89.76,477.9,
ULTRASOUND-BLADDER,4000055,CDM,402,RC,76857,HCPCS,outpatient,,,531,212.40,,451.35,85,,361.08,percent of total billed charges,85% of total billed charges,408.87,77,,327.1,percent of total billed charges,77% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,440.67,385,,,fee schedule,385% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,477.9,90,,382.32,percent of total billed charges,90% of total billed charges,424.8,80,,339.84,percent of total billed charges,80% of total billed charges,477.9,90,,382.32,percent of total billed charges,90% of total billed charges,398.25,75,,318.6,percent of total billed charges,75% of total billed charges,117.29,122,,,fee schedule,122% of HUMANA fee schedule,153.99,29,,123.192,percent of total billed charges,29% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,355.77,67,,284.616,percent of total billed charges,67% of total billed charges,58.64,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,424.8,80,,339.84,percent of total billed charges,80% of total billed charges,345.15,65,,276.12,percent of total billed charges,65% of total billed charges,189.41,35.67,,151.528,percent of total billed charges,35.67% of total billed charges,58.64,477.9,
ULTRASOUND-UMBILICAL DOPPLER,4000056,CDM,402,RC,76820,HCPCS,outpatient,,,531,212.40,,451.35,85,,361.08,percent of total billed charges,85% of total billed charges,408.87,77,,327.1,percent of total billed charges,77% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,440.67,385,,,fee schedule,385% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,477.9,90,,382.32,percent of total billed charges,90% of total billed charges,424.8,80,,339.84,percent of total billed charges,80% of total billed charges,477.9,90,,382.32,percent of total billed charges,90% of total billed charges,398.25,75,,318.6,percent of total billed charges,75% of total billed charges,117.29,122,,,fee schedule,122% of HUMANA fee schedule,153.99,29,,123.192,percent of total billed charges,29% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,355.77,67,,284.616,percent of total billed charges,67% of total billed charges,58.64,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,424.8,80,,339.84,percent of total billed charges,80% of total billed charges,345.15,65,,276.12,percent of total billed charges,65% of total billed charges,189.41,35.67,,151.528,percent of total billed charges,35.67% of total billed charges,58.64,477.9,
US BIOPHY PROFILE W/O NS TEST,4000065,CDM,402,RC,76819,HCPCS,outpatient,,,421,168.40,,357.85,85,,286.28,percent of total billed charges,85% of total billed charges,324.17,77,,259.34,percent of total billed charges,77% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,198.97,385,,,fee schedule,385% of BCBS fee schedule,207.24,401,,,fee schedule,401% of BCBS fee schedule,207.24,401,,,fee schedule,401% of BCBS fee schedule,207.24,401,,,fee schedule,401% of BCBS fee schedule,378.9,90,,303.12,percent of total billed charges,90% of total billed charges,336.8,80,,269.44,percent of total billed charges,80% of total billed charges,378.9,90,,303.12,percent of total billed charges,90% of total billed charges,315.75,75,,252.6,percent of total billed charges,75% of total billed charges,117.29,122,,,fee schedule,122% of HUMANA fee schedule,122.09,29,,97.672,percent of total billed charges,29% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,282.07,67,,225.656,percent of total billed charges,67% of total billed charges,89.76,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,336.8,80,,269.44,percent of total billed charges,80% of total billed charges,273.65,65,,218.92,percent of total billed charges,65% of total billed charges,150.17,35.67,,120.136,percent of total billed charges,35.67% of total billed charges,89.76,378.9,
US BIOPHY PROFILE W NON STRESS,4000070,CDM,402,RC,76818,HCPCS,outpatient,,,480,192.00,,408,85,,326.4,percent of total billed charges,85% of total billed charges,369.6,77,,295.68,percent of total billed charges,77% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,272.2,385,,,fee schedule,385% of BCBS fee schedule,283.51,401,,,fee schedule,401% of BCBS fee schedule,283.51,401,,,fee schedule,401% of BCBS fee schedule,283.51,401,,,fee schedule,401% of BCBS fee schedule,432,90,,345.6,percent of total billed charges,90% of total billed charges,384,80,,307.2,percent of total billed charges,80% of total billed charges,432,90,,345.6,percent of total billed charges,90% of total billed charges,360,75,,288,percent of total billed charges,75% of total billed charges,117.29,122,,,fee schedule,122% of HUMANA fee schedule,139.2,29,,111.36,percent of total billed charges,29% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,321.6,67,,257.28,percent of total billed charges,67% of total billed charges,89.76,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,384,80,,307.2,percent of total billed charges,80% of total billed charges,312,65,,249.6,percent of total billed charges,65% of total billed charges,171.22,35.67,,136.976,percent of total billed charges,35.67% of total billed charges,89.76,432,
ABD PARACENTESIS WITH GUIDANCE,4000105,CDM,402,RC,49083,HCPCS,outpatient,,,1666,666.40,,1150,,,,case rate,pays based on per visit,1282.82,77,,1026.26,percent of total billed charges,77% of total billed charges,792.74,100,,,fee schedule,100% of CMS OPPS rate,1366.12,82,,1092.896,percent of total billed charges,82% of total billed charges,1416.1,85,,1132.88,percent of total billed charges,85% of total billed charges,1416.1,85,,1132.88,percent of total billed charges,85% of total billed charges,1416.1,85,,1132.88,percent of total billed charges,85% of total billed charges,1499.4,90,,1199.52,percent of total billed charges,90% of total billed charges,1332.8,80,,1066.24,percent of total billed charges,80% of total billed charges,1499.4,90,,1199.52,percent of total billed charges,90% of total billed charges,1249.5,75,,999.6,percent of total billed charges,75% of total billed charges,967.14,122,,,fee schedule,122% of HUMANA fee schedule,334.95,100,,,fee schedule,100% of ASC tier grouping rate,792.74,100,,,fee schedule,100% of CMS OPPS rate,1116.22,67,,892.976,percent of total billed charges,67% of total billed charges,359.17,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,1332.8,80,,1066.24,percent of total billed charges,80% of total billed charges,1082.9,65,,866.32,percent of total billed charges,65% of total billed charges,411.99,123,,,fee schedule,123% of ASC tier grouping rate,334.95,1499.4,
US BREAST LIMITED RIGHT,4000111,CDM,402,RC,76642,HCPCS,outpatient,,,307,122.80,RT,260.95,85,,208.76,percent of total billed charges,85% of total billed charges,236.39,77,,189.11,percent of total billed charges,77% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,239.16,385,,,fee schedule,385% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,276.3,90,,221.04,percent of total billed charges,90% of total billed charges,245.6,80,,196.48,percent of total billed charges,80% of total billed charges,276.3,90,,221.04,percent of total billed charges,90% of total billed charges,230.25,75,,184.2,percent of total billed charges,75% of total billed charges,96.95,122,,,fee schedule,122% of HUMANA fee schedule,89.03,29,,71.224,percent of total billed charges,29% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,205.69,67,,164.552,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,245.6,80,,196.48,percent of total billed charges,80% of total billed charges,199.55,65,,159.64,percent of total billed charges,65% of total billed charges,109.51,35.67,,87.608,percent of total billed charges,35.67% of total billed charges,79.46,276.3,
US BREAST LIMITED LEFT,4000112,CDM,402,RC,76642,HCPCS,outpatient,,,307,122.80,LT,260.95,85,,208.76,percent of total billed charges,85% of total billed charges,236.39,77,,189.11,percent of total billed charges,77% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,239.16,385,,,fee schedule,385% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,276.3,90,,221.04,percent of total billed charges,90% of total billed charges,245.6,80,,196.48,percent of total billed charges,80% of total billed charges,276.3,90,,221.04,percent of total billed charges,90% of total billed charges,230.25,75,,184.2,percent of total billed charges,75% of total billed charges,96.95,122,,,fee schedule,122% of HUMANA fee schedule,89.03,29,,71.224,percent of total billed charges,29% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,205.69,67,,164.552,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,245.6,80,,196.48,percent of total billed charges,80% of total billed charges,199.55,65,,159.64,percent of total billed charges,65% of total billed charges,109.51,35.67,,87.608,percent of total billed charges,35.67% of total billed charges,79.46,276.3,
US BREAST COMPLETE RIGHT,4000113,CDM,402,RC,76641,HCPCS,outpatient,,,622,248.80,RT,528.7,85,,422.96,percent of total billed charges,85% of total billed charges,478.94,77,,383.15,percent of total billed charges,77% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,440.67,385,,,fee schedule,385% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,559.8,90,,447.84,percent of total billed charges,90% of total billed charges,497.6,80,,398.08,percent of total billed charges,80% of total billed charges,559.8,90,,447.84,percent of total billed charges,90% of total billed charges,466.5,75,,373.2,percent of total billed charges,75% of total billed charges,117.29,122,,,fee schedule,122% of HUMANA fee schedule,180.38,29,,144.304,percent of total billed charges,29% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,416.74,67,,333.392,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,497.6,80,,398.08,percent of total billed charges,80% of total billed charges,404.3,65,,323.44,percent of total billed charges,65% of total billed charges,221.87,35.67,,177.496,percent of total billed charges,35.67% of total billed charges,96.14,559.8,
"US UNIVERSAL, NON VASC. EXTEM",4000165,CDM,402,RC,76881,HCPCS,outpatient,,,327,130.80,,277.95,85,,222.36,percent of total billed charges,85% of total billed charges,251.79,77,,201.43,percent of total billed charges,77% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,274.97,385,,,fee schedule,385% of BCBS fee schedule,286.39,401,,,fee schedule,401% of BCBS fee schedule,286.39,401,,,fee schedule,401% of BCBS fee schedule,286.39,401,,,fee schedule,401% of BCBS fee schedule,294.3,90,,235.44,percent of total billed charges,90% of total billed charges,261.6,80,,209.28,percent of total billed charges,80% of total billed charges,294.3,90,,235.44,percent of total billed charges,90% of total billed charges,245.25,75,,196.2,percent of total billed charges,75% of total billed charges,117.29,122,,,fee schedule,122% of HUMANA fee schedule,94.83,29,,75.864,percent of total billed charges,29% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,219.09,67,,175.272,percent of total billed charges,67% of total billed charges,89.76,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,261.6,80,,209.28,percent of total billed charges,80% of total billed charges,212.55,65,,170.04,percent of total billed charges,65% of total billed charges,116.64,35.67,,93.312,percent of total billed charges,35.67% of total billed charges,89.76,294.3,
ULTRASOUND - FETAL POSITION,4000230,CDM,402,RC,76815,HCPCS,outpatient,,,554,221.60,,470.9,85,,376.72,percent of total billed charges,85% of total billed charges,426.58,77,,341.26,percent of total billed charges,77% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,440.67,385,,,fee schedule,385% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,498.6,90,,398.88,percent of total billed charges,90% of total billed charges,443.2,80,,354.56,percent of total billed charges,80% of total billed charges,498.6,90,,398.88,percent of total billed charges,90% of total billed charges,415.5,75,,332.4,percent of total billed charges,75% of total billed charges,117.29,122,,,fee schedule,122% of HUMANA fee schedule,160.66,29,,128.528,percent of total billed charges,29% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,371.18,67,,296.944,percent of total billed charges,67% of total billed charges,58.64,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,443.2,80,,354.56,percent of total billed charges,80% of total billed charges,360.1,65,,288.08,percent of total billed charges,65% of total billed charges,197.61,35.67,,158.088,percent of total billed charges,35.67% of total billed charges,58.64,498.6,
ULTRASOUND  HEAD,4000235,CDM,402,RC,76506,HCPCS,outpatient,,,522,208.80,,443.7,85,,354.96,percent of total billed charges,85% of total billed charges,401.94,77,,321.55,percent of total billed charges,77% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,440.67,385,,,fee schedule,385% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,469.8,90,,375.84,percent of total billed charges,90% of total billed charges,417.6,80,,334.08,percent of total billed charges,80% of total billed charges,469.8,90,,375.84,percent of total billed charges,90% of total billed charges,391.5,75,,313.2,percent of total billed charges,75% of total billed charges,117.29,122,,,fee schedule,122% of HUMANA fee schedule,151.38,29,,121.104,percent of total billed charges,29% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,349.74,67,,279.792,percent of total billed charges,67% of total billed charges,58.64,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,417.6,80,,334.08,percent of total billed charges,80% of total billed charges,339.3,65,,271.44,percent of total billed charges,65% of total billed charges,186.2,35.67,,148.96,percent of total billed charges,35.67% of total billed charges,58.64,469.8,
"ULTRASOUND, GUIDANCE NEEDLE PL",4000240,CDM,402,RC,76942,HCPCS,outpatient,,,593,237.20,,504.05,85,,403.24,percent of total billed charges,85% of total billed charges,456.61,77,,365.29,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,107.76,385,,,fee schedule,385% of BCBS fee schedule,112.24,401,,,fee schedule,401% of BCBS fee schedule,112.24,401,,,fee schedule,401% of BCBS fee schedule,112.24,401,,,fee schedule,401% of BCBS fee schedule,533.7,90,,426.96,percent of total billed charges,90% of total billed charges,474.4,80,,379.52,percent of total billed charges,80% of total billed charges,533.7,90,,426.96,percent of total billed charges,90% of total billed charges,444.75,75,,355.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,171.97,29,,137.576,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,397.31,67,,317.848,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,474.4,80,,379.52,percent of total billed charges,80% of total billed charges,385.45,65,,308.36,percent of total billed charges,65% of total billed charges,211.52,35.67,,169.216,percent of total billed charges,35.67% of total billed charges,107.76,533.7,
ULTRASOUND GALL BLADDER SCREEN,4000250,CDM,402,RC,76705,HCPCS,outpatient,,,541,216.40,,459.85,85,,367.88,percent of total billed charges,85% of total billed charges,416.57,77,,333.26,percent of total billed charges,77% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,440.67,385,,,fee schedule,385% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,486.9,90,,389.52,percent of total billed charges,90% of total billed charges,432.8,80,,346.24,percent of total billed charges,80% of total billed charges,486.9,90,,389.52,percent of total billed charges,90% of total billed charges,405.75,75,,324.6,percent of total billed charges,75% of total billed charges,117.29,122,,,fee schedule,122% of HUMANA fee schedule,156.89,29,,125.512,percent of total billed charges,29% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,362.47,67,,289.976,percent of total billed charges,67% of total billed charges,89.76,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,432.8,80,,346.24,percent of total billed charges,80% of total billed charges,351.65,65,,281.32,percent of total billed charges,65% of total billed charges,192.97,35.67,,154.376,percent of total billed charges,35.67% of total billed charges,89.76,486.9,
ULTRASOUND INTRAOPERATIVE,4000255,CDM,402,RC,76998,HCPCS,outpatient,,,600,240.00,,510,85,,408,percent of total billed charges,85% of total billed charges,462,77,,369.6,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,250.1,385,,,fee schedule,385% of BCBS fee schedule,260.49,401,,,fee schedule,401% of BCBS fee schedule,260.49,401,,,fee schedule,401% of BCBS fee schedule,260.49,401,,,fee schedule,401% of BCBS fee schedule,540,90,,432,percent of total billed charges,90% of total billed charges,480,80,,384,percent of total billed charges,80% of total billed charges,540,90,,432,percent of total billed charges,90% of total billed charges,450,75,,360,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,174,29,,139.2,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,402,67,,321.6,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,480,80,,384,percent of total billed charges,80% of total billed charges,390,65,,312,percent of total billed charges,65% of total billed charges,214.02,35.67,,171.216,percent of total billed charges,35.67% of total billed charges,174,540,
ULTRASOUND INFANT HIP DYNAMIC,4000256,CDM,402,RC,76885,HCPCS,outpatient,,,632,252.80,,537.2,85,,429.76,percent of total billed charges,85% of total billed charges,486.64,77,,389.31,percent of total billed charges,77% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,239.16,385,,,fee schedule,385% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,568.8,90,,455.04,percent of total billed charges,90% of total billed charges,505.6,80,,404.48,percent of total billed charges,80% of total billed charges,568.8,90,,455.04,percent of total billed charges,90% of total billed charges,474,75,,379.2,percent of total billed charges,75% of total billed charges,96.95,122,,,fee schedule,122% of HUMANA fee schedule,183.28,29,,146.624,percent of total billed charges,29% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,423.44,67,,338.752,percent of total billed charges,67% of total billed charges,58.64,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,505.6,80,,404.48,percent of total billed charges,80% of total billed charges,410.8,65,,328.64,percent of total billed charges,65% of total billed charges,225.43,35.67,,180.344,percent of total billed charges,35.67% of total billed charges,58.64,568.8,
ULTRASOUND INFANT HIP STATIC,4000257,CDM,402,RC,76886,HCPCS,outpatient,,,531,212.40,,451.35,85,,361.08,percent of total billed charges,85% of total billed charges,408.87,77,,327.1,percent of total billed charges,77% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,239.16,385,,,fee schedule,385% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,249.1,401,,,fee schedule,401% of BCBS fee schedule,477.9,90,,382.32,percent of total billed charges,90% of total billed charges,424.8,80,,339.84,percent of total billed charges,80% of total billed charges,477.9,90,,382.32,percent of total billed charges,90% of total billed charges,398.25,75,,318.6,percent of total billed charges,75% of total billed charges,96.95,122,,,fee schedule,122% of HUMANA fee schedule,153.99,29,,123.192,percent of total billed charges,29% of total billed charges,79.46,100,,,fee schedule,100% of CMS OPPS rate,355.77,67,,284.616,percent of total billed charges,67% of total billed charges,58.64,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,424.8,80,,339.84,percent of total billed charges,80% of total billed charges,345.15,65,,276.12,percent of total billed charges,65% of total billed charges,189.41,35.67,,151.528,percent of total billed charges,35.67% of total billed charges,58.64,477.9,
ULTRASOUND LIVER,4000260,CDM,402,RC,76705,HCPCS,outpatient,,,541,216.40,,459.85,85,,367.88,percent of total billed charges,85% of total billed charges,416.57,77,,333.26,percent of total billed charges,77% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,440.67,385,,,fee schedule,385% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,486.9,90,,389.52,percent of total billed charges,90% of total billed charges,432.8,80,,346.24,percent of total billed charges,80% of total billed charges,486.9,90,,389.52,percent of total billed charges,90% of total billed charges,405.75,75,,324.6,percent of total billed charges,75% of total billed charges,117.29,122,,,fee schedule,122% of HUMANA fee schedule,156.89,29,,125.512,percent of total billed charges,29% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,362.47,67,,289.976,percent of total billed charges,67% of total billed charges,89.76,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,432.8,80,,346.24,percent of total billed charges,80% of total billed charges,351.65,65,,281.32,percent of total billed charges,65% of total billed charges,192.97,35.67,,154.376,percent of total billed charges,35.67% of total billed charges,89.76,486.9,
ULTRASOUND OB COMPLETE 1ST TRI,4000281,CDM,402,RC,76801,HCPCS,outpatient,,,503,201.20,,427.55,85,,342.04,percent of total billed charges,85% of total billed charges,387.31,77,,309.85,percent of total billed charges,77% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,290.17,385,,,fee schedule,385% of BCBS fee schedule,302.23,401,,,fee schedule,401% of BCBS fee schedule,302.23,401,,,fee schedule,401% of BCBS fee schedule,302.23,401,,,fee schedule,401% of BCBS fee schedule,452.7,90,,362.16,percent of total billed charges,90% of total billed charges,402.4,80,,321.92,percent of total billed charges,80% of total billed charges,452.7,90,,362.16,percent of total billed charges,90% of total billed charges,377.25,75,,301.8,percent of total billed charges,75% of total billed charges,117.29,122,,,fee schedule,122% of HUMANA fee schedule,145.87,29,,116.696,percent of total billed charges,29% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,337.01,67,,269.608,percent of total billed charges,67% of total billed charges,89.76,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,402.4,80,,321.92,percent of total billed charges,80% of total billed charges,326.95,65,,261.56,percent of total billed charges,65% of total billed charges,179.42,35.67,,143.536,percent of total billed charges,35.67% of total billed charges,89.76,452.7,
ULTRASOUND 1ST TR EA ADD GEST,4000282,CDM,402,RC,76802,HCPCS,outpatient,,,394,157.60,,334.9,85,,267.92,percent of total billed charges,85% of total billed charges,303.38,77,,242.7,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,88.43,385,,,fee schedule,385% of BCBS fee schedule,92.11,401,,,fee schedule,401% of BCBS fee schedule,92.11,401,,,fee schedule,401% of BCBS fee schedule,92.11,401,,,fee schedule,401% of BCBS fee schedule,354.6,90,,283.68,percent of total billed charges,90% of total billed charges,315.2,80,,252.16,percent of total billed charges,80% of total billed charges,354.6,90,,283.68,percent of total billed charges,90% of total billed charges,295.5,75,,236.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,114.26,29,,91.408,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,263.98,67,,211.184,percent of total billed charges,67% of total billed charges,58.64,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,315.2,80,,252.16,percent of total billed charges,80% of total billed charges,256.1,65,,204.88,percent of total billed charges,65% of total billed charges,140.54,35.67,,112.432,percent of total billed charges,35.67% of total billed charges,58.64,354.6,
ULTRASOUND OB COMP 2-3 TRI,4000283,CDM,402,RC,76805,HCPCS,outpatient,,,624,249.60,,530.4,85,,424.32,percent of total billed charges,85% of total billed charges,480.48,77,,384.38,percent of total billed charges,77% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,362.02,385,,,fee schedule,385% of BCBS fee schedule,377.06,401,,,fee schedule,401% of BCBS fee schedule,377.06,401,,,fee schedule,401% of BCBS fee schedule,377.06,401,,,fee schedule,401% of BCBS fee schedule,561.6,90,,449.28,percent of total billed charges,90% of total billed charges,499.2,80,,399.36,percent of total billed charges,80% of total billed charges,561.6,90,,449.28,percent of total billed charges,90% of total billed charges,468,75,,374.4,percent of total billed charges,75% of total billed charges,117.29,122,,,fee schedule,122% of HUMANA fee schedule,180.96,29,,144.768,percent of total billed charges,29% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,418.08,67,,334.464,percent of total billed charges,67% of total billed charges,89.76,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,499.2,80,,399.36,percent of total billed charges,80% of total billed charges,405.6,65,,324.48,percent of total billed charges,65% of total billed charges,222.58,35.67,,178.064,percent of total billed charges,35.67% of total billed charges,89.76,561.6,
US OB COMPLETE EA GEST 2-3 TRI,4000284,CDM,402,RC,76810,HCPCS,outpatient,,,668,267.20,,567.8,85,,454.24,percent of total billed charges,85% of total billed charges,514.36,77,,411.49,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,169.94,385,,,fee schedule,385% of BCBS fee schedule,177,401,,,fee schedule,401% of BCBS fee schedule,177,401,,,fee schedule,401% of BCBS fee schedule,177,401,,,fee schedule,401% of BCBS fee schedule,601.2,90,,480.96,percent of total billed charges,90% of total billed charges,534.4,80,,427.52,percent of total billed charges,80% of total billed charges,601.2,90,,480.96,percent of total billed charges,90% of total billed charges,501,75,,400.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,193.72,29,,154.976,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,447.56,67,,358.048,percent of total billed charges,67% of total billed charges,89.76,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,534.4,80,,427.52,percent of total billed charges,80% of total billed charges,434.2,65,,347.36,percent of total billed charges,65% of total billed charges,238.28,35.67,,190.624,percent of total billed charges,35.67% of total billed charges,89.76,601.2,
ULTRASOUND OB FOLLOW UP,4000285,CDM,402,RC,76816,HCPCS,outpatient,,,531,212.40,,451.35,85,,361.08,percent of total billed charges,85% of total billed charges,408.87,77,,327.1,percent of total billed charges,77% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,440.67,385,,,fee schedule,385% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,477.9,90,,382.32,percent of total billed charges,90% of total billed charges,424.8,80,,339.84,percent of total billed charges,80% of total billed charges,477.9,90,,382.32,percent of total billed charges,90% of total billed charges,398.25,75,,318.6,percent of total billed charges,75% of total billed charges,117.29,122,,,fee schedule,122% of HUMANA fee schedule,153.99,29,,123.192,percent of total billed charges,29% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,355.77,67,,284.616,percent of total billed charges,67% of total billed charges,58.64,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,424.8,80,,339.84,percent of total billed charges,80% of total billed charges,345.15,65,,276.12,percent of total billed charges,65% of total billed charges,189.41,35.67,,151.528,percent of total billed charges,35.67% of total billed charges,58.64,477.9,
ULTRASOUND TRANS VAG OB,4000286,CDM,402,RC,76817,HCPCS,outpatient,,,531,212.40,,451.35,85,,361.08,percent of total billed charges,85% of total billed charges,408.87,77,,327.1,percent of total billed charges,77% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,440.67,385,,,fee schedule,385% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,477.9,90,,382.32,percent of total billed charges,90% of total billed charges,424.8,80,,339.84,percent of total billed charges,80% of total billed charges,477.9,90,,382.32,percent of total billed charges,90% of total billed charges,398.25,75,,318.6,percent of total billed charges,75% of total billed charges,117.29,122,,,fee schedule,122% of HUMANA fee schedule,153.99,29,,123.192,percent of total billed charges,29% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,355.77,67,,284.616,percent of total billed charges,67% of total billed charges,58.64,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,424.8,80,,339.84,percent of total billed charges,80% of total billed charges,345.15,65,,276.12,percent of total billed charges,65% of total billed charges,189.41,35.67,,151.528,percent of total billed charges,35.67% of total billed charges,58.64,477.9,
ULTRASOUND PSEUDOANEURYSM REPA,4000289,CDM,402,RC,76936,HCPCS,outpatient,,,988,395.20,,839.8,85,,671.84,percent of total billed charges,85% of total billed charges,760.76,77,,608.61,percent of total billed charges,77% of total billed charges,274.49,100,,,fee schedule,100% of CMS OPPS rate,685.34,385,,,fee schedule,385% of BCBS fee schedule,713.82,401,,,fee schedule,401% of BCBS fee schedule,713.82,401,,,fee schedule,401% of BCBS fee schedule,713.82,401,,,fee schedule,401% of BCBS fee schedule,889.2,90,,711.36,percent of total billed charges,90% of total billed charges,790.4,80,,632.32,percent of total billed charges,80% of total billed charges,889.2,90,,711.36,percent of total billed charges,90% of total billed charges,741,75,,592.8,percent of total billed charges,75% of total billed charges,334.88,122,,,fee schedule,122% of HUMANA fee schedule,286.52,29,,229.216,percent of total billed charges,29% of total billed charges,274.49,100,,,fee schedule,100% of CMS OPPS rate,661.96,67,,529.568,percent of total billed charges,67% of total billed charges,99.41,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,790.4,80,,632.32,percent of total billed charges,80% of total billed charges,642.2,65,,513.76,percent of total billed charges,65% of total billed charges,352.42,35.67,,281.936,percent of total billed charges,35.67% of total billed charges,99.41,889.2,
ULTRASOUND OB LIMITED,4000290,CDM,402,RC,76815,HCPCS,outpatient,,,564,225.60,,479.4,85,,383.52,percent of total billed charges,85% of total billed charges,434.28,77,,347.42,percent of total billed charges,77% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,440.67,385,,,fee schedule,385% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,507.6,90,,406.08,percent of total billed charges,90% of total billed charges,451.2,80,,360.96,percent of total billed charges,80% of total billed charges,507.6,90,,406.08,percent of total billed charges,90% of total billed charges,423,75,,338.4,percent of total billed charges,75% of total billed charges,117.29,122,,,fee schedule,122% of HUMANA fee schedule,163.56,29,,130.848,percent of total billed charges,29% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,377.88,67,,302.304,percent of total billed charges,67% of total billed charges,58.64,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,451.2,80,,360.96,percent of total billed charges,80% of total billed charges,366.6,65,,293.28,percent of total billed charges,65% of total billed charges,201.18,35.67,,160.944,percent of total billed charges,35.67% of total billed charges,58.64,507.6,
US OB FETAL ANATOMY SNGL FETUS,4000291,CDM,402,RC,76811,HCPCS,outpatient,,,593,237.20,,504.05,85,,403.24,percent of total billed charges,85% of total billed charges,456.61,77,,365.29,percent of total billed charges,77% of total billed charges,214.29,100,,,fee schedule,100% of CMS OPPS rate,335.76,385,,,fee schedule,385% of BCBS fee schedule,349.71,401,,,fee schedule,401% of BCBS fee schedule,349.71,401,,,fee schedule,401% of BCBS fee schedule,349.71,401,,,fee schedule,401% of BCBS fee schedule,533.7,90,,426.96,percent of total billed charges,90% of total billed charges,474.4,80,,379.52,percent of total billed charges,80% of total billed charges,533.7,90,,426.96,percent of total billed charges,90% of total billed charges,444.75,75,,355.8,percent of total billed charges,75% of total billed charges,261.43,122,,,fee schedule,122% of HUMANA fee schedule,171.97,29,,137.576,percent of total billed charges,29% of total billed charges,214.29,100,,,fee schedule,100% of CMS OPPS rate,397.31,67,,317.848,percent of total billed charges,67% of total billed charges,141.8,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,474.4,80,,379.52,percent of total billed charges,80% of total billed charges,385.45,65,,308.36,percent of total billed charges,65% of total billed charges,211.52,35.67,,169.216,percent of total billed charges,35.67% of total billed charges,141.8,533.7,
ULTRASOUND PANCREAS,4000300,CDM,402,RC,76705,HCPCS,outpatient,,,531,212.40,,451.35,85,,361.08,percent of total billed charges,85% of total billed charges,408.87,77,,327.1,percent of total billed charges,77% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,440.67,385,,,fee schedule,385% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,477.9,90,,382.32,percent of total billed charges,90% of total billed charges,424.8,80,,339.84,percent of total billed charges,80% of total billed charges,477.9,90,,382.32,percent of total billed charges,90% of total billed charges,398.25,75,,318.6,percent of total billed charges,75% of total billed charges,117.29,122,,,fee schedule,122% of HUMANA fee schedule,153.99,29,,123.192,percent of total billed charges,29% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,355.77,67,,284.616,percent of total billed charges,67% of total billed charges,89.76,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,424.8,80,,339.84,percent of total billed charges,80% of total billed charges,345.15,65,,276.12,percent of total billed charges,65% of total billed charges,189.41,35.67,,151.528,percent of total billed charges,35.67% of total billed charges,89.76,477.9,
ULTRASOUND PELVIC,4000320,CDM,402,RC,76856,HCPCS,outpatient,,,815,326.00,,692.75,85,,554.2,percent of total billed charges,85% of total billed charges,627.55,77,,502.04,percent of total billed charges,77% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,440.67,385,,,fee schedule,385% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,733.5,90,,586.8,percent of total billed charges,90% of total billed charges,652,80,,521.6,percent of total billed charges,80% of total billed charges,733.5,90,,586.8,percent of total billed charges,90% of total billed charges,611.25,75,,489,percent of total billed charges,75% of total billed charges,117.29,122,,,fee schedule,122% of HUMANA fee schedule,236.35,29,,189.08,percent of total billed charges,29% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,546.05,67,,436.84,percent of total billed charges,67% of total billed charges,89.76,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,652,80,,521.6,percent of total billed charges,80% of total billed charges,529.75,65,,423.8,percent of total billed charges,65% of total billed charges,290.71,35.67,,232.568,percent of total billed charges,35.67% of total billed charges,89.76,733.5,
ULTRASOUND RENAL (Limited),4000350,CDM,402,RC,76775,HCPCS,outpatient,,,531,212.40,,451.35,85,,361.08,percent of total billed charges,85% of total billed charges,408.87,77,,327.1,percent of total billed charges,77% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,440.67,385,,,fee schedule,385% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,477.9,90,,382.32,percent of total billed charges,90% of total billed charges,424.8,80,,339.84,percent of total billed charges,80% of total billed charges,477.9,90,,382.32,percent of total billed charges,90% of total billed charges,398.25,75,,318.6,percent of total billed charges,75% of total billed charges,117.29,122,,,fee schedule,122% of HUMANA fee schedule,153.99,29,,123.192,percent of total billed charges,29% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,355.77,67,,284.616,percent of total billed charges,67% of total billed charges,89.76,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,424.8,80,,339.84,percent of total billed charges,80% of total billed charges,345.15,65,,276.12,percent of total billed charges,65% of total billed charges,189.41,35.67,,151.528,percent of total billed charges,35.67% of total billed charges,89.76,477.9,
ULTRASOUND RENAL (COMPLETE),4000351,CDM,402,RC,76770,HCPCS,outpatient,,,753,301.20,,640.05,85,,512.04,percent of total billed charges,85% of total billed charges,579.81,77,,463.85,percent of total billed charges,77% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,440.67,385,,,fee schedule,385% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,677.7,90,,542.16,percent of total billed charges,90% of total billed charges,602.4,80,,481.92,percent of total billed charges,80% of total billed charges,677.7,90,,542.16,percent of total billed charges,90% of total billed charges,564.75,75,,451.8,percent of total billed charges,75% of total billed charges,117.29,122,,,fee schedule,122% of HUMANA fee schedule,218.37,29,,174.696,percent of total billed charges,29% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,504.51,67,,403.608,percent of total billed charges,67% of total billed charges,89.76,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,602.4,80,,481.92,percent of total billed charges,80% of total billed charges,489.45,65,,391.56,percent of total billed charges,65% of total billed charges,268.6,35.67,,214.88,percent of total billed charges,35.67% of total billed charges,89.76,677.7,
ULTRASOUND-SOFT TIS. EXTREMITY,4000355,CDM,402,RC,76882,HCPCS,outpatient,,,531,212.40,,451.35,85,,361.08,percent of total billed charges,85% of total billed charges,408.87,77,,327.1,percent of total billed charges,77% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,440.67,385,,,fee schedule,385% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,477.9,90,,382.32,percent of total billed charges,90% of total billed charges,424.8,80,,339.84,percent of total billed charges,80% of total billed charges,477.9,90,,382.32,percent of total billed charges,90% of total billed charges,398.25,75,,318.6,percent of total billed charges,75% of total billed charges,117.29,122,,,fee schedule,122% of HUMANA fee schedule,153.99,29,,123.192,percent of total billed charges,29% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,355.77,67,,284.616,percent of total billed charges,67% of total billed charges,58.64,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,424.8,80,,339.84,percent of total billed charges,80% of total billed charges,345.15,65,,276.12,percent of total billed charges,65% of total billed charges,189.41,35.67,,151.528,percent of total billed charges,35.67% of total billed charges,58.64,477.9,
ULTRASOUND SOFT TIS. HEAD/NECK,4000395,CDM,402,RC,76536,HCPCS,outpatient,,,657,262.80,,558.45,85,,446.76,percent of total billed charges,85% of total billed charges,505.89,77,,404.71,percent of total billed charges,77% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,440.67,385,,,fee schedule,385% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,591.3,90,,473.04,percent of total billed charges,90% of total billed charges,525.6,80,,420.48,percent of total billed charges,80% of total billed charges,591.3,90,,473.04,percent of total billed charges,90% of total billed charges,492.75,75,,394.2,percent of total billed charges,75% of total billed charges,117.29,122,,,fee schedule,122% of HUMANA fee schedule,190.53,29,,152.424,percent of total billed charges,29% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,440.19,67,,352.152,percent of total billed charges,67% of total billed charges,89.76,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,525.6,80,,420.48,percent of total billed charges,80% of total billed charges,427.05,65,,341.64,percent of total billed charges,65% of total billed charges,234.35,35.67,,187.48,percent of total billed charges,35.67% of total billed charges,89.76,591.3,
ULTRASOUND OF THE SPINAL CANAL,4000396,CDM,402,RC,76800,HCPCS,outpatient,,,522,208.80,,443.7,85,,354.96,percent of total billed charges,85% of total billed charges,401.94,77,,321.55,percent of total billed charges,77% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,440.67,385,,,fee schedule,385% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,469.8,90,,375.84,percent of total billed charges,90% of total billed charges,417.6,80,,334.08,percent of total billed charges,80% of total billed charges,469.8,90,,375.84,percent of total billed charges,90% of total billed charges,391.5,75,,313.2,percent of total billed charges,75% of total billed charges,117.29,122,,,fee schedule,122% of HUMANA fee schedule,151.38,29,,121.104,percent of total billed charges,29% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,349.74,67,,279.792,percent of total billed charges,67% of total billed charges,89.76,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,417.6,80,,334.08,percent of total billed charges,80% of total billed charges,339.3,65,,271.44,percent of total billed charges,65% of total billed charges,186.2,35.67,,148.96,percent of total billed charges,35.67% of total billed charges,89.76,469.8,
ULTRASOUND SPLEEN,4000400,CDM,402,RC,76705,HCPCS,outpatient,,,531,212.40,,451.35,85,,361.08,percent of total billed charges,85% of total billed charges,408.87,77,,327.1,percent of total billed charges,77% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,440.67,385,,,fee schedule,385% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,477.9,90,,382.32,percent of total billed charges,90% of total billed charges,424.8,80,,339.84,percent of total billed charges,80% of total billed charges,477.9,90,,382.32,percent of total billed charges,90% of total billed charges,398.25,75,,318.6,percent of total billed charges,75% of total billed charges,117.29,122,,,fee schedule,122% of HUMANA fee schedule,153.99,29,,123.192,percent of total billed charges,29% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,355.77,67,,284.616,percent of total billed charges,67% of total billed charges,89.76,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,424.8,80,,339.84,percent of total billed charges,80% of total billed charges,345.15,65,,276.12,percent of total billed charges,65% of total billed charges,189.41,35.67,,151.528,percent of total billed charges,35.67% of total billed charges,89.76,477.9,
ULTRASOUND TESTICULAR,4000410,CDM,402,RC,76870,HCPCS,outpatient,,,531,212.40,,451.35,85,,361.08,percent of total billed charges,85% of total billed charges,408.87,77,,327.1,percent of total billed charges,77% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,440.67,385,,,fee schedule,385% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,477.9,90,,382.32,percent of total billed charges,90% of total billed charges,424.8,80,,339.84,percent of total billed charges,80% of total billed charges,477.9,90,,382.32,percent of total billed charges,90% of total billed charges,398.25,75,,318.6,percent of total billed charges,75% of total billed charges,117.29,122,,,fee schedule,122% of HUMANA fee schedule,153.99,29,,123.192,percent of total billed charges,29% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,355.77,67,,284.616,percent of total billed charges,67% of total billed charges,89.76,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,424.8,80,,339.84,percent of total billed charges,80% of total billed charges,345.15,65,,276.12,percent of total billed charges,65% of total billed charges,189.41,35.67,,151.528,percent of total billed charges,35.67% of total billed charges,89.76,477.9,
ULTRASOUND THYROID,4000430,CDM,402,RC,76536,HCPCS,outpatient,,,657,262.80,,558.45,85,,446.76,percent of total billed charges,85% of total billed charges,505.89,77,,404.71,percent of total billed charges,77% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,440.67,385,,,fee schedule,385% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,591.3,90,,473.04,percent of total billed charges,90% of total billed charges,525.6,80,,420.48,percent of total billed charges,80% of total billed charges,591.3,90,,473.04,percent of total billed charges,90% of total billed charges,492.75,75,,394.2,percent of total billed charges,75% of total billed charges,117.29,122,,,fee schedule,122% of HUMANA fee schedule,190.53,29,,152.424,percent of total billed charges,29% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,440.19,67,,352.152,percent of total billed charges,67% of total billed charges,89.76,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,525.6,80,,420.48,percent of total billed charges,80% of total billed charges,427.05,65,,341.64,percent of total billed charges,65% of total billed charges,234.35,35.67,,187.48,percent of total billed charges,35.67% of total billed charges,89.76,591.3,
ULTRASOUND TRANSVAG PELVIS NON,4000470,CDM,402,RC,76830,HCPCS,outpatient,,,615,246.00,,522.75,85,,418.2,percent of total billed charges,85% of total billed charges,473.55,77,,378.84,percent of total billed charges,77% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,344.04,385,,,fee schedule,385% of BCBS fee schedule,358.33,401,,,fee schedule,401% of BCBS fee schedule,358.33,401,,,fee schedule,401% of BCBS fee schedule,358.33,401,,,fee schedule,401% of BCBS fee schedule,553.5,90,,442.8,percent of total billed charges,90% of total billed charges,492,80,,393.6,percent of total billed charges,80% of total billed charges,553.5,90,,442.8,percent of total billed charges,90% of total billed charges,461.25,75,,369,percent of total billed charges,75% of total billed charges,117.29,122,,,fee schedule,122% of HUMANA fee schedule,178.35,29,,142.68,percent of total billed charges,29% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,412.05,67,,329.64,percent of total billed charges,67% of total billed charges,89.76,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,492,80,,393.6,percent of total billed charges,80% of total billed charges,399.75,65,,319.8,percent of total billed charges,65% of total billed charges,219.37,35.67,,175.496,percent of total billed charges,35.67% of total billed charges,89.76,553.5,
"ULTRASOUND GUIDANCE BX, ASPIR",4003170,CDM,402,RC,,,outpatient,,,2538,1015.20,,2157.3,85,,1725.84,percent of total billed charges,85% of total billed charges,1954.26,77,,1563.41,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,2081.16,82,,1664.928,percent of total billed charges,82% of total billed charges,2157.3,85,,1725.84,percent of total billed charges,85% of total billed charges,2157.3,85,,1725.84,percent of total billed charges,85% of total billed charges,2157.3,85,,1725.84,percent of total billed charges,85% of total billed charges,2284.2,90,,1827.36,percent of total billed charges,90% of total billed charges,2030.4,80,,1624.32,percent of total billed charges,80% of total billed charges,2284.2,90,,1827.36,percent of total billed charges,90% of total billed charges,1903.5,75,,1522.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,736.02,29,,588.816,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1700.46,67,,1360.368,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,2030.4,80,,1624.32,percent of total billed charges,80% of total billed charges,1649.7,65,,1319.76,percent of total billed charges,65% of total billed charges,905.3,35.67,,724.24,percent of total billed charges,35.67% of total billed charges,736.02,2284.2,
ULTRASOUND GUIDANCE BX,4003175,CDM,402,RC,76942,HCPCS,outpatient,,,1483,593.20,,1260.55,85,,1008.44,percent of total billed charges,85% of total billed charges,1141.91,77,,913.53,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,107.76,385,,,fee schedule,385% of BCBS fee schedule,112.24,401,,,fee schedule,401% of BCBS fee schedule,112.24,401,,,fee schedule,401% of BCBS fee schedule,112.24,401,,,fee schedule,401% of BCBS fee schedule,1334.7,90,,1067.76,percent of total billed charges,90% of total billed charges,1186.4,80,,949.12,percent of total billed charges,80% of total billed charges,1334.7,90,,1067.76,percent of total billed charges,90% of total billed charges,1112.25,75,,889.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,430.07,29,,344.056,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,993.61,67,,794.888,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1186.4,80,,949.12,percent of total billed charges,80% of total billed charges,963.95,65,,771.16,percent of total billed charges,65% of total billed charges,528.99,35.67,,423.192,percent of total billed charges,35.67% of total billed charges,107.76,1334.7,
ULTRASOUND GUIDED PARACENTESIS,4003176,CDM,402,RC,49083,HCPCS,outpatient,,,4175,1670.00,,1150,,,,case rate,pays based on per visit,3214.75,77,,2571.8,percent of total billed charges,77% of total billed charges,792.74,100,,,fee schedule,100% of CMS OPPS rate,3423.5,82,,2738.8,percent of total billed charges,82% of total billed charges,3548.75,85,,2839,percent of total billed charges,85% of total billed charges,3548.75,85,,2839,percent of total billed charges,85% of total billed charges,3548.75,85,,2839,percent of total billed charges,85% of total billed charges,3757.5,90,,3006,percent of total billed charges,90% of total billed charges,3340,80,,2672,percent of total billed charges,80% of total billed charges,3757.5,90,,3006,percent of total billed charges,90% of total billed charges,3131.25,75,,2505,percent of total billed charges,75% of total billed charges,967.14,122,,,fee schedule,122% of HUMANA fee schedule,334.95,100,,,fee schedule,100% of ASC tier grouping rate,792.74,100,,,fee schedule,100% of CMS OPPS rate,2797.25,67,,2237.8,percent of total billed charges,67% of total billed charges,359.17,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,3340,80,,2672,percent of total billed charges,80% of total billed charges,2713.75,65,,2171,percent of total billed charges,65% of total billed charges,411.99,123,,,fee schedule,123% of ASC tier grouping rate,334.95,3757.5,
BLADDER SCAN,4021100,CDM,402,RC,51798,HCPCS,outpatient,,,305,122.00,,1150,,,,case rate,pays based on per visit,234.85,77,,187.88,percent of total billed charges,77% of total billed charges,53.49,100,,,fee schedule,100% of CMS OPPS rate,250.1,82,,200.08,percent of total billed charges,82% of total billed charges,259.25,85,,207.4,percent of total billed charges,85% of total billed charges,259.25,85,,207.4,percent of total billed charges,85% of total billed charges,259.25,85,,207.4,percent of total billed charges,85% of total billed charges,274.5,90,,219.6,percent of total billed charges,90% of total billed charges,244,80,,195.2,percent of total billed charges,80% of total billed charges,274.5,90,,219.6,percent of total billed charges,90% of total billed charges,228.75,75,,183,percent of total billed charges,75% of total billed charges,65.26,122,,,fee schedule,122% of HUMANA fee schedule,88.45,29,,70.76,percent of total billed charges,29% of total billed charges,53.49,100,,,fee schedule,100% of CMS OPPS rate,204.35,67,,163.48,percent of total billed charges,67% of total billed charges,42.55,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,244,80,,195.2,percent of total billed charges,80% of total billed charges,198.25,65,,158.6,percent of total billed charges,65% of total billed charges,108.79,35.67,,87.032,percent of total billed charges,35.67% of total billed charges,42.55,1150,
ULTRASOUND GUIDANCE VAD,4021120,CDM,402,RC,76937,HCPCS,outpatient,,,397,158.80,,337.45,85,,269.96,percent of total billed charges,85% of total billed charges,305.69,77,,244.55,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,66.34,385,,,fee schedule,385% of BCBS fee schedule,69.09,401,,,fee schedule,401% of BCBS fee schedule,69.09,401,,,fee schedule,401% of BCBS fee schedule,69.09,401,,,fee schedule,401% of BCBS fee schedule,357.3,90,,285.84,percent of total billed charges,90% of total billed charges,317.6,80,,254.08,percent of total billed charges,80% of total billed charges,357.3,90,,285.84,percent of total billed charges,90% of total billed charges,297.75,75,,238.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,115.13,29,,92.104,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,265.99,67,,212.792,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,317.6,80,,254.08,percent of total billed charges,80% of total billed charges,258.05,65,,206.44,percent of total billed charges,65% of total billed charges,141.61,35.67,,113.288,percent of total billed charges,35.67% of total billed charges,66.34,357.3,
US BIOPSY LYMPH NODE,4021200,CDM,402,RC,76942,HCPCS,outpatient,,,1483,593.20,,1260.55,85,,1008.44,percent of total billed charges,85% of total billed charges,1141.91,77,,913.53,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,107.76,385,,,fee schedule,385% of BCBS fee schedule,112.24,401,,,fee schedule,401% of BCBS fee schedule,112.24,401,,,fee schedule,401% of BCBS fee schedule,112.24,401,,,fee schedule,401% of BCBS fee schedule,1334.7,90,,1067.76,percent of total billed charges,90% of total billed charges,1186.4,80,,949.12,percent of total billed charges,80% of total billed charges,1334.7,90,,1067.76,percent of total billed charges,90% of total billed charges,1112.25,75,,889.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,430.07,29,,344.056,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,993.61,67,,794.888,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1186.4,80,,949.12,percent of total billed charges,80% of total billed charges,963.95,65,,771.16,percent of total billed charges,65% of total billed charges,528.99,35.67,,423.192,percent of total billed charges,35.67% of total billed charges,107.76,1334.7,
US BIOPSY THYROID,4021201,CDM,402,RC,76942,HCPCS,outpatient,,,1483,593.20,,1260.55,85,,1008.44,percent of total billed charges,85% of total billed charges,1141.91,77,,913.53,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,107.76,385,,,fee schedule,385% of BCBS fee schedule,112.24,401,,,fee schedule,401% of BCBS fee schedule,112.24,401,,,fee schedule,401% of BCBS fee schedule,112.24,401,,,fee schedule,401% of BCBS fee schedule,1334.7,90,,1067.76,percent of total billed charges,90% of total billed charges,1186.4,80,,949.12,percent of total billed charges,80% of total billed charges,1334.7,90,,1067.76,percent of total billed charges,90% of total billed charges,1112.25,75,,889.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,430.07,29,,344.056,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,993.61,67,,794.888,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1186.4,80,,949.12,percent of total billed charges,80% of total billed charges,963.95,65,,771.16,percent of total billed charges,65% of total billed charges,528.99,35.67,,423.192,percent of total billed charges,35.67% of total billed charges,107.76,1334.7,
US OB F/U ADDT GEST,4021202,CDM,402,RC,76815,HCPCS,outpatient,,,564,225.60,,479.4,85,,383.52,percent of total billed charges,85% of total billed charges,434.28,77,,347.42,percent of total billed charges,77% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,440.67,385,,,fee schedule,385% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,507.6,90,,406.08,percent of total billed charges,90% of total billed charges,451.2,80,,360.96,percent of total billed charges,80% of total billed charges,507.6,90,,406.08,percent of total billed charges,90% of total billed charges,423,75,,338.4,percent of total billed charges,75% of total billed charges,117.29,122,,,fee schedule,122% of HUMANA fee schedule,163.56,29,,130.848,percent of total billed charges,29% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,377.88,67,,302.304,percent of total billed charges,67% of total billed charges,58.64,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,451.2,80,,360.96,percent of total billed charges,80% of total billed charges,366.6,65,,293.28,percent of total billed charges,65% of total billed charges,201.18,35.67,,160.944,percent of total billed charges,35.67% of total billed charges,58.64,507.6,
US RENAL DOPPLER,4021203,CDM,402,RC,76770,HCPCS,outpatient,,,753,301.20,,640.05,85,,512.04,percent of total billed charges,85% of total billed charges,579.81,77,,463.85,percent of total billed charges,77% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,440.67,385,,,fee schedule,385% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,677.7,90,,542.16,percent of total billed charges,90% of total billed charges,602.4,80,,481.92,percent of total billed charges,80% of total billed charges,677.7,90,,542.16,percent of total billed charges,90% of total billed charges,564.75,75,,451.8,percent of total billed charges,75% of total billed charges,117.29,122,,,fee schedule,122% of HUMANA fee schedule,218.37,29,,174.696,percent of total billed charges,29% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,504.51,67,,403.608,percent of total billed charges,67% of total billed charges,89.76,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,602.4,80,,481.92,percent of total billed charges,80% of total billed charges,489.45,65,,391.56,percent of total billed charges,65% of total billed charges,268.6,35.67,,214.88,percent of total billed charges,35.67% of total billed charges,89.76,677.7,
US GUIDED BREAST BIOPSY EA.ADD,4021204,CDM,402,RC,19084,HCPCS,outpatient,,,1483,593.20,,1150,,,,case rate,pays based on per visit,1141.91,77,,913.53,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,1216.06,82,,972.848,percent of total billed charges,82% of total billed charges,1260.55,85,,1008.44,percent of total billed charges,85% of total billed charges,1260.55,85,,1008.44,percent of total billed charges,85% of total billed charges,1260.55,85,,1008.44,percent of total billed charges,85% of total billed charges,1334.7,90,,1067.76,percent of total billed charges,90% of total billed charges,1186.4,80,,949.12,percent of total billed charges,80% of total billed charges,1334.7,90,,1067.76,percent of total billed charges,90% of total billed charges,1112.25,75,,889.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,430.07,29,,344.056,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,993.61,67,,794.888,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1186.4,80,,949.12,percent of total billed charges,80% of total billed charges,963.95,65,,771.16,percent of total billed charges,65% of total billed charges,528.99,35.67,,423.192,percent of total billed charges,35.67% of total billed charges,430.07,1334.7,
US DOBUTAMINE STRESS ECHO,4021205,CDM,402,RC,93350,HCPCS,outpatient,,,1259,503.60,,1070.15,85,,856.12,percent of total billed charges,85% of total billed charges,969.43,77,,775.54,percent of total billed charges,77% of total billed charges,482.45,100,,,fee schedule,100% of CMS OPPS rate,595.84,350,,,fee schedule,350% of BCBS fee schedule,620.84,447,,,fee schedule,447% of BCBS fee schedule,620.84,447,,,fee schedule,447% of BCBS fee schedule,620.84,447,,,fee schedule,447% of BCBS fee schedule,1133.1,90,,906.48,percent of total billed charges,90% of total billed charges,1007.2,80,,805.76,percent of total billed charges,80% of total billed charges,1133.1,90,,906.48,percent of total billed charges,90% of total billed charges,944.25,75,,755.4,percent of total billed charges,75% of total billed charges,588.58,122,,,fee schedule,122% of HUMANA fee schedule,365.11,29,,292.088,percent of total billed charges,29% of total billed charges,482.45,100,,,fee schedule,100% of CMS OPPS rate,843.53,67,,674.824,percent of total billed charges,67% of total billed charges,366.13,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,1007.2,80,,805.76,percent of total billed charges,80% of total billed charges,818.35,65,,654.68,percent of total billed charges,65% of total billed charges,449.09,35.67,,359.272,percent of total billed charges,35.67% of total billed charges,365.11,1133.1,
US DOBUTAMINE STRESS W/MYO,4021206,CDM,402,RC,93351,HCPCS,outpatient,,,1751,700.40,,1488.35,85,,1190.68,percent of total billed charges,85% of total billed charges,1348.27,77,,1078.62,percent of total billed charges,77% of total billed charges,482.45,100,,,fee schedule,100% of CMS OPPS rate,649.72,429,,,fee schedule,429% of BCBS fee schedule,676.98,447,,,fee schedule,447% of BCBS fee schedule,676.98,447,,,fee schedule,447% of BCBS fee schedule,676.98,447,,,fee schedule,447% of BCBS fee schedule,1575.9,90,,1260.72,percent of total billed charges,90% of total billed charges,1400.8,80,,1120.64,percent of total billed charges,80% of total billed charges,1575.9,90,,1260.72,percent of total billed charges,90% of total billed charges,1313.25,75,,1050.6,percent of total billed charges,75% of total billed charges,588.58,122,,,fee schedule,122% of HUMANA fee schedule,507.79,29,,406.232,percent of total billed charges,29% of total billed charges,482.45,100,,,fee schedule,100% of CMS OPPS rate,1173.17,67,,938.536,percent of total billed charges,67% of total billed charges,540.04,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,1400.8,80,,1120.64,percent of total billed charges,80% of total billed charges,1138.15,65,,910.52,percent of total billed charges,65% of total billed charges,624.58,35.67,,499.664,percent of total billed charges,35.67% of total billed charges,482.45,1575.9,
US ECHO STRESS EXERCISE,4021207,CDM,402,RC,93017,HCPCS,outpatient,,,1227,490.80,,1042.95,85,,834.36,percent of total billed charges,85% of total billed charges,944.79,77,,755.83,percent of total billed charges,77% of total billed charges,274.49,100,,,fee schedule,100% of CMS OPPS rate,1067.48,429,,,fee schedule,429% of BCBS fee schedule,1112.27,447,,,fee schedule,447% of BCBS fee schedule,1112.27,447,,,fee schedule,447% of BCBS fee schedule,1112.27,447,,,fee schedule,447% of BCBS fee schedule,1104.3,90,,883.44,percent of total billed charges,90% of total billed charges,981.6,80,,785.28,percent of total billed charges,80% of total billed charges,1104.3,90,,883.44,percent of total billed charges,90% of total billed charges,920.25,75,,736.2,percent of total billed charges,75% of total billed charges,334.88,122,,,fee schedule,122% of HUMANA fee schedule,355.83,29,,284.664,percent of total billed charges,29% of total billed charges,274.49,100,,,fee schedule,100% of CMS OPPS rate,822.09,67,,657.672,percent of total billed charges,67% of total billed charges,166.12,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,981.6,80,,785.28,percent of total billed charges,80% of total billed charges,797.55,65,,638.04,percent of total billed charges,65% of total billed charges,437.67,35.67,,350.136,percent of total billed charges,35.67% of total billed charges,166.12,1112.27,
US SOFT TISSUE GROIN,4021208,CDM,402,RC,76881,HCPCS,outpatient,,,327,130.80,,277.95,85,,222.36,percent of total billed charges,85% of total billed charges,251.79,77,,201.43,percent of total billed charges,77% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,274.97,385,,,fee schedule,385% of BCBS fee schedule,286.39,401,,,fee schedule,401% of BCBS fee schedule,286.39,401,,,fee schedule,401% of BCBS fee schedule,286.39,401,,,fee schedule,401% of BCBS fee schedule,294.3,90,,235.44,percent of total billed charges,90% of total billed charges,261.6,80,,209.28,percent of total billed charges,80% of total billed charges,294.3,90,,235.44,percent of total billed charges,90% of total billed charges,245.25,75,,196.2,percent of total billed charges,75% of total billed charges,117.29,122,,,fee schedule,122% of HUMANA fee schedule,94.83,29,,75.864,percent of total billed charges,29% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,219.09,67,,175.272,percent of total billed charges,67% of total billed charges,89.76,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,261.6,80,,209.28,percent of total billed charges,80% of total billed charges,212.55,65,,170.04,percent of total billed charges,65% of total billed charges,116.64,35.67,,93.312,percent of total billed charges,35.67% of total billed charges,89.76,294.3,
US SOFT TISSUE ABDOMEN,4021209,CDM,402,RC,76700,HCPCS,outpatient,,,717,286.80,,609.45,85,,487.56,percent of total billed charges,85% of total billed charges,552.09,77,,441.67,percent of total billed charges,77% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,440.67,385,,,fee schedule,385% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,458.98,401,,,fee schedule,401% of BCBS fee schedule,645.3,90,,516.24,percent of total billed charges,90% of total billed charges,573.6,80,,458.88,percent of total billed charges,80% of total billed charges,645.3,90,,516.24,percent of total billed charges,90% of total billed charges,537.75,75,,430.2,percent of total billed charges,75% of total billed charges,117.29,122,,,fee schedule,122% of HUMANA fee schedule,207.93,29,,166.344,percent of total billed charges,29% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,480.39,67,,384.312,percent of total billed charges,67% of total billed charges,89.76,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,573.6,80,,458.88,percent of total billed charges,80% of total billed charges,466.05,65,,372.84,percent of total billed charges,65% of total billed charges,255.75,35.67,,204.6,percent of total billed charges,35.67% of total billed charges,89.76,645.3,
VESSEL MAPPING/HEMODIALYSIS AC,9200058,CDM,402,RC,93985,HCPCS,outpatient,,,808,323.20,,686.8,85,,549.44,percent of total billed charges,85% of total billed charges,622.16,77,,497.73,percent of total billed charges,77% of total billed charges,214.29,100,,,fee schedule,100% of CMS OPPS rate,892.58,385,,,fee schedule,385% of BCBS fee schedule,929.68,401,,,fee schedule,401% of BCBS fee schedule,929.68,401,,,fee schedule,401% of BCBS fee schedule,929.68,401,,,fee schedule,401% of BCBS fee schedule,727.2,90,,581.76,percent of total billed charges,90% of total billed charges,646.4,80,,517.12,percent of total billed charges,80% of total billed charges,727.2,90,,581.76,percent of total billed charges,90% of total billed charges,606,75,,484.8,percent of total billed charges,75% of total billed charges,261.43,122,,,fee schedule,122% of HUMANA fee schedule,234.32,29,,187.456,percent of total billed charges,29% of total billed charges,214.29,100,,,fee schedule,100% of CMS OPPS rate,541.36,67,,433.088,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,646.4,80,,517.12,percent of total billed charges,80% of total billed charges,525.2,65,,420.16,percent of total billed charges,65% of total billed charges,288.21,35.67,,230.568,percent of total billed charges,35.67% of total billed charges,214.29,929.68,
MAMMO SCREEN UNILATERAL 2D,4010001,CDM,403,RC,77067,HCPCS,outpatient,,,450,180.00,52,382.5,85,,306,percent of total billed charges,85% of total billed charges,346.5,77,,277.2,percent of total billed charges,77% of total billed charges,87.53,100,,,fee schedule,100% of CMS fee schedule,389.66,385,,,fee schedule,385% of BCBS fee schedule,405.85,401,,,fee schedule,401% of BCBS fee schedule,405.85,401,,,fee schedule,401% of BCBS fee schedule,405.85,401,,,fee schedule,401% of BCBS fee schedule,405,90,,324,percent of total billed charges,90% of total billed charges,360,80,,288,percent of total billed charges,80% of total billed charges,405,90,,324,percent of total billed charges,90% of total billed charges,337.5,75,,270,percent of total billed charges,75% of total billed charges,106.79,122,,,fee schedule,122% of HUMANA fee schedule,130.5,29,,104.4,percent of total billed charges,29% of total billed charges,87.53,100,,,fee schedule,100% of CMS fee schedule,301.5,67,,241.2,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,360,80,,288,percent of total billed charges,80% of total billed charges,292.5,65,,234,percent of total billed charges,65% of total billed charges,160.52,35.67,,128.416,percent of total billed charges,35.67% of total billed charges,87.53,405.85,
MAMMOGRAM SCREEN BIL/CAD 2D,4010005,CDM,403,RC,77067,HCPCS,outpatient,,,450,180.00,,382.5,85,,306,percent of total billed charges,85% of total billed charges,346.5,77,,277.2,percent of total billed charges,77% of total billed charges,87.53,100,,,fee schedule,100% of CMS fee schedule,389.66,385,,,fee schedule,385% of BCBS fee schedule,405.85,401,,,fee schedule,401% of BCBS fee schedule,405.85,401,,,fee schedule,401% of BCBS fee schedule,405.85,401,,,fee schedule,401% of BCBS fee schedule,405,90,,324,percent of total billed charges,90% of total billed charges,360,80,,288,percent of total billed charges,80% of total billed charges,405,90,,324,percent of total billed charges,90% of total billed charges,337.5,75,,270,percent of total billed charges,75% of total billed charges,106.79,122,,,fee schedule,122% of HUMANA fee schedule,130.5,29,,104.4,percent of total billed charges,29% of total billed charges,87.53,100,,,fee schedule,100% of CMS fee schedule,301.5,67,,241.2,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,360,80,,288,percent of total billed charges,80% of total billed charges,292.5,65,,234,percent of total billed charges,65% of total billed charges,160.52,35.67,,128.416,percent of total billed charges,35.67% of total billed charges,87.53,405.85,
SCREENING BIL BREAST TOMO,4010054,CDM,403,RC,77063,HCPCS,outpatient,,,117,46.80,,99.45,85,,79.56,percent of total billed charges,85% of total billed charges,90.09,77,,72.07,percent of total billed charges,77% of total billed charges,22.76,100,,,fee schedule,100% of CMS fee schedule,98.1,385,,,fee schedule,385% of BCBS fee schedule,102.17,401,,,fee schedule,401% of BCBS fee schedule,102.17,401,,,fee schedule,401% of BCBS fee schedule,102.17,401,,,fee schedule,401% of BCBS fee schedule,105.3,90,,84.24,percent of total billed charges,90% of total billed charges,93.6,80,,74.88,percent of total billed charges,80% of total billed charges,105.3,90,,84.24,percent of total billed charges,90% of total billed charges,87.75,75,,70.2,percent of total billed charges,75% of total billed charges,27.77,122,,,fee schedule,122% of HUMANA fee schedule,33.93,29,,27.144,percent of total billed charges,29% of total billed charges,22.76,100,,,fee schedule,100% of CMS fee schedule,78.39,67,,62.712,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,93.6,80,,74.88,percent of total billed charges,80% of total billed charges,76.05,65,,60.84,percent of total billed charges,65% of total billed charges,41.73,35.67,,33.384,percent of total billed charges,35.67% of total billed charges,22.76,105.3,
CARBOXYHEMOGLOBIN,4100013,CDM,410,RC,82375,HCPCS,outpatient,,,76,30.40,,64.6,85,,51.68,percent of total billed charges,85% of total billed charges,58.52,77,,46.82,percent of total billed charges,77% of total billed charges,12.32,100,,,fee schedule,100% of CMS fee schedule,53.24,350,,,fee schedule,350% of BCBS fee schedule,55.36,364,,,fee schedule,364% of BCBS fee schedule,55.36,364,,,fee schedule,364% of BCBS fee schedule,55.36,364,,,fee schedule,364% of BCBS fee schedule,68.4,90,,54.72,percent of total billed charges,90% of total billed charges,60.8,80,,48.64,percent of total billed charges,80% of total billed charges,68.4,90,,54.72,percent of total billed charges,90% of total billed charges,57,75,,45.6,percent of total billed charges,75% of total billed charges,15.03,122,,,fee schedule,122% of HUMANA fee schedule,22.04,29,,17.632,percent of total billed charges,29% of total billed charges,12.32,100,,,fee schedule,100% of CMS fee schedule,50.92,67,,40.736,percent of total billed charges,67% of total billed charges,18.33,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,60.8,80,,48.64,percent of total billed charges,80% of total billed charges,49.4,65,,39.52,percent of total billed charges,65% of total billed charges,27.11,35.67,,21.688,percent of total billed charges,35.67% of total billed charges,12.32,68.4,
HAND HELD NEBULIZER TX,4100110,CDM,410,RC,94640,HCPCS,outpatient,,,877,350.80,,745.45,85,,596.36,percent of total billed charges,85% of total billed charges,675.29,77,,540.23,percent of total billed charges,77% of total billed charges,186.52,100,,,fee schedule,100% of CMS OPPS rate,799.57,429,,,fee schedule,429% of BCBS fee schedule,833.12,447,,,fee schedule,447% of BCBS fee schedule,833.12,447,,,fee schedule,447% of BCBS fee schedule,833.12,447,,,fee schedule,447% of BCBS fee schedule,789.3,90,,631.44,percent of total billed charges,90% of total billed charges,701.6,80,,561.28,percent of total billed charges,80% of total billed charges,789.3,90,,631.44,percent of total billed charges,90% of total billed charges,657.75,75,,526.2,percent of total billed charges,75% of total billed charges,227.56,122,,,fee schedule,122% of HUMANA fee schedule,254.33,29,,203.464,percent of total billed charges,29% of total billed charges,186.52,100,,,fee schedule,100% of CMS OPPS rate,587.59,67,,470.072,percent of total billed charges,67% of total billed charges,27.69,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,701.6,80,,561.28,percent of total billed charges,80% of total billed charges,570.05,65,,456.04,percent of total billed charges,65% of total billed charges,312.83,35.67,,250.264,percent of total billed charges,35.67% of total billed charges,27.69,833.12,
HAND HELD NEB REPEAT TODAY,4100120,CDM,410,RC,94640,HCPCS,outpatient,,,877,350.80,76,745.45,85,,596.36,percent of total billed charges,85% of total billed charges,675.29,77,,540.23,percent of total billed charges,77% of total billed charges,186.52,100,,,fee schedule,100% of CMS OPPS rate,799.57,429,,,fee schedule,429% of BCBS fee schedule,833.12,447,,,fee schedule,447% of BCBS fee schedule,833.12,447,,,fee schedule,447% of BCBS fee schedule,833.12,447,,,fee schedule,447% of BCBS fee schedule,789.3,90,,631.44,percent of total billed charges,90% of total billed charges,701.6,80,,561.28,percent of total billed charges,80% of total billed charges,789.3,90,,631.44,percent of total billed charges,90% of total billed charges,657.75,75,,526.2,percent of total billed charges,75% of total billed charges,227.56,122,,,fee schedule,122% of HUMANA fee schedule,254.33,29,,203.464,percent of total billed charges,29% of total billed charges,186.52,100,,,fee schedule,100% of CMS OPPS rate,587.59,67,,470.072,percent of total billed charges,67% of total billed charges,27.69,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,701.6,80,,561.28,percent of total billed charges,80% of total billed charges,570.05,65,,456.04,percent of total billed charges,65% of total billed charges,312.83,35.67,,250.264,percent of total billed charges,35.67% of total billed charges,27.69,833.12,
PEP THERAPY - INITIAL,4100135,CDM,410,RC,94664,HCPCS,outpatient,,,520,208.00,,442,85,,353.6,percent of total billed charges,85% of total billed charges,400.4,77,,320.32,percent of total billed charges,77% of total billed charges,186.52,100,,,fee schedule,100% of CMS OPPS rate,799.57,429,,,fee schedule,429% of BCBS fee schedule,833.12,447,,,fee schedule,447% of BCBS fee schedule,833.12,447,,,fee schedule,447% of BCBS fee schedule,833.12,447,,,fee schedule,447% of BCBS fee schedule,468,90,,374.4,percent of total billed charges,90% of total billed charges,416,80,,332.8,percent of total billed charges,80% of total billed charges,468,90,,374.4,percent of total billed charges,90% of total billed charges,390,75,,312,percent of total billed charges,75% of total billed charges,227.56,122,,,fee schedule,122% of HUMANA fee schedule,150.8,29,,120.64,percent of total billed charges,29% of total billed charges,186.52,100,,,fee schedule,100% of CMS OPPS rate,348.4,67,,278.72,percent of total billed charges,67% of total billed charges,27.69,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,416,80,,332.8,percent of total billed charges,80% of total billed charges,338,65,,270.4,percent of total billed charges,65% of total billed charges,185.48,35.67,,148.384,percent of total billed charges,35.67% of total billed charges,27.69,833.12,
"MDI TREATMENT, INITIAL",4100150,CDM,410,RC,94640,HCPCS,outpatient,,,903,361.20,,767.55,85,,614.04,percent of total billed charges,85% of total billed charges,695.31,77,,556.25,percent of total billed charges,77% of total billed charges,186.52,100,,,fee schedule,100% of CMS OPPS rate,799.57,429,,,fee schedule,429% of BCBS fee schedule,833.12,447,,,fee schedule,447% of BCBS fee schedule,833.12,447,,,fee schedule,447% of BCBS fee schedule,833.12,447,,,fee schedule,447% of BCBS fee schedule,812.7,90,,650.16,percent of total billed charges,90% of total billed charges,722.4,80,,577.92,percent of total billed charges,80% of total billed charges,812.7,90,,650.16,percent of total billed charges,90% of total billed charges,677.25,75,,541.8,percent of total billed charges,75% of total billed charges,227.56,122,,,fee schedule,122% of HUMANA fee schedule,261.87,29,,209.496,percent of total billed charges,29% of total billed charges,186.52,100,,,fee schedule,100% of CMS OPPS rate,605.01,67,,484.008,percent of total billed charges,67% of total billed charges,27.69,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,722.4,80,,577.92,percent of total billed charges,80% of total billed charges,586.95,65,,469.56,percent of total billed charges,65% of total billed charges,322.1,35.67,,257.68,percent of total billed charges,35.67% of total billed charges,27.69,833.12,
MECHANICAL CHEST WALL OSCILLAT,4100155,CDM,410,RC,94669,HCPCS,outpatient,,,922,368.80,,783.7,85,,626.96,percent of total billed charges,85% of total billed charges,709.94,77,,567.95,percent of total billed charges,77% of total billed charges,186.52,100,,,fee schedule,100% of CMS OPPS rate,799.57,429,,,fee schedule,429% of BCBS fee schedule,833.12,447,,,fee schedule,447% of BCBS fee schedule,833.12,447,,,fee schedule,447% of BCBS fee schedule,833.12,447,,,fee schedule,447% of BCBS fee schedule,829.8,90,,663.84,percent of total billed charges,90% of total billed charges,737.6,80,,590.08,percent of total billed charges,80% of total billed charges,829.8,90,,663.84,percent of total billed charges,90% of total billed charges,691.5,75,,553.2,percent of total billed charges,75% of total billed charges,227.56,122,,,fee schedule,122% of HUMANA fee schedule,267.38,29,,213.904,percent of total billed charges,29% of total billed charges,186.52,100,,,fee schedule,100% of CMS OPPS rate,617.74,67,,494.192,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,737.6,80,,590.08,percent of total billed charges,80% of total billed charges,599.3,65,,479.44,percent of total billed charges,65% of total billed charges,328.88,35.67,,263.104,percent of total billed charges,35.67% of total billed charges,186.52,833.12,
"MDI TREATMENT, SUBSEQUENT",4100160,CDM,410,RC,94640,HCPCS,outpatient,,,922,368.80,76,783.7,85,,626.96,percent of total billed charges,85% of total billed charges,709.94,77,,567.95,percent of total billed charges,77% of total billed charges,186.52,100,,,fee schedule,100% of CMS OPPS rate,799.57,429,,,fee schedule,429% of BCBS fee schedule,833.12,447,,,fee schedule,447% of BCBS fee schedule,833.12,447,,,fee schedule,447% of BCBS fee schedule,833.12,447,,,fee schedule,447% of BCBS fee schedule,829.8,90,,663.84,percent of total billed charges,90% of total billed charges,737.6,80,,590.08,percent of total billed charges,80% of total billed charges,829.8,90,,663.84,percent of total billed charges,90% of total billed charges,691.5,75,,553.2,percent of total billed charges,75% of total billed charges,227.56,122,,,fee schedule,122% of HUMANA fee schedule,267.38,29,,213.904,percent of total billed charges,29% of total billed charges,186.52,100,,,fee schedule,100% of CMS OPPS rate,617.74,67,,494.192,percent of total billed charges,67% of total billed charges,27.69,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,737.6,80,,590.08,percent of total billed charges,80% of total billed charges,599.3,65,,479.44,percent of total billed charges,65% of total billed charges,328.88,35.67,,263.104,percent of total billed charges,35.67% of total billed charges,27.69,833.12,
MECH. VENTILATOR IN/OBS 1STDAY,4100170,CDM,410,RC,94002,HCPCS,outpatient,,,2276,910.40,,1934.6,85,,1547.68,percent of total billed charges,85% of total billed charges,1752.52,77,,1402.02,percent of total billed charges,77% of total billed charges,548.03,100,,,fee schedule,100% of CMS OPPS rate,1976.4,429,,,fee schedule,429% of BCBS fee schedule,2059.33,447,,,fee schedule,447% of BCBS fee schedule,2059.33,447,,,fee schedule,447% of BCBS fee schedule,2059.33,447,,,fee schedule,447% of BCBS fee schedule,2048.4,90,,1638.72,percent of total billed charges,90% of total billed charges,1820.8,80,,1456.64,percent of total billed charges,80% of total billed charges,2048.4,90,,1638.72,percent of total billed charges,90% of total billed charges,1707,75,,1365.6,percent of total billed charges,75% of total billed charges,668.59,122,,,fee schedule,122% of HUMANA fee schedule,660.04,29,,528.032,percent of total billed charges,29% of total billed charges,548.03,100,,,fee schedule,100% of CMS OPPS rate,1524.92,67,,1219.936,percent of total billed charges,67% of total billed charges,200.26,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,1820.8,80,,1456.64,percent of total billed charges,80% of total billed charges,1479.4,65,,1183.52,percent of total billed charges,65% of total billed charges,811.85,35.67,,649.48,percent of total billed charges,35.67% of total billed charges,200.26,2059.33,
DELIVERY/BIRTHING RESUSCITATE,4100175,CDM,410,RC,99465,HCPCS,outpatient,,,1126,450.40,,957.1,85,,765.68,percent of total billed charges,85% of total billed charges,867.02,77,,693.62,percent of total billed charges,77% of total billed charges,569.16,100,,,fee schedule,100% of CMS OPPS rate,635.86,429,,,fee schedule,429% of BCBS fee schedule,662.54,447,,,fee schedule,447% of BCBS fee schedule,662.54,447,,,fee schedule,447% of BCBS fee schedule,662.54,447,,,fee schedule,447% of BCBS fee schedule,1013.4,90,,810.72,percent of total billed charges,90% of total billed charges,900.8,80,,720.64,percent of total billed charges,80% of total billed charges,1013.4,90,,810.72,percent of total billed charges,90% of total billed charges,844.5,75,,675.6,percent of total billed charges,75% of total billed charges,694.37,122,,,fee schedule,122% of HUMANA fee schedule,326.54,29,,261.232,percent of total billed charges,29% of total billed charges,569.16,100,,,fee schedule,100% of CMS OPPS rate,754.42,67,,603.536,percent of total billed charges,67% of total billed charges,145.5,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,900.8,80,,720.64,percent of total billed charges,80% of total billed charges,731.9,65,,585.52,percent of total billed charges,65% of total billed charges,401.64,35.67,,321.312,percent of total billed charges,35.67% of total billed charges,145.5,1013.4,
MECH VENTILATOR - ADD. DAYS,4100180,CDM,410,RC,94003,HCPCS,outpatient,,,2276,910.40,,1934.6,85,,1547.68,percent of total billed charges,85% of total billed charges,1752.52,77,,1402.02,percent of total billed charges,77% of total billed charges,548.03,100,,,fee schedule,100% of CMS OPPS rate,1976.4,429,,,fee schedule,429% of BCBS fee schedule,2059.33,447,,,fee schedule,447% of BCBS fee schedule,2059.33,447,,,fee schedule,447% of BCBS fee schedule,2059.33,447,,,fee schedule,447% of BCBS fee schedule,2048.4,90,,1638.72,percent of total billed charges,90% of total billed charges,1820.8,80,,1456.64,percent of total billed charges,80% of total billed charges,2048.4,90,,1638.72,percent of total billed charges,90% of total billed charges,1707,75,,1365.6,percent of total billed charges,75% of total billed charges,668.59,122,,,fee schedule,122% of HUMANA fee schedule,660.04,29,,528.032,percent of total billed charges,29% of total billed charges,548.03,100,,,fee schedule,100% of CMS OPPS rate,1524.92,67,,1219.936,percent of total billed charges,67% of total billed charges,200.26,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,1820.8,80,,1456.64,percent of total billed charges,80% of total billed charges,1479.4,65,,1183.52,percent of total billed charges,65% of total billed charges,811.85,35.67,,649.48,percent of total billed charges,35.67% of total billed charges,200.26,2059.33,
BIPAP/CPAP,4100185,CDM,410,RC,94660,HCPCS,outpatient,,,922,368.80,,783.7,85,,626.96,percent of total billed charges,85% of total billed charges,709.94,77,,567.95,percent of total billed charges,77% of total billed charges,186.52,100,,,fee schedule,100% of CMS OPPS rate,799.57,429,,,fee schedule,429% of BCBS fee schedule,833.12,447,,,fee schedule,447% of BCBS fee schedule,833.12,447,,,fee schedule,447% of BCBS fee schedule,833.12,447,,,fee schedule,447% of BCBS fee schedule,829.8,90,,663.84,percent of total billed charges,90% of total billed charges,737.6,80,,590.08,percent of total billed charges,80% of total billed charges,829.8,90,,663.84,percent of total billed charges,90% of total billed charges,691.5,75,,553.2,percent of total billed charges,75% of total billed charges,227.55,122,,,fee schedule,122% of HUMANA fee schedule,267.38,29,,213.904,percent of total billed charges,29% of total billed charges,186.52,100,,,fee schedule,100% of CMS OPPS rate,617.74,67,,494.192,percent of total billed charges,67% of total billed charges,92.09,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,737.6,80,,590.08,percent of total billed charges,80% of total billed charges,599.3,65,,479.44,percent of total billed charges,65% of total billed charges,328.88,35.67,,263.104,percent of total billed charges,35.67% of total billed charges,92.09,833.12,
VENTILATION NON INVASIVE INIT.,4100188,CDM,410,RC,94002,HCPCS,outpatient,,,1723,689.20,,1464.55,85,,1171.64,percent of total billed charges,85% of total billed charges,1326.71,77,,1061.37,percent of total billed charges,77% of total billed charges,548.03,100,,,fee schedule,100% of CMS OPPS rate,1976.4,429,,,fee schedule,429% of BCBS fee schedule,2059.33,447,,,fee schedule,447% of BCBS fee schedule,2059.33,447,,,fee schedule,447% of BCBS fee schedule,2059.33,447,,,fee schedule,447% of BCBS fee schedule,1550.7,90,,1240.56,percent of total billed charges,90% of total billed charges,1378.4,80,,1102.72,percent of total billed charges,80% of total billed charges,1550.7,90,,1240.56,percent of total billed charges,90% of total billed charges,1292.25,75,,1033.8,percent of total billed charges,75% of total billed charges,668.59,122,,,fee schedule,122% of HUMANA fee schedule,499.67,29,,399.736,percent of total billed charges,29% of total billed charges,548.03,100,,,fee schedule,100% of CMS OPPS rate,1154.41,67,,923.528,percent of total billed charges,67% of total billed charges,200.26,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,1378.4,80,,1102.72,percent of total billed charges,80% of total billed charges,1119.95,65,,895.96,percent of total billed charges,65% of total billed charges,614.59,35.67,,491.672,percent of total billed charges,35.67% of total billed charges,200.26,2059.33,
NON INVASIVE VENT SUB DAY,4100189,CDM,410,RC,94003,HCPCS,outpatient,,,1378,551.20,,1171.3,85,,937.04,percent of total billed charges,85% of total billed charges,1061.06,77,,848.85,percent of total billed charges,77% of total billed charges,548.03,100,,,fee schedule,100% of CMS OPPS rate,1976.4,429,,,fee schedule,429% of BCBS fee schedule,2059.33,447,,,fee schedule,447% of BCBS fee schedule,2059.33,447,,,fee schedule,447% of BCBS fee schedule,2059.33,447,,,fee schedule,447% of BCBS fee schedule,1240.2,90,,992.16,percent of total billed charges,90% of total billed charges,1102.4,80,,881.92,percent of total billed charges,80% of total billed charges,1240.2,90,,992.16,percent of total billed charges,90% of total billed charges,1033.5,75,,826.8,percent of total billed charges,75% of total billed charges,668.59,122,,,fee schedule,122% of HUMANA fee schedule,399.62,29,,319.696,percent of total billed charges,29% of total billed charges,548.03,100,,,fee schedule,100% of CMS OPPS rate,923.26,67,,738.608,percent of total billed charges,67% of total billed charges,200.26,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,1102.4,80,,881.92,percent of total billed charges,80% of total billed charges,895.7,65,,716.56,percent of total billed charges,65% of total billed charges,491.53,35.67,,393.224,percent of total billed charges,35.67% of total billed charges,200.26,2059.33,
PERCUSSION & POSTURAL DRAINAGE,4100230,CDM,410,RC,94667,HCPCS,outpatient,,,509,203.60,,432.65,85,,346.12,percent of total billed charges,85% of total billed charges,391.93,77,,313.54,percent of total billed charges,77% of total billed charges,111.71,100,,,fee schedule,100% of CMS OPPS rate,450.62,429,,,fee schedule,429% of BCBS fee schedule,469.53,447,,,fee schedule,447% of BCBS fee schedule,469.53,447,,,fee schedule,447% of BCBS fee schedule,469.53,447,,,fee schedule,447% of BCBS fee schedule,458.1,90,,366.48,percent of total billed charges,90% of total billed charges,407.2,80,,325.76,percent of total billed charges,80% of total billed charges,458.1,90,,366.48,percent of total billed charges,90% of total billed charges,381.75,75,,305.4,percent of total billed charges,75% of total billed charges,136.28,122,,,fee schedule,122% of HUMANA fee schedule,147.61,29,,118.088,percent of total billed charges,29% of total billed charges,111.71,100,,,fee schedule,100% of CMS OPPS rate,341.03,67,,272.824,percent of total billed charges,67% of total billed charges,27.69,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,407.2,80,,325.76,percent of total billed charges,80% of total billed charges,330.85,65,,264.68,percent of total billed charges,65% of total billed charges,181.56,35.67,,145.248,percent of total billed charges,35.67% of total billed charges,27.69,469.53,
PERCUSSION/PD  SUBSEQUENT,4100231,CDM,410,RC,94668,HCPCS,outpatient,,,509,203.60,,432.65,85,,346.12,percent of total billed charges,85% of total billed charges,391.93,77,,313.54,percent of total billed charges,77% of total billed charges,111.71,100,,,fee schedule,100% of CMS OPPS rate,450.62,429,,,fee schedule,429% of BCBS fee schedule,469.53,447,,,fee schedule,447% of BCBS fee schedule,469.53,447,,,fee schedule,447% of BCBS fee schedule,469.53,447,,,fee schedule,447% of BCBS fee schedule,458.1,90,,366.48,percent of total billed charges,90% of total billed charges,407.2,80,,325.76,percent of total billed charges,80% of total billed charges,458.1,90,,366.48,percent of total billed charges,90% of total billed charges,381.75,75,,305.4,percent of total billed charges,75% of total billed charges,136.28,122,,,fee schedule,122% of HUMANA fee schedule,147.61,29,,118.088,percent of total billed charges,29% of total billed charges,111.71,100,,,fee schedule,100% of CMS OPPS rate,341.03,67,,272.824,percent of total billed charges,67% of total billed charges,27.69,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,407.2,80,,325.76,percent of total billed charges,80% of total billed charges,330.85,65,,264.68,percent of total billed charges,65% of total billed charges,181.56,35.67,,145.248,percent of total billed charges,35.67% of total billed charges,27.69,469.53,
"PULSE OX,PFT,SLEEP STUDY S/A",4100285,CDM,410,RC,,,outpatient,,,17,6.80,,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,13.09,77,,10.47,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,13.94,82,,11.152,percent of total billed charges,82% of total billed charges,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,15.3,90,,12.24,percent of total billed charges,90% of total billed charges,13.6,80,,10.88,percent of total billed charges,80% of total billed charges,15.3,90,,12.24,percent of total billed charges,90% of total billed charges,12.75,75,,10.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,4.93,29,,3.944,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,11.39,67,,9.112,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,13.6,80,,10.88,percent of total billed charges,80% of total billed charges,11.05,65,,8.84,percent of total billed charges,65% of total billed charges,6.06,35.67,,4.848,percent of total billed charges,35.67% of total billed charges,4.93,15.3,
INHALATION BRONCHIAL CHALLENGE,4100370,CDM,410,RC,95070,HCPCS,outpatient,,,865,346.00,,735.25,85,,588.2,percent of total billed charges,85% of total billed charges,666.05,77,,532.84,percent of total billed charges,77% of total billed charges,468.73,100,,,fee schedule,100% of CMS OPPS rate,135.48,429,,,fee schedule,429% of BCBS fee schedule,141.16,447,,,fee schedule,447% of BCBS fee schedule,141.16,447,,,fee schedule,447% of BCBS fee schedule,141.16,447,,,fee schedule,447% of BCBS fee schedule,778.5,90,,622.8,percent of total billed charges,90% of total billed charges,692,80,,553.6,percent of total billed charges,80% of total billed charges,778.5,90,,622.8,percent of total billed charges,90% of total billed charges,648.75,75,,519,percent of total billed charges,75% of total billed charges,571.84,122,,,fee schedule,122% of HUMANA fee schedule,250.85,29,,200.68,percent of total billed charges,29% of total billed charges,468.73,100,,,fee schedule,100% of CMS OPPS rate,579.55,67,,463.64,percent of total billed charges,67% of total billed charges,175.42,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,692,80,,553.6,percent of total billed charges,80% of total billed charges,562.25,65,,449.8,percent of total billed charges,65% of total billed charges,308.55,35.67,,246.84,percent of total billed charges,35.67% of total billed charges,135.48,778.5,
"DEMO &/OR EVAL OF AEROSOL, NEB",4100380,CDM,410,RC,94664,HCPCS,outpatient,,,903,361.20,,767.55,85,,614.04,percent of total billed charges,85% of total billed charges,695.31,77,,556.25,percent of total billed charges,77% of total billed charges,186.52,100,,,fee schedule,100% of CMS OPPS rate,799.57,429,,,fee schedule,429% of BCBS fee schedule,833.12,447,,,fee schedule,447% of BCBS fee schedule,833.12,447,,,fee schedule,447% of BCBS fee schedule,833.12,447,,,fee schedule,447% of BCBS fee schedule,812.7,90,,650.16,percent of total billed charges,90% of total billed charges,722.4,80,,577.92,percent of total billed charges,80% of total billed charges,812.7,90,,650.16,percent of total billed charges,90% of total billed charges,677.25,75,,541.8,percent of total billed charges,75% of total billed charges,227.56,122,,,fee schedule,122% of HUMANA fee schedule,261.87,29,,209.496,percent of total billed charges,29% of total billed charges,186.52,100,,,fee schedule,100% of CMS OPPS rate,605.01,67,,484.008,percent of total billed charges,67% of total billed charges,27.69,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,722.4,80,,577.92,percent of total billed charges,80% of total billed charges,586.95,65,,469.56,percent of total billed charges,65% of total billed charges,322.1,35.67,,257.68,percent of total billed charges,35.67% of total billed charges,27.69,833.12,
RESUSCITATION CPR,4800000,CDM,410,RC,92950,HCPCS,outpatient,,,1263,505.20,,1073.55,85,,858.84,percent of total billed charges,85% of total billed charges,972.51,77,,778.01,percent of total billed charges,77% of total billed charges,274.49,100,,,fee schedule,100% of CMS OPPS rate,822.18,429,,,fee schedule,429% of BCBS fee schedule,856.68,447,,,fee schedule,447% of BCBS fee schedule,856.68,447,,,fee schedule,447% of BCBS fee schedule,856.68,447,,,fee schedule,447% of BCBS fee schedule,1136.7,90,,909.36,percent of total billed charges,90% of total billed charges,1010.4,80,,808.32,percent of total billed charges,80% of total billed charges,1136.7,90,,909.36,percent of total billed charges,90% of total billed charges,947.25,75,,757.8,percent of total billed charges,75% of total billed charges,334.88,122,,,fee schedule,122% of HUMANA fee schedule,366.27,29,,293.016,percent of total billed charges,29% of total billed charges,274.49,100,,,fee schedule,100% of CMS OPPS rate,846.21,67,,676.968,percent of total billed charges,67% of total billed charges,145.5,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,1010.4,80,,808.32,percent of total billed charges,80% of total billed charges,820.95,65,,656.76,percent of total billed charges,65% of total billed charges,450.51,35.67,,360.408,percent of total billed charges,35.67% of total billed charges,145.5,1136.7,
PUL REHAB THERAPY PROCEDURE,9430020,CDM,410,RC,G0237,HCPCS,outpatient,,,91,36.40,,77.35,85,,61.88,percent of total billed charges,85% of total billed charges,70.07,77,,56.06,percent of total billed charges,77% of total billed charges,26.03,100,,,fee schedule,100% of CMS OPPS rate,43.11,429,,,fee schedule,429% of BCBS fee schedule,44.92,447,,,fee schedule,447% of BCBS fee schedule,44.92,447,,,fee schedule,447% of BCBS fee schedule,44.92,447,,,fee schedule,447% of BCBS fee schedule,81.9,90,,65.52,percent of total billed charges,90% of total billed charges,72.8,80,,58.24,percent of total billed charges,80% of total billed charges,81.9,90,,65.52,percent of total billed charges,90% of total billed charges,68.25,75,,54.6,percent of total billed charges,75% of total billed charges,31.76,122,,,fee schedule,122% of HUMANA fee schedule,26.39,29,,21.112,percent of total billed charges,29% of total billed charges,26.03,100,,,fee schedule,100% of CMS OPPS rate,60.97,67,,48.776,percent of total billed charges,67% of total billed charges,27.69,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,72.8,80,,58.24,percent of total billed charges,80% of total billed charges,59.15,65,,47.32,percent of total billed charges,65% of total billed charges,32.46,35.67,,25.968,percent of total billed charges,35.67% of total billed charges,26.03,81.9,
PUL REHAB OTHER RT PROC INDIVI,9430025,CDM,410,RC,G0238,HCPCS,outpatient,,,91,36.40,,77.35,85,,61.88,percent of total billed charges,85% of total billed charges,70.07,77,,56.06,percent of total billed charges,77% of total billed charges,26.03,100,,,fee schedule,100% of CMS OPPS rate,44.66,429,,,fee schedule,429% of BCBS fee schedule,46.53,447,,,fee schedule,447% of BCBS fee schedule,46.53,447,,,fee schedule,447% of BCBS fee schedule,46.53,447,,,fee schedule,447% of BCBS fee schedule,81.9,90,,65.52,percent of total billed charges,90% of total billed charges,72.8,80,,58.24,percent of total billed charges,80% of total billed charges,81.9,90,,65.52,percent of total billed charges,90% of total billed charges,68.25,75,,54.6,percent of total billed charges,75% of total billed charges,31.76,122,,,fee schedule,122% of HUMANA fee schedule,26.39,29,,21.112,percent of total billed charges,29% of total billed charges,26.03,100,,,fee schedule,100% of CMS OPPS rate,60.97,67,,48.776,percent of total billed charges,67% of total billed charges,27.69,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,72.8,80,,58.24,percent of total billed charges,80% of total billed charges,59.15,65,,47.32,percent of total billed charges,65% of total billed charges,32.46,35.67,,25.968,percent of total billed charges,35.67% of total billed charges,26.03,81.9,
PUL REHAB OTHER RT PRO GROUP,9430030,CDM,410,RC,G0239,HCPCS,outpatient,,,142,56.80,,120.7,85,,96.56,percent of total billed charges,85% of total billed charges,109.34,77,,87.47,percent of total billed charges,77% of total billed charges,35.07,100,,,fee schedule,100% of CMS OPPS rate,56.97,429,,,fee schedule,429% of BCBS fee schedule,59.36,447,,,fee schedule,447% of BCBS fee schedule,59.36,447,,,fee schedule,447% of BCBS fee schedule,59.36,447,,,fee schedule,447% of BCBS fee schedule,127.8,90,,102.24,percent of total billed charges,90% of total billed charges,113.6,80,,90.88,percent of total billed charges,80% of total billed charges,127.8,90,,102.24,percent of total billed charges,90% of total billed charges,106.5,75,,85.2,percent of total billed charges,75% of total billed charges,42.78,122,,,fee schedule,122% of HUMANA fee schedule,41.18,29,,32.944,percent of total billed charges,29% of total billed charges,35.07,100,,,fee schedule,100% of CMS OPPS rate,95.14,67,,76.112,percent of total billed charges,67% of total billed charges,27.69,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,113.6,80,,90.88,percent of total billed charges,80% of total billed charges,92.3,65,,73.84,percent of total billed charges,65% of total billed charges,50.65,35.67,,40.52,percent of total billed charges,35.67% of total billed charges,27.69,127.8,
COLD PACKS PT,4200020,CDM,420,RC,97010,HCPCS,outpatient,,,31,12.40,GP,26.35,85,,21.08,percent of total billed charges,85% of total billed charges,23.87,77,,19.1,percent of total billed charges,77% of total billed charges,6.04,100,,,fee schedule,100% of CMS fee schedule,27.71,429,,,fee schedule,429% of BCBS fee schedule,28.88,447,,,fee schedule,447% of BCBS fee schedule,28.88,447,,,fee schedule,447% of BCBS fee schedule,28.88,447,,,fee schedule,447% of BCBS fee schedule,27.9,90,,22.32,percent of total billed charges,90% of total billed charges,24.8,80,,19.84,percent of total billed charges,80% of total billed charges,27.9,90,,22.32,percent of total billed charges,90% of total billed charges,23.25,75,,18.6,percent of total billed charges,75% of total billed charges,7.37,122,,,fee schedule,122% of HUMANA fee schedule,8.99,29,,7.192,percent of total billed charges,29% of total billed charges,6.04,100,,,fee schedule,100% of CMS fee schedule,20.77,67,,16.616,percent of total billed charges,67% of total billed charges,5.69,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,24.8,80,,19.84,percent of total billed charges,80% of total billed charges,20.15,65,,16.12,percent of total billed charges,65% of total billed charges,11.06,35.67,,8.848,percent of total billed charges,35.67% of total billed charges,5.69,28.88,
CONTRAST BATH PER 15 MIN PT,4200040,CDM,420,RC,97034,HCPCS,outpatient,,,77,30.80,GP,65.45,85,,52.36,percent of total billed charges,85% of total billed charges,59.29,77,,47.43,percent of total billed charges,77% of total billed charges,13.56,100,,,fee schedule,100% of CMS fee schedule,66.19,429,,,fee schedule,429% of BCBS fee schedule,68.97,447,,,fee schedule,447% of BCBS fee schedule,68.97,447,,,fee schedule,447% of BCBS fee schedule,68.97,447,,,fee schedule,447% of BCBS fee schedule,69.3,90,,55.44,percent of total billed charges,90% of total billed charges,61.6,80,,49.28,percent of total billed charges,80% of total billed charges,69.3,90,,55.44,percent of total billed charges,90% of total billed charges,57.75,75,,46.2,percent of total billed charges,75% of total billed charges,16.54,122,,,fee schedule,122% of HUMANA fee schedule,22.33,29,,17.864,percent of total billed charges,29% of total billed charges,13.56,100,,,fee schedule,100% of CMS fee schedule,51.59,67,,41.272,percent of total billed charges,67% of total billed charges,17.77,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,61.6,80,,49.28,percent of total billed charges,80% of total billed charges,50.05,65,,40.04,percent of total billed charges,65% of total billed charges,27.47,35.67,,21.976,percent of total billed charges,35.67% of total billed charges,13.56,69.3,
DEBRIDE WND-FIRST 20 CM PT,4200052,CDM,420,RC,97597,HCPCS,outpatient,,,262,104.80,GP,222.7,85,,178.16,percent of total billed charges,85% of total billed charges,201.74,77,,161.39,percent of total billed charges,77% of total billed charges,175.08,100,,,fee schedule,100% of CMS OPPS rate,104.68,429,,,fee schedule,429% of BCBS fee schedule,109.07,447,,,fee schedule,447% of BCBS fee schedule,109.07,447,,,fee schedule,447% of BCBS fee schedule,109.07,447,,,fee schedule,447% of BCBS fee schedule,235.8,90,,188.64,percent of total billed charges,90% of total billed charges,209.6,80,,167.68,percent of total billed charges,80% of total billed charges,235.8,90,,188.64,percent of total billed charges,90% of total billed charges,196.5,75,,157.2,percent of total billed charges,75% of total billed charges,213.59,122,,,fee schedule,122% of HUMANA fee schedule,75.98,29,,60.784,percent of total billed charges,29% of total billed charges,175.08,100,,,fee schedule,100% of CMS OPPS rate,175.54,67,,140.432,percent of total billed charges,67% of total billed charges,97.74,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,209.6,80,,167.68,percent of total billed charges,80% of total billed charges,170.3,65,,136.24,percent of total billed charges,65% of total billed charges,93.46,35.67,,74.768,percent of total billed charges,35.67% of total billed charges,75.98,235.8,
DEBRIDE WND- EA ADD 20CM PT,4200053,CDM,420,RC,97598,HCPCS,outpatient,,,262,104.80,GP,222.7,85,,178.16,percent of total billed charges,85% of total billed charges,201.74,77,,161.39,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,49.25,429,,,fee schedule,429% of BCBS fee schedule,51.32,447,,,fee schedule,447% of BCBS fee schedule,51.32,447,,,fee schedule,447% of BCBS fee schedule,51.32,447,,,fee schedule,447% of BCBS fee schedule,235.8,90,,188.64,percent of total billed charges,90% of total billed charges,209.6,80,,167.68,percent of total billed charges,80% of total billed charges,235.8,90,,188.64,percent of total billed charges,90% of total billed charges,196.5,75,,157.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,75.98,29,,60.784,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,175.54,67,,140.432,percent of total billed charges,67% of total billed charges,97.74,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,209.6,80,,167.68,percent of total billed charges,80% of total billed charges,170.3,65,,136.24,percent of total billed charges,65% of total billed charges,93.46,35.67,,74.768,percent of total billed charges,35.67% of total billed charges,49.25,235.8,
DEBRIDEMENT-NON SELECTIVE PT,4200062,CDM,420,RC,97602,HCPCS,outpatient,,,319,127.60,GP,271.15,85,,216.92,percent of total billed charges,85% of total billed charges,245.63,77,,196.5,percent of total billed charges,77% of total billed charges,175.08,100,,,fee schedule,100% of CMS OPPS rate,724.8,429,,,fee schedule,429% of BCBS fee schedule,755.21,447,,,fee schedule,447% of BCBS fee schedule,755.21,447,,,fee schedule,447% of BCBS fee schedule,755.21,447,,,fee schedule,447% of BCBS fee schedule,287.1,90,,229.68,percent of total billed charges,90% of total billed charges,255.2,80,,204.16,percent of total billed charges,80% of total billed charges,287.1,90,,229.68,percent of total billed charges,90% of total billed charges,239.25,75,,191.4,percent of total billed charges,75% of total billed charges,213.59,122,,,fee schedule,122% of HUMANA fee schedule,92.51,29,,74.008,percent of total billed charges,29% of total billed charges,175.08,100,,,fee schedule,100% of CMS OPPS rate,213.73,67,,170.984,percent of total billed charges,67% of total billed charges,57.28,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,255.2,80,,204.16,percent of total billed charges,80% of total billed charges,207.35,65,,165.88,percent of total billed charges,65% of total billed charges,113.79,35.67,,91.032,percent of total billed charges,35.67% of total billed charges,57.28,755.21,
ELECTRICAL STIM. PER 15 MIN PT,4200100,CDM,420,RC,97032,HCPCS,outpatient,,,79,31.60,GP,67.15,85,,53.72,percent of total billed charges,85% of total billed charges,60.83,77,,48.66,percent of total billed charges,77% of total billed charges,13.95,100,,,fee schedule,100% of CMS fee schedule,67.74,429,,,fee schedule,429% of BCBS fee schedule,70.58,447,,,fee schedule,447% of BCBS fee schedule,70.58,447,,,fee schedule,447% of BCBS fee schedule,70.58,447,,,fee schedule,447% of BCBS fee schedule,71.1,90,,56.88,percent of total billed charges,90% of total billed charges,63.2,80,,50.56,percent of total billed charges,80% of total billed charges,71.1,90,,56.88,percent of total billed charges,90% of total billed charges,59.25,75,,47.4,percent of total billed charges,75% of total billed charges,17.02,122,,,fee schedule,122% of HUMANA fee schedule,22.91,29,,18.328,percent of total billed charges,29% of total billed charges,13.95,100,,,fee schedule,100% of CMS fee schedule,52.93,67,,42.344,percent of total billed charges,67% of total billed charges,18.86,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,63.2,80,,50.56,percent of total billed charges,80% of total billed charges,51.35,65,,41.08,percent of total billed charges,65% of total billed charges,28.18,35.67,,22.544,percent of total billed charges,35.67% of total billed charges,13.95,71.1,
HOT PACKS PT,4200170,CDM,420,RC,97010,HCPCS,outpatient,,,31,12.40,GP,26.35,85,,21.08,percent of total billed charges,85% of total billed charges,23.87,77,,19.1,percent of total billed charges,77% of total billed charges,6.04,100,,,fee schedule,100% of CMS fee schedule,27.71,429,,,fee schedule,429% of BCBS fee schedule,28.88,447,,,fee schedule,447% of BCBS fee schedule,28.88,447,,,fee schedule,447% of BCBS fee schedule,28.88,447,,,fee schedule,447% of BCBS fee schedule,27.9,90,,22.32,percent of total billed charges,90% of total billed charges,24.8,80,,19.84,percent of total billed charges,80% of total billed charges,27.9,90,,22.32,percent of total billed charges,90% of total billed charges,23.25,75,,18.6,percent of total billed charges,75% of total billed charges,7.37,122,,,fee schedule,122% of HUMANA fee schedule,8.99,29,,7.192,percent of total billed charges,29% of total billed charges,6.04,100,,,fee schedule,100% of CMS fee schedule,20.77,67,,16.616,percent of total billed charges,67% of total billed charges,5.69,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,24.8,80,,19.84,percent of total billed charges,80% of total billed charges,20.15,65,,16.12,percent of total billed charges,65% of total billed charges,11.06,35.67,,8.848,percent of total billed charges,35.67% of total billed charges,5.69,28.88,
EPLEY MANEUVER PER DAY PT,4200175,CDM,420,RC,95992,HCPCS,outpatient,,,93,37.20,GP,79.05,85,,63.24,percent of total billed charges,85% of total billed charges,71.61,77,,57.29,percent of total billed charges,77% of total billed charges,34.57,100,,,fee schedule,100% of CMS fee schedule,164.74,429,,,fee schedule,429% of BCBS fee schedule,171.65,447,,,fee schedule,447% of BCBS fee schedule,171.65,447,,,fee schedule,447% of BCBS fee schedule,171.65,447,,,fee schedule,447% of BCBS fee schedule,83.7,90,,66.96,percent of total billed charges,90% of total billed charges,74.4,80,,59.52,percent of total billed charges,80% of total billed charges,83.7,90,,66.96,percent of total billed charges,90% of total billed charges,69.75,75,,55.8,percent of total billed charges,75% of total billed charges,42.18,122,,,fee schedule,122% of HUMANA fee schedule,26.97,29,,21.576,percent of total billed charges,29% of total billed charges,34.57,100,,,fee schedule,100% of CMS fee schedule,62.31,67,,49.848,percent of total billed charges,67% of total billed charges,37.87,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,74.4,80,,59.52,percent of total billed charges,80% of total billed charges,60.45,65,,48.36,percent of total billed charges,65% of total billed charges,33.17,35.67,,26.536,percent of total billed charges,35.67% of total billed charges,26.97,171.65,
INSTRUCT EXER/MECH 15 MIN PT,4200190,CDM,420,RC,97535,HCPCS,outpatient,,,102,40.80,GP,86.7,85,,69.36,percent of total billed charges,85% of total billed charges,78.54,77,,62.83,percent of total billed charges,77% of total billed charges,31.67,100,,,fee schedule,100% of CMS fee schedule,150.88,429,,,fee schedule,429% of BCBS fee schedule,157.21,447,,,fee schedule,447% of BCBS fee schedule,157.21,447,,,fee schedule,447% of BCBS fee schedule,157.21,447,,,fee schedule,447% of BCBS fee schedule,91.8,90,,73.44,percent of total billed charges,90% of total billed charges,81.6,80,,65.28,percent of total billed charges,80% of total billed charges,91.8,90,,73.44,percent of total billed charges,90% of total billed charges,76.5,75,,61.2,percent of total billed charges,75% of total billed charges,38.64,122,,,fee schedule,122% of HUMANA fee schedule,29.58,29,,23.664,percent of total billed charges,29% of total billed charges,31.67,100,,,fee schedule,100% of CMS fee schedule,68.34,67,,54.672,percent of total billed charges,67% of total billed charges,34.73,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,81.6,80,,65.28,percent of total billed charges,80% of total billed charges,66.3,65,,53.04,percent of total billed charges,65% of total billed charges,36.38,35.67,,29.104,percent of total billed charges,35.67% of total billed charges,29.58,157.21,
IONTOPHORESIS PER 15 MIN PT,4200200,CDM,420,RC,97033,HCPCS,outpatient,,,103,41.20,GP,87.55,85,,70.04,percent of total billed charges,85% of total billed charges,79.31,77,,63.45,percent of total billed charges,77% of total billed charges,18.71,100,,,fee schedule,100% of CMS fee schedule,90.82,429,,,fee schedule,429% of BCBS fee schedule,94.63,447,,,fee schedule,447% of BCBS fee schedule,94.63,447,,,fee schedule,447% of BCBS fee schedule,94.63,447,,,fee schedule,447% of BCBS fee schedule,92.7,90,,74.16,percent of total billed charges,90% of total billed charges,82.4,80,,65.92,percent of total billed charges,80% of total billed charges,92.7,90,,74.16,percent of total billed charges,90% of total billed charges,77.25,75,,61.8,percent of total billed charges,75% of total billed charges,22.83,122,,,fee schedule,122% of HUMANA fee schedule,29.87,29,,23.896,percent of total billed charges,29% of total billed charges,18.71,100,,,fee schedule,100% of CMS fee schedule,69.01,67,,55.208,percent of total billed charges,67% of total billed charges,31.97,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,82.4,80,,65.92,percent of total billed charges,80% of total billed charges,66.95,65,,53.56,percent of total billed charges,65% of total billed charges,36.74,35.67,,29.392,percent of total billed charges,35.67% of total billed charges,18.71,94.63,
MASSAGE PER 15 MINUTES PT,4200210,CDM,420,RC,97124,HCPCS,outpatient,,,92,36.80,GP,78.2,85,,62.56,percent of total billed charges,85% of total billed charges,70.84,77,,56.67,percent of total billed charges,77% of total billed charges,29.29,100,,,fee schedule,100% of CMS fee schedule,133.93,429,,,fee schedule,429% of BCBS fee schedule,139.55,447,,,fee schedule,447% of BCBS fee schedule,139.55,447,,,fee schedule,447% of BCBS fee schedule,139.55,447,,,fee schedule,447% of BCBS fee schedule,82.8,90,,66.24,percent of total billed charges,90% of total billed charges,73.6,80,,58.88,percent of total billed charges,80% of total billed charges,82.8,90,,66.24,percent of total billed charges,90% of total billed charges,69,75,,55.2,percent of total billed charges,75% of total billed charges,35.73,122,,,fee schedule,122% of HUMANA fee schedule,26.68,29,,21.344,percent of total billed charges,29% of total billed charges,29.29,100,,,fee schedule,100% of CMS fee schedule,61.64,67,,49.312,percent of total billed charges,67% of total billed charges,26.12,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,73.6,80,,58.88,percent of total billed charges,80% of total billed charges,59.8,65,,47.84,percent of total billed charges,65% of total billed charges,32.82,35.67,,26.256,percent of total billed charges,35.67% of total billed charges,26.12,139.55,
MUSCLE TESTING/BODY W/HAND PT,4200270,CDM,420,RC,97750,HCPCS,outpatient,,,92,36.80,GP,78.2,85,,62.56,percent of total billed charges,85% of total billed charges,70.84,77,,56.67,percent of total billed charges,77% of total billed charges,32.94,100,,,fee schedule,100% of CMS fee schedule,164.74,429,,,fee schedule,429% of BCBS fee schedule,171.65,447,,,fee schedule,447% of BCBS fee schedule,171.65,447,,,fee schedule,447% of BCBS fee schedule,171.65,447,,,fee schedule,447% of BCBS fee schedule,82.8,90,,66.24,percent of total billed charges,90% of total billed charges,73.6,80,,58.88,percent of total billed charges,80% of total billed charges,82.8,90,,66.24,percent of total billed charges,90% of total billed charges,69,75,,55.2,percent of total billed charges,75% of total billed charges,40.19,122,,,fee schedule,122% of HUMANA fee schedule,26.68,29,,21.344,percent of total billed charges,29% of total billed charges,32.94,100,,,fee schedule,100% of CMS fee schedule,61.64,67,,49.312,percent of total billed charges,67% of total billed charges,32.79,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,73.6,80,,58.88,percent of total billed charges,80% of total billed charges,59.8,65,,47.84,percent of total billed charges,65% of total billed charges,32.82,35.67,,26.256,percent of total billed charges,35.67% of total billed charges,26.68,171.65,
MUSCLE TEST/BODY W/O HAND PT,4200280,CDM,420,RC,97750,HCPCS,outpatient,,,92,36.80,GP,78.2,85,,62.56,percent of total billed charges,85% of total billed charges,70.84,77,,56.67,percent of total billed charges,77% of total billed charges,32.94,100,,,fee schedule,100% of CMS fee schedule,164.74,429,,,fee schedule,429% of BCBS fee schedule,171.65,447,,,fee schedule,447% of BCBS fee schedule,171.65,447,,,fee schedule,447% of BCBS fee schedule,171.65,447,,,fee schedule,447% of BCBS fee schedule,82.8,90,,66.24,percent of total billed charges,90% of total billed charges,73.6,80,,58.88,percent of total billed charges,80% of total billed charges,82.8,90,,66.24,percent of total billed charges,90% of total billed charges,69,75,,55.2,percent of total billed charges,75% of total billed charges,40.19,122,,,fee schedule,122% of HUMANA fee schedule,26.68,29,,21.344,percent of total billed charges,29% of total billed charges,32.94,100,,,fee schedule,100% of CMS fee schedule,61.64,67,,49.312,percent of total billed charges,67% of total billed charges,32.79,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,73.6,80,,58.88,percent of total billed charges,80% of total billed charges,59.8,65,,47.84,percent of total billed charges,65% of total billed charges,32.82,35.67,,26.256,percent of total billed charges,35.67% of total billed charges,26.68,171.65,
MYOFASCIAL RELEASE PT 15 MIN,4200305,CDM,420,RC,97140,HCPCS,outpatient,,,92,36.80,GP,78.2,85,,62.56,percent of total billed charges,85% of total billed charges,70.84,77,,56.67,percent of total billed charges,77% of total billed charges,26.26,100,,,fee schedule,100% of CMS fee schedule,121.62,429,,,fee schedule,429% of BCBS fee schedule,126.72,447,,,fee schedule,447% of BCBS fee schedule,126.72,447,,,fee schedule,447% of BCBS fee schedule,126.72,447,,,fee schedule,447% of BCBS fee schedule,82.8,90,,66.24,percent of total billed charges,90% of total billed charges,73.6,80,,58.88,percent of total billed charges,80% of total billed charges,82.8,90,,66.24,percent of total billed charges,90% of total billed charges,69,75,,55.2,percent of total billed charges,75% of total billed charges,32.04,122,,,fee schedule,122% of HUMANA fee schedule,26.68,29,,21.344,percent of total billed charges,29% of total billed charges,26.26,100,,,fee schedule,100% of CMS fee schedule,61.64,67,,49.312,percent of total billed charges,67% of total billed charges,29.66,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,73.6,80,,58.88,percent of total billed charges,80% of total billed charges,59.8,65,,47.84,percent of total billed charges,65% of total billed charges,32.82,35.67,,26.256,percent of total billed charges,35.67% of total billed charges,26.26,126.72,
PARAFFIN BATH PT,4200350,CDM,420,RC,97018,HCPCS,outpatient,,,59,23.60,GP,50.15,85,,40.12,percent of total billed charges,85% of total billed charges,45.43,77,,36.34,percent of total billed charges,77% of total billed charges,5.41,100,,,fee schedule,100% of CMS fee schedule,38.48,429,,,fee schedule,429% of BCBS fee schedule,40.1,447,,,fee schedule,447% of BCBS fee schedule,40.1,447,,,fee schedule,447% of BCBS fee schedule,40.1,447,,,fee schedule,447% of BCBS fee schedule,53.1,90,,42.48,percent of total billed charges,90% of total billed charges,47.2,80,,37.76,percent of total billed charges,80% of total billed charges,53.1,90,,42.48,percent of total billed charges,90% of total billed charges,44.25,75,,35.4,percent of total billed charges,75% of total billed charges,6.6,122,,,fee schedule,122% of HUMANA fee schedule,17.11,29,,13.688,percent of total billed charges,29% of total billed charges,5.41,100,,,fee schedule,100% of CMS fee schedule,39.53,67,,31.624,percent of total billed charges,67% of total billed charges,10.73,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,47.2,80,,37.76,percent of total billed charges,80% of total billed charges,38.35,65,,30.68,percent of total billed charges,65% of total billed charges,21.05,35.67,,16.84,percent of total billed charges,35.67% of total billed charges,5.41,53.1,
PT EXERCISE 15 MINUTES PT,4200370,CDM,420,RC,97110,HCPCS,outpatient,,,93,37.20,GP,79.05,85,,63.24,percent of total billed charges,85% of total billed charges,71.61,77,,57.29,percent of total billed charges,77% of total billed charges,28.51,100,,,fee schedule,100% of CMS fee schedule,133.93,429,,,fee schedule,429% of BCBS fee schedule,139.55,447,,,fee schedule,447% of BCBS fee schedule,139.55,447,,,fee schedule,447% of BCBS fee schedule,139.55,447,,,fee schedule,447% of BCBS fee schedule,83.7,90,,66.96,percent of total billed charges,90% of total billed charges,74.4,80,,59.52,percent of total billed charges,80% of total billed charges,83.7,90,,66.96,percent of total billed charges,90% of total billed charges,69.75,75,,55.8,percent of total billed charges,75% of total billed charges,34.78,122,,,fee schedule,122% of HUMANA fee schedule,26.97,29,,21.576,percent of total billed charges,29% of total billed charges,28.51,100,,,fee schedule,100% of CMS fee schedule,62.31,67,,49.848,percent of total billed charges,67% of total billed charges,31.72,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,74.4,80,,59.52,percent of total billed charges,80% of total billed charges,60.45,65,,48.36,percent of total billed charges,65% of total billed charges,33.17,35.67,,26.536,percent of total billed charges,35.67% of total billed charges,26.97,139.55,
PT ADAPTIVE EQP TRAIN PER 15,4200381,CDM,420,RC,97535,HCPCS,outpatient,,,92,36.80,GP,78.2,85,,62.56,percent of total billed charges,85% of total billed charges,70.84,77,,56.67,percent of total billed charges,77% of total billed charges,31.67,100,,,fee schedule,100% of CMS fee schedule,150.88,429,,,fee schedule,429% of BCBS fee schedule,157.21,447,,,fee schedule,447% of BCBS fee schedule,157.21,447,,,fee schedule,447% of BCBS fee schedule,157.21,447,,,fee schedule,447% of BCBS fee schedule,82.8,90,,66.24,percent of total billed charges,90% of total billed charges,73.6,80,,58.88,percent of total billed charges,80% of total billed charges,82.8,90,,66.24,percent of total billed charges,90% of total billed charges,69,75,,55.2,percent of total billed charges,75% of total billed charges,38.64,122,,,fee schedule,122% of HUMANA fee schedule,26.68,29,,21.344,percent of total billed charges,29% of total billed charges,31.67,100,,,fee schedule,100% of CMS fee schedule,61.64,67,,49.312,percent of total billed charges,67% of total billed charges,34.73,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,73.6,80,,58.88,percent of total billed charges,80% of total billed charges,59.8,65,,47.84,percent of total billed charges,65% of total billed charges,32.82,35.67,,26.256,percent of total billed charges,35.67% of total billed charges,26.68,157.21,
PT ORTHOTIC TRN PER 15 MIN PT,4200382,CDM,420,RC,97760,HCPCS,outpatient,,,92,36.80,GP,78.2,85,,62.56,percent of total billed charges,85% of total billed charges,70.84,77,,56.67,percent of total billed charges,77% of total billed charges,45.98,100,,,fee schedule,100% of CMS fee schedule,204.76,429,,,fee schedule,429% of BCBS fee schedule,213.35,447,,,fee schedule,447% of BCBS fee schedule,213.35,447,,,fee schedule,447% of BCBS fee schedule,213.35,447,,,fee schedule,447% of BCBS fee schedule,82.8,90,,66.24,percent of total billed charges,90% of total billed charges,73.6,80,,58.88,percent of total billed charges,80% of total billed charges,82.8,90,,66.24,percent of total billed charges,90% of total billed charges,69,75,,55.2,percent of total billed charges,75% of total billed charges,56.1,122,,,fee schedule,122% of HUMANA fee schedule,26.68,29,,21.344,percent of total billed charges,29% of total billed charges,45.98,100,,,fee schedule,100% of CMS fee schedule,61.64,67,,49.312,percent of total billed charges,67% of total billed charges,37.82,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,73.6,80,,58.88,percent of total billed charges,80% of total billed charges,59.8,65,,47.84,percent of total billed charges,65% of total billed charges,32.82,35.67,,26.256,percent of total billed charges,35.67% of total billed charges,26.68,213.35,
PT PROSTHETIC TRAIN PER 15 PT,4200383,CDM,420,RC,97761,HCPCS,outpatient,,,92,36.80,GP,78.2,85,,62.56,percent of total billed charges,85% of total billed charges,70.84,77,,56.67,percent of total billed charges,77% of total billed charges,40.29,100,,,fee schedule,100% of CMS fee schedule,177.05,429,,,fee schedule,429% of BCBS fee schedule,184.48,447,,,fee schedule,447% of BCBS fee schedule,184.48,447,,,fee schedule,447% of BCBS fee schedule,184.48,447,,,fee schedule,447% of BCBS fee schedule,82.8,90,,66.24,percent of total billed charges,90% of total billed charges,73.6,80,,58.88,percent of total billed charges,80% of total billed charges,82.8,90,,66.24,percent of total billed charges,90% of total billed charges,69,75,,55.2,percent of total billed charges,75% of total billed charges,49.15,122,,,fee schedule,122% of HUMANA fee schedule,26.68,29,,21.344,percent of total billed charges,29% of total billed charges,40.29,100,,,fee schedule,100% of CMS fee schedule,61.64,67,,49.312,percent of total billed charges,67% of total billed charges,32.79,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,73.6,80,,58.88,percent of total billed charges,80% of total billed charges,59.8,65,,47.84,percent of total billed charges,65% of total billed charges,32.82,35.67,,26.256,percent of total billed charges,35.67% of total billed charges,26.68,184.48,
GAIT TRAINING 1-15 MINS PT,4200480,CDM,420,RC,97116,HCPCS,outpatient,,,100,40.00,GP,85,85,,68,percent of total billed charges,85% of total billed charges,77,77,,61.6,percent of total billed charges,77% of total billed charges,28.51,100,,,fee schedule,100% of CMS fee schedule,132.39,429,,,fee schedule,429% of BCBS fee schedule,137.94,447,,,fee schedule,447% of BCBS fee schedule,137.94,447,,,fee schedule,447% of BCBS fee schedule,137.94,447,,,fee schedule,447% of BCBS fee schedule,90,90,,72,percent of total billed charges,90% of total billed charges,80,80,,64,percent of total billed charges,80% of total billed charges,90,90,,72,percent of total billed charges,90% of total billed charges,75,75,,60,percent of total billed charges,75% of total billed charges,34.78,122,,,fee schedule,122% of HUMANA fee schedule,29,29,,23.2,percent of total billed charges,29% of total billed charges,28.51,100,,,fee schedule,100% of CMS fee schedule,67,67,,53.6,percent of total billed charges,67% of total billed charges,27.92,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,80,80,,64,percent of total billed charges,80% of total billed charges,65,65,,52,percent of total billed charges,65% of total billed charges,35.67,35.67,,28.536,percent of total billed charges,35.67% of total billed charges,27.92,137.94,
PHONOPHORESIS PER 15 MIN PT,4200500,CDM,420,RC,97035,HCPCS,outpatient,,,66,26.40,GP,56.1,85,,44.88,percent of total billed charges,85% of total billed charges,50.82,77,,40.66,percent of total billed charges,77% of total billed charges,13.56,100,,,fee schedule,100% of CMS fee schedule,58.52,429,,,fee schedule,429% of BCBS fee schedule,60.97,447,,,fee schedule,447% of BCBS fee schedule,60.97,447,,,fee schedule,447% of BCBS fee schedule,60.97,447,,,fee schedule,447% of BCBS fee schedule,59.4,90,,47.52,percent of total billed charges,90% of total billed charges,52.8,80,,42.24,percent of total billed charges,80% of total billed charges,59.4,90,,47.52,percent of total billed charges,90% of total billed charges,49.5,75,,39.6,percent of total billed charges,75% of total billed charges,16.54,122,,,fee schedule,122% of HUMANA fee schedule,19.14,29,,15.312,percent of total billed charges,29% of total billed charges,13.56,100,,,fee schedule,100% of CMS fee schedule,44.22,67,,35.376,percent of total billed charges,67% of total billed charges,12.4,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,52.8,80,,42.24,percent of total billed charges,80% of total billed charges,42.9,65,,34.32,percent of total billed charges,65% of total billed charges,23.54,35.67,,18.832,percent of total billed charges,35.67% of total billed charges,12.4,60.97,
THERAPEUTIC ACTIVITY PER 15 PT,4200522,CDM,420,RC,97530,HCPCS,outpatient,,,93,37.20,GP,79.05,85,,63.24,percent of total billed charges,85% of total billed charges,71.61,77,,57.29,percent of total billed charges,77% of total billed charges,35.45,100,,,fee schedule,100% of CMS fee schedule,177.05,429,,,fee schedule,429% of BCBS fee schedule,184.48,447,,,fee schedule,447% of BCBS fee schedule,184.48,447,,,fee schedule,447% of BCBS fee schedule,184.48,447,,,fee schedule,447% of BCBS fee schedule,83.7,90,,66.96,percent of total billed charges,90% of total billed charges,74.4,80,,59.52,percent of total billed charges,80% of total billed charges,83.7,90,,66.96,percent of total billed charges,90% of total billed charges,69.75,75,,55.8,percent of total billed charges,75% of total billed charges,43.25,122,,,fee schedule,122% of HUMANA fee schedule,26.97,29,,21.576,percent of total billed charges,29% of total billed charges,35.45,100,,,fee schedule,100% of CMS fee schedule,62.31,67,,49.848,percent of total billed charges,67% of total billed charges,34.71,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,74.4,80,,59.52,percent of total billed charges,80% of total billed charges,60.45,65,,48.36,percent of total billed charges,65% of total billed charges,33.17,35.67,,26.536,percent of total billed charges,35.67% of total billed charges,26.97,184.48,
THERAPEUTIC PROC 15 MIN PT,4200523,CDM,420,RC,97110,HCPCS,outpatient,,,92,36.80,GP,78.2,85,,62.56,percent of total billed charges,85% of total billed charges,70.84,77,,56.67,percent of total billed charges,77% of total billed charges,28.51,100,,,fee schedule,100% of CMS fee schedule,133.93,429,,,fee schedule,429% of BCBS fee schedule,139.55,447,,,fee schedule,447% of BCBS fee schedule,139.55,447,,,fee schedule,447% of BCBS fee schedule,139.55,447,,,fee schedule,447% of BCBS fee schedule,82.8,90,,66.24,percent of total billed charges,90% of total billed charges,73.6,80,,58.88,percent of total billed charges,80% of total billed charges,82.8,90,,66.24,percent of total billed charges,90% of total billed charges,69,75,,55.2,percent of total billed charges,75% of total billed charges,34.78,122,,,fee schedule,122% of HUMANA fee schedule,26.68,29,,21.344,percent of total billed charges,29% of total billed charges,28.51,100,,,fee schedule,100% of CMS fee schedule,61.64,67,,49.312,percent of total billed charges,67% of total billed charges,31.72,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,73.6,80,,58.88,percent of total billed charges,80% of total billed charges,59.8,65,,47.84,percent of total billed charges,65% of total billed charges,32.82,35.67,,26.256,percent of total billed charges,35.67% of total billed charges,26.68,139.55,
THERAPEUTIC PROC-GRP PT,4200526,CDM,420,RC,97150,HCPCS,outpatient,,,92,36.80,GP,78.2,85,,62.56,percent of total billed charges,85% of total billed charges,70.84,77,,56.67,percent of total billed charges,77% of total billed charges,17.49,100,,,fee schedule,100% of CMS fee schedule,80.05,429,,,fee schedule,429% of BCBS fee schedule,83.41,447,,,fee schedule,447% of BCBS fee schedule,83.41,447,,,fee schedule,447% of BCBS fee schedule,83.41,447,,,fee schedule,447% of BCBS fee schedule,82.8,90,,66.24,percent of total billed charges,90% of total billed charges,73.6,80,,58.88,percent of total billed charges,80% of total billed charges,82.8,90,,66.24,percent of total billed charges,90% of total billed charges,69,75,,55.2,percent of total billed charges,75% of total billed charges,21.34,122,,,fee schedule,122% of HUMANA fee schedule,26.68,29,,21.344,percent of total billed charges,29% of total billed charges,17.49,100,,,fee schedule,100% of CMS fee schedule,61.64,67,,49.312,percent of total billed charges,67% of total billed charges,20.58,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,73.6,80,,58.88,percent of total billed charges,80% of total billed charges,59.8,65,,47.84,percent of total billed charges,65% of total billed charges,32.82,35.67,,26.256,percent of total billed charges,35.67% of total billed charges,17.49,83.41,
NEUROMUSCULAR RE-ED 15 MIN PT,4200530,CDM,420,RC,97112,HCPCS,outpatient,,,93,37.20,GP,79.05,85,,63.24,percent of total billed charges,85% of total billed charges,71.61,77,,57.29,percent of total billed charges,77% of total billed charges,32.7,100,,,fee schedule,100% of CMS fee schedule,152.42,429,,,fee schedule,429% of BCBS fee schedule,158.82,447,,,fee schedule,447% of BCBS fee schedule,158.82,447,,,fee schedule,447% of BCBS fee schedule,158.82,447,,,fee schedule,447% of BCBS fee schedule,83.7,90,,66.96,percent of total billed charges,90% of total billed charges,74.4,80,,59.52,percent of total billed charges,80% of total billed charges,83.7,90,,66.96,percent of total billed charges,90% of total billed charges,69.75,75,,55.8,percent of total billed charges,75% of total billed charges,39.89,122,,,fee schedule,122% of HUMANA fee schedule,26.97,29,,21.576,percent of total billed charges,29% of total billed charges,32.7,100,,,fee schedule,100% of CMS fee schedule,62.31,67,,49.848,percent of total billed charges,67% of total billed charges,33.39,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,74.4,80,,59.52,percent of total billed charges,80% of total billed charges,60.45,65,,48.36,percent of total billed charges,65% of total billed charges,33.17,35.67,,26.536,percent of total billed charges,35.67% of total billed charges,26.97,158.82,
TENS APPLICATION PT,4200550,CDM,420,RC,97014,HCPCS,outpatient,,,79,31.60,GP,67.15,85,,53.72,percent of total billed charges,85% of total billed charges,60.83,77,,48.66,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,67.74,429,,,fee schedule,429% of BCBS fee schedule,70.58,447,,,fee schedule,447% of BCBS fee schedule,70.58,447,,,fee schedule,447% of BCBS fee schedule,70.58,447,,,fee schedule,447% of BCBS fee schedule,71.1,90,,56.88,percent of total billed charges,90% of total billed charges,63.2,80,,50.56,percent of total billed charges,80% of total billed charges,71.1,90,,56.88,percent of total billed charges,90% of total billed charges,59.25,75,,47.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,22.91,29,,18.328,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,52.93,67,,42.344,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,63.2,80,,50.56,percent of total billed charges,80% of total billed charges,51.35,65,,41.08,percent of total billed charges,65% of total billed charges,28.18,35.67,,22.544,percent of total billed charges,35.67% of total billed charges,22.91,71.1,
TRACTION MANUAL PT 15 MIN,4200560,CDM,420,RC,97140,HCPCS,outpatient,,,82,32.80,GP,69.7,85,,55.76,percent of total billed charges,85% of total billed charges,63.14,77,,50.51,percent of total billed charges,77% of total billed charges,26.26,100,,,fee schedule,100% of CMS fee schedule,121.62,429,,,fee schedule,429% of BCBS fee schedule,126.72,447,,,fee schedule,447% of BCBS fee schedule,126.72,447,,,fee schedule,447% of BCBS fee schedule,126.72,447,,,fee schedule,447% of BCBS fee schedule,73.8,90,,59.04,percent of total billed charges,90% of total billed charges,65.6,80,,52.48,percent of total billed charges,80% of total billed charges,73.8,90,,59.04,percent of total billed charges,90% of total billed charges,61.5,75,,49.2,percent of total billed charges,75% of total billed charges,32.04,122,,,fee schedule,122% of HUMANA fee schedule,23.78,29,,19.024,percent of total billed charges,29% of total billed charges,26.26,100,,,fee schedule,100% of CMS fee schedule,54.94,67,,43.952,percent of total billed charges,67% of total billed charges,29.66,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,65.6,80,,52.48,percent of total billed charges,80% of total billed charges,53.3,65,,42.64,percent of total billed charges,65% of total billed charges,29.25,35.67,,23.4,percent of total billed charges,35.67% of total billed charges,23.78,126.72,
"TRACTION,MECHANICAL PER DAY PT",4200590,CDM,420,RC,97012,HCPCS,outpatient,,,83,33.20,GP,70.55,85,,56.44,percent of total billed charges,85% of total billed charges,63.91,77,,51.13,percent of total billed charges,77% of total billed charges,13.63,100,,,fee schedule,100% of CMS fee schedule,64.65,429,,,fee schedule,429% of BCBS fee schedule,67.36,447,,,fee schedule,447% of BCBS fee schedule,67.36,447,,,fee schedule,447% of BCBS fee schedule,67.36,447,,,fee schedule,447% of BCBS fee schedule,74.7,90,,59.76,percent of total billed charges,90% of total billed charges,66.4,80,,53.12,percent of total billed charges,80% of total billed charges,74.7,90,,59.76,percent of total billed charges,90% of total billed charges,62.25,75,,49.8,percent of total billed charges,75% of total billed charges,16.63,122,,,fee schedule,122% of HUMANA fee schedule,24.07,29,,19.256,percent of total billed charges,29% of total billed charges,13.63,100,,,fee schedule,100% of CMS fee schedule,55.61,67,,44.488,percent of total billed charges,67% of total billed charges,15.84,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,66.4,80,,53.12,percent of total billed charges,80% of total billed charges,53.95,65,,43.16,percent of total billed charges,65% of total billed charges,29.61,35.67,,23.688,percent of total billed charges,35.67% of total billed charges,13.63,74.7,
VASOPNEUMATIC DEV TXT   PT,4200606,CDM,420,RC,97016,HCPCS,outpatient,,,81,32.40,GP,68.85,85,,55.08,percent of total billed charges,85% of total billed charges,62.37,77,,49.9,percent of total billed charges,77% of total billed charges,11.3,100,,,fee schedule,100% of CMS fee schedule,69.28,429,,,fee schedule,429% of BCBS fee schedule,72.19,447,,,fee schedule,447% of BCBS fee schedule,72.19,447,,,fee schedule,447% of BCBS fee schedule,72.19,447,,,fee schedule,447% of BCBS fee schedule,72.9,90,,58.32,percent of total billed charges,90% of total billed charges,64.8,80,,51.84,percent of total billed charges,80% of total billed charges,72.9,90,,58.32,percent of total billed charges,90% of total billed charges,60.75,75,,48.6,percent of total billed charges,75% of total billed charges,13.79,122,,,fee schedule,122% of HUMANA fee schedule,23.49,29,,18.792,percent of total billed charges,29% of total billed charges,11.3,100,,,fee schedule,100% of CMS fee schedule,54.27,67,,43.416,percent of total billed charges,67% of total billed charges,19.05,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,64.8,80,,51.84,percent of total billed charges,80% of total billed charges,52.65,65,,42.12,percent of total billed charges,65% of total billed charges,28.89,35.67,,23.112,percent of total billed charges,35.67% of total billed charges,11.3,72.9,
NEG PRESSURE WOUND TX-50 CM PT,4200607,CDM,420,RC,97607,HCPCS,outpatient,,,1506,602.40,GP,1280.1,85,,1024.08,percent of total billed charges,85% of total billed charges,1159.62,77,,927.7,percent of total billed charges,77% of total billed charges,348.71,100,,,fee schedule,100% of CMS OPPS rate,1333.33,429,,,fee schedule,429% of BCBS fee schedule,1389.28,447,,,fee schedule,447% of BCBS fee schedule,1389.28,447,,,fee schedule,447% of BCBS fee schedule,1389.28,447,,,fee schedule,447% of BCBS fee schedule,1355.4,90,,1084.32,percent of total billed charges,90% of total billed charges,1204.8,80,,963.84,percent of total billed charges,80% of total billed charges,1355.4,90,,1084.32,percent of total billed charges,90% of total billed charges,1129.5,75,,903.6,percent of total billed charges,75% of total billed charges,425.42,122,,,fee schedule,122% of HUMANA fee schedule,436.74,29,,349.392,percent of total billed charges,29% of total billed charges,348.71,100,,,fee schedule,100% of CMS OPPS rate,1009.02,67,,807.216,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1204.8,80,,963.84,percent of total billed charges,80% of total billed charges,978.9,65,,783.12,percent of total billed charges,65% of total billed charges,537.19,35.67,,429.752,percent of total billed charges,35.67% of total billed charges,348.71,1389.28,
NEG PRESSURE WOUND TX +50 PT,4200608,CDM,420,RC,97608,HCPCS,outpatient,,,1506,602.40,GP,1280.1,85,,1024.08,percent of total billed charges,85% of total billed charges,1159.62,77,,927.7,percent of total billed charges,77% of total billed charges,348.71,100,,,fee schedule,100% of CMS OPPS rate,1333.33,429,,,fee schedule,429% of BCBS fee schedule,1389.28,447,,,fee schedule,447% of BCBS fee schedule,1389.28,447,,,fee schedule,447% of BCBS fee schedule,1389.28,447,,,fee schedule,447% of BCBS fee schedule,1355.4,90,,1084.32,percent of total billed charges,90% of total billed charges,1204.8,80,,963.84,percent of total billed charges,80% of total billed charges,1355.4,90,,1084.32,percent of total billed charges,90% of total billed charges,1129.5,75,,903.6,percent of total billed charges,75% of total billed charges,425.42,122,,,fee schedule,122% of HUMANA fee schedule,436.74,29,,349.392,percent of total billed charges,29% of total billed charges,348.71,100,,,fee schedule,100% of CMS OPPS rate,1009.02,67,,807.216,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1204.8,80,,963.84,percent of total billed charges,80% of total billed charges,978.9,65,,783.12,percent of total billed charges,65% of total billed charges,537.19,35.67,,429.752,percent of total billed charges,35.67% of total billed charges,348.71,1389.28,
WHIRLPOOL 1 OR MORE AREAS PT,4200610,CDM,420,RC,97022,HCPCS,outpatient,,,106,42.40,GP,90.1,85,,72.08,percent of total billed charges,85% of total billed charges,81.62,77,,65.3,percent of total billed charges,77% of total billed charges,16.34,100,,,fee schedule,100% of CMS fee schedule,83.14,429,,,fee schedule,429% of BCBS fee schedule,86.63,447,,,fee schedule,447% of BCBS fee schedule,86.63,447,,,fee schedule,447% of BCBS fee schedule,86.63,447,,,fee schedule,447% of BCBS fee schedule,95.4,90,,76.32,percent of total billed charges,90% of total billed charges,84.8,80,,67.84,percent of total billed charges,80% of total billed charges,95.4,90,,76.32,percent of total billed charges,90% of total billed charges,79.5,75,,63.6,percent of total billed charges,75% of total billed charges,19.93,122,,,fee schedule,122% of HUMANA fee schedule,30.74,29,,24.592,percent of total billed charges,29% of total billed charges,16.34,100,,,fee schedule,100% of CMS fee schedule,71.02,67,,56.816,percent of total billed charges,67% of total billed charges,23.05,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,84.8,80,,67.84,percent of total billed charges,80% of total billed charges,68.9,65,,55.12,percent of total billed charges,65% of total billed charges,37.81,35.67,,30.248,percent of total billed charges,35.67% of total billed charges,16.34,95.4,
WHEELCHAIR TRAIN PER 15 MIN PT,4200650,CDM,420,RC,97542,HCPCS,outpatient,,,115,46.00,GP,97.75,85,,78.2,percent of total billed charges,85% of total billed charges,88.55,77,,70.84,percent of total billed charges,77% of total billed charges,30.77,100,,,fee schedule,100% of CMS fee schedule,146.25,429,,,fee schedule,429% of BCBS fee schedule,152.38,447,,,fee schedule,447% of BCBS fee schedule,152.38,447,,,fee schedule,447% of BCBS fee schedule,152.38,447,,,fee schedule,447% of BCBS fee schedule,103.5,90,,82.8,percent of total billed charges,90% of total billed charges,92,80,,73.6,percent of total billed charges,80% of total billed charges,103.5,90,,82.8,percent of total billed charges,90% of total billed charges,86.25,75,,69,percent of total billed charges,75% of total billed charges,37.54,122,,,fee schedule,122% of HUMANA fee schedule,33.35,29,,26.68,percent of total billed charges,29% of total billed charges,30.77,100,,,fee schedule,100% of CMS fee schedule,77.05,67,,61.64,percent of total billed charges,67% of total billed charges,30.38,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,92,80,,73.6,percent of total billed charges,80% of total billed charges,74.75,65,,59.8,percent of total billed charges,65% of total billed charges,41.02,35.67,,32.816,percent of total billed charges,35.67% of total billed charges,30.38,152.38,
MAN THERAPY TECHNIQUES PT 15 M,4200666,CDM,420,RC,97140,HCPCS,outpatient,,,83,33.20,GP,70.55,85,,56.44,percent of total billed charges,85% of total billed charges,63.91,77,,51.13,percent of total billed charges,77% of total billed charges,26.26,100,,,fee schedule,100% of CMS fee schedule,121.62,429,,,fee schedule,429% of BCBS fee schedule,126.72,447,,,fee schedule,447% of BCBS fee schedule,126.72,447,,,fee schedule,447% of BCBS fee schedule,126.72,447,,,fee schedule,447% of BCBS fee schedule,74.7,90,,59.76,percent of total billed charges,90% of total billed charges,66.4,80,,53.12,percent of total billed charges,80% of total billed charges,74.7,90,,59.76,percent of total billed charges,90% of total billed charges,62.25,75,,49.8,percent of total billed charges,75% of total billed charges,32.04,122,,,fee schedule,122% of HUMANA fee schedule,24.07,29,,19.256,percent of total billed charges,29% of total billed charges,26.26,100,,,fee schedule,100% of CMS fee schedule,55.61,67,,44.488,percent of total billed charges,67% of total billed charges,29.66,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,66.4,80,,53.12,percent of total billed charges,80% of total billed charges,53.95,65,,43.16,percent of total billed charges,65% of total billed charges,29.61,35.67,,23.688,percent of total billed charges,35.67% of total billed charges,24.07,126.72,
COLD PACKS PTA,4210020,CDM,420,RC,97010,HCPCS,outpatient,,,31,12.40,GPCQ,26.35,85,,21.08,percent of total billed charges,85% of total billed charges,23.87,77,,19.1,percent of total billed charges,77% of total billed charges,6.04,100,,,fee schedule,100% of CMS fee schedule,27.71,429,,,fee schedule,429% of BCBS fee schedule,28.88,447,,,fee schedule,447% of BCBS fee schedule,28.88,447,,,fee schedule,447% of BCBS fee schedule,28.88,447,,,fee schedule,447% of BCBS fee schedule,27.9,90,,22.32,percent of total billed charges,90% of total billed charges,24.8,80,,19.84,percent of total billed charges,80% of total billed charges,27.9,90,,22.32,percent of total billed charges,90% of total billed charges,23.25,75,,18.6,percent of total billed charges,75% of total billed charges,7.37,122,,,fee schedule,122% of HUMANA fee schedule,8.99,29,,7.192,percent of total billed charges,29% of total billed charges,6.04,100,,,fee schedule,100% of CMS fee schedule,20.77,67,,16.616,percent of total billed charges,67% of total billed charges,5.69,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,24.8,80,,19.84,percent of total billed charges,80% of total billed charges,20.15,65,,16.12,percent of total billed charges,65% of total billed charges,11.06,35.67,,8.848,percent of total billed charges,35.67% of total billed charges,5.69,28.88,
CONTRAST BATH PER 15 MIN PTA,4210040,CDM,420,RC,97034,HCPCS,outpatient,,,77,30.80,GPCQ,65.45,85,,52.36,percent of total billed charges,85% of total billed charges,59.29,77,,47.43,percent of total billed charges,77% of total billed charges,13.56,100,,,fee schedule,100% of CMS fee schedule,66.19,429,,,fee schedule,429% of BCBS fee schedule,68.97,447,,,fee schedule,447% of BCBS fee schedule,68.97,447,,,fee schedule,447% of BCBS fee schedule,68.97,447,,,fee schedule,447% of BCBS fee schedule,69.3,90,,55.44,percent of total billed charges,90% of total billed charges,61.6,80,,49.28,percent of total billed charges,80% of total billed charges,69.3,90,,55.44,percent of total billed charges,90% of total billed charges,57.75,75,,46.2,percent of total billed charges,75% of total billed charges,16.54,122,,,fee schedule,122% of HUMANA fee schedule,22.33,29,,17.864,percent of total billed charges,29% of total billed charges,13.56,100,,,fee schedule,100% of CMS fee schedule,51.59,67,,41.272,percent of total billed charges,67% of total billed charges,17.77,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,61.6,80,,49.28,percent of total billed charges,80% of total billed charges,50.05,65,,40.04,percent of total billed charges,65% of total billed charges,27.47,35.67,,21.976,percent of total billed charges,35.67% of total billed charges,13.56,69.3,
DEBRIDE WND FIRST 20 CM PTA,4210052,CDM,420,RC,97597,HCPCS,outpatient,,,262,104.80,GPCQ,222.7,85,,178.16,percent of total billed charges,85% of total billed charges,201.74,77,,161.39,percent of total billed charges,77% of total billed charges,175.08,100,,,fee schedule,100% of CMS OPPS rate,104.68,429,,,fee schedule,429% of BCBS fee schedule,109.07,447,,,fee schedule,447% of BCBS fee schedule,109.07,447,,,fee schedule,447% of BCBS fee schedule,109.07,447,,,fee schedule,447% of BCBS fee schedule,235.8,90,,188.64,percent of total billed charges,90% of total billed charges,209.6,80,,167.68,percent of total billed charges,80% of total billed charges,235.8,90,,188.64,percent of total billed charges,90% of total billed charges,196.5,75,,157.2,percent of total billed charges,75% of total billed charges,213.59,122,,,fee schedule,122% of HUMANA fee schedule,75.98,29,,60.784,percent of total billed charges,29% of total billed charges,175.08,100,,,fee schedule,100% of CMS OPPS rate,175.54,67,,140.432,percent of total billed charges,67% of total billed charges,97.74,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,209.6,80,,167.68,percent of total billed charges,80% of total billed charges,170.3,65,,136.24,percent of total billed charges,65% of total billed charges,93.46,35.67,,74.768,percent of total billed charges,35.67% of total billed charges,75.98,235.8,
DEBRIDE WND EACH ADD 20 PTA,4210053,CDM,420,RC,97598,HCPCS,outpatient,,,262,104.80,GPCQ,222.7,85,,178.16,percent of total billed charges,85% of total billed charges,201.74,77,,161.39,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,49.25,429,,,fee schedule,429% of BCBS fee schedule,51.32,447,,,fee schedule,447% of BCBS fee schedule,51.32,447,,,fee schedule,447% of BCBS fee schedule,51.32,447,,,fee schedule,447% of BCBS fee schedule,235.8,90,,188.64,percent of total billed charges,90% of total billed charges,209.6,80,,167.68,percent of total billed charges,80% of total billed charges,235.8,90,,188.64,percent of total billed charges,90% of total billed charges,196.5,75,,157.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,75.98,29,,60.784,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,175.54,67,,140.432,percent of total billed charges,67% of total billed charges,97.74,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,209.6,80,,167.68,percent of total billed charges,80% of total billed charges,170.3,65,,136.24,percent of total billed charges,65% of total billed charges,93.46,35.67,,74.768,percent of total billed charges,35.67% of total billed charges,49.25,235.8,
DEBRIDE NON SELECTIVE PTA,4210062,CDM,420,RC,97602,HCPCS,outpatient,,,819,327.60,GPCQ,696.15,85,,556.92,percent of total billed charges,85% of total billed charges,630.63,77,,504.5,percent of total billed charges,77% of total billed charges,175.08,100,,,fee schedule,100% of CMS OPPS rate,724.8,429,,,fee schedule,429% of BCBS fee schedule,755.21,447,,,fee schedule,447% of BCBS fee schedule,755.21,447,,,fee schedule,447% of BCBS fee schedule,755.21,447,,,fee schedule,447% of BCBS fee schedule,737.1,90,,589.68,percent of total billed charges,90% of total billed charges,655.2,80,,524.16,percent of total billed charges,80% of total billed charges,737.1,90,,589.68,percent of total billed charges,90% of total billed charges,614.25,75,,491.4,percent of total billed charges,75% of total billed charges,213.59,122,,,fee schedule,122% of HUMANA fee schedule,237.51,29,,190.008,percent of total billed charges,29% of total billed charges,175.08,100,,,fee schedule,100% of CMS OPPS rate,548.73,67,,438.984,percent of total billed charges,67% of total billed charges,57.28,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,655.2,80,,524.16,percent of total billed charges,80% of total billed charges,532.35,65,,425.88,percent of total billed charges,65% of total billed charges,292.14,35.67,,233.712,percent of total billed charges,35.67% of total billed charges,57.28,755.21,
ELECTRICAL STIM PER 15 MIN PTA,4210100,CDM,420,RC,G0283,HCPCS,outpatient,,,80,32.00,GPCQ,68,85,,54.4,percent of total billed charges,85% of total billed charges,61.6,77,,49.28,percent of total billed charges,77% of total billed charges,11.3,100,,,fee schedule,100% of CMS fee schedule,64.65,429,,,fee schedule,429% of BCBS fee schedule,67.36,447,,,fee schedule,447% of BCBS fee schedule,67.36,447,,,fee schedule,447% of BCBS fee schedule,67.36,447,,,fee schedule,447% of BCBS fee schedule,72,90,,57.6,percent of total billed charges,90% of total billed charges,64,80,,51.2,percent of total billed charges,80% of total billed charges,72,90,,57.6,percent of total billed charges,90% of total billed charges,60,75,,48,percent of total billed charges,75% of total billed charges,13.79,122,,,fee schedule,122% of HUMANA fee schedule,23.2,29,,18.56,percent of total billed charges,29% of total billed charges,11.3,100,,,fee schedule,100% of CMS fee schedule,53.6,67,,42.88,percent of total billed charges,67% of total billed charges,13.67,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,64,80,,51.2,percent of total billed charges,80% of total billed charges,52,65,,41.6,percent of total billed charges,65% of total billed charges,28.54,35.67,,22.832,percent of total billed charges,35.67% of total billed charges,11.3,72,
HOME EXER PROGRAM PTA,4210165,CDM,420,RC,97110,HCPCS,outpatient,,,154,61.60,GPCQ,130.9,85,,104.72,percent of total billed charges,85% of total billed charges,118.58,77,,94.86,percent of total billed charges,77% of total billed charges,28.51,100,,,fee schedule,100% of CMS fee schedule,133.93,429,,,fee schedule,429% of BCBS fee schedule,139.55,447,,,fee schedule,447% of BCBS fee schedule,139.55,447,,,fee schedule,447% of BCBS fee schedule,139.55,447,,,fee schedule,447% of BCBS fee schedule,138.6,90,,110.88,percent of total billed charges,90% of total billed charges,123.2,80,,98.56,percent of total billed charges,80% of total billed charges,138.6,90,,110.88,percent of total billed charges,90% of total billed charges,115.5,75,,92.4,percent of total billed charges,75% of total billed charges,34.78,122,,,fee schedule,122% of HUMANA fee schedule,44.66,29,,35.728,percent of total billed charges,29% of total billed charges,28.51,100,,,fee schedule,100% of CMS fee schedule,103.18,67,,82.544,percent of total billed charges,67% of total billed charges,31.72,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,123.2,80,,98.56,percent of total billed charges,80% of total billed charges,100.1,65,,80.08,percent of total billed charges,65% of total billed charges,54.93,35.67,,43.944,percent of total billed charges,35.67% of total billed charges,28.51,139.55,
HOT PACKS PTA,4210170,CDM,420,RC,97010,HCPCS,outpatient,,,31,12.40,GPCQ,26.35,85,,21.08,percent of total billed charges,85% of total billed charges,23.87,77,,19.1,percent of total billed charges,77% of total billed charges,6.04,100,,,fee schedule,100% of CMS fee schedule,27.71,429,,,fee schedule,429% of BCBS fee schedule,28.88,447,,,fee schedule,447% of BCBS fee schedule,28.88,447,,,fee schedule,447% of BCBS fee schedule,28.88,447,,,fee schedule,447% of BCBS fee schedule,27.9,90,,22.32,percent of total billed charges,90% of total billed charges,24.8,80,,19.84,percent of total billed charges,80% of total billed charges,27.9,90,,22.32,percent of total billed charges,90% of total billed charges,23.25,75,,18.6,percent of total billed charges,75% of total billed charges,7.37,122,,,fee schedule,122% of HUMANA fee schedule,8.99,29,,7.192,percent of total billed charges,29% of total billed charges,6.04,100,,,fee schedule,100% of CMS fee schedule,20.77,67,,16.616,percent of total billed charges,67% of total billed charges,5.69,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,24.8,80,,19.84,percent of total billed charges,80% of total billed charges,20.15,65,,16.12,percent of total billed charges,65% of total billed charges,11.06,35.67,,8.848,percent of total billed charges,35.67% of total billed charges,5.69,28.88,
EPLEY MANEUVER PER DAY PTA,4210175,CDM,420,RC,95992,HCPCS,outpatient,,,93,37.20,GPCQ,79.05,85,,63.24,percent of total billed charges,85% of total billed charges,71.61,77,,57.29,percent of total billed charges,77% of total billed charges,34.57,100,,,fee schedule,100% of CMS fee schedule,164.74,429,,,fee schedule,429% of BCBS fee schedule,171.65,447,,,fee schedule,447% of BCBS fee schedule,171.65,447,,,fee schedule,447% of BCBS fee schedule,171.65,447,,,fee schedule,447% of BCBS fee schedule,83.7,90,,66.96,percent of total billed charges,90% of total billed charges,74.4,80,,59.52,percent of total billed charges,80% of total billed charges,83.7,90,,66.96,percent of total billed charges,90% of total billed charges,69.75,75,,55.8,percent of total billed charges,75% of total billed charges,42.18,122,,,fee schedule,122% of HUMANA fee schedule,26.97,29,,21.576,percent of total billed charges,29% of total billed charges,34.57,100,,,fee schedule,100% of CMS fee schedule,62.31,67,,49.848,percent of total billed charges,67% of total billed charges,37.87,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,74.4,80,,59.52,percent of total billed charges,80% of total billed charges,60.45,65,,48.36,percent of total billed charges,65% of total billed charges,33.17,35.67,,26.536,percent of total billed charges,35.67% of total billed charges,26.97,171.65,
INST EXER/MECH 15 MIN PTA,4210190,CDM,420,RC,97535,HCPCS,outpatient,,,102,40.80,GPCQ,86.7,85,,69.36,percent of total billed charges,85% of total billed charges,78.54,77,,62.83,percent of total billed charges,77% of total billed charges,31.67,100,,,fee schedule,100% of CMS fee schedule,150.88,429,,,fee schedule,429% of BCBS fee schedule,157.21,447,,,fee schedule,447% of BCBS fee schedule,157.21,447,,,fee schedule,447% of BCBS fee schedule,157.21,447,,,fee schedule,447% of BCBS fee schedule,91.8,90,,73.44,percent of total billed charges,90% of total billed charges,81.6,80,,65.28,percent of total billed charges,80% of total billed charges,91.8,90,,73.44,percent of total billed charges,90% of total billed charges,76.5,75,,61.2,percent of total billed charges,75% of total billed charges,38.64,122,,,fee schedule,122% of HUMANA fee schedule,29.58,29,,23.664,percent of total billed charges,29% of total billed charges,31.67,100,,,fee schedule,100% of CMS fee schedule,68.34,67,,54.672,percent of total billed charges,67% of total billed charges,34.73,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,81.6,80,,65.28,percent of total billed charges,80% of total billed charges,66.3,65,,53.04,percent of total billed charges,65% of total billed charges,36.38,35.67,,29.104,percent of total billed charges,35.67% of total billed charges,29.58,157.21,
IONTOPHORESIS PER 15 MIN PTA,4210200,CDM,420,RC,97033,HCPCS,outpatient,,,103,41.20,GPCQ,87.55,85,,70.04,percent of total billed charges,85% of total billed charges,79.31,77,,63.45,percent of total billed charges,77% of total billed charges,18.71,100,,,fee schedule,100% of CMS fee schedule,90.82,429,,,fee schedule,429% of BCBS fee schedule,94.63,447,,,fee schedule,447% of BCBS fee schedule,94.63,447,,,fee schedule,447% of BCBS fee schedule,94.63,447,,,fee schedule,447% of BCBS fee schedule,92.7,90,,74.16,percent of total billed charges,90% of total billed charges,82.4,80,,65.92,percent of total billed charges,80% of total billed charges,92.7,90,,74.16,percent of total billed charges,90% of total billed charges,77.25,75,,61.8,percent of total billed charges,75% of total billed charges,22.83,122,,,fee schedule,122% of HUMANA fee schedule,29.87,29,,23.896,percent of total billed charges,29% of total billed charges,18.71,100,,,fee schedule,100% of CMS fee schedule,69.01,67,,55.208,percent of total billed charges,67% of total billed charges,31.97,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,82.4,80,,65.92,percent of total billed charges,80% of total billed charges,66.95,65,,53.56,percent of total billed charges,65% of total billed charges,36.74,35.67,,29.392,percent of total billed charges,35.67% of total billed charges,18.71,94.63,
MASSAGE PER 15 MIN PTA,4210210,CDM,420,RC,97124,HCPCS,outpatient,,,92,36.80,GPCQ,78.2,85,,62.56,percent of total billed charges,85% of total billed charges,70.84,77,,56.67,percent of total billed charges,77% of total billed charges,29.29,100,,,fee schedule,100% of CMS fee schedule,133.93,429,,,fee schedule,429% of BCBS fee schedule,139.55,447,,,fee schedule,447% of BCBS fee schedule,139.55,447,,,fee schedule,447% of BCBS fee schedule,139.55,447,,,fee schedule,447% of BCBS fee schedule,82.8,90,,66.24,percent of total billed charges,90% of total billed charges,73.6,80,,58.88,percent of total billed charges,80% of total billed charges,82.8,90,,66.24,percent of total billed charges,90% of total billed charges,69,75,,55.2,percent of total billed charges,75% of total billed charges,35.73,122,,,fee schedule,122% of HUMANA fee schedule,26.68,29,,21.344,percent of total billed charges,29% of total billed charges,29.29,100,,,fee schedule,100% of CMS fee schedule,61.64,67,,49.312,percent of total billed charges,67% of total billed charges,26.12,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,73.6,80,,58.88,percent of total billed charges,80% of total billed charges,59.8,65,,47.84,percent of total billed charges,65% of total billed charges,32.82,35.67,,26.256,percent of total billed charges,35.67% of total billed charges,26.12,139.55,
MUSCLE TEST/BODY W HAND PTA,4210270,CDM,420,RC,97750,HCPCS,outpatient,,,92,36.80,GPCQ,78.2,85,,62.56,percent of total billed charges,85% of total billed charges,70.84,77,,56.67,percent of total billed charges,77% of total billed charges,32.94,100,,,fee schedule,100% of CMS fee schedule,164.74,429,,,fee schedule,429% of BCBS fee schedule,171.65,447,,,fee schedule,447% of BCBS fee schedule,171.65,447,,,fee schedule,447% of BCBS fee schedule,171.65,447,,,fee schedule,447% of BCBS fee schedule,82.8,90,,66.24,percent of total billed charges,90% of total billed charges,73.6,80,,58.88,percent of total billed charges,80% of total billed charges,82.8,90,,66.24,percent of total billed charges,90% of total billed charges,69,75,,55.2,percent of total billed charges,75% of total billed charges,40.19,122,,,fee schedule,122% of HUMANA fee schedule,26.68,29,,21.344,percent of total billed charges,29% of total billed charges,32.94,100,,,fee schedule,100% of CMS fee schedule,61.64,67,,49.312,percent of total billed charges,67% of total billed charges,32.79,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,73.6,80,,58.88,percent of total billed charges,80% of total billed charges,59.8,65,,47.84,percent of total billed charges,65% of total billed charges,32.82,35.67,,26.256,percent of total billed charges,35.67% of total billed charges,26.68,171.65,
MUSCLE TEST/BODY W/O HAND PTA,4210280,CDM,420,RC,97750,HCPCS,outpatient,,,92,36.80,GPCQ,78.2,85,,62.56,percent of total billed charges,85% of total billed charges,70.84,77,,56.67,percent of total billed charges,77% of total billed charges,32.94,100,,,fee schedule,100% of CMS fee schedule,164.74,429,,,fee schedule,429% of BCBS fee schedule,171.65,447,,,fee schedule,447% of BCBS fee schedule,171.65,447,,,fee schedule,447% of BCBS fee schedule,171.65,447,,,fee schedule,447% of BCBS fee schedule,82.8,90,,66.24,percent of total billed charges,90% of total billed charges,73.6,80,,58.88,percent of total billed charges,80% of total billed charges,82.8,90,,66.24,percent of total billed charges,90% of total billed charges,69,75,,55.2,percent of total billed charges,75% of total billed charges,40.19,122,,,fee schedule,122% of HUMANA fee schedule,26.68,29,,21.344,percent of total billed charges,29% of total billed charges,32.94,100,,,fee schedule,100% of CMS fee schedule,61.64,67,,49.312,percent of total billed charges,67% of total billed charges,32.79,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,73.6,80,,58.88,percent of total billed charges,80% of total billed charges,59.8,65,,47.84,percent of total billed charges,65% of total billed charges,32.82,35.67,,26.256,percent of total billed charges,35.67% of total billed charges,26.68,171.65,
MYOFASCIAL RELEASE PTA 15 MIN,4210305,CDM,420,RC,97140,HCPCS,outpatient,,,92,36.80,GPCQ,78.2,85,,62.56,percent of total billed charges,85% of total billed charges,70.84,77,,56.67,percent of total billed charges,77% of total billed charges,26.26,100,,,fee schedule,100% of CMS fee schedule,121.62,429,,,fee schedule,429% of BCBS fee schedule,126.72,447,,,fee schedule,447% of BCBS fee schedule,126.72,447,,,fee schedule,447% of BCBS fee schedule,126.72,447,,,fee schedule,447% of BCBS fee schedule,82.8,90,,66.24,percent of total billed charges,90% of total billed charges,73.6,80,,58.88,percent of total billed charges,80% of total billed charges,82.8,90,,66.24,percent of total billed charges,90% of total billed charges,69,75,,55.2,percent of total billed charges,75% of total billed charges,32.04,122,,,fee schedule,122% of HUMANA fee schedule,26.68,29,,21.344,percent of total billed charges,29% of total billed charges,26.26,100,,,fee schedule,100% of CMS fee schedule,61.64,67,,49.312,percent of total billed charges,67% of total billed charges,29.66,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,73.6,80,,58.88,percent of total billed charges,80% of total billed charges,59.8,65,,47.84,percent of total billed charges,65% of total billed charges,32.82,35.67,,26.256,percent of total billed charges,35.67% of total billed charges,26.26,126.72,
PARAFIN BATH PTA,4210350,CDM,420,RC,97018,HCPCS,outpatient,,,59,23.60,GPCQ,50.15,85,,40.12,percent of total billed charges,85% of total billed charges,45.43,77,,36.34,percent of total billed charges,77% of total billed charges,5.41,100,,,fee schedule,100% of CMS fee schedule,38.48,429,,,fee schedule,429% of BCBS fee schedule,40.1,447,,,fee schedule,447% of BCBS fee schedule,40.1,447,,,fee schedule,447% of BCBS fee schedule,40.1,447,,,fee schedule,447% of BCBS fee schedule,53.1,90,,42.48,percent of total billed charges,90% of total billed charges,47.2,80,,37.76,percent of total billed charges,80% of total billed charges,53.1,90,,42.48,percent of total billed charges,90% of total billed charges,44.25,75,,35.4,percent of total billed charges,75% of total billed charges,6.6,122,,,fee schedule,122% of HUMANA fee schedule,17.11,29,,13.688,percent of total billed charges,29% of total billed charges,5.41,100,,,fee schedule,100% of CMS fee schedule,39.53,67,,31.624,percent of total billed charges,67% of total billed charges,10.73,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,47.2,80,,37.76,percent of total billed charges,80% of total billed charges,38.35,65,,30.68,percent of total billed charges,65% of total billed charges,21.05,35.67,,16.84,percent of total billed charges,35.67% of total billed charges,5.41,53.1,
EXERCISE 15 MIN PTA,4210370,CDM,420,RC,97110,HCPCS,outpatient,,,93,37.20,GPCQ,79.05,85,,63.24,percent of total billed charges,85% of total billed charges,71.61,77,,57.29,percent of total billed charges,77% of total billed charges,28.51,100,,,fee schedule,100% of CMS fee schedule,133.93,429,,,fee schedule,429% of BCBS fee schedule,139.55,447,,,fee schedule,447% of BCBS fee schedule,139.55,447,,,fee schedule,447% of BCBS fee schedule,139.55,447,,,fee schedule,447% of BCBS fee schedule,83.7,90,,66.96,percent of total billed charges,90% of total billed charges,74.4,80,,59.52,percent of total billed charges,80% of total billed charges,83.7,90,,66.96,percent of total billed charges,90% of total billed charges,69.75,75,,55.8,percent of total billed charges,75% of total billed charges,34.78,122,,,fee schedule,122% of HUMANA fee schedule,26.97,29,,21.576,percent of total billed charges,29% of total billed charges,28.51,100,,,fee schedule,100% of CMS fee schedule,62.31,67,,49.848,percent of total billed charges,67% of total billed charges,31.72,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,74.4,80,,59.52,percent of total billed charges,80% of total billed charges,60.45,65,,48.36,percent of total billed charges,65% of total billed charges,33.17,35.67,,26.536,percent of total billed charges,35.67% of total billed charges,26.97,139.55,
ADAPTIVE EQP TRAIN PER 15 PTA,4210381,CDM,420,RC,97535,HCPCS,outpatient,,,92,36.80,GPCQ,78.2,85,,62.56,percent of total billed charges,85% of total billed charges,70.84,77,,56.67,percent of total billed charges,77% of total billed charges,31.67,100,,,fee schedule,100% of CMS fee schedule,150.88,429,,,fee schedule,429% of BCBS fee schedule,157.21,447,,,fee schedule,447% of BCBS fee schedule,157.21,447,,,fee schedule,447% of BCBS fee schedule,157.21,447,,,fee schedule,447% of BCBS fee schedule,82.8,90,,66.24,percent of total billed charges,90% of total billed charges,73.6,80,,58.88,percent of total billed charges,80% of total billed charges,82.8,90,,66.24,percent of total billed charges,90% of total billed charges,69,75,,55.2,percent of total billed charges,75% of total billed charges,38.64,122,,,fee schedule,122% of HUMANA fee schedule,26.68,29,,21.344,percent of total billed charges,29% of total billed charges,31.67,100,,,fee schedule,100% of CMS fee schedule,61.64,67,,49.312,percent of total billed charges,67% of total billed charges,34.73,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,73.6,80,,58.88,percent of total billed charges,80% of total billed charges,59.8,65,,47.84,percent of total billed charges,65% of total billed charges,32.82,35.67,,26.256,percent of total billed charges,35.67% of total billed charges,26.68,157.21,
ORTHOTIC TRAIN PER 15 MIN PTA,4210382,CDM,420,RC,97760,HCPCS,outpatient,,,92,36.80,GPCQ,78.2,85,,62.56,percent of total billed charges,85% of total billed charges,70.84,77,,56.67,percent of total billed charges,77% of total billed charges,45.98,100,,,fee schedule,100% of CMS fee schedule,204.76,429,,,fee schedule,429% of BCBS fee schedule,213.35,447,,,fee schedule,447% of BCBS fee schedule,213.35,447,,,fee schedule,447% of BCBS fee schedule,213.35,447,,,fee schedule,447% of BCBS fee schedule,82.8,90,,66.24,percent of total billed charges,90% of total billed charges,73.6,80,,58.88,percent of total billed charges,80% of total billed charges,82.8,90,,66.24,percent of total billed charges,90% of total billed charges,69,75,,55.2,percent of total billed charges,75% of total billed charges,56.1,122,,,fee schedule,122% of HUMANA fee schedule,26.68,29,,21.344,percent of total billed charges,29% of total billed charges,45.98,100,,,fee schedule,100% of CMS fee schedule,61.64,67,,49.312,percent of total billed charges,67% of total billed charges,37.82,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,73.6,80,,58.88,percent of total billed charges,80% of total billed charges,59.8,65,,47.84,percent of total billed charges,65% of total billed charges,32.82,35.67,,26.256,percent of total billed charges,35.67% of total billed charges,26.68,213.35,
DRESSING CHANGE PTA,4210460,CDM,420,RC,97602,HCPCS,outpatient,,,319,127.60,GPCQ,271.15,85,,216.92,percent of total billed charges,85% of total billed charges,245.63,77,,196.5,percent of total billed charges,77% of total billed charges,175.08,100,,,fee schedule,100% of CMS OPPS rate,724.8,429,,,fee schedule,429% of BCBS fee schedule,755.21,447,,,fee schedule,447% of BCBS fee schedule,755.21,447,,,fee schedule,447% of BCBS fee schedule,755.21,447,,,fee schedule,447% of BCBS fee schedule,287.1,90,,229.68,percent of total billed charges,90% of total billed charges,255.2,80,,204.16,percent of total billed charges,80% of total billed charges,287.1,90,,229.68,percent of total billed charges,90% of total billed charges,239.25,75,,191.4,percent of total billed charges,75% of total billed charges,213.59,122,,,fee schedule,122% of HUMANA fee schedule,92.51,29,,74.008,percent of total billed charges,29% of total billed charges,175.08,100,,,fee schedule,100% of CMS OPPS rate,213.73,67,,170.984,percent of total billed charges,67% of total billed charges,57.28,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,255.2,80,,204.16,percent of total billed charges,80% of total billed charges,207.35,65,,165.88,percent of total billed charges,65% of total billed charges,113.79,35.67,,91.032,percent of total billed charges,35.67% of total billed charges,57.28,755.21,
GAIT TRAINING 1-15 MIN PTA,4210480,CDM,420,RC,97116,HCPCS,outpatient,,,100,40.00,GPCQ,85,85,,68,percent of total billed charges,85% of total billed charges,77,77,,61.6,percent of total billed charges,77% of total billed charges,28.51,100,,,fee schedule,100% of CMS fee schedule,132.39,429,,,fee schedule,429% of BCBS fee schedule,137.94,447,,,fee schedule,447% of BCBS fee schedule,137.94,447,,,fee schedule,447% of BCBS fee schedule,137.94,447,,,fee schedule,447% of BCBS fee schedule,90,90,,72,percent of total billed charges,90% of total billed charges,80,80,,64,percent of total billed charges,80% of total billed charges,90,90,,72,percent of total billed charges,90% of total billed charges,75,75,,60,percent of total billed charges,75% of total billed charges,34.78,122,,,fee schedule,122% of HUMANA fee schedule,29,29,,23.2,percent of total billed charges,29% of total billed charges,28.51,100,,,fee schedule,100% of CMS fee schedule,67,67,,53.6,percent of total billed charges,67% of total billed charges,27.92,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,80,80,,64,percent of total billed charges,80% of total billed charges,65,65,,52,percent of total billed charges,65% of total billed charges,35.67,35.67,,28.536,percent of total billed charges,35.67% of total billed charges,27.92,137.94,
PHONOPHORESIS PER 15 MIN PTA,4210500,CDM,420,RC,97035,HCPCS,outpatient,,,66,26.40,GPCQ,56.1,85,,44.88,percent of total billed charges,85% of total billed charges,50.82,77,,40.66,percent of total billed charges,77% of total billed charges,13.56,100,,,fee schedule,100% of CMS fee schedule,58.52,429,,,fee schedule,429% of BCBS fee schedule,60.97,447,,,fee schedule,447% of BCBS fee schedule,60.97,447,,,fee schedule,447% of BCBS fee schedule,60.97,447,,,fee schedule,447% of BCBS fee schedule,59.4,90,,47.52,percent of total billed charges,90% of total billed charges,52.8,80,,42.24,percent of total billed charges,80% of total billed charges,59.4,90,,47.52,percent of total billed charges,90% of total billed charges,49.5,75,,39.6,percent of total billed charges,75% of total billed charges,16.54,122,,,fee schedule,122% of HUMANA fee schedule,19.14,29,,15.312,percent of total billed charges,29% of total billed charges,13.56,100,,,fee schedule,100% of CMS fee schedule,44.22,67,,35.376,percent of total billed charges,67% of total billed charges,12.4,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,52.8,80,,42.24,percent of total billed charges,80% of total billed charges,42.9,65,,34.32,percent of total billed charges,65% of total billed charges,23.54,35.67,,18.832,percent of total billed charges,35.67% of total billed charges,12.4,60.97,
THERA ACTIVITY PER 15 MIN PTA,4210522,CDM,420,RC,97530,HCPCS,outpatient,,,93,37.20,GPCQ,79.05,85,,63.24,percent of total billed charges,85% of total billed charges,71.61,77,,57.29,percent of total billed charges,77% of total billed charges,35.45,100,,,fee schedule,100% of CMS fee schedule,177.05,429,,,fee schedule,429% of BCBS fee schedule,184.48,447,,,fee schedule,447% of BCBS fee schedule,184.48,447,,,fee schedule,447% of BCBS fee schedule,184.48,447,,,fee schedule,447% of BCBS fee schedule,83.7,90,,66.96,percent of total billed charges,90% of total billed charges,74.4,80,,59.52,percent of total billed charges,80% of total billed charges,83.7,90,,66.96,percent of total billed charges,90% of total billed charges,69.75,75,,55.8,percent of total billed charges,75% of total billed charges,43.25,122,,,fee schedule,122% of HUMANA fee schedule,26.97,29,,21.576,percent of total billed charges,29% of total billed charges,35.45,100,,,fee schedule,100% of CMS fee schedule,62.31,67,,49.848,percent of total billed charges,67% of total billed charges,34.71,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,74.4,80,,59.52,percent of total billed charges,80% of total billed charges,60.45,65,,48.36,percent of total billed charges,65% of total billed charges,33.17,35.67,,26.536,percent of total billed charges,35.67% of total billed charges,26.97,184.48,
THERAP PROC 15 MIN PTA,4210523,CDM,420,RC,97110,HCPCS,outpatient,,,92,36.80,GPCQ,78.2,85,,62.56,percent of total billed charges,85% of total billed charges,70.84,77,,56.67,percent of total billed charges,77% of total billed charges,28.51,100,,,fee schedule,100% of CMS fee schedule,133.93,429,,,fee schedule,429% of BCBS fee schedule,139.55,447,,,fee schedule,447% of BCBS fee schedule,139.55,447,,,fee schedule,447% of BCBS fee schedule,139.55,447,,,fee schedule,447% of BCBS fee schedule,82.8,90,,66.24,percent of total billed charges,90% of total billed charges,73.6,80,,58.88,percent of total billed charges,80% of total billed charges,82.8,90,,66.24,percent of total billed charges,90% of total billed charges,69,75,,55.2,percent of total billed charges,75% of total billed charges,34.78,122,,,fee schedule,122% of HUMANA fee schedule,26.68,29,,21.344,percent of total billed charges,29% of total billed charges,28.51,100,,,fee schedule,100% of CMS fee schedule,61.64,67,,49.312,percent of total billed charges,67% of total billed charges,31.72,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,73.6,80,,58.88,percent of total billed charges,80% of total billed charges,59.8,65,,47.84,percent of total billed charges,65% of total billed charges,32.82,35.67,,26.256,percent of total billed charges,35.67% of total billed charges,26.68,139.55,
THERAP PROC GROUP - PTA,4210526,CDM,420,RC,97150,HCPCS,outpatient,,,92,36.80,GPCQ,78.2,85,,62.56,percent of total billed charges,85% of total billed charges,70.84,77,,56.67,percent of total billed charges,77% of total billed charges,17.49,100,,,fee schedule,100% of CMS fee schedule,80.05,429,,,fee schedule,429% of BCBS fee schedule,83.41,447,,,fee schedule,447% of BCBS fee schedule,83.41,447,,,fee schedule,447% of BCBS fee schedule,83.41,447,,,fee schedule,447% of BCBS fee schedule,82.8,90,,66.24,percent of total billed charges,90% of total billed charges,73.6,80,,58.88,percent of total billed charges,80% of total billed charges,82.8,90,,66.24,percent of total billed charges,90% of total billed charges,69,75,,55.2,percent of total billed charges,75% of total billed charges,21.34,122,,,fee schedule,122% of HUMANA fee schedule,26.68,29,,21.344,percent of total billed charges,29% of total billed charges,17.49,100,,,fee schedule,100% of CMS fee schedule,61.64,67,,49.312,percent of total billed charges,67% of total billed charges,20.58,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,73.6,80,,58.88,percent of total billed charges,80% of total billed charges,59.8,65,,47.84,percent of total billed charges,65% of total billed charges,32.82,35.67,,26.256,percent of total billed charges,35.67% of total billed charges,17.49,83.41,
NEUROMUSC RE-ED 15 MIN PTA,4210530,CDM,420,RC,97112,HCPCS,outpatient,,,93,37.20,GPCQ,79.05,85,,63.24,percent of total billed charges,85% of total billed charges,71.61,77,,57.29,percent of total billed charges,77% of total billed charges,32.7,100,,,fee schedule,100% of CMS fee schedule,152.42,429,,,fee schedule,429% of BCBS fee schedule,158.82,447,,,fee schedule,447% of BCBS fee schedule,158.82,447,,,fee schedule,447% of BCBS fee schedule,158.82,447,,,fee schedule,447% of BCBS fee schedule,83.7,90,,66.96,percent of total billed charges,90% of total billed charges,74.4,80,,59.52,percent of total billed charges,80% of total billed charges,83.7,90,,66.96,percent of total billed charges,90% of total billed charges,69.75,75,,55.8,percent of total billed charges,75% of total billed charges,39.89,122,,,fee schedule,122% of HUMANA fee schedule,26.97,29,,21.576,percent of total billed charges,29% of total billed charges,32.7,100,,,fee schedule,100% of CMS fee schedule,62.31,67,,49.848,percent of total billed charges,67% of total billed charges,33.39,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,74.4,80,,59.52,percent of total billed charges,80% of total billed charges,60.45,65,,48.36,percent of total billed charges,65% of total billed charges,33.17,35.67,,26.536,percent of total billed charges,35.67% of total billed charges,26.97,158.82,
TENS APPLICATION PTA,4210550,CDM,420,RC,97014,HCPCS,outpatient,,,79,31.60,GPCQ,67.15,85,,53.72,percent of total billed charges,85% of total billed charges,60.83,77,,48.66,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,67.74,429,,,fee schedule,429% of BCBS fee schedule,70.58,447,,,fee schedule,447% of BCBS fee schedule,70.58,447,,,fee schedule,447% of BCBS fee schedule,70.58,447,,,fee schedule,447% of BCBS fee schedule,71.1,90,,56.88,percent of total billed charges,90% of total billed charges,63.2,80,,50.56,percent of total billed charges,80% of total billed charges,71.1,90,,56.88,percent of total billed charges,90% of total billed charges,59.25,75,,47.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,22.91,29,,18.328,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,52.93,67,,42.344,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,63.2,80,,50.56,percent of total billed charges,80% of total billed charges,51.35,65,,41.08,percent of total billed charges,65% of total billed charges,28.18,35.67,,22.544,percent of total billed charges,35.67% of total billed charges,22.91,71.1,
TRACTION MANUAL PTA 15 MIN,4210560,CDM,420,RC,97140,HCPCS,outpatient,,,83,33.20,GPCQ,70.55,85,,56.44,percent of total billed charges,85% of total billed charges,63.91,77,,51.13,percent of total billed charges,77% of total billed charges,26.26,100,,,fee schedule,100% of CMS fee schedule,121.62,429,,,fee schedule,429% of BCBS fee schedule,126.72,447,,,fee schedule,447% of BCBS fee schedule,126.72,447,,,fee schedule,447% of BCBS fee schedule,126.72,447,,,fee schedule,447% of BCBS fee schedule,74.7,90,,59.76,percent of total billed charges,90% of total billed charges,66.4,80,,53.12,percent of total billed charges,80% of total billed charges,74.7,90,,59.76,percent of total billed charges,90% of total billed charges,62.25,75,,49.8,percent of total billed charges,75% of total billed charges,32.04,122,,,fee schedule,122% of HUMANA fee schedule,24.07,29,,19.256,percent of total billed charges,29% of total billed charges,26.26,100,,,fee schedule,100% of CMS fee schedule,55.61,67,,44.488,percent of total billed charges,67% of total billed charges,29.66,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,66.4,80,,53.12,percent of total billed charges,80% of total billed charges,53.95,65,,43.16,percent of total billed charges,65% of total billed charges,29.61,35.67,,23.688,percent of total billed charges,35.67% of total billed charges,24.07,126.72,
TRACTION MECH PER DAY PTA,4210590,CDM,420,RC,97012,HCPCS,outpatient,,,83,33.20,GPCQ,70.55,85,,56.44,percent of total billed charges,85% of total billed charges,63.91,77,,51.13,percent of total billed charges,77% of total billed charges,13.63,100,,,fee schedule,100% of CMS fee schedule,64.65,429,,,fee schedule,429% of BCBS fee schedule,67.36,447,,,fee schedule,447% of BCBS fee schedule,67.36,447,,,fee schedule,447% of BCBS fee schedule,67.36,447,,,fee schedule,447% of BCBS fee schedule,74.7,90,,59.76,percent of total billed charges,90% of total billed charges,66.4,80,,53.12,percent of total billed charges,80% of total billed charges,74.7,90,,59.76,percent of total billed charges,90% of total billed charges,62.25,75,,49.8,percent of total billed charges,75% of total billed charges,16.63,122,,,fee schedule,122% of HUMANA fee schedule,24.07,29,,19.256,percent of total billed charges,29% of total billed charges,13.63,100,,,fee schedule,100% of CMS fee schedule,55.61,67,,44.488,percent of total billed charges,67% of total billed charges,15.84,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,66.4,80,,53.12,percent of total billed charges,80% of total billed charges,53.95,65,,43.16,percent of total billed charges,65% of total billed charges,29.61,35.67,,23.688,percent of total billed charges,35.67% of total billed charges,13.63,74.7,
ULTRASOUND TREAT PER 15 PTA,4210600,CDM,420,RC,97035,HCPCS,outpatient,,,67,26.80,GPCQ,56.95,85,,45.56,percent of total billed charges,85% of total billed charges,51.59,77,,41.27,percent of total billed charges,77% of total billed charges,13.56,100,,,fee schedule,100% of CMS fee schedule,58.52,429,,,fee schedule,429% of BCBS fee schedule,60.97,447,,,fee schedule,447% of BCBS fee schedule,60.97,447,,,fee schedule,447% of BCBS fee schedule,60.97,447,,,fee schedule,447% of BCBS fee schedule,60.3,90,,48.24,percent of total billed charges,90% of total billed charges,53.6,80,,42.88,percent of total billed charges,80% of total billed charges,60.3,90,,48.24,percent of total billed charges,90% of total billed charges,50.25,75,,40.2,percent of total billed charges,75% of total billed charges,16.54,122,,,fee schedule,122% of HUMANA fee schedule,19.43,29,,15.544,percent of total billed charges,29% of total billed charges,13.56,100,,,fee schedule,100% of CMS fee schedule,44.89,67,,35.912,percent of total billed charges,67% of total billed charges,12.4,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,53.6,80,,42.88,percent of total billed charges,80% of total billed charges,43.55,65,,34.84,percent of total billed charges,65% of total billed charges,23.9,35.67,,19.12,percent of total billed charges,35.67% of total billed charges,12.4,60.97,
VASOPNEUMATIC DEV TXT PTA,4210606,CDM,420,RC,97016,HCPCS,outpatient,,,81,32.40,GPCQ,68.85,85,,55.08,percent of total billed charges,85% of total billed charges,62.37,77,,49.9,percent of total billed charges,77% of total billed charges,11.3,100,,,fee schedule,100% of CMS fee schedule,69.28,429,,,fee schedule,429% of BCBS fee schedule,72.19,447,,,fee schedule,447% of BCBS fee schedule,72.19,447,,,fee schedule,447% of BCBS fee schedule,72.19,447,,,fee schedule,447% of BCBS fee schedule,72.9,90,,58.32,percent of total billed charges,90% of total billed charges,64.8,80,,51.84,percent of total billed charges,80% of total billed charges,72.9,90,,58.32,percent of total billed charges,90% of total billed charges,60.75,75,,48.6,percent of total billed charges,75% of total billed charges,13.79,122,,,fee schedule,122% of HUMANA fee schedule,23.49,29,,18.792,percent of total billed charges,29% of total billed charges,11.3,100,,,fee schedule,100% of CMS fee schedule,54.27,67,,43.416,percent of total billed charges,67% of total billed charges,19.05,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,64.8,80,,51.84,percent of total billed charges,80% of total billed charges,52.65,65,,42.12,percent of total billed charges,65% of total billed charges,28.89,35.67,,23.112,percent of total billed charges,35.67% of total billed charges,11.3,72.9,
NEG PRESSURE WND TX 50 CM PTA,4210607,CDM,420,RC,97607,HCPCS,outpatient,,,1506,602.40,GPCQ,1280.1,85,,1024.08,percent of total billed charges,85% of total billed charges,1159.62,77,,927.7,percent of total billed charges,77% of total billed charges,348.71,100,,,fee schedule,100% of CMS OPPS rate,1333.33,429,,,fee schedule,429% of BCBS fee schedule,1389.28,447,,,fee schedule,447% of BCBS fee schedule,1389.28,447,,,fee schedule,447% of BCBS fee schedule,1389.28,447,,,fee schedule,447% of BCBS fee schedule,1355.4,90,,1084.32,percent of total billed charges,90% of total billed charges,1204.8,80,,963.84,percent of total billed charges,80% of total billed charges,1355.4,90,,1084.32,percent of total billed charges,90% of total billed charges,1129.5,75,,903.6,percent of total billed charges,75% of total billed charges,425.42,122,,,fee schedule,122% of HUMANA fee schedule,436.74,29,,349.392,percent of total billed charges,29% of total billed charges,348.71,100,,,fee schedule,100% of CMS OPPS rate,1009.02,67,,807.216,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1204.8,80,,963.84,percent of total billed charges,80% of total billed charges,978.9,65,,783.12,percent of total billed charges,65% of total billed charges,537.19,35.67,,429.752,percent of total billed charges,35.67% of total billed charges,348.71,1389.28,
NEG PRESSURE WOUND TX +50 PTA,4210608,CDM,420,RC,97607,HCPCS,outpatient,,,1506,602.40,GPCQ,1280.1,85,,1024.08,percent of total billed charges,85% of total billed charges,1159.62,77,,927.7,percent of total billed charges,77% of total billed charges,348.71,100,,,fee schedule,100% of CMS OPPS rate,1333.33,429,,,fee schedule,429% of BCBS fee schedule,1389.28,447,,,fee schedule,447% of BCBS fee schedule,1389.28,447,,,fee schedule,447% of BCBS fee schedule,1389.28,447,,,fee schedule,447% of BCBS fee schedule,1355.4,90,,1084.32,percent of total billed charges,90% of total billed charges,1204.8,80,,963.84,percent of total billed charges,80% of total billed charges,1355.4,90,,1084.32,percent of total billed charges,90% of total billed charges,1129.5,75,,903.6,percent of total billed charges,75% of total billed charges,425.42,122,,,fee schedule,122% of HUMANA fee schedule,436.74,29,,349.392,percent of total billed charges,29% of total billed charges,348.71,100,,,fee schedule,100% of CMS OPPS rate,1009.02,67,,807.216,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1204.8,80,,963.84,percent of total billed charges,80% of total billed charges,978.9,65,,783.12,percent of total billed charges,65% of total billed charges,537.19,35.67,,429.752,percent of total billed charges,35.67% of total billed charges,348.71,1389.28,
WHIRLPOOL 1 OR MORE AREAS PTA,4210610,CDM,420,RC,97022,HCPCS,outpatient,,,106,42.40,GPCQ,90.1,85,,72.08,percent of total billed charges,85% of total billed charges,81.62,77,,65.3,percent of total billed charges,77% of total billed charges,16.34,100,,,fee schedule,100% of CMS fee schedule,83.14,429,,,fee schedule,429% of BCBS fee schedule,86.63,447,,,fee schedule,447% of BCBS fee schedule,86.63,447,,,fee schedule,447% of BCBS fee schedule,86.63,447,,,fee schedule,447% of BCBS fee schedule,95.4,90,,76.32,percent of total billed charges,90% of total billed charges,84.8,80,,67.84,percent of total billed charges,80% of total billed charges,95.4,90,,76.32,percent of total billed charges,90% of total billed charges,79.5,75,,63.6,percent of total billed charges,75% of total billed charges,19.93,122,,,fee schedule,122% of HUMANA fee schedule,30.74,29,,24.592,percent of total billed charges,29% of total billed charges,16.34,100,,,fee schedule,100% of CMS fee schedule,71.02,67,,56.816,percent of total billed charges,67% of total billed charges,23.05,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,84.8,80,,67.84,percent of total billed charges,80% of total billed charges,68.9,65,,55.12,percent of total billed charges,65% of total billed charges,37.81,35.67,,30.248,percent of total billed charges,35.67% of total billed charges,16.34,95.4,
WHEELCHAIR TRAIN PER 15 PTA,4210650,CDM,420,RC,97542,HCPCS,outpatient,,,115,46.00,GPCQ,97.75,85,,78.2,percent of total billed charges,85% of total billed charges,88.55,77,,70.84,percent of total billed charges,77% of total billed charges,30.77,100,,,fee schedule,100% of CMS fee schedule,146.25,429,,,fee schedule,429% of BCBS fee schedule,152.38,447,,,fee schedule,447% of BCBS fee schedule,152.38,447,,,fee schedule,447% of BCBS fee schedule,152.38,447,,,fee schedule,447% of BCBS fee schedule,103.5,90,,82.8,percent of total billed charges,90% of total billed charges,92,80,,73.6,percent of total billed charges,80% of total billed charges,103.5,90,,82.8,percent of total billed charges,90% of total billed charges,86.25,75,,69,percent of total billed charges,75% of total billed charges,37.54,122,,,fee schedule,122% of HUMANA fee schedule,33.35,29,,26.68,percent of total billed charges,29% of total billed charges,30.77,100,,,fee schedule,100% of CMS fee schedule,77.05,67,,61.64,percent of total billed charges,67% of total billed charges,30.38,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,92,80,,73.6,percent of total billed charges,80% of total billed charges,74.75,65,,59.8,percent of total billed charges,65% of total billed charges,41.02,35.67,,32.816,percent of total billed charges,35.67% of total billed charges,30.38,152.38,
MANUAL THERAPY TECH PTA 15 MIN,4210666,CDM,420,RC,97140,HCPCS,outpatient,,,140,56.00,GPCQ,119,85,,95.2,percent of total billed charges,85% of total billed charges,107.8,77,,86.24,percent of total billed charges,77% of total billed charges,26.26,100,,,fee schedule,100% of CMS fee schedule,121.62,429,,,fee schedule,429% of BCBS fee schedule,126.72,447,,,fee schedule,447% of BCBS fee schedule,126.72,447,,,fee schedule,447% of BCBS fee schedule,126.72,447,,,fee schedule,447% of BCBS fee schedule,126,90,,100.8,percent of total billed charges,90% of total billed charges,112,80,,89.6,percent of total billed charges,80% of total billed charges,126,90,,100.8,percent of total billed charges,90% of total billed charges,105,75,,84,percent of total billed charges,75% of total billed charges,32.04,122,,,fee schedule,122% of HUMANA fee schedule,40.6,29,,32.48,percent of total billed charges,29% of total billed charges,26.26,100,,,fee schedule,100% of CMS fee schedule,93.8,67,,75.04,percent of total billed charges,67% of total billed charges,29.66,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,112,80,,89.6,percent of total billed charges,80% of total billed charges,91,65,,72.8,percent of total billed charges,65% of total billed charges,49.94,35.67,,39.952,percent of total billed charges,35.67% of total billed charges,26.26,126.72,
PT DRESSING CHANGE PT,4200460,CDM,421,RC,97602,HCPCS,outpatient,,,319,127.60,GP,271.15,85,,216.92,percent of total billed charges,85% of total billed charges,245.63,77,,196.5,percent of total billed charges,77% of total billed charges,175.08,100,,,fee schedule,100% of CMS OPPS rate,724.8,429,,,fee schedule,429% of BCBS fee schedule,755.21,447,,,fee schedule,447% of BCBS fee schedule,755.21,447,,,fee schedule,447% of BCBS fee schedule,755.21,447,,,fee schedule,447% of BCBS fee schedule,287.1,90,,229.68,percent of total billed charges,90% of total billed charges,255.2,80,,204.16,percent of total billed charges,80% of total billed charges,287.1,90,,229.68,percent of total billed charges,90% of total billed charges,239.25,75,,191.4,percent of total billed charges,75% of total billed charges,213.59,122,,,fee schedule,122% of HUMANA fee schedule,92.51,29,,74.008,percent of total billed charges,29% of total billed charges,175.08,100,,,fee schedule,100% of CMS OPPS rate,213.73,67,,170.984,percent of total billed charges,67% of total billed charges,57.28,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,255.2,80,,204.16,percent of total billed charges,80% of total billed charges,207.35,65,,165.88,percent of total billed charges,65% of total billed charges,113.79,35.67,,91.032,percent of total billed charges,35.67% of total billed charges,57.28,755.21,
PT REEVALUATION,4200400,CDM,424,RC,97164,HCPCS,outpatient,,,162,64.80,GP,137.7,85,,110.16,percent of total billed charges,85% of total billed charges,124.74,77,,99.79,percent of total billed charges,77% of total billed charges,67.49,100,,,fee schedule,100% of CMS fee schedule,247.88,429,,,fee schedule,429% of BCBS fee schedule,258.28,447,,,fee schedule,447% of BCBS fee schedule,258.28,447,,,fee schedule,447% of BCBS fee schedule,258.28,447,,,fee schedule,447% of BCBS fee schedule,145.8,90,,116.64,percent of total billed charges,90% of total billed charges,129.6,80,,103.68,percent of total billed charges,80% of total billed charges,145.8,90,,116.64,percent of total billed charges,90% of total billed charges,121.5,75,,97.2,percent of total billed charges,75% of total billed charges,82.34,122,,,fee schedule,122% of HUMANA fee schedule,46.98,29,,37.584,percent of total billed charges,29% of total billed charges,67.49,100,,,fee schedule,100% of CMS fee schedule,108.54,67,,86.832,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,129.6,80,,103.68,percent of total billed charges,80% of total billed charges,105.3,65,,84.24,percent of total billed charges,65% of total billed charges,57.79,35.67,,46.232,percent of total billed charges,35.67% of total billed charges,46.98,258.28,
PT EVALUATION LOW COMPLEXITY,4200515,CDM,424,RC,97161,HCPCS,outpatient,,,240,96.00,GP,204,85,,163.2,percent of total billed charges,85% of total billed charges,184.8,77,,147.84,percent of total billed charges,77% of total billed charges,97.49,100,,,fee schedule,100% of CMS fee schedule,366.45,429,,,fee schedule,429% of BCBS fee schedule,381.83,447,,,fee schedule,447% of BCBS fee schedule,381.83,447,,,fee schedule,447% of BCBS fee schedule,381.83,447,,,fee schedule,447% of BCBS fee schedule,216,90,,172.8,percent of total billed charges,90% of total billed charges,192,80,,153.6,percent of total billed charges,80% of total billed charges,216,90,,172.8,percent of total billed charges,90% of total billed charges,180,75,,144,percent of total billed charges,75% of total billed charges,118.94,122,,,fee schedule,122% of HUMANA fee schedule,69.6,29,,55.68,percent of total billed charges,29% of total billed charges,97.49,100,,,fee schedule,100% of CMS fee schedule,160.8,67,,128.64,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,192,80,,153.6,percent of total billed charges,80% of total billed charges,156,65,,124.8,percent of total billed charges,65% of total billed charges,85.61,35.67,,68.488,percent of total billed charges,35.67% of total billed charges,69.6,381.83,
PT EVALUATION MOD COMPLEXITY,4200520,CDM,424,RC,97162,HCPCS,outpatient,,,313,125.20,GP,266.05,85,,212.84,percent of total billed charges,85% of total billed charges,241.01,77,,192.81,percent of total billed charges,77% of total billed charges,97.49,100,,,fee schedule,100% of CMS fee schedule,366.45,429,,,fee schedule,429% of BCBS fee schedule,381.83,447,,,fee schedule,447% of BCBS fee schedule,381.83,447,,,fee schedule,447% of BCBS fee schedule,381.83,447,,,fee schedule,447% of BCBS fee schedule,281.7,90,,225.36,percent of total billed charges,90% of total billed charges,250.4,80,,200.32,percent of total billed charges,80% of total billed charges,281.7,90,,225.36,percent of total billed charges,90% of total billed charges,234.75,75,,187.8,percent of total billed charges,75% of total billed charges,118.94,122,,,fee schedule,122% of HUMANA fee schedule,90.77,29,,72.616,percent of total billed charges,29% of total billed charges,97.49,100,,,fee schedule,100% of CMS fee schedule,209.71,67,,167.768,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,250.4,80,,200.32,percent of total billed charges,80% of total billed charges,203.45,65,,162.76,percent of total billed charges,65% of total billed charges,111.65,35.67,,89.32,percent of total billed charges,35.67% of total billed charges,90.77,381.83,
PT EVALUATION HIGH COMPLEXITY,4200525,CDM,424,RC,97163,HCPCS,outpatient,,,347,138.80,GP,294.95,85,,235.96,percent of total billed charges,85% of total billed charges,267.19,77,,213.75,percent of total billed charges,77% of total billed charges,97.49,100,,,fee schedule,100% of CMS fee schedule,366.45,429,,,fee schedule,429% of BCBS fee schedule,381.83,447,,,fee schedule,447% of BCBS fee schedule,381.83,447,,,fee schedule,447% of BCBS fee schedule,381.83,447,,,fee schedule,447% of BCBS fee schedule,312.3,90,,249.84,percent of total billed charges,90% of total billed charges,277.6,80,,222.08,percent of total billed charges,80% of total billed charges,312.3,90,,249.84,percent of total billed charges,90% of total billed charges,260.25,75,,208.2,percent of total billed charges,75% of total billed charges,118.94,122,,,fee schedule,122% of HUMANA fee schedule,100.63,29,,80.504,percent of total billed charges,29% of total billed charges,97.49,100,,,fee schedule,100% of CMS fee schedule,232.49,67,,185.992,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,277.6,80,,222.08,percent of total billed charges,80% of total billed charges,225.55,65,,180.44,percent of total billed charges,65% of total billed charges,123.77,35.67,,99.016,percent of total billed charges,35.67% of total billed charges,97.49,381.83,
OT RE-EVAL,4300005,CDM,430,RC,97168,HCPCS,outpatient,,,306,122.40,GO,260.1,85,,208.08,percent of total billed charges,85% of total billed charges,235.62,77,,188.5,percent of total billed charges,77% of total billed charges,67.81,100,,,fee schedule,100% of CMS fee schedule,269.45,429,,,fee schedule,429% of BCBS fee schedule,280.76,447,,,fee schedule,447% of BCBS fee schedule,280.76,447,,,fee schedule,447% of BCBS fee schedule,280.76,447,,,fee schedule,447% of BCBS fee schedule,275.4,90,,220.32,percent of total billed charges,90% of total billed charges,244.8,80,,195.84,percent of total billed charges,80% of total billed charges,275.4,90,,220.32,percent of total billed charges,90% of total billed charges,229.5,75,,183.6,percent of total billed charges,75% of total billed charges,82.73,122,,,fee schedule,122% of HUMANA fee schedule,88.74,29,,70.992,percent of total billed charges,29% of total billed charges,67.81,100,,,fee schedule,100% of CMS fee schedule,205.02,67,,164.016,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,244.8,80,,195.84,percent of total billed charges,80% of total billed charges,198.9,65,,159.12,percent of total billed charges,65% of total billed charges,109.15,35.67,,87.32,percent of total billed charges,35.67% of total billed charges,67.81,280.76,
OT PARAFFIN BATH,4300010,CDM,430,RC,97018,HCPCS,outpatient,,,47,18.80,GO,39.95,85,,31.96,percent of total billed charges,85% of total billed charges,36.19,77,,28.95,percent of total billed charges,77% of total billed charges,5.41,100,,,fee schedule,100% of CMS fee schedule,38.48,429,,,fee schedule,429% of BCBS fee schedule,40.1,447,,,fee schedule,447% of BCBS fee schedule,40.1,447,,,fee schedule,447% of BCBS fee schedule,40.1,447,,,fee schedule,447% of BCBS fee schedule,42.3,90,,33.84,percent of total billed charges,90% of total billed charges,37.6,80,,30.08,percent of total billed charges,80% of total billed charges,42.3,90,,33.84,percent of total billed charges,90% of total billed charges,35.25,75,,28.2,percent of total billed charges,75% of total billed charges,6.6,122,,,fee schedule,122% of HUMANA fee schedule,13.63,29,,10.904,percent of total billed charges,29% of total billed charges,5.41,100,,,fee schedule,100% of CMS fee schedule,31.49,67,,25.192,percent of total billed charges,67% of total billed charges,10.73,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,37.6,80,,30.08,percent of total billed charges,80% of total billed charges,30.55,65,,24.44,percent of total billed charges,65% of total billed charges,16.76,35.67,,13.408,percent of total billed charges,35.67% of total billed charges,5.41,42.3,
OT THERAPEUTIC EXERCISE 15 MIN,4300014,CDM,430,RC,97110,HCPCS,outpatient,,,154,61.60,GO,130.9,85,,104.72,percent of total billed charges,85% of total billed charges,118.58,77,,94.86,percent of total billed charges,77% of total billed charges,28.51,100,,,fee schedule,100% of CMS fee schedule,133.93,429,,,fee schedule,429% of BCBS fee schedule,139.55,447,,,fee schedule,447% of BCBS fee schedule,139.55,447,,,fee schedule,447% of BCBS fee schedule,139.55,447,,,fee schedule,447% of BCBS fee schedule,138.6,90,,110.88,percent of total billed charges,90% of total billed charges,123.2,80,,98.56,percent of total billed charges,80% of total billed charges,138.6,90,,110.88,percent of total billed charges,90% of total billed charges,115.5,75,,92.4,percent of total billed charges,75% of total billed charges,34.78,122,,,fee schedule,122% of HUMANA fee schedule,44.66,29,,35.728,percent of total billed charges,29% of total billed charges,28.51,100,,,fee schedule,100% of CMS fee schedule,103.18,67,,82.544,percent of total billed charges,67% of total billed charges,31.72,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,123.2,80,,98.56,percent of total billed charges,80% of total billed charges,100.1,65,,80.08,percent of total billed charges,65% of total billed charges,54.93,35.67,,43.944,percent of total billed charges,35.67% of total billed charges,28.51,139.55,
OT CONTRAST BATH PER 15 MIN,4300015,CDM,430,RC,97034,HCPCS,outpatient,,,77,30.80,GO,65.45,85,,52.36,percent of total billed charges,85% of total billed charges,59.29,77,,47.43,percent of total billed charges,77% of total billed charges,13.56,100,,,fee schedule,100% of CMS fee schedule,66.19,429,,,fee schedule,429% of BCBS fee schedule,68.97,447,,,fee schedule,447% of BCBS fee schedule,68.97,447,,,fee schedule,447% of BCBS fee schedule,68.97,447,,,fee schedule,447% of BCBS fee schedule,69.3,90,,55.44,percent of total billed charges,90% of total billed charges,61.6,80,,49.28,percent of total billed charges,80% of total billed charges,69.3,90,,55.44,percent of total billed charges,90% of total billed charges,57.75,75,,46.2,percent of total billed charges,75% of total billed charges,16.54,122,,,fee schedule,122% of HUMANA fee schedule,22.33,29,,17.864,percent of total billed charges,29% of total billed charges,13.56,100,,,fee schedule,100% of CMS fee schedule,51.59,67,,41.272,percent of total billed charges,67% of total billed charges,17.77,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,61.6,80,,49.28,percent of total billed charges,80% of total billed charges,50.05,65,,40.04,percent of total billed charges,65% of total billed charges,27.47,35.67,,21.976,percent of total billed charges,35.67% of total billed charges,13.56,69.3,
OT NEUROMUSCULAR PROC 15 MIN,4300016,CDM,430,RC,97112,HCPCS,outpatient,,,173,69.20,GO,147.05,85,,117.64,percent of total billed charges,85% of total billed charges,133.21,77,,106.57,percent of total billed charges,77% of total billed charges,32.7,100,,,fee schedule,100% of CMS fee schedule,152.42,429,,,fee schedule,429% of BCBS fee schedule,158.82,447,,,fee schedule,447% of BCBS fee schedule,158.82,447,,,fee schedule,447% of BCBS fee schedule,158.82,447,,,fee schedule,447% of BCBS fee schedule,155.7,90,,124.56,percent of total billed charges,90% of total billed charges,138.4,80,,110.72,percent of total billed charges,80% of total billed charges,155.7,90,,124.56,percent of total billed charges,90% of total billed charges,129.75,75,,103.8,percent of total billed charges,75% of total billed charges,39.89,122,,,fee schedule,122% of HUMANA fee schedule,50.17,29,,40.136,percent of total billed charges,29% of total billed charges,32.7,100,,,fee schedule,100% of CMS fee schedule,115.91,67,,92.728,percent of total billed charges,67% of total billed charges,33.39,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,138.4,80,,110.72,percent of total billed charges,80% of total billed charges,112.45,65,,89.96,percent of total billed charges,65% of total billed charges,61.71,35.67,,49.368,percent of total billed charges,35.67% of total billed charges,32.7,158.82,
OT THERAPEUTIC ACTIVITIES 15 M,4300020,CDM,430,RC,97530,HCPCS,outpatient,,,204,81.60,GO,173.4,85,,138.72,percent of total billed charges,85% of total billed charges,157.08,77,,125.66,percent of total billed charges,77% of total billed charges,35.45,100,,,fee schedule,100% of CMS fee schedule,177.05,429,,,fee schedule,429% of BCBS fee schedule,184.48,447,,,fee schedule,447% of BCBS fee schedule,184.48,447,,,fee schedule,447% of BCBS fee schedule,184.48,447,,,fee schedule,447% of BCBS fee schedule,183.6,90,,146.88,percent of total billed charges,90% of total billed charges,163.2,80,,130.56,percent of total billed charges,80% of total billed charges,183.6,90,,146.88,percent of total billed charges,90% of total billed charges,153,75,,122.4,percent of total billed charges,75% of total billed charges,43.25,122,,,fee schedule,122% of HUMANA fee schedule,59.16,29,,47.328,percent of total billed charges,29% of total billed charges,35.45,100,,,fee schedule,100% of CMS fee schedule,136.68,67,,109.344,percent of total billed charges,67% of total billed charges,34.71,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,163.2,80,,130.56,percent of total billed charges,80% of total billed charges,132.6,65,,106.08,percent of total billed charges,65% of total billed charges,72.77,35.67,,58.216,percent of total billed charges,35.67% of total billed charges,34.71,184.48,
OT SELF CARE/HOME MGMT 15 MIN,4300025,CDM,430,RC,97535,HCPCS,outpatient,,,171,68.40,GO,145.35,85,,116.28,percent of total billed charges,85% of total billed charges,131.67,77,,105.34,percent of total billed charges,77% of total billed charges,31.67,100,,,fee schedule,100% of CMS fee schedule,150.88,429,,,fee schedule,429% of BCBS fee schedule,157.21,447,,,fee schedule,447% of BCBS fee schedule,157.21,447,,,fee schedule,447% of BCBS fee schedule,157.21,447,,,fee schedule,447% of BCBS fee schedule,153.9,90,,123.12,percent of total billed charges,90% of total billed charges,136.8,80,,109.44,percent of total billed charges,80% of total billed charges,153.9,90,,123.12,percent of total billed charges,90% of total billed charges,128.25,75,,102.6,percent of total billed charges,75% of total billed charges,38.64,122,,,fee schedule,122% of HUMANA fee schedule,49.59,29,,39.672,percent of total billed charges,29% of total billed charges,31.67,100,,,fee schedule,100% of CMS fee schedule,114.57,67,,91.656,percent of total billed charges,67% of total billed charges,34.73,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,136.8,80,,109.44,percent of total billed charges,80% of total billed charges,111.15,65,,88.92,percent of total billed charges,65% of total billed charges,61,35.67,,48.8,percent of total billed charges,35.67% of total billed charges,31.67,157.21,
OT COMMUNITY WORK PER 15 MIN,4300030,CDM,430,RC,97537,HCPCS,outpatient,,,165,66.00,GO,140.25,85,,112.2,percent of total billed charges,85% of total billed charges,127.05,77,,101.64,percent of total billed charges,77% of total billed charges,30.77,100,,,fee schedule,100% of CMS fee schedule,144.74,429,,,fee schedule,429% of BCBS fee schedule,150.82,447,,,fee schedule,447% of BCBS fee schedule,150.82,447,,,fee schedule,447% of BCBS fee schedule,150.82,447,,,fee schedule,447% of BCBS fee schedule,148.5,90,,118.8,percent of total billed charges,90% of total billed charges,132,80,,105.6,percent of total billed charges,80% of total billed charges,148.5,90,,118.8,percent of total billed charges,90% of total billed charges,123.75,75,,99,percent of total billed charges,75% of total billed charges,37.54,122,,,fee schedule,122% of HUMANA fee schedule,47.85,29,,38.28,percent of total billed charges,29% of total billed charges,30.77,100,,,fee schedule,100% of CMS fee schedule,110.55,67,,88.44,percent of total billed charges,67% of total billed charges,30.04,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,132,80,,105.6,percent of total billed charges,80% of total billed charges,107.25,65,,85.8,percent of total billed charges,65% of total billed charges,58.86,35.67,,47.088,percent of total billed charges,35.67% of total billed charges,30.04,150.82,
OT DEVELOPMENT COG SKILLS 15 M,4300035,CDM,430,RC,97129,HCPCS,outpatient,,,89,35.60,,75.65,85,,60.52,percent of total billed charges,85% of total billed charges,68.53,77,,54.82,percent of total billed charges,77% of total billed charges,21.63,100,,,fee schedule,100% of CMS fee schedule,103.17,429,,,fee schedule,429% of BCBS fee schedule,107.5,447,,,fee schedule,447% of BCBS fee schedule,107.5,447,,,fee schedule,447% of BCBS fee schedule,107.5,447,,,fee schedule,447% of BCBS fee schedule,80.1,90,,64.08,percent of total billed charges,90% of total billed charges,71.2,80,,56.96,percent of total billed charges,80% of total billed charges,80.1,90,,64.08,percent of total billed charges,90% of total billed charges,66.75,75,,53.4,percent of total billed charges,75% of total billed charges,26.39,122,,,fee schedule,122% of HUMANA fee schedule,25.81,29,,20.648,percent of total billed charges,29% of total billed charges,21.63,100,,,fee schedule,100% of CMS fee schedule,59.63,67,,47.704,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,71.2,80,,56.96,percent of total billed charges,80% of total billed charges,57.85,65,,46.28,percent of total billed charges,65% of total billed charges,31.75,35.67,,25.4,percent of total billed charges,35.67% of total billed charges,21.63,107.5,
OT APPLICATION ARM SPLINT DYN,4300040,CDM,430,RC,29126,HCPCS,outpatient,,,339,135.60,GO,1150,,,,case rate,pays based on per visit,261.03,77,,208.82,percent of total billed charges,77% of total billed charges,111.71,100,,,fee schedule,100% of CMS OPPS rate,277.98,82,,222.384,percent of total billed charges,82% of total billed charges,288.15,85,,230.52,percent of total billed charges,85% of total billed charges,288.15,85,,230.52,percent of total billed charges,85% of total billed charges,288.15,85,,230.52,percent of total billed charges,85% of total billed charges,305.1,90,,244.08,percent of total billed charges,90% of total billed charges,271.2,80,,216.96,percent of total billed charges,80% of total billed charges,305.1,90,,244.08,percent of total billed charges,90% of total billed charges,254.25,75,,203.4,percent of total billed charges,75% of total billed charges,136.28,122,,,fee schedule,122% of HUMANA fee schedule,98.31,29,,78.648,percent of total billed charges,29% of total billed charges,111.71,100,,,fee schedule,100% of CMS OPPS rate,227.13,67,,181.704,percent of total billed charges,67% of total billed charges,73.52,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,271.2,80,,216.96,percent of total billed charges,80% of total billed charges,220.35,65,,176.28,percent of total billed charges,65% of total billed charges,120.92,35.67,,96.736,percent of total billed charges,35.67% of total billed charges,73.52,1150,
OT ARM SPLINT SHORT STATIC,4300041,CDM,430,RC,29125,HCPCS,outpatient,,,396,158.40,GO,1150,,,,case rate,pays based on per visit,304.92,77,,243.94,percent of total billed charges,77% of total billed charges,111.71,100,,,fee schedule,100% of CMS OPPS rate,324.72,82,,259.776,percent of total billed charges,82% of total billed charges,336.6,85,,269.28,percent of total billed charges,85% of total billed charges,336.6,85,,269.28,percent of total billed charges,85% of total billed charges,336.6,85,,269.28,percent of total billed charges,85% of total billed charges,356.4,90,,285.12,percent of total billed charges,90% of total billed charges,316.8,80,,253.44,percent of total billed charges,80% of total billed charges,356.4,90,,285.12,percent of total billed charges,90% of total billed charges,297,75,,237.6,percent of total billed charges,75% of total billed charges,136.28,122,,,fee schedule,122% of HUMANA fee schedule,114.84,29,,91.872,percent of total billed charges,29% of total billed charges,111.71,100,,,fee schedule,100% of CMS OPPS rate,265.32,67,,212.256,percent of total billed charges,67% of total billed charges,73.52,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,316.8,80,,253.44,percent of total billed charges,80% of total billed charges,257.4,65,,205.92,percent of total billed charges,65% of total billed charges,141.25,35.67,,113,percent of total billed charges,35.67% of total billed charges,73.52,1150,
OT APPL. FINGER SPLINT DYNAMIC,4300045,CDM,430,RC,29131,HCPCS,outpatient,,,300,120.00,GO,1150,,,,case rate,pays based on per visit,231,77,,184.8,percent of total billed charges,77% of total billed charges,53.49,100,,,fee schedule,100% of CMS OPPS rate,246,82,,196.8,percent of total billed charges,82% of total billed charges,255,85,,204,percent of total billed charges,85% of total billed charges,255,85,,204,percent of total billed charges,85% of total billed charges,255,85,,204,percent of total billed charges,85% of total billed charges,270,90,,216,percent of total billed charges,90% of total billed charges,240,80,,192,percent of total billed charges,80% of total billed charges,270,90,,216,percent of total billed charges,90% of total billed charges,225,75,,180,percent of total billed charges,75% of total billed charges,65.26,122,,,fee schedule,122% of HUMANA fee schedule,87,29,,69.6,percent of total billed charges,29% of total billed charges,53.49,100,,,fee schedule,100% of CMS OPPS rate,201,67,,160.8,percent of total billed charges,67% of total billed charges,73.52,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,240,80,,192,percent of total billed charges,80% of total billed charges,195,65,,156,percent of total billed charges,65% of total billed charges,107.01,35.67,,85.608,percent of total billed charges,35.67% of total billed charges,53.49,1150,
OT APPL. STATIC FINGER SPLINT,4300046,CDM,430,RC,29130,HCPCS,outpatient,,,300,120.00,GO,1150,,,,case rate,pays based on per visit,231,77,,184.8,percent of total billed charges,77% of total billed charges,111.71,100,,,fee schedule,100% of CMS OPPS rate,246,82,,196.8,percent of total billed charges,82% of total billed charges,255,85,,204,percent of total billed charges,85% of total billed charges,255,85,,204,percent of total billed charges,85% of total billed charges,255,85,,204,percent of total billed charges,85% of total billed charges,270,90,,216,percent of total billed charges,90% of total billed charges,240,80,,192,percent of total billed charges,80% of total billed charges,270,90,,216,percent of total billed charges,90% of total billed charges,225,75,,180,percent of total billed charges,75% of total billed charges,136.28,122,,,fee schedule,122% of HUMANA fee schedule,87,29,,69.6,percent of total billed charges,29% of total billed charges,111.71,100,,,fee schedule,100% of CMS OPPS rate,201,67,,160.8,percent of total billed charges,67% of total billed charges,73.52,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,240,80,,192,percent of total billed charges,80% of total billed charges,195,65,,156,percent of total billed charges,65% of total billed charges,107.01,35.67,,85.608,percent of total billed charges,35.67% of total billed charges,73.52,1150,
OT STRAPPING ELBOW/WRIST,4300050,CDM,430,RC,29260,HCPCS,outpatient,,,218,87.20,GO,1150,,,,case rate,pays based on per visit,167.86,77,,134.29,percent of total billed charges,77% of total billed charges,53.49,100,,,fee schedule,100% of CMS OPPS rate,178.76,82,,143.008,percent of total billed charges,82% of total billed charges,185.3,85,,148.24,percent of total billed charges,85% of total billed charges,185.3,85,,148.24,percent of total billed charges,85% of total billed charges,185.3,85,,148.24,percent of total billed charges,85% of total billed charges,196.2,90,,156.96,percent of total billed charges,90% of total billed charges,174.4,80,,139.52,percent of total billed charges,80% of total billed charges,196.2,90,,156.96,percent of total billed charges,90% of total billed charges,163.5,75,,130.8,percent of total billed charges,75% of total billed charges,65.26,122,,,fee schedule,122% of HUMANA fee schedule,63.22,29,,50.576,percent of total billed charges,29% of total billed charges,53.49,100,,,fee schedule,100% of CMS OPPS rate,146.06,67,,116.848,percent of total billed charges,67% of total billed charges,73.52,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,174.4,80,,139.52,percent of total billed charges,80% of total billed charges,141.7,65,,113.36,percent of total billed charges,65% of total billed charges,77.76,35.67,,62.208,percent of total billed charges,35.67% of total billed charges,53.49,1150,
OT STRAPPING HAND OR FINGER,4300055,CDM,430,RC,29280,HCPCS,outpatient,,,218,87.20,GO,1150,,,,case rate,pays based on per visit,167.86,77,,134.29,percent of total billed charges,77% of total billed charges,53.49,100,,,fee schedule,100% of CMS OPPS rate,178.76,82,,143.008,percent of total billed charges,82% of total billed charges,185.3,85,,148.24,percent of total billed charges,85% of total billed charges,185.3,85,,148.24,percent of total billed charges,85% of total billed charges,185.3,85,,148.24,percent of total billed charges,85% of total billed charges,196.2,90,,156.96,percent of total billed charges,90% of total billed charges,174.4,80,,139.52,percent of total billed charges,80% of total billed charges,196.2,90,,156.96,percent of total billed charges,90% of total billed charges,163.5,75,,130.8,percent of total billed charges,75% of total billed charges,65.26,122,,,fee schedule,122% of HUMANA fee schedule,63.22,29,,50.576,percent of total billed charges,29% of total billed charges,53.49,100,,,fee schedule,100% of CMS OPPS rate,146.06,67,,116.848,percent of total billed charges,67% of total billed charges,73.52,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,174.4,80,,139.52,percent of total billed charges,80% of total billed charges,141.7,65,,113.36,percent of total billed charges,65% of total billed charges,77.76,35.67,,62.208,percent of total billed charges,35.67% of total billed charges,53.49,1150,
OT MUSCLE TESTING HAND,4300060,CDM,430,RC,97161,HCPCS,outpatient,,,118,47.20,GO,100.3,85,,80.24,percent of total billed charges,85% of total billed charges,90.86,77,,72.69,percent of total billed charges,77% of total billed charges,97.49,100,,,fee schedule,100% of CMS fee schedule,366.45,429,,,fee schedule,429% of BCBS fee schedule,381.83,447,,,fee schedule,447% of BCBS fee schedule,381.83,447,,,fee schedule,447% of BCBS fee schedule,381.83,447,,,fee schedule,447% of BCBS fee schedule,106.2,90,,84.96,percent of total billed charges,90% of total billed charges,94.4,80,,75.52,percent of total billed charges,80% of total billed charges,106.2,90,,84.96,percent of total billed charges,90% of total billed charges,88.5,75,,70.8,percent of total billed charges,75% of total billed charges,118.94,122,,,fee schedule,122% of HUMANA fee schedule,34.22,29,,27.376,percent of total billed charges,29% of total billed charges,97.49,100,,,fee schedule,100% of CMS fee schedule,79.06,67,,63.248,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,94.4,80,,75.52,percent of total billed charges,80% of total billed charges,76.7,65,,61.36,percent of total billed charges,65% of total billed charges,42.09,35.67,,33.672,percent of total billed charges,35.67% of total billed charges,34.22,381.83,
OT RANGE OF MOTION HAND MEASUR,4300065,CDM,430,RC,95852,HCPCS,outpatient,,,89,35.60,GO,75.65,85,,60.52,percent of total billed charges,85% of total billed charges,68.53,77,,54.82,percent of total billed charges,77% of total billed charges,5.17,100,,,fee schedule,100% of CMS fee schedule,26.17,429,,,fee schedule,429% of BCBS fee schedule,27.27,447,,,fee schedule,447% of BCBS fee schedule,27.27,447,,,fee schedule,447% of BCBS fee schedule,27.27,447,,,fee schedule,447% of BCBS fee schedule,80.1,90,,64.08,percent of total billed charges,90% of total billed charges,71.2,80,,56.96,percent of total billed charges,80% of total billed charges,80.1,90,,64.08,percent of total billed charges,90% of total billed charges,66.75,75,,53.4,percent of total billed charges,75% of total billed charges,6.31,122,,,fee schedule,122% of HUMANA fee schedule,25.81,29,,20.648,percent of total billed charges,29% of total billed charges,5.17,100,,,fee schedule,100% of CMS fee schedule,59.63,67,,47.704,percent of total billed charges,67% of total billed charges,5.81,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,71.2,80,,56.96,percent of total billed charges,80% of total billed charges,57.85,65,,46.28,percent of total billed charges,65% of total billed charges,31.75,35.67,,25.4,percent of total billed charges,35.67% of total billed charges,5.17,80.1,
OT WHEELCHAIR MGMT 15 MIN,4300066,CDM,430,RC,97542,HCPCS,outpatient,,,166,66.40,GO,141.1,85,,112.88,percent of total billed charges,85% of total billed charges,127.82,77,,102.26,percent of total billed charges,77% of total billed charges,30.77,100,,,fee schedule,100% of CMS fee schedule,146.25,429,,,fee schedule,429% of BCBS fee schedule,152.38,447,,,fee schedule,447% of BCBS fee schedule,152.38,447,,,fee schedule,447% of BCBS fee schedule,152.38,447,,,fee schedule,447% of BCBS fee schedule,149.4,90,,119.52,percent of total billed charges,90% of total billed charges,132.8,80,,106.24,percent of total billed charges,80% of total billed charges,149.4,90,,119.52,percent of total billed charges,90% of total billed charges,124.5,75,,99.6,percent of total billed charges,75% of total billed charges,37.54,122,,,fee schedule,122% of HUMANA fee schedule,48.14,29,,38.512,percent of total billed charges,29% of total billed charges,30.77,100,,,fee schedule,100% of CMS fee schedule,111.22,67,,88.976,percent of total billed charges,67% of total billed charges,30.38,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,132.8,80,,106.24,percent of total billed charges,80% of total billed charges,107.9,65,,86.32,percent of total billed charges,65% of total billed charges,59.21,35.67,,47.368,percent of total billed charges,35.67% of total billed charges,30.38,152.38,
OT HOT PACKS,4300068,CDM,430,RC,97010,HCPCS,outpatient,,,31,12.40,GO,26.35,85,,21.08,percent of total billed charges,85% of total billed charges,23.87,77,,19.1,percent of total billed charges,77% of total billed charges,6.04,100,,,fee schedule,100% of CMS fee schedule,27.71,429,,,fee schedule,429% of BCBS fee schedule,28.88,447,,,fee schedule,447% of BCBS fee schedule,28.88,447,,,fee schedule,447% of BCBS fee schedule,28.88,447,,,fee schedule,447% of BCBS fee schedule,27.9,90,,22.32,percent of total billed charges,90% of total billed charges,24.8,80,,19.84,percent of total billed charges,80% of total billed charges,27.9,90,,22.32,percent of total billed charges,90% of total billed charges,23.25,75,,18.6,percent of total billed charges,75% of total billed charges,7.37,122,,,fee schedule,122% of HUMANA fee schedule,8.99,29,,7.192,percent of total billed charges,29% of total billed charges,6.04,100,,,fee schedule,100% of CMS fee schedule,20.77,67,,16.616,percent of total billed charges,67% of total billed charges,5.69,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,24.8,80,,19.84,percent of total billed charges,80% of total billed charges,20.15,65,,16.12,percent of total billed charges,65% of total billed charges,11.06,35.67,,8.848,percent of total billed charges,35.67% of total billed charges,5.69,28.88,
OT COLD PACKS,4300069,CDM,430,RC,97010,HCPCS,outpatient,,,31,12.40,GO,26.35,85,,21.08,percent of total billed charges,85% of total billed charges,23.87,77,,19.1,percent of total billed charges,77% of total billed charges,6.04,100,,,fee schedule,100% of CMS fee schedule,27.71,429,,,fee schedule,429% of BCBS fee schedule,28.88,447,,,fee schedule,447% of BCBS fee schedule,28.88,447,,,fee schedule,447% of BCBS fee schedule,28.88,447,,,fee schedule,447% of BCBS fee schedule,27.9,90,,22.32,percent of total billed charges,90% of total billed charges,24.8,80,,19.84,percent of total billed charges,80% of total billed charges,27.9,90,,22.32,percent of total billed charges,90% of total billed charges,23.25,75,,18.6,percent of total billed charges,75% of total billed charges,7.37,122,,,fee schedule,122% of HUMANA fee schedule,8.99,29,,7.192,percent of total billed charges,29% of total billed charges,6.04,100,,,fee schedule,100% of CMS fee schedule,20.77,67,,16.616,percent of total billed charges,67% of total billed charges,5.69,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,24.8,80,,19.84,percent of total billed charges,80% of total billed charges,20.15,65,,16.12,percent of total billed charges,65% of total billed charges,11.06,35.67,,8.848,percent of total billed charges,35.67% of total billed charges,5.69,28.88,
OT WHIRLPOOL,4300070,CDM,430,RC,97022,HCPCS,outpatient,,,95,38.00,GO,80.75,85,,64.6,percent of total billed charges,85% of total billed charges,73.15,77,,58.52,percent of total billed charges,77% of total billed charges,16.34,100,,,fee schedule,100% of CMS fee schedule,83.14,429,,,fee schedule,429% of BCBS fee schedule,86.63,447,,,fee schedule,447% of BCBS fee schedule,86.63,447,,,fee schedule,447% of BCBS fee schedule,86.63,447,,,fee schedule,447% of BCBS fee schedule,85.5,90,,68.4,percent of total billed charges,90% of total billed charges,76,80,,60.8,percent of total billed charges,80% of total billed charges,85.5,90,,68.4,percent of total billed charges,90% of total billed charges,71.25,75,,57,percent of total billed charges,75% of total billed charges,19.93,122,,,fee schedule,122% of HUMANA fee schedule,27.55,29,,22.04,percent of total billed charges,29% of total billed charges,16.34,100,,,fee schedule,100% of CMS fee schedule,63.65,67,,50.92,percent of total billed charges,67% of total billed charges,23.05,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,76,80,,60.8,percent of total billed charges,80% of total billed charges,61.75,65,,49.4,percent of total billed charges,65% of total billed charges,33.89,35.67,,27.112,percent of total billed charges,35.67% of total billed charges,16.34,86.63,
OT ELECTRICAL STIM UNATTENDED,4300071,CDM,430,RC,G0283,HCPCS,outpatient,,,47,18.80,GO,39.95,85,,31.96,percent of total billed charges,85% of total billed charges,36.19,77,,28.95,percent of total billed charges,77% of total billed charges,11.3,100,,,fee schedule,100% of CMS fee schedule,64.65,429,,,fee schedule,429% of BCBS fee schedule,67.36,447,,,fee schedule,447% of BCBS fee schedule,67.36,447,,,fee schedule,447% of BCBS fee schedule,67.36,447,,,fee schedule,447% of BCBS fee schedule,42.3,90,,33.84,percent of total billed charges,90% of total billed charges,37.6,80,,30.08,percent of total billed charges,80% of total billed charges,42.3,90,,33.84,percent of total billed charges,90% of total billed charges,35.25,75,,28.2,percent of total billed charges,75% of total billed charges,13.79,122,,,fee schedule,122% of HUMANA fee schedule,13.63,29,,10.904,percent of total billed charges,29% of total billed charges,11.3,100,,,fee schedule,100% of CMS fee schedule,31.49,67,,25.192,percent of total billed charges,67% of total billed charges,13.67,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,37.6,80,,30.08,percent of total billed charges,80% of total billed charges,30.55,65,,24.44,percent of total billed charges,65% of total billed charges,16.76,35.67,,13.408,percent of total billed charges,35.67% of total billed charges,11.3,67.36,
OT ELECTRICAL STIM PER 15 MIN,4300072,CDM,430,RC,97032,HCPCS,outpatient,,,79,31.60,GO,67.15,85,,53.72,percent of total billed charges,85% of total billed charges,60.83,77,,48.66,percent of total billed charges,77% of total billed charges,13.95,100,,,fee schedule,100% of CMS fee schedule,67.74,429,,,fee schedule,429% of BCBS fee schedule,70.58,447,,,fee schedule,447% of BCBS fee schedule,70.58,447,,,fee schedule,447% of BCBS fee schedule,70.58,447,,,fee schedule,447% of BCBS fee schedule,71.1,90,,56.88,percent of total billed charges,90% of total billed charges,63.2,80,,50.56,percent of total billed charges,80% of total billed charges,71.1,90,,56.88,percent of total billed charges,90% of total billed charges,59.25,75,,47.4,percent of total billed charges,75% of total billed charges,17.02,122,,,fee schedule,122% of HUMANA fee schedule,22.91,29,,18.328,percent of total billed charges,29% of total billed charges,13.95,100,,,fee schedule,100% of CMS fee schedule,52.93,67,,42.344,percent of total billed charges,67% of total billed charges,18.86,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,63.2,80,,50.56,percent of total billed charges,80% of total billed charges,51.35,65,,41.08,percent of total billed charges,65% of total billed charges,28.18,35.67,,22.544,percent of total billed charges,35.67% of total billed charges,13.95,71.1,
OT ULTRASOUND PER 15 MIN,4300073,CDM,430,RC,97035,HCPCS,outpatient,,,66,26.40,GO,56.1,85,,44.88,percent of total billed charges,85% of total billed charges,50.82,77,,40.66,percent of total billed charges,77% of total billed charges,13.56,100,,,fee schedule,100% of CMS fee schedule,58.52,429,,,fee schedule,429% of BCBS fee schedule,60.97,447,,,fee schedule,447% of BCBS fee schedule,60.97,447,,,fee schedule,447% of BCBS fee schedule,60.97,447,,,fee schedule,447% of BCBS fee schedule,59.4,90,,47.52,percent of total billed charges,90% of total billed charges,52.8,80,,42.24,percent of total billed charges,80% of total billed charges,59.4,90,,47.52,percent of total billed charges,90% of total billed charges,49.5,75,,39.6,percent of total billed charges,75% of total billed charges,16.54,122,,,fee schedule,122% of HUMANA fee schedule,19.14,29,,15.312,percent of total billed charges,29% of total billed charges,13.56,100,,,fee schedule,100% of CMS fee schedule,44.22,67,,35.376,percent of total billed charges,67% of total billed charges,12.4,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,52.8,80,,42.24,percent of total billed charges,80% of total billed charges,42.9,65,,34.32,percent of total billed charges,65% of total billed charges,23.54,35.67,,18.832,percent of total billed charges,35.67% of total billed charges,12.4,60.97,
OT IONTOPHORESIS PER 15 MIN,4300074,CDM,430,RC,97033,HCPCS,outpatient,,,103,41.20,GO,87.55,85,,70.04,percent of total billed charges,85% of total billed charges,79.31,77,,63.45,percent of total billed charges,77% of total billed charges,18.71,100,,,fee schedule,100% of CMS fee schedule,90.82,429,,,fee schedule,429% of BCBS fee schedule,94.63,447,,,fee schedule,447% of BCBS fee schedule,94.63,447,,,fee schedule,447% of BCBS fee schedule,94.63,447,,,fee schedule,447% of BCBS fee schedule,92.7,90,,74.16,percent of total billed charges,90% of total billed charges,82.4,80,,65.92,percent of total billed charges,80% of total billed charges,92.7,90,,74.16,percent of total billed charges,90% of total billed charges,77.25,75,,61.8,percent of total billed charges,75% of total billed charges,22.83,122,,,fee schedule,122% of HUMANA fee schedule,29.87,29,,23.896,percent of total billed charges,29% of total billed charges,18.71,100,,,fee schedule,100% of CMS fee schedule,69.01,67,,55.208,percent of total billed charges,67% of total billed charges,31.97,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,82.4,80,,65.92,percent of total billed charges,80% of total billed charges,66.95,65,,53.56,percent of total billed charges,65% of total billed charges,36.74,35.67,,29.392,percent of total billed charges,35.67% of total billed charges,18.71,94.63,
OT MYOFASCIAL REL PER 15 MIN,4300075,CDM,430,RC,97140,HCPCS,outpatient,,,137,54.80,GO,116.45,85,,93.16,percent of total billed charges,85% of total billed charges,105.49,77,,84.39,percent of total billed charges,77% of total billed charges,26.26,100,,,fee schedule,100% of CMS fee schedule,121.62,429,,,fee schedule,429% of BCBS fee schedule,126.72,447,,,fee schedule,447% of BCBS fee schedule,126.72,447,,,fee schedule,447% of BCBS fee schedule,126.72,447,,,fee schedule,447% of BCBS fee schedule,123.3,90,,98.64,percent of total billed charges,90% of total billed charges,109.6,80,,87.68,percent of total billed charges,80% of total billed charges,123.3,90,,98.64,percent of total billed charges,90% of total billed charges,102.75,75,,82.2,percent of total billed charges,75% of total billed charges,32.04,122,,,fee schedule,122% of HUMANA fee schedule,39.73,29,,31.784,percent of total billed charges,29% of total billed charges,26.26,100,,,fee schedule,100% of CMS fee schedule,91.79,67,,73.432,percent of total billed charges,67% of total billed charges,29.66,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,109.6,80,,87.68,percent of total billed charges,80% of total billed charges,89.05,65,,71.24,percent of total billed charges,65% of total billed charges,48.87,35.67,,39.096,percent of total billed charges,35.67% of total billed charges,26.26,126.72,
OT MASSAGE PER 15 MIN,4300076,CDM,430,RC,97124,HCPCS,outpatient,,,154,61.60,GO,130.9,85,,104.72,percent of total billed charges,85% of total billed charges,118.58,77,,94.86,percent of total billed charges,77% of total billed charges,29.29,100,,,fee schedule,100% of CMS fee schedule,133.93,429,,,fee schedule,429% of BCBS fee schedule,139.55,447,,,fee schedule,447% of BCBS fee schedule,139.55,447,,,fee schedule,447% of BCBS fee schedule,139.55,447,,,fee schedule,447% of BCBS fee schedule,138.6,90,,110.88,percent of total billed charges,90% of total billed charges,123.2,80,,98.56,percent of total billed charges,80% of total billed charges,138.6,90,,110.88,percent of total billed charges,90% of total billed charges,115.5,75,,92.4,percent of total billed charges,75% of total billed charges,35.73,122,,,fee schedule,122% of HUMANA fee schedule,44.66,29,,35.728,percent of total billed charges,29% of total billed charges,29.29,100,,,fee schedule,100% of CMS fee schedule,103.18,67,,82.544,percent of total billed charges,67% of total billed charges,26.12,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,123.2,80,,98.56,percent of total billed charges,80% of total billed charges,100.1,65,,80.08,percent of total billed charges,65% of total billed charges,54.93,35.67,,43.944,percent of total billed charges,35.67% of total billed charges,26.12,139.55,
OT AQUATIC EXERCISE PER 15 MIN,4300078,CDM,430,RC,97113,HCPCS,outpatient,,,195,78.00,GO,165.75,85,,132.6,percent of total billed charges,85% of total billed charges,150.15,77,,120.12,percent of total billed charges,77% of total billed charges,35.52,100,,,fee schedule,100% of CMS fee schedule,170.91,429,,,fee schedule,429% of BCBS fee schedule,178.08,447,,,fee schedule,447% of BCBS fee schedule,178.08,447,,,fee schedule,447% of BCBS fee schedule,178.08,447,,,fee schedule,447% of BCBS fee schedule,175.5,90,,140.4,percent of total billed charges,90% of total billed charges,156,80,,124.8,percent of total billed charges,80% of total billed charges,175.5,90,,140.4,percent of total billed charges,90% of total billed charges,146.25,75,,117,percent of total billed charges,75% of total billed charges,43.33,122,,,fee schedule,122% of HUMANA fee schedule,56.55,29,,45.24,percent of total billed charges,29% of total billed charges,35.52,100,,,fee schedule,100% of CMS fee schedule,130.65,67,,104.52,percent of total billed charges,67% of total billed charges,42.77,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,156,80,,124.8,percent of total billed charges,80% of total billed charges,126.75,65,,101.4,percent of total billed charges,65% of total billed charges,69.56,35.67,,55.648,percent of total billed charges,35.67% of total billed charges,35.52,178.08,
OT ORTHOTICS FIT/TRAIN 15 MIN,4300079,CDM,430,RC,97760,HCPCS,outpatient,,,232,92.80,,197.2,85,,157.76,percent of total billed charges,85% of total billed charges,178.64,77,,142.91,percent of total billed charges,77% of total billed charges,45.98,100,,,fee schedule,100% of CMS fee schedule,204.76,429,,,fee schedule,429% of BCBS fee schedule,213.35,447,,,fee schedule,447% of BCBS fee schedule,213.35,447,,,fee schedule,447% of BCBS fee schedule,213.35,447,,,fee schedule,447% of BCBS fee schedule,208.8,90,,167.04,percent of total billed charges,90% of total billed charges,185.6,80,,148.48,percent of total billed charges,80% of total billed charges,208.8,90,,167.04,percent of total billed charges,90% of total billed charges,174,75,,139.2,percent of total billed charges,75% of total billed charges,56.1,122,,,fee schedule,122% of HUMANA fee schedule,67.28,29,,53.824,percent of total billed charges,29% of total billed charges,45.98,100,,,fee schedule,100% of CMS fee schedule,155.44,67,,124.352,percent of total billed charges,67% of total billed charges,37.82,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,185.6,80,,148.48,percent of total billed charges,80% of total billed charges,150.8,65,,120.64,percent of total billed charges,65% of total billed charges,82.75,35.67,,66.2,percent of total billed charges,35.67% of total billed charges,37.82,213.35,
OT JOINT MOBILIZATION 15 MIN,4300081,CDM,430,RC,97140,HCPCS,outpatient,,,137,54.80,GO,116.45,85,,93.16,percent of total billed charges,85% of total billed charges,105.49,77,,84.39,percent of total billed charges,77% of total billed charges,26.26,100,,,fee schedule,100% of CMS fee schedule,121.62,429,,,fee schedule,429% of BCBS fee schedule,126.72,447,,,fee schedule,447% of BCBS fee schedule,126.72,447,,,fee schedule,447% of BCBS fee schedule,126.72,447,,,fee schedule,447% of BCBS fee schedule,123.3,90,,98.64,percent of total billed charges,90% of total billed charges,109.6,80,,87.68,percent of total billed charges,80% of total billed charges,123.3,90,,98.64,percent of total billed charges,90% of total billed charges,102.75,75,,82.2,percent of total billed charges,75% of total billed charges,32.04,122,,,fee schedule,122% of HUMANA fee schedule,39.73,29,,31.784,percent of total billed charges,29% of total billed charges,26.26,100,,,fee schedule,100% of CMS fee schedule,91.79,67,,73.432,percent of total billed charges,67% of total billed charges,29.66,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,109.6,80,,87.68,percent of total billed charges,80% of total billed charges,89.05,65,,71.24,percent of total billed charges,65% of total billed charges,48.87,35.67,,39.096,percent of total billed charges,35.67% of total billed charges,26.26,126.72,
OT PHONOPHORESIS PER 15 MIN,4300087,CDM,430,RC,97035,HCPCS,outpatient,,,66,26.40,GO,56.1,85,,44.88,percent of total billed charges,85% of total billed charges,50.82,77,,40.66,percent of total billed charges,77% of total billed charges,13.56,100,,,fee schedule,100% of CMS fee schedule,58.52,429,,,fee schedule,429% of BCBS fee schedule,60.97,447,,,fee schedule,447% of BCBS fee schedule,60.97,447,,,fee schedule,447% of BCBS fee schedule,60.97,447,,,fee schedule,447% of BCBS fee schedule,59.4,90,,47.52,percent of total billed charges,90% of total billed charges,52.8,80,,42.24,percent of total billed charges,80% of total billed charges,59.4,90,,47.52,percent of total billed charges,90% of total billed charges,49.5,75,,39.6,percent of total billed charges,75% of total billed charges,16.54,122,,,fee schedule,122% of HUMANA fee schedule,19.14,29,,15.312,percent of total billed charges,29% of total billed charges,13.56,100,,,fee schedule,100% of CMS fee schedule,44.22,67,,35.376,percent of total billed charges,67% of total billed charges,12.4,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,52.8,80,,42.24,percent of total billed charges,80% of total billed charges,42.9,65,,34.32,percent of total billed charges,65% of total billed charges,23.54,35.67,,18.832,percent of total billed charges,35.67% of total billed charges,12.4,60.97,
OT EVAL LOW COMPLEXITY,4300088,CDM,430,RC,97165,HCPCS,outpatient,,,448,179.20,GO,380.8,85,,304.64,percent of total billed charges,85% of total billed charges,344.96,77,,275.97,percent of total billed charges,77% of total billed charges,98.44,100,,,fee schedule,100% of CMS fee schedule,395.67,429,,,fee schedule,429% of BCBS fee schedule,412.27,447,,,fee schedule,447% of BCBS fee schedule,412.27,447,,,fee schedule,447% of BCBS fee schedule,412.27,447,,,fee schedule,447% of BCBS fee schedule,403.2,90,,322.56,percent of total billed charges,90% of total billed charges,358.4,80,,286.72,percent of total billed charges,80% of total billed charges,403.2,90,,322.56,percent of total billed charges,90% of total billed charges,336,75,,268.8,percent of total billed charges,75% of total billed charges,120.1,122,,,fee schedule,122% of HUMANA fee schedule,129.92,29,,103.936,percent of total billed charges,29% of total billed charges,98.44,100,,,fee schedule,100% of CMS fee schedule,300.16,67,,240.128,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,358.4,80,,286.72,percent of total billed charges,80% of total billed charges,291.2,65,,232.96,percent of total billed charges,65% of total billed charges,159.8,35.67,,127.84,percent of total billed charges,35.67% of total billed charges,98.44,412.27,
OT EVAL MOD COMPLEXITY,4300089,CDM,430,RC,97166,HCPCS,outpatient,,,448,179.20,GO,380.8,85,,304.64,percent of total billed charges,85% of total billed charges,344.96,77,,275.97,percent of total billed charges,77% of total billed charges,98.44,100,,,fee schedule,100% of CMS fee schedule,395.67,429,,,fee schedule,429% of BCBS fee schedule,412.27,447,,,fee schedule,447% of BCBS fee schedule,412.27,447,,,fee schedule,447% of BCBS fee schedule,412.27,447,,,fee schedule,447% of BCBS fee schedule,403.2,90,,322.56,percent of total billed charges,90% of total billed charges,358.4,80,,286.72,percent of total billed charges,80% of total billed charges,403.2,90,,322.56,percent of total billed charges,90% of total billed charges,336,75,,268.8,percent of total billed charges,75% of total billed charges,120.1,122,,,fee schedule,122% of HUMANA fee schedule,129.92,29,,103.936,percent of total billed charges,29% of total billed charges,98.44,100,,,fee schedule,100% of CMS fee schedule,300.16,67,,240.128,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,358.4,80,,286.72,percent of total billed charges,80% of total billed charges,291.2,65,,232.96,percent of total billed charges,65% of total billed charges,159.8,35.67,,127.84,percent of total billed charges,35.67% of total billed charges,98.44,412.27,
OT EVAL HIGH COMPLEXITY,4300090,CDM,430,RC,97167,HCPCS,outpatient,,,448,179.20,GO,380.8,85,,304.64,percent of total billed charges,85% of total billed charges,344.96,77,,275.97,percent of total billed charges,77% of total billed charges,98.44,100,,,fee schedule,100% of CMS fee schedule,395.67,429,,,fee schedule,429% of BCBS fee schedule,412.27,447,,,fee schedule,447% of BCBS fee schedule,412.27,447,,,fee schedule,447% of BCBS fee schedule,412.27,447,,,fee schedule,447% of BCBS fee schedule,403.2,90,,322.56,percent of total billed charges,90% of total billed charges,358.4,80,,286.72,percent of total billed charges,80% of total billed charges,403.2,90,,322.56,percent of total billed charges,90% of total billed charges,336,75,,268.8,percent of total billed charges,75% of total billed charges,120.1,122,,,fee schedule,122% of HUMANA fee schedule,129.92,29,,103.936,percent of total billed charges,29% of total billed charges,98.44,100,,,fee schedule,100% of CMS fee schedule,300.16,67,,240.128,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,358.4,80,,286.72,percent of total billed charges,80% of total billed charges,291.2,65,,232.96,percent of total billed charges,65% of total billed charges,159.8,35.67,,127.84,percent of total billed charges,35.67% of total billed charges,98.44,412.27,
SPEECH THERAPY EVAL,4400010,CDM,440,RC,92523,HCPCS,outpatient,,,993,397.20,GN,844.05,85,,675.24,percent of total billed charges,85% of total billed charges,764.61,77,,611.69,percent of total billed charges,77% of total billed charges,222.05,100,,,fee schedule,100% of CMS fee schedule,862.2,429,,,fee schedule,429% of BCBS fee schedule,898.38,447,,,fee schedule,447% of BCBS fee schedule,898.38,447,,,fee schedule,447% of BCBS fee schedule,898.38,447,,,fee schedule,447% of BCBS fee schedule,893.7,90,,714.96,percent of total billed charges,90% of total billed charges,794.4,80,,635.52,percent of total billed charges,80% of total billed charges,893.7,90,,714.96,percent of total billed charges,90% of total billed charges,744.75,75,,595.8,percent of total billed charges,75% of total billed charges,270.9,122,,,fee schedule,122% of HUMANA fee schedule,287.97,29,,230.376,percent of total billed charges,29% of total billed charges,222.05,100,,,fee schedule,100% of CMS fee schedule,665.31,67,,532.248,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,794.4,80,,635.52,percent of total billed charges,80% of total billed charges,645.45,65,,516.36,percent of total billed charges,65% of total billed charges,354.2,35.67,,283.36,percent of total billed charges,35.67% of total billed charges,222.05,898.38,
SPEECH THERAPY SWALLOWING EVAL,4400020,CDM,440,RC,92611,HCPCS,outpatient,,,185,74.00,GN,157.25,85,,125.8,percent of total billed charges,85% of total billed charges,142.45,77,,113.96,percent of total billed charges,77% of total billed charges,89.06,100,,,fee schedule,100% of CMS fee schedule,381.81,429,,,fee schedule,429% of BCBS fee schedule,397.83,447,,,fee schedule,447% of BCBS fee schedule,397.83,447,,,fee schedule,447% of BCBS fee schedule,397.83,447,,,fee schedule,447% of BCBS fee schedule,166.5,90,,133.2,percent of total billed charges,90% of total billed charges,148,80,,118.4,percent of total billed charges,80% of total billed charges,166.5,90,,133.2,percent of total billed charges,90% of total billed charges,138.75,75,,111,percent of total billed charges,75% of total billed charges,108.65,122,,,fee schedule,122% of HUMANA fee schedule,53.65,29,,42.92,percent of total billed charges,29% of total billed charges,89.06,100,,,fee schedule,100% of CMS fee schedule,123.95,67,,99.16,percent of total billed charges,67% of total billed charges,84.74,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,148,80,,118.4,percent of total billed charges,80% of total billed charges,120.25,65,,96.2,percent of total billed charges,65% of total billed charges,65.99,35.67,,52.792,percent of total billed charges,35.67% of total billed charges,53.65,397.83,
"SPEECH THERAPY, RE-EVAL",44001171,CDM,440,RC,S9152,HCPCS,outpatient,,,375,150.00,,318.75,85,,255,percent of total billed charges,85% of total billed charges,288.75,77,,231,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,307.5,82,,246,percent of total billed charges,82% of total billed charges,318.75,85,,255,percent of total billed charges,85% of total billed charges,318.75,85,,255,percent of total billed charges,85% of total billed charges,318.75,85,,255,percent of total billed charges,85% of total billed charges,337.5,90,,270,percent of total billed charges,90% of total billed charges,300,80,,240,percent of total billed charges,80% of total billed charges,337.5,90,,270,percent of total billed charges,90% of total billed charges,281.25,75,,225,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,108.75,29,,87,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,251.25,67,,201,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,300,80,,240,percent of total billed charges,80% of total billed charges,243.75,65,,195,percent of total billed charges,65% of total billed charges,133.76,35.67,,107.008,percent of total billed charges,35.67% of total billed charges,108.75,337.5,
SPEECH THERAPY MOTION EVAL,4400160,CDM,440,RC,92611,HCPCS,outpatient,,,812,324.80,,690.2,85,,552.16,percent of total billed charges,85% of total billed charges,625.24,77,,500.19,percent of total billed charges,77% of total billed charges,89.06,100,,,fee schedule,100% of CMS fee schedule,381.81,429,,,fee schedule,429% of BCBS fee schedule,397.83,447,,,fee schedule,447% of BCBS fee schedule,397.83,447,,,fee schedule,447% of BCBS fee schedule,397.83,447,,,fee schedule,447% of BCBS fee schedule,730.8,90,,584.64,percent of total billed charges,90% of total billed charges,649.6,80,,519.68,percent of total billed charges,80% of total billed charges,730.8,90,,584.64,percent of total billed charges,90% of total billed charges,609,75,,487.2,percent of total billed charges,75% of total billed charges,108.65,122,,,fee schedule,122% of HUMANA fee schedule,235.48,29,,188.384,percent of total billed charges,29% of total billed charges,89.06,100,,,fee schedule,100% of CMS fee schedule,544.04,67,,435.232,percent of total billed charges,67% of total billed charges,84.74,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,649.6,80,,519.68,percent of total billed charges,80% of total billed charges,527.8,65,,422.24,percent of total billed charges,65% of total billed charges,289.64,35.67,,231.712,percent of total billed charges,35.67% of total billed charges,84.74,730.8,
SPEECH THERAPY ENDO EVAL,4400170,CDM,440,RC,92612,HCPCS,outpatient,,,1022,408.80,,868.7,85,,694.96,percent of total billed charges,85% of total billed charges,786.94,77,,629.55,percent of total billed charges,77% of total billed charges,64.02,100,,,fee schedule,100% of CMS fee schedule,297.17,429,,,fee schedule,429% of BCBS fee schedule,309.64,447,,,fee schedule,447% of BCBS fee schedule,309.64,447,,,fee schedule,447% of BCBS fee schedule,309.64,447,,,fee schedule,447% of BCBS fee schedule,919.8,90,,735.84,percent of total billed charges,90% of total billed charges,817.6,80,,654.08,percent of total billed charges,80% of total billed charges,919.8,90,,735.84,percent of total billed charges,90% of total billed charges,766.5,75,,613.2,percent of total billed charges,75% of total billed charges,78.1,122,,,fee schedule,122% of HUMANA fee schedule,296.38,29,,237.104,percent of total billed charges,29% of total billed charges,64.02,100,,,fee schedule,100% of CMS fee schedule,684.74,67,,547.792,percent of total billed charges,67% of total billed charges,68.61,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,817.6,80,,654.08,percent of total billed charges,80% of total billed charges,664.3,65,,531.44,percent of total billed charges,65% of total billed charges,364.55,35.67,,291.64,percent of total billed charges,35.67% of total billed charges,64.02,919.8,
SPEECH FLUENCY EVAL,4401150,CDM,440,RC,92521,HCPCS,outpatient,,,562,224.80,GN,477.7,85,,382.16,percent of total billed charges,85% of total billed charges,432.74,77,,346.19,percent of total billed charges,77% of total billed charges,129.52,100,,,fee schedule,100% of CMS fee schedule,497.3,429,,,fee schedule,429% of BCBS fee schedule,518.16,447,,,fee schedule,447% of BCBS fee schedule,518.16,447,,,fee schedule,447% of BCBS fee schedule,518.16,447,,,fee schedule,447% of BCBS fee schedule,505.8,90,,404.64,percent of total billed charges,90% of total billed charges,449.6,80,,359.68,percent of total billed charges,80% of total billed charges,505.8,90,,404.64,percent of total billed charges,90% of total billed charges,421.5,75,,337.2,percent of total billed charges,75% of total billed charges,158.01,122,,,fee schedule,122% of HUMANA fee schedule,162.98,29,,130.384,percent of total billed charges,29% of total billed charges,129.52,100,,,fee schedule,100% of CMS fee schedule,376.54,67,,301.232,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,449.6,80,,359.68,percent of total billed charges,80% of total billed charges,365.3,65,,292.24,percent of total billed charges,65% of total billed charges,200.47,35.67,,160.376,percent of total billed charges,35.67% of total billed charges,129.52,518.16,
SPEECH SOUND PRODUCTION EVAL,4401160,CDM,440,RC,92522,HCPCS,outpatient,,,454,181.60,GN,385.9,85,,308.72,percent of total billed charges,85% of total billed charges,349.58,77,,279.66,percent of total billed charges,77% of total billed charges,108.37,100,,,fee schedule,100% of CMS fee schedule,400.3,429,,,fee schedule,429% of BCBS fee schedule,417.1,447,,,fee schedule,447% of BCBS fee schedule,417.1,447,,,fee schedule,447% of BCBS fee schedule,417.1,447,,,fee schedule,447% of BCBS fee schedule,408.6,90,,326.88,percent of total billed charges,90% of total billed charges,363.2,80,,290.56,percent of total billed charges,80% of total billed charges,408.6,90,,326.88,percent of total billed charges,90% of total billed charges,340.5,75,,272.4,percent of total billed charges,75% of total billed charges,132.21,122,,,fee schedule,122% of HUMANA fee schedule,131.66,29,,105.328,percent of total billed charges,29% of total billed charges,108.37,100,,,fee schedule,100% of CMS fee schedule,304.18,67,,243.344,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,363.2,80,,290.56,percent of total billed charges,80% of total billed charges,295.1,65,,236.08,percent of total billed charges,65% of total billed charges,161.94,35.67,,129.552,percent of total billed charges,35.67% of total billed charges,108.37,417.1,
BEHAVIORAL & QUALITATIVE ANALY,4401170,CDM,440,RC,92524,HCPCS,outpatient,,,434,173.60,GN,368.9,85,,295.12,percent of total billed charges,85% of total billed charges,334.18,77,,267.34,percent of total billed charges,77% of total billed charges,106.79,100,,,fee schedule,100% of CMS fee schedule,383.35,429,,,fee schedule,429% of BCBS fee schedule,399.44,447,,,fee schedule,447% of BCBS fee schedule,399.44,447,,,fee schedule,447% of BCBS fee schedule,399.44,447,,,fee schedule,447% of BCBS fee schedule,390.6,90,,312.48,percent of total billed charges,90% of total billed charges,347.2,80,,277.76,percent of total billed charges,80% of total billed charges,390.6,90,,312.48,percent of total billed charges,90% of total billed charges,325.5,75,,260.4,percent of total billed charges,75% of total billed charges,130.28,122,,,fee schedule,122% of HUMANA fee schedule,125.86,29,,100.688,percent of total billed charges,29% of total billed charges,106.79,100,,,fee schedule,100% of CMS fee schedule,290.78,67,,232.624,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,347.2,80,,277.76,percent of total billed charges,80% of total billed charges,282.1,65,,225.68,percent of total billed charges,65% of total billed charges,154.81,35.67,,123.848,percent of total billed charges,35.67% of total billed charges,106.79,399.44,
SPEECH THERAPY VISIT ASSIST,4400000,CDM,441,RC,92507,HCPCS,outpatient,,,375,150.00,GN,318.75,85,,255,percent of total billed charges,85% of total billed charges,288.75,77,,231,percent of total billed charges,77% of total billed charges,74.38,100,,,fee schedule,100% of CMS fee schedule,341.78,429,,,fee schedule,429% of BCBS fee schedule,356.12,447,,,fee schedule,447% of BCBS fee schedule,356.12,447,,,fee schedule,447% of BCBS fee schedule,356.12,447,,,fee schedule,447% of BCBS fee schedule,337.5,90,,270,percent of total billed charges,90% of total billed charges,300,80,,240,percent of total billed charges,80% of total billed charges,337.5,90,,270,percent of total billed charges,90% of total billed charges,281.25,75,,225,percent of total billed charges,75% of total billed charges,90.74,122,,,fee schedule,122% of HUMANA fee schedule,108.75,29,,87,percent of total billed charges,29% of total billed charges,74.38,100,,,fee schedule,100% of CMS fee schedule,251.25,67,,201,percent of total billed charges,67% of total billed charges,69.34,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,300,80,,240,percent of total billed charges,80% of total billed charges,243.75,65,,195,percent of total billed charges,65% of total billed charges,133.76,35.67,,107.008,percent of total billed charges,35.67% of total billed charges,69.34,356.12,
SPEECH THERAPY SWALLOW TREATME,4400006,CDM,441,RC,92526,HCPCS,outpatient,,,432,172.80,GN,367.2,85,,293.76,percent of total billed charges,85% of total billed charges,332.64,77,,266.11,percent of total billed charges,77% of total billed charges,82.36,100,,,fee schedule,100% of CMS fee schedule,374.13,429,,,fee schedule,429% of BCBS fee schedule,389.83,447,,,fee schedule,447% of BCBS fee schedule,389.83,447,,,fee schedule,447% of BCBS fee schedule,389.83,447,,,fee schedule,447% of BCBS fee schedule,388.8,90,,311.04,percent of total billed charges,90% of total billed charges,345.6,80,,276.48,percent of total billed charges,80% of total billed charges,388.8,90,,311.04,percent of total billed charges,90% of total billed charges,324,75,,259.2,percent of total billed charges,75% of total billed charges,100.48,122,,,fee schedule,122% of HUMANA fee schedule,125.28,29,,100.224,percent of total billed charges,29% of total billed charges,82.36,100,,,fee schedule,100% of CMS fee schedule,289.44,67,,231.552,percent of total billed charges,67% of total billed charges,73.46,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,345.6,80,,276.48,percent of total billed charges,80% of total billed charges,280.8,65,,224.64,percent of total billed charges,65% of total billed charges,154.09,35.67,,123.272,percent of total billed charges,35.67% of total billed charges,73.46,389.83,
SPEECH THERAPY - GROUP,4400008,CDM,441,RC,92508,HCPCS,outpatient,,,115,46.00,GN,97.75,85,,78.2,percent of total billed charges,85% of total billed charges,88.55,77,,70.84,percent of total billed charges,77% of total billed charges,23.57,100,,,fee schedule,100% of CMS fee schedule,100.09,429,,,fee schedule,429% of BCBS fee schedule,104.29,447,,,fee schedule,447% of BCBS fee schedule,104.29,447,,,fee schedule,447% of BCBS fee schedule,104.29,447,,,fee schedule,447% of BCBS fee schedule,103.5,90,,82.8,percent of total billed charges,90% of total billed charges,92,80,,73.6,percent of total billed charges,80% of total billed charges,103.5,90,,82.8,percent of total billed charges,90% of total billed charges,86.25,75,,69,percent of total billed charges,75% of total billed charges,28.76,122,,,fee schedule,122% of HUMANA fee schedule,33.35,29,,26.68,percent of total billed charges,29% of total billed charges,23.57,100,,,fee schedule,100% of CMS fee schedule,77.05,67,,61.64,percent of total billed charges,67% of total billed charges,18.7,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,92,80,,73.6,percent of total billed charges,80% of total billed charges,74.75,65,,59.8,percent of total billed charges,65% of total billed charges,41.02,35.67,,32.816,percent of total billed charges,35.67% of total billed charges,18.7,104.29,
SPEECH THERAPY VISIT ST,4400150,CDM,441,RC,92507,HCPCS,outpatient,,,375,150.00,GN,318.75,85,,255,percent of total billed charges,85% of total billed charges,288.75,77,,231,percent of total billed charges,77% of total billed charges,74.38,100,,,fee schedule,100% of CMS fee schedule,341.78,429,,,fee schedule,429% of BCBS fee schedule,356.12,447,,,fee schedule,447% of BCBS fee schedule,356.12,447,,,fee schedule,447% of BCBS fee schedule,356.12,447,,,fee schedule,447% of BCBS fee schedule,337.5,90,,270,percent of total billed charges,90% of total billed charges,300,80,,240,percent of total billed charges,80% of total billed charges,337.5,90,,270,percent of total billed charges,90% of total billed charges,281.25,75,,225,percent of total billed charges,75% of total billed charges,90.74,122,,,fee schedule,122% of HUMANA fee schedule,108.75,29,,87,percent of total billed charges,29% of total billed charges,74.38,100,,,fee schedule,100% of CMS fee schedule,251.25,67,,201,percent of total billed charges,67% of total billed charges,69.34,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,300,80,,240,percent of total billed charges,80% of total billed charges,243.75,65,,195,percent of total billed charges,65% of total billed charges,133.76,35.67,,107.008,percent of total billed charges,35.67% of total billed charges,69.34,356.12,
EMERGENCY ROOM LEVEL 1  25 MOD,4500010,CDM,450,RC,99281,HCPCS,outpatient,,,445,178.00,25,378.25,85,,302.6,percent of total billed charges,85% of total billed charges,342.65,77,,274.12,percent of total billed charges,77% of total billed charges,77.64,100,,,fee schedule,100% of CMS OPPS rate,376.94,429,,,fee schedule,429% of BCBS fee schedule,392.74,100,,,case rate ,pays based on per visit,392.74,100,,,case rate,pays based on per visit,392.74,100,,,case rate,pays based on per visit,400.5,90,,320.4,percent of total billed charges,90% of total billed charges,356,80,,284.8,percent of total billed charges,80% of total billed charges,400.5,90,,320.4,percent of total billed charges,90% of total billed charges,333.75,75,,267,percent of total billed charges,75% of total billed charges,94.71,122,,,fee schedule,122% of HUMANA fee schedule,129.05,29,,103.24,percent of total billed charges,29% of total billed charges,77.64,100,,,fee schedule,100% of CMS OPPS rate,298.15,67,,238.52,percent of total billed charges,67% of total billed charges,46.82,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,356,80,,284.8,percent of total billed charges,80% of total billed charges,289.25,65,,231.4,percent of total billed charges,65% of total billed charges,158.73,35.67,,126.984,percent of total billed charges,35.67% of total billed charges,46.82,400.5,
EMERGENCY ROOM LEVEL 2  25 MOD,4500011,CDM,450,RC,99282,HCPCS,outpatient,,,771,308.40,25,655.35,85,,524.28,percent of total billed charges,85% of total billed charges,593.67,77,,474.94,percent of total billed charges,77% of total billed charges,143.03,100,,,fee schedule,100% of CMS OPPS rate,684.33,429,,,fee schedule,429% of BCBS fee schedule,713,100,,,case rate ,pays based on per visit,713,100,,,case rate,pays based on per visit,713,100,,,case rate,pays based on per visit,693.9,90,,555.12,percent of total billed charges,90% of total billed charges,616.8,80,,493.44,percent of total billed charges,80% of total billed charges,693.9,90,,555.12,percent of total billed charges,90% of total billed charges,578.25,75,,462.6,percent of total billed charges,75% of total billed charges,174.49,122,,,fee schedule,122% of HUMANA fee schedule,223.59,29,,178.872,percent of total billed charges,29% of total billed charges,143.03,100,,,fee schedule,100% of CMS OPPS rate,516.57,67,,413.256,percent of total billed charges,67% of total billed charges,80.59,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,616.8,80,,493.44,percent of total billed charges,80% of total billed charges,501.15,65,,400.92,percent of total billed charges,65% of total billed charges,275.02,35.67,,220.016,percent of total billed charges,35.67% of total billed charges,80.59,713,
EMERGENCY ROOM LEVEL 3  25 MOD,4500012,CDM,450,RC,99283,HCPCS,outpatient,,,1357,542.80,25,1153.45,85,,922.76,percent of total billed charges,85% of total billed charges,1044.89,77,,835.91,percent of total billed charges,77% of total billed charges,249.52,100,,,fee schedule,100% of CMS OPPS rate,1202.86,429,,,fee schedule,429% of BCBS fee schedule,1253.26,100,,,case rate ,pays based on per visit,1253.26,100,,,case rate,pays based on per visit,1253.26,100,,,case rate,pays based on per visit,1221.3,90,,977.04,percent of total billed charges,90% of total billed charges,1085.6,80,,868.48,percent of total billed charges,80% of total billed charges,1221.3,90,,977.04,percent of total billed charges,90% of total billed charges,1017.75,75,,814.2,percent of total billed charges,75% of total billed charges,304.39,122,,,fee schedule,122% of HUMANA fee schedule,393.53,29,,314.824,percent of total billed charges,29% of total billed charges,249.52,100,,,fee schedule,100% of CMS OPPS rate,909.19,67,,727.352,percent of total billed charges,67% of total billed charges,126.81,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,1085.6,80,,868.48,percent of total billed charges,80% of total billed charges,882.05,65,,705.64,percent of total billed charges,65% of total billed charges,484.04,35.67,,387.232,percent of total billed charges,35.67% of total billed charges,126.81,1253.26,
EMERGENCY ROOM LEVEL 4  25 MOD,4500013,CDM,450,RC,99284,HCPCS,outpatient,,,2200,880.00,25,1870,85,,1496,percent of total billed charges,85% of total billed charges,1694,77,,1355.2,percent of total billed charges,77% of total billed charges,387.33,100,,,fee schedule,100% of CMS OPPS rate,1525.22,429,,,fee schedule,429% of BCBS fee schedule,1589.22,447,,,fee schedule,447% of BCBS fee schedule,1589.22,447,,,fee schedule,447% of BCBS fee schedule,1589.22,447,,,fee schedule,447% of BCBS fee schedule,1980,90,,1584,percent of total billed charges,90% of total billed charges,1760,80,,1408,percent of total billed charges,80% of total billed charges,1980,90,,1584,percent of total billed charges,90% of total billed charges,1650,75,,1320,percent of total billed charges,75% of total billed charges,472.55,122,,,fee schedule,122% of HUMANA fee schedule,638,29,,510.4,percent of total billed charges,29% of total billed charges,387.33,100,,,fee schedule,100% of CMS OPPS rate,1474,67,,1179.2,percent of total billed charges,67% of total billed charges,203.97,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,1760,80,,1408,percent of total billed charges,80% of total billed charges,1430,65,,1144,percent of total billed charges,65% of total billed charges,784.74,35.67,,627.792,percent of total billed charges,35.67% of total billed charges,203.97,1980,
EMERGENCY ROOM LEVEL 5  25 MOD,4500014,CDM,450,RC,99285,HCPCS,outpatient,,,3221,1288.40,25,2737.85,85,,2190.28,percent of total billed charges,85% of total billed charges,2480.17,77,,1984.14,percent of total billed charges,77% of total billed charges,561.72,100,,,fee schedule,100% of CMS OPPS rate,2859.47,429,,,fee schedule,429% of BCBS fee schedule,2979.26,100,,,case rate ,pays based on per visit,2979.26,100,,,case rate,pays based on per visit,2979.26,100,,,case rate,pays based on per visit,2898.9,90,,2319.12,percent of total billed charges,90% of total billed charges,2576.8,80,,2061.44,percent of total billed charges,80% of total billed charges,2898.9,90,,2319.12,percent of total billed charges,90% of total billed charges,2415.75,75,,1932.6,percent of total billed charges,75% of total billed charges,685.29,122,,,fee schedule,122% of HUMANA fee schedule,934.09,29,,747.272,percent of total billed charges,29% of total billed charges,561.72,100,,,fee schedule,100% of CMS OPPS rate,2158.07,67,,1726.456,percent of total billed charges,67% of total billed charges,301.36,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,2576.8,80,,2061.44,percent of total billed charges,80% of total billed charges,2093.65,65,,1674.92,percent of total billed charges,65% of total billed charges,1148.93,35.67,,919.144,percent of total billed charges,35.67% of total billed charges,301.36,2979.26,
EMERGENCY ROOM CRITICAL 25 MOD,4500015,CDM,450,RC,99291,HCPCS,outpatient,,,4538,1815.20,25,3857.3,85,,3085.84,percent of total billed charges,85% of total billed charges,3494.26,77,,2795.41,percent of total billed charges,77% of total billed charges,776.03,100,,,fee schedule,100% of CMS OPPS rate,3147.27,429,,,fee schedule,429% of BCBS fee schedule,3279.33,447,,,fee schedule,447% of BCBS fee schedule,3279.33,447,,,fee schedule,447% of BCBS fee schedule,3279.33,447,,,fee schedule,447% of BCBS fee schedule,4084.2,90,,3267.36,percent of total billed charges,90% of total billed charges,3630.4,80,,2904.32,percent of total billed charges,80% of total billed charges,4084.2,90,,3267.36,percent of total billed charges,90% of total billed charges,3403.5,75,,2722.8,percent of total billed charges,75% of total billed charges,946.75,122,,,fee schedule,122% of HUMANA fee schedule,1316.02,29,,1052.816,percent of total billed charges,29% of total billed charges,776.03,100,,,fee schedule,100% of CMS OPPS rate,3040.46,67,,2432.368,percent of total billed charges,67% of total billed charges,434.16,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,3630.4,80,,2904.32,percent of total billed charges,80% of total billed charges,2949.7,65,,2359.76,percent of total billed charges,65% of total billed charges,1618.7,35.67,,1294.96,percent of total billed charges,35.67% of total billed charges,434.16,4084.2,
EMERGENCY ROOM - MINIMAL I,4500030,CDM,450,RC,99281,HCPCS,outpatient,,,425,170.00,,361.25,85,,289,percent of total billed charges,85% of total billed charges,327.25,77,,261.8,percent of total billed charges,77% of total billed charges,77.64,100,,,fee schedule,100% of CMS OPPS rate,376.94,429,,,fee schedule,429% of BCBS fee schedule,392.74,100,,,case rate ,pays based on per visit,392.74,100,,,case rate,pays based on per visit,392.74,100,,,case rate,pays based on per visit,382.5,90,,306,percent of total billed charges,90% of total billed charges,340,80,,272,percent of total billed charges,80% of total billed charges,382.5,90,,306,percent of total billed charges,90% of total billed charges,318.75,75,,255,percent of total billed charges,75% of total billed charges,94.71,122,,,fee schedule,122% of HUMANA fee schedule,123.25,29,,98.6,percent of total billed charges,29% of total billed charges,77.64,100,,,fee schedule,100% of CMS OPPS rate,284.75,67,,227.8,percent of total billed charges,67% of total billed charges,46.82,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,340,80,,272,percent of total billed charges,80% of total billed charges,276.25,65,,221,percent of total billed charges,65% of total billed charges,151.6,35.67,,121.28,percent of total billed charges,35.67% of total billed charges,46.82,392.74,
EMERGENCY ROOM - ROUTINE  2,4500031,CDM,450,RC,99282,HCPCS,outpatient,,,771,308.40,,655.35,85,,524.28,percent of total billed charges,85% of total billed charges,593.67,77,,474.94,percent of total billed charges,77% of total billed charges,143.03,100,,,fee schedule,100% of CMS OPPS rate,684.33,429,,,fee schedule,429% of BCBS fee schedule,713,100,,,case rate ,pays based on per visit,713,100,,,case rate,pays based on per visit,713,100,,,case rate,pays based on per visit,693.9,90,,555.12,percent of total billed charges,90% of total billed charges,616.8,80,,493.44,percent of total billed charges,80% of total billed charges,693.9,90,,555.12,percent of total billed charges,90% of total billed charges,578.25,75,,462.6,percent of total billed charges,75% of total billed charges,174.49,122,,,fee schedule,122% of HUMANA fee schedule,223.59,29,,178.872,percent of total billed charges,29% of total billed charges,143.03,100,,,fee schedule,100% of CMS OPPS rate,516.57,67,,413.256,percent of total billed charges,67% of total billed charges,80.59,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,616.8,80,,493.44,percent of total billed charges,80% of total billed charges,501.15,65,,400.92,percent of total billed charges,65% of total billed charges,275.02,35.67,,220.016,percent of total billed charges,35.67% of total billed charges,80.59,713,
EMERGENCY ROOM - INTERMED.LEV3,4500032,CDM,450,RC,99283,HCPCS,outpatient,,,1357,542.80,,1153.45,85,,922.76,percent of total billed charges,85% of total billed charges,1044.89,77,,835.91,percent of total billed charges,77% of total billed charges,249.52,100,,,fee schedule,100% of CMS OPPS rate,1202.86,429,,,fee schedule,429% of BCBS fee schedule,1253.26,100,,,case rate ,pays based on per visit,1253.26,100,,,case rate,pays based on per visit,1253.26,100,,,case rate,pays based on per visit,1221.3,90,,977.04,percent of total billed charges,90% of total billed charges,1085.6,80,,868.48,percent of total billed charges,80% of total billed charges,1221.3,90,,977.04,percent of total billed charges,90% of total billed charges,1017.75,75,,814.2,percent of total billed charges,75% of total billed charges,304.39,122,,,fee schedule,122% of HUMANA fee schedule,393.53,29,,314.824,percent of total billed charges,29% of total billed charges,249.52,100,,,fee schedule,100% of CMS OPPS rate,909.19,67,,727.352,percent of total billed charges,67% of total billed charges,126.81,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,1085.6,80,,868.48,percent of total billed charges,80% of total billed charges,882.05,65,,705.64,percent of total billed charges,65% of total billed charges,484.04,35.67,,387.232,percent of total billed charges,35.67% of total billed charges,126.81,1253.26,
EMERGENCY ROOM - COMPREHEN 4,4500033,CDM,450,RC,99284,HCPCS,outpatient,,,2200,880.00,,1870,85,,1496,percent of total billed charges,85% of total billed charges,1694,77,,1355.2,percent of total billed charges,77% of total billed charges,387.33,100,,,fee schedule,100% of CMS OPPS rate,1525.22,429,,,fee schedule,429% of BCBS fee schedule,1589.22,447,,,fee schedule,447% of BCBS fee schedule,1589.22,447,,,fee schedule,447% of BCBS fee schedule,1589.22,447,,,fee schedule,447% of BCBS fee schedule,1980,90,,1584,percent of total billed charges,90% of total billed charges,1760,80,,1408,percent of total billed charges,80% of total billed charges,1980,90,,1584,percent of total billed charges,90% of total billed charges,1650,75,,1320,percent of total billed charges,75% of total billed charges,472.55,122,,,fee schedule,122% of HUMANA fee schedule,638,29,,510.4,percent of total billed charges,29% of total billed charges,387.33,100,,,fee schedule,100% of CMS OPPS rate,1474,67,,1179.2,percent of total billed charges,67% of total billed charges,203.97,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,1760,80,,1408,percent of total billed charges,80% of total billed charges,1430,65,,1144,percent of total billed charges,65% of total billed charges,784.74,35.67,,627.792,percent of total billed charges,35.67% of total billed charges,203.97,1980,
ER CRITICAL CARE EA ADD 30 MIN,4500035,CDM,450,RC,99292,HCPCS,outpatient,,,521,208.40,25,442.85,85,,354.28,percent of total billed charges,85% of total billed charges,401.17,77,,320.94,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,622.62,429,,,fee schedule,429% of BCBS fee schedule,648.71,100,,,case rate ,pays based on per visit,648.71,100,,,case rate,pays based on per visit,648.71,100,,,case rate,pays based on per visit,468.9,90,,375.12,percent of total billed charges,90% of total billed charges,416.8,80,,333.44,percent of total billed charges,80% of total billed charges,468.9,90,,375.12,percent of total billed charges,90% of total billed charges,390.75,75,,312.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,151.09,29,,120.872,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,349.07,67,,279.256,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,416.8,80,,333.44,percent of total billed charges,80% of total billed charges,338.65,65,,270.92,percent of total billed charges,65% of total billed charges,185.84,35.67,,148.672,percent of total billed charges,35.67% of total billed charges,151.09,648.71,
EMERGENCY ROOM - INTENSIVE 5,4500040,CDM,450,RC,99285,HCPCS,outpatient,,,3221,1288.40,,2737.85,85,,2190.28,percent of total billed charges,85% of total billed charges,2480.17,77,,1984.14,percent of total billed charges,77% of total billed charges,561.72,100,,,fee schedule,100% of CMS OPPS rate,2859.47,429,,,fee schedule,429% of BCBS fee schedule,2979.26,100,,,case rate ,pays based on per visit,2979.26,100,,,case rate,pays based on per visit,2979.26,100,,,case rate,pays based on per visit,2898.9,90,,2319.12,percent of total billed charges,90% of total billed charges,2576.8,80,,2061.44,percent of total billed charges,80% of total billed charges,2898.9,90,,2319.12,percent of total billed charges,90% of total billed charges,2415.75,75,,1932.6,percent of total billed charges,75% of total billed charges,685.29,122,,,fee schedule,122% of HUMANA fee schedule,934.09,29,,747.272,percent of total billed charges,29% of total billed charges,561.72,100,,,fee schedule,100% of CMS OPPS rate,2158.07,67,,1726.456,percent of total billed charges,67% of total billed charges,301.36,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,2576.8,80,,2061.44,percent of total billed charges,80% of total billed charges,2093.65,65,,1674.92,percent of total billed charges,65% of total billed charges,1148.93,35.67,,919.144,percent of total billed charges,35.67% of total billed charges,301.36,2979.26,
EMERGENCY ROOM OB DELIVERY,4500042,CDM,450,RC,,,outpatient,,,2200,880.00,,1870,85,,1496,percent of total billed charges,85% of total billed charges,1694,77,,1355.2,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,1804,82,,1443.2,percent of total billed charges,82% of total billed charges,1870,85,,1496,percent of total billed charges,85% of total billed charges,1870,85,,1496,percent of total billed charges,85% of total billed charges,1870,85,,1496,percent of total billed charges,85% of total billed charges,1980,90,,1584,percent of total billed charges,90% of total billed charges,1760,80,,1408,percent of total billed charges,80% of total billed charges,1980,90,,1584,percent of total billed charges,90% of total billed charges,1650,75,,1320,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,638,29,,510.4,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1474,67,,1179.2,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1760,80,,1408,percent of total billed charges,80% of total billed charges,1430,65,,1144,percent of total billed charges,65% of total billed charges,784.74,35.67,,627.792,percent of total billed charges,35.67% of total billed charges,638,1980,
ER-INJECTION IM/SUB-Q,4500046,CDM,450,RC,96372,HCPCS,outpatient,,,289,115.60,,245.65,85,,196.52,percent of total billed charges,85% of total billed charges,222.53,77,,178.02,percent of total billed charges,77% of total billed charges,61.6,100,,,fee schedule,100% of CMS OPPS rate,249.68,429,,,fee schedule,429% of BCBS fee schedule,260.15,447,,,fee schedule,447% of BCBS fee schedule,260.15,447,,,fee schedule,447% of BCBS fee schedule,260.15,447,,,fee schedule,447% of BCBS fee schedule,260.1,90,,208.08,percent of total billed charges,90% of total billed charges,231.2,80,,184.96,percent of total billed charges,80% of total billed charges,260.1,90,,208.08,percent of total billed charges,90% of total billed charges,216.75,75,,173.4,percent of total billed charges,75% of total billed charges,75.16,122,,,fee schedule,122% of HUMANA fee schedule,83.81,29,,67.048,percent of total billed charges,29% of total billed charges,61.6,100,,,fee schedule,100% of CMS OPPS rate,193.63,67,,154.904,percent of total billed charges,67% of total billed charges,32.45,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,231.2,80,,184.96,percent of total billed charges,80% of total billed charges,187.85,65,,150.28,percent of total billed charges,65% of total billed charges,103.09,35.67,,82.472,percent of total billed charges,35.67% of total billed charges,32.45,260.15,
THROMBOLYTIC IV ADMIN STROKE,4500047,CDM,450,RC,37195,HCPCS,outpatient,,,1597,638.80,,1150,,,,case rate,pays based on per visit,1229.69,77,,983.75,percent of total billed charges,77% of total billed charges,296.17,100,,,fee schedule,100% of CMS OPPS rate,1309.54,82,,1047.632,percent of total billed charges,82% of total billed charges,1357.45,85,,1085.96,percent of total billed charges,85% of total billed charges,1357.45,85,,1085.96,percent of total billed charges,85% of total billed charges,1357.45,85,,1085.96,percent of total billed charges,85% of total billed charges,1437.3,90,,1149.84,percent of total billed charges,90% of total billed charges,1277.6,80,,1022.08,percent of total billed charges,80% of total billed charges,1437.3,90,,1149.84,percent of total billed charges,90% of total billed charges,1197.75,75,,958.2,percent of total billed charges,75% of total billed charges,361.32,122,,,fee schedule,122% of HUMANA fee schedule,463.13,29,,370.504,percent of total billed charges,29% of total billed charges,296.17,100,,,fee schedule,100% of CMS OPPS rate,1069.99,67,,855.992,percent of total billed charges,67% of total billed charges,150.36,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,1277.6,80,,1022.08,percent of total billed charges,80% of total billed charges,1038.05,65,,830.44,percent of total billed charges,65% of total billed charges,569.65,35.67,,455.72,percent of total billed charges,35.67% of total billed charges,150.36,1437.3,
BLADDER IRRIGATION,4500049,CDM,450,RC,51700,HCPCS,outpatient,,,472,188.80,,1150,,,,case rate,pays based on per visit,363.44,77,,290.75,percent of total billed charges,77% of total billed charges,216.13,100,,,fee schedule,100% of CMS OPPS rate,387.04,82,,309.632,percent of total billed charges,82% of total billed charges,401.2,85,,320.96,percent of total billed charges,85% of total billed charges,401.2,85,,320.96,percent of total billed charges,85% of total billed charges,401.2,85,,320.96,percent of total billed charges,85% of total billed charges,424.8,90,,339.84,percent of total billed charges,90% of total billed charges,377.6,80,,302.08,percent of total billed charges,80% of total billed charges,424.8,90,,339.84,percent of total billed charges,90% of total billed charges,354,75,,283.2,percent of total billed charges,75% of total billed charges,263.68,122,,,fee schedule,122% of HUMANA fee schedule,44.3,100,,,fee schedule,100% of ASC tier grouping rate,216.13,100,,,fee schedule,100% of CMS OPPS rate,316.24,67,,252.992,percent of total billed charges,67% of total billed charges,127.12,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,377.6,80,,302.08,percent of total billed charges,80% of total billed charges,306.8,65,,245.44,percent of total billed charges,65% of total billed charges,54.49,123,,,fee schedule,123% of ASC tier grouping rate,44.3,1150,
BURN DRESSING/DEBRIDE  ER,4500050,CDM,450,RC,,,outpatient,,,114,45.60,,96.9,85,,77.52,percent of total billed charges,85% of total billed charges,87.78,77,,70.22,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,93.48,82,,74.784,percent of total billed charges,82% of total billed charges,96.9,85,,77.52,percent of total billed charges,85% of total billed charges,96.9,85,,77.52,percent of total billed charges,85% of total billed charges,96.9,85,,77.52,percent of total billed charges,85% of total billed charges,102.6,90,,82.08,percent of total billed charges,90% of total billed charges,91.2,80,,72.96,percent of total billed charges,80% of total billed charges,102.6,90,,82.08,percent of total billed charges,90% of total billed charges,85.5,75,,68.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,33.06,29,,26.448,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,76.38,67,,61.104,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,91.2,80,,72.96,percent of total billed charges,80% of total billed charges,74.1,65,,59.28,percent of total billed charges,65% of total billed charges,40.66,35.67,,32.528,percent of total billed charges,35.67% of total billed charges,33.06,102.6,
CHEST TUBE - ER,4500052,CDM,450,RC,,,outpatient,,,346,138.40,,294.1,85,,235.28,percent of total billed charges,85% of total billed charges,266.42,77,,213.14,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,283.72,82,,226.976,percent of total billed charges,82% of total billed charges,294.1,85,,235.28,percent of total billed charges,85% of total billed charges,294.1,85,,235.28,percent of total billed charges,85% of total billed charges,294.1,85,,235.28,percent of total billed charges,85% of total billed charges,311.4,90,,249.12,percent of total billed charges,90% of total billed charges,276.8,80,,221.44,percent of total billed charges,80% of total billed charges,311.4,90,,249.12,percent of total billed charges,90% of total billed charges,259.5,75,,207.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,100.34,29,,80.272,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,231.82,67,,185.456,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,276.8,80,,221.44,percent of total billed charges,80% of total billed charges,224.9,65,,179.92,percent of total billed charges,65% of total billed charges,123.42,35.67,,98.736,percent of total billed charges,35.67% of total billed charges,100.34,311.4,
CVP/SUBCLAVIAN INSERT   ER,4500053,CDM,450,RC,36556,HCPCS,outpatient,,,432,172.80,,1150,,,,case rate,pays based on per visit,332.64,77,,266.11,percent of total billed charges,77% of total billed charges,2787.55,100,,,fee schedule,100% of CMS OPPS rate,354.24,82,,283.392,percent of total billed charges,82% of total billed charges,367.2,85,,293.76,percent of total billed charges,85% of total billed charges,367.2,85,,293.76,percent of total billed charges,85% of total billed charges,367.2,85,,293.76,percent of total billed charges,85% of total billed charges,388.8,90,,311.04,percent of total billed charges,90% of total billed charges,345.6,80,,276.48,percent of total billed charges,80% of total billed charges,388.8,90,,311.04,percent of total billed charges,90% of total billed charges,324,75,,259.2,percent of total billed charges,75% of total billed charges,3400.8,122,,,fee schedule,122% of HUMANA fee schedule,1118.22,100,,,fee schedule,100% of ASC tier grouping rate,2787.55,100,,,fee schedule,100% of CMS OPPS rate,289.44,67,,231.552,percent of total billed charges,67% of total billed charges,723.08,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,345.6,80,,276.48,percent of total billed charges,80% of total billed charges,280.8,65,,224.64,percent of total billed charges,65% of total billed charges,1375.41,123,,,fee schedule,123% of ASC tier grouping rate,280.8,3400.8,
ENDOTRACHEAL INTUBATION ER,4500054,CDM,450,RC,31500,HCPCS,outpatient,,,977,390.80,,1150,,,,case rate,pays based on per visit,752.29,77,,601.83,percent of total billed charges,77% of total billed charges,213.61,100,,,fee schedule,100% of CMS OPPS rate,801.14,82,,640.912,percent of total billed charges,82% of total billed charges,830.45,85,,664.36,percent of total billed charges,85% of total billed charges,830.45,85,,664.36,percent of total billed charges,85% of total billed charges,830.45,85,,664.36,percent of total billed charges,85% of total billed charges,879.3,90,,703.44,percent of total billed charges,90% of total billed charges,781.6,80,,625.28,percent of total billed charges,80% of total billed charges,879.3,90,,703.44,percent of total billed charges,90% of total billed charges,732.75,75,,586.2,percent of total billed charges,75% of total billed charges,260.6,122,,,fee schedule,122% of HUMANA fee schedule,87.58,100,,,fee schedule,100% of ASC tier grouping rate,213.61,100,,,fee schedule,100% of CMS OPPS rate,654.59,67,,523.672,percent of total billed charges,67% of total billed charges,145.5,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,781.6,80,,625.28,percent of total billed charges,80% of total billed charges,635.05,65,,508.04,percent of total billed charges,65% of total billed charges,107.72,123,,,fee schedule,123% of ASC tier grouping rate,87.58,1150,
FB REMOVAL BY INCISION ER,4500056,CDM,450,RC,,,outpatient,,,160,64.00,,136,85,,108.8,percent of total billed charges,85% of total billed charges,123.2,77,,98.56,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,131.2,82,,104.96,percent of total billed charges,82% of total billed charges,136,85,,108.8,percent of total billed charges,85% of total billed charges,136,85,,108.8,percent of total billed charges,85% of total billed charges,136,85,,108.8,percent of total billed charges,85% of total billed charges,144,90,,115.2,percent of total billed charges,90% of total billed charges,128,80,,102.4,percent of total billed charges,80% of total billed charges,144,90,,115.2,percent of total billed charges,90% of total billed charges,120,75,,96,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,46.4,29,,37.12,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,107.2,67,,85.76,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,128,80,,102.4,percent of total billed charges,80% of total billed charges,104,65,,83.2,percent of total billed charges,65% of total billed charges,57.07,35.67,,45.656,percent of total billed charges,35.67% of total billed charges,46.4,144,
NG/GASTRIC LAVAGE - ER,4500057,CDM,450,RC,43753,HCPCS,outpatient,,,472,188.80,,1150,,,,case rate,pays based on per visit,363.44,77,,290.75,percent of total billed charges,77% of total billed charges,274.49,100,,,fee schedule,100% of CMS OPPS rate,387.04,82,,309.632,percent of total billed charges,82% of total billed charges,401.2,85,,320.96,percent of total billed charges,85% of total billed charges,401.2,85,,320.96,percent of total billed charges,85% of total billed charges,401.2,85,,320.96,percent of total billed charges,85% of total billed charges,424.8,90,,339.84,percent of total billed charges,90% of total billed charges,377.6,80,,302.08,percent of total billed charges,80% of total billed charges,424.8,90,,339.84,percent of total billed charges,90% of total billed charges,354,75,,283.2,percent of total billed charges,75% of total billed charges,334.88,122,,,fee schedule,122% of HUMANA fee schedule,136.88,29,,109.504,percent of total billed charges,29% of total billed charges,274.49,100,,,fee schedule,100% of CMS OPPS rate,316.24,67,,252.992,percent of total billed charges,67% of total billed charges,42.55,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,377.6,80,,302.08,percent of total billed charges,80% of total billed charges,306.8,65,,245.44,percent of total billed charges,65% of total billed charges,168.36,35.67,,134.688,percent of total billed charges,35.67% of total billed charges,42.55,1150,
NASAL PACKING - ER,4500058,CDM,450,RC,,,outpatient,,,151,60.40,,128.35,85,,102.68,percent of total billed charges,85% of total billed charges,116.27,77,,93.02,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,123.82,82,,99.056,percent of total billed charges,82% of total billed charges,128.35,85,,102.68,percent of total billed charges,85% of total billed charges,128.35,85,,102.68,percent of total billed charges,85% of total billed charges,128.35,85,,102.68,percent of total billed charges,85% of total billed charges,135.9,90,,108.72,percent of total billed charges,90% of total billed charges,120.8,80,,96.64,percent of total billed charges,80% of total billed charges,135.9,90,,108.72,percent of total billed charges,90% of total billed charges,113.25,75,,90.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,43.79,29,,35.032,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,101.17,67,,80.936,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,120.8,80,,96.64,percent of total billed charges,80% of total billed charges,98.15,65,,78.52,percent of total billed charges,65% of total billed charges,53.86,35.67,,43.088,percent of total billed charges,35.67% of total billed charges,43.79,135.9,
SPINAL TAP - ER,4500060,CDM,450,RC,,,outpatient,,,799,319.60,,679.15,85,,543.32,percent of total billed charges,85% of total billed charges,615.23,77,,492.18,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,655.18,82,,524.144,percent of total billed charges,82% of total billed charges,679.15,85,,543.32,percent of total billed charges,85% of total billed charges,679.15,85,,543.32,percent of total billed charges,85% of total billed charges,679.15,85,,543.32,percent of total billed charges,85% of total billed charges,719.1,90,,575.28,percent of total billed charges,90% of total billed charges,639.2,80,,511.36,percent of total billed charges,80% of total billed charges,719.1,90,,575.28,percent of total billed charges,90% of total billed charges,599.25,75,,479.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,231.71,29,,185.368,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,535.33,67,,428.264,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,639.2,80,,511.36,percent of total billed charges,80% of total billed charges,519.35,65,,415.48,percent of total billed charges,65% of total billed charges,285,35.67,,228,percent of total billed charges,35.67% of total billed charges,231.71,719.1,
THORACENTESIS - ER,4500061,CDM,450,RC,,,outpatient,,,277,110.80,,235.45,85,,188.36,percent of total billed charges,85% of total billed charges,213.29,77,,170.63,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,227.14,82,,181.712,percent of total billed charges,82% of total billed charges,235.45,85,,188.36,percent of total billed charges,85% of total billed charges,235.45,85,,188.36,percent of total billed charges,85% of total billed charges,235.45,85,,188.36,percent of total billed charges,85% of total billed charges,249.3,90,,199.44,percent of total billed charges,90% of total billed charges,221.6,80,,177.28,percent of total billed charges,80% of total billed charges,249.3,90,,199.44,percent of total billed charges,90% of total billed charges,207.75,75,,166.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,80.33,29,,64.264,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,185.59,67,,148.472,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,221.6,80,,177.28,percent of total billed charges,80% of total billed charges,180.05,65,,144.04,percent of total billed charges,65% of total billed charges,98.81,35.67,,79.048,percent of total billed charges,35.67% of total billed charges,80.33,249.3,
TRACHEOSTOMY - ER,4500062,CDM,450,RC,31603,HCPCS,outpatient,,,2815,1126.00,,1150,,,,case rate,pays based on per visit,2167.55,77,,1734.04,percent of total billed charges,77% of total billed charges,1333.69,100,,,fee schedule,100% of CMS OPPS rate,2308.3,82,,1846.64,percent of total billed charges,82% of total billed charges,2392.75,85,,1914.2,percent of total billed charges,85% of total billed charges,2392.75,85,,1914.2,percent of total billed charges,85% of total billed charges,2392.75,85,,1914.2,percent of total billed charges,85% of total billed charges,2533.5,90,,2026.8,percent of total billed charges,90% of total billed charges,2252,80,,1801.6,percent of total billed charges,80% of total billed charges,2533.5,90,,2026.8,percent of total billed charges,90% of total billed charges,2111.25,75,,1689,percent of total billed charges,75% of total billed charges,1627.1,122,,,fee schedule,122% of HUMANA fee schedule,420.64,100,,,fee schedule,100% of ASC tier grouping rate,1333.69,100,,,fee schedule,100% of CMS OPPS rate,1886.05,67,,1508.84,percent of total billed charges,67% of total billed charges,486.49,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,2252,80,,1801.6,percent of total billed charges,80% of total billed charges,1829.75,65,,1463.8,percent of total billed charges,65% of total billed charges,517.39,123,,,fee schedule,123% of ASC tier grouping rate,420.64,2533.5,
ER TREATMENT OF DISLOCATION,4500064,CDM,450,RC,,,outpatient,,,133,53.20,,113.05,85,,90.44,percent of total billed charges,85% of total billed charges,102.41,77,,81.93,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,109.06,82,,87.248,percent of total billed charges,82% of total billed charges,113.05,85,,90.44,percent of total billed charges,85% of total billed charges,113.05,85,,90.44,percent of total billed charges,85% of total billed charges,113.05,85,,90.44,percent of total billed charges,85% of total billed charges,119.7,90,,95.76,percent of total billed charges,90% of total billed charges,106.4,80,,85.12,percent of total billed charges,80% of total billed charges,119.7,90,,95.76,percent of total billed charges,90% of total billed charges,99.75,75,,79.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,38.57,29,,30.856,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,89.11,67,,71.288,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,106.4,80,,85.12,percent of total billed charges,80% of total billed charges,86.45,65,,69.16,percent of total billed charges,65% of total billed charges,47.44,35.67,,37.952,percent of total billed charges,35.67% of total billed charges,38.57,119.7,
SHOULDER DISLOC. W/O ANESTHES,4500065,CDM,450,RC,,,outpatient,,,522,208.80,,443.7,85,,354.96,percent of total billed charges,85% of total billed charges,401.94,77,,321.55,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,428.04,82,,342.432,percent of total billed charges,82% of total billed charges,443.7,85,,354.96,percent of total billed charges,85% of total billed charges,443.7,85,,354.96,percent of total billed charges,85% of total billed charges,443.7,85,,354.96,percent of total billed charges,85% of total billed charges,469.8,90,,375.84,percent of total billed charges,90% of total billed charges,417.6,80,,334.08,percent of total billed charges,80% of total billed charges,469.8,90,,375.84,percent of total billed charges,90% of total billed charges,391.5,75,,313.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,151.38,29,,121.104,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,349.74,67,,279.792,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,417.6,80,,334.08,percent of total billed charges,80% of total billed charges,339.3,65,,271.44,percent of total billed charges,65% of total billed charges,186.2,35.67,,148.96,percent of total billed charges,35.67% of total billed charges,151.38,469.8,
FX REDUCTION W/MANIPULATION,4500067,CDM,450,RC,,,outpatient,,,3587,1434.80,,3048.95,85,,2439.16,percent of total billed charges,85% of total billed charges,2761.99,77,,2209.59,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,2941.34,82,,2353.072,percent of total billed charges,82% of total billed charges,3048.95,85,,2439.16,percent of total billed charges,85% of total billed charges,3048.95,85,,2439.16,percent of total billed charges,85% of total billed charges,3048.95,85,,2439.16,percent of total billed charges,85% of total billed charges,3228.3,90,,2582.64,percent of total billed charges,90% of total billed charges,2869.6,80,,2295.68,percent of total billed charges,80% of total billed charges,3228.3,90,,2582.64,percent of total billed charges,90% of total billed charges,2690.25,75,,2152.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,1040.23,29,,832.184,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,2403.29,67,,1922.632,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,2869.6,80,,2295.68,percent of total billed charges,80% of total billed charges,2331.55,65,,1865.24,percent of total billed charges,65% of total billed charges,1279.48,35.67,,1023.584,percent of total billed charges,35.67% of total billed charges,1040.23,3228.3,
FX REDUCTION W/O MANIPULATION,4500068,CDM,450,RC,,,outpatient,,,522,208.80,,443.7,85,,354.96,percent of total billed charges,85% of total billed charges,401.94,77,,321.55,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,428.04,82,,342.432,percent of total billed charges,82% of total billed charges,443.7,85,,354.96,percent of total billed charges,85% of total billed charges,443.7,85,,354.96,percent of total billed charges,85% of total billed charges,443.7,85,,354.96,percent of total billed charges,85% of total billed charges,469.8,90,,375.84,percent of total billed charges,90% of total billed charges,417.6,80,,334.08,percent of total billed charges,80% of total billed charges,469.8,90,,375.84,percent of total billed charges,90% of total billed charges,391.5,75,,313.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,151.38,29,,121.104,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,349.74,67,,279.792,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,417.6,80,,334.08,percent of total billed charges,80% of total billed charges,339.3,65,,271.44,percent of total billed charges,65% of total billed charges,186.2,35.67,,148.96,percent of total billed charges,35.67% of total billed charges,151.38,469.8,
SPLINTING LONG LEG RIGHT ER,4500069,CDM,450,RC,29505,HCPCS,outpatient,,,311,124.40,RT,1150,,,,case rate,pays based on per visit,239.47,77,,191.58,percent of total billed charges,77% of total billed charges,137.79,100,,,fee schedule,100% of CMS OPPS rate,255.02,82,,204.016,percent of total billed charges,82% of total billed charges,264.35,85,,211.48,percent of total billed charges,85% of total billed charges,264.35,85,,211.48,percent of total billed charges,85% of total billed charges,264.35,85,,211.48,percent of total billed charges,85% of total billed charges,279.9,90,,223.92,percent of total billed charges,90% of total billed charges,248.8,80,,199.04,percent of total billed charges,80% of total billed charges,279.9,90,,223.92,percent of total billed charges,90% of total billed charges,233.25,75,,186.6,percent of total billed charges,75% of total billed charges,168.1,122,,,fee schedule,122% of HUMANA fee schedule,48.45,100,,,fee schedule,100% of ASC tier grouping rate,137.79,100,,,fee schedule,100% of CMS OPPS rate,208.37,67,,166.696,percent of total billed charges,67% of total billed charges,73.52,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,248.8,80,,199.04,percent of total billed charges,80% of total billed charges,202.15,65,,161.72,percent of total billed charges,65% of total billed charges,59.59,123,,,fee schedule,123% of ASC tier grouping rate,48.45,1150,
SPLINTING LONG LEG LEFT ER,4500070,CDM,450,RC,,,outpatient,,,316,126.40,,268.6,85,,214.88,percent of total billed charges,85% of total billed charges,243.32,77,,194.66,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,259.12,82,,207.296,percent of total billed charges,82% of total billed charges,268.6,85,,214.88,percent of total billed charges,85% of total billed charges,268.6,85,,214.88,percent of total billed charges,85% of total billed charges,268.6,85,,214.88,percent of total billed charges,85% of total billed charges,284.4,90,,227.52,percent of total billed charges,90% of total billed charges,252.8,80,,202.24,percent of total billed charges,80% of total billed charges,284.4,90,,227.52,percent of total billed charges,90% of total billed charges,237,75,,189.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,91.64,29,,73.312,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,211.72,67,,169.376,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,252.8,80,,202.24,percent of total billed charges,80% of total billed charges,205.4,65,,164.32,percent of total billed charges,65% of total billed charges,112.72,35.67,,90.176,percent of total billed charges,35.67% of total billed charges,91.64,284.4,
SPLINTING SHORT LEG RT ER,4500071,CDM,450,RC,29515,HCPCS,outpatient,,,246,98.40,RT,1150,,,,case rate,pays based on per visit,189.42,77,,151.54,percent of total billed charges,77% of total billed charges,137.79,100,,,fee schedule,100% of CMS OPPS rate,201.72,82,,161.376,percent of total billed charges,82% of total billed charges,209.1,85,,167.28,percent of total billed charges,85% of total billed charges,209.1,85,,167.28,percent of total billed charges,85% of total billed charges,209.1,85,,167.28,percent of total billed charges,85% of total billed charges,221.4,90,,177.12,percent of total billed charges,90% of total billed charges,196.8,80,,157.44,percent of total billed charges,80% of total billed charges,221.4,90,,177.12,percent of total billed charges,90% of total billed charges,184.5,75,,147.6,percent of total billed charges,75% of total billed charges,168.1,122,,,fee schedule,122% of HUMANA fee schedule,34.33,100,,,fee schedule,100% of ASC tier grouping rate,137.79,100,,,fee schedule,100% of CMS OPPS rate,164.82,67,,131.856,percent of total billed charges,67% of total billed charges,73.52,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,196.8,80,,157.44,percent of total billed charges,80% of total billed charges,159.9,65,,127.92,percent of total billed charges,65% of total billed charges,42.23,123,,,fee schedule,123% of ASC tier grouping rate,34.33,1150,
SPLINTING SHORT LEG LT ER,4500072,CDM,450,RC,29515,HCPCS,outpatient,,,242,96.80,LT,1150,,,,case rate,pays based on per visit,186.34,77,,149.07,percent of total billed charges,77% of total billed charges,137.79,100,,,fee schedule,100% of CMS OPPS rate,198.44,82,,158.752,percent of total billed charges,82% of total billed charges,205.7,85,,164.56,percent of total billed charges,85% of total billed charges,205.7,85,,164.56,percent of total billed charges,85% of total billed charges,205.7,85,,164.56,percent of total billed charges,85% of total billed charges,217.8,90,,174.24,percent of total billed charges,90% of total billed charges,193.6,80,,154.88,percent of total billed charges,80% of total billed charges,217.8,90,,174.24,percent of total billed charges,90% of total billed charges,181.5,75,,145.2,percent of total billed charges,75% of total billed charges,168.1,122,,,fee schedule,122% of HUMANA fee schedule,34.33,100,,,fee schedule,100% of ASC tier grouping rate,137.79,100,,,fee schedule,100% of CMS OPPS rate,162.14,67,,129.712,percent of total billed charges,67% of total billed charges,73.52,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,193.6,80,,154.88,percent of total billed charges,80% of total billed charges,157.3,65,,125.84,percent of total billed charges,65% of total billed charges,42.23,123,,,fee schedule,123% of ASC tier grouping rate,34.33,1150,
SPLINTING LONG ARM RT ER,4500073,CDM,450,RC,,,outpatient,,,316,126.40,,268.6,85,,214.88,percent of total billed charges,85% of total billed charges,243.32,77,,194.66,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,259.12,82,,207.296,percent of total billed charges,82% of total billed charges,268.6,85,,214.88,percent of total billed charges,85% of total billed charges,268.6,85,,214.88,percent of total billed charges,85% of total billed charges,268.6,85,,214.88,percent of total billed charges,85% of total billed charges,284.4,90,,227.52,percent of total billed charges,90% of total billed charges,252.8,80,,202.24,percent of total billed charges,80% of total billed charges,284.4,90,,227.52,percent of total billed charges,90% of total billed charges,237,75,,189.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,91.64,29,,73.312,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,211.72,67,,169.376,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,252.8,80,,202.24,percent of total billed charges,80% of total billed charges,205.4,65,,164.32,percent of total billed charges,65% of total billed charges,112.72,35.67,,90.176,percent of total billed charges,35.67% of total billed charges,91.64,284.4,
SPLINTING LONG ARM LT ER,4500074,CDM,450,RC,29105,HCPCS,outpatient,,,316,126.40,LT,1150,,,,case rate,pays based on per visit,243.32,77,,194.66,percent of total billed charges,77% of total billed charges,137.79,100,,,fee schedule,100% of CMS OPPS rate,259.12,82,,207.296,percent of total billed charges,82% of total billed charges,268.6,85,,214.88,percent of total billed charges,85% of total billed charges,268.6,85,,214.88,percent of total billed charges,85% of total billed charges,268.6,85,,214.88,percent of total billed charges,85% of total billed charges,284.4,90,,227.52,percent of total billed charges,90% of total billed charges,252.8,80,,202.24,percent of total billed charges,80% of total billed charges,284.4,90,,227.52,percent of total billed charges,90% of total billed charges,237,75,,189.6,percent of total billed charges,75% of total billed charges,168.1,122,,,fee schedule,122% of HUMANA fee schedule,40.14,100,,,fee schedule,100% of ASC tier grouping rate,137.79,100,,,fee schedule,100% of CMS OPPS rate,211.72,67,,169.376,percent of total billed charges,67% of total billed charges,73.52,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,252.8,80,,202.24,percent of total billed charges,80% of total billed charges,205.4,65,,164.32,percent of total billed charges,65% of total billed charges,49.37,123,,,fee schedule,123% of ASC tier grouping rate,40.14,1150,
SPLINTING SHORT ARM RT ER,4500075,CDM,450,RC,,,outpatient,,,246,98.40,,209.1,85,,167.28,percent of total billed charges,85% of total billed charges,189.42,77,,151.54,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,201.72,82,,161.376,percent of total billed charges,82% of total billed charges,209.1,85,,167.28,percent of total billed charges,85% of total billed charges,209.1,85,,167.28,percent of total billed charges,85% of total billed charges,209.1,85,,167.28,percent of total billed charges,85% of total billed charges,221.4,90,,177.12,percent of total billed charges,90% of total billed charges,196.8,80,,157.44,percent of total billed charges,80% of total billed charges,221.4,90,,177.12,percent of total billed charges,90% of total billed charges,184.5,75,,147.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,71.34,29,,57.072,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,164.82,67,,131.856,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,196.8,80,,157.44,percent of total billed charges,80% of total billed charges,159.9,65,,127.92,percent of total billed charges,65% of total billed charges,87.75,35.67,,70.2,percent of total billed charges,35.67% of total billed charges,71.34,221.4,
SPLINTING SHORT ARM LT ER,4500076,CDM,450,RC,,,outpatient,,,246,98.40,,209.1,85,,167.28,percent of total billed charges,85% of total billed charges,189.42,77,,151.54,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,201.72,82,,161.376,percent of total billed charges,82% of total billed charges,209.1,85,,167.28,percent of total billed charges,85% of total billed charges,209.1,85,,167.28,percent of total billed charges,85% of total billed charges,209.1,85,,167.28,percent of total billed charges,85% of total billed charges,221.4,90,,177.12,percent of total billed charges,90% of total billed charges,196.8,80,,157.44,percent of total billed charges,80% of total billed charges,221.4,90,,177.12,percent of total billed charges,90% of total billed charges,184.5,75,,147.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,71.34,29,,57.072,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,164.82,67,,131.856,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,196.8,80,,157.44,percent of total billed charges,80% of total billed charges,159.9,65,,127.92,percent of total billed charges,65% of total billed charges,87.75,35.67,,70.2,percent of total billed charges,35.67% of total billed charges,71.34,221.4,
SPLINTING - OTHER ER,4500077,CDM,450,RC,,,outpatient,,,106,42.40,,90.1,85,,72.08,percent of total billed charges,85% of total billed charges,81.62,77,,65.3,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,86.92,82,,69.536,percent of total billed charges,82% of total billed charges,90.1,85,,72.08,percent of total billed charges,85% of total billed charges,90.1,85,,72.08,percent of total billed charges,85% of total billed charges,90.1,85,,72.08,percent of total billed charges,85% of total billed charges,95.4,90,,76.32,percent of total billed charges,90% of total billed charges,84.8,80,,67.84,percent of total billed charges,80% of total billed charges,95.4,90,,76.32,percent of total billed charges,90% of total billed charges,79.5,75,,63.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,30.74,29,,24.592,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,71.02,67,,56.816,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,84.8,80,,67.84,percent of total billed charges,80% of total billed charges,68.9,65,,55.12,percent of total billed charges,65% of total billed charges,37.81,35.67,,30.248,percent of total billed charges,35.67% of total billed charges,30.74,95.4,
SPLINTING - SHOULDER,4500080,CDM,450,RC,,,outpatient,,,246,98.40,,209.1,85,,167.28,percent of total billed charges,85% of total billed charges,189.42,77,,151.54,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,201.72,82,,161.376,percent of total billed charges,82% of total billed charges,209.1,85,,167.28,percent of total billed charges,85% of total billed charges,209.1,85,,167.28,percent of total billed charges,85% of total billed charges,209.1,85,,167.28,percent of total billed charges,85% of total billed charges,221.4,90,,177.12,percent of total billed charges,90% of total billed charges,196.8,80,,157.44,percent of total billed charges,80% of total billed charges,221.4,90,,177.12,percent of total billed charges,90% of total billed charges,184.5,75,,147.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,71.34,29,,57.072,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,164.82,67,,131.856,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,196.8,80,,157.44,percent of total billed charges,80% of total billed charges,159.9,65,,127.92,percent of total billed charges,65% of total billed charges,87.75,35.67,,70.2,percent of total billed charges,35.67% of total billed charges,71.34,221.4,
SPLINTING - FINGER,4500082,CDM,450,RC,,,outpatient,,,107,42.80,,90.95,85,,72.76,percent of total billed charges,85% of total billed charges,82.39,77,,65.91,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,87.74,82,,70.192,percent of total billed charges,82% of total billed charges,90.95,85,,72.76,percent of total billed charges,85% of total billed charges,90.95,85,,72.76,percent of total billed charges,85% of total billed charges,90.95,85,,72.76,percent of total billed charges,85% of total billed charges,96.3,90,,77.04,percent of total billed charges,90% of total billed charges,85.6,80,,68.48,percent of total billed charges,80% of total billed charges,96.3,90,,77.04,percent of total billed charges,90% of total billed charges,80.25,75,,64.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,31.03,29,,24.824,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,71.69,67,,57.352,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,85.6,80,,68.48,percent of total billed charges,80% of total billed charges,69.55,65,,55.64,percent of total billed charges,65% of total billed charges,38.17,35.67,,30.536,percent of total billed charges,35.67% of total billed charges,31.03,96.3,
REPAIR LACERATION - ER 2.5 <,4500084,CDM,450,RC,,,outpatient,,,224,89.60,,190.4,85,,152.32,percent of total billed charges,85% of total billed charges,172.48,77,,137.98,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,183.68,82,,146.944,percent of total billed charges,82% of total billed charges,190.4,85,,152.32,percent of total billed charges,85% of total billed charges,190.4,85,,152.32,percent of total billed charges,85% of total billed charges,190.4,85,,152.32,percent of total billed charges,85% of total billed charges,201.6,90,,161.28,percent of total billed charges,90% of total billed charges,179.2,80,,143.36,percent of total billed charges,80% of total billed charges,201.6,90,,161.28,percent of total billed charges,90% of total billed charges,168,75,,134.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,64.96,29,,51.968,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,150.08,67,,120.064,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,179.2,80,,143.36,percent of total billed charges,80% of total billed charges,145.6,65,,116.48,percent of total billed charges,65% of total billed charges,79.9,35.67,,63.92,percent of total billed charges,35.67% of total billed charges,64.96,201.6,
REPAIR LACERATION ER 2.5 +,4500085,CDM,450,RC,,,outpatient,,,245,98.00,,208.25,85,,166.6,percent of total billed charges,85% of total billed charges,188.65,77,,150.92,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,200.9,82,,160.72,percent of total billed charges,82% of total billed charges,208.25,85,,166.6,percent of total billed charges,85% of total billed charges,208.25,85,,166.6,percent of total billed charges,85% of total billed charges,208.25,85,,166.6,percent of total billed charges,85% of total billed charges,220.5,90,,176.4,percent of total billed charges,90% of total billed charges,196,80,,156.8,percent of total billed charges,80% of total billed charges,220.5,90,,176.4,percent of total billed charges,90% of total billed charges,183.75,75,,147,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,71.05,29,,56.84,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,164.15,67,,131.32,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,196,80,,156.8,percent of total billed charges,80% of total billed charges,159.25,65,,127.4,percent of total billed charges,65% of total billed charges,87.39,35.67,,69.912,percent of total billed charges,35.67% of total billed charges,71.05,220.5,
REPAIR LACERATION 7.5 CMS +,4500086,CDM,450,RC,,,outpatient,,,266,106.40,,226.1,85,,180.88,percent of total billed charges,85% of total billed charges,204.82,77,,163.86,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,218.12,82,,174.496,percent of total billed charges,82% of total billed charges,226.1,85,,180.88,percent of total billed charges,85% of total billed charges,226.1,85,,180.88,percent of total billed charges,85% of total billed charges,226.1,85,,180.88,percent of total billed charges,85% of total billed charges,239.4,90,,191.52,percent of total billed charges,90% of total billed charges,212.8,80,,170.24,percent of total billed charges,80% of total billed charges,239.4,90,,191.52,percent of total billed charges,90% of total billed charges,199.5,75,,159.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,77.14,29,,61.712,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,178.22,67,,142.576,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,212.8,80,,170.24,percent of total billed charges,80% of total billed charges,172.9,65,,138.32,percent of total billed charges,65% of total billed charges,94.88,35.67,,75.904,percent of total billed charges,35.67% of total billed charges,77.14,239.4,
REPAIR LACERATION DEEP ER 2.5,4500087,CDM,450,RC,,,outpatient,,,177,70.80,,150.45,85,,120.36,percent of total billed charges,85% of total billed charges,136.29,77,,109.03,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,145.14,82,,116.112,percent of total billed charges,82% of total billed charges,150.45,85,,120.36,percent of total billed charges,85% of total billed charges,150.45,85,,120.36,percent of total billed charges,85% of total billed charges,150.45,85,,120.36,percent of total billed charges,85% of total billed charges,159.3,90,,127.44,percent of total billed charges,90% of total billed charges,141.6,80,,113.28,percent of total billed charges,80% of total billed charges,159.3,90,,127.44,percent of total billed charges,90% of total billed charges,132.75,75,,106.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,51.33,29,,41.064,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,118.59,67,,94.872,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,141.6,80,,113.28,percent of total billed charges,80% of total billed charges,115.05,65,,92.04,percent of total billed charges,65% of total billed charges,63.14,35.67,,50.512,percent of total billed charges,35.67% of total billed charges,51.33,159.3,
REPAIR LACERATION DEEP 2.5+,4500088,CDM,450,RC,,,outpatient,,,266,106.40,,226.1,85,,180.88,percent of total billed charges,85% of total billed charges,204.82,77,,163.86,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,218.12,82,,174.496,percent of total billed charges,82% of total billed charges,226.1,85,,180.88,percent of total billed charges,85% of total billed charges,226.1,85,,180.88,percent of total billed charges,85% of total billed charges,226.1,85,,180.88,percent of total billed charges,85% of total billed charges,239.4,90,,191.52,percent of total billed charges,90% of total billed charges,212.8,80,,170.24,percent of total billed charges,80% of total billed charges,239.4,90,,191.52,percent of total billed charges,90% of total billed charges,199.5,75,,159.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,77.14,29,,61.712,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,178.22,67,,142.576,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,212.8,80,,170.24,percent of total billed charges,80% of total billed charges,172.9,65,,138.32,percent of total billed charges,65% of total billed charges,94.88,35.67,,75.904,percent of total billed charges,35.67% of total billed charges,77.14,239.4,
REPAIR LACERATION DEEP ER 7.5+,4500089,CDM,450,RC,,,outpatient,,,292,116.80,,248.2,85,,198.56,percent of total billed charges,85% of total billed charges,224.84,77,,179.87,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,239.44,82,,191.552,percent of total billed charges,82% of total billed charges,248.2,85,,198.56,percent of total billed charges,85% of total billed charges,248.2,85,,198.56,percent of total billed charges,85% of total billed charges,248.2,85,,198.56,percent of total billed charges,85% of total billed charges,262.8,90,,210.24,percent of total billed charges,90% of total billed charges,233.6,80,,186.88,percent of total billed charges,80% of total billed charges,262.8,90,,210.24,percent of total billed charges,90% of total billed charges,219,75,,175.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,84.68,29,,67.744,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,195.64,67,,156.512,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,233.6,80,,186.88,percent of total billed charges,80% of total billed charges,189.8,65,,151.84,percent of total billed charges,65% of total billed charges,104.16,35.67,,83.328,percent of total billed charges,35.67% of total billed charges,84.68,262.8,
WOUND CLOSURE BY ADHESIVE ER,4500090,CDM,450,RC,,,outpatient,,,55,22.00,,46.75,85,,37.4,percent of total billed charges,85% of total billed charges,42.35,77,,33.88,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,45.1,82,,36.08,percent of total billed charges,82% of total billed charges,46.75,85,,37.4,percent of total billed charges,85% of total billed charges,46.75,85,,37.4,percent of total billed charges,85% of total billed charges,46.75,85,,37.4,percent of total billed charges,85% of total billed charges,49.5,90,,39.6,percent of total billed charges,90% of total billed charges,44,80,,35.2,percent of total billed charges,80% of total billed charges,49.5,90,,39.6,percent of total billed charges,90% of total billed charges,41.25,75,,33,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,15.95,29,,12.76,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,36.85,67,,29.48,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,44,80,,35.2,percent of total billed charges,80% of total billed charges,35.75,65,,28.6,percent of total billed charges,65% of total billed charges,19.62,35.67,,15.696,percent of total billed charges,35.67% of total billed charges,15.95,49.5,
ER-IV INFUSION EA ADD HR,4500091,CDM,450,RC,96366,HCPCS,outpatient,,,169,67.60,,143.65,85,,114.92,percent of total billed charges,85% of total billed charges,130.13,77,,104.1,percent of total billed charges,77% of total billed charges,41.54,100,,,fee schedule,100% of CMS OPPS rate,95.45,429,,,fee schedule,429% of BCBS fee schedule,99.46,447,,,fee schedule,447% of BCBS fee schedule,99.46,447,,,fee schedule,447% of BCBS fee schedule,99.46,447,,,fee schedule,447% of BCBS fee schedule,152.1,90,,121.68,percent of total billed charges,90% of total billed charges,135.2,80,,108.16,percent of total billed charges,80% of total billed charges,152.1,90,,121.68,percent of total billed charges,90% of total billed charges,126.75,75,,101.4,percent of total billed charges,75% of total billed charges,50.67,122,,,fee schedule,122% of HUMANA fee schedule,49.01,29,,39.208,percent of total billed charges,29% of total billed charges,41.54,100,,,fee schedule,100% of CMS OPPS rate,113.23,67,,90.584,percent of total billed charges,67% of total billed charges,32.45,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,135.2,80,,108.16,percent of total billed charges,80% of total billed charges,109.85,65,,87.88,percent of total billed charges,65% of total billed charges,60.28,35.67,,48.224,percent of total billed charges,35.67% of total billed charges,32.45,152.1,
ER-IV INFUSION INITIAL-TO 1HR,4500093,CDM,450,RC,96365,HCPCS,outpatient,,,451,180.40,,383.35,85,,306.68,percent of total billed charges,85% of total billed charges,347.27,77,,277.82,percent of total billed charges,77% of total billed charges,187.44,100,,,fee schedule,100% of CMS OPPS rate,317.16,429,,,fee schedule,429% of BCBS fee schedule,330.47,447,,,fee schedule,447% of BCBS fee schedule,330.47,447,,,fee schedule,447% of BCBS fee schedule,330.47,447,,,fee schedule,447% of BCBS fee schedule,405.9,90,,324.72,percent of total billed charges,90% of total billed charges,360.8,80,,288.64,percent of total billed charges,80% of total billed charges,405.9,90,,324.72,percent of total billed charges,90% of total billed charges,338.25,75,,270.6,percent of total billed charges,75% of total billed charges,228.67,122,,,fee schedule,122% of HUMANA fee schedule,130.79,29,,104.632,percent of total billed charges,29% of total billed charges,187.44,100,,,fee schedule,100% of CMS OPPS rate,302.17,67,,241.736,percent of total billed charges,67% of total billed charges,118.05,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,360.8,80,,288.64,percent of total billed charges,80% of total billed charges,293.15,65,,234.52,percent of total billed charges,65% of total billed charges,160.87,35.67,,128.696,percent of total billed charges,35.67% of total billed charges,118.05,405.9,
ER-IV HYDRATION INITIAL31-60MI,4500095,CDM,450,RC,96360,HCPCS,outpatient,,,303,121.20,,257.55,85,,206.04,percent of total billed charges,85% of total billed charges,233.31,77,,186.65,percent of total billed charges,77% of total billed charges,187.44,100,,,fee schedule,100% of CMS OPPS rate,203.22,429,,,fee schedule,429% of BCBS fee schedule,211.74,447,,,fee schedule,447% of BCBS fee schedule,211.74,447,,,fee schedule,447% of BCBS fee schedule,211.74,447,,,fee schedule,447% of BCBS fee schedule,272.7,90,,218.16,percent of total billed charges,90% of total billed charges,242.4,80,,193.92,percent of total billed charges,80% of total billed charges,272.7,90,,218.16,percent of total billed charges,90% of total billed charges,227.25,75,,181.8,percent of total billed charges,75% of total billed charges,228.67,122,,,fee schedule,122% of HUMANA fee schedule,87.87,29,,70.296,percent of total billed charges,29% of total billed charges,187.44,100,,,fee schedule,100% of CMS OPPS rate,203.01,67,,162.408,percent of total billed charges,67% of total billed charges,67.76,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,242.4,80,,193.92,percent of total billed charges,80% of total billed charges,196.95,65,,157.56,percent of total billed charges,65% of total billed charges,108.08,35.67,,86.464,percent of total billed charges,35.67% of total billed charges,67.76,272.7,
ER-IV HYDRATION EA ADD HR,4500100,CDM,450,RC,96361,HCPCS,outpatient,,,169,67.60,,143.65,85,,114.92,percent of total billed charges,85% of total billed charges,130.13,77,,104.1,percent of total billed charges,77% of total billed charges,41.54,100,,,fee schedule,100% of CMS OPPS rate,60.06,429,,,fee schedule,429% of BCBS fee schedule,62.58,447,,,fee schedule,447% of BCBS fee schedule,62.58,447,,,fee schedule,447% of BCBS fee schedule,62.58,447,,,fee schedule,447% of BCBS fee schedule,152.1,90,,121.68,percent of total billed charges,90% of total billed charges,135.2,80,,108.16,percent of total billed charges,80% of total billed charges,152.1,90,,121.68,percent of total billed charges,90% of total billed charges,126.75,75,,101.4,percent of total billed charges,75% of total billed charges,50.67,122,,,fee schedule,122% of HUMANA fee schedule,49.01,29,,39.208,percent of total billed charges,29% of total billed charges,41.54,100,,,fee schedule,100% of CMS OPPS rate,113.23,67,,90.584,percent of total billed charges,67% of total billed charges,23.12,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,135.2,80,,108.16,percent of total billed charges,80% of total billed charges,109.85,65,,87.88,percent of total billed charges,65% of total billed charges,60.28,35.67,,48.224,percent of total billed charges,35.67% of total billed charges,23.12,152.1,
ER-IV PUSH EA ADD NEW DRUG,4500105,CDM,450,RC,96375,HCPCS,outpatient,,,79,31.60,,67.15,85,,53.72,percent of total billed charges,85% of total billed charges,60.83,77,,48.66,percent of total billed charges,77% of total billed charges,41.54,100,,,fee schedule,100% of CMS OPPS rate,78.51,429,,,fee schedule,429% of BCBS fee schedule,81.8,447,,,fee schedule,447% of BCBS fee schedule,81.8,447,,,fee schedule,447% of BCBS fee schedule,81.8,447,,,fee schedule,447% of BCBS fee schedule,71.1,90,,56.88,percent of total billed charges,90% of total billed charges,63.2,80,,50.56,percent of total billed charges,80% of total billed charges,71.1,90,,56.88,percent of total billed charges,90% of total billed charges,59.25,75,,47.4,percent of total billed charges,75% of total billed charges,50.67,122,,,fee schedule,122% of HUMANA fee schedule,22.91,29,,18.328,percent of total billed charges,29% of total billed charges,41.54,100,,,fee schedule,100% of CMS OPPS rate,52.93,67,,42.344,percent of total billed charges,67% of total billed charges,32.45,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,63.2,80,,50.56,percent of total billed charges,80% of total billed charges,51.35,65,,41.08,percent of total billed charges,65% of total billed charges,28.18,35.67,,22.544,percent of total billed charges,35.67% of total billed charges,22.91,81.8,
ER-IV PUSH EA ADD SAME DRUG,4500110,CDM,450,RC,96376,HCPCS,outpatient,,,195,78.00,,165.75,85,,132.6,percent of total billed charges,85% of total billed charges,150.15,77,,120.12,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,98.54,429,,,fee schedule,429% of BCBS fee schedule,102.68,447,,,fee schedule,447% of BCBS fee schedule,102.68,447,,,fee schedule,447% of BCBS fee schedule,102.68,447,,,fee schedule,447% of BCBS fee schedule,175.5,90,,140.4,percent of total billed charges,90% of total billed charges,156,80,,124.8,percent of total billed charges,80% of total billed charges,175.5,90,,140.4,percent of total billed charges,90% of total billed charges,146.25,75,,117,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,56.55,29,,45.24,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,130.65,67,,104.52,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,156,80,,124.8,percent of total billed charges,80% of total billed charges,126.75,65,,101.4,percent of total billed charges,65% of total billed charges,69.56,35.67,,55.648,percent of total billed charges,35.67% of total billed charges,56.55,175.5,
ER-IV HYDATION EA ADD HR W/MOD,4500120,CDM,450,RC,96361,HCPCS,outpatient,,,167,66.80,59,141.95,85,,113.56,percent of total billed charges,85% of total billed charges,128.59,77,,102.87,percent of total billed charges,77% of total billed charges,41.54,100,,,fee schedule,100% of CMS OPPS rate,60.06,429,,,fee schedule,429% of BCBS fee schedule,62.58,447,,,fee schedule,447% of BCBS fee schedule,62.58,447,,,fee schedule,447% of BCBS fee schedule,62.58,447,,,fee schedule,447% of BCBS fee schedule,150.3,90,,120.24,percent of total billed charges,90% of total billed charges,133.6,80,,106.88,percent of total billed charges,80% of total billed charges,150.3,90,,120.24,percent of total billed charges,90% of total billed charges,125.25,75,,100.2,percent of total billed charges,75% of total billed charges,50.67,122,,,fee schedule,122% of HUMANA fee schedule,48.43,29,,38.744,percent of total billed charges,29% of total billed charges,41.54,100,,,fee schedule,100% of CMS OPPS rate,111.89,67,,89.512,percent of total billed charges,67% of total billed charges,23.12,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,133.6,80,,106.88,percent of total billed charges,80% of total billed charges,108.55,65,,86.84,percent of total billed charges,65% of total billed charges,59.57,35.67,,47.656,percent of total billed charges,35.67% of total billed charges,23.12,150.3,
ER-IV INFUSION SEQUEN NEW DRUG,4500150,CDM,450,RC,96367,HCPCS,outpatient,,,279,111.60,,237.15,85,,189.72,percent of total billed charges,85% of total billed charges,214.83,77,,171.86,percent of total billed charges,77% of total billed charges,61.6,100,,,fee schedule,100% of CMS OPPS rate,137.02,429,,,fee schedule,429% of BCBS fee schedule,142.77,447,,,fee schedule,447% of BCBS fee schedule,142.77,447,,,fee schedule,447% of BCBS fee schedule,142.77,447,,,fee schedule,447% of BCBS fee schedule,251.1,90,,200.88,percent of total billed charges,90% of total billed charges,223.2,80,,178.56,percent of total billed charges,80% of total billed charges,251.1,90,,200.88,percent of total billed charges,90% of total billed charges,209.25,75,,167.4,percent of total billed charges,75% of total billed charges,75.15,122,,,fee schedule,122% of HUMANA fee schedule,80.91,29,,64.728,percent of total billed charges,29% of total billed charges,61.6,100,,,fee schedule,100% of CMS OPPS rate,186.93,67,,149.544,percent of total billed charges,67% of total billed charges,32.45,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,223.2,80,,178.56,percent of total billed charges,80% of total billed charges,181.35,65,,145.08,percent of total billed charges,65% of total billed charges,99.52,35.67,,79.616,percent of total billed charges,35.67% of total billed charges,32.45,251.1,
ER-IV INFUSION CONCURRENT,4500160,CDM,450,RC,96368,HCPCS,outpatient,,,107,42.80,,90.95,85,,72.76,percent of total billed charges,85% of total billed charges,82.39,77,,65.91,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,90.82,429,,,fee schedule,429% of BCBS fee schedule,94.63,447,,,fee schedule,447% of BCBS fee schedule,94.63,447,,,fee schedule,447% of BCBS fee schedule,94.63,447,,,fee schedule,447% of BCBS fee schedule,96.3,90,,77.04,percent of total billed charges,90% of total billed charges,85.6,80,,68.48,percent of total billed charges,80% of total billed charges,96.3,90,,77.04,percent of total billed charges,90% of total billed charges,80.25,75,,64.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,31.03,29,,24.824,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,71.69,67,,57.352,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,85.6,80,,68.48,percent of total billed charges,80% of total billed charges,69.55,65,,55.64,percent of total billed charges,65% of total billed charges,38.17,35.67,,30.536,percent of total billed charges,35.67% of total billed charges,31.03,96.3,
ER-IV PUSH OF DRUG,4500254,CDM,450,RC,96374,HCPCS,outpatient,,,369,147.60,,313.65,85,,250.92,percent of total billed charges,85% of total billed charges,284.13,77,,227.3,percent of total billed charges,77% of total billed charges,187.44,100,,,fee schedule,100% of CMS OPPS rate,201.67,429,,,fee schedule,429% of BCBS fee schedule,210.13,447,,,fee schedule,447% of BCBS fee schedule,210.13,447,,,fee schedule,447% of BCBS fee schedule,210.13,447,,,fee schedule,447% of BCBS fee schedule,332.1,90,,265.68,percent of total billed charges,90% of total billed charges,295.2,80,,236.16,percent of total billed charges,80% of total billed charges,332.1,90,,265.68,percent of total billed charges,90% of total billed charges,276.75,75,,221.4,percent of total billed charges,75% of total billed charges,228.67,122,,,fee schedule,122% of HUMANA fee schedule,107.01,29,,85.608,percent of total billed charges,29% of total billed charges,187.44,100,,,fee schedule,100% of CMS OPPS rate,247.23,67,,197.784,percent of total billed charges,67% of total billed charges,32.45,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,295.2,80,,236.16,percent of total billed charges,80% of total billed charges,239.85,65,,191.88,percent of total billed charges,65% of total billed charges,131.62,35.67,,105.296,percent of total billed charges,35.67% of total billed charges,32.45,332.1,
ER-IVP CHEMO/OTHER COMPLEX DRU,4500262,CDM,450,RC,96409,HCPCS,outpatient,,,540,216.00,,459,85,,367.2,percent of total billed charges,85% of total billed charges,415.8,77,,332.64,percent of total billed charges,77% of total billed charges,296.17,100,,,fee schedule,100% of CMS OPPS rate,477.26,429,,,fee schedule,429% of BCBS fee schedule,497.29,447,,,fee schedule,447% of BCBS fee schedule,497.29,447,,,fee schedule,447% of BCBS fee schedule,497.29,447,,,fee schedule,447% of BCBS fee schedule,486,90,,388.8,percent of total billed charges,90% of total billed charges,432,80,,345.6,percent of total billed charges,80% of total billed charges,486,90,,388.8,percent of total billed charges,90% of total billed charges,405,75,,324,percent of total billed charges,75% of total billed charges,361.32,122,,,fee schedule,122% of HUMANA fee schedule,156.6,29,,125.28,percent of total billed charges,29% of total billed charges,296.17,100,,,fee schedule,100% of CMS OPPS rate,361.8,67,,289.44,percent of total billed charges,67% of total billed charges,118.05,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,432,80,,345.6,percent of total billed charges,80% of total billed charges,351,65,,280.8,percent of total billed charges,65% of total billed charges,192.62,35.67,,154.096,percent of total billed charges,35.67% of total billed charges,118.05,497.29,
ER-IVP-CHEMO/OTHER EA ADD SUBS,4500270,CDM,450,RC,96411,HCPCS,outpatient,,,290,116.00,,246.5,85,,197.2,percent of total billed charges,85% of total billed charges,223.3,77,,178.64,percent of total billed charges,77% of total billed charges,61.6,100,,,fee schedule,100% of CMS OPPS rate,255.6,429,,,fee schedule,429% of BCBS fee schedule,266.32,447,,,fee schedule,447% of BCBS fee schedule,266.32,447,,,fee schedule,447% of BCBS fee schedule,266.32,447,,,fee schedule,447% of BCBS fee schedule,261,90,,208.8,percent of total billed charges,90% of total billed charges,232,80,,185.6,percent of total billed charges,80% of total billed charges,261,90,,208.8,percent of total billed charges,90% of total billed charges,217.5,75,,174,percent of total billed charges,75% of total billed charges,75.15,122,,,fee schedule,122% of HUMANA fee schedule,84.1,29,,67.28,percent of total billed charges,29% of total billed charges,61.6,100,,,fee schedule,100% of CMS OPPS rate,194.3,67,,155.44,percent of total billed charges,67% of total billed charges,67.76,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,232,80,,185.6,percent of total billed charges,80% of total billed charges,188.5,65,,150.8,percent of total billed charges,65% of total billed charges,103.44,35.67,,82.752,percent of total billed charges,35.67% of total billed charges,61.6,266.32,
ER-IV INFUSION CHEMO/COMP 1 HR,4500275,CDM,450,RC,96413,HCPCS,outpatient,,,700,280.00,,595,85,,476,percent of total billed charges,85% of total billed charges,539,77,,431.2,percent of total billed charges,77% of total billed charges,296.17,100,,,fee schedule,100% of CMS OPPS rate,618.92,429,,,fee schedule,429% of BCBS fee schedule,644.89,447,,,fee schedule,447% of BCBS fee schedule,644.89,447,,,fee schedule,447% of BCBS fee schedule,644.89,447,,,fee schedule,447% of BCBS fee schedule,630,90,,504,percent of total billed charges,90% of total billed charges,560,80,,448,percent of total billed charges,80% of total billed charges,630,90,,504,percent of total billed charges,90% of total billed charges,525,75,,420,percent of total billed charges,75% of total billed charges,361.32,122,,,fee schedule,122% of HUMANA fee schedule,203,29,,162.4,percent of total billed charges,29% of total billed charges,296.17,100,,,fee schedule,100% of CMS OPPS rate,469,67,,375.2,percent of total billed charges,67% of total billed charges,193.67,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,560,80,,448,percent of total billed charges,80% of total billed charges,455,65,,364,percent of total billed charges,65% of total billed charges,249.69,35.67,,199.752,percent of total billed charges,35.67% of total billed charges,193.67,644.89,
ER-IV INFUSION CHEMO EA ADD HR,4500280,CDM,450,RC,96415,HCPCS,outpatient,,,288,115.20,,244.8,85,,195.84,percent of total billed charges,85% of total billed charges,221.76,77,,177.41,percent of total billed charges,77% of total billed charges,61.6,100,,,fee schedule,100% of CMS OPPS rate,135.48,429,,,fee schedule,429% of BCBS fee schedule,141.16,447,,,fee schedule,447% of BCBS fee schedule,141.16,447,,,fee schedule,447% of BCBS fee schedule,141.16,447,,,fee schedule,447% of BCBS fee schedule,259.2,90,,207.36,percent of total billed charges,90% of total billed charges,230.4,80,,184.32,percent of total billed charges,80% of total billed charges,259.2,90,,207.36,percent of total billed charges,90% of total billed charges,216,75,,172.8,percent of total billed charges,75% of total billed charges,75.15,122,,,fee schedule,122% of HUMANA fee schedule,83.52,29,,66.816,percent of total billed charges,29% of total billed charges,61.6,100,,,fee schedule,100% of CMS OPPS rate,192.96,67,,154.368,percent of total billed charges,67% of total billed charges,32.45,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,230.4,80,,184.32,percent of total billed charges,80% of total billed charges,187.2,65,,149.76,percent of total billed charges,65% of total billed charges,102.73,35.67,,82.184,percent of total billed charges,35.67% of total billed charges,32.45,259.2,
ER-INSERT CATH RESIDUAL URINE,4500315,CDM,450,RC,51701,HCPCS,outpatient,,,156,62.40,,1150,,,,case rate,pays based on per visit,120.12,77,,96.1,percent of total billed charges,77% of total billed charges,111.71,100,,,fee schedule,100% of CMS OPPS rate,127.92,82,,102.336,percent of total billed charges,82% of total billed charges,132.6,85,,106.08,percent of total billed charges,85% of total billed charges,132.6,85,,106.08,percent of total billed charges,85% of total billed charges,132.6,85,,106.08,percent of total billed charges,85% of total billed charges,140.4,90,,112.32,percent of total billed charges,90% of total billed charges,124.8,80,,99.84,percent of total billed charges,80% of total billed charges,140.4,90,,112.32,percent of total billed charges,90% of total billed charges,117,75,,93.6,percent of total billed charges,75% of total billed charges,136.28,122,,,fee schedule,122% of HUMANA fee schedule,45.24,29,,36.192,percent of total billed charges,29% of total billed charges,111.71,100,,,fee schedule,100% of CMS OPPS rate,104.52,67,,83.616,percent of total billed charges,67% of total billed charges,42.55,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,124.8,80,,99.84,percent of total billed charges,80% of total billed charges,101.4,65,,81.12,percent of total billed charges,65% of total billed charges,55.65,35.67,,44.52,percent of total billed charges,35.67% of total billed charges,42.55,1150,
ER-INSERT TEMP INDWL CATH COMP,4500325,CDM,450,RC,51703,HCPCS,outpatient,,,306,122.40,,1150,,,,case rate,pays based on per visit,235.62,77,,188.5,percent of total billed charges,77% of total billed charges,136.6,100,,,fee schedule,100% of CMS OPPS rate,250.92,82,,200.736,percent of total billed charges,82% of total billed charges,260.1,85,,208.08,percent of total billed charges,85% of total billed charges,260.1,85,,208.08,percent of total billed charges,85% of total billed charges,260.1,85,,208.08,percent of total billed charges,85% of total billed charges,275.4,90,,220.32,percent of total billed charges,90% of total billed charges,244.8,80,,195.84,percent of total billed charges,80% of total billed charges,275.4,90,,220.32,percent of total billed charges,90% of total billed charges,229.5,75,,183.6,percent of total billed charges,75% of total billed charges,166.65,122,,,fee schedule,122% of HUMANA fee schedule,57.79,100,,,fee schedule,100% of ASC tier grouping rate,136.6,100,,,fee schedule,100% of CMS OPPS rate,205.02,67,,164.016,percent of total billed charges,67% of total billed charges,72.31,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,244.8,80,,195.84,percent of total billed charges,80% of total billed charges,198.9,65,,159.12,percent of total billed charges,65% of total billed charges,71.08,123,,,fee schedule,123% of ASC tier grouping rate,57.79,1150,
ER-INTRA-ARTERL CHEMO/HIGH ADM,4500330,CDM,450,RC,96422,HCPCS,outpatient,,,911,364.40,,774.35,85,,619.48,percent of total billed charges,85% of total billed charges,701.47,77,,561.18,percent of total billed charges,77% of total billed charges,296.17,100,,,fee schedule,100% of CMS OPPS rate,806.78,429,,,fee schedule,429% of BCBS fee schedule,840.63,447,,,fee schedule,447% of BCBS fee schedule,840.63,447,,,fee schedule,447% of BCBS fee schedule,840.63,447,,,fee schedule,447% of BCBS fee schedule,819.9,90,,655.92,percent of total billed charges,90% of total billed charges,728.8,80,,583.04,percent of total billed charges,80% of total billed charges,819.9,90,,655.92,percent of total billed charges,90% of total billed charges,683.25,75,,546.6,percent of total billed charges,75% of total billed charges,361.32,122,,,fee schedule,122% of HUMANA fee schedule,264.19,29,,211.352,percent of total billed charges,29% of total billed charges,296.17,100,,,fee schedule,100% of CMS OPPS rate,610.37,67,,488.296,percent of total billed charges,67% of total billed charges,193.67,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,728.8,80,,583.04,percent of total billed charges,80% of total billed charges,592.15,65,,473.72,percent of total billed charges,65% of total billed charges,324.95,35.67,,259.96,percent of total billed charges,35.67% of total billed charges,193.67,840.63,
ER FOREIGN BODY REMOVAL,4500695,CDM,450,RC,,,outpatient,,,83,33.20,,70.55,85,,56.44,percent of total billed charges,85% of total billed charges,63.91,77,,51.13,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,68.06,82,,54.448,percent of total billed charges,82% of total billed charges,70.55,85,,56.44,percent of total billed charges,85% of total billed charges,70.55,85,,56.44,percent of total billed charges,85% of total billed charges,70.55,85,,56.44,percent of total billed charges,85% of total billed charges,74.7,90,,59.76,percent of total billed charges,90% of total billed charges,66.4,80,,53.12,percent of total billed charges,80% of total billed charges,74.7,90,,59.76,percent of total billed charges,90% of total billed charges,62.25,75,,49.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,24.07,29,,19.256,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,55.61,67,,44.488,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,66.4,80,,53.12,percent of total billed charges,80% of total billed charges,53.95,65,,43.16,percent of total billed charges,65% of total billed charges,29.61,35.67,,23.688,percent of total billed charges,35.67% of total billed charges,24.07,74.7,
ER MINOR PROCEDURE,4500700,CDM,450,RC,,,outpatient,,,174,69.60,,147.9,85,,118.32,percent of total billed charges,85% of total billed charges,133.98,77,,107.18,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,142.68,82,,114.144,percent of total billed charges,82% of total billed charges,147.9,85,,118.32,percent of total billed charges,85% of total billed charges,147.9,85,,118.32,percent of total billed charges,85% of total billed charges,147.9,85,,118.32,percent of total billed charges,85% of total billed charges,156.6,90,,125.28,percent of total billed charges,90% of total billed charges,139.2,80,,111.36,percent of total billed charges,80% of total billed charges,156.6,90,,125.28,percent of total billed charges,90% of total billed charges,130.5,75,,104.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,50.46,29,,40.368,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,116.58,67,,93.264,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,139.2,80,,111.36,percent of total billed charges,80% of total billed charges,113.1,65,,90.48,percent of total billed charges,65% of total billed charges,62.07,35.67,,49.656,percent of total billed charges,35.67% of total billed charges,50.46,156.6,
GASTROSTOMY TUBE REPLACE-ER,4500701,CDM,450,RC,43762,HCPCS,outpatient,,,400,160.00,,1150,,,,case rate,pays based on per visit,308,77,,246.4,percent of total billed charges,77% of total billed charges,216.13,100,,,fee schedule,100% of CMS OPPS rate,328,82,,262.4,percent of total billed charges,82% of total billed charges,340,85,,272,percent of total billed charges,85% of total billed charges,340,85,,272,percent of total billed charges,85% of total billed charges,340,85,,272,percent of total billed charges,85% of total billed charges,360,90,,288,percent of total billed charges,90% of total billed charges,320,80,,256,percent of total billed charges,80% of total billed charges,360,90,,288,percent of total billed charges,90% of total billed charges,300,75,,240,percent of total billed charges,75% of total billed charges,263.68,122,,,fee schedule,122% of HUMANA fee schedule,110.15,100,,,fee schedule,100% of ASC tier grouping rate,216.13,100,,,fee schedule,100% of CMS OPPS rate,268,67,,214.4,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,320,80,,256,percent of total billed charges,80% of total billed charges,260,65,,208,percent of total billed charges,65% of total billed charges,135.48,123,,,fee schedule,123% of ASC tier grouping rate,110.15,1150,
ARTHROCENTESIS,4500702,CDM,450,RC,,,outpatient,,,169,67.60,,143.65,85,,114.92,percent of total billed charges,85% of total billed charges,130.13,77,,104.1,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,138.58,82,,110.864,percent of total billed charges,82% of total billed charges,143.65,85,,114.92,percent of total billed charges,85% of total billed charges,143.65,85,,114.92,percent of total billed charges,85% of total billed charges,143.65,85,,114.92,percent of total billed charges,85% of total billed charges,152.1,90,,121.68,percent of total billed charges,90% of total billed charges,135.2,80,,108.16,percent of total billed charges,80% of total billed charges,152.1,90,,121.68,percent of total billed charges,90% of total billed charges,126.75,75,,101.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,49.01,29,,39.208,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,113.23,67,,90.584,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,135.2,80,,108.16,percent of total billed charges,80% of total billed charges,109.85,65,,87.88,percent of total billed charges,65% of total billed charges,60.28,35.67,,48.224,percent of total billed charges,35.67% of total billed charges,49.01,152.1,
ER I&D SMALL ABSCESS,4500703,CDM,450,RC,,,outpatient,,,107,42.80,,90.95,85,,72.76,percent of total billed charges,85% of total billed charges,82.39,77,,65.91,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,87.74,82,,70.192,percent of total billed charges,82% of total billed charges,90.95,85,,72.76,percent of total billed charges,85% of total billed charges,90.95,85,,72.76,percent of total billed charges,85% of total billed charges,90.95,85,,72.76,percent of total billed charges,85% of total billed charges,96.3,90,,77.04,percent of total billed charges,90% of total billed charges,85.6,80,,68.48,percent of total billed charges,80% of total billed charges,96.3,90,,77.04,percent of total billed charges,90% of total billed charges,80.25,75,,64.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,31.03,29,,24.824,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,71.69,67,,57.352,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,85.6,80,,68.48,percent of total billed charges,80% of total billed charges,69.55,65,,55.64,percent of total billed charges,65% of total billed charges,38.17,35.67,,30.536,percent of total billed charges,35.67% of total billed charges,31.03,96.3,
ER I&D LARGE ABSCESS,4500704,CDM,450,RC,,,outpatient,,,177,70.80,,150.45,85,,120.36,percent of total billed charges,85% of total billed charges,136.29,77,,109.03,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,145.14,82,,116.112,percent of total billed charges,82% of total billed charges,150.45,85,,120.36,percent of total billed charges,85% of total billed charges,150.45,85,,120.36,percent of total billed charges,85% of total billed charges,150.45,85,,120.36,percent of total billed charges,85% of total billed charges,159.3,90,,127.44,percent of total billed charges,90% of total billed charges,141.6,80,,113.28,percent of total billed charges,80% of total billed charges,159.3,90,,127.44,percent of total billed charges,90% of total billed charges,132.75,75,,106.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,51.33,29,,41.064,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,118.59,67,,94.872,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,141.6,80,,113.28,percent of total billed charges,80% of total billed charges,115.05,65,,92.04,percent of total billed charges,65% of total billed charges,63.14,35.67,,50.512,percent of total billed charges,35.67% of total billed charges,51.33,159.3,
AVULSION OF NAIL PLATE,4500705,CDM,450,RC,,,outpatient,,,117,46.80,,99.45,85,,79.56,percent of total billed charges,85% of total billed charges,90.09,77,,72.07,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,95.94,82,,76.752,percent of total billed charges,82% of total billed charges,99.45,85,,79.56,percent of total billed charges,85% of total billed charges,99.45,85,,79.56,percent of total billed charges,85% of total billed charges,99.45,85,,79.56,percent of total billed charges,85% of total billed charges,105.3,90,,84.24,percent of total billed charges,90% of total billed charges,93.6,80,,74.88,percent of total billed charges,80% of total billed charges,105.3,90,,84.24,percent of total billed charges,90% of total billed charges,87.75,75,,70.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,33.93,29,,27.144,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,78.39,67,,62.712,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,93.6,80,,74.88,percent of total billed charges,80% of total billed charges,76.05,65,,60.84,percent of total billed charges,65% of total billed charges,41.73,35.67,,33.384,percent of total billed charges,35.67% of total billed charges,33.93,105.3,
NEEDLE PLACE/INTRAOSSEOUS INF,4500706,CDM,450,RC,36680,HCPCS,outpatient,,,1723,689.20,,1150,,,,case rate,pays based on per visit,1326.71,77,,1061.37,percent of total billed charges,77% of total billed charges,348.44,100,,,fee schedule,100% of CMS OPPS rate,1412.86,82,,1130.288,percent of total billed charges,82% of total billed charges,1464.55,85,,1171.64,percent of total billed charges,85% of total billed charges,1464.55,85,,1171.64,percent of total billed charges,85% of total billed charges,1464.55,85,,1171.64,percent of total billed charges,85% of total billed charges,1550.7,90,,1240.56,percent of total billed charges,90% of total billed charges,1378.4,80,,1102.72,percent of total billed charges,80% of total billed charges,1550.7,90,,1240.56,percent of total billed charges,90% of total billed charges,1292.25,75,,1033.8,percent of total billed charges,75% of total billed charges,425.1,122,,,fee schedule,122% of HUMANA fee schedule,499.67,29,,399.736,percent of total billed charges,29% of total billed charges,348.44,100,,,fee schedule,100% of CMS OPPS rate,1154.41,67,,923.528,percent of total billed charges,67% of total billed charges,105.08,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,1378.4,80,,1102.72,percent of total billed charges,80% of total billed charges,1119.95,65,,895.96,percent of total billed charges,65% of total billed charges,614.59,35.67,,491.672,percent of total billed charges,35.67% of total billed charges,105.08,1550.7,
EXAM FOR ASSAULT - SPECIAL RN,4500750,CDM,450,RC,,,outpatient,,,174,69.60,,147.9,85,,118.32,percent of total billed charges,85% of total billed charges,133.98,77,,107.18,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,142.68,82,,114.144,percent of total billed charges,82% of total billed charges,147.9,85,,118.32,percent of total billed charges,85% of total billed charges,147.9,85,,118.32,percent of total billed charges,85% of total billed charges,147.9,85,,118.32,percent of total billed charges,85% of total billed charges,156.6,90,,125.28,percent of total billed charges,90% of total billed charges,139.2,80,,111.36,percent of total billed charges,80% of total billed charges,156.6,90,,125.28,percent of total billed charges,90% of total billed charges,130.5,75,,104.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,50.46,29,,40.368,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,116.58,67,,93.264,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,139.2,80,,111.36,percent of total billed charges,80% of total billed charges,113.1,65,,90.48,percent of total billed charges,65% of total billed charges,62.07,35.67,,49.656,percent of total billed charges,35.67% of total billed charges,50.46,156.6,
NOSEBLEED CONTROL-SIMPLE ANTER,4500800,CDM,450,RC,,,outpatient,,,331,132.40,,281.35,85,,225.08,percent of total billed charges,85% of total billed charges,254.87,77,,203.9,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,271.42,82,,217.136,percent of total billed charges,82% of total billed charges,281.35,85,,225.08,percent of total billed charges,85% of total billed charges,281.35,85,,225.08,percent of total billed charges,85% of total billed charges,281.35,85,,225.08,percent of total billed charges,85% of total billed charges,297.9,90,,238.32,percent of total billed charges,90% of total billed charges,264.8,80,,211.84,percent of total billed charges,80% of total billed charges,297.9,90,,238.32,percent of total billed charges,90% of total billed charges,248.25,75,,198.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,95.99,29,,76.792,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,221.77,67,,177.416,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,264.8,80,,211.84,percent of total billed charges,80% of total billed charges,215.15,65,,172.12,percent of total billed charges,65% of total billed charges,118.07,35.67,,94.456,percent of total billed charges,35.67% of total billed charges,95.99,297.9,
NOSEBLEED CONTROL-COMPLEX ANTE,4500810,CDM,450,RC,,,outpatient,,,360,144.00,,306,85,,244.8,percent of total billed charges,85% of total billed charges,277.2,77,,221.76,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,295.2,82,,236.16,percent of total billed charges,82% of total billed charges,306,85,,244.8,percent of total billed charges,85% of total billed charges,306,85,,244.8,percent of total billed charges,85% of total billed charges,306,85,,244.8,percent of total billed charges,85% of total billed charges,324,90,,259.2,percent of total billed charges,90% of total billed charges,288,80,,230.4,percent of total billed charges,80% of total billed charges,324,90,,259.2,percent of total billed charges,90% of total billed charges,270,75,,216,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,104.4,29,,83.52,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,241.2,67,,192.96,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,288,80,,230.4,percent of total billed charges,80% of total billed charges,234,65,,187.2,percent of total billed charges,65% of total billed charges,128.41,35.67,,102.728,percent of total billed charges,35.67% of total billed charges,104.4,324,
ER- REMOVAL IMPACTED CERUMEN,4500820,CDM,450,RC,69210,HCPCS,outpatient,,,169,67.60,,1150,,,,case rate,pays based on per visit,130.13,77,,104.1,percent of total billed charges,77% of total billed charges,53.49,100,,,fee schedule,100% of CMS OPPS rate,138.58,82,,110.864,percent of total billed charges,82% of total billed charges,143.65,85,,114.92,percent of total billed charges,85% of total billed charges,143.65,85,,114.92,percent of total billed charges,85% of total billed charges,143.65,85,,114.92,percent of total billed charges,85% of total billed charges,152.1,90,,121.68,percent of total billed charges,90% of total billed charges,135.2,80,,108.16,percent of total billed charges,80% of total billed charges,152.1,90,,121.68,percent of total billed charges,90% of total billed charges,126.75,75,,101.4,percent of total billed charges,75% of total billed charges,65.26,122,,,fee schedule,122% of HUMANA fee schedule,49.01,29,,39.208,percent of total billed charges,29% of total billed charges,53.49,100,,,fee schedule,100% of CMS OPPS rate,113.23,67,,90.584,percent of total billed charges,67% of total billed charges,42.55,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,135.2,80,,108.16,percent of total billed charges,80% of total billed charges,109.85,65,,87.88,percent of total billed charges,65% of total billed charges,60.28,35.67,,48.224,percent of total billed charges,35.67% of total billed charges,42.55,1150,
NOSEBLEED CONTROL-POSTERIOR,4500850,CDM,450,RC,,,outpatient,,,365,146.00,,310.25,85,,248.2,percent of total billed charges,85% of total billed charges,281.05,77,,224.84,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,299.3,82,,239.44,percent of total billed charges,82% of total billed charges,310.25,85,,248.2,percent of total billed charges,85% of total billed charges,310.25,85,,248.2,percent of total billed charges,85% of total billed charges,310.25,85,,248.2,percent of total billed charges,85% of total billed charges,328.5,90,,262.8,percent of total billed charges,90% of total billed charges,292,80,,233.6,percent of total billed charges,80% of total billed charges,328.5,90,,262.8,percent of total billed charges,90% of total billed charges,273.75,75,,219,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,105.85,29,,84.68,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,244.55,67,,195.64,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,292,80,,233.6,percent of total billed charges,80% of total billed charges,237.25,65,,189.8,percent of total billed charges,65% of total billed charges,130.2,35.67,,104.16,percent of total billed charges,35.67% of total billed charges,105.85,328.5,
TELESTROKE SITE FEE,4500900,CDM,450,RC,Q3014,HCPCS,outpatient,,,60,24.00,,51,85,,40.8,percent of total billed charges,85% of total billed charges,46.2,77,,36.96,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,49.2,82,,39.36,percent of total billed charges,82% of total billed charges,51,85,,40.8,percent of total billed charges,85% of total billed charges,51,85,,40.8,percent of total billed charges,85% of total billed charges,51,85,,40.8,percent of total billed charges,85% of total billed charges,54,90,,43.2,percent of total billed charges,90% of total billed charges,48,80,,38.4,percent of total billed charges,80% of total billed charges,54,90,,43.2,percent of total billed charges,90% of total billed charges,45,75,,36,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,17.4,29,,13.92,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,40.2,67,,32.16,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,48,80,,38.4,percent of total billed charges,80% of total billed charges,39,65,,31.2,percent of total billed charges,65% of total billed charges,21.4,35.67,,17.12,percent of total billed charges,35.67% of total billed charges,17.4,54,
CARDIOVERSION,4501000,CDM,450,RC,92960,HCPCS,outpatient,,,3093,1237.20,25,2629.05,85,,2103.24,percent of total billed charges,85% of total billed charges,2381.61,77,,1905.29,percent of total billed charges,77% of total billed charges,569.16,100,,,fee schedule,100% of CMS OPPS rate,2536.26,82,,2029.008,percent of total billed charges,82% of total billed charges,2629.05,85,,2103.24,percent of total billed charges,85% of total billed charges,2629.05,85,,2103.24,percent of total billed charges,85% of total billed charges,2629.05,85,,2103.24,percent of total billed charges,85% of total billed charges,2783.7,90,,2226.96,percent of total billed charges,90% of total billed charges,2474.4,80,,1979.52,percent of total billed charges,80% of total billed charges,2783.7,90,,2226.96,percent of total billed charges,90% of total billed charges,2319.75,75,,1855.8,percent of total billed charges,75% of total billed charges,694.37,122,,,fee schedule,122% of HUMANA fee schedule,896.97,29,,717.576,percent of total billed charges,29% of total billed charges,569.16,100,,,fee schedule,100% of CMS OPPS rate,2072.31,67,,1657.848,percent of total billed charges,67% of total billed charges,347.91,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,2474.4,80,,1979.52,percent of total billed charges,80% of total billed charges,2010.45,65,,1608.36,percent of total billed charges,65% of total billed charges,1103.27,35.67,,882.616,percent of total billed charges,35.67% of total billed charges,347.91,2783.7,
CONTINUED INHAL WITH MED 1ST H,4100151,CDM,460,RC,94644,HCPCS,outpatient,,,509,203.60,,432.65,85,,346.12,percent of total billed charges,85% of total billed charges,391.93,77,,313.54,percent of total billed charges,77% of total billed charges,111.71,100,,,fee schedule,100% of CMS OPPS rate,450.62,429,,,fee schedule,429% of BCBS fee schedule,469.53,447,,,fee schedule,447% of BCBS fee schedule,469.53,447,,,fee schedule,447% of BCBS fee schedule,469.53,447,,,fee schedule,447% of BCBS fee schedule,458.1,90,,366.48,percent of total billed charges,90% of total billed charges,407.2,80,,325.76,percent of total billed charges,80% of total billed charges,458.1,90,,366.48,percent of total billed charges,90% of total billed charges,381.75,75,,305.4,percent of total billed charges,75% of total billed charges,136.28,122,,,fee schedule,122% of HUMANA fee schedule,147.61,29,,118.088,percent of total billed charges,29% of total billed charges,111.71,100,,,fee schedule,100% of CMS OPPS rate,341.03,67,,272.824,percent of total billed charges,67% of total billed charges,42.55,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,407.2,80,,325.76,percent of total billed charges,80% of total billed charges,330.85,65,,264.68,percent of total billed charges,65% of total billed charges,181.56,35.67,,145.248,percent of total billed charges,35.67% of total billed charges,42.55,469.53,
CONT INHALED WITH MED EACH ADD,4100152,CDM,460,RC,94645,HCPCS,outpatient,,,263,105.20,,223.55,85,,178.84,percent of total billed charges,85% of total billed charges,202.51,77,,162.01,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,70.83,429,,,fee schedule,429% of BCBS fee schedule,73.8,447,,,fee schedule,447% of BCBS fee schedule,73.8,447,,,fee schedule,447% of BCBS fee schedule,73.8,447,,,fee schedule,447% of BCBS fee schedule,236.7,90,,189.36,percent of total billed charges,90% of total billed charges,210.4,80,,168.32,percent of total billed charges,80% of total billed charges,236.7,90,,189.36,percent of total billed charges,90% of total billed charges,197.25,75,,157.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,76.27,29,,61.016,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,176.21,67,,140.968,percent of total billed charges,67% of total billed charges,42.55,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,210.4,80,,168.32,percent of total billed charges,80% of total billed charges,170.95,65,,136.76,percent of total billed charges,65% of total billed charges,93.81,35.67,,75.048,percent of total billed charges,35.67% of total billed charges,42.55,236.7,
PUL STRESS 6 MINUTE WALK,4100181,CDM,460,RC,94618,HCPCS,outpatient,,,520,208.00,,442,85,,353.6,percent of total billed charges,85% of total billed charges,400.4,77,,320.32,percent of total billed charges,77% of total billed charges,111.71,100,,,fee schedule,100% of CMS OPPS rate,450.62,429,,,fee schedule,429% of BCBS fee schedule,469.53,447,,,fee schedule,447% of BCBS fee schedule,469.53,447,,,fee schedule,447% of BCBS fee schedule,469.53,447,,,fee schedule,447% of BCBS fee schedule,468,90,,374.4,percent of total billed charges,90% of total billed charges,416,80,,332.8,percent of total billed charges,80% of total billed charges,468,90,,374.4,percent of total billed charges,90% of total billed charges,390,75,,312,percent of total billed charges,75% of total billed charges,136.28,122,,,fee schedule,122% of HUMANA fee schedule,150.8,29,,120.64,percent of total billed charges,29% of total billed charges,111.71,100,,,fee schedule,100% of CMS OPPS rate,348.4,67,,278.72,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,416,80,,332.8,percent of total billed charges,80% of total billed charges,338,65,,270.4,percent of total billed charges,65% of total billed charges,185.48,35.67,,148.384,percent of total billed charges,35.67% of total billed charges,111.71,469.53,
MAXIMUM BREATHING CAPACITY MVV,4100192,CDM,460,RC,94200,HCPCS,outpatient,,,509,203.60,,432.65,85,,346.12,percent of total billed charges,85% of total billed charges,391.93,77,,313.54,percent of total billed charges,77% of total billed charges,53.49,100,,,fee schedule,100% of CMS OPPS rate,450.62,429,,,fee schedule,429% of BCBS fee schedule,469.53,447,,,fee schedule,447% of BCBS fee schedule,469.53,447,,,fee schedule,447% of BCBS fee schedule,469.53,447,,,fee schedule,447% of BCBS fee schedule,458.1,90,,366.48,percent of total billed charges,90% of total billed charges,407.2,80,,325.76,percent of total billed charges,80% of total billed charges,458.1,90,,366.48,percent of total billed charges,90% of total billed charges,381.75,75,,305.4,percent of total billed charges,75% of total billed charges,65.26,122,,,fee schedule,122% of HUMANA fee schedule,147.61,29,,118.088,percent of total billed charges,29% of total billed charges,53.49,100,,,fee schedule,100% of CMS OPPS rate,341.03,67,,272.824,percent of total billed charges,67% of total billed charges,48.24,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,407.2,80,,325.76,percent of total billed charges,80% of total billed charges,330.85,65,,264.68,percent of total billed charges,65% of total billed charges,181.56,35.67,,145.248,percent of total billed charges,35.67% of total billed charges,48.24,469.53,
FUNCTIONAL RESIDUAL CAPACITY,4100195,CDM,460,RC,94726,HCPCS,outpatient,,,1138,455.20,,967.3,85,,773.84,percent of total billed charges,85% of total billed charges,876.26,77,,701.01,percent of total billed charges,77% of total billed charges,274.49,100,,,fee schedule,100% of CMS OPPS rate,1067.48,429,,,fee schedule,429% of BCBS fee schedule,1112.27,447,,,fee schedule,447% of BCBS fee schedule,1112.27,447,,,fee schedule,447% of BCBS fee schedule,1112.27,447,,,fee schedule,447% of BCBS fee schedule,1024.2,90,,819.36,percent of total billed charges,90% of total billed charges,910.4,80,,728.32,percent of total billed charges,80% of total billed charges,1024.2,90,,819.36,percent of total billed charges,90% of total billed charges,853.5,75,,682.8,percent of total billed charges,75% of total billed charges,334.88,122,,,fee schedule,122% of HUMANA fee schedule,330.02,29,,264.016,percent of total billed charges,29% of total billed charges,274.49,100,,,fee schedule,100% of CMS OPPS rate,762.46,67,,609.968,percent of total billed charges,67% of total billed charges,48.24,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,910.4,80,,728.32,percent of total billed charges,80% of total billed charges,739.7,65,,591.76,percent of total billed charges,65% of total billed charges,405.92,35.67,,324.736,percent of total billed charges,35.67% of total billed charges,48.24,1112.27,
PFT PRE AND POST,4100240,CDM,460,RC,94060,HCPCS,outpatient,,,449,179.60,,381.65,85,,305.32,percent of total billed charges,85% of total billed charges,345.73,77,,276.58,percent of total billed charges,77% of total billed charges,274.49,100,,,fee schedule,100% of CMS OPPS rate,207.85,429,,,fee schedule,429% of BCBS fee schedule,216.57,447,,,fee schedule,447% of BCBS fee schedule,216.57,447,,,fee schedule,447% of BCBS fee schedule,216.57,447,,,fee schedule,447% of BCBS fee schedule,404.1,90,,323.28,percent of total billed charges,90% of total billed charges,359.2,80,,287.36,percent of total billed charges,80% of total billed charges,404.1,90,,323.28,percent of total billed charges,90% of total billed charges,336.75,75,,269.4,percent of total billed charges,75% of total billed charges,334.88,122,,,fee schedule,122% of HUMANA fee schedule,130.21,29,,104.168,percent of total billed charges,29% of total billed charges,274.49,100,,,fee schedule,100% of CMS OPPS rate,300.83,67,,240.664,percent of total billed charges,67% of total billed charges,92.09,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,359.2,80,,287.36,percent of total billed charges,80% of total billed charges,291.85,65,,233.48,percent of total billed charges,65% of total billed charges,160.16,35.67,,128.128,percent of total billed charges,35.67% of total billed charges,92.09,404.1,
PULMONARY FUNCTION - SIMPLE,4100250,CDM,460,RC,94010,HCPCS,outpatient,,,675,270.00,,573.75,85,,459,percent of total billed charges,85% of total billed charges,519.75,77,,415.8,percent of total billed charges,77% of total billed charges,136.6,100,,,fee schedule,100% of CMS OPPS rate,584.81,429,,,fee schedule,429% of BCBS fee schedule,609.35,401,,,fee schedule,401% of BCBS fee schedule,609.35,401,,,fee schedule,401% of BCBS fee schedule,609.35,401,,,fee schedule,401% of BCBS fee schedule,607.5,90,,486,percent of total billed charges,90% of total billed charges,540,80,,432,percent of total billed charges,80% of total billed charges,607.5,90,,486,percent of total billed charges,90% of total billed charges,506.25,75,,405,percent of total billed charges,75% of total billed charges,166.65,122,,,fee schedule,122% of HUMANA fee schedule,195.75,29,,156.6,percent of total billed charges,29% of total billed charges,136.6,100,,,fee schedule,100% of CMS OPPS rate,452.25,67,,361.8,percent of total billed charges,67% of total billed charges,48.24,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,540,80,,432,percent of total billed charges,80% of total billed charges,438.75,65,,351,percent of total billed charges,65% of total billed charges,240.77,35.67,,192.616,percent of total billed charges,35.67% of total billed charges,48.24,609.35,
PULSE OXIMETRY SINGLE USE,4100280,CDM,460,RC,94760,HCPCS,outpatient,,,29,11.60,,24.65,85,,19.72,percent of total billed charges,85% of total billed charges,22.33,77,,17.86,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,12.31,429,,,fee schedule,429% of BCBS fee schedule,12.83,447,,,fee schedule,447% of BCBS fee schedule,12.83,447,,,fee schedule,447% of BCBS fee schedule,12.83,447,,,fee schedule,447% of BCBS fee schedule,26.1,90,,20.88,percent of total billed charges,90% of total billed charges,23.2,80,,18.56,percent of total billed charges,80% of total billed charges,26.1,90,,20.88,percent of total billed charges,90% of total billed charges,21.75,75,,17.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,8.41,29,,6.728,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,19.43,67,,15.544,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,23.2,80,,18.56,percent of total billed charges,80% of total billed charges,18.85,65,,15.08,percent of total billed charges,65% of total billed charges,10.34,35.67,,8.272,percent of total billed charges,35.67% of total billed charges,8.41,26.1,
PULSE OXIMETRY REPEAT TODAY,4100281,CDM,460,RC,94760,HCPCS,outpatient,,,40,16.00,76,34,85,,27.2,percent of total billed charges,85% of total billed charges,30.8,77,,24.64,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,12.31,429,,,fee schedule,429% of BCBS fee schedule,12.83,447,,,fee schedule,447% of BCBS fee schedule,12.83,447,,,fee schedule,447% of BCBS fee schedule,12.83,447,,,fee schedule,447% of BCBS fee schedule,36,90,,28.8,percent of total billed charges,90% of total billed charges,32,80,,25.6,percent of total billed charges,80% of total billed charges,36,90,,28.8,percent of total billed charges,90% of total billed charges,30,75,,24,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,11.6,29,,9.28,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,26.8,67,,21.44,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,32,80,,25.6,percent of total billed charges,80% of total billed charges,26,65,,20.8,percent of total billed charges,65% of total billed charges,14.27,35.67,,11.416,percent of total billed charges,35.67% of total billed charges,11.6,36,
PULSE OXIMETRY CONTINUOUS/DAY,4100282,CDM,460,RC,94762,HCPCS,outpatient,,,674,269.60,,572.9,85,,458.32,percent of total billed charges,85% of total billed charges,518.98,77,,415.18,percent of total billed charges,77% of total billed charges,136.6,100,,,fee schedule,100% of CMS OPPS rate,584.81,429,,,fee schedule,429% of BCBS fee schedule,609.35,447,,,fee schedule,447% of BCBS fee schedule,609.35,447,,,fee schedule,447% of BCBS fee schedule,609.35,447,,,fee schedule,447% of BCBS fee schedule,606.6,90,,485.28,percent of total billed charges,90% of total billed charges,539.2,80,,431.36,percent of total billed charges,80% of total billed charges,606.6,90,,485.28,percent of total billed charges,90% of total billed charges,505.5,75,,404.4,percent of total billed charges,75% of total billed charges,166.65,122,,,fee schedule,122% of HUMANA fee schedule,195.46,29,,156.368,percent of total billed charges,29% of total billed charges,136.6,100,,,fee schedule,100% of CMS OPPS rate,451.58,67,,361.264,percent of total billed charges,67% of total billed charges,60.95,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,539.2,80,,431.36,percent of total billed charges,80% of total billed charges,438.1,65,,350.48,percent of total billed charges,65% of total billed charges,240.42,35.67,,192.336,percent of total billed charges,35.67% of total billed charges,60.95,609.35,
PULSE OXIMETERY FOR O2 SAT,4100283,CDM,460,RC,94761,HCPCS,outpatient,,,291,116.40,,247.35,85,,197.88,percent of total billed charges,85% of total billed charges,224.07,77,,179.26,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,20.03,429,,,fee schedule,429% of BCBS fee schedule,20.87,447,,,fee schedule,447% of BCBS fee schedule,20.87,447,,,fee schedule,447% of BCBS fee schedule,20.87,447,,,fee schedule,447% of BCBS fee schedule,261.9,90,,209.52,percent of total billed charges,90% of total billed charges,232.8,80,,186.24,percent of total billed charges,80% of total billed charges,261.9,90,,209.52,percent of total billed charges,90% of total billed charges,218.25,75,,174.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,84.39,29,,67.512,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,194.97,67,,155.976,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,232.8,80,,186.24,percent of total billed charges,80% of total billed charges,189.15,65,,151.32,percent of total billed charges,65% of total billed charges,103.8,35.67,,83.04,percent of total billed charges,35.67% of total billed charges,20.03,261.9,
RESPIRATORY FLOW VOLUME LOOP,4100291,CDM,460,RC,94375,HCPCS,outpatient,,,1206,482.40,,1025.1,85,,820.08,percent of total billed charges,85% of total billed charges,928.62,77,,742.9,percent of total billed charges,77% of total billed charges,274.49,100,,,fee schedule,100% of CMS OPPS rate,1067.48,429,,,fee schedule,429% of BCBS fee schedule,1112.27,447,,,fee schedule,447% of BCBS fee schedule,1112.27,447,,,fee schedule,447% of BCBS fee schedule,1112.27,447,,,fee schedule,447% of BCBS fee schedule,1085.4,90,,868.32,percent of total billed charges,90% of total billed charges,964.8,80,,771.84,percent of total billed charges,80% of total billed charges,1085.4,90,,868.32,percent of total billed charges,90% of total billed charges,904.5,75,,723.6,percent of total billed charges,75% of total billed charges,334.88,122,,,fee schedule,122% of HUMANA fee schedule,349.74,29,,279.792,percent of total billed charges,29% of total billed charges,274.49,100,,,fee schedule,100% of CMS OPPS rate,808.02,67,,646.416,percent of total billed charges,67% of total billed charges,48.24,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,964.8,80,,771.84,percent of total billed charges,80% of total billed charges,783.9,65,,627.12,percent of total billed charges,65% of total billed charges,430.18,35.67,,344.144,percent of total billed charges,35.67% of total billed charges,48.24,1112.27,
"VITAL CAPACITY, TOTAL",4100292,CDM,460,RC,94150,HCPCS,outpatient,,,662,264.80,,562.7,85,,450.16,percent of total billed charges,85% of total billed charges,509.74,77,,407.79,percent of total billed charges,77% of total billed charges,136.6,100,,,fee schedule,100% of CMS OPPS rate,584.81,429,,,fee schedule,429% of BCBS fee schedule,609.35,447,,,fee schedule,447% of BCBS fee schedule,609.35,447,,,fee schedule,447% of BCBS fee schedule,609.35,447,,,fee schedule,447% of BCBS fee schedule,595.8,90,,476.64,percent of total billed charges,90% of total billed charges,529.6,80,,423.68,percent of total billed charges,80% of total billed charges,595.8,90,,476.64,percent of total billed charges,90% of total billed charges,496.5,75,,397.2,percent of total billed charges,75% of total billed charges,166.65,122,,,fee schedule,122% of HUMANA fee schedule,191.98,29,,153.584,percent of total billed charges,29% of total billed charges,136.6,100,,,fee schedule,100% of CMS OPPS rate,443.54,67,,354.832,percent of total billed charges,67% of total billed charges,48.24,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,529.6,80,,423.68,percent of total billed charges,80% of total billed charges,430.3,65,,344.24,percent of total billed charges,65% of total billed charges,236.14,35.67,,188.912,percent of total billed charges,35.67% of total billed charges,48.24,609.35,
CARBON MONOXIDE DIFFUSING CAPA,4100350,CDM,460,RC,94729,HCPCS,outpatient,,,287,114.80,,243.95,85,,195.16,percent of total billed charges,85% of total billed charges,220.99,77,,176.79,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,198.63,429,,,fee schedule,429% of BCBS fee schedule,206.96,447,,,fee schedule,447% of BCBS fee schedule,206.96,447,,,fee schedule,447% of BCBS fee schedule,206.96,447,,,fee schedule,447% of BCBS fee schedule,258.3,90,,206.64,percent of total billed charges,90% of total billed charges,229.6,80,,183.68,percent of total billed charges,80% of total billed charges,258.3,90,,206.64,percent of total billed charges,90% of total billed charges,215.25,75,,172.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,83.23,29,,66.584,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,192.29,67,,153.832,percent of total billed charges,67% of total billed charges,58.06,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,229.6,80,,183.68,percent of total billed charges,80% of total billed charges,186.55,65,,149.24,percent of total billed charges,65% of total billed charges,102.37,35.67,,81.896,percent of total billed charges,35.67% of total billed charges,58.06,258.3,
BRONCHOSPASM PROVOCATION EVAL,4100360,CDM,460,RC,94070,HCPCS,outpatient,,,735,294.00,,624.75,85,,499.8,percent of total billed charges,85% of total billed charges,565.95,77,,452.76,percent of total billed charges,77% of total billed charges,274.49,100,,,fee schedule,100% of CMS OPPS rate,138.57,429,,,fee schedule,429% of BCBS fee schedule,144.38,447,,,fee schedule,447% of BCBS fee schedule,144.38,447,,,fee schedule,447% of BCBS fee schedule,144.38,447,,,fee schedule,447% of BCBS fee schedule,661.5,90,,529.2,percent of total billed charges,90% of total billed charges,588,80,,470.4,percent of total billed charges,80% of total billed charges,661.5,90,,529.2,percent of total billed charges,90% of total billed charges,551.25,75,,441,percent of total billed charges,75% of total billed charges,334.88,122,,,fee schedule,122% of HUMANA fee schedule,213.15,29,,170.52,percent of total billed charges,29% of total billed charges,274.49,100,,,fee schedule,100% of CMS OPPS rate,492.45,67,,393.96,percent of total billed charges,67% of total billed charges,175.42,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,588,80,,470.4,percent of total billed charges,80% of total billed charges,477.75,65,,382.2,percent of total billed charges,65% of total billed charges,262.17,35.67,,209.736,percent of total billed charges,35.67% of total billed charges,138.57,661.5,
DETERMINATION/RESISTANCE AIRFL,4100390,CDM,460,RC,94726,HCPCS,outpatient,,,1228,491.20,,1043.8,85,,835.04,percent of total billed charges,85% of total billed charges,945.56,77,,756.45,percent of total billed charges,77% of total billed charges,274.49,100,,,fee schedule,100% of CMS OPPS rate,1067.48,429,,,fee schedule,429% of BCBS fee schedule,1112.27,447,,,fee schedule,447% of BCBS fee schedule,1112.27,447,,,fee schedule,447% of BCBS fee schedule,1112.27,447,,,fee schedule,447% of BCBS fee schedule,1105.2,90,,884.16,percent of total billed charges,90% of total billed charges,982.4,80,,785.92,percent of total billed charges,80% of total billed charges,1105.2,90,,884.16,percent of total billed charges,90% of total billed charges,921,75,,736.8,percent of total billed charges,75% of total billed charges,334.88,122,,,fee schedule,122% of HUMANA fee schedule,356.12,29,,284.896,percent of total billed charges,29% of total billed charges,274.49,100,,,fee schedule,100% of CMS OPPS rate,822.76,67,,658.208,percent of total billed charges,67% of total billed charges,48.24,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,982.4,80,,785.92,percent of total billed charges,80% of total billed charges,798.2,65,,638.56,percent of total billed charges,65% of total billed charges,438.03,35.67,,350.424,percent of total billed charges,35.67% of total billed charges,48.24,1112.27,
CCHD - NEWBORN,4700014,CDM,460,RC,94761,HCPCS,outpatient,,,346,138.40,,294.1,85,,235.28,percent of total billed charges,85% of total billed charges,266.42,77,,213.14,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,20.03,429,,,fee schedule,429% of BCBS fee schedule,20.87,447,,,fee schedule,447% of BCBS fee schedule,20.87,447,,,fee schedule,447% of BCBS fee schedule,20.87,447,,,fee schedule,447% of BCBS fee schedule,311.4,90,,249.12,percent of total billed charges,90% of total billed charges,276.8,80,,221.44,percent of total billed charges,80% of total billed charges,311.4,90,,249.12,percent of total billed charges,90% of total billed charges,259.5,75,,207.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,100.34,29,,80.272,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,231.82,67,,185.456,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,276.8,80,,221.44,percent of total billed charges,80% of total billed charges,224.9,65,,179.92,percent of total billed charges,65% of total billed charges,123.42,35.67,,98.736,percent of total billed charges,35.67% of total billed charges,20.03,311.4,
INCREMENTAL NUR CARE PER HR,4700015,CDM,460,RC,,,outpatient,,,88,35.20,,74.8,85,,59.84,percent of total billed charges,85% of total billed charges,67.76,77,,54.21,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,72.16,82,,57.728,percent of total billed charges,82% of total billed charges,74.8,85,,59.84,percent of total billed charges,85% of total billed charges,74.8,85,,59.84,percent of total billed charges,85% of total billed charges,74.8,85,,59.84,percent of total billed charges,85% of total billed charges,79.2,90,,63.36,percent of total billed charges,90% of total billed charges,70.4,80,,56.32,percent of total billed charges,80% of total billed charges,79.2,90,,63.36,percent of total billed charges,90% of total billed charges,66,75,,52.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,25.52,29,,20.416,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,58.96,67,,47.168,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,70.4,80,,56.32,percent of total billed charges,80% of total billed charges,57.2,65,,45.76,percent of total billed charges,65% of total billed charges,31.39,35.67,,25.112,percent of total billed charges,35.67% of total billed charges,25.52,79.2,
EVOKED OTOACOSTIC EMISSION,4700000,CDM,470,RC,92587,HCPCS,outpatient,,,288,115.20,,244.8,85,,195.84,percent of total billed charges,85% of total billed charges,221.76,77,,177.41,percent of total billed charges,77% of total billed charges,274.49,100,,,fee schedule,100% of CMS OPPS rate,13.86,429,,,fee schedule,429% of BCBS fee schedule,14.44,447,,,fee schedule,447% of BCBS fee schedule,14.44,447,,,fee schedule,447% of BCBS fee schedule,14.44,447,,,fee schedule,447% of BCBS fee schedule,259.2,90,,207.36,percent of total billed charges,90% of total billed charges,230.4,80,,184.32,percent of total billed charges,80% of total billed charges,259.2,90,,207.36,percent of total billed charges,90% of total billed charges,216,75,,172.8,percent of total billed charges,75% of total billed charges,334.88,122,,,fee schedule,122% of HUMANA fee schedule,83.52,29,,66.816,percent of total billed charges,29% of total billed charges,274.49,100,,,fee schedule,100% of CMS OPPS rate,192.96,67,,154.368,percent of total billed charges,67% of total billed charges,64.51,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,230.4,80,,184.32,percent of total billed charges,80% of total billed charges,187.2,65,,149.76,percent of total billed charges,65% of total billed charges,102.73,35.67,,82.184,percent of total billed charges,35.67% of total billed charges,13.86,334.88,
AUDITORY EVOKED RESPONSE,4700010,CDM,470,RC,92650,HCPCS,outpatient,,,450,180.00,,382.5,85,,306,percent of total billed charges,85% of total billed charges,346.5,77,,277.2,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,107.21,350,,,fee schedule,350% of BCBS fee schedule,111.49,364,,,fee schedule,364% of BCBS fee schedule,111.49,364,,,fee schedule,364% of BCBS fee schedule,111.49,364,,,fee schedule,364% of BCBS fee schedule,405,90,,324,percent of total billed charges,90% of total billed charges,360,80,,288,percent of total billed charges,80% of total billed charges,405,90,,324,percent of total billed charges,90% of total billed charges,337.5,75,,270,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,130.5,29,,104.4,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,301.5,67,,241.2,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,360,80,,288,percent of total billed charges,80% of total billed charges,292.5,65,,234,percent of total billed charges,65% of total billed charges,160.52,35.67,,128.416,percent of total billed charges,35.67% of total billed charges,107.21,405,
HEARING SCREENING TST AIR ONLY,4700011,CDM,470,RC,92551,HCPCS,outpatient,,,89,35.60,,75.65,85,,60.52,percent of total billed charges,85% of total billed charges,68.53,77,,54.82,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,53.88,429,,,fee schedule,429% of BCBS fee schedule,56.14,447,,,fee schedule,447% of BCBS fee schedule,56.14,447,,,fee schedule,447% of BCBS fee schedule,56.14,447,,,fee schedule,447% of BCBS fee schedule,80.1,90,,64.08,percent of total billed charges,90% of total billed charges,71.2,80,,56.96,percent of total billed charges,80% of total billed charges,80.1,90,,64.08,percent of total billed charges,90% of total billed charges,66.75,75,,53.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,25.81,29,,20.648,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,59.63,67,,47.704,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,71.2,80,,56.96,percent of total billed charges,80% of total billed charges,57.85,65,,46.28,percent of total billed charges,65% of total billed charges,31.75,35.67,,25.4,percent of total billed charges,35.67% of total billed charges,25.81,80.1,
ECHO LIMITED/6 MO OR F/UP,48000022,CDM,480,RC,93308,HCPCS,outpatient,,,577,230.80,,490.45,85,,392.36,percent of total billed charges,85% of total billed charges,444.29,77,,355.43,percent of total billed charges,77% of total billed charges,214.29,100,,,fee schedule,100% of CMS OPPS rate,349.51,429,,,fee schedule,429% of BCBS fee schedule,364.17,447,,,fee schedule,447% of BCBS fee schedule,364.17,447,,,fee schedule,447% of BCBS fee schedule,364.17,447,,,fee schedule,447% of BCBS fee schedule,519.3,90,,415.44,percent of total billed charges,90% of total billed charges,461.6,80,,369.28,percent of total billed charges,80% of total billed charges,519.3,90,,415.44,percent of total billed charges,90% of total billed charges,432.75,75,,346.2,percent of total billed charges,75% of total billed charges,261.43,122,,,fee schedule,122% of HUMANA fee schedule,167.33,29,,133.864,percent of total billed charges,29% of total billed charges,214.29,100,,,fee schedule,100% of CMS OPPS rate,386.59,67,,309.272,percent of total billed charges,67% of total billed charges,206.16,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,461.6,80,,369.28,percent of total billed charges,80% of total billed charges,375.05,65,,300.04,percent of total billed charges,65% of total billed charges,205.82,35.67,,164.656,percent of total billed charges,35.67% of total billed charges,167.33,519.3,
ECHO - COMPLETE,4800021,CDM,480,RC,93306,HCPCS,outpatient,,,2472,988.80,,2101.2,85,,1680.96,percent of total billed charges,85% of total billed charges,1903.44,77,,1522.75,percent of total billed charges,77% of total billed charges,482.45,100,,,fee schedule,100% of CMS OPPS rate,594.29,429,,,fee schedule,429% of BCBS fee schedule,619.23,447,,,fee schedule,447% of BCBS fee schedule,619.23,447,,,fee schedule,447% of BCBS fee schedule,619.23,447,,,fee schedule,447% of BCBS fee schedule,2224.8,90,,1779.84,percent of total billed charges,90% of total billed charges,1977.6,80,,1582.08,percent of total billed charges,80% of total billed charges,2224.8,90,,1779.84,percent of total billed charges,90% of total billed charges,1854,75,,1483.2,percent of total billed charges,75% of total billed charges,588.58,122,,,fee schedule,122% of HUMANA fee schedule,716.88,29,,573.504,percent of total billed charges,29% of total billed charges,482.45,100,,,fee schedule,100% of CMS OPPS rate,1656.24,67,,1324.992,percent of total billed charges,67% of total billed charges,366.13,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,1977.6,80,,1582.08,percent of total billed charges,80% of total billed charges,1606.8,65,,1285.44,percent of total billed charges,65% of total billed charges,881.76,35.67,,705.408,percent of total billed charges,35.67% of total billed charges,366.13,2224.8,
TRANSTHORACIC ECHO/CONG CARD,4800022,CDM,480,RC,93303,HCPCS,outpatient,,,1507,602.80,,1280.95,85,,1024.76,percent of total billed charges,85% of total billed charges,1160.39,77,,928.31,percent of total billed charges,77% of total billed charges,482.45,100,,,fee schedule,100% of CMS OPPS rate,775.98,429,,,fee schedule,429% of BCBS fee schedule,808.53,447,,,fee schedule,447% of BCBS fee schedule,808.53,447,,,fee schedule,447% of BCBS fee schedule,808.53,447,,,fee schedule,447% of BCBS fee schedule,1356.3,90,,1085.04,percent of total billed charges,90% of total billed charges,1205.6,80,,964.48,percent of total billed charges,80% of total billed charges,1356.3,90,,1085.04,percent of total billed charges,90% of total billed charges,1130.25,75,,904.2,percent of total billed charges,75% of total billed charges,588.58,122,,,fee schedule,122% of HUMANA fee schedule,437.03,29,,349.624,percent of total billed charges,29% of total billed charges,482.45,100,,,fee schedule,100% of CMS OPPS rate,1009.69,67,,807.752,percent of total billed charges,67% of total billed charges,540.04,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,1205.6,80,,964.48,percent of total billed charges,80% of total billed charges,979.55,65,,783.64,percent of total billed charges,65% of total billed charges,537.55,35.67,,430.04,percent of total billed charges,35.67% of total billed charges,437.03,1356.3,
COLOR FLOW DOPPLER,4800025,CDM,480,RC,93325,HCPCS,outpatient,,,626,250.40,,532.1,85,,425.68,percent of total billed charges,85% of total billed charges,482.02,77,,385.62,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,98.54,429,,,fee schedule,429% of BCBS fee schedule,102.68,447,,,fee schedule,447% of BCBS fee schedule,102.68,447,,,fee schedule,447% of BCBS fee schedule,102.68,447,,,fee schedule,447% of BCBS fee schedule,563.4,90,,450.72,percent of total billed charges,90% of total billed charges,500.8,80,,400.64,percent of total billed charges,80% of total billed charges,563.4,90,,450.72,percent of total billed charges,90% of total billed charges,469.5,75,,375.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,181.54,29,,145.232,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,419.42,67,,335.536,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,500.8,80,,400.64,percent of total billed charges,80% of total billed charges,406.9,65,,325.52,percent of total billed charges,65% of total billed charges,223.29,35.67,,178.632,percent of total billed charges,35.67% of total billed charges,98.54,563.4,
CW/PW DOPPLER,4800040,CDM,480,RC,93320,HCPCS,outpatient,,,626,250.40,,532.1,85,,425.68,percent of total billed charges,85% of total billed charges,482.02,77,,385.62,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,157.06,429,,,fee schedule,429% of BCBS fee schedule,163.65,447,,,fee schedule,447% of BCBS fee schedule,163.65,447,,,fee schedule,447% of BCBS fee schedule,163.65,447,,,fee schedule,447% of BCBS fee schedule,563.4,90,,450.72,percent of total billed charges,90% of total billed charges,500.8,80,,400.64,percent of total billed charges,80% of total billed charges,563.4,90,,450.72,percent of total billed charges,90% of total billed charges,469.5,75,,375.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,181.54,29,,145.232,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,419.42,67,,335.536,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,500.8,80,,400.64,percent of total billed charges,80% of total billed charges,406.9,65,,325.52,percent of total billed charges,65% of total billed charges,223.29,35.67,,178.632,percent of total billed charges,35.67% of total billed charges,157.06,563.4,
STRESS ECHO,4800050,CDM,480,RC,93350,HCPCS,outpatient,,,1259,503.60,,1070.15,85,,856.12,percent of total billed charges,85% of total billed charges,969.43,77,,775.54,percent of total billed charges,77% of total billed charges,482.45,100,,,fee schedule,100% of CMS OPPS rate,595.84,350,,,fee schedule,350% of BCBS fee schedule,620.84,447,,,fee schedule,447% of BCBS fee schedule,620.84,447,,,fee schedule,447% of BCBS fee schedule,620.84,447,,,fee schedule,447% of BCBS fee schedule,1133.1,90,,906.48,percent of total billed charges,90% of total billed charges,1007.2,80,,805.76,percent of total billed charges,80% of total billed charges,1133.1,90,,906.48,percent of total billed charges,90% of total billed charges,944.25,75,,755.4,percent of total billed charges,75% of total billed charges,588.58,122,,,fee schedule,122% of HUMANA fee schedule,365.11,29,,292.088,percent of total billed charges,29% of total billed charges,482.45,100,,,fee schedule,100% of CMS OPPS rate,843.53,67,,674.824,percent of total billed charges,67% of total billed charges,366.13,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,1007.2,80,,805.76,percent of total billed charges,80% of total billed charges,818.35,65,,654.68,percent of total billed charges,65% of total billed charges,449.09,35.67,,359.272,percent of total billed charges,35.67% of total billed charges,365.11,1133.1,
STRESS TEST,7300050,CDM,482,RC,93017,HCPCS,outpatient,,,1227,490.80,,1042.95,85,,834.36,percent of total billed charges,85% of total billed charges,944.79,77,,755.83,percent of total billed charges,77% of total billed charges,274.49,100,,,fee schedule,100% of CMS OPPS rate,1067.48,429,,,fee schedule,429% of BCBS fee schedule,1112.27,447,,,fee schedule,447% of BCBS fee schedule,1112.27,447,,,fee schedule,447% of BCBS fee schedule,1112.27,447,,,fee schedule,447% of BCBS fee schedule,1104.3,90,,883.44,percent of total billed charges,90% of total billed charges,981.6,80,,785.28,percent of total billed charges,80% of total billed charges,1104.3,90,,883.44,percent of total billed charges,90% of total billed charges,920.25,75,,736.2,percent of total billed charges,75% of total billed charges,334.88,122,,,fee schedule,122% of HUMANA fee schedule,355.83,29,,284.664,percent of total billed charges,29% of total billed charges,274.49,100,,,fee schedule,100% of CMS OPPS rate,822.09,67,,657.672,percent of total billed charges,67% of total billed charges,166.12,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,981.6,80,,785.28,percent of total billed charges,80% of total billed charges,797.55,65,,638.04,percent of total billed charges,65% of total billed charges,437.67,35.67,,350.136,percent of total billed charges,35.67% of total billed charges,166.12,1112.27,
TELE-ENDO GLUCLOSE MNTR 30 DAY,7850069,CDM,510,RC,99091,HCPCS,outpatient,,,149,59.60,,126.65,85,,101.32,percent of total billed charges,85% of total billed charges,114.73,77,,91.78,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,250.97,429,,,fee schedule,429% of BCBS fee schedule,261.5,447,,,fee schedule,447% of BCBS fee schedule,261.5,447,,,fee schedule,447% of BCBS fee schedule,261.5,447,,,fee schedule,447% of BCBS fee schedule,134.1,90,,107.28,percent of total billed charges,90% of total billed charges,119.2,80,,95.36,percent of total billed charges,80% of total billed charges,134.1,90,,107.28,percent of total billed charges,90% of total billed charges,111.75,75,,89.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,43.21,29,,34.568,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,99.83,67,,79.864,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,119.2,80,,95.36,percent of total billed charges,80% of total billed charges,96.85,65,,77.48,percent of total billed charges,65% of total billed charges,53.15,35.67,,42.52,percent of total billed charges,35.67% of total billed charges,43.21,261.5,
TELECOMMUNICATION SERVICES,9999993,CDM,510,RC,,,outpatient,,,197,78.80,,167.45,85,,133.96,percent of total billed charges,85% of total billed charges,151.69,77,,121.35,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,161.54,82,,129.232,percent of total billed charges,82% of total billed charges,167.45,85,,133.96,percent of total billed charges,85% of total billed charges,167.45,85,,133.96,percent of total billed charges,85% of total billed charges,167.45,85,,133.96,percent of total billed charges,85% of total billed charges,177.3,90,,141.84,percent of total billed charges,90% of total billed charges,157.6,80,,126.08,percent of total billed charges,80% of total billed charges,177.3,90,,141.84,percent of total billed charges,90% of total billed charges,147.75,75,,118.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,57.13,29,,45.704,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,131.99,67,,105.592,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,157.6,80,,126.08,percent of total billed charges,80% of total billed charges,128.05,65,,102.44,percent of total billed charges,65% of total billed charges,70.27,35.67,,56.216,percent of total billed charges,35.67% of total billed charges,57.13,177.3,
EMS TRANSIT TO HOME SELF PAY,5400001,CDM,540,RC,,,outpatient,,,59,23.60,,50.15,85,,40.12,percent of total billed charges,85% of total billed charges,45.43,77,,36.34,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,48.38,82,,38.704,percent of total billed charges,82% of total billed charges,50.15,85,,40.12,percent of total billed charges,85% of total billed charges,50.15,85,,40.12,percent of total billed charges,85% of total billed charges,50.15,85,,40.12,percent of total billed charges,85% of total billed charges,53.1,90,,42.48,percent of total billed charges,90% of total billed charges,47.2,80,,37.76,percent of total billed charges,80% of total billed charges,53.1,90,,42.48,percent of total billed charges,90% of total billed charges,44.25,75,,35.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,17.11,29,,13.688,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,39.53,67,,31.624,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,47.2,80,,37.76,percent of total billed charges,80% of total billed charges,38.35,65,,30.68,percent of total billed charges,65% of total billed charges,21.05,35.67,,16.84,percent of total billed charges,35.67% of total billed charges,17.11,53.1,
BLS NON SKILLED/HOSP NON ER,5400003,CDM,540,RC,A0428,HCPCS,outpatient,,,1378,551.20,EHQN,1171.3,85,,937.04,percent of total billed charges,85% of total billed charges,1061.06,77,,848.85,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,1129.96,82,,903.968,percent of total billed charges,82% of total billed charges,1171.3,85,,937.04,percent of total billed charges,85% of total billed charges,1171.3,85,,937.04,percent of total billed charges,85% of total billed charges,1171.3,85,,937.04,percent of total billed charges,85% of total billed charges,1240.2,90,,992.16,percent of total billed charges,90% of total billed charges,1102.4,80,,881.92,percent of total billed charges,80% of total billed charges,1240.2,90,,992.16,percent of total billed charges,90% of total billed charges,1033.5,75,,826.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,306.88,100,,,fee schedule,100% of ASC tier grouping rate,,,,,other ,not seperately reimbursable,923.26,67,,738.608,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,218.88,80,,,fee schedule,80% of CMS fee schedule,1102.4,80,,881.92,percent of total billed charges,80% of total billed charges,895.7,65,,716.56,percent of total billed charges,65% of total billed charges,377.46,123,,,fee schedule,123% of ASC tier grouping rate,218.88,1240.2,
ADDITIONAL ATTENDANT,5400005,CDM,540,RC,A0424,HCPCS,outpatient,,,146,58.40,,124.1,85,,99.28,percent of total billed charges,85% of total billed charges,112.42,77,,89.94,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,119.72,82,,95.776,percent of total billed charges,82% of total billed charges,124.1,85,,99.28,percent of total billed charges,85% of total billed charges,124.1,85,,99.28,percent of total billed charges,85% of total billed charges,124.1,85,,99.28,percent of total billed charges,85% of total billed charges,131.4,90,,105.12,percent of total billed charges,90% of total billed charges,116.8,80,,93.44,percent of total billed charges,80% of total billed charges,131.4,90,,105.12,percent of total billed charges,90% of total billed charges,109.5,75,,87.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,42.34,29,,33.872,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,97.82,67,,78.256,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,116.8,80,,93.44,percent of total billed charges,80% of total billed charges,94.9,65,,75.92,percent of total billed charges,65% of total billed charges,52.08,35.67,,41.664,percent of total billed charges,35.67% of total billed charges,42.34,131.4,
NURSING HOME TRANSFER -CLIENT,5400015,CDM,540,RC,,,outpatient,,,179,71.60,,152.15,85,,121.72,percent of total billed charges,85% of total billed charges,137.83,77,,110.26,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,146.78,82,,117.424,percent of total billed charges,82% of total billed charges,152.15,85,,121.72,percent of total billed charges,85% of total billed charges,152.15,85,,121.72,percent of total billed charges,85% of total billed charges,152.15,85,,121.72,percent of total billed charges,85% of total billed charges,161.1,90,,128.88,percent of total billed charges,90% of total billed charges,143.2,80,,114.56,percent of total billed charges,80% of total billed charges,161.1,90,,128.88,percent of total billed charges,90% of total billed charges,134.25,75,,107.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,51.91,29,,41.528,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,119.93,67,,95.944,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,143.2,80,,114.56,percent of total billed charges,80% of total billed charges,116.35,65,,93.08,percent of total billed charges,65% of total billed charges,63.85,35.67,,51.08,percent of total billed charges,35.67% of total billed charges,51.91,161.1,
BLS RESIDENCE/RESIDENCE NON ER,5400016,CDM,540,RC,A0428,HCPCS,outpatient,,,1353,541.20,RRQN,1150.05,85,,920.04,percent of total billed charges,85% of total billed charges,1041.81,77,,833.45,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,1109.46,82,,887.568,percent of total billed charges,82% of total billed charges,1150.05,85,,920.04,percent of total billed charges,85% of total billed charges,1150.05,85,,920.04,percent of total billed charges,85% of total billed charges,1150.05,85,,920.04,percent of total billed charges,85% of total billed charges,1217.7,90,,974.16,percent of total billed charges,90% of total billed charges,1082.4,80,,865.92,percent of total billed charges,80% of total billed charges,1217.7,90,,974.16,percent of total billed charges,90% of total billed charges,1014.75,75,,811.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,306.88,100,,,fee schedule,100% of ASC tier grouping rate,,,,,other ,not seperately reimbursable,906.51,67,,725.208,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,218.88,80,,,fee schedule,80% of CMS fee schedule,1082.4,80,,865.92,percent of total billed charges,80% of total billed charges,879.45,65,,703.56,percent of total billed charges,65% of total billed charges,377.46,123,,,fee schedule,123% of ASC tier grouping rate,218.88,1217.7,
BLS RESIDENCE/SNF NON ER,5400017,CDM,540,RC,A0428,HCPCS,outpatient,,,1353,541.20,QNRN,1150.05,85,,920.04,percent of total billed charges,85% of total billed charges,1041.81,77,,833.45,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,1109.46,82,,887.568,percent of total billed charges,82% of total billed charges,1150.05,85,,920.04,percent of total billed charges,85% of total billed charges,1150.05,85,,920.04,percent of total billed charges,85% of total billed charges,1150.05,85,,920.04,percent of total billed charges,85% of total billed charges,1217.7,90,,974.16,percent of total billed charges,90% of total billed charges,1082.4,80,,865.92,percent of total billed charges,80% of total billed charges,1217.7,90,,974.16,percent of total billed charges,90% of total billed charges,1014.75,75,,811.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,306.88,100,,,fee schedule,100% of ASC tier grouping rate,,,,,other ,not seperately reimbursable,906.51,67,,725.208,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,218.88,80,,,fee schedule,80% of CMS fee schedule,1082.4,80,,865.92,percent of total billed charges,80% of total billed charges,879.45,65,,703.56,percent of total billed charges,65% of total billed charges,377.46,123,,,fee schedule,123% of ASC tier grouping rate,218.88,1217.7,
BLS RESIDENCE/NON SNF NON ER,5400018,CDM,540,RC,A0428,HCPCS,outpatient,,,1353,541.20,REQN,1150.05,85,,920.04,percent of total billed charges,85% of total billed charges,1041.81,77,,833.45,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,1109.46,82,,887.568,percent of total billed charges,82% of total billed charges,1150.05,85,,920.04,percent of total billed charges,85% of total billed charges,1150.05,85,,920.04,percent of total billed charges,85% of total billed charges,1150.05,85,,920.04,percent of total billed charges,85% of total billed charges,1217.7,90,,974.16,percent of total billed charges,90% of total billed charges,1082.4,80,,865.92,percent of total billed charges,80% of total billed charges,1217.7,90,,974.16,percent of total billed charges,90% of total billed charges,1014.75,75,,811.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,306.88,100,,,fee schedule,100% of ASC tier grouping rate,,,,,other ,not seperately reimbursable,906.51,67,,725.208,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,218.88,80,,,fee schedule,80% of CMS fee schedule,1082.4,80,,865.92,percent of total billed charges,80% of total billed charges,879.45,65,,703.56,percent of total billed charges,65% of total billed charges,377.46,123,,,fee schedule,123% of ASC tier grouping rate,218.88,1217.7,
BLS HOME/OFFICE NON ER,5400019,CDM,540,RC,A0428,HCPCS,outpatient,,,1353,541.20,QNRP,1150.05,85,,920.04,percent of total billed charges,85% of total billed charges,1041.81,77,,833.45,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,1109.46,82,,887.568,percent of total billed charges,82% of total billed charges,1150.05,85,,920.04,percent of total billed charges,85% of total billed charges,1150.05,85,,920.04,percent of total billed charges,85% of total billed charges,1150.05,85,,920.04,percent of total billed charges,85% of total billed charges,1217.7,90,,974.16,percent of total billed charges,90% of total billed charges,1082.4,80,,865.92,percent of total billed charges,80% of total billed charges,1217.7,90,,974.16,percent of total billed charges,90% of total billed charges,1014.75,75,,811.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,306.88,100,,,fee schedule,100% of ASC tier grouping rate,,,,,other ,not seperately reimbursable,906.51,67,,725.208,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,218.88,80,,,fee schedule,80% of CMS fee schedule,1082.4,80,,865.92,percent of total billed charges,80% of total billed charges,879.45,65,,703.56,percent of total billed charges,65% of total billed charges,377.46,123,,,fee schedule,123% of ASC tier grouping rate,218.88,1217.7,
BLS RESIDENCE/HOSPITAL NON ER,5400020,CDM,540,RC,A0428,HCPCS,outpatient,,,1378,551.20,QNRH,1171.3,85,,937.04,percent of total billed charges,85% of total billed charges,1061.06,77,,848.85,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,1129.96,82,,903.968,percent of total billed charges,82% of total billed charges,1171.3,85,,937.04,percent of total billed charges,85% of total billed charges,1171.3,85,,937.04,percent of total billed charges,85% of total billed charges,1171.3,85,,937.04,percent of total billed charges,85% of total billed charges,1240.2,90,,992.16,percent of total billed charges,90% of total billed charges,1102.4,80,,881.92,percent of total billed charges,80% of total billed charges,1240.2,90,,992.16,percent of total billed charges,90% of total billed charges,1033.5,75,,826.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,306.88,100,,,fee schedule,100% of ASC tier grouping rate,,,,,other ,not seperately reimbursable,923.26,67,,738.608,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,218.88,80,,,fee schedule,80% of CMS fee schedule,1102.4,80,,881.92,percent of total billed charges,80% of total billed charges,895.7,65,,716.56,percent of total billed charges,65% of total billed charges,377.46,123,,,fee schedule,123% of ASC tier grouping rate,218.88,1240.2,
BLS OFFICE/HOSP NON ER,5400022,CDM,540,RC,A0428,HCPCS,outpatient,,,1378,551.20,,1171.3,85,,937.04,percent of total billed charges,85% of total billed charges,1061.06,77,,848.85,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,1129.96,82,,903.968,percent of total billed charges,82% of total billed charges,1171.3,85,,937.04,percent of total billed charges,85% of total billed charges,1171.3,85,,937.04,percent of total billed charges,85% of total billed charges,1171.3,85,,937.04,percent of total billed charges,85% of total billed charges,1240.2,90,,992.16,percent of total billed charges,90% of total billed charges,1102.4,80,,881.92,percent of total billed charges,80% of total billed charges,1240.2,90,,992.16,percent of total billed charges,90% of total billed charges,1033.5,75,,826.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,306.88,100,,,fee schedule,100% of ASC tier grouping rate,,,,,other ,not seperately reimbursable,923.26,67,,738.608,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,218.88,80,,,fee schedule,80% of CMS fee schedule,1102.4,80,,881.92,percent of total billed charges,80% of total billed charges,895.7,65,,716.56,percent of total billed charges,65% of total billed charges,377.46,123,,,fee schedule,123% of ASC tier grouping rate,218.88,1240.2,
BLS OFFICE/RESIDENCE NON ER,5400023,CDM,540,RC,A0428,HCPCS,outpatient,,,1353,541.20,,1150.05,85,,920.04,percent of total billed charges,85% of total billed charges,1041.81,77,,833.45,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,1109.46,82,,887.568,percent of total billed charges,82% of total billed charges,1150.05,85,,920.04,percent of total billed charges,85% of total billed charges,1150.05,85,,920.04,percent of total billed charges,85% of total billed charges,1150.05,85,,920.04,percent of total billed charges,85% of total billed charges,1217.7,90,,974.16,percent of total billed charges,90% of total billed charges,1082.4,80,,865.92,percent of total billed charges,80% of total billed charges,1217.7,90,,974.16,percent of total billed charges,90% of total billed charges,1014.75,75,,811.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,306.88,100,,,fee schedule,100% of ASC tier grouping rate,,,,,other ,not seperately reimbursable,906.51,67,,725.208,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,218.88,80,,,fee schedule,80% of CMS fee schedule,1082.4,80,,865.92,percent of total billed charges,80% of total billed charges,879.45,65,,703.56,percent of total billed charges,65% of total billed charges,377.46,123,,,fee schedule,123% of ASC tier grouping rate,218.88,1217.7,
BLS SNF/HOSPITAL NON ER,5400025,CDM,540,RC,A0428,HCPCS,outpatient,,,1353,541.20,NHQN,1150.05,85,,920.04,percent of total billed charges,85% of total billed charges,1041.81,77,,833.45,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,1109.46,82,,887.568,percent of total billed charges,82% of total billed charges,1150.05,85,,920.04,percent of total billed charges,85% of total billed charges,1150.05,85,,920.04,percent of total billed charges,85% of total billed charges,1150.05,85,,920.04,percent of total billed charges,85% of total billed charges,1217.7,90,,974.16,percent of total billed charges,90% of total billed charges,1082.4,80,,865.92,percent of total billed charges,80% of total billed charges,1217.7,90,,974.16,percent of total billed charges,90% of total billed charges,1014.75,75,,811.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,306.88,100,,,fee schedule,100% of ASC tier grouping rate,,,,,other ,not seperately reimbursable,906.51,67,,725.208,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,218.88,80,,,fee schedule,80% of CMS fee schedule,1082.4,80,,865.92,percent of total billed charges,80% of total billed charges,879.45,65,,703.56,percent of total billed charges,65% of total billed charges,377.46,123,,,fee schedule,123% of ASC tier grouping rate,218.88,1217.7,
EMS FOOTBALL STANDBY,5400030,CDM,540,RC,,,outpatient,,,150,60.00,,127.5,85,,102,percent of total billed charges,85% of total billed charges,115.5,77,,92.4,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,123,82,,98.4,percent of total billed charges,82% of total billed charges,127.5,85,,102,percent of total billed charges,85% of total billed charges,127.5,85,,102,percent of total billed charges,85% of total billed charges,127.5,85,,102,percent of total billed charges,85% of total billed charges,135,90,,108,percent of total billed charges,90% of total billed charges,120,80,,96,percent of total billed charges,80% of total billed charges,135,90,,108,percent of total billed charges,90% of total billed charges,112.5,75,,90,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,43.5,29,,34.8,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,100.5,67,,80.4,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,120,80,,96,percent of total billed charges,80% of total billed charges,97.5,65,,78,percent of total billed charges,65% of total billed charges,53.51,35.67,,42.808,percent of total billed charges,35.67% of total billed charges,43.5,135,
BLS OFFICE/SNF NON ER,5400031,CDM,540,RC,A0428,HCPCS,outpatient,,,1353,541.20,PNQN,1150.05,85,,920.04,percent of total billed charges,85% of total billed charges,1041.81,77,,833.45,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,1109.46,82,,887.568,percent of total billed charges,82% of total billed charges,1150.05,85,,920.04,percent of total billed charges,85% of total billed charges,1150.05,85,,920.04,percent of total billed charges,85% of total billed charges,1150.05,85,,920.04,percent of total billed charges,85% of total billed charges,1217.7,90,,974.16,percent of total billed charges,90% of total billed charges,1082.4,80,,865.92,percent of total billed charges,80% of total billed charges,1217.7,90,,974.16,percent of total billed charges,90% of total billed charges,1014.75,75,,811.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,306.88,100,,,fee schedule,100% of ASC tier grouping rate,,,,,other ,not seperately reimbursable,906.51,67,,725.208,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,218.88,80,,,fee schedule,80% of CMS fee schedule,1082.4,80,,865.92,percent of total billed charges,80% of total billed charges,879.45,65,,703.56,percent of total billed charges,65% of total billed charges,377.46,123,,,fee schedule,123% of ASC tier grouping rate,218.88,1217.7,
BLS HOSP/SNF NON ER,5400032,CDM,540,RC,A0428,HCPCS,outpatient,,,1353,541.20,HNQN,1150.05,85,,920.04,percent of total billed charges,85% of total billed charges,1041.81,77,,833.45,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,1109.46,82,,887.568,percent of total billed charges,82% of total billed charges,1150.05,85,,920.04,percent of total billed charges,85% of total billed charges,1150.05,85,,920.04,percent of total billed charges,85% of total billed charges,1150.05,85,,920.04,percent of total billed charges,85% of total billed charges,1217.7,90,,974.16,percent of total billed charges,90% of total billed charges,1082.4,80,,865.92,percent of total billed charges,80% of total billed charges,1217.7,90,,974.16,percent of total billed charges,90% of total billed charges,1014.75,75,,811.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,306.88,100,,,fee schedule,100% of ASC tier grouping rate,,,,,other ,not seperately reimbursable,906.51,67,,725.208,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,218.88,80,,,fee schedule,80% of CMS fee schedule,1082.4,80,,865.92,percent of total billed charges,80% of total billed charges,879.45,65,,703.56,percent of total billed charges,65% of total billed charges,377.46,123,,,fee schedule,123% of ASC tier grouping rate,218.88,1217.7,
BLS HOSPITAL/DR OFFICE NON ER,5400033,CDM,540,RC,A0428,HCPCS,outpatient,,,1353,541.20,HPQN,1150.05,85,,920.04,percent of total billed charges,85% of total billed charges,1041.81,77,,833.45,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,1109.46,82,,887.568,percent of total billed charges,82% of total billed charges,1150.05,85,,920.04,percent of total billed charges,85% of total billed charges,1150.05,85,,920.04,percent of total billed charges,85% of total billed charges,1150.05,85,,920.04,percent of total billed charges,85% of total billed charges,1217.7,90,,974.16,percent of total billed charges,90% of total billed charges,1082.4,80,,865.92,percent of total billed charges,80% of total billed charges,1217.7,90,,974.16,percent of total billed charges,90% of total billed charges,1014.75,75,,811.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,306.88,100,,,fee schedule,100% of ASC tier grouping rate,,,,,other ,not seperately reimbursable,906.51,67,,725.208,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,218.88,80,,,fee schedule,80% of CMS fee schedule,1082.4,80,,865.92,percent of total billed charges,80% of total billed charges,879.45,65,,703.56,percent of total billed charges,65% of total billed charges,377.46,123,,,fee schedule,123% of ASC tier grouping rate,218.88,1217.7,
BLS HOSPITAL/RESIDENCE NON ER,5400034,CDM,540,RC,A0428,HCPCS,outpatient,,,1378,551.20,HRQN,1171.3,85,,937.04,percent of total billed charges,85% of total billed charges,1061.06,77,,848.85,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,1129.96,82,,903.968,percent of total billed charges,82% of total billed charges,1171.3,85,,937.04,percent of total billed charges,85% of total billed charges,1171.3,85,,937.04,percent of total billed charges,85% of total billed charges,1171.3,85,,937.04,percent of total billed charges,85% of total billed charges,1240.2,90,,992.16,percent of total billed charges,90% of total billed charges,1102.4,80,,881.92,percent of total billed charges,80% of total billed charges,1240.2,90,,992.16,percent of total billed charges,90% of total billed charges,1033.5,75,,826.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,306.88,100,,,fee schedule,100% of ASC tier grouping rate,,,,,other ,not seperately reimbursable,923.26,67,,738.608,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,218.88,80,,,fee schedule,80% of CMS fee schedule,1102.4,80,,881.92,percent of total billed charges,80% of total billed charges,895.7,65,,716.56,percent of total billed charges,65% of total billed charges,377.46,123,,,fee schedule,123% of ASC tier grouping rate,218.88,1240.2,
BLS HOSP/HOSPITAL NON ER,5400037,CDM,540,RC,A0428,HCPCS,outpatient,,,1378,551.20,QNHH,1171.3,85,,937.04,percent of total billed charges,85% of total billed charges,1061.06,77,,848.85,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,1129.96,82,,903.968,percent of total billed charges,82% of total billed charges,1171.3,85,,937.04,percent of total billed charges,85% of total billed charges,1171.3,85,,937.04,percent of total billed charges,85% of total billed charges,1171.3,85,,937.04,percent of total billed charges,85% of total billed charges,1240.2,90,,992.16,percent of total billed charges,90% of total billed charges,1102.4,80,,881.92,percent of total billed charges,80% of total billed charges,1240.2,90,,992.16,percent of total billed charges,90% of total billed charges,1033.5,75,,826.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,306.88,100,,,fee schedule,100% of ASC tier grouping rate,,,,,other ,not seperately reimbursable,923.26,67,,738.608,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,218.88,80,,,fee schedule,80% of CMS fee schedule,1102.4,80,,881.92,percent of total billed charges,80% of total billed charges,895.7,65,,716.56,percent of total billed charges,65% of total billed charges,377.46,123,,,fee schedule,123% of ASC tier grouping rate,218.88,1240.2,
BLS HOSPITAL/HOSPITAL NON ER,5400038,CDM,540,RC,A0428,HCPCS,outpatient,,,1378,551.20,HHQN,1171.3,85,,937.04,percent of total billed charges,85% of total billed charges,1061.06,77,,848.85,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,1129.96,82,,903.968,percent of total billed charges,82% of total billed charges,1171.3,85,,937.04,percent of total billed charges,85% of total billed charges,1171.3,85,,937.04,percent of total billed charges,85% of total billed charges,1171.3,85,,937.04,percent of total billed charges,85% of total billed charges,1240.2,90,,992.16,percent of total billed charges,90% of total billed charges,1102.4,80,,881.92,percent of total billed charges,80% of total billed charges,1240.2,90,,992.16,percent of total billed charges,90% of total billed charges,1033.5,75,,826.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,306.88,100,,,fee schedule,100% of ASC tier grouping rate,,,,,other ,not seperately reimbursable,923.26,67,,738.608,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,218.88,80,,,fee schedule,80% of CMS fee schedule,1102.4,80,,881.92,percent of total billed charges,80% of total billed charges,895.7,65,,716.56,percent of total billed charges,65% of total billed charges,377.46,123,,,fee schedule,123% of ASC tier grouping rate,218.88,1240.2,
BLS ACC SCENE/DR OFFICE NON ER,5400039,CDM,540,RC,A0428,HCPCS,outpatient,,,1353,541.20,QNSP,1150.05,85,,920.04,percent of total billed charges,85% of total billed charges,1041.81,77,,833.45,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,1109.46,82,,887.568,percent of total billed charges,82% of total billed charges,1150.05,85,,920.04,percent of total billed charges,85% of total billed charges,1150.05,85,,920.04,percent of total billed charges,85% of total billed charges,1150.05,85,,920.04,percent of total billed charges,85% of total billed charges,1217.7,90,,974.16,percent of total billed charges,90% of total billed charges,1082.4,80,,865.92,percent of total billed charges,80% of total billed charges,1217.7,90,,974.16,percent of total billed charges,90% of total billed charges,1014.75,75,,811.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,306.88,100,,,fee schedule,100% of ASC tier grouping rate,,,,,other ,not seperately reimbursable,906.51,67,,725.208,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,218.88,80,,,fee schedule,80% of CMS fee schedule,1082.4,80,,865.92,percent of total billed charges,80% of total billed charges,879.45,65,,703.56,percent of total billed charges,65% of total billed charges,377.46,123,,,fee schedule,123% of ASC tier grouping rate,218.88,1217.7,
ALS SNF/RESIDENCE NON ER,5400040,CDM,540,RC,A0426,HCPCS,outpatient,,,1690,676.00,NRQN,1436.5,85,,1149.2,percent of total billed charges,85% of total billed charges,1301.3,77,,1041.04,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,1385.8,82,,1108.64,percent of total billed charges,82% of total billed charges,1436.5,85,,1149.2,percent of total billed charges,85% of total billed charges,1436.5,85,,1149.2,percent of total billed charges,85% of total billed charges,1436.5,85,,1149.2,percent of total billed charges,85% of total billed charges,1521,90,,1216.8,percent of total billed charges,90% of total billed charges,1352,80,,1081.6,percent of total billed charges,80% of total billed charges,1521,90,,1216.8,percent of total billed charges,90% of total billed charges,1267.5,75,,1014,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,368.25,100,,,fee schedule,100% of ASC tier grouping rate,,,,,other ,not seperately reimbursable,1132.3,67,,905.84,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,262.66,80,,,fee schedule,80% of CMS fee schedule,1352,80,,1081.6,percent of total billed charges,80% of total billed charges,1098.5,65,,878.8,percent of total billed charges,65% of total billed charges,452.95,123,,,fee schedule,123% of ASC tier grouping rate,262.66,1521,
ALS RESIDENCE/NON SNF NON ER,5400042,CDM,540,RC,A0426,HCPCS,outpatient,,,1690,676.00,REQN,1436.5,85,,1149.2,percent of total billed charges,85% of total billed charges,1301.3,77,,1041.04,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,1385.8,82,,1108.64,percent of total billed charges,82% of total billed charges,1436.5,85,,1149.2,percent of total billed charges,85% of total billed charges,1436.5,85,,1149.2,percent of total billed charges,85% of total billed charges,1436.5,85,,1149.2,percent of total billed charges,85% of total billed charges,1521,90,,1216.8,percent of total billed charges,90% of total billed charges,1352,80,,1081.6,percent of total billed charges,80% of total billed charges,1521,90,,1216.8,percent of total billed charges,90% of total billed charges,1267.5,75,,1014,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,368.25,100,,,fee schedule,100% of ASC tier grouping rate,,,,,other ,not seperately reimbursable,1132.3,67,,905.84,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,262.66,80,,,fee schedule,80% of CMS fee schedule,1352,80,,1081.6,percent of total billed charges,80% of total billed charges,1098.5,65,,878.8,percent of total billed charges,65% of total billed charges,452.95,123,,,fee schedule,123% of ASC tier grouping rate,262.66,1521,
ALS RESIDENCE/DR OFFICE NON ER,5400043,CDM,540,RC,A0426,HCPCS,outpatient,,,1690,676.00,QNRP,1436.5,85,,1149.2,percent of total billed charges,85% of total billed charges,1301.3,77,,1041.04,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,1385.8,82,,1108.64,percent of total billed charges,82% of total billed charges,1436.5,85,,1149.2,percent of total billed charges,85% of total billed charges,1436.5,85,,1149.2,percent of total billed charges,85% of total billed charges,1436.5,85,,1149.2,percent of total billed charges,85% of total billed charges,1521,90,,1216.8,percent of total billed charges,90% of total billed charges,1352,80,,1081.6,percent of total billed charges,80% of total billed charges,1521,90,,1216.8,percent of total billed charges,90% of total billed charges,1267.5,75,,1014,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,368.25,100,,,fee schedule,100% of ASC tier grouping rate,,,,,other ,not seperately reimbursable,1132.3,67,,905.84,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,262.66,80,,,fee schedule,80% of CMS fee schedule,1352,80,,1081.6,percent of total billed charges,80% of total billed charges,1098.5,65,,878.8,percent of total billed charges,65% of total billed charges,452.95,123,,,fee schedule,123% of ASC tier grouping rate,262.66,1521,
ALS RESIDENCE/HOSPITAL NON ER,5400044,CDM,540,RC,A0428,HCPCS,outpatient,,,1723,689.20,RHQN,1464.55,85,,1171.64,percent of total billed charges,85% of total billed charges,1326.71,77,,1061.37,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,1412.86,82,,1130.288,percent of total billed charges,82% of total billed charges,1464.55,85,,1171.64,percent of total billed charges,85% of total billed charges,1464.55,85,,1171.64,percent of total billed charges,85% of total billed charges,1464.55,85,,1171.64,percent of total billed charges,85% of total billed charges,1550.7,90,,1240.56,percent of total billed charges,90% of total billed charges,1378.4,80,,1102.72,percent of total billed charges,80% of total billed charges,1550.7,90,,1240.56,percent of total billed charges,90% of total billed charges,1292.25,75,,1033.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,306.88,100,,,fee schedule,100% of ASC tier grouping rate,,,,,other ,not seperately reimbursable,1154.41,67,,923.528,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,218.88,80,,,fee schedule,80% of CMS fee schedule,1378.4,80,,1102.72,percent of total billed charges,80% of total billed charges,1119.95,65,,895.96,percent of total billed charges,65% of total billed charges,377.46,123,,,fee schedule,123% of ASC tier grouping rate,218.88,1550.7,
BLS OFFICE/OFFICE NON ER,5400045,CDM,540,RC,A0428,HCPCS,outpatient,,,1353,541.20,PPQN,1150.05,85,,920.04,percent of total billed charges,85% of total billed charges,1041.81,77,,833.45,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,1109.46,82,,887.568,percent of total billed charges,82% of total billed charges,1150.05,85,,920.04,percent of total billed charges,85% of total billed charges,1150.05,85,,920.04,percent of total billed charges,85% of total billed charges,1150.05,85,,920.04,percent of total billed charges,85% of total billed charges,1217.7,90,,974.16,percent of total billed charges,90% of total billed charges,1082.4,80,,865.92,percent of total billed charges,80% of total billed charges,1217.7,90,,974.16,percent of total billed charges,90% of total billed charges,1014.75,75,,811.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,306.88,100,,,fee schedule,100% of ASC tier grouping rate,,,,,other ,not seperately reimbursable,906.51,67,,725.208,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,218.88,80,,,fee schedule,80% of CMS fee schedule,1082.4,80,,865.92,percent of total billed charges,80% of total billed charges,879.45,65,,703.56,percent of total billed charges,65% of total billed charges,377.46,123,,,fee schedule,123% of ASC tier grouping rate,218.88,1217.7,
ALS OFFICE/HOSPITAL NON ER,5400046,CDM,540,RC,A0426,HCPCS,outpatient,,,1690,676.00,PHQN,1436.5,85,,1149.2,percent of total billed charges,85% of total billed charges,1301.3,77,,1041.04,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,1385.8,82,,1108.64,percent of total billed charges,82% of total billed charges,1436.5,85,,1149.2,percent of total billed charges,85% of total billed charges,1436.5,85,,1149.2,percent of total billed charges,85% of total billed charges,1436.5,85,,1149.2,percent of total billed charges,85% of total billed charges,1521,90,,1216.8,percent of total billed charges,90% of total billed charges,1352,80,,1081.6,percent of total billed charges,80% of total billed charges,1521,90,,1216.8,percent of total billed charges,90% of total billed charges,1267.5,75,,1014,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,368.25,100,,,fee schedule,100% of ASC tier grouping rate,,,,,other ,not seperately reimbursable,1132.3,67,,905.84,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,262.66,80,,,fee schedule,80% of CMS fee schedule,1352,80,,1081.6,percent of total billed charges,80% of total billed charges,1098.5,65,,878.8,percent of total billed charges,65% of total billed charges,452.95,123,,,fee schedule,123% of ASC tier grouping rate,262.66,1521,
ALS OFFICE/RESIDENCE NON ER,5400047,CDM,540,RC,A0426,HCPCS,outpatient,,,1690,676.00,QNPR,1436.5,85,,1149.2,percent of total billed charges,85% of total billed charges,1301.3,77,,1041.04,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,1385.8,82,,1108.64,percent of total billed charges,82% of total billed charges,1436.5,85,,1149.2,percent of total billed charges,85% of total billed charges,1436.5,85,,1149.2,percent of total billed charges,85% of total billed charges,1436.5,85,,1149.2,percent of total billed charges,85% of total billed charges,1521,90,,1216.8,percent of total billed charges,90% of total billed charges,1352,80,,1081.6,percent of total billed charges,80% of total billed charges,1521,90,,1216.8,percent of total billed charges,90% of total billed charges,1267.5,75,,1014,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,368.25,100,,,fee schedule,100% of ASC tier grouping rate,,,,,other ,not seperately reimbursable,1132.3,67,,905.84,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,262.66,80,,,fee schedule,80% of CMS fee schedule,1352,80,,1081.6,percent of total billed charges,80% of total billed charges,1098.5,65,,878.8,percent of total billed charges,65% of total billed charges,452.95,123,,,fee schedule,123% of ASC tier grouping rate,262.66,1521,
ALS SNF/HOSP NON ER,5400049,CDM,540,RC,A0426,HCPCS,outpatient,,,1723,689.20,QNNH,1464.55,85,,1171.64,percent of total billed charges,85% of total billed charges,1326.71,77,,1061.37,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,1412.86,82,,1130.288,percent of total billed charges,82% of total billed charges,1464.55,85,,1171.64,percent of total billed charges,85% of total billed charges,1464.55,85,,1171.64,percent of total billed charges,85% of total billed charges,1464.55,85,,1171.64,percent of total billed charges,85% of total billed charges,1550.7,90,,1240.56,percent of total billed charges,90% of total billed charges,1378.4,80,,1102.72,percent of total billed charges,80% of total billed charges,1550.7,90,,1240.56,percent of total billed charges,90% of total billed charges,1292.25,75,,1033.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,368.25,100,,,fee schedule,100% of ASC tier grouping rate,,,,,other ,not seperately reimbursable,1154.41,67,,923.528,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,262.66,80,,,fee schedule,80% of CMS fee schedule,1378.4,80,,1102.72,percent of total billed charges,80% of total billed charges,1119.95,65,,895.96,percent of total billed charges,65% of total billed charges,452.95,123,,,fee schedule,123% of ASC tier grouping rate,262.66,1550.7,
ALS OFFICE/SNF NON ER,5400055,CDM,540,RC,A0426,HCPCS,outpatient,,,1690,676.00,PNQN,1436.5,85,,1149.2,percent of total billed charges,85% of total billed charges,1301.3,77,,1041.04,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,1385.8,82,,1108.64,percent of total billed charges,82% of total billed charges,1436.5,85,,1149.2,percent of total billed charges,85% of total billed charges,1436.5,85,,1149.2,percent of total billed charges,85% of total billed charges,1436.5,85,,1149.2,percent of total billed charges,85% of total billed charges,1521,90,,1216.8,percent of total billed charges,90% of total billed charges,1352,80,,1081.6,percent of total billed charges,80% of total billed charges,1521,90,,1216.8,percent of total billed charges,90% of total billed charges,1267.5,75,,1014,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,368.25,100,,,fee schedule,100% of ASC tier grouping rate,,,,,other ,not seperately reimbursable,1132.3,67,,905.84,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,262.66,80,,,fee schedule,80% of CMS fee schedule,1352,80,,1081.6,percent of total billed charges,80% of total billed charges,1098.5,65,,878.8,percent of total billed charges,65% of total billed charges,452.95,123,,,fee schedule,123% of ASC tier grouping rate,262.66,1521,
ALS HOSP/SNF NON ER,5400056,CDM,540,RC,A0426,HCPCS,outpatient,,,1690,676.00,HNQN,1436.5,85,,1149.2,percent of total billed charges,85% of total billed charges,1301.3,77,,1041.04,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,1385.8,82,,1108.64,percent of total billed charges,82% of total billed charges,1436.5,85,,1149.2,percent of total billed charges,85% of total billed charges,1436.5,85,,1149.2,percent of total billed charges,85% of total billed charges,1436.5,85,,1149.2,percent of total billed charges,85% of total billed charges,1521,90,,1216.8,percent of total billed charges,90% of total billed charges,1352,80,,1081.6,percent of total billed charges,80% of total billed charges,1521,90,,1216.8,percent of total billed charges,90% of total billed charges,1267.5,75,,1014,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,368.25,100,,,fee schedule,100% of ASC tier grouping rate,,,,,other ,not seperately reimbursable,1132.3,67,,905.84,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,262.66,80,,,fee schedule,80% of CMS fee schedule,1352,80,,1081.6,percent of total billed charges,80% of total billed charges,1098.5,65,,878.8,percent of total billed charges,65% of total billed charges,452.95,123,,,fee schedule,123% of ASC tier grouping rate,262.66,1521,
ALS HOSPITAL/DR OFFICE NON ER,5400057,CDM,540,RC,A0426,HCPCS,outpatient,,,1690,676.00,HPQN,1436.5,85,,1149.2,percent of total billed charges,85% of total billed charges,1301.3,77,,1041.04,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,1385.8,82,,1108.64,percent of total billed charges,82% of total billed charges,1436.5,85,,1149.2,percent of total billed charges,85% of total billed charges,1436.5,85,,1149.2,percent of total billed charges,85% of total billed charges,1436.5,85,,1149.2,percent of total billed charges,85% of total billed charges,1521,90,,1216.8,percent of total billed charges,90% of total billed charges,1352,80,,1081.6,percent of total billed charges,80% of total billed charges,1521,90,,1216.8,percent of total billed charges,90% of total billed charges,1267.5,75,,1014,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,368.25,100,,,fee schedule,100% of ASC tier grouping rate,,,,,other ,not seperately reimbursable,1132.3,67,,905.84,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,262.66,80,,,fee schedule,80% of CMS fee schedule,1352,80,,1081.6,percent of total billed charges,80% of total billed charges,1098.5,65,,878.8,percent of total billed charges,65% of total billed charges,452.95,123,,,fee schedule,123% of ASC tier grouping rate,262.66,1521,
ALS HOSPITAL/RESIDENCE NON ER,5400058,CDM,540,RC,A0426,HCPCS,outpatient,,,1690,676.00,HRQN,1436.5,85,,1149.2,percent of total billed charges,85% of total billed charges,1301.3,77,,1041.04,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,1385.8,82,,1108.64,percent of total billed charges,82% of total billed charges,1436.5,85,,1149.2,percent of total billed charges,85% of total billed charges,1436.5,85,,1149.2,percent of total billed charges,85% of total billed charges,1436.5,85,,1149.2,percent of total billed charges,85% of total billed charges,1521,90,,1216.8,percent of total billed charges,90% of total billed charges,1352,80,,1081.6,percent of total billed charges,80% of total billed charges,1521,90,,1216.8,percent of total billed charges,90% of total billed charges,1267.5,75,,1014,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,368.25,100,,,fee schedule,100% of ASC tier grouping rate,,,,,other ,not seperately reimbursable,1132.3,67,,905.84,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,262.66,80,,,fee schedule,80% of CMS fee schedule,1352,80,,1081.6,percent of total billed charges,80% of total billed charges,1098.5,65,,878.8,percent of total billed charges,65% of total billed charges,452.95,123,,,fee schedule,123% of ASC tier grouping rate,262.66,1521,
ALS INPT DRG TRANSFER,5400059,CDM,540,RC,,,outpatient,,,1690,676.00,HHQN,1436.5,85,,1149.2,percent of total billed charges,85% of total billed charges,1301.3,77,,1041.04,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,1385.8,82,,1108.64,percent of total billed charges,82% of total billed charges,1436.5,85,,1149.2,percent of total billed charges,85% of total billed charges,1436.5,85,,1149.2,percent of total billed charges,85% of total billed charges,1436.5,85,,1149.2,percent of total billed charges,85% of total billed charges,1521,90,,1216.8,percent of total billed charges,90% of total billed charges,1352,80,,1081.6,percent of total billed charges,80% of total billed charges,1521,90,,1216.8,percent of total billed charges,90% of total billed charges,1267.5,75,,1014,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,490.1,29,,392.08,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1132.3,67,,905.84,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1352,80,,1081.6,percent of total billed charges,80% of total billed charges,1098.5,65,,878.8,percent of total billed charges,65% of total billed charges,602.82,35.67,,482.256,percent of total billed charges,35.67% of total billed charges,490.1,1521,
SERVICE REFUSED-CALL TO HOME,5400060,CDM,540,RC,,,outpatient,,,150,60.00,,127.5,85,,102,percent of total billed charges,85% of total billed charges,115.5,77,,92.4,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,123,82,,98.4,percent of total billed charges,82% of total billed charges,127.5,85,,102,percent of total billed charges,85% of total billed charges,127.5,85,,102,percent of total billed charges,85% of total billed charges,127.5,85,,102,percent of total billed charges,85% of total billed charges,135,90,,108,percent of total billed charges,90% of total billed charges,120,80,,96,percent of total billed charges,80% of total billed charges,135,90,,108,percent of total billed charges,90% of total billed charges,112.5,75,,90,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,43.5,29,,34.8,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,100.5,67,,80.4,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,120,80,,96,percent of total billed charges,80% of total billed charges,97.5,65,,78,percent of total billed charges,65% of total billed charges,53.51,35.67,,42.808,percent of total billed charges,35.67% of total billed charges,43.5,135,
ALS ACCIDENT/HOSPITAL NON ER,5400061,CDM,540,RC,A0426,HCPCS,outpatient,,,1690,676.00,SHQN,1436.5,85,,1149.2,percent of total billed charges,85% of total billed charges,1301.3,77,,1041.04,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,1385.8,82,,1108.64,percent of total billed charges,82% of total billed charges,1436.5,85,,1149.2,percent of total billed charges,85% of total billed charges,1436.5,85,,1149.2,percent of total billed charges,85% of total billed charges,1436.5,85,,1149.2,percent of total billed charges,85% of total billed charges,1521,90,,1216.8,percent of total billed charges,90% of total billed charges,1352,80,,1081.6,percent of total billed charges,80% of total billed charges,1521,90,,1216.8,percent of total billed charges,90% of total billed charges,1267.5,75,,1014,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,368.25,100,,,fee schedule,100% of ASC tier grouping rate,,,,,other ,not seperately reimbursable,1132.3,67,,905.84,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,262.66,80,,,fee schedule,80% of CMS fee schedule,1352,80,,1081.6,percent of total billed charges,80% of total billed charges,1098.5,65,,878.8,percent of total billed charges,65% of total billed charges,452.95,123,,,fee schedule,123% of ASC tier grouping rate,262.66,1521,
ALS HOSPITAL/HOSPITAL NON ER,5400062,CDM,540,RC,A0426,HCPCS,outpatient,,,1723,689.20,HHQN,1464.55,85,,1171.64,percent of total billed charges,85% of total billed charges,1326.71,77,,1061.37,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,1412.86,82,,1130.288,percent of total billed charges,82% of total billed charges,1464.55,85,,1171.64,percent of total billed charges,85% of total billed charges,1464.55,85,,1171.64,percent of total billed charges,85% of total billed charges,1464.55,85,,1171.64,percent of total billed charges,85% of total billed charges,1550.7,90,,1240.56,percent of total billed charges,90% of total billed charges,1378.4,80,,1102.72,percent of total billed charges,80% of total billed charges,1550.7,90,,1240.56,percent of total billed charges,90% of total billed charges,1292.25,75,,1033.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,368.25,100,,,fee schedule,100% of ASC tier grouping rate,,,,,other ,not seperately reimbursable,1154.41,67,,923.528,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,262.66,80,,,fee schedule,80% of CMS fee schedule,1378.4,80,,1102.72,percent of total billed charges,80% of total billed charges,1119.95,65,,895.96,percent of total billed charges,65% of total billed charges,452.95,123,,,fee schedule,123% of ASC tier grouping rate,262.66,1550.7,
ALS ACCIDENT/DR OFFICE NON ER,5400063,CDM,540,RC,A0426,HCPCS,outpatient,,,1690,676.00,SPQN,1436.5,85,,1149.2,percent of total billed charges,85% of total billed charges,1301.3,77,,1041.04,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,1385.8,82,,1108.64,percent of total billed charges,82% of total billed charges,1436.5,85,,1149.2,percent of total billed charges,85% of total billed charges,1436.5,85,,1149.2,percent of total billed charges,85% of total billed charges,1436.5,85,,1149.2,percent of total billed charges,85% of total billed charges,1521,90,,1216.8,percent of total billed charges,90% of total billed charges,1352,80,,1081.6,percent of total billed charges,80% of total billed charges,1521,90,,1216.8,percent of total billed charges,90% of total billed charges,1267.5,75,,1014,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,368.25,100,,,fee schedule,100% of ASC tier grouping rate,,,,,other ,not seperately reimbursable,1132.3,67,,905.84,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,262.66,80,,,fee schedule,80% of CMS fee schedule,1352,80,,1081.6,percent of total billed charges,80% of total billed charges,1098.5,65,,878.8,percent of total billed charges,65% of total billed charges,452.95,123,,,fee schedule,123% of ASC tier grouping rate,262.66,1521,
ALS OFFICE/DR OFFICE NON ER,5400064,CDM,540,RC,A0426,HCPCS,outpatient,,,1690,676.00,PPQN,1436.5,85,,1149.2,percent of total billed charges,85% of total billed charges,1301.3,77,,1041.04,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,1385.8,82,,1108.64,percent of total billed charges,82% of total billed charges,1436.5,85,,1149.2,percent of total billed charges,85% of total billed charges,1436.5,85,,1149.2,percent of total billed charges,85% of total billed charges,1436.5,85,,1149.2,percent of total billed charges,85% of total billed charges,1521,90,,1216.8,percent of total billed charges,90% of total billed charges,1352,80,,1081.6,percent of total billed charges,80% of total billed charges,1521,90,,1216.8,percent of total billed charges,90% of total billed charges,1267.5,75,,1014,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,368.25,100,,,fee schedule,100% of ASC tier grouping rate,,,,,other ,not seperately reimbursable,1132.3,67,,905.84,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,262.66,80,,,fee schedule,80% of CMS fee schedule,1352,80,,1081.6,percent of total billed charges,80% of total billed charges,1098.5,65,,878.8,percent of total billed charges,65% of total billed charges,452.95,123,,,fee schedule,123% of ASC tier grouping rate,262.66,1521,
BLS INPT DRG TRANSFER,5400065,CDM,540,RC,,,outpatient,,,1353,541.20,,1150.05,85,,920.04,percent of total billed charges,85% of total billed charges,1041.81,77,,833.45,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,1109.46,82,,887.568,percent of total billed charges,82% of total billed charges,1150.05,85,,920.04,percent of total billed charges,85% of total billed charges,1150.05,85,,920.04,percent of total billed charges,85% of total billed charges,1150.05,85,,920.04,percent of total billed charges,85% of total billed charges,1217.7,90,,974.16,percent of total billed charges,90% of total billed charges,1082.4,80,,865.92,percent of total billed charges,80% of total billed charges,1217.7,90,,974.16,percent of total billed charges,90% of total billed charges,1014.75,75,,811.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,392.37,29,,313.896,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,906.51,67,,725.208,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1082.4,80,,865.92,percent of total billed charges,80% of total billed charges,879.45,65,,703.56,percent of total billed charges,65% of total billed charges,482.62,35.67,,386.096,percent of total billed charges,35.67% of total billed charges,392.37,1217.7,
COURTESY TRANSPORT W/IN CITY,5400068,CDM,540,RC,,,outpatient,,,56,22.40,,47.6,85,,38.08,percent of total billed charges,85% of total billed charges,43.12,77,,34.5,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,45.92,82,,36.736,percent of total billed charges,82% of total billed charges,47.6,85,,38.08,percent of total billed charges,85% of total billed charges,47.6,85,,38.08,percent of total billed charges,85% of total billed charges,47.6,85,,38.08,percent of total billed charges,85% of total billed charges,50.4,90,,40.32,percent of total billed charges,90% of total billed charges,44.8,80,,35.84,percent of total billed charges,80% of total billed charges,50.4,90,,40.32,percent of total billed charges,90% of total billed charges,42,75,,33.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,16.24,29,,12.992,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,37.52,67,,30.016,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,44.8,80,,35.84,percent of total billed charges,80% of total billed charges,36.4,65,,29.12,percent of total billed charges,65% of total billed charges,19.98,35.67,,15.984,percent of total billed charges,35.67% of total billed charges,16.24,50.4,
COURTESTY TRANSPORT 30 MILE,5400069,CDM,540,RC,,,outpatient,,,84,33.60,,71.4,85,,57.12,percent of total billed charges,85% of total billed charges,64.68,77,,51.74,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,68.88,82,,55.104,percent of total billed charges,82% of total billed charges,71.4,85,,57.12,percent of total billed charges,85% of total billed charges,71.4,85,,57.12,percent of total billed charges,85% of total billed charges,71.4,85,,57.12,percent of total billed charges,85% of total billed charges,75.6,90,,60.48,percent of total billed charges,90% of total billed charges,67.2,80,,53.76,percent of total billed charges,80% of total billed charges,75.6,90,,60.48,percent of total billed charges,90% of total billed charges,63,75,,50.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,24.36,29,,19.488,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,56.28,67,,45.024,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,67.2,80,,53.76,percent of total billed charges,80% of total billed charges,54.6,65,,43.68,percent of total billed charges,65% of total billed charges,29.96,35.67,,23.968,percent of total billed charges,35.67% of total billed charges,24.36,75.6,
TREATMENT - NO TRANSPORT,5400070,CDM,540,RC,,,outpatient,,,297,118.80,,252.45,85,,201.96,percent of total billed charges,85% of total billed charges,228.69,77,,182.95,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,243.54,82,,194.832,percent of total billed charges,82% of total billed charges,252.45,85,,201.96,percent of total billed charges,85% of total billed charges,252.45,85,,201.96,percent of total billed charges,85% of total billed charges,252.45,85,,201.96,percent of total billed charges,85% of total billed charges,267.3,90,,213.84,percent of total billed charges,90% of total billed charges,237.6,80,,190.08,percent of total billed charges,80% of total billed charges,267.3,90,,213.84,percent of total billed charges,90% of total billed charges,222.75,75,,178.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,86.13,29,,68.904,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,198.99,67,,159.192,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,237.6,80,,190.08,percent of total billed charges,80% of total billed charges,193.05,65,,154.44,percent of total billed charges,65% of total billed charges,105.94,35.67,,84.752,percent of total billed charges,35.67% of total billed charges,86.13,267.3,
ALS HOSPITAL/NON SNF NON ER,5400071,CDM,540,RC,A0426,HCPCS,outpatient,,,1690,676.00,HEQN,1436.5,85,,1149.2,percent of total billed charges,85% of total billed charges,1301.3,77,,1041.04,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,1385.8,82,,1108.64,percent of total billed charges,82% of total billed charges,1436.5,85,,1149.2,percent of total billed charges,85% of total billed charges,1436.5,85,,1149.2,percent of total billed charges,85% of total billed charges,1436.5,85,,1149.2,percent of total billed charges,85% of total billed charges,1521,90,,1216.8,percent of total billed charges,90% of total billed charges,1352,80,,1081.6,percent of total billed charges,80% of total billed charges,1521,90,,1216.8,percent of total billed charges,90% of total billed charges,1267.5,75,,1014,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,368.25,100,,,fee schedule,100% of ASC tier grouping rate,,,,,other ,not seperately reimbursable,1132.3,67,,905.84,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,262.66,80,,,fee schedule,80% of CMS fee schedule,1352,80,,1081.6,percent of total billed charges,80% of total billed charges,1098.5,65,,878.8,percent of total billed charges,65% of total billed charges,452.95,123,,,fee schedule,123% of ASC tier grouping rate,262.66,1521,
EMS RODEO STANDBY,5400072,CDM,540,RC,,,outpatient,,,154,61.60,,130.9,85,,104.72,percent of total billed charges,85% of total billed charges,118.58,77,,94.86,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,126.28,82,,101.024,percent of total billed charges,82% of total billed charges,130.9,85,,104.72,percent of total billed charges,85% of total billed charges,130.9,85,,104.72,percent of total billed charges,85% of total billed charges,130.9,85,,104.72,percent of total billed charges,85% of total billed charges,138.6,90,,110.88,percent of total billed charges,90% of total billed charges,123.2,80,,98.56,percent of total billed charges,80% of total billed charges,138.6,90,,110.88,percent of total billed charges,90% of total billed charges,115.5,75,,92.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,44.66,29,,35.728,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,103.18,67,,82.544,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,123.2,80,,98.56,percent of total billed charges,80% of total billed charges,100.1,65,,80.08,percent of total billed charges,65% of total billed charges,54.93,35.67,,43.944,percent of total billed charges,35.67% of total billed charges,44.66,138.6,
EMS STANDBY - OILFIELD,5400073,CDM,540,RC,,,outpatient,,,97,38.80,,82.45,85,,65.96,percent of total billed charges,85% of total billed charges,74.69,77,,59.75,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,79.54,82,,63.632,percent of total billed charges,82% of total billed charges,82.45,85,,65.96,percent of total billed charges,85% of total billed charges,82.45,85,,65.96,percent of total billed charges,85% of total billed charges,82.45,85,,65.96,percent of total billed charges,85% of total billed charges,87.3,90,,69.84,percent of total billed charges,90% of total billed charges,77.6,80,,62.08,percent of total billed charges,80% of total billed charges,87.3,90,,69.84,percent of total billed charges,90% of total billed charges,72.75,75,,58.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,28.13,29,,22.504,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,64.99,67,,51.992,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,77.6,80,,62.08,percent of total billed charges,80% of total billed charges,63.05,65,,50.44,percent of total billed charges,65% of total billed charges,34.6,35.67,,27.68,percent of total billed charges,35.67% of total billed charges,28.13,87.3,
BLS RESIDENCE/HOSPITAL ER,5400080,CDM,540,RC,A0429,HCPCS,outpatient,,,1378,551.20,RHQN,1171.3,85,,937.04,percent of total billed charges,85% of total billed charges,1061.06,77,,848.85,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,1129.96,82,,903.968,percent of total billed charges,82% of total billed charges,1171.3,85,,937.04,percent of total billed charges,85% of total billed charges,1171.3,85,,937.04,percent of total billed charges,85% of total billed charges,1171.3,85,,937.04,percent of total billed charges,85% of total billed charges,1240.2,90,,992.16,percent of total billed charges,90% of total billed charges,1102.4,80,,881.92,percent of total billed charges,80% of total billed charges,1240.2,90,,992.16,percent of total billed charges,90% of total billed charges,1033.5,75,,826.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,491,100,,,fee schedule,100% of ASC tier grouping rate,,,,,other ,not seperately reimbursable,923.26,67,,738.608,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,350.21,80,,,fee schedule,80% of CMS fee schedule,1102.4,80,,881.92,percent of total billed charges,80% of total billed charges,895.7,65,,716.56,percent of total billed charges,65% of total billed charges,603.93,123,,,fee schedule,123% of ASC tier grouping rate,350.21,1240.2,
BLS OFFICE/HOSPITAL ER,5400082,CDM,540,RC,A0429,HCPCS,outpatient,,,1353,541.20,PHQN,1150.05,85,,920.04,percent of total billed charges,85% of total billed charges,1041.81,77,,833.45,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,1109.46,82,,887.568,percent of total billed charges,82% of total billed charges,1150.05,85,,920.04,percent of total billed charges,85% of total billed charges,1150.05,85,,920.04,percent of total billed charges,85% of total billed charges,1150.05,85,,920.04,percent of total billed charges,85% of total billed charges,1217.7,90,,974.16,percent of total billed charges,90% of total billed charges,1082.4,80,,865.92,percent of total billed charges,80% of total billed charges,1217.7,90,,974.16,percent of total billed charges,90% of total billed charges,1014.75,75,,811.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,491,100,,,fee schedule,100% of ASC tier grouping rate,,,,,other ,not seperately reimbursable,906.51,67,,725.208,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,350.21,80,,,fee schedule,80% of CMS fee schedule,1082.4,80,,865.92,percent of total billed charges,80% of total billed charges,879.45,65,,703.56,percent of total billed charges,65% of total billed charges,603.93,123,,,fee schedule,123% of ASC tier grouping rate,350.21,1217.7,
BLS HOSPITAL/DIALYSIS NON ER,5400083,CDM,540,RC,A0428,HCPCS,outpatient,,,1353,541.20,HJQN,1150.05,85,,920.04,percent of total billed charges,85% of total billed charges,1041.81,77,,833.45,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,1109.46,82,,887.568,percent of total billed charges,82% of total billed charges,1150.05,85,,920.04,percent of total billed charges,85% of total billed charges,1150.05,85,,920.04,percent of total billed charges,85% of total billed charges,1150.05,85,,920.04,percent of total billed charges,85% of total billed charges,1217.7,90,,974.16,percent of total billed charges,90% of total billed charges,1082.4,80,,865.92,percent of total billed charges,80% of total billed charges,1217.7,90,,974.16,percent of total billed charges,90% of total billed charges,1014.75,75,,811.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,306.88,100,,,fee schedule,100% of ASC tier grouping rate,,,,,other ,not seperately reimbursable,906.51,67,,725.208,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,218.88,80,,,fee schedule,80% of CMS fee schedule,1082.4,80,,865.92,percent of total billed charges,80% of total billed charges,879.45,65,,703.56,percent of total billed charges,65% of total billed charges,377.46,123,,,fee schedule,123% of ASC tier grouping rate,218.88,1217.7,
BLS SNF/HOSPITAL ER,5400085,CDM,540,RC,A0429,HCPCS,outpatient,,,1378,551.20,NHQN,1171.3,85,,937.04,percent of total billed charges,85% of total billed charges,1061.06,77,,848.85,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,1129.96,82,,903.968,percent of total billed charges,82% of total billed charges,1171.3,85,,937.04,percent of total billed charges,85% of total billed charges,1171.3,85,,937.04,percent of total billed charges,85% of total billed charges,1171.3,85,,937.04,percent of total billed charges,85% of total billed charges,1240.2,90,,992.16,percent of total billed charges,90% of total billed charges,1102.4,80,,881.92,percent of total billed charges,80% of total billed charges,1240.2,90,,992.16,percent of total billed charges,90% of total billed charges,1033.5,75,,826.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,491,100,,,fee schedule,100% of ASC tier grouping rate,,,,,other ,not seperately reimbursable,923.26,67,,738.608,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,350.21,80,,,fee schedule,80% of CMS fee schedule,1102.4,80,,881.92,percent of total billed charges,80% of total billed charges,895.7,65,,716.56,percent of total billed charges,65% of total billed charges,603.93,123,,,fee schedule,123% of ASC tier grouping rate,350.21,1240.2,
BLS ACCIDENT/HOSP ER,5400087,CDM,540,RC,A0429,HCPCS,outpatient,,,1378,551.20,SHQN,1171.3,85,,937.04,percent of total billed charges,85% of total billed charges,1061.06,77,,848.85,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,1129.96,82,,903.968,percent of total billed charges,82% of total billed charges,1171.3,85,,937.04,percent of total billed charges,85% of total billed charges,1171.3,85,,937.04,percent of total billed charges,85% of total billed charges,1171.3,85,,937.04,percent of total billed charges,85% of total billed charges,1240.2,90,,992.16,percent of total billed charges,90% of total billed charges,1102.4,80,,881.92,percent of total billed charges,80% of total billed charges,1240.2,90,,992.16,percent of total billed charges,90% of total billed charges,1033.5,75,,826.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,491,100,,,fee schedule,100% of ASC tier grouping rate,,,,,other ,not seperately reimbursable,923.26,67,,738.608,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,350.21,80,,,fee schedule,80% of CMS fee schedule,1102.4,80,,881.92,percent of total billed charges,80% of total billed charges,895.7,65,,716.56,percent of total billed charges,65% of total billed charges,603.93,123,,,fee schedule,123% of ASC tier grouping rate,350.21,1240.2,
BLS HOSPITAL/HOSPITAL ER,5400088,CDM,540,RC,A0429,HCPCS,outpatient,,,1378,551.20,HHQN,1171.3,85,,937.04,percent of total billed charges,85% of total billed charges,1061.06,77,,848.85,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,1129.96,82,,903.968,percent of total billed charges,82% of total billed charges,1171.3,85,,937.04,percent of total billed charges,85% of total billed charges,1171.3,85,,937.04,percent of total billed charges,85% of total billed charges,1171.3,85,,937.04,percent of total billed charges,85% of total billed charges,1240.2,90,,992.16,percent of total billed charges,90% of total billed charges,1102.4,80,,881.92,percent of total billed charges,80% of total billed charges,1240.2,90,,992.16,percent of total billed charges,90% of total billed charges,1033.5,75,,826.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,491,100,,,fee schedule,100% of ASC tier grouping rate,,,,,other ,not seperately reimbursable,923.26,67,,738.608,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,350.21,80,,,fee schedule,80% of CMS fee schedule,1102.4,80,,881.92,percent of total billed charges,80% of total billed charges,895.7,65,,716.56,percent of total billed charges,65% of total billed charges,603.93,123,,,fee schedule,123% of ASC tier grouping rate,350.21,1240.2,
ALS RESIDENCE/HOSPITAL ER,5400094,CDM,540,RC,A0427,HCPCS,outpatient,,,1723,689.20,RHQN,1464.55,85,,1171.64,percent of total billed charges,85% of total billed charges,1326.71,77,,1061.37,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,1412.86,82,,1130.288,percent of total billed charges,82% of total billed charges,1464.55,85,,1171.64,percent of total billed charges,85% of total billed charges,1464.55,85,,1171.64,percent of total billed charges,85% of total billed charges,1464.55,85,,1171.64,percent of total billed charges,85% of total billed charges,1550.7,90,,1240.56,percent of total billed charges,90% of total billed charges,1378.4,80,,1102.72,percent of total billed charges,80% of total billed charges,1550.7,90,,1240.56,percent of total billed charges,90% of total billed charges,1292.25,75,,1033.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,583.06,100,,,fee schedule,100% of ASC tier grouping rate,,,,,other ,not seperately reimbursable,1154.41,67,,923.528,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,415.87,80,,,fee schedule,80% of CMS fee schedule,1378.4,80,,1102.72,percent of total billed charges,80% of total billed charges,1119.95,65,,895.96,percent of total billed charges,65% of total billed charges,717.16,123,,,fee schedule,123% of ASC tier grouping rate,415.87,1550.7,
ALS OFFICE/HOSP ER,5400096,CDM,540,RC,A0427,HCPCS,outpatient,,,1723,689.20,PHQN,1464.55,85,,1171.64,percent of total billed charges,85% of total billed charges,1326.71,77,,1061.37,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,1412.86,82,,1130.288,percent of total billed charges,82% of total billed charges,1464.55,85,,1171.64,percent of total billed charges,85% of total billed charges,1464.55,85,,1171.64,percent of total billed charges,85% of total billed charges,1464.55,85,,1171.64,percent of total billed charges,85% of total billed charges,1550.7,90,,1240.56,percent of total billed charges,90% of total billed charges,1378.4,80,,1102.72,percent of total billed charges,80% of total billed charges,1550.7,90,,1240.56,percent of total billed charges,90% of total billed charges,1292.25,75,,1033.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,583.06,100,,,fee schedule,100% of ASC tier grouping rate,,,,,other ,not seperately reimbursable,1154.41,67,,923.528,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,415.87,80,,,fee schedule,80% of CMS fee schedule,1378.4,80,,1102.72,percent of total billed charges,80% of total billed charges,1119.95,65,,895.96,percent of total billed charges,65% of total billed charges,717.16,123,,,fee schedule,123% of ASC tier grouping rate,415.87,1550.7,
ALS ACCIDENT/HOSPITAL ER,5400097,CDM,540,RC,A0427,HCPCS,outpatient,,,1723,689.20,SHQN,1464.55,85,,1171.64,percent of total billed charges,85% of total billed charges,1326.71,77,,1061.37,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,1412.86,82,,1130.288,percent of total billed charges,82% of total billed charges,1464.55,85,,1171.64,percent of total billed charges,85% of total billed charges,1464.55,85,,1171.64,percent of total billed charges,85% of total billed charges,1464.55,85,,1171.64,percent of total billed charges,85% of total billed charges,1550.7,90,,1240.56,percent of total billed charges,90% of total billed charges,1378.4,80,,1102.72,percent of total billed charges,80% of total billed charges,1550.7,90,,1240.56,percent of total billed charges,90% of total billed charges,1292.25,75,,1033.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,583.06,100,,,fee schedule,100% of ASC tier grouping rate,,,,,other ,not seperately reimbursable,1154.41,67,,923.528,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,415.87,80,,,fee schedule,80% of CMS fee schedule,1378.4,80,,1102.72,percent of total billed charges,80% of total billed charges,1119.95,65,,895.96,percent of total billed charges,65% of total billed charges,717.16,123,,,fee schedule,123% of ASC tier grouping rate,415.87,1550.7,
ALS SNF/HOSPITAL ER,5400099,CDM,540,RC,A0427,HCPCS,outpatient,,,1723,689.20,NHQN,1464.55,85,,1171.64,percent of total billed charges,85% of total billed charges,1326.71,77,,1061.37,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,1412.86,82,,1130.288,percent of total billed charges,82% of total billed charges,1464.55,85,,1171.64,percent of total billed charges,85% of total billed charges,1464.55,85,,1171.64,percent of total billed charges,85% of total billed charges,1464.55,85,,1171.64,percent of total billed charges,85% of total billed charges,1550.7,90,,1240.56,percent of total billed charges,90% of total billed charges,1378.4,80,,1102.72,percent of total billed charges,80% of total billed charges,1550.7,90,,1240.56,percent of total billed charges,90% of total billed charges,1292.25,75,,1033.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,583.06,100,,,fee schedule,100% of ASC tier grouping rate,,,,,other ,not seperately reimbursable,1154.41,67,,923.528,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,415.87,80,,,fee schedule,80% of CMS fee schedule,1378.4,80,,1102.72,percent of total billed charges,80% of total billed charges,1119.95,65,,895.96,percent of total billed charges,65% of total billed charges,717.16,123,,,fee schedule,123% of ASC tier grouping rate,415.87,1550.7,
ALS HOSPITAL/HOSPITAL ER,5400100,CDM,540,RC,A0427,HCPCS,outpatient,,,1723,689.20,HHQN,1464.55,85,,1171.64,percent of total billed charges,85% of total billed charges,1326.71,77,,1061.37,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,1412.86,82,,1130.288,percent of total billed charges,82% of total billed charges,1464.55,85,,1171.64,percent of total billed charges,85% of total billed charges,1464.55,85,,1171.64,percent of total billed charges,85% of total billed charges,1464.55,85,,1171.64,percent of total billed charges,85% of total billed charges,1550.7,90,,1240.56,percent of total billed charges,90% of total billed charges,1378.4,80,,1102.72,percent of total billed charges,80% of total billed charges,1550.7,90,,1240.56,percent of total billed charges,90% of total billed charges,1292.25,75,,1033.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,583.06,100,,,fee schedule,100% of ASC tier grouping rate,,,,,other ,not seperately reimbursable,1154.41,67,,923.528,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,415.87,80,,,fee schedule,80% of CMS fee schedule,1378.4,80,,1102.72,percent of total billed charges,80% of total billed charges,1119.95,65,,895.96,percent of total billed charges,65% of total billed charges,717.16,123,,,fee schedule,123% of ASC tier grouping rate,415.87,1550.7,
ALS TREATMENT NO TRANSPORT ER,5400101,CDM,540,RC,A0998,HCPCS,outpatient,,,593,237.20,,504.05,85,,403.24,percent of total billed charges,85% of total billed charges,456.61,77,,365.29,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,486.26,82,,389.008,percent of total billed charges,82% of total billed charges,504.05,85,,403.24,percent of total billed charges,85% of total billed charges,504.05,85,,403.24,percent of total billed charges,85% of total billed charges,504.05,85,,403.24,percent of total billed charges,85% of total billed charges,533.7,90,,426.96,percent of total billed charges,90% of total billed charges,474.4,80,,379.52,percent of total billed charges,80% of total billed charges,533.7,90,,426.96,percent of total billed charges,90% of total billed charges,444.75,75,,355.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,171.97,29,,137.576,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,397.31,67,,317.848,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,474.4,80,,379.52,percent of total billed charges,80% of total billed charges,385.45,65,,308.36,percent of total billed charges,65% of total billed charges,211.52,35.67,,169.216,percent of total billed charges,35.67% of total billed charges,171.97,533.7,
ALS SCENE/SITE OF TSF ER,5400102,CDM,540,RC,A0427,HCPCS,outpatient,,,1690,676.00,SIQN,1436.5,85,,1149.2,percent of total billed charges,85% of total billed charges,1301.3,77,,1041.04,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,1385.8,82,,1108.64,percent of total billed charges,82% of total billed charges,1436.5,85,,1149.2,percent of total billed charges,85% of total billed charges,1436.5,85,,1149.2,percent of total billed charges,85% of total billed charges,1436.5,85,,1149.2,percent of total billed charges,85% of total billed charges,1521,90,,1216.8,percent of total billed charges,90% of total billed charges,1352,80,,1081.6,percent of total billed charges,80% of total billed charges,1521,90,,1216.8,percent of total billed charges,90% of total billed charges,1267.5,75,,1014,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,583.06,100,,,fee schedule,100% of ASC tier grouping rate,,,,,other ,not seperately reimbursable,1132.3,67,,905.84,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,415.87,80,,,fee schedule,80% of CMS fee schedule,1352,80,,1081.6,percent of total billed charges,80% of total billed charges,1098.5,65,,878.8,percent of total billed charges,65% of total billed charges,717.16,123,,,fee schedule,123% of ASC tier grouping rate,415.87,1521,
BLS SCENE/HOSPITAL NON ER,5400103,CDM,540,RC,A0428,HCPCS,outpatient,,,1378,551.20,SHQN,1171.3,85,,937.04,percent of total billed charges,85% of total billed charges,1061.06,77,,848.85,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,1129.96,82,,903.968,percent of total billed charges,82% of total billed charges,1171.3,85,,937.04,percent of total billed charges,85% of total billed charges,1171.3,85,,937.04,percent of total billed charges,85% of total billed charges,1171.3,85,,937.04,percent of total billed charges,85% of total billed charges,1240.2,90,,992.16,percent of total billed charges,90% of total billed charges,1102.4,80,,881.92,percent of total billed charges,80% of total billed charges,1240.2,90,,992.16,percent of total billed charges,90% of total billed charges,1033.5,75,,826.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,306.88,100,,,fee schedule,100% of ASC tier grouping rate,,,,,other ,not seperately reimbursable,923.26,67,,738.608,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,218.88,80,,,fee schedule,80% of CMS fee schedule,1102.4,80,,881.92,percent of total billed charges,80% of total billed charges,895.7,65,,716.56,percent of total billed charges,65% of total billed charges,377.46,123,,,fee schedule,123% of ASC tier grouping rate,218.88,1240.2,
BLS RESIDENCE/DIALYSIS NON ER,5400104,CDM,540,RC,A0428,HCPCS,outpatient,,,1353,541.20,RJQN,1150.05,85,,920.04,percent of total billed charges,85% of total billed charges,1041.81,77,,833.45,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,1109.46,82,,887.568,percent of total billed charges,82% of total billed charges,1150.05,85,,920.04,percent of total billed charges,85% of total billed charges,1150.05,85,,920.04,percent of total billed charges,85% of total billed charges,1150.05,85,,920.04,percent of total billed charges,85% of total billed charges,1217.7,90,,974.16,percent of total billed charges,90% of total billed charges,1082.4,80,,865.92,percent of total billed charges,80% of total billed charges,1217.7,90,,974.16,percent of total billed charges,90% of total billed charges,1014.75,75,,811.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,306.88,100,,,fee schedule,100% of ASC tier grouping rate,,,,,other ,not seperately reimbursable,906.51,67,,725.208,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,218.88,80,,,fee schedule,80% of CMS fee schedule,1082.4,80,,865.92,percent of total billed charges,80% of total billed charges,879.45,65,,703.56,percent of total billed charges,65% of total billed charges,377.46,123,,,fee schedule,123% of ASC tier grouping rate,218.88,1217.7,
BLS DIALYSIS/RESIDENCE NON ER,5400105,CDM,540,RC,A0428,HCPCS,outpatient,,,1353,541.20,JRQN,1150.05,85,,920.04,percent of total billed charges,85% of total billed charges,1041.81,77,,833.45,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,1109.46,82,,887.568,percent of total billed charges,82% of total billed charges,1150.05,85,,920.04,percent of total billed charges,85% of total billed charges,1150.05,85,,920.04,percent of total billed charges,85% of total billed charges,1150.05,85,,920.04,percent of total billed charges,85% of total billed charges,1217.7,90,,974.16,percent of total billed charges,90% of total billed charges,1082.4,80,,865.92,percent of total billed charges,80% of total billed charges,1217.7,90,,974.16,percent of total billed charges,90% of total billed charges,1014.75,75,,811.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,306.88,100,,,fee schedule,100% of ASC tier grouping rate,,,,,other ,not seperately reimbursable,906.51,67,,725.208,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,218.88,80,,,fee schedule,80% of CMS fee schedule,1082.4,80,,865.92,percent of total billed charges,80% of total billed charges,879.45,65,,703.56,percent of total billed charges,65% of total billed charges,377.46,123,,,fee schedule,123% of ASC tier grouping rate,218.88,1217.7,
BLS SNF/DIALYSIS NON ER,5400106,CDM,540,RC,A0428,HCPCS,outpatient,,,1353,541.20,NJQN,1150.05,85,,920.04,percent of total billed charges,85% of total billed charges,1041.81,77,,833.45,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,1109.46,82,,887.568,percent of total billed charges,82% of total billed charges,1150.05,85,,920.04,percent of total billed charges,85% of total billed charges,1150.05,85,,920.04,percent of total billed charges,85% of total billed charges,1150.05,85,,920.04,percent of total billed charges,85% of total billed charges,1217.7,90,,974.16,percent of total billed charges,90% of total billed charges,1082.4,80,,865.92,percent of total billed charges,80% of total billed charges,1217.7,90,,974.16,percent of total billed charges,90% of total billed charges,1014.75,75,,811.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,306.88,100,,,fee schedule,100% of ASC tier grouping rate,,,,,other ,not seperately reimbursable,906.51,67,,725.208,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,218.88,80,,,fee schedule,80% of CMS fee schedule,1082.4,80,,865.92,percent of total billed charges,80% of total billed charges,879.45,65,,703.56,percent of total billed charges,65% of total billed charges,377.46,123,,,fee schedule,123% of ASC tier grouping rate,218.88,1217.7,
BLS DIALYSIS/SNF NON ER,5400107,CDM,540,RC,A0428,HCPCS,outpatient,,,1353,541.20,JNQN,1150.05,85,,920.04,percent of total billed charges,85% of total billed charges,1041.81,77,,833.45,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,1109.46,82,,887.568,percent of total billed charges,82% of total billed charges,1150.05,85,,920.04,percent of total billed charges,85% of total billed charges,1150.05,85,,920.04,percent of total billed charges,85% of total billed charges,1150.05,85,,920.04,percent of total billed charges,85% of total billed charges,1217.7,90,,974.16,percent of total billed charges,90% of total billed charges,1082.4,80,,865.92,percent of total billed charges,80% of total billed charges,1217.7,90,,974.16,percent of total billed charges,90% of total billed charges,1014.75,75,,811.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,306.88,100,,,fee schedule,100% of ASC tier grouping rate,,,,,other ,not seperately reimbursable,906.51,67,,725.208,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,218.88,80,,,fee schedule,80% of CMS fee schedule,1082.4,80,,865.92,percent of total billed charges,80% of total billed charges,879.45,65,,703.56,percent of total billed charges,65% of total billed charges,377.46,123,,,fee schedule,123% of ASC tier grouping rate,218.88,1217.7,
ALS NON SNF/HOSPITAL ER,5400108,CDM,540,RC,A0427,HCPCS,outpatient,,,1723,689.20,EHQN,1464.55,85,,1171.64,percent of total billed charges,85% of total billed charges,1326.71,77,,1061.37,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,1412.86,82,,1130.288,percent of total billed charges,82% of total billed charges,1464.55,85,,1171.64,percent of total billed charges,85% of total billed charges,1464.55,85,,1171.64,percent of total billed charges,85% of total billed charges,1464.55,85,,1171.64,percent of total billed charges,85% of total billed charges,1550.7,90,,1240.56,percent of total billed charges,90% of total billed charges,1378.4,80,,1102.72,percent of total billed charges,80% of total billed charges,1550.7,90,,1240.56,percent of total billed charges,90% of total billed charges,1292.25,75,,1033.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,583.06,100,,,fee schedule,100% of ASC tier grouping rate,,,,,other ,not seperately reimbursable,1154.41,67,,923.528,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,415.87,80,,,fee schedule,80% of CMS fee schedule,1378.4,80,,1102.72,percent of total billed charges,80% of total billed charges,1119.95,65,,895.96,percent of total billed charges,65% of total billed charges,717.16,123,,,fee schedule,123% of ASC tier grouping rate,415.87,1550.7,
BLS NON-SNF/HOSP ER,5400109,CDM,540,RC,A0429,HCPCS,outpatient,,,1378,551.20,EHQN,1171.3,85,,937.04,percent of total billed charges,85% of total billed charges,1061.06,77,,848.85,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,1129.96,82,,903.968,percent of total billed charges,82% of total billed charges,1171.3,85,,937.04,percent of total billed charges,85% of total billed charges,1171.3,85,,937.04,percent of total billed charges,85% of total billed charges,1171.3,85,,937.04,percent of total billed charges,85% of total billed charges,1240.2,90,,992.16,percent of total billed charges,90% of total billed charges,1102.4,80,,881.92,percent of total billed charges,80% of total billed charges,1240.2,90,,992.16,percent of total billed charges,90% of total billed charges,1033.5,75,,826.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,491,100,,,fee schedule,100% of ASC tier grouping rate,,,,,other ,not seperately reimbursable,923.26,67,,738.608,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,350.21,80,,,fee schedule,80% of CMS fee schedule,1102.4,80,,881.92,percent of total billed charges,80% of total billed charges,895.7,65,,716.56,percent of total billed charges,65% of total billed charges,603.93,123,,,fee schedule,123% of ASC tier grouping rate,350.21,1240.2,
BLS HOSP/NON SNF NON ER,5400110,CDM,540,RC,A0428,HCPCS,outpatient,,,1378,551.20,HEQN,1171.3,85,,937.04,percent of total billed charges,85% of total billed charges,1061.06,77,,848.85,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,1129.96,82,,903.968,percent of total billed charges,82% of total billed charges,1171.3,85,,937.04,percent of total billed charges,85% of total billed charges,1171.3,85,,937.04,percent of total billed charges,85% of total billed charges,1171.3,85,,937.04,percent of total billed charges,85% of total billed charges,1240.2,90,,992.16,percent of total billed charges,90% of total billed charges,1102.4,80,,881.92,percent of total billed charges,80% of total billed charges,1240.2,90,,992.16,percent of total billed charges,90% of total billed charges,1033.5,75,,826.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,306.88,100,,,fee schedule,100% of ASC tier grouping rate,,,,,other ,not seperately reimbursable,923.26,67,,738.608,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,218.88,80,,,fee schedule,80% of CMS fee schedule,1102.4,80,,881.92,percent of total billed charges,80% of total billed charges,895.7,65,,716.56,percent of total billed charges,65% of total billed charges,377.46,123,,,fee schedule,123% of ASC tier grouping rate,218.88,1240.2,
BLS HOSP/THERAPEUTIC NON ER,5400111,CDM,540,RC,A0428,HCPCS,outpatient,,,1353,541.20,HDQN,1150.05,85,,920.04,percent of total billed charges,85% of total billed charges,1041.81,77,,833.45,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,1109.46,82,,887.568,percent of total billed charges,82% of total billed charges,1150.05,85,,920.04,percent of total billed charges,85% of total billed charges,1150.05,85,,920.04,percent of total billed charges,85% of total billed charges,1150.05,85,,920.04,percent of total billed charges,85% of total billed charges,1217.7,90,,974.16,percent of total billed charges,90% of total billed charges,1082.4,80,,865.92,percent of total billed charges,80% of total billed charges,1217.7,90,,974.16,percent of total billed charges,90% of total billed charges,1014.75,75,,811.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,306.88,100,,,fee schedule,100% of ASC tier grouping rate,,,,,other ,not seperately reimbursable,906.51,67,,725.208,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,218.88,80,,,fee schedule,80% of CMS fee schedule,1082.4,80,,865.92,percent of total billed charges,80% of total billed charges,879.45,65,,703.56,percent of total billed charges,65% of total billed charges,377.46,123,,,fee schedule,123% of ASC tier grouping rate,218.88,1217.7,
ALS SCENE(HELICOPTER T0 ER),5400112,CDM,540,RC,A0427,HCPCS,outpatient,,,1723,689.20,SIQN,1464.55,85,,1171.64,percent of total billed charges,85% of total billed charges,1326.71,77,,1061.37,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,1412.86,82,,1130.288,percent of total billed charges,82% of total billed charges,1464.55,85,,1171.64,percent of total billed charges,85% of total billed charges,1464.55,85,,1171.64,percent of total billed charges,85% of total billed charges,1464.55,85,,1171.64,percent of total billed charges,85% of total billed charges,1550.7,90,,1240.56,percent of total billed charges,90% of total billed charges,1378.4,80,,1102.72,percent of total billed charges,80% of total billed charges,1550.7,90,,1240.56,percent of total billed charges,90% of total billed charges,1292.25,75,,1033.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,583.06,100,,,fee schedule,100% of ASC tier grouping rate,,,,,other ,not seperately reimbursable,1154.41,67,,923.528,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,415.87,80,,,fee schedule,80% of CMS fee schedule,1378.4,80,,1102.72,percent of total billed charges,80% of total billed charges,1119.95,65,,895.96,percent of total billed charges,65% of total billed charges,717.16,123,,,fee schedule,123% of ASC tier grouping rate,415.87,1550.7,
BLS RESIDENCE/DIAGNOSTIC ER,5400113,CDM,540,RC,A0429,HCPCS,outpatient,,,1353,541.20,RDQN,1150.05,85,,920.04,percent of total billed charges,85% of total billed charges,1041.81,77,,833.45,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,1109.46,82,,887.568,percent of total billed charges,82% of total billed charges,1150.05,85,,920.04,percent of total billed charges,85% of total billed charges,1150.05,85,,920.04,percent of total billed charges,85% of total billed charges,1150.05,85,,920.04,percent of total billed charges,85% of total billed charges,1217.7,90,,974.16,percent of total billed charges,90% of total billed charges,1082.4,80,,865.92,percent of total billed charges,80% of total billed charges,1217.7,90,,974.16,percent of total billed charges,90% of total billed charges,1014.75,75,,811.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,491,100,,,fee schedule,100% of ASC tier grouping rate,,,,,other ,not seperately reimbursable,906.51,67,,725.208,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,350.21,80,,,fee schedule,80% of CMS fee schedule,1082.4,80,,865.92,percent of total billed charges,80% of total billed charges,879.45,65,,703.56,percent of total billed charges,65% of total billed charges,603.93,123,,,fee schedule,123% of ASC tier grouping rate,350.21,1217.7,
BLS DIAGNOSTIC/RESIDENCE NON E,5400114,CDM,540,RC,A0428,HCPCS,outpatient,,,1353,541.20,DRQN,1150.05,85,,920.04,percent of total billed charges,85% of total billed charges,1041.81,77,,833.45,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,1109.46,82,,887.568,percent of total billed charges,82% of total billed charges,1150.05,85,,920.04,percent of total billed charges,85% of total billed charges,1150.05,85,,920.04,percent of total billed charges,85% of total billed charges,1150.05,85,,920.04,percent of total billed charges,85% of total billed charges,1217.7,90,,974.16,percent of total billed charges,90% of total billed charges,1082.4,80,,865.92,percent of total billed charges,80% of total billed charges,1217.7,90,,974.16,percent of total billed charges,90% of total billed charges,1014.75,75,,811.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,306.88,100,,,fee schedule,100% of ASC tier grouping rate,,,,,other ,not seperately reimbursable,906.51,67,,725.208,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,218.88,80,,,fee schedule,80% of CMS fee schedule,1082.4,80,,865.92,percent of total billed charges,80% of total billed charges,879.45,65,,703.56,percent of total billed charges,65% of total billed charges,377.46,123,,,fee schedule,123% of ASC tier grouping rate,218.88,1217.7,
BLS DIALYSIS/HOSPITAL ER,5400115,CDM,540,RC,A0429,HCPCS,outpatient,,,1353,541.20,,1150.05,85,,920.04,percent of total billed charges,85% of total billed charges,1041.81,77,,833.45,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,1109.46,82,,887.568,percent of total billed charges,82% of total billed charges,1150.05,85,,920.04,percent of total billed charges,85% of total billed charges,1150.05,85,,920.04,percent of total billed charges,85% of total billed charges,1150.05,85,,920.04,percent of total billed charges,85% of total billed charges,1217.7,90,,974.16,percent of total billed charges,90% of total billed charges,1082.4,80,,865.92,percent of total billed charges,80% of total billed charges,1217.7,90,,974.16,percent of total billed charges,90% of total billed charges,1014.75,75,,811.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,491,100,,,fee schedule,100% of ASC tier grouping rate,,,,,other ,not seperately reimbursable,906.51,67,,725.208,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,350.21,80,,,fee schedule,80% of CMS fee schedule,1082.4,80,,865.92,percent of total billed charges,80% of total billed charges,879.45,65,,703.56,percent of total billed charges,65% of total billed charges,603.93,123,,,fee schedule,123% of ASC tier grouping rate,350.21,1217.7,
BLS NON SNF/DIALYSIS NON ER,5400116,CDM,540,RC,A0428,HCPCS,outpatient,,,1353,541.20,EJQN,1150.05,85,,920.04,percent of total billed charges,85% of total billed charges,1041.81,77,,833.45,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,1109.46,82,,887.568,percent of total billed charges,82% of total billed charges,1150.05,85,,920.04,percent of total billed charges,85% of total billed charges,1150.05,85,,920.04,percent of total billed charges,85% of total billed charges,1150.05,85,,920.04,percent of total billed charges,85% of total billed charges,1217.7,90,,974.16,percent of total billed charges,90% of total billed charges,1082.4,80,,865.92,percent of total billed charges,80% of total billed charges,1217.7,90,,974.16,percent of total billed charges,90% of total billed charges,1014.75,75,,811.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,306.88,100,,,fee schedule,100% of ASC tier grouping rate,,,,,other ,not seperately reimbursable,906.51,67,,725.208,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,218.88,80,,,fee schedule,80% of CMS fee schedule,1082.4,80,,865.92,percent of total billed charges,80% of total billed charges,879.45,65,,703.56,percent of total billed charges,65% of total billed charges,377.46,123,,,fee schedule,123% of ASC tier grouping rate,218.88,1217.7,
BLS DIALYSIS/NON SNF OR HOME,5400117,CDM,540,RC,A0428,HCPCS,outpatient,,,1353,541.20,JEQN,1150.05,85,,920.04,percent of total billed charges,85% of total billed charges,1041.81,77,,833.45,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,1109.46,82,,887.568,percent of total billed charges,82% of total billed charges,1150.05,85,,920.04,percent of total billed charges,85% of total billed charges,1150.05,85,,920.04,percent of total billed charges,85% of total billed charges,1150.05,85,,920.04,percent of total billed charges,85% of total billed charges,1217.7,90,,974.16,percent of total billed charges,90% of total billed charges,1082.4,80,,865.92,percent of total billed charges,80% of total billed charges,1217.7,90,,974.16,percent of total billed charges,90% of total billed charges,1014.75,75,,811.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,306.88,100,,,fee schedule,100% of ASC tier grouping rate,,,,,other ,not seperately reimbursable,906.51,67,,725.208,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,218.88,80,,,fee schedule,80% of CMS fee schedule,1082.4,80,,865.92,percent of total billed charges,80% of total billed charges,879.45,65,,703.56,percent of total billed charges,65% of total billed charges,377.46,123,,,fee schedule,123% of ASC tier grouping rate,218.88,1217.7,
BLS DIALYSIS/HOSP NON ER,5400118,CDM,540,RC,A0428,HCPCS,outpatient,,,1378,551.20,JHQN,1171.3,85,,937.04,percent of total billed charges,85% of total billed charges,1061.06,77,,848.85,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,1129.96,82,,903.968,percent of total billed charges,82% of total billed charges,1171.3,85,,937.04,percent of total billed charges,85% of total billed charges,1171.3,85,,937.04,percent of total billed charges,85% of total billed charges,1171.3,85,,937.04,percent of total billed charges,85% of total billed charges,1240.2,90,,992.16,percent of total billed charges,90% of total billed charges,1102.4,80,,881.92,percent of total billed charges,80% of total billed charges,1240.2,90,,992.16,percent of total billed charges,90% of total billed charges,1033.5,75,,826.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,306.88,100,,,fee schedule,100% of ASC tier grouping rate,,,,,other ,not seperately reimbursable,923.26,67,,738.608,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,218.88,80,,,fee schedule,80% of CMS fee schedule,1102.4,80,,881.92,percent of total billed charges,80% of total billed charges,895.7,65,,716.56,percent of total billed charges,65% of total billed charges,377.46,123,,,fee schedule,123% of ASC tier grouping rate,218.88,1240.2,
SCT HOSPITAL/HOSPITAL ER,5400120,CDM,540,RC,A0434,HCPCS,outpatient,,,2067,826.80,HHQN,1756.95,85,,1405.56,percent of total billed charges,85% of total billed charges,1591.59,77,,1273.27,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,1694.94,82,,1355.952,percent of total billed charges,82% of total billed charges,1756.95,85,,1405.56,percent of total billed charges,85% of total billed charges,1756.95,85,,1405.56,percent of total billed charges,85% of total billed charges,1756.95,85,,1405.56,percent of total billed charges,85% of total billed charges,1860.3,90,,1488.24,percent of total billed charges,90% of total billed charges,1653.6,80,,1322.88,percent of total billed charges,80% of total billed charges,1860.3,90,,1488.24,percent of total billed charges,90% of total billed charges,1550.25,75,,1240.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,997.35,100,,,fee schedule,100% of ASC tier grouping rate,,,,,other ,not seperately reimbursable,1384.89,67,,1107.912,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,711.36,80,,,fee schedule,80% of CMS fee schedule,1653.6,80,,1322.88,percent of total billed charges,80% of total billed charges,1343.55,65,,1074.84,percent of total billed charges,65% of total billed charges,1226.74,123,,,fee schedule,123% of ASC tier grouping rate,711.36,1860.3,
BLS OFFICE/NONSNF NON ER,5400121,CDM,540,RC,A0428,HCPCS,outpatient,,,1353,541.20,PEQN,1150.05,85,,920.04,percent of total billed charges,85% of total billed charges,1041.81,77,,833.45,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,1109.46,82,,887.568,percent of total billed charges,82% of total billed charges,1150.05,85,,920.04,percent of total billed charges,85% of total billed charges,1150.05,85,,920.04,percent of total billed charges,85% of total billed charges,1150.05,85,,920.04,percent of total billed charges,85% of total billed charges,1217.7,90,,974.16,percent of total billed charges,90% of total billed charges,1082.4,80,,865.92,percent of total billed charges,80% of total billed charges,1217.7,90,,974.16,percent of total billed charges,90% of total billed charges,1014.75,75,,811.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,306.88,100,,,fee schedule,100% of ASC tier grouping rate,,,,,other ,not seperately reimbursable,906.51,67,,725.208,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,218.88,80,,,fee schedule,80% of CMS fee schedule,1082.4,80,,865.92,percent of total billed charges,80% of total billed charges,879.45,65,,703.56,percent of total billed charges,65% of total billed charges,377.46,123,,,fee schedule,123% of ASC tier grouping rate,218.88,1217.7,
ALS2 RESIDENCE/HOSPITAL ER,5400130,CDM,540,RC,A0433,HCPCS,outpatient,,,1837,734.80,RHQN,1561.45,85,,1249.16,percent of total billed charges,85% of total billed charges,1414.49,77,,1131.59,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,1506.34,82,,1205.072,percent of total billed charges,82% of total billed charges,1561.45,85,,1249.16,percent of total billed charges,85% of total billed charges,1561.45,85,,1249.16,percent of total billed charges,85% of total billed charges,1561.45,85,,1249.16,percent of total billed charges,85% of total billed charges,1653.3,90,,1322.64,percent of total billed charges,90% of total billed charges,1469.6,80,,1175.68,percent of total billed charges,80% of total billed charges,1653.3,90,,1322.64,percent of total billed charges,90% of total billed charges,1377.75,75,,1102.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,843.9,100,,,fee schedule,100% of ASC tier grouping rate,,,,,other ,not seperately reimbursable,1230.79,67,,984.632,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,601.92,80,,,fee schedule,80% of CMS fee schedule,1469.6,80,,1175.68,percent of total billed charges,80% of total billed charges,1194.05,65,,955.24,percent of total billed charges,65% of total billed charges,1038,123,,,fee schedule,123% of ASC tier grouping rate,601.92,1653.3,
ALS2 SCENE/LZ ER,5400131,CDM,540,RC,A0433,HCPCS,outpatient,,,1802,720.80,QNSI,1531.7,85,,1225.36,percent of total billed charges,85% of total billed charges,1387.54,77,,1110.03,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,1477.64,82,,1182.112,percent of total billed charges,82% of total billed charges,1531.7,85,,1225.36,percent of total billed charges,85% of total billed charges,1531.7,85,,1225.36,percent of total billed charges,85% of total billed charges,1531.7,85,,1225.36,percent of total billed charges,85% of total billed charges,1621.8,90,,1297.44,percent of total billed charges,90% of total billed charges,1441.6,80,,1153.28,percent of total billed charges,80% of total billed charges,1621.8,90,,1297.44,percent of total billed charges,90% of total billed charges,1351.5,75,,1081.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,843.9,100,,,fee schedule,100% of ASC tier grouping rate,,,,,other ,not seperately reimbursable,1207.34,67,,965.872,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,601.92,80,,,fee schedule,80% of CMS fee schedule,1441.6,80,,1153.28,percent of total billed charges,80% of total billed charges,1171.3,65,,937.04,percent of total billed charges,65% of total billed charges,1038,123,,,fee schedule,123% of ASC tier grouping rate,601.92,1621.8,
ALS2 NON SNF/HOSPITAL ER,5400132,CDM,540,RC,A0433,HCPCS,outpatient,,,1802,720.80,QNEH,1531.7,85,,1225.36,percent of total billed charges,85% of total billed charges,1387.54,77,,1110.03,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,1477.64,82,,1182.112,percent of total billed charges,82% of total billed charges,1531.7,85,,1225.36,percent of total billed charges,85% of total billed charges,1531.7,85,,1225.36,percent of total billed charges,85% of total billed charges,1531.7,85,,1225.36,percent of total billed charges,85% of total billed charges,1621.8,90,,1297.44,percent of total billed charges,90% of total billed charges,1441.6,80,,1153.28,percent of total billed charges,80% of total billed charges,1621.8,90,,1297.44,percent of total billed charges,90% of total billed charges,1351.5,75,,1081.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,843.9,100,,,fee schedule,100% of ASC tier grouping rate,,,,,other ,not seperately reimbursable,1207.34,67,,965.872,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,601.92,80,,,fee schedule,80% of CMS fee schedule,1441.6,80,,1153.28,percent of total billed charges,80% of total billed charges,1171.3,65,,937.04,percent of total billed charges,65% of total billed charges,1038,123,,,fee schedule,123% of ASC tier grouping rate,601.92,1621.8,
ALS2 SNF/HOSPITAL ER,5400133,CDM,540,RC,A0433,HCPCS,outpatient,,,1802,720.80,QNNH,1531.7,85,,1225.36,percent of total billed charges,85% of total billed charges,1387.54,77,,1110.03,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,1477.64,82,,1182.112,percent of total billed charges,82% of total billed charges,1531.7,85,,1225.36,percent of total billed charges,85% of total billed charges,1531.7,85,,1225.36,percent of total billed charges,85% of total billed charges,1531.7,85,,1225.36,percent of total billed charges,85% of total billed charges,1621.8,90,,1297.44,percent of total billed charges,90% of total billed charges,1441.6,80,,1153.28,percent of total billed charges,80% of total billed charges,1621.8,90,,1297.44,percent of total billed charges,90% of total billed charges,1351.5,75,,1081.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,843.9,100,,,fee schedule,100% of ASC tier grouping rate,,,,,other ,not seperately reimbursable,1207.34,67,,965.872,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,601.92,80,,,fee schedule,80% of CMS fee schedule,1441.6,80,,1153.28,percent of total billed charges,80% of total billed charges,1171.3,65,,937.04,percent of total billed charges,65% of total billed charges,1038,123,,,fee schedule,123% of ASC tier grouping rate,601.92,1621.8,
ALS2 DIALYSIS/HOSP ER,5400134,CDM,540,RC,A0433,HCPCS,outpatient,,,1802,720.80,QNJH,1531.7,85,,1225.36,percent of total billed charges,85% of total billed charges,1387.54,77,,1110.03,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,1477.64,82,,1182.112,percent of total billed charges,82% of total billed charges,1531.7,85,,1225.36,percent of total billed charges,85% of total billed charges,1531.7,85,,1225.36,percent of total billed charges,85% of total billed charges,1531.7,85,,1225.36,percent of total billed charges,85% of total billed charges,1621.8,90,,1297.44,percent of total billed charges,90% of total billed charges,1441.6,80,,1153.28,percent of total billed charges,80% of total billed charges,1621.8,90,,1297.44,percent of total billed charges,90% of total billed charges,1351.5,75,,1081.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,843.9,100,,,fee schedule,100% of ASC tier grouping rate,,,,,other ,not seperately reimbursable,1207.34,67,,965.872,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,601.92,80,,,fee schedule,80% of CMS fee schedule,1441.6,80,,1153.28,percent of total billed charges,80% of total billed charges,1171.3,65,,937.04,percent of total billed charges,65% of total billed charges,1038,123,,,fee schedule,123% of ASC tier grouping rate,601.92,1621.8,
ALS2 ACCIDENT/HOSPITAL ER,5400135,CDM,540,RC,A0433,HCPCS,outpatient,,,1802,720.80,QNSH,1531.7,85,,1225.36,percent of total billed charges,85% of total billed charges,1387.54,77,,1110.03,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,1477.64,82,,1182.112,percent of total billed charges,82% of total billed charges,1531.7,85,,1225.36,percent of total billed charges,85% of total billed charges,1531.7,85,,1225.36,percent of total billed charges,85% of total billed charges,1531.7,85,,1225.36,percent of total billed charges,85% of total billed charges,1621.8,90,,1297.44,percent of total billed charges,90% of total billed charges,1441.6,80,,1153.28,percent of total billed charges,80% of total billed charges,1621.8,90,,1297.44,percent of total billed charges,90% of total billed charges,1351.5,75,,1081.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,843.9,100,,,fee schedule,100% of ASC tier grouping rate,,,,,other ,not seperately reimbursable,1207.34,67,,965.872,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,601.92,80,,,fee schedule,80% of CMS fee schedule,1441.6,80,,1153.28,percent of total billed charges,80% of total billed charges,1171.3,65,,937.04,percent of total billed charges,65% of total billed charges,1038,123,,,fee schedule,123% of ASC tier grouping rate,601.92,1621.8,
BLS RESIDENCE/SNF EMERGENCY,5400136,CDM,540,RC,A0429,HCPCS,outpatient,,,1353,541.20,RNQN,1150.05,85,,920.04,percent of total billed charges,85% of total billed charges,1041.81,77,,833.45,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,1109.46,82,,887.568,percent of total billed charges,82% of total billed charges,1150.05,85,,920.04,percent of total billed charges,85% of total billed charges,1150.05,85,,920.04,percent of total billed charges,85% of total billed charges,1150.05,85,,920.04,percent of total billed charges,85% of total billed charges,1217.7,90,,974.16,percent of total billed charges,90% of total billed charges,1082.4,80,,865.92,percent of total billed charges,80% of total billed charges,1217.7,90,,974.16,percent of total billed charges,90% of total billed charges,1014.75,75,,811.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,491,100,,,fee schedule,100% of ASC tier grouping rate,,,,,other ,not seperately reimbursable,906.51,67,,725.208,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,350.21,80,,,fee schedule,80% of CMS fee schedule,1082.4,80,,865.92,percent of total billed charges,80% of total billed charges,879.45,65,,703.56,percent of total billed charges,65% of total billed charges,603.93,123,,,fee schedule,123% of ASC tier grouping rate,350.21,1217.7,
BLS RESIDENCE/NON SNF EMS,5400137,CDM,540,RC,A0429,HCPCS,outpatient,,,1353,541.20,REQN,1150.05,85,,920.04,percent of total billed charges,85% of total billed charges,1041.81,77,,833.45,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,1109.46,82,,887.568,percent of total billed charges,82% of total billed charges,1150.05,85,,920.04,percent of total billed charges,85% of total billed charges,1150.05,85,,920.04,percent of total billed charges,85% of total billed charges,1150.05,85,,920.04,percent of total billed charges,85% of total billed charges,1217.7,90,,974.16,percent of total billed charges,90% of total billed charges,1082.4,80,,865.92,percent of total billed charges,80% of total billed charges,1217.7,90,,974.16,percent of total billed charges,90% of total billed charges,1014.75,75,,811.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,491,100,,,fee schedule,100% of ASC tier grouping rate,,,,,other ,not seperately reimbursable,906.51,67,,725.208,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,350.21,80,,,fee schedule,80% of CMS fee schedule,1082.4,80,,865.92,percent of total billed charges,80% of total billed charges,879.45,65,,703.56,percent of total billed charges,65% of total billed charges,603.93,123,,,fee schedule,123% of ASC tier grouping rate,350.21,1217.7,
ALS RESIDENCE/SNF EMS,5400138,CDM,540,RC,A0427,HCPCS,outpatient,,,1690,676.00,RNQN,1436.5,85,,1149.2,percent of total billed charges,85% of total billed charges,1301.3,77,,1041.04,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,1385.8,82,,1108.64,percent of total billed charges,82% of total billed charges,1436.5,85,,1149.2,percent of total billed charges,85% of total billed charges,1436.5,85,,1149.2,percent of total billed charges,85% of total billed charges,1436.5,85,,1149.2,percent of total billed charges,85% of total billed charges,1521,90,,1216.8,percent of total billed charges,90% of total billed charges,1352,80,,1081.6,percent of total billed charges,80% of total billed charges,1521,90,,1216.8,percent of total billed charges,90% of total billed charges,1267.5,75,,1014,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,583.06,100,,,fee schedule,100% of ASC tier grouping rate,,,,,other ,not seperately reimbursable,1132.3,67,,905.84,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,415.87,80,,,fee schedule,80% of CMS fee schedule,1352,80,,1081.6,percent of total billed charges,80% of total billed charges,1098.5,65,,878.8,percent of total billed charges,65% of total billed charges,717.16,123,,,fee schedule,123% of ASC tier grouping rate,415.87,1521,
ALS RESIDENCE/NON SNF EMS,5400139,CDM,540,RC,A0427,HCPCS,outpatient,,,1690,676.00,REQN,1436.5,85,,1149.2,percent of total billed charges,85% of total billed charges,1301.3,77,,1041.04,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,1385.8,82,,1108.64,percent of total billed charges,82% of total billed charges,1436.5,85,,1149.2,percent of total billed charges,85% of total billed charges,1436.5,85,,1149.2,percent of total billed charges,85% of total billed charges,1436.5,85,,1149.2,percent of total billed charges,85% of total billed charges,1521,90,,1216.8,percent of total billed charges,90% of total billed charges,1352,80,,1081.6,percent of total billed charges,80% of total billed charges,1521,90,,1216.8,percent of total billed charges,90% of total billed charges,1267.5,75,,1014,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,583.06,100,,,fee schedule,100% of ASC tier grouping rate,,,,,other ,not seperately reimbursable,1132.3,67,,905.84,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,415.87,80,,,fee schedule,80% of CMS fee schedule,1352,80,,1081.6,percent of total billed charges,80% of total billed charges,1098.5,65,,878.8,percent of total billed charges,65% of total billed charges,717.16,123,,,fee schedule,123% of ASC tier grouping rate,415.87,1521,
BLS NON SNF/HOSP NON ER,5400140,CDM,540,RC,A0428,HCPCS,outpatient,,,1353,541.20,QNHE,1150.05,85,,920.04,percent of total billed charges,85% of total billed charges,1041.81,77,,833.45,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,1109.46,82,,887.568,percent of total billed charges,82% of total billed charges,1150.05,85,,920.04,percent of total billed charges,85% of total billed charges,1150.05,85,,920.04,percent of total billed charges,85% of total billed charges,1150.05,85,,920.04,percent of total billed charges,85% of total billed charges,1217.7,90,,974.16,percent of total billed charges,90% of total billed charges,1082.4,80,,865.92,percent of total billed charges,80% of total billed charges,1217.7,90,,974.16,percent of total billed charges,90% of total billed charges,1014.75,75,,811.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,306.88,100,,,fee schedule,100% of ASC tier grouping rate,,,,,other ,not seperately reimbursable,906.51,67,,725.208,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,218.88,80,,,fee schedule,80% of CMS fee schedule,1082.4,80,,865.92,percent of total billed charges,80% of total billed charges,879.45,65,,703.56,percent of total billed charges,65% of total billed charges,377.46,123,,,fee schedule,123% of ASC tier grouping rate,218.88,1217.7,
FULL CODE - NO TRANSPORT,5400145,CDM,540,RC,A0428,HCPCS,outpatient,,,1723,689.20,QLQN,1464.55,85,,1171.64,percent of total billed charges,85% of total billed charges,1326.71,77,,1061.37,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,1412.86,82,,1130.288,percent of total billed charges,82% of total billed charges,1464.55,85,,1171.64,percent of total billed charges,85% of total billed charges,1464.55,85,,1171.64,percent of total billed charges,85% of total billed charges,1464.55,85,,1171.64,percent of total billed charges,85% of total billed charges,1550.7,90,,1240.56,percent of total billed charges,90% of total billed charges,1378.4,80,,1102.72,percent of total billed charges,80% of total billed charges,1550.7,90,,1240.56,percent of total billed charges,90% of total billed charges,1292.25,75,,1033.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,306.88,100,,,fee schedule,100% of ASC tier grouping rate,,,,,other ,not seperately reimbursable,1154.41,67,,923.528,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,218.88,80,,,fee schedule,80% of CMS fee schedule,1378.4,80,,1102.72,percent of total billed charges,80% of total billed charges,1119.95,65,,895.96,percent of total billed charges,65% of total billed charges,377.46,123,,,fee schedule,123% of ASC tier grouping rate,218.88,1550.7,
ALS TREATMENT/TIME OF DEATH,5400150,CDM,540,RC,A0429,HCPCS,outpatient,,,841,336.40,QLQN,714.85,85,,571.88,percent of total billed charges,85% of total billed charges,647.57,77,,518.06,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,689.62,82,,551.696,percent of total billed charges,82% of total billed charges,714.85,85,,571.88,percent of total billed charges,85% of total billed charges,714.85,85,,571.88,percent of total billed charges,85% of total billed charges,714.85,85,,571.88,percent of total billed charges,85% of total billed charges,756.9,90,,605.52,percent of total billed charges,90% of total billed charges,672.8,80,,538.24,percent of total billed charges,80% of total billed charges,756.9,90,,605.52,percent of total billed charges,90% of total billed charges,630.75,75,,504.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,491,100,,,fee schedule,100% of ASC tier grouping rate,,,,,other ,not seperately reimbursable,563.47,67,,450.776,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,350.21,80,,,fee schedule,80% of CMS fee schedule,672.8,80,,538.24,percent of total billed charges,80% of total billed charges,546.65,65,,437.32,percent of total billed charges,65% of total billed charges,603.93,123,,,fee schedule,123% of ASC tier grouping rate,350.21,756.9,
BLS SNF/DR OFFICE NON ER,5400155,CDM,540,RC,A0428,HCPCS,outpatient,,,1353,541.20,QNNP,1150.05,85,,920.04,percent of total billed charges,85% of total billed charges,1041.81,77,,833.45,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,1109.46,82,,887.568,percent of total billed charges,82% of total billed charges,1150.05,85,,920.04,percent of total billed charges,85% of total billed charges,1150.05,85,,920.04,percent of total billed charges,85% of total billed charges,1150.05,85,,920.04,percent of total billed charges,85% of total billed charges,1217.7,90,,974.16,percent of total billed charges,90% of total billed charges,1082.4,80,,865.92,percent of total billed charges,80% of total billed charges,1217.7,90,,974.16,percent of total billed charges,90% of total billed charges,1014.75,75,,811.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,306.88,100,,,fee schedule,100% of ASC tier grouping rate,,,,,other ,not seperately reimbursable,906.51,67,,725.208,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,218.88,80,,,fee schedule,80% of CMS fee schedule,1082.4,80,,865.92,percent of total billed charges,80% of total billed charges,879.45,65,,703.56,percent of total billed charges,65% of total billed charges,377.46,123,,,fee schedule,123% of ASC tier grouping rate,218.88,1217.7,
BLS NON SNF/DR OFFICE NON ER,5400156,CDM,540,RC,A0428,HCPCS,outpatient,,,1353,541.20,EPQN,1150.05,85,,920.04,percent of total billed charges,85% of total billed charges,1041.81,77,,833.45,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,1109.46,82,,887.568,percent of total billed charges,82% of total billed charges,1150.05,85,,920.04,percent of total billed charges,85% of total billed charges,1150.05,85,,920.04,percent of total billed charges,85% of total billed charges,1150.05,85,,920.04,percent of total billed charges,85% of total billed charges,1217.7,90,,974.16,percent of total billed charges,90% of total billed charges,1082.4,80,,865.92,percent of total billed charges,80% of total billed charges,1217.7,90,,974.16,percent of total billed charges,90% of total billed charges,1014.75,75,,811.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,306.88,100,,,fee schedule,100% of ASC tier grouping rate,,,,,other ,not seperately reimbursable,906.51,67,,725.208,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,218.88,80,,,fee schedule,80% of CMS fee schedule,1082.4,80,,865.92,percent of total billed charges,80% of total billed charges,879.45,65,,703.56,percent of total billed charges,65% of total billed charges,377.46,123,,,fee schedule,123% of ASC tier grouping rate,218.88,1217.7,
BLS SNF/RESIDENCE NON ER,5400157,CDM,540,RC,A0428,HCPCS,outpatient,,,1353,541.20,NRQN,1150.05,85,,920.04,percent of total billed charges,85% of total billed charges,1041.81,77,,833.45,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,1109.46,82,,887.568,percent of total billed charges,82% of total billed charges,1150.05,85,,920.04,percent of total billed charges,85% of total billed charges,1150.05,85,,920.04,percent of total billed charges,85% of total billed charges,1150.05,85,,920.04,percent of total billed charges,85% of total billed charges,1217.7,90,,974.16,percent of total billed charges,90% of total billed charges,1082.4,80,,865.92,percent of total billed charges,80% of total billed charges,1217.7,90,,974.16,percent of total billed charges,90% of total billed charges,1014.75,75,,811.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,306.88,100,,,fee schedule,100% of ASC tier grouping rate,,,,,other ,not seperately reimbursable,906.51,67,,725.208,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,218.88,80,,,fee schedule,80% of CMS fee schedule,1082.4,80,,865.92,percent of total billed charges,80% of total billed charges,879.45,65,,703.56,percent of total billed charges,65% of total billed charges,377.46,123,,,fee schedule,123% of ASC tier grouping rate,218.88,1217.7,
ALS NON SNF/SITE OF TSF ER,5400158,CDM,540,RC,A0427,HCPCS,outpatient,,,1690,676.00,QNEI,1436.5,85,,1149.2,percent of total billed charges,85% of total billed charges,1301.3,77,,1041.04,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,1385.8,82,,1108.64,percent of total billed charges,82% of total billed charges,1436.5,85,,1149.2,percent of total billed charges,85% of total billed charges,1436.5,85,,1149.2,percent of total billed charges,85% of total billed charges,1436.5,85,,1149.2,percent of total billed charges,85% of total billed charges,1521,90,,1216.8,percent of total billed charges,90% of total billed charges,1352,80,,1081.6,percent of total billed charges,80% of total billed charges,1521,90,,1216.8,percent of total billed charges,90% of total billed charges,1267.5,75,,1014,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,583.06,100,,,fee schedule,100% of ASC tier grouping rate,,,,,other ,not seperately reimbursable,1132.3,67,,905.84,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,415.87,80,,,fee schedule,80% of CMS fee schedule,1352,80,,1081.6,percent of total billed charges,80% of total billed charges,1098.5,65,,878.8,percent of total billed charges,65% of total billed charges,717.16,123,,,fee schedule,123% of ASC tier grouping rate,415.87,1521,
ALS DIALYSIS/HOSPITAL ER,5401071,CDM,540,RC,A0427,HCPCS,outpatient,,,1690,676.00,QNJH,1436.5,85,,1149.2,percent of total billed charges,85% of total billed charges,1301.3,77,,1041.04,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,1385.8,82,,1108.64,percent of total billed charges,82% of total billed charges,1436.5,85,,1149.2,percent of total billed charges,85% of total billed charges,1436.5,85,,1149.2,percent of total billed charges,85% of total billed charges,1436.5,85,,1149.2,percent of total billed charges,85% of total billed charges,1521,90,,1216.8,percent of total billed charges,90% of total billed charges,1352,80,,1081.6,percent of total billed charges,80% of total billed charges,1521,90,,1216.8,percent of total billed charges,90% of total billed charges,1267.5,75,,1014,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,583.06,100,,,fee schedule,100% of ASC tier grouping rate,,,,,other ,not seperately reimbursable,1132.3,67,,905.84,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,415.87,80,,,fee schedule,80% of CMS fee schedule,1352,80,,1081.6,percent of total billed charges,80% of total billed charges,1098.5,65,,878.8,percent of total billed charges,65% of total billed charges,717.16,123,,,fee schedule,123% of ASC tier grouping rate,415.87,1521,
ALS HOSPITAL/SITE OF TSF ER,5401072,CDM,540,RC,A0427,HCPCS,outpatient,,,1690,676.00,HSQN,1436.5,85,,1149.2,percent of total billed charges,85% of total billed charges,1301.3,77,,1041.04,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,1385.8,82,,1108.64,percent of total billed charges,82% of total billed charges,1436.5,85,,1149.2,percent of total billed charges,85% of total billed charges,1436.5,85,,1149.2,percent of total billed charges,85% of total billed charges,1436.5,85,,1149.2,percent of total billed charges,85% of total billed charges,1521,90,,1216.8,percent of total billed charges,90% of total billed charges,1352,80,,1081.6,percent of total billed charges,80% of total billed charges,1521,90,,1216.8,percent of total billed charges,90% of total billed charges,1267.5,75,,1014,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,583.06,100,,,fee schedule,100% of ASC tier grouping rate,,,,,other ,not seperately reimbursable,1132.3,67,,905.84,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,415.87,80,,,fee schedule,80% of CMS fee schedule,1352,80,,1081.6,percent of total billed charges,80% of total billed charges,1098.5,65,,878.8,percent of total billed charges,65% of total billed charges,717.16,123,,,fee schedule,123% of ASC tier grouping rate,415.87,1521,
ALS RESIDENCE/LANDING ZONE ER,5401073,CDM,540,RC,A0427,HCPCS,outpatient,,,1690,676.00,RIQN,1436.5,85,,1149.2,percent of total billed charges,85% of total billed charges,1301.3,77,,1041.04,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,1385.8,82,,1108.64,percent of total billed charges,82% of total billed charges,1436.5,85,,1149.2,percent of total billed charges,85% of total billed charges,1436.5,85,,1149.2,percent of total billed charges,85% of total billed charges,1436.5,85,,1149.2,percent of total billed charges,85% of total billed charges,1521,90,,1216.8,percent of total billed charges,90% of total billed charges,1352,80,,1081.6,percent of total billed charges,80% of total billed charges,1521,90,,1216.8,percent of total billed charges,90% of total billed charges,1267.5,75,,1014,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,583.06,100,,,fee schedule,100% of ASC tier grouping rate,,,,,other ,not seperately reimbursable,1132.3,67,,905.84,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,415.87,80,,,fee schedule,80% of CMS fee schedule,1352,80,,1081.6,percent of total billed charges,80% of total billed charges,1098.5,65,,878.8,percent of total billed charges,65% of total billed charges,717.16,123,,,fee schedule,123% of ASC tier grouping rate,415.87,1521,
BLS RESIDENCE/DR OFF/HOSP ER,5401077,CDM,540,RC,A0429,HCPCS,outpatient,,,1353,541.20,RXET,1150.05,85,,920.04,percent of total billed charges,85% of total billed charges,1041.81,77,,833.45,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,1109.46,82,,887.568,percent of total billed charges,82% of total billed charges,1150.05,85,,920.04,percent of total billed charges,85% of total billed charges,1150.05,85,,920.04,percent of total billed charges,85% of total billed charges,1150.05,85,,920.04,percent of total billed charges,85% of total billed charges,1217.7,90,,974.16,percent of total billed charges,90% of total billed charges,1082.4,80,,865.92,percent of total billed charges,80% of total billed charges,1217.7,90,,974.16,percent of total billed charges,90% of total billed charges,1014.75,75,,811.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,491,100,,,fee schedule,100% of ASC tier grouping rate,,,,,other ,not seperately reimbursable,906.51,67,,725.208,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,350.21,80,,,fee schedule,80% of CMS fee schedule,1082.4,80,,865.92,percent of total billed charges,80% of total billed charges,879.45,65,,703.56,percent of total billed charges,65% of total billed charges,603.93,123,,,fee schedule,123% of ASC tier grouping rate,350.21,1217.7,
BLS NONSNF/DR OFC/HOSP NON ER,5401078,CDM,540,RC,A0429,HCPCS,outpatient,,,1353,541.20,EXQN,1150.05,85,,920.04,percent of total billed charges,85% of total billed charges,1041.81,77,,833.45,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,1109.46,82,,887.568,percent of total billed charges,82% of total billed charges,1150.05,85,,920.04,percent of total billed charges,85% of total billed charges,1150.05,85,,920.04,percent of total billed charges,85% of total billed charges,1150.05,85,,920.04,percent of total billed charges,85% of total billed charges,1217.7,90,,974.16,percent of total billed charges,90% of total billed charges,1082.4,80,,865.92,percent of total billed charges,80% of total billed charges,1217.7,90,,974.16,percent of total billed charges,90% of total billed charges,1014.75,75,,811.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,491,100,,,fee schedule,100% of ASC tier grouping rate,,,,,other ,not seperately reimbursable,906.51,67,,725.208,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,350.21,80,,,fee schedule,80% of CMS fee schedule,1082.4,80,,865.92,percent of total billed charges,80% of total billed charges,879.45,65,,703.56,percent of total billed charges,65% of total billed charges,603.93,123,,,fee schedule,123% of ASC tier grouping rate,350.21,1217.7,
ALS2 HOSPITAL/HOSPITAL ER,5401080,CDM,540,RC,A0433,HCPCS,outpatient,,,1837,734.80,QNHH,1561.45,85,,1249.16,percent of total billed charges,85% of total billed charges,1414.49,77,,1131.59,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,1506.34,82,,1205.072,percent of total billed charges,82% of total billed charges,1561.45,85,,1249.16,percent of total billed charges,85% of total billed charges,1561.45,85,,1249.16,percent of total billed charges,85% of total billed charges,1561.45,85,,1249.16,percent of total billed charges,85% of total billed charges,1653.3,90,,1322.64,percent of total billed charges,90% of total billed charges,1469.6,80,,1175.68,percent of total billed charges,80% of total billed charges,1653.3,90,,1322.64,percent of total billed charges,90% of total billed charges,1377.75,75,,1102.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,843.9,100,,,fee schedule,100% of ASC tier grouping rate,,,,,other ,not seperately reimbursable,1230.79,67,,984.632,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,601.92,80,,,fee schedule,80% of CMS fee schedule,1469.6,80,,1175.68,percent of total billed charges,80% of total billed charges,1194.05,65,,955.24,percent of total billed charges,65% of total billed charges,1038,123,,,fee schedule,123% of ASC tier grouping rate,601.92,1653.3,
ALS PRISON/PRISON EMERGENCY,5401090,CDM,540,RC,A0427,HCPCS,outpatient,,,1690,676.00,RRQN,1436.5,85,,1149.2,percent of total billed charges,85% of total billed charges,1301.3,77,,1041.04,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,1385.8,82,,1108.64,percent of total billed charges,82% of total billed charges,1436.5,85,,1149.2,percent of total billed charges,85% of total billed charges,1436.5,85,,1149.2,percent of total billed charges,85% of total billed charges,1436.5,85,,1149.2,percent of total billed charges,85% of total billed charges,1521,90,,1216.8,percent of total billed charges,90% of total billed charges,1352,80,,1081.6,percent of total billed charges,80% of total billed charges,1521,90,,1216.8,percent of total billed charges,90% of total billed charges,1267.5,75,,1014,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,583.06,100,,,fee schedule,100% of ASC tier grouping rate,,,,,other ,not seperately reimbursable,1132.3,67,,905.84,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,415.87,80,,,fee schedule,80% of CMS fee schedule,1352,80,,1081.6,percent of total billed charges,80% of total billed charges,1098.5,65,,878.8,percent of total billed charges,65% of total billed charges,717.16,123,,,fee schedule,123% of ASC tier grouping rate,415.87,1521,
BLS NONSNF/NONSNF NON ER,5401100,CDM,540,RC,A0428,HCPCS,outpatient,,,1353,541.20,QNEE,1150.05,85,,920.04,percent of total billed charges,85% of total billed charges,1041.81,77,,833.45,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,1109.46,82,,887.568,percent of total billed charges,82% of total billed charges,1150.05,85,,920.04,percent of total billed charges,85% of total billed charges,1150.05,85,,920.04,percent of total billed charges,85% of total billed charges,1150.05,85,,920.04,percent of total billed charges,85% of total billed charges,1217.7,90,,974.16,percent of total billed charges,90% of total billed charges,1082.4,80,,865.92,percent of total billed charges,80% of total billed charges,1217.7,90,,974.16,percent of total billed charges,90% of total billed charges,1014.75,75,,811.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,306.88,100,,,fee schedule,100% of ASC tier grouping rate,,,,,other ,not seperately reimbursable,906.51,67,,725.208,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,218.88,80,,,fee schedule,80% of CMS fee schedule,1082.4,80,,865.92,percent of total billed charges,80% of total billed charges,879.45,65,,703.56,percent of total billed charges,65% of total billed charges,377.46,123,,,fee schedule,123% of ASC tier grouping rate,218.88,1217.7,
ALS2 RESIDENCE/LZ ER,5401105,CDM,540,RC,A0433,HCPCS,outpatient,,,1802,720.80,QNRI,1531.7,85,,1225.36,percent of total billed charges,85% of total billed charges,1387.54,77,,1110.03,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,1477.64,82,,1182.112,percent of total billed charges,82% of total billed charges,1531.7,85,,1225.36,percent of total billed charges,85% of total billed charges,1531.7,85,,1225.36,percent of total billed charges,85% of total billed charges,1531.7,85,,1225.36,percent of total billed charges,85% of total billed charges,1621.8,90,,1297.44,percent of total billed charges,90% of total billed charges,1441.6,80,,1153.28,percent of total billed charges,80% of total billed charges,1621.8,90,,1297.44,percent of total billed charges,90% of total billed charges,1351.5,75,,1081.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,843.9,100,,,fee schedule,100% of ASC tier grouping rate,,,,,other ,not seperately reimbursable,1207.34,67,,965.872,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,601.92,80,,,fee schedule,80% of CMS fee schedule,1441.6,80,,1153.28,percent of total billed charges,80% of total billed charges,1171.3,65,,937.04,percent of total billed charges,65% of total billed charges,1038,123,,,fee schedule,123% of ASC tier grouping rate,601.92,1621.8,
ALS RESIDENCE/SNF NON EMS,5401106,CDM,540,RC,A0426,HCPCS,outpatient,,,1690,676.00,QNRN,1436.5,85,,1149.2,percent of total billed charges,85% of total billed charges,1301.3,77,,1041.04,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,1385.8,82,,1108.64,percent of total billed charges,82% of total billed charges,1436.5,85,,1149.2,percent of total billed charges,85% of total billed charges,1436.5,85,,1149.2,percent of total billed charges,85% of total billed charges,1436.5,85,,1149.2,percent of total billed charges,85% of total billed charges,1521,90,,1216.8,percent of total billed charges,90% of total billed charges,1352,80,,1081.6,percent of total billed charges,80% of total billed charges,1521,90,,1216.8,percent of total billed charges,90% of total billed charges,1267.5,75,,1014,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,368.25,100,,,fee schedule,100% of ASC tier grouping rate,,,,,other ,not seperately reimbursable,1132.3,67,,905.84,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,262.66,80,,,fee schedule,80% of CMS fee schedule,1352,80,,1081.6,percent of total billed charges,80% of total billed charges,1098.5,65,,878.8,percent of total billed charges,65% of total billed charges,452.95,123,,,fee schedule,123% of ASC tier grouping rate,262.66,1521,
BLS CONTRACT PRICE,5409990,CDM,540,RC,,,outpatient,,,182,72.80,,154.7,85,,123.76,percent of total billed charges,85% of total billed charges,140.14,77,,112.11,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,149.24,82,,119.392,percent of total billed charges,82% of total billed charges,154.7,85,,123.76,percent of total billed charges,85% of total billed charges,154.7,85,,123.76,percent of total billed charges,85% of total billed charges,154.7,85,,123.76,percent of total billed charges,85% of total billed charges,163.8,90,,131.04,percent of total billed charges,90% of total billed charges,145.6,80,,116.48,percent of total billed charges,80% of total billed charges,163.8,90,,131.04,percent of total billed charges,90% of total billed charges,136.5,75,,109.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,52.78,29,,42.224,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,121.94,67,,97.552,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,145.6,80,,116.48,percent of total billed charges,80% of total billed charges,118.3,65,,94.64,percent of total billed charges,65% of total billed charges,64.92,35.67,,51.936,percent of total billed charges,35.67% of total billed charges,52.78,163.8,
MILEAGE CONTRACT PRICING,5409995,CDM,540,RC,,,outpatient,,,21,8.40,,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,16.17,77,,12.94,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,17.22,82,,13.776,percent of total billed charges,82% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,18.9,90,,15.12,percent of total billed charges,90% of total billed charges,16.8,80,,13.44,percent of total billed charges,80% of total billed charges,18.9,90,,15.12,percent of total billed charges,90% of total billed charges,15.75,75,,12.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,6.09,29,,4.872,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,14.07,67,,11.256,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,16.8,80,,13.44,percent of total billed charges,80% of total billed charges,13.65,65,,10.92,percent of total billed charges,65% of total billed charges,7.49,35.67,,5.992,percent of total billed charges,35.67% of total billed charges,6.09,18.9,
EMS TECH HOURLY RATE,5409999,CDM,540,RC,,,outpatient,,,44,17.60,,37.4,85,,29.92,percent of total billed charges,85% of total billed charges,33.88,77,,27.1,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,36.08,82,,28.864,percent of total billed charges,82% of total billed charges,37.4,85,,29.92,percent of total billed charges,85% of total billed charges,37.4,85,,29.92,percent of total billed charges,85% of total billed charges,37.4,85,,29.92,percent of total billed charges,85% of total billed charges,39.6,90,,31.68,percent of total billed charges,90% of total billed charges,35.2,80,,28.16,percent of total billed charges,80% of total billed charges,39.6,90,,31.68,percent of total billed charges,90% of total billed charges,33,75,,26.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,12.76,29,,10.208,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,29.48,67,,23.584,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,35.2,80,,28.16,percent of total billed charges,80% of total billed charges,28.6,65,,22.88,percent of total billed charges,65% of total billed charges,15.69,35.67,,12.552,percent of total billed charges,35.67% of total billed charges,12.76,39.6,
MILEAGE ACC/DR OFFICE NON-ER,5420101,CDM,540,RC,A0425,HCPCS,outpatient,,,21,8.40,QNSP,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,16.17,77,,12.94,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,17.22,82,,13.776,percent of total billed charges,82% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,18.9,90,,15.12,percent of total billed charges,90% of total billed charges,16.8,80,,13.44,percent of total billed charges,80% of total billed charges,18.9,90,,15.12,percent of total billed charges,90% of total billed charges,15.75,75,,12.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.07,67,,11.256,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,6.1,80,,,fee schedule,80% of CMS fee schedule,16.8,80,,13.44,percent of total billed charges,80% of total billed charges,13.65,65,,10.92,percent of total billed charges,65% of total billed charges,,,,,other ,not seperately reimbursable,6.1,18.9,
MILEAGE ACC/HOSPITAL NON ER,5420102,CDM,540,RC,A0425,HCPCS,outpatient,,,21,8.40,SHQN,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,16.17,77,,12.94,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,17.22,82,,13.776,percent of total billed charges,82% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,18.9,90,,15.12,percent of total billed charges,90% of total billed charges,16.8,80,,13.44,percent of total billed charges,80% of total billed charges,18.9,90,,15.12,percent of total billed charges,90% of total billed charges,15.75,75,,12.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.07,67,,11.256,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,6.1,80,,,fee schedule,80% of CMS fee schedule,16.8,80,,13.44,percent of total billed charges,80% of total billed charges,13.65,65,,10.92,percent of total billed charges,65% of total billed charges,,,,,other ,not seperately reimbursable,6.1,18.9,
MILEAGE ACC/HOSPITAL ER,5420103,CDM,540,RC,A0425,HCPCS,outpatient,,,21,8.40,SHQN,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,16.17,77,,12.94,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,17.22,82,,13.776,percent of total billed charges,82% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,18.9,90,,15.12,percent of total billed charges,90% of total billed charges,16.8,80,,13.44,percent of total billed charges,80% of total billed charges,18.9,90,,15.12,percent of total billed charges,90% of total billed charges,15.75,75,,12.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.07,67,,11.256,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,6.1,80,,,fee schedule,80% of CMS fee schedule,16.8,80,,13.44,percent of total billed charges,80% of total billed charges,13.65,65,,10.92,percent of total billed charges,65% of total billed charges,,,,,other ,not seperately reimbursable,6.1,18.9,
MILEAGE ACC/SITE OF TSF NON ER,5420104,CDM,540,RC,A0425,HCPCS,outpatient,,,21,8.40,QNSI,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,16.17,77,,12.94,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,17.22,82,,13.776,percent of total billed charges,82% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,18.9,90,,15.12,percent of total billed charges,90% of total billed charges,16.8,80,,13.44,percent of total billed charges,80% of total billed charges,18.9,90,,15.12,percent of total billed charges,90% of total billed charges,15.75,75,,12.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.07,67,,11.256,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,6.1,80,,,fee schedule,80% of CMS fee schedule,16.8,80,,13.44,percent of total billed charges,80% of total billed charges,13.65,65,,10.92,percent of total billed charges,65% of total billed charges,,,,,other ,not seperately reimbursable,6.1,18.9,
MILEAGE ACC/SITE OF TSF ER,5420105,CDM,540,RC,A0425,HCPCS,outpatient,,,21,8.40,QNSI,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,16.17,77,,12.94,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,17.22,82,,13.776,percent of total billed charges,82% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,18.9,90,,15.12,percent of total billed charges,90% of total billed charges,16.8,80,,13.44,percent of total billed charges,80% of total billed charges,18.9,90,,15.12,percent of total billed charges,90% of total billed charges,15.75,75,,12.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.07,67,,11.256,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,6.1,80,,,fee schedule,80% of CMS fee schedule,16.8,80,,13.44,percent of total billed charges,80% of total billed charges,13.65,65,,10.92,percent of total billed charges,65% of total billed charges,,,,,other ,not seperately reimbursable,6.1,18.9,
MILEAGE DIAGNO/RESIDENCE NONER,5420106,CDM,540,RC,A0425,HCPCS,outpatient,,,21,8.40,QNDR,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,16.17,77,,12.94,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,17.22,82,,13.776,percent of total billed charges,82% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,18.9,90,,15.12,percent of total billed charges,90% of total billed charges,16.8,80,,13.44,percent of total billed charges,80% of total billed charges,18.9,90,,15.12,percent of total billed charges,90% of total billed charges,15.75,75,,12.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.07,67,,11.256,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,6.1,80,,,fee schedule,80% of CMS fee schedule,16.8,80,,13.44,percent of total billed charges,80% of total billed charges,13.65,65,,10.92,percent of total billed charges,65% of total billed charges,,,,,other ,not seperately reimbursable,6.1,18.9,
MILEAGE DIALYSIS/RESIDEN NONER,5420107,CDM,540,RC,A0425,HCPCS,outpatient,,,21,8.40,QNJR,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,16.17,77,,12.94,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,17.22,82,,13.776,percent of total billed charges,82% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,18.9,90,,15.12,percent of total billed charges,90% of total billed charges,16.8,80,,13.44,percent of total billed charges,80% of total billed charges,18.9,90,,15.12,percent of total billed charges,90% of total billed charges,15.75,75,,12.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.07,67,,11.256,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,6.1,80,,,fee schedule,80% of CMS fee schedule,16.8,80,,13.44,percent of total billed charges,80% of total billed charges,13.65,65,,10.92,percent of total billed charges,65% of total billed charges,,,,,other ,not seperately reimbursable,6.1,18.9,
MILEAGE DIALYSIS/SNF NON ER,5420108,CDM,540,RC,A0425,HCPCS,outpatient,,,21,8.40,QNJN,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,16.17,77,,12.94,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,17.22,82,,13.776,percent of total billed charges,82% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,18.9,90,,15.12,percent of total billed charges,90% of total billed charges,16.8,80,,13.44,percent of total billed charges,80% of total billed charges,18.9,90,,15.12,percent of total billed charges,90% of total billed charges,15.75,75,,12.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.07,67,,11.256,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,6.1,80,,,fee schedule,80% of CMS fee schedule,16.8,80,,13.44,percent of total billed charges,80% of total billed charges,13.65,65,,10.92,percent of total billed charges,65% of total billed charges,,,,,other ,not seperately reimbursable,6.1,18.9,
MILEAGE DIALYSIS/NON SNF NONER,5420109,CDM,540,RC,A0425,HCPCS,outpatient,,,21,8.40,JEQN,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,16.17,77,,12.94,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,17.22,82,,13.776,percent of total billed charges,82% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,18.9,90,,15.12,percent of total billed charges,90% of total billed charges,16.8,80,,13.44,percent of total billed charges,80% of total billed charges,18.9,90,,15.12,percent of total billed charges,90% of total billed charges,15.75,75,,12.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.07,67,,11.256,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,6.1,80,,,fee schedule,80% of CMS fee schedule,16.8,80,,13.44,percent of total billed charges,80% of total billed charges,13.65,65,,10.92,percent of total billed charges,65% of total billed charges,,,,,other ,not seperately reimbursable,6.1,18.9,
MILEAGE DIALYSIS/HOSPITA NONER,5420110,CDM,540,RC,A0425,HCPCS,outpatient,,,21,8.40,QNJH,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,16.17,77,,12.94,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,17.22,82,,13.776,percent of total billed charges,82% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,18.9,90,,15.12,percent of total billed charges,90% of total billed charges,16.8,80,,13.44,percent of total billed charges,80% of total billed charges,18.9,90,,15.12,percent of total billed charges,90% of total billed charges,15.75,75,,12.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.07,67,,11.256,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,6.1,80,,,fee schedule,80% of CMS fee schedule,16.8,80,,13.44,percent of total billed charges,80% of total billed charges,13.65,65,,10.92,percent of total billed charges,65% of total billed charges,,,,,other ,not seperately reimbursable,6.1,18.9,
MILEAGE DIALYSIS/HOSPITAL ER,5420111,CDM,540,RC,A0425,HCPCS,outpatient,,,21,8.40,QNJH,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,16.17,77,,12.94,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,17.22,82,,13.776,percent of total billed charges,82% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,18.9,90,,15.12,percent of total billed charges,90% of total billed charges,16.8,80,,13.44,percent of total billed charges,80% of total billed charges,18.9,90,,15.12,percent of total billed charges,90% of total billed charges,15.75,75,,12.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.07,67,,11.256,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,6.1,80,,,fee schedule,80% of CMS fee schedule,16.8,80,,13.44,percent of total billed charges,80% of total billed charges,13.65,65,,10.92,percent of total billed charges,65% of total billed charges,,,,,other ,not seperately reimbursable,6.1,18.9,
MILEAGE DR OFF/SNF NON ER,5420112,CDM,540,RC,A0425,HCPCS,outpatient,,,21,8.40,PNQN,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,16.17,77,,12.94,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,17.22,82,,13.776,percent of total billed charges,82% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,18.9,90,,15.12,percent of total billed charges,90% of total billed charges,16.8,80,,13.44,percent of total billed charges,80% of total billed charges,18.9,90,,15.12,percent of total billed charges,90% of total billed charges,15.75,75,,12.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.07,67,,11.256,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,6.1,80,,,fee schedule,80% of CMS fee schedule,16.8,80,,13.44,percent of total billed charges,80% of total billed charges,13.65,65,,10.92,percent of total billed charges,65% of total billed charges,,,,,other ,not seperately reimbursable,6.1,18.9,
MILEAGE DR OFF/HOSPITAL NON ER,5420113,CDM,540,RC,A0425,HCPCS,outpatient,,,21,8.40,QNPH,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,16.17,77,,12.94,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,17.22,82,,13.776,percent of total billed charges,82% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,18.9,90,,15.12,percent of total billed charges,90% of total billed charges,16.8,80,,13.44,percent of total billed charges,80% of total billed charges,18.9,90,,15.12,percent of total billed charges,90% of total billed charges,15.75,75,,12.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.07,67,,11.256,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,6.1,80,,,fee schedule,80% of CMS fee schedule,16.8,80,,13.44,percent of total billed charges,80% of total billed charges,13.65,65,,10.92,percent of total billed charges,65% of total billed charges,,,,,other ,not seperately reimbursable,6.1,18.9,
MILEAGE DR OFF/HOSPITAL ER,5420114,CDM,540,RC,A0425,HCPCS,outpatient,,,21,8.40,QNPH,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,16.17,77,,12.94,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,17.22,82,,13.776,percent of total billed charges,82% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,18.9,90,,15.12,percent of total billed charges,90% of total billed charges,16.8,80,,13.44,percent of total billed charges,80% of total billed charges,18.9,90,,15.12,percent of total billed charges,90% of total billed charges,15.75,75,,12.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.07,67,,11.256,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,6.1,80,,,fee schedule,80% of CMS fee schedule,16.8,80,,13.44,percent of total billed charges,80% of total billed charges,13.65,65,,10.92,percent of total billed charges,65% of total billed charges,,,,,other ,not seperately reimbursable,6.1,18.9,
MILEAGE DR OFF/RESIDENCE NONER,5420115,CDM,540,RC,A0425,HCPCS,outpatient,,,21,8.40,QNPR,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,16.17,77,,12.94,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,17.22,82,,13.776,percent of total billed charges,82% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,18.9,90,,15.12,percent of total billed charges,90% of total billed charges,16.8,80,,13.44,percent of total billed charges,80% of total billed charges,18.9,90,,15.12,percent of total billed charges,90% of total billed charges,15.75,75,,12.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.07,67,,11.256,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,6.1,80,,,fee schedule,80% of CMS fee schedule,16.8,80,,13.44,percent of total billed charges,80% of total billed charges,13.65,65,,10.92,percent of total billed charges,65% of total billed charges,,,,,other ,not seperately reimbursable,6.1,18.9,
MILEAGE DR OFF/DR OFF NON ER,5420116,CDM,540,RC,A0425,HCPCS,outpatient,,,21,8.40,QNPP,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,16.17,77,,12.94,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,17.22,82,,13.776,percent of total billed charges,82% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,18.9,90,,15.12,percent of total billed charges,90% of total billed charges,16.8,80,,13.44,percent of total billed charges,80% of total billed charges,18.9,90,,15.12,percent of total billed charges,90% of total billed charges,15.75,75,,12.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.07,67,,11.256,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,6.1,80,,,fee schedule,80% of CMS fee schedule,16.8,80,,13.44,percent of total billed charges,80% of total billed charges,13.65,65,,10.92,percent of total billed charges,65% of total billed charges,,,,,other ,not seperately reimbursable,6.1,18.9,
MILEAGE HOSPITAL/SNF NON ER,5420117,CDM,540,RC,A0425,HCPCS,outpatient,,,21,8.40,HNQN,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,16.17,77,,12.94,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,17.22,82,,13.776,percent of total billed charges,82% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,18.9,90,,15.12,percent of total billed charges,90% of total billed charges,16.8,80,,13.44,percent of total billed charges,80% of total billed charges,18.9,90,,15.12,percent of total billed charges,90% of total billed charges,15.75,75,,12.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.07,67,,11.256,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,6.1,80,,,fee schedule,80% of CMS fee schedule,16.8,80,,13.44,percent of total billed charges,80% of total billed charges,13.65,65,,10.92,percent of total billed charges,65% of total billed charges,,,,,other ,not seperately reimbursable,6.1,18.9,
MILEAGE HOSPITAL/DR OFF NON ER,5420118,CDM,540,RC,A0425,HCPCS,outpatient,,,21,8.40,HPQN,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,16.17,77,,12.94,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,17.22,82,,13.776,percent of total billed charges,82% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,18.9,90,,15.12,percent of total billed charges,90% of total billed charges,16.8,80,,13.44,percent of total billed charges,80% of total billed charges,18.9,90,,15.12,percent of total billed charges,90% of total billed charges,15.75,75,,12.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.07,67,,11.256,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,6.1,80,,,fee schedule,80% of CMS fee schedule,16.8,80,,13.44,percent of total billed charges,80% of total billed charges,13.65,65,,10.92,percent of total billed charges,65% of total billed charges,,,,,other ,not seperately reimbursable,6.1,18.9,
MILEAGE HOSP/RESIDENCE NONER,5420119,CDM,540,RC,A0425,HCPCS,outpatient,,,21,8.40,HRQN,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,16.17,77,,12.94,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,17.22,82,,13.776,percent of total billed charges,82% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,18.9,90,,15.12,percent of total billed charges,90% of total billed charges,16.8,80,,13.44,percent of total billed charges,80% of total billed charges,18.9,90,,15.12,percent of total billed charges,90% of total billed charges,15.75,75,,12.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.07,67,,11.256,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,6.1,80,,,fee schedule,80% of CMS fee schedule,16.8,80,,13.44,percent of total billed charges,80% of total billed charges,13.65,65,,10.92,percent of total billed charges,65% of total billed charges,,,,,other ,not seperately reimbursable,6.1,18.9,
MILEAGE HOSPITAL/HOSP NON ER,5420120,CDM,540,RC,A0425,HCPCS,outpatient,,,21,8.40,HHQN,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,16.17,77,,12.94,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,17.22,82,,13.776,percent of total billed charges,82% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,18.9,90,,15.12,percent of total billed charges,90% of total billed charges,16.8,80,,13.44,percent of total billed charges,80% of total billed charges,18.9,90,,15.12,percent of total billed charges,90% of total billed charges,15.75,75,,12.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.07,67,,11.256,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,6.1,80,,,fee schedule,80% of CMS fee schedule,16.8,80,,13.44,percent of total billed charges,80% of total billed charges,13.65,65,,10.92,percent of total billed charges,65% of total billed charges,,,,,other ,not seperately reimbursable,6.1,18.9,
MILEAGE HOSPITAL/HOSPITAL ER,5420121,CDM,540,RC,A0425,HCPCS,outpatient,,,21,8.40,HHQN,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,16.17,77,,12.94,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,17.22,82,,13.776,percent of total billed charges,82% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,18.9,90,,15.12,percent of total billed charges,90% of total billed charges,16.8,80,,13.44,percent of total billed charges,80% of total billed charges,18.9,90,,15.12,percent of total billed charges,90% of total billed charges,15.75,75,,12.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.07,67,,11.256,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,6.1,80,,,fee schedule,80% of CMS fee schedule,16.8,80,,13.44,percent of total billed charges,80% of total billed charges,13.65,65,,10.92,percent of total billed charges,65% of total billed charges,,,,,other ,not seperately reimbursable,6.1,18.9,
MILEAGE HOSPITAL/DIALYS NON ER,5420122,CDM,540,RC,A0425,HCPCS,outpatient,,,21,8.40,HJQN,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,16.17,77,,12.94,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,17.22,82,,13.776,percent of total billed charges,82% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,18.9,90,,15.12,percent of total billed charges,90% of total billed charges,16.8,80,,13.44,percent of total billed charges,80% of total billed charges,18.9,90,,15.12,percent of total billed charges,90% of total billed charges,15.75,75,,12.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.07,67,,11.256,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,6.1,80,,,fee schedule,80% of CMS fee schedule,16.8,80,,13.44,percent of total billed charges,80% of total billed charges,13.65,65,,10.92,percent of total billed charges,65% of total billed charges,,,,,other ,not seperately reimbursable,6.1,18.9,
MILEAGE HOSPITAL/NON SNF NONER,5420123,CDM,540,RC,A0425,HCPCS,outpatient,,,21,8.40,HEQN,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,16.17,77,,12.94,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,17.22,82,,13.776,percent of total billed charges,82% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,18.9,90,,15.12,percent of total billed charges,90% of total billed charges,16.8,80,,13.44,percent of total billed charges,80% of total billed charges,18.9,90,,15.12,percent of total billed charges,90% of total billed charges,15.75,75,,12.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.07,67,,11.256,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,6.1,80,,,fee schedule,80% of CMS fee schedule,16.8,80,,13.44,percent of total billed charges,80% of total billed charges,13.65,65,,10.92,percent of total billed charges,65% of total billed charges,,,,,other ,not seperately reimbursable,6.1,18.9,
MILEAGE HOSPITAL/THERAPU NONER,5420124,CDM,540,RC,A0425,HCPCS,outpatient,,,21,8.40,HDQN,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,16.17,77,,12.94,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,17.22,82,,13.776,percent of total billed charges,82% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,18.9,90,,15.12,percent of total billed charges,90% of total billed charges,16.8,80,,13.44,percent of total billed charges,80% of total billed charges,18.9,90,,15.12,percent of total billed charges,90% of total billed charges,15.75,75,,12.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.07,67,,11.256,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,6.1,80,,,fee schedule,80% of CMS fee schedule,16.8,80,,13.44,percent of total billed charges,80% of total billed charges,13.65,65,,10.92,percent of total billed charges,65% of total billed charges,,,,,other ,not seperately reimbursable,6.1,18.9,
MILEAGE HOSPITAL/FREESTND NONE,5420125,CDM,540,RC,A0425,HCPCS,outpatient,,,21,8.40,HDQN,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,16.17,77,,12.94,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,17.22,82,,13.776,percent of total billed charges,82% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,18.9,90,,15.12,percent of total billed charges,90% of total billed charges,16.8,80,,13.44,percent of total billed charges,80% of total billed charges,18.9,90,,15.12,percent of total billed charges,90% of total billed charges,15.75,75,,12.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.07,67,,11.256,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,6.1,80,,,fee schedule,80% of CMS fee schedule,16.8,80,,13.44,percent of total billed charges,80% of total billed charges,13.65,65,,10.92,percent of total billed charges,65% of total billed charges,,,,,other ,not seperately reimbursable,6.1,18.9,
MILEAGE NON SNF/HOSPITAL NONER,5420126,CDM,540,RC,A0425,HCPCS,outpatient,,,21,8.40,QNEH,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,16.17,77,,12.94,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,17.22,82,,13.776,percent of total billed charges,82% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,18.9,90,,15.12,percent of total billed charges,90% of total billed charges,16.8,80,,13.44,percent of total billed charges,80% of total billed charges,18.9,90,,15.12,percent of total billed charges,90% of total billed charges,15.75,75,,12.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.07,67,,11.256,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,6.1,80,,,fee schedule,80% of CMS fee schedule,16.8,80,,13.44,percent of total billed charges,80% of total billed charges,13.65,65,,10.92,percent of total billed charges,65% of total billed charges,,,,,other ,not seperately reimbursable,6.1,18.9,
MILEAGE NONSNF/HOSPITAL ER,5420127,CDM,540,RC,A0425,HCPCS,outpatient,,,21,8.40,QNEH,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,16.17,77,,12.94,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,17.22,82,,13.776,percent of total billed charges,82% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,18.9,90,,15.12,percent of total billed charges,90% of total billed charges,16.8,80,,13.44,percent of total billed charges,80% of total billed charges,18.9,90,,15.12,percent of total billed charges,90% of total billed charges,15.75,75,,12.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.07,67,,11.256,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,6.1,80,,,fee schedule,80% of CMS fee schedule,16.8,80,,13.44,percent of total billed charges,80% of total billed charges,13.65,65,,10.92,percent of total billed charges,65% of total billed charges,,,,,other ,not seperately reimbursable,6.1,18.9,
MILEAGE NONSNF/DIALYSIS NONER,5420128,CDM,540,RC,A0425,HCPCS,outpatient,,,21,8.40,EJQN,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,16.17,77,,12.94,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,17.22,82,,13.776,percent of total billed charges,82% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,18.9,90,,15.12,percent of total billed charges,90% of total billed charges,16.8,80,,13.44,percent of total billed charges,80% of total billed charges,18.9,90,,15.12,percent of total billed charges,90% of total billed charges,15.75,75,,12.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.07,67,,11.256,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,6.1,80,,,fee schedule,80% of CMS fee schedule,16.8,80,,13.44,percent of total billed charges,80% of total billed charges,13.65,65,,10.92,percent of total billed charges,65% of total billed charges,,,,,other ,not seperately reimbursable,6.1,18.9,
MILEAGE NONSNF/DR OFF NON ER,5420129,CDM,540,RC,A0425,HCPCS,outpatient,,,21,8.40,EPQN,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,16.17,77,,12.94,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,17.22,82,,13.776,percent of total billed charges,82% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,18.9,90,,15.12,percent of total billed charges,90% of total billed charges,16.8,80,,13.44,percent of total billed charges,80% of total billed charges,18.9,90,,15.12,percent of total billed charges,90% of total billed charges,15.75,75,,12.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.07,67,,11.256,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,6.1,80,,,fee schedule,80% of CMS fee schedule,16.8,80,,13.44,percent of total billed charges,80% of total billed charges,13.65,65,,10.92,percent of total billed charges,65% of total billed charges,,,,,other ,not seperately reimbursable,6.1,18.9,
MILEAGE RESIDENCE/RESIDENCENON,5420130,CDM,540,RC,A0425,HCPCS,outpatient,,,21,8.40,RRQN,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,16.17,77,,12.94,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,17.22,82,,13.776,percent of total billed charges,82% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,18.9,90,,15.12,percent of total billed charges,90% of total billed charges,16.8,80,,13.44,percent of total billed charges,80% of total billed charges,18.9,90,,15.12,percent of total billed charges,90% of total billed charges,15.75,75,,12.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.07,67,,11.256,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,6.1,80,,,fee schedule,80% of CMS fee schedule,16.8,80,,13.44,percent of total billed charges,80% of total billed charges,13.65,65,,10.92,percent of total billed charges,65% of total billed charges,,,,,other ,not seperately reimbursable,6.1,18.9,
MILEAGE RESIDENCE/SNF NON ER,5420131,CDM,540,RC,A0425,HCPCS,outpatient,,,21,8.40,QNRN,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,16.17,77,,12.94,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,17.22,82,,13.776,percent of total billed charges,82% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,18.9,90,,15.12,percent of total billed charges,90% of total billed charges,16.8,80,,13.44,percent of total billed charges,80% of total billed charges,18.9,90,,15.12,percent of total billed charges,90% of total billed charges,15.75,75,,12.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.07,67,,11.256,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,6.1,80,,,fee schedule,80% of CMS fee schedule,16.8,80,,13.44,percent of total billed charges,80% of total billed charges,13.65,65,,10.92,percent of total billed charges,65% of total billed charges,,,,,other ,not seperately reimbursable,6.1,18.9,
MILEAGE RESIDENC/NON SNF NONER,5420132,CDM,540,RC,A0425,HCPCS,outpatient,,,21,8.40,REQN,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,16.17,77,,12.94,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,17.22,82,,13.776,percent of total billed charges,82% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,18.9,90,,15.12,percent of total billed charges,90% of total billed charges,16.8,80,,13.44,percent of total billed charges,80% of total billed charges,18.9,90,,15.12,percent of total billed charges,90% of total billed charges,15.75,75,,12.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.07,67,,11.256,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,6.1,80,,,fee schedule,80% of CMS fee schedule,16.8,80,,13.44,percent of total billed charges,80% of total billed charges,13.65,65,,10.92,percent of total billed charges,65% of total billed charges,,,,,other ,not seperately reimbursable,6.1,18.9,
MILEAGE RESIDENC/DR OFF NON ER,5420133,CDM,540,RC,A0425,HCPCS,outpatient,,,21,8.40,QNRP,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,16.17,77,,12.94,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,17.22,82,,13.776,percent of total billed charges,82% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,18.9,90,,15.12,percent of total billed charges,90% of total billed charges,16.8,80,,13.44,percent of total billed charges,80% of total billed charges,18.9,90,,15.12,percent of total billed charges,90% of total billed charges,15.75,75,,12.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.07,67,,11.256,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,6.1,80,,,fee schedule,80% of CMS fee schedule,16.8,80,,13.44,percent of total billed charges,80% of total billed charges,13.65,65,,10.92,percent of total billed charges,65% of total billed charges,,,,,other ,not seperately reimbursable,6.1,18.9,
MILEAGE RESIDENCE/HOSP NON ER,5420134,CDM,540,RC,A0425,HCPCS,outpatient,,,21,8.40,QNRH,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,16.17,77,,12.94,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,17.22,82,,13.776,percent of total billed charges,82% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,18.9,90,,15.12,percent of total billed charges,90% of total billed charges,16.8,80,,13.44,percent of total billed charges,80% of total billed charges,18.9,90,,15.12,percent of total billed charges,90% of total billed charges,15.75,75,,12.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.07,67,,11.256,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,6.1,80,,,fee schedule,80% of CMS fee schedule,16.8,80,,13.44,percent of total billed charges,80% of total billed charges,13.65,65,,10.92,percent of total billed charges,65% of total billed charges,,,,,other ,not seperately reimbursable,6.1,18.9,
MILEAGE RESIDENCE/HOSP ER,5420135,CDM,540,RC,A0425,HCPCS,outpatient,,,21,8.40,QNRH,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,16.17,77,,12.94,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,17.22,82,,13.776,percent of total billed charges,82% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,18.9,90,,15.12,percent of total billed charges,90% of total billed charges,16.8,80,,13.44,percent of total billed charges,80% of total billed charges,18.9,90,,15.12,percent of total billed charges,90% of total billed charges,15.75,75,,12.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.07,67,,11.256,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,6.1,80,,,fee schedule,80% of CMS fee schedule,16.8,80,,13.44,percent of total billed charges,80% of total billed charges,13.65,65,,10.92,percent of total billed charges,65% of total billed charges,,,,,other ,not seperately reimbursable,6.1,18.9,
MILEAGE RESIDENC/NONSNF NON ER,5420136,CDM,540,RC,A0425,HCPCS,outpatient,,,21,8.40,REQN,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,16.17,77,,12.94,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,17.22,82,,13.776,percent of total billed charges,82% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,18.9,90,,15.12,percent of total billed charges,90% of total billed charges,16.8,80,,13.44,percent of total billed charges,80% of total billed charges,18.9,90,,15.12,percent of total billed charges,90% of total billed charges,15.75,75,,12.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.07,67,,11.256,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,6.1,80,,,fee schedule,80% of CMS fee schedule,16.8,80,,13.44,percent of total billed charges,80% of total billed charges,13.65,65,,10.92,percent of total billed charges,65% of total billed charges,,,,,other ,not seperately reimbursable,6.1,18.9,
MILEAGE RESIDENC/DR OFF NONER,5420137,CDM,540,RC,A0425,HCPCS,outpatient,,,21,8.40,QNRP,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,16.17,77,,12.94,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,17.22,82,,13.776,percent of total billed charges,82% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,18.9,90,,15.12,percent of total billed charges,90% of total billed charges,16.8,80,,13.44,percent of total billed charges,80% of total billed charges,18.9,90,,15.12,percent of total billed charges,90% of total billed charges,15.75,75,,12.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.07,67,,11.256,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,6.1,80,,,fee schedule,80% of CMS fee schedule,16.8,80,,13.44,percent of total billed charges,80% of total billed charges,13.65,65,,10.92,percent of total billed charges,65% of total billed charges,,,,,other ,not seperately reimbursable,6.1,18.9,
MILEAGE RESIDENCE/HOSP NONER,5420138,CDM,540,RC,A0425,HCPCS,outpatient,,,21,8.40,QNRH,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,16.17,77,,12.94,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,17.22,82,,13.776,percent of total billed charges,82% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,18.9,90,,15.12,percent of total billed charges,90% of total billed charges,16.8,80,,13.44,percent of total billed charges,80% of total billed charges,18.9,90,,15.12,percent of total billed charges,90% of total billed charges,15.75,75,,12.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.07,67,,11.256,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,6.1,80,,,fee schedule,80% of CMS fee schedule,16.8,80,,13.44,percent of total billed charges,80% of total billed charges,13.65,65,,10.92,percent of total billed charges,65% of total billed charges,,,,,other ,not seperately reimbursable,6.1,18.9,
MILEAGE RESIDENC/DIALYS NON ER,5420139,CDM,540,RC,A0425,HCPCS,outpatient,,,21,8.40,QNRJ,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,16.17,77,,12.94,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,17.22,82,,13.776,percent of total billed charges,82% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,18.9,90,,15.12,percent of total billed charges,90% of total billed charges,16.8,80,,13.44,percent of total billed charges,80% of total billed charges,18.9,90,,15.12,percent of total billed charges,90% of total billed charges,15.75,75,,12.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.07,67,,11.256,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,6.1,80,,,fee schedule,80% of CMS fee schedule,16.8,80,,13.44,percent of total billed charges,80% of total billed charges,13.65,65,,10.92,percent of total billed charges,65% of total billed charges,,,,,other ,not seperately reimbursable,6.1,18.9,
MILEAGE SNF/HOSPITAL NON ER,5420140,CDM,540,RC,A0425,HCPCS,outpatient,,,21,8.40,QNNH,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,16.17,77,,12.94,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,17.22,82,,13.776,percent of total billed charges,82% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,18.9,90,,15.12,percent of total billed charges,90% of total billed charges,16.8,80,,13.44,percent of total billed charges,80% of total billed charges,18.9,90,,15.12,percent of total billed charges,90% of total billed charges,15.75,75,,12.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.07,67,,11.256,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,6.1,80,,,fee schedule,80% of CMS fee schedule,16.8,80,,13.44,percent of total billed charges,80% of total billed charges,13.65,65,,10.92,percent of total billed charges,65% of total billed charges,,,,,other ,not seperately reimbursable,6.1,18.9,
MILEAGE SNF/HOSPITAL ER,5420141,CDM,540,RC,A0425,HCPCS,outpatient,,,21,8.40,QNNH,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,16.17,77,,12.94,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,17.22,82,,13.776,percent of total billed charges,82% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,18.9,90,,15.12,percent of total billed charges,90% of total billed charges,16.8,80,,13.44,percent of total billed charges,80% of total billed charges,18.9,90,,15.12,percent of total billed charges,90% of total billed charges,15.75,75,,12.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.07,67,,11.256,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,6.1,80,,,fee schedule,80% of CMS fee schedule,16.8,80,,13.44,percent of total billed charges,80% of total billed charges,13.65,65,,10.92,percent of total billed charges,65% of total billed charges,,,,,other ,not seperately reimbursable,6.1,18.9,
MILEAGE SNF/RESIDENCE NON ER,5420142,CDM,540,RC,A0425,HCPCS,outpatient,,,21,8.40,NRQN,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,16.17,77,,12.94,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,17.22,82,,13.776,percent of total billed charges,82% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,18.9,90,,15.12,percent of total billed charges,90% of total billed charges,16.8,80,,13.44,percent of total billed charges,80% of total billed charges,18.9,90,,15.12,percent of total billed charges,90% of total billed charges,15.75,75,,12.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.07,67,,11.256,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,6.1,80,,,fee schedule,80% of CMS fee schedule,16.8,80,,13.44,percent of total billed charges,80% of total billed charges,13.65,65,,10.92,percent of total billed charges,65% of total billed charges,,,,,other ,not seperately reimbursable,6.1,18.9,
MILEAGE SNF/DIALYSIS NON ER,5420143,CDM,540,RC,A0425,HCPCS,outpatient,,,21,8.40,QNNJ,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,16.17,77,,12.94,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,17.22,82,,13.776,percent of total billed charges,82% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,18.9,90,,15.12,percent of total billed charges,90% of total billed charges,16.8,80,,13.44,percent of total billed charges,80% of total billed charges,18.9,90,,15.12,percent of total billed charges,90% of total billed charges,15.75,75,,12.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.07,67,,11.256,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,6.1,80,,,fee schedule,80% of CMS fee schedule,16.8,80,,13.44,percent of total billed charges,80% of total billed charges,13.65,65,,10.92,percent of total billed charges,65% of total billed charges,,,,,other ,not seperately reimbursable,6.1,18.9,
MILEAGE SNF/DR OFFICE NON ER,5420144,CDM,540,RC,A0425,HCPCS,outpatient,,,21,8.40,QNNP,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,16.17,77,,12.94,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,17.22,82,,13.776,percent of total billed charges,82% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,18.9,90,,15.12,percent of total billed charges,90% of total billed charges,16.8,80,,13.44,percent of total billed charges,80% of total billed charges,18.9,90,,15.12,percent of total billed charges,90% of total billed charges,15.75,75,,12.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.07,67,,11.256,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,6.1,80,,,fee schedule,80% of CMS fee schedule,16.8,80,,13.44,percent of total billed charges,80% of total billed charges,13.65,65,,10.92,percent of total billed charges,65% of total billed charges,,,,,other ,not seperately reimbursable,6.1,18.9,
MILEAGE HOSP/SITE OF TSF ER,5420145,CDM,540,RC,A0425,HCPCS,outpatient,,,21,8.40,HSQN,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,16.17,77,,12.94,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,17.22,82,,13.776,percent of total billed charges,82% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,18.9,90,,15.12,percent of total billed charges,90% of total billed charges,16.8,80,,13.44,percent of total billed charges,80% of total billed charges,18.9,90,,15.12,percent of total billed charges,90% of total billed charges,15.75,75,,12.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.07,67,,11.256,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,6.1,80,,,fee schedule,80% of CMS fee schedule,16.8,80,,13.44,percent of total billed charges,80% of total billed charges,13.65,65,,10.92,percent of total billed charges,65% of total billed charges,,,,,other ,not seperately reimbursable,6.1,18.9,
MILEAGE RESIDENCE/LAND ZONE ER,5420148,CDM,540,RC,A0425,HCPCS,outpatient,,,21,8.40,RIQN,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,16.17,77,,12.94,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,17.22,82,,13.776,percent of total billed charges,82% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,18.9,90,,15.12,percent of total billed charges,90% of total billed charges,16.8,80,,13.44,percent of total billed charges,80% of total billed charges,18.9,90,,15.12,percent of total billed charges,90% of total billed charges,15.75,75,,12.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.07,67,,11.256,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,6.1,80,,,fee schedule,80% of CMS fee schedule,16.8,80,,13.44,percent of total billed charges,80% of total billed charges,13.65,65,,10.92,percent of total billed charges,65% of total billed charges,,,,,other ,not seperately reimbursable,6.1,18.9,
MILEAGE NONSNF/DR OFC/HOSP NON,5420150,CDM,540,RC,A0425,HCPCS,outpatient,,,21,8.40,EX,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,16.17,77,,12.94,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,17.22,82,,13.776,percent of total billed charges,82% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,18.9,90,,15.12,percent of total billed charges,90% of total billed charges,16.8,80,,13.44,percent of total billed charges,80% of total billed charges,18.9,90,,15.12,percent of total billed charges,90% of total billed charges,15.75,75,,12.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.07,67,,11.256,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,6.1,80,,,fee schedule,80% of CMS fee schedule,16.8,80,,13.44,percent of total billed charges,80% of total billed charges,13.65,65,,10.92,percent of total billed charges,65% of total billed charges,,,,,other ,not seperately reimbursable,6.1,18.9,
MILEAGE PRISON/PRISON ER,5420190,CDM,540,RC,A0425,HCPCS,outpatient,,,21,8.40,RRQN,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,16.17,77,,12.94,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,17.22,82,,13.776,percent of total billed charges,82% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,18.9,90,,15.12,percent of total billed charges,90% of total billed charges,16.8,80,,13.44,percent of total billed charges,80% of total billed charges,18.9,90,,15.12,percent of total billed charges,90% of total billed charges,15.75,75,,12.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.07,67,,11.256,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,6.1,80,,,fee schedule,80% of CMS fee schedule,16.8,80,,13.44,percent of total billed charges,80% of total billed charges,13.65,65,,10.92,percent of total billed charges,65% of total billed charges,,,,,other ,not seperately reimbursable,6.1,18.9,
MILEAGE NON-EMERG NONSNF/NSNF,5420201,CDM,540,RC,A0425,HCPCS,outpatient,,,21,8.40,EEQN,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,16.17,77,,12.94,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,17.22,82,,13.776,percent of total billed charges,82% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,18.9,90,,15.12,percent of total billed charges,90% of total billed charges,16.8,80,,13.44,percent of total billed charges,80% of total billed charges,18.9,90,,15.12,percent of total billed charges,90% of total billed charges,15.75,75,,12.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.07,67,,11.256,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,6.1,80,,,fee schedule,80% of CMS fee schedule,16.8,80,,13.44,percent of total billed charges,80% of total billed charges,13.65,65,,10.92,percent of total billed charges,65% of total billed charges,,,,,other ,not seperately reimbursable,6.1,18.9,
MILEAGE DR OFFICE/NSF NON ER,5420202,CDM,540,RC,A0425,HCPCS,outpatient,,,21,8.40,QNPE,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,16.17,77,,12.94,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,17.22,82,,13.776,percent of total billed charges,82% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,18.9,90,,15.12,percent of total billed charges,90% of total billed charges,16.8,80,,13.44,percent of total billed charges,80% of total billed charges,18.9,90,,15.12,percent of total billed charges,90% of total billed charges,15.75,75,,12.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.07,67,,11.256,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,6.1,80,,,fee schedule,80% of CMS fee schedule,16.8,80,,13.44,percent of total billed charges,80% of total billed charges,13.65,65,,10.92,percent of total billed charges,65% of total billed charges,,,,,other ,not seperately reimbursable,6.1,18.9,
MILES BEYOND CLOSEST FACIL,5490012,CDM,540,RC,A0888,HCPCS,outpatient,,,21,8.40,HHQN,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,16.17,77,,12.94,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,17.22,82,,13.776,percent of total billed charges,82% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,18.9,90,,15.12,percent of total billed charges,90% of total billed charges,16.8,80,,13.44,percent of total billed charges,80% of total billed charges,18.9,90,,15.12,percent of total billed charges,90% of total billed charges,15.75,75,,12.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,6.09,29,,4.872,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,14.07,67,,11.256,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,16.8,80,,13.44,percent of total billed charges,80% of total billed charges,13.65,65,,10.92,percent of total billed charges,65% of total billed charges,7.49,35.67,,5.992,percent of total billed charges,35.67% of total billed charges,6.09,18.9,
ALS MILEAGE ONE WAY,5490102,CDM,540,RC,A0425,HCPCS,outpatient,,,21,8.40,QN,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,16.17,77,,12.94,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,17.22,82,,13.776,percent of total billed charges,82% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,18.9,90,,15.12,percent of total billed charges,90% of total billed charges,16.8,80,,13.44,percent of total billed charges,80% of total billed charges,18.9,90,,15.12,percent of total billed charges,90% of total billed charges,15.75,75,,12.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.07,67,,11.256,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,6.1,80,,,fee schedule,80% of CMS fee schedule,16.8,80,,13.44,percent of total billed charges,80% of total billed charges,13.65,65,,10.92,percent of total billed charges,65% of total billed charges,,,,,other ,not seperately reimbursable,6.1,18.9,
EMS TRANSFER INHOUSE - MRI-CT,9999100,CDM,540,RC,,,outpatient,,,2155,862.00,,1831.75,85,,1465.4,percent of total billed charges,85% of total billed charges,1659.35,77,,1327.48,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,1767.1,82,,1413.68,percent of total billed charges,82% of total billed charges,1831.75,85,,1465.4,percent of total billed charges,85% of total billed charges,1831.75,85,,1465.4,percent of total billed charges,85% of total billed charges,1831.75,85,,1465.4,percent of total billed charges,85% of total billed charges,1939.5,90,,1551.6,percent of total billed charges,90% of total billed charges,1724,80,,1379.2,percent of total billed charges,80% of total billed charges,1939.5,90,,1551.6,percent of total billed charges,90% of total billed charges,1616.25,75,,1293,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,624.95,29,,499.96,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1443.85,67,,1155.08,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1724,80,,1379.2,percent of total billed charges,80% of total billed charges,1400.75,65,,1120.6,percent of total billed charges,65% of total billed charges,768.69,35.67,,614.952,percent of total billed charges,35.67% of total billed charges,624.95,1939.5,
EMS EKG,5410106,CDM,541,RC,93005,HCPCS,outpatient,,,277,110.80,,235.45,85,,188.36,percent of total billed charges,85% of total billed charges,213.29,77,,170.63,percent of total billed charges,77% of total billed charges,53.49,100,,,fee schedule,100% of CMS OPPS rate,240.07,429,,,fee schedule,429% of BCBS fee schedule,250.14,447,,,fee schedule,447% of BCBS fee schedule,250.14,447,,,fee schedule,447% of BCBS fee schedule,250.14,447,,,fee schedule,447% of BCBS fee schedule,249.3,90,,199.44,percent of total billed charges,90% of total billed charges,221.6,80,,177.28,percent of total billed charges,80% of total billed charges,249.3,90,,199.44,percent of total billed charges,90% of total billed charges,207.75,75,,166.2,percent of total billed charges,75% of total billed charges,65.26,122,,,fee schedule,122% of HUMANA fee schedule,80.33,29,,64.264,percent of total billed charges,29% of total billed charges,53.49,100,,,fee schedule,100% of CMS OPPS rate,185.59,67,,148.472,percent of total billed charges,67% of total billed charges,24.92,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,221.6,80,,177.28,percent of total billed charges,80% of total billed charges,180.05,65,,144.04,percent of total billed charges,65% of total billed charges,98.81,35.67,,79.048,percent of total billed charges,35.67% of total billed charges,24.92,250.14,
MILEAGE NON SNF/SITE OF TSF ER,5420205,CDM,542,RC,A0425,HCPCS,outpatient,,,21,8.40,QNEI,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,16.17,77,,12.94,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,17.22,82,,13.776,percent of total billed charges,82% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,18.9,90,,15.12,percent of total billed charges,90% of total billed charges,16.8,80,,13.44,percent of total billed charges,80% of total billed charges,18.9,90,,15.12,percent of total billed charges,90% of total billed charges,15.75,75,,12.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.07,67,,11.256,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,6.1,80,,,fee schedule,80% of CMS fee schedule,16.8,80,,13.44,percent of total billed charges,80% of total billed charges,13.65,65,,10.92,percent of total billed charges,65% of total billed charges,,,,,other ,not seperately reimbursable,6.1,18.9,
MRI TEMPOROMANDIBULAR JOINT,6100020,CDM,610,RC,70336,HCPCS,outpatient,,,2056,822.40,,725,,,,case rate,pays based on per visit,1583.12,77,,1266.5,percent of total billed charges,77% of total billed charges,214.29,100,,,fee schedule,100% of CMS OPPS rate,1147.61,429,,,fee schedule,429% of BCBS fee schedule,1196.4,515,,,fee schedule,515% of BCBS fee schedule,1196.4,364,,,fee schedule,364% of BCBS fee schedule,1196.4,515,,,fee schedule,515% of BCBS fee schedule,1850.4,90,,1480.32,percent of total billed charges,90% of total billed charges,1644.8,80,,1315.84,percent of total billed charges,80% of total billed charges,1850.4,90,,1480.32,percent of total billed charges,90% of total billed charges,1542,75,,1233.6,percent of total billed charges,75% of total billed charges,261.43,122,,,fee schedule,122% of HUMANA fee schedule,596.24,29,,476.992,percent of total billed charges,29% of total billed charges,214.29,100,,,fee schedule,100% of CMS OPPS rate,1377.52,67,,1102.016,percent of total billed charges,67% of total billed charges,315.45,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,1644.8,80,,1315.84,percent of total billed charges,80% of total billed charges,1336.4,65,,1069.12,percent of total billed charges,65% of total billed charges,733.38,35.67,,586.704,percent of total billed charges,35.67% of total billed charges,214.29,1850.4,
MRI CERVICAL SPINE  W/O CONT,6100030,CDM,610,RC,72141,HCPCS,outpatient,,,2856,1142.40,,725,,,,case rate,pays based on per visit,2199.12,77,,1759.3,percent of total billed charges,77% of total billed charges,214.29,100,,,fee schedule,100% of CMS OPPS rate,1147.61,429,,,fee schedule,429% of BCBS fee schedule,1196.4,515,,,fee schedule,515% of BCBS fee schedule,1196.4,364,,,fee schedule,364% of BCBS fee schedule,1196.4,515,,,fee schedule,515% of BCBS fee schedule,2570.4,90,,2056.32,percent of total billed charges,90% of total billed charges,2284.8,80,,1827.84,percent of total billed charges,80% of total billed charges,2570.4,90,,2056.32,percent of total billed charges,90% of total billed charges,2142,75,,1713.6,percent of total billed charges,75% of total billed charges,261.43,122,,,fee schedule,122% of HUMANA fee schedule,828.24,29,,662.592,percent of total billed charges,29% of total billed charges,214.29,100,,,fee schedule,100% of CMS OPPS rate,1913.52,67,,1530.816,percent of total billed charges,67% of total billed charges,315.45,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,2284.8,80,,1827.84,percent of total billed charges,80% of total billed charges,1856.4,65,,1485.12,percent of total billed charges,65% of total billed charges,1018.74,35.67,,814.992,percent of total billed charges,35.67% of total billed charges,214.29,2570.4,
MRI CERVICAL SPINE WITH CONT,6100040,CDM,610,RC,72142,HCPCS,outpatient,,,3139,1255.60,,725,,,,case rate,pays based on per visit,2417.03,77,,1933.62,percent of total billed charges,77% of total billed charges,336.32,100,,,fee schedule,100% of CMS OPPS rate,2254.47,429,,,fee schedule,429% of BCBS fee schedule,2350.31,515,,,fee schedule,515% of BCBS fee schedule,2350.31,364,,,fee schedule,364% of BCBS fee schedule,2350.31,515,,,fee schedule,515% of BCBS fee schedule,2825.1,90,,2260.08,percent of total billed charges,90% of total billed charges,2511.2,80,,2008.96,percent of total billed charges,80% of total billed charges,2825.1,90,,2260.08,percent of total billed charges,90% of total billed charges,2354.25,75,,1883.4,percent of total billed charges,75% of total billed charges,410.31,122,,,fee schedule,122% of HUMANA fee schedule,910.31,29,,728.248,percent of total billed charges,29% of total billed charges,336.32,100,,,fee schedule,100% of CMS OPPS rate,2103.13,67,,1682.504,percent of total billed charges,67% of total billed charges,406.28,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,2511.2,80,,2008.96,percent of total billed charges,80% of total billed charges,2040.35,65,,1632.28,percent of total billed charges,65% of total billed charges,1119.68,35.67,,895.744,percent of total billed charges,35.67% of total billed charges,336.32,2825.1,
MRI THORACIC SPINE W/O CONT,6100050,CDM,610,RC,72146,HCPCS,outpatient,,,2856,1142.40,,725,,,,case rate,pays based on per visit,2199.12,77,,1759.3,percent of total billed charges,77% of total billed charges,214.29,100,,,fee schedule,100% of CMS OPPS rate,1147.61,429,,,fee schedule,429% of BCBS fee schedule,1196.4,515,,,fee schedule,515% of BCBS fee schedule,1196.4,364,,,fee schedule,364% of BCBS fee schedule,1196.4,515,,,fee schedule,515% of BCBS fee schedule,2570.4,90,,2056.32,percent of total billed charges,90% of total billed charges,2284.8,80,,1827.84,percent of total billed charges,80% of total billed charges,2570.4,90,,2056.32,percent of total billed charges,90% of total billed charges,2142,75,,1713.6,percent of total billed charges,75% of total billed charges,261.43,122,,,fee schedule,122% of HUMANA fee schedule,828.24,29,,662.592,percent of total billed charges,29% of total billed charges,214.29,100,,,fee schedule,100% of CMS OPPS rate,1913.52,67,,1530.816,percent of total billed charges,67% of total billed charges,315.45,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,2284.8,80,,1827.84,percent of total billed charges,80% of total billed charges,1856.4,65,,1485.12,percent of total billed charges,65% of total billed charges,1018.74,35.67,,814.992,percent of total billed charges,35.67% of total billed charges,214.29,2570.4,
MRI THORACIC SPINE WITH CONT,6100060,CDM,610,RC,72147,HCPCS,outpatient,,,3269,1307.60,,725,,,,case rate,pays based on per visit,2517.13,77,,2013.7,percent of total billed charges,77% of total billed charges,336.32,100,,,fee schedule,100% of CMS OPPS rate,2254.47,429,,,fee schedule,429% of BCBS fee schedule,2350.31,515,,,fee schedule,515% of BCBS fee schedule,2350.31,364,,,fee schedule,364% of BCBS fee schedule,2350.31,515,,,fee schedule,515% of BCBS fee schedule,2942.1,90,,2353.68,percent of total billed charges,90% of total billed charges,2615.2,80,,2092.16,percent of total billed charges,80% of total billed charges,2942.1,90,,2353.68,percent of total billed charges,90% of total billed charges,2451.75,75,,1961.4,percent of total billed charges,75% of total billed charges,410.31,122,,,fee schedule,122% of HUMANA fee schedule,948.01,29,,758.408,percent of total billed charges,29% of total billed charges,336.32,100,,,fee schedule,100% of CMS OPPS rate,2190.23,67,,1752.184,percent of total billed charges,67% of total billed charges,406.28,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,2615.2,80,,2092.16,percent of total billed charges,80% of total billed charges,2124.85,65,,1699.88,percent of total billed charges,65% of total billed charges,1166.05,35.67,,932.84,percent of total billed charges,35.67% of total billed charges,336.32,2942.1,
MRI LUMBAR SPINE W/O CONTRAST,6100070,CDM,610,RC,72148,HCPCS,outpatient,,,2856,1142.40,,725,,,,case rate,pays based on per visit,2199.12,77,,1759.3,percent of total billed charges,77% of total billed charges,214.29,100,,,fee schedule,100% of CMS OPPS rate,1147.61,429,,,fee schedule,429% of BCBS fee schedule,1196.4,515,,,fee schedule,515% of BCBS fee schedule,1196.4,364,,,fee schedule,364% of BCBS fee schedule,1196.4,515,,,fee schedule,515% of BCBS fee schedule,2570.4,90,,2056.32,percent of total billed charges,90% of total billed charges,2284.8,80,,1827.84,percent of total billed charges,80% of total billed charges,2570.4,90,,2056.32,percent of total billed charges,90% of total billed charges,2142,75,,1713.6,percent of total billed charges,75% of total billed charges,261.43,122,,,fee schedule,122% of HUMANA fee schedule,828.24,29,,662.592,percent of total billed charges,29% of total billed charges,214.29,100,,,fee schedule,100% of CMS OPPS rate,1913.52,67,,1530.816,percent of total billed charges,67% of total billed charges,315.45,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,2284.8,80,,1827.84,percent of total billed charges,80% of total billed charges,1856.4,65,,1485.12,percent of total billed charges,65% of total billed charges,1018.74,35.67,,814.992,percent of total billed charges,35.67% of total billed charges,214.29,2570.4,
MRI LUMBAR SPINE WITH CONTRAST,6100080,CDM,610,RC,72149,HCPCS,outpatient,,,3269,1307.60,,725,,,,case rate,pays based on per visit,2517.13,77,,2013.7,percent of total billed charges,77% of total billed charges,336.32,100,,,fee schedule,100% of CMS OPPS rate,2254.47,429,,,fee schedule,429% of BCBS fee schedule,2350.31,515,,,fee schedule,515% of BCBS fee schedule,2350.31,364,,,fee schedule,364% of BCBS fee schedule,2350.31,515,,,fee schedule,515% of BCBS fee schedule,2942.1,90,,2353.68,percent of total billed charges,90% of total billed charges,2615.2,80,,2092.16,percent of total billed charges,80% of total billed charges,2942.1,90,,2353.68,percent of total billed charges,90% of total billed charges,2451.75,75,,1961.4,percent of total billed charges,75% of total billed charges,410.31,122,,,fee schedule,122% of HUMANA fee schedule,948.01,29,,758.408,percent of total billed charges,29% of total billed charges,336.32,100,,,fee schedule,100% of CMS OPPS rate,2190.23,67,,1752.184,percent of total billed charges,67% of total billed charges,406.28,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,2615.2,80,,2092.16,percent of total billed charges,80% of total billed charges,2124.85,65,,1699.88,percent of total billed charges,65% of total billed charges,1166.05,35.67,,932.84,percent of total billed charges,35.67% of total billed charges,336.32,2942.1,
MRI C-SPINE WITH AND W/O CONT,6100090,CDM,610,RC,72156,HCPCS,outpatient,,,4757,1902.80,,725,,,,case rate,pays based on per visit,3662.89,77,,2930.31,percent of total billed charges,77% of total billed charges,336.32,100,,,fee schedule,100% of CMS OPPS rate,2254.47,429,,,fee schedule,429% of BCBS fee schedule,2350.31,515,,,fee schedule,515% of BCBS fee schedule,2350.31,364,,,fee schedule,364% of BCBS fee schedule,2350.31,515,,,fee schedule,515% of BCBS fee schedule,4281.3,90,,3425.04,percent of total billed charges,90% of total billed charges,3805.6,80,,3044.48,percent of total billed charges,80% of total billed charges,4281.3,90,,3425.04,percent of total billed charges,90% of total billed charges,3567.75,75,,2854.2,percent of total billed charges,75% of total billed charges,410.31,122,,,fee schedule,122% of HUMANA fee schedule,1379.53,29,,1103.624,percent of total billed charges,29% of total billed charges,336.32,100,,,fee schedule,100% of CMS OPPS rate,3187.19,67,,2549.752,percent of total billed charges,67% of total billed charges,497.81,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,3805.6,80,,3044.48,percent of total billed charges,80% of total billed charges,3092.05,65,,2473.64,percent of total billed charges,65% of total billed charges,1696.82,35.67,,1357.456,percent of total billed charges,35.67% of total billed charges,336.32,4281.3,
MRI T-SPINE W AND W/O CONTRAST,6100100,CDM,610,RC,72157,HCPCS,outpatient,,,4570,1828.00,,725,,,,case rate,pays based on per visit,3518.9,77,,2815.12,percent of total billed charges,77% of total billed charges,336.32,100,,,fee schedule,100% of CMS OPPS rate,2254.47,429,,,fee schedule,429% of BCBS fee schedule,2350.31,515,,,fee schedule,515% of BCBS fee schedule,2350.31,364,,,fee schedule,364% of BCBS fee schedule,2350.31,515,,,fee schedule,515% of BCBS fee schedule,4113,90,,3290.4,percent of total billed charges,90% of total billed charges,3656,80,,2924.8,percent of total billed charges,80% of total billed charges,4113,90,,3290.4,percent of total billed charges,90% of total billed charges,3427.5,75,,2742,percent of total billed charges,75% of total billed charges,410.31,122,,,fee schedule,122% of HUMANA fee schedule,1325.3,29,,1060.24,percent of total billed charges,29% of total billed charges,336.32,100,,,fee schedule,100% of CMS OPPS rate,3061.9,67,,2449.52,percent of total billed charges,67% of total billed charges,497.81,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,3656,80,,2924.8,percent of total billed charges,80% of total billed charges,2970.5,65,,2376.4,percent of total billed charges,65% of total billed charges,1630.12,35.67,,1304.096,percent of total billed charges,35.67% of total billed charges,336.32,4113,
MRI L SPINE W AND W/O CONT,6100110,CDM,610,RC,72158,HCPCS,outpatient,,,4757,1902.80,,725,,,,case rate,pays based on per visit,3662.89,77,,2930.31,percent of total billed charges,77% of total billed charges,336.32,100,,,fee schedule,100% of CMS OPPS rate,2254.47,429,,,fee schedule,429% of BCBS fee schedule,2350.31,515,,,fee schedule,515% of BCBS fee schedule,2350.31,364,,,fee schedule,364% of BCBS fee schedule,2350.31,515,,,fee schedule,515% of BCBS fee schedule,4281.3,90,,3425.04,percent of total billed charges,90% of total billed charges,3805.6,80,,3044.48,percent of total billed charges,80% of total billed charges,4281.3,90,,3425.04,percent of total billed charges,90% of total billed charges,3567.75,75,,2854.2,percent of total billed charges,75% of total billed charges,410.31,122,,,fee schedule,122% of HUMANA fee schedule,1379.53,29,,1103.624,percent of total billed charges,29% of total billed charges,336.32,100,,,fee schedule,100% of CMS OPPS rate,3187.19,67,,2549.752,percent of total billed charges,67% of total billed charges,497.81,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,3805.6,80,,3044.48,percent of total billed charges,80% of total billed charges,3092.05,65,,2473.64,percent of total billed charges,65% of total billed charges,1696.82,35.67,,1357.456,percent of total billed charges,35.67% of total billed charges,336.32,4281.3,
MRI ANGIO SPINAL CANAL W/O CON,6100120,CDM,610,RC,72159,HCPCS,outpatient,,,4787,1914.80,,725,,,,case rate,pays based on per visit,3685.99,77,,2948.79,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,969.97,385,,,fee schedule,385% of BCBS fee schedule,1010.28,401,,,fee schedule,401% of BCBS fee schedule,1010.28,401,,,fee schedule,401% of BCBS fee schedule,1010.28,401,,,fee schedule,401% of BCBS fee schedule,4308.3,90,,3446.64,percent of total billed charges,90% of total billed charges,3829.6,80,,3063.68,percent of total billed charges,80% of total billed charges,4308.3,90,,3446.64,percent of total billed charges,90% of total billed charges,3590.25,75,,2872.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,1388.23,29,,1110.584,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,3207.29,67,,2565.832,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,3829.6,80,,3063.68,percent of total billed charges,80% of total billed charges,3111.55,65,,2489.24,percent of total billed charges,65% of total billed charges,1707.52,35.67,,1366.016,percent of total billed charges,35.67% of total billed charges,725,4308.3,
MRI ANGIO SPINAL CANAL W/O-W C,6100123,CDM,610,RC,72159,HCPCS,outpatient,,,6731,2692.40,,725,,,,case rate,pays based on per visit,5182.87,77,,4146.3,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,969.97,385,,,fee schedule,385% of BCBS fee schedule,1010.28,401,,,fee schedule,401% of BCBS fee schedule,1010.28,401,,,fee schedule,401% of BCBS fee schedule,1010.28,401,,,fee schedule,401% of BCBS fee schedule,6057.9,90,,4846.32,percent of total billed charges,90% of total billed charges,5384.8,80,,4307.84,percent of total billed charges,80% of total billed charges,6057.9,90,,4846.32,percent of total billed charges,90% of total billed charges,5048.25,75,,4038.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,1951.99,29,,1561.592,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4509.77,67,,3607.816,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,5384.8,80,,4307.84,percent of total billed charges,80% of total billed charges,4375.15,65,,3500.12,percent of total billed charges,65% of total billed charges,2400.95,35.67,,1920.76,percent of total billed charges,35.67% of total billed charges,725,6057.9,
MRI ANGIO SPINAL CANAL W/CONTR,6100125,CDM,610,RC,72159,HCPCS,outpatient,,,5236,2094.40,,725,,,,case rate,pays based on per visit,4031.72,77,,3225.38,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,969.97,385,,,fee schedule,385% of BCBS fee schedule,1010.28,401,,,fee schedule,401% of BCBS fee schedule,1010.28,401,,,fee schedule,401% of BCBS fee schedule,1010.28,401,,,fee schedule,401% of BCBS fee schedule,4712.4,90,,3769.92,percent of total billed charges,90% of total billed charges,4188.8,80,,3351.04,percent of total billed charges,80% of total billed charges,4712.4,90,,3769.92,percent of total billed charges,90% of total billed charges,3927,75,,3141.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,1518.44,29,,1214.752,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,3508.12,67,,2806.496,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,4188.8,80,,3351.04,percent of total billed charges,80% of total billed charges,3403.4,65,,2722.72,percent of total billed charges,65% of total billed charges,1867.68,35.67,,1494.144,percent of total billed charges,35.67% of total billed charges,725,4712.4,
"MRI ORBIT, FACE AND NECK W/O",6100130,CDM,610,RC,70540,HCPCS,outpatient,,,2691,1076.40,,725,,,,case rate,pays based on per visit,2072.07,77,,1657.66,percent of total billed charges,77% of total billed charges,214.29,100,,,fee schedule,100% of CMS OPPS rate,1147.61,429,,,fee schedule,429% of BCBS fee schedule,1196.4,515,,,fee schedule,515% of BCBS fee schedule,1196.4,364,,,fee schedule,364% of BCBS fee schedule,1196.4,515,,,fee schedule,515% of BCBS fee schedule,2421.9,90,,1937.52,percent of total billed charges,90% of total billed charges,2152.8,80,,1722.24,percent of total billed charges,80% of total billed charges,2421.9,90,,1937.52,percent of total billed charges,90% of total billed charges,2018.25,75,,1614.6,percent of total billed charges,75% of total billed charges,261.43,122,,,fee schedule,122% of HUMANA fee schedule,780.39,29,,624.312,percent of total billed charges,29% of total billed charges,214.29,100,,,fee schedule,100% of CMS OPPS rate,1802.97,67,,1442.376,percent of total billed charges,67% of total billed charges,315.45,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,2152.8,80,,1722.24,percent of total billed charges,80% of total billed charges,1749.15,65,,1399.32,percent of total billed charges,65% of total billed charges,959.88,35.67,,767.904,percent of total billed charges,35.67% of total billed charges,214.29,2421.9,
MRI ORBIT/FACE/NECK W/CONTRAST,6100131,CDM,610,RC,70542,HCPCS,outpatient,,,3504,1401.60,,725,,,,case rate,pays based on per visit,2698.08,77,,2158.46,percent of total billed charges,77% of total billed charges,336.32,100,,,fee schedule,100% of CMS OPPS rate,2254.47,429,,,fee schedule,429% of BCBS fee schedule,2350.31,515,,,fee schedule,515% of BCBS fee schedule,2350.31,364,,,fee schedule,364% of BCBS fee schedule,2350.31,515,,,fee schedule,515% of BCBS fee schedule,3153.6,90,,2522.88,percent of total billed charges,90% of total billed charges,2803.2,80,,2242.56,percent of total billed charges,80% of total billed charges,3153.6,90,,2522.88,percent of total billed charges,90% of total billed charges,2628,75,,2102.4,percent of total billed charges,75% of total billed charges,410.31,122,,,fee schedule,122% of HUMANA fee schedule,1016.16,29,,812.928,percent of total billed charges,29% of total billed charges,336.32,100,,,fee schedule,100% of CMS OPPS rate,2347.68,67,,1878.144,percent of total billed charges,67% of total billed charges,406.28,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,2803.2,80,,2242.56,percent of total billed charges,80% of total billed charges,2277.6,65,,1822.08,percent of total billed charges,65% of total billed charges,1249.88,35.67,,999.904,percent of total billed charges,35.67% of total billed charges,336.32,3153.6,
MRI ORBIT/FACE/NECK W & W/O,6100132,CDM,610,RC,70543,HCPCS,outpatient,,,4283,1713.20,,725,,,,case rate,pays based on per visit,3297.91,77,,2638.33,percent of total billed charges,77% of total billed charges,336.32,100,,,fee schedule,100% of CMS OPPS rate,2254.47,429,,,fee schedule,429% of BCBS fee schedule,2350.31,515,,,fee schedule,515% of BCBS fee schedule,2350.31,364,,,fee schedule,364% of BCBS fee schedule,2350.31,515,,,fee schedule,515% of BCBS fee schedule,3854.7,90,,3083.76,percent of total billed charges,90% of total billed charges,3426.4,80,,2741.12,percent of total billed charges,80% of total billed charges,3854.7,90,,3083.76,percent of total billed charges,90% of total billed charges,3212.25,75,,2569.8,percent of total billed charges,75% of total billed charges,410.31,122,,,fee schedule,122% of HUMANA fee schedule,1242.07,29,,993.656,percent of total billed charges,29% of total billed charges,336.32,100,,,fee schedule,100% of CMS OPPS rate,2869.61,67,,2295.688,percent of total billed charges,67% of total billed charges,497.81,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,3426.4,80,,2741.12,percent of total billed charges,80% of total billed charges,2783.95,65,,2227.16,percent of total billed charges,65% of total billed charges,1527.75,35.67,,1222.2,percent of total billed charges,35.67% of total billed charges,336.32,3854.7,
MRA/MRV BRAIN W & W/O CONTRAST,6100140,CDM,610,RC,70546,HCPCS,outpatient,,,6099,2439.60,,725,,,,case rate,pays based on per visit,4696.23,77,,3756.98,percent of total billed charges,77% of total billed charges,336.32,100,,,fee schedule,100% of CMS OPPS rate,2254.47,429,,,fee schedule,429% of BCBS fee schedule,2350.31,515,,,fee schedule,515% of BCBS fee schedule,2350.31,364,,,fee schedule,364% of BCBS fee schedule,2350.31,515,,,fee schedule,515% of BCBS fee schedule,5489.1,90,,4391.28,percent of total billed charges,90% of total billed charges,4879.2,80,,3903.36,percent of total billed charges,80% of total billed charges,5489.1,90,,4391.28,percent of total billed charges,90% of total billed charges,4574.25,75,,3659.4,percent of total billed charges,75% of total billed charges,410.31,122,,,fee schedule,122% of HUMANA fee schedule,1768.71,29,,1414.968,percent of total billed charges,29% of total billed charges,336.32,100,,,fee schedule,100% of CMS OPPS rate,4086.33,67,,3269.064,percent of total billed charges,67% of total billed charges,497.81,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,4879.2,80,,3903.36,percent of total billed charges,80% of total billed charges,3964.35,65,,3171.48,percent of total billed charges,65% of total billed charges,2175.51,35.67,,1740.408,percent of total billed charges,35.67% of total billed charges,336.32,5489.1,
MRA/MRV BRAIN WITH CONTRAST,6100141,CDM,610,RC,70545,HCPCS,outpatient,,,4667,1866.80,,725,,,,case rate,pays based on per visit,3593.59,77,,2874.87,percent of total billed charges,77% of total billed charges,336.32,100,,,fee schedule,100% of CMS OPPS rate,1248.54,429,,,fee schedule,429% of BCBS fee schedule,1301.61,515,,,fee schedule,515% of BCBS fee schedule,1301.61,364,,,fee schedule,364% of BCBS fee schedule,1301.61,515,,,fee schedule,515% of BCBS fee schedule,4200.3,90,,3360.24,percent of total billed charges,90% of total billed charges,3733.6,80,,2986.88,percent of total billed charges,80% of total billed charges,4200.3,90,,3360.24,percent of total billed charges,90% of total billed charges,3500.25,75,,2800.2,percent of total billed charges,75% of total billed charges,410.31,122,,,fee schedule,122% of HUMANA fee schedule,1353.43,29,,1082.744,percent of total billed charges,29% of total billed charges,336.32,100,,,fee schedule,100% of CMS OPPS rate,3126.89,67,,2501.512,percent of total billed charges,67% of total billed charges,406.28,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,3733.6,80,,2986.88,percent of total billed charges,80% of total billed charges,3033.55,65,,2426.84,percent of total billed charges,65% of total billed charges,1664.72,35.67,,1331.776,percent of total billed charges,35.67% of total billed charges,336.32,4200.3,
MRA/MRV BRAIN WITHOUT CONTRAST,6100142,CDM,610,RC,70544,HCPCS,outpatient,,,4757,1902.80,,725,,,,case rate,pays based on per visit,3662.89,77,,2930.31,percent of total billed charges,77% of total billed charges,214.29,100,,,fee schedule,100% of CMS OPPS rate,1147.61,429,,,fee schedule,429% of BCBS fee schedule,1196.4,515,,,fee schedule,515% of BCBS fee schedule,1196.4,364,,,fee schedule,364% of BCBS fee schedule,1196.4,515,,,fee schedule,515% of BCBS fee schedule,4281.3,90,,3425.04,percent of total billed charges,90% of total billed charges,3805.6,80,,3044.48,percent of total billed charges,80% of total billed charges,4281.3,90,,3425.04,percent of total billed charges,90% of total billed charges,3567.75,75,,2854.2,percent of total billed charges,75% of total billed charges,261.43,122,,,fee schedule,122% of HUMANA fee schedule,1379.53,29,,1103.624,percent of total billed charges,29% of total billed charges,214.29,100,,,fee schedule,100% of CMS OPPS rate,3187.19,67,,2549.752,percent of total billed charges,67% of total billed charges,315.45,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,3805.6,80,,3044.48,percent of total billed charges,80% of total billed charges,3092.05,65,,2473.64,percent of total billed charges,65% of total billed charges,1696.82,35.67,,1357.456,percent of total billed charges,35.67% of total billed charges,214.29,4281.3,
MRA NECK WITHOUT CONTRAST,6100143,CDM,610,RC,70547,HCPCS,outpatient,,,3807,1522.80,,725,,,,case rate,pays based on per visit,2931.39,77,,2345.11,percent of total billed charges,77% of total billed charges,214.29,100,,,fee schedule,100% of CMS OPPS rate,1147.61,429,,,fee schedule,429% of BCBS fee schedule,1196.4,515,,,fee schedule,515% of BCBS fee schedule,1196.4,364,,,fee schedule,364% of BCBS fee schedule,1196.4,515,,,fee schedule,515% of BCBS fee schedule,3426.3,90,,2741.04,percent of total billed charges,90% of total billed charges,3045.6,80,,2436.48,percent of total billed charges,80% of total billed charges,3426.3,90,,2741.04,percent of total billed charges,90% of total billed charges,2855.25,75,,2284.2,percent of total billed charges,75% of total billed charges,261.43,122,,,fee schedule,122% of HUMANA fee schedule,1104.03,29,,883.224,percent of total billed charges,29% of total billed charges,214.29,100,,,fee schedule,100% of CMS OPPS rate,2550.69,67,,2040.552,percent of total billed charges,67% of total billed charges,315.45,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,3045.6,80,,2436.48,percent of total billed charges,80% of total billed charges,2474.55,65,,1979.64,percent of total billed charges,65% of total billed charges,1357.96,35.67,,1086.368,percent of total billed charges,35.67% of total billed charges,214.29,3426.3,
MRA NECK WITH CONTRAST,6100144,CDM,610,RC,70548,HCPCS,outpatient,,,3735,1494.00,,725,,,,case rate,pays based on per visit,2875.95,77,,2300.76,percent of total billed charges,77% of total billed charges,336.32,100,,,fee schedule,100% of CMS OPPS rate,1248.54,429,,,fee schedule,429% of BCBS fee schedule,1301.61,515,,,fee schedule,515% of BCBS fee schedule,1301.61,364,,,fee schedule,364% of BCBS fee schedule,1301.61,515,,,fee schedule,515% of BCBS fee schedule,3361.5,90,,2689.2,percent of total billed charges,90% of total billed charges,2988,80,,2390.4,percent of total billed charges,80% of total billed charges,3361.5,90,,2689.2,percent of total billed charges,90% of total billed charges,2801.25,75,,2241,percent of total billed charges,75% of total billed charges,410.31,122,,,fee schedule,122% of HUMANA fee schedule,1083.15,29,,866.52,percent of total billed charges,29% of total billed charges,336.32,100,,,fee schedule,100% of CMS OPPS rate,2502.45,67,,2001.96,percent of total billed charges,67% of total billed charges,406.28,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,2988,80,,2390.4,percent of total billed charges,80% of total billed charges,2427.75,65,,1942.2,percent of total billed charges,65% of total billed charges,1332.27,35.67,,1065.816,percent of total billed charges,35.67% of total billed charges,336.32,3361.5,
MRA NECK WITH & W/OUT CONTRAST,6100145,CDM,610,RC,70549,HCPCS,outpatient,,,5041,2016.40,,725,,,,case rate,pays based on per visit,3881.57,77,,3105.26,percent of total billed charges,77% of total billed charges,336.32,100,,,fee schedule,100% of CMS OPPS rate,2254.47,429,,,fee schedule,429% of BCBS fee schedule,2350.31,515,,,fee schedule,515% of BCBS fee schedule,2350.31,364,,,fee schedule,364% of BCBS fee schedule,2350.31,515,,,fee schedule,515% of BCBS fee schedule,4536.9,90,,3629.52,percent of total billed charges,90% of total billed charges,4032.8,80,,3226.24,percent of total billed charges,80% of total billed charges,4536.9,90,,3629.52,percent of total billed charges,90% of total billed charges,3780.75,75,,3024.6,percent of total billed charges,75% of total billed charges,410.31,122,,,fee schedule,122% of HUMANA fee schedule,1461.89,29,,1169.512,percent of total billed charges,29% of total billed charges,336.32,100,,,fee schedule,100% of CMS OPPS rate,3377.47,67,,2701.976,percent of total billed charges,67% of total billed charges,497.81,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,4032.8,80,,3226.24,percent of total billed charges,80% of total billed charges,3276.65,65,,2621.32,percent of total billed charges,65% of total billed charges,1798.12,35.67,,1438.496,percent of total billed charges,35.67% of total billed charges,336.32,4536.9,
MRI BRAIN WITHOUT CONTRAST,6100150,CDM,610,RC,70551,HCPCS,outpatient,,,3964,1585.60,,725,,,,case rate,pays based on per visit,3052.28,77,,2441.82,percent of total billed charges,77% of total billed charges,214.29,100,,,fee schedule,100% of CMS OPPS rate,1147.61,429,,,fee schedule,429% of BCBS fee schedule,1196.4,515,,,fee schedule,515% of BCBS fee schedule,1196.4,364,,,fee schedule,364% of BCBS fee schedule,1196.4,515,,,fee schedule,515% of BCBS fee schedule,3567.6,90,,2854.08,percent of total billed charges,90% of total billed charges,3171.2,80,,2536.96,percent of total billed charges,80% of total billed charges,3567.6,90,,2854.08,percent of total billed charges,90% of total billed charges,2973,75,,2378.4,percent of total billed charges,75% of total billed charges,261.43,122,,,fee schedule,122% of HUMANA fee schedule,1149.56,29,,919.648,percent of total billed charges,29% of total billed charges,214.29,100,,,fee schedule,100% of CMS OPPS rate,2655.88,67,,2124.704,percent of total billed charges,67% of total billed charges,315.45,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,3171.2,80,,2536.96,percent of total billed charges,80% of total billed charges,2576.6,65,,2061.28,percent of total billed charges,65% of total billed charges,1413.96,35.67,,1131.168,percent of total billed charges,35.67% of total billed charges,214.29,3567.6,
MRI BRAIN WITH CONTRAST,6100160,CDM,610,RC,70552,HCPCS,outpatient,,,4593,1837.20,,725,,,,case rate,pays based on per visit,3536.61,77,,2829.29,percent of total billed charges,77% of total billed charges,336.32,100,,,fee schedule,100% of CMS OPPS rate,1248.54,429,,,fee schedule,429% of BCBS fee schedule,1301.61,515,,,fee schedule,515% of BCBS fee schedule,1301.61,364,,,fee schedule,364% of BCBS fee schedule,1301.61,515,,,fee schedule,515% of BCBS fee schedule,4133.7,90,,3306.96,percent of total billed charges,90% of total billed charges,3674.4,80,,2939.52,percent of total billed charges,80% of total billed charges,4133.7,90,,3306.96,percent of total billed charges,90% of total billed charges,3444.75,75,,2755.8,percent of total billed charges,75% of total billed charges,410.31,122,,,fee schedule,122% of HUMANA fee schedule,1331.97,29,,1065.576,percent of total billed charges,29% of total billed charges,336.32,100,,,fee schedule,100% of CMS OPPS rate,3077.31,67,,2461.848,percent of total billed charges,67% of total billed charges,406.28,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,3674.4,80,,2939.52,percent of total billed charges,80% of total billed charges,2985.45,65,,2388.36,percent of total billed charges,65% of total billed charges,1638.32,35.67,,1310.656,percent of total billed charges,35.67% of total billed charges,336.32,4133.7,
MRI BRAIN WITH & W/O CONTRAST,6100170,CDM,610,RC,70553,HCPCS,outpatient,,,5760,2304.00,,725,,,,case rate,pays based on per visit,4435.2,77,,3548.16,percent of total billed charges,77% of total billed charges,336.32,100,,,fee schedule,100% of CMS OPPS rate,2254.47,429,,,fee schedule,429% of BCBS fee schedule,2350.31,515,,,fee schedule,515% of BCBS fee schedule,2350.31,364,,,fee schedule,364% of BCBS fee schedule,2350.31,515,,,fee schedule,515% of BCBS fee schedule,5184,90,,4147.2,percent of total billed charges,90% of total billed charges,4608,80,,3686.4,percent of total billed charges,80% of total billed charges,5184,90,,4147.2,percent of total billed charges,90% of total billed charges,4320,75,,3456,percent of total billed charges,75% of total billed charges,410.31,122,,,fee schedule,122% of HUMANA fee schedule,1670.4,29,,1336.32,percent of total billed charges,29% of total billed charges,336.32,100,,,fee schedule,100% of CMS OPPS rate,3859.2,67,,3087.36,percent of total billed charges,67% of total billed charges,497.81,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,4608,80,,3686.4,percent of total billed charges,80% of total billed charges,3744,65,,2995.2,percent of total billed charges,65% of total billed charges,2054.59,35.67,,1643.672,percent of total billed charges,35.67% of total billed charges,336.32,5184,
MRI BREAST BIL W/O CONTRAST,6100171,CDM,610,RC,77047,HCPCS,outpatient,,,3756,1502.40,,725,,,,case rate,pays based on per visit,2892.12,77,,2313.7,percent of total billed charges,77% of total billed charges,214.29,100,,,fee schedule,100% of CMS OPPS rate,1138.97,429,,,fee schedule,429% of BCBS fee schedule,1187.38,515,,,fee schedule,515% of BCBS fee schedule,1187.38,364,,,fee schedule,364% of BCBS fee schedule,1187.38,515,,,fee schedule,515% of BCBS fee schedule,3380.4,90,,2704.32,percent of total billed charges,90% of total billed charges,3004.8,80,,2403.84,percent of total billed charges,80% of total billed charges,3380.4,90,,2704.32,percent of total billed charges,90% of total billed charges,2817,75,,2253.6,percent of total billed charges,75% of total billed charges,261.43,122,,,fee schedule,122% of HUMANA fee schedule,1089.24,29,,871.392,percent of total billed charges,29% of total billed charges,214.29,100,,,fee schedule,100% of CMS OPPS rate,2516.52,67,,2013.216,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,3004.8,80,,2403.84,percent of total billed charges,80% of total billed charges,2441.4,65,,1953.12,percent of total billed charges,65% of total billed charges,1339.77,35.67,,1071.816,percent of total billed charges,35.67% of total billed charges,214.29,3380.4,
MRI BREAST BIL W/WO CONTRAST,6100173,CDM,610,RC,77049,HCPCS,outpatient,,,4381,1752.40,,725,,,,case rate,pays based on per visit,3373.37,77,,2698.7,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,1441.39,429,,,fee schedule,429% of BCBS fee schedule,1502.67,515,,,fee schedule,515% of BCBS fee schedule,1502.67,364,,,fee schedule,364% of BCBS fee schedule,1502.67,515,,,fee schedule,515% of BCBS fee schedule,3942.9,90,,3154.32,percent of total billed charges,90% of total billed charges,3504.8,80,,2803.84,percent of total billed charges,80% of total billed charges,3942.9,90,,3154.32,percent of total billed charges,90% of total billed charges,3285.75,75,,2628.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,1270.49,29,,1016.392,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,2935.27,67,,2348.216,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,3504.8,80,,2803.84,percent of total billed charges,80% of total billed charges,2847.65,65,,2278.12,percent of total billed charges,65% of total billed charges,1562.7,35.67,,1250.16,percent of total billed charges,35.67% of total billed charges,725,3942.9,
MRI BREAST W/WO CONTRAST LEFT,6100174,CDM,610,RC,77048,HCPCS,outpatient,,,3685,1474.00,LT,725,,,,case rate,pays based on per visit,2837.45,77,,2269.96,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,1448.46,429,,,fee schedule,429% of BCBS fee schedule,1510.03,515,,,fee schedule,515% of BCBS fee schedule,1510.03,364,,,fee schedule,364% of BCBS fee schedule,1510.03,515,,,fee schedule,515% of BCBS fee schedule,3316.5,90,,2653.2,percent of total billed charges,90% of total billed charges,2948,80,,2358.4,percent of total billed charges,80% of total billed charges,3316.5,90,,2653.2,percent of total billed charges,90% of total billed charges,2763.75,75,,2211,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,1068.65,29,,854.92,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,2468.95,67,,1975.16,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,2948,80,,2358.4,percent of total billed charges,80% of total billed charges,2395.25,65,,1916.2,percent of total billed charges,65% of total billed charges,1314.44,35.67,,1051.552,percent of total billed charges,35.67% of total billed charges,725,3316.5,
MRI BREAST W/WO CONTRAST RIGHT,6100175,CDM,610,RC,77048,HCPCS,outpatient,,,3685,1474.00,RT,725,,,,case rate,pays based on per visit,2837.45,77,,2269.96,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,1448.46,429,,,fee schedule,429% of BCBS fee schedule,1510.03,515,,,fee schedule,515% of BCBS fee schedule,1510.03,364,,,fee schedule,364% of BCBS fee schedule,1510.03,515,,,fee schedule,515% of BCBS fee schedule,3316.5,90,,2653.2,percent of total billed charges,90% of total billed charges,2948,80,,2358.4,percent of total billed charges,80% of total billed charges,3316.5,90,,2653.2,percent of total billed charges,90% of total billed charges,2763.75,75,,2211,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,1068.65,29,,854.92,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,2468.95,67,,1975.16,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,2948,80,,2358.4,percent of total billed charges,80% of total billed charges,2395.25,65,,1916.2,percent of total billed charges,65% of total billed charges,1314.44,35.67,,1051.552,percent of total billed charges,35.67% of total billed charges,725,3316.5,
MRI BREAST W/O CONTRAST LEFT,6100178,CDM,610,RC,77046,HCPCS,outpatient,,,3069,1227.60,LT,725,,,,case rate,pays based on per visit,2363.13,77,,1890.5,percent of total billed charges,77% of total billed charges,214.29,100,,,fee schedule,100% of CMS OPPS rate,1138.97,429,,,fee schedule,429% of BCBS fee schedule,1187.38,515,,,fee schedule,515% of BCBS fee schedule,1187.38,364,,,fee schedule,364% of BCBS fee schedule,1187.38,515,,,fee schedule,515% of BCBS fee schedule,2762.1,90,,2209.68,percent of total billed charges,90% of total billed charges,2455.2,80,,1964.16,percent of total billed charges,80% of total billed charges,2762.1,90,,2209.68,percent of total billed charges,90% of total billed charges,2301.75,75,,1841.4,percent of total billed charges,75% of total billed charges,261.43,122,,,fee schedule,122% of HUMANA fee schedule,890.01,29,,712.008,percent of total billed charges,29% of total billed charges,214.29,100,,,fee schedule,100% of CMS OPPS rate,2056.23,67,,1644.984,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,2455.2,80,,1964.16,percent of total billed charges,80% of total billed charges,1994.85,65,,1595.88,percent of total billed charges,65% of total billed charges,1094.71,35.67,,875.768,percent of total billed charges,35.67% of total billed charges,214.29,2762.1,
MRI BREAST W/O CONTRAST RIGHT,6100179,CDM,610,RC,77046,HCPCS,outpatient,,,3069,1227.60,RT,725,,,,case rate,pays based on per visit,2363.13,77,,1890.5,percent of total billed charges,77% of total billed charges,214.29,100,,,fee schedule,100% of CMS OPPS rate,1138.97,429,,,fee schedule,429% of BCBS fee schedule,1187.38,515,,,fee schedule,515% of BCBS fee schedule,1187.38,364,,,fee schedule,364% of BCBS fee schedule,1187.38,515,,,fee schedule,515% of BCBS fee schedule,2762.1,90,,2209.68,percent of total billed charges,90% of total billed charges,2455.2,80,,1964.16,percent of total billed charges,80% of total billed charges,2762.1,90,,2209.68,percent of total billed charges,90% of total billed charges,2301.75,75,,1841.4,percent of total billed charges,75% of total billed charges,261.43,122,,,fee schedule,122% of HUMANA fee schedule,890.01,29,,712.008,percent of total billed charges,29% of total billed charges,214.29,100,,,fee schedule,100% of CMS OPPS rate,2056.23,67,,1644.984,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,2455.2,80,,1964.16,percent of total billed charges,80% of total billed charges,1994.85,65,,1595.88,percent of total billed charges,65% of total billed charges,1094.71,35.67,,875.768,percent of total billed charges,35.67% of total billed charges,214.29,2762.1,
MRI CHEST WITHOUT CONTRAST,6100180,CDM,610,RC,71550,HCPCS,outpatient,,,2767,1106.80,,725,,,,case rate,pays based on per visit,2130.59,77,,1704.47,percent of total billed charges,77% of total billed charges,214.29,100,,,fee schedule,100% of CMS OPPS rate,1147.61,429,,,fee schedule,429% of BCBS fee schedule,1196.4,515,,,fee schedule,515% of BCBS fee schedule,1196.4,364,,,fee schedule,364% of BCBS fee schedule,1196.4,515,,,fee schedule,515% of BCBS fee schedule,2490.3,90,,1992.24,percent of total billed charges,90% of total billed charges,2213.6,80,,1770.88,percent of total billed charges,80% of total billed charges,2490.3,90,,1992.24,percent of total billed charges,90% of total billed charges,2075.25,75,,1660.2,percent of total billed charges,75% of total billed charges,261.43,122,,,fee schedule,122% of HUMANA fee schedule,802.43,29,,641.944,percent of total billed charges,29% of total billed charges,214.29,100,,,fee schedule,100% of CMS OPPS rate,1853.89,67,,1483.112,percent of total billed charges,67% of total billed charges,315.45,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,2213.6,80,,1770.88,percent of total billed charges,80% of total billed charges,1798.55,65,,1438.84,percent of total billed charges,65% of total billed charges,986.99,35.67,,789.592,percent of total billed charges,35.67% of total billed charges,214.29,2490.3,
MRI CHEST WITH CONTRAST,6100181,CDM,610,RC,71551,HCPCS,outpatient,,,3991,1596.40,,725,,,,case rate,pays based on per visit,3073.07,77,,2458.46,percent of total billed charges,77% of total billed charges,700.21,100,,,fee schedule,100% of CMS OPPS rate,3368.49,429,,,fee schedule,429% of BCBS fee schedule,3511.68,515,,,fee schedule,515% of BCBS fee schedule,3511.68,364,,,fee schedule,364% of BCBS fee schedule,3511.68,515,,,fee schedule,515% of BCBS fee schedule,3591.9,90,,2873.52,percent of total billed charges,90% of total billed charges,3192.8,80,,2554.24,percent of total billed charges,80% of total billed charges,3591.9,90,,2873.52,percent of total billed charges,90% of total billed charges,2993.25,75,,2394.6,percent of total billed charges,75% of total billed charges,854.26,122,,,fee schedule,122% of HUMANA fee schedule,1157.39,29,,925.912,percent of total billed charges,29% of total billed charges,700.21,100,,,fee schedule,100% of CMS OPPS rate,2673.97,67,,2139.176,percent of total billed charges,67% of total billed charges,406.28,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,3192.8,80,,2554.24,percent of total billed charges,80% of total billed charges,2594.15,65,,2075.32,percent of total billed charges,65% of total billed charges,1423.59,35.67,,1138.872,percent of total billed charges,35.67% of total billed charges,406.28,3591.9,
MRI CHEST WITH & W/O CONTRAST,6100182,CDM,610,RC,71552,HCPCS,outpatient,,,3363,1345.20,,725,,,,case rate,pays based on per visit,2589.51,77,,2071.61,percent of total billed charges,77% of total billed charges,336.32,100,,,fee schedule,100% of CMS OPPS rate,2254.47,429,,,fee schedule,429% of BCBS fee schedule,2350.31,515,,,fee schedule,515% of BCBS fee schedule,2350.31,364,,,fee schedule,364% of BCBS fee schedule,2350.31,515,,,fee schedule,515% of BCBS fee schedule,3026.7,90,,2421.36,percent of total billed charges,90% of total billed charges,2690.4,80,,2152.32,percent of total billed charges,80% of total billed charges,3026.7,90,,2421.36,percent of total billed charges,90% of total billed charges,2522.25,75,,2017.8,percent of total billed charges,75% of total billed charges,410.31,122,,,fee schedule,122% of HUMANA fee schedule,975.27,29,,780.216,percent of total billed charges,29% of total billed charges,336.32,100,,,fee schedule,100% of CMS OPPS rate,2253.21,67,,1802.568,percent of total billed charges,67% of total billed charges,497.81,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,2690.4,80,,2152.32,percent of total billed charges,80% of total billed charges,2185.95,65,,1748.76,percent of total billed charges,65% of total billed charges,1199.58,35.67,,959.664,percent of total billed charges,35.67% of total billed charges,336.32,3026.7,
MRI ANGIO OF CHEST W/O-W CONT,6100190,CDM,610,RC,71555,HCPCS,outpatient,,,6731,2692.40,,725,,,,case rate,pays based on per visit,5182.87,77,,4146.3,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,1554.82,429,,,fee schedule,429% of BCBS fee schedule,1620.91,515,,,fee schedule,515% of BCBS fee schedule,1620.91,364,,,fee schedule,364% of BCBS fee schedule,1620.91,515,,,fee schedule,515% of BCBS fee schedule,6057.9,90,,4846.32,percent of total billed charges,90% of total billed charges,5384.8,80,,4307.84,percent of total billed charges,80% of total billed charges,6057.9,90,,4846.32,percent of total billed charges,90% of total billed charges,5048.25,75,,4038.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,1951.99,29,,1561.592,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4509.77,67,,3607.816,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,5384.8,80,,4307.84,percent of total billed charges,80% of total billed charges,4375.15,65,,3500.12,percent of total billed charges,65% of total billed charges,2400.95,35.67,,1920.76,percent of total billed charges,35.67% of total billed charges,725,6057.9,
MRI ANGIO CHEST W/ CONTRAST,6100193,CDM,610,RC,71555,HCPCS,outpatient,,,5236,2094.40,,725,,,,case rate,pays based on per visit,4031.72,77,,3225.38,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,1554.82,429,,,fee schedule,429% of BCBS fee schedule,1620.91,515,,,fee schedule,515% of BCBS fee schedule,1620.91,364,,,fee schedule,364% of BCBS fee schedule,1620.91,515,,,fee schedule,515% of BCBS fee schedule,4712.4,90,,3769.92,percent of total billed charges,90% of total billed charges,4188.8,80,,3351.04,percent of total billed charges,80% of total billed charges,4712.4,90,,3769.92,percent of total billed charges,90% of total billed charges,3927,75,,3141.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,1518.44,29,,1214.752,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,3508.12,67,,2806.496,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,4188.8,80,,3351.04,percent of total billed charges,80% of total billed charges,3403.4,65,,2722.72,percent of total billed charges,65% of total billed charges,1867.68,35.67,,1494.144,percent of total billed charges,35.67% of total billed charges,725,4712.4,
MRI ANGIO CHEST W/O CONTRAST,6100195,CDM,610,RC,71555,HCPCS,outpatient,,,4787,1914.80,,725,,,,case rate,pays based on per visit,3685.99,77,,2948.79,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,1554.82,429,,,fee schedule,429% of BCBS fee schedule,1620.91,515,,,fee schedule,515% of BCBS fee schedule,1620.91,364,,,fee schedule,364% of BCBS fee schedule,1620.91,515,,,fee schedule,515% of BCBS fee schedule,4308.3,90,,3446.64,percent of total billed charges,90% of total billed charges,3829.6,80,,3063.68,percent of total billed charges,80% of total billed charges,4308.3,90,,3446.64,percent of total billed charges,90% of total billed charges,3590.25,75,,2872.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,1388.23,29,,1110.584,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,3207.29,67,,2565.832,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,3829.6,80,,3063.68,percent of total billed charges,80% of total billed charges,3111.55,65,,2489.24,percent of total billed charges,65% of total billed charges,1707.52,35.67,,1366.016,percent of total billed charges,35.67% of total billed charges,725,4308.3,
MRI PELVIS WITHOUT CONTRAST,6100200,CDM,610,RC,72195,HCPCS,outpatient,,,2856,1142.40,,725,,,,case rate,pays based on per visit,2199.12,77,,1759.3,percent of total billed charges,77% of total billed charges,214.29,100,,,fee schedule,100% of CMS OPPS rate,1147.61,429,,,fee schedule,429% of BCBS fee schedule,1196.4,515,,,fee schedule,515% of BCBS fee schedule,1196.4,364,,,fee schedule,364% of BCBS fee schedule,1196.4,515,,,fee schedule,515% of BCBS fee schedule,2570.4,90,,2056.32,percent of total billed charges,90% of total billed charges,2284.8,80,,1827.84,percent of total billed charges,80% of total billed charges,2570.4,90,,2056.32,percent of total billed charges,90% of total billed charges,2142,75,,1713.6,percent of total billed charges,75% of total billed charges,261.43,122,,,fee schedule,122% of HUMANA fee schedule,828.24,29,,662.592,percent of total billed charges,29% of total billed charges,214.29,100,,,fee schedule,100% of CMS OPPS rate,1913.52,67,,1530.816,percent of total billed charges,67% of total billed charges,315.45,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,2284.8,80,,1827.84,percent of total billed charges,80% of total billed charges,1856.4,65,,1485.12,percent of total billed charges,65% of total billed charges,1018.74,35.67,,814.992,percent of total billed charges,35.67% of total billed charges,214.29,2570.4,
MRI PELVIS WITH CONTRAST,6100201,CDM,610,RC,72196,HCPCS,outpatient,,,2951,1180.40,,725,,,,case rate,pays based on per visit,2272.27,77,,1817.82,percent of total billed charges,77% of total billed charges,336.32,100,,,fee schedule,100% of CMS OPPS rate,2254.47,429,,,fee schedule,429% of BCBS fee schedule,2350.31,515,,,fee schedule,515% of BCBS fee schedule,2350.31,364,,,fee schedule,364% of BCBS fee schedule,2350.31,515,,,fee schedule,515% of BCBS fee schedule,2655.9,90,,2124.72,percent of total billed charges,90% of total billed charges,2360.8,80,,1888.64,percent of total billed charges,80% of total billed charges,2655.9,90,,2124.72,percent of total billed charges,90% of total billed charges,2213.25,75,,1770.6,percent of total billed charges,75% of total billed charges,410.31,122,,,fee schedule,122% of HUMANA fee schedule,855.79,29,,684.632,percent of total billed charges,29% of total billed charges,336.32,100,,,fee schedule,100% of CMS OPPS rate,1977.17,67,,1581.736,percent of total billed charges,67% of total billed charges,406.28,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,2360.8,80,,1888.64,percent of total billed charges,80% of total billed charges,1918.15,65,,1534.52,percent of total billed charges,65% of total billed charges,1052.62,35.67,,842.096,percent of total billed charges,35.67% of total billed charges,336.32,2655.9,
MRI PELVIS WITH & W/O CONTRAST,6100202,CDM,610,RC,72197,HCPCS,outpatient,,,3427,1370.80,,725,,,,case rate,pays based on per visit,2638.79,77,,2111.03,percent of total billed charges,77% of total billed charges,336.32,100,,,fee schedule,100% of CMS OPPS rate,2254.47,429,,,fee schedule,429% of BCBS fee schedule,2350.31,515,,,fee schedule,515% of BCBS fee schedule,2350.31,364,,,fee schedule,364% of BCBS fee schedule,2350.31,515,,,fee schedule,515% of BCBS fee schedule,3084.3,90,,2467.44,percent of total billed charges,90% of total billed charges,2741.6,80,,2193.28,percent of total billed charges,80% of total billed charges,3084.3,90,,2467.44,percent of total billed charges,90% of total billed charges,2570.25,75,,2056.2,percent of total billed charges,75% of total billed charges,410.31,122,,,fee schedule,122% of HUMANA fee schedule,993.83,29,,795.064,percent of total billed charges,29% of total billed charges,336.32,100,,,fee schedule,100% of CMS OPPS rate,2296.09,67,,1836.872,percent of total billed charges,67% of total billed charges,497.81,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,2741.6,80,,2193.28,percent of total billed charges,80% of total billed charges,2227.55,65,,1782.04,percent of total billed charges,65% of total billed charges,1222.41,35.67,,977.928,percent of total billed charges,35.67% of total billed charges,336.32,3084.3,
MRI ANGIO OF PELVIS W/O-W CONT,6100210,CDM,610,RC,72198,HCPCS,outpatient,,,6731,2692.40,,725,,,,case rate,pays based on per visit,5182.87,77,,4146.3,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,1563.71,429,,,fee schedule,429% of BCBS fee schedule,1630.18,515,,,fee schedule,515% of BCBS fee schedule,1630.18,364,,,fee schedule,364% of BCBS fee schedule,1630.18,515,,,fee schedule,515% of BCBS fee schedule,6057.9,90,,4846.32,percent of total billed charges,90% of total billed charges,5384.8,80,,4307.84,percent of total billed charges,80% of total billed charges,6057.9,90,,4846.32,percent of total billed charges,90% of total billed charges,5048.25,75,,4038.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,1951.99,29,,1561.592,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4509.77,67,,3607.816,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,5384.8,80,,4307.84,percent of total billed charges,80% of total billed charges,4375.15,65,,3500.12,percent of total billed charges,65% of total billed charges,2400.95,35.67,,1920.76,percent of total billed charges,35.67% of total billed charges,725,6057.9,
MRI ANGIO PELVIS W/ CONTRAST,6100213,CDM,610,RC,72198,HCPCS,outpatient,,,5236,2094.40,,725,,,,case rate,pays based on per visit,4031.72,77,,3225.38,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,1563.71,429,,,fee schedule,429% of BCBS fee schedule,1630.18,515,,,fee schedule,515% of BCBS fee schedule,1630.18,364,,,fee schedule,364% of BCBS fee schedule,1630.18,515,,,fee schedule,515% of BCBS fee schedule,4712.4,90,,3769.92,percent of total billed charges,90% of total billed charges,4188.8,80,,3351.04,percent of total billed charges,80% of total billed charges,4712.4,90,,3769.92,percent of total billed charges,90% of total billed charges,3927,75,,3141.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,1518.44,29,,1214.752,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,3508.12,67,,2806.496,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,4188.8,80,,3351.04,percent of total billed charges,80% of total billed charges,3403.4,65,,2722.72,percent of total billed charges,65% of total billed charges,1867.68,35.67,,1494.144,percent of total billed charges,35.67% of total billed charges,725,4712.4,
MRI ANGIO PELVIS W/O CONTRAST,6100215,CDM,610,RC,72198,HCPCS,outpatient,,,4787,1914.80,,725,,,,case rate,pays based on per visit,3685.99,77,,2948.79,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,1563.71,429,,,fee schedule,429% of BCBS fee schedule,1630.18,515,,,fee schedule,515% of BCBS fee schedule,1630.18,364,,,fee schedule,364% of BCBS fee schedule,1630.18,515,,,fee schedule,515% of BCBS fee schedule,4308.3,90,,3446.64,percent of total billed charges,90% of total billed charges,3829.6,80,,3063.68,percent of total billed charges,80% of total billed charges,4308.3,90,,3446.64,percent of total billed charges,90% of total billed charges,3590.25,75,,2872.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,1388.23,29,,1110.584,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,3207.29,67,,2565.832,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,3829.6,80,,3063.68,percent of total billed charges,80% of total billed charges,3111.55,65,,2489.24,percent of total billed charges,65% of total billed charges,1707.52,35.67,,1366.016,percent of total billed charges,35.67% of total billed charges,725,4308.3,
MRI UPPER EXT WITHOUT CONTRAST,6100220,CDM,610,RC,73218,HCPCS,outpatient,,,2000,800.00,,725,,,,case rate,pays based on per visit,1540,77,,1232,percent of total billed charges,77% of total billed charges,214.29,100,,,fee schedule,100% of CMS OPPS rate,1147.61,429,,,fee schedule,429% of BCBS fee schedule,1196.4,515,,,fee schedule,515% of BCBS fee schedule,1196.4,364,,,fee schedule,364% of BCBS fee schedule,1196.4,515,,,fee schedule,515% of BCBS fee schedule,1800,90,,1440,percent of total billed charges,90% of total billed charges,1600,80,,1280,percent of total billed charges,80% of total billed charges,1800,90,,1440,percent of total billed charges,90% of total billed charges,1500,75,,1200,percent of total billed charges,75% of total billed charges,261.43,122,,,fee schedule,122% of HUMANA fee schedule,580,29,,464,percent of total billed charges,29% of total billed charges,214.29,100,,,fee schedule,100% of CMS OPPS rate,1340,67,,1072,percent of total billed charges,67% of total billed charges,315.45,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,1600,80,,1280,percent of total billed charges,80% of total billed charges,1300,65,,1040,percent of total billed charges,65% of total billed charges,713.4,35.67,,570.72,percent of total billed charges,35.67% of total billed charges,214.29,1800,
MRI UPPER EXT WITH CONTRAST,6100221,CDM,610,RC,73219,HCPCS,outpatient,,,2672,1068.80,,725,,,,case rate,pays based on per visit,2057.44,77,,1645.95,percent of total billed charges,77% of total billed charges,336.32,100,,,fee schedule,100% of CMS OPPS rate,2254.47,429,,,fee schedule,429% of BCBS fee schedule,2350.31,515,,,fee schedule,515% of BCBS fee schedule,2350.31,364,,,fee schedule,364% of BCBS fee schedule,2350.31,515,,,fee schedule,515% of BCBS fee schedule,2404.8,90,,1923.84,percent of total billed charges,90% of total billed charges,2137.6,80,,1710.08,percent of total billed charges,80% of total billed charges,2404.8,90,,1923.84,percent of total billed charges,90% of total billed charges,2004,75,,1603.2,percent of total billed charges,75% of total billed charges,410.31,122,,,fee schedule,122% of HUMANA fee schedule,774.88,29,,619.904,percent of total billed charges,29% of total billed charges,336.32,100,,,fee schedule,100% of CMS OPPS rate,1790.24,67,,1432.192,percent of total billed charges,67% of total billed charges,406.28,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,2137.6,80,,1710.08,percent of total billed charges,80% of total billed charges,1736.8,65,,1389.44,percent of total billed charges,65% of total billed charges,953.1,35.67,,762.48,percent of total billed charges,35.67% of total billed charges,336.32,2404.8,
MRI UPPER EXT WITH AND WITHOUT,6100222,CDM,610,RC,73220,HCPCS,outpatient,,,3363,1345.20,,725,,,,case rate,pays based on per visit,2589.51,77,,2071.61,percent of total billed charges,77% of total billed charges,336.32,100,,,fee schedule,100% of CMS OPPS rate,2254.47,429,,,fee schedule,429% of BCBS fee schedule,2350.31,515,,,fee schedule,515% of BCBS fee schedule,2350.31,364,,,fee schedule,364% of BCBS fee schedule,2350.31,515,,,fee schedule,515% of BCBS fee schedule,3026.7,90,,2421.36,percent of total billed charges,90% of total billed charges,2690.4,80,,2152.32,percent of total billed charges,80% of total billed charges,3026.7,90,,2421.36,percent of total billed charges,90% of total billed charges,2522.25,75,,2017.8,percent of total billed charges,75% of total billed charges,410.31,122,,,fee schedule,122% of HUMANA fee schedule,975.27,29,,780.216,percent of total billed charges,29% of total billed charges,336.32,100,,,fee schedule,100% of CMS OPPS rate,2253.21,67,,1802.568,percent of total billed charges,67% of total billed charges,497.81,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,2690.4,80,,2152.32,percent of total billed charges,80% of total billed charges,2185.95,65,,1748.76,percent of total billed charges,65% of total billed charges,1199.58,35.67,,959.664,percent of total billed charges,35.67% of total billed charges,336.32,3026.7,
MRI UPPER EXT JOINT W/O CONT.,6100230,CDM,610,RC,73221,HCPCS,outpatient,,,2856,1142.40,,725,,,,case rate,pays based on per visit,2199.12,77,,1759.3,percent of total billed charges,77% of total billed charges,214.29,100,,,fee schedule,100% of CMS OPPS rate,1147.61,429,,,fee schedule,429% of BCBS fee schedule,1196.4,515,,,fee schedule,515% of BCBS fee schedule,1196.4,364,,,fee schedule,364% of BCBS fee schedule,1196.4,515,,,fee schedule,515% of BCBS fee schedule,2570.4,90,,2056.32,percent of total billed charges,90% of total billed charges,2284.8,80,,1827.84,percent of total billed charges,80% of total billed charges,2570.4,90,,2056.32,percent of total billed charges,90% of total billed charges,2142,75,,1713.6,percent of total billed charges,75% of total billed charges,261.43,122,,,fee schedule,122% of HUMANA fee schedule,828.24,29,,662.592,percent of total billed charges,29% of total billed charges,214.29,100,,,fee schedule,100% of CMS OPPS rate,1913.52,67,,1530.816,percent of total billed charges,67% of total billed charges,315.45,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,2284.8,80,,1827.84,percent of total billed charges,80% of total billed charges,1856.4,65,,1485.12,percent of total billed charges,65% of total billed charges,1018.74,35.67,,814.992,percent of total billed charges,35.67% of total billed charges,214.29,2570.4,
MRI UPPER EXT JOINT WITH CONT.,6100231,CDM,610,RC,73222,HCPCS,outpatient,,,3991,1596.40,,725,,,,case rate,pays based on per visit,3073.07,77,,2458.46,percent of total billed charges,77% of total billed charges,700.21,100,,,fee schedule,100% of CMS OPPS rate,3368.49,429,,,fee schedule,429% of BCBS fee schedule,3511.68,515,,,fee schedule,515% of BCBS fee schedule,3511.68,364,,,fee schedule,364% of BCBS fee schedule,3511.68,515,,,fee schedule,515% of BCBS fee schedule,3591.9,90,,2873.52,percent of total billed charges,90% of total billed charges,3192.8,80,,2554.24,percent of total billed charges,80% of total billed charges,3591.9,90,,2873.52,percent of total billed charges,90% of total billed charges,2993.25,75,,2394.6,percent of total billed charges,75% of total billed charges,854.26,122,,,fee schedule,122% of HUMANA fee schedule,1157.39,29,,925.912,percent of total billed charges,29% of total billed charges,700.21,100,,,fee schedule,100% of CMS OPPS rate,2673.97,67,,2139.176,percent of total billed charges,67% of total billed charges,406.28,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,3192.8,80,,2554.24,percent of total billed charges,80% of total billed charges,2594.15,65,,2075.32,percent of total billed charges,65% of total billed charges,1423.59,35.67,,1138.872,percent of total billed charges,35.67% of total billed charges,406.28,3591.9,
MRI UPPER EXT JOINT W/O & WITH,6100232,CDM,610,RC,73223,HCPCS,outpatient,,,4201,1680.40,,725,,,,case rate,pays based on per visit,3234.77,77,,2587.82,percent of total billed charges,77% of total billed charges,336.32,100,,,fee schedule,100% of CMS OPPS rate,2254.47,429,,,fee schedule,429% of BCBS fee schedule,2350.31,515,,,fee schedule,515% of BCBS fee schedule,2350.31,364,,,fee schedule,364% of BCBS fee schedule,2350.31,515,,,fee schedule,515% of BCBS fee schedule,3780.9,90,,3024.72,percent of total billed charges,90% of total billed charges,3360.8,80,,2688.64,percent of total billed charges,80% of total billed charges,3780.9,90,,3024.72,percent of total billed charges,90% of total billed charges,3150.75,75,,2520.6,percent of total billed charges,75% of total billed charges,410.31,122,,,fee schedule,122% of HUMANA fee schedule,1218.29,29,,974.632,percent of total billed charges,29% of total billed charges,336.32,100,,,fee schedule,100% of CMS OPPS rate,2814.67,67,,2251.736,percent of total billed charges,67% of total billed charges,497.81,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,3360.8,80,,2688.64,percent of total billed charges,80% of total billed charges,2730.65,65,,2184.52,percent of total billed charges,65% of total billed charges,1498.5,35.67,,1198.8,percent of total billed charges,35.67% of total billed charges,336.32,3780.9,
MRI ANGIO UPPER EXTY W/O-W CON,6100240,CDM,610,RC,73225,HCPCS,outpatient,,,6731,2692.40,,725,,,,case rate,pays based on per visit,5182.87,77,,4146.3,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,1244.58,429,,,fee schedule,429% of BCBS fee schedule,1297.49,515,,,fee schedule,515% of BCBS fee schedule,1297.49,364,,,fee schedule,364% of BCBS fee schedule,1297.49,515,,,fee schedule,515% of BCBS fee schedule,6057.9,90,,4846.32,percent of total billed charges,90% of total billed charges,5384.8,80,,4307.84,percent of total billed charges,80% of total billed charges,6057.9,90,,4846.32,percent of total billed charges,90% of total billed charges,5048.25,75,,4038.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,1951.99,29,,1561.592,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4509.77,67,,3607.816,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,5384.8,80,,4307.84,percent of total billed charges,80% of total billed charges,4375.15,65,,3500.12,percent of total billed charges,65% of total billed charges,2400.95,35.67,,1920.76,percent of total billed charges,35.67% of total billed charges,725,6057.9,
MRI ANGIO UPPER EXTY W/O CONT,6100243,CDM,610,RC,73225,HCPCS,outpatient,,,4787,1914.80,,725,,,,case rate,pays based on per visit,3685.99,77,,2948.79,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,1244.58,429,,,fee schedule,429% of BCBS fee schedule,1297.49,515,,,fee schedule,515% of BCBS fee schedule,1297.49,364,,,fee schedule,364% of BCBS fee schedule,1297.49,515,,,fee schedule,515% of BCBS fee schedule,4308.3,90,,3446.64,percent of total billed charges,90% of total billed charges,3829.6,80,,3063.68,percent of total billed charges,80% of total billed charges,4308.3,90,,3446.64,percent of total billed charges,90% of total billed charges,3590.25,75,,2872.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,1388.23,29,,1110.584,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,3207.29,67,,2565.832,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,3829.6,80,,3063.68,percent of total billed charges,80% of total billed charges,3111.55,65,,2489.24,percent of total billed charges,65% of total billed charges,1707.52,35.67,,1366.016,percent of total billed charges,35.67% of total billed charges,725,4308.3,
MRI ANGIO UPPER EXTY W/ CONT,6100245,CDM,610,RC,73225,HCPCS,outpatient,,,5236,2094.40,,725,,,,case rate,pays based on per visit,4031.72,77,,3225.38,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,1244.58,429,,,fee schedule,429% of BCBS fee schedule,1297.49,515,,,fee schedule,515% of BCBS fee schedule,1297.49,364,,,fee schedule,364% of BCBS fee schedule,1297.49,515,,,fee schedule,515% of BCBS fee schedule,4712.4,90,,3769.92,percent of total billed charges,90% of total billed charges,4188.8,80,,3351.04,percent of total billed charges,80% of total billed charges,4712.4,90,,3769.92,percent of total billed charges,90% of total billed charges,3927,75,,3141.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,1518.44,29,,1214.752,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,3508.12,67,,2806.496,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,4188.8,80,,3351.04,percent of total billed charges,80% of total billed charges,3403.4,65,,2722.72,percent of total billed charges,65% of total billed charges,1867.68,35.67,,1494.144,percent of total billed charges,35.67% of total billed charges,725,4712.4,
MRI LOWER EXTREMITY W/O CONT.,6100250,CDM,610,RC,73718,HCPCS,outpatient,,,2856,1142.40,,725,,,,case rate,pays based on per visit,2199.12,77,,1759.3,percent of total billed charges,77% of total billed charges,214.29,100,,,fee schedule,100% of CMS OPPS rate,1147.61,429,,,fee schedule,429% of BCBS fee schedule,1196.4,515,,,fee schedule,515% of BCBS fee schedule,1196.4,364,,,fee schedule,364% of BCBS fee schedule,1196.4,515,,,fee schedule,515% of BCBS fee schedule,2570.4,90,,2056.32,percent of total billed charges,90% of total billed charges,2284.8,80,,1827.84,percent of total billed charges,80% of total billed charges,2570.4,90,,2056.32,percent of total billed charges,90% of total billed charges,2142,75,,1713.6,percent of total billed charges,75% of total billed charges,261.43,122,,,fee schedule,122% of HUMANA fee schedule,828.24,29,,662.592,percent of total billed charges,29% of total billed charges,214.29,100,,,fee schedule,100% of CMS OPPS rate,1913.52,67,,1530.816,percent of total billed charges,67% of total billed charges,315.45,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,2284.8,80,,1827.84,percent of total billed charges,80% of total billed charges,1856.4,65,,1485.12,percent of total billed charges,65% of total billed charges,1018.74,35.67,,814.992,percent of total billed charges,35.67% of total billed charges,214.29,2570.4,
MRI LOWER EXTREMITY WITH CONT.,6100251,CDM,610,RC,73719,HCPCS,outpatient,,,3269,1307.60,,725,,,,case rate,pays based on per visit,2517.13,77,,2013.7,percent of total billed charges,77% of total billed charges,336.32,100,,,fee schedule,100% of CMS OPPS rate,1248.54,429,,,fee schedule,429% of BCBS fee schedule,1301.61,515,,,fee schedule,515% of BCBS fee schedule,1301.61,364,,,fee schedule,364% of BCBS fee schedule,1301.61,515,,,fee schedule,515% of BCBS fee schedule,2942.1,90,,2353.68,percent of total billed charges,90% of total billed charges,2615.2,80,,2092.16,percent of total billed charges,80% of total billed charges,2942.1,90,,2353.68,percent of total billed charges,90% of total billed charges,2451.75,75,,1961.4,percent of total billed charges,75% of total billed charges,410.31,122,,,fee schedule,122% of HUMANA fee schedule,948.01,29,,758.408,percent of total billed charges,29% of total billed charges,336.32,100,,,fee schedule,100% of CMS OPPS rate,2190.23,67,,1752.184,percent of total billed charges,67% of total billed charges,406.28,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,2615.2,80,,2092.16,percent of total billed charges,80% of total billed charges,2124.85,65,,1699.88,percent of total billed charges,65% of total billed charges,1166.05,35.67,,932.84,percent of total billed charges,35.67% of total billed charges,336.32,2942.1,
MRI LOWER EXTREMITY W/O & WITH,6100252,CDM,610,RC,73720,HCPCS,outpatient,,,3427,1370.80,,725,,,,case rate,pays based on per visit,2638.79,77,,2111.03,percent of total billed charges,77% of total billed charges,336.32,100,,,fee schedule,100% of CMS OPPS rate,2254.47,429,,,fee schedule,429% of BCBS fee schedule,2350.31,515,,,fee schedule,515% of BCBS fee schedule,2350.31,364,,,fee schedule,364% of BCBS fee schedule,2350.31,515,,,fee schedule,515% of BCBS fee schedule,3084.3,90,,2467.44,percent of total billed charges,90% of total billed charges,2741.6,80,,2193.28,percent of total billed charges,80% of total billed charges,3084.3,90,,2467.44,percent of total billed charges,90% of total billed charges,2570.25,75,,2056.2,percent of total billed charges,75% of total billed charges,410.31,122,,,fee schedule,122% of HUMANA fee schedule,993.83,29,,795.064,percent of total billed charges,29% of total billed charges,336.32,100,,,fee schedule,100% of CMS OPPS rate,2296.09,67,,1836.872,percent of total billed charges,67% of total billed charges,497.81,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,2741.6,80,,2193.28,percent of total billed charges,80% of total billed charges,2227.55,65,,1782.04,percent of total billed charges,65% of total billed charges,1222.41,35.67,,977.928,percent of total billed charges,35.67% of total billed charges,336.32,3084.3,
MRI LOWER EXTREMITY JOINT W/O,6100260,CDM,610,RC,73721,HCPCS,outpatient,,,2595,1038.00,,725,,,,case rate,pays based on per visit,1998.15,77,,1598.52,percent of total billed charges,77% of total billed charges,214.29,100,,,fee schedule,100% of CMS OPPS rate,1147.61,429,,,fee schedule,429% of BCBS fee schedule,1196.4,515,,,fee schedule,515% of BCBS fee schedule,1196.4,364,,,fee schedule,364% of BCBS fee schedule,1196.4,515,,,fee schedule,515% of BCBS fee schedule,2335.5,90,,1868.4,percent of total billed charges,90% of total billed charges,2076,80,,1660.8,percent of total billed charges,80% of total billed charges,2335.5,90,,1868.4,percent of total billed charges,90% of total billed charges,1946.25,75,,1557,percent of total billed charges,75% of total billed charges,261.43,122,,,fee schedule,122% of HUMANA fee schedule,752.55,29,,602.04,percent of total billed charges,29% of total billed charges,214.29,100,,,fee schedule,100% of CMS OPPS rate,1738.65,67,,1390.92,percent of total billed charges,67% of total billed charges,315.45,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,2076,80,,1660.8,percent of total billed charges,80% of total billed charges,1686.75,65,,1349.4,percent of total billed charges,65% of total billed charges,925.64,35.67,,740.512,percent of total billed charges,35.67% of total billed charges,214.29,2335.5,
MRI LOWER EXT JOINT WITH CONT.,6100261,CDM,610,RC,73722,HCPCS,outpatient,,,3991,1596.40,,725,,,,case rate,pays based on per visit,3073.07,77,,2458.46,percent of total billed charges,77% of total billed charges,700.21,100,,,fee schedule,100% of CMS OPPS rate,3368.49,429,,,fee schedule,429% of BCBS fee schedule,3511.68,515,,,fee schedule,515% of BCBS fee schedule,3511.68,364,,,fee schedule,364% of BCBS fee schedule,3511.68,515,,,fee schedule,515% of BCBS fee schedule,3591.9,90,,2873.52,percent of total billed charges,90% of total billed charges,3192.8,80,,2554.24,percent of total billed charges,80% of total billed charges,3591.9,90,,2873.52,percent of total billed charges,90% of total billed charges,2993.25,75,,2394.6,percent of total billed charges,75% of total billed charges,854.26,122,,,fee schedule,122% of HUMANA fee schedule,1157.39,29,,925.912,percent of total billed charges,29% of total billed charges,700.21,100,,,fee schedule,100% of CMS OPPS rate,2673.97,67,,2139.176,percent of total billed charges,67% of total billed charges,406.28,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,3192.8,80,,2554.24,percent of total billed charges,80% of total billed charges,2594.15,65,,2075.32,percent of total billed charges,65% of total billed charges,1423.59,35.67,,1138.872,percent of total billed charges,35.67% of total billed charges,406.28,3591.9,
MRI LOWER EXT JOINT W & W/O,6100262,CDM,610,RC,73723,HCPCS,outpatient,,,4283,1713.20,LTRT,725,,,,case rate,pays based on per visit,3297.91,77,,2638.33,percent of total billed charges,77% of total billed charges,336.32,100,,,fee schedule,100% of CMS OPPS rate,2254.47,429,,,fee schedule,429% of BCBS fee schedule,2350.31,515,,,fee schedule,515% of BCBS fee schedule,2350.31,364,,,fee schedule,364% of BCBS fee schedule,2350.31,515,,,fee schedule,515% of BCBS fee schedule,3854.7,90,,3083.76,percent of total billed charges,90% of total billed charges,3426.4,80,,2741.12,percent of total billed charges,80% of total billed charges,3854.7,90,,3083.76,percent of total billed charges,90% of total billed charges,3212.25,75,,2569.8,percent of total billed charges,75% of total billed charges,410.31,122,,,fee schedule,122% of HUMANA fee schedule,1242.07,29,,993.656,percent of total billed charges,29% of total billed charges,336.32,100,,,fee schedule,100% of CMS OPPS rate,2869.61,67,,2295.688,percent of total billed charges,67% of total billed charges,497.81,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,3426.4,80,,2741.12,percent of total billed charges,80% of total billed charges,2783.95,65,,2227.16,percent of total billed charges,65% of total billed charges,1527.75,35.67,,1222.2,percent of total billed charges,35.67% of total billed charges,336.32,3854.7,
MRI ANGIO LOWER EXTY W/O-W CON,6100270,CDM,610,RC,73725,HCPCS,outpatient,,,6731,2692.40,,725,,,,case rate,pays based on per visit,5182.87,77,,4146.3,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,1560.15,429,,,fee schedule,429% of BCBS fee schedule,1626.47,515,,,fee schedule,515% of BCBS fee schedule,1626.47,364,,,fee schedule,364% of BCBS fee schedule,1626.47,515,,,fee schedule,515% of BCBS fee schedule,6057.9,90,,4846.32,percent of total billed charges,90% of total billed charges,5384.8,80,,4307.84,percent of total billed charges,80% of total billed charges,6057.9,90,,4846.32,percent of total billed charges,90% of total billed charges,5048.25,75,,4038.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,1951.99,29,,1561.592,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4509.77,67,,3607.816,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,5384.8,80,,4307.84,percent of total billed charges,80% of total billed charges,4375.15,65,,3500.12,percent of total billed charges,65% of total billed charges,2400.95,35.67,,1920.76,percent of total billed charges,35.67% of total billed charges,725,6057.9,
MRI ANGIO LOWER EXTY W/ CONTRA,6100273,CDM,610,RC,73725,HCPCS,outpatient,,,5236,2094.40,,725,,,,case rate,pays based on per visit,4031.72,77,,3225.38,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,1560.15,429,,,fee schedule,429% of BCBS fee schedule,1626.47,515,,,fee schedule,515% of BCBS fee schedule,1626.47,364,,,fee schedule,364% of BCBS fee schedule,1626.47,515,,,fee schedule,515% of BCBS fee schedule,4712.4,90,,3769.92,percent of total billed charges,90% of total billed charges,4188.8,80,,3351.04,percent of total billed charges,80% of total billed charges,4712.4,90,,3769.92,percent of total billed charges,90% of total billed charges,3927,75,,3141.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,1518.44,29,,1214.752,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,3508.12,67,,2806.496,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,4188.8,80,,3351.04,percent of total billed charges,80% of total billed charges,3403.4,65,,2722.72,percent of total billed charges,65% of total billed charges,1867.68,35.67,,1494.144,percent of total billed charges,35.67% of total billed charges,725,4712.4,
MRI ANGIO LOWER EXTY W/O CONT,6100275,CDM,610,RC,73725,HCPCS,outpatient,,,4787,1914.80,,725,,,,case rate,pays based on per visit,3685.99,77,,2948.79,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,1560.15,429,,,fee schedule,429% of BCBS fee schedule,1626.47,515,,,fee schedule,515% of BCBS fee schedule,1626.47,364,,,fee schedule,364% of BCBS fee schedule,1626.47,515,,,fee schedule,515% of BCBS fee schedule,4308.3,90,,3446.64,percent of total billed charges,90% of total billed charges,3829.6,80,,3063.68,percent of total billed charges,80% of total billed charges,4308.3,90,,3446.64,percent of total billed charges,90% of total billed charges,3590.25,75,,2872.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,1388.23,29,,1110.584,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,3207.29,67,,2565.832,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,3829.6,80,,3063.68,percent of total billed charges,80% of total billed charges,3111.55,65,,2489.24,percent of total billed charges,65% of total billed charges,1707.52,35.67,,1366.016,percent of total billed charges,35.67% of total billed charges,725,4308.3,
MRI ABDOMEN WITHOUT CONTRAST,6100280,CDM,610,RC,74181,HCPCS,outpatient,,,2856,1142.40,,725,,,,case rate,pays based on per visit,2199.12,77,,1759.3,percent of total billed charges,77% of total billed charges,214.29,100,,,fee schedule,100% of CMS OPPS rate,1147.61,429,,,fee schedule,429% of BCBS fee schedule,1196.4,515,,,fee schedule,515% of BCBS fee schedule,1196.4,364,,,fee schedule,364% of BCBS fee schedule,1196.4,515,,,fee schedule,515% of BCBS fee schedule,2570.4,90,,2056.32,percent of total billed charges,90% of total billed charges,2284.8,80,,1827.84,percent of total billed charges,80% of total billed charges,2570.4,90,,2056.32,percent of total billed charges,90% of total billed charges,2142,75,,1713.6,percent of total billed charges,75% of total billed charges,261.43,122,,,fee schedule,122% of HUMANA fee schedule,828.24,29,,662.592,percent of total billed charges,29% of total billed charges,214.29,100,,,fee schedule,100% of CMS OPPS rate,1913.52,67,,1530.816,percent of total billed charges,67% of total billed charges,315.45,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,2284.8,80,,1827.84,percent of total billed charges,80% of total billed charges,1856.4,65,,1485.12,percent of total billed charges,65% of total billed charges,1018.74,35.67,,814.992,percent of total billed charges,35.67% of total billed charges,214.29,2570.4,
MRI ABDOMEN WITH CONTRAST,6100281,CDM,610,RC,74182,HCPCS,outpatient,,,3269,1307.60,,725,,,,case rate,pays based on per visit,2517.13,77,,2013.7,percent of total billed charges,77% of total billed charges,336.32,100,,,fee schedule,100% of CMS OPPS rate,2254.47,429,,,fee schedule,429% of BCBS fee schedule,2350.31,515,,,fee schedule,515% of BCBS fee schedule,2350.31,364,,,fee schedule,364% of BCBS fee schedule,2350.31,515,,,fee schedule,515% of BCBS fee schedule,2942.1,90,,2353.68,percent of total billed charges,90% of total billed charges,2615.2,80,,2092.16,percent of total billed charges,80% of total billed charges,2942.1,90,,2353.68,percent of total billed charges,90% of total billed charges,2451.75,75,,1961.4,percent of total billed charges,75% of total billed charges,410.31,122,,,fee schedule,122% of HUMANA fee schedule,948.01,29,,758.408,percent of total billed charges,29% of total billed charges,336.32,100,,,fee schedule,100% of CMS OPPS rate,2190.23,67,,1752.184,percent of total billed charges,67% of total billed charges,406.28,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,2615.2,80,,2092.16,percent of total billed charges,80% of total billed charges,2124.85,65,,1699.88,percent of total billed charges,65% of total billed charges,1166.05,35.67,,932.84,percent of total billed charges,35.67% of total billed charges,336.32,2942.1,
MRI ABDOMEN W/O AND WITH CONT,6100282,CDM,610,RC,74183,HCPCS,outpatient,,,4283,1713.20,,725,,,,case rate,pays based on per visit,3297.91,77,,2638.33,percent of total billed charges,77% of total billed charges,336.32,100,,,fee schedule,100% of CMS OPPS rate,2254.47,429,,,fee schedule,429% of BCBS fee schedule,2350.31,515,,,fee schedule,515% of BCBS fee schedule,2350.31,364,,,fee schedule,364% of BCBS fee schedule,2350.31,515,,,fee schedule,515% of BCBS fee schedule,3854.7,90,,3083.76,percent of total billed charges,90% of total billed charges,3426.4,80,,2741.12,percent of total billed charges,80% of total billed charges,3854.7,90,,3083.76,percent of total billed charges,90% of total billed charges,3212.25,75,,2569.8,percent of total billed charges,75% of total billed charges,410.31,122,,,fee schedule,122% of HUMANA fee schedule,1242.07,29,,993.656,percent of total billed charges,29% of total billed charges,336.32,100,,,fee schedule,100% of CMS OPPS rate,2869.61,67,,2295.688,percent of total billed charges,67% of total billed charges,497.81,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,3426.4,80,,2741.12,percent of total billed charges,80% of total billed charges,2783.95,65,,2227.16,percent of total billed charges,65% of total billed charges,1527.75,35.67,,1222.2,percent of total billed charges,35.67% of total billed charges,336.32,3854.7,
MRI ANGIO OF ABDOMEN W OR W/O,6100290,CDM,610,RC,74185,HCPCS,outpatient,,,2616,1046.40,,725,,,,case rate,pays based on per visit,2014.32,77,,1611.46,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,1574.33,429,,,fee schedule,429% of BCBS fee schedule,1641.25,515,,,fee schedule,515% of BCBS fee schedule,1641.25,364,,,fee schedule,364% of BCBS fee schedule,1641.25,515,,,fee schedule,515% of BCBS fee schedule,2354.4,90,,1883.52,percent of total billed charges,90% of total billed charges,2092.8,80,,1674.24,percent of total billed charges,80% of total billed charges,2354.4,90,,1883.52,percent of total billed charges,90% of total billed charges,1962,75,,1569.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,758.64,29,,606.912,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1752.72,67,,1402.176,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,2092.8,80,,1674.24,percent of total billed charges,80% of total billed charges,1700.4,65,,1360.32,percent of total billed charges,65% of total billed charges,933.13,35.67,,746.504,percent of total billed charges,35.67% of total billed charges,725,2354.4,
MRI CARDIAC MORPHOLOGY W/O,6100300,CDM,610,RC,75557,HCPCS,outpatient,,,2616,1046.40,,725,,,,case rate,pays based on per visit,2014.32,77,,1611.46,percent of total billed charges,77% of total billed charges,214.29,100,,,fee schedule,100% of CMS OPPS rate,1147.61,429,,,fee schedule,429% of BCBS fee schedule,1196.4,515,,,fee schedule,515% of BCBS fee schedule,1196.4,364,,,fee schedule,364% of BCBS fee schedule,1196.4,515,,,fee schedule,515% of BCBS fee schedule,2354.4,90,,1883.52,percent of total billed charges,90% of total billed charges,2092.8,80,,1674.24,percent of total billed charges,80% of total billed charges,2354.4,90,,1883.52,percent of total billed charges,90% of total billed charges,1962,75,,1569.6,percent of total billed charges,75% of total billed charges,261.43,122,,,fee schedule,122% of HUMANA fee schedule,758.64,29,,606.912,percent of total billed charges,29% of total billed charges,214.29,100,,,fee schedule,100% of CMS OPPS rate,1752.72,67,,1402.176,percent of total billed charges,67% of total billed charges,315.45,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,2092.8,80,,1674.24,percent of total billed charges,80% of total billed charges,1700.4,65,,1360.32,percent of total billed charges,65% of total billed charges,933.13,35.67,,746.504,percent of total billed charges,35.67% of total billed charges,214.29,2354.4,
MRI BONE MARROW BLOOD SUPPLY,6100350,CDM,610,RC,77084,HCPCS,outpatient,,,1963,785.20,,725,,,,case rate,pays based on per visit,1511.51,77,,1209.21,percent of total billed charges,77% of total billed charges,214.29,100,,,fee schedule,100% of CMS OPPS rate,1209.11,429,,,fee schedule,429% of BCBS fee schedule,1260.51,515,,,fee schedule,515% of BCBS fee schedule,1260.51,364,,,fee schedule,364% of BCBS fee schedule,1260.51,515,,,fee schedule,515% of BCBS fee schedule,1766.7,90,,1413.36,percent of total billed charges,90% of total billed charges,1570.4,80,,1256.32,percent of total billed charges,80% of total billed charges,1766.7,90,,1413.36,percent of total billed charges,90% of total billed charges,1472.25,75,,1177.8,percent of total billed charges,75% of total billed charges,261.43,122,,,fee schedule,122% of HUMANA fee schedule,569.27,29,,455.416,percent of total billed charges,29% of total billed charges,214.29,100,,,fee schedule,100% of CMS OPPS rate,1315.21,67,,1052.168,percent of total billed charges,67% of total billed charges,315.45,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,1570.4,80,,1256.32,percent of total billed charges,80% of total billed charges,1275.95,65,,1020.76,percent of total billed charges,65% of total billed charges,700.2,35.67,,560.16,percent of total billed charges,35.67% of total billed charges,214.29,1766.7,
MRI-VENOGRAPHY HEAD W/CONTRAST,6100381,CDM,610,RC,70545,HCPCS,outpatient,,,2725,1090.00,,725,,,,case rate,pays based on per visit,2098.25,77,,1678.6,percent of total billed charges,77% of total billed charges,336.32,100,,,fee schedule,100% of CMS OPPS rate,1248.54,429,,,fee schedule,429% of BCBS fee schedule,1301.61,515,,,fee schedule,515% of BCBS fee schedule,1301.61,364,,,fee schedule,364% of BCBS fee schedule,1301.61,515,,,fee schedule,515% of BCBS fee schedule,2452.5,90,,1962,percent of total billed charges,90% of total billed charges,2180,80,,1744,percent of total billed charges,80% of total billed charges,2452.5,90,,1962,percent of total billed charges,90% of total billed charges,2043.75,75,,1635,percent of total billed charges,75% of total billed charges,410.31,122,,,fee schedule,122% of HUMANA fee schedule,790.25,29,,632.2,percent of total billed charges,29% of total billed charges,336.32,100,,,fee schedule,100% of CMS OPPS rate,1825.75,67,,1460.6,percent of total billed charges,67% of total billed charges,406.28,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,2180,80,,1744,percent of total billed charges,80% of total billed charges,1771.25,65,,1417,percent of total billed charges,65% of total billed charges,972.01,35.67,,777.608,percent of total billed charges,35.67% of total billed charges,336.32,2452.5,
MRI PROSTATE WITH CONTRAST,6100385,CDM,610,RC,72196,HCPCS,outpatient,,,3199,1279.60,,725,,,,case rate,pays based on per visit,2463.23,77,,1970.58,percent of total billed charges,77% of total billed charges,336.32,100,,,fee schedule,100% of CMS OPPS rate,2254.47,429,,,fee schedule,429% of BCBS fee schedule,2350.31,515,,,fee schedule,515% of BCBS fee schedule,2350.31,364,,,fee schedule,364% of BCBS fee schedule,2350.31,515,,,fee schedule,515% of BCBS fee schedule,2879.1,90,,2303.28,percent of total billed charges,90% of total billed charges,2559.2,80,,2047.36,percent of total billed charges,80% of total billed charges,2879.1,90,,2303.28,percent of total billed charges,90% of total billed charges,2399.25,75,,1919.4,percent of total billed charges,75% of total billed charges,410.31,122,,,fee schedule,122% of HUMANA fee schedule,927.71,29,,742.168,percent of total billed charges,29% of total billed charges,336.32,100,,,fee schedule,100% of CMS OPPS rate,2143.33,67,,1714.664,percent of total billed charges,67% of total billed charges,406.28,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,2559.2,80,,2047.36,percent of total billed charges,80% of total billed charges,2079.35,65,,1663.48,percent of total billed charges,65% of total billed charges,1141.08,35.67,,912.864,percent of total billed charges,35.67% of total billed charges,336.32,2879.1,
MRI PROSTATE WITHOUT CONTRAST,6100386,CDM,610,RC,72195,HCPCS,outpatient,,,2829,1131.60,,725,,,,case rate,pays based on per visit,2178.33,77,,1742.66,percent of total billed charges,77% of total billed charges,214.29,100,,,fee schedule,100% of CMS OPPS rate,1147.61,429,,,fee schedule,429% of BCBS fee schedule,1196.4,515,,,fee schedule,515% of BCBS fee schedule,1196.4,364,,,fee schedule,364% of BCBS fee schedule,1196.4,515,,,fee schedule,515% of BCBS fee schedule,2546.1,90,,2036.88,percent of total billed charges,90% of total billed charges,2263.2,80,,1810.56,percent of total billed charges,80% of total billed charges,2546.1,90,,2036.88,percent of total billed charges,90% of total billed charges,2121.75,75,,1697.4,percent of total billed charges,75% of total billed charges,261.43,122,,,fee schedule,122% of HUMANA fee schedule,820.41,29,,656.328,percent of total billed charges,29% of total billed charges,214.29,100,,,fee schedule,100% of CMS OPPS rate,1895.43,67,,1516.344,percent of total billed charges,67% of total billed charges,315.45,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,2263.2,80,,1810.56,percent of total billed charges,80% of total billed charges,1838.85,65,,1471.08,percent of total billed charges,65% of total billed charges,1009.1,35.67,,807.28,percent of total billed charges,35.67% of total billed charges,214.29,2546.1,
MRI PROSTATE WITH/WO CONTRAST,6100387,CDM,610,RC,72197,HCPCS,outpatient,,,4012,1604.80,,725,,,,case rate,pays based on per visit,3089.24,77,,2471.39,percent of total billed charges,77% of total billed charges,336.32,100,,,fee schedule,100% of CMS OPPS rate,2254.47,429,,,fee schedule,429% of BCBS fee schedule,2350.31,515,,,fee schedule,515% of BCBS fee schedule,2350.31,364,,,fee schedule,364% of BCBS fee schedule,2350.31,515,,,fee schedule,515% of BCBS fee schedule,3610.8,90,,2888.64,percent of total billed charges,90% of total billed charges,3209.6,80,,2567.68,percent of total billed charges,80% of total billed charges,3610.8,90,,2888.64,percent of total billed charges,90% of total billed charges,3009,75,,2407.2,percent of total billed charges,75% of total billed charges,410.31,122,,,fee schedule,122% of HUMANA fee schedule,1163.48,29,,930.784,percent of total billed charges,29% of total billed charges,336.32,100,,,fee schedule,100% of CMS OPPS rate,2688.04,67,,2150.432,percent of total billed charges,67% of total billed charges,497.81,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,3209.6,80,,2567.68,percent of total billed charges,80% of total billed charges,2607.8,65,,2086.24,percent of total billed charges,65% of total billed charges,1431.08,35.67,,1144.864,percent of total billed charges,35.67% of total billed charges,336.32,3610.8,
MR ANGIO ABDOMEN W/CONTRAST,6101000,CDM,610,RC,74185,HCPCS,outpatient,,,2616,1046.40,,725,,,,case rate,pays based on per visit,2014.32,77,,1611.46,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,1574.33,429,,,fee schedule,429% of BCBS fee schedule,1641.25,515,,,fee schedule,515% of BCBS fee schedule,1641.25,364,,,fee schedule,364% of BCBS fee schedule,1641.25,515,,,fee schedule,515% of BCBS fee schedule,2354.4,90,,1883.52,percent of total billed charges,90% of total billed charges,2092.8,80,,1674.24,percent of total billed charges,80% of total billed charges,2354.4,90,,1883.52,percent of total billed charges,90% of total billed charges,1962,75,,1569.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,758.64,29,,606.912,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1752.72,67,,1402.176,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,2092.8,80,,1674.24,percent of total billed charges,80% of total billed charges,1700.4,65,,1360.32,percent of total billed charges,65% of total billed charges,933.13,35.67,,746.504,percent of total billed charges,35.67% of total billed charges,725,2354.4,
MR ANGIO ABDOMEN W/O CONTRAST,6101001,CDM,610,RC,74185,HCPCS,outpatient,,,2616,1046.40,,725,,,,case rate,pays based on per visit,2014.32,77,,1611.46,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,1574.33,429,,,fee schedule,429% of BCBS fee schedule,1641.25,515,,,fee schedule,515% of BCBS fee schedule,1641.25,364,,,fee schedule,364% of BCBS fee schedule,1641.25,515,,,fee schedule,515% of BCBS fee schedule,2354.4,90,,1883.52,percent of total billed charges,90% of total billed charges,2092.8,80,,1674.24,percent of total billed charges,80% of total billed charges,2354.4,90,,1883.52,percent of total billed charges,90% of total billed charges,1962,75,,1569.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,758.64,29,,606.912,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1752.72,67,,1402.176,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,2092.8,80,,1674.24,percent of total billed charges,80% of total billed charges,1700.4,65,,1360.32,percent of total billed charges,65% of total billed charges,933.13,35.67,,746.504,percent of total billed charges,35.67% of total billed charges,725,2354.4,
MR ANGIO LE BI W/CONTRAST,6101002,CDM,610,RC,73725,HCPCS,outpatient,,,5236,2094.40,50,725,,,,case rate,pays based on per visit,4031.72,77,,3225.38,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,1560.15,429,,,fee schedule,429% of BCBS fee schedule,1626.47,515,,,fee schedule,515% of BCBS fee schedule,1626.47,364,,,fee schedule,364% of BCBS fee schedule,1626.47,515,,,fee schedule,515% of BCBS fee schedule,4712.4,90,,3769.92,percent of total billed charges,90% of total billed charges,4188.8,80,,3351.04,percent of total billed charges,80% of total billed charges,4712.4,90,,3769.92,percent of total billed charges,90% of total billed charges,3927,75,,3141.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,1518.44,29,,1214.752,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,3508.12,67,,2806.496,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,4188.8,80,,3351.04,percent of total billed charges,80% of total billed charges,3403.4,65,,2722.72,percent of total billed charges,65% of total billed charges,1867.68,35.67,,1494.144,percent of total billed charges,35.67% of total billed charges,725,4712.4,
MR ANGIO LE BI W/WO CONTRAST,6101003,CDM,610,RC,73725,HCPCS,outpatient,,,4787,1914.80,50,725,,,,case rate,pays based on per visit,3685.99,77,,2948.79,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,1560.15,429,,,fee schedule,429% of BCBS fee schedule,1626.47,515,,,fee schedule,515% of BCBS fee schedule,1626.47,364,,,fee schedule,364% of BCBS fee schedule,1626.47,515,,,fee schedule,515% of BCBS fee schedule,4308.3,90,,3446.64,percent of total billed charges,90% of total billed charges,3829.6,80,,3063.68,percent of total billed charges,80% of total billed charges,4308.3,90,,3446.64,percent of total billed charges,90% of total billed charges,3590.25,75,,2872.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,1388.23,29,,1110.584,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,3207.29,67,,2565.832,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,3829.6,80,,3063.68,percent of total billed charges,80% of total billed charges,3111.55,65,,2489.24,percent of total billed charges,65% of total billed charges,1707.52,35.67,,1366.016,percent of total billed charges,35.67% of total billed charges,725,4308.3,
MR ANGIO LE BI W/WO CONTRAST,6101004,CDM,610,RC,73725,HCPCS,outpatient,,,6731,2692.40,50,725,,,,case rate,pays based on per visit,5182.87,77,,4146.3,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,1560.15,429,,,fee schedule,429% of BCBS fee schedule,1626.47,515,,,fee schedule,515% of BCBS fee schedule,1626.47,364,,,fee schedule,364% of BCBS fee schedule,1626.47,515,,,fee schedule,515% of BCBS fee schedule,6057.9,90,,4846.32,percent of total billed charges,90% of total billed charges,5384.8,80,,4307.84,percent of total billed charges,80% of total billed charges,6057.9,90,,4846.32,percent of total billed charges,90% of total billed charges,5048.25,75,,4038.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,1951.99,29,,1561.592,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4509.77,67,,3607.816,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,5384.8,80,,4307.84,percent of total billed charges,80% of total billed charges,4375.15,65,,3500.12,percent of total billed charges,65% of total billed charges,2400.95,35.67,,1920.76,percent of total billed charges,35.67% of total billed charges,725,6057.9,
MR ANGIO LE LT W/CONTRAST,6101005,CDM,610,RC,73725,HCPCS,outpatient,,,5236,2094.40,LT,725,,,,case rate,pays based on per visit,4031.72,77,,3225.38,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,1560.15,429,,,fee schedule,429% of BCBS fee schedule,1626.47,515,,,fee schedule,515% of BCBS fee schedule,1626.47,364,,,fee schedule,364% of BCBS fee schedule,1626.47,515,,,fee schedule,515% of BCBS fee schedule,4712.4,90,,3769.92,percent of total billed charges,90% of total billed charges,4188.8,80,,3351.04,percent of total billed charges,80% of total billed charges,4712.4,90,,3769.92,percent of total billed charges,90% of total billed charges,3927,75,,3141.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,1518.44,29,,1214.752,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,3508.12,67,,2806.496,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,4188.8,80,,3351.04,percent of total billed charges,80% of total billed charges,3403.4,65,,2722.72,percent of total billed charges,65% of total billed charges,1867.68,35.67,,1494.144,percent of total billed charges,35.67% of total billed charges,725,4712.4,
MR ANGIO LE LT W/WO CONTRAST,6101006,CDM,610,RC,73725,HCPCS,outpatient,,,4787,1914.80,LT,725,,,,case rate,pays based on per visit,3685.99,77,,2948.79,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,1560.15,429,,,fee schedule,429% of BCBS fee schedule,1626.47,515,,,fee schedule,515% of BCBS fee schedule,1626.47,364,,,fee schedule,364% of BCBS fee schedule,1626.47,515,,,fee schedule,515% of BCBS fee schedule,4308.3,90,,3446.64,percent of total billed charges,90% of total billed charges,3829.6,80,,3063.68,percent of total billed charges,80% of total billed charges,4308.3,90,,3446.64,percent of total billed charges,90% of total billed charges,3590.25,75,,2872.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,1388.23,29,,1110.584,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,3207.29,67,,2565.832,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,3829.6,80,,3063.68,percent of total billed charges,80% of total billed charges,3111.55,65,,2489.24,percent of total billed charges,65% of total billed charges,1707.52,35.67,,1366.016,percent of total billed charges,35.67% of total billed charges,725,4308.3,
MR ANGIO LE LT W/WO CONTRAST,6101007,CDM,610,RC,73725,HCPCS,outpatient,,,6731,2692.40,LT,725,,,,case rate,pays based on per visit,5182.87,77,,4146.3,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,1560.15,429,,,fee schedule,429% of BCBS fee schedule,1626.47,515,,,fee schedule,515% of BCBS fee schedule,1626.47,364,,,fee schedule,364% of BCBS fee schedule,1626.47,515,,,fee schedule,515% of BCBS fee schedule,6057.9,90,,4846.32,percent of total billed charges,90% of total billed charges,5384.8,80,,4307.84,percent of total billed charges,80% of total billed charges,6057.9,90,,4846.32,percent of total billed charges,90% of total billed charges,5048.25,75,,4038.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,1951.99,29,,1561.592,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4509.77,67,,3607.816,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,5384.8,80,,4307.84,percent of total billed charges,80% of total billed charges,4375.15,65,,3500.12,percent of total billed charges,65% of total billed charges,2400.95,35.67,,1920.76,percent of total billed charges,35.67% of total billed charges,725,6057.9,
MR ANGIO LE RT W/CONTRAST,6101008,CDM,610,RC,73725,HCPCS,outpatient,,,5236,2094.40,RT,725,,,,case rate,pays based on per visit,4031.72,77,,3225.38,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,1560.15,429,,,fee schedule,429% of BCBS fee schedule,1626.47,515,,,fee schedule,515% of BCBS fee schedule,1626.47,364,,,fee schedule,364% of BCBS fee schedule,1626.47,515,,,fee schedule,515% of BCBS fee schedule,4712.4,90,,3769.92,percent of total billed charges,90% of total billed charges,4188.8,80,,3351.04,percent of total billed charges,80% of total billed charges,4712.4,90,,3769.92,percent of total billed charges,90% of total billed charges,3927,75,,3141.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,1518.44,29,,1214.752,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,3508.12,67,,2806.496,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,4188.8,80,,3351.04,percent of total billed charges,80% of total billed charges,3403.4,65,,2722.72,percent of total billed charges,65% of total billed charges,1867.68,35.67,,1494.144,percent of total billed charges,35.67% of total billed charges,725,4712.4,
MR ANGIO LE RT W/O CONTRAST,6101009,CDM,610,RC,73725,HCPCS,outpatient,,,4787,1914.80,RT,725,,,,case rate,pays based on per visit,3685.99,77,,2948.79,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,1560.15,429,,,fee schedule,429% of BCBS fee schedule,1626.47,515,,,fee schedule,515% of BCBS fee schedule,1626.47,364,,,fee schedule,364% of BCBS fee schedule,1626.47,515,,,fee schedule,515% of BCBS fee schedule,4308.3,90,,3446.64,percent of total billed charges,90% of total billed charges,3829.6,80,,3063.68,percent of total billed charges,80% of total billed charges,4308.3,90,,3446.64,percent of total billed charges,90% of total billed charges,3590.25,75,,2872.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,1388.23,29,,1110.584,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,3207.29,67,,2565.832,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,3829.6,80,,3063.68,percent of total billed charges,80% of total billed charges,3111.55,65,,2489.24,percent of total billed charges,65% of total billed charges,1707.52,35.67,,1366.016,percent of total billed charges,35.67% of total billed charges,725,4308.3,
MR ANGIO LE RT W/WO CONTRAST,6101010,CDM,610,RC,73725,HCPCS,outpatient,,,6731,2692.40,RT,725,,,,case rate,pays based on per visit,5182.87,77,,4146.3,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,1560.15,429,,,fee schedule,429% of BCBS fee schedule,1626.47,515,,,fee schedule,515% of BCBS fee schedule,1626.47,364,,,fee schedule,364% of BCBS fee schedule,1626.47,515,,,fee schedule,515% of BCBS fee schedule,6057.9,90,,4846.32,percent of total billed charges,90% of total billed charges,5384.8,80,,4307.84,percent of total billed charges,80% of total billed charges,6057.9,90,,4846.32,percent of total billed charges,90% of total billed charges,5048.25,75,,4038.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,1951.99,29,,1561.592,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4509.77,67,,3607.816,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,5384.8,80,,4307.84,percent of total billed charges,80% of total billed charges,4375.15,65,,3500.12,percent of total billed charges,65% of total billed charges,2400.95,35.67,,1920.76,percent of total billed charges,35.67% of total billed charges,725,6057.9,
MR ANGIO UE LT W/WO CONTRAST,6101011,CDM,610,RC,73225,HCPCS,outpatient,,,6731,2692.40,LT,725,,,,case rate,pays based on per visit,5182.87,77,,4146.3,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,1244.58,429,,,fee schedule,429% of BCBS fee schedule,1297.49,515,,,fee schedule,515% of BCBS fee schedule,1297.49,364,,,fee schedule,364% of BCBS fee schedule,1297.49,515,,,fee schedule,515% of BCBS fee schedule,6057.9,90,,4846.32,percent of total billed charges,90% of total billed charges,5384.8,80,,4307.84,percent of total billed charges,80% of total billed charges,6057.9,90,,4846.32,percent of total billed charges,90% of total billed charges,5048.25,75,,4038.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,1951.99,29,,1561.592,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4509.77,67,,3607.816,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,5384.8,80,,4307.84,percent of total billed charges,80% of total billed charges,4375.15,65,,3500.12,percent of total billed charges,65% of total billed charges,2400.95,35.67,,1920.76,percent of total billed charges,35.67% of total billed charges,725,6057.9,
MR ANGIO UE RT W/WO CONTRAST,6101012,CDM,610,RC,73225,HCPCS,outpatient,,,6731,2692.40,RT,725,,,,case rate,pays based on per visit,5182.87,77,,4146.3,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,1244.58,429,,,fee schedule,429% of BCBS fee schedule,1297.49,515,,,fee schedule,515% of BCBS fee schedule,1297.49,364,,,fee schedule,364% of BCBS fee schedule,1297.49,515,,,fee schedule,515% of BCBS fee schedule,6057.9,90,,4846.32,percent of total billed charges,90% of total billed charges,5384.8,80,,4307.84,percent of total billed charges,80% of total billed charges,6057.9,90,,4846.32,percent of total billed charges,90% of total billed charges,5048.25,75,,4038.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,1951.99,29,,1561.592,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4509.77,67,,3607.816,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,5384.8,80,,4307.84,percent of total billed charges,80% of total billed charges,4375.15,65,,3500.12,percent of total billed charges,65% of total billed charges,2400.95,35.67,,1920.76,percent of total billed charges,35.67% of total billed charges,725,6057.9,
MR BREAST BI W/CONTRAST,6101013,CDM,610,RC,77049,HCPCS,outpatient,,,4381,1752.40,50,725,,,,case rate,pays based on per visit,3373.37,77,,2698.7,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,1441.39,429,,,fee schedule,429% of BCBS fee schedule,1502.67,515,,,fee schedule,515% of BCBS fee schedule,1502.67,364,,,fee schedule,364% of BCBS fee schedule,1502.67,515,,,fee schedule,515% of BCBS fee schedule,3942.9,90,,3154.32,percent of total billed charges,90% of total billed charges,3504.8,80,,2803.84,percent of total billed charges,80% of total billed charges,3942.9,90,,3154.32,percent of total billed charges,90% of total billed charges,3285.75,75,,2628.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,1270.49,29,,1016.392,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,2935.27,67,,2348.216,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,3504.8,80,,2803.84,percent of total billed charges,80% of total billed charges,2847.65,65,,2278.12,percent of total billed charges,65% of total billed charges,1562.7,35.67,,1250.16,percent of total billed charges,35.67% of total billed charges,725,3942.9,
MR BREAST LT W/CONTRAST,6101014,CDM,610,RC,77048,HCPCS,outpatient,,,2163,865.20,LT,725,,,,case rate,pays based on per visit,1665.51,77,,1332.41,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,1448.46,429,,,fee schedule,429% of BCBS fee schedule,1510.03,515,,,fee schedule,515% of BCBS fee schedule,1510.03,364,,,fee schedule,364% of BCBS fee schedule,1510.03,515,,,fee schedule,515% of BCBS fee schedule,1946.7,90,,1557.36,percent of total billed charges,90% of total billed charges,1730.4,80,,1384.32,percent of total billed charges,80% of total billed charges,1946.7,90,,1557.36,percent of total billed charges,90% of total billed charges,1622.25,75,,1297.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,627.27,29,,501.816,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1449.21,67,,1159.368,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1730.4,80,,1384.32,percent of total billed charges,80% of total billed charges,1405.95,65,,1124.76,percent of total billed charges,65% of total billed charges,771.54,35.67,,617.232,percent of total billed charges,35.67% of total billed charges,627.27,1946.7,
MR BREAST RT W/CONTRAST,6101015,CDM,610,RC,77048,HCPCS,outpatient,,,2163,865.20,RT,725,,,,case rate,pays based on per visit,1665.51,77,,1332.41,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,1448.46,429,,,fee schedule,429% of BCBS fee schedule,1510.03,515,,,fee schedule,515% of BCBS fee schedule,1510.03,364,,,fee schedule,364% of BCBS fee schedule,1510.03,515,,,fee schedule,515% of BCBS fee schedule,1946.7,90,,1557.36,percent of total billed charges,90% of total billed charges,1730.4,80,,1384.32,percent of total billed charges,80% of total billed charges,1946.7,90,,1557.36,percent of total billed charges,90% of total billed charges,1622.25,75,,1297.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,627.27,29,,501.816,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1449.21,67,,1159.368,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1730.4,80,,1384.32,percent of total billed charges,80% of total billed charges,1405.95,65,,1124.76,percent of total billed charges,65% of total billed charges,771.54,35.67,,617.232,percent of total billed charges,35.67% of total billed charges,627.27,1946.7,
MR FACE W/CONTRAST,6101016,CDM,610,RC,70542,HCPCS,outpatient,,,3504,1401.60,,725,,,,case rate,pays based on per visit,2698.08,77,,2158.46,percent of total billed charges,77% of total billed charges,336.32,100,,,fee schedule,100% of CMS OPPS rate,2254.47,429,,,fee schedule,429% of BCBS fee schedule,2350.31,515,,,fee schedule,515% of BCBS fee schedule,2350.31,364,,,fee schedule,364% of BCBS fee schedule,2350.31,515,,,fee schedule,515% of BCBS fee schedule,3153.6,90,,2522.88,percent of total billed charges,90% of total billed charges,2803.2,80,,2242.56,percent of total billed charges,80% of total billed charges,3153.6,90,,2522.88,percent of total billed charges,90% of total billed charges,2628,75,,2102.4,percent of total billed charges,75% of total billed charges,410.31,122,,,fee schedule,122% of HUMANA fee schedule,1016.16,29,,812.928,percent of total billed charges,29% of total billed charges,336.32,100,,,fee schedule,100% of CMS OPPS rate,2347.68,67,,1878.144,percent of total billed charges,67% of total billed charges,406.28,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,2803.2,80,,2242.56,percent of total billed charges,80% of total billed charges,2277.6,65,,1822.08,percent of total billed charges,65% of total billed charges,1249.88,35.67,,999.904,percent of total billed charges,35.67% of total billed charges,336.32,3153.6,
MR FACE W/OUT CONTRAST,6101017,CDM,610,RC,70540,HCPCS,outpatient,,,2691,1076.40,,725,,,,case rate,pays based on per visit,2072.07,77,,1657.66,percent of total billed charges,77% of total billed charges,214.29,100,,,fee schedule,100% of CMS OPPS rate,1147.61,429,,,fee schedule,429% of BCBS fee schedule,1196.4,515,,,fee schedule,515% of BCBS fee schedule,1196.4,364,,,fee schedule,364% of BCBS fee schedule,1196.4,515,,,fee schedule,515% of BCBS fee schedule,2421.9,90,,1937.52,percent of total billed charges,90% of total billed charges,2152.8,80,,1722.24,percent of total billed charges,80% of total billed charges,2421.9,90,,1937.52,percent of total billed charges,90% of total billed charges,2018.25,75,,1614.6,percent of total billed charges,75% of total billed charges,261.43,122,,,fee schedule,122% of HUMANA fee schedule,780.39,29,,624.312,percent of total billed charges,29% of total billed charges,214.29,100,,,fee schedule,100% of CMS OPPS rate,1802.97,67,,1442.376,percent of total billed charges,67% of total billed charges,315.45,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,2152.8,80,,1722.24,percent of total billed charges,80% of total billed charges,1749.15,65,,1399.32,percent of total billed charges,65% of total billed charges,959.88,35.67,,767.904,percent of total billed charges,35.67% of total billed charges,214.29,2421.9,
MR FACE W/WO CONTRAST,6101018,CDM,610,RC,70543,HCPCS,outpatient,,,4283,1713.20,,725,,,,case rate,pays based on per visit,3297.91,77,,2638.33,percent of total billed charges,77% of total billed charges,336.32,100,,,fee schedule,100% of CMS OPPS rate,2254.47,429,,,fee schedule,429% of BCBS fee schedule,2350.31,515,,,fee schedule,515% of BCBS fee schedule,2350.31,364,,,fee schedule,364% of BCBS fee schedule,2350.31,515,,,fee schedule,515% of BCBS fee schedule,3854.7,90,,3083.76,percent of total billed charges,90% of total billed charges,3426.4,80,,2741.12,percent of total billed charges,80% of total billed charges,3854.7,90,,3083.76,percent of total billed charges,90% of total billed charges,3212.25,75,,2569.8,percent of total billed charges,75% of total billed charges,410.31,122,,,fee schedule,122% of HUMANA fee schedule,1242.07,29,,993.656,percent of total billed charges,29% of total billed charges,336.32,100,,,fee schedule,100% of CMS OPPS rate,2869.61,67,,2295.688,percent of total billed charges,67% of total billed charges,497.81,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,3426.4,80,,2741.12,percent of total billed charges,80% of total billed charges,2783.95,65,,2227.16,percent of total billed charges,65% of total billed charges,1527.75,35.67,,1222.2,percent of total billed charges,35.67% of total billed charges,336.32,3854.7,
MR MRCP,6101019,CDM,610,RC,74181,HCPCS,outpatient,,,2856,1142.40,,725,,,,case rate,pays based on per visit,2199.12,77,,1759.3,percent of total billed charges,77% of total billed charges,214.29,100,,,fee schedule,100% of CMS OPPS rate,1147.61,429,,,fee schedule,429% of BCBS fee schedule,1196.4,515,,,fee schedule,515% of BCBS fee schedule,1196.4,364,,,fee schedule,364% of BCBS fee schedule,1196.4,515,,,fee schedule,515% of BCBS fee schedule,2570.4,90,,2056.32,percent of total billed charges,90% of total billed charges,2284.8,80,,1827.84,percent of total billed charges,80% of total billed charges,2570.4,90,,2056.32,percent of total billed charges,90% of total billed charges,2142,75,,1713.6,percent of total billed charges,75% of total billed charges,261.43,122,,,fee schedule,122% of HUMANA fee schedule,828.24,29,,662.592,percent of total billed charges,29% of total billed charges,214.29,100,,,fee schedule,100% of CMS OPPS rate,1913.52,67,,1530.816,percent of total billed charges,67% of total billed charges,315.45,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,2284.8,80,,1827.84,percent of total billed charges,80% of total billed charges,1856.4,65,,1485.12,percent of total billed charges,65% of total billed charges,1018.74,35.67,,814.992,percent of total billed charges,35.67% of total billed charges,214.29,2570.4,
MR NECK W/CONTRAST,6101020,CDM,610,RC,70542,HCPCS,outpatient,,,3504,1401.60,,725,,,,case rate,pays based on per visit,2698.08,77,,2158.46,percent of total billed charges,77% of total billed charges,336.32,100,,,fee schedule,100% of CMS OPPS rate,2254.47,429,,,fee schedule,429% of BCBS fee schedule,2350.31,515,,,fee schedule,515% of BCBS fee schedule,2350.31,364,,,fee schedule,364% of BCBS fee schedule,2350.31,515,,,fee schedule,515% of BCBS fee schedule,3153.6,90,,2522.88,percent of total billed charges,90% of total billed charges,2803.2,80,,2242.56,percent of total billed charges,80% of total billed charges,3153.6,90,,2522.88,percent of total billed charges,90% of total billed charges,2628,75,,2102.4,percent of total billed charges,75% of total billed charges,410.31,122,,,fee schedule,122% of HUMANA fee schedule,1016.16,29,,812.928,percent of total billed charges,29% of total billed charges,336.32,100,,,fee schedule,100% of CMS OPPS rate,2347.68,67,,1878.144,percent of total billed charges,67% of total billed charges,406.28,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,2803.2,80,,2242.56,percent of total billed charges,80% of total billed charges,2277.6,65,,1822.08,percent of total billed charges,65% of total billed charges,1249.88,35.67,,999.904,percent of total billed charges,35.67% of total billed charges,336.32,3153.6,
MR NECK W/OUT CONTRAST,6101021,CDM,610,RC,70540,HCPCS,outpatient,,,2691,1076.40,,725,,,,case rate,pays based on per visit,2072.07,77,,1657.66,percent of total billed charges,77% of total billed charges,214.29,100,,,fee schedule,100% of CMS OPPS rate,1147.61,429,,,fee schedule,429% of BCBS fee schedule,1196.4,515,,,fee schedule,515% of BCBS fee schedule,1196.4,364,,,fee schedule,364% of BCBS fee schedule,1196.4,515,,,fee schedule,515% of BCBS fee schedule,2421.9,90,,1937.52,percent of total billed charges,90% of total billed charges,2152.8,80,,1722.24,percent of total billed charges,80% of total billed charges,2421.9,90,,1937.52,percent of total billed charges,90% of total billed charges,2018.25,75,,1614.6,percent of total billed charges,75% of total billed charges,261.43,122,,,fee schedule,122% of HUMANA fee schedule,780.39,29,,624.312,percent of total billed charges,29% of total billed charges,214.29,100,,,fee schedule,100% of CMS OPPS rate,1802.97,67,,1442.376,percent of total billed charges,67% of total billed charges,315.45,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,2152.8,80,,1722.24,percent of total billed charges,80% of total billed charges,1749.15,65,,1399.32,percent of total billed charges,65% of total billed charges,959.88,35.67,,767.904,percent of total billed charges,35.67% of total billed charges,214.29,2421.9,
MR NECK W/WO CONTRAST,6101022,CDM,610,RC,70543,HCPCS,outpatient,,,4283,1713.20,,725,,,,case rate,pays based on per visit,3297.91,77,,2638.33,percent of total billed charges,77% of total billed charges,336.32,100,,,fee schedule,100% of CMS OPPS rate,2254.47,429,,,fee schedule,429% of BCBS fee schedule,2350.31,515,,,fee schedule,515% of BCBS fee schedule,2350.31,364,,,fee schedule,364% of BCBS fee schedule,2350.31,515,,,fee schedule,515% of BCBS fee schedule,3854.7,90,,3083.76,percent of total billed charges,90% of total billed charges,3426.4,80,,2741.12,percent of total billed charges,80% of total billed charges,3854.7,90,,3083.76,percent of total billed charges,90% of total billed charges,3212.25,75,,2569.8,percent of total billed charges,75% of total billed charges,410.31,122,,,fee schedule,122% of HUMANA fee schedule,1242.07,29,,993.656,percent of total billed charges,29% of total billed charges,336.32,100,,,fee schedule,100% of CMS OPPS rate,2869.61,67,,2295.688,percent of total billed charges,67% of total billed charges,497.81,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,3426.4,80,,2741.12,percent of total billed charges,80% of total billed charges,2783.95,65,,2227.16,percent of total billed charges,65% of total billed charges,1527.75,35.67,,1222.2,percent of total billed charges,35.67% of total billed charges,336.32,3854.7,
MR ORBIT W/CONTRAST,6101023,CDM,610,RC,70542,HCPCS,outpatient,,,3504,1401.60,,725,,,,case rate,pays based on per visit,2698.08,77,,2158.46,percent of total billed charges,77% of total billed charges,336.32,100,,,fee schedule,100% of CMS OPPS rate,2254.47,429,,,fee schedule,429% of BCBS fee schedule,2350.31,515,,,fee schedule,515% of BCBS fee schedule,2350.31,364,,,fee schedule,364% of BCBS fee schedule,2350.31,515,,,fee schedule,515% of BCBS fee schedule,3153.6,90,,2522.88,percent of total billed charges,90% of total billed charges,2803.2,80,,2242.56,percent of total billed charges,80% of total billed charges,3153.6,90,,2522.88,percent of total billed charges,90% of total billed charges,2628,75,,2102.4,percent of total billed charges,75% of total billed charges,410.31,122,,,fee schedule,122% of HUMANA fee schedule,1016.16,29,,812.928,percent of total billed charges,29% of total billed charges,336.32,100,,,fee schedule,100% of CMS OPPS rate,2347.68,67,,1878.144,percent of total billed charges,67% of total billed charges,406.28,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,2803.2,80,,2242.56,percent of total billed charges,80% of total billed charges,2277.6,65,,1822.08,percent of total billed charges,65% of total billed charges,1249.88,35.67,,999.904,percent of total billed charges,35.67% of total billed charges,336.32,3153.6,
MR ORBIT W/OUT CONTRAST,6101024,CDM,610,RC,70540,HCPCS,outpatient,,,2691,1076.40,,725,,,,case rate,pays based on per visit,2072.07,77,,1657.66,percent of total billed charges,77% of total billed charges,214.29,100,,,fee schedule,100% of CMS OPPS rate,1147.61,429,,,fee schedule,429% of BCBS fee schedule,1196.4,515,,,fee schedule,515% of BCBS fee schedule,1196.4,364,,,fee schedule,364% of BCBS fee schedule,1196.4,515,,,fee schedule,515% of BCBS fee schedule,2421.9,90,,1937.52,percent of total billed charges,90% of total billed charges,2152.8,80,,1722.24,percent of total billed charges,80% of total billed charges,2421.9,90,,1937.52,percent of total billed charges,90% of total billed charges,2018.25,75,,1614.6,percent of total billed charges,75% of total billed charges,261.43,122,,,fee schedule,122% of HUMANA fee schedule,780.39,29,,624.312,percent of total billed charges,29% of total billed charges,214.29,100,,,fee schedule,100% of CMS OPPS rate,1802.97,67,,1442.376,percent of total billed charges,67% of total billed charges,315.45,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,2152.8,80,,1722.24,percent of total billed charges,80% of total billed charges,1749.15,65,,1399.32,percent of total billed charges,65% of total billed charges,959.88,35.67,,767.904,percent of total billed charges,35.67% of total billed charges,214.29,2421.9,
MR ORBIT W/WO CONTRAST,6101025,CDM,610,RC,70543,HCPCS,outpatient,,,4283,1713.20,,725,,,,case rate,pays based on per visit,3297.91,77,,2638.33,percent of total billed charges,77% of total billed charges,336.32,100,,,fee schedule,100% of CMS OPPS rate,2254.47,429,,,fee schedule,429% of BCBS fee schedule,2350.31,515,,,fee schedule,515% of BCBS fee schedule,2350.31,364,,,fee schedule,364% of BCBS fee schedule,2350.31,515,,,fee schedule,515% of BCBS fee schedule,3854.7,90,,3083.76,percent of total billed charges,90% of total billed charges,3426.4,80,,2741.12,percent of total billed charges,80% of total billed charges,3854.7,90,,3083.76,percent of total billed charges,90% of total billed charges,3212.25,75,,2569.8,percent of total billed charges,75% of total billed charges,410.31,122,,,fee schedule,122% of HUMANA fee schedule,1242.07,29,,993.656,percent of total billed charges,29% of total billed charges,336.32,100,,,fee schedule,100% of CMS OPPS rate,2869.61,67,,2295.688,percent of total billed charges,67% of total billed charges,497.81,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,3426.4,80,,2741.12,percent of total billed charges,80% of total billed charges,2783.95,65,,2227.16,percent of total billed charges,65% of total billed charges,1527.75,35.67,,1222.2,percent of total billed charges,35.67% of total billed charges,336.32,3854.7,
MR SACRUM W/CONTRAST,6101026,CDM,610,RC,72196,HCPCS,outpatient,,,2951,1180.40,,725,,,,case rate,pays based on per visit,2272.27,77,,1817.82,percent of total billed charges,77% of total billed charges,336.32,100,,,fee schedule,100% of CMS OPPS rate,2254.47,429,,,fee schedule,429% of BCBS fee schedule,2350.31,515,,,fee schedule,515% of BCBS fee schedule,2350.31,364,,,fee schedule,364% of BCBS fee schedule,2350.31,515,,,fee schedule,515% of BCBS fee schedule,2655.9,90,,2124.72,percent of total billed charges,90% of total billed charges,2360.8,80,,1888.64,percent of total billed charges,80% of total billed charges,2655.9,90,,2124.72,percent of total billed charges,90% of total billed charges,2213.25,75,,1770.6,percent of total billed charges,75% of total billed charges,410.31,122,,,fee schedule,122% of HUMANA fee schedule,855.79,29,,684.632,percent of total billed charges,29% of total billed charges,336.32,100,,,fee schedule,100% of CMS OPPS rate,1977.17,67,,1581.736,percent of total billed charges,67% of total billed charges,406.28,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,2360.8,80,,1888.64,percent of total billed charges,80% of total billed charges,1918.15,65,,1534.52,percent of total billed charges,65% of total billed charges,1052.62,35.67,,842.096,percent of total billed charges,35.67% of total billed charges,336.32,2655.9,
MR SACRUM W/OUT CONTRAST,6101027,CDM,610,RC,72195,HCPCS,outpatient,,,2856,1142.40,,725,,,,case rate,pays based on per visit,2199.12,77,,1759.3,percent of total billed charges,77% of total billed charges,214.29,100,,,fee schedule,100% of CMS OPPS rate,1147.61,429,,,fee schedule,429% of BCBS fee schedule,1196.4,515,,,fee schedule,515% of BCBS fee schedule,1196.4,364,,,fee schedule,364% of BCBS fee schedule,1196.4,515,,,fee schedule,515% of BCBS fee schedule,2570.4,90,,2056.32,percent of total billed charges,90% of total billed charges,2284.8,80,,1827.84,percent of total billed charges,80% of total billed charges,2570.4,90,,2056.32,percent of total billed charges,90% of total billed charges,2142,75,,1713.6,percent of total billed charges,75% of total billed charges,261.43,122,,,fee schedule,122% of HUMANA fee schedule,828.24,29,,662.592,percent of total billed charges,29% of total billed charges,214.29,100,,,fee schedule,100% of CMS OPPS rate,1913.52,67,,1530.816,percent of total billed charges,67% of total billed charges,315.45,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,2284.8,80,,1827.84,percent of total billed charges,80% of total billed charges,1856.4,65,,1485.12,percent of total billed charges,65% of total billed charges,1018.74,35.67,,814.992,percent of total billed charges,35.67% of total billed charges,214.29,2570.4,
MR SACRUM W/WO CONTRAST,6101028,CDM,610,RC,72197,HCPCS,outpatient,,,3427,1370.80,,725,,,,case rate,pays based on per visit,2638.79,77,,2111.03,percent of total billed charges,77% of total billed charges,336.32,100,,,fee schedule,100% of CMS OPPS rate,2254.47,429,,,fee schedule,429% of BCBS fee schedule,2350.31,515,,,fee schedule,515% of BCBS fee schedule,2350.31,364,,,fee schedule,364% of BCBS fee schedule,2350.31,515,,,fee schedule,515% of BCBS fee schedule,3084.3,90,,2467.44,percent of total billed charges,90% of total billed charges,2741.6,80,,2193.28,percent of total billed charges,80% of total billed charges,3084.3,90,,2467.44,percent of total billed charges,90% of total billed charges,2570.25,75,,2056.2,percent of total billed charges,75% of total billed charges,410.31,122,,,fee schedule,122% of HUMANA fee schedule,993.83,29,,795.064,percent of total billed charges,29% of total billed charges,336.32,100,,,fee schedule,100% of CMS OPPS rate,2296.09,67,,1836.872,percent of total billed charges,67% of total billed charges,497.81,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,2741.6,80,,2193.28,percent of total billed charges,80% of total billed charges,2227.55,65,,1782.04,percent of total billed charges,65% of total billed charges,1222.41,35.67,,977.928,percent of total billed charges,35.67% of total billed charges,336.32,3084.3,
MR VENOGRAPHY HEAD W/O CON,6101029,CDM,610,RC,70544,HCPCS,outpatient,,,4757,1902.80,,725,,,,case rate,pays based on per visit,3662.89,77,,2930.31,percent of total billed charges,77% of total billed charges,214.29,100,,,fee schedule,100% of CMS OPPS rate,1147.61,429,,,fee schedule,429% of BCBS fee schedule,1196.4,515,,,fee schedule,515% of BCBS fee schedule,1196.4,364,,,fee schedule,364% of BCBS fee schedule,1196.4,515,,,fee schedule,515% of BCBS fee schedule,4281.3,90,,3425.04,percent of total billed charges,90% of total billed charges,3805.6,80,,3044.48,percent of total billed charges,80% of total billed charges,4281.3,90,,3425.04,percent of total billed charges,90% of total billed charges,3567.75,75,,2854.2,percent of total billed charges,75% of total billed charges,261.43,122,,,fee schedule,122% of HUMANA fee schedule,1379.53,29,,1103.624,percent of total billed charges,29% of total billed charges,214.29,100,,,fee schedule,100% of CMS OPPS rate,3187.19,67,,2549.752,percent of total billed charges,67% of total billed charges,315.45,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,3805.6,80,,3044.48,percent of total billed charges,80% of total billed charges,3092.05,65,,2473.64,percent of total billed charges,65% of total billed charges,1696.82,35.67,,1357.456,percent of total billed charges,35.67% of total billed charges,214.29,4281.3,
MR VENOGRAPHY HEAD W/WO CON,6101030,CDM,610,RC,70549,HCPCS,outpatient,,,5041,2016.40,,725,,,,case rate,pays based on per visit,3881.57,77,,3105.26,percent of total billed charges,77% of total billed charges,336.32,100,,,fee schedule,100% of CMS OPPS rate,2254.47,429,,,fee schedule,429% of BCBS fee schedule,2350.31,515,,,fee schedule,515% of BCBS fee schedule,2350.31,364,,,fee schedule,364% of BCBS fee schedule,2350.31,515,,,fee schedule,515% of BCBS fee schedule,4536.9,90,,3629.52,percent of total billed charges,90% of total billed charges,4032.8,80,,3226.24,percent of total billed charges,80% of total billed charges,4536.9,90,,3629.52,percent of total billed charges,90% of total billed charges,3780.75,75,,3024.6,percent of total billed charges,75% of total billed charges,410.31,122,,,fee schedule,122% of HUMANA fee schedule,1461.89,29,,1169.512,percent of total billed charges,29% of total billed charges,336.32,100,,,fee schedule,100% of CMS OPPS rate,3377.47,67,,2701.976,percent of total billed charges,67% of total billed charges,497.81,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,4032.8,80,,3226.24,percent of total billed charges,80% of total billed charges,3276.65,65,,2621.32,percent of total billed charges,65% of total billed charges,1798.12,35.67,,1438.496,percent of total billed charges,35.67% of total billed charges,336.32,4536.9,
MR ANGIO UE LT W/CONTRAST,6101031,CDM,610,RC,73225,HCPCS,outpatient,,,5236,2094.40,LT,725,,,,case rate,pays based on per visit,4031.72,77,,3225.38,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,1244.58,429,,,fee schedule,429% of BCBS fee schedule,1297.49,515,,,fee schedule,515% of BCBS fee schedule,1297.49,364,,,fee schedule,364% of BCBS fee schedule,1297.49,515,,,fee schedule,515% of BCBS fee schedule,4712.4,90,,3769.92,percent of total billed charges,90% of total billed charges,4188.8,80,,3351.04,percent of total billed charges,80% of total billed charges,4712.4,90,,3769.92,percent of total billed charges,90% of total billed charges,3927,75,,3141.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,1518.44,29,,1214.752,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,3508.12,67,,2806.496,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,4188.8,80,,3351.04,percent of total billed charges,80% of total billed charges,3403.4,65,,2722.72,percent of total billed charges,65% of total billed charges,1867.68,35.67,,1494.144,percent of total billed charges,35.67% of total billed charges,725,4712.4,
MR ANGIO UE LT W/OUT CONTRAST,6101032,CDM,610,RC,73225,HCPCS,outpatient,,,4787,1914.80,LT,725,,,,case rate,pays based on per visit,3685.99,77,,2948.79,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,1244.58,429,,,fee schedule,429% of BCBS fee schedule,1297.49,515,,,fee schedule,515% of BCBS fee schedule,1297.49,364,,,fee schedule,364% of BCBS fee schedule,1297.49,515,,,fee schedule,515% of BCBS fee schedule,4308.3,90,,3446.64,percent of total billed charges,90% of total billed charges,3829.6,80,,3063.68,percent of total billed charges,80% of total billed charges,4308.3,90,,3446.64,percent of total billed charges,90% of total billed charges,3590.25,75,,2872.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,1388.23,29,,1110.584,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,3207.29,67,,2565.832,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,3829.6,80,,3063.68,percent of total billed charges,80% of total billed charges,3111.55,65,,2489.24,percent of total billed charges,65% of total billed charges,1707.52,35.67,,1366.016,percent of total billed charges,35.67% of total billed charges,725,4308.3,
MR ANGIO UE RT W/CONTRAST,6101033,CDM,610,RC,73225,HCPCS,outpatient,,,5236,2094.40,RT,725,,,,case rate,pays based on per visit,4031.72,77,,3225.38,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,1244.58,429,,,fee schedule,429% of BCBS fee schedule,1297.49,515,,,fee schedule,515% of BCBS fee schedule,1297.49,364,,,fee schedule,364% of BCBS fee schedule,1297.49,515,,,fee schedule,515% of BCBS fee schedule,4712.4,90,,3769.92,percent of total billed charges,90% of total billed charges,4188.8,80,,3351.04,percent of total billed charges,80% of total billed charges,4712.4,90,,3769.92,percent of total billed charges,90% of total billed charges,3927,75,,3141.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,1518.44,29,,1214.752,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,3508.12,67,,2806.496,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,4188.8,80,,3351.04,percent of total billed charges,80% of total billed charges,3403.4,65,,2722.72,percent of total billed charges,65% of total billed charges,1867.68,35.67,,1494.144,percent of total billed charges,35.67% of total billed charges,725,4712.4,
MR ANGIO UE RT W/OUT CONTRAST,6101034,CDM,610,RC,73225,HCPCS,outpatient,,,4787,1914.80,RT,725,,,,case rate,pays based on per visit,3685.99,77,,2948.79,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,1244.58,429,,,fee schedule,429% of BCBS fee schedule,1297.49,515,,,fee schedule,515% of BCBS fee schedule,1297.49,364,,,fee schedule,364% of BCBS fee schedule,1297.49,515,,,fee schedule,515% of BCBS fee schedule,4308.3,90,,3446.64,percent of total billed charges,90% of total billed charges,3829.6,80,,3063.68,percent of total billed charges,80% of total billed charges,4308.3,90,,3446.64,percent of total billed charges,90% of total billed charges,3590.25,75,,2872.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,1388.23,29,,1110.584,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,3207.29,67,,2565.832,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,3829.6,80,,3063.68,percent of total billed charges,80% of total billed charges,3111.55,65,,2489.24,percent of total billed charges,65% of total billed charges,1707.52,35.67,,1366.016,percent of total billed charges,35.67% of total billed charges,725,4308.3,
EPOGEN 1000 U (>10000 TOTAL)*,2503707,CDM,635,RC,J0885,HCPCS,outpatient,,,45,18.00,,38.25,85,,30.6,percent of total billed charges,85% of total billed charges,34.65,77,,27.72,percent of total billed charges,77% of total billed charges,7.53,100,,,fee schedule,100% of CMS OPPS rate,62.02,385,,,fee schedule,385% of BCBS fee schedule,64.6,401,,,fee schedule,401% of BCBS fee schedule,64.6,401,,,fee schedule,401% of BCBS fee schedule,64.6,401,,,fee schedule,401% of BCBS fee schedule,40.5,90,,32.4,percent of total billed charges,90% of total billed charges,36,80,,28.8,percent of total billed charges,80% of total billed charges,40.5,90,,32.4,percent of total billed charges,90% of total billed charges,33.75,75,,27,percent of total billed charges,75% of total billed charges,9.18,122,,,fee schedule,122% of HUMANA fee schedule,13.05,29,,10.44,percent of total billed charges,29% of total billed charges,7.53,100,,,fee schedule,100% of CMS OPPS rate,30.15,67,,24.12,percent of total billed charges,67% of total billed charges,10.16,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,36,80,,28.8,percent of total billed charges,80% of total billed charges,29.25,65,,23.4,percent of total billed charges,65% of total billed charges,16.05,35.67,,12.84,percent of total billed charges,35.67% of total billed charges,7.53,64.6,
ALBUTEROL INHALATION 0.021%,23500181,CDM,636,RC,,,outpatient,,,10,4.00,,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,10,100,,8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,8.2,82,,6.56,percent of total billed charges,82% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,9,90,,7.2,percent of total billed charges,90% of total billed charges,8,80,,6.4,percent of total billed charges,80% of total billed charges,9,90,,7.2,percent of total billed charges,90% of total billed charges,7.5,75,,6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.9,29,,2.32,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,6.7,67,,5.36,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,8,80,,6.4,percent of total billed charges,80% of total billed charges,6.5,65,,5.2,percent of total billed charges,65% of total billed charges,3.57,35.67,,2.856,percent of total billed charges,35.67% of total billed charges,2.9,10,
FLUZONE HD AGE 65+ 2023,2500001,CDM,636,RC,90662,HCPCS,outpatient,,,197,78.80,,167.45,85,,133.96,percent of total billed charges,85% of total billed charges,197,100,,157.6,percent of total billed charges,pays based on exceed threshold rate,83.49,100,,,fee schedule,100% of CMS fee schedule,123.12,385,,,fee schedule,385% of BCBS fee schedule,128.24,401,,,fee schedule,401% of BCBS fee schedule,128.24,401,,,fee schedule,401% of BCBS fee schedule,128.24,401,,,fee schedule,401% of BCBS fee schedule,177.3,90,,141.84,percent of total billed charges,90% of total billed charges,157.6,80,,126.08,percent of total billed charges,80% of total billed charges,177.3,90,,141.84,percent of total billed charges,90% of total billed charges,147.75,75,,118.2,percent of total billed charges,75% of total billed charges,101.86,122,,,fee schedule,122% of HUMANA fee schedule,57.13,29,,45.704,percent of total billed charges,29% of total billed charges,83.49,100,,,fee schedule,100% of CMS fee schedule,131.99,67,,105.592,percent of total billed charges,67% of total billed charges,32.47,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,157.6,80,,126.08,percent of total billed charges,80% of total billed charges,128.05,65,,102.44,percent of total billed charges,65% of total billed charges,70.27,35.67,,56.216,percent of total billed charges,35.67% of total billed charges,32.47,197,
"FLUZONE QUAD UP TO 64YRS, 2023",2500002,CDM,636,RC,90686,HCPCS,outpatient,,,59,23.60,,50.15,85,,40.12,percent of total billed charges,85% of total billed charges,59,100,,47.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,61.79,385,,,fee schedule,385% of BCBS fee schedule,64.36,401,,,fee schedule,401% of BCBS fee schedule,64.36,401,,,fee schedule,401% of BCBS fee schedule,64.36,401,,,fee schedule,401% of BCBS fee schedule,53.1,90,,42.48,percent of total billed charges,90% of total billed charges,47.2,80,,37.76,percent of total billed charges,80% of total billed charges,53.1,90,,42.48,percent of total billed charges,90% of total billed charges,44.25,75,,35.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,17.11,29,,13.688,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,39.53,67,,31.624,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,47.2,80,,37.76,percent of total billed charges,80% of total billed charges,38.35,65,,30.68,percent of total billed charges,65% of total billed charges,21.05,35.67,,16.84,percent of total billed charges,35.67% of total billed charges,17.11,64.36,
ABILIFY 9.75/1.3 ML SINGLE DOS,2500032,CDM,636,RC,J0400,HCPCS,outpatient,,,93,37.20,,79.05,85,,63.24,percent of total billed charges,85% of total billed charges,93,100,,74.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,2.73,385,,,fee schedule,385% of BCBS fee schedule,2.85,401,,,fee schedule,401% of BCBS fee schedule,2.85,401,,,fee schedule,401% of BCBS fee schedule,2.85,401,,,fee schedule,401% of BCBS fee schedule,83.7,90,,66.96,percent of total billed charges,90% of total billed charges,74.4,80,,59.52,percent of total billed charges,80% of total billed charges,83.7,90,,66.96,percent of total billed charges,90% of total billed charges,69.75,75,,55.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,26.97,29,,21.576,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,62.31,67,,49.848,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,74.4,80,,59.52,percent of total billed charges,80% of total billed charges,60.45,65,,48.36,percent of total billed charges,65% of total billed charges,33.17,35.67,,26.536,percent of total billed charges,35.67% of total billed charges,2.73,93,
ACETADOTE PER 100 MG (OUTPT),2500037,CDM,636,RC,J0132,HCPCS,outpatient,,,10,4.00,,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,10,100,,8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,8.35,385,,,fee schedule,385% of BCBS fee schedule,8.7,401,,,fee schedule,401% of BCBS fee schedule,8.7,401,,,fee schedule,401% of BCBS fee schedule,8.7,401,,,fee schedule,401% of BCBS fee schedule,9,90,,7.2,percent of total billed charges,90% of total billed charges,8,80,,6.4,percent of total billed charges,80% of total billed charges,9,90,,7.2,percent of total billed charges,90% of total billed charges,7.5,75,,6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.9,29,,2.32,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,6.7,67,,5.36,percent of total billed charges,67% of total billed charges,3.12,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,8,80,,6.4,percent of total billed charges,80% of total billed charges,6.5,65,,5.2,percent of total billed charges,65% of total billed charges,3.57,35.67,,2.856,percent of total billed charges,35.67% of total billed charges,2.9,10,
ACETADOTE 6000 MG/30 ML INJ,2500038,CDM,636,RC,J0132,HCPCS,outpatient,,,500,200.00,,425,85,,340,percent of total billed charges,85% of total billed charges,500,100,,400,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,8.35,385,,,fee schedule,385% of BCBS fee schedule,8.7,401,,,fee schedule,401% of BCBS fee schedule,8.7,401,,,fee schedule,401% of BCBS fee schedule,8.7,401,,,fee schedule,401% of BCBS fee schedule,450,90,,360,percent of total billed charges,90% of total billed charges,400,80,,320,percent of total billed charges,80% of total billed charges,450,90,,360,percent of total billed charges,90% of total billed charges,375,75,,300,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,145,29,,116,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,335,67,,268,percent of total billed charges,67% of total billed charges,3.12,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,400,80,,320,percent of total billed charges,80% of total billed charges,325,65,,260,percent of total billed charges,65% of total billed charges,178.35,35.67,,142.68,percent of total billed charges,35.67% of total billed charges,3.12,500,
ACTEMRA 400 MG,2500042,CDM,636,RC,J3262,HCPCS,outpatient,,,3311,1324.40,,2814.35,85,,2251.48,percent of total billed charges,85% of total billed charges,1738.28,52.5,,1390.62,percent of total billed charges,52.5 percent of total billed charges,5.96,100,,,fee schedule,100% of CMS OPPS rate,18.87,385,,,fee schedule,385% of BCBS fee schedule,19.65,401,,,fee schedule,401% of BCBS fee schedule,19.65,401,,,fee schedule,401% of BCBS fee schedule,19.65,401,,,fee schedule,401% of BCBS fee schedule,2979.9,90,,2383.92,percent of total billed charges,90% of total billed charges,2648.8,80,,2119.04,percent of total billed charges,80% of total billed charges,2979.9,90,,2383.92,percent of total billed charges,90% of total billed charges,2483.25,75,,1986.6,percent of total billed charges,75% of total billed charges,7.27,122,,,fee schedule,122% of HUMANA fee schedule,960.19,29,,768.152,percent of total billed charges,29% of total billed charges,5.96,100,,,fee schedule,100% of CMS OPPS rate,2218.37,67,,1774.696,percent of total billed charges,67% of total billed charges,3.74,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,2648.8,80,,2119.04,percent of total billed charges,80% of total billed charges,2152.15,65,,1721.72,percent of total billed charges,65% of total billed charges,1181.03,35.67,,944.824,percent of total billed charges,35.67% of total billed charges,3.74,2979.9,
"ACETAMINOPHEN 1,000 MG/100 ML",2500043,CDM,636,RC,J0131,HCPCS,outpatient,,,30,12.00,,25.5,85,,20.4,percent of total billed charges,85% of total billed charges,30,100,,24,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,1,385,,,fee schedule,385% of BCBS fee schedule,1.04,401,,,fee schedule,401% of BCBS fee schedule,1.04,401,,,fee schedule,401% of BCBS fee schedule,1.04,401,,,fee schedule,401% of BCBS fee schedule,27,90,,21.6,percent of total billed charges,90% of total billed charges,24,80,,19.2,percent of total billed charges,80% of total billed charges,27,90,,21.6,percent of total billed charges,90% of total billed charges,22.5,75,,18,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,8.7,29,,6.96,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,20.1,67,,16.08,percent of total billed charges,67% of total billed charges,0.11,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,24,80,,19.2,percent of total billed charges,80% of total billed charges,19.5,65,,15.6,percent of total billed charges,65% of total billed charges,10.7,35.67,,8.56,percent of total billed charges,35.67% of total billed charges,0.11,30,
ACTIVASE 100 MG VIAL,2500119,CDM,636,RC,J2997,HCPCS,outpatient,,,18175,7270.00,,15448.75,85,,12359,percent of total billed charges,85% of total billed charges,9541.88,52.5,,7633.5,percent of total billed charges,52.5 percent of total billed charges,91.47,100,,,fee schedule,100% of CMS OPPS rate,139.37,385,,,fee schedule,385% of BCBS fee schedule,145.16,401,,,fee schedule,401% of BCBS fee schedule,145.16,401,,,fee schedule,401% of BCBS fee schedule,145.16,401,,,fee schedule,401% of BCBS fee schedule,16357.5,90,,13086,percent of total billed charges,90% of total billed charges,14540,80,,11632,percent of total billed charges,80% of total billed charges,16357.5,90,,13086,percent of total billed charges,90% of total billed charges,13631.25,75,,10905,percent of total billed charges,75% of total billed charges,111.59,122,,,fee schedule,122% of HUMANA fee schedule,5270.75,29,,4216.6,percent of total billed charges,29% of total billed charges,91.47,100,,,fee schedule,100% of CMS OPPS rate,12177.25,67,,9741.8,percent of total billed charges,67% of total billed charges,3814,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,14540,80,,11632,percent of total billed charges,80% of total billed charges,11813.75,65,,9451,percent of total billed charges,65% of total billed charges,6483.02,35.67,,5186.416,percent of total billed charges,35.67% of total billed charges,91.47,16357.5,
ADACEL VACC 0.5ML <7 YRS OLD,2500124,CDM,636,RC,90700,HCPCS,outpatient,,,169,67.60,,143.65,85,,114.92,percent of total billed charges,85% of total billed charges,169,100,,135.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,100.91,385,,,fee schedule,385% of BCBS fee schedule,105.1,401,,,fee schedule,401% of BCBS fee schedule,105.1,401,,,fee schedule,401% of BCBS fee schedule,105.1,401,,,fee schedule,401% of BCBS fee schedule,152.1,90,,121.68,percent of total billed charges,90% of total billed charges,135.2,80,,108.16,percent of total billed charges,80% of total billed charges,152.1,90,,121.68,percent of total billed charges,90% of total billed charges,126.75,75,,101.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,49.01,29,,39.208,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,113.23,67,,90.584,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,135.2,80,,108.16,percent of total billed charges,80% of total billed charges,109.85,65,,87.88,percent of total billed charges,65% of total billed charges,60.28,35.67,,48.224,percent of total billed charges,35.67% of total billed charges,49.01,169,
ADENOSIN/ADENOCARD 90/30 ML,2500125,CDM,636,RC,J0153,HCPCS,outpatient,,,772,308.80,,656.2,85,,524.96,percent of total billed charges,85% of total billed charges,772,100,,617.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,4.85,385,,,fee schedule,385% of BCBS fee schedule,5.05,401,,,fee schedule,401% of BCBS fee schedule,5.05,401,,,fee schedule,401% of BCBS fee schedule,5.05,401,,,fee schedule,401% of BCBS fee schedule,694.8,90,,555.84,percent of total billed charges,90% of total billed charges,617.6,80,,494.08,percent of total billed charges,80% of total billed charges,694.8,90,,555.84,percent of total billed charges,90% of total billed charges,579,75,,463.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,223.88,29,,179.104,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,517.24,67,,413.792,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,617.6,80,,494.08,percent of total billed charges,80% of total billed charges,501.8,65,,401.44,percent of total billed charges,65% of total billed charges,275.37,35.67,,220.296,percent of total billed charges,35.67% of total billed charges,4.85,772,
ADENOCARD 6 MG/2ML PREFILLED,2500133,CDM,636,RC,J0153,HCPCS,outpatient,,,148,59.20,,125.8,85,,100.64,percent of total billed charges,85% of total billed charges,148,100,,118.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,4.85,385,,,fee schedule,385% of BCBS fee schedule,5.05,401,,,fee schedule,401% of BCBS fee schedule,5.05,401,,,fee schedule,401% of BCBS fee schedule,5.05,401,,,fee schedule,401% of BCBS fee schedule,133.2,90,,106.56,percent of total billed charges,90% of total billed charges,118.4,80,,94.72,percent of total billed charges,80% of total billed charges,133.2,90,,106.56,percent of total billed charges,90% of total billed charges,111,75,,88.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,42.92,29,,34.336,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,99.16,67,,79.328,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,118.4,80,,94.72,percent of total billed charges,80% of total billed charges,96.2,65,,76.96,percent of total billed charges,65% of total billed charges,52.79,35.67,,42.232,percent of total billed charges,35.67% of total billed charges,4.85,148,
ADACEL VAC 0.5ML PREFIL >7YRS,2500134,CDM,636,RC,90715,HCPCS,outpatient,,,443,177.20,,376.55,85,,301.24,percent of total billed charges,85% of total billed charges,443,100,,354.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,149.46,385,,,fee schedule,385% of BCBS fee schedule,155.67,401,,,fee schedule,401% of BCBS fee schedule,155.67,401,,,fee schedule,401% of BCBS fee schedule,155.67,401,,,fee schedule,401% of BCBS fee schedule,398.7,90,,318.96,percent of total billed charges,90% of total billed charges,354.4,80,,283.52,percent of total billed charges,80% of total billed charges,398.7,90,,318.96,percent of total billed charges,90% of total billed charges,332.25,75,,265.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,128.47,29,,102.776,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,296.81,67,,237.448,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,354.4,80,,283.52,percent of total billed charges,80% of total billed charges,287.95,65,,230.36,percent of total billed charges,65% of total billed charges,158.02,35.67,,126.416,percent of total billed charges,35.67% of total billed charges,128.47,443,
ADRENALIN 1:1000 INJ 30 ML VIA,2500135,CDM,636,RC,J0171,HCPCS,outpatient,,,239,95.60,,203.15,85,,162.52,percent of total billed charges,85% of total billed charges,239,100,,191.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,0.54,385,,,fee schedule,385% of BCBS fee schedule,0.56,401,,,fee schedule,401% of BCBS fee schedule,0.56,401,,,fee schedule,401% of BCBS fee schedule,0.56,401,,,fee schedule,401% of BCBS fee schedule,215.1,90,,172.08,percent of total billed charges,90% of total billed charges,191.2,80,,152.96,percent of total billed charges,80% of total billed charges,215.1,90,,172.08,percent of total billed charges,90% of total billed charges,179.25,75,,143.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,69.31,29,,55.448,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,160.13,67,,128.104,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,191.2,80,,152.96,percent of total billed charges,80% of total billed charges,155.35,65,,124.28,percent of total billed charges,65% of total billed charges,85.25,35.67,,68.2,percent of total billed charges,35.67% of total billed charges,0.54,239,
BIVALIRUDIN 1MG,2500223,CDM,636,RC,J0583,HCPCS,outpatient,,,600,240.00,,510,85,,408,percent of total billed charges,85% of total billed charges,600,100,,480,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,5.58,385,,,fee schedule,385% of BCBS fee schedule,5.81,401,,,fee schedule,401% of BCBS fee schedule,5.81,401,,,fee schedule,401% of BCBS fee schedule,5.81,401,,,fee schedule,401% of BCBS fee schedule,540,90,,432,percent of total billed charges,90% of total billed charges,480,80,,384,percent of total billed charges,80% of total billed charges,540,90,,432,percent of total billed charges,90% of total billed charges,450,75,,360,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,174,29,,139.2,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,402,67,,321.6,percent of total billed charges,67% of total billed charges,3.06,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,480,80,,384,percent of total billed charges,80% of total billed charges,390,65,,312,percent of total billed charges,65% of total billed charges,214.02,35.67,,171.216,percent of total billed charges,35.67% of total billed charges,3.06,600,
ALTEPLASE 2 MG VIAL,2500224,CDM,636,RC,J2997,HCPCS,outpatient,,,608,243.20,,516.8,85,,413.44,percent of total billed charges,85% of total billed charges,608,100,,486.4,percent of total billed charges,pays based on exceed threshold rate,91.47,100,,,fee schedule,100% of CMS OPPS rate,139.37,385,,,fee schedule,385% of BCBS fee schedule,145.16,401,,,fee schedule,401% of BCBS fee schedule,145.16,401,,,fee schedule,401% of BCBS fee schedule,145.16,401,,,fee schedule,401% of BCBS fee schedule,547.2,90,,437.76,percent of total billed charges,90% of total billed charges,486.4,80,,389.12,percent of total billed charges,80% of total billed charges,547.2,90,,437.76,percent of total billed charges,90% of total billed charges,456,75,,364.8,percent of total billed charges,75% of total billed charges,111.59,122,,,fee schedule,122% of HUMANA fee schedule,176.32,29,,141.056,percent of total billed charges,29% of total billed charges,91.47,100,,,fee schedule,100% of CMS OPPS rate,407.36,67,,325.888,percent of total billed charges,67% of total billed charges,50.7,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,486.4,80,,389.12,percent of total billed charges,80% of total billed charges,395.2,65,,316.16,percent of total billed charges,65% of total billed charges,216.87,35.67,,173.496,percent of total billed charges,35.67% of total billed charges,50.7,608,
AMBISOME 50 MG VIAL,2500319,CDM,636,RC,J0289,HCPCS,outpatient,,,776,310.40,,659.6,85,,527.68,percent of total billed charges,85% of total billed charges,776,100,,620.8,percent of total billed charges,pays based on exceed threshold rate,23.33,100,,,fee schedule,100% of CMS OPPS rate,116.42,385,,,fee schedule,385% of BCBS fee schedule,121.26,401,,,fee schedule,401% of BCBS fee schedule,121.26,401,,,fee schedule,401% of BCBS fee schedule,121.26,401,,,fee schedule,401% of BCBS fee schedule,698.4,90,,558.72,percent of total billed charges,90% of total billed charges,620.8,80,,496.64,percent of total billed charges,80% of total billed charges,698.4,90,,558.72,percent of total billed charges,90% of total billed charges,582,75,,465.6,percent of total billed charges,75% of total billed charges,28.46,122,,,fee schedule,122% of HUMANA fee schedule,225.04,29,,180.032,percent of total billed charges,29% of total billed charges,23.33,100,,,fee schedule,100% of CMS OPPS rate,519.92,67,,415.936,percent of total billed charges,67% of total billed charges,15.27,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,620.8,80,,496.64,percent of total billed charges,80% of total billed charges,504.4,65,,403.52,percent of total billed charges,65% of total billed charges,276.8,35.67,,221.44,percent of total billed charges,35.67% of total billed charges,15.27,776,
AMIKACIN 500 MG INJ 2 ML VIAL,2500360,CDM,636,RC,J0278,HCPCS,outpatient,,,38,15.20,,32.3,85,,25.84,percent of total billed charges,85% of total billed charges,38,100,,30.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,4.31,385,,,fee schedule,385% of BCBS fee schedule,4.49,401,,,fee schedule,401% of BCBS fee schedule,4.49,401,,,fee schedule,401% of BCBS fee schedule,4.49,401,,,fee schedule,401% of BCBS fee schedule,34.2,90,,27.36,percent of total billed charges,90% of total billed charges,30.4,80,,24.32,percent of total billed charges,80% of total billed charges,34.2,90,,27.36,percent of total billed charges,90% of total billed charges,28.5,75,,22.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,11.02,29,,8.816,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,25.46,67,,20.368,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,30.4,80,,24.32,percent of total billed charges,80% of total billed charges,24.7,65,,19.76,percent of total billed charges,65% of total billed charges,13.55,35.67,,10.84,percent of total billed charges,35.67% of total billed charges,4.31,38,
AMIKACIN 1 GM  4 ML VIAL,2500362,CDM,636,RC,J0278,HCPCS,outpatient,,,61,24.40,,51.85,85,,41.48,percent of total billed charges,85% of total billed charges,61,100,,48.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,4.31,385,,,fee schedule,385% of BCBS fee schedule,4.49,401,,,fee schedule,401% of BCBS fee schedule,4.49,401,,,fee schedule,401% of BCBS fee schedule,4.49,401,,,fee schedule,401% of BCBS fee schedule,54.9,90,,43.92,percent of total billed charges,90% of total billed charges,48.8,80,,39.04,percent of total billed charges,80% of total billed charges,54.9,90,,43.92,percent of total billed charges,90% of total billed charges,45.75,75,,36.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,17.69,29,,14.152,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,40.87,67,,32.696,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,48.8,80,,39.04,percent of total billed charges,80% of total billed charges,39.65,65,,31.72,percent of total billed charges,65% of total billed charges,21.76,35.67,,17.408,percent of total billed charges,35.67% of total billed charges,4.31,61,
AMINOPHYLLIN 250MG/10ML VIAL,2500365,CDM,636,RC,J0280,HCPCS,outpatient,,,44,17.60,,37.4,85,,29.92,percent of total billed charges,85% of total billed charges,44,100,,35.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,19.17,385,,,fee schedule,385% of BCBS fee schedule,19.97,401,,,fee schedule,401% of BCBS fee schedule,19.97,401,,,fee schedule,401% of BCBS fee schedule,19.97,401,,,fee schedule,401% of BCBS fee schedule,39.6,90,,31.68,percent of total billed charges,90% of total billed charges,35.2,80,,28.16,percent of total billed charges,80% of total billed charges,39.6,90,,31.68,percent of total billed charges,90% of total billed charges,33,75,,26.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,12.76,29,,10.208,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,29.48,67,,23.584,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,35.2,80,,28.16,percent of total billed charges,80% of total billed charges,28.6,65,,22.88,percent of total billed charges,65% of total billed charges,15.69,35.67,,12.552,percent of total billed charges,35.67% of total billed charges,12.76,44,
AMPICILLIN 1000 MG/4 ML INJ,2500480,CDM,636,RC,J0290,HCPCS,outpatient,,,34,13.60,,28.9,85,,23.12,percent of total billed charges,85% of total billed charges,34,100,,27.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,7.85,385,,,fee schedule,385% of BCBS fee schedule,8.18,401,,,fee schedule,401% of BCBS fee schedule,8.18,401,,,fee schedule,401% of BCBS fee schedule,8.18,401,,,fee schedule,401% of BCBS fee schedule,30.6,90,,24.48,percent of total billed charges,90% of total billed charges,27.2,80,,21.76,percent of total billed charges,80% of total billed charges,30.6,90,,24.48,percent of total billed charges,90% of total billed charges,25.5,75,,20.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,9.86,29,,7.888,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,22.78,67,,18.224,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,27.2,80,,21.76,percent of total billed charges,80% of total billed charges,22.1,65,,17.68,percent of total billed charges,65% of total billed charges,12.13,35.67,,9.704,percent of total billed charges,35.67% of total billed charges,7.85,34,
AMPICILLIN 250 MG/1 ML INJ,2500495,CDM,636,RC,J0290,HCPCS,outpatient,,,17,6.80,,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,17,100,,13.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,7.85,385,,,fee schedule,385% of BCBS fee schedule,8.18,401,,,fee schedule,401% of BCBS fee schedule,8.18,401,,,fee schedule,401% of BCBS fee schedule,8.18,401,,,fee schedule,401% of BCBS fee schedule,15.3,90,,12.24,percent of total billed charges,90% of total billed charges,13.6,80,,10.88,percent of total billed charges,80% of total billed charges,15.3,90,,12.24,percent of total billed charges,90% of total billed charges,12.75,75,,10.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,4.93,29,,3.944,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,11.39,67,,9.112,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,13.6,80,,10.88,percent of total billed charges,80% of total billed charges,11.05,65,,8.84,percent of total billed charges,65% of total billed charges,6.06,35.67,,4.848,percent of total billed charges,35.67% of total billed charges,4.93,17,
AMPICILLIN 750 MG INJ,2500565,CDM,636,RC,J0295,HCPCS,outpatient,,,17,6.80,,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,17,100,,13.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,10.36,385,,,fee schedule,385% of BCBS fee schedule,10.79,401,,,fee schedule,401% of BCBS fee schedule,10.79,401,,,fee schedule,401% of BCBS fee schedule,10.79,401,,,fee schedule,401% of BCBS fee schedule,15.3,90,,12.24,percent of total billed charges,90% of total billed charges,13.6,80,,10.88,percent of total billed charges,80% of total billed charges,15.3,90,,12.24,percent of total billed charges,90% of total billed charges,12.75,75,,10.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,4.93,29,,3.944,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,11.39,67,,9.112,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,13.6,80,,10.88,percent of total billed charges,80% of total billed charges,11.05,65,,8.84,percent of total billed charges,65% of total billed charges,6.06,35.67,,4.848,percent of total billed charges,35.67% of total billed charges,4.93,17,
ANECTINE 200 MG/10 ML INJ,2500612,CDM,636,RC,J0330,HCPCS,outpatient,,,120,48.00,,102,85,,81.6,percent of total billed charges,85% of total billed charges,120,100,,96,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,0.65,385,,,fee schedule,385% of BCBS fee schedule,0.68,401,,,fee schedule,401% of BCBS fee schedule,0.68,401,,,fee schedule,401% of BCBS fee schedule,0.68,401,,,fee schedule,401% of BCBS fee schedule,108,90,,86.4,percent of total billed charges,90% of total billed charges,96,80,,76.8,percent of total billed charges,80% of total billed charges,108,90,,86.4,percent of total billed charges,90% of total billed charges,90,75,,72,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,34.8,29,,27.84,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,80.4,67,,64.32,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,96,80,,76.8,percent of total billed charges,80% of total billed charges,78,65,,62.4,percent of total billed charges,65% of total billed charges,42.8,35.67,,34.24,percent of total billed charges,35.67% of total billed charges,0.65,120,
APRESOLINE .05CC/10 MG INJ,2500695,CDM,636,RC,J0360,HCPCS,outpatient,,,18,7.20,,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,18,100,,14.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,24.45,385,,,fee schedule,385% of BCBS fee schedule,25.46,401,,,fee schedule,401% of BCBS fee schedule,25.46,401,,,fee schedule,401% of BCBS fee schedule,25.46,401,,,fee schedule,401% of BCBS fee schedule,16.2,90,,12.96,percent of total billed charges,90% of total billed charges,14.4,80,,11.52,percent of total billed charges,80% of total billed charges,16.2,90,,12.96,percent of total billed charges,90% of total billed charges,13.5,75,,10.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,5.22,29,,4.176,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,12.06,67,,9.648,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,14.4,80,,11.52,percent of total billed charges,80% of total billed charges,11.7,65,,9.36,percent of total billed charges,65% of total billed charges,6.42,35.67,,5.136,percent of total billed charges,35.67% of total billed charges,5.22,25.46,
APRESOLINE .25CC/5 MG INJ,2500700,CDM,636,RC,J0360,HCPCS,outpatient,,,11,4.40,,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,11,100,,8.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,24.45,385,,,fee schedule,385% of BCBS fee schedule,25.46,401,,,fee schedule,401% of BCBS fee schedule,25.46,401,,,fee schedule,401% of BCBS fee schedule,25.46,401,,,fee schedule,401% of BCBS fee schedule,9.9,90,,7.92,percent of total billed charges,90% of total billed charges,8.8,80,,7.04,percent of total billed charges,80% of total billed charges,9.9,90,,7.92,percent of total billed charges,90% of total billed charges,8.25,75,,6.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,3.19,29,,2.552,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,7.37,67,,5.896,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,8.8,80,,7.04,percent of total billed charges,80% of total billed charges,7.15,65,,5.72,percent of total billed charges,65% of total billed charges,3.92,35.67,,3.136,percent of total billed charges,35.67% of total billed charges,3.19,25.46,
APRESOLINE 20 MG PER 1 CC INJ,2500720,CDM,636,RC,J0360,HCPCS,outpatient,,,352,140.80,,299.2,85,,239.36,percent of total billed charges,85% of total billed charges,352,100,,281.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,24.45,385,,,fee schedule,385% of BCBS fee schedule,25.46,401,,,fee schedule,401% of BCBS fee schedule,25.46,401,,,fee schedule,401% of BCBS fee schedule,25.46,401,,,fee schedule,401% of BCBS fee schedule,316.8,90,,253.44,percent of total billed charges,90% of total billed charges,281.6,80,,225.28,percent of total billed charges,80% of total billed charges,316.8,90,,253.44,percent of total billed charges,90% of total billed charges,264,75,,211.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,102.08,29,,81.664,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,235.84,67,,188.672,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,281.6,80,,225.28,percent of total billed charges,80% of total billed charges,228.8,65,,183.04,percent of total billed charges,65% of total billed charges,125.56,35.67,,100.448,percent of total billed charges,35.67% of total billed charges,24.45,352,
AQUAMEPHYTON 1CC/10 MG AMP INJ,2500750,CDM,636,RC,J3430,HCPCS,outpatient,,,167,66.80,,141.95,85,,113.56,percent of total billed charges,85% of total billed charges,167,100,,133.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,14.86,385,,,fee schedule,385% of BCBS fee schedule,15.48,401,,,fee schedule,401% of BCBS fee schedule,15.48,401,,,fee schedule,401% of BCBS fee schedule,15.48,401,,,fee schedule,401% of BCBS fee schedule,150.3,90,,120.24,percent of total billed charges,90% of total billed charges,133.6,80,,106.88,percent of total billed charges,80% of total billed charges,150.3,90,,120.24,percent of total billed charges,90% of total billed charges,125.25,75,,100.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,48.43,29,,38.744,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,111.89,67,,89.512,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,133.6,80,,106.88,percent of total billed charges,80% of total billed charges,108.55,65,,86.84,percent of total billed charges,65% of total billed charges,59.57,35.67,,47.656,percent of total billed charges,35.67% of total billed charges,14.86,167,
ARTISS FIBRIN 4ML,2500751,CDM,636,RC,C9250,HCPCS,outpatient,,,997,398.80,,847.45,85,,677.96,percent of total billed charges,85% of total billed charges,997,100,,797.6,percent of total billed charges,pays based on exceed threshold rate,138.35,100,,,fee schedule,100% of CMS OPPS rate,817.54,82,,654.032,percent of total billed charges,82% of total billed charges,847.45,85,,677.96,percent of total billed charges,85% of total billed charges,847.45,85,,677.96,percent of total billed charges,85% of total billed charges,847.45,85,,677.96,percent of total billed charges,85% of total billed charges,897.3,90,,717.84,percent of total billed charges,90% of total billed charges,797.6,80,,638.08,percent of total billed charges,80% of total billed charges,897.3,90,,717.84,percent of total billed charges,90% of total billed charges,747.75,75,,598.2,percent of total billed charges,75% of total billed charges,168.78,122,,,fee schedule,122% of HUMANA fee schedule,289.13,29,,231.304,percent of total billed charges,29% of total billed charges,138.35,100,,,fee schedule,100% of CMS OPPS rate,667.99,67,,534.392,percent of total billed charges,67% of total billed charges,68.42,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,797.6,80,,638.08,percent of total billed charges,80% of total billed charges,648.05,65,,518.44,percent of total billed charges,65% of total billed charges,355.63,35.67,,284.504,percent of total billed charges,35.67% of total billed charges,68.42,997,
ARANESP 1 MCG (MCR) (NON-ESRD),2500767,CDM,636,RC,J0881,HCPCS,outpatient,,,16,6.40,,13.6,85,,10.88,percent of total billed charges,85% of total billed charges,16,100,,12.8,percent of total billed charges,pays based on exceed threshold rate,3.04,100,,,fee schedule,100% of CMS OPPS rate,28.68,385,,,fee schedule,385% of BCBS fee schedule,29.87,401,,,fee schedule,401% of BCBS fee schedule,29.87,401,,,fee schedule,401% of BCBS fee schedule,29.87,401,,,fee schedule,401% of BCBS fee schedule,14.4,90,,11.52,percent of total billed charges,90% of total billed charges,12.8,80,,10.24,percent of total billed charges,80% of total billed charges,14.4,90,,11.52,percent of total billed charges,90% of total billed charges,12,75,,9.6,percent of total billed charges,75% of total billed charges,3.7,122,,,fee schedule,122% of HUMANA fee schedule,4.64,29,,3.712,percent of total billed charges,29% of total billed charges,3.04,100,,,fee schedule,100% of CMS OPPS rate,10.72,67,,8.576,percent of total billed charges,67% of total billed charges,3.42,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,12.8,80,,10.24,percent of total billed charges,80% of total billed charges,10.4,65,,8.32,percent of total billed charges,65% of total billed charges,5.71,35.67,,4.568,percent of total billed charges,35.67% of total billed charges,3.04,29.87,
ARANESP 1 MCG (MCR) (ESRD PT),2500768,CDM,636,RC,J0882,HCPCS,outpatient,,,16,6.40,,13.6,85,,10.88,percent of total billed charges,85% of total billed charges,16,100,,12.8,percent of total billed charges,pays based on exceed threshold rate,3.04,100,,,fee schedule,100% of CMS OPPS rate,28.68,385,,,fee schedule,385% of BCBS fee schedule,29.87,401,,,fee schedule,401% of BCBS fee schedule,29.87,401,,,fee schedule,401% of BCBS fee schedule,29.87,401,,,fee schedule,401% of BCBS fee schedule,14.4,90,,11.52,percent of total billed charges,90% of total billed charges,12.8,80,,10.24,percent of total billed charges,80% of total billed charges,14.4,90,,11.52,percent of total billed charges,90% of total billed charges,12,75,,9.6,percent of total billed charges,75% of total billed charges,3.7,122,,,fee schedule,122% of HUMANA fee schedule,4.64,29,,3.712,percent of total billed charges,29% of total billed charges,3.04,100,,,fee schedule,100% of CMS OPPS rate,10.72,67,,8.576,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,12.8,80,,10.24,percent of total billed charges,80% of total billed charges,10.4,65,,8.32,percent of total billed charges,65% of total billed charges,5.71,35.67,,4.568,percent of total billed charges,35.67% of total billed charges,3.04,29.87,
AVYCAZ CEFTAZIDIME INJ 2.5 G,2500857,CDM,636,RC,J0714,HCPCS,outpatient,,,515,206.00,,437.75,85,,350.2,percent of total billed charges,85% of total billed charges,515,100,,412,percent of total billed charges,pays based on exceed threshold rate,100.58,100,,,fee schedule,100% of CMS OPPS rate,288.02,385,,,fee schedule,385% of BCBS fee schedule,299.99,401,,,fee schedule,401% of BCBS fee schedule,299.99,401,,,fee schedule,401% of BCBS fee schedule,299.99,401,,,fee schedule,401% of BCBS fee schedule,463.5,90,,370.8,percent of total billed charges,90% of total billed charges,412,80,,329.6,percent of total billed charges,80% of total billed charges,463.5,90,,370.8,percent of total billed charges,90% of total billed charges,386.25,75,,309,percent of total billed charges,75% of total billed charges,122.7,122,,,fee schedule,122% of HUMANA fee schedule,149.35,29,,119.48,percent of total billed charges,29% of total billed charges,100.58,100,,,fee schedule,100% of CMS OPPS rate,345.05,67,,276.04,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,412,80,,329.6,percent of total billed charges,80% of total billed charges,334.75,65,,267.8,percent of total billed charges,65% of total billed charges,183.7,35.67,,146.96,percent of total billed charges,35.67% of total billed charges,100.58,515,
CANCIDAS 5 MG VIAL (OUTPT),2500882,CDM,636,RC,J0637,HCPCS,outpatient,,,85,34.00,,72.25,85,,57.8,percent of total billed charges,85% of total billed charges,85,100,,68,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,96.21,385,,,fee schedule,385% of BCBS fee schedule,100.21,401,,,fee schedule,401% of BCBS fee schedule,100.21,401,,,fee schedule,401% of BCBS fee schedule,100.21,401,,,fee schedule,401% of BCBS fee schedule,76.5,90,,61.2,percent of total billed charges,90% of total billed charges,68,80,,54.4,percent of total billed charges,80% of total billed charges,76.5,90,,61.2,percent of total billed charges,90% of total billed charges,63.75,75,,51,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,24.65,29,,19.72,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,56.95,67,,45.56,percent of total billed charges,67% of total billed charges,13.23,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,68,80,,54.4,percent of total billed charges,80% of total billed charges,55.25,65,,44.2,percent of total billed charges,65% of total billed charges,30.32,35.67,,24.256,percent of total billed charges,35.67% of total billed charges,13.23,100.21,
CANCIDAS 70 MG,2500883,CDM,636,RC,J0637,HCPCS,outpatient,,,953,381.20,,810.05,85,,648.04,percent of total billed charges,85% of total billed charges,953,100,,762.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,96.21,385,,,fee schedule,385% of BCBS fee schedule,100.21,401,,,fee schedule,401% of BCBS fee schedule,100.21,401,,,fee schedule,401% of BCBS fee schedule,100.21,401,,,fee schedule,401% of BCBS fee schedule,857.7,90,,686.16,percent of total billed charges,90% of total billed charges,762.4,80,,609.92,percent of total billed charges,80% of total billed charges,857.7,90,,686.16,percent of total billed charges,90% of total billed charges,714.75,75,,571.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,276.37,29,,221.096,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,638.51,67,,510.808,percent of total billed charges,67% of total billed charges,13.23,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,762.4,80,,609.92,percent of total billed charges,80% of total billed charges,619.45,65,,495.56,percent of total billed charges,65% of total billed charges,339.94,35.67,,271.952,percent of total billed charges,35.67% of total billed charges,13.23,953,
ATIVAN 2MG/ML,2500926,CDM,636,RC,J2060,HCPCS,outpatient,,,13,5.20,,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,13,100,,10.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,1.23,385,,,fee schedule,385% of BCBS fee schedule,1.28,401,,,fee schedule,401% of BCBS fee schedule,1.28,401,,,fee schedule,401% of BCBS fee schedule,1.28,401,,,fee schedule,401% of BCBS fee schedule,11.7,90,,9.36,percent of total billed charges,90% of total billed charges,10.4,80,,8.32,percent of total billed charges,80% of total billed charges,11.7,90,,9.36,percent of total billed charges,90% of total billed charges,9.75,75,,7.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,3.77,29,,3.016,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,8.71,67,,6.968,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,10.4,80,,8.32,percent of total billed charges,80% of total billed charges,8.45,65,,6.76,percent of total billed charges,65% of total billed charges,4.64,35.67,,3.712,percent of total billed charges,35.67% of total billed charges,1.23,13,
ATIVAN INJ 2 MG INJ,2500927,CDM,636,RC,J2060,HCPCS,outpatient,,,11,4.40,,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,11,100,,8.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,1.23,385,,,fee schedule,385% of BCBS fee schedule,1.28,401,,,fee schedule,401% of BCBS fee schedule,1.28,401,,,fee schedule,401% of BCBS fee schedule,1.28,401,,,fee schedule,401% of BCBS fee schedule,9.9,90,,7.92,percent of total billed charges,90% of total billed charges,8.8,80,,7.04,percent of total billed charges,80% of total billed charges,9.9,90,,7.92,percent of total billed charges,90% of total billed charges,8.25,75,,6.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,3.19,29,,2.552,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,7.37,67,,5.896,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,8.8,80,,7.04,percent of total billed charges,80% of total billed charges,7.15,65,,5.72,percent of total billed charges,65% of total billed charges,3.92,35.67,,3.136,percent of total billed charges,35.67% of total billed charges,1.23,11,
ATROPINE .4 MG/ML INJ,2500935,CDM,636,RC,J0461,HCPCS,outpatient,,,359,143.60,,305.15,85,,244.12,percent of total billed charges,85% of total billed charges,359,100,,287.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,0.04,385,,,fee schedule,385% of BCBS fee schedule,0.04,401,,,fee schedule,401% of BCBS fee schedule,0.04,401,,,fee schedule,401% of BCBS fee schedule,0.04,401,,,fee schedule,401% of BCBS fee schedule,323.1,90,,258.48,percent of total billed charges,90% of total billed charges,287.2,80,,229.76,percent of total billed charges,80% of total billed charges,323.1,90,,258.48,percent of total billed charges,90% of total billed charges,269.25,75,,215.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,104.11,29,,83.288,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,240.53,67,,192.424,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,287.2,80,,229.76,percent of total billed charges,80% of total billed charges,233.35,65,,186.68,percent of total billed charges,65% of total billed charges,128.06,35.67,,102.448,percent of total billed charges,35.67% of total billed charges,0.04,359,
ATROPINE .1 MG INJ,2500940,CDM,636,RC,J0461,HCPCS,outpatient,,,22,8.80,,18.7,85,,14.96,percent of total billed charges,85% of total billed charges,22,100,,17.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,0.04,385,,,fee schedule,385% of BCBS fee schedule,0.04,401,,,fee schedule,401% of BCBS fee schedule,0.04,401,,,fee schedule,401% of BCBS fee schedule,0.04,401,,,fee schedule,401% of BCBS fee schedule,19.8,90,,15.84,percent of total billed charges,90% of total billed charges,17.6,80,,14.08,percent of total billed charges,80% of total billed charges,19.8,90,,15.84,percent of total billed charges,90% of total billed charges,16.5,75,,13.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,6.38,29,,5.104,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,14.74,67,,11.792,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,17.6,80,,14.08,percent of total billed charges,80% of total billed charges,14.3,65,,11.44,percent of total billed charges,65% of total billed charges,7.85,35.67,,6.28,percent of total billed charges,35.67% of total billed charges,0.04,22,
ATROPINE .5 MG INJ,2500945,CDM,636,RC,J0461,HCPCS,outpatient,,,23,9.20,,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,23,100,,18.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,0.04,385,,,fee schedule,385% of BCBS fee schedule,0.04,401,,,fee schedule,401% of BCBS fee schedule,0.04,401,,,fee schedule,401% of BCBS fee schedule,0.04,401,,,fee schedule,401% of BCBS fee schedule,20.7,90,,16.56,percent of total billed charges,90% of total billed charges,18.4,80,,14.72,percent of total billed charges,80% of total billed charges,20.7,90,,16.56,percent of total billed charges,90% of total billed charges,17.25,75,,13.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,6.67,29,,5.336,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,15.41,67,,12.328,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,18.4,80,,14.72,percent of total billed charges,80% of total billed charges,14.95,65,,11.96,percent of total billed charges,65% of total billed charges,8.2,35.67,,6.56,percent of total billed charges,35.67% of total billed charges,0.04,23,
ATROPINE SULFATE 0.4MG/ML INJ,2500946,CDM,636,RC,J0461,HCPCS,outpatient,,,18,7.20,,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,18,100,,14.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,0.04,385,,,fee schedule,385% of BCBS fee schedule,0.04,401,,,fee schedule,401% of BCBS fee schedule,0.04,401,,,fee schedule,401% of BCBS fee schedule,0.04,401,,,fee schedule,401% of BCBS fee schedule,16.2,90,,12.96,percent of total billed charges,90% of total billed charges,14.4,80,,11.52,percent of total billed charges,80% of total billed charges,16.2,90,,12.96,percent of total billed charges,90% of total billed charges,13.5,75,,10.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,5.22,29,,4.176,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,12.06,67,,9.648,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,14.4,80,,11.52,percent of total billed charges,80% of total billed charges,11.7,65,,9.36,percent of total billed charges,65% of total billed charges,6.42,35.67,,5.136,percent of total billed charges,35.67% of total billed charges,0.04,18,
ATROPINE PFS 1 MG/10CC INJ.,2500970,CDM,636,RC,J0461,HCPCS,outpatient,,,46,18.40,,39.1,85,,31.28,percent of total billed charges,85% of total billed charges,46,100,,36.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,0.04,385,,,fee schedule,385% of BCBS fee schedule,0.04,401,,,fee schedule,401% of BCBS fee schedule,0.04,401,,,fee schedule,401% of BCBS fee schedule,0.04,401,,,fee schedule,401% of BCBS fee schedule,41.4,90,,33.12,percent of total billed charges,90% of total billed charges,36.8,80,,29.44,percent of total billed charges,80% of total billed charges,41.4,90,,33.12,percent of total billed charges,90% of total billed charges,34.5,75,,27.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,13.34,29,,10.672,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,30.82,67,,24.656,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,36.8,80,,29.44,percent of total billed charges,80% of total billed charges,29.9,65,,23.92,percent of total billed charges,65% of total billed charges,16.41,35.67,,13.128,percent of total billed charges,35.67% of total billed charges,0.04,46,
AVELOX 400 MG PREMIX BAG,2501027,CDM,636,RC,J2280,HCPCS,outpatient,,,160,64.00,,136,85,,108.8,percent of total billed charges,85% of total billed charges,160,100,,128,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,30.61,385,,,fee schedule,385% of BCBS fee schedule,31.88,401,,,fee schedule,401% of BCBS fee schedule,31.88,401,,,fee schedule,401% of BCBS fee schedule,31.88,401,,,fee schedule,401% of BCBS fee schedule,144,90,,115.2,percent of total billed charges,90% of total billed charges,128,80,,102.4,percent of total billed charges,80% of total billed charges,144,90,,115.2,percent of total billed charges,90% of total billed charges,120,75,,96,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,46.4,29,,37.12,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,107.2,67,,85.76,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,128,80,,102.4,percent of total billed charges,80% of total billed charges,104,65,,83.2,percent of total billed charges,65% of total billed charges,57.07,35.67,,45.656,percent of total billed charges,35.67% of total billed charges,30.61,160,
BAMLANIVIMAB 700MG/20 ML INJ,2501118,CDM,636,RC,Q0239,HCPCS,outpatient,,,4,1.60,,3.4,85,,2.72,percent of total billed charges,85% of total billed charges,4,100,,3.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,3.28,82,,2.624,percent of total billed charges,82% of total billed charges,3.4,85,,2.72,percent of total billed charges,85% of total billed charges,3.4,85,,2.72,percent of total billed charges,85% of total billed charges,3.4,85,,2.72,percent of total billed charges,85% of total billed charges,3.6,90,,2.88,percent of total billed charges,90% of total billed charges,3.2,80,,2.56,percent of total billed charges,80% of total billed charges,3.6,90,,2.88,percent of total billed charges,90% of total billed charges,3,75,,2.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,1.16,29,,0.928,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,2.68,67,,2.144,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,3.2,80,,2.56,percent of total billed charges,80% of total billed charges,2.6,65,,2.08,percent of total billed charges,65% of total billed charges,1.43,35.67,,1.144,percent of total billed charges,35.67% of total billed charges,1.16,4,
BENADRYL 12.5 INJ,2501155,CDM,636,RC,J1200,HCPCS,outpatient,,,9,3.60,,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,9,100,,7.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,3.2,385,,,fee schedule,385% of BCBS fee schedule,3.33,401,,,fee schedule,401% of BCBS fee schedule,3.33,401,,,fee schedule,401% of BCBS fee schedule,3.33,401,,,fee schedule,401% of BCBS fee schedule,8.1,90,,6.48,percent of total billed charges,90% of total billed charges,7.2,80,,5.76,percent of total billed charges,80% of total billed charges,8.1,90,,6.48,percent of total billed charges,90% of total billed charges,6.75,75,,5.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.61,29,,2.088,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,6.03,67,,4.824,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,7.2,80,,5.76,percent of total billed charges,80% of total billed charges,5.85,65,,4.68,percent of total billed charges,65% of total billed charges,3.21,35.67,,2.568,percent of total billed charges,35.67% of total billed charges,2.61,9,
BENADRYL 50 MG/ML VIAL,2501165,CDM,636,RC,J1200,HCPCS,outpatient,,,15,6.00,,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,15,100,,12,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,3.2,385,,,fee schedule,385% of BCBS fee schedule,3.33,401,,,fee schedule,401% of BCBS fee schedule,3.33,401,,,fee schedule,401% of BCBS fee schedule,3.33,401,,,fee schedule,401% of BCBS fee schedule,13.5,90,,10.8,percent of total billed charges,90% of total billed charges,12,80,,9.6,percent of total billed charges,80% of total billed charges,13.5,90,,10.8,percent of total billed charges,90% of total billed charges,11.25,75,,9,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,4.35,29,,3.48,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,10.05,67,,8.04,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,12,80,,9.6,percent of total billed charges,80% of total billed charges,9.75,65,,7.8,percent of total billed charges,65% of total billed charges,5.35,35.67,,4.28,percent of total billed charges,35.67% of total billed charges,3.2,15,
BENADRYL 50 MG/CC INJ,2501180,CDM,636,RC,J1200,HCPCS,outpatient,,,11,4.40,,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,11,100,,8.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,3.2,385,,,fee schedule,385% of BCBS fee schedule,3.33,401,,,fee schedule,401% of BCBS fee schedule,3.33,401,,,fee schedule,401% of BCBS fee schedule,3.33,401,,,fee schedule,401% of BCBS fee schedule,9.9,90,,7.92,percent of total billed charges,90% of total billed charges,8.8,80,,7.04,percent of total billed charges,80% of total billed charges,9.9,90,,7.92,percent of total billed charges,90% of total billed charges,8.25,75,,6.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,3.19,29,,2.552,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,7.37,67,,5.896,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,8.8,80,,7.04,percent of total billed charges,80% of total billed charges,7.15,65,,5.72,percent of total billed charges,65% of total billed charges,3.92,35.67,,3.136,percent of total billed charges,35.67% of total billed charges,3.19,11,
BENADRYL INJ PEDI 10 MG,2501195,CDM,636,RC,J1200,HCPCS,outpatient,,,7,2.80,,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,7,100,,5.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,3.2,385,,,fee schedule,385% of BCBS fee schedule,3.33,401,,,fee schedule,401% of BCBS fee schedule,3.33,401,,,fee schedule,401% of BCBS fee schedule,3.33,401,,,fee schedule,401% of BCBS fee schedule,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.25,75,,4.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.03,29,,1.624,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4.69,67,,3.752,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,4.55,65,,3.64,percent of total billed charges,65% of total billed charges,2.5,35.67,,2,percent of total billed charges,35.67% of total billed charges,2.03,7,
BENTYL 20 MG/2ML AMP,2501210,CDM,636,RC,J0500,HCPCS,outpatient,,,266,106.40,,226.1,85,,180.88,percent of total billed charges,85% of total billed charges,266,100,,212.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,164.47,385,,,fee schedule,385% of BCBS fee schedule,171.31,401,,,fee schedule,401% of BCBS fee schedule,171.31,401,,,fee schedule,401% of BCBS fee schedule,171.31,401,,,fee schedule,401% of BCBS fee schedule,239.4,90,,191.52,percent of total billed charges,90% of total billed charges,212.8,80,,170.24,percent of total billed charges,80% of total billed charges,239.4,90,,191.52,percent of total billed charges,90% of total billed charges,199.5,75,,159.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,77.14,29,,61.712,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,178.22,67,,142.576,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,212.8,80,,170.24,percent of total billed charges,80% of total billed charges,172.9,65,,138.32,percent of total billed charges,65% of total billed charges,94.88,35.67,,75.904,percent of total billed charges,35.67% of total billed charges,77.14,266,
BENTYL 20 MG/W PB INJ,2501220,CDM,636,RC,J0500,HCPCS,outpatient,,,74,29.60,,62.9,85,,50.32,percent of total billed charges,85% of total billed charges,74,100,,59.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,164.47,385,,,fee schedule,385% of BCBS fee schedule,171.31,401,,,fee schedule,401% of BCBS fee schedule,171.31,401,,,fee schedule,401% of BCBS fee schedule,171.31,401,,,fee schedule,401% of BCBS fee schedule,66.6,90,,53.28,percent of total billed charges,90% of total billed charges,59.2,80,,47.36,percent of total billed charges,80% of total billed charges,66.6,90,,53.28,percent of total billed charges,90% of total billed charges,55.5,75,,44.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,21.46,29,,17.168,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,49.58,67,,39.664,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,59.2,80,,47.36,percent of total billed charges,80% of total billed charges,48.1,65,,38.48,percent of total billed charges,65% of total billed charges,26.4,35.67,,21.12,percent of total billed charges,35.67% of total billed charges,21.46,171.31,
BICILLIN LA 1.2 MILL UNITS,2501295,CDM,636,RC,J0561,HCPCS,outpatient,,,685,274.00,,582.25,85,,465.8,percent of total billed charges,85% of total billed charges,685,100,,548,percent of total billed charges,pays based on exceed threshold rate,24.37,100,,,fee schedule,100% of CMS OPPS rate,45.97,385,,,fee schedule,385% of BCBS fee schedule,47.88,401,,,fee schedule,401% of BCBS fee schedule,47.88,401,,,fee schedule,401% of BCBS fee schedule,47.88,401,,,fee schedule,401% of BCBS fee schedule,616.5,90,,493.2,percent of total billed charges,90% of total billed charges,548,80,,438.4,percent of total billed charges,80% of total billed charges,616.5,90,,493.2,percent of total billed charges,90% of total billed charges,513.75,75,,411,percent of total billed charges,75% of total billed charges,29.73,122,,,fee schedule,122% of HUMANA fee schedule,198.65,29,,158.92,percent of total billed charges,29% of total billed charges,24.37,100,,,fee schedule,100% of CMS OPPS rate,458.95,67,,367.16,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,548,80,,438.4,percent of total billed charges,80% of total billed charges,445.25,65,,356.2,percent of total billed charges,65% of total billed charges,244.34,35.67,,195.472,percent of total billed charges,35.67% of total billed charges,24.37,685,
"BICILLIN CR 300,000U INJ",2501315,CDM,636,RC,J0558,HCPCS,outpatient,,,15,6.00,,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,15,100,,12,percent of total billed charges,pays based on exceed threshold rate,19.52,100,,,fee schedule,100% of CMS OPPS rate,17.71,385,,,fee schedule,385% of BCBS fee schedule,18.45,401,,,fee schedule,401% of BCBS fee schedule,18.45,401,,,fee schedule,401% of BCBS fee schedule,18.45,401,,,fee schedule,401% of BCBS fee schedule,13.5,90,,10.8,percent of total billed charges,90% of total billed charges,12,80,,9.6,percent of total billed charges,80% of total billed charges,13.5,90,,10.8,percent of total billed charges,90% of total billed charges,11.25,75,,9,percent of total billed charges,75% of total billed charges,23.81,122,,,fee schedule,122% of HUMANA fee schedule,4.35,29,,3.48,percent of total billed charges,29% of total billed charges,19.52,100,,,fee schedule,100% of CMS OPPS rate,10.05,67,,8.04,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,12,80,,9.6,percent of total billed charges,80% of total billed charges,9.75,65,,7.8,percent of total billed charges,65% of total billed charges,5.35,35.67,,4.28,percent of total billed charges,35.67% of total billed charges,4.35,23.81,
BLACK WIDOW ANTI VENOM,2501341,CDM,636,RC,,,outpatient,,,120,48.00,,102,85,,81.6,percent of total billed charges,85% of total billed charges,120,100,,96,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,98.4,82,,78.72,percent of total billed charges,82% of total billed charges,102,85,,81.6,percent of total billed charges,85% of total billed charges,102,85,,81.6,percent of total billed charges,85% of total billed charges,102,85,,81.6,percent of total billed charges,85% of total billed charges,108,90,,86.4,percent of total billed charges,90% of total billed charges,96,80,,76.8,percent of total billed charges,80% of total billed charges,108,90,,86.4,percent of total billed charges,90% of total billed charges,90,75,,72,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,34.8,29,,27.84,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,80.4,67,,64.32,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,96,80,,76.8,percent of total billed charges,80% of total billed charges,78,65,,62.4,percent of total billed charges,65% of total billed charges,42.8,35.67,,34.24,percent of total billed charges,35.67% of total billed charges,34.8,120,
BOTOX 100 UNIT INJECTION,2501348,CDM,636,RC,J0585,HCPCS,outpatient,,,1509,603.60,,1282.65,85,,1026.12,percent of total billed charges,85% of total billed charges,792.23,52.5,,633.78,percent of total billed charges,52.5 percent of total billed charges,6.41,100,,,fee schedule,100% of CMS OPPS rate,23.1,385,,,fee schedule,385% of BCBS fee schedule,24.06,401,,,fee schedule,401% of BCBS fee schedule,24.06,401,,,fee schedule,401% of BCBS fee schedule,24.06,401,,,fee schedule,401% of BCBS fee schedule,1358.1,90,,1086.48,percent of total billed charges,90% of total billed charges,1207.2,80,,965.76,percent of total billed charges,80% of total billed charges,1358.1,90,,1086.48,percent of total billed charges,90% of total billed charges,1131.75,75,,905.4,percent of total billed charges,75% of total billed charges,7.82,122,,,fee schedule,122% of HUMANA fee schedule,437.61,29,,350.088,percent of total billed charges,29% of total billed charges,6.41,100,,,fee schedule,100% of CMS OPPS rate,1011.03,67,,808.824,percent of total billed charges,67% of total billed charges,5.63,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,1207.2,80,,965.76,percent of total billed charges,80% of total billed charges,980.85,65,,784.68,percent of total billed charges,65% of total billed charges,538.26,35.67,,430.608,percent of total billed charges,35.67% of total billed charges,5.63,1358.1,
BRETHINE 1 MG/ML INJ,2501355,CDM,636,RC,J3105,HCPCS,outpatient,,,82,32.80,,69.7,85,,55.76,percent of total billed charges,85% of total billed charges,82,100,,65.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,10.63,385,,,fee schedule,385% of BCBS fee schedule,11.07,401,,,fee schedule,401% of BCBS fee schedule,11.07,401,,,fee schedule,401% of BCBS fee schedule,11.07,401,,,fee schedule,401% of BCBS fee schedule,73.8,90,,59.04,percent of total billed charges,90% of total billed charges,65.6,80,,52.48,percent of total billed charges,80% of total billed charges,73.8,90,,59.04,percent of total billed charges,90% of total billed charges,61.5,75,,49.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,23.78,29,,19.024,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,54.94,67,,43.952,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,65.6,80,,52.48,percent of total billed charges,80% of total billed charges,53.3,65,,42.64,percent of total billed charges,65% of total billed charges,29.25,35.67,,23.4,percent of total billed charges,35.67% of total billed charges,10.63,82,
BUTORPHAMOL TARTRATE 1 MG VIAL,2501452,CDM,636,RC,,,outpatient,,,23,9.20,,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,23,100,,18.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,18.86,82,,15.088,percent of total billed charges,82% of total billed charges,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,20.7,90,,16.56,percent of total billed charges,90% of total billed charges,18.4,80,,14.72,percent of total billed charges,80% of total billed charges,20.7,90,,16.56,percent of total billed charges,90% of total billed charges,17.25,75,,13.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,6.67,29,,5.336,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,15.41,67,,12.328,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,18.4,80,,14.72,percent of total billed charges,80% of total billed charges,14.95,65,,11.96,percent of total billed charges,65% of total billed charges,8.2,35.67,,6.56,percent of total billed charges,35.67% of total billed charges,6.67,23,
CALCIMAR 200U/CC INJ,2501545,CDM,636,RC,J0630,HCPCS,outpatient,,,2139,855.60,,1818.15,85,,1454.52,percent of total billed charges,85% of total billed charges,1122.98,52.5,,898.38,percent of total billed charges,52.5 percent of total billed charges,1173.06,100,,,fee schedule,100% of CMS OPPS rate,8671.89,385,,,fee schedule,385% of BCBS fee schedule,9032.28,401,,,fee schedule,401% of BCBS fee schedule,9032.28,401,,,fee schedule,401% of BCBS fee schedule,9032.28,401,,,fee schedule,401% of BCBS fee schedule,1925.1,90,,1540.08,percent of total billed charges,90% of total billed charges,1711.2,80,,1368.96,percent of total billed charges,80% of total billed charges,1925.1,90,,1540.08,percent of total billed charges,90% of total billed charges,1604.25,75,,1283.4,percent of total billed charges,75% of total billed charges,1431.13,122,,,fee schedule,122% of HUMANA fee schedule,620.31,29,,496.248,percent of total billed charges,29% of total billed charges,1173.06,100,,,fee schedule,100% of CMS OPPS rate,1433.13,67,,1146.504,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1711.2,80,,1368.96,percent of total billed charges,80% of total billed charges,1390.35,65,,1112.28,percent of total billed charges,65% of total billed charges,762.98,35.67,,610.384,percent of total billed charges,35.67% of total billed charges,620.31,9032.28,
CALCIUM GLUCONATE 1 GM INJ,2501555,CDM,636,RC,J0612,HCPCS,outpatient,,,20,8.00,,17,85,,13.6,percent of total billed charges,85% of total billed charges,20,100,,16,percent of total billed charges,pays based on exceed threshold rate,0.03,100,,,fee schedule,100% of CMS OPPS rate,16.4,82,,13.12,percent of total billed charges,82% of total billed charges,17,85,,13.6,percent of total billed charges,85% of total billed charges,17,85,,13.6,percent of total billed charges,85% of total billed charges,17,85,,13.6,percent of total billed charges,85% of total billed charges,18,90,,14.4,percent of total billed charges,90% of total billed charges,16,80,,12.8,percent of total billed charges,80% of total billed charges,18,90,,14.4,percent of total billed charges,90% of total billed charges,15,75,,12,percent of total billed charges,75% of total billed charges,0.03,122,,,fee schedule,122% of HUMANA fee schedule,5.8,29,,4.64,percent of total billed charges,29% of total billed charges,0.03,100,,,fee schedule,100% of CMS OPPS rate,13.4,67,,10.72,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,16,80,,12.8,percent of total billed charges,80% of total billed charges,13,65,,10.4,percent of total billed charges,65% of total billed charges,7.13,35.67,,5.704,percent of total billed charges,35.67% of total billed charges,0.03,20,
CALCIUM DISODIUM VERSENATE,2501558,CDM,636,RC,J0600,HCPCS,outpatient,,,4433,1773.20,,3768.05,85,,3014.44,percent of total billed charges,85% of total billed charges,2327.33,52.5,,1861.86,percent of total billed charges,52.5 percent of total billed charges,6086.32,100,,,fee schedule,100% of CMS OPPS rate,14331.36,385,,,fee schedule,385% of BCBS fee schedule,14926.94,401,,,fee schedule,401% of BCBS fee schedule,14926.94,401,,,fee schedule,401% of BCBS fee schedule,14926.94,401,,,fee schedule,401% of BCBS fee schedule,3989.7,90,,3191.76,percent of total billed charges,90% of total billed charges,3546.4,80,,2837.12,percent of total billed charges,80% of total billed charges,3989.7,90,,3191.76,percent of total billed charges,90% of total billed charges,3324.75,75,,2659.8,percent of total billed charges,75% of total billed charges,7425.31,122,,,fee schedule,122% of HUMANA fee schedule,1285.57,29,,1028.456,percent of total billed charges,29% of total billed charges,6086.32,100,,,fee schedule,100% of CMS OPPS rate,2970.11,67,,2376.088,percent of total billed charges,67% of total billed charges,207.48,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,3546.4,80,,2837.12,percent of total billed charges,80% of total billed charges,2881.45,65,,2305.16,percent of total billed charges,65% of total billed charges,1581.25,35.67,,1265,percent of total billed charges,35.67% of total billed charges,207.48,14926.94,
CARBOCAINE 1.5% 30 ML BOTTLE,2501617,CDM,636,RC,J0670,HCPCS,outpatient,,,22,8.80,,18.7,85,,14.96,percent of total billed charges,85% of total billed charges,22,100,,17.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,5.08,385,,,fee schedule,385% of BCBS fee schedule,5.29,401,,,fee schedule,401% of BCBS fee schedule,5.29,401,,,fee schedule,401% of BCBS fee schedule,5.29,401,,,fee schedule,401% of BCBS fee schedule,19.8,90,,15.84,percent of total billed charges,90% of total billed charges,17.6,80,,14.08,percent of total billed charges,80% of total billed charges,19.8,90,,15.84,percent of total billed charges,90% of total billed charges,16.5,75,,13.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,6.38,29,,5.104,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,14.74,67,,11.792,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,17.6,80,,14.08,percent of total billed charges,80% of total billed charges,14.3,65,,11.44,percent of total billed charges,65% of total billed charges,7.85,35.67,,6.28,percent of total billed charges,35.67% of total billed charges,5.08,22,
CARBOCAINE 1.5% PER 10ML,2501623,CDM,636,RC,J0670,HCPCS,outpatient,,,45,18.00,,38.25,85,,30.6,percent of total billed charges,85% of total billed charges,45,100,,36,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,5.08,385,,,fee schedule,385% of BCBS fee schedule,5.29,401,,,fee schedule,401% of BCBS fee schedule,5.29,401,,,fee schedule,401% of BCBS fee schedule,5.29,401,,,fee schedule,401% of BCBS fee schedule,40.5,90,,32.4,percent of total billed charges,90% of total billed charges,36,80,,28.8,percent of total billed charges,80% of total billed charges,40.5,90,,32.4,percent of total billed charges,90% of total billed charges,33.75,75,,27,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,13.05,29,,10.44,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,30.15,67,,24.12,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,36,80,,28.8,percent of total billed charges,80% of total billed charges,29.25,65,,23.4,percent of total billed charges,65% of total billed charges,16.05,35.67,,12.84,percent of total billed charges,35.67% of total billed charges,5.08,45,
CARIMUNE NF 1 GRAM VIAL,2501717,CDM,636,RC,J1566,HCPCS,outpatient,,,334,133.60,,283.9,85,,227.12,percent of total billed charges,85% of total billed charges,334,100,,267.2,percent of total billed charges,pays based on exceed threshold rate,82.19,100,,,fee schedule,100% of CMS OPPS rate,113.04,385,,,fee schedule,385% of BCBS fee schedule,117.73,401,,,fee schedule,401% of BCBS fee schedule,117.73,401,,,fee schedule,401% of BCBS fee schedule,117.73,401,,,fee schedule,401% of BCBS fee schedule,300.6,90,,240.48,percent of total billed charges,90% of total billed charges,267.2,80,,213.76,percent of total billed charges,80% of total billed charges,300.6,90,,240.48,percent of total billed charges,90% of total billed charges,250.5,75,,200.4,percent of total billed charges,75% of total billed charges,100.27,122,,,fee schedule,122% of HUMANA fee schedule,96.86,29,,77.488,percent of total billed charges,29% of total billed charges,82.19,100,,,fee schedule,100% of CMS OPPS rate,223.78,67,,179.024,percent of total billed charges,67% of total billed charges,33.19,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,267.2,80,,213.76,percent of total billed charges,80% of total billed charges,217.1,65,,173.68,percent of total billed charges,65% of total billed charges,119.14,35.67,,95.312,percent of total billed charges,35.67% of total billed charges,33.19,334,
CASIRIVIMAB 1200 MG -REGENERON,2501723,CDM,636,RC,Q0243,HCPCS,outpatient,,,2,0.80,,1.7,85,,1.36,percent of total billed charges,85% of total billed charges,2,100,,1.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,1.64,82,,1.312,percent of total billed charges,82% of total billed charges,1.7,85,,1.36,percent of total billed charges,85% of total billed charges,1.7,85,,1.36,percent of total billed charges,85% of total billed charges,1.7,85,,1.36,percent of total billed charges,85% of total billed charges,1.8,90,,1.44,percent of total billed charges,90% of total billed charges,1.6,80,,1.28,percent of total billed charges,80% of total billed charges,1.8,90,,1.44,percent of total billed charges,90% of total billed charges,1.5,75,,1.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,0.58,29,,0.464,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1.34,67,,1.072,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1.6,80,,1.28,percent of total billed charges,80% of total billed charges,1.3,65,,1.04,percent of total billed charges,65% of total billed charges,0.71,35.67,,0.568,percent of total billed charges,35.67% of total billed charges,0.58,2,
CEFOTETAN 1 GM PREMIXED BAG,2501801,CDM,636,RC,J0694,HCPCS,outpatient,,,65,26.00,,55.25,85,,44.2,percent of total billed charges,85% of total billed charges,65,100,,52,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,14.82,385,,,fee schedule,385% of BCBS fee schedule,15.44,401,,,fee schedule,401% of BCBS fee schedule,15.44,401,,,fee schedule,401% of BCBS fee schedule,15.44,401,,,fee schedule,401% of BCBS fee schedule,58.5,90,,46.8,percent of total billed charges,90% of total billed charges,52,80,,41.6,percent of total billed charges,80% of total billed charges,58.5,90,,46.8,percent of total billed charges,90% of total billed charges,48.75,75,,39,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,18.85,29,,15.08,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,43.55,67,,34.84,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,52,80,,41.6,percent of total billed charges,80% of total billed charges,42.25,65,,33.8,percent of total billed charges,65% of total billed charges,23.19,35.67,,18.552,percent of total billed charges,35.67% of total billed charges,14.82,65,
CEFOXITAN 2 GM DEXTROSE,2501802,CDM,636,RC,J0692,HCPCS,outpatient,,,103,41.20,,87.55,85,,70.04,percent of total billed charges,85% of total billed charges,103,100,,82.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,9.43,385,,,fee schedule,385% of BCBS fee schedule,9.82,401,,,fee schedule,401% of BCBS fee schedule,9.82,401,,,fee schedule,401% of BCBS fee schedule,9.82,401,,,fee schedule,401% of BCBS fee schedule,92.7,90,,74.16,percent of total billed charges,90% of total billed charges,82.4,80,,65.92,percent of total billed charges,80% of total billed charges,92.7,90,,74.16,percent of total billed charges,90% of total billed charges,77.25,75,,61.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,29.87,29,,23.896,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,69.01,67,,55.208,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,82.4,80,,65.92,percent of total billed charges,80% of total billed charges,66.95,65,,53.56,percent of total billed charges,65% of total billed charges,36.74,35.67,,29.392,percent of total billed charges,35.67% of total billed charges,9.43,103,
CELESTONE 12 MG INJ,2501835,CDM,636,RC,J0702,HCPCS,outpatient,,,34,13.60,,28.9,85,,23.12,percent of total billed charges,85% of total billed charges,34,100,,27.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,27.41,385,,,fee schedule,385% of BCBS fee schedule,28.55,401,,,fee schedule,401% of BCBS fee schedule,28.55,401,,,fee schedule,401% of BCBS fee schedule,28.55,401,,,fee schedule,401% of BCBS fee schedule,30.6,90,,24.48,percent of total billed charges,90% of total billed charges,27.2,80,,21.76,percent of total billed charges,80% of total billed charges,30.6,90,,24.48,percent of total billed charges,90% of total billed charges,25.5,75,,20.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,9.86,29,,7.888,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,22.78,67,,18.224,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,27.2,80,,21.76,percent of total billed charges,80% of total billed charges,22.1,65,,17.68,percent of total billed charges,65% of total billed charges,12.13,35.67,,9.704,percent of total billed charges,35.67% of total billed charges,9.86,34,
CELESTONE UP TO 30MG,2501845,CDM,636,RC,J0702,HCPCS,outpatient,,,157,62.80,,133.45,85,,106.76,percent of total billed charges,85% of total billed charges,157,100,,125.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,27.41,385,,,fee schedule,385% of BCBS fee schedule,28.55,401,,,fee schedule,401% of BCBS fee schedule,28.55,401,,,fee schedule,401% of BCBS fee schedule,28.55,401,,,fee schedule,401% of BCBS fee schedule,141.3,90,,113.04,percent of total billed charges,90% of total billed charges,125.6,80,,100.48,percent of total billed charges,80% of total billed charges,141.3,90,,113.04,percent of total billed charges,90% of total billed charges,117.75,75,,94.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,45.53,29,,36.424,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,105.19,67,,84.152,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,125.6,80,,100.48,percent of total billed charges,80% of total billed charges,102.05,65,,81.64,percent of total billed charges,65% of total billed charges,56,35.67,,44.8,percent of total billed charges,35.67% of total billed charges,27.41,157,
CEREBYX 500 MG INJ,2501882,CDM,636,RC,Q2009,HCPCS,outpatient,,,366,146.40,,311.1,85,,248.88,percent of total billed charges,85% of total billed charges,366,100,,292.8,percent of total billed charges,pays based on exceed threshold rate,3.2,100,,,fee schedule,100% of CMS OPPS rate,12.78,385,,,fee schedule,385% of BCBS fee schedule,13.31,401,,,fee schedule,401% of BCBS fee schedule,13.31,401,,,fee schedule,401% of BCBS fee schedule,13.31,401,,,fee schedule,401% of BCBS fee schedule,329.4,90,,263.52,percent of total billed charges,90% of total billed charges,292.8,80,,234.24,percent of total billed charges,80% of total billed charges,329.4,90,,263.52,percent of total billed charges,90% of total billed charges,274.5,75,,219.6,percent of total billed charges,75% of total billed charges,3.9,122,,,fee schedule,122% of HUMANA fee schedule,106.14,29,,84.912,percent of total billed charges,29% of total billed charges,3.2,100,,,fee schedule,100% of CMS OPPS rate,245.22,67,,196.176,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,292.8,80,,234.24,percent of total billed charges,80% of total billed charges,237.9,65,,190.32,percent of total billed charges,65% of total billed charges,130.55,35.67,,104.44,percent of total billed charges,35.67% of total billed charges,3.2,366,
CEREBYX 50 MG INJ*,2501889,CDM,636,RC,Q2009,HCPCS,outpatient,,,38,15.20,,32.3,85,,25.84,percent of total billed charges,85% of total billed charges,38,100,,30.4,percent of total billed charges,pays based on exceed threshold rate,3.2,100,,,fee schedule,100% of CMS OPPS rate,12.78,385,,,fee schedule,385% of BCBS fee schedule,13.31,401,,,fee schedule,401% of BCBS fee schedule,13.31,401,,,fee schedule,401% of BCBS fee schedule,13.31,401,,,fee schedule,401% of BCBS fee schedule,34.2,90,,27.36,percent of total billed charges,90% of total billed charges,30.4,80,,24.32,percent of total billed charges,80% of total billed charges,34.2,90,,27.36,percent of total billed charges,90% of total billed charges,28.5,75,,22.8,percent of total billed charges,75% of total billed charges,3.9,122,,,fee schedule,122% of HUMANA fee schedule,11.02,29,,8.816,percent of total billed charges,29% of total billed charges,3.2,100,,,fee schedule,100% of CMS OPPS rate,25.46,67,,20.368,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,30.4,80,,24.32,percent of total billed charges,80% of total billed charges,24.7,65,,19.76,percent of total billed charges,65% of total billed charges,13.55,35.67,,10.84,percent of total billed charges,35.67% of total billed charges,3.2,38,
EXPAREL 1.3% 20 ML VIAL 250 mg,2501896,CDM,636,RC,C9290,HCPCS,outpatient,,,822,328.80,,698.7,85,,558.96,percent of total billed charges,85% of total billed charges,822,100,,657.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,674.04,82,,539.232,percent of total billed charges,82% of total billed charges,698.7,85,,558.96,percent of total billed charges,85% of total billed charges,698.7,85,,558.96,percent of total billed charges,85% of total billed charges,698.7,85,,558.96,percent of total billed charges,85% of total billed charges,739.8,90,,591.84,percent of total billed charges,90% of total billed charges,657.6,80,,526.08,percent of total billed charges,80% of total billed charges,739.8,90,,591.84,percent of total billed charges,90% of total billed charges,616.5,75,,493.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,238.38,29,,190.704,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,550.74,67,,440.592,percent of total billed charges,67% of total billed charges,1.19,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,657.6,80,,526.08,percent of total billed charges,80% of total billed charges,534.3,65,,427.44,percent of total billed charges,65% of total billed charges,293.21,35.67,,234.568,percent of total billed charges,35.67% of total billed charges,1.19,822,
MENACTRA VACCINE,2501999,CDM,636,RC,90734,HCPCS,outpatient,,,357,142.80,,303.45,85,,242.76,percent of total billed charges,85% of total billed charges,357,100,,285.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,327.56,385,,,fee schedule,385% of BCBS fee schedule,341.17,401,,,fee schedule,401% of BCBS fee schedule,341.17,401,,,fee schedule,401% of BCBS fee schedule,341.17,401,,,fee schedule,401% of BCBS fee schedule,321.3,90,,257.04,percent of total billed charges,90% of total billed charges,285.6,80,,228.48,percent of total billed charges,80% of total billed charges,321.3,90,,257.04,percent of total billed charges,90% of total billed charges,267.75,75,,214.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,103.53,29,,82.824,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,239.19,67,,191.352,percent of total billed charges,67% of total billed charges,96.96,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,285.6,80,,228.48,percent of total billed charges,80% of total billed charges,232.05,65,,185.64,percent of total billed charges,65% of total billed charges,127.34,35.67,,101.872,percent of total billed charges,35.67% of total billed charges,96.96,357,
CIPRO 200 MG IV,2502014,CDM,636,RC,J0744,HCPCS,outpatient,,,61,24.40,,51.85,85,,41.48,percent of total billed charges,85% of total billed charges,61,100,,48.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,4.5,385,,,fee schedule,385% of BCBS fee schedule,4.69,401,,,fee schedule,401% of BCBS fee schedule,4.69,401,,,fee schedule,401% of BCBS fee schedule,4.69,401,,,fee schedule,401% of BCBS fee schedule,54.9,90,,43.92,percent of total billed charges,90% of total billed charges,48.8,80,,39.04,percent of total billed charges,80% of total billed charges,54.9,90,,43.92,percent of total billed charges,90% of total billed charges,45.75,75,,36.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,17.69,29,,14.152,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,40.87,67,,32.696,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,48.8,80,,39.04,percent of total billed charges,80% of total billed charges,39.65,65,,31.72,percent of total billed charges,65% of total billed charges,21.76,35.67,,17.408,percent of total billed charges,35.67% of total billed charges,4.5,61,
CIPRO 400MG IV INJ.,2502020,CDM,636,RC,J0744,HCPCS,outpatient,,,111,44.40,,94.35,85,,75.48,percent of total billed charges,85% of total billed charges,111,100,,88.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,4.5,385,,,fee schedule,385% of BCBS fee schedule,4.69,401,,,fee schedule,401% of BCBS fee schedule,4.69,401,,,fee schedule,401% of BCBS fee schedule,4.69,401,,,fee schedule,401% of BCBS fee schedule,99.9,90,,79.92,percent of total billed charges,90% of total billed charges,88.8,80,,71.04,percent of total billed charges,80% of total billed charges,99.9,90,,79.92,percent of total billed charges,90% of total billed charges,83.25,75,,66.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,32.19,29,,25.752,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,74.37,67,,59.496,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,88.8,80,,71.04,percent of total billed charges,80% of total billed charges,72.15,65,,57.72,percent of total billed charges,65% of total billed charges,39.59,35.67,,31.672,percent of total billed charges,35.67% of total billed charges,4.5,111,
CIPROFLOXACIN HCL 400MG/200 ML,2502022,CDM,636,RC,J0744,HCPCS,outpatient,,,11,4.40,,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,11,100,,8.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,4.5,385,,,fee schedule,385% of BCBS fee schedule,4.69,401,,,fee schedule,401% of BCBS fee schedule,4.69,401,,,fee schedule,401% of BCBS fee schedule,4.69,401,,,fee schedule,401% of BCBS fee schedule,9.9,90,,7.92,percent of total billed charges,90% of total billed charges,8.8,80,,7.04,percent of total billed charges,80% of total billed charges,9.9,90,,7.92,percent of total billed charges,90% of total billed charges,8.25,75,,6.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,3.19,29,,2.552,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,7.37,67,,5.896,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,8.8,80,,7.04,percent of total billed charges,80% of total billed charges,7.15,65,,5.72,percent of total billed charges,65% of total billed charges,3.92,35.67,,3.136,percent of total billed charges,35.67% of total billed charges,3.19,11,
CLAFORAN 1 GM INJ.IV,2502045,CDM,636,RC,J0698,HCPCS,outpatient,,,25,10.00,,21.25,85,,17,percent of total billed charges,85% of total billed charges,25,100,,20,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,5.85,385,,,fee schedule,385% of BCBS fee schedule,6.1,401,,,fee schedule,401% of BCBS fee schedule,6.1,401,,,fee schedule,401% of BCBS fee schedule,6.1,401,,,fee schedule,401% of BCBS fee schedule,22.5,90,,18,percent of total billed charges,90% of total billed charges,20,80,,16,percent of total billed charges,80% of total billed charges,22.5,90,,18,percent of total billed charges,90% of total billed charges,18.75,75,,15,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,7.25,29,,5.8,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,16.75,67,,13.4,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,20,80,,16,percent of total billed charges,80% of total billed charges,16.25,65,,13,percent of total billed charges,65% of total billed charges,8.92,35.67,,7.136,percent of total billed charges,35.67% of total billed charges,5.85,25,
CLEVIDIPINE BUTYRATE .5 MG/ML,2502047,CDM,636,RC,C9248,HCPCS,outpatient,,,102,40.80,,86.7,85,,69.36,percent of total billed charges,85% of total billed charges,102,100,,81.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,83.64,82,,66.912,percent of total billed charges,82% of total billed charges,86.7,85,,69.36,percent of total billed charges,85% of total billed charges,86.7,85,,69.36,percent of total billed charges,85% of total billed charges,86.7,85,,69.36,percent of total billed charges,85% of total billed charges,91.8,90,,73.44,percent of total billed charges,90% of total billed charges,81.6,80,,65.28,percent of total billed charges,80% of total billed charges,91.8,90,,73.44,percent of total billed charges,90% of total billed charges,76.5,75,,61.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,29.58,29,,23.664,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,68.34,67,,54.672,percent of total billed charges,67% of total billed charges,3.04,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,81.6,80,,65.28,percent of total billed charges,80% of total billed charges,66.3,65,,53.04,percent of total billed charges,65% of total billed charges,36.38,35.67,,29.104,percent of total billed charges,35.67% of total billed charges,3.04,102,
CLEVIPREX 50MG/100ML,2502048,CDM,636,RC,C9248,HCPCS,outpatient,,,616,246.40,,523.6,85,,418.88,percent of total billed charges,85% of total billed charges,616,100,,492.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,505.12,82,,404.096,percent of total billed charges,82% of total billed charges,523.6,85,,418.88,percent of total billed charges,85% of total billed charges,523.6,85,,418.88,percent of total billed charges,85% of total billed charges,523.6,85,,418.88,percent of total billed charges,85% of total billed charges,554.4,90,,443.52,percent of total billed charges,90% of total billed charges,492.8,80,,394.24,percent of total billed charges,80% of total billed charges,554.4,90,,443.52,percent of total billed charges,90% of total billed charges,462,75,,369.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,178.64,29,,142.912,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,412.72,67,,330.176,percent of total billed charges,67% of total billed charges,3.04,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,492.8,80,,394.24,percent of total billed charges,80% of total billed charges,400.4,65,,320.32,percent of total billed charges,65% of total billed charges,219.73,35.67,,175.784,percent of total billed charges,35.67% of total billed charges,3.04,616,
CLINDAMYCIN 300MG/2ML VIAL,2502134,CDM,636,RC,J3490,HCPCS,outpatient,,,13,5.20,,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,13,100,,10.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,10.66,82,,8.528,percent of total billed charges,82% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,11.7,90,,9.36,percent of total billed charges,90% of total billed charges,10.4,80,,8.32,percent of total billed charges,80% of total billed charges,11.7,90,,9.36,percent of total billed charges,90% of total billed charges,9.75,75,,7.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,3.77,29,,3.016,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,8.71,67,,6.968,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,10.4,80,,8.32,percent of total billed charges,80% of total billed charges,8.45,65,,6.76,percent of total billed charges,65% of total billed charges,4.64,35.67,,3.712,percent of total billed charges,35.67% of total billed charges,3.77,13,
DEXMEDETOMIDINE HCL 200MG/2ML,2502136,CDM,636,RC,J3490,HCPCS,outpatient,,,519,207.60,,441.15,85,,352.92,percent of total billed charges,85% of total billed charges,519,100,,415.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,425.58,82,,340.464,percent of total billed charges,82% of total billed charges,441.15,85,,352.92,percent of total billed charges,85% of total billed charges,441.15,85,,352.92,percent of total billed charges,85% of total billed charges,441.15,85,,352.92,percent of total billed charges,85% of total billed charges,467.1,90,,373.68,percent of total billed charges,90% of total billed charges,415.2,80,,332.16,percent of total billed charges,80% of total billed charges,467.1,90,,373.68,percent of total billed charges,90% of total billed charges,389.25,75,,311.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,150.51,29,,120.408,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,347.73,67,,278.184,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,415.2,80,,332.16,percent of total billed charges,80% of total billed charges,337.35,65,,269.88,percent of total billed charges,65% of total billed charges,185.13,35.67,,148.104,percent of total billed charges,35.67% of total billed charges,150.51,519,
COGENTIN 2 MG/2ML,2502176,CDM,636,RC,J0515,HCPCS,outpatient,,,197,78.80,,167.45,85,,133.96,percent of total billed charges,85% of total billed charges,197,100,,157.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,73.19,385,,,fee schedule,385% of BCBS fee schedule,76.23,401,,,fee schedule,401% of BCBS fee schedule,76.23,401,,,fee schedule,401% of BCBS fee schedule,76.23,401,,,fee schedule,401% of BCBS fee schedule,177.3,90,,141.84,percent of total billed charges,90% of total billed charges,157.6,80,,126.08,percent of total billed charges,80% of total billed charges,177.3,90,,141.84,percent of total billed charges,90% of total billed charges,147.75,75,,118.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,57.13,29,,45.704,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,131.99,67,,105.592,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,157.6,80,,126.08,percent of total billed charges,80% of total billed charges,128.05,65,,102.44,percent of total billed charges,65% of total billed charges,70.27,35.67,,56.216,percent of total billed charges,35.67% of total billed charges,57.13,197,
COMPAZINE 10 MG INJ,2502240,CDM,636,RC,J0780,HCPCS,outpatient,,,23,9.20,,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,23,100,,18.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,49.24,385,,,fee schedule,385% of BCBS fee schedule,51.29,401,,,fee schedule,401% of BCBS fee schedule,51.29,401,,,fee schedule,401% of BCBS fee schedule,51.29,401,,,fee schedule,401% of BCBS fee schedule,20.7,90,,16.56,percent of total billed charges,90% of total billed charges,18.4,80,,14.72,percent of total billed charges,80% of total billed charges,20.7,90,,16.56,percent of total billed charges,90% of total billed charges,17.25,75,,13.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,6.67,29,,5.336,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,15.41,67,,12.328,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,18.4,80,,14.72,percent of total billed charges,80% of total billed charges,14.95,65,,11.96,percent of total billed charges,65% of total billed charges,8.2,35.67,,6.56,percent of total billed charges,35.67% of total billed charges,6.67,51.29,
CORDARONE 150 MG 3 ML IV,2502291,CDM,636,RC,J0282,HCPCS,outpatient,,,24,9.60,,20.4,85,,16.32,percent of total billed charges,85% of total billed charges,24,100,,19.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,0.77,385,,,fee schedule,385% of BCBS fee schedule,0.8,401,,,fee schedule,401% of BCBS fee schedule,0.8,401,,,fee schedule,401% of BCBS fee schedule,0.8,401,,,fee schedule,401% of BCBS fee schedule,21.6,90,,17.28,percent of total billed charges,90% of total billed charges,19.2,80,,15.36,percent of total billed charges,80% of total billed charges,21.6,90,,17.28,percent of total billed charges,90% of total billed charges,18,75,,14.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,6.96,29,,5.568,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,16.08,67,,12.864,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,19.2,80,,15.36,percent of total billed charges,80% of total billed charges,15.6,65,,12.48,percent of total billed charges,65% of total billed charges,8.56,35.67,,6.848,percent of total billed charges,35.67% of total billed charges,0.77,24,
CORDARONE 150MG/100ML PREMIX,2502294,CDM,636,RC,J0282,HCPCS,outpatient,,,389,155.60,,330.65,85,,264.52,percent of total billed charges,85% of total billed charges,389,100,,311.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,0.77,385,,,fee schedule,385% of BCBS fee schedule,0.8,401,,,fee schedule,401% of BCBS fee schedule,0.8,401,,,fee schedule,401% of BCBS fee schedule,0.8,401,,,fee schedule,401% of BCBS fee schedule,350.1,90,,280.08,percent of total billed charges,90% of total billed charges,311.2,80,,248.96,percent of total billed charges,80% of total billed charges,350.1,90,,280.08,percent of total billed charges,90% of total billed charges,291.75,75,,233.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,112.81,29,,90.248,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,260.63,67,,208.504,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,311.2,80,,248.96,percent of total billed charges,80% of total billed charges,252.85,65,,202.28,percent of total billed charges,65% of total billed charges,138.76,35.67,,111.008,percent of total billed charges,35.67% of total billed charges,0.77,389,
CORDARONE 360MG/200ML PREMIX,2502296,CDM,636,RC,J0282,HCPCS,outpatient,,,432,172.80,,367.2,85,,293.76,percent of total billed charges,85% of total billed charges,432,100,,345.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,0.77,385,,,fee schedule,385% of BCBS fee schedule,0.8,401,,,fee schedule,401% of BCBS fee schedule,0.8,401,,,fee schedule,401% of BCBS fee schedule,0.8,401,,,fee schedule,401% of BCBS fee schedule,388.8,90,,311.04,percent of total billed charges,90% of total billed charges,345.6,80,,276.48,percent of total billed charges,80% of total billed charges,388.8,90,,311.04,percent of total billed charges,90% of total billed charges,324,75,,259.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,125.28,29,,100.224,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,289.44,67,,231.552,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,345.6,80,,276.48,percent of total billed charges,80% of total billed charges,280.8,65,,224.64,percent of total billed charges,65% of total billed charges,154.09,35.67,,123.272,percent of total billed charges,35.67% of total billed charges,0.77,432,
CORTROSYN 0.25MG INJ.,2502395,CDM,636,RC,J0834,HCPCS,outpatient,,,329,131.60,,279.65,85,,223.72,percent of total billed charges,85% of total billed charges,329,100,,263.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,213.41,385,,,fee schedule,385% of BCBS fee schedule,222.27,401,,,fee schedule,401% of BCBS fee schedule,222.27,401,,,fee schedule,401% of BCBS fee schedule,222.27,401,,,fee schedule,401% of BCBS fee schedule,296.1,90,,236.88,percent of total billed charges,90% of total billed charges,263.2,80,,210.56,percent of total billed charges,80% of total billed charges,296.1,90,,236.88,percent of total billed charges,90% of total billed charges,246.75,75,,197.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,95.41,29,,76.328,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,220.43,67,,176.344,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,263.2,80,,210.56,percent of total billed charges,80% of total billed charges,213.85,65,,171.08,percent of total billed charges,65% of total billed charges,117.35,35.67,,93.88,percent of total billed charges,35.67% of total billed charges,95.41,329,
CROFAB VIAL 1 GRAM,2502439,CDM,636,RC,J0840,HCPCS,outpatient,,,5366,2146.40,,4561.1,85,,3648.88,percent of total billed charges,85% of total billed charges,2817.15,52.5,,2253.72,percent of total billed charges,52.5 percent of total billed charges,1762.35,100,,,fee schedule,100% of CMS OPPS rate,11438.35,385,,,fee schedule,385% of BCBS fee schedule,11913.71,401,,,fee schedule,401% of BCBS fee schedule,11913.71,401,,,fee schedule,401% of BCBS fee schedule,11913.71,401,,,fee schedule,401% of BCBS fee schedule,4829.4,90,,3863.52,percent of total billed charges,90% of total billed charges,4292.8,80,,3434.24,percent of total billed charges,80% of total billed charges,4829.4,90,,3863.52,percent of total billed charges,90% of total billed charges,4024.5,75,,3219.6,percent of total billed charges,75% of total billed charges,2150.06,122,,,fee schedule,122% of HUMANA fee schedule,1556.14,29,,1244.912,percent of total billed charges,29% of total billed charges,1762.35,100,,,fee schedule,100% of CMS OPPS rate,3595.22,67,,2876.176,percent of total billed charges,67% of total billed charges,2327.64,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,4292.8,80,,3434.24,percent of total billed charges,80% of total billed charges,3487.9,65,,2790.32,percent of total billed charges,65% of total billed charges,1914.05,35.67,,1531.24,percent of total billed charges,35.67% of total billed charges,1556.14,11913.71,
CUBICIN 500 MG VIAL,2502463,CDM,636,RC,J0878,HCPCS,outpatient,,,1771,708.40,,1505.35,85,,1204.28,percent of total billed charges,85% of total billed charges,929.78,52.5,,743.82,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,2.39,385,,,fee schedule,385% of BCBS fee schedule,2.49,401,,,fee schedule,401% of BCBS fee schedule,2.49,401,,,fee schedule,401% of BCBS fee schedule,2.49,401,,,fee schedule,401% of BCBS fee schedule,1593.9,90,,1275.12,percent of total billed charges,90% of total billed charges,1416.8,80,,1133.44,percent of total billed charges,80% of total billed charges,1593.9,90,,1275.12,percent of total billed charges,90% of total billed charges,1328.25,75,,1062.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,513.59,29,,410.872,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1186.57,67,,949.256,percent of total billed charges,67% of total billed charges,0.55,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,1416.8,80,,1133.44,percent of total billed charges,80% of total billed charges,1151.15,65,,920.92,percent of total billed charges,65% of total billed charges,631.72,35.67,,505.376,percent of total billed charges,35.67% of total billed charges,0.55,1593.9,
CUBICIN PER 1 MG,2502464,CDM,636,RC,J0878,HCPCS,outpatient,,,5,2.00,,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,5,100,,4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,2.39,385,,,fee schedule,385% of BCBS fee schedule,2.49,401,,,fee schedule,401% of BCBS fee schedule,2.49,401,,,fee schedule,401% of BCBS fee schedule,2.49,401,,,fee schedule,401% of BCBS fee schedule,4.5,90,,3.6,percent of total billed charges,90% of total billed charges,4,80,,3.2,percent of total billed charges,80% of total billed charges,4.5,90,,3.6,percent of total billed charges,90% of total billed charges,3.75,75,,3,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,1.45,29,,1.16,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,3.35,67,,2.68,percent of total billed charges,67% of total billed charges,0.55,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,4,80,,3.2,percent of total billed charges,80% of total billed charges,3.25,65,,2.6,percent of total billed charges,65% of total billed charges,1.78,35.67,,1.424,percent of total billed charges,35.67% of total billed charges,0.55,5,
CYANOCOBALAMINE 1000MCG/ML,2502473,CDM,636,RC,J3420,HCPCS,outpatient,,,11,4.40,,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,11,100,,8.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,17.06,385,,,fee schedule,385% of BCBS fee schedule,17.76,401,,,fee schedule,401% of BCBS fee schedule,17.76,401,,,fee schedule,401% of BCBS fee schedule,17.76,401,,,fee schedule,401% of BCBS fee schedule,9.9,90,,7.92,percent of total billed charges,90% of total billed charges,8.8,80,,7.04,percent of total billed charges,80% of total billed charges,9.9,90,,7.92,percent of total billed charges,90% of total billed charges,8.25,75,,6.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,3.19,29,,2.552,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,7.37,67,,5.896,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,8.8,80,,7.04,percent of total billed charges,80% of total billed charges,7.15,65,,5.72,percent of total billed charges,65% of total billed charges,3.92,35.67,,3.136,percent of total billed charges,35.67% of total billed charges,3.19,17.76,
CUBICIN 350 MG VIAL,2502479,CDM,636,RC,J0878,HCPCS,outpatient,,,133,53.20,,113.05,85,,90.44,percent of total billed charges,85% of total billed charges,133,100,,106.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,2.39,385,,,fee schedule,385% of BCBS fee schedule,2.49,401,,,fee schedule,401% of BCBS fee schedule,2.49,401,,,fee schedule,401% of BCBS fee schedule,2.49,401,,,fee schedule,401% of BCBS fee schedule,119.7,90,,95.76,percent of total billed charges,90% of total billed charges,106.4,80,,85.12,percent of total billed charges,80% of total billed charges,119.7,90,,95.76,percent of total billed charges,90% of total billed charges,99.75,75,,79.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,38.57,29,,30.856,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,89.11,67,,71.288,percent of total billed charges,67% of total billed charges,0.55,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,106.4,80,,85.12,percent of total billed charges,80% of total billed charges,86.45,65,,69.16,percent of total billed charges,65% of total billed charges,47.44,35.67,,37.952,percent of total billed charges,35.67% of total billed charges,0.55,133,
DECADRON 4 MG/1 CC INJ,2502625,CDM,636,RC,J1100,HCPCS,outpatient,,,48,19.20,,40.8,85,,32.64,percent of total billed charges,85% of total billed charges,48,100,,38.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,0.12,385,,,fee schedule,385% of BCBS fee schedule,0.12,401,,,fee schedule,401% of BCBS fee schedule,0.12,401,,,fee schedule,401% of BCBS fee schedule,0.12,401,,,fee schedule,401% of BCBS fee schedule,43.2,90,,34.56,percent of total billed charges,90% of total billed charges,38.4,80,,30.72,percent of total billed charges,80% of total billed charges,43.2,90,,34.56,percent of total billed charges,90% of total billed charges,36,75,,28.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,13.92,29,,11.136,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,32.16,67,,25.728,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,38.4,80,,30.72,percent of total billed charges,80% of total billed charges,31.2,65,,24.96,percent of total billed charges,65% of total billed charges,17.12,35.67,,13.696,percent of total billed charges,35.67% of total billed charges,0.12,48,
DECADRON 4 MG TAB,2502630,CDM,636,RC,J8540,HCPCS,outpatient,,,11,4.40,,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,11,100,,8.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,0.04,385,,,fee schedule,385% of BCBS fee schedule,0.04,401,,,fee schedule,401% of BCBS fee schedule,0.04,401,,,fee schedule,401% of BCBS fee schedule,0.04,401,,,fee schedule,401% of BCBS fee schedule,9.9,90,,7.92,percent of total billed charges,90% of total billed charges,8.8,80,,7.04,percent of total billed charges,80% of total billed charges,9.9,90,,7.92,percent of total billed charges,90% of total billed charges,8.25,75,,6.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,3.19,29,,2.552,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,7.37,67,,5.896,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,8.8,80,,7.04,percent of total billed charges,80% of total billed charges,7.15,65,,5.72,percent of total billed charges,65% of total billed charges,3.92,35.67,,3.136,percent of total billed charges,35.67% of total billed charges,0.04,11,
DECADRON 120 MG/30ML,2502636,CDM,636,RC,J1100,HCPCS,outpatient,,,48,19.20,,40.8,85,,32.64,percent of total billed charges,85% of total billed charges,48,100,,38.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,0.12,385,,,fee schedule,385% of BCBS fee schedule,0.12,401,,,fee schedule,401% of BCBS fee schedule,0.12,401,,,fee schedule,401% of BCBS fee schedule,0.12,401,,,fee schedule,401% of BCBS fee schedule,43.2,90,,34.56,percent of total billed charges,90% of total billed charges,38.4,80,,30.72,percent of total billed charges,80% of total billed charges,43.2,90,,34.56,percent of total billed charges,90% of total billed charges,36,75,,28.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,13.92,29,,11.136,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,32.16,67,,25.728,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,38.4,80,,30.72,percent of total billed charges,80% of total billed charges,31.2,65,,24.96,percent of total billed charges,65% of total billed charges,17.12,35.67,,13.696,percent of total billed charges,35.67% of total billed charges,0.12,48,
DECADRON 8 MG INJ.,2502650,CDM,636,RC,J1100,HCPCS,outpatient,,,23,9.20,,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,23,100,,18.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,0.12,385,,,fee schedule,385% of BCBS fee schedule,0.12,401,,,fee schedule,401% of BCBS fee schedule,0.12,401,,,fee schedule,401% of BCBS fee schedule,0.12,401,,,fee schedule,401% of BCBS fee schedule,20.7,90,,16.56,percent of total billed charges,90% of total billed charges,18.4,80,,14.72,percent of total billed charges,80% of total billed charges,20.7,90,,16.56,percent of total billed charges,90% of total billed charges,17.25,75,,13.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,6.67,29,,5.336,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,15.41,67,,12.328,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,18.4,80,,14.72,percent of total billed charges,80% of total billed charges,14.95,65,,11.96,percent of total billed charges,65% of total billed charges,8.2,35.67,,6.56,percent of total billed charges,35.67% of total billed charges,0.12,23,
DEMEROL 100 MG INJ,2502730,CDM,636,RC,J2175,HCPCS,outpatient,,,13,5.20,,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,13,100,,10.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,3.62,385,,,fee schedule,385% of BCBS fee schedule,3.77,401,,,fee schedule,401% of BCBS fee schedule,3.77,401,,,fee schedule,401% of BCBS fee schedule,3.77,401,,,fee schedule,401% of BCBS fee schedule,11.7,90,,9.36,percent of total billed charges,90% of total billed charges,10.4,80,,8.32,percent of total billed charges,80% of total billed charges,11.7,90,,9.36,percent of total billed charges,90% of total billed charges,9.75,75,,7.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,3.77,29,,3.016,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,8.71,67,,6.968,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,10.4,80,,8.32,percent of total billed charges,80% of total billed charges,8.45,65,,6.76,percent of total billed charges,65% of total billed charges,4.64,35.67,,3.712,percent of total billed charges,35.67% of total billed charges,3.62,13,
DEMADEX 10 MG INJ,2502731,CDM,636,RC,J3265,HCPCS,outpatient,,,28,11.20,,23.8,85,,19.04,percent of total billed charges,85% of total billed charges,28,100,,22.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,7.93,385,,,fee schedule,385% of BCBS fee schedule,8.26,401,,,fee schedule,401% of BCBS fee schedule,8.26,401,,,fee schedule,401% of BCBS fee schedule,8.26,401,,,fee schedule,401% of BCBS fee schedule,25.2,90,,20.16,percent of total billed charges,90% of total billed charges,22.4,80,,17.92,percent of total billed charges,80% of total billed charges,25.2,90,,20.16,percent of total billed charges,90% of total billed charges,21,75,,16.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,8.12,29,,6.496,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,18.76,67,,15.008,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,22.4,80,,17.92,percent of total billed charges,80% of total billed charges,18.2,65,,14.56,percent of total billed charges,65% of total billed charges,9.99,35.67,,7.992,percent of total billed charges,35.67% of total billed charges,7.93,28,
DEMEROL 12.5 MG INJ,2502740,CDM,636,RC,J2175,HCPCS,outpatient,,,12,4.80,,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,12,100,,9.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,3.62,385,,,fee schedule,385% of BCBS fee schedule,3.77,401,,,fee schedule,401% of BCBS fee schedule,3.77,401,,,fee schedule,401% of BCBS fee schedule,3.77,401,,,fee schedule,401% of BCBS fee schedule,10.8,90,,8.64,percent of total billed charges,90% of total billed charges,9.6,80,,7.68,percent of total billed charges,80% of total billed charges,10.8,90,,8.64,percent of total billed charges,90% of total billed charges,9,75,,7.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,3.48,29,,2.784,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,8.04,67,,6.432,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,9.6,80,,7.68,percent of total billed charges,80% of total billed charges,7.8,65,,6.24,percent of total billed charges,65% of total billed charges,4.28,35.67,,3.424,percent of total billed charges,35.67% of total billed charges,3.48,12,
DEMEROL 35 MG INJ,2502760,CDM,636,RC,J2175,HCPCS,outpatient,,,11,4.40,,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,11,100,,8.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,3.62,385,,,fee schedule,385% of BCBS fee schedule,3.77,401,,,fee schedule,401% of BCBS fee schedule,3.77,401,,,fee schedule,401% of BCBS fee schedule,3.77,401,,,fee schedule,401% of BCBS fee schedule,9.9,90,,7.92,percent of total billed charges,90% of total billed charges,8.8,80,,7.04,percent of total billed charges,80% of total billed charges,9.9,90,,7.92,percent of total billed charges,90% of total billed charges,8.25,75,,6.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,3.19,29,,2.552,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,7.37,67,,5.896,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,8.8,80,,7.04,percent of total billed charges,80% of total billed charges,7.15,65,,5.72,percent of total billed charges,65% of total billed charges,3.92,35.67,,3.136,percent of total billed charges,35.67% of total billed charges,3.19,11,
DEMEROL 37.5 MG INJ,2502765,CDM,636,RC,J2175,HCPCS,outpatient,,,11,4.40,,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,11,100,,8.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,3.62,385,,,fee schedule,385% of BCBS fee schedule,3.77,401,,,fee schedule,401% of BCBS fee schedule,3.77,401,,,fee schedule,401% of BCBS fee schedule,3.77,401,,,fee schedule,401% of BCBS fee schedule,9.9,90,,7.92,percent of total billed charges,90% of total billed charges,8.8,80,,7.04,percent of total billed charges,80% of total billed charges,9.9,90,,7.92,percent of total billed charges,90% of total billed charges,8.25,75,,6.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,3.19,29,,2.552,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,7.37,67,,5.896,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,8.8,80,,7.04,percent of total billed charges,80% of total billed charges,7.15,65,,5.72,percent of total billed charges,65% of total billed charges,3.92,35.67,,3.136,percent of total billed charges,35.67% of total billed charges,3.19,11,
DEMEROL 50 MG INJ,2502770,CDM,636,RC,J2175,HCPCS,outpatient,,,15,6.00,,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,15,100,,12,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,3.62,385,,,fee schedule,385% of BCBS fee schedule,3.77,401,,,fee schedule,401% of BCBS fee schedule,3.77,401,,,fee schedule,401% of BCBS fee schedule,3.77,401,,,fee schedule,401% of BCBS fee schedule,13.5,90,,10.8,percent of total billed charges,90% of total billed charges,12,80,,9.6,percent of total billed charges,80% of total billed charges,13.5,90,,10.8,percent of total billed charges,90% of total billed charges,11.25,75,,9,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,4.35,29,,3.48,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,10.05,67,,8.04,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,12,80,,9.6,percent of total billed charges,80% of total billed charges,9.75,65,,7.8,percent of total billed charges,65% of total billed charges,5.35,35.67,,4.28,percent of total billed charges,35.67% of total billed charges,3.62,15,
DEMEROL 6.25 MG INJ,2502780,CDM,636,RC,J2175,HCPCS,outpatient,,,12,4.80,,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,12,100,,9.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,3.62,385,,,fee schedule,385% of BCBS fee schedule,3.77,401,,,fee schedule,401% of BCBS fee schedule,3.77,401,,,fee schedule,401% of BCBS fee schedule,3.77,401,,,fee schedule,401% of BCBS fee schedule,10.8,90,,8.64,percent of total billed charges,90% of total billed charges,9.6,80,,7.68,percent of total billed charges,80% of total billed charges,10.8,90,,8.64,percent of total billed charges,90% of total billed charges,9,75,,7.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,3.48,29,,2.784,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,8.04,67,,6.432,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,9.6,80,,7.68,percent of total billed charges,80% of total billed charges,7.8,65,,6.24,percent of total billed charges,65% of total billed charges,4.28,35.67,,3.424,percent of total billed charges,35.67% of total billed charges,3.48,12,
DEMEROL 75 MG INJ,2502785,CDM,636,RC,J2175,HCPCS,outpatient,,,11,4.40,,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,11,100,,8.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,3.62,385,,,fee schedule,385% of BCBS fee schedule,3.77,401,,,fee schedule,401% of BCBS fee schedule,3.77,401,,,fee schedule,401% of BCBS fee schedule,3.77,401,,,fee schedule,401% of BCBS fee schedule,9.9,90,,7.92,percent of total billed charges,90% of total billed charges,8.8,80,,7.04,percent of total billed charges,80% of total billed charges,9.9,90,,7.92,percent of total billed charges,90% of total billed charges,8.25,75,,6.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,3.19,29,,2.552,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,7.37,67,,5.896,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,8.8,80,,7.04,percent of total billed charges,80% of total billed charges,7.15,65,,5.72,percent of total billed charges,65% of total billed charges,3.92,35.67,,3.136,percent of total billed charges,35.67% of total billed charges,3.19,11,
DEPO ESTRADIOL 5 MG 1 CC INJ,2502825,CDM,636,RC,J1000,HCPCS,outpatient,,,146,58.40,,124.1,85,,99.28,percent of total billed charges,85% of total billed charges,146,100,,116.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,51.01,385,,,fee schedule,385% of BCBS fee schedule,53.13,401,,,fee schedule,401% of BCBS fee schedule,53.13,401,,,fee schedule,401% of BCBS fee schedule,53.13,401,,,fee schedule,401% of BCBS fee schedule,131.4,90,,105.12,percent of total billed charges,90% of total billed charges,116.8,80,,93.44,percent of total billed charges,80% of total billed charges,131.4,90,,105.12,percent of total billed charges,90% of total billed charges,109.5,75,,87.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,42.34,29,,33.872,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,97.82,67,,78.256,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,116.8,80,,93.44,percent of total billed charges,80% of total billed charges,94.9,65,,75.92,percent of total billed charges,65% of total billed charges,52.08,35.67,,41.664,percent of total billed charges,35.67% of total billed charges,42.34,146,
DEPO MEDROL 40 MG PER 1CC INJ,2502830,CDM,636,RC,J1030,HCPCS,outpatient,,,25,10.00,,21.25,85,,17,percent of total billed charges,85% of total billed charges,25,100,,20,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,13.82,385,,,fee schedule,385% of BCBS fee schedule,14.4,401,,,fee schedule,401% of BCBS fee schedule,14.4,401,,,fee schedule,401% of BCBS fee schedule,14.4,401,,,fee schedule,401% of BCBS fee schedule,22.5,90,,18,percent of total billed charges,90% of total billed charges,20,80,,16,percent of total billed charges,80% of total billed charges,22.5,90,,18,percent of total billed charges,90% of total billed charges,18.75,75,,15,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,7.25,29,,5.8,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,16.75,67,,13.4,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,20,80,,16,percent of total billed charges,80% of total billed charges,16.25,65,,13,percent of total billed charges,65% of total billed charges,8.92,35.67,,7.136,percent of total billed charges,35.67% of total billed charges,7.25,25,
DEPO MEDROL 80 MG PER 2CC INJ,2502835,CDM,636,RC,J1010,HCPCS,outpatient,,,59,23.60,,50.15,85,,40.12,percent of total billed charges,85% of total billed charges,59,100,,47.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,48.38,82,,38.704,percent of total billed charges,82% of total billed charges,50.15,85,,40.12,percent of total billed charges,85% of total billed charges,50.15,85,,40.12,percent of total billed charges,85% of total billed charges,50.15,85,,40.12,percent of total billed charges,85% of total billed charges,53.1,90,,42.48,percent of total billed charges,90% of total billed charges,47.2,80,,37.76,percent of total billed charges,80% of total billed charges,53.1,90,,42.48,percent of total billed charges,90% of total billed charges,44.25,75,,35.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,17.11,29,,13.688,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,39.53,67,,31.624,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,47.2,80,,37.76,percent of total billed charges,80% of total billed charges,38.35,65,,30.68,percent of total billed charges,65% of total billed charges,21.05,35.67,,16.84,percent of total billed charges,35.67% of total billed charges,17.11,59,
DEPO TESTOSTERONE 200MG/1CCINJ,2502840,CDM,636,RC,J1071,HCPCS,outpatient,,,106,42.40,,90.1,85,,72.08,percent of total billed charges,85% of total billed charges,106,100,,84.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,0.12,385,,,fee schedule,385% of BCBS fee schedule,0.12,401,,,fee schedule,401% of BCBS fee schedule,0.12,401,,,fee schedule,401% of BCBS fee schedule,0.12,401,,,fee schedule,401% of BCBS fee schedule,95.4,90,,76.32,percent of total billed charges,90% of total billed charges,84.8,80,,67.84,percent of total billed charges,80% of total billed charges,95.4,90,,76.32,percent of total billed charges,90% of total billed charges,79.5,75,,63.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,30.74,29,,24.592,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,71.02,67,,56.816,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,84.8,80,,67.84,percent of total billed charges,80% of total billed charges,68.9,65,,55.12,percent of total billed charges,65% of total billed charges,37.81,35.67,,30.248,percent of total billed charges,35.67% of total billed charges,0.12,106,
DEPO-PROVERA 100 1CC INJ.,2502845,CDM,636,RC,J1050,HCPCS,outpatient,,,91,36.40,,77.35,85,,61.88,percent of total billed charges,85% of total billed charges,91,100,,72.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,1.96,385,,,fee schedule,385% of BCBS fee schedule,2.05,401,,,fee schedule,401% of BCBS fee schedule,2.05,401,,,fee schedule,401% of BCBS fee schedule,2.05,401,,,fee schedule,401% of BCBS fee schedule,81.9,90,,65.52,percent of total billed charges,90% of total billed charges,72.8,80,,58.24,percent of total billed charges,80% of total billed charges,81.9,90,,65.52,percent of total billed charges,90% of total billed charges,68.25,75,,54.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,26.39,29,,21.112,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,60.97,67,,48.776,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,72.8,80,,58.24,percent of total billed charges,80% of total billed charges,59.15,65,,47.32,percent of total billed charges,65% of total billed charges,32.46,35.67,,25.968,percent of total billed charges,35.67% of total billed charges,1.96,91,
DEPO-TESTADIOL 1CC INJ.,2502855,CDM,636,RC,J1071,HCPCS,outpatient,,,20,8.00,,17,85,,13.6,percent of total billed charges,85% of total billed charges,20,100,,16,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,0.12,385,,,fee schedule,385% of BCBS fee schedule,0.12,401,,,fee schedule,401% of BCBS fee schedule,0.12,401,,,fee schedule,401% of BCBS fee schedule,0.12,401,,,fee schedule,401% of BCBS fee schedule,18,90,,14.4,percent of total billed charges,90% of total billed charges,16,80,,12.8,percent of total billed charges,80% of total billed charges,18,90,,14.4,percent of total billed charges,90% of total billed charges,15,75,,12,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,5.8,29,,4.64,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,13.4,67,,10.72,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,16,80,,12.8,percent of total billed charges,80% of total billed charges,13,65,,10.4,percent of total billed charges,65% of total billed charges,7.13,35.67,,5.704,percent of total billed charges,35.67% of total billed charges,0.12,20,
DEPO PROVERA 150MG/ 1CC IM,2502865,CDM,636,RC,J1050,HCPCS,outpatient,,,389,155.60,,330.65,85,,264.52,percent of total billed charges,85% of total billed charges,389,100,,311.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,1.96,385,,,fee schedule,385% of BCBS fee schedule,2.05,401,,,fee schedule,401% of BCBS fee schedule,2.05,401,,,fee schedule,401% of BCBS fee schedule,2.05,401,,,fee schedule,401% of BCBS fee schedule,350.1,90,,280.08,percent of total billed charges,90% of total billed charges,311.2,80,,248.96,percent of total billed charges,80% of total billed charges,350.1,90,,280.08,percent of total billed charges,90% of total billed charges,291.75,75,,233.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,112.81,29,,90.248,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,260.63,67,,208.504,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,311.2,80,,248.96,percent of total billed charges,80% of total billed charges,252.85,65,,202.28,percent of total billed charges,65% of total billed charges,138.76,35.67,,111.008,percent of total billed charges,35.67% of total billed charges,1.96,389,
DEPO PROVERA 50MG/THERAPUTIC,2502866,CDM,636,RC,J1050,HCPCS,outpatient,,,292,116.80,,248.2,85,,198.56,percent of total billed charges,85% of total billed charges,292,100,,233.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,1.96,385,,,fee schedule,385% of BCBS fee schedule,2.05,401,,,fee schedule,401% of BCBS fee schedule,2.05,401,,,fee schedule,401% of BCBS fee schedule,2.05,401,,,fee schedule,401% of BCBS fee schedule,262.8,90,,210.24,percent of total billed charges,90% of total billed charges,233.6,80,,186.88,percent of total billed charges,80% of total billed charges,262.8,90,,210.24,percent of total billed charges,90% of total billed charges,219,75,,175.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,84.68,29,,67.744,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,195.64,67,,156.512,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,233.6,80,,186.88,percent of total billed charges,80% of total billed charges,189.8,65,,151.84,percent of total billed charges,65% of total billed charges,104.16,35.67,,83.328,percent of total billed charges,35.67% of total billed charges,1.96,292,
DEXTROSE 5% 100 ML IV,2502921,CDM,636,RC,J7042,HCPCS,outpatient,,,38,15.20,,32.3,85,,25.84,percent of total billed charges,85% of total billed charges,38,100,,30.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,6.16,385,,,fee schedule,385% of BCBS fee schedule,6.42,401,,,fee schedule,401% of BCBS fee schedule,6.42,401,,,fee schedule,401% of BCBS fee schedule,6.42,401,,,fee schedule,401% of BCBS fee schedule,34.2,90,,27.36,percent of total billed charges,90% of total billed charges,30.4,80,,24.32,percent of total billed charges,80% of total billed charges,34.2,90,,27.36,percent of total billed charges,90% of total billed charges,28.5,75,,22.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,11.02,29,,8.816,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,25.46,67,,20.368,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,30.4,80,,24.32,percent of total billed charges,80% of total billed charges,24.7,65,,19.76,percent of total billed charges,65% of total billed charges,13.55,35.67,,10.84,percent of total billed charges,35.67% of total billed charges,6.16,38,
DEXTROSE 10% 500 ML IN WATER,2502922,CDM,636,RC,J7042,HCPCS,outpatient,,,89,35.60,,75.65,85,,60.52,percent of total billed charges,85% of total billed charges,89,100,,71.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,6.16,385,,,fee schedule,385% of BCBS fee schedule,6.42,401,,,fee schedule,401% of BCBS fee schedule,6.42,401,,,fee schedule,401% of BCBS fee schedule,6.42,401,,,fee schedule,401% of BCBS fee schedule,80.1,90,,64.08,percent of total billed charges,90% of total billed charges,71.2,80,,56.96,percent of total billed charges,80% of total billed charges,80.1,90,,64.08,percent of total billed charges,90% of total billed charges,66.75,75,,53.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,25.81,29,,20.648,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,59.63,67,,47.704,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,71.2,80,,56.96,percent of total billed charges,80% of total billed charges,57.85,65,,46.28,percent of total billed charges,65% of total billed charges,31.75,35.67,,25.4,percent of total billed charges,35.67% of total billed charges,6.16,89,
DHE 45 1 MG INJ,2502925,CDM,636,RC,J1110,HCPCS,outpatient,,,521,208.40,,442.85,85,,354.28,percent of total billed charges,85% of total billed charges,521,100,,416.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,664.13,385,,,fee schedule,385% of BCBS fee schedule,691.73,401,,,fee schedule,401% of BCBS fee schedule,691.73,401,,,fee schedule,401% of BCBS fee schedule,691.73,401,,,fee schedule,401% of BCBS fee schedule,468.9,90,,375.12,percent of total billed charges,90% of total billed charges,416.8,80,,333.44,percent of total billed charges,80% of total billed charges,468.9,90,,375.12,percent of total billed charges,90% of total billed charges,390.75,75,,312.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,151.09,29,,120.872,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,349.07,67,,279.256,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,416.8,80,,333.44,percent of total billed charges,80% of total billed charges,338.65,65,,270.92,percent of total billed charges,65% of total billed charges,185.84,35.67,,148.672,percent of total billed charges,35.67% of total billed charges,151.09,691.73,
DEXTROSE 5%NS+20MEG KCL LITER,2502926,CDM,636,RC,J7060,HCPCS,outpatient,,,46,18.40,,39.1,85,,31.28,percent of total billed charges,85% of total billed charges,46,100,,36.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,27.95,385,,,fee schedule,385% of BCBS fee schedule,29.11,401,,,fee schedule,401% of BCBS fee schedule,29.11,401,,,fee schedule,401% of BCBS fee schedule,29.11,401,,,fee schedule,401% of BCBS fee schedule,41.4,90,,33.12,percent of total billed charges,90% of total billed charges,36.8,80,,29.44,percent of total billed charges,80% of total billed charges,41.4,90,,33.12,percent of total billed charges,90% of total billed charges,34.5,75,,27.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,13.34,29,,10.672,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,30.82,67,,24.656,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,36.8,80,,29.44,percent of total billed charges,80% of total billed charges,29.9,65,,23.92,percent of total billed charges,65% of total billed charges,16.41,35.67,,13.128,percent of total billed charges,35.67% of total billed charges,13.34,46,
DEXTROSE 5%NS+20 MEQ KCL LITER,2502927,CDM,636,RC,J3480,HCPCS,outpatient,,,46,18.40,,39.1,85,,31.28,percent of total billed charges,85% of total billed charges,46,100,,36.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,0.15,385,,,fee schedule,385% of BCBS fee schedule,0.16,401,,,fee schedule,401% of BCBS fee schedule,0.16,401,,,fee schedule,401% of BCBS fee schedule,0.16,401,,,fee schedule,401% of BCBS fee schedule,41.4,90,,33.12,percent of total billed charges,90% of total billed charges,36.8,80,,29.44,percent of total billed charges,80% of total billed charges,41.4,90,,33.12,percent of total billed charges,90% of total billed charges,34.5,75,,27.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,13.34,29,,10.672,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,30.82,67,,24.656,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,36.8,80,,29.44,percent of total billed charges,80% of total billed charges,29.9,65,,23.92,percent of total billed charges,65% of total billed charges,16.41,35.67,,13.128,percent of total billed charges,35.67% of total billed charges,0.15,46,
DEXAMETHASONE 4 MG/ML 5 MLVIAL,2502928,CDM,636,RC,J1100,HCPCS,outpatient,,,18,7.20,,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,18,100,,14.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,0.12,385,,,fee schedule,385% of BCBS fee schedule,0.12,401,,,fee schedule,401% of BCBS fee schedule,0.12,401,,,fee schedule,401% of BCBS fee schedule,0.12,401,,,fee schedule,401% of BCBS fee schedule,16.2,90,,12.96,percent of total billed charges,90% of total billed charges,14.4,80,,11.52,percent of total billed charges,80% of total billed charges,16.2,90,,12.96,percent of total billed charges,90% of total billed charges,13.5,75,,10.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,5.22,29,,4.176,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,12.06,67,,9.648,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,14.4,80,,11.52,percent of total billed charges,80% of total billed charges,11.7,65,,9.36,percent of total billed charges,65% of total billed charges,6.42,35.67,,5.136,percent of total billed charges,35.67% of total billed charges,0.12,18,
DEXAMETHASONE SOD PHOS 4MG/30,2502929,CDM,636,RC,J1100,HCPCS,outpatient,,,28,11.20,,23.8,85,,19.04,percent of total billed charges,85% of total billed charges,28,100,,22.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,0.12,385,,,fee schedule,385% of BCBS fee schedule,0.12,401,,,fee schedule,401% of BCBS fee schedule,0.12,401,,,fee schedule,401% of BCBS fee schedule,0.12,401,,,fee schedule,401% of BCBS fee schedule,25.2,90,,20.16,percent of total billed charges,90% of total billed charges,22.4,80,,17.92,percent of total billed charges,80% of total billed charges,25.2,90,,20.16,percent of total billed charges,90% of total billed charges,21,75,,16.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,8.12,29,,6.496,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,18.76,67,,15.008,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,22.4,80,,17.92,percent of total billed charges,80% of total billed charges,18.2,65,,14.56,percent of total billed charges,65% of total billed charges,9.99,35.67,,7.992,percent of total billed charges,35.67% of total billed charges,0.12,28,
DEXTROSE 5% +KCL 20 MEQ LITER,2502931,CDM,636,RC,J7060,HCPCS,outpatient,,,46,18.40,,39.1,85,,31.28,percent of total billed charges,85% of total billed charges,46,100,,36.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,27.95,385,,,fee schedule,385% of BCBS fee schedule,29.11,401,,,fee schedule,401% of BCBS fee schedule,29.11,401,,,fee schedule,401% of BCBS fee schedule,29.11,401,,,fee schedule,401% of BCBS fee schedule,41.4,90,,33.12,percent of total billed charges,90% of total billed charges,36.8,80,,29.44,percent of total billed charges,80% of total billed charges,41.4,90,,33.12,percent of total billed charges,90% of total billed charges,34.5,75,,27.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,13.34,29,,10.672,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,30.82,67,,24.656,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,36.8,80,,29.44,percent of total billed charges,80% of total billed charges,29.9,65,,23.92,percent of total billed charges,65% of total billed charges,16.41,35.67,,13.128,percent of total billed charges,35.67% of total billed charges,13.34,46,
DEXAMETHASONE 10 MG/ML VIAL,2502932,CDM,636,RC,J1100,HCPCS,outpatient,,,63,25.20,,53.55,85,,42.84,percent of total billed charges,85% of total billed charges,63,100,,50.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,0.12,385,,,fee schedule,385% of BCBS fee schedule,0.12,401,,,fee schedule,401% of BCBS fee schedule,0.12,401,,,fee schedule,401% of BCBS fee schedule,0.12,401,,,fee schedule,401% of BCBS fee schedule,56.7,90,,45.36,percent of total billed charges,90% of total billed charges,50.4,80,,40.32,percent of total billed charges,80% of total billed charges,56.7,90,,45.36,percent of total billed charges,90% of total billed charges,47.25,75,,37.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,18.27,29,,14.616,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,42.21,67,,33.768,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,50.4,80,,40.32,percent of total billed charges,80% of total billed charges,40.95,65,,32.76,percent of total billed charges,65% of total billed charges,22.47,35.67,,17.976,percent of total billed charges,35.67% of total billed charges,0.12,63,
DEXTROSE 5% NS 0.45+KCL 10 MEQ,2502933,CDM,636,RC,J7060,HCPCS,outpatient,,,17,6.80,,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,17,100,,13.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,27.95,385,,,fee schedule,385% of BCBS fee schedule,29.11,401,,,fee schedule,401% of BCBS fee schedule,29.11,401,,,fee schedule,401% of BCBS fee schedule,29.11,401,,,fee schedule,401% of BCBS fee schedule,15.3,90,,12.24,percent of total billed charges,90% of total billed charges,13.6,80,,10.88,percent of total billed charges,80% of total billed charges,15.3,90,,12.24,percent of total billed charges,90% of total billed charges,12.75,75,,10.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,4.93,29,,3.944,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,11.39,67,,9.112,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,13.6,80,,10.88,percent of total billed charges,80% of total billed charges,11.05,65,,8.84,percent of total billed charges,65% of total billed charges,6.06,35.67,,4.848,percent of total billed charges,35.67% of total billed charges,4.93,29.11,
DEXTROSE 5% NS 0.45%+10MEQ KCL,2502936,CDM,636,RC,J3480,HCPCS,outpatient,,,46,18.40,,39.1,85,,31.28,percent of total billed charges,85% of total billed charges,46,100,,36.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,0.15,385,,,fee schedule,385% of BCBS fee schedule,0.16,401,,,fee schedule,401% of BCBS fee schedule,0.16,401,,,fee schedule,401% of BCBS fee schedule,0.16,401,,,fee schedule,401% of BCBS fee schedule,41.4,90,,33.12,percent of total billed charges,90% of total billed charges,36.8,80,,29.44,percent of total billed charges,80% of total billed charges,41.4,90,,33.12,percent of total billed charges,90% of total billed charges,34.5,75,,27.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,13.34,29,,10.672,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,30.82,67,,24.656,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,36.8,80,,29.44,percent of total billed charges,80% of total billed charges,29.9,65,,23.92,percent of total billed charges,65% of total billed charges,16.41,35.67,,13.128,percent of total billed charges,35.67% of total billed charges,0.15,46,
DEXMEDETOMIDIN 400MCG/1000 ML,2502937,CDM,636,RC,J3490,HCPCS,outpatient,,,568,227.20,,482.8,85,,386.24,percent of total billed charges,85% of total billed charges,568,100,,454.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,465.76,82,,372.608,percent of total billed charges,82% of total billed charges,482.8,85,,386.24,percent of total billed charges,85% of total billed charges,482.8,85,,386.24,percent of total billed charges,85% of total billed charges,482.8,85,,386.24,percent of total billed charges,85% of total billed charges,511.2,90,,408.96,percent of total billed charges,90% of total billed charges,454.4,80,,363.52,percent of total billed charges,80% of total billed charges,511.2,90,,408.96,percent of total billed charges,90% of total billed charges,426,75,,340.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,164.72,29,,131.776,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,380.56,67,,304.448,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,454.4,80,,363.52,percent of total billed charges,80% of total billed charges,369.2,65,,295.36,percent of total billed charges,65% of total billed charges,202.61,35.67,,162.088,percent of total billed charges,35.67% of total billed charges,164.72,568,
DIAMOX INJ 500 MG.,2502960,CDM,636,RC,J1120,HCPCS,outpatient,,,174,69.60,,147.9,85,,118.32,percent of total billed charges,85% of total billed charges,174,100,,139.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,108.45,385,,,fee schedule,385% of BCBS fee schedule,112.96,401,,,fee schedule,401% of BCBS fee schedule,112.96,401,,,fee schedule,401% of BCBS fee schedule,112.96,401,,,fee schedule,401% of BCBS fee schedule,156.6,90,,125.28,percent of total billed charges,90% of total billed charges,139.2,80,,111.36,percent of total billed charges,80% of total billed charges,156.6,90,,125.28,percent of total billed charges,90% of total billed charges,130.5,75,,104.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,50.46,29,,40.368,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,116.58,67,,93.264,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,139.2,80,,111.36,percent of total billed charges,80% of total billed charges,113.1,65,,90.48,percent of total billed charges,65% of total billed charges,62.07,35.67,,49.656,percent of total billed charges,35.67% of total billed charges,50.46,174,
DIFLUCAN 10 MG/ML 35 ML INJ.,2502989,CDM,636,RC,J1450,HCPCS,outpatient,,,279,111.60,,237.15,85,,189.72,percent of total billed charges,85% of total billed charges,279,100,,223.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,16.79,385,,,fee schedule,385% of BCBS fee schedule,17.48,401,,,fee schedule,401% of BCBS fee schedule,17.48,401,,,fee schedule,401% of BCBS fee schedule,17.48,401,,,fee schedule,401% of BCBS fee schedule,251.1,90,,200.88,percent of total billed charges,90% of total billed charges,223.2,80,,178.56,percent of total billed charges,80% of total billed charges,251.1,90,,200.88,percent of total billed charges,90% of total billed charges,209.25,75,,167.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,80.91,29,,64.728,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,186.93,67,,149.544,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,223.2,80,,178.56,percent of total billed charges,80% of total billed charges,181.35,65,,145.08,percent of total billed charges,65% of total billed charges,99.52,35.67,,79.616,percent of total billed charges,35.67% of total billed charges,16.79,279,
DIFLUCAN 200 MG BAG,2503006,CDM,636,RC,J1450,HCPCS,outpatient,,,186,74.40,,158.1,85,,126.48,percent of total billed charges,85% of total billed charges,186,100,,148.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,16.79,385,,,fee schedule,385% of BCBS fee schedule,17.48,401,,,fee schedule,401% of BCBS fee schedule,17.48,401,,,fee schedule,401% of BCBS fee schedule,17.48,401,,,fee schedule,401% of BCBS fee schedule,167.4,90,,133.92,percent of total billed charges,90% of total billed charges,148.8,80,,119.04,percent of total billed charges,80% of total billed charges,167.4,90,,133.92,percent of total billed charges,90% of total billed charges,139.5,75,,111.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,53.94,29,,43.152,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,124.62,67,,99.696,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,148.8,80,,119.04,percent of total billed charges,80% of total billed charges,120.9,65,,96.72,percent of total billed charges,65% of total billed charges,66.35,35.67,,53.08,percent of total billed charges,35.67% of total billed charges,16.79,186,
DIGIBIND 40 MG/4 CC INJ.*,2503015,CDM,636,RC,J1162,HCPCS,outpatient,,,6351,2540.40,,5398.35,85,,4318.68,percent of total billed charges,85% of total billed charges,3334.28,52.5,,2667.42,percent of total billed charges,52.5 percent of total billed charges,4888.1,100,,,fee schedule,100% of CMS OPPS rate,13016.85,385,,,fee schedule,385% of BCBS fee schedule,13557.81,401,,,fee schedule,401% of BCBS fee schedule,13557.81,401,,,fee schedule,401% of BCBS fee schedule,13557.81,401,,,fee schedule,401% of BCBS fee schedule,5715.9,90,,4572.72,percent of total billed charges,90% of total billed charges,5080.8,80,,4064.64,percent of total billed charges,80% of total billed charges,5715.9,90,,4572.72,percent of total billed charges,90% of total billed charges,4763.25,75,,3810.6,percent of total billed charges,75% of total billed charges,5963.48,122,,,fee schedule,122% of HUMANA fee schedule,1841.79,29,,1473.432,percent of total billed charges,29% of total billed charges,4888.1,100,,,fee schedule,100% of CMS OPPS rate,4255.17,67,,3404.136,percent of total billed charges,67% of total billed charges,926.79,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,5080.8,80,,4064.64,percent of total billed charges,80% of total billed charges,4128.15,65,,3302.52,percent of total billed charges,65% of total billed charges,2265.4,35.67,,1812.32,percent of total billed charges,35.67% of total billed charges,926.79,13557.81,
DILAUDID 1 MG SYRINGE,2503033,CDM,636,RC,J1170,HCPCS,outpatient,,,13,5.20,,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,13,100,,10.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,1.54,385,,,fee schedule,385% of BCBS fee schedule,1.6,401,,,fee schedule,401% of BCBS fee schedule,1.6,401,,,fee schedule,401% of BCBS fee schedule,1.6,401,,,fee schedule,401% of BCBS fee schedule,11.7,90,,9.36,percent of total billed charges,90% of total billed charges,10.4,80,,8.32,percent of total billed charges,80% of total billed charges,11.7,90,,9.36,percent of total billed charges,90% of total billed charges,9.75,75,,7.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,3.77,29,,3.016,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,8.71,67,,6.968,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,10.4,80,,8.32,percent of total billed charges,80% of total billed charges,8.45,65,,6.76,percent of total billed charges,65% of total billed charges,4.64,35.67,,3.712,percent of total billed charges,35.67% of total billed charges,1.54,13,
DILANTIN 250 MG INJ,2503035,CDM,636,RC,J1165,HCPCS,outpatient,,,24,9.60,,20.4,85,,16.32,percent of total billed charges,85% of total billed charges,24,100,,19.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,1.54,385,,,fee schedule,385% of BCBS fee schedule,1.6,401,,,fee schedule,401% of BCBS fee schedule,1.6,401,,,fee schedule,401% of BCBS fee schedule,1.6,401,,,fee schedule,401% of BCBS fee schedule,21.6,90,,17.28,percent of total billed charges,90% of total billed charges,19.2,80,,15.36,percent of total billed charges,80% of total billed charges,21.6,90,,17.28,percent of total billed charges,90% of total billed charges,18,75,,14.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,6.96,29,,5.568,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,16.08,67,,12.864,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,19.2,80,,15.36,percent of total billed charges,80% of total billed charges,15.6,65,,12.48,percent of total billed charges,65% of total billed charges,8.56,35.67,,6.848,percent of total billed charges,35.67% of total billed charges,1.54,24,
DILANTIN 100 MG/ 4ML UDC,2503061,CDM,636,RC,J1165,HCPCS,outpatient,,,9,3.60,,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,9,100,,7.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,1.54,385,,,fee schedule,385% of BCBS fee schedule,1.6,401,,,fee schedule,401% of BCBS fee schedule,1.6,401,,,fee schedule,401% of BCBS fee schedule,1.6,401,,,fee schedule,401% of BCBS fee schedule,8.1,90,,6.48,percent of total billed charges,90% of total billed charges,7.2,80,,5.76,percent of total billed charges,80% of total billed charges,8.1,90,,6.48,percent of total billed charges,90% of total billed charges,6.75,75,,5.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.61,29,,2.088,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,6.03,67,,4.824,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,7.2,80,,5.76,percent of total billed charges,80% of total billed charges,5.85,65,,4.68,percent of total billed charges,65% of total billed charges,3.21,35.67,,2.568,percent of total billed charges,35.67% of total billed charges,1.54,9,
DILAUDID 2 MG INJ,2503075,CDM,636,RC,J1170,HCPCS,outpatient,,,11,4.40,,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,11,100,,8.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,1.54,385,,,fee schedule,385% of BCBS fee schedule,1.6,401,,,fee schedule,401% of BCBS fee schedule,1.6,401,,,fee schedule,401% of BCBS fee schedule,1.6,401,,,fee schedule,401% of BCBS fee schedule,9.9,90,,7.92,percent of total billed charges,90% of total billed charges,8.8,80,,7.04,percent of total billed charges,80% of total billed charges,9.9,90,,7.92,percent of total billed charges,90% of total billed charges,8.25,75,,6.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,3.19,29,,2.552,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,7.37,67,,5.896,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,8.8,80,,7.04,percent of total billed charges,80% of total billed charges,7.15,65,,5.72,percent of total billed charges,65% of total billed charges,3.92,35.67,,3.136,percent of total billed charges,35.67% of total billed charges,1.54,11,
DILAUDID 0.1MGML 250 ML IV BAG,2503082,CDM,636,RC,J1170,HCPCS,outpatient,,,454,181.60,,385.9,85,,308.72,percent of total billed charges,85% of total billed charges,454,100,,363.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,1.54,385,,,fee schedule,385% of BCBS fee schedule,1.6,401,,,fee schedule,401% of BCBS fee schedule,1.6,401,,,fee schedule,401% of BCBS fee schedule,1.6,401,,,fee schedule,401% of BCBS fee schedule,408.6,90,,326.88,percent of total billed charges,90% of total billed charges,363.2,80,,290.56,percent of total billed charges,80% of total billed charges,408.6,90,,326.88,percent of total billed charges,90% of total billed charges,340.5,75,,272.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,131.66,29,,105.328,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,304.18,67,,243.344,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,363.2,80,,290.56,percent of total billed charges,80% of total billed charges,295.1,65,,236.08,percent of total billed charges,65% of total billed charges,161.94,35.67,,129.552,percent of total billed charges,35.67% of total billed charges,1.54,454,
DILAUDID HP 250 MG POWDER,2503086,CDM,636,RC,J1170,HCPCS,outpatient,,,372,148.80,,316.2,85,,252.96,percent of total billed charges,85% of total billed charges,372,100,,297.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,1.54,385,,,fee schedule,385% of BCBS fee schedule,1.6,401,,,fee schedule,401% of BCBS fee schedule,1.6,401,,,fee schedule,401% of BCBS fee schedule,1.6,401,,,fee schedule,401% of BCBS fee schedule,334.8,90,,267.84,percent of total billed charges,90% of total billed charges,297.6,80,,238.08,percent of total billed charges,80% of total billed charges,334.8,90,,267.84,percent of total billed charges,90% of total billed charges,279,75,,223.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,107.88,29,,86.304,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,249.24,67,,199.392,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,297.6,80,,238.08,percent of total billed charges,80% of total billed charges,241.8,65,,193.44,percent of total billed charges,65% of total billed charges,132.69,35.67,,106.152,percent of total billed charges,35.67% of total billed charges,1.54,372,
DILAUDID 2 MG/ML SDV,2503088,CDM,636,RC,J1170,HCPCS,outpatient,,,11,4.40,,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,11,100,,8.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,1.54,385,,,fee schedule,385% of BCBS fee schedule,1.6,401,,,fee schedule,401% of BCBS fee schedule,1.6,401,,,fee schedule,401% of BCBS fee schedule,1.6,401,,,fee schedule,401% of BCBS fee schedule,9.9,90,,7.92,percent of total billed charges,90% of total billed charges,8.8,80,,7.04,percent of total billed charges,80% of total billed charges,9.9,90,,7.92,percent of total billed charges,90% of total billed charges,8.25,75,,6.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,3.19,29,,2.552,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,7.37,67,,5.896,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,8.8,80,,7.04,percent of total billed charges,80% of total billed charges,7.15,65,,5.72,percent of total billed charges,65% of total billed charges,3.92,35.67,,3.136,percent of total billed charges,35.67% of total billed charges,1.54,11,
DILAUDID .5 MG SYRINGE,2503133,CDM,636,RC,J1170,HCPCS,outpatient,,,40,16.00,,34,85,,27.2,percent of total billed charges,85% of total billed charges,40,100,,32,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,1.54,385,,,fee schedule,385% of BCBS fee schedule,1.6,401,,,fee schedule,401% of BCBS fee schedule,1.6,401,,,fee schedule,401% of BCBS fee schedule,1.6,401,,,fee schedule,401% of BCBS fee schedule,36,90,,28.8,percent of total billed charges,90% of total billed charges,32,80,,25.6,percent of total billed charges,80% of total billed charges,36,90,,28.8,percent of total billed charges,90% of total billed charges,30,75,,24,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,11.6,29,,9.28,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,26.8,67,,21.44,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,32,80,,25.6,percent of total billed charges,80% of total billed charges,26,65,,20.8,percent of total billed charges,65% of total billed charges,14.27,35.67,,11.416,percent of total billed charges,35.67% of total billed charges,1.54,40,
DIPRIVAN 100MG/10ML,2503134,CDM,636,RC,J2704,HCPCS,outpatient,,,60,24.00,,51,85,,40.8,percent of total billed charges,85% of total billed charges,60,100,,48,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,0.27,385,,,fee schedule,385% of BCBS fee schedule,0.28,401,,,fee schedule,401% of BCBS fee schedule,0.28,401,,,fee schedule,401% of BCBS fee schedule,0.28,401,,,fee schedule,401% of BCBS fee schedule,54,90,,43.2,percent of total billed charges,90% of total billed charges,48,80,,38.4,percent of total billed charges,80% of total billed charges,54,90,,43.2,percent of total billed charges,90% of total billed charges,45,75,,36,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,17.4,29,,13.92,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,40.2,67,,32.16,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,48,80,,38.4,percent of total billed charges,80% of total billed charges,39,65,,31.2,percent of total billed charges,65% of total billed charges,21.4,35.67,,17.12,percent of total billed charges,35.67% of total billed charges,0.27,60,
DIPRIVAN 200 MG INJ,2503135,CDM,636,RC,J2704,HCPCS,outpatient,,,61,24.40,,51.85,85,,41.48,percent of total billed charges,85% of total billed charges,61,100,,48.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,0.27,385,,,fee schedule,385% of BCBS fee schedule,0.28,401,,,fee schedule,401% of BCBS fee schedule,0.28,401,,,fee schedule,401% of BCBS fee schedule,0.28,401,,,fee schedule,401% of BCBS fee schedule,54.9,90,,43.92,percent of total billed charges,90% of total billed charges,48.8,80,,39.04,percent of total billed charges,80% of total billed charges,54.9,90,,43.92,percent of total billed charges,90% of total billed charges,45.75,75,,36.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,17.69,29,,14.152,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,40.87,67,,32.696,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,48.8,80,,39.04,percent of total billed charges,80% of total billed charges,39.65,65,,31.72,percent of total billed charges,65% of total billed charges,21.76,35.67,,17.408,percent of total billed charges,35.67% of total billed charges,0.27,61,
DIPRIVAN 1000MG/100ML INJ,2503138,CDM,636,RC,J2704,HCPCS,outpatient,,,139,55.60,,118.15,85,,94.52,percent of total billed charges,85% of total billed charges,139,100,,111.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,0.27,385,,,fee schedule,385% of BCBS fee schedule,0.28,401,,,fee schedule,401% of BCBS fee schedule,0.28,401,,,fee schedule,401% of BCBS fee schedule,0.28,401,,,fee schedule,401% of BCBS fee schedule,125.1,90,,100.08,percent of total billed charges,90% of total billed charges,111.2,80,,88.96,percent of total billed charges,80% of total billed charges,125.1,90,,100.08,percent of total billed charges,90% of total billed charges,104.25,75,,83.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,40.31,29,,32.248,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,93.13,67,,74.504,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,111.2,80,,88.96,percent of total billed charges,80% of total billed charges,90.35,65,,72.28,percent of total billed charges,65% of total billed charges,49.58,35.67,,39.664,percent of total billed charges,35.67% of total billed charges,0.27,139,
DIPHTHERIA TETANUS TOXOID VACC,2503142,CDM,636,RC,90697,HCPCS,outpatient,,,455,182.00,,386.75,85,,309.4,percent of total billed charges,85% of total billed charges,455,100,,364,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,373.1,82,,298.48,percent of total billed charges,82% of total billed charges,386.75,85,,309.4,percent of total billed charges,85% of total billed charges,386.75,85,,309.4,percent of total billed charges,85% of total billed charges,386.75,85,,309.4,percent of total billed charges,85% of total billed charges,409.5,90,,327.6,percent of total billed charges,90% of total billed charges,364,80,,291.2,percent of total billed charges,80% of total billed charges,409.5,90,,327.6,percent of total billed charges,90% of total billed charges,341.25,75,,273,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,131.95,29,,105.56,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,304.85,67,,243.88,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,364,80,,291.2,percent of total billed charges,80% of total billed charges,295.75,65,,236.6,percent of total billed charges,65% of total billed charges,162.3,35.67,,129.84,percent of total billed charges,35.67% of total billed charges,131.95,455,
DOBUTAMINE 250MG/250ML,2503201,CDM,636,RC,,,outpatient,,,84,33.60,,71.4,85,,57.12,percent of total billed charges,85% of total billed charges,84,100,,67.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,68.88,82,,55.104,percent of total billed charges,82% of total billed charges,71.4,85,,57.12,percent of total billed charges,85% of total billed charges,71.4,85,,57.12,percent of total billed charges,85% of total billed charges,71.4,85,,57.12,percent of total billed charges,85% of total billed charges,75.6,90,,60.48,percent of total billed charges,90% of total billed charges,67.2,80,,53.76,percent of total billed charges,80% of total billed charges,75.6,90,,60.48,percent of total billed charges,90% of total billed charges,63,75,,50.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,24.36,29,,19.488,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,56.28,67,,45.024,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,67.2,80,,53.76,percent of total billed charges,80% of total billed charges,54.6,65,,43.68,percent of total billed charges,65% of total billed charges,29.96,35.67,,23.968,percent of total billed charges,35.67% of total billed charges,24.36,84,
DOBUTREX/DOBUTAMINE 250 MG INJ,2503205,CDM,636,RC,J1250,HCPCS,outpatient,,,23,9.20,,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,23,100,,18.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,10.97,385,,,fee schedule,385% of BCBS fee schedule,11.43,401,,,fee schedule,401% of BCBS fee schedule,11.43,401,,,fee schedule,401% of BCBS fee schedule,11.43,401,,,fee schedule,401% of BCBS fee schedule,20.7,90,,16.56,percent of total billed charges,90% of total billed charges,18.4,80,,14.72,percent of total billed charges,80% of total billed charges,20.7,90,,16.56,percent of total billed charges,90% of total billed charges,17.25,75,,13.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,6.67,29,,5.336,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,15.41,67,,12.328,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,18.4,80,,14.72,percent of total billed charges,80% of total billed charges,14.95,65,,11.96,percent of total billed charges,65% of total billed charges,8.2,35.67,,6.56,percent of total billed charges,35.67% of total billed charges,6.67,23,
DOBUTREX 250 MG/250 MI PREMIX,2503206,CDM,636,RC,J1250,HCPCS,outpatient,,,76,30.40,,64.6,85,,51.68,percent of total billed charges,85% of total billed charges,76,100,,60.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,10.97,385,,,fee schedule,385% of BCBS fee schedule,11.43,401,,,fee schedule,401% of BCBS fee schedule,11.43,401,,,fee schedule,401% of BCBS fee schedule,11.43,401,,,fee schedule,401% of BCBS fee schedule,68.4,90,,54.72,percent of total billed charges,90% of total billed charges,60.8,80,,48.64,percent of total billed charges,80% of total billed charges,68.4,90,,54.72,percent of total billed charges,90% of total billed charges,57,75,,45.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,22.04,29,,17.632,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,50.92,67,,40.736,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,60.8,80,,48.64,percent of total billed charges,80% of total billed charges,49.4,65,,39.52,percent of total billed charges,65% of total billed charges,27.11,35.67,,21.688,percent of total billed charges,35.67% of total billed charges,10.97,76,
LEVEMIR FLEXTOUCH 100 UN,2503208,CDM,636,RC,J1815,HCPCS,outpatient,,,299,119.60,,254.15,85,,203.32,percent of total billed charges,85% of total billed charges,299,100,,239.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,0.54,385,,,fee schedule,385% of BCBS fee schedule,0.56,401,,,fee schedule,401% of BCBS fee schedule,0.56,401,,,fee schedule,401% of BCBS fee schedule,0.56,401,,,fee schedule,401% of BCBS fee schedule,269.1,90,,215.28,percent of total billed charges,90% of total billed charges,239.2,80,,191.36,percent of total billed charges,80% of total billed charges,269.1,90,,215.28,percent of total billed charges,90% of total billed charges,224.25,75,,179.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,86.71,29,,69.368,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,200.33,67,,160.264,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,239.2,80,,191.36,percent of total billed charges,80% of total billed charges,194.35,65,,155.48,percent of total billed charges,65% of total billed charges,106.65,35.67,,85.32,percent of total billed charges,35.67% of total billed charges,0.54,299,
NOVOLOG FLEXPEN,2503209,CDM,636,RC,J1817,HCPCS,outpatient,,,362,144.80,,307.7,85,,246.16,percent of total billed charges,85% of total billed charges,362,100,,289.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,26.41,385,,,fee schedule,385% of BCBS fee schedule,27.51,401,,,fee schedule,401% of BCBS fee schedule,27.51,401,,,fee schedule,401% of BCBS fee schedule,27.51,401,,,fee schedule,401% of BCBS fee schedule,325.8,90,,260.64,percent of total billed charges,90% of total billed charges,289.6,80,,231.68,percent of total billed charges,80% of total billed charges,325.8,90,,260.64,percent of total billed charges,90% of total billed charges,271.5,75,,217.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,104.98,29,,83.984,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,242.54,67,,194.032,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,289.6,80,,231.68,percent of total billed charges,80% of total billed charges,235.3,65,,188.24,percent of total billed charges,65% of total billed charges,129.13,35.67,,103.304,percent of total billed charges,35.67% of total billed charges,26.41,362,
NOVOLOG 70/30 FLEXPEN,2503210,CDM,636,RC,J1817,HCPCS,outpatient,,,360,144.00,,306,85,,244.8,percent of total billed charges,85% of total billed charges,360,100,,288,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,26.41,385,,,fee schedule,385% of BCBS fee schedule,27.51,401,,,fee schedule,401% of BCBS fee schedule,27.51,401,,,fee schedule,401% of BCBS fee schedule,27.51,401,,,fee schedule,401% of BCBS fee schedule,324,90,,259.2,percent of total billed charges,90% of total billed charges,288,80,,230.4,percent of total billed charges,80% of total billed charges,324,90,,259.2,percent of total billed charges,90% of total billed charges,270,75,,216,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,104.4,29,,83.52,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,241.2,67,,192.96,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,288,80,,230.4,percent of total billed charges,80% of total billed charges,234,65,,187.2,percent of total billed charges,65% of total billed charges,128.41,35.67,,102.728,percent of total billed charges,35.67% of total billed charges,26.41,360,
ROSUVASTATIN 10 MG,2503211,CDM,636,RC,J8499,HCPCS,outpatient,,,23,9.20,,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,23,100,,18.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,18.86,82,,15.088,percent of total billed charges,82% of total billed charges,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,20.7,90,,16.56,percent of total billed charges,90% of total billed charges,18.4,80,,14.72,percent of total billed charges,80% of total billed charges,20.7,90,,16.56,percent of total billed charges,90% of total billed charges,17.25,75,,13.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,6.67,29,,5.336,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,15.41,67,,12.328,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,18.4,80,,14.72,percent of total billed charges,80% of total billed charges,14.95,65,,11.96,percent of total billed charges,65% of total billed charges,8.2,35.67,,6.56,percent of total billed charges,35.67% of total billed charges,6.67,23,
SIMVASTATIN 10MG,2503212,CDM,636,RC,J8499,HCPCS,outpatient,,,52,20.80,,44.2,85,,35.36,percent of total billed charges,85% of total billed charges,52,100,,41.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,42.64,82,,34.112,percent of total billed charges,82% of total billed charges,44.2,85,,35.36,percent of total billed charges,85% of total billed charges,44.2,85,,35.36,percent of total billed charges,85% of total billed charges,44.2,85,,35.36,percent of total billed charges,85% of total billed charges,46.8,90,,37.44,percent of total billed charges,90% of total billed charges,41.6,80,,33.28,percent of total billed charges,80% of total billed charges,46.8,90,,37.44,percent of total billed charges,90% of total billed charges,39,75,,31.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,15.08,29,,12.064,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,34.84,67,,27.872,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,41.6,80,,33.28,percent of total billed charges,80% of total billed charges,33.8,65,,27.04,percent of total billed charges,65% of total billed charges,18.55,35.67,,14.84,percent of total billed charges,35.67% of total billed charges,15.08,52,
DOPAMINE 400 MG VIAL,2503269,CDM,636,RC,J1265,HCPCS,outpatient,,,11,4.40,,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,11,100,,8.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,0.46,385,,,fee schedule,385% of BCBS fee schedule,0.48,401,,,fee schedule,401% of BCBS fee schedule,0.48,401,,,fee schedule,401% of BCBS fee schedule,0.48,401,,,fee schedule,401% of BCBS fee schedule,9.9,90,,7.92,percent of total billed charges,90% of total billed charges,8.8,80,,7.04,percent of total billed charges,80% of total billed charges,9.9,90,,7.92,percent of total billed charges,90% of total billed charges,8.25,75,,6.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,0.6,100,,,fee schedule,100% of ASC tier grouping rate,,,,,other ,not seperately reimbursable,7.37,67,,5.896,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,8.8,80,,7.04,percent of total billed charges,80% of total billed charges,7.15,65,,5.72,percent of total billed charges,65% of total billed charges,0.74,123,,,fee schedule,123% of ASC tier grouping rate,0.46,11,
DOPAMINE 800 MG INJ,2503270,CDM,636,RC,J1265,HCPCS,outpatient,,,60,24.00,,51,85,,40.8,percent of total billed charges,85% of total billed charges,60,100,,48,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,0.46,385,,,fee schedule,385% of BCBS fee schedule,0.48,401,,,fee schedule,401% of BCBS fee schedule,0.48,401,,,fee schedule,401% of BCBS fee schedule,0.48,401,,,fee schedule,401% of BCBS fee schedule,54,90,,43.2,percent of total billed charges,90% of total billed charges,48,80,,38.4,percent of total billed charges,80% of total billed charges,54,90,,43.2,percent of total billed charges,90% of total billed charges,45,75,,36,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,0.6,100,,,fee schedule,100% of ASC tier grouping rate,,,,,other ,not seperately reimbursable,40.2,67,,32.16,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,48,80,,38.4,percent of total billed charges,80% of total billed charges,39,65,,31.2,percent of total billed charges,65% of total billed charges,0.74,123,,,fee schedule,123% of ASC tier grouping rate,0.46,60,
DURAMORPH PF 10 MG/10 ML INJ.,2503431,CDM,636,RC,J2274,HCPCS,outpatient,,,53,21.20,,45.05,85,,36.04,percent of total billed charges,85% of total billed charges,53,100,,42.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,16.44,385,,,fee schedule,385% of BCBS fee schedule,17.12,401,,,fee schedule,401% of BCBS fee schedule,17.12,401,,,fee schedule,401% of BCBS fee schedule,17.12,401,,,fee schedule,401% of BCBS fee schedule,47.7,90,,38.16,percent of total billed charges,90% of total billed charges,42.4,80,,33.92,percent of total billed charges,80% of total billed charges,47.7,90,,38.16,percent of total billed charges,90% of total billed charges,39.75,75,,31.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,15.37,29,,12.296,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,35.51,67,,28.408,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,42.4,80,,33.92,percent of total billed charges,80% of total billed charges,34.45,65,,27.56,percent of total billed charges,65% of total billed charges,18.91,35.67,,15.128,percent of total billed charges,35.67% of total billed charges,15.37,53,
DURAMORPH 2 MG/2ML INJ,2503446,CDM,636,RC,J2274,HCPCS,outpatient,,,45,18.00,,38.25,85,,30.6,percent of total billed charges,85% of total billed charges,45,100,,36,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,16.44,385,,,fee schedule,385% of BCBS fee schedule,17.12,401,,,fee schedule,401% of BCBS fee schedule,17.12,401,,,fee schedule,401% of BCBS fee schedule,17.12,401,,,fee schedule,401% of BCBS fee schedule,40.5,90,,32.4,percent of total billed charges,90% of total billed charges,36,80,,28.8,percent of total billed charges,80% of total billed charges,40.5,90,,32.4,percent of total billed charges,90% of total billed charges,33.75,75,,27,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,13.05,29,,10.44,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,30.15,67,,24.12,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,36,80,,28.8,percent of total billed charges,80% of total billed charges,29.25,65,,23.4,percent of total billed charges,65% of total billed charges,16.05,35.67,,12.84,percent of total billed charges,35.67% of total billed charges,13.05,45,
DURAMORPH PF 1MG/2ML AMPULE,2503447,CDM,636,RC,J2275,HCPCS,outpatient,,,45,18.00,,38.25,85,,30.6,percent of total billed charges,85% of total billed charges,45,100,,36,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,36.9,82,,29.52,percent of total billed charges,82% of total billed charges,38.25,85,,30.6,percent of total billed charges,85% of total billed charges,38.25,85,,30.6,percent of total billed charges,85% of total billed charges,38.25,85,,30.6,percent of total billed charges,85% of total billed charges,40.5,90,,32.4,percent of total billed charges,90% of total billed charges,36,80,,28.8,percent of total billed charges,80% of total billed charges,40.5,90,,32.4,percent of total billed charges,90% of total billed charges,33.75,75,,27,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,13.05,29,,10.44,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,30.15,67,,24.12,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,36,80,,28.8,percent of total billed charges,80% of total billed charges,29.25,65,,23.4,percent of total billed charges,65% of total billed charges,16.05,35.67,,12.84,percent of total billed charges,35.67% of total billed charges,13.05,45,
EPHEDRINE 1 MG-ML AM,2503680,CDM,636,RC,J3490,HCPCS,outpatient,,,153,61.20,,130.05,85,,104.04,percent of total billed charges,85% of total billed charges,153,100,,122.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,125.46,82,,100.368,percent of total billed charges,82% of total billed charges,130.05,85,,104.04,percent of total billed charges,85% of total billed charges,130.05,85,,104.04,percent of total billed charges,85% of total billed charges,130.05,85,,104.04,percent of total billed charges,85% of total billed charges,137.7,90,,110.16,percent of total billed charges,90% of total billed charges,122.4,80,,97.92,percent of total billed charges,80% of total billed charges,137.7,90,,110.16,percent of total billed charges,90% of total billed charges,114.75,75,,91.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,44.37,29,,35.496,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,102.51,67,,82.008,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,122.4,80,,97.92,percent of total billed charges,80% of total billed charges,99.45,65,,79.56,percent of total billed charges,65% of total billed charges,54.58,35.67,,43.664,percent of total billed charges,35.67% of total billed charges,44.37,153,
EPINEPHRINE PF 1:1000 1MG/ML A,2503694,CDM,636,RC,J0171,HCPCS,outpatient,,,18,7.20,,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,18,100,,14.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,0.54,385,,,fee schedule,385% of BCBS fee schedule,0.56,401,,,fee schedule,401% of BCBS fee schedule,0.56,401,,,fee schedule,401% of BCBS fee schedule,0.56,401,,,fee schedule,401% of BCBS fee schedule,16.2,90,,12.96,percent of total billed charges,90% of total billed charges,14.4,80,,11.52,percent of total billed charges,80% of total billed charges,16.2,90,,12.96,percent of total billed charges,90% of total billed charges,13.5,75,,10.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,5.22,29,,4.176,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,12.06,67,,9.648,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,14.4,80,,11.52,percent of total billed charges,80% of total billed charges,11.7,65,,9.36,percent of total billed charges,65% of total billed charges,6.42,35.67,,5.136,percent of total billed charges,35.67% of total billed charges,0.54,18,
"EPINEPHRINE 1:10,000/10CC(INPT",2503695,CDM,636,RC,J0171,HCPCS,outpatient,,,27,10.80,,22.95,85,,18.36,percent of total billed charges,85% of total billed charges,27,100,,21.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,0.54,385,,,fee schedule,385% of BCBS fee schedule,0.56,401,,,fee schedule,401% of BCBS fee schedule,0.56,401,,,fee schedule,401% of BCBS fee schedule,0.56,401,,,fee schedule,401% of BCBS fee schedule,24.3,90,,19.44,percent of total billed charges,90% of total billed charges,21.6,80,,17.28,percent of total billed charges,80% of total billed charges,24.3,90,,19.44,percent of total billed charges,90% of total billed charges,20.25,75,,16.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,7.83,29,,6.264,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,18.09,67,,14.472,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,21.6,80,,17.28,percent of total billed charges,80% of total billed charges,17.55,65,,14.04,percent of total billed charges,65% of total billed charges,9.63,35.67,,7.704,percent of total billed charges,35.67% of total billed charges,0.54,27,
"EPINEPHRINE1:10,000AMP INJ 1MG",2503696,CDM,636,RC,J0171,HCPCS,outpatient,,,50,20.00,,42.5,85,,34,percent of total billed charges,85% of total billed charges,50,100,,40,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,0.54,385,,,fee schedule,385% of BCBS fee schedule,0.56,401,,,fee schedule,401% of BCBS fee schedule,0.56,401,,,fee schedule,401% of BCBS fee schedule,0.56,401,,,fee schedule,401% of BCBS fee schedule,45,90,,36,percent of total billed charges,90% of total billed charges,40,80,,32,percent of total billed charges,80% of total billed charges,45,90,,36,percent of total billed charges,90% of total billed charges,37.5,75,,30,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,14.5,29,,11.6,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,33.5,67,,26.8,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,40,80,,32,percent of total billed charges,80% of total billed charges,32.5,65,,26,percent of total billed charges,65% of total billed charges,17.84,35.67,,14.272,percent of total billed charges,35.67% of total billed charges,0.54,50,
"EPOGEN 20,000 UNITS INJ",2503697,CDM,636,RC,J0885,HCPCS,outpatient,,,3411,1364.40,,2899.35,85,,2319.48,percent of total billed charges,85% of total billed charges,1790.78,52.5,,1432.62,percent of total billed charges,52.5 percent of total billed charges,7.53,100,,,fee schedule,100% of CMS OPPS rate,62.02,385,,,fee schedule,385% of BCBS fee schedule,64.6,401,,,fee schedule,401% of BCBS fee schedule,64.6,401,,,fee schedule,401% of BCBS fee schedule,64.6,401,,,fee schedule,401% of BCBS fee schedule,3069.9,90,,2455.92,percent of total billed charges,90% of total billed charges,2728.8,80,,2183.04,percent of total billed charges,80% of total billed charges,3069.9,90,,2455.92,percent of total billed charges,90% of total billed charges,2558.25,75,,2046.6,percent of total billed charges,75% of total billed charges,9.18,122,,,fee schedule,122% of HUMANA fee schedule,989.19,29,,791.352,percent of total billed charges,29% of total billed charges,7.53,100,,,fee schedule,100% of CMS OPPS rate,2285.37,67,,1828.296,percent of total billed charges,67% of total billed charges,10.16,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,2728.8,80,,2183.04,percent of total billed charges,80% of total billed charges,2217.15,65,,1773.72,percent of total billed charges,65% of total billed charges,1216.7,35.67,,973.36,percent of total billed charges,35.67% of total billed charges,7.53,3069.9,
"EPOGEN 10,000 UNITS INJ",2503698,CDM,636,RC,J0885,HCPCS,outpatient,,,586,234.40,,498.1,85,,398.48,percent of total billed charges,85% of total billed charges,586,100,,468.8,percent of total billed charges,pays based on exceed threshold rate,7.53,100,,,fee schedule,100% of CMS OPPS rate,62.02,385,,,fee schedule,385% of BCBS fee schedule,64.6,401,,,fee schedule,401% of BCBS fee schedule,64.6,401,,,fee schedule,401% of BCBS fee schedule,64.6,401,,,fee schedule,401% of BCBS fee schedule,527.4,90,,421.92,percent of total billed charges,90% of total billed charges,468.8,80,,375.04,percent of total billed charges,80% of total billed charges,527.4,90,,421.92,percent of total billed charges,90% of total billed charges,439.5,75,,351.6,percent of total billed charges,75% of total billed charges,9.18,122,,,fee schedule,122% of HUMANA fee schedule,169.94,29,,135.952,percent of total billed charges,29% of total billed charges,7.53,100,,,fee schedule,100% of CMS OPPS rate,392.62,67,,314.096,percent of total billed charges,67% of total billed charges,10.16,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,468.8,80,,375.04,percent of total billed charges,80% of total billed charges,380.9,65,,304.72,percent of total billed charges,65% of total billed charges,209.03,35.67,,167.224,percent of total billed charges,35.67% of total billed charges,7.53,586,
EPOGEN 4000 U ML INJ,2503699,CDM,636,RC,J0885,HCPCS,outpatient,,,204,81.60,,173.4,85,,138.72,percent of total billed charges,85% of total billed charges,204,100,,163.2,percent of total billed charges,pays based on exceed threshold rate,7.53,100,,,fee schedule,100% of CMS OPPS rate,62.02,385,,,fee schedule,385% of BCBS fee schedule,64.6,401,,,fee schedule,401% of BCBS fee schedule,64.6,401,,,fee schedule,401% of BCBS fee schedule,64.6,401,,,fee schedule,401% of BCBS fee schedule,183.6,90,,146.88,percent of total billed charges,90% of total billed charges,163.2,80,,130.56,percent of total billed charges,80% of total billed charges,183.6,90,,146.88,percent of total billed charges,90% of total billed charges,153,75,,122.4,percent of total billed charges,75% of total billed charges,9.18,122,,,fee schedule,122% of HUMANA fee schedule,59.16,29,,47.328,percent of total billed charges,29% of total billed charges,7.53,100,,,fee schedule,100% of CMS OPPS rate,136.68,67,,109.344,percent of total billed charges,67% of total billed charges,10.16,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,163.2,80,,130.56,percent of total billed charges,80% of total billed charges,132.6,65,,106.08,percent of total billed charges,65% of total billed charges,72.77,35.67,,58.216,percent of total billed charges,35.67% of total billed charges,7.53,204,
EPOGEN 1000 UNITS INJ*NON ESRD,2503702,CDM,636,RC,J0885,HCPCS,outpatient,,,45,18.00,,38.25,85,,30.6,percent of total billed charges,85% of total billed charges,45,100,,36,percent of total billed charges,pays based on exceed threshold rate,7.53,100,,,fee schedule,100% of CMS OPPS rate,62.02,385,,,fee schedule,385% of BCBS fee schedule,64.6,401,,,fee schedule,401% of BCBS fee schedule,64.6,401,,,fee schedule,401% of BCBS fee schedule,64.6,401,,,fee schedule,401% of BCBS fee schedule,40.5,90,,32.4,percent of total billed charges,90% of total billed charges,36,80,,28.8,percent of total billed charges,80% of total billed charges,40.5,90,,32.4,percent of total billed charges,90% of total billed charges,33.75,75,,27,percent of total billed charges,75% of total billed charges,9.18,122,,,fee schedule,122% of HUMANA fee schedule,13.05,29,,10.44,percent of total billed charges,29% of total billed charges,7.53,100,,,fee schedule,100% of CMS OPPS rate,30.15,67,,24.12,percent of total billed charges,67% of total billed charges,10.16,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,36,80,,28.8,percent of total billed charges,80% of total billed charges,29.25,65,,23.4,percent of total billed charges,65% of total billed charges,16.05,35.67,,12.84,percent of total billed charges,35.67% of total billed charges,7.53,64.6,
EPOGEN 1000 UNITS MCR*NON ESRD,2503706,CDM,636,RC,J0885,HCPCS,outpatient,,,45,18.00,,38.25,85,,30.6,percent of total billed charges,85% of total billed charges,45,100,,36,percent of total billed charges,pays based on exceed threshold rate,7.53,100,,,fee schedule,100% of CMS OPPS rate,62.02,385,,,fee schedule,385% of BCBS fee schedule,64.6,401,,,fee schedule,401% of BCBS fee schedule,64.6,401,,,fee schedule,401% of BCBS fee schedule,64.6,401,,,fee schedule,401% of BCBS fee schedule,40.5,90,,32.4,percent of total billed charges,90% of total billed charges,36,80,,28.8,percent of total billed charges,80% of total billed charges,40.5,90,,32.4,percent of total billed charges,90% of total billed charges,33.75,75,,27,percent of total billed charges,75% of total billed charges,9.18,122,,,fee schedule,122% of HUMANA fee schedule,13.05,29,,10.44,percent of total billed charges,29% of total billed charges,7.53,100,,,fee schedule,100% of CMS OPPS rate,30.15,67,,24.12,percent of total billed charges,67% of total billed charges,10.16,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,36,80,,28.8,percent of total billed charges,80% of total billed charges,29.25,65,,23.4,percent of total billed charges,65% of total billed charges,16.05,35.67,,12.84,percent of total billed charges,35.67% of total billed charges,7.53,64.6,
ERYTHROCIN 500 MG INJ,2503770,CDM,636,RC,J1364,HCPCS,outpatient,,,252,100.80,,214.2,85,,171.36,percent of total billed charges,85% of total billed charges,252,100,,201.6,percent of total billed charges,pays based on exceed threshold rate,60.01,100,,,fee schedule,100% of CMS OPPS rate,72.3,385,,,fee schedule,385% of BCBS fee schedule,75.31,401,,,fee schedule,401% of BCBS fee schedule,75.31,401,,,fee schedule,401% of BCBS fee schedule,75.31,401,,,fee schedule,401% of BCBS fee schedule,226.8,90,,181.44,percent of total billed charges,90% of total billed charges,201.6,80,,161.28,percent of total billed charges,80% of total billed charges,226.8,90,,181.44,percent of total billed charges,90% of total billed charges,189,75,,151.2,percent of total billed charges,75% of total billed charges,73.2,122,,,fee schedule,122% of HUMANA fee schedule,73.08,29,,58.464,percent of total billed charges,29% of total billed charges,60.01,100,,,fee schedule,100% of CMS OPPS rate,168.84,67,,135.072,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,201.6,80,,161.28,percent of total billed charges,80% of total billed charges,163.8,65,,131.04,percent of total billed charges,65% of total billed charges,89.89,35.67,,71.912,percent of total billed charges,35.67% of total billed charges,60.01,252,
FERRIC CARBOXYMALTOSE 1 MG,2503928,CDM,636,RC,J1439,HCPCS,outpatient,,,82,32.80,,69.7,85,,55.76,percent of total billed charges,85% of total billed charges,82,100,,65.6,percent of total billed charges,pays based on exceed threshold rate,1.1,100,,,fee schedule,100% of CMS OPPS rate,4.81,385,,,fee schedule,385% of BCBS fee schedule,5.01,401,,,fee schedule,401% of BCBS fee schedule,5.01,401,,,fee schedule,401% of BCBS fee schedule,5.01,401,,,fee schedule,401% of BCBS fee schedule,73.8,90,,59.04,percent of total billed charges,90% of total billed charges,65.6,80,,52.48,percent of total billed charges,80% of total billed charges,73.8,90,,59.04,percent of total billed charges,90% of total billed charges,61.5,75,,49.2,percent of total billed charges,75% of total billed charges,1.34,122,,,fee schedule,122% of HUMANA fee schedule,23.78,29,,19.024,percent of total billed charges,29% of total billed charges,1.1,100,,,fee schedule,100% of CMS OPPS rate,54.94,67,,43.952,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,65.6,80,,52.48,percent of total billed charges,80% of total billed charges,53.3,65,,42.64,percent of total billed charges,65% of total billed charges,29.25,35.67,,23.4,percent of total billed charges,35.67% of total billed charges,1.1,82,
FLAGYL/METRONIDAZOLE 500MG INJ,2503995,CDM,636,RC,J3490,HCPCS,outpatient,,,36,14.40,,30.6,85,,24.48,percent of total billed charges,85% of total billed charges,36,100,,28.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,29.52,82,,23.616,percent of total billed charges,82% of total billed charges,30.6,85,,24.48,percent of total billed charges,85% of total billed charges,30.6,85,,24.48,percent of total billed charges,85% of total billed charges,30.6,85,,24.48,percent of total billed charges,85% of total billed charges,32.4,90,,25.92,percent of total billed charges,90% of total billed charges,28.8,80,,23.04,percent of total billed charges,80% of total billed charges,32.4,90,,25.92,percent of total billed charges,90% of total billed charges,27,75,,21.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,10.44,29,,8.352,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,24.12,67,,19.296,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,28.8,80,,23.04,percent of total billed charges,80% of total billed charges,23.4,65,,18.72,percent of total billed charges,65% of total billed charges,12.84,35.67,,10.272,percent of total billed charges,35.67% of total billed charges,10.44,36,
FORTAZ 1 GRAM INJ,2504120,CDM,636,RC,J0713,HCPCS,outpatient,,,55,22.00,,46.75,85,,37.4,percent of total billed charges,85% of total billed charges,55,100,,44,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,6.47,385,,,fee schedule,385% of BCBS fee schedule,6.74,401,,,fee schedule,401% of BCBS fee schedule,6.74,401,,,fee schedule,401% of BCBS fee schedule,6.74,401,,,fee schedule,401% of BCBS fee schedule,49.5,90,,39.6,percent of total billed charges,90% of total billed charges,44,80,,35.2,percent of total billed charges,80% of total billed charges,49.5,90,,39.6,percent of total billed charges,90% of total billed charges,41.25,75,,33,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,15.95,29,,12.76,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,36.85,67,,29.48,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,44,80,,35.2,percent of total billed charges,80% of total billed charges,35.75,65,,28.6,percent of total billed charges,65% of total billed charges,19.62,35.67,,15.696,percent of total billed charges,35.67% of total billed charges,6.47,55,
VENOFER IRON INJ 100 MG/5 ML,2504148,CDM,636,RC,J1756,HCPCS,outpatient,,,232,92.80,,197.2,85,,157.76,percent of total billed charges,85% of total billed charges,232,100,,185.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,1.39,385,,,fee schedule,385% of BCBS fee schedule,1.44,401,,,fee schedule,401% of BCBS fee schedule,1.44,401,,,fee schedule,401% of BCBS fee schedule,1.44,401,,,fee schedule,401% of BCBS fee schedule,208.8,90,,167.04,percent of total billed charges,90% of total billed charges,185.6,80,,148.48,percent of total billed charges,80% of total billed charges,208.8,90,,167.04,percent of total billed charges,90% of total billed charges,174,75,,139.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,67.28,29,,53.824,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,155.44,67,,124.352,percent of total billed charges,67% of total billed charges,0.28,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,185.6,80,,148.48,percent of total billed charges,80% of total billed charges,150.8,65,,120.64,percent of total billed charges,65% of total billed charges,82.75,35.67,,66.2,percent of total billed charges,35.67% of total billed charges,0.28,232,
VENOFER IRON SUCROSE 200/10 ML,2504149,CDM,636,RC,J1756,HCPCS,outpatient,,,228,91.20,,193.8,85,,155.04,percent of total billed charges,85% of total billed charges,228,100,,182.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,1.39,385,,,fee schedule,385% of BCBS fee schedule,1.44,401,,,fee schedule,401% of BCBS fee schedule,1.44,401,,,fee schedule,401% of BCBS fee schedule,1.44,401,,,fee schedule,401% of BCBS fee schedule,205.2,90,,164.16,percent of total billed charges,90% of total billed charges,182.4,80,,145.92,percent of total billed charges,80% of total billed charges,205.2,90,,164.16,percent of total billed charges,90% of total billed charges,171,75,,136.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,66.12,29,,52.896,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,152.76,67,,122.208,percent of total billed charges,67% of total billed charges,0.28,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,182.4,80,,145.92,percent of total billed charges,80% of total billed charges,148.2,65,,118.56,percent of total billed charges,65% of total billed charges,81.33,35.67,,65.064,percent of total billed charges,35.67% of total billed charges,0.28,228,
FULPHILA INJ 6 MG,2504151,CDM,636,RC,Q5108,HCPCS,outpatient,,,2569,1027.60,,2183.65,85,,1746.92,percent of total billed charges,85% of total billed charges,1348.73,52.5,,1078.98,percent of total billed charges,52.5 percent of total billed charges,135.53,100,,,fee schedule,100% of CMS OPPS rate,1580.62,385,,,fee schedule,385% of BCBS fee schedule,1646.31,401,,,fee schedule,401% of BCBS fee schedule,1646.31,401,,,fee schedule,401% of BCBS fee schedule,1646.31,401,,,fee schedule,401% of BCBS fee schedule,2312.1,90,,1849.68,percent of total billed charges,90% of total billed charges,2055.2,80,,1644.16,percent of total billed charges,80% of total billed charges,2312.1,90,,1849.68,percent of total billed charges,90% of total billed charges,1926.75,75,,1541.4,percent of total billed charges,75% of total billed charges,165.34,122,,,fee schedule,122% of HUMANA fee schedule,745.01,29,,596.008,percent of total billed charges,29% of total billed charges,135.53,100,,,fee schedule,100% of CMS OPPS rate,1721.23,67,,1376.984,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,2055.2,80,,1644.16,percent of total billed charges,80% of total billed charges,1669.85,65,,1335.88,percent of total billed charges,65% of total billed charges,916.36,35.67,,733.088,percent of total billed charges,35.67% of total billed charges,135.53,2312.1,
GARAMYCIN 120 MG INJ,2504170,CDM,636,RC,J1580,HCPCS,outpatient,,,53,21.20,,45.05,85,,36.04,percent of total billed charges,85% of total billed charges,53,100,,42.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,3.16,385,,,fee schedule,385% of BCBS fee schedule,3.29,401,,,fee schedule,401% of BCBS fee schedule,3.29,401,,,fee schedule,401% of BCBS fee schedule,3.29,401,,,fee schedule,401% of BCBS fee schedule,47.7,90,,38.16,percent of total billed charges,90% of total billed charges,42.4,80,,33.92,percent of total billed charges,80% of total billed charges,47.7,90,,38.16,percent of total billed charges,90% of total billed charges,39.75,75,,31.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,15.37,29,,12.296,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,35.51,67,,28.408,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,42.4,80,,33.92,percent of total billed charges,80% of total billed charges,34.45,65,,27.56,percent of total billed charges,65% of total billed charges,18.91,35.67,,15.128,percent of total billed charges,35.67% of total billed charges,3.16,53,
GARAMYCIN PEDI INJ 20 MG/2ML,2504171,CDM,636,RC,J1580,HCPCS,outpatient,,,19,7.60,,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,19,100,,15.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,3.16,385,,,fee schedule,385% of BCBS fee schedule,3.29,401,,,fee schedule,401% of BCBS fee schedule,3.29,401,,,fee schedule,401% of BCBS fee schedule,3.29,401,,,fee schedule,401% of BCBS fee schedule,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,15.2,80,,12.16,percent of total billed charges,80% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,14.25,75,,11.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,5.51,29,,4.408,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,12.73,67,,10.184,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,15.2,80,,12.16,percent of total billed charges,80% of total billed charges,12.35,65,,9.88,percent of total billed charges,65% of total billed charges,6.78,35.67,,5.424,percent of total billed charges,35.67% of total billed charges,3.16,19,
GARAMYCIN 40MG INJ,2504175,CDM,636,RC,J1580,HCPCS,outpatient,,,20,8.00,,17,85,,13.6,percent of total billed charges,85% of total billed charges,20,100,,16,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,3.16,385,,,fee schedule,385% of BCBS fee schedule,3.29,401,,,fee schedule,401% of BCBS fee schedule,3.29,401,,,fee schedule,401% of BCBS fee schedule,3.29,401,,,fee schedule,401% of BCBS fee schedule,18,90,,14.4,percent of total billed charges,90% of total billed charges,16,80,,12.8,percent of total billed charges,80% of total billed charges,18,90,,14.4,percent of total billed charges,90% of total billed charges,15,75,,12,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,5.8,29,,4.64,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,13.4,67,,10.72,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,16,80,,12.8,percent of total billed charges,80% of total billed charges,13,65,,10.4,percent of total billed charges,65% of total billed charges,7.13,35.67,,5.704,percent of total billed charges,35.67% of total billed charges,3.16,20,
GENTAMICIN 80 MG INJ,2504185,CDM,636,RC,J1580,HCPCS,outpatient,,,13,5.20,,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,13,100,,10.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,3.16,385,,,fee schedule,385% of BCBS fee schedule,3.29,401,,,fee schedule,401% of BCBS fee schedule,3.29,401,,,fee schedule,401% of BCBS fee schedule,3.29,401,,,fee schedule,401% of BCBS fee schedule,11.7,90,,9.36,percent of total billed charges,90% of total billed charges,10.4,80,,8.32,percent of total billed charges,80% of total billed charges,11.7,90,,9.36,percent of total billed charges,90% of total billed charges,9.75,75,,7.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,3.77,29,,3.016,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,8.71,67,,6.968,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,10.4,80,,8.32,percent of total billed charges,80% of total billed charges,8.45,65,,6.76,percent of total billed charges,65% of total billed charges,4.64,35.67,,3.712,percent of total billed charges,35.67% of total billed charges,3.16,13,
GARAMYCIN 90 MG INJ,2504190,CDM,636,RC,J1580,HCPCS,outpatient,,,21,8.40,,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,21,100,,16.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,3.16,385,,,fee schedule,385% of BCBS fee schedule,3.29,401,,,fee schedule,401% of BCBS fee schedule,3.29,401,,,fee schedule,401% of BCBS fee schedule,3.29,401,,,fee schedule,401% of BCBS fee schedule,18.9,90,,15.12,percent of total billed charges,90% of total billed charges,16.8,80,,13.44,percent of total billed charges,80% of total billed charges,18.9,90,,15.12,percent of total billed charges,90% of total billed charges,15.75,75,,12.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,6.09,29,,4.872,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,14.07,67,,11.256,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,16.8,80,,13.44,percent of total billed charges,80% of total billed charges,13.65,65,,10.92,percent of total billed charges,65% of total billed charges,7.49,35.67,,5.992,percent of total billed charges,35.67% of total billed charges,3.16,21,
GENTAMICIN 60 MG/50 ML  INJ,2504253,CDM,636,RC,J1580,HCPCS,outpatient,,,41,16.40,,34.85,85,,27.88,percent of total billed charges,85% of total billed charges,41,100,,32.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,3.16,385,,,fee schedule,385% of BCBS fee schedule,3.29,401,,,fee schedule,401% of BCBS fee schedule,3.29,401,,,fee schedule,401% of BCBS fee schedule,3.29,401,,,fee schedule,401% of BCBS fee schedule,36.9,90,,29.52,percent of total billed charges,90% of total billed charges,32.8,80,,26.24,percent of total billed charges,80% of total billed charges,36.9,90,,29.52,percent of total billed charges,90% of total billed charges,30.75,75,,24.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,11.89,29,,9.512,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,27.47,67,,21.976,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,32.8,80,,26.24,percent of total billed charges,80% of total billed charges,26.65,65,,21.32,percent of total billed charges,65% of total billed charges,14.62,35.67,,11.696,percent of total billed charges,35.67% of total billed charges,3.16,41,
GENTAMICIN 80 MG/NS 100 ML,2504258,CDM,636,RC,J1580,HCPCS,outpatient,,,27,10.80,,22.95,85,,18.36,percent of total billed charges,85% of total billed charges,27,100,,21.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,3.16,385,,,fee schedule,385% of BCBS fee schedule,3.29,401,,,fee schedule,401% of BCBS fee schedule,3.29,401,,,fee schedule,401% of BCBS fee schedule,3.29,401,,,fee schedule,401% of BCBS fee schedule,24.3,90,,19.44,percent of total billed charges,90% of total billed charges,21.6,80,,17.28,percent of total billed charges,80% of total billed charges,24.3,90,,19.44,percent of total billed charges,90% of total billed charges,20.25,75,,16.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,7.83,29,,6.264,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,18.09,67,,14.472,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,21.6,80,,17.28,percent of total billed charges,80% of total billed charges,17.55,65,,14.04,percent of total billed charges,65% of total billed charges,9.63,35.67,,7.704,percent of total billed charges,35.67% of total billed charges,3.16,27,
GEODON 20 MG/ML 1 ML VIAL,2504262,CDM,636,RC,J3486,HCPCS,outpatient,,,155,62.00,,131.75,85,,105.4,percent of total billed charges,85% of total billed charges,155,100,,124,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,87.4,385,,,fee schedule,385% of BCBS fee schedule,91.03,401,,,fee schedule,401% of BCBS fee schedule,91.03,401,,,fee schedule,401% of BCBS fee schedule,91.03,401,,,fee schedule,401% of BCBS fee schedule,139.5,90,,111.6,percent of total billed charges,90% of total billed charges,124,80,,99.2,percent of total billed charges,80% of total billed charges,139.5,90,,111.6,percent of total billed charges,90% of total billed charges,116.25,75,,93,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,44.95,29,,35.96,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,103.85,67,,83.08,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,124,80,,99.2,percent of total billed charges,80% of total billed charges,100.75,65,,80.6,percent of total billed charges,65% of total billed charges,55.29,35.67,,44.232,percent of total billed charges,35.67% of total billed charges,44.95,155,
GLUCAGON KIT,2504275,CDM,636,RC,J1610,HCPCS,outpatient,,,503,201.20,,427.55,85,,342.04,percent of total billed charges,85% of total billed charges,503,100,,402.4,percent of total billed charges,pays based on exceed threshold rate,192.3,100,,,fee schedule,100% of CMS OPPS rate,442.4,385,,,fee schedule,385% of BCBS fee schedule,460.79,401,,,fee schedule,401% of BCBS fee schedule,460.79,401,,,fee schedule,401% of BCBS fee schedule,460.79,401,,,fee schedule,401% of BCBS fee schedule,452.7,90,,362.16,percent of total billed charges,90% of total billed charges,402.4,80,,321.92,percent of total billed charges,80% of total billed charges,452.7,90,,362.16,percent of total billed charges,90% of total billed charges,377.25,75,,301.8,percent of total billed charges,75% of total billed charges,234.6,122,,,fee schedule,122% of HUMANA fee schedule,145.87,29,,116.696,percent of total billed charges,29% of total billed charges,192.3,100,,,fee schedule,100% of CMS OPPS rate,337.01,67,,269.608,percent of total billed charges,67% of total billed charges,114.58,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,402.4,80,,321.92,percent of total billed charges,80% of total billed charges,326.95,65,,261.56,percent of total billed charges,65% of total billed charges,179.42,35.67,,143.536,percent of total billed charges,35.67% of total billed charges,114.58,503,
GLUCAGON HYPOKIT (1 MG SYRINGE,2504282,CDM,636,RC,J1610,HCPCS,outpatient,,,365,146.00,,310.25,85,,248.2,percent of total billed charges,85% of total billed charges,365,100,,292,percent of total billed charges,pays based on exceed threshold rate,192.3,100,,,fee schedule,100% of CMS OPPS rate,442.4,385,,,fee schedule,385% of BCBS fee schedule,460.79,401,,,fee schedule,401% of BCBS fee schedule,460.79,401,,,fee schedule,401% of BCBS fee schedule,460.79,401,,,fee schedule,401% of BCBS fee schedule,328.5,90,,262.8,percent of total billed charges,90% of total billed charges,292,80,,233.6,percent of total billed charges,80% of total billed charges,328.5,90,,262.8,percent of total billed charges,90% of total billed charges,273.75,75,,219,percent of total billed charges,75% of total billed charges,234.6,122,,,fee schedule,122% of HUMANA fee schedule,105.85,29,,84.68,percent of total billed charges,29% of total billed charges,192.3,100,,,fee schedule,100% of CMS OPPS rate,244.55,67,,195.64,percent of total billed charges,67% of total billed charges,114.58,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,292,80,,233.6,percent of total billed charges,80% of total billed charges,237.25,65,,189.8,percent of total billed charges,65% of total billed charges,130.2,35.67,,104.16,percent of total billed charges,35.67% of total billed charges,105.85,460.79,
GRANIX 300 MCG SYRINGE,2504331,CDM,636,RC,J1447,HCPCS,outpatient,,,456,182.40,,387.6,85,,310.08,percent of total billed charges,85% of total billed charges,456,100,,364.8,percent of total billed charges,pays based on exceed threshold rate,0.39,100,,,fee schedule,100% of CMS OPPS rate,3.2,385,,,fee schedule,385% of BCBS fee schedule,3.33,401,,,fee schedule,401% of BCBS fee schedule,3.33,401,,,fee schedule,401% of BCBS fee schedule,3.33,401,,,fee schedule,401% of BCBS fee schedule,410.4,90,,328.32,percent of total billed charges,90% of total billed charges,364.8,80,,291.84,percent of total billed charges,80% of total billed charges,410.4,90,,328.32,percent of total billed charges,90% of total billed charges,342,75,,273.6,percent of total billed charges,75% of total billed charges,0.47,122,,,fee schedule,122% of HUMANA fee schedule,132.24,29,,105.792,percent of total billed charges,29% of total billed charges,0.39,100,,,fee schedule,100% of CMS OPPS rate,305.52,67,,244.416,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,364.8,80,,291.84,percent of total billed charges,80% of total billed charges,296.4,65,,237.12,percent of total billed charges,65% of total billed charges,162.66,35.67,,130.128,percent of total billed charges,35.67% of total billed charges,0.39,456,
GRANIX 480 MCG SYRINGE,2504333,CDM,636,RC,J1447,HCPCS,outpatient,,,740,296.00,,629,85,,503.2,percent of total billed charges,85% of total billed charges,740,100,,592,percent of total billed charges,pays based on exceed threshold rate,0.39,100,,,fee schedule,100% of CMS OPPS rate,3.2,385,,,fee schedule,385% of BCBS fee schedule,3.33,401,,,fee schedule,401% of BCBS fee schedule,3.33,401,,,fee schedule,401% of BCBS fee schedule,3.33,401,,,fee schedule,401% of BCBS fee schedule,666,90,,532.8,percent of total billed charges,90% of total billed charges,592,80,,473.6,percent of total billed charges,80% of total billed charges,666,90,,532.8,percent of total billed charges,90% of total billed charges,555,75,,444,percent of total billed charges,75% of total billed charges,0.47,122,,,fee schedule,122% of HUMANA fee schedule,214.6,29,,171.68,percent of total billed charges,29% of total billed charges,0.39,100,,,fee schedule,100% of CMS OPPS rate,495.8,67,,396.64,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,592,80,,473.6,percent of total billed charges,80% of total billed charges,481,65,,384.8,percent of total billed charges,65% of total billed charges,263.96,35.67,,211.168,percent of total billed charges,35.67% of total billed charges,0.39,740,
HABITROL 21 MG PATCH,2504356,CDM,636,RC,S4991,HCPCS,outpatient,,,18,7.20,,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,18,100,,14.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,14.76,82,,11.808,percent of total billed charges,82% of total billed charges,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,16.2,90,,12.96,percent of total billed charges,90% of total billed charges,14.4,80,,11.52,percent of total billed charges,80% of total billed charges,16.2,90,,12.96,percent of total billed charges,90% of total billed charges,13.5,75,,10.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,5.22,29,,4.176,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,12.06,67,,9.648,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,14.4,80,,11.52,percent of total billed charges,80% of total billed charges,11.7,65,,9.36,percent of total billed charges,65% of total billed charges,6.42,35.67,,5.136,percent of total billed charges,35.67% of total billed charges,5.22,18,
HALDOL 10 MG INJ.,2504390,CDM,636,RC,J1630,HCPCS,outpatient,,,25,10.00,,21.25,85,,17,percent of total billed charges,85% of total billed charges,25,100,,20,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,15.63,385,,,fee schedule,385% of BCBS fee schedule,16.28,401,,,fee schedule,401% of BCBS fee schedule,16.28,401,,,fee schedule,401% of BCBS fee schedule,16.28,401,,,fee schedule,401% of BCBS fee schedule,22.5,90,,18,percent of total billed charges,90% of total billed charges,20,80,,16,percent of total billed charges,80% of total billed charges,22.5,90,,18,percent of total billed charges,90% of total billed charges,18.75,75,,15,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,7.25,29,,5.8,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,16.75,67,,13.4,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,20,80,,16,percent of total billed charges,80% of total billed charges,16.25,65,,13,percent of total billed charges,65% of total billed charges,8.92,35.67,,7.136,percent of total billed charges,35.67% of total billed charges,7.25,25,
HALDOL 2 MG INJ.,2504400,CDM,636,RC,J1630,HCPCS,outpatient,,,10,4.00,,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,10,100,,8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,15.63,385,,,fee schedule,385% of BCBS fee schedule,16.28,401,,,fee schedule,401% of BCBS fee schedule,16.28,401,,,fee schedule,401% of BCBS fee schedule,16.28,401,,,fee schedule,401% of BCBS fee schedule,9,90,,7.2,percent of total billed charges,90% of total billed charges,8,80,,6.4,percent of total billed charges,80% of total billed charges,9,90,,7.2,percent of total billed charges,90% of total billed charges,7.5,75,,6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.9,29,,2.32,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,6.7,67,,5.36,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,8,80,,6.4,percent of total billed charges,80% of total billed charges,6.5,65,,5.2,percent of total billed charges,65% of total billed charges,3.57,35.67,,2.856,percent of total billed charges,35.67% of total billed charges,2.9,16.28,
HALDOL 3 MG INJ.,2504415,CDM,636,RC,J1630,HCPCS,outpatient,,,11,4.40,,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,11,100,,8.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,15.63,385,,,fee schedule,385% of BCBS fee schedule,16.28,401,,,fee schedule,401% of BCBS fee schedule,16.28,401,,,fee schedule,401% of BCBS fee schedule,16.28,401,,,fee schedule,401% of BCBS fee schedule,9.9,90,,7.92,percent of total billed charges,90% of total billed charges,8.8,80,,7.04,percent of total billed charges,80% of total billed charges,9.9,90,,7.92,percent of total billed charges,90% of total billed charges,8.25,75,,6.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,3.19,29,,2.552,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,7.37,67,,5.896,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,8.8,80,,7.04,percent of total billed charges,80% of total billed charges,7.15,65,,5.72,percent of total billed charges,65% of total billed charges,3.92,35.67,,3.136,percent of total billed charges,35.67% of total billed charges,3.19,16.28,
HALDOL 5 MG/ML INJ.,2504435,CDM,636,RC,J1630,HCPCS,outpatient,,,84,33.60,,71.4,85,,57.12,percent of total billed charges,85% of total billed charges,84,100,,67.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,15.63,385,,,fee schedule,385% of BCBS fee schedule,16.28,401,,,fee schedule,401% of BCBS fee schedule,16.28,401,,,fee schedule,401% of BCBS fee schedule,16.28,401,,,fee schedule,401% of BCBS fee schedule,75.6,90,,60.48,percent of total billed charges,90% of total billed charges,67.2,80,,53.76,percent of total billed charges,80% of total billed charges,75.6,90,,60.48,percent of total billed charges,90% of total billed charges,63,75,,50.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,24.36,29,,19.488,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,56.28,67,,45.024,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,67.2,80,,53.76,percent of total billed charges,80% of total billed charges,54.6,65,,43.68,percent of total billed charges,65% of total billed charges,29.96,35.67,,23.968,percent of total billed charges,35.67% of total billed charges,15.63,84,
"HEPARIN 1,000 UNITS INJ.",2504495,CDM,636,RC,J1644,HCPCS,outpatient,,,663,265.20,,563.55,85,,450.84,percent of total billed charges,85% of total billed charges,663,100,,530.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,0.73,385,,,fee schedule,385% of BCBS fee schedule,0.76,401,,,fee schedule,401% of BCBS fee schedule,0.76,401,,,fee schedule,401% of BCBS fee schedule,0.76,401,,,fee schedule,401% of BCBS fee schedule,596.7,90,,477.36,percent of total billed charges,90% of total billed charges,530.4,80,,424.32,percent of total billed charges,80% of total billed charges,596.7,90,,477.36,percent of total billed charges,90% of total billed charges,497.25,75,,397.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,192.27,29,,153.816,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,444.21,67,,355.368,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,530.4,80,,424.32,percent of total billed charges,80% of total billed charges,430.95,65,,344.76,percent of total billed charges,65% of total billed charges,236.49,35.67,,189.192,percent of total billed charges,35.67% of total billed charges,0.73,663,
"HEPARIN 10,000 UNITS INJ.",2504500,CDM,636,RC,J1644,HCPCS,outpatient,,,33,13.20,,28.05,85,,22.44,percent of total billed charges,85% of total billed charges,33,100,,26.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,0.73,385,,,fee schedule,385% of BCBS fee schedule,0.76,401,,,fee schedule,401% of BCBS fee schedule,0.76,401,,,fee schedule,401% of BCBS fee schedule,0.76,401,,,fee schedule,401% of BCBS fee schedule,29.7,90,,23.76,percent of total billed charges,90% of total billed charges,26.4,80,,21.12,percent of total billed charges,80% of total billed charges,29.7,90,,23.76,percent of total billed charges,90% of total billed charges,24.75,75,,19.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,9.57,29,,7.656,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,22.11,67,,17.688,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,26.4,80,,21.12,percent of total billed charges,80% of total billed charges,21.45,65,,17.16,percent of total billed charges,65% of total billed charges,11.77,35.67,,9.416,percent of total billed charges,35.67% of total billed charges,0.73,33,
"HEPARIN 2,000 UNITS INJ.",2504510,CDM,636,RC,J1644,HCPCS,outpatient,,,9,3.60,,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,9,100,,7.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,0.73,385,,,fee schedule,385% of BCBS fee schedule,0.76,401,,,fee schedule,401% of BCBS fee schedule,0.76,401,,,fee schedule,401% of BCBS fee schedule,0.76,401,,,fee schedule,401% of BCBS fee schedule,8.1,90,,6.48,percent of total billed charges,90% of total billed charges,7.2,80,,5.76,percent of total billed charges,80% of total billed charges,8.1,90,,6.48,percent of total billed charges,90% of total billed charges,6.75,75,,5.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.61,29,,2.088,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,6.03,67,,4.824,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,7.2,80,,5.76,percent of total billed charges,80% of total billed charges,5.85,65,,4.68,percent of total billed charges,65% of total billed charges,3.21,35.67,,2.568,percent of total billed charges,35.67% of total billed charges,0.73,9,
"HEPARIN 3,000 UNITS INJ.",2504525,CDM,636,RC,J1644,HCPCS,outpatient,,,9,3.60,,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,9,100,,7.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,0.73,385,,,fee schedule,385% of BCBS fee schedule,0.76,401,,,fee schedule,401% of BCBS fee schedule,0.76,401,,,fee schedule,401% of BCBS fee schedule,0.76,401,,,fee schedule,401% of BCBS fee schedule,8.1,90,,6.48,percent of total billed charges,90% of total billed charges,7.2,80,,5.76,percent of total billed charges,80% of total billed charges,8.1,90,,6.48,percent of total billed charges,90% of total billed charges,6.75,75,,5.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.61,29,,2.088,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,6.03,67,,4.824,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,7.2,80,,5.76,percent of total billed charges,80% of total billed charges,5.85,65,,4.68,percent of total billed charges,65% of total billed charges,3.21,35.67,,2.568,percent of total billed charges,35.67% of total billed charges,0.73,9,
"HEPARIN 4,000 UNITS INJ.",2504530,CDM,636,RC,J1644,HCPCS,outpatient,,,9,3.60,,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,9,100,,7.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,0.73,385,,,fee schedule,385% of BCBS fee schedule,0.76,401,,,fee schedule,401% of BCBS fee schedule,0.76,401,,,fee schedule,401% of BCBS fee schedule,0.76,401,,,fee schedule,401% of BCBS fee schedule,8.1,90,,6.48,percent of total billed charges,90% of total billed charges,7.2,80,,5.76,percent of total billed charges,80% of total billed charges,8.1,90,,6.48,percent of total billed charges,90% of total billed charges,6.75,75,,5.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.61,29,,2.088,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,6.03,67,,4.824,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,7.2,80,,5.76,percent of total billed charges,80% of total billed charges,5.85,65,,4.68,percent of total billed charges,65% of total billed charges,3.21,35.67,,2.568,percent of total billed charges,35.67% of total billed charges,0.73,9,
"HEPARIN 5,000 UNITS INJ.",2504535,CDM,636,RC,J1644,HCPCS,outpatient,,,11,4.40,,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,11,100,,8.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,0.73,385,,,fee schedule,385% of BCBS fee schedule,0.76,401,,,fee schedule,401% of BCBS fee schedule,0.76,401,,,fee schedule,401% of BCBS fee schedule,0.76,401,,,fee schedule,401% of BCBS fee schedule,9.9,90,,7.92,percent of total billed charges,90% of total billed charges,8.8,80,,7.04,percent of total billed charges,80% of total billed charges,9.9,90,,7.92,percent of total billed charges,90% of total billed charges,8.25,75,,6.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,3.19,29,,2.552,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,7.37,67,,5.896,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,8.8,80,,7.04,percent of total billed charges,80% of total billed charges,7.15,65,,5.72,percent of total billed charges,65% of total billed charges,3.92,35.67,,3.136,percent of total billed charges,35.67% of total billed charges,0.73,11,
"HEPARIN 25,000 UNITS",2504536,CDM,636,RC,J1644,HCPCS,outpatient,,,25,10.00,,21.25,85,,17,percent of total billed charges,85% of total billed charges,25,100,,20,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,0.73,385,,,fee schedule,385% of BCBS fee schedule,0.76,401,,,fee schedule,401% of BCBS fee schedule,0.76,401,,,fee schedule,401% of BCBS fee schedule,0.76,401,,,fee schedule,401% of BCBS fee schedule,22.5,90,,18,percent of total billed charges,90% of total billed charges,20,80,,16,percent of total billed charges,80% of total billed charges,22.5,90,,18,percent of total billed charges,90% of total billed charges,18.75,75,,15,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,7.25,29,,5.8,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,16.75,67,,13.4,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,20,80,,16,percent of total billed charges,80% of total billed charges,16.25,65,,13,percent of total billed charges,65% of total billed charges,8.92,35.67,,7.136,percent of total billed charges,35.67% of total billed charges,0.73,25,
HEPATITIS B INJ. 10MG/5ML,2504555,CDM,636,RC,90371,HCPCS,outpatient,,,1700,680.00,,1445,85,,1156,percent of total billed charges,85% of total billed charges,892.5,52.5,,714,percent of total billed charges,52.5 percent of total billed charges,139.93,100,,,fee schedule,100% of CMS OPPS rate,495.53,385,,,fee schedule,385% of BCBS fee schedule,516.13,401,,,fee schedule,401% of BCBS fee schedule,516.13,401,,,fee schedule,401% of BCBS fee schedule,516.13,401,,,fee schedule,401% of BCBS fee schedule,1530,90,,1224,percent of total billed charges,90% of total billed charges,1360,80,,1088,percent of total billed charges,80% of total billed charges,1530,90,,1224,percent of total billed charges,90% of total billed charges,1275,75,,1020,percent of total billed charges,75% of total billed charges,170.71,122,,,fee schedule,122% of HUMANA fee schedule,493,29,,394.4,percent of total billed charges,29% of total billed charges,139.93,100,,,fee schedule,100% of CMS OPPS rate,1139,67,,911.2,percent of total billed charges,67% of total billed charges,100.08,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,1360,80,,1088,percent of total billed charges,80% of total billed charges,1105,65,,884,percent of total billed charges,65% of total billed charges,606.39,35.67,,485.112,percent of total billed charges,35.67% of total billed charges,100.08,1530,
HEPATITIS B VACCINE 20 MCG,2504556,CDM,636,RC,90746,HCPCS,outpatient,,,343,137.20,,291.55,85,,233.24,percent of total billed charges,85% of total billed charges,343,100,,274.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,176.98,385,,,fee schedule,385% of BCBS fee schedule,184.34,401,,,fee schedule,401% of BCBS fee schedule,184.34,401,,,fee schedule,401% of BCBS fee schedule,184.34,401,,,fee schedule,401% of BCBS fee schedule,308.7,90,,246.96,percent of total billed charges,90% of total billed charges,274.4,80,,219.52,percent of total billed charges,80% of total billed charges,308.7,90,,246.96,percent of total billed charges,90% of total billed charges,257.25,75,,205.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,99.47,29,,79.576,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,229.81,67,,183.848,percent of total billed charges,67% of total billed charges,254.32,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,274.4,80,,219.52,percent of total billed charges,80% of total billed charges,222.95,65,,178.36,percent of total billed charges,65% of total billed charges,122.35,35.67,,97.88,percent of total billed charges,35.67% of total billed charges,99.47,343,
HEPATITIS B VACCINE INJ **,2504560,CDM,636,RC,90746,HCPCS,outpatient,,,250,100.00,,212.5,85,,170,percent of total billed charges,85% of total billed charges,250,100,,200,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,176.98,385,,,fee schedule,385% of BCBS fee schedule,184.34,401,,,fee schedule,401% of BCBS fee schedule,184.34,401,,,fee schedule,401% of BCBS fee schedule,184.34,401,,,fee schedule,401% of BCBS fee schedule,225,90,,180,percent of total billed charges,90% of total billed charges,200,80,,160,percent of total billed charges,80% of total billed charges,225,90,,180,percent of total billed charges,90% of total billed charges,187.5,75,,150,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,72.5,29,,58,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,167.5,67,,134,percent of total billed charges,67% of total billed charges,185.36,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,200,80,,160,percent of total billed charges,80% of total billed charges,162.5,65,,130,percent of total billed charges,65% of total billed charges,89.18,35.67,,71.344,percent of total billed charges,35.67% of total billed charges,72.5,250,
HEPATITIS B VACC CHILD 10CMG,2504564,CDM,636,RC,90744,HCPCS,outpatient,,,913,365.20,,776.05,85,,620.84,percent of total billed charges,85% of total billed charges,913,100,,730.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,75.11,385,,,fee schedule,385% of BCBS fee schedule,78.24,401,,,fee schedule,401% of BCBS fee schedule,78.24,401,,,fee schedule,401% of BCBS fee schedule,78.24,401,,,fee schedule,401% of BCBS fee schedule,821.7,90,,657.36,percent of total billed charges,90% of total billed charges,730.4,80,,584.32,percent of total billed charges,80% of total billed charges,821.7,90,,657.36,percent of total billed charges,90% of total billed charges,684.75,75,,547.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,264.77,29,,211.816,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,611.71,67,,489.368,percent of total billed charges,67% of total billed charges,676.95,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,730.4,80,,584.32,percent of total billed charges,80% of total billed charges,593.45,65,,474.76,percent of total billed charges,65% of total billed charges,325.67,35.67,,260.536,percent of total billed charges,35.67% of total billed charges,75.11,913,
HEPATITIS B IMMUN GLOUB IM,2504567,CDM,636,RC,90371,HCPCS,outpatient,,,774,309.60,,657.9,85,,526.32,percent of total billed charges,85% of total billed charges,774,100,,619.2,percent of total billed charges,pays based on exceed threshold rate,139.93,100,,,fee schedule,100% of CMS OPPS rate,495.53,385,,,fee schedule,385% of BCBS fee schedule,516.13,401,,,fee schedule,401% of BCBS fee schedule,516.13,401,,,fee schedule,401% of BCBS fee schedule,516.13,401,,,fee schedule,401% of BCBS fee schedule,696.6,90,,557.28,percent of total billed charges,90% of total billed charges,619.2,80,,495.36,percent of total billed charges,80% of total billed charges,696.6,90,,557.28,percent of total billed charges,90% of total billed charges,580.5,75,,464.4,percent of total billed charges,75% of total billed charges,170.71,122,,,fee schedule,122% of HUMANA fee schedule,224.46,29,,179.568,percent of total billed charges,29% of total billed charges,139.93,100,,,fee schedule,100% of CMS OPPS rate,518.58,67,,414.864,percent of total billed charges,67% of total billed charges,100.08,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,619.2,80,,495.36,percent of total billed charges,80% of total billed charges,503.1,65,,402.48,percent of total billed charges,65% of total billed charges,276.09,35.67,,220.872,percent of total billed charges,35.67% of total billed charges,100.08,774,
HEPATITIS B VACC ADULT 20 MCG,2504568,CDM,636,RC,90746,HCPCS,outpatient,,,904,361.60,,768.4,85,,614.72,percent of total billed charges,85% of total billed charges,904,100,,723.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,176.98,385,,,fee schedule,385% of BCBS fee schedule,184.34,401,,,fee schedule,401% of BCBS fee schedule,184.34,401,,,fee schedule,401% of BCBS fee schedule,184.34,401,,,fee schedule,401% of BCBS fee schedule,813.6,90,,650.88,percent of total billed charges,90% of total billed charges,723.2,80,,578.56,percent of total billed charges,80% of total billed charges,813.6,90,,650.88,percent of total billed charges,90% of total billed charges,678,75,,542.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,262.16,29,,209.728,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,605.68,67,,484.544,percent of total billed charges,67% of total billed charges,670.28,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,723.2,80,,578.56,percent of total billed charges,80% of total billed charges,587.6,65,,470.08,percent of total billed charges,65% of total billed charges,322.46,35.67,,257.968,percent of total billed charges,35.67% of total billed charges,176.98,904,
HYDROCORTISONE SODIUM 100M,2504701,CDM,636,RC,J1720,HCPCS,outpatient,,,66,26.40,,56.1,85,,44.88,percent of total billed charges,85% of total billed charges,66,100,,52.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,7.7,385,,,fee schedule,385% of BCBS fee schedule,8.02,401,,,fee schedule,401% of BCBS fee schedule,8.02,401,,,fee schedule,401% of BCBS fee schedule,8.02,401,,,fee schedule,401% of BCBS fee schedule,59.4,90,,47.52,percent of total billed charges,90% of total billed charges,52.8,80,,42.24,percent of total billed charges,80% of total billed charges,59.4,90,,47.52,percent of total billed charges,90% of total billed charges,49.5,75,,39.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,19.14,29,,15.312,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,44.22,67,,35.376,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,52.8,80,,42.24,percent of total billed charges,80% of total billed charges,42.9,65,,34.32,percent of total billed charges,65% of total billed charges,23.54,35.67,,18.832,percent of total billed charges,35.67% of total billed charges,7.7,66,
HYPER-TET INJ 250 UNITS*,2504710,CDM,636,RC,J1670,HCPCS,outpatient,,,1064,425.60,,904.4,85,,723.52,percent of total billed charges,85% of total billed charges,558.6,52.5,,446.88,percent of total billed charges,52.5 percent of total billed charges,581.78,100,,,fee schedule,100% of CMS OPPS rate,1917.42,385,,,fee schedule,385% of BCBS fee schedule,1997.1,401,,,fee schedule,401% of BCBS fee schedule,1997.1,401,,,fee schedule,401% of BCBS fee schedule,1997.1,401,,,fee schedule,401% of BCBS fee schedule,957.6,90,,766.08,percent of total billed charges,90% of total billed charges,851.2,80,,680.96,percent of total billed charges,80% of total billed charges,957.6,90,,766.08,percent of total billed charges,90% of total billed charges,798,75,,638.4,percent of total billed charges,75% of total billed charges,709.77,122,,,fee schedule,122% of HUMANA fee schedule,308.56,29,,246.848,percent of total billed charges,29% of total billed charges,581.78,100,,,fee schedule,100% of CMS OPPS rate,712.88,67,,570.304,percent of total billed charges,67% of total billed charges,284.61,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,851.2,80,,680.96,percent of total billed charges,80% of total billed charges,691.6,65,,553.28,percent of total billed charges,65% of total billed charges,379.53,35.67,,303.624,percent of total billed charges,35.67% of total billed charges,284.61,1997.1,
HYDROMORPHONE 250 MG POWDER IN,2504711,CDM,636,RC,J1170,HCPCS,outpatient,,,778,311.20,,661.3,85,,529.04,percent of total billed charges,85% of total billed charges,778,100,,622.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,1.54,385,,,fee schedule,385% of BCBS fee schedule,1.6,401,,,fee schedule,401% of BCBS fee schedule,1.6,401,,,fee schedule,401% of BCBS fee schedule,1.6,401,,,fee schedule,401% of BCBS fee schedule,700.2,90,,560.16,percent of total billed charges,90% of total billed charges,622.4,80,,497.92,percent of total billed charges,80% of total billed charges,700.2,90,,560.16,percent of total billed charges,90% of total billed charges,583.5,75,,466.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,225.62,29,,180.496,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,521.26,67,,417.008,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,622.4,80,,497.92,percent of total billed charges,80% of total billed charges,505.7,65,,404.56,percent of total billed charges,65% of total billed charges,277.51,35.67,,222.008,percent of total billed charges,35.67% of total billed charges,1.54,778,
HYALURONATE SODIUM 88 MG/4ML,2504712,CDM,636,RC,J7327,HCPCS,outpatient,,,3973,1589.20,,3377.05,85,,2701.64,percent of total billed charges,85% of total billed charges,2085.83,52.5,,1668.66,percent of total billed charges,52.5 percent of total billed charges,683.17,100,,,fee schedule,100% of CMS OPPS rate,3423.11,385,,,fee schedule,385% of BCBS fee schedule,3565.37,401,,,fee schedule,401% of BCBS fee schedule,3565.37,401,,,fee schedule,401% of BCBS fee schedule,3565.37,401,,,fee schedule,401% of BCBS fee schedule,3575.7,90,,2860.56,percent of total billed charges,90% of total billed charges,3178.4,80,,2542.72,percent of total billed charges,80% of total billed charges,3575.7,90,,2860.56,percent of total billed charges,90% of total billed charges,2979.75,75,,2383.8,percent of total billed charges,75% of total billed charges,833.46,122,,,fee schedule,122% of HUMANA fee schedule,1152.17,29,,921.736,percent of total billed charges,29% of total billed charges,683.17,100,,,fee schedule,100% of CMS OPPS rate,2661.91,67,,2129.528,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,3178.4,80,,2542.72,percent of total billed charges,80% of total billed charges,2582.45,65,,2065.96,percent of total billed charges,65% of total billed charges,1417.17,35.67,,1133.736,percent of total billed charges,35.67% of total billed charges,683.17,3575.7,
CAPSAICIN SKIN CLEANSER,2504713,CDM,636,RC,J7336,HCPCS,outpatient,,,9693,3877.20,,8239.05,85,,6591.24,percent of total billed charges,85% of total billed charges,5088.83,52.5,,4071.06,percent of total billed charges,52.5 percent of total billed charges,3.33,100,,,fee schedule,100% of CMS OPPS rate,11.63,385,,,fee schedule,385% of BCBS fee schedule,12.11,401,,,fee schedule,401% of BCBS fee schedule,12.11,401,,,fee schedule,401% of BCBS fee schedule,12.11,401,,,fee schedule,401% of BCBS fee schedule,8723.7,90,,6978.96,percent of total billed charges,90% of total billed charges,7754.4,80,,6203.52,percent of total billed charges,80% of total billed charges,8723.7,90,,6978.96,percent of total billed charges,90% of total billed charges,7269.75,75,,5815.8,percent of total billed charges,75% of total billed charges,4.05,122,,,fee schedule,122% of HUMANA fee schedule,2810.97,29,,2248.776,percent of total billed charges,29% of total billed charges,3.33,100,,,fee schedule,100% of CMS OPPS rate,6494.31,67,,5195.448,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,7754.4,80,,6203.52,percent of total billed charges,80% of total billed charges,6300.45,65,,5040.36,percent of total billed charges,65% of total billed charges,3457.49,35.67,,2765.992,percent of total billed charges,35.67% of total billed charges,3.33,8723.7,
CAPSAICIN .1%,2504714,CDM,636,RC,J3490,HCPCS,outpatient,,,37,14.80,,31.45,85,,25.16,percent of total billed charges,85% of total billed charges,37,100,,29.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,30.34,82,,24.272,percent of total billed charges,82% of total billed charges,31.45,85,,25.16,percent of total billed charges,85% of total billed charges,31.45,85,,25.16,percent of total billed charges,85% of total billed charges,31.45,85,,25.16,percent of total billed charges,85% of total billed charges,33.3,90,,26.64,percent of total billed charges,90% of total billed charges,29.6,80,,23.68,percent of total billed charges,80% of total billed charges,33.3,90,,26.64,percent of total billed charges,90% of total billed charges,27.75,75,,22.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,10.73,29,,8.584,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,24.79,67,,19.832,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,29.6,80,,23.68,percent of total billed charges,80% of total billed charges,24.05,65,,19.24,percent of total billed charges,65% of total billed charges,13.2,35.67,,10.56,percent of total billed charges,35.67% of total billed charges,10.73,37,
IMDEVIMAB 1200 MG,2504816,CDM,636,RC,Q0243,HCPCS,outpatient,,,3,1.20,,2.55,85,,2.04,percent of total billed charges,85% of total billed charges,3,100,,2.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,2.46,82,,1.968,percent of total billed charges,82% of total billed charges,2.55,85,,2.04,percent of total billed charges,85% of total billed charges,2.55,85,,2.04,percent of total billed charges,85% of total billed charges,2.55,85,,2.04,percent of total billed charges,85% of total billed charges,2.7,90,,2.16,percent of total billed charges,90% of total billed charges,2.4,80,,1.92,percent of total billed charges,80% of total billed charges,2.7,90,,2.16,percent of total billed charges,90% of total billed charges,2.25,75,,1.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,0.87,29,,0.696,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,2.01,67,,1.608,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,2.4,80,,1.92,percent of total billed charges,80% of total billed charges,1.95,65,,1.56,percent of total billed charges,65% of total billed charges,1.07,35.67,,0.856,percent of total billed charges,35.67% of total billed charges,0.87,3,
IMITREX 12 MG INJ,2504825,CDM,636,RC,J3030,HCPCS,outpatient,,,187,74.80,,158.95,85,,127.16,percent of total billed charges,85% of total billed charges,187,100,,149.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,93.13,385,,,fee schedule,385% of BCBS fee schedule,97,401,,,fee schedule,401% of BCBS fee schedule,97,401,,,fee schedule,401% of BCBS fee schedule,97,401,,,fee schedule,401% of BCBS fee schedule,168.3,90,,134.64,percent of total billed charges,90% of total billed charges,149.6,80,,119.68,percent of total billed charges,80% of total billed charges,168.3,90,,134.64,percent of total billed charges,90% of total billed charges,140.25,75,,112.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,54.23,29,,43.384,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,125.29,67,,100.232,percent of total billed charges,67% of total billed charges,53.45,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,149.6,80,,119.68,percent of total billed charges,80% of total billed charges,121.55,65,,97.24,percent of total billed charges,65% of total billed charges,66.7,35.67,,53.36,percent of total billed charges,35.67% of total billed charges,53.45,187,
IMITREX 6 MG INJ,2504830,CDM,636,RC,J3030,HCPCS,outpatient,,,328,131.20,,278.8,85,,223.04,percent of total billed charges,85% of total billed charges,328,100,,262.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,93.13,385,,,fee schedule,385% of BCBS fee schedule,97,401,,,fee schedule,401% of BCBS fee schedule,97,401,,,fee schedule,401% of BCBS fee schedule,97,401,,,fee schedule,401% of BCBS fee schedule,295.2,90,,236.16,percent of total billed charges,90% of total billed charges,262.4,80,,209.92,percent of total billed charges,80% of total billed charges,295.2,90,,236.16,percent of total billed charges,90% of total billed charges,246,75,,196.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,95.12,29,,76.096,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,219.76,67,,175.808,percent of total billed charges,67% of total billed charges,53.45,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,262.4,80,,209.92,percent of total billed charges,80% of total billed charges,213.2,65,,170.56,percent of total billed charges,65% of total billed charges,117,35.67,,93.6,percent of total billed charges,35.67% of total billed charges,53.45,328,
INAPSINE 2CC INJ (DOPEIDOL),2504860,CDM,636,RC,J1790,HCPCS,outpatient,,,17,6.80,,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,17,100,,13.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,6.43,385,,,fee schedule,385% of BCBS fee schedule,6.7,401,,,fee schedule,401% of BCBS fee schedule,6.7,401,,,fee schedule,401% of BCBS fee schedule,6.7,401,,,fee schedule,401% of BCBS fee schedule,15.3,90,,12.24,percent of total billed charges,90% of total billed charges,13.6,80,,10.88,percent of total billed charges,80% of total billed charges,15.3,90,,12.24,percent of total billed charges,90% of total billed charges,12.75,75,,10.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,4.93,29,,3.944,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,11.39,67,,9.112,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,13.6,80,,10.88,percent of total billed charges,80% of total billed charges,11.05,65,,8.84,percent of total billed charges,65% of total billed charges,6.06,35.67,,4.848,percent of total billed charges,35.67% of total billed charges,4.93,17,
INDERAL 1CC INJ.,2504895,CDM,636,RC,J1800,HCPCS,outpatient,,,68,27.20,,57.8,85,,46.24,percent of total billed charges,85% of total billed charges,68,100,,54.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,22.18,385,,,fee schedule,385% of BCBS fee schedule,23.1,401,,,fee schedule,401% of BCBS fee schedule,23.1,401,,,fee schedule,401% of BCBS fee schedule,23.1,401,,,fee schedule,401% of BCBS fee schedule,61.2,90,,48.96,percent of total billed charges,90% of total billed charges,54.4,80,,43.52,percent of total billed charges,80% of total billed charges,61.2,90,,48.96,percent of total billed charges,90% of total billed charges,51,75,,40.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,19.72,29,,15.776,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,45.56,67,,36.448,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,54.4,80,,43.52,percent of total billed charges,80% of total billed charges,44.2,65,,35.36,percent of total billed charges,65% of total billed charges,24.26,35.67,,19.408,percent of total billed charges,35.67% of total billed charges,19.72,68,
LANTUS 100 INJ. INSULIN,2504978,CDM,636,RC,J1815,HCPCS,outpatient,,,17,6.80,,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,17,100,,13.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,0.54,385,,,fee schedule,385% of BCBS fee schedule,0.56,401,,,fee schedule,401% of BCBS fee schedule,0.56,401,,,fee schedule,401% of BCBS fee schedule,0.56,401,,,fee schedule,401% of BCBS fee schedule,15.3,90,,12.24,percent of total billed charges,90% of total billed charges,13.6,80,,10.88,percent of total billed charges,80% of total billed charges,15.3,90,,12.24,percent of total billed charges,90% of total billed charges,12.75,75,,10.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,4.93,29,,3.944,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,11.39,67,,9.112,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,13.6,80,,10.88,percent of total billed charges,80% of total billed charges,11.05,65,,8.84,percent of total billed charges,65% of total billed charges,6.06,35.67,,4.848,percent of total billed charges,35.67% of total billed charges,0.54,17,
INVANZ 1000MG VIAL,2504991,CDM,636,RC,J1335,HCPCS,outpatient,,,324,129.60,,275.4,85,,220.32,percent of total billed charges,85% of total billed charges,324,100,,259.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,225.38,385,,,fee schedule,385% of BCBS fee schedule,234.75,401,,,fee schedule,401% of BCBS fee schedule,234.75,401,,,fee schedule,401% of BCBS fee schedule,234.75,401,,,fee schedule,401% of BCBS fee schedule,291.6,90,,233.28,percent of total billed charges,90% of total billed charges,259.2,80,,207.36,percent of total billed charges,80% of total billed charges,291.6,90,,233.28,percent of total billed charges,90% of total billed charges,243,75,,194.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,93.96,29,,75.168,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,217.08,67,,173.664,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,259.2,80,,207.36,percent of total billed charges,80% of total billed charges,210.6,65,,168.48,percent of total billed charges,65% of total billed charges,115.57,35.67,,92.456,percent of total billed charges,35.67% of total billed charges,93.96,324,
INVANZ 500 MG,2504992,CDM,636,RC,J1335,HCPCS,outpatient,,,95,38.00,,80.75,85,,64.6,percent of total billed charges,85% of total billed charges,95,100,,76,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,225.38,385,,,fee schedule,385% of BCBS fee schedule,234.75,401,,,fee schedule,401% of BCBS fee schedule,234.75,401,,,fee schedule,401% of BCBS fee schedule,234.75,401,,,fee schedule,401% of BCBS fee schedule,85.5,90,,68.4,percent of total billed charges,90% of total billed charges,76,80,,60.8,percent of total billed charges,80% of total billed charges,85.5,90,,68.4,percent of total billed charges,90% of total billed charges,71.25,75,,57,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,27.55,29,,22.04,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,63.65,67,,50.92,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,76,80,,60.8,percent of total billed charges,80% of total billed charges,61.75,65,,49.4,percent of total billed charges,65% of total billed charges,33.89,35.67,,27.112,percent of total billed charges,35.67% of total billed charges,27.55,234.75,
INSULIN ASPART 100 UNIT/ML,2505000,CDM,636,RC,J1815,HCPCS,outpatient,,,28,11.20,,23.8,85,,19.04,percent of total billed charges,85% of total billed charges,28,100,,22.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,0.54,385,,,fee schedule,385% of BCBS fee schedule,0.56,401,,,fee schedule,401% of BCBS fee schedule,0.56,401,,,fee schedule,401% of BCBS fee schedule,0.56,401,,,fee schedule,401% of BCBS fee schedule,25.2,90,,20.16,percent of total billed charges,90% of total billed charges,22.4,80,,17.92,percent of total billed charges,80% of total billed charges,25.2,90,,20.16,percent of total billed charges,90% of total billed charges,21,75,,16.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,8.12,29,,6.496,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,18.76,67,,15.008,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,22.4,80,,17.92,percent of total billed charges,80% of total billed charges,18.2,65,,14.56,percent of total billed charges,65% of total billed charges,9.99,35.67,,7.992,percent of total billed charges,35.67% of total billed charges,0.54,28,
JANSSEN J&J VACCINE,2505119,CDM,636,RC,91303,HCPCS,outpatient,,,2,0.80,,1.7,85,,1.36,percent of total billed charges,85% of total billed charges,2,100,,1.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,1.64,82,,1.312,percent of total billed charges,82% of total billed charges,1.7,85,,1.36,percent of total billed charges,85% of total billed charges,1.7,85,,1.36,percent of total billed charges,85% of total billed charges,1.7,85,,1.36,percent of total billed charges,85% of total billed charges,1.8,90,,1.44,percent of total billed charges,90% of total billed charges,1.6,80,,1.28,percent of total billed charges,80% of total billed charges,1.8,90,,1.44,percent of total billed charges,90% of total billed charges,1.5,75,,1.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,0.58,29,,0.464,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1.34,67,,1.072,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1.6,80,,1.28,percent of total billed charges,80% of total billed charges,1.3,65,,1.04,percent of total billed charges,65% of total billed charges,0.71,35.67,,0.568,percent of total billed charges,35.67% of total billed charges,0.58,2,
KANTREX 500 MG **,2505191,CDM,636,RC,J1840,HCPCS,outpatient,,,52,20.80,,44.2,85,,35.36,percent of total billed charges,85% of total billed charges,52,100,,41.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,28.84,385,,,fee schedule,385% of BCBS fee schedule,30.03,401,,,fee schedule,401% of BCBS fee schedule,30.03,401,,,fee schedule,401% of BCBS fee schedule,30.03,401,,,fee schedule,401% of BCBS fee schedule,46.8,90,,37.44,percent of total billed charges,90% of total billed charges,41.6,80,,33.28,percent of total billed charges,80% of total billed charges,46.8,90,,37.44,percent of total billed charges,90% of total billed charges,39,75,,31.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,15.08,29,,12.064,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,34.84,67,,27.872,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,41.6,80,,33.28,percent of total billed charges,80% of total billed charges,33.8,65,,27.04,percent of total billed charges,65% of total billed charges,18.55,35.67,,14.84,percent of total billed charges,35.67% of total billed charges,15.08,52,
KCL 10 MEQ PREMIX 100 ML,2505221,CDM,636,RC,J3480,HCPCS,outpatient,,,73,29.20,,62.05,85,,49.64,percent of total billed charges,85% of total billed charges,73,100,,58.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,0.15,385,,,fee schedule,385% of BCBS fee schedule,0.16,401,,,fee schedule,401% of BCBS fee schedule,0.16,401,,,fee schedule,401% of BCBS fee schedule,0.16,401,,,fee schedule,401% of BCBS fee schedule,65.7,90,,52.56,percent of total billed charges,90% of total billed charges,58.4,80,,46.72,percent of total billed charges,80% of total billed charges,65.7,90,,52.56,percent of total billed charges,90% of total billed charges,54.75,75,,43.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,21.17,29,,16.936,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,48.91,67,,39.128,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,58.4,80,,46.72,percent of total billed charges,80% of total billed charges,47.45,65,,37.96,percent of total billed charges,65% of total billed charges,26.04,35.67,,20.832,percent of total billed charges,35.67% of total billed charges,0.15,73,
KCL 20 MEQ PREMIXED 100 ML,2505222,CDM,636,RC,J3480,HCPCS,outpatient,,,25,10.00,,21.25,85,,17,percent of total billed charges,85% of total billed charges,25,100,,20,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,0.15,385,,,fee schedule,385% of BCBS fee schedule,0.16,401,,,fee schedule,401% of BCBS fee schedule,0.16,401,,,fee schedule,401% of BCBS fee schedule,0.16,401,,,fee schedule,401% of BCBS fee schedule,22.5,90,,18,percent of total billed charges,90% of total billed charges,20,80,,16,percent of total billed charges,80% of total billed charges,22.5,90,,18,percent of total billed charges,90% of total billed charges,18.75,75,,15,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,7.25,29,,5.8,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,16.75,67,,13.4,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,20,80,,16,percent of total billed charges,80% of total billed charges,16.25,65,,13,percent of total billed charges,65% of total billed charges,8.92,35.67,,7.136,percent of total billed charges,35.67% of total billed charges,0.15,25,
KCL 30 MEQ PREMIX 100 ML,2505223,CDM,636,RC,J3480,HCPCS,outpatient,,,71,28.40,,60.35,85,,48.28,percent of total billed charges,85% of total billed charges,71,100,,56.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,0.15,385,,,fee schedule,385% of BCBS fee schedule,0.16,401,,,fee schedule,401% of BCBS fee schedule,0.16,401,,,fee schedule,401% of BCBS fee schedule,0.16,401,,,fee schedule,401% of BCBS fee schedule,63.9,90,,51.12,percent of total billed charges,90% of total billed charges,56.8,80,,45.44,percent of total billed charges,80% of total billed charges,63.9,90,,51.12,percent of total billed charges,90% of total billed charges,53.25,75,,42.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,20.59,29,,16.472,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,47.57,67,,38.056,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,56.8,80,,45.44,percent of total billed charges,80% of total billed charges,46.15,65,,36.92,percent of total billed charges,65% of total billed charges,25.33,35.67,,20.264,percent of total billed charges,35.67% of total billed charges,0.15,71,
KCL 40 MEQ PREMIX 100 ML,2505224,CDM,636,RC,J3480,HCPCS,outpatient,,,70,28.00,,59.5,85,,47.6,percent of total billed charges,85% of total billed charges,70,100,,56,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,0.15,385,,,fee schedule,385% of BCBS fee schedule,0.16,401,,,fee schedule,401% of BCBS fee schedule,0.16,401,,,fee schedule,401% of BCBS fee schedule,0.16,401,,,fee schedule,401% of BCBS fee schedule,63,90,,50.4,percent of total billed charges,90% of total billed charges,56,80,,44.8,percent of total billed charges,80% of total billed charges,63,90,,50.4,percent of total billed charges,90% of total billed charges,52.5,75,,42,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,20.3,29,,16.24,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,46.9,67,,37.52,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,56,80,,44.8,percent of total billed charges,80% of total billed charges,45.5,65,,36.4,percent of total billed charges,65% of total billed charges,24.97,35.67,,19.976,percent of total billed charges,35.67% of total billed charges,0.15,70,
KEFZOL (ANCEF) 1GM INJ,2505260,CDM,636,RC,J0690,HCPCS,outpatient,,,19,7.60,,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,19,100,,15.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,0.62,385,,,fee schedule,385% of BCBS fee schedule,0.64,401,,,fee schedule,401% of BCBS fee schedule,0.64,401,,,fee schedule,401% of BCBS fee schedule,0.64,401,,,fee schedule,401% of BCBS fee schedule,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,15.2,80,,12.16,percent of total billed charges,80% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,14.25,75,,11.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,5.51,29,,4.408,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,12.73,67,,10.184,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,15.2,80,,12.16,percent of total billed charges,80% of total billed charges,12.35,65,,9.88,percent of total billed charges,65% of total billed charges,6.78,35.67,,5.424,percent of total billed charges,35.67% of total billed charges,0.62,19,
KEFZOL (ANCEF) 2GM INJ,2505270,CDM,636,RC,J0690,HCPCS,outpatient,,,43,17.20,,36.55,85,,29.24,percent of total billed charges,85% of total billed charges,43,100,,34.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,0.62,385,,,fee schedule,385% of BCBS fee schedule,0.64,401,,,fee schedule,401% of BCBS fee schedule,0.64,401,,,fee schedule,401% of BCBS fee schedule,0.64,401,,,fee schedule,401% of BCBS fee schedule,38.7,90,,30.96,percent of total billed charges,90% of total billed charges,34.4,80,,27.52,percent of total billed charges,80% of total billed charges,38.7,90,,30.96,percent of total billed charges,90% of total billed charges,32.25,75,,25.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,12.47,29,,9.976,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,28.81,67,,23.048,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,34.4,80,,27.52,percent of total billed charges,80% of total billed charges,27.95,65,,22.36,percent of total billed charges,65% of total billed charges,15.34,35.67,,12.272,percent of total billed charges,35.67% of total billed charges,0.62,43,
KEFZOL (ANCEF)375MG INJ,2505275,CDM,636,RC,J0690,HCPCS,outpatient,,,17,6.80,,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,17,100,,13.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,0.62,385,,,fee schedule,385% of BCBS fee schedule,0.64,401,,,fee schedule,401% of BCBS fee schedule,0.64,401,,,fee schedule,401% of BCBS fee schedule,0.64,401,,,fee schedule,401% of BCBS fee schedule,15.3,90,,12.24,percent of total billed charges,90% of total billed charges,13.6,80,,10.88,percent of total billed charges,80% of total billed charges,15.3,90,,12.24,percent of total billed charges,90% of total billed charges,12.75,75,,10.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,4.93,29,,3.944,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,11.39,67,,9.112,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,13.6,80,,10.88,percent of total billed charges,80% of total billed charges,11.05,65,,8.84,percent of total billed charges,65% of total billed charges,6.06,35.67,,4.848,percent of total billed charges,35.67% of total billed charges,0.62,17,
KEFZOL 1000 MG PREMIX BAG,2505276,CDM,636,RC,J0690,HCPCS,outpatient,,,20,8.00,,17,85,,13.6,percent of total billed charges,85% of total billed charges,20,100,,16,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,0.62,385,,,fee schedule,385% of BCBS fee schedule,0.64,401,,,fee schedule,401% of BCBS fee schedule,0.64,401,,,fee schedule,401% of BCBS fee schedule,0.64,401,,,fee schedule,401% of BCBS fee schedule,18,90,,14.4,percent of total billed charges,90% of total billed charges,16,80,,12.8,percent of total billed charges,80% of total billed charges,18,90,,14.4,percent of total billed charges,90% of total billed charges,15,75,,12,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,5.8,29,,4.64,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,13.4,67,,10.72,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,16,80,,12.8,percent of total billed charges,80% of total billed charges,13,65,,10.4,percent of total billed charges,65% of total billed charges,7.13,35.67,,5.704,percent of total billed charges,35.67% of total billed charges,0.62,20,
KENALOG INJ 1CC 40MG,2505305,CDM,636,RC,J3301,HCPCS,outpatient,,,41,16.40,,34.85,85,,27.88,percent of total billed charges,85% of total billed charges,41,100,,32.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,6.58,385,,,fee schedule,385% of BCBS fee schedule,6.86,401,,,fee schedule,401% of BCBS fee schedule,6.86,401,,,fee schedule,401% of BCBS fee schedule,6.86,401,,,fee schedule,401% of BCBS fee schedule,36.9,90,,29.52,percent of total billed charges,90% of total billed charges,32.8,80,,26.24,percent of total billed charges,80% of total billed charges,36.9,90,,29.52,percent of total billed charges,90% of total billed charges,30.75,75,,24.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,11.89,29,,9.512,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,27.47,67,,21.976,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,32.8,80,,26.24,percent of total billed charges,80% of total billed charges,26.65,65,,21.32,percent of total billed charges,65% of total billed charges,14.62,35.67,,11.696,percent of total billed charges,35.67% of total billed charges,6.58,41,
KEPPRA 500 MG INJ,2505324,CDM,636,RC,J1953,HCPCS,outpatient,,,190,76.00,,161.5,85,,129.2,percent of total billed charges,85% of total billed charges,190,100,,152,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,0.92,385,,,fee schedule,385% of BCBS fee schedule,0.96,401,,,fee schedule,401% of BCBS fee schedule,0.96,401,,,fee schedule,401% of BCBS fee schedule,0.96,401,,,fee schedule,401% of BCBS fee schedule,171,90,,136.8,percent of total billed charges,90% of total billed charges,152,80,,121.6,percent of total billed charges,80% of total billed charges,171,90,,136.8,percent of total billed charges,90% of total billed charges,142.5,75,,114,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,55.1,29,,44.08,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,127.3,67,,101.84,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,152,80,,121.6,percent of total billed charges,80% of total billed charges,123.5,65,,98.8,percent of total billed charges,65% of total billed charges,67.77,35.67,,54.216,percent of total billed charges,35.67% of total billed charges,0.92,190,
KEVZARA,2505327,CDM,636,RC,J3590,HCPCS,outpatient,,,3230,1292.00,,2745.5,85,,2196.4,percent of total billed charges,85% of total billed charges,1695.75,52.5,,1356.6,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,2648.6,82,,2118.88,percent of total billed charges,82% of total billed charges,2745.5,85,,2196.4,percent of total billed charges,85% of total billed charges,2745.5,85,,2196.4,percent of total billed charges,85% of total billed charges,2745.5,85,,2196.4,percent of total billed charges,85% of total billed charges,2907,90,,2325.6,percent of total billed charges,90% of total billed charges,2584,80,,2067.2,percent of total billed charges,80% of total billed charges,2907,90,,2325.6,percent of total billed charges,90% of total billed charges,2422.5,75,,1938,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,936.7,29,,749.36,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,2164.1,67,,1731.28,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,2584,80,,2067.2,percent of total billed charges,80% of total billed charges,2099.5,65,,1679.6,percent of total billed charges,65% of total billed charges,1152.14,35.67,,921.712,percent of total billed charges,35.67% of total billed charges,936.7,2907,
LANOXIN (DIGOXIN) 0.125MG INJ,2505425,CDM,636,RC,J1160,HCPCS,outpatient,,,11,4.40,,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,11,100,,8.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,14.63,385,,,fee schedule,385% of BCBS fee schedule,15.24,401,,,fee schedule,401% of BCBS fee schedule,15.24,401,,,fee schedule,401% of BCBS fee schedule,15.24,401,,,fee schedule,401% of BCBS fee schedule,9.9,90,,7.92,percent of total billed charges,90% of total billed charges,8.8,80,,7.04,percent of total billed charges,80% of total billed charges,9.9,90,,7.92,percent of total billed charges,90% of total billed charges,8.25,75,,6.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,3.19,29,,2.552,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,7.37,67,,5.896,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,8.8,80,,7.04,percent of total billed charges,80% of total billed charges,7.15,65,,5.72,percent of total billed charges,65% of total billed charges,3.92,35.67,,3.136,percent of total billed charges,35.67% of total billed charges,3.19,15.24,
LANOXIN (DIGOXIN) 0.25MG INJ,2505440,CDM,636,RC,J1160,HCPCS,outpatient,,,12,4.80,,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,12,100,,9.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,14.63,385,,,fee schedule,385% of BCBS fee schedule,15.24,401,,,fee schedule,401% of BCBS fee schedule,15.24,401,,,fee schedule,401% of BCBS fee schedule,15.24,401,,,fee schedule,401% of BCBS fee schedule,10.8,90,,8.64,percent of total billed charges,90% of total billed charges,9.6,80,,7.68,percent of total billed charges,80% of total billed charges,10.8,90,,8.64,percent of total billed charges,90% of total billed charges,9,75,,7.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,3.48,29,,2.784,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,8.04,67,,6.432,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,9.6,80,,7.68,percent of total billed charges,80% of total billed charges,7.8,65,,6.24,percent of total billed charges,65% of total billed charges,4.28,35.67,,3.424,percent of total billed charges,35.67% of total billed charges,3.48,15.24,
LANOXIN (DIGOXIN) 0.25MG INJ,2505445,CDM,636,RC,J1160,HCPCS,outpatient,,,10,4.00,,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,10,100,,8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,14.63,385,,,fee schedule,385% of BCBS fee schedule,15.24,401,,,fee schedule,401% of BCBS fee schedule,15.24,401,,,fee schedule,401% of BCBS fee schedule,15.24,401,,,fee schedule,401% of BCBS fee schedule,9,90,,7.2,percent of total billed charges,90% of total billed charges,8,80,,6.4,percent of total billed charges,80% of total billed charges,9,90,,7.2,percent of total billed charges,90% of total billed charges,7.5,75,,6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.9,29,,2.32,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,6.7,67,,5.36,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,8,80,,6.4,percent of total billed charges,80% of total billed charges,6.5,65,,5.2,percent of total billed charges,65% of total billed charges,3.57,35.67,,2.856,percent of total billed charges,35.67% of total billed charges,2.9,15.24,
LANOXIN (DIGOXIN) 0.5MG INJ,2505460,CDM,636,RC,J1160,HCPCS,outpatient,,,243,97.20,,206.55,85,,165.24,percent of total billed charges,85% of total billed charges,243,100,,194.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,14.63,385,,,fee schedule,385% of BCBS fee schedule,15.24,401,,,fee schedule,401% of BCBS fee schedule,15.24,401,,,fee schedule,401% of BCBS fee schedule,15.24,401,,,fee schedule,401% of BCBS fee schedule,218.7,90,,174.96,percent of total billed charges,90% of total billed charges,194.4,80,,155.52,percent of total billed charges,80% of total billed charges,218.7,90,,174.96,percent of total billed charges,90% of total billed charges,182.25,75,,145.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,70.47,29,,56.376,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,162.81,67,,130.248,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,194.4,80,,155.52,percent of total billed charges,80% of total billed charges,157.95,65,,126.36,percent of total billed charges,65% of total billed charges,86.68,35.67,,69.344,percent of total billed charges,35.67% of total billed charges,14.63,243,
LASIX 20 MG INJ,2505510,CDM,636,RC,J1940,HCPCS,outpatient,,,29,11.60,,24.65,85,,19.72,percent of total billed charges,85% of total billed charges,29,100,,23.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,6.35,385,,,fee schedule,385% of BCBS fee schedule,6.62,401,,,fee schedule,401% of BCBS fee schedule,6.62,401,,,fee schedule,401% of BCBS fee schedule,6.62,401,,,fee schedule,401% of BCBS fee schedule,26.1,90,,20.88,percent of total billed charges,90% of total billed charges,23.2,80,,18.56,percent of total billed charges,80% of total billed charges,26.1,90,,20.88,percent of total billed charges,90% of total billed charges,21.75,75,,17.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,8.41,29,,6.728,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,19.43,67,,15.544,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,23.2,80,,18.56,percent of total billed charges,80% of total billed charges,18.85,65,,15.08,percent of total billed charges,65% of total billed charges,10.34,35.67,,8.272,percent of total billed charges,35.67% of total billed charges,6.35,29,
LEVOTHROXINE SODIUM INJECT,2505511,CDM,636,RC,J3490,HCPCS,outpatient,,,589,235.60,,500.65,85,,400.52,percent of total billed charges,85% of total billed charges,589,100,,471.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,482.98,82,,386.384,percent of total billed charges,82% of total billed charges,500.65,85,,400.52,percent of total billed charges,85% of total billed charges,500.65,85,,400.52,percent of total billed charges,85% of total billed charges,500.65,85,,400.52,percent of total billed charges,85% of total billed charges,530.1,90,,424.08,percent of total billed charges,90% of total billed charges,471.2,80,,376.96,percent of total billed charges,80% of total billed charges,530.1,90,,424.08,percent of total billed charges,90% of total billed charges,441.75,75,,353.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,170.81,29,,136.648,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,394.63,67,,315.704,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,471.2,80,,376.96,percent of total billed charges,80% of total billed charges,382.85,65,,306.28,percent of total billed charges,65% of total billed charges,210.1,35.67,,168.08,percent of total billed charges,35.67% of total billed charges,170.81,589,
LASIX 3CC (30MG) INJ,2505515,CDM,636,RC,J1940,HCPCS,outpatient,,,12,4.80,,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,12,100,,9.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,6.35,385,,,fee schedule,385% of BCBS fee schedule,6.62,401,,,fee schedule,401% of BCBS fee schedule,6.62,401,,,fee schedule,401% of BCBS fee schedule,6.62,401,,,fee schedule,401% of BCBS fee schedule,10.8,90,,8.64,percent of total billed charges,90% of total billed charges,9.6,80,,7.68,percent of total billed charges,80% of total billed charges,10.8,90,,8.64,percent of total billed charges,90% of total billed charges,9,75,,7.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,3.48,29,,2.784,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,8.04,67,,6.432,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,9.6,80,,7.68,percent of total billed charges,80% of total billed charges,7.8,65,,6.24,percent of total billed charges,65% of total billed charges,4.28,35.67,,3.424,percent of total billed charges,35.67% of total billed charges,3.48,12,
LASIX 40MG INJ (4CC),2505520,CDM,636,RC,J1940,HCPCS,outpatient,,,56,22.40,,47.6,85,,38.08,percent of total billed charges,85% of total billed charges,56,100,,44.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,6.35,385,,,fee schedule,385% of BCBS fee schedule,6.62,401,,,fee schedule,401% of BCBS fee schedule,6.62,401,,,fee schedule,401% of BCBS fee schedule,6.62,401,,,fee schedule,401% of BCBS fee schedule,50.4,90,,40.32,percent of total billed charges,90% of total billed charges,44.8,80,,35.84,percent of total billed charges,80% of total billed charges,50.4,90,,40.32,percent of total billed charges,90% of total billed charges,42,75,,33.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,16.24,29,,12.992,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,37.52,67,,30.016,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,44.8,80,,35.84,percent of total billed charges,80% of total billed charges,36.4,65,,29.12,percent of total billed charges,65% of total billed charges,19.98,35.67,,15.984,percent of total billed charges,35.67% of total billed charges,6.35,56,
LASIX 60MG INJ,2505535,CDM,636,RC,J1940,HCPCS,outpatient,,,15,6.00,,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,15,100,,12,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,6.35,385,,,fee schedule,385% of BCBS fee schedule,6.62,401,,,fee schedule,401% of BCBS fee schedule,6.62,401,,,fee schedule,401% of BCBS fee schedule,6.62,401,,,fee schedule,401% of BCBS fee schedule,13.5,90,,10.8,percent of total billed charges,90% of total billed charges,12,80,,9.6,percent of total billed charges,80% of total billed charges,13.5,90,,10.8,percent of total billed charges,90% of total billed charges,11.25,75,,9,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,4.35,29,,3.48,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,10.05,67,,8.04,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,12,80,,9.6,percent of total billed charges,80% of total billed charges,9.75,65,,7.8,percent of total billed charges,65% of total billed charges,5.35,35.67,,4.28,percent of total billed charges,35.67% of total billed charges,4.35,15,
LASIX 80 MG INJ,2505540,CDM,636,RC,J1940,HCPCS,outpatient,,,17,6.80,,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,17,100,,13.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,6.35,385,,,fee schedule,385% of BCBS fee schedule,6.62,401,,,fee schedule,401% of BCBS fee schedule,6.62,401,,,fee schedule,401% of BCBS fee schedule,6.62,401,,,fee schedule,401% of BCBS fee schedule,15.3,90,,12.24,percent of total billed charges,90% of total billed charges,13.6,80,,10.88,percent of total billed charges,80% of total billed charges,15.3,90,,12.24,percent of total billed charges,90% of total billed charges,12.75,75,,10.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,4.93,29,,3.944,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,11.39,67,,9.112,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,13.6,80,,10.88,percent of total billed charges,80% of total billed charges,11.05,65,,8.84,percent of total billed charges,65% of total billed charges,6.06,35.67,,4.848,percent of total billed charges,35.67% of total billed charges,4.93,17,
LASIX 40MG/4ML UDC SOLUTION,2505541,CDM,636,RC,J1940,HCPCS,outpatient,,,7,2.80,,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,7,100,,5.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,6.35,385,,,fee schedule,385% of BCBS fee schedule,6.62,401,,,fee schedule,401% of BCBS fee schedule,6.62,401,,,fee schedule,401% of BCBS fee schedule,6.62,401,,,fee schedule,401% of BCBS fee schedule,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.25,75,,4.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.03,29,,1.624,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4.69,67,,3.752,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,4.55,65,,3.64,percent of total billed charges,65% of total billed charges,2.5,35.67,,2,percent of total billed charges,35.67% of total billed charges,2.03,7,
LASIX INJ. 100 MG,2505545,CDM,636,RC,J1940,HCPCS,outpatient,,,105,42.00,,89.25,85,,71.4,percent of total billed charges,85% of total billed charges,105,100,,84,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,6.35,385,,,fee schedule,385% of BCBS fee schedule,6.62,401,,,fee schedule,401% of BCBS fee schedule,6.62,401,,,fee schedule,401% of BCBS fee schedule,6.62,401,,,fee schedule,401% of BCBS fee schedule,94.5,90,,75.6,percent of total billed charges,90% of total billed charges,84,80,,67.2,percent of total billed charges,80% of total billed charges,94.5,90,,75.6,percent of total billed charges,90% of total billed charges,78.75,75,,63,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,30.45,29,,24.36,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,70.35,67,,56.28,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,84,80,,67.2,percent of total billed charges,80% of total billed charges,68.25,65,,54.6,percent of total billed charges,65% of total billed charges,37.45,35.67,,29.96,percent of total billed charges,35.67% of total billed charges,6.35,105,
LEVAQUIN 500 MG IV PREMIX,2505586,CDM,636,RC,J1956,HCPCS,outpatient,,,94,37.60,,79.9,85,,63.92,percent of total billed charges,85% of total billed charges,94,100,,75.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,6.62,385,,,fee schedule,385% of BCBS fee schedule,6.9,401,,,fee schedule,401% of BCBS fee schedule,6.9,401,,,fee schedule,401% of BCBS fee schedule,6.9,401,,,fee schedule,401% of BCBS fee schedule,84.6,90,,67.68,percent of total billed charges,90% of total billed charges,75.2,80,,60.16,percent of total billed charges,80% of total billed charges,84.6,90,,67.68,percent of total billed charges,90% of total billed charges,70.5,75,,56.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,27.26,29,,21.808,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,62.98,67,,50.384,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,75.2,80,,60.16,percent of total billed charges,80% of total billed charges,61.1,65,,48.88,percent of total billed charges,65% of total billed charges,33.53,35.67,,26.824,percent of total billed charges,35.67% of total billed charges,6.62,94,
LEVOTHYROXINIE 100 MCG,2505587,CDM,636,RC,J3490,HCPCS,outpatient,,,346,138.40,,294.1,85,,235.28,percent of total billed charges,85% of total billed charges,346,100,,276.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,283.72,82,,226.976,percent of total billed charges,82% of total billed charges,294.1,85,,235.28,percent of total billed charges,85% of total billed charges,294.1,85,,235.28,percent of total billed charges,85% of total billed charges,294.1,85,,235.28,percent of total billed charges,85% of total billed charges,311.4,90,,249.12,percent of total billed charges,90% of total billed charges,276.8,80,,221.44,percent of total billed charges,80% of total billed charges,311.4,90,,249.12,percent of total billed charges,90% of total billed charges,259.5,75,,207.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,100.34,29,,80.272,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,231.82,67,,185.456,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,276.8,80,,221.44,percent of total billed charges,80% of total billed charges,224.9,65,,179.92,percent of total billed charges,65% of total billed charges,123.42,35.67,,98.736,percent of total billed charges,35.67% of total billed charges,100.34,346,
LEVAQUIN 250 MG IV PREMIX,2505592,CDM,636,RC,J1956,HCPCS,outpatient,,,49,19.60,,41.65,85,,33.32,percent of total billed charges,85% of total billed charges,49,100,,39.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,6.62,385,,,fee schedule,385% of BCBS fee schedule,6.9,401,,,fee schedule,401% of BCBS fee schedule,6.9,401,,,fee schedule,401% of BCBS fee schedule,6.9,401,,,fee schedule,401% of BCBS fee schedule,44.1,90,,35.28,percent of total billed charges,90% of total billed charges,39.2,80,,31.36,percent of total billed charges,80% of total billed charges,44.1,90,,35.28,percent of total billed charges,90% of total billed charges,36.75,75,,29.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,14.21,29,,11.368,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,32.83,67,,26.264,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,39.2,80,,31.36,percent of total billed charges,80% of total billed charges,31.85,65,,25.48,percent of total billed charges,65% of total billed charges,17.48,35.67,,13.984,percent of total billed charges,35.67% of total billed charges,6.62,49,
LEVEMIR INSULIN 100 UNITS/ML,2505597,CDM,636,RC,J1815,HCPCS,outpatient,,,17,6.80,,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,17,100,,13.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,0.54,385,,,fee schedule,385% of BCBS fee schedule,0.56,401,,,fee schedule,401% of BCBS fee schedule,0.56,401,,,fee schedule,401% of BCBS fee schedule,0.56,401,,,fee schedule,401% of BCBS fee schedule,15.3,90,,12.24,percent of total billed charges,90% of total billed charges,13.6,80,,10.88,percent of total billed charges,80% of total billed charges,15.3,90,,12.24,percent of total billed charges,90% of total billed charges,12.75,75,,10.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,4.93,29,,3.944,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,11.39,67,,9.112,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,13.6,80,,10.88,percent of total billed charges,80% of total billed charges,11.05,65,,8.84,percent of total billed charges,65% of total billed charges,6.06,35.67,,4.848,percent of total billed charges,35.67% of total billed charges,0.54,17,
LEVAQUIN 750 MG/D5W IV PREMIXE,2505598,CDM,636,RC,J1956,HCPCS,outpatient,,,125,50.00,,106.25,85,,85,percent of total billed charges,85% of total billed charges,125,100,,100,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,6.62,385,,,fee schedule,385% of BCBS fee schedule,6.9,401,,,fee schedule,401% of BCBS fee schedule,6.9,401,,,fee schedule,401% of BCBS fee schedule,6.9,401,,,fee schedule,401% of BCBS fee schedule,112.5,90,,90,percent of total billed charges,90% of total billed charges,100,80,,80,percent of total billed charges,80% of total billed charges,112.5,90,,90,percent of total billed charges,90% of total billed charges,93.75,75,,75,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,36.25,29,,29,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,83.75,67,,67,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,100,80,,80,percent of total billed charges,80% of total billed charges,81.25,65,,65,percent of total billed charges,65% of total billed charges,44.59,35.67,,35.672,percent of total billed charges,35.67% of total billed charges,6.62,125,
LEXISCAN 0.4 MG/5ML PREFILLED,2505604,CDM,636,RC,J2785,HCPCS,outpatient,,,678,271.20,,576.3,85,,461.04,percent of total billed charges,85% of total billed charges,678,100,,542.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,228.15,385,,,fee schedule,385% of BCBS fee schedule,237.63,401,,,fee schedule,401% of BCBS fee schedule,237.63,401,,,fee schedule,401% of BCBS fee schedule,237.63,401,,,fee schedule,401% of BCBS fee schedule,610.2,90,,488.16,percent of total billed charges,90% of total billed charges,542.4,80,,433.92,percent of total billed charges,80% of total billed charges,610.2,90,,488.16,percent of total billed charges,90% of total billed charges,508.5,75,,406.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,196.62,29,,157.296,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,454.26,67,,363.408,percent of total billed charges,67% of total billed charges,55.29,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,542.4,80,,433.92,percent of total billed charges,80% of total billed charges,440.7,65,,352.56,percent of total billed charges,65% of total billed charges,241.84,35.67,,193.472,percent of total billed charges,35.67% of total billed charges,55.29,678,
LIDOCAINE 2% 50 ML INJ,2505667,CDM,636,RC,J2001,HCPCS,outpatient,,,29,11.60,,24.65,85,,19.72,percent of total billed charges,85% of total billed charges,29,100,,23.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,0.08,385,,,fee schedule,385% of BCBS fee schedule,0.08,401,,,fee schedule,401% of BCBS fee schedule,0.08,401,,,fee schedule,401% of BCBS fee schedule,0.08,401,,,fee schedule,401% of BCBS fee schedule,26.1,90,,20.88,percent of total billed charges,90% of total billed charges,23.2,80,,18.56,percent of total billed charges,80% of total billed charges,26.1,90,,20.88,percent of total billed charges,90% of total billed charges,21.75,75,,17.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,8.41,29,,6.728,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,19.43,67,,15.544,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,23.2,80,,18.56,percent of total billed charges,80% of total billed charges,18.85,65,,15.08,percent of total billed charges,65% of total billed charges,10.34,35.67,,8.272,percent of total billed charges,35.67% of total billed charges,0.08,29,
LIDOCAINE 100MG INJ.,2505685,CDM,636,RC,J2001,HCPCS,outpatient,,,176,70.40,,149.6,85,,119.68,percent of total billed charges,85% of total billed charges,176,100,,140.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,0.08,385,,,fee schedule,385% of BCBS fee schedule,0.08,401,,,fee schedule,401% of BCBS fee schedule,0.08,401,,,fee schedule,401% of BCBS fee schedule,0.08,401,,,fee schedule,401% of BCBS fee schedule,158.4,90,,126.72,percent of total billed charges,90% of total billed charges,140.8,80,,112.64,percent of total billed charges,80% of total billed charges,158.4,90,,126.72,percent of total billed charges,90% of total billed charges,132,75,,105.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,51.04,29,,40.832,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,117.92,67,,94.336,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,140.8,80,,112.64,percent of total billed charges,80% of total billed charges,114.4,65,,91.52,percent of total billed charges,65% of total billed charges,62.78,35.67,,50.224,percent of total billed charges,35.67% of total billed charges,0.08,176,
LINCOCIN INJ 2CC 600 MG,2505705,CDM,636,RC,J2010,HCPCS,outpatient,,,99,39.60,,84.15,85,,67.32,percent of total billed charges,85% of total billed charges,99,100,,79.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,29.38,385,,,fee schedule,385% of BCBS fee schedule,30.6,401,,,fee schedule,401% of BCBS fee schedule,30.6,401,,,fee schedule,401% of BCBS fee schedule,30.6,401,,,fee schedule,401% of BCBS fee schedule,89.1,90,,71.28,percent of total billed charges,90% of total billed charges,79.2,80,,63.36,percent of total billed charges,80% of total billed charges,89.1,90,,71.28,percent of total billed charges,90% of total billed charges,74.25,75,,59.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,28.71,29,,22.968,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,66.33,67,,53.064,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,79.2,80,,63.36,percent of total billed charges,80% of total billed charges,64.35,65,,51.48,percent of total billed charges,65% of total billed charges,35.31,35.67,,28.248,percent of total billed charges,35.67% of total billed charges,28.71,99,
FONDAPARINUX SODIUM 5MG/0.4ML,2505789,CDM,636,RC,J1652,HCPCS,outpatient,,,433,173.20,,368.05,85,,294.44,percent of total billed charges,85% of total billed charges,433,100,,346.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,7.97,385,,,fee schedule,385% of BCBS fee schedule,8.3,401,,,fee schedule,401% of BCBS fee schedule,8.3,401,,,fee schedule,401% of BCBS fee schedule,8.3,401,,,fee schedule,401% of BCBS fee schedule,389.7,90,,311.76,percent of total billed charges,90% of total billed charges,346.4,80,,277.12,percent of total billed charges,80% of total billed charges,389.7,90,,311.76,percent of total billed charges,90% of total billed charges,324.75,75,,259.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,125.57,29,,100.456,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,290.11,67,,232.088,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,346.4,80,,277.12,percent of total billed charges,80% of total billed charges,281.45,65,,225.16,percent of total billed charges,65% of total billed charges,154.45,35.67,,123.56,percent of total billed charges,35.67% of total billed charges,7.97,433,
FONDAPARINUX SODIUM 10MG/.8ML,2505791,CDM,636,RC,J1652,HCPCS,outpatient,,,433,173.20,,368.05,85,,294.44,percent of total billed charges,85% of total billed charges,433,100,,346.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,7.97,385,,,fee schedule,385% of BCBS fee schedule,8.3,401,,,fee schedule,401% of BCBS fee schedule,8.3,401,,,fee schedule,401% of BCBS fee schedule,8.3,401,,,fee schedule,401% of BCBS fee schedule,389.7,90,,311.76,percent of total billed charges,90% of total billed charges,346.4,80,,277.12,percent of total billed charges,80% of total billed charges,389.7,90,,311.76,percent of total billed charges,90% of total billed charges,324.75,75,,259.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,125.57,29,,100.456,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,290.11,67,,232.088,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,346.4,80,,277.12,percent of total billed charges,80% of total billed charges,281.45,65,,225.16,percent of total billed charges,65% of total billed charges,154.45,35.67,,123.56,percent of total billed charges,35.67% of total billed charges,7.97,433,
LOVENOX 10 MG INJ *,2505864,CDM,636,RC,J1650,HCPCS,outpatient,,,29,11.60,,24.65,85,,19.72,percent of total billed charges,85% of total billed charges,29,100,,23.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,1.04,385,,,fee schedule,385% of BCBS fee schedule,1.08,401,,,fee schedule,401% of BCBS fee schedule,1.08,401,,,fee schedule,401% of BCBS fee schedule,1.08,401,,,fee schedule,401% of BCBS fee schedule,26.1,90,,20.88,percent of total billed charges,90% of total billed charges,23.2,80,,18.56,percent of total billed charges,80% of total billed charges,26.1,90,,20.88,percent of total billed charges,90% of total billed charges,21.75,75,,17.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,8.41,29,,6.728,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,19.43,67,,15.544,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,23.2,80,,18.56,percent of total billed charges,80% of total billed charges,18.85,65,,15.08,percent of total billed charges,65% of total billed charges,10.34,35.67,,8.272,percent of total billed charges,35.67% of total billed charges,1.04,29,
ENOXAPARINE SODIUM 10 MG,2505866,CDM,636,RC,J1650,HCPCS,outpatient,,,191,76.40,,162.35,85,,129.88,percent of total billed charges,85% of total billed charges,191,100,,152.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,1.04,385,,,fee schedule,385% of BCBS fee schedule,1.08,401,,,fee schedule,401% of BCBS fee schedule,1.08,401,,,fee schedule,401% of BCBS fee schedule,1.08,401,,,fee schedule,401% of BCBS fee schedule,171.9,90,,137.52,percent of total billed charges,90% of total billed charges,152.8,80,,122.24,percent of total billed charges,80% of total billed charges,171.9,90,,137.52,percent of total billed charges,90% of total billed charges,143.25,75,,114.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,55.39,29,,44.312,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,127.97,67,,102.376,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,152.8,80,,122.24,percent of total billed charges,80% of total billed charges,124.15,65,,99.32,percent of total billed charges,65% of total billed charges,68.13,35.67,,54.504,percent of total billed charges,35.67% of total billed charges,1.04,191,
LOVENOX 60 MG/0.6 ML INJ SYRIN,2505867,CDM,636,RC,J1650,HCPCS,outpatient,,,201,80.40,,170.85,85,,136.68,percent of total billed charges,85% of total billed charges,201,100,,160.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,1.04,385,,,fee schedule,385% of BCBS fee schedule,1.08,401,,,fee schedule,401% of BCBS fee schedule,1.08,401,,,fee schedule,401% of BCBS fee schedule,1.08,401,,,fee schedule,401% of BCBS fee schedule,180.9,90,,144.72,percent of total billed charges,90% of total billed charges,160.8,80,,128.64,percent of total billed charges,80% of total billed charges,180.9,90,,144.72,percent of total billed charges,90% of total billed charges,150.75,75,,120.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,58.29,29,,46.632,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,134.67,67,,107.736,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,160.8,80,,128.64,percent of total billed charges,80% of total billed charges,130.65,65,,104.52,percent of total billed charges,65% of total billed charges,71.7,35.67,,57.36,percent of total billed charges,35.67% of total billed charges,1.04,201,
LOVENOX 100 MG/1.0 SYR INJ,2505868,CDM,636,RC,J1650,HCPCS,outpatient,,,335,134.00,,284.75,85,,227.8,percent of total billed charges,85% of total billed charges,335,100,,268,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,1.04,385,,,fee schedule,385% of BCBS fee schedule,1.08,401,,,fee schedule,401% of BCBS fee schedule,1.08,401,,,fee schedule,401% of BCBS fee schedule,1.08,401,,,fee schedule,401% of BCBS fee schedule,301.5,90,,241.2,percent of total billed charges,90% of total billed charges,268,80,,214.4,percent of total billed charges,80% of total billed charges,301.5,90,,241.2,percent of total billed charges,90% of total billed charges,251.25,75,,201,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,97.15,29,,77.72,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,224.45,67,,179.56,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,268,80,,214.4,percent of total billed charges,80% of total billed charges,217.75,65,,174.2,percent of total billed charges,65% of total billed charges,119.49,35.67,,95.592,percent of total billed charges,35.67% of total billed charges,1.04,335,
LOVENOX 8OMG/0.8 ML SYRINGE,2505872,CDM,636,RC,J1650,HCPCS,outpatient,,,268,107.20,,227.8,85,,182.24,percent of total billed charges,85% of total billed charges,268,100,,214.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,1.04,385,,,fee schedule,385% of BCBS fee schedule,1.08,401,,,fee schedule,401% of BCBS fee schedule,1.08,401,,,fee schedule,401% of BCBS fee schedule,1.08,401,,,fee schedule,401% of BCBS fee schedule,241.2,90,,192.96,percent of total billed charges,90% of total billed charges,214.4,80,,171.52,percent of total billed charges,80% of total billed charges,241.2,90,,192.96,percent of total billed charges,90% of total billed charges,201,75,,160.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,77.72,29,,62.176,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,179.56,67,,143.648,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,214.4,80,,171.52,percent of total billed charges,80% of total billed charges,174.2,65,,139.36,percent of total billed charges,65% of total billed charges,95.6,35.67,,76.48,percent of total billed charges,35.67% of total billed charges,1.04,268,
LOVENOX 40 MG/0.4 ML PREFILLED,2505878,CDM,636,RC,J1650,HCPCS,outpatient,,,148,59.20,,125.8,85,,100.64,percent of total billed charges,85% of total billed charges,148,100,,118.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,1.04,385,,,fee schedule,385% of BCBS fee schedule,1.08,401,,,fee schedule,401% of BCBS fee schedule,1.08,401,,,fee schedule,401% of BCBS fee schedule,1.08,401,,,fee schedule,401% of BCBS fee schedule,133.2,90,,106.56,percent of total billed charges,90% of total billed charges,118.4,80,,94.72,percent of total billed charges,80% of total billed charges,133.2,90,,106.56,percent of total billed charges,90% of total billed charges,111,75,,88.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,42.92,29,,34.336,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,99.16,67,,79.328,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,118.4,80,,94.72,percent of total billed charges,80% of total billed charges,96.2,65,,76.96,percent of total billed charges,65% of total billed charges,52.79,35.67,,42.232,percent of total billed charges,35.67% of total billed charges,1.04,148,
LUPRON 22.5 MG DEPOT INJ.,2505911,CDM,636,RC,J9217,HCPCS,outpatient,,,3634,1453.60,,3088.9,85,,2471.12,percent of total billed charges,85% of total billed charges,1907.85,52.5,,1526.28,percent of total billed charges,52.5 percent of total billed charges,176.51,100,,,fee schedule,100% of CMS OPPS rate,1715.18,385,,,fee schedule,385% of BCBS fee schedule,1786.46,401,,,fee schedule,401% of BCBS fee schedule,1786.46,401,,,fee schedule,401% of BCBS fee schedule,1786.46,401,,,fee schedule,401% of BCBS fee schedule,3270.6,90,,2616.48,percent of total billed charges,90% of total billed charges,2907.2,80,,2325.76,percent of total billed charges,80% of total billed charges,3270.6,90,,2616.48,percent of total billed charges,90% of total billed charges,2725.5,75,,2180.4,percent of total billed charges,75% of total billed charges,215.34,122,,,fee schedule,122% of HUMANA fee schedule,1053.86,29,,843.088,percent of total billed charges,29% of total billed charges,176.51,100,,,fee schedule,100% of CMS OPPS rate,2434.78,67,,1947.824,percent of total billed charges,67% of total billed charges,223.56,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,2907.2,80,,2325.76,percent of total billed charges,80% of total billed charges,2362.1,65,,1889.68,percent of total billed charges,65% of total billed charges,1296.25,35.67,,1037,percent of total billed charges,35.67% of total billed charges,176.51,3270.6,
MAGNESIUM SULFATE 5 GRAM INJ.,2505980,CDM,636,RC,J3475,HCPCS,outpatient,,,22,8.80,,18.7,85,,14.96,percent of total billed charges,85% of total billed charges,22,100,,17.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,0.27,385,,,fee schedule,385% of BCBS fee schedule,0.28,401,,,fee schedule,401% of BCBS fee schedule,0.28,401,,,fee schedule,401% of BCBS fee schedule,0.28,401,,,fee schedule,401% of BCBS fee schedule,19.8,90,,15.84,percent of total billed charges,90% of total billed charges,17.6,80,,14.08,percent of total billed charges,80% of total billed charges,19.8,90,,15.84,percent of total billed charges,90% of total billed charges,16.5,75,,13.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,6.38,29,,5.104,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,14.74,67,,11.792,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,17.6,80,,14.08,percent of total billed charges,80% of total billed charges,14.3,65,,11.44,percent of total billed charges,65% of total billed charges,7.85,35.67,,6.28,percent of total billed charges,35.67% of total billed charges,0.27,22,
MAGNESIUM SULFATE 1GR/2ML VIAL,2505986,CDM,636,RC,J3475,HCPCS,outpatient,,,11,4.40,,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,11,100,,8.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,0.27,385,,,fee schedule,385% of BCBS fee schedule,0.28,401,,,fee schedule,401% of BCBS fee schedule,0.28,401,,,fee schedule,401% of BCBS fee schedule,0.28,401,,,fee schedule,401% of BCBS fee schedule,9.9,90,,7.92,percent of total billed charges,90% of total billed charges,8.8,80,,7.04,percent of total billed charges,80% of total billed charges,9.9,90,,7.92,percent of total billed charges,90% of total billed charges,8.25,75,,6.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,3.19,29,,2.552,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,7.37,67,,5.896,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,8.8,80,,7.04,percent of total billed charges,80% of total billed charges,7.15,65,,5.72,percent of total billed charges,65% of total billed charges,3.92,35.67,,3.136,percent of total billed charges,35.67% of total billed charges,0.27,11,
MAGNESIUM 4 GM/100 ML PREMIX,2505987,CDM,636,RC,J3475,HCPCS,outpatient,,,33,13.20,,28.05,85,,22.44,percent of total billed charges,85% of total billed charges,33,100,,26.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,0.27,385,,,fee schedule,385% of BCBS fee schedule,0.28,401,,,fee schedule,401% of BCBS fee schedule,0.28,401,,,fee schedule,401% of BCBS fee schedule,0.28,401,,,fee schedule,401% of BCBS fee schedule,29.7,90,,23.76,percent of total billed charges,90% of total billed charges,26.4,80,,21.12,percent of total billed charges,80% of total billed charges,29.7,90,,23.76,percent of total billed charges,90% of total billed charges,24.75,75,,19.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,9.57,29,,7.656,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,22.11,67,,17.688,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,26.4,80,,21.12,percent of total billed charges,80% of total billed charges,21.45,65,,17.16,percent of total billed charges,65% of total billed charges,11.77,35.67,,9.416,percent of total billed charges,35.67% of total billed charges,0.27,33,
MODERNA BIVALENT VACCINE,2506002,CDM,636,RC,0134A,HCPCS,outpatient,,,3,1.20,,2.55,85,,2.04,percent of total billed charges,85% of total billed charges,3,100,,2.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,171.6,429,,,fee schedule,429% of BCBS fee schedule,178.8,447,,,fee schedule,447% of BCBS fee schedule,178.8,447,,,fee schedule,447% of BCBS fee schedule,178.8,447,,,fee schedule,447% of BCBS fee schedule,2.7,90,,2.16,percent of total billed charges,90% of total billed charges,2.4,80,,1.92,percent of total billed charges,80% of total billed charges,2.7,90,,2.16,percent of total billed charges,90% of total billed charges,2.25,75,,1.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,0.87,29,,0.696,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,2.01,67,,1.608,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,2.4,80,,1.92,percent of total billed charges,80% of total billed charges,1.95,65,,1.56,percent of total billed charges,65% of total billed charges,1.07,35.67,,0.856,percent of total billed charges,35.67% of total billed charges,0.87,178.8,
MANNITOL INJ 50CC,2506015,CDM,636,RC,J2150,HCPCS,outpatient,,,15,6.00,,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,15,100,,12,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,5.74,385,,,fee schedule,385% of BCBS fee schedule,5.97,401,,,fee schedule,401% of BCBS fee schedule,5.97,401,,,fee schedule,401% of BCBS fee schedule,5.97,401,,,fee schedule,401% of BCBS fee schedule,13.5,90,,10.8,percent of total billed charges,90% of total billed charges,12,80,,9.6,percent of total billed charges,80% of total billed charges,13.5,90,,10.8,percent of total billed charges,90% of total billed charges,11.25,75,,9,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,4.35,29,,3.48,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,10.05,67,,8.04,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,12,80,,9.6,percent of total billed charges,80% of total billed charges,9.75,65,,7.8,percent of total billed charges,65% of total billed charges,5.35,35.67,,4.28,percent of total billed charges,35.67% of total billed charges,4.35,15,
MARCAINE 0.5% 10ML VIAL(NO EPI,2506056,CDM,636,RC,J3490,HCPCS,outpatient,,,22,8.80,,18.7,85,,14.96,percent of total billed charges,85% of total billed charges,22,100,,17.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,18.04,82,,14.432,percent of total billed charges,82% of total billed charges,18.7,85,,14.96,percent of total billed charges,85% of total billed charges,18.7,85,,14.96,percent of total billed charges,85% of total billed charges,18.7,85,,14.96,percent of total billed charges,85% of total billed charges,19.8,90,,15.84,percent of total billed charges,90% of total billed charges,17.6,80,,14.08,percent of total billed charges,80% of total billed charges,19.8,90,,15.84,percent of total billed charges,90% of total billed charges,16.5,75,,13.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,6.38,29,,5.104,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,14.74,67,,11.792,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,17.6,80,,14.08,percent of total billed charges,80% of total billed charges,14.3,65,,11.44,percent of total billed charges,65% of total billed charges,7.85,35.67,,6.28,percent of total billed charges,35.67% of total billed charges,6.38,22,
MAXIPIME IV 1000 MG/50ML BAG,2506087,CDM,636,RC,J0692,HCPCS,outpatient,,,84,33.60,,71.4,85,,57.12,percent of total billed charges,85% of total billed charges,84,100,,67.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,9.43,385,,,fee schedule,385% of BCBS fee schedule,9.82,401,,,fee schedule,401% of BCBS fee schedule,9.82,401,,,fee schedule,401% of BCBS fee schedule,9.82,401,,,fee schedule,401% of BCBS fee schedule,75.6,90,,60.48,percent of total billed charges,90% of total billed charges,67.2,80,,53.76,percent of total billed charges,80% of total billed charges,75.6,90,,60.48,percent of total billed charges,90% of total billed charges,63,75,,50.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,24.36,29,,19.488,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,56.28,67,,45.024,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,67.2,80,,53.76,percent of total billed charges,80% of total billed charges,54.6,65,,43.68,percent of total billed charges,65% of total billed charges,29.96,35.67,,23.968,percent of total billed charges,35.67% of total billed charges,9.43,84,
MEFOXIN 1.0 GRAM INJ,2506130,CDM,636,RC,J0694,HCPCS,outpatient,,,52,20.80,,44.2,85,,35.36,percent of total billed charges,85% of total billed charges,52,100,,41.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,14.82,385,,,fee schedule,385% of BCBS fee schedule,15.44,401,,,fee schedule,401% of BCBS fee schedule,15.44,401,,,fee schedule,401% of BCBS fee schedule,15.44,401,,,fee schedule,401% of BCBS fee schedule,46.8,90,,37.44,percent of total billed charges,90% of total billed charges,41.6,80,,33.28,percent of total billed charges,80% of total billed charges,46.8,90,,37.44,percent of total billed charges,90% of total billed charges,39,75,,31.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,15.08,29,,12.064,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,34.84,67,,27.872,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,41.6,80,,33.28,percent of total billed charges,80% of total billed charges,33.8,65,,27.04,percent of total billed charges,65% of total billed charges,18.55,35.67,,14.84,percent of total billed charges,35.67% of total billed charges,14.82,52,
MEFOXIN 2.0 GRAM INJ,2506135,CDM,636,RC,J0694,HCPCS,outpatient,,,99,39.60,,84.15,85,,67.32,percent of total billed charges,85% of total billed charges,99,100,,79.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,14.82,385,,,fee schedule,385% of BCBS fee schedule,15.44,401,,,fee schedule,401% of BCBS fee schedule,15.44,401,,,fee schedule,401% of BCBS fee schedule,15.44,401,,,fee schedule,401% of BCBS fee schedule,89.1,90,,71.28,percent of total billed charges,90% of total billed charges,79.2,80,,63.36,percent of total billed charges,80% of total billed charges,89.1,90,,71.28,percent of total billed charges,90% of total billed charges,74.25,75,,59.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,28.71,29,,22.968,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,66.33,67,,53.064,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,79.2,80,,63.36,percent of total billed charges,80% of total billed charges,64.35,65,,51.48,percent of total billed charges,65% of total billed charges,35.31,35.67,,28.248,percent of total billed charges,35.67% of total billed charges,14.82,99,
MEPERIDINE 25MG/ML SOLUTION,2506204,CDM,636,RC,J2175,HCPCS,outpatient,,,20,8.00,,17,85,,13.6,percent of total billed charges,85% of total billed charges,20,100,,16,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,3.62,385,,,fee schedule,385% of BCBS fee schedule,3.77,401,,,fee schedule,401% of BCBS fee schedule,3.77,401,,,fee schedule,401% of BCBS fee schedule,3.77,401,,,fee schedule,401% of BCBS fee schedule,18,90,,14.4,percent of total billed charges,90% of total billed charges,16,80,,12.8,percent of total billed charges,80% of total billed charges,18,90,,14.4,percent of total billed charges,90% of total billed charges,15,75,,12,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,5.8,29,,4.64,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,13.4,67,,10.72,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,16,80,,12.8,percent of total billed charges,80% of total billed charges,13,65,,10.4,percent of total billed charges,65% of total billed charges,7.13,35.67,,5.704,percent of total billed charges,35.67% of total billed charges,3.62,20,
MEPERIDINE 300MG PCA INJ,2506206,CDM,636,RC,J2180,HCPCS,outpatient,,,46,18.40,,39.1,85,,31.28,percent of total billed charges,85% of total billed charges,46,100,,36.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,37.72,82,,30.176,percent of total billed charges,82% of total billed charges,39.1,85,,31.28,percent of total billed charges,85% of total billed charges,39.1,85,,31.28,percent of total billed charges,85% of total billed charges,39.1,85,,31.28,percent of total billed charges,85% of total billed charges,41.4,90,,33.12,percent of total billed charges,90% of total billed charges,36.8,80,,29.44,percent of total billed charges,80% of total billed charges,41.4,90,,33.12,percent of total billed charges,90% of total billed charges,34.5,75,,27.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,13.34,29,,10.672,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,30.82,67,,24.656,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,36.8,80,,29.44,percent of total billed charges,80% of total billed charges,29.9,65,,23.92,percent of total billed charges,65% of total billed charges,16.41,35.67,,13.128,percent of total billed charges,35.67% of total billed charges,13.34,46,
MERREM 500 MG VIAL,2506216,CDM,636,RC,J2185,HCPCS,outpatient,,,150,60.00,,127.5,85,,102,percent of total billed charges,85% of total billed charges,150,100,,120,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,10.63,385,,,fee schedule,385% of BCBS fee schedule,11.07,401,,,fee schedule,401% of BCBS fee schedule,11.07,401,,,fee schedule,401% of BCBS fee schedule,11.07,401,,,fee schedule,401% of BCBS fee schedule,135,90,,108,percent of total billed charges,90% of total billed charges,120,80,,96,percent of total billed charges,80% of total billed charges,135,90,,108,percent of total billed charges,90% of total billed charges,112.5,75,,90,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,43.5,29,,34.8,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,100.5,67,,80.4,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,120,80,,96,percent of total billed charges,80% of total billed charges,97.5,65,,78,percent of total billed charges,65% of total billed charges,53.51,35.67,,42.808,percent of total billed charges,35.67% of total billed charges,10.63,150,
METHERGINE 0.2MG/1CC INJ.,2506230,CDM,636,RC,J2210,HCPCS,outpatient,,,32,12.80,,27.2,85,,21.76,percent of total billed charges,85% of total billed charges,32,100,,25.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,37.38,385,,,fee schedule,385% of BCBS fee schedule,38.94,401,,,fee schedule,401% of BCBS fee schedule,38.94,401,,,fee schedule,401% of BCBS fee schedule,38.94,401,,,fee schedule,401% of BCBS fee schedule,28.8,90,,23.04,percent of total billed charges,90% of total billed charges,25.6,80,,20.48,percent of total billed charges,80% of total billed charges,28.8,90,,23.04,percent of total billed charges,90% of total billed charges,24,75,,19.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,9.28,29,,7.424,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,21.44,67,,17.152,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,25.6,80,,20.48,percent of total billed charges,80% of total billed charges,20.8,65,,16.64,percent of total billed charges,65% of total billed charges,11.41,35.67,,9.128,percent of total billed charges,35.67% of total billed charges,9.28,38.94,
MICAFUNGIN SODIUM 100MG,2506232,CDM,636,RC,J2248,HCPCS,outpatient,,,573,229.20,,487.05,85,,389.64,percent of total billed charges,85% of total billed charges,573,100,,458.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,7.2,385,,,fee schedule,385% of BCBS fee schedule,7.5,401,,,fee schedule,401% of BCBS fee schedule,7.5,401,,,fee schedule,401% of BCBS fee schedule,7.5,401,,,fee schedule,401% of BCBS fee schedule,515.7,90,,412.56,percent of total billed charges,90% of total billed charges,458.4,80,,366.72,percent of total billed charges,80% of total billed charges,515.7,90,,412.56,percent of total billed charges,90% of total billed charges,429.75,75,,343.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,166.17,29,,132.936,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,383.91,67,,307.128,percent of total billed charges,67% of total billed charges,0.97,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,458.4,80,,366.72,percent of total billed charges,80% of total billed charges,372.45,65,,297.96,percent of total billed charges,65% of total billed charges,204.39,35.67,,163.512,percent of total billed charges,35.67% of total billed charges,0.97,573,
METHYLERGONOVINE MALEATE .2MG,2506233,CDM,636,RC,J2210,HCPCS,outpatient,,,227,90.80,,192.95,85,,154.36,percent of total billed charges,85% of total billed charges,227,100,,181.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,37.38,385,,,fee schedule,385% of BCBS fee schedule,38.94,401,,,fee schedule,401% of BCBS fee schedule,38.94,401,,,fee schedule,401% of BCBS fee schedule,38.94,401,,,fee schedule,401% of BCBS fee schedule,204.3,90,,163.44,percent of total billed charges,90% of total billed charges,181.6,80,,145.28,percent of total billed charges,80% of total billed charges,204.3,90,,163.44,percent of total billed charges,90% of total billed charges,170.25,75,,136.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,65.83,29,,52.664,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,152.09,67,,121.672,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,181.6,80,,145.28,percent of total billed charges,80% of total billed charges,147.55,65,,118.04,percent of total billed charges,65% of total billed charges,80.97,35.67,,64.776,percent of total billed charges,35.67% of total billed charges,37.38,227,
MMR II 1 EACH INJ. 0.5 ML*,2506418,CDM,636,RC,90707,HCPCS,outpatient,,,255,102.00,,216.75,85,,173.4,percent of total billed charges,85% of total billed charges,255,100,,204,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,162.01,385,,,fee schedule,385% of BCBS fee schedule,168.74,401,,,fee schedule,401% of BCBS fee schedule,168.74,401,,,fee schedule,401% of BCBS fee schedule,168.74,401,,,fee schedule,401% of BCBS fee schedule,229.5,90,,183.6,percent of total billed charges,90% of total billed charges,204,80,,163.2,percent of total billed charges,80% of total billed charges,229.5,90,,183.6,percent of total billed charges,90% of total billed charges,191.25,75,,153,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,73.95,29,,59.16,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,170.85,67,,136.68,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,204,80,,163.2,percent of total billed charges,80% of total billed charges,165.75,65,,132.6,percent of total billed charges,65% of total billed charges,90.96,35.67,,72.768,percent of total billed charges,35.67% of total billed charges,73.95,255,
MODERNA COVID19 VACCINE,2506428,CDM,636,RC,91304,HCPCS,outpatient,,,2,0.80,,1.7,85,,1.36,percent of total billed charges,85% of total billed charges,2,100,,1.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,1.64,82,,1.312,percent of total billed charges,82% of total billed charges,1.7,85,,1.36,percent of total billed charges,85% of total billed charges,1.7,85,,1.36,percent of total billed charges,85% of total billed charges,1.7,85,,1.36,percent of total billed charges,85% of total billed charges,1.8,90,,1.44,percent of total billed charges,90% of total billed charges,1.6,80,,1.28,percent of total billed charges,80% of total billed charges,1.8,90,,1.44,percent of total billed charges,90% of total billed charges,1.5,75,,1.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,0.58,29,,0.464,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1.34,67,,1.072,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1.6,80,,1.28,percent of total billed charges,80% of total billed charges,1.3,65,,1.04,percent of total billed charges,65% of total billed charges,0.71,35.67,,0.568,percent of total billed charges,35.67% of total billed charges,0.58,2,
MODERNA COVID19 VACCINE DOSE 2,2506432,CDM,636,RC,90301,HCPCS,outpatient,,,2,0.80,,1.7,85,,1.36,percent of total billed charges,85% of total billed charges,2,100,,1.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,1.64,82,,1.312,percent of total billed charges,82% of total billed charges,1.7,85,,1.36,percent of total billed charges,85% of total billed charges,1.7,85,,1.36,percent of total billed charges,85% of total billed charges,1.7,85,,1.36,percent of total billed charges,85% of total billed charges,1.8,90,,1.44,percent of total billed charges,90% of total billed charges,1.6,80,,1.28,percent of total billed charges,80% of total billed charges,1.8,90,,1.44,percent of total billed charges,90% of total billed charges,1.5,75,,1.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,0.58,29,,0.464,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1.34,67,,1.072,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1.6,80,,1.28,percent of total billed charges,80% of total billed charges,1.3,65,,1.04,percent of total billed charges,65% of total billed charges,0.71,35.67,,0.568,percent of total billed charges,35.67% of total billed charges,0.58,2,
MODERNA COVID VACC 3 BOOSTER,2506441,CDM,636,RC,91301,HCPCS,outpatient,,,2,0.80,,1.7,85,,1.36,percent of total billed charges,85% of total billed charges,2,100,,1.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,1.64,82,,1.312,percent of total billed charges,82% of total billed charges,1.7,85,,1.36,percent of total billed charges,85% of total billed charges,1.7,85,,1.36,percent of total billed charges,85% of total billed charges,1.7,85,,1.36,percent of total billed charges,85% of total billed charges,1.8,90,,1.44,percent of total billed charges,90% of total billed charges,1.6,80,,1.28,percent of total billed charges,80% of total billed charges,1.8,90,,1.44,percent of total billed charges,90% of total billed charges,1.5,75,,1.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,0.58,29,,0.464,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1.34,67,,1.072,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1.6,80,,1.28,percent of total billed charges,80% of total billed charges,1.3,65,,1.04,percent of total billed charges,65% of total billed charges,0.71,35.67,,0.568,percent of total billed charges,35.67% of total billed charges,0.58,2,
MORPHINE 1 MG/ML 30ML PCA PUMP,2506474,CDM,636,RC,J2270,HCPCS,outpatient,,,51,20.40,,43.35,85,,34.68,percent of total billed charges,85% of total billed charges,51,100,,40.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,0.27,385,,,fee schedule,385% of BCBS fee schedule,0.28,401,,,fee schedule,401% of BCBS fee schedule,0.28,401,,,fee schedule,401% of BCBS fee schedule,0.28,401,,,fee schedule,401% of BCBS fee schedule,45.9,90,,36.72,percent of total billed charges,90% of total billed charges,40.8,80,,32.64,percent of total billed charges,80% of total billed charges,45.9,90,,36.72,percent of total billed charges,90% of total billed charges,38.25,75,,30.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,14.79,29,,11.832,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,34.17,67,,27.336,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,40.8,80,,32.64,percent of total billed charges,80% of total billed charges,33.15,65,,26.52,percent of total billed charges,65% of total billed charges,18.19,35.67,,14.552,percent of total billed charges,35.67% of total billed charges,0.27,51,
MORPHINE 10MG CARPUJET,2506475,CDM,636,RC,J2270,HCPCS,outpatient,,,11,4.40,,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,11,100,,8.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,0.27,385,,,fee schedule,385% of BCBS fee schedule,0.28,401,,,fee schedule,401% of BCBS fee schedule,0.28,401,,,fee schedule,401% of BCBS fee schedule,0.28,401,,,fee schedule,401% of BCBS fee schedule,9.9,90,,7.92,percent of total billed charges,90% of total billed charges,8.8,80,,7.04,percent of total billed charges,80% of total billed charges,9.9,90,,7.92,percent of total billed charges,90% of total billed charges,8.25,75,,6.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,3.19,29,,2.552,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,7.37,67,,5.896,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,8.8,80,,7.04,percent of total billed charges,80% of total billed charges,7.15,65,,5.72,percent of total billed charges,65% of total billed charges,3.92,35.67,,3.136,percent of total billed charges,35.67% of total billed charges,0.27,11,
MORPHINE 10 MG VIAL,2506477,CDM,636,RC,J2270,HCPCS,outpatient,,,11,4.40,,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,11,100,,8.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,0.27,385,,,fee schedule,385% of BCBS fee schedule,0.28,401,,,fee schedule,401% of BCBS fee schedule,0.28,401,,,fee schedule,401% of BCBS fee schedule,0.28,401,,,fee schedule,401% of BCBS fee schedule,9.9,90,,7.92,percent of total billed charges,90% of total billed charges,8.8,80,,7.04,percent of total billed charges,80% of total billed charges,9.9,90,,7.92,percent of total billed charges,90% of total billed charges,8.25,75,,6.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,3.19,29,,2.552,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,7.37,67,,5.896,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,8.8,80,,7.04,percent of total billed charges,80% of total billed charges,7.15,65,,5.72,percent of total billed charges,65% of total billed charges,3.92,35.67,,3.136,percent of total billed charges,35.67% of total billed charges,0.27,11,
MORPHINE 15 MG INJ,2506480,CDM,636,RC,J2270,HCPCS,outpatient,,,12,4.80,,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,12,100,,9.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,0.27,385,,,fee schedule,385% of BCBS fee schedule,0.28,401,,,fee schedule,401% of BCBS fee schedule,0.28,401,,,fee schedule,401% of BCBS fee schedule,0.28,401,,,fee schedule,401% of BCBS fee schedule,10.8,90,,8.64,percent of total billed charges,90% of total billed charges,9.6,80,,7.68,percent of total billed charges,80% of total billed charges,10.8,90,,8.64,percent of total billed charges,90% of total billed charges,9,75,,7.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,3.48,29,,2.784,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,8.04,67,,6.432,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,9.6,80,,7.68,percent of total billed charges,80% of total billed charges,7.8,65,,6.24,percent of total billed charges,65% of total billed charges,4.28,35.67,,3.424,percent of total billed charges,35.67% of total billed charges,0.27,12,
MORPHINE 1MG INJ,2506485,CDM,636,RC,J2270,HCPCS,outpatient,,,12,4.80,,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,12,100,,9.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,0.27,385,,,fee schedule,385% of BCBS fee schedule,0.28,401,,,fee schedule,401% of BCBS fee schedule,0.28,401,,,fee schedule,401% of BCBS fee schedule,0.28,401,,,fee schedule,401% of BCBS fee schedule,10.8,90,,8.64,percent of total billed charges,90% of total billed charges,9.6,80,,7.68,percent of total billed charges,80% of total billed charges,10.8,90,,8.64,percent of total billed charges,90% of total billed charges,9,75,,7.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,3.48,29,,2.784,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,8.04,67,,6.432,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,9.6,80,,7.68,percent of total billed charges,80% of total billed charges,7.8,65,,6.24,percent of total billed charges,65% of total billed charges,4.28,35.67,,3.424,percent of total billed charges,35.67% of total billed charges,0.27,12,
MORPHINE 2MG INJ,2506490,CDM,636,RC,J2270,HCPCS,outpatient,,,11,4.40,,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,11,100,,8.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,0.27,385,,,fee schedule,385% of BCBS fee schedule,0.28,401,,,fee schedule,401% of BCBS fee schedule,0.28,401,,,fee schedule,401% of BCBS fee schedule,0.28,401,,,fee schedule,401% of BCBS fee schedule,9.9,90,,7.92,percent of total billed charges,90% of total billed charges,8.8,80,,7.04,percent of total billed charges,80% of total billed charges,9.9,90,,7.92,percent of total billed charges,90% of total billed charges,8.25,75,,6.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,3.19,29,,2.552,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,7.37,67,,5.896,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,8.8,80,,7.04,percent of total billed charges,80% of total billed charges,7.15,65,,5.72,percent of total billed charges,65% of total billed charges,3.92,35.67,,3.136,percent of total billed charges,35.67% of total billed charges,0.27,11,
MORPHINE 3MG INJ.,2506495,CDM,636,RC,J2270,HCPCS,outpatient,,,13,5.20,,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,13,100,,10.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,0.27,385,,,fee schedule,385% of BCBS fee schedule,0.28,401,,,fee schedule,401% of BCBS fee schedule,0.28,401,,,fee schedule,401% of BCBS fee schedule,0.28,401,,,fee schedule,401% of BCBS fee schedule,11.7,90,,9.36,percent of total billed charges,90% of total billed charges,10.4,80,,8.32,percent of total billed charges,80% of total billed charges,11.7,90,,9.36,percent of total billed charges,90% of total billed charges,9.75,75,,7.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,3.77,29,,3.016,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,8.71,67,,6.968,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,10.4,80,,8.32,percent of total billed charges,80% of total billed charges,8.45,65,,6.76,percent of total billed charges,65% of total billed charges,4.64,35.67,,3.712,percent of total billed charges,35.67% of total billed charges,0.27,13,
MORPHINE 5 MG INJ.,2506505,CDM,636,RC,J2270,HCPCS,outpatient,,,13,5.20,,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,13,100,,10.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,0.27,385,,,fee schedule,385% of BCBS fee schedule,0.28,401,,,fee schedule,401% of BCBS fee schedule,0.28,401,,,fee schedule,401% of BCBS fee schedule,0.28,401,,,fee schedule,401% of BCBS fee schedule,11.7,90,,9.36,percent of total billed charges,90% of total billed charges,10.4,80,,8.32,percent of total billed charges,80% of total billed charges,11.7,90,,9.36,percent of total billed charges,90% of total billed charges,9.75,75,,7.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,3.77,29,,3.016,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,8.71,67,,6.968,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,10.4,80,,8.32,percent of total billed charges,80% of total billed charges,8.45,65,,6.76,percent of total billed charges,65% of total billed charges,4.64,35.67,,3.712,percent of total billed charges,35.67% of total billed charges,0.27,13,
MORPHINE 4 MG/1 ML,2506506,CDM,636,RC,J2270,HCPCS,outpatient,,,13,5.20,,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,13,100,,10.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,0.27,385,,,fee schedule,385% of BCBS fee schedule,0.28,401,,,fee schedule,401% of BCBS fee schedule,0.28,401,,,fee schedule,401% of BCBS fee schedule,0.28,401,,,fee schedule,401% of BCBS fee schedule,11.7,90,,9.36,percent of total billed charges,90% of total billed charges,10.4,80,,8.32,percent of total billed charges,80% of total billed charges,11.7,90,,9.36,percent of total billed charges,90% of total billed charges,9.75,75,,7.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,3.77,29,,3.016,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,8.71,67,,6.968,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,10.4,80,,8.32,percent of total billed charges,80% of total billed charges,8.45,65,,6.76,percent of total billed charges,65% of total billed charges,4.64,35.67,,3.712,percent of total billed charges,35.67% of total billed charges,0.27,13,
MORPHINE 6MG INJ.,2506510,CDM,636,RC,J2270,HCPCS,outpatient,,,11,4.40,,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,11,100,,8.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,0.27,385,,,fee schedule,385% of BCBS fee schedule,0.28,401,,,fee schedule,401% of BCBS fee schedule,0.28,401,,,fee schedule,401% of BCBS fee schedule,0.28,401,,,fee schedule,401% of BCBS fee schedule,9.9,90,,7.92,percent of total billed charges,90% of total billed charges,8.8,80,,7.04,percent of total billed charges,80% of total billed charges,9.9,90,,7.92,percent of total billed charges,90% of total billed charges,8.25,75,,6.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,3.19,29,,2.552,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,7.37,67,,5.896,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,8.8,80,,7.04,percent of total billed charges,80% of total billed charges,7.15,65,,5.72,percent of total billed charges,65% of total billed charges,3.92,35.67,,3.136,percent of total billed charges,35.67% of total billed charges,0.27,11,
MORPHINE 7MG INJ.,2506515,CDM,636,RC,J2270,HCPCS,outpatient,,,11,4.40,,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,11,100,,8.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,0.27,385,,,fee schedule,385% of BCBS fee schedule,0.28,401,,,fee schedule,401% of BCBS fee schedule,0.28,401,,,fee schedule,401% of BCBS fee schedule,0.28,401,,,fee schedule,401% of BCBS fee schedule,9.9,90,,7.92,percent of total billed charges,90% of total billed charges,8.8,80,,7.04,percent of total billed charges,80% of total billed charges,9.9,90,,7.92,percent of total billed charges,90% of total billed charges,8.25,75,,6.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,3.19,29,,2.552,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,7.37,67,,5.896,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,8.8,80,,7.04,percent of total billed charges,80% of total billed charges,7.15,65,,5.72,percent of total billed charges,65% of total billed charges,3.92,35.67,,3.136,percent of total billed charges,35.67% of total billed charges,0.27,11,
MORPHINE 8 MG INJ.,2506520,CDM,636,RC,J2270,HCPCS,outpatient,,,11,4.40,,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,11,100,,8.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,0.27,385,,,fee schedule,385% of BCBS fee schedule,0.28,401,,,fee schedule,401% of BCBS fee schedule,0.28,401,,,fee schedule,401% of BCBS fee schedule,0.28,401,,,fee schedule,401% of BCBS fee schedule,9.9,90,,7.92,percent of total billed charges,90% of total billed charges,8.8,80,,7.04,percent of total billed charges,80% of total billed charges,9.9,90,,7.92,percent of total billed charges,90% of total billed charges,8.25,75,,6.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,3.19,29,,2.552,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,7.37,67,,5.896,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,8.8,80,,7.04,percent of total billed charges,80% of total billed charges,7.15,65,,5.72,percent of total billed charges,65% of total billed charges,3.92,35.67,,3.136,percent of total billed charges,35.67% of total billed charges,0.27,11,
MORPHINE SULFATE INJ 1ML,2506533,CDM,636,RC,J2270,HCPCS,outpatient,,,26,10.40,,22.1,85,,17.68,percent of total billed charges,85% of total billed charges,26,100,,20.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,0.27,385,,,fee schedule,385% of BCBS fee schedule,0.28,401,,,fee schedule,401% of BCBS fee schedule,0.28,401,,,fee schedule,401% of BCBS fee schedule,0.28,401,,,fee schedule,401% of BCBS fee schedule,23.4,90,,18.72,percent of total billed charges,90% of total billed charges,20.8,80,,16.64,percent of total billed charges,80% of total billed charges,23.4,90,,18.72,percent of total billed charges,90% of total billed charges,19.5,75,,15.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,7.54,29,,6.032,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,17.42,67,,13.936,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,20.8,80,,16.64,percent of total billed charges,80% of total billed charges,16.9,65,,13.52,percent of total billed charges,65% of total billed charges,9.27,35.67,,7.416,percent of total billed charges,35.67% of total billed charges,0.27,26,
MUCOMYST 20% 200MG/ML SINGLE,2506564,CDM,636,RC,J7608,HCPCS,outpatient,,,44,17.60,,37.4,85,,29.92,percent of total billed charges,85% of total billed charges,44,100,,35.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,16.17,385,,,fee schedule,385% of BCBS fee schedule,16.84,401,,,fee schedule,401% of BCBS fee schedule,16.84,401,,,fee schedule,401% of BCBS fee schedule,16.84,401,,,fee schedule,401% of BCBS fee schedule,39.6,90,,31.68,percent of total billed charges,90% of total billed charges,35.2,80,,28.16,percent of total billed charges,80% of total billed charges,39.6,90,,31.68,percent of total billed charges,90% of total billed charges,33,75,,26.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,12.76,29,,10.208,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,29.48,67,,23.584,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,35.2,80,,28.16,percent of total billed charges,80% of total billed charges,28.6,65,,22.88,percent of total billed charges,65% of total billed charges,15.69,35.67,,12.552,percent of total billed charges,35.67% of total billed charges,12.76,44,
HYDROMORPHONE 10MG/50ML BAG,2506601,CDM,636,RC,J7999,HCPCS,outpatient,,,145,58.00,,123.25,85,,98.6,percent of total billed charges,85% of total billed charges,145,100,,116,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,118.9,82,,95.12,percent of total billed charges,82% of total billed charges,123.25,85,,98.6,percent of total billed charges,85% of total billed charges,123.25,85,,98.6,percent of total billed charges,85% of total billed charges,123.25,85,,98.6,percent of total billed charges,85% of total billed charges,130.5,90,,104.4,percent of total billed charges,90% of total billed charges,116,80,,92.8,percent of total billed charges,80% of total billed charges,130.5,90,,104.4,percent of total billed charges,90% of total billed charges,108.75,75,,87,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,42.05,29,,33.64,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,97.15,67,,77.72,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,116,80,,92.8,percent of total billed charges,80% of total billed charges,94.25,65,,75.4,percent of total billed charges,65% of total billed charges,51.72,35.67,,41.376,percent of total billed charges,35.67% of total billed charges,42.05,145,
FENTANYL CITRATE-9% 10MCG/ML,2506602,CDM,636,RC,J7999,HCPCS,outpatient,,,160,64.00,,136,85,,108.8,percent of total billed charges,85% of total billed charges,160,100,,128,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,131.2,82,,104.96,percent of total billed charges,82% of total billed charges,136,85,,108.8,percent of total billed charges,85% of total billed charges,136,85,,108.8,percent of total billed charges,85% of total billed charges,136,85,,108.8,percent of total billed charges,85% of total billed charges,144,90,,115.2,percent of total billed charges,90% of total billed charges,128,80,,102.4,percent of total billed charges,80% of total billed charges,144,90,,115.2,percent of total billed charges,90% of total billed charges,120,75,,96,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,46.4,29,,37.12,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,107.2,67,,85.76,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,128,80,,102.4,percent of total billed charges,80% of total billed charges,104,65,,83.2,percent of total billed charges,65% of total billed charges,57.07,35.67,,45.656,percent of total billed charges,35.67% of total billed charges,46.4,160,
KETAMINE HCL SODIUM 50MG/5ML,2506603,CDM,636,RC,J7999,HCPCS,outpatient,,,28,11.20,,23.8,85,,19.04,percent of total billed charges,85% of total billed charges,28,100,,22.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,22.96,82,,18.368,percent of total billed charges,82% of total billed charges,23.8,85,,19.04,percent of total billed charges,85% of total billed charges,23.8,85,,19.04,percent of total billed charges,85% of total billed charges,23.8,85,,19.04,percent of total billed charges,85% of total billed charges,25.2,90,,20.16,percent of total billed charges,90% of total billed charges,22.4,80,,17.92,percent of total billed charges,80% of total billed charges,25.2,90,,20.16,percent of total billed charges,90% of total billed charges,21,75,,16.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,8.12,29,,6.496,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,18.76,67,,15.008,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,22.4,80,,17.92,percent of total billed charges,80% of total billed charges,18.2,65,,14.56,percent of total billed charges,65% of total billed charges,9.99,35.67,,7.992,percent of total billed charges,35.67% of total billed charges,8.12,28,
NARCAN 0.4MG/CC INJ,2506770,CDM,636,RC,J2310,HCPCS,outpatient,,,99,39.60,,84.15,85,,67.32,percent of total billed charges,85% of total billed charges,99,100,,79.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,43.89,385,,,fee schedule,385% of BCBS fee schedule,45.71,401,,,fee schedule,401% of BCBS fee schedule,45.71,401,,,fee schedule,401% of BCBS fee schedule,45.71,401,,,fee schedule,401% of BCBS fee schedule,89.1,90,,71.28,percent of total billed charges,90% of total billed charges,79.2,80,,63.36,percent of total billed charges,80% of total billed charges,89.1,90,,71.28,percent of total billed charges,90% of total billed charges,74.25,75,,59.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,28.71,29,,22.968,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,66.33,67,,53.064,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,79.2,80,,63.36,percent of total billed charges,80% of total billed charges,64.35,65,,51.48,percent of total billed charges,65% of total billed charges,35.31,35.67,,28.248,percent of total billed charges,35.67% of total billed charges,28.71,99,
NARCAN 1 MG/ML INJ,2506771,CDM,636,RC,J2310,HCPCS,outpatient,,,148,59.20,,125.8,85,,100.64,percent of total billed charges,85% of total billed charges,148,100,,118.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,43.89,385,,,fee schedule,385% of BCBS fee schedule,45.71,401,,,fee schedule,401% of BCBS fee schedule,45.71,401,,,fee schedule,401% of BCBS fee schedule,45.71,401,,,fee schedule,401% of BCBS fee schedule,133.2,90,,106.56,percent of total billed charges,90% of total billed charges,118.4,80,,94.72,percent of total billed charges,80% of total billed charges,133.2,90,,106.56,percent of total billed charges,90% of total billed charges,111,75,,88.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,42.92,29,,34.336,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,99.16,67,,79.328,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,118.4,80,,94.72,percent of total billed charges,80% of total billed charges,96.2,65,,76.96,percent of total billed charges,65% of total billed charges,52.79,35.67,,42.232,percent of total billed charges,35.67% of total billed charges,42.92,148,
NEXPLANON 68 MG,2506772,CDM,636,RC,J7307,HCPCS,outpatient,,,1806,722.40,,1535.1,85,,1228.08,percent of total billed charges,85% of total billed charges,948.15,52.5,,758.52,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,3264.42,385,,,fee schedule,385% of BCBS fee schedule,3400.08,401,,,fee schedule,401% of BCBS fee schedule,3400.08,401,,,fee schedule,401% of BCBS fee schedule,3400.08,401,,,fee schedule,401% of BCBS fee schedule,1625.4,90,,1300.32,percent of total billed charges,90% of total billed charges,1444.8,80,,1155.84,percent of total billed charges,80% of total billed charges,1625.4,90,,1300.32,percent of total billed charges,90% of total billed charges,1354.5,75,,1083.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,523.74,29,,418.992,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1210.02,67,,968.016,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1444.8,80,,1155.84,percent of total billed charges,80% of total billed charges,1173.9,65,,939.12,percent of total billed charges,65% of total billed charges,644.2,35.67,,515.36,percent of total billed charges,35.67% of total billed charges,523.74,3400.08,
NAROPIN 5 MG/ML INJ,2506777,CDM,636,RC,J2795,HCPCS,outpatient,,,46,18.40,,39.1,85,,31.28,percent of total billed charges,85% of total billed charges,46,100,,36.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,0.19,385,,,fee schedule,385% of BCBS fee schedule,0.2,401,,,fee schedule,401% of BCBS fee schedule,0.2,401,,,fee schedule,401% of BCBS fee schedule,0.2,401,,,fee schedule,401% of BCBS fee schedule,41.4,90,,33.12,percent of total billed charges,90% of total billed charges,36.8,80,,29.44,percent of total billed charges,80% of total billed charges,41.4,90,,33.12,percent of total billed charges,90% of total billed charges,34.5,75,,27.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,13.34,29,,10.672,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,30.82,67,,24.656,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,36.8,80,,29.44,percent of total billed charges,80% of total billed charges,29.9,65,,23.92,percent of total billed charges,65% of total billed charges,16.41,35.67,,13.128,percent of total billed charges,35.67% of total billed charges,0.19,46,
NAROPIN 5 MG/ML INJ,2506778,CDM,636,RC,J2795,HCPCS,outpatient,,,36,14.40,,30.6,85,,24.48,percent of total billed charges,85% of total billed charges,36,100,,28.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,0.19,385,,,fee schedule,385% of BCBS fee schedule,0.2,401,,,fee schedule,401% of BCBS fee schedule,0.2,401,,,fee schedule,401% of BCBS fee schedule,0.2,401,,,fee schedule,401% of BCBS fee schedule,32.4,90,,25.92,percent of total billed charges,90% of total billed charges,28.8,80,,23.04,percent of total billed charges,80% of total billed charges,32.4,90,,25.92,percent of total billed charges,90% of total billed charges,27,75,,21.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,10.44,29,,8.352,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,24.12,67,,19.296,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,28.8,80,,23.04,percent of total billed charges,80% of total billed charges,23.4,65,,18.72,percent of total billed charges,65% of total billed charges,12.84,35.67,,10.272,percent of total billed charges,35.67% of total billed charges,0.19,36,
NATRECOR 1.5 MG INJ.,2506793,CDM,636,RC,J2325,HCPCS,outpatient,,,2231,892.40,,1896.35,85,,1517.08,percent of total billed charges,85% of total billed charges,1171.28,52.5,,937.02,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,271.81,385,,,fee schedule,385% of BCBS fee schedule,283.11,401,,,fee schedule,401% of BCBS fee schedule,283.11,401,,,fee schedule,401% of BCBS fee schedule,283.11,401,,,fee schedule,401% of BCBS fee schedule,2007.9,90,,1606.32,percent of total billed charges,90% of total billed charges,1784.8,80,,1427.84,percent of total billed charges,80% of total billed charges,2007.9,90,,1606.32,percent of total billed charges,90% of total billed charges,1673.25,75,,1338.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,646.99,29,,517.592,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1494.77,67,,1195.816,percent of total billed charges,67% of total billed charges,53.38,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,1784.8,80,,1427.84,percent of total billed charges,80% of total billed charges,1450.15,65,,1160.12,percent of total billed charges,65% of total billed charges,795.8,35.67,,636.64,percent of total billed charges,35.67% of total billed charges,53.38,2007.9,
NEBCIN 80MG INJ.,2506840,CDM,636,RC,J3260,HCPCS,outpatient,,,17,6.80,,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,17,100,,13.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,4.43,385,,,fee schedule,385% of BCBS fee schedule,4.61,401,,,fee schedule,401% of BCBS fee schedule,4.61,401,,,fee schedule,401% of BCBS fee schedule,4.61,401,,,fee schedule,401% of BCBS fee schedule,15.3,90,,12.24,percent of total billed charges,90% of total billed charges,13.6,80,,10.88,percent of total billed charges,80% of total billed charges,15.3,90,,12.24,percent of total billed charges,90% of total billed charges,12.75,75,,10.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,4.93,29,,3.944,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,11.39,67,,9.112,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,13.6,80,,10.88,percent of total billed charges,80% of total billed charges,11.05,65,,8.84,percent of total billed charges,65% of total billed charges,6.06,35.67,,4.848,percent of total billed charges,35.67% of total billed charges,4.43,17,
NEO-SYNEPHRINE 10MG INJ.,2506895,CDM,636,RC,J2371,HCPCS,outpatient,,,54,21.60,,45.9,85,,36.72,percent of total billed charges,85% of total billed charges,54,100,,43.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,44.28,82,,35.424,percent of total billed charges,82% of total billed charges,45.9,85,,36.72,percent of total billed charges,85% of total billed charges,45.9,85,,36.72,percent of total billed charges,85% of total billed charges,45.9,85,,36.72,percent of total billed charges,85% of total billed charges,48.6,90,,38.88,percent of total billed charges,90% of total billed charges,43.2,80,,34.56,percent of total billed charges,80% of total billed charges,48.6,90,,38.88,percent of total billed charges,90% of total billed charges,40.5,75,,32.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,15.66,29,,12.528,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,36.18,67,,28.944,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,43.2,80,,34.56,percent of total billed charges,80% of total billed charges,35.1,65,,28.08,percent of total billed charges,65% of total billed charges,19.26,35.67,,15.408,percent of total billed charges,35.67% of total billed charges,15.66,54,
NEOSTIGMINE INJ. 10 MG,2506970,CDM,636,RC,J2710,HCPCS,outpatient,,,359,143.60,,305.15,85,,244.12,percent of total billed charges,85% of total billed charges,359,100,,287.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,0.69,385,,,fee schedule,385% of BCBS fee schedule,0.72,401,,,fee schedule,401% of BCBS fee schedule,0.72,401,,,fee schedule,401% of BCBS fee schedule,0.72,401,,,fee schedule,401% of BCBS fee schedule,323.1,90,,258.48,percent of total billed charges,90% of total billed charges,287.2,80,,229.76,percent of total billed charges,80% of total billed charges,323.1,90,,258.48,percent of total billed charges,90% of total billed charges,269.25,75,,215.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,104.11,29,,83.288,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,240.53,67,,192.424,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,287.2,80,,229.76,percent of total billed charges,80% of total billed charges,233.35,65,,186.68,percent of total billed charges,65% of total billed charges,128.06,35.67,,102.448,percent of total billed charges,35.67% of total billed charges,0.69,359,
NEULASTA 6 MG PREFILLED SYRING,2506971,CDM,636,RC,J2506,HCPCS,outpatient,,,16392,6556.80,,13933.2,85,,11146.56,percent of total billed charges,85% of total billed charges,8605.8,52.5,,6884.64,percent of total billed charges,52.5 percent of total billed charges,31.14,100,,,fee schedule,100% of CMS OPPS rate,780.16,385,,,fee schedule,385% of BCBS fee schedule,812.59,401,,,fee schedule,401% of BCBS fee schedule,812.59,401,,,fee schedule,401% of BCBS fee schedule,812.59,401,,,fee schedule,401% of BCBS fee schedule,14752.8,90,,11802.24,percent of total billed charges,90% of total billed charges,13113.6,80,,10490.88,percent of total billed charges,80% of total billed charges,14752.8,90,,11802.24,percent of total billed charges,90% of total billed charges,12294,75,,9835.2,percent of total billed charges,75% of total billed charges,37.99,122,,,fee schedule,122% of HUMANA fee schedule,4753.68,29,,3802.944,percent of total billed charges,29% of total billed charges,31.14,100,,,fee schedule,100% of CMS OPPS rate,10982.64,67,,8786.112,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,13113.6,80,,10490.88,percent of total billed charges,80% of total billed charges,10654.8,65,,8523.84,percent of total billed charges,65% of total billed charges,5847.03,35.67,,4677.624,percent of total billed charges,35.67% of total billed charges,31.14,14752.8,
NESACAINE 3% INJ.,2506986,CDM,636,RC,J2401,HCPCS,outpatient,,,99,39.60,,84.15,85,,67.32,percent of total billed charges,85% of total billed charges,99,100,,79.2,percent of total billed charges,pays based on exceed threshold rate,0.03,100,,,fee schedule,100% of CMS OPPS rate,81.18,82,,64.944,percent of total billed charges,82% of total billed charges,84.15,85,,67.32,percent of total billed charges,85% of total billed charges,84.15,85,,67.32,percent of total billed charges,85% of total billed charges,84.15,85,,67.32,percent of total billed charges,85% of total billed charges,89.1,90,,71.28,percent of total billed charges,90% of total billed charges,79.2,80,,63.36,percent of total billed charges,80% of total billed charges,89.1,90,,71.28,percent of total billed charges,90% of total billed charges,74.25,75,,59.4,percent of total billed charges,75% of total billed charges,0.03,122,,,fee schedule,122% of HUMANA fee schedule,28.71,29,,22.968,percent of total billed charges,29% of total billed charges,0.03,100,,,fee schedule,100% of CMS OPPS rate,66.33,67,,53.064,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,79.2,80,,63.36,percent of total billed charges,80% of total billed charges,64.35,65,,51.48,percent of total billed charges,65% of total billed charges,35.31,35.67,,28.248,percent of total billed charges,35.67% of total billed charges,0.03,99,
NEUPOGEN 480 INJ *,2506989,CDM,636,RC,J1442,HCPCS,outpatient,,,1347,538.80,,1144.95,85,,915.96,percent of total billed charges,85% of total billed charges,707.18,52.5,,565.74,percent of total billed charges,52.5 percent of total billed charges,1,100,,,fee schedule,100% of CMS OPPS rate,3.77,385,,,fee schedule,385% of BCBS fee schedule,3.93,401,,,fee schedule,401% of BCBS fee schedule,3.93,401,,,fee schedule,401% of BCBS fee schedule,3.93,401,,,fee schedule,401% of BCBS fee schedule,1212.3,90,,969.84,percent of total billed charges,90% of total billed charges,1077.6,80,,862.08,percent of total billed charges,80% of total billed charges,1212.3,90,,969.84,percent of total billed charges,90% of total billed charges,1010.25,75,,808.2,percent of total billed charges,75% of total billed charges,1.22,122,,,fee schedule,122% of HUMANA fee schedule,390.63,29,,312.504,percent of total billed charges,29% of total billed charges,1,100,,,fee schedule,100% of CMS OPPS rate,902.49,67,,721.992,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1077.6,80,,862.08,percent of total billed charges,80% of total billed charges,875.55,65,,700.44,percent of total billed charges,65% of total billed charges,480.47,35.67,,384.376,percent of total billed charges,35.67% of total billed charges,1,1212.3,
NEUPOGEN 300 MCG/ML INJ.*,2506990,CDM,636,RC,J1442,HCPCS,outpatient,,,799,319.60,,679.15,85,,543.32,percent of total billed charges,85% of total billed charges,799,100,,639.2,percent of total billed charges,pays based on exceed threshold rate,1,100,,,fee schedule,100% of CMS OPPS rate,3.77,385,,,fee schedule,385% of BCBS fee schedule,3.93,401,,,fee schedule,401% of BCBS fee schedule,3.93,401,,,fee schedule,401% of BCBS fee schedule,3.93,401,,,fee schedule,401% of BCBS fee schedule,719.1,90,,575.28,percent of total billed charges,90% of total billed charges,639.2,80,,511.36,percent of total billed charges,80% of total billed charges,719.1,90,,575.28,percent of total billed charges,90% of total billed charges,599.25,75,,479.4,percent of total billed charges,75% of total billed charges,1.22,122,,,fee schedule,122% of HUMANA fee schedule,231.71,29,,185.368,percent of total billed charges,29% of total billed charges,1,100,,,fee schedule,100% of CMS OPPS rate,535.33,67,,428.264,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,639.2,80,,511.36,percent of total billed charges,80% of total billed charges,519.35,65,,415.48,percent of total billed charges,65% of total billed charges,285,35.67,,228,percent of total billed charges,35.67% of total billed charges,1,799,
NITROGLYCERIN IV,2507060,CDM,636,RC,J3490,HCPCS,outpatient,,,65,26.00,,55.25,85,,44.2,percent of total billed charges,85% of total billed charges,65,100,,52,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,53.3,82,,42.64,percent of total billed charges,82% of total billed charges,55.25,85,,44.2,percent of total billed charges,85% of total billed charges,55.25,85,,44.2,percent of total billed charges,85% of total billed charges,55.25,85,,44.2,percent of total billed charges,85% of total billed charges,58.5,90,,46.8,percent of total billed charges,90% of total billed charges,52,80,,41.6,percent of total billed charges,80% of total billed charges,58.5,90,,46.8,percent of total billed charges,90% of total billed charges,48.75,75,,39,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,18.85,29,,15.08,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,43.55,67,,34.84,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,52,80,,41.6,percent of total billed charges,80% of total billed charges,42.25,65,,33.8,percent of total billed charges,65% of total billed charges,23.19,35.67,,18.552,percent of total billed charges,35.67% of total billed charges,18.85,65,
NORFLEX INJ 60 MG/2 ML,2507125,CDM,636,RC,J2360,HCPCS,outpatient,,,84,33.60,,71.4,85,,57.12,percent of total billed charges,85% of total billed charges,84,100,,67.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,37.19,385,,,fee schedule,385% of BCBS fee schedule,38.74,401,,,fee schedule,401% of BCBS fee schedule,38.74,401,,,fee schedule,401% of BCBS fee schedule,38.74,401,,,fee schedule,401% of BCBS fee schedule,75.6,90,,60.48,percent of total billed charges,90% of total billed charges,67.2,80,,53.76,percent of total billed charges,80% of total billed charges,75.6,90,,60.48,percent of total billed charges,90% of total billed charges,63,75,,50.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,24.36,29,,19.488,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,56.28,67,,45.024,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,67.2,80,,53.76,percent of total billed charges,80% of total billed charges,54.6,65,,43.68,percent of total billed charges,65% of total billed charges,29.96,35.67,,23.968,percent of total billed charges,35.67% of total billed charges,24.36,84,
NORMAL SERUM ALBUMIN IV INJ.,2507150,CDM,636,RC,P9047,HCPCS,outpatient,,,508,203.20,,431.8,85,,345.44,percent of total billed charges,85% of total billed charges,508,100,,406.4,percent of total billed charges,pays based on exceed threshold rate,53.08,100,,,fee schedule,100% of CMS OPPS rate,239.51,385,,,fee schedule,385% of BCBS fee schedule,249.46,401,,,fee schedule,401% of BCBS fee schedule,249.46,401,,,fee schedule,401% of BCBS fee schedule,249.46,401,,,fee schedule,401% of BCBS fee schedule,457.2,90,,365.76,percent of total billed charges,90% of total billed charges,406.4,80,,325.12,percent of total billed charges,80% of total billed charges,457.2,90,,365.76,percent of total billed charges,90% of total billed charges,381,75,,304.8,percent of total billed charges,75% of total billed charges,64.75,122,,,fee schedule,122% of HUMANA fee schedule,52.45,100,,,fee schedule,100% of ASC tier grouping rate,53.08,100,,,fee schedule,100% of CMS OPPS rate,340.36,67,,272.288,percent of total billed charges,67% of total billed charges,71.44,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,406.4,80,,325.12,percent of total billed charges,80% of total billed charges,330.2,65,,264.16,percent of total billed charges,65% of total billed charges,64.51,123,,,fee schedule,123% of ASC tier grouping rate,52.45,508,
TRANDATE 100 MG/20 ML VIAL,2507160,CDM,636,RC,J3490,HCPCS,outpatient,,,117,46.80,,99.45,85,,79.56,percent of total billed charges,85% of total billed charges,117,100,,93.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,95.94,82,,76.752,percent of total billed charges,82% of total billed charges,99.45,85,,79.56,percent of total billed charges,85% of total billed charges,99.45,85,,79.56,percent of total billed charges,85% of total billed charges,99.45,85,,79.56,percent of total billed charges,85% of total billed charges,105.3,90,,84.24,percent of total billed charges,90% of total billed charges,93.6,80,,74.88,percent of total billed charges,80% of total billed charges,105.3,90,,84.24,percent of total billed charges,90% of total billed charges,87.75,75,,70.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,33.93,29,,27.144,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,78.39,67,,62.712,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,93.6,80,,74.88,percent of total billed charges,80% of total billed charges,76.05,65,,60.84,percent of total billed charges,65% of total billed charges,41.73,35.67,,33.384,percent of total billed charges,35.67% of total billed charges,33.93,117,
NUBAIN 10 MG 1 CC INJ.,2507245,CDM,636,RC,J2300,HCPCS,outpatient,,,40,16.00,,34,85,,27.2,percent of total billed charges,85% of total billed charges,40,100,,32,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,6.35,385,,,fee schedule,385% of BCBS fee schedule,6.62,401,,,fee schedule,401% of BCBS fee schedule,6.62,401,,,fee schedule,401% of BCBS fee schedule,6.62,401,,,fee schedule,401% of BCBS fee schedule,36,90,,28.8,percent of total billed charges,90% of total billed charges,32,80,,25.6,percent of total billed charges,80% of total billed charges,36,90,,28.8,percent of total billed charges,90% of total billed charges,30,75,,24,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,11.6,29,,9.28,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,26.8,67,,21.44,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,32,80,,25.6,percent of total billed charges,80% of total billed charges,26,65,,20.8,percent of total billed charges,65% of total billed charges,14.27,35.67,,11.416,percent of total billed charges,35.67% of total billed charges,6.35,40,
NOVOLOG 70/30 INJECTION,2507247,CDM,636,RC,J1815,HCPCS,outpatient,,,17,6.80,,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,17,100,,13.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,0.54,385,,,fee schedule,385% of BCBS fee schedule,0.56,401,,,fee schedule,401% of BCBS fee schedule,0.56,401,,,fee schedule,401% of BCBS fee schedule,0.56,401,,,fee schedule,401% of BCBS fee schedule,15.3,90,,12.24,percent of total billed charges,90% of total billed charges,13.6,80,,10.88,percent of total billed charges,80% of total billed charges,15.3,90,,12.24,percent of total billed charges,90% of total billed charges,12.75,75,,10.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,4.93,29,,3.944,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,11.39,67,,9.112,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,13.6,80,,10.88,percent of total billed charges,80% of total billed charges,11.05,65,,8.84,percent of total billed charges,65% of total billed charges,6.06,35.67,,4.848,percent of total billed charges,35.67% of total billed charges,0.54,17,
NUBAIN 15 MG INJ,2507250,CDM,636,RC,J2300,HCPCS,outpatient,,,18,7.20,,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,18,100,,14.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,6.35,385,,,fee schedule,385% of BCBS fee schedule,6.62,401,,,fee schedule,401% of BCBS fee schedule,6.62,401,,,fee schedule,401% of BCBS fee schedule,6.62,401,,,fee schedule,401% of BCBS fee schedule,16.2,90,,12.96,percent of total billed charges,90% of total billed charges,14.4,80,,11.52,percent of total billed charges,80% of total billed charges,16.2,90,,12.96,percent of total billed charges,90% of total billed charges,13.5,75,,10.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,5.22,29,,4.176,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,12.06,67,,9.648,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,14.4,80,,11.52,percent of total billed charges,80% of total billed charges,11.7,65,,9.36,percent of total billed charges,65% of total billed charges,6.42,35.67,,5.136,percent of total billed charges,35.67% of total billed charges,5.22,18,
NUBAIN 20MG/ML,2507252,CDM,636,RC,J2300,HCPCS,outpatient,,,25,10.00,,21.25,85,,17,percent of total billed charges,85% of total billed charges,25,100,,20,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,6.35,385,,,fee schedule,385% of BCBS fee schedule,6.62,401,,,fee schedule,401% of BCBS fee schedule,6.62,401,,,fee schedule,401% of BCBS fee schedule,6.62,401,,,fee schedule,401% of BCBS fee schedule,22.5,90,,18,percent of total billed charges,90% of total billed charges,20,80,,16,percent of total billed charges,80% of total billed charges,22.5,90,,18,percent of total billed charges,90% of total billed charges,18.75,75,,15,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,7.25,29,,5.8,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,16.75,67,,13.4,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,20,80,,16,percent of total billed charges,80% of total billed charges,16.25,65,,13,percent of total billed charges,65% of total billed charges,8.92,35.67,,7.136,percent of total billed charges,35.67% of total billed charges,6.35,25,
NUBAIN 2.5 MG INJ,2507255,CDM,636,RC,J2300,HCPCS,outpatient,,,11,4.40,,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,11,100,,8.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,6.35,385,,,fee schedule,385% of BCBS fee schedule,6.62,401,,,fee schedule,401% of BCBS fee schedule,6.62,401,,,fee schedule,401% of BCBS fee schedule,6.62,401,,,fee schedule,401% of BCBS fee schedule,9.9,90,,7.92,percent of total billed charges,90% of total billed charges,8.8,80,,7.04,percent of total billed charges,80% of total billed charges,9.9,90,,7.92,percent of total billed charges,90% of total billed charges,8.25,75,,6.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,3.19,29,,2.552,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,7.37,67,,5.896,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,8.8,80,,7.04,percent of total billed charges,80% of total billed charges,7.15,65,,5.72,percent of total billed charges,65% of total billed charges,3.92,35.67,,3.136,percent of total billed charges,35.67% of total billed charges,3.19,11,
NUBAIN 10 MG  0.5ML SUV,2507261,CDM,636,RC,J2300,HCPCS,outpatient,,,15,6.00,,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,15,100,,12,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,6.35,385,,,fee schedule,385% of BCBS fee schedule,6.62,401,,,fee schedule,401% of BCBS fee schedule,6.62,401,,,fee schedule,401% of BCBS fee schedule,6.62,401,,,fee schedule,401% of BCBS fee schedule,13.5,90,,10.8,percent of total billed charges,90% of total billed charges,12,80,,9.6,percent of total billed charges,80% of total billed charges,13.5,90,,10.8,percent of total billed charges,90% of total billed charges,11.25,75,,9,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,4.35,29,,3.48,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,10.05,67,,8.04,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,12,80,,9.6,percent of total billed charges,80% of total billed charges,9.75,65,,7.8,percent of total billed charges,65% of total billed charges,5.35,35.67,,4.28,percent of total billed charges,35.67% of total billed charges,4.35,15,
NUBAIN 2 MG INJ,2507265,CDM,636,RC,J2300,HCPCS,outpatient,,,9,3.60,,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,9,100,,7.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,6.35,385,,,fee schedule,385% of BCBS fee schedule,6.62,401,,,fee schedule,401% of BCBS fee schedule,6.62,401,,,fee schedule,401% of BCBS fee schedule,6.62,401,,,fee schedule,401% of BCBS fee schedule,8.1,90,,6.48,percent of total billed charges,90% of total billed charges,7.2,80,,5.76,percent of total billed charges,80% of total billed charges,8.1,90,,6.48,percent of total billed charges,90% of total billed charges,6.75,75,,5.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.61,29,,2.088,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,6.03,67,,4.824,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,7.2,80,,5.76,percent of total billed charges,80% of total billed charges,5.85,65,,4.68,percent of total billed charges,65% of total billed charges,3.21,35.67,,2.568,percent of total billed charges,35.67% of total billed charges,2.61,9,
NUBAIN 5 MG INJ,2507270,CDM,636,RC,J2300,HCPCS,outpatient,,,10,4.00,,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,10,100,,8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,6.35,385,,,fee schedule,385% of BCBS fee schedule,6.62,401,,,fee schedule,401% of BCBS fee schedule,6.62,401,,,fee schedule,401% of BCBS fee schedule,6.62,401,,,fee schedule,401% of BCBS fee schedule,9,90,,7.2,percent of total billed charges,90% of total billed charges,8,80,,6.4,percent of total billed charges,80% of total billed charges,9,90,,7.2,percent of total billed charges,90% of total billed charges,7.5,75,,6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.9,29,,2.32,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,6.7,67,,5.36,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,8,80,,6.4,percent of total billed charges,80% of total billed charges,6.5,65,,5.2,percent of total billed charges,65% of total billed charges,3.57,35.67,,2.856,percent of total billed charges,35.67% of total billed charges,2.9,10,
OFIRMEV 1000 MG/100 VIAL,2507341,CDM,636,RC,J0131,HCPCS,outpatient,,,142,56.80,,120.7,85,,96.56,percent of total billed charges,85% of total billed charges,142,100,,113.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,1,385,,,fee schedule,385% of BCBS fee schedule,1.04,401,,,fee schedule,401% of BCBS fee schedule,1.04,401,,,fee schedule,401% of BCBS fee schedule,1.04,401,,,fee schedule,401% of BCBS fee schedule,127.8,90,,102.24,percent of total billed charges,90% of total billed charges,113.6,80,,90.88,percent of total billed charges,80% of total billed charges,127.8,90,,102.24,percent of total billed charges,90% of total billed charges,106.5,75,,85.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,41.18,29,,32.944,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,95.14,67,,76.112,percent of total billed charges,67% of total billed charges,0.11,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,113.6,80,,90.88,percent of total billed charges,80% of total billed charges,92.3,65,,73.84,percent of total billed charges,65% of total billed charges,50.65,35.67,,40.52,percent of total billed charges,35.67% of total billed charges,0.11,142,
OMNIPAQUE 50 ML OR LESS,2507380,CDM,636,RC,Q9965,HCPCS,outpatient,,,169,67.60,,143.65,85,,114.92,percent of total billed charges,85% of total billed charges,169,100,,135.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,1.27,385,,,fee schedule,385% of BCBS fee schedule,1.32,401,,,fee schedule,401% of BCBS fee schedule,1.32,401,,,fee schedule,401% of BCBS fee schedule,1.32,401,,,fee schedule,401% of BCBS fee schedule,152.1,90,,121.68,percent of total billed charges,90% of total billed charges,135.2,80,,108.16,percent of total billed charges,80% of total billed charges,152.1,90,,121.68,percent of total billed charges,90% of total billed charges,126.75,75,,101.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,49.01,29,,39.208,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,113.23,67,,90.584,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,135.2,80,,108.16,percent of total billed charges,80% of total billed charges,109.85,65,,87.88,percent of total billed charges,65% of total billed charges,60.28,35.67,,48.224,percent of total billed charges,35.67% of total billed charges,1.27,169,
ORENCIA 250 MG SINGLE USE VIAL,2507506,CDM,636,RC,J0129,HCPCS,outpatient,,,1955,782.00,,1661.75,85,,1329.4,percent of total billed charges,85% of total billed charges,1026.38,52.5,,821.1,percent of total billed charges,52.5 percent of total billed charges,43.44,100,,,fee schedule,100% of CMS OPPS rate,149.92,385,,,fee schedule,385% of BCBS fee schedule,156.15,401,,,fee schedule,401% of BCBS fee schedule,156.15,401,,,fee schedule,401% of BCBS fee schedule,156.15,401,,,fee schedule,401% of BCBS fee schedule,1759.5,90,,1407.6,percent of total billed charges,90% of total billed charges,1564,80,,1251.2,percent of total billed charges,80% of total billed charges,1759.5,90,,1407.6,percent of total billed charges,90% of total billed charges,1466.25,75,,1173,percent of total billed charges,75% of total billed charges,52.99,122,,,fee schedule,122% of HUMANA fee schedule,566.95,29,,453.56,percent of total billed charges,29% of total billed charges,43.44,100,,,fee schedule,100% of CMS OPPS rate,1309.85,67,,1047.88,percent of total billed charges,67% of total billed charges,22.86,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,1564,80,,1251.2,percent of total billed charges,80% of total billed charges,1270.75,65,,1016.6,percent of total billed charges,65% of total billed charges,697.35,35.67,,557.88,percent of total billed charges,35.67% of total billed charges,22.86,1759.5,
"ORITAVANCIN 1,200 MG VIAL",2507509,CDM,636,RC,J2406,HCPCS,outpatient,,,8196,3278.40,JZ,6966.6,85,,5573.28,percent of total billed charges,85% of total billed charges,4302.9,52.5,,3442.32,percent of total billed charges,52.5 percent of total billed charges,42.5,100,,,fee schedule,100% of CMS OPPS rate,156.08,385,,,fee schedule,385% of BCBS fee schedule,162.57,401,,,fee schedule,401% of BCBS fee schedule,162.57,401,,,fee schedule,401% of BCBS fee schedule,162.57,401,,,fee schedule,401% of BCBS fee schedule,7376.4,90,,5901.12,percent of total billed charges,90% of total billed charges,6556.8,80,,5245.44,percent of total billed charges,80% of total billed charges,7376.4,90,,5901.12,percent of total billed charges,90% of total billed charges,6147,75,,4917.6,percent of total billed charges,75% of total billed charges,51.85,122,,,fee schedule,122% of HUMANA fee schedule,2376.84,29,,1901.472,percent of total billed charges,29% of total billed charges,42.5,100,,,fee schedule,100% of CMS OPPS rate,5491.32,67,,4393.056,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,6556.8,80,,5245.44,percent of total billed charges,80% of total billed charges,5327.4,65,,4261.92,percent of total billed charges,65% of total billed charges,2923.51,35.67,,2338.808,percent of total billed charges,35.67% of total billed charges,42.5,7376.4,
"PENICILLIN G AQU 1,000,000 INJ",2507655,CDM,636,RC,J0561,HCPCS,outpatient,,,15,6.00,,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,15,100,,12,percent of total billed charges,pays based on exceed threshold rate,24.37,100,,,fee schedule,100% of CMS OPPS rate,45.97,385,,,fee schedule,385% of BCBS fee schedule,47.88,401,,,fee schedule,401% of BCBS fee schedule,47.88,401,,,fee schedule,401% of BCBS fee schedule,47.88,401,,,fee schedule,401% of BCBS fee schedule,13.5,90,,10.8,percent of total billed charges,90% of total billed charges,12,80,,9.6,percent of total billed charges,80% of total billed charges,13.5,90,,10.8,percent of total billed charges,90% of total billed charges,11.25,75,,9,percent of total billed charges,75% of total billed charges,29.73,122,,,fee schedule,122% of HUMANA fee schedule,4.35,29,,3.48,percent of total billed charges,29% of total billed charges,24.37,100,,,fee schedule,100% of CMS OPPS rate,10.05,67,,8.04,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,12,80,,9.6,percent of total billed charges,80% of total billed charges,9.75,65,,7.8,percent of total billed charges,65% of total billed charges,5.35,35.67,,4.28,percent of total billed charges,35.67% of total billed charges,4.35,47.88,
PENICILLIN G AQU 5MU INJ,2507665,CDM,636,RC,J2540,HCPCS,outpatient,,,157,62.80,,133.45,85,,106.76,percent of total billed charges,85% of total billed charges,157,100,,125.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,4.85,385,,,fee schedule,385% of BCBS fee schedule,5.05,401,,,fee schedule,401% of BCBS fee schedule,5.05,401,,,fee schedule,401% of BCBS fee schedule,5.05,401,,,fee schedule,401% of BCBS fee schedule,141.3,90,,113.04,percent of total billed charges,90% of total billed charges,125.6,80,,100.48,percent of total billed charges,80% of total billed charges,141.3,90,,113.04,percent of total billed charges,90% of total billed charges,117.75,75,,94.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,45.53,29,,36.424,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,105.19,67,,84.152,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,125.6,80,,100.48,percent of total billed charges,80% of total billed charges,102.05,65,,81.64,percent of total billed charges,65% of total billed charges,56,35.67,,44.8,percent of total billed charges,35.67% of total billed charges,4.85,157,
PFIZER COVID19 VACCINE,2507781,CDM,636,RC,91304,HCPCS,outpatient,,,2,0.80,,1.7,85,,1.36,percent of total billed charges,85% of total billed charges,2,100,,1.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,1.64,82,,1.312,percent of total billed charges,82% of total billed charges,1.7,85,,1.36,percent of total billed charges,85% of total billed charges,1.7,85,,1.36,percent of total billed charges,85% of total billed charges,1.7,85,,1.36,percent of total billed charges,85% of total billed charges,1.8,90,,1.44,percent of total billed charges,90% of total billed charges,1.6,80,,1.28,percent of total billed charges,80% of total billed charges,1.8,90,,1.44,percent of total billed charges,90% of total billed charges,1.5,75,,1.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,0.58,29,,0.464,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1.34,67,,1.072,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1.6,80,,1.28,percent of total billed charges,80% of total billed charges,1.3,65,,1.04,percent of total billed charges,65% of total billed charges,0.71,35.67,,0.568,percent of total billed charges,35.67% of total billed charges,0.58,2,
PHENERGAN 12.5 MG INJ,2507850,CDM,636,RC,J2550,HCPCS,outpatient,,,13,5.20,,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,13,100,,10.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,4.93,385,,,fee schedule,385% of BCBS fee schedule,5.13,401,,,fee schedule,401% of BCBS fee schedule,5.13,401,,,fee schedule,401% of BCBS fee schedule,5.13,401,,,fee schedule,401% of BCBS fee schedule,11.7,90,,9.36,percent of total billed charges,90% of total billed charges,10.4,80,,8.32,percent of total billed charges,80% of total billed charges,11.7,90,,9.36,percent of total billed charges,90% of total billed charges,9.75,75,,7.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,3.77,29,,3.016,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,8.71,67,,6.968,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,10.4,80,,8.32,percent of total billed charges,80% of total billed charges,8.45,65,,6.76,percent of total billed charges,65% of total billed charges,4.64,35.67,,3.712,percent of total billed charges,35.67% of total billed charges,3.77,13,
PHENERGAN 25 MG INJ,2507870,CDM,636,RC,J2550,HCPCS,outpatient,,,12,4.80,,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,12,100,,9.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,4.93,385,,,fee schedule,385% of BCBS fee schedule,5.13,401,,,fee schedule,401% of BCBS fee schedule,5.13,401,,,fee schedule,401% of BCBS fee schedule,5.13,401,,,fee schedule,401% of BCBS fee schedule,10.8,90,,8.64,percent of total billed charges,90% of total billed charges,9.6,80,,7.68,percent of total billed charges,80% of total billed charges,10.8,90,,8.64,percent of total billed charges,90% of total billed charges,9,75,,7.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,3.48,29,,2.784,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,8.04,67,,6.432,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,9.6,80,,7.68,percent of total billed charges,80% of total billed charges,7.8,65,,6.24,percent of total billed charges,65% of total billed charges,4.28,35.67,,3.424,percent of total billed charges,35.67% of total billed charges,3.48,12,
PHENERGAN 6.25 MG INJ,2507890,CDM,636,RC,J2550,HCPCS,outpatient,,,12,4.80,,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,12,100,,9.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,4.93,385,,,fee schedule,385% of BCBS fee schedule,5.13,401,,,fee schedule,401% of BCBS fee schedule,5.13,401,,,fee schedule,401% of BCBS fee schedule,5.13,401,,,fee schedule,401% of BCBS fee schedule,10.8,90,,8.64,percent of total billed charges,90% of total billed charges,9.6,80,,7.68,percent of total billed charges,80% of total billed charges,10.8,90,,8.64,percent of total billed charges,90% of total billed charges,9,75,,7.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,3.48,29,,2.784,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,8.04,67,,6.432,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,9.6,80,,7.68,percent of total billed charges,80% of total billed charges,7.8,65,,6.24,percent of total billed charges,65% of total billed charges,4.28,35.67,,3.424,percent of total billed charges,35.67% of total billed charges,3.48,12,
PHENOBARBITAL 30 MG INJ,2507955,CDM,636,RC,J2560,HCPCS,outpatient,,,128,51.20,,108.8,85,,87.04,percent of total billed charges,85% of total billed charges,128,100,,102.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,102.49,385,,,fee schedule,385% of BCBS fee schedule,106.75,401,,,fee schedule,401% of BCBS fee schedule,106.75,401,,,fee schedule,401% of BCBS fee schedule,106.75,401,,,fee schedule,401% of BCBS fee schedule,115.2,90,,92.16,percent of total billed charges,90% of total billed charges,102.4,80,,81.92,percent of total billed charges,80% of total billed charges,115.2,90,,92.16,percent of total billed charges,90% of total billed charges,96,75,,76.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,37.12,29,,29.696,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,85.76,67,,68.608,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,102.4,80,,81.92,percent of total billed charges,80% of total billed charges,83.2,65,,66.56,percent of total billed charges,65% of total billed charges,45.66,35.67,,36.528,percent of total billed charges,35.67% of total billed charges,37.12,128,
PNEUMOCOCCAL VAC. 0.5ML INJ*,2507980,CDM,636,RC,90732,HCPCS,outpatient,,,55,22.00,,46.75,85,,37.4,percent of total billed charges,85% of total billed charges,55,100,,44,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,261.88,385,,,fee schedule,385% of BCBS fee schedule,272.76,401,,,fee schedule,401% of BCBS fee schedule,272.76,401,,,fee schedule,401% of BCBS fee schedule,272.76,401,,,fee schedule,401% of BCBS fee schedule,49.5,90,,39.6,percent of total billed charges,90% of total billed charges,44,80,,35.2,percent of total billed charges,80% of total billed charges,49.5,90,,39.6,percent of total billed charges,90% of total billed charges,41.25,75,,33,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,15.95,29,,12.76,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,36.85,67,,29.48,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,44,80,,35.2,percent of total billed charges,80% of total billed charges,35.75,65,,28.6,percent of total billed charges,65% of total billed charges,19.62,35.67,,15.696,percent of total billed charges,35.67% of total billed charges,15.95,272.76,
PNEUMOCOCAL VACCINE 0.5 ML,2507981,CDM,636,RC,90630,HCPCS,outpatient,,,495,198.00,,420.75,85,,336.6,percent of total billed charges,85% of total billed charges,495,100,,396,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,69.18,385,,,fee schedule,385% of BCBS fee schedule,72.06,401,,,fee schedule,401% of BCBS fee schedule,72.06,401,,,fee schedule,401% of BCBS fee schedule,72.06,401,,,fee schedule,401% of BCBS fee schedule,445.5,90,,356.4,percent of total billed charges,90% of total billed charges,396,80,,316.8,percent of total billed charges,80% of total billed charges,445.5,90,,356.4,percent of total billed charges,90% of total billed charges,371.25,75,,297,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,143.55,29,,114.84,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,331.65,67,,265.32,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,396,80,,316.8,percent of total billed charges,80% of total billed charges,321.75,65,,257.4,percent of total billed charges,65% of total billed charges,176.57,35.67,,141.256,percent of total billed charges,35.67% of total billed charges,69.18,495,
PNEUMOCOCAL COJ VAC 15 VAL.5ML,2507982,CDM,636,RC,90671,HCPCS,outpatient,,,495,198.00,,420.75,85,,336.6,percent of total billed charges,85% of total billed charges,495,100,,396,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,954.34,385,,,fee schedule,385% of BCBS fee schedule,994,401,,,fee schedule,401% of BCBS fee schedule,994,401,,,fee schedule,401% of BCBS fee schedule,994,401,,,fee schedule,401% of BCBS fee schedule,445.5,90,,356.4,percent of total billed charges,90% of total billed charges,396,80,,316.8,percent of total billed charges,80% of total billed charges,445.5,90,,356.4,percent of total billed charges,90% of total billed charges,371.25,75,,297,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,143.55,29,,114.84,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,331.65,67,,265.32,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,396,80,,316.8,percent of total billed charges,80% of total billed charges,321.75,65,,257.4,percent of total billed charges,65% of total billed charges,176.57,35.67,,141.256,percent of total billed charges,35.67% of total billed charges,143.55,994,
PITOCIN AMPS 1 CC/10 UNITS INJ,2508030,CDM,636,RC,J2590,HCPCS,outpatient,,,11,4.40,,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,11,100,,8.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,2.5,385,,,fee schedule,385% of BCBS fee schedule,2.61,401,,,fee schedule,401% of BCBS fee schedule,2.61,401,,,fee schedule,401% of BCBS fee schedule,2.61,401,,,fee schedule,401% of BCBS fee schedule,9.9,90,,7.92,percent of total billed charges,90% of total billed charges,8.8,80,,7.04,percent of total billed charges,80% of total billed charges,9.9,90,,7.92,percent of total billed charges,90% of total billed charges,8.25,75,,6.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,3.19,29,,2.552,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,7.37,67,,5.896,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,8.8,80,,7.04,percent of total billed charges,80% of total billed charges,7.15,65,,5.72,percent of total billed charges,65% of total billed charges,3.92,35.67,,3.136,percent of total billed charges,35.67% of total billed charges,2.5,11,
PNU-IMUNE 0.5 ML INJ*,2508061,CDM,636,RC,90732,HCPCS,outpatient,,,319,127.60,,271.15,85,,216.92,percent of total billed charges,85% of total billed charges,319,100,,255.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,261.88,385,,,fee schedule,385% of BCBS fee schedule,272.76,401,,,fee schedule,401% of BCBS fee schedule,272.76,401,,,fee schedule,401% of BCBS fee schedule,272.76,401,,,fee schedule,401% of BCBS fee schedule,287.1,90,,229.68,percent of total billed charges,90% of total billed charges,255.2,80,,204.16,percent of total billed charges,80% of total billed charges,287.1,90,,229.68,percent of total billed charges,90% of total billed charges,239.25,75,,191.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,92.51,29,,74.008,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,213.73,67,,170.984,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,255.2,80,,204.16,percent of total billed charges,80% of total billed charges,207.35,65,,165.88,percent of total billed charges,65% of total billed charges,113.79,35.67,,91.032,percent of total billed charges,35.67% of total billed charges,92.51,319,
POTASSIUM 30 MEQ INJ,2508155,CDM,636,RC,J3480,HCPCS,outpatient,,,13,5.20,,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,13,100,,10.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,0.15,385,,,fee schedule,385% of BCBS fee schedule,0.16,401,,,fee schedule,401% of BCBS fee schedule,0.16,401,,,fee schedule,401% of BCBS fee schedule,0.16,401,,,fee schedule,401% of BCBS fee schedule,11.7,90,,9.36,percent of total billed charges,90% of total billed charges,10.4,80,,8.32,percent of total billed charges,80% of total billed charges,11.7,90,,9.36,percent of total billed charges,90% of total billed charges,9.75,75,,7.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,3.77,29,,3.016,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,8.71,67,,6.968,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,10.4,80,,8.32,percent of total billed charges,80% of total billed charges,8.45,65,,6.76,percent of total billed charges,65% of total billed charges,4.64,35.67,,3.712,percent of total billed charges,35.67% of total billed charges,0.15,13,
POTASSIUM ACETATE 40MEQ/20ML,2508161,CDM,636,RC,J3480,HCPCS,outpatient,,,11,4.40,,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,11,100,,8.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,0.15,385,,,fee schedule,385% of BCBS fee schedule,0.16,401,,,fee schedule,401% of BCBS fee schedule,0.16,401,,,fee schedule,401% of BCBS fee schedule,0.16,401,,,fee schedule,401% of BCBS fee schedule,9.9,90,,7.92,percent of total billed charges,90% of total billed charges,8.8,80,,7.04,percent of total billed charges,80% of total billed charges,9.9,90,,7.92,percent of total billed charges,90% of total billed charges,8.25,75,,6.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,3.19,29,,2.552,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,7.37,67,,5.896,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,8.8,80,,7.04,percent of total billed charges,80% of total billed charges,7.15,65,,5.72,percent of total billed charges,65% of total billed charges,3.92,35.67,,3.136,percent of total billed charges,35.67% of total billed charges,0.15,11,
PREDNISONE (DELTASONE) 1MG TAB,2508210,CDM,636,RC,J7512,HCPCS,outpatient,,,7,2.80,,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,7,100,,5.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,0.04,385,,,fee schedule,385% of BCBS fee schedule,0.04,401,,,fee schedule,401% of BCBS fee schedule,0.04,401,,,fee schedule,401% of BCBS fee schedule,0.04,401,,,fee schedule,401% of BCBS fee schedule,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.25,75,,4.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.03,29,,1.624,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4.69,67,,3.752,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,4.55,65,,3.64,percent of total billed charges,65% of total billed charges,2.5,35.67,,2,percent of total billed charges,35.67% of total billed charges,0.04,7,
PREDNISONE (DELTASONE)20MG TAB,2508220,CDM,636,RC,J7512,HCPCS,outpatient,,,9,3.60,,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,9,100,,7.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,0.04,385,,,fee schedule,385% of BCBS fee schedule,0.04,401,,,fee schedule,401% of BCBS fee schedule,0.04,401,,,fee schedule,401% of BCBS fee schedule,0.04,401,,,fee schedule,401% of BCBS fee schedule,8.1,90,,6.48,percent of total billed charges,90% of total billed charges,7.2,80,,5.76,percent of total billed charges,80% of total billed charges,8.1,90,,6.48,percent of total billed charges,90% of total billed charges,6.75,75,,5.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.61,29,,2.088,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,6.03,67,,4.824,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,7.2,80,,5.76,percent of total billed charges,80% of total billed charges,5.85,65,,4.68,percent of total billed charges,65% of total billed charges,3.21,35.67,,2.568,percent of total billed charges,35.67% of total billed charges,0.04,9,
PREDNISONE 5 MG/5ML ORAL,2508241,CDM,636,RC,J7510,HCPCS,outpatient,,,8,3.20,,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,8,100,,6.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,0.39,385,,,fee schedule,385% of BCBS fee schedule,0.4,401,,,fee schedule,401% of BCBS fee schedule,0.4,401,,,fee schedule,401% of BCBS fee schedule,0.4,401,,,fee schedule,401% of BCBS fee schedule,7.2,90,,5.76,percent of total billed charges,90% of total billed charges,6.4,80,,5.12,percent of total billed charges,80% of total billed charges,7.2,90,,5.76,percent of total billed charges,90% of total billed charges,6,75,,4.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.32,29,,1.856,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,5.36,67,,4.288,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,6.4,80,,5.12,percent of total billed charges,80% of total billed charges,5.2,65,,4.16,percent of total billed charges,65% of total billed charges,2.85,35.67,,2.28,percent of total billed charges,35.67% of total billed charges,0.39,8,
PREDNISONE (DELTASONE) 5MG TAB,2508245,CDM,636,RC,J7512,HCPCS,outpatient,,,7,2.80,,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,7,100,,5.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,0.04,385,,,fee schedule,385% of BCBS fee schedule,0.04,401,,,fee schedule,401% of BCBS fee schedule,0.04,401,,,fee schedule,401% of BCBS fee schedule,0.04,401,,,fee schedule,401% of BCBS fee schedule,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.25,75,,4.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.03,29,,1.624,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4.69,67,,3.752,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,4.55,65,,3.64,percent of total billed charges,65% of total billed charges,2.5,35.67,,2,percent of total billed charges,35.67% of total billed charges,0.04,7,
PRELONE 15/5ML SYRUP UNIT DOSE,2508281,CDM,636,RC,J7510,HCPCS,outpatient,,,11,4.40,,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,11,100,,8.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,0.39,385,,,fee schedule,385% of BCBS fee schedule,0.4,401,,,fee schedule,401% of BCBS fee schedule,0.4,401,,,fee schedule,401% of BCBS fee schedule,0.4,401,,,fee schedule,401% of BCBS fee schedule,9.9,90,,7.92,percent of total billed charges,90% of total billed charges,8.8,80,,7.04,percent of total billed charges,80% of total billed charges,9.9,90,,7.92,percent of total billed charges,90% of total billed charges,8.25,75,,6.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,3.19,29,,2.552,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,7.37,67,,5.896,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,8.8,80,,7.04,percent of total billed charges,80% of total billed charges,7.15,65,,5.72,percent of total billed charges,65% of total billed charges,3.92,35.67,,3.136,percent of total billed charges,35.67% of total billed charges,0.39,11,
PREMARIN IV 25 MG 5CC,2508305,CDM,636,RC,J1410,HCPCS,outpatient,,,637,254.80,,541.45,85,,433.16,percent of total billed charges,85% of total billed charges,637,100,,509.6,percent of total billed charges,pays based on exceed threshold rate,382.79,100,,,fee schedule,100% of CMS OPPS rate,1109.42,385,,,fee schedule,385% of BCBS fee schedule,1155.52,401,,,fee schedule,401% of BCBS fee schedule,1155.52,401,,,fee schedule,401% of BCBS fee schedule,1155.52,401,,,fee schedule,401% of BCBS fee schedule,573.3,90,,458.64,percent of total billed charges,90% of total billed charges,509.6,80,,407.68,percent of total billed charges,80% of total billed charges,573.3,90,,458.64,percent of total billed charges,90% of total billed charges,477.75,75,,382.2,percent of total billed charges,75% of total billed charges,467,122,,,fee schedule,122% of HUMANA fee schedule,184.73,29,,147.784,percent of total billed charges,29% of total billed charges,382.79,100,,,fee schedule,100% of CMS OPPS rate,426.79,67,,341.432,percent of total billed charges,67% of total billed charges,129.22,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,509.6,80,,407.68,percent of total billed charges,80% of total billed charges,414.05,65,,331.24,percent of total billed charges,65% of total billed charges,227.22,35.67,,181.776,percent of total billed charges,35.67% of total billed charges,129.22,1155.52,
PRIMAXIN 500 MG IV USE ONLY,2508360,CDM,636,RC,J0743,HCPCS,outpatient,,,144,57.60,,122.4,85,,97.92,percent of total billed charges,85% of total billed charges,144,100,,115.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,17.29,385,,,fee schedule,385% of BCBS fee schedule,18,401,,,fee schedule,401% of BCBS fee schedule,18,401,,,fee schedule,401% of BCBS fee schedule,18,401,,,fee schedule,401% of BCBS fee schedule,129.6,90,,103.68,percent of total billed charges,90% of total billed charges,115.2,80,,92.16,percent of total billed charges,80% of total billed charges,129.6,90,,103.68,percent of total billed charges,90% of total billed charges,108,75,,86.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,41.76,29,,33.408,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,96.48,67,,77.184,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,115.2,80,,92.16,percent of total billed charges,80% of total billed charges,93.6,65,,74.88,percent of total billed charges,65% of total billed charges,51.36,35.67,,41.088,percent of total billed charges,35.67% of total billed charges,17.29,144,
PRIMAXIN ADDVANTAGE 500 MG INJ,2508361,CDM,636,RC,J0743,HCPCS,outpatient,,,141,56.40,,119.85,85,,95.88,percent of total billed charges,85% of total billed charges,141,100,,112.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,17.29,385,,,fee schedule,385% of BCBS fee schedule,18,401,,,fee schedule,401% of BCBS fee schedule,18,401,,,fee schedule,401% of BCBS fee schedule,18,401,,,fee schedule,401% of BCBS fee schedule,126.9,90,,101.52,percent of total billed charges,90% of total billed charges,112.8,80,,90.24,percent of total billed charges,80% of total billed charges,126.9,90,,101.52,percent of total billed charges,90% of total billed charges,105.75,75,,84.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,40.89,29,,32.712,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,94.47,67,,75.576,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,112.8,80,,90.24,percent of total billed charges,80% of total billed charges,91.65,65,,73.32,percent of total billed charges,65% of total billed charges,50.29,35.67,,40.232,percent of total billed charges,35.67% of total billed charges,17.29,141,
PRIMAXIN 500 MG VIAL IM USE ON,2508362,CDM,636,RC,J0743,HCPCS,outpatient,,,150,60.00,,127.5,85,,102,percent of total billed charges,85% of total billed charges,150,100,,120,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,17.29,385,,,fee schedule,385% of BCBS fee schedule,18,401,,,fee schedule,401% of BCBS fee schedule,18,401,,,fee schedule,401% of BCBS fee schedule,18,401,,,fee schedule,401% of BCBS fee schedule,135,90,,108,percent of total billed charges,90% of total billed charges,120,80,,96,percent of total billed charges,80% of total billed charges,135,90,,108,percent of total billed charges,90% of total billed charges,112.5,75,,90,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,43.5,29,,34.8,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,100.5,67,,80.4,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,120,80,,96,percent of total billed charges,80% of total billed charges,97.5,65,,78,percent of total billed charges,65% of total billed charges,53.51,35.67,,42.808,percent of total billed charges,35.67% of total billed charges,17.29,150,
PRIMACOR 10MG/10ML VIAL,2508364,CDM,636,RC,J2260,HCPCS,outpatient,,,29,11.60,,24.65,85,,19.72,percent of total billed charges,85% of total billed charges,29,100,,23.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,7.43,385,,,fee schedule,385% of BCBS fee schedule,7.74,401,,,fee schedule,401% of BCBS fee schedule,7.74,401,,,fee schedule,401% of BCBS fee schedule,7.74,401,,,fee schedule,401% of BCBS fee schedule,26.1,90,,20.88,percent of total billed charges,90% of total billed charges,23.2,80,,18.56,percent of total billed charges,80% of total billed charges,26.1,90,,20.88,percent of total billed charges,90% of total billed charges,21.75,75,,17.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,8.41,29,,6.728,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,19.43,67,,15.544,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,23.2,80,,18.56,percent of total billed charges,80% of total billed charges,18.85,65,,15.08,percent of total billed charges,65% of total billed charges,10.34,35.67,,8.272,percent of total billed charges,35.67% of total billed charges,7.43,29,
MILRINONE LACTATE 40 MG/200 MI,2508366,CDM,636,RC,J2260,HCPCS,outpatient,,,116,46.40,,98.6,85,,78.88,percent of total billed charges,85% of total billed charges,116,100,,92.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,7.43,385,,,fee schedule,385% of BCBS fee schedule,7.74,401,,,fee schedule,401% of BCBS fee schedule,7.74,401,,,fee schedule,401% of BCBS fee schedule,7.74,401,,,fee schedule,401% of BCBS fee schedule,104.4,90,,83.52,percent of total billed charges,90% of total billed charges,92.8,80,,74.24,percent of total billed charges,80% of total billed charges,104.4,90,,83.52,percent of total billed charges,90% of total billed charges,87,75,,69.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,33.64,29,,26.912,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,77.72,67,,62.176,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,92.8,80,,74.24,percent of total billed charges,80% of total billed charges,75.4,65,,60.32,percent of total billed charges,65% of total billed charges,41.38,35.67,,33.104,percent of total billed charges,35.67% of total billed charges,7.43,116,
PRIVIGEN IV EACH GRAM,2508393,CDM,636,RC,J1459,HCPCS,outpatient,,,334,133.60,,283.9,85,,227.12,percent of total billed charges,85% of total billed charges,334,100,,267.2,percent of total billed charges,pays based on exceed threshold rate,48.58,100,,,fee schedule,100% of CMS OPPS rate,175.95,385,,,fee schedule,385% of BCBS fee schedule,183.26,401,,,fee schedule,401% of BCBS fee schedule,183.26,401,,,fee schedule,401% of BCBS fee schedule,183.26,401,,,fee schedule,401% of BCBS fee schedule,300.6,90,,240.48,percent of total billed charges,90% of total billed charges,267.2,80,,213.76,percent of total billed charges,80% of total billed charges,300.6,90,,240.48,percent of total billed charges,90% of total billed charges,250.5,75,,200.4,percent of total billed charges,75% of total billed charges,59.26,122,,,fee schedule,122% of HUMANA fee schedule,96.86,29,,77.488,percent of total billed charges,29% of total billed charges,48.58,100,,,fee schedule,100% of CMS OPPS rate,223.78,67,,179.024,percent of total billed charges,67% of total billed charges,36.2,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,267.2,80,,213.76,percent of total billed charges,80% of total billed charges,217.1,65,,173.68,percent of total billed charges,65% of total billed charges,119.14,35.67,,95.312,percent of total billed charges,35.67% of total billed charges,36.2,334,
PRIVIGEN 100 ML/10 GM,2508394,CDM,636,RC,J1459,HCPCS,outpatient,,,1625,650.00,,1381.25,85,,1105,percent of total billed charges,85% of total billed charges,853.13,52.5,,682.5,percent of total billed charges,52.5 percent of total billed charges,48.58,100,,,fee schedule,100% of CMS OPPS rate,175.95,385,,,fee schedule,385% of BCBS fee schedule,183.26,401,,,fee schedule,401% of BCBS fee schedule,183.26,401,,,fee schedule,401% of BCBS fee schedule,183.26,401,,,fee schedule,401% of BCBS fee schedule,1462.5,90,,1170,percent of total billed charges,90% of total billed charges,1300,80,,1040,percent of total billed charges,80% of total billed charges,1462.5,90,,1170,percent of total billed charges,90% of total billed charges,1218.75,75,,975,percent of total billed charges,75% of total billed charges,59.26,122,,,fee schedule,122% of HUMANA fee schedule,471.25,29,,377,percent of total billed charges,29% of total billed charges,48.58,100,,,fee schedule,100% of CMS OPPS rate,1088.75,67,,871,percent of total billed charges,67% of total billed charges,36.2,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,1300,80,,1040,percent of total billed charges,80% of total billed charges,1056.25,65,,845,percent of total billed charges,65% of total billed charges,579.64,35.67,,463.712,percent of total billed charges,35.67% of total billed charges,36.2,1462.5,
PRIVIGEN 20 GRAM VIAL,2508399,CDM,636,RC,J1459,HCPCS,outpatient,,,3330,1332.00,,2830.5,85,,2264.4,percent of total billed charges,85% of total billed charges,1748.25,52.5,,1398.6,percent of total billed charges,52.5 percent of total billed charges,48.58,100,,,fee schedule,100% of CMS OPPS rate,175.95,385,,,fee schedule,385% of BCBS fee schedule,183.26,401,,,fee schedule,401% of BCBS fee schedule,183.26,401,,,fee schedule,401% of BCBS fee schedule,183.26,401,,,fee schedule,401% of BCBS fee schedule,2997,90,,2397.6,percent of total billed charges,90% of total billed charges,2664,80,,2131.2,percent of total billed charges,80% of total billed charges,2997,90,,2397.6,percent of total billed charges,90% of total billed charges,2497.5,75,,1998,percent of total billed charges,75% of total billed charges,59.26,122,,,fee schedule,122% of HUMANA fee schedule,965.7,29,,772.56,percent of total billed charges,29% of total billed charges,48.58,100,,,fee schedule,100% of CMS OPPS rate,2231.1,67,,1784.88,percent of total billed charges,67% of total billed charges,36.2,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,2664,80,,2131.2,percent of total billed charges,80% of total billed charges,2164.5,65,,1731.6,percent of total billed charges,65% of total billed charges,1187.81,35.67,,950.248,percent of total billed charges,35.67% of total billed charges,36.2,2997,
PROLIXIN INJ. 25 MG/CC,2508475,CDM,636,RC,J2680,HCPCS,outpatient,,,386,154.40,,328.1,85,,262.48,percent of total billed charges,85% of total billed charges,386,100,,308.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,71.73,385,,,fee schedule,385% of BCBS fee schedule,74.71,401,,,fee schedule,401% of BCBS fee schedule,74.71,401,,,fee schedule,401% of BCBS fee schedule,74.71,401,,,fee schedule,401% of BCBS fee schedule,347.4,90,,277.92,percent of total billed charges,90% of total billed charges,308.8,80,,247.04,percent of total billed charges,80% of total billed charges,347.4,90,,277.92,percent of total billed charges,90% of total billed charges,289.5,75,,231.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,111.94,29,,89.552,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,258.62,67,,206.896,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,308.8,80,,247.04,percent of total billed charges,80% of total billed charges,250.9,65,,200.72,percent of total billed charges,65% of total billed charges,137.69,35.67,,110.152,percent of total billed charges,35.67% of total billed charges,71.73,386,
PROLIXIN 50 MG INJ,2508477,CDM,636,RC,J2680,HCPCS,outpatient,,,40,16.00,,34,85,,27.2,percent of total billed charges,85% of total billed charges,40,100,,32,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,71.73,385,,,fee schedule,385% of BCBS fee schedule,74.71,401,,,fee schedule,401% of BCBS fee schedule,74.71,401,,,fee schedule,401% of BCBS fee schedule,74.71,401,,,fee schedule,401% of BCBS fee schedule,36,90,,28.8,percent of total billed charges,90% of total billed charges,32,80,,25.6,percent of total billed charges,80% of total billed charges,36,90,,28.8,percent of total billed charges,90% of total billed charges,30,75,,24,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,11.6,29,,9.28,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,26.8,67,,21.44,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,32,80,,25.6,percent of total billed charges,80% of total billed charges,26,65,,20.8,percent of total billed charges,65% of total billed charges,14.27,35.67,,11.416,percent of total billed charges,35.67% of total billed charges,11.6,74.71,
PROLIA PREFILLED 60 MG (OUTPT),2508478,CDM,636,RC,J0897,HCPCS,outpatient,,,2152,860.80,,1829.2,85,,1463.36,percent of total billed charges,85% of total billed charges,1129.8,52.5,,903.84,percent of total billed charges,52.5 percent of total billed charges,26.96,100,,,fee schedule,100% of CMS OPPS rate,68.34,385,,,fee schedule,385% of BCBS fee schedule,71.18,401,,,fee schedule,401% of BCBS fee schedule,71.18,401,,,fee schedule,401% of BCBS fee schedule,71.18,401,,,fee schedule,401% of BCBS fee schedule,1936.8,90,,1549.44,percent of total billed charges,90% of total billed charges,1721.6,80,,1377.28,percent of total billed charges,80% of total billed charges,1936.8,90,,1549.44,percent of total billed charges,90% of total billed charges,1614,75,,1291.2,percent of total billed charges,75% of total billed charges,32.89,122,,,fee schedule,122% of HUMANA fee schedule,624.08,29,,499.264,percent of total billed charges,29% of total billed charges,26.96,100,,,fee schedule,100% of CMS OPPS rate,1441.84,67,,1153.472,percent of total billed charges,67% of total billed charges,15.03,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,1721.6,80,,1377.28,percent of total billed charges,80% of total billed charges,1398.8,65,,1119.04,percent of total billed charges,65% of total billed charges,767.62,35.67,,614.096,percent of total billed charges,35.67% of total billed charges,15.03,1936.8,
PROSCAR 5 MG CAP,2508550,CDM,636,RC,S0138,HCPCS,outpatient,,,18,7.20,,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,18,100,,14.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,1.73,385,,,fee schedule,385% of BCBS fee schedule,1.8,401,,,fee schedule,401% of BCBS fee schedule,1.8,401,,,fee schedule,401% of BCBS fee schedule,1.8,401,,,fee schedule,401% of BCBS fee schedule,16.2,90,,12.96,percent of total billed charges,90% of total billed charges,14.4,80,,11.52,percent of total billed charges,80% of total billed charges,16.2,90,,12.96,percent of total billed charges,90% of total billed charges,13.5,75,,10.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,5.22,29,,4.176,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,12.06,67,,9.648,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,14.4,80,,11.52,percent of total billed charges,80% of total billed charges,11.7,65,,9.36,percent of total billed charges,65% of total billed charges,6.42,35.67,,5.136,percent of total billed charges,35.67% of total billed charges,1.73,18,
PROSTAPHLIN 1 GRAM INJ,2508565,CDM,636,RC,J2700,HCPCS,outpatient,,,55,22.00,,46.75,85,,37.4,percent of total billed charges,85% of total billed charges,55,100,,44,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,7.66,385,,,fee schedule,385% of BCBS fee schedule,7.98,401,,,fee schedule,401% of BCBS fee schedule,7.98,401,,,fee schedule,401% of BCBS fee schedule,7.98,401,,,fee schedule,401% of BCBS fee schedule,49.5,90,,39.6,percent of total billed charges,90% of total billed charges,44,80,,35.2,percent of total billed charges,80% of total billed charges,49.5,90,,39.6,percent of total billed charges,90% of total billed charges,41.25,75,,33,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,15.95,29,,12.76,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,36.85,67,,29.48,percent of total billed charges,67% of total billed charges,2.45,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,44,80,,35.2,percent of total billed charges,80% of total billed charges,35.75,65,,28.6,percent of total billed charges,65% of total billed charges,19.62,35.67,,15.696,percent of total billed charges,35.67% of total billed charges,2.45,55,
PROSTIGMIN INJ. 4MG.,2508580,CDM,636,RC,J2710,HCPCS,outpatient,,,116,46.40,,98.6,85,,78.88,percent of total billed charges,85% of total billed charges,116,100,,92.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,0.69,385,,,fee schedule,385% of BCBS fee schedule,0.72,401,,,fee schedule,401% of BCBS fee schedule,0.72,401,,,fee schedule,401% of BCBS fee schedule,0.72,401,,,fee schedule,401% of BCBS fee schedule,104.4,90,,83.52,percent of total billed charges,90% of total billed charges,92.8,80,,74.24,percent of total billed charges,80% of total billed charges,104.4,90,,83.52,percent of total billed charges,90% of total billed charges,87,75,,69.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,33.64,29,,26.912,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,77.72,67,,62.176,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,92.8,80,,74.24,percent of total billed charges,80% of total billed charges,75.4,65,,60.32,percent of total billed charges,65% of total billed charges,41.38,35.67,,33.104,percent of total billed charges,35.67% of total billed charges,0.69,116,
PROTAMINE 50 MG INJ,2508590,CDM,636,RC,J2720,HCPCS,outpatient,,,100,40.00,,85,85,,68,percent of total billed charges,85% of total billed charges,100,100,,80,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,4.08,385,,,fee schedule,385% of BCBS fee schedule,4.25,401,,,fee schedule,401% of BCBS fee schedule,4.25,401,,,fee schedule,401% of BCBS fee schedule,4.25,401,,,fee schedule,401% of BCBS fee schedule,90,90,,72,percent of total billed charges,90% of total billed charges,80,80,,64,percent of total billed charges,80% of total billed charges,90,90,,72,percent of total billed charges,90% of total billed charges,75,75,,60,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,29,29,,23.2,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,67,67,,53.6,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,80,80,,64,percent of total billed charges,80% of total billed charges,65,65,,52,percent of total billed charges,65% of total billed charges,35.67,35.67,,28.536,percent of total billed charges,35.67% of total billed charges,4.08,100,
PROVENTIL HFA INHALER,2508601,CDM,636,RC,J3535,HCPCS,outpatient,,,136,54.40,,115.6,85,,92.48,percent of total billed charges,85% of total billed charges,136,100,,108.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,111.52,82,,89.216,percent of total billed charges,82% of total billed charges,115.6,85,,92.48,percent of total billed charges,85% of total billed charges,115.6,85,,92.48,percent of total billed charges,85% of total billed charges,115.6,85,,92.48,percent of total billed charges,85% of total billed charges,122.4,90,,97.92,percent of total billed charges,90% of total billed charges,108.8,80,,87.04,percent of total billed charges,80% of total billed charges,122.4,90,,97.92,percent of total billed charges,90% of total billed charges,102,75,,81.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,39.44,29,,31.552,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,91.12,67,,72.896,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,108.8,80,,87.04,percent of total billed charges,80% of total billed charges,88.4,65,,70.72,percent of total billed charges,65% of total billed charges,48.51,35.67,,38.808,percent of total billed charges,35.67% of total billed charges,39.44,136,
PROTONIX 40 MG INJ,2508607,CDM,636,RC,J2470,HCPCS,outpatient,,,24,9.60,,20.4,85,,16.32,percent of total billed charges,85% of total billed charges,24,100,,19.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,19.68,82,,15.744,percent of total billed charges,82% of total billed charges,20.4,85,,16.32,percent of total billed charges,85% of total billed charges,20.4,85,,16.32,percent of total billed charges,85% of total billed charges,20.4,85,,16.32,percent of total billed charges,85% of total billed charges,21.6,90,,17.28,percent of total billed charges,90% of total billed charges,19.2,80,,15.36,percent of total billed charges,80% of total billed charges,21.6,90,,17.28,percent of total billed charges,90% of total billed charges,18,75,,14.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,6.96,29,,5.568,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,16.08,67,,12.864,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,19.2,80,,15.36,percent of total billed charges,80% of total billed charges,15.6,65,,12.48,percent of total billed charges,65% of total billed charges,8.56,35.67,,6.848,percent of total billed charges,35.67% of total billed charges,6.96,24,
PROTHROMBIN COMPLEX KCENTRA,2508609,CDM,636,RC,J7168,HCPCS,outpatient,,,2318,927.20,,1970.3,85,,1576.24,percent of total billed charges,85% of total billed charges,1216.95,52.5,,973.56,percent of total billed charges,52.5 percent of total billed charges,2.24,100,,,fee schedule,100% of CMS OPPS rate,10.05,385,,,fee schedule,385% of BCBS fee schedule,10.47,401,,,fee schedule,401% of BCBS fee schedule,10.47,401,,,fee schedule,401% of BCBS fee schedule,10.47,401,,,fee schedule,401% of BCBS fee schedule,2086.2,90,,1668.96,percent of total billed charges,90% of total billed charges,1854.4,80,,1483.52,percent of total billed charges,80% of total billed charges,2086.2,90,,1668.96,percent of total billed charges,90% of total billed charges,1738.5,75,,1390.8,percent of total billed charges,75% of total billed charges,2.73,122,,,fee schedule,122% of HUMANA fee schedule,672.22,29,,537.776,percent of total billed charges,29% of total billed charges,2.24,100,,,fee schedule,100% of CMS OPPS rate,1553.06,67,,1242.448,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1854.4,80,,1483.52,percent of total billed charges,80% of total billed charges,1506.7,65,,1205.36,percent of total billed charges,65% of total billed charges,826.83,35.67,,661.464,percent of total billed charges,35.67% of total billed charges,2.24,2086.2,
PROTHOMBIN KCENTRA 500 UNIT,2508611,CDM,636,RC,J7168,HCPCS,outpatient,,,4196,1678.40,,3566.6,85,,2853.28,percent of total billed charges,85% of total billed charges,2202.9,52.5,,1762.32,percent of total billed charges,52.5 percent of total billed charges,2.24,100,,,fee schedule,100% of CMS OPPS rate,10.05,385,,,fee schedule,385% of BCBS fee schedule,10.47,401,,,fee schedule,401% of BCBS fee schedule,10.47,401,,,fee schedule,401% of BCBS fee schedule,10.47,401,,,fee schedule,401% of BCBS fee schedule,3776.4,90,,3021.12,percent of total billed charges,90% of total billed charges,3356.8,80,,2685.44,percent of total billed charges,80% of total billed charges,3776.4,90,,3021.12,percent of total billed charges,90% of total billed charges,3147,75,,2517.6,percent of total billed charges,75% of total billed charges,2.73,122,,,fee schedule,122% of HUMANA fee schedule,1216.84,29,,973.472,percent of total billed charges,29% of total billed charges,2.24,100,,,fee schedule,100% of CMS OPPS rate,2811.32,67,,2249.056,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,3356.8,80,,2685.44,percent of total billed charges,80% of total billed charges,2727.4,65,,2181.92,percent of total billed charges,65% of total billed charges,1496.71,35.67,,1197.368,percent of total billed charges,35.67% of total billed charges,2.24,3776.4,
REGITINE 5MG/CC INJ,2508785,CDM,636,RC,J2760,HCPCS,outpatient,,,436,174.40,,370.6,85,,296.48,percent of total billed charges,85% of total billed charges,436,100,,348.8,percent of total billed charges,pays based on exceed threshold rate,367.12,100,,,fee schedule,100% of CMS OPPS rate,403.29,385,,,fee schedule,385% of BCBS fee schedule,420.05,401,,,fee schedule,401% of BCBS fee schedule,420.05,401,,,fee schedule,401% of BCBS fee schedule,420.05,401,,,fee schedule,401% of BCBS fee schedule,392.4,90,,313.92,percent of total billed charges,90% of total billed charges,348.8,80,,279.04,percent of total billed charges,80% of total billed charges,392.4,90,,313.92,percent of total billed charges,90% of total billed charges,327,75,,261.6,percent of total billed charges,75% of total billed charges,447.88,122,,,fee schedule,122% of HUMANA fee schedule,126.44,29,,101.152,percent of total billed charges,29% of total billed charges,367.12,100,,,fee schedule,100% of CMS OPPS rate,292.12,67,,233.696,percent of total billed charges,67% of total billed charges,56.22,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,348.8,80,,279.04,percent of total billed charges,80% of total billed charges,283.4,65,,226.72,percent of total billed charges,65% of total billed charges,155.52,35.67,,124.416,percent of total billed charges,35.67% of total billed charges,56.22,447.88,
RECLAST 5 MG INJECTION PREMIX,2508787,CDM,636,RC,J3489,HCPCS,outpatient,,,2377,950.80,,2020.45,85,,1616.36,percent of total billed charges,85% of total billed charges,1247.93,52.5,,998.34,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,31.19,385,,,fee schedule,385% of BCBS fee schedule,32.48,401,,,fee schedule,401% of BCBS fee schedule,32.48,401,,,fee schedule,401% of BCBS fee schedule,32.48,401,,,fee schedule,401% of BCBS fee schedule,2139.3,90,,1711.44,percent of total billed charges,90% of total billed charges,1901.6,80,,1521.28,percent of total billed charges,80% of total billed charges,2139.3,90,,1711.44,percent of total billed charges,90% of total billed charges,1782.75,75,,1426.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,689.33,29,,551.464,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1592.59,67,,1274.072,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1901.6,80,,1521.28,percent of total billed charges,80% of total billed charges,1545.05,65,,1236.04,percent of total billed charges,65% of total billed charges,847.88,35.67,,678.304,percent of total billed charges,35.67% of total billed charges,31.19,2139.3,
ZOMETA 4MG/5ML,2508788,CDM,636,RC,J3489,HCPCS,outpatient,,,168,67.20,,142.8,85,,114.24,percent of total billed charges,85% of total billed charges,168,100,,134.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,31.19,385,,,fee schedule,385% of BCBS fee schedule,32.48,401,,,fee schedule,401% of BCBS fee schedule,32.48,401,,,fee schedule,401% of BCBS fee schedule,32.48,401,,,fee schedule,401% of BCBS fee schedule,151.2,90,,120.96,percent of total billed charges,90% of total billed charges,134.4,80,,107.52,percent of total billed charges,80% of total billed charges,151.2,90,,120.96,percent of total billed charges,90% of total billed charges,126,75,,100.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,48.72,29,,38.976,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,112.56,67,,90.048,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,134.4,80,,107.52,percent of total billed charges,80% of total billed charges,109.2,65,,87.36,percent of total billed charges,65% of total billed charges,59.93,35.67,,47.944,percent of total billed charges,35.67% of total billed charges,31.19,168,
REGLAN 5MG INJ.*,2508790,CDM,636,RC,J2765,HCPCS,outpatient,,,10,4.00,,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,10,100,,8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,2.39,385,,,fee schedule,385% of BCBS fee schedule,2.49,401,,,fee schedule,401% of BCBS fee schedule,2.49,401,,,fee schedule,401% of BCBS fee schedule,2.49,401,,,fee schedule,401% of BCBS fee schedule,9,90,,7.2,percent of total billed charges,90% of total billed charges,8,80,,6.4,percent of total billed charges,80% of total billed charges,9,90,,7.2,percent of total billed charges,90% of total billed charges,7.5,75,,6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.9,29,,2.32,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,6.7,67,,5.36,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,8,80,,6.4,percent of total billed charges,80% of total billed charges,6.5,65,,5.2,percent of total billed charges,65% of total billed charges,3.57,35.67,,2.856,percent of total billed charges,35.67% of total billed charges,2.39,10,
REGLAN INJ 10 MG *,2508800,CDM,636,RC,J2765,HCPCS,outpatient,,,11,4.40,,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,11,100,,8.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,2.39,385,,,fee schedule,385% of BCBS fee schedule,2.49,401,,,fee schedule,401% of BCBS fee schedule,2.49,401,,,fee schedule,401% of BCBS fee schedule,2.49,401,,,fee schedule,401% of BCBS fee schedule,9.9,90,,7.92,percent of total billed charges,90% of total billed charges,8.8,80,,7.04,percent of total billed charges,80% of total billed charges,9.9,90,,7.92,percent of total billed charges,90% of total billed charges,8.25,75,,6.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,3.19,29,,2.552,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,7.37,67,,5.896,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,8.8,80,,7.04,percent of total billed charges,80% of total billed charges,7.15,65,,5.72,percent of total billed charges,65% of total billed charges,3.92,35.67,,3.136,percent of total billed charges,35.67% of total billed charges,2.39,11,
REMICADE/INFLIXIMAB 10 MG INJ*,2508823,CDM,636,RC,J1745,HCPCS,outpatient,,,246,98.40,,209.1,85,,167.28,percent of total billed charges,85% of total billed charges,246,100,,196.8,percent of total billed charges,pays based on exceed threshold rate,32.22,100,,,fee schedule,100% of CMS OPPS rate,418.15,385,,,fee schedule,385% of BCBS fee schedule,435.53,401,,,fee schedule,401% of BCBS fee schedule,435.53,401,,,fee schedule,401% of BCBS fee schedule,435.53,401,,,fee schedule,401% of BCBS fee schedule,221.4,90,,177.12,percent of total billed charges,90% of total billed charges,196.8,80,,157.44,percent of total billed charges,80% of total billed charges,221.4,90,,177.12,percent of total billed charges,90% of total billed charges,184.5,75,,147.6,percent of total billed charges,75% of total billed charges,39.29,122,,,fee schedule,122% of HUMANA fee schedule,71.34,29,,57.072,percent of total billed charges,29% of total billed charges,32.22,100,,,fee schedule,100% of CMS OPPS rate,164.82,67,,131.856,percent of total billed charges,67% of total billed charges,67.14,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,196.8,80,,157.44,percent of total billed charges,80% of total billed charges,159.9,65,,127.92,percent of total billed charges,65% of total billed charges,87.75,35.67,,70.2,percent of total billed charges,35.67% of total billed charges,32.22,435.53,
REMICADE 100MG IV,2508824,CDM,636,RC,J1745,HCPCS,outpatient,,,2050,820.00,,1742.5,85,,1394,percent of total billed charges,85% of total billed charges,1076.25,52.5,,861,percent of total billed charges,52.5 percent of total billed charges,32.22,100,,,fee schedule,100% of CMS OPPS rate,418.15,385,,,fee schedule,385% of BCBS fee schedule,435.53,401,,,fee schedule,401% of BCBS fee schedule,435.53,401,,,fee schedule,401% of BCBS fee schedule,435.53,401,,,fee schedule,401% of BCBS fee schedule,1845,90,,1476,percent of total billed charges,90% of total billed charges,1640,80,,1312,percent of total billed charges,80% of total billed charges,1845,90,,1476,percent of total billed charges,90% of total billed charges,1537.5,75,,1230,percent of total billed charges,75% of total billed charges,39.29,122,,,fee schedule,122% of HUMANA fee schedule,594.5,29,,475.6,percent of total billed charges,29% of total billed charges,32.22,100,,,fee schedule,100% of CMS OPPS rate,1373.5,67,,1098.8,percent of total billed charges,67% of total billed charges,67.14,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,1640,80,,1312,percent of total billed charges,80% of total billed charges,1332.5,65,,1066,percent of total billed charges,65% of total billed charges,731.24,35.67,,584.992,percent of total billed charges,35.67% of total billed charges,32.22,1845,
RETAVASE INJ 20 UNITS*,2508828,CDM,636,RC,J2993,HCPCS,outpatient,,,9818,3927.20,,8345.3,85,,6676.24,percent of total billed charges,85% of total billed charges,5154.45,52.5,,4123.56,percent of total billed charges,52.5 percent of total billed charges,2777.14,100,,,fee schedule,100% of CMS OPPS rate,8360.7,385,,,fee schedule,385% of BCBS fee schedule,8708.16,401,,,fee schedule,401% of BCBS fee schedule,8708.16,401,,,fee schedule,401% of BCBS fee schedule,8708.16,401,,,fee schedule,401% of BCBS fee schedule,8836.2,90,,7068.96,percent of total billed charges,90% of total billed charges,7854.4,80,,6283.52,percent of total billed charges,80% of total billed charges,8836.2,90,,7068.96,percent of total billed charges,90% of total billed charges,7363.5,75,,5890.8,percent of total billed charges,75% of total billed charges,3388.11,122,,,fee schedule,122% of HUMANA fee schedule,2847.22,29,,2277.776,percent of total billed charges,29% of total billed charges,2777.14,100,,,fee schedule,100% of CMS OPPS rate,6578.06,67,,5262.448,percent of total billed charges,67% of total billed charges,2371.38,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,7854.4,80,,6283.52,percent of total billed charges,80% of total billed charges,6381.7,65,,5105.36,percent of total billed charges,65% of total billed charges,3502.08,35.67,,2801.664,percent of total billed charges,35.67% of total billed charges,2371.38,8836.2,
RETAVASE W/EKG PANEL,2508831,CDM,636,RC,J2993,HCPCS,outpatient,,,7627,3050.80,,6482.95,85,,5186.36,percent of total billed charges,85% of total billed charges,4004.18,52.5,,3203.34,percent of total billed charges,52.5 percent of total billed charges,2777.14,100,,,fee schedule,100% of CMS OPPS rate,8360.7,385,,,fee schedule,385% of BCBS fee schedule,8708.16,401,,,fee schedule,401% of BCBS fee schedule,8708.16,401,,,fee schedule,401% of BCBS fee schedule,8708.16,401,,,fee schedule,401% of BCBS fee schedule,6864.3,90,,5491.44,percent of total billed charges,90% of total billed charges,6101.6,80,,4881.28,percent of total billed charges,80% of total billed charges,6864.3,90,,5491.44,percent of total billed charges,90% of total billed charges,5720.25,75,,4576.2,percent of total billed charges,75% of total billed charges,3388.11,122,,,fee schedule,122% of HUMANA fee schedule,2211.83,29,,1769.464,percent of total billed charges,29% of total billed charges,2777.14,100,,,fee schedule,100% of CMS OPPS rate,5110.09,67,,4088.072,percent of total billed charges,67% of total billed charges,2371.38,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,6101.6,80,,4881.28,percent of total billed charges,80% of total billed charges,4957.55,65,,3966.04,percent of total billed charges,65% of total billed charges,2720.55,35.67,,2176.44,percent of total billed charges,35.67% of total billed charges,2211.83,8708.16,
RHOGAM INJ 1500 UNITS,2508865,CDM,636,RC,J2790,HCPCS,outpatient,,,332,132.80,,282.2,85,,225.76,percent of total billed charges,85% of total billed charges,332,100,,265.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,290.75,385,,,fee schedule,385% of BCBS fee schedule,302.84,401,,,fee schedule,401% of BCBS fee schedule,302.84,401,,,fee schedule,401% of BCBS fee schedule,302.84,401,,,fee schedule,401% of BCBS fee schedule,298.8,90,,239.04,percent of total billed charges,90% of total billed charges,265.6,80,,212.48,percent of total billed charges,80% of total billed charges,298.8,90,,239.04,percent of total billed charges,90% of total billed charges,249,75,,199.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,96.28,29,,77.024,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,222.44,67,,177.952,percent of total billed charges,67% of total billed charges,86.29,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,265.6,80,,212.48,percent of total billed charges,80% of total billed charges,215.8,65,,172.64,percent of total billed charges,65% of total billed charges,118.42,35.67,,94.736,percent of total billed charges,35.67% of total billed charges,86.29,332,
RISPERDAL CONSTA 37.5 MG SYRIN,2508917,CDM,636,RC,J2794,HCPCS,outpatient,,,1562,624.80,,1327.7,85,,1062.16,percent of total billed charges,85% of total billed charges,820.05,52.5,,656.04,percent of total billed charges,52.5 percent of total billed charges,11.3,100,,,fee schedule,100% of CMS OPPS rate,32.65,385,,,fee schedule,385% of BCBS fee schedule,34,401,,,fee schedule,401% of BCBS fee schedule,34,401,,,fee schedule,401% of BCBS fee schedule,34,401,,,fee schedule,401% of BCBS fee schedule,1405.8,90,,1124.64,percent of total billed charges,90% of total billed charges,1249.6,80,,999.68,percent of total billed charges,80% of total billed charges,1405.8,90,,1124.64,percent of total billed charges,90% of total billed charges,1171.5,75,,937.2,percent of total billed charges,75% of total billed charges,13.78,122,,,fee schedule,122% of HUMANA fee schedule,452.98,29,,362.384,percent of total billed charges,29% of total billed charges,11.3,100,,,fee schedule,100% of CMS OPPS rate,1046.54,67,,837.232,percent of total billed charges,67% of total billed charges,5.61,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,1249.6,80,,999.68,percent of total billed charges,80% of total billed charges,1015.3,65,,812.24,percent of total billed charges,65% of total billed charges,557.17,35.67,,445.736,percent of total billed charges,35.67% of total billed charges,5.61,1405.8,
RISPERDAL CONSTA 25 MG INJ,2508919,CDM,636,RC,J2794,HCPCS,outpatient,,,794,317.60,,674.9,85,,539.92,percent of total billed charges,85% of total billed charges,794,100,,635.2,percent of total billed charges,pays based on exceed threshold rate,11.3,100,,,fee schedule,100% of CMS OPPS rate,32.65,385,,,fee schedule,385% of BCBS fee schedule,34,401,,,fee schedule,401% of BCBS fee schedule,34,401,,,fee schedule,401% of BCBS fee schedule,34,401,,,fee schedule,401% of BCBS fee schedule,714.6,90,,571.68,percent of total billed charges,90% of total billed charges,635.2,80,,508.16,percent of total billed charges,80% of total billed charges,714.6,90,,571.68,percent of total billed charges,90% of total billed charges,595.5,75,,476.4,percent of total billed charges,75% of total billed charges,13.78,122,,,fee schedule,122% of HUMANA fee schedule,230.26,29,,184.208,percent of total billed charges,29% of total billed charges,11.3,100,,,fee schedule,100% of CMS OPPS rate,531.98,67,,425.584,percent of total billed charges,67% of total billed charges,5.61,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,635.2,80,,508.16,percent of total billed charges,80% of total billed charges,516.1,65,,412.88,percent of total billed charges,65% of total billed charges,283.22,35.67,,226.576,percent of total billed charges,35.67% of total billed charges,5.61,794,
RISPERDAL CONSTA 50 MG INJ,2508921,CDM,636,RC,J2794,HCPCS,outpatient,,,2070,828.00,,1759.5,85,,1407.6,percent of total billed charges,85% of total billed charges,1086.75,52.5,,869.4,percent of total billed charges,52.5 percent of total billed charges,11.3,100,,,fee schedule,100% of CMS OPPS rate,32.65,385,,,fee schedule,385% of BCBS fee schedule,34,401,,,fee schedule,401% of BCBS fee schedule,34,401,,,fee schedule,401% of BCBS fee schedule,34,401,,,fee schedule,401% of BCBS fee schedule,1863,90,,1490.4,percent of total billed charges,90% of total billed charges,1656,80,,1324.8,percent of total billed charges,80% of total billed charges,1863,90,,1490.4,percent of total billed charges,90% of total billed charges,1552.5,75,,1242,percent of total billed charges,75% of total billed charges,13.78,122,,,fee schedule,122% of HUMANA fee schedule,600.3,29,,480.24,percent of total billed charges,29% of total billed charges,11.3,100,,,fee schedule,100% of CMS OPPS rate,1386.9,67,,1109.52,percent of total billed charges,67% of total billed charges,5.61,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,1656,80,,1324.8,percent of total billed charges,80% of total billed charges,1345.5,65,,1076.4,percent of total billed charges,65% of total billed charges,738.37,35.67,,590.696,percent of total billed charges,35.67% of total billed charges,5.61,1863,
RISPERDAL CONSTA .5MG (OUTPT),2508923,CDM,636,RC,J2794,HCPCS,outpatient,,,22,8.80,,18.7,85,,14.96,percent of total billed charges,85% of total billed charges,22,100,,17.6,percent of total billed charges,pays based on exceed threshold rate,11.3,100,,,fee schedule,100% of CMS OPPS rate,32.65,385,,,fee schedule,385% of BCBS fee schedule,34,401,,,fee schedule,401% of BCBS fee schedule,34,401,,,fee schedule,401% of BCBS fee schedule,34,401,,,fee schedule,401% of BCBS fee schedule,19.8,90,,15.84,percent of total billed charges,90% of total billed charges,17.6,80,,14.08,percent of total billed charges,80% of total billed charges,19.8,90,,15.84,percent of total billed charges,90% of total billed charges,16.5,75,,13.2,percent of total billed charges,75% of total billed charges,13.78,122,,,fee schedule,122% of HUMANA fee schedule,6.38,29,,5.104,percent of total billed charges,29% of total billed charges,11.3,100,,,fee schedule,100% of CMS OPPS rate,14.74,67,,11.792,percent of total billed charges,67% of total billed charges,5.61,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,17.6,80,,14.08,percent of total billed charges,80% of total billed charges,14.3,65,,11.44,percent of total billed charges,65% of total billed charges,7.85,35.67,,6.28,percent of total billed charges,35.67% of total billed charges,5.61,34,
RISPERDAL CONSTA 12.5 MG INJ,2508924,CDM,636,RC,J2794,HCPCS,outpatient,,,442,176.80,,375.7,85,,300.56,percent of total billed charges,85% of total billed charges,442,100,,353.6,percent of total billed charges,pays based on exceed threshold rate,11.3,100,,,fee schedule,100% of CMS OPPS rate,32.65,385,,,fee schedule,385% of BCBS fee schedule,34,401,,,fee schedule,401% of BCBS fee schedule,34,401,,,fee schedule,401% of BCBS fee schedule,34,401,,,fee schedule,401% of BCBS fee schedule,397.8,90,,318.24,percent of total billed charges,90% of total billed charges,353.6,80,,282.88,percent of total billed charges,80% of total billed charges,397.8,90,,318.24,percent of total billed charges,90% of total billed charges,331.5,75,,265.2,percent of total billed charges,75% of total billed charges,13.78,122,,,fee schedule,122% of HUMANA fee schedule,128.18,29,,102.544,percent of total billed charges,29% of total billed charges,11.3,100,,,fee schedule,100% of CMS OPPS rate,296.14,67,,236.912,percent of total billed charges,67% of total billed charges,5.61,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,353.6,80,,282.88,percent of total billed charges,80% of total billed charges,287.3,65,,229.84,percent of total billed charges,65% of total billed charges,157.66,35.67,,126.128,percent of total billed charges,35.67% of total billed charges,5.61,442,
ROBAXIN 1000MG INJ/10 ML,2508925,CDM,636,RC,J2800,HCPCS,outpatient,,,240,96.00,,204,85,,163.2,percent of total billed charges,85% of total billed charges,240,100,,192,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,151.92,385,,,fee schedule,385% of BCBS fee schedule,158.23,401,,,fee schedule,401% of BCBS fee schedule,158.23,401,,,fee schedule,401% of BCBS fee schedule,158.23,401,,,fee schedule,401% of BCBS fee schedule,216,90,,172.8,percent of total billed charges,90% of total billed charges,192,80,,153.6,percent of total billed charges,80% of total billed charges,216,90,,172.8,percent of total billed charges,90% of total billed charges,180,75,,144,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,69.6,29,,55.68,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,160.8,67,,128.64,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,192,80,,153.6,percent of total billed charges,80% of total billed charges,156,65,,124.8,percent of total billed charges,65% of total billed charges,85.61,35.67,,68.488,percent of total billed charges,35.67% of total billed charges,69.6,240,
ROBAXIN 750 MG INJ,2508935,CDM,636,RC,J2800,HCPCS,outpatient,,,17,6.80,,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,17,100,,13.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,151.92,385,,,fee schedule,385% of BCBS fee schedule,158.23,401,,,fee schedule,401% of BCBS fee schedule,158.23,401,,,fee schedule,401% of BCBS fee schedule,158.23,401,,,fee schedule,401% of BCBS fee schedule,15.3,90,,12.24,percent of total billed charges,90% of total billed charges,13.6,80,,10.88,percent of total billed charges,80% of total billed charges,15.3,90,,12.24,percent of total billed charges,90% of total billed charges,12.75,75,,10.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,4.93,29,,3.944,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,11.39,67,,9.112,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,13.6,80,,10.88,percent of total billed charges,80% of total billed charges,11.05,65,,8.84,percent of total billed charges,65% of total billed charges,6.06,35.67,,4.848,percent of total billed charges,35.67% of total billed charges,4.93,158.23,
ROCEPHIN 2000 MG VIAL INJ,2509023,CDM,636,RC,J0696,HCPCS,outpatient,,,285,114.00,,242.25,85,,193.8,percent of total billed charges,85% of total billed charges,285,100,,228,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,9.74,385,,,fee schedule,385% of BCBS fee schedule,10.15,401,,,fee schedule,401% of BCBS fee schedule,10.15,401,,,fee schedule,401% of BCBS fee schedule,10.15,401,,,fee schedule,401% of BCBS fee schedule,256.5,90,,205.2,percent of total billed charges,90% of total billed charges,228,80,,182.4,percent of total billed charges,80% of total billed charges,256.5,90,,205.2,percent of total billed charges,90% of total billed charges,213.75,75,,171,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,82.65,29,,66.12,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,190.95,67,,152.76,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,228,80,,182.4,percent of total billed charges,80% of total billed charges,185.25,65,,148.2,percent of total billed charges,65% of total billed charges,101.66,35.67,,81.328,percent of total billed charges,35.67% of total billed charges,9.74,285,
ROCEPHIN 1 GRAM INJ.,2509025,CDM,636,RC,J0696,HCPCS,outpatient,,,170,68.00,,144.5,85,,115.6,percent of total billed charges,85% of total billed charges,170,100,,136,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,9.74,385,,,fee schedule,385% of BCBS fee schedule,10.15,401,,,fee schedule,401% of BCBS fee schedule,10.15,401,,,fee schedule,401% of BCBS fee schedule,10.15,401,,,fee schedule,401% of BCBS fee schedule,153,90,,122.4,percent of total billed charges,90% of total billed charges,136,80,,108.8,percent of total billed charges,80% of total billed charges,153,90,,122.4,percent of total billed charges,90% of total billed charges,127.5,75,,102,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,49.3,29,,39.44,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,113.9,67,,91.12,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,136,80,,108.8,percent of total billed charges,80% of total billed charges,110.5,65,,88.4,percent of total billed charges,65% of total billed charges,60.64,35.67,,48.512,percent of total billed charges,35.67% of total billed charges,9.74,170,
ROCEPHIN 125MG INJ.,2509035,CDM,636,RC,J0696,HCPCS,outpatient,,,29,11.60,,24.65,85,,19.72,percent of total billed charges,85% of total billed charges,29,100,,23.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,9.74,385,,,fee schedule,385% of BCBS fee schedule,10.15,401,,,fee schedule,401% of BCBS fee schedule,10.15,401,,,fee schedule,401% of BCBS fee schedule,10.15,401,,,fee schedule,401% of BCBS fee schedule,26.1,90,,20.88,percent of total billed charges,90% of total billed charges,23.2,80,,18.56,percent of total billed charges,80% of total billed charges,26.1,90,,20.88,percent of total billed charges,90% of total billed charges,21.75,75,,17.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,8.41,29,,6.728,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,19.43,67,,15.544,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,23.2,80,,18.56,percent of total billed charges,80% of total billed charges,18.85,65,,15.08,percent of total billed charges,65% of total billed charges,10.34,35.67,,8.272,percent of total billed charges,35.67% of total billed charges,8.41,29,
ROCEPHIN 250 MG INJ,2509045,CDM,636,RC,J0696,HCPCS,outpatient,,,66,26.40,,56.1,85,,44.88,percent of total billed charges,85% of total billed charges,66,100,,52.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,9.74,385,,,fee schedule,385% of BCBS fee schedule,10.15,401,,,fee schedule,401% of BCBS fee schedule,10.15,401,,,fee schedule,401% of BCBS fee schedule,10.15,401,,,fee schedule,401% of BCBS fee schedule,59.4,90,,47.52,percent of total billed charges,90% of total billed charges,52.8,80,,42.24,percent of total billed charges,80% of total billed charges,59.4,90,,47.52,percent of total billed charges,90% of total billed charges,49.5,75,,39.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,19.14,29,,15.312,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,44.22,67,,35.376,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,52.8,80,,42.24,percent of total billed charges,80% of total billed charges,42.9,65,,34.32,percent of total billed charges,65% of total billed charges,23.54,35.67,,18.832,percent of total billed charges,35.67% of total billed charges,9.74,66,
ROCEPHIN 275 MG INJ,2509050,CDM,636,RC,J0696,HCPCS,outpatient,,,60,24.00,,51,85,,40.8,percent of total billed charges,85% of total billed charges,60,100,,48,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,9.74,385,,,fee schedule,385% of BCBS fee schedule,10.15,401,,,fee schedule,401% of BCBS fee schedule,10.15,401,,,fee schedule,401% of BCBS fee schedule,10.15,401,,,fee schedule,401% of BCBS fee schedule,54,90,,43.2,percent of total billed charges,90% of total billed charges,48,80,,38.4,percent of total billed charges,80% of total billed charges,54,90,,43.2,percent of total billed charges,90% of total billed charges,45,75,,36,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,17.4,29,,13.92,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,40.2,67,,32.16,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,48,80,,38.4,percent of total billed charges,80% of total billed charges,39,65,,31.2,percent of total billed charges,65% of total billed charges,21.4,35.67,,17.12,percent of total billed charges,35.67% of total billed charges,9.74,60,
ROCEPHIN 2 GM INJ.,2509055,CDM,636,RC,J0696,HCPCS,outpatient,,,279,111.60,,237.15,85,,189.72,percent of total billed charges,85% of total billed charges,279,100,,223.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,9.74,385,,,fee schedule,385% of BCBS fee schedule,10.15,401,,,fee schedule,401% of BCBS fee schedule,10.15,401,,,fee schedule,401% of BCBS fee schedule,10.15,401,,,fee schedule,401% of BCBS fee schedule,251.1,90,,200.88,percent of total billed charges,90% of total billed charges,223.2,80,,178.56,percent of total billed charges,80% of total billed charges,251.1,90,,200.88,percent of total billed charges,90% of total billed charges,209.25,75,,167.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,80.91,29,,64.728,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,186.93,67,,149.544,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,223.2,80,,178.56,percent of total billed charges,80% of total billed charges,181.35,65,,145.08,percent of total billed charges,65% of total billed charges,99.52,35.67,,79.616,percent of total billed charges,35.67% of total billed charges,9.74,279,
ROCEPHIN 300 MG INJ,2509060,CDM,636,RC,J0696,HCPCS,outpatient,,,38,15.20,,32.3,85,,25.84,percent of total billed charges,85% of total billed charges,38,100,,30.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,9.74,385,,,fee schedule,385% of BCBS fee schedule,10.15,401,,,fee schedule,401% of BCBS fee schedule,10.15,401,,,fee schedule,401% of BCBS fee schedule,10.15,401,,,fee schedule,401% of BCBS fee schedule,34.2,90,,27.36,percent of total billed charges,90% of total billed charges,30.4,80,,24.32,percent of total billed charges,80% of total billed charges,34.2,90,,27.36,percent of total billed charges,90% of total billed charges,28.5,75,,22.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,11.02,29,,8.816,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,25.46,67,,20.368,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,30.4,80,,24.32,percent of total billed charges,80% of total billed charges,24.7,65,,19.76,percent of total billed charges,65% of total billed charges,13.55,35.67,,10.84,percent of total billed charges,35.67% of total billed charges,9.74,38,
ROCEPHIN 350 MG INJ,2509065,CDM,636,RC,J0696,HCPCS,outpatient,,,44,17.60,,37.4,85,,29.92,percent of total billed charges,85% of total billed charges,44,100,,35.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,9.74,385,,,fee schedule,385% of BCBS fee schedule,10.15,401,,,fee schedule,401% of BCBS fee schedule,10.15,401,,,fee schedule,401% of BCBS fee schedule,10.15,401,,,fee schedule,401% of BCBS fee schedule,39.6,90,,31.68,percent of total billed charges,90% of total billed charges,35.2,80,,28.16,percent of total billed charges,80% of total billed charges,39.6,90,,31.68,percent of total billed charges,90% of total billed charges,33,75,,26.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,12.76,29,,10.208,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,29.48,67,,23.584,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,35.2,80,,28.16,percent of total billed charges,80% of total billed charges,28.6,65,,22.88,percent of total billed charges,65% of total billed charges,15.69,35.67,,12.552,percent of total billed charges,35.67% of total billed charges,9.74,44,
ROCEPHIN 375MG INJ,2509070,CDM,636,RC,J0696,HCPCS,outpatient,,,48,19.20,,40.8,85,,32.64,percent of total billed charges,85% of total billed charges,48,100,,38.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,9.74,385,,,fee schedule,385% of BCBS fee schedule,10.15,401,,,fee schedule,401% of BCBS fee schedule,10.15,401,,,fee schedule,401% of BCBS fee schedule,10.15,401,,,fee schedule,401% of BCBS fee schedule,43.2,90,,34.56,percent of total billed charges,90% of total billed charges,38.4,80,,30.72,percent of total billed charges,80% of total billed charges,43.2,90,,34.56,percent of total billed charges,90% of total billed charges,36,75,,28.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,13.92,29,,11.136,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,32.16,67,,25.728,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,38.4,80,,30.72,percent of total billed charges,80% of total billed charges,31.2,65,,24.96,percent of total billed charges,65% of total billed charges,17.12,35.67,,13.696,percent of total billed charges,35.67% of total billed charges,9.74,48,
ROCEPHIN 400 MG INJ.,2509075,CDM,636,RC,J0696,HCPCS,outpatient,,,60,24.00,,51,85,,40.8,percent of total billed charges,85% of total billed charges,60,100,,48,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,9.74,385,,,fee schedule,385% of BCBS fee schedule,10.15,401,,,fee schedule,401% of BCBS fee schedule,10.15,401,,,fee schedule,401% of BCBS fee schedule,10.15,401,,,fee schedule,401% of BCBS fee schedule,54,90,,43.2,percent of total billed charges,90% of total billed charges,48,80,,38.4,percent of total billed charges,80% of total billed charges,54,90,,43.2,percent of total billed charges,90% of total billed charges,45,75,,36,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,17.4,29,,13.92,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,40.2,67,,32.16,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,48,80,,38.4,percent of total billed charges,80% of total billed charges,39,65,,31.2,percent of total billed charges,65% of total billed charges,21.4,35.67,,17.12,percent of total billed charges,35.67% of total billed charges,9.74,60,
ROCEPHIN 425MG/INJ,2509085,CDM,636,RC,J0696,HCPCS,outpatient,,,63,25.20,,53.55,85,,42.84,percent of total billed charges,85% of total billed charges,63,100,,50.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,9.74,385,,,fee schedule,385% of BCBS fee schedule,10.15,401,,,fee schedule,401% of BCBS fee schedule,10.15,401,,,fee schedule,401% of BCBS fee schedule,10.15,401,,,fee schedule,401% of BCBS fee schedule,56.7,90,,45.36,percent of total billed charges,90% of total billed charges,50.4,80,,40.32,percent of total billed charges,80% of total billed charges,56.7,90,,45.36,percent of total billed charges,90% of total billed charges,47.25,75,,37.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,18.27,29,,14.616,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,42.21,67,,33.768,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,50.4,80,,40.32,percent of total billed charges,80% of total billed charges,40.95,65,,32.76,percent of total billed charges,65% of total billed charges,22.47,35.67,,17.976,percent of total billed charges,35.67% of total billed charges,9.74,63,
ROCEPHIN 450MG INJ,2509090,CDM,636,RC,J0696,HCPCS,outpatient,,,60,24.00,,51,85,,40.8,percent of total billed charges,85% of total billed charges,60,100,,48,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,9.74,385,,,fee schedule,385% of BCBS fee schedule,10.15,401,,,fee schedule,401% of BCBS fee schedule,10.15,401,,,fee schedule,401% of BCBS fee schedule,10.15,401,,,fee schedule,401% of BCBS fee schedule,54,90,,43.2,percent of total billed charges,90% of total billed charges,48,80,,38.4,percent of total billed charges,80% of total billed charges,54,90,,43.2,percent of total billed charges,90% of total billed charges,45,75,,36,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,17.4,29,,13.92,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,40.2,67,,32.16,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,48,80,,38.4,percent of total billed charges,80% of total billed charges,39,65,,31.2,percent of total billed charges,65% of total billed charges,21.4,35.67,,17.12,percent of total billed charges,35.67% of total billed charges,9.74,60,
ROCEPHIN 600MG INJ.,2509115,CDM,636,RC,J0696,HCPCS,outpatient,,,87,34.80,,73.95,85,,59.16,percent of total billed charges,85% of total billed charges,87,100,,69.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,9.74,385,,,fee schedule,385% of BCBS fee schedule,10.15,401,,,fee schedule,401% of BCBS fee schedule,10.15,401,,,fee schedule,401% of BCBS fee schedule,10.15,401,,,fee schedule,401% of BCBS fee schedule,78.3,90,,62.64,percent of total billed charges,90% of total billed charges,69.6,80,,55.68,percent of total billed charges,80% of total billed charges,78.3,90,,62.64,percent of total billed charges,90% of total billed charges,65.25,75,,52.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,25.23,29,,20.184,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,58.29,67,,46.632,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,69.6,80,,55.68,percent of total billed charges,80% of total billed charges,56.55,65,,45.24,percent of total billed charges,65% of total billed charges,31.03,35.67,,24.824,percent of total billed charges,35.67% of total billed charges,9.74,87,
ROCEPHIN 750 MG INJ,2509120,CDM,636,RC,J0696,HCPCS,outpatient,,,106,42.40,,90.1,85,,72.08,percent of total billed charges,85% of total billed charges,106,100,,84.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,9.74,385,,,fee schedule,385% of BCBS fee schedule,10.15,401,,,fee schedule,401% of BCBS fee schedule,10.15,401,,,fee schedule,401% of BCBS fee schedule,10.15,401,,,fee schedule,401% of BCBS fee schedule,95.4,90,,76.32,percent of total billed charges,90% of total billed charges,84.8,80,,67.84,percent of total billed charges,80% of total billed charges,95.4,90,,76.32,percent of total billed charges,90% of total billed charges,79.5,75,,63.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,30.74,29,,24.592,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,71.02,67,,56.816,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,84.8,80,,67.84,percent of total billed charges,80% of total billed charges,68.9,65,,55.12,percent of total billed charges,65% of total billed charges,37.81,35.67,,30.248,percent of total billed charges,35.67% of total billed charges,9.74,106,
ROCEPHIN 800 MG INJ,2509125,CDM,636,RC,J0696,HCPCS,outpatient,,,106,42.40,,90.1,85,,72.08,percent of total billed charges,85% of total billed charges,106,100,,84.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,9.74,385,,,fee schedule,385% of BCBS fee schedule,10.15,401,,,fee schedule,401% of BCBS fee schedule,10.15,401,,,fee schedule,401% of BCBS fee schedule,10.15,401,,,fee schedule,401% of BCBS fee schedule,95.4,90,,76.32,percent of total billed charges,90% of total billed charges,84.8,80,,67.84,percent of total billed charges,80% of total billed charges,95.4,90,,76.32,percent of total billed charges,90% of total billed charges,79.5,75,,63.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,30.74,29,,24.592,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,71.02,67,,56.816,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,84.8,80,,67.84,percent of total billed charges,80% of total billed charges,68.9,65,,55.12,percent of total billed charges,65% of total billed charges,37.81,35.67,,30.248,percent of total billed charges,35.67% of total billed charges,9.74,106,
ROCEPHIN 900 MG INJ.,2509130,CDM,636,RC,J0696,HCPCS,outpatient,,,111,44.40,,94.35,85,,75.48,percent of total billed charges,85% of total billed charges,111,100,,88.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,9.74,385,,,fee schedule,385% of BCBS fee schedule,10.15,401,,,fee schedule,401% of BCBS fee schedule,10.15,401,,,fee schedule,401% of BCBS fee schedule,10.15,401,,,fee schedule,401% of BCBS fee schedule,99.9,90,,79.92,percent of total billed charges,90% of total billed charges,88.8,80,,71.04,percent of total billed charges,80% of total billed charges,99.9,90,,79.92,percent of total billed charges,90% of total billed charges,83.25,75,,66.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,32.19,29,,25.752,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,74.37,67,,59.496,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,88.8,80,,71.04,percent of total billed charges,80% of total billed charges,72.15,65,,57.72,percent of total billed charges,65% of total billed charges,39.59,35.67,,31.672,percent of total billed charges,35.67% of total billed charges,9.74,111,
ROCEPHIN PEDI DOSE INJ.,2509135,CDM,636,RC,J0696,HCPCS,outpatient,,,30,12.00,,25.5,85,,20.4,percent of total billed charges,85% of total billed charges,30,100,,24,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,9.74,385,,,fee schedule,385% of BCBS fee schedule,10.15,401,,,fee schedule,401% of BCBS fee schedule,10.15,401,,,fee schedule,401% of BCBS fee schedule,10.15,401,,,fee schedule,401% of BCBS fee schedule,27,90,,21.6,percent of total billed charges,90% of total billed charges,24,80,,19.2,percent of total billed charges,80% of total billed charges,27,90,,21.6,percent of total billed charges,90% of total billed charges,22.5,75,,18,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,8.7,29,,6.96,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,20.1,67,,16.08,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,24,80,,19.2,percent of total billed charges,80% of total billed charges,19.5,65,,15.6,percent of total billed charges,65% of total billed charges,10.7,35.67,,8.56,percent of total billed charges,35.67% of total billed charges,8.7,30,
ROPIVACAINE 5 MG INJ (NAROPIN),2509171,CDM,636,RC,J2795,HCPCS,outpatient,,,97,38.80,,82.45,85,,65.96,percent of total billed charges,85% of total billed charges,97,100,,77.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,0.19,385,,,fee schedule,385% of BCBS fee schedule,0.2,401,,,fee schedule,401% of BCBS fee schedule,0.2,401,,,fee schedule,401% of BCBS fee schedule,0.2,401,,,fee schedule,401% of BCBS fee schedule,87.3,90,,69.84,percent of total billed charges,90% of total billed charges,77.6,80,,62.08,percent of total billed charges,80% of total billed charges,87.3,90,,69.84,percent of total billed charges,90% of total billed charges,72.75,75,,58.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,28.13,29,,22.504,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,64.99,67,,51.992,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,77.6,80,,62.08,percent of total billed charges,80% of total billed charges,63.05,65,,50.44,percent of total billed charges,65% of total billed charges,34.6,35.67,,27.68,percent of total billed charges,35.67% of total billed charges,0.19,97,
SANDOSTATIN 0.05MG/ML AMP,2509236,CDM,636,RC,J2354,HCPCS,outpatient,,,62,24.80,,52.7,85,,42.16,percent of total billed charges,85% of total billed charges,62,100,,49.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,1.19,385,,,fee schedule,385% of BCBS fee schedule,1.24,401,,,fee schedule,401% of BCBS fee schedule,1.24,401,,,fee schedule,401% of BCBS fee schedule,1.24,401,,,fee schedule,401% of BCBS fee schedule,55.8,90,,44.64,percent of total billed charges,90% of total billed charges,49.6,80,,39.68,percent of total billed charges,80% of total billed charges,55.8,90,,44.64,percent of total billed charges,90% of total billed charges,46.5,75,,37.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,17.98,29,,14.384,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,41.54,67,,33.232,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,49.6,80,,39.68,percent of total billed charges,80% of total billed charges,40.3,65,,32.24,percent of total billed charges,65% of total billed charges,22.12,35.67,,17.696,percent of total billed charges,35.67% of total billed charges,1.19,62,
SANDOSTATIN LAR 30MG DEPOT,2509251,CDM,636,RC,J2353,HCPCS,outpatient,,,22377,8950.80,,19020.45,85,,15216.36,percent of total billed charges,85% of total billed charges,11747.93,52.5,,9398.34,percent of total billed charges,52.5 percent of total billed charges,214.88,100,,,fee schedule,100% of CMS OPPS rate,676.02,385,,,fee schedule,385% of BCBS fee schedule,704.12,401,,,fee schedule,401% of BCBS fee schedule,704.12,401,,,fee schedule,401% of BCBS fee schedule,704.12,401,,,fee schedule,401% of BCBS fee schedule,20139.3,90,,16111.44,percent of total billed charges,90% of total billed charges,17901.6,80,,14321.28,percent of total billed charges,80% of total billed charges,20139.3,90,,16111.44,percent of total billed charges,90% of total billed charges,16782.75,75,,13426.2,percent of total billed charges,75% of total billed charges,262.14,122,,,fee schedule,122% of HUMANA fee schedule,6489.33,29,,5191.464,percent of total billed charges,29% of total billed charges,214.88,100,,,fee schedule,100% of CMS OPPS rate,14992.59,67,,11994.072,percent of total billed charges,67% of total billed charges,4704.34,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,17901.6,80,,14321.28,percent of total billed charges,80% of total billed charges,14545.05,65,,11636.04,percent of total billed charges,65% of total billed charges,7981.88,35.67,,6385.504,percent of total billed charges,35.67% of total billed charges,214.88,20139.3,
SANDOSTATIN LAR 20MG DEPOT,2509252,CDM,636,RC,J2353,HCPCS,outpatient,,,5682,2272.80,,4829.7,85,,3863.76,percent of total billed charges,85% of total billed charges,2983.05,52.5,,2386.44,percent of total billed charges,52.5 percent of total billed charges,214.88,100,,,fee schedule,100% of CMS OPPS rate,676.02,385,,,fee schedule,385% of BCBS fee schedule,704.12,401,,,fee schedule,401% of BCBS fee schedule,704.12,401,,,fee schedule,401% of BCBS fee schedule,704.12,401,,,fee schedule,401% of BCBS fee schedule,5113.8,90,,4091.04,percent of total billed charges,90% of total billed charges,4545.6,80,,3636.48,percent of total billed charges,80% of total billed charges,5113.8,90,,4091.04,percent of total billed charges,90% of total billed charges,4261.5,75,,3409.2,percent of total billed charges,75% of total billed charges,262.14,122,,,fee schedule,122% of HUMANA fee schedule,1647.78,29,,1318.224,percent of total billed charges,29% of total billed charges,214.88,100,,,fee schedule,100% of CMS OPPS rate,3806.94,67,,3045.552,percent of total billed charges,67% of total billed charges,130.84,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,4545.6,80,,3636.48,percent of total billed charges,80% of total billed charges,3693.3,65,,2954.64,percent of total billed charges,65% of total billed charges,2026.77,35.67,,1621.416,percent of total billed charges,35.67% of total billed charges,130.84,5113.8,
POT CHLORIDE .9%/40M,2509537,CDM,636,RC,J3480,HCPCS,outpatient,,,46,18.40,,39.1,85,,31.28,percent of total billed charges,85% of total billed charges,46,100,,36.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,0.15,385,,,fee schedule,385% of BCBS fee schedule,0.16,401,,,fee schedule,401% of BCBS fee schedule,0.16,401,,,fee schedule,401% of BCBS fee schedule,0.16,401,,,fee schedule,401% of BCBS fee schedule,41.4,90,,33.12,percent of total billed charges,90% of total billed charges,36.8,80,,29.44,percent of total billed charges,80% of total billed charges,41.4,90,,33.12,percent of total billed charges,90% of total billed charges,34.5,75,,27.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,13.34,29,,10.672,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,30.82,67,,24.656,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,36.8,80,,29.44,percent of total billed charges,80% of total billed charges,29.9,65,,23.92,percent of total billed charges,65% of total billed charges,16.41,35.67,,13.128,percent of total billed charges,35.67% of total billed charges,0.15,46,
SODIUM FERRIC GLUCONATE INJ,2509543,CDM,636,RC,J2916,HCPCS,outpatient,,,2123,849.20,,1804.55,85,,1443.64,percent of total billed charges,85% of total billed charges,1114.58,52.5,,891.66,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,16.94,385,,,fee schedule,385% of BCBS fee schedule,17.64,401,,,fee schedule,401% of BCBS fee schedule,17.64,401,,,fee schedule,401% of BCBS fee schedule,17.64,401,,,fee schedule,401% of BCBS fee schedule,1910.7,90,,1528.56,percent of total billed charges,90% of total billed charges,1698.4,80,,1358.72,percent of total billed charges,80% of total billed charges,1910.7,90,,1528.56,percent of total billed charges,90% of total billed charges,1592.25,75,,1273.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,615.67,29,,492.536,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1422.41,67,,1137.928,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1698.4,80,,1358.72,percent of total billed charges,80% of total billed charges,1379.95,65,,1103.96,percent of total billed charges,65% of total billed charges,757.27,35.67,,605.816,percent of total billed charges,35.67% of total billed charges,16.94,1910.7,
SOLU CORTEF 250MG INJ,2509555,CDM,636,RC,J1720,HCPCS,outpatient,,,62,24.80,,52.7,85,,42.16,percent of total billed charges,85% of total billed charges,62,100,,49.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,7.7,385,,,fee schedule,385% of BCBS fee schedule,8.02,401,,,fee schedule,401% of BCBS fee schedule,8.02,401,,,fee schedule,401% of BCBS fee schedule,8.02,401,,,fee schedule,401% of BCBS fee schedule,55.8,90,,44.64,percent of total billed charges,90% of total billed charges,49.6,80,,39.68,percent of total billed charges,80% of total billed charges,55.8,90,,44.64,percent of total billed charges,90% of total billed charges,46.5,75,,37.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,17.98,29,,14.384,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,41.54,67,,33.232,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,49.6,80,,39.68,percent of total billed charges,80% of total billed charges,40.3,65,,32.24,percent of total billed charges,65% of total billed charges,22.12,35.67,,17.696,percent of total billed charges,35.67% of total billed charges,7.7,62,
SOLU MEDROL 125MG INJ,2509570,CDM,636,RC,J2919,HCPCS,outpatient,,,33,13.20,,28.05,85,,22.44,percent of total billed charges,85% of total billed charges,33,100,,26.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,27.06,82,,21.648,percent of total billed charges,82% of total billed charges,28.05,85,,22.44,percent of total billed charges,85% of total billed charges,28.05,85,,22.44,percent of total billed charges,85% of total billed charges,28.05,85,,22.44,percent of total billed charges,85% of total billed charges,29.7,90,,23.76,percent of total billed charges,90% of total billed charges,26.4,80,,21.12,percent of total billed charges,80% of total billed charges,29.7,90,,23.76,percent of total billed charges,90% of total billed charges,24.75,75,,19.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,9.57,29,,7.656,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,22.11,67,,17.688,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,26.4,80,,21.12,percent of total billed charges,80% of total billed charges,21.45,65,,17.16,percent of total billed charges,65% of total billed charges,11.77,35.67,,9.416,percent of total billed charges,35.67% of total billed charges,9.57,33,
SOLU MEDROL 250MG INJ,2509575,CDM,636,RC,J2930,HCPCS,outpatient,,,57,22.80,,48.45,85,,38.76,percent of total billed charges,85% of total billed charges,57,100,,45.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,18.52,385,,,fee schedule,385% of BCBS fee schedule,19.29,401,,,fee schedule,401% of BCBS fee schedule,19.29,401,,,fee schedule,401% of BCBS fee schedule,19.29,401,,,fee schedule,401% of BCBS fee schedule,51.3,90,,41.04,percent of total billed charges,90% of total billed charges,45.6,80,,36.48,percent of total billed charges,80% of total billed charges,51.3,90,,41.04,percent of total billed charges,90% of total billed charges,42.75,75,,34.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,16.53,29,,13.224,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,38.19,67,,30.552,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,45.6,80,,36.48,percent of total billed charges,80% of total billed charges,37.05,65,,29.64,percent of total billed charges,65% of total billed charges,20.33,35.67,,16.264,percent of total billed charges,35.67% of total billed charges,16.53,57,
SOLU MEDROL 500MG INJ,2509580,CDM,636,RC,J2930,HCPCS,outpatient,,,125,50.00,,106.25,85,,85,percent of total billed charges,85% of total billed charges,125,100,,100,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,18.52,385,,,fee schedule,385% of BCBS fee schedule,19.29,401,,,fee schedule,401% of BCBS fee schedule,19.29,401,,,fee schedule,401% of BCBS fee schedule,19.29,401,,,fee schedule,401% of BCBS fee schedule,112.5,90,,90,percent of total billed charges,90% of total billed charges,100,80,,80,percent of total billed charges,80% of total billed charges,112.5,90,,90,percent of total billed charges,90% of total billed charges,93.75,75,,75,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,36.25,29,,29,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,83.75,67,,67,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,100,80,,80,percent of total billed charges,80% of total billed charges,81.25,65,,65,percent of total billed charges,65% of total billed charges,44.59,35.67,,35.672,percent of total billed charges,35.67% of total billed charges,18.52,125,
SOLUMEDROL 1 GM IV,2509581,CDM,636,RC,J2930,HCPCS,outpatient,,,66,26.40,,56.1,85,,44.88,percent of total billed charges,85% of total billed charges,66,100,,52.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,18.52,385,,,fee schedule,385% of BCBS fee schedule,19.29,401,,,fee schedule,401% of BCBS fee schedule,19.29,401,,,fee schedule,401% of BCBS fee schedule,19.29,401,,,fee schedule,401% of BCBS fee schedule,59.4,90,,47.52,percent of total billed charges,90% of total billed charges,52.8,80,,42.24,percent of total billed charges,80% of total billed charges,59.4,90,,47.52,percent of total billed charges,90% of total billed charges,49.5,75,,39.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,19.14,29,,15.312,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,44.22,67,,35.376,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,52.8,80,,42.24,percent of total billed charges,80% of total billed charges,42.9,65,,34.32,percent of total billed charges,65% of total billed charges,23.54,35.67,,18.832,percent of total billed charges,35.67% of total billed charges,18.52,66,
SOLU MEDROL 50MG INJ,2509585,CDM,636,RC,J2920,HCPCS,outpatient,,,26,10.40,,22.1,85,,17.68,percent of total billed charges,85% of total billed charges,26,100,,20.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,13.32,385,,,fee schedule,385% of BCBS fee schedule,13.87,401,,,fee schedule,401% of BCBS fee schedule,13.87,401,,,fee schedule,401% of BCBS fee schedule,13.87,401,,,fee schedule,401% of BCBS fee schedule,23.4,90,,18.72,percent of total billed charges,90% of total billed charges,20.8,80,,16.64,percent of total billed charges,80% of total billed charges,23.4,90,,18.72,percent of total billed charges,90% of total billed charges,19.5,75,,15.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,7.54,29,,6.032,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,17.42,67,,13.936,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,20.8,80,,16.64,percent of total billed charges,80% of total billed charges,16.9,65,,13.52,percent of total billed charges,65% of total billed charges,9.27,35.67,,7.416,percent of total billed charges,35.67% of total billed charges,7.54,26,
SOLU MEDROL 40 MG VIAL,2509586,CDM,636,RC,J2919,HCPCS,outpatient,,,24,9.60,,20.4,85,,16.32,percent of total billed charges,85% of total billed charges,24,100,,19.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,19.68,82,,15.744,percent of total billed charges,82% of total billed charges,20.4,85,,16.32,percent of total billed charges,85% of total billed charges,20.4,85,,16.32,percent of total billed charges,85% of total billed charges,20.4,85,,16.32,percent of total billed charges,85% of total billed charges,21.6,90,,17.28,percent of total billed charges,90% of total billed charges,19.2,80,,15.36,percent of total billed charges,80% of total billed charges,21.6,90,,17.28,percent of total billed charges,90% of total billed charges,18,75,,14.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,6.96,29,,5.568,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,16.08,67,,12.864,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,19.2,80,,15.36,percent of total billed charges,80% of total billed charges,15.6,65,,12.48,percent of total billed charges,65% of total billed charges,8.56,35.67,,6.848,percent of total billed charges,35.67% of total billed charges,6.96,24,
SOLU MEDROL PED INJ/UP T040MG.,2509590,CDM,636,RC,J2920,HCPCS,outpatient,,,26,10.40,,22.1,85,,17.68,percent of total billed charges,85% of total billed charges,26,100,,20.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,13.32,385,,,fee schedule,385% of BCBS fee schedule,13.87,401,,,fee schedule,401% of BCBS fee schedule,13.87,401,,,fee schedule,401% of BCBS fee schedule,13.87,401,,,fee schedule,401% of BCBS fee schedule,23.4,90,,18.72,percent of total billed charges,90% of total billed charges,20.8,80,,16.64,percent of total billed charges,80% of total billed charges,23.4,90,,18.72,percent of total billed charges,90% of total billed charges,19.5,75,,15.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,7.54,29,,6.032,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,17.42,67,,13.936,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,20.8,80,,16.64,percent of total billed charges,80% of total billed charges,16.9,65,,13.52,percent of total billed charges,65% of total billed charges,9.27,35.67,,7.416,percent of total billed charges,35.67% of total billed charges,7.54,26,
SPIRIVA HANIHALER (SMALL),2509648,CDM,636,RC,J3535,HCPCS,outpatient,,,59,23.60,,50.15,85,,40.12,percent of total billed charges,85% of total billed charges,59,100,,47.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,48.38,82,,38.704,percent of total billed charges,82% of total billed charges,50.15,85,,40.12,percent of total billed charges,85% of total billed charges,50.15,85,,40.12,percent of total billed charges,85% of total billed charges,50.15,85,,40.12,percent of total billed charges,85% of total billed charges,53.1,90,,42.48,percent of total billed charges,90% of total billed charges,47.2,80,,37.76,percent of total billed charges,80% of total billed charges,53.1,90,,42.48,percent of total billed charges,90% of total billed charges,44.25,75,,35.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,17.11,29,,13.688,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,39.53,67,,31.624,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,47.2,80,,37.76,percent of total billed charges,80% of total billed charges,38.35,65,,30.68,percent of total billed charges,65% of total billed charges,21.05,35.67,,16.84,percent of total billed charges,35.67% of total billed charges,17.11,59,
BUDESONDIDE/FORMOTEROL 160-4.5,2509649,CDM,636,RC,J3535,HCPCS,outpatient,,,1246,498.40,,1059.1,85,,847.28,percent of total billed charges,85% of total billed charges,654.15,52.5,,523.32,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,1021.72,82,,817.376,percent of total billed charges,82% of total billed charges,1059.1,85,,847.28,percent of total billed charges,85% of total billed charges,1059.1,85,,847.28,percent of total billed charges,85% of total billed charges,1059.1,85,,847.28,percent of total billed charges,85% of total billed charges,1121.4,90,,897.12,percent of total billed charges,90% of total billed charges,996.8,80,,797.44,percent of total billed charges,80% of total billed charges,1121.4,90,,897.12,percent of total billed charges,90% of total billed charges,934.5,75,,747.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,361.34,29,,289.072,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,834.82,67,,667.856,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,996.8,80,,797.44,percent of total billed charges,80% of total billed charges,809.9,65,,647.92,percent of total billed charges,65% of total billed charges,444.45,35.67,,355.56,percent of total billed charges,35.67% of total billed charges,361.34,1121.4,
STADOL 1MG INJ,2509655,CDM,636,RC,J0595,HCPCS,outpatient,,,23,9.20,,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,23,100,,18.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,4,385,,,fee schedule,385% of BCBS fee schedule,4.17,401,,,fee schedule,401% of BCBS fee schedule,4.17,401,,,fee schedule,401% of BCBS fee schedule,4.17,401,,,fee schedule,401% of BCBS fee schedule,20.7,90,,16.56,percent of total billed charges,90% of total billed charges,18.4,80,,14.72,percent of total billed charges,80% of total billed charges,20.7,90,,16.56,percent of total billed charges,90% of total billed charges,17.25,75,,13.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,6.67,29,,5.336,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,15.41,67,,12.328,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,18.4,80,,14.72,percent of total billed charges,80% of total billed charges,14.95,65,,11.96,percent of total billed charges,65% of total billed charges,8.2,35.67,,6.56,percent of total billed charges,35.67% of total billed charges,4,23,
STADOL 2MG INJ,2509660,CDM,636,RC,J0595,HCPCS,outpatient,,,22,8.80,,18.7,85,,14.96,percent of total billed charges,85% of total billed charges,22,100,,17.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,4,385,,,fee schedule,385% of BCBS fee schedule,4.17,401,,,fee schedule,401% of BCBS fee schedule,4.17,401,,,fee schedule,401% of BCBS fee schedule,4.17,401,,,fee schedule,401% of BCBS fee schedule,19.8,90,,15.84,percent of total billed charges,90% of total billed charges,17.6,80,,14.08,percent of total billed charges,80% of total billed charges,19.8,90,,15.84,percent of total billed charges,90% of total billed charges,16.5,75,,13.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,6.38,29,,5.104,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,14.74,67,,11.792,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,17.6,80,,14.08,percent of total billed charges,80% of total billed charges,14.3,65,,11.44,percent of total billed charges,65% of total billed charges,7.85,35.67,,6.28,percent of total billed charges,35.67% of total billed charges,4,22,
STADOL 4MG INJ,2509670,CDM,636,RC,J0595,HCPCS,outpatient,,,45,18.00,,38.25,85,,30.6,percent of total billed charges,85% of total billed charges,45,100,,36,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,4,385,,,fee schedule,385% of BCBS fee schedule,4.17,401,,,fee schedule,401% of BCBS fee schedule,4.17,401,,,fee schedule,401% of BCBS fee schedule,4.17,401,,,fee schedule,401% of BCBS fee schedule,40.5,90,,32.4,percent of total billed charges,90% of total billed charges,36,80,,28.8,percent of total billed charges,80% of total billed charges,40.5,90,,32.4,percent of total billed charges,90% of total billed charges,33.75,75,,27,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,13.05,29,,10.44,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,30.15,67,,24.12,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,36,80,,28.8,percent of total billed charges,80% of total billed charges,29.25,65,,23.4,percent of total billed charges,65% of total billed charges,16.05,35.67,,12.84,percent of total billed charges,35.67% of total billed charges,4,45,
SUBLIMAZE 2CC/0.1 MG INJ*,2509750,CDM,636,RC,J3010,HCPCS,outpatient,,,28,11.20,,23.8,85,,19.04,percent of total billed charges,85% of total billed charges,28,100,,22.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,1.5,385,,,fee schedule,385% of BCBS fee schedule,1.56,401,,,fee schedule,401% of BCBS fee schedule,1.56,401,,,fee schedule,401% of BCBS fee schedule,1.56,401,,,fee schedule,401% of BCBS fee schedule,25.2,90,,20.16,percent of total billed charges,90% of total billed charges,22.4,80,,17.92,percent of total billed charges,80% of total billed charges,25.2,90,,20.16,percent of total billed charges,90% of total billed charges,21,75,,16.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,8.12,29,,6.496,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,18.76,67,,15.008,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,22.4,80,,17.92,percent of total billed charges,80% of total billed charges,18.2,65,,14.56,percent of total billed charges,65% of total billed charges,9.99,35.67,,7.992,percent of total billed charges,35.67% of total billed charges,1.5,28,
SUBLIMAZE 5CC INJ,2509755,CDM,636,RC,J3010,HCPCS,outpatient,,,13,5.20,,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,13,100,,10.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,1.5,385,,,fee schedule,385% of BCBS fee schedule,1.56,401,,,fee schedule,401% of BCBS fee schedule,1.56,401,,,fee schedule,401% of BCBS fee schedule,1.56,401,,,fee schedule,401% of BCBS fee schedule,11.7,90,,9.36,percent of total billed charges,90% of total billed charges,10.4,80,,8.32,percent of total billed charges,80% of total billed charges,11.7,90,,9.36,percent of total billed charges,90% of total billed charges,9.75,75,,7.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,3.77,29,,3.016,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,8.71,67,,6.968,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,10.4,80,,8.32,percent of total billed charges,80% of total billed charges,8.45,65,,6.76,percent of total billed charges,65% of total billed charges,4.64,35.67,,3.712,percent of total billed charges,35.67% of total billed charges,1.5,13,
SUBLIMAZE FENTANYL CITRAT 20ML,2509756,CDM,636,RC,J3010,HCPCS,outpatient,,,78,31.20,,66.3,85,,53.04,percent of total billed charges,85% of total billed charges,78,100,,62.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,1.5,385,,,fee schedule,385% of BCBS fee schedule,1.56,401,,,fee schedule,401% of BCBS fee schedule,1.56,401,,,fee schedule,401% of BCBS fee schedule,1.56,401,,,fee schedule,401% of BCBS fee schedule,70.2,90,,56.16,percent of total billed charges,90% of total billed charges,62.4,80,,49.92,percent of total billed charges,80% of total billed charges,70.2,90,,56.16,percent of total billed charges,90% of total billed charges,58.5,75,,46.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,22.62,29,,18.096,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,52.26,67,,41.808,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,62.4,80,,49.92,percent of total billed charges,80% of total billed charges,50.7,65,,40.56,percent of total billed charges,65% of total billed charges,27.82,35.67,,22.256,percent of total billed charges,35.67% of total billed charges,1.5,78,
SUPARTZ 25 MG/2.5ML,2509788,CDM,636,RC,J7321,HCPCS,outpatient,,,396,158.40,,336.6,85,,269.28,percent of total billed charges,85% of total billed charges,396,100,,316.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,350.16,385,,,fee schedule,385% of BCBS fee schedule,364.71,401,,,fee schedule,401% of BCBS fee schedule,364.71,401,,,fee schedule,401% of BCBS fee schedule,364.71,401,,,fee schedule,401% of BCBS fee schedule,356.4,90,,285.12,percent of total billed charges,90% of total billed charges,316.8,80,,253.44,percent of total billed charges,80% of total billed charges,356.4,90,,285.12,percent of total billed charges,90% of total billed charges,297,75,,237.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,114.84,29,,91.872,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,265.32,67,,212.256,percent of total billed charges,67% of total billed charges,95.03,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,316.8,80,,253.44,percent of total billed charges,80% of total billed charges,257.4,65,,205.92,percent of total billed charges,65% of total billed charges,141.25,35.67,,113,percent of total billed charges,35.67% of total billed charges,95.03,396,
SUPARTZ 25MG.2.5MG INJ,2509789,CDM,636,RC,J7321,HCPCS,outpatient,,,787,314.80,,668.95,85,,535.16,percent of total billed charges,85% of total billed charges,787,100,,629.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,350.16,385,,,fee schedule,385% of BCBS fee schedule,364.71,401,,,fee schedule,401% of BCBS fee schedule,364.71,401,,,fee schedule,401% of BCBS fee schedule,364.71,401,,,fee schedule,401% of BCBS fee schedule,708.3,90,,566.64,percent of total billed charges,90% of total billed charges,629.6,80,,503.68,percent of total billed charges,80% of total billed charges,708.3,90,,566.64,percent of total billed charges,90% of total billed charges,590.25,75,,472.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,228.23,29,,182.584,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,527.29,67,,421.832,percent of total billed charges,67% of total billed charges,95.03,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,629.6,80,,503.68,percent of total billed charges,80% of total billed charges,511.55,65,,409.24,percent of total billed charges,65% of total billed charges,280.72,35.67,,224.576,percent of total billed charges,35.67% of total billed charges,95.03,787,
PHENTOLAMINE MESYLATE 1 GM,2509801,CDM,636,RC,J2760,HCPCS,outpatient,,,1826,730.40,,1552.1,85,,1241.68,percent of total billed charges,85% of total billed charges,958.65,52.5,,766.92,percent of total billed charges,52.5 percent of total billed charges,367.12,100,,,fee schedule,100% of CMS OPPS rate,403.29,385,,,fee schedule,385% of BCBS fee schedule,420.05,401,,,fee schedule,401% of BCBS fee schedule,420.05,401,,,fee schedule,401% of BCBS fee schedule,420.05,401,,,fee schedule,401% of BCBS fee schedule,1643.4,90,,1314.72,percent of total billed charges,90% of total billed charges,1460.8,80,,1168.64,percent of total billed charges,80% of total billed charges,1643.4,90,,1314.72,percent of total billed charges,90% of total billed charges,1369.5,75,,1095.6,percent of total billed charges,75% of total billed charges,447.88,122,,,fee schedule,122% of HUMANA fee schedule,529.54,29,,423.632,percent of total billed charges,29% of total billed charges,367.12,100,,,fee schedule,100% of CMS OPPS rate,1223.42,67,,978.736,percent of total billed charges,67% of total billed charges,56.22,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,1460.8,80,,1168.64,percent of total billed charges,80% of total billed charges,1186.9,65,,949.52,percent of total billed charges,65% of total billed charges,651.33,35.67,,521.064,percent of total billed charges,35.67% of total billed charges,56.22,1643.4,
NOVOLOG INSULIN ANY DOSE,2509813,CDM,636,RC,J1815,HCPCS,outpatient,,,15,6.00,,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,15,100,,12,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,0.54,385,,,fee schedule,385% of BCBS fee schedule,0.56,401,,,fee schedule,401% of BCBS fee schedule,0.56,401,,,fee schedule,401% of BCBS fee schedule,0.56,401,,,fee schedule,401% of BCBS fee schedule,13.5,90,,10.8,percent of total billed charges,90% of total billed charges,12,80,,9.6,percent of total billed charges,80% of total billed charges,13.5,90,,10.8,percent of total billed charges,90% of total billed charges,11.25,75,,9,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,4.35,29,,3.48,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,10.05,67,,8.04,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,12,80,,9.6,percent of total billed charges,80% of total billed charges,9.75,65,,7.8,percent of total billed charges,65% of total billed charges,5.35,35.67,,4.28,percent of total billed charges,35.67% of total billed charges,0.54,15,
"SYNVISC 2 ML, 16 MG INJ*",2509846,CDM,636,RC,J7325,HCPCS,outpatient,,,594,237.60,,504.9,85,,403.92,percent of total billed charges,85% of total billed charges,594,100,,475.2,percent of total billed charges,pays based on exceed threshold rate,9.16,100,,,fee schedule,100% of CMS OPPS rate,49.05,385,,,fee schedule,385% of BCBS fee schedule,51.09,401,,,fee schedule,401% of BCBS fee schedule,51.09,401,,,fee schedule,401% of BCBS fee schedule,51.09,401,,,fee schedule,401% of BCBS fee schedule,534.6,90,,427.68,percent of total billed charges,90% of total billed charges,475.2,80,,380.16,percent of total billed charges,80% of total billed charges,534.6,90,,427.68,percent of total billed charges,90% of total billed charges,445.5,75,,356.4,percent of total billed charges,75% of total billed charges,11.17,122,,,fee schedule,122% of HUMANA fee schedule,172.26,29,,137.808,percent of total billed charges,29% of total billed charges,9.16,100,,,fee schedule,100% of CMS OPPS rate,397.98,67,,318.384,percent of total billed charges,67% of total billed charges,12.58,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,475.2,80,,380.16,percent of total billed charges,80% of total billed charges,386.1,65,,308.88,percent of total billed charges,65% of total billed charges,211.88,35.67,,169.504,percent of total billed charges,35.67% of total billed charges,9.16,594,
SYNVISC INJ 16 MG/2ML SUBSEQUE,2509847,CDM,636,RC,J7325,HCPCS,outpatient,,,594,237.60,EJ,504.9,85,,403.92,percent of total billed charges,85% of total billed charges,594,100,,475.2,percent of total billed charges,pays based on exceed threshold rate,9.16,100,,,fee schedule,100% of CMS OPPS rate,49.05,385,,,fee schedule,385% of BCBS fee schedule,51.09,401,,,fee schedule,401% of BCBS fee schedule,51.09,401,,,fee schedule,401% of BCBS fee schedule,51.09,401,,,fee schedule,401% of BCBS fee schedule,534.6,90,,427.68,percent of total billed charges,90% of total billed charges,475.2,80,,380.16,percent of total billed charges,80% of total billed charges,534.6,90,,427.68,percent of total billed charges,90% of total billed charges,445.5,75,,356.4,percent of total billed charges,75% of total billed charges,11.17,122,,,fee schedule,122% of HUMANA fee schedule,172.26,29,,137.808,percent of total billed charges,29% of total billed charges,9.16,100,,,fee schedule,100% of CMS OPPS rate,397.98,67,,318.384,percent of total billed charges,67% of total billed charges,12.58,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,475.2,80,,380.16,percent of total billed charges,80% of total billed charges,386.1,65,,308.88,percent of total billed charges,65% of total billed charges,211.88,35.67,,169.504,percent of total billed charges,35.67% of total billed charges,9.16,594,
SYNVISC ONE PREFILLED 48MG OUT,2509852,CDM,636,RC,J7325,HCPCS,outpatient,,,2307,922.80,,1960.95,85,,1568.76,percent of total billed charges,85% of total billed charges,1211.18,52.5,,968.94,percent of total billed charges,52.5 percent of total billed charges,9.16,100,,,fee schedule,100% of CMS OPPS rate,49.05,385,,,fee schedule,385% of BCBS fee schedule,51.09,401,,,fee schedule,401% of BCBS fee schedule,51.09,401,,,fee schedule,401% of BCBS fee schedule,51.09,401,,,fee schedule,401% of BCBS fee schedule,2076.3,90,,1661.04,percent of total billed charges,90% of total billed charges,1845.6,80,,1476.48,percent of total billed charges,80% of total billed charges,2076.3,90,,1661.04,percent of total billed charges,90% of total billed charges,1730.25,75,,1384.2,percent of total billed charges,75% of total billed charges,11.17,122,,,fee schedule,122% of HUMANA fee schedule,669.03,29,,535.224,percent of total billed charges,29% of total billed charges,9.16,100,,,fee schedule,100% of CMS OPPS rate,1545.69,67,,1236.552,percent of total billed charges,67% of total billed charges,12.58,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,1845.6,80,,1476.48,percent of total billed charges,80% of total billed charges,1499.55,65,,1199.64,percent of total billed charges,65% of total billed charges,822.91,35.67,,658.328,percent of total billed charges,35.67% of total billed charges,9.16,2076.3,
DYLOJECT INJ 37.5 MG/ML,2509951,CDM,636,RC,J3490,HCPCS,outpatient,,,25,10.00,,21.25,85,,17,percent of total billed charges,85% of total billed charges,25,100,,20,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,20.5,82,,16.4,percent of total billed charges,82% of total billed charges,21.25,85,,17,percent of total billed charges,85% of total billed charges,21.25,85,,17,percent of total billed charges,85% of total billed charges,21.25,85,,17,percent of total billed charges,85% of total billed charges,22.5,90,,18,percent of total billed charges,90% of total billed charges,20,80,,16,percent of total billed charges,80% of total billed charges,22.5,90,,18,percent of total billed charges,90% of total billed charges,18.75,75,,15,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,7.25,29,,5.8,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,16.75,67,,13.4,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,20,80,,16,percent of total billed charges,80% of total billed charges,16.25,65,,13,percent of total billed charges,65% of total billed charges,8.92,35.67,,7.136,percent of total billed charges,35.67% of total billed charges,7.25,25,
"SODIUM,POTASSIUM PHOSPHATES",2509952,CDM,636,RC,J3490,HCPCS,outpatient,,,4,1.60,,3.4,85,,2.72,percent of total billed charges,85% of total billed charges,4,100,,3.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,3.28,82,,2.624,percent of total billed charges,82% of total billed charges,3.4,85,,2.72,percent of total billed charges,85% of total billed charges,3.4,85,,2.72,percent of total billed charges,85% of total billed charges,3.4,85,,2.72,percent of total billed charges,85% of total billed charges,3.6,90,,2.88,percent of total billed charges,90% of total billed charges,3.2,80,,2.56,percent of total billed charges,80% of total billed charges,3.6,90,,2.88,percent of total billed charges,90% of total billed charges,3,75,,2.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,1.16,29,,0.928,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,2.68,67,,2.144,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,3.2,80,,2.56,percent of total billed charges,80% of total billed charges,2.6,65,,2.08,percent of total billed charges,65% of total billed charges,1.43,35.67,,1.144,percent of total billed charges,35.67% of total billed charges,1.16,4,
LIDOCAINE-PRILOCAINE 2.5% CREA,2509953,CDM,636,RC,J3490,HCPCS,outpatient,,,58,23.20,,49.3,85,,39.44,percent of total billed charges,85% of total billed charges,58,100,,46.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,47.56,82,,38.048,percent of total billed charges,82% of total billed charges,49.3,85,,39.44,percent of total billed charges,85% of total billed charges,49.3,85,,39.44,percent of total billed charges,85% of total billed charges,49.3,85,,39.44,percent of total billed charges,85% of total billed charges,52.2,90,,41.76,percent of total billed charges,90% of total billed charges,46.4,80,,37.12,percent of total billed charges,80% of total billed charges,52.2,90,,41.76,percent of total billed charges,90% of total billed charges,43.5,75,,34.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,16.82,29,,13.456,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,38.86,67,,31.088,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,46.4,80,,37.12,percent of total billed charges,80% of total billed charges,37.7,65,,30.16,percent of total billed charges,65% of total billed charges,20.69,35.67,,16.552,percent of total billed charges,35.67% of total billed charges,16.82,58,
TRIPLE ANTIBIOTIC OINTMENT 28G,2509954,CDM,636,RC,J3490,HCPCS,outpatient,,,11,4.40,,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,11,100,,8.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,9.02,82,,7.216,percent of total billed charges,82% of total billed charges,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,9.9,90,,7.92,percent of total billed charges,90% of total billed charges,8.8,80,,7.04,percent of total billed charges,80% of total billed charges,9.9,90,,7.92,percent of total billed charges,90% of total billed charges,8.25,75,,6.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,3.19,29,,2.552,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,7.37,67,,5.896,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,8.8,80,,7.04,percent of total billed charges,80% of total billed charges,7.15,65,,5.72,percent of total billed charges,65% of total billed charges,3.92,35.67,,3.136,percent of total billed charges,35.67% of total billed charges,3.19,11,
SUGAMMADEX SODIUM 500 MG/ML ML,2509956,CDM,636,RC,J3490,HCPCS,outpatient,,,865,346.00,,735.25,85,,588.2,percent of total billed charges,85% of total billed charges,865,100,,692,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,709.3,82,,567.44,percent of total billed charges,82% of total billed charges,735.25,85,,588.2,percent of total billed charges,85% of total billed charges,735.25,85,,588.2,percent of total billed charges,85% of total billed charges,735.25,85,,588.2,percent of total billed charges,85% of total billed charges,778.5,90,,622.8,percent of total billed charges,90% of total billed charges,692,80,,553.6,percent of total billed charges,80% of total billed charges,778.5,90,,622.8,percent of total billed charges,90% of total billed charges,648.75,75,,519,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,250.85,29,,200.68,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,579.55,67,,463.64,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,692,80,,553.6,percent of total billed charges,80% of total billed charges,562.25,65,,449.8,percent of total billed charges,65% of total billed charges,308.55,35.67,,246.84,percent of total billed charges,35.67% of total billed charges,250.85,865,
LIDOCAINE HCL 20MG/ML,2509957,CDM,636,RC,J3490,HCPCS,outpatient,,,17,6.80,,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,17,100,,13.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,13.94,82,,11.152,percent of total billed charges,82% of total billed charges,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,15.3,90,,12.24,percent of total billed charges,90% of total billed charges,13.6,80,,10.88,percent of total billed charges,80% of total billed charges,15.3,90,,12.24,percent of total billed charges,90% of total billed charges,12.75,75,,10.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,4.93,29,,3.944,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,11.39,67,,9.112,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,13.6,80,,10.88,percent of total billed charges,80% of total billed charges,11.05,65,,8.84,percent of total billed charges,65% of total billed charges,6.06,35.67,,4.848,percent of total billed charges,35.67% of total billed charges,4.93,17,
TRAZADONE 100 MG TAB,2509982,CDM,636,RC,J3490,HCPCS,outpatient,,,11,4.40,,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,11,100,,8.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,9.02,82,,7.216,percent of total billed charges,82% of total billed charges,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,9.9,90,,7.92,percent of total billed charges,90% of total billed charges,8.8,80,,7.04,percent of total billed charges,80% of total billed charges,9.9,90,,7.92,percent of total billed charges,90% of total billed charges,8.25,75,,6.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,3.19,29,,2.552,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,7.37,67,,5.896,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,8.8,80,,7.04,percent of total billed charges,80% of total billed charges,7.15,65,,5.72,percent of total billed charges,65% of total billed charges,3.92,35.67,,3.136,percent of total billed charges,35.67% of total billed charges,3.19,11,
VASOPRESSIN 20 UNIT/ML,2509983,CDM,636,RC,J3490,HCPCS,outpatient,,,227,90.80,,192.95,85,,154.36,percent of total billed charges,85% of total billed charges,227,100,,181.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,186.14,82,,148.912,percent of total billed charges,82% of total billed charges,192.95,85,,154.36,percent of total billed charges,85% of total billed charges,192.95,85,,154.36,percent of total billed charges,85% of total billed charges,192.95,85,,154.36,percent of total billed charges,85% of total billed charges,204.3,90,,163.44,percent of total billed charges,90% of total billed charges,181.6,80,,145.28,percent of total billed charges,80% of total billed charges,204.3,90,,163.44,percent of total billed charges,90% of total billed charges,170.25,75,,136.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,65.83,29,,52.664,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,152.09,67,,121.672,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,181.6,80,,145.28,percent of total billed charges,80% of total billed charges,147.55,65,,118.04,percent of total billed charges,65% of total billed charges,80.97,35.67,,64.776,percent of total billed charges,35.67% of total billed charges,65.83,227,
XYLOCAINE W/EPINEPHRINE 1%50ML,2509984,CDM,636,RC,J3490,HCPCS,outpatient,,,38,15.20,,32.3,85,,25.84,percent of total billed charges,85% of total billed charges,38,100,,30.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,31.16,82,,24.928,percent of total billed charges,82% of total billed charges,32.3,85,,25.84,percent of total billed charges,85% of total billed charges,32.3,85,,25.84,percent of total billed charges,85% of total billed charges,32.3,85,,25.84,percent of total billed charges,85% of total billed charges,34.2,90,,27.36,percent of total billed charges,90% of total billed charges,30.4,80,,24.32,percent of total billed charges,80% of total billed charges,34.2,90,,27.36,percent of total billed charges,90% of total billed charges,28.5,75,,22.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,11.02,29,,8.816,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,25.46,67,,20.368,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,30.4,80,,24.32,percent of total billed charges,80% of total billed charges,24.7,65,,19.76,percent of total billed charges,65% of total billed charges,13.55,35.67,,10.84,percent of total billed charges,35.67% of total billed charges,11.02,38,
LIDOCAINE HCL 2%,2509988,CDM,636,RC,J3490,HCPCS,outpatient,,,34,13.60,,28.9,85,,23.12,percent of total billed charges,85% of total billed charges,34,100,,27.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,27.88,82,,22.304,percent of total billed charges,82% of total billed charges,28.9,85,,23.12,percent of total billed charges,85% of total billed charges,28.9,85,,23.12,percent of total billed charges,85% of total billed charges,28.9,85,,23.12,percent of total billed charges,85% of total billed charges,30.6,90,,24.48,percent of total billed charges,90% of total billed charges,27.2,80,,21.76,percent of total billed charges,80% of total billed charges,30.6,90,,24.48,percent of total billed charges,90% of total billed charges,25.5,75,,20.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,9.86,29,,7.888,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,22.78,67,,18.224,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,27.2,80,,21.76,percent of total billed charges,80% of total billed charges,22.1,65,,17.68,percent of total billed charges,65% of total billed charges,12.13,35.67,,9.704,percent of total billed charges,35.67% of total billed charges,9.86,34,
MANNITOL 20% SOLUTION,2509989,CDM,636,RC,J3490,HCPCS,outpatient,,,72,28.80,,61.2,85,,48.96,percent of total billed charges,85% of total billed charges,72,100,,57.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,59.04,82,,47.232,percent of total billed charges,82% of total billed charges,61.2,85,,48.96,percent of total billed charges,85% of total billed charges,61.2,85,,48.96,percent of total billed charges,85% of total billed charges,61.2,85,,48.96,percent of total billed charges,85% of total billed charges,64.8,90,,51.84,percent of total billed charges,90% of total billed charges,57.6,80,,46.08,percent of total billed charges,80% of total billed charges,64.8,90,,51.84,percent of total billed charges,90% of total billed charges,54,75,,43.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,20.88,29,,16.704,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,48.24,67,,38.592,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,57.6,80,,46.08,percent of total billed charges,80% of total billed charges,46.8,65,,37.44,percent of total billed charges,65% of total billed charges,25.68,35.67,,20.544,percent of total billed charges,35.67% of total billed charges,20.88,72,
CHOLECALCIFEROL 10MCG/ML,2509991,CDM,636,RC,J3490,HCPCS,outpatient,,,13,5.20,,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,13,100,,10.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,10.66,82,,8.528,percent of total billed charges,82% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,11.7,90,,9.36,percent of total billed charges,90% of total billed charges,10.4,80,,8.32,percent of total billed charges,80% of total billed charges,11.7,90,,9.36,percent of total billed charges,90% of total billed charges,9.75,75,,7.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,3.77,29,,3.016,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,8.71,67,,6.968,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,10.4,80,,8.32,percent of total billed charges,80% of total billed charges,8.45,65,,6.76,percent of total billed charges,65% of total billed charges,4.64,35.67,,3.712,percent of total billed charges,35.67% of total billed charges,3.77,13,
CITRANATAL PRENATAL SOFT GEL,2509993,CDM,636,RC,J3490,HCPCS,outpatient,,,11,4.40,,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,11,100,,8.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,9.02,82,,7.216,percent of total billed charges,82% of total billed charges,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,9.9,90,,7.92,percent of total billed charges,90% of total billed charges,8.8,80,,7.04,percent of total billed charges,80% of total billed charges,9.9,90,,7.92,percent of total billed charges,90% of total billed charges,8.25,75,,6.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,3.19,29,,2.552,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,7.37,67,,5.896,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,8.8,80,,7.04,percent of total billed charges,80% of total billed charges,7.15,65,,5.72,percent of total billed charges,65% of total billed charges,3.92,35.67,,3.136,percent of total billed charges,35.67% of total billed charges,3.19,11,
NAROPIN 0.2% 200 MG,2509999,CDM,636,RC,J2795,HCPCS,outpatient,,,171,68.40,,145.35,85,,116.28,percent of total billed charges,85% of total billed charges,171,100,,136.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,0.19,385,,,fee schedule,385% of BCBS fee schedule,0.2,401,,,fee schedule,401% of BCBS fee schedule,0.2,401,,,fee schedule,401% of BCBS fee schedule,0.2,401,,,fee schedule,401% of BCBS fee schedule,153.9,90,,123.12,percent of total billed charges,90% of total billed charges,136.8,80,,109.44,percent of total billed charges,80% of total billed charges,153.9,90,,123.12,percent of total billed charges,90% of total billed charges,128.25,75,,102.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,49.59,29,,39.672,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,114.57,67,,91.656,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,136.8,80,,109.44,percent of total billed charges,80% of total billed charges,111.15,65,,88.92,percent of total billed charges,65% of total billed charges,61,35.67,,48.8,percent of total billed charges,35.67% of total billed charges,0.19,171,
VARICELLA VACCINE,2510001,CDM,636,RC,90716,HCPCS,outpatient,,,259,103.60,,220.15,85,,176.12,percent of total billed charges,85% of total billed charges,259,100,,207.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,549.63,385,,,fee schedule,385% of BCBS fee schedule,572.47,401,,,fee schedule,401% of BCBS fee schedule,572.47,401,,,fee schedule,401% of BCBS fee schedule,572.47,401,,,fee schedule,401% of BCBS fee schedule,233.1,90,,186.48,percent of total billed charges,90% of total billed charges,207.2,80,,165.76,percent of total billed charges,80% of total billed charges,233.1,90,,186.48,percent of total billed charges,90% of total billed charges,194.25,75,,155.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,75.11,29,,60.088,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,173.53,67,,138.824,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,207.2,80,,165.76,percent of total billed charges,80% of total billed charges,168.35,65,,134.68,percent of total billed charges,65% of total billed charges,92.39,35.67,,73.912,percent of total billed charges,35.67% of total billed charges,75.11,572.47,
MIDAZOLAM 50 MG/50 ML BAG,25100074,CDM,636,RC,J2250,HCPCS,outpatient,,,264,105.60,,224.4,85,,179.52,percent of total billed charges,85% of total billed charges,264,100,,211.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,0.42,385,,,fee schedule,385% of BCBS fee schedule,0.44,401,,,fee schedule,401% of BCBS fee schedule,0.44,401,,,fee schedule,401% of BCBS fee schedule,0.44,401,,,fee schedule,401% of BCBS fee schedule,237.6,90,,190.08,percent of total billed charges,90% of total billed charges,211.2,80,,168.96,percent of total billed charges,80% of total billed charges,237.6,90,,190.08,percent of total billed charges,90% of total billed charges,198,75,,158.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,76.56,29,,61.248,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,176.88,67,,141.504,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,211.2,80,,168.96,percent of total billed charges,80% of total billed charges,171.6,65,,137.28,percent of total billed charges,65% of total billed charges,94.17,35.67,,75.336,percent of total billed charges,35.67% of total billed charges,0.42,264,
CIMZIA 400 MG,2510009,CDM,636,RC,J0717,HCPCS,outpatient,,,7619,3047.60,,6476.15,85,,5180.92,percent of total billed charges,85% of total billed charges,3999.98,52.5,,3199.98,percent of total billed charges,52.5 percent of total billed charges,4.65,100,,,fee schedule,100% of CMS OPPS rate,32.53,385,,,fee schedule,385% of BCBS fee schedule,33.88,401,,,fee schedule,401% of BCBS fee schedule,33.88,401,,,fee schedule,401% of BCBS fee schedule,33.88,401,,,fee schedule,401% of BCBS fee schedule,6857.1,90,,5485.68,percent of total billed charges,90% of total billed charges,6095.2,80,,4876.16,percent of total billed charges,80% of total billed charges,6857.1,90,,5485.68,percent of total billed charges,90% of total billed charges,5714.25,75,,4571.4,percent of total billed charges,75% of total billed charges,5.67,122,,,fee schedule,122% of HUMANA fee schedule,2209.51,29,,1767.608,percent of total billed charges,29% of total billed charges,4.65,100,,,fee schedule,100% of CMS OPPS rate,5104.73,67,,4083.784,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,6095.2,80,,4876.16,percent of total billed charges,80% of total billed charges,4952.35,65,,3961.88,percent of total billed charges,65% of total billed charges,2717.7,35.67,,2174.16,percent of total billed charges,35.67% of total billed charges,4.65,6857.1,
NOVULIN INSULIN,2510016,CDM,636,RC,J1815,HCPCS,outpatient,,,7,2.80,,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,7,100,,5.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,0.54,385,,,fee schedule,385% of BCBS fee schedule,0.56,401,,,fee schedule,401% of BCBS fee schedule,0.56,401,,,fee schedule,401% of BCBS fee schedule,0.56,401,,,fee schedule,401% of BCBS fee schedule,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.25,75,,4.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.03,29,,1.624,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4.69,67,,3.752,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,4.55,65,,3.64,percent of total billed charges,65% of total billed charges,2.5,35.67,,2,percent of total billed charges,35.67% of total billed charges,0.54,7,
LACOSAMIDE 200 MG/20 ML,2510018,CDM,636,RC,C9254,HCPCS,outpatient,,,171,68.40,,145.35,85,,116.28,percent of total billed charges,85% of total billed charges,171,100,,136.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,140.22,82,,112.176,percent of total billed charges,82% of total billed charges,145.35,85,,116.28,percent of total billed charges,85% of total billed charges,145.35,85,,116.28,percent of total billed charges,85% of total billed charges,145.35,85,,116.28,percent of total billed charges,85% of total billed charges,153.9,90,,123.12,percent of total billed charges,90% of total billed charges,136.8,80,,109.44,percent of total billed charges,80% of total billed charges,153.9,90,,123.12,percent of total billed charges,90% of total billed charges,128.25,75,,102.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,49.59,29,,39.672,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,114.57,67,,91.656,percent of total billed charges,67% of total billed charges,0.14,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,136.8,80,,109.44,percent of total billed charges,80% of total billed charges,111.15,65,,88.92,percent of total billed charges,65% of total billed charges,61,35.67,,48.8,percent of total billed charges,35.67% of total billed charges,0.14,171,
MAGNESIUM 2 MG/50 ML PREMIX,2510019,CDM,636,RC,J3475,HCPCS,outpatient,,,66,26.40,,56.1,85,,44.88,percent of total billed charges,85% of total billed charges,66,100,,52.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,0.27,385,,,fee schedule,385% of BCBS fee schedule,0.28,401,,,fee schedule,401% of BCBS fee schedule,0.28,401,,,fee schedule,401% of BCBS fee schedule,0.28,401,,,fee schedule,401% of BCBS fee schedule,59.4,90,,47.52,percent of total billed charges,90% of total billed charges,52.8,80,,42.24,percent of total billed charges,80% of total billed charges,59.4,90,,47.52,percent of total billed charges,90% of total billed charges,49.5,75,,39.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,19.14,29,,15.312,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,44.22,67,,35.376,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,52.8,80,,42.24,percent of total billed charges,80% of total billed charges,42.9,65,,34.32,percent of total billed charges,65% of total billed charges,23.54,35.67,,18.832,percent of total billed charges,35.67% of total billed charges,0.27,66,
DESMOPRESSIN 1 MCG,2510023,CDM,636,RC,J2597,HCPCS,outpatient,,,762,304.80,,647.7,85,,518.16,percent of total billed charges,85% of total billed charges,762,100,,609.6,percent of total billed charges,pays based on exceed threshold rate,5.42,100,,,fee schedule,100% of CMS OPPS rate,4.97,385,,,fee schedule,385% of BCBS fee schedule,5.17,401,,,fee schedule,401% of BCBS fee schedule,5.17,401,,,fee schedule,401% of BCBS fee schedule,5.17,401,,,fee schedule,401% of BCBS fee schedule,685.8,90,,548.64,percent of total billed charges,90% of total billed charges,609.6,80,,487.68,percent of total billed charges,80% of total billed charges,685.8,90,,548.64,percent of total billed charges,90% of total billed charges,571.5,75,,457.2,percent of total billed charges,75% of total billed charges,6.61,122,,,fee schedule,122% of HUMANA fee schedule,220.98,29,,176.784,percent of total billed charges,29% of total billed charges,5.42,100,,,fee schedule,100% of CMS OPPS rate,510.54,67,,408.432,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,609.6,80,,487.68,percent of total billed charges,80% of total billed charges,495.3,65,,396.24,percent of total billed charges,65% of total billed charges,271.81,35.67,,217.448,percent of total billed charges,35.67% of total billed charges,4.97,762,
DENOSUMAB 120 MG,2510057,CDM,636,RC,J0897,HCPCS,outpatient,,,4417,1766.80,,3754.45,85,,3003.56,percent of total billed charges,85% of total billed charges,2318.93,52.5,,1855.14,percent of total billed charges,52.5 percent of total billed charges,26.96,100,,,fee schedule,100% of CMS OPPS rate,68.34,385,,,fee schedule,385% of BCBS fee schedule,71.18,401,,,fee schedule,401% of BCBS fee schedule,71.18,401,,,fee schedule,401% of BCBS fee schedule,71.18,401,,,fee schedule,401% of BCBS fee schedule,3975.3,90,,3180.24,percent of total billed charges,90% of total billed charges,3533.6,80,,2826.88,percent of total billed charges,80% of total billed charges,3975.3,90,,3180.24,percent of total billed charges,90% of total billed charges,3312.75,75,,2650.2,percent of total billed charges,75% of total billed charges,32.89,122,,,fee schedule,122% of HUMANA fee schedule,1280.93,29,,1024.744,percent of total billed charges,29% of total billed charges,26.96,100,,,fee schedule,100% of CMS OPPS rate,2959.39,67,,2367.512,percent of total billed charges,67% of total billed charges,15.03,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,3533.6,80,,2826.88,percent of total billed charges,80% of total billed charges,2871.05,65,,2296.84,percent of total billed charges,65% of total billed charges,1575.54,35.67,,1260.432,percent of total billed charges,35.67% of total billed charges,15.03,3975.3,
SKYLA IUD,2510058,CDM,636,RC,J7301,HCPCS,outpatient,,,1690,676.00,,1436.5,85,,1149.2,percent of total billed charges,85% of total billed charges,887.25,52.5,,709.8,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,2751.6,385,,,fee schedule,385% of BCBS fee schedule,2865.95,401,,,fee schedule,401% of BCBS fee schedule,2865.95,401,,,fee schedule,401% of BCBS fee schedule,2865.95,401,,,fee schedule,401% of BCBS fee schedule,1521,90,,1216.8,percent of total billed charges,90% of total billed charges,1352,80,,1081.6,percent of total billed charges,80% of total billed charges,1521,90,,1216.8,percent of total billed charges,90% of total billed charges,1267.5,75,,1014,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,490.1,29,,392.08,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1132.3,67,,905.84,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1352,80,,1081.6,percent of total billed charges,80% of total billed charges,1098.5,65,,878.8,percent of total billed charges,65% of total billed charges,602.82,35.67,,482.256,percent of total billed charges,35.67% of total billed charges,490.1,2865.95,
BOOSTRIX TP/LK SYG,2510066,CDM,636,RC,90715,HCPCS,outpatient,,,118,47.20,,100.3,85,,80.24,percent of total billed charges,85% of total billed charges,118,100,,94.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,149.46,385,,,fee schedule,385% of BCBS fee schedule,155.67,401,,,fee schedule,401% of BCBS fee schedule,155.67,401,,,fee schedule,401% of BCBS fee schedule,155.67,401,,,fee schedule,401% of BCBS fee schedule,106.2,90,,84.96,percent of total billed charges,90% of total billed charges,94.4,80,,75.52,percent of total billed charges,80% of total billed charges,106.2,90,,84.96,percent of total billed charges,90% of total billed charges,88.5,75,,70.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,34.22,29,,27.376,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,79.06,67,,63.248,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,94.4,80,,75.52,percent of total billed charges,80% of total billed charges,76.7,65,,61.36,percent of total billed charges,65% of total billed charges,42.09,35.67,,33.672,percent of total billed charges,35.67% of total billed charges,34.22,155.67,
MIDAZOLAM 5 MG/5 ML INJ,2510072,CDM,636,RC,J2250,HCPCS,outpatient,,,23,9.20,,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,23,100,,18.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,0.42,385,,,fee schedule,385% of BCBS fee schedule,0.44,401,,,fee schedule,401% of BCBS fee schedule,0.44,401,,,fee schedule,401% of BCBS fee schedule,0.44,401,,,fee schedule,401% of BCBS fee schedule,20.7,90,,16.56,percent of total billed charges,90% of total billed charges,18.4,80,,14.72,percent of total billed charges,80% of total billed charges,20.7,90,,16.56,percent of total billed charges,90% of total billed charges,17.25,75,,13.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,6.67,29,,5.336,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,15.41,67,,12.328,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,18.4,80,,14.72,percent of total billed charges,80% of total billed charges,14.95,65,,11.96,percent of total billed charges,65% of total billed charges,8.2,35.67,,6.56,percent of total billed charges,35.67% of total billed charges,0.42,23,
MIDAZOLAM 50MG/10 ML,2510073,CDM,636,RC,J2250,HCPCS,outpatient,,,46,18.40,,39.1,85,,31.28,percent of total billed charges,85% of total billed charges,46,100,,36.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,0.42,385,,,fee schedule,385% of BCBS fee schedule,0.44,401,,,fee schedule,401% of BCBS fee schedule,0.44,401,,,fee schedule,401% of BCBS fee schedule,0.44,401,,,fee schedule,401% of BCBS fee schedule,41.4,90,,33.12,percent of total billed charges,90% of total billed charges,36.8,80,,29.44,percent of total billed charges,80% of total billed charges,41.4,90,,33.12,percent of total billed charges,90% of total billed charges,34.5,75,,27.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,13.34,29,,10.672,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,30.82,67,,24.656,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,36.8,80,,29.44,percent of total billed charges,80% of total billed charges,29.9,65,,23.92,percent of total billed charges,65% of total billed charges,16.41,35.67,,13.128,percent of total billed charges,35.67% of total billed charges,0.42,46,
DALVANCE 500 MG IV,2510091,CDM,636,RC,J0875,HCPCS,outpatient,,,3172,1268.80,,2696.2,85,,2156.96,percent of total billed charges,85% of total billed charges,1665.3,52.5,,1332.24,percent of total billed charges,52.5 percent of total billed charges,15.61,100,,,fee schedule,100% of CMS OPPS rate,59.1,385,,,fee schedule,385% of BCBS fee schedule,61.55,401,,,fee schedule,401% of BCBS fee schedule,61.55,401,,,fee schedule,401% of BCBS fee schedule,61.55,401,,,fee schedule,401% of BCBS fee schedule,2854.8,90,,2283.84,percent of total billed charges,90% of total billed charges,2537.6,80,,2030.08,percent of total billed charges,80% of total billed charges,2854.8,90,,2283.84,percent of total billed charges,90% of total billed charges,2379,75,,1903.2,percent of total billed charges,75% of total billed charges,19.04,122,,,fee schedule,122% of HUMANA fee schedule,919.88,29,,735.904,percent of total billed charges,29% of total billed charges,15.61,100,,,fee schedule,100% of CMS OPPS rate,2125.24,67,,1700.192,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,2537.6,80,,2030.08,percent of total billed charges,80% of total billed charges,2061.8,65,,1649.44,percent of total billed charges,65% of total billed charges,1131.45,35.67,,905.16,percent of total billed charges,35.67% of total billed charges,15.61,2854.8,
TESTOSTERONE INJ 1CC/100MG,2510110,CDM,636,RC,J1071,HCPCS,outpatient,,,10,4.00,,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,10,100,,8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,0.12,385,,,fee schedule,385% of BCBS fee schedule,0.12,401,,,fee schedule,401% of BCBS fee schedule,0.12,401,,,fee schedule,401% of BCBS fee schedule,0.12,401,,,fee schedule,401% of BCBS fee schedule,9,90,,7.2,percent of total billed charges,90% of total billed charges,8,80,,6.4,percent of total billed charges,80% of total billed charges,9,90,,7.2,percent of total billed charges,90% of total billed charges,7.5,75,,6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.9,29,,2.32,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,6.7,67,,5.36,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,8,80,,6.4,percent of total billed charges,80% of total billed charges,6.5,65,,5.2,percent of total billed charges,65% of total billed charges,3.57,35.67,,2.856,percent of total billed charges,35.67% of total billed charges,0.12,10,
TETANUS DIPTH TOX INJ,2510120,CDM,636,RC,90714,HCPCS,outpatient,,,91,36.40,,77.35,85,,61.88,percent of total billed charges,85% of total billed charges,91,100,,72.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,107.8,385,,,fee schedule,385% of BCBS fee schedule,112.28,401,,,fee schedule,401% of BCBS fee schedule,112.28,401,,,fee schedule,401% of BCBS fee schedule,112.28,401,,,fee schedule,401% of BCBS fee schedule,81.9,90,,65.52,percent of total billed charges,90% of total billed charges,72.8,80,,58.24,percent of total billed charges,80% of total billed charges,81.9,90,,65.52,percent of total billed charges,90% of total billed charges,68.25,75,,54.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,26.39,29,,21.112,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,60.97,67,,48.776,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,72.8,80,,58.24,percent of total billed charges,80% of total billed charges,59.15,65,,47.32,percent of total billed charges,65% of total billed charges,32.46,35.67,,25.968,percent of total billed charges,35.67% of total billed charges,26.39,112.28,
CEFEPIME 1 GRAM INJ,2510139,CDM,636,RC,J0692,HCPCS,outpatient,,,308,123.20,,261.8,85,,209.44,percent of total billed charges,85% of total billed charges,308,100,,246.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,9.43,385,,,fee schedule,385% of BCBS fee schedule,9.82,401,,,fee schedule,401% of BCBS fee schedule,9.82,401,,,fee schedule,401% of BCBS fee schedule,9.82,401,,,fee schedule,401% of BCBS fee schedule,277.2,90,,221.76,percent of total billed charges,90% of total billed charges,246.4,80,,197.12,percent of total billed charges,80% of total billed charges,277.2,90,,221.76,percent of total billed charges,90% of total billed charges,231,75,,184.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,89.32,29,,71.456,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,206.36,67,,165.088,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,246.4,80,,197.12,percent of total billed charges,80% of total billed charges,200.2,65,,160.16,percent of total billed charges,65% of total billed charges,109.86,35.67,,87.888,percent of total billed charges,35.67% of total billed charges,9.43,308,
POTASSIUM CHLORIDE 20 MEQ NACL,2510141,CDM,636,RC,J3480,HCPCS,outpatient,,,26,10.40,,22.1,85,,17.68,percent of total billed charges,85% of total billed charges,26,100,,20.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,0.15,385,,,fee schedule,385% of BCBS fee schedule,0.16,401,,,fee schedule,401% of BCBS fee schedule,0.16,401,,,fee schedule,401% of BCBS fee schedule,0.16,401,,,fee schedule,401% of BCBS fee schedule,23.4,90,,18.72,percent of total billed charges,90% of total billed charges,20.8,80,,16.64,percent of total billed charges,80% of total billed charges,23.4,90,,18.72,percent of total billed charges,90% of total billed charges,19.5,75,,15.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,7.54,29,,6.032,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,17.42,67,,13.936,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,20.8,80,,16.64,percent of total billed charges,80% of total billed charges,16.9,65,,13.52,percent of total billed charges,65% of total billed charges,9.27,35.67,,7.416,percent of total billed charges,35.67% of total billed charges,0.15,26,
TEFLARO 60 MG,2510199,CDM,636,RC,J0712,HCPCS,outpatient,,,611,244.40,,519.35,85,,415.48,percent of total billed charges,85% of total billed charges,611,100,,488.8,percent of total billed charges,pays based on exceed threshold rate,3.94,100,,,fee schedule,100% of CMS OPPS rate,10.32,385,,,fee schedule,385% of BCBS fee schedule,10.75,401,,,fee schedule,401% of BCBS fee schedule,10.75,401,,,fee schedule,401% of BCBS fee schedule,10.75,401,,,fee schedule,401% of BCBS fee schedule,549.9,90,,439.92,percent of total billed charges,90% of total billed charges,488.8,80,,391.04,percent of total billed charges,80% of total billed charges,549.9,90,,439.92,percent of total billed charges,90% of total billed charges,458.25,75,,366.6,percent of total billed charges,75% of total billed charges,4.8,122,,,fee schedule,122% of HUMANA fee schedule,177.19,29,,141.752,percent of total billed charges,29% of total billed charges,3.94,100,,,fee schedule,100% of CMS OPPS rate,409.37,67,,327.496,percent of total billed charges,67% of total billed charges,0.81,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,488.8,80,,391.04,percent of total billed charges,80% of total billed charges,397.15,65,,317.72,percent of total billed charges,65% of total billed charges,217.94,35.67,,174.352,percent of total billed charges,35.67% of total billed charges,0.81,611,
THIAMINE 100 MG IM,2510242,CDM,636,RC,J3411,HCPCS,outpatient,,,48,19.20,,40.8,85,,32.64,percent of total billed charges,85% of total billed charges,48,100,,38.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,11.82,385,,,fee schedule,385% of BCBS fee schedule,12.31,401,,,fee schedule,401% of BCBS fee schedule,12.31,401,,,fee schedule,401% of BCBS fee schedule,12.31,401,,,fee schedule,401% of BCBS fee schedule,43.2,90,,34.56,percent of total billed charges,90% of total billed charges,38.4,80,,30.72,percent of total billed charges,80% of total billed charges,43.2,90,,34.56,percent of total billed charges,90% of total billed charges,36,75,,28.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,13.92,29,,11.136,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,32.16,67,,25.728,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,38.4,80,,30.72,percent of total billed charges,80% of total billed charges,31.2,65,,24.96,percent of total billed charges,65% of total billed charges,17.12,35.67,,13.696,percent of total billed charges,35.67% of total billed charges,11.82,48,
THORAZINE 100 MG INJ,2510250,CDM,636,RC,J3230,HCPCS,outpatient,,,25,10.00,,21.25,85,,17,percent of total billed charges,85% of total billed charges,25,100,,20,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,76.38,385,,,fee schedule,385% of BCBS fee schedule,79.56,401,,,fee schedule,401% of BCBS fee schedule,79.56,401,,,fee schedule,401% of BCBS fee schedule,79.56,401,,,fee schedule,401% of BCBS fee schedule,22.5,90,,18,percent of total billed charges,90% of total billed charges,20,80,,16,percent of total billed charges,80% of total billed charges,22.5,90,,18,percent of total billed charges,90% of total billed charges,18.75,75,,15,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,7.25,29,,5.8,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,16.75,67,,13.4,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,20,80,,16,percent of total billed charges,80% of total billed charges,16.25,65,,13,percent of total billed charges,65% of total billed charges,8.92,35.67,,7.136,percent of total billed charges,35.67% of total billed charges,7.25,79.56,
THORAZINE 12.5 MG INJ,2510270,CDM,636,RC,J3230,HCPCS,outpatient,,,10,4.00,,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,10,100,,8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,76.38,385,,,fee schedule,385% of BCBS fee schedule,79.56,401,,,fee schedule,401% of BCBS fee schedule,79.56,401,,,fee schedule,401% of BCBS fee schedule,79.56,401,,,fee schedule,401% of BCBS fee schedule,9,90,,7.2,percent of total billed charges,90% of total billed charges,8,80,,6.4,percent of total billed charges,80% of total billed charges,9,90,,7.2,percent of total billed charges,90% of total billed charges,7.5,75,,6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.9,29,,2.32,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,6.7,67,,5.36,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,8,80,,6.4,percent of total billed charges,80% of total billed charges,6.5,65,,5.2,percent of total billed charges,65% of total billed charges,3.57,35.67,,2.856,percent of total billed charges,35.67% of total billed charges,2.9,79.56,
THORAZINE 50 MG 2 CC INJ,2510300,CDM,636,RC,J3230,HCPCS,outpatient,,,98,39.20,,83.3,85,,66.64,percent of total billed charges,85% of total billed charges,98,100,,78.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,76.38,385,,,fee schedule,385% of BCBS fee schedule,79.56,401,,,fee schedule,401% of BCBS fee schedule,79.56,401,,,fee schedule,401% of BCBS fee schedule,79.56,401,,,fee schedule,401% of BCBS fee schedule,88.2,90,,70.56,percent of total billed charges,90% of total billed charges,78.4,80,,62.72,percent of total billed charges,80% of total billed charges,88.2,90,,70.56,percent of total billed charges,90% of total billed charges,73.5,75,,58.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,28.42,29,,22.736,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,65.66,67,,52.528,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,78.4,80,,62.72,percent of total billed charges,80% of total billed charges,63.7,65,,50.96,percent of total billed charges,65% of total billed charges,34.96,35.67,,27.968,percent of total billed charges,35.67% of total billed charges,28.42,98,
THORAZINE INJ 1CC/25MG,2510315,CDM,636,RC,J3230,HCPCS,outpatient,,,18,7.20,,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,18,100,,14.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,76.38,385,,,fee schedule,385% of BCBS fee schedule,79.56,401,,,fee schedule,401% of BCBS fee schedule,79.56,401,,,fee schedule,401% of BCBS fee schedule,79.56,401,,,fee schedule,401% of BCBS fee schedule,16.2,90,,12.96,percent of total billed charges,90% of total billed charges,14.4,80,,11.52,percent of total billed charges,80% of total billed charges,16.2,90,,12.96,percent of total billed charges,90% of total billed charges,13.5,75,,10.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,5.22,29,,4.176,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,12.06,67,,9.648,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,14.4,80,,11.52,percent of total billed charges,80% of total billed charges,11.7,65,,9.36,percent of total billed charges,65% of total billed charges,6.42,35.67,,5.136,percent of total billed charges,35.67% of total billed charges,5.22,79.56,
MAGNESIUM SULFATE 50% 10 ML,2510317,CDM,636,RC,J3475,HCPCS,outpatient,,,13,5.20,,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,13,100,,10.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,0.27,385,,,fee schedule,385% of BCBS fee schedule,0.28,401,,,fee schedule,401% of BCBS fee schedule,0.28,401,,,fee schedule,401% of BCBS fee schedule,0.28,401,,,fee schedule,401% of BCBS fee schedule,11.7,90,,9.36,percent of total billed charges,90% of total billed charges,10.4,80,,8.32,percent of total billed charges,80% of total billed charges,11.7,90,,9.36,percent of total billed charges,90% of total billed charges,9.75,75,,7.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,3.77,29,,3.016,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,8.71,67,,6.968,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,10.4,80,,8.32,percent of total billed charges,80% of total billed charges,8.45,65,,6.76,percent of total billed charges,65% of total billed charges,4.64,35.67,,3.712,percent of total billed charges,35.67% of total billed charges,0.27,13,
ORTHOVISC 30 MG INJ,2510322,CDM,636,RC,J7324,HCPCS,outpatient,,,979,391.60,,832.15,85,,665.72,percent of total billed charges,85% of total billed charges,979,100,,783.2,percent of total billed charges,pays based on exceed threshold rate,122.91,100,,,fee schedule,100% of CMS OPPS rate,597.21,385,,,fee schedule,385% of BCBS fee schedule,622.03,401,,,fee schedule,401% of BCBS fee schedule,622.03,401,,,fee schedule,401% of BCBS fee schedule,622.03,401,,,fee schedule,401% of BCBS fee schedule,881.1,90,,704.88,percent of total billed charges,90% of total billed charges,783.2,80,,626.56,percent of total billed charges,80% of total billed charges,881.1,90,,704.88,percent of total billed charges,90% of total billed charges,734.25,75,,587.4,percent of total billed charges,75% of total billed charges,149.94,122,,,fee schedule,122% of HUMANA fee schedule,283.91,29,,227.128,percent of total billed charges,29% of total billed charges,122.91,100,,,fee schedule,100% of CMS OPPS rate,655.93,67,,524.744,percent of total billed charges,67% of total billed charges,175.03,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,783.2,80,,626.56,percent of total billed charges,80% of total billed charges,636.35,65,,509.08,percent of total billed charges,65% of total billed charges,349.21,35.67,,279.368,percent of total billed charges,35.67% of total billed charges,122.91,979,
RETACRIT ESRD DIALYSIS 100 UNT,2510334,CDM,636,RC,Q5105,HCPCS,outpatient,,,1689,675.60,,1435.65,85,,1148.52,percent of total billed charges,85% of total billed charges,886.73,52.5,,709.38,percent of total billed charges,52.5 percent of total billed charges,0.76,100,,,fee schedule,100% of CMS OPPS rate,5.01,385,,,fee schedule,385% of BCBS fee schedule,5.21,401,,,fee schedule,401% of BCBS fee schedule,5.21,401,,,fee schedule,401% of BCBS fee schedule,5.21,401,,,fee schedule,401% of BCBS fee schedule,1520.1,90,,1216.08,percent of total billed charges,90% of total billed charges,1351.2,80,,1080.96,percent of total billed charges,80% of total billed charges,1520.1,90,,1216.08,percent of total billed charges,90% of total billed charges,1266.75,75,,1013.4,percent of total billed charges,75% of total billed charges,0.92,122,,,fee schedule,122% of HUMANA fee schedule,489.81,29,,391.848,percent of total billed charges,29% of total billed charges,0.76,100,,,fee schedule,100% of CMS OPPS rate,1131.63,67,,905.304,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1351.2,80,,1080.96,percent of total billed charges,80% of total billed charges,1097.85,65,,878.28,percent of total billed charges,65% of total billed charges,602.47,35.67,,481.976,percent of total billed charges,35.67% of total billed charges,0.76,1520.1,
"RETACRIT 10,000 UNIT VIAL",2510336,CDM,636,RC,Q5106,HCPCS,outpatient,,,1705,682.00,,1449.25,85,,1159.4,percent of total billed charges,85% of total billed charges,895.13,52.5,,716.1,percent of total billed charges,52.5 percent of total billed charges,7.62,100,,,fee schedule,100% of CMS OPPS rate,50.13,385,,,fee schedule,385% of BCBS fee schedule,52.21,401,,,fee schedule,401% of BCBS fee schedule,52.21,401,,,fee schedule,401% of BCBS fee schedule,52.21,401,,,fee schedule,401% of BCBS fee schedule,1534.5,90,,1227.6,percent of total billed charges,90% of total billed charges,1364,80,,1091.2,percent of total billed charges,80% of total billed charges,1534.5,90,,1227.6,percent of total billed charges,90% of total billed charges,1278.75,75,,1023,percent of total billed charges,75% of total billed charges,9.27,122,,,fee schedule,122% of HUMANA fee schedule,494.45,29,,395.56,percent of total billed charges,29% of total billed charges,7.62,100,,,fee schedule,100% of CMS OPPS rate,1142.35,67,,913.88,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1364,80,,1091.2,percent of total billed charges,80% of total billed charges,1108.25,65,,886.6,percent of total billed charges,65% of total billed charges,608.17,35.67,,486.536,percent of total billed charges,35.67% of total billed charges,7.62,1534.5,
"RETACRIT 40,000 UNIT VIAL",2510337,CDM,636,RC,Q5106,HCPCS,outpatient,,,4414,1765.60,JW,3751.9,85,,3001.52,percent of total billed charges,85% of total billed charges,2317.35,52.5,,1853.88,percent of total billed charges,52.5 percent of total billed charges,7.62,100,,,fee schedule,100% of CMS OPPS rate,50.13,385,,,fee schedule,385% of BCBS fee schedule,52.21,401,,,fee schedule,401% of BCBS fee schedule,52.21,401,,,fee schedule,401% of BCBS fee schedule,52.21,401,,,fee schedule,401% of BCBS fee schedule,3972.6,90,,3178.08,percent of total billed charges,90% of total billed charges,3531.2,80,,2824.96,percent of total billed charges,80% of total billed charges,3972.6,90,,3178.08,percent of total billed charges,90% of total billed charges,3310.5,75,,2648.4,percent of total billed charges,75% of total billed charges,9.27,122,,,fee schedule,122% of HUMANA fee schedule,1280.06,29,,1024.048,percent of total billed charges,29% of total billed charges,7.62,100,,,fee schedule,100% of CMS OPPS rate,2957.38,67,,2365.904,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,3531.2,80,,2824.96,percent of total billed charges,80% of total billed charges,2869.1,65,,2295.28,percent of total billed charges,65% of total billed charges,1574.47,35.67,,1259.576,percent of total billed charges,35.67% of total billed charges,7.62,3972.6,
RETACRIT 2000 MG INJ,2510338,CDM,636,RC,Q5106,HCPCS,outpatient,,,553,221.20,,470.05,85,,376.04,percent of total billed charges,85% of total billed charges,553,100,,442.4,percent of total billed charges,pays based on exceed threshold rate,7.62,100,,,fee schedule,100% of CMS OPPS rate,50.13,385,,,fee schedule,385% of BCBS fee schedule,52.21,401,,,fee schedule,401% of BCBS fee schedule,52.21,401,,,fee schedule,401% of BCBS fee schedule,52.21,401,,,fee schedule,401% of BCBS fee schedule,497.7,90,,398.16,percent of total billed charges,90% of total billed charges,442.4,80,,353.92,percent of total billed charges,80% of total billed charges,497.7,90,,398.16,percent of total billed charges,90% of total billed charges,414.75,75,,331.8,percent of total billed charges,75% of total billed charges,9.27,122,,,fee schedule,122% of HUMANA fee schedule,160.37,29,,128.296,percent of total billed charges,29% of total billed charges,7.62,100,,,fee schedule,100% of CMS OPPS rate,370.51,67,,296.408,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,442.4,80,,353.92,percent of total billed charges,80% of total billed charges,359.45,65,,287.56,percent of total billed charges,65% of total billed charges,197.26,35.67,,157.808,percent of total billed charges,35.67% of total billed charges,7.62,553,
"RETACRIT 20,000 UNIT/ML",2510344,CDM,636,RC,Q5106,HCPCS,outpatient,,,682,272.80,,579.7,85,,463.76,percent of total billed charges,85% of total billed charges,682,100,,545.6,percent of total billed charges,pays based on exceed threshold rate,7.62,100,,,fee schedule,100% of CMS OPPS rate,50.13,385,,,fee schedule,385% of BCBS fee schedule,52.21,401,,,fee schedule,401% of BCBS fee schedule,52.21,401,,,fee schedule,401% of BCBS fee schedule,52.21,401,,,fee schedule,401% of BCBS fee schedule,613.8,90,,491.04,percent of total billed charges,90% of total billed charges,545.6,80,,436.48,percent of total billed charges,80% of total billed charges,613.8,90,,491.04,percent of total billed charges,90% of total billed charges,511.5,75,,409.2,percent of total billed charges,75% of total billed charges,9.27,122,,,fee schedule,122% of HUMANA fee schedule,197.78,29,,158.224,percent of total billed charges,29% of total billed charges,7.62,100,,,fee schedule,100% of CMS OPPS rate,456.94,67,,365.552,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,545.6,80,,436.48,percent of total billed charges,80% of total billed charges,443.3,65,,354.64,percent of total billed charges,65% of total billed charges,243.27,35.67,,194.616,percent of total billed charges,35.67% of total billed charges,7.62,682,
TIGAN INJ 2CC/200MG,2510410,CDM,636,RC,J3250,HCPCS,outpatient,,,56,22.40,,47.6,85,,38.08,percent of total billed charges,85% of total billed charges,56,100,,44.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,105.34,385,,,fee schedule,385% of BCBS fee schedule,109.71,401,,,fee schedule,401% of BCBS fee schedule,109.71,401,,,fee schedule,401% of BCBS fee schedule,109.71,401,,,fee schedule,401% of BCBS fee schedule,50.4,90,,40.32,percent of total billed charges,90% of total billed charges,44.8,80,,35.84,percent of total billed charges,80% of total billed charges,50.4,90,,40.32,percent of total billed charges,90% of total billed charges,42,75,,33.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,16.24,29,,12.992,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,37.52,67,,30.016,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,44.8,80,,35.84,percent of total billed charges,80% of total billed charges,36.4,65,,29.12,percent of total billed charges,65% of total billed charges,19.98,35.67,,15.984,percent of total billed charges,35.67% of total billed charges,16.24,109.71,
TNKASE KIT - SINGLE USE 50 MG,2510449,CDM,636,RC,J3101,HCPCS,outpatient,,,9824,3929.60,,8350.4,85,,6680.32,percent of total billed charges,85% of total billed charges,5157.6,52.5,,4126.08,percent of total billed charges,52.5 percent of total billed charges,157.72,100,,,fee schedule,100% of CMS OPPS rate,414.11,385,,,fee schedule,385% of BCBS fee schedule,431.32,401,,,fee schedule,401% of BCBS fee schedule,431.32,401,,,fee schedule,401% of BCBS fee schedule,431.32,401,,,fee schedule,401% of BCBS fee schedule,8841.6,90,,7073.28,percent of total billed charges,90% of total billed charges,7859.2,80,,6287.36,percent of total billed charges,80% of total billed charges,8841.6,90,,7073.28,percent of total billed charges,90% of total billed charges,7368,75,,5894.4,percent of total billed charges,75% of total billed charges,192.41,122,,,fee schedule,122% of HUMANA fee schedule,2848.96,29,,2279.168,percent of total billed charges,29% of total billed charges,157.72,100,,,fee schedule,100% of CMS OPPS rate,6582.08,67,,5265.664,percent of total billed charges,67% of total billed charges,68.51,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,7859.2,80,,6287.36,percent of total billed charges,80% of total billed charges,6385.6,65,,5108.48,percent of total billed charges,65% of total billed charges,3504.22,35.67,,2803.376,percent of total billed charges,35.67% of total billed charges,68.51,8841.6,
MIRENA IUD,2510559,CDM,636,RC,J7298,HCPCS,outpatient,,,1794,717.60,,1524.9,85,,1219.92,percent of total billed charges,85% of total billed charges,941.85,52.5,,753.48,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,3304.57,385,,,fee schedule,385% of BCBS fee schedule,3441.9,401,,,fee schedule,401% of BCBS fee schedule,3441.9,401,,,fee schedule,401% of BCBS fee schedule,3441.9,401,,,fee schedule,401% of BCBS fee schedule,1614.6,90,,1291.68,percent of total billed charges,90% of total billed charges,1435.2,80,,1148.16,percent of total billed charges,80% of total billed charges,1614.6,90,,1291.68,percent of total billed charges,90% of total billed charges,1345.5,75,,1076.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,520.26,29,,416.208,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1201.98,67,,961.584,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1435.2,80,,1148.16,percent of total billed charges,80% of total billed charges,1166.1,65,,932.88,percent of total billed charges,65% of total billed charges,639.92,35.67,,511.936,percent of total billed charges,35.67% of total billed charges,520.26,3441.9,
OMIDRIA GTTS,2510587,CDM,636,RC,J1097,HCPCS,outpatient,,,1640,656.00,,1394,85,,1115.2,percent of total billed charges,85% of total billed charges,861,52.5,,688.8,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,445.79,385,,,fee schedule,385% of BCBS fee schedule,464.32,401,,,fee schedule,401% of BCBS fee schedule,464.32,401,,,fee schedule,401% of BCBS fee schedule,464.32,401,,,fee schedule,401% of BCBS fee schedule,1476,90,,1180.8,percent of total billed charges,90% of total billed charges,1312,80,,1049.6,percent of total billed charges,80% of total billed charges,1476,90,,1180.8,percent of total billed charges,90% of total billed charges,1230,75,,984,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,475.6,29,,380.48,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1098.8,67,,879.04,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1312,80,,1049.6,percent of total billed charges,80% of total billed charges,1066,65,,852.8,percent of total billed charges,65% of total billed charges,584.99,35.67,,467.992,percent of total billed charges,35.67% of total billed charges,445.79,1476,
TORADOL 15 MG INJ.,2510594,CDM,636,RC,J1885,HCPCS,outpatient,,,18,7.20,,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,18,100,,14.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,0.85,385,,,fee schedule,385% of BCBS fee schedule,0.88,401,,,fee schedule,401% of BCBS fee schedule,0.88,401,,,fee schedule,401% of BCBS fee schedule,0.88,401,,,fee schedule,401% of BCBS fee schedule,16.2,90,,12.96,percent of total billed charges,90% of total billed charges,14.4,80,,11.52,percent of total billed charges,80% of total billed charges,16.2,90,,12.96,percent of total billed charges,90% of total billed charges,13.5,75,,10.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,5.22,29,,4.176,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,12.06,67,,9.648,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,14.4,80,,11.52,percent of total billed charges,80% of total billed charges,11.7,65,,9.36,percent of total billed charges,65% of total billed charges,6.42,35.67,,5.136,percent of total billed charges,35.67% of total billed charges,0.85,18,
TORADOL 30MG/ML INJ.,2510595,CDM,636,RC,J1885,HCPCS,outpatient,,,27,10.80,,22.95,85,,18.36,percent of total billed charges,85% of total billed charges,27,100,,21.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,0.85,385,,,fee schedule,385% of BCBS fee schedule,0.88,401,,,fee schedule,401% of BCBS fee schedule,0.88,401,,,fee schedule,401% of BCBS fee schedule,0.88,401,,,fee schedule,401% of BCBS fee schedule,24.3,90,,19.44,percent of total billed charges,90% of total billed charges,21.6,80,,17.28,percent of total billed charges,80% of total billed charges,24.3,90,,19.44,percent of total billed charges,90% of total billed charges,20.25,75,,16.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,7.83,29,,6.264,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,18.09,67,,14.472,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,21.6,80,,17.28,percent of total billed charges,80% of total billed charges,17.55,65,,14.04,percent of total billed charges,65% of total billed charges,9.63,35.67,,7.704,percent of total billed charges,35.67% of total billed charges,0.85,27,
TORADOL 60MG/ML INJ.,2510600,CDM,636,RC,J1885,HCPCS,outpatient,,,29,11.60,,24.65,85,,19.72,percent of total billed charges,85% of total billed charges,29,100,,23.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,0.85,385,,,fee schedule,385% of BCBS fee schedule,0.88,401,,,fee schedule,401% of BCBS fee schedule,0.88,401,,,fee schedule,401% of BCBS fee schedule,0.88,401,,,fee schedule,401% of BCBS fee schedule,26.1,90,,20.88,percent of total billed charges,90% of total billed charges,23.2,80,,18.56,percent of total billed charges,80% of total billed charges,26.1,90,,20.88,percent of total billed charges,90% of total billed charges,21.75,75,,17.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,8.41,29,,6.728,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,19.43,67,,15.544,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,23.2,80,,18.56,percent of total billed charges,80% of total billed charges,18.85,65,,15.08,percent of total billed charges,65% of total billed charges,10.34,35.67,,8.272,percent of total billed charges,35.67% of total billed charges,0.85,29,
ORITAVANCIN DISPHOS 400 MG INJ,2510626,CDM,636,RC,J2407,HCPCS,outpatient,,,19064,7625.60,,16204.4,85,,12963.52,percent of total billed charges,85% of total billed charges,10008.6,52.5,,8006.88,percent of total billed charges,52.5 percent of total billed charges,28.46,100,,,fee schedule,100% of CMS OPPS rate,93.05,385,,,fee schedule,385% of BCBS fee schedule,96.92,401,,,fee schedule,401% of BCBS fee schedule,96.92,401,,,fee schedule,401% of BCBS fee schedule,96.92,401,,,fee schedule,401% of BCBS fee schedule,17157.6,90,,13726.08,percent of total billed charges,90% of total billed charges,15251.2,80,,12200.96,percent of total billed charges,80% of total billed charges,17157.6,90,,13726.08,percent of total billed charges,90% of total billed charges,14298,75,,11438.4,percent of total billed charges,75% of total billed charges,34.72,122,,,fee schedule,122% of HUMANA fee schedule,5528.56,29,,4422.848,percent of total billed charges,29% of total billed charges,28.46,100,,,fee schedule,100% of CMS OPPS rate,12772.88,67,,10218.304,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,15251.2,80,,12200.96,percent of total billed charges,80% of total billed charges,12391.6,65,,9913.28,percent of total billed charges,65% of total billed charges,6800.13,35.67,,5440.104,percent of total billed charges,35.67% of total billed charges,28.46,17157.6,
FRAGMIN/DALTEPARIN 5000 UNITS,2510758,CDM,636,RC,J1645,HCPCS,outpatient,,,605,242.00,,514.25,85,,411.4,percent of total billed charges,85% of total billed charges,605,100,,484,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,71.49,385,,,fee schedule,385% of BCBS fee schedule,74.47,401,,,fee schedule,401% of BCBS fee schedule,74.47,401,,,fee schedule,401% of BCBS fee schedule,74.47,401,,,fee schedule,401% of BCBS fee schedule,544.5,90,,435.6,percent of total billed charges,90% of total billed charges,484,80,,387.2,percent of total billed charges,80% of total billed charges,544.5,90,,435.6,percent of total billed charges,90% of total billed charges,453.75,75,,363,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,175.45,29,,140.36,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,405.35,67,,324.28,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,484,80,,387.2,percent of total billed charges,80% of total billed charges,393.25,65,,314.6,percent of total billed charges,65% of total billed charges,215.8,35.67,,172.64,percent of total billed charges,35.67% of total billed charges,71.49,605,
TUBERSOL 5 U/0.1 ML INJ.,2510777,CDM,636,RC,86580,HCPCS,outpatient,,,31,12.40,,26.35,85,,21.08,percent of total billed charges,85% of total billed charges,31,100,,24.8,percent of total billed charges,pays based on exceed threshold rate,26.03,100,,,fee schedule,100% of CMS OPPS rate,61.15,350,,,fee schedule,350% of BCBS fee schedule,63.59,364,,,fee schedule,364% of BCBS fee schedule,63.59,364,,,fee schedule,364% of BCBS fee schedule,63.59,364,,,fee schedule,364% of BCBS fee schedule,27.9,90,,22.32,percent of total billed charges,90% of total billed charges,24.8,80,,19.84,percent of total billed charges,80% of total billed charges,27.9,90,,22.32,percent of total billed charges,90% of total billed charges,23.25,75,,18.6,percent of total billed charges,75% of total billed charges,31.76,122,,,fee schedule,122% of HUMANA fee schedule,8.99,29,,7.192,percent of total billed charges,29% of total billed charges,26.03,100,,,fee schedule,100% of CMS OPPS rate,20.77,67,,16.616,percent of total billed charges,67% of total billed charges,5.3,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,24.8,80,,19.84,percent of total billed charges,80% of total billed charges,20.15,65,,16.12,percent of total billed charges,65% of total billed charges,11.06,35.67,,8.848,percent of total billed charges,35.67% of total billed charges,5.3,63.59,
TYGACIL IV - 50 MG VIAL,2510866,CDM,636,RC,J3243,HCPCS,outpatient,,,460,184.00,,391,85,,312.8,percent of total billed charges,85% of total billed charges,460,100,,368,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,8.32,385,,,fee schedule,385% of BCBS fee schedule,8.66,401,,,fee schedule,401% of BCBS fee schedule,8.66,401,,,fee schedule,401% of BCBS fee schedule,8.66,401,,,fee schedule,401% of BCBS fee schedule,414,90,,331.2,percent of total billed charges,90% of total billed charges,368,80,,294.4,percent of total billed charges,80% of total billed charges,414,90,,331.2,percent of total billed charges,90% of total billed charges,345,75,,276,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,133.4,29,,106.72,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,308.2,67,,246.56,percent of total billed charges,67% of total billed charges,1.5,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,368,80,,294.4,percent of total billed charges,80% of total billed charges,299,65,,239.2,percent of total billed charges,65% of total billed charges,164.08,35.67,,131.264,percent of total billed charges,35.67% of total billed charges,1.5,460,
TYGACIL IV 100 MG,2510867,CDM,636,RC,J3243,HCPCS,outpatient,,,377,150.80,,320.45,85,,256.36,percent of total billed charges,85% of total billed charges,377,100,,301.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,8.32,385,,,fee schedule,385% of BCBS fee schedule,8.66,401,,,fee schedule,401% of BCBS fee schedule,8.66,401,,,fee schedule,401% of BCBS fee schedule,8.66,401,,,fee schedule,401% of BCBS fee schedule,339.3,90,,271.44,percent of total billed charges,90% of total billed charges,301.6,80,,241.28,percent of total billed charges,80% of total billed charges,339.3,90,,271.44,percent of total billed charges,90% of total billed charges,282.75,75,,226.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,109.33,29,,87.464,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,252.59,67,,202.072,percent of total billed charges,67% of total billed charges,1.5,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,301.6,80,,241.28,percent of total billed charges,80% of total billed charges,245.05,65,,196.04,percent of total billed charges,65% of total billed charges,134.48,35.67,,107.584,percent of total billed charges,35.67% of total billed charges,1.5,377,
UNASYN 3 GM INJ,2510970,CDM,636,RC,J0295,HCPCS,outpatient,,,67,26.80,,56.95,85,,45.56,percent of total billed charges,85% of total billed charges,67,100,,53.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,10.36,385,,,fee schedule,385% of BCBS fee schedule,10.79,401,,,fee schedule,401% of BCBS fee schedule,10.79,401,,,fee schedule,401% of BCBS fee schedule,10.79,401,,,fee schedule,401% of BCBS fee schedule,60.3,90,,48.24,percent of total billed charges,90% of total billed charges,53.6,80,,42.88,percent of total billed charges,80% of total billed charges,60.3,90,,48.24,percent of total billed charges,90% of total billed charges,50.25,75,,40.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,19.43,29,,15.544,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,44.89,67,,35.912,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,53.6,80,,42.88,percent of total billed charges,80% of total billed charges,43.55,65,,34.84,percent of total billed charges,65% of total billed charges,23.9,35.67,,19.12,percent of total billed charges,35.67% of total billed charges,10.36,67,
VALIUM 2.5 INJ.,2511055,CDM,636,RC,J3360,HCPCS,outpatient,,,10,4.00,,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,10,100,,8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,8.74,385,,,fee schedule,385% of BCBS fee schedule,9.1,401,,,fee schedule,401% of BCBS fee schedule,9.1,401,,,fee schedule,401% of BCBS fee schedule,9.1,401,,,fee schedule,401% of BCBS fee schedule,9,90,,7.2,percent of total billed charges,90% of total billed charges,8,80,,6.4,percent of total billed charges,80% of total billed charges,9,90,,7.2,percent of total billed charges,90% of total billed charges,7.5,75,,6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.9,29,,2.32,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,6.7,67,,5.36,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,8,80,,6.4,percent of total billed charges,80% of total billed charges,6.5,65,,5.2,percent of total billed charges,65% of total billed charges,3.57,35.67,,2.856,percent of total billed charges,35.67% of total billed charges,2.9,10,
VALIUM 2MG INJ.,2511065,CDM,636,RC,J3360,HCPCS,outpatient,,,12,4.80,,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,12,100,,9.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,8.74,385,,,fee schedule,385% of BCBS fee schedule,9.1,401,,,fee schedule,401% of BCBS fee schedule,9.1,401,,,fee schedule,401% of BCBS fee schedule,9.1,401,,,fee schedule,401% of BCBS fee schedule,10.8,90,,8.64,percent of total billed charges,90% of total billed charges,9.6,80,,7.68,percent of total billed charges,80% of total billed charges,10.8,90,,8.64,percent of total billed charges,90% of total billed charges,9,75,,7.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,3.48,29,,2.784,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,8.04,67,,6.432,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,9.6,80,,7.68,percent of total billed charges,80% of total billed charges,7.8,65,,6.24,percent of total billed charges,65% of total billed charges,4.28,35.67,,3.424,percent of total billed charges,35.67% of total billed charges,3.48,12,
VALIUM 5 MG/ML 10ML VIAL,2511071,CDM,636,RC,J3360,HCPCS,outpatient,,,25,10.00,,21.25,85,,17,percent of total billed charges,85% of total billed charges,25,100,,20,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,8.74,385,,,fee schedule,385% of BCBS fee schedule,9.1,401,,,fee schedule,401% of BCBS fee schedule,9.1,401,,,fee schedule,401% of BCBS fee schedule,9.1,401,,,fee schedule,401% of BCBS fee schedule,22.5,90,,18,percent of total billed charges,90% of total billed charges,20,80,,16,percent of total billed charges,80% of total billed charges,22.5,90,,18,percent of total billed charges,90% of total billed charges,18.75,75,,15,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,7.25,29,,5.8,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,16.75,67,,13.4,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,20,80,,16,percent of total billed charges,80% of total billed charges,16.25,65,,13,percent of total billed charges,65% of total billed charges,8.92,35.67,,7.136,percent of total billed charges,35.67% of total billed charges,7.25,25,
VALIUM INJ 2CC/10 MG,2511080,CDM,636,RC,J3360,HCPCS,outpatient,,,102,40.80,,86.7,85,,69.36,percent of total billed charges,85% of total billed charges,102,100,,81.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,8.74,385,,,fee schedule,385% of BCBS fee schedule,9.1,401,,,fee schedule,401% of BCBS fee schedule,9.1,401,,,fee schedule,401% of BCBS fee schedule,9.1,401,,,fee schedule,401% of BCBS fee schedule,91.8,90,,73.44,percent of total billed charges,90% of total billed charges,81.6,80,,65.28,percent of total billed charges,80% of total billed charges,91.8,90,,73.44,percent of total billed charges,90% of total billed charges,76.5,75,,61.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,29.58,29,,23.664,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,68.34,67,,54.672,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,81.6,80,,65.28,percent of total billed charges,80% of total billed charges,66.3,65,,53.04,percent of total billed charges,65% of total billed charges,36.38,35.67,,29.104,percent of total billed charges,35.67% of total billed charges,8.74,102,
VANCOMYCIN 1 GM INJ,2511102,CDM,636,RC,J3370,HCPCS,outpatient,,,127,50.80,,107.95,85,,86.36,percent of total billed charges,85% of total billed charges,127,100,,101.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,17.21,385,,,fee schedule,385% of BCBS fee schedule,17.92,401,,,fee schedule,401% of BCBS fee schedule,17.92,401,,,fee schedule,401% of BCBS fee schedule,17.92,401,,,fee schedule,401% of BCBS fee schedule,114.3,90,,91.44,percent of total billed charges,90% of total billed charges,101.6,80,,81.28,percent of total billed charges,80% of total billed charges,114.3,90,,91.44,percent of total billed charges,90% of total billed charges,95.25,75,,76.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,36.83,29,,29.464,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,85.09,67,,68.072,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,101.6,80,,81.28,percent of total billed charges,80% of total billed charges,82.55,65,,66.04,percent of total billed charges,65% of total billed charges,45.3,35.67,,36.24,percent of total billed charges,35.67% of total billed charges,17.21,127,
VANCOMYCIN 1000 MG VIAL,2511103,CDM,636,RC,J3370,HCPCS,outpatient,,,61,24.40,,51.85,85,,41.48,percent of total billed charges,85% of total billed charges,61,100,,48.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,17.21,385,,,fee schedule,385% of BCBS fee schedule,17.92,401,,,fee schedule,401% of BCBS fee schedule,17.92,401,,,fee schedule,401% of BCBS fee schedule,17.92,401,,,fee schedule,401% of BCBS fee schedule,54.9,90,,43.92,percent of total billed charges,90% of total billed charges,48.8,80,,39.04,percent of total billed charges,80% of total billed charges,54.9,90,,43.92,percent of total billed charges,90% of total billed charges,45.75,75,,36.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,17.69,29,,14.152,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,40.87,67,,32.696,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,48.8,80,,39.04,percent of total billed charges,80% of total billed charges,39.65,65,,31.72,percent of total billed charges,65% of total billed charges,21.76,35.67,,17.408,percent of total billed charges,35.67% of total billed charges,17.21,61,
VANCOMYCIN 500MG INJ.,2511110,CDM,636,RC,J3370,HCPCS,outpatient,,,32,12.80,,27.2,85,,21.76,percent of total billed charges,85% of total billed charges,32,100,,25.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,17.21,385,,,fee schedule,385% of BCBS fee schedule,17.92,401,,,fee schedule,401% of BCBS fee schedule,17.92,401,,,fee schedule,401% of BCBS fee schedule,17.92,401,,,fee schedule,401% of BCBS fee schedule,28.8,90,,23.04,percent of total billed charges,90% of total billed charges,25.6,80,,20.48,percent of total billed charges,80% of total billed charges,28.8,90,,23.04,percent of total billed charges,90% of total billed charges,24,75,,19.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,9.28,29,,7.424,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,21.44,67,,17.152,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,25.6,80,,20.48,percent of total billed charges,80% of total billed charges,20.8,65,,16.64,percent of total billed charges,65% of total billed charges,11.41,35.67,,9.128,percent of total billed charges,35.67% of total billed charges,9.28,32,
VANCOMYCIN 750 MG/150 MGL BAG,2511113,CDM,636,RC,J3370,HCPCS,outpatient,,,20,8.00,,17,85,,13.6,percent of total billed charges,85% of total billed charges,20,100,,16,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,17.21,385,,,fee schedule,385% of BCBS fee schedule,17.92,401,,,fee schedule,401% of BCBS fee schedule,17.92,401,,,fee schedule,401% of BCBS fee schedule,17.92,401,,,fee schedule,401% of BCBS fee schedule,18,90,,14.4,percent of total billed charges,90% of total billed charges,16,80,,12.8,percent of total billed charges,80% of total billed charges,18,90,,14.4,percent of total billed charges,90% of total billed charges,15,75,,12,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,5.8,29,,4.64,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,13.4,67,,10.72,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,16,80,,12.8,percent of total billed charges,80% of total billed charges,13,65,,10.4,percent of total billed charges,65% of total billed charges,7.13,35.67,,5.704,percent of total billed charges,35.67% of total billed charges,5.8,20,
VANCOMYCIN 1000 MG/150 ML,2511114,CDM,636,RC,J3370,HCPCS,outpatient,,,27,10.80,,22.95,85,,18.36,percent of total billed charges,85% of total billed charges,27,100,,21.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,17.21,385,,,fee schedule,385% of BCBS fee schedule,17.92,401,,,fee schedule,401% of BCBS fee schedule,17.92,401,,,fee schedule,401% of BCBS fee schedule,17.92,401,,,fee schedule,401% of BCBS fee schedule,24.3,90,,19.44,percent of total billed charges,90% of total billed charges,21.6,80,,17.28,percent of total billed charges,80% of total billed charges,24.3,90,,19.44,percent of total billed charges,90% of total billed charges,20.25,75,,16.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,7.83,29,,6.264,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,18.09,67,,14.472,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,21.6,80,,17.28,percent of total billed charges,80% of total billed charges,17.55,65,,14.04,percent of total billed charges,65% of total billed charges,9.63,35.67,,7.704,percent of total billed charges,35.67% of total billed charges,7.83,27,
VANCOMYCIN HCL 500 MG/100 BAG,2511116,CDM,636,RC,J3370,HCPCS,outpatient,,,14,5.60,,11.9,85,,9.52,percent of total billed charges,85% of total billed charges,14,100,,11.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,17.21,385,,,fee schedule,385% of BCBS fee schedule,17.92,401,,,fee schedule,401% of BCBS fee schedule,17.92,401,,,fee schedule,401% of BCBS fee schedule,17.92,401,,,fee schedule,401% of BCBS fee schedule,12.6,90,,10.08,percent of total billed charges,90% of total billed charges,11.2,80,,8.96,percent of total billed charges,80% of total billed charges,12.6,90,,10.08,percent of total billed charges,90% of total billed charges,10.5,75,,8.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,4.06,29,,3.248,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,9.38,67,,7.504,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,11.2,80,,8.96,percent of total billed charges,80% of total billed charges,9.1,65,,7.28,percent of total billed charges,65% of total billed charges,4.99,35.67,,3.992,percent of total billed charges,35.67% of total billed charges,4.06,17.92,
LYMPHAZURIN- ISO BLUE 50 MG,2511122,CDM,636,RC,Q9968,HCPCS,outpatient,,,1912,764.80,,1625.2,85,,1300.16,percent of total billed charges,85% of total billed charges,1003.8,52.5,,803.04,percent of total billed charges,52.5 percent of total billed charges,8.52,100,,,fee schedule,100% of CMS OPPS rate,4.47,385,,,fee schedule,385% of BCBS fee schedule,4.65,401,,,fee schedule,401% of BCBS fee schedule,4.65,401,,,fee schedule,401% of BCBS fee schedule,4.65,401,,,fee schedule,401% of BCBS fee schedule,1720.8,90,,1376.64,percent of total billed charges,90% of total billed charges,1529.6,80,,1223.68,percent of total billed charges,80% of total billed charges,1720.8,90,,1376.64,percent of total billed charges,90% of total billed charges,1434,75,,1147.2,percent of total billed charges,75% of total billed charges,10.4,122,,,fee schedule,122% of HUMANA fee schedule,554.48,29,,443.584,percent of total billed charges,29% of total billed charges,8.52,100,,,fee schedule,100% of CMS OPPS rate,1281.04,67,,1024.832,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1529.6,80,,1223.68,percent of total billed charges,80% of total billed charges,1242.8,65,,994.24,percent of total billed charges,65% of total billed charges,682.01,35.67,,545.608,percent of total billed charges,35.67% of total billed charges,4.47,1720.8,
VANCOMYCIN/WATER 1500MG/300 ML,2511126,CDM,636,RC,J3370,HCPCS,outpatient,,,17,6.80,,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,17,100,,13.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,17.21,385,,,fee schedule,385% of BCBS fee schedule,17.92,401,,,fee schedule,401% of BCBS fee schedule,17.92,401,,,fee schedule,401% of BCBS fee schedule,17.92,401,,,fee schedule,401% of BCBS fee schedule,15.3,90,,12.24,percent of total billed charges,90% of total billed charges,13.6,80,,10.88,percent of total billed charges,80% of total billed charges,15.3,90,,12.24,percent of total billed charges,90% of total billed charges,12.75,75,,10.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,4.93,29,,3.944,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,11.39,67,,9.112,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,13.6,80,,10.88,percent of total billed charges,80% of total billed charges,11.05,65,,8.84,percent of total billed charges,65% of total billed charges,6.06,35.67,,4.848,percent of total billed charges,35.67% of total billed charges,4.93,17.92,
VANCOMYCIN 1.25MG/250MG,2511127,CDM,636,RC,J3370,HCPCS,outpatient,,,59,23.60,,50.15,85,,40.12,percent of total billed charges,85% of total billed charges,59,100,,47.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,17.21,385,,,fee schedule,385% of BCBS fee schedule,17.92,401,,,fee schedule,401% of BCBS fee schedule,17.92,401,,,fee schedule,401% of BCBS fee schedule,17.92,401,,,fee schedule,401% of BCBS fee schedule,53.1,90,,42.48,percent of total billed charges,90% of total billed charges,47.2,80,,37.76,percent of total billed charges,80% of total billed charges,53.1,90,,42.48,percent of total billed charges,90% of total billed charges,44.25,75,,35.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,17.11,29,,13.688,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,39.53,67,,31.624,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,47.2,80,,37.76,percent of total billed charges,80% of total billed charges,38.35,65,,30.68,percent of total billed charges,65% of total billed charges,21.05,35.67,,16.84,percent of total billed charges,35.67% of total billed charges,17.11,59,
VANCOMYCIN 1.75/350ML,2511128,CDM,636,RC,J3370,HCPCS,outpatient,,,81,32.40,,68.85,85,,55.08,percent of total billed charges,85% of total billed charges,81,100,,64.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,17.21,385,,,fee schedule,385% of BCBS fee schedule,17.92,401,,,fee schedule,401% of BCBS fee schedule,17.92,401,,,fee schedule,401% of BCBS fee schedule,17.92,401,,,fee schedule,401% of BCBS fee schedule,72.9,90,,58.32,percent of total billed charges,90% of total billed charges,64.8,80,,51.84,percent of total billed charges,80% of total billed charges,72.9,90,,58.32,percent of total billed charges,90% of total billed charges,60.75,75,,48.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,23.49,29,,18.792,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,54.27,67,,43.416,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,64.8,80,,51.84,percent of total billed charges,80% of total billed charges,52.65,65,,42.12,percent of total billed charges,65% of total billed charges,28.89,35.67,,23.112,percent of total billed charges,35.67% of total billed charges,17.21,81,
VANCOMYCIN 2GM/400ML,2511137,CDM,636,RC,J3370,HCPCS,outpatient,,,87,34.80,,73.95,85,,59.16,percent of total billed charges,85% of total billed charges,87,100,,69.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,17.21,385,,,fee schedule,385% of BCBS fee schedule,17.92,401,,,fee schedule,401% of BCBS fee schedule,17.92,401,,,fee schedule,401% of BCBS fee schedule,17.92,401,,,fee schedule,401% of BCBS fee schedule,78.3,90,,62.64,percent of total billed charges,90% of total billed charges,69.6,80,,55.68,percent of total billed charges,80% of total billed charges,78.3,90,,62.64,percent of total billed charges,90% of total billed charges,65.25,75,,52.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,25.23,29,,20.184,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,58.29,67,,46.632,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,69.6,80,,55.68,percent of total billed charges,80% of total billed charges,56.55,65,,45.24,percent of total billed charges,65% of total billed charges,31.03,35.67,,24.824,percent of total billed charges,35.67% of total billed charges,17.21,87,
VERSED 1.5 MG INJ,2511255,CDM,636,RC,J2250,HCPCS,outpatient,,,15,6.00,,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,15,100,,12,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,0.42,385,,,fee schedule,385% of BCBS fee schedule,0.44,401,,,fee schedule,401% of BCBS fee schedule,0.44,401,,,fee schedule,401% of BCBS fee schedule,0.44,401,,,fee schedule,401% of BCBS fee schedule,13.5,90,,10.8,percent of total billed charges,90% of total billed charges,12,80,,9.6,percent of total billed charges,80% of total billed charges,13.5,90,,10.8,percent of total billed charges,90% of total billed charges,11.25,75,,9,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,4.35,29,,3.48,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,10.05,67,,8.04,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,12,80,,9.6,percent of total billed charges,80% of total billed charges,9.75,65,,7.8,percent of total billed charges,65% of total billed charges,5.35,35.67,,4.28,percent of total billed charges,35.67% of total billed charges,0.42,15,
VERSED 10 MG/2 ML INJ,2511260,CDM,636,RC,J2250,HCPCS,outpatient,,,40,16.00,,34,85,,27.2,percent of total billed charges,85% of total billed charges,40,100,,32,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,0.42,385,,,fee schedule,385% of BCBS fee schedule,0.44,401,,,fee schedule,401% of BCBS fee schedule,0.44,401,,,fee schedule,401% of BCBS fee schedule,0.44,401,,,fee schedule,401% of BCBS fee schedule,36,90,,28.8,percent of total billed charges,90% of total billed charges,32,80,,25.6,percent of total billed charges,80% of total billed charges,36,90,,28.8,percent of total billed charges,90% of total billed charges,30,75,,24,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,11.6,29,,9.28,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,26.8,67,,21.44,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,32,80,,25.6,percent of total billed charges,80% of total billed charges,26,65,,20.8,percent of total billed charges,65% of total billed charges,14.27,35.67,,11.416,percent of total billed charges,35.67% of total billed charges,0.42,40,
VERSED 1 MG INJ,2511265,CDM,636,RC,J2250,HCPCS,outpatient,,,13,5.20,,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,13,100,,10.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,0.42,385,,,fee schedule,385% of BCBS fee schedule,0.44,401,,,fee schedule,401% of BCBS fee schedule,0.44,401,,,fee schedule,401% of BCBS fee schedule,0.44,401,,,fee schedule,401% of BCBS fee schedule,11.7,90,,9.36,percent of total billed charges,90% of total billed charges,10.4,80,,8.32,percent of total billed charges,80% of total billed charges,11.7,90,,9.36,percent of total billed charges,90% of total billed charges,9.75,75,,7.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,3.77,29,,3.016,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,8.71,67,,6.968,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,10.4,80,,8.32,percent of total billed charges,80% of total billed charges,8.45,65,,6.76,percent of total billed charges,65% of total billed charges,4.64,35.67,,3.712,percent of total billed charges,35.67% of total billed charges,0.42,13,
VERSED 2.5 MG INJ,2511270,CDM,636,RC,J2250,HCPCS,outpatient,,,13,5.20,,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,13,100,,10.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,0.42,385,,,fee schedule,385% of BCBS fee schedule,0.44,401,,,fee schedule,401% of BCBS fee schedule,0.44,401,,,fee schedule,401% of BCBS fee schedule,0.44,401,,,fee schedule,401% of BCBS fee schedule,11.7,90,,9.36,percent of total billed charges,90% of total billed charges,10.4,80,,8.32,percent of total billed charges,80% of total billed charges,11.7,90,,9.36,percent of total billed charges,90% of total billed charges,9.75,75,,7.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,3.77,29,,3.016,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,8.71,67,,6.968,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,10.4,80,,8.32,percent of total billed charges,80% of total billed charges,8.45,65,,6.76,percent of total billed charges,65% of total billed charges,4.64,35.67,,3.712,percent of total billed charges,35.67% of total billed charges,0.42,13,
VERSED 2 MG INJ,2511275,CDM,636,RC,J2250,HCPCS,outpatient,,,13,5.20,,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,13,100,,10.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,0.42,385,,,fee schedule,385% of BCBS fee schedule,0.44,401,,,fee schedule,401% of BCBS fee schedule,0.44,401,,,fee schedule,401% of BCBS fee schedule,0.44,401,,,fee schedule,401% of BCBS fee schedule,11.7,90,,9.36,percent of total billed charges,90% of total billed charges,10.4,80,,8.32,percent of total billed charges,80% of total billed charges,11.7,90,,9.36,percent of total billed charges,90% of total billed charges,9.75,75,,7.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,3.77,29,,3.016,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,8.71,67,,6.968,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,10.4,80,,8.32,percent of total billed charges,80% of total billed charges,8.45,65,,6.76,percent of total billed charges,65% of total billed charges,4.64,35.67,,3.712,percent of total billed charges,35.67% of total billed charges,0.42,13,
VERSED 4 MG INJ,2511280,CDM,636,RC,J2250,HCPCS,outpatient,,,25,10.00,,21.25,85,,17,percent of total billed charges,85% of total billed charges,25,100,,20,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,0.42,385,,,fee schedule,385% of BCBS fee schedule,0.44,401,,,fee schedule,401% of BCBS fee schedule,0.44,401,,,fee schedule,401% of BCBS fee schedule,0.44,401,,,fee schedule,401% of BCBS fee schedule,22.5,90,,18,percent of total billed charges,90% of total billed charges,20,80,,16,percent of total billed charges,80% of total billed charges,22.5,90,,18,percent of total billed charges,90% of total billed charges,18.75,75,,15,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,7.25,29,,5.8,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,16.75,67,,13.4,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,20,80,,16,percent of total billed charges,80% of total billed charges,16.25,65,,13,percent of total billed charges,65% of total billed charges,8.92,35.67,,7.136,percent of total billed charges,35.67% of total billed charges,0.42,25,
VERSED 5 MG/1 CC INJ SH,2511285,CDM,636,RC,J2250,HCPCS,outpatient,,,27,10.80,,22.95,85,,18.36,percent of total billed charges,85% of total billed charges,27,100,,21.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,0.42,385,,,fee schedule,385% of BCBS fee schedule,0.44,401,,,fee schedule,401% of BCBS fee schedule,0.44,401,,,fee schedule,401% of BCBS fee schedule,0.44,401,,,fee schedule,401% of BCBS fee schedule,24.3,90,,19.44,percent of total billed charges,90% of total billed charges,21.6,80,,17.28,percent of total billed charges,80% of total billed charges,24.3,90,,19.44,percent of total billed charges,90% of total billed charges,20.25,75,,16.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,7.83,29,,6.264,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,18.09,67,,14.472,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,21.6,80,,17.28,percent of total billed charges,80% of total billed charges,17.55,65,,14.04,percent of total billed charges,65% of total billed charges,9.63,35.67,,7.704,percent of total billed charges,35.67% of total billed charges,0.42,27,
VERSED 5 MG/ML INJ MULTI DOSE,2511286,CDM,636,RC,J2250,HCPCS,outpatient,,,11,4.40,,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,11,100,,8.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,0.42,385,,,fee schedule,385% of BCBS fee schedule,0.44,401,,,fee schedule,401% of BCBS fee schedule,0.44,401,,,fee schedule,401% of BCBS fee schedule,0.44,401,,,fee schedule,401% of BCBS fee schedule,9.9,90,,7.92,percent of total billed charges,90% of total billed charges,8.8,80,,7.04,percent of total billed charges,80% of total billed charges,9.9,90,,7.92,percent of total billed charges,90% of total billed charges,8.25,75,,6.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,3.19,29,,2.552,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,7.37,67,,5.896,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,8.8,80,,7.04,percent of total billed charges,80% of total billed charges,7.15,65,,5.72,percent of total billed charges,65% of total billed charges,3.92,35.67,,3.136,percent of total billed charges,35.67% of total billed charges,0.42,11,
VESPRIN 10 MG INJ,2511300,CDM,636,RC,J3400,HCPCS,outpatient,,,22,8.80,,18.7,85,,14.96,percent of total billed charges,85% of total billed charges,22,100,,17.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,18.04,82,,14.432,percent of total billed charges,82% of total billed charges,18.7,85,,14.96,percent of total billed charges,85% of total billed charges,18.7,85,,14.96,percent of total billed charges,85% of total billed charges,18.7,85,,14.96,percent of total billed charges,85% of total billed charges,19.8,90,,15.84,percent of total billed charges,90% of total billed charges,17.6,80,,14.08,percent of total billed charges,80% of total billed charges,19.8,90,,15.84,percent of total billed charges,90% of total billed charges,16.5,75,,13.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,6.38,29,,5.104,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,14.74,67,,11.792,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,17.6,80,,14.08,percent of total billed charges,80% of total billed charges,14.3,65,,11.44,percent of total billed charges,65% of total billed charges,7.85,35.67,,6.28,percent of total billed charges,35.67% of total billed charges,6.38,22,
VISTARIL 25 MG INJ,2511440,CDM,636,RC,J3410,HCPCS,outpatient,,,11,4.40,,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,11,100,,8.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,1.89,385,,,fee schedule,385% of BCBS fee schedule,1.96,401,,,fee schedule,401% of BCBS fee schedule,1.96,401,,,fee schedule,401% of BCBS fee schedule,1.96,401,,,fee schedule,401% of BCBS fee schedule,9.9,90,,7.92,percent of total billed charges,90% of total billed charges,8.8,80,,7.04,percent of total billed charges,80% of total billed charges,9.9,90,,7.92,percent of total billed charges,90% of total billed charges,8.25,75,,6.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,3.19,29,,2.552,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,7.37,67,,5.896,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,8.8,80,,7.04,percent of total billed charges,80% of total billed charges,7.15,65,,5.72,percent of total billed charges,65% of total billed charges,3.92,35.67,,3.136,percent of total billed charges,35.67% of total billed charges,1.89,11,
VISTARIL 75 MG INJ,2511455,CDM,636,RC,J3410,HCPCS,outpatient,,,13,5.20,,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,13,100,,10.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,1.89,385,,,fee schedule,385% of BCBS fee schedule,1.96,401,,,fee schedule,401% of BCBS fee schedule,1.96,401,,,fee schedule,401% of BCBS fee schedule,1.96,401,,,fee schedule,401% of BCBS fee schedule,11.7,90,,9.36,percent of total billed charges,90% of total billed charges,10.4,80,,8.32,percent of total billed charges,80% of total billed charges,11.7,90,,9.36,percent of total billed charges,90% of total billed charges,9.75,75,,7.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,3.77,29,,3.016,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,8.71,67,,6.968,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,10.4,80,,8.32,percent of total billed charges,80% of total billed charges,8.45,65,,6.76,percent of total billed charges,65% of total billed charges,4.64,35.67,,3.712,percent of total billed charges,35.67% of total billed charges,1.89,13,
VISTARIL INJ 1 CC 50 MG,2511460,CDM,636,RC,J3410,HCPCS,outpatient,,,31,12.40,,26.35,85,,21.08,percent of total billed charges,85% of total billed charges,31,100,,24.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,1.89,385,,,fee schedule,385% of BCBS fee schedule,1.96,401,,,fee schedule,401% of BCBS fee schedule,1.96,401,,,fee schedule,401% of BCBS fee schedule,1.96,401,,,fee schedule,401% of BCBS fee schedule,27.9,90,,22.32,percent of total billed charges,90% of total billed charges,24.8,80,,19.84,percent of total billed charges,80% of total billed charges,27.9,90,,22.32,percent of total billed charges,90% of total billed charges,23.25,75,,18.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,8.99,29,,7.192,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,20.77,67,,16.616,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,24.8,80,,19.84,percent of total billed charges,80% of total billed charges,20.15,65,,16.12,percent of total billed charges,65% of total billed charges,11.06,35.67,,8.848,percent of total billed charges,35.67% of total billed charges,1.89,31,
VISTARIL INJ 2 CC 100 MG,2511465,CDM,636,RC,J3410,HCPCS,outpatient,,,16,6.40,,13.6,85,,10.88,percent of total billed charges,85% of total billed charges,16,100,,12.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,1.89,385,,,fee schedule,385% of BCBS fee schedule,1.96,401,,,fee schedule,401% of BCBS fee schedule,1.96,401,,,fee schedule,401% of BCBS fee schedule,1.96,401,,,fee schedule,401% of BCBS fee schedule,14.4,90,,11.52,percent of total billed charges,90% of total billed charges,12.8,80,,10.24,percent of total billed charges,80% of total billed charges,14.4,90,,11.52,percent of total billed charges,90% of total billed charges,12,75,,9.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,4.64,29,,3.712,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,10.72,67,,8.576,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,12.8,80,,10.24,percent of total billed charges,80% of total billed charges,10.4,65,,8.32,percent of total billed charges,65% of total billed charges,5.71,35.67,,4.568,percent of total billed charges,35.67% of total billed charges,1.89,16,
VISTARIL 50MG/ML MDV,2511467,CDM,636,RC,J3410,HCPCS,outpatient,,,42,16.80,,35.7,85,,28.56,percent of total billed charges,85% of total billed charges,42,100,,33.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,1.89,385,,,fee schedule,385% of BCBS fee schedule,1.96,401,,,fee schedule,401% of BCBS fee schedule,1.96,401,,,fee schedule,401% of BCBS fee schedule,1.96,401,,,fee schedule,401% of BCBS fee schedule,37.8,90,,30.24,percent of total billed charges,90% of total billed charges,33.6,80,,26.88,percent of total billed charges,80% of total billed charges,37.8,90,,30.24,percent of total billed charges,90% of total billed charges,31.5,75,,25.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,12.18,29,,9.744,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,28.14,67,,22.512,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,33.6,80,,26.88,percent of total billed charges,80% of total billed charges,27.3,65,,21.84,percent of total billed charges,65% of total billed charges,14.98,35.67,,11.984,percent of total billed charges,35.67% of total billed charges,1.89,42,
VITAMIN B 12 INJ,2511485,CDM,636,RC,J3420,HCPCS,outpatient,,,33,13.20,,28.05,85,,22.44,percent of total billed charges,85% of total billed charges,33,100,,26.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,17.06,385,,,fee schedule,385% of BCBS fee schedule,17.76,401,,,fee schedule,401% of BCBS fee schedule,17.76,401,,,fee schedule,401% of BCBS fee schedule,17.76,401,,,fee schedule,401% of BCBS fee schedule,29.7,90,,23.76,percent of total billed charges,90% of total billed charges,26.4,80,,21.12,percent of total billed charges,80% of total billed charges,29.7,90,,23.76,percent of total billed charges,90% of total billed charges,24.75,75,,19.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,9.57,29,,7.656,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,22.11,67,,17.688,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,26.4,80,,21.12,percent of total billed charges,80% of total billed charges,21.45,65,,17.16,percent of total billed charges,65% of total billed charges,11.77,35.67,,9.416,percent of total billed charges,35.67% of total billed charges,9.57,33,
XERAVA 1.6 MG,2511651,CDM,636,RC,J0122,HCPCS,outpatient,,,1800,720.00,,1530,85,,1224,percent of total billed charges,85% of total billed charges,945,52.5,,756,percent of total billed charges,52.5 percent of total billed charges,1.11,100,,,fee schedule,100% of CMS OPPS rate,3.77,385,,,fee schedule,385% of BCBS fee schedule,3.93,401,,,fee schedule,401% of BCBS fee schedule,3.93,401,,,fee schedule,401% of BCBS fee schedule,3.93,401,,,fee schedule,401% of BCBS fee schedule,1620,90,,1296,percent of total billed charges,90% of total billed charges,1440,80,,1152,percent of total billed charges,80% of total billed charges,1620,90,,1296,percent of total billed charges,90% of total billed charges,1350,75,,1080,percent of total billed charges,75% of total billed charges,1.34,122,,,fee schedule,122% of HUMANA fee schedule,522,29,,417.6,percent of total billed charges,29% of total billed charges,1.11,100,,,fee schedule,100% of CMS OPPS rate,1206,67,,964.8,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1440,80,,1152,percent of total billed charges,80% of total billed charges,1170,65,,936,percent of total billed charges,65% of total billed charges,642.06,35.67,,513.648,percent of total billed charges,35.67% of total billed charges,1.11,1620,
XYLOCAINE 1%% 20CC INJ.,2511670,CDM,636,RC,J2001,HCPCS,outpatient,,,13,5.20,,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,13,100,,10.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,0.08,385,,,fee schedule,385% of BCBS fee schedule,0.08,401,,,fee schedule,401% of BCBS fee schedule,0.08,401,,,fee schedule,401% of BCBS fee schedule,0.08,401,,,fee schedule,401% of BCBS fee schedule,11.7,90,,9.36,percent of total billed charges,90% of total billed charges,10.4,80,,8.32,percent of total billed charges,80% of total billed charges,11.7,90,,9.36,percent of total billed charges,90% of total billed charges,9.75,75,,7.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,3.77,29,,3.016,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,8.71,67,,6.968,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,10.4,80,,8.32,percent of total billed charges,80% of total billed charges,8.45,65,,6.76,percent of total billed charges,65% of total billed charges,4.64,35.67,,3.712,percent of total billed charges,35.67% of total billed charges,0.08,13,
XYLOCAINE 1% 2CC,2511675,CDM,636,RC,J2001,HCPCS,outpatient,,,16,6.40,,13.6,85,,10.88,percent of total billed charges,85% of total billed charges,16,100,,12.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,0.08,385,,,fee schedule,385% of BCBS fee schedule,0.08,401,,,fee schedule,401% of BCBS fee schedule,0.08,401,,,fee schedule,401% of BCBS fee schedule,0.08,401,,,fee schedule,401% of BCBS fee schedule,14.4,90,,11.52,percent of total billed charges,90% of total billed charges,12.8,80,,10.24,percent of total billed charges,80% of total billed charges,14.4,90,,11.52,percent of total billed charges,90% of total billed charges,12,75,,9.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,4.64,29,,3.712,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,10.72,67,,8.576,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,12.8,80,,10.24,percent of total billed charges,80% of total billed charges,10.4,65,,8.32,percent of total billed charges,65% of total billed charges,5.71,35.67,,4.568,percent of total billed charges,35.67% of total billed charges,0.08,16,
XYLOCAINE 1% 1CC INJ.,2511680,CDM,636,RC,J2001,HCPCS,outpatient,,,11,4.40,,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,11,100,,8.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,0.08,385,,,fee schedule,385% of BCBS fee schedule,0.08,401,,,fee schedule,401% of BCBS fee schedule,0.08,401,,,fee schedule,401% of BCBS fee schedule,0.08,401,,,fee schedule,401% of BCBS fee schedule,9.9,90,,7.92,percent of total billed charges,90% of total billed charges,8.8,80,,7.04,percent of total billed charges,80% of total billed charges,9.9,90,,7.92,percent of total billed charges,90% of total billed charges,8.25,75,,6.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,3.19,29,,2.552,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,7.37,67,,5.896,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,8.8,80,,7.04,percent of total billed charges,80% of total billed charges,7.15,65,,5.72,percent of total billed charges,65% of total billed charges,3.92,35.67,,3.136,percent of total billed charges,35.67% of total billed charges,0.08,11,
XYLOCAINE 1% INJ 3CC,2511685,CDM,636,RC,J2001,HCPCS,outpatient,,,20,8.00,,17,85,,13.6,percent of total billed charges,85% of total billed charges,20,100,,16,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,0.08,385,,,fee schedule,385% of BCBS fee schedule,0.08,401,,,fee schedule,401% of BCBS fee schedule,0.08,401,,,fee schedule,401% of BCBS fee schedule,0.08,401,,,fee schedule,401% of BCBS fee schedule,18,90,,14.4,percent of total billed charges,90% of total billed charges,16,80,,12.8,percent of total billed charges,80% of total billed charges,18,90,,14.4,percent of total billed charges,90% of total billed charges,15,75,,12,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,5.8,29,,4.64,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,13.4,67,,10.72,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,16,80,,12.8,percent of total billed charges,80% of total billed charges,13,65,,10.4,percent of total billed charges,65% of total billed charges,7.13,35.67,,5.704,percent of total billed charges,35.67% of total billed charges,0.08,20,
XYLOCAINE 1% INJ - ER,2511686,CDM,636,RC,J2001,HCPCS,outpatient,,,20,8.00,,17,85,,13.6,percent of total billed charges,85% of total billed charges,20,100,,16,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,0.08,385,,,fee schedule,385% of BCBS fee schedule,0.08,401,,,fee schedule,401% of BCBS fee schedule,0.08,401,,,fee schedule,401% of BCBS fee schedule,0.08,401,,,fee schedule,401% of BCBS fee schedule,18,90,,14.4,percent of total billed charges,90% of total billed charges,16,80,,12.8,percent of total billed charges,80% of total billed charges,18,90,,14.4,percent of total billed charges,90% of total billed charges,15,75,,12,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,5.8,29,,4.64,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,13.4,67,,10.72,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,16,80,,12.8,percent of total billed charges,80% of total billed charges,13,65,,10.4,percent of total billed charges,65% of total billed charges,7.13,35.67,,5.704,percent of total billed charges,35.67% of total billed charges,0.08,20,
XYLOCAINE 1% W/EPIN. 50CC IN,2511690,CDM,636,RC,J2001,HCPCS,outpatient,,,18,7.20,,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,18,100,,14.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,0.08,385,,,fee schedule,385% of BCBS fee schedule,0.08,401,,,fee schedule,401% of BCBS fee schedule,0.08,401,,,fee schedule,401% of BCBS fee schedule,0.08,401,,,fee schedule,401% of BCBS fee schedule,16.2,90,,12.96,percent of total billed charges,90% of total billed charges,14.4,80,,11.52,percent of total billed charges,80% of total billed charges,16.2,90,,12.96,percent of total billed charges,90% of total billed charges,13.5,75,,10.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,5.22,29,,4.176,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,12.06,67,,9.648,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,14.4,80,,11.52,percent of total billed charges,80% of total billed charges,11.7,65,,9.36,percent of total billed charges,65% of total billed charges,6.42,35.67,,5.136,percent of total billed charges,35.67% of total billed charges,0.08,18,
XYLOCAINE 1% 20 ML VIAL,2511691,CDM,636,RC,J2001,HCPCS,outpatient,,,15,6.00,,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,15,100,,12,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,0.08,385,,,fee schedule,385% of BCBS fee schedule,0.08,401,,,fee schedule,401% of BCBS fee schedule,0.08,401,,,fee schedule,401% of BCBS fee schedule,0.08,401,,,fee schedule,401% of BCBS fee schedule,13.5,90,,10.8,percent of total billed charges,90% of total billed charges,12,80,,9.6,percent of total billed charges,80% of total billed charges,13.5,90,,10.8,percent of total billed charges,90% of total billed charges,11.25,75,,9,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,4.35,29,,3.48,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,10.05,67,,8.04,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,12,80,,9.6,percent of total billed charges,80% of total billed charges,9.75,65,,7.8,percent of total billed charges,65% of total billed charges,5.35,35.67,,4.28,percent of total billed charges,35.67% of total billed charges,0.08,15,
XYLOCAINE 2% 2CC INJ,2511705,CDM,636,RC,J2001,HCPCS,outpatient,,,16,6.40,,13.6,85,,10.88,percent of total billed charges,85% of total billed charges,16,100,,12.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,0.08,385,,,fee schedule,385% of BCBS fee schedule,0.08,401,,,fee schedule,401% of BCBS fee schedule,0.08,401,,,fee schedule,401% of BCBS fee schedule,0.08,401,,,fee schedule,401% of BCBS fee schedule,14.4,90,,11.52,percent of total billed charges,90% of total billed charges,12.8,80,,10.24,percent of total billed charges,80% of total billed charges,14.4,90,,11.52,percent of total billed charges,90% of total billed charges,12,75,,9.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,4.64,29,,3.712,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,10.72,67,,8.576,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,12.8,80,,10.24,percent of total billed charges,80% of total billed charges,10.4,65,,8.32,percent of total billed charges,65% of total billed charges,5.71,35.67,,4.568,percent of total billed charges,35.67% of total billed charges,0.08,16,
XYLOCAINE .5% MPF 50 ML INJ,2511722,CDM,636,RC,J2001,HCPCS,outpatient,,,57,22.80,,48.45,85,,38.76,percent of total billed charges,85% of total billed charges,57,100,,45.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,0.08,385,,,fee schedule,385% of BCBS fee schedule,0.08,401,,,fee schedule,401% of BCBS fee schedule,0.08,401,,,fee schedule,401% of BCBS fee schedule,0.08,401,,,fee schedule,401% of BCBS fee schedule,51.3,90,,41.04,percent of total billed charges,90% of total billed charges,45.6,80,,36.48,percent of total billed charges,80% of total billed charges,51.3,90,,41.04,percent of total billed charges,90% of total billed charges,42.75,75,,34.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,16.53,29,,13.224,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,38.19,67,,30.552,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,45.6,80,,36.48,percent of total billed charges,80% of total billed charges,37.05,65,,29.64,percent of total billed charges,65% of total billed charges,20.33,35.67,,16.264,percent of total billed charges,35.67% of total billed charges,0.08,57,
XYLOCAINE 1.0% MPF 10 ML INJ,2511723,CDM,636,RC,J2001,HCPCS,outpatient,,,17,6.80,,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,17,100,,13.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,0.08,385,,,fee schedule,385% of BCBS fee schedule,0.08,401,,,fee schedule,401% of BCBS fee schedule,0.08,401,,,fee schedule,401% of BCBS fee schedule,0.08,401,,,fee schedule,401% of BCBS fee schedule,15.3,90,,12.24,percent of total billed charges,90% of total billed charges,13.6,80,,10.88,percent of total billed charges,80% of total billed charges,15.3,90,,12.24,percent of total billed charges,90% of total billed charges,12.75,75,,10.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,4.93,29,,3.944,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,11.39,67,,9.112,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,13.6,80,,10.88,percent of total billed charges,80% of total billed charges,11.05,65,,8.84,percent of total billed charges,65% of total billed charges,6.06,35.67,,4.848,percent of total billed charges,35.67% of total billed charges,0.08,17,
XELJANZ,2511734,CDM,636,RC,J8499,HCPCS,outpatient,,,252,100.80,,214.2,85,,171.36,percent of total billed charges,85% of total billed charges,252,100,,201.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,206.64,82,,165.312,percent of total billed charges,82% of total billed charges,214.2,85,,171.36,percent of total billed charges,85% of total billed charges,214.2,85,,171.36,percent of total billed charges,85% of total billed charges,214.2,85,,171.36,percent of total billed charges,85% of total billed charges,226.8,90,,181.44,percent of total billed charges,90% of total billed charges,201.6,80,,161.28,percent of total billed charges,80% of total billed charges,226.8,90,,181.44,percent of total billed charges,90% of total billed charges,189,75,,151.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,73.08,29,,58.464,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,168.84,67,,135.072,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,201.6,80,,161.28,percent of total billed charges,80% of total billed charges,163.8,65,,131.04,percent of total billed charges,65% of total billed charges,89.89,35.67,,71.912,percent of total billed charges,35.67% of total billed charges,73.08,252,
XYLOCAINE/LIDO 1% 50 ML INJ,2511737,CDM,636,RC,J2001,HCPCS,outpatient,,,24,9.60,,20.4,85,,16.32,percent of total billed charges,85% of total billed charges,24,100,,19.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,0.08,385,,,fee schedule,385% of BCBS fee schedule,0.08,401,,,fee schedule,401% of BCBS fee schedule,0.08,401,,,fee schedule,401% of BCBS fee schedule,0.08,401,,,fee schedule,401% of BCBS fee schedule,21.6,90,,17.28,percent of total billed charges,90% of total billed charges,19.2,80,,15.36,percent of total billed charges,80% of total billed charges,21.6,90,,17.28,percent of total billed charges,90% of total billed charges,18,75,,14.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,6.96,29,,5.568,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,16.08,67,,12.864,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,19.2,80,,15.36,percent of total billed charges,80% of total billed charges,15.6,65,,12.48,percent of total billed charges,65% of total billed charges,8.56,35.67,,6.848,percent of total billed charges,35.67% of total billed charges,0.08,24,
ERYTHROMYCIN BASE 250 MG TAB,2511741,CDM,636,RC,J8499,HCPCS,outpatient,,,22,8.80,,18.7,85,,14.96,percent of total billed charges,85% of total billed charges,22,100,,17.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,18.04,82,,14.432,percent of total billed charges,82% of total billed charges,18.7,85,,14.96,percent of total billed charges,85% of total billed charges,18.7,85,,14.96,percent of total billed charges,85% of total billed charges,18.7,85,,14.96,percent of total billed charges,85% of total billed charges,19.8,90,,15.84,percent of total billed charges,90% of total billed charges,17.6,80,,14.08,percent of total billed charges,80% of total billed charges,19.8,90,,15.84,percent of total billed charges,90% of total billed charges,16.5,75,,13.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,6.38,29,,5.104,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,14.74,67,,11.792,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,17.6,80,,14.08,percent of total billed charges,80% of total billed charges,14.3,65,,11.44,percent of total billed charges,65% of total billed charges,7.85,35.67,,6.28,percent of total billed charges,35.67% of total billed charges,6.38,22,
ARIPIPRAZOLE 10MG TABLET,2511742,CDM,636,RC,J8499,HCPCS,outpatient,,,102,40.80,,86.7,85,,69.36,percent of total billed charges,85% of total billed charges,102,100,,81.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,83.64,82,,66.912,percent of total billed charges,82% of total billed charges,86.7,85,,69.36,percent of total billed charges,85% of total billed charges,86.7,85,,69.36,percent of total billed charges,85% of total billed charges,86.7,85,,69.36,percent of total billed charges,85% of total billed charges,91.8,90,,73.44,percent of total billed charges,90% of total billed charges,81.6,80,,65.28,percent of total billed charges,80% of total billed charges,91.8,90,,73.44,percent of total billed charges,90% of total billed charges,76.5,75,,61.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,29.58,29,,23.664,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,68.34,67,,54.672,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,81.6,80,,65.28,percent of total billed charges,80% of total billed charges,66.3,65,,53.04,percent of total billed charges,65% of total billed charges,36.38,35.67,,29.104,percent of total billed charges,35.67% of total billed charges,29.58,102,
LEVOTHYROXINE SODIUM 25MG TAB,2511743,CDM,636,RC,J3490,HCPCS,outpatient,,,4,1.60,,3.4,85,,2.72,percent of total billed charges,85% of total billed charges,4,100,,3.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,3.28,82,,2.624,percent of total billed charges,82% of total billed charges,3.4,85,,2.72,percent of total billed charges,85% of total billed charges,3.4,85,,2.72,percent of total billed charges,85% of total billed charges,3.4,85,,2.72,percent of total billed charges,85% of total billed charges,3.6,90,,2.88,percent of total billed charges,90% of total billed charges,3.2,80,,2.56,percent of total billed charges,80% of total billed charges,3.6,90,,2.88,percent of total billed charges,90% of total billed charges,3,75,,2.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,1.16,29,,0.928,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,2.68,67,,2.144,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,3.2,80,,2.56,percent of total billed charges,80% of total billed charges,2.6,65,,2.08,percent of total billed charges,65% of total billed charges,1.43,35.67,,1.144,percent of total billed charges,35.67% of total billed charges,1.16,4,
XIFAXAN 550MG,2511744,CDM,636,RC,J8499,HCPCS,outpatient,,,130,52.00,,110.5,85,,88.4,percent of total billed charges,85% of total billed charges,130,100,,104,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,106.6,82,,85.28,percent of total billed charges,82% of total billed charges,110.5,85,,88.4,percent of total billed charges,85% of total billed charges,110.5,85,,88.4,percent of total billed charges,85% of total billed charges,110.5,85,,88.4,percent of total billed charges,85% of total billed charges,117,90,,93.6,percent of total billed charges,90% of total billed charges,104,80,,83.2,percent of total billed charges,80% of total billed charges,117,90,,93.6,percent of total billed charges,90% of total billed charges,97.5,75,,78,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,37.7,29,,30.16,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,87.1,67,,69.68,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,104,80,,83.2,percent of total billed charges,80% of total billed charges,84.5,65,,67.6,percent of total billed charges,65% of total billed charges,46.37,35.67,,37.096,percent of total billed charges,35.67% of total billed charges,37.7,130,
MORPHINE SULFATE 15MG TAB,2511750,CDM,636,RC,J8499,HCPCS,outpatient,,,4,1.60,,3.4,85,,2.72,percent of total billed charges,85% of total billed charges,4,100,,3.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,3.28,82,,2.624,percent of total billed charges,82% of total billed charges,3.4,85,,2.72,percent of total billed charges,85% of total billed charges,3.4,85,,2.72,percent of total billed charges,85% of total billed charges,3.4,85,,2.72,percent of total billed charges,85% of total billed charges,3.6,90,,2.88,percent of total billed charges,90% of total billed charges,3.2,80,,2.56,percent of total billed charges,80% of total billed charges,3.6,90,,2.88,percent of total billed charges,90% of total billed charges,3,75,,2.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,1.16,29,,0.928,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,2.68,67,,2.144,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,3.2,80,,2.56,percent of total billed charges,80% of total billed charges,2.6,65,,2.08,percent of total billed charges,65% of total billed charges,1.43,35.67,,1.144,percent of total billed charges,35.67% of total billed charges,1.16,4,
ZANTAC INJ 50MG/2CC,2511785,CDM,636,RC,J2780,HCPCS,outpatient,,,17,6.80,,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,17,100,,13.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,17.17,385,,,fee schedule,385% of BCBS fee schedule,17.88,401,,,fee schedule,401% of BCBS fee schedule,17.88,401,,,fee schedule,401% of BCBS fee schedule,17.88,401,,,fee schedule,401% of BCBS fee schedule,15.3,90,,12.24,percent of total billed charges,90% of total billed charges,13.6,80,,10.88,percent of total billed charges,80% of total billed charges,15.3,90,,12.24,percent of total billed charges,90% of total billed charges,12.75,75,,10.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,4.93,29,,3.944,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,11.39,67,,9.112,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,13.6,80,,10.88,percent of total billed charges,80% of total billed charges,11.05,65,,8.84,percent of total billed charges,65% of total billed charges,6.06,35.67,,4.848,percent of total billed charges,35.67% of total billed charges,4.93,17.88,
ZARXIO INJECTION 480 MGC,2511787,CDM,636,RC,Q5101,HCPCS,outpatient,,,1745,698.00,,1483.25,85,,1186.6,percent of total billed charges,85% of total billed charges,916.13,52.5,,732.9,percent of total billed charges,52.5 percent of total billed charges,0.36,100,,,fee schedule,100% of CMS OPPS rate,3.5,385,,,fee schedule,385% of BCBS fee schedule,3.65,401,,,fee schedule,401% of BCBS fee schedule,3.65,401,,,fee schedule,401% of BCBS fee schedule,3.65,401,,,fee schedule,401% of BCBS fee schedule,1570.5,90,,1256.4,percent of total billed charges,90% of total billed charges,1396,80,,1116.8,percent of total billed charges,80% of total billed charges,1570.5,90,,1256.4,percent of total billed charges,90% of total billed charges,1308.75,75,,1047,percent of total billed charges,75% of total billed charges,0.43,122,,,fee schedule,122% of HUMANA fee schedule,506.05,29,,404.84,percent of total billed charges,29% of total billed charges,0.36,100,,,fee schedule,100% of CMS OPPS rate,1169.15,67,,935.32,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1396,80,,1116.8,percent of total billed charges,80% of total billed charges,1134.25,65,,907.4,percent of total billed charges,65% of total billed charges,622.44,35.67,,497.952,percent of total billed charges,35.67% of total billed charges,0.36,1570.5,
ZITHROMAX 200MG/5 ML,2511882,CDM,636,RC,J0456,HCPCS,outpatient,,,29,11.60,,24.65,85,,19.72,percent of total billed charges,85% of total billed charges,29,100,,23.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,15.98,385,,,fee schedule,385% of BCBS fee schedule,16.64,401,,,fee schedule,401% of BCBS fee schedule,16.64,401,,,fee schedule,401% of BCBS fee schedule,16.64,401,,,fee schedule,401% of BCBS fee schedule,26.1,90,,20.88,percent of total billed charges,90% of total billed charges,23.2,80,,18.56,percent of total billed charges,80% of total billed charges,26.1,90,,20.88,percent of total billed charges,90% of total billed charges,21.75,75,,17.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,8.41,29,,6.728,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,19.43,67,,15.544,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,23.2,80,,18.56,percent of total billed charges,80% of total billed charges,18.85,65,,15.08,percent of total billed charges,65% of total billed charges,10.34,35.67,,8.272,percent of total billed charges,35.67% of total billed charges,8.41,29,
ZITHROMAX 500 MG IV,2511883,CDM,636,RC,J0456,HCPCS,outpatient,,,76,30.40,,64.6,85,,51.68,percent of total billed charges,85% of total billed charges,76,100,,60.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,15.98,385,,,fee schedule,385% of BCBS fee schedule,16.64,401,,,fee schedule,401% of BCBS fee schedule,16.64,401,,,fee schedule,401% of BCBS fee schedule,16.64,401,,,fee schedule,401% of BCBS fee schedule,68.4,90,,54.72,percent of total billed charges,90% of total billed charges,60.8,80,,48.64,percent of total billed charges,80% of total billed charges,68.4,90,,54.72,percent of total billed charges,90% of total billed charges,57,75,,45.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,22.04,29,,17.632,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,50.92,67,,40.736,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,60.8,80,,48.64,percent of total billed charges,80% of total billed charges,49.4,65,,39.52,percent of total billed charges,65% of total billed charges,27.11,35.67,,21.688,percent of total billed charges,35.67% of total billed charges,15.98,76,
ZOFRAN INJ. 4MG.,2511890,CDM,636,RC,J2405,HCPCS,outpatient,,,11,4.40,,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,11,100,,8.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,2.27,385,,,fee schedule,385% of BCBS fee schedule,2.37,401,,,fee schedule,401% of BCBS fee schedule,2.37,401,,,fee schedule,401% of BCBS fee schedule,2.37,401,,,fee schedule,401% of BCBS fee schedule,9.9,90,,7.92,percent of total billed charges,90% of total billed charges,8.8,80,,7.04,percent of total billed charges,80% of total billed charges,9.9,90,,7.92,percent of total billed charges,90% of total billed charges,8.25,75,,6.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,3.19,29,,2.552,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,7.37,67,,5.896,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,8.8,80,,7.04,percent of total billed charges,80% of total billed charges,7.15,65,,5.72,percent of total billed charges,65% of total billed charges,3.92,35.67,,3.136,percent of total billed charges,35.67% of total billed charges,2.27,11,
ZOFRAN 1 MG INJ*,2511891,CDM,636,RC,J2405,HCPCS,outpatient,,,25,10.00,,21.25,85,,17,percent of total billed charges,85% of total billed charges,25,100,,20,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,2.27,385,,,fee schedule,385% of BCBS fee schedule,2.37,401,,,fee schedule,401% of BCBS fee schedule,2.37,401,,,fee schedule,401% of BCBS fee schedule,2.37,401,,,fee schedule,401% of BCBS fee schedule,22.5,90,,18,percent of total billed charges,90% of total billed charges,20,80,,16,percent of total billed charges,80% of total billed charges,22.5,90,,18,percent of total billed charges,90% of total billed charges,18.75,75,,15,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,7.25,29,,5.8,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,16.75,67,,13.4,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,20,80,,16,percent of total billed charges,80% of total billed charges,16.25,65,,13,percent of total billed charges,65% of total billed charges,8.92,35.67,,7.136,percent of total billed charges,35.67% of total billed charges,2.27,25,
ZOMETA 2MG IVPB *,2511911,CDM,636,RC,J3489,HCPCS,outpatient,,,1190,476.00,,1011.5,85,,809.2,percent of total billed charges,85% of total billed charges,624.75,52.5,,499.8,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,31.19,385,,,fee schedule,385% of BCBS fee schedule,32.48,401,,,fee schedule,401% of BCBS fee schedule,32.48,401,,,fee schedule,401% of BCBS fee schedule,32.48,401,,,fee schedule,401% of BCBS fee schedule,1071,90,,856.8,percent of total billed charges,90% of total billed charges,952,80,,761.6,percent of total billed charges,80% of total billed charges,1071,90,,856.8,percent of total billed charges,90% of total billed charges,892.5,75,,714,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,345.1,29,,276.08,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,797.3,67,,637.84,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,952,80,,761.6,percent of total billed charges,80% of total billed charges,773.5,65,,618.8,percent of total billed charges,65% of total billed charges,424.47,35.67,,339.576,percent of total billed charges,35.67% of total billed charges,31.19,1071,
ZOMETA 4MG/100ML PREMIXED,2511917,CDM,636,RC,J3489,HCPCS,outpatient,,,96,38.40,,81.6,85,,65.28,percent of total billed charges,85% of total billed charges,96,100,,76.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,31.19,385,,,fee schedule,385% of BCBS fee schedule,32.48,401,,,fee schedule,401% of BCBS fee schedule,32.48,401,,,fee schedule,401% of BCBS fee schedule,32.48,401,,,fee schedule,401% of BCBS fee schedule,86.4,90,,69.12,percent of total billed charges,90% of total billed charges,76.8,80,,61.44,percent of total billed charges,80% of total billed charges,86.4,90,,69.12,percent of total billed charges,90% of total billed charges,72,75,,57.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,27.84,29,,22.272,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,64.32,67,,51.456,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,76.8,80,,61.44,percent of total billed charges,80% of total billed charges,62.4,65,,49.92,percent of total billed charges,65% of total billed charges,34.24,35.67,,27.392,percent of total billed charges,35.67% of total billed charges,27.84,96,
ZOSYN 3.375 INJ,2511920,CDM,636,RC,J2543,HCPCS,outpatient,,,82,32.80,,69.7,85,,55.76,percent of total billed charges,85% of total billed charges,82,100,,65.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,9.86,385,,,fee schedule,385% of BCBS fee schedule,10.27,401,,,fee schedule,401% of BCBS fee schedule,10.27,401,,,fee schedule,401% of BCBS fee schedule,10.27,401,,,fee schedule,401% of BCBS fee schedule,73.8,90,,59.04,percent of total billed charges,90% of total billed charges,65.6,80,,52.48,percent of total billed charges,80% of total billed charges,73.8,90,,59.04,percent of total billed charges,90% of total billed charges,61.5,75,,49.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,23.78,29,,19.024,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,54.94,67,,43.952,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,65.6,80,,52.48,percent of total billed charges,80% of total billed charges,53.3,65,,42.64,percent of total billed charges,65% of total billed charges,29.25,35.67,,23.4,percent of total billed charges,35.67% of total billed charges,9.86,82,
ZOSYN 4.5 GRAM VIALS,2511923,CDM,636,RC,J2543,HCPCS,outpatient,,,102,40.80,,86.7,85,,69.36,percent of total billed charges,85% of total billed charges,102,100,,81.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,9.86,385,,,fee schedule,385% of BCBS fee schedule,10.27,401,,,fee schedule,401% of BCBS fee schedule,10.27,401,,,fee schedule,401% of BCBS fee schedule,10.27,401,,,fee schedule,401% of BCBS fee schedule,91.8,90,,73.44,percent of total billed charges,90% of total billed charges,81.6,80,,65.28,percent of total billed charges,80% of total billed charges,91.8,90,,73.44,percent of total billed charges,90% of total billed charges,76.5,75,,61.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,29.58,29,,23.664,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,68.34,67,,54.672,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,81.6,80,,65.28,percent of total billed charges,80% of total billed charges,66.3,65,,53.04,percent of total billed charges,65% of total billed charges,36.38,35.67,,29.104,percent of total billed charges,35.67% of total billed charges,9.86,102,
ZOVIRAX 500 MG INJ,2511925,CDM,636,RC,J0133,HCPCS,outpatient,,,85,34.00,,72.25,85,,57.8,percent of total billed charges,85% of total billed charges,85,100,,68,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,0.19,385,,,fee schedule,385% of BCBS fee schedule,0.2,401,,,fee schedule,401% of BCBS fee schedule,0.2,401,,,fee schedule,401% of BCBS fee schedule,0.2,401,,,fee schedule,401% of BCBS fee schedule,76.5,90,,61.2,percent of total billed charges,90% of total billed charges,68,80,,54.4,percent of total billed charges,80% of total billed charges,76.5,90,,61.2,percent of total billed charges,90% of total billed charges,63.75,75,,51,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,24.65,29,,19.72,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,56.95,67,,45.56,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,68,80,,54.4,percent of total billed charges,80% of total billed charges,55.25,65,,44.2,percent of total billed charges,65% of total billed charges,30.32,35.67,,24.256,percent of total billed charges,35.67% of total billed charges,0.19,85,
ZOSYN 2.25 GM,2511944,CDM,636,RC,J2543,HCPCS,outpatient,,,61,24.40,,51.85,85,,41.48,percent of total billed charges,85% of total billed charges,61,100,,48.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,9.86,385,,,fee schedule,385% of BCBS fee schedule,10.27,401,,,fee schedule,401% of BCBS fee schedule,10.27,401,,,fee schedule,401% of BCBS fee schedule,10.27,401,,,fee schedule,401% of BCBS fee schedule,54.9,90,,43.92,percent of total billed charges,90% of total billed charges,48.8,80,,39.04,percent of total billed charges,80% of total billed charges,54.9,90,,43.92,percent of total billed charges,90% of total billed charges,45.75,75,,36.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,17.69,29,,14.152,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,40.87,67,,32.696,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,48.8,80,,39.04,percent of total billed charges,80% of total billed charges,39.65,65,,31.72,percent of total billed charges,65% of total billed charges,21.76,35.67,,17.408,percent of total billed charges,35.67% of total billed charges,9.86,61,
ZYVOX 600 MG PREMIXED BAG,2511972,CDM,636,RC,J2020,HCPCS,outpatient,,,459,183.60,,390.15,85,,312.12,percent of total billed charges,85% of total billed charges,459,100,,367.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,55.44,385,,,fee schedule,385% of BCBS fee schedule,57.74,401,,,fee schedule,401% of BCBS fee schedule,57.74,401,,,fee schedule,401% of BCBS fee schedule,57.74,401,,,fee schedule,401% of BCBS fee schedule,413.1,90,,330.48,percent of total billed charges,90% of total billed charges,367.2,80,,293.76,percent of total billed charges,80% of total billed charges,413.1,90,,330.48,percent of total billed charges,90% of total billed charges,344.25,75,,275.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,133.11,29,,106.488,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,307.53,67,,246.024,percent of total billed charges,67% of total billed charges,40.5,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,367.2,80,,293.76,percent of total billed charges,80% of total billed charges,298.35,65,,238.68,percent of total billed charges,65% of total billed charges,163.73,35.67,,130.984,percent of total billed charges,35.67% of total billed charges,40.5,459,
ZYVOX 200 MG/100ML PREMIXED BG,2511974,CDM,636,RC,J2020,HCPCS,outpatient,,,316,126.40,,268.6,85,,214.88,percent of total billed charges,85% of total billed charges,316,100,,252.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,55.44,385,,,fee schedule,385% of BCBS fee schedule,57.74,401,,,fee schedule,401% of BCBS fee schedule,57.74,401,,,fee schedule,401% of BCBS fee schedule,57.74,401,,,fee schedule,401% of BCBS fee schedule,284.4,90,,227.52,percent of total billed charges,90% of total billed charges,252.8,80,,202.24,percent of total billed charges,80% of total billed charges,284.4,90,,227.52,percent of total billed charges,90% of total billed charges,237,75,,189.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,91.64,29,,73.312,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,211.72,67,,169.376,percent of total billed charges,67% of total billed charges,40.5,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,252.8,80,,202.24,percent of total billed charges,80% of total billed charges,205.4,65,,164.32,percent of total billed charges,65% of total billed charges,112.72,35.67,,90.176,percent of total billed charges,35.67% of total billed charges,40.5,316,
LIDOCAINE 1% W/EPINEPHRINE,2513152,CDM,636,RC,J3490,HCPCS,outpatient,,,36,14.40,,30.6,85,,24.48,percent of total billed charges,85% of total billed charges,36,100,,28.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,29.52,82,,23.616,percent of total billed charges,82% of total billed charges,30.6,85,,24.48,percent of total billed charges,85% of total billed charges,30.6,85,,24.48,percent of total billed charges,85% of total billed charges,30.6,85,,24.48,percent of total billed charges,85% of total billed charges,32.4,90,,25.92,percent of total billed charges,90% of total billed charges,28.8,80,,23.04,percent of total billed charges,80% of total billed charges,32.4,90,,25.92,percent of total billed charges,90% of total billed charges,27,75,,21.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,10.44,29,,8.352,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,24.12,67,,19.296,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,28.8,80,,23.04,percent of total billed charges,80% of total billed charges,23.4,65,,18.72,percent of total billed charges,65% of total billed charges,12.84,35.67,,10.272,percent of total billed charges,35.67% of total billed charges,10.44,36,
DEXTROSE 5% SOLUTION,2513153,CDM,636,RC,J3490,HCPCS,outpatient,,,9,3.60,,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,9,100,,7.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,7.38,82,,5.904,percent of total billed charges,82% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,8.1,90,,6.48,percent of total billed charges,90% of total billed charges,7.2,80,,5.76,percent of total billed charges,80% of total billed charges,8.1,90,,6.48,percent of total billed charges,90% of total billed charges,6.75,75,,5.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.61,29,,2.088,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,6.03,67,,4.824,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,7.2,80,,5.76,percent of total billed charges,80% of total billed charges,5.85,65,,4.68,percent of total billed charges,65% of total billed charges,3.21,35.67,,2.568,percent of total billed charges,35.67% of total billed charges,2.61,9,
MANNITOL 20%INJ 250ML PREMIX,2513511,CDM,636,RC,J2150,HCPCS,outpatient,,,187,74.80,,158.95,85,,127.16,percent of total billed charges,85% of total billed charges,187,100,,149.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,5.74,385,,,fee schedule,385% of BCBS fee schedule,5.97,401,,,fee schedule,401% of BCBS fee schedule,5.97,401,,,fee schedule,401% of BCBS fee schedule,5.97,401,,,fee schedule,401% of BCBS fee schedule,168.3,90,,134.64,percent of total billed charges,90% of total billed charges,149.6,80,,119.68,percent of total billed charges,80% of total billed charges,168.3,90,,134.64,percent of total billed charges,90% of total billed charges,140.25,75,,112.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,54.23,29,,43.384,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,125.29,67,,100.232,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,149.6,80,,119.68,percent of total billed charges,80% of total billed charges,121.55,65,,97.24,percent of total billed charges,65% of total billed charges,66.7,35.67,,53.36,percent of total billed charges,35.67% of total billed charges,5.74,187,
ORBACTIV 1200 MG INJ,2513512,CDM,636,RC,J2407,HCPCS,outpatient,,,18904,7561.60,,16068.4,85,,12854.72,percent of total billed charges,85% of total billed charges,9924.6,52.5,,7939.68,percent of total billed charges,52.5 percent of total billed charges,28.46,100,,,fee schedule,100% of CMS OPPS rate,93.05,385,,,fee schedule,385% of BCBS fee schedule,96.92,401,,,fee schedule,401% of BCBS fee schedule,96.92,401,,,fee schedule,401% of BCBS fee schedule,96.92,401,,,fee schedule,401% of BCBS fee schedule,17013.6,90,,13610.88,percent of total billed charges,90% of total billed charges,15123.2,80,,12098.56,percent of total billed charges,80% of total billed charges,17013.6,90,,13610.88,percent of total billed charges,90% of total billed charges,14178,75,,11342.4,percent of total billed charges,75% of total billed charges,34.72,122,,,fee schedule,122% of HUMANA fee schedule,5482.16,29,,4385.728,percent of total billed charges,29% of total billed charges,28.46,100,,,fee schedule,100% of CMS OPPS rate,12665.68,67,,10132.544,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,15123.2,80,,12098.56,percent of total billed charges,80% of total billed charges,12287.6,65,,9830.08,percent of total billed charges,65% of total billed charges,6743.06,35.67,,5394.448,percent of total billed charges,35.67% of total billed charges,28.46,17013.6,
"TENIVAC -TET,DPT  0.5 INJ",2513514,CDM,636,RC,90715,HCPCS,outpatient,,,150,60.00,,127.5,85,,102,percent of total billed charges,85% of total billed charges,150,100,,120,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,149.46,385,,,fee schedule,385% of BCBS fee schedule,155.67,401,,,fee schedule,401% of BCBS fee schedule,155.67,401,,,fee schedule,401% of BCBS fee schedule,155.67,401,,,fee schedule,401% of BCBS fee schedule,135,90,,108,percent of total billed charges,90% of total billed charges,120,80,,96,percent of total billed charges,80% of total billed charges,135,90,,108,percent of total billed charges,90% of total billed charges,112.5,75,,90,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,43.5,29,,34.8,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,100.5,67,,80.4,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,120,80,,96,percent of total billed charges,80% of total billed charges,97.5,65,,78,percent of total billed charges,65% of total billed charges,53.51,35.67,,42.808,percent of total billed charges,35.67% of total billed charges,43.5,155.67,
"OXACILLIN,PROSTAPHLIN 1000 MG",2516981,CDM,636,RC,J2700,HCPCS,outpatient,,,117,46.80,,99.45,85,,79.56,percent of total billed charges,85% of total billed charges,117,100,,93.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,7.66,385,,,fee schedule,385% of BCBS fee schedule,7.98,401,,,fee schedule,401% of BCBS fee schedule,7.98,401,,,fee schedule,401% of BCBS fee schedule,7.98,401,,,fee schedule,401% of BCBS fee schedule,105.3,90,,84.24,percent of total billed charges,90% of total billed charges,93.6,80,,74.88,percent of total billed charges,80% of total billed charges,105.3,90,,84.24,percent of total billed charges,90% of total billed charges,87.75,75,,70.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,33.93,29,,27.144,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,78.39,67,,62.712,percent of total billed charges,67% of total billed charges,2.45,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,93.6,80,,74.88,percent of total billed charges,80% of total billed charges,76.05,65,,60.84,percent of total billed charges,65% of total billed charges,41.73,35.67,,33.384,percent of total billed charges,35.67% of total billed charges,2.45,117,
PHENYTOIN 100MG/2ML,2517881,CDM,636,RC,J1165,HCPCS,outpatient,,,15,6.00,,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,15,100,,12,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,1.54,385,,,fee schedule,385% of BCBS fee schedule,1.6,401,,,fee schedule,401% of BCBS fee schedule,1.6,401,,,fee schedule,401% of BCBS fee schedule,1.6,401,,,fee schedule,401% of BCBS fee schedule,13.5,90,,10.8,percent of total billed charges,90% of total billed charges,12,80,,9.6,percent of total billed charges,80% of total billed charges,13.5,90,,10.8,percent of total billed charges,90% of total billed charges,11.25,75,,9,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,4.35,29,,3.48,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,10.05,67,,8.04,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,12,80,,9.6,percent of total billed charges,80% of total billed charges,9.75,65,,7.8,percent of total billed charges,65% of total billed charges,5.35,35.67,,4.28,percent of total billed charges,35.67% of total billed charges,1.54,15,
AQUA-MEPHYTON NEONATAL PREFILL,2518121,CDM,636,RC,J3430,HCPCS,outpatient,,,21,8.40,,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,21,100,,16.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,14.86,385,,,fee schedule,385% of BCBS fee schedule,15.48,401,,,fee schedule,401% of BCBS fee schedule,15.48,401,,,fee schedule,401% of BCBS fee schedule,15.48,401,,,fee schedule,401% of BCBS fee schedule,18.9,90,,15.12,percent of total billed charges,90% of total billed charges,16.8,80,,13.44,percent of total billed charges,80% of total billed charges,18.9,90,,15.12,percent of total billed charges,90% of total billed charges,15.75,75,,12.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,6.09,29,,4.872,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,14.07,67,,11.256,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,16.8,80,,13.44,percent of total billed charges,80% of total billed charges,13.65,65,,10.92,percent of total billed charges,65% of total billed charges,7.49,35.67,,5.992,percent of total billed charges,35.67% of total billed charges,6.09,21,
SIVEXTRO 200 MG VIAL,2518123,CDM,636,RC,J3090,HCPCS,outpatient,,,682,272.80,,579.7,85,,463.76,percent of total billed charges,85% of total billed charges,682,100,,545.6,percent of total billed charges,pays based on exceed threshold rate,1.81,100,,,fee schedule,100% of CMS OPPS rate,5.12,385,,,fee schedule,385% of BCBS fee schedule,5.33,401,,,fee schedule,401% of BCBS fee schedule,5.33,401,,,fee schedule,401% of BCBS fee schedule,5.33,401,,,fee schedule,401% of BCBS fee schedule,613.8,90,,491.04,percent of total billed charges,90% of total billed charges,545.6,80,,436.48,percent of total billed charges,80% of total billed charges,613.8,90,,491.04,percent of total billed charges,90% of total billed charges,511.5,75,,409.2,percent of total billed charges,75% of total billed charges,2.2,122,,,fee schedule,122% of HUMANA fee schedule,197.78,29,,158.224,percent of total billed charges,29% of total billed charges,1.81,100,,,fee schedule,100% of CMS OPPS rate,456.94,67,,365.552,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,545.6,80,,436.48,percent of total billed charges,80% of total billed charges,443.3,65,,354.64,percent of total billed charges,65% of total billed charges,243.27,35.67,,194.616,percent of total billed charges,35.67% of total billed charges,1.81,682,
RABAVERT  RABIES VACCINE,2518774,CDM,636,RC,90676,HCPCS,outpatient,,,792,316.80,,673.2,85,,538.56,percent of total billed charges,85% of total billed charges,792,100,,633.6,percent of total billed charges,pays based on exceed threshold rate,279.14,100,,,fee schedule,100% of CMS OPPS rate,611.38,385,,,fee schedule,385% of BCBS fee schedule,636.79,401,,,fee schedule,401% of BCBS fee schedule,636.79,401,,,fee schedule,401% of BCBS fee schedule,636.79,401,,,fee schedule,401% of BCBS fee schedule,712.8,90,,570.24,percent of total billed charges,90% of total billed charges,633.6,80,,506.88,percent of total billed charges,80% of total billed charges,712.8,90,,570.24,percent of total billed charges,90% of total billed charges,594,75,,475.2,percent of total billed charges,75% of total billed charges,340.56,122,,,fee schedule,122% of HUMANA fee schedule,229.68,29,,183.744,percent of total billed charges,29% of total billed charges,279.14,100,,,fee schedule,100% of CMS OPPS rate,530.64,67,,424.512,percent of total billed charges,67% of total billed charges,153.85,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,633.6,80,,506.88,percent of total billed charges,80% of total billed charges,514.8,65,,411.84,percent of total billed charges,65% of total billed charges,282.51,35.67,,226.008,percent of total billed charges,35.67% of total billed charges,153.85,792,
ONDANSETRON 2 MG/1ML VIAL,2518999,CDM,636,RC,J2405,HCPCS,outpatient,,,24,9.60,,20.4,85,,16.32,percent of total billed charges,85% of total billed charges,24,100,,19.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,2.27,385,,,fee schedule,385% of BCBS fee schedule,2.37,401,,,fee schedule,401% of BCBS fee schedule,2.37,401,,,fee schedule,401% of BCBS fee schedule,2.37,401,,,fee schedule,401% of BCBS fee schedule,21.6,90,,17.28,percent of total billed charges,90% of total billed charges,19.2,80,,15.36,percent of total billed charges,80% of total billed charges,21.6,90,,17.28,percent of total billed charges,90% of total billed charges,18,75,,14.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,6.96,29,,5.568,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,16.08,67,,12.864,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,19.2,80,,15.36,percent of total billed charges,80% of total billed charges,15.6,65,,12.48,percent of total billed charges,65% of total billed charges,8.56,35.67,,6.848,percent of total billed charges,35.67% of total billed charges,2.27,24,
OXYTOCIN 30 UNITS/500 ML NS,2519908,CDM,636,RC,J2590,HCPCS,outpatient,,,67,26.80,,56.95,85,,45.56,percent of total billed charges,85% of total billed charges,67,100,,53.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,2.5,385,,,fee schedule,385% of BCBS fee schedule,2.61,401,,,fee schedule,401% of BCBS fee schedule,2.61,401,,,fee schedule,401% of BCBS fee schedule,2.61,401,,,fee schedule,401% of BCBS fee schedule,60.3,90,,48.24,percent of total billed charges,90% of total billed charges,53.6,80,,42.88,percent of total billed charges,80% of total billed charges,60.3,90,,48.24,percent of total billed charges,90% of total billed charges,50.25,75,,40.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,19.43,29,,15.544,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,44.89,67,,35.912,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,53.6,80,,42.88,percent of total billed charges,80% of total billed charges,43.55,65,,34.84,percent of total billed charges,65% of total billed charges,23.9,35.67,,19.12,percent of total billed charges,35.67% of total billed charges,2.5,67,
PITOCIN 10 UNITS/ML 10 ML VIAL,2519913,CDM,636,RC,J2590,HCPCS,outpatient,,,34,13.60,,28.9,85,,23.12,percent of total billed charges,85% of total billed charges,34,100,,27.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,2.5,385,,,fee schedule,385% of BCBS fee schedule,2.61,401,,,fee schedule,401% of BCBS fee schedule,2.61,401,,,fee schedule,401% of BCBS fee schedule,2.61,401,,,fee schedule,401% of BCBS fee schedule,30.6,90,,24.48,percent of total billed charges,90% of total billed charges,27.2,80,,21.76,percent of total billed charges,80% of total billed charges,30.6,90,,24.48,percent of total billed charges,90% of total billed charges,25.5,75,,20.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,9.86,29,,7.888,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,22.78,67,,18.224,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,27.2,80,,21.76,percent of total billed charges,80% of total billed charges,22.1,65,,17.68,percent of total billed charges,65% of total billed charges,12.13,35.67,,9.704,percent of total billed charges,35.67% of total billed charges,2.5,34,
HYDROMORPHONE 10 MG IV,2519914,CDM,636,RC,J1170,HCPCS,outpatient,,,25,10.00,,21.25,85,,17,percent of total billed charges,85% of total billed charges,25,100,,20,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,1.54,385,,,fee schedule,385% of BCBS fee schedule,1.6,401,,,fee schedule,401% of BCBS fee schedule,1.6,401,,,fee schedule,401% of BCBS fee schedule,1.6,401,,,fee schedule,401% of BCBS fee schedule,22.5,90,,18,percent of total billed charges,90% of total billed charges,20,80,,16,percent of total billed charges,80% of total billed charges,22.5,90,,18,percent of total billed charges,90% of total billed charges,18.75,75,,15,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,7.25,29,,5.8,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,16.75,67,,13.4,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,20,80,,16,percent of total billed charges,80% of total billed charges,16.25,65,,13,percent of total billed charges,65% of total billed charges,8.92,35.67,,7.136,percent of total billed charges,35.67% of total billed charges,1.54,25,
CEFEPIME 2 GRAM INJ,2519992,CDM,636,RC,J0692,HCPCS,outpatient,,,56,22.40,,47.6,85,,38.08,percent of total billed charges,85% of total billed charges,56,100,,44.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,9.43,385,,,fee schedule,385% of BCBS fee schedule,9.82,401,,,fee schedule,401% of BCBS fee schedule,9.82,401,,,fee schedule,401% of BCBS fee schedule,9.82,401,,,fee schedule,401% of BCBS fee schedule,50.4,90,,40.32,percent of total billed charges,90% of total billed charges,44.8,80,,35.84,percent of total billed charges,80% of total billed charges,50.4,90,,40.32,percent of total billed charges,90% of total billed charges,42,75,,33.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,16.24,29,,12.992,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,37.52,67,,30.016,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,44.8,80,,35.84,percent of total billed charges,80% of total billed charges,36.4,65,,29.12,percent of total billed charges,65% of total billed charges,19.98,35.67,,15.984,percent of total billed charges,35.67% of total billed charges,9.43,56,
BUTORPHANOL TARTRATE 1MG/ML,2519994,CDM,636,RC,J0595,HCPCS,outpatient,,,12,4.80,,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,12,100,,9.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,4,385,,,fee schedule,385% of BCBS fee schedule,4.17,401,,,fee schedule,401% of BCBS fee schedule,4.17,401,,,fee schedule,401% of BCBS fee schedule,4.17,401,,,fee schedule,401% of BCBS fee schedule,10.8,90,,8.64,percent of total billed charges,90% of total billed charges,9.6,80,,7.68,percent of total billed charges,80% of total billed charges,10.8,90,,8.64,percent of total billed charges,90% of total billed charges,9,75,,7.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,3.48,29,,2.784,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,8.04,67,,6.432,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,9.6,80,,7.68,percent of total billed charges,80% of total billed charges,7.8,65,,6.24,percent of total billed charges,65% of total billed charges,4.28,35.67,,3.424,percent of total billed charges,35.67% of total billed charges,3.48,12,
REMDESIVIR 100 MG VIAL,2519995,CDM,636,RC,J0248,HCPCS,outpatient,,,2039,815.60,,1733.15,85,,1386.52,percent of total billed charges,85% of total billed charges,1070.48,52.5,,856.38,percent of total billed charges,52.5 percent of total billed charges,6.35,100,,,fee schedule,100% of CMS OPPS rate,20.02,385,,,fee schedule,385% of BCBS fee schedule,20.85,401,,,fee schedule,401% of BCBS fee schedule,20.85,401,,,fee schedule,401% of BCBS fee schedule,20.85,401,,,fee schedule,401% of BCBS fee schedule,1835.1,90,,1468.08,percent of total billed charges,90% of total billed charges,1631.2,80,,1304.96,percent of total billed charges,80% of total billed charges,1835.1,90,,1468.08,percent of total billed charges,90% of total billed charges,1529.25,75,,1223.4,percent of total billed charges,75% of total billed charges,7.74,122,,,fee schedule,122% of HUMANA fee schedule,591.31,29,,473.048,percent of total billed charges,29% of total billed charges,6.35,100,,,fee schedule,100% of CMS OPPS rate,1366.13,67,,1092.904,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1631.2,80,,1304.96,percent of total billed charges,80% of total billed charges,1325.35,65,,1060.28,percent of total billed charges,65% of total billed charges,727.31,35.67,,581.848,percent of total billed charges,35.67% of total billed charges,6.35,1835.1,
BUTORPHANOL TARTRATE 4 MG INJ,2519997,CDM,636,RC,J0595,HCPCS,outpatient,,,15,6.00,,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,15,100,,12,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,4,385,,,fee schedule,385% of BCBS fee schedule,4.17,401,,,fee schedule,401% of BCBS fee schedule,4.17,401,,,fee schedule,401% of BCBS fee schedule,4.17,401,,,fee schedule,401% of BCBS fee schedule,13.5,90,,10.8,percent of total billed charges,90% of total billed charges,12,80,,9.6,percent of total billed charges,80% of total billed charges,13.5,90,,10.8,percent of total billed charges,90% of total billed charges,11.25,75,,9,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,4.35,29,,3.48,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,10.05,67,,8.04,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,12,80,,9.6,percent of total billed charges,80% of total billed charges,9.75,65,,7.8,percent of total billed charges,65% of total billed charges,5.35,35.67,,4.28,percent of total billed charges,35.67% of total billed charges,4,15,
MEROPENEM 1 GRAM INJ,2519998,CDM,636,RC,J2185,HCPCS,outpatient,,,221,88.40,,187.85,85,,150.28,percent of total billed charges,85% of total billed charges,221,100,,176.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,10.63,385,,,fee schedule,385% of BCBS fee schedule,11.07,401,,,fee schedule,401% of BCBS fee schedule,11.07,401,,,fee schedule,401% of BCBS fee schedule,11.07,401,,,fee schedule,401% of BCBS fee schedule,198.9,90,,159.12,percent of total billed charges,90% of total billed charges,176.8,80,,141.44,percent of total billed charges,80% of total billed charges,198.9,90,,159.12,percent of total billed charges,90% of total billed charges,165.75,75,,132.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,64.09,29,,51.272,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,148.07,67,,118.456,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,176.8,80,,141.44,percent of total billed charges,80% of total billed charges,143.65,65,,114.92,percent of total billed charges,65% of total billed charges,78.83,35.67,,63.064,percent of total billed charges,35.67% of total billed charges,10.63,221,
FERAHEME 510 MG INJ,2523001,CDM,636,RC,Q0138,HCPCS,outpatient,,,1083,433.20,U8,920.55,85,,736.44,percent of total billed charges,85% of total billed charges,568.58,52.5,,454.86,percent of total billed charges,52.5 percent of total billed charges,0.34,100,,,fee schedule,100% of CMS OPPS rate,5.7,385,,,fee schedule,385% of BCBS fee schedule,5.93,401,,,fee schedule,401% of BCBS fee schedule,5.93,401,,,fee schedule,401% of BCBS fee schedule,5.93,401,,,fee schedule,401% of BCBS fee schedule,974.7,90,,779.76,percent of total billed charges,90% of total billed charges,866.4,80,,693.12,percent of total billed charges,80% of total billed charges,974.7,90,,779.76,percent of total billed charges,90% of total billed charges,812.25,75,,649.8,percent of total billed charges,75% of total billed charges,0.41,122,,,fee schedule,122% of HUMANA fee schedule,314.07,29,,251.256,percent of total billed charges,29% of total billed charges,0.34,100,,,fee schedule,100% of CMS OPPS rate,725.61,67,,580.488,percent of total billed charges,67% of total billed charges,0.66,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,866.4,80,,693.12,percent of total billed charges,80% of total billed charges,703.95,65,,563.16,percent of total billed charges,65% of total billed charges,386.31,35.67,,309.048,percent of total billed charges,35.67% of total billed charges,0.34,974.7,
POT CHLO DX/NS 20 MEQ S,2524560,CDM,636,RC,J3480,HCPCS,outpatient,,,46,18.40,,39.1,85,,31.28,percent of total billed charges,85% of total billed charges,46,100,,36.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,0.15,385,,,fee schedule,385% of BCBS fee schedule,0.16,401,,,fee schedule,401% of BCBS fee schedule,0.16,401,,,fee schedule,401% of BCBS fee schedule,0.16,401,,,fee schedule,401% of BCBS fee schedule,41.4,90,,33.12,percent of total billed charges,90% of total billed charges,36.8,80,,29.44,percent of total billed charges,80% of total billed charges,41.4,90,,33.12,percent of total billed charges,90% of total billed charges,34.5,75,,27.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,13.34,29,,10.672,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,30.82,67,,24.656,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,36.8,80,,29.44,percent of total billed charges,80% of total billed charges,29.9,65,,23.92,percent of total billed charges,65% of total billed charges,16.41,35.67,,13.128,percent of total billed charges,35.67% of total billed charges,0.15,46,
D5 1/4 NORMAL SALINE 20MG KCL,2524562,CDM,636,RC,J3480,HCPCS,outpatient,,,23,9.20,,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,23,100,,18.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,0.15,385,,,fee schedule,385% of BCBS fee schedule,0.16,401,,,fee schedule,401% of BCBS fee schedule,0.16,401,,,fee schedule,401% of BCBS fee schedule,0.16,401,,,fee schedule,401% of BCBS fee schedule,20.7,90,,16.56,percent of total billed charges,90% of total billed charges,18.4,80,,14.72,percent of total billed charges,80% of total billed charges,20.7,90,,16.56,percent of total billed charges,90% of total billed charges,17.25,75,,13.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,6.67,29,,5.336,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,15.41,67,,12.328,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,18.4,80,,14.72,percent of total billed charges,80% of total billed charges,14.95,65,,11.96,percent of total billed charges,65% of total billed charges,8.2,35.67,,6.56,percent of total billed charges,35.67% of total billed charges,0.15,23,
IV NS 1000 CC,26000371,CDM,636,RC,J7030,HCPCS,outpatient,,,129,51.60,,109.65,85,,87.72,percent of total billed charges,85% of total billed charges,129,100,,103.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,63.64,385,,,fee schedule,385% of BCBS fee schedule,66.29,401,,,fee schedule,401% of BCBS fee schedule,66.29,401,,,fee schedule,401% of BCBS fee schedule,66.29,401,,,fee schedule,401% of BCBS fee schedule,116.1,90,,92.88,percent of total billed charges,90% of total billed charges,103.2,80,,82.56,percent of total billed charges,80% of total billed charges,116.1,90,,92.88,percent of total billed charges,90% of total billed charges,96.75,75,,77.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,37.41,29,,29.928,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,86.43,67,,69.144,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,103.2,80,,82.56,percent of total billed charges,80% of total billed charges,83.85,65,,67.08,percent of total billed charges,65% of total billed charges,46.01,35.67,,36.808,percent of total billed charges,35.67% of total billed charges,37.41,129,
IV DOPAMINE HCL 800 MG,26001814,CDM,636,RC,J1265,HCPCS,outpatient,,,340,136.00,,289,85,,231.2,percent of total billed charges,85% of total billed charges,340,100,,272,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,0.46,385,,,fee schedule,385% of BCBS fee schedule,0.48,401,,,fee schedule,401% of BCBS fee schedule,0.48,401,,,fee schedule,401% of BCBS fee schedule,0.48,401,,,fee schedule,401% of BCBS fee schedule,306,90,,244.8,percent of total billed charges,90% of total billed charges,272,80,,217.6,percent of total billed charges,80% of total billed charges,306,90,,244.8,percent of total billed charges,90% of total billed charges,255,75,,204,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,0.6,100,,,fee schedule,100% of ASC tier grouping rate,,,,,other ,not seperately reimbursable,227.8,67,,182.24,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,272,80,,217.6,percent of total billed charges,80% of total billed charges,221,65,,176.8,percent of total billed charges,65% of total billed charges,0.74,123,,,fee schedule,123% of ASC tier grouping rate,0.46,340,
IV MAG SULFATE 4 GM/100ML,27004071,CDM,636,RC,J3475,HCPCS,outpatient,,,316,126.40,,268.6,85,,214.88,percent of total billed charges,85% of total billed charges,316,100,,252.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,0.27,385,,,fee schedule,385% of BCBS fee schedule,0.28,401,,,fee schedule,401% of BCBS fee schedule,0.28,401,,,fee schedule,401% of BCBS fee schedule,0.28,401,,,fee schedule,401% of BCBS fee schedule,284.4,90,,227.52,percent of total billed charges,90% of total billed charges,252.8,80,,202.24,percent of total billed charges,80% of total billed charges,284.4,90,,227.52,percent of total billed charges,90% of total billed charges,237,75,,189.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,91.64,29,,73.312,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,211.72,67,,169.376,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,252.8,80,,202.24,percent of total billed charges,80% of total billed charges,205.4,65,,164.32,percent of total billed charges,65% of total billed charges,112.72,35.67,,90.176,percent of total billed charges,35.67% of total billed charges,0.27,316,
IV MAG SULFATE 40 GM/1000 ML,27004072,CDM,636,RC,J3475,HCPCS,outpatient,,,334,133.60,,283.9,85,,227.12,percent of total billed charges,85% of total billed charges,334,100,,267.2,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,0.27,385,,,fee schedule,385% of BCBS fee schedule,0.28,401,,,fee schedule,401% of BCBS fee schedule,0.28,401,,,fee schedule,401% of BCBS fee schedule,0.28,401,,,fee schedule,401% of BCBS fee schedule,300.6,90,,240.48,percent of total billed charges,90% of total billed charges,267.2,80,,213.76,percent of total billed charges,80% of total billed charges,300.6,90,,240.48,percent of total billed charges,90% of total billed charges,250.5,75,,200.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,96.86,29,,77.488,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,223.78,67,,179.024,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,267.2,80,,213.76,percent of total billed charges,80% of total billed charges,217.1,65,,173.68,percent of total billed charges,65% of total billed charges,119.14,35.67,,95.312,percent of total billed charges,35.67% of total billed charges,0.27,334,
DOBUTAMINE 250 MG,27008216,CDM,636,RC,J1250,HCPCS,outpatient,,,341,136.40,,289.85,85,,231.88,percent of total billed charges,85% of total billed charges,341,100,,272.8,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,10.97,385,,,fee schedule,385% of BCBS fee schedule,11.43,401,,,fee schedule,401% of BCBS fee schedule,11.43,401,,,fee schedule,401% of BCBS fee schedule,11.43,401,,,fee schedule,401% of BCBS fee schedule,306.9,90,,245.52,percent of total billed charges,90% of total billed charges,272.8,80,,218.24,percent of total billed charges,80% of total billed charges,306.9,90,,245.52,percent of total billed charges,90% of total billed charges,255.75,75,,204.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,98.89,29,,79.112,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,228.47,67,,182.776,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,272.8,80,,218.24,percent of total billed charges,80% of total billed charges,221.65,65,,177.32,percent of total billed charges,65% of total billed charges,121.63,35.67,,97.304,percent of total billed charges,35.67% of total billed charges,10.97,341,
EXPAREL 20ML,2701897,CDM,636,RC,C9290,HCPCS,outpatient,,,1162,464.80,,987.7,85,,790.16,percent of total billed charges,85% of total billed charges,610.05,52.5,,488.04,percent of total billed charges,52.5 percent of total billed charges,,,,,other ,not seperately reimbursable,952.84,82,,762.272,percent of total billed charges,82% of total billed charges,987.7,85,,790.16,percent of total billed charges,85% of total billed charges,987.7,85,,790.16,percent of total billed charges,85% of total billed charges,987.7,85,,790.16,percent of total billed charges,85% of total billed charges,1045.8,90,,836.64,percent of total billed charges,90% of total billed charges,929.6,80,,743.68,percent of total billed charges,80% of total billed charges,1045.8,90,,836.64,percent of total billed charges,90% of total billed charges,871.5,75,,697.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,336.98,29,,269.584,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,778.54,67,,622.832,percent of total billed charges,67% of total billed charges,1.19,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,929.6,80,,743.68,percent of total billed charges,80% of total billed charges,755.3,65,,604.24,percent of total billed charges,65% of total billed charges,414.49,35.67,,331.592,percent of total billed charges,35.67% of total billed charges,1.19,1045.8,
DOBUTAMINE 12.5 MG INJ,3400605,CDM,636,RC,J1250,HCPCS,outpatient,,,98,39.20,,83.3,85,,66.64,percent of total billed charges,85% of total billed charges,98,100,,78.4,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,10.97,385,,,fee schedule,385% of BCBS fee schedule,11.43,401,,,fee schedule,401% of BCBS fee schedule,11.43,401,,,fee schedule,401% of BCBS fee schedule,11.43,401,,,fee schedule,401% of BCBS fee schedule,88.2,90,,70.56,percent of total billed charges,90% of total billed charges,78.4,80,,62.72,percent of total billed charges,80% of total billed charges,88.2,90,,70.56,percent of total billed charges,90% of total billed charges,73.5,75,,58.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,28.42,29,,22.736,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,65.66,67,,52.528,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,78.4,80,,62.72,percent of total billed charges,80% of total billed charges,63.7,65,,50.96,percent of total billed charges,65% of total billed charges,34.96,35.67,,27.968,percent of total billed charges,35.67% of total billed charges,10.97,98,
DOBUTAMINE 1000 MG,3400606,CDM,636,RC,J1250,HCPCS,outpatient,,,997,398.80,,847.45,85,,677.96,percent of total billed charges,85% of total billed charges,997,100,,797.6,percent of total billed charges,pays based on exceed threshold rate,,,,,other ,not seperately reimbursable,10.97,385,,,fee schedule,385% of BCBS fee schedule,11.43,401,,,fee schedule,401% of BCBS fee schedule,11.43,401,,,fee schedule,401% of BCBS fee schedule,11.43,401,,,fee schedule,401% of BCBS fee schedule,897.3,90,,717.84,percent of total billed charges,90% of total billed charges,797.6,80,,638.08,percent of total billed charges,80% of total billed charges,897.3,90,,717.84,percent of total billed charges,90% of total billed charges,747.75,75,,598.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,289.13,29,,231.304,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,667.99,67,,534.392,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,797.6,80,,638.08,percent of total billed charges,80% of total billed charges,648.05,65,,518.44,percent of total billed charges,65% of total billed charges,355.63,35.67,,284.504,percent of total billed charges,35.67% of total billed charges,10.97,997,
ALDACTONE 50 MG TAB,2500200,CDM,637,RC,,,outpatient,,,9,3.60,,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,6.93,77,,5.54,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,7.38,82,,5.904,percent of total billed charges,82% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,8.1,90,,6.48,percent of total billed charges,90% of total billed charges,7.2,80,,5.76,percent of total billed charges,80% of total billed charges,8.1,90,,6.48,percent of total billed charges,90% of total billed charges,6.75,75,,5.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.61,29,,2.088,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,6.03,67,,4.824,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,7.2,80,,5.76,percent of total billed charges,80% of total billed charges,5.85,65,,4.68,percent of total billed charges,65% of total billed charges,3.21,35.67,,2.568,percent of total billed charges,35.67% of total billed charges,2.61,8.1,
ALDOMET 250 MG TAB,2500210,CDM,637,RC,,,outpatient,,,7,2.80,,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.39,77,,4.31,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,5.74,82,,4.592,percent of total billed charges,82% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.25,75,,4.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.03,29,,1.624,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4.69,67,,3.752,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,4.55,65,,3.64,percent of total billed charges,65% of total billed charges,2.5,35.67,,2,percent of total billed charges,35.67% of total billed charges,2.03,6.3,
ALEVE 220 MG TAB,2500237,CDM,637,RC,,,outpatient,,,7,2.80,,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.39,77,,4.31,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,5.74,82,,4.592,percent of total billed charges,82% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.25,75,,4.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.03,29,,1.624,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4.69,67,,3.752,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,4.55,65,,3.64,percent of total billed charges,65% of total billed charges,2.5,35.67,,2,percent of total billed charges,35.67% of total billed charges,2.03,6.3,
ALLEGRA 60 MG TAB PO,2500254,CDM,637,RC,,,outpatient,,,9,3.60,,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,6.93,77,,5.54,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,7.38,82,,5.904,percent of total billed charges,82% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,8.1,90,,6.48,percent of total billed charges,90% of total billed charges,7.2,80,,5.76,percent of total billed charges,80% of total billed charges,8.1,90,,6.48,percent of total billed charges,90% of total billed charges,6.75,75,,5.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.61,29,,2.088,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,6.03,67,,4.824,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,7.2,80,,5.76,percent of total billed charges,80% of total billed charges,5.85,65,,4.68,percent of total billed charges,65% of total billed charges,3.21,35.67,,2.568,percent of total billed charges,35.67% of total billed charges,2.61,8.1,
ALOE VERA LINIMENT 8 OZ TUBE,2500258,CDM,637,RC,,,outpatient,,,52,20.80,,44.2,85,,35.36,percent of total billed charges,85% of total billed charges,40.04,77,,32.03,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,42.64,82,,34.112,percent of total billed charges,82% of total billed charges,44.2,85,,35.36,percent of total billed charges,85% of total billed charges,44.2,85,,35.36,percent of total billed charges,85% of total billed charges,44.2,85,,35.36,percent of total billed charges,85% of total billed charges,46.8,90,,37.44,percent of total billed charges,90% of total billed charges,41.6,80,,33.28,percent of total billed charges,80% of total billed charges,46.8,90,,37.44,percent of total billed charges,90% of total billed charges,39,75,,31.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,15.08,29,,12.064,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,34.84,67,,27.872,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,41.6,80,,33.28,percent of total billed charges,80% of total billed charges,33.8,65,,27.04,percent of total billed charges,65% of total billed charges,18.55,35.67,,14.84,percent of total billed charges,35.67% of total billed charges,15.08,46.8,
ALPHAGAN P 5ML OPTH DROPS,2500268,CDM,637,RC,,,outpatient,,,347,138.80,,294.95,85,,235.96,percent of total billed charges,85% of total billed charges,267.19,77,,213.75,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,284.54,82,,227.632,percent of total billed charges,82% of total billed charges,294.95,85,,235.96,percent of total billed charges,85% of total billed charges,294.95,85,,235.96,percent of total billed charges,85% of total billed charges,294.95,85,,235.96,percent of total billed charges,85% of total billed charges,312.3,90,,249.84,percent of total billed charges,90% of total billed charges,277.6,80,,222.08,percent of total billed charges,80% of total billed charges,312.3,90,,249.84,percent of total billed charges,90% of total billed charges,260.25,75,,208.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,100.63,29,,80.504,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,232.49,67,,185.992,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,277.6,80,,222.08,percent of total billed charges,80% of total billed charges,225.55,65,,180.44,percent of total billed charges,65% of total billed charges,123.77,35.67,,99.016,percent of total billed charges,35.67% of total billed charges,100.63,312.3,
ALTACE 2.5 MG TAB,2500270,CDM,637,RC,,,outpatient,,,14,5.60,,11.9,85,,9.52,percent of total billed charges,85% of total billed charges,10.78,77,,8.62,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,11.48,82,,9.184,percent of total billed charges,82% of total billed charges,11.9,85,,9.52,percent of total billed charges,85% of total billed charges,11.9,85,,9.52,percent of total billed charges,85% of total billed charges,11.9,85,,9.52,percent of total billed charges,85% of total billed charges,12.6,90,,10.08,percent of total billed charges,90% of total billed charges,11.2,80,,8.96,percent of total billed charges,80% of total billed charges,12.6,90,,10.08,percent of total billed charges,90% of total billed charges,10.5,75,,8.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,4.06,29,,3.248,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,9.38,67,,7.504,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,11.2,80,,8.96,percent of total billed charges,80% of total billed charges,9.1,65,,7.28,percent of total billed charges,65% of total billed charges,4.99,35.67,,3.992,percent of total billed charges,35.67% of total billed charges,4.06,12.6,
ALPHAGAN P. 0.1% DROPS 5 ML,2500273,CDM,637,RC,,,outpatient,,,363,145.20,,308.55,85,,246.84,percent of total billed charges,85% of total billed charges,279.51,77,,223.61,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,297.66,82,,238.128,percent of total billed charges,82% of total billed charges,308.55,85,,246.84,percent of total billed charges,85% of total billed charges,308.55,85,,246.84,percent of total billed charges,85% of total billed charges,308.55,85,,246.84,percent of total billed charges,85% of total billed charges,326.7,90,,261.36,percent of total billed charges,90% of total billed charges,290.4,80,,232.32,percent of total billed charges,80% of total billed charges,326.7,90,,261.36,percent of total billed charges,90% of total billed charges,272.25,75,,217.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,105.27,29,,84.216,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,243.21,67,,194.568,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,290.4,80,,232.32,percent of total billed charges,80% of total billed charges,235.95,65,,188.76,percent of total billed charges,65% of total billed charges,129.48,35.67,,103.584,percent of total billed charges,35.67% of total billed charges,105.27,326.7,
ALTACE 10 MG CAP,2500276,CDM,637,RC,,,outpatient,,,17,6.80,,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,13.09,77,,10.47,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,13.94,82,,11.152,percent of total billed charges,82% of total billed charges,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,15.3,90,,12.24,percent of total billed charges,90% of total billed charges,13.6,80,,10.88,percent of total billed charges,80% of total billed charges,15.3,90,,12.24,percent of total billed charges,90% of total billed charges,12.75,75,,10.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,4.93,29,,3.944,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,11.39,67,,9.112,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,13.6,80,,10.88,percent of total billed charges,80% of total billed charges,11.05,65,,8.84,percent of total billed charges,65% of total billed charges,6.06,35.67,,4.848,percent of total billed charges,35.67% of total billed charges,4.93,15.3,
AMARYL 4 MG TAB,2500314,CDM,637,RC,,,outpatient,,,9,3.60,,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,6.93,77,,5.54,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,7.38,82,,5.904,percent of total billed charges,82% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,8.1,90,,6.48,percent of total billed charges,90% of total billed charges,7.2,80,,5.76,percent of total billed charges,80% of total billed charges,8.1,90,,6.48,percent of total billed charges,90% of total billed charges,6.75,75,,5.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.61,29,,2.088,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,6.03,67,,4.824,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,7.2,80,,5.76,percent of total billed charges,80% of total billed charges,5.85,65,,4.68,percent of total billed charges,65% of total billed charges,3.21,35.67,,2.568,percent of total billed charges,35.67% of total billed charges,2.61,8.1,
AMANTADINE 100 MG TAB,2500318,CDM,637,RC,,,outpatient,,,8,3.20,,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,6.16,77,,4.93,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,6.56,82,,5.248,percent of total billed charges,82% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,7.2,90,,5.76,percent of total billed charges,90% of total billed charges,6.4,80,,5.12,percent of total billed charges,80% of total billed charges,7.2,90,,5.76,percent of total billed charges,90% of total billed charges,6,75,,4.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.32,29,,1.856,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,5.36,67,,4.288,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,6.4,80,,5.12,percent of total billed charges,80% of total billed charges,5.2,65,,4.16,percent of total billed charges,65% of total billed charges,2.85,35.67,,2.28,percent of total billed charges,35.67% of total billed charges,2.32,7.2,
AMCIL PEDI DROPS 100 MG,2500340,CDM,637,RC,,,outpatient,,,19,7.60,,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,14.63,77,,11.7,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,15.58,82,,12.464,percent of total billed charges,82% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,15.2,80,,12.16,percent of total billed charges,80% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,14.25,75,,11.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,5.51,29,,4.408,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,12.73,67,,10.184,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,15.2,80,,12.16,percent of total billed charges,80% of total billed charges,12.35,65,,9.88,percent of total billed charges,65% of total billed charges,6.78,35.67,,5.424,percent of total billed charges,35.67% of total billed charges,5.51,17.1,
AMITIZA 24 MCG GELCAP,2500396,CDM,637,RC,,,outpatient,,,22,8.80,,18.7,85,,14.96,percent of total billed charges,85% of total billed charges,16.94,77,,13.55,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,18.04,82,,14.432,percent of total billed charges,82% of total billed charges,18.7,85,,14.96,percent of total billed charges,85% of total billed charges,18.7,85,,14.96,percent of total billed charges,85% of total billed charges,18.7,85,,14.96,percent of total billed charges,85% of total billed charges,19.8,90,,15.84,percent of total billed charges,90% of total billed charges,17.6,80,,14.08,percent of total billed charges,80% of total billed charges,19.8,90,,15.84,percent of total billed charges,90% of total billed charges,16.5,75,,13.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,6.38,29,,5.104,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,14.74,67,,11.792,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,17.6,80,,14.08,percent of total billed charges,80% of total billed charges,14.3,65,,11.44,percent of total billed charges,65% of total billed charges,7.85,35.67,,6.28,percent of total billed charges,35.67% of total billed charges,6.38,19.8,
AMOXIL 875 MG PO,2500401,CDM,637,RC,,,outpatient,,,7,2.80,,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.39,77,,4.31,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,5.74,82,,4.592,percent of total billed charges,82% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.25,75,,4.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.03,29,,1.624,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4.69,67,,3.752,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,4.55,65,,3.64,percent of total billed charges,65% of total billed charges,2.5,35.67,,2,percent of total billed charges,35.67% of total billed charges,2.03,6.3,
AMOXIL 250 MG/5CC & 100 CC,2500405,CDM,637,RC,,,outpatient,,,22,8.80,,18.7,85,,14.96,percent of total billed charges,85% of total billed charges,16.94,77,,13.55,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,18.04,82,,14.432,percent of total billed charges,82% of total billed charges,18.7,85,,14.96,percent of total billed charges,85% of total billed charges,18.7,85,,14.96,percent of total billed charges,85% of total billed charges,18.7,85,,14.96,percent of total billed charges,85% of total billed charges,19.8,90,,15.84,percent of total billed charges,90% of total billed charges,17.6,80,,14.08,percent of total billed charges,80% of total billed charges,19.8,90,,15.84,percent of total billed charges,90% of total billed charges,16.5,75,,13.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,6.38,29,,5.104,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,14.74,67,,11.792,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,17.6,80,,14.08,percent of total billed charges,80% of total billed charges,14.3,65,,11.44,percent of total billed charges,65% of total billed charges,7.85,35.67,,6.28,percent of total billed charges,35.67% of total billed charges,6.38,19.8,
AMOXIL 5 CC (ER),2500406,CDM,637,RC,,,outpatient,,,15,6.00,,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,11.55,77,,9.24,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,12.3,82,,9.84,percent of total billed charges,82% of total billed charges,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,13.5,90,,10.8,percent of total billed charges,90% of total billed charges,12,80,,9.6,percent of total billed charges,80% of total billed charges,13.5,90,,10.8,percent of total billed charges,90% of total billed charges,11.25,75,,9,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,4.35,29,,3.48,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,10.05,67,,8.04,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,12,80,,9.6,percent of total billed charges,80% of total billed charges,9.75,65,,7.8,percent of total billed charges,65% of total billed charges,5.35,35.67,,4.28,percent of total billed charges,35.67% of total billed charges,4.35,13.5,
ANTIVERT 25 MG TAB,2500655,CDM,637,RC,,,outpatient,,,8,3.20,,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,6.16,77,,4.93,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,6.56,82,,5.248,percent of total billed charges,82% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,7.2,90,,5.76,percent of total billed charges,90% of total billed charges,6.4,80,,5.12,percent of total billed charges,80% of total billed charges,7.2,90,,5.76,percent of total billed charges,90% of total billed charges,6,75,,4.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.32,29,,1.856,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,5.36,67,,4.288,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,6.4,80,,5.12,percent of total billed charges,80% of total billed charges,5.2,65,,4.16,percent of total billed charges,65% of total billed charges,2.85,35.67,,2.28,percent of total billed charges,35.67% of total billed charges,2.32,7.2,
ANUSOL OINTMENT,2500670,CDM,637,RC,,,outpatient,,,18,7.20,,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,13.86,77,,11.09,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,14.76,82,,11.808,percent of total billed charges,82% of total billed charges,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,16.2,90,,12.96,percent of total billed charges,90% of total billed charges,14.4,80,,11.52,percent of total billed charges,80% of total billed charges,16.2,90,,12.96,percent of total billed charges,90% of total billed charges,13.5,75,,10.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,5.22,29,,4.176,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,12.06,67,,9.648,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,14.4,80,,11.52,percent of total billed charges,80% of total billed charges,11.7,65,,9.36,percent of total billed charges,65% of total billed charges,6.42,35.67,,5.136,percent of total billed charges,35.67% of total billed charges,5.22,16.2,
APLENZIN ER 522 MG,2500684,CDM,637,RC,,,outpatient,,,150,60.00,,127.5,85,,102,percent of total billed charges,85% of total billed charges,115.5,77,,92.4,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,123,82,,98.4,percent of total billed charges,82% of total billed charges,127.5,85,,102,percent of total billed charges,85% of total billed charges,127.5,85,,102,percent of total billed charges,85% of total billed charges,127.5,85,,102,percent of total billed charges,85% of total billed charges,135,90,,108,percent of total billed charges,90% of total billed charges,120,80,,96,percent of total billed charges,80% of total billed charges,135,90,,108,percent of total billed charges,90% of total billed charges,112.5,75,,90,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,43.5,29,,34.8,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,100.5,67,,80.4,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,120,80,,96,percent of total billed charges,80% of total billed charges,97.5,65,,78,percent of total billed charges,65% of total billed charges,53.51,35.67,,42.808,percent of total billed charges,35.67% of total billed charges,43.5,135,
ARIMIDEX 1MG TAB,2500773,CDM,637,RC,,,outpatient,,,65,26.00,,55.25,85,,44.2,percent of total billed charges,85% of total billed charges,50.05,77,,40.04,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,53.3,82,,42.64,percent of total billed charges,82% of total billed charges,55.25,85,,44.2,percent of total billed charges,85% of total billed charges,55.25,85,,44.2,percent of total billed charges,85% of total billed charges,55.25,85,,44.2,percent of total billed charges,85% of total billed charges,58.5,90,,46.8,percent of total billed charges,90% of total billed charges,52,80,,41.6,percent of total billed charges,80% of total billed charges,58.5,90,,46.8,percent of total billed charges,90% of total billed charges,48.75,75,,39,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,18.85,29,,15.08,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,43.55,67,,34.84,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,52,80,,41.6,percent of total billed charges,80% of total billed charges,42.25,65,,33.8,percent of total billed charges,65% of total billed charges,23.19,35.67,,18.552,percent of total billed charges,35.67% of total billed charges,18.85,58.5,
ASPIRIN 81 MG TAB PO CHILD,2500820,CDM,637,RC,,,outpatient,,,7,2.80,,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.39,77,,4.31,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,5.74,82,,4.592,percent of total billed charges,82% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.25,75,,4.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.03,29,,1.624,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4.69,67,,3.752,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,4.55,65,,3.64,percent of total billed charges,65% of total billed charges,2.5,35.67,,2,percent of total billed charges,35.67% of total billed charges,2.03,6.3,
ASMANEX 220 MCG SIZE 14 INHALE,2500873,CDM,637,RC,,,outpatient,,,243,97.20,,206.55,85,,165.24,percent of total billed charges,85% of total billed charges,187.11,77,,149.69,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,199.26,82,,159.408,percent of total billed charges,82% of total billed charges,206.55,85,,165.24,percent of total billed charges,85% of total billed charges,206.55,85,,165.24,percent of total billed charges,85% of total billed charges,206.55,85,,165.24,percent of total billed charges,85% of total billed charges,218.7,90,,174.96,percent of total billed charges,90% of total billed charges,194.4,80,,155.52,percent of total billed charges,80% of total billed charges,218.7,90,,174.96,percent of total billed charges,90% of total billed charges,182.25,75,,145.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,70.47,29,,56.376,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,162.81,67,,130.248,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,194.4,80,,155.52,percent of total billed charges,80% of total billed charges,157.95,65,,126.36,percent of total billed charges,65% of total billed charges,86.68,35.67,,69.344,percent of total billed charges,35.67% of total billed charges,70.47,218.7,
ATACAND 16 MG PO,2500877,CDM,637,RC,,,outpatient,,,13,5.20,,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,10.01,77,,8.01,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,10.66,82,,8.528,percent of total billed charges,82% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,11.7,90,,9.36,percent of total billed charges,90% of total billed charges,10.4,80,,8.32,percent of total billed charges,80% of total billed charges,11.7,90,,9.36,percent of total billed charges,90% of total billed charges,9.75,75,,7.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,3.77,29,,3.016,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,8.71,67,,6.968,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,10.4,80,,8.32,percent of total billed charges,80% of total billed charges,8.45,65,,6.76,percent of total billed charges,65% of total billed charges,4.64,35.67,,3.712,percent of total billed charges,35.67% of total billed charges,3.77,11.7,
ATARAX 10 CC SUSP,2500880,CDM,637,RC,,,outpatient,,,8,3.20,,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,6.16,77,,4.93,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,6.56,82,,5.248,percent of total billed charges,82% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,7.2,90,,5.76,percent of total billed charges,90% of total billed charges,6.4,80,,5.12,percent of total billed charges,80% of total billed charges,7.2,90,,5.76,percent of total billed charges,90% of total billed charges,6,75,,4.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.32,29,,1.856,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,5.36,67,,4.288,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,6.4,80,,5.12,percent of total billed charges,80% of total billed charges,5.2,65,,4.16,percent of total billed charges,65% of total billed charges,2.85,35.67,,2.28,percent of total billed charges,35.67% of total billed charges,2.32,7.2,
ATACAND 4 MG TABLET,2500886,CDM,637,RC,,,outpatient,,,15,6.00,,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,11.55,77,,9.24,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,12.3,82,,9.84,percent of total billed charges,82% of total billed charges,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,13.5,90,,10.8,percent of total billed charges,90% of total billed charges,12,80,,9.6,percent of total billed charges,80% of total billed charges,13.5,90,,10.8,percent of total billed charges,90% of total billed charges,11.25,75,,9,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,4.35,29,,3.48,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,10.05,67,,8.04,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,12,80,,9.6,percent of total billed charges,80% of total billed charges,9.75,65,,7.8,percent of total billed charges,65% of total billed charges,5.35,35.67,,4.28,percent of total billed charges,35.67% of total billed charges,4.35,13.5,
ATARAX 5 CC SUSP,2500900,CDM,637,RC,,,outpatient,,,7,2.80,,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.39,77,,4.31,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,5.74,82,,4.592,percent of total billed charges,82% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.25,75,,4.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.03,29,,1.624,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4.69,67,,3.752,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,4.55,65,,3.64,percent of total billed charges,65% of total billed charges,2.5,35.67,,2,percent of total billed charges,35.67% of total billed charges,2.03,6.3,
ATIVAN 1 MG TAB,2500915,CDM,637,RC,,,outpatient,,,10,4.00,,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,7.7,77,,6.16,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,8.2,82,,6.56,percent of total billed charges,82% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,9,90,,7.2,percent of total billed charges,90% of total billed charges,8,80,,6.4,percent of total billed charges,80% of total billed charges,9,90,,7.2,percent of total billed charges,90% of total billed charges,7.5,75,,6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.9,29,,2.32,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,6.7,67,,5.36,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,8,80,,6.4,percent of total billed charges,80% of total billed charges,6.5,65,,5.2,percent of total billed charges,65% of total billed charges,3.57,35.67,,2.856,percent of total billed charges,35.67% of total billed charges,2.9,9,
ATROVENT 30 ML NASAL SPRAY,2500977,CDM,637,RC,,,outpatient,,,242,96.80,,205.7,85,,164.56,percent of total billed charges,85% of total billed charges,186.34,77,,149.07,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,198.44,82,,158.752,percent of total billed charges,82% of total billed charges,205.7,85,,164.56,percent of total billed charges,85% of total billed charges,205.7,85,,164.56,percent of total billed charges,85% of total billed charges,205.7,85,,164.56,percent of total billed charges,85% of total billed charges,217.8,90,,174.24,percent of total billed charges,90% of total billed charges,193.6,80,,154.88,percent of total billed charges,80% of total billed charges,217.8,90,,174.24,percent of total billed charges,90% of total billed charges,181.5,75,,145.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,70.18,29,,56.144,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,162.14,67,,129.712,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,193.6,80,,154.88,percent of total billed charges,80% of total billed charges,157.3,65,,125.84,percent of total billed charges,65% of total billed charges,86.32,35.67,,69.056,percent of total billed charges,35.67% of total billed charges,70.18,217.8,
AUGMENTIN BID 200MG/5 ML BOT,2500979,CDM,637,RC,,,outpatient,,,306,122.40,,260.1,85,,208.08,percent of total billed charges,85% of total billed charges,235.62,77,,188.5,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,250.92,82,,200.736,percent of total billed charges,82% of total billed charges,260.1,85,,208.08,percent of total billed charges,85% of total billed charges,260.1,85,,208.08,percent of total billed charges,85% of total billed charges,260.1,85,,208.08,percent of total billed charges,85% of total billed charges,275.4,90,,220.32,percent of total billed charges,90% of total billed charges,244.8,80,,195.84,percent of total billed charges,80% of total billed charges,275.4,90,,220.32,percent of total billed charges,90% of total billed charges,229.5,75,,183.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,88.74,29,,70.992,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,205.02,67,,164.016,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,244.8,80,,195.84,percent of total billed charges,80% of total billed charges,198.9,65,,159.12,percent of total billed charges,65% of total billed charges,109.15,35.67,,87.32,percent of total billed charges,35.67% of total billed charges,88.74,275.4,
AUGMENTIN 250 MG CHEW TAB,2500985,CDM,637,RC,,,outpatient,,,17,6.80,,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,13.09,77,,10.47,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,13.94,82,,11.152,percent of total billed charges,82% of total billed charges,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,15.3,90,,12.24,percent of total billed charges,90% of total billed charges,13.6,80,,10.88,percent of total billed charges,80% of total billed charges,15.3,90,,12.24,percent of total billed charges,90% of total billed charges,12.75,75,,10.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,4.93,29,,3.944,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,11.39,67,,9.112,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,13.6,80,,10.88,percent of total billed charges,80% of total billed charges,11.05,65,,8.84,percent of total billed charges,65% of total billed charges,6.06,35.67,,4.848,percent of total billed charges,35.67% of total billed charges,4.93,15.3,
AUGMENTIN 400 MG/5 ML BOTTLE,2500986,CDM,637,RC,,,outpatient,,,206,82.40,,175.1,85,,140.08,percent of total billed charges,85% of total billed charges,158.62,77,,126.9,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,168.92,82,,135.136,percent of total billed charges,82% of total billed charges,175.1,85,,140.08,percent of total billed charges,85% of total billed charges,175.1,85,,140.08,percent of total billed charges,85% of total billed charges,175.1,85,,140.08,percent of total billed charges,85% of total billed charges,185.4,90,,148.32,percent of total billed charges,90% of total billed charges,164.8,80,,131.84,percent of total billed charges,80% of total billed charges,185.4,90,,148.32,percent of total billed charges,90% of total billed charges,154.5,75,,123.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,59.74,29,,47.792,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,138.02,67,,110.416,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,164.8,80,,131.84,percent of total billed charges,80% of total billed charges,133.9,65,,107.12,percent of total billed charges,65% of total billed charges,73.48,35.67,,58.784,percent of total billed charges,35.67% of total billed charges,59.74,185.4,
AURALGAN OTIC SOL TOP,2501000,CDM,637,RC,,,outpatient,,,49,19.60,,41.65,85,,33.32,percent of total billed charges,85% of total billed charges,37.73,77,,30.18,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,40.18,82,,32.144,percent of total billed charges,82% of total billed charges,41.65,85,,33.32,percent of total billed charges,85% of total billed charges,41.65,85,,33.32,percent of total billed charges,85% of total billed charges,41.65,85,,33.32,percent of total billed charges,85% of total billed charges,44.1,90,,35.28,percent of total billed charges,90% of total billed charges,39.2,80,,31.36,percent of total billed charges,80% of total billed charges,44.1,90,,35.28,percent of total billed charges,90% of total billed charges,36.75,75,,29.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,14.21,29,,11.368,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,32.83,67,,26.264,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,39.2,80,,31.36,percent of total billed charges,80% of total billed charges,31.85,65,,25.48,percent of total billed charges,65% of total billed charges,17.48,35.67,,13.984,percent of total billed charges,35.67% of total billed charges,14.21,44.1,
AVAPRO 300 MG PO,2501004,CDM,637,RC,,,outpatient,,,11,4.40,,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,8.47,77,,6.78,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,9.02,82,,7.216,percent of total billed charges,82% of total billed charges,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,9.9,90,,7.92,percent of total billed charges,90% of total billed charges,8.8,80,,7.04,percent of total billed charges,80% of total billed charges,9.9,90,,7.92,percent of total billed charges,90% of total billed charges,8.25,75,,6.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,3.19,29,,2.552,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,7.37,67,,5.896,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,8.8,80,,7.04,percent of total billed charges,80% of total billed charges,7.15,65,,5.72,percent of total billed charges,65% of total billed charges,3.92,35.67,,3.136,percent of total billed charges,35.67% of total billed charges,3.19,9.9,
AVAPRO 150 MG PO,2501006,CDM,637,RC,,,outpatient,,,13,5.20,,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,10.01,77,,8.01,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,10.66,82,,8.528,percent of total billed charges,82% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,11.7,90,,9.36,percent of total billed charges,90% of total billed charges,10.4,80,,8.32,percent of total billed charges,80% of total billed charges,11.7,90,,9.36,percent of total billed charges,90% of total billed charges,9.75,75,,7.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,3.77,29,,3.016,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,8.71,67,,6.968,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,10.4,80,,8.32,percent of total billed charges,80% of total billed charges,8.45,65,,6.76,percent of total billed charges,65% of total billed charges,4.64,35.67,,3.712,percent of total billed charges,35.67% of total billed charges,3.77,11.7,
AVALIDE 300 MG 12.5 TAB PO,2501007,CDM,637,RC,,,outpatient,,,16,6.40,,13.6,85,,10.88,percent of total billed charges,85% of total billed charges,12.32,77,,9.86,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,13.12,82,,10.496,percent of total billed charges,82% of total billed charges,13.6,85,,10.88,percent of total billed charges,85% of total billed charges,13.6,85,,10.88,percent of total billed charges,85% of total billed charges,13.6,85,,10.88,percent of total billed charges,85% of total billed charges,14.4,90,,11.52,percent of total billed charges,90% of total billed charges,12.8,80,,10.24,percent of total billed charges,80% of total billed charges,14.4,90,,11.52,percent of total billed charges,90% of total billed charges,12,75,,9.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,4.64,29,,3.712,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,10.72,67,,8.576,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,12.8,80,,10.24,percent of total billed charges,80% of total billed charges,10.4,65,,8.32,percent of total billed charges,65% of total billed charges,5.71,35.67,,4.568,percent of total billed charges,35.67% of total billed charges,4.64,14.4,
AVEENO BATH 240 ML,2501016,CDM,637,RC,,,outpatient,,,22,8.80,,18.7,85,,14.96,percent of total billed charges,85% of total billed charges,16.94,77,,13.55,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,18.04,82,,14.432,percent of total billed charges,82% of total billed charges,18.7,85,,14.96,percent of total billed charges,85% of total billed charges,18.7,85,,14.96,percent of total billed charges,85% of total billed charges,18.7,85,,14.96,percent of total billed charges,85% of total billed charges,19.8,90,,15.84,percent of total billed charges,90% of total billed charges,17.6,80,,14.08,percent of total billed charges,80% of total billed charges,19.8,90,,15.84,percent of total billed charges,90% of total billed charges,16.5,75,,13.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,6.38,29,,5.104,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,14.74,67,,11.792,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,17.6,80,,14.08,percent of total billed charges,80% of total billed charges,14.3,65,,11.44,percent of total billed charges,65% of total billed charges,7.85,35.67,,6.28,percent of total billed charges,35.67% of total billed charges,6.38,19.8,
AVELOX 400 MG PO,2501017,CDM,637,RC,,,outpatient,,,93,37.20,,79.05,85,,63.24,percent of total billed charges,85% of total billed charges,71.61,77,,57.29,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,76.26,82,,61.008,percent of total billed charges,82% of total billed charges,79.05,85,,63.24,percent of total billed charges,85% of total billed charges,79.05,85,,63.24,percent of total billed charges,85% of total billed charges,79.05,85,,63.24,percent of total billed charges,85% of total billed charges,83.7,90,,66.96,percent of total billed charges,90% of total billed charges,74.4,80,,59.52,percent of total billed charges,80% of total billed charges,83.7,90,,66.96,percent of total billed charges,90% of total billed charges,69.75,75,,55.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,26.97,29,,21.576,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,62.31,67,,49.848,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,74.4,80,,59.52,percent of total billed charges,80% of total billed charges,60.45,65,,48.36,percent of total billed charges,65% of total billed charges,33.17,35.67,,26.536,percent of total billed charges,35.67% of total billed charges,26.97,83.7,
BACITRACIN OPTH OINT (3.5 GM),2501070,CDM,637,RC,,,outpatient,,,342,136.80,,290.7,85,,232.56,percent of total billed charges,85% of total billed charges,263.34,77,,210.67,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,280.44,82,,224.352,percent of total billed charges,82% of total billed charges,290.7,85,,232.56,percent of total billed charges,85% of total billed charges,290.7,85,,232.56,percent of total billed charges,85% of total billed charges,290.7,85,,232.56,percent of total billed charges,85% of total billed charges,307.8,90,,246.24,percent of total billed charges,90% of total billed charges,273.6,80,,218.88,percent of total billed charges,80% of total billed charges,307.8,90,,246.24,percent of total billed charges,90% of total billed charges,256.5,75,,205.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,99.18,29,,79.344,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,229.14,67,,183.312,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,273.6,80,,218.88,percent of total billed charges,80% of total billed charges,222.3,65,,177.84,percent of total billed charges,65% of total billed charges,121.99,35.67,,97.592,percent of total billed charges,35.67% of total billed charges,99.18,307.8,
BACTRIM SUSP 15 CC,2501095,CDM,637,RC,,,outpatient,,,8,3.20,,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,6.16,77,,4.93,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,6.56,82,,5.248,percent of total billed charges,82% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,7.2,90,,5.76,percent of total billed charges,90% of total billed charges,6.4,80,,5.12,percent of total billed charges,80% of total billed charges,7.2,90,,5.76,percent of total billed charges,90% of total billed charges,6,75,,4.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.32,29,,1.856,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,5.36,67,,4.288,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,6.4,80,,5.12,percent of total billed charges,80% of total billed charges,5.2,65,,4.16,percent of total billed charges,65% of total billed charges,2.85,35.67,,2.28,percent of total billed charges,35.67% of total billed charges,2.32,7.2,
BACTROBAN CREAM 15 GRAM,2501112,CDM,637,RC,,,outpatient,,,234,93.60,,198.9,85,,159.12,percent of total billed charges,85% of total billed charges,180.18,77,,144.14,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,191.88,82,,153.504,percent of total billed charges,82% of total billed charges,198.9,85,,159.12,percent of total billed charges,85% of total billed charges,198.9,85,,159.12,percent of total billed charges,85% of total billed charges,198.9,85,,159.12,percent of total billed charges,85% of total billed charges,210.6,90,,168.48,percent of total billed charges,90% of total billed charges,187.2,80,,149.76,percent of total billed charges,80% of total billed charges,210.6,90,,168.48,percent of total billed charges,90% of total billed charges,175.5,75,,140.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,67.86,29,,54.288,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,156.78,67,,125.424,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,187.2,80,,149.76,percent of total billed charges,80% of total billed charges,152.1,65,,121.68,percent of total billed charges,65% of total billed charges,83.47,35.67,,66.776,percent of total billed charges,35.67% of total billed charges,67.86,210.6,
BICITRA 10CC,2501126,CDM,637,RC,,,outpatient,,,6,2.40,,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,4.62,77,,3.7,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,4.92,82,,3.936,percent of total billed charges,82% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,5.4,90,,4.32,percent of total billed charges,90% of total billed charges,4.8,80,,3.84,percent of total billed charges,80% of total billed charges,5.4,90,,4.32,percent of total billed charges,90% of total billed charges,4.5,75,,3.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,1.74,29,,1.392,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4.02,67,,3.216,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,4.8,80,,3.84,percent of total billed charges,80% of total billed charges,3.9,65,,3.12,percent of total billed charges,65% of total billed charges,2.14,35.67,,1.712,percent of total billed charges,35.67% of total billed charges,1.74,5.4,
BENADRYL 10CC ELIXIR,2501150,CDM,637,RC,,,outpatient,,,7,2.80,,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.39,77,,4.31,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,5.74,82,,4.592,percent of total billed charges,82% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.25,75,,4.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.03,29,,1.624,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4.69,67,,3.752,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,4.55,65,,3.64,percent of total billed charges,65% of total billed charges,2.5,35.67,,2,percent of total billed charges,35.67% of total billed charges,2.03,6.3,
BENADRYL 5 CC ELIXER,2501170,CDM,637,RC,,,outpatient,,,6,2.40,,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,4.62,77,,3.7,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,4.92,82,,3.936,percent of total billed charges,82% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,5.4,90,,4.32,percent of total billed charges,90% of total billed charges,4.8,80,,3.84,percent of total billed charges,80% of total billed charges,5.4,90,,4.32,percent of total billed charges,90% of total billed charges,4.5,75,,3.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,1.74,29,,1.392,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4.02,67,,3.216,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,4.8,80,,3.84,percent of total billed charges,80% of total billed charges,3.9,65,,3.12,percent of total billed charges,65% of total billed charges,2.14,35.67,,1.712,percent of total billed charges,35.67% of total billed charges,1.74,5.4,
BENADRYL MELT TAB,2501174,CDM,637,RC,,,outpatient,,,6,2.40,,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,4.62,77,,3.7,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,4.92,82,,3.936,percent of total billed charges,82% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,5.4,90,,4.32,percent of total billed charges,90% of total billed charges,4.8,80,,3.84,percent of total billed charges,80% of total billed charges,5.4,90,,4.32,percent of total billed charges,90% of total billed charges,4.5,75,,3.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,1.74,29,,1.392,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4.02,67,,3.216,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,4.8,80,,3.84,percent of total billed charges,80% of total billed charges,3.9,65,,3.12,percent of total billed charges,65% of total billed charges,2.14,35.67,,1.712,percent of total billed charges,35.67% of total billed charges,1.74,5.4,
BENADRYL ELIXIR 15 CC,2501185,CDM,637,RC,,,outpatient,,,7,2.80,,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.39,77,,4.31,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,5.74,82,,4.592,percent of total billed charges,82% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.25,75,,4.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.03,29,,1.624,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4.69,67,,3.752,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,4.55,65,,3.64,percent of total billed charges,65% of total billed charges,2.5,35.67,,2,percent of total billed charges,35.67% of total billed charges,2.03,6.3,
BENADRYL ELIXIR PEDI DOSE,2501190,CDM,637,RC,,,outpatient,,,7,2.80,,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.39,77,,4.31,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,5.74,82,,4.592,percent of total billed charges,82% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.25,75,,4.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.03,29,,1.624,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4.69,67,,3.752,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,4.55,65,,3.64,percent of total billed charges,65% of total billed charges,2.5,35.67,,2,percent of total billed charges,35.67% of total billed charges,2.03,6.3,
BENICAR 20 MG TAB,2501204,CDM,637,RC,,,outpatient,,,17,6.80,,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,13.09,77,,10.47,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,13.94,82,,11.152,percent of total billed charges,82% of total billed charges,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,15.3,90,,12.24,percent of total billed charges,90% of total billed charges,13.6,80,,10.88,percent of total billed charges,80% of total billed charges,15.3,90,,12.24,percent of total billed charges,90% of total billed charges,12.75,75,,10.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,4.93,29,,3.944,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,11.39,67,,9.112,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,13.6,80,,10.88,percent of total billed charges,80% of total billed charges,11.05,65,,8.84,percent of total billed charges,65% of total billed charges,6.06,35.67,,4.848,percent of total billed charges,35.67% of total billed charges,4.93,15.3,
BENICAR 20 MG/HCT 12.5 MG TAB,2501208,CDM,637,RC,,,outpatient,,,11,4.40,,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,8.47,77,,6.78,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,9.02,82,,7.216,percent of total billed charges,82% of total billed charges,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,9.9,90,,7.92,percent of total billed charges,90% of total billed charges,8.8,80,,7.04,percent of total billed charges,80% of total billed charges,9.9,90,,7.92,percent of total billed charges,90% of total billed charges,8.25,75,,6.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,3.19,29,,2.552,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,7.37,67,,5.896,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,8.8,80,,7.04,percent of total billed charges,80% of total billed charges,7.15,65,,5.72,percent of total billed charges,65% of total billed charges,3.92,35.67,,3.136,percent of total billed charges,35.67% of total billed charges,3.19,9.9,
BETADINE OINT (TUBE),2501261,CDM,637,RC,,,outpatient,,,36,14.40,,30.6,85,,24.48,percent of total billed charges,85% of total billed charges,27.72,77,,22.18,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,29.52,82,,23.616,percent of total billed charges,82% of total billed charges,30.6,85,,24.48,percent of total billed charges,85% of total billed charges,30.6,85,,24.48,percent of total billed charges,85% of total billed charges,30.6,85,,24.48,percent of total billed charges,85% of total billed charges,32.4,90,,25.92,percent of total billed charges,90% of total billed charges,28.8,80,,23.04,percent of total billed charges,80% of total billed charges,32.4,90,,25.92,percent of total billed charges,90% of total billed charges,27,75,,21.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,10.44,29,,8.352,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,24.12,67,,19.296,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,28.8,80,,23.04,percent of total billed charges,80% of total billed charges,23.4,65,,18.72,percent of total billed charges,65% of total billed charges,12.84,35.67,,10.272,percent of total billed charges,35.67% of total billed charges,10.44,32.4,
BETAGAN .5% 5 ML EYE GTT,2501263,CDM,637,RC,,,outpatient,,,171,68.40,,145.35,85,,116.28,percent of total billed charges,85% of total billed charges,131.67,77,,105.34,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,140.22,82,,112.176,percent of total billed charges,82% of total billed charges,145.35,85,,116.28,percent of total billed charges,85% of total billed charges,145.35,85,,116.28,percent of total billed charges,85% of total billed charges,145.35,85,,116.28,percent of total billed charges,85% of total billed charges,153.9,90,,123.12,percent of total billed charges,90% of total billed charges,136.8,80,,109.44,percent of total billed charges,80% of total billed charges,153.9,90,,123.12,percent of total billed charges,90% of total billed charges,128.25,75,,102.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,49.59,29,,39.672,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,114.57,67,,91.656,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,136.8,80,,109.44,percent of total billed charges,80% of total billed charges,111.15,65,,88.92,percent of total billed charges,65% of total billed charges,61,35.67,,48.8,percent of total billed charges,35.67% of total billed charges,49.59,153.9,
BENZOCAINE 7 GM TUBE,2501267,CDM,637,RC,,,outpatient,,,16,6.40,,13.6,85,,10.88,percent of total billed charges,85% of total billed charges,12.32,77,,9.86,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,13.12,82,,10.496,percent of total billed charges,82% of total billed charges,13.6,85,,10.88,percent of total billed charges,85% of total billed charges,13.6,85,,10.88,percent of total billed charges,85% of total billed charges,13.6,85,,10.88,percent of total billed charges,85% of total billed charges,14.4,90,,11.52,percent of total billed charges,90% of total billed charges,12.8,80,,10.24,percent of total billed charges,80% of total billed charges,14.4,90,,11.52,percent of total billed charges,90% of total billed charges,12,75,,9.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,4.64,29,,3.712,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,10.72,67,,8.576,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,12.8,80,,10.24,percent of total billed charges,80% of total billed charges,10.4,65,,8.32,percent of total billed charges,65% of total billed charges,5.71,35.67,,4.568,percent of total billed charges,35.67% of total billed charges,4.64,14.4,
BIAXIN 250 MG TAB,2501284,CDM,637,RC,,,outpatient,,,22,8.80,,18.7,85,,14.96,percent of total billed charges,85% of total billed charges,16.94,77,,13.55,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,18.04,82,,14.432,percent of total billed charges,82% of total billed charges,18.7,85,,14.96,percent of total billed charges,85% of total billed charges,18.7,85,,14.96,percent of total billed charges,85% of total billed charges,18.7,85,,14.96,percent of total billed charges,85% of total billed charges,19.8,90,,15.84,percent of total billed charges,90% of total billed charges,17.6,80,,14.08,percent of total billed charges,80% of total billed charges,19.8,90,,15.84,percent of total billed charges,90% of total billed charges,16.5,75,,13.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,6.38,29,,5.104,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,14.74,67,,11.792,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,17.6,80,,14.08,percent of total billed charges,80% of total billed charges,14.3,65,,11.44,percent of total billed charges,65% of total billed charges,7.85,35.67,,6.28,percent of total billed charges,35.67% of total billed charges,6.38,19.8,
BICITRA LIQUID 10 CC,2501320,CDM,637,RC,,,outpatient,,,6,2.40,,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,4.62,77,,3.7,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,4.92,82,,3.936,percent of total billed charges,82% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,5.4,90,,4.32,percent of total billed charges,90% of total billed charges,4.8,80,,3.84,percent of total billed charges,80% of total billed charges,5.4,90,,4.32,percent of total billed charges,90% of total billed charges,4.5,75,,3.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,1.74,29,,1.392,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4.02,67,,3.216,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,4.8,80,,3.84,percent of total billed charges,80% of total billed charges,3.9,65,,3.12,percent of total billed charges,65% of total billed charges,2.14,35.67,,1.712,percent of total billed charges,35.67% of total billed charges,1.74,5.4,
BICITRA LIQUID 5 CC,2501330,CDM,637,RC,,,outpatient,,,6,2.40,,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,4.62,77,,3.7,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,4.92,82,,3.936,percent of total billed charges,82% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,5.4,90,,4.32,percent of total billed charges,90% of total billed charges,4.8,80,,3.84,percent of total billed charges,80% of total billed charges,5.4,90,,4.32,percent of total billed charges,90% of total billed charges,4.5,75,,3.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,1.74,29,,1.392,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4.02,67,,3.216,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,4.8,80,,3.84,percent of total billed charges,80% of total billed charges,3.9,65,,3.12,percent of total billed charges,65% of total billed charges,2.14,35.67,,1.712,percent of total billed charges,35.67% of total billed charges,1.74,5.4,
BYSTOLIC 5 MG TABLET,2501461,CDM,637,RC,,,outpatient,,,13,5.20,,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,10.01,77,,8.01,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,10.66,82,,8.528,percent of total billed charges,82% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,11.7,90,,9.36,percent of total billed charges,90% of total billed charges,10.4,80,,8.32,percent of total billed charges,80% of total billed charges,11.7,90,,9.36,percent of total billed charges,90% of total billed charges,9.75,75,,7.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,3.77,29,,3.016,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,8.71,67,,6.968,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,10.4,80,,8.32,percent of total billed charges,80% of total billed charges,8.45,65,,6.76,percent of total billed charges,65% of total billed charges,4.64,35.67,,3.712,percent of total billed charges,35.67% of total billed charges,3.77,11.7,
CALAN 40 MG/TAB,2501510,CDM,637,RC,,,outpatient,,,7,2.80,,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.39,77,,4.31,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,5.74,82,,4.592,percent of total billed charges,82% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.25,75,,4.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.03,29,,1.624,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4.69,67,,3.752,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,4.55,65,,3.64,percent of total billed charges,65% of total billed charges,2.5,35.67,,2,percent of total billed charges,35.67% of total billed charges,2.03,6.3,
CALAN 80 MG TAB,2501525,CDM,637,RC,,,outpatient,,,10,4.00,,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,7.7,77,,6.16,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,8.2,82,,6.56,percent of total billed charges,82% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,9,90,,7.2,percent of total billed charges,90% of total billed charges,8,80,,6.4,percent of total billed charges,80% of total billed charges,9,90,,7.2,percent of total billed charges,90% of total billed charges,7.5,75,,6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.9,29,,2.32,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,6.7,67,,5.36,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,8,80,,6.4,percent of total billed charges,80% of total billed charges,6.5,65,,5.2,percent of total billed charges,65% of total billed charges,3.57,35.67,,2.856,percent of total billed charges,35.67% of total billed charges,2.9,9,
CARDIZEM CD 360 MG PO,2501639,CDM,637,RC,,,outpatient,,,84,33.60,,71.4,85,,57.12,percent of total billed charges,85% of total billed charges,64.68,77,,51.74,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,68.88,82,,55.104,percent of total billed charges,82% of total billed charges,71.4,85,,57.12,percent of total billed charges,85% of total billed charges,71.4,85,,57.12,percent of total billed charges,85% of total billed charges,71.4,85,,57.12,percent of total billed charges,85% of total billed charges,75.6,90,,60.48,percent of total billed charges,90% of total billed charges,67.2,80,,53.76,percent of total billed charges,80% of total billed charges,75.6,90,,60.48,percent of total billed charges,90% of total billed charges,63,75,,50.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,24.36,29,,19.488,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,56.28,67,,45.024,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,67.2,80,,53.76,percent of total billed charges,80% of total billed charges,54.6,65,,43.68,percent of total billed charges,65% of total billed charges,29.96,35.67,,23.968,percent of total billed charges,35.67% of total billed charges,24.36,75.6,
CARDIZEM 180 MG LA TAB,2501642,CDM,637,RC,,,outpatient,,,18,7.20,,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,13.86,77,,11.09,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,14.76,82,,11.808,percent of total billed charges,82% of total billed charges,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,16.2,90,,12.96,percent of total billed charges,90% of total billed charges,14.4,80,,11.52,percent of total billed charges,80% of total billed charges,16.2,90,,12.96,percent of total billed charges,90% of total billed charges,13.5,75,,10.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,5.22,29,,4.176,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,12.06,67,,9.648,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,14.4,80,,11.52,percent of total billed charges,80% of total billed charges,11.7,65,,9.36,percent of total billed charges,65% of total billed charges,6.42,35.67,,5.136,percent of total billed charges,35.67% of total billed charges,5.22,16.2,
CARDIZEM 60 MG TAB,2501655,CDM,637,RC,,,outpatient,,,18,7.20,,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,13.86,77,,11.09,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,14.76,82,,11.808,percent of total billed charges,82% of total billed charges,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,16.2,90,,12.96,percent of total billed charges,90% of total billed charges,14.4,80,,11.52,percent of total billed charges,80% of total billed charges,16.2,90,,12.96,percent of total billed charges,90% of total billed charges,13.5,75,,10.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,5.22,29,,4.176,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,12.06,67,,9.648,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,14.4,80,,11.52,percent of total billed charges,80% of total billed charges,11.7,65,,9.36,percent of total billed charges,65% of total billed charges,6.42,35.67,,5.136,percent of total billed charges,35.67% of total billed charges,5.22,16.2,
CARDIZEM LA 120 MG,2501666,CDM,637,RC,,,outpatient,,,18,7.20,,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,13.86,77,,11.09,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,14.76,82,,11.808,percent of total billed charges,82% of total billed charges,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,16.2,90,,12.96,percent of total billed charges,90% of total billed charges,14.4,80,,11.52,percent of total billed charges,80% of total billed charges,16.2,90,,12.96,percent of total billed charges,90% of total billed charges,13.5,75,,10.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,5.22,29,,4.176,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,12.06,67,,9.648,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,14.4,80,,11.52,percent of total billed charges,80% of total billed charges,11.7,65,,9.36,percent of total billed charges,65% of total billed charges,6.42,35.67,,5.136,percent of total billed charges,35.67% of total billed charges,5.22,16.2,
CARDIZEM CD 180 MG CAP,2501675,CDM,637,RC,,,outpatient,,,10,4.00,,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,7.7,77,,6.16,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,8.2,82,,6.56,percent of total billed charges,82% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,9,90,,7.2,percent of total billed charges,90% of total billed charges,8,80,,6.4,percent of total billed charges,80% of total billed charges,9,90,,7.2,percent of total billed charges,90% of total billed charges,7.5,75,,6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.9,29,,2.32,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,6.7,67,,5.36,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,8,80,,6.4,percent of total billed charges,80% of total billed charges,6.5,65,,5.2,percent of total billed charges,65% of total billed charges,3.57,35.67,,2.856,percent of total billed charges,35.67% of total billed charges,2.9,9,
CARDIZEM CD 300 MG CAP,2501685,CDM,637,RC,,,outpatient,,,61,24.40,,51.85,85,,41.48,percent of total billed charges,85% of total billed charges,46.97,77,,37.58,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,50.02,82,,40.016,percent of total billed charges,82% of total billed charges,51.85,85,,41.48,percent of total billed charges,85% of total billed charges,51.85,85,,41.48,percent of total billed charges,85% of total billed charges,51.85,85,,41.48,percent of total billed charges,85% of total billed charges,54.9,90,,43.92,percent of total billed charges,90% of total billed charges,48.8,80,,39.04,percent of total billed charges,80% of total billed charges,54.9,90,,43.92,percent of total billed charges,90% of total billed charges,45.75,75,,36.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,17.69,29,,14.152,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,40.87,67,,32.696,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,48.8,80,,39.04,percent of total billed charges,80% of total billed charges,39.65,65,,31.72,percent of total billed charges,65% of total billed charges,21.76,35.67,,17.408,percent of total billed charges,35.67% of total billed charges,17.69,54.9,
CASODEX 50 MG PO,2501724,CDM,637,RC,,,outpatient,,,78,31.20,,66.3,85,,53.04,percent of total billed charges,85% of total billed charges,60.06,77,,48.05,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,63.96,82,,51.168,percent of total billed charges,82% of total billed charges,66.3,85,,53.04,percent of total billed charges,85% of total billed charges,66.3,85,,53.04,percent of total billed charges,85% of total billed charges,66.3,85,,53.04,percent of total billed charges,85% of total billed charges,70.2,90,,56.16,percent of total billed charges,90% of total billed charges,62.4,80,,49.92,percent of total billed charges,80% of total billed charges,70.2,90,,56.16,percent of total billed charges,90% of total billed charges,58.5,75,,46.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,22.62,29,,18.096,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,52.26,67,,41.808,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,62.4,80,,49.92,percent of total billed charges,80% of total billed charges,50.7,65,,40.56,percent of total billed charges,65% of total billed charges,27.82,35.67,,22.256,percent of total billed charges,35.67% of total billed charges,22.62,70.2,
CATAFLAN 50 TAB,2501734,CDM,637,RC,,,outpatient,,,13,5.20,,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,10.01,77,,8.01,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,10.66,82,,8.528,percent of total billed charges,82% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,11.7,90,,9.36,percent of total billed charges,90% of total billed charges,10.4,80,,8.32,percent of total billed charges,80% of total billed charges,11.7,90,,9.36,percent of total billed charges,90% of total billed charges,9.75,75,,7.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,3.77,29,,3.016,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,8.71,67,,6.968,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,10.4,80,,8.32,percent of total billed charges,80% of total billed charges,8.45,65,,6.76,percent of total billed charges,65% of total billed charges,4.64,35.67,,3.712,percent of total billed charges,35.67% of total billed charges,3.77,11.7,
CCH  MOUTH MIX 15 ML BOTTLE,2501736,CDM,637,RC,,,outpatient,,,20,8.00,,17,85,,13.6,percent of total billed charges,85% of total billed charges,15.4,77,,12.32,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,16.4,82,,13.12,percent of total billed charges,82% of total billed charges,17,85,,13.6,percent of total billed charges,85% of total billed charges,17,85,,13.6,percent of total billed charges,85% of total billed charges,17,85,,13.6,percent of total billed charges,85% of total billed charges,18,90,,14.4,percent of total billed charges,90% of total billed charges,16,80,,12.8,percent of total billed charges,80% of total billed charges,18,90,,14.4,percent of total billed charges,90% of total billed charges,15,75,,12,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,5.8,29,,4.64,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,13.4,67,,10.72,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,16,80,,12.8,percent of total billed charges,80% of total billed charges,13,65,,10.4,percent of total billed charges,65% of total billed charges,7.13,35.67,,5.704,percent of total billed charges,35.67% of total billed charges,5.8,18,
CATAPRES 0.2 MG TAB,2501740,CDM,637,RC,,,outpatient,,,15,6.00,,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,11.55,77,,9.24,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,12.3,82,,9.84,percent of total billed charges,82% of total billed charges,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,13.5,90,,10.8,percent of total billed charges,90% of total billed charges,12,80,,9.6,percent of total billed charges,80% of total billed charges,13.5,90,,10.8,percent of total billed charges,90% of total billed charges,11.25,75,,9,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,4.35,29,,3.48,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,10.05,67,,8.04,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,12,80,,9.6,percent of total billed charges,80% of total billed charges,9.75,65,,7.8,percent of total billed charges,65% of total billed charges,5.35,35.67,,4.28,percent of total billed charges,35.67% of total billed charges,4.35,13.5,
CEFTIN 125 MG 5 ML PO,2501798,CDM,637,RC,,,outpatient,,,388,155.20,,329.8,85,,263.84,percent of total billed charges,85% of total billed charges,298.76,77,,239.01,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,318.16,82,,254.528,percent of total billed charges,82% of total billed charges,329.8,85,,263.84,percent of total billed charges,85% of total billed charges,329.8,85,,263.84,percent of total billed charges,85% of total billed charges,329.8,85,,263.84,percent of total billed charges,85% of total billed charges,349.2,90,,279.36,percent of total billed charges,90% of total billed charges,310.4,80,,248.32,percent of total billed charges,80% of total billed charges,349.2,90,,279.36,percent of total billed charges,90% of total billed charges,291,75,,232.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,112.52,29,,90.016,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,259.96,67,,207.968,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,310.4,80,,248.32,percent of total billed charges,80% of total billed charges,252.2,65,,201.76,percent of total billed charges,65% of total billed charges,138.4,35.67,,110.72,percent of total billed charges,35.67% of total billed charges,112.52,349.2,
CEFZIL 5 CC (ER),2501811,CDM,637,RC,,,outpatient,,,15,6.00,,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,11.55,77,,9.24,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,12.3,82,,9.84,percent of total billed charges,82% of total billed charges,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,13.5,90,,10.8,percent of total billed charges,90% of total billed charges,12,80,,9.6,percent of total billed charges,80% of total billed charges,13.5,90,,10.8,percent of total billed charges,90% of total billed charges,11.25,75,,9,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,4.35,29,,3.48,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,10.05,67,,8.04,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,12,80,,9.6,percent of total billed charges,80% of total billed charges,9.75,65,,7.8,percent of total billed charges,65% of total billed charges,5.35,35.67,,4.28,percent of total billed charges,35.67% of total billed charges,4.35,13.5,
CEFZIL 250 MG PO (TAB),2501815,CDM,637,RC,,,outpatient,,,19,7.60,,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,14.63,77,,11.7,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,15.58,82,,12.464,percent of total billed charges,82% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,15.2,80,,12.16,percent of total billed charges,80% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,14.25,75,,11.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,5.51,29,,4.408,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,12.73,67,,10.184,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,15.2,80,,12.16,percent of total billed charges,80% of total billed charges,12.35,65,,9.88,percent of total billed charges,65% of total billed charges,6.78,35.67,,5.424,percent of total billed charges,35.67% of total billed charges,5.51,17.1,
CEFZIL 250 MG TAB,2501820,CDM,637,RC,,,outpatient,,,17,6.80,,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,13.09,77,,10.47,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,13.94,82,,11.152,percent of total billed charges,82% of total billed charges,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,15.3,90,,12.24,percent of total billed charges,90% of total billed charges,13.6,80,,10.88,percent of total billed charges,80% of total billed charges,15.3,90,,12.24,percent of total billed charges,90% of total billed charges,12.75,75,,10.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,4.93,29,,3.944,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,11.39,67,,9.112,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,13.6,80,,10.88,percent of total billed charges,80% of total billed charges,11.05,65,,8.84,percent of total billed charges,65% of total billed charges,6.06,35.67,,4.848,percent of total billed charges,35.67% of total billed charges,4.93,15.3,
CELEBREX 100 PO,2501838,CDM,637,RC,,,outpatient,,,19,7.60,,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,14.63,77,,11.7,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,15.58,82,,12.464,percent of total billed charges,82% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,15.2,80,,12.16,percent of total billed charges,80% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,14.25,75,,11.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,5.51,29,,4.408,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,12.73,67,,10.184,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,15.2,80,,12.16,percent of total billed charges,80% of total billed charges,12.35,65,,9.88,percent of total billed charges,65% of total billed charges,6.78,35.67,,5.424,percent of total billed charges,35.67% of total billed charges,5.51,17.1,
CENTRUM SILVER TAB PO,2501871,CDM,637,RC,,,outpatient,,,6,2.40,,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,4.62,77,,3.7,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,4.92,82,,3.936,percent of total billed charges,82% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,5.4,90,,4.32,percent of total billed charges,90% of total billed charges,4.8,80,,3.84,percent of total billed charges,80% of total billed charges,5.4,90,,4.32,percent of total billed charges,90% of total billed charges,4.5,75,,3.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,1.74,29,,1.392,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4.02,67,,3.216,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,4.8,80,,3.84,percent of total billed charges,80% of total billed charges,3.9,65,,3.12,percent of total billed charges,65% of total billed charges,2.14,35.67,,1.712,percent of total billed charges,35.67% of total billed charges,1.74,5.4,
CHARCO CAPS,2501905,CDM,637,RC,,,outpatient,,,24,9.60,,20.4,85,,16.32,percent of total billed charges,85% of total billed charges,18.48,77,,14.78,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,19.68,82,,15.744,percent of total billed charges,82% of total billed charges,20.4,85,,16.32,percent of total billed charges,85% of total billed charges,20.4,85,,16.32,percent of total billed charges,85% of total billed charges,20.4,85,,16.32,percent of total billed charges,85% of total billed charges,21.6,90,,17.28,percent of total billed charges,90% of total billed charges,19.2,80,,15.36,percent of total billed charges,80% of total billed charges,21.6,90,,17.28,percent of total billed charges,90% of total billed charges,18,75,,14.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,6.96,29,,5.568,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,16.08,67,,12.864,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,19.2,80,,15.36,percent of total billed charges,80% of total billed charges,15.6,65,,12.48,percent of total billed charges,65% of total billed charges,8.56,35.67,,6.848,percent of total billed charges,35.67% of total billed charges,6.96,21.6,
CHLORAL HYDRATE 500MG/5ML UDC,2501919,CDM,637,RC,,,outpatient,,,7,2.80,,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.39,77,,4.31,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,5.74,82,,4.592,percent of total billed charges,82% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.25,75,,4.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.03,29,,1.624,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4.69,67,,3.752,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,4.55,65,,3.64,percent of total billed charges,65% of total billed charges,2.5,35.67,,2,percent of total billed charges,35.67% of total billed charges,2.03,6.3,
CHRONULAC/LACTULOSE SYRUP 15CC,2502000,CDM,637,RC,,,outpatient,,,8,3.20,,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,6.16,77,,4.93,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,6.56,82,,5.248,percent of total billed charges,82% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,7.2,90,,5.76,percent of total billed charges,90% of total billed charges,6.4,80,,5.12,percent of total billed charges,80% of total billed charges,7.2,90,,5.76,percent of total billed charges,90% of total billed charges,6,75,,4.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.32,29,,1.856,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,5.36,67,,4.288,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,6.4,80,,5.12,percent of total billed charges,80% of total billed charges,5.2,65,,4.16,percent of total billed charges,65% of total billed charges,2.85,35.67,,2.28,percent of total billed charges,35.67% of total billed charges,2.32,7.2,
CILOXAN 5 ML OPTH GTTS .3%,2502012,CDM,637,RC,,,outpatient,,,93,37.20,,79.05,85,,63.24,percent of total billed charges,85% of total billed charges,71.61,77,,57.29,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,76.26,82,,61.008,percent of total billed charges,82% of total billed charges,79.05,85,,63.24,percent of total billed charges,85% of total billed charges,79.05,85,,63.24,percent of total billed charges,85% of total billed charges,79.05,85,,63.24,percent of total billed charges,85% of total billed charges,83.7,90,,66.96,percent of total billed charges,90% of total billed charges,74.4,80,,59.52,percent of total billed charges,80% of total billed charges,83.7,90,,66.96,percent of total billed charges,90% of total billed charges,69.75,75,,55.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,26.97,29,,21.576,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,62.31,67,,49.848,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,74.4,80,,59.52,percent of total billed charges,80% of total billed charges,60.45,65,,48.36,percent of total billed charges,65% of total billed charges,33.17,35.67,,26.536,percent of total billed charges,35.67% of total billed charges,26.97,83.7,
CIPRO 250MG TAB,2502015,CDM,637,RC,,,outpatient,,,22,8.80,,18.7,85,,14.96,percent of total billed charges,85% of total billed charges,16.94,77,,13.55,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,18.04,82,,14.432,percent of total billed charges,82% of total billed charges,18.7,85,,14.96,percent of total billed charges,85% of total billed charges,18.7,85,,14.96,percent of total billed charges,85% of total billed charges,18.7,85,,14.96,percent of total billed charges,85% of total billed charges,19.8,90,,15.84,percent of total billed charges,90% of total billed charges,17.6,80,,14.08,percent of total billed charges,80% of total billed charges,19.8,90,,15.84,percent of total billed charges,90% of total billed charges,16.5,75,,13.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,6.38,29,,5.104,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,14.74,67,,11.792,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,17.6,80,,14.08,percent of total billed charges,80% of total billed charges,14.3,65,,11.44,percent of total billed charges,65% of total billed charges,7.85,35.67,,6.28,percent of total billed charges,35.67% of total billed charges,6.38,19.8,
CIPRO 500MG TAB,2502025,CDM,637,RC,,,outpatient,,,24,9.60,,20.4,85,,16.32,percent of total billed charges,85% of total billed charges,18.48,77,,14.78,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,19.68,82,,15.744,percent of total billed charges,82% of total billed charges,20.4,85,,16.32,percent of total billed charges,85% of total billed charges,20.4,85,,16.32,percent of total billed charges,85% of total billed charges,20.4,85,,16.32,percent of total billed charges,85% of total billed charges,21.6,90,,17.28,percent of total billed charges,90% of total billed charges,19.2,80,,15.36,percent of total billed charges,80% of total billed charges,21.6,90,,17.28,percent of total billed charges,90% of total billed charges,18,75,,14.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,6.96,29,,5.568,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,16.08,67,,12.864,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,19.2,80,,15.36,percent of total billed charges,80% of total billed charges,15.6,65,,12.48,percent of total billed charges,65% of total billed charges,8.56,35.67,,6.848,percent of total billed charges,35.67% of total billed charges,6.96,21.6,
CITRACAL 200 MG PO,2502038,CDM,637,RC,,,outpatient,,,7,2.80,,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.39,77,,4.31,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,5.74,82,,4.592,percent of total billed charges,82% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.25,75,,4.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.03,29,,1.624,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4.69,67,,3.752,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,4.55,65,,3.64,percent of total billed charges,65% of total billed charges,2.5,35.67,,2,percent of total billed charges,35.67% of total billed charges,2.03,6.3,
CLARITIN 10 MG/TAB,2502085,CDM,637,RC,,,outpatient,,,7,2.80,,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.39,77,,4.31,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,5.74,82,,4.592,percent of total billed charges,82% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.25,75,,4.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.03,29,,1.624,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4.69,67,,3.752,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,4.55,65,,3.64,percent of total billed charges,65% of total billed charges,2.5,35.67,,2,percent of total billed charges,35.67% of total billed charges,2.03,6.3,
CLARITIN SYRUP 5 MG/5ML SYRING,2502087,CDM,637,RC,,,outpatient,,,23,9.20,,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,17.71,77,,14.17,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,18.86,82,,15.088,percent of total billed charges,82% of total billed charges,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,20.7,90,,16.56,percent of total billed charges,90% of total billed charges,18.4,80,,14.72,percent of total billed charges,80% of total billed charges,20.7,90,,16.56,percent of total billed charges,90% of total billed charges,17.25,75,,13.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,6.67,29,,5.336,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,15.41,67,,12.328,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,18.4,80,,14.72,percent of total billed charges,80% of total billed charges,14.95,65,,11.96,percent of total billed charges,65% of total billed charges,8.2,35.67,,6.56,percent of total billed charges,35.67% of total billed charges,6.67,20.7,
CLEOCIN T LOTION 60 ML TOPICAL,2502098,CDM,637,RC,,,outpatient,,,280,112.00,,238,85,,190.4,percent of total billed charges,85% of total billed charges,215.6,77,,172.48,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,229.6,82,,183.68,percent of total billed charges,82% of total billed charges,238,85,,190.4,percent of total billed charges,85% of total billed charges,238,85,,190.4,percent of total billed charges,85% of total billed charges,238,85,,190.4,percent of total billed charges,85% of total billed charges,252,90,,201.6,percent of total billed charges,90% of total billed charges,224,80,,179.2,percent of total billed charges,80% of total billed charges,252,90,,201.6,percent of total billed charges,90% of total billed charges,210,75,,168,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,81.2,29,,64.96,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,187.6,67,,150.08,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,224,80,,179.2,percent of total billed charges,80% of total billed charges,182,65,,145.6,percent of total billed charges,65% of total billed charges,99.88,35.67,,79.904,percent of total billed charges,35.67% of total billed charges,81.2,252,
CLEOCIN 600 MG CAP,2502110,CDM,637,RC,,,outpatient,,,9,3.60,,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,6.93,77,,5.54,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,7.38,82,,5.904,percent of total billed charges,82% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,8.1,90,,6.48,percent of total billed charges,90% of total billed charges,7.2,80,,5.76,percent of total billed charges,80% of total billed charges,8.1,90,,6.48,percent of total billed charges,90% of total billed charges,6.75,75,,5.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.61,29,,2.088,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,6.03,67,,4.824,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,7.2,80,,5.76,percent of total billed charges,80% of total billed charges,5.85,65,,4.68,percent of total billed charges,65% of total billed charges,3.21,35.67,,2.568,percent of total billed charges,35.67% of total billed charges,2.61,8.1,
CLEOCIN 75MG/5ML SUSP 100 BTL,2502118,CDM,637,RC,,,outpatient,,,237,94.80,,201.45,85,,161.16,percent of total billed charges,85% of total billed charges,182.49,77,,145.99,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,194.34,82,,155.472,percent of total billed charges,82% of total billed charges,201.45,85,,161.16,percent of total billed charges,85% of total billed charges,201.45,85,,161.16,percent of total billed charges,85% of total billed charges,201.45,85,,161.16,percent of total billed charges,85% of total billed charges,213.3,90,,170.64,percent of total billed charges,90% of total billed charges,189.6,80,,151.68,percent of total billed charges,80% of total billed charges,213.3,90,,170.64,percent of total billed charges,90% of total billed charges,177.75,75,,142.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,68.73,29,,54.984,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,158.79,67,,127.032,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,189.6,80,,151.68,percent of total billed charges,80% of total billed charges,154.05,65,,123.24,percent of total billed charges,65% of total billed charges,84.54,35.67,,67.632,percent of total billed charges,35.67% of total billed charges,68.73,213.3,
COLACE LIQUID 100 MG UDC,2502198,CDM,637,RC,,,outpatient,,,7,2.80,,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.39,77,,4.31,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,5.74,82,,4.592,percent of total billed charges,82% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.25,75,,4.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.03,29,,1.624,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4.69,67,,3.752,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,4.55,65,,3.64,percent of total billed charges,65% of total billed charges,2.5,35.67,,2,percent of total billed charges,35.67% of total billed charges,2.03,6.3,
COMBIVIR 150/300 MG PO,2502238,CDM,637,RC,,,outpatient,,,67,26.80,,56.95,85,,45.56,percent of total billed charges,85% of total billed charges,51.59,77,,41.27,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,54.94,82,,43.952,percent of total billed charges,82% of total billed charges,56.95,85,,45.56,percent of total billed charges,85% of total billed charges,56.95,85,,45.56,percent of total billed charges,85% of total billed charges,56.95,85,,45.56,percent of total billed charges,85% of total billed charges,60.3,90,,48.24,percent of total billed charges,90% of total billed charges,53.6,80,,42.88,percent of total billed charges,80% of total billed charges,60.3,90,,48.24,percent of total billed charges,90% of total billed charges,50.25,75,,40.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,19.43,29,,15.544,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,44.89,67,,35.912,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,53.6,80,,42.88,percent of total billed charges,80% of total billed charges,43.55,65,,34.84,percent of total billed charges,65% of total billed charges,23.9,35.67,,19.12,percent of total billed charges,35.67% of total billed charges,19.43,60.3,
COMBIGAN OPT SOL 5 ML,2502239,CDM,637,RC,,,outpatient,,,400,160.00,,340,85,,272,percent of total billed charges,85% of total billed charges,308,77,,246.4,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,328,82,,262.4,percent of total billed charges,82% of total billed charges,340,85,,272,percent of total billed charges,85% of total billed charges,340,85,,272,percent of total billed charges,85% of total billed charges,340,85,,272,percent of total billed charges,85% of total billed charges,360,90,,288,percent of total billed charges,90% of total billed charges,320,80,,256,percent of total billed charges,80% of total billed charges,360,90,,288,percent of total billed charges,90% of total billed charges,300,75,,240,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,116,29,,92.8,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,268,67,,214.4,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,320,80,,256,percent of total billed charges,80% of total billed charges,260,65,,208,percent of total billed charges,65% of total billed charges,142.68,35.67,,114.144,percent of total billed charges,35.67% of total billed charges,116,360,
COMPAZINE 10 MG TAB,2502250,CDM,637,RC,,,outpatient,,,7,2.80,,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.39,77,,4.31,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,5.74,82,,4.592,percent of total billed charges,82% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.25,75,,4.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.03,29,,1.624,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4.69,67,,3.752,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,4.55,65,,3.64,percent of total billed charges,65% of total billed charges,2.5,35.67,,2,percent of total billed charges,35.67% of total billed charges,2.03,6.3,
COMPAZINE 25 MG SUPPOS,2502275,CDM,637,RC,,,outpatient,,,48,19.20,,40.8,85,,32.64,percent of total billed charges,85% of total billed charges,36.96,77,,29.57,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,39.36,82,,31.488,percent of total billed charges,82% of total billed charges,40.8,85,,32.64,percent of total billed charges,85% of total billed charges,40.8,85,,32.64,percent of total billed charges,85% of total billed charges,40.8,85,,32.64,percent of total billed charges,85% of total billed charges,43.2,90,,34.56,percent of total billed charges,90% of total billed charges,38.4,80,,30.72,percent of total billed charges,80% of total billed charges,43.2,90,,34.56,percent of total billed charges,90% of total billed charges,36,75,,28.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,13.92,29,,11.136,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,32.16,67,,25.728,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,38.4,80,,30.72,percent of total billed charges,80% of total billed charges,31.2,65,,24.96,percent of total billed charges,65% of total billed charges,17.12,35.67,,13.696,percent of total billed charges,35.67% of total billed charges,13.92,43.2,
CONTACT KIT,2502283,CDM,637,RC,,,outpatient,,,15,6.00,,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,11.55,77,,9.24,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,12.3,82,,9.84,percent of total billed charges,82% of total billed charges,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,13.5,90,,10.8,percent of total billed charges,90% of total billed charges,12,80,,9.6,percent of total billed charges,80% of total billed charges,13.5,90,,10.8,percent of total billed charges,90% of total billed charges,11.25,75,,9,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,4.35,29,,3.48,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,10.05,67,,8.04,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,12,80,,9.6,percent of total billed charges,80% of total billed charges,9.75,65,,7.8,percent of total billed charges,65% of total billed charges,5.35,35.67,,4.28,percent of total billed charges,35.67% of total billed charges,4.35,13.5,
COREG 6.25 MG PO,2502312,CDM,637,RC,,,outpatient,,,13,5.20,,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,10.01,77,,8.01,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,10.66,82,,8.528,percent of total billed charges,82% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,11.7,90,,9.36,percent of total billed charges,90% of total billed charges,10.4,80,,8.32,percent of total billed charges,80% of total billed charges,11.7,90,,9.36,percent of total billed charges,90% of total billed charges,9.75,75,,7.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,3.77,29,,3.016,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,8.71,67,,6.968,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,10.4,80,,8.32,percent of total billed charges,80% of total billed charges,8.45,65,,6.76,percent of total billed charges,65% of total billed charges,4.64,35.67,,3.712,percent of total billed charges,35.67% of total billed charges,3.77,11.7,
COREG CR 10 MG CAP,2502316,CDM,637,RC,,,outpatient,,,22,8.80,,18.7,85,,14.96,percent of total billed charges,85% of total billed charges,16.94,77,,13.55,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,18.04,82,,14.432,percent of total billed charges,82% of total billed charges,18.7,85,,14.96,percent of total billed charges,85% of total billed charges,18.7,85,,14.96,percent of total billed charges,85% of total billed charges,18.7,85,,14.96,percent of total billed charges,85% of total billed charges,19.8,90,,15.84,percent of total billed charges,90% of total billed charges,17.6,80,,14.08,percent of total billed charges,80% of total billed charges,19.8,90,,15.84,percent of total billed charges,90% of total billed charges,16.5,75,,13.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,6.38,29,,5.104,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,14.74,67,,11.792,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,17.6,80,,14.08,percent of total billed charges,80% of total billed charges,14.3,65,,11.44,percent of total billed charges,65% of total billed charges,7.85,35.67,,6.28,percent of total billed charges,35.67% of total billed charges,6.38,19.8,
CORTANE B OTIC DROPS,2502357,CDM,637,RC,,,outpatient,,,57,22.80,,48.45,85,,38.76,percent of total billed charges,85% of total billed charges,43.89,77,,35.11,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,46.74,82,,37.392,percent of total billed charges,82% of total billed charges,48.45,85,,38.76,percent of total billed charges,85% of total billed charges,48.45,85,,38.76,percent of total billed charges,85% of total billed charges,48.45,85,,38.76,percent of total billed charges,85% of total billed charges,51.3,90,,41.04,percent of total billed charges,90% of total billed charges,45.6,80,,36.48,percent of total billed charges,80% of total billed charges,51.3,90,,41.04,percent of total billed charges,90% of total billed charges,42.75,75,,34.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,16.53,29,,13.224,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,38.19,67,,30.552,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,45.6,80,,36.48,percent of total billed charges,80% of total billed charges,37.05,65,,29.64,percent of total billed charges,65% of total billed charges,20.33,35.67,,16.264,percent of total billed charges,35.67% of total billed charges,16.53,51.3,
CORTONE 25 MG TAB PO,2502391,CDM,637,RC,,,outpatient,,,13,5.20,,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,10.01,77,,8.01,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,10.66,82,,8.528,percent of total billed charges,82% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,11.7,90,,9.36,percent of total billed charges,90% of total billed charges,10.4,80,,8.32,percent of total billed charges,80% of total billed charges,11.7,90,,9.36,percent of total billed charges,90% of total billed charges,9.75,75,,7.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,3.77,29,,3.016,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,8.71,67,,6.968,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,10.4,80,,8.32,percent of total billed charges,80% of total billed charges,8.45,65,,6.76,percent of total billed charges,65% of total billed charges,4.64,35.67,,3.712,percent of total billed charges,35.67% of total billed charges,3.77,11.7,
COUMADIN 7.5 MG TAB,2502440,CDM,637,RC,,,outpatient,,,10,4.00,,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,7.7,77,,6.16,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,8.2,82,,6.56,percent of total billed charges,82% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,9,90,,7.2,percent of total billed charges,90% of total billed charges,8,80,,6.4,percent of total billed charges,80% of total billed charges,9,90,,7.2,percent of total billed charges,90% of total billed charges,7.5,75,,6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.9,29,,2.32,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,6.7,67,,5.36,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,8,80,,6.4,percent of total billed charges,80% of total billed charges,6.5,65,,5.2,percent of total billed charges,65% of total billed charges,3.57,35.67,,2.856,percent of total billed charges,35.67% of total billed charges,2.9,9,
COZAAR 100 MG TAB,2502441,CDM,637,RC,,,outpatient,,,16,6.40,,13.6,85,,10.88,percent of total billed charges,85% of total billed charges,12.32,77,,9.86,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,13.12,82,,10.496,percent of total billed charges,82% of total billed charges,13.6,85,,10.88,percent of total billed charges,85% of total billed charges,13.6,85,,10.88,percent of total billed charges,85% of total billed charges,13.6,85,,10.88,percent of total billed charges,85% of total billed charges,14.4,90,,11.52,percent of total billed charges,90% of total billed charges,12.8,80,,10.24,percent of total billed charges,80% of total billed charges,14.4,90,,11.52,percent of total billed charges,90% of total billed charges,12,75,,9.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,4.64,29,,3.712,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,10.72,67,,8.576,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,12.8,80,,10.24,percent of total billed charges,80% of total billed charges,10.4,65,,8.32,percent of total billed charges,65% of total billed charges,5.71,35.67,,4.568,percent of total billed charges,35.67% of total billed charges,4.64,14.4,
COVERA HS 240 MG TAB,2502444,CDM,637,RC,,,outpatient,,,14,5.60,,11.9,85,,9.52,percent of total billed charges,85% of total billed charges,10.78,77,,8.62,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,11.48,82,,9.184,percent of total billed charges,82% of total billed charges,11.9,85,,9.52,percent of total billed charges,85% of total billed charges,11.9,85,,9.52,percent of total billed charges,85% of total billed charges,11.9,85,,9.52,percent of total billed charges,85% of total billed charges,12.6,90,,10.08,percent of total billed charges,90% of total billed charges,11.2,80,,8.96,percent of total billed charges,80% of total billed charges,12.6,90,,10.08,percent of total billed charges,90% of total billed charges,10.5,75,,8.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,4.06,29,,3.248,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,9.38,67,,7.504,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,11.2,80,,8.96,percent of total billed charges,80% of total billed charges,9.1,65,,7.28,percent of total billed charges,65% of total billed charges,4.99,35.67,,3.992,percent of total billed charges,35.67% of total billed charges,4.06,12.6,
CREON 10 MG CAP,2502449,CDM,637,RC,,,outpatient,,,9,3.60,,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,6.93,77,,5.54,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,7.38,82,,5.904,percent of total billed charges,82% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,8.1,90,,6.48,percent of total billed charges,90% of total billed charges,7.2,80,,5.76,percent of total billed charges,80% of total billed charges,8.1,90,,6.48,percent of total billed charges,90% of total billed charges,6.75,75,,5.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.61,29,,2.088,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,6.03,67,,4.824,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,7.2,80,,5.76,percent of total billed charges,80% of total billed charges,5.85,65,,4.68,percent of total billed charges,65% of total billed charges,3.21,35.67,,2.568,percent of total billed charges,35.67% of total billed charges,2.61,8.1,
CRESTOR 10 MG TAB,2502458,CDM,637,RC,,,outpatient,,,28,11.20,,23.8,85,,19.04,percent of total billed charges,85% of total billed charges,21.56,77,,17.25,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,22.96,82,,18.368,percent of total billed charges,82% of total billed charges,23.8,85,,19.04,percent of total billed charges,85% of total billed charges,23.8,85,,19.04,percent of total billed charges,85% of total billed charges,23.8,85,,19.04,percent of total billed charges,85% of total billed charges,25.2,90,,20.16,percent of total billed charges,90% of total billed charges,22.4,80,,17.92,percent of total billed charges,80% of total billed charges,25.2,90,,20.16,percent of total billed charges,90% of total billed charges,21,75,,16.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,8.12,29,,6.496,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,18.76,67,,15.008,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,22.4,80,,17.92,percent of total billed charges,80% of total billed charges,18.2,65,,14.56,percent of total billed charges,65% of total billed charges,9.99,35.67,,7.992,percent of total billed charges,35.67% of total billed charges,8.12,25.2,
CRESTOR 5 MG TAB,2502462,CDM,637,RC,,,outpatient,,,24,9.60,,20.4,85,,16.32,percent of total billed charges,85% of total billed charges,18.48,77,,14.78,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,19.68,82,,15.744,percent of total billed charges,82% of total billed charges,20.4,85,,16.32,percent of total billed charges,85% of total billed charges,20.4,85,,16.32,percent of total billed charges,85% of total billed charges,20.4,85,,16.32,percent of total billed charges,85% of total billed charges,21.6,90,,17.28,percent of total billed charges,90% of total billed charges,19.2,80,,15.36,percent of total billed charges,80% of total billed charges,21.6,90,,17.28,percent of total billed charges,90% of total billed charges,18,75,,14.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,6.96,29,,5.568,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,16.08,67,,12.864,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,19.2,80,,15.36,percent of total billed charges,80% of total billed charges,15.6,65,,12.48,percent of total billed charges,65% of total billed charges,8.56,35.67,,6.848,percent of total billed charges,35.67% of total billed charges,6.96,21.6,
CYCLOGYL 1% EYE DROP 15 ML BOT,2502466,CDM,637,RC,,,outpatient,,,174,69.60,,147.9,85,,118.32,percent of total billed charges,85% of total billed charges,133.98,77,,107.18,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,142.68,82,,114.144,percent of total billed charges,82% of total billed charges,147.9,85,,118.32,percent of total billed charges,85% of total billed charges,147.9,85,,118.32,percent of total billed charges,85% of total billed charges,147.9,85,,118.32,percent of total billed charges,85% of total billed charges,156.6,90,,125.28,percent of total billed charges,90% of total billed charges,139.2,80,,111.36,percent of total billed charges,80% of total billed charges,156.6,90,,125.28,percent of total billed charges,90% of total billed charges,130.5,75,,104.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,50.46,29,,40.368,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,116.58,67,,93.264,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,139.2,80,,111.36,percent of total billed charges,80% of total billed charges,113.1,65,,90.48,percent of total billed charges,65% of total billed charges,62.07,35.67,,49.656,percent of total billed charges,35.67% of total billed charges,50.46,156.6,
CYCLOCOT CREAM 0.1% 30GM TUBE,2502472,CDM,637,RC,,,outpatient,,,617,246.80,,524.45,85,,419.56,percent of total billed charges,85% of total billed charges,475.09,77,,380.07,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,505.94,82,,404.752,percent of total billed charges,82% of total billed charges,524.45,85,,419.56,percent of total billed charges,85% of total billed charges,524.45,85,,419.56,percent of total billed charges,85% of total billed charges,524.45,85,,419.56,percent of total billed charges,85% of total billed charges,555.3,90,,444.24,percent of total billed charges,90% of total billed charges,493.6,80,,394.88,percent of total billed charges,80% of total billed charges,555.3,90,,444.24,percent of total billed charges,90% of total billed charges,462.75,75,,370.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,178.93,29,,143.144,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,413.39,67,,330.712,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,493.6,80,,394.88,percent of total billed charges,80% of total billed charges,401.05,65,,320.84,percent of total billed charges,65% of total billed charges,220.08,35.67,,176.064,percent of total billed charges,35.67% of total billed charges,178.93,555.3,
DACRIOSE OPTH 1 OZ SOLUTION,2502520,CDM,637,RC,,,outpatient,,,18,7.20,,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,13.86,77,,11.09,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,14.76,82,,11.808,percent of total billed charges,82% of total billed charges,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,16.2,90,,12.96,percent of total billed charges,90% of total billed charges,14.4,80,,11.52,percent of total billed charges,80% of total billed charges,16.2,90,,12.96,percent of total billed charges,90% of total billed charges,13.5,75,,10.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,5.22,29,,4.176,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,12.06,67,,9.648,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,14.4,80,,11.52,percent of total billed charges,80% of total billed charges,11.7,65,,9.36,percent of total billed charges,65% of total billed charges,6.42,35.67,,5.136,percent of total billed charges,35.67% of total billed charges,5.22,16.2,
DAKINS 1/4 STRENGTH SOL 473 ML,2502524,CDM,637,RC,,,outpatient,,,33,13.20,,28.05,85,,22.44,percent of total billed charges,85% of total billed charges,25.41,77,,20.33,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,27.06,82,,21.648,percent of total billed charges,82% of total billed charges,28.05,85,,22.44,percent of total billed charges,85% of total billed charges,28.05,85,,22.44,percent of total billed charges,85% of total billed charges,28.05,85,,22.44,percent of total billed charges,85% of total billed charges,29.7,90,,23.76,percent of total billed charges,90% of total billed charges,26.4,80,,21.12,percent of total billed charges,80% of total billed charges,29.7,90,,23.76,percent of total billed charges,90% of total billed charges,24.75,75,,19.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,9.57,29,,7.656,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,22.11,67,,17.688,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,26.4,80,,21.12,percent of total billed charges,80% of total billed charges,21.45,65,,17.16,percent of total billed charges,65% of total billed charges,11.77,35.67,,9.416,percent of total billed charges,35.67% of total billed charges,9.57,29.7,
DALIRESP 500 MCG TABLET,2502541,CDM,637,RC,,,outpatient,,,46,18.40,,39.1,85,,31.28,percent of total billed charges,85% of total billed charges,35.42,77,,28.34,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,37.72,82,,30.176,percent of total billed charges,82% of total billed charges,39.1,85,,31.28,percent of total billed charges,85% of total billed charges,39.1,85,,31.28,percent of total billed charges,85% of total billed charges,39.1,85,,31.28,percent of total billed charges,85% of total billed charges,41.4,90,,33.12,percent of total billed charges,90% of total billed charges,36.8,80,,29.44,percent of total billed charges,80% of total billed charges,41.4,90,,33.12,percent of total billed charges,90% of total billed charges,34.5,75,,27.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,13.34,29,,10.672,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,30.82,67,,24.656,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,36.8,80,,29.44,percent of total billed charges,80% of total billed charges,29.9,65,,23.92,percent of total billed charges,65% of total billed charges,16.41,35.67,,13.128,percent of total billed charges,35.67% of total billed charges,13.34,41.4,
DARVOCET N 100 TAB,2502550,CDM,637,RC,,,outpatient,,,10,4.00,,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,7.7,77,,6.16,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,8.2,82,,6.56,percent of total billed charges,82% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,9,90,,7.2,percent of total billed charges,90% of total billed charges,8,80,,6.4,percent of total billed charges,80% of total billed charges,9,90,,7.2,percent of total billed charges,90% of total billed charges,7.5,75,,6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.9,29,,2.32,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,6.7,67,,5.36,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,8,80,,6.4,percent of total billed charges,80% of total billed charges,6.5,65,,5.2,percent of total billed charges,65% of total billed charges,3.57,35.67,,2.856,percent of total billed charges,35.67% of total billed charges,2.9,9,
DECADRON OCUMETER 1%/5CC,2502675,CDM,637,RC,,,outpatient,,,64,25.60,,54.4,85,,43.52,percent of total billed charges,85% of total billed charges,49.28,77,,39.42,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,52.48,82,,41.984,percent of total billed charges,82% of total billed charges,54.4,85,,43.52,percent of total billed charges,85% of total billed charges,54.4,85,,43.52,percent of total billed charges,85% of total billed charges,54.4,85,,43.52,percent of total billed charges,85% of total billed charges,57.6,90,,46.08,percent of total billed charges,90% of total billed charges,51.2,80,,40.96,percent of total billed charges,80% of total billed charges,57.6,90,,46.08,percent of total billed charges,90% of total billed charges,48,75,,38.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,18.56,29,,14.848,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,42.88,67,,34.304,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,51.2,80,,40.96,percent of total billed charges,80% of total billed charges,41.6,65,,33.28,percent of total billed charges,65% of total billed charges,22.83,35.67,,18.264,percent of total billed charges,35.67% of total billed charges,18.56,57.6,
DECLOMYCIN 300 TAB,2502711,CDM,637,RC,,,outpatient,,,28,11.20,,23.8,85,,19.04,percent of total billed charges,85% of total billed charges,21.56,77,,17.25,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,22.96,82,,18.368,percent of total billed charges,82% of total billed charges,23.8,85,,19.04,percent of total billed charges,85% of total billed charges,23.8,85,,19.04,percent of total billed charges,85% of total billed charges,23.8,85,,19.04,percent of total billed charges,85% of total billed charges,25.2,90,,20.16,percent of total billed charges,90% of total billed charges,22.4,80,,17.92,percent of total billed charges,80% of total billed charges,25.2,90,,20.16,percent of total billed charges,90% of total billed charges,21,75,,16.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,8.12,29,,6.496,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,18.76,67,,15.008,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,22.4,80,,17.92,percent of total billed charges,80% of total billed charges,18.2,65,,14.56,percent of total billed charges,65% of total billed charges,9.99,35.67,,7.992,percent of total billed charges,35.67% of total billed charges,8.12,25.2,
DEPAKOTE 500 MG TAB PO,2502822,CDM,637,RC,,,outpatient,,,16,6.40,,13.6,85,,10.88,percent of total billed charges,85% of total billed charges,12.32,77,,9.86,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,13.12,82,,10.496,percent of total billed charges,82% of total billed charges,13.6,85,,10.88,percent of total billed charges,85% of total billed charges,13.6,85,,10.88,percent of total billed charges,85% of total billed charges,13.6,85,,10.88,percent of total billed charges,85% of total billed charges,14.4,90,,11.52,percent of total billed charges,90% of total billed charges,12.8,80,,10.24,percent of total billed charges,80% of total billed charges,14.4,90,,11.52,percent of total billed charges,90% of total billed charges,12,75,,9.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,4.64,29,,3.712,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,10.72,67,,8.576,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,12.8,80,,10.24,percent of total billed charges,80% of total billed charges,10.4,65,,8.32,percent of total billed charges,65% of total billed charges,5.71,35.67,,4.568,percent of total billed charges,35.67% of total billed charges,4.64,14.4,
DEPROL TAB,2502870,CDM,637,RC,,,outpatient,,,11,4.40,,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,8.47,77,,6.78,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,9.02,82,,7.216,percent of total billed charges,82% of total billed charges,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,9.9,90,,7.92,percent of total billed charges,90% of total billed charges,8.8,80,,7.04,percent of total billed charges,80% of total billed charges,9.9,90,,7.92,percent of total billed charges,90% of total billed charges,8.25,75,,6.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,3.19,29,,2.552,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,7.37,67,,5.896,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,8.8,80,,7.04,percent of total billed charges,80% of total billed charges,7.15,65,,5.72,percent of total billed charges,65% of total billed charges,3.92,35.67,,3.136,percent of total billed charges,35.67% of total billed charges,3.19,9.9,
DESITIN OINTMENT (TOPICAL),2502885,CDM,637,RC,,,outpatient,,,20,8.00,,17,85,,13.6,percent of total billed charges,85% of total billed charges,15.4,77,,12.32,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,16.4,82,,13.12,percent of total billed charges,82% of total billed charges,17,85,,13.6,percent of total billed charges,85% of total billed charges,17,85,,13.6,percent of total billed charges,85% of total billed charges,17,85,,13.6,percent of total billed charges,85% of total billed charges,18,90,,14.4,percent of total billed charges,90% of total billed charges,16,80,,12.8,percent of total billed charges,80% of total billed charges,18,90,,14.4,percent of total billed charges,90% of total billed charges,15,75,,12,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,5.8,29,,4.64,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,13.4,67,,10.72,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,16,80,,12.8,percent of total billed charges,80% of total billed charges,13,65,,10.4,percent of total billed charges,65% of total billed charges,7.13,35.67,,5.704,percent of total billed charges,35.67% of total billed charges,5.8,18,
DESOWEN LOTION 4 OZ BOTTLE,2502887,CDM,637,RC,,,outpatient,,,454,181.60,,385.9,85,,308.72,percent of total billed charges,85% of total billed charges,349.58,77,,279.66,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,372.28,82,,297.824,percent of total billed charges,82% of total billed charges,385.9,85,,308.72,percent of total billed charges,85% of total billed charges,385.9,85,,308.72,percent of total billed charges,85% of total billed charges,385.9,85,,308.72,percent of total billed charges,85% of total billed charges,408.6,90,,326.88,percent of total billed charges,90% of total billed charges,363.2,80,,290.56,percent of total billed charges,80% of total billed charges,408.6,90,,326.88,percent of total billed charges,90% of total billed charges,340.5,75,,272.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,131.66,29,,105.328,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,304.18,67,,243.344,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,363.2,80,,290.56,percent of total billed charges,80% of total billed charges,295.1,65,,236.08,percent of total billed charges,65% of total billed charges,161.94,35.67,,129.552,percent of total billed charges,35.67% of total billed charges,131.66,408.6,
DESITIN OINTMENT 1 OZ,2502889,CDM,637,RC,,,outpatient,,,11,4.40,,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,8.47,77,,6.78,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,9.02,82,,7.216,percent of total billed charges,82% of total billed charges,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,9.9,90,,7.92,percent of total billed charges,90% of total billed charges,8.8,80,,7.04,percent of total billed charges,80% of total billed charges,9.9,90,,7.92,percent of total billed charges,90% of total billed charges,8.25,75,,6.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,3.19,29,,2.552,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,7.37,67,,5.896,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,8.8,80,,7.04,percent of total billed charges,80% of total billed charges,7.15,65,,5.72,percent of total billed charges,65% of total billed charges,3.92,35.67,,3.136,percent of total billed charges,35.67% of total billed charges,3.19,9.9,
DESYREL 150 MG TAB,2502890,CDM,637,RC,,,outpatient,,,15,6.00,,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,11.55,77,,9.24,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,12.3,82,,9.84,percent of total billed charges,82% of total billed charges,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,13.5,90,,10.8,percent of total billed charges,90% of total billed charges,12,80,,9.6,percent of total billed charges,80% of total billed charges,13.5,90,,10.8,percent of total billed charges,90% of total billed charges,11.25,75,,9,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,4.35,29,,3.48,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,10.05,67,,8.04,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,12,80,,9.6,percent of total billed charges,80% of total billed charges,9.75,65,,7.8,percent of total billed charges,65% of total billed charges,5.35,35.67,,4.28,percent of total billed charges,35.67% of total billed charges,4.35,13.5,
DETROL LA 4 MG PO,2502913,CDM,637,RC,,,outpatient,,,29,11.60,,24.65,85,,19.72,percent of total billed charges,85% of total billed charges,22.33,77,,17.86,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,23.78,82,,19.024,percent of total billed charges,82% of total billed charges,24.65,85,,19.72,percent of total billed charges,85% of total billed charges,24.65,85,,19.72,percent of total billed charges,85% of total billed charges,24.65,85,,19.72,percent of total billed charges,85% of total billed charges,26.1,90,,20.88,percent of total billed charges,90% of total billed charges,23.2,80,,18.56,percent of total billed charges,80% of total billed charges,26.1,90,,20.88,percent of total billed charges,90% of total billed charges,21.75,75,,17.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,8.41,29,,6.728,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,19.43,67,,15.544,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,23.2,80,,18.56,percent of total billed charges,80% of total billed charges,18.85,65,,15.08,percent of total billed charges,65% of total billed charges,10.34,35.67,,8.272,percent of total billed charges,35.67% of total billed charges,8.41,26.1,
LUNESTA 1 MG TAB,2502916,CDM,637,RC,,,outpatient,,,44,17.60,,37.4,85,,29.92,percent of total billed charges,85% of total billed charges,33.88,77,,27.1,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,36.08,82,,28.864,percent of total billed charges,82% of total billed charges,37.4,85,,29.92,percent of total billed charges,85% of total billed charges,37.4,85,,29.92,percent of total billed charges,85% of total billed charges,37.4,85,,29.92,percent of total billed charges,85% of total billed charges,39.6,90,,31.68,percent of total billed charges,90% of total billed charges,35.2,80,,28.16,percent of total billed charges,80% of total billed charges,39.6,90,,31.68,percent of total billed charges,90% of total billed charges,33,75,,26.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,12.76,29,,10.208,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,29.48,67,,23.584,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,35.2,80,,28.16,percent of total billed charges,80% of total billed charges,28.6,65,,22.88,percent of total billed charges,65% of total billed charges,15.69,35.67,,12.552,percent of total billed charges,35.67% of total billed charges,12.76,39.6,
DEXILANT 60 MG CAP,2502923,CDM,637,RC,,,outpatient,,,33,13.20,,28.05,85,,22.44,percent of total billed charges,85% of total billed charges,25.41,77,,20.33,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,27.06,82,,21.648,percent of total billed charges,82% of total billed charges,28.05,85,,22.44,percent of total billed charges,85% of total billed charges,28.05,85,,22.44,percent of total billed charges,85% of total billed charges,28.05,85,,22.44,percent of total billed charges,85% of total billed charges,29.7,90,,23.76,percent of total billed charges,90% of total billed charges,26.4,80,,21.12,percent of total billed charges,80% of total billed charges,29.7,90,,23.76,percent of total billed charges,90% of total billed charges,24.75,75,,19.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,9.57,29,,7.656,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,22.11,67,,17.688,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,26.4,80,,21.12,percent of total billed charges,80% of total billed charges,21.45,65,,17.16,percent of total billed charges,65% of total billed charges,11.77,35.67,,9.416,percent of total billed charges,35.67% of total billed charges,9.57,29.7,
DIFLUCAN 150 MG TAB,2502991,CDM,637,RC,,,outpatient,,,117,46.80,,99.45,85,,79.56,percent of total billed charges,85% of total billed charges,90.09,77,,72.07,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,95.94,82,,76.752,percent of total billed charges,82% of total billed charges,99.45,85,,79.56,percent of total billed charges,85% of total billed charges,99.45,85,,79.56,percent of total billed charges,85% of total billed charges,99.45,85,,79.56,percent of total billed charges,85% of total billed charges,105.3,90,,84.24,percent of total billed charges,90% of total billed charges,93.6,80,,74.88,percent of total billed charges,80% of total billed charges,105.3,90,,84.24,percent of total billed charges,90% of total billed charges,87.75,75,,70.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,33.93,29,,27.144,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,78.39,67,,62.712,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,93.6,80,,74.88,percent of total billed charges,80% of total billed charges,76.05,65,,60.84,percent of total billed charges,65% of total billed charges,41.73,35.67,,33.384,percent of total billed charges,35.67% of total billed charges,33.93,105.3,
DIFLUCAN 50MG TAB,2503005,CDM,637,RC,,,outpatient,,,12,4.80,,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,9.24,77,,7.39,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,9.84,82,,7.872,percent of total billed charges,82% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,10.8,90,,8.64,percent of total billed charges,90% of total billed charges,9.6,80,,7.68,percent of total billed charges,80% of total billed charges,10.8,90,,8.64,percent of total billed charges,90% of total billed charges,9,75,,7.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,3.48,29,,2.784,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,8.04,67,,6.432,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,9.6,80,,7.68,percent of total billed charges,80% of total billed charges,7.8,65,,6.24,percent of total billed charges,65% of total billed charges,4.28,35.67,,3.424,percent of total billed charges,35.67% of total billed charges,3.48,10.8,
DILANTIN 200 MG CAP,2503030,CDM,637,RC,,,outpatient,,,7,2.80,,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.39,77,,4.31,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,5.74,82,,4.592,percent of total billed charges,82% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.25,75,,4.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.03,29,,1.624,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4.69,67,,3.752,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,4.55,65,,3.64,percent of total billed charges,65% of total billed charges,2.5,35.67,,2,percent of total billed charges,35.67% of total billed charges,2.03,6.3,
DILANTIN 300 MG CAP,2503045,CDM,637,RC,,,outpatient,,,6,2.40,,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,4.62,77,,3.7,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,4.92,82,,3.936,percent of total billed charges,82% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,5.4,90,,4.32,percent of total billed charges,90% of total billed charges,4.8,80,,3.84,percent of total billed charges,80% of total billed charges,5.4,90,,4.32,percent of total billed charges,90% of total billed charges,4.5,75,,3.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,1.74,29,,1.392,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4.02,67,,3.216,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,4.8,80,,3.84,percent of total billed charges,80% of total billed charges,3.9,65,,3.12,percent of total billed charges,65% of total billed charges,2.14,35.67,,1.712,percent of total billed charges,35.67% of total billed charges,1.74,5.4,
DIMETANE DX LIQ.,2503105,CDM,637,RC,,,outpatient,,,23,9.20,,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,17.71,77,,14.17,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,18.86,82,,15.088,percent of total billed charges,82% of total billed charges,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,20.7,90,,16.56,percent of total billed charges,90% of total billed charges,18.4,80,,14.72,percent of total billed charges,80% of total billed charges,20.7,90,,16.56,percent of total billed charges,90% of total billed charges,17.25,75,,13.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,6.67,29,,5.336,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,15.41,67,,12.328,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,18.4,80,,14.72,percent of total billed charges,80% of total billed charges,14.95,65,,11.96,percent of total billed charges,65% of total billed charges,8.2,35.67,,6.56,percent of total billed charges,35.67% of total billed charges,6.67,20.7,
DIOVAN 160 MG PO,2503121,CDM,637,RC,,,outpatient,,,20,8.00,,17,85,,13.6,percent of total billed charges,85% of total billed charges,15.4,77,,12.32,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,16.4,82,,13.12,percent of total billed charges,82% of total billed charges,17,85,,13.6,percent of total billed charges,85% of total billed charges,17,85,,13.6,percent of total billed charges,85% of total billed charges,17,85,,13.6,percent of total billed charges,85% of total billed charges,18,90,,14.4,percent of total billed charges,90% of total billed charges,16,80,,12.8,percent of total billed charges,80% of total billed charges,18,90,,14.4,percent of total billed charges,90% of total billed charges,15,75,,12,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,5.8,29,,4.64,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,13.4,67,,10.72,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,16,80,,12.8,percent of total billed charges,80% of total billed charges,13,65,,10.4,percent of total billed charges,65% of total billed charges,7.13,35.67,,5.704,percent of total billed charges,35.67% of total billed charges,5.8,18,
DIOVAN 160 12.5 HCTZ PO,2503123,CDM,637,RC,,,outpatient,,,13,5.20,,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,10.01,77,,8.01,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,10.66,82,,8.528,percent of total billed charges,82% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,11.7,90,,9.36,percent of total billed charges,90% of total billed charges,10.4,80,,8.32,percent of total billed charges,80% of total billed charges,11.7,90,,9.36,percent of total billed charges,90% of total billed charges,9.75,75,,7.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,3.77,29,,3.016,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,8.71,67,,6.968,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,10.4,80,,8.32,percent of total billed charges,80% of total billed charges,8.45,65,,6.76,percent of total billed charges,65% of total billed charges,4.64,35.67,,3.712,percent of total billed charges,35.67% of total billed charges,3.77,11.7,
DIOVAN 40 MG TAB,2503127,CDM,637,RC,,,outpatient,,,17,6.80,,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,13.09,77,,10.47,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,13.94,82,,11.152,percent of total billed charges,82% of total billed charges,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,15.3,90,,12.24,percent of total billed charges,90% of total billed charges,13.6,80,,10.88,percent of total billed charges,80% of total billed charges,15.3,90,,12.24,percent of total billed charges,90% of total billed charges,12.75,75,,10.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,4.93,29,,3.944,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,11.39,67,,9.112,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,13.6,80,,10.88,percent of total billed charges,80% of total billed charges,11.05,65,,8.84,percent of total billed charges,65% of total billed charges,6.06,35.67,,4.848,percent of total billed charges,35.67% of total billed charges,4.93,15.3,
DIDTROPAN XL 5 MG PO,2503186,CDM,637,RC,,,outpatient,,,23,9.20,,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,17.71,77,,14.17,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,18.86,82,,15.088,percent of total billed charges,82% of total billed charges,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,20.7,90,,16.56,percent of total billed charges,90% of total billed charges,18.4,80,,14.72,percent of total billed charges,80% of total billed charges,20.7,90,,16.56,percent of total billed charges,90% of total billed charges,17.25,75,,13.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,6.67,29,,5.336,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,15.41,67,,12.328,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,18.4,80,,14.72,percent of total billed charges,80% of total billed charges,14.95,65,,11.96,percent of total billed charges,65% of total billed charges,8.2,35.67,,6.56,percent of total billed charges,35.67% of total billed charges,6.67,20.7,
DONNATAL CAPS,2503235,CDM,637,RC,,,outpatient,,,6,2.40,,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,4.62,77,,3.7,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,4.92,82,,3.936,percent of total billed charges,82% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,5.4,90,,4.32,percent of total billed charges,90% of total billed charges,4.8,80,,3.84,percent of total billed charges,80% of total billed charges,5.4,90,,4.32,percent of total billed charges,90% of total billed charges,4.5,75,,3.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,1.74,29,,1.392,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4.02,67,,3.216,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,4.8,80,,3.84,percent of total billed charges,80% of total billed charges,3.9,65,,3.12,percent of total billed charges,65% of total billed charges,2.14,35.67,,1.712,percent of total billed charges,35.67% of total billed charges,1.74,5.4,
DONNATAL ELIXIR 5 ML UDC,2503240,CDM,637,RC,,,outpatient,,,39,15.60,,33.15,85,,26.52,percent of total billed charges,85% of total billed charges,30.03,77,,24.02,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,31.98,82,,25.584,percent of total billed charges,82% of total billed charges,33.15,85,,26.52,percent of total billed charges,85% of total billed charges,33.15,85,,26.52,percent of total billed charges,85% of total billed charges,33.15,85,,26.52,percent of total billed charges,85% of total billed charges,35.1,90,,28.08,percent of total billed charges,90% of total billed charges,31.2,80,,24.96,percent of total billed charges,80% of total billed charges,35.1,90,,28.08,percent of total billed charges,90% of total billed charges,29.25,75,,23.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,11.31,29,,9.048,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,26.13,67,,20.904,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,31.2,80,,24.96,percent of total billed charges,80% of total billed charges,25.35,65,,20.28,percent of total billed charges,65% of total billed charges,13.91,35.67,,11.128,percent of total billed charges,35.67% of total billed charges,11.31,35.1,
DOVONEX 0.005% CREAM 60 GM TUB,2503271,CDM,637,RC,,,outpatient,,,1401,560.40,,1190.85,85,,952.68,percent of total billed charges,85% of total billed charges,1078.77,77,,863.02,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,1148.82,82,,919.056,percent of total billed charges,82% of total billed charges,1190.85,85,,952.68,percent of total billed charges,85% of total billed charges,1190.85,85,,952.68,percent of total billed charges,85% of total billed charges,1190.85,85,,952.68,percent of total billed charges,85% of total billed charges,1260.9,90,,1008.72,percent of total billed charges,90% of total billed charges,1120.8,80,,896.64,percent of total billed charges,80% of total billed charges,1260.9,90,,1008.72,percent of total billed charges,90% of total billed charges,1050.75,75,,840.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,406.29,29,,325.032,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,938.67,67,,750.936,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1120.8,80,,896.64,percent of total billed charges,80% of total billed charges,910.65,65,,728.52,percent of total billed charges,65% of total billed charges,499.74,35.67,,399.792,percent of total billed charges,35.67% of total billed charges,406.29,1260.9,
DR DUGI STOMACH MIX 30CC,2503325,CDM,637,RC,,,outpatient,,,25,10.00,,21.25,85,,17,percent of total billed charges,85% of total billed charges,19.25,77,,15.4,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,20.5,82,,16.4,percent of total billed charges,82% of total billed charges,21.25,85,,17,percent of total billed charges,85% of total billed charges,21.25,85,,17,percent of total billed charges,85% of total billed charges,21.25,85,,17,percent of total billed charges,85% of total billed charges,22.5,90,,18,percent of total billed charges,90% of total billed charges,20,80,,16,percent of total billed charges,80% of total billed charges,22.5,90,,18,percent of total billed charges,90% of total billed charges,18.75,75,,15,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,7.25,29,,5.8,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,16.75,67,,13.4,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,20,80,,16,percent of total billed charges,80% of total billed charges,16.25,65,,13,percent of total billed charges,65% of total billed charges,8.92,35.67,,7.136,percent of total billed charges,35.67% of total billed charges,7.25,22.5,
DR. DUGI TOPICAL OINTMENT,2503326,CDM,637,RC,,,outpatient,,,40,16.00,,34,85,,27.2,percent of total billed charges,85% of total billed charges,30.8,77,,24.64,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,32.8,82,,26.24,percent of total billed charges,82% of total billed charges,34,85,,27.2,percent of total billed charges,85% of total billed charges,34,85,,27.2,percent of total billed charges,85% of total billed charges,34,85,,27.2,percent of total billed charges,85% of total billed charges,36,90,,28.8,percent of total billed charges,90% of total billed charges,32,80,,25.6,percent of total billed charges,80% of total billed charges,36,90,,28.8,percent of total billed charges,90% of total billed charges,30,75,,24,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,11.6,29,,9.28,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,26.8,67,,21.44,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,32,80,,25.6,percent of total billed charges,80% of total billed charges,26,65,,20.8,percent of total billed charges,65% of total billed charges,14.27,35.67,,11.416,percent of total billed charges,35.67% of total billed charges,11.6,36,
DR HILL'S GI COCKTAIL 15 ML UD,2503328,CDM,637,RC,,,outpatient,,,24,9.60,,20.4,85,,16.32,percent of total billed charges,85% of total billed charges,18.48,77,,14.78,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,19.68,82,,15.744,percent of total billed charges,82% of total billed charges,20.4,85,,16.32,percent of total billed charges,85% of total billed charges,20.4,85,,16.32,percent of total billed charges,85% of total billed charges,20.4,85,,16.32,percent of total billed charges,85% of total billed charges,21.6,90,,17.28,percent of total billed charges,90% of total billed charges,19.2,80,,15.36,percent of total billed charges,80% of total billed charges,21.6,90,,17.28,percent of total billed charges,90% of total billed charges,18,75,,14.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,6.96,29,,5.568,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,16.08,67,,12.864,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,19.2,80,,15.36,percent of total billed charges,80% of total billed charges,15.6,65,,12.48,percent of total billed charges,65% of total billed charges,8.56,35.67,,6.848,percent of total billed charges,35.67% of total billed charges,6.96,21.6,
DR. REESE STOMACH MIX 15 ML UD,2503331,CDM,637,RC,,,outpatient,,,22,8.80,,18.7,85,,14.96,percent of total billed charges,85% of total billed charges,16.94,77,,13.55,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,18.04,82,,14.432,percent of total billed charges,82% of total billed charges,18.7,85,,14.96,percent of total billed charges,85% of total billed charges,18.7,85,,14.96,percent of total billed charges,85% of total billed charges,18.7,85,,14.96,percent of total billed charges,85% of total billed charges,19.8,90,,15.84,percent of total billed charges,90% of total billed charges,17.6,80,,14.08,percent of total billed charges,80% of total billed charges,19.8,90,,15.84,percent of total billed charges,90% of total billed charges,16.5,75,,13.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,6.38,29,,5.104,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,14.74,67,,11.792,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,17.6,80,,14.08,percent of total billed charges,80% of total billed charges,14.3,65,,11.44,percent of total billed charges,65% of total billed charges,7.85,35.67,,6.28,percent of total billed charges,35.67% of total billed charges,6.38,19.8,
DR SMITH'S DIAPER OINTMENT,2503333,CDM,637,RC,,,outpatient,,,28,11.20,,23.8,85,,19.04,percent of total billed charges,85% of total billed charges,21.56,77,,17.25,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,22.96,82,,18.368,percent of total billed charges,82% of total billed charges,23.8,85,,19.04,percent of total billed charges,85% of total billed charges,23.8,85,,19.04,percent of total billed charges,85% of total billed charges,23.8,85,,19.04,percent of total billed charges,85% of total billed charges,25.2,90,,20.16,percent of total billed charges,90% of total billed charges,22.4,80,,17.92,percent of total billed charges,80% of total billed charges,25.2,90,,20.16,percent of total billed charges,90% of total billed charges,21,75,,16.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,8.12,29,,6.496,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,18.76,67,,15.008,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,22.4,80,,17.92,percent of total billed charges,80% of total billed charges,18.2,65,,14.56,percent of total billed charges,65% of total billed charges,9.99,35.67,,7.992,percent of total billed charges,35.67% of total billed charges,8.12,25.2,
DUGI STOMACH MIX PER DOSE,2503395,CDM,637,RC,,,outpatient,,,7,2.80,,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.39,77,,4.31,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,5.74,82,,4.592,percent of total billed charges,82% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.25,75,,4.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.03,29,,1.624,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4.69,67,,3.752,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,4.55,65,,3.64,percent of total billed charges,65% of total billed charges,2.5,35.67,,2,percent of total billed charges,35.67% of total billed charges,2.03,6.3,
DURATUSS G 1200 MG PO,2503436,CDM,637,RC,,,outpatient,,,10,4.00,,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,7.7,77,,6.16,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,8.2,82,,6.56,percent of total billed charges,82% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,9,90,,7.2,percent of total billed charges,90% of total billed charges,8,80,,6.4,percent of total billed charges,80% of total billed charges,9,90,,7.2,percent of total billed charges,90% of total billed charges,7.5,75,,6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.9,29,,2.32,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,6.7,67,,5.36,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,8,80,,6.4,percent of total billed charges,80% of total billed charges,6.5,65,,5.2,percent of total billed charges,65% of total billed charges,3.57,35.67,,2.856,percent of total billed charges,35.67% of total billed charges,2.9,9,
DURICEF 500MG CAP,2503450,CDM,637,RC,,,outpatient,,,31,12.40,,26.35,85,,21.08,percent of total billed charges,85% of total billed charges,23.87,77,,19.1,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,25.42,82,,20.336,percent of total billed charges,82% of total billed charges,26.35,85,,21.08,percent of total billed charges,85% of total billed charges,26.35,85,,21.08,percent of total billed charges,85% of total billed charges,26.35,85,,21.08,percent of total billed charges,85% of total billed charges,27.9,90,,22.32,percent of total billed charges,90% of total billed charges,24.8,80,,19.84,percent of total billed charges,80% of total billed charges,27.9,90,,22.32,percent of total billed charges,90% of total billed charges,23.25,75,,18.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,8.99,29,,7.192,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,20.77,67,,16.616,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,24.8,80,,19.84,percent of total billed charges,80% of total billed charges,20.15,65,,16.12,percent of total billed charges,65% of total billed charges,11.06,35.67,,8.848,percent of total billed charges,35.67% of total billed charges,8.99,27.9,
DYAZIDE CAP,2503455,CDM,637,RC,,,outpatient,,,9,3.60,,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,6.93,77,,5.54,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,7.38,82,,5.904,percent of total billed charges,82% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,8.1,90,,6.48,percent of total billed charges,90% of total billed charges,7.2,80,,5.76,percent of total billed charges,80% of total billed charges,8.1,90,,6.48,percent of total billed charges,90% of total billed charges,6.75,75,,5.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.61,29,,2.088,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,6.03,67,,4.824,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,7.2,80,,5.76,percent of total billed charges,80% of total billed charges,5.85,65,,4.68,percent of total billed charges,65% of total billed charges,3.21,35.67,,2.568,percent of total billed charges,35.67% of total billed charges,2.61,8.1,
DYRENIUM 50 MG CAP PO,2503484,CDM,637,RC,,,outpatient,,,8,3.20,,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,6.16,77,,4.93,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,6.56,82,,5.248,percent of total billed charges,82% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,7.2,90,,5.76,percent of total billed charges,90% of total billed charges,6.4,80,,5.12,percent of total billed charges,80% of total billed charges,7.2,90,,5.76,percent of total billed charges,90% of total billed charges,6,75,,4.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.32,29,,1.856,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,5.36,67,,4.288,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,6.4,80,,5.12,percent of total billed charges,80% of total billed charges,5.2,65,,4.16,percent of total billed charges,65% of total billed charges,2.85,35.67,,2.28,percent of total billed charges,35.67% of total billed charges,2.32,7.2,
EFFEXOR XR 37.5 MG PO,2503526,CDM,637,RC,,,outpatient,,,25,10.00,,21.25,85,,17,percent of total billed charges,85% of total billed charges,19.25,77,,15.4,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,20.5,82,,16.4,percent of total billed charges,82% of total billed charges,21.25,85,,17,percent of total billed charges,85% of total billed charges,21.25,85,,17,percent of total billed charges,85% of total billed charges,21.25,85,,17,percent of total billed charges,85% of total billed charges,22.5,90,,18,percent of total billed charges,90% of total billed charges,20,80,,16,percent of total billed charges,80% of total billed charges,22.5,90,,18,percent of total billed charges,90% of total billed charges,18.75,75,,15,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,7.25,29,,5.8,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,16.75,67,,13.4,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,20,80,,16,percent of total billed charges,80% of total billed charges,16.25,65,,13,percent of total billed charges,65% of total billed charges,8.92,35.67,,7.136,percent of total billed charges,35.67% of total billed charges,7.25,22.5,
ELIXOPHYLLIN ELIXIR 5CC,2503590,CDM,637,RC,,,outpatient,,,20,8.00,,17,85,,13.6,percent of total billed charges,85% of total billed charges,15.4,77,,12.32,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,16.4,82,,13.12,percent of total billed charges,82% of total billed charges,17,85,,13.6,percent of total billed charges,85% of total billed charges,17,85,,13.6,percent of total billed charges,85% of total billed charges,17,85,,13.6,percent of total billed charges,85% of total billed charges,18,90,,14.4,percent of total billed charges,90% of total billed charges,16,80,,12.8,percent of total billed charges,80% of total billed charges,18,90,,14.4,percent of total billed charges,90% of total billed charges,15,75,,12,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,5.8,29,,4.64,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,13.4,67,,10.72,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,16,80,,12.8,percent of total billed charges,80% of total billed charges,13,65,,10.4,percent of total billed charges,65% of total billed charges,7.13,35.67,,5.704,percent of total billed charges,35.67% of total billed charges,5.8,18,
ELIQUIS 5 MG PO,2503591,CDM,637,RC,,,outpatient,,,18,7.20,,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,13.86,77,,11.09,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,14.76,82,,11.808,percent of total billed charges,82% of total billed charges,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,16.2,90,,12.96,percent of total billed charges,90% of total billed charges,14.4,80,,11.52,percent of total billed charges,80% of total billed charges,16.2,90,,12.96,percent of total billed charges,90% of total billed charges,13.5,75,,10.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,5.22,29,,4.176,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,12.06,67,,9.648,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,14.4,80,,11.52,percent of total billed charges,80% of total billed charges,11.7,65,,9.36,percent of total billed charges,65% of total billed charges,6.42,35.67,,5.136,percent of total billed charges,35.67% of total billed charges,5.22,16.2,
ENABLEX 7.5 MG TABLET,2503607,CDM,637,RC,,,outpatient,,,26,10.40,,22.1,85,,17.68,percent of total billed charges,85% of total billed charges,20.02,77,,16.02,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,21.32,82,,17.056,percent of total billed charges,82% of total billed charges,22.1,85,,17.68,percent of total billed charges,85% of total billed charges,22.1,85,,17.68,percent of total billed charges,85% of total billed charges,22.1,85,,17.68,percent of total billed charges,85% of total billed charges,23.4,90,,18.72,percent of total billed charges,90% of total billed charges,20.8,80,,16.64,percent of total billed charges,80% of total billed charges,23.4,90,,18.72,percent of total billed charges,90% of total billed charges,19.5,75,,15.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,7.54,29,,6.032,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,17.42,67,,13.936,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,20.8,80,,16.64,percent of total billed charges,80% of total billed charges,16.9,65,,13.52,percent of total billed charges,65% of total billed charges,9.27,35.67,,7.416,percent of total billed charges,35.67% of total billed charges,7.54,23.4,
ENTEX 5CC LIQUID,2503655,CDM,637,RC,,,outpatient,,,7,2.80,,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.39,77,,4.31,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,5.74,82,,4.592,percent of total billed charges,82% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.25,75,,4.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.03,29,,1.624,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4.69,67,,3.752,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,4.55,65,,3.64,percent of total billed charges,65% of total billed charges,2.5,35.67,,2,percent of total billed charges,35.67% of total billed charges,2.03,6.3,
ENTEX CAP,2503660,CDM,637,RC,,,outpatient,,,41,16.40,,34.85,85,,27.88,percent of total billed charges,85% of total billed charges,31.57,77,,25.26,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,33.62,82,,26.896,percent of total billed charges,82% of total billed charges,34.85,85,,27.88,percent of total billed charges,85% of total billed charges,34.85,85,,27.88,percent of total billed charges,85% of total billed charges,34.85,85,,27.88,percent of total billed charges,85% of total billed charges,36.9,90,,29.52,percent of total billed charges,90% of total billed charges,32.8,80,,26.24,percent of total billed charges,80% of total billed charges,36.9,90,,29.52,percent of total billed charges,90% of total billed charges,30.75,75,,24.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,11.89,29,,9.512,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,27.47,67,,21.976,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,32.8,80,,26.24,percent of total billed charges,80% of total billed charges,26.65,65,,21.32,percent of total billed charges,65% of total billed charges,14.62,35.67,,11.696,percent of total billed charges,35.67% of total billed charges,11.89,36.9,
ERYC 250 MG CAP,2503720,CDM,637,RC,,,outpatient,,,27,10.80,,22.95,85,,18.36,percent of total billed charges,85% of total billed charges,20.79,77,,16.63,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,22.14,82,,17.712,percent of total billed charges,82% of total billed charges,22.95,85,,18.36,percent of total billed charges,85% of total billed charges,22.95,85,,18.36,percent of total billed charges,85% of total billed charges,22.95,85,,18.36,percent of total billed charges,85% of total billed charges,24.3,90,,19.44,percent of total billed charges,90% of total billed charges,21.6,80,,17.28,percent of total billed charges,80% of total billed charges,24.3,90,,19.44,percent of total billed charges,90% of total billed charges,20.25,75,,16.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,7.83,29,,6.264,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,18.09,67,,14.472,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,21.6,80,,17.28,percent of total billed charges,80% of total billed charges,17.55,65,,14.04,percent of total billed charges,65% of total billed charges,9.63,35.67,,7.704,percent of total billed charges,35.67% of total billed charges,7.83,24.3,
ERYTHROCIN 500MG TAB,2503775,CDM,637,RC,,,outpatient,,,6,2.40,,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,4.62,77,,3.7,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,4.92,82,,3.936,percent of total billed charges,82% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,5.4,90,,4.32,percent of total billed charges,90% of total billed charges,4.8,80,,3.84,percent of total billed charges,80% of total billed charges,5.4,90,,4.32,percent of total billed charges,90% of total billed charges,4.5,75,,3.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,1.74,29,,1.392,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4.02,67,,3.216,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,4.8,80,,3.84,percent of total billed charges,80% of total billed charges,3.9,65,,3.12,percent of total billed charges,65% of total billed charges,2.14,35.67,,1.712,percent of total billed charges,35.67% of total billed charges,1.74,5.4,
ERYTHROCIN PASTE/VIT E&SUROSE,2503780,CDM,637,RC,,,outpatient,,,116,46.40,,98.6,85,,78.88,percent of total billed charges,85% of total billed charges,89.32,77,,71.46,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,95.12,82,,76.096,percent of total billed charges,82% of total billed charges,98.6,85,,78.88,percent of total billed charges,85% of total billed charges,98.6,85,,78.88,percent of total billed charges,85% of total billed charges,98.6,85,,78.88,percent of total billed charges,85% of total billed charges,104.4,90,,83.52,percent of total billed charges,90% of total billed charges,92.8,80,,74.24,percent of total billed charges,80% of total billed charges,104.4,90,,83.52,percent of total billed charges,90% of total billed charges,87,75,,69.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,33.64,29,,26.912,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,77.72,67,,62.176,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,92.8,80,,74.24,percent of total billed charges,80% of total billed charges,75.4,65,,60.32,percent of total billed charges,65% of total billed charges,41.38,35.67,,33.104,percent of total billed charges,35.67% of total billed charges,33.64,104.4,
EURAX LOTION TOPICAL,2503873,CDM,637,RC,,,outpatient,,,54,21.60,,45.9,85,,36.72,percent of total billed charges,85% of total billed charges,41.58,77,,33.26,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,44.28,82,,35.424,percent of total billed charges,82% of total billed charges,45.9,85,,36.72,percent of total billed charges,85% of total billed charges,45.9,85,,36.72,percent of total billed charges,85% of total billed charges,45.9,85,,36.72,percent of total billed charges,85% of total billed charges,48.6,90,,38.88,percent of total billed charges,90% of total billed charges,43.2,80,,34.56,percent of total billed charges,80% of total billed charges,48.6,90,,38.88,percent of total billed charges,90% of total billed charges,40.5,75,,32.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,15.66,29,,12.528,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,36.18,67,,28.944,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,43.2,80,,34.56,percent of total billed charges,80% of total billed charges,35.1,65,,28.08,percent of total billed charges,65% of total billed charges,19.26,35.67,,15.408,percent of total billed charges,35.67% of total billed charges,15.66,48.6,
EXELON 4.6 MG PATCH,2503889,CDM,637,RC,,,outpatient,,,48,19.20,,40.8,85,,32.64,percent of total billed charges,85% of total billed charges,36.96,77,,29.57,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,39.36,82,,31.488,percent of total billed charges,82% of total billed charges,40.8,85,,32.64,percent of total billed charges,85% of total billed charges,40.8,85,,32.64,percent of total billed charges,85% of total billed charges,40.8,85,,32.64,percent of total billed charges,85% of total billed charges,43.2,90,,34.56,percent of total billed charges,90% of total billed charges,38.4,80,,30.72,percent of total billed charges,80% of total billed charges,43.2,90,,34.56,percent of total billed charges,90% of total billed charges,36,75,,28.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,13.92,29,,11.136,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,32.16,67,,25.728,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,38.4,80,,30.72,percent of total billed charges,80% of total billed charges,31.2,65,,24.96,percent of total billed charges,65% of total billed charges,17.12,35.67,,13.696,percent of total billed charges,35.67% of total billed charges,13.92,43.2,
EZ CHAR PELLETS 25 GRAM BOTTLE,2503896,CDM,637,RC,,,outpatient,,,48,19.20,,40.8,85,,32.64,percent of total billed charges,85% of total billed charges,36.96,77,,29.57,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,39.36,82,,31.488,percent of total billed charges,82% of total billed charges,40.8,85,,32.64,percent of total billed charges,85% of total billed charges,40.8,85,,32.64,percent of total billed charges,85% of total billed charges,40.8,85,,32.64,percent of total billed charges,85% of total billed charges,43.2,90,,34.56,percent of total billed charges,90% of total billed charges,38.4,80,,30.72,percent of total billed charges,80% of total billed charges,43.2,90,,34.56,percent of total billed charges,90% of total billed charges,36,75,,28.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,13.92,29,,11.136,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,32.16,67,,25.728,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,38.4,80,,30.72,percent of total billed charges,80% of total billed charges,31.2,65,,24.96,percent of total billed charges,65% of total billed charges,17.12,35.67,,13.696,percent of total billed charges,35.67% of total billed charges,13.92,43.2,
EXELON 9.5 MG PATCH,2503898,CDM,637,RC,,,outpatient,,,48,19.20,,40.8,85,,32.64,percent of total billed charges,85% of total billed charges,36.96,77,,29.57,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,39.36,82,,31.488,percent of total billed charges,82% of total billed charges,40.8,85,,32.64,percent of total billed charges,85% of total billed charges,40.8,85,,32.64,percent of total billed charges,85% of total billed charges,40.8,85,,32.64,percent of total billed charges,85% of total billed charges,43.2,90,,34.56,percent of total billed charges,90% of total billed charges,38.4,80,,30.72,percent of total billed charges,80% of total billed charges,43.2,90,,34.56,percent of total billed charges,90% of total billed charges,36,75,,28.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,13.92,29,,11.136,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,32.16,67,,25.728,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,38.4,80,,30.72,percent of total billed charges,80% of total billed charges,31.2,65,,24.96,percent of total billed charges,65% of total billed charges,17.12,35.67,,13.696,percent of total billed charges,35.67% of total billed charges,13.92,43.2,
FEOSOL 325MG TAB,2503920,CDM,637,RC,,,outpatient,,,7,2.80,,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.39,77,,4.31,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,5.74,82,,4.592,percent of total billed charges,82% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.25,75,,4.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.03,29,,1.624,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4.69,67,,3.752,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,4.55,65,,3.64,percent of total billed charges,65% of total billed charges,2.5,35.67,,2,percent of total billed charges,35.67% of total billed charges,2.03,6.3,
FLAGYL SUSPENSION PER BOTTLE,2504001,CDM,637,RC,,,outpatient,,,267,106.80,,226.95,85,,181.56,percent of total billed charges,85% of total billed charges,205.59,77,,164.47,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,218.94,82,,175.152,percent of total billed charges,82% of total billed charges,226.95,85,,181.56,percent of total billed charges,85% of total billed charges,226.95,85,,181.56,percent of total billed charges,85% of total billed charges,226.95,85,,181.56,percent of total billed charges,85% of total billed charges,240.3,90,,192.24,percent of total billed charges,90% of total billed charges,213.6,80,,170.88,percent of total billed charges,80% of total billed charges,240.3,90,,192.24,percent of total billed charges,90% of total billed charges,200.25,75,,160.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,77.43,29,,61.944,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,178.89,67,,143.112,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,213.6,80,,170.88,percent of total billed charges,80% of total billed charges,173.55,65,,138.84,percent of total billed charges,65% of total billed charges,95.24,35.67,,76.192,percent of total billed charges,35.67% of total billed charges,77.43,240.3,
FLEET PHOSPHO-SODA/45 ML BOTTL,2504021,CDM,637,RC,,,outpatient,,,16,6.40,,13.6,85,,10.88,percent of total billed charges,85% of total billed charges,12.32,77,,9.86,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,13.12,82,,10.496,percent of total billed charges,82% of total billed charges,13.6,85,,10.88,percent of total billed charges,85% of total billed charges,13.6,85,,10.88,percent of total billed charges,85% of total billed charges,13.6,85,,10.88,percent of total billed charges,85% of total billed charges,14.4,90,,11.52,percent of total billed charges,90% of total billed charges,12.8,80,,10.24,percent of total billed charges,80% of total billed charges,14.4,90,,11.52,percent of total billed charges,90% of total billed charges,12,75,,9.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,4.64,29,,3.712,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,10.72,67,,8.576,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,12.8,80,,10.24,percent of total billed charges,80% of total billed charges,10.4,65,,8.32,percent of total billed charges,65% of total billed charges,5.71,35.67,,4.568,percent of total billed charges,35.67% of total billed charges,4.64,14.4,
FLOVENT 220 MCG INHALER,2504053,CDM,637,RC,,,outpatient,,,575,230.00,,488.75,85,,391,percent of total billed charges,85% of total billed charges,442.75,77,,354.2,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,471.5,82,,377.2,percent of total billed charges,82% of total billed charges,488.75,85,,391,percent of total billed charges,85% of total billed charges,488.75,85,,391,percent of total billed charges,85% of total billed charges,488.75,85,,391,percent of total billed charges,85% of total billed charges,517.5,90,,414,percent of total billed charges,90% of total billed charges,460,80,,368,percent of total billed charges,80% of total billed charges,517.5,90,,414,percent of total billed charges,90% of total billed charges,431.25,75,,345,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,166.75,29,,133.4,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,385.25,67,,308.2,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,460,80,,368,percent of total billed charges,80% of total billed charges,373.75,65,,299,percent of total billed charges,65% of total billed charges,205.1,35.67,,164.08,percent of total billed charges,35.67% of total billed charges,166.75,517.5,
FOLATE/FOLIC ACID 1MG TAB,2504110,CDM,637,RC,,,outpatient,,,7,2.80,,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.39,77,,4.31,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,5.74,82,,4.592,percent of total billed charges,82% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.25,75,,4.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.03,29,,1.624,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4.69,67,,3.752,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,4.55,65,,3.64,percent of total billed charges,65% of total billed charges,2.5,35.67,,2,percent of total billed charges,35.67% of total billed charges,2.03,6.3,
FLURESS OPTH DROPS 5 ML,2504122,CDM,637,RC,,,outpatient,,,173,69.20,,147.05,85,,117.64,percent of total billed charges,85% of total billed charges,133.21,77,,106.57,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,141.86,82,,113.488,percent of total billed charges,82% of total billed charges,147.05,85,,117.64,percent of total billed charges,85% of total billed charges,147.05,85,,117.64,percent of total billed charges,85% of total billed charges,147.05,85,,117.64,percent of total billed charges,85% of total billed charges,155.7,90,,124.56,percent of total billed charges,90% of total billed charges,138.4,80,,110.72,percent of total billed charges,80% of total billed charges,155.7,90,,124.56,percent of total billed charges,90% of total billed charges,129.75,75,,103.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,50.17,29,,40.136,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,115.91,67,,92.728,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,138.4,80,,110.72,percent of total billed charges,80% of total billed charges,112.45,65,,89.96,percent of total billed charges,65% of total billed charges,61.71,35.67,,49.368,percent of total billed charges,35.67% of total billed charges,50.17,155.7,
FOSAMAX 70 MG P,2504124,CDM,637,RC,,,outpatient,,,96,38.40,,81.6,85,,65.28,percent of total billed charges,85% of total billed charges,73.92,77,,59.14,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,78.72,82,,62.976,percent of total billed charges,82% of total billed charges,81.6,85,,65.28,percent of total billed charges,85% of total billed charges,81.6,85,,65.28,percent of total billed charges,85% of total billed charges,81.6,85,,65.28,percent of total billed charges,85% of total billed charges,86.4,90,,69.12,percent of total billed charges,90% of total billed charges,76.8,80,,61.44,percent of total billed charges,80% of total billed charges,86.4,90,,69.12,percent of total billed charges,90% of total billed charges,72,75,,57.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,27.84,29,,22.272,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,64.32,67,,51.456,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,76.8,80,,61.44,percent of total billed charges,80% of total billed charges,62.4,65,,49.92,percent of total billed charges,65% of total billed charges,34.24,35.67,,27.392,percent of total billed charges,35.67% of total billed charges,27.84,86.4,
GENERIC LIQUID 60 ML PO,2504207,CDM,637,RC,,,outpatient,,,10,4.00,,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,7.7,77,,6.16,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,8.2,82,,6.56,percent of total billed charges,82% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,9,90,,7.2,percent of total billed charges,90% of total billed charges,8,80,,6.4,percent of total billed charges,80% of total billed charges,9,90,,7.2,percent of total billed charges,90% of total billed charges,7.5,75,,6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.9,29,,2.32,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,6.7,67,,5.36,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,8,80,,6.4,percent of total billed charges,80% of total billed charges,6.5,65,,5.2,percent of total billed charges,65% of total billed charges,3.57,35.67,,2.856,percent of total billed charges,35.67% of total billed charges,2.9,9,
GENERIC TOPICAL CHARGE,2504208,CDM,637,RC,,,outpatient,,,20,8.00,,17,85,,13.6,percent of total billed charges,85% of total billed charges,15.4,77,,12.32,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,16.4,82,,13.12,percent of total billed charges,82% of total billed charges,17,85,,13.6,percent of total billed charges,85% of total billed charges,17,85,,13.6,percent of total billed charges,85% of total billed charges,17,85,,13.6,percent of total billed charges,85% of total billed charges,18,90,,14.4,percent of total billed charges,90% of total billed charges,16,80,,12.8,percent of total billed charges,80% of total billed charges,18,90,,14.4,percent of total billed charges,90% of total billed charges,15,75,,12,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,5.8,29,,4.64,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,13.4,67,,10.72,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,16,80,,12.8,percent of total billed charges,80% of total billed charges,13,65,,10.4,percent of total billed charges,65% of total billed charges,7.13,35.67,,5.704,percent of total billed charges,35.67% of total billed charges,5.8,18,
GENERIC INHALER,2504209,CDM,637,RC,,,outpatient,,,10,4.00,,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,7.7,77,,6.16,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,8.2,82,,6.56,percent of total billed charges,82% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,9,90,,7.2,percent of total billed charges,90% of total billed charges,8,80,,6.4,percent of total billed charges,80% of total billed charges,9,90,,7.2,percent of total billed charges,90% of total billed charges,7.5,75,,6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.9,29,,2.32,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,6.7,67,,5.36,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,8,80,,6.4,percent of total billed charges,80% of total billed charges,6.5,65,,5.2,percent of total billed charges,65% of total billed charges,3.57,35.67,,2.856,percent of total billed charges,35.67% of total billed charges,2.9,9,
GENERIC PO DRUG,2504211,CDM,637,RC,,,outpatient,,,6,2.40,,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,4.62,77,,3.7,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,4.92,82,,3.936,percent of total billed charges,82% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,5.4,90,,4.32,percent of total billed charges,90% of total billed charges,4.8,80,,3.84,percent of total billed charges,80% of total billed charges,5.4,90,,4.32,percent of total billed charges,90% of total billed charges,4.5,75,,3.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,1.74,29,,1.392,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4.02,67,,3.216,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,4.8,80,,3.84,percent of total billed charges,80% of total billed charges,3.9,65,,3.12,percent of total billed charges,65% of total billed charges,2.14,35.67,,1.712,percent of total billed charges,35.67% of total billed charges,1.74,5.4,
GENERIC OPTH OINT,2504212,CDM,637,RC,,,outpatient,,,20,8.00,,17,85,,13.6,percent of total billed charges,85% of total billed charges,15.4,77,,12.32,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,16.4,82,,13.12,percent of total billed charges,82% of total billed charges,17,85,,13.6,percent of total billed charges,85% of total billed charges,17,85,,13.6,percent of total billed charges,85% of total billed charges,17,85,,13.6,percent of total billed charges,85% of total billed charges,18,90,,14.4,percent of total billed charges,90% of total billed charges,16,80,,12.8,percent of total billed charges,80% of total billed charges,18,90,,14.4,percent of total billed charges,90% of total billed charges,15,75,,12,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,5.8,29,,4.64,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,13.4,67,,10.72,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,16,80,,12.8,percent of total billed charges,80% of total billed charges,13,65,,10.4,percent of total billed charges,65% of total billed charges,7.13,35.67,,5.704,percent of total billed charges,35.67% of total billed charges,5.8,18,
GENERIC POWDER,2504214,CDM,637,RC,,,outpatient,,,20,8.00,,17,85,,13.6,percent of total billed charges,85% of total billed charges,15.4,77,,12.32,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,16.4,82,,13.12,percent of total billed charges,82% of total billed charges,17,85,,13.6,percent of total billed charges,85% of total billed charges,17,85,,13.6,percent of total billed charges,85% of total billed charges,17,85,,13.6,percent of total billed charges,85% of total billed charges,18,90,,14.4,percent of total billed charges,90% of total billed charges,16,80,,12.8,percent of total billed charges,80% of total billed charges,18,90,,14.4,percent of total billed charges,90% of total billed charges,15,75,,12,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,5.8,29,,4.64,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,13.4,67,,10.72,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,16,80,,12.8,percent of total billed charges,80% of total billed charges,13,65,,10.4,percent of total billed charges,65% of total billed charges,7.13,35.67,,5.704,percent of total billed charges,35.67% of total billed charges,5.8,18,
GERIPLEX CAPS,2504255,CDM,637,RC,,,outpatient,,,6,2.40,,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,4.62,77,,3.7,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,4.92,82,,3.936,percent of total billed charges,82% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,5.4,90,,4.32,percent of total billed charges,90% of total billed charges,4.8,80,,3.84,percent of total billed charges,80% of total billed charges,5.4,90,,4.32,percent of total billed charges,90% of total billed charges,4.5,75,,3.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,1.74,29,,1.392,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4.02,67,,3.216,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,4.8,80,,3.84,percent of total billed charges,80% of total billed charges,3.9,65,,3.12,percent of total billed charges,65% of total billed charges,2.14,35.67,,1.712,percent of total billed charges,35.67% of total billed charges,1.74,5.4,
GENTEAL OPTH GEL,2504256,CDM,637,RC,,,outpatient,,,18,7.20,,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,13.86,77,,11.09,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,14.76,82,,11.808,percent of total billed charges,82% of total billed charges,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,16.2,90,,12.96,percent of total billed charges,90% of total billed charges,14.4,80,,11.52,percent of total billed charges,80% of total billed charges,16.2,90,,12.96,percent of total billed charges,90% of total billed charges,13.5,75,,10.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,5.22,29,,4.176,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,12.06,67,,9.648,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,14.4,80,,11.52,percent of total billed charges,80% of total billed charges,11.7,65,,9.36,percent of total billed charges,65% of total billed charges,6.42,35.67,,5.136,percent of total billed charges,35.67% of total billed charges,5.22,16.2,
GLUCOVANCE 1.25/250 MG PO,2504276,CDM,637,RC,,,outpatient,,,8,3.20,,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,6.16,77,,4.93,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,6.56,82,,5.248,percent of total billed charges,82% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,7.2,90,,5.76,percent of total billed charges,90% of total billed charges,6.4,80,,5.12,percent of total billed charges,80% of total billed charges,7.2,90,,5.76,percent of total billed charges,90% of total billed charges,6,75,,4.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.32,29,,1.856,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,5.36,67,,4.288,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,6.4,80,,5.12,percent of total billed charges,80% of total billed charges,5.2,65,,4.16,percent of total billed charges,65% of total billed charges,2.85,35.67,,2.28,percent of total billed charges,35.67% of total billed charges,2.32,7.2,
GLUCOSAMINE TAB,2504278,CDM,637,RC,,,outpatient,,,9,3.60,,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,6.93,77,,5.54,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,7.38,82,,5.904,percent of total billed charges,82% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,8.1,90,,6.48,percent of total billed charges,90% of total billed charges,7.2,80,,5.76,percent of total billed charges,80% of total billed charges,8.1,90,,6.48,percent of total billed charges,90% of total billed charges,6.75,75,,5.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.61,29,,2.088,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,6.03,67,,4.824,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,7.2,80,,5.76,percent of total billed charges,80% of total billed charges,5.85,65,,4.68,percent of total billed charges,65% of total billed charges,3.21,35.67,,2.568,percent of total billed charges,35.67% of total billed charges,2.61,8.1,
GLUCOPHAGE XR PO,2504281,CDM,637,RC,,,outpatient,,,8,3.20,,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,6.16,77,,4.93,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,6.56,82,,5.248,percent of total billed charges,82% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,7.2,90,,5.76,percent of total billed charges,90% of total billed charges,6.4,80,,5.12,percent of total billed charges,80% of total billed charges,7.2,90,,5.76,percent of total billed charges,90% of total billed charges,6,75,,4.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.32,29,,1.856,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,5.36,67,,4.288,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,6.4,80,,5.12,percent of total billed charges,80% of total billed charges,5.2,65,,4.16,percent of total billed charges,65% of total billed charges,2.85,35.67,,2.28,percent of total billed charges,35.67% of total billed charges,2.32,7.2,
GLUCOTROL 2.5 MG TAB,2504285,CDM,637,RC,,,outpatient,,,6,2.40,,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,4.62,77,,3.7,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,4.92,82,,3.936,percent of total billed charges,82% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,5.4,90,,4.32,percent of total billed charges,90% of total billed charges,4.8,80,,3.84,percent of total billed charges,80% of total billed charges,5.4,90,,4.32,percent of total billed charges,90% of total billed charges,4.5,75,,3.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,1.74,29,,1.392,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4.02,67,,3.216,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,4.8,80,,3.84,percent of total billed charges,80% of total billed charges,3.9,65,,3.12,percent of total billed charges,65% of total billed charges,2.14,35.67,,1.712,percent of total billed charges,35.67% of total billed charges,1.74,5.4,
GLUCOTROL XL 2.5 MG PO,2504286,CDM,637,RC,,,outpatient,,,7,2.80,,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.39,77,,4.31,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,5.74,82,,4.592,percent of total billed charges,82% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.25,75,,4.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.03,29,,1.624,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4.69,67,,3.752,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,4.55,65,,3.64,percent of total billed charges,65% of total billed charges,2.5,35.67,,2,percent of total billed charges,35.67% of total billed charges,2.03,6.3,
GLUCOTROL XL 5 MG TAB,2504301,CDM,637,RC,,,outpatient,,,7,2.80,,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.39,77,,4.31,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,5.74,82,,4.592,percent of total billed charges,82% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.25,75,,4.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.03,29,,1.624,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4.69,67,,3.752,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,4.55,65,,3.64,percent of total billed charges,65% of total billed charges,2.5,35.67,,2,percent of total billed charges,35.67% of total billed charges,2.03,6.3,
GYN-LOTRIMIN VAG TAB-6 TOP,2504345,CDM,637,RC,,,outpatient,,,40,16.00,,34,85,,27.2,percent of total billed charges,85% of total billed charges,30.8,77,,24.64,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,32.8,82,,26.24,percent of total billed charges,82% of total billed charges,34,85,,27.2,percent of total billed charges,85% of total billed charges,34,85,,27.2,percent of total billed charges,85% of total billed charges,34,85,,27.2,percent of total billed charges,85% of total billed charges,36,90,,28.8,percent of total billed charges,90% of total billed charges,32,80,,25.6,percent of total billed charges,80% of total billed charges,36,90,,28.8,percent of total billed charges,90% of total billed charges,30,75,,24,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,11.6,29,,9.28,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,26.8,67,,21.44,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,32,80,,25.6,percent of total billed charges,80% of total billed charges,26,65,,20.8,percent of total billed charges,65% of total billed charges,14.27,35.67,,11.416,percent of total billed charges,35.67% of total billed charges,11.6,36,
HALFLYTERLY 2000 ML BOTTLE,2504456,CDM,637,RC,,,outpatient,,,200,80.00,,170,85,,136,percent of total billed charges,85% of total billed charges,154,77,,123.2,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,164,82,,131.2,percent of total billed charges,82% of total billed charges,170,85,,136,percent of total billed charges,85% of total billed charges,170,85,,136,percent of total billed charges,85% of total billed charges,170,85,,136,percent of total billed charges,85% of total billed charges,180,90,,144,percent of total billed charges,90% of total billed charges,160,80,,128,percent of total billed charges,80% of total billed charges,180,90,,144,percent of total billed charges,90% of total billed charges,150,75,,120,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,58,29,,46.4,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,134,67,,107.2,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,160,80,,128,percent of total billed charges,80% of total billed charges,130,65,,104,percent of total billed charges,65% of total billed charges,71.34,35.67,,57.072,percent of total billed charges,35.67% of total billed charges,58,180,
HEMOCYTE TAB,2504483,CDM,637,RC,,,outpatient,,,7,2.80,,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.39,77,,4.31,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,5.74,82,,4.592,percent of total billed charges,82% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.25,75,,4.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.03,29,,1.624,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4.69,67,,3.752,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,4.55,65,,3.64,percent of total billed charges,65% of total billed charges,2.5,35.67,,2,percent of total billed charges,35.67% of total billed charges,2.03,6.3,
HEMOCYTE F TAB,2504485,CDM,637,RC,,,outpatient,,,7,2.80,,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.39,77,,4.31,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,5.74,82,,4.592,percent of total billed charges,82% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.25,75,,4.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.03,29,,1.624,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4.69,67,,3.752,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,4.55,65,,3.64,percent of total billed charges,65% of total billed charges,2.5,35.67,,2,percent of total billed charges,35.67% of total billed charges,2.03,6.3,
HEMOCYTE PLUS TAB,2504490,CDM,637,RC,,,outpatient,,,7,2.80,,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.39,77,,4.31,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,5.74,82,,4.592,percent of total billed charges,82% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.25,75,,4.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.03,29,,1.624,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4.69,67,,3.752,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,4.55,65,,3.64,percent of total billed charges,65% of total billed charges,2.5,35.67,,2,percent of total billed charges,35.67% of total billed charges,2.03,6.3,
HUMALOG 75/25 LIS INJECTION250,2504597,CDM,637,RC,,,outpatient,,,17,6.80,,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,13.09,77,,10.47,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,13.94,82,,11.152,percent of total billed charges,82% of total billed charges,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,15.3,90,,12.24,percent of total billed charges,90% of total billed charges,13.6,80,,10.88,percent of total billed charges,80% of total billed charges,15.3,90,,12.24,percent of total billed charges,90% of total billed charges,12.75,75,,10.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,4.93,29,,3.944,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,11.39,67,,9.112,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,13.6,80,,10.88,percent of total billed charges,80% of total billed charges,11.05,65,,8.84,percent of total billed charges,65% of total billed charges,6.06,35.67,,4.848,percent of total billed charges,35.67% of total billed charges,4.93,15.3,
HUMALOG 3 ML VIAL,2504618,CDM,637,RC,,,outpatient,,,202,80.80,,171.7,85,,137.36,percent of total billed charges,85% of total billed charges,155.54,77,,124.43,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,165.64,82,,132.512,percent of total billed charges,82% of total billed charges,171.7,85,,137.36,percent of total billed charges,85% of total billed charges,171.7,85,,137.36,percent of total billed charges,85% of total billed charges,171.7,85,,137.36,percent of total billed charges,85% of total billed charges,181.8,90,,145.44,percent of total billed charges,90% of total billed charges,161.6,80,,129.28,percent of total billed charges,80% of total billed charges,181.8,90,,145.44,percent of total billed charges,90% of total billed charges,151.5,75,,121.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,58.58,29,,46.864,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,135.34,67,,108.272,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,161.6,80,,129.28,percent of total billed charges,80% of total billed charges,131.3,65,,105.04,percent of total billed charges,65% of total billed charges,72.05,35.67,,57.64,percent of total billed charges,35.67% of total billed charges,58.58,181.8,
HYCOTUSS 5CC SYRUP,2504625,CDM,637,RC,,,outpatient,,,7,2.80,,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.39,77,,4.31,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,5.74,82,,4.592,percent of total billed charges,82% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.25,75,,4.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.03,29,,1.624,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4.69,67,,3.752,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,4.55,65,,3.64,percent of total billed charges,65% of total billed charges,2.5,35.67,,2,percent of total billed charges,35.67% of total billed charges,2.03,6.3,
HYDREA CAPS 500 MG,2504650,CDM,637,RC,,,outpatient,,,9,3.60,,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,6.93,77,,5.54,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,7.38,82,,5.904,percent of total billed charges,82% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,8.1,90,,6.48,percent of total billed charges,90% of total billed charges,7.2,80,,5.76,percent of total billed charges,80% of total billed charges,8.1,90,,6.48,percent of total billed charges,90% of total billed charges,6.75,75,,5.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.61,29,,2.088,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,6.03,67,,4.824,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,7.2,80,,5.76,percent of total billed charges,80% of total billed charges,5.85,65,,4.68,percent of total billed charges,65% of total billed charges,3.21,35.67,,2.568,percent of total billed charges,35.67% of total billed charges,2.61,8.1,
HYDROXYUREA 500 MG PO,2504656,CDM,637,RC,,,outpatient,,,8,3.20,,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,6.16,77,,4.93,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,6.56,82,,5.248,percent of total billed charges,82% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,7.2,90,,5.76,percent of total billed charges,90% of total billed charges,6.4,80,,5.12,percent of total billed charges,80% of total billed charges,7.2,90,,5.76,percent of total billed charges,90% of total billed charges,6,75,,4.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.32,29,,1.856,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,5.36,67,,4.288,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,6.4,80,,5.12,percent of total billed charges,80% of total billed charges,5.2,65,,4.16,percent of total billed charges,65% of total billed charges,2.85,35.67,,2.28,percent of total billed charges,35.67% of total billed charges,2.32,7.2,
HYDROCOCORTISONE CMPD KIT,2504657,CDM,637,RC,,,outpatient,,,237,94.80,,201.45,85,,161.16,percent of total billed charges,85% of total billed charges,182.49,77,,145.99,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,194.34,82,,155.472,percent of total billed charges,82% of total billed charges,201.45,85,,161.16,percent of total billed charges,85% of total billed charges,201.45,85,,161.16,percent of total billed charges,85% of total billed charges,201.45,85,,161.16,percent of total billed charges,85% of total billed charges,213.3,90,,170.64,percent of total billed charges,90% of total billed charges,189.6,80,,151.68,percent of total billed charges,80% of total billed charges,213.3,90,,170.64,percent of total billed charges,90% of total billed charges,177.75,75,,142.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,68.73,29,,54.984,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,158.79,67,,127.032,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,189.6,80,,151.68,percent of total billed charges,80% of total billed charges,154.05,65,,123.24,percent of total billed charges,65% of total billed charges,84.54,35.67,,67.632,percent of total billed charges,35.67% of total billed charges,68.73,213.3,
HYDROCORTISONE 1% CREAM PACKET,2504658,CDM,637,RC,,,outpatient,,,18,7.20,,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,13.86,77,,11.09,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,14.76,82,,11.808,percent of total billed charges,82% of total billed charges,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,16.2,90,,12.96,percent of total billed charges,90% of total billed charges,14.4,80,,11.52,percent of total billed charges,80% of total billed charges,16.2,90,,12.96,percent of total billed charges,90% of total billed charges,13.5,75,,10.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,5.22,29,,4.176,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,12.06,67,,9.648,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,14.4,80,,11.52,percent of total billed charges,80% of total billed charges,11.7,65,,9.36,percent of total billed charges,65% of total billed charges,6.42,35.67,,5.136,percent of total billed charges,35.67% of total billed charges,5.22,16.2,
ICAP PLUS TAB,2504777,CDM,637,RC,,,outpatient,,,7,2.80,,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.39,77,,4.31,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,5.74,82,,4.592,percent of total billed charges,82% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.25,75,,4.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.03,29,,1.624,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4.69,67,,3.752,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,4.55,65,,3.64,percent of total billed charges,65% of total billed charges,2.5,35.67,,2,percent of total billed charges,35.67% of total billed charges,2.03,6.3,
IMDUR 30 MG PO,2504821,CDM,637,RC,,,outpatient,,,13,5.20,,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,10.01,77,,8.01,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,10.66,82,,8.528,percent of total billed charges,82% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,11.7,90,,9.36,percent of total billed charges,90% of total billed charges,10.4,80,,8.32,percent of total billed charges,80% of total billed charges,11.7,90,,9.36,percent of total billed charges,90% of total billed charges,9.75,75,,7.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,3.77,29,,3.016,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,8.71,67,,6.968,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,10.4,80,,8.32,percent of total billed charges,80% of total billed charges,8.45,65,,6.76,percent of total billed charges,65% of total billed charges,4.64,35.67,,3.712,percent of total billed charges,35.67% of total billed charges,3.77,11.7,
IMDUR 60 MG TAB,2504822,CDM,637,RC,,,outpatient,,,14,5.60,,11.9,85,,9.52,percent of total billed charges,85% of total billed charges,10.78,77,,8.62,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,11.48,82,,9.184,percent of total billed charges,82% of total billed charges,11.9,85,,9.52,percent of total billed charges,85% of total billed charges,11.9,85,,9.52,percent of total billed charges,85% of total billed charges,11.9,85,,9.52,percent of total billed charges,85% of total billed charges,12.6,90,,10.08,percent of total billed charges,90% of total billed charges,11.2,80,,8.96,percent of total billed charges,80% of total billed charges,12.6,90,,10.08,percent of total billed charges,90% of total billed charges,10.5,75,,8.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,4.06,29,,3.248,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,9.38,67,,7.504,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,11.2,80,,8.96,percent of total billed charges,80% of total billed charges,9.1,65,,7.28,percent of total billed charges,65% of total billed charges,4.99,35.67,,3.992,percent of total billed charges,35.67% of total billed charges,4.06,12.6,
IMODIUM AD LIG. 60 ML BOTTLE,2504845,CDM,637,RC,,,outpatient,,,24,9.60,,20.4,85,,16.32,percent of total billed charges,85% of total billed charges,18.48,77,,14.78,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,19.68,82,,15.744,percent of total billed charges,82% of total billed charges,20.4,85,,16.32,percent of total billed charges,85% of total billed charges,20.4,85,,16.32,percent of total billed charges,85% of total billed charges,20.4,85,,16.32,percent of total billed charges,85% of total billed charges,21.6,90,,17.28,percent of total billed charges,90% of total billed charges,19.2,80,,15.36,percent of total billed charges,80% of total billed charges,21.6,90,,17.28,percent of total billed charges,90% of total billed charges,18,75,,14.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,6.96,29,,5.568,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,16.08,67,,12.864,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,19.2,80,,15.36,percent of total billed charges,80% of total billed charges,15.6,65,,12.48,percent of total billed charges,65% of total billed charges,8.56,35.67,,6.848,percent of total billed charges,35.67% of total billed charges,6.96,21.6,
INDERAL LA 60MG CAP,2504910,CDM,637,RC,,,outpatient,,,48,19.20,,40.8,85,,32.64,percent of total billed charges,85% of total billed charges,36.96,77,,29.57,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,39.36,82,,31.488,percent of total billed charges,82% of total billed charges,40.8,85,,32.64,percent of total billed charges,85% of total billed charges,40.8,85,,32.64,percent of total billed charges,85% of total billed charges,40.8,85,,32.64,percent of total billed charges,85% of total billed charges,43.2,90,,34.56,percent of total billed charges,90% of total billed charges,38.4,80,,30.72,percent of total billed charges,80% of total billed charges,43.2,90,,34.56,percent of total billed charges,90% of total billed charges,36,75,,28.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,13.92,29,,11.136,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,32.16,67,,25.728,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,38.4,80,,30.72,percent of total billed charges,80% of total billed charges,31.2,65,,24.96,percent of total billed charges,65% of total billed charges,17.12,35.67,,13.696,percent of total billed charges,35.67% of total billed charges,13.92,43.2,
INDOCIN 25MG CAP,2504930,CDM,637,RC,,,outpatient,,,7,2.80,,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.39,77,,4.31,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,5.74,82,,4.592,percent of total billed charges,82% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.25,75,,4.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.03,29,,1.624,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4.69,67,,3.752,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,4.55,65,,3.64,percent of total billed charges,65% of total billed charges,2.5,35.67,,2,percent of total billed charges,35.67% of total billed charges,2.03,6.3,
INDOCIN 75 MG SR CAP,2504940,CDM,637,RC,,,outpatient,,,11,4.40,,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,8.47,77,,6.78,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,9.02,82,,7.216,percent of total billed charges,82% of total billed charges,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,9.9,90,,7.92,percent of total billed charges,90% of total billed charges,8.8,80,,7.04,percent of total billed charges,80% of total billed charges,9.9,90,,7.92,percent of total billed charges,90% of total billed charges,8.25,75,,6.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,3.19,29,,2.552,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,7.37,67,,5.896,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,8.8,80,,7.04,percent of total billed charges,80% of total billed charges,7.15,65,,5.72,percent of total billed charges,65% of total billed charges,3.92,35.67,,3.136,percent of total billed charges,35.67% of total billed charges,3.19,9.9,
IOPIDINE .5% 5 ML OPTH SOL.,2505001,CDM,637,RC,,,outpatient,,,374,149.60,,317.9,85,,254.32,percent of total billed charges,85% of total billed charges,287.98,77,,230.38,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,306.68,82,,245.344,percent of total billed charges,82% of total billed charges,317.9,85,,254.32,percent of total billed charges,85% of total billed charges,317.9,85,,254.32,percent of total billed charges,85% of total billed charges,317.9,85,,254.32,percent of total billed charges,85% of total billed charges,336.6,90,,269.28,percent of total billed charges,90% of total billed charges,299.2,80,,239.36,percent of total billed charges,80% of total billed charges,336.6,90,,269.28,percent of total billed charges,90% of total billed charges,280.5,75,,224.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,108.46,29,,86.768,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,250.58,67,,200.464,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,299.2,80,,239.36,percent of total billed charges,80% of total billed charges,243.1,65,,194.48,percent of total billed charges,65% of total billed charges,133.41,35.67,,106.728,percent of total billed charges,35.67% of total billed charges,108.46,336.6,
ISOPTO CARPINE .5% GTTS 15 ML,2505069,CDM,637,RC,,,outpatient,,,128,51.20,,108.8,85,,87.04,percent of total billed charges,85% of total billed charges,98.56,77,,78.85,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,104.96,82,,83.968,percent of total billed charges,82% of total billed charges,108.8,85,,87.04,percent of total billed charges,85% of total billed charges,108.8,85,,87.04,percent of total billed charges,85% of total billed charges,108.8,85,,87.04,percent of total billed charges,85% of total billed charges,115.2,90,,92.16,percent of total billed charges,90% of total billed charges,102.4,80,,81.92,percent of total billed charges,80% of total billed charges,115.2,90,,92.16,percent of total billed charges,90% of total billed charges,96,75,,76.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,37.12,29,,29.696,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,85.76,67,,68.608,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,102.4,80,,81.92,percent of total billed charges,80% of total billed charges,83.2,65,,66.56,percent of total billed charges,65% of total billed charges,45.66,35.67,,36.528,percent of total billed charges,35.67% of total billed charges,37.12,115.2,
ISOPTO CARPINE 2% OPTH SOL.,2505075,CDM,637,RC,,,outpatient,,,305,122.00,,259.25,85,,207.4,percent of total billed charges,85% of total billed charges,234.85,77,,187.88,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,250.1,82,,200.08,percent of total billed charges,82% of total billed charges,259.25,85,,207.4,percent of total billed charges,85% of total billed charges,259.25,85,,207.4,percent of total billed charges,85% of total billed charges,259.25,85,,207.4,percent of total billed charges,85% of total billed charges,274.5,90,,219.6,percent of total billed charges,90% of total billed charges,244,80,,195.2,percent of total billed charges,80% of total billed charges,274.5,90,,219.6,percent of total billed charges,90% of total billed charges,228.75,75,,183,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,88.45,29,,70.76,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,204.35,67,,163.48,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,244,80,,195.2,percent of total billed charges,80% of total billed charges,198.25,65,,158.6,percent of total billed charges,65% of total billed charges,108.79,35.67,,87.032,percent of total billed charges,35.67% of total billed charges,88.45,274.5,
JANUVIA 100 MG TAB,2505118,CDM,637,RC,,,outpatient,,,41,16.40,,34.85,85,,27.88,percent of total billed charges,85% of total billed charges,31.57,77,,25.26,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,33.62,82,,26.896,percent of total billed charges,82% of total billed charges,34.85,85,,27.88,percent of total billed charges,85% of total billed charges,34.85,85,,27.88,percent of total billed charges,85% of total billed charges,34.85,85,,27.88,percent of total billed charges,85% of total billed charges,36.9,90,,29.52,percent of total billed charges,90% of total billed charges,32.8,80,,26.24,percent of total billed charges,80% of total billed charges,36.9,90,,29.52,percent of total billed charges,90% of total billed charges,30.75,75,,24.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,11.89,29,,9.512,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,27.47,67,,21.976,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,32.8,80,,26.24,percent of total billed charges,80% of total billed charges,26.65,65,,21.32,percent of total billed charges,65% of total billed charges,14.62,35.67,,11.696,percent of total billed charges,35.67% of total billed charges,11.89,36.9,
K-DUR 10 MEQ TAB,2505165,CDM,637,RC,,,outpatient,,,7,2.80,,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.39,77,,4.31,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,5.74,82,,4.592,percent of total billed charges,82% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.25,75,,4.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.03,29,,1.624,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4.69,67,,3.752,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,4.55,65,,3.64,percent of total billed charges,65% of total billed charges,2.5,35.67,,2,percent of total billed charges,35.67% of total billed charges,2.03,6.3,
KALETRA TABLET,2505192,CDM,637,RC,,,outpatient,,,31,12.40,,26.35,85,,21.08,percent of total billed charges,85% of total billed charges,23.87,77,,19.1,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,25.42,82,,20.336,percent of total billed charges,82% of total billed charges,26.35,85,,21.08,percent of total billed charges,85% of total billed charges,26.35,85,,21.08,percent of total billed charges,85% of total billed charges,26.35,85,,21.08,percent of total billed charges,85% of total billed charges,27.9,90,,22.32,percent of total billed charges,90% of total billed charges,24.8,80,,19.84,percent of total billed charges,80% of total billed charges,27.9,90,,22.32,percent of total billed charges,90% of total billed charges,23.25,75,,18.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,8.99,29,,7.192,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,20.77,67,,16.616,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,24.8,80,,19.84,percent of total billed charges,80% of total billed charges,20.15,65,,16.12,percent of total billed charges,65% of total billed charges,11.06,35.67,,8.848,percent of total billed charges,35.67% of total billed charges,8.99,27.9,
KAOPECTATE LIQ 10CC,2505215,CDM,637,RC,,,outpatient,,,7,2.80,,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.39,77,,4.31,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,5.74,82,,4.592,percent of total billed charges,82% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.25,75,,4.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.03,29,,1.624,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4.69,67,,3.752,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,4.55,65,,3.64,percent of total billed charges,65% of total billed charges,2.5,35.67,,2,percent of total billed charges,35.67% of total billed charges,2.03,6.3,
KAOPECTATE LIQ 5CC,2505220,CDM,637,RC,,,outpatient,,,6,2.40,,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,4.62,77,,3.7,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,4.92,82,,3.936,percent of total billed charges,82% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,5.4,90,,4.32,percent of total billed charges,90% of total billed charges,4.8,80,,3.84,percent of total billed charges,80% of total billed charges,5.4,90,,4.32,percent of total billed charges,90% of total billed charges,4.5,75,,3.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,1.74,29,,1.392,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4.02,67,,3.216,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,4.8,80,,3.84,percent of total billed charges,80% of total billed charges,3.9,65,,3.12,percent of total billed charges,65% of total billed charges,2.14,35.67,,1.712,percent of total billed charges,35.67% of total billed charges,1.74,5.4,
KAYEXALATE ENEMA,2505226,CDM,637,RC,,,outpatient,,,74,29.60,,62.9,85,,50.32,percent of total billed charges,85% of total billed charges,56.98,77,,45.58,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,60.68,82,,48.544,percent of total billed charges,82% of total billed charges,62.9,85,,50.32,percent of total billed charges,85% of total billed charges,62.9,85,,50.32,percent of total billed charges,85% of total billed charges,62.9,85,,50.32,percent of total billed charges,85% of total billed charges,66.6,90,,53.28,percent of total billed charges,90% of total billed charges,59.2,80,,47.36,percent of total billed charges,80% of total billed charges,66.6,90,,53.28,percent of total billed charges,90% of total billed charges,55.5,75,,44.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,21.46,29,,17.168,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,49.58,67,,39.664,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,59.2,80,,47.36,percent of total billed charges,80% of total billed charges,48.1,65,,38.48,percent of total billed charges,65% of total billed charges,26.4,35.67,,21.12,percent of total billed charges,35.67% of total billed charges,21.46,66.6,
KENALOG CREAM,2505295,CDM,637,RC,,,outpatient,,,30,12.00,,25.5,85,,20.4,percent of total billed charges,85% of total billed charges,23.1,77,,18.48,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,24.6,82,,19.68,percent of total billed charges,82% of total billed charges,25.5,85,,20.4,percent of total billed charges,85% of total billed charges,25.5,85,,20.4,percent of total billed charges,85% of total billed charges,25.5,85,,20.4,percent of total billed charges,85% of total billed charges,27,90,,21.6,percent of total billed charges,90% of total billed charges,24,80,,19.2,percent of total billed charges,80% of total billed charges,27,90,,21.6,percent of total billed charges,90% of total billed charges,22.5,75,,18,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,8.7,29,,6.96,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,20.1,67,,16.08,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,24,80,,19.2,percent of total billed charges,80% of total billed charges,19.5,65,,15.6,percent of total billed charges,65% of total billed charges,10.7,35.67,,8.56,percent of total billed charges,35.67% of total billed charges,8.7,27,
KENALOG IN ORABASE 5 GM,2505310,CDM,637,RC,,,outpatient,,,500,200.00,,425,85,,340,percent of total billed charges,85% of total billed charges,385,77,,308,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,410,82,,328,percent of total billed charges,82% of total billed charges,425,85,,340,percent of total billed charges,85% of total billed charges,425,85,,340,percent of total billed charges,85% of total billed charges,425,85,,340,percent of total billed charges,85% of total billed charges,450,90,,360,percent of total billed charges,90% of total billed charges,400,80,,320,percent of total billed charges,80% of total billed charges,450,90,,360,percent of total billed charges,90% of total billed charges,375,75,,300,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,145,29,,116,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,335,67,,268,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,400,80,,320,percent of total billed charges,80% of total billed charges,325,65,,260,percent of total billed charges,65% of total billed charges,178.35,35.67,,142.68,percent of total billed charges,35.67% of total billed charges,145,450,
KEPPRA 100 MG/1ML 60 ML BOTTLE,2505323,CDM,637,RC,,,outpatient,,,211,84.40,,179.35,85,,143.48,percent of total billed charges,85% of total billed charges,162.47,77,,129.98,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,173.02,82,,138.416,percent of total billed charges,82% of total billed charges,179.35,85,,143.48,percent of total billed charges,85% of total billed charges,179.35,85,,143.48,percent of total billed charges,85% of total billed charges,179.35,85,,143.48,percent of total billed charges,85% of total billed charges,189.9,90,,151.92,percent of total billed charges,90% of total billed charges,168.8,80,,135.04,percent of total billed charges,80% of total billed charges,189.9,90,,151.92,percent of total billed charges,90% of total billed charges,158.25,75,,126.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,61.19,29,,48.952,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,141.37,67,,113.096,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,168.8,80,,135.04,percent of total billed charges,80% of total billed charges,137.15,65,,109.72,percent of total billed charges,65% of total billed charges,75.26,35.67,,60.208,percent of total billed charges,35.67% of total billed charges,61.19,189.9,
KLONOPIN 1MG TAB,2505340,CDM,637,RC,,,outpatient,,,8,3.20,,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,6.16,77,,4.93,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,6.56,82,,5.248,percent of total billed charges,82% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,7.2,90,,5.76,percent of total billed charges,90% of total billed charges,6.4,80,,5.12,percent of total billed charges,80% of total billed charges,7.2,90,,5.76,percent of total billed charges,90% of total billed charges,6,75,,4.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.32,29,,1.856,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,5.36,67,,4.288,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,6.4,80,,5.12,percent of total billed charges,80% of total billed charges,5.2,65,,4.16,percent of total billed charges,65% of total billed charges,2.85,35.67,,2.28,percent of total billed charges,35.67% of total billed charges,2.32,7.2,
KWELL (LINDANE) LOTION,2505365,CDM,637,RC,,,outpatient,,,373,149.20,,317.05,85,,253.64,percent of total billed charges,85% of total billed charges,287.21,77,,229.77,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,305.86,82,,244.688,percent of total billed charges,82% of total billed charges,317.05,85,,253.64,percent of total billed charges,85% of total billed charges,317.05,85,,253.64,percent of total billed charges,85% of total billed charges,317.05,85,,253.64,percent of total billed charges,85% of total billed charges,335.7,90,,268.56,percent of total billed charges,90% of total billed charges,298.4,80,,238.72,percent of total billed charges,80% of total billed charges,335.7,90,,268.56,percent of total billed charges,90% of total billed charges,279.75,75,,223.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,108.17,29,,86.536,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,249.91,67,,199.928,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,298.4,80,,238.72,percent of total billed charges,80% of total billed charges,242.45,65,,193.96,percent of total billed charges,65% of total billed charges,133.05,35.67,,106.44,percent of total billed charges,35.67% of total billed charges,108.17,335.7,
LAMICTAL 100 MG PO,2505407,CDM,637,RC,,,outpatient,,,30,12.00,,25.5,85,,20.4,percent of total billed charges,85% of total billed charges,23.1,77,,18.48,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,24.6,82,,19.68,percent of total billed charges,82% of total billed charges,25.5,85,,20.4,percent of total billed charges,85% of total billed charges,25.5,85,,20.4,percent of total billed charges,85% of total billed charges,25.5,85,,20.4,percent of total billed charges,85% of total billed charges,27,90,,21.6,percent of total billed charges,90% of total billed charges,24,80,,19.2,percent of total billed charges,80% of total billed charges,27,90,,21.6,percent of total billed charges,90% of total billed charges,22.5,75,,18,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,8.7,29,,6.96,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,20.1,67,,16.08,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,24,80,,19.2,percent of total billed charges,80% of total billed charges,19.5,65,,15.6,percent of total billed charges,65% of total billed charges,10.7,35.67,,8.56,percent of total billed charges,35.67% of total billed charges,8.7,27,
LAMISIL TAB,2505411,CDM,637,RC,,,outpatient,,,91,36.40,,77.35,85,,61.88,percent of total billed charges,85% of total billed charges,70.07,77,,56.06,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,74.62,82,,59.696,percent of total billed charges,82% of total billed charges,77.35,85,,61.88,percent of total billed charges,85% of total billed charges,77.35,85,,61.88,percent of total billed charges,85% of total billed charges,77.35,85,,61.88,percent of total billed charges,85% of total billed charges,81.9,90,,65.52,percent of total billed charges,90% of total billed charges,72.8,80,,58.24,percent of total billed charges,80% of total billed charges,81.9,90,,65.52,percent of total billed charges,90% of total billed charges,68.25,75,,54.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,26.39,29,,21.112,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,60.97,67,,48.776,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,72.8,80,,58.24,percent of total billed charges,80% of total billed charges,59.15,65,,47.32,percent of total billed charges,65% of total billed charges,32.46,35.67,,25.968,percent of total billed charges,35.67% of total billed charges,26.39,81.9,
LAMISIL 1% 12 GRAM TUBE,2505413,CDM,637,RC,,,outpatient,,,40,16.00,,34,85,,27.2,percent of total billed charges,85% of total billed charges,30.8,77,,24.64,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,32.8,82,,26.24,percent of total billed charges,82% of total billed charges,34,85,,27.2,percent of total billed charges,85% of total billed charges,34,85,,27.2,percent of total billed charges,85% of total billed charges,34,85,,27.2,percent of total billed charges,85% of total billed charges,36,90,,28.8,percent of total billed charges,90% of total billed charges,32,80,,25.6,percent of total billed charges,80% of total billed charges,36,90,,28.8,percent of total billed charges,90% of total billed charges,30,75,,24,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,11.6,29,,9.28,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,26.8,67,,21.44,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,32,80,,25.6,percent of total billed charges,80% of total billed charges,26,65,,20.8,percent of total billed charges,65% of total billed charges,14.27,35.67,,11.416,percent of total billed charges,35.67% of total billed charges,11.6,36,
LAMISIL 1% 30 GR TUBE,2505414,CDM,637,RC,,,outpatient,,,48,19.20,,40.8,85,,32.64,percent of total billed charges,85% of total billed charges,36.96,77,,29.57,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,39.36,82,,31.488,percent of total billed charges,82% of total billed charges,40.8,85,,32.64,percent of total billed charges,85% of total billed charges,40.8,85,,32.64,percent of total billed charges,85% of total billed charges,40.8,85,,32.64,percent of total billed charges,85% of total billed charges,43.2,90,,34.56,percent of total billed charges,90% of total billed charges,38.4,80,,30.72,percent of total billed charges,80% of total billed charges,43.2,90,,34.56,percent of total billed charges,90% of total billed charges,36,75,,28.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,13.92,29,,11.136,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,32.16,67,,25.728,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,38.4,80,,30.72,percent of total billed charges,80% of total billed charges,31.2,65,,24.96,percent of total billed charges,65% of total billed charges,17.12,35.67,,13.696,percent of total billed charges,35.67% of total billed charges,13.92,43.2,
LANOXIN ANY STRENGTH TAB,2505470,CDM,637,RC,,,outpatient,,,6,2.40,,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,4.62,77,,3.7,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,4.92,82,,3.936,percent of total billed charges,82% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,5.4,90,,4.32,percent of total billed charges,90% of total billed charges,4.8,80,,3.84,percent of total billed charges,80% of total billed charges,5.4,90,,4.32,percent of total billed charges,90% of total billed charges,4.5,75,,3.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,1.74,29,,1.392,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4.02,67,,3.216,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,4.8,80,,3.84,percent of total billed charges,80% of total billed charges,3.9,65,,3.12,percent of total billed charges,65% of total billed charges,2.14,35.67,,1.712,percent of total billed charges,35.67% of total billed charges,1.74,5.4,
LANTISEPTIC OINT PER TUBE,2505476,CDM,637,RC,,,outpatient,,,16,6.40,,13.6,85,,10.88,percent of total billed charges,85% of total billed charges,12.32,77,,9.86,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,13.12,82,,10.496,percent of total billed charges,82% of total billed charges,13.6,85,,10.88,percent of total billed charges,85% of total billed charges,13.6,85,,10.88,percent of total billed charges,85% of total billed charges,13.6,85,,10.88,percent of total billed charges,85% of total billed charges,14.4,90,,11.52,percent of total billed charges,90% of total billed charges,12.8,80,,10.24,percent of total billed charges,80% of total billed charges,14.4,90,,11.52,percent of total billed charges,90% of total billed charges,12,75,,9.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,4.64,29,,3.712,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,10.72,67,,8.576,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,12.8,80,,10.24,percent of total billed charges,80% of total billed charges,10.4,65,,8.32,percent of total billed charges,65% of total billed charges,5.71,35.67,,4.568,percent of total billed charges,35.67% of total billed charges,4.64,14.4,
JANUVIA 100 MG TAB,2505518,CDM,637,RC,,,outpatient,,,24,9.60,,20.4,85,,16.32,percent of total billed charges,85% of total billed charges,18.48,77,,14.78,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,19.68,82,,15.744,percent of total billed charges,82% of total billed charges,20.4,85,,16.32,percent of total billed charges,85% of total billed charges,20.4,85,,16.32,percent of total billed charges,85% of total billed charges,20.4,85,,16.32,percent of total billed charges,85% of total billed charges,21.6,90,,17.28,percent of total billed charges,90% of total billed charges,19.2,80,,15.36,percent of total billed charges,80% of total billed charges,21.6,90,,17.28,percent of total billed charges,90% of total billed charges,18,75,,14.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,6.96,29,,5.568,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,16.08,67,,12.864,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,19.2,80,,15.36,percent of total billed charges,80% of total billed charges,15.6,65,,12.48,percent of total billed charges,65% of total billed charges,8.56,35.67,,6.848,percent of total billed charges,35.67% of total billed charges,6.96,21.6,
LASIX LIQ. 60MG/CC,2505550,CDM,637,RC,,,outpatient,,,41,16.40,,34.85,85,,27.88,percent of total billed charges,85% of total billed charges,31.57,77,,25.26,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,33.62,82,,26.896,percent of total billed charges,82% of total billed charges,34.85,85,,27.88,percent of total billed charges,85% of total billed charges,34.85,85,,27.88,percent of total billed charges,85% of total billed charges,34.85,85,,27.88,percent of total billed charges,85% of total billed charges,36.9,90,,29.52,percent of total billed charges,90% of total billed charges,32.8,80,,26.24,percent of total billed charges,80% of total billed charges,36.9,90,,29.52,percent of total billed charges,90% of total billed charges,30.75,75,,24.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,11.89,29,,9.512,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,27.47,67,,21.976,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,32.8,80,,26.24,percent of total billed charges,80% of total billed charges,26.65,65,,21.32,percent of total billed charges,65% of total billed charges,14.62,35.67,,11.696,percent of total billed charges,35.67% of total billed charges,11.89,36.9,
LESCOL 20 MG CAP,2505571,CDM,637,RC,,,outpatient,,,14,5.60,,11.9,85,,9.52,percent of total billed charges,85% of total billed charges,10.78,77,,8.62,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,11.48,82,,9.184,percent of total billed charges,82% of total billed charges,11.9,85,,9.52,percent of total billed charges,85% of total billed charges,11.9,85,,9.52,percent of total billed charges,85% of total billed charges,11.9,85,,9.52,percent of total billed charges,85% of total billed charges,12.6,90,,10.08,percent of total billed charges,90% of total billed charges,11.2,80,,8.96,percent of total billed charges,80% of total billed charges,12.6,90,,10.08,percent of total billed charges,90% of total billed charges,10.5,75,,8.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,4.06,29,,3.248,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,9.38,67,,7.504,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,11.2,80,,8.96,percent of total billed charges,80% of total billed charges,9.1,65,,7.28,percent of total billed charges,65% of total billed charges,4.99,35.67,,3.992,percent of total billed charges,35.67% of total billed charges,4.06,12.6,
LEVSIN PB DROPS,2505595,CDM,637,RC,,,outpatient,,,154,61.60,,130.9,85,,104.72,percent of total billed charges,85% of total billed charges,118.58,77,,94.86,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,126.28,82,,101.024,percent of total billed charges,82% of total billed charges,130.9,85,,104.72,percent of total billed charges,85% of total billed charges,130.9,85,,104.72,percent of total billed charges,85% of total billed charges,130.9,85,,104.72,percent of total billed charges,85% of total billed charges,138.6,90,,110.88,percent of total billed charges,90% of total billed charges,123.2,80,,98.56,percent of total billed charges,80% of total billed charges,138.6,90,,110.88,percent of total billed charges,90% of total billed charges,115.5,75,,92.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,44.66,29,,35.728,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,103.18,67,,82.544,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,123.2,80,,98.56,percent of total billed charges,80% of total billed charges,100.1,65,,80.08,percent of total billed charges,65% of total billed charges,54.93,35.67,,43.944,percent of total billed charges,35.67% of total billed charges,44.66,138.6,
LEVSIN PB DROPS (ER ONLY),2505596,CDM,637,RC,,,outpatient,,,9,3.60,,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,6.93,77,,5.54,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,7.38,82,,5.904,percent of total billed charges,82% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,8.1,90,,6.48,percent of total billed charges,90% of total billed charges,7.2,80,,5.76,percent of total billed charges,80% of total billed charges,8.1,90,,6.48,percent of total billed charges,90% of total billed charges,6.75,75,,5.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.61,29,,2.088,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,6.03,67,,4.824,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,7.2,80,,5.76,percent of total billed charges,80% of total billed charges,5.85,65,,4.68,percent of total billed charges,65% of total billed charges,3.21,35.67,,2.568,percent of total billed charges,35.67% of total billed charges,2.61,8.1,
LEXAPRO 10 MG CAP,2505602,CDM,637,RC,,,outpatient,,,25,10.00,,21.25,85,,17,percent of total billed charges,85% of total billed charges,19.25,77,,15.4,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,20.5,82,,16.4,percent of total billed charges,82% of total billed charges,21.25,85,,17,percent of total billed charges,85% of total billed charges,21.25,85,,17,percent of total billed charges,85% of total billed charges,21.25,85,,17,percent of total billed charges,85% of total billed charges,22.5,90,,18,percent of total billed charges,90% of total billed charges,20,80,,16,percent of total billed charges,80% of total billed charges,22.5,90,,18,percent of total billed charges,90% of total billed charges,18.75,75,,15,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,7.25,29,,5.8,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,16.75,67,,13.4,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,20,80,,16,percent of total billed charges,80% of total billed charges,16.25,65,,13,percent of total billed charges,65% of total billed charges,8.92,35.67,,7.136,percent of total billed charges,35.67% of total billed charges,7.25,22.5,
LEXAPRO 20 MG TAB,2505603,CDM,637,RC,,,outpatient,,,15,6.00,,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,11.55,77,,9.24,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,12.3,82,,9.84,percent of total billed charges,82% of total billed charges,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,13.5,90,,10.8,percent of total billed charges,90% of total billed charges,12,80,,9.6,percent of total billed charges,80% of total billed charges,13.5,90,,10.8,percent of total billed charges,90% of total billed charges,11.25,75,,9,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,4.35,29,,3.48,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,10.05,67,,8.04,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,12,80,,9.6,percent of total billed charges,80% of total billed charges,9.75,65,,7.8,percent of total billed charges,65% of total billed charges,5.35,35.67,,4.28,percent of total billed charges,35.67% of total billed charges,4.35,13.5,
LIBRAX CAPS,2505605,CDM,637,RC,,,outpatient,,,42,16.80,,35.7,85,,28.56,percent of total billed charges,85% of total billed charges,32.34,77,,25.87,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,34.44,82,,27.552,percent of total billed charges,82% of total billed charges,35.7,85,,28.56,percent of total billed charges,85% of total billed charges,35.7,85,,28.56,percent of total billed charges,85% of total billed charges,35.7,85,,28.56,percent of total billed charges,85% of total billed charges,37.8,90,,30.24,percent of total billed charges,90% of total billed charges,33.6,80,,26.88,percent of total billed charges,80% of total billed charges,37.8,90,,30.24,percent of total billed charges,90% of total billed charges,31.5,75,,25.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,12.18,29,,9.744,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,28.14,67,,22.512,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,33.6,80,,26.88,percent of total billed charges,80% of total billed charges,27.3,65,,21.84,percent of total billed charges,65% of total billed charges,14.98,35.67,,11.984,percent of total billed charges,35.67% of total billed charges,12.18,37.8,
LIBRIUM 50MG CAP,2505640,CDM,637,RC,,,outpatient,,,12,4.80,,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,9.24,77,,7.39,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,9.84,82,,7.872,percent of total billed charges,82% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,10.8,90,,8.64,percent of total billed charges,90% of total billed charges,9.6,80,,7.68,percent of total billed charges,80% of total billed charges,10.8,90,,8.64,percent of total billed charges,90% of total billed charges,9,75,,7.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,3.48,29,,2.784,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,8.04,67,,6.432,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,9.6,80,,7.68,percent of total billed charges,80% of total billed charges,7.8,65,,6.24,percent of total billed charges,65% of total billed charges,4.28,35.67,,3.424,percent of total billed charges,35.67% of total billed charges,3.48,10.8,
LIDOCAINE OINTMENT 5% TOPICAL,2505658,CDM,637,RC,,,outpatient,,,29,11.60,,24.65,85,,19.72,percent of total billed charges,85% of total billed charges,22.33,77,,17.86,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,23.78,82,,19.024,percent of total billed charges,82% of total billed charges,24.65,85,,19.72,percent of total billed charges,85% of total billed charges,24.65,85,,19.72,percent of total billed charges,85% of total billed charges,24.65,85,,19.72,percent of total billed charges,85% of total billed charges,26.1,90,,20.88,percent of total billed charges,90% of total billed charges,23.2,80,,18.56,percent of total billed charges,80% of total billed charges,26.1,90,,20.88,percent of total billed charges,90% of total billed charges,21.75,75,,17.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,8.41,29,,6.728,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,19.43,67,,15.544,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,23.2,80,,18.56,percent of total billed charges,80% of total billed charges,18.85,65,,15.08,percent of total billed charges,65% of total billed charges,10.34,35.67,,8.272,percent of total billed charges,35.67% of total billed charges,8.41,26.1,
LIDEX 0.05% CREAM 60 GRAM TUBE,2505661,CDM,637,RC,,,outpatient,,,357,142.80,,303.45,85,,242.76,percent of total billed charges,85% of total billed charges,274.89,77,,219.91,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,292.74,82,,234.192,percent of total billed charges,82% of total billed charges,303.45,85,,242.76,percent of total billed charges,85% of total billed charges,303.45,85,,242.76,percent of total billed charges,85% of total billed charges,303.45,85,,242.76,percent of total billed charges,85% of total billed charges,321.3,90,,257.04,percent of total billed charges,90% of total billed charges,285.6,80,,228.48,percent of total billed charges,80% of total billed charges,321.3,90,,257.04,percent of total billed charges,90% of total billed charges,267.75,75,,214.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,103.53,29,,82.824,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,239.19,67,,191.352,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,285.6,80,,228.48,percent of total billed charges,80% of total billed charges,232.05,65,,185.64,percent of total billed charges,65% of total billed charges,127.34,35.67,,101.872,percent of total billed charges,35.67% of total billed charges,103.53,321.3,
LIPITOR 20 MG PO,2505708,CDM,637,RC,,,outpatient,,,34,13.60,,28.9,85,,23.12,percent of total billed charges,85% of total billed charges,26.18,77,,20.94,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,27.88,82,,22.304,percent of total billed charges,82% of total billed charges,28.9,85,,23.12,percent of total billed charges,85% of total billed charges,28.9,85,,23.12,percent of total billed charges,85% of total billed charges,28.9,85,,23.12,percent of total billed charges,85% of total billed charges,30.6,90,,24.48,percent of total billed charges,90% of total billed charges,27.2,80,,21.76,percent of total billed charges,80% of total billed charges,30.6,90,,24.48,percent of total billed charges,90% of total billed charges,25.5,75,,20.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,9.86,29,,7.888,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,22.78,67,,18.224,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,27.2,80,,21.76,percent of total billed charges,80% of total billed charges,22.1,65,,17.68,percent of total billed charges,65% of total billed charges,12.13,35.67,,9.704,percent of total billed charges,35.67% of total billed charges,9.86,30.6,
LIPITOR 10 MG TAB,2505709,CDM,637,RC,,,outpatient,,,25,10.00,,21.25,85,,17,percent of total billed charges,85% of total billed charges,19.25,77,,15.4,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,20.5,82,,16.4,percent of total billed charges,82% of total billed charges,21.25,85,,17,percent of total billed charges,85% of total billed charges,21.25,85,,17,percent of total billed charges,85% of total billed charges,21.25,85,,17,percent of total billed charges,85% of total billed charges,22.5,90,,18,percent of total billed charges,90% of total billed charges,20,80,,16,percent of total billed charges,80% of total billed charges,22.5,90,,18,percent of total billed charges,90% of total billed charges,18.75,75,,15,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,7.25,29,,5.8,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,16.75,67,,13.4,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,20,80,,16,percent of total billed charges,80% of total billed charges,16.25,65,,13,percent of total billed charges,65% of total billed charges,8.92,35.67,,7.136,percent of total billed charges,35.67% of total billed charges,7.25,22.5,
LOPID 600 MG/TAB,2505755,CDM,637,RC,,,outpatient,,,18,7.20,,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,13.86,77,,11.09,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,14.76,82,,11.808,percent of total billed charges,82% of total billed charges,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,16.2,90,,12.96,percent of total billed charges,90% of total billed charges,14.4,80,,11.52,percent of total billed charges,80% of total billed charges,16.2,90,,12.96,percent of total billed charges,90% of total billed charges,13.5,75,,10.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,5.22,29,,4.176,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,12.06,67,,9.648,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,14.4,80,,11.52,percent of total billed charges,80% of total billed charges,11.7,65,,9.36,percent of total billed charges,65% of total billed charges,6.42,35.67,,5.136,percent of total billed charges,35.67% of total billed charges,5.22,16.2,
LOPRESSOR 50 MG TAB,2505785,CDM,637,RC,,,outpatient,,,7,2.80,,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.39,77,,4.31,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,5.74,82,,4.592,percent of total billed charges,82% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.25,75,,4.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.03,29,,1.624,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4.69,67,,3.752,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,4.55,65,,3.64,percent of total billed charges,65% of total billed charges,2.5,35.67,,2,percent of total billed charges,35.67% of total billed charges,2.03,6.3,
LORTAB 5 TAB,2505820,CDM,637,RC,,,outpatient,,,7,2.80,,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.39,77,,4.31,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,5.74,82,,4.592,percent of total billed charges,82% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.25,75,,4.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.03,29,,1.624,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4.69,67,,3.752,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,4.55,65,,3.64,percent of total billed charges,65% of total billed charges,2.5,35.67,,2,percent of total billed charges,35.67% of total billed charges,2.03,6.3,
LOTEMAX 0.5% OPTH SUSP 10ML,2505826,CDM,637,RC,,,outpatient,,,175,70.00,,148.75,85,,119,percent of total billed charges,85% of total billed charges,134.75,77,,107.8,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,143.5,82,,114.8,percent of total billed charges,82% of total billed charges,148.75,85,,119,percent of total billed charges,85% of total billed charges,148.75,85,,119,percent of total billed charges,85% of total billed charges,148.75,85,,119,percent of total billed charges,85% of total billed charges,157.5,90,,126,percent of total billed charges,90% of total billed charges,140,80,,112,percent of total billed charges,80% of total billed charges,157.5,90,,126,percent of total billed charges,90% of total billed charges,131.25,75,,105,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,50.75,29,,40.6,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,117.25,67,,93.8,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,140,80,,112,percent of total billed charges,80% of total billed charges,113.75,65,,91,percent of total billed charges,65% of total billed charges,62.42,35.67,,49.936,percent of total billed charges,35.67% of total billed charges,50.75,157.5,
LOTENSIN 20MG TAB,2505840,CDM,637,RC,,,outpatient,,,13,5.20,,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,10.01,77,,8.01,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,10.66,82,,8.528,percent of total billed charges,82% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,11.7,90,,9.36,percent of total billed charges,90% of total billed charges,10.4,80,,8.32,percent of total billed charges,80% of total billed charges,11.7,90,,9.36,percent of total billed charges,90% of total billed charges,9.75,75,,7.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,3.77,29,,3.016,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,8.71,67,,6.968,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,10.4,80,,8.32,percent of total billed charges,80% of total billed charges,8.45,65,,6.76,percent of total billed charges,65% of total billed charges,4.64,35.67,,3.712,percent of total billed charges,35.67% of total billed charges,3.77,11.7,
LOTREL 10/20 CAP,2505844,CDM,637,RC,,,outpatient,,,28,11.20,,23.8,85,,19.04,percent of total billed charges,85% of total billed charges,21.56,77,,17.25,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,22.96,82,,18.368,percent of total billed charges,82% of total billed charges,23.8,85,,19.04,percent of total billed charges,85% of total billed charges,23.8,85,,19.04,percent of total billed charges,85% of total billed charges,23.8,85,,19.04,percent of total billed charges,85% of total billed charges,25.2,90,,20.16,percent of total billed charges,90% of total billed charges,22.4,80,,17.92,percent of total billed charges,80% of total billed charges,25.2,90,,20.16,percent of total billed charges,90% of total billed charges,21,75,,16.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,8.12,29,,6.496,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,18.76,67,,15.008,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,22.4,80,,17.92,percent of total billed charges,80% of total billed charges,18.2,65,,14.56,percent of total billed charges,65% of total billed charges,9.99,35.67,,7.992,percent of total billed charges,35.67% of total billed charges,8.12,25.2,
LOTREL 5/20 PO,2505845,CDM,637,RC,,,outpatient,,,24,9.60,,20.4,85,,16.32,percent of total billed charges,85% of total billed charges,18.48,77,,14.78,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,19.68,82,,15.744,percent of total billed charges,82% of total billed charges,20.4,85,,16.32,percent of total billed charges,85% of total billed charges,20.4,85,,16.32,percent of total billed charges,85% of total billed charges,20.4,85,,16.32,percent of total billed charges,85% of total billed charges,21.6,90,,17.28,percent of total billed charges,90% of total billed charges,19.2,80,,15.36,percent of total billed charges,80% of total billed charges,21.6,90,,17.28,percent of total billed charges,90% of total billed charges,18,75,,14.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,6.96,29,,5.568,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,16.08,67,,12.864,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,19.2,80,,15.36,percent of total billed charges,80% of total billed charges,15.6,65,,12.48,percent of total billed charges,65% of total billed charges,8.56,35.67,,6.848,percent of total billed charges,35.67% of total billed charges,6.96,21.6,
LOTREL 5/10 MG PO CAP,2505847,CDM,637,RC,,,outpatient,,,23,9.20,,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,17.71,77,,14.17,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,18.86,82,,15.088,percent of total billed charges,82% of total billed charges,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,20.7,90,,16.56,percent of total billed charges,90% of total billed charges,18.4,80,,14.72,percent of total billed charges,80% of total billed charges,20.7,90,,16.56,percent of total billed charges,90% of total billed charges,17.25,75,,13.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,6.67,29,,5.336,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,15.41,67,,12.328,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,18.4,80,,14.72,percent of total billed charges,80% of total billed charges,14.95,65,,11.96,percent of total billed charges,65% of total billed charges,8.2,35.67,,6.56,percent of total billed charges,35.67% of total billed charges,6.67,20.7,
LOTRIMIN CREAM 1% 45 GRAM TUBE,2505851,CDM,637,RC,,,outpatient,,,41,16.40,,34.85,85,,27.88,percent of total billed charges,85% of total billed charges,31.57,77,,25.26,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,33.62,82,,26.896,percent of total billed charges,82% of total billed charges,34.85,85,,27.88,percent of total billed charges,85% of total billed charges,34.85,85,,27.88,percent of total billed charges,85% of total billed charges,34.85,85,,27.88,percent of total billed charges,85% of total billed charges,36.9,90,,29.52,percent of total billed charges,90% of total billed charges,32.8,80,,26.24,percent of total billed charges,80% of total billed charges,36.9,90,,29.52,percent of total billed charges,90% of total billed charges,30.75,75,,24.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,11.89,29,,9.512,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,27.47,67,,21.976,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,32.8,80,,26.24,percent of total billed charges,80% of total billed charges,26.65,65,,21.32,percent of total billed charges,65% of total billed charges,14.62,35.67,,11.696,percent of total billed charges,35.67% of total billed charges,11.89,36.9,
LOTRISONE CR. 45GM TUBE,2505860,CDM,637,RC,,,outpatient,,,281,112.40,,238.85,85,,191.08,percent of total billed charges,85% of total billed charges,216.37,77,,173.1,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,230.42,82,,184.336,percent of total billed charges,82% of total billed charges,238.85,85,,191.08,percent of total billed charges,85% of total billed charges,238.85,85,,191.08,percent of total billed charges,85% of total billed charges,238.85,85,,191.08,percent of total billed charges,85% of total billed charges,252.9,90,,202.32,percent of total billed charges,90% of total billed charges,224.8,80,,179.84,percent of total billed charges,80% of total billed charges,252.9,90,,202.32,percent of total billed charges,90% of total billed charges,210.75,75,,168.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,81.49,29,,65.192,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,188.27,67,,150.616,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,224.8,80,,179.84,percent of total billed charges,80% of total billed charges,182.65,65,,146.12,percent of total billed charges,65% of total billed charges,100.23,35.67,,80.184,percent of total billed charges,35.67% of total billed charges,81.49,252.9,
LOTENSIN 5 MG TAB,2505869,CDM,637,RC,,,outpatient,,,7,2.80,,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.39,77,,4.31,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,5.74,82,,4.592,percent of total billed charges,82% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.25,75,,4.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.03,29,,1.624,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4.69,67,,3.752,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,4.55,65,,3.64,percent of total billed charges,65% of total billed charges,2.5,35.67,,2,percent of total billed charges,35.67% of total billed charges,2.03,6.3,
LUBRIDERM LOTION 8 OZ,2505890,CDM,637,RC,,,outpatient,,,14,5.60,,11.9,85,,9.52,percent of total billed charges,85% of total billed charges,10.78,77,,8.62,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,11.48,82,,9.184,percent of total billed charges,82% of total billed charges,11.9,85,,9.52,percent of total billed charges,85% of total billed charges,11.9,85,,9.52,percent of total billed charges,85% of total billed charges,11.9,85,,9.52,percent of total billed charges,85% of total billed charges,12.6,90,,10.08,percent of total billed charges,90% of total billed charges,11.2,80,,8.96,percent of total billed charges,80% of total billed charges,12.6,90,,10.08,percent of total billed charges,90% of total billed charges,10.5,75,,8.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,4.06,29,,3.248,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,9.38,67,,7.504,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,11.2,80,,8.96,percent of total billed charges,80% of total billed charges,9.1,65,,7.28,percent of total billed charges,65% of total billed charges,4.99,35.67,,3.992,percent of total billed charges,35.67% of total billed charges,4.06,12.6,
LUGOL'S SOLUTION 60 ML TOP,2505901,CDM,637,RC,,,outpatient,,,18,7.20,,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,13.86,77,,11.09,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,14.76,82,,11.808,percent of total billed charges,82% of total billed charges,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,16.2,90,,12.96,percent of total billed charges,90% of total billed charges,14.4,80,,11.52,percent of total billed charges,80% of total billed charges,16.2,90,,12.96,percent of total billed charges,90% of total billed charges,13.5,75,,10.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,5.22,29,,4.176,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,12.06,67,,9.648,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,14.4,80,,11.52,percent of total billed charges,80% of total billed charges,11.7,65,,9.36,percent of total billed charges,65% of total billed charges,6.42,35.67,,5.136,percent of total billed charges,35.67% of total billed charges,5.22,16.2,
LUMIGAN 0.03% 5ML OPTH SOLUTIO,2505902,CDM,637,RC,,,outpatient,,,381,152.40,,323.85,85,,259.08,percent of total billed charges,85% of total billed charges,293.37,77,,234.7,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,312.42,82,,249.936,percent of total billed charges,82% of total billed charges,323.85,85,,259.08,percent of total billed charges,85% of total billed charges,323.85,85,,259.08,percent of total billed charges,85% of total billed charges,323.85,85,,259.08,percent of total billed charges,85% of total billed charges,342.9,90,,274.32,percent of total billed charges,90% of total billed charges,304.8,80,,243.84,percent of total billed charges,80% of total billed charges,342.9,90,,274.32,percent of total billed charges,90% of total billed charges,285.75,75,,228.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,110.49,29,,88.392,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,255.27,67,,204.216,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,304.8,80,,243.84,percent of total billed charges,80% of total billed charges,247.65,65,,198.12,percent of total billed charges,65% of total billed charges,135.9,35.67,,108.72,percent of total billed charges,35.67% of total billed charges,110.49,342.9,
LUMIGAN 0.3% 2.5 ML OPTH SOL,2505903,CDM,637,RC,,,outpatient,,,353,141.20,,300.05,85,,240.04,percent of total billed charges,85% of total billed charges,271.81,77,,217.45,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,289.46,82,,231.568,percent of total billed charges,82% of total billed charges,300.05,85,,240.04,percent of total billed charges,85% of total billed charges,300.05,85,,240.04,percent of total billed charges,85% of total billed charges,300.05,85,,240.04,percent of total billed charges,85% of total billed charges,317.7,90,,254.16,percent of total billed charges,90% of total billed charges,282.4,80,,225.92,percent of total billed charges,80% of total billed charges,317.7,90,,254.16,percent of total billed charges,90% of total billed charges,264.75,75,,211.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,102.37,29,,81.896,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,236.51,67,,189.208,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,282.4,80,,225.92,percent of total billed charges,80% of total billed charges,229.45,65,,183.56,percent of total billed charges,65% of total billed charges,125.92,35.67,,100.736,percent of total billed charges,35.67% of total billed charges,102.37,317.7,
LUNESTA 3 MG,2505917,CDM,637,RC,,,outpatient,,,17,6.80,,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,13.09,77,,10.47,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,13.94,82,,11.152,percent of total billed charges,82% of total billed charges,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,15.3,90,,12.24,percent of total billed charges,90% of total billed charges,13.6,80,,10.88,percent of total billed charges,80% of total billed charges,15.3,90,,12.24,percent of total billed charges,90% of total billed charges,12.75,75,,10.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,4.93,29,,3.944,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,11.39,67,,9.112,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,13.6,80,,10.88,percent of total billed charges,80% of total billed charges,11.05,65,,8.84,percent of total billed charges,65% of total billed charges,6.06,35.67,,4.848,percent of total billed charges,35.67% of total billed charges,4.93,15.3,
LYRICA 150 MG CAP,2505926,CDM,637,RC,,,outpatient,,,22,8.80,,18.7,85,,14.96,percent of total billed charges,85% of total billed charges,16.94,77,,13.55,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,18.04,82,,14.432,percent of total billed charges,82% of total billed charges,18.7,85,,14.96,percent of total billed charges,85% of total billed charges,18.7,85,,14.96,percent of total billed charges,85% of total billed charges,18.7,85,,14.96,percent of total billed charges,85% of total billed charges,19.8,90,,15.84,percent of total billed charges,90% of total billed charges,17.6,80,,14.08,percent of total billed charges,80% of total billed charges,19.8,90,,15.84,percent of total billed charges,90% of total billed charges,16.5,75,,13.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,6.38,29,,5.104,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,14.74,67,,11.792,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,17.6,80,,14.08,percent of total billed charges,80% of total billed charges,14.3,65,,11.44,percent of total billed charges,65% of total billed charges,7.85,35.67,,6.28,percent of total billed charges,35.67% of total billed charges,6.38,19.8,
MAALOX 30 ML UNIT DOSE CUP,2505939,CDM,637,RC,,,outpatient,,,7,2.80,,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.39,77,,4.31,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,5.74,82,,4.592,percent of total billed charges,82% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.25,75,,4.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.03,29,,1.624,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4.69,67,,3.752,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,4.55,65,,3.64,percent of total billed charges,65% of total billed charges,2.5,35.67,,2,percent of total billed charges,35.67% of total billed charges,2.03,6.3,
MAALOX TC 360 ML PO,2505944,CDM,637,RC,,,outpatient,,,8,3.20,,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,6.16,77,,4.93,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,6.56,82,,5.248,percent of total billed charges,82% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,7.2,90,,5.76,percent of total billed charges,90% of total billed charges,6.4,80,,5.12,percent of total billed charges,80% of total billed charges,7.2,90,,5.76,percent of total billed charges,90% of total billed charges,6,75,,4.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.32,29,,1.856,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,5.36,67,,4.288,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,6.4,80,,5.12,percent of total billed charges,80% of total billed charges,5.2,65,,4.16,percent of total billed charges,65% of total billed charges,2.85,35.67,,2.28,percent of total billed charges,35.67% of total billed charges,2.32,7.2,
MACRODANTIN 100 MG CAP,2505955,CDM,637,RC,,,outpatient,,,12,4.80,,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,9.24,77,,7.39,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,9.84,82,,7.872,percent of total billed charges,82% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,10.8,90,,8.64,percent of total billed charges,90% of total billed charges,9.6,80,,7.68,percent of total billed charges,80% of total billed charges,10.8,90,,8.64,percent of total billed charges,90% of total billed charges,9,75,,7.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,3.48,29,,2.784,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,8.04,67,,6.432,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,9.6,80,,7.68,percent of total billed charges,80% of total billed charges,7.8,65,,6.24,percent of total billed charges,65% of total billed charges,4.28,35.67,,3.424,percent of total billed charges,35.67% of total billed charges,3.48,10.8,
MACRODANTIN 50MG CAP,2505960,CDM,637,RC,,,outpatient,,,12,4.80,,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,9.24,77,,7.39,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,9.84,82,,7.872,percent of total billed charges,82% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,10.8,90,,8.64,percent of total billed charges,90% of total billed charges,9.6,80,,7.68,percent of total billed charges,80% of total billed charges,10.8,90,,8.64,percent of total billed charges,90% of total billed charges,9,75,,7.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,3.48,29,,2.784,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,8.04,67,,6.432,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,9.6,80,,7.68,percent of total billed charges,80% of total billed charges,7.8,65,,6.24,percent of total billed charges,65% of total billed charges,4.28,35.67,,3.424,percent of total billed charges,35.67% of total billed charges,3.48,10.8,
MAG SAL TAB,2505970,CDM,637,RC,,,outpatient,,,7,2.80,,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.39,77,,4.31,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,5.74,82,,4.592,percent of total billed charges,82% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.25,75,,4.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.03,29,,1.624,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4.69,67,,3.752,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,4.55,65,,3.64,percent of total billed charges,65% of total billed charges,2.5,35.67,,2,percent of total billed charges,35.67% of total billed charges,2.03,6.3,
MAXIDEX 0.1% OPTH GTTS 5 ML,2506081,CDM,637,RC,,,outpatient,,,271,108.40,,230.35,85,,184.28,percent of total billed charges,85% of total billed charges,208.67,77,,166.94,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,222.22,82,,177.776,percent of total billed charges,82% of total billed charges,230.35,85,,184.28,percent of total billed charges,85% of total billed charges,230.35,85,,184.28,percent of total billed charges,85% of total billed charges,230.35,85,,184.28,percent of total billed charges,85% of total billed charges,243.9,90,,195.12,percent of total billed charges,90% of total billed charges,216.8,80,,173.44,percent of total billed charges,80% of total billed charges,243.9,90,,195.12,percent of total billed charges,90% of total billed charges,203.25,75,,162.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,78.59,29,,62.872,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,181.57,67,,145.256,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,216.8,80,,173.44,percent of total billed charges,80% of total billed charges,176.15,65,,140.92,percent of total billed charges,65% of total billed charges,96.67,35.67,,77.336,percent of total billed charges,35.67% of total billed charges,78.59,243.9,
MAXALT 10 MG PO,2506082,CDM,637,RC,,,outpatient,,,144,57.60,,122.4,85,,97.92,percent of total billed charges,85% of total billed charges,110.88,77,,88.7,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,118.08,82,,94.464,percent of total billed charges,82% of total billed charges,122.4,85,,97.92,percent of total billed charges,85% of total billed charges,122.4,85,,97.92,percent of total billed charges,85% of total billed charges,122.4,85,,97.92,percent of total billed charges,85% of total billed charges,129.6,90,,103.68,percent of total billed charges,90% of total billed charges,115.2,80,,92.16,percent of total billed charges,80% of total billed charges,129.6,90,,103.68,percent of total billed charges,90% of total billed charges,108,75,,86.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,41.76,29,,33.408,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,96.48,67,,77.184,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,115.2,80,,92.16,percent of total billed charges,80% of total billed charges,93.6,65,,74.88,percent of total billed charges,65% of total billed charges,51.36,35.67,,41.088,percent of total billed charges,35.67% of total billed charges,41.76,129.6,
MAXALT - MLT 5 MG PO,2506084,CDM,637,RC,,,outpatient,,,153,61.20,,130.05,85,,104.04,percent of total billed charges,85% of total billed charges,117.81,77,,94.25,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,125.46,82,,100.368,percent of total billed charges,82% of total billed charges,130.05,85,,104.04,percent of total billed charges,85% of total billed charges,130.05,85,,104.04,percent of total billed charges,85% of total billed charges,130.05,85,,104.04,percent of total billed charges,85% of total billed charges,137.7,90,,110.16,percent of total billed charges,90% of total billed charges,122.4,80,,97.92,percent of total billed charges,80% of total billed charges,137.7,90,,110.16,percent of total billed charges,90% of total billed charges,114.75,75,,91.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,44.37,29,,35.496,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,102.51,67,,82.008,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,122.4,80,,97.92,percent of total billed charges,80% of total billed charges,99.45,65,,79.56,percent of total billed charges,65% of total billed charges,54.58,35.67,,43.664,percent of total billed charges,35.67% of total billed charges,44.37,137.7,
MAXITROL OPTH OINT 3.5 GM,2506085,CDM,637,RC,,,outpatient,,,333,133.20,,283.05,85,,226.44,percent of total billed charges,85% of total billed charges,256.41,77,,205.13,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,273.06,82,,218.448,percent of total billed charges,82% of total billed charges,283.05,85,,226.44,percent of total billed charges,85% of total billed charges,283.05,85,,226.44,percent of total billed charges,85% of total billed charges,283.05,85,,226.44,percent of total billed charges,85% of total billed charges,299.7,90,,239.76,percent of total billed charges,90% of total billed charges,266.4,80,,213.12,percent of total billed charges,80% of total billed charges,299.7,90,,239.76,percent of total billed charges,90% of total billed charges,249.75,75,,199.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,96.57,29,,77.256,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,223.11,67,,178.488,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,266.4,80,,213.12,percent of total billed charges,80% of total billed charges,216.45,65,,173.16,percent of total billed charges,65% of total billed charges,118.78,35.67,,95.024,percent of total billed charges,35.67% of total billed charges,96.57,299.7,
MATULANE 50 MG TAB,2506088,CDM,637,RC,,,outpatient,,,196,78.40,,166.6,85,,133.28,percent of total billed charges,85% of total billed charges,150.92,77,,120.74,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,160.72,82,,128.576,percent of total billed charges,82% of total billed charges,166.6,85,,133.28,percent of total billed charges,85% of total billed charges,166.6,85,,133.28,percent of total billed charges,85% of total billed charges,166.6,85,,133.28,percent of total billed charges,85% of total billed charges,176.4,90,,141.12,percent of total billed charges,90% of total billed charges,156.8,80,,125.44,percent of total billed charges,80% of total billed charges,176.4,90,,141.12,percent of total billed charges,90% of total billed charges,147,75,,117.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,56.84,29,,45.472,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,131.32,67,,105.056,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,156.8,80,,125.44,percent of total billed charges,80% of total billed charges,127.4,65,,101.92,percent of total billed charges,65% of total billed charges,69.91,35.67,,55.928,percent of total billed charges,35.67% of total billed charges,56.84,176.4,
DR MCLEOD MOUTH MIX 15 ML,2506108,CDM,637,RC,,,outpatient,,,20,8.00,,17,85,,13.6,percent of total billed charges,85% of total billed charges,15.4,77,,12.32,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,16.4,82,,13.12,percent of total billed charges,82% of total billed charges,17,85,,13.6,percent of total billed charges,85% of total billed charges,17,85,,13.6,percent of total billed charges,85% of total billed charges,17,85,,13.6,percent of total billed charges,85% of total billed charges,18,90,,14.4,percent of total billed charges,90% of total billed charges,16,80,,12.8,percent of total billed charges,80% of total billed charges,18,90,,14.4,percent of total billed charges,90% of total billed charges,15,75,,12,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,5.8,29,,4.64,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,13.4,67,,10.72,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,16,80,,12.8,percent of total billed charges,80% of total billed charges,13,65,,10.4,percent of total billed charges,65% of total billed charges,7.13,35.67,,5.704,percent of total billed charges,35.67% of total billed charges,5.8,18,
MEGACE SUSP 40 MG/ML 60 ML,2506156,CDM,637,RC,,,outpatient,,,162,64.80,,137.7,85,,110.16,percent of total billed charges,85% of total billed charges,124.74,77,,99.79,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,132.84,82,,106.272,percent of total billed charges,82% of total billed charges,137.7,85,,110.16,percent of total billed charges,85% of total billed charges,137.7,85,,110.16,percent of total billed charges,85% of total billed charges,137.7,85,,110.16,percent of total billed charges,85% of total billed charges,145.8,90,,116.64,percent of total billed charges,90% of total billed charges,129.6,80,,103.68,percent of total billed charges,80% of total billed charges,145.8,90,,116.64,percent of total billed charges,90% of total billed charges,121.5,75,,97.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,46.98,29,,37.584,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,108.54,67,,86.832,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,129.6,80,,103.68,percent of total billed charges,80% of total billed charges,105.3,65,,84.24,percent of total billed charges,65% of total billed charges,57.79,35.67,,46.232,percent of total billed charges,35.67% of total billed charges,46.98,145.8,
MALATONIN 3 MG PO,2506158,CDM,637,RC,,,outpatient,,,7,2.80,,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.39,77,,4.31,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,5.74,82,,4.592,percent of total billed charges,82% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.25,75,,4.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.03,29,,1.624,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4.69,67,,3.752,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,4.55,65,,3.64,percent of total billed charges,65% of total billed charges,2.5,35.67,,2,percent of total billed charges,35.67% of total billed charges,2.03,6.3,
MEGACE ES 625MG/5ML SUSP UDC,2506163,CDM,637,RC,,,outpatient,,,101,40.40,,85.85,85,,68.68,percent of total billed charges,85% of total billed charges,77.77,77,,62.22,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,82.82,82,,66.256,percent of total billed charges,82% of total billed charges,85.85,85,,68.68,percent of total billed charges,85% of total billed charges,85.85,85,,68.68,percent of total billed charges,85% of total billed charges,85.85,85,,68.68,percent of total billed charges,85% of total billed charges,90.9,90,,72.72,percent of total billed charges,90% of total billed charges,80.8,80,,64.64,percent of total billed charges,80% of total billed charges,90.9,90,,72.72,percent of total billed charges,90% of total billed charges,75.75,75,,60.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,29.29,29,,23.432,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,67.67,67,,54.136,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,80.8,80,,64.64,percent of total billed charges,80% of total billed charges,65.65,65,,52.52,percent of total billed charges,65% of total billed charges,36.03,35.67,,28.824,percent of total billed charges,35.67% of total billed charges,29.29,90.9,
MEPHYTON 5 MG PO,2506207,CDM,637,RC,,,outpatient,,,71,28.40,,60.35,85,,48.28,percent of total billed charges,85% of total billed charges,54.67,77,,43.74,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,58.22,82,,46.576,percent of total billed charges,82% of total billed charges,60.35,85,,48.28,percent of total billed charges,85% of total billed charges,60.35,85,,48.28,percent of total billed charges,85% of total billed charges,60.35,85,,48.28,percent of total billed charges,85% of total billed charges,63.9,90,,51.12,percent of total billed charges,90% of total billed charges,56.8,80,,45.44,percent of total billed charges,80% of total billed charges,63.9,90,,51.12,percent of total billed charges,90% of total billed charges,53.25,75,,42.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,20.59,29,,16.472,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,47.57,67,,38.056,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,56.8,80,,45.44,percent of total billed charges,80% of total billed charges,46.15,65,,36.92,percent of total billed charges,65% of total billed charges,25.33,35.67,,20.264,percent of total billed charges,35.67% of total billed charges,20.59,63.9,
METHADONE 10 MG PO,2506222,CDM,637,RC,,,outpatient,,,7,2.80,,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.39,77,,4.31,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,5.74,82,,4.592,percent of total billed charges,82% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.25,75,,4.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.03,29,,1.624,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4.69,67,,3.752,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,4.55,65,,3.64,percent of total billed charges,65% of total billed charges,2.5,35.67,,2,percent of total billed charges,35.67% of total billed charges,2.03,6.3,
METANX TABLET,2506227,CDM,637,RC,,,outpatient,,,9,3.60,,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,6.93,77,,5.54,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,7.38,82,,5.904,percent of total billed charges,82% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,8.1,90,,6.48,percent of total billed charges,90% of total billed charges,7.2,80,,5.76,percent of total billed charges,80% of total billed charges,8.1,90,,6.48,percent of total billed charges,90% of total billed charges,6.75,75,,5.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.61,29,,2.088,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,6.03,67,,4.824,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,7.2,80,,5.76,percent of total billed charges,80% of total billed charges,5.85,65,,4.68,percent of total billed charges,65% of total billed charges,3.21,35.67,,2.568,percent of total billed charges,35.67% of total billed charges,2.61,8.1,
METHOTREXATE TABS 2.5 MG*,2506240,CDM,637,RC,,,outpatient,,,25,10.00,,21.25,85,,17,percent of total billed charges,85% of total billed charges,19.25,77,,15.4,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,20.5,82,,16.4,percent of total billed charges,82% of total billed charges,21.25,85,,17,percent of total billed charges,85% of total billed charges,21.25,85,,17,percent of total billed charges,85% of total billed charges,21.25,85,,17,percent of total billed charges,85% of total billed charges,22.5,90,,18,percent of total billed charges,90% of total billed charges,20,80,,16,percent of total billed charges,80% of total billed charges,22.5,90,,18,percent of total billed charges,90% of total billed charges,18.75,75,,15,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,7.25,29,,5.8,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,16.75,67,,13.4,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,20,80,,16,percent of total billed charges,80% of total billed charges,16.25,65,,13,percent of total billed charges,65% of total billed charges,8.92,35.67,,7.136,percent of total billed charges,35.67% of total billed charges,7.25,22.5,
METROGEL .75% TOPICAL 1 OZ,2506251,CDM,637,RC,,,outpatient,,,374,149.60,,317.9,85,,254.32,percent of total billed charges,85% of total billed charges,287.98,77,,230.38,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,306.68,82,,245.344,percent of total billed charges,82% of total billed charges,317.9,85,,254.32,percent of total billed charges,85% of total billed charges,317.9,85,,254.32,percent of total billed charges,85% of total billed charges,317.9,85,,254.32,percent of total billed charges,85% of total billed charges,336.6,90,,269.28,percent of total billed charges,90% of total billed charges,299.2,80,,239.36,percent of total billed charges,80% of total billed charges,336.6,90,,269.28,percent of total billed charges,90% of total billed charges,280.5,75,,224.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,108.46,29,,86.768,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,250.58,67,,200.464,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,299.2,80,,239.36,percent of total billed charges,80% of total billed charges,243.1,65,,194.48,percent of total billed charges,65% of total billed charges,133.41,35.67,,106.728,percent of total billed charges,35.67% of total billed charges,108.46,336.6,
MEVACOR 20MG TAB,2506255,CDM,637,RC,,,outpatient,,,14,5.60,,11.9,85,,9.52,percent of total billed charges,85% of total billed charges,10.78,77,,8.62,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,11.48,82,,9.184,percent of total billed charges,82% of total billed charges,11.9,85,,9.52,percent of total billed charges,85% of total billed charges,11.9,85,,9.52,percent of total billed charges,85% of total billed charges,11.9,85,,9.52,percent of total billed charges,85% of total billed charges,12.6,90,,10.08,percent of total billed charges,90% of total billed charges,11.2,80,,8.96,percent of total billed charges,80% of total billed charges,12.6,90,,10.08,percent of total billed charges,90% of total billed charges,10.5,75,,8.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,4.06,29,,3.248,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,9.38,67,,7.504,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,11.2,80,,8.96,percent of total billed charges,80% of total billed charges,9.1,65,,7.28,percent of total billed charges,65% of total billed charges,4.99,35.67,,3.992,percent of total billed charges,35.67% of total billed charges,4.06,12.6,
MICRO K 10 MEQ (750MG) CAP,2506270,CDM,637,RC,,,outpatient,,,17,6.80,,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,13.09,77,,10.47,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,13.94,82,,11.152,percent of total billed charges,82% of total billed charges,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,15.3,90,,12.24,percent of total billed charges,90% of total billed charges,13.6,80,,10.88,percent of total billed charges,80% of total billed charges,15.3,90,,12.24,percent of total billed charges,90% of total billed charges,12.75,75,,10.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,4.93,29,,3.944,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,11.39,67,,9.112,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,13.6,80,,10.88,percent of total billed charges,80% of total billed charges,11.05,65,,8.84,percent of total billed charges,65% of total billed charges,6.06,35.67,,4.848,percent of total billed charges,35.67% of total billed charges,4.93,15.3,
MICARDIS 40 MG PO,2506271,CDM,637,RC,,,outpatient,,,22,8.80,,18.7,85,,14.96,percent of total billed charges,85% of total billed charges,16.94,77,,13.55,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,18.04,82,,14.432,percent of total billed charges,82% of total billed charges,18.7,85,,14.96,percent of total billed charges,85% of total billed charges,18.7,85,,14.96,percent of total billed charges,85% of total billed charges,18.7,85,,14.96,percent of total billed charges,85% of total billed charges,19.8,90,,15.84,percent of total billed charges,90% of total billed charges,17.6,80,,14.08,percent of total billed charges,80% of total billed charges,19.8,90,,15.84,percent of total billed charges,90% of total billed charges,16.5,75,,13.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,6.38,29,,5.104,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,14.74,67,,11.792,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,17.6,80,,14.08,percent of total billed charges,80% of total billed charges,14.3,65,,11.44,percent of total billed charges,65% of total billed charges,7.85,35.67,,6.28,percent of total billed charges,35.67% of total billed charges,6.38,19.8,
MICRO-K LS 20 MEQ/PACKET,2506280,CDM,637,RC,,,outpatient,,,7,2.80,,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.39,77,,4.31,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,5.74,82,,4.592,percent of total billed charges,82% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.25,75,,4.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.03,29,,1.624,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4.69,67,,3.752,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,4.55,65,,3.64,percent of total billed charges,65% of total billed charges,2.5,35.67,,2,percent of total billed charges,35.67% of total billed charges,2.03,6.3,
MILK OF MAGNESIA 10CC,2506315,CDM,637,RC,,,outpatient,,,6,2.40,,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,4.62,77,,3.7,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,4.92,82,,3.936,percent of total billed charges,82% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,5.4,90,,4.32,percent of total billed charges,90% of total billed charges,4.8,80,,3.84,percent of total billed charges,80% of total billed charges,5.4,90,,4.32,percent of total billed charges,90% of total billed charges,4.5,75,,3.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,1.74,29,,1.392,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4.02,67,,3.216,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,4.8,80,,3.84,percent of total billed charges,80% of total billed charges,3.9,65,,3.12,percent of total billed charges,65% of total billed charges,2.14,35.67,,1.712,percent of total billed charges,35.67% of total billed charges,1.74,5.4,
MILK OF MAGNESIA 15CC,2506320,CDM,637,RC,,,outpatient,,,6,2.40,,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,4.62,77,,3.7,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,4.92,82,,3.936,percent of total billed charges,82% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,5.4,90,,4.32,percent of total billed charges,90% of total billed charges,4.8,80,,3.84,percent of total billed charges,80% of total billed charges,5.4,90,,4.32,percent of total billed charges,90% of total billed charges,4.5,75,,3.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,1.74,29,,1.392,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4.02,67,,3.216,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,4.8,80,,3.84,percent of total billed charges,80% of total billed charges,3.9,65,,3.12,percent of total billed charges,65% of total billed charges,2.14,35.67,,1.712,percent of total billed charges,35.67% of total billed charges,1.74,5.4,
MILK OF MAGNESIA TAB,2506345,CDM,637,RC,,,outpatient,,,7,2.80,,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.39,77,,4.31,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,5.74,82,,4.592,percent of total billed charges,82% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.25,75,,4.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.03,29,,1.624,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4.69,67,,3.752,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,4.55,65,,3.64,percent of total billed charges,65% of total billed charges,2.5,35.67,,2,percent of total billed charges,35.67% of total billed charges,2.03,6.3,
MINERAL OIL 45CC,2506355,CDM,637,RC,,,outpatient,,,7,2.80,,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.39,77,,4.31,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,5.74,82,,4.592,percent of total billed charges,82% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.25,75,,4.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.03,29,,1.624,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4.69,67,,3.752,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,4.55,65,,3.64,percent of total billed charges,65% of total billed charges,2.5,35.67,,2,percent of total billed charges,35.67% of total billed charges,2.03,6.3,
MONSEL'S PASTE 8 ML PASTE,2506439,CDM,637,RC,,,outpatient,,,68,27.20,,57.8,85,,46.24,percent of total billed charges,85% of total billed charges,52.36,77,,41.89,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,55.76,82,,44.608,percent of total billed charges,82% of total billed charges,57.8,85,,46.24,percent of total billed charges,85% of total billed charges,57.8,85,,46.24,percent of total billed charges,85% of total billed charges,57.8,85,,46.24,percent of total billed charges,85% of total billed charges,61.2,90,,48.96,percent of total billed charges,90% of total billed charges,54.4,80,,43.52,percent of total billed charges,80% of total billed charges,61.2,90,,48.96,percent of total billed charges,90% of total billed charges,51,75,,40.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,19.72,29,,15.776,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,45.56,67,,36.448,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,54.4,80,,43.52,percent of total billed charges,80% of total billed charges,44.2,65,,35.36,percent of total billed charges,65% of total billed charges,24.26,35.67,,19.408,percent of total billed charges,35.67% of total billed charges,19.72,61.2,
MONISTAT 7VAG/CR W/APPLICATON,2506440,CDM,637,RC,,,outpatient,,,40,16.00,,34,85,,27.2,percent of total billed charges,85% of total billed charges,30.8,77,,24.64,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,32.8,82,,26.24,percent of total billed charges,82% of total billed charges,34,85,,27.2,percent of total billed charges,85% of total billed charges,34,85,,27.2,percent of total billed charges,85% of total billed charges,34,85,,27.2,percent of total billed charges,85% of total billed charges,36,90,,28.8,percent of total billed charges,90% of total billed charges,32,80,,25.6,percent of total billed charges,80% of total billed charges,36,90,,28.8,percent of total billed charges,90% of total billed charges,30,75,,24,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,11.6,29,,9.28,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,26.8,67,,21.44,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,32,80,,25.6,percent of total billed charges,80% of total billed charges,26,65,,20.8,percent of total billed charges,65% of total billed charges,14.27,35.67,,11.416,percent of total billed charges,35.67% of total billed charges,11.6,36,
MONISTAT SUPP. VAG. 7/BOX,2506455,CDM,637,RC,,,outpatient,,,45,18.00,,38.25,85,,30.6,percent of total billed charges,85% of total billed charges,34.65,77,,27.72,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,36.9,82,,29.52,percent of total billed charges,82% of total billed charges,38.25,85,,30.6,percent of total billed charges,85% of total billed charges,38.25,85,,30.6,percent of total billed charges,85% of total billed charges,38.25,85,,30.6,percent of total billed charges,85% of total billed charges,40.5,90,,32.4,percent of total billed charges,90% of total billed charges,36,80,,28.8,percent of total billed charges,80% of total billed charges,40.5,90,,32.4,percent of total billed charges,90% of total billed charges,33.75,75,,27,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,13.05,29,,10.44,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,30.15,67,,24.12,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,36,80,,28.8,percent of total billed charges,80% of total billed charges,29.25,65,,23.4,percent of total billed charges,65% of total billed charges,16.05,35.67,,12.84,percent of total billed charges,35.67% of total billed charges,13.05,40.5,
MONOPRIL 10MG PO,2506465,CDM,637,RC,,,outpatient,,,8,3.20,,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,6.16,77,,4.93,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,6.56,82,,5.248,percent of total billed charges,82% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,7.2,90,,5.76,percent of total billed charges,90% of total billed charges,6.4,80,,5.12,percent of total billed charges,80% of total billed charges,7.2,90,,5.76,percent of total billed charges,90% of total billed charges,6,75,,4.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.32,29,,1.856,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,5.36,67,,4.288,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,6.4,80,,5.12,percent of total billed charges,80% of total billed charges,5.2,65,,4.16,percent of total billed charges,65% of total billed charges,2.85,35.67,,2.28,percent of total billed charges,35.67% of total billed charges,2.32,7.2,
MOTRIN 300 MG TAB,2506535,CDM,637,RC,,,outpatient,,,6,2.40,,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,4.62,77,,3.7,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,4.92,82,,3.936,percent of total billed charges,82% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,5.4,90,,4.32,percent of total billed charges,90% of total billed charges,4.8,80,,3.84,percent of total billed charges,80% of total billed charges,5.4,90,,4.32,percent of total billed charges,90% of total billed charges,4.5,75,,3.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,1.74,29,,1.392,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4.02,67,,3.216,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,4.8,80,,3.84,percent of total billed charges,80% of total billed charges,3.9,65,,3.12,percent of total billed charges,65% of total billed charges,2.14,35.67,,1.712,percent of total billed charges,35.67% of total billed charges,1.74,5.4,
MOTRIN 400 MG PO,2506537,CDM,637,RC,,,outpatient,,,7,2.80,,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.39,77,,4.31,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,5.74,82,,4.592,percent of total billed charges,82% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.25,75,,4.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.03,29,,1.624,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4.69,67,,3.752,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,4.55,65,,3.64,percent of total billed charges,65% of total billed charges,2.5,35.67,,2,percent of total billed charges,35.67% of total billed charges,2.03,6.3,
MOTRIN 600 TAB,2506540,CDM,637,RC,,,outpatient,,,7,2.80,,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.39,77,,4.31,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,5.74,82,,4.592,percent of total billed charges,82% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.25,75,,4.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.03,29,,1.624,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4.69,67,,3.752,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,4.55,65,,3.64,percent of total billed charges,65% of total billed charges,2.5,35.67,,2,percent of total billed charges,35.67% of total billed charges,2.03,6.3,
MOTRIN 800 MG TAB,2506545,CDM,637,RC,,,outpatient,,,7,2.80,,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.39,77,,4.31,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,5.74,82,,4.592,percent of total billed charges,82% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.25,75,,4.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.03,29,,1.624,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4.69,67,,3.752,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,4.55,65,,3.64,percent of total billed charges,65% of total billed charges,2.5,35.67,,2,percent of total billed charges,35.67% of total billed charges,2.03,6.3,
MULTAQ 400 MG TABLET,2506574,CDM,637,RC,,,outpatient,,,41,16.40,,34.85,85,,27.88,percent of total billed charges,85% of total billed charges,31.57,77,,25.26,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,33.62,82,,26.896,percent of total billed charges,82% of total billed charges,34.85,85,,27.88,percent of total billed charges,85% of total billed charges,34.85,85,,27.88,percent of total billed charges,85% of total billed charges,34.85,85,,27.88,percent of total billed charges,85% of total billed charges,36.9,90,,29.52,percent of total billed charges,90% of total billed charges,32.8,80,,26.24,percent of total billed charges,80% of total billed charges,36.9,90,,29.52,percent of total billed charges,90% of total billed charges,30.75,75,,24.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,11.89,29,,9.512,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,27.47,67,,21.976,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,32.8,80,,26.24,percent of total billed charges,80% of total billed charges,26.65,65,,21.32,percent of total billed charges,65% of total billed charges,14.62,35.67,,11.696,percent of total billed charges,35.67% of total billed charges,11.89,36.9,
MYLICON LIQ. 30CC,2506645,CDM,637,RC,,,outpatient,,,22,8.80,,18.7,85,,14.96,percent of total billed charges,85% of total billed charges,16.94,77,,13.55,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,18.04,82,,14.432,percent of total billed charges,82% of total billed charges,18.7,85,,14.96,percent of total billed charges,85% of total billed charges,18.7,85,,14.96,percent of total billed charges,85% of total billed charges,18.7,85,,14.96,percent of total billed charges,85% of total billed charges,19.8,90,,15.84,percent of total billed charges,90% of total billed charges,17.6,80,,14.08,percent of total billed charges,80% of total billed charges,19.8,90,,15.84,percent of total billed charges,90% of total billed charges,16.5,75,,13.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,6.38,29,,5.104,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,14.74,67,,11.792,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,17.6,80,,14.08,percent of total billed charges,80% of total billed charges,14.3,65,,11.44,percent of total billed charges,65% of total billed charges,7.85,35.67,,6.28,percent of total billed charges,35.67% of total billed charges,6.38,19.8,
MYOFLEX CREAM 4 OZ,2506670,CDM,637,RC,,,outpatient,,,19,7.60,,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,14.63,77,,11.7,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,15.58,82,,12.464,percent of total billed charges,82% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,15.2,80,,12.16,percent of total billed charges,80% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,14.25,75,,11.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,5.51,29,,4.408,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,12.73,67,,10.184,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,15.2,80,,12.16,percent of total billed charges,80% of total billed charges,12.35,65,,9.88,percent of total billed charges,65% of total billed charges,6.78,35.67,,5.424,percent of total billed charges,35.67% of total billed charges,5.51,17.1,
NEURONTIN 800 MG TAB,2506701,CDM,637,RC,,,outpatient,,,17,6.80,,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,13.09,77,,10.47,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,13.94,82,,11.152,percent of total billed charges,82% of total billed charges,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,15.3,90,,12.24,percent of total billed charges,90% of total billed charges,13.6,80,,10.88,percent of total billed charges,80% of total billed charges,15.3,90,,12.24,percent of total billed charges,90% of total billed charges,12.75,75,,10.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,4.93,29,,3.944,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,11.39,67,,9.112,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,13.6,80,,10.88,percent of total billed charges,80% of total billed charges,11.05,65,,8.84,percent of total billed charges,65% of total billed charges,6.06,35.67,,4.848,percent of total billed charges,35.67% of total billed charges,4.93,15.3,
NASALCROM SPRAY 26 ML,2506786,CDM,637,RC,,,outpatient,,,42,16.80,,35.7,85,,28.56,percent of total billed charges,85% of total billed charges,32.34,77,,25.87,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,34.44,82,,27.552,percent of total billed charges,82% of total billed charges,35.7,85,,28.56,percent of total billed charges,85% of total billed charges,35.7,85,,28.56,percent of total billed charges,85% of total billed charges,35.7,85,,28.56,percent of total billed charges,85% of total billed charges,37.8,90,,30.24,percent of total billed charges,90% of total billed charges,33.6,80,,26.88,percent of total billed charges,80% of total billed charges,37.8,90,,30.24,percent of total billed charges,90% of total billed charges,31.5,75,,25.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,12.18,29,,9.744,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,28.14,67,,22.512,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,33.6,80,,26.88,percent of total billed charges,80% of total billed charges,27.3,65,,21.84,percent of total billed charges,65% of total billed charges,14.98,35.67,,11.984,percent of total billed charges,35.67% of total billed charges,12.18,37.8,
NEO-SYNEPHRINE SPRAY 1/4% 15ML,2506910,CDM,637,RC,,,outpatient,,,12,4.80,,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,9.24,77,,7.39,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,9.84,82,,7.872,percent of total billed charges,82% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,10.8,90,,8.64,percent of total billed charges,90% of total billed charges,9.6,80,,7.68,percent of total billed charges,80% of total billed charges,10.8,90,,8.64,percent of total billed charges,90% of total billed charges,9,75,,7.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,3.48,29,,2.784,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,8.04,67,,6.432,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,9.6,80,,7.68,percent of total billed charges,80% of total billed charges,7.8,65,,6.24,percent of total billed charges,65% of total billed charges,4.28,35.67,,3.424,percent of total billed charges,35.67% of total billed charges,3.48,10.8,
NEODECADRON OPT OINT,2506915,CDM,637,RC,,,outpatient,,,16,6.40,,13.6,85,,10.88,percent of total billed charges,85% of total billed charges,12.32,77,,9.86,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,13.12,82,,10.496,percent of total billed charges,82% of total billed charges,13.6,85,,10.88,percent of total billed charges,85% of total billed charges,13.6,85,,10.88,percent of total billed charges,85% of total billed charges,13.6,85,,10.88,percent of total billed charges,85% of total billed charges,14.4,90,,11.52,percent of total billed charges,90% of total billed charges,12.8,80,,10.24,percent of total billed charges,80% of total billed charges,14.4,90,,11.52,percent of total billed charges,90% of total billed charges,12,75,,9.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,4.64,29,,3.712,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,10.72,67,,8.576,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,12.8,80,,10.24,percent of total billed charges,80% of total billed charges,10.4,65,,8.32,percent of total billed charges,65% of total billed charges,5.71,35.67,,4.568,percent of total billed charges,35.67% of total billed charges,4.64,14.4,
NEOSPORIN 10% OPTH SOL.,2506935,CDM,637,RC,,,outpatient,,,41,16.40,,34.85,85,,27.88,percent of total billed charges,85% of total billed charges,31.57,77,,25.26,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,33.62,82,,26.896,percent of total billed charges,82% of total billed charges,34.85,85,,27.88,percent of total billed charges,85% of total billed charges,34.85,85,,27.88,percent of total billed charges,85% of total billed charges,34.85,85,,27.88,percent of total billed charges,85% of total billed charges,36.9,90,,29.52,percent of total billed charges,90% of total billed charges,32.8,80,,26.24,percent of total billed charges,80% of total billed charges,36.9,90,,29.52,percent of total billed charges,90% of total billed charges,30.75,75,,24.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,11.89,29,,9.512,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,27.47,67,,21.976,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,32.8,80,,26.24,percent of total billed charges,80% of total billed charges,26.65,65,,21.32,percent of total billed charges,65% of total billed charges,14.62,35.67,,11.696,percent of total billed charges,35.67% of total billed charges,11.89,36.9,
NEOSYNEPHRINE 1/8% PEDIA GTTS,2506975,CDM,637,RC,,,outpatient,,,15,6.00,,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,11.55,77,,9.24,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,12.3,82,,9.84,percent of total billed charges,82% of total billed charges,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,13.5,90,,10.8,percent of total billed charges,90% of total billed charges,12,80,,9.6,percent of total billed charges,80% of total billed charges,13.5,90,,10.8,percent of total billed charges,90% of total billed charges,11.25,75,,9,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,4.35,29,,3.48,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,10.05,67,,8.04,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,12,80,,9.6,percent of total billed charges,80% of total billed charges,9.75,65,,7.8,percent of total billed charges,65% of total billed charges,5.35,35.67,,4.28,percent of total billed charges,35.67% of total billed charges,4.35,13.5,
NEOSYNEPHRINE SPRAY 1%,2506980,CDM,637,RC,,,outpatient,,,15,6.00,,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,11.55,77,,9.24,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,12.3,82,,9.84,percent of total billed charges,82% of total billed charges,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,13.5,90,,10.8,percent of total billed charges,90% of total billed charges,12,80,,9.6,percent of total billed charges,80% of total billed charges,13.5,90,,10.8,percent of total billed charges,90% of total billed charges,11.25,75,,9,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,4.35,29,,3.48,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,10.05,67,,8.04,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,12,80,,9.6,percent of total billed charges,80% of total billed charges,9.75,65,,7.8,percent of total billed charges,65% of total billed charges,5.35,35.67,,4.28,percent of total billed charges,35.67% of total billed charges,4.35,13.5,
NEPTAZANE 50MG TAB,2506985,CDM,637,RC,,,outpatient,,,14,5.60,,11.9,85,,9.52,percent of total billed charges,85% of total billed charges,10.78,77,,8.62,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,11.48,82,,9.184,percent of total billed charges,82% of total billed charges,11.9,85,,9.52,percent of total billed charges,85% of total billed charges,11.9,85,,9.52,percent of total billed charges,85% of total billed charges,11.9,85,,9.52,percent of total billed charges,85% of total billed charges,12.6,90,,10.08,percent of total billed charges,90% of total billed charges,11.2,80,,8.96,percent of total billed charges,80% of total billed charges,12.6,90,,10.08,percent of total billed charges,90% of total billed charges,10.5,75,,8.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,4.06,29,,3.248,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,9.38,67,,7.504,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,11.2,80,,8.96,percent of total billed charges,80% of total billed charges,9.1,65,,7.28,percent of total billed charges,65% of total billed charges,4.99,35.67,,3.992,percent of total billed charges,35.67% of total billed charges,4.06,12.6,
NEURONTIN 400 MG CAP,2506994,CDM,637,RC,,,outpatient,,,15,6.00,,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,11.55,77,,9.24,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,12.3,82,,9.84,percent of total billed charges,82% of total billed charges,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,13.5,90,,10.8,percent of total billed charges,90% of total billed charges,12,80,,9.6,percent of total billed charges,80% of total billed charges,13.5,90,,10.8,percent of total billed charges,90% of total billed charges,11.25,75,,9,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,4.35,29,,3.48,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,10.05,67,,8.04,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,12,80,,9.6,percent of total billed charges,80% of total billed charges,9.75,65,,7.8,percent of total billed charges,65% of total billed charges,5.35,35.67,,4.28,percent of total billed charges,35.67% of total billed charges,4.35,13.5,
NEXIUM 40 MG PO,2506996,CDM,637,RC,,,outpatient,,,33,13.20,,28.05,85,,22.44,percent of total billed charges,85% of total billed charges,25.41,77,,20.33,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,27.06,82,,21.648,percent of total billed charges,82% of total billed charges,28.05,85,,22.44,percent of total billed charges,85% of total billed charges,28.05,85,,22.44,percent of total billed charges,85% of total billed charges,28.05,85,,22.44,percent of total billed charges,85% of total billed charges,29.7,90,,23.76,percent of total billed charges,90% of total billed charges,26.4,80,,21.12,percent of total billed charges,80% of total billed charges,29.7,90,,23.76,percent of total billed charges,90% of total billed charges,24.75,75,,19.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,9.57,29,,7.656,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,22.11,67,,17.688,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,26.4,80,,21.12,percent of total billed charges,80% of total billed charges,21.45,65,,17.16,percent of total billed charges,65% of total billed charges,11.77,35.67,,9.416,percent of total billed charges,35.67% of total billed charges,9.57,29.7,
NEXIUM 20MG CAP,2506997,CDM,637,RC,,,outpatient,,,24,9.60,,20.4,85,,16.32,percent of total billed charges,85% of total billed charges,18.48,77,,14.78,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,19.68,82,,15.744,percent of total billed charges,82% of total billed charges,20.4,85,,16.32,percent of total billed charges,85% of total billed charges,20.4,85,,16.32,percent of total billed charges,85% of total billed charges,20.4,85,,16.32,percent of total billed charges,85% of total billed charges,21.6,90,,17.28,percent of total billed charges,90% of total billed charges,19.2,80,,15.36,percent of total billed charges,80% of total billed charges,21.6,90,,17.28,percent of total billed charges,90% of total billed charges,18,75,,14.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,6.96,29,,5.568,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,16.08,67,,12.864,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,19.2,80,,15.36,percent of total billed charges,80% of total billed charges,15.6,65,,12.48,percent of total billed charges,65% of total billed charges,8.56,35.67,,6.848,percent of total billed charges,35.67% of total billed charges,6.96,21.6,
NEURONTIN 600 MG,2506999,CDM,637,RC,,,outpatient,,,23,9.20,,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,17.71,77,,14.17,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,18.86,82,,15.088,percent of total billed charges,82% of total billed charges,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,20.7,90,,16.56,percent of total billed charges,90% of total billed charges,18.4,80,,14.72,percent of total billed charges,80% of total billed charges,20.7,90,,16.56,percent of total billed charges,90% of total billed charges,17.25,75,,13.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,6.67,29,,5.336,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,15.41,67,,12.328,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,18.4,80,,14.72,percent of total billed charges,80% of total billed charges,14.95,65,,11.96,percent of total billed charges,65% of total billed charges,8.2,35.67,,6.56,percent of total billed charges,35.67% of total billed charges,6.67,20.7,
NIACIN (NICOTINE ACID)50MG TAB,2507000,CDM,637,RC,,,outpatient,,,7,2.80,,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.39,77,,4.31,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,5.74,82,,4.592,percent of total billed charges,82% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.25,75,,4.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.03,29,,1.624,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4.69,67,,3.752,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,4.55,65,,3.64,percent of total billed charges,65% of total billed charges,2.5,35.67,,2,percent of total billed charges,35.67% of total billed charges,2.03,6.3,
NEUTRA-PHOS K PACKET 1 PKT,2507006,CDM,637,RC,,,outpatient,,,7,2.80,,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.39,77,,4.31,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,5.74,82,,4.592,percent of total billed charges,82% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.25,75,,4.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.03,29,,1.624,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4.69,67,,3.752,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,4.55,65,,3.64,percent of total billed charges,65% of total billed charges,2.5,35.67,,2,percent of total billed charges,35.67% of total billed charges,2.03,6.3,
NICODERM PATCH 22,2507007,CDM,637,RC,,,outpatient,,,18,7.20,,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,13.86,77,,11.09,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,14.76,82,,11.808,percent of total billed charges,82% of total billed charges,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,16.2,90,,12.96,percent of total billed charges,90% of total billed charges,14.4,80,,11.52,percent of total billed charges,80% of total billed charges,16.2,90,,12.96,percent of total billed charges,90% of total billed charges,13.5,75,,10.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,5.22,29,,4.176,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,12.06,67,,9.648,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,14.4,80,,11.52,percent of total billed charges,80% of total billed charges,11.7,65,,9.36,percent of total billed charges,65% of total billed charges,6.42,35.67,,5.136,percent of total billed charges,35.67% of total billed charges,5.22,16.2,
NICODERM PATCH 21,2507009,CDM,637,RC,,,outpatient,,,16,6.40,,13.6,85,,10.88,percent of total billed charges,85% of total billed charges,12.32,77,,9.86,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,13.12,82,,10.496,percent of total billed charges,82% of total billed charges,13.6,85,,10.88,percent of total billed charges,85% of total billed charges,13.6,85,,10.88,percent of total billed charges,85% of total billed charges,13.6,85,,10.88,percent of total billed charges,85% of total billed charges,14.4,90,,11.52,percent of total billed charges,90% of total billed charges,12.8,80,,10.24,percent of total billed charges,80% of total billed charges,14.4,90,,11.52,percent of total billed charges,90% of total billed charges,12,75,,9.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,4.64,29,,3.712,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,10.72,67,,8.576,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,12.8,80,,10.24,percent of total billed charges,80% of total billed charges,10.4,65,,8.32,percent of total billed charges,65% of total billed charges,5.71,35.67,,4.568,percent of total billed charges,35.67% of total billed charges,4.64,14.4,
NIFEREX 150 TAB,2507020,CDM,637,RC,,,outpatient,,,8,3.20,,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,6.16,77,,4.93,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,6.56,82,,5.248,percent of total billed charges,82% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,7.2,90,,5.76,percent of total billed charges,90% of total billed charges,6.4,80,,5.12,percent of total billed charges,80% of total billed charges,7.2,90,,5.76,percent of total billed charges,90% of total billed charges,6,75,,4.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.32,29,,1.856,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,5.36,67,,4.288,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,6.4,80,,5.12,percent of total billed charges,80% of total billed charges,5.2,65,,4.16,percent of total billed charges,65% of total billed charges,2.85,35.67,,2.28,percent of total billed charges,35.67% of total billed charges,2.32,7.2,
NITRODUR 5 CM PATCH,2507050,CDM,637,RC,,,outpatient,,,9,3.60,,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,6.93,77,,5.54,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,7.38,82,,5.904,percent of total billed charges,82% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,8.1,90,,6.48,percent of total billed charges,90% of total billed charges,7.2,80,,5.76,percent of total billed charges,80% of total billed charges,8.1,90,,6.48,percent of total billed charges,90% of total billed charges,6.75,75,,5.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.61,29,,2.088,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,6.03,67,,4.824,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,7.2,80,,5.76,percent of total billed charges,80% of total billed charges,5.85,65,,4.68,percent of total billed charges,65% of total billed charges,3.21,35.67,,2.568,percent of total billed charges,35.67% of total billed charges,2.61,8.1,
NITROL 2% OINTMENT,2507070,CDM,637,RC,,,outpatient,,,42,16.80,,35.7,85,,28.56,percent of total billed charges,85% of total billed charges,32.34,77,,25.87,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,34.44,82,,27.552,percent of total billed charges,82% of total billed charges,35.7,85,,28.56,percent of total billed charges,85% of total billed charges,35.7,85,,28.56,percent of total billed charges,85% of total billed charges,35.7,85,,28.56,percent of total billed charges,85% of total billed charges,37.8,90,,30.24,percent of total billed charges,90% of total billed charges,33.6,80,,26.88,percent of total billed charges,80% of total billed charges,37.8,90,,30.24,percent of total billed charges,90% of total billed charges,31.5,75,,25.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,12.18,29,,9.744,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,28.14,67,,22.512,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,33.6,80,,26.88,percent of total billed charges,80% of total billed charges,27.3,65,,21.84,percent of total billed charges,65% of total billed charges,14.98,35.67,,11.984,percent of total billed charges,35.67% of total billed charges,12.18,37.8,
NIZORAL CREAM,2507095,CDM,637,RC,,,outpatient,,,368,147.20,,312.8,85,,250.24,percent of total billed charges,85% of total billed charges,283.36,77,,226.69,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,301.76,82,,241.408,percent of total billed charges,82% of total billed charges,312.8,85,,250.24,percent of total billed charges,85% of total billed charges,312.8,85,,250.24,percent of total billed charges,85% of total billed charges,312.8,85,,250.24,percent of total billed charges,85% of total billed charges,331.2,90,,264.96,percent of total billed charges,90% of total billed charges,294.4,80,,235.52,percent of total billed charges,80% of total billed charges,331.2,90,,264.96,percent of total billed charges,90% of total billed charges,276,75,,220.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,106.72,29,,85.376,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,246.56,67,,197.248,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,294.4,80,,235.52,percent of total billed charges,80% of total billed charges,239.2,65,,191.36,percent of total billed charges,65% of total billed charges,131.27,35.67,,105.016,percent of total billed charges,35.67% of total billed charges,106.72,331.2,
NIZORAL SHAMPOO,2507100,CDM,637,RC,,,outpatient,,,223,89.20,,189.55,85,,151.64,percent of total billed charges,85% of total billed charges,171.71,77,,137.37,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,182.86,82,,146.288,percent of total billed charges,82% of total billed charges,189.55,85,,151.64,percent of total billed charges,85% of total billed charges,189.55,85,,151.64,percent of total billed charges,85% of total billed charges,189.55,85,,151.64,percent of total billed charges,85% of total billed charges,200.7,90,,160.56,percent of total billed charges,90% of total billed charges,178.4,80,,142.72,percent of total billed charges,80% of total billed charges,200.7,90,,160.56,percent of total billed charges,90% of total billed charges,167.25,75,,133.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,64.67,29,,51.736,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,149.41,67,,119.528,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,178.4,80,,142.72,percent of total billed charges,80% of total billed charges,144.95,65,,115.96,percent of total billed charges,65% of total billed charges,79.54,35.67,,63.632,percent of total billed charges,35.67% of total billed charges,64.67,200.7,
NOCTEC LIQ PER DOSE 500 MG/5CC,2507110,CDM,637,RC,,,outpatient,,,7,2.80,,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.39,77,,4.31,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,5.74,82,,4.592,percent of total billed charges,82% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.25,75,,4.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.03,29,,1.624,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4.69,67,,3.752,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,4.55,65,,3.64,percent of total billed charges,65% of total billed charges,2.5,35.67,,2,percent of total billed charges,35.67% of total billed charges,2.03,6.3,
NORMAL SALINE 1 CC,2507145,CDM,637,RC,,,outpatient,,,8,3.20,,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,6.16,77,,4.93,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,6.56,82,,5.248,percent of total billed charges,82% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,7.2,90,,5.76,percent of total billed charges,90% of total billed charges,6.4,80,,5.12,percent of total billed charges,80% of total billed charges,7.2,90,,5.76,percent of total billed charges,90% of total billed charges,6,75,,4.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.32,29,,1.856,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,5.36,67,,4.288,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,6.4,80,,5.12,percent of total billed charges,80% of total billed charges,5.2,65,,4.16,percent of total billed charges,65% of total billed charges,2.85,35.67,,2.28,percent of total billed charges,35.67% of total billed charges,2.32,7.2,
NOREL DM 60 ML BOTTLE,2507156,CDM,637,RC,,,outpatient,,,25,10.00,,21.25,85,,17,percent of total billed charges,85% of total billed charges,19.25,77,,15.4,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,20.5,82,,16.4,percent of total billed charges,82% of total billed charges,21.25,85,,17,percent of total billed charges,85% of total billed charges,21.25,85,,17,percent of total billed charges,85% of total billed charges,21.25,85,,17,percent of total billed charges,85% of total billed charges,22.5,90,,18,percent of total billed charges,90% of total billed charges,20,80,,16,percent of total billed charges,80% of total billed charges,22.5,90,,18,percent of total billed charges,90% of total billed charges,18.75,75,,15,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,7.25,29,,5.8,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,16.75,67,,13.4,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,20,80,,16,percent of total billed charges,80% of total billed charges,16.25,65,,13,percent of total billed charges,65% of total billed charges,8.92,35.67,,7.136,percent of total billed charges,35.67% of total billed charges,7.25,22.5,
NORVASC 10 MG TAB,2507220,CDM,637,RC,,,outpatient,,,19,7.60,,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,14.63,77,,11.7,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,15.58,82,,12.464,percent of total billed charges,82% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,15.2,80,,12.16,percent of total billed charges,80% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,14.25,75,,11.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,5.51,29,,4.408,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,12.73,67,,10.184,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,15.2,80,,12.16,percent of total billed charges,80% of total billed charges,12.35,65,,9.88,percent of total billed charges,65% of total billed charges,6.78,35.67,,5.424,percent of total billed charges,35.67% of total billed charges,5.51,17.1,
NORVASC 2.5 MG TAB,2507226,CDM,637,RC,,,outpatient,,,12,4.80,,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,9.24,77,,7.39,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,9.84,82,,7.872,percent of total billed charges,82% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,10.8,90,,8.64,percent of total billed charges,90% of total billed charges,9.6,80,,7.68,percent of total billed charges,80% of total billed charges,10.8,90,,8.64,percent of total billed charges,90% of total billed charges,9,75,,7.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,3.48,29,,2.784,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,8.04,67,,6.432,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,9.6,80,,7.68,percent of total billed charges,80% of total billed charges,7.8,65,,6.24,percent of total billed charges,65% of total billed charges,4.28,35.67,,3.424,percent of total billed charges,35.67% of total billed charges,3.48,10.8,
NOXZEMA 2.5 OZ JAR,2507248,CDM,637,RC,,,outpatient,,,8,3.20,,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,6.16,77,,4.93,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,6.56,82,,5.248,percent of total billed charges,82% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,7.2,90,,5.76,percent of total billed charges,90% of total billed charges,6.4,80,,5.12,percent of total billed charges,80% of total billed charges,7.2,90,,5.76,percent of total billed charges,90% of total billed charges,6,75,,4.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.32,29,,1.856,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,5.36,67,,4.288,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,6.4,80,,5.12,percent of total billed charges,80% of total billed charges,5.2,65,,4.16,percent of total billed charges,65% of total billed charges,2.85,35.67,,2.28,percent of total billed charges,35.67% of total billed charges,2.32,7.2,
NULYTELY 4000 ML PO,2507294,CDM,637,RC,,,outpatient,,,119,47.60,,101.15,85,,80.92,percent of total billed charges,85% of total billed charges,91.63,77,,73.3,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,97.58,82,,78.064,percent of total billed charges,82% of total billed charges,101.15,85,,80.92,percent of total billed charges,85% of total billed charges,101.15,85,,80.92,percent of total billed charges,85% of total billed charges,101.15,85,,80.92,percent of total billed charges,85% of total billed charges,107.1,90,,85.68,percent of total billed charges,90% of total billed charges,95.2,80,,76.16,percent of total billed charges,80% of total billed charges,107.1,90,,85.68,percent of total billed charges,90% of total billed charges,89.25,75,,71.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,34.51,29,,27.608,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,79.73,67,,63.784,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,95.2,80,,76.16,percent of total billed charges,80% of total billed charges,77.35,65,,61.88,percent of total billed charges,65% of total billed charges,42.45,35.67,,33.96,percent of total billed charges,35.67% of total billed charges,34.51,107.1,
OCUPRESS 1% 5 ML BOTTLE,2507337,CDM,637,RC,,,outpatient,,,80,32.00,,68,85,,54.4,percent of total billed charges,85% of total billed charges,61.6,77,,49.28,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,65.6,82,,52.48,percent of total billed charges,82% of total billed charges,68,85,,54.4,percent of total billed charges,85% of total billed charges,68,85,,54.4,percent of total billed charges,85% of total billed charges,68,85,,54.4,percent of total billed charges,85% of total billed charges,72,90,,57.6,percent of total billed charges,90% of total billed charges,64,80,,51.2,percent of total billed charges,80% of total billed charges,72,90,,57.6,percent of total billed charges,90% of total billed charges,60,75,,48,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,23.2,29,,18.56,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,53.6,67,,42.88,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,64,80,,51.2,percent of total billed charges,80% of total billed charges,52,65,,41.6,percent of total billed charges,65% of total billed charges,28.54,35.67,,22.832,percent of total billed charges,35.67% of total billed charges,23.2,72,
OCUVITE TAB,2507340,CDM,637,RC,,,outpatient,,,7,2.80,,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.39,77,,4.31,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,5.74,82,,4.592,percent of total billed charges,82% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.25,75,,4.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.03,29,,1.624,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4.69,67,,3.752,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,4.55,65,,3.64,percent of total billed charges,65% of total billed charges,2.5,35.67,,2,percent of total billed charges,35.67% of total billed charges,2.03,6.3,
OMACOR CAPSULE,2507366,CDM,637,RC,,,outpatient,,,13,5.20,,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,10.01,77,,8.01,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,10.66,82,,8.528,percent of total billed charges,82% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,11.7,90,,9.36,percent of total billed charges,90% of total billed charges,10.4,80,,8.32,percent of total billed charges,80% of total billed charges,11.7,90,,9.36,percent of total billed charges,90% of total billed charges,9.75,75,,7.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,3.77,29,,3.016,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,8.71,67,,6.968,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,10.4,80,,8.32,percent of total billed charges,80% of total billed charges,8.45,65,,6.76,percent of total billed charges,65% of total billed charges,4.64,35.67,,3.712,percent of total billed charges,35.67% of total billed charges,3.77,11.7,
ONGLYZA 5 MG TAB,2507371,CDM,637,RC,,,outpatient,,,54,21.60,,45.9,85,,36.72,percent of total billed charges,85% of total billed charges,41.58,77,,33.26,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,44.28,82,,35.424,percent of total billed charges,82% of total billed charges,45.9,85,,36.72,percent of total billed charges,85% of total billed charges,45.9,85,,36.72,percent of total billed charges,85% of total billed charges,45.9,85,,36.72,percent of total billed charges,85% of total billed charges,48.6,90,,38.88,percent of total billed charges,90% of total billed charges,43.2,80,,34.56,percent of total billed charges,80% of total billed charges,48.6,90,,38.88,percent of total billed charges,90% of total billed charges,40.5,75,,32.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,15.66,29,,12.528,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,36.18,67,,28.944,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,43.2,80,,34.56,percent of total billed charges,80% of total billed charges,35.1,65,,28.08,percent of total billed charges,65% of total billed charges,19.26,35.67,,15.408,percent of total billed charges,35.67% of total billed charges,15.66,48.6,
ORAJEL - BABY 0.33OZ,2507417,CDM,637,RC,,,outpatient,,,18,7.20,,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,13.86,77,,11.09,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,14.76,82,,11.808,percent of total billed charges,82% of total billed charges,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,16.2,90,,12.96,percent of total billed charges,90% of total billed charges,14.4,80,,11.52,percent of total billed charges,80% of total billed charges,16.2,90,,12.96,percent of total billed charges,90% of total billed charges,13.5,75,,10.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,5.22,29,,4.176,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,12.06,67,,9.648,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,14.4,80,,11.52,percent of total billed charges,80% of total billed charges,11.7,65,,9.36,percent of total billed charges,65% of total billed charges,6.42,35.67,,5.136,percent of total billed charges,35.67% of total billed charges,5.22,16.2,
OSCAL 500 MG TAB,2507480,CDM,637,RC,,,outpatient,,,7,2.80,,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.39,77,,4.31,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,5.74,82,,4.592,percent of total billed charges,82% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.25,75,,4.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.03,29,,1.624,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4.69,67,,3.752,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,4.55,65,,3.64,percent of total billed charges,65% of total billed charges,2.5,35.67,,2,percent of total billed charges,35.67% of total billed charges,2.03,6.3,
PAMELOR 10MG CAP,2507500,CDM,637,RC,,,outpatient,,,103,41.20,,87.55,85,,70.04,percent of total billed charges,85% of total billed charges,79.31,77,,63.45,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,84.46,82,,67.568,percent of total billed charges,82% of total billed charges,87.55,85,,70.04,percent of total billed charges,85% of total billed charges,87.55,85,,70.04,percent of total billed charges,85% of total billed charges,87.55,85,,70.04,percent of total billed charges,85% of total billed charges,92.7,90,,74.16,percent of total billed charges,90% of total billed charges,82.4,80,,65.92,percent of total billed charges,80% of total billed charges,92.7,90,,74.16,percent of total billed charges,90% of total billed charges,77.25,75,,61.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,29.87,29,,23.896,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,69.01,67,,55.208,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,82.4,80,,65.92,percent of total billed charges,80% of total billed charges,66.95,65,,53.56,percent of total billed charges,65% of total billed charges,36.74,35.67,,29.392,percent of total billed charges,35.67% of total billed charges,29.87,92.7,
OSTEO BI-FLEX DOUBLE STRENGTH,2507503,CDM,637,RC,,,outpatient,,,6,2.40,,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,4.62,77,,3.7,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,4.92,82,,3.936,percent of total billed charges,82% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,5.4,90,,4.32,percent of total billed charges,90% of total billed charges,4.8,80,,3.84,percent of total billed charges,80% of total billed charges,5.4,90,,4.32,percent of total billed charges,90% of total billed charges,4.5,75,,3.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,1.74,29,,1.392,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4.02,67,,3.216,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,4.8,80,,3.84,percent of total billed charges,80% of total billed charges,3.9,65,,3.12,percent of total billed charges,65% of total billed charges,2.14,35.67,,1.712,percent of total billed charges,35.67% of total billed charges,1.74,5.4,
PAMELOR 25MG CAP (AVENTYL),2507505,CDM,637,RC,,,outpatient,,,105,42.00,,89.25,85,,71.4,percent of total billed charges,85% of total billed charges,80.85,77,,64.68,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,86.1,82,,68.88,percent of total billed charges,82% of total billed charges,89.25,85,,71.4,percent of total billed charges,85% of total billed charges,89.25,85,,71.4,percent of total billed charges,85% of total billed charges,89.25,85,,71.4,percent of total billed charges,85% of total billed charges,94.5,90,,75.6,percent of total billed charges,90% of total billed charges,84,80,,67.2,percent of total billed charges,80% of total billed charges,94.5,90,,75.6,percent of total billed charges,90% of total billed charges,78.75,75,,63,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,30.45,29,,24.36,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,70.35,67,,56.28,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,84,80,,67.2,percent of total billed charges,80% of total billed charges,68.25,65,,54.6,percent of total billed charges,65% of total billed charges,37.45,35.67,,29.96,percent of total billed charges,35.67% of total billed charges,30.45,94.5,
PEDIAPRED 5 MG/5ML ORAL BOTTLE,2507626,CDM,637,RC,,,outpatient,,,93,37.20,,79.05,85,,63.24,percent of total billed charges,85% of total billed charges,71.61,77,,57.29,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,76.26,82,,61.008,percent of total billed charges,82% of total billed charges,79.05,85,,63.24,percent of total billed charges,85% of total billed charges,79.05,85,,63.24,percent of total billed charges,85% of total billed charges,79.05,85,,63.24,percent of total billed charges,85% of total billed charges,83.7,90,,66.96,percent of total billed charges,90% of total billed charges,74.4,80,,59.52,percent of total billed charges,80% of total billed charges,83.7,90,,66.96,percent of total billed charges,90% of total billed charges,69.75,75,,55.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,26.97,29,,21.576,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,62.31,67,,49.848,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,74.4,80,,59.52,percent of total billed charges,80% of total billed charges,60.45,65,,48.36,percent of total billed charges,65% of total billed charges,33.17,35.67,,26.536,percent of total billed charges,35.67% of total billed charges,26.97,83.7,
PEN VK 500MG TAB,2507645,CDM,637,RC,,,outpatient,,,7,2.80,,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.39,77,,4.31,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,5.74,82,,4.592,percent of total billed charges,82% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.25,75,,4.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.03,29,,1.624,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4.69,67,,3.752,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,4.55,65,,3.64,percent of total billed charges,65% of total billed charges,2.5,35.67,,2,percent of total billed charges,35.67% of total billed charges,2.03,6.3,
PEPCID AC TAB,2507684,CDM,637,RC,,,outpatient,,,7,2.80,,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.39,77,,4.31,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,5.74,82,,4.592,percent of total billed charges,82% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.25,75,,4.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.03,29,,1.624,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4.69,67,,3.752,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,4.55,65,,3.64,percent of total billed charges,65% of total billed charges,2.5,35.67,,2,percent of total billed charges,35.67% of total billed charges,2.03,6.3,
PEPTO BISMOL TAB,2507725,CDM,637,RC,,,outpatient,,,7,2.80,,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.39,77,,4.31,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,5.74,82,,4.592,percent of total billed charges,82% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.25,75,,4.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.03,29,,1.624,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4.69,67,,3.752,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,4.55,65,,3.64,percent of total billed charges,65% of total billed charges,2.5,35.67,,2,percent of total billed charges,35.67% of total billed charges,2.03,6.3,
PERCODAN TAB,2507735,CDM,637,RC,,,outpatient,,,8,3.20,,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,6.16,77,,4.93,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,6.56,82,,5.248,percent of total billed charges,82% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,7.2,90,,5.76,percent of total billed charges,90% of total billed charges,6.4,80,,5.12,percent of total billed charges,80% of total billed charges,7.2,90,,5.76,percent of total billed charges,90% of total billed charges,6,75,,4.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.32,29,,1.856,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,5.36,67,,4.288,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,6.4,80,,5.12,percent of total billed charges,80% of total billed charges,5.2,65,,4.16,percent of total billed charges,65% of total billed charges,2.85,35.67,,2.28,percent of total billed charges,35.67% of total billed charges,2.32,7.2,
PER-COLACE CAP,2507745,CDM,637,RC,,,outpatient,,,7,2.80,,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.39,77,,4.31,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,5.74,82,,4.592,percent of total billed charges,82% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.25,75,,4.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.03,29,,1.624,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4.69,67,,3.752,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,4.55,65,,3.64,percent of total billed charges,65% of total billed charges,2.5,35.67,,2,percent of total billed charges,35.67% of total billed charges,2.03,6.3,
PERIACTIN 4MG TAB,2507760,CDM,637,RC,,,outpatient,,,7,2.80,,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.39,77,,4.31,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,5.74,82,,4.592,percent of total billed charges,82% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.25,75,,4.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.03,29,,1.624,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4.69,67,,3.752,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,4.55,65,,3.64,percent of total billed charges,65% of total billed charges,2.5,35.67,,2,percent of total billed charges,35.67% of total billed charges,2.03,6.3,
PERIDEX 5 ML UDC,2507776,CDM,637,RC,,,outpatient,,,7,2.80,,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.39,77,,4.31,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,5.74,82,,4.592,percent of total billed charges,82% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.25,75,,4.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.03,29,,1.624,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4.69,67,,3.752,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,4.55,65,,3.64,percent of total billed charges,65% of total billed charges,2.5,35.67,,2,percent of total billed charges,35.67% of total billed charges,2.03,6.3,
PERIDEX MOUTH WASH 40Z BOTTLE,2507780,CDM,637,RC,,,outpatient,,,10,4.00,,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,7.7,77,,6.16,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,8.2,82,,6.56,percent of total billed charges,82% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,9,90,,7.2,percent of total billed charges,90% of total billed charges,8,80,,6.4,percent of total billed charges,80% of total billed charges,9,90,,7.2,percent of total billed charges,90% of total billed charges,7.5,75,,6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.9,29,,2.32,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,6.7,67,,5.36,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,8,80,,6.4,percent of total billed charges,80% of total billed charges,6.5,65,,5.2,percent of total billed charges,65% of total billed charges,3.57,35.67,,2.856,percent of total billed charges,35.67% of total billed charges,2.9,9,
PHENERGAN SYRUP,2507851,CDM,637,RC,,,outpatient,,,16,6.40,,13.6,85,,10.88,percent of total billed charges,85% of total billed charges,12.32,77,,9.86,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,13.12,82,,10.496,percent of total billed charges,82% of total billed charges,13.6,85,,10.88,percent of total billed charges,85% of total billed charges,13.6,85,,10.88,percent of total billed charges,85% of total billed charges,13.6,85,,10.88,percent of total billed charges,85% of total billed charges,14.4,90,,11.52,percent of total billed charges,90% of total billed charges,12.8,80,,10.24,percent of total billed charges,80% of total billed charges,14.4,90,,11.52,percent of total billed charges,90% of total billed charges,12,75,,9.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,4.64,29,,3.712,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,10.72,67,,8.576,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,12.8,80,,10.24,percent of total billed charges,80% of total billed charges,10.4,65,,8.32,percent of total billed charges,65% of total billed charges,5.71,35.67,,4.568,percent of total billed charges,35.67% of total billed charges,4.64,14.4,
PHENERGAN EXP PLAIN 10 CCS,2507900,CDM,637,RC,,,outpatient,,,6,2.40,,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,4.62,77,,3.7,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,4.92,82,,3.936,percent of total billed charges,82% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,5.4,90,,4.32,percent of total billed charges,90% of total billed charges,4.8,80,,3.84,percent of total billed charges,80% of total billed charges,5.4,90,,4.32,percent of total billed charges,90% of total billed charges,4.5,75,,3.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,1.74,29,,1.392,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4.02,67,,3.216,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,4.8,80,,3.84,percent of total billed charges,80% of total billed charges,3.9,65,,3.12,percent of total billed charges,65% of total billed charges,2.14,35.67,,1.712,percent of total billed charges,35.67% of total billed charges,1.74,5.4,
PHENERGAN EXP PLAIN 5 CC,2507905,CDM,637,RC,,,outpatient,,,6,2.40,,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,4.62,77,,3.7,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,4.92,82,,3.936,percent of total billed charges,82% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,5.4,90,,4.32,percent of total billed charges,90% of total billed charges,4.8,80,,3.84,percent of total billed charges,80% of total billed charges,5.4,90,,4.32,percent of total billed charges,90% of total billed charges,4.5,75,,3.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,1.74,29,,1.392,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4.02,67,,3.216,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,4.8,80,,3.84,percent of total billed charges,80% of total billed charges,3.9,65,,3.12,percent of total billed charges,65% of total billed charges,2.14,35.67,,1.712,percent of total billed charges,35.67% of total billed charges,1.74,5.4,
PHENERGAN EXP PLAIN 15 CC,2507910,CDM,637,RC,,,outpatient,,,7,2.80,,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.39,77,,4.31,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,5.74,82,,4.592,percent of total billed charges,82% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.25,75,,4.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.03,29,,1.624,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4.69,67,,3.752,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,4.55,65,,3.64,percent of total billed charges,65% of total billed charges,2.5,35.67,,2,percent of total billed charges,35.67% of total billed charges,2.03,6.3,
PHENERGAN VC CODEINE 5 ML UDC,2507915,CDM,637,RC,,,outpatient,,,12,4.80,,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,9.24,77,,7.39,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,9.84,82,,7.872,percent of total billed charges,82% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,10.8,90,,8.64,percent of total billed charges,90% of total billed charges,9.6,80,,7.68,percent of total billed charges,80% of total billed charges,10.8,90,,8.64,percent of total billed charges,90% of total billed charges,9,75,,7.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,3.48,29,,2.784,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,8.04,67,,6.432,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,9.6,80,,7.68,percent of total billed charges,80% of total billed charges,7.8,65,,6.24,percent of total billed charges,65% of total billed charges,4.28,35.67,,3.424,percent of total billed charges,35.67% of total billed charges,3.48,10.8,
PHENERGAN VC CODEINE 15 CC,2507920,CDM,637,RC,,,outpatient,,,7,2.80,,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.39,77,,4.31,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,5.74,82,,4.592,percent of total billed charges,82% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.25,75,,4.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.03,29,,1.624,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4.69,67,,3.752,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,4.55,65,,3.64,percent of total billed charges,65% of total billed charges,2.5,35.67,,2,percent of total billed charges,35.67% of total billed charges,2.03,6.3,
PHENERGAN VC SYRUP 60 ML,2507921,CDM,637,RC,,,outpatient,,,44,17.60,,37.4,85,,29.92,percent of total billed charges,85% of total billed charges,33.88,77,,27.1,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,36.08,82,,28.864,percent of total billed charges,82% of total billed charges,37.4,85,,29.92,percent of total billed charges,85% of total billed charges,37.4,85,,29.92,percent of total billed charges,85% of total billed charges,37.4,85,,29.92,percent of total billed charges,85% of total billed charges,39.6,90,,31.68,percent of total billed charges,90% of total billed charges,35.2,80,,28.16,percent of total billed charges,80% of total billed charges,39.6,90,,31.68,percent of total billed charges,90% of total billed charges,33,75,,26.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,12.76,29,,10.208,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,29.48,67,,23.584,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,35.2,80,,28.16,percent of total billed charges,80% of total billed charges,28.6,65,,22.88,percent of total billed charges,65% of total billed charges,15.69,35.67,,12.552,percent of total billed charges,35.67% of total billed charges,12.76,39.6,
PHENERGAN VC CODEINE 5 CC,2507925,CDM,637,RC,,,outpatient,,,8,3.20,,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,6.16,77,,4.93,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,6.56,82,,5.248,percent of total billed charges,82% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,7.2,90,,5.76,percent of total billed charges,90% of total billed charges,6.4,80,,5.12,percent of total billed charges,80% of total billed charges,7.2,90,,5.76,percent of total billed charges,90% of total billed charges,6,75,,4.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.32,29,,1.856,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,5.36,67,,4.288,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,6.4,80,,5.12,percent of total billed charges,80% of total billed charges,5.2,65,,4.16,percent of total billed charges,65% of total billed charges,2.85,35.67,,2.28,percent of total billed charges,35.67% of total billed charges,2.32,7.2,
PHENERGAN VC LIQ 10 CC,2507930,CDM,637,RC,,,outpatient,,,8,3.20,,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,6.16,77,,4.93,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,6.56,82,,5.248,percent of total billed charges,82% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,7.2,90,,5.76,percent of total billed charges,90% of total billed charges,6.4,80,,5.12,percent of total billed charges,80% of total billed charges,7.2,90,,5.76,percent of total billed charges,90% of total billed charges,6,75,,4.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.32,29,,1.856,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,5.36,67,,4.288,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,6.4,80,,5.12,percent of total billed charges,80% of total billed charges,5.2,65,,4.16,percent of total billed charges,65% of total billed charges,2.85,35.67,,2.28,percent of total billed charges,35.67% of total billed charges,2.32,7.2,
PHENERGAN VC LIQ 5 ML UDC,2507940,CDM,637,RC,,,outpatient,,,7,2.80,,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.39,77,,4.31,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,5.74,82,,4.592,percent of total billed charges,82% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.25,75,,4.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.03,29,,1.624,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4.69,67,,3.752,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,4.55,65,,3.64,percent of total billed charges,65% of total billed charges,2.5,35.67,,2,percent of total billed charges,35.67% of total billed charges,2.03,6.3,
PHENERGAN W/ CODEINE 5 ML DOSE,2507941,CDM,637,RC,,,outpatient,,,7,2.80,,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.39,77,,4.31,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,5.74,82,,4.592,percent of total billed charges,82% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.25,75,,4.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.03,29,,1.624,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4.69,67,,3.752,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,4.55,65,,3.64,percent of total billed charges,65% of total billed charges,2.5,35.67,,2,percent of total billed charges,35.67% of total billed charges,2.03,6.3,
PHENERGAN VC WITH CODEINE LIQ,2507945,CDM,637,RC,,,outpatient,,,6,2.40,,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,4.62,77,,3.7,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,4.92,82,,3.936,percent of total billed charges,82% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,5.4,90,,4.32,percent of total billed charges,90% of total billed charges,4.8,80,,3.84,percent of total billed charges,80% of total billed charges,5.4,90,,4.32,percent of total billed charges,90% of total billed charges,4.5,75,,3.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,1.74,29,,1.392,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4.02,67,,3.216,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,4.8,80,,3.84,percent of total billed charges,80% of total billed charges,3.9,65,,3.12,percent of total billed charges,65% of total billed charges,2.14,35.67,,1.712,percent of total billed charges,35.67% of total billed charges,1.74,5.4,
PHYENYTEK 300 MG CAP,2507984,CDM,637,RC,,,outpatient,,,8,3.20,,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,6.16,77,,4.93,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,6.56,82,,5.248,percent of total billed charges,82% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,7.2,90,,5.76,percent of total billed charges,90% of total billed charges,6.4,80,,5.12,percent of total billed charges,80% of total billed charges,7.2,90,,5.76,percent of total billed charges,90% of total billed charges,6,75,,4.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.32,29,,1.856,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,5.36,67,,4.288,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,6.4,80,,5.12,percent of total billed charges,80% of total billed charges,5.2,65,,4.16,percent of total billed charges,65% of total billed charges,2.85,35.67,,2.28,percent of total billed charges,35.67% of total billed charges,2.32,7.2,
PILOPINE HS 4% OPTH GEL,2508000,CDM,637,RC,,,outpatient,,,291,116.40,,247.35,85,,197.88,percent of total billed charges,85% of total billed charges,224.07,77,,179.26,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,238.62,82,,190.896,percent of total billed charges,82% of total billed charges,247.35,85,,197.88,percent of total billed charges,85% of total billed charges,247.35,85,,197.88,percent of total billed charges,85% of total billed charges,247.35,85,,197.88,percent of total billed charges,85% of total billed charges,261.9,90,,209.52,percent of total billed charges,90% of total billed charges,232.8,80,,186.24,percent of total billed charges,80% of total billed charges,261.9,90,,209.52,percent of total billed charges,90% of total billed charges,218.25,75,,174.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,84.39,29,,67.512,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,194.97,67,,155.976,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,232.8,80,,186.24,percent of total billed charges,80% of total billed charges,189.15,65,,151.32,percent of total billed charges,65% of total billed charges,103.8,35.67,,83.04,percent of total billed charges,35.67% of total billed charges,84.39,261.9,
POLY VI FLOR DROPS 50 ML PO,2508066,CDM,637,RC,,,outpatient,,,74,29.60,,62.9,85,,50.32,percent of total billed charges,85% of total billed charges,56.98,77,,45.58,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,60.68,82,,48.544,percent of total billed charges,82% of total billed charges,62.9,85,,50.32,percent of total billed charges,85% of total billed charges,62.9,85,,50.32,percent of total billed charges,85% of total billed charges,62.9,85,,50.32,percent of total billed charges,85% of total billed charges,66.6,90,,53.28,percent of total billed charges,90% of total billed charges,59.2,80,,47.36,percent of total billed charges,80% of total billed charges,66.6,90,,53.28,percent of total billed charges,90% of total billed charges,55.5,75,,44.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,21.46,29,,17.168,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,49.58,67,,39.664,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,59.2,80,,47.36,percent of total billed charges,80% of total billed charges,48.1,65,,38.48,percent of total billed charges,65% of total billed charges,26.4,35.67,,21.12,percent of total billed charges,35.67% of total billed charges,21.46,66.6,
PODOCON 25  15 ML BOTTLE,2508067,CDM,637,RC,,,outpatient,,,371,148.40,,315.35,85,,252.28,percent of total billed charges,85% of total billed charges,285.67,77,,228.54,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,304.22,82,,243.376,percent of total billed charges,82% of total billed charges,315.35,85,,252.28,percent of total billed charges,85% of total billed charges,315.35,85,,252.28,percent of total billed charges,85% of total billed charges,315.35,85,,252.28,percent of total billed charges,85% of total billed charges,333.9,90,,267.12,percent of total billed charges,90% of total billed charges,296.8,80,,237.44,percent of total billed charges,80% of total billed charges,333.9,90,,267.12,percent of total billed charges,90% of total billed charges,278.25,75,,222.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,107.59,29,,86.072,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,248.57,67,,198.856,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,296.8,80,,237.44,percent of total billed charges,80% of total billed charges,241.15,65,,192.92,percent of total billed charges,65% of total billed charges,132.34,35.67,,105.872,percent of total billed charges,35.67% of total billed charges,107.59,333.9,
PREDA FORTE 1% OPTH GTTS,2508190,CDM,637,RC,,,outpatient,,,325,130.00,,276.25,85,,221,percent of total billed charges,85% of total billed charges,250.25,77,,200.2,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,266.5,82,,213.2,percent of total billed charges,82% of total billed charges,276.25,85,,221,percent of total billed charges,85% of total billed charges,276.25,85,,221,percent of total billed charges,85% of total billed charges,276.25,85,,221,percent of total billed charges,85% of total billed charges,292.5,90,,234,percent of total billed charges,90% of total billed charges,260,80,,208,percent of total billed charges,80% of total billed charges,292.5,90,,234,percent of total billed charges,90% of total billed charges,243.75,75,,195,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,94.25,29,,75.4,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,217.75,67,,174.2,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,260,80,,208,percent of total billed charges,80% of total billed charges,211.25,65,,169,percent of total billed charges,65% of total billed charges,115.93,35.67,,92.744,percent of total billed charges,35.67% of total billed charges,94.25,292.5,
PREDNISONE (DELTASOME) 10MG,2508200,CDM,637,RC,,,outpatient,,,6,2.40,,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,4.62,77,,3.7,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,4.92,82,,3.936,percent of total billed charges,82% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,5.4,90,,4.32,percent of total billed charges,90% of total billed charges,4.8,80,,3.84,percent of total billed charges,80% of total billed charges,5.4,90,,4.32,percent of total billed charges,90% of total billed charges,4.5,75,,3.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,1.74,29,,1.392,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4.02,67,,3.216,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,4.8,80,,3.84,percent of total billed charges,80% of total billed charges,3.9,65,,3.12,percent of total billed charges,65% of total billed charges,2.14,35.67,,1.712,percent of total billed charges,35.67% of total billed charges,1.74,5.4,
PRADAXA 150 MG CAPSULE,2508201,CDM,637,RC,,,outpatient,,,20,8.00,,17,85,,13.6,percent of total billed charges,85% of total billed charges,15.4,77,,12.32,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,16.4,82,,13.12,percent of total billed charges,82% of total billed charges,17,85,,13.6,percent of total billed charges,85% of total billed charges,17,85,,13.6,percent of total billed charges,85% of total billed charges,17,85,,13.6,percent of total billed charges,85% of total billed charges,18,90,,14.4,percent of total billed charges,90% of total billed charges,16,80,,12.8,percent of total billed charges,80% of total billed charges,18,90,,14.4,percent of total billed charges,90% of total billed charges,15,75,,12,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,5.8,29,,4.64,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,13.4,67,,10.72,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,16,80,,12.8,percent of total billed charges,80% of total billed charges,13,65,,10.4,percent of total billed charges,65% of total billed charges,7.13,35.67,,5.704,percent of total billed charges,35.67% of total billed charges,5.8,18,
PREDNISONE (DELTASONE) 15 MG,2508205,CDM,637,RC,,,outpatient,,,6,2.40,,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,4.62,77,,3.7,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,4.92,82,,3.936,percent of total billed charges,82% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,5.4,90,,4.32,percent of total billed charges,90% of total billed charges,4.8,80,,3.84,percent of total billed charges,80% of total billed charges,5.4,90,,4.32,percent of total billed charges,90% of total billed charges,4.5,75,,3.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,1.74,29,,1.392,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4.02,67,,3.216,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,4.8,80,,3.84,percent of total billed charges,80% of total billed charges,3.9,65,,3.12,percent of total billed charges,65% of total billed charges,2.14,35.67,,1.712,percent of total billed charges,35.67% of total billed charges,1.74,5.4,
PREVACID 15 MG CAP,2508206,CDM,637,RC,,,outpatient,,,40,16.00,,34,85,,27.2,percent of total billed charges,85% of total billed charges,30.8,77,,24.64,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,32.8,82,,26.24,percent of total billed charges,82% of total billed charges,34,85,,27.2,percent of total billed charges,85% of total billed charges,34,85,,27.2,percent of total billed charges,85% of total billed charges,34,85,,27.2,percent of total billed charges,85% of total billed charges,36,90,,28.8,percent of total billed charges,90% of total billed charges,32,80,,25.6,percent of total billed charges,80% of total billed charges,36,90,,28.8,percent of total billed charges,90% of total billed charges,30,75,,24,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,11.6,29,,9.28,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,26.8,67,,21.44,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,32,80,,25.6,percent of total billed charges,80% of total billed charges,26,65,,20.8,percent of total billed charges,65% of total billed charges,14.27,35.67,,11.416,percent of total billed charges,35.67% of total billed charges,11.6,36,
PREDNISONE (DELTASONE)30MG TAB,2508230,CDM,637,RC,,,outpatient,,,7,2.80,,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.39,77,,4.31,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,5.74,82,,4.592,percent of total billed charges,82% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.25,75,,4.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.03,29,,1.624,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4.69,67,,3.752,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,4.55,65,,3.64,percent of total billed charges,65% of total billed charges,2.5,35.67,,2,percent of total billed charges,35.67% of total billed charges,2.03,6.3,
PREDNISONE (DELTASONE)40MG TAB,2508235,CDM,637,RC,,,outpatient,,,7,2.80,,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.39,77,,4.31,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,5.74,82,,4.592,percent of total billed charges,82% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.25,75,,4.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.03,29,,1.624,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4.69,67,,3.752,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,4.55,65,,3.64,percent of total billed charges,65% of total billed charges,2.5,35.67,,2,percent of total billed charges,35.67% of total billed charges,2.03,6.3,
PREDNISONE (DELTASONE) LIQ 5CC,2508270,CDM,637,RC,,,outpatient,,,39,15.60,,33.15,85,,26.52,percent of total billed charges,85% of total billed charges,30.03,77,,24.02,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,31.98,82,,25.584,percent of total billed charges,82% of total billed charges,33.15,85,,26.52,percent of total billed charges,85% of total billed charges,33.15,85,,26.52,percent of total billed charges,85% of total billed charges,33.15,85,,26.52,percent of total billed charges,85% of total billed charges,35.1,90,,28.08,percent of total billed charges,90% of total billed charges,31.2,80,,24.96,percent of total billed charges,80% of total billed charges,35.1,90,,28.08,percent of total billed charges,90% of total billed charges,29.25,75,,23.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,11.31,29,,9.048,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,26.13,67,,20.904,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,31.2,80,,24.96,percent of total billed charges,80% of total billed charges,25.35,65,,20.28,percent of total billed charges,65% of total billed charges,13.91,35.67,,11.128,percent of total billed charges,35.67% of total billed charges,11.31,35.1,
PREMARIN 2.5 MG TAB,2508295,CDM,637,RC,,,outpatient,,,6,2.40,,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,4.62,77,,3.7,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,4.92,82,,3.936,percent of total billed charges,82% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,5.4,90,,4.32,percent of total billed charges,90% of total billed charges,4.8,80,,3.84,percent of total billed charges,80% of total billed charges,5.4,90,,4.32,percent of total billed charges,90% of total billed charges,4.5,75,,3.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,1.74,29,,1.392,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4.02,67,,3.216,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,4.8,80,,3.84,percent of total billed charges,80% of total billed charges,3.9,65,,3.12,percent of total billed charges,65% of total billed charges,2.14,35.67,,1.712,percent of total billed charges,35.67% of total billed charges,1.74,5.4,
PRILOSEC 20 MG TAB,2508335,CDM,637,RC,,,outpatient,,,29,11.60,,24.65,85,,19.72,percent of total billed charges,85% of total billed charges,22.33,77,,17.86,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,23.78,82,,19.024,percent of total billed charges,82% of total billed charges,24.65,85,,19.72,percent of total billed charges,85% of total billed charges,24.65,85,,19.72,percent of total billed charges,85% of total billed charges,24.65,85,,19.72,percent of total billed charges,85% of total billed charges,26.1,90,,20.88,percent of total billed charges,90% of total billed charges,23.2,80,,18.56,percent of total billed charges,80% of total billed charges,26.1,90,,20.88,percent of total billed charges,90% of total billed charges,21.75,75,,17.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,8.41,29,,6.728,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,19.43,67,,15.544,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,23.2,80,,18.56,percent of total billed charges,80% of total billed charges,18.85,65,,15.08,percent of total billed charges,65% of total billed charges,10.34,35.67,,8.272,percent of total billed charges,35.67% of total billed charges,8.41,26.1,
PRINIVIL (ZESTRIL) 40 MG PO,2508376,CDM,637,RC,,,outpatient,,,9,3.60,,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,6.93,77,,5.54,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,7.38,82,,5.904,percent of total billed charges,82% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,8.1,90,,6.48,percent of total billed charges,90% of total billed charges,7.2,80,,5.76,percent of total billed charges,80% of total billed charges,8.1,90,,6.48,percent of total billed charges,90% of total billed charges,6.75,75,,5.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.61,29,,2.088,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,6.03,67,,4.824,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,7.2,80,,5.76,percent of total billed charges,80% of total billed charges,5.85,65,,4.68,percent of total billed charges,65% of total billed charges,3.21,35.67,,2.568,percent of total billed charges,35.67% of total billed charges,2.61,8.1,
PRINIZIDE (ZESTORECTIC) 12.5MG,2508380,CDM,637,RC,,,outpatient,,,10,4.00,,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,7.7,77,,6.16,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,8.2,82,,6.56,percent of total billed charges,82% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,9,90,,7.2,percent of total billed charges,90% of total billed charges,8,80,,6.4,percent of total billed charges,80% of total billed charges,9,90,,7.2,percent of total billed charges,90% of total billed charges,7.5,75,,6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.9,29,,2.32,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,6.7,67,,5.36,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,8,80,,6.4,percent of total billed charges,80% of total billed charges,6.5,65,,5.2,percent of total billed charges,65% of total billed charges,3.57,35.67,,2.856,percent of total billed charges,35.67% of total billed charges,2.9,9,
PROAMATINE 10 MG TAB,2508391,CDM,637,RC,,,outpatient,,,24,9.60,,20.4,85,,16.32,percent of total billed charges,85% of total billed charges,18.48,77,,14.78,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,19.68,82,,15.744,percent of total billed charges,82% of total billed charges,20.4,85,,16.32,percent of total billed charges,85% of total billed charges,20.4,85,,16.32,percent of total billed charges,85% of total billed charges,20.4,85,,16.32,percent of total billed charges,85% of total billed charges,21.6,90,,17.28,percent of total billed charges,90% of total billed charges,19.2,80,,15.36,percent of total billed charges,80% of total billed charges,21.6,90,,17.28,percent of total billed charges,90% of total billed charges,18,75,,14.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,6.96,29,,5.568,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,16.08,67,,12.864,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,19.2,80,,15.36,percent of total billed charges,80% of total billed charges,15.6,65,,12.48,percent of total billed charges,65% of total billed charges,8.56,35.67,,6.848,percent of total billed charges,35.67% of total billed charges,6.96,21.6,
PRISTIQ 50 MG TAB,2508392,CDM,637,RC,,,outpatient,,,25,10.00,,21.25,85,,17,percent of total billed charges,85% of total billed charges,19.25,77,,15.4,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,20.5,82,,16.4,percent of total billed charges,82% of total billed charges,21.25,85,,17,percent of total billed charges,85% of total billed charges,21.25,85,,17,percent of total billed charges,85% of total billed charges,21.25,85,,17,percent of total billed charges,85% of total billed charges,22.5,90,,18,percent of total billed charges,90% of total billed charges,20,80,,16,percent of total billed charges,80% of total billed charges,22.5,90,,18,percent of total billed charges,90% of total billed charges,18.75,75,,15,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,7.25,29,,5.8,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,16.75,67,,13.4,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,20,80,,16,percent of total billed charges,80% of total billed charges,16.25,65,,13,percent of total billed charges,65% of total billed charges,8.92,35.67,,7.136,percent of total billed charges,35.67% of total billed charges,7.25,22.5,
PROLIXIN 1 MG TAB,2508460,CDM,637,RC,,,outpatient,,,7,2.80,,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.39,77,,4.31,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,5.74,82,,4.592,percent of total billed charges,82% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.25,75,,4.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.03,29,,1.624,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4.69,67,,3.752,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,4.55,65,,3.64,percent of total billed charges,65% of total billed charges,2.5,35.67,,2,percent of total billed charges,35.67% of total billed charges,2.03,6.3,
PROPINE OPTH SO,2508535,CDM,637,RC,,,outpatient,,,53,21.20,,45.05,85,,36.04,percent of total billed charges,85% of total billed charges,40.81,77,,32.65,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,43.46,82,,34.768,percent of total billed charges,82% of total billed charges,45.05,85,,36.04,percent of total billed charges,85% of total billed charges,45.05,85,,36.04,percent of total billed charges,85% of total billed charges,45.05,85,,36.04,percent of total billed charges,85% of total billed charges,47.7,90,,38.16,percent of total billed charges,90% of total billed charges,42.4,80,,33.92,percent of total billed charges,80% of total billed charges,47.7,90,,38.16,percent of total billed charges,90% of total billed charges,39.75,75,,31.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,15.37,29,,12.296,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,35.51,67,,28.408,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,42.4,80,,33.92,percent of total billed charges,80% of total billed charges,34.45,65,,27.56,percent of total billed charges,65% of total billed charges,18.91,35.67,,15.128,percent of total billed charges,35.67% of total billed charges,15.37,47.7,
PROVENTIL (VENTOLIN) INH 17GM,2508615,CDM,637,RC,,,outpatient,,,131,52.40,,111.35,85,,89.08,percent of total billed charges,85% of total billed charges,100.87,77,,80.7,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,107.42,82,,85.936,percent of total billed charges,82% of total billed charges,111.35,85,,89.08,percent of total billed charges,85% of total billed charges,111.35,85,,89.08,percent of total billed charges,85% of total billed charges,111.35,85,,89.08,percent of total billed charges,85% of total billed charges,117.9,90,,94.32,percent of total billed charges,90% of total billed charges,104.8,80,,83.84,percent of total billed charges,80% of total billed charges,117.9,90,,94.32,percent of total billed charges,90% of total billed charges,98.25,75,,78.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,37.99,29,,30.392,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,87.77,67,,70.216,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,104.8,80,,83.84,percent of total billed charges,80% of total billed charges,85.15,65,,68.12,percent of total billed charges,65% of total billed charges,46.73,35.67,,37.384,percent of total billed charges,35.67% of total billed charges,37.99,117.9,
PROVIDEX SMALL AMOUNT ER/OUT,2508648,CDM,637,RC,,,outpatient,,,15,6.00,,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,11.55,77,,9.24,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,12.3,82,,9.84,percent of total billed charges,82% of total billed charges,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,13.5,90,,10.8,percent of total billed charges,90% of total billed charges,12,80,,9.6,percent of total billed charges,80% of total billed charges,13.5,90,,10.8,percent of total billed charges,90% of total billed charges,11.25,75,,9,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,4.35,29,,3.48,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,10.05,67,,8.04,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,12,80,,9.6,percent of total billed charges,80% of total billed charges,9.75,65,,7.8,percent of total billed charges,65% of total billed charges,5.35,35.67,,4.28,percent of total billed charges,35.67% of total billed charges,4.35,13.5,
PROZAC 20 MG TAB,2508655,CDM,637,RC,,,outpatient,,,29,11.60,,24.65,85,,19.72,percent of total billed charges,85% of total billed charges,22.33,77,,17.86,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,23.78,82,,19.024,percent of total billed charges,82% of total billed charges,24.65,85,,19.72,percent of total billed charges,85% of total billed charges,24.65,85,,19.72,percent of total billed charges,85% of total billed charges,24.65,85,,19.72,percent of total billed charges,85% of total billed charges,26.1,90,,20.88,percent of total billed charges,90% of total billed charges,23.2,80,,18.56,percent of total billed charges,80% of total billed charges,26.1,90,,20.88,percent of total billed charges,90% of total billed charges,21.75,75,,17.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,8.41,29,,6.728,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,19.43,67,,15.544,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,23.2,80,,18.56,percent of total billed charges,80% of total billed charges,18.85,65,,15.08,percent of total billed charges,65% of total billed charges,10.34,35.67,,8.272,percent of total billed charges,35.67% of total billed charges,8.41,26.1,
PYRAZINAMIDE TABLET,2508701,CDM,637,RC,,,outpatient,,,41,16.40,,34.85,85,,27.88,percent of total billed charges,85% of total billed charges,31.57,77,,25.26,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,33.62,82,,26.896,percent of total billed charges,82% of total billed charges,34.85,85,,27.88,percent of total billed charges,85% of total billed charges,34.85,85,,27.88,percent of total billed charges,85% of total billed charges,34.85,85,,27.88,percent of total billed charges,85% of total billed charges,36.9,90,,29.52,percent of total billed charges,90% of total billed charges,32.8,80,,26.24,percent of total billed charges,80% of total billed charges,36.9,90,,29.52,percent of total billed charges,90% of total billed charges,30.75,75,,24.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,11.89,29,,9.512,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,27.47,67,,21.976,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,32.8,80,,26.24,percent of total billed charges,80% of total billed charges,26.65,65,,21.32,percent of total billed charges,65% of total billed charges,14.62,35.67,,11.696,percent of total billed charges,35.67% of total billed charges,11.89,36.9,
RAPAFLO 8 MG CAPSULE,2508773,CDM,637,RC,,,outpatient,,,23,9.20,,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,17.71,77,,14.17,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,18.86,82,,15.088,percent of total billed charges,82% of total billed charges,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,20.7,90,,16.56,percent of total billed charges,90% of total billed charges,18.4,80,,14.72,percent of total billed charges,80% of total billed charges,20.7,90,,16.56,percent of total billed charges,90% of total billed charges,17.25,75,,13.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,6.67,29,,5.336,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,15.41,67,,12.328,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,18.4,80,,14.72,percent of total billed charges,80% of total billed charges,14.95,65,,11.96,percent of total billed charges,65% of total billed charges,8.2,35.67,,6.56,percent of total billed charges,35.67% of total billed charges,6.67,20.7,
RELAFEN 500 MG TAB,2508825,CDM,637,RC,,,outpatient,,,8,3.20,,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,6.16,77,,4.93,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,6.56,82,,5.248,percent of total billed charges,82% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,7.2,90,,5.76,percent of total billed charges,90% of total billed charges,6.4,80,,5.12,percent of total billed charges,80% of total billed charges,7.2,90,,5.76,percent of total billed charges,90% of total billed charges,6,75,,4.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.32,29,,1.856,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,5.36,67,,4.288,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,6.4,80,,5.12,percent of total billed charges,80% of total billed charges,5.2,65,,4.16,percent of total billed charges,65% of total billed charges,2.85,35.67,,2.28,percent of total billed charges,35.67% of total billed charges,2.32,7.2,
RETROVIR 100 MG CAP,2508837,CDM,637,RC,,,outpatient,,,12,4.80,,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,9.24,77,,7.39,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,9.84,82,,7.872,percent of total billed charges,82% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,10.8,90,,8.64,percent of total billed charges,90% of total billed charges,9.6,80,,7.68,percent of total billed charges,80% of total billed charges,10.8,90,,8.64,percent of total billed charges,90% of total billed charges,9,75,,7.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,3.48,29,,2.784,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,8.04,67,,6.432,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,9.6,80,,7.68,percent of total billed charges,80% of total billed charges,7.8,65,,6.24,percent of total billed charges,65% of total billed charges,4.28,35.67,,3.424,percent of total billed charges,35.67% of total billed charges,3.48,10.8,
RENAGEL 800 MG TAB,2508841,CDM,637,RC,,,outpatient,,,18,7.20,,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,13.86,77,,11.09,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,14.76,82,,11.808,percent of total billed charges,82% of total billed charges,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,16.2,90,,12.96,percent of total billed charges,90% of total billed charges,14.4,80,,11.52,percent of total billed charges,80% of total billed charges,16.2,90,,12.96,percent of total billed charges,90% of total billed charges,13.5,75,,10.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,5.22,29,,4.176,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,12.06,67,,9.648,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,14.4,80,,11.52,percent of total billed charges,80% of total billed charges,11.7,65,,9.36,percent of total billed charges,65% of total billed charges,6.42,35.67,,5.136,percent of total billed charges,35.67% of total billed charges,5.22,16.2,
RENAX CAPLET,2508842,CDM,637,RC,,,outpatient,,,7,2.80,,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.39,77,,4.31,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,5.74,82,,4.592,percent of total billed charges,82% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.25,75,,4.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.03,29,,1.624,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4.69,67,,3.752,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,4.55,65,,3.64,percent of total billed charges,65% of total billed charges,2.5,35.67,,2,percent of total billed charges,35.67% of total billed charges,2.03,6.3,
RELPAX 20 MG TAB,2508846,CDM,637,RC,,,outpatient,,,131,52.40,,111.35,85,,89.08,percent of total billed charges,85% of total billed charges,100.87,77,,80.7,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,107.42,82,,85.936,percent of total billed charges,82% of total billed charges,111.35,85,,89.08,percent of total billed charges,85% of total billed charges,111.35,85,,89.08,percent of total billed charges,85% of total billed charges,111.35,85,,89.08,percent of total billed charges,85% of total billed charges,117.9,90,,94.32,percent of total billed charges,90% of total billed charges,104.8,80,,83.84,percent of total billed charges,80% of total billed charges,117.9,90,,94.32,percent of total billed charges,90% of total billed charges,98.25,75,,78.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,37.99,29,,30.392,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,87.77,67,,70.216,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,104.8,80,,83.84,percent of total billed charges,80% of total billed charges,85.15,65,,68.12,percent of total billed charges,65% of total billed charges,46.73,35.67,,37.384,percent of total billed charges,35.67% of total billed charges,37.99,117.9,
RESERPINE 0.25 MG/TAB,2508850,CDM,637,RC,,,outpatient,,,7,2.80,,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.39,77,,4.31,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,5.74,82,,4.592,percent of total billed charges,82% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.25,75,,4.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.03,29,,1.624,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4.69,67,,3.752,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,4.55,65,,3.64,percent of total billed charges,65% of total billed charges,2.5,35.67,,2,percent of total billed charges,35.67% of total billed charges,2.03,6.3,
RHINOCORT NASAL SPRAY,2508863,CDM,637,RC,,,outpatient,,,177,70.80,,150.45,85,,120.36,percent of total billed charges,85% of total billed charges,136.29,77,,109.03,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,145.14,82,,116.112,percent of total billed charges,82% of total billed charges,150.45,85,,120.36,percent of total billed charges,85% of total billed charges,150.45,85,,120.36,percent of total billed charges,85% of total billed charges,150.45,85,,120.36,percent of total billed charges,85% of total billed charges,159.3,90,,127.44,percent of total billed charges,90% of total billed charges,141.6,80,,113.28,percent of total billed charges,80% of total billed charges,159.3,90,,127.44,percent of total billed charges,90% of total billed charges,132.75,75,,106.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,51.33,29,,41.064,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,118.59,67,,94.872,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,141.6,80,,113.28,percent of total billed charges,80% of total billed charges,115.05,65,,92.04,percent of total billed charges,65% of total billed charges,63.14,35.67,,50.512,percent of total billed charges,35.67% of total billed charges,51.33,159.3,
RIFADIN 150 MG PO,2508879,CDM,637,RC,,,outpatient,,,14,5.60,,11.9,85,,9.52,percent of total billed charges,85% of total billed charges,10.78,77,,8.62,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,11.48,82,,9.184,percent of total billed charges,82% of total billed charges,11.9,85,,9.52,percent of total billed charges,85% of total billed charges,11.9,85,,9.52,percent of total billed charges,85% of total billed charges,11.9,85,,9.52,percent of total billed charges,85% of total billed charges,12.6,90,,10.08,percent of total billed charges,90% of total billed charges,11.2,80,,8.96,percent of total billed charges,80% of total billed charges,12.6,90,,10.08,percent of total billed charges,90% of total billed charges,10.5,75,,8.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,4.06,29,,3.248,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,9.38,67,,7.504,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,11.2,80,,8.96,percent of total billed charges,80% of total billed charges,9.1,65,,7.28,percent of total billed charges,65% of total billed charges,4.99,35.67,,3.992,percent of total billed charges,35.67% of total billed charges,4.06,12.6,
ROBAXIN 500 MG TAB,2508930,CDM,637,RC,,,outpatient,,,9,3.60,,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,6.93,77,,5.54,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,7.38,82,,5.904,percent of total billed charges,82% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,8.1,90,,6.48,percent of total billed charges,90% of total billed charges,7.2,80,,5.76,percent of total billed charges,80% of total billed charges,8.1,90,,6.48,percent of total billed charges,90% of total billed charges,6.75,75,,5.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.61,29,,2.088,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,6.03,67,,4.824,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,7.2,80,,5.76,percent of total billed charges,80% of total billed charges,5.85,65,,4.68,percent of total billed charges,65% of total billed charges,3.21,35.67,,2.568,percent of total billed charges,35.67% of total billed charges,2.61,8.1,
ROBINUL PH TAB,2508970,CDM,637,RC,,,outpatient,,,12,4.80,,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,9.24,77,,7.39,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,9.84,82,,7.872,percent of total billed charges,82% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,10.8,90,,8.64,percent of total billed charges,90% of total billed charges,9.6,80,,7.68,percent of total billed charges,80% of total billed charges,10.8,90,,8.64,percent of total billed charges,90% of total billed charges,9,75,,7.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,3.48,29,,2.784,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,8.04,67,,6.432,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,9.6,80,,7.68,percent of total billed charges,80% of total billed charges,7.8,65,,6.24,percent of total billed charges,65% of total billed charges,4.28,35.67,,3.424,percent of total billed charges,35.67% of total billed charges,3.48,10.8,
ROBITUSSIN 2.5CC SYRUP,2508980,CDM,637,RC,,,outpatient,,,7,2.80,,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.39,77,,4.31,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,5.74,82,,4.592,percent of total billed charges,82% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.25,75,,4.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.03,29,,1.624,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4.69,67,,3.752,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,4.55,65,,3.64,percent of total billed charges,65% of total billed charges,2.5,35.67,,2,percent of total billed charges,35.67% of total billed charges,2.03,6.3,
ROBITUSSIN LIQ 5CC,2509015,CDM,637,RC,,,outpatient,,,7,2.80,,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.39,77,,4.31,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,5.74,82,,4.592,percent of total billed charges,82% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.25,75,,4.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.03,29,,1.624,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4.69,67,,3.752,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,4.55,65,,3.64,percent of total billed charges,65% of total billed charges,2.5,35.67,,2,percent of total billed charges,35.67% of total billed charges,2.03,6.3,
ROBITUSSIN 15 CC,2509021,CDM,637,RC,,,outpatient,,,8,3.20,,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,6.16,77,,4.93,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,6.56,82,,5.248,percent of total billed charges,82% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,7.2,90,,5.76,percent of total billed charges,90% of total billed charges,6.4,80,,5.12,percent of total billed charges,80% of total billed charges,7.2,90,,5.76,percent of total billed charges,90% of total billed charges,6,75,,4.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.32,29,,1.856,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,5.36,67,,4.288,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,6.4,80,,5.12,percent of total billed charges,80% of total billed charges,5.2,65,,4.16,percent of total billed charges,65% of total billed charges,2.85,35.67,,2.28,percent of total billed charges,35.67% of total billed charges,2.32,7.2,
RONDEC DM 5 CC,2509160,CDM,637,RC,,,outpatient,,,9,3.60,,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,6.93,77,,5.54,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,7.38,82,,5.904,percent of total billed charges,82% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,8.1,90,,6.48,percent of total billed charges,90% of total billed charges,7.2,80,,5.76,percent of total billed charges,80% of total billed charges,8.1,90,,6.48,percent of total billed charges,90% of total billed charges,6.75,75,,5.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.61,29,,2.088,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,6.03,67,,4.824,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,7.2,80,,5.76,percent of total billed charges,80% of total billed charges,5.85,65,,4.68,percent of total billed charges,65% of total billed charges,3.21,35.67,,2.568,percent of total billed charges,35.67% of total billed charges,2.61,8.1,
ROXISOL LIQ. 1CC,2509175,CDM,637,RC,,,outpatient,,,8,3.20,,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,6.16,77,,4.93,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,6.56,82,,5.248,percent of total billed charges,82% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,7.2,90,,5.76,percent of total billed charges,90% of total billed charges,6.4,80,,5.12,percent of total billed charges,80% of total billed charges,7.2,90,,5.76,percent of total billed charges,90% of total billed charges,6,75,,4.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.32,29,,1.856,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,5.36,67,,4.288,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,6.4,80,,5.12,percent of total billed charges,80% of total billed charges,5.2,65,,4.16,percent of total billed charges,65% of total billed charges,2.85,35.67,,2.28,percent of total billed charges,35.67% of total billed charges,2.32,7.2,
ROZEREM 8 MG TAB,2509184,CDM,637,RC,,,outpatient,,,32,12.80,,27.2,85,,21.76,percent of total billed charges,85% of total billed charges,24.64,77,,19.71,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,26.24,82,,20.992,percent of total billed charges,82% of total billed charges,27.2,85,,21.76,percent of total billed charges,85% of total billed charges,27.2,85,,21.76,percent of total billed charges,85% of total billed charges,27.2,85,,21.76,percent of total billed charges,85% of total billed charges,28.8,90,,23.04,percent of total billed charges,90% of total billed charges,25.6,80,,20.48,percent of total billed charges,80% of total billed charges,28.8,90,,23.04,percent of total billed charges,90% of total billed charges,24,75,,19.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,9.28,29,,7.424,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,21.44,67,,17.152,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,25.6,80,,20.48,percent of total billed charges,80% of total billed charges,20.8,65,,16.64,percent of total billed charges,65% of total billed charges,11.41,35.67,,9.128,percent of total billed charges,35.67% of total billed charges,9.28,28.8,
SENOKOT TAB,2509295,CDM,637,RC,,,outpatient,,,8,3.20,,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,6.16,77,,4.93,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,6.56,82,,5.248,percent of total billed charges,82% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,7.2,90,,5.76,percent of total billed charges,90% of total billed charges,6.4,80,,5.12,percent of total billed charges,80% of total billed charges,7.2,90,,5.76,percent of total billed charges,90% of total billed charges,6,75,,4.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.32,29,,1.856,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,5.36,67,,4.288,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,6.4,80,,5.12,percent of total billed charges,80% of total billed charges,5.2,65,,4.16,percent of total billed charges,65% of total billed charges,2.85,35.67,,2.28,percent of total billed charges,35.67% of total billed charges,2.32,7.2,
SEPTRA SUSPENSION 60 ML BOTTLE,2509304,CDM,637,RC,,,outpatient,,,29,11.60,,24.65,85,,19.72,percent of total billed charges,85% of total billed charges,22.33,77,,17.86,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,23.78,82,,19.024,percent of total billed charges,82% of total billed charges,24.65,85,,19.72,percent of total billed charges,85% of total billed charges,24.65,85,,19.72,percent of total billed charges,85% of total billed charges,24.65,85,,19.72,percent of total billed charges,85% of total billed charges,26.1,90,,20.88,percent of total billed charges,90% of total billed charges,23.2,80,,18.56,percent of total billed charges,80% of total billed charges,26.1,90,,20.88,percent of total billed charges,90% of total billed charges,21.75,75,,17.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,8.41,29,,6.728,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,19.43,67,,15.544,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,23.2,80,,18.56,percent of total billed charges,80% of total billed charges,18.85,65,,15.08,percent of total billed charges,65% of total billed charges,10.34,35.67,,8.272,percent of total billed charges,35.67% of total billed charges,8.41,26.1,
"SEPTRA SUSPENSION, 5 ML UDC",2509307,CDM,637,RC,,,outpatient,,,17,6.80,,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,13.09,77,,10.47,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,13.94,82,,11.152,percent of total billed charges,82% of total billed charges,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,15.3,90,,12.24,percent of total billed charges,90% of total billed charges,13.6,80,,10.88,percent of total billed charges,80% of total billed charges,15.3,90,,12.24,percent of total billed charges,90% of total billed charges,12.75,75,,10.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,4.93,29,,3.944,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,11.39,67,,9.112,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,13.6,80,,10.88,percent of total billed charges,80% of total billed charges,11.05,65,,8.84,percent of total billed charges,65% of total billed charges,6.06,35.67,,4.848,percent of total billed charges,35.67% of total billed charges,4.93,15.3,
SEROQUEL XR 50 MG TAB,2509341,CDM,637,RC,,,outpatient,,,29,11.60,,24.65,85,,19.72,percent of total billed charges,85% of total billed charges,22.33,77,,17.86,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,23.78,82,,19.024,percent of total billed charges,82% of total billed charges,24.65,85,,19.72,percent of total billed charges,85% of total billed charges,24.65,85,,19.72,percent of total billed charges,85% of total billed charges,24.65,85,,19.72,percent of total billed charges,85% of total billed charges,26.1,90,,20.88,percent of total billed charges,90% of total billed charges,23.2,80,,18.56,percent of total billed charges,80% of total billed charges,26.1,90,,20.88,percent of total billed charges,90% of total billed charges,21.75,75,,17.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,8.41,29,,6.728,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,19.43,67,,15.544,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,23.2,80,,18.56,percent of total billed charges,80% of total billed charges,18.85,65,,15.08,percent of total billed charges,65% of total billed charges,10.34,35.67,,8.272,percent of total billed charges,35.67% of total billed charges,8.41,26.1,
SINEMET CR 25/100 TABS,2509378,CDM,637,RC,,,outpatient,,,8,3.20,,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,6.16,77,,4.93,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,6.56,82,,5.248,percent of total billed charges,82% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,7.2,90,,5.76,percent of total billed charges,90% of total billed charges,6.4,80,,5.12,percent of total billed charges,80% of total billed charges,7.2,90,,5.76,percent of total billed charges,90% of total billed charges,6,75,,4.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.32,29,,1.856,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,5.36,67,,4.288,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,6.4,80,,5.12,percent of total billed charges,80% of total billed charges,5.2,65,,4.16,percent of total billed charges,65% of total billed charges,2.85,35.67,,2.28,percent of total billed charges,35.67% of total billed charges,2.32,7.2,
SINEQUAN 50 MG CAP,2509400,CDM,637,RC,,,outpatient,,,7,2.80,,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.39,77,,4.31,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,5.74,82,,4.592,percent of total billed charges,82% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.25,75,,4.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.03,29,,1.624,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4.69,67,,3.752,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,4.55,65,,3.64,percent of total billed charges,65% of total billed charges,2.5,35.67,,2,percent of total billed charges,35.67% of total billed charges,2.03,6.3,
SINEQUAN 100 MG CAP,2509406,CDM,637,RC,,,outpatient,,,9,3.60,,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,6.93,77,,5.54,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,7.38,82,,5.904,percent of total billed charges,82% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,8.1,90,,6.48,percent of total billed charges,90% of total billed charges,7.2,80,,5.76,percent of total billed charges,80% of total billed charges,8.1,90,,6.48,percent of total billed charges,90% of total billed charges,6.75,75,,5.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.61,29,,2.088,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,6.03,67,,4.824,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,7.2,80,,5.76,percent of total billed charges,80% of total billed charges,5.85,65,,4.68,percent of total billed charges,65% of total billed charges,3.21,35.67,,2.568,percent of total billed charges,35.67% of total billed charges,2.61,8.1,
SINGULAIR CHEWTAB 5 MG PO,2509418,CDM,637,RC,,,outpatient,,,25,10.00,,21.25,85,,17,percent of total billed charges,85% of total billed charges,19.25,77,,15.4,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,20.5,82,,16.4,percent of total billed charges,82% of total billed charges,21.25,85,,17,percent of total billed charges,85% of total billed charges,21.25,85,,17,percent of total billed charges,85% of total billed charges,21.25,85,,17,percent of total billed charges,85% of total billed charges,22.5,90,,18,percent of total billed charges,90% of total billed charges,20,80,,16,percent of total billed charges,80% of total billed charges,22.5,90,,18,percent of total billed charges,90% of total billed charges,18.75,75,,15,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,7.25,29,,5.8,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,16.75,67,,13.4,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,20,80,,16,percent of total billed charges,80% of total billed charges,16.25,65,,13,percent of total billed charges,65% of total billed charges,8.92,35.67,,7.136,percent of total billed charges,35.67% of total billed charges,7.25,22.5,
SINGULAIR 4 MG GRANUALES 1 PKT,2509421,CDM,637,RC,,,outpatient,,,16,6.40,,13.6,85,,10.88,percent of total billed charges,85% of total billed charges,12.32,77,,9.86,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,13.12,82,,10.496,percent of total billed charges,82% of total billed charges,13.6,85,,10.88,percent of total billed charges,85% of total billed charges,13.6,85,,10.88,percent of total billed charges,85% of total billed charges,13.6,85,,10.88,percent of total billed charges,85% of total billed charges,14.4,90,,11.52,percent of total billed charges,90% of total billed charges,12.8,80,,10.24,percent of total billed charges,80% of total billed charges,14.4,90,,11.52,percent of total billed charges,90% of total billed charges,12,75,,9.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,4.64,29,,3.712,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,10.72,67,,8.576,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,12.8,80,,10.24,percent of total billed charges,80% of total billed charges,10.4,65,,8.32,percent of total billed charges,65% of total billed charges,5.71,35.67,,4.568,percent of total billed charges,35.67% of total billed charges,4.64,14.4,
SKELAXIN TAB 800 MG,2509426,CDM,637,RC,,,outpatient,,,22,8.80,,18.7,85,,14.96,percent of total billed charges,85% of total billed charges,16.94,77,,13.55,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,18.04,82,,14.432,percent of total billed charges,82% of total billed charges,18.7,85,,14.96,percent of total billed charges,85% of total billed charges,18.7,85,,14.96,percent of total billed charges,85% of total billed charges,18.7,85,,14.96,percent of total billed charges,85% of total billed charges,19.8,90,,15.84,percent of total billed charges,90% of total billed charges,17.6,80,,14.08,percent of total billed charges,80% of total billed charges,19.8,90,,15.84,percent of total billed charges,90% of total billed charges,16.5,75,,13.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,6.38,29,,5.104,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,14.74,67,,11.792,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,17.6,80,,14.08,percent of total billed charges,80% of total billed charges,14.3,65,,11.44,percent of total billed charges,65% of total billed charges,7.85,35.67,,6.28,percent of total billed charges,35.67% of total billed charges,6.38,19.8,
SLOPHYLLIN 80MG 5CC,2509465,CDM,637,RC,,,outpatient,,,20,8.00,,17,85,,13.6,percent of total billed charges,85% of total billed charges,15.4,77,,12.32,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,16.4,82,,13.12,percent of total billed charges,82% of total billed charges,17,85,,13.6,percent of total billed charges,85% of total billed charges,17,85,,13.6,percent of total billed charges,85% of total billed charges,17,85,,13.6,percent of total billed charges,85% of total billed charges,18,90,,14.4,percent of total billed charges,90% of total billed charges,16,80,,12.8,percent of total billed charges,80% of total billed charges,18,90,,14.4,percent of total billed charges,90% of total billed charges,15,75,,12,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,5.8,29,,4.64,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,13.4,67,,10.72,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,16,80,,12.8,percent of total billed charges,80% of total billed charges,13,65,,10.4,percent of total billed charges,65% of total billed charges,7.13,35.67,,5.704,percent of total billed charges,35.67% of total billed charges,5.8,18,
SLOW FE TAB,2509480,CDM,637,RC,,,outpatient,,,7,2.80,,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.39,77,,4.31,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,5.74,82,,4.592,percent of total billed charges,82% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.25,75,,4.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.03,29,,1.624,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4.69,67,,3.752,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,4.55,65,,3.64,percent of total billed charges,65% of total billed charges,2.5,35.67,,2,percent of total billed charges,35.67% of total billed charges,2.03,6.3,
SLOW MAG TAB,2509490,CDM,637,RC,,,outpatient,,,7,2.80,,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.39,77,,4.31,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,5.74,82,,4.592,percent of total billed charges,82% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.25,75,,4.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.03,29,,1.624,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4.69,67,,3.752,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,4.55,65,,3.64,percent of total billed charges,65% of total billed charges,2.5,35.67,,2,percent of total billed charges,35.67% of total billed charges,2.03,6.3,
"SM AMT E,N,E&T GTTS-ER",2509495,CDM,637,RC,,,outpatient,,,6,2.40,,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,4.62,77,,3.7,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,4.92,82,,3.936,percent of total billed charges,82% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,5.4,90,,4.32,percent of total billed charges,90% of total billed charges,4.8,80,,3.84,percent of total billed charges,80% of total billed charges,5.4,90,,4.32,percent of total billed charges,90% of total billed charges,4.5,75,,3.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,1.74,29,,1.392,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4.02,67,,3.216,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,4.8,80,,3.84,percent of total billed charges,80% of total billed charges,3.9,65,,3.12,percent of total billed charges,65% of total billed charges,2.14,35.67,,1.712,percent of total billed charges,35.67% of total billed charges,1.74,5.4,
SM AMT OF OINTMENT/CREAM,2509497,CDM,637,RC,,,outpatient,,,7,2.80,,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.39,77,,4.31,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,5.74,82,,4.592,percent of total billed charges,82% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.25,75,,4.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.03,29,,1.624,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4.69,67,,3.752,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,4.55,65,,3.64,percent of total billed charges,65% of total billed charges,2.5,35.67,,2,percent of total billed charges,35.67% of total billed charges,2.03,6.3,
SODIUM CHLORIDE 1000 MG TAB,2509532,CDM,637,RC,,,outpatient,,,7,2.80,,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.39,77,,4.31,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,5.74,82,,4.592,percent of total billed charges,82% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.25,75,,4.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.03,29,,1.624,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4.69,67,,3.752,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,4.55,65,,3.64,percent of total billed charges,65% of total billed charges,2.5,35.67,,2,percent of total billed charges,35.67% of total billed charges,2.03,6.3,
SOMA 350MG TAB,2509595,CDM,637,RC,,,outpatient,,,30,12.00,,25.5,85,,20.4,percent of total billed charges,85% of total billed charges,23.1,77,,18.48,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,24.6,82,,19.68,percent of total billed charges,82% of total billed charges,25.5,85,,20.4,percent of total billed charges,85% of total billed charges,25.5,85,,20.4,percent of total billed charges,85% of total billed charges,25.5,85,,20.4,percent of total billed charges,85% of total billed charges,27,90,,21.6,percent of total billed charges,90% of total billed charges,24,80,,19.2,percent of total billed charges,80% of total billed charges,27,90,,21.6,percent of total billed charges,90% of total billed charges,22.5,75,,18,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,8.7,29,,6.96,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,20.1,67,,16.08,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,24,80,,19.2,percent of total billed charges,80% of total billed charges,19.5,65,,15.6,percent of total billed charges,65% of total billed charges,10.7,35.67,,8.56,percent of total billed charges,35.67% of total billed charges,8.7,27,
SONATA 5 MG PO,2509609,CDM,637,RC,,,outpatient,,,16,6.40,,13.6,85,,10.88,percent of total billed charges,85% of total billed charges,12.32,77,,9.86,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,13.12,82,,10.496,percent of total billed charges,82% of total billed charges,13.6,85,,10.88,percent of total billed charges,85% of total billed charges,13.6,85,,10.88,percent of total billed charges,85% of total billed charges,13.6,85,,10.88,percent of total billed charges,85% of total billed charges,14.4,90,,11.52,percent of total billed charges,90% of total billed charges,12.8,80,,10.24,percent of total billed charges,80% of total billed charges,14.4,90,,11.52,percent of total billed charges,90% of total billed charges,12,75,,9.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,4.64,29,,3.712,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,10.72,67,,8.576,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,12.8,80,,10.24,percent of total billed charges,80% of total billed charges,10.4,65,,8.32,percent of total billed charges,65% of total billed charges,5.71,35.67,,4.568,percent of total billed charges,35.67% of total billed charges,4.64,14.4,
SPECTAZOLE 1% CREAM 15 GM,2509611,CDM,637,RC,,,outpatient,,,74,29.60,,62.9,85,,50.32,percent of total billed charges,85% of total billed charges,56.98,77,,45.58,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,60.68,82,,48.544,percent of total billed charges,82% of total billed charges,62.9,85,,50.32,percent of total billed charges,85% of total billed charges,62.9,85,,50.32,percent of total billed charges,85% of total billed charges,62.9,85,,50.32,percent of total billed charges,85% of total billed charges,66.6,90,,53.28,percent of total billed charges,90% of total billed charges,59.2,80,,47.36,percent of total billed charges,80% of total billed charges,66.6,90,,53.28,percent of total billed charges,90% of total billed charges,55.5,75,,44.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,21.46,29,,17.168,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,49.58,67,,39.664,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,59.2,80,,47.36,percent of total billed charges,80% of total billed charges,48.1,65,,38.48,percent of total billed charges,65% of total billed charges,26.4,35.67,,21.12,percent of total billed charges,35.67% of total billed charges,21.46,66.6,
STRESSTABS 600 TAB,2509730,CDM,637,RC,,,outpatient,,,7,2.80,,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.39,77,,4.31,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,5.74,82,,4.592,percent of total billed charges,82% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.25,75,,4.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.03,29,,1.624,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4.69,67,,3.752,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,4.55,65,,3.64,percent of total billed charges,65% of total billed charges,2.5,35.67,,2,percent of total billed charges,35.67% of total billed charges,2.03,6.3,
SURBEX WITH IRON LIQ 5CC,2509760,CDM,637,RC,,,outpatient,,,6,2.40,,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,4.62,77,,3.7,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,4.92,82,,3.936,percent of total billed charges,82% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,5.4,90,,4.32,percent of total billed charges,90% of total billed charges,4.8,80,,3.84,percent of total billed charges,80% of total billed charges,5.4,90,,4.32,percent of total billed charges,90% of total billed charges,4.5,75,,3.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,1.74,29,,1.392,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4.02,67,,3.216,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,4.8,80,,3.84,percent of total billed charges,80% of total billed charges,3.9,65,,3.12,percent of total billed charges,65% of total billed charges,2.14,35.67,,1.712,percent of total billed charges,35.67% of total billed charges,1.74,5.4,
SUDAFED TAB 30 MG,2509775,CDM,637,RC,,,outpatient,,,7,2.80,,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.39,77,,4.31,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,5.74,82,,4.592,percent of total billed charges,82% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.25,75,,4.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.03,29,,1.624,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4.69,67,,3.752,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,4.55,65,,3.64,percent of total billed charges,65% of total billed charges,2.5,35.67,,2,percent of total billed charges,35.67% of total billed charges,2.03,6.3,
SULAR 20 MG TAB,2509782,CDM,637,RC,,,outpatient,,,13,5.20,,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,10.01,77,,8.01,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,10.66,82,,8.528,percent of total billed charges,82% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,11.7,90,,9.36,percent of total billed charges,90% of total billed charges,10.4,80,,8.32,percent of total billed charges,80% of total billed charges,11.7,90,,9.36,percent of total billed charges,90% of total billed charges,9.75,75,,7.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,3.77,29,,3.016,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,8.71,67,,6.968,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,10.4,80,,8.32,percent of total billed charges,80% of total billed charges,8.45,65,,6.76,percent of total billed charges,65% of total billed charges,4.64,35.67,,3.712,percent of total billed charges,35.67% of total billed charges,3.77,11.7,
SULAR 10 MG TAB,2509783,CDM,637,RC,,,outpatient,,,11,4.40,,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,8.47,77,,6.78,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,9.02,82,,7.216,percent of total billed charges,82% of total billed charges,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,9.9,90,,7.92,percent of total billed charges,90% of total billed charges,8.8,80,,7.04,percent of total billed charges,80% of total billed charges,9.9,90,,7.92,percent of total billed charges,90% of total billed charges,8.25,75,,6.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,3.19,29,,2.552,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,7.37,67,,5.896,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,8.8,80,,7.04,percent of total billed charges,80% of total billed charges,7.15,65,,5.72,percent of total billed charges,65% of total billed charges,3.92,35.67,,3.136,percent of total billed charges,35.67% of total billed charges,3.19,9.9,
SUPER B COMPLEX PO,2509787,CDM,637,RC,,,outpatient,,,7,2.80,,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.39,77,,4.31,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,5.74,82,,4.592,percent of total billed charges,82% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.25,75,,4.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.03,29,,1.624,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4.69,67,,3.752,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,4.55,65,,3.64,percent of total billed charges,65% of total billed charges,2.5,35.67,,2,percent of total billed charges,35.67% of total billed charges,2.03,6.3,
HUMULIN R ANY DOSE,2509812,CDM,637,RC,,,outpatient,,,9,3.60,,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,6.93,77,,5.54,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,7.38,82,,5.904,percent of total billed charges,82% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,8.1,90,,6.48,percent of total billed charges,90% of total billed charges,7.2,80,,5.76,percent of total billed charges,80% of total billed charges,8.1,90,,6.48,percent of total billed charges,90% of total billed charges,6.75,75,,5.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.61,29,,2.088,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,6.03,67,,4.824,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,7.2,80,,5.76,percent of total billed charges,80% of total billed charges,5.85,65,,4.68,percent of total billed charges,65% of total billed charges,3.21,35.67,,2.568,percent of total billed charges,35.67% of total billed charges,2.61,8.1,
SYMBICORT 160/4.5 MCG INHALER,2509837,CDM,637,RC,,,outpatient,,,407,162.80,,345.95,85,,276.76,percent of total billed charges,85% of total billed charges,313.39,77,,250.71,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,333.74,82,,266.992,percent of total billed charges,82% of total billed charges,345.95,85,,276.76,percent of total billed charges,85% of total billed charges,345.95,85,,276.76,percent of total billed charges,85% of total billed charges,345.95,85,,276.76,percent of total billed charges,85% of total billed charges,366.3,90,,293.04,percent of total billed charges,90% of total billed charges,325.6,80,,260.48,percent of total billed charges,80% of total billed charges,366.3,90,,293.04,percent of total billed charges,90% of total billed charges,305.25,75,,244.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,118.03,29,,94.424,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,272.69,67,,218.152,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,325.6,80,,260.48,percent of total billed charges,80% of total billed charges,264.55,65,,211.64,percent of total billed charges,65% of total billed charges,145.18,35.67,,116.144,percent of total billed charges,35.67% of total billed charges,118.03,366.3,
SYMBICORT 80/4.5 MCG INHALER,2509838,CDM,637,RC,,,outpatient,,,375,150.00,,318.75,85,,255,percent of total billed charges,85% of total billed charges,288.75,77,,231,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,307.5,82,,246,percent of total billed charges,82% of total billed charges,318.75,85,,255,percent of total billed charges,85% of total billed charges,318.75,85,,255,percent of total billed charges,85% of total billed charges,318.75,85,,255,percent of total billed charges,85% of total billed charges,337.5,90,,270,percent of total billed charges,90% of total billed charges,300,80,,240,percent of total billed charges,80% of total billed charges,337.5,90,,270,percent of total billed charges,90% of total billed charges,281.25,75,,225,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,108.75,29,,87,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,251.25,67,,201,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,300,80,,240,percent of total billed charges,80% of total billed charges,243.75,65,,195,percent of total billed charges,65% of total billed charges,133.76,35.67,,107.008,percent of total billed charges,35.67% of total billed charges,108.75,337.5,
SYNTHROID 0.1MG TAB,2509875,CDM,637,RC,,,outpatient,,,7,2.80,,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.39,77,,4.31,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,5.74,82,,4.592,percent of total billed charges,82% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.25,75,,4.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.03,29,,1.624,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4.69,67,,3.752,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,4.55,65,,3.64,percent of total billed charges,65% of total billed charges,2.5,35.67,,2,percent of total billed charges,35.67% of total billed charges,2.03,6.3,
TAGAMET 400 MG TAB,2509910,CDM,637,RC,,,outpatient,,,9,3.60,,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,6.93,77,,5.54,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,7.38,82,,5.904,percent of total billed charges,82% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,8.1,90,,6.48,percent of total billed charges,90% of total billed charges,7.2,80,,5.76,percent of total billed charges,80% of total billed charges,8.1,90,,6.48,percent of total billed charges,90% of total billed charges,6.75,75,,5.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.61,29,,2.088,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,6.03,67,,4.824,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,7.2,80,,5.76,percent of total billed charges,80% of total billed charges,5.85,65,,4.68,percent of total billed charges,65% of total billed charges,3.21,35.67,,2.568,percent of total billed charges,35.67% of total billed charges,2.61,8.1,
TALWIN NX TAB,2509935,CDM,637,RC,,,outpatient,,,9,3.60,,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,6.93,77,,5.54,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,7.38,82,,5.904,percent of total billed charges,82% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,8.1,90,,6.48,percent of total billed charges,90% of total billed charges,7.2,80,,5.76,percent of total billed charges,80% of total billed charges,8.1,90,,6.48,percent of total billed charges,90% of total billed charges,6.75,75,,5.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.61,29,,2.088,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,6.03,67,,4.824,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,7.2,80,,5.76,percent of total billed charges,80% of total billed charges,5.85,65,,4.68,percent of total billed charges,65% of total billed charges,3.21,35.67,,2.568,percent of total billed charges,35.67% of total billed charges,2.61,8.1,
TASMAR 200 MG PO,2509959,CDM,637,RC,,,outpatient,,,15,6.00,,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,11.55,77,,9.24,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,12.3,82,,9.84,percent of total billed charges,82% of total billed charges,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,13.5,90,,10.8,percent of total billed charges,90% of total billed charges,12,80,,9.6,percent of total billed charges,80% of total billed charges,13.5,90,,10.8,percent of total billed charges,90% of total billed charges,11.25,75,,9,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,4.35,29,,3.48,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,10.05,67,,8.04,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,12,80,,9.6,percent of total billed charges,80% of total billed charges,9.75,65,,7.8,percent of total billed charges,65% of total billed charges,5.35,35.67,,4.28,percent of total billed charges,35.67% of total billed charges,4.35,13.5,
TAMIFLU 12 MG/ML SUSP BOTTLE,2509962,CDM,637,RC,,,outpatient,,,173,69.20,,147.05,85,,117.64,percent of total billed charges,85% of total billed charges,133.21,77,,106.57,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,141.86,82,,113.488,percent of total billed charges,82% of total billed charges,147.05,85,,117.64,percent of total billed charges,85% of total billed charges,147.05,85,,117.64,percent of total billed charges,85% of total billed charges,147.05,85,,117.64,percent of total billed charges,85% of total billed charges,155.7,90,,124.56,percent of total billed charges,90% of total billed charges,138.4,80,,110.72,percent of total billed charges,80% of total billed charges,155.7,90,,124.56,percent of total billed charges,90% of total billed charges,129.75,75,,103.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,50.17,29,,40.136,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,115.91,67,,92.728,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,138.4,80,,110.72,percent of total billed charges,80% of total billed charges,112.45,65,,89.96,percent of total billed charges,65% of total billed charges,61.71,35.67,,49.368,percent of total billed charges,35.67% of total billed charges,50.17,155.7,
TANDEM CAPSULE,2509972,CDM,637,RC,,,outpatient,,,8,3.20,,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,6.16,77,,4.93,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,6.56,82,,5.248,percent of total billed charges,82% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,7.2,90,,5.76,percent of total billed charges,90% of total billed charges,6.4,80,,5.12,percent of total billed charges,80% of total billed charges,7.2,90,,5.76,percent of total billed charges,90% of total billed charges,6,75,,4.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.32,29,,1.856,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,5.36,67,,4.288,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,6.4,80,,5.12,percent of total billed charges,80% of total billed charges,5.2,65,,4.16,percent of total billed charges,65% of total billed charges,2.85,35.67,,2.28,percent of total billed charges,35.67% of total billed charges,2.32,7.2,
TANDEM OB,2509973,CDM,637,RC,,,outpatient,,,7,2.80,,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.39,77,,4.31,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,5.74,82,,4.592,percent of total billed charges,82% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.25,75,,4.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.03,29,,1.624,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4.69,67,,3.752,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,4.55,65,,3.64,percent of total billed charges,65% of total billed charges,2.5,35.67,,2,percent of total billed charges,35.67% of total billed charges,2.03,6.3,
TANDEM PLUS CAPSULE,2509974,CDM,637,RC,,,outpatient,,,7,2.80,,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.39,77,,4.31,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,5.74,82,,4.592,percent of total billed charges,82% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.25,75,,4.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.03,29,,1.624,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4.69,67,,3.752,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,4.55,65,,3.64,percent of total billed charges,65% of total billed charges,2.5,35.67,,2,percent of total billed charges,35.67% of total billed charges,2.03,6.3,
TEAR NATURAL II OPTH GTTS,2509975,CDM,637,RC,,,outpatient,,,41,16.40,,34.85,85,,27.88,percent of total billed charges,85% of total billed charges,31.57,77,,25.26,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,33.62,82,,26.896,percent of total billed charges,82% of total billed charges,34.85,85,,27.88,percent of total billed charges,85% of total billed charges,34.85,85,,27.88,percent of total billed charges,85% of total billed charges,34.85,85,,27.88,percent of total billed charges,85% of total billed charges,36.9,90,,29.52,percent of total billed charges,90% of total billed charges,32.8,80,,26.24,percent of total billed charges,80% of total billed charges,36.9,90,,29.52,percent of total billed charges,90% of total billed charges,30.75,75,,24.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,11.89,29,,9.512,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,27.47,67,,21.976,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,32.8,80,,26.24,percent of total billed charges,80% of total billed charges,26.65,65,,21.32,percent of total billed charges,65% of total billed charges,14.62,35.67,,11.696,percent of total billed charges,35.67% of total billed charges,11.89,36.9,
TAMIFLU 6 MG/ML 60 ML BOTTLE,2509981,CDM,637,RC,,,outpatient,,,67,26.80,,56.95,85,,45.56,percent of total billed charges,85% of total billed charges,51.59,77,,41.27,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,54.94,82,,43.952,percent of total billed charges,82% of total billed charges,56.95,85,,45.56,percent of total billed charges,85% of total billed charges,56.95,85,,45.56,percent of total billed charges,85% of total billed charges,56.95,85,,45.56,percent of total billed charges,85% of total billed charges,60.3,90,,48.24,percent of total billed charges,90% of total billed charges,53.6,80,,42.88,percent of total billed charges,80% of total billed charges,60.3,90,,48.24,percent of total billed charges,90% of total billed charges,50.25,75,,40.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,19.43,29,,15.544,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,44.89,67,,35.912,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,53.6,80,,42.88,percent of total billed charges,80% of total billed charges,43.55,65,,34.84,percent of total billed charges,65% of total billed charges,23.9,35.67,,19.12,percent of total billed charges,35.67% of total billed charges,19.43,60.3,
BYSTOLIC 10 MG PO,2509992,CDM,637,RC,,,outpatient,,,23,9.20,,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,17.71,77,,14.17,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,18.86,82,,15.088,percent of total billed charges,82% of total billed charges,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,20.7,90,,16.56,percent of total billed charges,90% of total billed charges,18.4,80,,14.72,percent of total billed charges,80% of total billed charges,20.7,90,,16.56,percent of total billed charges,90% of total billed charges,17.25,75,,13.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,6.67,29,,5.336,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,15.41,67,,12.328,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,18.4,80,,14.72,percent of total billed charges,80% of total billed charges,14.95,65,,11.96,percent of total billed charges,65% of total billed charges,8.2,35.67,,6.56,percent of total billed charges,35.67% of total billed charges,6.67,20.7,
BYSTOLIC  - NEBIVOLOL 5 MG PO,2509994,CDM,637,RC,,,outpatient,,,23,9.20,,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,17.71,77,,14.17,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,18.86,82,,15.088,percent of total billed charges,82% of total billed charges,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,20.7,90,,16.56,percent of total billed charges,90% of total billed charges,18.4,80,,14.72,percent of total billed charges,80% of total billed charges,20.7,90,,16.56,percent of total billed charges,90% of total billed charges,17.25,75,,13.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,6.67,29,,5.336,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,15.41,67,,12.328,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,18.4,80,,14.72,percent of total billed charges,80% of total billed charges,14.95,65,,11.96,percent of total billed charges,65% of total billed charges,8.2,35.67,,6.56,percent of total billed charges,35.67% of total billed charges,6.67,20.7,
TEGOPEN(CLOXACCILLIN)500MG CAP,2509995,CDM,637,RC,,,outpatient,,,10,4.00,,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,7.7,77,,6.16,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,8.2,82,,6.56,percent of total billed charges,82% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,9,90,,7.2,percent of total billed charges,90% of total billed charges,8,80,,6.4,percent of total billed charges,80% of total billed charges,9,90,,7.2,percent of total billed charges,90% of total billed charges,7.5,75,,6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.9,29,,2.32,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,6.7,67,,5.36,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,8,80,,6.4,percent of total billed charges,80% of total billed charges,6.5,65,,5.2,percent of total billed charges,65% of total billed charges,3.57,35.67,,2.856,percent of total billed charges,35.67% of total billed charges,2.9,9,
SUCRETS,2509998,CDM,637,RC,,,outpatient,,,11,4.40,,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,8.47,77,,6.78,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,9.02,82,,7.216,percent of total billed charges,82% of total billed charges,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,9.9,90,,7.92,percent of total billed charges,90% of total billed charges,8.8,80,,7.04,percent of total billed charges,80% of total billed charges,9.9,90,,7.92,percent of total billed charges,90% of total billed charges,8.25,75,,6.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,3.19,29,,2.552,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,7.37,67,,5.896,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,8.8,80,,7.04,percent of total billed charges,80% of total billed charges,7.15,65,,5.72,percent of total billed charges,65% of total billed charges,3.92,35.67,,3.136,percent of total billed charges,35.67% of total billed charges,3.19,9.9,
PULMICORT FLEXHALER 90 MCG,2510002,CDM,637,RC,,,outpatient,,,274,109.60,,232.9,85,,186.32,percent of total billed charges,85% of total billed charges,210.98,77,,168.78,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,224.68,82,,179.744,percent of total billed charges,82% of total billed charges,232.9,85,,186.32,percent of total billed charges,85% of total billed charges,232.9,85,,186.32,percent of total billed charges,85% of total billed charges,232.9,85,,186.32,percent of total billed charges,85% of total billed charges,246.6,90,,197.28,percent of total billed charges,90% of total billed charges,219.2,80,,175.36,percent of total billed charges,80% of total billed charges,246.6,90,,197.28,percent of total billed charges,90% of total billed charges,205.5,75,,164.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,79.46,29,,63.568,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,183.58,67,,146.864,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,219.2,80,,175.36,percent of total billed charges,80% of total billed charges,178.1,65,,142.48,percent of total billed charges,65% of total billed charges,97.74,35.67,,78.192,percent of total billed charges,35.67% of total billed charges,79.46,246.6,
TEGRETOL 200MG TAB,2510005,CDM,637,RC,,,outpatient,,,9,3.60,,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,6.93,77,,5.54,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,7.38,82,,5.904,percent of total billed charges,82% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,8.1,90,,6.48,percent of total billed charges,90% of total billed charges,7.2,80,,5.76,percent of total billed charges,80% of total billed charges,8.1,90,,6.48,percent of total billed charges,90% of total billed charges,6.75,75,,5.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.61,29,,2.088,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,6.03,67,,4.824,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,7.2,80,,5.76,percent of total billed charges,80% of total billed charges,5.85,65,,4.68,percent of total billed charges,65% of total billed charges,3.21,35.67,,2.568,percent of total billed charges,35.67% of total billed charges,2.61,8.1,
TEGRETOL XR 100MG TAB,2510011,CDM,637,RC,,,outpatient,,,7,2.80,,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.39,77,,4.31,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,5.74,82,,4.592,percent of total billed charges,82% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.25,75,,4.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.03,29,,1.624,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4.69,67,,3.752,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,4.55,65,,3.64,percent of total billed charges,65% of total billed charges,2.5,35.67,,2,percent of total billed charges,35.67% of total billed charges,2.03,6.3,
TEGRETOL XR 400 TAB,2510012,CDM,637,RC,,,outpatient,,,10,4.00,,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,7.7,77,,6.16,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,8.2,82,,6.56,percent of total billed charges,82% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,9,90,,7.2,percent of total billed charges,90% of total billed charges,8,80,,6.4,percent of total billed charges,80% of total billed charges,9,90,,7.2,percent of total billed charges,90% of total billed charges,7.5,75,,6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.9,29,,2.32,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,6.7,67,,5.36,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,8,80,,6.4,percent of total billed charges,80% of total billed charges,6.5,65,,5.2,percent of total billed charges,65% of total billed charges,3.57,35.67,,2.856,percent of total billed charges,35.67% of total billed charges,2.9,9,
TEGRETOL 350MG TAB,2510015,CDM,637,RC,,,outpatient,,,6,2.40,,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,4.62,77,,3.7,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,4.92,82,,3.936,percent of total billed charges,82% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,5.4,90,,4.32,percent of total billed charges,90% of total billed charges,4.8,80,,3.84,percent of total billed charges,80% of total billed charges,5.4,90,,4.32,percent of total billed charges,90% of total billed charges,4.5,75,,3.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,1.74,29,,1.392,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4.02,67,,3.216,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,4.8,80,,3.84,percent of total billed charges,80% of total billed charges,3.9,65,,3.12,percent of total billed charges,65% of total billed charges,2.14,35.67,,1.712,percent of total billed charges,35.67% of total billed charges,1.74,5.4,
FIORINOL 1 PO,2510067,CDM,637,RC,,,outpatient,,,11,4.40,,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,8.47,77,,6.78,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,9.02,82,,7.216,percent of total billed charges,82% of total billed charges,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,9.9,90,,7.92,percent of total billed charges,90% of total billed charges,8.8,80,,7.04,percent of total billed charges,80% of total billed charges,9.9,90,,7.92,percent of total billed charges,90% of total billed charges,8.25,75,,6.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,3.19,29,,2.552,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,7.37,67,,5.896,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,8.8,80,,7.04,percent of total billed charges,80% of total billed charges,7.15,65,,5.72,percent of total billed charges,65% of total billed charges,3.92,35.67,,3.136,percent of total billed charges,35.67% of total billed charges,3.19,9.9,
TENORMIN 50 TAB,2510070,CDM,637,RC,,,outpatient,,,10,4.00,,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,7.7,77,,6.16,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,8.2,82,,6.56,percent of total billed charges,82% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,9,90,,7.2,percent of total billed charges,90% of total billed charges,8,80,,6.4,percent of total billed charges,80% of total billed charges,9,90,,7.2,percent of total billed charges,90% of total billed charges,7.5,75,,6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.9,29,,2.32,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,6.7,67,,5.36,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,8,80,,6.4,percent of total billed charges,80% of total billed charges,6.5,65,,5.2,percent of total billed charges,65% of total billed charges,3.57,35.67,,2.856,percent of total billed charges,35.67% of total billed charges,2.9,9,
TETRACYCLINE 500 MG CAP,2510135,CDM,637,RC,,,outpatient,,,7,2.80,,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.39,77,,4.31,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,5.74,82,,4.592,percent of total billed charges,82% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.25,75,,4.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.03,29,,1.624,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4.69,67,,3.752,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,4.55,65,,3.64,percent of total billed charges,65% of total billed charges,2.5,35.67,,2,percent of total billed charges,35.67% of total billed charges,2.03,6.3,
TEVETEN HCT 600/12.5 MG TAB,2510138,CDM,637,RC,,,outpatient,,,14,5.60,,11.9,85,,9.52,percent of total billed charges,85% of total billed charges,10.78,77,,8.62,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,11.48,82,,9.184,percent of total billed charges,82% of total billed charges,11.9,85,,9.52,percent of total billed charges,85% of total billed charges,11.9,85,,9.52,percent of total billed charges,85% of total billed charges,11.9,85,,9.52,percent of total billed charges,85% of total billed charges,12.6,90,,10.08,percent of total billed charges,90% of total billed charges,11.2,80,,8.96,percent of total billed charges,80% of total billed charges,12.6,90,,10.08,percent of total billed charges,90% of total billed charges,10.5,75,,8.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,4.06,29,,3.248,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,9.38,67,,7.504,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,11.2,80,,8.96,percent of total billed charges,80% of total billed charges,9.1,65,,7.28,percent of total billed charges,65% of total billed charges,4.99,35.67,,3.992,percent of total billed charges,35.67% of total billed charges,4.06,12.6,
TETRACAINE 5 ML,2510157,CDM,637,RC,,,outpatient,,,40,16.00,,34,85,,27.2,percent of total billed charges,85% of total billed charges,30.8,77,,24.64,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,32.8,82,,26.24,percent of total billed charges,82% of total billed charges,34,85,,27.2,percent of total billed charges,85% of total billed charges,34,85,,27.2,percent of total billed charges,85% of total billed charges,34,85,,27.2,percent of total billed charges,85% of total billed charges,36,90,,28.8,percent of total billed charges,90% of total billed charges,32,80,,25.6,percent of total billed charges,80% of total billed charges,36,90,,28.8,percent of total billed charges,90% of total billed charges,30,75,,24,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,11.6,29,,9.28,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,26.8,67,,21.44,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,32,80,,25.6,percent of total billed charges,80% of total billed charges,26,65,,20.8,percent of total billed charges,65% of total billed charges,14.27,35.67,,11.416,percent of total billed charges,35.67% of total billed charges,11.6,36,
THEO-DUR 200MG TAB,2510165,CDM,637,RC,,,outpatient,,,7,2.80,,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.39,77,,4.31,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,5.74,82,,4.592,percent of total billed charges,82% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.25,75,,4.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.03,29,,1.624,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4.69,67,,3.752,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,4.55,65,,3.64,percent of total billed charges,65% of total billed charges,2.5,35.67,,2,percent of total billed charges,35.67% of total billed charges,2.03,6.3,
THEODUR 300 MG TAB,2510175,CDM,637,RC,,,outpatient,,,7,2.80,,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.39,77,,4.31,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,5.74,82,,4.592,percent of total billed charges,82% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.25,75,,4.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.03,29,,1.624,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4.69,67,,3.752,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,4.55,65,,3.64,percent of total billed charges,65% of total billed charges,2.5,35.67,,2,percent of total billed charges,35.67% of total billed charges,2.03,6.3,
THERAVITE LIQUID 60 ML BOTTLE,2510231,CDM,637,RC,,,outpatient,,,13,5.20,,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,10.01,77,,8.01,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,10.66,82,,8.528,percent of total billed charges,82% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,11.7,90,,9.36,percent of total billed charges,90% of total billed charges,10.4,80,,8.32,percent of total billed charges,80% of total billed charges,11.7,90,,9.36,percent of total billed charges,90% of total billed charges,9.75,75,,7.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,3.77,29,,3.016,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,8.71,67,,6.968,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,10.4,80,,8.32,percent of total billed charges,80% of total billed charges,8.45,65,,6.76,percent of total billed charges,65% of total billed charges,4.64,35.67,,3.712,percent of total billed charges,35.67% of total billed charges,3.77,11.7,
THERAVITE 5 ML UDC,2510232,CDM,637,RC,,,outpatient,,,7,2.80,,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.39,77,,4.31,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,5.74,82,,4.592,percent of total billed charges,82% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.25,75,,4.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.03,29,,1.624,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4.69,67,,3.752,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,4.55,65,,3.64,percent of total billed charges,65% of total billed charges,2.5,35.67,,2,percent of total billed charges,35.67% of total billed charges,2.03,6.3,
THICHLOROACETIC ACID 15 ML BOT,2510241,CDM,637,RC,,,outpatient,,,197,78.80,,167.45,85,,133.96,percent of total billed charges,85% of total billed charges,151.69,77,,121.35,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,161.54,82,,129.232,percent of total billed charges,82% of total billed charges,167.45,85,,133.96,percent of total billed charges,85% of total billed charges,167.45,85,,133.96,percent of total billed charges,85% of total billed charges,167.45,85,,133.96,percent of total billed charges,85% of total billed charges,177.3,90,,141.84,percent of total billed charges,90% of total billed charges,157.6,80,,126.08,percent of total billed charges,80% of total billed charges,177.3,90,,141.84,percent of total billed charges,90% of total billed charges,147.75,75,,118.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,57.13,29,,45.704,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,131.99,67,,105.592,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,157.6,80,,126.08,percent of total billed charges,80% of total billed charges,128.05,65,,102.44,percent of total billed charges,65% of total billed charges,70.27,35.67,,56.216,percent of total billed charges,35.67% of total billed charges,57.13,177.3,
VISINE ADVANCED,2510316,CDM,637,RC,,,outpatient,,,13,5.20,,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,10.01,77,,8.01,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,10.66,82,,8.528,percent of total billed charges,82% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,11.7,90,,9.36,percent of total billed charges,90% of total billed charges,10.4,80,,8.32,percent of total billed charges,80% of total billed charges,11.7,90,,9.36,percent of total billed charges,90% of total billed charges,9.75,75,,7.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,3.77,29,,3.016,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,8.71,67,,6.968,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,10.4,80,,8.32,percent of total billed charges,80% of total billed charges,8.45,65,,6.76,percent of total billed charges,65% of total billed charges,4.64,35.67,,3.712,percent of total billed charges,35.67% of total billed charges,3.77,11.7,
PAIN EASE SPRAY,2510323,CDM,637,RC,,,outpatient,,,56,22.40,,47.6,85,,38.08,percent of total billed charges,85% of total billed charges,43.12,77,,34.5,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,45.92,82,,36.736,percent of total billed charges,82% of total billed charges,47.6,85,,38.08,percent of total billed charges,85% of total billed charges,47.6,85,,38.08,percent of total billed charges,85% of total billed charges,47.6,85,,38.08,percent of total billed charges,85% of total billed charges,50.4,90,,40.32,percent of total billed charges,90% of total billed charges,44.8,80,,35.84,percent of total billed charges,80% of total billed charges,50.4,90,,40.32,percent of total billed charges,90% of total billed charges,42,75,,33.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,16.24,29,,12.992,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,37.52,67,,30.016,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,44.8,80,,35.84,percent of total billed charges,80% of total billed charges,36.4,65,,29.12,percent of total billed charges,65% of total billed charges,19.98,35.67,,15.984,percent of total billed charges,35.67% of total billed charges,16.24,50.4,
TIAZAC 360 MG PO,2510384,CDM,637,RC,,,outpatient,,,15,6.00,,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,11.55,77,,9.24,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,12.3,82,,9.84,percent of total billed charges,82% of total billed charges,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,13.5,90,,10.8,percent of total billed charges,90% of total billed charges,12,80,,9.6,percent of total billed charges,80% of total billed charges,13.5,90,,10.8,percent of total billed charges,90% of total billed charges,11.25,75,,9,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,4.35,29,,3.48,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,10.05,67,,8.04,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,12,80,,9.6,percent of total billed charges,80% of total billed charges,9.75,65,,7.8,percent of total billed charges,65% of total billed charges,5.35,35.67,,4.28,percent of total billed charges,35.67% of total billed charges,4.35,13.5,
TIAZAC 120 MG CAP PO,2510386,CDM,637,RC,,,outpatient,,,9,3.60,,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,6.93,77,,5.54,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,7.38,82,,5.904,percent of total billed charges,82% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,8.1,90,,6.48,percent of total billed charges,90% of total billed charges,7.2,80,,5.76,percent of total billed charges,80% of total billed charges,8.1,90,,6.48,percent of total billed charges,90% of total billed charges,6.75,75,,5.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.61,29,,2.088,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,6.03,67,,4.824,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,7.2,80,,5.76,percent of total billed charges,80% of total billed charges,5.85,65,,4.68,percent of total billed charges,65% of total billed charges,3.21,35.67,,2.568,percent of total billed charges,35.67% of total billed charges,2.61,8.1,
TIAZAC 300 MG PO,2510387,CDM,637,RC,,,outpatient,,,15,6.00,,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,11.55,77,,9.24,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,12.3,82,,9.84,percent of total billed charges,82% of total billed charges,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,13.5,90,,10.8,percent of total billed charges,90% of total billed charges,12,80,,9.6,percent of total billed charges,80% of total billed charges,13.5,90,,10.8,percent of total billed charges,90% of total billed charges,11.25,75,,9,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,4.35,29,,3.48,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,10.05,67,,8.04,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,12,80,,9.6,percent of total billed charges,80% of total billed charges,9.75,65,,7.8,percent of total billed charges,65% of total billed charges,5.35,35.67,,4.28,percent of total billed charges,35.67% of total billed charges,4.35,13.5,
TIAZAC 240 MG CAP,2510388,CDM,637,RC,,,outpatient,,,16,6.40,,13.6,85,,10.88,percent of total billed charges,85% of total billed charges,12.32,77,,9.86,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,13.12,82,,10.496,percent of total billed charges,82% of total billed charges,13.6,85,,10.88,percent of total billed charges,85% of total billed charges,13.6,85,,10.88,percent of total billed charges,85% of total billed charges,13.6,85,,10.88,percent of total billed charges,85% of total billed charges,14.4,90,,11.52,percent of total billed charges,90% of total billed charges,12.8,80,,10.24,percent of total billed charges,80% of total billed charges,14.4,90,,11.52,percent of total billed charges,90% of total billed charges,12,75,,9.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,4.64,29,,3.712,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,10.72,67,,8.576,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,12.8,80,,10.24,percent of total billed charges,80% of total billed charges,10.4,65,,8.32,percent of total billed charges,65% of total billed charges,5.71,35.67,,4.568,percent of total billed charges,35.67% of total billed charges,4.64,14.4,
TIAZAC 180 MG CAP,2510389,CDM,637,RC,,,outpatient,,,13,5.20,,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,10.01,77,,8.01,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,10.66,82,,8.528,percent of total billed charges,82% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,11.7,90,,9.36,percent of total billed charges,90% of total billed charges,10.4,80,,8.32,percent of total billed charges,80% of total billed charges,11.7,90,,9.36,percent of total billed charges,90% of total billed charges,9.75,75,,7.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,3.77,29,,3.016,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,8.71,67,,6.968,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,10.4,80,,8.32,percent of total billed charges,80% of total billed charges,8.45,65,,6.76,percent of total billed charges,65% of total billed charges,4.64,35.67,,3.712,percent of total billed charges,35.67% of total billed charges,3.77,11.7,
TIGAN SUPP 100MG PEDIATRIC,2510415,CDM,637,RC,,,outpatient,,,8,3.20,,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,6.16,77,,4.93,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,6.56,82,,5.248,percent of total billed charges,82% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,7.2,90,,5.76,percent of total billed charges,90% of total billed charges,6.4,80,,5.12,percent of total billed charges,80% of total billed charges,7.2,90,,5.76,percent of total billed charges,90% of total billed charges,6,75,,4.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.32,29,,1.856,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,5.36,67,,4.288,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,6.4,80,,5.12,percent of total billed charges,80% of total billed charges,5.2,65,,4.16,percent of total billed charges,65% of total billed charges,2.85,35.67,,2.28,percent of total billed charges,35.67% of total billed charges,2.32,7.2,
TIMOPTIC OPTH GTTS 0.25% 5CC,2510450,CDM,637,RC,,,outpatient,,,53,21.20,,45.05,85,,36.04,percent of total billed charges,85% of total billed charges,40.81,77,,32.65,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,43.46,82,,34.768,percent of total billed charges,82% of total billed charges,45.05,85,,36.04,percent of total billed charges,85% of total billed charges,45.05,85,,36.04,percent of total billed charges,85% of total billed charges,45.05,85,,36.04,percent of total billed charges,85% of total billed charges,47.7,90,,38.16,percent of total billed charges,90% of total billed charges,42.4,80,,33.92,percent of total billed charges,80% of total billed charges,47.7,90,,38.16,percent of total billed charges,90% of total billed charges,39.75,75,,31.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,15.37,29,,12.296,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,35.51,67,,28.408,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,42.4,80,,33.92,percent of total billed charges,80% of total billed charges,34.45,65,,27.56,percent of total billed charges,65% of total billed charges,18.91,35.67,,15.128,percent of total billed charges,35.67% of total billed charges,15.37,47.7,
TOPROL XL 50 MG TAB PO,2510584,CDM,637,RC,,,outpatient,,,8,3.20,,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,6.16,77,,4.93,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,6.56,82,,5.248,percent of total billed charges,82% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,7.2,90,,5.76,percent of total billed charges,90% of total billed charges,6.4,80,,5.12,percent of total billed charges,80% of total billed charges,7.2,90,,5.76,percent of total billed charges,90% of total billed charges,6,75,,4.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.32,29,,1.856,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,5.36,67,,4.288,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,6.4,80,,5.12,percent of total billed charges,80% of total billed charges,5.2,65,,4.16,percent of total billed charges,65% of total billed charges,2.85,35.67,,2.28,percent of total billed charges,35.67% of total billed charges,2.32,7.2,
TOPROL XL 100MG,2510585,CDM,637,RC,,,outpatient,,,11,4.40,,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,8.47,77,,6.78,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,9.02,82,,7.216,percent of total billed charges,82% of total billed charges,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,9.9,90,,7.92,percent of total billed charges,90% of total billed charges,8.8,80,,7.04,percent of total billed charges,80% of total billed charges,9.9,90,,7.92,percent of total billed charges,90% of total billed charges,8.25,75,,6.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,3.19,29,,2.552,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,7.37,67,,5.896,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,8.8,80,,7.04,percent of total billed charges,80% of total billed charges,7.15,65,,5.72,percent of total billed charges,65% of total billed charges,3.92,35.67,,3.136,percent of total billed charges,35.67% of total billed charges,3.19,9.9,
TRANSDERM NITRO 15CM 0.6MG,2510650,CDM,637,RC,,,outpatient,,,20,8.00,,17,85,,13.6,percent of total billed charges,85% of total billed charges,15.4,77,,12.32,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,16.4,82,,13.12,percent of total billed charges,82% of total billed charges,17,85,,13.6,percent of total billed charges,85% of total billed charges,17,85,,13.6,percent of total billed charges,85% of total billed charges,17,85,,13.6,percent of total billed charges,85% of total billed charges,18,90,,14.4,percent of total billed charges,90% of total billed charges,16,80,,12.8,percent of total billed charges,80% of total billed charges,18,90,,14.4,percent of total billed charges,90% of total billed charges,15,75,,12,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,5.8,29,,4.64,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,13.4,67,,10.72,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,16,80,,12.8,percent of total billed charges,80% of total billed charges,13,65,,10.4,percent of total billed charges,65% of total billed charges,7.13,35.67,,5.704,percent of total billed charges,35.67% of total billed charges,5.8,18,
TRANSDERM NITRO 2.5CM 0.1MG,2510655,CDM,637,RC,,,outpatient,,,16,6.40,,13.6,85,,10.88,percent of total billed charges,85% of total billed charges,12.32,77,,9.86,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,13.12,82,,10.496,percent of total billed charges,82% of total billed charges,13.6,85,,10.88,percent of total billed charges,85% of total billed charges,13.6,85,,10.88,percent of total billed charges,85% of total billed charges,13.6,85,,10.88,percent of total billed charges,85% of total billed charges,14.4,90,,11.52,percent of total billed charges,90% of total billed charges,12.8,80,,10.24,percent of total billed charges,80% of total billed charges,14.4,90,,11.52,percent of total billed charges,90% of total billed charges,12,75,,9.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,4.64,29,,3.712,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,10.72,67,,8.576,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,12.8,80,,10.24,percent of total billed charges,80% of total billed charges,10.4,65,,8.32,percent of total billed charges,65% of total billed charges,5.71,35.67,,4.568,percent of total billed charges,35.67% of total billed charges,4.64,14.4,
TRENTAL 400 MG TAB,2510695,CDM,637,RC,,,outpatient,,,9,3.60,,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,6.93,77,,5.54,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,7.38,82,,5.904,percent of total billed charges,82% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,8.1,90,,6.48,percent of total billed charges,90% of total billed charges,7.2,80,,5.76,percent of total billed charges,80% of total billed charges,8.1,90,,6.48,percent of total billed charges,90% of total billed charges,6.75,75,,5.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.61,29,,2.088,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,6.03,67,,4.824,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,7.2,80,,5.76,percent of total billed charges,80% of total billed charges,5.85,65,,4.68,percent of total billed charges,65% of total billed charges,3.21,35.67,,2.568,percent of total billed charges,35.67% of total billed charges,2.61,8.1,
TREXIMET 85/500 MG,2510697,CDM,637,RC,,,outpatient,,,106,42.40,,90.1,85,,72.08,percent of total billed charges,85% of total billed charges,81.62,77,,65.3,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,86.92,82,,69.536,percent of total billed charges,82% of total billed charges,90.1,85,,72.08,percent of total billed charges,85% of total billed charges,90.1,85,,72.08,percent of total billed charges,85% of total billed charges,90.1,85,,72.08,percent of total billed charges,85% of total billed charges,95.4,90,,76.32,percent of total billed charges,90% of total billed charges,84.8,80,,67.84,percent of total billed charges,80% of total billed charges,95.4,90,,76.32,percent of total billed charges,90% of total billed charges,79.5,75,,63.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,30.74,29,,24.592,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,71.02,67,,56.816,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,84.8,80,,67.84,percent of total billed charges,80% of total billed charges,68.9,65,,55.12,percent of total billed charges,65% of total billed charges,37.81,35.67,,30.248,percent of total billed charges,35.67% of total billed charges,30.74,95.4,
TRICOR 200 MG PO,2510733,CDM,637,RC,,,outpatient,,,12,4.80,,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,9.24,77,,7.39,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,9.84,82,,7.872,percent of total billed charges,82% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,10.8,90,,8.64,percent of total billed charges,90% of total billed charges,9.6,80,,7.68,percent of total billed charges,80% of total billed charges,10.8,90,,8.64,percent of total billed charges,90% of total billed charges,9,75,,7.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,3.48,29,,2.784,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,8.04,67,,6.432,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,9.6,80,,7.68,percent of total billed charges,80% of total billed charges,7.8,65,,6.24,percent of total billed charges,65% of total billed charges,4.28,35.67,,3.424,percent of total billed charges,35.67% of total billed charges,3.48,10.8,
TRIGLIDE 160 MG TAB,2510742,CDM,637,RC,,,outpatient,,,30,12.00,,25.5,85,,20.4,percent of total billed charges,85% of total billed charges,23.1,77,,18.48,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,24.6,82,,19.68,percent of total billed charges,82% of total billed charges,25.5,85,,20.4,percent of total billed charges,85% of total billed charges,25.5,85,,20.4,percent of total billed charges,85% of total billed charges,25.5,85,,20.4,percent of total billed charges,85% of total billed charges,27,90,,21.6,percent of total billed charges,90% of total billed charges,24,80,,19.2,percent of total billed charges,80% of total billed charges,27,90,,21.6,percent of total billed charges,90% of total billed charges,22.5,75,,18,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,8.7,29,,6.96,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,20.1,67,,16.08,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,24,80,,19.2,percent of total billed charges,80% of total billed charges,19.5,65,,15.6,percent of total billed charges,65% of total billed charges,10.7,35.67,,8.56,percent of total billed charges,35.67% of total billed charges,8.7,27,
TRILIPIX 45 MG CAPSULE,2510761,CDM,637,RC,,,outpatient,,,11,4.40,,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,8.47,77,,6.78,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,9.02,82,,7.216,percent of total billed charges,82% of total billed charges,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,9.9,90,,7.92,percent of total billed charges,90% of total billed charges,8.8,80,,7.04,percent of total billed charges,80% of total billed charges,9.9,90,,7.92,percent of total billed charges,90% of total billed charges,8.25,75,,6.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,3.19,29,,2.552,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,7.37,67,,5.896,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,8.8,80,,7.04,percent of total billed charges,80% of total billed charges,7.15,65,,5.72,percent of total billed charges,65% of total billed charges,3.92,35.67,,3.136,percent of total billed charges,35.67% of total billed charges,3.19,9.9,
TUSSI-ORGANIDIN DM 10 CC LIQ,2510830,CDM,637,RC,,,outpatient,,,14,5.60,,11.9,85,,9.52,percent of total billed charges,85% of total billed charges,10.78,77,,8.62,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,11.48,82,,9.184,percent of total billed charges,82% of total billed charges,11.9,85,,9.52,percent of total billed charges,85% of total billed charges,11.9,85,,9.52,percent of total billed charges,85% of total billed charges,11.9,85,,9.52,percent of total billed charges,85% of total billed charges,12.6,90,,10.08,percent of total billed charges,90% of total billed charges,11.2,80,,8.96,percent of total billed charges,80% of total billed charges,12.6,90,,10.08,percent of total billed charges,90% of total billed charges,10.5,75,,8.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,4.06,29,,3.248,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,9.38,67,,7.504,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,11.2,80,,8.96,percent of total billed charges,80% of total billed charges,9.1,65,,7.28,percent of total billed charges,65% of total billed charges,4.99,35.67,,3.992,percent of total billed charges,35.67% of total billed charges,4.06,12.6,
TUSSIONEX SUSP 5CC LIQ,2510860,CDM,637,RC,,,outpatient,,,6,2.40,,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,4.62,77,,3.7,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,4.92,82,,3.936,percent of total billed charges,82% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,5.4,90,,4.32,percent of total billed charges,90% of total billed charges,4.8,80,,3.84,percent of total billed charges,80% of total billed charges,5.4,90,,4.32,percent of total billed charges,90% of total billed charges,4.5,75,,3.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,1.74,29,,1.392,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4.02,67,,3.216,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,4.8,80,,3.84,percent of total billed charges,80% of total billed charges,3.9,65,,3.12,percent of total billed charges,65% of total billed charges,2.14,35.67,,1.712,percent of total billed charges,35.67% of total billed charges,1.74,5.4,
TYLENOL 80 MG LIQ,2510880,CDM,637,RC,,,outpatient,,,17,6.80,,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,13.09,77,,10.47,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,13.94,82,,11.152,percent of total billed charges,82% of total billed charges,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,15.3,90,,12.24,percent of total billed charges,90% of total billed charges,13.6,80,,10.88,percent of total billed charges,80% of total billed charges,15.3,90,,12.24,percent of total billed charges,90% of total billed charges,12.75,75,,10.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,4.93,29,,3.944,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,11.39,67,,9.112,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,13.6,80,,10.88,percent of total billed charges,80% of total billed charges,11.05,65,,8.84,percent of total billed charges,65% of total billed charges,6.06,35.67,,4.848,percent of total billed charges,35.67% of total billed charges,4.93,15.3,
TYLENOL CHEWABLE 80MG TAB,2510890,CDM,637,RC,,,outpatient,,,7,2.80,,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.39,77,,4.31,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,5.74,82,,4.592,percent of total billed charges,82% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.25,75,,4.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.03,29,,1.624,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4.69,67,,3.752,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,4.55,65,,3.64,percent of total billed charges,65% of total billed charges,2.5,35.67,,2,percent of total billed charges,35.67% of total billed charges,2.03,6.3,
TYLENOL ES 500 MG/15ML 60 BTL,2510901,CDM,637,RC,,,outpatient,,,8,3.20,,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,6.16,77,,4.93,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,6.56,82,,5.248,percent of total billed charges,82% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,7.2,90,,5.76,percent of total billed charges,90% of total billed charges,6.4,80,,5.12,percent of total billed charges,80% of total billed charges,7.2,90,,5.76,percent of total billed charges,90% of total billed charges,6,75,,4.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.32,29,,1.856,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,5.36,67,,4.288,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,6.4,80,,5.12,percent of total billed charges,80% of total billed charges,5.2,65,,4.16,percent of total billed charges,65% of total billed charges,2.85,35.67,,2.28,percent of total billed charges,35.67% of total billed charges,2.32,7.2,
TYLENOL LIQ. 5ML 60 ML BOTTLE,2510905,CDM,637,RC,,,outpatient,,,13,5.20,,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,10.01,77,,8.01,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,10.66,82,,8.528,percent of total billed charges,82% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,11.7,90,,9.36,percent of total billed charges,90% of total billed charges,10.4,80,,8.32,percent of total billed charges,80% of total billed charges,11.7,90,,9.36,percent of total billed charges,90% of total billed charges,9.75,75,,7.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,3.77,29,,3.016,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,8.71,67,,6.968,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,10.4,80,,8.32,percent of total billed charges,80% of total billed charges,8.45,65,,6.76,percent of total billed charges,65% of total billed charges,4.64,35.67,,3.712,percent of total billed charges,35.67% of total billed charges,3.77,11.7,
TYLENOL W/CODEINE 10CC ELIX,2510920,CDM,637,RC,,,outpatient,,,7,2.80,,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.39,77,,4.31,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,5.74,82,,4.592,percent of total billed charges,82% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.25,75,,4.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.03,29,,1.624,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4.69,67,,3.752,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,4.55,65,,3.64,percent of total billed charges,65% of total billed charges,2.5,35.67,,2,percent of total billed charges,35.67% of total billed charges,2.03,6.3,
TYLENOL W/CODEINE ELIX 2.5CC,2510925,CDM,637,RC,,,outpatient,,,5,2.00,,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,3.85,77,,3.08,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,4.1,82,,3.28,percent of total billed charges,82% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,4.5,90,,3.6,percent of total billed charges,90% of total billed charges,4,80,,3.2,percent of total billed charges,80% of total billed charges,4.5,90,,3.6,percent of total billed charges,90% of total billed charges,3.75,75,,3,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,1.45,29,,1.16,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,3.35,67,,2.68,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,4,80,,3.2,percent of total billed charges,80% of total billed charges,3.25,65,,2.6,percent of total billed charges,65% of total billed charges,1.78,35.67,,1.424,percent of total billed charges,35.67% of total billed charges,1.45,4.5,
TYLENOL WITH CODEINE ELIX 5CC,2510930,CDM,637,RC,,,outpatient,,,7,2.80,,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.39,77,,4.31,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,5.74,82,,4.592,percent of total billed charges,82% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.25,75,,4.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.03,29,,1.624,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4.69,67,,3.752,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,4.55,65,,3.64,percent of total billed charges,65% of total billed charges,2.5,35.67,,2,percent of total billed charges,35.67% of total billed charges,2.03,6.3,
TYLENOL CHILDREN'S SUSPENSION,2510932,CDM,637,RC,,,outpatient,,,13,5.20,,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,10.01,77,,8.01,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,10.66,82,,8.528,percent of total billed charges,82% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,11.7,90,,9.36,percent of total billed charges,90% of total billed charges,10.4,80,,8.32,percent of total billed charges,80% of total billed charges,11.7,90,,9.36,percent of total billed charges,90% of total billed charges,9.75,75,,7.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,3.77,29,,3.016,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,8.71,67,,6.968,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,10.4,80,,8.32,percent of total billed charges,80% of total billed charges,8.45,65,,6.76,percent of total billed charges,65% of total billed charges,4.64,35.67,,3.712,percent of total billed charges,35.67% of total billed charges,3.77,11.7,
URECHOLINE 25 MG TAB,2510990,CDM,637,RC,,,outpatient,,,18,7.20,,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,13.86,77,,11.09,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,14.76,82,,11.808,percent of total billed charges,82% of total billed charges,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,16.2,90,,12.96,percent of total billed charges,90% of total billed charges,14.4,80,,11.52,percent of total billed charges,80% of total billed charges,16.2,90,,12.96,percent of total billed charges,90% of total billed charges,13.5,75,,10.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,5.22,29,,4.176,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,12.06,67,,9.648,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,14.4,80,,11.52,percent of total billed charges,80% of total billed charges,11.7,65,,9.36,percent of total billed charges,65% of total billed charges,6.42,35.67,,5.136,percent of total billed charges,35.67% of total billed charges,5.22,16.2,
UROXATRAL 10MG EXTENDED REL TA,2511013,CDM,637,RC,,,outpatient,,,53,21.20,,45.05,85,,36.04,percent of total billed charges,85% of total billed charges,40.81,77,,32.65,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,43.46,82,,34.768,percent of total billed charges,82% of total billed charges,45.05,85,,36.04,percent of total billed charges,85% of total billed charges,45.05,85,,36.04,percent of total billed charges,85% of total billed charges,45.05,85,,36.04,percent of total billed charges,85% of total billed charges,47.7,90,,38.16,percent of total billed charges,90% of total billed charges,42.4,80,,33.92,percent of total billed charges,80% of total billed charges,47.7,90,,38.16,percent of total billed charges,90% of total billed charges,39.75,75,,31.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,15.37,29,,12.296,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,35.51,67,,28.408,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,42.4,80,,33.92,percent of total billed charges,80% of total billed charges,34.45,65,,27.56,percent of total billed charges,65% of total billed charges,18.91,35.67,,15.128,percent of total billed charges,35.67% of total billed charges,15.37,47.7,
VALERIAN ROOT CAPSULE,2511038,CDM,637,RC,,,outpatient,,,7,2.80,,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.39,77,,4.31,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,5.74,82,,4.592,percent of total billed charges,82% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.25,75,,4.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.03,29,,1.624,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4.69,67,,3.752,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,4.55,65,,3.64,percent of total billed charges,65% of total billed charges,2.5,35.67,,2,percent of total billed charges,35.67% of total billed charges,2.03,6.3,
VALIUM 2.5 MG TAB,2511060,CDM,637,RC,,,outpatient,,,7,2.80,,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.39,77,,4.31,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,5.74,82,,4.592,percent of total billed charges,82% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.25,75,,4.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.03,29,,1.624,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4.69,67,,3.752,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,4.55,65,,3.64,percent of total billed charges,65% of total billed charges,2.5,35.67,,2,percent of total billed charges,35.67% of total billed charges,2.03,6.3,
VANCOMYCIN 250MG TAB,2511105,CDM,637,RC,,,outpatient,,,216,86.40,,183.6,85,,146.88,percent of total billed charges,85% of total billed charges,166.32,77,,133.06,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,177.12,82,,141.696,percent of total billed charges,82% of total billed charges,183.6,85,,146.88,percent of total billed charges,85% of total billed charges,183.6,85,,146.88,percent of total billed charges,85% of total billed charges,183.6,85,,146.88,percent of total billed charges,85% of total billed charges,194.4,90,,155.52,percent of total billed charges,90% of total billed charges,172.8,80,,138.24,percent of total billed charges,80% of total billed charges,194.4,90,,155.52,percent of total billed charges,90% of total billed charges,162,75,,129.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,62.64,29,,50.112,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,144.72,67,,115.776,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,172.8,80,,138.24,percent of total billed charges,80% of total billed charges,140.4,65,,112.32,percent of total billed charges,65% of total billed charges,77.05,35.67,,61.64,percent of total billed charges,35.67% of total billed charges,62.64,194.4,
VANTIN 100 MG TAB,2511129,CDM,637,RC,,,outpatient,,,38,15.20,,32.3,85,,25.84,percent of total billed charges,85% of total billed charges,29.26,77,,23.41,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,31.16,82,,24.928,percent of total billed charges,82% of total billed charges,32.3,85,,25.84,percent of total billed charges,85% of total billed charges,32.3,85,,25.84,percent of total billed charges,85% of total billed charges,32.3,85,,25.84,percent of total billed charges,85% of total billed charges,34.2,90,,27.36,percent of total billed charges,90% of total billed charges,30.4,80,,24.32,percent of total billed charges,80% of total billed charges,34.2,90,,27.36,percent of total billed charges,90% of total billed charges,28.5,75,,22.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,11.02,29,,8.816,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,25.46,67,,20.368,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,30.4,80,,24.32,percent of total billed charges,80% of total billed charges,24.7,65,,19.76,percent of total billed charges,65% of total billed charges,13.55,35.67,,10.84,percent of total billed charges,35.67% of total billed charges,11.02,34.2,
VAPONEFRIN 15 ML NEB.,2511131,CDM,637,RC,,,outpatient,,,31,12.40,,26.35,85,,21.08,percent of total billed charges,85% of total billed charges,23.87,77,,19.1,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,25.42,82,,20.336,percent of total billed charges,82% of total billed charges,26.35,85,,21.08,percent of total billed charges,85% of total billed charges,26.35,85,,21.08,percent of total billed charges,85% of total billed charges,26.35,85,,21.08,percent of total billed charges,85% of total billed charges,27.9,90,,22.32,percent of total billed charges,90% of total billed charges,24.8,80,,19.84,percent of total billed charges,80% of total billed charges,27.9,90,,22.32,percent of total billed charges,90% of total billed charges,23.25,75,,18.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,8.99,29,,7.192,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,20.77,67,,16.616,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,24.8,80,,19.84,percent of total billed charges,80% of total billed charges,20.15,65,,16.12,percent of total billed charges,65% of total billed charges,11.06,35.67,,8.848,percent of total billed charges,35.67% of total billed charges,8.99,27.9,
VASOTEC 10 MG TAB,2511165,CDM,637,RC,,,outpatient,,,21,8.40,,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,16.17,77,,12.94,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,17.22,82,,13.776,percent of total billed charges,82% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,18.9,90,,15.12,percent of total billed charges,90% of total billed charges,16.8,80,,13.44,percent of total billed charges,80% of total billed charges,18.9,90,,15.12,percent of total billed charges,90% of total billed charges,15.75,75,,12.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,6.09,29,,4.872,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,14.07,67,,11.256,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,16.8,80,,13.44,percent of total billed charges,80% of total billed charges,13.65,65,,10.92,percent of total billed charges,65% of total billed charges,7.49,35.67,,5.992,percent of total billed charges,35.67% of total billed charges,6.09,18.9,
VASOTEC 5 MG TAB,2511185,CDM,637,RC,,,outpatient,,,14,5.60,,11.9,85,,9.52,percent of total billed charges,85% of total billed charges,10.78,77,,8.62,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,11.48,82,,9.184,percent of total billed charges,82% of total billed charges,11.9,85,,9.52,percent of total billed charges,85% of total billed charges,11.9,85,,9.52,percent of total billed charges,85% of total billed charges,11.9,85,,9.52,percent of total billed charges,85% of total billed charges,12.6,90,,10.08,percent of total billed charges,90% of total billed charges,11.2,80,,8.96,percent of total billed charges,80% of total billed charges,12.6,90,,10.08,percent of total billed charges,90% of total billed charges,10.5,75,,8.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,4.06,29,,3.248,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,9.38,67,,7.504,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,11.2,80,,8.96,percent of total billed charges,80% of total billed charges,9.1,65,,7.28,percent of total billed charges,65% of total billed charges,4.99,35.67,,3.992,percent of total billed charges,35.67% of total billed charges,4.06,12.6,
EFFEXOR XR 75 MG PO,2511229,CDM,637,RC,,,outpatient,,,25,10.00,,21.25,85,,17,percent of total billed charges,85% of total billed charges,19.25,77,,15.4,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,20.5,82,,16.4,percent of total billed charges,82% of total billed charges,21.25,85,,17,percent of total billed charges,85% of total billed charges,21.25,85,,17,percent of total billed charges,85% of total billed charges,21.25,85,,17,percent of total billed charges,85% of total billed charges,22.5,90,,18,percent of total billed charges,90% of total billed charges,20,80,,16,percent of total billed charges,80% of total billed charges,22.5,90,,18,percent of total billed charges,90% of total billed charges,18.75,75,,15,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,7.25,29,,5.8,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,16.75,67,,13.4,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,20,80,,16,percent of total billed charges,80% of total billed charges,16.25,65,,13,percent of total billed charges,65% of total billed charges,8.92,35.67,,7.136,percent of total billed charges,35.67% of total billed charges,7.25,22.5,
VERMOX 100 MG TAB,2511250,CDM,637,RC,,,outpatient,,,22,8.80,,18.7,85,,14.96,percent of total billed charges,85% of total billed charges,16.94,77,,13.55,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,18.04,82,,14.432,percent of total billed charges,82% of total billed charges,18.7,85,,14.96,percent of total billed charges,85% of total billed charges,18.7,85,,14.96,percent of total billed charges,85% of total billed charges,18.7,85,,14.96,percent of total billed charges,85% of total billed charges,19.8,90,,15.84,percent of total billed charges,90% of total billed charges,17.6,80,,14.08,percent of total billed charges,80% of total billed charges,19.8,90,,15.84,percent of total billed charges,90% of total billed charges,16.5,75,,13.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,6.38,29,,5.104,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,14.74,67,,11.792,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,17.6,80,,14.08,percent of total billed charges,80% of total billed charges,14.3,65,,11.44,percent of total billed charges,65% of total billed charges,7.85,35.67,,6.28,percent of total billed charges,35.67% of total billed charges,6.38,19.8,
VENTOLIN HFA INHALER,2511261,CDM,637,RC,,,outpatient,,,59,23.60,,50.15,85,,40.12,percent of total billed charges,85% of total billed charges,45.43,77,,36.34,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,48.38,82,,38.704,percent of total billed charges,82% of total billed charges,50.15,85,,40.12,percent of total billed charges,85% of total billed charges,50.15,85,,40.12,percent of total billed charges,85% of total billed charges,50.15,85,,40.12,percent of total billed charges,85% of total billed charges,53.1,90,,42.48,percent of total billed charges,90% of total billed charges,47.2,80,,37.76,percent of total billed charges,80% of total billed charges,53.1,90,,42.48,percent of total billed charges,90% of total billed charges,44.25,75,,35.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,17.11,29,,13.688,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,39.53,67,,31.624,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,47.2,80,,37.76,percent of total billed charges,80% of total billed charges,38.35,65,,30.68,percent of total billed charges,65% of total billed charges,21.05,35.67,,16.84,percent of total billed charges,35.67% of total billed charges,17.11,53.1,
VENTOLIN INHALER 18 GR,2511262,CDM,637,RC,,,outpatient,,,141,56.40,,119.85,85,,95.88,percent of total billed charges,85% of total billed charges,108.57,77,,86.86,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,115.62,82,,92.496,percent of total billed charges,82% of total billed charges,119.85,85,,95.88,percent of total billed charges,85% of total billed charges,119.85,85,,95.88,percent of total billed charges,85% of total billed charges,119.85,85,,95.88,percent of total billed charges,85% of total billed charges,126.9,90,,101.52,percent of total billed charges,90% of total billed charges,112.8,80,,90.24,percent of total billed charges,80% of total billed charges,126.9,90,,101.52,percent of total billed charges,90% of total billed charges,105.75,75,,84.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,40.89,29,,32.712,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,94.47,67,,75.576,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,112.8,80,,90.24,percent of total billed charges,80% of total billed charges,91.65,65,,73.32,percent of total billed charges,65% of total billed charges,50.29,35.67,,40.232,percent of total billed charges,35.67% of total billed charges,40.89,126.9,
VENTOLIN HFA 8 GM,2511264,CDM,637,RC,,,outpatient,,,64,25.60,,54.4,85,,43.52,percent of total billed charges,85% of total billed charges,49.28,77,,39.42,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,52.48,82,,41.984,percent of total billed charges,82% of total billed charges,54.4,85,,43.52,percent of total billed charges,85% of total billed charges,54.4,85,,43.52,percent of total billed charges,85% of total billed charges,54.4,85,,43.52,percent of total billed charges,85% of total billed charges,57.6,90,,46.08,percent of total billed charges,90% of total billed charges,51.2,80,,40.96,percent of total billed charges,80% of total billed charges,57.6,90,,46.08,percent of total billed charges,90% of total billed charges,48,75,,38.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,18.56,29,,14.848,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,42.88,67,,34.304,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,51.2,80,,40.96,percent of total billed charges,80% of total billed charges,41.6,65,,33.28,percent of total billed charges,65% of total billed charges,22.83,35.67,,18.264,percent of total billed charges,35.67% of total billed charges,18.56,57.6,
VESICARE 5 MG TABLET,2511287,CDM,637,RC,,,outpatient,,,31,12.40,,26.35,85,,21.08,percent of total billed charges,85% of total billed charges,23.87,77,,19.1,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,25.42,82,,20.336,percent of total billed charges,82% of total billed charges,26.35,85,,21.08,percent of total billed charges,85% of total billed charges,26.35,85,,21.08,percent of total billed charges,85% of total billed charges,26.35,85,,21.08,percent of total billed charges,85% of total billed charges,27.9,90,,22.32,percent of total billed charges,90% of total billed charges,24.8,80,,19.84,percent of total billed charges,80% of total billed charges,27.9,90,,22.32,percent of total billed charges,90% of total billed charges,23.25,75,,18.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,8.99,29,,7.192,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,20.77,67,,16.616,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,24.8,80,,19.84,percent of total billed charges,80% of total billed charges,20.15,65,,16.12,percent of total billed charges,65% of total billed charges,11.06,35.67,,8.848,percent of total billed charges,35.67% of total billed charges,8.99,27.9,
VIACTIVE 500 MG CALCIUM D CHEW,2511322,CDM,637,RC,,,outpatient,,,7,2.80,,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.39,77,,4.31,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,5.74,82,,4.592,percent of total billed charges,82% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.25,75,,4.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.03,29,,1.624,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4.69,67,,3.752,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,4.55,65,,3.64,percent of total billed charges,65% of total billed charges,2.5,35.67,,2,percent of total billed charges,35.67% of total billed charges,2.03,6.3,
VIBRAMYCIN 50 MG CAP,2511330,CDM,637,RC,,,outpatient,,,8,3.20,,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,6.16,77,,4.93,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,6.56,82,,5.248,percent of total billed charges,82% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,7.2,90,,5.76,percent of total billed charges,90% of total billed charges,6.4,80,,5.12,percent of total billed charges,80% of total billed charges,7.2,90,,5.76,percent of total billed charges,90% of total billed charges,6,75,,4.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.32,29,,1.856,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,5.36,67,,4.288,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,6.4,80,,5.12,percent of total billed charges,80% of total billed charges,5.2,65,,4.16,percent of total billed charges,65% of total billed charges,2.85,35.67,,2.28,percent of total billed charges,35.67% of total billed charges,2.32,7.2,
VIBRAMYCIN 100 MG CAP,2511333,CDM,637,RC,,,outpatient,,,26,10.40,,22.1,85,,17.68,percent of total billed charges,85% of total billed charges,20.02,77,,16.02,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,21.32,82,,17.056,percent of total billed charges,82% of total billed charges,22.1,85,,17.68,percent of total billed charges,85% of total billed charges,22.1,85,,17.68,percent of total billed charges,85% of total billed charges,22.1,85,,17.68,percent of total billed charges,85% of total billed charges,23.4,90,,18.72,percent of total billed charges,90% of total billed charges,20.8,80,,16.64,percent of total billed charges,80% of total billed charges,23.4,90,,18.72,percent of total billed charges,90% of total billed charges,19.5,75,,15.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,7.54,29,,6.032,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,17.42,67,,13.936,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,20.8,80,,16.64,percent of total billed charges,80% of total billed charges,16.9,65,,13.52,percent of total billed charges,65% of total billed charges,9.27,35.67,,7.416,percent of total billed charges,35.67% of total billed charges,7.54,23.4,
VIOKASE 16 TABLET,2511357,CDM,637,RC,,,outpatient,,,7,2.80,,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.39,77,,4.31,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,5.74,82,,4.592,percent of total billed charges,82% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.25,75,,4.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.03,29,,1.624,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4.69,67,,3.752,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,4.55,65,,3.64,percent of total billed charges,65% of total billed charges,2.5,35.67,,2,percent of total billed charges,35.67% of total billed charges,2.03,6.3,
VIMOVO 500 MG/20 MG TABLET,2511366,CDM,637,RC,,,outpatient,,,11,4.40,,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,8.47,77,,6.78,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,9.02,82,,7.216,percent of total billed charges,82% of total billed charges,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,9.9,90,,7.92,percent of total billed charges,90% of total billed charges,8.8,80,,7.04,percent of total billed charges,80% of total billed charges,9.9,90,,7.92,percent of total billed charges,90% of total billed charges,8.25,75,,6.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,3.19,29,,2.552,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,7.37,67,,5.896,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,8.8,80,,7.04,percent of total billed charges,80% of total billed charges,7.15,65,,5.72,percent of total billed charges,65% of total billed charges,3.92,35.67,,3.136,percent of total billed charges,35.67% of total billed charges,3.19,9.9,
VIGAMOX OPTHALMIC 3 ML,2511384,CDM,637,RC,,,outpatient,,,309,123.60,,262.65,85,,210.12,percent of total billed charges,85% of total billed charges,237.93,77,,190.34,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,253.38,82,,202.704,percent of total billed charges,82% of total billed charges,262.65,85,,210.12,percent of total billed charges,85% of total billed charges,262.65,85,,210.12,percent of total billed charges,85% of total billed charges,262.65,85,,210.12,percent of total billed charges,85% of total billed charges,278.1,90,,222.48,percent of total billed charges,90% of total billed charges,247.2,80,,197.76,percent of total billed charges,80% of total billed charges,278.1,90,,222.48,percent of total billed charges,90% of total billed charges,231.75,75,,185.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,89.61,29,,71.688,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,207.03,67,,165.624,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,247.2,80,,197.76,percent of total billed charges,80% of total billed charges,200.85,65,,160.68,percent of total billed charges,65% of total billed charges,110.22,35.67,,88.176,percent of total billed charges,35.67% of total billed charges,89.61,278.1,
VIROPTIC 1% OPTH SOLUTION,2511406,CDM,637,RC,,,outpatient,,,370,148.00,,314.5,85,,251.6,percent of total billed charges,85% of total billed charges,284.9,77,,227.92,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,303.4,82,,242.72,percent of total billed charges,82% of total billed charges,314.5,85,,251.6,percent of total billed charges,85% of total billed charges,314.5,85,,251.6,percent of total billed charges,85% of total billed charges,314.5,85,,251.6,percent of total billed charges,85% of total billed charges,333,90,,266.4,percent of total billed charges,90% of total billed charges,296,80,,236.8,percent of total billed charges,80% of total billed charges,333,90,,266.4,percent of total billed charges,90% of total billed charges,277.5,75,,222,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,107.3,29,,85.84,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,247.9,67,,198.32,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,296,80,,236.8,percent of total billed charges,80% of total billed charges,240.5,65,,192.4,percent of total billed charges,65% of total billed charges,131.98,35.67,,105.584,percent of total billed charges,35.67% of total billed charges,107.3,333,
"VITAMIN A 10,000 IU CAP",2511476,CDM,637,RC,,,outpatient,,,7,2.80,,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.39,77,,4.31,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,5.74,82,,4.592,percent of total billed charges,82% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.25,75,,4.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.03,29,,1.624,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4.69,67,,3.752,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,4.55,65,,3.64,percent of total billed charges,65% of total billed charges,2.5,35.67,,2,percent of total billed charges,35.67% of total billed charges,2.03,6.3,
"VITAMIN D 50,000 IU CAP",2511506,CDM,637,RC,,,outpatient,,,11,4.40,,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,8.47,77,,6.78,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,9.02,82,,7.216,percent of total billed charges,82% of total billed charges,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,9.9,90,,7.92,percent of total billed charges,90% of total billed charges,8.8,80,,7.04,percent of total billed charges,80% of total billed charges,9.9,90,,7.92,percent of total billed charges,90% of total billed charges,8.25,75,,6.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,3.19,29,,2.552,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,7.37,67,,5.896,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,8.8,80,,7.04,percent of total billed charges,80% of total billed charges,7.15,65,,5.72,percent of total billed charges,65% of total billed charges,3.92,35.67,,3.136,percent of total billed charges,35.67% of total billed charges,3.19,9.9,
VOLTAREN 50 MG/TAB,2511550,CDM,637,RC,,,outpatient,,,7,2.80,,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.39,77,,4.31,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,5.74,82,,4.592,percent of total billed charges,82% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,5.25,75,,4.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.03,29,,1.624,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4.69,67,,3.752,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,4.55,65,,3.64,percent of total billed charges,65% of total billed charges,2.5,35.67,,2,percent of total billed charges,35.67% of total billed charges,2.03,6.3,
WELLBUTRIN XL 150 MG TAB,2511576,CDM,637,RC,,,outpatient,,,34,13.60,,28.9,85,,23.12,percent of total billed charges,85% of total billed charges,26.18,77,,20.94,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,27.88,82,,22.304,percent of total billed charges,82% of total billed charges,28.9,85,,23.12,percent of total billed charges,85% of total billed charges,28.9,85,,23.12,percent of total billed charges,85% of total billed charges,28.9,85,,23.12,percent of total billed charges,85% of total billed charges,30.6,90,,24.48,percent of total billed charges,90% of total billed charges,27.2,80,,21.76,percent of total billed charges,80% of total billed charges,30.6,90,,24.48,percent of total billed charges,90% of total billed charges,25.5,75,,20.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,9.86,29,,7.888,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,22.78,67,,18.224,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,27.2,80,,21.76,percent of total billed charges,80% of total billed charges,22.1,65,,17.68,percent of total billed charges,65% of total billed charges,12.13,35.67,,9.704,percent of total billed charges,35.67% of total billed charges,9.86,30.6,
WESTCORT CREAM 15MG,2511580,CDM,637,RC,,,outpatient,,,65,26.00,,55.25,85,,44.2,percent of total billed charges,85% of total billed charges,50.05,77,,40.04,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,53.3,82,,42.64,percent of total billed charges,82% of total billed charges,55.25,85,,44.2,percent of total billed charges,85% of total billed charges,55.25,85,,44.2,percent of total billed charges,85% of total billed charges,55.25,85,,44.2,percent of total billed charges,85% of total billed charges,58.5,90,,46.8,percent of total billed charges,90% of total billed charges,52,80,,41.6,percent of total billed charges,80% of total billed charges,58.5,90,,46.8,percent of total billed charges,90% of total billed charges,48.75,75,,39,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,18.85,29,,15.08,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,43.55,67,,34.84,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,52,80,,41.6,percent of total billed charges,80% of total billed charges,42.25,65,,33.8,percent of total billed charges,65% of total billed charges,23.19,35.67,,18.552,percent of total billed charges,35.67% of total billed charges,18.85,58.5,
XANAX (ALPRAZOLAM) 0.125 MG TB,2511640,CDM,637,RC,,,outpatient,,,6,2.40,,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,4.62,77,,3.7,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,4.92,82,,3.936,percent of total billed charges,82% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,5.4,90,,4.32,percent of total billed charges,90% of total billed charges,4.8,80,,3.84,percent of total billed charges,80% of total billed charges,5.4,90,,4.32,percent of total billed charges,90% of total billed charges,4.5,75,,3.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,1.74,29,,1.392,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4.02,67,,3.216,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,4.8,80,,3.84,percent of total billed charges,80% of total billed charges,3.9,65,,3.12,percent of total billed charges,65% of total billed charges,2.14,35.67,,1.712,percent of total billed charges,35.67% of total billed charges,1.74,5.4,
XOPENEX 1.25MG/0.5ML,2511689,CDM,637,RC,,,outpatient,,,24,9.60,,20.4,85,,16.32,percent of total billed charges,85% of total billed charges,18.48,77,,14.78,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,19.68,82,,15.744,percent of total billed charges,82% of total billed charges,20.4,85,,16.32,percent of total billed charges,85% of total billed charges,20.4,85,,16.32,percent of total billed charges,85% of total billed charges,20.4,85,,16.32,percent of total billed charges,85% of total billed charges,21.6,90,,17.28,percent of total billed charges,90% of total billed charges,19.2,80,,15.36,percent of total billed charges,80% of total billed charges,21.6,90,,17.28,percent of total billed charges,90% of total billed charges,18,75,,14.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,6.96,29,,5.568,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,16.08,67,,12.864,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,19.2,80,,15.36,percent of total billed charges,80% of total billed charges,15.6,65,,12.48,percent of total billed charges,65% of total billed charges,8.56,35.67,,6.848,percent of total billed charges,35.67% of total billed charges,6.96,21.6,
XENADERM OINT 60 GM TUBE,2511697,CDM,637,RC,,,outpatient,,,244,97.60,,207.4,85,,165.92,percent of total billed charges,85% of total billed charges,187.88,77,,150.3,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,200.08,82,,160.064,percent of total billed charges,82% of total billed charges,207.4,85,,165.92,percent of total billed charges,85% of total billed charges,207.4,85,,165.92,percent of total billed charges,85% of total billed charges,207.4,85,,165.92,percent of total billed charges,85% of total billed charges,219.6,90,,175.68,percent of total billed charges,90% of total billed charges,195.2,80,,156.16,percent of total billed charges,80% of total billed charges,219.6,90,,175.68,percent of total billed charges,90% of total billed charges,183,75,,146.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,70.76,29,,56.608,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,163.48,67,,130.784,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,195.2,80,,156.16,percent of total billed charges,80% of total billed charges,158.6,65,,126.88,percent of total billed charges,65% of total billed charges,87.03,35.67,,69.624,percent of total billed charges,35.67% of total billed charges,70.76,219.6,
XOPENEX HFA 45 MCG INHALER,2511701,CDM,637,RC,,,outpatient,,,159,63.60,,135.15,85,,108.12,percent of total billed charges,85% of total billed charges,122.43,77,,97.94,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,130.38,82,,104.304,percent of total billed charges,82% of total billed charges,135.15,85,,108.12,percent of total billed charges,85% of total billed charges,135.15,85,,108.12,percent of total billed charges,85% of total billed charges,135.15,85,,108.12,percent of total billed charges,85% of total billed charges,143.1,90,,114.48,percent of total billed charges,90% of total billed charges,127.2,80,,101.76,percent of total billed charges,80% of total billed charges,143.1,90,,114.48,percent of total billed charges,90% of total billed charges,119.25,75,,95.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,46.11,29,,36.888,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,106.53,67,,85.224,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,127.2,80,,101.76,percent of total billed charges,80% of total billed charges,103.35,65,,82.68,percent of total billed charges,65% of total billed charges,56.72,35.67,,45.376,percent of total billed charges,35.67% of total billed charges,46.11,143.1,
XIFAXAN 550 MG,2511702,CDM,637,RC,,,outpatient,,,105,42.00,,89.25,85,,71.4,percent of total billed charges,85% of total billed charges,80.85,77,,64.68,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,86.1,82,,68.88,percent of total billed charges,82% of total billed charges,89.25,85,,71.4,percent of total billed charges,85% of total billed charges,89.25,85,,71.4,percent of total billed charges,85% of total billed charges,89.25,85,,71.4,percent of total billed charges,85% of total billed charges,94.5,90,,75.6,percent of total billed charges,90% of total billed charges,84,80,,67.2,percent of total billed charges,80% of total billed charges,94.5,90,,75.6,percent of total billed charges,90% of total billed charges,78.75,75,,63,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,30.45,29,,24.36,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,70.35,67,,56.28,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,84,80,,67.2,percent of total billed charges,80% of total billed charges,68.25,65,,54.6,percent of total billed charges,65% of total billed charges,37.45,35.67,,29.96,percent of total billed charges,35.67% of total billed charges,30.45,94.5,
XARELTO 20 MG TAB,2511704,CDM,637,RC,,,outpatient,,,40,16.00,,34,85,,27.2,percent of total billed charges,85% of total billed charges,30.8,77,,24.64,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,32.8,82,,26.24,percent of total billed charges,82% of total billed charges,34,85,,27.2,percent of total billed charges,85% of total billed charges,34,85,,27.2,percent of total billed charges,85% of total billed charges,34,85,,27.2,percent of total billed charges,85% of total billed charges,36,90,,28.8,percent of total billed charges,90% of total billed charges,32,80,,25.6,percent of total billed charges,80% of total billed charges,36,90,,28.8,percent of total billed charges,90% of total billed charges,30,75,,24,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,11.6,29,,9.28,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,26.8,67,,21.44,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,32,80,,25.6,percent of total billed charges,80% of total billed charges,26,65,,20.8,percent of total billed charges,65% of total billed charges,14.27,35.67,,11.416,percent of total billed charges,35.67% of total billed charges,11.6,36,
XYLOCAINE-BEN-MALLOX 60ML PO,2511736,CDM,637,RC,,,outpatient,,,13,5.20,,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,10.01,77,,8.01,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,10.66,82,,8.528,percent of total billed charges,82% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,11.7,90,,9.36,percent of total billed charges,90% of total billed charges,10.4,80,,8.32,percent of total billed charges,80% of total billed charges,11.7,90,,9.36,percent of total billed charges,90% of total billed charges,9.75,75,,7.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,3.77,29,,3.016,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,8.71,67,,6.968,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,10.4,80,,8.32,percent of total billed charges,80% of total billed charges,8.45,65,,6.76,percent of total billed charges,65% of total billed charges,4.64,35.67,,3.712,percent of total billed charges,35.67% of total billed charges,3.77,11.7,
ZANAFLEX 4 MG PO,2511762,CDM,637,RC,,,outpatient,,,16,6.40,,13.6,85,,10.88,percent of total billed charges,85% of total billed charges,12.32,77,,9.86,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,13.12,82,,10.496,percent of total billed charges,82% of total billed charges,13.6,85,,10.88,percent of total billed charges,85% of total billed charges,13.6,85,,10.88,percent of total billed charges,85% of total billed charges,13.6,85,,10.88,percent of total billed charges,85% of total billed charges,14.4,90,,11.52,percent of total billed charges,90% of total billed charges,12.8,80,,10.24,percent of total billed charges,80% of total billed charges,14.4,90,,11.52,percent of total billed charges,90% of total billed charges,12,75,,9.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,4.64,29,,3.712,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,10.72,67,,8.576,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,12.8,80,,10.24,percent of total billed charges,80% of total billed charges,10.4,65,,8.32,percent of total billed charges,65% of total billed charges,5.71,35.67,,4.568,percent of total billed charges,35.67% of total billed charges,4.64,14.4,
ZANTAC 150 MG TAB,2511770,CDM,637,RC,,,outpatient,,,20,8.00,,17,85,,13.6,percent of total billed charges,85% of total billed charges,15.4,77,,12.32,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,16.4,82,,13.12,percent of total billed charges,82% of total billed charges,17,85,,13.6,percent of total billed charges,85% of total billed charges,17,85,,13.6,percent of total billed charges,85% of total billed charges,17,85,,13.6,percent of total billed charges,85% of total billed charges,18,90,,14.4,percent of total billed charges,90% of total billed charges,16,80,,12.8,percent of total billed charges,80% of total billed charges,18,90,,14.4,percent of total billed charges,90% of total billed charges,15,75,,12,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,5.8,29,,4.64,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,13.4,67,,10.72,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,16,80,,12.8,percent of total billed charges,80% of total billed charges,13,65,,10.4,percent of total billed charges,65% of total billed charges,7.13,35.67,,5.704,percent of total billed charges,35.67% of total billed charges,5.8,18,
ZANTAC 150MG/10 ML UDC,2511791,CDM,637,RC,,,outpatient,,,31,12.40,,26.35,85,,21.08,percent of total billed charges,85% of total billed charges,23.87,77,,19.1,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,25.42,82,,20.336,percent of total billed charges,82% of total billed charges,26.35,85,,21.08,percent of total billed charges,85% of total billed charges,26.35,85,,21.08,percent of total billed charges,85% of total billed charges,26.35,85,,21.08,percent of total billed charges,85% of total billed charges,27.9,90,,22.32,percent of total billed charges,90% of total billed charges,24.8,80,,19.84,percent of total billed charges,80% of total billed charges,27.9,90,,22.32,percent of total billed charges,90% of total billed charges,23.25,75,,18.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,8.99,29,,7.192,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,20.77,67,,16.616,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,24.8,80,,19.84,percent of total billed charges,80% of total billed charges,20.15,65,,16.12,percent of total billed charges,65% of total billed charges,11.06,35.67,,8.848,percent of total billed charges,35.67% of total billed charges,8.99,27.9,
ZENTRON 10 CC LIQUID,2511810,CDM,637,RC,,,outpatient,,,6,2.40,,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,4.62,77,,3.7,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,4.92,82,,3.936,percent of total billed charges,82% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,5.4,90,,4.32,percent of total billed charges,90% of total billed charges,4.8,80,,3.84,percent of total billed charges,80% of total billed charges,5.4,90,,4.32,percent of total billed charges,90% of total billed charges,4.5,75,,3.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,1.74,29,,1.392,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,4.02,67,,3.216,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,4.8,80,,3.84,percent of total billed charges,80% of total billed charges,3.9,65,,3.12,percent of total billed charges,65% of total billed charges,2.14,35.67,,1.712,percent of total billed charges,35.67% of total billed charges,1.74,5.4,
ZITHROMAX 250 MG CAP,2511880,CDM,637,RC,,,outpatient,,,19,7.60,,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,14.63,77,,11.7,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,15.58,82,,12.464,percent of total billed charges,82% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,15.2,80,,12.16,percent of total billed charges,80% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,14.25,75,,11.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,5.51,29,,4.408,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,12.73,67,,10.184,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,15.2,80,,12.16,percent of total billed charges,80% of total billed charges,12.35,65,,9.88,percent of total billed charges,65% of total billed charges,6.78,35.67,,5.424,percent of total billed charges,35.67% of total billed charges,5.51,17.1,
ZOCOR 5 MG TAB,2511884,CDM,637,RC,,,outpatient,,,12,4.80,,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,9.24,77,,7.39,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,9.84,82,,7.872,percent of total billed charges,82% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,10.8,90,,8.64,percent of total billed charges,90% of total billed charges,9.6,80,,7.68,percent of total billed charges,80% of total billed charges,10.8,90,,8.64,percent of total billed charges,90% of total billed charges,9,75,,7.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,3.48,29,,2.784,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,8.04,67,,6.432,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,9.6,80,,7.68,percent of total billed charges,80% of total billed charges,7.8,65,,6.24,percent of total billed charges,65% of total billed charges,4.28,35.67,,3.424,percent of total billed charges,35.67% of total billed charges,3.48,10.8,
ZOCOR TAB 10 MG,2511885,CDM,637,RC,,,outpatient,,,14,5.60,,11.9,85,,9.52,percent of total billed charges,85% of total billed charges,10.78,77,,8.62,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,11.48,82,,9.184,percent of total billed charges,82% of total billed charges,11.9,85,,9.52,percent of total billed charges,85% of total billed charges,11.9,85,,9.52,percent of total billed charges,85% of total billed charges,11.9,85,,9.52,percent of total billed charges,85% of total billed charges,12.6,90,,10.08,percent of total billed charges,90% of total billed charges,11.2,80,,8.96,percent of total billed charges,80% of total billed charges,12.6,90,,10.08,percent of total billed charges,90% of total billed charges,10.5,75,,8.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,4.06,29,,3.248,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,9.38,67,,7.504,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,11.2,80,,8.96,percent of total billed charges,80% of total billed charges,9.1,65,,7.28,percent of total billed charges,65% of total billed charges,4.99,35.67,,3.992,percent of total billed charges,35.67% of total billed charges,4.06,12.6,
ZOCOR 20 MG TAB,2511886,CDM,637,RC,,,outpatient,,,30,12.00,,25.5,85,,20.4,percent of total billed charges,85% of total billed charges,23.1,77,,18.48,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,24.6,82,,19.68,percent of total billed charges,82% of total billed charges,25.5,85,,20.4,percent of total billed charges,85% of total billed charges,25.5,85,,20.4,percent of total billed charges,85% of total billed charges,25.5,85,,20.4,percent of total billed charges,85% of total billed charges,27,90,,21.6,percent of total billed charges,90% of total billed charges,24,80,,19.2,percent of total billed charges,80% of total billed charges,27,90,,21.6,percent of total billed charges,90% of total billed charges,22.5,75,,18,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,8.7,29,,6.96,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,20.1,67,,16.08,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,24,80,,19.2,percent of total billed charges,80% of total billed charges,19.5,65,,15.6,percent of total billed charges,65% of total billed charges,10.7,35.67,,8.56,percent of total billed charges,35.67% of total billed charges,8.7,27,
ZOFRAN TABLETS,2511895,CDM,637,RC,,,outpatient,,,97,38.80,,82.45,85,,65.96,percent of total billed charges,85% of total billed charges,74.69,77,,59.75,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,79.54,82,,63.632,percent of total billed charges,82% of total billed charges,82.45,85,,65.96,percent of total billed charges,85% of total billed charges,82.45,85,,65.96,percent of total billed charges,85% of total billed charges,82.45,85,,65.96,percent of total billed charges,85% of total billed charges,87.3,90,,69.84,percent of total billed charges,90% of total billed charges,77.6,80,,62.08,percent of total billed charges,80% of total billed charges,87.3,90,,69.84,percent of total billed charges,90% of total billed charges,72.75,75,,58.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,28.13,29,,22.504,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,64.99,67,,51.992,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,77.6,80,,62.08,percent of total billed charges,80% of total billed charges,63.05,65,,50.44,percent of total billed charges,65% of total billed charges,34.6,35.67,,27.68,percent of total billed charges,35.67% of total billed charges,28.13,87.3,
ZOSTRIL CREAM,2511915,CDM,637,RC,,,outpatient,,,63,25.20,,53.55,85,,42.84,percent of total billed charges,85% of total billed charges,48.51,77,,38.81,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,51.66,82,,41.328,percent of total billed charges,82% of total billed charges,53.55,85,,42.84,percent of total billed charges,85% of total billed charges,53.55,85,,42.84,percent of total billed charges,85% of total billed charges,53.55,85,,42.84,percent of total billed charges,85% of total billed charges,56.7,90,,45.36,percent of total billed charges,90% of total billed charges,50.4,80,,40.32,percent of total billed charges,80% of total billed charges,56.7,90,,45.36,percent of total billed charges,90% of total billed charges,47.25,75,,37.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,18.27,29,,14.616,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,42.21,67,,33.768,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,50.4,80,,40.32,percent of total billed charges,80% of total billed charges,40.95,65,,32.76,percent of total billed charges,65% of total billed charges,22.47,35.67,,17.976,percent of total billed charges,35.67% of total billed charges,18.27,56.7,
ZOVIRAX SUSP PER DOSE,2511940,CDM,637,RC,,,outpatient,,,124,49.60,,105.4,85,,84.32,percent of total billed charges,85% of total billed charges,95.48,77,,76.38,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,101.68,82,,81.344,percent of total billed charges,82% of total billed charges,105.4,85,,84.32,percent of total billed charges,85% of total billed charges,105.4,85,,84.32,percent of total billed charges,85% of total billed charges,105.4,85,,84.32,percent of total billed charges,85% of total billed charges,111.6,90,,89.28,percent of total billed charges,90% of total billed charges,99.2,80,,79.36,percent of total billed charges,80% of total billed charges,111.6,90,,89.28,percent of total billed charges,90% of total billed charges,93,75,,74.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,35.96,29,,28.768,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,83.08,67,,66.464,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,99.2,80,,79.36,percent of total billed charges,80% of total billed charges,80.6,65,,64.48,percent of total billed charges,65% of total billed charges,44.23,35.67,,35.384,percent of total billed charges,35.67% of total billed charges,35.96,111.6,
ZYBAN 150 MG PO,2511947,CDM,637,RC,,,outpatient,,,19,7.60,,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,14.63,77,,11.7,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,15.58,82,,12.464,percent of total billed charges,82% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,15.2,80,,12.16,percent of total billed charges,80% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,14.25,75,,11.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,5.51,29,,4.408,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,12.73,67,,10.184,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,15.2,80,,12.16,percent of total billed charges,80% of total billed charges,12.35,65,,9.88,percent of total billed charges,65% of total billed charges,6.78,35.67,,5.424,percent of total billed charges,35.67% of total billed charges,5.51,17.1,
ZYRTEC SYRUP PER 5 ML SYRINGE,2511964,CDM,637,RC,,,outpatient,,,9,3.60,,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,6.93,77,,5.54,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,7.38,82,,5.904,percent of total billed charges,82% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,8.1,90,,6.48,percent of total billed charges,90% of total billed charges,7.2,80,,5.76,percent of total billed charges,80% of total billed charges,8.1,90,,6.48,percent of total billed charges,90% of total billed charges,6.75,75,,5.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,2.61,29,,2.088,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,6.03,67,,4.824,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,7.2,80,,5.76,percent of total billed charges,80% of total billed charges,5.85,65,,4.68,percent of total billed charges,65% of total billed charges,3.21,35.67,,2.568,percent of total billed charges,35.67% of total billed charges,2.61,8.1,
ZYVOX 200 MG *,2511970,CDM,637,RC,,,outpatient,,,96,38.40,,81.6,85,,65.28,percent of total billed charges,85% of total billed charges,73.92,77,,59.14,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,78.72,82,,62.976,percent of total billed charges,82% of total billed charges,81.6,85,,65.28,percent of total billed charges,85% of total billed charges,81.6,85,,65.28,percent of total billed charges,85% of total billed charges,81.6,85,,65.28,percent of total billed charges,85% of total billed charges,86.4,90,,69.12,percent of total billed charges,90% of total billed charges,76.8,80,,61.44,percent of total billed charges,80% of total billed charges,86.4,90,,69.12,percent of total billed charges,90% of total billed charges,72,75,,57.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,27.84,29,,22.272,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,64.32,67,,51.456,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,76.8,80,,61.44,percent of total billed charges,80% of total billed charges,62.4,65,,49.92,percent of total billed charges,65% of total billed charges,34.24,35.67,,27.392,percent of total billed charges,35.67% of total billed charges,27.84,86.4,
ZYVOX ORAL SUSP 100MG/5ML BOT,2511975,CDM,637,RC,,,outpatient,,,1732,692.80,,1472.2,85,,1177.76,percent of total billed charges,85% of total billed charges,1333.64,77,,1066.91,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,1420.24,82,,1136.192,percent of total billed charges,82% of total billed charges,1472.2,85,,1177.76,percent of total billed charges,85% of total billed charges,1472.2,85,,1177.76,percent of total billed charges,85% of total billed charges,1472.2,85,,1177.76,percent of total billed charges,85% of total billed charges,1558.8,90,,1247.04,percent of total billed charges,90% of total billed charges,1385.6,80,,1108.48,percent of total billed charges,80% of total billed charges,1558.8,90,,1247.04,percent of total billed charges,90% of total billed charges,1299,75,,1039.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,502.28,29,,401.824,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1160.44,67,,928.352,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1385.6,80,,1108.48,percent of total billed charges,80% of total billed charges,1125.8,65,,900.64,percent of total billed charges,65% of total billed charges,617.8,35.67,,494.24,percent of total billed charges,35.67% of total billed charges,502.28,1558.8,
LIDOCAINE 1% BUFFERED,2513148,CDM,637,RC,,,outpatient,,,5,2.00,,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,3.85,77,,3.08,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,4.1,82,,3.28,percent of total billed charges,82% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,4.5,90,,3.6,percent of total billed charges,90% of total billed charges,4,80,,3.2,percent of total billed charges,80% of total billed charges,4.5,90,,3.6,percent of total billed charges,90% of total billed charges,3.75,75,,3,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,1.45,29,,1.16,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,3.35,67,,2.68,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,4,80,,3.2,percent of total billed charges,80% of total billed charges,3.25,65,,2.6,percent of total billed charges,65% of total billed charges,1.78,35.67,,1.424,percent of total billed charges,35.67% of total billed charges,1.45,4.5,
ENTRESTO 24 MG PO,2513513,CDM,637,RC,,,outpatient,,,31,12.40,,26.35,85,,21.08,percent of total billed charges,85% of total billed charges,23.87,77,,19.1,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,25.42,82,,20.336,percent of total billed charges,82% of total billed charges,26.35,85,,21.08,percent of total billed charges,85% of total billed charges,26.35,85,,21.08,percent of total billed charges,85% of total billed charges,26.35,85,,21.08,percent of total billed charges,85% of total billed charges,27.9,90,,22.32,percent of total billed charges,90% of total billed charges,24.8,80,,19.84,percent of total billed charges,80% of total billed charges,27.9,90,,22.32,percent of total billed charges,90% of total billed charges,23.25,75,,18.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,8.99,29,,7.192,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,20.77,67,,16.616,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,24.8,80,,19.84,percent of total billed charges,80% of total billed charges,20.15,65,,16.12,percent of total billed charges,65% of total billed charges,11.06,35.67,,8.848,percent of total billed charges,35.67% of total billed charges,8.99,27.9,
SIVEXTRO 200 MG PO,2518122,CDM,637,RC,,,outpatient,,,643,257.20,,546.55,85,,437.24,percent of total billed charges,85% of total billed charges,495.11,77,,396.09,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,527.26,82,,421.808,percent of total billed charges,82% of total billed charges,546.55,85,,437.24,percent of total billed charges,85% of total billed charges,546.55,85,,437.24,percent of total billed charges,85% of total billed charges,546.55,85,,437.24,percent of total billed charges,85% of total billed charges,578.7,90,,462.96,percent of total billed charges,90% of total billed charges,514.4,80,,411.52,percent of total billed charges,80% of total billed charges,578.7,90,,462.96,percent of total billed charges,90% of total billed charges,482.25,75,,385.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,186.47,29,,149.176,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,430.81,67,,344.648,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,514.4,80,,411.52,percent of total billed charges,80% of total billed charges,417.95,65,,334.36,percent of total billed charges,65% of total billed charges,229.36,35.67,,183.488,percent of total billed charges,35.67% of total billed charges,186.47,578.7,
VERAPAMIL SR 240 MG,2523991,CDM,637,RC,,,outpatient,,,22,8.80,,18.7,85,,14.96,percent of total billed charges,85% of total billed charges,16.94,77,,13.55,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,18.04,82,,14.432,percent of total billed charges,82% of total billed charges,18.7,85,,14.96,percent of total billed charges,85% of total billed charges,18.7,85,,14.96,percent of total billed charges,85% of total billed charges,18.7,85,,14.96,percent of total billed charges,85% of total billed charges,19.8,90,,15.84,percent of total billed charges,90% of total billed charges,17.6,80,,14.08,percent of total billed charges,80% of total billed charges,19.8,90,,15.84,percent of total billed charges,90% of total billed charges,16.5,75,,13.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,6.38,29,,5.104,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,14.74,67,,11.792,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,17.6,80,,14.08,percent of total billed charges,80% of total billed charges,14.3,65,,11.44,percent of total billed charges,65% of total billed charges,7.85,35.67,,6.28,percent of total billed charges,35.67% of total billed charges,6.38,19.8,
LESCOL XL 80 MG TAB,2590008,CDM,637,RC,,,outpatient,,,23,9.20,,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,17.71,77,,14.17,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,18.86,82,,15.088,percent of total billed charges,82% of total billed charges,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,20.7,90,,16.56,percent of total billed charges,90% of total billed charges,18.4,80,,14.72,percent of total billed charges,80% of total billed charges,20.7,90,,16.56,percent of total billed charges,90% of total billed charges,17.25,75,,13.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,6.67,29,,5.336,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,15.41,67,,12.328,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,18.4,80,,14.72,percent of total billed charges,80% of total billed charges,14.95,65,,11.96,percent of total billed charges,65% of total billed charges,8.2,35.67,,6.56,percent of total billed charges,35.67% of total billed charges,6.67,20.7,
TRILEPTAL 300 MG/5ML 60ML BOT,2590021,CDM,637,RC,,,outpatient,,,364,145.60,,309.4,85,,247.52,percent of total billed charges,85% of total billed charges,280.28,77,,224.22,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,298.48,82,,238.784,percent of total billed charges,82% of total billed charges,309.4,85,,247.52,percent of total billed charges,85% of total billed charges,309.4,85,,247.52,percent of total billed charges,85% of total billed charges,309.4,85,,247.52,percent of total billed charges,85% of total billed charges,327.6,90,,262.08,percent of total billed charges,90% of total billed charges,291.2,80,,232.96,percent of total billed charges,80% of total billed charges,327.6,90,,262.08,percent of total billed charges,90% of total billed charges,273,75,,218.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,105.56,29,,84.448,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,243.88,67,,195.104,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,291.2,80,,232.96,percent of total billed charges,80% of total billed charges,236.6,65,,189.28,percent of total billed charges,65% of total billed charges,129.84,35.67,,103.872,percent of total billed charges,35.67% of total billed charges,105.56,327.6,
MISC DRUGS FOR PHARMACY,9999991,CDM,637,RC,,,outpatient,,,15,6.00,,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,11.55,77,,9.24,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,12.3,82,,9.84,percent of total billed charges,82% of total billed charges,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,13.5,90,,10.8,percent of total billed charges,90% of total billed charges,12,80,,9.6,percent of total billed charges,80% of total billed charges,13.5,90,,10.8,percent of total billed charges,90% of total billed charges,11.25,75,,9,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,4.35,29,,3.48,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,10.05,67,,8.04,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,12,80,,9.6,percent of total billed charges,80% of total billed charges,9.75,65,,7.8,percent of total billed charges,65% of total billed charges,5.35,35.67,,4.28,percent of total billed charges,35.67% of total billed charges,4.35,13.5,
MISC PHARMACY CHARGE,9999997,CDM,637,RC,,,outpatient,,,44,17.60,,37.4,85,,29.92,percent of total billed charges,85% of total billed charges,33.88,77,,27.1,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,36.08,82,,28.864,percent of total billed charges,82% of total billed charges,37.4,85,,29.92,percent of total billed charges,85% of total billed charges,37.4,85,,29.92,percent of total billed charges,85% of total billed charges,37.4,85,,29.92,percent of total billed charges,85% of total billed charges,39.6,90,,31.68,percent of total billed charges,90% of total billed charges,35.2,80,,28.16,percent of total billed charges,80% of total billed charges,39.6,90,,31.68,percent of total billed charges,90% of total billed charges,33,75,,26.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,12.76,29,,10.208,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,29.48,67,,23.584,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,35.2,80,,28.16,percent of total billed charges,80% of total billed charges,28.6,65,,22.88,percent of total billed charges,65% of total billed charges,15.69,35.67,,12.552,percent of total billed charges,35.67% of total billed charges,12.76,39.6,
TRAUMA ACTIVATION,6840100,CDM,684,RC,G0390,HCPCS,outpatient,,,3270,1308.00,,2779.5,85,,2223.6,percent of total billed charges,85% of total billed charges,2517.9,77,,2014.32,percent of total billed charges,77% of total billed charges,1197.32,100,,,fee schedule,100% of CMS OPPS rate,4107.98,429,,,fee schedule,429% of BCBS fee schedule,4280.34,447,,,fee schedule,447% of BCBS fee schedule,4280.34,447,,,fee schedule,447% of BCBS fee schedule,4280.34,447,,,fee schedule,447% of BCBS fee schedule,2943,90,,2354.4,percent of total billed charges,90% of total billed charges,2616,80,,2092.8,percent of total billed charges,80% of total billed charges,2943,90,,2354.4,percent of total billed charges,90% of total billed charges,2452.5,75,,1962,percent of total billed charges,75% of total billed charges,1460.72,122,,,fee schedule,122% of HUMANA fee schedule,948.3,29,,758.64,percent of total billed charges,29% of total billed charges,1197.32,100,,,fee schedule,100% of CMS OPPS rate,2190.9,67,,1752.72,percent of total billed charges,67% of total billed charges,750.92,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,2616,80,,2092.8,percent of total billed charges,80% of total billed charges,2125.5,65,,1700.4,percent of total billed charges,65% of total billed charges,1166.41,35.67,,933.128,percent of total billed charges,35.67% of total billed charges,750.92,4280.34,
RECOVERY ROOM 1-30 MINUTES,7100010,CDM,710,RC,,,outpatient,,,1378,551.20,,1171.3,85,,937.04,percent of total billed charges,85% of total billed charges,1061.06,77,,848.85,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,1129.96,82,,903.968,percent of total billed charges,82% of total billed charges,1171.3,85,,937.04,percent of total billed charges,85% of total billed charges,1171.3,85,,937.04,percent of total billed charges,85% of total billed charges,1171.3,85,,937.04,percent of total billed charges,85% of total billed charges,1240.2,90,,992.16,percent of total billed charges,90% of total billed charges,1102.4,80,,881.92,percent of total billed charges,80% of total billed charges,1240.2,90,,992.16,percent of total billed charges,90% of total billed charges,1033.5,75,,826.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,399.62,29,,319.696,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,923.26,67,,738.608,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1102.4,80,,881.92,percent of total billed charges,80% of total billed charges,895.7,65,,716.56,percent of total billed charges,65% of total billed charges,491.53,35.67,,393.224,percent of total billed charges,35.67% of total billed charges,399.62,1240.2,
RECOVERY ROOM 31 - 60 MINUTES,7100020,CDM,710,RC,,,outpatient,,,2526,1010.40,,2147.1,85,,1717.68,percent of total billed charges,85% of total billed charges,1945.02,77,,1556.02,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,2071.32,82,,1657.056,percent of total billed charges,82% of total billed charges,2147.1,85,,1717.68,percent of total billed charges,85% of total billed charges,2147.1,85,,1717.68,percent of total billed charges,85% of total billed charges,2147.1,85,,1717.68,percent of total billed charges,85% of total billed charges,2273.4,90,,1818.72,percent of total billed charges,90% of total billed charges,2020.8,80,,1616.64,percent of total billed charges,80% of total billed charges,2273.4,90,,1818.72,percent of total billed charges,90% of total billed charges,1894.5,75,,1515.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,732.54,29,,586.032,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1692.42,67,,1353.936,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,2020.8,80,,1616.64,percent of total billed charges,80% of total billed charges,1641.9,65,,1313.52,percent of total billed charges,65% of total billed charges,901.02,35.67,,720.816,percent of total billed charges,35.67% of total billed charges,732.54,2273.4,
RECOVERY ROOM 61-90 MINUTES,7100030,CDM,710,RC,,,outpatient,,,3100,1240.00,,2635,85,,2108,percent of total billed charges,85% of total billed charges,2387,77,,1909.6,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,2542,82,,2033.6,percent of total billed charges,82% of total billed charges,2635,85,,2108,percent of total billed charges,85% of total billed charges,2635,85,,2108,percent of total billed charges,85% of total billed charges,2635,85,,2108,percent of total billed charges,85% of total billed charges,2790,90,,2232,percent of total billed charges,90% of total billed charges,2480,80,,1984,percent of total billed charges,80% of total billed charges,2790,90,,2232,percent of total billed charges,90% of total billed charges,2325,75,,1860,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,899,29,,719.2,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,2077,67,,1661.6,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,2480,80,,1984,percent of total billed charges,80% of total billed charges,2015,65,,1612,percent of total billed charges,65% of total billed charges,1105.77,35.67,,884.616,percent of total billed charges,35.67% of total billed charges,899,2790,
RECOVERY ROOM EACH ADD 30 MIN,7100040,CDM,710,RC,,,outpatient,,,575,230.00,,488.75,85,,391,percent of total billed charges,85% of total billed charges,442.75,77,,354.2,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,471.5,82,,377.2,percent of total billed charges,82% of total billed charges,488.75,85,,391,percent of total billed charges,85% of total billed charges,488.75,85,,391,percent of total billed charges,85% of total billed charges,488.75,85,,391,percent of total billed charges,85% of total billed charges,517.5,90,,414,percent of total billed charges,90% of total billed charges,460,80,,368,percent of total billed charges,80% of total billed charges,517.5,90,,414,percent of total billed charges,90% of total billed charges,431.25,75,,345,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,166.75,29,,133.4,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,385.25,67,,308.2,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,460,80,,368,percent of total billed charges,80% of total billed charges,373.75,65,,299,percent of total billed charges,65% of total billed charges,205.1,35.67,,164.08,percent of total billed charges,35.67% of total billed charges,166.75,517.5,
RECOVERY PHASE 2 1-60 MIN,7100090,CDM,710,RC,,,outpatient,,,690,276.00,,586.5,85,,469.2,percent of total billed charges,85% of total billed charges,531.3,77,,425.04,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,565.8,82,,452.64,percent of total billed charges,82% of total billed charges,586.5,85,,469.2,percent of total billed charges,85% of total billed charges,586.5,85,,469.2,percent of total billed charges,85% of total billed charges,586.5,85,,469.2,percent of total billed charges,85% of total billed charges,621,90,,496.8,percent of total billed charges,90% of total billed charges,552,80,,441.6,percent of total billed charges,80% of total billed charges,621,90,,496.8,percent of total billed charges,90% of total billed charges,517.5,75,,414,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,200.1,29,,160.08,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,462.3,67,,369.84,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,552,80,,441.6,percent of total billed charges,80% of total billed charges,448.5,65,,358.8,percent of total billed charges,65% of total billed charges,246.12,35.67,,196.896,percent of total billed charges,35.67% of total billed charges,200.1,621,
RECOVERY PHASE 2 EA ADD'L 60 M,7100095,CDM,710,RC,,,outpatient,,,677,270.80,,575.45,85,,460.36,percent of total billed charges,85% of total billed charges,521.29,77,,417.03,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,555.14,82,,444.112,percent of total billed charges,82% of total billed charges,575.45,85,,460.36,percent of total billed charges,85% of total billed charges,575.45,85,,460.36,percent of total billed charges,85% of total billed charges,575.45,85,,460.36,percent of total billed charges,85% of total billed charges,609.3,90,,487.44,percent of total billed charges,90% of total billed charges,541.6,80,,433.28,percent of total billed charges,80% of total billed charges,609.3,90,,487.44,percent of total billed charges,90% of total billed charges,507.75,75,,406.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,196.33,29,,157.064,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,453.59,67,,362.872,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,541.6,80,,433.28,percent of total billed charges,80% of total billed charges,440.05,65,,352.04,percent of total billed charges,65% of total billed charges,241.49,35.67,,193.192,percent of total billed charges,35.67% of total billed charges,196.33,609.3,
RECOVERY ROOM OB 1-30 MIN,7600070,CDM,710,RC,,,outpatient,,,1353,541.20,,1150.05,85,,920.04,percent of total billed charges,85% of total billed charges,1041.81,77,,833.45,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,1109.46,82,,887.568,percent of total billed charges,82% of total billed charges,1150.05,85,,920.04,percent of total billed charges,85% of total billed charges,1150.05,85,,920.04,percent of total billed charges,85% of total billed charges,1150.05,85,,920.04,percent of total billed charges,85% of total billed charges,1217.7,90,,974.16,percent of total billed charges,90% of total billed charges,1082.4,80,,865.92,percent of total billed charges,80% of total billed charges,1217.7,90,,974.16,percent of total billed charges,90% of total billed charges,1014.75,75,,811.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,392.37,29,,313.896,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,906.51,67,,725.208,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1082.4,80,,865.92,percent of total billed charges,80% of total billed charges,879.45,65,,703.56,percent of total billed charges,65% of total billed charges,482.62,35.67,,386.096,percent of total billed charges,35.67% of total billed charges,392.37,1217.7,
RECOVERY ROOM OB 31-60 MIN,7600075,CDM,710,RC,,,outpatient,,,2526,1010.40,,2147.1,85,,1717.68,percent of total billed charges,85% of total billed charges,1945.02,77,,1556.02,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,2071.32,82,,1657.056,percent of total billed charges,82% of total billed charges,2147.1,85,,1717.68,percent of total billed charges,85% of total billed charges,2147.1,85,,1717.68,percent of total billed charges,85% of total billed charges,2147.1,85,,1717.68,percent of total billed charges,85% of total billed charges,2273.4,90,,1818.72,percent of total billed charges,90% of total billed charges,2020.8,80,,1616.64,percent of total billed charges,80% of total billed charges,2273.4,90,,1818.72,percent of total billed charges,90% of total billed charges,1894.5,75,,1515.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,732.54,29,,586.032,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1692.42,67,,1353.936,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,2020.8,80,,1616.64,percent of total billed charges,80% of total billed charges,1641.9,65,,1313.52,percent of total billed charges,65% of total billed charges,901.02,35.67,,720.816,percent of total billed charges,35.67% of total billed charges,732.54,2273.4,
RECOVERY ROOM OB 61- 90 MIN,7600080,CDM,710,RC,,,outpatient,,,3100,1240.00,,2635,85,,2108,percent of total billed charges,85% of total billed charges,2387,77,,1909.6,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,2542,82,,2033.6,percent of total billed charges,82% of total billed charges,2635,85,,2108,percent of total billed charges,85% of total billed charges,2635,85,,2108,percent of total billed charges,85% of total billed charges,2635,85,,2108,percent of total billed charges,85% of total billed charges,2790,90,,2232,percent of total billed charges,90% of total billed charges,2480,80,,1984,percent of total billed charges,80% of total billed charges,2790,90,,2232,percent of total billed charges,90% of total billed charges,2325,75,,1860,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,899,29,,719.2,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,2077,67,,1661.6,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,2480,80,,1984,percent of total billed charges,80% of total billed charges,2015,65,,1612,percent of total billed charges,65% of total billed charges,1105.77,35.67,,884.616,percent of total billed charges,35.67% of total billed charges,899,2790,
RECOVERY ROOM OB 120 MINUTES,7600085,CDM,710,RC,,,outpatient,,,3100,1240.00,,2635,85,,2108,percent of total billed charges,85% of total billed charges,2387,77,,1909.6,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,2542,82,,2033.6,percent of total billed charges,82% of total billed charges,2635,85,,2108,percent of total billed charges,85% of total billed charges,2635,85,,2108,percent of total billed charges,85% of total billed charges,2635,85,,2108,percent of total billed charges,85% of total billed charges,2790,90,,2232,percent of total billed charges,90% of total billed charges,2480,80,,1984,percent of total billed charges,80% of total billed charges,2790,90,,2232,percent of total billed charges,90% of total billed charges,2325,75,,1860,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,899,29,,719.2,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,2077,67,,1661.6,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,2480,80,,1984,percent of total billed charges,80% of total billed charges,2015,65,,1612,percent of total billed charges,65% of total billed charges,1105.77,35.67,,884.616,percent of total billed charges,35.67% of total billed charges,899,2790,
RECOVERY ROOM OB EACH ADD 30,7600090,CDM,710,RC,,,outpatient,,,564,225.60,,479.4,85,,383.52,percent of total billed charges,85% of total billed charges,434.28,77,,347.42,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,462.48,82,,369.984,percent of total billed charges,82% of total billed charges,479.4,85,,383.52,percent of total billed charges,85% of total billed charges,479.4,85,,383.52,percent of total billed charges,85% of total billed charges,479.4,85,,383.52,percent of total billed charges,85% of total billed charges,507.6,90,,406.08,percent of total billed charges,90% of total billed charges,451.2,80,,360.96,percent of total billed charges,80% of total billed charges,507.6,90,,406.08,percent of total billed charges,90% of total billed charges,423,75,,338.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,163.56,29,,130.848,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,377.88,67,,302.304,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,451.2,80,,360.96,percent of total billed charges,80% of total billed charges,366.6,65,,293.28,percent of total billed charges,65% of total billed charges,201.18,35.67,,160.944,percent of total billed charges,35.67% of total billed charges,163.56,507.6,
FETAL HEART MONITOR/NST,2600047,CDM,720,RC,59025,HCPCS,outpatient,,,499,199.60,,1150,,,,case rate,pays based on per visit,384.23,77,,307.38,percent of total billed charges,77% of total billed charges,174.26,100,,,fee schedule,100% of CMS OPPS rate,80.05,429,,,fee schedule,429% of BCBS fee schedule,83.41,447,,,fee schedule,447% of BCBS fee schedule,83.41,447,,,fee schedule,447% of BCBS fee schedule,83.41,447,,,fee schedule,447% of BCBS fee schedule,449.1,90,,359.28,percent of total billed charges,90% of total billed charges,399.2,80,,319.36,percent of total billed charges,80% of total billed charges,449.1,90,,359.28,percent of total billed charges,90% of total billed charges,374.25,75,,299.4,percent of total billed charges,75% of total billed charges,212.59,122,,,fee schedule,122% of HUMANA fee schedule,15.78,100,,,fee schedule,100% of ASC tier grouping rate,174.26,100,,,fee schedule,100% of CMS OPPS rate,334.33,67,,267.464,percent of total billed charges,67% of total billed charges,103.28,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,399.2,80,,319.36,percent of total billed charges,80% of total billed charges,324.35,65,,259.48,percent of total billed charges,65% of total billed charges,19.41,123,,,fee schedule,123% of ASC tier grouping rate,15.78,1150,
CAR SEAT TEST NB 60 MIN,4700020,CDM,720,RC,94780,HCPCS,outpatient,,,346,138.40,,294.1,85,,235.28,percent of total billed charges,85% of total billed charges,266.42,77,,213.14,percent of total billed charges,77% of total billed charges,35.07,100,,,fee schedule,100% of CMS OPPS rate,136.42,429,,,fee schedule,429% of BCBS fee schedule,142.15,447,,,fee schedule,447% of BCBS fee schedule,142.15,447,,,fee schedule,447% of BCBS fee schedule,142.15,447,,,fee schedule,447% of BCBS fee schedule,311.4,90,,249.12,percent of total billed charges,90% of total billed charges,276.8,80,,221.44,percent of total billed charges,80% of total billed charges,311.4,90,,249.12,percent of total billed charges,90% of total billed charges,259.5,75,,207.6,percent of total billed charges,75% of total billed charges,42.78,122,,,fee schedule,122% of HUMANA fee schedule,100.34,29,,80.272,percent of total billed charges,29% of total billed charges,35.07,100,,,fee schedule,100% of CMS OPPS rate,231.82,67,,185.456,percent of total billed charges,67% of total billed charges,42.55,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,276.8,80,,221.44,percent of total billed charges,80% of total billed charges,224.9,65,,179.92,percent of total billed charges,65% of total billed charges,123.42,35.67,,98.736,percent of total billed charges,35.67% of total billed charges,35.07,311.4,
DELIVERY ROOM LEVEL 1,7200001,CDM,720,RC,,,outpatient,,,1035,414.00,,879.75,85,,703.8,percent of total billed charges,85% of total billed charges,796.95,77,,637.56,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,848.7,82,,678.96,percent of total billed charges,82% of total billed charges,879.75,85,,703.8,percent of total billed charges,85% of total billed charges,879.75,85,,703.8,percent of total billed charges,85% of total billed charges,879.75,85,,703.8,percent of total billed charges,85% of total billed charges,931.5,90,,745.2,percent of total billed charges,90% of total billed charges,828,80,,662.4,percent of total billed charges,80% of total billed charges,931.5,90,,745.2,percent of total billed charges,90% of total billed charges,776.25,75,,621,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,300.15,29,,240.12,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,693.45,67,,554.76,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,828,80,,662.4,percent of total billed charges,80% of total billed charges,672.75,65,,538.2,percent of total billed charges,65% of total billed charges,369.18,35.67,,295.344,percent of total billed charges,35.67% of total billed charges,300.15,931.5,
LABOR ROOM PER HOUR,7200002,CDM,720,RC,G0378,HCPCS,outpatient,,,84,33.60,,71.4,85,,57.12,percent of total billed charges,85% of total billed charges,64.68,77,,51.74,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,543.5,429,,,fee schedule,429% of BCBS fee schedule,566.3,447,,,fee schedule,447% of BCBS fee schedule,566.3,447,,,fee schedule,447% of BCBS fee schedule,566.3,447,,,fee schedule,447% of BCBS fee schedule,75.6,90,,60.48,percent of total billed charges,90% of total billed charges,67.2,80,,53.76,percent of total billed charges,80% of total billed charges,75.6,90,,60.48,percent of total billed charges,90% of total billed charges,63,75,,50.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,24.36,29,,19.488,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,56.28,67,,45.024,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,67.2,80,,53.76,percent of total billed charges,80% of total billed charges,54.6,65,,43.68,percent of total billed charges,65% of total billed charges,29.96,35.67,,23.968,percent of total billed charges,35.67% of total billed charges,24.36,566.3,
DELIVERY ROOM LEVEL 2,7200012,CDM,720,RC,,,outpatient,,,1263,505.20,,1073.55,85,,858.84,percent of total billed charges,85% of total billed charges,972.51,77,,778.01,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,1035.66,82,,828.528,percent of total billed charges,82% of total billed charges,1073.55,85,,858.84,percent of total billed charges,85% of total billed charges,1073.55,85,,858.84,percent of total billed charges,85% of total billed charges,1073.55,85,,858.84,percent of total billed charges,85% of total billed charges,1136.7,90,,909.36,percent of total billed charges,90% of total billed charges,1010.4,80,,808.32,percent of total billed charges,80% of total billed charges,1136.7,90,,909.36,percent of total billed charges,90% of total billed charges,947.25,75,,757.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,366.27,29,,293.016,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,846.21,67,,676.968,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1010.4,80,,808.32,percent of total billed charges,80% of total billed charges,820.95,65,,656.76,percent of total billed charges,65% of total billed charges,450.51,35.67,,360.408,percent of total billed charges,35.67% of total billed charges,366.27,1136.7,
DELIVERY ROOM LEVEL 3,7200013,CDM,720,RC,,,outpatient,,,1465,586.00,,1245.25,85,,996.2,percent of total billed charges,85% of total billed charges,1128.05,77,,902.44,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,1201.3,82,,961.04,percent of total billed charges,82% of total billed charges,1245.25,85,,996.2,percent of total billed charges,85% of total billed charges,1245.25,85,,996.2,percent of total billed charges,85% of total billed charges,1245.25,85,,996.2,percent of total billed charges,85% of total billed charges,1318.5,90,,1054.8,percent of total billed charges,90% of total billed charges,1172,80,,937.6,percent of total billed charges,80% of total billed charges,1318.5,90,,1054.8,percent of total billed charges,90% of total billed charges,1098.75,75,,879,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,424.85,29,,339.88,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,981.55,67,,785.24,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1172,80,,937.6,percent of total billed charges,80% of total billed charges,952.25,65,,761.8,percent of total billed charges,65% of total billed charges,522.57,35.67,,418.056,percent of total billed charges,35.67% of total billed charges,424.85,1318.5,
DELIVERY ROOM LEVEL 4,7200014,CDM,720,RC,,,outpatient,,,1723,689.20,,1464.55,85,,1171.64,percent of total billed charges,85% of total billed charges,1326.71,77,,1061.37,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,1412.86,82,,1130.288,percent of total billed charges,82% of total billed charges,1464.55,85,,1171.64,percent of total billed charges,85% of total billed charges,1464.55,85,,1171.64,percent of total billed charges,85% of total billed charges,1464.55,85,,1171.64,percent of total billed charges,85% of total billed charges,1550.7,90,,1240.56,percent of total billed charges,90% of total billed charges,1378.4,80,,1102.72,percent of total billed charges,80% of total billed charges,1550.7,90,,1240.56,percent of total billed charges,90% of total billed charges,1292.25,75,,1033.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,499.67,29,,399.736,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1154.41,67,,923.528,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1378.4,80,,1102.72,percent of total billed charges,80% of total billed charges,1119.95,65,,895.96,percent of total billed charges,65% of total billed charges,614.59,35.67,,491.672,percent of total billed charges,35.67% of total billed charges,499.67,1550.7,
ATTEND DEL/STABALIZATION NB,7200015,CDM,720,RC,99464,HCPCS,outpatient,,,289,115.60,,245.65,85,,196.52,percent of total billed charges,85% of total billed charges,222.53,77,,178.02,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,326.38,429,,,fee schedule,429% of BCBS fee schedule,340.08,447,,,fee schedule,447% of BCBS fee schedule,340.08,447,,,fee schedule,447% of BCBS fee schedule,340.08,447,,,fee schedule,447% of BCBS fee schedule,260.1,90,,208.08,percent of total billed charges,90% of total billed charges,231.2,80,,184.96,percent of total billed charges,80% of total billed charges,260.1,90,,208.08,percent of total billed charges,90% of total billed charges,216.75,75,,173.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,83.81,29,,67.048,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,193.63,67,,154.904,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,231.2,80,,184.96,percent of total billed charges,80% of total billed charges,187.85,65,,150.28,percent of total billed charges,65% of total billed charges,103.09,35.67,,82.472,percent of total billed charges,35.67% of total billed charges,83.81,340.08,
INSERT FETAL SCALP ELECT/IUP,7200016,CDM,720,RC,59050,HCPCS,outpatient,,,289,115.60,,1150,,,,case rate,pays based on per visit,222.53,77,,178.02,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,236.98,82,,189.584,percent of total billed charges,82% of total billed charges,245.65,85,,196.52,percent of total billed charges,85% of total billed charges,245.65,85,,196.52,percent of total billed charges,85% of total billed charges,245.65,85,,196.52,percent of total billed charges,85% of total billed charges,260.1,90,,208.08,percent of total billed charges,90% of total billed charges,231.2,80,,184.96,percent of total billed charges,80% of total billed charges,260.1,90,,208.08,percent of total billed charges,90% of total billed charges,216.75,75,,173.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,83.81,29,,67.048,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,193.63,67,,154.904,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,231.2,80,,184.96,percent of total billed charges,80% of total billed charges,187.85,65,,150.28,percent of total billed charges,65% of total billed charges,103.09,35.67,,82.472,percent of total billed charges,35.67% of total billed charges,83.81,1150,
INSERTION CERVICAL DILATOR,7200017,CDM,720,RC,59200,HCPCS,outpatient,,,508,203.20,,1150,,,,case rate,pays based on per visit,391.16,77,,312.93,percent of total billed charges,77% of total billed charges,280.55,100,,,fee schedule,100% of CMS OPPS rate,416.56,82,,333.248,percent of total billed charges,82% of total billed charges,431.8,85,,345.44,percent of total billed charges,85% of total billed charges,431.8,85,,345.44,percent of total billed charges,85% of total billed charges,431.8,85,,345.44,percent of total billed charges,85% of total billed charges,457.2,90,,365.76,percent of total billed charges,90% of total billed charges,406.4,80,,325.12,percent of total billed charges,80% of total billed charges,457.2,90,,365.76,percent of total billed charges,90% of total billed charges,381,75,,304.8,percent of total billed charges,75% of total billed charges,342.26,122,,,fee schedule,122% of HUMANA fee schedule,147.32,29,,117.856,percent of total billed charges,29% of total billed charges,280.55,100,,,fee schedule,100% of CMS OPPS rate,340.36,67,,272.288,percent of total billed charges,67% of total billed charges,103.28,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,406.4,80,,325.12,percent of total billed charges,80% of total billed charges,330.2,65,,264.16,percent of total billed charges,65% of total billed charges,181.2,35.67,,144.96,percent of total billed charges,35.67% of total billed charges,103.28,1150,
MANUAL DEL PLACENTA,7200018,CDM,720,RC,59414,HCPCS,outpatient,,,4643,1857.20,,1150,,,,case rate,pays based on per visit,3575.11,77,,2860.09,percent of total billed charges,77% of total billed charges,2734.09,100,,,fee schedule,100% of CMS OPPS rate,3807.26,82,,3045.808,percent of total billed charges,82% of total billed charges,3946.55,85,,3157.24,percent of total billed charges,85% of total billed charges,3946.55,85,,3157.24,percent of total billed charges,85% of total billed charges,3946.55,85,,3157.24,percent of total billed charges,85% of total billed charges,4178.7,90,,3342.96,percent of total billed charges,90% of total billed charges,3714.4,80,,2971.52,percent of total billed charges,80% of total billed charges,4178.7,90,,3342.96,percent of total billed charges,90% of total billed charges,3482.25,75,,2785.8,percent of total billed charges,75% of total billed charges,3335.58,122,,,fee schedule,122% of HUMANA fee schedule,1063.52,100,,,fee schedule,100% of ASC tier grouping rate,2734.09,100,,,fee schedule,100% of CMS OPPS rate,3110.81,67,,2488.648,percent of total billed charges,67% of total billed charges,1346.28,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,3714.4,80,,2971.52,percent of total billed charges,80% of total billed charges,3017.95,65,,2414.36,percent of total billed charges,65% of total billed charges,1308.13,123,,,fee schedule,123% of ASC tier grouping rate,1063.52,4178.7,
OB NON STRESS TEST,2600157,CDM,729,RC,59025,HCPCS,outpatient,,,551,220.40,,1150,,,,case rate,pays based on per visit,424.27,77,,339.42,percent of total billed charges,77% of total billed charges,174.26,100,,,fee schedule,100% of CMS OPPS rate,80.05,429,,,fee schedule,429% of BCBS fee schedule,83.41,447,,,fee schedule,447% of BCBS fee schedule,83.41,447,,,fee schedule,447% of BCBS fee schedule,83.41,447,,,fee schedule,447% of BCBS fee schedule,495.9,90,,396.72,percent of total billed charges,90% of total billed charges,440.8,80,,352.64,percent of total billed charges,80% of total billed charges,495.9,90,,396.72,percent of total billed charges,90% of total billed charges,413.25,75,,330.6,percent of total billed charges,75% of total billed charges,212.59,122,,,fee schedule,122% of HUMANA fee schedule,15.78,100,,,fee schedule,100% of ASC tier grouping rate,174.26,100,,,fee schedule,100% of CMS OPPS rate,369.17,67,,295.336,percent of total billed charges,67% of total billed charges,103.28,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,440.8,80,,352.64,percent of total billed charges,80% of total billed charges,358.15,65,,286.52,percent of total billed charges,65% of total billed charges,19.41,123,,,fee schedule,123% of ASC tier grouping rate,15.78,1150,
EKG,7300010,CDM,730,RC,93005,HCPCS,outpatient,,,277,110.80,,235.45,85,,188.36,percent of total billed charges,85% of total billed charges,213.29,77,,170.63,percent of total billed charges,77% of total billed charges,53.49,100,,,fee schedule,100% of CMS OPPS rate,240.07,429,,,fee schedule,429% of BCBS fee schedule,250.14,447,,,fee schedule,447% of BCBS fee schedule,250.14,447,,,fee schedule,447% of BCBS fee schedule,250.14,447,,,fee schedule,447% of BCBS fee schedule,249.3,90,,199.44,percent of total billed charges,90% of total billed charges,221.6,80,,177.28,percent of total billed charges,80% of total billed charges,249.3,90,,199.44,percent of total billed charges,90% of total billed charges,207.75,75,,166.2,percent of total billed charges,75% of total billed charges,65.26,122,,,fee schedule,122% of HUMANA fee schedule,80.33,29,,64.264,percent of total billed charges,29% of total billed charges,53.49,100,,,fee schedule,100% of CMS OPPS rate,185.59,67,,148.472,percent of total billed charges,67% of total billed charges,24.92,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,221.6,80,,177.28,percent of total billed charges,80% of total billed charges,180.05,65,,144.04,percent of total billed charges,65% of total billed charges,98.81,35.67,,79.048,percent of total billed charges,35.67% of total billed charges,24.92,250.14,
RHYTHM STRIP,7300030,CDM,730,RC,93041,HCPCS,outpatient,,,271,108.40,,230.35,85,,184.28,percent of total billed charges,85% of total billed charges,208.67,77,,166.94,percent of total billed charges,77% of total billed charges,53.49,100,,,fee schedule,100% of CMS OPPS rate,240.07,429,,,fee schedule,429% of BCBS fee schedule,250.14,447,,,fee schedule,447% of BCBS fee schedule,250.14,447,,,fee schedule,447% of BCBS fee schedule,250.14,447,,,fee schedule,447% of BCBS fee schedule,243.9,90,,195.12,percent of total billed charges,90% of total billed charges,216.8,80,,173.44,percent of total billed charges,80% of total billed charges,243.9,90,,195.12,percent of total billed charges,90% of total billed charges,203.25,75,,162.6,percent of total billed charges,75% of total billed charges,65.26,122,,,fee schedule,122% of HUMANA fee schedule,78.59,29,,62.872,percent of total billed charges,29% of total billed charges,53.49,100,,,fee schedule,100% of CMS OPPS rate,181.57,67,,145.256,percent of total billed charges,67% of total billed charges,17.54,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,216.8,80,,173.44,percent of total billed charges,80% of total billed charges,176.15,65,,140.92,percent of total billed charges,65% of total billed charges,96.67,35.67,,77.336,percent of total billed charges,35.67% of total billed charges,17.54,250.14,
SIGNAL AVERAGE EKG,7300040,CDM,730,RC,93278,HCPCS,outpatient,,,272,108.80,,231.2,85,,184.96,percent of total billed charges,85% of total billed charges,209.44,77,,167.55,percent of total billed charges,77% of total billed charges,53.49,100,,,fee schedule,100% of CMS OPPS rate,240.07,429,,,fee schedule,429% of BCBS fee schedule,250.14,447,,,fee schedule,447% of BCBS fee schedule,250.14,447,,,fee schedule,447% of BCBS fee schedule,250.14,447,,,fee schedule,447% of BCBS fee schedule,244.8,90,,195.84,percent of total billed charges,90% of total billed charges,217.6,80,,174.08,percent of total billed charges,80% of total billed charges,244.8,90,,195.84,percent of total billed charges,90% of total billed charges,204,75,,163.2,percent of total billed charges,75% of total billed charges,65.26,122,,,fee schedule,122% of HUMANA fee schedule,78.88,29,,63.104,percent of total billed charges,29% of total billed charges,53.49,100,,,fee schedule,100% of CMS OPPS rate,182.24,67,,145.792,percent of total billed charges,67% of total billed charges,17.54,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,217.6,80,,174.08,percent of total billed charges,80% of total billed charges,176.8,65,,141.44,percent of total billed charges,65% of total billed charges,97.02,35.67,,77.616,percent of total billed charges,35.67% of total billed charges,17.54,250.14,
HOLTER MONITOR APPL.,7300022,CDM,731,RC,93225,HCPCS,outpatient,,,520,208.00,,442,85,,353.6,percent of total billed charges,85% of total billed charges,400.4,77,,320.32,percent of total billed charges,77% of total billed charges,111.71,100,,,fee schedule,100% of CMS OPPS rate,450.62,429,,,fee schedule,429% of BCBS fee schedule,469.53,447,,,fee schedule,447% of BCBS fee schedule,469.53,447,,,fee schedule,447% of BCBS fee schedule,469.53,447,,,fee schedule,447% of BCBS fee schedule,468,90,,374.4,percent of total billed charges,90% of total billed charges,416,80,,332.8,percent of total billed charges,80% of total billed charges,468,90,,374.4,percent of total billed charges,90% of total billed charges,390,75,,312,percent of total billed charges,75% of total billed charges,136.28,122,,,fee schedule,122% of HUMANA fee schedule,150.8,29,,120.64,percent of total billed charges,29% of total billed charges,111.71,100,,,fee schedule,100% of CMS OPPS rate,348.4,67,,278.72,percent of total billed charges,67% of total billed charges,60.95,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,416,80,,332.8,percent of total billed charges,80% of total billed charges,338,65,,270.4,percent of total billed charges,65% of total billed charges,185.48,35.67,,148.384,percent of total billed charges,35.67% of total billed charges,60.95,469.53,
HOLTER MONITOR ANALYSIS/REPORT,7300025,CDM,731,RC,93226,HCPCS,outpatient,,,509,203.60,,432.65,85,,346.12,percent of total billed charges,85% of total billed charges,391.93,77,,313.54,percent of total billed charges,77% of total billed charges,53.49,100,,,fee schedule,100% of CMS OPPS rate,450.62,429,,,fee schedule,429% of BCBS fee schedule,469.53,447,,,fee schedule,447% of BCBS fee schedule,469.53,447,,,fee schedule,447% of BCBS fee schedule,469.53,447,,,fee schedule,447% of BCBS fee schedule,458.1,90,,366.48,percent of total billed charges,90% of total billed charges,407.2,80,,325.76,percent of total billed charges,80% of total billed charges,458.1,90,,366.48,percent of total billed charges,90% of total billed charges,381.75,75,,305.4,percent of total billed charges,75% of total billed charges,65.26,122,,,fee schedule,122% of HUMANA fee schedule,147.61,29,,118.088,percent of total billed charges,29% of total billed charges,53.49,100,,,fee schedule,100% of CMS OPPS rate,341.03,67,,272.824,percent of total billed charges,67% of total billed charges,60.95,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,407.2,80,,325.76,percent of total billed charges,80% of total billed charges,330.85,65,,264.68,percent of total billed charges,65% of total billed charges,181.56,35.67,,145.248,percent of total billed charges,35.67% of total billed charges,53.49,469.53,
CARDIAC REMOTE HOOK UP FEE,7300026,CDM,731,RC,93270,HCPCS,outpatient,,,520,208.00,,442,85,,353.6,percent of total billed charges,85% of total billed charges,400.4,77,,320.32,percent of total billed charges,77% of total billed charges,32.97,100,,,fee schedule,100% of CMS OPPS rate,161.9,429,,,fee schedule,429% of BCBS fee schedule,168.7,447,,,fee schedule,447% of BCBS fee schedule,168.7,447,,,fee schedule,447% of BCBS fee schedule,168.7,447,,,fee schedule,447% of BCBS fee schedule,468,90,,374.4,percent of total billed charges,90% of total billed charges,416,80,,332.8,percent of total billed charges,80% of total billed charges,468,90,,374.4,percent of total billed charges,90% of total billed charges,390,75,,312,percent of total billed charges,75% of total billed charges,40.23,122,,,fee schedule,122% of HUMANA fee schedule,150.8,29,,120.64,percent of total billed charges,29% of total billed charges,32.97,100,,,fee schedule,100% of CMS OPPS rate,348.4,67,,278.72,percent of total billed charges,67% of total billed charges,60.95,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,416,80,,332.8,percent of total billed charges,80% of total billed charges,338,65,,270.4,percent of total billed charges,65% of total billed charges,185.48,35.67,,148.384,percent of total billed charges,35.67% of total billed charges,32.97,468,
CARDIAC REMOTE ANALYSIS/REPORT,7300027,CDM,731,RC,93271,HCPCS,outpatient,,,509,203.60,,432.65,85,,346.12,percent of total billed charges,85% of total billed charges,391.93,77,,313.54,percent of total billed charges,77% of total billed charges,84.65,100,,,fee schedule,100% of CMS OPPS rate,746.72,429,,,fee schedule,429% of BCBS fee schedule,778.05,447,,,fee schedule,447% of BCBS fee schedule,778.05,447,,,fee schedule,447% of BCBS fee schedule,778.05,447,,,fee schedule,447% of BCBS fee schedule,458.1,90,,366.48,percent of total billed charges,90% of total billed charges,407.2,80,,325.76,percent of total billed charges,80% of total billed charges,458.1,90,,366.48,percent of total billed charges,90% of total billed charges,381.75,75,,305.4,percent of total billed charges,75% of total billed charges,103.27,122,,,fee schedule,122% of HUMANA fee schedule,147.61,29,,118.088,percent of total billed charges,29% of total billed charges,84.65,100,,,fee schedule,100% of CMS OPPS rate,341.03,67,,272.824,percent of total billed charges,67% of total billed charges,104.46,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,407.2,80,,325.76,percent of total billed charges,80% of total billed charges,330.85,65,,264.68,percent of total billed charges,65% of total billed charges,181.56,35.67,,145.248,percent of total billed charges,35.67% of total billed charges,84.65,778.05,
CARDIAC REMOTE 3-7 HOOK UP FEE,7300028,CDM,731,RC,93242,HCPCS,outpatient,,,520,208.00,,442,85,,353.6,percent of total billed charges,85% of total billed charges,400.4,77,,320.32,percent of total billed charges,77% of total billed charges,35.07,100,,,fee schedule,100% of CMS OPPS rate,118.44,350,,,fee schedule,350% of BCBS fee schedule,123.18,364,,,fee schedule,364% of BCBS fee schedule,123.18,364,,,fee schedule,364% of BCBS fee schedule,123.18,364,,,fee schedule,364% of BCBS fee schedule,468,90,,374.4,percent of total billed charges,90% of total billed charges,416,80,,332.8,percent of total billed charges,80% of total billed charges,468,90,,374.4,percent of total billed charges,90% of total billed charges,390,75,,312,percent of total billed charges,75% of total billed charges,42.78,122,,,fee schedule,122% of HUMANA fee schedule,150.8,29,,120.64,percent of total billed charges,29% of total billed charges,35.07,100,,,fee schedule,100% of CMS OPPS rate,348.4,67,,278.72,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,416,80,,332.8,percent of total billed charges,80% of total billed charges,338,65,,270.4,percent of total billed charges,65% of total billed charges,185.48,35.67,,148.384,percent of total billed charges,35.67% of total billed charges,35.07,468,
CARDIAC REMOTE 8-14 HOOKUP FEE,7300029,CDM,731,RC,93246,HCPCS,outpatient,,,520,208.00,,442,85,,353.6,percent of total billed charges,85% of total billed charges,400.4,77,,320.32,percent of total billed charges,77% of total billed charges,35.07,100,,,fee schedule,100% of CMS OPPS rate,194.81,350,,,fee schedule,350% of BCBS fee schedule,202.6,364,,,fee schedule,364% of BCBS fee schedule,202.6,364,,,fee schedule,364% of BCBS fee schedule,202.6,364,,,fee schedule,364% of BCBS fee schedule,468,90,,374.4,percent of total billed charges,90% of total billed charges,416,80,,332.8,percent of total billed charges,80% of total billed charges,468,90,,374.4,percent of total billed charges,90% of total billed charges,390,75,,312,percent of total billed charges,75% of total billed charges,42.78,122,,,fee schedule,122% of HUMANA fee schedule,150.8,29,,120.64,percent of total billed charges,29% of total billed charges,35.07,100,,,fee schedule,100% of CMS OPPS rate,348.4,67,,278.72,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,416,80,,332.8,percent of total billed charges,80% of total billed charges,338,65,,270.4,percent of total billed charges,65% of total billed charges,185.48,35.67,,148.384,percent of total billed charges,35.67% of total billed charges,35.07,468,
ELECTROENCEPHALOGRAM - EEG,7400010,CDM,740,RC,95816,HCPCS,outpatient,,,1538,615.20,,1307.3,85,,1045.84,percent of total billed charges,85% of total billed charges,1184.26,77,,947.41,percent of total billed charges,77% of total billed charges,274.49,100,,,fee schedule,100% of CMS OPPS rate,1336.38,429,,,fee schedule,429% of BCBS fee schedule,1392.45,447,,,fee schedule,447% of BCBS fee schedule,1392.45,447,,,fee schedule,447% of BCBS fee schedule,1392.45,447,,,fee schedule,447% of BCBS fee schedule,1384.2,90,,1107.36,percent of total billed charges,90% of total billed charges,1230.4,80,,984.32,percent of total billed charges,80% of total billed charges,1384.2,90,,1107.36,percent of total billed charges,90% of total billed charges,1153.5,75,,922.8,percent of total billed charges,75% of total billed charges,334.88,122,,,fee schedule,122% of HUMANA fee schedule,446.02,29,,356.816,percent of total billed charges,29% of total billed charges,274.49,100,,,fee schedule,100% of CMS OPPS rate,1030.46,67,,824.368,percent of total billed charges,67% of total billed charges,158.53,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,1230.4,80,,984.32,percent of total billed charges,80% of total billed charges,999.7,65,,799.76,percent of total billed charges,65% of total billed charges,548.6,35.67,,438.88,percent of total billed charges,35.67% of total billed charges,158.53,1392.45,
3 CHANNEL SLEEP STUDY,7400020,CDM,740,RC,95807,HCPCS,outpatient,,,1961,784.40,,1666.85,85,,1333.48,percent of total billed charges,85% of total billed charges,1509.97,77,,1207.98,percent of total billed charges,77% of total billed charges,468.73,100,,,fee schedule,100% of CMS OPPS rate,1736.68,429,,,fee schedule,429% of BCBS fee schedule,1809.55,447,,,fee schedule,447% of BCBS fee schedule,1809.55,447,,,fee schedule,447% of BCBS fee schedule,1809.55,447,,,fee schedule,447% of BCBS fee schedule,1764.9,90,,1411.92,percent of total billed charges,90% of total billed charges,1568.8,80,,1255.04,percent of total billed charges,80% of total billed charges,1764.9,90,,1411.92,percent of total billed charges,90% of total billed charges,1470.75,75,,1176.6,percent of total billed charges,75% of total billed charges,571.84,122,,,fee schedule,122% of HUMANA fee schedule,568.69,29,,454.952,percent of total billed charges,29% of total billed charges,468.73,100,,,fee schedule,100% of CMS OPPS rate,1313.87,67,,1051.096,percent of total billed charges,67% of total billed charges,740.68,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,1568.8,80,,1255.04,percent of total billed charges,80% of total billed charges,1274.65,65,,1019.72,percent of total billed charges,65% of total billed charges,699.49,35.67,,559.592,percent of total billed charges,35.67% of total billed charges,468.73,1809.55,
COMPLEX POLYSOMNOGRAPHY,7400045,CDM,740,RC,95810,HCPCS,outpatient,,,3234,1293.60,,2748.9,85,,2199.12,percent of total billed charges,85% of total billed charges,2490.18,77,,1992.14,percent of total billed charges,77% of total billed charges,914.35,100,,,fee schedule,100% of CMS OPPS rate,2200.13,429,,,fee schedule,429% of BCBS fee schedule,2292.44,447,,,fee schedule,447% of BCBS fee schedule,2292.44,447,,,fee schedule,447% of BCBS fee schedule,2292.44,447,,,fee schedule,447% of BCBS fee schedule,2910.6,90,,2328.48,percent of total billed charges,90% of total billed charges,2587.2,80,,2069.76,percent of total billed charges,80% of total billed charges,2910.6,90,,2328.48,percent of total billed charges,90% of total billed charges,2425.5,75,,1940.4,percent of total billed charges,75% of total billed charges,1115.5,122,,,fee schedule,122% of HUMANA fee schedule,937.86,29,,750.288,percent of total billed charges,29% of total billed charges,914.35,100,,,fee schedule,100% of CMS OPPS rate,2166.78,67,,1733.424,percent of total billed charges,67% of total billed charges,740.68,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,2587.2,80,,2069.76,percent of total billed charges,80% of total billed charges,2102.1,65,,1681.68,percent of total billed charges,65% of total billed charges,1153.57,35.67,,922.856,percent of total billed charges,35.67% of total billed charges,740.68,2910.6,
COMPLEX POLYSOMNOGRAPHY <6HRS,7400048,CDM,740,RC,95810,HCPCS,outpatient,,,2485,994.00,52,2112.25,85,,1689.8,percent of total billed charges,85% of total billed charges,1913.45,77,,1530.76,percent of total billed charges,77% of total billed charges,914.35,100,,,fee schedule,100% of CMS OPPS rate,2200.13,429,,,fee schedule,429% of BCBS fee schedule,2292.44,447,,,fee schedule,447% of BCBS fee schedule,2292.44,447,,,fee schedule,447% of BCBS fee schedule,2292.44,447,,,fee schedule,447% of BCBS fee schedule,2236.5,90,,1789.2,percent of total billed charges,90% of total billed charges,1988,80,,1590.4,percent of total billed charges,80% of total billed charges,2236.5,90,,1789.2,percent of total billed charges,90% of total billed charges,1863.75,75,,1491,percent of total billed charges,75% of total billed charges,1115.5,122,,,fee schedule,122% of APC rate,720.65,29,,576.52,percent of total billed charges,29% of total billed charges,914.35,100,,,fee schedule,100% of CMS OPPS rate,1664.95,67,,1331.96,percent of total billed charges,67% of total billed charges,740.68,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,1988,80,,1590.4,percent of total billed charges,80% of total billed charges,1615.25,65,,1292.2,percent of total billed charges,65% of total billed charges,886.4,35.67,,709.12,percent of total billed charges,35.67% of total billed charges,720.65,2292.44,
COMPLETE POLY W/CPAP,7400058,CDM,740,RC,95811,HCPCS,outpatient,,,3576,1430.40,,3039.6,85,,2431.68,percent of total billed charges,85% of total billed charges,2753.52,77,,2202.82,percent of total billed charges,77% of total billed charges,914.35,100,,,fee schedule,100% of CMS OPPS rate,2315.61,429,,,fee schedule,429% of BCBS fee schedule,2412.77,447,,,fee schedule,447% of BCBS fee schedule,2412.77,447,,,fee schedule,447% of BCBS fee schedule,2412.77,447,,,fee schedule,447% of BCBS fee schedule,3218.4,90,,2574.72,percent of total billed charges,90% of total billed charges,2860.8,80,,2288.64,percent of total billed charges,80% of total billed charges,3218.4,90,,2574.72,percent of total billed charges,90% of total billed charges,2682,75,,2145.6,percent of total billed charges,75% of total billed charges,1115.5,122,,,fee schedule,122% of APC rate,1037.04,29,,829.632,percent of total billed charges,29% of total billed charges,914.35,100,,,fee schedule,100% of CMS OPPS rate,2395.92,67,,1916.736,percent of total billed charges,67% of total billed charges,740.68,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,2860.8,80,,2288.64,percent of total billed charges,80% of total billed charges,2324.4,65,,1859.52,percent of total billed charges,65% of total billed charges,1275.56,35.67,,1020.448,percent of total billed charges,35.67% of total billed charges,740.68,3218.4,
COMPLETE POLY W/CPAP <6 HRS,7400065,CDM,740,RC,95811,HCPCS,outpatient,,,2614,1045.60,52,2221.9,85,,1777.52,percent of total billed charges,85% of total billed charges,2012.78,77,,1610.22,percent of total billed charges,77% of total billed charges,914.35,100,,,fee schedule,100% of CMS OPPS rate,2315.61,429,,,fee schedule,429% of BCBS fee schedule,2412.77,447,,,fee schedule,447% of BCBS fee schedule,2412.77,447,,,fee schedule,447% of BCBS fee schedule,2412.77,447,,,fee schedule,447% of BCBS fee schedule,2352.6,90,,1882.08,percent of total billed charges,90% of total billed charges,2091.2,80,,1672.96,percent of total billed charges,80% of total billed charges,2352.6,90,,1882.08,percent of total billed charges,90% of total billed charges,1960.5,75,,1568.4,percent of total billed charges,75% of total billed charges,1115.5,122,,,fee schedule,122% of APC rate,758.06,29,,606.448,percent of total billed charges,29% of total billed charges,914.35,100,,,fee schedule,100% of CMS OPPS rate,1751.38,67,,1401.104,percent of total billed charges,67% of total billed charges,740.68,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,2091.2,80,,1672.96,percent of total billed charges,80% of total billed charges,1699.1,65,,1359.28,percent of total billed charges,65% of total billed charges,932.41,35.67,,745.928,percent of total billed charges,35.67% of total billed charges,740.68,2412.77,
MULTIPLE SLEEP LATENCY TEST,7400070,CDM,740,RC,95805,HCPCS,outpatient,,,1928,771.20,,1638.8,85,,1311.04,percent of total billed charges,85% of total billed charges,1484.56,77,,1187.65,percent of total billed charges,77% of total billed charges,468.73,100,,,fee schedule,100% of CMS OPPS rate,1625.82,429,,,fee schedule,429% of BCBS fee schedule,1694.04,447,,,fee schedule,447% of BCBS fee schedule,1694.04,447,,,fee schedule,447% of BCBS fee schedule,1694.04,447,,,fee schedule,447% of BCBS fee schedule,1735.2,90,,1388.16,percent of total billed charges,90% of total billed charges,1542.4,80,,1233.92,percent of total billed charges,80% of total billed charges,1735.2,90,,1388.16,percent of total billed charges,90% of total billed charges,1446,75,,1156.8,percent of total billed charges,75% of total billed charges,571.84,122,,,fee schedule,122% of APC rate,559.12,29,,447.296,percent of total billed charges,29% of total billed charges,468.73,100,,,fee schedule,100% of CMS OPPS rate,1291.76,67,,1033.408,percent of total billed charges,67% of total billed charges,740.68,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,1542.4,80,,1233.92,percent of total billed charges,80% of total billed charges,1253.2,65,,1002.56,percent of total billed charges,65% of total billed charges,687.72,35.67,,550.176,percent of total billed charges,35.67% of total billed charges,468.73,1735.2,
COMPLEX POLYSOMNOGRAPHY <6 YRS,7400075,CDM,740,RC,95782,HCPCS,outpatient,,,3892,1556.80,,3308.2,85,,2646.56,percent of total billed charges,85% of total billed charges,2996.84,77,,2397.47,percent of total billed charges,77% of total billed charges,914.35,100,,,fee schedule,100% of CMS OPPS rate,3448.77,429,,,fee schedule,429% of BCBS fee schedule,3593.48,447,,,fee schedule,447% of BCBS fee schedule,3593.48,447,,,fee schedule,447% of BCBS fee schedule,3593.48,447,,,fee schedule,447% of BCBS fee schedule,3502.8,90,,2802.24,percent of total billed charges,90% of total billed charges,3113.6,80,,2490.88,percent of total billed charges,80% of total billed charges,3502.8,90,,2802.24,percent of total billed charges,90% of total billed charges,2919,75,,2335.2,percent of total billed charges,75% of total billed charges,1115.5,122,,,fee schedule,122% of APC rate,1128.68,29,,902.944,percent of total billed charges,29% of total billed charges,914.35,100,,,fee schedule,100% of CMS OPPS rate,2607.64,67,,2086.112,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,3113.6,80,,2490.88,percent of total billed charges,80% of total billed charges,2529.8,65,,2023.84,percent of total billed charges,65% of total billed charges,1388.28,35.67,,1110.624,percent of total billed charges,35.67% of total billed charges,914.35,3593.48,
COMPLETE POLY W/CPAP <6YRS OLD,7400080,CDM,740,RC,95783,HCPCS,outpatient,,,4137,1654.80,,3516.45,85,,2813.16,percent of total billed charges,85% of total billed charges,3185.49,77,,2548.39,percent of total billed charges,77% of total billed charges,914.35,100,,,fee schedule,100% of CMS OPPS rate,3665.85,429,,,fee schedule,429% of BCBS fee schedule,3819.66,447,,,fee schedule,447% of BCBS fee schedule,3819.66,447,,,fee schedule,447% of BCBS fee schedule,3819.66,447,,,fee schedule,447% of BCBS fee schedule,3723.3,90,,2978.64,percent of total billed charges,90% of total billed charges,3309.6,80,,2647.68,percent of total billed charges,80% of total billed charges,3723.3,90,,2978.64,percent of total billed charges,90% of total billed charges,3102.75,75,,2482.2,percent of total billed charges,75% of total billed charges,1115.5,122,,,fee schedule,122% of APC rate,1199.73,29,,959.784,percent of total billed charges,29% of total billed charges,914.35,100,,,fee schedule,100% of CMS OPPS rate,2771.79,67,,2217.432,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,3309.6,80,,2647.68,percent of total billed charges,80% of total billed charges,2689.05,65,,2151.24,percent of total billed charges,65% of total billed charges,1475.67,35.67,,1180.536,percent of total billed charges,35.67% of total billed charges,914.35,3819.66,
COMPLEX POLYSOMN <6YRS <7HRS,7400090,CDM,740,RC,95782,HCPCS,outpatient,,,3892,1556.80,52,3308.2,85,,2646.56,percent of total billed charges,85% of total billed charges,2996.84,77,,2397.47,percent of total billed charges,77% of total billed charges,914.35,100,,,fee schedule,100% of CMS OPPS rate,3448.77,429,,,fee schedule,429% of BCBS fee schedule,3593.48,447,,,fee schedule,447% of BCBS fee schedule,3593.48,447,,,fee schedule,447% of BCBS fee schedule,3593.48,447,,,fee schedule,447% of BCBS fee schedule,3502.8,90,,2802.24,percent of total billed charges,90% of total billed charges,3113.6,80,,2490.88,percent of total billed charges,80% of total billed charges,3502.8,90,,2802.24,percent of total billed charges,90% of total billed charges,2919,75,,2335.2,percent of total billed charges,75% of total billed charges,1115.5,122,,,fee schedule,122% of APC rate,1128.68,29,,902.944,percent of total billed charges,29% of total billed charges,914.35,100,,,fee schedule,100% of CMS OPPS rate,2607.64,67,,2086.112,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,3113.6,80,,2490.88,percent of total billed charges,80% of total billed charges,2529.8,65,,2023.84,percent of total billed charges,65% of total billed charges,1388.28,35.67,,1110.624,percent of total billed charges,35.67% of total billed charges,914.35,3593.48,
COMPLETE POLY W/CPAP <6YRS<7HR,7400095,CDM,740,RC,95783,HCPCS,outpatient,,,4137,1654.80,52,3516.45,85,,2813.16,percent of total billed charges,85% of total billed charges,3185.49,77,,2548.39,percent of total billed charges,77% of total billed charges,914.35,100,,,fee schedule,100% of CMS OPPS rate,3665.85,429,,,fee schedule,429% of BCBS fee schedule,3819.66,447,,,fee schedule,447% of BCBS fee schedule,3819.66,447,,,fee schedule,447% of BCBS fee schedule,3819.66,447,,,fee schedule,447% of BCBS fee schedule,3723.3,90,,2978.64,percent of total billed charges,90% of total billed charges,3309.6,80,,2647.68,percent of total billed charges,80% of total billed charges,3723.3,90,,2978.64,percent of total billed charges,90% of total billed charges,3102.75,75,,2482.2,percent of total billed charges,75% of total billed charges,1115.5,122,,,fee schedule,122% of APC rate,1199.73,29,,959.784,percent of total billed charges,29% of total billed charges,914.35,100,,,fee schedule,100% of CMS OPPS rate,2771.79,67,,2217.432,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,3309.6,80,,2647.68,percent of total billed charges,80% of total billed charges,2689.05,65,,2151.24,percent of total billed charges,65% of total billed charges,1475.67,35.67,,1180.536,percent of total billed charges,35.67% of total billed charges,914.35,3819.66,
HOME SLEEP STUDY UNATTENDED,7400100,CDM,740,RC,95806,HCPCS,outpatient,,,674,269.60,,572.9,85,,458.32,percent of total billed charges,85% of total billed charges,518.98,77,,415.18,percent of total billed charges,77% of total billed charges,136.6,100,,,fee schedule,100% of CMS OPPS rate,474.22,429,,,fee schedule,429% of BCBS fee schedule,494.11,447,,,fee schedule,447% of BCBS fee schedule,494.11,447,,,fee schedule,447% of BCBS fee schedule,494.11,447,,,fee schedule,447% of BCBS fee schedule,606.6,90,,485.28,percent of total billed charges,90% of total billed charges,539.2,80,,431.36,percent of total billed charges,80% of total billed charges,606.6,90,,485.28,percent of total billed charges,90% of total billed charges,505.5,75,,404.4,percent of total billed charges,75% of total billed charges,166.65,122,,,fee schedule,122% of APC rate,195.46,29,,156.368,percent of total billed charges,29% of total billed charges,136.6,100,,,fee schedule,100% of CMS OPPS rate,451.58,67,,361.264,percent of total billed charges,67% of total billed charges,158.53,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,539.2,80,,431.36,percent of total billed charges,80% of total billed charges,438.1,65,,350.48,percent of total billed charges,65% of total billed charges,240.42,35.67,,192.336,percent of total billed charges,35.67% of total billed charges,136.6,606.6,
ENDOSCOPY ROOM  UP TO 30 MIN,3600190,CDM,750,RC,,,outpatient,,,3214,1285.60,,2731.9,85,,2185.52,percent of total billed charges,85% of total billed charges,2474.78,77,,1979.82,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,2635.48,82,,2108.384,percent of total billed charges,82% of total billed charges,2731.9,85,,2185.52,percent of total billed charges,85% of total billed charges,2731.9,85,,2185.52,percent of total billed charges,85% of total billed charges,2731.9,85,,2185.52,percent of total billed charges,85% of total billed charges,2892.6,90,,2314.08,percent of total billed charges,90% of total billed charges,2571.2,80,,2056.96,percent of total billed charges,80% of total billed charges,2892.6,90,,2314.08,percent of total billed charges,90% of total billed charges,2410.5,75,,1928.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,932.06,29,,745.648,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,2153.38,67,,1722.704,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,2571.2,80,,2056.96,percent of total billed charges,80% of total billed charges,2089.1,65,,1671.28,percent of total billed charges,65% of total billed charges,1146.43,35.67,,917.144,percent of total billed charges,35.67% of total billed charges,932.06,2892.6,
ENDOSCOPY ROOM 31-60 MIN,3600200,CDM,750,RC,,,outpatient,,,4017,1606.80,,3414.45,85,,2731.56,percent of total billed charges,85% of total billed charges,3093.09,77,,2474.47,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,3293.94,82,,2635.152,percent of total billed charges,82% of total billed charges,3414.45,85,,2731.56,percent of total billed charges,85% of total billed charges,3414.45,85,,2731.56,percent of total billed charges,85% of total billed charges,3414.45,85,,2731.56,percent of total billed charges,85% of total billed charges,3615.3,90,,2892.24,percent of total billed charges,90% of total billed charges,3213.6,80,,2570.88,percent of total billed charges,80% of total billed charges,3615.3,90,,2892.24,percent of total billed charges,90% of total billed charges,3012.75,75,,2410.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,1164.93,29,,931.944,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,2691.39,67,,2153.112,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,3213.6,80,,2570.88,percent of total billed charges,80% of total billed charges,2611.05,65,,2088.84,percent of total billed charges,65% of total billed charges,1432.86,35.67,,1146.288,percent of total billed charges,35.67% of total billed charges,1164.93,3615.3,
ENDOSCOPY ROOM 61-90 MIN,3600210,CDM,750,RC,,,outpatient,,,4590,1836.00,,3901.5,85,,3121.2,percent of total billed charges,85% of total billed charges,3534.3,77,,2827.44,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,3763.8,82,,3011.04,percent of total billed charges,82% of total billed charges,3901.5,85,,3121.2,percent of total billed charges,85% of total billed charges,3901.5,85,,3121.2,percent of total billed charges,85% of total billed charges,3901.5,85,,3121.2,percent of total billed charges,85% of total billed charges,4131,90,,3304.8,percent of total billed charges,90% of total billed charges,3672,80,,2937.6,percent of total billed charges,80% of total billed charges,4131,90,,3304.8,percent of total billed charges,90% of total billed charges,3442.5,75,,2754,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,1331.1,29,,1064.88,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,3075.3,67,,2460.24,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,3672,80,,2937.6,percent of total billed charges,80% of total billed charges,2983.5,65,,2386.8,percent of total billed charges,65% of total billed charges,1637.25,35.67,,1309.8,percent of total billed charges,35.67% of total billed charges,1331.1,4131,
ENDOSCOPY ROOM EA ADD'L 30 MIN,3600220,CDM,750,RC,,,outpatient,,,654,261.60,,555.9,85,,444.72,percent of total billed charges,85% of total billed charges,503.58,77,,402.86,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,536.28,82,,429.024,percent of total billed charges,82% of total billed charges,555.9,85,,444.72,percent of total billed charges,85% of total billed charges,555.9,85,,444.72,percent of total billed charges,85% of total billed charges,555.9,85,,444.72,percent of total billed charges,85% of total billed charges,588.6,90,,470.88,percent of total billed charges,90% of total billed charges,523.2,80,,418.56,percent of total billed charges,80% of total billed charges,588.6,90,,470.88,percent of total billed charges,90% of total billed charges,490.5,75,,392.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,189.66,29,,151.728,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,438.18,67,,350.544,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,523.2,80,,418.56,percent of total billed charges,80% of total billed charges,425.1,65,,340.08,percent of total billed charges,65% of total billed charges,233.28,35.67,,186.624,percent of total billed charges,35.67% of total billed charges,189.66,588.6,
CAR SEAT TEST NB ADD 30 MIN,4700025,CDM,760,RC,94781,HCPCS,outpatient,,,174,69.60,,147.9,85,,118.32,percent of total billed charges,85% of total billed charges,133.98,77,,107.18,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,36.94,429,,,fee schedule,429% of BCBS fee schedule,38.49,447,,,fee schedule,447% of BCBS fee schedule,38.49,447,,,fee schedule,447% of BCBS fee schedule,38.49,447,,,fee schedule,447% of BCBS fee schedule,156.6,90,,125.28,percent of total billed charges,90% of total billed charges,139.2,80,,111.36,percent of total billed charges,80% of total billed charges,156.6,90,,125.28,percent of total billed charges,90% of total billed charges,130.5,75,,104.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,50.46,29,,40.368,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,116.58,67,,93.264,percent of total billed charges,67% of total billed charges,42.55,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,139.2,80,,111.36,percent of total billed charges,80% of total billed charges,113.1,65,,90.48,percent of total billed charges,65% of total billed charges,62.07,35.67,,49.656,percent of total billed charges,35.67% of total billed charges,36.94,156.6,
THERAP INJ IM/SUBQ,2600206,CDM,761,RC,96372,HCPCS,outpatient,,,289,115.60,,245.65,85,,196.52,percent of total billed charges,85% of total billed charges,222.53,77,,178.02,percent of total billed charges,77% of total billed charges,61.6,100,,,fee schedule,100% of CMS OPPS rate,249.68,429,,,fee schedule,429% of BCBS fee schedule,260.15,447,,,fee schedule,447% of BCBS fee schedule,260.15,447,,,fee schedule,447% of BCBS fee schedule,260.15,447,,,fee schedule,447% of BCBS fee schedule,260.1,90,,208.08,percent of total billed charges,90% of total billed charges,231.2,80,,184.96,percent of total billed charges,80% of total billed charges,260.1,90,,208.08,percent of total billed charges,90% of total billed charges,216.75,75,,173.4,percent of total billed charges,75% of total billed charges,75.16,122,,,fee schedule,122% of APC rate,83.81,29,,67.048,percent of total billed charges,29% of total billed charges,61.6,100,,,fee schedule,100% of CMS OPPS rate,193.63,67,,154.904,percent of total billed charges,67% of total billed charges,32.45,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,231.2,80,,184.96,percent of total billed charges,80% of total billed charges,187.85,65,,150.28,percent of total billed charges,65% of total billed charges,103.09,35.67,,82.472,percent of total billed charges,35.67% of total billed charges,32.45,260.15,
INJECTION OF DRUG (IVP) INITIA,2600254,CDM,761,RC,96374,HCPCS,outpatient,,,288,115.20,,244.8,85,,195.84,percent of total billed charges,85% of total billed charges,221.76,77,,177.41,percent of total billed charges,77% of total billed charges,187.44,100,,,fee schedule,100% of CMS OPPS rate,201.67,429,,,fee schedule,429% of BCBS fee schedule,210.13,447,,,fee schedule,447% of BCBS fee schedule,210.13,447,,,fee schedule,447% of BCBS fee schedule,210.13,447,,,fee schedule,447% of BCBS fee schedule,259.2,90,,207.36,percent of total billed charges,90% of total billed charges,230.4,80,,184.32,percent of total billed charges,80% of total billed charges,259.2,90,,207.36,percent of total billed charges,90% of total billed charges,216,75,,172.8,percent of total billed charges,75% of total billed charges,228.67,122,,,fee schedule,122% of APC rate,83.52,29,,66.816,percent of total billed charges,29% of total billed charges,187.44,100,,,fee schedule,100% of CMS OPPS rate,192.96,67,,154.368,percent of total billed charges,67% of total billed charges,32.45,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,230.4,80,,184.32,percent of total billed charges,80% of total billed charges,187.2,65,,149.76,percent of total billed charges,65% of total billed charges,102.73,35.67,,82.184,percent of total billed charges,35.67% of total billed charges,32.45,259.2,
IVP EA ADD IVP NEW DRUG,2600257,CDM,761,RC,96375,HCPCS,outpatient,,,279,111.60,,237.15,85,,189.72,percent of total billed charges,85% of total billed charges,214.83,77,,171.86,percent of total billed charges,77% of total billed charges,41.54,100,,,fee schedule,100% of CMS OPPS rate,78.51,429,,,fee schedule,429% of BCBS fee schedule,81.8,447,,,fee schedule,447% of BCBS fee schedule,81.8,447,,,fee schedule,447% of BCBS fee schedule,81.8,447,,,fee schedule,447% of BCBS fee schedule,251.1,90,,200.88,percent of total billed charges,90% of total billed charges,223.2,80,,178.56,percent of total billed charges,80% of total billed charges,251.1,90,,200.88,percent of total billed charges,90% of total billed charges,209.25,75,,167.4,percent of total billed charges,75% of total billed charges,50.67,122,,,fee schedule,122% of APC rate,80.91,29,,64.728,percent of total billed charges,29% of total billed charges,41.54,100,,,fee schedule,100% of CMS OPPS rate,186.93,67,,149.544,percent of total billed charges,67% of total billed charges,32.45,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,223.2,80,,178.56,percent of total billed charges,80% of total billed charges,181.35,65,,145.08,percent of total billed charges,65% of total billed charges,99.52,35.67,,79.616,percent of total billed charges,35.67% of total billed charges,32.45,251.1,
IV PUSH EA ADD SAME DRUG M/S,2600258,CDM,761,RC,96376,HCPCS,outpatient,,,279,111.60,,237.15,85,,189.72,percent of total billed charges,85% of total billed charges,214.83,77,,171.86,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,98.54,429,,,fee schedule,429% of BCBS fee schedule,102.68,447,,,fee schedule,447% of BCBS fee schedule,102.68,447,,,fee schedule,447% of BCBS fee schedule,102.68,447,,,fee schedule,447% of BCBS fee schedule,251.1,90,,200.88,percent of total billed charges,90% of total billed charges,223.2,80,,178.56,percent of total billed charges,80% of total billed charges,251.1,90,,200.88,percent of total billed charges,90% of total billed charges,209.25,75,,167.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,80.91,29,,64.728,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,186.93,67,,149.544,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,223.2,80,,178.56,percent of total billed charges,80% of total billed charges,181.35,65,,145.08,percent of total billed charges,65% of total billed charges,99.52,35.67,,79.616,percent of total billed charges,35.67% of total billed charges,80.91,251.1,
IVP EA ADD SAME DRUG REPEAT,2600261,CDM,761,RC,96376,HCPCS,outpatient,,,113,45.20,59,96.05,85,,76.84,percent of total billed charges,85% of total billed charges,87.01,77,,69.61,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,98.54,429,,,fee schedule,429% of BCBS fee schedule,102.68,447,,,fee schedule,447% of BCBS fee schedule,102.68,447,,,fee schedule,447% of BCBS fee schedule,102.68,447,,,fee schedule,447% of BCBS fee schedule,101.7,90,,81.36,percent of total billed charges,90% of total billed charges,90.4,80,,72.32,percent of total billed charges,80% of total billed charges,101.7,90,,81.36,percent of total billed charges,90% of total billed charges,84.75,75,,67.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,32.77,29,,26.216,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,75.71,67,,60.568,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,90.4,80,,72.32,percent of total billed charges,80% of total billed charges,73.45,65,,58.76,percent of total billed charges,65% of total billed charges,40.31,35.67,,32.248,percent of total billed charges,35.67% of total billed charges,32.77,102.68,
IVP-CHEMO/OTHER COMPLEX EA ADD,2600264,CDM,761,RC,96411,HCPCS,outpatient,,,290,116.00,,246.5,85,,197.2,percent of total billed charges,85% of total billed charges,223.3,77,,178.64,percent of total billed charges,77% of total billed charges,61.6,100,,,fee schedule,100% of CMS OPPS rate,255.6,429,,,fee schedule,429% of BCBS fee schedule,266.32,447,,,fee schedule,447% of BCBS fee schedule,266.32,447,,,fee schedule,447% of BCBS fee schedule,266.32,447,,,fee schedule,447% of BCBS fee schedule,261,90,,208.8,percent of total billed charges,90% of total billed charges,232,80,,185.6,percent of total billed charges,80% of total billed charges,261,90,,208.8,percent of total billed charges,90% of total billed charges,217.5,75,,174,percent of total billed charges,75% of total billed charges,75.15,122,,,fee schedule,122% of APC rate,84.1,29,,67.28,percent of total billed charges,29% of total billed charges,61.6,100,,,fee schedule,100% of CMS OPPS rate,194.3,67,,155.44,percent of total billed charges,67% of total billed charges,67.76,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,232,80,,185.6,percent of total billed charges,80% of total billed charges,188.5,65,,150.8,percent of total billed charges,65% of total billed charges,103.44,35.67,,82.752,percent of total billed charges,35.67% of total billed charges,61.6,266.32,
IRRIGATION DRUG DELIVERY DEV,2600270,CDM,761,RC,96523,HCPCS,outpatient,,,302,120.80,,256.7,85,,205.36,percent of total billed charges,85% of total billed charges,232.54,77,,186.03,percent of total billed charges,77% of total billed charges,53.49,100,,,fee schedule,100% of CMS OPPS rate,240.07,429,,,fee schedule,429% of BCBS fee schedule,250.14,447,,,fee schedule,447% of BCBS fee schedule,250.14,447,,,fee schedule,447% of BCBS fee schedule,250.14,447,,,fee schedule,447% of BCBS fee schedule,271.8,90,,217.44,percent of total billed charges,90% of total billed charges,241.6,80,,193.28,percent of total billed charges,80% of total billed charges,271.8,90,,217.44,percent of total billed charges,90% of total billed charges,226.5,75,,181.2,percent of total billed charges,75% of total billed charges,65.26,122,,,fee schedule,122% of APC rate,87.58,29,,70.064,percent of total billed charges,29% of total billed charges,53.49,100,,,fee schedule,100% of CMS OPPS rate,202.34,67,,161.872,percent of total billed charges,67% of total billed charges,39.76,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,241.6,80,,193.28,percent of total billed charges,80% of total billed charges,196.3,65,,157.04,percent of total billed charges,65% of total billed charges,107.72,35.67,,86.176,percent of total billed charges,35.67% of total billed charges,39.76,271.8,
THERAP INJ IM/SUBQ,2650201,CDM,761,RC,96372,HCPCS,outpatient,,,283,113.20,,240.55,85,,192.44,percent of total billed charges,85% of total billed charges,217.91,77,,174.33,percent of total billed charges,77% of total billed charges,61.6,100,,,fee schedule,100% of CMS OPPS rate,249.68,429,,,fee schedule,429% of BCBS fee schedule,260.15,447,,,fee schedule,447% of BCBS fee schedule,260.15,447,,,fee schedule,447% of BCBS fee schedule,260.15,447,,,fee schedule,447% of BCBS fee schedule,254.7,90,,203.76,percent of total billed charges,90% of total billed charges,226.4,80,,181.12,percent of total billed charges,80% of total billed charges,254.7,90,,203.76,percent of total billed charges,90% of total billed charges,212.25,75,,169.8,percent of total billed charges,75% of total billed charges,75.16,122,,,fee schedule,122% of APC rate,82.07,29,,65.656,percent of total billed charges,29% of total billed charges,61.6,100,,,fee schedule,100% of CMS OPPS rate,189.61,67,,151.688,percent of total billed charges,67% of total billed charges,32.45,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,226.4,80,,181.12,percent of total billed charges,80% of total billed charges,183.95,65,,147.16,percent of total billed charges,65% of total billed charges,100.95,35.67,,80.76,percent of total billed charges,35.67% of total billed charges,32.45,260.15,
THERAP INJ IM/SUBQ,2650206,CDM,761,RC,96372,HCPCS,outpatient,,,289,115.60,,245.65,85,,196.52,percent of total billed charges,85% of total billed charges,222.53,77,,178.02,percent of total billed charges,77% of total billed charges,61.6,100,,,fee schedule,100% of CMS OPPS rate,249.68,429,,,fee schedule,429% of BCBS fee schedule,260.15,447,,,fee schedule,447% of BCBS fee schedule,260.15,447,,,fee schedule,447% of BCBS fee schedule,260.15,447,,,fee schedule,447% of BCBS fee schedule,260.1,90,,208.08,percent of total billed charges,90% of total billed charges,231.2,80,,184.96,percent of total billed charges,80% of total billed charges,260.1,90,,208.08,percent of total billed charges,90% of total billed charges,216.75,75,,173.4,percent of total billed charges,75% of total billed charges,75.16,122,,,fee schedule,122% of APC rate,83.81,29,,67.048,percent of total billed charges,29% of total billed charges,61.6,100,,,fee schedule,100% of CMS OPPS rate,193.63,67,,154.904,percent of total billed charges,67% of total billed charges,32.45,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,231.2,80,,184.96,percent of total billed charges,80% of total billed charges,187.85,65,,150.28,percent of total billed charges,65% of total billed charges,103.09,35.67,,82.472,percent of total billed charges,35.67% of total billed charges,32.45,260.15,
IV HYDRATION EACH ADD HR  OP,2650213,CDM,761,RC,96361,HCPCS,outpatient,,,167,66.80,,141.95,85,,113.56,percent of total billed charges,85% of total billed charges,128.59,77,,102.87,percent of total billed charges,77% of total billed charges,41.54,100,,,fee schedule,100% of CMS OPPS rate,60.06,429,,,fee schedule,429% of BCBS fee schedule,62.58,447,,,fee schedule,447% of BCBS fee schedule,62.58,447,,,fee schedule,447% of BCBS fee schedule,62.58,447,,,fee schedule,447% of BCBS fee schedule,150.3,90,,120.24,percent of total billed charges,90% of total billed charges,133.6,80,,106.88,percent of total billed charges,80% of total billed charges,150.3,90,,120.24,percent of total billed charges,90% of total billed charges,125.25,75,,100.2,percent of total billed charges,75% of total billed charges,50.67,122,,,fee schedule,122% of APC rate,48.43,29,,38.744,percent of total billed charges,29% of total billed charges,41.54,100,,,fee schedule,100% of CMS OPPS rate,111.89,67,,89.512,percent of total billed charges,67% of total billed charges,23.12,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,133.6,80,,106.88,percent of total billed charges,80% of total billed charges,108.55,65,,86.84,percent of total billed charges,65% of total billed charges,59.57,35.67,,47.656,percent of total billed charges,35.67% of total billed charges,23.12,150.3,
INJECTION DRUG IVP INITIAL OP,2650254,CDM,761,RC,96374,HCPCS,outpatient,,,233,93.20,,198.05,85,,158.44,percent of total billed charges,85% of total billed charges,179.41,77,,143.53,percent of total billed charges,77% of total billed charges,187.44,100,,,fee schedule,100% of CMS OPPS rate,201.67,429,,,fee schedule,429% of BCBS fee schedule,210.13,447,,,fee schedule,447% of BCBS fee schedule,210.13,447,,,fee schedule,447% of BCBS fee schedule,210.13,447,,,fee schedule,447% of BCBS fee schedule,209.7,90,,167.76,percent of total billed charges,90% of total billed charges,186.4,80,,149.12,percent of total billed charges,80% of total billed charges,209.7,90,,167.76,percent of total billed charges,90% of total billed charges,174.75,75,,139.8,percent of total billed charges,75% of total billed charges,228.67,122,,,fee schedule,122% of APC rate,67.57,29,,54.056,percent of total billed charges,29% of total billed charges,187.44,100,,,fee schedule,100% of CMS OPPS rate,156.11,67,,124.888,percent of total billed charges,67% of total billed charges,32.45,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,186.4,80,,149.12,percent of total billed charges,80% of total billed charges,151.45,65,,121.16,percent of total billed charges,65% of total billed charges,83.11,35.67,,66.488,percent of total billed charges,35.67% of total billed charges,32.45,228.67,
INJECTION IV DRUG OP,2650256,CDM,761,RC,96374,HCPCS,outpatient,,,230,92.00,,195.5,85,,156.4,percent of total billed charges,85% of total billed charges,177.1,77,,141.68,percent of total billed charges,77% of total billed charges,187.44,100,,,fee schedule,100% of CMS OPPS rate,201.67,429,,,fee schedule,429% of BCBS fee schedule,210.13,447,,,fee schedule,447% of BCBS fee schedule,210.13,447,,,fee schedule,447% of BCBS fee schedule,210.13,447,,,fee schedule,447% of BCBS fee schedule,207,90,,165.6,percent of total billed charges,90% of total billed charges,184,80,,147.2,percent of total billed charges,80% of total billed charges,207,90,,165.6,percent of total billed charges,90% of total billed charges,172.5,75,,138,percent of total billed charges,75% of total billed charges,228.67,122,,,fee schedule,122% of APC rate,66.7,29,,53.36,percent of total billed charges,29% of total billed charges,187.44,100,,,fee schedule,100% of CMS OPPS rate,154.1,67,,123.28,percent of total billed charges,67% of total billed charges,32.45,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,184,80,,147.2,percent of total billed charges,80% of total billed charges,149.5,65,,119.6,percent of total billed charges,65% of total billed charges,82.04,35.67,,65.632,percent of total billed charges,35.67% of total billed charges,32.45,228.67,
IVP EACH ADD NEW DRUG OP,2650257,CDM,761,RC,96375,HCPCS,outpatient,,,279,111.60,,237.15,85,,189.72,percent of total billed charges,85% of total billed charges,214.83,77,,171.86,percent of total billed charges,77% of total billed charges,41.54,100,,,fee schedule,100% of CMS OPPS rate,78.51,429,,,fee schedule,429% of BCBS fee schedule,81.8,447,,,fee schedule,447% of BCBS fee schedule,81.8,447,,,fee schedule,447% of BCBS fee schedule,81.8,447,,,fee schedule,447% of BCBS fee schedule,251.1,90,,200.88,percent of total billed charges,90% of total billed charges,223.2,80,,178.56,percent of total billed charges,80% of total billed charges,251.1,90,,200.88,percent of total billed charges,90% of total billed charges,209.25,75,,167.4,percent of total billed charges,75% of total billed charges,50.67,122,,,fee schedule,122% of APC rate,80.91,29,,64.728,percent of total billed charges,29% of total billed charges,41.54,100,,,fee schedule,100% of CMS OPPS rate,186.93,67,,149.544,percent of total billed charges,67% of total billed charges,32.45,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,223.2,80,,178.56,percent of total billed charges,80% of total billed charges,181.35,65,,145.08,percent of total billed charges,65% of total billed charges,99.52,35.67,,79.616,percent of total billed charges,35.67% of total billed charges,32.45,251.1,
IV PUSH EACH ADD SAME MED OP,2650258,CDM,761,RC,96376,HCPCS,outpatient,,,273,109.20,,232.05,85,,185.64,percent of total billed charges,85% of total billed charges,210.21,77,,168.17,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,98.54,429,,,fee schedule,429% of BCBS fee schedule,102.68,447,,,fee schedule,447% of BCBS fee schedule,102.68,447,,,fee schedule,447% of BCBS fee schedule,102.68,447,,,fee schedule,447% of BCBS fee schedule,245.7,90,,196.56,percent of total billed charges,90% of total billed charges,218.4,80,,174.72,percent of total billed charges,80% of total billed charges,245.7,90,,196.56,percent of total billed charges,90% of total billed charges,204.75,75,,163.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,79.17,29,,63.336,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,182.91,67,,146.328,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,218.4,80,,174.72,percent of total billed charges,80% of total billed charges,177.45,65,,141.96,percent of total billed charges,65% of total billed charges,97.38,35.67,,77.904,percent of total billed charges,35.67% of total billed charges,79.17,245.7,
IVP EACH ADD SAME DRUG OP,2650261,CDM,761,RC,96376,HCPCS,outpatient,,,80,32.00,,68,85,,54.4,percent of total billed charges,85% of total billed charges,61.6,77,,49.28,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,98.54,429,,,fee schedule,429% of BCBS fee schedule,102.68,447,,,fee schedule,447% of BCBS fee schedule,102.68,447,,,fee schedule,447% of BCBS fee schedule,102.68,447,,,fee schedule,447% of BCBS fee schedule,72,90,,57.6,percent of total billed charges,90% of total billed charges,64,80,,51.2,percent of total billed charges,80% of total billed charges,72,90,,57.6,percent of total billed charges,90% of total billed charges,60,75,,48,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,23.2,29,,18.56,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,53.6,67,,42.88,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,64,80,,51.2,percent of total billed charges,80% of total billed charges,52,65,,41.6,percent of total billed charges,65% of total billed charges,28.54,35.67,,22.832,percent of total billed charges,35.67% of total billed charges,23.2,102.68,
NEW PATIENT MED VISIT LEVEL 1,3600008,CDM,761,RC,G0463,HCPCS,outpatient,,,170,68.00,,144.5,85,,115.6,percent of total billed charges,85% of total billed charges,130.9,77,,104.72,percent of total billed charges,77% of total billed charges,115.6,100,,,fee schedule,100% of CMS OPPS rate,487.73,429,,,fee schedule,429% of BCBS fee schedule,508.19,447,,,fee schedule,447% of BCBS fee schedule,508.19,447,,,fee schedule,447% of BCBS fee schedule,508.19,447,,,fee schedule,447% of BCBS fee schedule,153,90,,122.4,percent of total billed charges,90% of total billed charges,136,80,,108.8,percent of total billed charges,80% of total billed charges,153,90,,122.4,percent of total billed charges,90% of total billed charges,127.5,75,,102,percent of total billed charges,75% of total billed charges,141.02,122,,,fee schedule,122% of APC rate,49.3,29,,39.44,percent of total billed charges,29% of total billed charges,115.6,100,,,fee schedule,100% of CMS OPPS rate,113.9,67,,91.12,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,136,80,,108.8,percent of total billed charges,80% of total billed charges,110.5,65,,88.4,percent of total billed charges,65% of total billed charges,60.64,35.67,,48.512,percent of total billed charges,35.67% of total billed charges,49.3,508.19,
NEW PATIENT MED VISIT LEVEL 2,3600009,CDM,761,RC,G0463,HCPCS,outpatient,,,250,100.00,,212.5,85,,170,percent of total billed charges,85% of total billed charges,192.5,77,,154,percent of total billed charges,77% of total billed charges,115.6,100,,,fee schedule,100% of CMS OPPS rate,487.73,429,,,fee schedule,429% of BCBS fee schedule,508.19,447,,,fee schedule,447% of BCBS fee schedule,508.19,447,,,fee schedule,447% of BCBS fee schedule,508.19,447,,,fee schedule,447% of BCBS fee schedule,225,90,,180,percent of total billed charges,90% of total billed charges,200,80,,160,percent of total billed charges,80% of total billed charges,225,90,,180,percent of total billed charges,90% of total billed charges,187.5,75,,150,percent of total billed charges,75% of total billed charges,141.02,122,,,fee schedule,122% of APC rate,72.5,29,,58,percent of total billed charges,29% of total billed charges,115.6,100,,,fee schedule,100% of CMS OPPS rate,167.5,67,,134,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,200,80,,160,percent of total billed charges,80% of total billed charges,162.5,65,,130,percent of total billed charges,65% of total billed charges,89.18,35.67,,71.344,percent of total billed charges,35.67% of total billed charges,72.5,508.19,
NEW PATIENT MED VISIT LEVEL 3,3600010,CDM,761,RC,99203,HCPCS,outpatient,,,380,152.00,,323,85,,258.4,percent of total billed charges,85% of total billed charges,292.6,77,,234.08,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,334.11,429,,,fee schedule,429% of BCBS fee schedule,348.12,447,,,fee schedule,447% of BCBS fee schedule,348.12,447,,,fee schedule,447% of BCBS fee schedule,348.12,447,,,fee schedule,447% of BCBS fee schedule,342,90,,273.6,percent of total billed charges,90% of total billed charges,304,80,,243.2,percent of total billed charges,80% of total billed charges,342,90,,273.6,percent of total billed charges,90% of total billed charges,285,75,,228,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,110.2,29,,88.16,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,254.6,67,,203.68,percent of total billed charges,67% of total billed charges,88.66,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,304,80,,243.2,percent of total billed charges,80% of total billed charges,247,65,,197.6,percent of total billed charges,65% of total billed charges,135.55,35.67,,108.44,percent of total billed charges,35.67% of total billed charges,88.66,348.12,
NEW PATIENT MED VISIT LEVEL 4,3600011,CDM,761,RC,99204,HCPCS,outpatient,,,636,254.40,,540.6,85,,432.48,percent of total billed charges,85% of total billed charges,489.72,77,,391.78,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,563.49,429,,,fee schedule,429% of BCBS fee schedule,587.13,447,,,fee schedule,447% of BCBS fee schedule,587.13,447,,,fee schedule,447% of BCBS fee schedule,587.13,447,,,fee schedule,447% of BCBS fee schedule,572.4,90,,457.92,percent of total billed charges,90% of total billed charges,508.8,80,,407.04,percent of total billed charges,80% of total billed charges,572.4,90,,457.92,percent of total billed charges,90% of total billed charges,477,75,,381.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,184.44,29,,147.552,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,426.12,67,,340.896,percent of total billed charges,67% of total billed charges,121.56,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,508.8,80,,407.04,percent of total billed charges,80% of total billed charges,413.4,65,,330.72,percent of total billed charges,65% of total billed charges,226.86,35.67,,181.488,percent of total billed charges,35.67% of total billed charges,121.56,587.13,
NEW PATIENT MED VISIT LEVEL 5,3600012,CDM,761,RC,99205,HCPCS,outpatient,,,848,339.20,,720.8,85,,576.64,percent of total billed charges,85% of total billed charges,652.96,77,,522.37,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,735.95,429,,,fee schedule,429% of BCBS fee schedule,766.83,447,,,fee schedule,447% of BCBS fee schedule,766.83,447,,,fee schedule,447% of BCBS fee schedule,766.83,447,,,fee schedule,447% of BCBS fee schedule,763.2,90,,610.56,percent of total billed charges,90% of total billed charges,678.4,80,,542.72,percent of total billed charges,80% of total billed charges,763.2,90,,610.56,percent of total billed charges,90% of total billed charges,636,75,,508.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,245.92,29,,196.736,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,568.16,67,,454.528,percent of total billed charges,67% of total billed charges,164.53,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,678.4,80,,542.72,percent of total billed charges,80% of total billed charges,551.2,65,,440.96,percent of total billed charges,65% of total billed charges,302.48,35.67,,241.984,percent of total billed charges,35.67% of total billed charges,164.53,766.83,
ESTABLISHED PT MED VISIT LEV 1,3600013,CDM,761,RC,99211,HCPCS,outpatient,,,174,69.60,,147.9,85,,118.32,percent of total billed charges,85% of total billed charges,133.98,77,,107.18,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,40.03,429,,,fee schedule,429% of BCBS fee schedule,41.71,447,,,fee schedule,447% of BCBS fee schedule,41.71,447,,,fee schedule,447% of BCBS fee schedule,41.71,447,,,fee schedule,447% of BCBS fee schedule,156.6,90,,125.28,percent of total billed charges,90% of total billed charges,139.2,80,,111.36,percent of total billed charges,80% of total billed charges,156.6,90,,125.28,percent of total billed charges,90% of total billed charges,130.5,75,,104.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,50.46,29,,40.368,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,116.58,67,,93.264,percent of total billed charges,67% of total billed charges,50.14,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,139.2,80,,111.36,percent of total billed charges,80% of total billed charges,113.1,65,,90.48,percent of total billed charges,65% of total billed charges,62.07,35.67,,49.656,percent of total billed charges,35.67% of total billed charges,40.03,156.6,
ESTABLISHED PT MED VISIT LEV 2,3600014,CDM,761,RC,99212,HCPCS,outpatient,,,182,72.80,,154.7,85,,123.76,percent of total billed charges,85% of total billed charges,140.14,77,,112.11,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,110.85,429,,,fee schedule,429% of BCBS fee schedule,115.5,447,,,fee schedule,447% of BCBS fee schedule,115.5,447,,,fee schedule,447% of BCBS fee schedule,115.5,447,,,fee schedule,447% of BCBS fee schedule,163.8,90,,131.04,percent of total billed charges,90% of total billed charges,145.6,80,,116.48,percent of total billed charges,80% of total billed charges,163.8,90,,131.04,percent of total billed charges,90% of total billed charges,136.5,75,,109.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,52.78,29,,42.224,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,121.94,67,,97.552,percent of total billed charges,67% of total billed charges,67.2,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,145.6,80,,116.48,percent of total billed charges,80% of total billed charges,118.3,65,,94.64,percent of total billed charges,65% of total billed charges,64.92,35.67,,51.936,percent of total billed charges,35.67% of total billed charges,52.78,163.8,
ESTABLISHED PT MED VISIT LEV 3,3600015,CDM,761,RC,99213,HCPCS,outpatient,,,260,104.00,,221,85,,176.8,percent of total billed charges,85% of total billed charges,200.2,77,,160.16,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,223.25,429,,,fee schedule,429% of BCBS fee schedule,232.62,447,,,fee schedule,447% of BCBS fee schedule,232.62,447,,,fee schedule,447% of BCBS fee schedule,232.62,447,,,fee schedule,447% of BCBS fee schedule,234,90,,187.2,percent of total billed charges,90% of total billed charges,208,80,,166.4,percent of total billed charges,80% of total billed charges,234,90,,187.2,percent of total billed charges,90% of total billed charges,195,75,,156,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,75.4,29,,60.32,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,174.2,67,,139.36,percent of total billed charges,67% of total billed charges,67.2,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,208,80,,166.4,percent of total billed charges,80% of total billed charges,169,65,,135.2,percent of total billed charges,65% of total billed charges,92.74,35.67,,74.192,percent of total billed charges,35.67% of total billed charges,67.2,234,
ESTABLISHED PT MED VISIT LEV 4,3600016,CDM,761,RC,99214,HCPCS,outpatient,,,387,154.80,,328.95,85,,263.16,percent of total billed charges,85% of total billed charges,297.99,77,,238.39,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,341.78,429,,,fee schedule,429% of BCBS fee schedule,356.12,447,,,fee schedule,447% of BCBS fee schedule,356.12,447,,,fee schedule,447% of BCBS fee schedule,356.12,447,,,fee schedule,447% of BCBS fee schedule,348.3,90,,278.64,percent of total billed charges,90% of total billed charges,309.6,80,,247.68,percent of total billed charges,80% of total billed charges,348.3,90,,278.64,percent of total billed charges,90% of total billed charges,290.25,75,,232.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,112.23,29,,89.784,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,259.29,67,,207.432,percent of total billed charges,67% of total billed charges,88.66,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,309.6,80,,247.68,percent of total billed charges,80% of total billed charges,251.55,65,,201.24,percent of total billed charges,65% of total billed charges,138.04,35.67,,110.432,percent of total billed charges,35.67% of total billed charges,88.66,356.12,
ESTABLISHED PT MED VISIT LEV 5,3600017,CDM,761,RC,99215,HCPCS,outpatient,,,547,218.80,,464.95,85,,371.96,percent of total billed charges,85% of total billed charges,421.19,77,,336.95,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,483.44,429,,,fee schedule,429% of BCBS fee schedule,503.72,447,,,fee schedule,447% of BCBS fee schedule,503.72,447,,,fee schedule,447% of BCBS fee schedule,503.72,447,,,fee schedule,447% of BCBS fee schedule,492.3,90,,393.84,percent of total billed charges,90% of total billed charges,437.6,80,,350.08,percent of total billed charges,80% of total billed charges,492.3,90,,393.84,percent of total billed charges,90% of total billed charges,410.25,75,,328.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,158.63,29,,126.904,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,366.49,67,,293.192,percent of total billed charges,67% of total billed charges,121.56,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,437.6,80,,350.08,percent of total billed charges,80% of total billed charges,355.55,65,,284.44,percent of total billed charges,65% of total billed charges,195.11,35.67,,156.088,percent of total billed charges,35.67% of total billed charges,121.56,503.72,
PROCEDURE RM - OUTPT,3600018,CDM,761,RC,,,outpatient,,,2186,874.40,,1858.1,85,,1486.48,percent of total billed charges,85% of total billed charges,1683.22,77,,1346.58,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,1792.52,82,,1434.016,percent of total billed charges,82% of total billed charges,1858.1,85,,1486.48,percent of total billed charges,85% of total billed charges,1858.1,85,,1486.48,percent of total billed charges,85% of total billed charges,1858.1,85,,1486.48,percent of total billed charges,85% of total billed charges,1967.4,90,,1573.92,percent of total billed charges,90% of total billed charges,1748.8,80,,1399.04,percent of total billed charges,80% of total billed charges,1967.4,90,,1573.92,percent of total billed charges,90% of total billed charges,1639.5,75,,1311.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,633.94,29,,507.152,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1464.62,67,,1171.696,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1748.8,80,,1399.04,percent of total billed charges,80% of total billed charges,1420.9,65,,1136.72,percent of total billed charges,65% of total billed charges,779.75,35.67,,623.8,percent of total billed charges,35.67% of total billed charges,633.94,1967.4,
NEW PATIENT WOUND VISIT 2,3600042,CDM,761,RC,G0463,HCPCS,outpatient,,,250,100.00,,212.5,85,,170,percent of total billed charges,85% of total billed charges,192.5,77,,154,percent of total billed charges,77% of total billed charges,115.6,100,,,fee schedule,100% of CMS OPPS rate,487.73,429,,,fee schedule,429% of BCBS fee schedule,508.19,447,,,fee schedule,447% of BCBS fee schedule,508.19,447,,,fee schedule,447% of BCBS fee schedule,508.19,447,,,fee schedule,447% of BCBS fee schedule,225,90,,180,percent of total billed charges,90% of total billed charges,200,80,,160,percent of total billed charges,80% of total billed charges,225,90,,180,percent of total billed charges,90% of total billed charges,187.5,75,,150,percent of total billed charges,75% of total billed charges,141.02,122,,,fee schedule,122% of APC rate,72.5,29,,58,percent of total billed charges,29% of total billed charges,115.6,100,,,fee schedule,100% of CMS OPPS rate,167.5,67,,134,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,200,80,,160,percent of total billed charges,80% of total billed charges,162.5,65,,130,percent of total billed charges,65% of total billed charges,89.18,35.67,,71.344,percent of total billed charges,35.67% of total billed charges,72.5,508.19,
NEW PATIENT WOUND VISIT 3,3600043,CDM,761,RC,G0463,HCPCS,outpatient,,,380,152.00,,323,85,,258.4,percent of total billed charges,85% of total billed charges,292.6,77,,234.08,percent of total billed charges,77% of total billed charges,115.6,100,,,fee schedule,100% of CMS OPPS rate,487.73,429,,,fee schedule,429% of BCBS fee schedule,508.19,447,,,fee schedule,447% of BCBS fee schedule,508.19,447,,,fee schedule,447% of BCBS fee schedule,508.19,447,,,fee schedule,447% of BCBS fee schedule,342,90,,273.6,percent of total billed charges,90% of total billed charges,304,80,,243.2,percent of total billed charges,80% of total billed charges,342,90,,273.6,percent of total billed charges,90% of total billed charges,285,75,,228,percent of total billed charges,75% of total billed charges,141.02,122,,,fee schedule,122% of APC rate,110.2,29,,88.16,percent of total billed charges,29% of total billed charges,115.6,100,,,fee schedule,100% of CMS OPPS rate,254.6,67,,203.68,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,304,80,,243.2,percent of total billed charges,80% of total billed charges,247,65,,197.6,percent of total billed charges,65% of total billed charges,135.55,35.67,,108.44,percent of total billed charges,35.67% of total billed charges,110.2,508.19,
NEW PATIENT WOUND VISIT 4,3600044,CDM,761,RC,G0463,HCPCS,outpatient,,,636,254.40,,540.6,85,,432.48,percent of total billed charges,85% of total billed charges,489.72,77,,391.78,percent of total billed charges,77% of total billed charges,115.6,100,,,fee schedule,100% of CMS OPPS rate,487.73,429,,,fee schedule,429% of BCBS fee schedule,508.19,447,,,fee schedule,447% of BCBS fee schedule,508.19,447,,,fee schedule,447% of BCBS fee schedule,508.19,447,,,fee schedule,447% of BCBS fee schedule,572.4,90,,457.92,percent of total billed charges,90% of total billed charges,508.8,80,,407.04,percent of total billed charges,80% of total billed charges,572.4,90,,457.92,percent of total billed charges,90% of total billed charges,477,75,,381.6,percent of total billed charges,75% of total billed charges,141.02,122,,,fee schedule,122% of APC rate,184.44,29,,147.552,percent of total billed charges,29% of total billed charges,115.6,100,,,fee schedule,100% of CMS OPPS rate,426.12,67,,340.896,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,508.8,80,,407.04,percent of total billed charges,80% of total billed charges,413.4,65,,330.72,percent of total billed charges,65% of total billed charges,226.86,35.67,,181.488,percent of total billed charges,35.67% of total billed charges,115.6,572.4,
NEW PATIENT WOUND VISIT 5,3600045,CDM,761,RC,G0463,HCPCS,outpatient,,,848,339.20,,720.8,85,,576.64,percent of total billed charges,85% of total billed charges,652.96,77,,522.37,percent of total billed charges,77% of total billed charges,115.6,100,,,fee schedule,100% of CMS OPPS rate,487.73,429,,,fee schedule,429% of BCBS fee schedule,508.19,447,,,fee schedule,447% of BCBS fee schedule,508.19,447,,,fee schedule,447% of BCBS fee schedule,508.19,447,,,fee schedule,447% of BCBS fee schedule,763.2,90,,610.56,percent of total billed charges,90% of total billed charges,678.4,80,,542.72,percent of total billed charges,80% of total billed charges,763.2,90,,610.56,percent of total billed charges,90% of total billed charges,636,75,,508.8,percent of total billed charges,75% of total billed charges,141.02,122,,,fee schedule,122% of APC rate,245.92,29,,196.736,percent of total billed charges,29% of total billed charges,115.6,100,,,fee schedule,100% of CMS OPPS rate,568.16,67,,454.528,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,678.4,80,,542.72,percent of total billed charges,80% of total billed charges,551.2,65,,440.96,percent of total billed charges,65% of total billed charges,302.48,35.67,,241.984,percent of total billed charges,35.67% of total billed charges,115.6,763.2,
EST PATIENT WOUND VISIT 1,3600081,CDM,761,RC,G0463,HCPCS,outpatient,,,174,69.60,,147.9,85,,118.32,percent of total billed charges,85% of total billed charges,133.98,77,,107.18,percent of total billed charges,77% of total billed charges,115.6,100,,,fee schedule,100% of CMS OPPS rate,487.73,429,,,fee schedule,429% of BCBS fee schedule,508.19,447,,,fee schedule,447% of BCBS fee schedule,508.19,447,,,fee schedule,447% of BCBS fee schedule,508.19,447,,,fee schedule,447% of BCBS fee schedule,156.6,90,,125.28,percent of total billed charges,90% of total billed charges,139.2,80,,111.36,percent of total billed charges,80% of total billed charges,156.6,90,,125.28,percent of total billed charges,90% of total billed charges,130.5,75,,104.4,percent of total billed charges,75% of total billed charges,141.02,122,,,fee schedule,122% of APC rate,50.46,29,,40.368,percent of total billed charges,29% of total billed charges,115.6,100,,,fee schedule,100% of CMS OPPS rate,116.58,67,,93.264,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,139.2,80,,111.36,percent of total billed charges,80% of total billed charges,113.1,65,,90.48,percent of total billed charges,65% of total billed charges,62.07,35.67,,49.656,percent of total billed charges,35.67% of total billed charges,50.46,508.19,
EST PATIENT WOUND VISIT 2,3600082,CDM,761,RC,G0463,HCPCS,outpatient,,,182,72.80,,154.7,85,,123.76,percent of total billed charges,85% of total billed charges,140.14,77,,112.11,percent of total billed charges,77% of total billed charges,115.6,100,,,fee schedule,100% of CMS OPPS rate,487.73,429,,,fee schedule,429% of BCBS fee schedule,508.19,447,,,fee schedule,447% of BCBS fee schedule,508.19,447,,,fee schedule,447% of BCBS fee schedule,508.19,447,,,fee schedule,447% of BCBS fee schedule,163.8,90,,131.04,percent of total billed charges,90% of total billed charges,145.6,80,,116.48,percent of total billed charges,80% of total billed charges,163.8,90,,131.04,percent of total billed charges,90% of total billed charges,136.5,75,,109.2,percent of total billed charges,75% of total billed charges,141.02,122,,,fee schedule,122% of APC rate,52.78,29,,42.224,percent of total billed charges,29% of total billed charges,115.6,100,,,fee schedule,100% of CMS OPPS rate,121.94,67,,97.552,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,145.6,80,,116.48,percent of total billed charges,80% of total billed charges,118.3,65,,94.64,percent of total billed charges,65% of total billed charges,64.92,35.67,,51.936,percent of total billed charges,35.67% of total billed charges,52.78,508.19,
EST PATIENT WOUND VISIT 3,3600083,CDM,761,RC,G0463,HCPCS,outpatient,,,260,104.00,,221,85,,176.8,percent of total billed charges,85% of total billed charges,200.2,77,,160.16,percent of total billed charges,77% of total billed charges,115.6,100,,,fee schedule,100% of CMS OPPS rate,487.73,429,,,fee schedule,429% of BCBS fee schedule,508.19,447,,,fee schedule,447% of BCBS fee schedule,508.19,447,,,fee schedule,447% of BCBS fee schedule,508.19,447,,,fee schedule,447% of BCBS fee schedule,234,90,,187.2,percent of total billed charges,90% of total billed charges,208,80,,166.4,percent of total billed charges,80% of total billed charges,234,90,,187.2,percent of total billed charges,90% of total billed charges,195,75,,156,percent of total billed charges,75% of total billed charges,141.02,122,,,fee schedule,122% of APC rate,75.4,29,,60.32,percent of total billed charges,29% of total billed charges,115.6,100,,,fee schedule,100% of CMS OPPS rate,174.2,67,,139.36,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,208,80,,166.4,percent of total billed charges,80% of total billed charges,169,65,,135.2,percent of total billed charges,65% of total billed charges,92.74,35.67,,74.192,percent of total billed charges,35.67% of total billed charges,75.4,508.19,
EST PATIENT WOUND VISIT 4,3600084,CDM,761,RC,G0463,HCPCS,outpatient,,,387,154.80,,328.95,85,,263.16,percent of total billed charges,85% of total billed charges,297.99,77,,238.39,percent of total billed charges,77% of total billed charges,115.6,100,,,fee schedule,100% of CMS OPPS rate,487.73,429,,,fee schedule,429% of BCBS fee schedule,508.19,447,,,fee schedule,447% of BCBS fee schedule,508.19,447,,,fee schedule,447% of BCBS fee schedule,508.19,447,,,fee schedule,447% of BCBS fee schedule,348.3,90,,278.64,percent of total billed charges,90% of total billed charges,309.6,80,,247.68,percent of total billed charges,80% of total billed charges,348.3,90,,278.64,percent of total billed charges,90% of total billed charges,290.25,75,,232.2,percent of total billed charges,75% of total billed charges,141.02,122,,,fee schedule,122% of APC rate,112.23,29,,89.784,percent of total billed charges,29% of total billed charges,115.6,100,,,fee schedule,100% of CMS OPPS rate,259.29,67,,207.432,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,309.6,80,,247.68,percent of total billed charges,80% of total billed charges,251.55,65,,201.24,percent of total billed charges,65% of total billed charges,138.04,35.67,,110.432,percent of total billed charges,35.67% of total billed charges,112.23,508.19,
EST PATIENT WOUND VISIT 5,3600085,CDM,761,RC,G0463,HCPCS,outpatient,,,547,218.80,,464.95,85,,371.96,percent of total billed charges,85% of total billed charges,421.19,77,,336.95,percent of total billed charges,77% of total billed charges,115.6,100,,,fee schedule,100% of CMS OPPS rate,487.73,429,,,fee schedule,429% of BCBS fee schedule,508.19,447,,,fee schedule,447% of BCBS fee schedule,508.19,447,,,fee schedule,447% of BCBS fee schedule,508.19,447,,,fee schedule,447% of BCBS fee schedule,492.3,90,,393.84,percent of total billed charges,90% of total billed charges,437.6,80,,350.08,percent of total billed charges,80% of total billed charges,492.3,90,,393.84,percent of total billed charges,90% of total billed charges,410.25,75,,328.2,percent of total billed charges,75% of total billed charges,141.02,122,,,fee schedule,122% of APC rate,158.63,29,,126.904,percent of total billed charges,29% of total billed charges,115.6,100,,,fee schedule,100% of CMS OPPS rate,366.49,67,,293.192,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,437.6,80,,350.08,percent of total billed charges,80% of total billed charges,355.55,65,,284.44,percent of total billed charges,65% of total billed charges,195.11,35.67,,156.088,percent of total billed charges,35.67% of total billed charges,115.6,508.19,
NEW PATIENT PAIN MGMT LEVEL 2,3600091,CDM,761,RC,G0463,HCPCS,outpatient,,,250,100.00,,212.5,85,,170,percent of total billed charges,85% of total billed charges,192.5,77,,154,percent of total billed charges,77% of total billed charges,115.6,100,,,fee schedule,100% of CMS OPPS rate,487.73,429,,,fee schedule,429% of BCBS fee schedule,508.19,447,,,fee schedule,447% of BCBS fee schedule,508.19,447,,,fee schedule,447% of BCBS fee schedule,508.19,447,,,fee schedule,447% of BCBS fee schedule,225,90,,180,percent of total billed charges,90% of total billed charges,200,80,,160,percent of total billed charges,80% of total billed charges,225,90,,180,percent of total billed charges,90% of total billed charges,187.5,75,,150,percent of total billed charges,75% of total billed charges,141.02,122,,,fee schedule,122% of APC rate,72.5,29,,58,percent of total billed charges,29% of total billed charges,115.6,100,,,fee schedule,100% of CMS OPPS rate,167.5,67,,134,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,200,80,,160,percent of total billed charges,80% of total billed charges,162.5,65,,130,percent of total billed charges,65% of total billed charges,89.18,35.67,,71.344,percent of total billed charges,35.67% of total billed charges,72.5,508.19,
NEW PATIENT PAIN MGMT LEVEL 3,3600092,CDM,761,RC,G0463,HCPCS,outpatient,,,380,152.00,,323,85,,258.4,percent of total billed charges,85% of total billed charges,292.6,77,,234.08,percent of total billed charges,77% of total billed charges,115.6,100,,,fee schedule,100% of CMS OPPS rate,487.73,429,,,fee schedule,429% of BCBS fee schedule,508.19,447,,,fee schedule,447% of BCBS fee schedule,508.19,447,,,fee schedule,447% of BCBS fee schedule,508.19,447,,,fee schedule,447% of BCBS fee schedule,342,90,,273.6,percent of total billed charges,90% of total billed charges,304,80,,243.2,percent of total billed charges,80% of total billed charges,342,90,,273.6,percent of total billed charges,90% of total billed charges,285,75,,228,percent of total billed charges,75% of total billed charges,141.02,122,,,fee schedule,122% of APC rate,110.2,29,,88.16,percent of total billed charges,29% of total billed charges,115.6,100,,,fee schedule,100% of CMS OPPS rate,254.6,67,,203.68,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,304,80,,243.2,percent of total billed charges,80% of total billed charges,247,65,,197.6,percent of total billed charges,65% of total billed charges,135.55,35.67,,108.44,percent of total billed charges,35.67% of total billed charges,110.2,508.19,
NEW PATIENT PAIN MGMT LEVEL 4,3600093,CDM,761,RC,G0463,HCPCS,outpatient,,,636,254.40,,540.6,85,,432.48,percent of total billed charges,85% of total billed charges,489.72,77,,391.78,percent of total billed charges,77% of total billed charges,115.6,100,,,fee schedule,100% of CMS OPPS rate,487.73,429,,,fee schedule,429% of BCBS fee schedule,508.19,447,,,fee schedule,447% of BCBS fee schedule,508.19,447,,,fee schedule,447% of BCBS fee schedule,508.19,447,,,fee schedule,447% of BCBS fee schedule,572.4,90,,457.92,percent of total billed charges,90% of total billed charges,508.8,80,,407.04,percent of total billed charges,80% of total billed charges,572.4,90,,457.92,percent of total billed charges,90% of total billed charges,477,75,,381.6,percent of total billed charges,75% of total billed charges,141.02,122,,,fee schedule,122% of APC rate,184.44,29,,147.552,percent of total billed charges,29% of total billed charges,115.6,100,,,fee schedule,100% of CMS OPPS rate,426.12,67,,340.896,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,508.8,80,,407.04,percent of total billed charges,80% of total billed charges,413.4,65,,330.72,percent of total billed charges,65% of total billed charges,226.86,35.67,,181.488,percent of total billed charges,35.67% of total billed charges,115.6,572.4,
NEW PATIENT PAIN MGMT LEVEL 5,3600094,CDM,761,RC,G0463,HCPCS,outpatient,,,823,329.20,,699.55,85,,559.64,percent of total billed charges,85% of total billed charges,633.71,77,,506.97,percent of total billed charges,77% of total billed charges,115.6,100,,,fee schedule,100% of CMS OPPS rate,487.73,429,,,fee schedule,429% of BCBS fee schedule,508.19,447,,,fee schedule,447% of BCBS fee schedule,508.19,447,,,fee schedule,447% of BCBS fee schedule,508.19,447,,,fee schedule,447% of BCBS fee schedule,740.7,90,,592.56,percent of total billed charges,90% of total billed charges,658.4,80,,526.72,percent of total billed charges,80% of total billed charges,740.7,90,,592.56,percent of total billed charges,90% of total billed charges,617.25,75,,493.8,percent of total billed charges,75% of total billed charges,141.02,122,,,fee schedule,122% of APC rate,238.67,29,,190.936,percent of total billed charges,29% of total billed charges,115.6,100,,,fee schedule,100% of CMS OPPS rate,551.41,67,,441.128,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,658.4,80,,526.72,percent of total billed charges,80% of total billed charges,534.95,65,,427.96,percent of total billed charges,65% of total billed charges,293.56,35.67,,234.848,percent of total billed charges,35.67% of total billed charges,115.6,740.7,
EST PATIENT PAIN MGMT LEVEL 2,3600096,CDM,761,RC,G0463,HCPCS,outpatient,,,176,70.40,,149.6,85,,119.68,percent of total billed charges,85% of total billed charges,135.52,77,,108.42,percent of total billed charges,77% of total billed charges,115.6,100,,,fee schedule,100% of CMS OPPS rate,487.73,429,,,fee schedule,429% of BCBS fee schedule,508.19,447,,,fee schedule,447% of BCBS fee schedule,508.19,447,,,fee schedule,447% of BCBS fee schedule,508.19,447,,,fee schedule,447% of BCBS fee schedule,158.4,90,,126.72,percent of total billed charges,90% of total billed charges,140.8,80,,112.64,percent of total billed charges,80% of total billed charges,158.4,90,,126.72,percent of total billed charges,90% of total billed charges,132,75,,105.6,percent of total billed charges,75% of total billed charges,141.02,122,,,fee schedule,122% of APC rate,51.04,29,,40.832,percent of total billed charges,29% of total billed charges,115.6,100,,,fee schedule,100% of CMS OPPS rate,117.92,67,,94.336,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,140.8,80,,112.64,percent of total billed charges,80% of total billed charges,114.4,65,,91.52,percent of total billed charges,65% of total billed charges,62.78,35.67,,50.224,percent of total billed charges,35.67% of total billed charges,51.04,508.19,
EST PATIENT PAIN MGMT LEVEL 3,3600097,CDM,761,RC,G0463,HCPCS,outpatient,,,260,104.00,,221,85,,176.8,percent of total billed charges,85% of total billed charges,200.2,77,,160.16,percent of total billed charges,77% of total billed charges,115.6,100,,,fee schedule,100% of CMS OPPS rate,487.73,429,,,fee schedule,429% of BCBS fee schedule,508.19,447,,,fee schedule,447% of BCBS fee schedule,508.19,447,,,fee schedule,447% of BCBS fee schedule,508.19,447,,,fee schedule,447% of BCBS fee schedule,234,90,,187.2,percent of total billed charges,90% of total billed charges,208,80,,166.4,percent of total billed charges,80% of total billed charges,234,90,,187.2,percent of total billed charges,90% of total billed charges,195,75,,156,percent of total billed charges,75% of total billed charges,141.02,122,,,fee schedule,122% of APC rate,75.4,29,,60.32,percent of total billed charges,29% of total billed charges,115.6,100,,,fee schedule,100% of CMS OPPS rate,174.2,67,,139.36,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,208,80,,166.4,percent of total billed charges,80% of total billed charges,169,65,,135.2,percent of total billed charges,65% of total billed charges,92.74,35.67,,74.192,percent of total billed charges,35.67% of total billed charges,75.4,508.19,
EST PATIENT PAIN MGMT LEVEL 4,3600098,CDM,761,RC,G0463,HCPCS,outpatient,,,387,154.80,,328.95,85,,263.16,percent of total billed charges,85% of total billed charges,297.99,77,,238.39,percent of total billed charges,77% of total billed charges,115.6,100,,,fee schedule,100% of CMS OPPS rate,487.73,429,,,fee schedule,429% of BCBS fee schedule,508.19,447,,,fee schedule,447% of BCBS fee schedule,508.19,447,,,fee schedule,447% of BCBS fee schedule,508.19,447,,,fee schedule,447% of BCBS fee schedule,348.3,90,,278.64,percent of total billed charges,90% of total billed charges,309.6,80,,247.68,percent of total billed charges,80% of total billed charges,348.3,90,,278.64,percent of total billed charges,90% of total billed charges,290.25,75,,232.2,percent of total billed charges,75% of total billed charges,141.02,122,,,fee schedule,122% of APC rate,112.23,29,,89.784,percent of total billed charges,29% of total billed charges,115.6,100,,,fee schedule,100% of CMS OPPS rate,259.29,67,,207.432,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,309.6,80,,247.68,percent of total billed charges,80% of total billed charges,251.55,65,,201.24,percent of total billed charges,65% of total billed charges,138.04,35.67,,110.432,percent of total billed charges,35.67% of total billed charges,112.23,508.19,
EST PATIENT PAIN MGMT LEVEL 5,3600099,CDM,761,RC,G0463,HCPCS,outpatient,,,547,218.80,,464.95,85,,371.96,percent of total billed charges,85% of total billed charges,421.19,77,,336.95,percent of total billed charges,77% of total billed charges,115.6,100,,,fee schedule,100% of CMS OPPS rate,487.73,429,,,fee schedule,429% of BCBS fee schedule,508.19,447,,,fee schedule,447% of BCBS fee schedule,508.19,447,,,fee schedule,447% of BCBS fee schedule,508.19,447,,,fee schedule,447% of BCBS fee schedule,492.3,90,,393.84,percent of total billed charges,90% of total billed charges,437.6,80,,350.08,percent of total billed charges,80% of total billed charges,492.3,90,,393.84,percent of total billed charges,90% of total billed charges,410.25,75,,328.2,percent of total billed charges,75% of total billed charges,141.02,122,,,fee schedule,122% of APC rate,158.63,29,,126.904,percent of total billed charges,29% of total billed charges,115.6,100,,,fee schedule,100% of CMS OPPS rate,366.49,67,,293.192,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,437.6,80,,350.08,percent of total billed charges,80% of total billed charges,355.55,65,,284.44,percent of total billed charges,65% of total billed charges,195.11,35.67,,156.088,percent of total billed charges,35.67% of total billed charges,115.6,508.19,
PROCEDURE ROOM JOINT INJECTION,3600110,CDM,761,RC,,,outpatient,,,415,166.00,,352.75,85,,282.2,percent of total billed charges,85% of total billed charges,319.55,77,,255.64,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,340.3,82,,272.24,percent of total billed charges,82% of total billed charges,352.75,85,,282.2,percent of total billed charges,85% of total billed charges,352.75,85,,282.2,percent of total billed charges,85% of total billed charges,352.75,85,,282.2,percent of total billed charges,85% of total billed charges,373.5,90,,298.8,percent of total billed charges,90% of total billed charges,332,80,,265.6,percent of total billed charges,80% of total billed charges,373.5,90,,298.8,percent of total billed charges,90% of total billed charges,311.25,75,,249,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,120.35,29,,96.28,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,278.05,67,,222.44,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,332,80,,265.6,percent of total billed charges,80% of total billed charges,269.75,65,,215.8,percent of total billed charges,65% of total billed charges,148.03,35.67,,118.424,percent of total billed charges,35.67% of total billed charges,120.35,373.5,
PROCEDURE ROOM FOR ESI IN OP,3600112,CDM,761,RC,,,outpatient,,,328,131.20,,278.8,85,,223.04,percent of total billed charges,85% of total billed charges,252.56,77,,202.05,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,268.96,82,,215.168,percent of total billed charges,82% of total billed charges,278.8,85,,223.04,percent of total billed charges,85% of total billed charges,278.8,85,,223.04,percent of total billed charges,85% of total billed charges,278.8,85,,223.04,percent of total billed charges,85% of total billed charges,295.2,90,,236.16,percent of total billed charges,90% of total billed charges,262.4,80,,209.92,percent of total billed charges,80% of total billed charges,295.2,90,,236.16,percent of total billed charges,90% of total billed charges,246,75,,196.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,95.12,29,,76.096,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,219.76,67,,175.808,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,262.4,80,,209.92,percent of total billed charges,80% of total billed charges,213.2,65,,170.56,percent of total billed charges,65% of total billed charges,117,35.67,,93.6,percent of total billed charges,35.67% of total billed charges,95.12,295.2,
PROCEDURE ROOM BIL. JOINT INJ,3600115,CDM,761,RC,,,outpatient,,,817,326.80,,694.45,85,,555.56,percent of total billed charges,85% of total billed charges,629.09,77,,503.27,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,669.94,82,,535.952,percent of total billed charges,82% of total billed charges,694.45,85,,555.56,percent of total billed charges,85% of total billed charges,694.45,85,,555.56,percent of total billed charges,85% of total billed charges,694.45,85,,555.56,percent of total billed charges,85% of total billed charges,735.3,90,,588.24,percent of total billed charges,90% of total billed charges,653.6,80,,522.88,percent of total billed charges,80% of total billed charges,735.3,90,,588.24,percent of total billed charges,90% of total billed charges,612.75,75,,490.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,236.93,29,,189.544,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,547.39,67,,437.912,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,653.6,80,,522.88,percent of total billed charges,80% of total billed charges,531.05,65,,424.84,percent of total billed charges,65% of total billed charges,291.42,35.67,,233.136,percent of total billed charges,35.67% of total billed charges,236.93,735.3,
PROCEDURE ROOM/APPLI. SPLINT,3600123,CDM,761,RC,,,outpatient,,,166,66.40,,141.1,85,,112.88,percent of total billed charges,85% of total billed charges,127.82,77,,102.26,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,136.12,82,,108.896,percent of total billed charges,82% of total billed charges,141.1,85,,112.88,percent of total billed charges,85% of total billed charges,141.1,85,,112.88,percent of total billed charges,85% of total billed charges,141.1,85,,112.88,percent of total billed charges,85% of total billed charges,149.4,90,,119.52,percent of total billed charges,90% of total billed charges,132.8,80,,106.24,percent of total billed charges,80% of total billed charges,149.4,90,,119.52,percent of total billed charges,90% of total billed charges,124.5,75,,99.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,48.14,29,,38.512,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,111.22,67,,88.976,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,132.8,80,,106.24,percent of total billed charges,80% of total billed charges,107.9,65,,86.32,percent of total billed charges,65% of total billed charges,59.21,35.67,,47.368,percent of total billed charges,35.67% of total billed charges,48.14,149.4,
INSERTION OF IUD,3600125,CDM,761,RC,58300,HCPCS,outpatient,,,580,232.00,,1150,,,,case rate,pays based on per visit,446.6,77,,357.28,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,475.6,82,,380.48,percent of total billed charges,82% of total billed charges,493,85,,394.4,percent of total billed charges,85% of total billed charges,493,85,,394.4,percent of total billed charges,85% of total billed charges,493,85,,394.4,percent of total billed charges,85% of total billed charges,522,90,,417.6,percent of total billed charges,90% of total billed charges,464,80,,371.2,percent of total billed charges,80% of total billed charges,522,90,,417.6,percent of total billed charges,90% of total billed charges,435,75,,348,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,168.2,29,,134.56,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,388.6,67,,310.88,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,464,80,,371.2,percent of total billed charges,80% of total billed charges,377,65,,301.6,percent of total billed charges,65% of total billed charges,206.89,35.67,,165.512,percent of total billed charges,35.67% of total billed charges,168.2,1150,
INSERTION OF IUD,3600128,CDM,761,RC,58300,HCPCS,outpatient,,,580,232.00,,1150,,,,case rate,pays based on per visit,446.6,77,,357.28,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,475.6,82,,380.48,percent of total billed charges,82% of total billed charges,493,85,,394.4,percent of total billed charges,85% of total billed charges,493,85,,394.4,percent of total billed charges,85% of total billed charges,493,85,,394.4,percent of total billed charges,85% of total billed charges,522,90,,417.6,percent of total billed charges,90% of total billed charges,464,80,,371.2,percent of total billed charges,80% of total billed charges,522,90,,417.6,percent of total billed charges,90% of total billed charges,435,75,,348,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,168.2,29,,134.56,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,388.6,67,,310.88,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,464,80,,371.2,percent of total billed charges,80% of total billed charges,377,65,,301.6,percent of total billed charges,65% of total billed charges,206.89,35.67,,165.512,percent of total billed charges,35.67% of total billed charges,168.2,1150,
REMOVAL OF IUD,3600129,CDM,761,RC,58301,HCPCS,outpatient,,,580,232.00,,1150,,,,case rate,pays based on per visit,446.6,77,,357.28,percent of total billed charges,77% of total billed charges,280.55,100,,,fee schedule,100% of CMS OPPS rate,475.6,82,,380.48,percent of total billed charges,82% of total billed charges,493,85,,394.4,percent of total billed charges,85% of total billed charges,493,85,,394.4,percent of total billed charges,85% of total billed charges,493,85,,394.4,percent of total billed charges,85% of total billed charges,522,90,,417.6,percent of total billed charges,90% of total billed charges,464,80,,371.2,percent of total billed charges,80% of total billed charges,522,90,,417.6,percent of total billed charges,90% of total billed charges,435,75,,348,percent of total billed charges,75% of total billed charges,342.27,122,,,fee schedule,122% of APC rate,51.22,100,,,fee schedule,100% of ASC tier grouping rate,280.55,100,,,fee schedule,100% of CMS OPPS rate,388.6,67,,310.88,percent of total billed charges,67% of total billed charges,103.28,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,464,80,,371.2,percent of total billed charges,80% of total billed charges,377,65,,301.6,percent of total billed charges,65% of total billed charges,63,123,,,fee schedule,123% of ASC tier grouping rate,51.22,1150,
PROCEDURE ROOM FOR COLPOSCOPY,3600130,CDM,761,RC,57452,HCPCS,outpatient,,,1173,469.20,,1150,,,,case rate,pays based on per visit,903.21,77,,722.57,percent of total billed charges,77% of total billed charges,174.26,100,,,fee schedule,100% of CMS OPPS rate,961.86,82,,769.488,percent of total billed charges,82% of total billed charges,997.05,85,,797.64,percent of total billed charges,85% of total billed charges,997.05,85,,797.64,percent of total billed charges,85% of total billed charges,997.05,85,,797.64,percent of total billed charges,85% of total billed charges,1055.7,90,,844.56,percent of total billed charges,90% of total billed charges,938.4,80,,750.72,percent of total billed charges,80% of total billed charges,1055.7,90,,844.56,percent of total billed charges,90% of total billed charges,879.75,75,,703.8,percent of total billed charges,75% of total billed charges,212.59,122,,,fee schedule,122% of APC rate,56.75,100,,,fee schedule,100% of ASC tier grouping rate,174.26,100,,,fee schedule,100% of CMS OPPS rate,785.91,67,,628.728,percent of total billed charges,67% of total billed charges,103.28,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,938.4,80,,750.72,percent of total billed charges,80% of total billed charges,762.45,65,,609.96,percent of total billed charges,65% of total billed charges,69.8,123,,,fee schedule,123% of ASC tier grouping rate,56.75,1150,
REMOVE & INSERT NEXPLANON,3600131,CDM,761,RC,11983,HCPCS,outpatient,,,580,232.00,,1150,,,,case rate,pays based on per visit,446.6,77,,357.28,percent of total billed charges,77% of total billed charges,348.44,100,,,fee schedule,100% of CMS OPPS rate,475.6,82,,380.48,percent of total billed charges,82% of total billed charges,493,85,,394.4,percent of total billed charges,85% of total billed charges,493,85,,394.4,percent of total billed charges,85% of total billed charges,493,85,,394.4,percent of total billed charges,85% of total billed charges,522,90,,417.6,percent of total billed charges,90% of total billed charges,464,80,,371.2,percent of total billed charges,80% of total billed charges,522,90,,417.6,percent of total billed charges,90% of total billed charges,435,75,,348,percent of total billed charges,75% of total billed charges,425.1,122,,,fee schedule,122% of APC rate,76,100,,,fee schedule,100% of ASC tier grouping rate,348.44,100,,,fee schedule,100% of CMS OPPS rate,388.6,67,,310.88,percent of total billed charges,67% of total billed charges,42.55,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,464,80,,371.2,percent of total billed charges,80% of total billed charges,377,65,,301.6,percent of total billed charges,65% of total billed charges,93.48,123,,,fee schedule,123% of ASC tier grouping rate,42.55,1150,
INSERTION OF NEXPLANON,3600132,CDM,761,RC,11981,HCPCS,outpatient,,,362,144.80,,1150,,,,case rate,pays based on per visit,278.74,77,,222.99,percent of total billed charges,77% of total billed charges,111.71,100,,,fee schedule,100% of CMS OPPS rate,296.84,82,,237.472,percent of total billed charges,82% of total billed charges,307.7,85,,246.16,percent of total billed charges,85% of total billed charges,307.7,85,,246.16,percent of total billed charges,85% of total billed charges,307.7,85,,246.16,percent of total billed charges,85% of total billed charges,325.8,90,,260.64,percent of total billed charges,90% of total billed charges,289.6,80,,231.68,percent of total billed charges,80% of total billed charges,325.8,90,,260.64,percent of total billed charges,90% of total billed charges,271.5,75,,217.2,percent of total billed charges,75% of total billed charges,136.28,122,,,fee schedule,122% of APC rate,46.38,100,,,fee schedule,100% of ASC tier grouping rate,111.71,100,,,fee schedule,100% of CMS OPPS rate,242.54,67,,194.032,percent of total billed charges,67% of total billed charges,42.55,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,289.6,80,,231.68,percent of total billed charges,80% of total billed charges,235.3,65,,188.24,percent of total billed charges,65% of total billed charges,57.05,123,,,fee schedule,123% of ASC tier grouping rate,42.55,1150,
REMOVAL OF NEXPLANON,3600133,CDM,761,RC,11982,HCPCS,outpatient,,,580,232.00,,1150,,,,case rate,pays based on per visit,446.6,77,,357.28,percent of total billed charges,77% of total billed charges,348.44,100,,,fee schedule,100% of CMS OPPS rate,475.6,82,,380.48,percent of total billed charges,82% of total billed charges,493,85,,394.4,percent of total billed charges,85% of total billed charges,493,85,,394.4,percent of total billed charges,85% of total billed charges,493,85,,394.4,percent of total billed charges,85% of total billed charges,522,90,,417.6,percent of total billed charges,90% of total billed charges,464,80,,371.2,percent of total billed charges,80% of total billed charges,522,90,,417.6,percent of total billed charges,90% of total billed charges,435,75,,348,percent of total billed charges,75% of total billed charges,425.1,122,,,fee schedule,122% of APC rate,54.42,100,,,fee schedule,100% of ASC tier grouping rate,348.44,100,,,fee schedule,100% of CMS OPPS rate,388.6,67,,310.88,percent of total billed charges,67% of total billed charges,42.55,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,464,80,,371.2,percent of total billed charges,80% of total billed charges,377,65,,301.6,percent of total billed charges,65% of total billed charges,66.94,123,,,fee schedule,123% of ASC tier grouping rate,42.55,1150,
REPAIR OF CENTRAL VENOUS ACCES,3600139,CDM,761,RC,36575,HCPCS,outpatient,,,1313,525.20,,1150,,,,case rate,pays based on per visit,1011.01,77,,808.81,percent of total billed charges,77% of total billed charges,549.37,100,,,fee schedule,100% of CMS OPPS rate,1076.66,82,,861.328,percent of total billed charges,82% of total billed charges,1116.05,85,,892.84,percent of total billed charges,85% of total billed charges,1116.05,85,,892.84,percent of total billed charges,85% of total billed charges,1116.05,85,,892.84,percent of total billed charges,85% of total billed charges,1181.7,90,,945.36,percent of total billed charges,90% of total billed charges,1050.4,80,,840.32,percent of total billed charges,80% of total billed charges,1181.7,90,,945.36,percent of total billed charges,90% of total billed charges,984.75,75,,787.8,percent of total billed charges,75% of total billed charges,670.25,122,,,fee schedule,122% of APC rate,223.75,100,,,fee schedule,100% of ASC tier grouping rate,549.37,100,,,fee schedule,100% of CMS OPPS rate,879.71,67,,703.768,percent of total billed charges,67% of total billed charges,405.16,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,1050.4,80,,840.32,percent of total billed charges,80% of total billed charges,853.45,65,,682.76,percent of total billed charges,65% of total billed charges,275.21,123,,,fee schedule,123% of ASC tier grouping rate,223.75,1181.7,
WOUND CARE NON SELECTIVE,3600140,CDM,761,RC,97602,HCPCS,outpatient,,,596,238.40,,506.6,85,,405.28,percent of total billed charges,85% of total billed charges,458.92,77,,367.14,percent of total billed charges,77% of total billed charges,175.08,100,,,fee schedule,100% of CMS OPPS rate,724.8,429,,,fee schedule,429% of BCBS fee schedule,755.21,447,,,fee schedule,447% of BCBS fee schedule,755.21,447,,,fee schedule,447% of BCBS fee schedule,755.21,447,,,fee schedule,447% of BCBS fee schedule,536.4,90,,429.12,percent of total billed charges,90% of total billed charges,476.8,80,,381.44,percent of total billed charges,80% of total billed charges,536.4,90,,429.12,percent of total billed charges,90% of total billed charges,447,75,,357.6,percent of total billed charges,75% of total billed charges,213.59,122,,,fee schedule,122% of APC rate,172.84,29,,138.272,percent of total billed charges,29% of total billed charges,175.08,100,,,fee schedule,100% of CMS OPPS rate,399.32,67,,319.456,percent of total billed charges,67% of total billed charges,57.28,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,476.8,80,,381.44,percent of total billed charges,80% of total billed charges,387.4,65,,309.92,percent of total billed charges,65% of total billed charges,212.59,35.67,,170.072,percent of total billed charges,35.67% of total billed charges,57.28,755.21,
DEBRIDE WOUND-FIRST 20 CM,3600141,CDM,761,RC,97597,HCPCS,outpatient,,,262,104.80,,222.7,85,,178.16,percent of total billed charges,85% of total billed charges,201.74,77,,161.39,percent of total billed charges,77% of total billed charges,175.08,100,,,fee schedule,100% of CMS OPPS rate,104.68,429,,,fee schedule,429% of BCBS fee schedule,109.07,447,,,fee schedule,447% of BCBS fee schedule,109.07,447,,,fee schedule,447% of BCBS fee schedule,109.07,447,,,fee schedule,447% of BCBS fee schedule,235.8,90,,188.64,percent of total billed charges,90% of total billed charges,209.6,80,,167.68,percent of total billed charges,80% of total billed charges,235.8,90,,188.64,percent of total billed charges,90% of total billed charges,196.5,75,,157.2,percent of total billed charges,75% of total billed charges,213.59,122,,,fee schedule,122% of APC rate,75.98,29,,60.784,percent of total billed charges,29% of total billed charges,175.08,100,,,fee schedule,100% of CMS OPPS rate,175.54,67,,140.432,percent of total billed charges,67% of total billed charges,97.74,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,209.6,80,,167.68,percent of total billed charges,80% of total billed charges,170.3,65,,136.24,percent of total billed charges,65% of total billed charges,93.46,35.67,,74.768,percent of total billed charges,35.67% of total billed charges,75.98,235.8,
DEBRIDE WOUND-EA ADD 20 CM,3600142,CDM,761,RC,97598,HCPCS,outpatient,,,262,104.80,,222.7,85,,178.16,percent of total billed charges,85% of total billed charges,201.74,77,,161.39,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,49.25,429,,,fee schedule,429% of BCBS fee schedule,51.32,447,,,fee schedule,447% of BCBS fee schedule,51.32,447,,,fee schedule,447% of BCBS fee schedule,51.32,447,,,fee schedule,447% of BCBS fee schedule,235.8,90,,188.64,percent of total billed charges,90% of total billed charges,209.6,80,,167.68,percent of total billed charges,80% of total billed charges,235.8,90,,188.64,percent of total billed charges,90% of total billed charges,196.5,75,,157.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,75.98,29,,60.784,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,175.54,67,,140.432,percent of total billed charges,67% of total billed charges,97.74,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,209.6,80,,167.68,percent of total billed charges,80% of total billed charges,170.3,65,,136.24,percent of total billed charges,65% of total billed charges,93.46,35.67,,74.768,percent of total billed charges,35.67% of total billed charges,49.25,235.8,
WOUND CARE VAC 50 CM,3600143,CDM,761,RC,97606,HCPCS,outpatient,,,863,345.20,,733.55,85,,586.84,percent of total billed charges,85% of total billed charges,664.51,77,,531.61,percent of total billed charges,77% of total billed charges,348.71,100,,,fee schedule,100% of CMS OPPS rate,1333.33,429,,,fee schedule,429% of BCBS fee schedule,1389.28,447,,,fee schedule,447% of BCBS fee schedule,1389.28,447,,,fee schedule,447% of BCBS fee schedule,1389.28,447,,,fee schedule,447% of BCBS fee schedule,776.7,90,,621.36,percent of total billed charges,90% of total billed charges,690.4,80,,552.32,percent of total billed charges,80% of total billed charges,776.7,90,,621.36,percent of total billed charges,90% of total billed charges,647.25,75,,517.8,percent of total billed charges,75% of total billed charges,425.43,122,,,fee schedule,122% of APC rate,250.27,29,,200.216,percent of total billed charges,29% of total billed charges,348.71,100,,,fee schedule,100% of CMS OPPS rate,578.21,67,,462.568,percent of total billed charges,67% of total billed charges,97.74,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,690.4,80,,552.32,percent of total billed charges,80% of total billed charges,560.95,65,,448.76,percent of total billed charges,65% of total billed charges,307.83,35.67,,246.264,percent of total billed charges,35.67% of total billed charges,97.74,1389.28,
WOUND CARE VAC 20 CM,3600150,CDM,761,RC,97605,HCPCS,outpatient,,,863,345.20,,733.55,85,,586.84,percent of total billed charges,85% of total billed charges,664.51,77,,531.61,percent of total billed charges,77% of total billed charges,175.08,100,,,fee schedule,100% of CMS OPPS rate,724.8,429,,,fee schedule,429% of BCBS fee schedule,755.21,447,,,fee schedule,447% of BCBS fee schedule,755.21,447,,,fee schedule,447% of BCBS fee schedule,755.21,447,,,fee schedule,447% of BCBS fee schedule,776.7,90,,621.36,percent of total billed charges,90% of total billed charges,690.4,80,,552.32,percent of total billed charges,80% of total billed charges,776.7,90,,621.36,percent of total billed charges,90% of total billed charges,647.25,75,,517.8,percent of total billed charges,75% of total billed charges,213.59,122,,,fee schedule,122% of APC rate,250.27,29,,200.216,percent of total billed charges,29% of total billed charges,175.08,100,,,fee schedule,100% of CMS OPPS rate,578.21,67,,462.568,percent of total billed charges,67% of total billed charges,57.28,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,690.4,80,,552.32,percent of total billed charges,80% of total billed charges,560.95,65,,448.76,percent of total billed charges,65% of total billed charges,307.83,35.67,,246.264,percent of total billed charges,35.67% of total billed charges,57.28,776.7,
APPLY RIGID LEG CAST,3600151,CDM,761,RC,29445,HCPCS,outpatient,,,471,188.40,,1150,,,,case rate,pays based on per visit,362.67,77,,290.14,percent of total billed charges,77% of total billed charges,234.86,100,,,fee schedule,100% of CMS OPPS rate,386.22,82,,308.976,percent of total billed charges,82% of total billed charges,400.35,85,,320.28,percent of total billed charges,85% of total billed charges,400.35,85,,320.28,percent of total billed charges,85% of total billed charges,400.35,85,,320.28,percent of total billed charges,85% of total billed charges,423.9,90,,339.12,percent of total billed charges,90% of total billed charges,376.8,80,,301.44,percent of total billed charges,80% of total billed charges,423.9,90,,339.12,percent of total billed charges,90% of total billed charges,353.25,75,,282.6,percent of total billed charges,75% of total billed charges,286.52,122,,,fee schedule,122% of APC rate,49.56,100,,,fee schedule,100% of ASC tier grouping rate,234.86,100,,,fee schedule,100% of CMS OPPS rate,315.57,67,,252.456,percent of total billed charges,67% of total billed charges,167.37,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,376.8,80,,301.44,percent of total billed charges,80% of total billed charges,306.15,65,,244.92,percent of total billed charges,65% of total billed charges,60.96,123,,,fee schedule,123% of ASC tier grouping rate,49.56,1150,
STRAPPING OF UNNA BOOT,3600152,CDM,761,RC,29580,HCPCS,outpatient,,,262,104.80,,1150,,,,case rate,pays based on per visit,201.74,77,,161.39,percent of total billed charges,77% of total billed charges,137.79,100,,,fee schedule,100% of CMS OPPS rate,214.84,82,,171.872,percent of total billed charges,82% of total billed charges,222.7,85,,178.16,percent of total billed charges,85% of total billed charges,222.7,85,,178.16,percent of total billed charges,85% of total billed charges,222.7,85,,178.16,percent of total billed charges,85% of total billed charges,235.8,90,,188.64,percent of total billed charges,90% of total billed charges,209.6,80,,167.68,percent of total billed charges,80% of total billed charges,235.8,90,,188.64,percent of total billed charges,90% of total billed charges,196.5,75,,157.2,percent of total billed charges,75% of total billed charges,168.1,122,,,fee schedule,122% of APC rate,35.16,100,,,fee schedule,100% of ASC tier grouping rate,137.79,100,,,fee schedule,100% of CMS OPPS rate,175.54,67,,140.432,percent of total billed charges,67% of total billed charges,73.52,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,209.6,80,,167.68,percent of total billed charges,80% of total billed charges,170.3,65,,136.24,percent of total billed charges,65% of total billed charges,43.25,123,,,fee schedule,123% of ASC tier grouping rate,35.16,1150,
APPLY MULTILAYER COMPR LWR LEG,3600153,CDM,761,RC,29581,HCPCS,outpatient,,,262,104.80,,1150,,,,case rate,pays based on per visit,201.74,77,,161.39,percent of total billed charges,77% of total billed charges,137.79,100,,,fee schedule,100% of CMS OPPS rate,214.84,82,,171.872,percent of total billed charges,82% of total billed charges,222.7,85,,178.16,percent of total billed charges,85% of total billed charges,222.7,85,,178.16,percent of total billed charges,85% of total billed charges,222.7,85,,178.16,percent of total billed charges,85% of total billed charges,235.8,90,,188.64,percent of total billed charges,90% of total billed charges,209.6,80,,167.68,percent of total billed charges,80% of total billed charges,235.8,90,,188.64,percent of total billed charges,90% of total billed charges,196.5,75,,157.2,percent of total billed charges,75% of total billed charges,168.1,122,,,fee schedule,122% of APC rate,56.48,100,,,fee schedule,100% of ASC tier grouping rate,137.79,100,,,fee schedule,100% of CMS OPPS rate,175.54,67,,140.432,percent of total billed charges,67% of total billed charges,73.52,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,209.6,80,,167.68,percent of total billed charges,80% of total billed charges,170.3,65,,136.24,percent of total billed charges,65% of total billed charges,69.47,123,,,fee schedule,123% of ASC tier grouping rate,56.48,1150,
APPLY MULTILAY COMPR AMR/HAND,3600154,CDM,761,RC,29584,HCPCS,outpatient,,,262,104.80,,1150,,,,case rate,pays based on per visit,201.74,77,,161.39,percent of total billed charges,77% of total billed charges,137.79,100,,,fee schedule,100% of CMS OPPS rate,214.84,82,,171.872,percent of total billed charges,82% of total billed charges,222.7,85,,178.16,percent of total billed charges,85% of total billed charges,222.7,85,,178.16,percent of total billed charges,85% of total billed charges,222.7,85,,178.16,percent of total billed charges,85% of total billed charges,235.8,90,,188.64,percent of total billed charges,90% of total billed charges,209.6,80,,167.68,percent of total billed charges,80% of total billed charges,235.8,90,,188.64,percent of total billed charges,90% of total billed charges,196.5,75,,157.2,percent of total billed charges,75% of total billed charges,168.1,122,,,fee schedule,122% of APC rate,58.14,100,,,fee schedule,100% of ASC tier grouping rate,137.79,100,,,fee schedule,100% of CMS OPPS rate,175.54,67,,140.432,percent of total billed charges,67% of total billed charges,73.52,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,209.6,80,,167.68,percent of total billed charges,80% of total billed charges,170.3,65,,136.24,percent of total billed charges,65% of total billed charges,71.51,123,,,fee schedule,123% of ASC tier grouping rate,58.14,1150,
PICC LINE INSERTION OVER AGE 5,3600550,CDM,761,RC,36569,HCPCS,outpatient,,,1382,552.80,,1150,,,,case rate,pays based on per visit,1064.14,77,,851.31,percent of total billed charges,77% of total billed charges,1400.59,100,,,fee schedule,100% of CMS OPPS rate,1133.24,82,,906.592,percent of total billed charges,82% of total billed charges,1174.7,85,,939.76,percent of total billed charges,85% of total billed charges,1174.7,85,,939.76,percent of total billed charges,85% of total billed charges,1174.7,85,,939.76,percent of total billed charges,85% of total billed charges,1243.8,90,,995.04,percent of total billed charges,90% of total billed charges,1105.6,80,,884.48,percent of total billed charges,80% of total billed charges,1243.8,90,,995.04,percent of total billed charges,90% of total billed charges,1036.5,75,,829.2,percent of total billed charges,75% of total billed charges,1708.71,122,,,fee schedule,122% of APC rate,446.27,100,,,fee schedule,100% of ASC tier grouping rate,1400.59,100,,,fee schedule,100% of CMS OPPS rate,925.94,67,,740.752,percent of total billed charges,67% of total billed charges,723.08,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,1105.6,80,,884.48,percent of total billed charges,80% of total billed charges,898.3,65,,718.64,percent of total billed charges,65% of total billed charges,548.91,123,,,fee schedule,123% of ASC tier grouping rate,446.27,1708.71,
MIDLINE PLACEMENT,3600552,CDM,761,RC,36410,HCPCS,outpatient,,,831,332.40,,1150,,,,case rate,pays based on per visit,639.87,77,,511.9,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,681.42,82,,545.136,percent of total billed charges,82% of total billed charges,706.35,85,,565.08,percent of total billed charges,85% of total billed charges,706.35,85,,565.08,percent of total billed charges,85% of total billed charges,706.35,85,,565.08,percent of total billed charges,85% of total billed charges,747.9,90,,598.32,percent of total billed charges,90% of total billed charges,664.8,80,,531.84,percent of total billed charges,80% of total billed charges,747.9,90,,598.32,percent of total billed charges,90% of total billed charges,623.25,75,,498.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,240.99,29,,192.792,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,556.77,67,,445.416,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,664.8,80,,531.84,percent of total billed charges,80% of total billed charges,540.15,65,,432.12,percent of total billed charges,65% of total billed charges,296.42,35.67,,237.136,percent of total billed charges,35.67% of total billed charges,240.99,1150,
VASECTOMY REMOVAL SPERM DUCTS,3600553,CDM,761,RC,55250,HCPCS,outpatient,,,1422,568.80,,1150,,,,case rate,pays based on per visit,1094.94,77,,875.95,percent of total billed charges,77% of total billed charges,1781.25,100,,,fee schedule,100% of CMS OPPS rate,1166.04,82,,932.832,percent of total billed charges,82% of total billed charges,1208.7,85,,966.96,percent of total billed charges,85% of total billed charges,1208.7,85,,966.96,percent of total billed charges,85% of total billed charges,1208.7,85,,966.96,percent of total billed charges,85% of total billed charges,1279.8,90,,1023.84,percent of total billed charges,90% of total billed charges,1137.6,80,,910.08,percent of total billed charges,80% of total billed charges,1279.8,90,,1023.84,percent of total billed charges,90% of total billed charges,1066.5,75,,853.2,percent of total billed charges,75% of total billed charges,2173.12,122,,,fee schedule,122% of APC rate,652.8,100,,,fee schedule,100% of ASC tier grouping rate,1781.25,100,,,fee schedule,100% of CMS OPPS rate,952.74,67,,762.192,percent of total billed charges,67% of total billed charges,1538.87,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,1137.6,80,,910.08,percent of total billed charges,80% of total billed charges,924.3,65,,739.44,percent of total billed charges,65% of total billed charges,802.94,123,,,fee schedule,123% of ASC tier grouping rate,652.8,2173.12,
ULTRASOUND PROCEDURE ROOM,4003180,CDM,761,RC,,,outpatient,,,2035,814.00,,1729.75,85,,1383.8,percent of total billed charges,85% of total billed charges,1566.95,77,,1253.56,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,1668.7,82,,1334.96,percent of total billed charges,82% of total billed charges,1729.75,85,,1383.8,percent of total billed charges,85% of total billed charges,1729.75,85,,1383.8,percent of total billed charges,85% of total billed charges,1729.75,85,,1383.8,percent of total billed charges,85% of total billed charges,1831.5,90,,1465.2,percent of total billed charges,90% of total billed charges,1628,80,,1302.4,percent of total billed charges,80% of total billed charges,1831.5,90,,1465.2,percent of total billed charges,90% of total billed charges,1526.25,75,,1221,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,590.15,29,,472.12,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1363.45,67,,1090.76,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,1628,80,,1302.4,percent of total billed charges,80% of total billed charges,1322.75,65,,1058.2,percent of total billed charges,65% of total billed charges,725.88,35.67,,580.704,percent of total billed charges,35.67% of total billed charges,590.15,1831.5,
OB VISIT OB NEW PT 30 MIN -1HR,7600052,CDM,761,RC,99202,HCPCS,outpatient,,,396,158.40,,336.6,85,,269.28,percent of total billed charges,85% of total billed charges,304.92,77,,243.94,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,220.16,429,,,fee schedule,429% of BCBS fee schedule,229.4,447,,,fee schedule,447% of BCBS fee schedule,229.4,447,,,fee schedule,447% of BCBS fee schedule,229.4,447,,,fee schedule,447% of BCBS fee schedule,356.4,90,,285.12,percent of total billed charges,90% of total billed charges,316.8,80,,253.44,percent of total billed charges,80% of total billed charges,356.4,90,,285.12,percent of total billed charges,90% of total billed charges,297,75,,237.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,114.84,29,,91.872,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,265.32,67,,212.256,percent of total billed charges,67% of total billed charges,67.2,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,316.8,80,,253.44,percent of total billed charges,80% of total billed charges,257.4,65,,205.92,percent of total billed charges,65% of total billed charges,141.25,35.67,,113,percent of total billed charges,35.67% of total billed charges,67.2,356.4,
OP VISIT OB NEW PT 2-5 HRS,7600053,CDM,761,RC,99203,HCPCS,outpatient,,,677,270.80,,575.45,85,,460.36,percent of total billed charges,85% of total billed charges,521.29,77,,417.03,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,334.11,429,,,fee schedule,429% of BCBS fee schedule,348.12,447,,,fee schedule,447% of BCBS fee schedule,348.12,447,,,fee schedule,447% of BCBS fee schedule,348.12,447,,,fee schedule,447% of BCBS fee schedule,609.3,90,,487.44,percent of total billed charges,90% of total billed charges,541.6,80,,433.28,percent of total billed charges,80% of total billed charges,609.3,90,,487.44,percent of total billed charges,90% of total billed charges,507.75,75,,406.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,196.33,29,,157.064,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,453.59,67,,362.872,percent of total billed charges,67% of total billed charges,88.66,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,541.6,80,,433.28,percent of total billed charges,80% of total billed charges,440.05,65,,352.04,percent of total billed charges,65% of total billed charges,241.49,35.67,,193.192,percent of total billed charges,35.67% of total billed charges,88.66,609.3,
OP VISIT OB NEW PT 5-7 HOURS,7600054,CDM,761,RC,99204,HCPCS,outpatient,,,902,360.80,,766.7,85,,613.36,percent of total billed charges,85% of total billed charges,694.54,77,,555.63,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,563.49,429,,,fee schedule,429% of BCBS fee schedule,587.13,447,,,fee schedule,447% of BCBS fee schedule,587.13,447,,,fee schedule,447% of BCBS fee schedule,587.13,447,,,fee schedule,447% of BCBS fee schedule,811.8,90,,649.44,percent of total billed charges,90% of total billed charges,721.6,80,,577.28,percent of total billed charges,80% of total billed charges,811.8,90,,649.44,percent of total billed charges,90% of total billed charges,676.5,75,,541.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,261.58,29,,209.264,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,604.34,67,,483.472,percent of total billed charges,67% of total billed charges,121.56,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,721.6,80,,577.28,percent of total billed charges,80% of total billed charges,586.3,65,,469.04,percent of total billed charges,65% of total billed charges,321.74,35.67,,257.392,percent of total billed charges,35.67% of total billed charges,121.56,811.8,
OP VISIT OB OVER 7 HOURS,7600055,CDM,761,RC,99205,HCPCS,outpatient,,,1802,720.80,,1531.7,85,,1225.36,percent of total billed charges,85% of total billed charges,1387.54,77,,1110.03,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,735.95,429,,,fee schedule,429% of BCBS fee schedule,766.83,447,,,fee schedule,447% of BCBS fee schedule,766.83,447,,,fee schedule,447% of BCBS fee schedule,766.83,447,,,fee schedule,447% of BCBS fee schedule,1621.8,90,,1297.44,percent of total billed charges,90% of total billed charges,1441.6,80,,1153.28,percent of total billed charges,80% of total billed charges,1621.8,90,,1297.44,percent of total billed charges,90% of total billed charges,1351.5,75,,1081.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,522.58,29,,418.064,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1207.34,67,,965.872,percent of total billed charges,67% of total billed charges,164.53,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,1441.6,80,,1153.28,percent of total billed charges,80% of total billed charges,1171.3,65,,937.04,percent of total billed charges,65% of total billed charges,642.77,35.67,,514.216,percent of total billed charges,35.67% of total billed charges,164.53,1621.8,
OP VISIT OB EST PT 30 MIN,7600056,CDM,761,RC,99211,HCPCS,outpatient,,,231,92.40,,196.35,85,,157.08,percent of total billed charges,85% of total billed charges,177.87,77,,142.3,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,40.03,429,,,fee schedule,429% of BCBS fee schedule,41.71,447,,,fee schedule,447% of BCBS fee schedule,41.71,447,,,fee schedule,447% of BCBS fee schedule,41.71,447,,,fee schedule,447% of BCBS fee schedule,207.9,90,,166.32,percent of total billed charges,90% of total billed charges,184.8,80,,147.84,percent of total billed charges,80% of total billed charges,207.9,90,,166.32,percent of total billed charges,90% of total billed charges,173.25,75,,138.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,66.99,29,,53.592,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,154.77,67,,123.816,percent of total billed charges,67% of total billed charges,50.14,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,184.8,80,,147.84,percent of total billed charges,80% of total billed charges,150.15,65,,120.12,percent of total billed charges,65% of total billed charges,82.4,35.67,,65.92,percent of total billed charges,35.67% of total billed charges,40.03,207.9,
OP VISIT OB EST PT 1-2 HRS,7600057,CDM,761,RC,99212,HCPCS,outpatient,,,339,135.60,,288.15,85,,230.52,percent of total billed charges,85% of total billed charges,261.03,77,,208.82,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,110.85,429,,,fee schedule,429% of BCBS fee schedule,115.5,447,,,fee schedule,447% of BCBS fee schedule,115.5,447,,,fee schedule,447% of BCBS fee schedule,115.5,447,,,fee schedule,447% of BCBS fee schedule,305.1,90,,244.08,percent of total billed charges,90% of total billed charges,271.2,80,,216.96,percent of total billed charges,80% of total billed charges,305.1,90,,244.08,percent of total billed charges,90% of total billed charges,254.25,75,,203.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,98.31,29,,78.648,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,227.13,67,,181.704,percent of total billed charges,67% of total billed charges,67.2,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,271.2,80,,216.96,percent of total billed charges,80% of total billed charges,220.35,65,,176.28,percent of total billed charges,65% of total billed charges,120.92,35.67,,96.736,percent of total billed charges,35.67% of total billed charges,67.2,305.1,
OP VISIT OP EST PT 2-5 HRS,7600058,CDM,761,RC,99213,HCPCS,outpatient,,,564,225.60,,479.4,85,,383.52,percent of total billed charges,85% of total billed charges,434.28,77,,347.42,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,223.25,429,,,fee schedule,429% of BCBS fee schedule,232.62,447,,,fee schedule,447% of BCBS fee schedule,232.62,447,,,fee schedule,447% of BCBS fee schedule,232.62,447,,,fee schedule,447% of BCBS fee schedule,507.6,90,,406.08,percent of total billed charges,90% of total billed charges,451.2,80,,360.96,percent of total billed charges,80% of total billed charges,507.6,90,,406.08,percent of total billed charges,90% of total billed charges,423,75,,338.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,163.56,29,,130.848,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,377.88,67,,302.304,percent of total billed charges,67% of total billed charges,67.2,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,451.2,80,,360.96,percent of total billed charges,80% of total billed charges,366.6,65,,293.28,percent of total billed charges,65% of total billed charges,201.18,35.67,,160.944,percent of total billed charges,35.67% of total billed charges,67.2,507.6,
OP VISIT OB EST PT 5-7 HRS,7600059,CDM,761,RC,99214,HCPCS,outpatient,,,846,338.40,,719.1,85,,575.28,percent of total billed charges,85% of total billed charges,651.42,77,,521.14,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,341.78,429,,,fee schedule,429% of BCBS fee schedule,356.12,447,,,fee schedule,447% of BCBS fee schedule,356.12,447,,,fee schedule,447% of BCBS fee schedule,356.12,447,,,fee schedule,447% of BCBS fee schedule,761.4,90,,609.12,percent of total billed charges,90% of total billed charges,676.8,80,,541.44,percent of total billed charges,80% of total billed charges,761.4,90,,609.12,percent of total billed charges,90% of total billed charges,634.5,75,,507.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,245.34,29,,196.272,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,566.82,67,,453.456,percent of total billed charges,67% of total billed charges,88.66,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,676.8,80,,541.44,percent of total billed charges,80% of total billed charges,549.9,65,,439.92,percent of total billed charges,65% of total billed charges,301.77,35.67,,241.416,percent of total billed charges,35.67% of total billed charges,88.66,761.4,
OP VISIT OB EST PT OVER 7 HRS,7600062,CDM,761,RC,99215,HCPCS,outpatient,,,1690,676.00,,1436.5,85,,1149.2,percent of total billed charges,85% of total billed charges,1301.3,77,,1041.04,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,483.44,429,,,fee schedule,429% of BCBS fee schedule,503.72,447,,,fee schedule,447% of BCBS fee schedule,503.72,447,,,fee schedule,447% of BCBS fee schedule,503.72,447,,,fee schedule,447% of BCBS fee schedule,1521,90,,1216.8,percent of total billed charges,90% of total billed charges,1352,80,,1081.6,percent of total billed charges,80% of total billed charges,1521,90,,1216.8,percent of total billed charges,90% of total billed charges,1267.5,75,,1014,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,490.1,29,,392.08,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,1132.3,67,,905.84,percent of total billed charges,67% of total billed charges,121.56,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,1352,80,,1081.6,percent of total billed charges,80% of total billed charges,1098.5,65,,878.8,percent of total billed charges,65% of total billed charges,602.82,35.67,,482.256,percent of total billed charges,35.67% of total billed charges,121.56,1521,
INSERTION/TEMP URINE CATH,7610010,CDM,761,RC,51702,HCPCS,outpatient,,,286,114.40,,1150,,,,case rate,pays based on per visit,220.22,77,,176.18,percent of total billed charges,77% of total billed charges,111.71,100,,,fee schedule,100% of CMS OPPS rate,234.52,82,,187.616,percent of total billed charges,82% of total billed charges,243.1,85,,194.48,percent of total billed charges,85% of total billed charges,243.1,85,,194.48,percent of total billed charges,85% of total billed charges,243.1,85,,194.48,percent of total billed charges,85% of total billed charges,257.4,90,,205.92,percent of total billed charges,90% of total billed charges,228.8,80,,183.04,percent of total billed charges,80% of total billed charges,257.4,90,,205.92,percent of total billed charges,90% of total billed charges,214.5,75,,171.6,percent of total billed charges,75% of total billed charges,136.28,122,,,fee schedule,122% of APC rate,82.94,29,,66.352,percent of total billed charges,29% of total billed charges,111.71,100,,,fee schedule,100% of CMS OPPS rate,191.62,67,,153.296,percent of total billed charges,67% of total billed charges,42.55,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,228.8,80,,183.04,percent of total billed charges,80% of total billed charges,185.9,65,,148.72,percent of total billed charges,65% of total billed charges,102.02,35.67,,81.616,percent of total billed charges,35.67% of total billed charges,42.55,1150,
INSERT STRAIGHT UA CATH SPEC,7610015,CDM,761,RC,P9612,HCPCS,outpatient,,,160,64.00,,136,85,,108.8,percent of total billed charges,85% of total billed charges,123.2,77,,98.56,percent of total billed charges,77% of total billed charges,8.83,100,,,fee schedule,100% of CMS fee schedule,131.2,82,,104.96,percent of total billed charges,82% of total billed charges,136,85,,108.8,percent of total billed charges,85% of total billed charges,136,85,,108.8,percent of total billed charges,85% of total billed charges,136,85,,108.8,percent of total billed charges,85% of total billed charges,144,90,,115.2,percent of total billed charges,90% of total billed charges,128,80,,102.4,percent of total billed charges,80% of total billed charges,144,90,,115.2,percent of total billed charges,90% of total billed charges,120,75,,96,percent of total billed charges,75% of total billed charges,10.77,122,,,fee schedule,122% of APC rate,46.4,29,,37.12,percent of total billed charges,29% of total billed charges,8.83,100,,,fee schedule,100% of CMS fee schedule,107.2,67,,85.76,percent of total billed charges,67% of total billed charges,3.15,105,,,fee schedule,105% of CMS fee schedule,,,,,other,not seperately reimbursable,128,80,,102.4,percent of total billed charges,80% of total billed charges,104,65,,83.2,percent of total billed charges,65% of total billed charges,57.07,35.67,,45.656,percent of total billed charges,35.67% of total billed charges,3.15,144,
INSERT TEMP INDWELL CATH-COMPL,7610025,CDM,761,RC,51703,HCPCS,outpatient,,,287,114.80,,1150,,,,case rate,pays based on per visit,220.99,77,,176.79,percent of total billed charges,77% of total billed charges,136.6,100,,,fee schedule,100% of CMS OPPS rate,235.34,82,,188.272,percent of total billed charges,82% of total billed charges,243.95,85,,195.16,percent of total billed charges,85% of total billed charges,243.95,85,,195.16,percent of total billed charges,85% of total billed charges,243.95,85,,195.16,percent of total billed charges,85% of total billed charges,258.3,90,,206.64,percent of total billed charges,90% of total billed charges,229.6,80,,183.68,percent of total billed charges,80% of total billed charges,258.3,90,,206.64,percent of total billed charges,90% of total billed charges,215.25,75,,172.2,percent of total billed charges,75% of total billed charges,166.65,122,,,fee schedule,122% of APC rate,57.79,100,,,fee schedule,100% of ASC tier grouping rate,136.6,100,,,fee schedule,100% of CMS OPPS rate,192.29,67,,153.832,percent of total billed charges,67% of total billed charges,72.31,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,229.6,80,,183.68,percent of total billed charges,80% of total billed charges,186.55,65,,149.24,percent of total billed charges,65% of total billed charges,71.08,123,,,fee schedule,123% of ASC tier grouping rate,57.79,1150,
"THORACENTESIS, INITIAL",7610030,CDM,761,RC,32554,HCPCS,outpatient,,,812,324.80,,1150,,,,case rate,pays based on per visit,625.24,77,,500.19,percent of total billed charges,77% of total billed charges,549.37,100,,,fee schedule,100% of CMS OPPS rate,665.84,82,,532.672,percent of total billed charges,82% of total billed charges,690.2,85,,552.16,percent of total billed charges,85% of total billed charges,690.2,85,,552.16,percent of total billed charges,85% of total billed charges,690.2,85,,552.16,percent of total billed charges,85% of total billed charges,730.8,90,,584.64,percent of total billed charges,90% of total billed charges,649.6,80,,519.68,percent of total billed charges,80% of total billed charges,730.8,90,,584.64,percent of total billed charges,90% of total billed charges,609,75,,487.2,percent of total billed charges,75% of total billed charges,670.25,122,,,fee schedule,122% of APC rate,223.75,100,,,fee schedule,100% of ASC tier grouping rate,549.37,100,,,fee schedule,100% of CMS OPPS rate,544.04,67,,435.232,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,649.6,80,,519.68,percent of total billed charges,80% of total billed charges,527.8,65,,422.24,percent of total billed charges,65% of total billed charges,275.21,123,,,fee schedule,123% of ASC tier grouping rate,223.75,1150,
THORACENTESIS W/ TUBE INSERTIO,7610035,CDM,761,RC,,,outpatient,,,895,358.00,,760.75,85,,608.6,percent of total billed charges,85% of total billed charges,689.15,77,,551.32,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,733.9,82,,587.12,percent of total billed charges,82% of total billed charges,760.75,85,,608.6,percent of total billed charges,85% of total billed charges,760.75,85,,608.6,percent of total billed charges,85% of total billed charges,760.75,85,,608.6,percent of total billed charges,85% of total billed charges,805.5,90,,644.4,percent of total billed charges,90% of total billed charges,716,80,,572.8,percent of total billed charges,80% of total billed charges,805.5,90,,644.4,percent of total billed charges,90% of total billed charges,671.25,75,,537,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,259.55,29,,207.64,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,599.65,67,,479.72,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,716,80,,572.8,percent of total billed charges,80% of total billed charges,581.75,65,,465.4,percent of total billed charges,65% of total billed charges,319.25,35.67,,255.4,percent of total billed charges,35.67% of total billed charges,259.55,805.5,
"PARACENTESIS, INITIAL",7610040,CDM,761,RC,49082,HCPCS,outpatient,,,879,351.60,,1150,,,,case rate,pays based on per visit,676.83,77,,541.46,percent of total billed charges,77% of total billed charges,792.74,100,,,fee schedule,100% of CMS OPPS rate,720.78,82,,576.624,percent of total billed charges,82% of total billed charges,747.15,85,,597.72,percent of total billed charges,85% of total billed charges,747.15,85,,597.72,percent of total billed charges,85% of total billed charges,747.15,85,,597.72,percent of total billed charges,85% of total billed charges,791.1,90,,632.88,percent of total billed charges,90% of total billed charges,703.2,80,,562.56,percent of total billed charges,80% of total billed charges,791.1,90,,632.88,percent of total billed charges,90% of total billed charges,659.25,75,,527.4,percent of total billed charges,75% of total billed charges,967.14,122,,,fee schedule,122% of APC rate,334.95,100,,,fee schedule,100% of ASC tier grouping rate,792.74,100,,,fee schedule,100% of CMS OPPS rate,588.93,67,,471.144,percent of total billed charges,67% of total billed charges,359.17,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,703.2,80,,562.56,percent of total billed charges,80% of total billed charges,571.35,65,,457.08,percent of total billed charges,65% of total billed charges,411.99,123,,,fee schedule,123% of ASC tier grouping rate,334.95,1150,
SPINAL TAP - OUTPT,7610050,CDM,761,RC,,,outpatient,,,799,319.60,,679.15,85,,543.32,percent of total billed charges,85% of total billed charges,615.23,77,,492.18,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,655.18,82,,524.144,percent of total billed charges,82% of total billed charges,679.15,85,,543.32,percent of total billed charges,85% of total billed charges,679.15,85,,543.32,percent of total billed charges,85% of total billed charges,679.15,85,,543.32,percent of total billed charges,85% of total billed charges,719.1,90,,575.28,percent of total billed charges,90% of total billed charges,639.2,80,,511.36,percent of total billed charges,80% of total billed charges,719.1,90,,575.28,percent of total billed charges,90% of total billed charges,599.25,75,,479.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,231.71,29,,185.368,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,535.33,67,,428.264,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,639.2,80,,511.36,percent of total billed charges,80% of total billed charges,519.35,65,,415.48,percent of total billed charges,65% of total billed charges,285,35.67,,228,percent of total billed charges,35.67% of total billed charges,231.71,719.1,
PROCEDURE - MED SURG,7610055,CDM,761,RC,,,outpatient,,,186,74.40,,158.1,85,,126.48,percent of total billed charges,85% of total billed charges,143.22,77,,114.58,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,152.52,82,,122.016,percent of total billed charges,82% of total billed charges,158.1,85,,126.48,percent of total billed charges,85% of total billed charges,158.1,85,,126.48,percent of total billed charges,85% of total billed charges,158.1,85,,126.48,percent of total billed charges,85% of total billed charges,167.4,90,,133.92,percent of total billed charges,90% of total billed charges,148.8,80,,119.04,percent of total billed charges,80% of total billed charges,167.4,90,,133.92,percent of total billed charges,90% of total billed charges,139.5,75,,111.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,53.94,29,,43.152,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,124.62,67,,99.696,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,148.8,80,,119.04,percent of total billed charges,80% of total billed charges,120.9,65,,96.72,percent of total billed charges,65% of total billed charges,66.35,35.67,,53.08,percent of total billed charges,35.67% of total billed charges,53.94,167.4,
OBSERVATION PER HR,7600025,CDM,762,RC,G0378,HCPCS,outpatient,,,147,58.80,,124.95,85,,99.96,percent of total billed charges,85% of total billed charges,113.19,77,,90.55,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,543.5,429,,,fee schedule,429% of BCBS fee schedule,566.3,447,,,fee schedule,447% of BCBS fee schedule,566.3,447,,,fee schedule,447% of BCBS fee schedule,566.3,447,,,fee schedule,447% of BCBS fee schedule,132.3,90,,105.84,percent of total billed charges,90% of total billed charges,117.6,80,,94.08,percent of total billed charges,80% of total billed charges,132.3,90,,105.84,percent of total billed charges,90% of total billed charges,110.25,75,,88.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,42.63,29,,34.104,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,98.49,67,,78.792,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,117.6,80,,94.08,percent of total billed charges,80% of total billed charges,95.55,65,,76.44,percent of total billed charges,65% of total billed charges,52.43,35.67,,41.944,percent of total billed charges,35.67% of total billed charges,42.63,566.3,
OBSERVATION ROOM 1ST HOUR (REG,7600060,CDM,762,RC,G0378,HCPCS,outpatient,,,193,77.20,,164.05,85,,131.24,percent of total billed charges,85% of total billed charges,148.61,77,,118.89,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,543.5,429,,,fee schedule,429% of BCBS fee schedule,566.3,447,,,fee schedule,447% of BCBS fee schedule,566.3,447,,,fee schedule,447% of BCBS fee schedule,566.3,447,,,fee schedule,447% of BCBS fee schedule,173.7,90,,138.96,percent of total billed charges,90% of total billed charges,154.4,80,,123.52,percent of total billed charges,80% of total billed charges,173.7,90,,138.96,percent of total billed charges,90% of total billed charges,144.75,75,,115.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,55.97,29,,44.776,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,129.31,67,,103.448,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,154.4,80,,123.52,percent of total billed charges,80% of total billed charges,125.45,65,,100.36,percent of total billed charges,65% of total billed charges,68.84,35.67,,55.072,percent of total billed charges,35.67% of total billed charges,55.97,566.3,
DIRECT ADMIT TO OBSERVATION,76200060,CDM,762,RC,G0379,HCPCS,outpatient,,,659,263.60,,560.15,85,,448.12,percent of total billed charges,85% of total billed charges,507.43,77,,405.94,percent of total billed charges,77% of total billed charges,561.72,100,,,fee schedule,100% of CMS OPPS rate,543.5,429,,,fee schedule,429% of BCBS fee schedule,566.3,447,,,fee schedule,447% of BCBS fee schedule,566.3,447,,,fee schedule,447% of BCBS fee schedule,566.3,447,,,fee schedule,447% of BCBS fee schedule,593.1,90,,474.48,percent of total billed charges,90% of total billed charges,527.2,80,,421.76,percent of total billed charges,80% of total billed charges,593.1,90,,474.48,percent of total billed charges,90% of total billed charges,494.25,75,,395.4,percent of total billed charges,75% of total billed charges,685.29,122,,,fee schedule,122% of APC rate,191.11,29,,152.888,percent of total billed charges,29% of total billed charges,561.72,100,,,fee schedule,100% of CMS OPPS rate,441.53,67,,353.224,percent of total billed charges,67% of total billed charges,50.14,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,527.2,80,,421.76,percent of total billed charges,80% of total billed charges,428.35,65,,342.68,percent of total billed charges,65% of total billed charges,235.07,35.67,,188.056,percent of total billed charges,35.67% of total billed charges,50.14,685.29,
CASIRIVIMAB-IMDEVIMAB ADMIN,2501722,CDM,771,RC,M0240,HCPCS,outpatient,,,890,356.00,,756.5,85,,605.2,percent of total billed charges,85% of total billed charges,685.3,77,,548.24,percent of total billed charges,77% of total billed charges,413.49,100,,,fee schedule,100% of CMS OPPS rate,1930.5,429,,,fee schedule,429% of BCBS fee schedule,2011.5,447,,,fee schedule,447% of BCBS fee schedule,2011.5,447,,,fee schedule,447% of BCBS fee schedule,2011.5,447,,,fee schedule,447% of BCBS fee schedule,801,90,,640.8,percent of total billed charges,90% of total billed charges,712,80,,569.6,percent of total billed charges,80% of total billed charges,801,90,,640.8,percent of total billed charges,90% of total billed charges,667.5,75,,534,percent of total billed charges,75% of total billed charges,504.46,122,,,fee schedule,122% of APC rate,258.1,29,,206.48,percent of total billed charges,29% of total billed charges,413.49,100,,,fee schedule,100% of CMS OPPS rate,596.3,67,,477.04,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,712,80,,569.6,percent of total billed charges,80% of total billed charges,578.5,65,,462.8,percent of total billed charges,65% of total billed charges,317.46,35.67,,253.968,percent of total billed charges,35.67% of total billed charges,258.1,2011.5,
IMDEVIMAB ADMIN INFUSION,2504817,CDM,771,RC,M0243,HCPCS,outpatient,,,873,349.20,,742.05,85,,593.64,percent of total billed charges,85% of total billed charges,672.21,77,,537.77,percent of total billed charges,77% of total billed charges,413.49,100,,,fee schedule,100% of CMS OPPS rate,1930.5,429,,,fee schedule,429% of BCBS fee schedule,2011.5,447,,,fee schedule,447% of BCBS fee schedule,2011.5,447,,,fee schedule,447% of BCBS fee schedule,2011.5,447,,,fee schedule,447% of BCBS fee schedule,785.7,90,,628.56,percent of total billed charges,90% of total billed charges,698.4,80,,558.72,percent of total billed charges,80% of total billed charges,785.7,90,,628.56,percent of total billed charges,90% of total billed charges,654.75,75,,523.8,percent of total billed charges,75% of total billed charges,504.46,122,,,fee schedule,122% of APC rate,253.17,29,,202.536,percent of total billed charges,29% of total billed charges,413.49,100,,,fee schedule,100% of CMS OPPS rate,584.91,67,,467.928,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,698.4,80,,558.72,percent of total billed charges,80% of total billed charges,567.45,65,,453.96,percent of total billed charges,65% of total billed charges,311.4,35.67,,249.12,percent of total billed charges,35.67% of total billed charges,253.17,2011.5,
JANSSEN J&J BOOSTER ADMIN FEE,2505122,CDM,771,RC,0034A,HCPCS,outpatient,,,48,19.20,,40.8,85,,32.64,percent of total billed charges,85% of total billed charges,36.96,77,,29.57,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,171.6,429,,,fee schedule,429% of BCBS fee schedule,178.8,447,,,fee schedule,447% of BCBS fee schedule,178.8,447,,,fee schedule,447% of BCBS fee schedule,178.8,447,,,fee schedule,447% of BCBS fee schedule,43.2,90,,34.56,percent of total billed charges,90% of total billed charges,38.4,80,,30.72,percent of total billed charges,80% of total billed charges,43.2,90,,34.56,percent of total billed charges,90% of total billed charges,36,75,,28.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,13.92,29,,11.136,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,32.16,67,,25.728,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,38.4,80,,30.72,percent of total billed charges,80% of total billed charges,31.2,65,,24.96,percent of total billed charges,65% of total billed charges,17.12,35.67,,13.696,percent of total billed charges,35.67% of total billed charges,13.92,178.8,
MODERNA COVID VACCINE ADMIN #1,2506429,CDM,771,RC,0011A,HCPCS,outpatient,,,48,19.20,,40.8,85,,32.64,percent of total billed charges,85% of total billed charges,36.96,77,,29.57,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,171.6,429,,,fee schedule,429% of BCBS fee schedule,178.8,447,,,fee schedule,447% of BCBS fee schedule,178.8,447,,,fee schedule,447% of BCBS fee schedule,178.8,447,,,fee schedule,447% of BCBS fee schedule,43.2,90,,34.56,percent of total billed charges,90% of total billed charges,38.4,80,,30.72,percent of total billed charges,80% of total billed charges,43.2,90,,34.56,percent of total billed charges,90% of total billed charges,36,75,,28.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,13.92,29,,11.136,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,32.16,67,,25.728,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,38.4,80,,30.72,percent of total billed charges,80% of total billed charges,31.2,65,,24.96,percent of total billed charges,65% of total billed charges,17.12,35.67,,13.696,percent of total billed charges,35.67% of total billed charges,13.92,178.8,
MODERNA COVID VACCINE ADMIN #2,2506431,CDM,771,RC,0012A,HCPCS,outpatient,,,48,19.20,,40.8,85,,32.64,percent of total billed charges,85% of total billed charges,36.96,77,,29.57,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,171.6,429,,,fee schedule,429% of BCBS fee schedule,178.8,447,,,fee schedule,447% of BCBS fee schedule,178.8,447,,,fee schedule,447% of BCBS fee schedule,178.8,447,,,fee schedule,447% of BCBS fee schedule,43.2,90,,34.56,percent of total billed charges,90% of total billed charges,38.4,80,,30.72,percent of total billed charges,80% of total billed charges,43.2,90,,34.56,percent of total billed charges,90% of total billed charges,36,75,,28.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,13.92,29,,11.136,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,32.16,67,,25.728,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,38.4,80,,30.72,percent of total billed charges,80% of total billed charges,31.2,65,,24.96,percent of total billed charges,65% of total billed charges,17.12,35.67,,13.696,percent of total billed charges,35.67% of total billed charges,13.92,178.8,
MODERNA PEDIATRIC COVID ADM 1,2506435,CDM,771,RC,,,outpatient,,,48,19.20,,40.8,85,,32.64,percent of total billed charges,85% of total billed charges,36.96,77,,29.57,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,39.36,82,,31.488,percent of total billed charges,82% of total billed charges,40.8,85,,32.64,percent of total billed charges,85% of total billed charges,40.8,85,,32.64,percent of total billed charges,85% of total billed charges,40.8,85,,32.64,percent of total billed charges,85% of total billed charges,43.2,90,,34.56,percent of total billed charges,90% of total billed charges,38.4,80,,30.72,percent of total billed charges,80% of total billed charges,43.2,90,,34.56,percent of total billed charges,90% of total billed charges,36,75,,28.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,13.92,29,,11.136,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,32.16,67,,25.728,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,38.4,80,,30.72,percent of total billed charges,80% of total billed charges,31.2,65,,24.96,percent of total billed charges,65% of total billed charges,17.12,35.67,,13.696,percent of total billed charges,35.67% of total billed charges,13.92,43.2,
MODERNA COVID VACC ADMIN 3,2506442,CDM,771,RC,0013A,HCPCS,outpatient,,,48,19.20,,40.8,85,,32.64,percent of total billed charges,85% of total billed charges,36.96,77,,29.57,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,171.6,429,,,fee schedule,429% of BCBS fee schedule,178.8,447,,,fee schedule,447% of BCBS fee schedule,178.8,447,,,fee schedule,447% of BCBS fee schedule,178.8,447,,,fee schedule,447% of BCBS fee schedule,43.2,90,,34.56,percent of total billed charges,90% of total billed charges,38.4,80,,30.72,percent of total billed charges,80% of total billed charges,43.2,90,,34.56,percent of total billed charges,90% of total billed charges,36,75,,28.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,13.92,29,,11.136,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,32.16,67,,25.728,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,38.4,80,,30.72,percent of total billed charges,80% of total billed charges,31.2,65,,24.96,percent of total billed charges,65% of total billed charges,17.12,35.67,,13.696,percent of total billed charges,35.67% of total billed charges,13.92,178.8,
MODERNA COVID VACC BOOSTER,2506446,CDM,771,RC,0064A,HCPCS,outpatient,,,48,19.20,,40.8,85,,32.64,percent of total billed charges,85% of total billed charges,36.96,77,,29.57,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,171.6,429,,,fee schedule,429% of BCBS fee schedule,178.8,447,,,fee schedule,447% of BCBS fee schedule,178.8,447,,,fee schedule,447% of BCBS fee schedule,178.8,447,,,fee schedule,447% of BCBS fee schedule,43.2,90,,34.56,percent of total billed charges,90% of total billed charges,38.4,80,,30.72,percent of total billed charges,80% of total billed charges,43.2,90,,34.56,percent of total billed charges,90% of total billed charges,36,75,,28.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,13.92,29,,11.136,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,32.16,67,,25.728,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,38.4,80,,30.72,percent of total billed charges,80% of total billed charges,31.2,65,,24.96,percent of total billed charges,65% of total billed charges,17.12,35.67,,13.696,percent of total billed charges,35.67% of total billed charges,13.92,178.8,
MODERNA BIVALENT ADMIN,2506501,CDM,771,RC,0134A,HCPCS,outpatient,,,48,19.20,,40.8,85,,32.64,percent of total billed charges,85% of total billed charges,36.96,77,,29.57,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,171.6,429,,,fee schedule,429% of BCBS fee schedule,178.8,447,,,fee schedule,447% of BCBS fee schedule,178.8,447,,,fee schedule,447% of BCBS fee schedule,178.8,447,,,fee schedule,447% of BCBS fee schedule,43.2,90,,34.56,percent of total billed charges,90% of total billed charges,38.4,80,,30.72,percent of total billed charges,80% of total billed charges,43.2,90,,34.56,percent of total billed charges,90% of total billed charges,36,75,,28.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,13.92,29,,11.136,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,32.16,67,,25.728,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,38.4,80,,30.72,percent of total billed charges,80% of total billed charges,31.2,65,,24.96,percent of total billed charges,65% of total billed charges,17.12,35.67,,13.696,percent of total billed charges,35.67% of total billed charges,13.92,178.8,
PFIZER COVID VACCINE ADMIN #1,2507782,CDM,771,RC,0001A,HCPCS,outpatient,,,48,19.20,,40.8,85,,32.64,percent of total billed charges,85% of total billed charges,36.96,77,,29.57,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,171.6,429,,,fee schedule,429% of BCBS fee schedule,178.8,447,,,fee schedule,447% of BCBS fee schedule,178.8,447,,,fee schedule,447% of BCBS fee schedule,178.8,447,,,fee schedule,447% of BCBS fee schedule,43.2,90,,34.56,percent of total billed charges,90% of total billed charges,38.4,80,,30.72,percent of total billed charges,80% of total billed charges,43.2,90,,34.56,percent of total billed charges,90% of total billed charges,36,75,,28.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,13.92,29,,11.136,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,32.16,67,,25.728,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,38.4,80,,30.72,percent of total billed charges,80% of total billed charges,31.2,65,,24.96,percent of total billed charges,65% of total billed charges,17.12,35.67,,13.696,percent of total billed charges,35.67% of total billed charges,13.92,178.8,
PFIZER COVID VACCINE ADMIN #2,2507783,CDM,771,RC,0002A,HCPCS,outpatient,,,48,19.20,,40.8,85,,32.64,percent of total billed charges,85% of total billed charges,36.96,77,,29.57,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,171.6,429,,,fee schedule,429% of BCBS fee schedule,178.8,447,,,fee schedule,447% of BCBS fee schedule,178.8,447,,,fee schedule,447% of BCBS fee schedule,178.8,447,,,fee schedule,447% of BCBS fee schedule,43.2,90,,34.56,percent of total billed charges,90% of total billed charges,38.4,80,,30.72,percent of total billed charges,80% of total billed charges,43.2,90,,34.56,percent of total billed charges,90% of total billed charges,36,75,,28.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,13.92,29,,11.136,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,32.16,67,,25.728,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,38.4,80,,30.72,percent of total billed charges,80% of total billed charges,31.2,65,,24.96,percent of total billed charges,65% of total billed charges,17.12,35.67,,13.696,percent of total billed charges,35.67% of total billed charges,13.92,178.8,
PFIZER COVID VACC ADMIN 3 BOOS,2507784,CDM,771,RC,0003A,HCPCS,outpatient,,,48,19.20,,40.8,85,,32.64,percent of total billed charges,85% of total billed charges,36.96,77,,29.57,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,171.6,429,,,fee schedule,429% of BCBS fee schedule,178.8,447,,,fee schedule,447% of BCBS fee schedule,178.8,447,,,fee schedule,447% of BCBS fee schedule,178.8,447,,,fee schedule,447% of BCBS fee schedule,43.2,90,,34.56,percent of total billed charges,90% of total billed charges,38.4,80,,30.72,percent of total billed charges,80% of total billed charges,43.2,90,,34.56,percent of total billed charges,90% of total billed charges,36,75,,28.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,13.92,29,,11.136,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,32.16,67,,25.728,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,38.4,80,,30.72,percent of total billed charges,80% of total billed charges,31.2,65,,24.96,percent of total billed charges,65% of total billed charges,17.12,35.67,,13.696,percent of total billed charges,35.67% of total billed charges,13.92,178.8,
PFIZER PEDIATRIC COVID ADM 1,2507789,CDM,771,RC,0071A,HCPCS,outpatient,,,48,19.20,,40.8,85,,32.64,percent of total billed charges,85% of total billed charges,36.96,77,,29.57,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,171.6,429,,,fee schedule,429% of BCBS fee schedule,178.8,447,,,fee schedule,447% of BCBS fee schedule,178.8,447,,,fee schedule,447% of BCBS fee schedule,178.8,447,,,fee schedule,447% of BCBS fee schedule,43.2,90,,34.56,percent of total billed charges,90% of total billed charges,38.4,80,,30.72,percent of total billed charges,80% of total billed charges,43.2,90,,34.56,percent of total billed charges,90% of total billed charges,36,75,,28.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,13.92,29,,11.136,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,32.16,67,,25.728,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,38.4,80,,30.72,percent of total billed charges,80% of total billed charges,31.2,65,,24.96,percent of total billed charges,65% of total billed charges,17.12,35.67,,13.696,percent of total billed charges,35.67% of total billed charges,13.92,178.8,
PFIZER PEDIATRIC COVID ADM 2,2507791,CDM,771,RC,0072A,HCPCS,outpatient,,,48,19.20,,40.8,85,,32.64,percent of total billed charges,85% of total billed charges,36.96,77,,29.57,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,171.6,429,,,fee schedule,429% of BCBS fee schedule,178.8,447,,,fee schedule,447% of BCBS fee schedule,178.8,447,,,fee schedule,447% of BCBS fee schedule,178.8,447,,,fee schedule,447% of BCBS fee schedule,43.2,90,,34.56,percent of total billed charges,90% of total billed charges,38.4,80,,30.72,percent of total billed charges,80% of total billed charges,43.2,90,,34.56,percent of total billed charges,90% of total billed charges,36,75,,28.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,13.92,29,,11.136,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,32.16,67,,25.728,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,38.4,80,,30.72,percent of total billed charges,80% of total billed charges,31.2,65,,24.96,percent of total billed charges,65% of total billed charges,17.12,35.67,,13.696,percent of total billed charges,35.67% of total billed charges,13.92,178.8,
FLU VACCINE ADMINISTRATION,2600011,CDM,771,RC,G0008,HCPCS,outpatient,,,90,36.00,,76.5,85,,61.2,percent of total billed charges,85% of total billed charges,69.3,77,,55.44,percent of total billed charges,77% of total billed charges,41.54,100,,,fee schedule,100% of CMS OPPS rate,101.63,429,,,fee schedule,429% of BCBS fee schedule,105.89,447,,,fee schedule,447% of BCBS fee schedule,105.89,447,,,fee schedule,447% of BCBS fee schedule,105.89,447,,,fee schedule,447% of BCBS fee schedule,81,90,,64.8,percent of total billed charges,90% of total billed charges,72,80,,57.6,percent of total billed charges,80% of total billed charges,81,90,,64.8,percent of total billed charges,90% of total billed charges,67.5,75,,54,percent of total billed charges,75% of total billed charges,50.67,122,,,fee schedule,122% of APC rate,26.1,29,,20.88,percent of total billed charges,29% of total billed charges,41.54,100,,,fee schedule,100% of CMS OPPS rate,60.3,67,,48.24,percent of total billed charges,67% of total billed charges,23.12,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,72,80,,57.6,percent of total billed charges,80% of total billed charges,58.5,65,,46.8,percent of total billed charges,65% of total billed charges,32.1,35.67,,25.68,percent of total billed charges,35.67% of total billed charges,23.12,105.89,
BAMLANIVIMAB INFUSION,2600198,CDM,771,RC,M0245,HCPCS,outpatient,,,864,345.60,,734.4,85,,587.52,percent of total billed charges,85% of total billed charges,665.28,77,,532.22,percent of total billed charges,77% of total billed charges,413.49,100,,,fee schedule,100% of CMS OPPS rate,1930.5,429,,,fee schedule,429% of BCBS fee schedule,2011.5,447,,,fee schedule,447% of BCBS fee schedule,2011.5,447,,,fee schedule,447% of BCBS fee schedule,2011.5,447,,,fee schedule,447% of BCBS fee schedule,777.6,90,,622.08,percent of total billed charges,90% of total billed charges,691.2,80,,552.96,percent of total billed charges,80% of total billed charges,777.6,90,,622.08,percent of total billed charges,90% of total billed charges,648,75,,518.4,percent of total billed charges,75% of total billed charges,504.46,122,,,fee schedule,122% of APC rate,250.56,29,,200.448,percent of total billed charges,29% of total billed charges,413.49,100,,,fee schedule,100% of CMS OPPS rate,578.88,67,,463.104,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,691.2,80,,552.96,percent of total billed charges,80% of total billed charges,561.6,65,,449.28,percent of total billed charges,65% of total billed charges,308.19,35.67,,246.552,percent of total billed charges,35.67% of total billed charges,250.56,2011.5,
INJECTION OF VACCINE OUTPT,2600205,CDM,771,RC,90471,HCPCS,outpatient,,,205,82.00,,174.25,85,,139.4,percent of total billed charges,85% of total billed charges,157.85,77,,126.28,percent of total billed charges,77% of total billed charges,61.6,100,,,fee schedule,100% of CMS OPPS rate,249.68,429,,,fee schedule,429% of BCBS fee schedule,260.15,447,,,fee schedule,447% of BCBS fee schedule,260.15,447,,,fee schedule,447% of BCBS fee schedule,260.15,447,,,fee schedule,447% of BCBS fee schedule,184.5,90,,147.6,percent of total billed charges,90% of total billed charges,164,80,,131.2,percent of total billed charges,80% of total billed charges,184.5,90,,147.6,percent of total billed charges,90% of total billed charges,153.75,75,,123,percent of total billed charges,75% of total billed charges,75.16,122,,,fee schedule,122% of APC rate,59.45,29,,47.56,percent of total billed charges,29% of total billed charges,61.6,100,,,fee schedule,100% of CMS OPPS rate,137.35,67,,109.88,percent of total billed charges,67% of total billed charges,32.45,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,164,80,,131.2,percent of total billed charges,80% of total billed charges,133.25,65,,106.6,percent of total billed charges,65% of total billed charges,73.12,35.67,,58.496,percent of total billed charges,35.67% of total billed charges,32.45,260.15,
INJECTION - FLU SHOT M/S,2600207,CDM,771,RC,G0008,HCPCS,outpatient,,,90,36.00,,76.5,85,,61.2,percent of total billed charges,85% of total billed charges,69.3,77,,55.44,percent of total billed charges,77% of total billed charges,41.54,100,,,fee schedule,100% of CMS OPPS rate,101.63,429,,,fee schedule,429% of BCBS fee schedule,105.89,447,,,fee schedule,447% of BCBS fee schedule,105.89,447,,,fee schedule,447% of BCBS fee schedule,105.89,447,,,fee schedule,447% of BCBS fee schedule,81,90,,64.8,percent of total billed charges,90% of total billed charges,72,80,,57.6,percent of total billed charges,80% of total billed charges,81,90,,64.8,percent of total billed charges,90% of total billed charges,67.5,75,,54,percent of total billed charges,75% of total billed charges,50.67,122,,,fee schedule,122% of APC rate,26.1,29,,20.88,percent of total billed charges,29% of total billed charges,41.54,100,,,fee schedule,100% of CMS OPPS rate,60.3,67,,48.24,percent of total billed charges,67% of total billed charges,23.12,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,72,80,,57.6,percent of total billed charges,80% of total billed charges,58.5,65,,46.8,percent of total billed charges,65% of total billed charges,32.1,35.67,,25.68,percent of total billed charges,35.67% of total billed charges,23.12,105.89,
INJECTION-VACCINE EA ADD'L,2600214,CDM,771,RC,90472,HCPCS,outpatient,,,63,25.20,,53.55,85,,42.84,percent of total billed charges,85% of total billed charges,48.51,77,,38.81,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,55.43,429,,,fee schedule,429% of BCBS fee schedule,57.75,447,,,fee schedule,447% of BCBS fee schedule,57.75,447,,,fee schedule,447% of BCBS fee schedule,57.75,447,,,fee schedule,447% of BCBS fee schedule,56.7,90,,45.36,percent of total billed charges,90% of total billed charges,50.4,80,,40.32,percent of total billed charges,80% of total billed charges,56.7,90,,45.36,percent of total billed charges,90% of total billed charges,47.25,75,,37.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,18.27,29,,14.616,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,42.21,67,,33.768,percent of total billed charges,67% of total billed charges,23.12,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,50.4,80,,40.32,percent of total billed charges,80% of total billed charges,40.95,65,,32.76,percent of total billed charges,65% of total billed charges,22.47,35.67,,17.976,percent of total billed charges,35.67% of total billed charges,18.27,57.75,
INJECTION VACCINE - INSURANCE,2600242,CDM,771,RC,90471,HCPCS,outpatient,,,205,82.00,,174.25,85,,139.4,percent of total billed charges,85% of total billed charges,157.85,77,,126.28,percent of total billed charges,77% of total billed charges,61.6,100,,,fee schedule,100% of CMS OPPS rate,249.68,429,,,fee schedule,429% of BCBS fee schedule,260.15,447,,,fee schedule,447% of BCBS fee schedule,260.15,447,,,fee schedule,447% of BCBS fee schedule,260.15,447,,,fee schedule,447% of BCBS fee schedule,184.5,90,,147.6,percent of total billed charges,90% of total billed charges,164,80,,131.2,percent of total billed charges,80% of total billed charges,184.5,90,,147.6,percent of total billed charges,90% of total billed charges,153.75,75,,123,percent of total billed charges,75% of total billed charges,75.16,122,,,fee schedule,122% of APC rate,59.45,29,,47.56,percent of total billed charges,29% of total billed charges,61.6,100,,,fee schedule,100% of CMS OPPS rate,137.35,67,,109.88,percent of total billed charges,67% of total billed charges,32.45,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,164,80,,131.2,percent of total billed charges,80% of total billed charges,133.25,65,,106.6,percent of total billed charges,65% of total billed charges,73.12,35.67,,58.496,percent of total billed charges,35.67% of total billed charges,32.45,260.15,
INJECTION OF PNEUMONIA VACCINE,2600265,CDM,771,RC,G0009,HCPCS,outpatient,,,195,78.00,,165.75,85,,132.6,percent of total billed charges,85% of total billed charges,150.15,77,,120.12,percent of total billed charges,77% of total billed charges,41.54,100,,,fee schedule,100% of CMS OPPS rate,204.76,429,,,fee schedule,429% of BCBS fee schedule,213.35,447,,,fee schedule,447% of BCBS fee schedule,213.35,447,,,fee schedule,447% of BCBS fee schedule,213.35,447,,,fee schedule,447% of BCBS fee schedule,175.5,90,,140.4,percent of total billed charges,90% of total billed charges,156,80,,124.8,percent of total billed charges,80% of total billed charges,175.5,90,,140.4,percent of total billed charges,90% of total billed charges,146.25,75,,117,percent of total billed charges,75% of total billed charges,50.67,122,,,fee schedule,122% of APC rate,56.55,29,,45.24,percent of total billed charges,29% of total billed charges,41.54,100,,,fee schedule,100% of CMS OPPS rate,130.65,67,,104.52,percent of total billed charges,67% of total billed charges,23.12,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,156,80,,124.8,percent of total billed charges,80% of total billed charges,126.75,65,,101.4,percent of total billed charges,65% of total billed charges,69.56,35.67,,55.648,percent of total billed charges,35.67% of total billed charges,23.12,213.35,
INJECTION OF VACCINE OP,2650205,CDM,771,RC,90471,HCPCS,outpatient,,,205,82.00,,174.25,85,,139.4,percent of total billed charges,85% of total billed charges,157.85,77,,126.28,percent of total billed charges,77% of total billed charges,61.6,100,,,fee schedule,100% of CMS OPPS rate,249.68,429,,,fee schedule,429% of BCBS fee schedule,260.15,447,,,fee schedule,447% of BCBS fee schedule,260.15,447,,,fee schedule,447% of BCBS fee schedule,260.15,447,,,fee schedule,447% of BCBS fee schedule,184.5,90,,147.6,percent of total billed charges,90% of total billed charges,164,80,,131.2,percent of total billed charges,80% of total billed charges,184.5,90,,147.6,percent of total billed charges,90% of total billed charges,153.75,75,,123,percent of total billed charges,75% of total billed charges,75.16,122,,,fee schedule,122% of APC rate,59.45,29,,47.56,percent of total billed charges,29% of total billed charges,61.6,100,,,fee schedule,100% of CMS OPPS rate,137.35,67,,109.88,percent of total billed charges,67% of total billed charges,32.45,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,164,80,,131.2,percent of total billed charges,80% of total billed charges,133.25,65,,106.6,percent of total billed charges,65% of total billed charges,73.12,35.67,,58.496,percent of total billed charges,35.67% of total billed charges,32.45,260.15,
INJECTION VACCINE EACH ADD OP,2650214,CDM,771,RC,90472,HCPCS,outpatient,,,63,25.20,,53.55,85,,42.84,percent of total billed charges,85% of total billed charges,48.51,77,,38.81,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,55.43,429,,,fee schedule,429% of BCBS fee schedule,57.75,447,,,fee schedule,447% of BCBS fee schedule,57.75,447,,,fee schedule,447% of BCBS fee schedule,57.75,447,,,fee schedule,447% of BCBS fee schedule,56.7,90,,45.36,percent of total billed charges,90% of total billed charges,50.4,80,,40.32,percent of total billed charges,80% of total billed charges,56.7,90,,45.36,percent of total billed charges,90% of total billed charges,47.25,75,,37.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,18.27,29,,14.616,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,42.21,67,,33.768,percent of total billed charges,67% of total billed charges,23.12,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,50.4,80,,40.32,percent of total billed charges,80% of total billed charges,40.95,65,,32.76,percent of total billed charges,65% of total billed charges,22.47,35.67,,17.976,percent of total billed charges,35.67% of total billed charges,18.27,57.75,
INJECTION VACCINE OP,2650242,CDM,771,RC,90471,HCPCS,outpatient,,,205,82.00,,174.25,85,,139.4,percent of total billed charges,85% of total billed charges,157.85,77,,126.28,percent of total billed charges,77% of total billed charges,61.6,100,,,fee schedule,100% of CMS OPPS rate,249.68,429,,,fee schedule,429% of BCBS fee schedule,260.15,447,,,fee schedule,447% of BCBS fee schedule,260.15,447,,,fee schedule,447% of BCBS fee schedule,260.15,447,,,fee schedule,447% of BCBS fee schedule,184.5,90,,147.6,percent of total billed charges,90% of total billed charges,164,80,,131.2,percent of total billed charges,80% of total billed charges,184.5,90,,147.6,percent of total billed charges,90% of total billed charges,153.75,75,,123,percent of total billed charges,75% of total billed charges,75.16,122,,,fee schedule,122% of APC rate,59.45,29,,47.56,percent of total billed charges,29% of total billed charges,61.6,100,,,fee schedule,100% of CMS OPPS rate,137.35,67,,109.88,percent of total billed charges,67% of total billed charges,32.45,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,164,80,,131.2,percent of total billed charges,80% of total billed charges,133.25,65,,106.6,percent of total billed charges,65% of total billed charges,73.12,35.67,,58.496,percent of total billed charges,35.67% of total billed charges,32.45,260.15,
INJECTION FLU VACCINE OP,2650244,CDM,771,RC,G0008,HCPCS,outpatient,,,117,46.80,,99.45,85,,79.56,percent of total billed charges,85% of total billed charges,90.09,77,,72.07,percent of total billed charges,77% of total billed charges,41.54,100,,,fee schedule,100% of CMS OPPS rate,101.63,429,,,fee schedule,429% of BCBS fee schedule,105.89,447,,,fee schedule,447% of BCBS fee schedule,105.89,447,,,fee schedule,447% of BCBS fee schedule,105.89,447,,,fee schedule,447% of BCBS fee schedule,105.3,90,,84.24,percent of total billed charges,90% of total billed charges,93.6,80,,74.88,percent of total billed charges,80% of total billed charges,105.3,90,,84.24,percent of total billed charges,90% of total billed charges,87.75,75,,70.2,percent of total billed charges,75% of total billed charges,50.67,122,,,fee schedule,122% of APC rate,33.93,29,,27.144,percent of total billed charges,29% of total billed charges,41.54,100,,,fee schedule,100% of CMS OPPS rate,78.39,67,,62.712,percent of total billed charges,67% of total billed charges,23.12,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,93.6,80,,74.88,percent of total billed charges,80% of total billed charges,76.05,65,,60.84,percent of total billed charges,65% of total billed charges,41.73,35.67,,33.384,percent of total billed charges,35.67% of total billed charges,23.12,105.89,
ER-INJECTION VACCINE - INITIAL,4500045,CDM,771,RC,90471,HCPCS,outpatient,,,205,82.00,,174.25,85,,139.4,percent of total billed charges,85% of total billed charges,157.85,77,,126.28,percent of total billed charges,77% of total billed charges,61.6,100,,,fee schedule,100% of CMS OPPS rate,249.68,429,,,fee schedule,429% of BCBS fee schedule,260.15,447,,,fee schedule,447% of BCBS fee schedule,260.15,447,,,fee schedule,447% of BCBS fee schedule,260.15,447,,,fee schedule,447% of BCBS fee schedule,184.5,90,,147.6,percent of total billed charges,90% of total billed charges,164,80,,131.2,percent of total billed charges,80% of total billed charges,184.5,90,,147.6,percent of total billed charges,90% of total billed charges,153.75,75,,123,percent of total billed charges,75% of total billed charges,75.16,122,,,fee schedule,122% of APC rate,59.45,29,,47.56,percent of total billed charges,29% of total billed charges,61.6,100,,,fee schedule,100% of CMS OPPS rate,137.35,67,,109.88,percent of total billed charges,67% of total billed charges,32.45,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,164,80,,131.2,percent of total billed charges,80% of total billed charges,133.25,65,,106.6,percent of total billed charges,65% of total billed charges,73.12,35.67,,58.496,percent of total billed charges,35.67% of total billed charges,32.45,260.15,
INJECTION FLU VACCINE OB,7600049,CDM,771,RC,G0008,HCPCS,outpatient,,,90,36.00,,76.5,85,,61.2,percent of total billed charges,85% of total billed charges,69.3,77,,55.44,percent of total billed charges,77% of total billed charges,41.54,100,,,fee schedule,100% of CMS OPPS rate,101.63,429,,,fee schedule,429% of BCBS fee schedule,105.89,447,,,fee schedule,447% of BCBS fee schedule,105.89,447,,,fee schedule,447% of BCBS fee schedule,105.89,447,,,fee schedule,447% of BCBS fee schedule,81,90,,64.8,percent of total billed charges,90% of total billed charges,72,80,,57.6,percent of total billed charges,80% of total billed charges,81,90,,64.8,percent of total billed charges,90% of total billed charges,67.5,75,,54,percent of total billed charges,75% of total billed charges,50.67,122,,,fee schedule,122% of APC rate,26.1,29,,20.88,percent of total billed charges,29% of total billed charges,41.54,100,,,fee schedule,100% of CMS OPPS rate,60.3,67,,48.24,percent of total billed charges,67% of total billed charges,23.12,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,72,80,,57.6,percent of total billed charges,80% of total billed charges,58.5,65,,46.8,percent of total billed charges,65% of total billed charges,32.1,35.67,,25.68,percent of total billed charges,35.67% of total billed charges,23.12,105.89,
TELECARD FACILITY ORIGIN FEE,7800000,CDM,780,RC,Q3014,HCPCS,outpatient,,,60,24.00,,51,85,,40.8,percent of total billed charges,85% of total billed charges,46.2,77,,36.96,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,49.2,82,,39.36,percent of total billed charges,82% of total billed charges,51,85,,40.8,percent of total billed charges,85% of total billed charges,51,85,,40.8,percent of total billed charges,85% of total billed charges,51,85,,40.8,percent of total billed charges,85% of total billed charges,54,90,,43.2,percent of total billed charges,90% of total billed charges,48,80,,38.4,percent of total billed charges,80% of total billed charges,54,90,,43.2,percent of total billed charges,90% of total billed charges,45,75,,36,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,17.4,29,,13.92,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,40.2,67,,32.16,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,48,80,,38.4,percent of total billed charges,80% of total billed charges,39,65,,31.2,percent of total billed charges,65% of total billed charges,21.4,35.67,,17.12,percent of total billed charges,35.67% of total billed charges,17.4,54,
FOLLOW UP INPT CONSULT TELE 25,7800010,CDM,780,RC,G0407,HCPCS,outpatient,,,258,103.20,GT,219.3,85,,175.44,percent of total billed charges,85% of total billed charges,198.66,77,,158.93,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,314.07,429,,,fee schedule,429% of BCBS fee schedule,327.25,447,,,fee schedule,447% of BCBS fee schedule,327.25,447,,,fee schedule,447% of BCBS fee schedule,327.25,447,,,fee schedule,447% of BCBS fee schedule,232.2,90,,185.76,percent of total billed charges,90% of total billed charges,206.4,80,,165.12,percent of total billed charges,80% of total billed charges,232.2,90,,185.76,percent of total billed charges,90% of total billed charges,193.5,75,,154.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,74.82,29,,59.856,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,172.86,67,,138.288,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,206.4,80,,165.12,percent of total billed charges,80% of total billed charges,167.7,65,,134.16,percent of total billed charges,65% of total billed charges,92.03,35.67,,73.624,percent of total billed charges,35.67% of total billed charges,74.82,327.25,
FOLLOW UP INPT CONSULT TELE 35,7800020,CDM,780,RC,G0408,HCPCS,outpatient,,,258,103.20,GT,219.3,85,,175.44,percent of total billed charges,85% of total billed charges,198.66,77,,158.93,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,451.09,429,,,fee schedule,429% of BCBS fee schedule,470.02,447,,,fee schedule,447% of BCBS fee schedule,470.02,447,,,fee schedule,447% of BCBS fee schedule,470.02,447,,,fee schedule,447% of BCBS fee schedule,232.2,90,,185.76,percent of total billed charges,90% of total billed charges,206.4,80,,165.12,percent of total billed charges,80% of total billed charges,232.2,90,,185.76,percent of total billed charges,90% of total billed charges,193.5,75,,154.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,74.82,29,,59.856,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,172.86,67,,138.288,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,206.4,80,,165.12,percent of total billed charges,80% of total billed charges,167.7,65,,134.16,percent of total billed charges,65% of total billed charges,92.03,35.67,,73.624,percent of total billed charges,35.67% of total billed charges,74.82,470.02,
TELECARD CONSULT ER 70MIN,7800030,CDM,780,RC,G0427,HCPCS,outpatient,,,258,103.20,GT,219.3,85,,175.44,percent of total billed charges,85% of total billed charges,198.66,77,,158.93,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,877.61,429,,,fee schedule,429% of BCBS fee schedule,914.43,447,,,fee schedule,447% of BCBS fee schedule,914.43,447,,,fee schedule,447% of BCBS fee schedule,914.43,447,,,fee schedule,447% of BCBS fee schedule,232.2,90,,185.76,percent of total billed charges,90% of total billed charges,206.4,80,,165.12,percent of total billed charges,80% of total billed charges,232.2,90,,185.76,percent of total billed charges,90% of total billed charges,193.5,75,,154.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,74.82,29,,59.856,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,172.86,67,,138.288,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,206.4,80,,165.12,percent of total billed charges,80% of total billed charges,167.7,65,,134.16,percent of total billed charges,65% of total billed charges,92.03,35.67,,73.624,percent of total billed charges,35.67% of total billed charges,74.82,914.43,
ECHO INTERPRETATION TELECARD,7800040,CDM,780,RC,93306,HCPCS,outpatient,,,508,203.20,26,431.8,85,,345.44,percent of total billed charges,85% of total billed charges,391.16,77,,312.93,percent of total billed charges,77% of total billed charges,482.45,100,,,fee schedule,100% of CMS OPPS rate,594.29,429,,,fee schedule,429% of BCBS fee schedule,619.23,447,,,fee schedule,447% of BCBS fee schedule,619.23,447,,,fee schedule,447% of BCBS fee schedule,619.23,447,,,fee schedule,447% of BCBS fee schedule,457.2,90,,365.76,percent of total billed charges,90% of total billed charges,406.4,80,,325.12,percent of total billed charges,80% of total billed charges,457.2,90,,365.76,percent of total billed charges,90% of total billed charges,381,75,,304.8,percent of total billed charges,75% of total billed charges,588.58,122,,,fee schedule,122% of APC rate,147.32,29,,117.856,percent of total billed charges,29% of total billed charges,482.45,100,,,fee schedule,100% of CMS OPPS rate,340.36,67,,272.288,percent of total billed charges,67% of total billed charges,366.13,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,406.4,80,,325.12,percent of total billed charges,80% of total billed charges,330.2,65,,264.16,percent of total billed charges,65% of total billed charges,181.2,35.67,,144.96,percent of total billed charges,35.67% of total billed charges,147.32,619.23,
TELECARD OFFICE VISIT 99205,7800060,CDM,780,RC,99205,HCPCS,outpatient,,,841,336.40,,714.85,85,,571.88,percent of total billed charges,85% of total billed charges,647.57,77,,518.06,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,735.95,429,,,fee schedule,429% of BCBS fee schedule,766.83,447,,,fee schedule,447% of BCBS fee schedule,766.83,447,,,fee schedule,447% of BCBS fee schedule,766.83,447,,,fee schedule,447% of BCBS fee schedule,756.9,90,,605.52,percent of total billed charges,90% of total billed charges,672.8,80,,538.24,percent of total billed charges,80% of total billed charges,756.9,90,,605.52,percent of total billed charges,90% of total billed charges,630.75,75,,504.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,243.89,29,,195.112,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,563.47,67,,450.776,percent of total billed charges,67% of total billed charges,164.53,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,672.8,80,,538.24,percent of total billed charges,80% of total billed charges,546.65,65,,437.32,percent of total billed charges,65% of total billed charges,299.98,35.67,,239.984,percent of total billed charges,35.67% of total billed charges,164.53,766.83,
TELECARD HOLTER READ,7800065,CDM,780,RC,93225,HCPCS,outpatient,,,203,81.20,26,172.55,85,,138.04,percent of total billed charges,85% of total billed charges,156.31,77,,125.05,percent of total billed charges,77% of total billed charges,111.71,100,,,fee schedule,100% of CMS OPPS rate,450.62,429,,,fee schedule,429% of BCBS fee schedule,469.53,447,,,fee schedule,447% of BCBS fee schedule,469.53,447,,,fee schedule,447% of BCBS fee schedule,469.53,447,,,fee schedule,447% of BCBS fee schedule,182.7,90,,146.16,percent of total billed charges,90% of total billed charges,162.4,80,,129.92,percent of total billed charges,80% of total billed charges,182.7,90,,146.16,percent of total billed charges,90% of total billed charges,152.25,75,,121.8,percent of total billed charges,75% of total billed charges,136.28,122,,,fee schedule,122% of APC rate,58.87,29,,47.096,percent of total billed charges,29% of total billed charges,111.71,100,,,fee schedule,100% of CMS OPPS rate,136.01,67,,108.808,percent of total billed charges,67% of total billed charges,60.95,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,162.4,80,,129.92,percent of total billed charges,80% of total billed charges,131.95,65,,105.56,percent of total billed charges,65% of total billed charges,72.41,35.67,,57.928,percent of total billed charges,35.67% of total billed charges,58.87,469.53,
TELECARD TELEMETRY READ,7800066,CDM,780,RC,93228,HCPCS,outpatient,,,116,46.40,26,98.6,85,,78.88,percent of total billed charges,85% of total billed charges,89.32,77,,71.46,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,113.94,429,,,fee schedule,429% of BCBS fee schedule,118.72,447,,,fee schedule,447% of BCBS fee schedule,118.72,447,,,fee schedule,447% of BCBS fee schedule,118.72,447,,,fee schedule,447% of BCBS fee schedule,104.4,90,,83.52,percent of total billed charges,90% of total billed charges,92.8,80,,74.24,percent of total billed charges,80% of total billed charges,104.4,90,,83.52,percent of total billed charges,90% of total billed charges,87,75,,69.6,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,33.64,29,,26.912,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,77.72,67,,62.176,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,92.8,80,,74.24,percent of total billed charges,80% of total billed charges,75.4,65,,60.32,percent of total billed charges,65% of total billed charges,41.38,35.67,,33.104,percent of total billed charges,35.67% of total billed charges,33.64,118.72,
STRESS TEST READ TELECARD,7800070,CDM,780,RC,93018,HCPCS,outpatient,,,229,91.60,,194.65,85,,155.72,percent of total billed charges,85% of total billed charges,176.33,77,,141.06,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,64.65,429,,,fee schedule,429% of BCBS fee schedule,67.36,447,,,fee schedule,447% of BCBS fee schedule,67.36,447,,,fee schedule,447% of BCBS fee schedule,67.36,447,,,fee schedule,447% of BCBS fee schedule,206.1,90,,164.88,percent of total billed charges,90% of total billed charges,183.2,80,,146.56,percent of total billed charges,80% of total billed charges,206.1,90,,164.88,percent of total billed charges,90% of total billed charges,171.75,75,,137.4,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,66.41,29,,53.128,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,153.43,67,,122.744,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,183.2,80,,146.56,percent of total billed charges,80% of total billed charges,148.85,65,,119.08,percent of total billed charges,65% of total billed charges,81.68,35.67,,65.344,percent of total billed charges,35.67% of total billed charges,64.65,206.1,
TELECARD EKG INTERPRETATION,7800071,CDM,780,RC,93010,HCPCS,outpatient,,,70,28.00,,59.5,85,,47.6,percent of total billed charges,85% of total billed charges,53.9,77,,43.12,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,36.94,429,,,fee schedule,429% of BCBS fee schedule,38.49,447,,,fee schedule,447% of BCBS fee schedule,38.49,447,,,fee schedule,447% of BCBS fee schedule,38.49,447,,,fee schedule,447% of BCBS fee schedule,63,90,,50.4,percent of total billed charges,90% of total billed charges,56,80,,44.8,percent of total billed charges,80% of total billed charges,63,90,,50.4,percent of total billed charges,90% of total billed charges,52.5,75,,42,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,20.3,29,,16.24,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,46.9,67,,37.52,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,56,80,,44.8,percent of total billed charges,80% of total billed charges,45.5,65,,36.4,percent of total billed charges,65% of total billed charges,24.97,35.67,,19.976,percent of total billed charges,35.67% of total billed charges,20.3,63,
TELECONSULT CRITICAL CARE,7800072,CDM,780,RC,G0508,HCPCS,outpatient,,,547,218.80,,464.95,85,,371.96,percent of total billed charges,85% of total billed charges,421.19,77,,336.95,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,872.97,429,,,fee schedule,429% of BCBS fee schedule,909.6,447,,,fee schedule,447% of BCBS fee schedule,909.6,447,,,fee schedule,447% of BCBS fee schedule,909.6,447,,,fee schedule,447% of BCBS fee schedule,492.3,90,,393.84,percent of total billed charges,90% of total billed charges,437.6,80,,350.08,percent of total billed charges,80% of total billed charges,492.3,90,,393.84,percent of total billed charges,90% of total billed charges,410.25,75,,328.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,158.63,29,,126.904,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,366.49,67,,293.192,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,437.6,80,,350.08,percent of total billed charges,80% of total billed charges,355.55,65,,284.44,percent of total billed charges,65% of total billed charges,195.11,35.67,,156.088,percent of total billed charges,35.67% of total billed charges,158.63,909.6,
SMOKING CESSATION COUNCIL TELE,7800073,CDM,780,RC,99406,HCPCS,outpatient,,,34,13.60,,28.9,85,,23.12,percent of total billed charges,85% of total billed charges,26.18,77,,20.94,percent of total billed charges,77% of total billed charges,25.09,100,,,fee schedule,100% of CMS OPPS rate,53.88,429,,,fee schedule,429% of BCBS fee schedule,56.14,447,,,fee schedule,447% of BCBS fee schedule,56.14,447,,,fee schedule,447% of BCBS fee schedule,56.14,447,,,fee schedule,447% of BCBS fee schedule,30.6,90,,24.48,percent of total billed charges,90% of total billed charges,27.2,80,,21.76,percent of total billed charges,80% of total billed charges,30.6,90,,24.48,percent of total billed charges,90% of total billed charges,25.5,75,,20.4,percent of total billed charges,75% of total billed charges,30.61,122,,,fee schedule,122% of APC rate,9.86,29,,7.888,percent of total billed charges,29% of total billed charges,25.09,100,,,fee schedule,100% of CMS OPPS rate,22.78,67,,18.224,percent of total billed charges,67% of total billed charges,19.53,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,27.2,80,,21.76,percent of total billed charges,80% of total billed charges,22.1,65,,17.68,percent of total billed charges,65% of total billed charges,12.13,35.67,,9.704,percent of total billed charges,35.67% of total billed charges,9.86,56.14,
TELECARD OP VISIT 99214,7800074,CDM,780,RC,99214,HCPCS,outpatient,,,452,180.80,,384.2,85,,307.36,percent of total billed charges,85% of total billed charges,348.04,77,,278.43,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,341.78,429,,,fee schedule,429% of BCBS fee schedule,356.12,447,,,fee schedule,447% of BCBS fee schedule,356.12,447,,,fee schedule,447% of BCBS fee schedule,356.12,447,,,fee schedule,447% of BCBS fee schedule,406.8,90,,325.44,percent of total billed charges,90% of total billed charges,361.6,80,,289.28,percent of total billed charges,80% of total billed charges,406.8,90,,325.44,percent of total billed charges,90% of total billed charges,339,75,,271.2,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,131.08,29,,104.864,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,302.84,67,,242.272,percent of total billed charges,67% of total billed charges,88.66,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,361.6,80,,289.28,percent of total billed charges,80% of total billed charges,293.8,65,,235.04,percent of total billed charges,65% of total billed charges,161.23,35.67,,128.984,percent of total billed charges,35.67% of total billed charges,88.66,406.8,
OFFICE VISIT PROLONGED TELECAR,7800075,CDM,780,RC,99356,HCPCS,outpatient,,,170,68.00,,144.5,85,,115.6,percent of total billed charges,85% of total billed charges,130.9,77,,104.72,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,401.84,429,,,fee schedule,429% of BCBS fee schedule,418.7,447,,,fee schedule,447% of BCBS fee schedule,418.7,447,,,fee schedule,447% of BCBS fee schedule,418.7,447,,,fee schedule,447% of BCBS fee schedule,153,90,,122.4,percent of total billed charges,90% of total billed charges,136,80,,108.8,percent of total billed charges,80% of total billed charges,153,90,,122.4,percent of total billed charges,90% of total billed charges,127.5,75,,102,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,49.3,29,,39.44,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,113.9,67,,91.12,percent of total billed charges,67% of total billed charges,170,100,,,fee schedule,Pays at line item charges due to Status Indicator C on the CMS APC fee schedule,,,,,other,not seperately reimbursable,136,80,,108.8,percent of total billed charges,80% of total billed charges,110.5,65,,88.4,percent of total billed charges,65% of total billed charges,60.64,35.67,,48.512,percent of total billed charges,35.67% of total billed charges,49.3,418.7,
OFFICE VISIT TELECARD LEVEL 3,7800080,CDM,780,RC,99203,HCPCS,outpatient,,,508,203.20,,431.8,85,,345.44,percent of total billed charges,85% of total billed charges,391.16,77,,312.93,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,334.11,429,,,fee schedule,429% of BCBS fee schedule,348.12,447,,,fee schedule,447% of BCBS fee schedule,348.12,447,,,fee schedule,447% of BCBS fee schedule,348.12,447,,,fee schedule,447% of BCBS fee schedule,457.2,90,,365.76,percent of total billed charges,90% of total billed charges,406.4,80,,325.12,percent of total billed charges,80% of total billed charges,457.2,90,,365.76,percent of total billed charges,90% of total billed charges,381,75,,304.8,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,147.32,29,,117.856,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,340.36,67,,272.288,percent of total billed charges,67% of total billed charges,88.66,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,406.4,80,,325.12,percent of total billed charges,80% of total billed charges,330.2,65,,264.16,percent of total billed charges,65% of total billed charges,181.2,35.67,,144.96,percent of total billed charges,35.67% of total billed charges,88.66,457.2,
TELEBEHAVIORAL FACILITY FEE,7800081,CDM,780,RC,Q3014,HCPCS,outpatient,,,60,24.00,,51,85,,40.8,percent of total billed charges,85% of total billed charges,46.2,77,,36.96,percent of total billed charges,77% of total billed charges,,,,,other ,not seperately reimbursable,49.2,82,,39.36,percent of total billed charges,82% of total billed charges,51,85,,40.8,percent of total billed charges,85% of total billed charges,51,85,,40.8,percent of total billed charges,85% of total billed charges,51,85,,40.8,percent of total billed charges,85% of total billed charges,54,90,,43.2,percent of total billed charges,90% of total billed charges,48,80,,38.4,percent of total billed charges,80% of total billed charges,54,90,,43.2,percent of total billed charges,90% of total billed charges,45,75,,36,percent of total billed charges,75% of total billed charges,,,,,other,not seperately reimbursable,17.4,29,,13.92,percent of total billed charges,29% of total billed charges,,,,,other ,not seperately reimbursable,40.2,67,,32.16,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,48,80,,38.4,percent of total billed charges,80% of total billed charges,39,65,,31.2,percent of total billed charges,65% of total billed charges,21.4,35.67,,17.12,percent of total billed charges,35.67% of total billed charges,17.4,54,
PSYCHOTHERAPY 30 MIN,7800082,CDM,780,RC,90832,HCPCS,outpatient,,,203,81.20,95,172.55,85,,138.04,percent of total billed charges,85% of total billed charges,156.31,77,,125.05,percent of total billed charges,77% of total billed charges,139.43,100,,,fee schedule,100% of CMS OPPS rate,166.46,82,,133.168,percent of total billed charges,82% of total billed charges,172.55,85,,138.04,percent of total billed charges,85% of total billed charges,172.55,85,,138.04,percent of total billed charges,85% of total billed charges,172.55,85,,138.04,percent of total billed charges,85% of total billed charges,182.7,90,,146.16,percent of total billed charges,90% of total billed charges,162.4,80,,129.92,percent of total billed charges,80% of total billed charges,182.7,90,,146.16,percent of total billed charges,90% of total billed charges,152.25,75,,121.8,percent of total billed charges,75% of total billed charges,170.1,122,,,fee schedule,122% of APC rate,58.87,29,,47.096,percent of total billed charges,29% of total billed charges,139.43,100,,,fee schedule,100% of CMS OPPS rate,136.01,67,,108.808,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,162.4,80,,129.92,percent of total billed charges,80% of total billed charges,131.95,65,,105.56,percent of total billed charges,65% of total billed charges,72.41,35.67,,57.928,percent of total billed charges,35.67% of total billed charges,58.87,182.7,
PSYCHOTHERAPY 45 MIN,7800083,CDM,780,RC,90834,HCPCS,outpatient,,,247,98.80,95,209.95,85,,167.96,percent of total billed charges,85% of total billed charges,190.19,77,,152.15,percent of total billed charges,77% of total billed charges,139.43,100,,,fee schedule,100% of CMS OPPS rate,202.54,82,,162.032,percent of total billed charges,82% of total billed charges,209.95,85,,167.96,percent of total billed charges,85% of total billed charges,209.95,85,,167.96,percent of total billed charges,85% of total billed charges,209.95,85,,167.96,percent of total billed charges,85% of total billed charges,222.3,90,,177.84,percent of total billed charges,90% of total billed charges,197.6,80,,158.08,percent of total billed charges,80% of total billed charges,222.3,90,,177.84,percent of total billed charges,90% of total billed charges,185.25,75,,148.2,percent of total billed charges,75% of total billed charges,170.1,122,,,fee schedule,122% of APC rate,71.63,29,,57.304,percent of total billed charges,29% of total billed charges,139.43,100,,,fee schedule,100% of CMS OPPS rate,165.49,67,,132.392,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,197.6,80,,158.08,percent of total billed charges,80% of total billed charges,160.55,65,,128.44,percent of total billed charges,65% of total billed charges,88.1,35.67,,70.48,percent of total billed charges,35.67% of total billed charges,71.63,222.3,
PSYCHOTHERAPY 60 MIN,7800084,CDM,780,RC,90837,HCPCS,outpatient,,,329,131.60,95,279.65,85,,223.72,percent of total billed charges,85% of total billed charges,253.33,77,,202.66,percent of total billed charges,77% of total billed charges,139.43,100,,,fee schedule,100% of CMS OPPS rate,269.78,82,,215.824,percent of total billed charges,82% of total billed charges,279.65,85,,223.72,percent of total billed charges,85% of total billed charges,279.65,85,,223.72,percent of total billed charges,85% of total billed charges,279.65,85,,223.72,percent of total billed charges,85% of total billed charges,296.1,90,,236.88,percent of total billed charges,90% of total billed charges,263.2,80,,210.56,percent of total billed charges,80% of total billed charges,296.1,90,,236.88,percent of total billed charges,90% of total billed charges,246.75,75,,197.4,percent of total billed charges,75% of total billed charges,170.1,122,,,fee schedule,122% of APC rate,95.41,29,,76.328,percent of total billed charges,29% of total billed charges,139.43,100,,,fee schedule,100% of CMS OPPS rate,220.43,67,,176.344,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,263.2,80,,210.56,percent of total billed charges,80% of total billed charges,213.85,65,,171.08,percent of total billed charges,65% of total billed charges,117.35,35.67,,93.88,percent of total billed charges,35.67% of total billed charges,95.41,296.1,
HEMODIALYSIS PER DAY I/P,8010000,CDM,801,RC,90935,HCPCS,outpatient,,,1802,720.80,,1531.7,85,,1225.36,percent of total billed charges,85% of total billed charges,1387.54,77,,1110.03,percent of total billed charges,77% of total billed charges,611.12,100,,,fee schedule,100% of CMS OPPS rate,1477.64,82,,1182.112,percent of total billed charges,82% of total billed charges,1531.7,85,,1225.36,percent of total billed charges,85% of total billed charges,1531.7,85,,1225.36,percent of total billed charges,85% of total billed charges,1531.7,85,,1225.36,percent of total billed charges,85% of total billed charges,1621.8,90,,1297.44,percent of total billed charges,90% of total billed charges,1441.6,80,,1153.28,percent of total billed charges,80% of total billed charges,1621.8,90,,1297.44,percent of total billed charges,90% of total billed charges,1351.5,75,,1081.2,percent of total billed charges,75% of total billed charges,745.56,122,,,fee schedule,122% of APC rate,522.58,29,,418.064,percent of total billed charges,29% of total billed charges,611.12,100,,,fee schedule,100% of CMS OPPS rate,1207.34,67,,965.872,percent of total billed charges,67% of total billed charges,436.06,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,1441.6,80,,1153.28,percent of total billed charges,80% of total billed charges,1171.3,65,,937.04,percent of total billed charges,65% of total billed charges,642.77,35.67,,514.216,percent of total billed charges,35.67% of total billed charges,436.06,1621.8,
HEMODIALYSIS UNSCHEDULED ESRD,8010001,CDM,801,RC,G0257,HCPCS,outpatient,,,1837,734.80,,1561.45,85,,1249.16,percent of total billed charges,85% of total billed charges,1414.49,77,,1131.59,percent of total billed charges,77% of total billed charges,611.12,100,,,fee schedule,100% of CMS OPPS rate,2565.55,429,,,fee schedule,429% of BCBS fee schedule,2673.19,447,,,fee schedule,447% of BCBS fee schedule,2673.19,447,,,fee schedule,447% of BCBS fee schedule,2673.19,447,,,fee schedule,447% of BCBS fee schedule,1653.3,90,,1322.64,percent of total billed charges,90% of total billed charges,1469.6,80,,1175.68,percent of total billed charges,80% of total billed charges,1653.3,90,,1322.64,percent of total billed charges,90% of total billed charges,1377.75,75,,1102.2,percent of total billed charges,75% of total billed charges,745.56,122,,,fee schedule,122% of APC rate,532.73,29,,426.184,percent of total billed charges,29% of total billed charges,611.12,100,,,fee schedule,100% of CMS OPPS rate,1230.79,67,,984.632,percent of total billed charges,67% of total billed charges,436.06,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,1469.6,80,,1175.68,percent of total billed charges,80% of total billed charges,1194.05,65,,955.24,percent of total billed charges,65% of total billed charges,655.26,35.67,,524.208,percent of total billed charges,35.67% of total billed charges,436.06,2673.19,
HEMODIALYSIS PER DAY O/P,8010002,CDM,821,RC,90935,HCPCS,outpatient,,,1802,720.80,,1531.7,85,,1225.36,percent of total billed charges,85% of total billed charges,1387.54,77,,1110.03,percent of total billed charges,77% of total billed charges,611.12,100,,,fee schedule,100% of CMS OPPS rate,1477.64,82,,1182.112,percent of total billed charges,82% of total billed charges,1531.7,85,,1225.36,percent of total billed charges,85% of total billed charges,1531.7,85,,1225.36,percent of total billed charges,85% of total billed charges,1531.7,85,,1225.36,percent of total billed charges,85% of total billed charges,1621.8,90,,1297.44,percent of total billed charges,90% of total billed charges,1441.6,80,,1153.28,percent of total billed charges,80% of total billed charges,1621.8,90,,1297.44,percent of total billed charges,90% of total billed charges,1351.5,75,,1081.2,percent of total billed charges,75% of total billed charges,745.56,122,,,fee schedule,122% of APC rate,522.58,29,,418.064,percent of total billed charges,29% of total billed charges,611.12,100,,,fee schedule,100% of CMS OPPS rate,1207.34,67,,965.872,percent of total billed charges,67% of total billed charges,436.06,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,1441.6,80,,1153.28,percent of total billed charges,80% of total billed charges,1171.3,65,,937.04,percent of total billed charges,65% of total billed charges,642.77,35.67,,514.216,percent of total billed charges,35.67% of total billed charges,436.06,1621.8,
HEMODIALYSIS UNSCHEDULED O/P,8010003,CDM,821,RC,G0257,HCPCS,outpatient,,,1837,734.80,,1561.45,85,,1249.16,percent of total billed charges,85% of total billed charges,1414.49,77,,1131.59,percent of total billed charges,77% of total billed charges,611.12,100,,,fee schedule,100% of CMS OPPS rate,2565.55,429,,,fee schedule,429% of BCBS fee schedule,2673.19,447,,,fee schedule,447% of BCBS fee schedule,2673.19,447,,,fee schedule,447% of BCBS fee schedule,2673.19,447,,,fee schedule,447% of BCBS fee schedule,1653.3,90,,1322.64,percent of total billed charges,90% of total billed charges,1469.6,80,,1175.68,percent of total billed charges,80% of total billed charges,1653.3,90,,1322.64,percent of total billed charges,90% of total billed charges,1377.75,75,,1102.2,percent of total billed charges,75% of total billed charges,745.56,122,,,fee schedule,122% of APC rate,532.73,29,,426.184,percent of total billed charges,29% of total billed charges,611.12,100,,,fee schedule,100% of CMS OPPS rate,1230.79,67,,984.632,percent of total billed charges,67% of total billed charges,436.06,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,1469.6,80,,1175.68,percent of total billed charges,80% of total billed charges,1194.05,65,,955.24,percent of total billed charges,65% of total billed charges,655.26,35.67,,524.208,percent of total billed charges,35.67% of total billed charges,436.06,2673.19,
RECURRENT LARYNGEAL MONITORING,2603341,CDM,920,RC,95865,HCPCS,outpatient,,,509,203.60,,432.65,85,,346.12,percent of total billed charges,85% of total billed charges,391.93,77,,313.54,percent of total billed charges,77% of total billed charges,111.71,100,,,fee schedule,100% of CMS OPPS rate,450.62,429,,,fee schedule,429% of BCBS fee schedule,469.53,447,,,fee schedule,447% of BCBS fee schedule,469.53,447,,,fee schedule,447% of BCBS fee schedule,469.53,447,,,fee schedule,447% of BCBS fee schedule,458.1,90,,366.48,percent of total billed charges,90% of total billed charges,407.2,80,,325.76,percent of total billed charges,80% of total billed charges,458.1,90,,366.48,percent of total billed charges,90% of total billed charges,381.75,75,,305.4,percent of total billed charges,75% of total billed charges,136.28,122,,,fee schedule,122% of APC rate,147.61,29,,118.088,percent of total billed charges,29% of total billed charges,111.71,100,,,fee schedule,100% of CMS OPPS rate,341.03,67,,272.824,percent of total billed charges,67% of total billed charges,78.4,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,407.2,80,,325.76,percent of total billed charges,80% of total billed charges,330.85,65,,264.68,percent of total billed charges,65% of total billed charges,181.56,35.67,,145.248,percent of total billed charges,35.67% of total billed charges,78.4,469.53,
US VEN EXT UNI,4000210,CDM,921,RC,93971,HCPCS,outpatient,,,895,358.00,,760.75,85,,608.6,percent of total billed charges,85% of total billed charges,689.15,77,,551.32,percent of total billed charges,77% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,431.1,429,,,fee schedule,429% of BCBS fee schedule,449.19,447,,,fee schedule,447% of BCBS fee schedule,449.19,447,,,fee schedule,447% of BCBS fee schedule,449.19,447,,,fee schedule,447% of BCBS fee schedule,805.5,90,,644.4,percent of total billed charges,90% of total billed charges,716,80,,572.8,percent of total billed charges,80% of total billed charges,805.5,90,,644.4,percent of total billed charges,90% of total billed charges,671.25,75,,537,percent of total billed charges,75% of total billed charges,117.29,122,,,fee schedule,122% of APC rate,259.55,29,,207.64,percent of total billed charges,29% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,599.65,67,,479.72,percent of total billed charges,67% of total billed charges,89.76,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,716,80,,572.8,percent of total billed charges,80% of total billed charges,581.75,65,,465.4,percent of total billed charges,65% of total billed charges,319.25,35.67,,255.4,percent of total billed charges,35.67% of total billed charges,89.76,805.5,
ULTRASOUND VEN. EXT BIL,4000215,CDM,921,RC,93970,HCPCS,outpatient,,,1286,514.40,,1093.1,85,,874.48,percent of total billed charges,85% of total billed charges,990.22,77,,792.18,percent of total billed charges,77% of total billed charges,214.29,100,,,fee schedule,100% of CMS OPPS rate,712.83,429,,,fee schedule,429% of BCBS fee schedule,742.74,447,,,fee schedule,447% of BCBS fee schedule,742.74,447,,,fee schedule,447% of BCBS fee schedule,742.74,447,,,fee schedule,447% of BCBS fee schedule,1157.4,90,,925.92,percent of total billed charges,90% of total billed charges,1028.8,80,,823.04,percent of total billed charges,80% of total billed charges,1157.4,90,,925.92,percent of total billed charges,90% of total billed charges,964.5,75,,771.6,percent of total billed charges,75% of total billed charges,261.43,122,,,fee schedule,122% of APC rate,372.94,29,,298.352,percent of total billed charges,29% of total billed charges,214.29,100,,,fee schedule,100% of CMS OPPS rate,861.62,67,,689.296,percent of total billed charges,67% of total billed charges,141.8,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,1028.8,80,,823.04,percent of total billed charges,80% of total billed charges,835.9,65,,668.72,percent of total billed charges,65% of total billed charges,458.72,35.67,,366.976,percent of total billed charges,35.67% of total billed charges,141.8,1157.4,
ULTRASOUND ART/VEN ABD PELVIS,4000501,CDM,921,RC,93975,HCPCS,outpatient,,,1196,478.40,,1016.6,85,,813.28,percent of total billed charges,85% of total billed charges,920.92,77,,736.74,percent of total billed charges,77% of total billed charges,214.29,100,,,fee schedule,100% of CMS OPPS rate,989.96,429,,,fee schedule,429% of BCBS fee schedule,1031.5,447,,,fee schedule,447% of BCBS fee schedule,1031.5,447,,,fee schedule,447% of BCBS fee schedule,1031.5,447,,,fee schedule,447% of BCBS fee schedule,1076.4,90,,861.12,percent of total billed charges,90% of total billed charges,956.8,80,,765.44,percent of total billed charges,80% of total billed charges,1076.4,90,,861.12,percent of total billed charges,90% of total billed charges,897,75,,717.6,percent of total billed charges,75% of total billed charges,261.43,122,,,fee schedule,122% of APC rate,346.84,29,,277.472,percent of total billed charges,29% of total billed charges,214.29,100,,,fee schedule,100% of CMS OPPS rate,801.32,67,,641.056,percent of total billed charges,67% of total billed charges,141.8,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,956.8,80,,765.44,percent of total billed charges,80% of total billed charges,777.4,65,,621.92,percent of total billed charges,65% of total billed charges,426.61,35.67,,341.288,percent of total billed charges,35.67% of total billed charges,141.8,1076.4,
ARTERIAL DUPLEX LOW EXT UNI,9200010,CDM,921,RC,93926,HCPCS,outpatient,,,615,246.00,,522.75,85,,418.2,percent of total billed charges,85% of total billed charges,473.55,77,,378.84,percent of total billed charges,77% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,508.06,429,,,fee schedule,429% of BCBS fee schedule,529.38,447,,,fee schedule,447% of BCBS fee schedule,529.38,447,,,fee schedule,447% of BCBS fee schedule,529.38,447,,,fee schedule,447% of BCBS fee schedule,553.5,90,,442.8,percent of total billed charges,90% of total billed charges,492,80,,393.6,percent of total billed charges,80% of total billed charges,553.5,90,,442.8,percent of total billed charges,90% of total billed charges,461.25,75,,369,percent of total billed charges,75% of total billed charges,117.29,122,,,fee schedule,122% of APC rate,178.35,29,,142.68,percent of total billed charges,29% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,412.05,67,,329.64,percent of total billed charges,67% of total billed charges,89.76,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,492,80,,393.6,percent of total billed charges,80% of total billed charges,399.75,65,,319.8,percent of total billed charges,65% of total billed charges,219.37,35.67,,175.496,percent of total billed charges,35.67% of total billed charges,89.76,553.5,
ARTERIAL DUPLEX LOW EXT BI,9200011,CDM,921,RC,93925,HCPCS,outpatient,,,1177,470.80,,1000.45,85,,800.36,percent of total billed charges,85% of total billed charges,906.29,77,,725.03,percent of total billed charges,77% of total billed charges,214.29,100,,,fee schedule,100% of CMS OPPS rate,973.06,429,,,fee schedule,429% of BCBS fee schedule,1013.89,447,,,fee schedule,447% of BCBS fee schedule,1013.89,447,,,fee schedule,447% of BCBS fee schedule,1013.89,447,,,fee schedule,447% of BCBS fee schedule,1059.3,90,,847.44,percent of total billed charges,90% of total billed charges,941.6,80,,753.28,percent of total billed charges,80% of total billed charges,1059.3,90,,847.44,percent of total billed charges,90% of total billed charges,882.75,75,,706.2,percent of total billed charges,75% of total billed charges,261.43,122,,,fee schedule,122% of APC rate,341.33,29,,273.064,percent of total billed charges,29% of total billed charges,214.29,100,,,fee schedule,100% of CMS OPPS rate,788.59,67,,630.872,percent of total billed charges,67% of total billed charges,141.8,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,941.6,80,,753.28,percent of total billed charges,80% of total billed charges,765.05,65,,612.04,percent of total billed charges,65% of total billed charges,419.84,35.67,,335.872,percent of total billed charges,35.67% of total billed charges,141.8,1059.3,
ARTERIAL DUPLEX UPPER EXT UNI,9200020,CDM,921,RC,93931,HCPCS,outpatient,,,758,303.20,,644.3,85,,515.44,percent of total billed charges,85% of total billed charges,583.66,77,,466.93,percent of total billed charges,77% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,463.41,429,,,fee schedule,429% of BCBS fee schedule,482.85,447,,,fee schedule,447% of BCBS fee schedule,482.85,447,,,fee schedule,447% of BCBS fee schedule,482.85,447,,,fee schedule,447% of BCBS fee schedule,682.2,90,,545.76,percent of total billed charges,90% of total billed charges,606.4,80,,485.12,percent of total billed charges,80% of total billed charges,682.2,90,,545.76,percent of total billed charges,90% of total billed charges,568.5,75,,454.8,percent of total billed charges,75% of total billed charges,117.29,122,,,fee schedule,122% of APC rate,219.82,29,,175.856,percent of total billed charges,29% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,507.86,67,,406.288,percent of total billed charges,67% of total billed charges,89.76,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,606.4,80,,485.12,percent of total billed charges,80% of total billed charges,492.7,65,,394.16,percent of total billed charges,65% of total billed charges,270.38,35.67,,216.304,percent of total billed charges,35.67% of total billed charges,89.76,682.2,
ARTERIAL DUPLEX UPPER EXT BI,9200021,CDM,921,RC,93930,HCPCS,outpatient,,,1092,436.80,,928.2,85,,742.56,percent of total billed charges,85% of total billed charges,840.84,77,,672.67,percent of total billed charges,77% of total billed charges,214.29,100,,,fee schedule,100% of CMS OPPS rate,506.52,429,,,fee schedule,429% of BCBS fee schedule,527.77,447,,,fee schedule,447% of BCBS fee schedule,527.77,447,,,fee schedule,447% of BCBS fee schedule,527.77,447,,,fee schedule,447% of BCBS fee schedule,982.8,90,,786.24,percent of total billed charges,90% of total billed charges,873.6,80,,698.88,percent of total billed charges,80% of total billed charges,982.8,90,,786.24,percent of total billed charges,90% of total billed charges,819,75,,655.2,percent of total billed charges,75% of total billed charges,261.43,122,,,fee schedule,122% of APC rate,316.68,29,,253.344,percent of total billed charges,29% of total billed charges,214.29,100,,,fee schedule,100% of CMS OPPS rate,731.64,67,,585.312,percent of total billed charges,67% of total billed charges,141.8,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,873.6,80,,698.88,percent of total billed charges,80% of total billed charges,709.8,65,,567.84,percent of total billed charges,65% of total billed charges,389.52,35.67,,311.616,percent of total billed charges,35.67% of total billed charges,141.8,982.8,
US ANKLE BRACHIAL INDEX TEST,9200040,CDM,921,RC,93922,HCPCS,outpatient,,,536,214.40,,455.6,85,,364.48,percent of total billed charges,85% of total billed charges,412.72,77,,330.18,percent of total billed charges,77% of total billed charges,111.71,100,,,fee schedule,100% of CMS OPPS rate,450.62,429,,,fee schedule,429% of BCBS fee schedule,469.53,447,,,fee schedule,447% of BCBS fee schedule,469.53,447,,,fee schedule,447% of BCBS fee schedule,469.53,447,,,fee schedule,447% of BCBS fee schedule,482.4,90,,385.92,percent of total billed charges,90% of total billed charges,428.8,80,,343.04,percent of total billed charges,80% of total billed charges,482.4,90,,385.92,percent of total billed charges,90% of total billed charges,402,75,,321.6,percent of total billed charges,75% of total billed charges,136.28,122,,,fee schedule,122% of APC rate,155.44,29,,124.352,percent of total billed charges,29% of total billed charges,111.71,100,,,fee schedule,100% of CMS OPPS rate,359.12,67,,287.296,percent of total billed charges,67% of total billed charges,60.95,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,428.8,80,,343.04,percent of total billed charges,80% of total billed charges,348.4,65,,278.72,percent of total billed charges,65% of total billed charges,191.19,35.67,,152.952,percent of total billed charges,35.67% of total billed charges,60.95,482.4,
DIGITAL PRESSURES,9200045,CDM,921,RC,93923,HCPCS,outpatient,,,690,276.00,,586.5,85,,469.2,percent of total billed charges,85% of total billed charges,531.3,77,,425.04,percent of total billed charges,77% of total billed charges,136.6,100,,,fee schedule,100% of CMS OPPS rate,501.93,429,,,fee schedule,429% of BCBS fee schedule,522.99,447,,,fee schedule,447% of BCBS fee schedule,522.99,447,,,fee schedule,447% of BCBS fee schedule,522.99,447,,,fee schedule,447% of BCBS fee schedule,621,90,,496.8,percent of total billed charges,90% of total billed charges,552,80,,441.6,percent of total billed charges,80% of total billed charges,621,90,,496.8,percent of total billed charges,90% of total billed charges,517.5,75,,414,percent of total billed charges,75% of total billed charges,166.65,122,,,fee schedule,122% of APC rate,200.1,29,,160.08,percent of total billed charges,29% of total billed charges,136.6,100,,,fee schedule,100% of CMS OPPS rate,462.3,67,,369.84,percent of total billed charges,67% of total billed charges,99.41,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,552,80,,441.6,percent of total billed charges,80% of total billed charges,448.5,65,,358.8,percent of total billed charges,65% of total billed charges,246.12,35.67,,196.896,percent of total billed charges,35.67% of total billed charges,99.41,621,
SEGEMENTAL PRESSURES,9200050,CDM,921,RC,93923,HCPCS,outpatient,,,690,276.00,,586.5,85,,469.2,percent of total billed charges,85% of total billed charges,531.3,77,,425.04,percent of total billed charges,77% of total billed charges,136.6,100,,,fee schedule,100% of CMS OPPS rate,501.93,429,,,fee schedule,429% of BCBS fee schedule,522.99,447,,,fee schedule,447% of BCBS fee schedule,522.99,447,,,fee schedule,447% of BCBS fee schedule,522.99,447,,,fee schedule,447% of BCBS fee schedule,621,90,,496.8,percent of total billed charges,90% of total billed charges,552,80,,441.6,percent of total billed charges,80% of total billed charges,621,90,,496.8,percent of total billed charges,90% of total billed charges,517.5,75,,414,percent of total billed charges,75% of total billed charges,166.65,122,,,fee schedule,122% of APC rate,200.1,29,,160.08,percent of total billed charges,29% of total billed charges,136.6,100,,,fee schedule,100% of CMS OPPS rate,462.3,67,,369.84,percent of total billed charges,67% of total billed charges,99.41,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,552,80,,441.6,percent of total billed charges,80% of total billed charges,448.5,65,,358.8,percent of total billed charges,65% of total billed charges,246.12,35.67,,196.896,percent of total billed charges,35.67% of total billed charges,99.41,621,
GRAFTS-HEMODIALYSIS,9200057,CDM,921,RC,93990,HCPCS,outpatient,,,583,233.20,,495.55,85,,396.44,percent of total billed charges,85% of total billed charges,448.91,77,,359.13,percent of total billed charges,77% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,491.03,429,,,fee schedule,429% of BCBS fee schedule,511.64,447,,,fee schedule,447% of BCBS fee schedule,511.64,447,,,fee schedule,447% of BCBS fee schedule,511.64,447,,,fee schedule,447% of BCBS fee schedule,524.7,90,,419.76,percent of total billed charges,90% of total billed charges,466.4,80,,373.12,percent of total billed charges,80% of total billed charges,524.7,90,,419.76,percent of total billed charges,90% of total billed charges,437.25,75,,349.8,percent of total billed charges,75% of total billed charges,117.29,122,,,fee schedule,122% of APC rate,169.07,29,,135.256,percent of total billed charges,29% of total billed charges,96.14,100,,,fee schedule,100% of CMS OPPS rate,390.61,67,,312.488,percent of total billed charges,67% of total billed charges,89.76,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,466.4,80,,373.12,percent of total billed charges,80% of total billed charges,378.95,65,,303.16,percent of total billed charges,65% of total billed charges,207.96,35.67,,166.368,percent of total billed charges,35.67% of total billed charges,89.76,524.7,
DIGITAL PPG WAVEFORMS,9200060,CDM,921,RC,93923,HCPCS,outpatient,,,690,276.00,,586.5,85,,469.2,percent of total billed charges,85% of total billed charges,531.3,77,,425.04,percent of total billed charges,77% of total billed charges,136.6,100,,,fee schedule,100% of CMS OPPS rate,501.93,429,,,fee schedule,429% of BCBS fee schedule,522.99,447,,,fee schedule,447% of BCBS fee schedule,522.99,447,,,fee schedule,447% of BCBS fee schedule,522.99,447,,,fee schedule,447% of BCBS fee schedule,621,90,,496.8,percent of total billed charges,90% of total billed charges,552,80,,441.6,percent of total billed charges,80% of total billed charges,621,90,,496.8,percent of total billed charges,90% of total billed charges,517.5,75,,414,percent of total billed charges,75% of total billed charges,166.65,122,,,fee schedule,122% of APC rate,200.1,29,,160.08,percent of total billed charges,29% of total billed charges,136.6,100,,,fee schedule,100% of CMS OPPS rate,462.3,67,,369.84,percent of total billed charges,67% of total billed charges,99.41,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,552,80,,441.6,percent of total billed charges,80% of total billed charges,448.5,65,,358.8,percent of total billed charges,65% of total billed charges,246.12,35.67,,196.896,percent of total billed charges,35.67% of total billed charges,99.41,621,
POST EXERCISE STRESS TEST,9200065,CDM,921,RC,93924,HCPCS,outpatient,,,757,302.80,,643.45,85,,514.76,percent of total billed charges,85% of total billed charges,582.89,77,,466.31,percent of total billed charges,77% of total billed charges,136.6,100,,,fee schedule,100% of CMS OPPS rate,637.41,429,,,fee schedule,429% of BCBS fee schedule,664.15,447,,,fee schedule,447% of BCBS fee schedule,664.15,447,,,fee schedule,447% of BCBS fee schedule,664.15,447,,,fee schedule,447% of BCBS fee schedule,681.3,90,,545.04,percent of total billed charges,90% of total billed charges,605.6,80,,484.48,percent of total billed charges,80% of total billed charges,681.3,90,,545.04,percent of total billed charges,90% of total billed charges,567.75,75,,454.2,percent of total billed charges,75% of total billed charges,166.65,122,,,fee schedule,122% of APC rate,219.53,29,,175.624,percent of total billed charges,29% of total billed charges,136.6,100,,,fee schedule,100% of CMS OPPS rate,507.19,67,,405.752,percent of total billed charges,67% of total billed charges,99.41,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,605.6,80,,484.48,percent of total billed charges,80% of total billed charges,492.05,65,,393.64,percent of total billed charges,65% of total billed charges,270.02,35.67,,216.016,percent of total billed charges,35.67% of total billed charges,99.41,681.3,
THORACIC OUTLET TEST,9200080,CDM,921,RC,93923,HCPCS,outpatient,,,690,276.00,,586.5,85,,469.2,percent of total billed charges,85% of total billed charges,531.3,77,,425.04,percent of total billed charges,77% of total billed charges,136.6,100,,,fee schedule,100% of CMS OPPS rate,501.93,429,,,fee schedule,429% of BCBS fee schedule,522.99,447,,,fee schedule,447% of BCBS fee schedule,522.99,447,,,fee schedule,447% of BCBS fee schedule,522.99,447,,,fee schedule,447% of BCBS fee schedule,621,90,,496.8,percent of total billed charges,90% of total billed charges,552,80,,441.6,percent of total billed charges,80% of total billed charges,621,90,,496.8,percent of total billed charges,90% of total billed charges,517.5,75,,414,percent of total billed charges,75% of total billed charges,166.65,122,,,fee schedule,122% of APC rate,200.1,29,,160.08,percent of total billed charges,29% of total billed charges,136.6,100,,,fee schedule,100% of CMS OPPS rate,462.3,67,,369.84,percent of total billed charges,67% of total billed charges,99.41,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,552,80,,441.6,percent of total billed charges,80% of total billed charges,448.5,65,,358.8,percent of total billed charges,65% of total billed charges,246.12,35.67,,196.896,percent of total billed charges,35.67% of total billed charges,99.41,621,
PALMER ARCH TEST,9200095,CDM,921,RC,93923,HCPCS,outpatient,,,690,276.00,,586.5,85,,469.2,percent of total billed charges,85% of total billed charges,531.3,77,,425.04,percent of total billed charges,77% of total billed charges,136.6,100,,,fee schedule,100% of CMS OPPS rate,501.93,429,,,fee schedule,429% of BCBS fee schedule,522.99,447,,,fee schedule,447% of BCBS fee schedule,522.99,447,,,fee schedule,447% of BCBS fee schedule,522.99,447,,,fee schedule,447% of BCBS fee schedule,621,90,,496.8,percent of total billed charges,90% of total billed charges,552,80,,441.6,percent of total billed charges,80% of total billed charges,621,90,,496.8,percent of total billed charges,90% of total billed charges,517.5,75,,414,percent of total billed charges,75% of total billed charges,166.65,122,,,fee schedule,122% of APC rate,200.1,29,,160.08,percent of total billed charges,29% of total billed charges,136.6,100,,,fee schedule,100% of CMS OPPS rate,462.3,67,,369.84,percent of total billed charges,67% of total billed charges,99.41,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,552,80,,441.6,percent of total billed charges,80% of total billed charges,448.5,65,,358.8,percent of total billed charges,65% of total billed charges,246.12,35.67,,196.896,percent of total billed charges,35.67% of total billed charges,99.41,621,
CAROTID DUPLEX,9210000,CDM,921,RC,93880,HCPCS,outpatient,,,1142,456.80,,970.7,85,,776.56,percent of total billed charges,85% of total billed charges,879.34,77,,703.47,percent of total billed charges,77% of total billed charges,214.29,100,,,fee schedule,100% of CMS OPPS rate,506.52,429,,,fee schedule,429% of BCBS fee schedule,527.77,447,,,fee schedule,447% of BCBS fee schedule,527.77,447,,,fee schedule,447% of BCBS fee schedule,527.77,447,,,fee schedule,447% of BCBS fee schedule,1027.8,90,,822.24,percent of total billed charges,90% of total billed charges,913.6,80,,730.88,percent of total billed charges,80% of total billed charges,1027.8,90,,822.24,percent of total billed charges,90% of total billed charges,856.5,75,,685.2,percent of total billed charges,75% of total billed charges,261.43,122,,,fee schedule,122% of APC rate,331.18,29,,264.944,percent of total billed charges,29% of total billed charges,214.29,100,,,fee schedule,100% of CMS OPPS rate,765.14,67,,612.112,percent of total billed charges,67% of total billed charges,141.8,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,913.6,80,,730.88,percent of total billed charges,80% of total billed charges,742.3,65,,593.84,percent of total billed charges,65% of total billed charges,407.35,35.67,,325.88,percent of total billed charges,35.67% of total billed charges,141.8,1027.8,
PHOTOTHERAPY,3910005,CDM,940,RC,96900,HCPCS,outpatient,,,76,30.40,,64.6,85,,51.68,percent of total billed charges,85% of total billed charges,58.52,77,,46.82,percent of total billed charges,77% of total billed charges,35.07,100,,,fee schedule,100% of CMS OPPS rate,136.42,429,,,fee schedule,429% of BCBS fee schedule,142.15,447,,,fee schedule,447% of BCBS fee schedule,142.15,447,,,fee schedule,447% of BCBS fee schedule,142.15,447,,,fee schedule,447% of BCBS fee schedule,68.4,90,,54.72,percent of total billed charges,90% of total billed charges,60.8,80,,48.64,percent of total billed charges,80% of total billed charges,68.4,90,,54.72,percent of total billed charges,90% of total billed charges,57,75,,45.6,percent of total billed charges,75% of total billed charges,42.78,122,,,fee schedule,122% of APC rate,22.04,29,,17.632,percent of total billed charges,29% of total billed charges,35.07,100,,,fee schedule,100% of CMS OPPS rate,50.92,67,,40.736,percent of total billed charges,67% of total billed charges,32.86,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,60.8,80,,48.64,percent of total billed charges,80% of total billed charges,49.4,65,,39.52,percent of total billed charges,65% of total billed charges,27.11,35.67,,21.688,percent of total billed charges,35.67% of total billed charges,22.04,142.15,
SMOKE/TOBACCO COUNSEL 3-10 MIN,9420100,CDM,942,RC,99406,HCPCS,outpatient,,,70,28.00,,59.5,85,,47.6,percent of total billed charges,85% of total billed charges,53.9,77,,43.12,percent of total billed charges,77% of total billed charges,25.09,100,,,fee schedule,100% of CMS OPPS rate,53.88,429,,,fee schedule,429% of BCBS fee schedule,56.14,447,,,fee schedule,447% of BCBS fee schedule,56.14,447,,,fee schedule,447% of BCBS fee schedule,56.14,447,,,fee schedule,447% of BCBS fee schedule,63,90,,50.4,percent of total billed charges,90% of total billed charges,56,80,,44.8,percent of total billed charges,80% of total billed charges,63,90,,50.4,percent of total billed charges,90% of total billed charges,52.5,75,,42,percent of total billed charges,75% of total billed charges,30.61,122,,,fee schedule,122% of APC rate,20.3,29,,16.24,percent of total billed charges,29% of total billed charges,25.09,100,,,fee schedule,100% of CMS OPPS rate,46.9,67,,37.52,percent of total billed charges,67% of total billed charges,19.53,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,56,80,,44.8,percent of total billed charges,80% of total billed charges,45.5,65,,36.4,percent of total billed charges,65% of total billed charges,24.97,35.67,,19.976,percent of total billed charges,35.67% of total billed charges,19.53,63,
SMOKE/TOBACCO COUNSEL >10 MIN,9420200,CDM,942,RC,99407,HCPCS,outpatient,,,70,28.00,,59.5,85,,47.6,percent of total billed charges,85% of total billed charges,53.9,77,,43.12,percent of total billed charges,77% of total billed charges,25.09,100,,,fee schedule,100% of CMS OPPS rate,112.4,429,,,fee schedule,429% of BCBS fee schedule,117.11,447,,,fee schedule,447% of BCBS fee schedule,117.11,447,,,fee schedule,447% of BCBS fee schedule,117.11,447,,,fee schedule,447% of BCBS fee schedule,63,90,,50.4,percent of total billed charges,90% of total billed charges,56,80,,44.8,percent of total billed charges,80% of total billed charges,63,90,,50.4,percent of total billed charges,90% of total billed charges,52.5,75,,42,percent of total billed charges,75% of total billed charges,30.61,122,,,fee schedule,122% of APC rate,20.3,29,,16.24,percent of total billed charges,29% of total billed charges,25.09,100,,,fee schedule,100% of CMS OPPS rate,46.9,67,,37.52,percent of total billed charges,67% of total billed charges,19.53,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,56,80,,44.8,percent of total billed charges,80% of total billed charges,45.5,65,,36.4,percent of total billed charges,65% of total billed charges,24.97,35.67,,19.976,percent of total billed charges,35.67% of total billed charges,19.53,117.11,
CARDIAC REHAB WITH MONITORING,9430005,CDM,943,RC,93798,HCPCS,outpatient,,,295,118.00,,250.75,85,,200.6,percent of total billed charges,85% of total billed charges,227.15,77,,181.72,percent of total billed charges,77% of total billed charges,115.55,100,,,fee schedule,100% of CMS OPPS rate,61.6,429,,,fee schedule,429% of BCBS fee schedule,64.19,447,,,fee schedule,447% of BCBS fee schedule,64.19,447,,,fee schedule,447% of BCBS fee schedule,64.19,447,,,fee schedule,447% of BCBS fee schedule,265.5,90,,212.4,percent of total billed charges,90% of total billed charges,236,80,,188.8,percent of total billed charges,80% of total billed charges,265.5,90,,212.4,percent of total billed charges,90% of total billed charges,221.25,75,,177,percent of total billed charges,75% of total billed charges,140.97,122,,,fee schedule,122% of APC rate,85.55,29,,68.44,percent of total billed charges,29% of total billed charges,115.55,100,,,fee schedule,100% of CMS OPPS rate,197.65,67,,158.12,percent of total billed charges,67% of total billed charges,64.88,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,236,80,,188.8,percent of total billed charges,80% of total billed charges,191.75,65,,153.4,percent of total billed charges,65% of total billed charges,105.23,35.67,,84.184,percent of total billed charges,35.67% of total billed charges,61.6,265.5,
CARDIAC REHAB W/OUT MONITORING,9430010,CDM,943,RC,93797,HCPCS,outpatient,,,295,118.00,,250.75,85,,200.6,percent of total billed charges,85% of total billed charges,227.15,77,,181.72,percent of total billed charges,77% of total billed charges,115.55,100,,,fee schedule,100% of CMS OPPS rate,38.48,429,,,fee schedule,429% of BCBS fee schedule,40.1,447,,,fee schedule,447% of BCBS fee schedule,40.1,447,,,fee schedule,447% of BCBS fee schedule,40.1,447,,,fee schedule,447% of BCBS fee schedule,265.5,90,,212.4,percent of total billed charges,90% of total billed charges,236,80,,188.8,percent of total billed charges,80% of total billed charges,265.5,90,,212.4,percent of total billed charges,90% of total billed charges,221.25,75,,177,percent of total billed charges,75% of total billed charges,140.97,122,,,fee schedule,122% of APC rate,85.55,29,,68.44,percent of total billed charges,29% of total billed charges,115.55,100,,,fee schedule,100% of CMS OPPS rate,197.65,67,,158.12,percent of total billed charges,67% of total billed charges,64.88,105,,,fee schedule,105% of APC rate,,,,,other,not seperately reimbursable,236,80,,188.8,percent of total billed charges,80% of total billed charges,191.75,65,,153.4,percent of total billed charges,65% of total billed charges,105.23,35.67,,84.184,percent of total billed charges,35.67% of total billed charges,38.48,265.5,
PUL REHAB EVAL W/O MNTR,9430014,CDM,948,RC,94625,HCPCS,outpatient,,,148,59.20,,125.8,85,,100.64,percent of total billed charges,85% of total billed charges,113.96,77,,91.17,percent of total billed charges,77% of total billed charges,53.49,100,,,fee schedule,100% of CMS OPPS rate,85.03,429,,,fee schedule,429% of BCBS fee schedule,88.6,447,,,fee schedule,447% of BCBS fee schedule,88.6,447,,,fee schedule,447% of BCBS fee schedule,88.6,447,,,fee schedule,447% of BCBS fee schedule,133.2,90,,106.56,percent of total billed charges,90% of total billed charges,118.4,80,,94.72,percent of total billed charges,80% of total billed charges,133.2,90,,106.56,percent of total billed charges,90% of total billed charges,111,75,,88.8,percent of total billed charges,75% of total billed charges,65.25,122,,,fee schedule,122% of APC rate,42.92,29,,34.336,percent of total billed charges,29% of total billed charges,53.49,100,,,fee schedule,100% of CMS OPPS rate,99.16,67,,79.328,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,118.4,80,,94.72,percent of total billed charges,80% of total billed charges,96.2,65,,76.96,percent of total billed charges,65% of total billed charges,52.79,35.67,,42.232,percent of total billed charges,35.67% of total billed charges,42.92,133.2,
PUL REHAB WITH EXERC W/MNTR,9430015,CDM,948,RC,94626,HCPCS,outpatient,,,148,59.20,,125.8,85,,100.64,percent of total billed charges,85% of total billed charges,113.96,77,,91.17,percent of total billed charges,77% of total billed charges,53.49,100,,,fee schedule,100% of CMS OPPS rate,122.14,429,,,fee schedule,429% of BCBS fee schedule,127.26,447,,,fee schedule,447% of BCBS fee schedule,127.26,447,,,fee schedule,447% of BCBS fee schedule,127.26,447,,,fee schedule,447% of BCBS fee schedule,133.2,90,,106.56,percent of total billed charges,90% of total billed charges,118.4,80,,94.72,percent of total billed charges,80% of total billed charges,133.2,90,,106.56,percent of total billed charges,90% of total billed charges,111,75,,88.8,percent of total billed charges,75% of total billed charges,65.25,122,,,fee schedule,122% of APC rate,42.92,29,,34.336,percent of total billed charges,29% of total billed charges,53.49,100,,,fee schedule,100% of CMS OPPS rate,99.16,67,,79.328,percent of total billed charges,67% of total billed charges,,,,,other , not seperately reimbursable,,,,,other,not seperately reimbursable,118.4,80,,94.72,percent of total billed charges,80% of total billed charges,96.2,65,,76.96,percent of total billed charges,65% of total billed charges,52.79,35.67,,42.232,percent of total billed charges,35.67% of total billed charges,42.92,133.2,
HEART TRANSPLANT OR IMPLANT OF HEART ASSIST SYSTEM WITH MCC,,,1,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,226917.04,100,MS-DRG,181533.632,case rate,100% of CMS IPPS 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,800,100,MS-DRG,640,case rate,100% of CMS IPPS rate,226917.04,100,MS-DRG,181533.632,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,226917.04,100,MS-DRG,181533.632,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,132813.9,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,800,226917.04,
HEART TRANSPLANT OR IMPLANT OF HEART ASSIST SYSTEM WITHOUT MCC,,,2,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,104174.85,100,MS-DRG,83339.88,case rate,100% of CMS IPPS 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,800,100,MS-DRG,640,case rate,100% of CMS IPPS rate,104174.85,100,MS-DRG,83339.88,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,104174.85,100,MS-DRG,83339.88,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,76419.11,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,800,104174.85,
"ECMO OR TRACHEOSTOMY WITH MV >96 HOURS OR PRINCIPAL DIAGNOSIS EXCEPT FACE, MOUTH AND NECK WITH MAJOR O.R. PROCEDURES",,,3,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,179171.16,100,MS-DRG,143336.928,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,274131.65,100,,,case rate,100% of CMS IPPS rate,274131.65,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,800,100,MS-DRG,640,case rate,100% of CMS IPPS rate,179171.16,100,MS-DRG,143336.928,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,179171.16,100,MS-DRG,143336.928,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,98424.21,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,800,274131.65,
"TRACHEOSTOMY WITH MV >96 HOURS OR PRINCIPAL DIAGNOSIS EXCEPT FACE, MOUTH AND NECK WITHOUT MAJOR O.R. PROCEDURES",,,4,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,124467.86,100,MS-DRG,99574.288,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,171082.45,100,,,case rate,100% of CMS IPPS rate,171082.45,100,,,case rate,100% of CMS IPPS rate,274131.65,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,800,100,MS-DRG,640,case rate,100% of CMS IPPS rate,124467.86,100,MS-DRG,99574.288,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,124467.86,100,MS-DRG,99574.288,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,59762.81,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,800,274131.65,
LIVER TRANSPLANT WITH MCC OR INTESTINAL TRANSPLANT,,,5,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,88523.98,100,MS-DRG,70819.184,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,171082.45,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,800,100,MS-DRG,640,case rate,100% of CMS IPPS rate,88523.98,100,MS-DRG,70819.184,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,88523.98,100,MS-DRG,70819.184,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,57335.67,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,800,171082.45,
LIVER TRANSPLANT WITHOUT MCC,,,6,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,42969.44,100,MS-DRG,34375.552,case rate,100% of CMS IPPS 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,800,100,MS-DRG,640,case rate,100% of CMS IPPS rate,42969.44,100,MS-DRG,34375.552,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,42969.44,100,MS-DRG,34375.552,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,27930.45,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,800,42969.44,
LUNG TRANSPLANT,,,7,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,104359.12,100,MS-DRG,83487.296,case rate,100% of CMS IPPS 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,825,100,MS-DRG,660,case rate,100% of CMS IPPS rate,104359.12,100,MS-DRG,83487.296,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,104359.12,100,MS-DRG,83487.296,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,53996.64,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,825,104359.12,
SIMULTANEOUS PANCREAS AND KIDNEY TRANSPLANT,,,8,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,46479.55,100,MS-DRG,37183.64,case rate,100% of CMS IPPS 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,825,100,MS-DRG,660,case rate,100% of CMS IPPS rate,46479.55,100,MS-DRG,37183.64,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,46479.55,100,MS-DRG,37183.64,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,27994.45,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,825,46479.55,
PANCREAS TRANSPLANT,,,10,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,42776.91,100,MS-DRG,34221.528,case rate,100% of CMS IPPS 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,825,100,MS-DRG,660,case rate,100% of CMS IPPS rate,42776.91,100,MS-DRG,34221.528,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,42776.91,100,MS-DRG,34221.528,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,21279.19,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,825,42776.91,
"TRACHEOSTOMY FOR FACE, MOUTH AND NECK DIAGNOSES OR LARYNGECTOMY WITH MCC",,,11,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,45608.63,100,MS-DRG,36486.904,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,73597.58,100,,,case rate,100% of CMS IPPS rate,73597.58,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,825,100,MS-DRG,660,case rate,100% of CMS IPPS rate,45608.63,100,MS-DRG,36486.904,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,45608.63,100,MS-DRG,36486.904,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,27333.1,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,825,73597.58,
"TRACHEOSTOMY FOR FACE, MOUTH AND NECK DIAGNOSES OR LARYNGECTOMY WITH CC",,,12,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,36094.64,100,MS-DRG,28875.712,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,57136.85,100,,,case rate,100% of CMS IPPS rate,57136.85,100,,,case rate,100% of CMS IPPS rate,73597.58,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,825,100,MS-DRG,660,case rate,100% of CMS IPPS rate,36094.64,100,MS-DRG,28875.712,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,36094.64,100,MS-DRG,28875.712,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,16934.19,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,825,73597.58,
"TRACHEOSTOMY FOR FACE, MOUTH AND NECK DIAGNOSES OR LARYNGECTOMY WITHOUT CC/MCC",,,13,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,25194.15,100,MS-DRG,20155.32,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,34855.62,100,,,case rate,100% of CMS IPPS rate,34855.62,100,,,case rate,100% of CMS IPPS rate,57136.85,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,825,100,MS-DRG,660,case rate,100% of CMS IPPS rate,25194.15,100,MS-DRG,20155.32,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,25194.15,100,MS-DRG,20155.32,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,10384.14,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,825,57136.85,
ALLOGENEIC BONE MARROW TRANSPLANT,,,14,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,97703.3,100,MS-DRG,78162.64,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,34855.62,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,825,100,MS-DRG,660,case rate,100% of CMS IPPS rate,97703.3,100,MS-DRG,78162.64,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,97703.3,100,MS-DRG,78162.64,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,56229.59,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,825,97703.3,
AUTOLOGOUS BONE MARROW TRANSPLANT WITH CC/MCC,,,16,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,54042.63,100,MS-DRG,43234.104,case rate,100% of CMS IPPS 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,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,54042.63,100,MS-DRG,43234.104,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,54042.63,100,MS-DRG,43234.104,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,34531.92,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,54042.63,
AUTOLOGOUS BONE MARROW TRANSPLANT WITHOUT CC/MCC,,,17,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,54042.63,100,MS-DRG,43234.104,case rate,100% of CMS IPPS 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,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,54042.63,100,MS-DRG,43234.104,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,54042.63,100,MS-DRG,43234.104,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,23644.52,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,54042.63,
CHIMERIC ANTIGEN RECEPTOR (CAR) T-CELL AND OTHER IMMUNOTHERAPIES,,,18,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,307432.18,100,MS-DRG,245945.744,case rate,100% of CMS IPPS 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,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,307432.18,100,MS-DRG,245945.744,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,307432.18,100,MS-DRG,245945.744,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,307432.18,
SIMULTANEOUS PANCREAS AND KIDNEY TRANSPLANT WITH HEMODIALYSIS,,,19,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,69052.3,100,MS-DRG,55241.84,case rate,100% of CMS IPPS 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,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,69052.3,100,MS-DRG,55241.84,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,69052.3,100,MS-DRG,55241.84,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,69052.3,
INTRACRANIAL VASCULAR PROCEDURES WITH PRINCIPAL DIAGNOSIS HEMORRHAGE WITH MCC,,,20,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,72844.18,100,MS-DRG,58275.344,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,156191.84,100,,,case rate,100% of CMS IPPS rate,156191.84,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,72844.18,100,MS-DRG,58275.344,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,72844.18,100,MS-DRG,58275.344,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,46515.01,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,156191.84,
INTRACRANIAL VASCULAR PROCEDURES WITH PRINCIPAL DIAGNOSIS HEMORRHAGE WITH CC,,,21,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,53748.46,100,MS-DRG,42998.768,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,118441.7,100,,,case rate,100% of CMS IPPS rate,118441.7,100,,,case rate,100% of CMS IPPS rate,156191.84,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,53748.46,100,MS-DRG,42998.768,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,53748.46,100,MS-DRG,42998.768,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,35211.32,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,156191.84,
INTRACRANIAL VASCULAR PROCEDURES WITH PRINCIPAL DIAGNOSIS HEMORRHAGE WITHOUT CC/MCC,,,22,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,35415.43,100,MS-DRG,28332.344,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,77269.67,100,,,case rate,100% of CMS IPPS rate,77269.67,100,,,case rate,100% of CMS IPPS rate,118441.7,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,35415.43,100,MS-DRG,28332.344,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,35415.43,100,MS-DRG,28332.344,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,22701.45,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,118441.7,
CRANIOTOMY WITH MAJOR DEVICE IMPLANT OR ACUTE COMPLEX CNS PRINCIPAL DIAGNOSIS WITH MCC OR CHEMOTHERAPY IMPLANT OR EPILEPSY WITH NEUROSTIMULATOR,,,23,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,49843.39,100,MS-DRG,39874.712,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,81803.22,100,,,case rate,100% of CMS IPPS rate,81803.22,100,,,case rate,100% of CMS IPPS rate,77269.67,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,49843.39,100,MS-DRG,39874.712,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,49843.39,100,MS-DRG,39874.712,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,29334.11,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,81803.22,
CRANIOTOMY WITH MAJOR DEVICE IMPLANT OR ACUTE COMPLEX CNS PRINCIPAL DIAGNOSIS WITHOUT MCC,,,24,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,34309.03,100,MS-DRG,27447.224,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,58720.45,100,,,case rate,100% of CMS IPPS rate,58720.45,100,,,case rate,100% of CMS IPPS rate,81803.22,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,34309.03,100,MS-DRG,27447.224,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,34309.03,100,MS-DRG,27447.224,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,19871.7,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,81803.22,
CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITH MCC,,,25,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,39491.55,100,MS-DRG,31593.24,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,64085.51,100,,,case rate,100% of CMS IPPS rate,64085.51,100,,,case rate,100% of CMS IPPS rate,58720.45,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,39491.55,100,MS-DRG,31593.24,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,39491.55,100,MS-DRG,31593.24,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,25670.15,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,64085.51,
CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITH CC,,,26,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,27403.66,100,MS-DRG,21922.928,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,45181.22,100,,,case rate,100% of CMS IPPS rate,45181.22,100,,,case rate,100% of CMS IPPS rate,64085.51,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,27403.66,100,MS-DRG,21922.928,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,27403.66,100,MS-DRG,21922.928,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,16284.87,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,64085.51,
CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITHOUT CC/MCC,,,27,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,23105.28,100,MS-DRG,18484.224,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,36042.2,100,,,case rate,100% of CMS IPPS rate,36042.2,100,,,case rate,100% of CMS IPPS rate,45181.22,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,23105.28,100,MS-DRG,18484.224,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,23105.28,100,MS-DRG,18484.224,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,11660.89,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,45181.22,
SPINAL PROCEDURES WITH MCC,,,28,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,52795.75,100,MS-DRG,42236.6,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,80525.25,100,,,case rate,100% of CMS IPPS rate,80525.25,100,,,case rate,100% of CMS IPPS rate,36042.2,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,52795.75,100,MS-DRG,42236.6,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,52795.75,100,MS-DRG,42236.6,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,30893.67,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,80525.25,
SPINAL PROCEDURES WITH CC OR SPINAL NEUROSTIMULATORS,,,29,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,31329.4,100,MS-DRG,25063.52,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,47278.7,100,,,case rate,100% of CMS IPPS rate,47278.7,100,,,case rate,100% of CMS IPPS rate,80525.25,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,31329.4,100,MS-DRG,25063.52,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,31329.4,100,MS-DRG,25063.52,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,15485.13,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,80525.25,
SPINAL PROCEDURES WITHOUT CC/MCC,,,30,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,22164.13,100,MS-DRG,17731.304,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,32596.34,100,,,case rate,100% of CMS IPPS rate,32596.34,100,,,case rate,100% of CMS IPPS rate,47278.7,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,22164.13,100,MS-DRG,17731.304,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,22164.13,100,MS-DRG,17731.304,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,9257.82,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,47278.7,
VENTRICULAR SHUNT PROCEDURES WITH MCC,,,31,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,37017.63,100,MS-DRG,29614.104,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,62668.21,100,,,case rate,100% of CMS IPPS rate,62668.21,100,,,case rate,100% of CMS IPPS rate,32596.34,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,37017.63,100,MS-DRG,29614.104,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,37017.63,100,MS-DRG,29614.104,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,24358.39,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,62668.21,
VENTRICULAR SHUNT PROCEDURES WITH CC,,,32,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,20799.08,100,MS-DRG,16639.264,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,34490.06,100,,,case rate,100% of CMS IPPS rate,34490.06,100,,,case rate,100% of CMS IPPS rate,62668.21,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,20799.08,100,MS-DRG,16639.264,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,20799.08,100,MS-DRG,16639.264,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,10662.03,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,62668.21,
VENTRICULAR SHUNT PROCEDURES WITHOUT CC/MCC,,,33,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,16412.27,100,MS-DRG,13129.816,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,25285.12,100,,,case rate,100% of CMS IPPS rate,25285.12,100,,,case rate,100% of CMS IPPS rate,34490.06,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,16412.27,100,MS-DRG,13129.816,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,16412.27,100,MS-DRG,13129.816,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,7704.82,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,34490.06,
CAROTID ARTERY STENT PROCEDURES WITH MCC,,,34,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,35239.43,100,MS-DRG,28191.544,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,53932.2,100,,,case rate,100% of CMS IPPS rate,53932.2,100,,,case rate,100% of CMS IPPS rate,25285.12,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,35239.43,100,MS-DRG,28191.544,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,35239.43,100,MS-DRG,28191.544,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,19147.45,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,53932.2,
CAROTID ARTERY STENT PROCEDURES WITH CC,,,35,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,22002.99,100,MS-DRG,17602.392,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,33264.53,100,,,case rate,100% of CMS IPPS rate,33264.53,100,,,case rate,100% of CMS IPPS rate,53932.2,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,22002.99,100,MS-DRG,17602.392,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,22002.99,100,MS-DRG,17602.392,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,11738.57,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,53932.2,
CAROTID ARTERY STENT PROCEDURES WITHOUT CC/MCC,,,36,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,17943.4,100,MS-DRG,14354.72,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,25858.93,100,,,case rate,100% of CMS IPPS rate,25858.93,100,,,case rate,100% of CMS IPPS rate,33264.53,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,17943.4,100,MS-DRG,14354.72,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,17943.4,100,MS-DRG,14354.72,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,9053.23,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,33264.53,
EXTRACRANIAL PROCEDURES WITH MCC,,,37,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,30894.77,100,MS-DRG,24715.816,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,48089.22,100,,,case rate,100% of CMS IPPS rate,48089.22,100,,,case rate,100% of CMS IPPS rate,25858.93,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,30894.77,100,MS-DRG,24715.816,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,30894.77,100,MS-DRG,24715.816,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,16872.92,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,48089.22,
EXTRACRANIAL PROCEDURES WITH CC,,,38,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,16222.22,100,MS-DRG,12977.776,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,25045.41,100,,,case rate,100% of CMS IPPS rate,25045.41,100,,,case rate,100% of CMS IPPS rate,48089.22,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,16222.22,100,MS-DRG,12977.776,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,16222.22,100,MS-DRG,12977.776,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,8645.15,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,48089.22,
EXTRACRANIAL PROCEDURES WITHOUT CC/MCC,,,39,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,12430.35,100,MS-DRG,9944.28,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,16965.62,100,,,case rate,100% of CMS IPPS rate,16965.62,100,,,case rate,100% of CMS IPPS rate,25045.41,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,12430.35,100,MS-DRG,9944.28,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,12430.35,100,MS-DRG,9944.28,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,5637.07,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,25045.41,
"PERIPHERAL, CRANIAL NERVE AND OTHER NERVOUS SYSTEM PROCEDURES WITH MCC",,,40,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,34818.85,100,MS-DRG,27855.08,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,58852.29,100,,,case rate,100% of CMS IPPS rate,58852.29,100,,,case rate,100% of CMS IPPS rate,16965.62,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,34818.85,100,MS-DRG,27855.08,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,34818.85,100,MS-DRG,27855.08,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,22061.98,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,58852.29,
"PERIPHERAL, CRANIAL NERVE AND OTHER NERVOUS SYSTEM PROCEDURES WITH CC OR PERIPHERAL NEUROSTIMULATOR",,,41,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,21434.5,100,MS-DRG,17147.6,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,35333.55,100,,,case rate,100% of CMS IPPS rate,35333.55,100,,,case rate,100% of CMS IPPS rate,58852.29,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,21434.5,100,MS-DRG,17147.6,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,21434.5,100,MS-DRG,17147.6,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,11911.43,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,58852.29,
"PERIPHERAL, CRANIAL NERVE AND OTHER NERVOUS SYSTEM PROCEDURES WITHOUT CC/MCC",,,42,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,17378.21,100,MS-DRG,13902.568,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,28038.81,100,,,case rate,100% of CMS IPPS rate,28038.81,100,,,case rate,100% of CMS IPPS rate,35333.55,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,17378.21,100,MS-DRG,13902.568,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,17378.21,100,MS-DRG,13902.568,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,9541.18,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,35333.55,
SPINAL DISORDERS AND INJURIES WITH CC/MCC,,,52,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,19069.64,100,MS-DRG,15255.712,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,25475.39,100,,,case rate,100% of CMS IPPS rate,25475.39,100,,,case rate,100% of CMS IPPS rate,28038.81,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,19069.64,100,MS-DRG,15255.712,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,19069.64,100,MS-DRG,15255.712,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,8418.68,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,28038.81,
SPINAL DISORDERS AND INJURIES WITHOUT CC/MCC,,,53,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,11131.4,100,MS-DRG,8905.12,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,13695.05,100,,,case rate,100% of CMS IPPS rate,13695.05,100,,,case rate,100% of CMS IPPS rate,25475.39,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,11131.4,100,MS-DRG,8905.12,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,11131.4,100,MS-DRG,8905.12,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,4679.23,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,25475.39,
NERVOUS SYSTEM NEOPLASMS WITH MCC,,,54,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,15177.78,100,MS-DRG,12142.224,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,19725.3,100,,,case rate,100% of CMS IPPS rate,19725.3,100,,,case rate,100% of CMS IPPS rate,13695.05,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,15177.78,100,MS-DRG,12142.224,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,15177.78,100,MS-DRG,12142.224,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,8030.3,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,19725.3,
NERVOUS SYSTEM NEOPLASMS WITHOUT MCC,,,55,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,11870.13,100,MS-DRG,9496.104,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,15689.15,100,,,case rate,100% of CMS IPPS rate,15689.15,100,,,case rate,100% of CMS IPPS rate,19725.3,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,11870.13,100,MS-DRG,9496.104,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,11870.13,100,MS-DRG,9496.104,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,5885.97,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,19725.3,
DEGENERATIVE NERVOUS SYSTEM DISORDERS WITH MCC,,,56,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,22783.84,100,MS-DRG,18227.072,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,31829.26,100,,,case rate,100% of CMS IPPS rate,31829.26,100,,,case rate,100% of CMS IPPS rate,15689.15,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,22783.84,100,MS-DRG,18227.072,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,22783.84,100,MS-DRG,18227.072,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,9658.24,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,31829.26,
DEGENERATIVE NERVOUS SYSTEM DISORDERS WITHOUT MCC,,,57,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,14266.38,100,MS-DRG,11413.104,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,18111.74,100,,,case rate,100% of CMS IPPS rate,18111.74,100,,,case rate,100% of CMS IPPS rate,31829.26,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,14266.38,100,MS-DRG,11413.104,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,14266.38,100,MS-DRG,11413.104,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,5279.87,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,31829.26,
MULTIPLE SCLEROSIS AND CEREBELLAR ATAXIA WITH MCC,,,58,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,17279.88,100,MS-DRG,13823.904,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,26362.33,100,,,case rate,100% of CMS IPPS rate,26362.33,100,,,case rate,100% of CMS IPPS rate,18111.74,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,17279.88,100,MS-DRG,13823.904,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,17279.88,100,MS-DRG,13823.904,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,8327.33,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,26362.33,
MULTIPLE SCLEROSIS AND CEREBELLAR ATAXIA WITH CC,,,59,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,12812.11,100,MS-DRG,10249.688,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,16469.71,100,,,case rate,100% of CMS IPPS rate,16469.71,100,,,case rate,100% of CMS IPPS rate,26362.33,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,12812.11,100,MS-DRG,10249.688,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,12812.11,100,MS-DRG,10249.688,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,5569.24,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,26362.33,
MULTIPLE SCLEROSIS AND CEREBELLAR ATAXIA WITHOUT CC/MCC,,,60,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,10417.49,100,MS-DRG,8333.992,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,12475.51,100,,,case rate,100% of CMS IPPS rate,12475.51,100,,,case rate,100% of CMS IPPS rate,16469.71,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,10417.49,100,MS-DRG,8333.992,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,10417.49,100,MS-DRG,8333.992,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,4167.22,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,16469.71,
"ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITH MCC",,,61,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,26161.74,100,MS-DRG,20929.392,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,42664.24,100,,,case rate,100% of CMS IPPS rate,42664.24,100,,,case rate,100% of CMS IPPS rate,12475.51,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,26161.74,100,MS-DRG,20929.392,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,26161.74,100,MS-DRG,20929.392,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,15756.45,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,42664.24,
"ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITH CC",,,62,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,18468.09,100,MS-DRG,14774.472,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,29120.51,100,,,case rate,100% of CMS IPPS rate,29120.51,100,,,case rate,100% of CMS IPPS rate,42664.24,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,18468.09,100,MS-DRG,14774.472,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,18468.09,100,MS-DRG,14774.472,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,10670.23,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,42664.24,
"ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITHOUT CC/MCC",,,63,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,15287.68,100,MS-DRG,12230.144,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,24390.7,100,,,case rate,100% of CMS IPPS rate,24390.7,100,,,case rate,100% of CMS IPPS rate,29120.51,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,15287.68,100,MS-DRG,12230.144,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,15287.68,100,MS-DRG,12230.144,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,8402.82,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,29120.51,
INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITH MCC,,,64,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,19553.03,100,MS-DRG,15642.424,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,28004.35,100,,,case rate,100% of CMS IPPS rate,28004.35,100,,,case rate,100% of CMS IPPS rate,24390.7,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,19553.03,100,MS-DRG,15642.424,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,19553.03,100,MS-DRG,15642.424,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,10150.01,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,28004.35,
INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITH CC OR TPA IN 24 HOURS,,,65,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,11400.79,100,MS-DRG,9120.632,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,15453.93,100,,,case rate,100% of CMS IPPS rate,15453.93,100,,,case rate,100% of CMS IPPS rate,28004.35,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,11400.79,100,MS-DRG,9120.632,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,11400.79,100,MS-DRG,9120.632,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,6282.56,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,28004.35,
INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITHOUT CC/MCC,,,66,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,8683.1,100,MS-DRG,6946.48,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,10888.92,100,,,case rate,100% of CMS IPPS rate,10888.92,100,,,case rate,100% of CMS IPPS rate,15453.93,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,8683.1,100,MS-DRG,6946.48,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,8683.1,100,MS-DRG,6946.48,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,4433.62,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,15453.93,
NONSPECIFIC CVA AND PRECEREBRAL OCCLUSION WITHOUT INFARCTION WITH MCC,,,67,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,14710.1,100,MS-DRG,11768.08,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,22493.97,100,,,case rate,100% of CMS IPPS rate,22493.97,100,,,case rate,100% of CMS IPPS rate,10888.92,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,14710.1,100,MS-DRG,11768.08,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,14710.1,100,MS-DRG,11768.08,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,7918.16,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,22493.97,
NONSPECIFIC CVA AND PRECEREBRAL OCCLUSION WITHOUT INFARCTION WITHOUT MCC,,,68,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,10199.34,100,MS-DRG,8159.472,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,13464.32,100,,,case rate,100% of CMS IPPS rate,13464.32,100,,,case rate,100% of CMS IPPS rate,22493.97,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,10199.34,100,MS-DRG,8159.472,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,10199.34,100,MS-DRG,8159.472,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,4869.05,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,22493.97,
TRANSIENT ISCHEMIA WITHOUT THROMBOLYTIC,,,69,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,9601.94,100,MS-DRG,7681.552,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,11468.72,100,,,case rate,100% of CMS IPPS rate,11468.72,100,,,case rate,100% of CMS IPPS rate,13464.32,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,9601.94,100,MS-DRG,7681.552,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,9601.94,100,MS-DRG,7681.552,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,4018.98,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,13464.32,
NONSPECIFIC CEREBROVASCULAR DISORDERS WITH MCC,,,70,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,17788.88,100,MS-DRG,14231.104,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,24649.88,100,,,case rate,100% of CMS IPPS rate,24649.88,100,,,case rate,100% of CMS IPPS rate,11468.72,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,17788.88,100,MS-DRG,14231.104,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,17788.88,100,MS-DRG,14231.104,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,9862.82,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,24649.88,
NONSPECIFIC CEREBROVASCULAR DISORDERS WITH CC,,,71,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,11775.92,100,MS-DRG,9420.736,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,14769.26,100,,,case rate,100% of CMS IPPS rate,14769.26,100,,,case rate,100% of CMS IPPS rate,24649.88,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,11775.92,100,MS-DRG,9420.736,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,11775.92,100,MS-DRG,9420.736,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,5786.41,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,24649.88,
NONSPECIFIC CEREBROVASCULAR DISORDERS WITHOUT CC/MCC,,,72,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,9472.22,100,MS-DRG,7577.776,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,11116.64,100,,,case rate,100% of CMS IPPS rate,11116.64,100,,,case rate,100% of CMS IPPS rate,14769.26,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,9472.22,100,MS-DRG,7577.776,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,9472.22,100,MS-DRG,7577.776,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,3958.81,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,14769.26,
CRANIAL AND PERIPHERAL NERVE DISORDERS WITH MCC,,,73,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,15504.17,100,MS-DRG,12403.336,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,21141.1,100,,,case rate,100% of CMS IPPS rate,21141.1,100,,,case rate,100% of CMS IPPS rate,11116.64,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,15504.17,100,MS-DRG,12403.336,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,15504.17,100,MS-DRG,12403.336,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,7086.68,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,21141.1,
CRANIAL AND PERIPHERAL NERVE DISORDERS WITHOUT MCC,,,74,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,11481.76,100,MS-DRG,9185.408,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,14590.97,100,,,case rate,100% of CMS IPPS rate,14590.97,100,,,case rate,100% of CMS IPPS rate,21141.1,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,11481.76,100,MS-DRG,9185.408,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,11481.76,100,MS-DRG,9185.408,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,4728.47,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,21141.1,
VIRAL MENINGITIS WITH CC/MCC,,,75,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,18815.96,100,MS-DRG,15052.768,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,22197.33,100,,,case rate,100% of CMS IPPS rate,22197.33,100,,,case rate,100% of CMS IPPS rate,14590.97,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,18815.96,100,MS-DRG,15052.768,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,18815.96,100,MS-DRG,15052.768,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,9406.61,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,22197.33,
VIRAL MENINGITIS WITHOUT CC/MCC,,,76,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,10624.89,100,MS-DRG,8499.912,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,12357.15,100,,,case rate,100% of CMS IPPS rate,12357.15,100,,,case rate,100% of CMS IPPS rate,22197.33,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,10624.89,100,MS-DRG,8499.912,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,10624.89,100,MS-DRG,8499.912,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,4787,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,22197.33,
HYPERTENSIVE ENCEPHALOPATHY WITH MCC,,,77,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,15486.82,100,MS-DRG,12389.456,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,23252.06,100,,,case rate,100% of CMS IPPS rate,23252.06,100,,,case rate,100% of CMS IPPS rate,12357.15,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,15486.82,100,MS-DRG,12389.456,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,15486.82,100,MS-DRG,12389.456,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,9073.47,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,23252.06,
HYPERTENSIVE ENCEPHALOPATHY WITH CC,,,78,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,11404.91,100,MS-DRG,9123.928,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,14534.04,100,,,case rate,100% of CMS IPPS rate,14534.04,100,,,case rate,100% of CMS IPPS rate,23252.06,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,11404.91,100,MS-DRG,9123.928,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,11404.91,100,MS-DRG,9123.928,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,5579.63,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,23252.06,
HYPERTENSIVE ENCEPHALOPATHY WITHOUT CC/MCC,,,79,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,9123.51,100,MS-DRG,7298.808,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,11184.06,100,,,case rate,100% of CMS IPPS rate,11184.06,100,,,case rate,100% of CMS IPPS rate,14534.04,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,9123.51,100,MS-DRG,7298.808,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,9123.51,100,MS-DRG,7298.808,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,3948.41,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,14534.04,
NONTRAUMATIC STUPOR AND COMA WITH MCC,,,80,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,21252.72,100,MS-DRG,17002.176,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,28148.18,100,,,case rate,100% of CMS IPPS rate,28148.18,100,,,case rate,100% of CMS IPPS rate,11184.06,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,21252.72,100,MS-DRG,17002.176,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,21252.72,100,MS-DRG,17002.176,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,6490.43,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,28148.18,
NONTRAUMATIC STUPOR AND COMA WITHOUT MCC,,,81,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,10517.48,100,MS-DRG,8413.984,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,12803.62,100,,,case rate,100% of CMS IPPS rate,12803.62,100,,,case rate,100% of CMS IPPS rate,28148.18,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,10517.48,100,MS-DRG,8413.984,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,10517.48,100,MS-DRG,8413.984,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,4033.75,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,28148.18,
TRAUMATIC STUPOR AND COMA >1 HOUR WITH MCC,,,82,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,21827.82,100,MS-DRG,17462.256,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,32340.15,100,,,case rate,100% of CMS IPPS rate,32340.15,100,,,case rate,100% of CMS IPPS rate,12803.62,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,21827.82,100,MS-DRG,17462.256,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,21827.82,100,MS-DRG,17462.256,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,11085.42,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,32340.15,
TRAUMATIC STUPOR AND COMA >1 HOUR WITH CC,,,83,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,14210.2,100,MS-DRG,11368.16,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,19401.69,100,,,case rate,100% of CMS IPPS rate,19401.69,100,,,case rate,100% of CMS IPPS rate,32340.15,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,14210.2,100,MS-DRG,11368.16,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,14210.2,100,MS-DRG,11368.16,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,7421.46,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,32340.15,
TRAUMATIC STUPOR AND COMA >1 HOUR WITHOUT CC/MCC,,,84,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,10601.76,100,MS-DRG,8481.408,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,13832.88,100,,,case rate,100% of CMS IPPS rate,13832.88,100,,,case rate,100% of CMS IPPS rate,19401.69,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,10601.76,100,MS-DRG,8481.408,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,10601.76,100,MS-DRG,8481.408,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,4607.03,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,19401.69,
TRAUMATIC STUPOR AND COMA <1 HOUR WITH MCC,,,85,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,21782.37,100,MS-DRG,17425.896,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,32660.76,100,,,case rate,100% of CMS IPPS rate,32660.76,100,,,case rate,100% of CMS IPPS rate,13832.88,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,21782.37,100,MS-DRG,17425.896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,21782.37,100,MS-DRG,17425.896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,11751.7,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,32660.76,
TRAUMATIC STUPOR AND COMA <1 HOUR WITH CC,,,86,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,13885.45,100,MS-DRG,11108.36,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,18624.12,100,,,case rate,100% of CMS IPPS rate,18624.12,100,,,case rate,100% of CMS IPPS rate,32660.76,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,13885.45,100,MS-DRG,11108.36,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,13885.45,100,MS-DRG,11108.36,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,6432.44,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,32660.76,
TRAUMATIC STUPOR AND COMA <1 HOUR WITHOUT CC/MCC,,,87,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,10324.95,100,MS-DRG,8259.96,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,12664.28,100,,,case rate,100% of CMS IPPS rate,12664.28,100,,,case rate,100% of CMS IPPS rate,18624.12,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,10324.95,100,MS-DRG,8259.96,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,10324.95,100,MS-DRG,8259.96,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,4285.38,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,18624.12,
CONCUSSION WITH MCC,,,88,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,15676.04,100,MS-DRG,12540.832,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,22167.37,100,,,case rate,100% of CMS IPPS rate,22167.37,100,,,case rate,100% of CMS IPPS rate,12664.28,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,15676.04,100,MS-DRG,12540.832,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,15676.04,100,MS-DRG,12540.832,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,8849.19,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,22167.37,
CONCUSSION WITH CC,,,89,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,12503.89,100,MS-DRG,10003.112,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,15993.29,100,,,case rate,100% of CMS IPPS rate,15993.29,100,,,case rate,100% of CMS IPPS rate,22167.37,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,12503.89,100,MS-DRG,10003.112,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,12503.89,100,MS-DRG,10003.112,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,5365.75,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,22167.37,
CONCUSSION WITHOUT CC/MCC,,,90,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,10726.53,100,MS-DRG,8581.224,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,11886.72,100,,,case rate,100% of CMS IPPS rate,11886.72,100,,,case rate,100% of CMS IPPS rate,15993.29,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,10726.53,100,MS-DRG,8581.224,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,10726.53,100,MS-DRG,8581.224,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,3991.63,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,15993.29,
OTHER DISORDERS OF NERVOUS SYSTEM WITH MCC,,,91,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,17786.4,100,MS-DRG,14229.12,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,24150.98,100,,,case rate,100% of CMS IPPS rate,24150.98,100,,,case rate,100% of CMS IPPS rate,11886.72,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,17786.4,100,MS-DRG,14229.12,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,17786.4,100,MS-DRG,14229.12,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,8882.56,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,24150.98,
OTHER DISORDERS OF NERVOUS SYSTEM WITH CC,,,92,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,11480.94,100,MS-DRG,9184.752,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,14132.52,100,,,case rate,100% of CMS IPPS rate,14132.52,100,,,case rate,100% of CMS IPPS rate,24150.98,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,11480.94,100,MS-DRG,9184.752,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,11480.94,100,MS-DRG,9184.752,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,5058.32,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,24150.98,
OTHER DISORDERS OF NERVOUS SYSTEM WITHOUT CC/MCC,,,93,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,9401.15,100,MS-DRG,7520.92,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,11053.72,100,,,case rate,100% of CMS IPPS rate,11053.72,100,,,case rate,100% of CMS IPPS rate,14132.52,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,9401.15,100,MS-DRG,7520.92,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,9401.15,100,MS-DRG,7520.92,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,3692.95,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,14132.52,
BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITH MCC,,,94,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,32936.55,100,MS-DRG,26349.24,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,55102.3,100,,,case rate,100% of CMS IPPS rate,55102.3,100,,,case rate,100% of CMS IPPS rate,11053.72,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,32936.55,100,MS-DRG,26349.24,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,32936.55,100,MS-DRG,26349.24,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,18732.26,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,55102.3,
BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITH CC,,,95,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,22702.86,100,MS-DRG,18162.288,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,35670.64,100,,,case rate,100% of CMS IPPS rate,35670.64,100,,,case rate,100% of CMS IPPS rate,55102.3,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,22702.86,100,MS-DRG,18162.288,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,22702.86,100,MS-DRG,18162.288,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,12998.36,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,55102.3,
BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITHOUT CC/MCC,,,96,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,21013.08,100,MS-DRG,16810.464,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,31627,100,,,case rate,100% of CMS IPPS rate,31627,100,,,case rate,100% of CMS IPPS rate,35670.64,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,21013.08,100,MS-DRG,16810.464,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,21013.08,100,MS-DRG,16810.464,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,10431.18,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,35670.64,
NON-BACTERIAL INFECTION OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS WITH MCC,,,97,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,33053.88,100,MS-DRG,26443.104,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,53019.8,100,,,case rate,100% of CMS IPPS rate,53019.8,100,,,case rate,100% of CMS IPPS rate,31627,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,33053.88,100,MS-DRG,26443.104,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,33053.88,100,MS-DRG,26443.104,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,17580.77,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,53019.8,
NON-BACTERIAL INFECTION OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS WITH CC,,,98,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,20804.86,100,MS-DRG,16643.888,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,27724.19,100,,,case rate,100% of CMS IPPS rate,27724.19,100,,,case rate,100% of CMS IPPS rate,53019.8,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,20804.86,100,MS-DRG,16643.888,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,20804.86,100,MS-DRG,16643.888,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,9999.03,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,53019.8,
NON-BACTERIAL INFECTION OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS WITHOUT CC/MCC,,,99,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,13911.07,100,MS-DRG,11128.856,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,19070.59,100,,,case rate,100% of CMS IPPS rate,19070.59,100,,,case rate,100% of CMS IPPS rate,27724.19,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,13911.07,100,MS-DRG,11128.856,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,13911.07,100,MS-DRG,11128.856,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,6727.84,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,27724.19,
SEIZURES WITH MCC,,,100,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,19383.63,100,MS-DRG,15506.904,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,27153.38,100,,,case rate,100% of CMS IPPS rate,27153.38,100,,,case rate,100% of CMS IPPS rate,19070.59,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,19383.63,100,MS-DRG,15506.904,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,19383.63,100,MS-DRG,15506.904,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,8344.29,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,27153.38,
SEIZURES WITHOUT MCC,,,101,RC,,,Inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10518.3,100,MS-DRG,8414.64,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,13023.85,100,,,case rate,100% of CMS IPPS rate,13023.85,100,,,case rate,100% of CMS IPPS rate,27153.38,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,10518.3,100,MS-DRG,8414.64,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,10518.3,100,MS-DRG,8414.64,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,4168.32,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,27153.38,
HEADACHES WITH MCC,,,102,RC,,,Inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12972.4,100,MS-DRG,10377.92,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,16128.12,100,,,case rate,100% of CMS IPPS rate,16128.12,100,,,case rate,100% of CMS IPPS rate,13023.85,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,12972.4,100,MS-DRG,10377.92,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,12972.4,100,MS-DRG,10377.92,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,5540.8,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,16128.12,
HEADACHES WITHOUT MCC,,,103,RC,,,Inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9963.04,100,MS-DRG,7970.432,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,11706.93,100,,,case rate,100% of CMS IPPS rate,11706.93,100,,,case rate,100% of CMS IPPS rate,16128.12,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,9963.04,100,MS-DRG,7970.432,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,9963.04,100,MS-DRG,7970.432,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,3652.47,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,16128.12,
ORBITAL PROCEDURES WITH CC/MCC,,,113,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,23720.03,100,MS-DRG,18976.024,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,34499.05,100,,,case rate,100% of CMS IPPS rate,34499.05,100,,,case rate,100% of CMS IPPS rate,11706.93,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,23720.03,100,MS-DRG,18976.024,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,23720.03,100,MS-DRG,18976.024,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,10306.46,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,34499.05,
ORBITAL PROCEDURES WITHOUT CC/MCC,,,114,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,13180.63,100,MS-DRG,10544.504,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,18803.91,100,,,case rate,100% of CMS IPPS rate,18803.91,100,,,case rate,100% of CMS IPPS rate,34499.05,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,13180.63,100,MS-DRG,10544.504,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,13180.63,100,MS-DRG,10544.504,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,5073.64,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,34499.05,
EXTRAOCULAR PROCEDURES EXCEPT ORBIT,,,115,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,15928.9,100,MS-DRG,12743.12,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,20406.98,100,,,case rate,100% of CMS IPPS rate,20406.98,100,,,case rate,100% of CMS IPPS rate,18803.91,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,15928.9,100,MS-DRG,12743.12,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,15928.9,100,MS-DRG,12743.12,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,6698.84,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,20406.98,
INTRAOCULAR PROCEDURES WITH CC/MCC,,,116,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,18130.15,100,MS-DRG,14504.12,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,25589.26,100,,,case rate,100% of CMS IPPS rate,25589.26,100,,,case rate,100% of CMS IPPS rate,20406.98,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,18130.15,100,MS-DRG,14504.12,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,18130.15,100,MS-DRG,14504.12,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,7101.45,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,25589.26,
INTRAOCULAR PROCEDURES WITHOUT CC/MCC,,,117,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,12904.64,100,MS-DRG,10323.712,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,15019.46,100,,,case rate,100% of CMS IPPS rate,15019.46,100,,,case rate,100% of CMS IPPS rate,25589.26,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,12904.64,100,MS-DRG,10323.712,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,12904.64,100,MS-DRG,10323.712,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,4188.56,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,25589.26,
ACUTE MAJOR EYE INFECTIONS WITH CC/MCC,,,121,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,13588.83,100,MS-DRG,10871.064,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,15870.43,100,,,case rate,100% of CMS IPPS rate,15870.43,100,,,case rate,100% of CMS IPPS rate,15019.46,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,13588.83,100,MS-DRG,10871.064,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,13588.83,100,MS-DRG,10871.064,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,5710.92,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,15870.43,
ACUTE MAJOR EYE INFECTIONS WITHOUT CC/MCC,,,122,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,9154.08,100,MS-DRG,7323.264,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,10574.3,100,,,case rate,100% of CMS IPPS rate,10574.3,100,,,case rate,100% of CMS IPPS rate,15870.43,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,9154.08,100,MS-DRG,7323.264,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,9154.08,100,MS-DRG,7323.264,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,3448.43,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,15870.43,
NEUROLOGICAL EYE DISORDERS,,,123,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,9645.73,100,MS-DRG,7716.584,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,11279.95,100,,,case rate,100% of CMS IPPS rate,11279.95,100,,,case rate,100% of CMS IPPS rate,10574.3,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,9645.73,100,MS-DRG,7716.584,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,9645.73,100,MS-DRG,7716.584,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,3903.01,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,11279.95,
OTHER DISORDERS OF THE EYE WITH MCC OR THROMBOLYTIC AGENT,,,124,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,13925.11,100,MS-DRG,11140.088,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,19945.54,100,,,case rate,100% of CMS IPPS rate,19945.54,100,,,case rate,100% of CMS IPPS rate,11279.95,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,13925.11,100,MS-DRG,11140.088,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,13925.11,100,MS-DRG,11140.088,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,6401.26,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,19945.54,
OTHER DISORDERS OF THE EYE WITHOUT MCC,,,125,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,9592.03,100,MS-DRG,7673.624,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,12138.42,100,,,case rate,100% of CMS IPPS rate,12138.42,100,,,case rate,100% of CMS IPPS rate,19945.54,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,9592.03,100,MS-DRG,7673.624,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,9592.03,100,MS-DRG,7673.624,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,3784.31,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,19945.54,
SINUS AND MASTOID PROCEDURES WITH CC/MCC,,,135,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,24916.51,100,MS-DRG,19933.208,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,34431.63,100,,,case rate,100% of CMS IPPS rate,34431.63,100,,,case rate,100% of CMS IPPS rate,12138.42,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,24916.51,100,MS-DRG,19933.208,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,24916.51,100,MS-DRG,19933.208,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,10920.22,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,34431.63,
SINUS AND MASTOID PROCEDURES WITHOUT CC/MCC,,,136,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,11631.32,100,MS-DRG,9305.056,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,18165.68,100,,,case rate,100% of CMS IPPS rate,18165.68,100,,,case rate,100% of CMS IPPS rate,34431.63,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,11631.32,100,MS-DRG,9305.056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,11631.32,100,MS-DRG,9305.056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,5532.59,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,34431.63,
MOUTH PROCEDURES WITH CC/MCC,,,137,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,15435.59,100,MS-DRG,12348.472,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,20631.71,100,,,case rate,100% of CMS IPPS rate,20631.71,100,,,case rate,100% of CMS IPPS rate,18165.68,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,15435.59,100,MS-DRG,12348.472,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,15435.59,100,MS-DRG,12348.472,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,7198.82,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,20631.71,
MOUTH PROCEDURES WITHOUT CC/MCC,,,138,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,10155.56,100,MS-DRG,8124.448,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,12662.79,100,,,case rate,100% of CMS IPPS rate,12662.79,100,,,case rate,100% of CMS IPPS rate,20631.71,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,10155.56,100,MS-DRG,8124.448,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,10155.56,100,MS-DRG,8124.448,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,4258.03,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,20631.71,
SALIVARY GLAND PROCEDURES,,,139,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,12816.23,100,MS-DRG,10252.984,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,17385.11,100,,,case rate,100% of CMS IPPS rate,17385.11,100,,,case rate,100% of CMS IPPS rate,12662.79,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,12816.23,100,MS-DRG,10252.984,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,12816.23,100,MS-DRG,10252.984,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,4928.13,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,17385.11,
MAJOR HEAD AND NECK PROCEDURES WITH MCC,,,140,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,34220.6,100,MS-DRG,27376.48,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,17385.11,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,34220.6,100,MS-DRG,27376.48,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,34220.6,100,MS-DRG,27376.48,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,34220.6,
MAJOR HEAD AND NECK PROCEDURES WITH CC,,,141,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,20120.68,100,MS-DRG,16096.544,case rate,100% of CMS IPPS 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,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,20120.68,100,MS-DRG,16096.544,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,20120.68,100,MS-DRG,16096.544,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,20120.68,
MAJOR HEAD AND NECK PROCEDURES WITHOUT CC/MCC,,,142,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,15768.59,100,MS-DRG,12614.872,case rate,100% of CMS IPPS 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,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,15768.59,100,MS-DRG,12614.872,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,15768.59,100,MS-DRG,12614.872,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,15768.59,
"OTHER EAR, NOSE, MOUTH AND THROAT O.R. PROCEDURES WITH MCC",,,143,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,30481.61,100,MS-DRG,24385.288,case rate,100% of CMS IPPS 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,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,30481.61,100,MS-DRG,24385.288,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,30481.61,100,MS-DRG,24385.288,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,30481.61,
"OTHER EAR, NOSE, MOUTH AND THROAT O.R. PROCEDURES WITH CC",,,144,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,17301.37,100,MS-DRG,13841.096,case rate,100% of CMS IPPS 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,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,17301.37,100,MS-DRG,13841.096,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,17301.37,100,MS-DRG,13841.096,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,17301.37,
"OTHER EAR, NOSE, MOUTH AND THROAT O.R. PROCEDURES WITHOUT CC/MCC",,,145,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,13092.22,100,MS-DRG,10473.776,case rate,100% of CMS IPPS 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,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,13092.22,100,MS-DRG,10473.776,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,13092.22,100,MS-DRG,10473.776,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,13092.22,
"EAR, NOSE, MOUTH AND THROAT MALIGNANCY WITH MCC",,,146,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,20445.43,100,MS-DRG,16356.344,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,28811.88,100,,,case rate,100% of CMS IPPS rate,28811.88,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,20445.43,100,MS-DRG,16356.344,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,20445.43,100,MS-DRG,16356.344,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,11306.42,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,28811.88,
"EAR, NOSE, MOUTH AND THROAT MALIGNANCY WITH CC",,,147,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,13213.68,100,MS-DRG,10570.944,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,18734.99,100,,,case rate,100% of CMS IPPS rate,18734.99,100,,,case rate,100% of CMS IPPS rate,28811.88,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,13213.68,100,MS-DRG,10570.944,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,13213.68,100,MS-DRG,10570.944,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,6710.88,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,28811.88,
"EAR, NOSE, MOUTH AND THROAT MALIGNANCY WITHOUT CC/MCC",,,148,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,10353.87,100,MS-DRG,8283.096,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,10843.97,100,,,case rate,100% of CMS IPPS rate,10843.97,100,,,case rate,100% of CMS IPPS rate,18734.99,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,10353.87,100,MS-DRG,8283.096,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,10353.87,100,MS-DRG,8283.096,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,4114.16,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,18734.99,
DYSEQUILIBRIUM,,,149,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,9155.73,100,MS-DRG,7324.584,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,10653.7,100,,,case rate,100% of CMS IPPS rate,10653.7,100,,,case rate,100% of CMS IPPS rate,10843.97,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,9155.73,100,MS-DRG,7324.584,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,9155.73,100,MS-DRG,7324.584,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,3473.6,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,10843.97,
EPISTAXIS WITH MCC,,,150,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,13863.98,100,MS-DRG,11091.184,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,19888.61,100,,,case rate,100% of CMS IPPS rate,19888.61,100,,,case rate,100% of CMS IPPS rate,10653.7,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,13863.98,100,MS-DRG,11091.184,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,13863.98,100,MS-DRG,11091.184,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,7167.64,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,19888.61,
EPISTAXIS WITHOUT MCC,,,151,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,9370.57,100,MS-DRG,7496.456,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,10544.33,100,,,case rate,100% of CMS IPPS rate,10544.33,100,,,case rate,100% of CMS IPPS rate,19888.61,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,9370.57,100,MS-DRG,7496.456,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,9370.57,100,MS-DRG,7496.456,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,3610.9,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,19888.61,
OTITIS MEDIA AND URI WITH MCC,,,152,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,12820.36,100,MS-DRG,10256.288,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,15612.74,100,,,case rate,100% of CMS IPPS rate,15612.74,100,,,case rate,100% of CMS IPPS rate,10544.33,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,12820.36,100,MS-DRG,10256.288,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,12820.36,100,MS-DRG,10256.288,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,5235.01,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,15612.74,
OTITIS MEDIA AND URI WITHOUT MCC,,,153,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,9073.94,100,MS-DRG,7259.152,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,10664.19,100,,,case rate,100% of CMS IPPS rate,10664.19,100,,,case rate,100% of CMS IPPS rate,15612.74,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,9073.94,100,MS-DRG,7259.152,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,9073.94,100,MS-DRG,7259.152,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,3444.06,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,15612.74,
"OTHER EAR, NOSE, MOUTH AND THROAT DIAGNOSES WITH MCC",,,154,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,15712.4,100,MS-DRG,12569.92,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,21671.46,100,,,case rate,100% of CMS IPPS rate,21671.46,100,,,case rate,100% of CMS IPPS rate,10664.19,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,15712.4,100,MS-DRG,12569.92,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,15712.4,100,MS-DRG,12569.92,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,7786.87,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,21671.46,
"OTHER EAR, NOSE, MOUTH AND THROAT DIAGNOSES WITH CC",,,155,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,10824.03,100,MS-DRG,8659.224,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,13233.6,100,,,case rate,100% of CMS IPPS rate,13233.6,100,,,case rate,100% of CMS IPPS rate,21671.46,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,10824.03,100,MS-DRG,8659.224,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,10824.03,100,MS-DRG,8659.224,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,4915,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,21671.46,
"OTHER EAR, NOSE, MOUTH AND THROAT DIAGNOSES WITHOUT CC/MCC",,,156,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,8418.67,100,MS-DRG,6734.936,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,9886.62,100,,,case rate,100% of CMS IPPS rate,9886.62,100,,,case rate,100% of CMS IPPS rate,13233.6,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,8418.67,100,MS-DRG,6734.936,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,8418.67,100,MS-DRG,6734.936,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,3387.17,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,13233.6,
DENTAL AND ORAL DISEASES WITH MCC,,,157,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,17107.2,100,MS-DRG,13685.76,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,25064.89,100,,,case rate,100% of CMS IPPS rate,25064.89,100,,,case rate,100% of CMS IPPS rate,9886.62,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,17107.2,100,MS-DRG,13685.76,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,17107.2,100,MS-DRG,13685.76,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,8802.69,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,25064.89,
DENTAL AND ORAL DISEASES WITH CC,,,158,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,10757.1,100,MS-DRG,8605.68,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,13338.47,100,,,case rate,100% of CMS IPPS rate,13338.47,100,,,case rate,100% of CMS IPPS rate,25064.89,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,10757.1,100,MS-DRG,8605.68,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,10757.1,100,MS-DRG,8605.68,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,4907.34,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,25064.89,
DENTAL AND ORAL DISEASES WITHOUT CC/MCC,,,159,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,8581.47,100,MS-DRG,6865.176,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,10163.79,100,,,case rate,100% of CMS IPPS rate,10163.79,100,,,case rate,100% of CMS IPPS rate,13338.47,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,8581.47,100,MS-DRG,6865.176,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,8581.47,100,MS-DRG,6865.176,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,3173.28,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,13338.47,
MAJOR CHEST PROCEDURES WITH MCC,,,163,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,41950.62,100,MS-DRG,33560.496,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,73700.95,100,,,case rate,100% of CMS IPPS rate,73700.95,100,,,case rate,100% of CMS IPPS rate,10163.79,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,41950.62,100,MS-DRG,33560.496,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,41950.62,100,MS-DRG,33560.496,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,27848.94,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,73700.95,
MAJOR CHEST PROCEDURES WITH CC,,,164,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,24076.16,100,MS-DRG,19260.928,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,38487.26,100,,,case rate,100% of CMS IPPS rate,38487.26,100,,,case rate,100% of CMS IPPS rate,73700.95,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,24076.16,100,MS-DRG,19260.928,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,24076.16,100,MS-DRG,19260.928,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,14238.46,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,73700.95,
MAJOR CHEST PROCEDURES WITHOUT CC/MCC,,,165,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,18506.94,100,MS-DRG,14805.552,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,27752.66,100,,,case rate,100% of CMS IPPS rate,27752.66,100,,,case rate,100% of CMS IPPS rate,38487.26,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,18506.94,100,MS-DRG,14805.552,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,18506.94,100,MS-DRG,14805.552,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,9766.55,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,38487.26,
OTHER RESPIRATORY SYSTEM O.R. PROCEDURES WITH MCC,,,166,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,36531.75,100,MS-DRG,29225.4,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,52407.04,100,,,case rate,100% of CMS IPPS rate,52407.04,100,,,case rate,100% of CMS IPPS rate,27752.66,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,36531.75,100,MS-DRG,29225.4,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,36531.75,100,MS-DRG,29225.4,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,20415.99,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,52407.04,
OTHER RESPIRATORY SYSTEM O.R. PROCEDURES WITH CC,,,167,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,18039.26,100,MS-DRG,14431.408,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,28429.84,100,,,case rate,100% of CMS IPPS rate,28429.84,100,,,case rate,100% of CMS IPPS rate,52407.04,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,18039.26,100,MS-DRG,14431.408,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,18039.26,100,MS-DRG,14431.408,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,11255,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,52407.04,
OTHER RESPIRATORY SYSTEM O.R. PROCEDURES WITHOUT CC/MCC,,,168,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,14204.41,100,MS-DRG,11363.528,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,20099.85,100,,,case rate,100% of CMS IPPS rate,20099.85,100,,,case rate,100% of CMS IPPS rate,28429.84,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,14204.41,100,MS-DRG,11363.528,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,14204.41,100,MS-DRG,11363.528,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,6996.97,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,28429.84,
ULTRASOUND ACCELERATED AND OTHER THROMBOLYSIS WITH PRINCIPAL DIAGNOSIS PULMONARY EMBOLISM,,,173,RC,,,Inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,28410.92,100,MS-DRG,22728.736,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,20099.85,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,28410.92,100,MS-DRG,22728.736,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,28410.92,100,MS-DRG,22728.736,case rate,100% of CMS IPPS 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,850,28410.92,
PULMONARY EMBOLISM WITH MCC OR ACUTE COR PULMONALE,,,175,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,14595.26,100,MS-DRG,11676.208,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,21947.13,100,,,case rate,100% of CMS IPPS rate,21947.13,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,14595.26,100,MS-DRG,11676.208,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,14595.26,100,MS-DRG,11676.208,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,8868.34,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,21947.13,
PULMONARY EMBOLISM WITHOUT MCC,,,176,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,9741.59,100,MS-DRG,7793.272,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,13468.82,100,,,case rate,100% of CMS IPPS rate,13468.82,100,,,case rate,100% of CMS IPPS rate,21947.13,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,9741.59,100,MS-DRG,7793.272,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,9741.59,100,MS-DRG,7793.272,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,5735.54,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,21947.13,
RESPIRATORY INFECTIONS AND INFLAMMATIONS WITH MCC,,,177,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,17019.6,100,MS-DRG,13615.68,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,27578.87,100,,,case rate,100% of CMS IPPS rate,27578.87,100,,,case rate,100% of CMS IPPS rate,13468.82,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,17019.6,100,MS-DRG,13615.68,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,17019.6,100,MS-DRG,13615.68,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,11297.67,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,27578.87,
RESPIRATORY INFECTIONS AND INFLAMMATIONS WITH CC,,,178,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,11155.38,100,MS-DRG,8924.304,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,19093.06,100,,,case rate,100% of CMS IPPS rate,19093.06,100,,,case rate,100% of CMS IPPS rate,27578.87,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,11155.38,100,MS-DRG,8924.304,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,11155.38,100,MS-DRG,8924.304,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,8015.53,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,27578.87,
RESPIRATORY INFECTIONS AND INFLAMMATIONS WITHOUT CC/MCC,,,179,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,9309.42,100,MS-DRG,7447.536,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,13805.91,100,,,case rate,100% of CMS IPPS rate,13805.91,100,,,case rate,100% of CMS IPPS rate,19093.06,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,9309.42,100,MS-DRG,7447.536,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,9309.42,100,MS-DRG,7447.536,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,5483.91,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,19093.06,
RESPIRATORY NEOPLASMS WITH MCC,,,180,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,17364.99,100,MS-DRG,13891.992,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,25409.47,100,,,case rate,100% of CMS IPPS rate,25409.47,100,,,case rate,100% of CMS IPPS rate,13805.91,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,17364.99,100,MS-DRG,13891.992,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,17364.99,100,MS-DRG,13891.992,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,9519.84,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,25409.47,
RESPIRATORY NEOPLASMS WITH CC,,,181,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,12100.66,100,MS-DRG,9680.528,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,17092.96,100,,,case rate,100% of CMS IPPS rate,17092.96,100,,,case rate,100% of CMS IPPS rate,25409.47,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,12100.66,100,MS-DRG,9680.528,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,12100.66,100,MS-DRG,9680.528,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,6693.92,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,25409.47,
RESPIRATORY NEOPLASMS WITHOUT CC/MCC,,,182,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,9602.77,100,MS-DRG,7682.216,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,11912.19,100,,,case rate,100% of CMS IPPS rate,11912.19,100,,,case rate,100% of CMS IPPS rate,17092.96,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,9602.77,100,MS-DRG,7682.216,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,9602.77,100,MS-DRG,7682.216,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,4620.16,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,17092.96,
MAJOR CHEST TRAUMA WITH MCC,,,183,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,16012.34,100,MS-DRG,12809.872,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,22336.66,100,,,case rate,100% of CMS IPPS rate,22336.66,100,,,case rate,100% of CMS IPPS rate,11912.19,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,16012.34,100,MS-DRG,12809.872,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,16012.34,100,MS-DRG,12809.872,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,8038.5,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,22336.66,
MAJOR CHEST TRAUMA WITH CC,,,184,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,11694.12,100,MS-DRG,9355.296,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,15047.92,100,,,case rate,100% of CMS IPPS rate,15047.92,100,,,case rate,100% of CMS IPPS rate,22336.66,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,11694.12,100,MS-DRG,9355.296,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,11694.12,100,MS-DRG,9355.296,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,5517.27,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,22336.66,
MAJOR CHEST TRAUMA WITHOUT CC/MCC,,,185,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,9246.63,100,MS-DRG,7397.304,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,10971.32,100,,,case rate,100% of CMS IPPS rate,10971.32,100,,,case rate,100% of CMS IPPS rate,15047.92,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,9246.63,100,MS-DRG,7397.304,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,9246.63,100,MS-DRG,7397.304,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,3836.27,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,15047.92,
PLEURAL EFFUSION WITH MCC,,,186,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,15827.26,100,MS-DRG,12661.808,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,23364.43,100,,,case rate,100% of CMS IPPS rate,23364.43,100,,,case rate,100% of CMS IPPS rate,10971.32,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,15827.26,100,MS-DRG,12661.808,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,15827.26,100,MS-DRG,12661.808,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,8656.09,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,23364.43,
PLEURAL EFFUSION WITH CC,,,187,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,11234.7,100,MS-DRG,8987.76,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,15791.03,100,,,case rate,100% of CMS IPPS rate,15791.03,100,,,case rate,100% of CMS IPPS rate,23364.43,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,11234.7,100,MS-DRG,8987.76,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,11234.7,100,MS-DRG,8987.76,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,6084.54,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,23364.43,
PLEURAL EFFUSION WITHOUT CC/MCC,,,188,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,9170.61,100,MS-DRG,7336.488,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,11494.19,100,,,case rate,100% of CMS IPPS rate,11494.19,100,,,case rate,100% of CMS IPPS rate,15791.03,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,9170.61,100,MS-DRG,7336.488,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,9170.61,100,MS-DRG,7336.488,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,4211.53,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,15791.03,
PULMONARY EDEMA AND RESPIRATORY FAILURE,,,189,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,13182.28,100,MS-DRG,10545.824,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,18507.26,100,,,case rate,100% of CMS IPPS rate,18507.26,100,,,case rate,100% of CMS IPPS rate,11494.19,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,13182.28,100,MS-DRG,10545.824,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,13182.28,100,MS-DRG,10545.824,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,6943.91,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,18507.26,
CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH MCC,,,190,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,12108.1,100,MS-DRG,9686.48,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,17839.07,100,,,case rate,100% of CMS IPPS rate,17839.07,100,,,case rate,100% of CMS IPPS rate,18507.26,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,12108.1,100,MS-DRG,9686.48,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,12108.1,100,MS-DRG,9686.48,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,6391.42,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,18507.26,
CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH CC,,,191,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,10017.56,100,MS-DRG,8014.048,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,13692.05,100,,,case rate,100% of CMS IPPS rate,13692.05,100,,,case rate,100% of CMS IPPS rate,17839.07,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,10017.56,100,MS-DRG,8014.048,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,10017.56,100,MS-DRG,8014.048,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,5266.74,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,17839.07,
CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITHOUT CC/MCC,,,192,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,8305.48,100,MS-DRG,6644.384,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,10848.47,100,,,case rate,100% of CMS IPPS rate,10848.47,100,,,case rate,100% of CMS IPPS rate,13692.05,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,8305.48,100,MS-DRG,6644.384,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,8305.48,100,MS-DRG,6644.384,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,3873.47,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,13692.05,
SIMPLE PNEUMONIA AND PLEURISY WITH MCC,,,193,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,13963.97,100,MS-DRG,11171.176,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,19726.8,100,,,case rate,100% of CMS IPPS rate,19726.8,100,,,case rate,100% of CMS IPPS rate,10848.47,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,13963.97,100,MS-DRG,11171.176,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,13963.97,100,MS-DRG,11171.176,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,8176.9,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,19726.8,
SIMPLE PNEUMONIA AND PLEURISY WITH CC,,,194,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,9796.12,100,MS-DRG,7836.896,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,13486.8,100,,,case rate,100% of CMS IPPS rate,13486.8,100,,,case rate,100% of CMS IPPS rate,19726.8,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,9796.12,100,MS-DRG,7836.896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,9796.12,100,MS-DRG,7836.896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,5484.45,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,19726.8,
SIMPLE PNEUMONIA AND PLEURISY WITHOUT CC/MCC,,,195,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,8171.62,100,MS-DRG,6537.296,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,10289.64,100,,,case rate,100% of CMS IPPS rate,10289.64,100,,,case rate,100% of CMS IPPS rate,13486.8,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,8171.62,100,MS-DRG,6537.296,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,8171.62,100,MS-DRG,6537.296,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,3849.4,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,13486.8,
INTERSTITIAL LUNG DISEASE WITH MCC,,,196,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,18663.93,100,MS-DRG,14931.144,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,24542.01,100,,,case rate,100% of CMS IPPS rate,24542.01,100,,,case rate,100% of CMS IPPS rate,10289.64,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,18663.93,100,MS-DRG,14931.144,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,18663.93,100,MS-DRG,14931.144,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,9064.72,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,24542.01,
INTERSTITIAL LUNG DISEASE WITH CC,,,197,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,11244.61,100,MS-DRG,8995.688,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,15007.47,100,,,case rate,100% of CMS IPPS rate,15007.47,100,,,case rate,100% of CMS IPPS rate,24542.01,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,11244.61,100,MS-DRG,8995.688,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,11244.61,100,MS-DRG,8995.688,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,5986.07,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,24542.01,
INTERSTITIAL LUNG DISEASE WITHOUT CC/MCC,,,198,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,9432.55,100,MS-DRG,7546.04,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,11363.85,100,,,case rate,100% of CMS IPPS rate,11363.85,100,,,case rate,100% of CMS IPPS rate,15007.47,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,9432.55,100,MS-DRG,7546.04,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,9432.55,100,MS-DRG,7546.04,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,4288.11,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,15007.47,
PNEUMOTHORAX WITH MCC,,,199,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,17661.64,100,MS-DRG,14129.312,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,26709.91,100,,,case rate,100% of CMS IPPS rate,26709.91,100,,,case rate,100% of CMS IPPS rate,11363.85,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,17661.64,100,MS-DRG,14129.312,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,17661.64,100,MS-DRG,14129.312,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,9925.73,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,26709.91,
PNEUMOTHORAX WITH CC,,,200,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,11901.52,100,MS-DRG,9521.216,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,16102.65,100,,,case rate,100% of CMS IPPS rate,16102.65,100,,,case rate,100% of CMS IPPS rate,26709.91,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,11901.52,100,MS-DRG,9521.216,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,11901.52,100,MS-DRG,9521.216,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,5411.15,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,26709.91,
PNEUMOTHORAX WITHOUT CC/MCC,,,201,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,8836.78,100,MS-DRG,7069.424,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,10470.92,100,,,case rate,100% of CMS IPPS rate,10470.92,100,,,case rate,100% of CMS IPPS rate,16102.65,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,8836.78,100,MS-DRG,7069.424,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,8836.78,100,MS-DRG,7069.424,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,3895.35,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,16102.65,
BRONCHITIS AND ASTHMA WITH CC/MCC,,,202,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,10914.09,100,MS-DRG,8731.272,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,14084.58,100,,,case rate,100% of CMS IPPS rate,14084.58,100,,,case rate,100% of CMS IPPS rate,10470.92,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,10914.09,100,MS-DRG,8731.272,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,10914.09,100,MS-DRG,8731.272,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,4660.09,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,14084.58,
BRONCHITIS AND ASTHMA WITHOUT CC/MCC,,,203,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,8744.24,100,MS-DRG,6995.392,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,10442.45,100,,,case rate,100% of CMS IPPS rate,10442.45,100,,,case rate,100% of CMS IPPS rate,14084.58,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,8744.24,100,MS-DRG,6995.392,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,8744.24,100,MS-DRG,6995.392,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,3354.89,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,14084.58,
RESPIRATORY SIGNS AND SYMPTOMS,,,204,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,9801.9,100,MS-DRG,7841.52,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,11500.18,100,,,case rate,100% of CMS IPPS rate,11500.18,100,,,case rate,100% of CMS IPPS rate,10442.45,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,9801.9,100,MS-DRG,7841.52,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,9801.9,100,MS-DRG,7841.52,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,3590.66,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,11500.18,
OTHER RESPIRATORY SYSTEM DIAGNOSES WITH MCC,,,205,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,17960.74,100,MS-DRG,14368.592,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,22741.18,100,,,case rate,100% of CMS IPPS rate,22741.18,100,,,case rate,100% of CMS IPPS rate,11500.18,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,17960.74,100,MS-DRG,14368.592,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,17960.74,100,MS-DRG,14368.592,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,7288.53,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,22741.18,
OTHER RESPIRATORY SYSTEM DIAGNOSES WITHOUT MCC,,,206,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,10550.53,100,MS-DRG,8440.424,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,12936.96,100,,,case rate,100% of CMS IPPS rate,12936.96,100,,,case rate,100% of CMS IPPS rate,22741.18,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,10550.53,100,MS-DRG,8440.424,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,10550.53,100,MS-DRG,8440.424,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,4138.23,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,22741.18,
RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT >96 HOURS,,,207,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,60082.85,100,MS-DRG,48066.28,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,83846.76,100,,,case rate,100% of CMS IPPS rate,83846.76,100,,,case rate,100% of CMS IPPS rate,12936.96,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,60082.85,100,MS-DRG,48066.28,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,60082.85,100,MS-DRG,48066.28,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,28955.57,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,83846.76,
RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT <=96 HOURS,,,208,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,25343.71,100,MS-DRG,20274.968,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,36517.13,100,,,case rate,100% of CMS IPPS rate,36517.13,100,,,case rate,100% of CMS IPPS rate,83846.76,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,25343.71,100,MS-DRG,20274.968,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,25343.71,100,MS-DRG,20274.968,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,12419.61,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,83846.76,
CONCOMITANT AORTIC AND MITRAL VALVE PROCEDURES,,,212,RC,,,Inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,92000.2,100,MS-DRG,73600.16,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,36517.13,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,92000.2,100,MS-DRG,73600.16,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,92000.2,100,MS-DRG,73600.16,case rate,100% of CMS IPPS 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,850,92000.2,
OTHER HEART ASSIST SYSTEM IMPLANT,,,215,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,87406.82,100,MS-DRG,69925.456,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,193059.55,100,,,case rate,100% of CMS IPPS rate,193059.55,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,87406.82,100,MS-DRG,69925.456,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,87406.82,100,MS-DRG,69925.456,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,75286.23,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,193059.55,
CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITH MCC,,,216,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,83196.84,100,MS-DRG,66557.472,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,147136.72,100,,,case rate,100% of CMS IPPS rate,147136.72,100,,,case rate,100% of CMS IPPS rate,193059.55,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,83196.84,100,MS-DRG,66557.472,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,83196.84,100,MS-DRG,66557.472,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,53018.56,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,193059.55,
CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITH CC,,,217,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,55598.55,100,MS-DRG,44478.84,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,95327.47,100,,,case rate,100% of CMS IPPS rate,95327.47,100,,,case rate,100% of CMS IPPS rate,147136.72,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,55598.55,100,MS-DRG,44478.84,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,55598.55,100,MS-DRG,44478.84,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,35549.38,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,147136.72,
CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITHOUT CC/MCC,,,218,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,50073.93,100,MS-DRG,40059.144,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,88473.2,100,,,case rate,100% of CMS IPPS rate,88473.2,100,,,case rate,100% of CMS IPPS rate,95327.47,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,50073.93,100,MS-DRG,40059.144,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,50073.93,100,MS-DRG,40059.144,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,28299.69,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,95327.47,
CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITHOUT CARDIAC CATHETERIZATION WITH MCC,,,219,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,66719.67,100,MS-DRG,53375.736,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,115235.55,100,,,case rate,100% of CMS IPPS rate,115235.55,100,,,case rate,100% of CMS IPPS rate,88473.2,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,66719.67,100,MS-DRG,53375.736,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,66719.67,100,MS-DRG,53375.736,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,44207.66,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,115235.55,
CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITHOUT CARDIAC CATHETERIZATION WITH CC,,,220,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,46338.25,100,MS-DRG,37070.6,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,77985.8,100,,,case rate,100% of CMS IPPS rate,77985.8,100,,,case rate,100% of CMS IPPS rate,115235.55,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,46338.25,100,MS-DRG,37070.6,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,46338.25,100,MS-DRG,37070.6,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,28774.5,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,115235.55,
CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITHOUT CARDIAC CATHETERIZATION WITHOUT CC/MCC,,,221,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,41413.52,100,MS-DRG,33130.816,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,69028.07,100,,,case rate,100% of CMS IPPS rate,69028.07,100,,,case rate,100% of CMS IPPS rate,77985.8,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,41413.52,100,MS-DRG,33130.816,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,41413.52,100,MS-DRG,33130.816,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,23884.67,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,77985.8,
OTHER CARDIOTHORACIC PROCEDURES WITH MCC,,,228,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,44636.89,100,MS-DRG,35709.512,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,98524.63,100,,,case rate,100% of CMS IPPS rate,98524.63,100,,,case rate,100% of CMS IPPS rate,69028.07,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,44636.89,100,MS-DRG,35709.512,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,44636.89,100,MS-DRG,35709.512,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,40176.1,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,98524.63,
OTHER CARDIOTHORACIC PROCEDURES WITHOUT MCC,,,229,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,29275.23,100,MS-DRG,23420.184,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,69642.33,100,,,case rate,100% of CMS IPPS rate,69642.33,100,,,case rate,100% of CMS IPPS rate,98524.63,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,29275.23,100,MS-DRG,23420.184,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,29275.23,100,MS-DRG,23420.184,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,25465.01,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,98524.63,
CORONARY BYPASS WITH PTCA WITH MCC,,,231,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,70057.9,100,MS-DRG,56046.32,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,125832.32,100,,,case rate,100% of CMS IPPS rate,125832.32,100,,,case rate,100% of CMS IPPS rate,69642.33,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,70057.9,100,MS-DRG,56046.32,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,70057.9,100,MS-DRG,56046.32,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,43260.77,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,125832.32,
CORONARY BYPASS WITH PTCA WITHOUT MCC,,,232,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,52155.37,100,MS-DRG,41724.296,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,92295.11,100,,,case rate,100% of CMS IPPS rate,92295.11,100,,,case rate,100% of CMS IPPS rate,125832.32,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,52155.37,100,MS-DRG,41724.296,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,52155.37,100,MS-DRG,41724.296,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,31010.73,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,125832.32,
CORONARY BYPASS WITH CARDIAC CATHETERIZATION OR OPEN ABLATION WITH MCC,,,233,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,67450.11,100,MS-DRG,53960.088,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,114428.02,100,,,case rate,100% of CMS IPPS rate,114428.02,100,,,case rate,100% of CMS IPPS rate,92295.11,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,67450.11,100,MS-DRG,53960.088,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,67450.11,100,MS-DRG,53960.088,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,39067.29,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,114428.02,
CORONARY BYPASS WITH CARDIAC CATHETERIZATION OR OPEN ABLATION WITHOUT MCC,,,234,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,45952.36,100,MS-DRG,36761.888,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,77115.35,100,,,case rate,100% of CMS IPPS rate,77115.35,100,,,case rate,100% of CMS IPPS rate,114428.02,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,45952.36,100,MS-DRG,36761.888,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,45952.36,100,MS-DRG,36761.888,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,26428.87,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,114428.02,
CORONARY BYPASS WITHOUT CARDIAC CATHETERIZATION WITH MCC,,,235,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,51593.49,100,MS-DRG,41274.792,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,87043.92,100,,,case rate,100% of CMS IPPS rate,87043.92,100,,,case rate,100% of CMS IPPS rate,77115.35,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,51593.49,100,MS-DRG,41274.792,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,51593.49,100,MS-DRG,41274.792,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,32308.82,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,87043.92,
CORONARY BYPASS WITHOUT CARDIAC CATHETERIZATION WITHOUT MCC,,,236,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,36394.6,100,MS-DRG,29115.68,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,58823.83,100,,,case rate,100% of CMS IPPS rate,58823.83,100,,,case rate,100% of CMS IPPS rate,87043.92,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,36394.6,100,MS-DRG,29115.68,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,36394.6,100,MS-DRG,29115.68,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,20633.71,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,87043.92,
AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITH MCC,,,239,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,42720.73,100,MS-DRG,34176.584,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,70554.73,100,,,case rate,100% of CMS IPPS rate,70554.73,100,,,case rate,100% of CMS IPPS rate,58823.83,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,42720.73,100,MS-DRG,34176.584,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,42720.73,100,MS-DRG,34176.584,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,25929.44,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,70554.73,
AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITH CC,,,240,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,26214.63,100,MS-DRG,20971.704,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,41124.09,100,,,case rate,100% of CMS IPPS rate,41124.09,100,,,case rate,100% of CMS IPPS rate,70554.73,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,26214.63,100,MS-DRG,20971.704,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,26214.63,100,MS-DRG,20971.704,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,14257.06,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,70554.73,
AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITHOUT CC/MCC,,,241,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,14520.89,100,MS-DRG,11616.712,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,23911.27,100,,,case rate,100% of CMS IPPS rate,23911.27,100,,,case rate,100% of CMS IPPS rate,41124.09,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,14520.89,100,MS-DRG,11616.712,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,14520.89,100,MS-DRG,11616.712,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,8171.98,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,41124.09,
PERMANENT CARDIAC PACEMAKER IMPLANT WITH MCC,,,242,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,31551.67,100,MS-DRG,25241.336,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,55986.24,100,,,case rate,100% of CMS IPPS rate,55986.24,100,,,case rate,100% of CMS IPPS rate,23911.27,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,31551.67,100,MS-DRG,25241.336,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,31551.67,100,MS-DRG,25241.336,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,20149.59,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,55986.24,
PERMANENT CARDIAC PACEMAKER IMPLANT WITH CC,,,243,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,21822.03,100,MS-DRG,17457.624,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,38268.52,100,,,case rate,100% of CMS IPPS rate,38268.52,100,,,case rate,100% of CMS IPPS rate,55986.24,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,21822.03,100,MS-DRG,17457.624,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,21822.03,100,MS-DRG,17457.624,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,14421.17,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,55986.24,
PERMANENT CARDIAC PACEMAKER IMPLANT WITHOUT CC/MCC,,,244,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,18119.4,100,MS-DRG,14495.52,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,31624.01,100,,,case rate,100% of CMS IPPS rate,31624.01,100,,,case rate,100% of CMS IPPS rate,38268.52,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,18119.4,100,MS-DRG,14495.52,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,18119.4,100,MS-DRG,14495.52,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,11234.76,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,38268.52,
AICD GENERATOR PROCEDURES,,,245,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,40445.11,100,MS-DRG,32356.088,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,75091.28,100,,,case rate,100% of CMS IPPS rate,75091.28,100,,,case rate,100% of CMS IPPS rate,31624.01,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,40445.11,100,MS-DRG,32356.088,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,40445.11,100,MS-DRG,32356.088,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,22956.91,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,75091.28,
PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITHOUT INTRALUMINAL DEVICE WITH MCC,,,250,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,22426.89,100,MS-DRG,17941.512,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,38755.44,100,,,case rate,100% of CMS IPPS rate,38755.44,100,,,case rate,100% of CMS IPPS rate,75091.28,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,22426.89,100,MS-DRG,17941.512,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,22426.89,100,MS-DRG,17941.512,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,15820.45,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,75091.28,
PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITHOUT INTRALUMINAL DEVICE WITHOUT MCC,,,251,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,16114.81,100,MS-DRG,12891.848,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,25136.8,100,,,case rate,100% of CMS IPPS rate,25136.8,100,,,case rate,100% of CMS IPPS rate,38755.44,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,16114.81,100,MS-DRG,12891.848,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,16114.81,100,MS-DRG,12891.848,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,10090.93,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,38755.44,
OTHER VASCULAR PROCEDURES WITH MCC,,,252,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,30714.64,100,MS-DRG,24571.712,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,48838.32,100,,,case rate,100% of CMS IPPS rate,48838.32,100,,,case rate,100% of CMS IPPS rate,25136.8,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,30714.64,100,MS-DRG,24571.712,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,30714.64,100,MS-DRG,24571.712,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,16336.84,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,48838.32,
OTHER VASCULAR PROCEDURES WITH CC,,,253,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,24081.95,100,MS-DRG,19265.56,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,38867.8,100,,,case rate,100% of CMS IPPS rate,38867.8,100,,,case rate,100% of CMS IPPS rate,48838.32,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,24081.95,100,MS-DRG,19265.56,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,24081.95,100,MS-DRG,19265.56,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,13364.87,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,48838.32,
OTHER VASCULAR PROCEDURES WITHOUT CC/MCC,,,254,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,17339.38,100,MS-DRG,13871.504,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,27117.42,100,,,case rate,100% of CMS IPPS rate,27117.42,100,,,case rate,100% of CMS IPPS rate,38867.8,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,17339.38,100,MS-DRG,13871.504,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,17339.38,100,MS-DRG,13871.504,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,9037.37,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,38867.8,
UPPER LIMB AND TOE AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS WITH MCC,,,255,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,25703.97,100,MS-DRG,20563.176,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,38058.77,100,,,case rate,100% of CMS IPPS rate,38058.77,100,,,case rate,100% of CMS IPPS rate,27117.42,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,25703.97,100,MS-DRG,20563.176,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,25703.97,100,MS-DRG,20563.176,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,13780.6,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,38058.77,
UPPER LIMB AND TOE AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS WITH CC,,,256,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,16551.09,100,MS-DRG,13240.872,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,26199.02,100,,,case rate,100% of CMS IPPS rate,26199.02,100,,,case rate,100% of CMS IPPS rate,38058.77,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,16551.09,100,MS-DRG,13240.872,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,16551.09,100,MS-DRG,13240.872,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,8771.51,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,38058.77,
UPPER LIMB AND TOE AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS WITHOUT CC/MCC,,,257,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,11190.91,100,MS-DRG,8952.728,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,16871.23,100,,,case rate,100% of CMS IPPS rate,16871.23,100,,,case rate,100% of CMS IPPS rate,26199.02,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,11190.91,100,MS-DRG,8952.728,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,11190.91,100,MS-DRG,8952.728,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,4962.05,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,26199.02,
CARDIAC PACEMAKER DEVICE REPLACEMENT WITH MCC,,,258,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,25383.37,100,MS-DRG,20306.696,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,44778.2,100,,,case rate,100% of CMS IPPS rate,44778.2,100,,,case rate,100% of CMS IPPS rate,16871.23,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,25383.37,100,MS-DRG,20306.696,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,25383.37,100,MS-DRG,20306.696,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,16254.24,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,44778.2,
CARDIAC PACEMAKER DEVICE REPLACEMENT WITHOUT MCC,,,259,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,18425.96,100,MS-DRG,14740.768,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,31417.25,100,,,case rate,100% of CMS IPPS rate,31417.25,100,,,case rate,100% of CMS IPPS rate,44778.2,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,18425.96,100,MS-DRG,14740.768,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,18425.96,100,MS-DRG,14740.768,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,9965.12,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,44778.2,
CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITH MCC,,,260,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,30395.69,100,MS-DRG,24316.552,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,54227.35,100,,,case rate,100% of CMS IPPS rate,54227.35,100,,,case rate,100% of CMS IPPS rate,31417.25,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,30395.69,100,MS-DRG,24316.552,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,30395.69,100,MS-DRG,24316.552,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,19855.29,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,54227.35,
CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITH CC,,,261,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,18551.55,100,MS-DRG,14841.24,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,29841.15,100,,,case rate,100% of CMS IPPS rate,29841.15,100,,,case rate,100% of CMS IPPS rate,54227.35,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,18551.55,100,MS-DRG,14841.24,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,18551.55,100,MS-DRG,14841.24,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,9162.64,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,54227.35,
CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITHOUT CC/MCC,,,262,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,16597.36,100,MS-DRG,13277.888,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,24434.14,100,,,case rate,100% of CMS IPPS rate,24434.14,100,,,case rate,100% of CMS IPPS rate,29841.15,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,16597.36,100,MS-DRG,13277.888,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,16597.36,100,MS-DRG,13277.888,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,6430.8,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,29841.15,
VEIN LIGATION AND STRIPPING,,,263,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,26346.83,100,MS-DRG,21077.464,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,35839.94,100,,,case rate,100% of CMS IPPS rate,35839.94,100,,,case rate,100% of CMS IPPS rate,24434.14,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,26346.83,100,MS-DRG,21077.464,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,26346.83,100,MS-DRG,21077.464,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,8876,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,35839.94,
OTHER CIRCULATORY SYSTEM O.R. PROCEDURES,,,264,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,29989.15,100,MS-DRG,23991.32,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,47322.15,100,,,case rate,100% of CMS IPPS rate,47322.15,100,,,case rate,100% of CMS IPPS rate,35839.94,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,29989.15,100,MS-DRG,23991.32,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,29989.15,100,MS-DRG,23991.32,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,13992.85,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,47322.15,
AICD LEAD PROCEDURES,,,265,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,32204.45,100,MS-DRG,25763.56,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,46694.4,100,,,case rate,100% of CMS IPPS rate,46694.4,100,,,case rate,100% of CMS IPPS rate,47322.15,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,32204.45,100,MS-DRG,25763.56,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,32204.45,100,MS-DRG,25763.56,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,12654.28,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,47322.15,
ENDOVASCULAR CARDIAC VALVE REPLACEMENT AND SUPPLEMENT PROCEDURES WITH MCC,,,266,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,54613.61,100,MS-DRG,43690.888,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,107743.05,100,,,case rate,100% of CMS IPPS rate,107743.05,100,,,case rate,100% of CMS IPPS rate,46694.4,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,54613.61,100,MS-DRG,43690.888,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,54613.61,100,MS-DRG,43690.888,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,107743.05,
ENDOVASCULAR CARDIAC VALVE REPLACEMENT AND SUPPLEMENT PROCEDURES WITHOUT MCC,,,267,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,43327.22,100,MS-DRG,34661.776,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,87616.23,100,,,case rate,100% of CMS IPPS rate,87616.23,100,,,case rate,100% of CMS IPPS rate,107743.05,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,43327.22,100,MS-DRG,34661.776,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,43327.22,100,MS-DRG,34661.776,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,107743.05,
AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON WITH MCC,,,268,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,59642.44,100,MS-DRG,47713.952,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,100434.83,100,,,case rate,100% of CMS IPPS rate,100434.83,100,,,case rate,100% of CMS IPPS rate,87616.23,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,59642.44,100,MS-DRG,47713.952,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,59642.44,100,MS-DRG,47713.952,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100434.83,
AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON WITHOUT MCC,,,269,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,37364.67,100,MS-DRG,29891.736,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,62188.78,100,,,case rate,100% of CMS IPPS rate,62188.78,100,,,case rate,100% of CMS IPPS rate,100434.83,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,37364.67,100,MS-DRG,29891.736,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,37364.67,100,MS-DRG,29891.736,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100434.83,
OTHER MAJOR CARDIOVASCULAR PROCEDURES WITH MCC,,,270,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,44787.29,100,MS-DRG,35829.832,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,75834.39,100,,,case rate,100% of CMS IPPS rate,75834.39,100,,,case rate,100% of CMS IPPS rate,62188.78,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,44787.29,100,MS-DRG,35829.832,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,44787.29,100,MS-DRG,35829.832,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,75834.39,
OTHER MAJOR CARDIOVASCULAR PROCEDURES WITH CC,,,271,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,31560.77,100,MS-DRG,25248.616,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,52344.11,100,,,case rate,100% of CMS IPPS rate,52344.11,100,,,case rate,100% of CMS IPPS rate,75834.39,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,31560.77,100,MS-DRG,25248.616,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,31560.77,100,MS-DRG,25248.616,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,75834.39,
OTHER MAJOR CARDIOVASCULAR PROCEDURES WITHOUT CC/MCC,,,272,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,23159.81,100,MS-DRG,18527.848,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,39224.37,100,,,case rate,100% of CMS IPPS rate,39224.37,100,,,case rate,100% of CMS IPPS rate,52344.11,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,23159.81,100,MS-DRG,18527.848,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,23159.81,100,MS-DRG,18527.848,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,52344.11,
PERCUTANEOUS AND OTHER INTRACARDIAC PROCEDURES WITH MCC,,,273,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,35203.08,100,MS-DRG,28162.464,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,54721.76,100,,,case rate,100% of CMS IPPS rate,54721.76,100,,,case rate,100% of CMS IPPS rate,39224.37,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,35203.08,100,MS-DRG,28162.464,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,35203.08,100,MS-DRG,28162.464,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,54721.76,
PERCUTANEOUS AND OTHER INTRACARDIAC PROCEDURES WITHOUT MCC,,,274,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,29780.92,100,MS-DRG,23824.736,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,44620.89,100,,,case rate,100% of CMS IPPS rate,44620.89,100,,,case rate,100% of CMS IPPS rate,54721.76,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,29780.92,100,MS-DRG,23824.736,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,29780.92,100,MS-DRG,23824.736,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,54721.76,
CARDIAC DEFIBRILLATOR IMPLANT WITH CARDIAC CATHETERIZATION AND MCC,,,275,RC,,,Inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,61138.85,100,MS-DRG,48911.08,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,44620.89,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,61138.85,100,MS-DRG,48911.08,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,61138.85,100,MS-DRG,48911.08,case rate,100% of CMS IPPS 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,850,61138.85,
CARDIAC DEFIBRILLATOR IMPLANT WITH MCC OR CAROTID SINUS NEUROSTIMULATOR,,,276,RC,,,Inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,54316.96,100,MS-DRG,43453.568,case rate,100% of CMS IPPS 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,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,54316.96,100,MS-DRG,43453.568,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,54316.96,100,MS-DRG,43453.568,case rate,100% of CMS IPPS 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,850,54316.96,
CARDIAC DEFIBRILLATOR IMPLANT WITHOUT MCC,,,277,RC,,,Inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,42519.1,100,MS-DRG,34015.28,case rate,100% of CMS IPPS 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,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,42519.1,100,MS-DRG,34015.28,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,42519.1,100,MS-DRG,34015.28,case rate,100% of CMS IPPS 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,850,42519.1,
ULTRASOUND ACCELERATED AND OTHER THROMBOLYSIS OF PERIPHERAL VASCULAR STRUCTURES WITH MCC,,,278,RC,,,Inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,39858.43,100,MS-DRG,31886.744,case rate,100% of CMS IPPS 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,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,39858.43,100,MS-DRG,31886.744,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,39858.43,100,MS-DRG,31886.744,case rate,100% of CMS IPPS 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,850,39858.43,
ULTRASOUND ACCELERATED AND OTHER THROMBOLYSIS OF PERIPHERAL VASCULAR STRUCTURES WITHOUT MCC,,,279,RC,,,Inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,29448.75,100,MS-DRG,23559,case rate,100% of CMS IPPS 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,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,29448.75,100,MS-DRG,23559,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,29448.75,100,MS-DRG,23559,case rate,100% of CMS IPPS 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,850,29448.75,
"ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH MCC",,,280,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,16111.5,100,MS-DRG,12889.2,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,24826.67,100,,,case rate,100% of CMS IPPS rate,24826.67,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,16111.5,100,MS-DRG,12889.2,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,16111.5,100,MS-DRG,12889.2,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,9792.26,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,24826.67,
"ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH CC",,,281,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,10546.4,100,MS-DRG,8437.12,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,14676.37,100,,,case rate,100% of CMS IPPS rate,14676.37,100,,,case rate,100% of CMS IPPS rate,24826.67,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,10546.4,100,MS-DRG,8437.12,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,10546.4,100,MS-DRG,8437.12,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,6278.73,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,24826.67,
"ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITHOUT CC/MCC",,,282,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,8935.95,100,MS-DRG,7148.76,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,11221.52,100,,,case rate,100% of CMS IPPS rate,11221.52,100,,,case rate,100% of CMS IPPS rate,14676.37,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,8935.95,100,MS-DRG,7148.76,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,8935.95,100,MS-DRG,7148.76,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,4297.41,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,14676.37,
"ACUTE MYOCARDIAL INFARCTION, EXPIRED WITH MCC",,,283,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,19291.92,100,MS-DRG,15433.536,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,27038.02,100,,,case rate,100% of CMS IPPS rate,27038.02,100,,,case rate,100% of CMS IPPS rate,11221.52,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,19291.92,100,MS-DRG,15433.536,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,19291.92,100,MS-DRG,15433.536,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,9363.94,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,27038.02,
"ACUTE MYOCARDIAL INFARCTION, EXPIRED WITH CC",,,284,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,9114.42,100,MS-DRG,7291.536,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,11485.2,100,,,case rate,100% of CMS IPPS rate,11485.2,100,,,case rate,100% of CMS IPPS rate,27038.02,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,9114.42,100,MS-DRG,7291.536,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,9114.42,100,MS-DRG,7291.536,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,4594.99,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,27038.02,
"ACUTE MYOCARDIAL INFARCTION, EXPIRED WITHOUT CC/MCC",,,285,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,7040.43,100,MS-DRG,5632.344,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,8935.26,100,,,case rate,100% of CMS IPPS rate,8935.26,100,,,case rate,100% of CMS IPPS rate,11485.2,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,7040.43,100,MS-DRG,5632.344,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,7040.43,100,MS-DRG,5632.344,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,2954.47,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,11485.2,
"CIRCULATORY DISORDERS EXCEPT AMI, WITH CARDIAC CATHETERIZATION WITH MCC",,,286,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,20813.96,100,MS-DRG,16651.168,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,32672.75,100,,,case rate,100% of CMS IPPS rate,32672.75,100,,,case rate,100% of CMS IPPS rate,8935.26,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,20813.96,100,MS-DRG,16651.168,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,20813.96,100,MS-DRG,16651.168,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,11137.39,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,32672.75,
"CIRCULATORY DISORDERS EXCEPT AMI, WITH CARDIAC CATHETERIZATION WITHOUT MCC",,,287,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,11939.53,100,MS-DRG,9551.624,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,17063,100,,,case rate,100% of CMS IPPS rate,17063,100,,,case rate,100% of CMS IPPS rate,32672.75,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,11939.53,100,MS-DRG,9551.624,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,11939.53,100,MS-DRG,9551.624,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,5876.67,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,32672.75,
ACUTE AND SUBACUTE ENDOCARDITIS WITH MCC,,,288,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,24428.17,100,MS-DRG,19542.536,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,40363.01,100,,,case rate,100% of CMS IPPS rate,40363.01,100,,,case rate,100% of CMS IPPS rate,17063,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,24428.17,100,MS-DRG,19542.536,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,24428.17,100,MS-DRG,19542.536,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,15674.4,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,40363.01,
ACUTE AND SUBACUTE ENDOCARDITIS WITH CC,,,289,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,15212.49,100,MS-DRG,12169.992,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,25617.72,100,,,case rate,100% of CMS IPPS rate,25617.72,100,,,case rate,100% of CMS IPPS rate,40363.01,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,15212.49,100,MS-DRG,12169.992,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,15212.49,100,MS-DRG,12169.992,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,10121.02,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,40363.01,
ACUTE AND SUBACUTE ENDOCARDITIS WITHOUT CC/MCC,,,290,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,11968.45,100,MS-DRG,9574.76,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,15152.79,100,,,case rate,100% of CMS IPPS rate,15152.79,100,,,case rate,100% of CMS IPPS rate,25617.72,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,11968.45,100,MS-DRG,9574.76,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,11968.45,100,MS-DRG,9574.76,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,6094.38,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,25617.72,
HEART FAILURE AND SHOCK WITH MCC,,,291,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,13611.12,100,MS-DRG,10888.896,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,20156.78,100,,,case rate,100% of CMS IPPS rate,20156.78,100,,,case rate,100% of CMS IPPS rate,15152.79,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,13611.12,100,MS-DRG,10888.896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,13611.12,100,MS-DRG,10888.896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,8210.82,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,20156.78,
HEART FAILURE AND SHOCK WITH CC,,,292,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,10079.53,100,MS-DRG,8063.624,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,13780.44,100,,,case rate,100% of CMS IPPS rate,13780.44,100,,,case rate,100% of CMS IPPS rate,20156.78,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,10079.53,100,MS-DRG,8063.624,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,10079.53,100,MS-DRG,8063.624,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,5587.29,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,20156.78,
HEART FAILURE AND SHOCK WITHOUT CC/MCC,,,293,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,7641.96,100,MS-DRG,6113.568,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,9972.02,100,,,case rate,100% of CMS IPPS rate,9972.02,100,,,case rate,100% of CMS IPPS rate,13780.44,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,7641.96,100,MS-DRG,6113.568,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,7641.96,100,MS-DRG,6113.568,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,3695.69,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,13780.44,
DEEP VEIN THROMBOPHLEBITIS WITH CC/MCC,,,294,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,12039.51,100,MS-DRG,9631.608,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,17391.11,100,,,case rate,100% of CMS IPPS rate,17391.11,100,,,case rate,100% of CMS IPPS rate,9972.02,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,12039.51,100,MS-DRG,9631.608,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,12039.51,100,MS-DRG,9631.608,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,5424.28,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,17391.11,
DEEP VEIN THROMBOPHLEBITIS WITHOUT CC/MCC,,,295,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,9588.72,100,MS-DRG,7670.976,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,8259.58,100,,,case rate,100% of CMS IPPS rate,8259.58,100,,,case rate,100% of CMS IPPS rate,17391.11,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,9588.72,100,MS-DRG,7670.976,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,9588.72,100,MS-DRG,7670.976,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,3824.78,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,17391.11,
"CARDIAC ARREST, UNEXPLAINED WITH MCC",,,296,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,16249.5,100,MS-DRG,12999.6,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,23004.86,100,,,case rate,100% of CMS IPPS rate,23004.86,100,,,case rate,100% of CMS IPPS rate,8259.58,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,16249.5,100,MS-DRG,12999.6,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,16249.5,100,MS-DRG,12999.6,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,7053.86,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,23004.86,
"CARDIAC ARREST, UNEXPLAINED WITH CC",,,297,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,9022.71,100,MS-DRG,7218.168,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,9774.26,100,,,case rate,100% of CMS IPPS rate,9774.26,100,,,case rate,100% of CMS IPPS rate,23004.86,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,9022.71,100,MS-DRG,7218.168,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,9022.71,100,MS-DRG,7218.168,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,3596.13,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,23004.86,
"CARDIAC ARREST, UNEXPLAINED WITHOUT CC/MCC",,,298,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,6635.53,100,MS-DRG,5308.424,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,7228.82,100,,,case rate,100% of CMS IPPS rate,7228.82,100,,,case rate,100% of CMS IPPS rate,9774.26,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,6635.53,100,MS-DRG,5308.424,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,6635.53,100,MS-DRG,5308.424,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,2214.35,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,9774.26,
PERIPHERAL VASCULAR DISORDERS WITH MCC,,,299,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,16026.4,100,MS-DRG,12821.12,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,21729.89,100,,,case rate,100% of CMS IPPS rate,21729.89,100,,,case rate,100% of CMS IPPS rate,7228.82,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,16026.4,100,MS-DRG,12821.12,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,16026.4,100,MS-DRG,12821.12,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,7504.61,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,21729.89,
PERIPHERAL VASCULAR DISORDERS WITH CC,,,300,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,11818.89,100,MS-DRG,9455.112,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,15337.07,100,,,case rate,100% of CMS IPPS rate,15337.07,100,,,case rate,100% of CMS IPPS rate,21729.89,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,11818.89,100,MS-DRG,9455.112,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,11818.89,100,MS-DRG,9455.112,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,5304.48,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,21729.89,
PERIPHERAL VASCULAR DISORDERS WITHOUT CC/MCC,,,301,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,8867.36,100,MS-DRG,7093.888,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,10879.93,100,,,case rate,100% of CMS IPPS rate,10879.93,100,,,case rate,100% of CMS IPPS rate,15337.07,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,8867.36,100,MS-DRG,7093.888,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,8867.36,100,MS-DRG,7093.888,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,3635.51,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,15337.07,
ATHEROSCLEROSIS WITH MCC,,,302,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,12265.92,100,MS-DRG,9812.736,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,16023.25,100,,,case rate,100% of CMS IPPS rate,16023.25,100,,,case rate,100% of CMS IPPS rate,10879.93,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,12265.92,100,MS-DRG,9812.736,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,12265.92,100,MS-DRG,9812.736,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,5486.09,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,16023.25,
ATHEROSCLEROSIS WITHOUT MCC,,,303,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,8440.17,100,MS-DRG,6752.136,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,9970.52,100,,,case rate,100% of CMS IPPS rate,9970.52,100,,,case rate,100% of CMS IPPS rate,16023.25,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,8440.17,100,MS-DRG,6752.136,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,8440.17,100,MS-DRG,6752.136,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,3138.27,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,16023.25,
HYPERTENSION WITH MCC,,,304,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,12496.45,100,MS-DRG,9997.16,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,16197.04,100,,,case rate,100% of CMS IPPS rate,16197.04,100,,,case rate,100% of CMS IPPS rate,9970.52,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,12496.45,100,MS-DRG,9997.16,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,12496.45,100,MS-DRG,9997.16,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,5359.18,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,16197.04,
HYPERTENSION WITHOUT MCC,,,305,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,9228.44,100,MS-DRG,7382.752,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,10785.54,100,,,case rate,100% of CMS IPPS rate,10785.54,100,,,case rate,100% of CMS IPPS rate,16197.04,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,9228.44,100,MS-DRG,7382.752,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,9228.44,100,MS-DRG,7382.752,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,3353.25,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,16197.04,
CARDIAC CONGENITAL AND VALVULAR DISORDERS WITH MCC,,,306,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,15700.83,100,MS-DRG,12560.664,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,21106.64,100,,,case rate,100% of CMS IPPS rate,21106.64,100,,,case rate,100% of CMS IPPS rate,10785.54,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,15700.83,100,MS-DRG,12560.664,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,15700.83,100,MS-DRG,12560.664,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,7286.89,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,21106.64,
CARDIAC CONGENITAL AND VALVULAR DISORDERS WITHOUT MCC,,,307,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,10790.98,100,MS-DRG,8632.784,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,12824.59,100,,,case rate,100% of CMS IPPS rate,12824.59,100,,,case rate,100% of CMS IPPS rate,21106.64,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,10790.98,100,MS-DRG,8632.784,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,10790.98,100,MS-DRG,8632.784,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,4229.58,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,21106.64,
CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITH MCC,,,308,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,12936.05,100,MS-DRG,10348.84,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,18032.34,100,,,case rate,100% of CMS IPPS rate,18032.34,100,,,case rate,100% of CMS IPPS rate,12824.59,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,12936.05,100,MS-DRG,10348.84,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,12936.05,100,MS-DRG,10348.84,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,6719.08,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,18032.34,
CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITH CC,,,309,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,9155.73,100,MS-DRG,7324.584,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,11438.76,100,,,case rate,100% of CMS IPPS rate,11438.76,100,,,case rate,100% of CMS IPPS rate,18032.34,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,9155.73,100,MS-DRG,7324.584,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,9155.73,100,MS-DRG,7324.584,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,4460.97,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,18032.34,
CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITHOUT CC/MCC,,,310,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,7571.73,100,MS-DRG,6057.384,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,8424.38,100,,,case rate,100% of CMS IPPS rate,8424.38,100,,,case rate,100% of CMS IPPS rate,11438.76,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,7571.73,100,MS-DRG,6057.384,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,7571.73,100,MS-DRG,6057.384,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,3067.7,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,11438.76,
ANGINA PECTORIS,,,311,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,8770.68,100,MS-DRG,7016.544,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,10295.63,100,,,case rate,100% of CMS IPPS rate,10295.63,100,,,case rate,100% of CMS IPPS rate,8424.38,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,8770.68,100,MS-DRG,7016.544,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,8770.68,100,MS-DRG,7016.544,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,2771.77,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,10295.63,
SYNCOPE AND COLLAPSE,,,312,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,10137.37,100,MS-DRG,8109.896,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,12008.07,100,,,case rate,100% of CMS IPPS rate,12008.07,100,,,case rate,100% of CMS IPPS rate,10295.63,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,10137.37,100,MS-DRG,8109.896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,10137.37,100,MS-DRG,8109.896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,3905.2,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,12008.07,
CHEST PAIN,,,313,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,8981.39,100,MS-DRG,7185.112,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,10596.77,100,,,case rate,100% of CMS IPPS rate,10596.77,100,,,case rate,100% of CMS IPPS rate,12008.07,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,8981.39,100,MS-DRG,7185.112,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,8981.39,100,MS-DRG,7185.112,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,2972.52,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,12008.07,
OTHER CIRCULATORY SYSTEM DIAGNOSES WITH MCC,,,314,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,20300.82,100,MS-DRG,16240.656,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,30310.08,100,,,case rate,100% of CMS IPPS rate,30310.08,100,,,case rate,100% of CMS IPPS rate,10596.77,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,20300.82,100,MS-DRG,16240.656,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,20300.82,100,MS-DRG,16240.656,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,10057.56,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,30310.08,
OTHER CIRCULATORY SYSTEM DIAGNOSES WITH CC,,,315,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,10995.07,100,MS-DRG,8796.056,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,14321.29,100,,,case rate,100% of CMS IPPS rate,14321.29,100,,,case rate,100% of CMS IPPS rate,30310.08,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,10995.07,100,MS-DRG,8796.056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,10995.07,100,MS-DRG,8796.056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,5257.99,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,30310.08,
OTHER CIRCULATORY SYSTEM DIAGNOSES WITHOUT CC/MCC,,,316,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,8726.06,100,MS-DRG,6980.848,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,11255.98,100,,,case rate,100% of CMS IPPS rate,11255.98,100,,,case rate,100% of CMS IPPS rate,14321.29,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,8726.06,100,MS-DRG,6980.848,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,8726.06,100,MS-DRG,6980.848,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,3319.34,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,14321.29,
CONCOMITANT LEFT ATRIAL APPENDAGE CLOSURE AND CARDIAC ABLATION,,,317,RC,,,Inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,31329.4,100,MS-DRG,25063.52,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11255.98,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,9741.59,100,MS-DRG,7793.272,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,11901.52,100,MS-DRG,9521.216,case rate,100% of CMS IPPS 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,850,31329.4,
OTHER ENDOVASCULAR CARDIAC VALVE PROCEDURES WITH MCC,,,319,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,39044.53,100,MS-DRG,31235.624,case rate,100% of CMS IPPS 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,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,39044.53,100,MS-DRG,31235.624,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,39044.53,100,MS-DRG,31235.624,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,39044.53,
OTHER ENDOVASCULAR CARDIAC VALVE PROCEDURES WITHOUT MCC,,,320,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,21395.66,100,MS-DRG,17116.528,case rate,100% of CMS IPPS 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,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,21395.66,100,MS-DRG,17116.528,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,21395.66,100,MS-DRG,17116.528,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,21395.66,
PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITH INTRALUMINAL DEVICE WITH MCC OR 4+ ARTERIES/INTRALUMINAL DEVICES,,,321,RC,,,Inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26755.84,100,MS-DRG,21404.672,case rate,100% of CMS IPPS 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,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,26755.84,100,MS-DRG,21404.672,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,26755.84,100,MS-DRG,21404.672,case rate,100% of CMS IPPS 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,850,26755.84,
PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITH INTRALUMINAL DEVICE WITHOUT MCC,,,322,RC,,,Inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18069,100,MS-DRG,14455.2,case rate,100% of CMS IPPS 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,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,18069,100,MS-DRG,14455.2,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,18069,100,MS-DRG,14455.2,case rate,100% of CMS IPPS 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,850,18069,
CORONARY INTRAVASCULAR LITHOTRIPSY WITH INTRALUMINAL DEVICE WITH MCC,,,323,RC,,,Inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,37210.97,100,MS-DRG,29768.776,case rate,100% of CMS IPPS 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,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,37210.97,100,MS-DRG,29768.776,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,37210.97,100,MS-DRG,29768.776,case rate,100% of CMS IPPS 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,850,37210.97,
CORONARY INTRAVASCULAR LITHOTRIPSY WITH INTRALUMINAL DEVICE WITHOUT MCC,,,324,RC,,,Inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27531.75,100,MS-DRG,22025.4,case rate,100% of CMS IPPS 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,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,27531.75,100,MS-DRG,22025.4,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,27531.75,100,MS-DRG,22025.4,case rate,100% of CMS IPPS 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,850,27531.75,
CORONARY INTRAVASCULAR LITHOTRIPSY WITHOUT INTRALUMINAL DEVICE,,,325,RC,,,Inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24852.06,100,MS-DRG,19881.648,case rate,100% of CMS IPPS 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,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,24852.06,100,MS-DRG,19881.648,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,24852.06,100,MS-DRG,19881.648,case rate,100% of CMS IPPS 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,850,24852.06,
"STOMACH, ESOPHAGEAL AND DUODENAL PROCEDURES WITH MCC",,,326,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,44969.9,100,MS-DRG,35975.92,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,78743.89,100,,,case rate,100% of CMS IPPS rate,78743.89,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,44969.9,100,MS-DRG,35975.92,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,44969.9,100,MS-DRG,35975.92,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,31072.55,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,78743.89,
"STOMACH, ESOPHAGEAL AND DUODENAL PROCEDURES WITH CC",,,327,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,23638.23,100,MS-DRG,18910.584,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,37219.78,100,,,case rate,100% of CMS IPPS rate,37219.78,100,,,case rate,100% of CMS IPPS rate,78743.89,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,23638.23,100,MS-DRG,18910.584,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,23638.23,100,MS-DRG,18910.584,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,15026.72,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,78743.89,
"STOMACH, ESOPHAGEAL AND DUODENAL PROCEDURES WITHOUT CC/MCC",,,328,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,16200.73,100,MS-DRG,12960.584,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,23103.74,100,,,case rate,100% of CMS IPPS rate,23103.74,100,,,case rate,100% of CMS IPPS rate,37219.78,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,16200.73,100,MS-DRG,12960.584,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,16200.73,100,MS-DRG,12960.584,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,7575.17,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,37219.78,
MAJOR SMALL AND LARGE BOWEL PROCEDURES WITH MCC,,,329,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,40324.46,100,MS-DRG,32259.568,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,74800.63,100,,,case rate,100% of CMS IPPS rate,74800.63,100,,,case rate,100% of CMS IPPS rate,23103.74,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,40324.46,100,MS-DRG,32259.568,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,40324.46,100,MS-DRG,32259.568,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,29109.83,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,74800.63,
MAJOR SMALL AND LARGE BOWEL PROCEDURES WITH CC,,,330,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,22602.88,100,MS-DRG,18082.304,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,37804.08,100,,,case rate,100% of CMS IPPS rate,37804.08,100,,,case rate,100% of CMS IPPS rate,74800.63,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,22602.88,100,MS-DRG,18082.304,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,22602.88,100,MS-DRG,18082.304,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,14173.91,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,74800.63,
MAJOR SMALL AND LARGE BOWEL PROCEDURES WITHOUT CC/MCC,,,331,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,16817.98,100,MS-DRG,13454.384,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,25390,100,,,case rate,100% of CMS IPPS rate,25390,100,,,case rate,100% of CMS IPPS rate,37804.08,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,16817.98,100,MS-DRG,13454.384,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,16817.98,100,MS-DRG,13454.384,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,8891.31,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,37804.08,
RECTAL RESECTION WITH MCC,,,332,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,33197.65,100,MS-DRG,26558.12,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,50911.83,100,,,case rate,100% of CMS IPPS rate,50911.83,100,,,case rate,100% of CMS IPPS rate,25390,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,33197.65,100,MS-DRG,26558.12,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,33197.65,100,MS-DRG,26558.12,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,26635.1,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,50911.83,
RECTAL RESECTION WITH CC,,,333,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,20185.13,100,MS-DRG,16148.104,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,28882.3,100,,,case rate,100% of CMS IPPS rate,28882.3,100,,,case rate,100% of CMS IPPS rate,50911.83,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,20185.13,100,MS-DRG,16148.104,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,20185.13,100,MS-DRG,16148.104,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,13543.2,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,50911.83,
RECTAL RESECTION WITHOUT CC/MCC,,,334,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,16265.18,100,MS-DRG,13012.144,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,19569.49,100,,,case rate,100% of CMS IPPS rate,19569.49,100,,,case rate,100% of CMS IPPS rate,28882.3,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,16265.18,100,MS-DRG,13012.144,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,16265.18,100,MS-DRG,13012.144,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,8773.15,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,28882.3,
PERITONEAL ADHESIOLYSIS WITH MCC,,,335,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,32542.4,100,MS-DRG,26033.92,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,60856.88,100,,,case rate,100% of CMS IPPS rate,60856.88,100,,,case rate,100% of CMS IPPS rate,19569.49,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,32542.4,100,MS-DRG,26033.92,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,32542.4,100,MS-DRG,26033.92,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,23454.16,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,60856.88,
PERITONEAL ADHESIOLYSIS WITH CC,,,336,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,20398.32,100,MS-DRG,16318.656,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,34431.63,100,,,case rate,100% of CMS IPPS rate,34431.63,100,,,case rate,100% of CMS IPPS rate,60856.88,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,20398.32,100,MS-DRG,16318.656,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,20398.32,100,MS-DRG,16318.656,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,12795.96,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,60856.88,
PERITONEAL ADHESIOLYSIS WITHOUT CC/MCC,,,337,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,15367.01,100,MS-DRG,12293.608,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,24020.64,100,,,case rate,100% of CMS IPPS rate,24020.64,100,,,case rate,100% of CMS IPPS rate,34431.63,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,15367.01,100,MS-DRG,12293.608,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,15367.01,100,MS-DRG,12293.608,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,8181.28,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,34431.63,
MINOR SMALL AND LARGE BOWEL PROCEDURES WITH MCC,,,344,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,25646.13,100,MS-DRG,20516.904,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,44754.23,100,,,case rate,100% of CMS IPPS rate,44754.23,100,,,case rate,100% of CMS IPPS rate,24020.64,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,25646.13,100,MS-DRG,20516.904,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,25646.13,100,MS-DRG,20516.904,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,17909.53,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,44754.23,
MINOR SMALL AND LARGE BOWEL PROCEDURES WITH CC,,,345,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,15732.24,100,MS-DRG,12585.792,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,24534.52,100,,,case rate,100% of CMS IPPS rate,24534.52,100,,,case rate,100% of CMS IPPS rate,44754.23,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,15732.24,100,MS-DRG,12585.792,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,15732.24,100,MS-DRG,12585.792,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,9291.73,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,44754.23,
MINOR SMALL AND LARGE BOWEL PROCEDURES WITHOUT CC/MCC,,,346,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,13643.35,100,MS-DRG,10914.68,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,18526.74,100,,,case rate,100% of CMS IPPS rate,18526.74,100,,,case rate,100% of CMS IPPS rate,24534.52,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,13643.35,100,MS-DRG,10914.68,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,13643.35,100,MS-DRG,10914.68,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,6388.68,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,24534.52,
ANAL AND STOMAL PROCEDURES WITH MCC,,,347,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,24065.42,100,MS-DRG,19252.336,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,36123.1,100,,,case rate,100% of CMS IPPS rate,36123.1,100,,,case rate,100% of CMS IPPS rate,18526.74,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,24065.42,100,MS-DRG,19252.336,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,24065.42,100,MS-DRG,19252.336,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,13856.09,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,36123.1,
ANAL AND STOMAL PROCEDURES WITH CC,,,348,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,13755.73,100,MS-DRG,11004.584,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,20974.8,100,,,case rate,100% of CMS IPPS rate,20974.8,100,,,case rate,100% of CMS IPPS rate,36123.1,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,13755.73,100,MS-DRG,11004.584,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,13755.73,100,MS-DRG,11004.584,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,7675.28,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,36123.1,
ANAL AND STOMAL PROCEDURES WITHOUT CC/MCC,,,349,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,11065.31,100,MS-DRG,8852.248,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,14228.41,100,,,case rate,100% of CMS IPPS rate,14228.41,100,,,case rate,100% of CMS IPPS rate,20974.8,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,11065.31,100,MS-DRG,8852.248,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,11065.31,100,MS-DRG,8852.248,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,4417.21,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,20974.8,
INGUINAL AND FEMORAL HERNIA PROCEDURES WITH MCC,,,350,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,22833.41,100,MS-DRG,18266.728,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,36653.46,100,,,case rate,100% of CMS IPPS rate,36653.46,100,,,case rate,100% of CMS IPPS rate,14228.41,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,22833.41,100,MS-DRG,18266.728,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,22833.41,100,MS-DRG,18266.728,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,13788.81,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,36653.46,
INGUINAL AND FEMORAL HERNIA PROCEDURES WITH CC,,,351,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,15029.88,100,MS-DRG,12023.904,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,22474.5,100,,,case rate,100% of CMS IPPS rate,22474.5,100,,,case rate,100% of CMS IPPS rate,36653.46,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,15029.88,100,MS-DRG,12023.904,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,15029.88,100,MS-DRG,12023.904,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,7569.16,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,36653.46,
INGUINAL AND FEMORAL HERNIA PROCEDURES WITHOUT CC/MCC,,,352,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,12165.94,100,MS-DRG,9732.752,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,15783.54,100,,,case rate,100% of CMS IPPS rate,15783.54,100,,,case rate,100% of CMS IPPS rate,22474.5,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,12165.94,100,MS-DRG,9732.752,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,12165.94,100,MS-DRG,9732.752,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,4718.07,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,22474.5,
HERNIA PROCEDURES EXCEPT INGUINAL AND FEMORAL WITH MCC,,,353,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,27165.69,100,MS-DRG,21732.552,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,44435.11,100,,,case rate,100% of CMS IPPS rate,44435.11,100,,,case rate,100% of CMS IPPS rate,15783.54,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,27165.69,100,MS-DRG,21732.552,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,27165.69,100,MS-DRG,21732.552,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,15553.5,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,44435.11,
HERNIA PROCEDURES EXCEPT INGUINAL AND FEMORAL WITH CC,,,354,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,17196.43,100,MS-DRG,13757.144,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,25933.84,100,,,case rate,100% of CMS IPPS rate,25933.84,100,,,case rate,100% of CMS IPPS rate,44435.11,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,17196.43,100,MS-DRG,13757.144,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,17196.43,100,MS-DRG,13757.144,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,8583.34,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,44435.11,
HERNIA PROCEDURES EXCEPT INGUINAL AND FEMORAL WITHOUT CC/MCC,,,355,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,14261.42,100,MS-DRG,11409.136,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,20297.61,100,,,case rate,100% of CMS IPPS rate,20297.61,100,,,case rate,100% of CMS IPPS rate,25933.84,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,14261.42,100,MS-DRG,11409.136,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,14261.42,100,MS-DRG,11409.136,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,5876.67,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,25933.84,
OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITH MCC,,,356,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,38357.05,100,MS-DRG,30685.64,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,59563.94,100,,,case rate,100% of CMS IPPS rate,59563.94,100,,,case rate,100% of CMS IPPS rate,20297.61,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,38357.05,100,MS-DRG,30685.64,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,38357.05,100,MS-DRG,30685.64,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,21677.43,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,59563.94,
OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITH CC,,,357,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,21154.39,100,MS-DRG,16923.512,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,32012.04,100,,,case rate,100% of CMS IPPS rate,32012.04,100,,,case rate,100% of CMS IPPS rate,59563.94,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,21154.39,100,MS-DRG,16923.512,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,21154.39,100,MS-DRG,16923.512,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,11945.89,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,59563.94,
OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITHOUT CC/MCC,,,358,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,13587.99,100,MS-DRG,10870.392,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,20200.23,100,,,case rate,100% of CMS IPPS rate,20200.23,100,,,case rate,100% of CMS IPPS rate,32012.04,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,13587.99,100,MS-DRG,10870.392,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,13587.99,100,MS-DRG,10870.392,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,7145.21,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,32012.04,
MAJOR ESOPHAGEAL DISORDERS WITH MCC,,,368,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,16652.72,100,MS-DRG,13322.176,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,29125.01,100,,,case rate,100% of CMS IPPS rate,29125.01,100,,,case rate,100% of CMS IPPS rate,20200.23,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,16652.72,100,MS-DRG,13322.176,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,16652.72,100,MS-DRG,13322.176,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,10134.15,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,29125.01,
MAJOR ESOPHAGEAL DISORDERS WITH CC,,,369,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,11168.59,100,MS-DRG,8934.872,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,16612.04,100,,,case rate,100% of CMS IPPS rate,16612.04,100,,,case rate,100% of CMS IPPS rate,29125.01,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,11168.59,100,MS-DRG,8934.872,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,11168.59,100,MS-DRG,8934.872,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,5952.7,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,29125.01,
MAJOR ESOPHAGEAL DISORDERS WITHOUT CC/MCC,,,370,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,9147.47,100,MS-DRG,7317.976,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,11136.12,100,,,case rate,100% of CMS IPPS rate,11136.12,100,,,case rate,100% of CMS IPPS rate,16612.04,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,9147.47,100,MS-DRG,7317.976,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,9147.47,100,MS-DRG,7317.976,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,4085.71,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,16612.04,
MAJOR GASTROINTESTINAL DISORDERS AND PERITONEAL INFECTIONS WITH MCC,,,371,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,17443.48,100,MS-DRG,13954.784,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,26050.7,100,,,case rate,100% of CMS IPPS rate,26050.7,100,,,case rate,100% of CMS IPPS rate,11136.12,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,17443.48,100,MS-DRG,13954.784,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,17443.48,100,MS-DRG,13954.784,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,11139.58,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,26050.7,
MAJOR GASTROINTESTINAL DISORDERS AND PERITONEAL INFECTIONS WITH CC,,,372,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,11614.8,100,MS-DRG,9291.84,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,15557.31,100,,,case rate,100% of CMS IPPS rate,15557.31,100,,,case rate,100% of CMS IPPS rate,26050.7,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,11614.8,100,MS-DRG,9291.84,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,11614.8,100,MS-DRG,9291.84,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,7007.91,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,26050.7,
MAJOR GASTROINTESTINAL DISORDERS AND PERITONEAL INFECTIONS WITHOUT CC/MCC,,,373,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,8922.72,100,MS-DRG,7138.176,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,11350.36,100,,,case rate,100% of CMS IPPS rate,11350.36,100,,,case rate,100% of CMS IPPS rate,15557.31,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,8922.72,100,MS-DRG,7138.176,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,8922.72,100,MS-DRG,7138.176,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,4615.23,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,15557.31,
DIGESTIVE MALIGNANCY WITH MCC,,,374,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,20346.26,100,MS-DRG,16277.008,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,30937.83,100,,,case rate,100% of CMS IPPS rate,30937.83,100,,,case rate,100% of CMS IPPS rate,11350.36,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,20346.26,100,MS-DRG,16277.008,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,20346.26,100,MS-DRG,16277.008,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,11460.68,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,30937.83,
DIGESTIVE MALIGNANCY WITH CC,,,375,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,12903.81,100,MS-DRG,10323.048,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,18078.78,100,,,case rate,100% of CMS IPPS rate,18078.78,100,,,case rate,100% of CMS IPPS rate,30937.83,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,12903.81,100,MS-DRG,10323.048,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,12903.81,100,MS-DRG,10323.048,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,7029.79,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,30937.83,
DIGESTIVE MALIGNANCY WITHOUT CC/MCC,,,376,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,10367.91,100,MS-DRG,8294.328,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,13719.02,100,,,case rate,100% of CMS IPPS rate,13719.02,100,,,case rate,100% of CMS IPPS rate,18078.78,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,10367.91,100,MS-DRG,8294.328,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,10367.91,100,MS-DRG,8294.328,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,4767.31,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,18078.78,
GASTROINTESTINAL HEMORRHAGE WITH MCC,,,377,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,17795.49,100,MS-DRG,14236.392,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,26799.8,100,,,case rate,100% of CMS IPPS rate,26799.8,100,,,case rate,100% of CMS IPPS rate,13719.02,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,17795.49,100,MS-DRG,14236.392,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,17795.49,100,MS-DRG,14236.392,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,9649.49,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,26799.8,
GASTROINTESTINAL HEMORRHAGE WITH CC,,,378,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,11131.4,100,MS-DRG,8905.12,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,14836.67,100,,,case rate,100% of CMS IPPS rate,14836.67,100,,,case rate,100% of CMS IPPS rate,26799.8,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,11131.4,100,MS-DRG,8905.12,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,11131.4,100,MS-DRG,8905.12,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,5600.42,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,26799.8,
GASTROINTESTINAL HEMORRHAGE WITHOUT CC/MCC,,,379,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,8234.41,100,MS-DRG,6587.528,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,9786.24,100,,,case rate,100% of CMS IPPS rate,9786.24,100,,,case rate,100% of CMS IPPS rate,14836.67,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,8234.41,100,MS-DRG,6587.528,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,8234.41,100,MS-DRG,6587.528,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,3865.81,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,14836.67,
COMPLICATED PEPTIC ULCER WITH MCC,,,380,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,19102.69,100,MS-DRG,15282.152,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,29154.97,100,,,case rate,100% of CMS IPPS rate,29154.97,100,,,case rate,100% of CMS IPPS rate,9786.24,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,19102.69,100,MS-DRG,15282.152,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,19102.69,100,MS-DRG,15282.152,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,10314.12,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,29154.97,
COMPLICATED PEPTIC ULCER WITH CC,,,381,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,11868.46,100,MS-DRG,9494.768,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,16405.29,100,,,case rate,100% of CMS IPPS rate,16405.29,100,,,case rate,100% of CMS IPPS rate,29154.97,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,11868.46,100,MS-DRG,9494.768,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,11868.46,100,MS-DRG,9494.768,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,6187.38,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,29154.97,
COMPLICATED PEPTIC ULCER WITHOUT CC/MCC,,,382,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,9258.2,100,MS-DRG,7406.56,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,11503.18,100,,,case rate,100% of CMS IPPS rate,11503.18,100,,,case rate,100% of CMS IPPS rate,16405.29,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,9258.2,100,MS-DRG,7406.56,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,9258.2,100,MS-DRG,7406.56,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,4388.77,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,16405.29,
UNCOMPLICATED PEPTIC ULCER WITH MCC,,,383,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,14555.58,100,MS-DRG,11644.464,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,20240.68,100,,,case rate,100% of CMS IPPS rate,20240.68,100,,,case rate,100% of CMS IPPS rate,11503.18,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,14555.58,100,MS-DRG,11644.464,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,14555.58,100,MS-DRG,11644.464,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,6842.71,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,20240.68,
UNCOMPLICATED PEPTIC ULCER WITHOUT MCC,,,384,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,10238.19,100,MS-DRG,8190.552,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,12814.1,100,,,case rate,100% of CMS IPPS rate,12814.1,100,,,case rate,100% of CMS IPPS rate,20240.68,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,10238.19,100,MS-DRG,8190.552,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,10238.19,100,MS-DRG,8190.552,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,4635.47,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,20240.68,
INFLAMMATORY BOWEL DISEASE WITH MCC,,,385,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,15949.55,100,MS-DRG,12759.64,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,25437.94,100,,,case rate,100% of CMS IPPS rate,25437.94,100,,,case rate,100% of CMS IPPS rate,12814.1,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,15949.55,100,MS-DRG,12759.64,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,15949.55,100,MS-DRG,12759.64,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,10133.6,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,25437.94,
INFLAMMATORY BOWEL DISEASE WITH CC,,,386,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,11030.6,100,MS-DRG,8824.48,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,14683.86,100,,,case rate,100% of CMS IPPS rate,14683.86,100,,,case rate,100% of CMS IPPS rate,25437.94,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,11030.6,100,MS-DRG,8824.48,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,11030.6,100,MS-DRG,8824.48,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,5797.35,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,25437.94,
INFLAMMATORY BOWEL DISEASE WITHOUT CC/MCC,,,387,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,8655,100,MS-DRG,6924,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,10437.96,100,,,case rate,100% of CMS IPPS rate,10437.96,100,,,case rate,100% of CMS IPPS rate,14683.86,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,8655,100,MS-DRG,6924,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,8655,100,MS-DRG,6924,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,4237.79,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,14683.86,
GASTROINTESTINAL OBSTRUCTION WITH MCC,,,388,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,15012.52,100,MS-DRG,12010.016,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,22932.95,100,,,case rate,100% of CMS IPPS rate,22932.95,100,,,case rate,100% of CMS IPPS rate,10437.96,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,15012.52,100,MS-DRG,12010.016,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,15012.52,100,MS-DRG,12010.016,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,9082.22,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,22932.95,
GASTROINTESTINAL OBSTRUCTION WITH CC,,,389,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,9582.93,100,MS-DRG,7666.344,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,12632.82,100,,,case rate,100% of CMS IPPS rate,12632.82,100,,,case rate,100% of CMS IPPS rate,22932.95,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,9582.93,100,MS-DRG,7666.344,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,9582.93,100,MS-DRG,7666.344,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,5111.93,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,22932.95,
GASTROINTESTINAL OBSTRUCTION WITHOUT CC/MCC,,,390,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,7621.3,100,MS-DRG,6097.04,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,8854.36,100,,,case rate,100% of CMS IPPS rate,8854.36,100,,,case rate,100% of CMS IPPS rate,12632.82,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,7621.3,100,MS-DRG,6097.04,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,7621.3,100,MS-DRG,6097.04,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,3500.4,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,12632.82,
"ESOPHAGITIS, GASTROENTERITIS AND MISCELLANEOUS DIGESTIVE DISORDERS WITH MCC",,,391,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,13543.38,100,MS-DRG,10834.704,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,18300.51,100,,,case rate,100% of CMS IPPS rate,18300.51,100,,,case rate,100% of CMS IPPS rate,8854.36,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,13543.38,100,MS-DRG,10834.704,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,13543.38,100,MS-DRG,10834.704,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,6478.94,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,18300.51,
"ESOPHAGITIS, GASTROENTERITIS AND MISCELLANEOUS DIGESTIVE DISORDERS WITHOUT MCC",,,392,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,9493.69,100,MS-DRG,7594.952,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,11317.4,100,,,case rate,100% of CMS IPPS rate,11317.4,100,,,case rate,100% of CMS IPPS rate,18300.51,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,9493.69,100,MS-DRG,7594.952,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,9493.69,100,MS-DRG,7594.952,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,3960.99,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,18300.51,
OTHER DIGESTIVE SYSTEM DIAGNOSES WITH MCC,,,393,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,16385,100,MS-DRG,13108,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,24459.61,100,,,case rate,100% of CMS IPPS rate,24459.61,100,,,case rate,100% of CMS IPPS rate,11317.4,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,16385,100,MS-DRG,13108,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,16385,100,MS-DRG,13108,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,9162.64,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,24459.61,
OTHER DIGESTIVE SYSTEM DIAGNOSES WITH CC,,,394,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,10743.89,100,MS-DRG,8595.112,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,14099.56,100,,,case rate,100% of CMS IPPS rate,14099.56,100,,,case rate,100% of CMS IPPS rate,24459.61,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,10743.89,100,MS-DRG,8595.112,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,10743.89,100,MS-DRG,8595.112,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,5414.43,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,24459.61,
OTHER DIGESTIVE SYSTEM DIAGNOSES WITHOUT CC/MCC,,,395,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,8352.58,100,MS-DRG,6682.064,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,10135.32,100,,,case rate,100% of CMS IPPS rate,10135.32,100,,,case rate,100% of CMS IPPS rate,14099.56,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,8352.58,100,MS-DRG,6682.064,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,8352.58,100,MS-DRG,6682.064,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,3633.87,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,14099.56,
APPENDIX PROCEDURES WITH MCC,,,397,RC,,,Inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21565.89,100,MS-DRG,17252.712,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,10135.32,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,21565.89,100,MS-DRG,17252.712,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,21565.89,100,MS-DRG,17252.712,case rate,100% of CMS IPPS 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,850,21565.89,
APPENDIX PROCEDURES WITH CC,,,398,RC,,,Inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15506.66,100,MS-DRG,12405.328,case rate,100% of CMS IPPS 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,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,15506.66,100,MS-DRG,12405.328,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,15506.66,100,MS-DRG,12405.328,case rate,100% of CMS IPPS 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,850,15506.66,
APPENDIX PROCEDURES WITHOUT CC/MCC,,,399,RC,,,Inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12199.8,100,MS-DRG,9759.84,case rate,100% of CMS IPPS 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,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,12199.8,100,MS-DRG,9759.84,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,12199.8,100,MS-DRG,9759.84,case rate,100% of CMS IPPS 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,850,12199.8,
SINGLE LEVEL COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION EXCEPT CERVICAL,,,402,RC,,,Inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22164.13,100,MS-DRG,17731.304,case rate,100% of CMS IPPS 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,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,17019.6,100,MS-DRG,13615.68,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,8836.78,100,MS-DRG,7069.424,case rate,100% of CMS IPPS 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,850,22164.13,
"PANCREAS, LIVER AND SHUNT PROCEDURES WITH MCC",,,405,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,48491.57,100,MS-DRG,38793.256,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,80589.68,100,,,case rate,100% of CMS IPPS rate,80589.68,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,48491.57,100,MS-DRG,38793.256,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,48491.57,100,MS-DRG,38793.256,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,31271.66,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,80589.68,
"PANCREAS, LIVER AND SHUNT PROCEDURES WITH CC",,,406,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,26860.8,100,MS-DRG,21488.64,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,42438.01,100,,,case rate,100% of CMS IPPS rate,42438.01,100,,,case rate,100% of CMS IPPS rate,80589.68,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,26860.8,100,MS-DRG,21488.64,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,26860.8,100,MS-DRG,21488.64,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,14538.23,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,80589.68,
"PANCREAS, LIVER AND SHUNT PROCEDURES WITHOUT CC/MCC",,,407,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,20775.94,100,MS-DRG,16620.752,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,30065.88,100,,,case rate,100% of CMS IPPS rate,30065.88,100,,,case rate,100% of CMS IPPS rate,42438.01,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,20775.94,100,MS-DRG,16620.752,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,20775.94,100,MS-DRG,16620.752,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,10151.11,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,42438.01,
BILIARY TRACT PROCEDURES EXCEPT ONLY CHOLECYSTECTOMY WITH OR WITHOUT C.D.E. WITH MCC,,,408,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,33758.72,100,MS-DRG,27006.976,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,60624.66,100,,,case rate,100% of CMS IPPS rate,60624.66,100,,,case rate,100% of CMS IPPS rate,30065.88,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,33758.72,100,MS-DRG,27006.976,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,33758.72,100,MS-DRG,27006.976,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,21988.68,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,60624.66,
BILIARY TRACT PROCEDURES EXCEPT ONLY CHOLECYSTECTOMY WITH OR WITHOUT C.D.E. WITH CC,,,409,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,19175.41,100,MS-DRG,15340.328,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,34798.69,100,,,case rate,100% of CMS IPPS rate,34798.69,100,,,case rate,100% of CMS IPPS rate,60624.66,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,19175.41,100,MS-DRG,15340.328,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,19175.41,100,MS-DRG,15340.328,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,12647.17,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,60624.66,
BILIARY TRACT PROCEDURES EXCEPT ONLY CHOLECYSTECTOMY WITH OR WITHOUT C.D.E. WITHOUT CC/MCC,,,410,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,15935.49,100,MS-DRG,12748.392,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,24759.25,100,,,case rate,100% of CMS IPPS rate,24759.25,100,,,case rate,100% of CMS IPPS rate,34798.69,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,15935.49,100,MS-DRG,12748.392,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,15935.49,100,MS-DRG,12748.392,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,8338.27,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,34798.69,
CHOLECYSTECTOMY WITH C.D.E. WITH MCC,,,411,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,28125.02,100,MS-DRG,22500.016,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,59899.53,100,,,case rate,100% of CMS IPPS rate,59899.53,100,,,case rate,100% of CMS IPPS rate,24759.25,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,28125.02,100,MS-DRG,22500.016,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,28125.02,100,MS-DRG,22500.016,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,19594.91,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,59899.53,
CHOLECYSTECTOMY WITH C.D.E. WITH CC,,,412,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,20074.42,100,MS-DRG,16059.536,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,35685.63,100,,,case rate,100% of CMS IPPS rate,35685.63,100,,,case rate,100% of CMS IPPS rate,59899.53,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,20074.42,100,MS-DRG,16059.536,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,20074.42,100,MS-DRG,16059.536,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,13120.35,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,59899.53,
CHOLECYSTECTOMY WITH C.D.E. WITHOUT CC/MCC,,,413,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,15476.08,100,MS-DRG,12380.864,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,25262.65,100,,,case rate,100% of CMS IPPS rate,25262.65,100,,,case rate,100% of CMS IPPS rate,35685.63,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,15476.08,100,MS-DRG,12380.864,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,15476.08,100,MS-DRG,12380.864,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,9523.12,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,35685.63,
CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITH MCC,,,414,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,32130.91,100,MS-DRG,25704.728,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,53593.61,100,,,case rate,100% of CMS IPPS rate,53593.61,100,,,case rate,100% of CMS IPPS rate,25262.65,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,32130.91,100,MS-DRG,25704.728,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,32130.91,100,MS-DRG,25704.728,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,20069.73,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,53593.61,
CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITH CC,,,415,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,19328.27,100,MS-DRG,15462.616,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,30245.66,100,,,case rate,100% of CMS IPPS rate,30245.66,100,,,case rate,100% of CMS IPPS rate,53593.61,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,19328.27,100,MS-DRG,15462.616,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,19328.27,100,MS-DRG,15462.616,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,11288.91,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,53593.61,
CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITHOUT CC/MCC,,,416,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,14068.07,100,MS-DRG,11254.456,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,20871.42,100,,,case rate,100% of CMS IPPS rate,20871.42,100,,,case rate,100% of CMS IPPS rate,30245.66,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,14068.07,100,MS-DRG,11254.456,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,14068.07,100,MS-DRG,11254.456,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,7432.95,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,30245.66,
LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITH MCC,,,417,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,22154.2,100,MS-DRG,17723.36,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,36307.38,100,,,case rate,100% of CMS IPPS rate,36307.38,100,,,case rate,100% of CMS IPPS rate,20871.42,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,22154.2,100,MS-DRG,17723.36,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,22154.2,100,MS-DRG,17723.36,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,13850.08,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,36307.38,
LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITH CC,,,418,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,16509.77,100,MS-DRG,13207.816,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,24933.04,100,,,case rate,100% of CMS IPPS rate,24933.04,100,,,case rate,100% of CMS IPPS rate,36307.38,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,16509.77,100,MS-DRG,13207.816,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,16509.77,100,MS-DRG,13207.816,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,9249.61,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,36307.38,
LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITHOUT CC/MCC,,,419,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,13853.23,100,MS-DRG,11082.584,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,19539.52,100,,,case rate,100% of CMS IPPS rate,19539.52,100,,,case rate,100% of CMS IPPS rate,24933.04,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,13853.23,100,MS-DRG,11082.584,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,13853.23,100,MS-DRG,11082.584,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,6462.53,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,24933.04,
HEPATOBILIARY DIAGNOSTIC PROCEDURES WITH MCC,,,420,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,29450.4,100,MS-DRG,23560.32,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,52700.68,100,,,case rate,100% of CMS IPPS rate,52700.68,100,,,case rate,100% of CMS IPPS rate,19539.52,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,29450.4,100,MS-DRG,23560.32,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,29450.4,100,MS-DRG,23560.32,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,20845.95,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,52700.68,
HEPATOBILIARY DIAGNOSTIC PROCEDURES WITH CC,,,421,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,17128.67,100,MS-DRG,13702.936,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,26654.48,100,,,case rate,100% of CMS IPPS rate,26654.48,100,,,case rate,100% of CMS IPPS rate,52700.68,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,17128.67,100,MS-DRG,13702.936,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,17128.67,100,MS-DRG,13702.936,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,10437.75,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,52700.68,
HEPATOBILIARY DIAGNOSTIC PROCEDURES WITHOUT CC/MCC,,,422,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,14661.35,100,MS-DRG,11729.08,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,22586.86,100,,,case rate,100% of CMS IPPS rate,22586.86,100,,,case rate,100% of CMS IPPS rate,26654.48,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,14661.35,100,MS-DRG,11729.08,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,14661.35,100,MS-DRG,11729.08,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,6741.51,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,26654.48,
OTHER HEPATOBILIARY OR PANCREAS O.R. PROCEDURES WITH MCC,,,423,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,35317.94,100,MS-DRG,28254.352,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,59118.97,100,,,case rate,100% of CMS IPPS rate,59118.97,100,,,case rate,100% of CMS IPPS rate,22586.86,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,35317.94,100,MS-DRG,28254.352,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,35317.94,100,MS-DRG,28254.352,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,22970.59,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,59118.97,
OTHER HEPATOBILIARY OR PANCREAS O.R. PROCEDURES WITH CC,,,424,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,20616.47,100,MS-DRG,16493.176,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,32827.06,100,,,case rate,100% of CMS IPPS rate,32827.06,100,,,case rate,100% of CMS IPPS rate,59118.97,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,20616.47,100,MS-DRG,16493.176,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,20616.47,100,MS-DRG,16493.176,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,13353.38,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,59118.97,
OTHER HEPATOBILIARY OR PANCREAS O.R. PROCEDURES WITHOUT CC/MCC,,,425,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,16238.75,100,MS-DRG,12991,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,22366.63,100,,,case rate,100% of CMS IPPS rate,22366.63,100,,,case rate,100% of CMS IPPS rate,32827.06,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,16238.75,100,MS-DRG,12991,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,16238.75,100,MS-DRG,12991,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,9312.52,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,32827.06,
MULTIPLE LEVEL COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION EXCEPT CERVICAL WITH MCC OR CUSTOM-MADE ANATOMICALLY DESIGNED INTERBODY FUSION DEVICE,,,426,RC,,,Inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,37017.63,100,MS-DRG,29614.104,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,22366.63,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,11155.38,100,MS-DRG,8924.304,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,10914.09,100,MS-DRG,8731.272,case rate,100% of CMS IPPS 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,850,37017.63,
MULTIPLE LEVEL COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION EXCEPT CERVICAL WITH CC,,,427,RC,,,Inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20799.08,100,MS-DRG,16639.264,case rate,100% of CMS IPPS 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,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,9309.42,100,MS-DRG,7447.536,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,8744.24,100,MS-DRG,6995.392,case rate,100% of CMS IPPS 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,850,20799.08,
MULTIPLE LEVEL COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION EXCEPT CERVICAL WITHOUT CC/MCC,,,428,RC,,,Inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16412.27,100,MS-DRG,13129.816,case rate,100% of CMS IPPS 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,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,17364.99,100,MS-DRG,13891.992,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,9801.9,100,MS-DRG,7841.52,case rate,100% of CMS IPPS 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,850,17364.99,
COMBINED ANTERIOR AND POSTERIOR CERVICAL SPINAL FUSION WITH MCC,,,429,RC,,,Inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,35239.43,100,MS-DRG,28191.544,case rate,100% of CMS IPPS 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,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,12100.66,100,MS-DRG,9680.528,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,17960.74,100,MS-DRG,14368.592,case rate,100% of CMS IPPS 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,850,35239.43,
COMBINED ANTERIOR AND POSTERIOR CERVICAL SPINAL FUSION WITHOUT MCC,,,430,RC,,,Inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22002.99,100,MS-DRG,17602.392,case rate,100% of CMS IPPS 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,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,9602.77,100,MS-DRG,7682.216,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,10550.53,100,MS-DRG,8440.424,case rate,100% of CMS IPPS 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,850,22002.99,
CIRRHOSIS AND ALCOHOLIC HEPATITIS WITH MCC,,,432,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,18834.15,100,MS-DRG,15067.32,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,27357.13,100,,,case rate,100% of CMS IPPS rate,27357.13,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,18834.15,100,MS-DRG,15067.32,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,18834.15,100,MS-DRG,15067.32,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,9155.52,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,27357.13,
CIRRHOSIS AND ALCOHOLIC HEPATITIS WITH CC,,,433,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,11521.43,100,MS-DRG,9217.144,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,15400,100,,,case rate,100% of CMS IPPS rate,15400,100,,,case rate,100% of CMS IPPS rate,27357.13,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,11521.43,100,MS-DRG,9217.144,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,11521.43,100,MS-DRG,9217.144,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,5155.14,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,27357.13,
CIRRHOSIS AND ALCOHOLIC HEPATITIS WITHOUT CC/MCC,,,434,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,8534.37,100,MS-DRG,6827.496,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,9754.78,100,,,case rate,100% of CMS IPPS rate,9754.78,100,,,case rate,100% of CMS IPPS rate,15400,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,8534.37,100,MS-DRG,6827.496,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,8534.37,100,MS-DRG,6827.496,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,3328.09,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,15400,
MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITH MCC,,,435,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,17544.31,100,MS-DRG,14035.448,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,25434.94,100,,,case rate,100% of CMS IPPS rate,25434.94,100,,,case rate,100% of CMS IPPS rate,9754.78,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,17544.31,100,MS-DRG,14035.448,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,17544.31,100,MS-DRG,14035.448,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,9819.06,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,25434.94,
MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITH CC,,,436,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,12097.36,100,MS-DRG,9677.888,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,17018.05,100,,,case rate,100% of CMS IPPS rate,17018.05,100,,,case rate,100% of CMS IPPS rate,25434.94,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,12097.36,100,MS-DRG,9677.888,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,12097.36,100,MS-DRG,9677.888,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,6545.13,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,25434.94,
MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITHOUT CC/MCC,,,437,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,9869.67,100,MS-DRG,7895.736,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,12971.42,100,,,case rate,100% of CMS IPPS rate,12971.42,100,,,case rate,100% of CMS IPPS rate,17018.05,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,9869.67,100,MS-DRG,7895.736,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,9869.67,100,MS-DRG,7895.736,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,5092.24,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,17018.05,
DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITH MCC,,,438,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,16791.54,100,MS-DRG,13433.232,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,24543.51,100,,,case rate,100% of CMS IPPS rate,24543.51,100,,,case rate,100% of CMS IPPS rate,12971.42,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,16791.54,100,MS-DRG,13433.232,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,16791.54,100,MS-DRG,13433.232,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,9726.62,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,24543.51,
DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITH CC,,,439,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,10068.8,100,MS-DRG,8055.04,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,12918.98,100,,,case rate,100% of CMS IPPS rate,12918.98,100,,,case rate,100% of CMS IPPS rate,24543.51,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,10068.8,100,MS-DRG,8055.04,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,10068.8,100,MS-DRG,8055.04,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,5395.83,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,24543.51,
DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITHOUT CC/MCC,,,440,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,8089,100,MS-DRG,6471.2,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,9308.32,100,,,case rate,100% of CMS IPPS rate,9308.32,100,,,case rate,100% of CMS IPPS rate,12918.98,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,8089,100,MS-DRG,6471.2,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,8089,100,MS-DRG,6471.2,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,3704.44,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,12918.98,
"DISORDERS OF LIVER EXCEPT MALIGNANCY, CIRRHOSIS OR ALCOHOLIC HEPATITIS WITH MCC",,,441,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,18108.66,100,MS-DRG,14486.928,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,27824.57,100,,,case rate,100% of CMS IPPS rate,27824.57,100,,,case rate,100% of CMS IPPS rate,9308.32,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,18108.66,100,MS-DRG,14486.928,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,18108.66,100,MS-DRG,14486.928,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,10323.97,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,27824.57,
"DISORDERS OF LIVER EXCEPT MALIGNANCY, CIRRHOSIS OR ALCOHOLIC HEPATITIS WITH CC",,,442,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,10864.52,100,MS-DRG,8691.616,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,14066.6,100,,,case rate,100% of CMS IPPS rate,14066.6,100,,,case rate,100% of CMS IPPS rate,27824.57,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,10864.52,100,MS-DRG,8691.616,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,10864.52,100,MS-DRG,8691.616,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,5249.23,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,27824.57,
"DISORDERS OF LIVER EXCEPT MALIGNANCY, CIRRHOSIS OR ALCOHOLIC HEPATITIS WITHOUT CC/MCC",,,443,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,8907.84,100,MS-DRG,7126.272,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,10424.48,100,,,case rate,100% of CMS IPPS rate,10424.48,100,,,case rate,100% of CMS IPPS rate,14066.6,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,8907.84,100,MS-DRG,7126.272,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,8907.84,100,MS-DRG,7126.272,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,3579.17,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,14066.6,
DISORDERS OF THE BILIARY TRACT WITH MCC,,,444,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,16497.38,100,MS-DRG,13197.904,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,24134.5,100,,,case rate,100% of CMS IPPS rate,24134.5,100,,,case rate,100% of CMS IPPS rate,10424.48,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,16497.38,100,MS-DRG,13197.904,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,16497.38,100,MS-DRG,13197.904,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,8797.77,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,24134.5,
DISORDERS OF THE BILIARY TRACT WITH CC,,,445,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,11982.49,100,MS-DRG,9585.992,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,15994.78,100,,,case rate,100% of CMS IPPS rate,15994.78,100,,,case rate,100% of CMS IPPS rate,24134.5,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,11982.49,100,MS-DRG,9585.992,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,11982.49,100,MS-DRG,9585.992,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,5841.11,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,24134.5,
DISORDERS OF THE BILIARY TRACT WITHOUT CC/MCC,,,446,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,9625.08,100,MS-DRG,7700.064,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,11910.69,100,,,case rate,100% of CMS IPPS rate,11910.69,100,,,case rate,100% of CMS IPPS rate,15994.78,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,9625.08,100,MS-DRG,7700.064,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,9625.08,100,MS-DRG,7700.064,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,3950.6,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,15994.78,
MULTIPLE LEVEL SPINAL FUSION EXCEPT CERVICAL WITH MCC OR CUSTOM-MADE ANATOMICALLY DESIGNED INTERBODY FUSION DEVICE,,,447,RC,,,Inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17943.4,100,MS-DRG,14354.72,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11910.69,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,16012.34,100,MS-DRG,12809.872,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,60082.85,100,MS-DRG,48066.28,case rate,100% of CMS IPPS 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,850,60082.85,
MULTIPLE LEVEL SPINAL FUSION EXCEPT CERVICAL WITHOUT MCC,,,448,RC,,,Inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30894.77,100,MS-DRG,24715.816,case rate,100% of CMS IPPS 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,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,11694.12,100,MS-DRG,9355.296,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,25343.71,100,MS-DRG,20274.968,case rate,100% of CMS IPPS 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,850,30894.77,
SINGLE LEVEL SPINAL FUSION EXCEPT CERVICAL WITH MCC OR CUSTOM-MADE ANATOMICALLY DESIGNED INTERBODY FUSION DEVICE,,,450,RC,,,Inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16222.22,100,MS-DRG,12977.776,case rate,100% of CMS IPPS 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,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,9246.63,100,MS-DRG,7397.304,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,87406.82,100,MS-DRG,69925.456,case rate,100% of CMS IPPS 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,850,87406.82,
SINGLE LEVEL SPINAL FUSION EXCEPT CERVICAL WITHOUT MCC,,,451,RC,,,Inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12430.35,100,MS-DRG,9944.28,case rate,100% of CMS IPPS 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,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,15827.26,100,MS-DRG,12661.808,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,83196.84,100,MS-DRG,66557.472,case rate,100% of CMS IPPS 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,850,83196.84,
"SPINAL FUSION EXCEPT CERVICAL WITH SPINAL CURVATURE, MALIGNANCY, INFECTION OR EXTENSIVE FUSIONS WITH MCC",,,456,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,72654.13,100,MS-DRG,58123.304,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,136713.75,100,,,case rate,100% of CMS IPPS rate,136713.75,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,72654.13,100,MS-DRG,58123.304,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,72654.13,100,MS-DRG,58123.304,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,53691.4,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,136713.75,
"SPINAL FUSION EXCEPT CERVICAL WITH SPINAL CURVATURE, MALIGNANCY, INFECTION OR EXTENSIVE FUSIONS WITH CC",,,457,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,53202.29,100,MS-DRG,42561.832,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,98051.2,100,,,case rate,100% of CMS IPPS rate,98051.2,100,,,case rate,100% of CMS IPPS rate,136713.75,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,53202.29,100,MS-DRG,42561.832,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,53202.29,100,MS-DRG,42561.832,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,34694.93,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,136713.75,
"SPINAL FUSION EXCEPT CERVICAL WITH SPINAL CURVATURE, MALIGNANCY, INFECTION OR EXTENSIVE FUSIONS WITHOUT CC/MCC",,,458,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,40441.79,100,MS-DRG,32353.432,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,76725.82,100,,,case rate,100% of CMS IPPS rate,76725.82,100,,,case rate,100% of CMS IPPS rate,98051.2,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,40441.79,100,MS-DRG,32353.432,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,40441.79,100,MS-DRG,32353.432,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,27660.22,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,98051.2,
BILATERAL OR MULTIPLE MAJOR JOINT PROCEDURES OF LOWER EXTREMITY WITH MCC,,,461,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,59343.33,100,MS-DRG,47474.664,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,67156.82,100,,,case rate,100% of CMS IPPS rate,67156.82,100,,,case rate,100% of CMS IPPS rate,76725.82,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,59343.33,100,MS-DRG,47474.664,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,59343.33,100,MS-DRG,47474.664,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,29531.04,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,76725.82,
BILATERAL OR MULTIPLE MAJOR JOINT PROCEDURES OF LOWER EXTREMITY WITHOUT MCC,,,462,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,26521.19,100,MS-DRG,21216.952,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,47854.01,100,,,case rate,100% of CMS IPPS rate,47854.01,100,,,case rate,100% of CMS IPPS rate,67156.82,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,26521.19,100,MS-DRG,21216.952,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,26521.19,100,MS-DRG,21216.952,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,18248.14,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,67156.82,
WOUND DEBRIDEMENT AND SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DISORDERS WITH MCC,,,463,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,49801.25,100,MS-DRG,39841,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,76886.13,100,,,case rate,100% of CMS IPPS rate,76886.13,100,,,case rate,100% of CMS IPPS rate,47854.01,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,49801.25,100,MS-DRG,39841,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,49801.25,100,MS-DRG,39841,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,27590.75,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,76886.13,
WOUND DEBRIDEMENT AND SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DISORDERS WITH CC,,,464,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,27802.77,100,MS-DRG,22242.216,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,44107.01,100,,,case rate,100% of CMS IPPS rate,44107.01,100,,,case rate,100% of CMS IPPS rate,76886.13,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,27802.77,100,MS-DRG,22242.216,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,27802.77,100,MS-DRG,22242.216,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,16223.61,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,76886.13,
WOUND DEBRIDEMENT AND SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DISORDERS WITHOUT CC/MCC,,,465,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,18460.66,100,MS-DRG,14768.528,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,27527.93,100,,,case rate,100% of CMS IPPS rate,27527.93,100,,,case rate,100% of CMS IPPS rate,44107.01,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,18460.66,100,MS-DRG,14768.528,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,18460.66,100,MS-DRG,14768.528,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,9521.48,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,44107.01,
REVISION OF HIP OR KNEE REPLACEMENT WITH MCC,,,466,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,45858.99,100,MS-DRG,36687.192,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,76605.96,100,,,case rate,100% of CMS IPPS rate,76605.96,100,,,case rate,100% of CMS IPPS rate,27527.93,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,45858.99,100,MS-DRG,36687.192,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,45858.99,100,MS-DRG,36687.192,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,27248.31,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,76605.96,
REVISION OF HIP OR KNEE REPLACEMENT WITH CC,,,467,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,31809.48,100,MS-DRG,25447.584,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,51993.53,100,,,case rate,100% of CMS IPPS rate,51993.53,100,,,case rate,100% of CMS IPPS rate,76605.96,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,31809.48,100,MS-DRG,25447.584,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,31809.48,100,MS-DRG,25447.584,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,17743.79,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,76605.96,
REVISION OF HIP OR KNEE REPLACEMENT WITHOUT CC/MCC,,,468,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,25061.12,100,MS-DRG,20048.896,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,41820.75,100,,,case rate,100% of CMS IPPS rate,41820.75,100,,,case rate,100% of CMS IPPS rate,51993.53,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,25061.12,100,MS-DRG,20048.896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,25061.12,100,MS-DRG,20048.896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,14058.49,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,51993.53,
MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY WITH MCC OR TOTAL ANKLE REPLACEMENT,,,469,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,30516.32,100,MS-DRG,24413.056,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,47555.86,100,,,case rate,100% of CMS IPPS rate,47555.86,100,,,case rate,100% of CMS IPPS rate,41820.75,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,30516.32,100,MS-DRG,24413.056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,30516.32,100,MS-DRG,24413.056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,18827.44,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,47555.86,
MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY WITHOUT MCC,,,470,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,18550.74,100,MS-DRG,14840.592,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,29811.18,100,,,case rate,100% of CMS IPPS rate,29811.18,100,,,case rate,100% of CMS IPPS rate,47555.86,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,18550.74,100,MS-DRG,14840.592,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,18550.74,100,MS-DRG,14840.592,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,11414.18,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,47555.86,
CERVICAL SPINAL FUSION WITH MCC,,,471,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,43647.82,100,MS-DRG,34918.256,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,75070.31,100,,,case rate,100% of CMS IPPS rate,75070.31,100,,,case rate,100% of CMS IPPS rate,29811.18,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,43647.82,100,MS-DRG,34918.256,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,43647.82,100,MS-DRG,34918.256,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,24858.91,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,75070.31,
CERVICAL SPINAL FUSION WITH CC,,,472,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,27422.66,100,MS-DRG,21938.128,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,44148.96,100,,,case rate,100% of CMS IPPS rate,44148.96,100,,,case rate,100% of CMS IPPS rate,75070.31,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,27422.66,100,MS-DRG,21938.128,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,27422.66,100,MS-DRG,21938.128,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,15265.22,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,75070.31,
CERVICAL SPINAL FUSION WITHOUT CC/MCC,,,473,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,23334.16,100,MS-DRG,18667.328,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,35550.79,100,,,case rate,100% of CMS IPPS rate,35550.79,100,,,case rate,100% of CMS IPPS rate,44148.96,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,23334.16,100,MS-DRG,18667.328,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,23334.16,100,MS-DRG,18667.328,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,11384.64,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,44148.96,
AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITH MCC,,,474,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,38556.19,100,MS-DRG,30844.952,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,56858.19,100,,,case rate,100% of CMS IPPS rate,56858.19,100,,,case rate,100% of CMS IPPS rate,35550.79,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,38556.19,100,MS-DRG,30844.952,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,38556.19,100,MS-DRG,30844.952,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,19740.97,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,56858.19,
AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITH CC,,,475,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,20723.89,100,MS-DRG,16579.112,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,32193.32,100,,,case rate,100% of CMS IPPS rate,32193.32,100,,,case rate,100% of CMS IPPS rate,56858.19,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,20723.89,100,MS-DRG,16579.112,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,20723.89,100,MS-DRG,16579.112,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,10791.67,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,56858.19,
AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITHOUT CC/MCC,,,476,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,12726.99,100,MS-DRG,10181.592,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,17239.79,100,,,case rate,100% of CMS IPPS rate,17239.79,100,,,case rate,100% of CMS IPPS rate,32193.32,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,12726.99,100,MS-DRG,10181.592,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,12726.99,100,MS-DRG,10181.592,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,5775.47,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,32193.32,
BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC,,,477,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,30840.23,100,MS-DRG,24672.184,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,47019.51,100,,,case rate,100% of CMS IPPS rate,47019.51,100,,,case rate,100% of CMS IPPS rate,17239.79,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,30840.23,100,MS-DRG,24672.184,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,30840.23,100,MS-DRG,24672.184,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,18924.81,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,47019.51,
BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH CC,,,478,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,22698.73,100,MS-DRG,18158.984,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,34146.97,100,,,case rate,100% of CMS IPPS rate,34146.97,100,,,case rate,100% of CMS IPPS rate,47019.51,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,22698.73,100,MS-DRG,18158.984,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,22698.73,100,MS-DRG,18158.984,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,12461.73,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,47019.51,
BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT CC/MCC,,,479,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,18404.47,100,MS-DRG,14723.576,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,26937.64,100,,,case rate,100% of CMS IPPS rate,26937.64,100,,,case rate,100% of CMS IPPS rate,34146.97,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,18404.47,100,MS-DRG,14723.576,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,18404.47,100,MS-DRG,14723.576,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,9204.76,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,34146.97,
HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITH MCC,,,480,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,27368.96,100,MS-DRG,21895.168,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,45401.45,100,,,case rate,100% of CMS IPPS rate,45401.45,100,,,case rate,100% of CMS IPPS rate,26937.64,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,27368.96,100,MS-DRG,21895.168,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,27368.96,100,MS-DRG,21895.168,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,16715.38,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,45401.45,
HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITH CC,,,481,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,20147.14,100,MS-DRG,16117.712,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,30897.38,100,,,case rate,100% of CMS IPPS rate,30897.38,100,,,case rate,100% of CMS IPPS rate,45401.45,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,20147.14,100,MS-DRG,16117.712,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,20147.14,100,MS-DRG,16117.712,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,10444.31,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,45401.45,
HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITHOUT CC/MCC,,,482,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,16127.2,100,MS-DRG,12901.76,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,24937.54,100,,,case rate,100% of CMS IPPS rate,24937.54,100,,,case rate,100% of CMS IPPS rate,30897.38,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,16127.2,100,MS-DRG,12901.76,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,16127.2,100,MS-DRG,12901.76,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,8477.76,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,30897.38,
MAJOR JOINT OR LIMB REATTACHMENT PROCEDURES OF UPPER EXTREMITIES,,,483,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,23529.15,100,MS-DRG,18823.32,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,35709.6,100,,,case rate,100% of CMS IPPS rate,35709.6,100,,,case rate,100% of CMS IPPS rate,24937.54,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,23529.15,100,MS-DRG,18823.32,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,23529.15,100,MS-DRG,18823.32,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,13135.12,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,35709.6,
KNEE PROCEDURES WITH PRINCIPAL DIAGNOSIS OF INFECTION WITH MCC,,,485,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,30220.51,100,MS-DRG,24176.408,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,49502.03,100,,,case rate,100% of CMS IPPS rate,49502.03,100,,,case rate,100% of CMS IPPS rate,35709.6,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,30220.51,100,MS-DRG,24176.408,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,30220.51,100,MS-DRG,24176.408,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,17190.2,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,49502.03,
KNEE PROCEDURES WITH PRINCIPAL DIAGNOSIS OF INFECTION WITH CC,,,486,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,19596.82,100,MS-DRG,15677.456,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,33236.07,100,,,case rate,100% of CMS IPPS rate,33236.07,100,,,case rate,100% of CMS IPPS rate,49502.03,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,19596.82,100,MS-DRG,15677.456,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,19596.82,100,MS-DRG,15677.456,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,11291.1,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,49502.03,
KNEE PROCEDURES WITH PRINCIPAL DIAGNOSIS OF INFECTION WITHOUT CC/MCC,,,487,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,15767.76,100,MS-DRG,12614.208,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,24723.3,100,,,case rate,100% of CMS IPPS rate,24723.3,100,,,case rate,100% of CMS IPPS rate,33236.07,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,15767.76,100,MS-DRG,12614.208,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,15767.76,100,MS-DRG,12614.208,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,8164.32,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,33236.07,
KNEE PROCEDURES WITHOUT PRINCIPAL DIAGNOSIS OF INFECTION WITH CC/MCC,,,488,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,20409.07,100,MS-DRG,16327.256,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,31649.48,100,,,case rate,100% of CMS IPPS rate,31649.48,100,,,case rate,100% of CMS IPPS rate,24723.3,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,20409.07,100,MS-DRG,16327.256,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,20409.07,100,MS-DRG,16327.256,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,9400.04,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,31649.48,
KNEE PROCEDURES WITHOUT PRINCIPAL DIAGNOSIS OF INFECTION WITHOUT CC/MCC,,,489,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,13229.37,100,MS-DRG,10583.496,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,19437.65,100,,,case rate,100% of CMS IPPS rate,19437.65,100,,,case rate,100% of CMS IPPS rate,31649.48,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,13229.37,100,MS-DRG,10583.496,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,13229.37,100,MS-DRG,10583.496,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,6719.63,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,31649.48,
"LOWER EXTREMITY AND HUMERUS PROCEDURES EXCEPT HIP, FOOT AND FEMUR WITH MCC",,,492,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,31609.51,100,MS-DRG,25287.608,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,50796.47,100,,,case rate,100% of CMS IPPS rate,50796.47,100,,,case rate,100% of CMS IPPS rate,19437.65,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,31609.51,100,MS-DRG,25287.608,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,31609.51,100,MS-DRG,25287.608,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,16683.11,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,50796.47,
"LOWER EXTREMITY AND HUMERUS PROCEDURES EXCEPT HIP, FOOT AND FEMUR WITH CC",,,493,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,22847.47,100,MS-DRG,18277.976,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,33651.07,100,,,case rate,100% of CMS IPPS rate,33651.07,100,,,case rate,100% of CMS IPPS rate,50796.47,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,22847.47,100,MS-DRG,18277.976,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,22847.47,100,MS-DRG,18277.976,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,10268.17,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,50796.47,
"LOWER EXTREMITY AND HUMERUS PROCEDURES EXCEPT HIP, FOOT AND FEMUR WITHOUT CC/MCC",,,494,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,18447.43,100,MS-DRG,14757.944,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,26276.93,100,,,case rate,100% of CMS IPPS rate,26276.93,100,,,case rate,100% of CMS IPPS rate,33651.07,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,18447.43,100,MS-DRG,14757.944,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,18447.43,100,MS-DRG,14757.944,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,7394.66,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,33651.07,
LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES EXCEPT HIP AND FEMUR WITH MCC,,,495,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,32593.63,100,MS-DRG,26074.904,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,51872.18,100,,,case rate,100% of CMS IPPS rate,51872.18,100,,,case rate,100% of CMS IPPS rate,26276.93,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,32593.63,100,MS-DRG,26074.904,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,32593.63,100,MS-DRG,26074.904,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,15858.74,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,51872.18,
LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES EXCEPT HIP AND FEMUR WITH CC,,,496,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,19424.94,100,MS-DRG,15539.952,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,29378.2,100,,,case rate,100% of CMS IPPS rate,29378.2,100,,,case rate,100% of CMS IPPS rate,51872.18,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,19424.94,100,MS-DRG,15539.952,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,19424.94,100,MS-DRG,15539.952,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,8972.82,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,51872.18,
LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES EXCEPT HIP AND FEMUR WITHOUT CC/MCC,,,497,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,14796.86,100,MS-DRG,11837.488,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,21499.17,100,,,case rate,100% of CMS IPPS rate,21499.17,100,,,case rate,100% of CMS IPPS rate,29378.2,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,14796.86,100,MS-DRG,11837.488,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,14796.86,100,MS-DRG,11837.488,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,5966.93,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,29378.2,
LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES OF HIP AND FEMUR WITH CC/MCC,,,498,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,24576.9,100,MS-DRG,19661.52,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,34129,100,,,case rate,100% of CMS IPPS rate,34129,100,,,case rate,100% of CMS IPPS rate,21499.17,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,24576.9,100,MS-DRG,19661.52,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,24576.9,100,MS-DRG,19661.52,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,11102.93,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,34129,
LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES OF HIP AND FEMUR WITHOUT CC/MCC,,,499,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,13659.87,100,MS-DRG,10927.896,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,16767.85,100,,,case rate,100% of CMS IPPS rate,16767.85,100,,,case rate,100% of CMS IPPS rate,34129,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,13659.87,100,MS-DRG,10927.896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,13659.87,100,MS-DRG,10927.896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,5148.58,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,34129,
SOFT TISSUE PROCEDURES WITH MCC,,,500,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,29797.44,100,MS-DRG,23837.952,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,45964.78,100,,,case rate,100% of CMS IPPS rate,45964.78,100,,,case rate,100% of CMS IPPS rate,16767.85,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,29797.44,100,MS-DRG,23837.952,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,29797.44,100,MS-DRG,23837.952,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,17338.44,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,45964.78,
SOFT TISSUE PROCEDURES WITH CC,,,501,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,17344.34,100,MS-DRG,13875.472,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,25280.63,100,,,case rate,100% of CMS IPPS rate,25280.63,100,,,case rate,100% of CMS IPPS rate,45964.78,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,17344.34,100,MS-DRG,13875.472,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,17344.34,100,MS-DRG,13875.472,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,8590.45,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,45964.78,
SOFT TISSUE PROCEDURES WITHOUT CC/MCC,,,502,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,14427.52,100,MS-DRG,11542.016,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,19343.26,100,,,case rate,100% of CMS IPPS rate,19343.26,100,,,case rate,100% of CMS IPPS rate,25280.63,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,14427.52,100,MS-DRG,11542.016,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,14427.52,100,MS-DRG,11542.016,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,5674.27,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,25280.63,
FOOT PROCEDURES WITH MCC,,,503,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,25162.75,100,MS-DRG,20130.2,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,38386.88,100,,,case rate,100% of CMS IPPS rate,38386.88,100,,,case rate,100% of CMS IPPS rate,19343.26,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,25162.75,100,MS-DRG,20130.2,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,25162.75,100,MS-DRG,20130.2,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,12593.56,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,38386.88,
FOOT PROCEDURES WITH CC,,,504,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,17273.27,100,MS-DRG,13818.616,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,25911.37,100,,,case rate,100% of CMS IPPS rate,25911.37,100,,,case rate,100% of CMS IPPS rate,38386.88,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,17273.27,100,MS-DRG,13818.616,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,17273.27,100,MS-DRG,13818.616,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,8455.33,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,38386.88,
FOOT PROCEDURES WITHOUT CC/MCC,,,505,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,17096.45,100,MS-DRG,13677.16,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,23668.56,100,,,case rate,100% of CMS IPPS rate,23668.56,100,,,case rate,100% of CMS IPPS rate,25911.37,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,17096.45,100,MS-DRG,13677.16,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,17096.45,100,MS-DRG,13677.16,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,6179.72,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,25911.37,
MAJOR THUMB OR JOINT PROCEDURES,,,506,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,15087.72,100,MS-DRG,12070.176,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,21129.11,100,,,case rate,100% of CMS IPPS rate,21129.11,100,,,case rate,100% of CMS IPPS rate,23668.56,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,15087.72,100,MS-DRG,12070.176,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,15087.72,100,MS-DRG,12070.176,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,6356.95,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,23668.56,
MAJOR SHOULDER OR ELBOW JOINT PROCEDURES WITH CC/MCC,,,507,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,20616.47,100,MS-DRG,16493.176,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,29102.54,100,,,case rate,100% of CMS IPPS rate,29102.54,100,,,case rate,100% of CMS IPPS rate,21129.11,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,20616.47,100,MS-DRG,16493.176,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,20616.47,100,MS-DRG,16493.176,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,10245.74,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,29102.54,
MAJOR SHOULDER OR ELBOW JOINT PROCEDURES WITHOUT CC/MCC,,,508,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,14851.4,100,MS-DRG,11881.12,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,21684.95,100,,,case rate,100% of CMS IPPS rate,21684.95,100,,,case rate,100% of CMS IPPS rate,29102.54,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,14851.4,100,MS-DRG,11881.12,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,14851.4,100,MS-DRG,11881.12,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,6604.76,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,29102.54,
ARTHROSCOPY,,,509,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,14290.34,100,MS-DRG,11432.272,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,25024.43,100,,,case rate,100% of CMS IPPS rate,25024.43,100,,,case rate,100% of CMS IPPS rate,21684.95,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,14290.34,100,MS-DRG,11432.272,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,14290.34,100,MS-DRG,11432.272,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,7650.66,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,25024.43,
"SHOULDER, ELBOW OR FOREARM PROCEDURES, EXCEPT MAJOR JOINT PROCEDURES WITH MCC",,,510,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,25482.53,100,MS-DRG,20386.024,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,40936.82,100,,,case rate,100% of CMS IPPS rate,40936.82,100,,,case rate,100% of CMS IPPS rate,25024.43,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,25482.53,100,MS-DRG,20386.024,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,25482.53,100,MS-DRG,20386.024,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,12311.3,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,40936.82,
"SHOULDER, ELBOW OR FOREARM PROCEDURES, EXCEPT MAJOR JOINT PROCEDURES WITH CC",,,511,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,19477.01,100,MS-DRG,15581.608,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,27676.25,100,,,case rate,100% of CMS IPPS rate,27676.25,100,,,case rate,100% of CMS IPPS rate,40936.82,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,19477.01,100,MS-DRG,15581.608,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,19477.01,100,MS-DRG,15581.608,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,8210.27,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,40936.82,
"SHOULDER, ELBOW OR FOREARM PROCEDURES, EXCEPT MAJOR JOINT PROCEDURES WITHOUT CC/MCC",,,512,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,16337.09,100,MS-DRG,13069.672,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,22804.1,100,,,case rate,100% of CMS IPPS rate,22804.1,100,,,case rate,100% of CMS IPPS rate,27676.25,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,16337.09,100,MS-DRG,13069.672,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,16337.09,100,MS-DRG,13069.672,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,5897.45,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,27676.25,
"HAND OR WRIST PROCEDURES, EXCEPT MAJOR THUMB OR JOINT PROCEDURES WITH CC/MCC",,,513,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,16396.57,100,MS-DRG,13117.256,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,24564.49,100,,,case rate,100% of CMS IPPS rate,24564.49,100,,,case rate,100% of CMS IPPS rate,22804.1,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,16396.57,100,MS-DRG,13117.256,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,16396.57,100,MS-DRG,13117.256,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,7262.28,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,24564.49,
"HAND OR WRIST PROCEDURES, EXCEPT MAJOR THUMB OR JOINT PROCEDURES WITHOUT CC/MCC",,,514,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,11608.19,100,MS-DRG,9286.552,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,14979,100,,,case rate,100% of CMS IPPS rate,14979,100,,,case rate,100% of CMS IPPS rate,24564.49,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,11608.19,100,MS-DRG,9286.552,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,11608.19,100,MS-DRG,9286.552,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,4537.56,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,24564.49,
OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE O.R. PROCEDURES WITH MCC,,,515,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,29125.67,100,MS-DRG,23300.536,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,46174.52,100,,,case rate,100% of CMS IPPS rate,46174.52,100,,,case rate,100% of CMS IPPS rate,14979,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,29125.67,100,MS-DRG,23300.536,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,29125.67,100,MS-DRG,23300.536,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,17688.54,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,46174.52,
OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE O.R. PROCEDURES WITH CC,,,516,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,19865.37,100,MS-DRG,15892.296,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,28247.06,100,,,case rate,100% of CMS IPPS rate,28247.06,100,,,case rate,100% of CMS IPPS rate,46174.52,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,19865.37,100,MS-DRG,15892.296,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,19865.37,100,MS-DRG,15892.296,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,10831.6,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,46174.52,
OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE O.R. PROCEDURES WITHOUT CC/MCC,,,517,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,15350.48,100,MS-DRG,12280.384,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,20688.64,100,,,case rate,100% of CMS IPPS rate,20688.64,100,,,case rate,100% of CMS IPPS rate,28247.06,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,15350.48,100,MS-DRG,12280.384,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,15350.48,100,MS-DRG,12280.384,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,8509.49,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,28247.06,
BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITH MCC OR DISC DEVICE OR NEUROSTIMULATOR,,,518,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,33176.99,100,MS-DRG,26541.592,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,46447.2,100,,,case rate,100% of CMS IPPS rate,46447.2,100,,,case rate,100% of CMS IPPS rate,20688.64,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,33176.99,100,MS-DRG,26541.592,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,33176.99,100,MS-DRG,26541.592,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,46447.2,
BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITH CC,,,519,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,19268.78,100,MS-DRG,15415.024,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,27896.48,100,,,case rate,100% of CMS IPPS rate,27896.48,100,,,case rate,100% of CMS IPPS rate,46447.2,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,19268.78,100,MS-DRG,15415.024,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,19268.78,100,MS-DRG,15415.024,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,46447.2,
BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITHOUT CC/MCC,,,520,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,14830.74,100,MS-DRG,11864.592,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,19687.85,100,,,case rate,100% of CMS IPPS rate,19687.85,100,,,case rate,100% of CMS IPPS rate,27896.48,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,14830.74,100,MS-DRG,11864.592,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,14830.74,100,MS-DRG,11864.592,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,27896.48,
HIP REPLACEMENT WITH PRINCIPAL DIAGNOSIS OF HIP FRACTURE WITH MCC,,,521,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,27743.27,100,MS-DRG,22194.616,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,19687.85,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,27743.27,100,MS-DRG,22194.616,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,27743.27,100,MS-DRG,22194.616,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,27743.27,
HIP REPLACEMENT WITH PRINCIPAL DIAGNOSIS OF HIP FRACTURE WITHOUT MCC,,,522,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,20455.34,100,MS-DRG,16364.272,case rate,100% of CMS IPPS 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,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,20455.34,100,MS-DRG,16364.272,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,20455.34,100,MS-DRG,16364.272,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,20455.34,
FRACTURES OF FEMUR WITH MCC,,,533,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,16482.5,100,MS-DRG,13186,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,22929.95,100,,,case rate,100% of CMS IPPS rate,22929.95,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,16482.5,100,MS-DRG,13186,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,16482.5,100,MS-DRG,13186,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,8833.33,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,22929.95,
FRACTURES OF FEMUR WITHOUT MCC,,,534,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,9695.31,100,MS-DRG,7756.248,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,11618.54,100,,,case rate,100% of CMS IPPS rate,11618.54,100,,,case rate,100% of CMS IPPS rate,22929.95,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,9695.31,100,MS-DRG,7756.248,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,9695.31,100,MS-DRG,7756.248,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,4131.66,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,22929.95,
FRACTURES OF HIP AND PELVIS WITH MCC,,,535,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,13716.89,100,MS-DRG,10973.512,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,18799.41,100,,,case rate,100% of CMS IPPS rate,18799.41,100,,,case rate,100% of CMS IPPS rate,11618.54,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,13716.89,100,MS-DRG,10973.512,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,13716.89,100,MS-DRG,10973.512,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,7257.35,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,18799.41,
FRACTURES OF HIP AND PELVIS WITHOUT MCC,,,536,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,9506.08,100,MS-DRG,7604.864,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,11341.37,100,,,case rate,100% of CMS IPPS rate,11341.37,100,,,case rate,100% of CMS IPPS rate,18799.41,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,9506.08,100,MS-DRG,7604.864,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,9506.08,100,MS-DRG,7604.864,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,3969.2,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,18799.41,
"SPRAINS, STRAINS, AND DISLOCATIONS OF HIP, PELVIS AND THIGH WITH CC/MCC",,,537,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,10992.59,100,MS-DRG,8794.072,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,13641.11,100,,,case rate,100% of CMS IPPS rate,13641.11,100,,,case rate,100% of CMS IPPS rate,11341.37,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,10992.59,100,MS-DRG,8794.072,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,10992.59,100,MS-DRG,8794.072,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,4607.03,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,13641.11,
"SPRAINS, STRAINS, AND DISLOCATIONS OF HIP, PELVIS AND THIGH WITHOUT CC/MCC",,,538,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,8861.58,100,MS-DRG,7089.264,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,10891.91,100,,,case rate,100% of CMS IPPS rate,10891.91,100,,,case rate,100% of CMS IPPS rate,13641.11,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,8861.58,100,MS-DRG,7089.264,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,8861.58,100,MS-DRG,7089.264,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,3429.83,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,13641.11,
OSTEOMYELITIS WITH MCC,,,539,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,19399.34,100,MS-DRG,15519.472,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,30251.65,100,,,case rate,100% of CMS IPPS rate,30251.65,100,,,case rate,100% of CMS IPPS rate,10891.91,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,19399.34,100,MS-DRG,15519.472,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,19399.34,100,MS-DRG,15519.472,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,10887.4,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,30251.65,
OSTEOMYELITIS WITH CC,,,540,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,13729.29,100,MS-DRG,10983.432,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,19430.16,100,,,case rate,100% of CMS IPPS rate,19430.16,100,,,case rate,100% of CMS IPPS rate,30251.65,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,13729.29,100,MS-DRG,10983.432,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,13729.29,100,MS-DRG,10983.432,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,7315.34,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,30251.65,
OSTEOMYELITIS WITHOUT CC/MCC,,,541,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,10091.11,100,MS-DRG,8072.888,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,13224.61,100,,,case rate,100% of CMS IPPS rate,13224.61,100,,,case rate,100% of CMS IPPS rate,19430.16,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,10091.11,100,MS-DRG,8072.888,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,10091.11,100,MS-DRG,8072.888,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,4817.08,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,19430.16,
PATHOLOGICAL FRACTURES AND MUSCULOSKELETAL AND CONNECTIVE TISSUE MALIGNANCY WITH MCC,,,542,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,18071.47,100,MS-DRG,14457.176,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,27346.64,100,,,case rate,100% of CMS IPPS rate,27346.64,100,,,case rate,100% of CMS IPPS rate,13224.61,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,18071.47,100,MS-DRG,14457.176,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,18071.47,100,MS-DRG,14457.176,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,11169.66,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,27346.64,
PATHOLOGICAL FRACTURES AND MUSCULOSKELETAL AND CONNECTIVE TISSUE MALIGNANCY WITH CC,,,543,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,12014.72,100,MS-DRG,9611.776,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,16068.2,100,,,case rate,100% of CMS IPPS rate,16068.2,100,,,case rate,100% of CMS IPPS rate,27346.64,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,12014.72,100,MS-DRG,9611.776,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,12014.72,100,MS-DRG,9611.776,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,6410.56,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,27346.64,
PATHOLOGICAL FRACTURES AND MUSCULOSKELETAL AND CONNECTIVE TISSUE MALIGNANCY WITHOUT CC/MCC,,,544,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,9344.13,100,MS-DRG,7475.304,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,11961.63,100,,,case rate,100% of CMS IPPS rate,11961.63,100,,,case rate,100% of CMS IPPS rate,16068.2,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,9344.13,100,MS-DRG,7475.304,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,9344.13,100,MS-DRG,7475.304,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,4190.2,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,16068.2,
CONNECTIVE TISSUE DISORDERS WITH MCC,,,545,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,23603.54,100,MS-DRG,18882.832,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,37141.88,100,,,case rate,100% of CMS IPPS rate,37141.88,100,,,case rate,100% of CMS IPPS rate,11961.63,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,23603.54,100,MS-DRG,18882.832,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,23603.54,100,MS-DRG,18882.832,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,13531.71,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,37141.88,
CONNECTIVE TISSUE DISORDERS WITH CC,,,546,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,12912.07,100,MS-DRG,10329.656,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,18194.14,100,,,case rate,100% of CMS IPPS rate,18194.14,100,,,case rate,100% of CMS IPPS rate,37141.88,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,12912.07,100,MS-DRG,10329.656,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,12912.07,100,MS-DRG,10329.656,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,6481.68,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,37141.88,
CONNECTIVE TISSUE DISORDERS WITHOUT CC/MCC,,,547,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,9805.21,100,MS-DRG,7844.168,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,12848.56,100,,,case rate,100% of CMS IPPS rate,12848.56,100,,,case rate,100% of CMS IPPS rate,18194.14,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,9805.21,100,MS-DRG,7844.168,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,9805.21,100,MS-DRG,7844.168,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,4067.12,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,18194.14,
SEPTIC ARTHRITIS WITH MCC,,,548,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,19113.43,100,MS-DRG,15290.744,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,30970.79,100,,,case rate,100% of CMS IPPS rate,30970.79,100,,,case rate,100% of CMS IPPS rate,12848.56,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,19113.43,100,MS-DRG,15290.744,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,19113.43,100,MS-DRG,15290.744,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,10317.4,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,30970.79,
SEPTIC ARTHRITIS WITH CC,,,549,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,12969.09,100,MS-DRG,10375.272,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,18640.6,100,,,case rate,100% of CMS IPPS rate,18640.6,100,,,case rate,100% of CMS IPPS rate,30970.79,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,12969.09,100,MS-DRG,10375.272,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,12969.09,100,MS-DRG,10375.272,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,6783.09,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,30970.79,
SEPTIC ARTHRITIS WITHOUT CC/MCC,,,550,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,10798.41,100,MS-DRG,8638.728,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,13840.37,100,,,case rate,100% of CMS IPPS rate,13840.37,100,,,case rate,100% of CMS IPPS rate,18640.6,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,10798.41,100,MS-DRG,8638.728,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,10798.41,100,MS-DRG,8638.728,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,4027.73,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,18640.6,
MEDICAL BACK PROBLEMS WITH MCC,,,551,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,17065.05,100,MS-DRG,13652.04,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,23845.35,100,,,case rate,100% of CMS IPPS rate,23845.35,100,,,case rate,100% of CMS IPPS rate,13840.37,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,17065.05,100,MS-DRG,13652.04,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,17065.05,100,MS-DRG,13652.04,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,9163.18,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,23845.35,
MEDICAL BACK PROBLEMS WITHOUT MCC,,,552,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,10986.81,100,MS-DRG,8789.448,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,13498.78,100,,,case rate,100% of CMS IPPS rate,13498.78,100,,,case rate,100% of CMS IPPS rate,23845.35,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,10986.81,100,MS-DRG,8789.448,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,10986.81,100,MS-DRG,8789.448,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,4600.46,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,23845.35,
BONE DISEASES AND ARTHROPATHIES WITH MCC,,,553,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,14169.7,100,MS-DRG,11335.76,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,18541.72,100,,,case rate,100% of CMS IPPS rate,18541.72,100,,,case rate,100% of CMS IPPS rate,13498.78,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,14169.7,100,MS-DRG,11335.76,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,14169.7,100,MS-DRG,11335.76,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,6511.21,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,18541.72,
BONE DISEASES AND ARTHROPATHIES WITHOUT MCC,,,554,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,9792.82,100,MS-DRG,7834.256,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,11339.88,100,,,case rate,100% of CMS IPPS rate,11339.88,100,,,case rate,100% of CMS IPPS rate,18541.72,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,9792.82,100,MS-DRG,7834.256,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,9792.82,100,MS-DRG,7834.256,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,3825.88,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,18541.72,
SIGNS AND SYMPTOMS OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC,,,555,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,14562.2,100,MS-DRG,11649.76,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,19164.97,100,,,case rate,100% of CMS IPPS rate,19164.97,100,,,case rate,100% of CMS IPPS rate,11339.88,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,14562.2,100,MS-DRG,11649.76,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,14562.2,100,MS-DRG,11649.76,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,6468,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,19164.97,
SIGNS AND SYMPTOMS OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT MCC,,,556,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,9814.29,100,MS-DRG,7851.432,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,11501.68,100,,,case rate,100% of CMS IPPS rate,11501.68,100,,,case rate,100% of CMS IPPS rate,19164.97,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,9814.29,100,MS-DRG,7851.432,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,9814.29,100,MS-DRG,7851.432,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,3658.49,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,19164.97,
"TENDONITIS, MYOSITIS AND BURSITIS WITH MCC",,,557,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,15866.09,100,MS-DRG,12692.872,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,21460.22,100,,,case rate,100% of CMS IPPS rate,21460.22,100,,,case rate,100% of CMS IPPS rate,11501.68,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,15866.09,100,MS-DRG,12692.872,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,15866.09,100,MS-DRG,12692.872,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,8390.79,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,21460.22,
"TENDONITIS, MYOSITIS AND BURSITIS WITHOUT MCC",,,558,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,10260.49,100,MS-DRG,8208.392,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,12936.96,100,,,case rate,100% of CMS IPPS rate,12936.96,100,,,case rate,100% of CMS IPPS rate,21460.22,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,10260.49,100,MS-DRG,8208.392,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,10260.49,100,MS-DRG,8208.392,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,4911.72,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,21460.22,
"AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC",,,559,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,18292.92,100,MS-DRG,14634.336,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,26948.12,100,,,case rate,100% of CMS IPPS rate,26948.12,100,,,case rate,100% of CMS IPPS rate,12936.96,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,18292.92,100,MS-DRG,14634.336,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,18292.92,100,MS-DRG,14634.336,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,10305.37,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,26948.12,
"AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH CC",,,560,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,12356.81,100,MS-DRG,9885.448,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,15307.11,100,,,case rate,100% of CMS IPPS rate,15307.11,100,,,case rate,100% of CMS IPPS rate,26948.12,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,12356.81,100,MS-DRG,9885.448,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,12356.81,100,MS-DRG,9885.448,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,5598.23,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,26948.12,
"AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT CC/MCC",,,561,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,9449.08,100,MS-DRG,7559.264,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,11327.89,100,,,case rate,100% of CMS IPPS rate,11327.89,100,,,case rate,100% of CMS IPPS rate,15307.11,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,9449.08,100,MS-DRG,7559.264,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,9449.08,100,MS-DRG,7559.264,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,3339.03,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,15307.11,
"FRACTURE, SPRAIN, STRAIN AND DISLOCATION EXCEPT FEMUR, HIP, PELVIS AND THIGH WITH MCC",,,562,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,15567.8,100,MS-DRG,12454.24,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,21096.15,100,,,case rate,100% of CMS IPPS rate,21096.15,100,,,case rate,100% of CMS IPPS rate,11327.89,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,15567.8,100,MS-DRG,12454.24,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,15567.8,100,MS-DRG,12454.24,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,7660.51,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,21096.15,
"FRACTURE, SPRAIN, STRAIN AND DISLOCATION EXCEPT FEMUR, HIP, PELVIS AND THIGH WITHOUT MCC",,,563,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,10402.61,100,MS-DRG,8322.088,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,12556.41,100,,,case rate,100% of CMS IPPS rate,12556.41,100,,,case rate,100% of CMS IPPS rate,21096.15,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,10402.61,100,MS-DRG,8322.088,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,10402.61,100,MS-DRG,8322.088,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,4043.59,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,21096.15,
OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DIAGNOSES WITH MCC,,,564,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,15908.23,100,MS-DRG,12726.584,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,23554.7,100,,,case rate,100% of CMS IPPS rate,23554.7,100,,,case rate,100% of CMS IPPS rate,12556.41,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,15908.23,100,MS-DRG,12726.584,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,15908.23,100,MS-DRG,12726.584,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,8097.58,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,23554.7,
OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DIAGNOSES WITH CC,,,565,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,11260.31,100,MS-DRG,9008.248,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,14619.44,100,,,case rate,100% of CMS IPPS rate,14619.44,100,,,case rate,100% of CMS IPPS rate,23554.7,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,11260.31,100,MS-DRG,9008.248,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,11260.31,100,MS-DRG,9008.248,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,5195.62,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,23554.7,
OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DIAGNOSES WITHOUT CC/MCC,,,566,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,9203.66,100,MS-DRG,7362.928,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,11420.78,100,,,case rate,100% of CMS IPPS rate,11420.78,100,,,case rate,100% of CMS IPPS rate,14619.44,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,9203.66,100,MS-DRG,7362.928,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,9203.66,100,MS-DRG,7362.928,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,3485.08,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,14619.44,
SKIN DEBRIDEMENT WITH MCC,,,570,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,27148.35,100,MS-DRG,21718.68,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,45465.88,100,,,case rate,100% of CMS IPPS rate,45465.88,100,,,case rate,100% of CMS IPPS rate,11420.78,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,27148.35,100,MS-DRG,21718.68,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,27148.35,100,MS-DRG,21718.68,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,13762,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,45465.88,
SKIN DEBRIDEMENT WITH CC,,,571,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,16982.42,100,MS-DRG,13585.936,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,25512.85,100,,,case rate,100% of CMS IPPS rate,25512.85,100,,,case rate,100% of CMS IPPS rate,45465.88,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,16982.42,100,MS-DRG,13585.936,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,16982.42,100,MS-DRG,13585.936,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,8438.92,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,45465.88,
SKIN DEBRIDEMENT WITHOUT CC/MCC,,,572,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,12418.78,100,MS-DRG,9935.024,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,17657.79,100,,,case rate,100% of CMS IPPS rate,17657.79,100,,,case rate,100% of CMS IPPS rate,25512.85,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,12418.78,100,MS-DRG,9935.024,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,12418.78,100,MS-DRG,9935.024,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,5400.21,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,25512.85,
SKIN GRAFT FOR SKIN ULCER OR CELLULITIS WITH MCC,,,573,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,54382.23,100,MS-DRG,43505.784,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,78677.97,100,,,case rate,100% of CMS IPPS rate,78677.97,100,,,case rate,100% of CMS IPPS rate,17657.79,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,54382.23,100,MS-DRG,43505.784,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,54382.23,100,MS-DRG,43505.784,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,18734.99,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,78677.97,
SKIN GRAFT FOR SKIN ULCER OR CELLULITIS WITH CC,,,574,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,31144.31,100,MS-DRG,24915.448,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,45633.67,100,,,case rate,100% of CMS IPPS rate,45633.67,100,,,case rate,100% of CMS IPPS rate,78677.97,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,31144.31,100,MS-DRG,24915.448,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,31144.31,100,MS-DRG,24915.448,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,14760.87,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,78677.97,
SKIN GRAFT FOR SKIN ULCER OR CELLULITIS WITHOUT CC/MCC,,,575,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,19908.33,100,MS-DRG,15926.664,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,26347.35,100,,,case rate,100% of CMS IPPS rate,26347.35,100,,,case rate,100% of CMS IPPS rate,45633.67,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,19908.33,100,MS-DRG,15926.664,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,19908.33,100,MS-DRG,15926.664,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,6712.52,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,45633.67,
SKIN GRAFT EXCEPT FOR SKIN ULCER OR CELLULITIS WITH MCC,,,576,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,49961.55,100,MS-DRG,39969.24,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,73122.65,100,,,case rate,100% of CMS IPPS rate,73122.65,100,,,case rate,100% of CMS IPPS rate,26347.35,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,49961.55,100,MS-DRG,39969.24,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,49961.55,100,MS-DRG,39969.24,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,19110.8,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,73122.65,
SKIN GRAFT EXCEPT FOR SKIN ULCER OR CELLULITIS WITH CC,,,577,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,24891.72,100,MS-DRG,19913.376,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,37592.83,100,,,case rate,100% of CMS IPPS rate,37592.83,100,,,case rate,100% of CMS IPPS rate,73122.65,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,24891.72,100,MS-DRG,19913.376,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,24891.72,100,MS-DRG,19913.376,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,9910.96,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,73122.65,
SKIN GRAFT EXCEPT FOR SKIN ULCER OR CELLULITIS WITHOUT CC/MCC,,,578,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,16309.81,100,MS-DRG,13047.848,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,22917.97,100,,,case rate,100% of CMS IPPS rate,22917.97,100,,,case rate,100% of CMS IPPS rate,37592.83,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,16309.81,100,MS-DRG,13047.848,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,16309.81,100,MS-DRG,13047.848,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,5844.39,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,37592.83,
"OTHER SKIN, SUBCUTANEOUS TISSUE AND BREAST PROCEDURES WITH MCC",,,579,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,30618.79,100,MS-DRG,24495.032,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,41916.64,100,,,case rate,100% of CMS IPPS rate,41916.64,100,,,case rate,100% of CMS IPPS rate,22917.97,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,30618.79,100,MS-DRG,24495.032,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,30618.79,100,MS-DRG,24495.032,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,14734.06,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,41916.64,
"OTHER SKIN, SUBCUTANEOUS TISSUE AND BREAST PROCEDURES WITH CC",,,580,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,17434.41,100,MS-DRG,13947.528,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,23818.38,100,,,case rate,100% of CMS IPPS rate,23818.38,100,,,case rate,100% of CMS IPPS rate,41916.64,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,17434.41,100,MS-DRG,13947.528,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,17434.41,100,MS-DRG,13947.528,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,8096.49,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,41916.64,
"OTHER SKIN, SUBCUTANEOUS TISSUE AND BREAST PROCEDURES WITHOUT CC/MCC",,,581,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,14130.04,100,MS-DRG,11304.032,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,18523.74,100,,,case rate,100% of CMS IPPS rate,18523.74,100,,,case rate,100% of CMS IPPS rate,23818.38,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,14130.04,100,MS-DRG,11304.032,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,14130.04,100,MS-DRG,11304.032,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,5195.08,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,23818.38,
MASTECTOMY FOR MALIGNANCY WITH CC/MCC,,,582,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,17390.61,100,MS-DRG,13912.488,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,23514.25,100,,,case rate,100% of CMS IPPS rate,23514.25,100,,,case rate,100% of CMS IPPS rate,18523.74,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,17390.61,100,MS-DRG,13912.488,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,17390.61,100,MS-DRG,13912.488,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,6292.95,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,23514.25,
MASTECTOMY FOR MALIGNANCY WITHOUT CC/MCC,,,583,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,15577.71,100,MS-DRG,12462.168,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,20646.69,100,,,case rate,100% of CMS IPPS rate,20646.69,100,,,case rate,100% of CMS IPPS rate,23514.25,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,15577.71,100,MS-DRG,12462.168,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,15577.71,100,MS-DRG,12462.168,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,4793.02,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,23514.25,
"BREAST BIOPSY, LOCAL EXCISION AND OTHER BREAST PROCEDURES WITH CC/MCC",,,584,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,19186.15,100,MS-DRG,15348.92,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,28037.31,100,,,case rate,100% of CMS IPPS rate,28037.31,100,,,case rate,100% of CMS IPPS rate,20646.69,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,19186.15,100,MS-DRG,15348.92,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,19186.15,100,MS-DRG,15348.92,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,9019.32,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,28037.31,
"BREAST BIOPSY, LOCAL EXCISION AND OTHER BREAST PROCEDURES WITHOUT CC/MCC",,,585,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,16917.14,100,MS-DRG,13533.712,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,23457.32,100,,,case rate,100% of CMS IPPS rate,23457.32,100,,,case rate,100% of CMS IPPS rate,28037.31,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,16917.14,100,MS-DRG,13533.712,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,16917.14,100,MS-DRG,13533.712,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,6019.44,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,28037.31,
SKIN ULCERS WITH MCC,,,592,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,20272.72,100,MS-DRG,16218.176,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,25592.25,100,,,case rate,100% of CMS IPPS rate,25592.25,100,,,case rate,100% of CMS IPPS rate,23457.32,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,20272.72,100,MS-DRG,16218.176,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,20272.72,100,MS-DRG,16218.176,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,8070.23,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,25592.25,
SKIN ULCERS WITH CC,,,593,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,12999.67,100,MS-DRG,10399.736,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,16920.67,100,,,case rate,100% of CMS IPPS rate,16920.67,100,,,case rate,100% of CMS IPPS rate,25592.25,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,12999.67,100,MS-DRG,10399.736,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,12999.67,100,MS-DRG,10399.736,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,5622.85,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,25592.25,
SKIN ULCERS WITHOUT CC/MCC,,,594,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,9508.57,100,MS-DRG,7606.856,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,12138.42,100,,,case rate,100% of CMS IPPS rate,12138.42,100,,,case rate,100% of CMS IPPS rate,16920.67,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,9508.57,100,MS-DRG,7606.856,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,9508.57,100,MS-DRG,7606.856,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,3818.77,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,16920.67,
MAJOR SKIN DISORDERS WITH MCC,,,595,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,20974.25,100,MS-DRG,16779.4,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,29767.74,100,,,case rate,100% of CMS IPPS rate,29767.74,100,,,case rate,100% of CMS IPPS rate,12138.42,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,20974.25,100,MS-DRG,16779.4,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,20974.25,100,MS-DRG,16779.4,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,10741.34,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,29767.74,
MAJOR SKIN DISORDERS WITHOUT MCC,,,596,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,11339.64,100,MS-DRG,9071.712,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,15154.29,100,,,case rate,100% of CMS IPPS rate,15154.29,100,,,case rate,100% of CMS IPPS rate,29767.74,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,11339.64,100,MS-DRG,9071.712,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,11339.64,100,MS-DRG,9071.712,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,4881.63,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,29767.74,
MALIGNANT BREAST DISORDERS WITH MCC,,,597,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,16227.19,100,MS-DRG,12981.752,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,25769.04,100,,,case rate,100% of CMS IPPS rate,25769.04,100,,,case rate,100% of CMS IPPS rate,15154.29,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,16227.19,100,MS-DRG,12981.752,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,16227.19,100,MS-DRG,12981.752,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,9075.11,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,25769.04,
MALIGNANT BREAST DISORDERS WITH CC,,,598,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,12907.94,100,MS-DRG,10326.352,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,17413.58,100,,,case rate,100% of CMS IPPS rate,17413.58,100,,,case rate,100% of CMS IPPS rate,25769.04,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,12907.94,100,MS-DRG,10326.352,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,12907.94,100,MS-DRG,10326.352,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,6361.88,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,25769.04,
MALIGNANT BREAST DISORDERS WITHOUT CC/MCC,,,599,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,8561.62,100,MS-DRG,6849.296,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,10733.1,100,,,case rate,100% of CMS IPPS rate,10733.1,100,,,case rate,100% of CMS IPPS rate,17413.58,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,8561.62,100,MS-DRG,6849.296,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,8561.62,100,MS-DRG,6849.296,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,3718.66,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,17413.58,
NON-MALIGNANT BREAST DISORDERS WITH CC/MCC,,,600,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,11475.98,100,MS-DRG,9180.784,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,14322.79,100,,,case rate,100% of CMS IPPS rate,14322.79,100,,,case rate,100% of CMS IPPS rate,10733.1,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,11475.98,100,MS-DRG,9180.784,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,11475.98,100,MS-DRG,9180.784,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,5354.26,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,14322.79,
NON-MALIGNANT BREAST DISORDERS WITHOUT CC/MCC,,,601,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,8236.89,100,MS-DRG,6589.512,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,9276.85,100,,,case rate,100% of CMS IPPS rate,9276.85,100,,,case rate,100% of CMS IPPS rate,14322.79,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,8236.89,100,MS-DRG,6589.512,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,8236.89,100,MS-DRG,6589.512,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,3329.18,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,14322.79,
CELLULITIS WITH MCC,,,602,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,15293.47,100,MS-DRG,12234.776,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,21634.01,100,,,case rate,100% of CMS IPPS rate,21634.01,100,,,case rate,100% of CMS IPPS rate,9276.85,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,15293.47,100,MS-DRG,12234.776,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,15293.47,100,MS-DRG,12234.776,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,7984.89,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,21634.01,
CELLULITIS WITHOUT MCC,,,603,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,10312.55,100,MS-DRG,8250.04,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,12700.24,100,,,case rate,100% of CMS IPPS rate,12700.24,100,,,case rate,100% of CMS IPPS rate,21634.01,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,10312.55,100,MS-DRG,8250.04,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,10312.55,100,MS-DRG,8250.04,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,4619.06,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,21634.01,
"TRAUMA TO THE SKIN, SUBCUTANEOUS TISSUE AND BREAST WITH MCC",,,604,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,15447.99,100,MS-DRG,12358.392,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,21226.5,100,,,case rate,100% of CMS IPPS rate,21226.5,100,,,case rate,100% of CMS IPPS rate,12700.24,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,15447.99,100,MS-DRG,12358.392,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,15447.99,100,MS-DRG,12358.392,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,7124.97,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,21226.5,
"TRAUMA TO THE SKIN, SUBCUTANEOUS TISSUE AND BREAST WITHOUT MCC",,,605,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,10511.69,100,MS-DRG,8409.352,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,12892.01,100,,,case rate,100% of CMS IPPS rate,12892.01,100,,,case rate,100% of CMS IPPS rate,21226.5,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,10511.69,100,MS-DRG,8409.352,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,10511.69,100,MS-DRG,8409.352,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,4041.41,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,21226.5,
MINOR SKIN DISORDERS WITH MCC,,,606,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,16105.71,100,MS-DRG,12884.568,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,20687.15,100,,,case rate,100% of CMS IPPS rate,20687.15,100,,,case rate,100% of CMS IPPS rate,12892.01,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,16105.71,100,MS-DRG,12884.568,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,16105.71,100,MS-DRG,12884.568,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,7439.51,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,20687.15,
MINOR SKIN DISORDERS WITHOUT MCC,,,607,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,10385.27,100,MS-DRG,8308.216,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,12000.58,100,,,case rate,100% of CMS IPPS rate,12000.58,100,,,case rate,100% of CMS IPPS rate,20687.15,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,10385.27,100,MS-DRG,8308.216,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,10385.27,100,MS-DRG,8308.216,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,3802.9,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,20687.15,
ADRENAL AND PITUITARY PROCEDURES WITH CC/MCC,,,614,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,21613.81,100,MS-DRG,17291.048,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,35411.46,100,,,case rate,100% of CMS IPPS rate,35411.46,100,,,case rate,100% of CMS IPPS rate,12000.58,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,21613.81,100,MS-DRG,17291.048,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,21613.81,100,MS-DRG,17291.048,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,13445.83,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,35411.46,
ADRENAL AND PITUITARY PROCEDURES WITHOUT CC/MCC,,,615,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,15157.95,100,MS-DRG,12126.36,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,22191.34,100,,,case rate,100% of CMS IPPS rate,22191.34,100,,,case rate,100% of CMS IPPS rate,35411.46,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,15157.95,100,MS-DRG,12126.36,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,15157.95,100,MS-DRG,12126.36,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,7832.82,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,35411.46,
"AMPUTATION OF LOWER LIMB FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH MCC",,,616,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,35704.64,100,MS-DRG,28563.712,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,61953.57,100,,,case rate,100% of CMS IPPS rate,61953.57,100,,,case rate,100% of CMS IPPS rate,22191.34,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,35704.64,100,MS-DRG,28563.712,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,35704.64,100,MS-DRG,28563.712,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,24032.36,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,61953.57,
"AMPUTATION OF LOWER LIMB FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH CC",,,617,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,19400.16,100,MS-DRG,15520.128,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,31066.68,100,,,case rate,100% of CMS IPPS rate,31066.68,100,,,case rate,100% of CMS IPPS rate,61953.57,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,19400.16,100,MS-DRG,15520.128,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,19400.16,100,MS-DRG,15520.128,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,11043.3,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,61953.57,
"AMPUTATION OF LOWER LIMB FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITHOUT CC/MCC",,,618,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,12599.74,100,MS-DRG,10079.792,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,17368.63,100,,,case rate,100% of CMS IPPS rate,17368.63,100,,,case rate,100% of CMS IPPS rate,31066.68,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,12599.74,100,MS-DRG,10079.792,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,12599.74,100,MS-DRG,10079.792,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,6354.22,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,31066.68,
O.R. PROCEDURES FOR OBESITY WITH MCC,,,619,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,24506.66,100,MS-DRG,19605.328,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,43757.93,100,,,case rate,100% of CMS IPPS rate,43757.93,100,,,case rate,100% of CMS IPPS rate,17368.63,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,24506.66,100,MS-DRG,19605.328,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,24506.66,100,MS-DRG,19605.328,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,19120.09,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,43757.93,
O.R. PROCEDURES FOR OBESITY WITH CC,,,620,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,16406.49,100,MS-DRG,13125.192,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,27111.43,100,,,case rate,100% of CMS IPPS rate,27111.43,100,,,case rate,100% of CMS IPPS rate,43757.93,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,16406.49,100,MS-DRG,13125.192,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,16406.49,100,MS-DRG,13125.192,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,10056.47,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,43757.93,
O.R. PROCEDURES FOR OBESITY WITHOUT CC/MCC,,,621,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,15539.7,100,MS-DRG,12431.76,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,23646.09,100,,,case rate,100% of CMS IPPS rate,23646.09,100,,,case rate,100% of CMS IPPS rate,27111.43,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,15539.7,100,MS-DRG,12431.76,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,15539.7,100,MS-DRG,12431.76,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,8115.09,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,27111.43,
"SKIN GRAFTS AND WOUND DEBRIDEMENT FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH MCC",,,622,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,34613.1,100,MS-DRG,27690.48,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,56901.64,100,,,case rate,100% of CMS IPPS rate,56901.64,100,,,case rate,100% of CMS IPPS rate,23646.09,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,34613.1,100,MS-DRG,27690.48,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,34613.1,100,MS-DRG,27690.48,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,20972.31,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,56901.64,
"SKIN GRAFTS AND WOUND DEBRIDEMENT FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH CC",,,623,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,18383,100,MS-DRG,14706.4,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,28813.38,100,,,case rate,100% of CMS IPPS rate,28813.38,100,,,case rate,100% of CMS IPPS rate,56901.64,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,18383,100,MS-DRG,14706.4,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,18383,100,MS-DRG,14706.4,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,10142.9,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,56901.64,
"SKIN GRAFTS AND WOUND DEBRIDEMENT FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITHOUT CC/MCC",,,624,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,12211.38,100,MS-DRG,9769.104,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,19416.67,100,,,case rate,100% of CMS IPPS rate,19416.67,100,,,case rate,100% of CMS IPPS rate,28813.38,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,12211.38,100,MS-DRG,9769.104,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,12211.38,100,MS-DRG,9769.104,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,5451.08,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,28813.38,
"THYROID, PARATHYROID AND THYROGLOSSAL PROCEDURES WITH MCC",,,625,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,27140.08,100,MS-DRG,21712.064,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,41699.4,100,,,case rate,100% of CMS IPPS rate,41699.4,100,,,case rate,100% of CMS IPPS rate,19416.67,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,27140.08,100,MS-DRG,21712.064,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,27140.08,100,MS-DRG,21712.064,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,12355.61,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,41699.4,
"THYROID, PARATHYROID AND THYROGLOSSAL PROCEDURES WITH CC",,,626,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,15329.82,100,MS-DRG,12263.856,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,24130.01,100,,,case rate,100% of CMS IPPS rate,24130.01,100,,,case rate,100% of CMS IPPS rate,41699.4,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,15329.82,100,MS-DRG,12263.856,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,15329.82,100,MS-DRG,12263.856,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,6390.32,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,41699.4,
"THYROID, PARATHYROID AND THYROGLOSSAL PROCEDURES WITHOUT CC/MCC",,,627,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,13215.33,100,MS-DRG,10572.264,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,16255.47,100,,,case rate,100% of CMS IPPS rate,16255.47,100,,,case rate,100% of CMS IPPS rate,24130.01,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,13215.33,100,MS-DRG,10572.264,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,13215.33,100,MS-DRG,10572.264,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,4380.56,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,24130.01,
"OTHER ENDOCRINE, NUTRITIONAL AND METABOLIC O.R. PROCEDURES WITH MCC",,,628,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,36173.97,100,MS-DRG,28939.176,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,55058.85,100,,,case rate,100% of CMS IPPS rate,55058.85,100,,,case rate,100% of CMS IPPS rate,16255.47,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,36173.97,100,MS-DRG,28939.176,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,36173.97,100,MS-DRG,28939.176,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,17792.47,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,55058.85,
"OTHER ENDOCRINE, NUTRITIONAL AND METABOLIC O.R. PROCEDURES WITH CC",,,629,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,21699.74,100,MS-DRG,17359.792,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,35038.4,100,,,case rate,100% of CMS IPPS rate,35038.4,100,,,case rate,100% of CMS IPPS rate,55058.85,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,21699.74,100,MS-DRG,17359.792,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,21699.74,100,MS-DRG,17359.792,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,12076.63,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,55058.85,
"OTHER ENDOCRINE, NUTRITIONAL AND METABOLIC O.R. PROCEDURES WITHOUT CC/MCC",,,630,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,14539.88,100,MS-DRG,11631.904,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,22989.88,100,,,case rate,100% of CMS IPPS rate,22989.88,100,,,case rate,100% of CMS IPPS rate,35038.4,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,14539.88,100,MS-DRG,11631.904,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,14539.88,100,MS-DRG,11631.904,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,7181.32,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,35038.4,
DIABETES WITH MCC,,,637,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,14977.83,100,MS-DRG,11982.264,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,20694.64,100,,,case rate,100% of CMS IPPS rate,20694.64,100,,,case rate,100% of CMS IPPS rate,22989.88,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,14977.83,100,MS-DRG,11982.264,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,14977.83,100,MS-DRG,11982.264,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,7876.04,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,22989.88,
DIABETES WITH CC,,,638,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,10434.02,100,MS-DRG,8347.216,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,13067.3,100,,,case rate,100% of CMS IPPS rate,13067.3,100,,,case rate,100% of CMS IPPS rate,20694.64,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,10434.02,100,MS-DRG,8347.216,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,10434.02,100,MS-DRG,8347.216,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,4467.54,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,20694.64,
DIABETES WITHOUT CC/MCC,,,639,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,8146,100,MS-DRG,6516.8,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,9467.13,100,,,case rate,100% of CMS IPPS rate,9467.13,100,,,case rate,100% of CMS IPPS rate,13067.3,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,8146,100,MS-DRG,6516.8,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,8146,100,MS-DRG,6516.8,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,3010.27,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,13067.3,
"MISCELLANEOUS DISORDERS OF NUTRITION, METABOLISM, FLUIDS AND ELECTROLYTES WITH MCC",,,640,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,13869.75,100,MS-DRG,11095.8,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,17831.58,100,,,case rate,100% of CMS IPPS rate,17831.58,100,,,case rate,100% of CMS IPPS rate,9467.13,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,13869.75,100,MS-DRG,11095.8,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,13869.75,100,MS-DRG,11095.8,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,6085.63,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,17831.58,
"MISCELLANEOUS DISORDERS OF NUTRITION, METABOLISM, FLUIDS AND ELECTROLYTES WITHOUT MCC",,,641,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,9458.99,100,MS-DRG,7567.192,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,11264.97,100,,,case rate,100% of CMS IPPS rate,11264.97,100,,,case rate,100% of CMS IPPS rate,17831.58,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,9458.99,100,MS-DRG,7567.192,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,9458.99,100,MS-DRG,7567.192,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,3822.6,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,17831.58,
INBORN AND OTHER DISORDERS OF METABOLISM,,,642,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,13771.43,100,MS-DRG,11017.144,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,18929.76,100,,,case rate,100% of CMS IPPS rate,18929.76,100,,,case rate,100% of CMS IPPS rate,11264.97,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,13771.43,100,MS-DRG,11017.144,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,13771.43,100,MS-DRG,11017.144,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,6133.22,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,18929.76,
ENDOCRINE DISORDERS WITH MCC,,,643,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,16595.72,100,MS-DRG,13276.576,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,24482.09,100,,,case rate,100% of CMS IPPS rate,24482.09,100,,,case rate,100% of CMS IPPS rate,18929.76,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,16595.72,100,MS-DRG,13276.576,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,16595.72,100,MS-DRG,13276.576,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,9330.57,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,24482.09,
ENDOCRINE DISORDERS WITH CC,,,644,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,11775.1,100,MS-DRG,9420.08,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,15169.28,100,,,case rate,100% of CMS IPPS rate,15169.28,100,,,case rate,100% of CMS IPPS rate,24482.09,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,11775.1,100,MS-DRG,9420.08,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,11775.1,100,MS-DRG,9420.08,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,5789.14,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,24482.09,
ENDOCRINE DISORDERS WITHOUT CC/MCC,,,645,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,9289.6,100,MS-DRG,7431.68,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,11130.13,100,,,case rate,100% of CMS IPPS rate,11130.13,100,,,case rate,100% of CMS IPPS rate,15169.28,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,9289.6,100,MS-DRG,7431.68,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,9289.6,100,MS-DRG,7431.68,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,3967.01,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,15169.28,
KIDNEY TRANSPLANT WITH HEMODIALYSIS WITH MCC,,,650,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,40164.99,100,MS-DRG,32131.992,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11130.13,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,40164.99,100,MS-DRG,32131.992,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,40164.99,100,MS-DRG,32131.992,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,40164.99,
KIDNEY TRANSPLANT WITH HEMODIALYSIS WITHOUT MCC,,,651,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,31578.94,100,MS-DRG,25263.152,case rate,100% of CMS IPPS 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,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,31578.94,100,MS-DRG,25263.152,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,31578.94,100,MS-DRG,25263.152,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,31578.94,
KIDNEY TRANSPLANT,,,652,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,27827.56,100,MS-DRG,22262.048,case rate,100% of CMS IPPS 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,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,27827.56,100,MS-DRG,22262.048,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,27827.56,100,MS-DRG,22262.048,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,16688.03,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,27827.56,
MAJOR BLADDER PROCEDURES WITH MCC,,,653,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,47734.68,100,MS-DRG,38187.744,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,82236.2,100,,,case rate,100% of CMS IPPS rate,82236.2,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,47734.68,100,MS-DRG,38187.744,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,47734.68,100,MS-DRG,38187.744,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,32410.57,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,82236.2,
MAJOR BLADDER PROCEDURES WITH CC,,,654,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,25622.17,100,MS-DRG,20497.736,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,43047.78,100,,,case rate,100% of CMS IPPS rate,43047.78,100,,,case rate,100% of CMS IPPS rate,82236.2,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,25622.17,100,MS-DRG,20497.736,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,25622.17,100,MS-DRG,20497.736,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,16721.4,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,82236.2,
MAJOR BLADDER PROCEDURES WITHOUT CC/MCC,,,655,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,20418.98,100,MS-DRG,16335.184,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,31120.61,100,,,case rate,100% of CMS IPPS rate,31120.61,100,,,case rate,100% of CMS IPPS rate,43047.78,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,20418.98,100,MS-DRG,16335.184,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,20418.98,100,MS-DRG,16335.184,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,10904.36,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,43047.78,
KIDNEY AND URETER PROCEDURES FOR NEOPLASM WITH MCC,,,656,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,28928.18,100,MS-DRG,23142.544,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,49854.1,100,,,case rate,100% of CMS IPPS rate,49854.1,100,,,case rate,100% of CMS IPPS rate,31120.61,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,28928.18,100,MS-DRG,23142.544,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,28928.18,100,MS-DRG,23142.544,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,19889.21,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,49854.1,
KIDNEY AND URETER PROCEDURES FOR NEOPLASM WITH CC,,,657,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,18240.87,100,MS-DRG,14592.696,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,29175.95,100,,,case rate,100% of CMS IPPS rate,29175.95,100,,,case rate,100% of CMS IPPS rate,49854.1,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,18240.87,100,MS-DRG,14592.696,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,18240.87,100,MS-DRG,14592.696,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,11009.93,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,49854.1,
KIDNEY AND URETER PROCEDURES FOR NEOPLASM WITHOUT CC/MCC,,,658,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,15234.8,100,MS-DRG,12187.84,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,23467.8,100,,,case rate,100% of CMS IPPS rate,23467.8,100,,,case rate,100% of CMS IPPS rate,29175.95,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,15234.8,100,MS-DRG,12187.84,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,15234.8,100,MS-DRG,12187.84,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,8040.14,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,29175.95,
KIDNEY AND URETER PROCEDURES FOR NON-NEOPLASM WITH MCC,,,659,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,24394.3,100,MS-DRG,19515.44,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,40857.41,100,,,case rate,100% of CMS IPPS rate,40857.41,100,,,case rate,100% of CMS IPPS rate,23467.8,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,24394.3,100,MS-DRG,19515.44,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,24394.3,100,MS-DRG,19515.44,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,18945.59,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,40857.41,
KIDNEY AND URETER PROCEDURES FOR NON-NEOPLASM WITH CC,,,660,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,14123.44,100,MS-DRG,11298.752,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,21687.94,100,,,case rate,100% of CMS IPPS rate,21687.94,100,,,case rate,100% of CMS IPPS rate,40857.41,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,14123.44,100,MS-DRG,11298.752,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,14123.44,100,MS-DRG,11298.752,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,10311.93,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,40857.41,
KIDNEY AND URETER PROCEDURES FOR NON-NEOPLASM WITHOUT CC/MCC,,,661,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,11665.2,100,MS-DRG,9332.16,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,16072.69,100,,,case rate,100% of CMS IPPS rate,16072.69,100,,,case rate,100% of CMS IPPS rate,21687.94,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,11665.2,100,MS-DRG,9332.16,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,11665.2,100,MS-DRG,9332.16,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,7122.24,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,21687.94,
MINOR BLADDER PROCEDURES WITH MCC,,,662,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,27763.93,100,MS-DRG,22211.144,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,47623.28,100,,,case rate,100% of CMS IPPS rate,47623.28,100,,,case rate,100% of CMS IPPS rate,16072.69,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,27763.93,100,MS-DRG,22211.144,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,27763.93,100,MS-DRG,22211.144,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,16264.63,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,47623.28,
MINOR BLADDER PROCEDURES WITH CC,,,663,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,15057.97,100,MS-DRG,12046.376,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,24574.97,100,,,case rate,100% of CMS IPPS rate,24574.97,100,,,case rate,100% of CMS IPPS rate,47623.28,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,15057.97,100,MS-DRG,12046.376,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,15057.97,100,MS-DRG,12046.376,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,8091.02,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,47623.28,
MINOR BLADDER PROCEDURES WITHOUT CC/MCC,,,664,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,11774.27,100,MS-DRG,9419.416,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,17764.16,100,,,case rate,100% of CMS IPPS rate,17764.16,100,,,case rate,100% of CMS IPPS rate,24574.97,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,11774.27,100,MS-DRG,9419.416,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,11774.27,100,MS-DRG,9419.416,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,6164.4,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,24574.97,
PROSTATECTOMY WITH MCC,,,665,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,28527.43,100,MS-DRG,22821.944,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,47624.78,100,,,case rate,100% of CMS IPPS rate,47624.78,100,,,case rate,100% of CMS IPPS rate,17764.16,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,28527.43,100,MS-DRG,22821.944,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,28527.43,100,MS-DRG,22821.944,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,18475.7,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,47624.78,
PROSTATECTOMY WITH CC,,,666,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,17193.12,100,MS-DRG,13754.496,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,26654.48,100,,,case rate,100% of CMS IPPS rate,26654.48,100,,,case rate,100% of CMS IPPS rate,47624.78,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,17193.12,100,MS-DRG,13754.496,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,17193.12,100,MS-DRG,13754.496,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,8699.85,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,47624.78,
PROSTATECTOMY WITHOUT CC/MCC,,,667,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,11675.11,100,MS-DRG,9340.088,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,16186.55,100,,,case rate,100% of CMS IPPS rate,16186.55,100,,,case rate,100% of CMS IPPS rate,26654.48,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,11675.11,100,MS-DRG,9340.088,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,11675.11,100,MS-DRG,9340.088,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,4446.2,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,26654.48,
TRANSURETHRAL PROCEDURES WITH MCC,,,668,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,26287.33,100,MS-DRG,21029.864,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,42168.34,100,,,case rate,100% of CMS IPPS rate,42168.34,100,,,case rate,100% of CMS IPPS rate,16186.55,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,26287.33,100,MS-DRG,21029.864,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,26287.33,100,MS-DRG,21029.864,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,13955.65,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,42168.34,
TRANSURETHRAL PROCEDURES WITH CC,,,669,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,15682.66,100,MS-DRG,12546.128,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,23709.02,100,,,case rate,100% of CMS IPPS rate,23709.02,100,,,case rate,100% of CMS IPPS rate,42168.34,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,15682.66,100,MS-DRG,12546.128,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,15682.66,100,MS-DRG,12546.128,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,6948.29,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,42168.34,
TRANSURETHRAL PROCEDURES WITHOUT CC/MCC,,,670,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,10956.24,100,MS-DRG,8764.992,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,14435.16,100,,,case rate,100% of CMS IPPS rate,14435.16,100,,,case rate,100% of CMS IPPS rate,23709.02,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,10956.24,100,MS-DRG,8764.992,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,10956.24,100,MS-DRG,8764.992,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,4270.06,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,23709.02,
URETHRAL PROCEDURES WITH CC/MCC,,,671,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,17147.67,100,MS-DRG,13718.136,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,25222.2,100,,,case rate,100% of CMS IPPS rate,25222.2,100,,,case rate,100% of CMS IPPS rate,14435.16,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,17147.67,100,MS-DRG,13718.136,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,17147.67,100,MS-DRG,13718.136,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,8095.94,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,25222.2,
URETHRAL PROCEDURES WITHOUT CC/MCC,,,672,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,10748.83,100,MS-DRG,8599.064,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,15834.48,100,,,case rate,100% of CMS IPPS rate,15834.48,100,,,case rate,100% of CMS IPPS rate,25222.2,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,10748.83,100,MS-DRG,8599.064,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,10748.83,100,MS-DRG,8599.064,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,4618.52,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,25222.2,
OTHER KIDNEY AND URINARY TRACT PROCEDURES WITH MCC,,,673,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,33558.75,100,MS-DRG,26847,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,53595.11,100,,,case rate,100% of CMS IPPS rate,53595.11,100,,,case rate,100% of CMS IPPS rate,15834.48,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,33558.75,100,MS-DRG,26847,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,33558.75,100,MS-DRG,26847,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,16342.31,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,53595.11,
OTHER KIDNEY AND URINARY TRACT PROCEDURES WITH CC,,,674,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,22686.33,100,MS-DRG,18149.064,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,34639.88,100,,,case rate,100% of CMS IPPS rate,34639.88,100,,,case rate,100% of CMS IPPS rate,53595.11,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,22686.33,100,MS-DRG,18149.064,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,22686.33,100,MS-DRG,18149.064,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,11672.38,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,53595.11,
OTHER KIDNEY AND URINARY TRACT PROCEDURES WITHOUT CC/MCC,,,675,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,16111.5,100,MS-DRG,12889.2,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,24350.24,100,,,case rate,100% of CMS IPPS rate,24350.24,100,,,case rate,100% of CMS IPPS rate,34639.88,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,16111.5,100,MS-DRG,12889.2,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,16111.5,100,MS-DRG,12889.2,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,7343.78,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,34639.88,
RENAL FAILURE WITH MCC,,,682,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,15403.36,100,MS-DRG,12322.688,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,22952.42,100,,,case rate,100% of CMS IPPS rate,22952.42,100,,,case rate,100% of CMS IPPS rate,24350.24,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,15403.36,100,MS-DRG,12322.688,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,15403.36,100,MS-DRG,12322.688,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,8976.65,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,24350.24,
RENAL FAILURE WITH CC,,,683,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,10445.6,100,MS-DRG,8356.48,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,13768.46,100,,,case rate,100% of CMS IPPS rate,13768.46,100,,,case rate,100% of CMS IPPS rate,22952.42,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,10445.6,100,MS-DRG,8356.48,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,10445.6,100,MS-DRG,8356.48,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,5570.34,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,22952.42,
RENAL FAILURE WITHOUT CC/MCC,,,684,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,8030.32,100,MS-DRG,6424.256,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,9285.84,100,,,case rate,100% of CMS IPPS rate,9285.84,100,,,case rate,100% of CMS IPPS rate,13768.46,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,8030.32,100,MS-DRG,6424.256,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,8030.32,100,MS-DRG,6424.256,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,3505.87,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,13768.46,
KIDNEY AND URINARY TRACT NEOPLASMS WITH MCC,,,686,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,18201.2,100,MS-DRG,14560.96,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,25733.08,100,,,case rate,100% of CMS IPPS rate,25733.08,100,,,case rate,100% of CMS IPPS rate,9285.84,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,18201.2,100,MS-DRG,14560.96,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,18201.2,100,MS-DRG,14560.96,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,9734.27,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,25733.08,
KIDNEY AND URINARY TRACT NEOPLASMS WITH CC,,,687,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,11639.58,100,MS-DRG,9311.664,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,15786.53,100,,,case rate,100% of CMS IPPS rate,15786.53,100,,,case rate,100% of CMS IPPS rate,25733.08,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,11639.58,100,MS-DRG,9311.664,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,11639.58,100,MS-DRG,9311.664,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,5720.77,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,25733.08,
KIDNEY AND URINARY TRACT NEOPLASMS WITHOUT CC/MCC,,,688,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,9454.85,100,MS-DRG,7563.88,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,11849.26,100,,,case rate,100% of CMS IPPS rate,11849.26,100,,,case rate,100% of CMS IPPS rate,15786.53,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,9454.85,100,MS-DRG,7563.88,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,9454.85,100,MS-DRG,7563.88,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,3545.8,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,15786.53,
KIDNEY AND URINARY TRACT INFECTIONS WITH MCC,,,689,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,12706.34,100,MS-DRG,10165.072,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,16653.99,100,,,case rate,100% of CMS IPPS rate,16653.99,100,,,case rate,100% of CMS IPPS rate,11849.26,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,12706.34,100,MS-DRG,10165.072,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,12706.34,100,MS-DRG,10165.072,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,6562.63,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,16653.99,
KIDNEY AND URINARY TRACT INFECTIONS WITHOUT MCC,,,690,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,9669.69,100,MS-DRG,7735.752,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,11897.21,100,,,case rate,100% of CMS IPPS rate,11897.21,100,,,case rate,100% of CMS IPPS rate,16653.99,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,9669.69,100,MS-DRG,7735.752,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,9669.69,100,MS-DRG,7735.752,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,4305.07,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,16653.99,
URINARY STONES WITH MCC,,,693,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,14705.15,100,MS-DRG,11764.12,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,19830.18,100,,,case rate,100% of CMS IPPS rate,19830.18,100,,,case rate,100% of CMS IPPS rate,11897.21,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,14705.15,100,MS-DRG,11764.12,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,14705.15,100,MS-DRG,11764.12,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,7387.55,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,19830.18,
URINARY STONES WITHOUT MCC,,,694,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,9469.73,100,MS-DRG,7575.784,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,10518.86,100,,,case rate,100% of CMS IPPS rate,10518.86,100,,,case rate,100% of CMS IPPS rate,19830.18,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,9469.73,100,MS-DRG,7575.784,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,9469.73,100,MS-DRG,7575.784,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,3878.39,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,19830.18,
KIDNEY AND URINARY TRACT SIGNS AND SYMPTOMS WITH MCC,,,695,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,12884.82,100,MS-DRG,10307.856,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,17209.82,100,,,case rate,100% of CMS IPPS rate,17209.82,100,,,case rate,100% of CMS IPPS rate,10518.86,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,12884.82,100,MS-DRG,10307.856,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,12884.82,100,MS-DRG,10307.856,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,6896.87,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,17209.82,
KIDNEY AND URINARY TRACT SIGNS AND SYMPTOMS WITHOUT MCC,,,696,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,8721.11,100,MS-DRG,6976.888,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,10316.61,100,,,case rate,100% of CMS IPPS rate,10316.61,100,,,case rate,100% of CMS IPPS rate,17209.82,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,8721.11,100,MS-DRG,6976.888,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,8721.11,100,MS-DRG,6976.888,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,3527.75,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,17209.82,
URETHRAL STRICTURE,,,697,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,12199.8,100,MS-DRG,9759.84,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,14382.72,100,,,case rate,100% of CMS IPPS rate,14382.72,100,,,case rate,100% of CMS IPPS rate,10316.61,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,12199.8,100,MS-DRG,9759.84,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,12199.8,100,MS-DRG,9759.84,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,4430.34,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,14382.72,
OTHER KIDNEY AND URINARY TRACT DIAGNOSES WITH MCC,,,698,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,16672.56,100,MS-DRG,13338.048,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,24197.43,100,,,case rate,100% of CMS IPPS rate,24197.43,100,,,case rate,100% of CMS IPPS rate,14382.72,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,16672.56,100,MS-DRG,13338.048,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,16672.56,100,MS-DRG,13338.048,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,8788.47,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,24197.43,
OTHER KIDNEY AND URINARY TRACT DIAGNOSES WITH CC,,,699,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,11437.15,100,MS-DRG,9149.72,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,15400,100,,,case rate,100% of CMS IPPS rate,15400,100,,,case rate,100% of CMS IPPS rate,24197.43,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,11437.15,100,MS-DRG,9149.72,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,11437.15,100,MS-DRG,9149.72,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,5469.14,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,24197.43,
OTHER KIDNEY AND URINARY TRACT DIAGNOSES WITHOUT CC/MCC,,,700,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,8854.97,100,MS-DRG,7083.976,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,11381.83,100,,,case rate,100% of CMS IPPS rate,11381.83,100,,,case rate,100% of CMS IPPS rate,15400,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,8854.97,100,MS-DRG,7083.976,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,8854.97,100,MS-DRG,7083.976,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,3710.46,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,15400,
MAJOR MALE PELVIC PROCEDURES WITH CC/MCC,,,707,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,19213.42,100,MS-DRG,15370.736,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,26838.75,100,,,case rate,100% of CMS IPPS rate,26838.75,100,,,case rate,100% of CMS IPPS rate,11381.83,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,19213.42,100,MS-DRG,15370.736,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,19213.42,100,MS-DRG,15370.736,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,9982.62,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,26838.75,
MAJOR MALE PELVIC PROCEDURES WITHOUT CC/MCC,,,708,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,15053.84,100,MS-DRG,12043.072,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,21072.18,100,,,case rate,100% of CMS IPPS rate,21072.18,100,,,case rate,100% of CMS IPPS rate,26838.75,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,15053.84,100,MS-DRG,12043.072,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,15053.84,100,MS-DRG,12043.072,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,6978.37,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,26838.75,
PENIS PROCEDURES WITH CC/MCC,,,709,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,20939.55,100,MS-DRG,16751.64,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,30440.43,100,,,case rate,100% of CMS IPPS rate,30440.43,100,,,case rate,100% of CMS IPPS rate,21072.18,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,20939.55,100,MS-DRG,16751.64,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,20939.55,100,MS-DRG,16751.64,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,10557,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,30440.43,
PENIS PROCEDURES WITHOUT CC/MCC,,,710,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,13721.85,100,MS-DRG,10977.48,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,25012.45,100,,,case rate,100% of CMS IPPS rate,25012.45,100,,,case rate,100% of CMS IPPS rate,30440.43,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,13721.85,100,MS-DRG,10977.48,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,13721.85,100,MS-DRG,10977.48,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,6914.37,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,30440.43,
TESTES PROCEDURES WITH CC/MCC,,,711,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,20543.75,100,MS-DRG,16435,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,31215,100,,,case rate,100% of CMS IPPS rate,31215,100,,,case rate,100% of CMS IPPS rate,25012.45,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,20543.75,100,MS-DRG,16435,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,20543.75,100,MS-DRG,16435,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,10381.4,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,31215,
TESTES PROCEDURES WITHOUT CC/MCC,,,712,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,12822.02,100,MS-DRG,10257.616,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,16132.62,100,,,case rate,100% of CMS IPPS rate,16132.62,100,,,case rate,100% of CMS IPPS rate,31215,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,12822.02,100,MS-DRG,10257.616,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,12822.02,100,MS-DRG,10257.616,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,4322.03,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,31215,
TRANSURETHRAL PROSTATECTOMY WITH CC/MCC,,,713,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,14989.38,100,MS-DRG,11991.504,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,21924.66,100,,,case rate,100% of CMS IPPS rate,21924.66,100,,,case rate,100% of CMS IPPS rate,16132.62,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,14989.38,100,MS-DRG,11991.504,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,14989.38,100,MS-DRG,11991.504,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,6594.91,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,21924.66,
TRANSURETHRAL PROSTATECTOMY WITHOUT CC/MCC,,,714,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,10922.36,100,MS-DRG,8737.888,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,13641.11,100,,,case rate,100% of CMS IPPS rate,13641.11,100,,,case rate,100% of CMS IPPS rate,21924.66,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,10922.36,100,MS-DRG,8737.888,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,10922.36,100,MS-DRG,8737.888,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,3670.52,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,21924.66,
OTHER MALE REPRODUCTIVE SYSTEM O.R. PROCEDURES FOR MALIGNANCY WITH CC/MCC,,,715,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,21242.8,100,MS-DRG,16994.24,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,33108.72,100,,,case rate,100% of CMS IPPS rate,33108.72,100,,,case rate,100% of CMS IPPS rate,13641.11,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,21242.8,100,MS-DRG,16994.24,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,21242.8,100,MS-DRG,16994.24,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,9603.54,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,33108.72,
OTHER MALE REPRODUCTIVE SYSTEM O.R. PROCEDURES FOR MALIGNANCY WITHOUT CC/MCC,,,716,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,14753.89,100,MS-DRG,11803.112,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,21918.67,100,,,case rate,100% of CMS IPPS rate,21918.67,100,,,case rate,100% of CMS IPPS rate,33108.72,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,14753.89,100,MS-DRG,11803.112,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,14753.89,100,MS-DRG,11803.112,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,4761.29,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,33108.72,
OTHER MALE REPRODUCTIVE SYSTEM O.R. PROCEDURES EXCEPT MALIGNANCY WITH CC/MCC,,,717,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,17988.85,100,MS-DRG,14391.08,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,29279.32,100,,,case rate,100% of CMS IPPS rate,29279.32,100,,,case rate,100% of CMS IPPS rate,21918.67,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,17988.85,100,MS-DRG,14391.08,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,17988.85,100,MS-DRG,14391.08,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,8942.73,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,29279.32,
OTHER MALE REPRODUCTIVE SYSTEM O.R. PROCEDURES EXCEPT MALIGNANCY WITHOUT CC/MCC,,,718,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,12717.89,100,MS-DRG,10174.312,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,18466.81,100,,,case rate,100% of CMS IPPS rate,18466.81,100,,,case rate,100% of CMS IPPS rate,29279.32,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,12717.89,100,MS-DRG,10174.312,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,12717.89,100,MS-DRG,10174.312,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,4456.05,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,29279.32,
"MALIGNANCY, MALE REPRODUCTIVE SYSTEM WITH MCC",,,722,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,18493.71,100,MS-DRG,14794.968,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,24865.63,100,,,case rate,100% of CMS IPPS rate,24865.63,100,,,case rate,100% of CMS IPPS rate,18466.81,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,18493.71,100,MS-DRG,14794.968,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,18493.71,100,MS-DRG,14794.968,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,8606.86,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,24865.63,
"MALIGNANCY, MALE REPRODUCTIVE SYSTEM WITH CC",,,723,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,12209.74,100,MS-DRG,9767.792,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,16502.67,100,,,case rate,100% of CMS IPPS rate,16502.67,100,,,case rate,100% of CMS IPPS rate,24865.63,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,12209.74,100,MS-DRG,9767.792,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,12209.74,100,MS-DRG,9767.792,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,5567.6,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,24865.63,
"MALIGNANCY, MALE REPRODUCTIVE SYSTEM WITHOUT CC/MCC",,,724,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,9691.17,100,MS-DRG,7752.936,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,10325.59,100,,,case rate,100% of CMS IPPS rate,10325.59,100,,,case rate,100% of CMS IPPS rate,16502.67,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,9691.17,100,MS-DRG,7752.936,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,9691.17,100,MS-DRG,7752.936,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,3678.18,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,16502.67,
BENIGN PROSTATIC HYPERTROPHY WITH MCC,,,725,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,13255.83,100,MS-DRG,10604.664,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,18192.64,100,,,case rate,100% of CMS IPPS rate,18192.64,100,,,case rate,100% of CMS IPPS rate,10325.59,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,13255.83,100,MS-DRG,10604.664,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,13255.83,100,MS-DRG,10604.664,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,6814.27,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,18192.64,
BENIGN PROSTATIC HYPERTROPHY WITHOUT MCC,,,726,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,9041.72,100,MS-DRG,7233.376,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,11453.74,100,,,case rate,100% of CMS IPPS rate,11453.74,100,,,case rate,100% of CMS IPPS rate,18192.64,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,9041.72,100,MS-DRG,7233.376,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,9041.72,100,MS-DRG,7233.376,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,3981.78,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,18192.64,
INFLAMMATION OF THE MALE REPRODUCTIVE SYSTEM WITH MCC,,,727,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,16396.57,100,MS-DRG,13117.256,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,21544.12,100,,,case rate,100% of CMS IPPS rate,21544.12,100,,,case rate,100% of CMS IPPS rate,11453.74,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,16396.57,100,MS-DRG,13117.256,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,16396.57,100,MS-DRG,13117.256,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,7791.8,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,21544.12,
INFLAMMATION OF THE MALE REPRODUCTIVE SYSTEM WITHOUT MCC,,,728,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,9613.5,100,MS-DRG,7690.8,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,11856.75,100,,,case rate,100% of CMS IPPS rate,11856.75,100,,,case rate,100% of CMS IPPS rate,21544.12,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,9613.5,100,MS-DRG,7690.8,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,9613.5,100,MS-DRG,7690.8,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,4293.04,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,21544.12,
OTHER MALE REPRODUCTIVE SYSTEM DIAGNOSES WITH CC/MCC,,,729,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,11297.5,100,MS-DRG,9038,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,16210.52,100,,,case rate,100% of CMS IPPS rate,16210.52,100,,,case rate,100% of CMS IPPS rate,11856.75,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,11297.5,100,MS-DRG,9038,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,11297.5,100,MS-DRG,9038,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,5964.19,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,16210.52,
OTHER MALE REPRODUCTIVE SYSTEM DIAGNOSES WITHOUT CC/MCC,,,730,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,8138.57,100,MS-DRG,6510.856,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,8515.77,100,,,case rate,100% of CMS IPPS rate,8515.77,100,,,case rate,100% of CMS IPPS rate,16210.52,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,8138.57,100,MS-DRG,6510.856,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,8138.57,100,MS-DRG,6510.856,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,3422.18,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,16210.52,
"PELVIC EVISCERATION, RADICAL HYSTERECTOMY AND RADICAL VULVECTOMY WITH CC/MCC",,,734,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,20962.69,100,MS-DRG,16770.152,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,34546.99,100,,,case rate,100% of CMS IPPS rate,34546.99,100,,,case rate,100% of CMS IPPS rate,8515.77,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,20962.69,100,MS-DRG,16770.152,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,20962.69,100,MS-DRG,16770.152,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,13466.61,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,34546.99,
"PELVIC EVISCERATION, RADICAL HYSTERECTOMY AND RADICAL VULVECTOMY WITHOUT CC/MCC",,,735,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,13415.29,100,MS-DRG,10732.232,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,20450.43,100,,,case rate,100% of CMS IPPS rate,20450.43,100,,,case rate,100% of CMS IPPS rate,34546.99,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,13415.29,100,MS-DRG,10732.232,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,13415.29,100,MS-DRG,10732.232,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,6678.06,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,34546.99,
UTERINE AND ADNEXA PROCEDURES FOR OVARIAN OR ADNEXAL MALIGNANCY WITH MCC,,,736,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,35122.1,100,MS-DRG,28097.68,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,60386.45,100,,,case rate,100% of CMS IPPS rate,60386.45,100,,,case rate,100% of CMS IPPS rate,20450.43,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,35122.1,100,MS-DRG,28097.68,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,35122.1,100,MS-DRG,28097.68,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,24767.01,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,60386.45,
UTERINE AND ADNEXA PROCEDURES FOR OVARIAN OR ADNEXAL MALIGNANCY WITH CC,,,737,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,19311.75,100,MS-DRG,15449.4,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,30434.43,100,,,case rate,100% of CMS IPPS rate,30434.43,100,,,case rate,100% of CMS IPPS rate,60386.45,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,19311.75,100,MS-DRG,15449.4,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,19311.75,100,MS-DRG,15449.4,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,11061.35,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,60386.45,
UTERINE AND ADNEXA PROCEDURES FOR OVARIAN OR ADNEXAL MALIGNANCY WITHOUT CC/MCC,,,738,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,14277.95,100,MS-DRG,11422.36,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,20859.44,100,,,case rate,100% of CMS IPPS rate,20859.44,100,,,case rate,100% of CMS IPPS rate,30434.43,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,14277.95,100,MS-DRG,11422.36,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,14277.95,100,MS-DRG,11422.36,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,6657.27,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,30434.43,
UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY WITH MCC,,,739,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,32883.66,100,MS-DRG,26306.928,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,53900.74,100,,,case rate,100% of CMS IPPS rate,53900.74,100,,,case rate,100% of CMS IPPS rate,20859.44,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,32883.66,100,MS-DRG,26306.928,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,32883.66,100,MS-DRG,26306.928,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,18419.36,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,53900.74,
UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY WITH CC,,,740,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,17768.22,100,MS-DRG,14214.576,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,26112.13,100,,,case rate,100% of CMS IPPS rate,26112.13,100,,,case rate,100% of CMS IPPS rate,53900.74,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,17768.22,100,MS-DRG,14214.576,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,17768.22,100,MS-DRG,14214.576,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,8441.11,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,53900.74,
UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY WITHOUT CC/MCC,,,741,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,13738.38,100,MS-DRG,10990.704,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,19893.1,100,,,case rate,100% of CMS IPPS rate,19893.1,100,,,case rate,100% of CMS IPPS rate,26112.13,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,13738.38,100,MS-DRG,10990.704,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,13738.38,100,MS-DRG,10990.704,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,6127.2,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,26112.13,
UTERINE AND ADNEXA PROCEDURES FOR NON-MALIGNANCY WITH CC/MCC,,,742,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,17726.09,100,MS-DRG,14180.872,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,25679.15,100,,,case rate,100% of CMS IPPS rate,25679.15,100,,,case rate,100% of CMS IPPS rate,19893.1,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,17726.09,100,MS-DRG,14180.872,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,17726.09,100,MS-DRG,14180.872,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,7801.64,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,25679.15,
UTERINE AND ADNEXA PROCEDURES FOR NON-MALIGNANCY WITHOUT CC/MCC,,,743,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,12603.87,100,MS-DRG,10083.096,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,16713.92,100,,,case rate,100% of CMS IPPS rate,16713.92,100,,,case rate,100% of CMS IPPS rate,25679.15,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,12603.87,100,MS-DRG,10083.096,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,12603.87,100,MS-DRG,10083.096,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,5090.6,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,25679.15,
"D&C, CONIZATION, LAPAROSCOPY AND TUBAL INTERRUPTION WITH CC/MCC",,,744,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,18556.51,100,MS-DRG,14845.208,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,25324.07,100,,,case rate,100% of CMS IPPS rate,25324.07,100,,,case rate,100% of CMS IPPS rate,16713.92,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,18556.51,100,MS-DRG,14845.208,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,18556.51,100,MS-DRG,14845.208,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,8087.74,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,25324.07,
"D&C, CONIZATION, LAPAROSCOPY AND TUBAL INTERRUPTION WITHOUT CC/MCC",,,745,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,11561.92,100,MS-DRG,9249.536,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,16021.75,100,,,case rate,100% of CMS IPPS rate,16021.75,100,,,case rate,100% of CMS IPPS rate,25324.07,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,11561.92,100,MS-DRG,9249.536,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,11561.92,100,MS-DRG,9249.536,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,4352.11,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,25324.07,
"VAGINA, CERVIX AND VULVA PROCEDURES WITH CC/MCC",,,746,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,16851.87,100,MS-DRG,13481.496,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,25135.3,100,,,case rate,100% of CMS IPPS rate,25135.3,100,,,case rate,100% of CMS IPPS rate,16021.75,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,16851.87,100,MS-DRG,13481.496,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,16851.87,100,MS-DRG,13481.496,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,7107.47,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,25135.3,
"VAGINA, CERVIX AND VULVA PROCEDURES WITHOUT CC/MCC",,,747,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,10333.21,100,MS-DRG,8266.568,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,14355.75,100,,,case rate,100% of CMS IPPS rate,14355.75,100,,,case rate,100% of CMS IPPS rate,25135.3,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,10333.21,100,MS-DRG,8266.568,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,10333.21,100,MS-DRG,8266.568,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,4943.99,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,25135.3,
FEMALE REPRODUCTIVE SYSTEM RECONSTRUCTIVE PROCEDURES,,,748,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,14610.94,100,MS-DRG,11688.752,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,19386.71,100,,,case rate,100% of CMS IPPS rate,19386.71,100,,,case rate,100% of CMS IPPS rate,14355.75,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,14610.94,100,MS-DRG,11688.752,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,14610.94,100,MS-DRG,11688.752,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,5167.73,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,19386.71,
OTHER FEMALE REPRODUCTIVE SYSTEM O.R. PROCEDURES WITH CC/MCC,,,749,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,23801.84,100,MS-DRG,19041.472,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,38983.16,100,,,case rate,100% of CMS IPPS rate,38983.16,100,,,case rate,100% of CMS IPPS rate,19386.71,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,23801.84,100,MS-DRG,19041.472,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,23801.84,100,MS-DRG,19041.472,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,13830.38,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,38983.16,
OTHER FEMALE REPRODUCTIVE SYSTEM O.R. PROCEDURES WITHOUT CC/MCC,,,750,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,14239.94,100,MS-DRG,11391.952,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,18336.47,100,,,case rate,100% of CMS IPPS rate,18336.47,100,,,case rate,100% of CMS IPPS rate,38983.16,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,14239.94,100,MS-DRG,11391.952,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,14239.94,100,MS-DRG,11391.952,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,5907.3,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,38983.16,
"MALIGNANCY, FEMALE REPRODUCTIVE SYSTEM WITH MCC",,,754,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,18309.45,100,MS-DRG,14647.56,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,27587.85,100,,,case rate,100% of CMS IPPS rate,27587.85,100,,,case rate,100% of CMS IPPS rate,18336.47,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,18309.45,100,MS-DRG,14647.56,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,18309.45,100,MS-DRG,14647.56,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,11220.54,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,27587.85,
"MALIGNANCY, FEMALE REPRODUCTIVE SYSTEM WITH CC",,,755,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,11965.15,100,MS-DRG,9572.12,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,16029.24,100,,,case rate,100% of CMS IPPS rate,16029.24,100,,,case rate,100% of CMS IPPS rate,27587.85,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,11965.15,100,MS-DRG,9572.12,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,11965.15,100,MS-DRG,9572.12,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,6323.59,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,27587.85,
"MALIGNANCY, FEMALE REPRODUCTIVE SYSTEM WITHOUT CC/MCC",,,756,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,11180.16,100,MS-DRG,8944.128,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,11687.46,100,,,case rate,100% of CMS IPPS rate,11687.46,100,,,case rate,100% of CMS IPPS rate,16029.24,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,11180.16,100,MS-DRG,8944.128,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,11180.16,100,MS-DRG,8944.128,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,3392.64,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,16029.24,
"INFECTIONS, FEMALE REPRODUCTIVE SYSTEM WITH MCC",,,757,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,15327.35,100,MS-DRG,12261.88,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,21587.56,100,,,case rate,100% of CMS IPPS rate,21587.56,100,,,case rate,100% of CMS IPPS rate,11687.46,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,15327.35,100,MS-DRG,12261.88,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,15327.35,100,MS-DRG,12261.88,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,8525.35,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,21587.56,
"INFECTIONS, FEMALE REPRODUCTIVE SYSTEM WITH CC",,,758,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,11204.13,100,MS-DRG,8963.304,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,15287.63,100,,,case rate,100% of CMS IPPS rate,15287.63,100,,,case rate,100% of CMS IPPS rate,21587.56,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,11204.13,100,MS-DRG,8963.304,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,11204.13,100,MS-DRG,8963.304,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,5829.62,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,21587.56,
"INFECTIONS, FEMALE REPRODUCTIVE SYSTEM WITHOUT CC/MCC",,,759,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,8341.85,100,MS-DRG,6673.48,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,10647.71,100,,,case rate,100% of CMS IPPS rate,10647.71,100,,,case rate,100% of CMS IPPS rate,15287.63,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,8341.85,100,MS-DRG,6673.48,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,8341.85,100,MS-DRG,6673.48,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,4006.4,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,15287.63,
MENSTRUAL AND OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS WITH CC/MCC,,,760,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,11227.26,100,MS-DRG,8981.808,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,13059.81,100,,,case rate,100% of CMS IPPS rate,13059.81,100,,,case rate,100% of CMS IPPS rate,10647.71,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,11227.26,100,MS-DRG,8981.808,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,11227.26,100,MS-DRG,8981.808,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,4317.11,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,13059.81,
MENSTRUAL AND OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS WITHOUT CC/MCC,,,761,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,8006.37,100,MS-DRG,6405.096,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,8231.11,100,,,case rate,100% of CMS IPPS rate,8231.11,100,,,case rate,100% of CMS IPPS rate,13059.81,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,8006.37,100,MS-DRG,6405.096,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,8006.37,100,MS-DRG,6405.096,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,2817.17,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,13059.81,
VAGINAL DELIVERY WITH O.R. PROCEDURES EXCEPT STERILIZATION AND/OR D&C,,,768,RC,,,Inpatient,,,,,,1650,100,MS-DRG,1320,case rate,100% of CMS IPPS rate,1337,100,MS-DRG,1069.6,case rate,100% of CMS IPPS rate,13067.42,100,MS-DRG,10453.936,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,16950.63,100,,,case rate,100% of CMS IPPS rate,16950.63,100,,,case rate,100% of CMS IPPS rate,8231.11,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,13067.42,100,MS-DRG,10453.936,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,13067.42,100,MS-DRG,10453.936,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,9944.88,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1700,100,MS-DRG,1360,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,16950.63,
POSTPARTUM AND POST ABORTION DIAGNOSES WITH O.R. PROCEDURES,,,769,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,15759.49,100,MS-DRG,12607.592,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,21842.26,100,,,case rate,100% of CMS IPPS rate,21842.26,100,,,case rate,100% of CMS IPPS rate,16950.63,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,15759.49,100,MS-DRG,12607.592,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,15759.49,100,MS-DRG,12607.592,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,8347.02,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,21842.26,
"ABORTION WITH D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY",,,770,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,9601.94,100,MS-DRG,7681.552,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,15999.28,100,,,case rate,100% of CMS IPPS rate,15999.28,100,,,case rate,100% of CMS IPPS rate,21842.26,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,9601.94,100,MS-DRG,7681.552,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,9601.94,100,MS-DRG,7681.552,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,3475.24,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,21842.26,
POSTPARTUM AND POST ABORTION DIAGNOSES WITHOUT O.R. PROCEDURES,,,776,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,8924.38,100,MS-DRG,7139.504,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,9873.14,100,,,case rate,100% of CMS IPPS rate,9873.14,100,,,case rate,100% of CMS IPPS rate,15999.28,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,8924.38,100,MS-DRG,7139.504,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,8924.38,100,MS-DRG,7139.504,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,3520.64,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,15999.28,
ABORTION WITHOUT D&C,,,779,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,11176.03,100,MS-DRG,8940.824,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,11300.92,100,,,case rate,100% of CMS IPPS rate,11300.92,100,,,case rate,100% of CMS IPPS rate,9873.14,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,11176.03,100,MS-DRG,8940.824,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,11176.03,100,MS-DRG,8940.824,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,2808.42,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,11300.92,
CESAREAN SECTION WITH STERILIZATION WITH MCC,,,783,RC,,,Inpatient,,,,,,2700,100,MS-DRG,2160,case rate,100% of CMS IPPS rate,2785,100,MS-DRG,2228,case rate,100% of CMS IPPS rate,17642.63,100,MS-DRG,14114.104,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,26151.08,100,,,case rate,100% of CMS IPPS rate,26151.08,100,,,case rate,100% of CMS IPPS rate,11300.92,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,17642.63,100,MS-DRG,14114.104,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,17642.63,100,MS-DRG,14114.104,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,2534,100,MS-DRG,2027.2,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,26151.08,
CESAREAN SECTION WITH STERILIZATION WITH CC,,,784,RC,,,Inpatient,,,,,,2700,100,MS-DRG,2160,case rate,100% of CMS IPPS rate,2785,100,MS-DRG,2228,case rate,100% of CMS IPPS rate,11464.41,100,MS-DRG,9171.528,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,16511.66,100,,,case rate,100% of CMS IPPS rate,16511.66,100,,,case rate,100% of CMS IPPS rate,26151.08,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,11464.41,100,MS-DRG,9171.528,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,11464.41,100,MS-DRG,9171.528,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,2534,100,MS-DRG,2027.2,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,26151.08,
CESAREAN SECTION WITH STERILIZATION WITHOUT CC/MCC,,,785,RC,,,Inpatient,,,,,,2700,100,MS-DRG,2160,case rate,100% of CMS IPPS rate,2785,100,MS-DRG,2228,case rate,100% of CMS IPPS rate,10160.51,100,MS-DRG,8128.408,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,12667.28,100,,,case rate,100% of CMS IPPS rate,12667.28,100,,,case rate,100% of CMS IPPS rate,16511.66,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,10160.51,100,MS-DRG,8128.408,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,10160.51,100,MS-DRG,8128.408,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,2534,100,MS-DRG,2027.2,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,16511.66,
CESAREAN SECTION WITHOUT STERILIZATION WITH MCC,,,786,RC,,,Inpatient,,,,,,2700,100,MS-DRG,2160,case rate,100% of CMS IPPS rate,2785,100,MS-DRG,2228,case rate,100% of CMS IPPS rate,17458.36,100,MS-DRG,13966.688,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,23294.01,100,,,case rate,100% of CMS IPPS rate,23294.01,100,,,case rate,100% of CMS IPPS rate,12667.28,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,17458.36,100,MS-DRG,13966.688,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,17458.36,100,MS-DRG,13966.688,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,2534,100,MS-DRG,2027.2,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,23294.01,
CESAREAN SECTION WITHOUT STERILIZATION WITH CC,,,787,RC,,,Inpatient,,,,,,2700,100,MS-DRG,2160,case rate,100% of CMS IPPS rate,2785,100,MS-DRG,2228,case rate,100% of CMS IPPS rate,11687.51,100,MS-DRG,9350.008,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,16197.04,100,,,case rate,100% of CMS IPPS rate,16197.04,100,,,case rate,100% of CMS IPPS rate,23294.01,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,11687.51,100,MS-DRG,9350.008,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,11687.51,100,MS-DRG,9350.008,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,2534,100,MS-DRG,2027.2,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,23294.01,
CESAREAN SECTION WITHOUT STERILIZATION WITHOUT CC/MCC,,,788,RC,,,Inpatient,,,,,,2700,100,MS-DRG,2160,case rate,100% of CMS IPPS rate,2785,100,MS-DRG,2228,case rate,100% of CMS IPPS rate,10067.14,100,MS-DRG,8053.712,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,13494.29,100,,,case rate,100% of CMS IPPS rate,13494.29,100,,,case rate,100% of CMS IPPS rate,16197.04,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,10067.14,100,MS-DRG,8053.712,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,10067.14,100,MS-DRG,8053.712,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,2534,100,MS-DRG,2027.2,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,16197.04,
"NEONATES, DIED OR TRANSFERRED TO ANOTHER ACUTE CARE FACILITY",,,789,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,18035.94,100,MS-DRG,14428.752,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,13494.29,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,18035.94,100,MS-DRG,14428.752,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,18035.94,100,MS-DRG,14428.752,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,8168.69,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,18035.94,
"EXTREME IMMATURITY OR RESPIRATORY DISTRESS SYNDROME, NEONATE",,,790,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,52580.91,100,MS-DRG,42064.728,case rate,100% of CMS IPPS 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,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,52580.91,100,MS-DRG,42064.728,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,52580.91,100,MS-DRG,42064.728,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,26937.05,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,52580.91,
PREMATURITY WITH MAJOR PROBLEMS,,,791,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,36861.45,100,MS-DRG,29489.16,case rate,100% of CMS IPPS 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,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,36861.45,100,MS-DRG,29489.16,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,36861.45,100,MS-DRG,29489.16,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,18396.93,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,36861.45,
PREMATURITY WITHOUT MAJOR PROBLEMS,,,792,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,23432.49,100,MS-DRG,18745.992,case rate,100% of CMS IPPS 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,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,23432.49,100,MS-DRG,18745.992,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,23432.49,100,MS-DRG,18745.992,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,11100.74,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,23432.49,
FULL TERM NEONATE WITH MAJOR PROBLEMS,,,793,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,37783.6,100,MS-DRG,30226.88,case rate,100% of CMS IPPS 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,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,37783.6,100,MS-DRG,30226.88,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,37783.6,100,MS-DRG,30226.88,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,18898,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,37783.6,
NEONATE WITH OTHER SIGNIFICANT PROBLEMS,,,794,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,15313.3,100,MS-DRG,12250.64,case rate,100% of CMS IPPS 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,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,15313.3,100,MS-DRG,12250.64,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,15313.3,100,MS-DRG,12250.64,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,6688.45,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,15313.3,
NORMAL NEWBORN,,,795,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,4668.95,100,MS-DRG,3735.16,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,2762.68,100,,,case rate,100% of CMS IPPS rate,2762.68,100,,,case rate,100% of CMS IPPS rate,,,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,4668.95,100,MS-DRG,3735.16,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,4668.95,100,MS-DRG,3735.16,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,905.87,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,4668.95,
VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C WITH MCC,,,796,RC,,,Inpatient,,,,,,1650,100,MS-DRG,1320,case rate,100% of CMS IPPS rate,1337,100,MS-DRG,1069.6,case rate,100% of CMS IPPS rate,14722.5,100,MS-DRG,11778,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,21996.57,100,,,case rate,100% of CMS IPPS rate,21996.57,100,,,case rate,100% of CMS IPPS rate,2762.68,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,14722.5,100,MS-DRG,11778,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,14722.5,100,MS-DRG,11778,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,1700,100,MS-DRG,1360,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,21996.57,
VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C WITH CC,,,797,RC,,,Inpatient,,,,,,1650,100,MS-DRG,1320,case rate,100% of CMS IPPS rate,1337,100,MS-DRG,1069.6,case rate,100% of CMS IPPS rate,11231.39,100,MS-DRG,8985.112,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,12688.26,100,,,case rate,100% of CMS IPPS rate,12688.26,100,,,case rate,100% of CMS IPPS rate,21996.57,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,11231.39,100,MS-DRG,8985.112,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,11231.39,100,MS-DRG,8985.112,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,1700,100,MS-DRG,1360,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,21996.57,
VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C WITHOUT CC/MCC,,,798,RC,,,Inpatient,,,,,,1650,100,MS-DRG,1320,case rate,100% of CMS IPPS rate,1337,100,MS-DRG,1069.6,case rate,100% of CMS IPPS rate,9902.71,100,MS-DRG,7922.168,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,12688.26,100,,,case rate,100% of CMS IPPS rate,12688.26,100,,,case rate,100% of CMS IPPS rate,12688.26,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,9902.71,100,MS-DRG,7922.168,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,9902.71,100,MS-DRG,7922.168,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,1700,100,MS-DRG,1360,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,12688.26,
SPLENIC PROCEDURES WITH MCC,,,799,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,43941.99,100,MS-DRG,35153.592,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,70439.37,100,,,case rate,100% of CMS IPPS rate,70439.37,100,,,case rate,100% of CMS IPPS rate,12688.26,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,43941.99,100,MS-DRG,35153.592,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,43941.99,100,MS-DRG,35153.592,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,27461.1,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,70439.37,
SPLENIC PROCEDURES WITH CC,,,800,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,26284.86,100,MS-DRG,21027.888,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,39354.72,100,,,case rate,100% of CMS IPPS rate,39354.72,100,,,case rate,100% of CMS IPPS rate,70439.37,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,26284.86,100,MS-DRG,21027.888,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,26284.86,100,MS-DRG,21027.888,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,13880.71,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,70439.37,
SPLENIC PROCEDURES WITHOUT CC/MCC,,,801,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,17790.54,100,MS-DRG,14232.432,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,23316.49,100,,,case rate,100% of CMS IPPS rate,23316.49,100,,,case rate,100% of CMS IPPS rate,39354.72,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,17790.54,100,MS-DRG,14232.432,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,17790.54,100,MS-DRG,14232.432,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,8280.83,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,39354.72,
OTHER O.R. PROCEDURES OF THE BLOOD AND BLOOD FORMING ORGANS WITH MCC,,,802,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,31350.88,100,MS-DRG,25080.704,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,50147.75,100,,,case rate,100% of CMS IPPS rate,50147.75,100,,,case rate,100% of CMS IPPS rate,23316.49,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,31350.88,100,MS-DRG,25080.704,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,31350.88,100,MS-DRG,25080.704,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,18968.57,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,50147.75,
OTHER O.R. PROCEDURES OF THE BLOOD AND BLOOD FORMING ORGANS WITH CC,,,803,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,18356.54,100,MS-DRG,14685.232,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,25800.5,100,,,case rate,100% of CMS IPPS rate,25800.5,100,,,case rate,100% of CMS IPPS rate,50147.75,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,18356.54,100,MS-DRG,14685.232,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,18356.54,100,MS-DRG,14685.232,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,9450.92,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,50147.75,
OTHER O.R. PROCEDURES OF THE BLOOD AND BLOOD FORMING ORGANS WITHOUT CC/MCC,,,804,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,13003.8,100,MS-DRG,10403.04,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,18435.35,100,,,case rate,100% of CMS IPPS rate,18435.35,100,,,case rate,100% of CMS IPPS rate,25800.5,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,13003.8,100,MS-DRG,10403.04,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,13003.8,100,MS-DRG,10403.04,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,5630.51,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,25800.5,
VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITH MCC,,,805,RC,,,Inpatient,,,,,,1650,100,MS-DRG,1320,case rate,100% of CMS IPPS rate,1337,100,MS-DRG,1069.6,case rate,100% of CMS IPPS rate,11333.03,100,MS-DRG,9066.424,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,15329.58,100,,,case rate,100% of CMS IPPS rate,15329.58,100,,,case rate,100% of CMS IPPS rate,18435.35,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,11333.03,100,MS-DRG,9066.424,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,11333.03,100,MS-DRG,9066.424,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,1700,100,MS-DRG,1360,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,18435.35,
VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITH CC,,,806,RC,,,Inpatient,,,,,,1650,100,MS-DRG,1320,case rate,100% of CMS IPPS rate,1337,100,MS-DRG,1069.6,case rate,100% of CMS IPPS rate,9172.26,100,MS-DRG,7337.808,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,10598.27,100,,,case rate,100% of CMS IPPS rate,10598.27,100,,,case rate,100% of CMS IPPS rate,15329.58,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,9172.26,100,MS-DRG,7337.808,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,9172.26,100,MS-DRG,7337.808,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,1700,100,MS-DRG,1360,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,15329.58,
VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITHOUT CC/MCC,,,807,RC,,,Inpatient,,,,,,1650,100,MS-DRG,1320,case rate,100% of CMS IPPS rate,1337,100,MS-DRG,1069.6,case rate,100% of CMS IPPS rate,8408.76,100,MS-DRG,6727.008,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,9198.95,100,,,case rate,100% of CMS IPPS rate,9198.95,100,,,case rate,100% of CMS IPPS rate,10598.27,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,8408.76,100,MS-DRG,6727.008,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,8408.76,100,MS-DRG,6727.008,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,1700,100,MS-DRG,1360,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,10598.27,
MAJOR HEMATOLOGICAL AND IMMUNOLOGICAL DIAGNOSES EXCEPT SICKLE CELL CRISIS AND COAGULATION DISORDERS WITH MCC,,,808,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,21099.03,100,MS-DRG,16879.224,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,32199.31,100,,,case rate,100% of CMS IPPS rate,32199.31,100,,,case rate,100% of CMS IPPS rate,9198.95,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,21099.03,100,MS-DRG,16879.224,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,21099.03,100,MS-DRG,16879.224,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,11436.61,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,32199.31,
MAJOR HEMATOLOGICAL AND IMMUNOLOGICAL DIAGNOSES EXCEPT SICKLE CELL CRISIS AND COAGULATION DISORDERS WITH CC,,,809,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,12954.22,100,MS-DRG,10363.376,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,18045.82,100,,,case rate,100% of CMS IPPS rate,18045.82,100,,,case rate,100% of CMS IPPS rate,32199.31,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,12954.22,100,MS-DRG,10363.376,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,12954.22,100,MS-DRG,10363.376,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,6626.64,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,32199.31,
MAJOR HEMATOLOGICAL AND IMMUNOLOGICAL DIAGNOSES EXCEPT SICKLE CELL CRISIS AND COAGULATION DISORDERS WITHOUT CC/MCC,,,810,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,11302.46,100,MS-DRG,9041.968,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,13813.4,100,,,case rate,100% of CMS IPPS rate,13813.4,100,,,case rate,100% of CMS IPPS rate,18045.82,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,11302.46,100,MS-DRG,9041.968,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,11302.46,100,MS-DRG,9041.968,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,4768.95,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,18045.82,
RED BLOOD CELL DISORDERS WITH MCC,,,811,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,14600.2,100,MS-DRG,11680.16,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,20315.59,100,,,case rate,100% of CMS IPPS rate,20315.59,100,,,case rate,100% of CMS IPPS rate,13813.4,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,14600.2,100,MS-DRG,11680.16,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,14600.2,100,MS-DRG,11680.16,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,6663.83,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,20315.59,
RED BLOOD CELL DISORDERS WITHOUT MCC,,,812,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,10444.76,100,MS-DRG,8355.808,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,13232.1,100,,,case rate,100% of CMS IPPS rate,13232.1,100,,,case rate,100% of CMS IPPS rate,20315.59,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,10444.76,100,MS-DRG,8355.808,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,10444.76,100,MS-DRG,8355.808,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,4332.42,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,20315.59,
COAGULATION DISORDERS,,,813,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,15892.53,100,MS-DRG,12714.024,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,24143.49,100,,,case rate,100% of CMS IPPS rate,24143.49,100,,,case rate,100% of CMS IPPS rate,13232.1,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,15892.53,100,MS-DRG,12714.024,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,15892.53,100,MS-DRG,12714.024,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,8258.95,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,24143.49,
RETICULOENDOTHELIAL AND IMMUNITY DISORDERS WITH MCC,,,814,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,20586.71,100,MS-DRG,16469.368,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,24915.07,100,,,case rate,100% of CMS IPPS rate,24915.07,100,,,case rate,100% of CMS IPPS rate,24143.49,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,20586.71,100,MS-DRG,16469.368,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,20586.71,100,MS-DRG,16469.368,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,9173.03,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,24915.07,
RETICULOENDOTHELIAL AND IMMUNITY DISORDERS WITH CC,,,815,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,11217.35,100,MS-DRG,8973.88,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,14647.9,100,,,case rate,100% of CMS IPPS rate,14647.9,100,,,case rate,100% of CMS IPPS rate,24915.07,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,11217.35,100,MS-DRG,8973.88,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,11217.35,100,MS-DRG,8973.88,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,5366.84,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,24915.07,
RETICULOENDOTHELIAL AND IMMUNITY DISORDERS WITHOUT CC/MCC,,,816,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,8870.67,100,MS-DRG,7096.536,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,10811.01,100,,,case rate,100% of CMS IPPS rate,10811.01,100,,,case rate,100% of CMS IPPS rate,14647.9,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,8870.67,100,MS-DRG,7096.536,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,8870.67,100,MS-DRG,7096.536,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,3931.45,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,14647.9,
OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURES WITH MCC,,,817,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,26277.42,100,MS-DRG,21021.936,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,37929.93,100,,,case rate,100% of CMS IPPS rate,37929.93,100,,,case rate,100% of CMS IPPS rate,10811.01,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,26277.42,100,MS-DRG,21021.936,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,26277.42,100,MS-DRG,21021.936,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,37929.93,
OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURES WITH CC,,,818,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,14827.44,100,MS-DRG,11861.952,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,20353.05,100,,,case rate,100% of CMS IPPS rate,20353.05,100,,,case rate,100% of CMS IPPS rate,37929.93,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,14827.44,100,MS-DRG,11861.952,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,14827.44,100,MS-DRG,11861.952,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,37929.93,
OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURES WITHOUT CC/MCC,,,819,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,10498.47,100,MS-DRG,8398.776,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,12569.9,100,,,case rate,100% of CMS IPPS rate,12569.9,100,,,case rate,100% of CMS IPPS rate,20353.05,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,10498.47,100,MS-DRG,8398.776,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,10498.47,100,MS-DRG,8398.776,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,20353.05,
LYMPHOMA AND LEUKEMIA WITH MAJOR O.R. PROCEDURES WITH MCC,,,820,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,52965.97,100,MS-DRG,42372.776,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,81557.51,100,,,case rate,100% of CMS IPPS rate,81557.51,100,,,case rate,100% of CMS IPPS rate,12569.9,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,52965.97,100,MS-DRG,42372.776,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,52965.97,100,MS-DRG,42372.776,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,33213.6,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,81557.51,
LYMPHOMA AND LEUKEMIA WITH MAJOR O.R. PROCEDURES WITH CC,,,821,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,21446.07,100,MS-DRG,17156.856,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,35871.4,100,,,case rate,100% of CMS IPPS rate,35871.4,100,,,case rate,100% of CMS IPPS rate,81557.51,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,21446.07,100,MS-DRG,17156.856,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,21446.07,100,MS-DRG,17156.856,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,12945.85,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,81557.51,
LYMPHOMA AND LEUKEMIA WITH MAJOR O.R. PROCEDURES WITHOUT CC/MCC,,,822,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,13238.47,100,MS-DRG,10590.776,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,18125.22,100,,,case rate,100% of CMS IPPS rate,18125.22,100,,,case rate,100% of CMS IPPS rate,35871.4,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,13238.47,100,MS-DRG,10590.776,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,13238.47,100,MS-DRG,10590.776,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,6664.38,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,35871.4,
LYMPHOMA AND NON-ACUTE LEUKEMIA WITH OTHER PROCEDURES WITH MCC,,,823,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,40201.34,100,MS-DRG,32161.072,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,67787.56,100,,,case rate,100% of CMS IPPS rate,67787.56,100,,,case rate,100% of CMS IPPS rate,18125.22,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,40201.34,100,MS-DRG,32161.072,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,40201.34,100,MS-DRG,32161.072,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,24396.13,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,67787.56,
LYMPHOMA AND NON-ACUTE LEUKEMIA WITH OTHER PROCEDURES WITH CC,,,824,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,21452.68,100,MS-DRG,17162.144,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,32876.5,100,,,case rate,100% of CMS IPPS rate,32876.5,100,,,case rate,100% of CMS IPPS rate,67787.56,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,21452.68,100,MS-DRG,17162.144,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,21452.68,100,MS-DRG,17162.144,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,12687.1,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,67787.56,
LYMPHOMA AND NON-ACUTE LEUKEMIA WITH OTHER PROCEDURES WITHOUT CC/MCC,,,825,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,13673.1,100,MS-DRG,10938.48,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,20360.54,100,,,case rate,100% of CMS IPPS rate,20360.54,100,,,case rate,100% of CMS IPPS rate,32876.5,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,13673.1,100,MS-DRG,10938.48,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,13673.1,100,MS-DRG,10938.48,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,6981.11,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,32876.5,
MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH MAJOR O.R. PROCEDURES WITH MCC,,,826,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,41240.82,100,MS-DRG,32992.656,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,74129.44,100,,,case rate,100% of CMS IPPS rate,74129.44,100,,,case rate,100% of CMS IPPS rate,20360.54,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,41240.82,100,MS-DRG,32992.656,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,41240.82,100,MS-DRG,32992.656,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,27644.9,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,74129.44,
MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH MAJOR O.R. PROCEDURES WITH CC,,,827,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,22149.25,100,MS-DRG,17719.4,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,33734.97,100,,,case rate,100% of CMS IPPS rate,33734.97,100,,,case rate,100% of CMS IPPS rate,74129.44,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,22149.25,100,MS-DRG,17719.4,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,22149.25,100,MS-DRG,17719.4,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,12394.45,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,74129.44,
MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH MAJOR O.R. PROCEDURES WITHOUT CC/MCC,,,828,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,16556.87,100,MS-DRG,13245.496,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,24501.56,100,,,case rate,100% of CMS IPPS rate,24501.56,100,,,case rate,100% of CMS IPPS rate,33734.97,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,16556.87,100,MS-DRG,13245.496,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,16556.87,100,MS-DRG,13245.496,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,7156.15,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,33734.97,
MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH OTHER PROCEDURES WITH CC/MCC,,,829,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,29062.05,100,MS-DRG,23249.64,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,46589.53,100,,,case rate,100% of CMS IPPS rate,46589.53,100,,,case rate,100% of CMS IPPS rate,24501.56,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,29062.05,100,MS-DRG,23249.64,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,29062.05,100,MS-DRG,23249.64,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,15622.98,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,46589.53,
MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH OTHER PROCEDURES WITHOUT CC/MCC,,,830,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,16067.71,100,MS-DRG,12854.168,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,21256.46,100,,,case rate,100% of CMS IPPS rate,21256.46,100,,,case rate,100% of CMS IPPS rate,46589.53,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,16067.71,100,MS-DRG,12854.168,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,16067.71,100,MS-DRG,12854.168,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,6354.22,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,46589.53,
OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURES WITH MCC,,,831,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,11887.47,100,MS-DRG,9509.976,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,15402.99,100,,,case rate,100% of CMS IPPS rate,15402.99,100,,,case rate,100% of CMS IPPS rate,21256.46,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,11887.47,100,MS-DRG,9509.976,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,11887.47,100,MS-DRG,9509.976,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,21256.46,
OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURES WITH CC,,,832,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,9097.89,100,MS-DRG,7278.312,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,10769.06,100,,,case rate,100% of CMS IPPS rate,10769.06,100,,,case rate,100% of CMS IPPS rate,15402.99,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,9097.89,100,MS-DRG,7278.312,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,9097.89,100,MS-DRG,7278.312,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,15402.99,
OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURES WITHOUT CC/MCC,,,833,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,7231.3,100,MS-DRG,5785.04,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,7195.85,100,,,case rate,100% of CMS IPPS rate,7195.85,100,,,case rate,100% of CMS IPPS rate,10769.06,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,7231.3,100,MS-DRG,5785.04,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,7231.3,100,MS-DRG,5785.04,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,10769.06,
ACUTE LEUKEMIA WITH MCC,,,834,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,49266.64,100,MS-DRG,39413.312,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,82517.86,100,,,case rate,100% of CMS IPPS rate,82517.86,100,,,case rate,100% of CMS IPPS rate,7195.85,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,49266.64,100,MS-DRG,39413.312,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,49266.64,100,MS-DRG,39413.312,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,29323.71,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,82517.86,
ACUTE LEUKEMIA WITH CC,,,835,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,21474.17,100,MS-DRG,17179.336,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,32001.55,100,,,case rate,100% of CMS IPPS rate,32001.55,100,,,case rate,100% of CMS IPPS rate,82517.86,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,21474.17,100,MS-DRG,17179.336,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,21474.17,100,MS-DRG,17179.336,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,12931.62,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,82517.86,
ACUTE LEUKEMIA WITHOUT CC/MCC,,,836,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,14668.78,100,MS-DRG,11735.024,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,18167.17,100,,,case rate,100% of CMS IPPS rate,18167.17,100,,,case rate,100% of CMS IPPS rate,32001.55,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,14668.78,100,MS-DRG,11735.024,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,14668.78,100,MS-DRG,11735.024,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,5999.2,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,32001.55,
CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS OR WITH HIGH DOSE CHEMOTHERAPY AGENT WITH MCC,,,837,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,43028.09,100,MS-DRG,34422.472,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,80514.77,100,,,case rate,100% of CMS IPPS rate,80514.77,100,,,case rate,100% of CMS IPPS rate,18167.17,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,43028.09,100,MS-DRG,34422.472,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,43028.09,100,MS-DRG,34422.472,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,35586.58,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,80514.77,
CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH CC OR HIGH DOSE CHEMOTHERAPY AGENT,,,838,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,19542.29,100,MS-DRG,15633.832,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,35246.65,100,,,case rate,100% of CMS IPPS rate,35246.65,100,,,case rate,100% of CMS IPPS rate,80514.77,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,19542.29,100,MS-DRG,15633.832,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,19542.29,100,MS-DRG,15633.832,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,17881.63,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,80514.77,
CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITHOUT CC/MCC,,,839,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,13769.77,100,MS-DRG,11015.816,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,18815.89,100,,,case rate,100% of CMS IPPS rate,18815.89,100,,,case rate,100% of CMS IPPS rate,35246.65,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,13769.77,100,MS-DRG,11015.816,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,13769.77,100,MS-DRG,11015.816,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,6905.07,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,35246.65,
LYMPHOMA AND NON-ACUTE LEUKEMIA WITH MCC,,,840,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,28825.73,100,MS-DRG,23060.584,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,49334.23,100,,,case rate,100% of CMS IPPS rate,49334.23,100,,,case rate,100% of CMS IPPS rate,18815.89,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,28825.73,100,MS-DRG,23060.584,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,28825.73,100,MS-DRG,23060.584,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,16602.15,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,49334.23,
LYMPHOMA AND NON-ACUTE LEUKEMIA WITH CC,,,841,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,16004.08,100,MS-DRG,12803.264,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,24492.57,100,,,case rate,100% of CMS IPPS rate,24492.57,100,,,case rate,100% of CMS IPPS rate,49334.23,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,16004.08,100,MS-DRG,12803.264,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,16004.08,100,MS-DRG,12803.264,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,8939.45,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,49334.23,
LYMPHOMA AND NON-ACUTE LEUKEMIA WITHOUT CC/MCC,,,842,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,11813.93,100,MS-DRG,9451.144,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,16796.32,100,,,case rate,100% of CMS IPPS rate,16796.32,100,,,case rate,100% of CMS IPPS rate,24492.57,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,11813.93,100,MS-DRG,9451.144,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,11813.93,100,MS-DRG,9451.144,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,5542.98,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,24492.57,
OTHER MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASTIC DIAGNOSES WITH MCC,,,843,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,18376.38,100,MS-DRG,14701.104,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,27656.77,100,,,case rate,100% of CMS IPPS rate,27656.77,100,,,case rate,100% of CMS IPPS rate,16796.32,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,18376.38,100,MS-DRG,14701.104,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,18376.38,100,MS-DRG,14701.104,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,10338.19,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,27656.77,
OTHER MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASTIC DIAGNOSES WITH CC,,,844,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,12564.21,100,MS-DRG,10051.368,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,17660.78,100,,,case rate,100% of CMS IPPS rate,17660.78,100,,,case rate,100% of CMS IPPS rate,27656.77,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,12564.21,100,MS-DRG,10051.368,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,12564.21,100,MS-DRG,10051.368,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,6427.52,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,27656.77,
OTHER MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASTIC DIAGNOSES WITHOUT CC/MCC,,,845,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,10148.95,100,MS-DRG,8119.16,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,12977.41,100,,,case rate,100% of CMS IPPS rate,12977.41,100,,,case rate,100% of CMS IPPS rate,17660.78,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,10148.95,100,MS-DRG,8119.16,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,10148.95,100,MS-DRG,8119.16,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,4357.59,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,17660.78,
CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH MCC,,,846,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,23196.99,100,MS-DRG,18557.592,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,42217.78,100,,,case rate,100% of CMS IPPS rate,42217.78,100,,,case rate,100% of CMS IPPS rate,12977.41,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,23196.99,100,MS-DRG,18557.592,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,23196.99,100,MS-DRG,18557.592,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,12501.12,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,42217.78,
CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH CC,,,847,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,13021.97,100,MS-DRG,10417.576,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,19873.62,100,,,case rate,100% of CMS IPPS rate,19873.62,100,,,case rate,100% of CMS IPPS rate,42217.78,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,13021.97,100,MS-DRG,10417.576,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,13021.97,100,MS-DRG,10417.576,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,5550.1,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,42217.78,
CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITHOUT CC/MCC,,,848,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,9911.8,100,MS-DRG,7929.44,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,13972.21,100,,,case rate,100% of CMS IPPS rate,13972.21,100,,,case rate,100% of CMS IPPS rate,19873.62,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,9911.8,100,MS-DRG,7929.44,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,9911.8,100,MS-DRG,7929.44,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,4180.9,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,19873.62,
RADIOTHERAPY,,,849,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,25241.26,100,MS-DRG,20193.008,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,29517.54,100,,,case rate,100% of CMS IPPS rate,29517.54,100,,,case rate,100% of CMS IPPS rate,13972.21,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,25241.26,100,MS-DRG,20193.008,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,25241.26,100,MS-DRG,20193.008,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,7180.77,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,29517.54,
ACUTE LEUKEMIA WITH OTHER PROCEDURES,,,850,RC,,,Inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,34818.85,100,MS-DRG,27855.08,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,29517.54,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,11234.7,100,MS-DRG,8987.76,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,55598.55,100,MS-DRG,44478.84,case rate,100% of CMS IPPS 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,850,55598.55,
INFECTIOUS AND PARASITIC DISEASES WITH O.R. PROCEDURES WITH MCC,,,853,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,44311.35,100,MS-DRG,35449.08,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,75765.47,100,,,case rate,100% of CMS IPPS rate,75765.47,100,,,case rate,100% of CMS IPPS rate,,,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,44311.35,100,MS-DRG,35449.08,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,44311.35,100,MS-DRG,35449.08,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,29904.65,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,75765.47,
INFECTIOUS AND PARASITIC DISEASES WITH O.R. PROCEDURES WITH CC,,,854,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,19843.88,100,MS-DRG,15875.104,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,33002.35,100,,,case rate,100% of CMS IPPS rate,33002.35,100,,,case rate,100% of CMS IPPS rate,75765.47,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,19843.88,100,MS-DRG,15875.104,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,19843.88,100,MS-DRG,15875.104,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,14524.01,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,75765.47,
INFECTIOUS AND PARASITIC DISEASES WITH O.R. PROCEDURES WITHOUT CC/MCC,,,855,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,17064.21,100,MS-DRG,13651.368,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,23371.92,100,,,case rate,100% of CMS IPPS rate,23371.92,100,,,case rate,100% of CMS IPPS rate,33002.35,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,17064.21,100,MS-DRG,13651.368,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,17064.21,100,MS-DRG,13651.368,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,8756.74,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,33002.35,
POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROCEDURES WITH MCC,,,856,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,39594.02,100,MS-DRG,31675.216,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,67243.71,100,,,case rate,100% of CMS IPPS rate,67243.71,100,,,case rate,100% of CMS IPPS rate,23371.92,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,39594.02,100,MS-DRG,31675.216,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,39594.02,100,MS-DRG,31675.216,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,27125.78,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,67243.71,
POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROCEDURES WITH CC,,,857,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,20649.52,100,MS-DRG,16519.616,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,30813.48,100,,,case rate,100% of CMS IPPS rate,30813.48,100,,,case rate,100% of CMS IPPS rate,67243.71,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,20649.52,100,MS-DRG,16519.616,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,20649.52,100,MS-DRG,16519.616,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,11337.6,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,67243.71,
POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROCEDURES WITHOUT CC/MCC,,,858,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,13607,100,MS-DRG,10885.6,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,20676.66,100,,,case rate,100% of CMS IPPS rate,20676.66,100,,,case rate,100% of CMS IPPS rate,30813.48,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,13607,100,MS-DRG,10885.6,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,13607,100,MS-DRG,10885.6,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,7227.27,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,30813.48,
POSTOPERATIVE AND POST-TRAUMATIC INFECTIONS WITH MCC,,,862,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,18222.69,100,MS-DRG,14578.152,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,27382.6,100,,,case rate,100% of CMS IPPS rate,27382.6,100,,,case rate,100% of CMS IPPS rate,20676.66,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,18222.69,100,MS-DRG,14578.152,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,18222.69,100,MS-DRG,14578.152,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,10515.42,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,27382.6,
POSTOPERATIVE AND POST-TRAUMATIC INFECTIONS WITHOUT MCC,,,863,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,11310.72,100,MS-DRG,9048.576,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,14754.27,100,,,case rate,100% of CMS IPPS rate,14754.27,100,,,case rate,100% of CMS IPPS rate,27382.6,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,11310.72,100,MS-DRG,9048.576,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,11310.72,100,MS-DRG,9048.576,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,5439.05,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,27382.6,
FEVER AND INFLAMMATORY CONDITIONS,,,864,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,10296.84,100,MS-DRG,8237.472,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,12948.94,100,,,case rate,100% of CMS IPPS rate,12948.94,100,,,case rate,100% of CMS IPPS rate,14754.27,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,10296.84,100,MS-DRG,8237.472,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,10296.84,100,MS-DRG,8237.472,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,4560.53,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,14754.27,
VIRAL ILLNESS WITH MCC,,,865,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,16552.74,100,MS-DRG,13242.192,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,20708.12,100,,,case rate,100% of CMS IPPS rate,20708.12,100,,,case rate,100% of CMS IPPS rate,12948.94,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,16552.74,100,MS-DRG,13242.192,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,16552.74,100,MS-DRG,13242.192,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,8647.89,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,20708.12,
VIRAL ILLNESS WITHOUT MCC,,,866,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,10585.23,100,MS-DRG,8468.184,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,12291.23,100,,,case rate,100% of CMS IPPS rate,12291.23,100,,,case rate,100% of CMS IPPS rate,20708.12,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,10585.23,100,MS-DRG,8468.184,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,10585.23,100,MS-DRG,8468.184,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,4073.13,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,20708.12,
OTHER INFECTIOUS AND PARASITIC DISEASES DIAGNOSES WITH MCC,,,867,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,20290.9,100,MS-DRG,16232.72,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,31955.11,100,,,case rate,100% of CMS IPPS rate,31955.11,100,,,case rate,100% of CMS IPPS rate,12291.23,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,20290.9,100,MS-DRG,16232.72,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,20290.9,100,MS-DRG,16232.72,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,13961.67,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,31955.11,
OTHER INFECTIOUS AND PARASITIC DISEASES DIAGNOSES WITH CC,,,868,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,11971.76,100,MS-DRG,9577.408,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,16134.12,100,,,case rate,100% of CMS IPPS rate,16134.12,100,,,case rate,100% of CMS IPPS rate,31955.11,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,11971.76,100,MS-DRG,9577.408,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,11971.76,100,MS-DRG,9577.408,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,5916.6,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,31955.11,
OTHER INFECTIOUS AND PARASITIC DISEASES DIAGNOSES WITHOUT CC/MCC,,,869,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,8709.54,100,MS-DRG,6967.632,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,11504.68,100,,,case rate,100% of CMS IPPS rate,11504.68,100,,,case rate,100% of CMS IPPS rate,16134.12,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,8709.54,100,MS-DRG,6967.632,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,8709.54,100,MS-DRG,6967.632,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,3678.18,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,16134.12,
SEPTICEMIA OR SEVERE SEPSIS WITH MV >96 HOURS,,,870,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,60553.01,100,MS-DRG,48442.408,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,94316.18,100,,,case rate,100% of CMS IPPS rate,94316.18,100,,,case rate,100% of CMS IPPS rate,11504.68,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,60553.01,100,MS-DRG,48442.408,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,60553.01,100,MS-DRG,48442.408,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,31912.77,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,94316.18,
SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITH MCC,,,871,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,19384.46,100,MS-DRG,15507.568,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,27812.58,100,,,case rate,100% of CMS IPPS rate,27812.58,100,,,case rate,100% of CMS IPPS rate,94316.18,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,19384.46,100,MS-DRG,15507.568,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,19384.46,100,MS-DRG,15507.568,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,10442.67,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,94316.18,
SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITHOUT MCC,,,872,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,11512.33,100,MS-DRG,9209.864,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,15774.55,100,,,case rate,100% of CMS IPPS rate,15774.55,100,,,case rate,100% of CMS IPPS rate,27812.58,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,11512.33,100,MS-DRG,9209.864,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,11512.33,100,MS-DRG,9209.864,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,6202.69,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,27812.58,
O.R. PROCEDURES WITH PRINCIPAL DIAGNOSIS OF MENTAL ILLNESS,,,876,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,33835.55,100,MS-DRG,27068.44,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,15774.55,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,33835.55,100,MS-DRG,27068.44,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,33835.55,100,MS-DRG,27068.44,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,15491.14,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,33835.55,
ACUTE ADJUSTMENT REACTION AND PSYCHOSOCIAL DYSFUNCTION,,,880,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,10890.14,100,MS-DRG,8712.112,case rate,100% of CMS IPPS 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,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,10890.14,100,MS-DRG,8712.112,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,10890.14,100,MS-DRG,8712.112,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,3466.48,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,10890.14,
DEPRESSIVE NEUROSES,,,881,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,10492.69,100,MS-DRG,8394.152,case rate,100% of CMS IPPS 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,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,10492.69,100,MS-DRG,8394.152,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,10492.69,100,MS-DRG,8394.152,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,3367.47,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,10492.69,
NEUROSES EXCEPT DEPRESSIVE,,,882,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,10763.71,100,MS-DRG,8610.968,case rate,100% of CMS IPPS 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,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,10763.71,100,MS-DRG,8610.968,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,10763.71,100,MS-DRG,8610.968,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,3591.75,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,10763.71,
DISORDERS OF PERSONALITY AND IMPULSE CONTROL,,,883,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,18498.67,100,MS-DRG,14798.936,case rate,100% of CMS IPPS 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,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,18498.67,100,MS-DRG,14798.936,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,18498.67,100,MS-DRG,14798.936,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,6489.88,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,18498.67,
ORGANIC DISTURBANCES AND INTELLECTUAL DISABILITY,,,884,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,17519.51,100,MS-DRG,14015.608,case rate,100% of CMS IPPS 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,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,17519.51,100,MS-DRG,14015.608,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,17519.51,100,MS-DRG,14015.608,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,5212.58,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,17519.51,
PSYCHOSES,,,885,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,14292.82,100,MS-DRG,11434.256,case rate,100% of CMS IPPS 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,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,14292.82,100,MS-DRG,11434.256,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,14292.82,100,MS-DRG,11434.256,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,5037.53,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,14292.82,
BEHAVIORAL AND DEVELOPMENTAL DISORDERS,,,886,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,16898.14,100,MS-DRG,13518.512,case rate,100% of CMS IPPS 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,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,16898.14,100,MS-DRG,13518.512,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,16898.14,100,MS-DRG,13518.512,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,4084.07,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,16898.14,
OTHER MENTAL DISORDER DIAGNOSES,,,887,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,13707.8,100,MS-DRG,10966.24,case rate,100% of CMS IPPS 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,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,13707.8,100,MS-DRG,10966.24,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,13707.8,100,MS-DRG,10966.24,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,4479.57,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,13707.8,
"ALCOHOL, DRUG ABUSE OR DEPENDENCE, LEFT AMA",,,894,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,7749.39,100,MS-DRG,6199.512,case rate,100% of CMS IPPS 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,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,7749.39,100,MS-DRG,6199.512,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,7749.39,100,MS-DRG,6199.512,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,2354.39,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,7749.39,
"ALCOHOL, DRUG ABUSE OR DEPENDENCE WITH REHABILITATION THERAPY",,,895,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,16295.76,100,MS-DRG,13036.608,case rate,100% of CMS IPPS 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,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,16295.76,100,MS-DRG,13036.608,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,16295.76,100,MS-DRG,13036.608,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,5991,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,16295.76,
"ALCOHOL, DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITH MCC",,,896,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,17694.68,100,MS-DRG,14155.744,case rate,100% of CMS IPPS 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,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,17694.68,100,MS-DRG,14155.744,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,17694.68,100,MS-DRG,14155.744,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,7961.92,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,17694.68,
"ALCOHOL, DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITHOUT MCC",,,897,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,10072.1,100,MS-DRG,8057.68,case rate,100% of CMS IPPS 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,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,10072.1,100,MS-DRG,8057.68,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,10072.1,100,MS-DRG,8057.68,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,3657.94,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,10072.1,
WOUND DEBRIDEMENTS FOR INJURIES WITH MCC,,,901,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,38762.76,100,MS-DRG,31010.208,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,66893.13,100,,,case rate,100% of CMS IPPS rate,66893.13,100,,,case rate,100% of CMS IPPS rate,,,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,38762.76,100,MS-DRG,31010.208,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,38762.76,100,MS-DRG,31010.208,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,22444.35,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,66893.13,
WOUND DEBRIDEMENTS FOR INJURIES WITH CC,,,902,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,18575.52,100,MS-DRG,14860.416,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,28771.43,100,,,case rate,100% of CMS IPPS rate,28771.43,100,,,case rate,100% of CMS IPPS rate,66893.13,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,18575.52,100,MS-DRG,14860.416,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,18575.52,100,MS-DRG,14860.416,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,9812.5,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,66893.13,
WOUND DEBRIDEMENTS FOR INJURIES WITHOUT CC/MCC,,,903,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,13260.77,100,MS-DRG,10608.616,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,17437.55,100,,,case rate,100% of CMS IPPS rate,17437.55,100,,,case rate,100% of CMS IPPS rate,28771.43,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,13260.77,100,MS-DRG,10608.616,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,13260.77,100,MS-DRG,10608.616,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,5777.66,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,28771.43,
SKIN GRAFTS FOR INJURIES WITH CC/MCC,,,904,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,29908.17,100,MS-DRG,23926.536,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,48331.93,100,,,case rate,100% of CMS IPPS rate,48331.93,100,,,case rate,100% of CMS IPPS rate,17437.55,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,29908.17,100,MS-DRG,23926.536,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,29908.17,100,MS-DRG,23926.536,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,16988.89,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,48331.93,
SKIN GRAFTS FOR INJURIES WITHOUT CC/MCC,,,905,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,16088.37,100,MS-DRG,12870.696,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,26506.15,100,,,case rate,100% of CMS IPPS rate,26506.15,100,,,case rate,100% of CMS IPPS rate,48331.93,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,16088.37,100,MS-DRG,12870.696,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,16088.37,100,MS-DRG,12870.696,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,6401.26,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,48331.93,
HAND PROCEDURES FOR INJURIES,,,906,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,18549.9,100,MS-DRG,14839.92,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,27614.82,100,,,case rate,100% of CMS IPPS rate,27614.82,100,,,case rate,100% of CMS IPPS rate,26506.15,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,18549.9,100,MS-DRG,14839.92,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,18549.9,100,MS-DRG,14839.92,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,5779.85,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,27614.82,
OTHER O.R. PROCEDURES FOR INJURIES WITH MCC,,,907,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,33736.4,100,MS-DRG,26989.12,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,63165.61,100,,,case rate,100% of CMS IPPS rate,63165.61,100,,,case rate,100% of CMS IPPS rate,27614.82,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,33736.4,100,MS-DRG,26989.12,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,33736.4,100,MS-DRG,26989.12,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,21695.48,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,63165.61,
OTHER O.R. PROCEDURES FOR INJURIES WITH CC,,,908,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,19562.11,100,MS-DRG,15649.688,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,29856.13,100,,,case rate,100% of CMS IPPS rate,29856.13,100,,,case rate,100% of CMS IPPS rate,63165.61,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,19562.11,100,MS-DRG,15649.688,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,19562.11,100,MS-DRG,15649.688,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,10556.45,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,63165.61,
OTHER O.R. PROCEDURES FOR INJURIES WITHOUT CC/MCC,,,909,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,14209.36,100,MS-DRG,11367.488,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,19857.14,100,,,case rate,100% of CMS IPPS rate,19857.14,100,,,case rate,100% of CMS IPPS rate,29856.13,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,14209.36,100,MS-DRG,11367.488,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,14209.36,100,MS-DRG,11367.488,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,6352.03,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,29856.13,
TRAUMATIC INJURY WITH MCC,,,913,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,15351.31,100,MS-DRG,12281.048,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,22052.01,100,,,case rate,100% of CMS IPPS rate,22052.01,100,,,case rate,100% of CMS IPPS rate,19857.14,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,15351.31,100,MS-DRG,12281.048,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,15351.31,100,MS-DRG,12281.048,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,6814.81,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,22052.01,
TRAUMATIC INJURY WITHOUT MCC,,,914,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,10502.6,100,MS-DRG,8402.08,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,12551.92,100,,,case rate,100% of CMS IPPS rate,12551.92,100,,,case rate,100% of CMS IPPS rate,22052.01,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,10502.6,100,MS-DRG,8402.08,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,10502.6,100,MS-DRG,8402.08,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,3882.22,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,22052.01,
ALLERGIC REACTIONS WITH MCC,,,915,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,17660.8,100,MS-DRG,14128.64,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,25123.32,100,,,case rate,100% of CMS IPPS rate,25123.32,100,,,case rate,100% of CMS IPPS rate,12551.92,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,17660.8,100,MS-DRG,14128.64,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,17660.8,100,MS-DRG,14128.64,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,7986.54,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,25123.32,
ALLERGIC REACTIONS WITHOUT MCC,,,916,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,8445.95,100,MS-DRG,6756.76,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,9518.06,100,,,case rate,100% of CMS IPPS rate,9518.06,100,,,case rate,100% of CMS IPPS rate,25123.32,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,8445.95,100,MS-DRG,6756.76,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,8445.95,100,MS-DRG,6756.76,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,2645.4,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,25123.32,
POISONING AND TOXIC EFFECTS OF DRUGS WITH MCC,,,917,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,16189.17,100,MS-DRG,12951.336,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,22078.97,100,,,case rate,100% of CMS IPPS rate,22078.97,100,,,case rate,100% of CMS IPPS rate,9518.06,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,16189.17,100,MS-DRG,12951.336,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,16189.17,100,MS-DRG,12951.336,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,8192.76,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,22078.97,
POISONING AND TOXIC EFFECTS OF DRUGS WITHOUT MCC,,,918,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,10115.9,100,MS-DRG,8092.72,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,11666.48,100,,,case rate,100% of CMS IPPS rate,11666.48,100,,,case rate,100% of CMS IPPS rate,22078.97,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,10115.9,100,MS-DRG,8092.72,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,10115.9,100,MS-DRG,8092.72,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,3406.86,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,22078.97,
COMPLICATIONS OF TREATMENT WITH MCC,,,919,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,18079.74,100,MS-DRG,14463.792,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,27331.66,100,,,case rate,100% of CMS IPPS rate,27331.66,100,,,case rate,100% of CMS IPPS rate,11666.48,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,18079.74,100,MS-DRG,14463.792,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,18079.74,100,MS-DRG,14463.792,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,8906.63,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,27331.66,
COMPLICATIONS OF TREATMENT WITH CC,,,920,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,11544.56,100,MS-DRG,9235.648,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,15028.44,100,,,case rate,100% of CMS IPPS rate,15028.44,100,,,case rate,100% of CMS IPPS rate,27331.66,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,11544.56,100,MS-DRG,9235.648,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,11544.56,100,MS-DRG,9235.648,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,5267.28,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,27331.66,
COMPLICATIONS OF TREATMENT WITHOUT CC/MCC,,,921,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,8768.21,100,MS-DRG,7014.568,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,10586.28,100,,,case rate,100% of CMS IPPS rate,10586.28,100,,,case rate,100% of CMS IPPS rate,15028.44,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,8768.21,100,MS-DRG,7014.568,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,8768.21,100,MS-DRG,7014.568,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,3463.75,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,15028.44,
"OTHER INJURY, POISONING AND TOXIC EFFECT DIAGNOSES WITH MCC",,,922,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,17420.35,100,MS-DRG,13936.28,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,23347.95,100,,,case rate,100% of CMS IPPS rate,23347.95,100,,,case rate,100% of CMS IPPS rate,10586.28,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,17420.35,100,MS-DRG,13936.28,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,17420.35,100,MS-DRG,13936.28,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,8067.5,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,23347.95,
"OTHER INJURY, POISONING AND TOXIC EFFECT DIAGNOSES WITHOUT MCC",,,923,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,11359.47,100,MS-DRG,9087.576,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,13031.34,100,,,case rate,100% of CMS IPPS rate,13031.34,100,,,case rate,100% of CMS IPPS rate,23347.95,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,11359.47,100,MS-DRG,9087.576,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,11359.47,100,MS-DRG,9087.576,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,3687.48,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,23347.95,
EXTENSIVE BURNS OR FULL THICKNESS BURNS WITH MV >96 HOURS WITH SKIN GRAFT,,,927,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,220803.27,100,MS-DRG,176642.616,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,13031.34,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,220803.27,100,MS-DRG,176642.616,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,220803.27,100,MS-DRG,176642.616,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,66207.83,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,220803.27,
FULL THICKNESS BURN WITH SKIN GRAFT OR INHALATION INJURY WITH CC/MCC,,,928,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,60179.53,100,MS-DRG,48143.624,case rate,100% of CMS IPPS 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,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,60179.53,100,MS-DRG,48143.624,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,60179.53,100,MS-DRG,48143.624,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,26754.35,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,60179.53,
FULL THICKNESS BURN WITH SKIN GRAFT OR INHALATION INJURY WITHOUT CC/MCC,,,929,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,29571.86,100,MS-DRG,23657.488,case rate,100% of CMS IPPS 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,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,29571.86,100,MS-DRG,23657.488,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,29571.86,100,MS-DRG,23657.488,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,11913.61,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,29571.86,
EXTENSIVE BURNS OR FULL THICKNESS BURNS WITH MV >96 HOURS WITHOUT SKIN GRAFT,,,933,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,28055.62,100,MS-DRG,22444.496,case rate,100% of CMS IPPS 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,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,28055.62,100,MS-DRG,22444.496,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,28055.62,100,MS-DRG,22444.496,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,12499.48,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,28055.62,
FULL THICKNESS BURN WITHOUT SKIN GRAFT OR INHALATION INJURY,,,934,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,20292.56,100,MS-DRG,16234.048,case rate,100% of CMS IPPS 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,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,20292.56,100,MS-DRG,16234.048,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,20292.56,100,MS-DRG,16234.048,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,7657.23,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,20292.56,
NON-EXTENSIVE BURNS,,,935,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,19867.85,100,MS-DRG,15894.28,case rate,100% of CMS IPPS 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,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,19867.85,100,MS-DRG,15894.28,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,19867.85,100,MS-DRG,15894.28,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,6877.17,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,19867.85,
O.R. PROCEDURES WITH DIAGNOSES OF OTHER CONTACT WITH HEALTH SERVICES WITH MCC,,,939,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,29570.21,100,MS-DRG,23656.168,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,49121.48,100,,,case rate,100% of CMS IPPS rate,49121.48,100,,,case rate,100% of CMS IPPS rate,,,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,29570.21,100,MS-DRG,23656.168,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,29570.21,100,MS-DRG,23656.168,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,16769.54,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,49121.48,
O.R. PROCEDURES WITH DIAGNOSES OF OTHER CONTACT WITH HEALTH SERVICES WITH CC,,,940,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,20904.85,100,MS-DRG,16723.88,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,32578.36,100,,,case rate,100% of CMS IPPS rate,32578.36,100,,,case rate,100% of CMS IPPS rate,49121.48,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,20904.85,100,MS-DRG,16723.88,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,20904.85,100,MS-DRG,16723.88,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,9670.27,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,49121.48,
O.R. PROCEDURES WITH DIAGNOSES OF OTHER CONTACT WITH HEALTH SERVICES WITHOUT CC/MCC,,,941,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,18338.37,100,MS-DRG,14670.696,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,27737.67,100,,,case rate,100% of CMS IPPS rate,27737.67,100,,,case rate,100% of CMS IPPS rate,32578.36,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,18338.37,100,MS-DRG,14670.696,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,18338.37,100,MS-DRG,14670.696,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,6286.39,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,32578.36,
REHABILITATION WITH CC/MCC,,,945,RC,,,Inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15475.25,100,MS-DRG,12380.2,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,27737.67,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,15475.25,100,MS-DRG,12380.2,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,15475.25,100,MS-DRG,12380.2,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,7281.97,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,27737.67,
REHABILITATION WITHOUT CC/MCC,,,946,RC,,,Inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11370.21,100,MS-DRG,9096.168,case rate,100% of CMS IPPS 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,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,11370.21,100,MS-DRG,9096.168,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,11370.21,100,MS-DRG,9096.168,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,7050.58,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,11370.21,
SIGNS AND SYMPTOMS WITH MCC,,,947,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,13344.24,100,MS-DRG,10675.392,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,18062.3,100,,,case rate,100% of CMS IPPS rate,18062.3,100,,,case rate,100% of CMS IPPS rate,,,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,13344.24,100,MS-DRG,10675.392,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,13344.24,100,MS-DRG,10675.392,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,6186.28,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,18062.3,
SIGNS AND SYMPTOMS WITHOUT MCC,,,948,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,9620.95,100,MS-DRG,7696.76,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,11688.96,100,,,case rate,100% of CMS IPPS rate,11688.96,100,,,case rate,100% of CMS IPPS rate,18062.3,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,9620.95,100,MS-DRG,7696.76,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,9620.95,100,MS-DRG,7696.76,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,3787.04,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,18062.3,
AFTERCARE WITH CC/MCC,,,949,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,11866.82,100,MS-DRG,9493.456,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,17172.37,100,,,case rate,100% of CMS IPPS rate,17172.37,100,,,case rate,100% of CMS IPPS rate,11688.96,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,11866.82,100,MS-DRG,9493.456,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,11866.82,100,MS-DRG,9493.456,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,5199.45,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,17172.37,
AFTERCARE WITHOUT CC/MCC,,,950,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,8279.04,100,MS-DRG,6623.232,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,11160.09,100,,,case rate,100% of CMS IPPS rate,11160.09,100,,,case rate,100% of CMS IPPS rate,17172.37,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,8279.04,100,MS-DRG,6623.232,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,8279.04,100,MS-DRG,6623.232,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,2830.84,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,17172.37,
OTHER FACTORS INFLUENCING HEALTH STATUS,,,951,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,7877.46,100,MS-DRG,6301.968,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,11961.63,100,,,case rate,100% of CMS IPPS rate,11961.63,100,,,case rate,100% of CMS IPPS rate,11160.09,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,7877.46,100,MS-DRG,6301.968,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,7877.46,100,MS-DRG,6301.968,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,3963.18,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,11961.63,
CRANIOTOMY FOR MULTIPLE SIGNIFICANT TRAUMA,,,955,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,53325.41,100,MS-DRG,42660.328,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,91343.76,100,,,case rate,100% of CMS IPPS rate,91343.76,100,,,case rate,100% of CMS IPPS rate,11961.63,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,53325.41,100,MS-DRG,42660.328,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,53325.41,100,MS-DRG,42660.328,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,29828.62,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,91343.76,
"LIMB REATTACHMENT, HIP AND FEMUR PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA",,,956,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,35047.73,100,MS-DRG,28038.184,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,56688.89,100,,,case rate,100% of CMS IPPS rate,56688.89,100,,,case rate,100% of CMS IPPS rate,91343.76,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,35047.73,100,MS-DRG,28038.184,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,35047.73,100,MS-DRG,28038.184,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,19868.97,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,91343.76,
OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITH MCC,,,957,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,62764.2,100,MS-DRG,50211.36,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,113840.73,100,,,case rate,100% of CMS IPPS rate,113840.73,100,,,case rate,100% of CMS IPPS rate,56688.89,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,62764.2,100,MS-DRG,50211.36,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,62764.2,100,MS-DRG,50211.36,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,36112.82,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,113840.73,
OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITH CC,,,958,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,36424.34,100,MS-DRG,29139.472,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,62621.76,100,,,case rate,100% of CMS IPPS rate,62621.76,100,,,case rate,100% of CMS IPPS rate,113840.73,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,36424.34,100,MS-DRG,29139.472,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,36424.34,100,MS-DRG,29139.472,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,20508.44,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,113840.73,
OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITHOUT CC/MCC,,,959,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,23927.44,100,MS-DRG,19141.952,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,36716.39,100,,,case rate,100% of CMS IPPS rate,36716.39,100,,,case rate,100% of CMS IPPS rate,62621.76,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,23927.44,100,MS-DRG,19141.952,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,23927.44,100,MS-DRG,19141.952,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,13517.49,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,62621.76,
OTHER MULTIPLE SIGNIFICANT TRAUMA WITH MCC,,,963,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,25595.72,100,MS-DRG,20476.576,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,41874.69,100,,,case rate,100% of CMS IPPS rate,41874.69,100,,,case rate,100% of CMS IPPS rate,36716.39,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,25595.72,100,MS-DRG,20476.576,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,25595.72,100,MS-DRG,20476.576,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,15477.47,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,41874.69,
OTHER MULTIPLE SIGNIFICANT TRAUMA WITH CC,,,964,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,15405.02,100,MS-DRG,12324.016,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,22096.95,100,,,case rate,100% of CMS IPPS rate,22096.95,100,,,case rate,100% of CMS IPPS rate,41874.69,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,15405.02,100,MS-DRG,12324.016,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,15405.02,100,MS-DRG,12324.016,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,8295.6,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,41874.69,
OTHER MULTIPLE SIGNIFICANT TRAUMA WITHOUT CC/MCC,,,965,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,10900.88,100,MS-DRG,8720.704,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,14596.96,100,,,case rate,100% of CMS IPPS rate,14596.96,100,,,case rate,100% of CMS IPPS rate,22096.95,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,10900.88,100,MS-DRG,8720.704,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,10900.88,100,MS-DRG,8720.704,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,5532.59,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,22096.95,
HIV WITH EXTENSIVE O.R. PROCEDURES WITH MCC,,,969,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,59790.35,100,MS-DRG,47832.28,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,83879.72,100,,,case rate,100% of CMS IPPS rate,83879.72,100,,,case rate,100% of CMS IPPS rate,14596.96,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,59790.35,100,MS-DRG,47832.28,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,59790.35,100,MS-DRG,47832.28,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,30719.72,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,83879.72,
HIV WITH EXTENSIVE O.R. PROCEDURES WITHOUT MCC,,,970,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,25970.05,100,MS-DRG,20776.04,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,41765.32,100,,,case rate,100% of CMS IPPS rate,41765.32,100,,,case rate,100% of CMS IPPS rate,83879.72,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,25970.05,100,MS-DRG,20776.04,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,25970.05,100,MS-DRG,20776.04,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,12939.83,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,83879.72,
HIV WITH MAJOR RELATED CONDITION WITH MCC,,,974,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,27101.24,100,MS-DRG,21680.992,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,40795.99,100,,,case rate,100% of CMS IPPS rate,40795.99,100,,,case rate,100% of CMS IPPS rate,41765.32,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,27101.24,100,MS-DRG,21680.992,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,27101.24,100,MS-DRG,21680.992,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,14804.08,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,41765.32,
HIV WITH MAJOR RELATED CONDITION WITH CC,,,975,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,14267.2,100,MS-DRG,11413.76,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,19325.28,100,,,case rate,100% of CMS IPPS rate,19325.28,100,,,case rate,100% of CMS IPPS rate,40795.99,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,14267.2,100,MS-DRG,11413.76,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,14267.2,100,MS-DRG,11413.76,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,7360.19,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,40795.99,
HIV WITH MAJOR RELATED CONDITION WITHOUT CC/MCC,,,976,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,9986.99,100,MS-DRG,7989.592,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,14062.11,100,,,case rate,100% of CMS IPPS rate,14062.11,100,,,case rate,100% of CMS IPPS rate,19325.28,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,9986.99,100,MS-DRG,7989.592,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,9986.99,100,MS-DRG,7989.592,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,4731.2,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,19325.28,
HIV WITH OR WITHOUT OTHER RELATED CONDITION,,,977,RC,,,Inpatient,,,,,,900,100,MS-DRG,720,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,14703.49,100,MS-DRG,11762.792,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,17527.44,100,,,case rate,100% of CMS IPPS rate,17527.44,100,,,case rate,100% of CMS IPPS rate,14062.11,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,14703.49,100,MS-DRG,11762.792,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,14703.49,100,MS-DRG,11762.792,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,5898.55,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1120,100,MS-DRG,896,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,17527.44,
EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH MCC,,,981,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,42172.06,100,MS-DRG,33737.648,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,65478.83,100,,,case rate,100% of CMS IPPS rate,65478.83,100,,,case rate,100% of CMS IPPS rate,17527.44,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,42172.06,100,MS-DRG,33737.648,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,42172.06,100,MS-DRG,33737.648,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,27719.3,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,65478.83,
EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH CC,,,982,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,23544.03,100,MS-DRG,18835.224,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,36749.35,100,,,case rate,100% of CMS IPPS rate,36749.35,100,,,case rate,100% of CMS IPPS rate,65478.83,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,23544.03,100,MS-DRG,18835.224,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,23544.03,100,MS-DRG,18835.224,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,16056.22,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,65478.83,
EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITHOUT CC/MCC,,,983,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,16513.9,100,MS-DRG,13211.12,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,23508.26,100,,,case rate,100% of CMS IPPS rate,23508.26,100,,,case rate,100% of CMS IPPS rate,36749.35,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,16513.9,100,MS-DRG,13211.12,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,16513.9,100,MS-DRG,13211.12,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,9520.39,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,36749.35,
NON-EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH MCC,,,987,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,30903.86,100,MS-DRG,24723.088,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,49929.01,100,,,case rate,100% of CMS IPPS rate,49929.01,100,,,case rate,100% of CMS IPPS rate,23508.26,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,30903.86,100,MS-DRG,24723.088,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,30903.86,100,MS-DRG,24723.088,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,18620.12,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,49929.01,
NON-EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH CC,,,988,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,17024.56,100,MS-DRG,13619.648,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,25366.02,100,,,case rate,100% of CMS IPPS rate,25366.02,100,,,case rate,100% of CMS IPPS rate,49929.01,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,17024.56,100,MS-DRG,13619.648,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,17024.56,100,MS-DRG,13619.648,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,10156.58,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,49929.01,
NON-EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITHOUT CC/MCC,,,989,RC,,,Inpatient,,,,,,1050,100,MS-DRG,840,case rate,100% of CMS IPPS rate,946.85,100,MS-DRG,757.48,case rate,100% of CMS IPPS rate,11928.79,100,MS-DRG,9543.032,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,15591.77,100,,,case rate,100% of CMS IPPS rate,15591.77,100,,,case rate,100% of CMS IPPS rate,25366.02,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,11928.79,100,MS-DRG,9543.032,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,11928.79,100,MS-DRG,9543.032,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,5789.14,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,1320,100,MS-DRG,1056,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,25366.02,
PRINCIPAL DIAGNOSIS INVALID AS DISCHARGE DIAGNOSIS,,,998,RC,,,Inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3002.31,100,MS-DRG,2401.848,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,15591.77,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,3002.31,100,MS-DRG,2401.848,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,3002.31,100,MS-DRG,2401.848,case rate,100% of CMS IPPS 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,850,15591.77,
UNGROUPABLE,,,999,RC,,,Inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3002.31,100,MS-DRG,2401.848,case rate,100% of CMS IPPS 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,850,100,MS-DRG,680,case rate,100% of CMS IPPS rate,3002.31,100,MS-DRG,2401.848,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,3002.31,100,MS-DRG,2401.848,case rate,100% of CMS IPPS 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,850,3002.31,